Medical Specialties Commons^™

Diffuse Sclerosing Papillary Carcinoma In A Pediatric Patient With Intrauterine Diagnostic Xray Exposure, Luke O'Connor, Cheryl Rosenfeld, William Inabnet

Touro College of Osteopathic Medicine (Middletown) Publications and Research

Objective: The relationship between occurrence of childhood cancer and intrauterine exposure to radiation is well known. We describe a case of diffuse sclerosing papillary carcinoma (PTC) in a pediatric patient exposed to diagnostic radiation in utero.

Methods: Clinical presentation, including radiation history and outcome, was reported.

Case Presentation: A 14 year old male was referred for a thyroid cancer consultation in 2008. His history was notable for a rapidly growing thyroid mass during the preceding 3 months and in utero exposure to radiation, in the form of multiple xrays and CT scans, at 12 weeks gestation as a result of …

2015-2016 Pediatric Subspecialty Trainees, Children's Mercy Hospital

Residents and Fellows Portraits

Photo composite of the graduate pediatric trainees in allergy/immunology, child abuse pediatrics, child neurology, clinical child psychology, clinical cytogenetics, clinical pharmacology, developmental-behavioral pediatrics, neonatal-perinatal medicine, pediatric adolescent gynecology, pediatric & congenital cardiac perfusion, pediatric cardiology, pediatric critical care, pediatric dentistry, pediatric dermatology, pediatric emergency medicine, pediatric endocrinology, pediatric gastroenterology, pediatric hematology/oncology, pediatric hospital medicine, pediatric infectious diseases, pediatric nephrology, pediatric ophthalmology, pediatric optometry, pediatric otolaryngology, pediatric ophthalmology/optometry, pediatric otolaryngology, pediatric radiology, pediatric rehabilitation, pediatric surgery, pediatric residency and med/peds residency

Strategies For The Management Of Postoperative Anemia In Elective Orthopedic Surgery, Taylor D. Steuber, Meredith L. Howard, Sarah A. Nisly

Scholarship and Professional Work – COPHS

Objective: To assess the use of oral iron, intravenous (IV) iron, and erythropoiesis-stimulating agents (ESAs) for the prevention and management of perioperative anemia in elective orthopedic surgery patients, and to provide a clinical algorithm for use. Data Sources: A PubMed and MEDLINE search was conducted from 1964 through March 2016 using the following search terms alone or in combination: orthopedic, surgery, elective, anemia, blood transfusion, iron, erythropoiesisstimulating agents, and erythropoietin. Study Selection and Data Extraction: All English-language prospective and retrospective human studies and meta-analyses evaluating oral iron, IV iron, or ESA alone or in combination in elective orthopedic surgery …

The Impact Of An Implemented Scribe Program In Emergency Room Settings On Patient And Provider Satisfaction, Overall Patient Volume, And Emergency Room Cost Effectiveness, Kendra L. Kruger, Tara L. Tait

All Electronic Theses and Dissertations

The purpose of the study is to evaluate medical scribe programs in emergency room settings as to their role, impact on patient satisfaction, patient volume, and cost-effectiveness, as well as their perceived value by emergency room medical providers through survey methods. This prospective, quantitative research study obtained information via surveys of Emergency Physicians Professional Association (EPPA) providers concerning the value emergency room providers placed on the function and role of scribes in emergency room settings. The data obtained from the surveys was analyzed using correlation and comparison of means. The results of the study indicated that emergency room providers thought …

Awareness Of Antibiotic Resistance In The General Population As Related To Education Level, Rachel M. Cantlon, Emma Wilson

All Electronic Theses and Dissertations

An antibiotic is a drug, also known as an antimicrobial, which is used to treat infectious diseases caused by bacteria (National Institute of Allergy and Infectious Diseases (NIAID), 2012). The effect of antibiotic overuse and mistreatment with these drugs has led to infectious bacteria developing antibiotic resistance (Centers for Disease Control and Prevention (CDC), 2014). Antibiotic resistance results in at least 23,000 deaths each year in the United States alone (CDC, 2014). The purpose of this study was to evaluate the general population’s awareness of antibiotic resistance in regard to education level, and proper use of antibiotics as measured by …

Differential Rna Expression Profile Of Skeletal Muscle Induced By Experimental Autoimmune Myasthenia Gravis In Rats, Henry J. Kaminski, Keiichi Himuro, Jumana Alshaikh, Bendi Gong, Georgiama Cheng, Linda L. Kusner

Neurology Faculty Publications

The differential susceptibility of skeletal muscle by myasthenia gravis (MG) is not well understood. We utilized RNA expression profiling of extraocular muscle (EOM), diaphragm (DIA), and extensor digitorum (EDL) of rats with experimental autoimmune MG (EAMG) to evaluate the hypothesis that muscles respond differentially to injury produced by EAMG. EAMG was induced in female Lewis rats by immunization with acetylcholine receptor purified from the electric organ of the Torpedo. Six weeks later after rats had developed weakness and serum antibodies directed against the AChR, animals underwent euthanasia and RNA profiling performed on DIA, EDL, and EOM. Profiling results were validated …

Protective Role Of Dietary Curcumin In The Prevention Of The Oxidative Stress Induced By Chronic Alcohol With Respect To Hepatic Injury And Antiatherogenic Markers, Ravi Varatharajalu, Mamatha Garige, Leslie C Leckey, Karina Reyes-Gordillo, Ruchi Shah, M. Raj Lakshman

Biochemistry and Molecular Medicine Faculty Publications

No abstract provided.

T Cell/Histiocyte-Rich Large B Cell Lymphoma Of The Thymus: A Diagnostic Pitfall., Jie Xu, Xiaojun Wu, Vishnu Reddy

Pathology Faculty Publications

T cell/histiocyte-rich large B cell lymphoma (THRLBCL) is predominantly a nodal disease, with extranodal involvement, such as bone marrow, spleen, and liver. However, primary THRLBCL has never been reported in the thymus in the English literature. Here we report a case of THRLBCL presenting as mediastinal mass and lymphadenopathy. Based on the frozen section diagnosis of "thymoma," a 12 cm mass was excised. A year later she developed multiple enlarged lymph nodes and pulmonary nodules. Consultant review of the excised mediastinal mass showed scattered large atypical cells that were CD20+ and PAX-5+ and negative for pan-cytokeratin, AE1, and AE3, compatible …

Mitosis In Circulating Tumor Cells Stratifies Highly Aggressive Breast Carcinomas., Daniel L. Adams, Diane K. Adams, Steingrimur Stefansson, Christian Haudenschild, Stuart S. Martin, Monica Charpentier, Saranya Chumsri, Massimo Cristofanilli, Cha-Mei Tang, R Katherine Alpaugh

Pathology Faculty Publications

BACKGROUND: Enumeration of circulating tumor cells (CTCs) isolated from the peripheral blood of breast cancer patients holds promise as a clinically relevant, minimally invasive diagnostic test. However, CTC utility has been limited as a prognostic indicator of survival by the inability to stratify patients beyond general enumeration. In comparison, histological biopsy examinations remain the standard method for confirming malignancy and grading malignant cells, allowing for cancer identification and then assessing patient cohorts for prognostic and predictive value. Typically, CTC identification relies on immunofluorescent staining assessed as absent/present, which is somewhat subjective and limited in its ability to characterize these cells. …

Attitudes And Factors Affecting Acceptability Of Self-Administered Cervicovaginal Sampling For Human Papillomavirus (Hpv) Genotyping As An Alternative To Pap Testing Among Multiethnic Malaysian Women., Mahirah Ma'som, Nirmala Bhoo-Pathy, Nazrila Hairizan Nasir, Jerome Bellinson, Shridevi Subramaniam, Yuntong Ma, Siew-Hwei Yap, Pik-Pin Goh, Patti Gravitt, Yin Ling Woo

Global Health Faculty Publications

OBJECTIVE: The objective of this study was to determine the attitudes and acceptability of self-administered cervicovaginal sampling compared with conventional physician-acquired Papanicolaou (Pap) smear among multiethnic Malaysian women.

METHOD: A cross-sectional study was carried out via interviewer-administered surveys from August 2013 through August 2015 at five government-run, urban health clinics in the state of Selangor. Subjects were participants from an ongoing community-based human papillomavirus (HPV) prevalence study who answered a standard questionnaire before and after self-sampling. The cervicovaginal self-sampling for HPV genotyping was performed using a simple brush ('Just for Me'; Preventive Oncology International, Hong Kong). Detailed data on sociodemographics, …

Smallpox And Dracunculiasis: The Scientific Value Of Infectious Diseases That Have Been Eradicated Or Targeted For Eradication. Is Schistosomiasis Next?, Michael H. Hsieh, Margaret M. Mentink-Kane

Urology Faculty Publications

No abstract provided.

Examination Of Reticulocytosis Among Chronically Transfused Children With Sickle Cell Anemia., Megha Kaushal, Colleen Byrnes, Zarir Khademian, Natalie Duncan, Naomi L.C. Luban, Jeffery L Miller, Ross M. Fasano, Emily Riehm Meier

Pediatrics Faculty Publications

Sickle cell anemia (SCA) is an inherited hemolytic anemia with compensatory reticulocytosis. Recent studies have shown that increased levels of reticulocytosis during infancy are associated with increased hospitalizations for SCA sequelae as well as cerebrovascular pathologies. In this study, absolute reticulocyte counts (ARC) measured prior to transfusion were analysed among a cohort of 29 pediatric SCA patients receiving chronic transfusion therapy (CTT) for primary and secondary stroke prevention. A cross-sectional flow cytometric analysis of the reticulocyte phenotype was also performed. Mean duration of CTT was 3.1 ± 2.6 years. Fifteen subjects with magnetic resonance angiography (MRA) -vasculopathy had significantly higher …

Graduate Medical Education 2015-2016 Annual Report, Children's Mercy Hospital

GME Annual Reports

Annual report of the Children's Mercy Hospital Graduate Medical Education department, including pediatric residency, internal medicine/pediatrics residency, fellowship programs, medical students, continuing medical education, and library services.

Minimally Invasive Surgery In Pediatric Trauma: One Institution's 20-Year Experience, Gustavo Stringel, Min Li Xu, Joseph Lopez

NYMC Faculty Publications

BACKGROUND: Minimally invasive surgery (MIS) for trauma in pediatric cases remains controversial. Recent studies have shown the validity of using minimally invasive techniques to decrease the rate of negative and nontherapeutic laparotomy and thoracotomy. The purpose of this study was to evaluate the diagnostic accuracy and therapeutic options of MIS in pediatric trauma at a level I pediatric trauma center.

METHODS: We reviewed cases of patients aged 15 years and younger who had undergone laparoscopy or thoracoscopy for trauma in our institution over the past 20 years. Each case was evaluated for mechanism of injury, computed tomographic (CT) scan findings, …

Interpreting Patient-Reported Outcomes From Clinical Trials In Copd: A Discussion, Paul W. Jones, Stephen I. Rennard, Maggie Tabberer, John H. Riley, Mitra Vahdati-Bolouri, Neil C. Barnes

Journal Articles: Pulmonary & Critical Care Med

One of the challenges faced by the practising physician is the interpretation of patient-reported outcomes (PROs) in clinical trials and the relevance of such data to their patients. This is especially true when caring for patients with progressive diseases such as COPD. In an attempt to incorporate the patient perspective, many clinical trials now include assessments of PROs. These are formalized methods of capturing patient-centered information. Given the importance of PROs in evaluating the potential utility of an intervention for a patient with COPD, it is important that physicians are able to critically interpret (and critique) the results derived from …

Upregulation Of Rgs2: A New Mechanism For Pirfenidone Amelioration Of Pulmonary Fibrosis, Yan Xie, Haihong Jiang, Qian Zhang, Suneet Mehrotra, Peter W. Abel, Myron L. Toews, Dennis W. Wolff, Stephen I. Rennard, Reynold A. Panettieri, Thomas B. Casale, Yaping Tu

Journal Articles: Pulmonary & Critical Care Med

BACKGROUND: Pirfenidone was recently approved for treatment of idiopathic pulmonary fibrosis. However, the therapeutic dose of pirfenidone is very high, causing side effects that limit its doses and therapeutic effectiveness. Understanding the molecular mechanisms of action of pirfenidone could improve its safety and efficacy. Because activated fibroblasts are critical effector cells associated with the progression of fibrosis, this study investigated the genes that change expression rapidly in response to pirfenidone treatment of pulmonary fibroblasts and explored their contributions to the anti-fibrotic effects of pirfenidone.

METHODS: We used the GeneChip microarray to screen for genes that were rapidly up-regulated upon exposure …

Effects Of Roflumilast In Copd Patients Receiving Inhaled Corticosteroid/Long-Acting Β2-Agonist Fixed-Dose Combination: Re(2)Spond Rationale And Study Design, Stephen I. Rennard, Fernando J. Martinez, Klaus F. Rabe, Sanjay Sethi, Emilio Pizzichini, Andrew Mcivor, Shahid Siddiqui, Antonio Anzueto, Haiyuan Zhu

Journal Articles: Pulmonary & Critical Care Med

BACKGROUND: Roflumilast, a once-daily, selective phosphodiesterase-4 inhibitor, reduces the risk of COPD exacerbations in patients with severe COPD associated with chronic bronchitis and a history of exacerbations. The RE(2)SPOND study is examining whether roflumilast, when added to an inhaled corticosteroid/long-acting β2-agonist (ICS/LABA) fixed-dose combination (FDC), further reduces exacerbations. The methodology is described herein.

METHODS: In this Phase IV, multicenter, double-blind, placebo-controlled, parallel-group trial, participants were randomized 1:1 (stratified by long-acting muscarinic antagonist use) to receive roflumilast or placebo, plus ICS/LABA FDC, for 52 weeks. Eligible participants had severe COPD associated with chronic bronchitis, had two or more moderate-severe exacerbations within …

Effect Of Tiotropium On Night-Time Awakening And Daily Rescue Medication Use In Patients With Copd, Peter M.A. Calverley, Stephen I. Rennard, Emmanuelle Clerisme-Beaty, Norbert Metzdorf, Valentina Bayer Zubek, Richard Zuwallack

Journal Articles: Pulmonary & Critical Care Med

BACKGROUND: Several small studies found night-time awakenings due to COPD symptoms were associated with decreased health status. In this study, night-time awakenings in patients with COPD were examined and effects of tiotropium therapy evaluated.

METHODS: This study was a post hoc, exploratory, pooled analysis of twin, multicenter, double-blind, randomized, placebo-controlled, parallel-group trials. Patients with stable moderate-to-severe COPD were randomized to tiotropium HandiHaler® (n = 550) or placebo (n = 371) and followed for 13 weeks. During a 2-week, pre-treatment baseline period and for 13 weeks on treatment, self-reported night-time awakenings due to COPD symptoms, rescue medication (albuterol) use, and morning …

Doctor Of Osteopathic Medicine Curriculum, Nova Southeastern University

Health Professions Divisions Course Catalogs and Course Descriptions

No abstract provided.

Com Outlook Winter 2016, College Of Osteopathic Medicine

COM Outlook

No abstract provided.

Lineage-Specific Differences In The Gp120 Inner Domain Layer 3 Of Human And Simian Immunodeficiency Viruses, Shilei Ding, Halima Medjahed, Jérémie Prévost, Mathieu Coutu, Shi-Hua Xiang, Andrés Finzi

Nebraska Center for Virology: Faculty Publications

Binding of HIV-1 and SIV gp120 exterior envelope glycoprotein to CD4 triggers conformational changes in gp120 that promote its interaction with one of the chemokine receptors, usually CCR5, ultimately leading to gp41-mediated virus-cell membrane fusion and entry. We previously described that topological Layers (Layer 1, Layer 2 and Layer 3) in the gp120 inner domain contribute to gp120-trimer association in the unliganded state but also help secure CD4 binding. Relative to Layer 1 of HIV-1 gp120, the SIVmac239 gp120 Layer 1 plays a more prominent role in maintaining gp120-trimer association but is minimally involved in promoting CD4 binding, which could …

How To Manage Knee Arthritis: Best Practices For Treatment Prior To Orthopaedic Referral, Ali Oliashirazi Md, Alex Caughran Md, Zain Quazi Md, Grant Buchanan Md, Akash Sharma, Franklin D. Shuler Md, Phd

Orthopaedics

Osteoarthritis (OA) of the knee is a debilitating disease in which degeneration of the joint space cartilage can lead to life-altering pain and stiffness. The prevalence of OA has a strong correlation with age, with evidence of radiographic knee OA found in 37.4% of persons older than 60 years of age. According to the Agency for Healthcare Research and Quality’s (AHRQ) 2013 report, osteoarthritis was ranked the second most expensive condition for Medicare and private insurers, with over 90% of the hospitalizations for OA involving a knee or hip replacement. It is projected that by 2030 the number of primary …

Delaying Chemotherapy In The Treatment Of Stage Iv Non-Small Cell Lung Cancer Does Not Adversely Affect Survival Outcome, Mohammad Mozayen Md, Mohamed Alsharedi, Inderjit Mehmi, Todd W. Gress Md, Maria Tria Tirona Md

Biochemistry and Microbiology

Background: Whether a delay in the initiation of chemotherapy for advanced non-small cell lung cancer (NSCLC) can affect overall survival is not well studied. We aim to evaluate the effect of the time interval between diagnosis and initiation of chemotherapy on overall survival in patients with stage IV NSCLC.

Methods: A retrospective review of newly diagnosed stage IV NSCLC patients who received chemotherapy between 1995 and 2012 was conducted. Demographics, histology and site(s) of metastases of patients were reviewed. Time interval between the date of diagnosis and the date of starting chemotherapy was calculated in days. Patients were divided in …

Adiposity Predicts Pulse Pressure In Subjects With Chronic Kidney Disease: Data From The Modification Of Diet In Renal Disease, Preeya T. Shah Phd, Rebecca Martin, Juan R. Sanabria, Zeid Khitan Md, Prasanna Santhanam, Komal Sodhi, Nader G. Abraham, Joseph I. Shapiro Md

Biochemistry and Microbiology

Obesity is a known risk factor for hypertension, but the mechanisms by which this occurs are still unclear. As the body mass index (BMI) is frequently used to define obesity, but the BMI does not distinguish between adipose and other tissues, we sought to develop another index of obesity. We decided to look at the ratio of BMI to urinary creatinine excretion as the latter measurement is believed to be an index of muscle mass. We used data from the modification of diet in renal disease (MDRD) study as urinary creatinine collections and blood pressure measurements were readily available in …

Gallic Acid, A Phenolic Compound, Exerts Anti-Angiogenic Effects Via The Pten/Akt/Hif-1Α/Vegf Signaling Pathway In Ovarian Cancer Cells, Zhiping He, Allen Y. Chen, Yon Rojanasakul, Gary O. Rankin, Yi Charlie Chen

Pharmacology, Physiology and Toxicology

Gallic acid (GA), a polyphenol, is widely found in numerous fruits and vegetables, particularly in hickory nuts. In the present study, we found that gallic acid, a natural phenolic compound isolated from fruits and vegetables, had a more potent growth inhibitory effect on two ovarian cancer cell lines, OVCAR-3 and A2780/CP70, than the effect on a normal ovarian cell line, IOSE-364. These results demonstrated that GA selectively inhibits the growth of cancer cells. Gene expression was examined by ELISA and western blot analysis, and gene pathways were examined by luciferase assay. It was found that GA inhibited VEGF secretion and …

Principles Of Fatigue In Residency Education: A Qualitative Study, Taryn S Taylor, Christopher J Watling, Pim W Teunissen, Tim Dornan, Lorelei Lingard

Obstetrics & Gynaecology Publications

BACKGROUND: Proposals to implement fatigue-management strategies in residency education assume that medicine shares the view of other risk-adverse industries that fatigue is hazardous. This view is an essential underpinning of fatigue-management strategies that other industries have embedded as part of their workplace occupational health and safety programs. We sought to explore how residents understand fatigue in the context of their training environment.

METHODS: We interviewed 21 residents in 7 surgical and nonsurgical programs at Western University in 2014. All participants met the inclusion criteria of routinely working 24-hour call shifts while enrolled in their training program. Data collection and analysis …

Rac1 Signaling Is Required For Anterior Second Heart Field Cellular Organization And Cardiac Outflow Tract Development, Carmen Leung, Yin Liu, Xiangru Lu, Mella Kim, Thomas A. Drysdale, Qingping Feng

Paediatrics Publications

Background-The small GTPase Rac1 regulates diverse cellular functions, including both apicobasal and planar cell polarity pathways; however, its role in cardiac outflow tract (OFT) development remains unknown. In the present study, we aimed to examine the role of Rac1 in the anterior second heart field (SHF) splanchnic mesoderm and subsequent OFT development during heart morphogenesis. Methods and Results-Using the Cre/loxP system, mice with an anterior SHF-specific deletion of Rac1 (Rac1SHF) were generated. Embryos were collected at various developmental time points for immunostaining and histological analysis. Intrauterine echocardiography was also performed to assess aortic valve blood flow in embryos at embryonic …

Is Testosterone Detrimental To Renal Function?, Guido Filler, Amanda Ramsaroop, Robert Stein, Claire Grant, Raanan Marants, Aaron So, Christopher Mcintyre

Paediatrics Publications

No abstract provided.

January 2016, New England Osteopathic Heritage Center

New England Osteopathic Heritage Center Newsletter

Annual newsletter created by the New England Osteopathic Heritage Center in January 2016.

Burnout’S Prevalence Estimations: A House Of Cards?, Renzo Bianchi, Irvin Sam Schonfeld, Eric Laurent

Publications and Research

Elmariah et al. (2016) found that 65% of the internal medicine residents who were assessed suffered from burnout. We have 3 concerns about the conclusion. First, the authors used a cutoff score on a burnout measure that is problematic because (a) it is devoid of theoretical or clinical grounding and (b) burnout items were formatted in an unorthodox manner, and (c) including residents who responded "neutral" to a symptom item among those identified as burned out. Second, the authors identified as burned out residents who worked on the night float rotation although the data suggest otherwise. Third information on symptom …