Johns Hopkins Medical Institute

Baltimore, MD, United States

Johns Hopkins Medical Institute

Baltimore, MD, United States
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Chung C.H.,Johns Hopkins Medical Institute | Bagheri A.,Johns Hopkins Medical Institute
Oral Oncology | Year: 2014

Objective To describe what is known about the epidemiology of oral human papillomavirus (HPV) infection. Methods In this article we review current data on HPV prevalence, natural history, mode of acquisition, and risk factors for oral HPV infection. Results & Conclusion Over the past several years new studies have informed our understanding of oral HPV infection. These data suggest oral HPV prevalence is higher in men than women and support the sexual transmission of HPV to the mouth by oral sex. Data is emerging suggesting that most oral HPV infections usually clear within a year on and describing risk factors for prevalent and persistent infection. Recent data support likely efficacy of the HPV vaccine for oral HPV, suggesting vaccination may reduce risk of HPV-related oropharyngeal cancer. © 2014 Elsevier Ltd. All rights reserved.

Wirtz A.L.,Johns Hopkins Medical Institute | Radix A.,Callen Lorde Community Health Center | Borquez A.,Imperial College London | Silva-Santisteban A.,Cayetano Heredia Peruvian University | And 4 more authors.
The Lancet | Year: 2015

Worldwide, transgender women who engage in sex work have a disproportionate risk for HIV compared with natal male and female sex workers. We reviewed recent epidemiological research on HIV in transgender women and show that transgender women sex workers (TSW) face unique structural, interpersonal, and individual vulnerabilities that contribute to risk for HIV. Only six studies of evidence-based prevention interventions were identified, none of which focused exclusively on TSW. We developed a deterministic model based on findings related to HIV risks and interventions. The model examines HIV prevention approaches in TSW in two settings (Lima, Peru and San Francisco, CA, USA) to identify which interventions would probably achieve the UN goal of 50% reduction in HIV incidence in 10 years. A combination of interventions that achieves small changes in behaviour and low coverage of biomedical interventions was promising in both settings, suggesting that the expansion of prevention services in TSW would be highly effective. However, this expansion needs appropriate sustainable interventions to tackle the upstream drivers of HIV risk and successfully reach this population. Case studies of six countries show context-specific issues that should inform development and implementation of key interventions across heterogeneous settings. We summarise the evidence and knowledge gaps that affect the HIV epidemic in TSW, and propose a research agenda to improve HIV services and policies for this population. © 2015 Elsevier Ltd.

News Article | December 2, 2016

When Dr. Debra Bourdeau decided she was ready for a change, she knew she still wanted to run her own business and have the opportunity to have a meaningful impact on the lives of people in her community. Now she’s pleased to announce that those two passions have come full circle with the launch of her new small business, Caring Transitions of North Oakland County. Caring Transitions is America’s largest resource for managing senior relocations as well as downsizing and estate liquidations. In addition to organizing, packing, de-cluttering, moving and resettling, Caring Transitions can handle estate sales, liquidations, and preparing homes for market. Caring Transitions of North Oakland County serves Linden, Fenton, Holly, Davisburg, Clarkston, White Lake, Lake Orion, Rochester, Ortonville, Brandon Township, Oxford, Argentine and the surrounding communities. “The stress of relocating and clearing an estate can tear families apart – especially when you have a house full of memories and a deadline. I understand what it’s like to like to try to go through that process without professional assistance and I know how disappointing it can be when you feel like you just have to have a garage sale when you could make made a decent profit with an estate sale. I’m hoping, with Caring Transitions, I can help families get through those transitions more smoothly,” Bourdeau said. Whether your situation is planned or unexpected, Caring Transitions’ services are perfect for seniors moving in with family or into a safer living situation as well as busy families and people clearing out the home of a loved one who has passed. All of Caring Transitions’ services are customizable, so clients only pay for the services they need – whether that means managing the entire move and estate-clearing or just getting someone resettled into their new place. “The Caring Transitions concept is unique because we can manage the entire process – from space planning and deciding what you want to take to the new place to preparing your old home for market – and we do it with a compassionate team who specialize in working with seniors and families,” Bourdeau said. “We aren’t here to tear through your stuff, pack you up and drop you off someplace new. We are here to help you make sure your next chapter starts on the right foot and we will take your life into consideration throughout the process. We understand this is a sensitive and challenging transition for many people and we want to ease that stress so you can enjoy the time you have with your loved ones,” she added. Bourdeau studied at The Michigan College of Optometry and obtained a Fellowship through Johns Hopkins Medical Institute. Prior to opening Caring Transitions, Bourdeau built and operated her own optometry practice. As part of her work for the last decade, she’s worked extensively with seniors and special needs patients. “From medicine to moving, nothing fills me with more satisfaction than knowing I provided another individual with a service or solution that will alleviate stress, improve their quality of life or guide them to the correct resources they may need. I’m looking forward to bringing the same commitment to quality, service, professionalism and care I provided with my optometry practice to Caring Transitions of North Oakland County,” Bourdeau said. Bourdeau opened Caring Transitions with the support of her husband Brady and son Brayden as well as her parents Edward and Sharon Bourdeau. Bourdeau’s family also includes three cats and three Yorkies. She and Brayden are also working on starting a cat rescue in their spare time. Bourdeau is a Certified Relocation and Transition Specialists, a designation bestowed by an independent organization that evaluates providers of senior relocation services. Caring Transitions of North Oakland County is bonded and insured and all employees are background-checked. For additional information about Caring Transitions, call (248)270-6822, email DBourdeau(at)CaringTransitions(dot)com or visit

Patwa H.S.,Yale University | Chaudhry V.,Johns Hopkins Medical Institute | Katzberg H.,University of Toronto | Rae-Grant A.D.,Cleveland Clinic | So Y.T.,Stanford University
Neurology | Year: 2012

Objective: To assess the evidence for the efficacy of IV immunoglobulin (IVIg) to treat neuromuscular disorders. Methods: The MEDLINE, Web of Science, and EMBASE databases were searched (1966-2009). Selected articles were rated according to the American Academy of Neurology's therapeutic classification of evidence scheme; recommendations were based on the evidence level. Results and Recommendations: IVIg is as efficacious as plasmapheresis and should be offered for treating Guillain-Barré syndrome (GBS) in adults (Level A). IVIg is effective and should be offered in the long-term treatment of chronic inflammatory demyelinating polyneuropathy (Level A). IVIg is probably effective and should be considered for treating moderate to severe myasthenia gravis and multifocal motor neuropathy (Level B). IVIg is possibly effective and may be considered for treating nonresponsive dermatomyositis in adults and Lambert-Eaton myasthenic syndrome (Level C). Evidence is insufficient to support or refute use of IVIg in the treatment of immunoglobulin M paraprotein- associated neuropathy, inclusion body myositis, polymyositis, diabetic radiculoplexoneuropathy, or Miller Fisher syndrome, or in the routine treatment of postpolio syndrome or in children with GBS (Level U). IVIg combined with plasmapheresis should not be considered for treating GBS (Level B). More data are needed regarding IVIg efficacy as compared with other treatments/treatment combinations. Most studies concluded IVIg-related serious adverse effects were rare. Given the variable nature of these diseases, individualized treatments depending on patient need and physician judgment are important. Copyright © 2012 by AAN Enterprises, Inc.

Irani S.,Virginia Mason Medical Center | Baron T.H.,University of North Carolina at Charlotte | Grimm I.S.,University of North Carolina at Charlotte | Khashab M.A.,Johns Hopkins Medical Institute
Gastrointestinal Endoscopy | Year: 2015

Background and Aims Nonsurgical techniques for gallbladder drainage are percutaneous, and endoscopic. EUS-guided transmural gallbladder drainage (EUS-GBD) is a relatively new approach, although data are limited. Our aim was to describe the outcome after EUS-GBD with a lumen-apposing metal stent (LAMS). Patients and Methods This was a retrospective review of prospectively collected data on 15 nonsurgical patients who underwent EUS-GBD for various indications. Procedures were performed at 3 tertiary care centers with expertise in the management of complex biliary problems. The main outcome measures were technical and clinical success and adverse events. Results Fifteen patients (8 male, 7 female) with a median age of 74 years (range 42-89) underwent EUS-GBD by using a LAMS to decompress the gallbladder (7 patients calculous cholecystitis, 4 acalculous cholecystitis, 2 patients biliary obstruction, 1 patient gallbladder hydrops, 1 patient symptomatic cholelithiasis). Patients were nonsurgical candidates according to the American Society of Anesthesiologists Physical Status Classification System; findings were class IV or higher in 9 patients and advanced malignancies in 6. Percutaneous transhepatic gallbladder drainage (PT-GBD) was refused by all patients and was further precluded by perihepatic ascites in 3 patients, coagulopathy or need for anticoagulation in 4 patients, and need for internal biliary drainage in 2 patients. Transduodenal access and stenting was achieved in 14 of 15 patients and transgastric stenting was achieved in 1. Technical success was achieved in 14 of 15 patients (93%), whereas clinical success was achieved in all 15 patients with a median follow-up of 160 days. One mild adverse event (postprocedure fever for 3 days) was noted. The limitations of this study are the small select group of patients and retrospective study design. Conclusions EUS-GBD with a LAMS is technically safe and effective for decompressing the gallbladder for cholecystitis and biliary or cystic duct obstruction in patients who are poor surgical candidates. Copyright © 2015 by the American Society for Gastrointestinal Endoscopy.

Ziessman H.A.,Johns Hopkins Medical Institute
Journal of Nuclear Medicine | Year: 2014

Cholescintigraphy with 99mTc-hepatobiliary radiopharmaceuticals has been an important, clinically useful diagnostic imaging study for almost 4 decades. It continues to be in much clinical demand; however, the indications, methodology, and interpretative criteria have evolved over the years. This review will emphasize state-of-the-art methodology and diagnostic criteria for various clinical indications, including acute cholecystitis, chronic acalculous gallbladder disease, high-grade and partial biliary obstruction, and the postcholecystectomy pain syndrome, including sphincter-of-Oddi dysfunction and biliary atresia. The review will also emphasize the use of diagnostic pharmacologic interventions, particularly sincalide. Copyright © 2014 by the Society of Nuclear Medicine and Molecular Imaging, Inc.

Redett R.J.,Johns Hopkins Medical Institute
Plastic and Reconstructive Surgery | Year: 2010

Background: The development of surgical repair of cleft lip-cleft palate closure has been well documented in the literature. However, the contributions of an unlikely pioneer, Harvey Cushing, in the development of cleft lip-cleft palate closure have been to date unknown. Methods: Patient surgical records from 1896 to 1912 at The Johns Hopkins Hospital documenting Harvey Cushing's cases were reviewed. Results: Three cases of Cushing's surgical closure of cleft lip-cleft palate, using a variety of techniques, are described and placed into historical context in the development of cleft lip-cleft palate surgery. Conclusions: Harvey Cushing's contributions to the field of plastic and reconstructive surgery have largely remained unknown. The cases reported here illustrate the early work of this pioneering surgeon in the area of cleft lip-cleft palate surgery. Copyright © 2010 by the American Society of Plastic Surgeons.

Boahene K.,Johns Hopkins Medical Institute
Facial Plastic Surgery | Year: 2015

Facial paralysis following acoustic neuroma (AN) resection can be devastating, but timely and strategic intervention can minimize the resulting facial morbidity. A central strategy in reanimating the paralyzed face after AN resection is to restore function of the native facial muscles using available facial nerves or repurposed cranial nerves, mainly the hypoglossal or masseter nerves. The timing of reinnervation is the single most influential factor that determines outcomes in facial reanimation surgery. The rate of recovery of facial function in the first 6 months following AN resection may be used to predict ultimate facial function. Patients who show no signs of recovery in the first 6 months, even when their facial nerves are intact, recover poorly and are candidates for early facial reinnervation. With delay, facial muscles become irreversibly paralyzed. Reanimation in irreversible paralysis requires the transfer of functional muscle units such as the gracilis or the temporalis muscle tendon unit. © 2015 by Thieme Medical Publishers, Inc.

Sherman K.E.,University of Cincinnati | Thomas D.,Johns Hopkins Medical Institute | Chung R.T.,Harvard University
Hepatology | Year: 2014

In the United States, more than 1.1 million individuals are infected with the human immunodeficiency virus (HIV). These patients exhibit a high frequency of coinfections with other hepatotropic viruses and ongoing fibrosis, leading to cirrhosis and liver-related mortality. Etiologies of liver disease include viral hepatitis coinfections, drug-related hepatotoxicity, fatty liver disease, and direct and indirect effects from HIV infection, including increased bacterial translocation, immune activation, and presence of soluble proteins, that modulate the hepatic cytokine environment. New treatments for hepatitis C virus (HCV) using direct-acting agents appear viable, though issues related to intrinsic toxicities and drug-drug interactions remain. Recent research suggests that acute HCV infection, unrecognized hepatitis D infection, and hepatitis E may all represent emergent areas of concern. Antiretroviral agents, including those used in recent years, may represent risk factors for hepatic injury and portal hypertension. Key issues in the future include systematic implementation of liver disease management and new treatment in HIV-infected populations with concomitant injection drug use, alcohol use, and low socioeconomic status. © 2013 by the American Association for the Study of Liver Diseases.

Khashab M.A.,Johns Hopkins Medical Institute | Kalloo A.N.,Johns Hopkins Medical Institute
Current Opinion in Gastroenterology | Year: 2010

Purpose Of review: Since its introduction in 2000, natural orifice translumenal endoscopic surgery (NOTES) has gained a great deal of attention from gastroenterologists and surgeons all over the world. In this article, we will review the progress in the field of NOTES and present the latest publications that provide some answers and solutions to the barriers suggested by the Natural Orifice Surgery Consortium for Assessment and Research white paper. Recent findings: Because of the first human NOTES procedure by Rao and Reddy, more pioneering procedures, including transgastric and transvaginal cholecystectomies, appendectomies, and hernia repairs, have been performed. Although NOTES researchers continue to experiment with new innovative equipment and procedures in the lab, more structured work, including randomized controlled trials, has been published. Summary: In the last several years, there has been growing interest in NOTES, which has translated into exciting animal research work and publication of randomized controlled trials. Additionally, preliminary NOTES human procedures have been successfully performed. When suitable instruments become available, the subsequent step should be comparing NOTES with current laparoscopic approaches. Superiority or even equality of NOTES to laparoscopic surgery would be the best argument for advancing and integrating implementation into clinical practice. © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.

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