Medical Specialties Commons^™

Improving Midstream Urine Collection For Urine Culture Through The Use Of A Novel Device, Flipcatch, Christopher Neely, Dante Varotsis, Helen Xu

Phase 1

Background : A midstream, clean-catch urine sample is the gold standard for diagnosing urinary tract infections and determining treatment. The current method of collection is not standardized, frustrating both patients and providers. The current method results in a high rate of contaminated samples (30-40%), which often need to be repeated in order to obtain a diagnosis and antibiotic susceptibility data. A design project was conducted in order to create a more effective urine collection device with the goals of decreasing contamination and improving patient and provider experience.

Methods : We conducted interviews of patients, allied health professionals, physicians, and clinical …

Cross-Sectional Analysis Of Sound Levels In The Neonatal Intensive Care Unit (Nicu) At Thomas Jefferson University Hospital, Caroline Komlo, Martin Morris, Robert Ries, Michael Velez

Phase 1

Introduction . Infants in the NICU are considered at greater risk of developmental delay. It is now known that excessively loud noise can have a negative impact on parameters such as blood pressure, breathing, heart beat and oxygen saturation. Previous research has concluded that the optimal decibel (dB) level for proper growth of neonate hair cells rests around 45dB. Consequently, the American Academy of Pediatrics recommends that noise levels in the NICU be maintained to a maximum of 45dBA. However, little research has focused on designing new noise-altering products and their impact on neonatal outcomes.

Methods. This was a cross …

Subcellular Compartmentalization Of Pkm2 Identifies Anti-Pkm2 Therapy Response In Vitro And In Vivo Mouse Model Of Human Non-Small-Cell Lung Cancer., Akiko Suzuki, Sachin Puri, Pamela Leland, Ankit Puri, Tarsem Moudgil, Bernard A Fox, Raj K Puri, Bharat H Joshi

Articles, Abstracts, and Reports

Pyruvate kinase M2 (PKM2) is an alternatively spliced variant, which mediates the conversion of glucose to lactate in cancer cells under normoxic conditions, known as the Warburg effect. Previously, we demonstrated that PKM2 is one of 97 genes that are overexpressed in non-small-cell lung cancer (NSCLC) cell lines. Herein, we demonstrate a novel role of subcellular PKM2 expression as a biomarker of therapeutic response after targeting this gene by shRNA or small molecule inhibitor (SMI) of PKM2 enzyme activity in vitro and in vivo. We examined two established lung cancer cell lines, nine patients derived NSCLC and three normal lung …

Radiation Safety Practices Of Dental Hygienists In The United States, Kimberly Lintag, Ann M. Bruhn, Susan Lynn Tolle, Norou Diawara

Dental Hygiene Faculty Publications

Purpose: The As Low As Reasonably Achievable (ALARA) principle was developed to promote awareness and minimization of radiation exposure and is supported by radiation control and professional organizations. The purpose of this study was to determine licensed dental hygienists' current radiation safety practices.

Methods: Data were collected with a 22 item, online survey administered to a convenience sample of 1,500 dental hygienists in the United States. Questions focused on respondents' use of the American Dental Association (ADA) radiographic examination selection guidelines, their individual dental practice policies, and hand-held portable x-ray device use and training. Cross tabulations were obtained using logistic …

Central Pain Mimicking Trigeminal Neuralgia As A Result Of Lateral Medullary Ischemic Stroke, Abinayaa Ravichandran, Kareem S. Elsayed, Hussam A. Yacoub

Neurology Faculty Publications

Background. Central pain mimicking trigeminal neuralgia (TN) as a result of lateral medullary infarction or Wallenberg syndrome has been rarely reported. Case Report. We discuss a patient who presented with a lateral medullary infarct and shortly after developed facial pain mimicking TN. We also elaborate on the anatomical pathway of the trigeminal nerve explaining facial pain as a result of a lateral medullary lesion. Discussion. Clinicians should be aware of this typical complication of lateral medullary infarct in order to attain proper management and work-up.

A Case Report Of Extensive Cerebral Venous Sinus Thrombosis As A Presenting Sign Of Relapsing Nephrotic Syndrome, Janet K. Lee, Kathleen Murray, Swetha Renati

Neurology Faculty Publications

Nephrotic syndrome is defined by three characteristic features including proteinuria of >3 g in 24 hours, hypoalbuminemia of less than 3 g/dL, and peripheral edema. Multiple nephropathies can result in nephrotic syndrome. Most commonly, minimal change disease is seen in children under the age of 10, while adults are more commonly found to have membranous nephropathy. Hypercoagulability and thrombotic sequela can be seen in nephrotic syndrome, regardless of underlying etiology, and thrombosis is most commonly seen in deep veins of the lower extremities and renal veins. Our case identifies an adult with previously diagnosed and treated for minimal change disease …

Lamotrigine Odt-Induced Seizure In A 3-Year-Old Child After Accidental Ingestion, Ashley Griswold, Briana Tully, Kenneth Katz, Gillian Beauchamp, Matthew Cook, Robert Cannon

Pediatrics Faculty Publications

Lamotrigine is a new generation antiepileptic which blocks sodium channels and can cause significant toxicity in overdose. A case of a three-year-old child who suffered a seizure and required endotracheal intubation after accidental lamotrigine ingestion is presented. The lamotrigine concentration measured 23.2 mcg/mL which is the highest reported after accidental pediatric exposure. A review of the literature regarding pediatric lamotrigine poisoning is also included.

Wire Guided Cannulation Facilitates Endoscopic Management Of Buried Bumper Syndrome: A Novel Technique, Jacquelin Peck, Kaitlin Sapp, Alexander Wilsey, Michael Wilsey

Pediatrics Faculty Publications

Buried bumper syndrome is a rare but potentially severe complication of percutaneous endoscopic gastrostomy tube insertion. Though this complication is uncommon, it may lead to pressure necrosis, bleeding, perforation, peritonitis, sepsis, or death. Each case of buried bumper syndrome is unique in terms of patient comorbidities and anatomic positioning of the buried bumper. For this reason, many approaches have been described in the management of buried bumper syndrome. In this case report, we describe the case of an adolescent Caucasian female who developed buried bumper syndrome three years after undergoing percutaneous endoscopic gastrostomy insertion. We review diagnosis and management of …

Vital Signs, Winter 2019, Boonshoft School Of Medicine

Vital Signs

A thirty-two page newsletter created by the Boonshoft School of Medicine to document the current affairs of the school. This issue includes a variety of feature articles, alumni profiles, class notes, and more.

Systemic Sclerosis Presenting With Bilateral Retinal Cotton Wool Spots, Christina E. Borchers, Ronald E. Warwar

Dermatology Faculty Publications

Systemic sclerosis is a systemic inflammatory diseasecharacterized by a triad of autoimmune reactions,vasculopathy, and fibrosis due to collagen deposition. Thediffuse sclerosis type includes vascular abnormalities in theskin (puffy, taut, thickened skin, pitting of fingertips), soft tissues(arthralgias, myalgias), lungs (pulmonary hypertension,interstitial fibrosis), gastrointestinal tract (esophagealdysmotility, GERD), kidneys (scleroderma renal crisis), andheart (arrhythmias, heart failure).Rarely, systemic sclerosis can present with signs of retinalvascular occlusion and cotton wool spots in the eyes. Thefollowing case report describes a patient presenting with cottonwool spots as an early manifestation of systemic sclerosis.

Kiaa1549-Braf Expression Establishes A Permissive Tumor Microenvironment Through Nfκb-Mediated Ccl2 Production, Ran Chen, Chanel Keoni, Christopher A. Waker, Robert M. Lober, Robert M. Lober, Yihsien Chen, David H. Gutmann

Pediatrics Faculty Publications

KIAA1549-BRAF is the most frequently identified genetic mutation in sporadic pilocytic astrocytoma (PA), creating a fusion BRAF (f-BRAF) protein with increased BRAF activity. Fusion-BRAF-expressing neural stem cells (NSCs) exhibit increased cell growth and can generate glioma-like lesions following injection into the cerebella of naïve mice. Increased Iba1+ monocyte (microglia) infiltration is associated with murine f-BRAF-expressing NSC-induced glioma-like lesion formation, suggesting that f-BRAF-expressing NSCs attract microglia to establish a microenvironment supportive of tumorigenesis. Herein, we identify Ccl2 as the chemokine produced by f-BRAF-expressing NSCs, which is critical for creating a permissive stroma for gliomagenesis. In addition, f-BRAF regulation of Ccl2 production …

Primary Cardiac Sarcoma: A Rare, Aggressive Malignancy With A High Propensity For Brain Metastases., Brittany L Siontis, Lili Zhao, Monika Leja, Jonathan B Mchugh, Maryann M Shango, Laurence H Baker, Scott M Schuetze, Rashmi Chugh

Articles, Abstracts, and Reports

Introduction: Primary cardiac sarcoma (PCS) has a poor prognosis compared to other sarcomas due to late presentation, challenging resection, incidence of metastases, and limited efficacy of systemic therapies.

Methods: A medical record search engine was queried to identify patients diagnosed with PCS from 1992 to 2017 at the University of Michigan.

Results: Thirty-nine patients with PCS had a median age of 41 years (range 2-77). Common histologies were angiosarcoma (AS, 14), high-grade undifferentiated pleomorphic sarcoma (UPS, 10), and leiomyosarcoma (LMS, 5). Sites of origin were left atrium (18), right atrium (16), and pericardium (5). AS was the most common right-sided …

Association Of Skeletal Muscle And Psychological Responses To Immobility After Major Injury, Jacob T. Higgins

Theses and Dissertations--Nursing

The purpose of this dissertation was to explore the physical and psychological responses to the combination of major trauma (Injury Severity Score [ISS] > 15) and variable periods of immobility. Specific aims were to: 1) develop a conceptual model that illustrates physiological and psychological alterations that occur after injury and subsequent immobility, and their association with skeletal muscle responses and recovery; 2) evaluate daily measures of skeletal muscle strength (bicep and quadricep) using dynamometry and skeletal muscle (rectus femoris and biceps brachii) muscle thickness measured with ultrasound in patients after major trauma; and 3) assess the predictive ability of anxiety and …

Global Health Experience In Botswana, Sarah Bieser

Posters

Describes experience providing care at the Botswana-Baylor Children's Center of Excellence in Gabarone, Botswana and the Princess Marina Hospital.

Global Health Elective, Philippine Children's Medical Center, Keith J. Martin

Posters

Describes a global health learning experience working in the Philippine Children's Medical Center in Quezon City, Metro Manila, Philippines.

Global Health Elective In San Pedro La Laguna, Guatemala, Page Pomo

Posters

Future outpatient general pediatrician serving bilingual populations describes working in rural Guatemala and opportunities to practice Spanish language skills.

Nutrition Manual For Nsu Student Athletes, Kaitlyn Flaskerud, Katie Emerson, Stephanie Fonesca, Angel Marquez, Alejandra Velandia, Marilyn Gordon

Faculty Articles

No abstract provided.

An Ensemble Of Flexible Conformations Underlies Mechanotransduction By The Cadherin–Catenin Adhesion Complex, Martin Bush, Bashir M. Alhanshali, Shuo Qian, Christopher B. Stanley, William T. Heller, Tsutomu Matsui, Thomas M. Weiss, Iain D. Nicholl, Thomas Walz, David J. E. Callaway, Zimei Bu

Publications and Research

The cadherin–catenin adhesion complex is the central component of the cell–cell adhesion adherens junctions that transmit mechanical stress from cell to cell. We have determined the nanoscale structure of the adherens junction complex formed by the α-catenin•β-catenin•epithelial cadherin cytoplasmic domain (ABE) using negative stain electron microscopy, small-angle X-ray scattering, and selective deuteration/small-angle neutron scattering. The ABE complex is highly pliable and displays a wide spectrum of flexible structures that are facilitated by protein-domain motions in α- and β-catenin. Moreover, the 107-residue intrinsically disordered N-terminal segment of β-catenin forms a flexible “tongue” that is inserted into α-catenin and participates in the …

Patients’ Experiences On Accessing Health Care Services For Management Of Hypertension In Rural Bangladesh, Pakistan And Sri Lanka: A Qualitative Study, Helena Legido Quigley, Aliya Naheed, H. Asita De Silva, Imtiaz Jehan, Z Samad

Department of Medicine

Hypertension is the leading risk factor for cardiovascular disease and leading cause of premature death globally. In 2008, approximately 40% of adults were diagnosed with hypertension, with more than 1.5 billion people estimated to be affected globally by 2025. Hypertensiondisproportionally affects low- and middle-income countries, where the prevalence is higher and where the health systems are more fragile. This qualitative study explored patients' experiences on the management and control of hypertension in rural Bangladesh, Sri Lanka and Pakistan. We conducted sixty semi-structured interviews, with 20 participants in each country. Hypertensive individuals were recruited based on age, gender and hypertensive status. …

Incidence And Contributing Factors Of Glucose Intolerance In Saudi Postpartum Women: Sub-Group Analysis From Rahma Study, Hayfaa Wahabi, Amel Fayed, Safaa M. S. T Tunkar, Ali Al-Hazmi, Amna R. Siddiqui

Community Health Sciences

Objectives: The objectives of this study were to determine incidence and risk factors of glucose intolerance one year after delivery in a sub-cohort of Riyadh Mother and Baby Cohort Study (RAHMA) study.
Methods: This is a follow-up study of a sub-cohort from RAHMA study from King Khalid University Hospital (KKUH). All women from RAHMA database who completed one year since delivery at KKUH were contacted by phone to participate in the study. Previously collected data from RAHMA registry for each participant were linked to this study data. Clinical data measured for each participant included current weight and height to calculate …

Lamotrigine Odt-Induced Seizure In A 3-Year-Old Child After Accidental Ingestion, Ashley Griswold Do, Briana Tully, Kenneth D. Katz Md, Gillian A. Beauchamp Md, Matthew D. Cook Do, Robert D. Cannon Do

Department of Emergency Medicine

Lamotrigine is a new generation antiepileptic which blocks sodium channels and can cause significant toxicity in overdose. A case of a three-year-old child who suffered a seizure and required endotracheal intubation after accidental lamotrigine ingestion is presented. The lamotrigine concentration measured 23.2 mcg/mL which is the highest reported after accidental pediatric exposure. A review of the literature regarding pediatric lamotrigine poisoning is also included.

Burnout And Resilience Among Pediatric Residents In Stockholm, Sweden: Findings From A Mixed-Methods Study, Lauren Poull, Sanaz Skyttner-Rahmani, Andrea P. Anderson, Weston T. Powell, Jiaqi Yin, Carolyn C. Foster, Maneesh Batra

Posters

Objective

 To measure the prevalence of burnout among pediatric residents at Karolinska University Hospital (KUH).
 To describe the local drivers of burnout and the protective factors that lead to resilience and workplace engagement.

Conclusions

 Prevalence of burnout among Swedish pediatric residents in this study was 39%, which is lower than reported in the US (50-60%).
 Drivers of burnout were identified across all four domains. They included local features of the learning environment, and many are modifiable.
 Protective factors include perceived control over scheduling, better mental and physical health, lower perceived stress, and being a parent. …

Eukaryotic Initiation Factor 3, Subunit C Silencing Inhibits Cell Proliferation And Promotes Apoptosis In Human Ovarian Cancer Cells, Fang Wen, Zhang-Ying Wu, Lei Nie, Qi-Zhu Zhang, Yuan-Kun Qin, Zun-Lun Zhou, Jin-Jian Wu, Xing Zhao, Jun Tan, Darrell Sawmiller, Dan Zi

Psychiatry & Behavioral Neurosciences Faculty Publications

Ovarian cancer remains the leading cause of death among all gynaecological cancers, illustrating the urgent need to understand the molecular mechanisms involved in this disease. Eukaryotic initiation factor 3c (EIF3c) plays an important role in protein translation and cancer cell growth and proliferation, but its role in human ovarian cancer is unclear. Our results showed that EIF3c silencing significantly up-regulated 217 and down-regulated 340 genes. Ingenuity Pathway Analysis (IPA) indicated that the top differentially expressed genes are involved in ‘Classical Pathways’, ‘Diseases and Functions’ and ‘Networks’, especially those involved in signalling and cellular growth and proliferation. In addition, eIF3c silencing …

Nasopharyngeal Angiofibroma: A Forgotten Entity In Older Patients, Vanessa C. Stubbs, Lauren E. Miller, Arjun K. Parasher, Jordan T. Glicksman, Nithin D. Adappa, James Palmer

Otolaryngology Head & Neck Surgery Faculty Publications

Introduction: Nasopharyngeal angiofibroma (NA) characteristically affects adolescent men. Although benign, these tumors can cause local destruction and surgical resection is warranted.

Objective: We present a case of a 62-year-old man with nasal congestion and epistaxis, found to be a right NA on pathology. We also present a review of the available NA staging systems.

Findings: In this case of NA, imaging revealed an aggressive, hypervascular mass in the nasal cavity with involvement of the middle cranial fossa and cavernous sinus. The patient underwent complete endoscopic surgical resection following vascular embolization.

Conclusion: Although it is rare, NA should not be disregarded …

Gutting The Brain Of Inflammation: A Key Role Of Gut Microbiome In Human Umbilical Cord Blood Plasma Therapy In Parkinson's Disease Model, Jea-Young Lee, Julian P. Tuazon, Jared Ehrhart, Paul R. Sanberg, Cesar V. Borlongan

Neurosurgery and Brain Repair Faculty Publications

Current therapies for Parkinson's disease (PD), including L-3,4-dihydroxyphenylalanine (L-DOPA), and clinical trials investigating dopaminergic cell transplants, have generated mixed results with the eventual induction of dyskinetic side effects. Although human umbilical cord blood (hUCB) stem/progenitor cells present with no or minimal capacity of differentiation into mature dopaminergic neurons, their transplantation significantly attenuates parkinsonian symptoms likely via bystander effects, specifically stem cell graft-mediated secretion of growth factors, anti-inflammatory cytokines, or synaptic function altogether promoting brain repair. Recognizing this non-cell replacement mechanism, we examined here the effects of intravenously transplanted combination of hUCB-derived plasma into the 1-methyl-4-phenyl-1,2,3,6-tetrahydropyridine (MPTP)-induced rat model of PD. …

Retrospective Case Series Of Traumatic Brain Injury And Post-Traumatic Stress Disorder Treated With Hyperbaric Oxygen Therapy, R. Douglas Shytle, David J. Eve, Soel-Hee Kim, Allan Spiegel, Paul R. Sanberg, Cesar V. Borlongan

Neurosurgery and Brain Repair Faculty Publications

Returning veterans are frequently diagnosed with traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD). Considering a recent case-controlled study of hyperbaric oxygen therapy (HBOT) reporting a reduction in suicidal ideation, we investigated retrospectively three veterans with chronic TBI/PTSD symptoms who were treated with multiple rounds of HBOT with neurophysiological testing performed before and after treatment. Improvements were detected on parameters within neurocognitive domains, including reductions in suicide-related symptoms. These findings independently confirm that HBOT may be effective in treating specific symptoms of TBI/PTSD that are not currently addressed with existing therapeutic approaches.

Administration Of Rctrp9 Attenuates Neuronal Apoptosis Through Adipor1/Pi3k/Akt Signaling Pathway After Ich In Mice, Lianhua Zhao, John H. Zhang, Prativa Sherchan, Paul R. Krafft, Wei Zhao, Sa Wang, Shengpan Chen, Zaiyu Guo, Jiping Tang

Neurosurgery and Brain Repair Faculty Publications

Targeting neuronal apoptosis after intracerebral hemorrhage (ICH) may be an important therapeutic strategy for ICH patients. Emerging evidence indicates that C1q/TNF-Related Protein 9 (CTRP9), a newly discovered adiponectin receptor agonist, exerts neuroprotection in cerebrovascular disease. The aim of this study was to investigate the anti-apoptotic role of CTRP9 after experimental ICH and to explore the underlying molecular mechanisms. ICH was induced in mice via intrastriatal injection of bacterial collagenase. Recombinant CTRP9 (rCTRP9) was administrated intranasally at 1 h after ICH. To elucidate the underlying mechanisms, adiponectin receptor1 small interfering ribonucleic acid (AdipoR1 siRNA) and selective PI3 K inhibitor LY294002 were …

Pathophysiology Of Ganglioside Gm1 In Ischemic Stroke: Ganglioside Gm1: A Critical Review, Wenchao Zhang, Paul R. Krafft, Tianlong Wang, John H. Zhang, Li Li, Jiping Tang

Neurosurgery and Brain Repair Faculty Publications

Ganglioside GM1 is a member of the ganglioside family which has been used in many countries and is thought of as a promising alternative treatment for preventing several neurological diseases, including cerebral ischemic injury. The therapeutic effects of GM1 have been proved both in neonates and in adults following ischemic brain damage; however, its clinical efficacy in patients with ischemic stroke is still uncertain. This review examines the recent knowledge of the neuroprotective properties of GM1 in ischemic stroke, collected in the past two decades. We conclude that GM1 may have potential for stroke treatment, although we need to be …

Safety, Pharmacodynamics, And Potential Benefit Of Omaveloxolone In Friedreich Ataxia, David R. Lynch, Jennifer Farmer, Lauren Hauser, Ian A. Blair, Qing Qing Wang, Clementina Mesaros, Nathaniel Snyder, Sylvia Boesch, Melanie Chin, Martin B. Delatycki, Paola Giunti, Angela Goldsberry, Chad Hoyle, Michael G. Mcbride, Wolfgang Nachbauer, Megan O'Grady, Susan Perlman, S. H. Subramony, George R. Wilmot, Theresa A. Zesiewicz, Colin Meyer

Neurology Faculty Publications

Objective Previous studies have demonstrated that suppression of Nrf2 in Friedreich ataxia tissues contributes to excess oxidative stress, mitochondrial dysfunction, and reduced ATP production. Omaveloxolone, an Nrf2 activator and NF-kB suppressor, targets dysfunctional inflammatory, metabolic, and bioenergetic pathways. The dose-ranging portion of this Phase 2 study assessed the safety, pharmacodynamics, and potential benefit of omaveloxolone in Friedreich ataxia patients (NCT02255435).

Methods Sixty-nine Friedreich ataxia patients were randomized 3:1 to either omaveloxolone or placebo administered once daily for 12 weeks. Patients were randomized in cohorts of eight patients, at dose levels of 2.5–300 mg/day.

Results Omaveloxolone was well tolerated, and adverse …

Down The Rabbit Hole-Considerations For Ingested Foreign Bodies, Jerry Brown, Molly Kidder, Abigail Fabbrini, Jonathan Devries, Jason Robertson, Nicole Chandler, Michael Wilsey

Pediatrics Faculty Publications

We report the case of a seven-year-old boy with an ingested foreign body, which was retained within the appendix for a known duration of ten months, ultimately requiring appendectomy. The ingested foreign body was incidentally discovered by abdominal x-ray at an emergency room visit for constipation. Despite four bowel cleanouts, subsequent x-rays showed persistence of the foreign body in the right lower quadrant. While the patient did not have signs or symptoms of acute appendicitis, laparoscopic appendectomy was performed due to the risk of this foreign body causing appendicitis in the future. A small metallic object was found within the …