Medicine and Health Sciences Commons^™

Wellbody Alliance, Sierra Leone, Kevin Rurak

CwiC-PH

Pharmacy Project:

Inventory database development

• Streamlined tracking of daily and monthly drug dispensing
• New database to plan requisitions based on trends

Jeffhealth Soil-Transmitted Helminths, David Maniscalco

CwiC-PH

Soil-transmitted helminth (STH) infections are known to be a significant problem in Rwanda. The Ministry of Health and individual villages are aware of its impact on people’s health and well-being as well as its impact on the country’s economy. The goal of the JeffHEALTH project is to educate poor, rural villages in Rwanda so that village members can take the knowledge they gain, put it into practice and share this knowledge with generations to come.

Assessment Of Nutritional Adequacy In Patients On Extracorporeal Membrane Oxygenation., Hitoshi Hirose, Md, Phd, Joseph Miessau, Pa-C, Evanthia Foliou, Rd, Pawel Karbowski, Pa-C, Ms, Melanie K. Sion, Md, Christine Feldmeier, Md

Department of Surgery Faculty Papers

Introduction: Nutrition is a key element of recovery from the state of critical illness. Little is known about nutritional adequacy in patients supported on extracorporeal membrane oxygenation (ECMO) for severe cardio-respiratory dysfunction. A study was performed whether or not early nutrition support improve outcomes of the patients on ECMO.

Methods: A retrospective IRB approved review was conducted of all patients supported on ECMO from 7/10 to 6/12. The patients were divided into 2 groups, survivors and non-survivors. Age, sex, preoperative comorbidities, type and duration of ECMO, day to initiation and goal feeding, caloric intake, weekly biomarkers (pre-albumin, albumin, …

What's New In Adult Reconstructive Knee Surgery., Carl A Deirmengian, Jess H Lonner

Rothman Institute Papers

No abstract provided.

Acetabular Components In Total Hip Arthroplasty: Is There Evidence That Cementless Fixation Is Better?, Nader Toossi, Bahar Adeli, Andrew J Timperley, Fares S Haddad, Mitchell Maltenfort, Javad Parvizi

Rothman Institute Papers

BACKGROUND: The use of cementless acetabular components in total hip arthroplasty has gained popularity over the past decade. Most total hip arthroplasties being performed in North America currently use cementless acetabular components. The objective of this systematic review and meta-analysis was to compare the survivorship and revision rate of cemented and cementless acetabular components utilized in total hip arthroplasty.

METHODS: A primary literature search in PubMed identified 3488 articles, of which 3407 did not meet the inclusion criteria and were excluded. Only English-language articles on either the survivorship or revision rate of primary total hip arthroplasty at a minimum of …

The Stigma Of Migraine, William B. Young, Jung E. Park, Iris X. Tian, Joanna Kempner

Department of Neurology Faculty Papers

Background

People who have a disease often experience stigma, a socially and culturally embedded process through which individuals experience stereotyping, devaluation, and discrimination. Stigma has great impact on quality of life, behavior, and life chances. We do not know whether or not migraine is stigmatizing.

Methods

We studied 123 episodic migraine patients, 123 chronic migraine patients, and 62 epilepsy patients in a clinical setting to investigate the extent to which stigma attaches to migraine, using epilepsy as a comparison. We used the stigma scale for chronic illness, a 24-item questionnaire suitable for studying chronic neurologic diseases, and various disease impact …

Early Results Of Prostate Cancer Radiation Therapy: An Analysis With Emphasis On Research Strategies To Improve Treatment Delivery And Outcomes., Kosj Yamoah, Kwamena Beecham, Sarah E Hegarty, Terry Hyslop, Timothy Showalter, Joel Yarney

Department of Radiation Oncology Faculty Papers

ABSTRACT: BACKGROUND: There is scant data regarding disease presentation and treatment response among black men living in Africa. In this study we evaluate disease presentation and early clinical outcomes among Ghanaian men with prostate cancer treated with external beam radiotherapy (EBRT). METHODS: A total of 379 men with prostate cancer were referred to the National Center for Radiotherapy, Ghana from 2003 to 2009. Data were collected regarding patient-and tumor-related factors such as age, prostate specific antigen (PSA), Gleason score (GS), clinical stage (T), and use of androgen deprivation therapy (ADT). For patients who received EBRT, freedom from biochemical failure (FFbF) …

Jefferson Digital Commons Quarterly Report: October-December 2013, Daniel G. Kipnis, Msi

Jefferson Digital Commons Reports

Year end quarterly report for the Jefferson Digital Commons. Includes statistics, pie chart breaking down types of resources indexed in the JDC, comments from users, highlighted new assets in the collection.

Retro-Aortic Left Renal Vein, Joann Aichroth, Rdms, Traci B. Fox, Ms, Rt(R), Rdms, Rvt

Department of Radiologic Sciences Faculty Papers

The term retro-aortic left renal vein (RLRV) is defined as the left renal vein coursing posterior to the abdominal aorta. RLRV is an uncommon condition in which the left renal vein passes posterior to the abdominal aorta and anterior to the vertebrae. RLRV may lead to left renal vein hypertension (LRVH) syndrome, which is also known as Nutcracker syndrome. Nutcracker syndrome (NCS) is a condition in which the left renal vein is compressed causing hypertension of the vessel. RLRV and Nutcracker syndrome are vascular anomalies considered to be of clinical importance especially during surgical procedures of the renal vasculature.

College Within The College: Population Health, James D. Plumb, Md, Mph, Rickie Brawer, Mph, Phd, Mches, Abbie Santana, Msph, Rob Simmons, Drph, Mph, Mches, Cph, Nancy L. Chernett, Ma, Mph

College of Population Health Lectures, Presentations, Workshops

College within the College (CwiC) – Population Health Skills for Physicians

• Incorporate culturally relevant information into a treatment plan for a patient

• Counsel individuals about healthy lifestyles

• Identify community support and resources to serve patients

• Coordinate health care services as a member of multidisciplinary teams

• Promote primary and secondary prevention

• Advocate for the needs of patients and the community

• Conduct population health research/evaluation

• Promote healthy lifestyles in communities

• Work in partnership with community based agencies and organizations

Value-Based Analysis Of Routine Pathologic Septal And Inferior Turbinate Specimens., James J Daniero, Jaemi S Chu, Brian J O'Hara, Edmund A. Pribitkin

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

This article was presented at the 2012 AAO-HNSF Annual Meeting & OTO EXPO; September 9-12, 2012; Washington, DC.

Objective To determine the frequency and clinical relevance of unanticipated histopathologic results in routine sinonasal surgery and evaluate the necessity for histologic processing of nasal septal cartilage, bone, and inferior turbinate specimens. Study Design Case series with chart review. Setting Tertiary care academic medical center. Subjects and Methods A retrospective review of surgical pathology reports on adult patients undergoing sinonasal surgery during a 5-year period from 2005 to 2010 was performed. All cases with the preoperative diagnosis of sinonasal neoplasia, autoimmune disease, …

Xiaoqinglong Granules As Add-On Therapy For Asthma: Latent Class Analysis Of Symptom Predictors Of Response., Qinglin Zha, Seqi Lin, Chi Zhang, Christopher Chang, Hanrong Xue, Cheng Lu, Miao Jiang, Yan Liu, Zuke Xiao, Weiyou Liu, Yunfei Shang, Jianjian Chen, Minyong Wen, Aiping Lu

Department of Medicine Faculty Papers

Xiaoqinglong granules (XQLG) has been shown to be an effective therapy in asthma animal models. We reviewed the literature and conducted this study to assess the impact of XQLG as an add-on therapy to treatment with fluticasone/salmeterol (seretide) in adult patients with mild-to-moderate, persistent asthma. A total of 178 patients were randomly assigned to receive XQLG and seretide or seretide plus placebo for 90 days. Asthma control was assessed by asthma control test (ACT), symptoms scores, FEV(1), and PEF. Baseline patient-reported Chinese medicine (CM)-specific symptoms were analyzed to determine whether the symptoms may be possible indicators of treatment response by …

Aortic Dissection Presenting As Gait Disturbance: A Case Report., Michael Estreicher, Joseph Portale, Bernard Lopez

Department of Emergency Medicine Faculty Papers

Emergency medicine dogma traditionally teaches that aortic dissection presents as tearing chest pain, radiating to the back. This case report describes a 55 year old woman presenting with a left homonymous hemianopsia and resultant gait disturbance. Initial head CT demonstrated a right parietal infarct, and chest radiograph demonstrated a markedly widened mediastinum. Acute Stanford Type A aortic dissection was subsequently confirmed. This report provides further evidence for atypical, painless presentations of aortic dissection. Given recent literature on the increasing prevalence of painless dissection, the disease entity should be included in the differential diagnosis for stroke, and a simple portable chest …

Ginsenoside Rd Attenuates Myocardial Ischemia/Reperfusion Injury Via Akt/Gsk-3Β Signaling And Inhibition Of The Mitochondria-Dependent Apoptotic Pathway., Yang Wang, Xu Li, Xiaoliang Wang, Wayne Bond Lau, Yajing Wang, Yuan Xing, Xing Zhang, Xinliang Ma, Feng Gao

Department of Emergency Medicine Faculty Papers

Evidence suggests Ginsenoside Rd (GSRd), a biologically active extract from the medical plant Panax Ginseng, exerts antioxidant effect, decreasing reactive oxygen species (ROS) formation. Current study determined the effect of GSRd on myocardial ischemia/reperfusion (MI/R) injury (a pathological condition where ROS production is significantly increased) and investigated the underlying mechanisms. The current study utilized an in vivo rat model of MI/R injury and an in vitro neonatal rat cardiomyocyte (NRC) model of simulated ischemia/reperfusion (SI/R) injury. Infarct size was measured by Evans blue/TTC double staining. NRC injury was determined by MTT and lactate dehydrogenase (LDH) leakage assay. ROS accumulation and …

Different Mechanisms Of Inflammation Induced In Virus And Autoimmune-Mediated Models Of Multiple Sclerosis In C57bl6 Mice., Abhinoy Kishore, Anurag Kanaujia, Soma Nag, A M Rostami, Lawrence C. Kenyon, Kenneth S Shindler, Jayasri Das Sarma

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Multiple sclerosis (MS) is an inflammatory demyelinating disease of the human central nervous system (CNS). Neurotropic demyelinating strain of MHV (MHV-A59 or its isogenic recombinant strain RSA59) induces MS-like disease in mice mediated by microglia, along with a small population of T cells. The mechanism of demyelination is at least in part due to microglia-mediated myelin stripping, with some direct axonal injury. Immunization with myelin oligodendrocyte glycoprotein (MOG) induces experimental autoimmune encephalomyelitis (EAE), a mainly CD4(+) T-cell-mediated disease, although CD8(+) T cells may play a significant role in demyelination. It is possible that both autoimmune and nonimmune mechanisms such as …

A Genome-Wide Methylation Study On Essential Hypertension In Young African American Males., Xiaoling Wang, Bonita Falkner, Haidong Zhu, Huidong Shi, Shaoyong Su, Xiaojing Xu, Ashok Kumar Sharma, Yanbin Dong, Frank Treiber, Bernard Gutin, Gregory Harshfield, Harold Snieder

Department of Medicine Faculty Papers

OBJECTIVE: There is emerging evidence from animal studies suggesting a key role for methylation in the pathogenesis of essential hypertension. However, to date, very few studies have investigated the role of methylation in the development of human hypertension, and none has taken a genome-wide approach. Based on the recent studies that highlight the involvement of inflammation in the development of hypertension, we hypothesize that changes in DNA methylation of leukocytes are involved in the pathogenesis of hypertension.

METHOD & RESULTS: We conducted a genome-wide methylation analysis on 8 hypertensive cases and 8 normotensive age-matched controls aged 14-23 years and performed …

Inhibitory Effect Of Matrine On Blood-Brain Barrier Disruption For The Treatment Of Experimental Autoimmune Encephalomyelitis., Su Zhang, Quan-Cheng Kan, Yuming Xu, Guang-Xian Zhang, Lin Zhu

Department of Neurology Faculty Papers

Dysfunction of the blood-brain barrier (BBB) is a primary characteristic of experimental autoimmune encephalomyelitis (EAE), an experimental model of multiple sclerosis (MS). Matrine (MAT), a quinolizidine alkaloid derived from the herb Radix Sophorae Flave, has been recently found to suppress clinical EAE and CNS inflammation. However, whether this effect of MAT is through protecting the integrity and function of the BBB is not known. In the present study, we show that MAT treatment had a therapeutic effect comparable to dexamethasone (DEX) in EAE rats, with reduced Evans Blue extravasation, increased expression of collagen IV, the major component of the basement …

Warning Signal: Unaware Of An In Absentia Conviction, South African Cancer Specialist Jailed On Return To The United Arab Emirates., Philip R Cohen, Razelle Kurzrock, Lawrence Parish

Department of Dermatology and Cutaneous Biology Faculty Papers

In 2002, Dr. Cyril Karabus, a specialist in pediatric cancers and retired head of the Oncology and Hematology Unit of Red Cross Children's Hospital in Capetown, South Africa, spent a brief locum at Sheikh Khalifa Medical City, a hospital in Abu Dhabi in the United Arab Emirates (UAE). He was there for only 5 weeks, during which time he treated a young girl who died of acute myeloblastic leukemia. After Karabus returned home, the girl's father complained to police about his daughter's death, and Karabus was convicted of murder in absentia. Karabus knew nothing of the charges or of the …

Glutamine Supplementation Alleviates Vasculopathy And Corrects Metabolic Profile In An In Vivo Model Of Endothelial Cell Dysfunction., Francesco Addabbo, Qiuying Chen, Dhara P Patel, May Rabadi, Brian Ratliff, Frank Zhang, Jean-Francois Jasmin, Michael Wolin, Michael Lisanti, Steven S Gross, Michael S Goligorsky

Kimmel Cancer Center Faculty Papers

Endothelial Cell Dysfunction (ECD) is a recognized harbinger of a host of chronic cardiovascular diseases. Using a mouse model of ECD triggered by treatment with L-Nω-methylarginine (L-NMMA), we previously demonstrated that renal microvasculature displays a perturbed protein profile, including diminished expression of two key enzymes of the Krebs cycle associated with a Warburg-type suppression of mitochondrial metabolism. We hypothesized that supplementation with L-glutamine (GLN), that can enter the Krebs cycle downstream this enzymatic bottleneck, would normalize vascular function and alleviate mitochondrial dysfunction. To test this hypothesis, mice with chronic L-NMMA-induced ECD were co-treated with GLN at different concentrations for 2 …

Developing Ambulatory Care Registered Nurse Competencies For Care Coordination And Transition Management, Sheila Haas, Beth Ann Swan, Traci Haynes

College of Nursing Faculty Papers & Presentations

The need for care coordination and management of transitions between Patient-Centered Medical Home providers, outpatient and community settings, including the Accountable Care Organization is often overlooked, episodic, and accountability for coordinating care and managing transitions between providers and services is lacking.

Key Neurological And Neurochemical Features In A Model Of Repetitive Concussions: Implications For Post-Concussion Headache, C. Macolino, B. Daiutolo, A. Tyburski, Melanie B. Elliott

Department of Neurosurgery Faculty Papers

Introduction

Incidence rates for concussion will continue to grow along with the increasing awareness and improvements in diagnosis. Headache is a hallmark feature of post-concussion syndrome. Post-concussion headache (PCH) is highly prevalent in the military with as high as 97.8% reporting having headaches¹. occurring in up to 85% of athletes following ^2-4. In the Military and sports, return to duty or play guidelines state that a soldier/player should be asymptomatic before returning to physical activity. However, headache following concussion is commonly dismissed. PCH can be a new headache resulting from head trauma or worsening of pre-existing headache …

Ash2 Acts As An Ecdysone Receptor Coactivator By Stabilizing The Histone Methyltransferase Trr., Albert Carbonell, Alexander Mazo, Florenci Serras, Montserrat Corominas

Department of Biochemistry and Molecular Biology Faculty Papers

The molting hormone ecdysone triggers chromatin changes via histone modifications that are important for gene regulation. On hormone activation, the ecdysone receptor (EcR) binds to the SET domain-containing histone H3 methyltransferase trithorax-related protein (Trr). Methylation of histone H3 at lysine 4 (H3K4me), which is associated with transcriptional activation, requires several cofactors, including Ash2. We find that ash2 mutants have severe defects in pupariation and metamorphosis due to a lack of activation of ecdysone-responsive genes. This transcriptional defect is caused by the absence of the H3K4me3 marks set by Trr in these genes. We present evidence that Ash2 interacts with Trr …

Hyperosmolar Therapy For Raised Intracranial Pressure., Ethan A Benardete

Department of Neurosurgery Faculty Papers

No abstract provided.

Root Causes Of Intraoperative Hypoglycemia: A Case Series., Eric S. Schwenk, Boris Mraovic, Ryan P. Maxwell, Gina S. Kim, Jesse M. Ehrenfeld, Richard H. Epstein

Department of Anesthesiology Faculty Papers

STUDY OBJECTIVE: To describe the root causes of intraoperative hypoglycemic events.

DESIGN: Retrospective analysis.

SETTING: Large academic teaching hospital.

MEASUREMENTS: Data from 80,379 ASA physical status 1, 2, 3, 4, and 5 surgical patients were reviewed. Blood glucose values, insulin, oral hypoglycemic medication doses, and doses of glucose or other medications for hypoglycemia treatment were recorded.

MAIN RESULTS: Hypoglycemia in many patients had multiple etiologies, with many cases (8 of 17) involving preventable errors. The most common root causes of hypoglycemia were ineffective communication, circulatory shock, failure to monitor, and excessive insulin administration.

CONCLUSION: Intraoperative hypoglycemia was rare, but often …

Influence Of Body Mass Index And Antibiotic Dose On The Risk Of Surgical Site Infections In Pediatric Clean Orthopedic Surgery., Jeffrey J Cies, Shannon Chan, Jobayer Hossain, B Randall Brenn, M Cecilia Di Pentima

Department of Anesthesiology Faculty Papers

OBJECTIVE: To evaluate body mass index (BMI) and antimicrobial dose as risk factors for surgical site infections in pediatric patients.

PATIENTS AND METHODS: Children between 2 and 19 years of age undergoing clean orthopedic procedures and receiving at least one dose of perioperative antibiotics (cefazolin, vancomycin, or clindamycin) were studied. The retrospective case-controlled study was conducted at the Alfred I. duPont Hospital for Children, a 180-bed tertiary-care academic pediatric hospital in Wilmington, DE. Data were collected from January 1, 2002, to December 31, 2005.

RESULTS: Underweight children had a higher risk for SSIs than overweight and normal-weight children. American Society …

Limited Sampling Estimates Of Epigallocatechin Gallate Exposures In Cirrhotic And Noncirrhotic Patients With Hepatitis C After Single Oral Doses Of Green Tea Extract., Dina Halegoua-De Marzio, Walter K. Kraft, Constantine Daskalakis, Xie Ying, Roy L Hawke, Victor J. Navarro

Division of Gastroenterology and Hepatology Faculty Papers

BACKGROUND: Epigallocatechin-3-gallate (EGCG) has antiangiogenic, antioxidant, and antifibrotic properties that may have therapeutic potential for the treatment of cirrhosis induced by hepatitis C virus (HCV). However, cirrhosis might affect EGCG disposition and augment its reported dose-dependent hepatotoxic potential.

OBJECTIVE: The safety, tolerability, and disposition of a single oral dose of EGCG in cirrhotic patients with HCV were examined in an exploratory fashion.

METHODS: Eleven patients with hepatitis C and detectable viremia were enrolled. Four had Child-Pugh (CP) class A cirrhosis, 4 had Child-Pugh class B cirrhosis, and 3 were noncirrhotic. After a single oral dose of green tea extract 400 …

Risk Factors For Wound Complications After Ankle Fracture Surgery., Adam G Miller, Andrew Margules, Steven M Raikin

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: The overall rate of complications after ankle fracture fixation varies between 5% and 40% depending on the population investigated, and wound complications have been reported to occur in 1.4% to 18.8% of patients. Large studies have focused on complications in terms of readmission, but few studies have examined risk factors for wound-related issues in the outpatient setting in a large number of patients. A review was performed to identify risk factors for wound complications tracked in the hospital and outpatient setting.

METHODS: Four hundred and seventy-eight patients underwent open reduction and internal fixation of an ankle fracture between 2003 …

Metabolic Syndrome And Migraine., Amit Sachdev, Michael J Marmura

Department of Jefferson Headache Center Papers and Presentations

Migraine and metabolic syndrome are highly prevalent and costly conditions. The two conditions coexist, but it is unclear what relationship may exist between the two processes. Metabolic syndrome involves a number of findings, including insulin resistance, systemic hypertension, obesity, a proinflammatory state, and a prothrombotic state. Only one study addresses migraine in metabolic syndrome, finding significant differences in the presentation of metabolic syndrome in migraineurs. However, controversy exists regarding the contribution of each individual risk factor to migraine pathogenesis and prevalence. It is unclear what treatment implications, if any, exist as a result of the concomitant diagnosis of migraine and …

Exploring The Depths Of Health Literacy Are We Teaching This And Why Does It Matter?, Susan Toth-Cohen, Phd, Otr/L, Tracey Vause-Earland, Ms, Otr/L

Department of Occupational Therapy Posters and Presentations

Background: Why does Health Literacy Matter?

• Healthcare practitioners often work with older persons with low health literacy without realizing that this issues limiting the success of their interventions. They may also lack awareness of the serious impact that low health literacy can have, since it is associated with lower reported health status, increased hospitalizations, and increased morbidity (Levasseur & Carrier, 2011).
• The current US healthcare system places increase demands on consumers to manage their own health (Smith & Gutman, 2011).
• Educators in the health professions must instill a sense of responsibility in future practitioners to understand the important role they …

Efficacy Of Miniaturized Imacor Trans-Esophageal Echocardiografm (Tee) Prove In Mechanical Circulatory Support., Hitoshi Hirose, Christopher Y. Kang, Joshua K. Wong, Harrison T. Pitcher, Caitlyn M. Johnson, Konrad Sarosiek, Linda J Bogar, Nicholas C. Cavarocchi

Department of Surgery Faculty Papers

Application of the miniaturized ImaCor Trans-Esophageal Echocardiogram (TEE) probe in Heart Transplant/Mechanical Cardiac Support Patients In the surgical cardiac care unit (SCCU), therapeutic interventions often need to be done at the bedside, necessitating the need for a rapidly employable diagnostic tool for the cardiac intensivist. We report the clinical utility of the miniature ImaCor TEE-probe in guiding management of post heart transplant (H-Txp) and mechanical cardiac support patients (MCS) and describe the economic benefit of such a device. This is an IRB approved retrospective review of MCS/H-Txp patients who had ImaCor TEE monitoring in the SCCU of our institution in …