Medical Specialties Commons^™

Risk Factors Of Recurrent Falls Among Older Adults Admitted To The Trauma Surgery Department., William Curran-Groome, Gary Klein, Stanton Miller, Azor Hui, Jordan S Wilson, Chol Kuoiloi, Venkata Masarapu, Andre Alabd, Toni Mascaro, Gideon Logan, Jonathan Lubeck

Department of Surgery Faculty Papers

Falls affect more than 29 million American adults ages ≥65 years annually. Many older adults experience recurrent falls requiring medical attention. These recurrent falls may be prevented through screening and intervention. In 2014 to 2015, records for 199 older adult patients admitted from a major urban teaching hospital’s emergency department were queried. Open-ended variables from clinicians’ notes were coded to supplement existing closed-ended variables. Of the 199 patients, 52 (26.1%) experienced one or more recurrent falls within 365 days after their initial fall. Half (50.0%) of all recurrent falls occurred within the first 90 days following discharge. A large proportion …

Percutaneous Intervention Or Bypass Graft For Left Main Coronary Artery Disease? A Systematic Review And Meta-Analysis, Waqas Ullah, Yasar Sattar, Irfan Ullah, Ammu Susheela, Maryam Mukhtar, M Chadi Alraies, Mamas A Mamas, D L Fischman

Abington Jefferson Health Papers

Background: The safety and efficacy of percutaneous coronary intervention (PCI) versus coronary artery bypass grafting (CABG) for stable left main coronary artery disease (LMCAD) remains controversial.

Methods: Digital databases were searched to compare the major adverse cardiovascular and cerebrovascular events (MACCE) and its components. A random effect model was used to compute an unadjusted odds ratio (OR).

Results: A total of 43 studies (37 observational and 6 RCTs) consisting of 29,187 patients (PCI 13,709 and CABG 15,478) were identified. The 30-day rate of MACCE (OR, 0.56; 95% CI, 0.42-0.76;

Conclusion: PCI might offer early safety advantages, while CABG provides greater …

The Medicine Forum: Volume 21

The Medicine Forum

The Journal of Thomas Jefferson University Hospital - Department of Internal Medicine, Volume 21, 2019-2020

TABLE OF CONTENTS

Clinical Images

Case Reports

• Cardiology
• Gastroenterology and Hepatology
• Hematology and Oncology
• Infectious Disease
• Pulmonary Medicine

Literature Review

Editorial

Beyond The Waiver Training: Practical Tips You May Not Have Learned, Lara Weinstein, Md, Mph, Drph, Erica Li, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Objectives

• Understand the critical importance of philosophy, structure, and access in MAT
• Share practical tips for starting MAT in your practice
• Discuss lessons learned with developing a MAT program

Journal Club: Emergency Department–Initiated Buprenorphine/Naloxone Treatment For Opioid Dependence, Simon Newsom

Department of Family & Community Medicine Presentations and Grand Rounds

Learning Objectives

• Briefly highlight OUD
• Current ED practices
• Review study
• Future directions

Regional And Experiential Differences In Surgeon Preference For The Treatment Of Cervical Facet Injuries: A Case Study Survey With The Ao Spine Cervical Classification Validation Group, Jose A Canseco, Gregory D Schroeder, Parthik D Patel, Giovanni Grasso, Michael Chang, Frank Kandziora, Emiliano N Vialle, F Cumhur Oner, Klaus J Schnake, Marcel F Dvorak, Jens R Chapman, Lorin M Benneker, Shanmuganathan Rajasekaran, Christopher K Kepler, Alexander R Vaccaro

Department of Neurosurgery Faculty Papers

PURPOSE: The management of cervical facet dislocation injuries remains controversial. The main purpose of this investigation was to identify whether a surgeon's geographic location or years in practice influences their preferred management of traumatic cervical facet dislocation injuries.

METHODS: A survey was sent to 272 AO Spine members across all geographic regions and with a variety of practice experience. The survey included clinical case scenarios of cervical facet dislocation injuries and asked responders to select preferences among various diagnostic and management options.

RESULTS: A total of 189 complete responses were received. Over 50% of responding surgeons in each region elected …

Can Contrast Enhanced Ultrasound Differentiate Intrahepatic Cholangiocarcinoma From Hepatocellular Carcinoma?, Jia-Yan Huang, Jia-Wu Li, Wen-Wu Ling, Tao Li, Yan Luo, Ji-Bin Liu, Qiang Lu

Department of Radiology Faculty Papers

BACKGROUND: Hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC) differ in treatment and prognosis, warranting an effective differential diagnosis between them. The LR-M category in the contrast-enhanced ultrasound (CEUS) liver imaging reporting and data system (LI-RADS) was set up for lesions that are malignant but not specific to HCC. However, a substantial number of HCC cases in this category elevated the diagnostic challenge.

AIM: To investigate the possibility and efficacy of differentiating ICC from HCC classified in the LR-M category according to the CEUS LI-RADS.

METHODS: Patients with complete CEUS records together with pathologically confirmed ICC and LR-M HCC (HCC classified …

Review Of Treatment Options For Pneumonia In The Inpatient Setting, Shirley B Bonanni

Department of Family & Community Medicine Presentations and Grand Rounds

No abstract provided.

Refugee Health In Philadelphia, Marc Altshuler

Department of Family & Community Medicine Presentations and Grand Rounds

Objectives

1. Define the U.S. refugee resettlement process
2. Discuss the history of refugee health in Philadelphia and the creation of the Jefferson Center for Refugee Health
3. Review selected data on our patients
4. Learn how to utilize new resources to care for refugees

Management Of Neonatal Hyperbilirubinemia, David Schutzman

Department of Family & Community Medicine Presentations and Grand Rounds

No abstract provided.

'It's Common Sense That An Individual Must Eat': Advocating For Food Justice With People With Psychiatric Disabilities Through Photovoice., Lara Carson Weinstein, Mariana Chilton, Renee Turchi, Ann C Klassen, Marianna Lanoue, Alexis Silvero, Leopoldo J Cabassa

Department of Family & Community Medicine Faculty Papers

BACKGROUND: People with SMI have often been excluded in advocacy efforts focused on physical health, health care and health and social policy.

OBJECTIVE: Following a Photovoice project focused on barriers to healthy eating and physical activity in urban neighbourhoods, participant-researchers were invited to present their insights in community advocacy settings. The purpose of this study was to explore the feasibility and participant-researchers' experience of these community advocacy activities.

DESIGN: We held four focus groups with the eight participant-researchers after each community advocacy activity to explore their experience with public speaking, presenting their experiences and advocating.

SETTING AND PARTICIPANTS: People with …

Integrative Medicine In Health And Well-Being, Andrew Newberg, Madeline Becker

Department of Family & Community Medicine Presentations and Grand Rounds

For integrative approaches to become part of standard care, research is required to understand clinical effects. Clinical data needs to be supplemented by mechanistic studies. Integrative medicine and general medicine have multiple areas of intersection. Studies can evaluate mental and physical disorders such as depression or anxiety or chronic pain and fatigue. Studies can evaluate psychological symptoms associated with other medical and neurological disorders. It is important to establish efficacy and also mechanism. Future collaborations are very welcome!

Employment And Patient Satisfaction After Liver Transplantation, Christopher Cao, Dina Halegoua-De Marzio, Shady Guirguis, Crystal Chen, Jonathan M. Fenkel, Steven Herrine

Division of Gastroenterology and Hepatology Faculty Papers

Background and Aims: This study serves to revisit the effects of liver transplantation (LT) on employment in an era of improving survival outcomes post-transplant, and to identify areas of improvement in the transplant process to better op-timize post-LT employment and patient satisfaction. Methods: Prospectively, patients who had undergone LT at a single tertiary LT center were surveyed in person and by e-mail. Primary outcomes included employment rate pre-and post-LT, annual salary, weekly hours worked, barriers to re-employment, and patient satisfaction. Results: Responses were collected and analyzed from 121 patients who underwent LT. Pre-LT, 68 (56.1%) reported full-time employ-ment, 13 (10.7%) …

Drug-Resistant Epilepsy In Children With Juvenile Huntington's Disease: A Challenging Case And Brief Review, Abdulhafeez Khair, Jessica Kabrt, Stephen Falchek

Department of Neurology Faculty Papers

Huntington's Disease (HD) is an autosomal dominant neurodegenerative disorder with a progressive decline in cognitive, motor, and psychological function. Chorea tends to be the most common associated movement disorder, although other variants of several abnormal movements are also seen. Adult-onset HD is the most common subtype. Juvenile Huntington's disease (JHD) accounts for 5%-10% of all HD cases and presents as a rapidly progressive disorder with a multitude of characteristics. We report on a 9-year-old male with JHD who presented with refractory epilepsy. His EEG findings, seizure type, and antiepileptic drug usage are discussed with a brief review of the currently …

A Mysterious Paratracheal Mass: Parathyroid Carcinoma., Qian Zhang, Khine S. Shan, Neethu Gopisetti, Md, Thomas Yoon, Iqra Iqbal

Abington Jefferson Health Papers

Parathyroid carcinoma is a rare cause of primary hyperparathyroidism. We detail a 60-years-old gentleman who was otherwise healthy presented to the hospital due to acute encephalopathy. He was subsequently found to have parathyroid carcinoma as the cause of the acute encephalopathy with impressive serum calcium and parathyroid hormone levels. The parathyroid carcinoma was later surgically resected with the diagnosis confirmed via pathology specimen. The patient was safely discharged from the hospital with recommendations of close routine outpatient followup.

Fruit And Vegetable Consumption Is Associated With Lower Prevalence Of Asymptomatic Diverticulosis: A Cross-Sectional Colonoscopy-Based Study., Benjamin Maxner, Jessica Mcgoldrick, Danielle Bellavance, Po-Hong Liu, Ramnik J Xavier, Joseph C Yarze, Rocco Ricciardi, Kyle Staller, Daniel C Chung, Hamed Khalili

Department of Medicine Faculty Papers

BACKGROUND: Previous studies of the relationship between dietary factors and risk of diverticulosis have yielded inconsistent results. We therefore sought to investigate the association between consumption of fruit and vegetables and prevalent diverticulosis.

METHODS: Our study population included participants in the Gastrointestinal Disease and Endoscopy Registry (GIDER), a colonoscopy-based longitudinal cohort at the Massachusetts General Hospital, who provided comprehensive information on dietary intake and lifestyle factors using validated questionnaires prior to colonoscopy. Information on presence and location of diverticula was obtained from the endoscopist at the end of each procedure. We used Poisson regression modeling to calculate the prevalence ratios …

Resident Ume Updates, Fred Markham, Marisyl Delacruz

Department of Family & Community Medicine Presentations and Grand Rounds

Agenda

1. Guidelines for Students in Clinical Spaces
2. Grading and feedback
3. RIME scheme
4. Telehealth, QI curriculum
5. Phase 3 Updates and JeffDOT
6. Q&A

Perfusion-Guided Sonopermeation Of Neuroblastoma: A Novel Strategy For Monitoring And Predicting Liposomal Doxorubicin Uptake, Aditi Bellary, Arelly Villarreal, Rojin Eslami, Quincy J Undseth, Bianca Lec, Ann M Defnet, Naina Bagrodia, Jessica J Kandel, Mark A Borden, Sumbul Shaikh, Rajiv Chopra, Theodore W Laetsch, Lauren J. Delaney, Colette Shaw, Md, John R. Eisenbrey, Sonia L Hernandez, Shashank R Sirsi

Department of Radiology Faculty Papers

Neuroblastoma (NB) is the most common extracranial solid tumor in infants and children, and imposes significant morbidity and mortality in this population. The aggressive chemoradiotherapy required to treat high-risk NB results in survival of less than 50%, yet is associated with significant long-term adverse effects in survivors. Boosting efficacy and reducing morbidity are therefore key goals of treatment for affected children. We hypothesize that these may be achieved by developing strategies that both focus and limit toxic therapies to the region of the tumor. One such strategy is the use of targeted image-guided drug delivery (IGDD), which is growing in …

Consensus Guidelines For Digital Scholarship In Academic Promotion., Abbas Husain, Zachary Repanshek, Manpreet Singh, Felix Ankel, Jennifer Beck-Esmay, Daniel Cabrera, Teresa M Chan, Robert Cooney, Michael Gisondi, Michael Gottlieb, Jay Khadpe, Jennifer Repanshek, Jessica Mason, Dimitrios Papanagnou, Jeff Riddell, N Seth Trueger, Fareen Zaver, Emily Brumfield

Department of Emergency Medicine Faculty Papers

INTRODUCTION: As scholarship moves into the digital sphere, applicant and promotion and tenure (P&T) committee members lack formal guidance on evaluating the impact of digital scholarly work. The P&T process requires the appraisal of individual scholarly impact in comparison to scholars across institutions and disciplines. As dissemination methods evolve in the digital era, we must adapt traditional P&T processes to include emerging forms of digital scholarship.

METHODS: We conducted a blended, expert consensus procedure using a nominal group process to create a consensus document at the Council of Emergency Medicine Residency Directors Academic Assembly on April 1, 2019.

RESULTS: We …

Ophthalmic Manifestations Of Rosai-Dorfman Disease In Five Patients, Babak Masoomian, Sara E. Lally, Jerry A Shields, Carol L Shields

Wills Eye Hospital Papers

Purpose: To report clinical features, pathology characteristics, and treatment outcomes of five patients with Rosai-Dorfman disease (RDD).

Methods: A retrospective case series of patients with RDD from the Ocular Oncology Service of Wills Eye Hospital between 1974 and 2018.

Results: There were six eyes of five patients (3 males, 2 females) with ophthalmic manifestations of RDD. The mean age at the initial presentation was 33 years (median 35, range 10-52 years). Before referral, the tumor was initially suspected to be lymphoma (n = 3), idiopathic orbital inflammation (n = 2), or pterygium (n = 1). The disease was unilateral (n …

Insulin-Like Growth Factor 2 Mrna-Binding Protein 3 Modulates Aggressiveness Of Ewing Sarcoma By Regulating The Cd164-Cxcr4 Axis, Caterina Mancarella, Giulia Caldoni, Irene Ribolsi, Alessandro Parra, Maria Cristina Manara, Arthur M Mercurio, Andrea Morrione, Katia Scotlandi

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Ewing sarcoma (EWS) is the second most common bone and soft tissue-associated malignancy in children and young adults. It is driven by the fusion oncogene EWS/FLI1 and characterized by rapid growth and early metastasis. We have previously discovered that the mRNA binding protein IGF2BP3 constitutes an important biomarker for EWS as high expression of IGF2BP3 in primary tumors predicts poor prognosis of EWS patients. We additionally demonstrated that IGF2BP3 enhances anchorage-independent growth and migration of EWS cells suggesting that IGF2BP3 might work as molecular driver and predictor of EWS progression. The aim of this study was to further define the …

Meta-Analysis Of Outcomes Of Patients With Covid-19 Infection With Versus Without Gastrointestinal Symptoms., Fahad Gul, Kevin Bryan Lo, Julie Peterson, Peter A Mccullough, Abhinav Goyal, Janani Rangaswami

COVID-19 Papers, Posters, and Presentations

This systematic review analyzed whether the presence or absence of gastrointestinal symptoms in patients with SARS-COV-2 infection is associated with adverse outcomes. Searching the Cochrane Center Register of Controlled Trials, we included any studies looking at patients with COVID-19 with gastrointestinal symptoms (nausea, vomiting, diarrhea, abdominal pain) compared to those with COVID-19 but without gastrointestinal manifestations as a control group. The final search yielded 186 articles, all of which were individually screened. Seven studies were identified but three were excluded: one due to lack of a control group without gastrointestinal symptoms, one reported as viral RNA in the stool, and …

Patterns Of Regional Cerebral Blood Flow As A Function Of Obesity In Adults., Daniel G Amen, Joseph Wu, Noble George, Andrew Newberg

Marcus Institute of Integrative Health Faculty Papers

BACKGROUND: While obesity has been shown to be a risk factor for Alzheimer's disease, the potential mechanisms underlying this risk may be clarified with better understanding of underlying physiology in obese persons.

OBJECTIVE: To identify patterns of cerebral perfusion abnormality in adults as a function of body mass index (BMI) defined weight categories, including overweight or obese status.

METHODS: A large psychiatric cohort of 35,442 brain scans across 17,721 adults (mean age 40.8±16.2 years, range 18-94 years) were imaged with SPECT during baseline and concentration scans, the latter done after each participant completed the Connors Continuous Performance Test II. ANOVA …

A Foldable Nonpenetrating Keratoprosthesis: Medium To Long-Term Clinical Results In Patients With Corneal Blindness Due To Noninflammatory Anterior Cornea Disease., Jose M Vargas, Eric Shiuey

Department of Medicine Faculty Papers

PURPOSE: To report the medium to long-term safety and performance outcomes of the KeraKlear nonpenetrating artificial cornea (KeraKlear) as the primary procedure in patients with corneal blindness due to noninflammatory anterior cornea disease.

METHODS: Fifteen patients with corneal blindness (preoperative visual acuity [VA] of ≥20/200) due to a non-inflammatory anterior corneal condition were included in this prospective, single-center study. Preoperative diagnoses included corneal scars, keratoconus, and corneal dystrophies. Diseased corneas were implanted with the KeraKlear (KeraMed Inc., Irvine, California, USA) by a single surgeon (JMV) using a femtosecond laser to create all incisions. Participants were followed up with for as …

Calculating Life And Death In A Time Of Covid, Larry Hirschhorn, Phd

School of Continuing and Professional Studies Coronavirus Papers

The current pandemic makes us feel helpless. We can respond to its predation pragmatically but its silent march through the population promotes dread. Our helplessness undermines our belief in our culture as the source of our self-esteem and felt significance. One response to our experience of helplessness is the omnipotent stance, the idea that we can master the virus, stop it in its tracks, command one another to comply with injunctions and wreak a path of destruction by devastating the economy. Omnipotence promotes magical thinking. In the service of defeating death, we ignore actual suffering; deaths of despair and deaths …

Stress Urinary Incontinence Post-Holmium Laser Enucleation Of The Prostate: A Single-Surgeon Experience., Akhil K Das, Seth Teplitsky, Tomy Perez, Jenny Guo, Joon Yau Leong, Patrick J Shenot

Department of Urology Faculty Papers

PURPOSE: To identify incidence and predictors of stress urinary incontinence (SUI) following Holmium laser enucleation of the prostate (HoLEP).

MATERIALS AND METHODS: We performed a retrospective review of 589 HoLEP patients from 2012-2018. Patients were assessed at pre-operative and post-operative visits. Univariate and multivariate regression analyses were performed to identify predictors of SUI.

RESULTS: 52/589 patients (8.8%) developed transient SUI, while 9/589 (1.5%) developed long-term SUI. tSUI resolved for 46 patients (88.5%) within the first six weeks and in 6 patients (11.5%) between 6 weeks to 3 months. Long-term SUI patients required intervention, achieving continence at 16.4 months on average, …

Reply: There Are Limits To Autonomy., John W C Entwistle, Kathleen N Fenton

Department of Surgery Faculty Papers

No abstract provided.

Dimethyl Fumarate Suppresses Granulocyte Macrophage Colony-Stimulating Factor-Producing Th1 Cells In Cns Neuroinflammation., Farinaz Safavi, Rodolfo Thome, Zichen Li, Guang-Xian Zhang, Abdolmohamad Rostami

Department of Neurology Faculty Papers

Objective To study the immunomodulatory effect of dimethyl fumarate (DF) on granulocyte macrophage colony-stimulating factor (GM-CSF) production in CD4+ T cells in experimental autoimmune encephalomyelitis (EAE) and human peripheral blood mononuclear cells (PBMCs).

Methods We collected splenocytes and CD4+ T cells from C57BL/6 wild-type and interferon (IFN)-γ–deficient mice. For human PBMCs, venous blood was collected from healthy donors, and PBMCs were collected using the Percoll gradient method. Cells were cultured with anti-CD3/28 in the presence/absence of DF for 3 to 5 days. Cells were stained and analyzed by flow cytometry. Cytokines were measured by ELISA in cell supernatants. For in …

Health Insurance Coverage Disruptions And Cancer Care And Outcomes: Systematic Review Of Published Research, K Robin Yabroff, Katherine Reeder-Hayes, Jingxuan Zhao, Michael T Halpern, Ana Maria Lopez, Leon Bernal-Mizrachi, Anderson B Collier, Joan Neuner, Jonathan Phillips, William Blackstock, Manali Patel

Kimmel Cancer Center Faculty Papers

BACKGROUND: Lack of health insurance coverage is associated with poor access and receipt of cancer care and survival in the United States. Disruptions in coverage are common among low-income populations, but little is known about associations of disruptions with cancer care, including prevention, screening, and treatment, as well as outcomes of stage at diagnosis and survival.

METHODS: We conducted a systematic review of studies of health insurance coverage disruptions and cancer care and outcomes published between 1980 and 2019. We used the PubMed, EMBASE, Scopus, and CINAHL databases and identified 29 observational studies. Study characteristics and key findings were abstracted …

Wax Models In Dermatology: Updated Through 2019, Lawrence Parish

Department of Dermatology and Cutaneous Biology Faculty Papers

Wax models have occupied an unique position in the teaching of dermatology. While watercolor depictions of skin lesions and later photographic illustrations have been used, the wax model offers an unique presentation of the morphology, often not captured by other methods .