Medicine and Health Sciences Commons^™

Abdomen Actin’ Up: A Unique Presentation Of Disseminated Abdominal Actinomycosis, Arpana Parachuri, Md, Brianna Shinn, Md, Rino Sato, Md

The Medicine Forum

INTRODUCTION

Abdominal actinomycosis is a chronic, indolent disease characterized by nonspecific symptoms such as fatigue, weight loss, fever, and abdominal pain. Actinomyces is a genus of fastidious, gram-positive, non-acid-fast, branching filamentous bacilli characterized by sulfur granules that is normally found in oral flora and inhabits the gastrointestinal (GI) tract. Actinomyces infections are relatively rare, however when present, they have the ability to invade multiple organs and disseminate throughout multiple body cavities. Factors that increase the risk of developing actinomycosis include poor oral hygiene, alcoholism, and preexisting dental disease. Intrauterine devices (IUDs) also increase the risk of developing pelvic actinomycosis. Over …

Resistant Raoultella Ornithinolytica Bacteremia In A Patient With New Acute Myeloid Leukemia, Mario Caldararo, Md

The Medicine Forum

INTRODUCTION

Members of the Raoultella genus were formerly considered to be Klebsiella species until they were differentiated based on phylogenetic Deoxyribonucleic acid (DNA) analysis.1 Since then, Raoultella ornithinolytica has been sparsely implicated in clinically-apparent disease, though more case reports are appearing as of late. Here we report the first documented instance of R. ornithinolytica bacteremia in a patient with new acute myeloid leukemia (AML).

A Case Of Secondary Hemophagocytic Lymphohistiocytosis In An Adult Patient Treated With Concurrent Dexamethasone And Interleukin-1 Receptor Blockade, Vikas Sunder, Md

The Medicine Forum

INTRODUCTION

Hemophagocytic Lymphohistiocytosis (HLH) is a rare, life-threatening syndrome of overwhelming inflammation caused by activation and proliferation of T-lymphocytes and hemophagocytic macrophages. This uncontrolled proliferation of macrophages creates a cytokine storm with resultant tissue damage. HLH is associated with clinical and laboratory findings which include fever, cytopenias, hepatic dysfunction, splenomegaly, and marked hyperferritinemia.1-3 There exists limited epidemiologic data on adult (age ≥ 18 years) cases of HLH, and its incidence is uncertain. HLH can be due to inherited mutations causing immune system dysregulation or secondary to underlying malignancy, infection, or rheumatologic condition. Macrophage activation syndrome (MAS) refers to HLH that …

Death By Delirium: A 71-Year-Old Male With Poor Post-Operative Recovery, William Bradford, Md

The Medicine Forum

INTRODUCTION

Delirium is an acute decline in attention and cognition not better explained by another medical condition.1 It is multifactorial in origin, with risk factors including advanced age, male sex, baseline decreased cognitive status, sensory impairment, poor baseline functional status, polypharmacy, and multiple comorbid conditions. Acute precipitants for delirium include administration of psychoactive medications (particularly benzodiazepines, narcotics, anticholinergic medications, and general anesthesia), sleep deprivation, major surgery, and new illness or worsening of current illness.Delirium accounts for some 49% of all hospital days in older patients, increases rates of mortality and morbidity, and is associated with lasting cognitive impairment after discharge, …

When Dequervain’S Depigments: A Case Of Iatrogenic Hypopigmentation, Tatiana Bekker, Md

The Medicine Forum

INTRODUCTION

Localized joint and soft tissue corticosteroid injections are being increasingly utilized to decrease inflammation, improve pain, and recover mobility. Adverse effects from injections are rare, with a 1% incidence of skin depigmentation.

Maggots—Friend Or Foe? Treating Myiasis In A Patient With Chronic Wounds, James Harrigan, Pharmd, Anita Modi, Md, Gretchen Diemer, Md

The Medicine Forum

INTRODUCTION

Myiasis, or the infestation of living vertebrates with dipterous (two-winged fly) larvae, can take many forms. Depending on their species, maggots will feed on living or dead tissue, liquid body substances, or even ingested food.1 The anatomical classification system of such larvae is based on the host location of infestation: sanguinivorous, cavitary, or cutaneous, including furuncular, migratory, or wound.1 While pathologic myiasis can result in significant morbidity in both humans and livestock, therapeutic myiasis has played an important role in wound debridement for centuries. This article will explore the varying forms of pathologic cutaneous myiasis and the evolving role …

Liver Abscess Turned Metastatic Infection In An Otherwise Healthy Patient: A Case Report, Samik Shah, Md, Ritu Nahar, Md, Neha Bansal Etherington, Md

The Medicine Forum

INTRODUCTION

The most common type of visceral abscesses are liver abscesses, which have a mortality rate of at least 2.5 percent.1,2 Most liver abscesses are polymicrobial, containing both facultative and anaerobic enteric pathogens, and develop secondary to another infection such as peritonitis and cholangitis, or from hematogenous spread.2-4 Liver abscesses are sometimes associated with systemic diseases such as colorectal cancer and diabetes mellitus.5,6 Rarely, as in our case presentation, primary liver abscesses occur spontaneously in patients with no identifiable precipitating or predisposing conditions.

Octreotide-Induced Hypoglycemia In A Cirrhotic Patient, Debbie Chen, Md

The Medicine Forum

INTRODUCTION

Hepatorenal syndrome (HRS) is characterized by functional renal impairment in patients with end-stage liver cirrhosis and no parenchymal kidney disease. It is due to splanchnic vasodilation, which results in renal vasoconstriction with consequent reduction in renal plasma flow and glomerular filtration rate.1 In the United States, treatment is with a combination of octreotide, midodrine, and human albumin to increase the effective blood volume and subsequently improve renal function.2 While octreotide, a long-acting somatostatin analog, is used to induce splanchnic vasoconstriction in this setting, it also affects the secretion of insulin and glucagon.

Case Report: Coexistence Of Papillary Thyroid Cancer And Thyroid Lymphoma, Christine Mathai, Md, Edward Ruby, Md

The Medicine Forum

We describe a case of a 75-year-old female found to have concurrent papillary thyroid cancer and diffuse large B cell lymphoma of the thyroid.

Cat Scratching Your Valve: An Elusive Case Of Bartonella Endocarditis, Ritu Nahar, Md, Evan Caruso, Md

The Medicine Forum

INTRODUCTION

Bartonella Henselae is an uncommon, but significant cause of “culture-negative” endocarditis. While six Bartonella species have reportedly caused infective endocarditis (IE) in humans, the vast majority of cases are secondary to either B. quintana or B. henselae. The epidemiologic features of patients predisposed to Bartonella endocarditis are varied. Alcoholism, body lice infestation, and homelessness have been associated with B. quintana endocarditis, while B. henselae endocarditis has been linked to prior valvular disease and cat exposure.1-4 Patients with Bartonella endocarditis have clinical manifestations similar to those seen with traditional forms of subacute bacterial endocarditis. However, the rarity of the disease …

Acute Aortic And Mitral Valve Insufficiency Precipitated By Infective Endocarditis, Raj Patel, Md, Tatiana Bekker, Md, Daniel Kramer, Md

The Medicine Forum

INTRODUCTION

Acute severe valvular regurgitation is a medical emergency requiring prompt recognition and diagnosis. Both mitral and aortic valve rupture, if left untreated, inevitably lead to advanced heart failure, cardiovascular collapse, and death. As such, rapid diagnosis is critical and surgical valve repair or replacement is a life-saving intervention. We present a case of a patient with both mitral valve and aortic valve bacterial endocarditis who developed acute valvular rupture, regurgitation, and cardiovascular collapse.

Roth Spots In Bacterial Endocarditis, Michael Weintraub, Md

The Medicine Forum

CASE PRESENTATION

A 30-year-old female with a history of intravenous drug use presented to the hospital with left wrist pain. Physical exam revealed a left volar ulnar wrist abscess with purulent drainage, a holosystolic murmur heard best at the apex radiating to the axilla and Janeway lesions on the right hand and bilateral feet. A transthoracic echocardiogram revealed a 20 mm mobile vegetation on the mitral valve along with valve perforation and severe regurgitation consistent with bacterial endocarditis. On eye exam, Roth spots (Figure 1) were noted bilaterally. Roth spots are present in less than 2% of all infective endocarditis …

Massive Pneumoperitoneum, Harry Wang, Md

The Medicine Forum

CASE PRESENTATION

A 72-year-old man with a past medical history of pancreatic adenocarcinoma status post biliary and duodenal stent placement presented to the emergency department for one week of cramping abdominal pain in the setting of a surveillance abdominal/pelvis computed tomography (CT) scan done two days prior to admission that showed massive pneumoperitoneum (Figure 1). The patient felt bloated but otherwise had no complaints on presentation. His physical exam was significant for marked abdominal distension with mild diffuse tenderness on palpation, normal bowel sounds, and no peritoneal findings of guarding or rebound. Given concern for perforated viscus causing pneumoperitoneum, he …

Clinical Image: Halo Sign, Brandon Menachem, Md, Alan Gandler, Md

The Medicine Forum

CASE PRESENTATION

A 68-year-old man with no significant past medical history was transferred to our hospital for evaluation of newly diagnosed acute leukemia. His bone marrow biopsy showed acute undifferentiated leukemia. He was initiated on standard induction chemotherapy with cytarabine and idarubicin. His hospital course was complicated by neutropenic fever secondary to Fusobacterium bacteremia. He was started on antibiotic therapy with intravenous cefepime and oral metronidazole. Intravenous vancomycin was added in the setting of recurrent intermittent fevers. On hospital day 20, he developed minimal hemoptysis, pleuritic chest pain, and recurrent fevers. A CT scan of the chest showed a right …

Table Of Contents: The Medicine Forum Volume 19, 2017-2018

The Medicine Forum

Table of Contents: The Medicine Forum Volume 19, 2017-2018

From The Editors, Neha Bansal Etherington, Md, Anita Modi, Md, Debbie Chen, Md, Brianna Shinn, Md, Colin Thomas, Md

The Medicine Forum

We are delighted to present you with the 19th annual edition of The Medicine Forum. Here in the birthplace of our nation, we like to think of The Medicine Forum as being of the housestaff, by the housestaff and for the housestaff. Undeniably, this publication would not be possible without the countless hours dedicated by our residents, students, fellows and faculty.

From The Desk Of The Residency Program Director, Emily Stewart, Md, Facp

The Medicine Forum

It has been another wonderful year in the Jefferson Internal Medicine Residency Program. Our program continues to train the best and brightest residents in the country. This publication is just one example of the passion, dedication and creativity our residents continue to provide to the Jefferson Community. The residents are not just outstanding clinicians but excel in all aspects of medicine including: research, humanities and medical education.

The Medicine Forum: Volume 19

The Medicine Forum

The Medicine Forum: Volume 19

Results From A 78-Week, Single-Arm, Open-Label Phase 2 Study To Evaluate Ux007 In Pediatric And Adult Patients With Severe Long-Chain Fatty Acid Oxidation Disorders (Lc-Faod)., Jerry Vockley, Barbara Burton, Gerard T Berry, Nicola Longo, John Phillips, Pranoot Tanpaiboon, +Several Additional Authors

Pediatrics Faculty Publications

Long-chain fatty acid oxidation disorders (LC-FAOD) are rare disorders characterized by acute crises of energy metabolism and severe energy deficiency that may present with cardiomyopathy, hypoglycemia, and/or rhabdomyolysis, which can lead to frequent hospitalizations and early death. An open-label Phase 2 study evaluated the efficacy of UX007, an investigational odd-carbon medium-chain triglyceride, in 29 subjects with severe LC-FAOD. UX007 was administered over 78 weeks at a target dose of 25-35% total daily caloric intake (mean 27.5%). The frequency and duration of major clinical events (hospitalizations, emergency room visits, and emergency home interventions due to rhabdomyolysis, hypoglycemia, and cardiomyopathy) occurring during …

What's Happening: July 9, 2018, Maine Medical Center

What's Happening

No abstract provided.

Anesthetic Considerations For The Parturient With Immune Thrombocytopenic Purpura, Leah A. Davis

Nursing Capstones

No abstract provided.

Ada News - 07/09/2018, American Dental Association, Publishing Division

ADA News

Established in 1970 as the official newspaper of the American Dental Association, the ADA News serves practicing dentists and others allied to the dental profession in the U.S. and internationally. It is the No. 1 source of news and information about the many benefits and services the ADA delivers to members daily as well as timely information on scientific, social, political and economic developments affecting dentistry and health care.

Building Soft Nanomachines From Polydiacetylene Liposomes, Timothy W. Hanks

Journal of the South Carolina Academy of Science

No abstract provided.

Ca2+, Astrocyte Activation And Calcineurin/Nfat Signaling In Age-Related Neurodegenerative Diseases, Pradoldej Sompol, Christopher M. Norris

Sanders-Brown Center on Aging Faculty Publications

Mounting evidence supports a fundamental role for Ca²⁺ dysregulation in astrocyte activation. Though the activated astrocyte phenotype is complex, cell-type targeting approaches have revealed a number of detrimental roles of activated astrocytes involving neuroinflammation, release of synaptotoxic factors and loss of glutamate regulation. Work from our lab and others has suggested that the Ca²⁺/calmodulin dependent protein phosphatase, calcineurin (CN), provides a critical link between Ca²⁺ dysregulation and the activated astrocyte phenotype. A proteolyzed, hyperactivated form of CN appears at high levels in activated astrocytes in both human tissue and rodent tissue around regions of amyloid and …

Validity Of The Food Insecurity Experience Scale For Use In Sub-Saharan Africa And Characteristics Of Food-Insecure Individuals, Edwina A. Wambogo, Hala Ghattas Ph.D., Kenneth L. Leonard, Nadine R. Sahyoun

Faculty Publications

Background

The Food Insecurity Experience Scale (FIES) is a UN FAO-Voices of the Hungry project (FAO-VoH) metric of food insecurity (FI). The FAO-VoH tested the psychometric properties of FIES with the use of global 2014 Gallup World Poll (GWP) data. However, similarities in its psychometric structure in sub-Saharan Africa (SSA) to allow aggregation of SSA results were untested.

Objectives

We aimed to 1) assess the validity of FIES for use in SSA, 2) determine the prevalence of FI by country, age group, and gender, and 3) examine the sociodemographic and economic characteristics of individuals with FI.

Methods

The Rasch modeling …

Platelet Reactivity And Risk Of Ischemic Stroke After Coronary Drug-Eluting Stent Implantation: From The Adapt-Des Study., Gennaro Giustino, Björn Redfors, Ajay J Kirtane, Roxana Mehran, George D Dangas, Bernhard Witzenbichler, Franz-Josef Neumann, Giora Weisz, Philippe Généreux, Akiko Maehara, Thomas Mcandrew, Serdar Farhan, Michael J Rinaldi, D Christopher Metzger, David A. Cox Md, Peter L Duffy, Ernest L Mazzaferri, Bruce R Brodie, Thomas D Stuckey, Paul Gurbel, Ori Ben-Yehuda, Gregg W Stone

Department of Medicine

OBJECTIVES: The authors sought to investigate the association between P2Y

BACKGROUND: The association between platelet reactivity on clopidogrel and the risk for ischemic cerebrovascular events remains unclear.

METHODS: Incidence, predictors, and prognostic impact of IS were evaluated among patients enrolled in the multicenter, prospective ADAPT-DES (Assessment of Dual AntiPlatelet Therapy With Drug Eluting Stents) study. By protocol, patients were maintained on aspirin for 2 years and clopidogrel for at least 1 year. Baseline platelet reactivity on clopidogrel and aspirin were assessed by means of VerifyNow point-of-care assay after successful DES implantation.

RESULTS: Among 8,582 patients enrolled, 68 (0.8%) had an …

A Novel Deep Learning Framework For Internal Gross Target Volume Definition From 4d Computed Tomography Of Lung Cancer Patients, Xiadong Li, Ziheng Deng, Qinghua Deng, Lidan Zhang, Tianye Niu, Yu Kuang

Health Physics and Diagnostic Sciences Faculty Research

In this paper, we study the reliability of a novel deep learning framework for internal gross target volume (IGTV) delineation from four-dimensional computed tomography (4DCT), which is applied to patients with lung cancer treated by Stereotactic Body Radiation Therapy (SBRT). 77 patients who underwent SBRT followed by 4DCT scans were incorporated in a retrospective study. The IGTV_DL was delineated using a novel deep machine learning algorithm with a linear exhaustive optimal combination framework, for the purpose of comparison, three other IGTVs base on common methods was also delineated, we compared the relative volume difference (RVI), matching index (MI) and encompassment …

Week Of July 9, 2018, New York Medical College

InTouch

• Marina Kaufman Holz, Ph.D., Is Named Dean of the Graduate School of Basic Medical Sciences
• Center for Disaster Medicine Brings Military Training to Westchester County's Bravest Police
• School of Medicine First Day of Giving Raises More Than $450,000 to Support Next Generation of Medical Leaders
• School of Medicine Class of 2020 Transitions to the Clinical Years

Medical School Watercooler Newsletter - July 8, 2018, Lindsey Lyle

Watercooler Newsletter

This is the June 8, 2018 edition of the Frederick P. Whiddon College of Medicine's newsletter - Watercooler.

Contents Include:

• USA COM Partners with MCHD to Better Monitor Mosquito-Borne Viruses
• USA College of Medicine Welcomes Dr. Valeria L. Dal Zotto
• Register Now: South Alabama Regional Conference on Mental Health
• USA Medical Students Selected as Inaugural Blue Cross and Blue Shield of Alabama Scholarship Recipients
• USA Basic Medical Sciences Student Awarded ALEPSCoR Fellowship
• USA Welcomes Dr. Ninh Doan to Neurosurgery

Grp78 Is A Targetable Receptor On Cancer And Stromal Cells, Nathalia Araujo, Nikhil Hebbar, Vivek M. Rangnekar

Toxicology and Cancer Biology Faculty Publications

No abstract provided.