Delaware medical journal最新文献

{"title":"Deep Transcranial Magnetic Stimulation: A Promising Drug-Free Treatment Modality in the Treatment of Chronic Low Back Pain.","authors":"Erin Yates,&nbsp;Ganesh Balu","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Unlabelled: </strong>Deep Transcranial Magnetic Stimulation (dTMS) is the next generation of technology used to treat Major Depressive Disorder (MDD). dTMS has been proven to be a safe and effective treatment modality for MDD and may have secondary benefits in patients with chronic low back pain by reducing pain related morbidity. We are presenting two case studies with MDD and chronic low back pain to demonstrate the effectiveness of both the antidepressant and analgesic effects of dTMS.</p><p><strong>Background: </strong>Transcranial Magnetic Stimulation (rTMS) utilizes MRI-strength magnetic pulses outside the cranium to stimulate the brain to a depth of approximately 1 cm. The technique was approved by the US Food and Drug Administration (FDA) for the treatment of Major Depressive Disorder (MDD) in 2008. In 2013 the Brainsway Deep Transcranial Magnetic Stimulation (dTMS) device, which has the potential for cranial penetration up to 5 cm received FDA clearance for pharmacotherapy and psychotherapy resistant MDD. The mechanism of action of dTMS in MDD is not completely understood. However, its clinical efficacy is proven.' The effect of dTMS on the brain has been studied since 1985 in clinical trials and has been demonstrated as an effective treatment modality for refractory depressive symptoms. The mechanism of action of dTMS is thought to be mediated by increased connectivity between the dorsolateral prefrontal cortex (DLPFC) and the thalamus and reduced subgenual cingulate to caudate connectivity. These brain areas are believed to be responsible for modulating mood. Chronic pain is often accompanied by MDD. Specifically, chronic low back pain is highly prevalent and accompanied by significant disability.2 Low back pain is defined as chronic when the pain is continuous for more than three months. The current chronic pain treatment algorithm includes judicious use of non pharmacological interventions like physical therapy, chiropractic adjustments, therapeutic massage, or acupuncture combined with pharmacological interventions that utilize non-narcotic or narcotic oral medications, spinal/paraspinal injections and, in selected cases, surgery. In patients who fail this extensive algorithm for chronic pain management and are left with significant morbidity and disability, coincident MDD frequently becomes refractory to therapy. Two illustrative examples of chronic low back pain patients with medically refractory MDD treated successfully using dTMS are presented here to discuss the potential therapeutic benefits for both MDD and chronic low back pain in this setting.</p>","PeriodicalId":75779,"journal":{"name":"Delaware medical journal","volume":"88 3","pages":"90-2"},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34510106","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Tobacco Cessation for Patients with Coronary Artery Disease.","authors":"Denise Taylor,&nbsp;Elisabeth Bradley,&nbsp;Stephen Meng,&nbsp;Jhapat Thapa,&nbsp;Edward Goldenberg","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":75779,"journal":{"name":"Delaware medical journal","volume":"88 3","pages":"84-8"},"PeriodicalIF":0.0,"publicationDate":"2016-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34509651","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Aggressive Measures to Decrease Door to Balloon Time May Increase the Incidence of Unnecessary Cardiac Catheterization and Delay Appropriate Care.","authors":"Zaher Fanari,&nbsp;Niksad Abraham,&nbsp;Sumaya Hammami,&nbsp;Andrew J Doorey","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Door-to-balloon (DTB) time is an important quality measure for ST-segment myocardial elevation infarction (STEMI). Aggressive measures to reduce DTB time can increase the incidence of false positive-STEMI and may increase mortality in that group. Efforts to reduce DTB time should be monitored systematically to avoid unnecessary procedures especially in critically ill patients who don't have STEMI and may benefit from other appropriate therapies in timely manner. We report two cases where trying to achieve an aggressive DTB time may have led to unwarranted outcomes.</p>","PeriodicalId":75779,"journal":{"name":"Delaware medical journal","volume":"87 9","pages":"276-9"},"PeriodicalIF":0.0,"publicationDate":"2015-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34185599","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risks Associated with Co-Prescribing Opioids and Benzodiazepines and Delaware's Prescription Drug Monitoring Program.","authors":"Iman Parhami,&nbsp;Jonathan Massey,&nbsp;Imran Trimzi,&nbsp;Kevin Huckshorn,&nbsp;Gerard Gallucci","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":75779,"journal":{"name":"Delaware medical journal","volume":"87 9","pages":"270-4; quizz 281"},"PeriodicalIF":0.0,"publicationDate":"2015-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34185597","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Discussion about Life at the End.","authors":"Nancy Fan","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":75779,"journal":{"name":"Delaware medical journal","volume":"87 9","pages":"265-6"},"PeriodicalIF":0.0,"publicationDate":"2015-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34185595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Physician Directorships the Focus of New Fraud Alert.","authors":"Bruce D Armon,&nbsp;Karilynn Bayus","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":75779,"journal":{"name":"Delaware medical journal","volume":"87 8","pages":"249"},"PeriodicalIF":0.0,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34030721","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Effects of Right Ventricular Apical Pacing Frequency on Left Ventricle Function and Pulmonary Artery Pressure.","authors":"Zaher Fanari,&nbsp;Sumaya Hammami,&nbsp;Muhammad Baraa Hammami,&nbsp;Safa Hammami,&nbsp;Mossaab Shuraih","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Objective: </strong>We studied the effect of the frequency of right ventricular (HV) pacing on left ventricle (LV) function pulmonary hypertension.</p><p><strong>Background: </strong>The incidence of new or worsening pulmonary hypertension after permanent pacemaker (PPM) or implantable cardioverter defibrillator (lCD) lead placement has not been well investigated.</p><p><strong>Methods: </strong>We reviewed the charts of all patients undergoing PPM or ICD lead placement in our electrophysiology laboratory from December 2007 to December 2012.</p><p><strong>Results: </strong>Two hundred and six patients (120 with PPM and 86 with ICD) had baseline echocardiography within six months before, and a follow up study at least six months after lead insertion. The mean age was 74 ± 14 years; 56 percent were men. The follow-up period was 29 ± 19 months. RV pacing was associated with a worsening of left ventricular ejection fraction (LVEF) in patients with high frequency of RV (55 ± 16 vs. 44 ± 18; P = 0.001), but not with those with low frequency pacing (55 ± 16 vs. 54 ± 17; P = 0.87). Similarly, RV pacing was associated with a worsening in both right ventricular systolic pressure (RVSP) (42 ± 14 vs. 48 ± 15; P = 0.01) and Pulmonary Artery Systolic Pressure (PASP) (50 ± 17 vs. 56 ± 18; P = 0.005) in patients with high frequency RV, but not in those with low frequency RV pacing [RVSP (43 ± 12 vs. 46 ± 13; P = 0.06) and PASP (51 ± 15 vs. 54 ± 16; P = 0.11)].</p><p><strong>Onclusion: </strong>PPM or IICD lead implantation worsens LV function and pulmonary hypertension in patients with high frequency of RV pacing frequency. This is probably caused by the mechanical dyssynchrony induced by RV pacing.</p>","PeriodicalId":75779,"journal":{"name":"Delaware medical journal","volume":"87 8","pages":"244-7"},"PeriodicalIF":0.0,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34030720","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"AMA Annual Meeting 2015.","authors":"Nancy Fan","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":75779,"journal":{"name":"Delaware medical journal","volume":"87 8","pages":"233-4"},"PeriodicalIF":0.0,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34099643","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pharmacogenetics in the Development of Lipid Lowering Medications: Lomitapide & Mipomersen in Clinical Practice.","authors":"Jeffrey A Marbach,&nbsp;Jhapat Thapa,&nbsp;Edward Goldenberg,&nbsp;Danielle Duffy","doi":"","DOIUrl":"","url":null,"abstract":"<p><strong>Introduction: </strong>The familial hypercholesterolemias (FH) are a group of undertreated genetically inherited disorders of lipid metabolism that lead to severely elevated cholesterol levels and early onset cardiovascular disease. Aggressive lifestyle modifications and lipid-lowering medications such as statins and bile acid sequestrants are the backbone of current treatment. Despite these interventions, homozygous FH (HoFH) patients are unable to reach LDL-C targets and remain at significantly increased risk of cardiovascular disease. Recently, two novel lipid-lowering medications, lomitapide and mipomersen, have been approved for the treatment of HoFH.</p><p><strong>Case descriptions: </strong>We present two patients with HoFH who have been unable to reach target LDL-C goals on standard therapy. Patient A is a 41-year-old male and patient B is a 64-year-old female, both of whom have complex histories of multi-vessel coronary artery disease. In attempt to improve their LDL-C levels and lower their cardiovascular risk, lomitapide and mipomersen were initiated in patient A and B, respectively.</p><p><strong>Discussion/conclusion: </strong>Through inhibition of the microsomal triglyceride transfer protein, lomitapide prevents the formation of triglyceride rich lipoproteins. Mipomersen is an antisense oligonucleotide that inhibits the translation of apolipoprotein B-100. Both medications employ novel mechanisms developed through advances in pharmacogenetic technology and achieve unprecedented LDL-C reductions.</p>","PeriodicalId":75779,"journal":{"name":"Delaware medical journal","volume":"87 8","pages":"238-43"},"PeriodicalIF":0.0,"publicationDate":"2015-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"34030719","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Postmenopausal Bleeding Resulting from Acute Myeloid Leukemia Infiltration of the Endometrium.","authors":"Megan Wasson,&nbsp;Moses Hochman,&nbsp;Mark Cadungog","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Postmenopausal bleeding can be the result of numerous etiologies including endometrial carcinoma, vaginal atrophy, and endometrial polyps. Manifestation of a hematologic disease, such as acute myeloid leukemia (AML), is a rare occurrence. A 65-year-old woman with pancytopenia and postmenopausal bleeding was diagnosed with AML. Endometrial biopsy following dilation and curettage of the uterus revealed extensive mononuclear cell infiltrate consistent with AML. The patient was a poor surgical candidate and subsequently underwent treatment with chemotherapy, hormonal therapy, pelvic radiation, and uterine artery embolization to control her vaginal bleeding. A multi-disciplinary approach is necessary for treatment of post-menopausal bleeding resulting from AML infiltration of the endometrium.</p>","PeriodicalId":75779,"journal":{"name":"Delaware medical journal","volume":"87 7","pages":"212-5"},"PeriodicalIF":0.0,"publicationDate":"2015-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"33931899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}