Medical Specialties Commons^™

Pelvic Kidney: A Review Of The Literature., Seif Eid, Joe Iwanaga, Marios Loukas, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

Kidney development is a complex process that begins during the sixth to eighth weeks of life. Failure of ascent of the kidney will cause the kidney to remain in the pelvis i.e., pelvic kidney. Here, we review this entity in detail and illustrate such embryological derailment. In most cases, a pelvic kidney is an incidental finding and is usually asymptomatic. Anatomic variations of the renal vasculature have been reported in cases of pelvic kidneys and these are highlighted in this review. Clinicians who treat patients for renal or pelvic disease or interpret images of the pelvis should be well informed …

An Unusual Variation Of The Accessory Nerve., Yusuf Alimi, Joe Iwanaga, Marios Loukas, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

The accessory nerve is an important nerve in the head and neck regions. Some variants of this nerve's anatomy have been reported. Herein, we present an unusual report and review the extant medical literature regarding other more commonly found derailments of this nerve's anatomy.

Letter To The Editor: Management Of Pfo: More Evidence, Same Recommendation, Halima Ali, Md

Clinical Research in Practice: The Journal of Team Hippocrates

The author offers more evidence to support Zhang's assertion in CRP 3(2) that closure of patent foramen ovale or medical therapy alone are both appropriate choices for preventing recurrent cryptogenic strokes (https://doi.org/10.22237/crp/1518739380).

Implementation Of Attending-Supervised Ipass Handoff In The Neuro-Icu, Laura Cifrese, Md, Sonia Gill, Md, Megan Margiotta, Md, Muhammad Athar, Md, Rodney Bell, Md, Sara Hefton, Md, Fred Rincon, Md, Msc, Mbe, Syed Shah, Md, Mba, Jacqueline Urtecho, Md, Matthew Vibbert, Md, David Wyler, Md, Amandeep Dolla, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Background

• Duty hour restrictions, cross coverage, and the growing number of mid-level practitioners has led to an increased number of handoffs across medical specialties
• These handoffs are well-known points of communication breakdown which can lead to patient safety issues
• Factors contributing to an effective handoff include standardization of communication, appropriate training and supervision, ample time, a quiet environment, and a supportive culture
• We hypothesize that attending supervision of handoffs is feasible and can improve practitioner perception of transitions of care

Establishing Cost-Effective Management Of Postoperative Urinary Retention After Spine Surgery, Nikolaos Mouchtouris, Md, Catriona Harrop, Md, Edward Kloniecke, Md, Victoria English, Crnp, David Wyler, Md, Kamini Patel, Rn, Mba, Ashwini Sharan, Md, James Harrop, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Goal

Our goal is to develop evidence-based guidelines that:

1. streamline the order/timing of interventions in patients who develop PUR after spine surgery
2. identify those at high-risk of long-term urinary retention that require further workup
3. minimize the rate of PUR –goal is to reduce to 3.5% in FY 2019
4. and determine the cost savings from our intervention when applied to all surgeries

Prevention And Screening Of Vte In Sci Patients At Thomas Jefferson University Hospital, Erika Dillard, Md, Phd, Yusef Mosley, Md, Joshua Marks, Md, Christina Jacovides, Md, Geoffrey Ouma, Md, James Harrop, Md

Department of Neurosurgery Posters

Currently no protocol exists for thromboprophylaxis (TPx) and screening in SCI patients at TJUH. As such, often patients are either not started on TPx or are started on an inappropriate regimen depending on admitting team preference. In addition, patients often receive an admission DUS then weekly thereafter as a screening mechanism for DVT even if asymptomatic.

Our goal is to determine the effectiveness of our current method for initiating pharmacological TPx as well as efficacy and cost of our current screening method compared to national guidelines by addressing these questions:

• What is the occurrence of VTE in SCI patients at …

Atrx Mutation In Pineal Parenchymal Tumor Of Intermediate Differentiation, Michelle Nagurney, Md, Christopher Farrell, Md, Zi-Xuan Wang, Phd, Mark T. Curtis, Md

Department of Pathology, Anatomy, and Cell Biology Posters

Objectives

Based on our identification of an ATRX mutation in a PPTID of a 22 year old female, we analyzed the frequency of ATRX loss in pineal parenchymal tumors using ATRX immunohistochemical staining.

Improving Medical And Endovascular Management For Acute Ischemic Stroke Through Multidisciplinary Education And Simulation, Richard F. Schmidt, Md, Megan Margiotta, Md, Elan Miller, Md, Robin D'Ambrosio, Bsn, Scrn, Robin Dharia, Md, Maria Aini, Md, Diana Tzeng, Md, Fred Rincon, Md, Pascal Jabbour, Md, Nabeel Herial, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Primary goals:

1. Reduce door to treatment times (both DTN and DTP) to meet and exceed existing guidelines metrics.
2. Educate residents about acute stroke management, including national guidelines and new institutional protocols to improve efficiency during stroke alerts.

Process Improvement For Endovascular Thrombectomy In Patients Presenting With Acute Ischemic Stroke, Richard F. Schmidt, Md, Michael J. Lang, Md, Robin Dharia, Md, Fred Rincon, Md, Thomas Zdanowski, Rn, Msn, Robin D'Ambrosio, Rn, Msn, Stavropoula Tjoumakaris, Md, M. Reid Gooch, Md, Pascal Jabbour, Md, Nabeel Herial, Md

House Staff Quality Improvement and Patient Safety Conference (2016-2019)

Aims

1. Critically evaluate the existing stroke activation and ET protocols for compliance with new 2018 metrics and guidelines.
2. Review DTP times under the existing protocol to assess for potential inefficiencies or gaps in care delivery, specifically addressing differences between processes at JHN compared to ED/Gibbon.
3. Make changes to the existing stroke alert protocol to better reflect current guidelines, streamline care, and ultimately improve process metrics (DTP times).
4. Establish a system for recursive continuous analysis of AIS patients to identify protocol gaps, inefficiencies and areas for further intervention.

A Comprehensive Review Of The Fabella Bone., Dominic Dalip, Joe Iwanaga, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

The fabella is a sesamoid bone that is embedded in the lateral head of the gastrocnemius muscle and often articulates directly with the lateral femoral condyle. It is present in 10-30% of the general population with a higher incidence in Asians. The fabella can lead to various pathologies such as fabella pain syndrome and common fibular nerve palsy. Conservative treatment involves physical therapy or injecting local anesthetics or steroids around this bone. However, if symptoms persist, then a fabellectomy can be performed. Physicians should be aware of the fabella bone and the multiple pathologies associated with it in order to …

Setting The Stage: Neurobiological Effects Of Music On The Brain, Samata R. Sharma, David Silbersweig

Crossroads of Music and Medicine

A better understanding of how and why we are so moved by music can emerge from a closer look at how the brain functions. Music causes both structural and functional changes in the brain, both with immediate exposure and over several weeks, months and years.

By the very fact that music is processed by so many areas of the brain (ranging from the cortex, to the limbic system, to the neuroendocrine and even autonomic nervous systems), exerts an effect not only on our brain, but also on our bodies.

As our understanding of how the biological processes of the brain …

Recurrent Cns Haemangioblastomas With New Onset Of Retinal Angiomas In A Female Patient Diagnosed As Von Hippel Lindau Syndrome, Javerya Sattar, Ateeq Ahmed Khan

Pakistan Journal of Neurological Sciences (PJNS)

Von hippellindau(VHL) disease being a rare genetic disorder, presents with broad spectrum of clinical manifestation and multiorgan neoplasms. The diagnostic criteria for VHL disease include (i) one central nervous system haemangioblastoma and visceral manifestation , (ii) more than one central nervous system haemangioblastomas and (iii) known family history of VHL disease and any of the visceral manifestation. We report a case of 35 years-female patient who presented with recurrent cerebellar and spinal haemangioblastomas with new onset of retinal angioma,hepatichaemangioma and pancreatic cyst, with previous history of surgical resection of cerebellar and spinal cord lesions. This report highlights the importance of …

Trevo Stent-Retriever Mechanical Thrombectomy For Acute Ischemic Stroke Secondary To Large Vessel Occlusion Registry., Osama O Zaidat, Alicia C Castonguay, Raul G Nogueira, Diogo C Haussen, Joey D English, Sudhakar R Satti, Jennifer Chen, Hamed Farid, Candace Borders, Erol Veznedaroglu, Mandy J Binning, Ajit Puri, Nirav A Vora, Ron F Budzik, Guilherme Dabus, Italo Linfante, Vallabh Janardhan, Amer Alshekhlee, Michael G Abraham, Randall Edgell, Muhammad Asif Taqi, Ramy El Khoury, Maxim Mokin, Aniel Q Majjhoo, Mouhammed R Kabbani, Michael T Froehler, Ira Finch, Sameer A Ansari, Roberta Novakovic, Thanh N Nguyen

Articles, Abstracts, and Reports

BACKGROUND: Recent randomized clinical trials (RCTs) demonstrated the efficacy of mechanical thrombectomy using stent-retrievers in patients with acute ischemic stroke (AIS) with large vessel occlusions; however, it remains unclear if these results translate to a real-world setting. The TREVO Stent-Retriever Acute Stroke (TRACK) multicenter Registry aimed to evaluate the use of the Trevo device in everyday clinical practice.

METHODS: Twenty-three centers enrolled consecutive AIS patients treated from March 2013 through August 2015 with the Trevo device. The primary outcome was defined as achieving a Thrombolysis in Cerebral Infarction (TICI) score of ≥2b. Secondary outcomes included 90-day modified Rankin Scale (mRS), …

Creutzfeldt-Jakob Disease: A Case Report Presenting To The Emergency Department, Muhammad Akbar Baig, Sadaf Sheikh

Pakistan Journal of Neurological Sciences (PJNS)

Creutzfeldt-Jakob disease is lethal and most common spongiform encephalopathy worldwide and is rarely encountered in the Emergency department. For the benefit of patients and healthcare workers, rapid consideration of this condition needs to be sought in the setting of rapid neurological decline and myoclonic jerky movements. We present a case of a 54-year old male with behavioral changes, jerky body movements, cognitive dysfunction and left sided weakness developing over the course of few months and presented to our Emergency Department for the evaluation for stroke. Due to the non-specific nature of psychiatric and neurologic complaints, the initial diagnosis remained unclear. …

Frequency Of Vitamin D Deficiency In Multiple Sclerosis Patients: A Cross Sectional Study., Samar Iltaf Pechuho, Alam Ibrahim Siddiqui, Sajjad Husain Jalbani, Safia Sultana, Samina Shaikh, Nagina Shaikh, Fahim Soomro, Mukesh Kumar, Abdul Rehman, Tariq Qazi, Shoaib Soomro, Rizwan Shaikh, Ghulam Mustafa Tunio, Abdul Qayoom Memon

Pakistan Journal of Neurological Sciences (PJNS)

Vitamin D deficiency is linked to poor treatment response in patients with Multiple S clerosis. The aim of this study is to define the frequency of Vitamin D deficiency for early detection and timely intervention leading to improved morbidity rates.

An Uncommon And Elusive Cause Of Cerebral Venous Thrombosis, Farheen Niazi, Saadia Riaz

Pakistan Journal of Neurological Sciences (PJNS)

We present a case of of young 27year male who was admitted with history of headache and vomiting for one week. He was diagnosed as having dural sinus thrombosis of superior sagittal, right lateral, right sigmoid sinus. There was previous history of uveitis 6 months prior to it. All thrombophilia workup was negative except homocysteine levels were moderately high. He was also found to be having recurring genital and oral ulcers. Pathergy test was negative. His HLA B 51/5 testing came back positive. Final diagnosis of Bechet’s disease was made and responded well to long term steroids and Colchicine. A …

Targeting Twist1 Through Loss Of Function Inhibits Tumorigenicity Of Human Glioblastoma., Andrei M Mikheev, Svetlana A Mikheeva, Liza J Severs, Cory C Funk, Lei Huang, José L Mcfaline-Figueroa, Jeanette Schwensen, Cole Trapnell, Nathan D Price, Stephen Wong, Robert C Rostomily

Articles, Abstracts, and Reports

TWIST1 (TW) is a bHLH transcription factor (TF) and master regulator of the epithelial-to-mesenchymal transition (EMT). In vitro, TW promotes mesenchymal change, invasion, and self-renewal in glioblastoma (GBM) cells. However, the potential therapeutic relevance of TW has not been established through loss-of-function studies in human GBM cell xenograft models. The effects of TW loss of function (gene editing and knockdown) on inhibition of tumorigenicity of U87MG and GBM4 glioma stem cells were tested in orthotopic xenograft models and conditional knockdown in established flank xenograft tumors. RNAseq and the analysis of tumors investigated putative TW-associated mechanisms. Multiple bioinformatic tools revealed significant …

Neuroimmunology Diagnostics, Mohammad Saeed, Tariq Gazdar, Nadir Ali Syed, Arsalan Ahmad

Pakistan Journal of Neurological Sciences (PJNS)

Neuroimmunology has led to advanced diagnostics of previously cryptic disorders, using autoantibody testing against neurological targets. Neuropsychiatric syndromes and autoimmune encephalitis can now be routinely diagnosed using specialized antibody tests such as immunofluorescence and immunoblot assays in specialized laboratories. This helps in early and accurate diagnosis, leading to favorable patient prognosis. Here, we briefly review the diagnostics for Neuroimmunologic and related disorders including autoimmune encephalitis, demyelinating diseases, neuropathies, paraneoplastic syndromes, stiffperson syndrome, inflammatory myopathies as well as Alzheimer’s disease.

Cerebral Venous Thrombosis Presenting As Subarachnoid Haemorrhage, Farheen Niazi

Pakistan Journal of Neurological Sciences (PJNS)

We present a 31 years old lady who was 19 days postpartum who was admitted with fits and loss of consciousness. At presentation Glasgow Coma Scale was 8/15. No focal deficit. CT scan brain showed findings suggestive of subarachnoid haemorrhage(SAH) in left sylvian fissure along with few parenchymal haemorrhagic areas in frontal and parietal lobes. MRI brain and MRV confirmed superior sagittal sinus thrombosis, inferior sagittal, straight and right transverse and sigmoid sinus thrombosis. Patient was treated conservatively and was anticoagulated for 6 months and had a complete recovery. Further workup of thrombophilia was negative. Postpartum being the only risk …

Pattern Of Mental Health Disorders In Adult Population Attending A Tertiary Mental Health Care Setting, Nasir Mehmood, Uroosa Talib, Raza Ur Rehman

Pakistan Journal of Neurological Sciences (PJNS)

Mental health disorders contribute significantly to the global burden of disease (32.4%), . Mental health disorders are the 4th leading cause of disability in developed countries, and the most disabling disorders in low-income and middle-income countries (LAMIC). Over one third of people in most LIMIC fulfill sufficient diagnostic criteria for a mental health disorder at some point in their life.

Profile Of Dementia Patients From A Tertiary Care Center In Karachi, Pakistan, Qurat Ul Ain Khan, Sana Siddiqui, Mohammad Zaman, Abdullah Waqar, Sumera Aziz Ali

Pakistan Journal of Neurological Sciences (PJNS)

BACKGROUND: According to an estimate currently over 46 million people live with dementia worldwide and 58% reside in developing countries. However like some other developing countries, not much is known about the demographics, characteristics, and associated conditions of those suffering from dementia in Pakistan. OBJECTIVE: To study profile of dementia patients from a tertiary care hospital in Karachi, Pakistan.

Association Of Serum Albumin Levels And Guillain Barre Syndrome (Gbs) Outcome., Mazhar Badshah, Ghulam Shabbir, Sumaira Fazal Nabi, Daniyal Ahmed

Pakistan Journal of Neurological Sciences (PJNS)

Guillain-Barre syndrome (GBS) is a polyradiculoneuropathy characterized by a rapidly progressive bilateral paresis of the limbs. Nadir is typically reached within a number of days or weeks, followed by a recovery that is generally much slower and often incomplete. Guillain-Barre syndrome is usually preceded by infection or other immune stimulation that induces an aberrant autoimmune response targeting peripheral nerves and their spinal roots.IVIG and Plasmapheresis are used first line treatments in GBS treatment. For better assessment of treatment response, biomarkers reflecting Plasmapheresis and IVIG efficacy are needed. Aim of this study is to determine serum albumin as an independent biomarker …

Circadian Variation Of Brain Proteins: Importance In Experiments, Muhammad Rafiq, Zahid Mahmood, Sajed Ali

Pakistan Journal of Neurological Sciences (PJNS)

Circadian (from the Latin word circa, meaning 'about', and dies, meaning 'day') rhythms are the rhythms occurring within a period of 24 hours and are endogenously driven in biochemical, physiological or behavioral processes [1]. Circadian rhythms are also entrained by the external environmental cues called zeitgebers, the primary one of which is day light [2]. Circadian rhythms have been widely observed in plants, animals, fungi and cyanobacteria [3]. The study of the biological processes that vary during different time of the day, is called chronobiology. A number of studies on mammalian species have confirmed that the circadian pacemaker resides in …

Child Protection In Pakistan: Legislation & Implementation, Sana Younus, Aisha S Chachar, Ayesha Mian

Pakistan Journal of Neurological Sciences (PJNS)

Children are an integral part of any society. Their dependency on others for the fulfilment of their basic needs like food, shelter, education, safety and security makes them a vulnerable group. Society is judged on its ability to provide for the needs of the vulnerable. Provision of each of these needs is the responsibility of primary caregivers but requires assistance from multiple agencies working at the national level to ensure an effective delivery. Children’s rights can be defined as “the rights, which are concerned both with the protection of the individual child and with the creation of the conditions in …

Myelin As An Inflammatory Mediator: Myelin Interactions With Complement, Macrophages, And Microglia In Spinal Cord Injury, Timothy J. Kopper, John C. Gensel

Spinal Cord and Brain Injury Research Center Faculty Publications

Spinal cord injury (SCI) triggers chronic intraspinal inflammation consisting of activated resident and infiltrating immune cells (especially microglia/macrophages). The environmental factors contributing to this protracted inflammation are not well understood; however, myelin lipid debris is a hallmark of SCI. Myelin is also a potent macrophage stimulus and target of complement‐mediated clearance and inflammation. The downstream effects of these neuroimmune interactions have the potential to contribute to ongoing pathology or facilitate repair. This depends in large part on whether myelin drives pathological or reparative macrophage activation states, commonly referred to as M1 (proinflammatory) or M2 (alternatively) macrophages, respectively. Here we review …

Telesurgery: Past, Present, And Future., Paul J Choi, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

Telesurgery uses wireless networking and robotic technology to allow surgeons to operate on patients who are distantly located. This technology not only benefits today's shortage of surgeons, but it also eliminates geographical barriers that prevent timely and high-quality surgical intervention, financial burden, complications, and often risky long-distance travel. The system also provides improved surgical accuracy and ensures the safety of surgeons. In this paper, we describe the current trend of telesurgery's innovative developments and its future.

Extreme Lateral Interbody Fusion Complicated By Fungal Osteomyelitis: Case Report And Quick Review Of The Literature., Ronen Blecher, Emre Yilmaz, Marc Moisi, Rod J Oskouian, Jens Chapman

Articles, Abstracts, and Reports

The authors describe a 67-year-old man with a prior history of alcohol abuse who presented with a complaint of worsening low back pain. Four months prior to his presentation, the patient had undergone extreme lateral interbody fusion (XLIF) of his lumbar 3-4 segment for the treatment of his chronic low back and legs pain. Imaging revealed a loosening of his interbody fusion implant on top of his prior lumbar spine instrumentation. In surgery, the removal of his loose implant was followed by decompression, the stabilization of the collapsed segment, and the implant of antibiotic-impregnated polymethyl-methacrylate (PMMA) spacer and beads. At …

Temporal Arteritis Presenting As An Isolated Bilateral Abducens Nerve Palsy: A Rare Case Of A 65-Year-Old Male, Abhishek Lunagariya, Chintan Rupareliya, Pradeep C. Bollu, Zabeen Mahuwala

Neurology Faculty Publications

Giant cell arteritis (GCA) or temporal arteritis (TA) is a granulomatous inflammation of medium to large-sized arteries. It may have a diverse presentation. The most common presenting symptoms of GCA are fever, malaise, unilateral headache, jaw claudication, polymyalgia rheumatica (PMR) and ophthalmoplegia. Most severe sequelae of GCA could be blindness. We report a case of a 65-year-old Caucasian male who presented for the third time with recurrent episodes of diplopia. Neurologic exam showed bilateral cranial nerve (CN) VI palsy, slightly worse on the right than the left side. Other focal neurological deficits were absent. GCA was considered and biopsy of …

Neural Responses To Naturalistic Clips Of Behaving Animals Under Two Different Task Contexts, Samuel A. Nastase, Yaroslav O. Halchenko, Andrew C. Connolly, M. Ida Gobbini, James V. Haxby

Dartmouth Scholarship

The human brain rapidly deploys semantic information during perception to facilitate our interaction with the world. These semantic representations are encoded in the activity of distributed populations of neurons (Haxby et al., 2001; McClelland and Rogers, 2003; Kriegeskorte et al., 2008b) and command widespread cortical real estate (Binder et al., 2009; Huth et al., 2012). The neural representation of a stimulus can be described as a location (i.e., response vector) in a high-dimensional neural representational space (Kriegeskorte and Kievit, 2013; Haxby et al., 2014). This resonates with behavioral and theoretical work describing mental representations of objects and actions as being …

Regional Microglia Are Transcriptionally Distinct But Similarly Exacerbate Neurodegeneration In A Culture Model Of Parkinson's Disease., Eric Wildon Kostuk, Jingli Cai, Lorraine Iacovitti

Department of Neuroscience Faculty Papers

BACKGROUND: Parkinson's disease (PD) is characterized by selective degeneration of dopaminergic (DA) neurons of the substantia nigra pars compacta (SN) while neighboring ventral tegmental area (VTA) DA neurons are relatively spared. Mechanisms underlying the selective protection of the VTA and susceptibility of the SN are still mostly unknown. Here, we demonstrate the importance of balance between astrocytes and microglia in the susceptibility of SN DA neurons to the PD mimetic toxin 1-methyl-4-phenylpyridinium (MPP

METHODS: Previously established methods were used to isolate astrocytes and microglia from the cortex (CTX), SN, and VTA, as well as embryonic midbrain DA neurons from the …