Medical Specialties Commons^™

Cancer Stem Cells In The Screening Of Anticancer Drugs For Central Nervous System Tumors, Sarah Elizabeth Daron-Mathis

Theses, Dissertations and Capstones

There is a growing need (in the medical field) to design personalized therapy for cancer patients. Decades of cancer research have found no silver bullet that can cure all or even most patients. This study evaluated four patients affected by central nervous system (CNS) tumors (Ependymoma and Glioblastoma), and found that tumors with the same histology had unique responses to treatment. Each sample presented different levels of heterogeneity in expressed biomarkers and responded to drugs at varying levels.

Oncologists conventionally treat cancer patients with drugs tested in large clinical trials. However, often patients do not experience positive outcomes following treatments …

Investigation Of Ultrasound Targeted Microbubbles As A Therapeutic Gene Delivery System For Prostate Cancer, Rounak Paramjeet Nande

Theses, Dissertations and Capstones

A major challenge for effective gene therapy is systemic delivery of viruses carrying therapeutic genes into affected tissue. The immunogenic nature of human adenoviruses (Ads) limits their use for intratumoral (IT) injection in gene therapy. Ads transfection is further hampered by the fluctuating presence of Coxsackie and Adenovirus Receptor (CAR) and integrins on the cells’ surface. To circumvent these limitations we developed a novel approach wherein Ads are encapsulated inside the shell of lyophilized, lipid-encapsulated, perfluorocarbon microbubbles (MBs)/ultrasound (US) contrast agents, which act as delivery vehicles for a sitespecific gene transfer system.

We performed infection studies with Ad.GFP (Green Fluorescent …

Tell Me A Story: The Relationship Between Identity And Life Stories Following Brain Injury, Sara Henson

Theses, Dissertations and Capstones

Following brain injury, people can demonstrate cognitive-linguistic deficits as well as a shift in their identities. Clinicians use assessment and treatment methods that focus on cognitive-linguistic deficits with this population; however, they rarely (if ever) consider identity as a viable and necessary target for intervention efforts. For individuals with brain injury, life narratives can be used to assess and treat the cognitive-linguistic skills and discourse at a macro-systemic level, build relationships through the use of a client-centered approach, develop a strong sense of self-identity that aids in goal setting, establish life purpose that motivates greater participation and effort in rehabilitation, …

Effects Of Ondansetron 4 Milligrams Compared With Ondansetron 8 Milligrams On The Incidence Of Post-Operative Nausea And Vomiting In Patients With Body Mass Index Greater Than 30kg/M2 Undergoing Mastectomy, Diego Alejandro Arroyo

Theses, Dissertations and Capstones

Introduction: Post-Operative Nausea and Vomiting (PONV) is a recurrent and frequent issue for the patient, the anesthesia team, and Post Anesthesia Care Unit (PACU) team. Both pharmacologic and non-pharmacologic recommended modalities have been utilized for both the prevention and treatment of PONV in the surgical-anesthesia setting. The 5-HT3-receptor antagonist ondansetron is one of the many known pharmacological modalities commonly utilized by anesthesia providers in preventing PONV.

Methodology: The design used for this research was a quantitative, retrospective case control study that evaluated existing data enclosed in the Electronic Medical Records (EMR) from Charleston Area Medical Center (CAMC), which is …

Inhalation Anesthesia Vs. Total Intravenous Anesthesia For Ambulatory Dental Surgery In Children, Kristin D. Neal

Theses, Dissertations and Capstones

Abstract: The purpose of this study was to compare inhalation anesthesia with sevoflurane versus Total Intra Venous Anesthesia (TIVA) with propofol infusion as it relates to the quality of recovery including postoperative pain, Post Operative Nausea and Vomiting (PONV), and Post Anesthesia Care Unit (PACU) Length Of Stay (LOS) in pediatric patients undergoing ambulatory dental surgery. Introduction: Pediatric dental procedures are increasingly performed in an outpatient setting under general anesthesia due to inadequate cooperation, circumstantial anxiety, and other behavioral and health issues. Commonly used inhalation anesthetics, such as sevoflurane, can induce hyperalgesia in children. While sevoflurane increases the risk PONV, …

Type I Diabetes In Children And Vitamin D, Ashley B. Litchfield, Rebecca M. Hayes, Franklin D. Shuler Md, Phd, Susan L. Flesher Md

MIIR Faculty Research

Vitamin D deficiency is associated with multiple childhood diseases including type 1 diabetes mellitus (T1DM). T1DM in children is becoming more prevalent, with a 23% increase nationally from 2001 to 2009. Similarly, West Virginia has had an 8.1% increase in children with type 1Diabetes from 2008/2009 to 2010/2011. This article highlights the association between vitamin D and type 1 diabetes and discusses vitamin D’s potential role in the reduction and management of T1DM in children.

Treatment Of Sigmoid Volvulus By Deflation Versus Surgery: A Single Site Report, Yonas Raru, Patricia Messmer, Arthur Williams, Dawood Sultan, Ashenafi Adale, Yalelet Shiferaw, Paul Hart, Hugh Pettigrew

Internal Medicine

Background: Although very common in developing regions like Africa, sigmoid volvulus (SV) has a much lower incidence in the West. There is a dearth of literature on the treatment of SV in countries with limited resources. This paper reports study results using a cohort of 200 SV patients in a low-income developing country. Objectives: The aim of this study was to identify the characteristics associated with length of hospital stay (LOS) in the largest sample of sigmoid volvulus patients drawn from a single site within a single year and to examine the effects of treatment complications and previous attacks of …

Hemophagocytic Lymphohistiocytosis: A Series Of Five Clinical Cases In Adult Patients At A Single Institution With A Review Of The Literature, David Thomas, Nihar Shah Md, Hiren Patel, Tapan Pandya, Dron Gauchan, Michael Maroules

Gastroenterology

Context: Hemophagocytic Lymphohistiocytosis or the “Hemophagocytic Syndrome” is a spectrum of disorders of regulatory immunomodulatory pathways inciting phagocytosis of hematopoietic cells resulting in end-organ damage. The condition appears in both heritable and non-heritable forms from a multitude of possible environmental triggers, most notably infection. The condition often results in a fatal outcome without prompt diagnosis and treatment. Cases in children have been reported much more frequently and classically than in adult patients.

Case Report: In this case series we examined fi ve such cases in adult patients that were found at our institution in a window as small at 2 …

Enterogenous Cyst Of The Small Bowel Causing Intussusception In An Adult: Case Report And Review Of Literature, Nihar Shah Md, Therese Lizardo-Escaño, Hamid Shaaban, Gautamy Dhadham, Arya Karki, Robert Spira

Gastroenterology

Small bowel intussusception is a rare congenital disease entity, mostly manifesting before the age of two with abdominal pain and acute intestinal obstruction. In adults, colon intussusception is a rare event causing approximately 1% of all acute intestinal obstructions and they can occur idiopathically in adults or due to an intraluminal tumor mass. We report a case of an enterogenous cyst causing intussusception and iron deficiency anemia in an adult treated by surgical excision and resection of the small bowel.

Unilateral Heat Accelerates Bone Elongation And Lengthens Extremities Of Growing Mice, Maria A. Serrat, Thomas J. Schlierf, Morgan L. Efaw, Franklin D. Shuler, Justin Godby, Laura M. Stanko

Orthopaedics

Linear growth failure results from a broad spectrum of systemic and local disorders that can generate chronic musculoskeletal disability. Current bone lengthening protocols involve invasive surgeries or drug regimens, which are only partially effective. Exposure to warm ambient temperature during growth increases limb length, suggesting that targeted heat could noninvasively enhance bone elongation. We tested the hypothesis that daily heat exposure on one side of the body unilaterally increases femoral and tibial lengths. Mice (N = 20) were treated with 40 °C unilateral heat for 40 min/day for 14 days post-weaning. Non-treated mice (N = 6) served as controls. Unilateral …

Hip Fracture Evaluation With Alternatives Of Total Hip Arthroplasty Versus Hemiarthroplasty (Health): Protocol For A Multicentre Randomised Trial, Mohit Bhandari, P. J. Devereaux, Thomas A. Einhorn, Lehana Thabane, Emil H. Schemitsch, Kenneth J. Koval, Frede Frihagen, Rudolf W. Poolman, Kevin Tetsworth, Ernesto Guerra-Farfán, Kim Madden, Sheila Sprague, Gordon Guyatt, Ali Oliasharazi, Franklin D. Shuler, Jonathon Salva, James Day, Tigran Garabekyan, Felix Cheung, Linda Morgan, Timothy Wilson-Byrne Md, Mary Beth Cordle

Orthopaedics

Introduction: Hip fractures are a leading cause of mortality and disability worldwide, and the number of hip fractures is expected to rise to over 6 million per year by 2050. The optimal approach for the surgical management of displaced femoral neck fractures remains unknown. Current evidence suggests the use of arthroplasty; however, there is lack of evidence regarding whether patients with displaced femoral neck fractures experience better outcomes with total hip arthroplasty (THA) or hemiarthroplasty (HA). The HEALTH trial compares outcomes following THA versus HA in patients 50 years of age or older with displaced femoral neck fractures.

Methods and …

Management Of Severe Hyponatremia: Infusion Of Hypertonic Saline And Desmopressin Or Infusion Of Vasopressin Inhibitors?, Antonios H. Tzamaloukas Md, Joseph I. Shapiro Md, Dominic S. Raj Md, Glen H. Murata Md, Robert H. Glew Phd, Deepak Malhotra Md, Phd

Pharmaceutical Science and Research

Rapid correction of severe hyponatremia carries the risk of osmotic demyelination. Two recently introduced methods of correction of hyponatremia have diametrically opposite effects on aquaresis. Inhibitors of vasopressin V2 receptor (vaptans) lead to the production of dilute urine, whereas infusion of desmopressin causes urinary concentration. Identification of the category of hyponatremia that will benefit from one or the other treatment is critical. In general, vaptans are effective in hyponatremias presenting with concentrated urine and, with the exception of hypovolemic hyponatremia, can be used as their primary treatment. Desmopressin is effective in hyponatremias presenting with dilute urine or developing urinary dilution …

West Virginia Nursing Homes: Are They Up To The Standard?, Guillermo Madero Md, Shirley M. Neitch Md

Internal Medicine

Quality measurement and performance monitoring are under continuous assessment in Nursing Homes (NH). Through this research project we assess the quality of care provided in the NH in the state of West Virginia by publicly accessible quality measurements. The methodology for this research study was through the retrieval of data from the Nursing Home Compare website in which a total of 80 NH were located and analyzed. The results demonstrate that more than 50% of NH in West Virginia are at or above the national average when compared using the Five Star Rating System by CMS, in overall rating (59%), …

Safety And Immunogenicity Of Human Serum Albumin-Free Mmr Vaccine In Us Children Aged 12–15 Months, Maurice A. Mufson, Clemente Diaz, Michael Leonardi, Christopher J. Harrison, Stanley Grogg, Antonio Carbayo, Simon Carlo-Torres, Robert Jean Freau, Ana Quintero-Del-Rio, Gisele Bautista, Michael Povey, Christopher Da Costa, Ouzama Nicholson, Bruce L. Innis

Internal Medicine

Background: M-M-RTMII (MMRII; Merck & Co) is currently the only measles-mumps-rubella (MMR) vaccine licensed in the United States. Another licensed vaccine would reinforce MMR supply. This study assessed the immunogenicity of a candidate vaccine (PriorixTM, GlaxoSmithKline Vaccines [MMR-RIT]) when used as a first dose among eligible children in the United States.

Methods: In this exploratory Phase-2, multicenter, observer-blind study, 1220 healthy subjects aged 12–15 months were randomized (3:3:3:3) and received 1 dose of 1 of 3 MMR-RIT lots with differing mumps virus titers (MMR-RIT-1 [4.8 log10]; MMR-RIT-2 [4.1 log10]; MMR-RIT-3 [3.7 log10] CCID50) or MMRII co-administered with hepatitis Avaccine (HAV), …

The Trade-Off Between Dietary Salt And Cardiovascular Disease; A Role For Na/K-Atpase Signaling?, Joe X. Xie, Anna Pearl Shapiro, Joseph I. Shapiro Md

Biochemistry and Microbiology

It has been postulated for some time that endogenous digitalis-like substances, also called cardiotonic steroids (CTS), exist, and that these substances are involved in sodium handling. Within the past 20 years, these substances have been unequivocally identified and measurements of circulating and tissue concentrations have been made. More recently, it has been identified that CTS also mediate signal transduction through the Na/K-ATPase, and consequently been implicated in profibrotic pathways. This review will discuss the mechanism of CTS in renal sodium handling and a potential “trade-off” effect from their role in inducing tissue fibrosis.

Update On Adolescent Tobacco Cessation, Madeline Keyser, Lynne J. Goebel

Internal Medicine

Adolescent tobacco use is decreasing in West Virginia, a state which features the Not on Tobacco (NOT) and RAZE programs. This manuscript gives an overview of recent studies in adolescent tobacco cessation, what works and what doesn’t. More research is needed to improve cessation rates in adolescents.

E-Cigarettes: An Up To Date Review And Discussion Of The Controversy, Zachary Sanford, Lynne J. Goebel Md

Internal Medicine

Electronic cigarettes (e-cigarettes) present a novel method for nicotine delivery that is reportedly advantageous when compared to traditional cigarette usage. Manufacturers and consumers claim reduced chemical exposure, decreased symptom profiles, and efficacy in smoking reduction and cessation greater than conventional nicotine replacement therapies (NRT). However these products present new challenges and concerns to legislators, clinicians, and public health advocates. Questions of authority in state and federal legislation, establishing product quality control, assessing long-term studies on e-cigarettes and quantifying usefulness in harm reduction represent only a portion of the many unanswered topics being discussed. The purpose of this article is to …

The Anatomical And Functional Benefit Of Bevacizumab In The Treatment Of Macular Edema Associated With Purtscher-Like Retinopathy, B. Lw. Nesmith, Maya Bitar, S. Schaal

Ophthalmology

We read the article by Miguel et al1 regarding Purtscher’s and Purtscher-like retinopathies with great interest. As the authors well describe, ‘Purtscher-like retinopathy’ is diagnosed in patients with fundus findings similar to Purtscher’s retinopathy, without a history of trauma but with known systemic associations.¹ Current proposed mechanisms for the underlying pathogenesis include leukocyte aggregation by activated complement factor 5 (C5a).² As noted by the authors’ systematic review, there is currently no established treatment for Purtscher-like retinopathy, although the literature consists of several case reports of treatment with corticosteroids, without certainty as to effect on the clinical course.1 Herein, …

Safety Of Infliximab In Children With Ibd: The Experience Of An Academic Center In Wv, Michael Northcutt Md, Awni Al-Subu Md, Brooke Bella Rn, Yoram Elitsur Md

Biochemistry and Microbiology

BACKGROUND: The immune-modulating drug, infliximab, is approved for Inflammatory Bowel Disease (IBD) treatment in children. Chronic therapy with infliximab is associated with the development of early and delayed infusion reactions. We reviewed our experience with infliximab treatment and its side effects in a cohort of children diagnosed with IBD who were treated in our clinic.

METHODS: A retrospective analysis of all IBD children treated with infliximab in our center from 2006-2011 was performed. The demographic, chronological and clinical data were recorded. The infliximab infusion was given at 5mg/ kg according to a standard protocol after pre-treatment with low dose …

Preventing Falls With Vitamin D, Franklin D. Shuler Md, Phd, Thomas Schlierf, Matthew Wingate

Orthopaedics

Falls are the number one cause for injury-related morbidity and mortality in West Virginia’s seniors. Multiple independent variables contribute to the risk of a fall: previous falls, alterations in balance and vision, impairments in gait and strength, and medications most highly correlate with the risk for a fall. Vitamin D supplementation is emerging as an easy, safe and well-tolerated fall reduction/prevention strategy due to the beneficial effects on the musculoskeletal system with improvements in strength, function and navigational abilities. From meta-analysis data, maximal fall reduction benefit in seniors is achieved when correcting vitamin D deficiency and when using adjunctive calcium …

Compassion In Medicine, Lawrence M. Wyner M.D.

Surgery

“Doctor, you know this patient’s HIV-positive.” The scrub nurse’s words hit me like a ton of bricks. I had been called into the operating room to assist one of my colleagues, a good friend and a good surgeon, who had requested my help after he had inadvertently gotten into the bladder during a hernia repair. I scrubbed in and took a look – the bladder neck was almost completely detached from the bladder. A small papillary tumor was visible just lateral to the left ureteral orifice. I snipped off the tumor with the Metzenbaum scissors, fulgurated its base, and proceeded …

Regional-Specific Effects Of Ovarian Hormone Loss On Synaptic Plasticity In Adult Human Apoe Targeted Replacement Mice, Rebecca C. Klein, Shyla Saini, Mary-Louise Risher, Shawn K. Acheson, Rebekah L. Fleming, Hannah G. Sexton, H. Scott Swartzwelder, Scott D. Moore

Biomedical Sciences

The human apolipoprotein ε4 allele (APOE4) has been implicated as one of the strongest genetic risk factors associated with Alzheimer’s disease (AD) and in influencing normal cognitive functioning. Previous studies have demonstrated that mice expressing human apoE4 display deficits in behavioral and neurophysiological outcomes compared to those with apoE3. Ovarian hormones have also been shown to be important in modulating synaptic processes underlying cognitive function, yet little is known about how their effects are influenced by apoE. In the current study, female adult human APOE targeted replacement (TR) mice were utilized to examine the effects of human APOE …

Intravenous Immunoglobulin In The Treatment Of Severe Clostridium Difficile Colitis, Nihar Shah Md

Gastroenterology

Intravenous immunoglobulin (IVIG) has been utilized in patients with recurrent and refractory Clostridium difficile colitis. It is increasingly being used in patients with initial clinical presentation of severe colitis. Herein, we report a case of severe C. Difficile colitis successfully treated with IVIG with a review of the medical literature to identify the optimal timing and clinical characteristics for this treatment strategy.

The American Epidemic: The U.S. Nursing Shortage And Turnover Problem, Patrick Cox, William K. Willis, Alberto Coustasse

Management Faculty Research

Introduction: Nursing shortages have been on the rise throughout the country which has continued to become a problem due to an aging baby-boomer population causing increased turnover through the United States (U.S.). With this need for nurses expected to rise, determining the root causes of this problem are essential for health care providers as costs continue to grow.

Methods: The methodology for the qualitative study was a literature research review of case studies as well as a semi-structured interview. Five electronic databases were minded. Thirty-six articles were utilized in this study.

Results: Through the use of a conceptual framework the …

Secondhand Smoke Exposure As A Risk Factor For Perioperative Airway Complications In Pediatric Outpatient Procedures, Ashlee Denise Loudin

Theses, Dissertations and Capstones

Abstract: The purpose of this study is to assess the risk of perioperative airway complications, analyze extubation times, and PACU Length Of Stay (LOS), and their association with secondhand smoke exposure in pediatric populations receiving outpatient procedures that require general anesthesia.

Introduction: Tobacco Smoke Exposure (TSE), is well documented to cause physiologic changes in lung tissue that are associated with decreased lung function, increased risk of lower and upper respiratory tract illness, exacerbation of asthma or increased risk of asthma, increased prevalence of non-allergic bronchial hyperresponsiveness, sudden infant death syndrome, and a host of other respiratory complications in adult and …

Metabolomic Analysis Of Liver Tissue From The Vx2 Rabbit Model Of Secondary Liver Tumors, Rafael A. Ibarra, J. E. Dazard, Y. Sandlers, F. Rehman, R. Abbas, R. Kombu, G. F. Zhang, H. Brunengraber, Juan R. Sanabria

Surgery

Purpose. The incidence of liver neoplasms is rising in USA. The purpose of this study was to determine metabolic profiles of liver tissue during early cancer development.

Methods. We used the rabbitVX2 model of liver tumors (LT) and a control group consisting of sham animals implanted with Gelfoam into their livers (LG). After two weeks from implantation, liver tissue from lobes with and without tumor was obtained from experimental animals (LT+/LT−) as well as liver tissue from controls (LG+/LG−). Peaks obtained by Gas Chromatography-Mass Spectrometry were subjected to identification. 56 metabolites were identified and their profiles compared between groups using …

Improved Growth And Development In Premature Infants Managed With Nasal Continuous Positive Airway Pressure, Susan L. Flesher M.D., Renee S. Domanico M.D.

Pediatrics

Objective: Our goal was to assess the association between the use of nasal continuous positive airway pressure (NCPAP) vs. conventional ventilation (CV) in premature infants and its effects on: 1) growth in the NICU and at follow up visits 2) neurodevelopmental outcomes measured by Bayley Infant Neurodevelopmental Screener (BINS) 3) the incidence of retinopathy of prematurity (ROP) and chronic lung disease (CLD).

Methods: A retrospective chart review of two groups of NICU patients was conducted. The first group was from 1/1999 – 12/2000 (n=140) and was managed by CV. The second group (n=168) was from 1/2003 – 12/2004 and was …

Operative Environment, Pouya Alijanipour Md, Joseph Karam Md, Adolfo Llinas Md, Kelly G. Vince Md, Charalampos Zalavras Md, Matthew Austin Md, Grant Garrigues Md, Snir Heller Md, James Huddleston Md, Brian Klatt Md, Viktor Krebs Md, Christoph Lohmann Md, Edward J. Mcpherson Md, Robert Molloy Md, Ali Oliashirazi Md, Mitchell Schwaber Md, Eoin Sheehan Md, Eric Smith Md, Robert Sterling Md, Gregory Stocks Md, Shrinand Vaidya Md

Orthopaedics

Postoperative SSIs are believed to occur via bacterial inoculation at the time of surgery or as a result of bacterial contamination of the wound via open pathways to the deep tissue layers.^1–3 The probability of SSI is reflected by interaction of parameters that can be categorized into three major groups.² The first group consists of factors related to the ability of bacteria to cause infection and include initial inoculation load and genetically determined virulence factors that are required for adherence, reproduction, toxin production, and bypassing host defense mechanisms. The second group involves those factors related to the defense …

Management Of Severe Hyponatremia: Infusion Of Hypertonic Saline And Desmopressin Or Infusion Of Vasopressin Inhibitors?, Antonios H. Tzamaloukas Md, Joseph I. Shapiro Md, Dominic S. Raj Md, Glen H. Murata Md, Deepak Malhotra Md, Phd, Robert H. Glew Phd

Biochemistry and Microbiology

Rapid correction of severe hyponatremia carries the risk of osmotic demyelination. Two recently introduced methods of correction of hyponatremia have diametrically opposite effects on aquaresis. inhibitors of vasopressin V2 receptor (vaptans) lead to the production of dilute urine, whereas infusion of desmopressin causes urinary concentration. Identification of the category of hyponatremia that will benefit from one or the other treatment is critical. In general, vaptans are effective in hyponatremias presenting with concentrated urine and, with the exception of hypovolemic hyponatremia, can be used as their primary treatment. Desmopressin is effective in hyponatremias presenting with dilute urine or developing urinary dilution …

Medical Tourism: Comparing Coronary Bypass Surgery In The U.S. And Abroad, William K. Willis, Alberto Coustasse

Management Faculty Research

Rising health care costs have employers searching for remedies to the increasing rates they pay for employee health insurance. The development of U.S. health insurance policies, with the option of utilizing medical tourism as a low cost care provider for treatment of cardiac coronary bypass surgery provides a method for receiving treatment. The medical tourism approach to providing treatment for bypass surgery has prompted hospitals in India, Thailand, and Singapore to seek U.S. patients. A comparison of costs for bypass treatment between the U.S. and these countries illustrates some of the issues and concerns that arise when making such comparisons. …