Medical Specialties Commons^™

Using Patient Flow Analysis With Real-Time Patient Tracking To Optimize Radiation Oncology Consultation Visits, Shane Mesko, Julius Weng, Prajnan Das, Albert C Koong, Joseph M Herman, Dorothy Elrod-Joplin, Ashley Kerr, Thomas Aloia, John Frenzel, Katy E French, Wendi Martinez, Iris Recinos, Abdulaziz Alshaikh, Utpala Daftary, Amy C Moreno, Quynh-Nhu Nguyen

Faculty, Staff and Student Publications

PURPOSE: Clinical efficiency is a key component of the value-based care model and a driver of patient satisfaction. The purpose of this study was to identify and address inefficiencies at a high-volume radiation oncology clinic.

METHODS AND MATERIALS: Patient flow analysis (PFA) was used to create process maps and optimize the workflow of consultation visits in a gastrointestinal radiation oncology clinic at a large academic cancer center. Metrics such as cycle times, waiting times, and rooming times were assessed by using a real-time patient status function in the electronic medical record for 556 consults and compared between before vs after …

Defining Cellular Population Dynamics At Single-Cell Resolution During Prostate Cancer Progression, Alexandre A Germanos, Sonali Arora, Ye Zheng, Erica T Goddard, Ilsa M Coleman, Anson T Ku, Scott Wilkinson, Hanbing Song, Nicholas J Brady, Robert A Amezquita, Michael Zager, Annalysa Long, Yu Chi Yang, Jason H Bielas, Raphael Gottardo, David S Rickman, Franklin W Huang, Cyrus M Ghajar, Peter S Nelson, Adam G Sowalsky, Manu Setty, Andrew C Hsieh

Faculty, Staff and Student Publications

Advanced prostate malignancies are a leading cause of cancer-related deaths in men, in large part due to our incomplete understanding of cellular drivers of disease progression. We investigate prostate cancer cell dynamics at single-cell resolution from disease onset to the development of androgen independence in an in vivo murine model. We observe an expansion of a castration-resistant intermediate luminal cell type that correlates with treatment resistance and poor prognosis in human patients. Moreover, transformed epithelial cells and associated fibroblasts create a microenvironment conducive to pro-tumorigenic immune infiltration, which is partially androgen responsive. Androgen-independent prostate cancer leads to significant diversification of …

Mir21 Modulates The Hippo Signaling Pathway Via Interference With Pp2a Bβ To Inhibit Trophoblast Invasion And Cause Preeclampsia, Mingyu Hu, Yangxi Zheng, Jiujiang Liao, Li Wen, Juan Cheng, Jiayu Huang, Biao Huang, Li Lin, Yao Long, Yue Wu, Xuan Ye, Yong Fu, Hongbo Qi, Philip N Baker, Chao Tong

Faculty, Staff and Student Publications

Preeclampsia (PE) is a pregnancy-specific disorder attributed to deficient extravillous trophoblast (EVT) invasion into the uterus, but the mechanism of EVT invasion remains unclear. In this study, we found significantly elevated expression of microRNA 21 (miR21), which negatively regulates trophoblast invasion and migration, in preeclamptic placentae. Whole-genome RNA sequencing revealed that PPP2R2B, which encodes PP2A Bβ, and the Hippo pathway are downstream targets of miR21. The effects of miR21 on trophoblast mobility were abolished in LATS1T1079A/S909A and YAP-5SA mutants. Moreover, we found that PP2A Bβ dephosphorylates LATS1 via direct protein-protein interactions and thus modulates the phosphorylation and subcellular distribution …

A Computational Method For Estimating Trunk Muscle Activations During Gait Using Lower Extremity Muscle Synergies, Geng Li, Di Ao, Marleny M Vega, Mohammad S Shourijeh, Payam Zandiyeh, Shuo-Hsiu Chang, Valerae O Lewis, Nicholas J Dunbar, Ata Babazadeh-Naseri, Andrew J Baines, Benjamin J Fregly

Faculty, Staff and Student Publications

One of the surgical treatments for pelvic sarcoma is the restoration of hip function with a custom pelvic prosthesis after cancerous tumor removal. The orthopedic oncologist and orthopedic implant company must make numerous often subjective decisions regarding the design of the pelvic surgery and custom pelvic prosthesis. Using personalized musculoskeletal computer models to predict post-surgery walking function and custom pelvic prosthesis loading is an emerging method for making surgical and custom prosthesis design decisions in a more objective manner. Such predictions would necessitate the estimation of forces generated by muscles spanning the lower trunk and all joints of the lower …

Egfr-Phosphorylated Gdh1 Harmonizes With Rsk2 To Drive Creb Activation And Tumor Metastasis In Egfr-Activated Lung Cancer, Jihoon Kang, Jaemoo Chun, Jung Seok Hwang, Chaoyun Pan, Jie Li, Austin C Boese, Isabelle Young, Courteney M Malin, Yibin Kang, Don L Gibbons, Gabriel Sica, Haian Fu, Suresh S Ramalingam, Lingtao Jin, Sumin Kang

Faculty, Staff and Student Publications

The cancer metastasis process involves dysregulated oncogenic kinase signaling, but how this orchestrates metabolic networks and signal cascades to promote metastasis is largely unclear. Here we report that inhibition of glutamate dehydrogenase 1 (GDH1) and ribosomal S6 kinase 2 (RSK2) synergistically attenuates cell invasion, anoikis resistance, and immune escape in lung cancer and more evidently in tumors harboring epidermal growth factor receptor (EGFR)-activating or EGFR inhibitor-resistant mutations. Mechanistically, GDH1 is activated by EGFR through phosphorylation at tyrosine 135 and, together with RSK2, enhances the cAMP response element-binding protein (CREB) activity via CaMKIV signaling, thereby promoting metastasis. Co-targeting RSK2 and GDH1 …

Neuronal Signal-Regulatory Protein Alpha Drives Microglial Phagocytosis By Limiting Microglial Interaction With Cd47 In The Retina, Danye Jiang, Courtney A Burger, Viktor Akhanov, Justine H Liang, Robert D Mackin, Nicholas E Albrecht, Pilar Andrade, Dorothy P Schafer, Melanie A Samuel

Center on Aging Staff Publications

Microglia utilize their phagocytic activity to prune redundant synapses and refine neural circuits during precise developmental periods. However, the neuronal signals that control this phagocytic clockwork remain largely undefined. Here, we show that neuronal signal-regulatory protein alpha (SIRPα) is a permissive cue for microglial phagocytosis in the developing murine retina. Removal of neuronal, but not microglial, SIRPα reduced microglial phagocytosis, increased synpase numbers, and impaired circuit function. Conversely, prolonging neuronal SIRPα expression extended developmental microglial phagocytosis. These outcomes depended on the interaction of presynaptic SIRPα with postsynaptic CD47. Global CD47 deficiency modestly increased microglial phagocytosis, while CD47 overexpression reduced it. …

Gata1 Controls Numbers Of Hematopoietic Progenitors And Their Response To Autoimmune Neuroinflammation, Daniel Hwang, Larissa Ishikawa, Maryam S. Seyedsadr, Elisabeth R. Mari, Ezgi Kasimoglu, Ziver Sahin, Alexandra Boehm, Soohwa Jang, Javad Rasouli, Courtney Vaccaro, Michael Gonzalez, Hakon Hakonarson, Mohamad Rostami, Guang-Xian Zhang, Bogoljub Ciric

Department of Neurology Faculty Papers

GATA-binding factor 1 (GATA1) is a transcription factor that governs the development and function of multiple hematopoietic cell lineages. GATA1 is expressed in hematopoietic stem and progenitor cells (HSPCs) and is essential for erythroid lineage commitment; however, whether it plays a role in hematopoietic stem cell (HSC) biology and the development of myeloid cells, and what that role might be, remains unclear. We initially set out to test the role of eosinophils in experimental autoimmune encephalomyelitis (EAE), a model of central nervous system autoimmunity, using mice lacking a double GATA-site (ΔdblGATA), which lacks eosinophils due to the deletion of the …

Association Of Sepsis-Induced Cardiomyopathy And Mortality: A Systematic Review And Meta-Analysis, Yu-Min Lin, Mei-Chuan Lee, Han Siong Toh, Wei-Ting Chang, Sih-Yao Chen, Fang-Hsiu Kuo, Hsin-Ju Tang, Yi-Ming Hua, Dongmei Wei, Jesus D. Melgarejo, Zhen-Yu Zhang, Chia-Te Liao

School of Medicine Publications

Background

The implication of sepsis-induced cardiomyopathy (SIC) to prognosis is controversial, and its association with mortality at different stages remains unclear. We conducted a systematic review and meta-analysis to understand the association between SIC and mortality in septic patients.

Methods

We searched and appraised observational studies regarding the mortality related to SIC among septic patients in PubMed and Embase from inception until 8 July 2021. Outcomes comprised in-hospital and 1-month mortality. We adopted the random-effects model to examine the mortality risk ratio in patients with and without SIC. Meta-regression, subgroup, and sensitivity analyses were applied to examine the outcome’s heterogeneity. …

Super-Enhanced Marco Variant Drives Triple-Negative Breast Cancer Progression, Weei-Chin Lin, Fang-Tsyr Lin

Faculty, Staff and Students Publications

No abstract provided.

Total Hip Arthroplasty In Patients With Neurological Conditions: A Systematic Review, Conor S O'Driscoll, Andrew J Hughes, Martin S Davey, Joseph M Queally, Brendan J O'Daly

Rothman Institute Papers

Background: As operative techniques and implant design have evolved over time, total hip arthroplasty (THA) is increasingly being carried out for patients with neurological impairment. This patient group places unique surgical challenges to the arthroplasty surgeon, which may include contractures, instability, and altered muscular tone. The purpose of this systematic review is to report the patient outcomes, complications, and implant survival following THA for patients with neurological conditions affecting the hip. Thus, we aim to support orthopaedic surgeon decision-making when considering and planning THA for these patients.

Methods: A systematic review was performed as per Preferred Reporting Items for Systematic …

Clinical Characteristics And Electrophysiologic Properties Of Scn5a Variants In Fever-Induced Brugada Syndrome, Gan-Xiao Chen, Hector Barajas-Martinez, Giuseppe Ciconte, Cheng-I Wu, Michelle M Monasky, Hao Xia, Bian Li, John A Capra, Kai Guo, Zhong-He Zhang, Xiu Chen, Bo Yang, Hong Jiang, Gary Tse, Chloe Miu Mak, Yoshiyasu Aizawa, Michael H Gollob, Charles Antzelevitch, Arthur A M Wilde, Carlo Pappone, Dan Hu

Division of Cardiology Faculty Papers

Background: Brugada syndrome (BrS) is a severe inherited arrhythmia syndrome that can be unmasked by fever.

Methods: A multicentre clinical analysis was performed in 261 patients diagnosed with fever-induced BrS, including 198 (75.9%) and 27 (10.3%) patients who received next-generation genetic sequencing and epicardial arrhythmogenic substrate (AS) mapping, respectively.

Findings: In fever-induced BrS patients, pathogenic or likely pathogenic (P/LP) SCN5A variant carriers developed fever-induced BrS at a younger age, and more often in females and those of Caucasian descent. They exhibited significant electrophysical abnormalities, including a larger epicardial AS area, and more prolonged abnormal epicardial electrograms. During a median follow-up …

Issues In Melanoma Detection: Semisupervised Deep Learning Algorithm Development Via A Combination Of Human And Artificial Intelligence, Xinyuan Zhang, Ziqian Xie, Yang Xiang, Imran Baig, Mena Kozman, Carly Stender, Luca Giancardo, Cui Tao

Faculty, Staff and Student Publications

BACKGROUND: Automatic skin lesion recognition has shown to be effective in increasing access to reliable dermatology evaluation; however, most existing algorithms rely solely on images. Many diagnostic rules, including the 3-point checklist, are not considered by artificial intelligence algorithms, which comprise human knowledge and reflect the diagnosis process of human experts.

OBJECTIVE: In this paper, we aimed to develop a semisupervised model that can not only integrate the dermoscopic features and scoring rule from the 3-point checklist but also automate the feature-annotation process.

METHODS: We first trained the semisupervised model on a small, annotated data set with disease and dermoscopic …

The Geriatric Emergency Department At The University Of California San Francisco: Structures, Roles, And Lessons Learned, Todd James

Journal of Geriatric Emergency Medicine

No abstract provided.

Co-Management Strategies For Acute Myeloid Leukemia Patients In The Community Setting, Christopher Benton, Michael R Grunwald, Hana Safah, Margaret Kasner

Department of Medical Oncology Faculty Papers

The treatment landscape for acute myeloid leukemia (AML) has changed substantially in recent years. The introduction of newer therapies, including oral agents, less myelosuppressive agents, and parenteral regimens suitable for outpatient administration, has made it feasible for select patients to receive therapy in the outpatient setting and in community practices. Thorough patient evaluation (including molecular testing), planned supportive care (eg, transfusion support, antimicrobial prophylaxis), and vigilant patient monitoring (for tumor lysis syndrome and adverse events) by a multidisciplinary team are required for successful management of patients both in the community and at specialized leukemia centers. Some patients are unable or …

Gabapentin Disrupts Binding Of Perlecan To The Α 2Δ1 Voltage Sensitive Calcium Channel Subunit And Impairs Skeletal Mechanosensation, Perla C Reyes Fernandez, Christian S Wright, Adrianna N Masterson, Xin Yi, Tristen V Tellman, Andrei Bonteanu, Katie Rust, Megan L Noonan, Kenneth E White, Karl J Lewis, Uma Sankar, Julia M Hum, Gregory Bix, Danielle Wu, Alexander G Robling, Rajesh Sardar, Mary C Farach-Carson, William R Thompson

Faculty, Staff and Student Publications

Our understanding of how osteocytes, the principal mechanosensors within bone, sense and perceive force remains unclear. Previous work identified "tethering elements" (TEs) spanning the pericellular space of osteocytes and transmitting mechanical information into biochemical signals. While we identified the heparan sulfate proteoglycan perlecan (PLN) as a component of these TEs, PLN must attach to the cell surface to induce biochemical responses. As voltage-sensitive calcium channels (VSCCs) are critical for bone mechanotransduction, we hypothesized that PLN binds the extracellular α2δ1 subunit of VSCCs to couple the bone matrix to the osteocyte membrane. Here, we showed co-localization of PLN and α2δ1 along …

Mapping Single-Cell Transcriptomes In The Intra-Tumoral And Associated Territories Of Kidney Cancer, Ruoyan Li, John R Ferdinand, Kevin W Loudon, Georgina S Bowyer, Sean Laidlaw, Francesc Muyas, Lira Mamanova, Joana B Neves, Liam Bolt, Eirini S Fasouli, Andrew R J Lawson, Matthew D Young, Yvette Hooks, Thomas R W Oliver, Timothy M Butler, James N Armitage, Tev Aho, Antony C P Riddick, Vincent Gnanapragasam, Sarah J Welsh, Kerstin B Meyer, Anne Y Warren, Maxine G B Tran, Grant D Stewart, Isidro Cortés-Ciriano, Sam Behjati, Menna R Clatworthy, Peter J Campbell, Sarah A Teichmann, Thomas J Mitchell

Faculty, Staff and Student Publications

Tumor behavior is intricately dependent on the oncogenic properties of cancer cells and their multi-cellular interactions. To understand these dependencies within the wider microenvironment, we studied over 270,000 single-cell transcriptomes and 100 microdissected whole exomes from 12 patients with kidney tumors, prior to validation using spatial transcriptomics. Tissues were sampled from multiple regions of the tumor core, the tumor-normal interface, normal surrounding tissues, and peripheral blood. We find that the tissue-type location of CD8+ T cell clonotypes largely defines their exhaustion state with intra-tumoral spatial heterogeneity that is not well explained by somatic heterogeneity. De novo mutation calling from single-cell …

The Spectral Sensitivity Of Human Circadian Phase Resetting And Melatonin Suppression To Light Changes Dynamically With Light Duration, Melissa A. St Hilaire, María L. Ámundadóttir, Shadab A. Rahman, Shantha M. W. Rajaratnam, Melanie Rüger, George C. Brainard, Charles A. Czeisler, Marilyne Andersen, Joshua J. Gooley, Steven W. Lockley

Department of Neurology Faculty Papers

Human circadian, neuroendocrine, and neurobehavioral responses to light are mediated primarily by melanopsin-containing intrinsically-photosensitive retinal ganglion cells (ipRGCs) but they also receive input from visual photoreceptors. Relative photoreceptor contributions are irradiance- and duration-dependent but results for long-duration light exposures are limited. We constructed irradiance-response curves and action spectra for melatonin suppression and circadian resetting responses in participants exposed to 6.5-h monochromatic 420, 460, 480, 507, 555, or 620 nm light exposures initiated near the onset of nocturnal melatonin secretion. Melatonin suppression and phase resetting action spectra were best fit by a single-opsin template with lambda_max at 481 and 483 …

A Path To Translation: How 3d Patient Tumor Avatars Enable Next Generation Precision Oncology, Shree Bose, Margarida Barroso, Milan G Chheda, Hans Clevers, Elena Elez, Salma Kaochar, Scott E Kopetz, Xiao-Nan Li, Funda Meric-Bernstam, Clifford A Meyer, Haiwei Mou, Kristen M Naegle, Martin F Pera, Zinaida Perova, Katerina A Politi, Benjamin J Raphael, Paul Robson, Rosalie C Sears, Josep Tabernero, David A Tuveson, Alana L Welm, Bryan E Welm, Christopher D Willey, Konstantin Salnikow, Jeffrey H Chuang, Xiling Shen

Faculty, Staff and Students Publications

3D patient tumor avatars (3D-PTAs) hold promise for next-generation precision medicine. Here, we describe the benefits and challenges of 3D-PTA technologies and necessary future steps to realize their potential for clinical decision making. 3D-PTAs require standardization criteria and prospective trials to establish clinical benefits. Innovative trial designs that combine omics and 3D-PTA readouts may lead to more accurate clinical predictors, and an integrated platform that combines diagnostic and therapeutic development will accelerate new treatments for patients with refractory disease.

Place Cells Dynamically Refine Grid Cell Activities To Reduce Error Accumulation During Path Integration In A Continuous Attractor Model, Jose A Fernandez-Leon, Ahmet Kerim Uysal, Daoyun Ji

Faculty, Staff and Students Publications

Navigation is one of the most fundamental skills of animals. During spatial navigation, grid cells in the medial entorhinal cortex process speed and direction of the animal to map the environment. Hippocampal place cells, in turn, encode place using sensory signals and reduce the accumulated error of grid cells for path integration. Although both cell types are part of the path integration system, the dynamic relationship between place and grid cells and the error reduction mechanism is yet to be understood. We implemented a realistic model of grid cells based on a continuous attractor model. The grid cell model was …

Contributions Of Semantic And Phonological Working Memory To Narrative Language Independent Of Single Word Production: Evidence From Acute Stroke, Rachel Zahn, Tatiana T Schnur, Randi C Martin

Faculty, Staff and Student Publications

Neuropsychological case studies have provided evidence that individuals with semantic, but not phonological, working memory (WM) deficits have difficulty producing phrases containing several content words. These findings supported the claim of a phrasal scope of planning at the grammatical formulation stage of production, where semantic WM supports the maintenance of lexical-semantic representations as they are inserted into slots in phrasal constituents. Recent narrative production results for individuals at the acute stage of stroke supported the role for semantic WM in phrasal elaboration while suggesting a role for phonological WM at a subsequent phonological encoding stage in supporting fluent, rapid speech. …

Trib3 Mediates Fibroblast Activation And Fibrosis Though Interaction With Atf4 In Ipf, Lan Wang, Wenyu Zhao, Cong Xia, Zhongzheng Li, Weiming Zhao, Kai Xu, Ningdan Wang, Hui Lian, Ivan O Rosas, Guoying Yu

Faculty, Staff and Students Publications

Idiopathic pulmonary fibrosis (IPF) is a fatal interstitial lung disease characterized by fibroblast activation, excessive deposition of extracellular matrix, and progressive scarring; the pathogenesis remains elusive. The present study explored the role of Tribbles pseudokinase 3 (TRIB3), a well-known stress and metabolic sensor, in IPF. TRIB3 is down-regulated in the lungs of IPF patients in comparison to control subjects. Deficiency of TRIB3 markedly inhibited A549 epithelial cells’ proliferation and migration, significantly reducing wound healing. Conversely, overexpression of TRIB3 promoted A549 cell proliferation and transmigration while it inhibited its apoptosis. Meanwhile, overexpressed TRIB3 inhibited fibroblast activation and decreased ECM …

Estimulación Cognitiva Y De La Actividad Fisica En La Persona Mayor - Una Experiencia Desde La Práctica, Maria Victoria Rojas Martinez, Adriana Hernandez Bustos, Blanca Gregoria Melo Melo

Ciencias de la Salud

El trabajar con la persona mayor que presenta limitación física o mental, lleva a la aparición de grandes retos para el estudiante y futuro profesional de enfermería, más aún cuando el campo de acción es el hogar, porque el cuidado será compartido entre la persona, el cuidador o grupo familiar, dentro de su propio espacio, por lo tanto, se convierte en una intervención individual con el uso de recursos propios y generalmente con la participación directa del cuidador o acompañante. Para el cuidado en el hogar el autocuidado es base fundamental para el cumplimiento de metas en la salud de …

Factors Likely To Affect The Uptake Of Genomic Approaches To Cancer Screening In Primary Care: A Scoping Review, Kaitlyn V Davis, Mie H Hallman, Melissa Dicarlo, Sophie M Wambua, Rachel L Jaffe, Allison W Welsh, Cameron Kerber, Hushan Yang, Christopher Chambers, Ronald E. Myers

Department of Family & Community Medicine Faculty Papers

Genomic tests are being developed for use in cancer screening. As most screening is offered in primary care settings, primary care provider and patient perceptions of such tests are likely to affect uptake. We conducted a scoping review to synthesize information on factors likely to affect patient and provider use of biospecimen collection and analysis for cancer screening, methods referred to as liquid biopsy or multi-cancer early detection (MCED) testing when used to detect multiple cancers. We ultimately identified 7 articles for review and analyzed them for major themes. None reported on primary care provider perspectives. Six articles focused on …

Intercellular Communication Via Gap Junctions Influences Cell Survival During Hypoxia, Lauren E. Harmon, David L. Geenen

Student Summer Scholars Manuscripts

Stem cell therapy can be beneficial following myocardial infarction. However, when murine bone marrow-derived mesenchymal stem cells (mBM-MSCs) are injected into the ischemic area, a large percentage of these cells undergo apoptosis resulting in decreased therapeutic benefits. We hypothesize that the loss of these mBM-MSCs is regulated by intercellular channels or gap junctions (GJs) that provide apoptotic signals passed between ischemic cardiomyocytes and mBM-MSCs. Our research aims to attenuate these GJs by suppressing Connexin-43 (Cx43) expression, the predominant channel-forming protein. We will accomplish this by transiently transfecting a Cx43 siRNA into mBM-MSCs. Our data demonstrate that intracellular fluorescent dyes and …

A Case Of Inferior Dislocation Of Right Shoulder, Gauri A. Nair

Digital Journal of Clinical Medicine

Dislocation of the shoulder is the commonest of all large joint dislocations. Inferior dislocation of the shoulder, also called luxatio erecta, is a rare form. It appears in less than 0.5% of all shoulder dislocations. Patient characteristically presents with an arm locked in upright position - Luxatio erecta. Its etiology, clinical presentation and radiographic findings are distinct. An awareness of associated potential neurovascular injuries and rotator cuff tears is important in this rare entity and should be excluded with high index of suspicion. Preferred modality of treatment depends upon the age of the patient and the extent of neurovascular involvement. …

Depression Secondary To Isotretinoin – A Case Report, Rohan Karkra, Megha Sadashiv, Kishor M

Digital Journal of Clinical Medicine

Depression is one of the leading causes of morbidity in the world and significantly affects the lives of people suffering from it. The exact cause of depression has not been established and it is believed to be a complex play between various social, biological, environmental, personal factors. A relatively rare but distinct cause includes pharmacological agents.

In this case report, we describe the case of a 17-year-old girl who developed depression with psychotic symptoms on two occasions, both preceded by a history of Isotretinoin use. She was admitted and treated with anti-psychotics and psychotherapy with significant improvement in her mental …

Personality Disorder Predisposing To Alcohol Dependence, Samarchitha S Ms., Venkatesh Babu Dr., Megha Sadashiv Dr., Sudeep Pk Mr.

Digital Journal of Clinical Medicine

No abstract provided.

High-Velocity Fracture: Case Of Displaced Intertrochanteric Fracture Offemur With Spiral Fracture Of Shaft Of Right Femur, Gayathri Sureshkumar Nair

Digital Journal of Clinical Medicine

BACKGROUND

Intertrochanteric fracture is a common orthopedic condition characterized by extracapsular fractures of the proximal femur that occur between the greater and lesser trochanter with predominance in elderly population, especially those with osteoporosis, wherein even a low energy mechanism is enough to cause the fracture.

There is an observed female predominance with ratio between 2:1 and 8:1. [1,2]

Commonly observed symptoms include shortened and externally rotated limb, pain and bony tenderness around the hip joint, inability to bear weight on the affected limb to name a few.

Management depends upon age of patient, nature of the fracture, number of comminuted …

A Rare Case Of Extra-Ventricular Supra-Sellar Neurocytoma – A Diagnostic Conundrum, Rohan Karkra, Suchitha Satish, Peri Keerthi

Digital Journal of Clinical Medicine

The brain and its associated structures are often the primary source or site of metastases for many tumors. Neurocytoma is a relatively rare neuronal neoplasm, first described as an intra-ventricular tumor that is not known to be very aggressive. It constitutes less than 0.5% of CNS neoplasms. Extraventricular Neurocytoma (EVN) is an extremely rare variant, of which only 12 cases have ever been reported in the supra-sellar region. In all of these 12 cases, the patient was initially misdiagnosed; hence, this condition is a diagnostic conundrum. Grossly, the tumor is firm and smooth with extensive blood supply and fibrous tissue. …

Comparison Of Conventional Pap Smear And Manual Liquid Based Cytology With P16 Marker In Screening For Cervical Cancer In Indian Tertiary Healthcare Setups In Mysuru, Gayathri Sureshkumar Nair, Nandini Manoli, Nandish Manoli

Digital Journal of Clinical Medicine

In India, there are 20.2 per 100000 new cases of Cervical Cancer diagnosed and 11.1 per 100000 deaths annually accounting for more than one fifths of global cervical cancer deaths. [1] Thus, due to an absence of a national immunization program to cover human papillomavirus (HPV) vaccination and lack of accessible cervical cancer screening, the disease is characterized by late detection, lack of access to affordable and quality health care, and high mortality rates. [2]

Papanicolaou Smear Test was a novel invention by Dr George Papanicolaou in the year 1927 which gained maximum popularity in 1950 as a screening test …