Medical Specialties Commons^™

Review/Overview Of Pain In Sickle Cell Disease., Samir K. Ballas, Deepika S. Darbari

Cardeza Foundation for Hematologic Research

Sickle cell disease (SCD) is a highly complex inherited disorder of hemoglobin structure. Although the molecular lesion is a single-point mutation, the sickle gene is pleiotropic in nature causing multiple phenotypic expressions that constitute the various complications of the disease. Its manifestations could be acute, chronic, nociceptive, neuropathic that could occur singly or in various combinations. Pain continues to be the major factor of SCD phenotypic complications and the most common cause of admissions to the Emergency Department and/or the hospital. Although progress has been made in understanding the pathophysiology of SCD as well as in developing curative therapies such …

Mount Fuji Sign Following Nasal Polypectomy: Conservative Management Of Pneumocephalus, Matthew Szymaszek, Gentian Toshkezi

Department of Emergency Medicine Faculty Papers

Pneumocephalus is seen in conjunction with a variety of conditions, particularly traumatic injury, neurosurgical, and ears, nose, and throat (ENT) procedures. We describe the successful, non-operative management with supplemental oxygen of symptomatic pneumocephalus following polypectomy without further complication. This case adds to other case reports of pneumocephalus but differs in the non-invasive, conservative management with supplemental oxygen obviating the need for more invasive neurosurgical intervention such as decompressive craniectomy, burr holes, or drain placement.

The Bull Or The Horn - What Are Outcomes Data?, James Harrop

Department of Neurosurgery Faculty Papers

No abstract provided.

Management Of Patients With Isolated Acute Cervical Carotid Artery Occlusion And Normal Neurological Exam: Technical Note And Case Series, Joshua H. Weinberg, Nohra Chalouhi, Ahmad Sweid, Stavropoula Tjoumakaris, Michael Reid Gooch, Robert H. Rosenwasswer, Pascal Jabbour, Hekmat Zarzour

Department of Neurosurgery Faculty Papers

Objectives

Limited data exists on the management and outcome of patients with isolated acute cervical internal carotid artery (cICA) occlusion presenting with normal neurologic exam after experiencing a period of neurological deficits. These patients are at risk for progressive neurologic deterioration but have not yet progressed to stroke. Current management is no intervention due to intervention risk of embolization. We aim to determine the optimal management of patients with isolated acute cICA occlusion presenting with a normal neurological exam after experiencing neurological deficits.

Patients and methods

Data was collected on 3 patients with acute cICA occlusion that presented with a …

Cystoid Macular Edema In A Child., Jordan Hamburger, Xiaolu Yang, Carol L Shields

Wills Eye Hospital Papers

N/A

Pilomatrix Carcinoma Of The Lacrimal Caruncle: A Case Report., Ibrahim Inan Harbiyeli, Altan A Ozcan, Arbil Acıkalin, Emine Ciloglu, Carol L Shields

Wills Eye Hospital Papers

A 45-year-old man presented with a 3-month history of a mass located in the caruncle of his right eye. An incisional biopsy had been performed one month prior by another specialist, and the histopathology report showed basal cell carcinoma. The mass was completely excised with a 2 mm safety margin, and the large conjunctival defect was reconstructed with one sheet of amniotic membrane allograft. A histological diagnosis of pilomatrix carcinoma was established. To prevent recurrence after surgery, we added bevacizumab (25 mg/mL, 1.25 mg/mL per drop) eye drops four times per day for three months. At the one-year follow-up, the …

Bone Marrow Dendritic Cells Deficient For Cd40 And Il-23p19 Are Tolerogenic In Vitro, Tahereh Kalantari, Bogoljub Ciric, Eskandar Kamali-Sarvestani, Abdolmohamad Rostami

Department of Neurology Faculty Papers

Objective(s): In addition to pro-inflammatory role, dendritic cells (DCs) can also be anti-inflammatory when they acquire tolerogenic phenotype. In this study we tested the role of CD40 and IL-23p19 in antigen presenting function of bone marrow-derived DCs (BMDCs) by comparing BMDCs derived from CD40 knockout (CD40KO-DCs) and IL-23p19 (IL-23p19KO-DCs) knockout mice with those from C57BL/6 mice (Cont-DCs). We have focused on CD40 and IL-23, as these molecules have well established pro-inflammatory roles in a number of autoimmune and inflammatory diseases.

Materials and Methods: The expression of maturation markers MHC II and co-stimulatory molecules CD40, CD80, and CD86 was analyzed by …

Disestablishmentarianism: Or Why Political Correctness Is Racist, Anti-Gay, Anti-Transgender, Misogynist, Anti-Science, And Anti-You., W Clark Lambert, Shreya Patel, Lawrence Charles Parish

Department of Dermatology and Cutaneous Biology Faculty Papers

Disestablishmentarianism is known to most of us as one of the longest words in the English language (before some over-eager college students, even a few doctors, invented some mostly quite silly longer ones). A few may also know it as a rather dull, perhaps equally silly facet of British history. This is a shame, because this rather bizarre movement that began in eighteenth century England, has much to teach us about modern times.

Using The Medical Expenditure Panel Survey To Explore The Association Between High Healthcare Utilization And Behavioral Health Diagnoses In A Pediatric Population With Chronic Conditions, Marlon D. Satchell, Phd, Mph

Population Health Science Program Doctoral Dissertations

The 2010 Affordable Care Act (ACA) introduced an era of changing healthcare delivery and utilization, which is still evolving and changing to this day. Healthcare providers and healthcare systems need to identify strategies to provide better care to patients, that results in better patient outcomes, in a cost effective way. One strategy to accomplish this goal is to focus on managing the care of the most vulnerable patients, particularly including pediatric patients with one or more chronic conditions. The objective of this study was to assess the extent to which a behavioral health diagnosis in addition to another chronic condition …

Setting The Standards: Examining Research Productivity Among Academic Urologists In The Usa And Canada In 2019., Thenappan Chandrasekar, Timothy M. Han, Lydia Glick, Joon Yau Leong, Seth Teplitsky, Rodrigo Noorani, Hanan Goldberg, Zachary Klaassen, Christopher J.D. Wallis, James R. Mark, Edouard J. Trabulsi, Costas D. Lallas, Leonard G. Gomella

Department of Urology Faculty Papers

BACKGROUND: Research productivity among academic urologists is strongly encouraged, but little data are available on productivity metrics within the field.

OBJECTIVE: To provide the first comprehensive survey of research productivity among academic urologists in the USA and Canada.

DESIGN, SETTING, AND PARTICIPANTS: Using the Accreditation Council for Graduate Medical Education, the Canadian Resident Matching Service, and individual program websites, all active accredited urology faculties were identified. For each individual, we collected data on American Urological Association section, title, gender, fellowship training, Scopus H-index, and citations. Comprehensive searches were completed during March-May 2019.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Descriptive statistics for …

Shedding Light On Endometriosis: Patient And Provider Perspectives On A Challenging Disease, Madalene Zale, Emily Lambert, Marianna Lanoue, Amy E. Leader

College of Nursing Faculty Papers & Presentations

Background: Endometriosis is a serious yet understudied medical condition impacting millions of women worldwide.

Methods: This mixed methods study aimed to understand health care provider perceptions and patient experiences with endometriosis in the United States. Providers were surveyed to assess their understanding of disease prevalence. A subset of providers also participated in short, open-ended interviews about treating patients who have or are suspected to have endometriosis. Interviews were also conducted with women diagnosed with endometriosis to understand their experiences with the disease. Means and frequencies were calculated for survey data; interviews were transcribed and separately analyzed by two coders using …

Modular Stem In Total Hip Arthroplasty For Patients With Trochanter Valgus Deformity: Surgical Technique And Case Series., Xiangpeng Kong, Wei Chai, Minzhi Yang, Alvin Ong, Jiying Chen, Yan Wang, Yonggang Zhou

Rothman Institute Papers

BACKGROUND: Trochanter valgus deformity (TVD) is a rare condition of total hip arthroplasty (THA). Femoral osteotomy could be required in correcting the deformity to implant femoral stem in severe TVD. In this study, we described one unpublished technique of reverse sleeve of S-ROM to get through the complex situation. This study aimed to summarize and evaluate its technical challenges, safety and effectiveness.

METHODS: From January 2006 to December 2014, we enrolled patients whose sleeves were implanted towards the great trochanter in THA with TVD. Their demographics, perioperative and postoperative information were recorded. To explore its indication, we measured and analyzed …

Mucopolysaccharidosis Iva: Diagnosis, Treatment, And Management., Kazuki Sawamoto, José Víctor Álvarez González, Matthew Piechnik, Francisco J. Otero, Maria L. Couce, Yasuyuki Suzuki, Shunji Tomatsu

Department of Pediatrics Faculty Papers

Mucopolysaccharidosis type IVA (MPS IVA, or Morquio syndrome type A) is an inherited metabolic lysosomal disease caused by the deficiency of the N-acetylglucosamine-6-sulfate sulfatase enzyme. The deficiency of this enzyme accumulates the specific glycosaminoglycans (GAG), keratan sulfate, and chondroitin-6-sulfate mainly in bone, cartilage, and its extracellular matrix. GAG accumulation in these lesions leads to unique skeletal dysplasia in MPS IVA patients. Clinical, radiographic, and biochemical tests are needed to complete the diagnosis of MPS IVA since some clinical characteristics in MPS IVA are overlapped with other disorders. Early and accurate diagnosis is vital to optimizing patient management, which provides a …

Extra-Articular Synovial Chondromatosis Of The Ankle: Unusual Case With Radiologic-Pathologic Correlation., Sachin Dheer, Paul E Sullivan, Faith Schick, Homyar Karanjia, Nicholas Taweel, John Abraham, Wei Jiang

Department of Radiology Faculty Papers

Extra-articular synovial chondromatosis is a rare entity in the foot and ankle. We present a case of a 49-year-old female who presented for evaluation of a palpable concern following trauma; which was found to represent synovial chondromatosis. This case demonstrates the multimodality imaging findings, including ultrasound and MRI, with histopathologic correlation.

Tailored For Real-World: A Whole Slide Image Classification System Validated On Uncurated Multi-Site Data Emulating The Prospective Pathology Workload., Julianna D. Ianni, Rajath E. Soans, Sivaramakrishnan Sankarapandian, Ramachandra Vikas Chamarthi, Devi Ayyagari, Thomas G. Olsen, Michael J. Bonham, Coleman C. Stavish, Kiran Motaparthi, Clay J. Cockerell, Theresa A. Feeser, Jason B. Lee

Department of Dermatology and Cutaneous Biology Faculty Papers

Standard of care diagnostic procedure for suspected skin cancer is microscopic examination of hematoxylin & eosin stained tissue by a pathologist. Areas of high inter-pathologist discordance and rising biopsy rates necessitate higher efficiency and diagnostic reproducibility. We present and validate a deep learning system which classifies digitized dermatopathology slides into 4 categories. The system is developed using 5,070 images from a single lab, and tested on an uncurated set of 13,537 images from 3 test labs, using whole slide scanners manufactured by 3 different vendors. The system's use of deep-learning-based confidence scoring as a criterion to consider the result as …

False Lumen Embolization As A Rescue Technique In The Setting Of Acute And Chronic Dissecting Aneurysms As Adjunct To Thoracic Endovascular Aortic Repair., Stephanie Rakestraw, Anthony Feghali, Tuong Nguyen, Dawn Salvatore, Paul Dimuzio, Babak Abai

Department of Surgery Faculty Papers

Complicated type B aortic dissection (TBAD) is a life-threatening condition requiring surgical intervention. One such complication in the acute or chronic setting is aneurysmal degeneration. The dissected aortic wall is weakened, and the pressures in the false lumen are often high. In the past decade, thoracic endovascular aortic repair (TEVAR) has become the treatment of choice for TBAD. TEVAR can be complicated by lack of false lumen thrombosis, increasing the risk of death. We present three cases of TBAD with patent false lumens after TEVAR that were treated by false lumen coil embolization.

Simulation-Based Mastery Learning Compared To Standard Education For Discussing Diagnostic Uncertainty With Patients In The Emergency Department: A Randomized Controlled Trial., Danielle M. Mccarthy, Rhea E. Powell, Kenzie A. Cameron, David H. Salzman, Dimitrios Papanagnou, Amanda Doty, Benjamin E. Leiby, Katherine Piserchia, Matthew R. Klein, Xiao C. Zhang, William C. Mcgaghie, Kristin L. Rising

Department of Pharmacology and Experimental Therapeutics Faculty Papers

BACKGROUND: Diagnostic uncertainty occurs frequently in emergency medical care, with more than one-third of patients leaving the emergency department (ED) without a clear diagnosis. Despite this frequency, ED providers are not adequately trained on how to discuss diagnostic uncertainty with these patients, who often leave the ED confused and concerned. To address this training need, we developed the Uncertainty Communication Education Module (UCEM) to teach physicians how to discuss diagnostic uncertainty. The purpose of the study is to evaluate the effectiveness of the UCEM in improving physician communications.

METHODS: The trial is a multicenter, two-arm randomized controlled trial designed to …

Development Of An Abbreviated Symptom Score For The Neonatal Abstinence Syndrome., I. Chervoneva, S. C. Adeniyi-Jones, F. Blanco, W. K. Kraft

Department of Pharmacology and Experimental Therapeutics Faculty Papers

OBJECTIVE: We sought a shortened MOTHER neonatal abstinence syndrome (NAS) and Finnegan score that would retain comparable performance characteristics of the full instrument.

STUDY DESIGN: Retrospective cohort.

RESULTS: In total, 124,170 MOTHER NAS scores between August 2007 and May 2016 from 775 infants (≥36 weeks) were examined. Classification and regression tree model identified the most important subsets of the scored variables. A 9-element shortened scale yielded >90% sensitivity and specificity to predict clinical endpoints based on the full 19-element MOTHER NAS score. Conversion of the data sets to the Finnegan score, and applying the same procedure resulted in a nine-element …

Effects Of Oral, Smoked, And Vaporized Cannabis On Endocrine Pathways Related To Appetite And Metabolism: A Randomized, Double-Blind, Placebo-Controlled, Human Laboratory Study., Mehdi Farokhnia, Gray R Mcdiarmid, Matthew N Newmeyer, Vikas Munjal, Osama A Abulseoud, Marilyn A Huestis, Lorenzo Leggio

Institute of Emerging Health Professions Faculty Papers

As perspectives on cannabis continue to shift, understanding the physiological and behavioral effects of cannabis use is of paramount importance. Previous data suggest that cannabis use influences food intake, appetite, and metabolism, yet human research in this regard remains scant. The present study investigated the effects of cannabis administration, via different routes, on peripheral concentrations of appetitive and metabolic hormones in a sample of cannabis users. This was a randomized, crossover, double-blind, placebo-controlled study. Twenty participants underwent four experimental sessions during which oral cannabis, smoked cannabis, vaporized cannabis, or placebo was administered. Active compounds contained 6.9 ± 0.95% (~50.6 mg) …

First Pass Effect In Patients Treated With The Trevo Stent-Retriever: A Track Registry Study Analysis., Maxim Mokin, Christopher T. Primiani, 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, Anie Q. Majjhoo, Mouhammed R. Kabbani, Michael T. Froehler, Ira Finch, Sameer A. Ansari, Roberta Novakovic, Thanh N. Nguyen, Osama O. Zaidat

Department of Radiology Faculty Papers

Background and Objective: The first pass effect (FPE; achieving complete recanalization with a single thrombectomy device pass) has been shown to be associated with higher rates of good clinical outcomes in patients with acute ischemic stroke. Here, we investigate clinical and radiographic factors associated with FPE in a large U.S. post-marketing registry (TRACK, Trevo Stent-Retriever Acute Stroke).

Methods: We analyzed the TRACK database (multicenter registry of 634 patients from 23 centers from March 2013 through August 2015), which 609 patients were included in the final analysis. FPE was defined as a single pass/use of device, TICI 2c/3 recanalization, and no …

Postoperative Delirium After Major Orthopedic Surgery., Michael K. Urban, Mayu Sasaki, Abigail M. Schmucker, Steven K. Magid

Student Papers, Posters & Projects

BACKGROUND: Postoperative delirium (POD) is one of the most common complications in older adult patients undergoing elective surgery. Few studies have compared, within the same institution, the type of surgery, risk factors and type of anesthesia and analgesia associated with the development of POD.

AIM: To investigate the following three questions: (1) What is the incidence of POD after non-ambulatory orthopedic surgery at a high-volume orthopedic specialty hospital? (2) Does surgical procedure influence incidence of POD after non-ambulatory orthopedic surgery? And (3) For POD after non-ambulatory orthopedic surgery, what are modifiable risk factors?

METHODS: A retrospective cohort study was conducted …

Long-Term Follow-Up Posthematopoietic Stem Cell Transplantation In A Japanese Patient With Type-Vii Mucopolysaccharidosis, Kenji Orii, Yasuyuki Suzuki, Shunji Tomatsu, Tadao Orii, Toshiyuki Fukao

Department of Pediatrics Faculty Papers

The effectiveness of hematopoietic stem cell transplantation (HSCT) for type-VII mucopolysaccharidosis (MPS VII, Sly syndrome) remains controversial, although recent studies have shown that it has a clinical impact. In 1998, Yamada et al. reported the first patient with MPS VII, who underwent HSCT at 12 years of age. Here, we report the results of a 22-year follow-up of that patient post-HSCT, who harbored the p.Ala619Val mutation associated with an attenuated phenotype. The purpose of this study was to evaluate changes in physical symptoms, the activity of daily living (ADL), and the intellectual status in the 34-year-old female MPS VII patient …

Iseqqc: A Tool For Expression-Based Quality Control In Rna Sequencing., Gaurav Kumar, Adam Ertel, George Feldman, Joan Kupper, Paolo Fortina

Department of Cancer Biology Faculty Papers

BACKGROUND: Quality Control in any high-throughput sequencing technology is a critical step, which if overlooked can compromise an experiment and the resulting conclusions. A number of methods exist to identify biases during sequencing or alignment, yet not many tools exist to interpret biases due to outliers.

RESULTS: Hence, we developed iSeqQC, an expression-based QC tool that detects outliers either produced due to variable laboratory conditions or due to dissimilarity within a phenotypic group. iSeqQC implements various statistical approaches including unsupervised clustering, agglomerative hierarchical clustering and correlation coefficients to provide insight into outliers. It can be utilized through command-line (Github: https://github.com/gkumar09/iSeqQC) …

Adverse Drug Effects Related To Multiday Ketamine Infusions: Multicenter Study., Andrew M. Mendelson, Lynn Kohan, Joseph Okai, Mariam Wanees, Joseph C. Gonnella, Marc C. Torjman, Eugene R. Viscusi, Eric S. Schwenk

Department of Anesthesiology Faculty Papers

No abstract provided.

The Zoom Picture Book Game: A Creative Way To Promote Teamwork In Undergraduate Medical Education., Xiao Chi Zhang, Arjun Balakumar, Carlos Rodriguez, Anthony Sielicki, Dimitrios Papanagnou

Department of Emergency Medicine Faculty Papers

Effective team building and leadership are crucial in running an effective and safe healthcare system with improved patient care and clinical outcomes. Currently, there is a great demand for formal leadership training throughout the extensive medical education curriculum. We constructed an interactive team-building activity utilizing gamification-theory with the Zoom game. The Zoom activity requires a team of learners to organize a set of sequential images, each of which contains a "zoomed out" section from the previous image, into the correct order within a set time frame. Given the unique and approachable nature of this team-based activity, we propose the following: …

Predictors Of Impending Acute Chest Syndrome In Patients With Sickle Cell Anaemia., Salam Alkindi, Ikhlas Al-Busaidi, Bushra Al-Salami, Samir Raniga, Anil Pathare, Samir K. Ballas

Cardeza Foundation for Hematologic Research

Acute chest syndrome (ACS) is a major complication of sickle cell anaemia (SCA) and a leading cause for hospital admissions and death. We aimed to study the spectrum of clinical and laboratory features of ACS and to assess the predisposing factors and predictors of severity. A retrospective case-control cohort was studied by retrieving patient information from electronic medical records after ethical approval. One hundred adolescents and adults with SCA and hospital admissions for ACS were identified through the discharge summaries, along with 20 additional patients presenting with VOC, but without ACS (controls). Among the patients with ACS, fever (>38.5 …

Expression Of Tryptophan 2,3-Dioxygenase In Metastatic Uveal Melanoma, Mizue Terai, Eric R Londin, Ankit Rochani, Emma Link, Bao Lam, Gagan Kaushal, Alok Bhushan, Marlana Orloff, Takami Sato

Kimmel Cancer Center Faculty Papers

Uveal melanoma (UM) is the most common primary eye malignancy in adults and up to 50% of patients subsequently develop systemic metastasis. Metastatic uveal melanoma (MUM) is highly resistant to immunotherapy. One of the mechanisms for resistance would be the immune-suppressive tumor microenvironment. Here, we have investigated the role of tryptophan 2,3-dioxygenase (TDO) in UM. Both TDO and indoleamine 2,3-dioxygenase (IDO) catalyze tryptophan and produce kynurenine, which could cause inhibition of T cell immune responses. We first studied the expression of TDO on tumor tissue specimens obtained from UM hepatic metastasis. High expression of TDO protein was confirmed in all …

A Step Towards Personalizing Next Line Therapy For Resected Pancreatic And Related Cancer Patients: A Single Institution's Experience, Cinthya Y. Lowder, Teena Dhir, Austin B. Goetz, Henry L. Thomsett, Joseph Bender, Talar Tatarian, Subha Madhavan, Emanuel F. Petricoin, Edik Blais, Harish Lavu, Jordan M. Winter, James Posey Iii, Jonathan Brody, Michael J. Pishvaian, Charles J. Yeo

Department of Surgery Faculty Papers

Background: There is a lack of precision medicine in pancreatic ductal adenocarcinoma (PDA) and related cancers, and outcomes for patients with this diagnosis remain poor despite decades of research investigating this disease. Therefore, it is necessary to explore novel therapeutic options for these patients who may benefit from personalized therapies.

Objective: Molecular profiling of hepatopancreaticobiliary malignancies at our institution, including but not limited to PDA, was initiated to assess the feasibility of incorporating molecular profiling results into patient oncological therapy planning.

Methods: All eligible patients from Thomas Jefferson University (TJU) with hepatopancreaticobiliary tumors including PDA, who agreed to molecular testing …

Robotic Adrenalectomy For Functional Adenoma In Second Trimester Treats Worsening Hypertension, Courtney Capella, Bs, Joseph Godovchik, Bs, May Jean Counsilman, Md, Thenappan Chandrasekar, Md, Costas D. Lallas, Md, Huda B. Al-Kouatly, Md

Department of Obstetrics and Gynecology Posters

Robotic adrenalectomy is a feasible surgical alternative in the second trimester and can reverse the hypertensive disease and its associated maternal-fetal complications

Improving Utilization Of Aspirin For Prevention Of Preeclampsia In A High Risk Urban Cohort, Rupsa C. Boelig, Md, Mariam Wanees, Ba, Vincenzo Berghella, Md, Amanda Roman, Md

Department of Obstetrics and Gynecology Posters

High risk women without a history of preeclampsia were less likely to be recommended aspirin for preeclampsia prevention. A simple screening tool at 1st trimester ultrasound can significantly improve aspirin utilization for preeclampsia prevention