Digital Commons Network^™

Referral Mechanism Improves Uptake Of Art Services For Hiv+ Fp Clients, Population Council

Reproductive Health

An operations research intervention by the Population Council in Kenya aimed to design a referral framework for linking HIV‐positive family planning (FP) clients to treatment and care in selected health facilities. The project also assessed the acceptability and effectiveness in increasing the number of eligible HIV‐positive FP clients receiving HIV care and treatment services. This summary details the effort to improve the linkage between FP services and comprehensive care centers that led to a dramatic increase in the proportions of HIV-positive clients in FP clinics who go on to receive HIV/AIDS treatment and care services at the same facility. Recommendations …

Efficacy And Safety Of Mitomycin C As An Agent To Treat Corneal Scarring In Horses Using An In Vitro Model, Dylan G. Buss, Ajay Sharma, Elizabeth A. Giuliano, Rajiv R. Mohan

Pharmacy Faculty Articles and Research

Objective—Mitomycin C (MMC) is used clinically to treat corneal scarring in human patients. We investigated the safety and efficacy of MMC to treat corneal scarring in horses by examining its effects at the early and late stages of disease using an in-vitro model.

Procedure—An in-vitro model of equine corneal fibroblast (ECF) developed was used. The equine corneal fibroblast or myofibroblast cultures were produced by growing primary ECF in the presence or absence of transforming growth factor beta-1 (TGFβ1) under serum-free conditions. The MMC dose for the equine cornea was defined with dose-dependent trypan blue exclusion and MTT [(3-4,5-Dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] assays …

"Transduction Efficiency Of Aav 2/6, 2/8 And 2/9 Vectors For Delivering Genes In Human Corneal Fibroblasts ", Ajay Sharma, Arkasubhra Ghosh, Eric T. Hansen, Jason M. Newman, Rajiv R. Mohan

Pharmacy Faculty Articles and Research

In the present study, cellular tropism and relative transduction efficiency of AAV2/6, AAV2/8 and AAV2/9 vectors have been tested for the cornea using primary cultures of human corneal fibroblasts. The AAV6, AAV8 and AAV9 serotypes having AAV2 ITR plasmid encoding for alkaline phosphatase (AP) gene were generated by transfecting HEK293 cell line with pHelper, pARAP4 and pRep/Cap plasmids. Primary cultures of human corneal fibroblasts were exposed to AAV infectious particles at two different doses (1×105 and 2×105 MOI). Cytochemistry and enzyme assays were used to measure delivered transgene expression in samples collected at 4 and 30 hours after AAV infection …

Fdg-Pet Staging And Importance Of Lymph Node Suv In Head And Neck Cancer., Gregory J Kubicek, Collin Champ, Shannon Fogh, Fen Wang, Eashwer Reddy, Charles Intenzo, Reginald W Dusing, Mitchell Machtay

Department of Radiation Oncology Faculty Papers

OBJECTIVES: The role of positron emission tomography (PET) with fluoro-deoxy-glucose (FDG) in the staging of head and neck cancer (HNC) is unclear. The NCCN guidelines do not recommend FDG-PET as a part of standard workup. The purpose of this report is to examine the role of FDG-PET imaging in altering management and providing prognostic information for HNC.

METHODS: Retrospective review of HNC patients who had a staging FDG-PET scan performed at either Thomas Jefferson University or University of Kansas Medical Center between the years 2001 and 2007. A total of 212 PET scans were performed in patients who went on …

The Female Athlete, Dilip R. Patel, Donald E. Greydanus, Hatim A. Omar

Pediatrics Faculty Publications

The female athlete has today became an accepted part of sports in elementary school, junior high, senior high, and college. This chapter covers various aspects of the prepubertal and pubertal female athlete. An historical perspective will be presented and selected comments provided on psychological and physiologic aspects of the female athlete. Concepts of adolescent gynecology are reviewed, including breast concerns and menstrual dilemmas in relation to sports activity. Exercise during pregnancy is also considered. Iron deficiency anemia and stress urinary incontinence

Labrad : Vol 35, Issue 1 - January - February 2010, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• Assessment of Osteoporosis Risk by NTx- A Biochemical Marker
• Antibodies Against Cyclic Citrullinated Peptides (Anti-CCP) Assay in Rheumatoid Arthritis
• A Disintegrin and Metallopeptidase with Thrombospondin Type 1 Motif, 13 (ADAMTS-13)
• Soluble Transferrin Receptor (sTfR)
• Diagnosis of Cryptococcal Meningitis
• Infections in Thalassaemia
• CDX-2, A Reliable Diagnostic Marker for Carcinomas of Colorectal Origin
• Radiopaque Metallic Marker Insertion in Breast Cancers Prior to Neoadjuvant/Preoperative Chemotherapy
• Meeting Reports: 10TH International Radiological Conference 2009
• Continuing Medical Education Seminar Organised by Clinical Laboratory at AKUH

Solar Simulated Radiation Induced Cell Death Depends On Spectral Distribution And Irradiance But Not Output Delivery, Alanna Maguire, Fiona Lyng, James Walsh

Articles

Photo biological investigations are dependent on calibration and characterisation to determine the relevance of an artificial irradiator to the study at hand. The importance of this has been voiced in the literature. However, the importance of output delivery is relatively unknown. The biological relevance of a high energy, rapidly pulsing solar simulator was investigated using the clonogenic assay and was found to be reciprocity law compliant despite an exaggerated UV irradiance in excess of 1600 Wm-2 delivered per pulse. In fact, it was found to be the least cytotoxic irradiator compared to a second solar simulator and a UVB fluorescent …

Application Of Magnetic Resonance Imaging To Understanding The Pathogenesis Of The X-Linked Leukodystrophy Pelizaeus-Merzbacher Disease, Jeremy Jerome Laukka

Wayne State University Dissertations

Myelin is a multilamellar membrane structure surrounding axons in both the CNS and PNS that facilitates nerve conduction. In the CNS, myelin is synthesized by oligodendrocytes, while in the PNS, myelin is synthesized by Schwann cells. In the CNS, Proteolipid protein 1 (PLP1), an integral membrane protein, is the major protein component of myelin, constituting ~50% of myelin protein. Mutations of the PLP1 gene in man cause a spectrum of neurological disease, ranging from the severe Pelizaeus-Merzbacher disease (PMD), that typically begins during infancy with nystagmus, seizures and hypotonia and evolves into spastic quadriparesis, cognitive impairment and ataxia, to ¡¥pure¡¦ …

Independent Living Outcomes Evaluation Project, Craig J. Padgett

All Graduate Theses, Dissertations, and Other Capstone Projects

This project developed specific examples of skills and resources for three example categories of ILST and developed recommendations for enhancing the creation of goals. It was important to develop indicators into a tiered structure for reinforcing those skills and resources into knowledge through an added educational component. Methodology was developed and necessary instrumentation and processes were designed for implementation. And, an informed consent was designed for any organization providing Independent Living Skills Training (ILST).

Acute Subarachnoid Hemorrhage And Cardiac Abnormalities: Takotsubo Cardiomyopathy Or Neurogenic Stunned Myocardium? A Case Report, C Franco, B Khaled, L Afonso, M Raufi

Wayne State University Associated BioMed Central Scholarship

Abstract

Introduction

Cardiac abnormalities can be seen with subarachnoid hemorrhage. To date, there have been isolated case reports of transient left ventricular apical ballooning cardiomyopathy, also known as Takotsubo cardiomyopathy in patients suffering from subarachnoid hemorrhage.

Case presentation

An adult female was brought to the emergency department with somnolence. A 3 × 3 mm ruptured basilar aneurysm was found and successfully embolized. Two days after the patient developed acute heart failure. Troponin-I was elevated to 4.2 (normal <0.4). On ECG, new symmetric T wave inversion in V3, V4, V5 with prolonged QT were evident. Transthoracic echocardiogram showed severe systolic dysfunction with an ejection fraction of 20% and akinetic apex along with the distal left ventricular segments, consistent with Takotsubo cardiomyopathy. Myocardial contrast echocardiography showed a decrease in capillary blood flow and volume in the akinetic areas with delayed contrast replenishment, sparing the basal segments. A repeat study 2 weeks later showed near normalization of the perfusion parameters. The patient improved with medical management. A repeat echocardiogram, a month later revealed an ejection fraction of 45% with no identifiable wall motion abnormality.

Conclusion

Our case, as well as others reported previously, supports the diagnosis of Takotsubo cardiomyopathy in patients with Subarachnoid Hemorrhage who fulfill the …

Utility Of Immunohistochemical Markers In Differentiating Benign From Malignant Follicular-Derived Thyroid Nodules, Husain A. Saleh, Bo Jin, John Barnwell, Opada Alzohaili

Wayne State University Associated BioMed Central Scholarship

Abstract

Background

Thyroid nodules are common among adults though only a small percentage is malignant, which can histologically mimic benign nodules. Accurate diagnosis of these thyroid nodules is critical for the proper clinical management.

Methods

We investigated immunoexpression in 98 surgically removed benign thyroid nodules including 52 hyperplastic nodules (HN) and 46 follicular/Hurthle cell adenomas (FA), and 54 malignant tumors including 22 follicular carcinoma (FC), 20 classic papillary carcinoma (PTC), and 12 follicular variant papillary carcinoma (FVPC).

Results

The staining results showed that malignant tumors express galectin-3, HBME-1, CK19 and Ret oncoprotein significantly more than benign nodules. The sensitivity of …

Standard Patients On Labor And Delivery, Amy B. Smith Phd, Melissa Walsh Bs, Kristin Friel Md, Meredith Rochon Md

Department of Education

No abstract provided.

Montgomery County Breast Cancer Study: Demographic Analysis Of Breast Cancer In Montgomery County, Ohio, Danial Jilani

Master of Public Health Program Student Publications

Background: Disparities exist in cancer incidence and mortality between specific population groups in the United States. Breast cancer is the second most common form of cancer diagnosed in women. Breast cancer ranks as the second highest leading cause of death for women in the state of Ohio and in the United States. Perhaps more concerning, breast cancer is the leading cause of death for Hispanic women and ranks second for white, black, Asian, and Native American women. Specifically, women of low socioeconomic status (SES) have been shown to have lower rates of survival.

Methods: A descriptive study of …

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 …

Quality Of Life And Persons With Intellectual Disability: Can We Measure Qol In This Population?, Søren Ventegodt, Hatim A. Omar, Flemming Struve, Tove K. Nielsen, Isack Kandel, Joav Merrick

Pediatrics Faculty Publications

Quality of life (QOL) has been discussed by professionals working with persons with intellectual disability (ID) for some time, but since QOL is concerned with subjective well-being, satisfaction and happiness, how is it possible to measure, when the person in question is unable to communicate? Consciousness is believed to be an internal and personal thing, but we have done the simple experiment to ask observers to rate QOL of another person, also in sub dimensions like self-assessed physical and mental health, relationship with self, self-assessed sexual ability, self-assessed social ability, and we have found that people are able to assess …

Prepubertal Office Gynecology, Hatim A. Omar, Wendy Jackson, Amit M. Deokar

Pediatrics Faculty Publications

Clinical presentation and complaints of the vulvo-vaginal area are quite prevalent in the pediatric population and the primary care providers the first individuals called upon to evaluate the patients. One of the most difficult tasks for an individual that rarely performs the genitourinary examination is performing one on a pediatric patient. This chapter has been written to aid the primary care provider in successful examination, documentation and diagnosis.

Contraception, Donald E. Greydanus, Hatim A. Omar, Lyubov A. Matytsina, Artemis Tsitsika

Pediatrics Faculty Publications

Contraception is an important concept for sexually active adolescent females to understand who do not wish to become pregnant. This chapter reviews important, effective, and safe contraceptive methods that can be used by female youth. These methods include abstinence, oral contraception, contraceptive patch. mini-pills, emergency contraceptives, injectable contraception (DMPA), implants (lmplanon), intravaginal ring, vaginal barrier contraceptives, intrauterine devices, and natural family planning. Promotion of sexual responsibility should be the charge of health professionals caring for adolescents and young adults.

Breast Disorders In Children And Adolescents, Donald E. Greydanus, Hatim A. Omar, Lyubov A. Matytsina, Artemis Tsitsika

Pediatrics Faculty Publications

Concerns about problems of the breast are often noted in adolescents and their parents. This review discusses issues and disorders of the breast in children and adolescents, starting with basic principles of embryology and adolescent breast development. Concepts that are covered include congenital breast disorders, abnormal timing of breast development, breast asymmetry, underdeveloped breasts, breast atrophy, tuberous breasts, mammary hyperplasia, fibroadenoma, giant fibroadenoma, cystosarcoma phyllodes, intraductal breast papilloma, adenocarcinoma, mastitis, traumatic breast disorders, benign breast disease, fibrocystic change, mastalgia, gynocomastia, and galactorrhea. A number of figures are provided illustrating breast pathology. Clinicians caring for children and adolescents are encouraged to …

Menstrual Disorders In Adolescent Females, Donald E. Greydanus, Hatim A. Omar, Artemis Tsitsika, Dilip R. Patel

Pediatrics Faculty Publications

Onset of menstruation (i.e., menarche) is a determining event of the adolescent female signifying the progress of puberty, which in the majotity of cases is visibly initiated with thelarche (onset of breast development or breast buds). Menarche usually occurs during the earlier time of the second decade of life and ends with menopause, typically in the 5th decade of life. The adolescent can present with a wide variety of menstrual dilemmas and disorders which will be discussed in this chapter.

Hiv Prevention Through Sport: The Case Of The Mathare Youth Sport Association In Kenya., Wim Delva, Kristien Michielsen, Bert Meulders, Sandy Groeninck, Edwin Wasonga, Pauline Ajwang, Marleen Temmerman, Bart Vanreusel

Obstetrics and Gynaecology, East Africa

Sport has become a popular tool for HIV prevention, based on claims that it can foster life skills that are necessary to translate knowledge, attitudes and behavioural intentions into actual behaviour. Empirical evidence of the effectiveness of sport-based HIV prevention programmes is, however, sorely lacking. We therefore conducted a cross-sectional survey assessing sexual behaviour and the determinants thereof among 454 youth of the Mathare Youth Sport Association (MYSA) in Kenya and a control group of 318 non-MYSA members. Multiple (ordinal) logistic regression models were applied to measure the association between MYSA membership and attitudes, subjective norms and self-efficacy related to …

Localization Of Angiotensin Converting Enzyme In Rabbit Cornea And Its Role In Controlling Corneal Angiogenesis In Vivo, Ajay Sharma, Daniel I. Bettis, John W. Cowden, Rajiv R. Mohan

Pharmacy Faculty Articles and Research

Purpose: The renin angiotensin system (RAS) has been shown to modulate vascular endothelial growth factor and angiogenesis. In this study we investigated (i) the existence of the RAS components angiotensin converting enzyme (ACE) and angiotensin II receptors (AT1 and AT2) in the rabbit cornea using in vitro and ex vivo models and (ii) the effect of enalapril, an ACE inhibitor, to inhibit angiogenesis in rabbit cornea in vivo.

Methods: New Zealand White rabbits were used. Cultured corneal fibroblasts and corneal epithelial cells were used for RNA isolation and cDNA preparation using standard molecular biology techniques. PCR was performed to …

Aav Serotype Influences Gene Transfer In Corneal Stroma In Vivo, Ajay Sharma, Jonathan C. K. Tovey, Arkasubhra Ghosh, Rajiv R. Mohan

Pharmacy Faculty Articles and Research

This study evaluated the cellular tropism and relative transduction efficiency of three AAV serotypes, AAV6, AAV8 and AAV9, for corneal gene delivery using mouse cornea in vivo and donor human cornea ex vivo. The AAV6, AAV8 and AAV9 serotypes having AAV2 plasmid encoding for alkaline phosphatase (AP) gene were generated by transfecting HEK293 cell line with pHelper, pARAP4 and pRep/Cap plasmids. Viral vectors (109 vg/μl) were topically applied onto mouse cornea in vivo and human cornea ex vivo after removing the epithelium. Human corneas were processed for transgene delivery at day 5 after viral vector application. Mouse corneas were harvested …

Assessing Abortion-Related Experiences And Needs In Four Districts Of Maharashtra And Rajasthan, 2006, Shireen J. Jejeebhoy, A.J. Francis Zavier, Shveta Kalyanwala

Poverty, Gender, and Youth

Recognizing the urgent need to enable rural women to acquire accessible and high-quality abortion services in India, a consortium of organizations—including the Population Council—has come together with the goal of increasing access to legal, safe, and comprehensive abortion services, including postabortion family planning, in the public health system, especially among the rural poor. One of its key activities was to develop a comprehensive and evidence-based abortion care model suitable for rural women. The aim of this report is to shed light on community-level perspectives about abortion services and probe the experiences of women who had undergone abortion, to better understand …

Increasing Postpartum Contraception In Rural Uttar Pradesh: Implications For Behavior Change Communication, Population Council

Reproductive Health

The Population Council conducted a formative study in rural Uttar Pradesh, India to assess the level of adoption of postpartum contraception for spacing among low parity women, identify the facilitating factors and barriers to the adoption of this target behavior, and identify programmatic and behavior change communications (BCC) initiatives that could accelerate the adoption of postpartum contraception for spacing and improve the service delivery system, if required, to facilitate the process. Barriers included low awareness of consequences of closely spaced births, misconceptions about contraceptive methods, lack of counseling by health workers, reluctance to include husbands, and programmatic emphasis on limiting …

Mainstreaming Emergency Contraception Pills In Kenya, Jill Keesbury, Monica Wanjiru, Katherine Maina

Reproductive Health

To improve access to emergency contraception (ECP) and ensure that adequate information is provided to all users, the Kenyan Ministry of Public Health and Sanitation, the Population Council, and Population Services International-Kenya undertook a three-year effort to mainstream ECP in Kenya. This brief presents the results of this initiative and discusses strategies for further strengthening ECP provision. Kenya has emerged as a leader in ECP programming in the region and has demonstrated that it is possible to strengthen ECP services in both the public and private sectors while at the same time increasing public awareness, knowledge, and use of the …

Assessing The Feasibility Of Home Administration Of Misoprostol In The Prevention Of Postpartum Hemorrhage In Rural Pakistan, Ali M. Mir, Abdul Wajid, Sadaf Gull

Reproductive Health

This report details an operations research project carried out by the Population Council as part of the Pakistan Initiative for Mothers and Newborns. The overall goal of the project was to test the feasibility of administering misoprostol for the prevention of postpartum hemorrhage (PPH) in a home setting through community‐based healthcare providers, including traditional birth attendants (TBAs), or family members, in two districts of Pakistan. Furthermore, it aimed to identify common side effects of misoprostol and determine the reduction in demand for referral due to PPH after oral ingestion of misoprostol. The results provide a useful addition to the literature …

The Pregnancy Cycle Approach To Safe Motherhood, Saumya Ramarao, Sarah Raifman

Reproductive Health

The Population Council's Reproductive Health program partnered with the Maternal Health Task Force (MHTF), the Partnership for Maternal, Newborn and Child Health (PMNCH), and the PAC Consortium, to address the UN Millenium Development Goal of improving maternal health, and reducing child mortality. Specifically this brief examines the pregnancy cycle approach whereby women’s needs from facilitating a desired pregnancy to successful parturition are addressed in a range of settings—home, community and health facility. This brief covers the different stages including abortion and postabortion care, antenatal care, delivery, and postpartum and beyond.

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.

Emergency Contraception: Idea To Program, Saumya Ramarao, John Townsend, Sarah Raifman

Reproductive Health

This report summarizes the role of the Population Council in generating evidence, providing technical leadership, and demonstrating at scale that emergency contraception (EC) can be easily integrated into national family planning programs and other reproductive health services. Since the 1990s, the Population Council, along with other partners, has contributed to the changes seen in the provision and availability of EC, now available in over 140 countries around the world. While much progress has been made in the campaign for access to EC, the Council is committed to improving existing methods of service delivery and to leading advocacy efforts and research …

Hereditary 1,25-Dihydroxyvitamin D-Resistant Rickets With Alopecia Resulting From A Novel Missense Mutation In The Dna-Binding Domain Of The Vitamin D Receptor., Peter J. Malloy, Jining Wang, Tarak Srivastava, David Feldman

Manuscripts, Articles, Book Chapters and Other Papers

The rare genetic recessive disease, hereditary vitamin D resistant rickets (HVDRR), is caused by mutations in the vitamin D receptor (VDR) that result in resistance to the active hormone 1,25-dihydroxyvitamin D(3) (1,25(OH)(2)D(3) or calcitriol). In this study, we examined the VDR from a young boy with clinical features of HVDRR including severe rickets, hypocalcemia, hypophosphatemia and partial alopecia. The pattern of alopecia was very unusual with areas of total baldness, adjacent to normal hair and regions of scant hair. The child failed to improve on oral calcium and vitamin D therapy but his abnormal chemistries and his bone X-rays normalized …