Digital Commons Network^™

Livedoid Vasculopathy In The Setting Of Disseminated Intravascular Coagulation Diagnosed As Thrombotic Thrombocytopenic Purpura, Steven Oberlender Md, Phd, Anthony J. Gust Md, Christian W. Oram Do

Department of Medicine

No abstract provided.

Malpositioned Pacemaker Lead Presenting As A Peculiar 12-Lead Ekg, Amit Nanavati Md, Robert F. Malacoff Md, Facc

Department of Medicine

No abstract provided.

Case Of An Acute Dual Plaque Rupture, Adrian C. Bell Do, Amit N. Nanavati Md, Sarang S. Mangalmurti Md

Department of Medicine

No abstract provided.

Infrapopliteal Stenosis Requiring Proximal And Distal Approach, Amit N. Nanavati Md, Adrian C. Bell Do, Sarang S. Mangalmurti Md

Department of Medicine

No abstract provided.

Community Cancer Services, Clinical Trials, And Quality Initiatives--Year 2 Ncccp At Lehigh Valley Health Network, Ada M. Rivera Ba, Lenore A. Mcgonigle Ms, Maryellen Shiels Bs, Smiyyah Q. Whitney Rn, Suresh G. Nair Md, Janelle M. Sharma, Kathy Sevedge Rn, Ma, Aocn, Eliot L. Friedman Md, Nadesda Mack Rn, Bsn, Mba, Ocn, Gregory R. Harper Md, Phd

Department of Medicine

No abstract provided.

Car Seat Dermatitis - A Case Report, Marie S. Lewars Do, Joshua M. Levin Md, Stephen Purcell Do

Department of Medicine

No abstract provided.

Post Gastric Bypass Hypoglycemia: Four Cases Treated Successfully With Alphaglucosidase Inhibitor Therapy, Shavon S. Frankhouser Do, Aakif N. Ahmad Do, Gretchen A. Perilli Md, Benjamin J. Quintana Md, Marc A. Vengrove Do, Facp

Department of Medicine

No abstract provided.

Spontaneous Coronary Artery Dissection: A Rare But Deadly Cause Of Acs In Younger Patients, Daniel J. Makowski Do, David A. Cox Md

Department of Medicine

No abstract provided.

Factors Associated With Loss To Follow-Up Among Hiv-Infected Patients At An Urban, Hospital-Based Outpatient Hiv Clinic, Timothy J. Friel Md, Anthony Nerino, Lynn Nagel, J D'Aversa, Anthony Strobel, Dorothy Faulkner Phd

Department of Medicine

No abstract provided.

A Quality Improvement Initiative Using A Novel Travel Survey To Define High-Risk International Travel And Promote Patient-Centered Counseling, Craig A. Mackaness Do, Mark Knouse Md, Suzanne J. Templer Do, Deepti Verma Md, Allison Osborne Ba, Michael J. Weiss Mph

Department of Medicine

No abstract provided.

Rapid Door To Balloon Time In The Treatment Of Acute St- Elevation Myocardial Infarction Meaningfully Reduces Overall Hospital Stay, Amit N. Nanavati Md, Nainesh Patel Md, Bruce Feldman Do, J Patrick Kleaveland Md, Orlando E. Rivera Rn, David A. Cox Md

Department of Medicine

No abstract provided.

Severe Lamotrigine Neurotoxicity Treated With Intralipid Emulsion Therapy, Philip W. Moore Do, Megan C. Urquhart Do, Dale L. Mcmillion Do, Keith K. Burkhart Md, Louis R. Cantilena Jr, Md, J Ward Donovan Md

Department of Emergency Medicine

No abstract provided.

Trends In The Utilization Of Outpatient Advanced Imaging After The Deficit Reduction Act., David C Levin, Vijay M Rao, Laurence Parker

Department of Radiology Faculty Papers

PURPOSE: After the Deficit Reduction Act (DRA) took effect in 2007, there was concern that private office-based imaging facilities would close, that advanced imaging would shift to less convenient hospital-based facilities, and that access to advanced imaging might be restricted. The aim of this study was to see if these developments occurred during the years after the DRA.

METHODS: Using Medicare data, outpatient CT, MRI, and nuclear medicine trends before and after the DRA were studied. Procedure volumes performed in private offices and hospital outpatient departments (HOPDs) were tabulated separately. Volumes were tracked from 2000 to 2006 (before the DRA) …

Left Atrial Volume: Comparison Of 2d And 3d Transthoracic Echocardiography With Ecg-Gated Ct Angiography., Anish R Koka, Stuart D Gould, Alyson N Owen, Ethan J. Halpern

Department of Radiology Faculty Papers

RATIONALE AND OBJECTIVES: Left atrial volume (LAV) measurement by conventional two-dimensional (2D) transthoracic echocardiography (TTE) may be limited by the geometric model, by suboptimal definition of left atrial endocardium, or by chamber foreshortening. Three-dimensional (3D) TTE is posited to eliminate chamber foreshortening, and LAV measurement by 3D TTE should be more reflective of true LAV. The aim of this study was to compare conventional 2D TTE and newer 3D TTE for measurements of LAV to multidetector computed tomographic (MDCT) measurements using automated chamber reconstruction (ACR).

MATERIALS AND METHODS: Twenty-two subjects consented to undergo 2D TTE and 3D TTE immediately prior …

Optical Imaging For Determination Of Apoptosis Medicated Therapeutic Efficacy, Kaijun Zhang, Bishnuhari Paudyal, Neil Mehta, Brian Gray, Koon Y. Pak, Eric Wickstrom, Mathew L Thakur

Department of Radiology Faculty Papers

No abstract provided.

Hdm2 Small-Molecule Inhibitors For Therapeutic Intervention In B-Cell Lymphoma, Angela Sosin

Wayne State University Dissertations

Lymphomas frequently retain wild-type (wt) p53 function but overexpress HDM2, compromising p53 activity. Therefore, lymphoma is a suitable model for studying therapeutic value of disrupting HDM2-p53 association by small-molecule inhibitors (SMIs). HDM2 SMIs have been developed and are currently under various stages of preclinical and clinical investigation. This study examined various molecular mechanisms associated and biological effects of two different classes of HDM2 SMIs: the spiro-oxindoles (MI-219) and cis-imidazoline (Nutlin-3) in lymphoma cell lines and patient-derived B-lymphoma cells. Surprisingly, results revealed significant quantitative and qualitative differences between these two agents. At the molecular level, effect of Nutlin-3 was generally more …

The Experiences Of Cancer Survivors As They Transition From Chemotherapy Treatment To Life After Cancer, Violet Platt

Theses: Doctorates and Masters

This study explored and described the experience of people with a diagnosis of cancer, as they transitioned from life as a chemotherapy patient to life after treatment as a cancer survivor. The purpose of this study was to ultimately improve the care of people as they transitioned into life after completion of chemotherapy treatment. There is minimal information related to this phase of the cancer trajectory, therefore this study was intentionally exploratory and descriptive. To achieve the proposed outcome a two-phased approach was undertaken. In Phase One a qualitative approach was followed using Grounded Theory to the descriptive level of …

Investigating The Impact Of Cd147 And Its Expression On Neurodegenaration And Alzheimer's Disease (Ad), Limbikani J. Kanyenda

Theses: Doctorates and Masters

CD147, also known as basigin, extracellular matrix metalloproteinase inducer, neurothelin, tumour cell-derived collagenase stimulatory factor, M6, HT7, OX47 or gp42, is a transmembrane glycoprotein of the immunoglobulin super-family. It is expressed in many neuronal and non-neuronal tissues with high expression in the hippocampus, pre-frontal cortex, thyroid, heart, early erythroid, amygdala and placenta. This protein is involved in various cellular and biological functions such as lymphocyte migration and maturation, tissue repair, cancer progression, T and B lymphocyte activation and induction of extracellular matrix metalloproteinase. The CD147 protein interacts with with cyclophilin A, cyclophilin B, sterol carrier protein, caveolin-1 and integrins, and …

Contegra Valved Conduit In The Paediatric Population: An Exciting Prospect For Right Ventricle To Pulmonary Artery Reconstruction; Experience And Outcomes At Aga Khan University, Maria Tariq Siddiqui, Asif Hasan, Shazia Mohsin, Mohammad Hamid, Muneer Amanullah

Department of Anaesthesia

Objective: The focus of this study is to share the experience and outcomes of Contegra graft implantation in the paediatric and adult population in Pakistan. Methods: Between May 2007 and July 2011, 16 patients, underwent implantation of a Contegra valved conduit. All operations were performed through a median sternotomy with cardiopulmonary bypass. Indications included: Pulmonary atresia with ventricular septal defect (n=11), Tetralogy of Fallot with absent Pulmonary Valve (PV) syndrome (n=2), double outlet right ventricle, transposition of great arteries and pulmonary stenosis (n=1), isolated aortic valve disease (n=1) and a pseudo-aneurysm with infective endocarditis (n=1).Conduit sizes varied between 16-22 mm. …

Examining Cancer-Related Pain And Quality Of Life In Lehigh Valley Home Care Patients, Linda G. Alley Phd, Rn, Hannah D. Paxton Rn, Mph, Michelle D. Flores Bsn, Rn, Carol A. Foltz Phd, Jen Wike Mph, Mba, Vickie Cunningham Bsn, Rn, Jeffrey Etchason Md

Administration & Leadership

No abstract provided.

Short-Term Plasticity At The Schaffer Collateral: A New Model With Implications For Hippocampal Processing, Andrew Hamilton Toland

Dissertations and Theses

A new mathematical model of short-term synaptic plasticity (STP) at the Schaffer collateral is introduced. Like other models of STP, the new model relates short-term synaptic plasticity to an interaction between facilitative and depressive dynamic influences. Unlike previous models, the new model successfully simulates facilitative and depressive dynamics within the framework of the synaptic vesicle cycle. The novelty of the model lies in the description of a competitive interaction between calcium-sensitive proteins for binding sites on the vesicle release machinery. By attributing specific molecular causes to observable presynaptic effects, the new model of STP can predict the effects of specific …

An Examination Of Factors Affecting Non-Urgent Use Of Emergency Department Services By Patients With "Universal" Healthcare, Gregory Smith Feltenberger

Health Services Research Dissertations

The purpose of this research is to examine the factors affecting non-urgent utilization of emergency department (ED) services by individuals with "universal" healthcare using the Behavioral Model of Health Services Use. Since Air Force Medical Service beneficiaries have free and unlimited use of the full-range of healthcare services, they are ideally suited for this study. The findings of this research may also apply to other populations with free or low-cost access to healthcare (i.e., universal or single-payer healthcare). Using secondary data extracted from the Air Force Medical Service's electronic health record system at several military hospitals, this study will present …

Detection Of Evolving Injury To The Brachial Plexus During Transaxillary Robotic Thyroidectomy., Adam Luginbuhl, Daniel M Schwartz, Anthony K Sestokas, David Cognetti, Edmund Pribitkin

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

OBJECTIVES/HYPOTHESIS: Continuous intraoperative neuromonitoring (IONM) of transcranial electric motor evoked potentials (tceMEPs) and somatosensory evoked potentials (SSEPs) has gained universal acceptance as an efficacious method for detecting emerging positional brachial plexopathy or peripheral nerve compression during spinal and shoulder surgery. This has implications for transaxillary thyroid surgery.

STUDY DESIGN: Case report with literature review.

METHODS: The patient underwent robotic transaxillary thyroid surgery with continuous tceMEP and SSEP monitoring of brachial plexus function. We present detailed IONM data depicting the emergence of positional brachial plexopathy.

RESULTS: Significant amplitude loss of both IONM modalities were identified during an evolving positional plexopathy, which …

The Effectiveness Of Airway Management In The Pre Hospital Treatment Of Traumatic Brain Injury : A Retrospective, Observational Study Of Pre Hospital Treatment Of Traumatic Brain Injury (Tbi) In The Western Australian Ambulance Service, Joseph Cuthbertson

Theses: Doctorates and Masters

There is concern over mortality and the potential for secondary brain injury in the head-injured patient. The use of advanced airway management and rapid sequence intubation in the pre hospital treatment of patients with Traumatic Brain Injury is controversial. Currently in St John Ambulance Service Australia (WA) Inc. three forms of pre hospital treatment are utilized to manage the airway of the adult head-injured patient. If attended by on-road paramedic staff, basic airway management is utilized unless the patient is unconscious and areflexic, in which case advanced airway management utilising endotracheal intubation or laryngeal mask insertion is authorised. In the …

Evaluation Of Elevated Alanine Aminotransferase And Hepatitis B Virus Dna In Healthy Seronegative Blood Donors, Natasha Ali, Bushra Moiz, Tariq Moatter

Department of Pathology and Laboratory Medicine

Background: Serum alanine transaminase (ALT) has been used as a surrogate marker for detection of hepatitis B and C in blood donors in Pakistan since 1985. Since the introduction of more sensitive assays the value of ALT became questionable but it was still used with subsequent wastage of blood units with raised ALT.
Finding: We conducted a study for a period of one year to evaluate the usefulness of ALT. During the study period, 25117 subjects donated blood. Eight hundred and seventy two donors (3.4%) were positive for one or more serological tests. ALT of all donors ranged from …

Lymphangioma Circumscriptum In The Scrotum: A Case Report, Saroona Haroon, Sheema H. Hasan

Department of Pathology and Laboratory Medicine

Introduction:
Lymphangioma circumscriptum is a rare benign skin disorder involving hamartomatous lymphatic malformation of deep dermal and subcutaneous lymphatic channels. It is a therapeutic challenge for the dermatologist when it occurs at common sites such as axilla, shoulder, groin and buttocks and a diagnostic challenge for the surgeon when it occurs at rare sites such as the scrotum. Surgical treatment is the most commonly used method to treat scrotal lymphangioma circumscriptum but there are high rates of recurrence.
Case Presentation:
We report the case of a 30-year-old Pakistani man who presented with scrotal swelling which was clinically misinterpreted as an …

Neonatal Hyperbilirubinemia In Infants With G6pd C563c > T Variant, Bushra Moiz, Amna Nasir, Sarosh Ahmed Khan, Saleema Amin Kherani, Maqbool Qadir

Department of Pathology and Laboratory Medicine

Background: There is a strong correlation between glucose-6-phosphate dehydrogenase (G6PD) deficiency and neonatal hyperbilirubinemia with a rare but potential threat of devastating acute bilirubin encephalopathy. G6PD deficiency was observed in 4–14% of hospitalized icteric neonates in Pakistan. G6PD c.563C > T is the most frequently reported variant in this population. The present study was aimed at evaluating the time to onset of hyperbilirubinemia and the postnatal bilirubin trajectory in infants having G6PD c.563C > T.
Methods: This was a case–control study conducted at The Aga Khan University, Pakistan during the year 2008. We studied 216 icteric male neonates who were re-admitted for …

Outcome Of Match Related Allogeneic Stem Cell Transplantation Procedures Performed From 2004 Till 2011, Natasha Ali, Salman Naseem Adil, Mohammad Usman Shaikh, Munira Moosajee, Nehal Masood

Department of Pathology and Laboratory Medicine

We present our initial experience of allogeneic stem cell transplant procedure performed between April 2004 and August 2011 for various haematological disorders. All patients with non-malignant and malignant haematological disorders with HLA matched donors were selected after pre-transplant workup. Ninety seven patients underwent the procedure. Most common indications for transplant were aplastic anaemia in n=34 (35%), followed by beta-Thalassemia major in n=21 (21.6%) and chronic myeloid leukemia in n=11 patients (11.3%). Primary graft failure present was present in 2.06%. Incidence of graft versus host disease (GvHD) in our patients was 34%. After median follow-up of five years the overall survival …

Conversion From Enzyme-Inducing Antiepileptic Drugs To Topiramate: Effects On Lipids And C-Reactive Protein., Scott Mintzer, Christopher T Skidmore, Sara J Rankin, Inna Chervoneva, Edward Pequinot, David M Capuzzi, Michael R Sperling

Department of Neurology Faculty Papers

PURPOSE: We previously demonstrated that converting patients from the enzyme-inducers phenytoin or carbamazepine to the non-inducers levetiracetam or lamotrigine reduces serum lipids and C-reactive protein (CRP). We sought to determine if the same changes would occur when patients were switched to topiramate, which has shown some evidence of enzyme induction at high doses. We also examined the effects of drug switch on low-density lipoprotein (LDL) particle concentration.

METHODS: We converted 13 patients from phenytoin or carbamazepine monotherapy to topiramate monotherapy (most at doses of 100-150 mg/day). Fasting lipids, including LDL particle concentration, and CRP were obtained before and ≥6 weeks …

Cost Effectiveness Of A Home-Based Intervention That Helps Functionally Vulnerable Older Adults Age In Place At Home., Eric Jutkowitz, Laura N Gitlin, Laura T. Pizzi, Edward Lee, Marie P Dennis

College of Population Health Faculty Papers

Evaluating cost effectiveness of interventions for aging in place is essential for adoption in service settings. We present the cost effectiveness of Advancing Better Living for Elders (ABLE), previously shown in a randomized trial to reduce functional difficulties and mortality in 319 community-dwelling elders. ABLE involved occupational and physical therapy sessions and home modifications to address client-identified functional difficulties, performance goals, and home safety. Incremental cost-effectiveness ratio (ICER), expressed as additional cost to bring about one additional year of life, was calculated. Two models were then developed to account for potential cost differences in implementing ABLE. Probabilistic sensitivity analyses were …