Medicine and Health Sciences Commons^™

Genotyping And Drug Resistance Patterns Of M. Tuberculosis Strains In Pakistan., Mahnaz Tanveer, Zahra Hasan, Amna R Siddiqui, Asho Ali, Akbar Kanji, Solomon Ghebremicheal, Rumina Hasan

Department of Pathology and Laboratory Medicine

Background:The incidence of tuberculosis in Pakistan is 181/100,000 population. However, information about transmission and geographical prevalence of Mycobacterium tuberculosis strains and their evolutionary genetics as well as drug resistance remains limited. Our objective was to determine the clonal composition, evolutionary genetics and drug resistance of M. tuberculosis isolates from different regions of the country.

Methods:

M. tuberculosis strains isolated (2003-2005) from specimens submitted to the laboratory through collection units nationwide were included. Drug susceptibility was performed and strains were spoligotyped.

Results:

Of 926 M. tuberculosis strains studied, 721(78%) were grouped into 59 "shared types", while 205 (22%) were identified …

Splenic Rupture, Secondary To G-Csf Use For Chemotherapy Induced Neutropenia: A Case Report And Review Of Literature., Nehal Masood, Asim Jamal Shaikh, Wasim Ahmed Memon, Romana Idress

Section of Haematology/Oncology

Introduction: Chemotherapy Induced neutropenia is a frequent and serious complication of cytotoxic cancer treatment. Granulocyte colony stimulating factors (G-CSF) are frequently used to counter neutropenia, attempt rapid recovery of Patients and allow for continuation of treatment without compromise on dose, especially in curative malignancies. Generally regarded as safe, G-CSF use has been very rarely reported to have resulted in serious side effects, such as, splenic rupture. Case Presentation: We are reporting a case of a twenty years old man, who was being treated for T cell acute lymphoblastic leukemia and received colony stimulating factors for treatment of severe neutropenia and …

Outcomes In Culture Positive And Culture Negative Ascitic Fluid Infection In Patients With Viral Cirrhosis: Cohort Study, Lubna Kamani, Khalid Mumtaz, Umair S. Ahmed, Ailia W. Ali, Wasim Jafri

Department of Medicine

Background: Ascitic fluid infection (AFI) in cirrhotic Patients has a high morbidity and mortality. It has two variants namely, spontaneous bacterial peritonitis (SBP) and culture negative neutrocytic ascites (CNNA). The aim of this study was to determine the outcome in cirrhotic Patients with culture positive (SBP) and culture negative neutrocytic ascites. Methods: We analyzed 675 consecutive hepatitis B and/or C related cirrhosis Patients with ascites admitted in our hospital from November 2005 to December 2007. Of these, 187 Patients had AFI, clinical and laboratory parameters of these Patients including causes of cirrhosis, Child Turcotte Pugh (CTP) score were recorded. Results: …

Identifying People At High Risk For Developing Sleep Apnea Syndrome (Sas): A Cross-Sectional Study In A Pakistani Population, Fawad Taj, Zarmeneh Aly, Mahwash Kassi, Mansoor Ahmed

Department of Medicine

Background: Obstructive Sleep Apnea (OSA) is associated with many cardiovascular and psychiatric diseases. Day-time sleepiness is a common consequence of sleep apnea and correlates with road-traffic accidents (RTA). Pakistan has a high prevalence of factors which predispose an individual to OSA and death from RTAs are a huge burden. However there is a dearth of prevalence studies in this regard. We aim to understand local relevance of the disease and estimate the prevalence of individuals high-risk for OSA. Methods: This cross-sectional survey was conducted among 450 individuals at Aga Khan University Hospital (AKUH), which is a tertiary care teaching hospital …

Denaturation And Unfolding Of Human Anaphylatoxin C3a: An Unusually Low Covalent Stability Of Its Native Disulfide Bonds, Jui-Yoa Chang, Curtis C-J Lin, Silvia Salamanca, Michael K Pangburn, Rick A Wetsel

Journal Articles

The complement C3a anaphylatoxin is a major molecular mediator of innate immunity. It is a potent activator of mast cells, basophils and eosinophils and causes smooth muscle contraction. Structurally, C3a is a relatively small protein (77 amino acids) comprising a N-terminal domain connected by 3 native disulfide bonds and a helical C-terminal segment. The structural stability of C3a has been investigated here using three different methods: Disulfide scrambling; Differential CD spectroscopy; and Reductive unfolding. Two uncommon features regarding the stability of C3a and the structure of denatured C3a have been observed in this study. (a) There is an unusual disconnection …

Kelly, Rita Helen Roberts (Fa 353), Manuscripts & Folklife Archives

FA Finding Aids

Finding aid and full-text scan of paper (Click on “Additional Files” below) for Folklife Archives Project 353. Paper: "Good Mothering through Breast Feeding: Observations of a Meeting of the La Leche League" written by Rita H. Kelly for a Western Kentucky University folk studies class.

Bullying Of Medical Students In Pakistan: A Cross-Sectional Questionnaire Survey., Syed Ahmer, Abdul Wahab Yousafzai, Naila Bhutto, Sumira Alam, Amanullah Khan Sarangzai, Arshad Iqbal

Department of Psychiatry

Background: Several studies from other countries have shown that bullying, harassment, abuse or belittlement are a regular phenomenon faced not only by medical students, but also junior doctors, doctors undertaking research and other healthcare professionals. While research has been carried out on bullying experienced by psychiatrists and psychiatry trainees in Pakistan no such research has been conducted on medical students in this country. Methodology/Principal Findings: We conducted a cross-sectional questionnaire survey on final year medical students in six medical colleges of Pakistan. The response rate was 63%. Fifty-two percent of respondents reported that they had faced bullying or harassment …

Effects Of Shielding Adenoviral Vectors With Polyethylene Glycol On Vector-Specific And Vaccine-Mediated Immune Responses, Eric A. Weaver, Michael A. Barry

Nebraska Center for Virology: Faculty Publications

Many individuals have been previously exposed to human adenovirus serotype 5 (Ad5). This prior immunity has long been known to hinder its use for gene therapy and as a gene-based vaccine. Given these immunogenicity problems, we have tested whether polyethylene glycol (PEG) can blunt immune effects against Ad5 during systemic and mucosal vaccination. Ad5 vectors were covalently modified with 5-, 20-, and 35-kDa linear PEG polymers and evaluated for their ability to produce immune responses against transgene antigen products and the vector itself. We show that shielding Ad5 with different-sized PEGs generally reduces transduction and primary antibody responses by the …

Mesenteric Panniculitis With Pedal Edema In A 33-Year-Old Pakistani Man: A Case Report And Literature Review., Abdul M Zafar, Muhamad A Rauf, Tabish Chawla, Gule Khanda

Department of Radiology

Introduction:Mesenteric panniculitis is a rare pathology of unknown etiology characterized by inflammation and fibrosis in the mesentery. Its protean clinical and radiological manifestations make it a diagnostic challenge. There is no established treatment available for its management. The clinical outcome is inconsistent, with the prognosis ranging from complete resolution without any treatment to rapid progression culminating in death. Case Presentation: A 33-year-old Pakistani man presented with vague abdominal pain, an ill-defined epigastric mass and bilateral pedal edema. A detailed review of his history and laboratory investigations did not point to any diagnosis. The Patient underwent an exploratory laparotomy based …

Fatal Transfusion Related Acute Lung Injury Following Coronary Artery By-Pass Surgery: A Case Report., Fauzia Ahmad Bawany, Hasanat Sharif

Section of Cardiothoracic Surgery

Background:Transfusion related acute lung injury (TRALI) is a potentially fatal Acute Lung Injury following transfusion of blood components. Hypotheses implicate donor-derived anti-human leukocyte antigen or granulocyte antibodies reacting with recipients' leukocytes, releasing inflammatory mediators. Lack of agreement on underlying cellular and molecular mechanisms renders improving transfusion safety difficult and expensive.

Case Presentation:

Literature search has not revealed any case of TRALI from Pakistan. We report the case of fatal TRALI in a 68 year old male who received blood products after coronary artery by-pass surgery.

Conclusion:

This article aims to create awareness about this complication and suggests that post …

Consistency Check Of Planned Adaptive Option On Helical Tomotherapy., M Schirm, S Yartsev, G Bauman, Jerry J. Battista Dr., Jacob Van Dyk

Oncology Publications

This study aims to evaluate a new Planned Adaptive software (TomoTherapy Inc., Madison, WI) of the helical tomotherapy system by retrospective verification and adaptive re-planning of radiation treatment. Four patients with different disease sites (brain, nasal cavity, lungs, prostate) were planned in duplicate using the diagnostic planning kVCT data set and MVCT studies of the first treatment fraction with the same optimization parameters for both plan types. The dosimetric characteristics of minimum, maximum, and mean dose to the targets as well as to organs at risk were compared. Both sets of plans were used for calculation of dose distributions in …

Evaluation Of The Stability And Validity Of Participant Samples Recruited Over The Internet., Daniel Z Lieberman

Psychiatry and Behavioral Sciences Faculty Publications

Research conducted via the Internet has the potential to reach important clinical populations of participants who would not participate in traditional studies. Concerns exist, however, about the validity of samples recruited in this manner, especially when participants are anonymous and never have contact with study staff. This study evaluated two anonymous samples that were recruited over the Internet to test an online program designed to help problem drinkers. The two studies were conducted 3 years apart, and different recruitment strategies were utilized. Despite these differences, the two samples were highly similar in demographic and clinical features. Correlations that have been …

Retinoid X Receptor And Peroxisome Proliferator-Activated Receptor-Gamma Agonists Cooperate To Inhibit Matrix Metalloproteinase Gene Expression, Peter S. Burrage, Adam C. Schmucker, Yanqing Ren, Michael B. Sporn, Constance E. Brinckerhoff

Dartmouth Scholarship

We recently described the ability of retinoid X receptor (RXR) ligand LG100268 (LG268) to inhibit interleukin-1-beta (IL-1-β)-driven matrix metalloproteinase-1 (MMP-1) and MMP-13 gene expression in SW-1353 chondrosarcoma cells. Other investigators have demonstrated similar effects in chondrocytes treated with rosiglitazone, a ligand for peroxisome proliferator-activated receptor-gamma (PPARγ), for which RXR is an obligate dimerization partner. The goals of this study were to evaluate the inhibition of IL-1--induced expression of MMP-1andMMP-13 by combinatorial treatment with RXR and PPAR  ligands and to investigate the molecular mechanisms of this inhibition.

Intracerebral Hemorrhage For The Palliative Care Provider: What You Need To Know., B Brent Simmons, Susan M Parks

Department of Family & Community Medicine Faculty Papers

Intracerebral hemorrhage (ICH) makes up 10%-30% of all strokes. Palliative care providers are often asked to get involved with ICH cases to aid with development of short-term and long-term goals. Prognosis can be calculated using the ICH score (based on Glasgow Coma Score score, ICH volume, presence of intraventricular hemorrhage, age, and location of origin) or the Essen score (based on age, NIH Stroke Scale [NIHSS], and level of consciousness). Do-not-resuscitate (DNR) status is important to discuss with families. Expert consensus states DNR is appropriate if the patient has two of the following: severe stroke, life-threatening brain damage, or significant …

Pathological Sub-Types, Risk Factors And Outcome Of Stroke At The Nairobi Hospital, Kenya, James Jowi, Peter Mativo

Internal Medicine, East Africa

Background: Stroke is one of the most common causes of morbidity and mortality the world over. Established risk factors such as arterial hypertension, diabetes mellitus, cigarette smoking, hyper-lipidaemia, micro-vascular rupture, male gender, age and observed co-morbities such as sickle cell disease, HIV/AIDS infection and cerebral malaria are increasingly being encountered in the tropics.

Objectives: To determine pathological sub-types, risk factors, in-hospital period prevalence and in-hospital outcome of stroke.

Design: Hospital-based retrospective study.

Setting: The Nairobi Hospital, Nairobi, Kenya.

Subjects: Patients with recorded diagnosis of stroke/cerebral vascular accident; as per WHO criteria for diagnosis of stroke, …

Silencing Of Mbd1 And Mecp2 In Prostate-Cancer-Derived Pc3 Cells Produces Differential Gene Expression Profiles And Cellular Phenotypes, Yaqinuddin Ahmed, Farhat Abbas, Syed S. Naqvi, Mohammad U. Bashir, Romena Qazi, Sohail A. Qureshi

Section of Urology

Alterations in genomic CpG methylation patterns have been found to be associated with cell transformation and neoplasia. Although it is recognized that methylation of CpG residues negatively regulates gene expression, how the various MBPs (methyl-binding proteins) contribute to this process remains elusive. To determine whether the two well characterized proteins MeCP2 (methyl-CpG-binding protein 2) and MBD1 (methyl-CpG-binding domain 1) have distinct or redundant functions, we employed RNAi (RNA interference) to silence their expression in the prostate cancer-derived PC3cell line, and subsequently compared cell growth, invasion and migration properties of these cell lines in addition to their respective mRNA-expressionprofiles. Cells devoid …

Awareness Of The Risk Factors, Presenting Features And Complications Of Hypertension Amongst Hypertensives And Normotensives, Syed Nabeel Zafar, Saqib A. Gowani, Faria Amber Irani, Mohammad Ishaq

Section of Cardiology

OBJECTIVES: To assess the level of awareness with regards to risk factors, presenting features and complications of hypertension. Moreover, to Compare the level of awareness amongst patients (hypertensives) and nonpatients (normotensives) in Karachi, Pakistan.METHODS: This cross-sectional study was carried out on a random sample of 440 people (220-normotensives/220-hypertensives) using an interview based questionnaire. Data entry was performed on Epi-info v 6 and managed and analyzed on SPSS v 14. Proportions were calculated for categorical data, means and standard deviations were calculated for continuous data.RESULTS: Hypertensives had a higher mean awareness score than the normotensives (p

Genomic Rna Profiling And The Programme Controlling Preimplantation Mammalian Development., Christine E Bell, Michele D Calder, Andrew J Watson

Obstetrics & Gynaecology Publications

Preimplantation development shifts from a maternal to embryonic programme rapidly after fertilization. Although the majority of oogenetic products are lost during the maternal to embryonic transition (MET), several do survive this interval to contribute directly to supporting preimplantation development. Embryonic genome activation (EGA) is characterized by the transient expression of several genes that are necessary for MET, and while EGA represents the first major wave of gene expression, a second mid-preimplantation wave of transcription that supports development to the blastocyst stage has been discovered. The application of genomic approaches has greatly assisted in the discovery of stage specific gene expression …

A Comparison Of Treatments Offered To Patients With Nonalcoholic Steatohepatitis, Saleem Perwaiz Iqbal, Sadia Mahmud, Saeed Hamid, Omrana Pasha, Khabir Ahmad

Department of Paediatrics and Child Health

OBJECTIVE: To compare various treatment options provided to patients with Nonalcoholic Steatohepatitis (NASH) and assess improvement in liver status via reduction in serum Alanine Aminotransferase (ALT) levels.

STUDY DESIGN: Retrospective cohort study.

PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi, from April 2000 to April 2007.

METHODOLOGY: All available records of patients aged between 20-70 years, fatty liver on ultrasound, elevated serum ALT and having at least one follow-up, after a baseline visit were included. The patients had variable number of follow-ups and a maximum of 3 follow-ups were considered. Information was collected on demographic and clinical …

Response Of Imitanib Meysylate In Patients With Gastrointestinal Stromal Cell Tumour, Abdullah Ladha, Mohammad Usman Shaikh

Department of Pathology and Laboratory Medicine

In this study, the response of Imitanib Mesylate in patients with Gastro-intestinal stromal cell tumour (GIST) was assessed. GIST results from a mutation in one of the receptor protein tyrosine kinases. Imitanib Mesylate, a tyrosine kinase inhibitor, has emerged as a promising new treatment for GISTs. Total 16 cases were reviewed. Diagnosis was based on biopsy and immunohistochemistry. Response assessment was done using CT scans, at a median duration of 4 months. The median age of the patients was 52 years, Majority were male (n=14). Most common presenting complaint was abdominal pain (n=7). Commonest primary site was stomach (n=7), Liver …

Use Of Anticonvulsants Drugs For Neuropathic Painful Conditions, Aziza Mohammad Hussain, Gauhar Afshan

Department of Anaesthesia

Neuropathic pain, a form of chronic pain initiated and sustained by an insult to the peripheral or central nervous system, is a challenge to clinicians as it does not respond well to traditional pain therapies. However exact pathophysiology is not known but considering similarities between epilepsy models and in neuropathic pain models justify the rationale for use of anticonvulsant drugs in the symptomatic management of neuropathic pain disorders. The role of anticonvulsant drugs in the treatment of neuropathic pain is evolving and various clinical trials have used these anticonvulsants and shown positive results in the treatment of trigeminal neuralgia, painful …

Coordinated Changes In Mrna Turnover, Translation, And Rna Processing Bodies In Bronchial Epithelial Cells Following Inflammatory Stimulation, Yuxin Zhai, Zhenping Zhong, Chyi-Ying A Chen, Zhenfang Xia, Ling Song, Michael R Blackburn, Ann-Bin Shyu

Journal Articles

Bronchial epithelial cells play a pivotal role in airway inflammation, but little is known about posttranscriptional regulation of mediator gene expression during the inflammatory response in these cells. Here, we show that activation of human bronchial epithelial BEAS-2B cells by proinflammatory cytokines interleukin-4 (IL-4) and tumor necrosis factor alpha (TNF-alpha) leads to an increase in the mRNA stability of the key chemokines monocyte chemotactic protein 1 and IL-8, an elevation of the global translation rate, an increase in the levels of several proteins critical for translation, and a reduction of microRNA-mediated translational repression. Moreover, using the BEAS-2B cell system and …

Increased Myocardial Susceptibility To Repetitive Ischemia With High-Fat Diet-Induced Obesity, Geeta D Thakker, Nikolaos G Frangogiannis, Pawel T Zymek, Saumya Sharma, Joe L Raya, Philip M Barger, Heinrich Taegtmeyer, Mark L Entman, Christie M Ballantyne

Journal Articles

Obesity and diabetes are frequently associated with cardiovascular disease. When a normal heart is subjected to brief/sublethal repetitive ischemia and reperfusion (I/R), adaptive responses are activated to preserve cardiac structure and function. These responses include but are not limited to alterations in cardiac metabolism, reduced calcium responsiveness, and induction of antioxidant enzymes. In a model of ischemic cardiomyopathy inducible by brief repetitive I/R, we hypothesized that dysregulation of these adaptive responses in diet-induced obese (DIO) mice would contribute to enhanced myocardial injury. DIO C57BL/6J mice were subjected to 15 min of daily repetitive I/R while under short-acting anesthesia, a protocol …

Stromal Gene Signatures In Large-B-Cell Lymphomas., G Lenz, G Wright, S S Dave, W Xiao, J Powell, H Zhao, W Xu, B Tan, N Goldschmidt, Javeed Iqbal, Julie M. Vose, M Bast, Kai Fu, D D. Weisenburger, T C Greiner, James O. Armitage, A Kyle, L May, R D Gascoyne, J M Connors, G Troen, H Holte, S Kvaloy, D Dierickx, G Verhoef, J Delabie, E B Smeland, P Jares, A Martinez, A Lopez-Guillermo, E Montserrat, E Campo, R M Braziel, T P Miller, L M Rimsza, J R Cook, B Pohlman, J Sweetenham, R R Tubbs, R I Fisher, E Hartmann, A Rosenwald, G Ott, H-K Muller-Hermelink, D Wrench, T A Lister, E S Jaffe, W H Wilson, W C. Chan, L M Staudt

Journal Articles: Pathology and Microbiology

BACKGROUND: The addition of rituximab to combination chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), or R-CHOP, has significantly improved the survival of patients with diffuse large-B-cell lymphoma. Whether gene-expression signatures correlate with survival after treatment of diffuse large-B-cell lymphoma is unclear.

METHODS: We profiled gene expression in pretreatment biopsy specimens from 181 patients with diffuse large-B-cell lymphoma who received CHOP and 233 patients with this disease who received R-CHOP. A multivariate gene-expression-based survival-predictor model derived from a training group was tested in a validation group.

RESULTS: A multivariate model created from three gene-expression signatures--termed "germinal-center B-cell," "stromal-1," and "stromal-2"--predicted …

Pacemaker Patients' Perception Of Unsafe Activities: A Survey, Masooma Aqeel, Azam Shafquat, Nawal Salahuddin

Section of Cardiology

Background: Cardiac pacing is a recognized and widely used treatment for Patients presenting with bradycardia. Physicians expect Patients to return to normal activities almost immediately post implantation. However, Patients themselves may perceive interference to pacemaker function by various routine activities and devices, and hence continue to lead restricted, disabled lives. The aim of this study is to determine if routine activities are perceived by pacemaker Patients to interfere with their device function. Methods: A descriptive cross sectional survey was carried out on consecutive Patients at the pacemaker clinic at a public hospital in Karachi, Pakistan. A 47-question tool was developed …

Mrsa Usa300 Clone And Vref--A Us-Colombian Connection?, Cesar A Arias, Sandra Rincon, Shahreen Chowdhury, Ernesto Martínez, Wilfrido Coronell, Jinnethe Reyes, Sreedhar R Nallapareddy, Barbara E Murray

Journal Articles

No abstract provided.

Prevalence And Factors Associated With Intestinal Parasitic Infection Among Children In An Urban Slum Of Karachi., Vikram Mehraj, Juanita Hatcher, Saeed Akhtar, Ghazala Rafique, Mohammad Asim Beg

Department of Pathology and Laboratory Medicine

Background:Intestinal parasitic infections are endemic worldwide and have been described as constituting the greatest single worldwide cause of illness and disease. Poverty, illiteracy, poor hygiene, lack of access to potable water and hot and humid tropical climate are the factors associated with intestinal parasitic infections. The study aimed to estimate prevalence and identify factors associated with intestinal parasitic infections among 1 to 5 years old children residing in an urban slum of Karachi Pakistan. Methods And Principal
Findings:A cross sectional survey was conducted from February to June 2006 in Ghosia Colony Gulshan Town Karachi, Pakistan. A simple random …

Predictors Of Gastrointestinal Lesions On Endoscopy In Iron Deficiency Anemia Without Gastrointestinal Symptoms, Shahid Majid, Mohammad Salih, Rozina Wasaya, Wasim Jafri

Section of Gastroenterology

Background:Iron deficiency anaemia (IDA) due to occult gastrointestinal (GI) blood loss usually remains unnoticed until Patient become symptomatic. There is sparse data in IDA Patients without gastrointestinal symptoms. This study was designed to find out the frequency and predictors of endoscopic lesions in IDA without gastrointestinal symptoms. Cross-sectional study performed on a convenience sample of consecutive subjects.

Methods: Ninety five consecutive Patients with laboratory based diagnosis of IDA having no gastrointestinal symptoms were interviewed and their clinical and biochemical variables were recorded. All the study Patients underwent esophago-gastroduodenoscopy (EGD) and colonoscopy. Endoscopic findings were documented as presence/absence of bleeding …

Blood Pressure Lowering And Vasomodulator Effects Of Piperine, Syed Intasar Husain Taqvi, Abdul Jabbar Shah, Anwar Gilani

Department of Biological & Biomedical Sciences

This study was aimed to explore underlying mechanism(s) of cardiovascular effects of piperine. Intravenous administration of piperine caused a dose-dependent (1 to 10 mg/kg) decrease in mean arterial pressure (MAP) in normotensive anesthetized rats, the next higher dose (30 mg/kg) did not cause any further change in MAP. The fall in blood pressure (BP) was followed by small increase in MAP after each dose. In Langendorrf's rabbit heart preparation, piperine caused partial inhibition and verapamil caused complete inhibition of force and rate of ventricular contractions and coronary flow. In rabbit aortic rings, piperine inhibited high K(+) (80 mM) precontractions and …

Young Woman With Chronic Conversion Disorder With Dramatic Improvement In Upper Motor Neuron Type Syndromes Through The Use Of Electromyography (Emg) Triggered Biofeedback, Bruce H. Hsu, Md, Nethra S. Ankam, Md, Ralph J. Marino

Department of Rehabilitation Medicine Faculty Papers

Patient: 31 year old woman chronic flexion contracture of hand, prior history seizure disorder, chronic conversion disorder.

Program Description: Patient presented initially to neurology service with chronic right hand flexion contracture in the context of 3 days of weakness and numbness in lower extremities after exertion. MRI/MRA Brain, Head CT, CT of entire spine were all unrevealing. Patient was transferred to the rehabilitation unit 8 days after initial admission. On rehabilitation admission patient exam was noted to have right hand markedly flexed with pain to passive ranging out of extreme flexion, chronic in nature. Patient initially had her hand ranged …