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Early Recovery In Post Varicella Transverse Myelitis, Prem Chand, Shahnaz Brahim, Syed Sohail Zaidi, Nida Amjad

Department of Paediatrics and Child Health

A two and a half year old Kenyan girl presented with recurrent chest infections and difficulty in swallowing. Her clinical and laboratory workup was suggestive of lower respiratory tract infection for which she received a course of antibiotics; however, she remains symptomatic after the management of her suspected diagnosis. Therefore, further radiological workup including a chest CT scan and barium study were performed. This showed a homogeneous mass surrounded by ascending and descending aorta in the posterior mediastinum that was compressing the middle esophagus. She had a posterolateral thoracotomy which revealed a cystic mass with smooth surfaces (5 x 5 …

Effect Of L-Type Calcium Channel Blocker (Amlodipine) On Myocardial Iron Deposition In Patients With Thalassaemia With Moderate-To-Severe Myocardial Iron Deposition: Protocol For A Randomised, Controlled Trial, Amarah Shakoor, Maaman Zahoor, Alina Sadaf, Najveen Alvi, Zehra Fadoo, Arjumand Rizvi, Farheen Quadri, Fateh Ali Tipoo, Mohammad Khurshid, Zaffar Sajjad, Steven Colan, Babar S Hasan

Department of Paediatrics and Child Health

Introduction: Sideroblastic cardiomyopathy secondary to repeated blood transfusions is a feared complication in thalassaemia. Control of myocardial iron is thus becoming the cornerstone of thalassaemia management. Recent evidence suggests a role for L-type Ca²⁺ channels in mediating iron uptake by the heart. Blocking the cellular iron uptake through these channels may add to the benefit of therapy to standard chelation in reducing myocardial iron. We aim to determine the efficacy of amlodipine (a calcium channel blocker) as an adjunct to standard aggressive chelation in retarding myocardial iron deposition in thalassaemics with or without cardiomyopathy.
Outcomes: The primary outcome …

Community Based Interventions For The Prevention And Control Of Tuberculosis, Ahmed Arshad, Rehana A. Salam, Zohra S. Lassi, Jai K. Das, Imama Naqvi, Zulfiqar A. Bhutta

Department of Paediatrics and Child Health

In 2012, an estimated 8.6 million people developed tuberculosis (TB) and 1.3 million died from the disease. With its recent resurgence with the human immunodeficiency virus (HIV); TB prevention and management has become further challenging. We systematically evaluated the effectiveness of community based interventions (CBI) for the prevention and treatment of TB and a total of 41 studies were identified for inclusion. Findings suggest that CBI for TB prevention and case detection showed significant increase in TB detection rates (RR: 3.1, 95% CI: 2.92, 3.28) with non-significant impact on TB incidence. CBI for treating patients with active TB showed an …

A Gut Gone To Pot: A Case Of Cannabinoid Hyperemesis Syndrome Due To K2, A Synthetic Cannabinoid., Anene Ukaigwe, Paras Karmacharya, Anthony A. Donato

Reading Hospital Internal Medicine Residency

Cannabinoid Hyperemesis Syndrome (CHS) was first described in 2004. Due to its novelty, CHS is often unrecognized by clinicians leading to expensive workup of these patients with cyclical symptoms. It may take up to 9 years to diagnose CHS. CHS is characterized by cyclical nausea and vomiting, abdominal pain, and an unusual compulsion to take hot showers in the presence of chronic use of cannabinoids. Cannabicyclohexanol is a synthetic cannabinoid, popularly known as K2 spice. It is a popular marijuana alternative among teenagers and young adults since it is readily available as herbal incense. Unlike marijuana, many users know that …

Dr. Seishu Hanaoka (1760-1835): Surgeon, Pharmacist, And Anesthesiologist., Drew L. Kotler, B.A., Hitoshi Hirose, Md, Charles J. Yeo, Md, Scott W. Cowan, Md

Department of Surgery Gibbon Society Historical Profiles

The notion of decreasing pain in surgery stretches back thousands of years with alcohol noted as one of the first anesthetics. Natural elements including coca and opium have been used by various civilizations in an attempt to mute the searing pain of surgery. By the 16th century, physicians around the world began to experiment with nitrous oxide and ether, providing the groundwork for the future of modern anesthesia. The successful application of general anesthesia in surgery was first documented in 1804 by Dr. Seishu Hanaoka (Fig. 1) in Wakayama, Japan, during a breast lumpectomy. During the case, Dr. Hanaoka served …

Isprm Discussion Paper: Proposing A Conceptual Description Of Health-Related Rehabilitation Services., Thorsten Meyer, Christoph Gutenbrunner, Carlotte Kiekens, Dimitrios Skempes, John L Melvin, Kuno Schedler, Marta Imamura, Gerold Stucki

Department of Rehabilitation Medicine Faculty Papers

There is a need for a comprehensive classification system of health-related rehabilitation services. For conceptual clarity our aim is to provide a health-related conceptual description of the term "rehabilitation service". First, we introduce a common understanding of the term "rehabilitation", based on the current definition in the World Health Organization's World Report on Disability, and a conceptual description of rehabilitation agreed upon by international Physical and Rehabilitation Medicine organizations. From a health perspective, rehabilitation can be regarded as a general health strategy with the aim of enabling persons with health conditions experiencing or likely to experience disability to achieve and …

Use Of Femoral Nail With Spiral Blade In Subtrochanteric Fractures, Masood Umer, Haroon Rashid, Idrees Shah, Irfan Qadir

Section of Orthopaedic Surgery

Objective: The aim of this study was to evaluate the outcome of acute subtrochanteric fractures managed with intramedullary nail and spiral blade fixation of the proximal fragment.
Methods: Charts of 33 patients (17 males and 16 females) with acute subtrochanteric fractures operated with intramedullary nail and spiral blade at our institution between March 2006 and February 2011 were retrospectively reviewed. The most common (67%) mechanism of injury was ground-level fall, predominantly involving elderly patients. Results were evaluated in terms of union time, implant failure rate, infection rate and functional outcome.
Results: Mean duration of surgery was 2.4 hours and average …

Refusal To Autopsy: A Societal Practice In Pakistan Context, Laila Akber Cassum

School of Nursing & Midwifery

Autopsies or post-mortem examinations have become a common practice in Western medicine for verifying the cause of death, and to obtain additional scientific information on certain diseases. In monotheistic religions autopsies present several ethical questions even though the advantages attributed to post-mortems in the West are well acknowledged by people living in this modern world. In Islamic Republic of Pakistan where Islam is the prevailing religion followed by the Muslims, Pakistani society have diverse perception, assumptions and hypothesis on the concept of autopsy. This presumption is due to presence of diverse objections raised in religious and sociocultural context. In our …

Compliance With Continuous Positive Airway Pressure (Cpap) Therapy For Obstructive Sleep Apnea Among Privately Paying Patients- A Cross Sectional Study, Syed Fayyaz Hussain, Muhammad Irfan, Zeeshan Waheed, Naveen Alam, Saba Mansoor, Muhammad Islam

Section of Pulmonary & Critical Care

Background: To evaluate the compliance, benefits and side effects associated with continuous positive airway pressure (CPAP) therapy among Pakistani patients treated for obstructive sleep apnea (OSA) in private sector.Methods: Patients diagnosed to have OSA based on overnight study who were recommended for CPAP therapy, between 1998 and 2003, were evaluated by telephonic survey and review of hospital notes. Compliance, benefits and side effects associated with CPAP therapy were assessed.Results: Out of 135 patients who were prescribed CPAP therapy, 75 could be contacted. Sixty (80%) started using CPAP within one month of diagnosis and 46 (61%) continued to use it long-term …

What We Are Not Talking About, Hatim A. Omar

Pediatrics Faculty Publications

Adolescents undergo significant physical and cognitive changes during their pubertal development. These changes contribute to and impact their future development. Educating adolescents at an early age about their expected development decreases the possible anxiety associated with this period of life and also helps adolescents make better choices in regards to their sexuality. In order to assess the degree of education regarding pubertal development and sexuality, we conducted a survey of late adolescents (median age 19 years) and parents of adolescents. A total of 409 adolescents (237 females, 172 males) and 124 parents completed the survey. 14.4% of teens (36.6% of …

Westgate Shootings: An Emergency Department Approach To A Mass-Casualty Incident, Benjamin Wachira, Ramadhani Abdalla, Lee Wallis

Emergency Medicine, East Africa

At approximately 12:30 pm on Saturday September 21, 2013, armed assailants attacked the upscale Westgate shopping mall in the Westlands area of Nairobi, Kenya. Using the seven key Major Incident Medical Management and Support (MIMMS) principles, command, safety, communication, assessment, triage, treatment, and transport, the Aga Khan University Hospital, Nairobi (AKUH,N) emergency department (ED) successfully coordinated the reception and care of all the casualties brought to the hospital. This report describes the AKUH,N ED response to the first civilian mass-casualty shooting incident in Kenya, with the hope of informing the development and implementation of mass-casualty emergency preparedness plans by other …

Muc1 Regulates Cyclin D1 Gene Expression Through P120 Catenin And Β-Catenin, X. Liu, Thomas C. Caffrey, M. M. Steele, Ashley M. Mohr, Pankaj K. Singh, Prakash Radhakrishnan, David L. Kelly, Y. Wen, Michael A. Hollingsworth

Journal Articles: Eppley Institute

MUC1 interacts with β-catenin and p120 catenin to modulate WNT signaling. We investigated the effect of overexpressing MUC1 on the regulation of cyclin D1, a downstream target for the WNT/β-catenin signaling pathway, in two human pancreatic cancer cell lines, Panc-1 and S2-013. We observed a significant enhancement in the activation of cyclin D1 promoter-reporter activity in poorly differentiated Panc1.MUC1F cells that overexpress recombinant MUC1 relative to Panc-1.NEO cells, which express very low levels of endogenous MUC1. In stark contrast, cyclin D1 promoter activity was not affected in moderately differentiated S2-013.MUC1F cells that overexpressed recombinant MUC1 relative to S2-013.NEO cells that …

Pediatric Obesity: Taking Advantage Of Well-Child Visits For Early Identification, James E. Gelement

DNP Projects

Background: Pediatric obesity has reached epidemic levels in the United States and the burden of early identification and prevention lies with Primary Care Providers. With this burden comes the responsibility of increased documentation in order for patients to obtain the appropriate counseling, treatment, and referrals.

Objective: The objective of this study is to identify missed opportunities to identify pediatric patients that meet the criteria for overweight or obesity during well-child visits within a primary care practice.

Method: A retrospective chart review of 100 randomly selected patients born between 9/1/2001 and 9/1/2010 that have received a well-child visit between 1/1/2010 and …

Controversial Issues In Kyphoplasty And Vertebroplasty In Osteoporotic Vertebral Fractures, Ioannis D. Papanastassiou, Andreas Filis, Maria A. Gerochristou, Frank D. Vrionis

Orthopaedics and Sports Medicine Faculty Publications

Kyphoplasty (KP) and vertebroplasty (VP) have been successfully employed for many years for the treatment of osteoporotic vertebral fractures. The purpose of this review is to resolve the controversial issues raised by the two randomized trials that claimed no difference between VP and SHAM procedure. In particular we compare nonsurgical management (NSM) and KP and VP, in terms of clinical parameters (pain, disability, quality of life, and new fractures), cost-effectiveness, radiological variables (kyphosis correction and vertebral height restoration), and VP versus KP for cement extravasation and complications profile. Cement types and optimal filling are analyzed and technological innovations are presented. …

Genetic Variation And Possible Mechanisms Driving The Evolution Of Worldwide Fig Mosaic Virus Isolates, Jeewan Jyot Walia, Anouk Willemsen, Eminur Elci, Kadriye Caglayan, Bryce W. Falk, Luis Rubio

Nebraska Center for Virology: Faculty Publications

Fig mosaic virus (FMV) is a multipartite negative-sense RNA virus infecting fig trees worldwide. FMV is transmitted by vegetative propagation and grafting of plant materials, and by the eriophyid mite Aceria ficus. In this work, the genetic variation and evolutionary mechanisms shaping FMV populations were characterized. Nucleotide sequences from four genomic regions (each within the genomic RNAs 1, 2, 3, and 4) from FMV isolates from different countries were determined and analyzed. FMV genetic variation was low, as is seen for many other plant viruses. Phylogenetic analysis showed some geographically distant FMV isolates which clustered together, suggesting long-distance migration. …

Turnip Crinkle Virus Coat Protein Inhibits The Basal Immune Response To Virus Invasion In Arabidopsis By Binding To The Nac Transcription Factor Tip, Teresa Donze, Feng Qu, Paul Twigg, T. Jack Morris

Nebraska Center for Virology: Faculty Publications

Turnip crinkle virus (TCV) has been shown to interact with a NAC transcription factor, TIP, of Arabidopsis thaliana, via its coat protein (CP). This interaction correlates with the resistance response manifested in TCV-resistant Arabidopsis ecotype Di-17. We report that failure of a mutated CP to interact with TIP triggered the corresponding TCV mutant (R6A) to cause more severe symptoms in the TCV-susceptible ecotype Col-0. We hypothesized that TCV regulates antiviral basal immunity through TIP-CP interaction. Consistent with this hypothesis, we found that the rate of accumulation of R6A was measurably slower than wild-type TCV over the course of an …

Differences In Semg Between Normal Squats And Accentuated Eccentric Loaded Squats In Competitive Collegiate Weightlifters, Christopher Macdonalds, Kimitake Sato, Christian Carter, Hugh Lamont, William Sands, Michael H. Stone, Michael Israetel, Jeremy A. Gentles, Jason Cholewa, John Garner, Michael Ramsey, Guy Hornsby

ETSU Faculty Works

The purpose of the present work was to compare the effect of accentuated eccentric loaded (AEL) squats to normally loaded (NOR) squats on surface measured muscle activation (sEMG) in competitive weightlifters. Eight experienced, competitive weightlifters (six males, two females) completed both an AEL and NOR squat session (seven days apart), comprised of nine sets of squats, and was identical to their normal scheduled training. sEMG data from the vastus medialis (VM), vastus lateralis (VL), and biceps femoris (BF) was collected (at 1000Hz) during the entirety of the concentric (CON) phases of the AEL and NOR sessions. RMANOVAs (set x session-type) …

Implementation And Evaluation Of The Helping Babies Breathe Curriculum In Three Resource Limited Settings: Does Helping Babies Breathe Save Lives? A Study Protocol, Akash Bang, Roopa Bellad, Peter Gisore, Patricia Hibberd, Archana Patel, Shivaprasad Goudar, Fabian Esamai, Norman Goco, Sreelatha Meleth, Richard J. Derman, Edward A. Liechty, Elizabeth Mcclure, Waldemar A. Carlo, Linda L. Wright

Paediatrics and Child Health, East Africa

Background: Neonatal deaths account for over 40% of all under-5 year deaths; their reduction is increasingly critical for achieving Millennium Development Goal 4. An estimated 3 million newborns die annually during their first month of life; half of these deaths occur during delivery or within 24 hours. Every year, 6 million babies require help to breathe immediately after birth. Resuscitation training to help babies breathe and prevent/manage birth asphyxia is not routine in low-middle income facility settings. Helping Babies Breathe (HBB), a simulation-training program for babies wherever they are born, was developed for use in low-middle income countries. We evaluated …

Randomised Double Blind Study To Compare Effectiveness Of Honey, Salbutamol And Placebo In Treatment Of Cough In Children With Common Cold, Adil Waris, William Macharia, E. K. Njeru, F. Essajee

Paediatrics and Child Health, East Africa

Background: Acute upper respiratory infection is the most common childhood illness and presents with cough, coryza and fever. Available evidence suggests that cough medicines may be no more effective than honey-based cough remedies.

Objective: To compare effectiveness of honey, salbutamol and placebo in the treatment of cough in children with acute onset cough.

Design: Randomised control trial

Setting: Aga Khan University Hospital Paediatric Casualty

Subjects: Children between ages one to twelve years presenting with a common cold between December 2010 and February 2012 were enrolled.

Outcome measures: Frequency, severity and extent to which cough bothered and disturbed child and parental …

Hyperparathyroidism Two Years After Radioactive Iodine Therapy In An Adolescent Male, Danielle L. Gomez, Dorothy I. Shulman

Pediatrics Faculty Publications

Primary hyperparathyroidism is a very rare complication following radioactive iodine therapy. There is typically a latency period of more than a decade following radiation exposure and, therefore, it is observed almost exclusively in adults. Consequently, pediatricians are not aware of the association. We present a case of primary hyperparathyroidism due to a solitary parathyroid adenoma occurring in an adolescent male two years following radioactive iodine treatment for papillary thyroid carcinoma. Periodic screening of serum calcium following ablative doses of radioactive iodine for thyroid cancer may be justified even in adolescents.

Fish Odor Syndrome: A Case Report Of Trimethylaminuria, Catherine A. Ulman, Julian J. Trevino, Marvin E. Miller, Rishi K. Gandhi

Pediatrics Faculty Publications

Trimethylaminuria is a rare, autosomal recessive, metabolic disorder that results in accumulation of trimethylamine (TMA), which smells like rotten fish. The chemical is excreted in sweat and urine owing to a deficiency in the enzyme flavin monooxygenase 3 (FMO3). We report a case of trimethylaminuria in a 12-year-old girl. The patient failed treatment with diet and hygiene modification, but achieved symptomatic improvement after a four-month course of metronidazole.

Challenges And Considerations In Optimizing Ovarian Stimulation Protocols In Oncofertility Patients, Kathryn Coyne, Makenzie Purdy, Kathleen O'Leary, Jerome L. Yaklic, Steven R. Lindheim, Leslie A. Appiah

Obstetrics and Gynecology Faculty Publications

The scope of cancer treatment in women of childbearing age has changed in the last decade. Fertility preservation is no longer an afterthought but central to multi-disciplinary cancer treatment planning and should be addressed due to the cytotoxic effects of cancer therapy. However, oncology patients present as a unique treatment challenge as the physician must balance the urgency of fertility preservation with the risks of delaying cancer therapy. Controlled ovarian stimulation (COS) is routinely applied in assisted reproductive technology but can be contraindicated in women with estrogen-receptor-positive tumors. This paper reviews some of the challenges to consider when using COS …

Factors For Recurrent Injuries In Victims Of Suspected Non-Accidental Trauma: A Retrospective Cohort Study, Katherine Deans, Jonathan D. Thackeray, Johnathan I. Groner, Jennifer N. Cooper, Peter Minneci

Pediatrics Faculty Publications

Background

Many children who are victims of non-accidental trauma (NAT) may be repeatedly evaluated for injuries related to maltreatment. The purpose of this study was to identify risk factors for repeated injuries in children with suspected NAT.

Methods

We conducted a retrospective cohort study using claims data from a pediatric Medicaid accountable care organization. Children with birth claims and at least one non-birth related claim indicating a diagnosis of NAT or skeletal survey in 2007–2011 were included. Recurrent events were defined as independent episodes of care involving an urgent/emergent care setting that included a diagnosis code specific for child abuse, …

Monitoring Brown Fat Metabolic Activity Using Microwave Radiometry: Antenna Design And Frequency Selection, Dario B. Rodrigues, Paul R. Stauffer, Paolo F. Maccarini

Department of Radiation Oncology Faculty Papers

This paper describes the use of microwave radiometry for monitoring brown fat metabolism (mBAT). The radiometric frequency band and receive antenna were optimized for coupling to 2-6 ml BAT depots in the supraclavicular region. Radiometric signal variations induced by higher metabolic activity resulting from a cold stimulus were calculated with electromagnetic and thermal simulations in a segmented computational model of the human neck including BAT. A 2.5 cm dia. log spiral antenna was selected as optimum using a 500 MHz bandwidth and center frequency 2.75 GHz. Results suggest sufficient sensitivity to track subsurface temperature variations during long term mBAT monitoring …

Novel Microwave Applicators Based On Zero-Order Mode Resonance For Hyperthermia Treatment Of Cancer, David Vrba, Jan Vrba, Paul R. Stauffer

Department of Radiation Oncology Faculty Papers

In this paper, three novel microwave applicator prototypes based on zero-order mode resonators are proposed for use in hyperthermia treatment of cancer. The ability of all three applicators to homogenously irradiate muscle tissue-equivalent phantoms is demonstrated with results of numerical simulations, and relative performance of the applicators is compared.

Osteoarthritis And Articular Cartilage: Biomechanics And Novel Treatment Paradigms, Ray Marks

Publications and Research

Background: Osteoarthritis is a widespread highly painful disabling age-related disease with no known cure. Although novel strategies for ameliorating osteoarthritic damage abound, it is likely that none will be successful over time if the entire spectrum of the disease and the effects of joint biomechanics on joint tissues are not carefully considered.

Objectives: 1) To detail the structure of healthy articular cartilage, the key tissue affected by osteoarthritis. 2) To detail what aspects of cartilage damage best characterize osteoarthritis. 3) To consider the role of biomechanical factors in developing solutions to treat osteoarthritic joint damage. Methods: Literature sources from 1980 …

High-Intensity Tasks With External Load In Military Applications: A Review, Eric K. O'Neal, Jared H. Hornsby, Kyle J. Kelleran

Human Movement Studies & Special Education Faculty Publications

This article provides a synopsis of the limited investigations examining the impact of external load (EL) on performance of high-intensity tasks under load (HITL), EL training intervention effects on HITL performance, and injuries from EL training. Repetitive lifting tasks and initiation of locomotion, such as rapidly moving from a prone position to sprinting appear to be more hindered by EL than maximal sprinting velocity and may explain why training with EL does not improve obstacle course or prolonged (200-300 yard shuttle) drills. EL training appears to offer very little if any benefit for HITL in lesser trained populations. This contrast …

Four-Month-Old Infant With Intussusception Presenting As Altered Mental Status, Luis Maldonado, Jennifer Takagishi

Pediatrics Faculty Publications

Objective: To remind pediatric care providers that an altered mental status can be the only presenting symptom for intussusception, a life-threatening diagnosis.

Method: A case report that presents a unique presentation of intussusception: a 4-month old boy with neurological findings after a reported head injury.

Conclusion: Diagnosis of intussusception in the pediatric population is highly dependent on its classical presenting signs and symptoms: sudden severe colicky abdominal pain, vomiting, and an abdominal mass in children between 3 months and 6 years of age. Consider that an altered mental status can be the only presenting symptom.

Maternal Opioid Drug Use During Pregnancy And Its Impact On Perinatal Morbidity, Mortality, And The Costs Of Medical Care In The United States, Valerie E. Whiteman, Jason L. Salemi, Mulubrhan F. Mogos, Mary Ashley Cain, Muktar H. Aliyu, Hamisu M. Salihu

Obstetrics & Gynecology Faculty Publications

Objective. To identify factors associated with opioid use during pregnancy and to compare perinatal morbidity, mortality, and healthcare costs between opioid users and nonusers. Methods. We conducted a cross-sectional analysis of pregnancy-related discharges from 1998 to 2009 using the largest publicly available all-payer inpatient database in the United States. We scanned ICD-9-CM codes for opioid use and perinatal outcomes. Costs of care were estimated from hospital charges. Survey logistic regression was used to assess the association between maternal opioid use and each outcome; generalized linear modeling was used to compare hospitalization costs by opioid use status. Results. …

The Difficult Intraoperative Nasogastric Tube Intubation: A Review Of The Literature And A Novel Approach, Yiu-Hei Ching, Stephanie M. Socias, David J. Ciesla, Rachel A. Karlnoski, Enrico M. Camporesi, Devanand Mangar

Surgery Faculty Publications

Nasogastric tube intubation of a patient under general anesthesia with an endotracheal tube in place can pose a challenge to the most experienced anesthesiologist. Physiologic and pathologic variations in a patient’s functional anatomy can present further difficulty. While numerous techniques to the difficult nasogastric tube intubation have been described, there is no consensus for a standard approach. Therefore, selecting the most appropriate approach requires a working knowledge of the techniques available, mindful consideration of individual patient and clinical factors, and the operator’s experience and preference. This article reviews the relevant literature regarding various approaches to the difficult nasogastric tube intubation …