Digital Commons Network^™

The Effect Of Culture On Urinary Incontinence: Do We Really Understand?, Karen A. Karlowicz

Ellmer School of Nursing Faculty Publications

No abstract provided.

Autoimmunity In Transfusion Babesiosis: A Spectrum Of Clinical Presentations., Jay H Herman, Saleh Ayache, Danuta Olkowska

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Transfusion-acquired babesiosis can be an asymptomatic or self-limited febrile hemolytic illness in a healthy host. A persistent, relapsing, and/or fulminant course with the development of life-threatening complications may be seen in immunocompromised or splenectomized patients. As in malaria, erythrocyte parasitemia is often associated with nonimmune hemolysis, and can be treated with erythrocytapheresis. Just as warm autoantibodies have been reported in malaria infection, the development of autoantibody-mediated immune hemolysis has been reported in babesiosis. We treated a previously healthy male with multiple injuries from a motor vehicle accident necessitating massive transfusion. Late in the hospitalization, his blood smear revealed Babesia microti, …

The Development And Implementation Of A Curriculum Using Simulation To Teach Interns Basic Invasive Clinical Skills, C. Sultana, K. Berg, J. Kairys, J. Majdan, M. Vergare, D. Berg

Department of Obstetrics and Gynecology Faculty Papers

The ACGME requires that all residents are competent in performing basic invasive clinical procedures. Although simulation models have been used in other programs to teach these skills to interns with the intent to provide training and skills attainment before learning and performing on real patients, a large scale, mandatory simulation training, in which every incoming intern must satisfactorily complete training in a simulation center, prior to starting their intern year, has yet to be described. We describe such a curricular intervention produced in our Simulation Center.

A Novel Curriculum Using Simulation To Teach And Assess Indications And Technique Of Handwashing To Gme Learners, K. Berg, C. Sultana, R. Sorokin, J. Kairys, M. Vergare, D. Berg

Department of Obstetrics and Gynecology Faculty Papers

Proficiency in the clinical skill of effective hand washing is integral to high quality health care. Studies at our hospital revealed that in 2008, of 1215 direct, anonymous, observations of residents and attendings, only 53.3% washed their hands correctly during clinical activities. Medical students in fiscal year 2009 (July 1, 2008-June 30 2009) had a 52% compliance rate from 109 observations. This data prompted our hospital to work with the faculty of the University Clinical Skills and Simulation Center (UCSSC) to develop a module on the indications and technique of effective handwashing. This intervention, using multimedia simulation was introduced to …

Reduced Mortality And Increased Bpd With Histological Chorioamnionitis And Leukocytosis In Very-Low-Birth-Weight Infants., David A. Paul, Md, Kelly Zook, Md, Amy Mackley, Rnc, Robert G. Locke, Do

Department of Pediatrics Faculty Papers

OBJECTIVE: To investigate the association between leukocytosis, mortality and bronchopulmonary dysplasia (BPD) in very-low-birth-weight infants (VLBW) born to mothers with histological chorioamnionitis.

STUDY DESIGN: A retrospective cohort study from a single level 3 neonatal intensive care unit. The study sample included infants born to mothers with histological chorioamnionitis (n=252). Total white blood cells (WBCs) after birth were measured. Leukocytosis was defined as a total WBC count >30 000 per mm(3) in the first 2 days of life. Outcomes investigated included BPD and death. Both unadjusted and multivariable analyses were carried out.

RESULT: After controlling for potential confounding variables, infants who …

Vertical Facial And Dental Arch Dimensional Changes In Extraction Vs. Non-Extraction Orthodontic Treatment, Meena Kumari, Mubassar Fida

Section of Dental-Oral Maxillofacial Surgery

OBJECTIVE: To compare the vertical facial and dental arch dimensional changes occurring with extraction and nonextraction orthodontic treatments.

STUDY DESIGN: Cross-sectional comparative study.

PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi during the period 2003 to 2005.

METHODOLOGY: Data were collected using records of patients who visited the study setting during the study period. Pre- and post-treatment lateral cephalographs and study casts of 81 orthodontic patients (41=non-extraction and 40=premolar extractions) were taken. Variables used for evaluating vertical dimension were Frankfort mandibular plane angle (FMA), facial height (N-Me), facial height ratio (N-ANS/ANS-Me), soft tissue facial height (G' to …

Neuroaids In Africa, Kevin Robertson, Jeff Liner, James Hakim, Jean-Louis Sankalé, Igor Grant, Scott Letendre, David Clifford, Amadou Gallo Diop, Assan Jaye, Georgette Kanmogne, Alfred Njamnshi, T. Dianne Langford, Tufa Gemechu Weyessa, Charles Wood, Mwanza Banda, Mina Hosseinipour, Ned Sacktor, Noeline Nakasuja, Paul Bangirana, Robert Paul, John Joska, Joseph Wong, Michael Boivin, Penny Holding, Betsy Kammerer, Annelies Van Rie, Prudence Ive, Avindra Nath, Kathy Lawler, Clement Adebamowo, Walter Royal Iii, Jeymohan Joseph

Nebraska Center for Virology: Faculty Publications

In July 2009, the Center for Mental Health Research on AIDS at the National Institute of Mental Health organized and supported the meeting “NeuroAIDS in Africa.” This meeting was held in Cape Town, South Africa, and was affiliated with the 5th IAS Conference on HIV Pathogenesis, Treatment and Prevention. Presentations began with an overview of the epidemiology of HIV in sub-Saharan Africa, the molecular epidemiology of HIV, HIV-associated neurocognitive disorders (HANDs), and HAND treatment. These introductory talks were followed by presentations on HAND research and clinical care in Botswana, Cameroon, Ethiopia, The Gambia, Kenya, Malawi, Nigeria, Senegal, South Africa, Uganda, …

Increased Dendrite Branching In Aβpp/Ps1 Mice And Elongation Of Dendrite Arbors By Fasudil Administration, Brian A. Couch, George J. Demarco, Shannon L. Gourley, Anthony J. Koleske

School of Biological Sciences: Faculty Publications

Amyloid-β (Aβ) overproduction and dendrite arbor atrophy are hallmarks of Alzheimer’s disease. The RhoA GTPase (Rho) signals through Rho kinase (ROCK) to control cytoskeletal dynamics and regulate neuron structure. Hyperactive Rho signaling destabilizes neurons leading to dendritic regression that can be rescued by genetic or pharmacological reduction of ROCK signaling. To understand what effect reduced ROCK signaling has on the dendrite arbors of mice that overproduce Aβ, we administered the ROCK inhibitor fasudil to AβPP/PS1 transgenic mice. We report that increased dendrite branching occurs in AβPP/PS1 mice and that fasudil promotes …

Synaptic Clustering Of Psd-95 Is Regulated By C-Abl Through Tyrosine Phosphorylation, Karen Perez De Arce, Lorena Varela-Nallar, Olivia Farias, Alejandra Cifuentes, Paulina Bull, Brian A. Couch, Anthony J. Koleske, Nibaldo C. Inestrosa, Alejandra R. Alvarez

School of Biological Sciences: Faculty Publications

The c-Abl tyrosine kinase is present in mouse brain synapses, but its precise synaptic function is unknown. We found that c-Abl levels in the rat hippocampus increase postnatally, with expression peaking at the first postnatal week. In 14 d in vitro hippocampal neuron cultures, c-Abl localizes primarily to the postsynaptic compartment, in which it colocalizes with the postsynaptic scaffold protein postsynaptic density protein-95 (PSD-95) in apposition to presynaptic markers. c-Abl associates with PSD-95, and chemical or genetic inhibition of c-Abl kinase activity reduces PSD-95 tyrosine phosphorylation, leading to reduced PSD-95 clustering and reduced synapses in treated neurons. c-Abl can phosphorylate …

Purification Of Parvalbumin From Carp: A Protocol That Avoids Heat Treatment, Stef J. Koppelman, Roland A. Romijn, Harmen H. J. De Jongh, Julie A. Nordlee, Sander Piersma, Martin Hessing, Steve L. Taylor

Department of Food Science and Technology: Faculty Publications

Parvalbumin from carp, a major allergen,was purified to homogeneity using ion exchange chromatography and size exclusion chromatography (estimated purity > 95% to 98% based on SDS-PAGE and native PAGE) with a yield of 318 mg, and a number of basic biochemical characteristics were determined. The identity was confirmed by peptide-mass fingerprinting, and IgE-binding was demonstrated. The UV/Vis absorbance spectra were explained using the previously published amino acid sequences. Far UV-CD spectroscopy was used to confirm the folding character of parvalbumin. We conclude that parvalbumin from carp can be purified on a comparatively large (hundreds of milligrams) scale using a purification protocol …

Conformity To The Surviving Sepsis Campaign International Guidelines Among Physicians In A General Intensive Care Unit In Nairobi, Vitalis Mung’Ayi, R. Karuga

Anaesthesiology, East Africa

Background: There are emerging therapies for managing septic critically-ill patients. There is little data from the developing world on their usage.

Objectives: To determine the conformity rate for resuscitation and management bundles for septic patients amongst physicians in a general intensive care unit.

Design: Cross sectional observational study.

Setting: The general intensive care unit, Aga Khan University Hospital, Nairobi.

Subjects: Admitting physicians from all specialties in the general intensive care unit.

Results: The physicians had high conformity rates of 92% and 96% for the fluid resuscitation and use of va so pressors respectively for the initial resuscitation bundle. They had …

Bone Marrow Examination Findings At Aga Khan University Hospital, Nairobi, Nancy Okinda, Riyat Malkit

Pathology, East Africa

Objective: To establish the bone marrow examination findings and determine the indication for bone marrow examination.

Design: A retrospective audit.

Setting: Aga Khan University Hospital, Nairobi.

Subjects: All bone marrow aspirates done at Aga Khan University for the period comprising February 2003 to February 2006 were retrieved and analysed.

Results: A total of 356 patient’s case histories including bone marrow examination results were analysed. Ages of the patients ranged from 18 months to 91 years. Males were 180 (50.6%) and females were 176 (49.4%). Nutritional anaemia as a group was the most common haematological disorder found on bone marrow …

Who Gets Prompt Access To Artemisinin-Based Combination Therapy? A Prospective Community-Based Study In Children From Rural Kilosa, Tanzania, D.O. Simba, M. Warsame, D. Kakoko, Z. Mrango, G. Tomson, Zul Premji, M. Petzold

Pathology, East Africa

Background: Effective and timely case management remains one of the fundamental pillars for control of malaria. Tanzania introduced artemisinin-combination therapy [ACT] for uncomplicated malaria; however, the policy change is challenged by limited availability of ACTs due to high cost. This study aimed to determine factors influencing prompt access to ACTs among febrile children in rural Kilosa, Tanzania.

Methods and Findings: In a community-based study, 1,235 randomly selected children under five were followed up weekly for six months, in 2008. Using a structured questionnaire, children's caretakers were asked about the child's febrile history in the last seven days, and treatment …

Understanding Caretakers' Dilemma In Deciding Whether Or Not To Adhere With Referral Advice After Pre-Referral Treatment With Rectal Artesunate, D.O. Simba, D.C. Kakoko, M. Warsame, Zul Premji, M.F. Gomes, G. Tomson, E. Johansson

Pathology, East Africa

Background: Malaria kills. A single rectal dose of artesunate before referral can reduce mortality and prevent permanent disability. However, the success of this intervention depends on caretakers' adherence to referral advice for follow-up care. This paper explores the dilemma facing caretakers when they are in the process of deciding whether or not to transit their child to a health facility after pre-referral treatment with rectal artesunate.

Methods: Four focus group discussions were held in each of three purposively selected villages in Mtwara rural district of Tanzania. Data were analysed manually using latent qualitative content analysis.

Results: The theme «Caretakers dilemma …

Population Genetic Analysis Of Large Sequence Polymorphisms In Plasmodium Falciparum Blood-Stage Antigens, A.D. Ahouidi, A.K. Bei, D.E. Neafsey, O. Sarr, S. Volkman, D. Milner, J. Cox-Singh, M.U. Ferreira, O. Ndir, Zul Premji, S. Mboup, M.T. Duraisingh

Pathology, East Africa

Plasmodium falciparum, the causative agent of human malaria, invades host erythrocytes using several proteins on the surface of the invasive merozoite, which have been proposed as potential vaccine candidates. Members of the multi-gene PfRh family are surface antigens that have been shown to play a central role in directing merozoites to alternative erythrocyte receptors for invasion. Recently, we identified a large structural polymorphism, a 0.58 Kb deletion, in the C-terminal region of the PfRh2b gene, present at a high frequency in parasite populations from Senegal. We hypothesize that this region is a target of humoral immunity. Here, by analyzing 371 …

The Effects Of Pet Ownership On Physical Well-Being In Older Adults, Tami Pohnert

Theses and Dissertations

A large percentage of Americans own pets which may impact their health. This study examines pet ownership’s effect on well being in older adults looking at race/ethnicity. A sample of 6,565 older adults (>60) was selected from the Third National Health and Nutrition Survey. Pet owners comprised 28.3% of the sample. The theories of symbolic interaction and social integration were used to examine pet ownership’s effect on physical components of well-being. The descriptive results showed statistically significant differences in age, education, income, and marital status between pet owners and non-pet owners. Pet owners were younger, more educate, higher income …

Knowledge, Attitudes And Practices Of Medical Students Regarding Needle Stick Injuries, Taimur Saleem, Umair Khalid, Sidra Ishaque, Afia Zafar

Department of Pathology and Laboratory Medicine

Objective: To ascertain knowledge, attitude and practices of medical students regarding needle stick injuries.
Methods: A cross sectional survey was conducted among the consenting medical students of 3rd, 4th and 5th years at a teaching hospital of Karachi, Pakistan. Convenience sampling was used. Pre-tested questionnaires were administered to approximately 70% of each class. Data was analyzed using SPSS version 16.0. Associations were assessed using chi-square test and Fisher's exact test. A p-value of <0.05 was considered as significant.
Results: The response rate of the survey was 85.7%. Sixty one students (33.9%) were from 3rd and 4th year each while 58 students (32.2%) were …

Doxazosin Induces Apoptosis In Pten–Positive Androgen-Independent Pc Cells Via Inhibition Of Akt Activation, Hanna M Romanska, Maciej Salagierski, Rachel Bruton, P D Abel, Marek Sosnowski, El Nasir Lalani

Department of Pathology and Laboratory Medicine

Doxazosin, a selective α1-adrenoreceptor antagonist widely used in the management of benign prostatic hyperplasia (BPH), has been shown to induce apoptosis in androgen-independent (AI) and PTEN (phosphatases and tensin homolog)-negative prostate cancer (PC) cells. The objective of this study was to assess the effects of doxazosin on the growth of PC cells with a functional PTEN/PI3K/Akt pathway in relation to cell androgen sensitivity and Bcl-2 expression. Material and methods. The DU145 cell line and two derivatives: 1) DKC9 [DU145 (Bcl2 +/+)] and 2) DAR19 [DU145 (AR+/+)] were used. The effect of doxazosin on i) cell proliferation and ii) Akt phosphorylation …

Successful Use Of Rituximab In Evans Syndrome And Refractory Immune Thrombocytopenic Purpura, Muhammad Kashif, Adnan Qureshi, Salman Naseem Adil, Mohammad Khurshid

Department of Pathology and Laboratory Medicine

Immune cytopenias are mediated by auto-antibodies produced by B-lymphocytes. Conventional treatment of immune-mediated haematological disorders includes immunosuppression with steroids and other immune modulating therapies and in some refractory cases, splenectomy. Response rates to conventional and second-line agents are variable and a proportion of patients require lifelong immunosuppression to maintain the disease in remission. Rituximab, an anti- CD 20 monoclonal antibody has gained widespread acceptance in the management of B-cell malignancies. Additionally, it has been used to treat the disorders associated with autoantibody production. We report herein the successful use of Rituximab in the treatment of two patients with autoimmune cytopenias …

Genetic Diversity Among Plasmodium Falciparum Field Isolates In Pakistan Measured With Pcr Genotyping Of The Merozoite Surface Protein 1 And 2, Najia Ghanchi, Andreas Martensson, Johan Ursing, Sana Jafri, Sandor Bereczky, Rabia Hussain, Mohammad Asim Beg

Department of Pathology and Laboratory Medicine

Background:The genetic diversity of Plasmodium falciparum has been extensively studied in various parts of the world. However, limited data are available from Pakistan. This study aimed to establish molecular characterization of P. falciparum field isolates in Pakistan measured with two highly polymorphic genetic markers, i.e. the merozoite surface protein 1 (msp-1) and 2 (msp-2).
Methods:Between October 2005 and October 2007, 244 blood samples from Patients with symptomatic blood-slide confirmed P. falciparum mono-infections attending the Aga Khan University Hospital, Karachi, or its collection units located in Sindh and Baluchistan provinces, Pakistan were collected. The genetic diversity of P. falciparum …

Carcinosarcoma Of The Esophagus, Ziaur Rehman, Inam Pal, Zubair Ahmad, Asim Qureshi

Section of General Surgery

Carcinosarcoma of the esophagus is a rare neoplasm characterized histologically by presence of carcinomatous and sarcomatous elements. Case report of carcinosarcoma of the esophagogastric junction whose morphological and immunohistochemical features makes it quite distinctive from other tumours is presented. It was an ulcerated lesion diagnosed in an elderly Afghan lady located 34 cms from the incisor teeth. The patient was a smoker.

Treatment Of Asymptomatic Carriers With Artemether-Lumefantrine: An Opportunity To Reduce The Burden Of Malaria?, B. Ogutu, A.B. Tiono, M. Makanga, Zul Premji, A.D. Gbadoe, D. Ubben, A.C. Marrast, O. Gaye

Pathology, East Africa

Background: Increased investment and commitment to malaria prevention and treatment strategies across Africa has produced impressive reductions in the incidence of this disease. Nevertheless, it is clear that further interventions will be necessary to meet the international target of a reversal in the incidence of malaria by 2015. This article discusses the prospective role of an innovative malaria control strategy - the community-based treatment of asymptomatic carriers of Plasmodium falciparum, with artemisinin-based combination therapy (ACT). The potential of this intervention was considered by key scientists in the field at an Advisory Board meeting held in Basel, in April 2009. …

Assessing Gaps In Services For Geriatric Patients With Mental Health Needs, Angela Nelson

All Graduate Theses, Dissertations, and Other Capstone Projects

Older adults in southwest Minnesota have limited options regarding mental health services. Sanford Tracy Medical Center and Sanford Westbrook Medical Center sought to identify the needs of this population so they can better serve their patients. The following research questions were asked: Do local service providers feel gaps in services exist for older adults experiencing mental health needs in the rural southwestern Minnesota communities of Tracy and Westbrook and the surrounding areas? Do area service providers feel that geriatric patients would benefit from a mental health intervention implemented within the primary healthcare setting? A survey of area geriatric service providers …

Differential Gene Expression Profile Of Retinoblastoma Compared To Normal Retina., Arupa Ganguly, Carol L Shields

Wills Eye Hospital Papers

PURPOSE: The retinoblastoma gene (RB1) is a tumor suppressor gene that was first discovered in a rare ocular pediatric tumor called retinoblastoma (RB). The RB1 gene is essential for normal progression through the cell cycle and exerts part of its function through the family of transcription factors (E2F) and many other intermediaries. In the absence of normal RB1, genomic instability and chromosomal aberrations accumulate, leading to tumor initiation, progression, and ultimately metastasis. The purpose of this report was to identify the molecular pathways that are deregulated in retinoblastoma.

METHODS: We compared gene expression signatures of matched normal retinal tissue and …

Differential Genome-Wide Array–Based Methylation Profiles In Prognostic Subsets Of Chronic Lymphocytic Leukemia, Meena Kanduri, Nicola Cahill, Hanna Göransson, Camilla Enström, Fergus Ryan, Anders Isaksson, Richard Rosenquist

Articles

Global hypomethylation and regional hypermethylation are well-known epigenetic features of cancer; however, in chronic lymphocytic leukemia (CLL), studies on genome-wide epigenetic modifications are limited. Here, we analyzed the global methylation profiles in CLL, by applying high-resolution methylation microarrays (27 578 CpG sites) to 23 CLL samples, belonging to the immunoglobulin heavy-chain variable (IGHV) mutated (favorable) and IGHV unmutated/IGHV3-21 (poor-prognostic) subsets. Overall, results demonstrated significant differences in methylation patterns between these subgroups. Specifically, in IGHV unmutated CLL, we identified methylation of 7 known or candidate tumor suppressor genes (eg, VHL, ABI3, and IGSF4) as well as 8 unmethylated genes involved in …

Evaluation Of Lumbosacral Orthosis In Flexion And Extension Movements Of Lumbar Spine., Norazian Abd Razak

Student Works (2010-2019)

Lumbosacral orthosis (LSO) is a type of spinal orthosis that has been recommended for abdominal support, pain management, and motion or positional control. By implemented radiographic technique, objectives of this study was to evaluate the changes of lumbar lordosis in flexion and extension of trunk movements with and without wearing the LSO measured by Cobb, Centroid, and Posterior Tangent techniques and to correlate the value of lordotic angles in particular posture. Ten healthy male subjects without any history of low back pain participated and a semi-rigid LSO was utilized. Antero-posterior and lateral radiographs of spine images during neutral, flexion, and …

Identification Of A Novel Cytokine Inducible Stat5 Phosphoserine Site (Ps193) That Positively Regulates Its Transcriptional Activity And Is Found Constitutively Activated In Certain Hematopoietic Cancers, Abhisek Mitra

Open Access Theses & Dissertations

Hematological malignancies such as leukemia and lymphoma, can develop from aberrant changes in the cell signaling molecules to drive their uncontrolled cellular proliferation and differentiation. Activation, maturation, expansion and differentiation of T cells are critically regulated by the dynamics of various transcription factors activated by a variety of cytokines. Additionally, multiple effector molecules that mediate these T cells dependent signals include the JAK (Janus Kinase)-STAT (Signal transducer and activator of transcription) cascade. These signaling proteins are activated in response to a broad array of cytokines. Constitutively activated JAKs and STATs have been described in several T cell malignancies. A growing …

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 …

Helicobacter Pylori: Prevalence And Antibiotic Susceptibility Among Kenyans, Andrew Nyerere Kimang’A, Gunturu Revathi, Samuel Kariuki, Shahin Sayed, Smita Devani

Pathology, East Africa

Background. Helicobacter pylori infection in Kenya is staggeringly high. Evidence links infection of the gastric mucosa by H. pylori with subsequent development of gastric pathologies.

Aim. We investigated the prevalence of H. pylori in dyspeptic patients, its relationship with gastric pathologies, and associated antibiotic susceptibility profiles, and compared two media to find the appropriate medium that enhances growth and expedites culture and isolation.

Methods. Rapid urease and histological tests were used to screen for H. pylori. Culture was performed to test sensitivity and evaluate media. Selective and nutritional supplements were added to culture media (Colombia blood agar and brainheart infusion …

Population Pharmacokinetics And Pharmacodynamics Of Artemether And Lumefantrine During Combination Treatment In Children With Uncomplicated Falciparum Malaria In Tanzania, S.F. Hietala, A. Martensson, B. Ngasala, S. Dahlstrom, N. Lindegardh, A. Annerberg, Zul Premji, A. Farnert, P. Gil, A. Bjorkman, M. Ashton

Pathology, East Africa

The combination of artemether (ARM) and lumefantrine is currently the first-line treatment of uncomplicated falciparum malaria in mainland Tanzania. While the exposure to lumefantrine has been associated with the probability of adequate clinical and parasitological cure, increasing exposure to artemether and the active metabolite dihydroartemisinin (DHA) has been shown to decrease the parasite clearance time. The aim of this analysis was to describe the pharmacokinetics and pharmacodynamics of artemether, dihydroartemisinin, and lumefantrine in African children with uncomplicated malaria. In addition to drug concentrations and parasitemias from 50 Tanzanian children with falciparum malaria, peripheral parasite densities from 11 asymptomatic children were …