Medical Specialties Commons^™

Isolated Inferior Rectus Muscle Entrapment Following Endoscopic Sinus Surgery, Scott Shapiro, Jamie L. Schaefer, Sumeet Gupta, John Nguyen, Brian Kellerymeyer

Faculty & Staff Scholarship

Orbital complications are known risks of endoscopic sinus surgery (ESS). The lamina papyracea and medial rectus muscle are the most commonly injured structures during ESS. Inferior rectus injury is more rare, with only one reported case of isolated inferior rectus injury in the literature. Guidelines for managing ESS-induced inferior rectus injury do not exist, and delayed intervention and management of adjacent sinuses may affect long-term outcomes such as persistent diplopia and disfigurement. In this report, we present a case of a 67-year-old man with diplopia due to isolated left inferior rectus muscle entrapment and injury from violation of the orbital …

High Myopic Photorefractive Keratectomy Outcomes With The Alcon Wavelight® Ex500 Excimer Laser, Mark D. Mifflin, Brent S. Betts, Jason Nguyen, Severin Pouly

Faculty & Staff Scholarship

Purpose: To present refractive outcomes from consecutive cases with the Alcon Wavelight® EX500 excimer laser using photorefractive keratectomy (PRK) in patients with high myopia. Methods: A retrospective chart review of consecutive cases of high myopic eyes ($6.0 Diopters [D]) undergoing PRK with the Alcon Wavelight EX500 excimer laser (Alcon Labo- ratories, Fort Worth, TX, USA) was done. Moderately high myopic eyes (6.0 to ,8.0 D [6 D]) were compared with high myopic eyes (8.0 D or greater [8 D]). Outcomes measured included pre- and postoperative refractive error, uncorrected distance visual acuity (UDVA), corrected distance visual acuity, spherical equivalent correction (SEQ), …

Remarkable Presentation: Anaplastic Thyroid Carcinoma Arising From Chronic Hyperthyroidism, Habib G. Zalzal, Jeffson Chung, Jessica A. Perini

Faculty & Staff Scholarship

Background. Undifferentiated anaplastic carcinoma rarely develops from chronic hyperthyroidism. Although acute hyperthy- roidism can develop prior to anaplastic transformation, chronic hyperthyroidism was thought to be a protective measure against thyroid malignancy. Methods. A 79-year-old female presented acutely to the hospital with dyspnea. She had been taking methimazole for chronic hyperthyroidism due to toxic thyroid nodules, previously biopsied as benign. Upon admission, imaging showed tracheal compression, requiring a total thyroidectomy with tracheostomy for airway management. Results. Pathology demonstrated undifferentiated anaplastic thyroid carcinoma. The patient passed away shortly after hospital discharge. Despite treatment with methimazole for many years, abrupt enlargement of her …

Pseudomonas Aeruginosa Algr Phosphorylation Status Differentially Regulates Pyocyanin And Pyoverdine Production, Alexander S. Little, Yuta Okkotsu, Alexandria A. Reinhart, Heath Damron, Mariette Barbier, Brandon Barrett, Amanda G. Ogledby-Sherrouse, Joanna B. Goldberg, William L. Cody, Michael J. Schurr, Michael L. Vasil

Faculty & Staff Scholarship

Pseudomonas aeruginosa employs numerous, complex regulatory ele- ments to control expression of its many virulence systems. The P. aeruginosa AlgZR two-component regulatory system controls the expression of several crucial viru- lence phenotypes. We recently determined, through transcriptomic profiling of a PAO1 ΔalgR mutant strain compared to wild-type PAO1, that algZR and hemCD are cotranscribed and show differential iron-dependent gene expression. Previous ex- pression profiling was performed in strains without algR and revealed that AlgR acts as either an activator or repressor, depending on the gene. Thus, examination of P. aeruginosa gene expression from cells locked into different AlgR phosphorylation states …

Tracheocutaneous Sinus Following Tracheocutaneous Fistula Repair: Management Strategies In A Pediatric Patient, Adam Bender-Heine, Habib G. Zalzal, Nainika Nanda, Hassan Ramadan

Faculty & Staff Scholarship

Objective. To present a rare case of a pediatric tracheocutaneous sinus years after repair of a tracheocutaneous fistula and to review management strategies. Background. A tracheocutaneous fistula is a common sequela of pediatric tracheostomy and can occur in as many as one in three pediatric patients. There is debate in the literature regarding optimal surgical management. Case Presentation. An 8-year-old girl presented to the emergency department with swelling and erythema over the anterior neck. Clinical exam and diagnostic imaging revealed an underlying tracheocutaneous sinus. Discussion. Complications following pediatric tracheostomy are common and range in complexity from stomal granulation to tracheocutaneous …

A Retrospective Database Analysis Of Neonatal Morbidities To Evaluate A Composite Endpoint For Use In Preterm Labor Clinical Trials, Jeanne M. Pimenta, Myla Ebeling, Timothy H. Montague, Kathleen J. Beach, Jill Abell, Michael T. O'Shea, Macy Powell, Thomas C. Hulsey

Faculty & Staff Scholarship

Objective To propose and assess a composite endpoint (CE) of neonatal benefit based on neonatal mortality and morbidities by gestational age (GA) for use in preterm labor clinical trials. Study Design A descriptive, retrospective analysis of the Medical University of South Carolina Perinatal Information System database was conducted. Neonatal morbidities were assessed for inclusion in the CE based on clinical significance/risk of childhood neurodevelopmental impairment, frequency, and association with GA in a mother– neonate linked cohort, comprising women with uncomplicated singleton pregnancies delivered at !24 weeks’ GA.

Results Among 17,912 mother–neonate pairs, neonates were at a risk of numerous severe …

A Severe Case Of Ipilimumab-Induced Ileocolitis Refractory To Glucocorticosteroids And Infliximab, Behdod Poushanchi, Hiren Vallabh, Gorman Joel Reynolds

Faculty & Staff Scholarship

Ipilimumab is a monoclonal antibody that works as an immunotherapeutic agent through selective targeting of T cells to strengthen the response to metastatic melanoma. It is well known that this pharmaceutical agent can cause the adverse effect of colitis. We report a rare presentation of ileocolitis refractory to both glucocorticosteroids and infliximab with a resultant pneumatosis and perforation requiring subtotal colectomy and end ileostomy.

Impact Of Universal Medical Insurance System On The Accessibility Of Medical Service Supply And Affordability Of Patients In China, Xiaolei Xiong, Zhiguo Zhang, Jing Ren, Jie Zhang, Xiaoyun Pan, Liang Zhang, Shiwei Gong, Si Jin

Faculty & Staff Scholarship

Background

China’s universal medical insurance system (UMIS) is designed to promote social fairness through improving access to medical services and reducing out-of-pocket (OOP) costs for all Chinese. However, it is still not known whether UMIS has a significant impact on the accessibility of medical service supply and the affordability, as well as the seeking-care choice, of patients in China.

Methods

Segmented time-series regression analysis, as a powerful statistical method of interrupted time series design, was used to estimate the changes in the quantity and quality of medical service supply before and after the implementation of UMIS. The rates of catastrophic …

Resting Hormone Alterations And Injuries: Block Vs. Dup Weight-Training Among D-1 Track And Field Athletes, Keith B. Painter, G Gregory Haff, N Travis Triplett, Chales Stuart, Guy Hornsby, Mike W. Ramsey, Caleb D. Bazyler, Michael H. Stone

Faculty & Staff Scholarship

Daily undulating periodization (DUP), using daily alterations in repetitions, has been advocated as a superior method of resistance training, while traditional forms of programming for periodization (Block) have been questioned. Nineteen Division I track and field athletes were assigned to either a 10-week Block or DUP training group. Year and event were controlled. Over the course of the study, there were four testing sessions, which were used to evaluate a variety of strength characteristics, including maximum isometric strength, rate of force development, and one repetition maximum (1RM). Although, performance trends favored the Block group for strength and rate of force …

Hyperspectral Imaging And K-Means Classification For Histologic Evaluation Of Ductal Carcinoma In Situ, Yasser Khouj, Jeremy Dawson, James Coad, Linda Vona-Davis

Faculty & Staff Scholarship

Hyperspectral imaging (HSI) is a non-invasive optical imaging modality that shows the potential to aid pathologists in breast cancer diagnoses cases. In this study, breast cancer tissues from different patients were imaged by a hyperspectral system to detect spectral differences between normal and breast cancer tissues. Tissue samples mounted on slides were identified from 10 different patients. Samples from each patient included both normal and ductal carcinoma tissue, both stained with hematoxylin and eosin stain and unstained. Slides were imaged using a snapshot HSI system, and the spec- tral reflectance differences were evaluated. Analysis of the spectral reflectance values indicated …

Macrophage Sensing Of Single- Walled Carbon Nanotubes Via Toll- Like Receptors, Sourav P. Mukherjee, Olesja Bondarenko, Pekka Kohonen, Fernando T. Andon, Tana Brzicova, Isabel Gessner, Sanjay Mathur, Massimo Bottini, Paolo Calligari, Lorenzo Stella, Elena Kisin, Anna Shvedova, Reija Autio, Heli Salminen-Mankonen, Ritta Lahesmaa, Bengt Fadeel

Faculty & Staff Scholarship

Carbon-based nanomaterials including carbon nanotubes (CNTs) have been shown to trigger

inflammation. However, how these materials are ‘sensed’ by immune cells is not known. Here we compared the effects of two carbon-based nanomaterials, single-walled CNTs (SWCNTs) and graphene oxide (GO), on primary human monocyte-derived macrophages. Genome-wide transcriptomics assessment was performed at sub-cytotoxic doses. Pathway analysis of the microarray data revealed pronounced effects on chemokine-encoding genes in macrophages exposed to SWCNTs, but not in response to GO, and these results were validated by multiplex array-based cytokine and chemokine profiling. Conditioned medium from SWCNT-exposed cells acted as a chemoattractant for dendritic cells. …

Thoracic Stent Graft Placement For Repair Of Iatrogenic Aortic Injury Secondary To Sheath Placement During Pacemaker Insertion, Jared T. Feyko, Kelsey Musgrove, Cara Lyle, Alexandre D'Audiffret

Faculty & Staff Scholarship

We describe the inadvertent cannulation of the proximal descending thoracic aortic stent with a five French sheath during attempted pacemaker placement in an 88- year-old male. The injury was managed successfully by the percutaneous placement of a thoracic aortic stent graft with good outcome. Our case highlights the feasibility of managing this uncommon injury with this technique.

Absolute Lymphocyte And Neutrophil Counts In Neonatal Ischemic Brain Injury, Jessica M. Povroznik, Elizabeth B. Engler-Chiurazzi, Tania Nanavati, Paola Pergami

Faculty & Staff Scholarship

Objectives: This study aimed to identify differences in absolute neutrophils, lymphocytes, and neutrophil-to-lymphocyte ratio between neonates with two forms of ischemic brain injury, hypoxic-ischemic encephalopathy, and acute ischemic stroke, compared to controls. We also aimed to determine whether this neutrophil/lymphocyte response pattern is associated with disease severity or is a consequence of the effects of total-body cooling, an approved treatment for moderate-to-severe hypoxic-ischemic encephalopathy. Methods: A retrospective chart review of 101 neonates with hypoxic-ischemic encephalopathy + total-body cooling (n = 26), hypoxic-ischemic encephalopathy (n=12), acute ischemic stroke (n=15), and transient tachypnea of the newborn (n=48) was conducted; transient tachypnea of …

Palatine Tonsil Stenting Of The Airway As Determined By Drug-Induced Sleep Endoscopy, Habib G. Zalzal, Steven Coutras

Faculty & Staff Scholarship

Objective. To demonstrate lateral pharyngeal wall collapse and increased apnea-hypopnea index in a child posttonsillectomy. Background. Some children have worsening of their sleep symptoms after tonsillectomy for obstructive sleep apnea. This case report demonstrates an open airway on drug-induced sleep endoscopy (DISE) in a child with tonsillar hypertrophy followed by more pronounced airway obstruction related to lateral pharyngeal wall collapse after tonsillectomy. Case Presentation. A 7-year- old boy presented with obstructive sleep apnea and underwent workup with DISE. Following adenotonsillectomy and subsequent lingual tonsillectomy with epiglottopexy, the patient’s sleep apnea symptoms and polysomnogram results worsened. Subsequent DISE showed a more …

Breast Cancer Development In A Transgender Male Receiving Testosterone Therapy, Nadia Barghouthi, Jennifer Turner, Jessica Perini

Faculty & Staff Scholarship

Context. To describe a case of invasive ductal carcinoma of the breast in a transgender male receiving testosterone therapy for gender-affirming treatment. Case Description. A 28-year-old transgender male receiving intramuscular testosterone was found to have a breast mass on ultrasound after self-exam revealed a palpable breast lump. Ultrasound-guided breast biopsy revealed estrogen receptor/progesterone receptor (ER/PR) negative, human epidermal growth factor receptor-2 (HER-2) positive, invasive ductal carcinoma of the left breast. He underwent neoadjuvant and adjuvant chemotherapy along with bilateral mastectomy. At patient request, his testosterone injections were permanently discontinued. Conclusion. Fewer than 20 cases of breast cancer in transgender male …

Cost Effect Of Surgeon And Patient Discretion In Regard To Cataract Surgery, Tyler D. Oostra, Thomas F. Mauger

Faculty & Staff Scholarship

Purpose: The purpose of this study is to examine the cost effect of surgeon and patient discretion in regard to cataract surgery and how this affects population health care costs. Methods: A model of cataract progression was created from preexisting published data and combined with mortality data and Medicare cataract statistics to estimate the effect of mortality on decreasing the rate of cataract surgery if surgery was delayed until any cataract progression occurred.

Results: Five-year cataract progression rates were determined for a given patient age, sex, and type of cataract. Combined with 5-year death rates, delaying surgery until progression occurred …

Anomalous Origin Of A Right Coronary Artery From Pulmonary Artery, Muhammad Shabbir Rawala, S. Tahira Shah Naqvi, Kinaan Farhan, Muhammad Yasin, Syed Bilal Rizvi

Faculty & Staff Scholarship

Congenital defects of the coronary arteries are noted in 0.2–1.4% of the general population. The first case of an anomalous origin of right coronary artery from pulmonary artery (ARCAPA) was described by Brooks in 1885. ARCAPA has an overall incidence of 0.002% in the general population. Most of the cases are asymptomatic; however, it can lead to serious complications such as heart failure, ischemia, and sudden death. A 57-year-old man presented to the cardiologist’s office with complaints of shortness of breath and fatigue. The patient also had a previous history of coronary stents and heart failure. Initially, he was evaluated …

Perfluoroalkyl Substances And Kidney Function In Chronic Kidney Disease, Anemia, And Diabetes, Baqiyyah N. Conway, Ashley N. Badders, Tina Costacou, John M. Arthur, Kim E. Innes

Faculty & Staff Scholarship

Background: Anemia often complicates chronic kidney disease (CKD), leading to insufficient tissue oxygenation and hypoxic injury, the factor thought to underlie progression from CKD to renal failure. Perfluorocarbons are potent oxygen transporters used in organ preservation and synthetic blood development. Data are scarce on their relationship with kidney function, especially in diabetes where anemia and hypoxia are more prevalent. We investigated the relationship of perfluoroalkyl acids (PFAS) with kidney function and variation by diabetes and anemia status.

Methods: Data on 53,650 adults (5,210 with diabetes) were obtained from the C8 Health Project. CKD was defined as an estimated glomerular filtration …

First Uses Of Haart 300 Rings For Aortic Valve Repair In Poland – 4 Case Studies, Jacek H. Juscinski, Andrzej Koprowski, Magdalena Kotackowska, Maciej M. Kowalik, Jan A. Rogowski, James S. Rankin

Faculty & Staff Scholarship

Introduction: Aortic valve reconstructions using geometric an- nuloplasty rings HAART 300/200 open new era in aortic valve surgery. The HAART technology resizes, reshapes, stabilizes and simplifies aortic valve repair. The HAART aortic repair rings are designed to be implanted directly into aortic annulus (un- der aortic valve leaflets).

Aim: We present first in Poland 4 cases of aortic valve recon- structions using geometric annuloplasty rings HAART 300. Material and methods: Two patients had type IA aortic insuf- ficiency (due to El-Khoury classification) – they were treated by HAART 300 ring insertion and ascending aorta prosthesis implantation. Third patient, Marfan with …

Mycobacterium Tuberculosis Infection In The Setting Of Interstitial Lung Disease: Coincidence Or Bad Luck?, Christian Wong, Sonu Sahni, Muhammad Azaz I. Cheema, Asma Iftikhar

Touro College of Osteopathic Medicine (New York) Publications and Research

Mycobacterium tuberculosis (MTB) infection is the ninth leading cause of death worldwide, with many individuals with undiagnosed active or latent disease. The presence of parenchymal lung disease, such as interstitial lung disease (ILD), has been suggested to increase the risk of pulmonary tuberculosis (TB). In the clinical setting of ILD, the diagnosis of an underlying MTB infection may be challenging due to the interstitial process and underlying fibrosis, which may mask the infection. An atypical presentation and misleading radiological patterns may delay the diagnosis of the underlying MTB infection. Herein, we describe a unique case of ILD complicated by active …

Optimal Scene Time To Achieve Favorable Outcomes In Out-Of-Hospital Cardiac Arrest: How Long Is Too Long?, Glenn Goodwin, Dyana Picache, Brian J. Louie, Nicholas Gaeto, Tarik Zeid, Paxton P. Aung, Sonu Sahni

Touro College of Osteopathic Medicine (New York) Publications and Research

Despite advances in resuscitation science and public health, out-of-hospital cardiac arrest (OOHCA) cases have an average survival rate of only 12% nationwide, compared to 24.8% of cases occurring in hospital. Many factors, including resuscitation interventions, contribute to positive patient outcomes and have, therefore, been studied in attempts to optimize emergency medical services (EMS) protocols to achieve higher rates of return of spontaneous circulation (ROSC) in the field. However, no consensus has been met regarding the appropriate amount of time for EMS to spend on scene.

Evaluation Of Concussion Incidence And Modulating Factors In The 2013-2017 Australian Football League, Ryan Adams, George K. Lau, Jennifer B. Dai, Adam Y. Li, Kevin P. Cheung, Syed Haider, Alex Gometz

Touro College of Osteopathic Medicine (New York) Publications and Research

The increasing awareness and popularization of concussions in the research realm over the last few years have begun to shed more light on the detrimental effects associated with repetitive head trauma. While the majority of the current literature focuses on the National Football League (NFL) and National Hockey League (NHL), several other high-impact sports have been implementing concussion management protocols to protect their players. The Australian Football League (AFL) is a prime example of a major contact sport that has undertaken recent changes to its concussion assessment and management modalities. We recognize the benefit of reporting potential changes in concussion …

The Effectiveness Of Anatomy Laboratory Videos On Osteopathic Medical Students’ Performance, Sumathilatha Sakthi Velavan, Bedia Castellanos

Touro College of Osteopathic Medicine (New York) Publications and Research

Introduction: The usage of audio-visual aids in medical education has always been rewarding. This study aimed at evaluating the efficacy of supplementing traditional dissection based laboratories with the video demonstration of specimens.

Methods: The study was conducted among first-year osteopathic medical students of two consecutive years. The laboratory demonstration videos were recorded and provided to the experimental group and the previous class served as the historical controls. Two Likert scale based questionnaires were completed by the experimental group before and after their final examination. The students' performance in the Anatomy practical examinations were compared between the two groups. …

Total Sulfane Sulfur Bioavailability Reflects Ethnic And Gender Disparities In Cardiovascular Disease, Saurabh Rajpal, Pavan Katikaneni, Matthew Deshotels, Sibile Pardue, John Glawe, Xinggui Shen, Nuri Akkus, Kalgi Modi, Ruchi Bhandari, Paari Dominic, Pratap Reddy, Gopi K. Kolluru, Christopher G. Kevil

Faculty & Staff Scholarship

Hydrogen sulfide (H2S) has emerged as an important physiological and pathophysiological signaling molecule in the cardiovascular system influencing vascular tone, cytoprotective responses, redox reactions, vascular adap- tation, and mitochondrial respiration. However, bioavailable levels of H2S in its various biochemical metabolite forms during clinical cardiovascular disease remain poorly understood. We performed a case-controlled study to quantify and compare the bioavailability of various biochemical forms of H2S in patients with and without cardiovascular disease (CVD). In our study, we used the reverse-phase high performance liquid chromatography monobromobimane assay to analytically measure bioavailable pools of H2S. Single nucleotide polymorphisms (SNPs) were also identified …

Determinants And Outcomes Of Vasoplegia Following Left Ventricular Assist Device Implantation, K. M. Tecson, B. Lima, A. Y. Lee, F. S. Raza, G. Ching, C. Lee, J. Felius, R. D. Baxter, S. Still, S. M. Joseph, +2 Additional Authors

Journal Articles

No abstract provided.

High-Frequency Percussive Ventilation Facilitates Weaning From Extracorporeal Membrane Oxygenation In Adults, I. Gulkarov, J. Schiffenhaus, I. Wong, A. Afzal, F. Khusid, B. Worku

Journal Articles

© 2018 American Society of Extra-Corporeal Technology. All Rights Reserved. Venoarterial extracorporeal membrane oxygenation (VA-ECMO) is an invaluable rescue therapy for patients suffering from cardiopulmonary arrest, but it is not without its drawbacks. There are cases where patients recover their cardiac function, yet they fail to wean to mechanical conventional ventilation (MCV). The use of high-frequency percussive ventilation (HFPV) has been described in patients with acute respiratory failure (RF) who fail MCV. We describe our experience with five patients who underwent VA-ECMO for cardiopulmonary arrest who were successfully weaned from VA-ECMO with HFPV after failure to wean with MCV. Weaning …

Sternotomy Closure Using Rigid Plate Fixation: A Paradigm Shift From Wire Cerclage, K. B. Allen, K. J. Icke, V. H. Thourani, Y. Naka, K. J. Grubb, J. Grehan, N. Patel, T. S. Guy, K. Landolfo, M. Bonnell, +1 Additional Author

Journal Articles

No abstract provided.

Twelve-Month Efficacy And Safety Data For The "Stress Incontinence Control, Efficacy And Safety Study": A Phase Iii, Multicenter, Prospective, Randomized, Controlled Study Treating Female Stress Urinary Incontinence Using The Vesair Intravesical Balloon, H. Winkler, K. Jacoby, S. Kalota, J. Snyder, K. Cline, K. Robertson, R. Kahan, L. Green, K. Mccammon, C. Rardin, +1 Author

Journal Articles

© 2018 Wolters Kluwer Health, Inc. Objectives The "Stress Incontinence Control, Efficacy and Safety Study" (SUCCESS) is a phase III study of the Vesair Balloon in women with stress urinary incontinence who had failed conservative therapy, and either failed surgery, were not candidates for surgery, or chose not to have surgery. The safety and efficacy of the balloon at 12 months is reported for those participants in the treatment arm who elected to continue with the SUCCESS trial beyond the primary end point at 3 months. Methods The SUCCESS trial is a multicenter, prospective, single-blinded, randomized, sham-controlled study. Participants were …

Two Successful Pregnancies Following Fertility Preservation In A Patient With Anaplastic Astrocytoma: A Case Report, A. Peyser, S. L. Bristow, A. Hershlag

Journal Articles

No abstract provided.

Severe Maternal Morbidity Associated With Systemic Lupus Erythematosus Flare In The Second Trimester Of Pregnancy., M. J. Blitz, A. Fleischer

Journal Articles

Pregnancy in women with systemic lupus erythematosus (SLE) is associated with an increased risk of adverse maternal and fetal outcomes. Here, we present a case of severe maternal morbidity in a 23-year-old primigravida with SLE and secondary Sjögren's syndrome who experienced a life-threatening multisystem flare at 17 weeks of gestational age. She presented to the emergency department complaining of cough with hemoptysis and shortness of breath. She developed hypoxic respiratory failure and was admitted to the intensive care unit. Bronchoscopy confirmed diffuse alveolar hemorrhage. Physical exam and laboratory evaluation were consistent with an active SLE flare, pancytopenia, and new-onset lupus …