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The Medicine Forum: Volume 22

The Medicine Forum

The Journal of Thomas Jefferson University Hospital - Department of Internal Medicine, Volume 22, 2020-2021

TABLE OF CONTENTS

Clinical Images

Case Reports

• Cardiology
• Gastroenterology and Hepatology
• General Medicine
• Hematology and Oncology
• Pulmonary Medicine

Resident Reflection

Covid-19 Newsletter (Vol. 89), Center For Disaster Medicine, New York Medical College

COVID-19 Newsletter

No abstract provided.

2021-10-05_Michiganoverview_Covidlongtermcare, Michigan Department Of Health & Human Services

Michigan COVID-19 Long Term Care Data

The COVID Long Term Care Facilities page was obtained from Michigan's COVID-19 data page: https://www.michigan.gov/coronavirus/0,9753,7-406-98163_98173-526911--,00.html.

This report is created by the Michigan Department of Health & Human Services from data self-reported by long-term care facilities into EMResource. Data for all reporting facilities is posted weekly each Monday.

The information below represents COVID-19 data reported directly to MDHHS by licensed and operating Skilled Nursing, Home for the Aged and Adult Foster Care facilities (licensed to serve 13 or more individuals) in Michigan from January 1, 2020. All long-term care facilities additionally have an obligation to report COVID-positive residents and/or staff …

2021-10-05_Michiganoverview_Covidsymptoms, Michigan Department Of Health & Human Services

Michigan COVID-19 Syndromic Surveillance System Data

The Syndromic Surveillance System Data report was obtained from Michigan's COVID-19 dashboard, from under the link "​Coronavirus Symptoms": https://www.michigan.gov/coronavirus. Data was compiled by the Michigan Department of Health and Human Services (MDHHS). The information was updated three times a week on Mondays, Wednesdays and Fridays.

Syndromic Surveillance System data is obtained from approximately 216 facilities participating in syndromic surveillance (139 Emergency Departments (ED), 77 Urgent Care) across the State of Michigan. The reporting is based on individuals who present at EDs and may not be representative of the overall population. The coronavirus-like symptoms query searches visit free-text (chief complaint, …

Year In Review 2020-2021, Dugoni School Of Dentistry

Dugoni Academic Year in Review

Highlights of academic programs, clinical services, research, community outreach and other areas of University of the Pacific's Arthur A. Dugoni School of Dentistry.

Neutrophil Dynamics Affect Mycobacterium Tuberculosis Granuloma Outcomes And Dissemination, Caitlin Hult, Joshua T. Mattila, Hannah P. Gideon, Jennifer J. Linderman, Denise E. Kischner

Math Faculty Publications

Neutrophil infiltration into tuberculous granulomas is often associated with higher bacteria loads and severe disease but the basis for this relationship is not well understood. To better elucidate the connection between neutrophils and pathology in primate systems, we paired data from experimental studies with our next generation computational model GranSim to identify neutrophil-related factors, including neutrophil recruitment, lifespan, and intracellular bacteria numbers, that drive granuloma-level outcomes. We predict mechanisms underlying spatial organization of neutrophils within granulomas and identify how neutrophils contribute to granuloma dissemination. We also performed virtual deletion and depletion of neutrophils within granulomas and found that neutrophils play …

Incidence And Outcomes Of Infective Endocarditis After Transcatheter Or Surgical Aortic Valve Replacement., Jonas Lanz, Michael J Reardon, Thomas Pilgrim, Stefan Stortecky, G Michael Deeb, Stanley Chetcuti, Steven J Yakubov, Thomas G Gleason, Jian Huang, Stephan Windecker

Heart and Vascular Articles

Background Data comparing the frequency and outcomes of infective endocarditis (IE) after transcatheter (TAVR) to surgical aortic valve replacement (SAVR) are scarce. The objective of this study is to compare the incidence and outcomes of IE after TAVR using a supra-annular, self-expanding platform (CoreValve and Evolut) to SAVR. Methods and Results Data of 3 randomized clinical trials comparing TAVR to SAVR and a prospective continued TAVR access study were pooled. IE was defined on the basis of the modified Duke criteria. The cumulative incidence of IE was determined by modeling the cause-specific hazard. Estimates of all-cause mortality were calculated by …

Neuron-Specific Imp2 Overexpression By Synapsin Promoter-Driven Aav9: A Tool To Study Its Role In Axon Regeneration., Sarah Blizard, Danielle Park, Natalie O'Toole, Sheeva Norooz, Martin Dela Torre, Young Son, Adam Holstein, Scarlett Austin, Joshua Harman, Samantha Haraszti, Daved Fared, Mei Xu

PCOM Scholarly Works

Insulin-like growth factor II mRNA-binding protein (IMP) 2 is one of the three homologues (IMP1-3) that belong to a conserved family of mRNA-binding proteins. Its alternative splice product is aberrantly expressed in human hepatocellular carcinoma, and it is therefore identified as HCC. Previous works have indicated that IMP1/ZBP1 (zipcode binding protein) is critical in axon guidance and regeneration by regulating localization and translation of specific mRNAs. However, the role of IMP2 in the nervous system is largely unknown. We used the synapsin promoter-driven adeno-associated viral (AAV) 9 constructs for transgene expression both in vitro and in vivo. These viral vectors …

Patient-Reported Reasons For Stopping Care Or Switching Clinics In Zambia: A Multisite, Regionally Representative Estimate Using A Multistage Sampling-Based Approach In Zambia, Izukanji Sikazwe, Ingrid Eshun-Wilson, Kombatende Sikombe, Laura K Beres, Paul Somwe, Aaloke Mody, Sandra Simbeza, Chama Bukankala, David V Glidden, Lloyd B Mulenga, Nancy Padian, Peter Ehrenkranz, Carolyn Bolton-Moore, Charles B Holmes, Elvin H Geng

2020-Current year OA Pubs

BACKGROUND: Understanding patient-reported reasons for lapses of retention in human immunodeficiency virus (HIV) treatment can drive improvements in the care cascade. A systematic assessment of outcomes among a random sample of patients lost to follow-up (LTFU) from 32 clinics in Zambia to understand the reasons for silent transfers and disengagement from care was undertaken.

METHODS: We traced a simple random sample of LTFU patients (>90 days from last scheduled visit) as determined from clinic-based electronic medical records from a probability sample of facilities. Among patients found in person, we solicited reasons for either stopping or switching care and predictors …

A Randomized Phase 2 Study Of Vt-1161 For The Treatment Of Acute Vulvovaginal Candidiasis, Stephen R Brand, Jack D Sobel, Paul Nyirjesy, Mahmoud A Ghannoum, Robert J Schotzinger, Thorsten P Degenhardt

Department of Obstetrics and Gynecology Faculty Papers

Background: Acute vulvovaginal candidiasis (VVC) is common among women, but current azole antifungal treatments are often associated with safety and resistance issues. VT-1161 (oteseconazole) is an oral agent with increased selectivity for fungal CYP51. In this phase 2 clinical study, we evaluated the efficacy and safety of VT-1161 vs fluconazole in participants with moderate to severe acute VVC.

Methods: Participants presenting with an acute episode of VVC (n = 55) were randomized to receive VT-1161 300 mg once daily (q.d.) for 3 days, 600 mg q.d. for 3 days, or 600 mg twice daily (b.i.d.) for 3 days or to …

Serotonin 5-Ht2a Receptor Activity Mediates Adipocyte Differentiation Through Control Of Adipogenic Gene Expression, Bangning Yu, Diana M. Battaglia, Timothy P. Foster, Charles D. Nichols

School of Medicine Faculty Publications

Serotonin 5-HT2 receptors are expressed in many tissues and play important roles in biological processes. Although the 5-HT2A receptor is primarily known for its role in central nervous system, it is also expressed in peripheral tissues. We have found that 5-HT2A receptor antagonists inhibit human subcutaneous primary adipocyte differentiation. We also show that siRNA knockdown of the 5-HT2A receptor blocks differentiation. Using gene expression analysis in combination with receptor antagonists we found that activity of 5-HT2A receptors is necessary very early in the differentiation process to mediate expression of adipogenic genes, including peroxisome proliferator-activated receptor gamma (ppar-γ), adipocyte protein 2 …

Phds/Cpt1b/Vdac1 Axis Regulates Long-Chain Fatty Acid Oxidation In Cardiomyocytes, Aude Angelini, Pradip K Saha, Antrix Jain, Sung Yun Jung, Randall L Mynatt, Xinchun Pi, Liang Xie

Faculty, Staff and Students Publications

Cardiac metabolism is a high-oxygen-consuming process, showing a preference for long-chain fatty acid (LCFA) as the fuel source under physiological conditions. However, a metabolic switch (favoring glucose instead of LCFA) is commonly reported in ischemic or late-stage failing hearts. The mechanism regulating this metabolic switch remains poorly understood. Here, we report that loss of PHD2/3, the cellular oxygen sensors, blocks LCFA mitochondria uptake and β-oxidation in cardiomyocytes. In high-fat-fed mice, PHD2/3 deficiency improves glucose metabolism but exacerbates the cardiac defects. Mechanistically, we find that PHD2/3 bind to CPT1B, a key enzyme of mitochondrial LCFA uptake, promoting CPT1B-P295 hydroxylation. Further, we …

Justifying Advocacy Of Patients’ Belief Diversity W/ Support From William James’ Lectures On Pragmatism: A New Name For Some Old Ways Of Thinking, The Variety Of Religious Experiences & The Will To Believe, Sterling Courtney

The Hilltop Review

Abstract:

Predating monastic healthcare in the Middle Ages (Siraisi, 2019), spirituality and/or religion have been unified with healing, caring for the sick and consoling the dying, as documented by historical writings as early as c.3000 BCE-c.500 BCE in Mesopotamia and followed by coinciding accounts from c.750 BCE-c.280 BCE Greece and Rome (Mann, 2014). Via philosophy and science, a movement towards secularization has been perceived (as the Renaissance faded and the scientific revolution led into the Age of Enlightenment), therefore creating a dichotomy between treating the physical body separate from the metaphysical soul. In the early 1900’s, Abraham Flexner discredited any …

Hemorrhagic Bullae In The Setting Of A Rare Opportunistic Infection, Taylor K. Thieman, Ritu N. Swali, Corey J. Georgesen

Graduate Medical Education Research Journal

No abstract provided.

Traumatic Optic Neuropathy And Cerebrospinal Fluid Leak: A Case Report, Adam B. Robinson, Jason B. Untrauer

Graduate Medical Education Research Journal

No abstract provided.

General Anesthesia... Hold The Volatile And Propofol, Please!, Mackenzie S. Laurila, Kunal Sualy

Graduate Medical Education Research Journal

No abstract provided.

Atypical Lateral Knee Injury, Hannah Hornsby, T. Jason Meredith

Graduate Medical Education Research Journal

No abstract provided.

Coexistence Of Focal And Idiopathic Generalized Epilepsy: A Case Report, Navnika Gupta, Arun Swaminathan

Graduate Medical Education Research Journal

No abstract provided.

Tremor As A Probable Adverse Drug Reaction To Levetiracetam: A Case Report, Navnika Gupta, Mara Seier, Aditya Vuppala

Graduate Medical Education Research Journal

No abstract provided.

Raw Onions Or A Raw Deal? The Straightforward Admission That Wasn't, Karl Enroth

Graduate Medical Education Research Journal

No abstract provided.

Sando Syndrome Associated With New Polg Heterozygous Gene Mutation: Case Report, Daniel Crespo, Deepmala Nandanwar, Sachin Kedar, Danish E. Bhatti

Graduate Medical Education Research Journal

No abstract provided.

Bilateral Limb-Shaking Transient Ischemic Attack Secondary To Bilateral Anterior Cerebral Artery Stenosis And Right A3 Thrombosis, Daniel Crespo, Michael Pichler

Graduate Medical Education Research Journal

No abstract provided.

Parkinsonism-Hyperpyrexia Syndrome Secondary To Deep Brain Stimulation Withdrawal Treated With High Doses Of Levodopa-Carbidopa: A Rare Life-Threatening Emergency, Daniel Crespo, Kiel Woodward, Miguel Situ-Kcomt

Graduate Medical Education Research Journal

No abstract provided.

Varicella-Zoster Virus-Associated Longitudinally Extensive Transverse Myelitis In An Immunocompetent Adult: An Unusual And Rare Complication Of Herpes Zoster, Daniel Crespo, Amrita-Amanda Vuppala, David Semerad, John M. Bertoni

Graduate Medical Education Research Journal

No abstract provided.

Unilateral Livedoid Hyperpigmentation Of The Lower Extremity, Dillon Clarey, Devor O'Connor, Ashley Wysong

Graduate Medical Education Research Journal

No abstract provided.

This Is Why You Take Your Vitamins, Alison Bauer, T. Jason Meredith

Graduate Medical Education Research Journal

No abstract provided.

Anesthetic Considerations For Non-Cardiac Surgery In An Adult Patient With Right Atrial Isomerism, Sagar Bansal, Rebecca A. Aron

Graduate Medical Education Research Journal

No abstract provided.

Breast Conservation In Low- And Middle-Income Countries: Global Trends In Breast Cancer Care, Philip Mccarthy, Jessica Maxwell, Benjamin Acton

Graduate Medical Education Research Journal

No abstract provided.

Resident Perception Of Respiratory Therapist Directed Asthma Protocol Weaning And The Impact On Education, Simone Warrack, Nathaniel Goodrich, Lauren Maskin, Allison Ashford, Kristy Carlson

Graduate Medical Education Research Journal

No abstract provided.

Patient Safety Ward Of Woe: Using Gamification To Reinforce Patient Safety At A Large Academic Hospital, Grant A. Turner, Julie Fedderson, Bethany Lowndes

Graduate Medical Education Research Journal

No abstract provided.