Digital Commons Network^™

E-Mail Communication In Paediatrics: Ethical And Clinical Considerations, Susan Albersheim

Paediatrics Publications

E-mail has become a commonplace ‘procedure’ in medical practice because it is efficient and inexpensive. However, there are potential misuses and abuses of this form of written communication, with clinical and ethical implications. Common uses of e-mail in paediatics include general communication with colleagues in a professional setting; electronic formal consultation, in which patient confidentiality is paramount; electronic ‘curbside’ consultation, which may be perceived as a formal consultation; electronic discussion groups, which lack peer review; communication with current patients or their parents, which should be limited to simple, nonurgent issues; and communication with individuals seeking medical advice who are not …

Schedule For Ct Image Guidance In Treating Prostate Cancer With Helical Tomotherapy., G Beldjoudi, S Yartsev, G Bauman, Jerry J. Battista Dr., Jacob Van Dyk

Oncology Publications

The aim of this study was to determine the effect of reducing the number of image guidance sessions and patient-specific target margins on the dose distribution in the treatment of prostate cancer with helical tomotherapy. 20 patients with prostate cancer who were treated with helical tomotherapy using daily megavoltage CT (MVCT) imaging before treatment served as the study population. The average geometric shifts applied for set-up corrections, as a result of co-registration of MVCT and planning kilovoltage CT studies over an increasing number of image guidance sessions, were determined. Simulation of the consequences of various imaging scenarios on the dose …

Surgical Response To Catastrophe - Learning From Canada’S Experience Abroad, Vivian Mcalister

Data and Test Instruments

No abstract provided.

The Utility Of Modified Butler-Leggett Criteria For Right Ventricular Hypertrophy In Detection Of Clinically Significant Shunt Ratio In Ostium Secundum-Type Atrial Septal Defect In Adults, Adeel M. Siddiqui, Zainab Samad, Nina Hakacova, James Kinsella, Cary Ward, Michael White, Anna Lisa C. Crowley, Galen S. Wagner, J. Kevin Harrison

Section of Cardiology

Background: This study was performed to test the hypothesis that there exists a correlation between the Butler-Leggett (BL) criterion for right ventricular hypertrophy on the electrocardiogram and the Qp/Qs shunt ratio in adults with ostium secundum atrial septal defects (ASDs).

Methods: Demographic, cardiac catheterization, ASD closure, and electrocardiographic data were acquired on 70 patients with secundum ASDs closed percutaneously. Simple linear regression and logistic regression models were created to test the hypothesis.

Results: The mean Qp/Qs ratio and BL criterion value were 1.61 +/- 0.46 and 0.11 +/- 0.41, respectively. The BL criterion values correlated with shunt ratios (r(2) = …

Clinical Outcome Of Iridotomy With Argon-Yag Laser At A Tertiary Care Center In Karachi, Pakistan, Rashid Baig, Aziz Khan

Section of Ophthalmology

Objective: To assess the the efficacy and early and late complications of Argon-YAG combined laser iridotomy in the outpatient department of a tertiary care hospital.
Methods: This was a prospective observational study conducted at Aga Khan University Hospital Karachi, Pakistan. After detailed history taking and clinical examination, patients who had goniscopically evident closed angles and a positive provocative test were selected for laser iridotomy. They underwent iridotomy using Argon laser followed by YAG laser. The main outcome measures were patency of iridotomy at 6 months, angle grading at 6 months and early and late complications.
Results: Overall 40 eyes of …

Qrs Duration And Echocardiographic Evidence Of Left Ventricular Dyssynchrony In Patients With Left Ventricular Systolic Dysfunction, Hafeez Ahmed, Javed Tai, Sohail Abrar Khan, Muniza Yousuf

Section of Cardiology

Objective: To determine the association between left ventricular (LV) dyssynchrony assessed by tissue Doppler imaging (TDI) in patients with left ventricular ejection fraction (LVEF) < 35% and prolonged ventricular depolarization on electrocardiography.
Study design: A cross-sectional study.
Place and duration of study: The Aga Khan University, Karachi, from June to September 2007.
Methodology: All patients with LVEF < 35% were included. Apical 2-D images were obtained in 4 chamber and 2 chamber views. TDI pulse wave Doppler parameters were measured from these 2 color-coded images. Time interval between the onset of QRS complex and the peak systolic velocity per region was derived. Patients with valvular heart disease, mitral annular calcification, atrial fibrillation and paced rhythm were excluded. Fischer's exact test was used to determine the association between QRS duration and left ventricular dyssynchrony.
Results: A total of 60 patients were included. Twenty one patients had QRS duration of > 120 msec. Out of those 21 patients, a total of 6 patients (28.6%) had evidence of dyssynchrony on TDI. Five patients (23.8%) had dyssynchrony on the basis of basal septal and basal lateral velocity difference (p=0.045) …

Neovascularity Patterns In Breast Carcinoma: Correlation Of Doppler Ultrasound Features With Sonographic Tumour Morphology, Riffat Shaheen, Saba Sohail, Kauser Jahan Siddiqui

Department of Radiology

Objective: To determine the association and correlation between morphologic features of breast cancer on gray scale ultrasound, and vascularity patterns and indices on color and spectral Doppler ultrasound.
Study design: Cross-sectional, analytical study.
Place and duration of study: Department of Radiology, Dow University of Health Sciences and Civil Hospital, Karachi, from August 2006 to June 2007.
Methodology: Fifty adult female patients with histopathological proven breast cancer underwent ultrasound for evaluation of morphologic features on gray scale mode; vascularity patterns on color Doppler scan and flow indices measurement on spectral Doppler ultrasound. Regression analysis was conducted to determine correlation between the …

Ultrasound Visualization Vs. Electrical Nerve Stimulation For Interscalene And Axillary Nerve Block In Upper Extremity Surgery: A Prospective Randomized Trial (Poster), Joseph W. Galassi Md, Jodie Buxbaum Md, J John Collins Md, Dorothy Hartman Md, Michael He Md, Farheen Hussain Ms, Leslie Baga Bsn, Sherrine Eid Mph, Mary Jane Cerrone Msn, Nanette M. Schwann Md

Department of Anesthesiology

No abstract provided.

Oncolog Volume 55, Number 03, March 2010, Bryan Tutt, Joe Munch

OncoLog MD Anderson's Report to Physicians (All issues) Archives

• Benign Tumors That Cause Big Problems:Fortunately, parathyroid tumors can be removed with minimally invasive surgery.
• Preventing Bone Loss nad Fractures in Cancer Patients
• INBRIEF: Leukemia Cells Observed Burning Fat to Evade Death/Assesment Tool Takes Aim at Graft-versus-Host Disease
• House call: Immunotherapy:Boosting the Body's Fight Against Cancer

Increased Isolation Of Esbl Producing Klebsiella Pneumoniae With Emergence Of Carbapenem Resistant Isolates In Pakistan: Report From A Tertiary Care Hospital, Erum Khan, Muslima Ejaz, Afia Zafar, Kauser Jabeen, Sadia Shakoor, Raunaq Inayat, Rumina Hasan

Department of Pathology and Laboratory Medicine

OBJECTIVE: To report trends of extended spectrum beta lactamase (ESBL), multidrug resistant (MDR) ESBL and emergence of carbapenem resistant ESBL producing isolates of K. pneumoniae from Pakistan.

METHODS: Retrospective analysis of laboratory data was conducted (2002-2007). K. pneumoniae were isolated and identified from clinical samples using standard microbiological techniques. Antimicrobial susceptibility testing was performed by Kirby Bauer. ESBL was detected using combined disc method. Statistical analysis was performed using SPSS version 13.

RESULTS: 15914 K. pneumoniae isolates (2002-2007) were analyzed. Significant increase in ESBL and MDR ESBL producing K. pneumoniae (p = or < 0.0001) was observed. We found significant association of ESBL positive K. pneumoniae with age less than 10 years, males and blood isolates (p = 0.001). 0.4% (n=23) of ESBL positive isolates were carbapenem resistant.

CONCLUSIONS: Increase in ESBL and carbapenem resistant …

Vital Signs, Spring 2010, Boonshoft School Of Medicine

Vital Signs

A fifty-six page newsletter created by the Boonshoft School of Medicine to document the current affairs of the school. This issue includes a variety of feature articles, a research spotlight, a calendar of events, and more.

Acellular Dermal Regeneration Template For Soft Tissue Reconstruction Of The Digits., John S. Taras, Anthony Sapienza, Josh B. Roach, John P. Taras

Department of Orthopaedic Surgery Faculty Papers

PURPOSE: Trauma to the digits often leaves soft tissue defects with exposed bone, joint, and/or tendon that require soft tissue replacement. The objective of this study was to evaluate the effectiveness of acellular dermal regeneration template combined with full-thickness skin grafting for soft tissue reconstruction in digital injuries with soft tissue defects.

METHODS: Acellular dermal regeneration template was used to reconstruct digital injuries with exposed bone, joint, tendon, and/or hardware not amenable to treatment with healing by secondary intention, rotation flaps, or primary skin grafts. Acellular dermal regeneration template was applied to 21 digits in 17 patients. Nineteen digits had …

On Pump Coronary Surgical Revascularization In A Patient With Chronic Immune Thrombocytopenic Purpura, Saulat Fatimi, Danesh K Kella, Marium Muzaffar, Hashim Muhammad Hanif

Section of Cardiothoracic Surgery

We performed on-pump coronary artery bypass graft surgery on a 54-year-old female, known case of chronic Idiopathic Thrombocytopenic Purpura (ITP), hypertension and dyslipidaemia who had presented to us with progressive exertional shortness of breath and chest pain. The decision of going on with CABG was made after two weeks of preoperative treatment with prednisolone. Her platelet counts pre-operatively and on the 4th post-operative day were 135 x 10(9)/L and 32 x 10(9)/L. She had an unremarkable post-operative recovery, without requiring whole blood or platelet transfusions. We recommend preoperative steroid treatment in patients with chronic ITP undergoing CABG.

Cardiomyocyte-Derived Adiponectin Is Biologically Active In Protecting Against Myocardial Ischemia-Reperfusion Injury., Yajing Wang, Wayne Bond Lau, Erhe Gao, Ling Tao, Yuexing Yuan, Rong Li, Xiaoliang Wang, Walter J. Koch, Xin-Liang Ma

Department of Emergency Medicine Faculty Papers

Adiponectin (APN) has traditionally been viewed as an adipocyte-specific endocrine molecule with cardioprotective effects. Recent studies suggest that APN is also expressed in cardiomyocytes. However, biological significances of this locally produced APN remain completely unknown. The aim of this study was to investigate the pathological and pharmacological significance of cardiac-derived APN in cardiomyocyte pathology. Adult cardiomyocytes from wild-type littermates (WT) or gene-deficient mice were pretreated with vehicle (V) or rosiglitazone (RSG) for 6 h followed by simulated ischemia-reperfusion (SI/R, 3 h/12 h). Compared with WT cardiomyocytes, myocytes from APN knockout (APN-KO) mice sustained greater SI/R injury, evidenced by greater oxidative/nitrative …

Optimizing Patient Care And Resident Education In An Obstetrics And Gynecology Clinic: The Lehigh Valley Experience, Joseph E. Patruno Md, Eduardo Lara-Torre Md, Craig Koller Me, Sherrine Eid Mph

Department of Obstetrics & Gynecology

No abstract provided.

Needle Stick Injuries Among Health Care Workers Of Public Sector Tertiary Care Hospitals Of Karachi, Mubashir Aslam, Tahir Taj, Arif Ali, Waseem Mirza, Hammad Ali, Mudassir Iqbal Dar, Nasira Badar

Community Health Sciences

OBJECTIVE: To estimate the frequency of needle stick injuries (NSI) among health care workers (nurses, student nurses and paramedical staff) in public hospitals of Karachi.STUDY DESIGN: Cross sectional, observational.PLACE AND DURATION OF STUDY: This study was conducted in three public tertiary care hospitals of Karachi, from November 2007 to January 2008.METHODOLOGY: Data was collected by structured interview-based questionnaires in Urdu and English language. Questionnaire was designed to obtain information regarding demography, work experience, hepatitis vaccination status, and occurrence of needle stick injuries with associated factors. Needle stick injury that occurred in the previous month was the defined outcome. Data was …

Emerging Issues In Adolescent Healthcare : An Urgent Call For Action, Waris Qidwai Dr, Tabinda Ashfaq Ashfaq

Department of Family Medicine

No abstract provided.

A National Survey Into Desirable Personality Traits In Anaesthesia Trainees In A Developing Country, Fauzia Anis Khan, Fauzia N. Minai

Department of Anaesthesia

OBJECTIVE: To explore personality traits considered to be important in selection of trainees by consultant anaesthetists in a developing country.

METHODS: A questionnaire listing 28 traits was sent to 125 consultant anaesthetists. The raters were asked to mark each trait on a scale of 1 to 10, with one being least desirable and 10 as most desirable. Listing of five most desirable and one least desirable trait was also required.

RESULTS: The response rate was 79%. The most desirable trait was identified as reliability by 40%, followed by honesty 17%, functionality under stress 9%, punctuality 7%, and discipline 4%. The …

Sharing Neurological Expertise: Development Of A High Risk Obstetrical Course, Maureen T. Smith Msn, Rn, Cnrn

Patient Care Services / Nursing

No abstract provided.

The Outcome Of Patients With Platinum-Resistant/Refractory Ovarian Cancer Treated With The Combination Of Pegylated Liposomal Doxorubicin And Gemcitabine, Vijaya Galic Md, Mba, Richard Boulay Md, M Bijoy Thomas Md, Cody Gillenwater, Christine C. Chen Md, Martin Martino Md

Department of Obstetrics & Gynecology

No abstract provided.

Knowledge Of Human Papillomavirus (Hpv) Among Private Office And Community-Based Clinic Populations: An Assessment Of What The Public Understands About Hpv, Carol Chen, Kimberly Mclaughlin, Andrea Waxman Md, Sharon R. Kimmel Phd, Mha, Martin Martino Md

Department of Obstetrics & Gynecology

No abstract provided.

Maternal And Neonatal Outcomes By Labor Onset Type And Gestational Age, Jennifer L Bailit, Kimberly D Gregory, Uma M Reddy, Victor H Gonzalez-Quintero, Judith U Hibbard, Mildred M Ramirez, D Ware Branch, Ronald Burkman, Shoshana Haberman, Christos G Hatjis, Matthew K Hoffman, Michelle Kominiarek, Helain J Landy, Lee A Learman, James Troendle, Paul Van Veldhuisen, Isabelle Wilkins, Liping Sun, Jun Zhang

Faculty, Staff and Student Publications

OBJECTIVE: We sought to determine maternal and neonatal outcomes by labor onset type and gestational age.

STUDY DESIGN: We used electronic medical records data from 10 US institutions in the Consortium on Safe Labor on 115,528 deliveries from 2002 through 2008. Deliveries were divided by labor onset type (spontaneous, elective induction, indicated induction, unlabored cesarean). Neonatal and maternal outcomes were calculated by labor onset type and gestational age.

RESULTS: Neonatal intensive care unit admissions and sepsis improved with each week of gestational age until 39 weeks (P < .001). After adjusting for complications, elective induction of labor was associated with a lower risk of ventilator use (odds ratio [OR], 0.38; 95% confidence interval [CI], 0.28-0.53), sepsis (OR, 0.36; 95% CI, 0.26-0.49), and neonatal intensive care unit admissions (OR, 0.52; 95% CI, 0.48-0.57) compared to spontaneous labor. The relative risk of hysterectomy at term was 3.21 (95% CI, 1.08-9.54) with elective induction, 1.16 (95% CI, 0.24-5.58) with indicated induction, and 6.57 (95% CI, 1.78-24.30) with cesarean without labor compared to spontaneous labor.

CONCLUSION: Some neonatal outcomes improved until 39 weeks. Babies born with elective induction …

Impact Study Of A Central Lines Simulation Training Program Using Kirkpatrick’S Four-Level Evaluation Model, James P. Orlando Edd, Andrew C. Miller Do, William Bond Md, Ms, Valerie A. Rupp Rn, Bsn, Bryan G. Kane Md, Cindy Umbrell Rn, Msn, Michael Pasquale Md

Department of Emergency Medicine

No abstract provided.

Comparison Of Different Treatment Modalities In Advanced Laryngeal Hypopharyngeal Squamous Cell Carcinoma, Shehzad Ghaffar, Mubasher Ikram, Sardar Zakariya Imam, Yasir Jamal Sepah

Section of Otolaryngology, Head & Neck Surgery

OBJECTIVE: To compare outcome of patients with advanced laryngeal hypopharyngeal squamous cell carcinoma treated surgically or with chemotherapy and/or radiotherapy.

STUDY DESIGN: Observational study.

PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi, from January 2000 to December 2005.

METHODOLOGY: Medical records of already treated stage-III and IV squamous cell carcinoma of larynx/hypopharynx patients were reviewed. Group-A comprised of patients treated with surgery +/- adjuvant therapy whereas non-surgically managed patients were labeled as group-B. One hundred and nineteen out of 275 met the inclusion criteria. Kaplan Meier technique was used to estimate mean recurrence time with standard errors. …

Cardioprotection By Regular Ethanol Consumption: Potential Mechanisms And Clinical Application., Masami Miyamae, Kazuhiro Kaneda, Naochika Domae, Vincent M. Figueredo, M.D.

Division of Cardiology Faculty Papers

Epidemiological studies demonstrate that excessive drinking is associated with hypertension, cerebral bleeding and loss of cardiac contractility. Conversely, studies have shown that mortality rates for people who regularly drink ethanol in moderation are lower than in abstainers, primarily due to decreased fatal ischemic heart disease. Further, moderate ethanol consumers have lower rates of myocardial infarction compared with abstainers. These beneficial cardiac effects may be due to pleiotropic effects of ethanol on lipids, platelets, and fibrinolytic activity. During the past decade, studies conducted in several animal models have revealed that light to moderate regular ethanol consumption renders hearts more tolerant to …

Can Urethral Retroresistance Pressures Predict Midurethral Sling Outcomes?, Patrick J. Culligan, Jennifer Lewis-Priestley, Linda Blackwell, Susan B. Tate

Faculty Articles

OBJECTIVE: To determine whether preoperative urethral resistance pressure (URP) measurements could predict success or failure of a tension-free vaginal tape (TVT) sling.

METHODS: Subjects came from a previously published study comparing URP measurements to a validated urinary incontinence symptom survey (UISS). We contacted patients from that study to determine whether they had subsequently undergone TVT surgery. Within that cohort, we determined the “current” (i.e., postoperative) UISS and Sandvik urinary incontinence severity score. Success of a TVT sling in this group was defined in 4 ways: (1) postoperative UISS score < 3, (2) postoperative UISS score < 75% of the preoperative score, (3) postoperative Sandvik score < 6, and (4) postoperative Sandvik score < 2. These definitions of “success” were compared across demographic and treatment variables using the Student’s t test, ANOVA, χ 2 and ROC curves.

RESULTS: We contacted 69 women who had in fact received …

Magnetic Resonance Imaging Findings In Patients With Schizophrenia, Waseem Akhtar, Haider A Naqvi, Sajjad Hussain, Arif Ali, Nadeem Ahmad

Department of Radiology

OBJECTIVE: To determine structural abnormalities in the brain of patients with schizophrenia by Magnetic Resonance Imaging (MRI).

STUDY DESIGN: Comparative study.

PLACE AND DURATION OF STUDY: The Departments of Radiology and Psychiatry, the Aga Khan University Hospital, Karachi, from January 2007 to June 2008.

METHODOLOGY: Thirty-three cases of schizophrenia (n=33) and thirty-three age-matched controls, (n=33) were enrolled for this study. Screening Magnetic Resonance Imaging (MRI) of brain was done in order to see structural changes in brain matter. Findings were compared among groups using chi-square and Fisher's exact test with significance at p < 0.05.

RESULTS: Among the total of 66 (n=66) …

Qrs Duration And Echocardiographic Evidence Of Left Ventricular Dyssynchrony In Patients With Left Ventricular Systolic Dysfunction, Hafeez Ahmed, Javed Tai, Sohail Abrar Khan, Muniza Yousuf

Department of Medicine

Objective: To determine the association between left ventricular (LV) dyssynchrony assessed by tissue Doppler imaging (TDI) in patients with left ventricular ejection fraction (LVEF) < 35% and prolonged ventricular depolarization on electrocardiography.
Study Design: A cross-sectional study.
Place and Duration of Study: The Aga Khan University, Karachi, from June to September 2007.
Methodology: All patients with LVEF < 35% were included. Apical 2-D images were obtained in 4 chamber and 2 chamber views. TDI pulse wave Doppler parameters were measured from these 2 color-coded images. Time interval between the onset of QRS complex and the peak systolic velocity per region was derived. Patients with valvular heart disease, mitral annular calcification, atrial fibrillation and paced rhythm were excluded. Fischer’s exact test was used to determine the association between QRS duration and left ventricular dyssynchrony.
Results: A total of 60 patients were included. Twenty one patients had QRS duration of > 120 msec. Out of those 21 patients, a total of 6 patients (28.6%) had evidence of dyssynchrony on TDI. Five patients (23.8%) had dyssynchrony on the basis of basal septal and basal lateral velocity difference …

Differences In Reporting Of Violence And Deliberate Self Harm Related Injuries To Health And Police Authorities, Rawalpindi, Pakistan, Umar Farooq, Mudassir Majeed, Junaid Ahmad Bhatti, Jahangir Sarwar Khan, Junaid Razzak, Muhammad Mussadiq Khan

Department of Emergency Medicine

Background:

The aim of study was to assess differences in reporting of violence and deliberate self harm (DSH) related injuries to police and emergency department (ED) in an urban town of Pakistan.

Methods/Principal Findings:

Study setting was Rawalpindi city of 1.6 million inhabitants. Incidences of violence and DSH related injuries and deaths were estimated from record linkage of police and ED data. These were then compared to reported figures in both datasets. All persons reporting violence and DSH related injury to the police station, the public hospital's ED, or both in Rawalpindi city from July 1, 2007 to June 30, …

Microrna In Situ Hybridization In The Human Entorhinal And Transentorhinal Cortex, Peter T. Nelson, James Dimayuga, Bernard R. Wilfred

Pathology and Laboratory Medicine Faculty Publications

MicroRNAs (miRNAs) play key roles in gene expression regulation in both healthy and disease brains. To better understand those roles, it is necessary to characterize the miRNAs that are expressed in particular cell types under a range of conditions. In situ hybridization (ISH) can demonstrate cell- and lamina-specific patterns of miRNA expression that would be lost in tissue-level expression profiling. In the present study, ISH was performed with special focus on the human entorhinal cortex (EC) and transentorhinal cortex (TEC). The TEC is the area of the cerebral cortex that first develops neurofibrillary tangles in Alzheimer's disease (AD). However, the …