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Awareness, Use And Perceptions About E-Cigarettes Among Adult Smokers In Karachi, Pakistan., Maryam Sarfraz, Hamza Abdur Rahim Khan, Amna Urooba, Zainab Manan, Omar Irfan, Ramlah Nadeem, Huma Baqir, Saad Farooq, Zarrar Khan, Javaid Khan, Sarah saleem 2018 Aga Khan University

Awareness, Use And Perceptions About E-Cigarettes Among Adult Smokers In Karachi, Pakistan., Maryam Sarfraz, Hamza Abdur Rahim Khan, Amna Urooba, Zainab Manan, Omar Irfan, Ramlah Nadeem, Huma Baqir, Saad Farooq, Zarrar Khan, Javaid Khan, Sarah Saleem

Section of Pulmonary & Critical Care

OBJECTIVE: To estimate the prevalence of awareness, current use and intention to use of e-cigarettes among adult smokers.

METHODS: This cross-sectional survey was carried out at the Aga Khan University Hospital, Karachi, from July to August 2016, and comprised people aged above 18 years who had smoked more than 100 cigarettes in their lifetime. Convenience sampling method was used. A self-administered questionnaire was used to collect data. SPSS 22 was used for data analysis..

RESULTS: Of the 387 participants, 359(92.8%) were male. The overall mean age was 32.4±12.6 years. Moreover, 215(55.5%) respondents belonged ...


Fluid Choice During Perioperative Care In Children: A Survey Of Present‑Day Proposing Practice By Anesthesiologists In A Intertiary Care Hospital, Muhammad Faisal Khan, Khalid Maudood Siddiqui, Ali Asghar 2018 Aga Khan University

Fluid Choice During Perioperative Care In Children: A Survey Of Present‑Day Proposing Practice By Anesthesiologists In A Intertiary Care Hospital, Muhammad Faisal Khan, Khalid Maudood Siddiqui, Ali Asghar

Department of Anaesthesia

Background: Perioperative fluid therapy in pediatrics has always been a challenging avenue for anesthesiologists.

Inappropriate choice of fluid leads to multiple side effects, for instance iatrogenic hyponatremia. Our aim was to observe the

current practice of perioperative fluid therapy in pediatric population undergoing surgery in a tertiary care hospital.

Methods: After obtaining approval from the Departmental Research Review Committee, a survey form including questions

was emailed to anesthesiologists from January 2015 to June 2015. Individual responses were recorded and analyzed.

Results: Overall response was 100% from consultant and resident, and total 55 anesthesiologists were participated in

this survey. Majority of ...


Intermediate-Term Risk Of Stroke Following Cardiac Procedures In A Nationally Representative Data Set., Laura Stein, Alison Thaler, John W. Liang, Stanley Tuhrim, Amit S. Dhamoon, Mandip S. Dhamoon 2017 Icahn School of Medicine at Mount Sinai

Intermediate-Term Risk Of Stroke Following Cardiac Procedures In A Nationally Representative Data Set., Laura Stein, Alison Thaler, John W. Liang, Stanley Tuhrim, Amit S. Dhamoon, Mandip S. Dhamoon

Department of Neurology Faculty Papers

BACKGROUND: Studies on stroke risk following cardiac procedures addressed only perioperative and long-term risk following limited higher-risk procedures, were poorly generalizable, and often failed to stratify by stroke type. We calculated stroke risk in the intermediate risk period following cardiac procedures compared with common noncardiac surgeries and medical admissions.

METHODS AND RESULTS: The Nationwide Readmissions Database contains readmission data for 49% of US admissions in 2013. We compared age-adjusted stroke readmission rates up to 90 days postdischarge. We used Cox regression to calculate hazard ratios, up to 1 year, of stroke risk comparing transcatheter aortic valve replacement versus surgical aortic ...


Variations In Practice Of Apnea Test For Brain Death: Review From A Multihospital Health Care System, Jeffrey Stein, Marvi V. Rijhwani, Ernesto Brauer 2017 Department of Internal Medicine, Aurora Sinai Medical Center

Variations In Practice Of Apnea Test For Brain Death: Review From A Multihospital Health Care System, Jeffrey Stein, Marvi V. Rijhwani, Ernesto Brauer

Journal of Patient-Centered Research and Reviews

Background: Ventilation encompasses both active and passive processes. Air is initially drawn into the lungs due to a negative intrathoracic pressure created using the respiratory muscles, most importantly the diaphragm. In contrast, expiration is the passive relaxation of the respiratory muscles. Oxygenation occurs when oxygen diffuses across the alveolar-capillary membrane. The ability to oxygenate without ventilation has been termed apneic diffusion oxygenation or apneic oxygenation. We believe it is crucial to keep alveoli open in order for adequate oxygenation to occur. This can be achieved with the aid of positive end-expiratory pressure (PEEP). We investigated this concept in patients who ...


New Approaches To The Trauma Patient With Life-Threatening Bleeding With Notes.Pptx, Richard N. Bradley 2017 The University of Texas Health Science Center at Houston

New Approaches To The Trauma Patient With Life-Threatening Bleeding With Notes.Pptx, Richard N. Bradley

Richard N Bradley

Trauma patients are still bleeding to death — but improved response to hemorrhage through new approaches and technology will reduce morbidity and mortality from trauma. Dr. Bradley will review the lethal triad that leads to death in trauma patients, and how we can do a better job of treating these patients. The session will include an overview of the latest guidelines on bleeding control, use of ultrasound to detect hidden bleeding, out-of-hospital therapy including transfusion of blood products and hypotensive resuscitation, aortic balloon occlusion, thromboelastography, blood substitutes and antifibrinolytic therapy.


When Should A First-Aid Provider Stop Cpr: Answer From The American Red Cross Scientific Advisory Council, Stamatios Lerakis, Wendell Jones, Richard N. Bradley 2017 The University of Texas Health Science Center at Houston

When Should A First-Aid Provider Stop Cpr: Answer From The American Red Cross Scientific Advisory Council, Stamatios Lerakis, Wendell Jones, Richard N. Bradley

Richard N Bradley

No abstract provided.


Bronchial Carcinoid Presenting As Multiple Lung Abscesses, Zeeshan Waheed, Muhammad Irfan, Saulat Fatimi, Ruqaiya Shahid 2017 Aga Khan University

Bronchial Carcinoid Presenting As Multiple Lung Abscesses, Zeeshan Waheed, Muhammad Irfan, Saulat Fatimi, Ruqaiya Shahid

Saulat Fatimi

Bronchial carcinoid tumours is a rare group of pulmonary malignant neoplasm that is derived from neuroendocrine system. Bronchial carcinoid usually present with hilar masses, atelactasis, bronchiectasis, or post-obstructive pneumonia. This case describes a very unusual presentation of bronchial carcinoid tumour with multiple lung abscesses involving the whole lung. This report is of an adult lady who presented with multiple lung abscesses involving her whole of the right lung. She was found to have an endo-bronchial lesion in her right main bronchus which eventually turned out to be carcinoid tumour. She responded to resection and antibiotic therapy.


When Should A First-Aid Provider Stop Cpr: Answer From The American Red Cross Scientific Advisory Council, Stamatios Lerakis, Wendell Jones, Richard N. Bradley 2017 The University of Texas Health Science Center at Houston

When Should A First-Aid Provider Stop Cpr: Answer From The American Red Cross Scientific Advisory Council, Stamatios Lerakis, Wendell Jones, Richard N. Bradley

International Journal of First Aid Education

No abstract provided.


Differential Live Mycobacterium Tuberculosis- , M. Bovis Bcg-, Recombinant Esat6-, And Culture Filtrate Protein 10-Induced Immunity In Tuberculosis, Zahra Hasan, Bushra Jamil, Mussarat Ashraf, Muniba Islam, Maqboola Dojki, Muhammad Irfan, Rabia Hussain 2017 Aga Khan University

Differential Live Mycobacterium Tuberculosis- , M. Bovis Bcg-, Recombinant Esat6-, And Culture Filtrate Protein 10-Induced Immunity In Tuberculosis, Zahra Hasan, Bushra Jamil, Mussarat Ashraf, Muniba Islam, Maqboola Dojki, Muhammad Irfan, Rabia Hussain

Bushra Jamil

The high prevalence of Mycobacterium tuberculosis makes it imperative that immune responses to evaluate could be predictive of infection. We investigated live Mycobacterium- and recombinant antigen-induced cytokine and chemokine responses in patients with active tuberculosis (TB) compared with those of healthy controls from an area where TB is endemic (ECs). M. tuberculosis-, M. bovis BCG-, ESAT6-, and culture filtrate protein 10 (CFP10)-induced responses were determined in peripheral blood mononuclear cells from patients with pulmonary TB (n = 38) and ECs (n = 39). The levels of the cytokines gamma interferon (IFN-γ) and interleukin-10 (IL-10) and the chemokines CCL2, CCL3, and CXCL9 ...


Ccl2 Responses To Mycobacterium Tuberculosis Are Associated With Disease Severity In Tuberculosis, Zahra Hasan, Jacqueline M. Cliff, Hazel M. Dockrell, Bushra Jamil, Muhammad Irfan, Mussarat Ashraf, Rabia Hussain 2017 Aga Khan University

Ccl2 Responses To Mycobacterium Tuberculosis Are Associated With Disease Severity In Tuberculosis, Zahra Hasan, Jacqueline M. Cliff, Hazel M. Dockrell, Bushra Jamil, Muhammad Irfan, Mussarat Ashraf, Rabia Hussain

Bushra Jamil

Background Leucocyte activating chemokines such as CCL2, CCL3, and CXCL8 together with proinflammatory IFNγ, TNFα and downmodulatory IL10 play a central role in the restriction of M. tuberculosis infections, but is unclear whether these markers are indicative of tuberculosis disease severity. Methodology We investigated live M. tuberculosis- and M. bovis BCG- induced peripheral blood mononuclear cell responses in patients with tuberculosis (TB) and healthy endemic controls (ECs, n = 36). TB patients comprised pulmonary (PTB, n = 34) and extrapulmonary groups, subdivided into those with less severe localized extrapulmonary TB (L-ETB, n = 16) or severe disseminated ETB (D-ETB, n = 16). Secretion of ...


Implementation Of An Innovative Early Warning System: Evidenced-Based Strategies For Ensuring System-Wide Nursing Adoption, Shirley S. Paulson 2017 University of San Francisco

Implementation Of An Innovative Early Warning System: Evidenced-Based Strategies For Ensuring System-Wide Nursing Adoption, Shirley S. Paulson

Doctor of Nursing Practice (DNP) Projects

Early deterioration in adult medical-surgical patients is associated with increased intensive care unit and hospital mortality (Goldhill, 2001). Failure to recognize deterioration is a preventable patient safety and quality issue. To address this problem, since 2013, Kaiser Permanente Northern California (KP NCAL) has piloted Advance Alert Monitor (AAM) at two hospitals. This early warning system employs a set of predictive models developed by the KP NCAL Division of Research, which automatically predicts patient deterioration within the next 12 hours based on a complex algorithm of laboratory and clinical data points. Improvements in mortality and length of stay have been realized ...


Data On The Effect Of Sex On The Size, Cellular Content, And Neuronal Density Of The Developing Brain In Mice Exposed To Isoflurane And Carbon Monoxid, L Wang, A Wang, W W. Supplee, K Koffler, Y Cheng, Z M.N. Quezado, R J. Levy 2017 George Washington University

Data On The Effect Of Sex On The Size, Cellular Content, And Neuronal Density Of The Developing Brain In Mice Exposed To Isoflurane And Carbon Monoxid, L Wang, A Wang, W W. Supplee, K Koffler, Y Cheng, Z M.N. Quezado, R J. Levy

Anesthesiology and Critical Care Medicine Faculty Publications

The data presented here detail the changes in size, cellular content, and neuronal density of the developing brain over time with respect to sex in C57Bl/6 mice following neonatal exposure to isoflurane, carbon monoxide, or their combination. Specifically, brain weight- and brain volume-to-body weight ratios are presented, representative immunoblots of whole brain cell-specific protein content are depicted, and quantification of the number of neurons in the primary somatosensory cortex and CA3 region of the hippocampus are shown. Three discrete postnatal time points are represented: P7 (prior to exposure), P14 (one-week post exposure), and P42-56 (5–7 weeks post exposure ...


Call For Vigilance – Red Flags In Systemic Lupus Erythematous, Badar Hasan, Talal Asif, Maryam Hasan, Amr Edrees 2017 University of Missouri - Kansas City

Call For Vigilance – Red Flags In Systemic Lupus Erythematous, Badar Hasan, Talal Asif, Maryam Hasan, Amr Edrees

Marshall Journal of Medicine

Systemic Lupus Erythematous(SLE) is a multisystem autoimmune disease. It has been identified as the underlying cause for death for an average 1,034 deaths from 2000 and 2014. Our cases highlight two rare but life threatening complications of SLE; Catastrophic antiphospholipid syndrome (CAPS) and Diffuse alveolar hemorrhage (DAH) with mortality as high as 50-90%. Both cases presenting with respiratory symptoms, required meticulous monitoring in ICU and initially treated with broad spectrum antibiotics However, unlike pneumonia these patients required immunosuppressive and plasmapheresis leading to clinical improvement.


“Can’T You Just Say?” – Contrasting Communication Preferences Between Surrogate Decision-Makers And Physicians During Outcome Prognostication In Critically-Ill Traumatic Brain Injury Patients, Thomas Quinn, Jesse Moskowitz, Muhammad Khan, Lori Shutter, Robert J. Goldberg, Nananda Col, Kathleen M. Mazor, Susanne Muehlschlegel 2017 University of Massachusetts Medical School

“Can’T You Just Say?” – Contrasting Communication Preferences Between Surrogate Decision-Makers And Physicians During Outcome Prognostication In Critically-Ill Traumatic Brain Injury Patients, Thomas Quinn, Jesse Moskowitz, Muhammad Khan, Lori Shutter, Robert J. Goldberg, Nananda Col, Kathleen M. Mazor, Susanne Muehlschlegel

Kathleen M. Mazor

Objective: Surrogate decision-makers (“surrogates”) and physicians of incapacitated patients have different views of prognosis and how it should be communicated, but this has not been investigated in neurocritically-ill patients. We examined communication preferences in surrogates and physician practices during the outcome prognostication for critically-ill traumatic brain injury (ciTBI) patients in neuroICUs.

Design: Qualitative study using in-person semi-structured interviews with surrogates of ciTBI patients and physicians with expertise in TBI.

Setting: Two neuroICUs at two level-1 trauma centers (surrogates); seven academic U.S. medical centers (physicians).

Subjects: Sixteen surrogates for 15 ciTBI patients and 20 attending physicians from neurocritical care, neurosurgery ...


The Impact Of Septicemia Occurring During Hospitalization For Renal Transplantation Procedures On Outcomes In Adults In United States, Veerajalandhar Allareddy, Sankeerth Rampa, Alexandre T Rotta, Veerasathpurush Allareddy 2017 University of Iowa, Stead Family Children's Hospital

The Impact Of Septicemia Occurring During Hospitalization For Renal Transplantation Procedures On Outcomes In Adults In United States, Veerajalandhar Allareddy, Sankeerth Rampa, Alexandre T Rotta, Veerasathpurush Allareddy

Stead Family Department of Pediatrics Publications

INTRODUCTION: Immediate success rates of renal transplantation (RT) procedures are generally very high. National estimates of the impact of post-operative complications, specifically, septicemia occurring during hospitalization for RT's on outcomes is unclear. We sought, to examine the prevalence of septicemia in patients having renal transplantation procedures and to quantify the impact of septicemia on in-hospital mortality (IHM), length of stay (LOS), and hospital charges (HC).

MATERIALS AND METHODS: We performed a retrospective analysis of the Nationwide Inpatient Sample (NIS) for the years 2004 to 2010. All patients aged ≥18 years who underwent RT were selected. Association between occurrence of ...


Sepsis In Patients With Ventilator Associated Pneumonia Due To Methicillin- Resistant Staphylococcus Aureus: Incidence And Impact On Clinical Outcomes, Anupama Raghuram, Martin Gnoni, Timothy Lee Wiemken, Leslie Beavin, Julio A. Ramirez, Forest W. Arnold, Marcus J. Zervos, Daniel H. Kett, Thomas M. File Jr., Gary Stein, Kimbal D. Ford, Paula Peyrani, the IMPACT-HAP Investigators 2017 University of Louisville, Louisville, KY

Sepsis In Patients With Ventilator Associated Pneumonia Due To Methicillin- Resistant Staphylococcus Aureus: Incidence And Impact On Clinical Outcomes, Anupama Raghuram, Martin Gnoni, Timothy Lee Wiemken, Leslie Beavin, Julio A. Ramirez, Forest W. Arnold, Marcus J. Zervos, Daniel H. Kett, Thomas M. File Jr., Gary Stein, Kimbal D. Ford, Paula Peyrani, The Impact-Hap Investigators

The University of Louisville Journal of Respiratory Infections

Background: Sepsis is a clinical syndrome associated with organ dysfunction due to a dysregulated host response to infection. Methicillin-resistant Staphylococcus aureus (MRSA) Ventilator-associated pneumonia (VAP) is a serious infection frequently associated with sepsis. The objectives of this study were to define the incidence of sepsis and clinical failure in patients with MRSA VAP.

Methods: This was a secondary analysis of the Improving Medicine through Pathway Assessment of Critical Therapy in Hospital-Acquired Pneumonia (IMPACT-HAP) study database. VAP was defined according to CDC criteria. MRSA VAP was considered when MRSA was isolated from a tracheal aspirate or bronchoalveolar lavage. We used the ...


Predictors Of Cardiac Mortality In The Ccu: A Retrospective Study In A Tertiary Center, Summer Aldrugh, Aditya Vaze, Adedotun Anthony Ogunsua, Gloria Shan, Amrit V. Vinod, Modupeola Diyaolu, Craig Smith 2017 University of Massachusetts Medical School

Predictors Of Cardiac Mortality In The Ccu: A Retrospective Study In A Tertiary Center, Summer Aldrugh, Aditya Vaze, Adedotun Anthony Ogunsua, Gloria Shan, Amrit V. Vinod, Modupeola Diyaolu, Craig Smith

UMass Center for Clinical and Translational Science Research Retreat

Background: Although prior studies have linked troponin I (TnI) elevation, serum sodium (Na) fluctuation, and reduced ejection fraction (EF) with an increased mortality in the medical/surgical critical care units, this has not been validated in the CCU. We aim to identify clinical and laboratory factors to predict cardiac related length of survival (LOS) in the CCU.

Methods: We retrospectively analyzed 134 consecutive patients who were admitted to the CCU from December 2012 to March 2015, and who died during that admission. We used student T-test, correlation matrices, and Framingham risk factors adjusted multivariable logistic regression models to examine the ...


Principles Of Augmentative And Alternative Communication System Design In The Icu Setting, Miriam A. Goldberg, Leigh R. Hochberg, Dawn Carpenter, Johnny L. Isenberger, Stephen O. Heard, J. Matthias Walz 2017 University of Massachusetts Medical School

Principles Of Augmentative And Alternative Communication System Design In The Icu Setting, Miriam A. Goldberg, Leigh R. Hochberg, Dawn Carpenter, Johnny L. Isenberger, Stephen O. Heard, J. Matthias Walz

UMass Center for Clinical and Translational Science Research Retreat

Introduction: The ICU as a technology design setting requires specific and thoughtful awareness of patient-, caregiver-, and environment-related constraints. Designing an ICU-specific communication system involves an even deeper understanding of patient needs and desires, building on existing work exploring available technologies for use in this setting1,2. We report our initial experience from a pilot study with a novel communication device engineered specifically to allow mechanically ventilated ICU patients to communicate with caregivers3.

Methods: We used a validated survey for nurses about communication purposes to explore relevant beliefs, attitudes, and desires of nurses4. Existing technologies available for ...


Testing A Novel Manual Communication System For Mechanically Ventilated Icu Patients, Miriam A. Goldberg, Leigh R. Hochberg, Dawn Carpenter, Johnny L. Isenberger, Stephen O. Heard, J. Matthias Walz 2017 University of Massachusetts Medical School

Testing A Novel Manual Communication System For Mechanically Ventilated Icu Patients, Miriam A. Goldberg, Leigh R. Hochberg, Dawn Carpenter, Johnny L. Isenberger, Stephen O. Heard, J. Matthias Walz

UMass Center for Clinical and Translational Science Research Retreat

Introduction: Available communication methods for intubated patients in the ICU are insufficient to meet patient needs. Both ICU patients and their care providers report broadly unsuccessful communication attempts, resulting in less effective medical care and undue stress1,2. Use of existing methods - including letter boards, writing, and mouthing words - for mechanically ventilated (MV) patients has led to a consensus that new methods are required3. We report on the testing of a new system designed to address the communication needs of MV patients that is currently being tested in a low- to medium- acuity surgical ICU4.

Methods: We ...


Pediatric Critical Care Transfusion And Anemia Expertise Initiative, Stacey L. Valentine, Scot T. Bateman, Mela Bembea, Phillip Spinella, Allan Doctor, Nabil Hassan, Robert Parker, Marie Steiner, Marisa Tucci, Jacques Lacroix 2017 University of Massachusetts Medical School

Pediatric Critical Care Transfusion And Anemia Expertise Initiative, Stacey L. Valentine, Scot T. Bateman, Mela Bembea, Phillip Spinella, Allan Doctor, Nabil Hassan, Robert Parker, Marie Steiner, Marisa Tucci, Jacques Lacroix

UMass Center for Clinical and Translational Science Research Retreat

Introduction/Hypothesis: Despite evidence that a lower hemoglobin threshold is safe in hemodynamically stable children, studies have shown that transfusion thresholds in practice are higher, exposing these children to the morbidity and mortality associated with RBC transfusion. Therefore, there is increased need for evidence-based blood management strategies for clinicians caring for critically ill children.

Methods: The Pediatric Critical Care Transfusion and Anemia Expertise Initiative has brought together a group of 49 international experts in pediatric transfusion/critical care in collaboration with the Pediatric Critical Care Blood Research Network (BloodNet), and the Pediatric Acute Lung Injury and Sepsis Investigators (PALISI), to ...


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