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Renin-Angiotensin System Activation Correlates With Microvascular Dysfunction In A Prospective Cohort Study Of Clinical Sepsis, Kevin C. Doerschug, Angela S. Delsing, Gregory A. Schmidt, Alix Ashare

Dartmouth Scholarship

Microvascular dysregulation characterized by hyporesponsive vessels and heterogeneous bloodflow is implicated in the pathogenesis of organ failure in sepsis. The renin-angiotensin system (RAS) affects the microvasculature, yet the relationships between RAS and organ injury in clinical sepsis remain unclear. We tested our hypothesis that systemic RAS mediators are associated with dysregulation of the microvasculature and with organ failure in clinical severe sepsis.

Structure Of Vibrio Cholerae Toxt Reveals A Mechanism For Fatty Acid Regulation Of Virulence Genes, Michael J. Lowden, Karen Skorupski, Maria Pellegrini, Michael G. Chiorazzo, Ronald K. Taylor, F. Jon Kull

Dartmouth Scholarship

Cholera is an acute intestinal infection caused by the bacterium Vibrio cholerae. In order for V. cholerae to cause disease, it must produce two virulence factors, the toxin-coregulated pilus (TCP) and cholera toxin (CT), whose expression is controlled by a transcriptional cascade culminating with the expression of the AraC-family regulator, ToxT. We have solved the 1.9 A resolution crystal structure of ToxT, which reveals folds in the N- and C-terminal domains that share a number of features in common with AraC, MarA, and Rob as well as the unexpected presence of a buried 16-carbon fatty acid, cis-palmitoleate. The finding that …

Evaluation Of Solid Breast Masses Using Sonographic Acr Bi-Rads Lexicon Descriptors, Brian N. Bwombuna

Master of Medicine in Imaging and Diagnostic Radiology

Purpose of the study: To which of the ACR sonographic BIRADS lexicon descriptors can be used reliably to differentiate benign from malignant solid breast masses. Objectives: 1.Main Objective: To determine the association of sonographic ACR BI-RADS descriptors and solid breast masses 2. Specific Objective: To determine the predictive probabilities of sonographic BI-RADS lexicon descriptors Methodology: This was a 15 months prospective cross sectional study in which 125 consecutive patients who met the inclusion criteria were enrolled. The study was carried out at theAga KhanUniversity hospitalradiology department between October 2008 and December 2009 inclusive. The scans were performed in ourradiology department …

Dual-Task Interference: The Effects Of Verbal Cognitive Tasks On Upright Postural Stability In Parkinson's Disease, J. D. Holmes, M. E. Jenkins, Andrew M. Johnson, S. G. Adams, S. J. Spaulding

Occupational Therapy Publications

Although dual-task interference has previously been demonstrated to have a significant effect on postural control among individuals with Parkinson's disease, the impact of speech complexity on postural control has not been demonstrated using quantitative biomechanical measures. The postural stability of twelve participants with idiopathic Parkinson's disease and twelve healthy age-matched controls was evaluated under three conditions: (1) without a secondary task, (2) performing a rote repetition task and (3) generating a monologue. Results suggested a significant effect of cognitive load on biomechanical parameters of postural stability. Although both groups increased their postural excursion, individuals with Parkinson's disease demonstrated significantly reduced …

Algal Biofuel, Feb. 12, 2010, Harry Reid Center, University Of Nevada, Las Vegas

Biofuels

News in Brief

1. Fatty Acids Protect Against Aging (Feb. 8, 2010)

International Migration Of Doctors, And Its Impact On Availability Of Psychiatrists In Low And Middle Income Countries, Rachel Jenkins, Robert Kydd, Paul Mullen, Kenneth Thomson, James Sculley, Susan Kuper, Joanna Carroll, Oye Gureje, Simon Hatcher, Sharon Brownie, Christopher Carroll, Sheila Hollins, Mai Luen Wong

School of Nursing & Midwifery, East Africa

Background: Migration of health professionals from low and middle income countries to rich countries is a large scale and long-standing phenomenon, which is detrimental to the health systems in the donor countries. We sought to explore the extent of psychiatric migration.

Methods: In our study, we use the respective professional databases in each country to establish the numbers of psychiatrists currently registered in the UK, US, New Zealand, and Australia who originate from other countries. We also estimate the impact of this migration on the psychiatrist population ratios in the donor countries.

Findings: We document large numbers of psychiatrists currently …

Nutrition And Exercise Prevent Excess Weight Gain In Overweight Pregnant Women, Michelle F. Mottola, Isabelle Giroux, Robert Gratton, Jo Anne Hammond, Anthony Hanley, Stewart Harris, Ruth Mcmanus, Margie H. Davenport, Maggie M. Sopper

Paediatrics Publications

Purpose: To determine the effect of a Nutrition and Exercise Lifestyle Intervention Program (NELIP) for overweight (OW) and obese (OB) pregnant women on pregnancy weight gain, birth weight, and maternal weight retention at 2 months postpartum. Methods: This is a single-arm intervention matched by prepregnant body mass index, age, and parity to a historical cohort (4:1). Women with a prepregnancy body mass index of>25.0 kg•m (N = 65) participated in a NELIP starting at 16-20 wk of pregnancy, continuing until delivery. NELIP consisted of an individualized nutrition plan with total energy intake of approximately 2000 kcal•d (8360 kJ•d) and …

Antibiotics In Acute Necrotizing Pancreatitis: Perspective Of A Developing Country, Afrasyab Khan, Sadaf Khan

Section of General Surgery

Prophylactic antibiotics in acute necrotizing pancreatitis is controversial. The mortality of acute necrotizing pancreatitis is 8-25% in the western world. In view of the limited resources available for managing the complications of infected pancreatitis in developing countries, the use of prophylactic antibiotics may be recommended in selected cases.
Various antibiotics show good penetration into the pancreatic tissue; imipenem and quinolones have better penetration. Clinical trials on the use of prophylactic antibiotics in necrotizing pancreatitis have been reviewed.
Prophylactic antibiotics have been considered if greater than 30% pancreatic necrosis as documented by CT scan. Imipenem can be given for a duration …

Emergency Evaluation Of Acute Chest Pain, Aysha Almas, Om Parkash, Aamir Hameed, Muhammad Islam

Section of Cardiology

OBJECTIVE: To determine the sensitivity and specificity of initial clinical assessment about the diagnosis of acute coronary syndrome (ACS) in patients presenting with acute chest pain by a cardiology resident in the emergency room and assess the 30-day outcome of patients with ACS and non ACS.

STUDY DESIGN: Cohort study.

PLACE AND DURATION OF STUDY: The study was conducted in the emergency department and cardiac care units of the Aga Khan University in 2006-07.

METHODOLOGY: A total of 202 patients, who presented to the emergency room with chest pain, were given an initial ECG and troponin check. Patients were assigned …

Attachment-Based Family Therapy For Adolescents With Suicidal Ideation: A Randomized Controlled Trial., Guy S. Diamond, Matthew B. Wintersteen, Gregory K. Brown, Gary M. Diamond, Robert Gallop, Karni Shelef, Suzanne Levy

Department of Psychiatry and Human Behavior Faculty Papers

OBJECTIVE: To evaluate whether Attachment-Based Family Therapy (ABFT) is more effective than Enhanced Usual Care (EUC) for reducing suicidal ideation and depressive symptoms in adolescents. METHOD: This was a randomized controlled trial of suicidal adolescents between the ages of 12 and 17, identified in primary care and emergency departments. Of 341 adolescents screened, 66 (70% African American) entered the study for 3 months of treatment. Assessment occurred at baseline, 6 weeks, 12 weeks, and 24 weeks. ABFT consisted of individual and family meetings, and EUC consisted of a facilitated referral to other providers. All participants received weekly monitoring and access …

Anti-Argonaute Rip-Chip Shows That Mirna Transfections Alter Global Patterns Of Mrna Recruitment To Microribonucleoprotein Complexes, Wang-Xia Wang, Bernard R. Wilfred, Yanling Hu, Arnold J. Stromberg, Peter T. Nelson

Pathology and Laboratory Medicine Faculty Publications

MicroRNAs (miRNAs) play key roles in gene expression regulation by guiding Argonaute (AGO)-containing microribonucleoprotein (miRNP) effector complexes to target polynucleotides. There are still uncertainties about how miRNAs interact with mRNAs. Here we employed a biochemical approach to isolate AGO-containing miRNPs from human H4 tumor cells by co-immunoprecipitation (co-IP) with a previously described anti-AGO antibody. Co-immunoprecipitated (co-IPed) RNAs were subjected to downstream Affymetrix Human Gene 1.0 ST microarray analysis. During rigorous validation, the "RIP-Chip" assay identified target mRNAs specifically associated with AGO complexes. RIP-Chip was performed after transfecting brain-enriched miRNAs (miR-107, miR-124, miR-128, and miR-320) and nonphysiologic control miRNA to identify …

Biomarkers In Systemic Sclerosis., Susan V. Castro, Sergio A. Jimenez

Scleroderma Center Faculty Papers

Systemic sclerosis is an autoimmune inflammatory disorder of unknown etiologycharacterized b y pronounced fibroproliferative alterations in the microvasculature, and frequent cellular and humoral immunity abnormalities, culminating in a severe and often progressive fibrotic process. Numerous biomarkers reflecting the three main pathogenetic mechanisms in systemic sclerosis have been described; however, aside from several disease-specific autoantibodies, other biomarkers have not been thoroughly validated and require further study. Thus, there is an unmet need for validated biomarkers for diagnosis, disease classification, and evaluation of organ involvement and therapeutic response in systemic sclerosis.

Oncolog Volume 55, Number 02, February 2010, Joe Munch, John Lebas

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

• Risk-Based Cancer Screening: M.D. Anderson's revised guidelines offer more precise individualized recommendations on screening for common cancers.
• Screen Guidelines INBRIEF
• Electronic Navigatin Biopsy for Peripheral Lung Lesion Diagnosis
• House Call: Couples and Cancer: Cancer-Related Issues Can Disrupt Relationships
• INBRIEF: Researchers Find Glioblastoma's Resistance to Treatment Rooted in Immunosuppression

Lead Extraction In The Contemporary Setting: The Lexicon Study. An Observational Retrospective Study Of Consecutive Laser Lead Extractions, Oussama Wazni, Md, Laurence M. Epstein, Md, Roger G. Carrillo, Md, Charles Love, Md, Stuart W. Adler, Md, David W. Riggio, Md, Shahzad S. Karim, Md, Jamil Bashir, Md, Arnold J. Greenspon, Md, John P. Dimarco, Md, Phd, Joshua M. Cooper, Md, John R. Onufer, Md, Kenneth A. Ellenbogen, Md, Stephen P. Kutalek, Md, Sherri Dentry-Mabry, Msn, Carolyn M. Ervin, Phd, Bruce L. Wilkoff, Md

Division of Cardiology Faculty Papers

Objectives: This study sought to examine the safety and efficacy of laser-assisted lead extraction and the indications, outcomes, and risk factors in a large series of consecutive patients.

Background: The need for lead extraction has been increasing in direct relationship to the increased numbers of cardiovascular implantable electronic devices.

Methods: Consecutive patients undergoing transvenous laser-assisted lead extraction at 13 centers were included.

Results: Between January 2004 and December 2007, 1,449 consecutive patients underwent laser-assisted lead extraction of 2,405 leads (20 to 270 procedures/site). Median implantation duration was 82.1 months (0.4 to 356.8 months). Leads were completely removed 96.5% of the …

Irritable Bowel Syndrome: Is It Associated With Genotypes Of Blastocystis Hominis., Javed Yakoob, Wasim Jafri, Mohammad Asim Beg, Z Abbas, Shagufta Naz, Muhammad Islam, Rustam Khan

Section of Gastroenterology

Blastocystis hominis is the most common intestinal parasite in humans. An extensive genetic variability has been described recently in B. hominis isolates. The aim of this study was to analyze genotypes of B. hominis isolates obtained from the healthy individuals and patients with irritable bowel syndrome-diarrhea (IBS-D). The patients with IBS-D were enrolled from gastroenterology outpatient department at the Aga Khan University Hospital. History and physical examination was done. Stool microscopy, culture, and polymerase chain reaction for B. hominis genotyping were carried out. The study included 158 patients with IBS-D, mean age 41 +/- 15, age range 16-83 years, and …

Role Of Cardiac Magnetic Resonance Imaging In The Detection Of Cardiac Amyloidosis, Imran S. Syed Md, James F. Glockner Md, Dali Feng Md, Philip A. Araoz Md, Matthew W. Martinez, William D. Edwards Md, Morie A. Gertz Md, Angela Dispenzieri Md, Jae K. Oh Md, Diego Bellavia Md, Phd, A Jamil Tajik Md, Martha Grogan Md

Department of Medicine

No abstract provided.

Partial And Transitional Atrioventricular Septal Defect Outcomes., L Luann Minich, Andrew M. Atz, Steven D. Colan, Lynn A. Sleeper, Seema Mital, James Jaggers, Renee Margossian, Ashwin Prakash, Jennifer S. Li, Meryl S. Cohen, Ronald V. Lacro, Gloria L. Klein, John A. Hawkins, Pediatric Heart Network Investigators, Girish S. Shirali

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Surgical and perioperative improvements permit earlier repair of partial and transitional atrioventricular septal defects (AVSD). We sought to describe contemporary outcomes in a multicenter cohort.

METHODS: We studied 87 patients undergoing primary biventricular repair of partial or transitional AVSD between June 2004 and February 2006 across seven North American centers. One-month and 6-month postoperative data included weight-for-age z-scores, left atrioventricular valve regurgitation (LAVVR) grade, residual shunts, and left ventricular ejection fraction. Paired methods were used to assess 6-month change.

RESULTS: Median age at surgery was 1.8 years; median weight z-score was -0.88. Median days for ventilation were 1, intensive …

Factor Vii Deficiency And Pregnancy: A Case Report And Review Of Literature, Syed Mohammad Asad Zaidi, Rahat Qureshi, Salman Naseem Adil

Department of Obstetrics & Gynaecology

Factor VII deficiency is one of the 'rare inherited disorders of coagulation.' Few cases of Factor VII deficiency have been reported during pregnancy, a state which could potentially cause fatal haemorrhage. Here we report a case of a pregnant lady with a history of heavy menorrhagia and multiple first pregnancy failures. Delivery was carried out via Caesarean section due to non-reassuring foetal heart monitoring. Patient was treated with Fresh Frozen Plasma (FFPs) and Factor VII concentrates, however, the patient developed bleeding postoperatively. Literature indicates that whilst Factor VII levels rise during pregnancy in normal women, no increase is seen in …

Familial Hypercholesterolemia: A Decade Of Progress, Samuel S. Gidding, Md

Department of Pediatrics Faculty Papers

Natural history studies of familial hypercholesterolemia (FH), a genetic disorder associated with elevated cholesterol and premature coronary artery disease, and with a frequency of about 1:500 in the general population, were first conducted in the 1970s. 1 Homozygotes, with cholesterol levels in excess of 500 mg/dl experience coronary events as early as adolescence and heterozygotes (with one normal and one abnormal gene) are affected prematurely in middle age. The first major breakthrough in understanding the disease came with the discovery of the low density lipoprotein (LDL) receptor by Brown and Goldstein, work that won the Nobel prize.

Telemedicine And Advanced Technology Research Center: Quarterly Report, October 18, 2009 To January 17, 2010, Bea Babbitt

Telemedicine & Advanced Technology Research Center

Development of a P.O.I. and a Blended Learning Ecology for use in Combat Lifesaver Skills Training for the Army.

Ganglionic Plexus Ablation During Pulmonary Vein Isolation--Predisposing To Ventricular Arrhythmias?, Faizel Osman, Suman Kundu, Jiun Tuan, Jeilan Mohamed, Peter J. Stafford, G. Andre' Ng

Internal Medicine, East Africa

Catheter ablation is increasingly used to treat patients with atrial fibrillation (AF). Ablation of ganglionic plexi is often performed to reduce vagal innervation and has been shown to confer a better long-term outcome in terms of AF recurrence. We report a case of a patient having AF ablation with a profound vagal response, suggesting ganglionic plexus ablation, who subsequently developed ventricular fibrillation after programmed ventricular stimulation. Reduced vagal modulation is known to predispose to ventricular arrhythmias and vagal denervation following AF ablation may predispose to ventricular arrhythmias and requires further study.

Cardiomyocyte Pdgfr-Beta Signaling Is An Essential Component Of The Mouse Cardiac Response To Load-Induced Stress, Vishnu Chintalgattu, Di Ai, Robert R Langley, Jianhu Zhang, James A Bankson, Tiffany L Shih, Anilkumar K Reddy, Kevin R Coombes, Iyad N Daher, Shibani Pati, Shalin S Patel, Jennifer S Pocius, George E Taffet, L Maximillian Buja, Mark L Entman, Aarif Y Khakoo

Faculty, Staff and Student Publications

PDGFR is an important target for novel anticancer therapeutics because it is overexpressed in a wide variety of malignancies. Recently, however, several anticancer drugs that inhibit PDGFR signaling have been associated with clinical heart failure. Understanding this effect of PDGFR inhibitors has been difficult because the role of PDGFR signaling in the heart remains largely unexplored. As described herein, we have found that PDGFR-beta expression and activation increase dramatically in the hearts of mice exposed to load-induced cardiac stress. In mice in which Pdgfrb was knocked out in the heart in development or in adulthood, exposure to load-induced stress resulted …

Humoral Immunity In Tuberculin Skin Test Anergy And Its Role In High-Risk Persons Exposed To Active Tuberculosis, Liliana Encinales, Joaquin Zuñiga, Julio Granados-Montiel, Maria Yunis, Julio Granados, Ingrid Almeciga, Olga Clavijo, Carlos Awad, Vilma Collazos, María Inés Vargas-Rojas, José Luis Bañales-Mendez, Lilia Vazquez-Castañeda, Joel N Stern, Viviana Romero, Masha Fridkis-Hareli, Masha Frindkis-Hareli, Daniel Terreros, Marcelo Fernandez-Viña, Edmond J Yunis

Faculty, Staff and Student Publications

The most common test to identify latent tuberculosis is the tuberculin skin test that detects T cell responses of delayed type hypersensitivity type IV. Since it produces false negative reactions in active tuberculosis or in high-risk persons exposed to tuberculosis patients as shown in this report, we studied antibody profiles to explain the anergy of such responses in high-risk individuals without active infection. Our results showed that humoral immunity against tuberculin, regardless of the result of the tuberculin skin test is important for protection from active tuberculosis and that the presence of high antibody titers is a more reliable indicator …

Factors Associated With Recurrent Nasal Polyps: A Tertiary Care Experience, Shabbir Akhtar, Mubasher Ikram, Iqbal Azam, Tariq Dahri

Section of Otolaryngology, Head & Neck Surgery

OBJECTIVE: To assess the factors associated with recurrence of nasal polyps in operated patients by endoscopic surgery.

METHODS: A retrospective study was conducted on 192 patients operated for nasal polyps in a hospital set-up between 2001 and 2007. The median follow-up period was 24 months (range 12 months to 60 months). Ten variables were analyzed to study their association with polyp recurrence namely; age, gender, history of purulent nasal discharge, facial pain, anosmia, post nasal dripping (PND), headache, nasal allergy, asthma and computed tomography (C.T) staging. Analysis of recurrences was accomplished using independent sample t-test, chi-square and Fishers exact test. …

Elevated Albumin In Retinas Of Monkeys With Experimental Glaucoma, Louvenia Carter-Dawson, Yujin Zhang, Ronald S Harwerth, Ricky Rojas, Pramod Dash, Xinping C Zhao, Elizabeth Woldemussie, Guadalupe Ruiz, Alice Chuang, William P Dubinsky, John B Redell

Faculty, Staff and Student Publications

PURPOSE: To establish the identity of a prominent protein, approximately 70 kDa, that is markedly increased in the retina of monkeys with experimental glaucoma compared with the fellow control retina, the relationship to glaucoma severity, and its localization in the retina.

METHODS: Retinal extracts were subjected to 2-D gel electrophoresis to identify differentially expressed proteins. Purified peptides from the abundant 70 kDa protein were analyzed and identified by liquid chromatography/mass spectrometry/mass spectrometry (LC/MS/MS) separation, and collision-induced dissociation sequencing. Protein identity was performed on MASCOT (Matrix Science, Boston, MA) and confirmed by Western blot. The relationship between the increase in this …

Emergency Evaluation Of Acute Chest Pain., Aysha Almas, Om Parkash, Aamir Hameed, Muhammad Islam

Department of Medicine

Objective: To determine the sensitivity and specificity of initial clinical assessment about the diagnosis of acute coronary syndrome (ACS) in patients presenting with acute chest pain by a cardiology resident in the emergency room and assess the 30-day outcome of patients with ACS and non ACS.

Study Design: Cohort study.

Place and Duration of Study: The study was conducted in the emergency department and cardiac care units of the Aga Khan University in 2006-07.

Methodology: A total of 202 patients, who presented to the emergency room with chest pain, were given an initial ECG and troponin check. Patients were assigned …

Improving Schizophrenia Diagnosis Through Biomarkers: An Upcoming Prospect, Syed Mohammad Asad Zaidi, Abdul Latif Bikak, Rameez-Ul Hassan

Medical College Documents

No abstract provided.

Acute Necrotizing Encephalopathy Of Childhood: A Fatal Complication Of Swine Flu, Muhammad Rehan Khan, Prem Kumar Maheshwari, Syed Asad Ali, Anwarul Haque

Department of Paediatrics and Child Health

Acute necrotizing encephalopathy of childhood (ANEC) is a rare condition characterized by the presence of multifocal symmetrical brain lesions involving mainly thalami, brainstem, cerebellum and white matter. ANEC is a serious and life threatening complication of simple viral infections. We present a case of a young child who developed this condition with classical clinical and radiological findings consistent with ANEC, secondary to swine flu (H1N1). He needed ventilatory support and had profound motor and intellectual deficit on discharge. We report this case with aim of raising awareness about this fatal complication of swine flu which has become a global health …

Efficacy And Safety Of Procedural Sedation And Analgesia By Paediatric Intensivist In Paediatric Oncology Unit, Anwarul Haque, Zahra Fadoo

Department of Paediatrics and Child Health

Children with cancer especially acute leukaemia undergo multiple painful procedures like bone marrow biopsy (BM) and lumber puncture (LP) for intrathecal chemotherapy during their first year of treatment. The purpose of this study is to report safety and efficacy of Procedural Sedation and Analgesia (PSA) by paediatric intensivist for oncology procedures in controlled setting in paediatric oncology unit. During 20 months, 124 children received PSA for 499 procedures. 324 LP alone, 175 BM alone and 40 combined LP and BM were done. The most common diagnosis was acute leukaemia and lymphoma. All procedures were in compliance with American Society of …

Ct And Mri Features Following Uterine Fibroid Embolization, Sachit Verma Md, Carin F. Gonsalves Md, Oksana H. Baltarowich Md, Donald G. Mitchell Md, Anna Lev-Toaff Md, Diane Bergin Md

Department of Radiology Faculty Papers

Uterine artery embolization (UAE) is an effective treatment for symptomaticuterine fibroids. Magnetic resonance (MR) imaging is typically employed to evaluate the uterus following UAE for fibroid infarction, size, location change, persistent enhancement, changes in adenomyosis and uterine necrosis. Variable pattern of calcification on computed tomography (CT) can differentiate embolic particles and fibroid involution. CT following UAE may be requested because of acute pelvic pain or chest discomfort or pyrexia and/or for complications that may require treatment in acute phase. Visualization of gas in uterus and uterine vessels following UAE is an expected finding that should not be misinterpreted as a …