Medicine and Health Sciences Commons^™

Kallikrein Family Proteases Klk6 And Klk7 Are Potential Early Detection And Diagnostic Biomarkers For Serous And Papillary Serous Ovarian Cancer Subtypes., Ayala Tamir, Ushma Jag, Sreeja Sarojini, Craig Schindewolf, Takemi Tanaka, Rajendra Gharbaran, Hiren Patel, Anil Sood, Wei Hu, Ruzeen Patwa, Patrick Blake, Polina Chirina, Jin Oh Jeong, Heejin Lim, Andre Goy, Andrew Pecora, K Stephen Suh

Department of Medicine Faculty Papers

BACKGROUND: Early detection of ovarian cancer remains a challenge due to widespread metastases and a lack of biomarkers for early-stage disease. This study was conducted to identify relevant biomarkers for both laparoscopic and serum diagnostics in ovarian cancer.

METHODS: Bioinformatics analysis and expression screening in ovarian cancer cell lines were employed. Selected biomarkers were further validated in bio-specimens of diverse cancer types and ovarian cancer subtypes. For non-invasive detection, biomarker proteins were evaluated in serum samples from ovarian cancer patients.

RESULTS: Two kallikrein (KLK) serine protease family members (KLK6 and KLK7) were found to be significantly overexpressed relative to normal …

Spontaneous Asj-2j Mutant Mouse As A Model For Generalized Arterial Calcification Of Infancy: A Large Deletion/Insertion Mutation In The Enpp1 Gene., Qiaoli Li, C Herbert Pratt, Louise A Dionne, Heather Fairfield, Son Yong Karst, John P Sundberg, Jouni Uitto, Yin Tintut

Department of Dermatology and Cutaneous Biology Faculty Papers

Generalized arterial calcification of infancy (GACI), an autosomal recessive disorder caused by mutations in the ENPP1 gene, manifests with extensive mineralization of the cardiovascular system. The affected individuals in most cases die within the first year of life, and there is currently no effective treatment for this disorder. In this study, we characterized a spontaneous mutant mouse, asj-2J, as a model for GACI. These mice were identified as part of a phenotypic deviant search in a large-scale production colony of BALB/cJ mice at The Jackson Laboratory. They demonstrated a characteristic gait due to stiffening of the joints, with phenotypic similarity …

Multiple Interventions To Transform A Family Medicine Practice, Nyann Biery Ms, Robin Schroeder Md, Faafp

Department of Family Medicine

No abstract provided.

Toward An Improved Understanding Of The Ionizing Radiation Induced Dna Damage/Response Networks In Human Malignancies., Daphne A Haas-Kogan, David R Raleigh, Adam Paul Dicker

Department of Radiation Oncology Faculty Papers

No abstract provided.

Evaluating The Effectivesness Of Information Sources Regarding Hiv Among Gold Miners In Quảng Nam, Noah Landesberg

Independent Study Project (ISP) Collection

Young migrant males in strenuous manual labor environments represent a high-­‐risk population for the transmission of HIV/AIDS. In Vietnam, gold miners are representative of this high-­‐risk population. Phước Sơn district, Quảng Nam province is home to much of Vietnam’s mining activity and has a comparatively high rate of HIV. Previous studies have been done on HIV/AIDS prevalence in Quảng Nam as well as related knowledge and practices. This analysis of a 2014 questionnaire examines the effects of varying information sources on HIV/AIDS knowledge. The sample of workers was mostly male and between 25 and 49 years old. Migrants made up …

Propranolol Therapy For Infantile Hemangioma Is Less Toxic But Longer In Duration Than Corticosteroid Therapy, Kathryn Sawa, Arjang Yazdani, Michael J. Rieder, Guido Filler

Paediatrics Publications

BACKGROUND: Infantile hemangioma is the most common benign, self-limiting tumour of childhood. Treatment is reserved for hemangiomas that obstruct vital structures or cause significant disfigurement. Traditionally, corticosteroids have been the medical treatment of choice. Since 2008, however, propranolol has been rapidly adopted as an effective pharmacological treatment for infantile hemangioma. Published data regarding the long-term side effects of propranolol are currently lacking. OBJECTIVE: To describe the long-term effects of propranolol and corticosteroids on anthropometric measurements (height, body mass index [BMI]) and blood pressure in children. METHODS: A prospective database analysis of all infantile hemangioma patient visits to the pediatric vascular …

The Health Initiative Program For Kids (Hip Kids): Effects Of A 1-Year Multidisciplinary Lifestyle Intervention On Adiposity And Quality Of Life In Obese Children And Adolescents -- A Longitudinal Pilot Intervention Study, Dirk E. Bock, Tracy Robinson, Jamie A Seabrook, Meghan Rombeek, Kambiz Norozi, Guido Filler, Ralf Rauch, Cheril L Clarson

Paediatrics Publications

BACKGROUND: Though recent data suggest that multidisciplinary outpatient interventions can have a positive effect on childhood obesity, it is still unclear which program components are most beneficial and how they affect quality of life (QoL). The aim of this study was to determine if a 1-year multidisciplinary, family-centered outpatient intervention based on social cognitive theory would be effective in (i) preventing further increases in BMI and BMI z-score, and (ii) improving QoL in obese children and adolescents.

METHODS: Obese children and adolescents 8-17 years of age and their families participated in this 1-year longitudinal pilot intervention study. The intervention consisted …

Effects Of Video Enhancement In A Stated-Choice Experiment On Medical Decision Making, Susanne Hoffmann, Joachim Winter, Francis G. Caro, Alison Gottlieb

Gerontology Institute Publications

Background. The internet can be useful in administering stated-choice experiments to understand medical decision making and refine the content of patient decision aids. In internet-based stated-choice experiments, video and audio files can be used to provide information to respondents. Quality of data may or may not be affected.

Objectives. In a methodological experiment concerned with administration of a stated-choice experiment on the internet concerned with knee-replacement surgery, we compared the data quality obtained with video-enhanced and conventional text formats.

Methods. Members of the RAND Corporation’s American Life Panel and 50 years of age or older (n=1616) were randomly assigned to …

Site-Specific Mutation Of The Sensor Kinase Gras In Staphylococcus Aureus Alters The Adaptive Response To Distinct Cationic Antimicrobial Peptides, Ambrose L. Cheung, Arnold S. Bayer, Michael R. Yeaman, Yan Q. Xiong, Alan J. Waring, Guido Memmi, Niles Donegan

Dartmouth Scholarship

The Staphylococcus aureus two-component regulatory system, GraRS, is involved in resistance to killing by distinct host defense cationic antimicrobial peptides (HD-CAPs). It is believed to regulate downstream target genes such as mprF and dltABCD to modify the S. aureus surface charge. However, the detailed mechanism(s) by which the histidine kinase, GraS, senses specific HD-CAPs is not well defined. Here, we studied a well-characterized clinical methicillin-resistant S. aureus (MRSA) strain (MW2), its isogenic graS deletion mutant (ΔgraS strain), a nonameric extracellular loop mutant (ΔEL strain), and four residue-specific ΔEL mutants (D37A, P39A, P39S, and D35G D37G D41G strains). The ΔgraS and …

Integrative Therapy Use For Management Of Side Effects And Toxicities Experienced By Pediatric Oncology Patients, Shana Jacobs

Pediatrics Faculty Publications

Integrative Therapies (IT), otherwise known as Complementary and Alternative Medicine, are widely used among pediatric oncology patients, despite a paucity of available evidence. This review summarizes surveys that describe the prevalence of IT use by pediatric oncology patients, both during therapy and in survivorship, as well as the modalities being used. Additionally, the evidence that exists for specific treatments that appear to be efficacious in controlling specific symptoms is described. Finally, there are recommendations for practitioners on how to best counsel patients about IT use.

Food Choices And Practices During Pregnancy Of Immigrant Women With High-Risk Pregnancies In Canada: A Pilot Study, Gina M A. Higginbottom, Helen Vallianatos, Joan Forgeron, Donna Gibbons, Fabiana Mamede, Rubina Barolia

School of Nursing & Midwifery

Background: Immigrant women may be regarded as a vulnerable population with respect to access and navigation of maternity care services. They may encounter difficulties when accessing culturally safe and appropriate maternity care, which may be further exacerbated by language difficulties and discriminatory practices or attitudes. The project aimed to understand ethnocultural food and health practices and how these intersect in a particular social context of cultural adaptation and adjustment in order to improve the care-giving capacities of health practitioners working in multicultural perinatal clinics.
Methods: This four-phase study employed a case study design allowing for multiple means of data collection …

A Study Protocol: Using Demand-Side Financing To Meet The Birth Spacing Needs Of The Underserved In Punjab Province In Pakistan, Syed Khurram Azmat, Moazzam Ali, Waqas Hameed, Ghulam Mustafa, Ghazanfer Abbas, Muhammad Ishaque, Mohsina Bilgrami, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: High fertility rates, unwanted pregnancies, low modern contraceptive prevalence and a huge unmet need for contraception adversely affect women’s health in Pakistan and this problem is compounded by limited access to reliable information and quality services regarding birth spacing especially in rural and underserved areas. This paper presents a study protocol that describes an evaluation of a demand-side financing (DSF) voucher approach which aims to increase the uptake of modern contraception among women of the lowest two wealth quintiles in Punjab Province, Pakistan.

Methods/Design: This study will use quasi-experimental design with control arm and be implemented in: six government …

Newborn Care In Indonesia, Lao People’S Democratic Republic And The Philippines: A Comprehensive Needs Assessment, Els Duysburgh, Birgit Kerstens, Melissa Diaz, Vini Fardhdiani, Katherine Ann Reyes, Khamphong Phommachanh, Marleen Temmerman, Basil Rodriques, Nabila Zaka

Obstetrics and Gynaecology, East Africa

Background: Between 1990 and 2011, global neonatal mortality decline was slower than that of under-five mortality. As a result, the proportion of under-five deaths due to neonatal mortality increased. This increase is primarily a consequence of decreasing post-neonatal and child under-five mortality as a result of the typical focus of child survival programmes of the past two decades on diseases affecting children over four weeks of age. Newborns are lagging behind in improved child health outcomes. The aim of this study was to conduct a comprehensive, equity-focussed newborn care assessment and to explore options to improve newborn survival in Indonesia, …

Repeated Transradial Catheterization: Feasibility, Efficacy, And Safety, Marinos A Charalambous, Savvas S Constantinides, Michael A Talias, Elpidoforos S Soteriades, Christos P Christou

The Texas Heart Institute Journal

Transradial access is an alternative to the transfemoral approach in coronary interventions. It results in less access-site bleeding, shorter hospital stays, lower costs, and less pain for the patient. However, some authors have suggested that the transradial approach might lead to radial artery occlusion, which precludes repeated same-artery catheterizations. Using data from our center, we evaluated the feasibility, safety, and efficacy of repeated transradial catheterization.

We reviewed the 3,006 transradial catheterizations performed at our center from 2006 through 2009. Patients who had undergone at least one repeated transradial catheterization were identified, their cases monitored through 2012, and their baseline characteristics …

Brachiocephalic Artery Cannulation In Proximal Aortic Surgery That Requires Circulatory Arrest, Mehmet Unal, Oguz Yilmaz, Ilker Akar, Ilker Ince, Cemal Aslan, Fatih Koc, Haluk Kafali

The Texas Heart Institute Journal

The brachiocephalic artery is an alternative cannulation site in the repair of ascending aortic lesions that require circulatory arrest. We evaluate the effectiveness and safety of this technique.

Proximal aortic surgery was performed in 32 patients from 2006 through 2012 via brachiocephalic artery cannulation and circulatory arrest. Twenty-four (75%) of the patients were men. The mean age was 48.69 ± 9.43 years (range, 30–68 yr). Twelve had type I dissection, 2 had type II dissection, and 18 had true aneurysms of the ascending aorta. All operations were performed through a median sternotomy. The arterial cannula was inserted through an 8-mm …

Aortic Valve Reconstruction With Use Of Pericardial Leaflets In Adults With Bicuspid Aortic Valve Disease: Early And Midterm Outcomes, Meong Gun Song, Hyun Suk Yang, Jong Bum Choi, Je Kyoun Shin, Hyun Keun Chee, Jun Seok Kim

The Texas Heart Institute Journal

In this study, we retrospectively analyzed the outcomes of adults with bicuspid aortic valve (BAV) disease who underwent aortic valve reconstructive surgery (AVRS), consisting of replacement of the diseased BAV with 2 or 3 pericardial leaflets plus fixation of the sinotubular junction for accurate and constant leaflet coaptation. From December 2007 through April 2013, 135 consecutive patients (mean age, 49.2 ± 13.1 yr; 73.3% men) with symptomatic BAV disease underwent AVRS. Raphe was observed in 84 patients (62.2%), and the remaining 51 patients had pure BAV without raphe. A total of 122 patients (90.4%) underwent 3-leaflet reconstruction, and 13 (9.6%) …

Percutaneous Repair Of Post-Myocardial Infarction Ventricular Septal Defect: Current Approaches And Future Perspectives, Maria D Baldasare, Mark Polyakov, Glenn W Laub, Joseph T Costic, Daniel J Mccormick, Sheldon Goldberg

The Texas Heart Institute Journal

Post-myocardial infarction ventricular septal defect is a devastating complication of ST-elevation myocardial infarction. Although surgical intervention is considered the gold standard for treatment, it carries high morbidity and mortality rates. We present 2 cases that illustrate the application of percutaneous closure of a post-myocardial infarction ventricular septal defect: the first in a patient who had undergone prior surgical closure and then developed a new shunt, and the second as a bridge to definitive surgery in a critically ill patient.

Anticoagulation With Bivalirudin During Deep Hypothermic Circulatory Arrest In A Patient With Heparin-Induced Thrombocytopenia, Agamemnon Pericleous, Mostafa Sadek, Mary Fitzmaurice, Constance Caldwell, Kris Natividad, Konstadinos A Plestis

The Texas Heart Institute Journal

Heparin-induced thrombocytopenia is a well-recognized complication of anticoagulation with heparin. We present the case of a patient with recent heparin-induced thrombocytopenia who subsequently needed surgery on an emergency basis for acute type A aortic dissection. This article reports the successful use of bivalirudin, a direct thrombin inhibitor, as an alternative to heparin throughout cardiopulmonary bypass and deep hypothermic circulatory arrest. We contend that bivalirudin is a safe alternative to heparin when performing surgery for aortic dissection and should be considered as an option for use in patients who present with heparin-induced thrombocytopenia.

Adults With Intellectual Disability Or Autism Spectrum Disorder. Executive Summary, Kimberly I. Snow Mhsa, Ba, Stuart Bratesman Mpp, Taryn Bowe, Julie T. Fralich Mba

Disability & Aging

This chartbook describes Maine’s historical trends in meeting the needs of adults with ID/ASD through institutional and community based services in comparison to other states; a detailed analysis of the population’s utilization of different types of services and their costs in SFY 2010; the implementation of the Supports Intensity Scale (SIS) as a means of identifying the supports needs of the adults with ID/ASD; and the complement of providers serving this population in Maine.

Pupillometry: A Non-Invasive Technique For Pain Assessment In Paediatric Patients., Mark A. Connelly, Jacob T. Brown, Gregory L. Kearns, Rawni A. Anderson, Shawn D. St Peter, Kathleen A. Neville

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: Pupillometry has been used to assess pain intensity and response to analgesic medications in adults. The aim of this observational study was to explore proof of concept for the use of this technique in paediatric patients. Changes in pupil parameters before and after opioid exposure also were evaluated.

DESIGN AND SETTING: This was a single-centre, prospective study conducted at an academic paediatric medical centre.

PATIENTS: Children 9-17 years of age undergoing elective surgical correction of pectus excavatum were enrolled into a protocol approved by the human ethical committee (institutional review board).

INTERVENTIONS: Pupil size and reactivity were measured using …

Is Postpartum Depression A Disease Of Modern Civilization?, Jennifer Hahn-Holbrook, Martie Haselton

Psychology Faculty Articles and Research

Access to calorie-dense foods, medicine, and other comforts has made modern humans healthier than our prehistoric ancestors in many respects. However, the epidemics of obesity, diabetes, and cardiovascular disease suggest that there are also drawbacks to modern living. Here, we address the question of whether the dramatic cultural changes that have occurred over the past century have inflated rates of postpartum depression, adding postpartum depression to the list of diseases of modern civilization. We review evidence from cross-cultural, epidemiological, and experimental studies documenting associations between postpartum depression and modern patterns of early weaning, diets deficient in essential fatty acids, low …

Variability Of Magnification On Digital Pelvic Radiographs From Patients With Fractures Of The Femoral Neck - A Retrospective Audit, Akbar Jaleel Zubairi, Tashfeen Ahmad

Department of Surgery

Abstract

OBJECTIVE:

To determine the variability in magnification of radiographs in an emergency setting.

METHODS:

The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised records of patients who underwent Austin Moore hemiarthroplasty over a two-year periodfrom 1st January 2006 to 31st December 2007. Magnification factor was determined using measurements obtained from preoperative and postoperative radiographs and comparing them with the actual size of implant used. Intra-observer and inter-observer reliability of measurements were calculated. SPSS 19 was used for data analysis.

RESULTS:

Of the 63 patients studied, 25(39.7%) were males and 38(60.3%) were females with an overall …

Use Of Fresh Parental Fibular Allograft For Reconstruction Of Skeletal Defects After Limb Salvage Surgery, Muhammad Masood Kadir, Raza Askari, Sher Baz

Department of Surgery

Abstract

OBJECTIVE:

To share early experience with paediatric patients having undergone skeletal reconstruction after limb salvage surgery.

METHODS:

A reterorespective audit study was conducted at Aga Khan University Hospital, Karachi, from 1994 to 2011 An audit of the institutional tumour registry was done and relevant cases of paediatric patients having undergone skeletal reconstruction after limbsalvage surgery were tracked. Outcomes were objectively assessed through Musculoskeletal Tumour Society score. International Society of Limb Salvage grading was used to measure union of the graft to the host bone.

RESULTS:

Of the total 9 patients, 5(55.6%) were males and 4(44.4%) were females with an …

Transfusion Practice In Orthopedic Patients: Do We Really Need It?, Kashif Abbas, Raza Askari, Masood Umer, Kamran Hafeez

Department of Surgery

Abstract

OBJECTIVE:

To determine the proportion of inappropriate transfusions in patients undergoing orthopaedic surgery at a tertiary care university hospital, and factors associated with inappropriate transfusions.

METHODS:

The prospective study was conducted at Aga Khan University Hospital, Karachi, from December 2008 to September 2009, and comprised patients admitted to the Orthopaedic Department and received transfusion of at least one packed cell. Patients were divided into four groups: A, those with haemoglobin < 7, B, haemoglobin 7.1-10 without ischemic heart disease, C, haemoglobin 7.1-10 with ischemic heart disease, and D, haemoglobin >10. Variables recorded were, pre-transfusion haemoglobin level, co-morbids, symptoms of hypovolemia, pre-transfusion volume replacement with fluids, transfusion reactions, and haemoglobin after 48 hours. Indications of transfusion were assessed in …

Operative Management Of Patients With Non-Spinal Metastatic Bone Disease. Does It Actually Improve Quality Of Life?, Masood Umer, Yasir Mohib, Hafiz Muhammad Umer

Department of Surgery

Abstract

OBJECTIVE:

To determine the survival rate and functional outcome of skeletal stabilisation in patients with metastatic bone disease.

METHODS:

The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised data of patients with non-spinalmetastatic bone disease managed surgically from January 2002 to December 2010. All patients had been managed by experienced orthopaedic, oncology and multidisciplinary teams. Patients managed by non-oncologic orthopaedic surgeons were excluded. The prognostic influence of clinical, pathological and treatment variables on Musculoskeletal Tumour Society score, range of motion, local complications and death rate were measured. SPSS 19 was used for statistical analysis.

RESULTS: …

Interventions To Promote Adherence To Antiretroviral Therapy In Africa: A Network Meta-Analysis, Edward J. Mills, Richard Lester, Kristian Thorlund, Maria Lorenzi, Katherine Muldoon, Steve Kanters, Sebastian Linnemayr, Robert Gross, Yvette Calderon, K Rivet Amico, Harsha Thirumurthy, Cynthia Pearson, Robert H. Remien, Lawrence Mbuagbaw, Lehana Thabane, Michael Chung, Ira B. Wilson, Albert Liu, Olalekan A. Uthman, Jane Simoni, David Bangsberg, Sanni Yaya, Till Bärnighausen, Nathan Ford, Jean B. Nachega

Internal Medicine, East Africa

Background: Adherence to antiretroviral therapy (ART) is necessary for the improvement of the health of patients and for public health. We sought to determine the comparative effectiveness of different interventions for improving ART adherence in HIV-infected people living in Africa.

Methods: We searched for randomised trials of interventions to promote antiretroviral adherence within adults in Africa. We searched AMED, CINAHL, Embase, Medline (via PubMed), and ClinicalTrials.gov from inception to Oct 31, 2014, with the terms “HIV”, “ART”, “adherence”, and “Africa”. We created a network of the interventions by pooling the published and individual patients' data for comparable treatments and comparing …

Competing Interests Of Undergraduate Medical Education And Industry: Integration Into Longitudinal Curricular Themes., Shahryar Noordin, Sheilla Pinjani

Department of Surgery

Abstract

Recent changes in curricula around the globe with emphasis on teaching/learning and assessing professionalism in medical schools has been the priority. With the changing public expectations and professional demands, it has become imperative to develop clear guidelines and policies for students and faculty to better understand and meet the expectations of them as part of professionalism. In order to analyse this problem and highlight potential solutions, a literature search was conducted using Eric, Medline, Google Scholar and CINAHL Plus databases from 1985 to February 2013. We reviewed publications regarding the relationship between the pharmaceutical and device industry and medical …

Dynamic Hip Screw Fixation For Inter-Trochanteric Fractures: Determinants Of Outcomes, Adil Aijaz Shah, Santosh Kumar, Abdull Rehman

Department of Surgery

bstract

OBJECTIVE:

To evaluate factors associated with revision of dynamic hip screw implant in patients undergoing the procedure for the fixation of intertrochanteric fractures.

METHODS:

The retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised records of patients who had undergone dynamic hip screw fixation surgery between 2008 and 2012. Medical records and data for all patients were obtained from the medical records office. For all patients, the record files were systematically reviewed using a structured, pre-defined data extraction sheet. SPSS 20 was used statistical analysis.

RESULTS:

Out of 317 patients who had undergone the procedure, …

Functional And Radiological Outcome Of Intramedullary Nailing Vs. Plate Fixation For Humeral Shaft Fractures. Does Treatment Method Bring Any Difference?, Pervaiz Hashmi, Yasir Mohib

Department of Surgery

Abstract

BACKGROUD:

Operative Management of Humeral shaft fractures may be accomplished with the help of Plate fixation or IM Nails. Controversy exists as to which modality is superior to the other in terms of fewer complications and better functional and radiologicaloutcome.

OBJECTIVE:

To compare the differences in radiological and functional outcome of humeral shaft fractures managed by platefixation and antegrade intramedullary nails.

METHODS:

The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised records of Patients managed surgically for uncomplicated humeral shaft fractures between 2007 and 2012. The patients were followed up for one year at clinic, …

Our Experience With Van Nes Rotationplasty For Locally Advanced Lower Extremity Tumours, Raza Askari, Masood Umer, Mohsin-E-Azam, Haroon Rashid

Department of Surgery

Abstract

OBJECTIVE:

To present an early experience with the time-tested technique of Van Ness Rotationplasty to save distal lmbs.

METHODS:

Van Nes Rotationplasty for locally advanced lower extremity tumours. A reterorespective audit was conducted at Aga Khan University Hospital, Karachi, and comprised cases of bone and soft tissue sarcoma who underwent Van Ness Rotationplasty over seven years from January 2005 to December 2011. Demographic data, family history, past history, co-morbids, date since diagnosis, duration of symptoms, type of tumour, metastasis, pre-op and post-op functional status, recurrence and survival were collected.

RESULTS:

Of the 351 cases of bone and soft tissue …