Possible Skull Base Erosion After Prolonged Frontal Sinus Stenting

Frontal sinus stenting is widely used with the goal of maintaining nasofrontal duct patency after sinus surgery. The general recommendation is to leave stents in place for 6 months; however, prolonged stenting up to 6 years has been reported with no complication. We present the first reported case of frontal sinus posterior table and skull base erosion following prolonged frontal sinus stenting. A 57-year-old female presented with chronic sinusitis and nasal obstruction. Imaging revealed pansinusitis with retained stents in each frontal sinus that were placed 8 years prior. On the right, there was an area of skull base erosion at the tip of the stent. The patient underwent functional endoscopic sinus surgery with polypectomy. The stents were removed, revealing posterior table erosion on the right side but intact mucosa. Two months after surgery, there were no signs or symptoms of cerebrospinal fluid leak or other complications. Recent literature has suggested that prolonged stenting is safe; however, this case highlights a complication with potentially serious outcomes that can result from prolonged stenting. We recommend stent removal once stable nasofrontal duct patency has been achieved. If prolonged stenting is utilized, patients should be closely monitored and consideration should be given to periodic imaging to evaluate stent position

Drug Interaction Study Of Apixaban With Cyclosporine Or Tacrolimus: Results From A Phase 1, Randomized, Open-Label, Crossover Study In Healthy Volunteers

BACKGROUND Solid organ transplant recipients commonly require anticoagulation. Apixaban (APX) is principally metabolized by CYP3A4, undergoes direct intestinal excretion, and is a substrate to P-glycoprotein (P-gp) and Breast Cancer Resistance Protein (BCRP) transporters. We examined the potential drug interaction between cyclosporine (CsA) and tacrolimus (Tac) [combined inhibitors of CYP3A4, P-gp and, BCRP] with APX.https://jdc.jefferson.edu/petposters/1005/thumbnail.jp

Uncommon Hepatic Sequelae from an Acute Sickle Cell Crisis

Background Sickle cell crises are commonly treated at our institution given its large sickle cell patient population and well-established hematology department. While pain management is a crucial aspect to these patients\u27 care, it is important to remember that a vasa-occlusive crisis can be life threatening. Many organs can be at risk, including the lungs (acute chest syndrome), brain (stroke), eyes (retinopathy) and as in our case, the liver. We hope this case report can become incorporated in future differential diagnoses pertaining to sickle cell crises. Case Presentation A 48-year-old black female with a past medical history of sickle cell anemia, HIV on antiretroviral therapy, pulmonary hypertension on 4L of home oxygen, lymphocytic interstitial pneumonitis, chronic obstructive pulmonary disease, remote history of deep vein thrombosis, and pulmonary embolism, presented to the emergency department with complaints of shortness of breath, increased abdominal girth and lower extremity swelling for four days. She also complained of lower back and leg pain typical of her sickle cell crises. Her prescribed medications included tenofovir/emtricitabine, atazanavir, ritonavir, folic acid, oxycodone/acetaminophen, oral hydromorphone, and furosemide. Her social history was significant for smoking one fourth of a pack of cigarettes daily

Integration of Assertive Community Treatment into a Residency Curriculum: The Resident\u27s Perspective

Assertive Community Treatment (ACT) is a service delivery system designed to provide long-term quality care to patients with chronic mental illnesses. A brief description of these programs is presented. These programs can provide valuable training experiences for psychiatric residents. The authors report the results of their survey of residents whose training included a rotation through these services

Virtual and Augmented Reality in Neurosurgery: The Evolution of its Application and Study Designs.

BACKGROUND: As the art of neurosurgery evolves in the 21st century, more emphasis is placed on minimally invasive techniques, which require technical precision. Simultaneously, the reduction on training hours continues, and teachers of neurosurgery faces double jeopardy -with harder skills to teach and less time to teach them. Mixed reality appears as the neurosurgical educators\u27 natural ally: Virtual reality facilitates the learning of spatial relationships and permits rehearsal of skills, while augmented reality can make procedures safer and more efficient. Little wonder then, that the body of literature on mixed reality in neurosurgery has grown exponentially. METHODS: Publications involving virtual and augmented reality in neurosurgery were examined. A total of 414 papers were included, and they were categorized according to study design and analyzed. RESULTS: Half of the papers were published within the last 3 years alone. Whereas in the earlier half, most of the publications involved experiments in virtual reality simulation and the efficacy of skills acquisition, many of the more recent publication are proof-of-concept studies. This attests to the evolution of mixed reality in neurosurgery. As the technology advances, neurosurgeons are finding more applications, both in training and clinical practice. CONCLUSIONS: With parallel advancement in Internet speed and artificial intelligence, the utilization of mixed reality will permeate neurosurgery. From solving staff problems in global neurosurgery, to mitigating the deleterious effect of duty-hour reductions, to improving individual operations, mixed reality will have a positive effect in many aspects of neurosurgery

Population Pharmacokinetic and Pharmacodynamic Analysis of Buprenorphine for the Treatment of Neonatal Abstinence Syndrome

Neonatal abstinence syndrome (NAS) is a condition affecting newborns exposed to an opioid in utero. Symptoms of NAS include excessive crying, poor feeding, and disordered autonomic control. Up to 2/3 of infants will require pharmacologic therapies to reach symptom control. Opioids including morphine and methadone are the current first-line treatments. Buprenorphine is being investigated as a treatment of NAS. The purpose of this analysis was to evaluate the pharmacokinetics (PK) and pharmacodynamics (PD) of BUP in infants with NAS. Poster presented at American Society for Clinical Pharmacology and Therapeutics (ASCPT) 2017 Annual Meeting, March 15-18, 2017 in Washington DC.https://jdc.jefferson.edu/petposters/1004/thumbnail.jp

Metastatic Uveal Malignant Melanoma: A Case Report

Case Report A 77-year-old woman presented with a chief complaint of one day history of severe, acute abdominal pain. The patient described the pain as intense, non-radiating, and located primarily in the left upper abdominal quadrant.The pain was associated with nausea and multiple episodes of non-bilious, non-bloody emesis. She denied melena and hematochezia. On physical examination, her abdomen was soft and exquisitely tender in the left upper quadrant and epigastric regions. Aside from trace lower extremity edema.the remainder of her physical examination was unremarkable. Laboratory results at the time of admission were notable for:hemoglobin 10.8 g/dL, alkaline phosphatase 459 U/L, aspartate transaminase 56 U/L, and alanine transaminase 66 U/L. The patient\u27s past medical history was significant for hypertension, gastroesophageal reflux disease, papillary thyroid carcinoma. and right eye uveal melanoma. The ocular melanoma was treated 16 years ago with radioactive plaque followed by transpupillary thermal therapy. The patient was diagnosed with metastatic disease to her liver approximately 6 years prior and she had received several rounds of hepatic radiation and chemotherapeutic embolizations. The patient\u27s oncologist closely monitored her for disease progression through regular abdominal imaging studies

Undergraduate Medical Education Sex- and Gender-based Education: An Institutional Audit and Integration Project

Background: While evidence-based medicine (EBM) supports the incorporation of Sex- and Gender-based Medicine (SGBM) into patient care, a significant gap exists in its translation to current undergraduate medical education (UME). Several studies assessing medical student and resident physician knowledge regarding SGBM demonstrate suboptimal awareness, knowledge base, and clinical incorporation. There is urgent need to evaluate UME under a SGBM-focused lens, to emphasize the existing SGBM content, and to identify additional opportunities for inclusion. Method: Lectures from two pre-clinical UME modules, ‘Cardiovascular’ (CV) and ‘Musculoskeletal/ Dermatology’ (MSK/Derm), at the University of Alabama at Birmingham School of Medicine were subjected to a SGBM taskforce audit. Taskforce auditors were tasked with 1) assessing for pre-existing inclusion of SGBM as well as 2) opportunities for SGBM incorporation. Opportunities for inclusion were identified by a taskforce SGBM expert. Evidence-based SGBM material (e.g. slides) to fill the opportune gaps were subsequently created for module director consideration and ready incorporation. Post-audit follow-up of SGBM incorporation and uptake was completed for both modules. Results: Sixty-four lectures in the MSK/Derm and 23 CV lectures were reviewed by the SGBM audit taskforce. Approximately a third (36%) of all sessions included an element of pre-existing SGBM material (35% of CV; 36% MSK/Derm). Fourteen CV-specific SGBM opportunities were identified, and correlative SGBM inclusive material, was given to the CV module directors; thirteen of these were incorporated (92.8%). Nine MSK/Derm-specific SGBM opportunities were identified with correlative SGBM-inclusive material provided; two (22%) of these were incorporated. Conclusion: Inclusion of SGBM into medical school curriculum is important for comprehensive medical education and ultimately, for patient care. Identifying and collaborating on SGBM educational opportunities will be crucial for its timely uptake into the UME world. The creation of a dedicated taskforce which searches for inclusion opportunities across the curriculum is one approach to increase SGBM within UME.https://jdc.jefferson.edu/sexandgenderhealth/1031/thumbnail.jp

Impact of Preadmission Beta-blocker Use on Cardiac Abnormalities and In-hospital Mortality in Patients with Aneurysmal Subarachnoid Hemorrhage

Introduction: Various cardiac abnormalities, including dysrhythmias, left ventricular (LV) dysfunction, and myocardial injury, are commonly seen after subarachnoid hemorrhage (SAH). In patients taking a beta-blocker (BB) chronically, the medication is generally discontinued after hospitalization due to the concern of compromising cerebral perfusion. We hypothesized that sudden BB discontinuation might inadvertently lead to an increased incidence of composite cardiac abnormalities and higher in-hospital mortality in patients presenting with nontraumatic SAH

Ethanol Pharmacokinetics in Neonates and Infants

Introduction: Ethanol has been used for years in neonatal and infant liquid medications, yet the pharmacokinetics, pharmacodynamics, and safety of ethanol in this vulnerable population have not been well characterized. The purpose of this review is to raise awareness of ethanol use as an excipient in neonatal and infant medications and to provide insight, based on the available evidence, into clearance rates of ethanol in babies. We also discuss ethanol pharmacokinetics in adults, theoretical pharmaco-kinetic changes in neonates and infants as it may apply to ethanol disposition, and case reports involving ethanol exposure in neonates and infants. Materials and methods: This study was a narrative review in which relevant papers were selected using databases and scientific search engines such as PubMed with the key words ethanol, infant, and newborn infant. Results: It remains unclear what ethanol exposure is safe for neonates and infants. The Food and Drug Administration and American Academy of Pediatrics have both taken action, by either setting limits of ethanol content in over-the-counter medications or by recommending restricted exposure to ethanol- containing pediatric formulations. Conclusions: Until the short- and long-term health effects of chronic ethanol administration can be further characterized, ethanol-containing medications should be used with caution