Digital Commons Network^™

A Randomized Trial Of Bilevel Positive Airway Pressure Device And High Flow Oxygen For Persistent Dyspnea In, David Hui

Dissertations and Theses (Open Access)

Background: Dyspnea is a common and distressing symptom among patients with advanced cancer. The role of bilevel positive airway pressure (BIPAP) and Vapotherm in the relief of dyspnea have not been well defined. We aimed to determine and to compare the efficacy of BIPAP and VapoTherm for cancer related dyspnea.

Methods: In this randomized, open-label, crossover study, we randomly assigned advanced cancer patients with persistent dyspnea >=3/10 to either Vapotherm for 2 hours followed by BiPAP for 2 hours, or BiPAP followed by Vaptherm. A variable washout period was instituted between interventions. The primary end point was change in numeric …

Ureteroscopic Laser Treatment Of Upper Urinary Tract Neoplasms., Demetrius H. Bagley, Michael Grasso

Department of Radiology Faculty Papers

BACKGROUND: Endoscopic management of upper urinary tract transitional cell carcinoma has assumed an important role in diagnosis and treatment. The introduction of small diameter rigid and flexible ureteroscopes has permitted access to the upper tract. Biopsy techniques have been developed for accurate diagnosis, and the addition of lasers has given the urologists an excellent tool for treatment. METHODS: Medical literature available relative to the endoscopic laser treatment of upper tract neoplasms has been reviewed. RESULTS: Ureteroscopic treatment has been characterized by good success with high recurrence rates, both in the upper tract and in the bladder. Bladder recurrence rates are …

Post-Prandial Vomiting And Abdominal Pain: A Case Report, Hilary F. Basham Do, Kathleen Kane Md

Department of Emergency Medicine

No abstract provided.

Parotidectomy: A Review Of 112 Patients Treated At A Teaching Hospital In Pakistan, Naeem Sultan Ali, Ahmad Nawaz, Shaheryar Rajput, Mubasher Ikram

Section of Otolaryngology, Head & Neck Surgery

Objective:The Purpose of this study was to analyze the clinical presentation, histopathology and complications following parotid surgery.

Methods:

We retrospectively reviewed the charts of 112 Patients who underwent parotidectomy from January 2000 to February 2010. Data including age, sex, clinical signs and symptoms, histology and complication were collected from medical records.

Results:

Of the total, 82 (74%) had benign lesions, 30 (36%) had malignant tumors. The most common benign tumor was pleomorphic adenoma (57%), and the most common malignant tumor was mucoepidermoid carcinoma (16%). Analysis of the correlation between fine-needle aspiration cytology and final histology revealed that fine-needle aspiration …

Increase In Organization Index Predicts Atrial Fibrillation Termination With Flecainide Post-Ablation: Spectral Analysis Of Intracardiac Electrograms, Jiun Tuan, Faizel Osman, Jeilan Mohamed, Suman Kundu, Rajkumar Mantravadi, Peter J. Stafford, G. André Ng

Internal Medicine, East Africa

Aims: The mechanism of the action of flecainide in the termination of human atrial fibrillation (AF) is not fully understood. We studied the acute effects of flecainide on AF electrograms in the time and frequency domain to identify factors associated with AF termination.

Methods and results: Patients who were still in AF at the end of catheter ablation for AF were given intravenous flecainide. Dominant frequency (DF) and organization index (OI) were obtained by fast Fourier transform of electrograms from the coronary sinus catheter over 10 s in AF, before and after flecainide infusion. Mean AF cycle length (CL) was …

Hydatid Disease Of The Breast, Imrana Masroor, M. Azeemuddin, S. Khan, A. Barakzai

Department of Radiology

Cystic hydatid disease is caused by the parasite Echinococcus granulosus. Humans are the accidental intermediate hosts of this organism. Hydatid disease is endemic in countries in which raising sheep and cattle constitutes an important means of livelihood. The most commonly affected organs are the liver and lungs. Involvement of the kidney, bone, brain and other organs is rare. Breast involvement in this disease is also very rare. A case of isolated hydatid cyst of the breast is presented, along with a review of the literature and a discussion on the pertinent clinical and radiological aspects of the disease.

Headache In Cerebral Venous Thrombosis: Incidence, Pattern And Location In 200 Consecutive Patients., Mohammad Wasay, Suleman Kojan, Alper I Dai, George Bobustuc, Zubair Sheikh

Section of Neurology

We analyzed the incidence, pattern and location of headache in consecutive 200 Patients with proven diagnosis of CVT to identify an association between localization of headache and site of sinus involvement. Headache was present in 136 (68%) Patients. The duration of headache (reported in 128 Patients) was reported as acute (1-3 days), 81 Patients (60%), sub-acute (4-14 days), 33 Patients (24%), and chronic (more than 14 days), 14 Patients (10%). The quality of headache (reported in 72 Patients) was reported as throbbing 12 (9%), band like 27 (20%), thunderclap 7 (5%), and other (pounding, exploding, stabbing, etc.) 26 (20%). The …

The International Surgical Trial In Intracerebral Haemorrhage (Stich)--What Are Its Implications In A Resource Limited Health System Like Pakistan, Maria Khan, Ayeesha Kamran Kamal

Section of Neurology

No abstract provided.

Crimean-Congo Hemorrhagic Fever In A Dengue-Endemic Region: Lessons For The Future., Farheen Ali, Taimur Saleem, Umair Khalid, Syed Faisal Mahmood, Bushra Jamil

Department of Medicine

Crimean-Congo hemorrhagic fever and dengue hemorrhagic fever are endemic in Pakistan. However, the overlap of geographic distribution and early clinical features between the two conditions make a reliable diagnosis difficult in the initial stage of illness. A 16-year-old boy presented with a history of hematemesis and high-grade fever. A preliminary diagnosis of dengue hemorrhagic fever was made and supportive treatment was instituted; however, the patient continued to deteriorate clinically. Dengue IgM antibody testing was negative on the third day of admission. Qualitative polymerase chain reaction test for Crimean-Congo hemorrhagic fever viral RNA was sent but the patient expired shortly after …

Dyssegemental Dyspalsia; Rolland-Desbuquois Type--A Case Report From Pakistan, Bushra Afroze

Department of Paediatrics and Child Health

Two different forms of dyssegmental dysplasia can be distinguished; the lethal Silverman-Handmaker type and less severe Rolland-Desbuquois type. Patients with Rolland-Desbuquois type often survive beyond neonatal period. The purpose of this paper is to report a rare case of Dyssegmental dysplasia, Rolland-Desbuquois type from Pakistan.

Paracoccidiomycosis And Hiv/Aids: A Common Problem In An Uncommon Location, Astrid Radermacher Do, Joseph L. Yozviak Do, Facp, Marcelo Gareca Md

Department of Medicine

No abstract provided.

Teaching Paediatric Critical Care Medicine To Paediatric Residents, Anwarul Haque, Rizwan Haider, Muhammad Sohail Salat

Department of Paediatrics and Child Health

Critical care training during paediatric residency provides an ideal opportunity to learn and refine the skills needed in the early recognition and prompt treatment of the acutely ill paediatric patients. Paediatric critical care medicine is a relatively young sub-specialty in Pakistan. The aim of this study is to describe our experience of teaching paediatric residents in paediatric critical care medicine during paediatric intensive care unit rotation. Our paediatric critical care teaching curriculum for residents is based on the spectrum of our common critical care problems along with basic principal of critical care. The clinical rotation in our paediatric intensive care …

Simple Linear Measurements Of The Normal Liver: Interobserver Agreement And Correlation With Hepatic Volume On Mri, Sachit K. Verma, Kristen Mcclure, Laurence Parker, Donald G. Mitchell, Manisha Verma, Diane Bergin

Department of Radiology Faculty Papers

OBJECTIVE. To retrospectively evaluate interobserver agreement for 4 manually determined linear hepatic measurements on magnetic resonance imaging (MRI) and correlation of these linear measurements with hepatic volume.

MATERIALS AND METHODS. Hepatic linear measurements: midhepatic point craniocaudad (MHP CC), maximum CC to liver tip (Max CC), maximum transverse and MHP anteroposterior (AP) dimensions were performed on 116 patients without liver disease who had 1.5 T MR imaging of the abdomen.Linear measurements: MHP CC, Max CC, maximum transverse, MHP AP dimensions and products of CC with MHP AP dimension were correlated with hepatic volumes. Correlation analysis (Pearson product moment correlation), Student t …

Type 1 Diabetes Associated With Pegylated Interferon/Ribavirin Therapy In Chronic Hepatitis C, Ankush Sharma Md, Joseph L. Yozviak Do

Department of Medicine

No abstract provided.

Molecular Cross Talk Between Misfolded Proteins In Animal Models Of Alzheimer's And Prion Diseases, Rodrigo Morales, Lisbell D Estrada, Rodrigo Diaz-Espinoza, Diego Morales-Scheihing, Maria C Jara, Joaquin Castilla, Claudio Soto

Faculty, Staff and Student Publications

The central event in protein misfolding disorders (PMDs) is the accumulation of a misfolded form of a naturally expressed protein. Despite the diversity of clinical symptoms associated with different PMDs, many similarities in their mechanism suggest that distinct pathologies may cross talk at the molecular level. The main goal of this study was to analyze the interaction of the protein misfolding processes implicated in Alzheimer's and prion diseases. For this purpose, we inoculated prions in an Alzheimer's transgenic mouse model that develop typical amyloid plaques and followed the progression of pathological changes over time. Our findings show a dramatic acceleration …

Synthesis, Biological Evaluation, And Molecular Modeling Studies Of 1-Aryl-1h-Pyrazole-Fused Curcumin Analogues As Anticancer Agents, L Curtis, P Datta, X Liu, N Bogdanova, R Heidelberger, R Janz

Faculty, Staff and Student Publications

Ribbon synapses of the vertebrate retina are specialized synapses that release neurotransmitter by synaptic vesicle exocytosis in a manner that is proportional to the level of depolarization of the cell. This release property is different from conventional neurons, in which the release of neurotransmitter occurs as a short-lived burst triggered by an action potential. Synaptic vesicle exocytosis is a calcium regulated process that is dependent on a set of interacting synaptic proteins that form the so-called SNARE (soluble N-ethylmaleimide sensitive factor attachment protein receptor) complex. Syntaxin 3B has been identified as a specialized SNARE molecule in ribbon synapses of the …

Improving Health Outcomes For Children (Ihoc) In Maine Logic Model For Primary Care Practice Improvement, Cutler Institute Of Health And Social Policy

Population Health & Health Policy

Improving Health Outcomes for Children (IHOC) is a 5-year demonstration grant from the Centers for Medicare & Medicaid Services, and authorized by 401 (d) of the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA).

IHOC works with doctors' offices, practices and other agencies who want to improve health care in Maine and Vermont to:

• Collect and report on the use of evidenced-based child health quality measures
• Expand the Health Information Technology to improve the flow of child health data
• Promote a collaborative child health learning environment

Omega-3 Fatty Acids: Potential Role In The Management Of Early Alzheimer's Disease, Gregory A. Jicha, William R. Markesbery

Sanders-Brown Center on Aging Faculty Publications

Omega-3 fatty acids are essential for brain growth and development. They play an important role throughout life, as critical modulators of neuronal function and regulation of oxidative stress mechanisms, in brain health and disease. Docosahexanoic acid (DHA), the major omega-3 fatty acid found in neurons, has taken on a central role as a target for therapeutic intervention in Alzheimer's disease (AD). A plethora of in vitro, animal model, and human data, gathered over the past decade, highlight the important role DHA may play in the development of a variety of neurological and psychiatric disorders, including AD. Cross sectional and prospective …

Diagnosis Of Enteric Fever In The Emergency Department: A Retrospective Study From Pakistan., Uzma R. Khan, J. Razzak, Ali Faisal Saleem Dr, Adnan Ahmed, Sabeena Jalal

Department of Emergency Medicine

Background:Enteric fever is one of the top differential diagnoses of fever in many parts of the world. Generally, the diagnosis is suspected and treatment is initiated based on clinical and basic laboratory parameters.
Aims: The present study identifies the clinical and laboratory parameters predicting enteric fever in Patients visiting the emergency department of a tertiary care hospital in Pakistan.
Methods:This is a retrospective chart review of all adult Patients with clinically suspected enteric fever admitted to the hospital through the emergency department during a 5-year period (2000-2005).
Results:A total of 421 emergency department Patients were admitted to …

Rbc And Wbc Fatty Acid Composition Following Consumption Of An Omega 3 Supplement: Lessons For Future Clinical Trials, Theodore R. Witte, Alexander J. Salazar, Oscar F. Ballester, W. Elaine Hardman

Biochemistry and Microbiology

Background: Results from increasing numbers of in vitro and in vivo studies have demonstrated that omega 3 fatty acids incorporated in cell culture media or in the diet of the animals can suppress the growth of cancers. When human clinical trials are initiated to determine the ability of omega 3 fatty acids to alter growth or response to chemotherapeutic interventions of cancers, it will be essential to determine the omega 3 intake of individuals in the trial to determine compliance with consumption of the supplement and to correlate with endpoints of efficacy. We wondered if the fatty acid composition of …

Comparison Of A New Opposed Phase Imaging Protocol To The Standard Conventional Mri Protocol In Demonstration Of Lumbar Degenerative Disc Disease At 1.5t., Peter C. Magabe

Master of Medicine in Imaging and Diagnostic Radiology

Purpose: The purpose of the study was to compare diagnostic yield of a new Opposed Phase Imaging protocol [OPI] to the standard conventional MRI protocol [CONV] in demonstration of lumbar degenerative disc disease at 1.5T. Materials and Methods: A total of 102 patients suspected of lumbar disc disease were examined using the two protocols. Images from both protocols were then analyzed independently by two radiologists. Category of disc disease[normal, bulge ,protrusion, extrusion] and anatomic clarity of spinal structures related to disc disease[nerve roots, osteophytes, modic changes and hemangiomas ] were assessed using a standard 4 point scoring scale [1=inadequate,2 =adequate,3=normal …

Trpm7-Mediated Ca2+ Signals Confer Fibrogenesis In Human Atrial Fibrillation, Jianyang Du, Jia Xie, Zheng Zhang, Hiroto Tsujikawa, Daniel Fusco, David Silverman, Bruce Liang, Lixia Yue

UCHC Articles - Research

Rationale—Cardiac fibrosis contributes to pathogenesis of atrial fibrillation (AF), which is the most sustained arrhythmia and a major cause of morbidity and mortality. Although it has been suggested that Ca2+ signals are involved in fibrosis promotion, the molecular basis of Ca2+ signaling mechanisms and how Ca2+ signals contribute to fibrogenesis remain unknown.
Objective—To determine the molecular mechanisms of Ca2+-permeable channel(s) in human atrial fibroblasts, and to investigate how Ca2+ signals contribute to fibrogenesis in human AF.
Methods and Results—We demonstrate that the transient receptor potential melastatin related 7 (TRPM7) is the molecular basis of the major Ca2+-permeable channel in human …

Association Of Depression With Newly Diagnosed Type 2 Diabetes Among Adults Aged Between 25 To 60 Years In Karachi, Pakistan., Shazia Perveen, Muhammad S Otho, Muhammad N Siddiqi, Juanita Hatcher, Ghazala Rafique

Section of Cardiothoracic Surgery

Background:The combination of depression with type 2 diabetes is a public health problem. If diabetes is managed in its initial phase, the morbidity and mortality due to this combination may be prevented at an early stage. Therefore, we aimed to determine the association of depression with newly diagnosed type 2 diabetes among adults aged between 25 to 60 years in Karachi, Pakistan.

Methods:

From July 2006 to September 2007, a matched case control study (n = 592) was conducted in Civil Hospital, Karachi. Incident cases of type 2 diabetes (n = 296) diagnosed within one month were recruited from …

Trends In Salmonella Enteric Serovar Typhi In Nairobi, Kenya From 2004 To 2006, Doris M. Mengo1, Sam Kariuki, Ann W. T. Muigai, Gunturu Revathi

Pathology, East Africa

Background: Typhoid fever is a global health problem. The World Health Organization (WHO) estimates that the current annual global burden of typhoid is approximately 22 million new cases, 5% of which are fatal.

Methodology: To assess the trends in antibiotic resistance in 100 Salmonella enterica serovar Typhi strains were isolated from the blood of patients in Nairobi, Kenya, from 2004 to 2006. All isolates were tested against ampicilin, chloramphenic, nalidixic acid, ciprofloxacin, cotrimoxazole, cefuroxime, cefriaxone, amoxycillin/clavulanic acid, tetracycline and gentamycin. Susceptibility and resistance were determined using MIC and disk diffusion tests.

Results: From 2004 to 2006 a total of 100 …

Hip Fracture Types In Men And Women Change Differently With Age, David A. Tanner, Marita Kloseck, Richard G. Crilly, Bert Chesworth, Jason Gilliland

Health Studies Publications

BACKGROUND: Hip fractures are expensive and a frequent cause of morbidity and mortality in the elderly. In most studies hip fractures have been viewed as a unitary fracture but recently the two main types of fracture (intertrochanteric and subcapital) have been viewed as two fractures with a different etiology and requiring a different approach to prevention. The relative proportion of intertrochanteric fractures increases with age in women. In previous studies no particular pattern in men has been noted. In this study, we explored changes in the relative proportion of the two fracture types with age in the two genders. METHODS: …

New Approaches To Preventing, Diagnosing, And Treating Neonatal Sepsis, Karen Edmond, Anita K. M. Zaidi

Department of Paediatrics and Child Health

No abstract provided.

Electronic Medical Records As A Research Tool: Evaluating Topiramate Use At A Headache Center., Michael J. Marmura, Md, Mary Hopkins, Rn, Msn, Jocelyn Andrel, Msph, William B. Young, Md, David M. Biondi, Do, Marcia F.T. Rupnow, Phd, Robert B. Armstrong, Md

Department of Neurology Faculty Papers

Background.—Electronic medical records (EMRs) are used in large healthcare centers to increase efficiency and accuracy of documentation. These databases may be utilized for clinical research or to describe clinical practices such as medication usage.

Methods.—We conducted a retrospective analysis of EMR data from a headache clinic to evaluate clinician prescription use and dosing patterns of topiramate. The study cohort comprised 4833 unique de-identified records, which were used to determine topiramate dose and persistence of treatment.

Results.—Within the cohort, migraine was the most common headache diagnosis (n = 3753, 77.7%), followed by tension-type headache (n = 338, 7.0%) and cluster or …

Three-Dimensional Structure Of Tropism-Switching Bordetella Bacteriophage, Wei Dai, Asher Hodes, Wong H Hui, Mari Gingery, Jeff F Miller, Z Hong Zhou

Faculty, Staff and Student Publications

Bacteriophage BPP-1, which infects Bordetella species, can switch its specificity by mutations to the ligand-binding surface of its major tropism-determinant protein, Mtd. This targeted mutagenesis results from the activity of a phage-encoded diversity-generating retroelement. Purified Mtd binds its receptor with low affinity, yet BPP-1 binding and infection of Bordettella cells are efficient because of high-avidity binding between phage-associated Mtd and its receptor. Here, using an integrative approach of three-dimensional (3D) structural analyses of the entire phage by cryo-electron tomography and single-prticle cryo-electron microscopy, we provide direct localization of Mtd in the phage and the structural basis of the high-avidity binding …

Medical Education Digest, Vol. 12 No. 2 (March/April 2010), Nova Southeastern University

Medical Education Digest

No abstract provided.

Tips And Tricks For The Trauma Patient., Anthony D Goei, Brian H Ching, Mark W Meyermann, Timothy Nunez, David Sacks

Reading Hospital Interventional Radiology

Interventions on the trauma patient are an essential component of the complete scope of care that is provided to the multiply injured patient today. The active participation by the interventional radiologist along the entire spectrum of clinical care is very important to optimize patient outcomes. Suggestions on how to establish a clinical presence are presented. A few of the newer concepts and terminology applicable to trauma care are reviewed. Tips useful in the trauma room, in the interventional radiology suite, and during the postprocedural period are discussed.