Medical Specialties Commons^™

Defining Current Gaps In Quality Measures For Cancer Immunotherapy: Consensus Report From The Society For Immunotherapy Of Cancer (Sitc) 2019 Quality Summit, Sara Pai, David Blaisdell, Rachel Brodie, Robert G. Carlson, Heidi Finnes, Michele Galioto, Roxanne E. Jensen, Tom Valuck, Antonia R. Sepulveda, Howard L. Kaufman

Population and Public Health Sciences Faculty Publications

Background Quality measures are important because they can help improve and standardize the delivery of cancer care among healthcare providers and across tumor types. In an environment characterized by a rapidly shifting immunotherapeutic landscape and lack of associated long-term outcome data, defining quality measures for cancer immunotherapy is a high priority yet fraught with many challenges. Methods Thus, the Society for Immunotherapy of Cancer convened a multistakeholder expert panel to, first, identify the current gaps in measures of quality cancer care delivery as it relates to immunotherapy and to, second, advance priority concepts surrounding quality measures that could be developed …

The Va Mission Act Of 2018: A Potential Game Changer For Rural Gme Expansion And Veteran Health Care, Anne Victoria Neale, Phil Lupo, Marjorie A. Bowman, Dean A. Seehusen

Population and Public Health Sciences Faculty Publications

The Veterans Healthcare Administration (VHA) is the largest health care delivery system in the United States. It includes 172 medical centers (VAMCs), with over 1,100 Community Based Outpatient Centers (CBOCs) and various other sites of care. In addition to training physicians to care for veterans and active duty service members, the VHA is also directed to assist in supplying health care personnel to the nation.Through its Office of Academic Affiliations (OAA), VHA develops partnerships with Accreditation Council for Graduate Medical Education (ACGME)/American Osteopathic Association (AOA) accredited residency program sponsoring institutions. These collaborations include 144 out of 152 allopathic medical schools …

Lsd1 Promotes Bladder Cancer Progression By Upregulating Lef1 And Enhancing Emt., Qiubo Xie, Tang Tang, Jian Pang, Jing Xu, Xingxia Yang, Linang Wang, Yiqiang Huang, Zhuowei Huang, Gaolei Liu, Dali Tong, Yao Zhang, Luofu Wang, Dianzheng Zhang, Weihua Lan, Qiuli Liu, Jun Jiang

PCOM Scholarly Works

Epithelial-to-mesenchymal transition (EMT) is one of the important underlying molecular mechanisms for most types of cancers including bladder cancer. The precise underlying molecular mechanism in EMT-mediated bladder cancer progression is far from completed. LSD1, a histone lysine-specific demethylase, is known to promote cancer cell proliferation, metastasis, and chemoresistance. We found in this study that LSD1 is highly upregulated in bladder cancer specimens, especially those underwent chemotherapy, and the elevated levels of LSD1 are highly associated with bladder cancer grades, metastasis status, and prognosis. Inhibiting or knockdown LSD1 repressed not only EMT process but also cancer progression. Mechanistically, LSD1 complexes with …

The Vhl/Hif Axis In The Development And Treatment Of Pheochromocytoma/Paraganglioma, Song Peng, Jun Zhang, Xintao Tan, Yiqiang Huang, Jing Xu, Natalie Silk, Dianzheng Zhang, Qiuli Liu, Jun Jiang

PCOM Scholarly Works

Pheochromocytomas and paragangliomas (PPGLs) are rare neuroendocrine tumors originating from chromaffin cells in the adrenal medulla (PCCs) or extra-adrenal sympathetic or parasympathetic paraganglia (PGLs). About 40% of PPGLs result from germline mutations and therefore they are highly inheritable. Although dysfunction of any one of a panel of more than 20 genes can lead to PPGLs, mutations in genes involved in the VHL/HIF axis including

Myo/Nog Cells Are Nonprofessional Phagocytes, Jacquelyn Gerhart, Lindsay Gugerty, Paul Lecker, Fathma Abdalla, Mark Martin, Olivia Gerhart, Colby Gerhart, Karanveer Johal, Jake Bernstein, John Spikes, Keith Mathers, Arturo Bravo Nuevo, Mindy George-Weinstein

PCOM Scholarly Works

Myo/Nog cells were discovered in the chick embryo epiblast. Their expression of MyoD reflects a commitment to the skeletal muscle lineage and capacity to differentiate into myofibroblasts. Release of Noggin by Myo/Nog cells is essential for normal morphogenesis. Myo/Nog cells rapidly respond to wounding in the skin and eyes. In this report, we present evidence suggesting that Myo/Nog cells phagocytose tattoo ink in tissue sections of human skin and engulf cell corpses in cultures of anterior human lens tissue and magnetic beads injected into the anterior chamber of mice in vivo. Myo/Nog cells are distinct from macrophages in the skin …

Serum 25-Hydroxyvitamin D Levels In Children With Mild And Severe Atopic Asthma, Rhoda Ndinda Masaku

Master of Medicine in Paediatrics and Child Health

Background: Asthma is a chronic respiratory illness affecting an estimated 334 million people worldwide, including 14% of the total pediatric population. It results in significant morbidity, and therefore the etiologies and risk factors associated with asthma are of great interest. Serum 25- hydroxyvitamin D (25(OH)D) has substantial immunomodulatory effects on the innate immune system. It reduces the probability of viral respiratory infections and asthma exacerbations by potentiating the anti-inflammatory action of corticosteroids. Objectives: This study was conducted to determine if there was a difference in serum 25-hydroxyvitamin D levels between children with mild and severe atopic asthma and explored the …

Analysis Of Terminal Duct Lobular Unit Involution In Luminal, Her-2enriched And Triple Negative Breast Cancer Subtypes, Joseph Nyaguti Kiwinga

Master of Medicine in Anatomic Pathology

Introduction: The terminal duct lobular unit (TDLU) of the breast is the most common origin of most breast cancers (BC). With increasing age and menopause, physiologic involution of TDLU occurs with a reduction in both the number and size of the lobules. Reduced TDLU involution is associated with a higher mammographic breast density (MBD) which by itself is a strong breast cancer risk factor. Recent studies have shown that TDLU involution is associated with a reduced risk of breast cancer and involution also differs with molecular subtypes of BC. Studies have shown that the etiology, pathogenesis and prognosis of the …

The Needs At 48 Hours Of Immediate Family Members Of Patients Admitted To The Intensive Care Unit At The Aga Khan University Hospital, Nairobi, Maalim Fahad

Master of Medicine in Anaesthesiology

Background: Family members of patients admitted to Intensive Care Unit (ICU) have been shown to have important needs. Inability of the critical personnel to interrelate appropriately with relatives of critically unwell patients, or to recognize or meet their needs, may lead to increased anxiety, misconception and distrust from relatives. Aim: To determine the needs of immediate family members of adult patients admitted to ICU at 48 hours at the Aga Khan University Hospital, Nairobi. Methods: This was a cross-sectional descriptive study. The Critical Care Family Needs Inventory questionnaire was employed to identify the needs of the immediate relatives of adult …

Determinants Of Pathological Response To Neoadjuvant Chemotherapy In Women With Breast Cancer In Kenya, Ngayu Munga Thairu

Master of Medicine in Anatomic Pathology

Background: Breast cancer (BC) is the most common cause of cancer deaths in Kenya. Standard treatment involves surgery followed by adjuvant chemo/radiotherapy as appropriate. Neoadjuvant chemotherapy (NACT) facilitates surgery in locally advanced breast cancer. The Residual Cancer Burden (RCB) is an objective, standardised measure of pathological response to NACT. Pathological complete response (pCR) (RCB Class 0) is a robust prognostic indicator, used in clinical trials. This study aimed to use RCB to improve understanding of current practice and effectiveness of NACT for breast cancer patients at Aga Khan University Hospital Nairobi (AKUH, N.).

Methods: 67 breast cancer patients …

Etiologies Of Lower Respiratory Tract Infections Among Adult Patients Presenting To A Tertiary Institution In Nairobi, Mary Achakolong

Master of Medicine in Anatomic Pathology

Background: Lower respiratory tract infections continue to contribute significantly to morbidity and mortality across all age groups globally. Viral pathogens in isolation or as co-infections are an important cause of pneumonia and associated with several life threatening syndromes that warrant appropriate and timely lifesaving diagnosis. Many viral respiratory infections demonstrate substantial regional and seasonal variations which are poorly understood. In addition, there are very few studies in sub-Saharan Africa that have examined the role of viruses as causes of community acquired pneumonia. The availability of molecular techniques such as multiplex PCR that are much more sensitive than traditional methods and …

Caffeine Ingestion Enhances Repetition Velocity In Resistance Exercise: A Randomized, Crossover, Double-Blind Study Involving Control And Placebo Conditions, Jozo Grgic, Sandro Venier, Brad J. Schoenfeld, Pavle Mikulic

Publications and Research

We aimed to examine the effects of placebo and caffeine compared to a control condition on mean velocity in the bench press exercise. Twenty-five resistance-trained men participated in this randomized, crossover, double-blind study. The participants performed the bench press with loads of 50%, 75%, and 90% of one-repetition maximum (1RM), after no supplementation (i.e., control), and after ingesting caffeine (6 mg/kg), and placebo (6 mg/kg of dextrose). At 50% 1RM, there was a significant effect of caffeine on mean velocity compared to control (effect size [ES] = 0.29; p = 0.003), but not when compared to placebo (ES = 0.09; …

Fmic Annual Report 2020 | Pashto (پشتو), French Medical Institute For Mothers And Children

French Medical Institute for Mothers and Children (FMIC) Archives

No abstract provided.

Fmic Annual Report 2020 | English, French Medical Institute For Mothers And Children

French Medical Institute for Mothers and Children (FMIC) Archives

No abstract provided.

Fmic Annual Report 2020 | Dari (دری), French Medical Institute For Mothers And Children

French Medical Institute for Mothers and Children (FMIC) Archives

No abstract provided.

Association Between Eccentric Knee Flexor Strength And Hamstring Injury Risk In 185 Elite Gaelic Football Players, Mark Roe, Eamonn Delahunt, Malachy Mchugh, Conor Gissane, Shane Malone, Kieran Collins, Catherine Blake

Articles

Hamstring strains are the most common time-loss injury in elite Gaelic football affecting over 20% of players per season. Thus, there is a need to identify factors contributing to the onset of hamstring injuries in order to inform injury risk management strategies. The current study investigated whether eccentric knee flexor strength and between-limb imbalances were associated with increased risk of sustaining a timeloss hamstring injury in elite Gaelic football players. A total of 185 elite male players (26.9 ± 2.7 years, 86.4 ± 6.2 kg, 183.4 ± 5.6) were prospectively followed for 12 weeks from the day of testing. Injury …

Tick-Borne Infections In New Hampshire: An Evaluation Of The Diagnostic Process In A Local Patient Population, Katherine Anderson

Honors Theses and Capstones

Overall, approximately 95 percent of reported cases of vector-borne disease were associated with ticks, making these the most medically important group of arthropods in the United States.¹ Despite the prevalence of tick-borne infections, the process for the diagnosis of this condition is not well studied. This study aims to analyze data from a pool of 100 patients who underwent testing for tick-borne disease in the same institution in Dover, New Hampshire during the most recent peak tick season of 2019. Information utilized in this study included: patient age, sex, location of testing (inpatient versus outpatient), diagnostic testing methods used …

Identification Of A Novel Single Amino Acid Substitution (V666g) Of Jak1 From A Patient With Acute Lymphoblastic Leukemia Impairs Jak3 Mediated Il-2 Signaling, Alice Hernandez Grant

Open Access Theses & Dissertations

The Janus kinase (JAK) family, notably JAK1, JAK2 and JAK3 are recognized as oncogenic drivers in high risk Acute Lymphoblastic Leukemia (ALL). The bulk of activating JAK mutations are thought to occur within functional hot-spots across Janus Homology (JH) domains. The most frequently mutated regions is the JH2 pseudo-kinase, which provides a negative regulatory role to the adjacent catalytically active JH1 kinase domain. Despite the prevalence of JAK activating mutations and a need for new therapeutic inhibitors, there is a lack of understanding in the allosteric regulation of JAK kinases. Here we sought to identify mutations involved in driving ALL …

Effect Of Hemolysis On Fourier Transform Infrared And Raman Spectra Of Blood Plasma, Dinesh Medipally, Daniel Cullen, Valérie Untereiner, Jane Bryant, Ganesh D. Sockalingum, Thi Nguyet Que Nguyen, Emma Noone, Shirley Bradshaw, Marie Finn, Mary Dunne, Aoife M. Shannon, John Armstrong, Aidan Meade, Fiona Lyng

Articles

Hemolysis is a very common phenomenon and is referred as the release of intracellular components from red blood cells to the extracellular fluid. Hemolyzed samples are often rejected in clinics due to the interference of hemoglobin and intracellular components in laboratory measurements. Plasma and serum based vibrational spectroscopy studies are extensively applied to generate spectral biomarkers for various diseases. However, no studies have reported the effect of hemolysis in blood based vibrational spectroscopy studies. This study was undertaken to evaluate the effect of hemolysis on infrared and Raman spectra of blood plasma. In this study, prostate cancer plasma samples (n …

Corpus Cavernosum Abscess Secondary To Traumatic Perforation Of Urethral Diverticulum, Thomas C. Gore, Anna Schepcoff, Domenick Sorresso

West Florida Division GME Research Day 2020

A corpus cavernosum abscess is a rare condition. Usual etiologies include penile injection of erectile dysfunction medications or illicit drugs, priapism, sexually transmitted infections, and trauma; however, there have been reported cases of idiopathic etiology. The most common causative organisms include Staphylococcus aureus, Streptococci, and Bacteroides [1]. Diagnosis is typically made clinically and through imaging (computed tomography [CT] and ultrasound). The first-line treatment is the use of intravenous (IV) antibiotics and surgical drainage. More conservative treatment, however, includes aspiration in conjunction with IV antibiotics [2-3]. Urethral diverticulum (UD) is the formation of a saccular outpouching of the urethral lumen. Symptoms …

A Rare Case Of Trichilemmal Carcinoma: Histology And Management, Lisa F. Fronek, Allyson Brahs, Maheera Farsi, Richard Miller

West Florida Division GME Research Day 2020

Trichilemmal carcinoma (TC) is a rare, malignant, adnexal neoplasm that is derived from the outer root sheath (ORS) of the hair follicle. These tumors predominantly occur in elderly patients on sun-exposed areas, specifically on the head and neck with the face defined as the most common location. The mean age of diagnosis is 70 years old with a slight male predominance. These lesions are commonly identified as a papular, nodular, and sometimes, exophytic. They generally arise de-novo, but may also derivate from an underlying proliferating trichilemmal cyst with a loss of p53, a seborrheic keratosis, a nevus sebaceous, or a …

Localized Cytokine Responses To Total Knee Arthroplasty And Total Knee Revision Complications, Nicole Prince, Julia A. Penatzer, Matthew J. Dietz, Jonathan W. Boyd

Faculty & Staff Scholarship

Background

The study of localized immune-related factors has proven beneficial for a variety of conditions, and one area of interest in the field of orthopaedics is the impact of implants and localized infections on immune response. Several cytokines have shown increased systemic concentrations (in serum/plasma) in response to implants and infection, but tissue-level cytokines have not been investigated as thoroughly.

Methods

This exploratory study investigated tissue-level cytokines in a cohort of patients (N = 17) in response to total knee arthroplasty and total knee revision to better understand the immune response to implants and localized infection (e.g., prosthetic joint infection). …

Spatially Fractionated Radiation Therapy: History, Present And The Future, Weisi Yan, Mohammad K. Khan, Xiaodong Wu, Charles B. Simone Ii, Jiajin Fan, Eric Gressen, Xin Zhang, Charles L. Limoli, Houda Bahig, Slavisa Tubin, Waleed F. Mourad

Department of Radiation Oncology Faculty Papers

No abstract provided.

Neoangiogenesis And Blood-Brain Barrier Dysfunction In Human Tsc Brain Lesions, Kimberly Sansalone, Pelin Dilsiz, Howard Weiner, Orrin Devinsky, Delia M. Talos

Phase 1

Introduction: Tuberous sclerosis complex (TSC) is a genetic disorder characterized by the presence of multiple benign tumors throughout the body and brain. Patients with TSC experience severe cognitive dysfunction and therapy-resistant seizures, which can be associated with refractory epilepsy and poor developmental outcomes. We hypothesize that neoangiogenesis, disruption of the blood-brain barrier, and leakage of serum proteins into the brain parenchyma play vital roles in the pathogenesis of TSC.

Methods: In order to assess blood-brain barrier integrity, cortical tissue samples from TSC patients with intractable seizures, non-TSC patients with therapy-resistant epilepsy, and control subjects were immunolabeled for the serum …

Characteristics And Outcomes Of Patients Directly Discharged To Home From The Intensive Care Unit, Ann Zheng, Preeyal M. Patel, Michele Fiorella, Lauren Mcdonnell, Mina Yasuoka, Erika J. Yoo, Md

Phase 1

Introduction: Given the current era of decreasing hospital bed availability, there has been a rise in the practice of direct discharge to home (DDH) from ICUs. We evaluated the demographics, clinical characteristics, outcomes and readmission patterns among DDH patients.

Methods: Retrospective review of patients from 2 MICUs from June 2017 to June 2019 at Thomas Jefferson University hospital, an urban tertiary care center. Primary outcome of interest was 30-day hospital readmission. Patients were dichotomized into two groups based on time between ward transfer order and hospital discharge (<24 or ≥24 hours). Risk adjustment performed with Mortality Probability Model (MPM0 -III). ICU workload at admission and discharge was estimated with nine equivalents of nursing manpower use score (NEMS). Patient characteristics compared using t-test and Fisher exact or χ² test.

Results: 331 DDH patients were analyzed, with the majority …

Continuous-Flow Left Ventricular Assist Device Outflow Graft Stenting: Indications And Outcomes, Chelsey T. Wood, Mfa, Elizabeth J. Maynes, Md, Thomas J. O'Malley, Md, Rohinton J. Morris, Md, Louis E. Samuels, Md, H. Todd Massey, Md, Vakhtang Tchantchaleishvili

Phase 1

Introduction: Stenosis in the continuous-flow left ventricular assist device (CF-LVAD) outflow graft can be caused by various mechanical and anatomical factors. Increasingly, percutaneous management has been utilized to re-establish adequate CF-LVAD flow. We sought to evaluate indications for such interventions and their outcomes.

Methods: An electronic search was performed to identify all studies in the English literature reporting CF-LVAD outflow graft stenting for various etiologies. Twenty-one studies consisting of 26 patients were included in the analysis.

Results: Median patient age was 59 years [45.8-67.0] and 65.4% (17/26) were male. 58.3% (14/24) of patients had HeartWare HVAD, 37.5% (9/24) had HeartMate …

Development Of A Hert Trained Interprofessional Student Decontamination Team For Hospital Mass Casualty Response, Ashley Wong, Claire Zurlo, Edward Jasper

Phase 1

Introduction: FEMA’s Hospital Emergency Response Training (HERT) prepares healthcare workers to decontaminate patients during a mass casualty incident. This depletes the emergency department (ED) staff when they are needed most though. Developing an interprofessional student composed HERT team to screen and decontaminate affected populations will allow ED staff to handle more medically complex situations during a mass casualty event.

Methods: Likert scale surveys were conducted among ED physicians and nurses at Jefferson Hospital and HERT trained medical and nursing students at Jefferson University. These were to evaluate the training program and ED staff opinions of utilizing a student HERT …

Conversion Total Knee Arthroplasty Needs Its Own Diagnosis Related Group Facility Reimbursement Code, Jonah Stein, Michael Yayac, Md, Gregory K. Deirmengian, Md, Javad Parvizi, Md, P. Maxwell Courtney, Md

Phase 1

Introduction: Conversion from a prior surgery to a total knee arthroplasty (TKA) is a more technically difficult procedure than primary TKA and is associated with worse short-term outcomes and increased complication and readmission rates, despite being undifferentiated under the current bundled payment model. The aim of this study was to determine differences in facility costs between primary TKA and conversion TKA, which we hypothesize are significant, to ensure providers are not penalized for treatment and high-risk patients have the same access to care.

Methods: We retrospectively reviewed a consecutive series of patients undergoing primary TKA at two hospitals within …

Cardiac Risk Factors Predicting 30/90-Day Readmission Rates In Lumbar Decompression Surgeries, Kevin Xiao, Blake Nourie, Joseph Bechay, Dhruv K.C. Goyal

Phase 1

Preoperative cardiopulmonary disease is known to be a risk factor for perioperative complications in deformity surgery and lumbar fusion procedures, however there is a lack of literature evaluating cardiac risk factors and their influence on readmission rates following lumbar decompression surgery. We want to determine whether preoperative cardiac risk factors influenced the 30 and 90-day readmission rates in patients undergoing lumbar decompression surgery. Patient charts from Rothman Institute between were reviewed for history of preoperative cardiac risk factors such as coronary artery disease, congestive heart failure, myocardial infarction, stroke, cardiac catheterization, stent placement, coronary artery bypass graft, aspirin and/or clopidogrel …

Phenotype-Genotype Correlations In Patients With Epidermolysis Bullosa With Plec Mutations, Elizabeth Zhang, Masoomeh Faghankani, Hassan Vahidnezhad, Jouni Uitto

Phase 1

Epidermolysis bullosa (EB) is a heterogeneous group of genetic disorders characterized by blistering skin and mucous membranes. Mutations of the protein plectin, encoded by PLEC, cause autosomal recessive EB simplex with muscular dystrophy (EBS-MD) and EB simplex with pyloric atresia (EBS-PA). Until now, no clear genotype-phenotype correlation has been identified from the positions of mutations in the PLEC gene. How do ten distinct families with PLEC mutations manifesting as various EB disorders compare with regard to gene mutations? The hypothesis is that clinical manifestations of EB will be more extreme in patients with more severe gene mutations.

The design of …

Surgical Resection Of Convexity Meningiomas: A Single Center Retrospective Analysis, Haley Wendt, Michael Baldassari, Donald Ye, Kevin Judy

Phase 1

Introduction: Dural convexity meningiomas (CMs) are the most common primary intracranial tumors. Although surgical resection carries relatively low risk, it is necessary to quantify perioperative risks from a large patient cohort and identify factors contributing to short-term and long-term outcomes.

Methods: Patients who underwent craniotomy for resection of CMs between January 2012-December 2018 at a single large academic center were reviewed for pre-operative demographics, radiographic characteristics, and post-operative outcomes.

Results: 122 cases of CMs were identified. Common presenting symptoms included headache (39.3%), seizure (27.0%) and weakness/paralysis (18%). CMs were located over frontal, parietal, temporal, and occipital lobes in 57.4%, …