Digital Commons Network^™

Mental Health Services For Youth In The Eastern Mediterranean Region: Challenges And Opportunities (Editorial), Atif Rahman, Hesham M. Hamoda, Afarin Rahimi-Movaghar, Murad M. Khan Dr., Khalid Saeed

Department of Psychiatry

The Global Burden of Disease study shows that the burden from mental and substance use disorders, measured in Disability Adjusted Life Years (DALYs), has steadily risen in the Eastern Mediterranean Region (EMR) over the last three decades and is higher than the global average for almost all EMR countries). Even more alarming is the finding that depression, self-harm, anxiety and conduct disorders constitute four of the top 10 causes of DALYs among girls and boys aged 15-19 years and suicide is a leading cause of adolescent mortality.

Aortoduodenal Fistula Forms From Primary Aortic Stump Graft In A Two-Time Multi-Visceral Transplant Patient With Presentation Of Gastrointestinal Bleed And Bowel Perforation: A Case Report, Brielle Corrente

Graduate Student Research Symposium

Usually not diagnosed until open laparotomy, aortoduodenalfistulas (ADF) are one of the rarest complications of intestinal transplant surgery. With an incidence rate of only 0.04% at autopsy and only 250 documented cases since the early 1800’s, aortoduodenal fistulas are the most deadly complications of intestinal transplantation with a mortality rate of 100% without surgical intervention. A 39 year old, two-time multi-visceral transplant African American female patient suffered from a primary aortoduodenal fistula formation in a primary modified multi-visceral transplant aortic stump graft site. With emergency open laparotomy repair, revascularization of the secondary multi-visceral transplant was performed, saving the life of …

Lewy Body Dementia Association's Research Centers Of Excellence Program: Inaugural Meeting Proceedings., Bethany Peterson, Melissa Armstrong, Douglas Galasko, James E. Galvin, Jennifer Goldman, David Irwin, Henry Paulson, Daniel Kaufer, James Leverenz, Angela Lunde, Ian G. Mckeith, Andrew Siderowf, Angela Taylor, Katherine Amodeo, Matt Barrett, Kimiko Domoto-Reilly, John Duda, Stephen Gomperts, Neill Graff-Radford, Samantha Holden, Lawrence Honig, Daniel Huddleston, Carol Lippa, Irene Litvan, Carol Manning, Karen Marder, Charbel Moussa, Chiadi Onyike, Fernando Pagan, Alexander Pantelyat, Victoria Pelak, Kathleen Poston, Joseph Quinn, Irene Richard, Liana S. Rosenthal, Marwan Sabbagh, Douglas Scharre, Sharon Sha, Holly Shill, Yasar Torres-Yaghi, Tina Christie, Todd Graham, Ian Richards, Mike Koehler, Brad Boeve

Department of Neurology Faculty Papers

The first Lewy Body Dementia Association (LBDA) Research Centers of Excellence (RCOE) Investigator's meeting was held on December 14, 2017, in New Orleans. The program was established to increase patient access to clinical experts on Lewy body dementia (LBD), which includes dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD), and to create a clinical trials-ready network. Four working groups (WG) were created to pursue the LBDA RCOE aims: (1) increase access to high-quality clinical care, (2) increase access to support for people living with LBD and their caregivers, (3) increase knowledge of LBD among medical and allied (or …

Protecting Women And Children In Conflict Settings, Zulfiqar Ahmed Bhutta, Michelle F. Gaffey, Karl Blanchet, Ron Waldman, Kamran Abbasi

Department of Paediatrics and Child Health

No abstract provided.

Progress In Adolescent Health And Wellbeing: Tracking 12 Headline Indicators For 195 Countries And Territories, 1990–2016, Peter S. Azzopardi, Stephen J. C. Hearps, Kate L. Francis, Elissa C. Kennedy, Ali H. Mokdad, Nicholas J. Kassebaum, Stephen Lim, Caleb M. S. Irvine, Theo Vos, Alex D. Brown, Surabhi Dogra, Stuart A. Kinner, Natasha S. Kaoma, Mariam Naguib, Nicola J. Reavley, Jennifer Requejo, John S. Santelli, Susan M. Sawyer, Vegard Skirbekk, Marleen Temmerman, Jordan Tewhaiti-Smith, Joseph L. Ward, Russell M. Viner, George C. Patton

Obstetrics and Gynaecology, East Africa

Background: Rapid demographic, epidemiological, and nutritional transitons have brought a pressing need to track progress in adolescent health. Here, we present country-level estimates of 12 headline indicators from the Lancet Commission on adolescent health and wellbeing, from 1990 to 2016.

Methods: Indicators included those of health outcomes (disability-adjusted life-years [DALYs] due to communicable, maternal, and nutritional diseases; injuries; and non-communicable diseases); health risks (tobacco smoking, binge drinking, overweight, and anaemia); and social determinants of health (adolescent fertility; completion of secondary education; not in education, employment, or training [NEET]; child marriage; and demand for contraception satisfied with modern methods). We drew …

Current Athletic Training Educational Preparation For Dry Needling, Brian V. Hortz, Sue Falsone, Duncan Tulimieri

Journal of Sports Medicine and Allied Health Sciences: Official Journal of the Ohio Athletic Trainers Association

Purpose: Dry needling is an advanced practice skill that many athletic trainers are being trained to perform. The purpose of this study is to determine the degree to which the current athletic training educational competencies and standards prepare practitioners for the performance of dry needling tasks. Methods: An expert panel review was used to verify which of the dry needling tasks are currently taught through entry-level athletic education as defined by the 5^th edition competencies and 2020 standards. Results: Results demonstrated that 11% of the tasks were dry needling specific and these were regarded as not provided through entry-level …

Global Monitoring Of Antimicrobial Resistance Based On Metagenomics Analyses Of Urban Sewage, Rene S. Hendriksen, Patrick Munk, Patrick Njage, Bram Van Bunnik, Luke Mcnally, Oksana Lukjancenko, Timo Röder, David Nieuwenhuijse, Rumina Hasan, Sadia Shakoor

Department of Pathology and Laboratory Medicine

Antimicrobial resistance (AMR) is a serious threat to global public health, but obtaining representative data on AMR for healthy human populations is difficult. Here, we use metagenomic analysis of untreated sewage to characterize the bacterial resistome from 79 sites in 60 countries. We find systematic differences in abundance and diversity of AMR genes between Europe/North-America/Oceania and Africa/Asia/South-America. Antimicrobial use data and bacterial taxonomy only explains a minor part of the AMR variation that we observe. We find no evidence for cross-selection between antimicrobial classes, or for effect of air travel between sites. However, AMR gene abundance strongly correlates with socio-economic, …

Genetic Interaction Analysis Among Oncogenesis-Related Genes Revealed Novel Genes And Networks In Lung Cancer Development., Yafang Li, Xiangjun Xiao, Yohan Bossé, Olga Gorlova, Ivan Gorlov, Younghun Han, Jinyoung Byun, Natasha Leighl, Jakob S Johansen, Matt Barnett, Chu Chen, Gary E Goodman, Angela Cox, Fiona Taylor, Penella Woll, H Erich Wichmann, Judith Manz, Thomas Muley, Angela Risch, Albert Rosenberger, Jiali Han, Katherine Siminovitch, Susanne M Arnold, Eric B Haura, Ciprian Bolca, Ivana Holcatova, Vladimir Janout, Milica Kontic, Jolanta Lissowska, Anush Mukeria, Simona Ognjanovic, Tadeusz M Orlowski, Ghislaine Scelo, Beata Swiatkowska, David Zaridze, Per Bakke, Vidar Skaug, Shanbeh Zienolddiny, Eric J Duell, Lesley M Butler, Richard Houlston, María Soler Artigas, Kjell Grankvist, Mikael Johansson, Frances A Shepherd, Michael W Marcus, Hans Brunnström, Jonas Manjer, Olle Melander, David C Muller, Kim Overvad, Antonia Trichopoulou, Rosario Tumino, Geoffrey Liu, Stig E Bojesen, Xifeng Wu, Loic Le Marchand, Demetrios Albanes, Heike Bickeböller, Melinda C Aldrich, William S Bush, Adonina Tardon, Gad Rennert, M Dawn Teare, John K Field, Lambertus A Kiemeney, Philip Lazarus, Aage Haugen, Stephen Lam, Matthew B Schabath, Angeline S Andrew, Pier Alberto Bertazzi, Angela C Pesatori, David C Christiani, Neil Caporaso, Mattias Johansson, James D Mckay, Paul Brennan, Rayjean J Hung, Christopher I Amos

Articles, Abstracts, and Reports

The development of cancer is driven by the accumulation of many oncogenesis-related genetic alterations and tumorigenesis is triggered by complex networks of involved genes rather than independent actions. To explore the epistasis existing among oncogenesis-related genes in lung cancer development, we conducted pairwise genetic interaction analyses among 35,031 SNPs from 2027 oncogenesis-related genes. The genotypes from three independent genome-wide association studies including a total of 24,037 lung cancer patients and 20,401 healthy controls with Caucasian ancestry were analyzed in the study. Using a two-stage study design including discovery and replication studies, and stringent Bonferroni correction for multiple statistical analysis, we …

Genetic Interaction Analysis Among Oncogenesis-Related Genes Revealed Novel Genes And Networks In Lung Cancer Development, Yafang Li, Xiangjun Xiao, Yohan Bossé, Olga Gorlova, Ivan Gorlov, Younghun Han, Jinyoung Byun, Natasha Leighl, Jakob S. Johansen, Matt Barnett, Chu Chen, Gary Goodman, Angela Cox, Fiona Taylor, Penella Woll, H. Erich Wichmann, Judith Manz, Thomas Muley, Angela Risch, Albert Rosenberger, Jiali Han, Katherine Siminovitch, Susanne M. Arnold, Eric B. Haura, Ciprian Bolca, Ivana Holcatova, Vladimir Janout, Milica Kontic, Jolanta Lissowska, Anush Mukeria

Markey Cancer Center Faculty Publications

The development of cancer is driven by the accumulation of many oncogenesis-related genetic alterationsand tumorigenesis is triggered by complex networks of involved genes rather than independent actions. To explore the epistasis existing among oncogenesis-related genes in lung cancer development, we conducted pairwise genetic interaction analyses among 35,031 SNPs from 2027 oncogenesis-related genes. The genotypes from three independent genome-wide association studies including a total of 24,037 lung cancer patients and 20,401 healthy controls with Caucasian ancestry were analyzed in the study. Using a two-stage study design including discovery and replication studies, and stringent Bonferroni correction for multiple statistical analysis, we identified …

Geographical Variation And Predictors Of Physical Activity Level In Adults With Congenital Heart Disease., Lena Larsson, Bengt Johansson, Camilla Sandberg, Silke Apers, Adrienne Kovacs, Koen Luyckx, Corina Thomet, Werner Budts, Junko Enomoto, Maayke Sluman, Jou-Kou Wang, Jamie Jackson, Paul Khairy, Stephen Cook, Luis Alday, Katrine Eriksen, Mikael Dellborg, Malin Berghammer, Gwen Rempel, Samuel Menahem, Maryanne Caruana, Martha Tomlin, Alexandra Soufi, Susan Fernandes, Kamila White, Edward Callus, Shelby Kutty, Philip Moons

Psychology Faculty Works

Background: Physical activity is important to maintain and promote health. This is of particular interest in patients with congenital heart disease (CHD) where acquired heart disease should be prevented. The World Health Organization (WHO) recommends a minimum of 2.5 h/week of physical activity exceeding 3 metabolic equivalents (METS) to achieve positive health effects. It is unknown whether physical activity levels (PAL) in adult CHD patients differ by country of origin. Methods: 3896 adults with CHD recruited from 15 countries over 5 continents completed self-reported instruments, including the Health Behaviour Scale (HBS-CHD), within the APPROACH-IS project. For each patient, we calculated …

Improving Rural Pediatric Patient Management Through Streamlined High-Volume Patient Clinical Pathways Enhanced By Standardized Nursing Education For Care Confidence, Marie-Cassandre O. Macdonnell

Doctoral Projects

Rural America creates a challenging, poorly financed environment for pediatric health. More than 20 million Americans live in areas with physician shortages too great to meet basic health need (Petlz et al., 2013). In comparing rural versus urban data, rural population experience a 7% higher rate of chronic health conditions (44% versus 37%), increased inpatient costs ($8, 507 versus $7, 174) and higher odds ratios for pediatric 30-day readmission. Findings from Khan et al., (2015) note that hospital readmission rates have higher odds ratios in pediatric patients (95% CI); of Caucasian ethnicity 0.74 [0.65–0.84] to 0.88 [0.79–0.99]); when admitted to …

Nonalcoholic Fatty Liver Disease And The Pnpla3 Gene, Lori Houghton-Rahrig, Debra Schutte, Jenifer I. Fenton, Jennifer Awad

Peer Reviewed Articles

Nonalcoholic fatty liver disease (NAFLD) is a rapidly emerging worldwide public health concern strongly associated with obesity, insulin resistance/diabetes type 2, and the metabolic syndrome (Younossi et al., 2011). It is the most common cause of liver disease in the world (World Gastro - enterology Organisation [WGO], 2012). Defined as a total liver weight comprised of more than 5% fat, NAFLD can progress from simple fatty liver disease to nonalcoholic steatohepatitis with or without fibrosis, liver cirrhosis, liver cancer, or liver failure resulting in premature death (Levene & Goldin, 2012). The development and progression of NAFLD is influenced by genetic …

Femoral Vein Transposition Arteriovenous Fistula Is A Feasible Option In "Selected" Patients As Hemodialysis Access, Zia Ur Rehman, Asfia Arham, Ziad Sophie

Section of Cardiothoracic Surgery

Introduction: Lower extremity hemodialysis access is offered to the patients who have severe central venous stenosis. Femoral vein transposition arteriovenous fistula (FV tAVF) is an alternative to lower leg arteriovenous prosthetic grafts. Its safety and patency is under observation.
Materials and Methods: This is a retrospective review of patients who had FV tAVF between January 2011 and March 2016. Preoperative clinical findings, intraoperative findings, postoperative complications, and patency of the AVF were noted and analyzed.
Results: There were 7 patients who underwent FV tAVF during this study period. Most patients were female (6 : 1), with mean …

Relationship Between Dietary Intake And Obesity Among A Group Of Primary School-Aged Children In Cairo Governorate, Ahmed S. Marei, Hany H. El-Gazzar, Khaled Elkelany, Mohamed F. Al Soda, Saher A. Khairy, Salwa M. Saleh, Mahmood D. Al-Mendalawi

Journal of Medicine in Scientific Research

No abstract provided.

Effect Of 10-Valent Pneumococcal Conjugate Vaccine On The Incidence Of Radiologically-Confirmed Pneumonia And Clinically-Defined Pneumonia In Kenyan Children: An Interrupted Time-Series Analysis, Micah Silaba, Michael Ooko, Christian Bottomley, Joyce Sande, Rachel Benamore, Kate Park, James Ignas, Kathryn Maitland, Neema Mturi, Anne Makumi

Imaging & Diagnostic Radiology, East Africa

Background: Pneumococcal conjugate vaccines (PCV) are highly protective against invasive pneumococcal disease caused by vaccine serotypes, but the burden of pneumococcal disease in low-income and middle-income countries is dominated by pneumonia, most of which is non-bacteraemic. We examined the effect of 10-valent PCV on the incidence of pneumonia in Kenya.

Methods: We linked prospective hospital surveillance for clinically-defined WHO severe or very severe pneumonia at Kilifi County Hospital, Kenya, from 2002 to 2015, to population surveillance at Kilifi Health and Demographic Surveillance System, comprising 45000 children younger than 5 years. Chest radiographs were read according to a WHO standard. A …

Epithelioid Glioblastoma Presenting As Aphasia In A Young Adult With Ovarian Cancer: A Case Report, Megan M. Finneran, Joseph Georges, Michael Kakareka, Ryan Moncman, Miriam Enriquez, Todd Siegal, Gregory Kubicek, Alan Turtz, Steven S. Yocom, H Warren Goldman

PCOM Scholarly Works

Our patient's clinical history and preoperative radiographic evaluation suggested central nervous system (CNS) metastatic disease. Ultimately, final pathology revealed epithelioid glioblastoma (eGBM), a newly classified CNS primary tumor. This reinforces the importance of direct tissue sampling and including eGBM on the differential for young patients with histories of systemic cancer presenting with new CNS lesions.

Healthy Heart Africa-Kenya: A 12-Month Prospective Evaluation Of Program Impact On Health Care Providers' Knowledge And Treatment Of Hypertension, Elijah N. Ogola, Francis O. Okello, Jane L. Herr, Elizabeth Macgregor-Skinner, Ashling Mulvaney, Gerald Yonga

Internal Medicine, East Africa

Background: Given the rising burden of hypertension in Africa, the Healthy Heart Africa program was developed to improve access to quality hypertension care in the primary care setting. The Healthy Heart Africa program provides a comprehensive, coordinated intervention directed at health care providers (HCPs) and the general public.

Objective: The impact of Healthy Heart Africa on HCPs' knowledge of hypertension and facility-level services in Kenya was evaluated by a 12-month prospective study.

Methods: Intervention facilities were selected by stratified random sampling and matched to similar control facilities. Intervention facilities received a hypertension treatment protocol, equipment, training and patient education materials, …

Early Neonatal Vitamin A Supplementation And Infant Mortality: An Individual Participant Data Meta-Analysis Of Randomised Controlled Trials, Rajiv Bahl, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: Biannual vitamin A supplementation is a well-established survival tool for preschool children 6 months and older in vitamin A deficient populations but this schedule misses the opportunity to intervene on most young infant deaths. Randomised trials of neonatal vitamin A supplementation (NVAS) in the first few days of life to assess its impact on under 6-month mortality in low/middle-income countries have had varying results.
Methods: Investigators of 11 published randomised placebo-controlled NVAS trials (n=163 567 children) reanalysed their data according to an agreed plan and pooled the primary outcomes of mortality from supplementation through 6 and 12 months of …

Effect Of Conditioning Regimen Dose Reduction In Obese Patients Undergoing Autologous Hematopoietic Cell Transplantation., Claudio G. Brunstein, Marcelo C. Pasquini, Soyoung Kim, Mingwei Fei, Kehinde Adekola, Ibrahim A. Ahmed, Mahmoud Aljurf, Vaibhav Agrawal, Jeffrey J. Auletta, Minoo Battiwalla, Nelli Bejanyan, Joseph Bubalo, Jan Cerny, Lynette Chee, Stefan O. Ciurea, Cesar Freytes, Shahinaz M. Gadalla, Robert Peter Gale, Siddhartha Ganguly, Shahrukh K. Hashmi, Peiman Hematti, Gerhard Hildebrandt, Leona A. Holmberg, Oscar B. Lahoud, Heather Landau, Hillard M. Lazarus, Marcos De Lima, Vikram Mathews, Richard Maziarz, Taiga Nishihori, Maxim Norkin, Richard Olsson, Ran Reshef, Seth Rotz, Bipin Savani, Harry C. Schouten, Sachiko Seo, Baldeep M. Wirk, Jean Yared, Shin Mineishi, John Rogosheske, Miguel-Angel Perales

Manuscripts, Articles, Book Chapters and Other Papers

Data are limited on whether to adjust high-dose chemotherapy before autologous hematopoietic cell transplant (autoHCT) in obese patients. This study explores the effects of dose adjustment on the outcomes of obese patients, defined as body mass index (BMI) ≥ 30 kg/m2. Dose adjustment was defined as a reduction in standard dosing ≥20%, based on ideal, reported dosing and actual weights. We included 2 groups of US patients who had received autoHCT between 2008 and 2014. Specifically, we included patients with multiple myeloma (MM, n = 1696) treated with high-dose melphalan and patients with Hodgkin or non-Hodgkin lymphomas (n = 781) …

Effectiveness Of 10-Valent Pneumococcal Conjugate Vaccine Against Vaccine-Type Invasive Pneumococcal Disease In Pakistan, Atif Riaz, Syed Mohiuddin, Sara Husain, Mohammad Tahir Yousafzai, Muhammad Sajid, Furqan Kabir, Najeeb Rehman, Waseem Mirza, Basit Salam, Naila Naila, Khatidja Pardhan, Anita K. M. Zaidi, Syed Asad Ali

Department of Paediatrics and Child Health

Objective: To assess the effectiveness of 10-valent pneumococcal conjugate vaccine (PCV10) against invasive pneumococcal disease (IPD) due to vaccine serotypes of Streptococcus pneumoniae post introduction of the vaccine into the routine immunization program in Pakistan.
Methods: A matched case-control study was conducted at 16 hospitals in Sindh Province, Pakistan. Children aged (eligible to receive PCV10) who presented with radiographically confirmed pneumonia and/or meningitis were enrolled as cases. PCR for the lytA gene was conducted on blood (for radiographic pneumonia) and cerebrospinal fluid (for meningitis) samples to detect S. pneumoniae. The proportion of IPD due to vaccine serotypes (including vaccine-related serogroups) …

Can An Exercise-Based Educational And Motivational Intervention Be Durably Effective In Changing Compliance To Physical Activity And Anthropometric Risk In People With Type 2 Diabetes? A Follow-Up Study, Francesca Gallè, Jesse C. Krakauer, Nir Krakauer, Giuliana Valerio, Giorgio Liguori

Publications and Research

Aims. A nine-month motivational exercise-based intervention was previously offered to subjects with type 2 diabetes (T2D). A year after the end of the intervention, compliance to physical activity (PA) and anthropometric indices of participants were analyzed to evaluate the durability of its effects. Methods. PA levels, expressed as total energy expenditure per week, were assessed with the International Physical Activity Questionnaire (IPAQ). Changes in Body Mass Index (BMI), A Body Shape Index (ABSI), Hip Index (HI) z-scores, the relative mortality risk related to each of these measures, and a combined Anthropometric Risk Index (ARI) were also evaluated. Results. Of a …

Parallel Transjugular Intrahepatic Portosystemic Shunt With Viatorr® Stents For Primary Tips Insufficiency: Case Series And Review Of Literature, Driss Raissi, Qian Yu, Michael Nisiewicz, Steven Krohmer

Radiology Faculty Publications

BACKGROUND

Transjugular intrahepatic portosystemic shunts (TIPS) can alleviate complications of portal hypertension such as ascites and variceal bleeding by decreasing the portosystemic gradient. In limited clinical situations, parallel TIPS may be only solution to alleviate either variceal bleeding or ascites secondary to portal hypertension when the primary TIPS fails to do so. Data specifically addressing the use of this partially polytetrafluoroethylene covered nitinol stent (Viatorr^®) is largely lacking despite Viatorr^® being the current gold standard for modern TIPS placement.

CASE SUMMARY

All three patients had portal hypertension and already had a primary Viatorr^® TIPS placed previously. …

“Build A Bridge So You Can Cross It:” A Photo-Elicitation Study Of Health And Wellness Among Homeless And Marginally Housed Veterans, Keri L. Rodriguez, Lauren M. Broyles, Michael A. Mitchell, Melissa E. Wieland, Gala True, Adam J. Gordon

The Qualitative Report

As part of a photo-elicitation interview study, we aimed to describe homeless and marginally housed Veterans’ experiences with health and wellness, health decisions, and health-related behaviors. Twenty Veterans receiving Veterans Affairs Homeless Patient-Aligned Care Team care took photographs depicting health and wellness, then used their photographs to discuss the same topics in 30-60 minute audio-recorded, semi-structured photo-elicitation interviews. Transcripts were analyzed using template analysis. Veterans described eight dimensions related to their health and wellness; physical, social, and environmental were most commonly discussed, followed by emotional, intellectual, spiritual, occupational, and financial wellness. Photographs contained literal and metaphorical depictions that were positively-oriented, …

Maternal And Gestational Influences On Childhood Blood Pressure., Bonita Falkner

Department of Medicine Faculty Papers

Exposures that contribute to a sub-optimal intrauterine environment can have an effect on the developing fetus. Impaired fetal growth that results in low birth weight is an established risk factor for cardio-metabolic disorders later in life. Recent epidemiologic and prospective cohort studies that include the maternal and gestational period have identified maternal and gestational conditions that confer increased risk for subsequent cardio-metabolic disorders in the absence of low birth weight. Maternal pre-conception health status, including chronic obesity and type 2 diabetes, increase risk for childhood obesity and obesity-related higher blood pressure (BP) in child offspring. Maternal gestational exposures, including gestational …

A Closer Look At Arsa Activity In A Patient With Metachromatic Leukodystrophy., Kathleen Doherty, S. Barron Frazier, Matthew Clark, Anna Childers, Sumit Pruthi, David A. Wenger, Jessica Duis

Department of Neurology Faculty Papers

Metachromatic leukodystrophy (MLD) is an autosomal recessive lysosomal storage disease mainly caused by a deficiency of arylsulfatase A activity. The typical clinical course of patients with the late infantile form includes a regression in motor skills with progression to dysphagia, seizures, hypotonia and death. We present a case of a 4-year-old female with rapidly progressive developmental regression with loss of motor milestones, spasticity and dysphagia. MRI showed volume loss and markedly abnormal deep white matter. Enzymatic testing in one laboratory showed arylsulfatase A activity in their normal range. However, extraction of urine showed a large increase in sulfatide excretion in …

Health Care Seeking For Maternal And Newborn Illnesses In Low- And Middle-Income Countries: A Systematic Review Of Observational And Qualitative Studies, Zohra S. Lassi, Philippa Middleton, Zulfiqar Ahmed Bhutta, Caroline Crowther

Woman and Child Health

Background: In low- and middle-income countries, a large number of maternal and newborn deaths occur due to delays in health care seeking. These delays occur at three levels i.e. delay in making decision to seek care, delay in access to care, and delay in receiving care. Factors that cause delays are therefore need to be understand to prevent and avoid these delays to improve health and survival of mothers and babies.
Methods: A systematic review of observational and qualitative studies to identify factors and barriers associated with delays in health care seeking.
Results: A total of 159 observational and qualitative …

Toxoplasma Gondii Igg Associations With Sleepwake Problems, Sleep Duration And Timing, Celine C. Corona, Ma Zhang, Abhishek Wadhawan, Melanie L. Daue, Maureen W. Groer, Aline Dagang, Christopher A. Lowry, Kathleen A. Ryan, Andrew J. Hoisington, John W. Stiller, Dietmar Fuchs, Braxton D. Mitchell, Teodor T. Postolache

Faculty Publications

Background: Evidence links Toxoplasma gondii (T. gondii), a neurotropic parasite, with schizophrenia, mood disorders and suicidal behavior, all of which are associated and exacerbated by disrupted sleep. Moreover, low-grade immune activation and dopaminergic overstimulation, which are consequences of T. gondii infection, could alter sleep patterns and duration. Methods: Sleep data on 833 Amish participants [mean age (SD) = 44.28 (16.99) years; 59.06% women] were obtained via self-reported questionnaires that assessed sleep problems, duration and timing. T. gondii IgG was measured with ELISA. Data were analyzed using multivariable logistic regressions and linear mixed models, with adjustment for age, sex and family …

Early Progression Of Krabbe Disease In Patients With Symptom Onset Between 0 And 5 Months., Maria L. Beltran-Quintero, Nicholas A. Bascou, Michele D. Poe, David A. Wenger, Carlos A. Saavedra-Matiz, Matthew J. Nichols, Maria L. Escolar

Department of Neurology Faculty Papers

BACKGROUND: Krabbe disease is a rare neurological disorder caused by a deficiency in the lysosomal enzyme, β-galactocerebrosidase, resulting in demyelination of the central and peripheral nervous systems. If left without treatment, Krabbe disease results in progressive neurodegeneration with reduced quality of life and early death. The purpose of this prospective study was to describe the natural progression of early onset Krabbe disease in a large cohort of patients.

METHODS: Patients with early onset Krabbe disease were prospectively evaluated between 1999 and 2018. Data sources included diagnostic testing, parent questionnaires, standardized multidisciplinary neurodevelopmental assessments, and neuroradiological and neurophysiological tests.

RESULTS: We …

Early Dexamethasone Administration In Adults With Suspected Meningitis Lowers Morbidity And Mortality, Dana Siegel

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of de Gans J, van de Beek D, Investigators EDiABMS. Dexamethasone in adults with bacterial meningitis. New Eng J Med. 2002;347(20):1549-1556. doi: 10.1056/NEJMoa021334.

Pharmacological And Non-Pharmacological Treatments For The Neonatal Abstinence Syndrome (Nas)., A. K. Mangat, G. M. Schmölzer, W. K. Kraft

Department of Pharmacology and Experimental Therapeutics Faculty Papers

Neonatal abstinence syndrome is defined by signs and symptoms of withdrawal that infants develop after intrauterine maternal drug exposure. All infants with documented in utero opioid exposure, or a high pre-test probability of exposure should have monitoring with a standard assessment instrument such as a Finnegan Score. A Finnegan score of >8 is suggestive of opioid exposure, even in the absence of declared use during pregnancy. At least half of infants in most locales can be treated without the use of pharmacologic means. For this reason, symptom scores will drive the decision for pharmacologic therapy. Nevertheless, all infants, regardless of …