Medical Specialties Commons^™

Lar Inhibitory Peptide Promotes Recovery Of Diaphragm Function And Multiple Forms Of Respiratory Neural Circuit Plasticity After Cervical Spinal Cord Injury., Lan Cheng, Armin Sami, Biswarup Ghosh, Mark W Urban, Nicolette M Heinsinger, Sophia S Liang, George M Smith, Megan C Wright, Shuxin Li, Angelo C Lepore

Farber Institute for Neuroscience Faculty Papers

Chondroitin sulfate proteoglycans (CSPGs), up-regulated in and around the lesion after traumatic spinal cord injury (SCI), are key extracellular matrix inhibitory molecules that limit axon growth and consequent recovery of function. CSPG-mediated inhibition occurs via interactions with axonal receptors, including leukocyte common antigen- related (LAR) phosphatase. We tested the effects of a novel LAR inhibitory peptide in rats after hemisection at cervical level 2, a SCI model in which bulbospinal inspiratory neural circuitry originating in the medullary rostral ventral respiratory group (rVRG) becomes disconnected from phrenic motor neuron (PhMN) targets in cervical spinal cord, resulting in persistent partial-to-complete diaphragm paralysis. …

Orthopedic Principles To Facilitate Enhanced Recovery After Cardiac Surgery, Marc W Gerdisch, Keith B Allen, Yoshifumi Naka, Mark R Bonnell, Kevin P Landolfo, John Grehan, Kendra J Grubb, David J Cohen, T. Sloane Guy, Nirav C Patel, Vinod H Thourani

Department of Surgery Faculty Papers

Enhanced recovery after surgery (ERAS) protocols recognize early postoperative mobilization as a driver of faster postoperative recovery, return to normal activities, and improved long-term patient outcomes. For patients undergoing open cardiac surgery, an opportunity for facilitating earlier mobilization and a return to normal activity lies in the use of improved techniques to stabilize the sternal osteotomy. By following the key orthopedic principles of approximation, compression, and rigid fixation, a more nuanced approach to sternal precaution protocols is possible, which may enable earlier patient mobilization, physical rehabilitation, and recovery.

Breast Carcinoma Metastasis In A Resected Meningioma With Early Diagnosis Of Oligometastatic Disease: A Case Report., Christian Fernandez, Louis Cappelli, Sara Chapin,, Lawrence Kenyon, Christopher J Farrell, Wenyin Shi

Department of Radiation Oncology Faculty Papers

Tumor-to-tumor metastasis describes the ability of primary tumors to metastasize to other primary tumors. These events generally occur in aggressive and widely-metastatic disease, with the appropriate management and significance of these events unknown. A 56-year-old woman with a history of bilateral, localized, invasive lobular breast carcinoma treated with surgery, systemic therapy, and adjuvant radiation presented five and two years post-treatment with progressive neurological symptoms. Imaging revealed an intracranial meningioma, and the patient underwent resection. Pathology revealed metastatic invasive lobular carcinoma cells within the resected meningioma, and the patient was treated with postoperative radiation without sequelae. Subsequent staging scans revealed a …

Caseous Mitral Valve Calcification And Concurrent Hypertrophic Obstructive Cardiomyopathy: A Rare Cause Of Stroke, Waqas Ullah, Donald C. Haas, Talal Almas, Aws- Al-Mukhtar, Asad Inayat

Division of Cardiology Faculty Papers

No abstract provided.

Site-Specific Multi Disciplinary Tumour Board Is An Important Milestone In Cancer Patient's Treatment Journey, Ahmed Nadeem Abbasi, Sehrish Abrar, Bilal Mazhar Qureshi

Department of Radiation Oncology

No abstract provided.

The Tuskegee Syphilis Experiment: The Implications Of Its Legacy, Joshua Barash, Md

Department of Family & Community Medicine Presentations and Grand Rounds

Objectives

• Discuss details of the Tuskegee Study
• Summarize ethical issues
• Explore the legacy of Tuskegee: Distrust of the Medical Establishment

Proposal Of Rt-Pcrebased Mass Population Screening For Severe Acute Respiratory Syndrome Coronavirus 2 (Coronavirus Disease 2019), Nikhil S. Sahajpal, Ashis K. Mondal, Allan Njau, Sudha Ananth, Kimya Jones, Pankaj K. Ahluwalia, Meenakshi Ahluwalia, Yasmeen Jilani, Alka Chaubey, Madhuri Hegde, Vamsi Kota, Amyn Rojiani, Ravindra Kolhe

Pathology, East Africa

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) testing has lagged in many countries because of test kit shortages and analytical process bottlenecks. This study investigated the feasibility and accuracy of a sample pooling approach for wide-scale population screening for coronavirus disease 2019. A total of 940 nasopharyngeal swab samples (934 negative and 6 positive) previously tested for SARS-CoV-2 were deidentified and assigned random numbers for analysis, and 94 pools of 10 samples each were generated. Automated RNA extraction, followed by RT-PCR, was performed in a 96-well plate. Positive pools were identified, and the individual samples were reanalyzed. Of the 94 …

Low-Shot Deep Learning Of Diabetic Retinopathy With Potential Applications To Address Artificial Intelligence Bias In Retinal Diagnostics And Rare Ophthalmic Diseases, Philippe Burlina, William Paul, Philip Mathew, Neil Joshi, Katia D Pacheco, Neil M Bressler

Faculty, Staff and Students Publications

IMPORTANCE: Recent studies have demonstrated the successful application of artificial intelligence (AI) for automated retinal disease diagnostics but have not addressed a fundamental challenge for deep learning systems: the current need for large, criterion standard-annotated retinal data sets for training. Low-shot learning algorithms, aiming to learn from a relatively low number of training data, may be beneficial for clinical situations involving rare retinal diseases or when addressing potential bias resulting from data that may not adequately represent certain groups for training, such as individuals older than 85 years.

OBJECTIVE: To evaluate whether low-shot deep learning methods are beneficial when using …

Ampk Regulation Of Raptor And Tsc2 Mediate Metformin Effects On Transcriptional Control Of Anabolism And Inflammation, Jeanine L Van Nostrand, Kristina Hellberg, En-Ching Luo, Eric L Van Nostrand, Alina Dayn, Jingting Yu, Maxim N Shokhirev, Yelena Dayn, Gene W Yeo, Reuben J Shaw

Faculty, Staff and Students Publications

Despite being the frontline therapy for type 2 diabetes, the mechanisms of action of the biguanide drug metformin are still being discovered. In particular, the detailed molecular interplays between the AMPK and the mTORC1 pathway in the hepatic benefits of metformin are still ill defined. Metformin-dependent activation of AMPK classically inhibits mTORC1 via TSC/RHEB, but several lines of evidence suggest additional mechanisms at play in metformin inhibition of mTORC1. Here we investigated the role of direct AMPK-mediated serine phosphorylation of RAPTOR in a new

Serially Assessed Bisphenol A And Phthalate Exposure And Association With Kidney Function In Children With Chronic Kidney Disease In The Us And Canada: A Longitudinal Cohort Study., Melanie H. Jacobson, Yinxiang Wu, Mengling Liu, Teresa M. Attina, Mrudula Naidu, Rajendiran Karthikraj, Kurunthachalam Kannan, Bradley A. Warady, Susan Furth, Suzanne Vento, Howard Trachtman, Leonardo Trasande

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Exposure to environmental chemicals may be a modifiable risk factor for progression of chronic kidney disease (CKD). The purpose of this study was to examine the impact of serially assessed exposure to bisphenol A (BPA) and phthalates on measures of kidney function, tubular injury, and oxidative stress over time in a cohort of children with CKD.

METHODS AND FINDINGS: Samples were collected between 2005 and 2015 from 618 children and adolescents enrolled in the Chronic Kidney Disease in Children study, an observational cohort study of pediatric CKD patients from the US and Canada. Most study participants were male (63.8%) …

Superficial Basal Cell Carcinoma Of The Face Successfully Treated With Ingenol Mebutate 005% Gel: Case Report And A Review Of The Literature, Theodore Rosen, Kami Lowery

Faculty, Staff and Students Publications

A 64 year-old Caucasian male patient with a long history of ultraviolet light exposure and multiple actinic keratoses presented with a large, erythematous, and scaly plaque on his forehead. Biopsies revealed superficial basal cell carcinoma (sBCC). Because the patient wanted the shortest possible topical regimen, his sBCC was treated with two overnight ingenol mebutate (IM) 0.05% gel applications. He tolerated the local skin reaction (LSR) well, and at approximately six weeks post-treatment, biopsies showed no evidence of sBCC. The patient was happy with the cosmetic outcome and has remained free of clinical recurrence for 18 months. Although IM gel is …

Usability Testing Of A Sensor-Controlled Digital Game To Engage Older Adults With Heart Failure In Physical Activity And Weight Monitoring, Kavita Radhakrishnan, Christine Julien, Matthew O'Hair, Thomas Baranowski, Grace Lee, Catherine Allen, Atami Sagna, Edison Thomaz, Miyong Kim

Faculty, Staff and Students Publications

BACKGROUND: Poor self-management of heart failure (HF) has contributed to poor health outcomes. Sensor-controlled digital games (SCDGs) integrates data from behavior-tracking sensors to trigger progress, rewards, content, and positive feedback in a digital game to motivate real-time behaviors.

OBJECTIVES: To assess the usability of an SCDG prototype over a week of game-playing among 10 older adults with HF in their homes.

METHODS: During initial play, participants' SCDG experiences were observed in their homes using a checklist based on the seven-item Serious Game User Evaluator (SeGUE) instrument. After a week of game-playing, participants completed a survey guided by the Intrinsic Motivation …

Sirolimus For Kaposiform Hemangioendothelioma And Kasabach-Merritt Phenomenon In A Neonate, Trevor B Cabrera, Allison L Speer, Matthew R Greives, Donna A Goff, Neethu M Menon, Eric W Reynolds

Faculty, Staff and Student Publications

We present a case of a neonate born with kaposiform hemangioendothelioma (KHE), complicated by Kasabach-Merritt phenomenon (KMP) and other serious conditions, who was successfully treated with sirolimus. In addition to complications from thrombocytopenia and fluid overload, during the course of therapy, our patient experienced supratherapeutic drug levels at the commonly accepted starting dose of sirolimus. Patients with KHE and KMP should be closely monitored for potential complications of both the initial disease and unexpected side effects of treatments.

Policies And Practices Of Shea Research Network Hospitals During The Covid-19 Pandemic., Michael S. Calderwood, Valerie M. Deloney, Deverick J. Anderson, Vincent Chi-Chung Cheng, Shruti Gohil, Jennie H. Kwon, Lona Mody, Elizabeth Monsees, Valerie M. Vaughn, Timothy L. Wiemken, Matthew J. Ziegler, Eric Lofgren

Manuscripts, Articles, Book Chapters and Other Papers

To understand hospital policies and practices as the COVID-19 pandemic accelerated, the Society for Healthcare Epidemiology of America (SHEA) conducted a survey through the SHEA Research Network (SRN). The survey assessed policies and practices around the optimization of personal protection equipment (PPE), testing, healthcare personnel policies, visitors of COVID-19 patients in relation to procedures, and types of patients. Overall, 69 individual healthcare facilities responded in the United States and internationally, for a 73% response rate.

Anesthetic Drugs And Cancer Progression, Juan P Cata, Anil K Sood, Holger K Eltzschig

Faculty, Staff and Student Publications

No abstract provided.

Canakinumab To Reduce Deterioration Of Cardiac And Respiratory Function In Sars-Cov-2 Associated Myocardial Injury With Heightened Inflammation (Canakinumab In Covid-19 Cardiac Injury: The Three C Study), Calvin C Sheng, Debasis Sahoo, Siddharth Dugar, Robier Aguillon Prada, Tom Kai Ming Wang, Ossama K Abou Hassan, Danielle Brennan, Daniel A Culver, Prabalini Rajendram, Abhijit Duggal, A Michael Lincoff, Steven E Nissen, Venu Menon, Paul C Cremer

Faculty, Staff and Student Publications

BACKGROUND: In patients with Covid-19, myocardial injury and increased inflammation are associated with morbidity and mortality. We designed a proof-of-concept randomized controlled trial to evaluate whether treatment with canakinumab prevents progressive respiratory failure and worsening cardiac dysfunction in patients with SARS-CoV2 infection, myocardial injury, and high levels of inflammation.

HYPOTHESIS: The primary hypothesis is that canakiumab will shorten time to recovery.

METHODS: The three C study (canakinumab in Covid-19 Cardiac Injury, NCT04365153) is a double-blind, randomized controlled trial comparing canakinumab 300 mg IV, 600 mg IV, or placebo in a 1:1:1 ratio in hospitalized Covid-19 patients with elevations in troponin …

Yebc Regulates Variable Surface Antigen Vlse Expression And Is Required For Host Immune Evasion In Borrelia Burgdorferi, Yan Zhang, Tong Chen, Sajith Raghunandanan, Xuwu Xiang, Jing Yang, Qiang Liu, Diane G Edmondson, Steven J Norris, X Frank Yang, Yongliang Lou

Faculty, Staff and Student Publications

Borrelia burgdorferi, the Lyme disease pathogen causes persistent infection by evading the host immune response. Differential expression of the surface-exposed lipoprotein VlsE that undergoes antigenic variation is a key immune evasion strategy employed by B. burgdorferi. Most studies focused on the mechanism of VlsE antigen variation, but little is known about VlsE regulation and factor(s) that regulates differential vlsE expression. In this study, we investigated BB0025, a putative YebC family transcriptional regulator (and hence designated BB0025 as YebC of B. burgdorferi herein). We constructed yebC mutant and complemented strain in an infectious strain of B. burgdorferi. The yebC mutant could …

Preventing Falls-Interventions In Geriatric Psychiatry Patients: An Overview Of Current Literature, Samantha Beckwith

MaineHealth Maine Medical Center

PREVENTING FALLS-INTERVENTIONS IN GERIATRIC PSYCHIATRY PATIENTS: AN OVERVIEW OF CURRENT LITERATURE

Samantha Beckwith, BSN, RN, PMH-BC, P6

Background: The Inpatient Psychiatry unit at Maine Medical Center (P6) is a 21-bed unit specializing in geriatric and medical psychiatry. The majority of patients have a primary diagnosis of Dementia with Behavioral Disturbance. The unit features 12 double occupancy rooms and one single occupancy room, as well as a large activity room. Patients participate in a therapeutic milieu in which they are encouraged to interact with other patients in common areas and ambulate around the unit. The average number of patients is 19.6 …

Prognostic Impact Of Single And Multiple Descriptors In Pathologically Staged T3n0m0 Non-Small Cell Lung Cancer, Takefumi Komiya Md, Emily Powell Phd, Shinkichi Takamori Md Phd

PCI Publications and Projects

Background

T components of the current 8th edition of lung cancer American Joint Commission on Cancer (AJCC) staging assignment include size of primary tumor and others such as chest wall invasion. The role of the presence of multiple T3 descriptors in prognosis remains unknown.

Materials and methods

Using National Cancer Database (NCDB) and of AJCC 7th edition, pathologically staged (R0) N0M0 non-small cell lung cancer (NSCLC) cases diagnosed in 2010-2016 were analyzed. Selected cases had primary size larger than 5cm or staged as T3 by AJCC 7th edition despite size <5cm. T3 descriptor status by 8th edition was defined as single descriptor (“T3-single”) as primary size 5-7cm or size <5cm and T3 per 7th edition (“T3-other”), or multiple descriptor (“T3-multi”) as presence of both descriptors. Survival analysis was performed with validation of multivariate analyses.

Results

Of the 108,632 surgically resected pathologically staged N0M0R0 NSCLC …

Technology And Workflow Recommendations To Improve Use Of Guideline Directed Medical Therapy For Heart Failure With Reduced Ejection Fraction., Roy Robertson Md, Ryan Ahmed, Tammy Toscos Phd, Victor P. Cornet Ms, Shauna Wagner, Sarah Colletta, Carly Daley, Michael Mirro Md

Health Services and Informatics Research

BACKGROUND: Optimal use of Guideline Directed Medical Therapy (GDMT) is the cornerstone of reducing mortality and morbidity in heart failure patients with reduced ejection fraction (HFrEF). Interventions targeted at increasing GDMT use are necessary to improve outcomes. Integration of a pharmacist in specialty clinics may improve GDMT use; However, the potential benefit may be underrealized due to constraints in technology use and workflow.

PROJECT INTENT: To understand existing processes and explore workflow optimization opportunities to enhance use of GDMT prescription for patients with HFrEF.

METHODOLOGY: Teams of 2 researchers performed contextual inquiry4 during in-situ, 2-hour observations with 5 physicians, 3 …

Axios Lumen Apposing Metal Stent In The Treatment Of Peripancreatic Fluid Collections, 4 Year Retrospective Observation At A Large Care Center, Michal Kloska Md, Valery Hrad Md, Abdul Aleem Md, Soorya N. Aggarwal Do, Shashin Shah Md, Zachary Zator Md, Hiral N. Shah Md

Department of Medicine

No abstract provided.

Reorganising For Covid-19 Pandemic: A Review Of Structural Modifications By The Department Of Internal Medicine In Low To Middle-Income Countries, Shakeel Ur Rehman, Muhammad Arslan Ahmed, Ghufran Adnan, Maria Ali Khan

Department of Medicine

Scientists classified the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) as a novel coronavirus on January 7, 2020. The World Health Organization (WHO) acknowledged the SARS-CoV-2 outburst a public health emergency of international concern on January 30, 2020. Since its origin, this virus has disrupted the best healthcare systems, economies, and strained financial resources; and for underdeveloped countries' healthcare systems, the virus has become a crisis. To tackle the potential hazards from this virus, our Department restructured the services that not only helped us to cope with the pandemic, but also provided an example to copy for other contemporary institutes. …

Acute Symptomatic Seizures In Critically Ill Children: Frequency, Etiology And Outcomes, Sanam B. Rajper, Mujtaba Moazzam, Arsheen Zeeshan, Qalab Abbas

Department of Paediatrics and Child Health

Background: Critically ill individuals have an increased risk of acute symptomatic seizures secondary to systemic illnesses; unrecognized or untreated seizures can quickly convert into status epilepticus, which is associated with high morbidity and mortality.
Objective: The aim of this study was to determine frequency, etiology, and outcome of seizures in critical ill children admitted in intensive care unit of a tertiary care hospital.
Materials and methods: Retrospective review of medical records of all children admitted in pediatric intensive care unit (PICU) of the Aga Khan University from January 2016 to December 2018 and who had a new-onset seizure irrespective of …

Measures Of Pediatric Function And Physical Activity In Arthritis, Anna E. Greer, Maura D. Iversen

Exercise Science Faculty Publications

Physical function can be assessed through physical examination with the use of performance-based measures and patient-reported outcome measures (PROMs). Each form of assessment provides a unique contribution to the understanding of the impact of rheumatologic conditions on the patient. PROMs of physical function (PF) are an important component of the assessment of children with arthritis and have been included in the recommended core set of measures for childhood arthritis and musculoskeletal conditions. These measures provide the child’s or parent’s perspective of function within the context of daily living. Measures of PF include both generic measures, which are designed for use …

Assessing Time From Door-To-Antibiotic Administration For Adult Cancer Patients With Neutropenic Fever In The Emergency Department, Sarah Roy, Tina Magsarili

All Nursing Boot Camp Posters

Background:

Infection, related to febrile neutropenia, in patients receiving chemotherapy for cancer remains a common complication and is a medical emergency. Fever is often the only sign of severe underlying infection in neutropenic patients due to the patient’s immunosuppressed state (Butts, et.al, 2017). Vigilant nursing assessment and immediate medical attention for neutropenic fever (NF) is imperative because the rate of major organ complication and mortality is as high as 30% and 11% respectively (Freifield et.al, 2011 & Taplitz et.al, 2018). In the setting of severe sepsis or septic shock the mortality rate may be as high as 50% (Taplitz et.al, …

Gender Identity And Pronoun Usage In Standardized Patient Encounters, Martha M. Popescu, Emily J. Noonan, Laura A. Weingartner

Undergraduate Research Events

The standardized documentation clinicians use to record evaluations of a patient are called Subjective, Objective, Assessment, and Plan (SOAP) notes. Consistent pronoun documentation and usage in these notes is especially important for affirming transgender and gender non-conforming patients as this population experiences significant health disparities linked to medical mistrust. A sample of SOAP notes (n=286) was taken from standardized patient encounters at the University of Louisville School of Medicine in 2017 (n=137) and 2018 (n=149). There were five case iterations of the standardized patient based on gender identity. The notes were coded using the software Dedoose for the following themes: …

Ultrasound-Guided Peripheral Vascular Catheterization In Pediatric Patients: A Narrative Review, Yoshinobu Nakayama, Jun Takeshita, Yasufumi Nakajima, Nobuaki Shime

Publications and Research

Peripheral vascular catheterization (PVC) in pediatric patients is technically challenging. Ultrasound guidance has gained the most interest in perioperative and intensive care fields because it visualizes the exact location of small target vessels and is less invasive than other techniques. There have been a growing number of studies related to ultrasound guidance for PVC with or without difficult access in pediatric patients, and most findings have demonstrated its superiority to other techniques. There are various ultrasound guidance approaches, and a comprehensive understanding of the basics, operator experience, and selection of appropriate techniques is required for the successful utilization of this …

Adakah Perubahan Kesintasan Karsinoma Sel Hati Di Indonesia?, Chyntia Olivia Maurine Jasirwan

Jurnal Penyakit Dalam Indonesia

No abstract provided.

The Association Between Degree Of Diabetic Peripheral Neuropathy With Ankle Brachial Index, Toe Brachial Index, And Transcutaneus Partial Oxygen Pressure In Patients With Type 2 Diabetes Mellitus, Taufik Rizkian Asir, Dono Antono, Em Yunir, Hamzah Shatri

Jurnal Penyakit Dalam Indonesia

Introduction. Diabetic peripheral neuropathy (DPN) in the lower extremity caused by complications of diabetes in the microvascular which can damage nerve in the lower extremity. Then, it is necessary to be aware of the process of aterosclerosis elsewhere, both in the macro and microvascular arteries in the lower extremity. This study was conducted to assess the association of the degree of diabetic peripheral neuropathy assessed by Toronto clinical scoring system (TCSS) with the process of atherosclerosis in the blood vessels of the lower extremity, both macrovascular with ankle brachial index (ABI) and toe brachial index (TBI), as well as microvascular …

Liver Function And Treatment Modalities Are Predictors Of Survival In Patients With Hepatocellular Carcinoma, Irsan Hasan, Imelda Maria Loho, Cosmas Rinaldi Lesmana, Rino A. Gani

Jurnal Penyakit Dalam Indonesia

Introduction. Hepatocellular carcinoma (HCC) is a major health problem in Indonesia because most patients are diagnosed in late stages when curative treatment is no longer possible. The aim of this study is to evaluate one-year survival rate, prognostic factors, and treatment modalities of patients with hepatocellular carcinoma. Methods. A retrospective analysis was done in patients with HCC who were admitted to Cipto Mangunkusumo General Hospital (CMGH) between January 2013 and March 2014. Clinical parameters and treatment modalities were evaluated. Patients outcome at one-year of follow-up were recorded from medical records or patients were contacted by phone call. Survival curve was …