Medicine and Health Sciences Commons^™

A Harmonized Public Resource Of Deeply Sequenced Diverse Human Genomes, Zan Koenig, Mary T Yohannes, Lethukuthula L Nkambule, Xuefang Zhao, Julia K Goodrich, Heesu Ally Kim, Michael W Wilson, Grace Tiao, Stephanie P Hao, Nareh Sahakian, Katherine R Chao, Mark A Walker, Yunfei Lyu, Heidi L Rehm, Benjamin M Neale, Michael E Talkowski, Mark J Daly, Harrison Brand, Konrad J Karczewski, Elizabeth G Atkinson, Alicia R Martin

Faculty, Staff and Students Publications

Underrepresented populations are often excluded from genomic studies owing in part to a lack of resources supporting their analyses. The 1000 Genomes Project (1kGP) and Human Genome Diversity Project (HGDP), which have recently been sequenced to high coverage, are valuable genomic resources because of the global diversity they capture and their open data sharing policies. Here, we harmonized a high-quality set of 4094 whole genomes from 80 populations in the HGDP and 1kGP with data from the Genome Aggregation Database (gnomAD) and identified over 153 million high-quality SNVs, indels, and SVs. We performed a detailed ancestry analysis of this cohort, …

Myeloablative Vs Nonmyeloablative Consolidation For Primary Central Nervous System Lymphoma: Results Of Alliance 51101, Tracy T Batchelor, Brad S Kahl, Nancy L Bartlett, Nina Wagner-Johnston, Et Al.

2020-Current year OA Pubs

Although it is evident that standard-dose whole-brain radiotherapy as consolidation is associated with significant neurotoxicity, the optimal consolidative strategy for primary central nervous system lymphoma (PCNSL) is not defined. We performed a randomized phase 2 clinical trial via the US Alliance cancer cooperative group to compare myeloablative consolidation supported by autologous stem cell transplantation with nonmyeloablative consolidation after induction therapy for PCNSL. To our knowledge, this is the first randomized trial to be initiated that eliminates whole-brain radiotherapy as a consolidative approach in newly diagnosed PCNSL. Patients aged 18 to 75 years were randomly assigned in a 1:1 manner to …

Role Of The Afferent Lymph As An Immunological Conduit To Analyze Tissue Antigenic And Inflammatory Load, Padma P Nanaware, Cheryl F Lichti, Xiaoxiao Wan, Emil R Unanue, Et Al.

2020-Current year OA Pubs

The lymphatic fluid is the conduit by which part of the tissue "omics" is transported to the draining lymph node for immunosurveillance. Following cannulation of the pre-nodal cervical and mesenteric afferent lymphatics, herein we investigate the lymph proteomic composition, uncovering that its composition varies according to the tissue of origin. Tissue specificity is also reflected in the dendritic cell-major histocompatibility complex class II-eluted immunopeptidome harvested from the cervical and mesenteric nodes. Following inflammatory disruption of the gut barrier, the lymph antigenic and inflammatory loads are analyzed in both mice and subjects with inflammatory bowel diseases. Gastrointestinal tissue damage reflects the …

A Case Report Of Acute Idiopathic Hepatitis Requiring Liver Transplant, Nathan Rim, Nevin Varghese, Md, Zachary Pang, Md

The Medicine Forum

Acute liver injury may be very difficult to treat, especially when the etiology is unknown. We describe a case of a patient who presented with signs and symptoms of acute liver injury and went through an extensive work-up that did not reveal a definitive cause. The lack of diagnosis can be distressing for the patient, so it is important to regularly communicate the current plan and potential future necessary steps (such as a transplant surgery) to facilitate smooth, informed decision-making throughout the whole process.

A Rare Case Of Upper Gastrointestinal Bleeding And Esophageal Candidiasis In Severe Achalasia, Nevin Varghese, Md, Bertilia Tavárez, Md, Justin Robbins, Md

The Medicine Forum

Achalasia is an esophageal dysmotility disorder characterized by failure of relaxation of the lower esophageal sphincter (LES), accompanied by aperistalsis of the distal esophagus. Recent data show that the prevalence of achalasia in the United States is 10 per 100,000 individuals.¹ Complications of achalasia include esophagitis, esophageal ulcer, esophagealtracheal fistula, esophageal rupture, aspiration pneumonia, and squamous cell carcinoma. We report a rare case of upper gastrointestinal bleeding associated with esophageal ulcer and candidiasis in a patient with severe achalasia requiring multiple endoscopic interventions.

Bicuspid Aortic Valve With Right Coronary Cusp And Noncoronary Cusp Fusion On Transesophageal Echocardiogram, Kashka Mallari, Md

The Medicine Forum

A 39 year old male with a bicuspid aortic valve (BAV) developed progression of aortic valve regurgitation and enlargement of the ascending aorta, despite showing no symptoms. BAV, affecting approximately 2% of the population, poses risks such as aortic stenosis, aortic regurgitation, endocarditis, and aortic dilation, which can lead to aortic aneurysm and potential rupture. Due to the risk of further progression, he underwent a trans-esophageal echocardiogram (TEE) to facilitate aortic valve repair. While majority of patients with BAV exhibit fusion between the right coronary cusp (RCC) and left coronary cusp (LCC), this patient displayed fusion between the RCC and …

Hypertrophic Cardiomyopathy Illustrated On A Transthoracic Echocardiogram And Cardiac Mri, Youssef Elfatatry, Md, Marina Gonzalez, Md

The Medicine Forum

A 46-year-old woman presented to the hospital with subacute dyspnea on exertion and syncope. She had three syncopal episodes in the months prior, all of which occurred after standing from seated position and were associated with complete loss of consciousness. Echocardiogram showed severe concentric left ventricular hypertrophy (LVH) with preserved systolic function (Panels A and B). Cardiac magnetic resonance (CMR) imaging was performed which confirmed asymmetric septal hypertrophy measuring 28-mm in thickness (Panel C, arrow). Patchy, late gadolinium enhancement was also seen within the myocardium (Panel D, arrows). A diagnosis of hypertrophic cardiomyopathy (HCM) was made. The patient had no …

Wellens' Syndrome On Electrocardiogram, A Highly Specific Indicator Of Critical Stenosis Of The Left Anterior Descending Coronary Artery, Youssef Elfatatry, Md, Ryan Gardner, Md

The Medicine Forum

An 85-year-old male with a past medical history of hyperlipidemia presented to his primary care physician with chest pain. The patient had experienced an acute episode of substernal chest pain that resolved spontaneously three days prior to presentation. An electrocardiogram (ECG) was obtained in the office which showed inverted and biphasic T-waves throughout the precordial chest leads (Panel A, arrows). The patient was sent to the emergency department and underwent an emergent cardiac catheterization which revealed a 99% proximal left anterior descending (LAD) artery occlusion (Panel B, arrow). A drug-eluting stent was placed with successful revascularization (Panel C, arrow). Wellens …

Investigating The Etiology Of Non-Ischemic Cardiomyopathy; A Case Report Of Cardiac Amyloidosis, Zachary Pang, Md, Joshua M. Riley, Md, Yair Lev, Md

The Medicine Forum

Amyloidosis is the result of misfolded protein deposition in organs and tissues, including the heart also known as cardiac amyloidosis. We describe a case of a patient presenting with decompensated heart failure, which highlights the importance of identifying the etiology of the patient’s cardiomyopathy through a thorough history and physical. This led to a diagnosis of cardiac amyloidosis. The patient was subsequently initiated on tafamidis, a medication that is associated with reductions in all-cause mortality and cardiovascular-related hospitalizations, reduced decline in functional capacity, and improved quality of life of the patient.

Laao Device Mass: A Classic Condition Involving A Not - So - Classic Device, Ryan Gardner, Md, Rabia Naheed, Md, Youssef Elfatatry, Md, Irfan Ahsan, Md, Alyson N. Owen, Md

The Medicine Forum

Current evidence suggests Class 2a recommendation for a left atrial appendage occlusion with a closure device in patients with atrial fibrillation who have moderate to high risk of stroke (CHA2DS2-VASc score ≥2) and a contraindication to long-term oral anticoagulation due to a nonreversible cause.¹ Watchman device (WD) related infection is infrequent due to complete endothelialization of the device in a few weeks.² We report a highly challenging case of possible WD-related infection that involved complex decision-making.

Dissecting The Literature: A Systematic Review Of Conservative Therapy Versus Revascularization In Spontaneous Coronary Artery Dissection, Avinash Saraiya, Ms, Brian Schonewald, Md

The Medicine Forum

Spontaneous coronary artery dissection (SCAD) is a rare, but increasingly recognized cause of acute coronary syndrome (ACS). While previously only described in case series, the advent of advanced imaging techniques such as intravascular ultrasound (IVUS) and optical coherence tomography (OCT) has increased its prevalence dramatically. Anatomically, SCAD results from the formation of an intramural hematoma with or without intimal tear in a coronary artery, potentially leading to occlusion and ischemia. This phenomenon is especially common in women, accounting for 35% of ACS in women under the age of 50, and representing the leading cause of peripartum myocardial infarct.¹ There …

From The Chief Residents, Michael Dong, Md, Chantel Venkataraman, Md, Tamar Wolinsky Md, Benjamin Claxton, Md

The Medicine Forum

As we introduce the latest edition of The Medicine Forum, the journal of our Internal Medicine residency program, we're thrilled to showcase the diverse talents and perspectives of our resident physicians. Evolving alongside our program, this publication serves as both a platform for scientific inquiry and a canvas for creativity, reflecting the dynamic interests of each resident cohort.

We must extend our heartfelt gratitude to our current editors, Amman Bhasin, Suraj Nyalakonda, Mez Kamanu, and Alex Grivas, for their unwavering dedication and tireless efforts in shepherding this journal to new heights. Their commitment to excellence and their vision for …

From The Editors, Amman Bhasin, Md, Suraj Nyalakonda, Md, Chukwuemezie Kamanu, Md, Alexandros Grivas, Md

The Medicine Forum

We are honored to present the 25th Annual edition of The Medicine Forum, carrying forth a quarter-century tradition of scholarly work produced by faculty, residents, and students -- proudly shared with the Jefferson community and beyond. The Medicine Forum embodies the collective voice and spirit of our residency, serving as a vibrant platform for scholarly and artistic expression, and showcasing the remarkable talents and diverse perspectives of our program’s faculty, residents, and students.

Throughout the years, The Medicine Forum has evolved alongside our program, adapting to the changing interests and passions of each new cohort of residents. It serves …

Foreword From Faculty Advisor, Dagan Coppock, Md, Msce

The Medicine Forum

The latest edition of The Medicine Forum celebrates our community’s efforts toward scholarly inquiry and creativity. Our current editors have approached this project with a true passion. Throughout the academic year, it has been my pleasure to work with Amman, Suraj, Mez, and Alex, not only on this project, but also on the medical wards. They have applied the same thoughtfulness and joy to editing this journal that they do to the care of patients. I am in awe of their efforts.

As a department, we are a productive group of writers, thinkers, scientists, and artists. So much of our …

From The Desk Of The Residency Program Director, Christopher Henry, Md, Facp

The Medicine Forum

As we celebrate the silver jubilee of our beloved Jefferson Forum, it is with great pride and admiration that I extend a warm welcome to each of you. For a quarter-century, this annual publication has stood as a testament to the dedication, passion, and scholarly pursuits of our internal medicine residents.

Within the pages of the Jefferson Forum, you will find the embodiment of our residents' commitment to excellence in patient care, education, and research. As the Program Director, I have had the privilege of witnessing firsthand the remarkable growth and development of our residents. Their journey from eager learners …

Table Of Contents: The Medicine Forum, Volume 25, 2023-2024

The Medicine Forum

Table of Contents: The Medicine Forum, Volume 25, 2023-2024

The Medicine Forum: Volume 25

The Medicine Forum

The Journal of Thomas Jefferson University Hospital - Department of Internal Medicine, Volume 25, 2023-2024

TABLE OF CONTENTS

• Case Reports
• Clinical Images
• Humanities & Reflections

A Homogeneous Time-Resolved Fluorescence Screen To Identify Sirt2 Deacetylase And Defatty-Acylase Inhibitors, Jie Yang, Joel Cassel, Brian C Boyle, Daniel Oppong, Young-Hoon Ahn, Brian P Weiser

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Human sirtuin-2 (SIRT2) has emerged as an attractive drug target for a variety of diseases. The enzyme is a deacylase that can remove chemically different acyl modifications from protein lysine residues. Here, we developed a high-throughput screen based on a homogeneous time-resolved fluorescence (HTRF) binding assay to identify inhibitors of SIRT2's demyristoylase activity, which is uncommon among many ligands that only affect its deacetylase activity. From a test screen of 9600 compounds, we identified a small molecule that inhibited SIRT2's deacetylase activity (IC50 = 7 μM) as well as its demyristoylase activity (IC50 = 37 μM). The inhibitor was composed …

Keep Your Summer Fun Safe, Maggie Mckay, Laura Kemerling

Parent-ish Podcast

Laura Kemerling, MSN, RN, C-NPT, CPST, discusses summer safety and how to prevent injuries - no matter what your summer fun entails!

Click here to stream the podcast episode.

Ephrin-B2 Promotes Nociceptive Plasticity And Hyperalgesic Priming Through Ephb2-Mnk-Eif4e Signaling In Both Mice And Humans, Eric David, Muhammad Saad Yousuf, Hao-Ruei Mei, Ashita Jain, Sharada Krishnagiri, Hajira Elahi, Rupali Venkatesan, Kolluru Srikanth, Gregory Dussor, Matthew Dalva, Theodore Price

Department of Neuroscience Faculty Papers

Ephrin-B-EphB signaling can promote pain through ligand-receptor interactions between peripheral cells, like immune cells expressing ephrin-Bs, and EphB receptors expressed by DRG neurons. Previous studies have shown increased ephrin-B2 expression in peripheral tissues like synovium of rheumatoid and osteoarthritis patients, indicating the clinical significance of this signaling. The primary goal of this study was to understand how ephrin-B2 acts on mouse and human DRG neurons, which express EphB receptors, to promote pain and nociceptor plasticity. We hypothesized that ephrin-B2 would promote nociceptor plasticity and hyperalgesic priming through MNK-eIF4E signaling, a critical mechanism for nociceptive plasticity induced by growth factors, cytokines …

Intouch Week Of June 24, 2024, New York Medical College

InTouch

• Teeing Off for Tomorrow’s Scholars at the Golf Outing
• New Medical School Linkage Agreement for GSBMS Students
• Dr. Halperin Offers Thoughts on the American Hearing Aid Market
• Scarring Persists in Patients with COVID-19 Vaccine-Associated Myocarditis
• Study Suggests Diagnostic Surgery Can Be Used Safely on Children with Epilepsy
• Department Spotlight: The Office of Government Affairs Advances the College’s Mission, Education, and Research
• Alumni Spotlight: Dr. Mboge Plants Seeds of Change from The Gambia to New York

The Attainment Of A Patient Acceptable Symptom State In Patients Undergoing Revision Spine Fusion, Tariq Z. Issa, Omar H. Tarawneh, Teeto Ezeonu, Ameer A. Haider, Rajkishen Narayanan, Jose A. Canseco, Alan S. Hilibrand, Alexander R. Vaccaro, Gregory D. Schroeder, Christopher K. Kepler

Rothman Institute Papers

INTRODUCTION: Revision lumbar fusion is most commonly due to nonunion, adjacent segment disease (ASD), or recurrent stenosis, but it is unclear if diagnosis affects patient outcomes. The primary aim of this study was to assess whether patients achieved the patient acceptable symptom state (PASS) or minimal clinically important difference (MCID) after revision lumbar fusion and assess whether this was influenced by the indication for revision.

METHODS: We retrospectively identified all 1-3 level revision lumbar fusions at a single institution. Oswestry Disability Index (ODI) was collected at preoperative, three-month postoperative, and one-year postoperative time points. The MCID was calculated using a …

Effectiveness Of An Online Text-Based Stress Management Program For Employees Who Work In Micro- And Small-Sized Enterprises: A Randomized Controlled Trial, Natsu Sasaki, Sayaka Ogawa, Utako Sawada, Taichi Shimazu, Byron J Powell, Hajime Takeno, Akizumi Tsutsumi, Kotaro Imamura

2020-Current year OA Pubs

BACKGROUND: Internet psychoeducational interventions improve employees' mental health. However, implementing them for employees in micro- and small-sized enterprises (MSEs) is challenging.

OBJECTIVES: This randomized controlled trial examined the effectiveness of a fully automated text-based stress management program, "WellBe-LINE," in improving mental health and job-related outcomes for employees in workplaces with fewer than 50 employees.

METHODS: The program was developed based on stakeholder interviews and surveys of 1000 employees at MSEs. Adult full-time employees at an enterprise with fewer than 50 employees were recruited from registered members of a web survey company in Japan. Participants were randomly allocated to the intervention …

The Vaginal Immunoproteome For The Prediction Of Spontaneous Preterm Birth: A Retrospective Longitudinal Study, Zachary Shaffer, Roberto Romero, Adi L Tarca, Jose Galaz, Marcia Arenas-Hernandez, Dereje W Gudicha, Tinnakorn Chaiworapongsa, Eunjung Jung, Manaphat Suksai, Kevin R Theis, Nardhy Gomez-Lopez

2020-Current year OA Pubs

BACKGROUND: Preterm birth is the leading cause of neonatal morbidity and mortality worldwide. Most cases of preterm birth occur spontaneously and result from preterm labor with intact (spontaneous preterm labor [sPTL]) or ruptured (preterm prelabor rupture of membranes [PPROM]) membranes. The prediction of spontaneous preterm birth (sPTB) remains underpowered due to its syndromic nature and the dearth of independent analyses of the vaginal host immune response. Thus, we conducted the largest longitudinal investigation targeting vaginal immune mediators, referred to herein as the immunoproteome, in a population at high risk for sPTB.

METHODS: Vaginal swabs were collected across gestation from pregnant …

06.24.2024 Orsp Connect, Liz Williamson

ORED Newsletter

Research Networking Lunch (LINC), NIH podcast, CREW (Community First Research Center for Wellbeing and Creative Achievement) Premier Physics Experiment

Postnatal Corticosteroid Therapy In Bronchopulmonary Dysplasia - Why Animal Studies Disagree With Clinical Trials?, Anantha Harijith, Thomas M. Raffay, Rita M. Ryan

Faculty Scholarship

Abstract: The systematic review and meta-analysis of newborn animal models by Irene Lok et al. is the first to extensively summarize the literature regarding postnatal systemic corticosteroid use on lung development of newborn rodent models. The meta-analysis showed that the use of postnatal corticosteroids resulted in a reduction in body weight along with persistent alveolar simplification. The most frequently used corticosteroid was dexamethasone. Corticosteroids have been extensively used in clinical trials in preterm newborns. Trials using early systemic administration of corticosteroids reduced the rate of BPD or mortality with no increase in the rates of cerebral palsy. Use of late …

High Boarding Rates Of Older Adults In The Emergency Department: An On-Going Threat To Quality And Safety, Stacie Levine

Journal of Geriatric Emergency Medicine

No abstract provided.

Facebook’S Shared Articles On Hpv Vaccination: Analysis Of Persuasive Strategies, Ashley Hedrick Mckenzie, Elaine Avshman, Ross Shegog, Lara S Savas, L Aubree Shay

Faculty, Staff and Student Publications

Background: The current study analyzed articles shared on Facebook between 2019 and 2021 that discuss the HPV vaccine. Results address a gap in knowledge about the persuasive strategies used in HPV vaccine discourse on Facebook.

Methods: Using Buzzsumo.com, we collected 138 articles, shared on Facebook between 2019 and 2021, with the highest "engagement scores," or total number of reactions, comments, and shares. Using a content analysis methodology, three independent coders were trained in using the study codebook, achieved acceptable inter-rater reliability (Krippendorf's alpha = 0.811), and coded each article in Atlas.ti.

Results: Seventy-two articles had a positive valence toward the …

Understanding Perceptions Of Speech Therapy And Willingness To Continue Seeking Speech Therapy Among Adults Who Stutter, Jaclyn Lucey

USF Tampa Graduate Theses and Dissertations

This project investigates factors associated with treatment-seeking behaviors among adults who stutter (AWS). Specifically, we hypothesized that perceptions of previous speech therapy, including satisfaction with therapy and perceived effectiveness would be related to willingness to seek continued speech therapy. Our project was motivated by a widely used theoretical framework of health service use, and it expands on existing ancillary evidence in stuttering research.

To achieve our objective, we used both qualitative and quantitative methods to gain a more holistic understanding of barriers and facilitators to seeking continued speech therapy. Simultaneously, across two studies, we conducted and analyzed semi- structured interviews …

Achieving Fairness Across Local And Global Models In Federated Learning, Disha Makhija, Xing Han, Joydeep Ghosh, Yejin Kim

Faculty, Staff and Student Publications

Achieving fairness across diverse clients in Federated Learning (FL) remains a significant challenge due to the heterogeneity of the data and the inaccessibility of sensitive attributes from clients' private datasets. This study addresses this issue by introducing \texttt{EquiFL}, a novel approach designed to enhance both local and global fairness in federated learning environments. \texttt{EquiFL} incorporates a fairness term into the local optimization objective, effectively balancing local performance and fairness. The proposed coordination mechanism also prevents bias from propagating across clients during the collaboration phase. Through extensive experiments across multiple benchmarks, we demonstrate that \texttt{EquiFL} not only strikes a better balance …