Digital Commons Network^™

Antibiotic-Like Actions Of Vitamin D, Franklin D. Shuler Md, Phd, Josh Hendrix, Adam Short, Sammy Hodroge

Orthopaedics

Vitamin D is a secosteroid hormone that has expanding importance for a healthy lifestyle and disease prevention. A multitude of studies have highlighted that vitamin D acts not only in bone and calcium homeostasis but is critically important for human immunity. The discovery that the storage form of vitamin D (25-hydroxyvitamin D3) can be locally converted to the active form (1,25-hydroxyvitamin D3) in immune cells, epithelial cells and numerous other non-renal tissues highlights the importance of maintaining sufficient stores. When responding to a specific external stimulus, like bacterial invasion, intracrine synthesis of active vitamin D has the ability to regulate …

Surgical Management Of Pediatric Gastroesophageal Reflux Disease, Hope T. Jackson, Timothy D. Kane

Surgery Faculty Publications

No abstract provided.

Wound Care Challenges In Children And Adults With Spina Bifida: An Open-Cohort Study, Katherine Ottolini, Amy B. Harris, June K. Amling, Ann M. Kennelly, Leslie A. Phillips, Laura L. Tosi

Pediatrics Faculty Publications

Skin breakdown is a frequent concern for individuals with spina bifida. We explored wound incidence in patients with spina bifida and how it varies across a person's life span and functional neurologic level. We examined the settings in which skin breakdown most commonly occurred, looking for evidence of chronic, non-healing wounds. We also sought to develop criteria to improve wound monitoring. We identified reported wound episodes in an open-cohort study over a 13-year period, examining the hospital and outpatient clinical records of spina bifida patients at Children's National Medical Center (CNMC). Current age, age at wound presentation, sex, weight, functional …

Low Plasma Citrulline Levels Are Associated With Acute Respiratory Distress Syndrome In Patients With Severe Sepsis, Lorraine B. Ware, Jordan A. Magarik, Nancy Wickersham, Gary Cunningham, Todd W. Rice, Brian W. Christman, Arthur P. Wheeler, Gordon R. Bernard, Marshall Summar

Pediatrics Faculty Publications

Introduction: The role of nitric oxide synthase (NOS) in the pathophysiology of acute respiratory distress syndrome (ARDS) is not well understood. Inducible NOS is upregulated during physiologic stress; however, if NOS substrate is insufficient then NOS can uncouple and switch from NO generation to production of damaging peroxynitrites. We hypothesized that NOS substrate levels are low in patients with severe sepsis and that low levels of the NOS substrate citrulline would be associated with end organ damage including ARDS in severe sepsis.

Methods: Plasma citrulline, arginine and ornithine levels and nitrate/nitrite were measured at baseline in 135 patients with severe …

Screening Diabetic And Hypertensive Patients For Ocular Pathology Using Telemedicine Technology In Rural West Virginia: A Retrospective Chart Review, Rezwan Ahmed Md, Stephen M. Petrany, Russell Fry Ii, Michael Krasnow Do, Phd

Internal Medicine

Abstract: Purpose: There is a disparity between the number of people who need healthcare and availability of medical services in rural areas. This paper describes the experience of using telemedicine technologies for ophthalmologic evaluation in diabetic and hypertensive patients presenting to a community health center in rural West Virginia.

Methods: A registered nurse at a community health center in McDowell County, WV was trained to use a retinal camera to capture high-resolution digital images of the retina. Patients with diabetes or hypertension were screened during their routine primary care visits. Retinal photos were transmitted to an ophthalmologist for review and …

Vancomycin And Gentamicin Pharmacokinetic Alterations In An Adolescent Amputee, Kristen R. Nichols, Kari M. Edison, Michelle D. Rosenbaum, Chad A. Knoderer

Scholarship and Professional Work – COPHS

A 14-year-old male with bilateral above-the-knee amputations presented to our hospital for treatment of a skin and soft-tissue infection. We report the experience of vancomycin and gentamicin therapy in this patient. Because these medications require weight-based dosages and pharmacokinetic monitoring of serum levels, it was necessary to obtain peak and trough levels of the two drugs in order to determine the pharmacokinetic differences in this patient compared to those in an adolescent male without amputations. To our knowledge, this is the first report describing pharmacokinetic differences in an adolescent amputee.

Geriatric Medication Therapy: Weighing The Evidence Versus Best Practice, Lindsay M. Saum, Cathy Ramey

Scholarship and Professional Work – COPHS

Goals: The goal of this article is to provide a review of available evidence for safe prescribing in older adults and recommend medication therapies based on anticipated pharmacokinetic/physiologic changes in this population.

Graduate Medical Education 2012-2013 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.

Gender Differences In The Development Of Uremic Cardiomyopathy Following Partial Nephrectomy: Role Of Progesterone, Christopher A. Drummond, George Buddny, Steven T. Haller, Jiang Liu, Yanling Yan, Zijian Xie, Deepak Malhotra, Joseph I. Shapiro Md, Jiang Tian

Biochemistry and Microbiology

Gender difference has been suggested as a risk factor for developing cardiovascular and renal diseases in humans and experimental animals. As a major sex hormone, progesterone was reported to compete with cardiotonic steroid binding to Na/K-ATPase. Our previous publication demonstrated that cardiotonic steroids (e.g., marinobufagenin) play an important role in the development of experimental uremic cardiomyopathy. We also observed that the putative mineralocorticoid antagonists, spironolactone and its major metabolite canrenone, antagonize binding of cardiotonic steroids to Na/K-ATPase in a competitive manner and also ameliorate experimental uremic cardiomyopathy induced by partial nephrectomy. In the following studies, we noted that progesterone displayed …

Diet And Nutrition In Cancer Survivorship And Palliative Care., Anthony J Bazzan, Andrew B Newberg, William C Cho, Daniel A Monti

Marcus Institute of Integrative Health Faculty Papers

The primary goal of palliative cancer care is typically to relieve suffering and improve quality of life. Most approaches to diet in this setting have focused only on eating as many calories as possible to avoid cachexia. However, as the concept of palliative care has evolved to include all aspects of cancer survivorship and not just end of life care, there is an increasing need to thoughtfully consider diet and nutrition approaches that can impact not only quality of life but overall health outcomes and perhaps even positively affect cancer recurrence and progression. In this regard, there has been a …

Linking Environmental Toxicant Exposure To Diabetes Susceptibility, Jannifer Beth Tyrrell

Wayne State University Dissertations

An important and unresolved question in the environmental health field is whether exposure to common environmental toxicants, such as dioxin and heavy metals like Pb, increase the risk of developing diabetes, especially in combination with other common metabolic stressors such as obesity.

Previous studies suggested that dioxin exposure increased peripheral insulin resistance but did not appear to cause fasting hyperglycemia or elevated hepatic glucose output. In concordance with those findings we observed that dioxin treatment caused a strong suppression of the expression of the key hepatic gluconeogenic genes PEPCK and G6Pase. However, this suppression was not solely mediated by the …

Risk Of Childhood Asthma In A Tropical African Urban Setting: A Case - Control Study At The Aga Khan Hospital, Dar-Es-Salaam, Tanzania, Lynda C. Koech

Master of Medicine in Family Medicine

Objective: To determine the modifiable and non-modifiable risk factors for childhood asthma in children aged between two and 15years in a tropical urban East-African setting. Methods: Hospital based case-control study matched for age + two months and sex. Data were obtained from parents of cases and controls using a structured interviewer-administered questionnaire. The study sample consisted of 226 cases of two to 15years old, with physician-confirmed asthma, who met a set of defined clinical criteria and 226 controls with no previous diagnosis or symptoms of asthma matched by sex and age (+two months). The Risk Factors included in this study …

Gently Into The Good Night: Toward A Compassionate Response To End-Stage Illness, George P. Smith Ii

Scholarly Articles

End-of-life decision making by health care providers must respect individual patient values. Indeed, these values must always be viewed as the baseline for developing and pursuing patient-centered palliative care for those with terminal illness. Co-ordinate with this fundamental bioethics principle is that of beneficence or, in other words, respect for conduct which benefits the dying patient by alleviating end-stage suffering — be it physical or existential. Compassion, charity, agape and/or just common sense, should be a part of setting normative standards and of legislative and judicial responses to the task of managing death. Aided by the principles of medical futility, …

Simplified Regimens For Management Of Neonates And Young Infants With Severe Infection When Hospital Admission Is Not Possible, Antoinette Tshef, Adrien Lokangaka, Cyril Engmann, Fabian Esamai, Peter Gisore, Adejumoke Idowu Ayede, Adegoke Gbadegesin Falade, Ebunoluwa A. Adejuyigbe, Chineme Henry Anyabolu, Robinson D. Wammanda, William N. Ogala, Lu Gram, Simon Cousens, Rajiv Bahl, Nigel Rollins, Sachiyo Yoshida, Shamim Ahmad Qazi

Paediatrics and Child Health, East Africa

Background: In resource-limited settings, most young infants with signs of severe infection do not receive the recommended inpatient treatment with intravenous broad spectrum antibiotics for 10 days or more because such treatment is not accessible, acceptable or affordable to families. This trial was initiated in the Democratic Republic of Congo, Kenya and Nigeria to assess the safety and efficacy of simplified treatment regimens for the young infants with signs of severe infection who cannot receive hospital care.

Methods: This is a randomized, open-label equivalence trial in which 3600 young infants with signs of clinical severe infection will be enrolled. The …

A Rare Case Of Aeromonas Hydrophila Catheter Related Sepsis In A Patient With Chronic Kidney Disease Receiving Steroids And Dialysis: A Case Report And Review Of Aeromonas Infections In Chronic Kidney Disease Patients, Muhammad Abdul Mabood Khalil, Abdur Rehman, Waqar Uddin Kashif, Manickam Rangasami, Jackson Tan

Section of Nephrology

Aeromonas hydrophila (AH) is an aquatic bacterium. We present a case of fifty-five-year-old gentleman with chronic kidney disease (CKD) due to crescentic IgA nephropathy who presented to us with fever. He was recently pulsed with methyl prednisolone followed by oral prednisolone and discharged on maintenance dialysis through a double lumen dialysis catheter. Blood culture from peripheral vein and double lumen dialysis catheter grew AH. We speculate low immunity due to steroids and uremia along with touch contamination of dialysis catheter by the patient or dialysis nurse could have led to this rare infection. Dialysis catheter related infection by AH is …

The Political Economy Of Undernutrition National Report: Pakistan, Shehla Zaidi, Zulfiqar Ahmed Bhutta, Shandana Khan Mohmand, Andres Mejia Acosta

Epidemiology and Biostatistics Section

No abstract provided.

Anxiety In Disabling Osteoarthritis: Implications For Research And Practice, Ray Marks

Publications and Research

No abstract provided.

‘What’S In The Niddk Cdr?’—Public Query Tools For The Niddk Central Data Repository, Huaqin Pan, Mary-Anne Ardini, Vesselina Bakalov, Michael Delatte, Paul Eggers, Laxminarayana Ganapathi, Craig R. Hollingsworth, Joshua Levy, Sheping Li, Joseph Pratt, Norma Pugh, Ying Qin, Rebekah Rasooly, Helen Ray, Jean E. Richardson, Amanda Flynn Riley, Susan M. Rogers, Sylvia Tan, Charles F. Turner, Stacie White, Philip C. Cooley

Publications and Research

The National Institute of Diabetes and Digestive Disease (NIDDK) Central Data Repository (CDR) is a web-enabled resource available to researchers and the general public. The CDR warehouses clinical data and study documentation from NIDDK funded research, including such landmark studies as The Diabetes Control and Complications Trial (DCCT, 1983–93) and the Epidemiology of Diabetes Interventions and Complications (EDIC, 1994–present) follow-up study which has been ongoing for more than 20 years. The CDR also houses data from over 7 million biospecimens representing 2 million subjects. To help users explore the vast amount of data stored in the NIDDK CDR, we developed …

Neuromyelitis Optica In Child: Diagnostic And Therapeutic Challenges, Karolina Dembinski, Maria Gieron-Korthals, Carlos R. Martinez, Lisa Rodriguez

Pediatrics Faculty Publications

Neuromyelitis optica (NMO) is a rare syndrome of severe inflammatory demyelination of the central nervous system, causing attacks of optic neuritis and transverse myelitis. Although uncommon, attention should be given to the proper identification and management of the affected patients. We present a case of a 13-year-old girl with severe neuromyelitis optica. The patient’s initial presentation consisted of encephalopathy and optic neuritis. Approximately 2 months later, coinciding with the weaning of steroid treatment, she presented with ascending paralysis and respiratory failure. She was seropositive for NMO-IgG. Treatment included intravenous immune globulin, steroids, plasmapheresis, and rituximab and was complemented with proper …

Foot Dimensions As A Tool For Gender Determination In Kenyan Adults, Maureen W. Waithaka

Master of Medicine in Anatomic Pathology

Introduction: Anthropometry has gained popularity over the years as a reliable method to determine gender. In forensic investigation, there are cases where gender cannot be readily determined using anatomy such as in mass casualty disasters with dismemberment and commingling of limbs. Kenyan descriptive data of foot dimensions is lacking as are formulae for estimating gender. Proven differences in foot dimensions across races prevent application of formula obtained using different populations necessitating generation of local data and formulae. Objectives: To describe the foot lengths, breaths and navicular heights of a representative adult Kenyan population, both male and female, and derive from …

Fmic Annual Report 2013 | English, French Medical Institute For Mothers And Children

French Medical Institute for Mothers and Children (FMIC) Archives

No abstract provided.

Nutritional Status Of Children Admitted For Diarrhoeal Diseases In A Referral Hospital In Western Kenya, I. Marete, J. Simba, Peter Gisore, C. Tenge, D. Bosire, A. Mwangi, F. Esamai

Paediatrics and Child Health, East Africa

Objectives: To determine the prevalence of malnutrition among children admitted with acute diarrhoea disease at Moi Teaching and Referral Hospital and to establish the effect of malnutrition on duration of hospital stay.

Design: Prospective observational study.

Setting: Paediatric wards of Moi Teaching and Referral Hospital, Eldoret, Kenya

Subjects: A total of 191 children aged 6 and 59 months admitted with acute diarrhoea disease, without chronic co-morbidities or visible severe malnutrition, were systematically enrolled into the study between November 2011 and March 2012.

Outcome Measures: Nutritional status based on WHO WHZ scores taken at admission and …

Advancing Maternal Survival In The Global Context: Are Our Strategies Working?, Omar A Khan, Richard Derman, Nancy L Sloan

Department of Family & Community Medicine Faculty Papers

There have been significant gains in improving maternal mortality over the last two decades. Researchers have suggested a variety of interventions and mechanisms to explain these improvements. While it is likely that much of what has been done in research and programs has contributed to this decline, the evidence regarding what works in the settings in which women deliver continues to face many challenges. We review the evidence for these improvements and suggest that there remain areas to focus on, particularly the births which currently take place in an unsupervised or substandard environments. We highlight the main areas where more …

Pediatric Obesity Class: Teaching Kids How To Live Healthy Lifestyle, Sara Wilson Reece

Scholarly Posters

Childhood obesity has reached epidemic proportions in the United States. At The Longstreet Clinic, PC, Diabetes Education and Medical Nutritional Therapy Department, and Pediatric Department have joined together to create the Pediatric Obesity Class to address the epidemic of pediatric obesity in the local community. In the class, the child and parent are taught about calories, how to develop healthy eating habits and become physically active as a family. Visual aids as well as hands on activities for both nutritional and physical activity components of class are utilized. Thus far, approximately 120 children along with their parent(s) have participated in …

A Double Blind Community-Based Randomized Trial Of Amoxicillin Versus Placebo For Fast Breathing Pneumonia In Children Aged 2-59 Months In Karachi, Pakistan (Retapp), Fyezah Jehan, Muhammad Imran Nisar, Salima Kerai, Nick Brown, Benazir Balouch, Zulfiqar Hyder, Gwen Ambler, Amy Sarah Ginsburg, Anita K. M. Zaidi

Department of Paediatrics and Child Health

Background: Fast breathing pneumonia is characterized by tachypnoea in the absence of danger signs and is mostly viral in etiology. Current guidelines recommend antibiotic therapy for all children with fast breathing pneumonia in resource limited settings, presuming that most pneumonia is bacterial. High quality clinical trial evidence to challenge or support the continued use of antibiotics, as recommended by the World Health Organization is lacking.

Methods/Design: This is a randomized double blinded placebo-controlled non-inferiority trial using parallel assignment with 1:1 allocation ratio, to be conducted in low income squatter settlements of urban Karachi, Pakistan. Children 2-59 months old with fast …

Synapsis: Philadelphia Campus (2013), Philadelphia College Of Osteopathic Medicine

All Yearbooks

This yearbook includes American Medical Association (AMA), American Medical Student Association (AMSA), American Medical Women's Association (AMWA), Association of the American College of Osteopathic Family Physicians (ACOFP), Asian Pacific American Medical Student Association (APAMSA), Robert Berger, DO Pediatrics Society, Christian Medical Dental Association (CMDA), Kappa Sigma Phi, KSPh, (ΚΣΦ) Women's Osteopathic Society, Medical Students for Choice, Military Osteopathic Physicians and Surgeons (AMOPS), Muslim Student Medical Association, National Latino Health Organization (NLHO), Phi Sigma Gamma PSG, (ΦΣΓ) Fraternity, Physicians for Human Rights Club, Physicians for Social Responsibility Club, Sigma Sigma Phi SSPh, (ΣΣΦ) Honorary Osteopathic Service Fraternity, Student American Osteopathic Academy …

Erosive Hand Osteoarthritis Is Associated With Subclinical Atherosclerosis And Endothelial Dysfunction, Athanasios Koutroumpas, Athanasios Giannoukas, Elias Zintzaras, Ekaterini Exarchou, Aris Baliakos, Konstantinos Makaritsis, Lazaros I. Sakkas

Biological Sciences Faculty Publications

Chronic inflammatory disorders have been associated with accelerated atherosclerosis and increased cardiovascular (CV) risk. Recent evidence suggests that erosive hand osteoarthritis (EOA) has considerable inflammation; therefore, we examined the presence of subclinical atherosclerosis and endothelial dysfunction in EOA. Twenty-four patients with EOA and 24 age- and sex-matched healthy individuals without clinical OA were included in the study. No subject had a history of CV disease. Intima-media thickness (IMT) and atheromatous plaques in the common carotid and common femoral arteries were measured by Doppler ultrasonography. The endothelium-dependent, flow-mediated dilatation (FMD) and endothelium-independent, sublingual glyceryl trinitrate (NTG)-induced dilatation (NMD) of the brachial …

Validation Of The Ottawa Ankle Rules At A Tertiary Teaching Hospital: A Cross-Sectional Study, Mark Karanja Tharao

Master of Medicine in General Surgery

Introduction: Ankle joint and foot injuries are among the commonest injuries seen at the Accident and Emergency Department of any hospital. Within the United States it is the second most common musculoskeletal injury seen by physicians. Assessment of these injuries is done clinically and when deemed necessary a radiograph is requested. Studies have shown that radiographs are ordered in over 95% of cases yet the prevalence of fractures is in the range of 15-20%. This means that more than 80% of patients are exposed to unnecessary radiation. The Ottawa ankle rules have been designed to reduce the need for performing …

Prevalence Of Vitamin D Deficiency In An Ethnic African Urban Obstetric Population In An Equatorial City Hospital, Raj Hasmukh Dodia

Master of Medicine in Obstetrics and Gynecology

Introduction: Low Vitamin D levels in pregnancy have been associated with an increased risk of gestational diabetes, pre-eclampsia, bacterial vaginosis, preterm birth, disordered fetal skeletal homeostasis, and impaired offspring lung health. As a result, current public health advice in several countries is to universally supplement Vitamin D during pregnancy. Data regarding the Vitamin D levels of the ethnic obstetric population in Kenya are not available; hence recommendations for Vitamin D supplementation have no scientific basis. Objectives of study: This research was carried out to determine the prevalence of deficiency of Vitamin D in ethnic African obstetric patients who had delivered …

Comprendre Les Grossesses Non Désirées Au Sénégal: Rapport Du Profil Pays, Kaila Clarke, Mohamadou Sall, Babacar Mane, Nafissatou Diop, Bocar Mamadou Daff

Reproductive Health

Un profil pays a été préparé pour le Sénégal pour compiler et synthétiser les informations disponibles sur la santé de la reproduction, en particulier les grossesses non désirées et par conséquent les besoins non satisfaits en matière de planification familiale. D’importants efforts ont été consentis par l’Etat sénégalais, mais de nombreux obstacles continuent de freiner les progrès réalisés. Un programme national plus cohérent et ciblé est donc nécessaire pour réduire ces obstacles. Dans le même temps, les acteurs non-gouvernementaux devraient poursuivre leurs efforts pour renforcer leur programmation pour produire des effets plus immédiats, tout en assurant une meilleure coordination entre …