Digital Commons Network^™

Brain Abscess Complicating Hemorrhagic Contusion In A Case Of Closed Head Injury, A.A. Wani, Altaf U Ramzan, Nayil K Malik, Furqan A Nizami, Anil Dhar, Ashish Kumar, M A Wani

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Pakistan Society Of Neurosurgeons Neurotrauma Karachi 2011

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

A Rare Case Of Candidal Meningitis In Immuna Competent Host, M. Mittal, Deepak Goel, Garima Mittal, Krishan K. Bansal

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Psychological And Cognitive Determinants Of Vision Function In Age-Related Macular Degeneration., Barry W. Rovner, Robin J Casten, Robert W Massof, Benjamin E Leiby, William S Tasman

Department of Neurology Faculty Papers

OBJECTIVE: To investigate the effect of coping strategies, depression, physical health, and cognition on National Eye Institute Visual Function Questionnaire scores obtained at baseline in a sample of older patients with age-related macular degeneration (AMD) enrolled in the Improving Function in AMD Trial, a randomized controlled clinical trial that compares the efficacy of problem-solving therapy with that of supportive therapy to improve vision function in patients with AMD.

METHODS: Baseline evaluation of 241 older outpatients with advanced AMD who were enrolled in a clinical trial testing the efficacy of a behavioral intervention to improve vision function. Vision function was characterized …

Generation Of A Kupffer Cell-Evading Adenovirus For Systemic And Liver-Directed Gene Transfer, Reeti Khare, Shannon M. May, Francesco Vetrini, Eric A. Weaver, Donna Palmer, Amanda Rosewell, Nathan Grove, Philip Ng, Michael A. Barry

Nebraska Center for Virology: Faculty Publications

As much as 90% of an intravenously (i.v.) injected dose of adenovirus serotype 5 (Ad5) is absorbed and destroyed by liver Kupffer cells. Viruses that escape these cells can then transduce hepatocytes after binding factor X (FX). Given that interactions with FX and Kupffer cells are thought to occur on the Ad5 hexon protein, we replaced its exposed hypervariable regions (HVR) with those from Ad6. When tested in vivo in BALB/c mice and in hamsters, the Ad5/6 chimera mediated >10 times higher transduction in the liver. This effect was not due to changes in FX binding. Rather, Ad5/6 appeared to …

Development Of A P.O.I. And A Blended Learning Ecology For Use In Combat Lifesaver Skills Training For The Army, Bea Babbitt

Telemedicine & Advanced Technology Research Center

The primary purpose of the project, as originally conceived, was to design and implement a series of applied research studies to validate the effectiveness of a blended learning ecology in the teaching of life saving medical skills to US Army combat military personnel. The project has since undergone several changes to include changing the focus to the development of a Program of Instruction (POI) for Combat Lifesaver Skills (CLS). Additionally, the CLS course content was integrated with Personal Response Systems (PRS) to promote the learning outcomes outlined in the POI, and 2 eLearning Modules were created to further reinforce content. …

Cytological Diagnosis Of Typical Carcinoid On Bronchoscopic Brush Smears In An Hiv-Positive Patient, Neeta Kumar, Shahin Sayed, Swati Das

Internal Medicine, East Africa

We report a case of typical carcinoid of the lung in a 60-year-old human immunodeficiency virus (HIV)-positive man diagnosed on brush cytology smears. Bronchial carcinoids are rare tumors, accounting for 1% to 2% of all lung tumors. Although the exact incidence in HIV-infected individuals is not known, the paucity of their documentation in the literature indicates that they may be equally rare. Cytological diagnosis on brush smears is rarely documented as the tumor is covered with mucosa and cellular yield is often not good. In this case, bronchial brushings showed distinctive cytological features of typical carcinoid. The awareness of its …

Factors Associated With Serum Brain Natriuretic Peptide Levels After The Fontan Procedure., Andrew M. Atz, Victor Zak, Roger E. Breitbart, Steven D. Colan, Sara K. Pasquali, Daphne T. Hsu, Minmin Lu, Lynn Mahony, Stephen M. Paridon, Michael D. Puchalski, Tal Geva, Brian W. Mccrindle, Pediatric Heart Network Investigators, Girish S. Shirali

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: Although a useful marker of heart failure in adults, the utility of brain natriuretic peptide concentration (BNP) for children after the Fontan procedure is not well studied.

DESIGN: BNP was measured in 510 patients who were 6-18 years old in the Pediatric Heart Network Fontan cross-sectional study at a median of 8.2 years after Fontan. Patients underwent echocardiography, exercise testing, magnetic resonance imaging (MRI) and functional health status questionnaires. Associations of BNP with baseline patient characteristics, medical history and cross-sectional assessment were examined with multivariable linear regression analyses.

RESULTS: The distribution of BNP was highly skewed, median 13.0 pg/mL …

Malignant Peripheral Nerve Sheath Tumour Of Maxilla, Naeem Sultan Ali, Montasir Junaid, Kanwal Aftab

Section of Otolaryngology, Head & Neck Surgery

Malignant peripheral nerve sheath tumour (MPNST) is a very rare entity in head and neck with high rate of recurrences and local invasiveness. This tumour is usually found in lower extremities and only 10-12% occur in head and neck region. The diagnosis is considered as the most elusive and difficult among soft tissue sarcomas because of its non specific presentation, both clinically as well as pathologically. This difficulty has now been overcome by immunohistochemistry. We report here a case of MPNST in a 50 years old male with a localized right maxillary growth.

Tumor-Derived Interleukin-10 As A Prognostic Factor In Stage Iii Patients Undergoing Adjuvant Treatment With An Autologous Melanoma Cell Vaccine., Amit Mahipal, Mizue Terai, David Berd, Inna Chervoneva, Kashyap Patel, Michael Mastrangelo, Takami Sato

Department of Medical Oncology Faculty Papers

OBJECTIVES: Interleukin-10 (IL-10) downregulates T-cell-mediated immune responses. We studied the association between IL-10 production by freshly isolated melanoma cell suspensions in vitro and overall survival in patients undergoing adjuvant treatment with a vaccine prepared from the same autologous melanoma cells modified with a hapten, dinitrophenyl (DNP).

METHODS: Forty-four patients with cutaneous melanoma (29 stage III and 15 stage IV) were prospectively evaluated. Tumor cells were extracted from metastatic deposits for production of DNP-modified autologous melanoma cell vaccine. Small aliquots of the melanoma cell suspensions were separated prior to vaccine processing and cultured overnight for IL-10 production. Based on a blind …

Cerebral Nocardiosis, Rohana Naqi, Humera Ahsan, Muhammad Azeemuddin

Department of Radiology

Localized and multisystem nocardiosis is an opportunistic disease that occurs commonly in immunocompromised patients. Rarely, it is also seen in immunocompetent individuals. The most common disease sites include lung, skin and central nervous system. We report a case of 73 years old man who is a known case of rheumatoid arthritis for more than 15 years and was on Methotrexate and Prednisolone. Now presented with generalized tonic clonic seizures. His Magnetic Resonace Imaging (MRI) scan showed a ring enhancing lesion with mild surrounding oedema in right posterior parietal cortex. Based on the finding, the most probable diagnosis of cerebral abscess …

My Patient Just Had A Transient Ischaemic Attack. Can I Predict His Risk For Stroke? Is Stroke Inevitable Or Preventable?, Maria Khan, Ayeesha Kamran Kamal

Section of Neurology

No abstract provided.

Superficial Temporal Artery Calcification In Patients With End-Stage Renal Disease: Association With Vascular Risk Factors And Ischemic Cerebrovascular Disease, Zeeshan Anwar, Elcin Zan, Marco Carone, Arzu Ozturk, Stephen M Sozio, David M Yousem

Department of Medicine

Background And Purpose: Extracranial superficial temporal artery (STA) calcification is an unusual finding seen in Patients with chronic kidney disease and has unknown ramifications with respect to intracranial ischemic disease. We sought to determine the association between the risk factors for vascular calcification and this rare phenomenon, in Patients with chronic renal failure, and to assess the coexistence of cerebral ischemia. Materials And Methods: Medical records and laboratory data on risk factors for vascular calcification were retrospectively retrieved for 453 Patients with a discharge diagnosis of end-stage renal disease (ESRD). CT head examinations were reviewed to identify and associate STA …

Factors Predicting The Recurrence Of Spontaneous Bacterial Peritonitis In Patients With Cirrhosis, Sajjad Jamil, Shahid Ahmed, Adil Memon, Sara Masood, Syed H Shah, Saeed Sadiq Hamid, Wasim Jafri

Department of Medicine

Objective: To evaluate the frequency of recurrence of spontaneous bacterial peritonitis (SBP) in patients with end stage liver disease and the factors responsible for it.

Study Design: Descriptive study.

Place and Duration of Study: The Aga Khan University Hospital, Karachi, from November 2008 till November 2009.

Methodology: Patients with cirrhosis who were admitted at AKUH with diagnosis of SBP during the study period were included. Any episode of SBP after resolution of the first index case of SBP within one year was considered as recurrence.

Results: Out of 238 cirrhotic patients, 157 (66%) had single, while 81 (34%) had recurrent …

My Patient Just Had A Transient Ischaemic Attack. Can I Predict His Risk For Stroke? Is Stroke Inevitable Or Preventable?, Maria Khan, Ayeesha Kamran Kamal

Department of Medicine

No abstract provided.

Pregnancy Loss And Distress Among U.S. Women, Karina M. Shreffler, Arthur L. Greil, Julia Mcquillan

Department of Sociology: Faculty Publications

Although pregnancy loss—especially miscarriage— is a relatively common experience among reproductive-aged women, much of our understanding about the experience has come from small clinic-based or other nonrepresentative samples. We compared fertility-specific distress among a national sample of 1,284 women who have ever experienced a stillbirth or miscarriage. We found that commitment/attachment to pregnancy that ended in loss as well as current childbearing contexts and attitudes were associated with distress following pregnancy loss. Practitioners working with women or couples who have experienced pregnancy loss should be aware of the importance of characteristics associated with higher distress, such as whether the pregnancy …

Relationship Between The Quetelet’S Index, Homa-Ir Index And Prostate Size In Patients With Benign Prostatic Hyperplasia At St.Mary’S Hospital In, Timothy Onyuma

Master of Medicine in Anatomic Pathology

Introduction: Benign prostatic hyperplasia is a highly prevalent disease and is considered an inevitable correlate of ageing. Several theories have been advanced in a bid to explain its pathogenesis, the most popular ones relating to sex steroid hormones (1). Currently facets of the metabolic syndrome of which two principal components are insulin resistance and high BMI have been postulated to be related to growth of the prostate (2). Insulin resistance is assessed by the HOMA-IR index. Some studies have demonstrated an association between these indices and the size of the prostate (3). While others have not (4). We set out …

Department Of Radiology-Annual Executive Summary Report-July 1, 2010 To June 30, 2011, Vijay M. Rao, Md

Department of Radiology Administrative Documents and Reports

90 page Department of Radiology Annual Executive Summary Report, July 1, 2010 to June 30, 2011, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States.

Tables of Contents:

Department of Radiology

Chairman, Vice Chairmen 1

Divisions and Directors 1

Committees and Chairmen 1

Radiology Department Faculty Rank 2

Faculty with Secondary Appointments 3

Clinical Divisions 4

Radiology Residents and Fellows 5

Department Organizational Chart 6

Department Administration Chart 7

State of the Department 8

Appendix I: Publications Journal Articles 22

Books and Book Chapters 30

Abstracts 33

Appendix II: Formal Scientific Presentations 44

Appendix III: Honors, Editorial Activities, Service to Regional …

Malignant Lymphoma Subtypes In A Private Hospital In Nairobi: A Retrospective Cross-Sectional Study, Omar A. Sherman

Master of Medicine in Anatomic Pathology

Introduction: Lymphoma diagnosis integrates clinical, morphological, immunophenotypical and molecular genetic features as evident from the World Health Organization (WHO) classification of lymphoid malignancies.(1, 2) Although it is standard practice for histopathology laboratories in developed countries to confirm and further sub classify lymphomas using immunohistochemistry and other molecular techniques, the same is not true for developing countries like Kenya. The reasons that prevent the performance of these tests are the prohibitive costs and inadequate trained personnel. Objectives: The aims of this study were to retrospectively classify lymphomas diagnosed at The Aga Khan University Hospital (AKUHN) Laboratory based on the WHO classification …

The Impact Of A Multimodal Approach To Pre-Emptive Analgesia On Postoperative Pain And Analgesic Requirements For Patients Undergoing Orthopaedic Lower Limb Surgery At The Aga Khan University Hospital, Nairobi: A Single Blind Randomised Controlled Trial, John M. Bugo

Master of Medicine in Anaesthesiology

Study Objective: The aim of this study was to evaluate the postoperative morphine-sparing and pain reducing effects of a preemptive, multimodal, perioperative analgesic regimen incorporating the use of preincisional intrathecal blockade plus parenteral anti-inflammatory agents, in patients undergoing lower limb orthopaedic surgery. Study design: Prospective Single blinded Randomized Controlled Trial. Study setting: The Aga Khan Hospital, Nairobi, Kenya. Methods: 44 ASA physical status 1 and 2 patients undergoing lower limb orthopaedic surgery were randomly allocated into two groups of 22 patients each. Patients in the Intervention group were given a preincisional subarachnoid injection of 15mg hyperbaric Bupivacaine and 25mcg Fentanyl, …

A Randomised Controlled Trial Investigating The Effect Of Adding Fentanyl To Low Dose Bupivacaine In Combined Spinal-Epidural Anaesthesia, Using Epidural Volume Extension Technique In Caesarean Section, Mudola V. Manyano

Master of Medicine in Anaesthesiology

Background: Epidural volume extension (EVE), is a technique whereby a small-dose intrathecal block is enhanced by an epidural injection of physiological saline. This epidural injection exerts a compression effect on the dura, which then leads to a cranial increase in sensory spread of the intrathecal local anaesthetic. The lower dose of local anaesthetic required in the EVE technique has made it possible to avoid the side effects of the conventional dose of local anaesthetic while still having the benefit of adequate anaesthesia. Several studies have been conducted in this area; these studies have either used or omitted fentanyl. The successful …

Prevalence Of Postpartum Depression Using The Edinburgh Postpartum Depression Scale At The Aga Khan University Hospital, Nairobi, Warfa Khadija

Master of Medicine in Obstetrics and Gynecology

Background: Postpartum depression is an illness that affects 10-20% of mothers following delivery; the impact it has on the family, partner and the new born baby is significant. There are insufficient data in Kenya as its rate and severity hence the impact is unknown. Screening could allow earlier treatment of these mothers and prevent the long term effects on the family. Objectives: The primary objective was to identify the prevalence of postpartum depression at the Aga Khan University Hospital and to identify associations between participant’s socio demographics and depression. Methods: Cross sectional study to screen postpartum women six weeks after …

The Use Of Mcv And Mch To Screen For Iron Deficiency In Pregnancy Among Women With Normal Haemoglobin Values, Charles M. Muteshi

Master of Medicine in Obstetrics and Gynecology

Background: Worldwide the commonest cause of anaemia is inadequate nutritional supply manifest as iron deficiency. Iron deficiency affects 25% of the world’s population and up to 50% in the developing world. Most susceptible are women of child bearing age and infants. In pregnancy most iron deficiency is detected when there is already resultant anaemia by measuring the haemoglobin content. It is important to develop a tool that could pick out women who are iron deficient before anaemia ensues. This study aims to determine the predictive ability of red cell mean corpuscular haemoglobin (MCH) and mean corpuscular volume (MCV) in screening …

Hepatitis B Vaccination Rate And Determining Factors Amongst Health Care Workers At Aga Khan University Hospital, Nairobi, Herman Ekea

Master of Medicine in Internal Medicine

Aim: To determine Hepatitis B vaccination rate and determining factors for health care workers (HCWs) at AKUHN. Design: Cross sectional analytical study Study subjects and setting: Aga Khan University Hospital-Nairobi, is a 254 bed tertiary hospital, with 815 HCWs with occupational risk of infection with hepatitis B virus (HBV). The hospital has a HCW vaccination policy and vaccine available to HCWs as part of medical scheme Methodology: Two hundred and sixty six (266) eligible HCWs of all cadres were stratified then randomly recruited after giving informed consent. A questionnaire was then administered to assess knowledge, attitude and practice towards HBV …

Prevalence Of Low Bone Mineral Density Amongst Resident Doctors At The Aga Khan University Hospital, Nairobi, Rose Ndumia

Master of Medicine in Imaging and Diagnostic Radiology

Objective: This was a cross-sectional study carried out amongst resident doctors training at the Aga Khan University Hospital, Nairobi to determine their bone mineral density and investigate for any association between the bone mineral density and the residents’ lifestyle. Methods: 65 randomly selected residents from various departments in the Aga Khan University Hospital, Nairobi, underwent a Dual Energy X-ray Absorptiometry (DXA) scan and filled out questionnaires to assess their physical activity, sunlight exposure and calcium intake. This was carried out between April and June 2011. Results: 65 residents were included in the final analysis. 50 residents (76.9% with a 95% …

The Influence Of Depression On Adherence To Antiretroviral Therapy Among Hiv Infected Patients At Aga Khan University Hospital (Nairobi), Evelyn W. Karanja-Mbugua

Master of Medicine in Internal Medicine

Aim: To determine the influence of depression on adherence to antiretroviral (ARV) therapy among HIV-infected patients. Design: Cross-sectional survey Patients: One hundred and forty HIV-positive patients on treatment with Combination Antiretroviral Therapy selected from the out-patient department of Aga Khan University Hospital took part in the survey. Methodology: Every third patient who was eligible was assessed for adherence to antiretroviral therapy using The Adult AIDS Clinical Trial Group follow up adherence questionnaire followed by screening for depression using the Patient Health Questionnaire 9. Pharmacy data was then retrieved for the same patients and used to assess adherence by the medication …

Stratification Of White Matter Hyperintensities In Young And Middle Age Adults Using Hydrogen Magnetic Resonance (H-Mr) Spectroscopy, M’Mene E. Elvis

Master of Medicine in Imaging and Diagnostic Radiology

Objective: The objective of this study was to stratify white matter hyperintensities on the basis of neuronal integrity in young and middle age adults by comparing the level of N-acetyl aspartate and creatine ratios in white matter hyperintensity lesions and normal appearing white matter using hydrogen magnetic resonance (H-MR) spectroscopy at 1.5 Tesla(T) Methods: Fifty consecutive patients who fulfilled the inclusion criteria aged 18-50yrs who were referred for magnetic resonance imaging(MRI) of the brain at the Radiology department of Aga Khan University Hospital over a six month period between January and June 2011 were included in the study. These patients …

Prevalence Of Nasal Carriage Of Methicillin-Resistant Staphylococcus Aureus In Healthcare Workers At Aga Khan University Hospital, Nairobi, Geoffrey A. Omuse

Master of Medicine in Clinical Pathology

Objective: To establish the prevalence of nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) in healthcare workers (HCW) at Aga Khan University Hospital, Nairobi (AKUHN). Background: Healthcare workers are a major reservoir of MRSA and may play a role in the spread of nosocomial MRSA infections. MRSA can cause significant morbidity and mortality. There is both molecular and epidemiological evidence linking HCW to MRSA outbreaks. Method: A cross sectional study conducted between July and December 2010. Nasal swabs were taken from 246 randomly selected HCW from various departments.MRSA was identified using both phenotypic and genotypic methods. Antibiotic susceptibility testing of all …

Prevalence Of Genital Chlamydia Infection In Urban Women Of Reproductive Age, Ruchika Kohli-Kochhar

Master of Medicine in Clinical Pathology

Background: Chlamydia trachomatis is one of the major causes of sexually transmitted infections throughout the world. It is the primary cause for pelvic inflammatory disease, tubal infertility and ectopic pregnancy in females. Most infections are asymptomatic and remain undetected. The burden of disease in the Kenyan population is not well characterised and few previous studies, done in Kenya, show the prevalence of genital Chlamydia infection in sexually active females. There is a need to define prevalence in our local population as a public health need and to determine whether rapid point-of-care testing should be incorporated as a component of sexually …

Comparison Of Wavelet Compressed Mri Cineloop Images Versus Originally Acquired Non-Modified Mri Images For Detection Of Brain Lesions, Patrice K. Anangwe

Master of Medicine in Imaging and Diagnostic Radiology

Brief background: Image compression has been widely accepted as the solution to the explosion of imaging data since the advent of multiaxial multisequence imaging. However, compromise on diagnostic quality secondary to this modification has been an issue. Many studies have been carried out looking at just noticeable differences but few have been undertaken to look at the difference in ability to detect pathology in original versus cineloop compressed images. This study was done to compare lesion detection ability of cineloop compressed images as compared to original images. Objectives: A comparative study to evaluate detection of brain lesions in wavelet compressed …