Medicine and Health Sciences Commons^™

Aggressive Herpes Zoster In Young Patients With Multiple Sclerosis Under Dimethyl Fumarate: Significance Of Cd8, Maria Anagnostouli, Georgios Velonakis, Marinos Dalakas

Department of Neurology Faculty Papers

Dimethyl fumarate (DMF), approved for relapsing-remitting multiple sclerosis (RRMS), exerts immune-mediated mechanisms crucial for T-cell survival and migration, preferentially reducing CD8+ T cells.1 Although baseline absolute lymphocyte count (ALC) is considered the most critical predictor of developing lymphopenia,2 it was recently concluded that lymphocyte subset monitoring is not required for safety vigilance because T-cell subset reduction does not increase risks for serious infections.3 We present 2 young patients with RRMS, under DMF treatment, negative for HIV and SARSCoV-2 (by RT-PCR in nasal swab) and with normal follow-up white blood cell (WBC)/ALC counts, who developed severe herpes zoster (HZ) infection with …

Exome Sequencing Revealed Pde11a As A Novel Candidate Gene For Early-Onset Alzheimer's Disease, Wei Qin, Aihong Zhou, Xiumei Zuo, Longfei Jia, Fangyu Li, Qi Wang, Ying Li, Yiping Wei, Hongmei Jin, Carlos Cruchaga, Bruno A Benitez, Jianping Jia

2020-Current year OA Pubs

To identify novel risk genes and better understand the molecular pathway underlying Alzheimer's disease (AD), whole-exome sequencing was performed in 215 early-onset AD (EOAD) patients and 255 unrelated healthy controls of Han Chinese ethnicity. Subsequent validation, computational annotation and in vitro functional studies were performed to evaluate the role of candidate variants in EOAD. We identified two rare missense variants in the phosphodiesterase 11A (PDE11A) gene in individuals with EOAD. Both variants are located in evolutionarily highly conserved amino acids, are predicted to alter the protein conformation and are classified as pathogenic. Furthermore, we found significantly decreased protein levels of …

Laser-Assisted Tooth Extraction In Patients With Impaired Hemostasis, Elena Larionova Dr., Ekaterina Diachkova Dr., Elena Morozova Prof., Albert Davtyan Dr., Svetlana Tarasenko Prof.

BioMedicine

Introduction: The provision of efficient dental care to patients with hemostatic disorders is tied to difficulties and problems such as prolonged bleeding after or during surgical manipulation.

Aim: This study aims to increase the efficiency of oral surgery in patients with thrombocytopenia with the use of erbium laser on different stages of tooth extraction.

Methods: Patients (n = 96) were selected for tooth extraction on an outpatient basis: patients with confirmed thrombocytopenia (age 44 ± 15.4, 19–74) were included in the 1st group, and patients without impaired hemostasis (age 47.6 ± 15.3, 19¬81) were included in the …

Bioactivities And Action Mechanisms Of Active Compounds From Hottuynia Cordata Thunb On Human Lung Cancer Cells, Yuh-Fung Chen, Wen-Hsin Chang, Huei-Yann Tsai, Min-Min Lee, Tian-Shung Wu

BioMedicine

Background: Lung cancer is the leading cause of death in Taiwan for years. Besides the currently used chemotherapy, herbal medicine may play a role in the treatment of lung cancer. Hottuynia cordata Thunb (HC), one of the frequently used herbal medicine in Taiwan, has been widely used in various diseases. Review from literatures, HC has many effects, including anti-inflammatory, anti-viral, anti-bacterial, anti-SARS, and anti-tumor activities. However, there is no literatures describe its active compounds on lung cancer. This present study aims to evaluate the possible effect and action mechanism of active compounds from HC (aristolactam BII, aristolactam AII, and …

Microrna-26a-5p As A Potential Predictive Factor For Determining The Effectiveness Of Trastuzumab Therapy In Her-2 Positive Breast Cancer Patients, Sadra Samavarchi Tehrani, Ehsan Zaboli, Farzin Sadeghi, Soraya Khafri, Ansar Karimian, Mahnoosh Rafie, Hadi Parsian

BioMedicine

Background: Breast cancer (BC) is known as the most prevalence type of cancer among women. Trastuzumab, as a cancer drug, has been used broadly in human epidermal growth factor receptor 2 (HER-2) positive BC patients. On the other hand, accumulating evidence has demonstrated that microRNAs involved in pathogenesis BC. Hence, we aimed to investigate the effect of trastuzumab on the expression levels of microRNA-26a in HER-2positiveBC patients.

Methods: This study was conducted on HER-2 positive BC patients and HER-2 Negative BC patients. Serum expression of microRNA-26a were detected by real-time PCR. Then, we assessed the correlation of microRNA-26a level with …

Evaluation Of Sleep Quality And Duration In Pregnancy And Risk Of Gestational Diabetes Mellitus: A Prospective Follow-Up Study, Saloumeh Peivandi, Ali Habibi, Seyed Hamzeh Hosseini, Mohammad Khademloo, Mohammad Raisian, Hedieh Pournorouz

BioMedicine

Background and Objectives: Sleep disorders during pregnancy may be linked with increased risk of adverse pregnancy outcomes. This study aimed to evaluate the relationship between sleep quality and duration in pregnancy and risk of gestational diabetes mellitus (GDM).

Materials and Methods: This prospective follow-up study was performed on 240 pregnant women with a gestational age between 20 to 24 weeks, who were referred to Imam Khomeini Hospital in Sari from 2018 to 2019 for prenatal care. The sleep quality of all eligible women were evaluated with the Pittsburgh Sleep Quality Index (PSQI). During the 26 to 28 weeks of …

Comparison Between C4d Immunohistochemical Staining And Other Clinical- Hisopathological Findings In Iga Nephropathy, Hossein Samadi Kafil, Hamed Sharifi

BioMedicine

Introduction: IgAN occurs following abnormal IgA deposition in the glomerular mesangial regions. It is the most common primary glomerular disease and one of the causes of CKD-KRT, so it is necessary to identify clinical and histopathological findings that predict progression to CKD-KRT. In the physiopathology of this disease, C₄d causes serious renal injuries and should be counted as a significant prognostic factor too. This study examined C₄d biomarker and compare it with findings affecting prognosis, to determine the predictive value of the C₄d in progression to CKD-KRT in IgAN.

Materials and methods: In this …

Polymorphisms Of Vascular Endothelial Growth Factor -2578c/A Rs699947 Are Risk Factors For Diabetic Retinopathy In Type-2 Diabetes Mellitus Patients In Bali, Indonesia, Audrey Rachel Wijaya, I Wayan Surudarma, Desak Made Wihandani, I Wayan Ardyan Sudharta Putra

BioMedicine

Background: Diabetic retinopathy (DR) is one of the complications in diabetes mellitus (DM) which caused by microvascular damage in the retina due to long term metabolic changes in diabetes. To date, there has been much research targeted on the determinant of genetic identification in DR patients. In DR, Vascular Endothelial Growth Factor (VEGF) gene is accountable for breaking down the blood-retinal barrier and implicated in the role of neovascularization. It is thought that the polymorphism of VEGF -2578C/A (rs699947) contributed to the development of diabetic retinopathy in type 2 DM.

Aim: To determine whether the polymorphisms of VEGF-2578C/A are the …

Hormones Can Influence Drug Addiction-A Narrative Review, Morteza Karimian, Hamidreza Famitafreshi

BioMedicine

Drug addiction is a dangerous condition that is the concern of human societies. Nevertheless, several issues exist ahead of people with a drug use disorder during addiction. Accordingly, various types of studies have been conducted to understand better the problems that people with a drug use disorder encountered. People with a drug use disorder usually have a problem tolerating the withdrawal period and some relapse to drug abuse. Complementary studies further revealed that some hormones like oxytocin (OXT), vasopressin, hypothalamic-pituitary-adrenal axis (HPA) axis hormones, sex hormones, thyroid hormones, and nutritional hormones are probably involved in addiction processes. These hormones completely …

Predictors Of Mortality In Hospitalized Covid-19 Patients: A Mexican Population-Based Cohort Study., Fernando Mesta Dr., Ángel Mario Coll Dr., Miguel Ángel Ramírez M.Sc., Livan Delgado-Roche Dr.

BioMedicine

Objectives. COVID-19 outbreak brings a challenge to healthcare systems. The sex, age, and cardiometabolic comorbidities have been considered risk factors for disease severity. To evaluate the association between risk factors with death as well the risk of death in hospitalized COVID-19 patients.

Methods. The present cross-sectional cohort study, includes hospitalized SARS‑CoV‑2 confirmed cases. Data analysis was performed using the National COVID‑19 Cases Report Database. Pearson´s χ² test and odds ratios (95% CI) were calculated to determine the association between variables. Thereafter, risk of death was evaluated by Cox proportional hazards model.

Results. A total of 67 …

Improving Utilization Of Sglt2 Inhibitors In The Inpatient Setting, Andrea Verghese, Md, Bharaniabirami Rajaram, Md, Fred Karaisz, Md, Jason Ho, Md, Kaya Patel, Md, Michael Grodsky, Md, Shifa Gandhi, Md, Xuejun Wang, Md, Yair Lev, Md

Health Equity and Quality Improvement (HEQI) Summit

• SGLT2 inhibitors have been shown to have a significant benefit for patients with DM2 or CAD (DAPA-HF, Emperor-reduced)
• The usage of these medications are low compared to other Goal Directed Medical Therapy.
• There are multiple contributing factors as to why these medications are underutilized

Our aim is to assess barriers against prescription of SGLT2-i at the time of discharge from TJUH and to increase utilization after placement on formulary.

Improving Safety Of Direct Oral Anticoagulant (Doac) Dosing In Patients With Severe Chronic And End-Stage Renal Disease, Naman Upadhyay, Md, R. Mohammed, Md, Kirpal Kochar, Md, Max Ruge, Md, Sean Dikdan, Md, Yair Lev, Md

Health Equity and Quality Improvement (HEQI) Summit

The significance of this study is to determine the degree of inconsistency in dosing practice of DOACs at a quaternary care institution such as Thomas Jefferson University Hospital.

1. What is the primary indication for anticoagulation in out population?
2. What percentage is dosed correctly?
3. Are patients primarily over or underdosed?

Evaluating The Efficacy Of A Nursing-Driven Versus Provider-Driven Heparin Protocol, Naman Upadhyay, Md, Joseph Soucy, Md, Steven Manobianco, Md, Samantha Sokoloff, Md, Sairamya Bodempudi, Md, Veda Pejaver, Md, Max Ruge, Md, Lynda Thomson, Pharmd, Lily Ackermann, Md

Health Equity and Quality Improvement (HEQI) Summit

At Thomas Jefferson University Hospital patients who require heparin infusions are monitored either by nursing alone or the resident and the nurse together.

This project aims to determine:

1. Which protocol more efficiently shortens the time to therapeutic?
2. Are patients therapeutic longer under a certain protocol?
3. Do more patients under either protocol suffer from bleeding complications?

Tolerability Of Switching Cholinesterase Inhibitors To Memantine Monotherapy Versus Adding Memantine As Combination Therapy For All-Cause Neurodegenerative Disorders, Estevana Isaac, Md, Mijail Serruya, Md, Phd, Keith Scott, Phd, Michael R. Sperling, Md, Carol Lippa, Md

Health Equity and Quality Improvement (HEQI) Summit

Background: Prior studies have focused on the clinical efficacy of combination therapy, Donepezil and Memantine, for patient’s diagnosed with Alzheimer’s disease. However, the potential adverse drug reactions while described as mild can have serious sequelae in older adults who are already managing the side effects of polypharmacy.

Objective: This study looks to explore the tolerability of switching cholinesterase inhibitors to memantine monotherapy versus adding memantine as combination therapy for all-cause neurodegenerative disorders.

Methods: The study is a retrospective chart review that includes 175 patients aged 50 and older diagnosed with neurocognitive disorders (ICD 10 F00-F03.91 and ICD10 G30-G31.84) managed on …

Decreasing Post Insulin Hypoglycemia Incidence In End Stage Renal Disease (Esrd) Patients, Anna Lo, Md, Rachana Mundada, Md, Eric Shiffrin, Md, Jenny Wang, Md

Health Equity and Quality Improvement (HEQI) Summit

ESRD patients are vulnerable to hypoglycemia due to impaired insulin clearance, glucose metabolism changes, and effects of dialysis. Hypoglycemic events lead to serious and life-threatening complications.

Aims for Improvement:

To decrease the rate of hypoglycemic events amongst ESRD patients receiving insulin for hyperkalemia treatment.

Outpatient Mineralocorticoid Receptor Antagonist Prescription Rate For Heart Failure, Svenja Schneider, Md, Sairamya Bodempudi, Md, Joshua Bernard, Md, Ryan D'Angelo, Pharmd, Eitan Frankel, Md, Sara Collins, Md, Yair Lev, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement:

Improve MRA prescription rate in the outpatient cardiology clinic by 25%

Medication Safety In The Operating Room, Tzvi Grossman, Michael Glick, Alexandra Mulholland, Febina Padiyath, Fred Balzer

Health Equity and Quality Improvement (HEQI) Summit

The operating room is an area where a significant number of adverse drug events occur. Anesthesia providers administer potentially dangerous medications with very little oversight. We looked for a way to decrease the likelihood that a lethal dose of phenylephrine (10mg) would be given to a patient.

Perioperative Outcomes Of A Hydrocortisone Protocol After Endonasal Surgery For Pituitary Adenoma Resection, Tyler D. Alexander, Ms, Sarah Collopy, Michael Karsy, Md, Phd, Msc, Chandala Chitguppi, Md, Christopher J. Farrell, Md, James J. Evans, Md

Health Equity and Quality Improvement (HEQI) Summit

Adrenal insufficiency after transsphenoidal resection of pituitary adenoma (PA) can be seen in 1-12% of cases. In PA, the use of postoperative cortisol measurement and supplementation remains controversial. It is unclear whether postoperative cortisol supplementation has a measurable effect on improving outcomes in patients with pituitary adenoma undergoing endoscopic transsphenoidal surgery (ETS). The objective of the study was to evaluate a postoperative steroid treatment protocol in patients with PA undergoing ETS.

Perioperative Vte Chemical Prophylaxis At Jefferson Hospital: A Retrospective Review Of The Department Of Surgery, Walker Lyons, Md, Matthew Metzinger, Mba, Cphq, Tyler Grenda, Md, Craig Binney, Mba, Scott Cowan, Md

Health Equity and Quality Improvement (HEQI) Summit

Only 26.1% of patients are receiving perioperative VTE chemical prophylaxis for elective cases in the Department of Surgery

Utilization Of A Palliative Care Trigger In The Surgical Intensive Care Unit, Gillian Love, Md, Shawn Mangan, Msn, Rnfa, Anp-Bc, Agacnp-Bc, Michelle Mckay, Phd, Rn, Ccrn, Joshua Marks, Md, Facs, John Liantonio, Md, Mba, Hmdc

Health Equity and Quality Improvement (HEQI) Summit

• Our project aims to expand palliative care availability in the SICU by implementing a consult trigger program.
• We also aim to learn about and measure compassion fatigue of providers within the SICU.

Reforming The Pre-Operative Clearance Process In The Covid-19 Era, Ritam Ghosh, Md, René Daniel, Md, Jesse Edwards, Md, Catriona Harrop, Md, Janeen Duckworth, Msn, Amy Della Penna, Msn

Health Equity and Quality Improvement (HEQI) Summit

The problem at hand was increasing cancellation rates, increasing frustration amongst physicians, and lack of communication which guided our interventions

Some of the interventions used to improve the process are:

• PAT practioners routinely checking laboratory tests after the initial visit
• PAT practioners routinely documenting addendums in medical record in order to improve transparency and medical record
• Two step verification process: residents/surgeons going through medical record and communicating to PAT practioners if clearance was not ironclad
• Consulting physicians (i.e. cardiologists) with improved communication and documentation with PAT practioners in the event of additional testing necessary prior to clearance
• PAT physicians communicate …

Improving Time To Defibrillation At Thomas Jefferson University Hospital, Sairamya Bodempudi, Md, Lisa Wus, Dnp, Rn, Crnp, Pccn-Cmc, Juergen Kloo, Md, Patrick Zeniecki, Ma, Frances Mae West, Md, Yair Lev, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

• Increase in timely defibrillation by 30% over 1 year
• Decrease in the amount of Vfib/VTach cardiac arrests that are not defibrillated to <1% within a 1 year time frame

Preventing Iatrogenic Pneumothorax “Just-In-Time”, Jason Ho, Md, Ammar Saati, Md, Ryan Commins, Md, Justin Henneman, Md, Frances Mae West, Md

Health Equity and Quality Improvement (HEQI) Summit

• In 2020 a high incidence of iatrogenic pneumothorax was noticed at TJUH after internal jugular central line insertion - Accepted rate is 0.1%
• With long periods of time between ICU rotations, residents suffer from significant procedural skill decay
• The COVID-19 pandemic brought with it an increase in the number of central lines placed
• During the COVID-19 pandemic, there has been a lack of large group training opportunities due to social distancing constraints

By December 31st 2021, our intervention will improve rates of iatrogenic pneumothorax after US-guided internal jugular central line insertion by 50% of baseline, as measured by chart review …

Mind The Gap: A Call For Attention At The Telemetry Station, N. Haroian, Md, T. Zivan, D. Frisch, A. Greenspon, Y. Lev, Md

Health Equity and Quality Improvement (HEQI) Summit

"Gaps" in telemetry recordings are a risk factor for patient identification errors and have led to near misses and adverse events in our hospital.

Goal: Completely eliminate wrongful telemetry data display by the end of the academic year.

Team-Based Outreach To Improve Colorectal Cancer Screening Rates In An Urban Family Medicine Practice, Alexa Waters, Md, Olivia Seecof, Md, Graham Stratton, Md, Caitlyn Haines, Md, Brittany Hozick, Md, Jose Medina, Md, Kathryn Topalis, Md, Hannah Facey, Md, Chelsea Salas-Tam, Md, David Peters, Md

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

• Aim to increase CRCS rates for our resident team patients by 5% by May, 2021
• Target Population (n=99): Age 50-74, due for CRCS, office visit within last 2 years, team resident listed as PCP, active on MyChart, and speak English

Adolescent And Young Adult Oncology Patient And Provider Perspectives In Philadelphia (Aya-4p), Christoher Terry, Md, Miriam Pomerantz, Lsw, Jodi Sandos, Lcsw, Lindsay Wilde, Md

Health Equity and Quality Improvement (HEQI) Summit

Primary Objectives

• To assess the current perspective of AYA patients regarding medical services and psychosocial support delivered to AYAs in Philadelphia
• To assess the current knowledge and perspective of healthcare providers at the SKCC about the care and services needed by AYA patients

Improving Practice Accessibility Through Mychart Utilization, G. Bires, M. Taskier, P. Padgaonkar, L. Flink, R. Wiley, S. Newsom, J. Mitchell, S. Cokenakes, J. Schutzman, A. Nwaobasi, T. Huang

Health Equity and Quality Improvement (HEQI) Summit

Aims for Improvement

• Increase patient portal MyChart activation for a cohort of approximately 2,000 patients at JFMA by 1% from February to April 2021.
• Demonstrate evidence of utilization including appointment scheduling, results review, and communication with providers through MyChart after activation.

Addressing Health Disparities And Access In The Department Of Neurology Outpatient Setting In The Era Of The Covid-19 Pandemic: A Quality Improvement Initiative, V. Wang, M. Rehman, K. Burda, L. Liao, M. Braslavsky, T. Chuang, J. Diep, Md, E. Isaac, E. Wong

Health Equity and Quality Improvement (HEQI) Summit

Neurology, a largely outpatient specialty, has joined many other fields in the endeavor of incorporating telemedicine.^4,6,7 We present the results of analysis of the Epic Electronic Medical Record (EMR) of all outpatient visits from the Thomas Jefferson University Hospital Department of Neurology from 2019 to 2020 in order to identify areas of ethnic minority and geographic disparities with regards to usage of telemedicine. For our analyses, we have included Neurology patients across the General Neurology (JUP Neurology 909 Walnut NEU), Headache Center (HA), and Multiple Sclerosis Center (MS). Additionally, based on patient surveys from a subset of our outpatient …

Improving The Use Of Asthma Action Plans, Pooja Pandit, Md, Aaron B. Kaye, Md, Hassan Shahid, Md, Colin Peters, Do, Jessica Most, Md

Health Equity and Quality Improvement (HEQI) Summit

Objectives

• Identify the percentage of asthmatics in Friday fellows’ clinic with an AAP in place.
• Determine if clinician education can increase the number of AAP created for patients.

Addressing Catheter Associated Uti In The Neuro Icu, Aria Mahtabfar, Md, Giuliana Labella, Msn, Caitlin Harley, Msn, Omar Shah, Md, Mba

Health Equity and Quality Improvement (HEQI) Summit

Increasing systemic pressures have forced clinicians to identify and address a variety of metrics to provide better “quality” care. Catheter associated UTIs (CAUTI) are a common health careassociated infection in the Neuro ICU and are associated with increased LOS and overall mortality.

Aims for Improvement: Improving the incidence of CAUTI at the Gibbon and JHN ICUs on an annual basis after incremental interventions.