Bridgeman M.B.,Rutgers University |
Bridgeman M.B.,Capital Health Regional Medical Center |
Pathak R.,Rutgers University |
Pathak R.,St Josephs Regional Medical Center
Clinical Therapeutics | Year: 2011
Background: Osteoporosis is a prevalent condition that may lead to increased risks for bone fracture and other morbidities and increased health care costs. Treatment modalities for osteoporosis aim to prevent further bone loss and to reduce the risk for fracture. Denosumab is a human monoclonal antibody developed for use in osteoporosis. It inhibits the receptor activator of nuclear factor KB ligand, a cytokine that mediates osteoclast-mediated bone resorption. Objective: The intent of this article was to review the clinical pharmacology, pharmacokinetic and pharmacodynamic properties, efficacy, and tolerability of denosumab in the prevention and treatment of postmenopausal osteoporosis. Methods: The MEDLINE and MEDLINE In-Process & Other Non-Indexed Citations databases were searched for English-language reviews, abstracts, presentations, and clinical trials of denosumab in humans, published from 1995 through July 2011. Search terms included denosumab, osteoporosis, RANK ligand, and bone resorption. Available data were evaluated, and relevant clinical data were selected for inclusion. Results: Three Phase II and 4 Phase III studies that evaluated the efficacy of denosumab in postmenopausal women were identified. In a Phase III study, the percentage change from baseline in bone mineral density (BMD) was significantly greater with denosumab compared with placebo (+6.5% vs -0.6%, respectively; P < 0.0001). In another Phase III trial, the cumulative prevalence of vertebral fractures was significantly lower with denosumab compared with placebo (2.3% vs 7.2%; 95% CI, 0.26-0.41; P < 0.001). Denosumab treatment was associated with significantly greater changes in BMD at the total hip (+4.5% vs +3.4%; P < 0.0001) and distal radius (+1.1% vs +0.6%; P = 0.0001) compared with alendronate. Adverse events reported with the use of denosumab have included back pain (34.7%); pain in the extremities (11.7%); general musculoskeletal pain (7.6%); elevated cholesterol (7.2%); inflammation of the bladder (5.9%); and dermatologic conditions including dermatitis, eczema, and rashes (combined prevalence, 10.8%). Serious adverse events have included hypocalcemia (1.7%), pancreatitis (0.2%), and severe infection (0.2%). Several cases of osteonecrosis of the jaw have also been reported. Conclusions: Based on the data from the available literature, denosumab is an efficacious and well-tolerated treatment for postmenopausal osteoporosis. © 2011 Elsevier HS Journals, Inc.
Su E.P.,Cornell University |
Su S.L.,St Josephs Regional Medical Center
Orthopedics | Year: 2011
Hip resurfacing has been performed for over a decade but still raises controversy as an alternative to traditional total hip arthroplasty (THA). Concerns exist about the potential complications of hip resurfacing, including femoral neck fracture and osteonecrosis of the femoral head. Recently, attention has been given to the metal-on-metal bearing of hip resurfacing with regard to production of metal ions, possible tissue necrosis, and rare instances of metal hypersensitivity. Given the success of the goldstandard THA, it is understandable why some surgeons believe metal-on-metal surface replacement to be "a triumph of hope over reason." However, this article opposes that viewpoint, demonstrating that data exist to justify the practice of preserving bone in younger patients. Hip resurfacing can maintain femoral bone without the expense of removing additional acetabular bone by using modern implants with incremental sizing. Furthermore, many of the problems cited with the bearing couple (such as excess metal production) have been due to poor implant designs, which have now been removed from the market. Finally, we now realize that the metal-on-metal articulation is more sensitive to malposition; thus, good surgical technique and experience can solve many of the problems that have been cited in the past. National registry results confirm that in a select population, hip resurfacing performs comparably to THA, while fulfilling the goal of bone preservation.
Gutierrez D.,St Josephs Regional Medical Center |
Kaplan S.L.,Rutgers University
Physical Therapy | Year: 2016
Background and Purpose. A hospital-based pediatric outpatient center, wanting to weave evidence into practice, initiated an update of knowledge, skills, and documentation patterns with its staff physical therapists and occupational therapists who treat people with congenital muscular torticollis (CMT). This case report describes 2 cycles of implementation: (1) the facilitators and barriers to implementation and (2) selected quality improvement outcomes aligned with published clinical practice guidelines (CPGs). Case Description. The Pediatric Therapy Services of St Joseph’s Regional Medical Center in New Jersey has 4 full-time, 1 part-time, and 3 per diem staff. Chart audits in 2012 revealed variations in measurement, interventions, and documentation that led to quality improvement initiatives. An iterative process, loosely following the knowledge-to-action cycle, included a series of in-service training sessions to review the basic anatomy, pathokinesiology, and treatment strategies for CMT; reading assignments of the available CPGs; journal review; documentation revisions; and training on the recommended measurements to implement 2 published CPGs and measure outcomes. Outcomes. A previous 1-page generic narrative became a 3-page CMT-specific form aligned with the American Physical Therapy Association Section on Pediatrics CMT CPG recommendations. Staff training on the Face, Legs, Activity, Cry, Consolability (FLACC) pain scale, classification of severity, type of CMT, prognostication, measures of cervical range of motion, and developmental progression improved documentation consistency from 0% to 81.9% to 100%. Clinicians responded positively to using the longer initial evaluation form. Discussion. Successful implementation of both clinical and documentation practices were facilitated by a multifaceted approach to knowledge translation that included a culture supportive of evidence-based practice, administrative support for training and documentation redesign, commitment by clinicians to embrace changes aimed at improved care, and clinical guidelines that provide implementable recommendations. © 2016 American Physical Therapy Association.
Lapalorcia L.M.,Asl 1 of Umbria |
Podda S.,St Josephs Regional Medical Center |
Cordellini M.,Asl 1 of Umbria
Aesthetic Plastic Surgery | Year: 2013
Background: We present a rare case involving severe hypertrophy of the labia majora. This 39-year-old married woman developed a clinically noticeable bilateral lipodystrophy of her labia majora following the administration of chronic antiretroviral therapy. Different combination drug regimens that included drugs like Crixivan®, Epivir®, and Zerit® were administered to the patient from 1998 to 2005. The patient is currently on a single drug regimen of Atripla® with the disease under control and no other comorbidities. The severity of the pubic protuberance created an appearance resembling male genitalia, even when covered by underwear. This anatomical abnormality obviously impaired her social life and forced her to avoid wearing tight pants, swimming garments, and tight clothes in general. She also avoided any sexual activity. Methods: Her pubic hair was shaved. Crural creases and vulvar mucosa were marked in order not to be violated. The estimated amount of skin and fat to be removed was marked. Intraoperative tailor-tacking suturing was used to mark the extent of the resection of the labia majora. Sutures were left in place to verify the accurate tension of the remaining skin. The procedure was performed with the patient under general anesthesia. Labial skin resection was performed by sharp dissection. Electrocautery was then used to excise the lobulated fat accumulation. Two layers of 3/0 Vicryl® sutures were used in the lax subcutaneous tissue. 4/0 Vicryl® rapide was used on the skin to approximate wound edges. Suction drains were left in place for 48 h to reduce the dead space and to manage postoperative bleeding. The patient was instructed to keep ice and compression pads on the area for the first 24 h and to keep the area clean. This was followed by the application of antibiotic ointment two times a day on the wounds to avoid blood crust formation and to keep the skin soft. Results: Stitches were removed on POD 14 after an overall uneventful postoperative course. The sensitivity of the labia majora's interior aspect was preserved, even initially. With the legs slightly open, the labia majora just covered the entrance to the vagina. The clitoris and labia minora became visible again, restoring a normal anatomical appearance. Moderate edema was observed for 4 weeks after surgery. Conclusion: The surgical technique used provided an excellent result according to the patient, who regained her self-confidence and started having a normal sexual life again. Level of Evidence V: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266. © 2013 Springer Science+Business Media New York and International Society of Aesthetic Plastic Surgery.
Rosenberg M.,St Josephs Regional Medical Center |
Lamba S.,UMDNJ New Jersey Medical School |
Misra S.,Vanderbilt University
Clinics in Geriatric Medicine | Year: 2013
Patients with serious or life-threatening illness are likely to find themselves in an emergency department at some point along their trajectory of illness, and they should expect to receive high-quality palliative care in that setting. Recently, emergency medicine has increasingly taken a central role in the early implementation of palliative care. This article presents an overview of palliative care in the emergency department and describes commonly encountered palliative emergencies, strategies for acute symptom management, communication strategies, and issues related to optimal use of hospice service in the emergency department. © 2013 Elsevier Inc.
Shah P.,St Josephs Regional Medical Center |
Bajaj S.,St Michaels Medical Center |
Shamoon F.,St Michaels Medical Center
Texas Heart Institute Journal | Year: 2016
Aortic dissection, a rare sequela of percutaneous coronary intervention, can be fatal when it is not recognized and treated promptly. Treatment varies from conservative management to invasive aortic repair and revascularization. We report the cases of 2 patients whose aortic dissection was caused by percutaneous coronary intervention. In addition, we present detailed analyses of 86 previously reported cases. Aortic dissection was most often seen during intervention to the right coronary artery (in 76.7% of instances). The 2 most frequently reported causes were catheter trauma (in 54% of cases) and balloon inflation (in 23.8%). The overall mortality rate was 7.1%. We conclude that most patients can be treated conservatively or by means of stenting alone, with no need for surgical intervention. © 2016 by the Texas Heart® Institute, Houston.
Wessner S.,St Josephs Regional Medical Center |
Burjonrappa S.,St Josephs Regional Medical Center
Journal of Pediatric Surgery | Year: 2014
Introduction Malnourished adult patients who undergo surgical procedures tend to have worse clinical outcomes compared to well-nourished patients. In the pediatric surgical patient, nutritional assessment is considered a critical aspect of the initial evaluation, but a correlation between preoperative malnutrition and poor surgical outcomes is not clear. We hypothesized that an evidence-based review would reveal that measures of nutritional assessment in children would not correlate pre-operative malnutrition with poor surgical outcomes. Materials and Methods A search of major English language medical databases (Medline, Cochrane, SCOPUS) was conducted for the key words nutritional assessment, pediatric, children, surgery, and outcomes. All methods of nutritional assessment in pediatric surgery were evaluated for their relevance and relation to outcomes after surgery. The Oxford Center for Evidence Based Medicine (CEBM) classification for levels of evidence was used to develop grades of clinical recommendation for each variable studied. Results 35 articles were evaluated after an exhaustive literature search, of which six met inclusion criteria for this review. There is a paucity of high quality evidence correlating preoperative malnutrition in pediatric surgical patients with clinical outcomes. Factors contributing to the low level of evidence include a lack of high quality randomized controlled trials, a lack of consensus in study design and methods, and utilization of incongruous methods of nutritional assessment, including methods that may be unproven in the study population. Conclusion Larger multi center randomized studies are needed to offer higher level of evidence to support nutritional intervention prior to major elective pediatric surgery. © 2014 Elsevier Inc.
Chowdhury D.N.,St Josephs Regional Medical Center |
Dhadham C.G.,Seton Hall University |
Shah A.,Seton Hall University |
Baddoura W.,Seton Hall University
Journal of Global Infectious Diseases | Year: 2014
Strongyloides stercoralis (S. stercoralis) is a soil transmitted intestinal roundworm that has a unique ability to multiply within the human host and reinfect the human carrier by a process of autoinfection. By this property, S. stercoralis can persist as an occult infection for many decades. In situations of immunosuppression or other permissive gastrointestinal conditions, there occurs a massive increase in parasite multiplication. The parasites penetrate through the intestinal mucosa and are carried in circulation and can cause multisystem involvement. We report a case of a 76-year-old Columbian male who presented with intractable vomiting and hyponatremia who was then diagnosed to have syndrome of inappropriate antidiuretic hormone (SIADH). The patient's symptoms improved after treatment with two doses of ivermectin and his serum sodium levels returned to normal. S. stercoralis infection should be suspected in patients from endemic regions who present with gastrointestinal symptoms and unexplained hyponatremia.
Moskowitz R.,St Josephs Regional Medical Center |
Rundback J.,The Interventional Institute at Holy Name Medical Center
Annals of vascular surgery | Year: 2014
Rupture of a middle colic artery branch aneurysm is a rare presentation of visceral artery aneurysms. We report a case of a 53-year-old male complaining of acute-onset abdominal pain found to have a massive intraabdominal hematoma secondary to a leaking branch aneurysm of the middle colic artery. The patient underwent laparotomy and ligation of the aneurysm after an attempted endovascular intervention. Following the case report, a review of the literature entailing incidence, presentation, possible etiologies, and potential management strategies is presented. Copyright © 2014 Elsevier Inc. All rights reserved.
Su E.P.,Hospital for Special Surgery |
Su S.L.,Hospital for Special Surgery |
Su S.L.,St Josephs Regional Medical Center
Bone and Joint Journal | Year: 2014
Surgical interventions consisting of internal fixation (IF) or total hip replacement (THR) are required to restore patient mobility after hip fractures. Conventionally, this decision was based solely upon the degree of fracture displacement. However, in the last ten years, there has been a move to incorporate patient characteristics into the decision making process. Research demonstrating that joint replacement renders superior functional results when compared with I F, in the treatment of displaced femoral neck fractures, has swayed the pendulum in favour of THR. However, a high risk of dislocation has always been the concern. Fortunately, there are newer technologies and alternative surgical approaches that can help reduce the risk of dislocation. The authors propose an algorithm for the treatment of femoral neck fractures: if minimally displaced, in the absence of hip joint arthritis, IF should be performed; if arthritis is present, or the fracture is displaced, then THR is preferred. © 2014 The British Editorial Society of Bone and Joint Surgery.