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Factor Vii Deficiency And Pregnancy: A Case Report And Review Of Literature, Syed Mohammad Asad Zaidi, Rahat Qureshi, Salman Naseem Adil

Department of Obstetrics & Gynaecology

Factor VII deficiency is one of the 'rare inherited disorders of coagulation.' Few cases of Factor VII deficiency have been reported during pregnancy, a state which could potentially cause fatal haemorrhage. Here we report a case of a pregnant lady with a history of heavy menorrhagia and multiple first pregnancy failures. Delivery was carried out via Caesarean section due to non-reassuring foetal heart monitoring. Patient was treated with Fresh Frozen Plasma (FFPs) and Factor VII concentrates, however, the patient developed bleeding postoperatively. Literature indicates that whilst Factor VII levels rise during pregnancy in normal women, no increase is seen in …

Lead Extraction In The Contemporary Setting: The Lexicon Study. An Observational Retrospective Study Of Consecutive Laser Lead Extractions, Oussama Wazni, Md, Laurence M. Epstein, Md, Roger G. Carrillo, Md, Charles Love, Md, Stuart W. Adler, Md, David W. Riggio, Md, Shahzad S. Karim, Md, Jamil Bashir, Md, Arnold J. Greenspon, Md, John P. Dimarco, Md, Phd, Joshua M. Cooper, Md, John R. Onufer, Md, Kenneth A. Ellenbogen, Md, Stephen P. Kutalek, Md, Sherri Dentry-Mabry, Msn, Carolyn M. Ervin, Phd, Bruce L. Wilkoff, Md

Division of Cardiology Faculty Papers

Objectives: This study sought to examine the safety and efficacy of laser-assisted lead extraction and the indications, outcomes, and risk factors in a large series of consecutive patients.

Background: The need for lead extraction has been increasing in direct relationship to the increased numbers of cardiovascular implantable electronic devices.

Methods: Consecutive patients undergoing transvenous laser-assisted lead extraction at 13 centers were included.

Results: Between January 2004 and December 2007, 1,449 consecutive patients underwent laser-assisted lead extraction of 2,405 leads (20 to 270 procedures/site). Median implantation duration was 82.1 months (0.4 to 356.8 months). Leads were completely removed 96.5% of the …

Ct And Mri Features Following Uterine Fibroid Embolization, Sachit Verma Md, Carin F. Gonsalves Md, Oksana H. Baltarowich Md, Donald G. Mitchell Md, Anna Lev-Toaff Md, Diane Bergin Md

Department of Radiology Faculty Papers

Uterine artery embolization (UAE) is an effective treatment for symptomaticuterine fibroids. Magnetic resonance (MR) imaging is typically employed to evaluate the uterus following UAE for fibroid infarction, size, location change, persistent enhancement, changes in adenomyosis and uterine necrosis. Variable pattern of calcification on computed tomography (CT) can differentiate embolic particles and fibroid involution. CT following UAE may be requested because of acute pelvic pain or chest discomfort or pyrexia and/or for complications that may require treatment in acute phase. Visualization of gas in uterus and uterine vessels following UAE is an expected finding that should not be misinterpreted as a …

Factors Associated With Recurrent Nasal Polyps: A Tertiary Care Experience, Shabbir Akhtar, Mubasher Ikram, Iqbal Azam, Tariq Dahri

Section of Otolaryngology, Head & Neck Surgery

OBJECTIVE: To assess the factors associated with recurrence of nasal polyps in operated patients by endoscopic surgery.

METHODS: A retrospective study was conducted on 192 patients operated for nasal polyps in a hospital set-up between 2001 and 2007. The median follow-up period was 24 months (range 12 months to 60 months). Ten variables were analyzed to study their association with polyp recurrence namely; age, gender, history of purulent nasal discharge, facial pain, anosmia, post nasal dripping (PND), headache, nasal allergy, asthma and computed tomography (C.T) staging. Analysis of recurrences was accomplished using independent sample t-test, chi-square and Fishers exact test. …

Improving Schizophrenia Diagnosis Through Biomarkers: An Upcoming Prospect, Syed Mohammad Asad Zaidi, Abdul Latif Bikak, Rameez-Ul Hassan

Medical College Documents

No abstract provided.

Humoral Immunity In Tuberculin Skin Test Anergy And Its Role In High-Risk Persons Exposed To Active Tuberculosis, Liliana Encinales, Joaquin Zuñiga, Julio Granados-Montiel, Maria Yunis, Julio Granados, Ingrid Almeciga, Olga Clavijo, Carlos Awad, Vilma Collazos, María Inés Vargas-Rojas, José Luis Bañales-Mendez, Lilia Vazquez-Castañeda, Joel N Stern, Viviana Romero, Masha Fridkis-Hareli, Masha Frindkis-Hareli, Daniel Terreros, Marcelo Fernandez-Viña, Edmond J Yunis

Journal Articles

The most common test to identify latent tuberculosis is the tuberculin skin test that detects T cell responses of delayed type hypersensitivity type IV. Since it produces false negative reactions in active tuberculosis or in high-risk persons exposed to tuberculosis patients as shown in this report, we studied antibody profiles to explain the anergy of such responses in high-risk individuals without active infection. Our results showed that humoral immunity against tuberculin, regardless of the result of the tuberculin skin test is important for protection from active tuberculosis and that the presence of high antibody titers is a more reliable indicator …

Efficacy And Safety Of Procedural Sedation And Analgesia By Paediatric Intensivist In Paediatric Oncology Unit, Anwarul Haque, Zahra Fadoo

Department of Paediatrics and Child Health

Children with cancer especially acute leukaemia undergo multiple painful procedures like bone marrow biopsy (BM) and lumber puncture (LP) for intrathecal chemotherapy during their first year of treatment. The purpose of this study is to report safety and efficacy of Procedural Sedation and Analgesia (PSA) by paediatric intensivist for oncology procedures in controlled setting in paediatric oncology unit. During 20 months, 124 children received PSA for 499 procedures. 324 LP alone, 175 BM alone and 40 combined LP and BM were done. The most common diagnosis was acute leukaemia and lymphoma. All procedures were in compliance with American Society of …

Acute Necrotizing Encephalopathy Of Childhood: A Fatal Complication Of Swine Flu, Muhammad Rehan Khan, Prem Kumar Maheshwari, Syed Asad Ali, Anwarul Haque

Department of Paediatrics and Child Health

Acute necrotizing encephalopathy of childhood (ANEC) is a rare condition characterized by the presence of multifocal symmetrical brain lesions involving mainly thalami, brainstem, cerebellum and white matter. ANEC is a serious and life threatening complication of simple viral infections. We present a case of a young child who developed this condition with classical clinical and radiological findings consistent with ANEC, secondary to swine flu (H1N1). He needed ventilatory support and had profound motor and intellectual deficit on discharge. We report this case with aim of raising awareness about this fatal complication of swine flu which has become a global health …

Role Of Cardiac Magnetic Resonance Imaging In The Detection Of Cardiac Amyloidosis, Imran S. Syed Md, James F. Glockner Md, Dali Feng Md, Philip A. Araoz Md, Matthew W. Martinez, William D. Edwards Md, Morie A. Gertz Md, Angela Dispenzieri Md, Jae K. Oh Md, Diego Bellavia Md, Phd, A Jamil Tajik Md, Martha Grogan Md

Department of Medicine

No abstract provided.

Stroke Prevalence In A Poor Neighbourhood Of Sao Paulo, Brazil: Applying A Stroke Symptom Questionnaire, Paulo A. Lotufo

Paulo A Lotufo

Background Brazil has one of the highest stroke mortality rates in the world, these rates are most endemic in the poor. We verified the prevalence of stroke in a deprived neighbourhood in the city of Sa˜ o Paulo, Brazil and compared it with other surveys worldwide. Methods A questionnaire with six questions concerning limb and facial weakness, articulation, sensory disturbances, impaired vision, and past diagnosis of stroke was completed door-to-door in a well-defined area of 15 000 people. Questionnaires were considered positive when a participant answered two or more questions about stroke symptoms or the presence of stroke being confirmed …

Crystal Structure Of The Cystic Fibrosis Transmembrane Conductance Regulator Inhibitory Factor Cif Reveals Novel Active-Site Features Of An Epoxide Hydrolase Virulence Factor, Christopher D. Bahl, Christophe Morisseau, Jennifer M. Bomberger, Bruce A. Stanton, Bruce D. Hammock, George A. O'Toole, Dean R. Madden

Dartmouth Scholarship

Cystic fibrosis transmembrane conductance regulator (CFTR) inhibitory factor (Cif) is a virulence factor secreted by Pseudomonas aeruginosa that reduces the quantity of CFTR in the apical membrane of human airway epithelial cells. Initial sequence analysis suggested that Cif is an epoxide hydrolase (EH), but its sequence violates two strictly conserved EH motifs and also is compatible with other alpha/beta hydrolase family members with diverse substrate specificities. To investigate the mechanistic basis of Cif activity, we have determined its structure at 1.8-A resolution by X-ray crystallography. The catalytic triad consists of residues Asp129, His297, and Glu153, which are conserved across the …

Progressive Changes In Microglia And Macrophages In Spinal Cord And Peripheral Nerve In The Transgenic Rat Model Of Amyotrophic Lateral Sclerosis, David J. Graber, William F. Hickey, Brent T. Harris

Dartmouth Scholarship

The role of neuroinflammation in motor neuron death of amyotrophic lateral sclerosis (ALS) is unclear. The human mutant superoxide dismutase-1 (hmSOD1)-expressing murine transgenic model of ALS has provided some insight into changes in microglia activity during disease progression. The purpose of this study was to gain further knowledge by characterizing the immunological changes during disease progression in the spinal cord and peripheral nerve using the more recently developed hmSOD1 rat transgenic model of ALS. Using immunohistochemistry, the extent and intensity of tissue CD11b expression in spinal cord, lumbar nerve roots, and sciatic nerve were evaluated in hmSOD1 rats that were …

Appendicitis: When Simple Becomes Not So Simple, Elizabeth H. Ey, Jeffrey C. Pence

Department of Surgery Faculty Publications

No abstract provided.

An Open Letter To The Citizens Of Northwest Louisiana, Frederick J. White Iii

Frederick J White III

We, the undersigned physicians, want to publicly address our community regarding the health system debate in Congress. This is a historic time, and decisions made in these next days will impact you as citizens and as patients for generations. We recognize that the health system needs change. But the path that the Congress has taken is unwise and unnecessary. And although the American Medical Association has endorsed both the House and Senate bills, (1) we want to be clear—the AMA does not speak for us on these issues.

Aging-In-Place Research At Orcatech: Making Sense Of The Data, Tamara Hayes

Systems Science Friday Noon Seminar Series

The Oregon Center for Aging and Technology (ORCATECH) seeks to facilitate successful aging and reduce the cost of healthcare by establishing the evidence base for technologies supporting aging-in-place research and care. This is done through pilot studies evaluating the role of the technologies, as well as large longitudinal studies in which sensors are placed in the homes of community-dwelling elders to monitor daily patterns of activity, walking speeds, medication adherence, and other behaviors. These sensors collect continuous data that reflect normal variability in behaviors as well as trends that may indicate problematic changes in cognition or mobility. Because data are …

Analysis Of The Uk Recommendations On Obesity Based On A Proposed Implementation Framework, Amudha S. Poobalan, Lorna S. Aucott, Sheraz Ahmed, W. Cairns S. Smith

Department of Paediatrics and Child Health

Background: There is considerable expertise in the obesity field in identifying, appraising, and synthesising evidence to develop guidelines and recommendations for policy and practice. The recommendations, while based on evidence, are not formulated in a way that readily leads to implementation. This paper analyses the recent UK recommendations on obesity using a proposed implementation framework. Methods: Two bibliographic databases (Medline and Embase) and various health related and government websites were systematically searched for obesity recommendations published between 1996 and 2007. All the documents published on recommendations for either prevention or treatment of obesity in the UK were assessed. A proposed …

A Woman With Hiv Infection, Brain Abscesses, And Eosinophilia, Marcela Campo, Man K Phung, Rehan Ahmed, Paul Cantey, Henry Bishop, Tanvir K Bell, Carolyn Gardiner, Cesar A Arias

Journal Articles

No abstract provided.

Clinical Profile And Treatment Of Infantile Spasms Using Vigabatrin And Acth - A Developing Country Perspective, S. H. Ibrahim, Shamshad Gulab, Sidra Ishaque, Taimur Saleem

Department of Paediatrics and Child Health

Background: Infantile spasms represent a serious epileptic syndrome that occurs in the early infantile age. ACTH and Vigabatrin are actively investigated drugs in its treatment. This study describes the comparison of their efficacy in a large series of Patients with infantile spasms from Pakistan. Methods: All Patients with infantile spasms who presented to Aga Khan University Hospital, Karachi, Pakistan from January, 2006 to April, 2008 were included in this study. Inclusion criteria were clinical symptoms of infantile spasms, hypsarrythmia or modified hyparrythmia on electroencephalography, at least six months of follow-up period and receipt of any of the two drugs mentioned …

Anion-Sensitive Regions Of L-Type Cav1.2 Calcium Channels Expressed In Hek293 Cells., Norbert Babai, Nataly Kanevsky, Nathan Dascal, George J. Rozanski, Dhirendra P. Singh, Nigar Fatma, Wallace B. Thoreson

Journal Articles: Ophthalmology

L-type calcium currents (I(Ca)) are influenced by changes in extracellular chloride, but sites of anion effects have not been identified. Our experiments showed that CaV1.2 currents expressed in HEK293 cells are strongly inhibited by replacing extracellular chloride with gluconate or perchlorate. Variance-mean analysis of I(Ca) and cell-attached patch single channel recordings indicate that gluconate-induced inhibition is due to intracellular anion effects on Ca(2+) channel open probability, not conductance. Inhibition of CaV1.2 currents produced by replacing chloride with gluconate was reduced from approximately 75%-80% to approximately 50% by omitting beta subunits but unaffected by omitting alpha(2)delta subunits. Similarly, gluconate inhibition was …

Activation Of Tumor Cell Death Program By Targeting The Ubiquitin-Proteasome Pathway: Significance In Cancer Treatment And Prevention, Michael Joseph Frezza

Wayne State University Dissertations

ACTIVATION OF TUMOR CELL DEATH PROGRAM BY TARGETING THE UBIQUITIN-PROTEASOME PATHWAY: SIGNIFICANCE IN CANCER TREATMENT AND PREVENTION

by

MICHAEL FREZZA

August 2010

Advisor: Dr. Q. Ping Dou

Major: Cancer Biology

Degree: Doctor of Philosophy

The ubiquitin-proteasome pathway serves as a quality control mechanism to regulate the degradation of intracellular proteins involved in a wide array of cellular processes including tumorigeneis. Thus targeting key features of protein turnover responsible for the growth and proliferation of cancer have emerged as a favorable approach in cancer therapy. Both in vitro and in vivo experimental and clinical results have demonstrated the potential use of …

Introducing And Pilot-Testing The National Guidelines On Integrating The Management Of Stis/Rtis Into Reproductive Health Settings In Kenya, Wilson Liambila, Saiqa Mullick, Ian Askew, Nathalie Broutet, Bartilol Kigen, Cosmas Mutunga, Daniel Sande, Nimrod Garama, Benjamin Tsofa, Christine Awuor, Ibrahim Mohammed

Reproductive Health

This report evaluated a project in ten Kenyan health facilities. It examined the feasibility, acceptability and effect of introducing reproductive tract infection and sexually transmitted infection (RTI/STI) guidelines on the quality of care provided, and the incremental costs of integrating these services into existing reproductive health (RH) services; it also disseminated the results and lessons learnt within Kenya. Overall, the results showed that integration of activities to screen for and manage STIs/RTIs into RH services is feasible, acceptable to clients and providers, and effective in improving the range and quality of services offered to clients.

Increasing Institutional Delivery And Access To Emergency Obstetric Care Services In Rural Uttar Pradesh: Implications For Behavior Change Communication, Population Council

Reproductive Health

The Population Council conducted a formative in rural Uttar Pradesh (UP), India to determine the impact of the Janani Suraksha Yojana (JSY) scheme on the current status of institutional delivery in the region, to understand the facilitating factors and barriers in delivering in a health facility, and to identify programmatic and behavior change communication (BCC) initiatives that could accelerate the adoption of institutional delivery. JSY was launched as an intervention to address the barriers to institutional delivery, through the introduction of community-based women volunteers. The study shows that with the introduction of the JSY the rate of institutional delivery jumped …

Notch-1 Activates Nf-Кb Activity In Cervical Cancer And Estrogen Receptor Negative Breast Cancer, Yin Peng

Dissertations

Breast and cervical cancer are two common cancers that severely endanger women's health. The fatality rates of breast and cervical cancer are ranked first and fifth, respectively, in cancer related deaths in women worldwide. Continuous dedication to cancer research is urgently required to elucidate the cancer cell survival mechanism that is responsible for disease aggressiveness and poor prognosis.

Emerging data indicate that Notch-1 is aberrantly regulated in human cervical and ER- breast cancer and inhibiting Notch-1 sensitizes cancer cells to apoptosis. However, the mechanism by which Notch-1 promotes cell survival is not known. NF-КB is also deregulated in these two …

Radical Hysterectomy With Pelvic Lymphadenectomy: Indications, Technique, And Complications, Rachel A. Ware, John R. Van Nagell Jr.

Obstetrics and Gynecology Faculty Publications

Radical hysterectomy with pelvic lymphadenectomy remains the treatment of choice for women with Stages IA₂ and IB₁carcinoma of the cervix, and selected patients with Stage II endometrial cancer. Improvement in surgical techniqe, administration of prophylactic antibiotics, thromboemolic prophylaxis, and advances in critical care medicine have resulted in lower operative morbidity associated with this procedure. Major urinary tract complications such as ureteral injury or vesico-vaginal fistula are now extremely rare (< 1%). Five-year survival rates following this procedure vary according to a number of clinical and histologic variables, and may be as high as 90% in women without lymph node metastases.

Acute Musculoskeletal Sports Injury And Topical Nsaid, Amit M. Deokar, Shawn J. Smith, Hatim A. Omar

Pediatrics Faculty Publications

The objective of this chapter is to summarize the current standards of pain management in minor sports related musculoskeletal injuries. We also address the topical form of non-steroidal anti-inflammatory drug as an effective pain management option in an out-patient setting. Design: Quantitive systematic review of randomized controlled trials. Methods: The data was obtained through literature review of articles published in the last 10 years. In addition, FDA information on non-steroidal anti-inflammatory medications was also reviewed. The patient population studied in the articles included children and adults. Conclusion: Current standards of managing pain resulting from sports injuries involve a number of …

A Comprehensive Approach To Obesity, Hypertension, And Mental Health Evaluation, Stefan G. Kiessling, Kimberly K. Mcclanahan, Hatim A. Omar

Pediatrics Faculty Publications

The global epidemic of childhood and adolescent obesity in developing and developed countries has become a major public health concern. Given the relationship between obesity and hypertension as documented in several landmark studies, it is no surprise that, as the prevalence of obesity has increased in the pediatric population, rates of hypertension have also increased substantially. Hypertension is one of the most important risk factors for cardiovascular diseases and stroke; therefore, evaluation and initiation of appropriate treatment are extremely important in the pediatric population. Evaluation for secondary causes of hypertension, including renovascular, renoparenchymal, and endocrine disease, is the approach most …

Down Syndrome And Sexuality, Maria José Carvalho Sant'anna, Bruna Marques Bononi, André Chao Vasconcellos De Oliveira, Tadeu Silveira Renattini, Carla Franchi Pinto, Maria Lucia Passarelli, Veronica Coates, Hatim A. Omar

Pediatrics Faculty Publications

In recent years important gains and changes have been observed in the life of teenagers with Down syndrome (DS) with increased inclusion into society. This chapter will discuss adolescence and sexuality in teenagers with DS from a descriptive study of 50 patients with DS between the ages of 10 and 20 years. The mean age was 13.5 years, 50% females. 86% went to school with 62.2% in school for over six years. Of the patients that attended school, 60% went to special education school and only 10% read and wrote correctly. In evaluation of autonomy, 66% took shower, 78% performed …

Mental Health And Chronic Disease, Marlene B. Huff, Kimberly K. Mcclanahan, Hatim A. Omar

Pediatrics Faculty Publications

By 2015, worldwide, 1.2 billion children aged 5-14 years will have some kind of significant chronic disease. Although scientific evidence indicates that children with chronic illness have more mental health issues than their healthy peers, many controversies and gaps in the literature exist. It is imperative that an understanding of the effects of chronic illness upon the mental health status of children and adolescents be undertaken. This chapter uses a biopsychosocial perspective to investigate the connection between chronic illness and mental health. The intent of the chapter is to suggest ways that medical and mental health professionals can provide services …

Chronic Illness And Mental Health Issues, Marlene B. Huff, Kimberly K. Mcclanahan, Hatim A. Omar

Pediatrics Faculty Publications

By 2015, worldwide, 1.2 billion children aged 5-14 years will have some kind of significant chronic disease. Although scientific evidence indicates that children with chronic illness have more mental health issues than their healthy peers, many controversies and gaps in the literature exist. It is imperative that an understanding of the effects of chronic illness upon the mental health status of children and adolescent be undertaken. This article uses a biopsychosocial perspective to investigate the connection between chronic illness and mental health. The intent of the article is to suggest ways that medical and mental health professionals can provide services …

Educating Adolescents About Puberty: Are We Missing Something?, Hatim A. Omar

Pediatrics Faculty Publications

Adolescents undergo significant physical and cognitive changes during their pubertal development. These changes contribute to and impact their future development. Educating adolescents at an early age about their expected development decreases the possible anxiety associated with this period of life and also helps adolescents make better choices in regards to their sexuality. In order to assess the degree of education regarding pubertal development and sexuality, we conducted a survey of late adolescents (median age 19 years) and parents of adolescents. A total of 409 adolescents (237 females, 172 males) and 124 parents completed the survey. 14.4% of teens (36.6% of …