Diseases Commons^™

Surgical Thrombectomy For Pulmonary Embolism: Updated Performance Rates And Outcomes, Fahad Alqahtani, Muhammad Bilal Munir, Sami Aljohani, Abdul Tarabishy, Ahmad Almustafa, Mohamad Alkhouli

The Texas Heart Institute Journal

Treatments for pulmonary embolism are numerous and often complex. Current data on surgical thrombectomy are important but are not readily available. We studied the National Inpatient Sample to evaluate trends in the performance rates and outcomes of surgical thrombectomy in the United States from 2003 through 2014. We think that our findings have meaningful application to the triage and risk stratification of patients who have hemodynamically significant pulmonary embolism.

The Man With 2 Hearts: 25 Years From Heterotopic To Orthotopic Heart Transplantation, Elizabeth L Godfrey, Michael L Kueht, Abbas Rana, O H Frazier

The Texas Heart Institute Journal

Substantial technological advances in mechanical circulatory support have caused a shift in the management of end-stage heart failure. From the 1970s through the 1990s, heterotopic heart transplantation was routinely performed in patients in whom orthotopic transplantation was likely to fail. Heterotopic heart transplantation is now performed less often because modern mechanical circulatory assist devices are routinely used as bridges to orthotopic transplantation; regardless, the operation has helped numerous patients who would not otherwise have received adequate allografts. We describe the case of a man with idiopathic nonischemic cardiomyopathy who, at age 17, was given an ABO- and size-matched heterotopic allograft …

Osborn Waves: Differential Diagnosis, Akriti G Jain, Hammad Zafar, Sanjay Jain, Jason D'Souza

The Texas Heart Institute Journal

No abstract provided.

Percutaneous Coronary Intervention For Interposed Coronary Graft Stenosis After Modified Bentall Procedure In A Teenaged Boy With Takayasu Arteritis, Hiroki Ikenaga, Satoshi Kurisu, Yasuki Kihara

The Texas Heart Institute Journal

Anastomotic occlusion of an interposed coronary artery graft after a Bentall procedure is rare and catastrophic. It can lead to myocardial infarction or sudden cardiac death. We found several reports of occlusion and stenosis of a coronary-graft anastomosis, but few describe occlusion of the interposed coronary graft itself, as evaluated with use of intracoronary ultrasonography and computed tomography. We report the case of a 17-year-old boy with Takayasu arteritis who had a myocardial infarction caused by severe ostial stenosis in an interposed left coronary graft. The graft occlusion was confirmed by results of electrocardiography, aortography, and intracoronary ultrasonography. The patient …

Anomalous Origin Of The Right Coronary Artery From The Pulmonary Artery In A Neonate With Turner Syndrome And Aortic Arch Hypoplasia, Bryan P Stefek, Jason R Imundo, Joseph B Clark

The Texas Heart Institute Journal

Anomalous origin of the right coronary artery from the pulmonary artery, a rare congenital cardiac defect, is typically not diagnosed during infancy. On the other hand, Turner syndrome is usually diagnosed early, and it is classically associated with bicuspid aortic valve and aortic coarctation. Individuals with Turner syndrome are also at increased risk for coronary artery anomalies. We present a case of anomalous right coronary artery from the pulmonary artery in a week-old neonate who also had Turner syndrome, patent ductus arteriosus, transverse aortic arch hypoplasia, and impaired ventricular function. Prostaglandin therapy through the ductus increased the patient's myocardial perfusion. …

Delirium In Long Term Care Rehabilitation Residents: A Correlational Retrospective Study, Rebecca Lerma-Kjonegaard

Dissertations

Abstract Background: Delirium is associated with devastating outcomes, cognitive loss,

decreased function and an increase risk of mortality which affects patients and places a heavy burden on family and the healthcare system. The purpose of this study was to describe the relationship between select demographics, clinical characteristics, CHART- DEL-derived delirium diagnosis and ICD-10 coded discharge delirium diagnoses among Long Term Care (LTC) rehabilitation residents.

Method: A retrospective correlational design from174 LTC rehabilitation residents age 65 years or older using EMR and hard copy charts. The setting was a Southern California community hospital-based 100-bed LTC. Abstracted data included demographic characteristics (age, …

Sub-Region Based Radiomics Analysis For Survival Prediction In Oesophageal Tumours Treated By Definitive Concurrent Chemoradiotherapy, Congying Xie, Pengfei Yang, Xuebang Zhang, Lei Xu, Xiaoju Wang, Xiadong Li, Luhan Zhang, Ruifei Xie, Ling Yang, Zhao Jing, Hongfang Zhang, Lingyu Ding, Yu Kuang, Tianye Niu, Shixiu Wu

Health Physics and Diagnostic Sciences Faculty Research

Background: Evaluating clinical outcome prior to concurrent chemoradiotherapy remains challenging for oesophageal squamous cell carcinoma (OSCC) as traditional prognostic markers are assessed at the completion of treatment. Herein, we investigated the potential of using sub-region radiomics as a novel tumour biomarker in predicting overall survival of OSCC patients treated by concurrent chemoradiotherapy. Methods: Independent patient cohorts from two hospitals were included for training (n = 87) and validation (n = 46). Radiomics features were extracted from sub-regions clustered from patients' tumour regions using K-means method. The LASSO regression for ‘Cox’ method was used for feature selection. The survival prediction model …

Heavy Menstrual Bleeding In Adolescent Females With Platelet Function Disorders, Lauren Amos Md

Research Days

No abstract provided.

Pediatric Ppi Use And Fractures, Nathan R. Fleishman Md, Thomas M. Attard, Troy E. Richardson

Research Days

No abstract provided.

Provider Education And Rapid Antigen Detection Test Use In An Academic Pediatric Clinic, Steven Dahl

Research Days

No abstract provided.

Initial Evaluation Of Adolescent Females Hospitalized With Heavy Menstrual Bleeding, Lauren Amos Md

Research Days

No abstract provided.

Individual Free Fatty Acids Have Unique Associations With Inflammatory Biomarkers, Insulin Resistance And Insulin Secretion In Healthy And Gestational Diabetic Pregnant Women., Xinhua Chen, T Peter Stein, Robert A Steer, Theresa O Scholl

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Objective: We investigated the relationships of maternal circulating individual free fatty acids (FFA) with insulin resistance, insulin secretion and inflammatory biomarkers during mid-pregnancy.

Research design and methods: The data were drawn from a prospective cohort of generally healthy pregnant women (n=1368, African-American 36%, Hispanic 48%, Caucasian 16%) in Camden, NJ. We quantitatively determined 11 FFAs, seven cytokine/adipokine, homeostatic model assessment of insulin resistance (HOMA-IR) and C-peptide levels from the fasting blood samples that were collected at 16 weeks of gestation. Multivariate analyses were performed along with separate analyses for each individual FFA.

Results: High HOMA-IR (p

Conclusion: Our results suggest …

The Effect Of Antihypertensive Medications Dosing On Blood Pressure Control And Left Ventricular Hypertrophy In Children With Chronic Kidney Disease, Benjamin A. Matta

Research Days

No abstract provided.

Effect Of Crohn’S Disease On Villous Length And Cyp3a4 Expression In The Pediatric Small Intestine, Brian D. Chapron

Research Days

No abstract provided.

Thyrotoxicosis Presenting With Nondiabetic Ketoacidosis In A 4 Year Old Female: A Case Report, Henry S. Jeng, Michelle Knoll, Figen Ugrasbul

Posters

Objective: To raise awareness that thyrotoxicosis should be on the differential diagnosis for ketoacidosis in the pediatric population

Permanent Junctional Reciprocating Tachycardia In Infants And Children, Ranjit I. Kylat Md, Ricardo A. Samson

School of Medicine Faculty Research

Permanent junctional reciprocating tachycardia (PJRT) is a rare form of supraventricular tachycardia (SVT). It generally presents in infants but can be difficult to diagnose. The characteristic EKG findings, response to Adenosine and persistence or frequent recurrences are helpful in making the diagnosis. It is usually difficult to manage with the initial and single medications used in SVT. Many patients are misdiagnosed and not treated effectively and end up having end stage cardiomyopathy and are diagnosed in patients referred for transplant. Hence all patients referred for a cardiac transplant with dilated cardiomyopathy need to be evaluated for this arrhythmia. If appropriate …

Health Literacy Screening To Increase Antihypertensive Medication Adherence, Boyann Bonjean

Evidence-Based Practice Project Reports

Hypertension contributes to the risk of developing cardiovascular disease (CVD), stroke, heart attack, and chronic kidney disease (CKD) (Abegaz et al., 2016; Weir, 2014; Whelton et al., 2017). Evidence indicates that 30 to 50% of people who are prescribed antihypertensive medication therapy are nonadherent (Hedna et al., 2015). Non-adherence to antihypertensive medications is a major contributor to hypertension treatment failure (Al Ghurair et al., 2012; Hu, 2016; Whelton et al., 2017). Evidence has shown that low health literacy may impact antihypertensive therapy (Slade, 2017). The purpose of this EBP project was to provide an organizational change by implementing a health …

Rising Rural Body-Mass Index Is The Main Driver Of The Global Obesity Epidemic In Adults, Con Burns, Tara Coppinger, Janette Walton, Et Al

Publications

Body-mass index (BMI) has increased steadily in most countries in parallel with a rise in the proportion of the population who live in cities1,2. This has led to a widely reported view that urbanization is one of the most important drivers of the global rise in obesity3,4,5,6. Here we use 2,009 population-based studies, with measurements of height and weight in more than 112 million adults, to report national, regional and global trends in mean BMI segregated by place of residence (a rural or urban area) from 1985 to …

Development Of A Sonically Powered Biodegradable Nanogenerator For Bone Regeneration, Avi Patel

Honors Scholar Theses

Background: Reconstruction of bone fractures and defects remains a big challenge in orthopedic surgery. While regenerative engineering has advanced the field greatly using a combination of biomaterial scaffolds and stem cells, one matter of difficulty is inducing osteogenesis in these cells. Recent works have shown electricity’s ability to promote osteogenesis in stem cell lines when seeded in bone scaffolds; however, typical electrical stimulators are either (a) externally housed and require overcomplex percutaneous wires be connected to the implanted scaffold or (b) implanted non-degradable devices which contain toxic batteries and require invasive removal surgeries.

Objective: Here, we establish a biodegradable, piezoelectric …

Evaluation Of The Role Of Microvascular Pathology On Peripheral Artery Disease, Constance Mietus

Theses & Dissertations

Background: Peripheral Artery Disease (PAD) begins with atherosclerotic narrowing of arteries, including those that supply the legs. Individuals with PAD experience pain during walking, which becomes increasingly limiting. Studies from our group and others have shown that a myopathy is present in the skeletal muscle of PAD patients, and is characterized by myofiber degeneration, fibrosis, and remodeling of vessels ranging from 50 – 150 mm in diameter. However, microvascular pathology, particularly of the smallest microvessels (5 – 15 mm in diameter) remains poorly characterized. Furthermore, little is known about the relationships between microvascular architecture, microperfusion, and patient walking performance. We …

The Role Of Ros In The Progression And Treatment Of Castration-Resistant Prostate Cancer, Dannah R. Miller

Theses & Dissertations

Prostate cancer is the second leading cause of cancer-related deaths in U.S. men, primarily due to the development of castration-resistant (CR) prostate cancer (PCa), of which there are no effective treatment options. Reactive oxygen species (ROS) plays a critical role in prostate carcinogenesis, including the progression of the CR PCa phenotype. ROS regulates both cell proliferation and apoptosis; a moderate increase in ROS can promote proliferation; however, a substantial rise in ROS levels will result in apoptosis. Oxidase p66Shc is elevated in clinical PCa cells and has been associated with a metastatic phenotype of CR PCa cells, promoting PCa cell …

Visual And Verbal Serial List Learning In Patients With Statistically-Determined Mild Cognitive Impairment., Victor Wasserman, Sheina Emrani, Emily F Matusz, David Miller, Kelly Davis Garrett, Katherine A Gifford, Timothy J Hohman, Angela L Jefferson, Rhoda Au, Rod Swenson, David J Libon, Consortium For Clinical And Epidemiological Neuropsychological Data Analysis (Cenda).

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Background and Objective: Prior research with patients with mild cognitive impairment (MCI) suggests that visual versus verbal episodic memory test performance may be more sensitive to emergent illness. However, little research has examined visual versus verbal episodic memory performance as related to MCI subtypes.

Research Design and Methods: Patients were diagnosed with non-MCI, amnestic MCI (aMCI), and combined mixed/dysexecutive MCI (mixed/dys MCI). Visual and verbal episodic memory were assessed with the Brief Visuospatial Memory Test-Revised (BVMT-R) and the 12-word Philadelphia (repeatable) Verbal Learning Test (P[r]VLT), respectively.

Results: BVMT-R and P(r)VLT scores yielded similar between-group patterns of performance. Non-MCI patients scored …

A Lifestyle Modification Program For Adult Patients With Coronary Artery Disease, Amanda M. Yarbrough

Evidence-Based Practice Project Reports

As a leading cause of death worldwide, coronary artery disease affects people of all races and ethnicities. The foundation for the prevention of secondary fatal cardiac events, such as stroke or myocardial infarction, is lifestyle modification to effectively lower cholesterol levels. Lifestyle change impacts diet, physical activity, smoking habits, vital sign measures, and stress management. The purpose of this evidence-based practice project was to reduce implement a lifestyle intervention to lower LDL-C levels and promote healthier lifestyles. This practice change was developed utilizing Stetler’s Research Utilization model to promote evidence-based practice changes in the clinical setting. Nola Pender’s Health Promotion …

Cardio-Metabolic Disease Risk Factors Among South Asian Labour Migrants To The Middle East: A Scoping Review And Policy Analysis, Shiva Raj Mishra, Saruna Ghimire, Chandni Joshi, Bishal Gyawali, Archana Shrestha, Dinesh Neupane, Sudesh Raj Sharma, Yashashwi Pokharel, Salim S. Virani

Office of the Provost

This paper aims to explore the burgeoning burden of cardiovascular and metabolic disease (CMD) risk factors among South Asian labor migrants to the Middle East. We conducted a qualitative synthesis of literature using PubMed/Medline and grey literature searches, supplemented by a policy review of policies from the South Asian countries. We found a high burden of cardio-metabolic risk factors among the migrants as well as among the populations in the home and the host countries. For example, two studies reported the prevalence of diabetes mellitus (DM) ranging between 9 and 17% among South Asian migrants. Overweight and obesity were highly …

Referral Patterns, Procedures, And Outcomes Of A Large Community- Based Urology Group: A Retrospective Chart Review, Hassan A. Al Saleh, Gregory C. Mcmahon, Michael Douglas, Michael Console, Mihir Thaker, Gordon A. Brown

Rowan-Virtua Research Day

In 2012 The United States Preventive Services Task Force (USPSTF) recommended against prostate cancer (Pca) screening. The purpose of our study is to assess the effects of the USPSTF grade D recommendation for PSA based screening on new PCa diagnoses within a large-community based private practice setting. We completed a retrospective chart review of men with an elevated PSA seen in our clinic between May 2009–May 2015 who had undergone a prostate biopsy and were diagnosed with PCa. We observed that following the 2012 USPSTF recommendations, there was a significant increase in patients with clinically significant prostate cancer GG ≥ …

Painful Proximal Oriented Large Heterotopic Spur Formation In An Active Adult Non-Traumatic Amputee, Jack Annunziato, Daniel Shor, Shailesh Parikh

Rowan-Virtua Research Day

Heterotopic ossification (HO) is excess bone growth in soft tissues, typically juxta-articular and interfascicular, with varying incidence. HO has been well documented in traumatic amputees but less frequently observed in the non-traumatic amputee population. Symptomatic HO usually includes pain during prosthetic use, with management involving prosthetic adjustments for comfort. This atypical case highlights a non-traumatic amputee developing proximal oriented large spur formation that was painful not with ambulation but with doffing of his prosthesis.

Arthroscopic Medial Meniscus Transplant Utilizing A Multi-Technique Fixation, Elizabeth Ford, Michael Defrance, Sean Mcmillan

Rowan-Virtua Research Day

Arthroscopic medial meniscus transplantation can be a daunting procedure for even the most skilled surgeon. While all-inside suture fixation devices have improved, the ability to successfully perform this procedure via arthroscopy is reliant upon the surgeon's ability to utilize a variety of fixation techniques. Based upon the review of the literature, this paper is the first of it's kind describing the methodology and algorithm for completing an arthroscopic medial meniscus transplant using four techniques.

Atypical Presentation Of Stemi With Cardiac Tamponade Related To Malignancy, Matthew J. Johnson, Rohan Penmetcha

Rowan-Virtua Research Day

Cardiac tamponade and myocardial infarction are rare as the initial presentation of a malignancy. Here, we describe a case with an atypical presentation of a myocardial infarction due to a thrombus in the right coronary artery occurring in the setting of a pericardial effusion causing tamponade physiology related to malignancy. We present this unique case of myocardial infarction and cardiac tamponade as this was not caused by a type-A aortic dissection. In conclusion, we suggest that malignancy be considered in the differential diagnosis when these findings present together.

Occult Renal Cell Carcinoma Presenting As A Palpable Supraclavicular Virchow's Node, Luke Perry, Jandie Schwartz, Gus Slotman, Omar Al Ustwani, Nandini Kulkarni

Rowan-Virtua Research Day

Occult papillary renal cell carcinoma (RCC) is a rare disease process in which there is evidence of metastatic kidney cancer, but no primary kidney tumor can be found on physical exam or imaging. The papillary subtype of RCC accounts for 10-15% of RCC’s. These lesions infrequently present as occult disease. A Virchow’s node can be positive for multiple cancer types, most notably gastric cancer, but also gallbladder, pancreas, kidneys, testicular, and prostate cancer. We describe a case of occult papillary renal cell carcinoma diagnosed by biopsy of a Virchow’s node.

Recurrent Renal Cell Carcinoma Post Radical Nephrectomy: A Case Report, Amarnath Polepalle, Neethi Dasu, Adam Freilich, Jayram Krishnan

Rowan-Virtua Research Day

This is a case of a 73-year-old Caucasian male presenting with an asymptomatic right adrenal mass.

Renal Cell Carcinoma (RCC) constitutes 80 to 85% of primary renal neoplasms. At presentation, up to 25% of patients with RCC will have evidence of metastases or locally advanced disease. [1] Patients will rarely present with any symptoms since the majority of patients are incidentally diagnosed due to radiologic procedures performed for other indications. RCC is considered the most lethal of urologic cancers because a patient without intervention who has stage IV metastatic disease has a 5-year survival rate of 23% in comparison to …