Medical Specialties Commons^™

Case Report: Thyrotoxic Pediodic Paralysis, Jesse Edwards, Md

The Medicine Forum

Introduction:

Thyrotoxic Periodic Paralysis (TPP) presents as a triad of acute attacks of muscle weakness, hypokalemia, and thyrotoxicosis. TPP was first described in East Asian countries, specifically Japan and China, where it was found to occur at an overall incidence of 2% and preferentially affected males.1,2 TPP also develops in other ethnicities, however, and given the growing ethnic heterogeneity of global society, it is becoming increasingly important for all physicians to be familiar with the diagnosis and management of TPP. The following case represents a typical presentation of TPP and serves as a valuable resource for informing our differential diagnoses …

Clinical Images: Sigmoid Volvulus, Divya Chalikonda, Md, Brian Lutman, Do, Alan Gandler, Md

The Medicine Forum

Case Presentation:

A 72-year-old male with a history of Parkinson's disease, Type 2 diabetes, hypertension, hyperlipidemia, and cerebral vascular accident presented to the emergency room for 10 minutes of unresponsiveness at his nursing home. A workup for the unresponsiveness was unrevealing. His hospital course was complicated by constipation, a condition that resulted in multiple hospitalizations in the prior 6 months. Abdominal exam was notable for mild distension, and an initial x-ray demonstrated an ileus. The severity of his distention acutely worsened two days after it was initially noted, and was associated with borborygmi and high-pitched bowel sounds. A repeat x-ray …

Clinical Images: Physical Diagnosis: When Blue Is A Clue, Matthew A. Murphy, Md

The Medicine Forum

Figure 1:

The classic blue sclera of a patient with type 1 osteogenesis imperfecta. Due to a defect in type 1 collagen, the overlying sclera is abnormally thin, resulting in increased visibility of the underlying choroidal veins and the blue color of the eyes. This patient also had a history of more than forty bone fractures throughout his life.

Table Of Contents: The Medicine Forum Volume 18, 2016-2017

The Medicine Forum

Table of Contents: The Medicine Forum Volume 18, 2016-2017

From The Editors, Neha Bansal Etherington, Md, Shuwei Wang, Md, Anita Modi, Md, Debbie Chen, Md, Jad Al Danaf, Md

The Medicine Forum

Dear Students, Residents, Faculty, and Friends of the Forum,

We are delighted to present you with the 18th annual edition of The Medicine Forum. Each year, we continue to be humbled by the dedication and passion of our students, mentors and colleagues and thankful for the opportunity to work with and among them.

At Jefferson, we are privileged to treat a diverse and complex panel of patients in the heart of Philadelphia, making this institution and this city a wonderful place to learn medicine. The backbone of The Medicine Forum has always been a place for Jefferson students, residents, and …

From The Desk Of The Residency Director, Emily Stewart, Md

The Medicine Forum

It has been another wonderful year in the Jefferson Internal Medicine Residency Program. Our program continues to train the best and brightest residents in the country. During the three years we are fortunate to have them at our program. It is my distinct pleasure to watch them grow into confident, dedicated, compassionate clinicians. The residents are not just outstanding clinicians but excel in all aspects of medicine including research, humanities and medical education.

Plk2 Plays An Essential Role In High D-Glucose-Induced Apoptosis, Ros Generation And Inflammation In Podocytes., Hong-Hong Zou, Ping-Ping Yang, Tian-Lun Huang, Xiao-Xu Zheng, Gao-Si Xu

Medicine Faculty Publications

Diabetic kidney disease (DKD) is a serious complication of hyperglycemia. Currently, there is no effective therapeutic intervention for DKD. In this study, we sought to provide a set of gene profile in diabetic kidneys. We identified 338 genes altered in diabetes-induced DKD glomeruli, and PLK2 exhibited the most dramatic change. Gene set enrichment analysis (GSEA) indicated multiple signaling pathways are involved DKD pathogenesis. Here, we investigated whether PLK2 contributes to podocyte dysfunction, a characteristic change in the development of DKD. High D-glucose (HDG) significantly increased PLK2 expression in mouse podocytes. Suppressing PLK2 attenuated HDG-induced apoptosis and inflammatory responses both in …

Discoidin Domain Receptor 1 Modulates Insulin Receptor Signaling And Biological Responses In Breast Cancer Cells., Veronica Vella, Roberta Malaguarnera, Maria Luisa Nicolosi, Chiara Palladino, Cristina Spoleti, Michele Massimino, Paolo Vigneri, Michele Purrello, Marco Ragusa, Andrea Morrione, Antonino Belfiore

Department of Urology Faculty Papers

The fetal isoform A of the insulin receptor (IR-A) is frequently overexpressed in a variety of malignancies including breast cancer. IR overexpression has a recognized role in cancer progression and resistance to anticancer therapies. In particular, IR-A has a peculiar mitogenic potential and is activated not only by insulin but also by IGF-2. Previously, we identified discoidin domain receptor 1 (DDR1) as a new IR-A interacting protein. DDR1, a non-integrin collagen tyrosine kinase receptor, is overexpressed in several malignancies and plays a role in cancer progression and metastasis.We now evaluated whether DDR1 is able to exert a role in breast …

Disseminated Nocardia Cyriacigeorgia Causing Pancreatitis In A Haploidentical Stem Cell Transplant Recipient., Jason Chen, Md, Jonathan Pan, Md, Joanne Filicko-O'Hara, Margaret Kasner, Phyllis Flomenberg

Department of Medicine Faculty Papers

We report the first published case of acute pancreatitis secondary to disseminated nocardiosis in a hematopoietic stem cell transplant (HSCT) recipient on chronic immunosuppression for graft-versus-host disease (GVHD). Nocardiosis in the HSCT population is relatively rare, and has not yet been described in haploidentical HSCT recipients. Our patient is a 28-year-old male with a history of haploidentical HSCT and GVHD of the skin and lung who was admitted to the hospital with acute pancreatitis. The workup for the etiology of his pancreatitis was initially unrevealing. He subsequently developed worsening sepsis and respiratory failure despite broad spectrum antimicrobials. After multiple bronchoscopies …

Pembrolizumab-Associated Hypothyroidism: Case Report And Review Of Literature, Niranjan Tachamo, Saroj Lohani, Salik Nazir, Rishikesh Joshi, Mrunalini Deshmukh

Reading Hospital Internal Medicine Residency

Pembrolizumab is a Programmed Death 1 (PD-1) inhibitor used to treat advanced malignant melanoma and metastatic non-small cell lung cancer. It causes various endocrinological side effects including immune mediated thyroiditis. Thyroiditis caused by Pembrolizumab can mimic other immune mediated thyroiditis like Hashimoto thyroiditis and Grave’s disease.

Cytotoxicity Of Platinum Anticancer Drugs In Mammalian Cell Lines Of Metastatic Cancer, Hosannah Evie

Mahurin Honors College Capstone Experience/Thesis Projects

With the invention of advanced technology, focus has been put on understanding and looking for potential cures for many diseases, one of which is cancer. The difference in the leaving and non-leaving ligands of the FDA approved cancer drugs contributes to the differential cell specific cytotoxic effects. These drugs such as oxaliplatin approved for colorectal cancer, cisplatin approved for testicular cancer, and their analogs were used to treat different cancer cell lines in an MTT assay. This project aims to determine how changing the molecular shape of these compounds affects their uptake and toxicity into different cell lines. The assay …

Investigating The Synergistic Effects Of Cisplatin And Two Curcuminoid Compounds On Cancer, Denis Hodzic

Mahurin Honors College Capstone Experience/Thesis Projects

Cisplatin is an anti-cancer drug effective against several cancers which can produce the serious side-effect of hearing loss. Curcumin, a natural plant compound, can increase the activity of cisplatin against cancer and counteract cisplatin’s effect against hearing. Because curcumin exhibits poor bioavailability, there is considerable interest in developing synthetic curcumin analogs (curcuminoids) that are more soluble and which retain anti-cancer activity and otoprotective function. This study investigated whether two curcuminoids, EF-24 and CLEFMA, increase the cytotoxic and ototoxic effects of cisplatin against the lung cancer cell line, A549, and the colorectal cancer cell line, Caco2. Cytotoxicity was measured by using …

Assessment Of Endpoint Criteria And Perceived Barriers During Maximal Cardiorespiratory Testing Among Pregnant Women, Caitlin Hesse

Mahurin Honors College Capstone Experience/Thesis Projects

PURPOSE: Plateau in oxygen consumption (VO₂) is the primary indicator for determining if an individual has reached their true maximal aerobic capacity (Howley et al., 1995). Although age and gender-specific secondary criteria (i.e. additional criteria that can be used to identify one’s attainment of maximal effort) have been developed for the healthy population, no secondary criteria have been established for pregnant women (Edvarsen et al., 2014). The primary purpose of this study was to analyze secondary endpoint criteria during VO_2max testing among pregnant women during the 2nd trimester. A secondary purpose was to identify emotional and physical …

My Crown And Glory: Community, Identity, Culture, And Black Women’S Concerns Of Hair Product-Related Breast Cancer Risk, Dede K. Teteh, Susanne B. Montgomery, Sabine Monice, Laura Stiel, Phyllis Y. Clark, Eudora Mitchell

Health Sciences and Kinesiology Faculty Articles

Breast cancer (BC) incidence rates for Black and non-Hispanic White women have recently converged; however, Black women continue to die at higher rates from the disease. Black women also use hair products containing hormonally active chemicals at higher rates than other races and ethnic groups. Studies now link chemical components in hair and personal care products to breast cancer risk. Using a community-based participatory research approach, this qualitative study explored community concerns about the role of hair products on breast cancer risk. Focus groups and key informant interviews using triangulation to assure relevant perspectives (women with and without breast cancer …

A Functional Algorithm For Weight Loss And Obesity Practice: Guide For Clinical Decision-Making For Treating Women, Jennifer A. Tice Williams

Dissertations

ABSTRACT

Background

Overweight and obesity have significant impact and consequences on women leading to reduced quality of life, comorbid conditions and premature mortality. Many healthcare providers lack adequate training and the time to properly treat overweight and obesity. Algorithms have been shown to improve clinical knowledge and save time.

Objectives

To develop an algorithm for weight loss assessment and treatment to aid in the clinical decision-making process while improving the quality of care for overweight and obese clients in an efficient manner that can be replicated.

Methods

After an extensive literature review to identify best-practice guidelines for weight loss a …

Efficient Synthesis Of Cn2097 Using In Situ Activation Of Sulfhydryl Group, Shaban Darwish, Keykavous Parang, John Marshall, Dennis J. Goebel, Rakesh Tiwari

Pharmacy Faculty Articles and Research

CN2097 (R₇Cs-sCYK[KTE(β-Ala)]V) is a rationally designed peptidomimetic that shows effectiveness in preclinical models for the treatment of neurological disorders, such as Angelman syndrome, traumatic brain injury (TBI), and stroke. Because of its potential therapeutic activity for the treatment of human CNS disorders, there was an urgent need to develop an efficient strategy for large-scale synthesis of CN2097. The synthesis of CN2097 was accomplished using Fmoc/tBu solid phase chemistry in multiple steps. Two different peptide fragments (activated polyarginine peptide Npys-sCR₇ and CYK[KTE(β-Ala)]V) were synthesized, followed by solution phase coupling in water. Activation of the polyarginine (CR₇) …

Degenerative Changes Of The Canine Cervical Spine After Discectomy Procedures, An In Vivo Study., Peter Grunert, Yu Moriguchi, Brian P Grossbard, Rodolfo J Ricart Arbona, Lawrence J Bonassar, Roger Härtl

Articles, Abstracts, and Reports

BACKGROUND: Discectomies are a common surgical treatment for disc herniations in the canine spine. However, the effect of these procedures on intervertebral disc tissue is not fully understood. The objective of this study was to assess degenerative changes of cervical spinal segments undergoing discectomy procedures, in vivo.

RESULTS: Discectomies led to a 60% drop in disc height and 24% drop in foraminal height. Segments did not fuse but showed osteophyte formation as well as endplate sclerosis. MR imaging revealed terminal degenerative changes with collapse of the disc space and loss of T2 signal intensity. The endplates showed degenerative type II …

Development Of Bone Targeting Drugs., Molly Stapleton, Kazuki Sawamoto, Carlos J. Alméciga-Díaz, William G. Mackenzie, Robert W. Mason, Tadao Orii, Shunji Tomatsu

Department of Pediatrics Faculty Papers

The skeletal system, comprising bones, ligaments, cartilage and their connective tissues, is critical for the structure and support of the body. Diseases that affect the skeletal system can be difficult to treat, mainly because of the avascular cartilage region. Targeting drugs to the site of action can not only increase efficacy but also reduce toxicity. Bone-targeting drugs are designed with either of two general targeting moieties, aimed at the entire skeletal system or a specific cell type. Most bone-targeting drugs utilize an affinity to hydroxyapatite, a major component of the bone matrix that includes a high concentration of positively-charged Ca(2+). …

Establishment Of An Orthotopic Patient-Derived Xenograft Mouse Model Using Uveal Melanoma Hepatic Metastasis., Ken Kageyama, Masahiro Ohara, Kengo Saito, Shinji Ozaki, Mizue Terai, Michael J. Mastrangelo, Paolo Fortina, Andrew E. Aplin, Takami Sato

Department of Medical Oncology Faculty Papers

BACKGROUND: Metastatic uveal melanoma is a highly fatal disease; most patients die from their hepatic metastasis within 1 year. A major drawback in the development of new treatments for metastatic uveal melanoma is the difficulty in obtaining appropriate cell lines and the lack of appropriate animal models. Patient-derived xenograft (PDX) tumor models, bearing ectopically implanted tumors at a subcutaneous site, have been developed. However, these ectopically implanted PDX models have obstacles to translational research, including a low engraftment rate, slow tumor growth, and biological changes after multiple passages due to the different microenvironment. To overcome these limitations, we developed a …

The Indirect Efficacy Comparison Of Dna Methylation In Sputum For Early Screening And Auxiliary Detection Of Lung Cancer: A Meta-Analysis, Di Liu, Hongli Peng, Qi Sun, Zhongyoa Zhao, Xinwei Yu, Siqi Ge, Hao Wang, Honghong Fang, Qing Gao, Jiaonan Liu, Lijuan Wu, Manshu Song, Youxin Wang

Research outputs 2014 to 2021

Background

DNA methylation in sputum has been an attractive candidate biomarker for the non-invasive screening and detection of lung cancer.

Materials and Methods

Databases including PubMed, Ovid, Cochrane library, Web of Science databases, Chinese Biological Medicine (CBM), Chinese National Knowledge Infrastructure (CNKI), Wanfang, Vip Databases and Google Scholar were searched to collect the diagnostic trials on aberrant DNA methylation in the screening and detection of lung cancer published until 1 December 2016. Indirect comparison meta-analysis was used to evaluate the diagnostic value of the included candidate genes.

Results

The systematic literature search yielded a total of 33 studies including a …

Outcomes Of Post-Neurosurgical Ventriculostomy-Associated Infections, Muhammad Ehsan Bari, Ghani Haider, Komail Malik, Muhammad Waqas, Syed Faisal Mahmood, Mubbashira Siddiqui

Section of Neurosurgery

Background: Ventriculostomy-associated infection (VAI) is a major concern to physicians. Limited studies have looked at the outcomes of external ventricular drain (EVD) infection and predictors of unfavorable outcomes. In this study, we assessed the outcomes of EVD infection and predictors of unfavorable outcomes.
Methods: This was a retrospective medical chart review, conducted at the Aga Khan University Hospital. All the patients irrespective of age and gender, fulfilling the diagnostic criteria of VAI were included. Patients with preexisting bacterial meningitis or ventriculitis were excluded from the study. Outcome assessment was based on Glasgow outcome scale (GOS) at 1 and 3 months …

Chemical Modulation Of Cancer Cells To Enhance Tumor Immunity, Florisela Herrejon Chavez

PSU McNair Scholars Online Journal

Breakthroughs in immunotherapy have led to cancer therapeutics that activate the immune system by blocking inhibitory mechanisms. This class of therapeutics has resulted in longer survival rates for cancer patients, some living over 10 years after being diagnosed as terminally ill. However, only a small fraction of patients who receive immunotherapy drugs respond favorably.Recent studies suggest that certain anticancer agents (both cytotoxic chemotherapeutics and targeted drugs) stimulate immune recognition of cancers. Identification of such immunomodulatory anticancer agents would make ideal partners for current immunotherapy treatments, thus increasing the proportion of the treated patients who benefit from immunotherapy. This study aimed …

Anxiety Associated Increased Cpg Methylation In The Promoter Of Asb1: A Translational Approach Evidenced By Epidemiological And Clinical Studies And A Murine Model, Rebecca T. Emeny, Jens Baumert, Anthony S. Zannas, Sonja Kunze, Simone Wahl, Stella Iurato

Dartmouth Scholarship

Epigenetic regulation in anxiety is suggested, but evidence from large studies is needed. We conducted an epigenome-wide association study (EWAS) on anxiety in a population-based cohort and validated our finding in a clinical cohort as well as a murine model. In the KORA cohort, participants (n= 1522, age 32–72 years) were administered the Generalized Anxiety Disorder (GAD-7) instrument, whole blood DNA methylation was measured (Illumina 450K BeadChip), and circulating levels of hs-CRP and IL-18 were assessed in the association between anxiety and methylation. DNA methylation was measured using the same instrument in a study of patients with anxiety disorders recruited …

Calcineurin/Nfat Signaling In Activated Astrocytes Drives Network Hyperexcitability In AΒ-Bearing Mice, Pradoldej Sompol, Jennifer L. Furman, Melanie M. Pleiss, Susan D. Kraner, Irina A. Artiushin, Seth R. Batten, Jorge E. Quintero, Linda A. Simmerman, Tina L. Beckett, Mark A. Lovell, M. Paul Murphy, Greg A. Gerhardt, Christopher M. Norris

Sanders-Brown Center on Aging Faculty Publications

Hyperexcitable neuronal networks are mechanistically linked to the pathologic and clinical features of Alzheimer's disease (AD). Astrocytes are a primary defense against hyperexcitability, but their functional phenotype during AD is poorly understood. Here, we found that activated astrocytes in the 5xFAD mouse model were strongly associated with proteolysis of the protein phosphatase calcineurin (CN) and the elevated expression of the CN-dependent transcription factor nuclear factor of activated T cells 4 (NFAT4). Intrahippocampal injections of adeno-associated virus vectors containing the astrocyte-specific promoter Gfa2 and the NFAT inhibitory peptide VIVIT reduced signs of glutamate-mediated hyperexcitability in 5xFAD mice, measured in vivo with …

A Protocol For Prospective Studies" "5-Hydroxyvitamin D, Leptin And B Ass Index In Relation To Cutaneou Elanoma Incidence And Survival, Jo S. Stenehjem, Tom K. Grimsrud, Judy R. Rees, Linda Vos, Ronnie Babigumira, Marit B. Veierød, Trude E. Robsahm

Dartmouth Scholarship

Introduction The incidence and mortality rates of

cutaneous melanoma (CM) are increasing among fai skinned populations worldwide. Ultraviolet radiation s the principal risk factor for CM, but is also the mai source of 25-hydroxyvitamin D (25(OH)D), which has associated with reduced risk and better prognosis of cancer types. However, both low and high 25(OH)D l have been associated with increased risk of CM. Obe as measured by body mass index (BMI) is associated risk of several cancers and has also been suggested risk factor for CM, and may also be related to insuffi 25(OH)D and/or high leptin levels. Moreover, contract …

Validating Candidate Congenital Heart Disease Genes In Drosophila., Jun-Yi Zhu, Yulong Fu, Adam Richman, Zhe Han

Pediatrics Faculty Publications

Genomic sequencing efforts can implicate large numbers of genes and de novo mutations as potential disease risk factors. A high throughput in vivo model system to validate candidate gene association with pathology is therefore useful. We present such a system employing Drosophila to validate candidate congenital heart disease (CHD) genes. The protocols exploit comprehensive libraries of UAS-GeneX-RNAi fly strains that when crossed into a 4×Hand-Gal4 genetic background afford highly efficient cardiac-specific knockdown of endogenous fly orthologs of human genes. A panel of quantitative assays evaluates phenotypic severity across multiple cardiac parameters. These include developmental lethality, larva and adult heart morphology, …

Use Of Social Adaptability Index To Explain Self-Care And Diabetes Outcomes, Jennifer A. Campbell, Rebekah J. Walker, Brittany L. Smalls, Leonard E. Egede

Center for Health Services Research Faculty Publications

Background: To examine whether the social adaptability index (SAI) alone or components of the index provide a better explanatory model for self-care and diabetes outcomes.

Methods: Six hundred fifteen patients were recruited from two primary care settings. A series of multiple linear regression models were run to assess (1) associations between the SAI and diabetes self-care/outcomes, and (2) associations between individual SAI indicator variables and diabetes self-care/outcomes. Separate models were run for each self-care behavior and outcome. Two models were run for each dependent variable to compare associations with the SAI and components of the index.

Results: The SAI has …

Igf2 Mrna Binding Protein 3 (Imp3) Promotes Glioma Cell Migration By Enhancing The Translation Of Rela/P65., Shruti Bhargava, Abhirami Visvanathan, Vikas Patil, Anuj Kumar, Santosh Kesari, Saumitra Das, Alangar S Hegde, Arimappamagan Arivazhagan, Vani Santosh, Kumaravel Somasundaram

Articles, Abstracts, and Reports

The diffusely infiltrative nature of glioblastoma (GBM) makes them highly recurrent. IGF2 mRNA-binding protein 3 (IMP3), a GBM upregulated RNA binding protein, promotes glioma cell migration. An integrative bioinformatics analysis identified p65 (RELA), a subunit of NF-κB heterodimer as a target and an important mediator of IMP3 promoted glioma cell migration. IMP3 increased p65 protein levels without any change in p65 transcript levels, but promoted its polysome association. RIP-PCR demonstrated the binding of IMP3 to p65 transcript. UV crosslinking experiments with in vitro transcribed RNA confirmed the specific and direct binding of IMP3 to sites on p65 3'UTR. Further, IMP3 …

Individual Patient-Level Meta-Analysis Of The Performance Of The Decipher Genomic Classifier In High-Risk Men After Prostatectomy To Predict Development Of Metastatic Disease., Daniel E. Spratt, Kasra Yousefi, Samineh Deheshi, Ashley E. Ross, Robert B. Den, Edward M. Schaeffer, Bruce J. Trock, Jingbin Zhang, Andrew G. Glass, Adam P. Dicker, Firas Abdollah, Shuang G Zhao, Lucia L.C. Lam, Marguerite Du Plessis, Voleak Choeurng, Zaid Haddad, Christine Buerki, Elai Davicioni, Sheila Weinmann, Stephen J. Freedland, Eric A. Klein, R. Jeffrey Karnes, Felix Y. Feng

Department of Radiation Oncology Faculty Papers

Purpose To perform the first meta-analysis of the performance of the genomic classifier test, Decipher, in men with prostate cancer postprostatectomy. Methods MEDLINE, EMBASE, and the Decipher genomic resource information database were searched for published reports between 2011 and 2016 of men treated by prostatectomy that assessed the benefit of the Decipher test. Multivariable Cox proportional hazards models fit to individual patient data were performed; meta-analyses were conducted by pooling the study-specific hazard ratios (HRs) using random-effects modeling. Extent of heterogeneity between studies was determined with the I(2) test. Results Five studies (975 total patients, and 855 patients with individual …

Ctrp3 Is A Novel Biomarker For Diabetic Retinopathy And Inhibits Hghl-Induced Vcam-1 Expression In An Ampk-Dependent Manner., Zheyi Yan, Jianli Zhao, Lu Gan, Yanqing Zhang, Rui Guo, Xiaoming Cao, Wayne Bond Lau, Xin Ma, Yajing Wang

Department of Emergency Medicine Faculty Papers

OBJECTIVES: Diabetic retinopathy (DR) is a severe complication of chronic diabetes. The C1q/TNF-related protein family (CTRPs) has been demonstrated to exert protective effects against obesity and atherosclerosis in animal studies. Heretofore, the association between circulating CTRPs and DR patients has been unexplored. In the current study, we attempt to define this association, as well as the effect of CTRPs upon DR pathophysiology.

DESIGN: The present investigation is a case control study that enrolled control subjects and type 2 diabetes mellitus (T2DM) patients diagnosed with DR. Serum CTRPs and sVACM-1 were determined by ELISA.

RESULTS: Serum CTRP3 and CTRP5 levels were …