Digital Commons Network^™

Occurrence Of Pulmonary Arteritis With Lungworm Infections In Gray Seals From New England, 2013-2020, Jillian R. Broadhurst, Inga Sidor Dvm, Ms, Dacvp

Honors Theses and Capstones

Gray seals (Halichoerus grypus) are a common pinniped species in New England coastal waters. Parasitic infection is an important cause of mortality for this species, and lungworm species are frequently implicated in cases of respiratory infection, especially in pups and weanling seals. The most common of these is Otostrongylus circumlitus, a large nematode found in the bronchi and bronchioles of affected seals. The full life cycle is unknown but its presence in lungs and sometimes pulmonary arteries suggests that migration via arterial circulation occurs. Signs and microscopic findings are widely variable; our cases included dyspnea, bloody mucoid …

Purpuric Lesion In A Patient With Leprosy: Was It A Lucio’S Phenomenon Or An Epiphenomenon?, Sri Linuwih Menaldi, Melani Marissa, Inadia Putri Chairista, Henry W. Lim, Rahadi Rihatmadja

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Lucio’s phenomenon (LP) is a severe necrotizing cutaneous reaction that occurs in patients with Lucio’s leprosy. The exact pathomechanism is not fully understood, but typically abundant acid-fast bacilli in the walls of blood vessels point to direct perturbation of blood supply to the epidermis. We report a case of LP where epidermal necrosis occurred in the absence of vascular invasion by mycobacteria, raising the question whether this was an epiphenomenon or a true LP.

Case Illustration: A 34-year-old male was referred for an episodic swelling of his hands and feet that persisted for two years. There were …

Cutaneous Candidiasis Mimicking Inverse Psoriasis Lesion In A Type 2 Diabetes Mellitus Patient, Steven Philip Surya, Kardiana Purnama Dewi, Regina Regina

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: Type 2 diabetes mellitus (T2DM) condition could affect the skin. The disease is among the greatest risk factors of skin infection such as cutaneous candidiasis and is also associated with autoimmune skin diseases such as psoriasis, which lesion morphologies and predilection areas are quite similar. These similarities are a source of confusion to clinicians.

Case illustration: We present a 60-year-old female patient with uncontrolled T2DM and multiple erythematous plaques in the form of shiny lesions at the intertriginous area that developed 1 week prior to her hyperglycemic state. The lesions had recurred at the same site for …

Reversal Reaction With Nodules Clinical Manifestations That Initially Diagnosed As Erythema Nodosum Leprosum In Borderline Lepromatous Leprosy, Laila Tsaqilah, Pati Aji Achdiat, Hendra Gunawan

Journal of General - Procedural Dermatology and Venereology Indonesia

Background: The reversal leprosy reaction generally manifest as larger, swollen, red and shiny the pre-existing skin lesions which are accompanied with pain. This reaction can be manifest as infiltration and nodules which resembles the features of erythema nodosum leprosum (ENL) leprosy reaction.

Case Illustration: We present a case of 26-year-old woman with erythematous nodules on almost all the body since two weeks ago. She had pre-existing erythema plaque on the right elbow became more erythematous and arouse with partially felt pain, fever, and malaise. Nodule lesions in BL leprosy with reaction need to be distinguished between ENL and …

Decomposing Differences In Coronavirus Disease 2019-Related Case-Fatality Rates Across Seventeen Nations, Ashley Wendell Kranjac, Dinko Kranjac

Sociology Faculty Articles and Research

As of 1 November 2020, estimated case-fatality rates associated with coronavirus disease 2019 are not uniformly patterned across the world and differ substantially in magnitude. Given the global spatial heterogeneity in case-fatality rates, we applied the Blinder-Oaxaca regression decomposition technique to identify how putative sociodemographic, structural, and environmental sources influence variation in case-fatality rates. We show that compositional and associational differences in country-level risk factors explain a substantial proportion of the coronavirus disease 2019-related case-fatality rate gap across nations. Asian countries fair better vis-à-vis case-fatality rate differences mainly due to variation in returns to sociodemographic, structural, and environmental sources among …

Predictors Of Mortality In Hospitalized Patients With Influenza: A Five-Year Experience From A Tertiary Care Centre In Pakistan, Iffat Khanum, Amber Sabeen Ahmed, Safia Awan, Sabiha Banu, Bushra Jamil

Department of Medicine

Influenza outbreaks are associated with significant morbidity. Our aim was to determine the factors associated with increased mortality in hospitalized patients admitted with diagnosis of influenza, at a tertiary care center in Pakistan. This study included all adult patients with an influenza infection, confirmed by realtime reverse-transcriptase polymerase-chain-reaction (RT-PCR) at Aga Khan University Hospital Pakistan. In our study, 112 patients with laboratory-confirmed influenza virus infection were admittedat our hospital from the 1st of January 2013 to the 31st of December 2018. Eighty-nine patients (79.46%) were managed in ward or special care units and 23 patients (20.5%) received treatment in intensive …

An Australian Conundrum: Genomic Technology, Data, And The Covidsafe App, David Morrison, Patrick T. Quirk

Pace International Law Review

This paper examines the difficulties that have arisen in Australia in the use of its contact-tracing app. We examine the privacy implications around the use of the app, the wider economic imperative, and the balancing of those concerns against the health threat of the COVID-19 pandemic. We posit that default options are superior in times of emergency and rather than begging for the adoption of lifesaving technology, we suggest that the evidence gathered by behavioral economists provides an apposite and powerful alternative worthy of consideration.

Efficacy Of Fecal Microbiota Transplant In Conjunction With Oral Vancomycin For The Treatment Of Recurrent Clostridium Difficile, Abigayle Afflick, Jackson Laboue

Physician Assistant Capstones, 2020-current

Objective: To determine the effectiveness of fecal microbiota transplant in addition to traditional therapy of oral vancomycin for the treatment of recurrent Clostridium difficile infections. Methods: Google Scholar was searched to identify randomized control trials using the terms vancomycin, fecal transplant, c. diff, and recurrent. Results: Three studies met inclusion criteria and two found a statistically significant benefit to the addition of fecal microbiota transplant to vancomycin therapy. Cammarota, et al. reported a 90% cure rate when administering fecal microbiota transplant in addition to vancomycin as opposed to a 26% cure rate with vancomycin alone with a P value …

Gender Variations In Neonatal And Early Infant Mortality In India And Pakistan: A Secondary Analysis From The Global Network Maternal Newborn Health Registry, Zubair H. Aghai, Shivaprasad S. Goudar, Archana Patel, Sarah Saleem, Sangappa M. Dhaded, Avinash Kavi, Parth Lalakia, Farnaz Naqvi, Patricia L. Hibberd, Elizabeth M. Mcclure

Community Health Sciences

Background: To determine the gender differences in neonatal mortality, stillbirths, and perinatal mortality in south Asia using the Global Network data from the Maternal Newborn Health Registry.
Methods: This study is a secondary analysis of prospectively collected data from the three south Asian sites of the Global Network. The maternal and neonatal demographic, clinical characteristics, rates of stillbirths, early neonatal mortality (1-7 days), late neonatal mortality (8-28 days), mortality between 29-42 days and the number of infants hospitalized after birth were compared between the male and female infants.
Results: Between 2010 and 2018, 297,509 births [154,790 males (52.03%) and 142,719 …

Feasibility Of Continuous Fever Monitoring Using Wearable Devices, Benjamin L. Smarr, Kirstin Aschbacher, Sarah M. Fisher, Anoushka Chowdhary, Stephan Dilchert, Karena Puldon, Adam Rao, Frederick M. Hecht, Ashley E. Mason

Publications and Research

Elevated core temperature constitutes an important biomarker for COVID-19 infection; however, no standards currently exist to monitor fever using wearable peripheral temperature sensors. Evidence that sensors could be used to develop fever monitoring capabilities would enable large-scale health-monitoring research and provide high-temporal resolution data on fever responses across heterogeneous populations. We launched the TemPredict study in March of 2020 to capture continuous physiological data, including peripheral temperature, from a commercially available wearable device during the novel coronavirus pandemic. We coupled these data with symptom reports and COVID-19 diagnosis data. Here we report findings from the first 50 subjects who reported …

Analyses Of The 2020 Nobel Prize In Physiology Or Medicine: Taking The Hepatitis C Virus From Mystery Killer To Preventable And Treatable Disease, Neyda V. Gilman

Library Scholarship

Harvey J. Alter, Michael Houghton, and Charles M. Rice share the 2020 Nobel in Physiology or Medicine for their contributions to the identification, treatment, and eventual elimination of the hepatitis C virus (HCV). The then novel molecular techniques they used have laid the groundwork for future work on HCV and other viruses. This article will give a brief overview of the hepatitis disease and the work of this year's laureates. It will also take a bibliometric look at the scientist’s research and add to the discussions about the way modern science is done and the limitations of prestigious science awards …

The Role Of Anti-Inflammatory Cytokine Interleukin-10 (Il-10) In Tauopathies, Lea L. Weston

Biomedical Sciences ETDs

Tauopathies are neurodegenerative diseases, including Alzheimer’s disease, that are associated with pathological accumulation of the microtubule associated protein tau (MAPT, or tau) (Lee et al., 2001). Abnormal hyperphosphorylated tau (pTau) strongly correlate with cognitive impairment (Nelson et al., 2012). Neuroinflammation is also associated with tauopathies (Gerhard et al., 2006b; Edison et al., 2008) and is implicated in driving tau pathology (Yoshiyama et al., 2007, Maphis et al., 2015b). Therefore, it is compelling to understand the role of anti-inflammatory cytokines in limiting neuroinflammation and tau pathology. Interleukin-10 (IL-10) is a well-established anti-inflammatory cytokine with roles in limiting inflammation in the central …

Trypanosoma Cruzi Modulates Piwi-Interacting Rna Expression In Primary Human Cardiac Myocytes During The Early Phase Of Infection, Kayla J. Rayford, Ayorinde Cooley, Ashutosh Arun, Girish Rachakonda, Yulia Kleschenko, Fernando Villalta, Siddharth Pratap, Maria F. Lima, Pius N. Nde

Publications and Research

Trypanosoma cruzi dysregulates the gene expression profile of primary human cardiomyocytes (PHCM) during the early phase of infection through a mechanism which remains to be elucidated. The role that small non-coding RNAs (sncRNA) including PIWI-interacting RNA (piRNA) play in regulating gene expression during the early phase of infection is unknown. To understand how T. cruzi dysregulate gene expression in the heart, we challenged PHCM with T. cruzi trypomastigotes and analyzed sncRNA, especially piRNA, by RNA-sequencing. The parasite induced significant differential expression of host piRNAs, which can target and regulate the genes which are important during the early infection phase. An …

Knowledge, Attitudes, And Practices Against The Growing Threat Of Covid-19 Among Medical Students Of Pakistan, Khola Noreen, Zil-E Rubab, Muhammad Umar, Rehana Rehman, Mukhtiar Baig, Fizzah Baig

Department of Biological & Biomedical Sciences

Background: On account of the COVID-19 pandemic, many changes have been implicated in university medical students. We are cognizant that pandemic can be controlled with dedicated contributions from all involved in the healthcare profession. Therefore, it is important to know the pandemic and application of knowledge by the medical students to formulate a further line of management in Pakistan.
Objective: We aimed toinvestigate the knowledge, attitudes, and practices (KAP) regarding COVID-19 and its impact on medical students of Pakistan.
Methods: A cross-sectional survey was conducted in June 2020 by a validated self-administered questionnaire. The survey instrument was tailored from a …

Customized Blister Packaging For Patients Living With Hiv: Assessment Of Patient Attitudes And Satisfaction, Holly Groteluschen, Harlan Sayles, Rebecca Osborn, Joshua P. Havens, Sara Bares, Jasmine R. Marcelin

Graduate Medical Education Research Journal

Adherence to antiretroviral medication results in reduced HIV transmission and improved health outcomes, yet challenges with medication adherence remain. A Collaborative Care Program was developed with a community pharmacy integrating a multi-dose adherence packaging service. We surveyed program participants to assess their satisfaction with this program and found an overall positive sentiment toward the program, that the program helped with reducing missed doses, and all patients would recommend the program to others.

An Overview Of The Effect Of Bioaerosol Size In Coronavirus Disease 2019 Transmission, Marcelo I. Guzman

Chemistry Faculty Publications

The fast spread of coronavirus disease 2019 (COVID-19) constitutes a worldwide challenge to the public health, educational and trade systems, affecting the overall well-being of human societies. The high transmission and mortality rates of this virus, and the unavailability of a vaccine or treatment, resulted in the decision of multiple governments to enact measures of social distancing. Such measures can reduce the exposure to bioaerosols, which can result in pathogen deposition in the respiratory tract of the host causing disease and an immunological response. Thus, it is important to consider the validity of the proposal for keeping a distance of …

Understanding Of Aerosol Transmission Of Covid 19 In Indoor Environments, Adama Barro, Cathal O'Toole, Jacob S. Lopez, Matthew Quinones, Sherene Moore

Publications and Research

Our reason for discussing severe acute respiratory syndrome corona virus 2 (SARS-CoV-2) or 2019 novel corona virus (Covid-19), is to understand its aerosol transmission characteristics in indoor spaces and to mitigate further spread of this disease by designing a new HVAC system. The problem that we are tackling is the spread of covid-19 droplets through aerosol transmission by looking at potential engineering solutions to the existing HVAC systems. The purpose is to eradicate the spread of the COVID-19 by testing indoor spaces in an effort to understand the effectiveness of ventilation controls. We believe that scientists and engineers have not …

Impact Of A Pharmacist-Driven Methicillin-Resistant Staphylococcus Aureus Nasal Swab Protocol On The De-Escalation Of Empiric Vancomycin In The Setting Of Community Acquired Pneumonia, Grether Hernandez Gama, Winifred Pardo, Wilbert Fuerte, James Adefisoye

All Publications

No abstract provided.

Prevention Of Pediatric Mortality Associated With Malaria: An Exhaustive Literature Review, Taylor Mosley

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Malaria, a disease that is preventable yet frequently fatal, disproportionately affects pediatric African populations at a rate that results in a child under the age of 5 dying every two minutes. Since 1955, the World Health Organization has contributed to a significant reduction in the morbidity and mortality of malaria; however, progress has stalled in recent years. In some countries, particularly those in sub-Saharan Africa, cases have increased since 2015. This literature review seeks to identify factors associated with this incline, as well as what interventions can have the greatest impact to prevent pediatric mortality in areas with the largest …

Rigorous Hand Hygiene Practices Among Health Care Workers Reduce Hospital-Associated Infections During The Covid-19 Pandemic, Rozina Roshan, Anam Shahil Feroz, Zohra Rafique, Nazleen Virani

Section of Internal Medicine

The experiences of these recent months have left us with as many new questions as they have given us new solutions. The main question that infection prevention and control department is having these days is "Why have hospital-associated infections (HAIs) reduced during COVID-19 pandemic?" What is the one unique strategy that has brought decline in increasing HAIs? Would it be appropriate to say that rigorous hand hygiene practices among health care workers (HCWs) have reduced HAIs in a tertiary care hospital of Pakistan? This commentary is written to understand the effect of rigorous hand hygiene among HCWs on number of …

The Link Between Heart Disease In Low Socioeconomic Communities In America, Khristopher Chea

Nursing | Senior Theses

As a future medical professional in the healthcare field, we continue to see patients admitted for cardiovascular issues. Cardiovascular diseases (CVDs) remain the leading cause of mortality among adults living in the U.S. despite advances in treatment throughout the past century. A number of risk factors such as hypertension, obesity, smoking, and physical inactivity contribute to the significant rise of cardiovascular disease. Research data suggests that there is correlation between cardiovascular disease, low socioeconomic status, and diet. According to the American Phycological Association socioeconomic status is measured by income, educational status, and occupation, and has been shown to be closely …

A Collaborative Approach To Reduce The Spread Of Covid-19 In A Large Urban Hospital In South Florida, David Schneider, Roberto L. Roman Laporte

Nursing & Health Sciences Research Journal

The novel Coronavirus has proven challenging for many healthcare organizations. Hospitals are pressed to secure sufficient personal protective equipment to ensure the safety of their healthcare personnel and various strategies have been implemented to stop the spread of the virus. There are still many unknowns about COVID-19 and hospitals are rapidly adapting to new information while trying to maintain the safety and wellbeing of healthcare personnel. Baptist Hospital of Miami developed a collaborative data driven plan to monitor, disseminate vital information, and implement various strategies to protect employees and patients during the pandemic.

A Drive-Thru Anticoagulation Testing Clinic During Covid-19 Pandemic, Tina Hyman, Nohemi Sadule Rios, Robert P. Ramirez

Nursing & Health Sciences Research Journal

As COVID-19 started to spread rapidly in their community, a team of nurses at South Miami Hospital initiated a drive-thru anticoagulation testing process to provide safe access to care for patients on anticoagulation therapy, requiring Internationalized Ratio (INR) testing. This article describes the implementation of a drive-thru anticoagulation testing process and implications for best practices during a pandemic crisis.

Great Expectations: Phosph(On)Ate Prodrugs In Drug Design—Opportunities And Limitations, Victoria Yan

Dissertations and Theses (Open Access)

Phosphate and phosphonates are chemical moieties with historical precedence in anticancer and antiviral nucleotide analogues. Synchronous to modern efforts identifying novel therapeutic targets in cancer, such chemical moieties are being investigated in the design of novel inhibitors with antineoplastic potential. A central challenge to the delivery of phosph(on)ate-containing drugs is their anionic character at physiological pH, which portends poor membrane permeability. This limitation has been successfully overcome through the use of prodrugs. When attached to the phosph(on)ate moiety, prodrugs mask the negative charge and easily enable cell permeability. Upon cellular entry, the promoieties are enzymatically or environmentally cleaved to unveil …

Utilization Of Blood Culture In South Asia For The Diagnosis And Treatment Of Febrile Illness, Caitlin Hemlock, Stephen P. Luby, Shampa Saha, Farah Naz Qamar, Jason R. Andrews, Samir K. Saha, Dipesh Tamrakar, Kashmira Date, Ashley T. Longley, Denise O. Garrett, Isaac I. Bogoch

Department of Paediatrics and Child Health

Background: Blood culture is the current standard for diagnosing bacteremic illnesses, yet it is not clear how physicians in many low- and middle-income countries utilize blood culture for diagnostic purposes and to inform treatment decisions.
Methods: We screened suspected enteric fever cases from 6 hospitals in Bangladesh, Nepal, and Pakistan, and enrolled patients if blood culture was prescribed by the treating physician. We used generalized additive regression models to analyze the probability of receiving blood culture by age, and linear regression models to analyze changes by month to the proportion of febrile cases prescribed a blood culture compared with the …

Illness Severity And Outcomes Among Enteric Fever Cases From Bangladesh, Nepal, And Pakistan: Data From The Surveillance For Enteric Fever In Asia Project, 2016-2019, Ashley T. Longley, Caitlin Hemlock, Kashmira Date, Stephen P. Luby, Jason R. Andrews, Samir K. Saha, Isaac I. Bogoch, Mohammad Tahir Yousafzai, Denise O. Garrett, Farah Naz Qamar

Department of Paediatrics and Child Health

Background: Enteric fever can lead to prolonged hospital stays, clinical complications, and death. The Surveillance for Enteric Fever in Asia Project (SEAP), a prospective surveillance study, characterized the burden of enteric fever, including illness severity, in selected settings in Bangladesh, Nepal, and Pakistan. We assessed disease severity, including hospitalization, clinical complications, and death among SEAP participants.
Methods: We analyzed clinical and laboratory data from blood culture-confirmed enteric fever cases enrolled in SEAP hospitals and associated network laboratories from September 2016 to September 2019. We used hospitalization and duration of hospital stay as proxies for severity. We conducted a follow-up interview …

Diagnostic Value Of Clinical Features To Distinguish Enteric Fever From Other Febrile Illnesses In Bangladesh, Nepal, And Pakistan, Kristen Aiemjoy, Dipesh Tamrakar, Shampa Saha, Shiva R. Naga, Alexander T. Yu, Ashley Longley, Kashmira Date, Caitlin Hemlock, Farah Naz Qamar, Samir K. Saha

Department of Paediatrics and Child Health

Background: Enteric fever, a bacterial infection caused by Salmonella enterica serotypes Typhi and Paratyphi A, frequently presents as a nonlocalizing febrile illness that is difficult to distinguish from other infectious causes of fever. Blood culture is not widely available in endemic settings and, even when available, results can take up to 5 days. We evaluated the diagnostic performance of clinical features, including both reported symptoms and clinical signs, of enteric fever among patients participating in the Surveillance for Enteric Fever in Asia Project (SEAP), a 3-year surveillance study in Bangladesh, Nepal, and Pakistan.
Methods: Outpatients presenting with ≥3 consecutive days …

Antibiotic Use Prior To Hospital Presentation Among Individuals With Suspected Enteric Fever In Nepal, Bangladesh, And Pakistan, Krista Vaidya, Kristen Aiemjoy, Farah Naz Qamar, Samir K. Saha, Dipesh Tamrakar, Shiva R. Naga, Shampa Saha, Caitlin Hemlock, Ashley T. Longley, Kashmira Date

Department of Paediatrics and Child Health

Background: Antibiotic use prior to seeking care at a hospital may reduce the sensitivity of blood culture for enteric fever, with implications for both clinical care and surveillance. The Surveillance for Enteric Fever in Asia Project (SEAP) is a prospective study of enteric fever incidence in Nepal, Bangladesh, and Pakistan. Nested within SEAP, we evaluated the accuracy of self-reported antibiotic use and investigated the association between antibiotic use and blood culture positivity.
Methods: Between November 2016 and April 2019, we collected urine samples among a subset of SEAP participants to test for antibiotic use prior to the hospital visit using …

Healthcare Utilization Patterns For Acute Febrile Illness In Bangladesh, Nepal, And Pakistan: Results From The Surveillance For Enteric Fever In Asia Project, Jason R. Andrews, Krista Vaidya, Shampa Saha, Mohammad Tahir Yousafzai, Caitlin Hemlock, Ashley Longley, Kristen Aiemjoy, Alexander T. Yu, Isaac I. Bogoch, Farah Naz Qamar

Department of Paediatrics and Child Health

Background: Characterizing healthcare-seeking patterns for acute febrile illness is critical for generating population-based enteric fever incidence estimates from facility-based surveillance data.
Methods: We used a hybrid model in the Surveillance for Enteric Fever in Asia Project (SEAP) to assess incidence of enteric fever at 6 study hospitals in 3 countries. We recruited individuals presenting to the hospitals and obtained blood cultures to evaluate for enteric fever. For this analysis, we undertook cluster random household surveys in Dhaka, Bangladesh (2 sites); Karachi, Pakistan; Kathmandu, Nepal; and Kavrepalanchok, Nepal between January 2017 and February 2019, to ascertain care-seeking behavior for individuals with …

Burden Of Culture Confirmed Enteric Fever Cases In Karachi, Pakistan: Surveillance For Enteric Fever In Asia Project (Seap), 2016-2019, Mohammad Tahir Yousafzai, Seema Irfan, Rozina Thobani, Abdul Momin Kazi, Aneeta Hotwani, Ashraf M. Memon, Khalid Iqbal, Saqib Hamid Qazi, Nasir S. Saddal, Najeeb Rehman, Irum Fatima Dehraj, Mohammed J. Hunzai, Junaid Mehmood, Farah Naz Qamar

Department of Paediatrics and Child Health

Background: The Surveillance for Enteric Fever in Asia Project (SEAP) is a multicenter, multicountry study conducted in Pakistan, Nepal, and Bangladesh. The objectives of the study were to characterize disease incidence among patients with enteric fever. We report the burden of enteric fever at selected sites of Karachi, Pakistan.
Methods: During September 2016 to September 2019, prospective surveillance was conducted at inpatient, outpatient, surgical departments, and laboratory networks of Aga Khan University Hospital, Kharadar General Hospital, and surgery units of National Institute of Child Health and Jinnah Postgraduate Medical Centre. Socio-demographic, clinical, and laboratory data were obtained from all suspected …