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Recurrent intrathecal catheter-tip granuloma in a patient receiving high dose hydromorphone: A case report

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Advances in Bioscience and Biotechnology 2013年第1期4卷 147-152页

作者： Teena Varghese Joshua Bemporad Stefano Camici Steven Mortazavi lehigh valley Hospital and health network Allentown USA valley Pain Specialists PC Bethlehem USA

Study Design: Case report. Patient Sample: A 42- year-old Caucasian male. Results: Catheter-tip granuloma formation is possible despite a normal catheter access study in patients with intrathecal (IT) infu- sion systems and its recurrence is possible after surgical excision. Increasing concentrations of hydromorphone from 50 mg/ml to 100 mg/ml without altering the daily dosage may have precipitated granuloma formation. Conclusions: In patients with previously implanted spinal catheters for intrathecal drug delivery, catheter access studies cannot be relied upon to rule out catheter-tip granulomas, which should be included in the differential diagnosis in patients with worsening clinical conditions or new onset neurologic symptoms. Caution should be exercised when increasing concentrations of intrathecal opioids while monitoring for signs or symptoms of intrathecal catheter- tip granuloma formation. Removal of previously implanted catheters and/or reductions in opioid concentrations may be necessary to prevent recurrent granuloma formations, which can occur quickly after surgical excision.

关键词： Catheter-Tip Granuloma Intrathecal Hydromorphone Morphine Spinal Cord Catheter Access Study

The Chikungunya virus: An emerging US pathogen

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World Journal of Emergency Medicine 2016年第1期7卷 65-67页

作者： Thomas M.Nappe Craig M.Chuhran Steven A.Johnson Department of Emergency Medicine Lehigh Valley Hospital USF Morsani College of Medicine Department of Medicine Lehigh Valley Hospital USF Morsani College of Medicine

BACKGROUND:The Chikungunya(CHIK)virus was recently reported by the CDC to have spread to the United *** report an early documented case of CHIK from the state of Pennsylvania after a patient recently returned from Haiti in June of ***:A 39-year-old man presented to the emergency department complaining of fever,fatigue,polyarthralgias and a diffuse rash for two *** days before,he returned from a mission trip to Haiti and reported that four of his accompanying friends had also become ill.A CHIK antibody titer was obtained and it was found to be *** his hospital stay,he responded well to supportive care,including anti-inflammatories,intravenous hydration and ***:His condition improved within two days and he was ultimately discharged ***:Manifestations of CHIK can be similar to Dengue fever,which is transmitted by the same species of mosquito,and occasionally as a *** should include Chikungunya virus in their differential diagnosis of patients who present with fever,polyarthralgia and rash with a recent history of travel to endemic areas,including those within the United States.

关键词： Chikungunya virus Arbovirus Mosquito-borne disease Polyarthralgia

Identifying diabetes management opportunity areas in the USA

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Family Medicine and Community health 2020年第1期8卷 53-58页

作者： Michael Topmiller Kyle Shaak Peter J Mallow Autumn M Kieber-Emmons health Landscape LLCCincinnatiOhioUSA Department of Family Medicine Lehigh Valley Health NetworkAllentownPennsylvaniaUSA health Services Administration Xavier UniversityCincinnatiOhioUSA School of Medicine University of South FloridaTampaFloridaUSA

Using adherence to diabetes management guidelines as a case study,this paper applied a novel geospatial hot-spot and cold-spot methodology to identify priority counties to target *** for this study were obtained from the Dartmouth Atlas of healthcare,the United States Census Bureau’s American Community Survey and the University of Wisconsin County health Rankings.A geospatial approach was used to identify four tiers of priority counties for diabetes preventive and management services:diabetes management cold-spots,clusters of counties with low rates of adherence to diabetes preventive and management services(Tier D);Medicare spending hot-spots,clusters of counties with high rates of spending and were diabetes management cold-spots(Tier C);preventable hospitalisation hot-spots,clusters of counties with high rates of spending and are diabetes management cold-spots(Tier B);and counties that were located in a diabetes management cold-spot cluster,preventable hospitalisation hot-spot cluster and Medicare spending hot-spot cluster(Tier A).The four tiers of priority counties were geographically concentrated in Texas and Oklahoma,the Southeast and central *** these tiers,there were 62 Tier A *** of preventable hospitalisations and Medicare spending were higher in Tier A counties compared with national *** same counties had much lower rates of adherence to diabetes preventive and management *** novel geospatial mapping approach used in this study may allow practitioners and policy makers to target interventions in areas that have the highest *** refinement of this approach is necessary before making policy recommendations.

关键词： diabetes policy counties

fRAP 2.0:a community engagement method applied to cervical cancer disparities among Hispanic women

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Family Medicine and Community health 2024年第S02期12卷 44-57页

作者： Autumn M Kieber-Emmons Susan E Hansen Michael Topmiller Jaskaran Grewal Carlos Roberto Jaen Benjamin F Crabtree William L Miller Department of Family Medicine Lehigh Valley Health NetworkAllentownPennsylvaniaUSA College of Medicine USFTampaFloridaUSA lehigh valley health network AllentownPennsylvaniaUSA American Academy of Family Physicians-health Landscape CincinattiOHUSA Lafayette College EastonPennsylvaniaUSA UT health San Antonio San AntonioTexasUSA Rutgers Robert Wood Johnson Medical School PiscatawayNew JerseyUSA Cancer Institute of New Jersey New BrunswickNew JerseyUSA

focused Rapid Assessment Process(fRAP)2.0 is a community engagement approach combining geospatial mapping with rapid qualitative assessment in cyclical fashion within communities to capture multifactorial and multilevel features impacting primary care *** 2.0 offers primary care researchers a methodology framework for exploring complex community features that impact primary healthcare delivery and *** fRAP 2.0 study design expands the fRAP from a sequential design to a cyclical process of geospatial mapping and rapid qualitative assessment in search of modifiable contextual *** participants are stakeholders from various socioecological levels whose perspectives inform study outcomes that they may use to then become the agents of change for the very problems they helped ***,we present a proof-of-concept study for fRAP 2.0 examining disparities in cervical cancer mortality rates among Hispanic women in *** primary outcomes of interest are features at the community level,medical health system level and regional government policy levels that offer opportunities for collaborative interventions to improve cervical cancer *** this study,geospatial mapping of county and ZIP code-level variables impacting postdiagnosis cervical cancer care at community,medical and policy levels were created using publicly available data and then overlaid with maps created with Texas Cancer Registry data for cervical cancer cases in three of the largest population *** disparate areas were then qualitatively explored using participant observation and ethnographic field work,alongside 39 key informant *** discussion groups and stakeholder engagement existed at every phase of the *** the fRAP 2.0 method,we created an action-oriented roadmap of next steps to improve cervical cancer care disparities in the three Texas counties with emphasis on the high disparity *** identified local change

关键词： cervical qualitative policy

Tiotropium Bromide/Olodaterol Related Acute Cognitive Impairments

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Case Reports in Clinical Medicine 2023年第5期12卷 119-125页

作者： Samer Alkhuja Monika Girgis Department of Medicine The Commonwealth Medical College Lehigh Valley Health Network-Pocono Stroudsburg PA USA

Background: The use of anticholinergics has been on the rise. With the increase in population longevity, more medication-related cognitive impairments (ACIs) have been reported. These impairments result in significant morbidities. We present a case that stresses on the importance of being vigilant when prescribing anticholinergic medications, especially in the elderlies. Case Report: A case of ACIs related to the use of tiotropium bromide/olodaterol (Stiolto Respimat) is being reported in a 71-year-old white man with COPD. Treatment with budesonide 180 mcg/actuation, and tiotropium bromide/olodaterol (Stiolto Respimat) inhalers was initiated. Two days after initiating treatment, the patient developed ACIs which manifested by gait imbalance, short-term memory dysfunction, inability to remember his family members, or to take his medications. Tiotropium bromide/olodaterol (Stiolto Respimat) was discontinued. After three days, a full recovery of ACIs was reported. A month later, due to worsening dyspnea, the patient self-resumed the medicine. Similar ACIs were reported within two days of resuming treatment. Tiotropium bromide/olodaterol (Stiolto Respimat) was discontinued indefinitely. Full recovery of ACIs was reported. Conclusion: ACIs should be noted as a significant side effect of tiotropium bromide/olodaterol. Clinicians should be vigilant, when prescribing anticholinergic medications to elderlies.

关键词： Cognitive Impairment Stiolto Tiotropium Bromide/Olodaterol COPD

PCSK9 inhibitors: A new era of lipid lowering therapy

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World Journal of Cardiology 2017年第2期9卷 76-91页

作者： Rahul Chaudhary Jalaj Garg Neeraj Shah Andrew Sumner Department of Medicine Sinai Hospital of BaltimoreJohns Hopkins University Division of Cardiology Lehigh Valley Health Network

Hyperlipidemia is a well-established risk factor for developing cardiovascular disease(CVD). The recent American College of Cardiology and American Heart Association guidelines on lipid management emphasize treatment of individuals at increased risk for developing CVD events with 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors(statins) at doses proven to reduce CVD events. However, there are limited options for patients who are either intolerant to statin therapy, develop CVD despite being on maximally tolerated statin therapy, or have severe hypercholesterolemia. Recently the Food and Drug Administration approved two novel medications for low-density lipoprotein(LDL)-cholesterol reduction: Evolocumab and Alirocumab. These agents target and inactivate proprotein convertase subtilsinkexin type 9(PCSK9), a hepatic protease that attaches and internalizes LDL receptors into lysosomes hence promoting their destruction. By preventing LDL receptor destruction, LDL-C levels can be lowered 50%-60% above that achieved by statin therapy alone. This review explores PCSK-9 biology and the mechanisms available to alter it; clinical trials targeting PCSK9 activity, and the current state of clinically available inhibitors of PCSK9.

关键词： Hyperlipidemia Statins Proprotein convertase subtilsin-kexin type 9

Somnambulism: Varenicline-Induced Sleep Driving

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Case Reports in Clinical Medicine 2023年第7期12卷 213-217页

作者： Samer Alkhuja Monika Girgis Mohammad Ali Pravinkumar Patel Olutunde Odeyemi Department of Medicine The Commonwealth Medical College Lehigh Valley Health Network-Pocon Stroudsburg Pennsylvania USA

Background: Varenicline, which is derived from the cytisine compound, is used to assess in smoking cessation. Sleep driving (SD) is often classified as a variant of somnambulism. Although, somnambulism has been reported as a side effect of varenicline, varenicline-induced sleep driving (VISD) has not been reported. Case Report: A 56-year-old man with a history of 35 pack year smoking who presented for smoking cessation counseling. Treatment with varenicline was initiated. In the following night, the patient drove to a shopping center and woke up in his car. Varenicline was discontinued. SD has not been reported in the following nights. In a repeated attempt to stop smoking, treatment with varenicline was resumed by the patient. SD reoccurred in the following night. Varenicline was discontinued indefinitely, and SD has not been reported.

关键词： Varenicline Sleep Walking Arousal Parasomnia

Outcomes of pediatric thyroidectomy:a cross-sectional evaluation

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World Journal of Pediatric Surgery 2020年第4期3卷 13-22页

作者： Sarah Azari Jackson Randolph Harry Shi Travis Hoover Daniel Weaver Jillian Mattioni Sri Kiran Chennupati University of South Florida College of Medicine TampaFloridaUSA Penn State College of Medicine HersheyPennsylvaniaUSA lehigh University BethlehemPennsylvaniaUSA Otolaryngology-Head and Neck Surgery PCOMPhiladelphiaPennsylvaniaUSA Pediatric Otolaryngology Lehigh Valley Health NetworkAllentownPennsylvaniaUSA

Introduction Pediatric thyroidectomy is performed by a variety of surgical *** can result in a number of *** studies cite that the most common complications in children are pain and transient *** purposes of this report are to assess the adverse events of thyroidectomies performed in the pediatric population and to assess the relationship between surgical specialties and postoperative thyroidectomy *** We conducted a cross-sectional analysis of cases from January 1,2014 through November 1,2015 using the National Surgical Quality Improvement Program database for patients undergoing excision of cyst or adenoma of the thyroid,unilateral thyroid lobectomy,or total *** Of the 344 patients who underwent thyroidectomy,10(2.9%)experienced at least one *** most common complications were readmission,surgical site infections,and wound *** was a statistically significant association between complication incidence and surgical specialty(p=0.006).Pediatric otolaryngology had a statistically significantly higher number of complications than pediatric surgery(p<0.008).Conclusion Overall,the incidence of adverse events following pediatric thyroidectomy was low.

关键词： pediatric wound sectional

Sigmoid Micro-Perforation and Pelvic Abscess Masquerading as Hyperactive Delirium

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Case Reports in Clinical Medicine 2024年第8期13卷 315-320页

作者： Samer Alkhuja Susheer Gandotra Hirenkumar Faldu Pravinkumar Patel Olutunde Odeyemi Department of Medicine Thomas Jefferson Medical School Thomas Jefferson University Lehigh Valley Health Network-Pocono Stroudsburg PA USA

Diagnoses Background: Delirium is a common finding in elderly patients with sepsis. Early identification of the cause of delirium and treatment is important to avoid any worsening of mental or physical status. Sepsis secondary to colonic micro-perforation (CMP) in a patient with a history of diverticulosis should be high on the list of differential diagnosis. Case Report: We present a case of a patient who presented with hyperactive sepsis-associated delirium (SAD). Six days after the presentation, the patient started complaining of abdominal pain. An abdominal and pelvic computed tomography (CT) scan showed free air in the abdomen. The patient underwent surgical intervention and treatment with intravenous antibiotics. Pathological examination showed CMP connected to the patient’s history of diverticulosis. Delirium superimposed on dementia (DSD) resulted in the worsening of both the mental and physical status of our patient with the need for placement in a nursing home.

关键词： Delirium Dementia Colon Perforation Sepsis Diverticulosis