Medical Specialties Commons^™

Challenge In Diagnosis And Management Of Lentigo Maligna And Lentigo Maligna Melanoma, Ika Anggraini, Elisa Miranda, Larisa Paramitha Wibawa, Roro Inge Ade Krisanti, Adhimukti T. Sampurna

Journal of General - Procedural Dermatology and Venereology Indonesia

Lentigo maligna (LM) is a subtype of melanoma in situ, which can evolve into lentigo maligna melanoma (LMM) if treated inadequately. LM and LMM are usually found on chronically sun damaged skin such as the face (cheek and nose) of the elderly on seventh or eight decades. Clinical manifestation of LM may be quite subtle, so early diagnosis is difficult to perform.The treatment of LM and LMM are challenging due to ill-defined clinical margin, predilection on the face with great size, and preponderance of the elderly, which are potential for recurrency and progressiveness from LM into LMM.

Clinician Attitudes About Health Care Services Addressing Adverse Childhood Experiences, Chris C. Sexton, Briana A. Woods-Jaeger, Bridget Cho, Kathy Goggin

Manuscripts, Articles, Book Chapters and Other Papers

Objectives

Study objectives were to elicit feedback from clinical experts in areas with demonstrated health disparities to assess: (1) Perceptions of the relations among Adverse Childhood Experiences (ACEs), parenting, and childhood health disparities; and (2) Recommendations about pediatric health care services to address ACEs and toxic stress.

Methods

Qualitative interviews were conducted with clinical experts (n = 5) in pediatric primary care, asthma and allergy, obesity, and trauma. Interviews were transcribed and coded through iterative thematic extraction.

Results

Two major themes emerged: (1) Need for improved health care access; and (2) Need for family-centered care. Clinicians reported several health care …

Effectiveness Of Transcutaneous Bilirubin Measurement In Managing Neonatal Jaundice In Postnatal Ward Of A Tertiary Care Hospital In Pakistan, Ali Shabbir Hussain, Muhammad Hussain Shah, Maryam Lakhdir, Shabina Ariff, Simon Demas, Fatima Qaiser, Syed Rehan Ali

Department of Paediatrics and Child Health

Introduction: Neonatal jaundice is a common cause of concern in immediate newborn period for parents as well as for the caregivers. Babies with visible jaundice are identified by the healthcare provider, and blood samples are sent for confirmation. Clinical expertise varies from person to person and may lead to sending excessive blood sampling. Obtaining blood bilirubin samples is a painful procedure; it predisposes the baby to infections and requires skilled health personnel. Moreover, laboratory tests are costly and time consuming, leading to unnecessary delays in commencing phototherapy and discharge from hospital. Transcutaneous bilirubinometer has been in use for a long …

Principal Component Regression Analysis Of Nutrition Factors And Physical Activities With Diabetes, Ke-Sheng Wang, Ying Lu, Xin Xie, Shaoqing Gong, Chun Xu, Zhanxin Sha

Health & Biomedical Sciences Faculty Publications

The associations of nutrition factors and physical activities with adult diabetes are inconsistent; while most of these factors are inter correlated. The aims of this study are to overcome the disturbance of the multicollinearity of the risk factors and examine the associations of these factors with diabetes using the principal component analysis (PCA) and regression analysis with principal component scores (PCS). Totally, 659 adults with diabetes and 2827 non-diabetic were selected from the 2012 Health Information National Trends Survey (HINTS 4, Cycle 2). PCA was utilized to deal with multicollinearity of the risk factors. Weighted univariate and multiple logistic regression …

Cancer-Related Risk Factors And Incidence Of Major Cancers By Race, Gender And Region; Analysis Of The Nih-Aarp Diet And Health Study, Tomi Akinyemiju, Howard Wiener, Maria Pisu

Epidemiology and Environmental Health Faculty Publications

Background: Racial disparities in the incidence of major cancers may be attributed to differences in the prevalence of established, modifiable risk factors such as obesity, smoking, physical activity and diet.

Methods: Data from a prospective cohort of 566,398 adults aged 50–71 years, 19,677 African-American and 450,623 Whites, was analyzed. Baseline data on cancer-related risk factors such as smoking, alcohol, physical activity and dietary patterns were used to create an individual adherence score. Differences in adherence by race, gender and geographic region were assessed using descriptive statistics, and Cox proportional hazards models were used to determine the association between adherence and …

Pulmonary Tumor Embolism Secondary To Soft Tissue And Bone Sarcomas: A Case Report And Literature Review., Nicholas Latchana, Vincent C Daniel, Robert W Gould, Raphael E Pollock

Oncology Articles

BACKGROUND: Tumor embolisms (TE) are an underappreciated source of pulmonary embolisms in sarcoma. Most evidence in the literature is limited to case reports and none have described the presence of TE secondary to myxofibrosarcoma. We report the first case of myxofibrosarcoma TE and perform a review of the literature for TE secondary to bone and soft tissue sarcomas (STS).

CASE PRESENTATION: A 36-year-old female presented with debilitating pain of the right upper extremity secondary to a recurrent soft tissue sarcoma. She had distant metastasis to the lung. An MRI revealed a 25-cm shoulder mass involving the proximal arm muscles with …

Attitudes Toward Antipsychotic Treatment Among Patients With Bipolar Disorders And Their Clinicians: A Systematic Review, Martha Sajatovic

Faculty Scholarship

Introduction: Antipsychotics are recommended as first-line therapy for acute mania and maintenance treatment of bipolar disorder; however, published literature suggests their real-world use remains limited. Understanding attitudes toward these medications may help identify barriers and inform personalized therapy. This literature review evaluated patient and clinician attitudes toward the use of antipsychotics for treating bipolar disorder. Materials and methods: A systematic search of the Cochrane Library, Ovid MEDLINE, Embase, and BIOSIS Previews identified English language articles published between January 1, 2000, and June 15, 2016, that reported attitudinal data from patients, health care professionals, or caregivers; treatment decision-making; or patient characteristics …

Comprehensive Genomic Profiling In Routine Clinical Practice Leads To A Low Rate Of Benefit From Genotype-Directed Therapy, Talal Hilal, Mary Nakazawa, Jacob Hodskins, John L. Villano, Aju Mathew, Gaurav Goel, Lars M. Wagner, Susanne M. Arnold, Philip Desimone, Lowell B. Anthony, Peter J. Hosein

Markey Cancer Center Faculty Publications

Background: Describe a single-center real-world experience with comprehensive genomic profiling (CGP) to identify genotype directed therapy (GDT) options for patients with malignancies refractory to standard treatment options.

Methods: Patients who had CGP by a CLIA-certified laboratory between November 2012 and December 2015 were included. The medical records were analyzed retrospectively after Institutional Review Board (IRB) approval. The treating oncologist made the decision to obtain the assay to provide potential therapeutic options. The objectives of this study were to determine the proportion of patients who benefited from GDT, and to identify barriers to receiving GDT.

Results: A total of 125 pediatric …

Debate On Human Aging And Lifespan, Mohammad Rafi, Abass Alavi

Department of Neurology Faculty Papers

The issue of human lifespan has long been a matter of controversy among scientists. In spite of the recent claim by Dong et al that human lifespan is limited to 115 years, with the mounting improvements in biotechnology and scientific understanding of aging, we may be confident that aging will slow down over the course of the current century extending human longevity much longer than 115 years.

Clopidogrel Alone Is Safer Than Clopidogrel And Aspirin For Secondary Prevention Of Acute Ischemic Stroke., Bradford J. Woelke, Daniel Angell Do, Katherine Litow Md

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Diener HC, Bogousslavsky J, Brass LM, et al. Aspirin and clopidogrel compared with clopidogrel alone after recent ischaemic stroke or transient ischaemic attack in high-risk patients (MATCH): randomised, double-blind, placebo-controlled trial. Lancet. 2004;364(9431):331-337. doi: 10.1016/s0140-6736(04)16721-4

Post-Traumatic Stress Disorder And Its Predictors In Emergency Medical Service Personnel: A Cross-Sectional Study From Karachi, Pakistan, Salima Kerai, Uzma R. Khan, Muhammad Islam, Nargis Asad, Junaid Razzak, Omrana Pasha

Department of Paediatrics and Child Health

Background: Emergency medical service (EMS) personnel who work to provide emergency medical care at the scene and during transportation are exposed to various kinds of stressors and are particularly susceptible to developing stress-reactions. This study assesses symptoms of post-traumatic stress disorder and its predictors among the personnel of a selected EMS in Karachi, Pakistan.
Methods: Data were gathered from 518 personnel working in an EMS setting from February to May 2014. Participants were screened for post-traumatic stress symptoms using the Impact of Event Scale-Revised (IES-R). Demographic and work-related characteristics, coping styles and the social support systems of the participants were …

A New Opportunity For Memri, Ryan Cloyd, Moriel H. Vandsburger, Jose F. Abisambra

Sanders-Brown Center on Aging Faculty Publications

No abstract provided.

The Farnesoid X Receptor Negatively Regulates Osteoclastogenesis In Bone Remodeling And Pathological Bone Loss, Ting Zheng, Ju-Hee Kang, Jung-Sun Sim, Jung-Woo Kim, Jeong-Tae Koh, Chan Soo Shin, Hyungsik Lim, Mijung Yim

Publications and Research

Farnesoid X receptor (FXR, NR1H4) is a member of the nuclear receptor superfamily of ligand-activated transcription factors. Since the role of FXR in osteoclast differentiation remains ill-defined, we investigated the biological function of FXR on osteoclastogenesis, using FXR-deficient mice. We demonstrated that FXR deficiency increases osteoclast formation in vitro and in vivo. First, FXR deficiency was found to accelerate osteoclast formation via down-regulation of c-Jun N-terminal kinase (JNK) 1/2 expression. Increased expression of peroxisome proliferator-activated receptor (PPAR)γ and peroxisome proliferator-activated receptor gamma coactivator 1 (PGC- 1)β seems to mediate the pro-osteoclastogenic effect of FXR deficiency via the JNK pathway. In …

The Effects Of Perinatal Oxycodone Exposure On Behavioral Outcome In A Rodent Model, Thitinart Sithisarn, Sandra J. Legan, Philip M. Westgate, Melinda E. Wilson, Kristen Wellmann, Henrietta S. Bada, Susan Barron

Pediatrics Faculty Publications

Opiate addiction is now a major public health problem. Perinatal insults and exposure to opiates such as morphine in utero are well known to affect development of the hypothalamic–pituitary–adrenal axis of the offspring adversely and are associated with a higher risk of developing neurobehavioral problems. Oxycodone is now one of the most frequently abused pain killers during pregnancy; however, limited data are available regarding whether and how perinatal oxycodone exposure (POE) alters neurobehavioral outcomes of the offspring. We demonstrated that exposure to 0.5 mg/kg/day oxycodone in utero was associated with hyperactivity in adult rats in an open field. No significant …

Quality? Safety? Stop Being Naïve., Rana K. Zaban Do, Steven Istephan, Jonathan Serman Md

Clinical Research in Practice: The Journal of Team Hippocrates

The first day of our inpatient medicine rotation, the Emergency Department (ED) admitted a patient to a general medical floor without notifying our rounding team. We used the institution’s system improvement tracking software to draw attention to communication breakdown in the interest of patient safety. This piece illustrates how there is a prominent hierarchy in medicine; it is inherent to the framework of the way in which hospitals function. A discussion ensues with our attending physician supervisor on our patient medicine service. During this discussion, we ponder whether it is possible to impact quality and safety from our position as …

Treating Diabetic Ketoacidosis With Subcutaneous Insulin?, Marlene Aziza Azar

Clinical Research in Practice: The Journal of Team Hippocrates

The author examines the evidence for treating diabetic ketoacidosis with subcutaneous insulin vs IV insulin.

State Reform And Respect For The Rights Of The Disabled People: A Reflection On The Olmstead Decision The Case Of New York State, Roseanne L. Flores

Publications and Research

Individuals with serious mental illness are often forced to live in institutional settings which limit their freedom and rights to become fully integrated into the community. The Olmstead v. L.C., 527 U.S. 581 (1999) decision ruled that states must provide individuals with disabilities the opportunity to live in the most integrated settings based on their needs. Since that time several lawsuits have been filed on behalf of individuals with disabilities against states for failing to comply with the Olmstead decision. New York State is one such state. The purpose of this paper is to describe the lawsuit which was brought …

Oxidative Stress-Induced Jnk/Ap-1 Signaling Is A Major Pathway Involved In Selective Apoptosis Of Myelodysplastic Syndrome Cells By Withaferin-A, Karine Z. Oben, Sara S. Alhakeem, Mary Kathryn Mckenna, Jason A. Brandon, Rajeswaran Mani, Sunil K. Noothi, Jinpeng Liu, Shailaja Akunuru, Sanjit Kumar Dhar, Inder P. Singh, Ying Liang, Chi Wang, Ahmed Abdel-Latif, Harold F. Stills Jr., Daret K. St Clair, Hartmut Geiger, Natarajan Muthusamy, Kaoru Tohyama, Ramesh C. Gupta, Subbarao Bondada

Markey Cancer Center Faculty Publications

Myelodysplastic syndromes (MDS) are a diverse group of malignant clonal hematopoietic stem cell disorders characterized by ineffective hematopoiesis, dysplastic cell morphology in one or more hematopoietic lineages, and a risk of progression to acute myeloid leukemia (AML). Approximately 50% of MDS patients respond to current FDA-approved drug therapies but a majority of responders relapse within 2-3 years. There is therefore a compelling need to identify potential new therapies for MDS treatment. We utilized the MDS-L cell line to investigate the anticancer potential and mechanisms of action of a plant-derived compound, Withaferin A (WFA), in MDS. WFA was potently cytotoxic to …

Integrated Results From The Copernicus And Galileo Studies., Amelie Pielen, W. Lloyd Clark, David S. Boyer, Yuichiro Ogura, Frank G. Holz, Jean-Francois Korobelnik, Brigitte Stemper, Friedrich Asmus, Kay D. Rittenhouse, Christiane Ahlers, Robert Vitti, Namrata Saroj, Oliver Zeitz, Julia A. Haller

Wills Eye Hospital Papers

OBJECTIVES: To report on the efficacy and safety of intravitreal aflibercept in patients with macular edema secondary to central retinal vein occlusion (CRVO) in an integrated analysis of COPERNICUS and GALILEO.

PATIENTS AND METHODS: Patients were randomized to receive intravitreal aflibercept 2 mg every 4 weeks or sham injections until week 24. From week 24 to week 52, all intravitreal aflibercept-treated patients in both studies and sham-treated patients in COPERNICUS were eligible to receive intravitreal aflibercept based on prespecified criteria. In GALILEO, sham-treated patients continued to receive sham treatment through week 52.

RESULTS: At week 24, mean gain in best-corrected …

A Brave New World Comes From Strong Roots, Nihit N. Mehta

Akesis

I feel like a monument,

a witnesss to Father Time.

Welcoming Clinical Medicine,

with certain excitement and shine.

A brave new world now awaits behind life's doors,

my roots are strong,

as I come from UNE's shores.

Pressed, Samantha Stephen

Akesis

Pushing myself to reconnect with what makes me feel grounded during my medical pursuits.

Reminding myself what it feels like to think abstractly.

Sunbathers, Jessica Rehrig

Akesis

in series with previous submission

Meditation, Jessica Rehrig

Akesis

in series with first submission

Surfers, Jessica Rehrig

Akesis

this goes in series with my first submission

this photo is "surfers"

Our Love For The Ocean Has Rooted Us Here, Jessica Rehrig

Akesis

Harun Yahya once said,

"I always wonder why birds choose to stay in the same place when they can fly anywhere on the earth, then I ask myself the same question."

This quote echoes a deeper meaning that is intertwined with the human experience, the human connection - to people, to culture, to memory. Often in life we move for school, travel for work, explore different countries for adventure, but we always come back "home". We are all rooted in somewhere or someone, and those connections and relationships shape us into who we are today and give life meaning.

The …

The Opposite Of Rhetoric, Jack C. Lewis

Akesis

There are a handful of moments from my past that continue to motivate me to pursue this medical education. This one in particular, telling a family that there is nothing more we can do for their deceased loved one, left me wanting to say much more than is professionally acceptable. And when I ask “why am I subjecting myself to this grueling education?,” I can find strength in these moments of not knowing whether or not there is more that I could’ve done to help an individual or family through a difficult moment.

Anti-Herv-K (Hml-2) Capsid Antibody Responses In Hiv Elite Controllers., Miguel De Mulder, Devi Sengupta, Steven G Deeks, Jeffrey N Martin, Christopher D Pilcher, Frederick M Hecht, Jonah B Sacha, Douglas F Nixon, Henri-Alexandre Michaud

Microbiology, Immunology, and Tropical Medicine Faculty Publications

Background

Human endogenous retroviruses (HERVs) comprise approximately 8% of the human genome and while the majority are transcriptionally silent, the most recently integrated HERV, HERV-K (HML-2), remains active. During HIV infection, HERV-K (HML-2) specific mRNA transcripts and viral proteins can be detected. In this study, we aimed to understand the antibody response against HERV-K (HML-2) Gag in the context of HIV-1 infection.

Results

We developed an ELISA assay using either recombinant protein or 164 redundant “15mer” HERV-K (HML-2) Gag peptides to test sera for antibody reactivity. We identified a total of eight potential HERV-K (HML-2) Gag immunogenic domains: two on …

Results Of A Pilot Study In The U.S. And Vietnam To Assess The Utility And Acceptability Of A Multi-Level Pregnancy Test (Mlpt) For Home Monitoring Of Hcg Trends After Assisted Reproduction., Tara Shochet, Ioanna A Comstock, Nguyen Thi Nhu Ngoc, Lynn M Westphal, Wendy R Sheldon, Ly Thai Loc, Jennifer Blum, Beverly Winikoff, Paul D Blumenthal

Obstetrics and Gynecology Faculty Publications

Background

To evaluate the utility and acceptability of using multi-level pregnancy tests (MLPTs) at home to monitor hCG trends following assisted reproductive technology (ART).

Methods

One hundred and four women presenting for ART at either Stanford Medicine Fertility and Reproductive Health Clinic (Stanford, CA) or Hung Vuong Hospital (Ho Chi Minh City, Vietnam) participated in this pilot study. Women were asked to perform the MLPT at home, primarily on days when they were also scheduled to receive standard clinic-based serum hCG testing. These tests were administered up to 6 times over the 6-week period following embryo transfer or intrauterine insemination …

Growth And Weight Gain In Children With Juvenile Idiopathic Arthritis: Results From The Reacch-Out Cohort., Jaime Guzman, Tristan Kerr, Leanne M Ward, Jinhui Ma, Kiem Oen, Alan M Rosenberg, Brian M Feldman, Gilles Boire, Kristin Houghton, Paul Dancey, Rosie Scuccimarri, Alessandra Bruns, Adam M Huber, Karen Watanabe Duffy, Natalie J Shiff, Roberta A Berard, Deborah M Levy, Elizabeth Stringer, Kimberly Morishita, Nicole Johnson, David A Cabral, Maggie Larché, Ross E Petty, Ronald M Laxer, Earl Silverman, Paivi Miettunen, Anne-Laure Chetaille, Elie Haddad, Lynn Spiegel, Stuart E Turvey, Heinrike Schmeling, Bianca Lang, Janet Ellsworth, Suzanne E Ramsey, Johannes Roth, Sarah Campillo, Susanne Benseler, Gaëlle Chédeville, Rayfel Schneider, Shirley M L Tse, Roxana Bolaria, Katherine Gross, Debbie Feldman, Bonnie Cameron, Roman Jurencak, Jean Dorval, Claire Leblanc, Claire St Cyr, Michele Gibbon, Rae S M Yeung, Ciarán M Duffy, Lori B Tucker

Paediatrics Publications

BACKGROUND: With modern treatments, the effect of juvenile idiopathic arthritis (JIA) on growth may be less than previously reported. Our objective was to describe height, weight and body mass index (BMI) development in a contemporary JIA inception cohort.

METHODS: Canadian children newly-diagnosed with JIA 2005-2010 had weight and height measurements every 6 months for 2 years, then yearly up to 5 years. These measurements were used to calculate mean age- and sex-standardized Z-scores, and estimate prevalence and cumulative incidence of growth impairments, and the impact of disease activity and corticosteroids on growth.

RESULTS: One thousand one hundred forty seven children …

Availability Of Healthcare Resources And Epithelial Ovarian Cancer Stage Of Diagnosis And Mortality Among Blacks And Whites, Swati Sakhuja, Huifeng Yun, Maria Pisu, Tomi Akinyemiju

Epidemiology and Environmental Health Faculty Publications

Background: The purpose of this study is to examine whether racial disparities in epithelial ovarian cancer stage at diagnosis and survival may be explained by geographic availability of healthcare resources among Blacks and Whites.

Methods: Data from the Surveillance, Epidemiology and End Results (SEER) database was used to identify White and Black women ages 40 years and above diagnosed with epithelial ovarian cancer between 2000 and 2010. Data on county-level availability of healthcare resources was obtained from the Area Resource File. Multi-level regression models, overall and stratified by race and age, were used to examine the associations of health care …