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Shades Of Grey: An Exploration Of The Student Learning Experience In Diagnostic Radiology Education, Kathleen Linda Linaker

Dissertations

Diagnostic radiology education is a specialty within healthcare education and encompasses education at both the undergraduate and resident level. There is little research regarding what constitutes effective radiology education. The broad purpose of this study was to investigate through the student perspective how chiropractic students learned diagnostic radiology within their curriculum and what contributed to this learning. This interview-based, qualitative research explored the learning experiences of 12 fourth-year chiropractic students at two colleges. Specifically this study investigated a) the learning strategies students believe both worked and didn't work in learning radiology, b) student perceptions of the effectiveness of instructional methods …

Stress Reactions Of Division-I Track Athletes, Laura Elizabeth Skarda

Dissertations and Theses

Problem: Track and field athletes, along with cross-country athletes have multiple and back to back seasons, creating overuse injuries. Stress fractures or stress reactions to the bone are the overuse injuries focused on in this study and literature review. There is a lack of information in the literature regarding stress reactions. Purpose: The goal of the study is to understand more information about stress reactions to bone and possibly increase the knowledge of health care professionals. Methods: Three case studies were examined through pre-existing medical chart notes and athletic trainer's notes regarding the stress reactions. A literature review was also …

Cisplatin-Induced Posterior Reversible Encephalopathy Syndrome And Successful Re-Treatment In A Patient With Non-Seminomatous Germ Cell Tumor: A Case Report, Muhammad Nauman Zahir, Nehal Masood, Munira Shabbir-Moosajee

Department of Radiation Oncology

UNLABELLED: Introduction: Cisplatin is a platinum compound that has revolutionized the treatment of various solid organ tumors. Cisplatin is associated with a variety of side effects and has recently been indicted in the development of posterior reversible encephalopathy syndrome. Posterior reversible encephalopathy syndrome is a potentially reversible condition, with the mainstay of therapy being correction of the underlying cause and withdrawal of the offending drug. However, there are no clear guidelines regarding the possibility of subsequent re-treatment with the causative agent.CASE PRESENTATION: A 23-year-old Asian man presented to our Emergency Department with a four-month history of concomitant abdominal pain and …

Outcome Of Febrile Neutropenic Patients On Granulocyte Colony Stimulating Factor In A Tertiary Care Hospital, Asif Husain Osmani, Tayyaba Zehra Ansari, Nehal Masood, Bilal Ahmed

Department of Radiation Oncology

Introduction: Febrile neutropenia is a relatively frequent event in cancer patients treated with chemotherapy and improvement in absolute neutrophil count (ANC) has been linked directly to improved outcome. Evaluation of granulocyte colony stimulating factors (GCSFs) for treatment has shown reduced incidences of episodes of prolonged neutropenia and protracted hospitalization. To determine absolute neutrophil counts with GCSF in febrile neutropenic cancer patients admitted to a tertiary care centre and to co-relate the improvement in ANC with mortality and hospital discharge.Methods: A prospective cross sectional study was carried at an oncology ward at Aga Khan University hospital from January 2010 to June …

Dentoalveolar Heights In Skeletal Class I Normodivergent Facial Patterns, Zafar-Ul-Islam, Attiya Shaikh, Mubassar Fida

Section of Dental-Oral Maxillofacial Surgery

OBJECTIVE: To determine the dentoalveolar heights (mm) in skeletal class I normodivergent facial pattern and compare the same heights in male and female subjects.

STUDY DESIGN: Cross-sectional observational study.

PLACE AND DURATION OF STUDY: Orthodontics Clinic, The Aga Khan University Hospital, Karachi, from July to October 2009.

METHODOLOGY: Eighty one subjects were selected from the orthodontic record at the Aga Khan University Hospital Karachi. The inclusion criteria were an age range of 12 to 30 years and skeletal class I normodivergent facial pattern with exclusion criteria of prior orthodontic treatment, restored teeth and craniofacial anomalies/syndromes. The pre-treatment cephalographs of the …

Clinical Spectrum And Severity Of Hemolytic Anemia In Glucose 6-Phosphate Dehydrogenase-Deficient Children Receiving Dapsone, Allan Pamba, Naomi D. Richardson, Nick Carter, Stephan Duparc, Zul Premji, Alfred B. Tiono, Lucio Luzzatto

Pathology, East Africa

Drug-induced acute hemolytic anemia led to the discovery of G6PD deficiency. However, most clinical data are from isolated case reports. In 2 clinical trials of antimalarial preparations containing dapsone (4,4′-diaminodiphenylsulfone; 2.5 mg/kg once daily for 3 days), 95 G6PD-deficient hemizygous boys, 24 G6PD-deficient homozygous girls, and 200 girls heterozygous for G6PD deficiency received this agent. In the first 2 groups, there was a maximum decrease in hemoglobin averaging -2.64 g/dL (range -6.70 to +0.30 g/dL), which was significantly greater than for the comparator group receiving artemether-lumefantrine (adjusted difference -1.46 g/dL; 95% confidence interval -1.76, -1.15). Hemoglobin concentrations were decreased by …

Adherence To Artemether/Lumefantrine Treatment In Children Under Real-Life Situations In Rural Tanzania, D.O. Simba, D. Kakoko, G. Tomson, Zul Premji, M. Petzold, M. Mahindi, L.L. Gustafsson

Pathology, East Africa

A follow-up study was conducted to determine the magnitude of and factors related to adherence to artemether/lumefantrine (ALu) treatment in rural settings in Tanzania. Children in five villages of Kilosa District treated at health facilities were followed-up at their homes on Day 7 after the first dose of ALu. For those found to be positive using a rapid diagnostic test for malaria and treated with ALu, their caretakers were interviewed on drug administration habits. In addition, capillary blood samples were collected on Day 7 to determine lumefantrine concentrations. The majority of children (392/444; 88.3%) were reported to have received all …

Correlates Of Morbidity And Mortality In Severe Necrotizing Pancreatitis, K. M. Pal, Pashtoon Murtaza Kasi, Mohammad Tayyeb, S. M. Faisal Mosharraf, Zafar Fatmi

Community Health Sciences

Acute severe pancreatitis is associated with a high morbidity and mortality and frequently is accompanied by underlying pancreatic parenchymal necrosis. Patients with pancreatic necrosis must be identified, because the morbidity and mortality rate in this subgroup is much higher. Our objective was to compare the clinical outcomes of these patients based on the degree of pancreatic necrosis. A total of 35 patients were noted to have pancreatic necrosis. These were divided into 2 groups based on extent of necrosis: group A had less than 50% necrosis and group B had more than 50% necrosis. The rate of mortality (5% versus …

Sindh Health Sector Strategy 2012 – 2020, Shehla Zaidi

Community Health Sciences

No abstract provided.

Extent Of Liver Inflammation In Predicting Response To Interferon Alpha & Ribavirin In Chronic Hepatitis C Patients: A Cohort Study, Shirin Mirza, Amna Rehana Siddiqui, Saeed Hamid, Muhammad Umar, Shaheena Bashir

Community Health Sciences

Background: Liver inflammation due to HCV infection leads to fibrosis, which is an independent predictor of treatment response to interferon therapy in Chronic Hepatitis C (CHC) patients. This relationship has not been studied for liver inflammation on pretreatment liver biopsy and End of Treatment Response (ETR). ALT is a less invasive test than liver biopsy for measuring liver inflammation. Aim of this study was to compare ETR to Interferon alpha (recombinant Interferon) & Ribavirin in CHC patients having higher and lower grades of liver inflammation and to determine the diagnostic accuracy of pretreatment ALT for grades of liver inflammation.Methods: A …

Lymph Node Ratio Is An Important And Independent Prognostic Factor For Patients With Stage Iii Melanoma., Adam C. Berger, Michael Fierro, John C Kairys, David Berd, Takami Sato, Jocelyn Andrel, Terry Hyslop, Michael J Mastrangelo

Department of Surgery Faculty Papers

INTRODUCTION: The incidence of melanoma is dramatically increasing worldwide. We hypothesized that the ratio of metastatic to examined lymph node ratio (LNR) would be the most important prognostic factor for stage III patients.

METHODS: We retrospectively reviewed our institutional database of melanoma patients and identified 168 patients who underwent lymph node dissection (LND) for stage III disease between 1993 and 2007. Patients were divided into three groups based on LNR (≤10%, n = 93; 10-≤25%, n = 45; and >25%, n = 30). Univariate and multivariate analysis was performed using Cox proportional hazards model.

RESULTS: The median survival time of …

Right Ventricular Rupture And Tamponade Caused By Malposition Of The Avalon Cannula For Venovenous Extracorporeal Membrane Oxygenation., Hitoshi Hirose, Kentaro Yamane, Gregary D. Marhefka, Nicholas C. Cavarocchi

Department of Surgery Faculty Papers

Placement of the Avalon Elite bicaval dual lumen cannula for venovenous extracorporeal membrane oxygenation (VV-ECMO) via the internal jugular vein requires precise positioning of the cannula tip in the inferior vena cava with echocardiography or fluoroscopy guidance. Correct guidewire placement is clearly the key first step in assuring proper advancement of the cannula. We report a case of unexpected wire migration into the right ventricle at the time of final cannula advancement, resulting in right ventricular rupture and tamponade. Transesophageal echocardiography is an important monitoring modality for appropriate placement of the VV-ECMO guidewire and Avalon cannula, and in particular, for …

Preoperative Fdg-Pet/Ct Is An Important Tool In The Management Of Patients With Thick (T4) Melanoma., Rodrigo Arrangoiz, Pavlos Papavasiliou, Carrie A Stransky, Jian Q Yu, Li Tianyu, Elin R Sigurdson, Adam C. Berger, Jeffrey M Farma

Department of Surgery Faculty Papers

The yield of preoperative PET/CT (PET/CT) for regional and distant metastases for thin/intermediate thickness melanoma is low. Objective of this study is to determine if PET/CT performed for T4 melanomas helps guide management and alter treatment plans. Methods. Retrospective cohort of 216 patients with T4 melanomas treated at two tertiary institutions. Fifty-six patients met our inclusion criteria (T4 lesion, PET/CT and no clinical evidence of metastatic disease). Results. Fifty-six patients (M: 32, F: 24) with median tumor thickness of 6 mm were identified. PET/CT recognized twelve with regional and four patients with metastatic disease. Melanoma-related treatment plan was altered in …

Tracking Of In-111-Labeled Human Umbilical Tissue-Derived Cells (Hutc) In A Rat Model Of Cerebral Ischemia Using Spect Imaging, Ali S. Arbab, Christine Thiffault, Bradford Navia, Stephen J. Victor, Klaudyne Hong, Li Zhang, Quan Jiang, Nadimpalli Rs Varma, Asm Iskander, Michael Chopp

Wayne State University Associated BioMed Central Scholarship

Abstract

Background

In order to increase understanding of how infused cells work, it becomes important to track their initial movement, localization, and engraftment efficiency following transplantation. However, the available in vivo cell tracking techniques are suboptimal. The study objective was to determine the biodistribution of intravenously administered Indium-111 (In-111) oxine labeled human umbilical tissue-derived cells (hUTC) in a rat model of transient middle cerebral occlusion (tMCAo) using single photon emission computed tomography (SPECT).

Methods

Rats received 3 million In-111 labeled hUTC (i.v.) 48 hrs after tMCAo. Following the administration of either hUTC or equivalent dose of In-111-oxine (18.5 MBq), animals …

Using Learned Under-Sampling Pattern For Increasing Speed Of Cardiac Cine Mri Based On Compressive Sensing Principles, Pooria Zamani, Mohammad Kayvanrad, Hamid Soltanian-Zadeh

Wayne State University Associated BioMed Central Scholarship

Abstract

This article presents a compressive sensing approach for reducing data acquisition time in cardiac cine magnetic resonance imaging (MRI). In cardiac cine MRI, several images are acquired throughout the cardiac cycle, each of which is reconstructed from the raw data acquired in the Fourier transform domain, traditionally called k-space. In the proposed approach, a majority, e.g., 62.5%, of the k-space lines (trajectories) are acquired at the odd time points and a minority, e.g., 37.5%, of the k-space lines are acquired at the even time points of the cardiac cycle. Optimal data acquisition at the even time points is learned …

Fibroblast-Secreted Hepatocyte Growth Factor Mediates Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitor Resistance In Triple-Negative Breast Cancers Through Paracrine Activation Of Met, Kelly L. Mueller, Julie M. Madden, Gina L. Zoratti, Charlotte Kuperwasser, Karin List, Julie L. Boerner

Wayne State University Associated BioMed Central Scholarship

Abstract

Introduction

Epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) have shown clinical efficacy in lung, colon, and pancreatic cancers. In lung cancer, resistance to EGFR TKIs correlates with amplification of the hepatocyte growth factor (HGF) receptor tyrosine kinase Met. Breast cancers do not respond to EGFR TKIs, even though EGFR is overexpressed. This intrinsic resistance to EGFR TKIs in breast cancer does not correlate with Met amplification. In several tissue monoculture models of human breast cancer, Met, although expressed, is not phosphorylated, suggesting a requirement for a paracrine-produced ligand. In fact, HGF, the ligand for Met, is not …

Norepinephrine: The Next Therapeutics Frontier For Parkinson's Disease, Peter A. Lewitt

Wayne State University Associated BioMed Central Scholarship

Abstract

Tissue concentrations of norepinephrine (NE) are markedly decreased in various regions of the Parkinson's disease (PD) brain. As in the substantia nigra pars compacta, neuronal dropout and Lewy bodies are prominent changes affecting the locus coeruleus, which is the source of ascending NErgic projections. Despite the major roles of NE throughout the brain, there has been only minimal exploration of pharmacological intervention with NErgic neurotransmission. Cognitive operations, "freezing" of gait, tremor, dyskinesia, REM sleep regulation, and other aspects of brain function are tied into signaling by NE, and there is also evidence that it may have a role in …

Signaling In Colon Cancer Stem Cells, Sanchita Roy, Adhip Pn Majumdar

Wayne State University Associated BioMed Central Scholarship

Abstract

Hdm2 Antagonist Mi-219 (Spiro-Oxindole), But Not Nutlin-3 (Cis-Imidazoline), Regulates P53 Through Enhanced Hdm2 Autoubiquitination And Degradation In Human Malignant B-Cell Lymphomas, Angela M. Sosin, Angelika M. Burger, Aisha Siddiqi, Judith Abrams, Ramzi M. Mohammad, Ayad M. Al-Katib

Wayne State University Associated BioMed Central Scholarship

Abstract

Background

Lymphomas frequently retain wild-type (wt) p53 function but overexpress HDM2, thereby compromising p53 activity. Therefore, lymphoma is a suitable model for studying the therapeutic value of disrupting the HDM2-p53 interaction by small-molecule inhibitors (SMIs). HDM2 have been developed and are under various stages of preclinical and clinical investigation. Previously, we examined the anti-lymphoma activity of MI-319, the laboratory grade of a new class of HDM2 SMI, the spiro-oxindole, in follicular lymphoma. Since then, MI-219, the clinical grade has become readily available. This study further examines the preclinical effects and mechanisms of MI-219 in a panel of human lymphoma …

The Proton-Coupled Folate Transporter: Biology And Therapeutic Applications To Cancer, Sita Desmoulin

Wayne State University Dissertations

Folates are essential cofactors of tumor cell proliferation and survival required for nucleotide biosynthesis and amino acid metabolism. In cancer therapy, inhibition of folate-dependent metabolic pathways has been achieved through the use of antifolates. Unfortunately, the efficacy of many clinically approved antifolates is limited by a lack of tumor selectivity. Facilitative transport of folates into mammalian cells is achieved by the reduced folate carrier (RFC) and proton-coupled folate transporter (PCFT). As PCFT is a folate-proton symporter with an acidic pH optimum, PCFT may provide a mechanism for targeting cytotoxic antifolates to tumors, based on their acidic microenvironments. To establish the …

Falls And Physical Activity In Persons With Multiple Sclerosis, J. J. Sosnoff, B. M. Sandroff, J. H. Pula, S. M. Morrison, R. W. Motl

Rehabilitation Sciences Faculty Publications

Objectives. To examine the association between fall history and physical activity using an objective measure of physical activity (i.e., accelerometry) in persons with multiple sclerosis.

Design. A community-based sample of 75 ambulatory persons with multiple sclerosis volunteered for the investigation. Participants self-reported fall history in the last year, underwent a neurological exam to determine Expanded Disability Status Scale (EDSS) score, and wore an accelerometer around the waist for 7 consecutive days to determine physical activity.

Results. Overall, 37 persons (49.3% of the sample) reported falling in the last year with 28 of the 37 falling more than once. Persons who …

High Isoniazid Resistance Rates In Rifampicin Susceptible Mycobacterium Tuberculosis Pulmonary Isolates From Pakistan, Naima Fasih, Yasraba Rafiq, Kausar Jabeen, Rumina Hasan

Department of Pathology and Laboratory Medicine

Background:
Rapid new diagnostic methods (including Xpert MTB/RIF assay) use rifampicin resistance as a surrogate marker for multidrug resistant tuberculosis. Patients infected with rifampicin susceptible strains are prescribed first line anti-tuberculosis therapy. The roll out of such methods raises a concern that strains with resistance to other first line anti-tuberculosis drugs including isoniazid will be missed and inappropriate treatment given. To evaluate implications of using such methods review of resistance data from high burden settings such as ours is essential.
Objective:
To determine resistance to first line anti-tuberculosis drugs amongst rifampicin susceptible pulmonary Mycobacterium tuberculosis (MTB) isolates from Pakistan.
Material …

Is Nalidixic Acid Screening Still Valid For The Detection Of Reduced Susceptibility Of Fluoroquinolone With Salmonella Typhi?, Seema Irfan, Kauser Jabeen, Umair Anwar Jilani, Bushra Ahmed, Jaishri Mehraj, Tanwir Ahsan, Afia Zafar

Department of Pathology and Laboratory Medicine

Introduction: Considering the limitations of screening with nalidixic acid to detect reduced susceptibility to fluoroquinolones of Salmonella enterica serovar Typhi (S.Typhi) strains, we evaluated the use of a 30 µg nalidixic acid disc screening method in Pakistan.
Methodology: Non duplicate nalidixic acid susceptible S. Typhi isolates (246) from 2003-2008 were retrieved from the Salmonella strain bank. Minimum inhibitory concentrations of ciprofloxacin for all strains were determined by agar dilution and further rechecked by ciprofloxacin E-tests.E. coli ATCC 25922 was used as the control strain. The MIC data for ciprofloxacin were compared with nalidixic acid disk (30µg) zone diameters.
Results: …

A New Antiplatelet Agent Cilostazol: What Is The Evidence For Its Use And Tolerability?, Shaista Anwar Sidddiqi, Ayeesha Kamran Kamal

Section of Neurology

No abstract provided.

Peripheral (Limb) Myokymic Discharges In Motor Neuron Disease, Javeria Rauf, Junaid Akhtar, Bhojo Assumal Khealani, Liaquat Ali

Section of Neurology

We present the case of a 28-year-old gentleman who presented with weakness and wasting in the right arm. He complained about painful cramps in his left leg but there were no sensory, visual or swallowing problems. Neurological examination was significant for asymmetric weakness of both upper and lower limbs and deep tendon reflexes were asymmetrically brisk. Initial laboratory investigations, MRI brain and MRI spine were normal. Electromyography revealed active denervation and chronic neurogenic motor unit action potential. Myokymic discharges were noted in the left deltoid muscle.

Pathophysiology And Management Of Spontaneous Intracranial Hypotension--A Review, Nadir Ali Syed, Farhan Arshad Mirza, Aqueel Hussain Pabaney, Rameez-Ul-Hassan

Section of Neurology

Spontaneous Intracranial Hypotension is a syndrome involving reduced intracranial pressure secondary to a dural tear which occurs mostly due to connective tissue disorders such as Marfans Syndrome, and Ehler Danlos Syndrome. Patients with dural ectasias leading to CSF leakage into the subdural or epidural space classically present with orthostatic headaches and cranial nerve deficits mostly seen in cranial nerves V-VIII. Diagnosis of SIH is confirmed with the aid of neuroimaging modalities of which Cranial MR imaging is most widely used. SIH can be treated conservatively or with epidural blood patches which are now widely being used to repair dural tears, …

Prevalence And Factors Associated With Hepatitis B Immunization And Infection Among Men Who Have Sex With Men In Beijing, China, Chao Wang, You Xin Wang, Xiao Jie Huang, Xia Li, Tong Zhang, Manshu Song, Li Juan Wu, Juan Du, Xiao Qin Lu, Shuang Shao, Fei Fei Zhao, Michele Ball, Hao Wu, Wei Wang

Research outputs 2012

Background: Among the Chinese population of 1.3 billion, there are an estimated 93 million carriers of hepatitis B virus (HBV). Men who have sex with men (MSM) are at increased risk for HBV infection; however, the prevalence of HBV immunization and infection among Chinese MSM remains undetermined. Methods: A cross-sectional survey of 1,114 eligible participants was conducted in Beijing, China. Multiple methods were used to recruit study participants. Demographic information and potential correlated factors were collected by questionnaire. Additionally, blood specimens were collected and tested for sexually transmitted infections and serologic markers of hepatitis B immunization and infection. Results: Laboratory …

Multigene Interactions And The Prediction Of Depression In The Wisconsin Longitudinal Study, N S Roetker, J A Yonker, C. Lee, V Chang, J J Basson, C L Roan, T S Hauser, R M Hauser, Craig Atwood

Research outputs 2012

Objectives: Single genetic loci offer little predictive power for the identification of depression. This study examined whether an analysis of gene-gene (G x G) interactions of 78 single nucleotide polymorphisms (SNPs) in genes associated with depression and agerelated diseases would identify significant interactions with increased predictive power for depression. Design: A retrospective cohort study. Setting: A survey of participants in the Wisconsin Longitudinal Study. Participants: A total of 4811 persons (2464 women and 2347 men) who provided saliva for genotyping; the group comes from a randomly selected sample of Wisconsin high school graduates from the class of 1957 as well …

Getting Back To My Life: Exploring Adaptation To Change Through The Experiences Of Breast Cancer Survivors, Charles A. Foster

Antioch University Dissertations & Theses

The holding environment concept, developed by Donald Winnicott, has been used to represent the type of support that encourages adaptive change during psychosocial transitions. The leadership and change literature posited that the holding environment had the ability to shape the trajectory of the transition, yet did not test this empirically. The psychosocial breast cancer literature empirically researched support during and after treatments ended, but did not incorporate the holding environment concept. This presented the opportunity to inform both the leadership and breast cancer fields by studying holding environments in the breast cancer setting. This study had a twofold purpose: 1) …

The Influence Of Federally Qualified Health Centers On Selected Ambulatory Care Sensitive Conditions In Georgia, Mary W. King Mathis

College of Graduate Studies: Theses & Dissertations

Author's Abstract: Ambulatory care sensitive conditions (ACSCs) resulting in hospitalizations make up a substantial proportion of health care costs, but should not because these conditions are manageable in quality primary care settings that promote prevention in an effort to avoid exacerbations that can lead to hospitalization. The use of emergency departments (EDs) as a safety net for ACSCs has increased the burden on hospitals because patients who do not regularly utilize primary care often resort to the use of EDs for treatment of ACSCs. Federally qualified health centers (FQHCs) are designed to provide consistent, high-quality primary care to all people, …