Medical Specialties Commons^™

Wellens' Syndrome Presenting As Epigastric Pain And Syncope: An Unusual Presentation, Temitope Ajibawo, Alexander Andreev, Sonu Sahni

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

Wellens' syndrome, also regarded as left anterior descending coronary T-wave syndrome, is an electrocardiography (EKG) pattern that indicates critical proximal left anterior descending artery (LAD) stenosis. It is characterized by deeply inverted T-waves or biphasic T-waves in the anterior precordial chest leads in a patient with unstable angina. Patients typically present with symptoms consistent with acute coronary syndrome. We present a unique case of Wellens' syndrome with no angiographic findings of significant stenosis in the proximal LAD but with significant occlusion of the proximal circumflex artery and initial presentation with a chief complaint of epigastric pain and syncope. Physicians need …

High-Sensitivity C-Reactive Protein Discordance With Atherogenic Lipid Measures And Incidence Of Atherosclerotic Cardiovascular Disease In Primary Prevention: The Aric Study, Renato Quispe, Erin D. Michos, Seth S. Martin, Rishi Puri, Peter P. Toth, Jassim Al Suwaidi, Maciej Banach, Salim S. Virani, Roger S. Blumenthal, Steven R. Jones

Office of the Provost

Background: Inflammation is an independent causal risk factor for atherosclerotic cardiovascular diseases (ASCVDs). However, whether hsCRP (high‐sensitivity C‐reactive protein) is prognostic across various levels of atherogenic lipid measures such as low‐density lipoprotein cholesterol, non–high‐density lipoprotein cholesterol, apolipoprotein B and total cholesterol/high‐density lipoprotein cholesterol in primary prevention is unknown.
Methods and Results: We studied 9748 ARIC (Atherosclerosis Risk in Communities) study participants who were free of ASCVD at baseline (visit 4, 1996–1998) and had measurements of lipids, apolipoprotein B, and hsCRP. We used multivariable adjusted Cox models to estimate the risk of incident ASCVD events associated with hsCRP levels (less than/greater …

Racial/Ethnic Differences In Glycemic Control In Older Adults With Type 2 Diabetes: United States 2003-2014, Brittany L. Smalls, Tiarney D. Ritchwood, Kinfe G. Bishu, Leonard E. Egede

Family and Community Medicine Faculty Publications

The aim of this study was to determine whether racial differences in HbA1c persist in older adults (≥65 years) living with type 2 diabetes. Data from The National Health and Nutrition Examination Survey (NHANES) 2003-2014 were used to examine the association between HbA1c and older adults (≥65 years) over time. Compared to non-Hispanic Whites, Mexican Americans had the greatest difference in average HbA1c among minority groups, followed by those with unspecified/mixed ethnicities and non-Hispanic Blacks. In the adjusted linear model, racial minorities had a statistically significant relationship with HbA1c. There was no relationship between HbA1c and older age and insulin …

Assessing Structural Damage Progression In Psoriatic Arthritis And Its Role As An Outcome In Research., Désirée Van Der Heijde, Dafna D Gladman, Arthur Kavanaugh, Philip Mease

Articles, Abstracts, and Reports

Psoriatic arthritis (PsA) is an immune-mediated, clinically heterogeneous disease characterized by arthritis, enthesitis, dactylitis, spondylitis, and psoriasis of the skin and nails. Persistent articular inflammation in patients with PsA can lead to structural damage, which can result in reduced physical function and quality of life. Structural damage can occur rapidly, and irreversible joint damage may be observed if patients are not treated promptly and appropriately. Therefore, evaluating therapeutic agents for their ability to inhibit structural progression has become increasingly important, with radiographic progression becoming a key efficacy outcome in clinical trials in PsA. Here, we review how structural damage and …

Ethnic Disparity And Exposure To Supplements Rather Than Adverse Childhood Experiences Linked To Preterm Birth In Pakistani Women, Kiran Shaikh, Shahirose Sadrudin Premjib, Sharifa Bashir Lalani, Ntonghanwah Forcheh, Aliyah Dosanic, Ilona S. Yim, Pauline Samia, Christopher Naugler, Nicole Letourneau, The Maternal Infant Global Health Team (Might) Collaborators In Research

Paediatrics and Child Health, East Africa

Background: Adverse childhood experiences (ACEs) are associated with prenatal mental health and negative pregnancy outcomes in high income countries, but whether the same association exists in Pakistan, a low- to middle-income (LMI) country, remains unclear.

Methods: Secondary data analyses of a prospective longitudinal cohort study examining biopsychosocial measures of 300 pregnant women at four sites in Karachi, Pakistan. A predictive multiple logistic regression model for preterm birth (PTB; i.e., <37 weeks’ gestation) was developed from variables significantly (P < 0.05) or marginally (P < 0.10) associated with PTB in the bivariate analyses.

Results: Of the 300 women, 263 (88%) returned for delivery and were included in the current analyses. The PTB rate was 11.1%. We found no association between ACE and PTB. Mother's …

Rivastigmine Modifies The Α-Secretase Pathway And Potentially Early Alzheimer's Disease, Balmiki Ray, Bryan Maloney, Kumar Sambamurti, Hanuma K. Karnati, Peter T. Nelson, Nigel H. Greig, Debomoy K. Lahiri

Sanders-Brown Center on Aging Faculty Publications

Rivastigmine (or Exelon) is a cholinesterase inhibitor, currently used as a symptomatic treatment for mild-to-moderate Alzheimer’s disease (AD). Amyloid-β peptide (Aβ) generated from its precursor protein (APP) by β-secretase (or BACE1) and γ-secretase endoproteolysis. Alternative APP cleavage by α-secretase (a family of membrane-bound metalloproteases– Adamalysins) precludes the generation of toxic Aβ and yields a neuroprotective and neurotrophic secreted sAPPα fragment. Several signal transduction pathways, including protein kinase C and MAP kinase, stimulate α-secretase. We present data to suggest that rivastigmine, in addition to anticholinesterase activity, directs APP processing away from BACE1 and towards α-secretases. We treated rat neuronal PC12 cells …

Hsp47 Promotes Cancer Metastasis By Enhancing Collagen-Dependent Cancer Cell-Platelet Interaction, Gaofeng Xiong, Jie Chen, Guoying Zhang, Shike Wang, Kunito Kawasaki, Jieqing Zhu, Yan Zhang, Kazuhiro Nagata, Zhenyu Li, Binhua P. Zhou, Ren Xu

Markey Cancer Center Faculty Publications

Increased expression of extracellular matrix (ECM) proteins in circulating tumor cells (CTCs) suggests potential function of cancer cell-produced ECM in initiation of cancer cell colonization. Here, we showed that collagen and heat shock protein 47 (Hsp47), a chaperone facilitating collagen secretion and deposition, were highly expressed during the epithelial-mesenchymal transition (EMT) and in CTCs. Hsp47 expression induced mesenchymal phenotypes in mammary epithelial cells (MECs), enhanced platelet recruitment, and promoted lung retention and colonization of cancer cells. Platelet depletion in vivo abolished Hsp47-induced cancer cell retention in the lung, suggesting that Hsp47 promotes cancer cell colonization by enhancing cancer cell–platelet interaction. …

Patients' Perspectives Of Tuberculosis Treatment Challenges And Barriers To Treatment Adherence In Ukraine: A Qualitative Study, Omowunmi Aibana, Emily Dauria, Tetiana Kiriazova, Olena Makarenko, Mariya Bachmaha, Natasha Rybak, Timothy Palen Flanigan, Vasyl Petrenko, Anne E Becker, Megan B Murray

Faculty, Staff and Student Publications

OBJECTIVES: To understand the challenges faced by patients with tuberculosis (TB) and factors that influence TB treatment adherence in Ukraine.

DESIGN: Qualitative study.

SETTING: TB treatment facilities in Kyiv Oblast, Ukraine.

PARTICIPANTS: Sixty adults who had undergone treatment for drug-sensitive TB between June 2012 and August 2015.

METHODS: We conducted semistructured, in-depth, individual interviews among a purposively selected clinical sample of patients previously treated for drug-sensitive TB. Interview content encompassed WHO's framework for barriers to adherence to long-term therapies and included questions about patient preferences and motivators concerning treatment adherence. We examined treatment experience across strata defined by previously identified …

Gibbon Surgical Society

Gibbon Surgical Review

The John H. Gibbon, Jr. Surgical Society (GSS) at Sidney Kimmel Medical College (SKMC) at Thomas Jefferson University is a unique student interest group that has been working hard to increase interest in the field of surgery among medical students for the last 37 years. The society has over 400 total active members on a year to year basis, spread across the four-year curriculum. The GSS increases exposure and interest to the surgical field through a unique blend of episodic and longitudinal programming that helps bring together students, residents, and faculty in an educational setting.

Chloraprep Dry Time, Nikki Jones, Chelsea Dennison, Becca Millard, Kristin Sapp

Nurse Presentations

Describes a project to increase the dry time compliance for solutions used in general surgery in the operating room.

Comparison Of Upper Extremity Function In Women With And Women Without A History Of Breast Cancer, Mary Insana Fisher, Gilson Capilouto, Terry Malone, Heather Bush, Timothy L. Uhl

Physical Therapy Faculty Publications

Design: This was an observational cross-sectional study.

Methods: Women who were diagnosed with breast cancer and had a mean post–surgical treatment time of 51 months (range = 12–336 months) were compared with women who did not have breast cancer (CTRL group). Self-reported upper extremity function using the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and shoulder range of motion, strength, and muscular endurance were measured. Participants were divided into 3 groups: breast cancer involving the nondominant limb (BC-ND), breast cancer involving the dominant limb (BC-DOM), and CTRL.

Results: A total of 59 women in the CTRL group, 23 …

Cancer Rehabilitation Publications (2008–2018) With A Focus On Physical Function: A Scoping Review, Shana Harrington, Nicole L. Stout, Elizabeth Hile, Mary Insana Fisher, Melissa Eden, Victoria Marchese, Lucinda Pfalzer

Physical Therapy Faculty Publications

Background: Cancer rehabilitation research has accelerated over the last decade. However, closer examination of the published literature reveals that the majority of this work has focused on psychological interventions and cognitive and behavioral therapies. Recent initiatives have aggregated expert consensus around research priorities, highlighting a dearth in research regarding measurement of and interventions for physical function. Increasingly loud calls for the need to address the myriad of physical functional impairments that develop in people living with and beyond cancer have been published in the literature. A detailed survey of the landscape of published research has not been reported to our …

Turning Passion Into Purpose: A Journey To Medicine Through Global Health, Laurenie Louissaint Md

Family Medicine

No abstract provided.

An Unusual Atrial Septal Defect Producing Symptoms In A Young Lady, Md Mashiul Alam, Md Al-Amin

Internal Medicine

Atrial septal defect is the most common congenital heart disease among adult population. Secundum variety of atrial septal defect comprises most frequently encountered atrial septal anomaly which presents during late age. Primum atrial septal defect usually associated with atrio-ventricular cushion defect among patients with Down syndrome. Small number of patients may present with fenestrated atrial septal defect. We have presented case of a woman who is young and symptomatic due to atrial septal defect comprising both secundum and primum type.

Insights Image For "Evidence Of Increased Hypoxia Signalling In Fetal Liver From Maternal Nutrient Restriction In Mice"., Bethany N Radford, Victor K M Han

Paediatrics Publications

No abstract provided.

Evidence Of Increased Hypoxia Signaling In Fetal Liver From Maternal Nutrient Restriction In Mice., Bethany N Radford, Victor K M Han

Paediatrics Publications

BACKGROUND: Intrauterine growth restriction (IUGR) is a pregnancy condition where fetal growth is reduced, and offspring from IUGR pregnancies are at increased risk for type II diabetes as adults. The liver is susceptible to fetal undernutrition experienced by IUGR infants and animal models of growth restriction. This study aimed to examine hepatic expression changes in a maternal nutrient restriction (MNR) mouse model of IUGR to understand fetal adaptations that influence adult metabolism.

METHODS: Liver samples of male offspring from MNR (70% of ad libitum starting at E6.5) or control pregnancies were obtained at E18.5 and differential expression was assessed by …

Color-Based Template Selection For Detection Of Gastric Abnormalities In Video Endoscopy, Hussam Ali, Muhammad Sharif, Mussarat Yasmin, Mubashir Husain Rehmani

Publications

Computer-aided diagnosis of gastric diseases from endoscopy frames is an important task. It facilitates both the patient and gastroenterologist in terms of time, money and most important health. Colors are the basic visual features of endoscopic images and also provide clues about abnormal regions in endoscopy frames. A variety of color spaces available for representation of color frames. However, we are not certain about which color space is more suitable for representing color features of gastric images. This paper presents a comparison of color features in different color spaces for detection of abnormal areas in chromoendoscopy (CH) frames. In addition, …

Mandatory And Permissive Reporting Laws: Obligations, Challenges, Moral Dilemmas, And Opportunities, Joel M. Geiderman, Catherine A. Marco

Emergency Medicine Faculty Publications

The duty to report certain conditions to public health or law enforcement authorities is one that falls on all physicians and other health care workers as part of their duty to protect the public from harm. In an open society, others, such as teachers, clergy, police officers, or simply neighbors, share the responsibility of protecting individuals at risk, often by reporting them to authorities. The emergency physician and others in the emergency department are uniquely positioned to identify people at risk or who pose a risk, and to report them as required or allowed under the law. In some circumstances, …

A Comparison Between The Teg 6s And Teg 5000 Analyzers To Assess Coagulation In Trauma Patients, Matthew D. Neal, Ernest E. Moore, Mark Walsh, Scott Thomas, Rachael A. Callcut, Lucy Z. Kornbilth, Martin Schreiber, Akpofure Peter Ekeh, Adam J. Singer, Lawrence Lottenberg, Michael Foreman, Susan Evans, Robert D. Winfield, Michael D. Goodman, Carl Freeman, David Milia, Noelle Saillant, Jan Hartmann, Hardean E. Achneck

Department of Surgery Faculty Publications

BACKGROUND

Trauma-induced coagulopathy is a major driver of mortality following severe injury. Viscoelastic goal-directed resuscitation can reduce mortality after injury. The TEG 5000 system is widely used for viscoelastic testing. However, the TEG 6s system incorporates newer technology, with encouraging results in cardiovascular interventions. The purpose of this study was to validate the TEG 6s system for use in trauma patients.

METHODS

Multicenter noninvasive observational study for method comparison conducted at 12 US Levels I and II trauma centers. Agreement between the TEG 6s and TEG 5000 systems was examined using citrated kaolin reaction time (CK.R), citrated functional fibrinogen maximum …

A Comprehensive Basic Understanding Of Pelvis And Acetabular Fractures After High-Energy Trauma With Associated Injuries: Narrative Review Of Targeted Literature, Muhammad Atif, Obada Hussein Hasan, Naveed Baloch, Masood Umer

Section of Orthopaedic Surgery

Acetabular fractures are caused by energy trauma which is high enough to cause such a fracture with incidence of 3 patients / 100000. In older individuals, most commonmechanism of injury is fall and, in younger individuals, road traffic accidents. Acetabular fractures are usually associated with visceral injuries and other musculoskeletal injuries (about 50% of patient). In this narrative review of targeted English literature from all level of evidences, which is written and supervised by experienced specialized orthopedic and trauma surgeons who were among the pioneers of conducting pelvis fracture management workshops in the country, we aim to describe the mechanism …

Functional And Clinical Outcomes Of Open Versus Closed Radius And Ulna Shaft Fractures In Adults: A Prospective Cohort Study, Tashfeen Ahmad, Zehra Abdul Muhammad, Pervaiz Hashmi

Section of Orthopaedic Surgery

Objective: To compare functional and clinical outcomes of open versus closed radius ulna shaft fractures in adults treated by internal fixation.
Methods: A prospective cohort study was conducted on patients presenting with traumatic radius and ulna shaft fractures to Aga Khan University and undergoing internal fixation between July 2015 to June 2019. Data was extracted from an ongoing orthopaedic trauma registry. Functional and clinical outcomes were assessed by Price et al. criteria at 6 weeks, 3, 6 and 12 months follow-up. Outcome scores of open versus closed fractures were compared.
Results: Twenty-nine adult patients with isolated radius and ulna shaft …

In The Cost-Conscious Era: Ilizarov Circular Frame Or Uniplanar External Fixator For Management Of Complex Open Tibia Shaft Fracture, Retrospective Cohort Study From A Level-1 Trauma Center, Muhammad Atif, Yasir Mohib, Obada Hussein Hasan, Haroon Rashid

Section of Orthopaedic Surgery

Objective: External fixation is the most commonly used method for temporary management of open fractures of the Tibial shaft followed by internal fixation. This can also be used as a definitive method of fixation. Ilizarov is more superior and can be the primary and definite option where expertise is available. This study was conducted todetermine the outcome of open tibia shaft fracture treated with either Ilizarov or AO External Fixator.
Methods: Anon-commercial retrospective cohort was conducted at Aga Khan University Hospital Karachi on patients operated for isolated open tibia fractures Gustillo type III (A, B, C) stabilized with external fixation …

Comparison Of Intraarticular Distal Humerus Fracture Outcomes Treated With Or Without Olecranon Osteotomy - A Case Series, Naveed Baloch, Tashfeen Ahmad, Zehra Abdul Muhammad

Section of Orthopaedic Surgery

A case series was extracted from the trauma registry at Aga Khan University Hospital from the period June 2015 to June 2019. Included were 16 adult patients who presented with intra-articular distal humerus fracture type C2. The functional, clinical and radiological outcomes of fractures treated with or without olecranon osteotomy up to 12 months follow-up were compared. Outcomes were assessed at 6 weeks, 3, 6 and 12 months re-visits. Among the 16 studied patients, 9 (56%) were males and 7 (44%) were females. In the group without osteotomy, there was a good functional and clinical outcome with a mean Quick …

Patient Outcomes Association With Patient Factors And Care Provided: Trauma Registry Derived Cohort Study, Tashfeen Ahmad, Zehra Abdul Muhammad

Section of Orthopaedic Surgery

Objective: To determine the association of delay in treatment with injury-specific patient outcomes.
Methods: This was a single-center, longitudinal cohort study on orthopaedic trauma registry. Data on patients enrolled between June 2015 and June 2018 were analyzed. Data was collected from admitted consenting patients' medical records. Definitive surgical care provided after 24 hours was considered as 'delayed surgical treatment'. Outcomes of patients were serially assessed on follow-up visits up to 12 months using injury-specific scoring system.
Results: A total of 789 patients, were enrolled with 856 upper or lower extremity injuries altogether; in 67 cases both extremities were involved. Surgery …

Successful Recovery In A Paediatric Patient With Polytrauma Following Multiple Gunshot Wounds: Case Report And Review Of Literature, Areej Saleem, Rida Ahmed, Abeer Aziz, Sohail Asghar Dogar

Section of Paediatric Surgery

Our case report evaluates a 2½ year old boy who presented to emergency care, following multiple gunshot injuries and was managed emergently using a multidisciplinary surgical approach at our center. The patient was unresponsive, had poor perfusion, bilaterally decreased air entry, a distended abdomen, and multiple entry and exit wounds. A multidisciplinary team including Paediatric Surgery, Cardiothoracic Surgery, Paediatric anaesthesiology team and Orthopaedic surgery were taken on board. Following effective immediate management and stabilization, the patient was admitted to the ward under careful observation. He was discharged on post-operative day 28 after a successful recovery and on his 6 month …

Isolated Gallbladder Injury From Blunt Abdominal Trauma: A Rare Co-Incidence, Muhammad Rizwan Khan, Saleema Begum

Section of General Surgery

Gallbladder injury resulting from blunt abdominal trauma is a rare entity and generally associated with other intra-abdominal injuries. Incidence of isolated gallbladder injury has not been reported yet. The most common mechanism of injury reported is road traffic accident. Diagnosis is usually made on imaging as clinical presentation may vary from no symptoms to peritonitis due to extravasation of bile in the abdominal cavity. Cholecystectomy is the treatment of choice and minimally invasive approach can be considered in haemodynamically stable patients.

Delay Between Onset Of Indication And Definitive Surgery For Tracheal Trauma, Mohammad Bin Pervez, Hassan Mushtaq, Shahmir Chauhan, Ali Aahil Noorali, Yasir Bilal Khan, Muhammad Saad Yousuf, Saulat Fatimi

Section of Cardiothoracic Surgery

Tracheal stenosis is rare but a recognized complication after traumatic injury or prolonged intubation. We assessed the time lag between onset of indication for tracheal reconstruction surgery following trauma and actual surgical intervention. We reviewed our operative records for all patients undergoing tracheal reconstruction over the past 10 years. Files were reviewed retrospectively to collect all the relevant data. Surgically all patients were operated via cervical approach. Series 12 cases were identified with an equal split between external trauma and iatrogenic tracheal trauma from prolonged intubation. On, an average patients presented 185 days after initial indication of surgery however there …

Interview With Dr. Geoffrey Krampitz, Colin Yost

Gibbon Surgical Review

Geoffrey Krampitz, MD, PhD is a hepatopancreaticobiliary surgeon with an extensive background in surgical oncology, stem cell science, and cancer immunotherapy research who recently joined the faculty here at Thomas Jefferson University as an Assistant Professor of Surgery. After earning his BSE in biomedical engineering at Johns Hopkins University and before starting medical training, Dr. Krampitz worked in consulting in the San Francisco Bay Area and eventually helped launch two internet startup companies in Silicon Valley. He then went to UC San Francisco for his Master’s degree, where he investigated the role of HIF1-alpha in stem cell differentiation. Dr. Krampitz …

Primum Non Nocere: Surgeons And The Politics Of Firearm Trauma, Kaushal Desai

Gibbon Surgical Review

The crisis of firearm violence in America continues to worsen and the call to action cannot be ignored. If we are to make a real impact, we must be just as skilled policy makers as proceduralists. We must wield the pen as well as we wield the scalpel. All the clinical knowledge and surgical skills in the world will make no difference if we do not reduce the number of firearm injuries. The skillset we need is policy analysis and lobbying, which can only be developed through political activism and engagement, not more practice questions and Online MedEd.

General Surgery 101: Nissen Fundoplication, Kelley Yuan, Tyler Bauer

Gibbon Surgical Review

The first time that medical students enter the OR can be a jarring experience. Successfully maintaining sterility is hard enough, but remembering relevant patient history, answering “pimp” questions, and performing basic suturing skills can make the third year medical student experience difficult. In this article we describe a common surgery performed by both general and thoracic surgeons with a specific focus on “medical student level” understanding. This piece is the product of a collaboration between an MS1 and MS4, both of whom are interested in a career in surgery. We hope you find it helpful!