Digital Commons Network^™

Postnatal Growth Standards For Preterm Infants: The Preterm Postnatal Follow-Up Study Of The Intergrowth-21st Project, José Villar, Francesca Giuliani, Zulfiqar A. Bhutta, Enrico Bertino, Eric O. Ohuma, Leila Cheikh Ismail, Fernando C. Barros, Douglas G. Altman, Cesar Victora, Julia A. Noble, Michael G. Gravett, Manorama Purwar, Ruyan Pang, Ann Lambert, Aris T. Papageorghiou, Roseline Ochieng, Yasmin A. Jaffer, Stephen H. Kennedy

Paediatrics and Child Health, East Africa

Background: Charts of size at birth are used to assess the postnatal growth of preterm babies on the assumption that extrauterine growth should mimic that in the uterus.

Methods: The INTERGROWTH-21st Project assessed fetal, newborn, and postnatal growth in eight geographically defined populations, in which maternal health care and nutritional needs were met. From these populations, the Fetal Growth Longitudinal Study selected low-risk women starting antenatal care before 14 weeks’ gestation and monitored fetal growth by ultrasonography. All preterm births from this cohort were eligible for the Preterm Postnatal Follow-up Study, which included standardised anthropometric measurements, feeding practices based on …

A Prospective Analysis Of Factors Associated With Decreased Physical Activity In Patients With Cirrhosis Undergoing Transplant Evaluation, Anna Christina Dela Cruz, Valery Vilchez, Sooyeon Kim, Benjamin Barnes, Abhishek Ravinuthala, Anthony Zanni, Roberto Galuppo, Achuthan Sourianarayanane, Trushar Patel, Erin Colleen Maynard, Malay B. Shah, Michael F. Daily, Timothy L. Uhl, Karyn A. Esser, Roberto Gedaly

Internal Medicine Faculty Publications

BACKGROUND: Physical activity has been associated with improved recovery time after transplantation. Handgrip strength has been related to post-transplant outcomes.

AIM: To evaluate predictors of physical activity and grip strength in cirrhotic patients undergoing liver transplant evaluation.

METHODS: Single center, prospective analysis.

RESULTS: A hundred patients were evaluated (54% male, mean age 53 ± 9). Common etiologies of liver disease were non-alcoholic hepatitis (27%), hepatitis C (22%), and alcoholic liver disease (21%). Mean MELD score was 13.5. Forty one percent had a history of smoking. Ninety-three patients completed the International Physical Activity Questionnaire. The median total physical activity score of …

Residual Impact Of Previous Injury On Musculoskeletal Characteristics In Special Forces Operators, Jeffrey J. Parr, Nicholas C. Clark, John P. Abt, Julie Y. Kresta, Karen A. Keenan, Shawn F Kane, Scott M. Lephart

Physical Therapy Faculty Publications

Background: Musculoskeletal injuries are a significant burden to United States Army Special Operations Forces. The advanced tactical skill level and physical training required of Army Special Operators highlights the need to optimize musculoskeletal characteristics to reduce the likelihood of suffering a recurrent injury.

Purpose: To identify the residual impact of previous injury on musculoskeletal characteristics.

Study Design: Cross-sectional study; Level of evidence, 3.

Methods: Isokinetic strength of the knee, shoulder, and back and flexibility of the shoulder and hamstrings were assessed as part of a comprehensive human performance protocol, and self-reported musculoskeletal injury history was obtained. Subjects were stratified based …

Role Of Acute Pain Service In Optimizing Postoperative Pain Relief In A Tertiary Care Teaching Hospital, Aliya Ahmed, Muhammad Yasir

Department of Anaesthesia

Objective: To assess the frequency and types of adjustments that acute pain service makes to postoperative analgesic regimes to improve pain relief or treat side effects.Methods: The prospective observational study was conducted at the Aga Khan University Hospital, Karachi, from December 1, 2012, to March 31, 2013. Data was collected from Acute Pain Service register four hours after the pain rounds by a Service member not involved in rounds. Data was collected on a standardised form and analysed using SPSS 19.Results: Of the 323 patients, 209(65%) were receiving epidural infusions and 114(35%) were receiving intravenous patient-controlled analgesia. Overall, 114(35%) required …

Residual Barriers For Utilization Of Maternal And Child Health Services: Community Perceptions From Rural Pakistan., Zahid Memon, Shehla Zaidi, Atif Riaz

Community Health Sciences

Low utilization of maternal and child care services in rural areas has constrained Pakistan from meeting targets of Millennium Development Goals (MDGs) 4 and 5. This study explores community barriers in accessing Maternal and Child Health (MCH) services in ten remote rural districts of Pakistan. It further presents how the barriers differ across a range of MCH services, and also whether the presence of Community Health Workers (CHWs) reduces client barriers. Qualitative methods were used involving altogether sixty focus group discussions with mothers, their spouses and community health workers. Low awareness, formidable distances, expense, and poorly functional services were the …

Can Contracted Out Health Facilities Improve Access, Equity, And Quality Of Maternal And Newborn Health Services? Evidence From Pakistan., Shehla Zaidi, Atif Riaz, F. Rabbani, Iqbal Azam Syed, Syeda Nida Imran, Nousheen Pradhan, Gul Nawaz Khan Nawaz Khan

Community Health Sciences

BACKGROUND:

The case of contracting out government health services to non-governmental organizations (NGOs) has been weak for maternal, newborn, and child health (MNCH) services, with documented gains being mainly in curative services. We present an in-depth assessment of the comparative advantages of contracting out on MNCH access, quality, and equity, using a case study from Pakistan.

METHODS:

An end-line, cross-sectional assessment was conducted of government facilities contracted out to a large national NGO and government-managed centres serving as controls, in two remote rural districts of Pakistan. Contracting out was specific for augmenting MNCH services but without contractual performance incentives. A …

Trends In Management Of Neck Of Femur Fracture, Tashfeen Ahmad, Umair Ashraf, Omar Irfan, Zehra Abdul Muhammad

Department of Surgery Docs

Abstract

OBJECTIVE:

To identify trends related to surgical procedure for the management of neck of femur fracture to see how the choice is changing over time in relation to different age groups.

METHODS:

The retrospective audit was conducted at Aga Khan University Hospital, Karachi, and comprised data of all patients who presented with neck of femur fracture from 1995 to 2014. Patients with open fractures and those having external fixators were excluded. Data was retrieved from the hospital database, and analysed using SPSS 17.

RESULTS:

Records of 1039 patients were reviewed. The proportion of patients in the 70+ years age …

Velamentous Cord: A Dangerous Case Complicated By A Rural Population, Adam Franks, Md, Carolyn Curtis, Md, Shawndra Barker, Md

Marshall Journal of Medicine

A velamentous cord insertion occurs when the umbilical cord’s Wharton jelly fails to reach the placenta, due to early placental atrophy around the insertion site, leaving a segment of unprotected vessels running through the thin membranes of the amniotic sac. This area of weakness exposes a threat to the well-being of the fetus through acute hemorrhage and both acute and chronic restriction of nutrition. With advances in technology, resolution capabilities of ultrasounds allow for antenatal diagnosis, when previously this was impossible. With this knowledge, considerations for screening and management of this pathology are essential when dealing with a rural population …

Alkali Therapy In Lactic Acidosis, Zeid J. Khitan, Md, Deepak Malhotra, Md, Dominic S. Raj, Md, Antonios H. Tzamaloukas, Md, Joseph I. Shapiro, Md

Marshall Journal of Medicine

This report attempts to frame the debate about clinical administration of sodium bicarbonate in the setting of lactic acidosis in terms of simple questions. Specifically, we address why we develop lactic acidosis in some circumstances, how acute lactic acidosis impairs cardiovascular function and why sodium bicarbonate may have deleterious effects which limit its utility. We also attempt to explore treatment alternatives to sodium bicarbonate.

Interrater Variability In Identifying Ventilator Associated Pneumonia Using Six Different Definitions, Ahmad Nusair, Md, Balwinder Singh, Md, Ms., Shifang Ding, Md, Phd., Ognjen Gajic, Md, Guangxi Li, Md

Marshall Journal of Medicine

Objective

There is no widely accepted standard definition for Ventilator Associated Pneumonia (VAP). The reliability of the current definitions in use remains controversial. Our objective was to assess the reliability of six commonly used VAP definitions: The Loose, The Rigorous, The Modified Clinical Pulmonary Infection Score (CPIS), The Canadian Critical Care Trials Group (CCCTG), The International Sepsis Forum Consensus (ISFC) and The Center for Disease Control and Prevention (CDC).

Design

We examined the electronic health records of all the consecutively admitted adult patients at our institution who received invasive mechanical ventilation (IMV) for ≥ 48 hours, from January 2006 through …

Central Lines In Children, Rishi Agrawal, Neha H. Shah

E-Learning Modules

Children with special health care needs are increasingly prevalent in US hospitals. The pediatric hospitalist is often the primary provider of inpatient care for these patients. However, exposure to this patient population during training varies from provider to provider. No published educational curricula are specific to the inpatient care of this population.

This publication is a self-directed education module on central lines in children, including indications for placement, types of lines available, and prevention and treatment of complications. The module includes a PowerPoint slide show, instructor guide, and questions for assessment.

The purpose of this project is to build a …

Low-Income African American Women’S Perceptions Of Primary Care Physician Weight Loss Counseling: A Positive Deviance Study, Elaine Banerjee Md, Mph, Sharon J. Herring Md, Mph, Katherine Puskarz Mph, Neil Shah Mph, Kyle Yebernetsky Md, Katelyn E. Hurley Mph, Marianna Lanoue Phd

Department of Family Medicine

No abstract provided.

A Comparison Of Static Stretching Versus Combined Static And Ballistic Stretching In Active Knee Range Of Motion, Nathan R. Blackhurst, James C. Peterson, Valerie W. Herzog, Ericka P. Zimmerman

Internet Journal of Allied Health Sciences and Practice

Background: There is continued controversy related to flexibility gains from different stretching protocols and within single protocols. Stretching methods include static, ballistic, dynamic, and proprioceptive neuromuscular facilitation (PNF). A combination of stretching methods may be an improved way to increase active knee range of motion (ROM). This study evaluated a single program formulated with static and ballistic components. Objective: To compare active knee ROM following stretching programs which either included combined static and ballistic stretching (CSBS) or static stretching (SS) alone. It was hypothesized that CSBS would show a greater increase in active knee ROM than SS. Setting …

Pnaktide Inhibits Na/K-Atpase Reactive Oxygen Species Amplification And Attenuates Adipogenesis, Komal Sodhi, Kyle Maxwell, Yanling Yan, Jiang Liu, Muhammad Chaudhry, Morgan Getty, Zijian Xie, Nader G. Abraham, Joseph I. Shapiro Md

Biochemistry and Microbiology

Obesity has become a worldwide epidemic and is a major risk factor for metabolic syndrome. Oxidative stress is known to play a role in the generation and maintenance of an obesity phenotype in both isolated adipocytes and intact animals. Because we had identified that the Na/K-ATPase can amplify oxidant signaling, we speculated that a peptide designed to inhibit this pathway, pNaKtide, might ameliorate an obesity phenotype. To test this hypothesis, we first performed studies in isolated murine preadipocytes (3T3L1 cells) and found that pNaKtide attenuated oxidant stress and lipid accumulation in a dose-dependent manner. Complementary experiments in C57Bl6 mice fed …

Autophagy Protects Against Cyp2e1/Chronic Ethanol-Induced Hepatotoxicity, Yongke Lu, Arthur I. Cederbaum

Pharmacology, Physiology and Toxicology

Autophagy is an intracellular pathway by which lysosomes degrade and recycle long-lived proteins and cellular organelles. The effects of ethanol on autophagy are complex but recent studies have shown that autophagy serves a protective function against ethanol-induced liver injury. Autophagy was found to also be protective against CYP2E1-dependent toxicity in vitro in HepG2 cells which express CYP2E1 and in vivo in an acute alcohol/CYPE1-dependent liver injury model. The goal of the current report was to extend the previous in vitro and acute in vivo experiments to a chronic ethanol model to evaluate whether autophagy is also protective against CYP2E1-dependent liver …

The Trial Of Calcium And Vitamin D For The Prevention Of Colorectal Adenomas, John A. Baron, Elizabeth L. Barry, Leila A. Mott, Judy R. Rees

Dartmouth Scholarship

BACKGROUND Epidemiologic and preclinical data suggest that higher intake and serum levels of vitamin D and higher intake of calcium reduce the risk of colorectal neoplasia. To further study the chemopreventive potential of these nutrients, we conducted a randomized, double-blind, placebo-controlled trial of supplementation with vitamin D, calcium, or both for the prevention of colorectal adenomas. METHODS We recruited patients with recently diagnosed adenomas and no known colorectal polyps remaining after complete colonoscopy. We randomly assigned 2259 participants to receive daily vitamin D3 (1000 IU), calcium as carbonate (1200 mg), both, or neither in a partial 2Å~2 factorial design. Women …

Mitochondrial Mass, A New Metabolic Biomarker For Stem-Like Cancer Cells: Understanding Wnt/Fgf-Driven Anabolic Signaling., Rebecca Lamb, Gloria Bonuccelli, Béla Ozsvári, Maria Peiris-Pagès, Marco Fiorillo, Duncan L Smith, Generoso Bevilacqua, Chiara Maria Mazzanti, Liam A Mcdonnell, Antonio Giuseppe Naccarato, Maybo Chiu, Luke Wynne, Ubaldo E Martinez-Outschoorn, Federica Sotgia, Michael P. Lisanti

Kimmel Cancer Center Faculty Papers

Here, we developed an isogenic cell model of "stemness" to facilitate protein biomarker discovery in breast cancer. For this purpose, we used knowledge gained previously from the study of the mouse mammary tumor virus (MMTV). MMTV initiates mammary tumorigenesis in mice by promoter insertion adjacent to two main integration sites, namely Int-1 (Wnt1) and Int-2 (Fgf3), which ultimately activates Wnt/β-catenin signaling, driving the propagation of mammary cancer stem cells (CSCs). Thus, to develop a humanized model of MMTV signaling, we over-expressed WNT1 and FGF3 in MCF7 cells, an ER(+) human breast cancer cell line. We then validated that MCF7 cells …

Vascular Ring In An Adolescent Patient With Nausea And Mild Dysphagia, Kristen Kametz Crnp

Department of Pediatrics

No abstract provided.

Enhanced Fitness And Renal Function In Type 2 Diabetes., Eric S. Nylen, S. M. Gandhi, Raya E. Kheirbek, Peter Kokkinos

Medicine Faculty Publications

Aims

To investigate the renal effects of fitness in people with diabetes with mild renal dysfunction.

Methods

The effect of a 12-week exercise programme on estimated GFR in 128 people with diabetes was evaluated.

Results

All cardiometabolic variables improved after 12 weeks of supervised exercise. Although there was a modest 3.9% increase in estimated GFR from baseline in the 128 people who completed the study, those with baseline chronic kidney disease stages 2 and 3 were found to have significant (6 and 12%, respectively; p < 0.01) improvements in post-exercise estimated GFR. Moreover, 42% of the people with chronic kidney disease stage 3 improved to chronic kidney disease stage 2 after the intervention.

Conclusion

Short-term exercise improves renal function in those with more moderate baseline chronic kidney disease. …

Women With Disabilities: Reproductive Care And Women’S Health, Stephanie Stockburger, Hatim A. Omar

Pediatrics Faculty Publications

Children, adolescents, and women with disabilities experience the same sexual development, pubertal changes, concerns, and desire to reproduce as their typically developing counterparts. However, society has tended to stigmatize women with disabilities as “asexual” and ignore this aspect of their health care. These women are less likely to receive gynecological exams, contraception, and evaluation of sexual dysfunction. Unfortunately, having a disability places women at risk for sexual exploitation and abuse as well as sexually transmitted infections. Therefore, reproductive health care for these women is imperative. A number of barriers to receiving reproductive care exist. However, with proper education and knowledge …

Dietary Almonds Increase Serum Hdl Cholesterol In Coronary Artery Disease Patients In A Randomized Controlled Trial., Humaira Jamshed, Fateh Ali Tipoo Sultan, Romaina Iqbal, Anwar Gilani

Section of Cardiology

Background: More than one-half of coronary artery disease (CAD) patients have low HDL cholesterol despite having well-managed LDL cholesterol. Almond supplementation has not been shown to elevate circulating HDL cholesterol concentrations in clinical trials, perhaps because the baseline HDL cholesterol of trial subjects was not low.

Objective: This clinical trial was designed to test the effect of almond supplementation on low HDL cholesterol in CAD patients.

Methods: A total of 150 CAD patients (50 per group), with serum LDL cholesterol ≤100 mg/dL and HDL cholesterol ≤40 mg/dL in men and ≤50 mg/dL in women, were recruited from the Aga Khan …

Isoniazid Induced Motor-Dominant Neuropathy, Rabeeya Arsalan, Saniya Sabzwari

Department of Family Medicine

Isoniazid though a very effective treatment for tuberculosis can cause severe motor-dominant neuropathy which can be reversible with pyridoxine supplementation. A 45-year-old female diagnosed with psoas abscess, culture positive for mycobacterium tuberculosis, was started on anti- tuberculous treatment with four drugs, including isoniazid at a dose of 5 mg/kg/day. Three months later she developed severe motor weakness of lower limbs with loss of ankle and knee reflexes. She was treated with vitamin B6 injections and isoniazid treatment was continued. Her motor weakness gradually improved in a few months, but mild sensory impairment persisted even after two years. There is need …

Anemia In A Middle Aged Female With Aortitis: A Case Report., Shabneez Hussain, Salman Naseem Adil, Shahid Ahmed Sami

Department of Surgery Docs

Abstract

BACKGROUND:

Idiopathic aortitis is among the most common causes of non-infectious aortitis, which rarely presents with anemia.

CASE PRESENTATION:

Here we report a case of a 49-year-old muhajir female who presented with shortness of breath and easy fatigability for the past 6 months. Physical examination revealed pallor and a diastolic murmur in the aortic region. Echocardiography showed thickened and calcified aortic and mitral valves, severe aortic regurgitation and dilatation of ascending aorta. She was advised aortic valve replacement and was referred to a haematologist due to concomitant anemia. Complete blood counts revealed haemoglobin: 7.7 gm/dl, mean corpuscular volume (MCV): …

Laparoscopic-Assisted Percutaneous Endoscopic Gastrostomy Tube Insertion In The Immediate Post-Partum Period For Head And Neck Cancer, Adil Aijaz Shah, Shabbir Akhtar, Nadeem Zuberi, Kamran Ali, Dania Aijaz Shah, Amir Hafeez Shariff

Department of Surgery Docs

Abstract

Percutaneous endoscopic gastrostomy (PEG) tube placement serves as a well-tolerated and efficacious technique for long-term enteral access in patients with medical conditions precluding oral food intake. The nutritional optimisation of patients with oral cancer is mostly achieved via PEG tube placement. However, certain special situations, such as pregnancy and the immediatepost-partum period, may render the placement of PEG tubes to be a challenge. A 28-year-old pregnant female patient presented to us with the diagnosis of squamous cell carcinoma of the tongue during her third trimester. Definitive surgical resection was planned post-delivery along with simultaneous PEG tube placement. Immediately following …

Effects Of Adipocyte Aryl Hydrocarbon Receptor Deficiency On Pcb-Induced Disruption Of Glucose Homeostasis In Lean And Obese Mice, Nicki A. Baker, Robin Shoemaker, Victoria English, Nika Larian, Manjula Sunkara, Andrew J. Morris, Mary Walker, Frederique Yiannikouris, Lisa A. Cassis

Saha Cardiovascular Research Center Faculty Publications

BACKGROUND: Coplanar polychlorinated biphenyls (PCBs) promote adipocyte inflammation and impair glucose homeostasis in lean mice. The diabetes-promoting effects of lipophilic PCBs have been observed only during weight loss in obese mice. The molecular mechanisms linking PCB exposures to impaired glucose metabolism are unclear.

OBJECTIVES: In this study we tested the hypothesis that coplanar PCBs act at adipocyte aryl hydrocarbon receptors (AhRs) to promote adipose inflammation and impair glucose homeostasis in lean mice and in obese mice during weight loss.

METHODS AND RESULTS: PCB-77 administration impaired glucose and insulin tolerance in LF (low fat diet)-fed control (AhR^fl/fl) mice …

Iv And Ip Administration Of Rhodamine In Visualization Of Wbc-Bbb Interactions In Cerebral Vessels., Zachary Wilmer Reichenbach, Hongbo Li, John P. Gaughan, Melanie B. Elliott, Ronald Tuma

Department of Neurosurgery Faculty Papers

Epi-illuminescence intravital fluorescence microscopy has been employed to study leukocyte-endothelial interactions in a number of brain pathologies. Historically, dyes such as Rhodamine 6G have been injected intravenously. However, intravenous injections can predispose experimental animals to a multitude of complications and requires a high degree of technical skill. Here, we study the efficacy of injecting Rhodamine 6G into the peritoneum (IP) for the purpose of analyzing leukocyte-endothelial interactions through a cranial window during real time intravital microscopy. After examining the number of rolling and adherent leukocytes through a cranial window, we found no advantage to the intravenous injection (IV). Additionally, we …

Fear, Blame And Transparency: Obstetric Caregivers' Rationales For High Caesarean Section Rates In A Low-Resource Setting, Helena Litorp, Andrew Mgaya, Columba Mbekenga, Hussein L. Kidanto, Sara Johnsdotter, Birgitta Essén

School of Nursing & Midwifery, East Africa

In recent decades, there has been growing attention to the overuse of caesarean section (CS) globally. In light of a high CS rate at a university hospital in Tanzania, we aimed to explore obstetric caregivers' rationales for their hospital's CS rate to identify factors that might cause CS overuse. After participant observations, we performed 22 semi-structured individual in-depth interviews and 2 focus group discussions with 5–6 caregivers in each. Respondents were consultants, specialists, residents, and midwives. The study relied on a framework of naturalistic inquiry and we analyzed data using thematic analysis. As a conceptual framework, we situated our findings …

Monitoring Human Growth And Development: A Continuum From The Womb To The Classroom, José Villar, Aris T. Papageorghiou, Ruyan Pang, Laurent J. Salomon, Ana Langer, Cesar Victora, Manorama Purwar, Cameron Chumlea, Wu Qingqing, Sicco A. Scherjon, Fernando C. Barros, Maria Carvalho, Douglas G. Altman, Francesca Giuliani, Enrico Bertino, Yasmin A. Jaffer, Leila Cheikh Ismail, Eric O. Ohuma, Ann Lambert, J. Alison Noble, Michael G. Gravett, Zulfiqar A. Bhutta, Stephen H. Kennedy

Obstetrics and Gynaecology, East Africa

A comprehensive set of fully integrated anthropometric measures is needed to evaluate human growth from conception to infancy so that consistent judgments can be made about the appropriateness of fetal and infant growth. At present, there are 2 barriers to this strategy. First, descriptive reference charts, which are derived from local, unselected samples with inadequate methods and poor characterization of their putatively healthy populations, commonly are used rather than prescriptive standards. The use of prescriptive standards is justified by the extensive biologic, genetic, and epidemiologic evidence that skeletal growth is similar from conception to childhood across geographic populations, when health, …

Effect Of Nutritional Deficiency On The Efficacy Of The Polio Vaccines In Pakistan., Aamir Abbas, Romaina Iqbal

Department of Medicine

No abstract provided.

Severity Of Depression, Anxious Distress And The Risk Of Cardiovascular Disease In A Swedish Population-Based Cohort., Aysha Almas, Yvonne Forsell,, Romaina Iqbal, Imre Janszky,, Jette Moller

Department of Medicine

Background: Depression is known to be associated with cardiovascular diseases (CVD). This population-based cohort study aimed to determine the association between depression of varying severity and risk for CVD and to study the effect of concomitant anxious distress on this association.

Methods: We utilized data from a longitudinal cohort study of mental health, work and relations among adults (20–64 years), with a total of 10,443 individuals. Depression and anxious distress were assessed using psychiatric rating scales and defined according to DSM-5. Outcomes were register-based and self-reported cardiovascular diseases.

Findings: Overall increased odds ratios of 1.5 to 2.6 were seen …