Digital Commons Network^™

Impact Of Vitamin A Supplementation On Infant And Childhood Mortality, Aamer Imdad, Mohammad Yawar Yakoob, Christopher Sudfeld, Batool A. Haider, Robert E. Black, Zulfiqar Ahmed Bhutta

Woman and Child Health

Introduction:Vitamin A is important for the integrity and regeneration of respiratory and gastrointestinal epithelia and is involved in regulating human immune function. It has been shown previously that vitamin A has a preventive effect on all-cause and disease specific mortality in children under five. The Purpose of this paper was to get a point estimate of efficacy of vitamin A supplementation in reducing cause specific mortality by using Child Health Epidemiology Reference Group (CHERG) guidelines.

Methods:

A literature search was done on PubMed, Cochrane Library and WHO regional data bases using various free and Mesh terms for vitamin A …

Preventive Zinc Supplementation In Developing Countries: Impact On Mortality And Morbidity Due To Diarrhea, Pneumonia And Malaria, Mohammad Yawar Yakoob, Evropi Theodoratou, Afshan Jabeen, Aamer Imdad, Thomas P. Eisele, Joy Ferguson, Arnoupe Jhass, Igor Rudan, Harry Campbell, Robert E. Black, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background:Zinc deficiency is commonly prevalent in children in developing countries and plays a role in decreased immunity and increased risk of infection. Preventive zinc supplementation in healthy children can reduce mortality due to common causes like diarrhea, pneumonia and malaria. The main objective was to determine all-cause mortality and cause-specific mortality and morbidity in children under five in developing countries for preventive zinc supplementation. Data sources/review methods: A literature search was carried out on PubMed, the Cochrane Library and the WHO regional databases to identify RCTs on zinc supplementation for greater than 3 months in children less than 5 …

An Evaluation Of The Emerging Interventions Against Respiratory Syncytial Virus (Rsv)-Associated Acute Lower Respiratory Infections In Children, Harish Nair, Vasundhara R. Verma, Evropi Theodoratou, Lina Zgaga, Tanvir Huda, Eric Af Simoes, Peter F. Wright, Igor Rudan, Harry Campbell

Dartmouth Scholarship

Background: Respiratory Syncytial Virus (RSV) is the leading cause of acute lower respiratory infections (ALRI) in children. It is estimated to cause approximately 33.8 million new episodes of ALRI in children annually, 96% of these occurring in developing countries. It is also estimated to result in about 53,000 to 199,000 deaths annually in young children. Currently there are several vaccine and immunoprophylaxis candidates against RSV in the developmental phase targeting active and passive immunization.

Methods: We used a modified CHNRI methodology for setting priorities in health research investments. This was done in two stages. In Stage I, we systematically reviewed …

Effect Of Case Management On Neonatal Mortality Due To Sepsis And Pneumonia, Anita K. M. Zaidi, Hammad A. Ganatra, Sana Syed, Simon Cousens, Anne C. C. Lee, Robert Black, Zulfiqar A. Bhutta, Joy E. Lawn

Department of Paediatrics and Child Health

Background: Each year almost one million newborns die from infections, mostly in low-income countries. Timely case management would save many lives but the relative mortality effect of varying strategies is unknown. We have estimated the effect of providing oral, or injectable antibiotics at home or in first-level facilities, and of in-Patient hospital care on neonatal mortality from pneumonia and sepsis for use in the Lives Saved Tool (LiST). Methods: We conducted systematic searches of multiple databases to identify relevant studies with mortality data. Standardized abstraction tables were used and study quality assessed by adapted GRADE criteria. Meta-analyses were undertaken where …

Com Outlook Spring 2011, College Of Osteopathic Medicine

COM Outlook

No abstract provided.

Multicentric Hepatic Ebv-Associated Smooth Muscle Tumors In An Aids Patient: A Case Report, Investigation Of Mtor Activation And Review Of The Literature, Qi Shen, Wei Feng, Michael S Long, Xiuzhen Duan, Siraya Jaijakul, Cesar A Arias, Robert E Brown, Bihong Zhao

Faculty, Staff and Student Publications

Epstein-Barr virus (EBV) - associated smooth muscle tumors (EBV-SMT) are a rare, recently recognized distinct group of mesenchymal tumors that develop exclusively in patients with immunosuppression. It is believed that tumorigenesis is, at least in part, through the activation of the Akt/mammalian target of rapamycin (mTOR) signal pathway. We describe the clinicopathologic and immunohistochemical features of a multifocal hepatic EBV-SMT in a 34-year-old acquired immunodeficiency syndrome (AIDS) patient and investigate the activation status of the mTOR signal pathway in this tumor. In addition, we provide a review of the literature on the clinicopathologic findings of hepatic EBV-SMT in adult AIDS …

Evaluation Of A Novel Non-Penetrating Electrode For Use In Dna Vaccination, Amy Donate, Domenico Coppola, Yolmari Cruz, Richard Heller

Bioelectrics Publications

Current progress in the development of vaccines has decreased the incidence of fatal and non-fatal infections and increased longevity. However, new technologies need to be developed to combat an emerging generation of infectious diseases. DNA vaccination has been demonstrated to have great potential for use with a wide variety of diseases. Alone, this technology does not generate a significant immune response for vaccination, but combined with delivery by electroporation (EP), can enhance plasmid expression and immunity. Most EP systems, while effective, can be invasive and painful making them less desirable for use in vaccination. Our lab recently developed a non-invasive …

A Novel Approach For A New Era: Successful Integration Of Multidisciplinary, Hepatitis C Care Within An Established Hiv Primary Care Practice, Joseph L. Yozviak Do, Facp, Orlando J. Penaloza Md, Facp, Timothy J. Friel Md

Department of Medicine

No abstract provided.

Advances And Future Challenges In Adenoviral Vector Pharmacology And Targeting, Reeti Khare, Christopher Y. Chen, Eric A. Weaver, Michael A. Barry

Nebraska Center for Virology: Faculty Publications

Adenovirus is a robust vector for therapeutic applications, but its use is limited by our understanding of its complex in vivo pharmacology. In this review we describe the necessity of identifying its natural, widespread, and multifaceted interactions with the host since this information will be crucial for efficiently redirecting virus into target cells. In the rational design of vectors, the notion of overcoming a sequence of viral “sinks” must be combined with re-targeting to target populations with capsid as well as shielding the vectors from pre-existing or toxic immune responses. It must also be noted that most known adenoviral pharmacology …

Dimensions Of Aging And Belonging For The Older Person And The Effects Of Ageism, Laurence C. Nolan

Brigham Young University Journal of Public Law

No abstract provided.

Whole-Genome Sequencing Of Staphylococcus Aureus Strain Rn4220, A Key Laboratory Strain Used In Virulence Research, Identifies Mutations That Affect Not Only Virulence Factors But Also The Fitness Of The Strain, Dhanalakshmi Nair, Guido Memmi, David Hernandez, Jonathan Bard, Marie Beaume, Steven Gill, Patrice Francois, Ambrose L. Cheung

Dartmouth Scholarship

Staphylococcus aureus RN4220, a cloning intermediate, is sometimes used in virulence, resistance, and metabolic studies. Using whole-genome sequencing, we showed that RN4220 differs from NCTC8325 and contains a number of genetic polymorphisms that affect both virulence and general fitness, implying a need for caution in using this strain for such studies.

Enhanced Neutralization Potency Of Botulinum Neurotoxin Antibodies Using A Red Blood Cell-Targeting Fusion Protein., Sharad P Adekar, Andrew T Segan, Cindy Chen, Rodney Bermudez, M D Elias, Bernard H Selling, B P Kapadnis, Lance L Simpson, Paul M Simon, Scott K Dessain

Division of Infectious Diseases and Environmental Medicine Faculty Papers

Botulinum neurotoxin (BoNT) potently inhibits cholinergic signaling at the neuromuscular junction. The ideal countermeasures for BoNT exposure are monoclonal antibodies or BoNT antisera, which form BoNT-containing immune complexes that are rapidly cleared from the general circulation. Clearance of opsonized toxins may involve complement receptor-mediated immunoadherence to red blood cells (RBC) in primates or to platelets in rodents. Methods of enhancing immunoadherence of BoNT-specific antibodies may increase their potency in vivo. We designed a novel fusion protein (FP) to link biotinylated molecules to glycophorin A (GPA) on the RBC surface. The FP consists of an scFv specific for murine GPA fused …

Improving Outcomes For Hispanic Patients Undergoing Peginterferon/Ribavirin Therapy For Chronic Hepatitis C In An Internist-Led, Multidisciplinary, Multi-Cultural Practice: A Unique Application Of The Medical, Joseph L. Yozviak Do, Facp, Orlando J. Penaloza Md, Facp, Judith A. Knoop

Department of Medicine

No abstract provided.

Urological Involvement In Renal Transplantation., Daniel D Sackett, Pooja Singh, Costas D Lallas

Department of Urology Faculty Papers

Historically, urologists were the primary surgeons in renal transplantation. Specialization and increased complexity of the field of transplantation, coupled with a de-emphasis of vascular surgical training in urology, has created a situation where many renal transplants are carried out by surgeons with a general surgery background. Because of its genitourinary nature, however, urological input in renal transplantation is still vital. For living donors, a urologist should be involved to help evaluate and prepare certain patients for eventual donation. This could involve both medical and surgical intervention. Additionally, urologists who carry out living donor nephrectomy maintain a sense of ownership in …

Septic Shock: Current Management And New Therapeutic Frontiers, R. Phillip Dellinger, Md

Division of Pulmonary, Allergy, and Critical Care Medicine Presentations and Grand Rounds

No audio is available for this presentation.

Dr. R. Phillip Dellinger is a Professor of Medicine who holds a faculty appointment in the Division of Pulmonary and Critical Care Medicine at the Robert Wood Johnson School of Medicine, University of Medicine and Dentistry of New Jersey. He is also the Vice-Chair, Department of Medicine and the Director, Medical/Surgical/Cardiovascular Surgical Intensive Care Unit at the Cooper Medical Center in Camden New Jersey. In 2006-2007, he was selected as South Jersey Top Docs by South Jersey Magazine. Dr. Dellinger's interests are in the treatment and outcomes of septic shock.

An Analysis Of The Clinical Practice Of Emergency Medicine In Public Emergency Centres In Kenya, Benjamin W. Wachira

Master of Medicine in Internal Medicine

Objectives: To describe the case mix, interventions, procedures and management of patients in public accident and emergency departments (A&Es) in Kenya. Methods: This was an observational study of patients who presented to 15 A&Es from 1 October to 31 December 2010. The study was conducted across Kenya in two national referral hospitals, five secondary level hospitals, and eight primary level hospitals. All patients presenting alive to the A&E during the 24 hour study period that were seen by a doctor or clinical officer were included in the study. A data collection form was completed by the primary investigator at the …

Primary Amebic Meningoencephalitis Caused By Naegleria Fowleri, Karachi, Pakistan., Sadia Shakoor, Mohammad Asim Beg,, Syed Faisal Mahmood, Rebecca Bandea, Rama Sriram, Fatima Noman, Farheen Ali,, Govinda S. Visvesvara, Afia Zafar

Department of Medicine

We report 13 cases of Naegleria fowleri primary amebic meningoencephalitis in persons in Karachi, Pakistan, who had no history of aquatic activities. Infection likely occurred through ablution with tap water. An increase in primary amebic meningoencephalitis cases may be attributed to rising temperatures, reduced levels of chlorine in potable water, or deteriorating water distribution systems.

Size Or The Number Of Portal Tracts: Which Matters In A Liver Biopsy Core In Chronic Hepatitis C?, Om Parkash, Khalid Mumtaz, Zubair Ahmed, Saeed Hamid, Fatima Jafri, Wasim Jafri

Section of Gastroenterology

Liver biopsy has an important role in staging of fibrosis (SoF) and grading of inflammation (GoI) in chronic hepatitis C (CHC) patients. The effect of size and number of portal tracts (NoP) on grading and staging of liver biopsy was evaluated. A total of 150 consecutive liver biopsy core (LBC) of patients with CHC were obtained. There were 98 (65.3%) males. Mean length of LBC was 1.45 ± 0.48 cm. Mean number of portal tracts (NoP) was 11±4.6. Mean length of LBC was greater (1.60±0.45 cm) in stage 4 (n=41; 27.3%) and lesser (1.28+0.39) in stage 1 (n=23; 15%, p=0.04). …

Comparative Gender Analysis Of The Efficacy And Safety Of Atazanavir/Ritonavir And Lopinavir/Ritonavir At 96 Weeks In The Castle Study., Kathleen E Squires, Margaret Johnson, Rong Yang, Jonathan Uy, Louise Sheppard, Judith Absalon, Donnie Mcgrath

Department of Medicine Faculty Papers

OBJECTIVES: To examine whether the overall results of the CASTLE study pertain to both genders, we analysed the efficacy and safety of atazanavir/ritonavir and lopinavir/ritonavir in 277 female and 606 male patients in the open-label, multinational trial over 96 weeks. The trial is registered with ClinicalTrials.gov, number NCT00272779.

METHODS: Treatment-naive patients aged ≥ 18 years with HIV-1 RNA ≥ 5000 copies/mL were randomized to receive either atazanavir/ritonavir 300/100 mg once daily or lopinavir/ritonavir 400/100 mg twice daily, with fixed-dose tenofovir/emtricitabine 300/200 mg once daily.

RESULTS: At week 96, confirmed virological response rates (HIV RNA <50 copies>/mL; intent-to-treat analysis) were higher in …

Prevalence Of Resistance Associated Polymorphisms In Plasmodium Falciparum Field Isolates From Southern Pakistan, Najia Karim Ghanchi, Johan Ursing, Mohammad A. Beg, Maria I. Veiga, Sana Jafri, Andreas Martensson

Department of Pathology and Laboratory Medicine

Background:Scarce data are available on Plasmodium falciparum anti-malarial drug resistance in Pakistan. The aim of this study was, therefore, to determine the prevalence of P. falciparum resistance associated polymorphisms in field isolates from southern Pakistan.
Methods:
Blood samples from 244 Patients with blood-slide confirmed P. falciparum mono-infections were collected between 2005-2007. Single nucleotide polymorphisms in the P. falciparum chloroquine resistance transporter (pfcrt K76T), multi drug resistance (pfmdr1 N86Y), dihydrofolate reductase (pfdhfr A16V, N51I, C59R, S108N, I164L) and dihydropteroate synthetase (pfdhps A436S, G437A and E540K) genes and pfmdr1 gene copy numbers were determined using PCR based methods.
Results:The prevalence …

Correcting Mortality For Loss To Follow-Up: A Nomogram Applied To Antiretroviral Treatment Programmes In Sub-Saharan Africa, Matthias Egger, Ben D. Spycher, John Sidle, Ralf Weigel, Elvin H. Geng, Matthew P. Fox, Patrick Macphail, Gilles Van Custem, Eugene Messou, Robin Wood, Denis Nash, Margaret Pascoe, Diana Dickinson

Publications and Research

Background

The World Health Organization estimates that in sub-Saharan Africa about 4 million HIV-infected patients had started antiretroviral therapy (ART) by the end of 2008. Loss of patients to follow-up and care is an important problem for treatment programmes in this region. As mortality is high in these patients compared to patients remaining in care, ART programmes with high rates of loss to follow-up may substantially underestimate mortality of all patients starting ART.

Methods and Findings

We developed a nomogram to correct mortality estimates for loss to follow-up, based on the fact that mortality of all patients starting ART in …

The Nurse's Knowledge Of Blood Conservation As A Part Of Blood Management, Lindsey Putnam Austin

Nursing Theses and Capstone Projects

Medicine has historically regarded blood transfusion as an integral component of major surgery or illness. However, clinical studies have shown that allogeneic blood transfusions are associated with increased morbidity and decreased survival. Knowledge of this research and the concepts of blood conservation so as to avoid unnecessary blood transfusions is needed in order to deliver holistic care and serve as patient advocate. This knowledge reaches every specialty of nursing care.

This study of the nurse's knowledge of blood conservation as a part of blood management utilizes The Conservation Model developed by Myra E. Levine in 1973. Levine's work is a …

Efficacy Of Limited Cefuroxime Prophylaxis In Pediatric Patients After Cardiovascular Surgery, Chad A. Knoderer, Elaine G. Cox, Michelle D. Berg, Andrea H. Webster, Mark W. Turrentine

Scholarship and Professional Work – COPHS

Purpose The efficacy of limited cefuroxime prophylaxis in pediatric patients after cardiovascular surgery was evaluated.

Methods All patients age 18 years or younger who underwent cardiovascular surgery and received postoperative care from the cardiovascular surgery team between February and July 2006 (preintervention group) and between August 2006 and January 2007 (postintervention group) were eligible for study inclusion. Patients were excluded if they did not receive cefuroxime as postoperative prophylaxis, had a preexisting infection, underwent cardiac transplantation or extracorporeal membrane oxygenation, or underwent delayed sternal closure. The preintervention group received prolonged cefuroxime prophylaxis, and the postintervention group received 24 hours of …

Graduate Medical Education 2010 Annual Report, Children's Mercy Hospital

GME Annual Reports

Annual report of the Children's Mercy Hospital Graduate Medical Education department, including pediatric residency, internal medicine/pediatrics residency, fellowship programs, medical students, continuing medical education, and library services.

Hyperphosphatemia In Pediatric Oncology Patients Receiving Liposomal Amphotericin B, Chad A. Knoderer, Holly M. Knoderer

Scholarship and Professional Work – COPHS

OBJECTIVE: After transitioning our front-line amphotericin product to the liposomal formulation, we observed an increased incidence of hyperphosphatemia. We aimed to determine the incidence of hyperphosphatemia in children with oncologic disorders receiving an amphotericin B product and to establish whether the incidence varies depending on amphotericin formulation.

METHODS: This retrospective review of the medical record was conducted at a tertiary, free standing children’s hospital. Pharmacy data revealed 159 patients receiving an amphotericin product between November 2006 and December 2008. Doses of amphotericin, serum phosphorous, calcium and creatinine concentrations were recorded at daily time points during the 10 days following both …

Research Annual Report 2010, Children's Mercy Hospital

Research Annual Reports

Annual report of the research at Children's Mercy Hospital in Kansas City MO, a pediatric medical center.

Graduate Medical Education 2010-2011 Annual Report, Children's Mercy Hospital

GME Annual Reports

Annual report of the Children's Mercy Hospital Graduate Medical Education department, including pediatric residency, internal medicine/pediatrics residency, fellowship programs, medical students, continuing medical education, and library services.

Children's Mercy Hospital Annual Report 2010, Children's Mercy Hospital

Children's Mercy Annual Reports

Annual report for The Children's Mercy Hospital in Kansas City MO, a pediatric medical center.

Evaluation Of Vancomycin Dosing And Corresponding Drug Concentrations In Pediatric Patients, Lauren Maurer Pharmd, Jenny Boucher Pharmd, Bcps, Ejd

Department of Pharmacy

No abstract provided.

Effect Of Clinical Laboratory Practitioner Licensing On Wages, Mary Hotaling

Walden Dissertations and Doctoral Studies

Professional licensing directly affects about 29% of U.S. workers and is considered a primary means to establish and maintain health care practitioner competence. Clinical laboratory practitioner licensing was largely ignored in the literature with only 2 studies 30 years apart that provided conflicting conclusions regarding wage effects. This research provided the first study of clinical laboratory practitioner licensing effects on wages after controlling for human capital and individual characteristics wage determinants. This nonexperimental correlational study extended the literature on licensing effects on wages, including women's wages and professions not uniformly licensed across 50 states. The theoretical foundation relied on the …