Digital Commons Network^™

Drug Related Critical Incidents, F A. Khan, M Q. Hoda

Department of Anaesthesia

Drug related incidents are a common form of reported medical errors. This paper reviews the critical incidents related to drug errors reported from the main operating theatre suite in a teaching hospital in a developing country from January 1997 to December 2002. Each report was evaluated individually by two reviewers using a structured process. During this period, 44 874 anaesthetics were administered; 768 critical incidents were reported, 165 (21%) of which were related to drug errors. Underdosage, side-effect/drug reaction and syringe swap were the most common. A total of 76% were classified as preventable; 56% due to human error and …

Symptoms Of Gastro-Oesophageal Reflux Disease And The Severity Of Obstructive Sleep Apnoea Syndrome Are Not Related In Sleep Disorders Center Patients, H.-N. Kim, R. D. Vorona, M. P. Winn, M. Doviak, D. A. Johnson, J. Catesby Ware

Mathematics & Statistics Faculty Publications

Background: Studies suggest obstructive sleep apnea syndrome (OSAS) frequently manifests in patients with gastroesophageal reflux disease (GERD) and that there may be a causal relationship.

Aim: To determine the relationship between OSAS and symptoms of GERD.

Methods: Consecutive patients referred to the Sleep Disorders Center (SDC) 18 years and older with polysomnographically defined OSAS were evaluated prospectively for GERD using a validated symptoms questionnaire. The GERD and OSAS relationship was assessed by 1) determining frequency of GERD in patients with and without OSAS; 2) ascertaining the relationship between OSAS severity categories and presence of GERD; 3) examining GERD score in …

Chloride Equilibrium Potential In Salamander Cones., Wallace B. Thoreson, Eric J. Bryson

Journal Articles: Ophthalmology

BACKGROUND: GABAergic inhibition and effects of intracellular chloride ions on calcium channel activity have been proposed to regulate neurotransmission from photoreceptors. To assess the impact of these and other chloride-dependent mechanisms on release from cones, the chloride equilibrium potential (ECl) was determined in red-sensitive, large single cones from the tiger salamander retinal slice.

RESULTS: Whole cell recordings were done using gramicidin perforated patch techniques to maintain endogenous Cl- levels. Membrane potentials were corrected for liquid junction potentials. Cone resting potentials were found to average -46 mV. To measure ECl, we applied long depolarizing steps to activate the calcium-activated chloride current …

Clinical Study On The Use Of Nozovent In A Tertiary Care Setting, M Sohail Awan, M Mubarik Ali, Manzoor Ahmed, Asim Iqbal, M Javed Aslam

Section of Otolaryngology, Head & Neck Surgery

Objective: To assess the effectiveness of the Nozovent device in Pakistani subjects at Aga Khan University Hospital, Karachi and Sir Ganga Ram Hospital, Lahore from 15 January 2001 to 15 January 2002.Methods: Sixty males and 40 females were selected by non probability purposive sampling, from OPD of ENT Department, complaining of nasal obstruction due to various reasons, e.g. vasomotor rhinitis, allergic rhinitis, congestion during pregnancy and menstruation, common cold, traumatic nose and nasal valve problem.Results: All patients benefited subjectively but the degree of relief varied in individuals.CONCLUSION: The Nozovent provides a unique method to relieve nasal obstruction with no side …

Diagnostic Value Of Fine Needle Aspiration Cytology In Parotid Tumors, Muhammad Sohail Awan, Zafar Ahmad

Section of Otolaryngology, Head & Neck Surgery

Objective: To evaluate the usefulness and accuracy of fine needle aspiration cytology in the diagnosis of parotid gland tumors.Methods: We reviewed files of all patients who underwent parotidectomy for various parotid pathologies at Aga Khan University Hospital. Study design included a comparison between results of preoperative FNAC with final histopathological diagnosis. Galen & Ganbino method was used to calculate sensitivity and specificity of FNAC.Results: Among 50 patients reviewed, there was one false positive and 3 false negative results reported on FNAC. This gives a sensitivity of FNAC for reporting malignancy to be 74% and specificity to rule out malignancy 97%. …

Cbct Panoramic Images Vs. Traditional Panoramic Radiographs, Sunny Young Hutchinson

Loma Linda University Electronic Theses, Dissertations & Projects

The purpose of this research was to compare the accuracy of angular measurements of the panoramic image of the Newtom 9000™ Cone Beam Computed Tomography (CBCT) with the Sirona™ Orthophos panoramic unit. The study was separated into three parts: phantom study, patient study, and archform study. The phantom study used fabricated phantom typodonts to compare angular measurements between the Newtom 9000™ panoramic image and the Sirona™ panoramic radiograph. Accuracies of the measurements were then determined by comparing the values to the actual phantom typodont. No marked differences in angular measurements were recorded for the phantom typodont using either of the …

Methods And Apparatus For In Vivo Identification And Characterization Of Vulnerable Atherosclerotic Plaques, Pedro Moreno, Robert A. Lodder, William O'Connor, James E. Muller

Internal Medicine Faculty Patents

Methods and apparatus for analyzing the chemical composition of vulnerable plaques with an intravascular catheter having a near-infrared light source, a fiber-optic probe, a mechanism for directing the light from the light source into a blood vessel, and detectors for detecting light reflected or scattered by the tissue. The light source may be a tunable laser, and may transmit an incident beam having a wavelength ranging from 1400 to 4100 nm. A computer may be included to receive and process the spectral data in the analysis of the vulnerable plaques. A catheter system may be configured to provide near-IR spectrometric …

An Emergency Department Staff Tackles The Healthy Workplace Initiative : A Staff Nurse Perspective., Paul Clark

Faculty and Staff Scholarship

This article describes the Healthy Workplace Initiative in the adult emergency department from the staff nurse perspective. Examples of one action planning team's processes and outcomes are delineated. The Rapid Diagnostics action planning team is delineated as lived while caring for patients in today's high-pressure emergency department. The Healthy Workplace Initiative empowers staff, with the guidance of facilitators, to make changes that improve the workplace and to create a healthy workplace for staff and patients. The result is greater staff ownership of the emergency department which leads to greater job satisfaction and improved patient care.

Maternal Anaemia And Its Impact On Perinatal Outcome In A Tertiary Care Hospital In Pakistan, F W. Lone, R N. Qureshi, F Emmanuel

Department of Obstetrics & Gynaecology

Maternal anaemia is a common problem in pregnancy, particularly in developing countries. We investigated the relationship between maternal anaemia and perinatal outcome in a cohort of 629 pregnant women from October 2001 to 2002. Of these, 313 were anaemic (haemoglobin < 11 g/L). Perinatal outcomes included preterm delivery, low birth weight, intrauterine growth retardation, perinatal death, low Apgar scores and intrauterine fetal death. Univariate and multivariate analyses were performed. The risk of preterm delivery and low birth weight among the anaemic women was 4 and 1.9 times more respectively than the non-anaemic women. The neonates of anaemic women also had 1.8 times increased risk having low Apgar scores at 1 minute and there was a 3.7 greater risk of intrauterine fetal death among the anaemic women than the non-anaemic women.

Blinding Trachoma : A Disease Of Poverty, Khabir Ahmed, Pashtoon M. Kasi, Ahmed I Gilani, Naveed Janjua

Department of Surgery Docs

No abstract provided.

Orbital Embryonal Rhabdomyosarcomain Karachi (1998-2002), Yasmin Bhurgri, A. Mazhar, H. Bhurgri, A. Usman, J. Malik, A. Bhurgri, R. Ahmed, S. Muzaffar, N. Kayani, Shahid Pervez, S. H. Hasan

Department of Pathology and Laboratory Medicine

Objective: To study the epidemiology of ocular Rhabdomyosarcoma (ORMS) in Karachi.

Methods: Incident ORMS cases resident of Karachi, registered at Karachi Cancer Registry (KCR) during 1st January 1998 to 31st December 2002 were included in the study. The data were classified using ICD-O2; computerized with Canreg-3, and analyzed using SPSS 10.0.

Results: Ten cases of ORMS were reported to KCR during 1998-2002. RMS originated in the orbit in eight cases, conjunctiva in one and eyelid in one. Nine cases presented with proptosis, associated with conjunctivitis in four cases. One case presented with eyelid swelling. The crude annual incidence rate was …

Anaesthesia For Surgical Correction Of Scoliosis With Spinal Cord Monitoring--A Case Series, M Q. Hoda, S U. Zafar

Department of Anaesthesia

Objective: To share our experience of anaesthetic management of scoliosis with intra-operative somatosensory evoked potential monitoring and wake up test.Methods: All the cases of scoliosis surgery scheduled during a period of two years in which SSEP and intra-operative wake-up test was planned were included in the study. The patient in which intra-operative wake-up test was not planned were excluded from this case series.Results: We managed a series of sixteen cases of scoliosis in our hospital. Eleven patients were female and five were male with the age ranging from six to twenty two years. SSEPs were monitored throughout the procedure and …

Sensory Hypoinnervation In Club Foot, M Ahmed, N Ahmed, K. M. Khan, Masood Umer, H. Rashid,, Pervaiz Hashmi

Department of Surgery Docs

Abstract

We have compared the density of nerve fibres in the synovium in club foot with that of specimens obtained from the synovium of the hip at operations for developmental dysplasia. The study focused on the sensory neuropeptides substance P; calcitonin gene-related peptide; protein gene product 9.5, a general marker for mature peripheral nerve fibres; and growth associated protein 43, a neuronal marker for new or regenerating nerve fibres. In order to establish whether there might be any inherent difference we analysed the density of calcitonin gene-related peptide-positive nerve fibres in the hip and ankle joints in young rats. Semi-quantitative …

Assessment Of A Body Composition-Focused Approach To Obesity Treatment, Beverly D. Hall

Loma Linda University Electronic Theses, Dissertations & Projects

Obesity is a significant United States’ public health concern. However, high relapse rates continue to be a problem for obesity treatment programs while the focus remains on weight loss, not body composition change. This study examined whether a clinic-based obesity treatment program, focused on body composition change through resistance training, lead to improved body composition, exercise behaviors, and attitude change from focus on weight loss to body composition change. Improvements in self efficacy, outcome expectations and stages of change were also examined. Forty-eight physician-referred overweight or obese adult women (mean body fat 41%, SD = 6.65%), completed assessments and questionnaires …

Medical Education Digest, Vol. 6 No. 5 (September 15, 2004), Nova Southeastern University

Medical Education Digest

No abstract provided.

Headache Management For The Pain Specialist, Avi Ashkenazi, Stephen Silberstein

Department of Neurology Faculty Papers

Headache is a common symptom caused by a wide variety of diseases. Primary headaches include migraine, cluster headache, tension-type headache and other less common diseases. It is important to differentiate these headaches from secondary headaches caused by vascular, neoplastic, infectious, metabolic and toxic disorders. Most primary headaches have a genetic basis, with environmental factors acting as triggers. Recent advances in basic research resulted in the development of more specific and effective therapies. Medication overuse headache is a very common cause of chronic daily headache. Detoxification from the offending drug is essential for headache improvement. Cervicogenic headache is common and needs …

Long-Term Correction Of Ornithine Transcarbamylase Deficiency By Wpre-Mediated Overexpression Using A Helper-Dependent Adenovirus, Asad Mian, W. Michael Mccormack Jr, Viraj Mane, Soledad Kleppe, Philip Ng, Milton Finegold, William E. O'Brien, John R. Rodgers, Arthur L. Beaude, Brendan Lee

Department of Emergency Medicine

The urea cycle disorders (UCDs) are important models for developing gene replacement therapy for liver diseases. Long-term correction of the most common UCD, ornithine transcarbamylase (OTC) deficiency, has yet to be achieved in clinical or preclinical settings. The single human clinical trial using early-generation adenovirus (Ad) failed to show any biochemical correction. In adult OTC-deficient mice, an E1/E2-deleted Ad vector expressing the mouse OTC gene, but not the human, was only transiently therapeutic. By using post-transcriptional overexpression in the context of the less immunogenic helper-dependent adenoviral vector, we achieved metabolic correction of adult OTC-deficient mice for >6 months. Demonstrating this …

Prevalence Of Degenerative Joint Disease In A Pre-Orthodontic Adolescent Sample, Marie Mansour

Loma Linda University Electronic Theses, Dissertations & Projects

The purpose of this research was to determine a prevalence of degenerative joint disease in our pre-orthodontic adolescent patients age ten through seventeen. The prevalence was assessed according to gender. Severity of DJD was established for each patient and a "red flag" for diagnosis was identified. The purpose was also to establish norms for joint space for patients with and without degenerative joint disease. Correlations to distal condyle position and angle classification were described. 123 consecutive patients, 77 female and 46 male T1 NewTom records were reviewed. Severity of DJD was classified according to none, mild, moderate, and severe. Sagittal …

Infant Heart Transplant: Perioperative Indicators Of Neurocognitive Development, Joy Michelle Gardner

Loma Linda University Electronic Theses, Dissertations & Projects

Approximately five to eight births per 1000 in the United States are born with a congenital heart defect (Limperopoulos et al, 1999), the primary defect in 57% is hypoplastic left heart syndrome (Johnston, 1991). A fatal disease twenty years ago, survival has jumped from less than 5% to 91% of infants surviving their one-month birthday due to advances in palliative and transplant procedures (Razzouk et al, 1996). Unfortunately, the decrease in mortality has been unmatched by a decrease in morbidity, which continues to be a major risk factor when undergoing deep hypothermia (du Plessis, 2000). While neurodevelopmental and cognitive dysfunction …

Vital Signs, Fall 2004, Boonshoft School Of Medicine

Vital Signs

A twenty-seven page newsletter created by the Boonshoft School of Medicine to document the current affairs of the school. This issue includes a variety of feature articles, alumni profiles, class notes, and more.

Com Outlook Summer 2004, College Of Osteopathic Medicine

COM Outlook

No abstract provided.

Transvaginal Sonography- Technique And Limitations, Saba Sohail

Department of Radiology

No abstract provided.

Multiple Testing Methods For Chip-Chip High Density Oligonucleotide Array Data, Sunduz Keles, Mark J. Van Der Laan, Sandrine Dudoit, Simon E. Cawley

U.C. Berkeley Division of Biostatistics Working Paper Series

Cawley et al. (2004) have recently mapped the locations of binding sites for three transcription factors along human chromosomes 21 and 22 using ChIP-Chip experiments. ChIP-Chip experiments are a new approach to the genome-wide identification of transcription factor binding sites and consist of chromatin (Ch) immunoprecipitation (IP) of transcription factor-bound genomic DNA followed by high density oligonucleotide hybridization (Chip) of the IP-enriched DNA. We investigate the ChIP-Chip data structure and propose methods for inferring the location of transcription factor binding sites from these data. The proposed methods involve testing for each probe whether it is part of a bound sequence …

Roger W. Anderson, Phd, Oral History Interview, May 18, 2004, Roger W. Anderson Phd, Lesley W. Brunet

Interview Sessions

Major Topics Covered:

• Career at MD Anderson
• The history of the Pharmacy Division
• Integrating pharmacists within departments at MD Anderson including Nursing and Developmental Therapeutics
• Pharmacist's role in improving chemotherapy drugs and safety monitoring

Diabetes: The Interrelationship Between Vascular, Nervous Systems And Avandia, Salameh Bweir

Loma Linda University Electronic Theses, Dissertations & Projects

Diabetes Mellitus has been linked to vascular and neurological impairments. The purpose of this study was to assess the relationship between vascular endothelial dysfunction, autonomic and somatic nervous systems impairment in diabetic patients. These studies also evaluated the effects of rosiglitazone (Avandia) on the vascular, autonomic, and somatic nervous systems.

Fourteen diabetic subjects and fourteen control subjects (age matched) participated in three series of experiments. Using Whitney volume plesythmography to assess post occlusion blood flow in the subject’s forearm did assessment of vascular endothelial function. Evaluating skin blood flow, orthostatic tolerance, heart rate, and thermal responses under thermal and postural …

Comparison Of Transcranial Electric Motor And Somatosensory Evoked Potential Monitoring During Cervical Spine Surgery., Alan S Hilibrand, Daniel M Schwartz, Venkat Sethuraman, Alexander R Vaccaro, Todd J Albert

Rothman Institute Papers

BACKGROUND: There has been little enthusiasm for somatosensory evoked potential monitoring in cervical spine surgery as a result, in part, of the increased risk of motor tract injury at this level, to which somatosensory monitoring may be insensitive. Transcranial electric motor evoked potential monitoring allows assessment of the motor tracts; therefore, we compared transcranial electric motor evoked potential and somatosensory evoked potential monitoring during cervical spine surgery to determine the temporal relationship between the changes in the potentials demonstrated by each type of monitoring and neurological sequelae and to identify patient-related and surgical factors associated with intraoperative neurophysiological changes.

METHODS: …

Operative Treatment Of Bilateral Hip Dislocation In Children With Arthrogryposis Multiplex Congenita, S Asif, Masood Umer, Rashid Baig

Department of Surgery Docs

Abstract

PURPOSE:

Arthrogryposis multiplex congenita (AMC) is a rare syndrome with multiple joint contractures. It is commonly believed that bilaterally dislocated hips associated with joint contractures should not be reduced, because movement is satisfactory, while open reduction leads to poor results. This report presents our experience with surgical management of bilateral dislocation of hips in children with AMC.

METHODS:

During the period 1990 to 2000, we performed open reduction on 8 hips of 4 children with AMC. The mean age at surgery was 23 months (range, 5-48 months). Open reduction and capsular plication without any bony procedure were performed in …

Diagnostic Surgical Pathology: The Importance Of Second Opinion In A Developing Country, Z. Ahmed, N. Yaqoob, S. Muzaffar, N. Kayani, Shahid Pervez, S. H. Hasan

Department of Pathology and Laboratory Medicine

Objective: To review the cases sent to the section of histopathology, Aga Khan Universty (AKU) for second opinion and see whether there are significant differences in the original outside diagnosis and the subsequent diagnosis submitted by us.

Methods: A retrospective study of all consecutive cases for second opinion in the form of paraffin blocks from 1st Novemver 2001 to 31st July 2002. The primary submitted diagnosis in each case was compared with the subsequent AKU diagnosis.

Results: The study included a total of 381 cases. However, in 45 cases (11.81%), initial histopathological diagnosis was not provided. Out of the remaining …

Bronchiolitis Obliterans Organizing Pneumonia Associated With Cytomegalovirus Infection In A Patient With Systemic Lupus Erythematosus., Muhammad Irfan, Ali Bin Sarwar Zubairi, S.J. Husain

Department of Medicine

No abstract provided.

Percutaneous Embolisation And Transverse Myelitis: A Rare Association, O Ashraf, F Aslam, M Irfan, A B. Zubairi, M Azeemuddin

Department of Radiology

No abstract provided.