Medicine and Health Sciences Commons^™

Radiation Therapy For Older Women With Early Breast Cancer: An Unnecessary Hardship, Lauren E. Shawver

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report appraising:

Kunkler IH, Williams LJ, Jack WJ, Cameron DA, Dixon JM; PRIME II investigators. Breast-conserving surgery with or without irradiation in women aged 65 years or older with early breast cancer (PRIME II): a randomised controlled trial [published correction appears in Lancet Oncol. 2015 Mar;16(3):e105]. Lancet Oncol. 2015;16(3):266-273. https://doi.org/10.1016/S1470-2045(14)71221-5

for an older patient seeking treatment for Stage 1 Ductal Breast Carcinoma

Enhanced Recovery After Surgery (Eras) Protocols Decrease Length Of Hospital Stay And Maintain Functional Independence In Elderly Patients Undergoing Colorectal Surgery, Kristen Hawes

Clinical Research in Practice: The Journal of Team Hippocrates

A clinical decision report using

Ostermann S, Morel P, Chalé JJ, et al. Randomized controlled trial of enhanced recovery program dedicated to elderly patients after colorectal surgery. Dis Colon Rectum. 2019;62(9):1105-1116. https://doi.org/10.1097/DCR.0000000000001442

for an elderly patient undergoing colorectal surgery.

Trapped Heart With Overlying Chest Wall Deformity And Sternal Defect, Muniraju Maralakunte, Arun Sharma, Neelam Dahiya, Manphool Singhal

Journal of the Saudi Heart Association

No abstract provided.

A Retrospective Analysis Of Endocrine Disease In Sphingosine-1-Phosphate Lyase Insufficiency: Case Series And Literature Review, Avinaash Maharaj, Ruth Kwong, Jack Williams, Christopher Smith, Helen Storr, Ruth Krone, Debora Braslavsky, Maria Clemente, Nanik Ram, Indraneel Banerjee

Section of Diabetes, Endocrinology and Metabolism

Sphingosine-1-phosphate lyase (SGPL1) insufficiency syndrome (SPLIS) is an autosomal recessive multi-system disorder, which mainly incorporates steroid-resistant nephrotic syndrome and primary adrenal insufficiency. Other variable endocrine manifestations are described. In this study, we aimed to comprehensively annotate the endocrinopathies associated with pathogenic SGPL1 variants and assess for genotype-phenotype correlations by retrospectively reviewing the reports of endocrine disease within our patient cohort and all published cases in the wider literature up to February 2022. Glucocorticoid insufficiency in early childhood is the most common endocrine manifestation affecting 64% of the 50 patients reported with SPLIS, and a third of these individuals have additional …

Metastatic Primary Brain Rhabdomyosarcoma In A Pediatric Patient: Illustrative Case, Michel Gustavo Mondragón-Soto, Luis Del Valle, José Alfredo González-Soto, Roberto Alfonso De Leo-Vargas

School of Medicine Faculty Publications

BACKGROUND: Primary intracranial rhabdomyosarcoma is an extraordinarily rare malignant tumor, with even fewer presenting with distant metastasis. To date, only five cases, including the one presented here, have been reported to present metastatic activity. OBSERVATIONS: A 12-year-old boy presented with a few days of headache, nausea, vomiting, but no neurological deficit. Brain computed tomography and magnetic resonance imaging demonstrated hydrocephalus and a cystic lesion with left parieto-occipital extension. After resection, pathology reported primary rhabdomyosarcoma, with positive desmin and myogenin on immunohistochemistry. The patient presented with pulmonary metastasis. The patient had an overall survival of 21 months after diagnosis with optimal …

Examining Demographic And Environmental Factors In Predicting The Perceived Impact Of Cancer On Childhood And Adolescent Cancer Survivors, Nazan Cetin

Dissertations and Theses

Cancer survivors' perceptions on how cancer has impacted their lives has been identified as a "critical predictor" of psychosocial well-being and quality of life outcomes. Given the dramatic increase in survival rates and the long-term health and psychosocial challenges, as well as survivorship care barriers, this study focuses special attention on childhood and adolescent cancer survivors and is guided by Tedeschi and Calhoun's theory of posttraumatic growth and Hammond's theory of distinctiveness. This study aims to examine the influence of demographic (i.e., age at diagnosis, biological sex, race/ethnicity, type of cancer) and environmental factors (i.e., geographical location and insurance type), …

Parenteral Nsaids For Acute Treatment Of Migraine: Adherence To The Ihs Guidelines For Controlled Trials, John G. Curran, John Waters, Hsiangkuo Yuan

Department of Neurology Faculty Papers

Background: Parenteral non-steroidal anti-inflammatory drugs (NSAIDs) are important alternatives to oral NSAIDs, especially in patients with severe migraine who have emesis or gastroparesis. With increasing research on using parenteral NSAIDs for acute migraine, it is critical to examine the quality of these studies. Our goal was to assess the adherence of these trials to the International Headache Society (IHS) controlled trial guidelines for acute treatment of migraine. Methods: We queried PubMed for clinical trials investigating parenteral NSAIDs for acute treatment of migraine in adult patients. We developed a 14-point scoring system based on the essential components of the IHS guidelines. …

Implementation Evaluation Of A Leadership Development Intervention For Improved Family Experience In A Private Paediatric Care Hospital, Pakistan, Muneera A. Rasheed, Ayesha Hussain, Amin Hashwani, Johannes T. Kedzierski, Babar S. Hasan

Department of Paediatrics and Child Health

Background: A study from a tertiary care center in Pakistan demonstrated that a leadership development intervention led to improved family experience of care outcomes. The objective of the current paper is to assess the implementation of this intervention and identify barriers and facilitators to inform sustainability and scalability.
Methods: A working group designed the intervention using a theory-of-change model to strengthen leadership development to achieve greater employee engagement. The interventions included: i) purpose and vision through purpose-driven leadership skills trainings; ii) engaging managers via on-the-job mentorship programme for managers, iii) employee voice i.e., facilitation of upward communication to hear the …

Measuring Contraceptive Method Mix, Prevalence, And Demand Satisfied By Age And Marital Status In 204 Countries And Territories, 1970-2019: A Systematic Analysis For The Global Burden Of Disease Study 2019, Annie Haakenstad, Olivia Angelino, Caleb M S Irvine, Zulfiqar Ahmed Bhutta, Kelly Bienhoff, Corinne Bintz, Kate Causey, M Ashworth Dirac, Nancy Fullman, Emmanuela Gakidou

Department of Paediatrics and Child Health

Background: Meeting the contraceptive needs of women of reproductive age is beneficial for the health of women and children, and the economic and social empowerment of women. Higher rates of contraceptive coverage have been linked to the availability of a more diverse range of contraceptive methods. We present estimates of the contraceptive prevalence rate (CPR), modern contraceptive prevalence rate (mCPR), demand satisfied, and the method of contraception used for both partnered and unpartnered women for 5-year age groups in 204 countries and territories between 1970 and 2019.
Methods: We used 1162 population-based surveys capturing contraceptive use among women between 1970 …

Ccl4 Functions As A Biomarker Of Type 2 Airway Inflammation, Yoshiki Kobayashi, Hanh Hong Chu, Akira Kanda, Yasutaka Yun, Masami Shimono, Linh Manh Nguyen, Akitoshi Mitani, Kensuke Suzuki, Mikiya Asako, Hiroshi Iwai

Journal Articles

Eosinophilic airway inflammatory disease is associated with bronchial asthma, with eosinophilic chronic rhinosinusitis (ECRS) typical of refractory type 2 airway inflammation. CCL4 produced at local inflammatory sites is involved in them via the accumulation and activation of type 2 inflammatory cells, including eosinophils. The detailed mechanism of CCL4 production remains unclear, and also the possibility it could function as a biomarker of type 2 airway inflammation remains unresolved. In this study, we evaluated CCL4 mRNA expression and production via the TSLP receptor (TSLPR) and toll-like receptors (TLRs) or proteinase-activated receptor-2 (PAR2) in BEAS-2B bronchial epithelial cells co-incubated with purified eosinophils …

Use Of Autoreactive Antibodies In Blood Of Patients With Pancreatic Intraductal Papillary Mucinous Neoplasms (Ipmn) For Grade Distinction And Detection Of Malignancy, Niall Brindl, Henning Boekhoff, Andrea S Bauer, Matthias M Gaida, Hien Dang, Jörg Kaiser, Jörg D Hoheisel, Klaus Felix

Department of Surgery Faculty Papers

(1) Background: A reliable non-invasive distinction between low- and high-risk pancreatic intraductal papillary mucinous neoplasms (IPMN) is needed to effectively detect IPMN with malignant potential. This would improve preventative care and reduce the risk of developing pancreatic cancer and overtreatment. The present study aimed at exploring the presence of autoreactive antibodies in the blood of patients with IPMN of various grades of dysplasia. (2) Methods: A single-center cohort was studied composed of 378 serum samples from patients with low-grade IPMN (n = 91), high-grade IPMN (n = 66), IPMN with associated invasive cancer (n = 30), pancreatic …

Association Of U.S. Birth, Duration Of Residence In The U.S., And Atherosclerotic Cardiovascular Disease Risk Factors Among Asian Adults, Mahmoud Al Rifai, Sina Kianoush, Vardhmaan Jain, Parag H. Joshi, Miguel Cainzos-Achirica, Khurram Nasir, Anwar T. Merchant, Sunita Dodani, Sally S. Wong, Zainab Samad

Section of Cardiology

Introduction: Prior studies have shown a direct association between U.S. birth and duration of residence with atherosclerotic cardiovascular disease (ASCVD) though, few have specifically focused on Asian Americans.
Methods: We utilized cross-sectional data from the 2006 to 2015 National Health Interview Survey. We compared prevalent cardiovascular risk factors and ASCVD among Asian American individuals by U.S. birth and duration of time spent in the U.S.
Results: The study sample consisted of 18,150 Asian individuals of whom 20.5 % were Asian Indian, 20.5 % were Chinese, 23.4 % were Filipino, and 35.6 % were of other Asian ethnic groups. The mean …

The Virtual Peripheral Nerve Academy: Education For The Identification And Treatment Of Peripheral Nerve Disorders, Erica B. Lee, Allison Podsednik, Kimberly Khoo, Amal Cheema, Raysa Cabrejo, Chen Shen, Joseph Rosen, A Lee Dellon

School of Medicine Publications and Presentations

Millions of people around the globe suffer peripheral nerve injuries caused by trauma and medical disorders. However, medical school curricula are profoundly deficient in peripheral nerve education. This lack of knowledge within the healthcare profession may cause inadequate patient care. We developed the Virtual Peripheral Nerve Academy (VPNA) as a reusable virtual learning environment to provide medical students with detailed education on the peripheral nervous system (PNS). Students are introduced to the PNS through virtual 3D rendering of the human body, wherein they visualize individual nerves through dissection and observe normal motor and sensory function associated with each nerve. PNS …

Endoscopic Outcomes In Patients With Aerd Treated With Topical Antibiotics And Intranasal Corticosteroids, Jhon F. Martinez Paredes, Garret Choby, Michael Marino, Devyani Lal, Osarenoma Olomu, Razan Alfakir, Janalee K. Stokken, Erin O’Brien, Angela M. Donaldson

School of Medicine Publications and Presentations

Background: Identifying effective therapy for recalcitrant chronic rhinosinusitis with nasal polyposis (CRSwNP) is a major challenge; and subtypes such as aspirin-exacerbated respiratory disease (AERD) are even more difficult to treat. Evidence on topical antibiotics use in (CRSwNP) is lacking. Current consensus guidelines recommend against its routine use, but recent reviews show some benefit when managing recalcitrant disease after endoscopic sinus surgery (ESS).

Objective: Evaluate the effect of culture-directed topical antibiotics on sinonasal outcomes in AERD patients with a positive perioperative sinonasal bacterial culture who have undergone ESS.

Methods: A retrospective cohort study of AERD patients with positive sinonasal culture, who …

Multiplex Pcr Assay To Detect High Risk Lineages Of Salmonella Typhi And Paratyphi A, Fahad Khokhar, Derek Pickard, Zoe Dyson, Junaid Iqbal, Agila Pragasam, Jobin Jacob John, Balaji Veeraraghavan, Farah Qamar, Gordon Dougan, Hilary Macqueen

Department of Paediatrics and Child Health

Enteric fever infections remain a significant public health issue, with up to 20 million infections per year. Increasing rates of antibiotic resistant strains have rendered many first-line antibiotics potentially ineffective. Genotype 4.3.1 (H58) is the main circulating lineage of S. Typhi in many South Asian countries and is associated with high levels of antibiotic resistance. The emergence and spread of extensively drug resistant (XDR) typhoid strains has increased the need for a rapid molecular test to identify and track these high-risk lineages for surveillance and vaccine prioritisation. Current methods require samples to be cultured for several days, followed by DNA …

The Impact Of Hpv Vaccine Narratives On Social Media: Testing Narrative Engagement Theory With A Diverse Sample Of Young Adults., Amy Leader, Michelle Miller-Day, Rikishi T Rey, Preethi Selvan, Anne E Pezalla, Michael L Hecht

Department of Medical Oncology Faculty Papers

Rates of human papillomavirus (HPV) infection are highest in young adults, who can be vaccinated against HPV if they were not vaccinated as adolescents. Since young adults increasingly access health information on social media, we tested the impact of a social media campaign with narrative-based health information on intentions related to HPV vaccination. We also aimed to understand which ads resonated most with young adults and led to higher survey completion rates. We created social media posts featuring videos promoting HPV vaccination. We launched a sponsored ad campaign on Facebook to reach young women, ages 18-26, across the country. Participants …

Sirpα Mediates Igf1 Receptor In Cardiomyopathy Induced By Chronic Kidney Disease, Sandhya S Thomas, Jiao Wu, Giovanni Davogustto, Michael W Holliday, Kristin Eckel-Mahan, Daniela Verzola, Giacomo Garibotto, Zhaoyong Hu, William E Mitch, Heinrich Taegtmeyer

Journal Articles

BACKGROUND: Chronic kidney disease (CKD) is characterized by increased myocardial mass despite near-normal blood pressure, suggesting the presence of a separate trigger. A potential driver is SIRPα (signal regulatory protein alpha)-a mediator impairing insulin signaling. The objective of this study is to assess the role of circulating SIRPα in CKD-induced adverse cardiac remodeling.

METHODS: SIRPα expression was evaluated in mouse models and patients with CKD. Specifically, mutant, muscle-specific, or cardiac muscle-specific SIRPα KO (knockout) mice were examined after subtotal nephrectomy. Cardiac function was assessed by echocardiography. Metabolic responses were confirmed in cultured muscle cells or cardiomyocytes.

RESULTS: We demonstrate that …

Anticancer Effects And Mechanisms Of Cfi-400945 And Radiation In Breast Cancer, Sierra M. Pellizzari

Electronic Thesis and Dissertation Repository

Breast cancer is a leading cause of death in women and development of new treatments is essential. Polo-like Kinase 4 (PLK4) controls centriole duplication and its inhibition by CFI-400945 induces genomic instability and aneuploidy. Radiation therapy (RT) also induces aneuploidy leading to cell death, although development of radioresistance is common. We hypothesized that CFI-400945 and RT act synergistically in breast cancer. Colony formation assays identified synergistic anticancer effects of CFI-400945 and RT, with combinatorial effects also observed for RT with either siRNA inhibition of PLK4 or with the PLK4 inhibitor Centrinone B. This suggests that the antiproliferative effect of these …

Understanding The Role Of Sex On Outcomes For The Cancer Patient Undergoing Treatment With Immune Checkpoint Inhibitors: A Scoping Review Protocol, Amy L Shaver, Nikita Nikita, Swapnil Sharma, Daniel S Lefler, Atrayee Basu-Mallick, Jennifer M Johnson, Meghan L Butryn, Grace Lu-Yao

Department of Medical Oncology Faculty Papers

INTRODUCTION: Immune checkpoint inhibitors (ICIs) have changed the treatment landscape for multiple cancer types. Sex plays an important role in both the development of cancer as well as the functioning of the immune system. Though a difference in response to immune therapy is emerging between men and women it is unclear how this difference affects cancer outcomes and what the potential underlying mechanisms are for those effects. The objective of this study is to describe the influence that sex has on the outcomes experienced by cancer patients on ICI therapy and to identify and analyse any knowledge gaps in the …

Advanced-Stage Melanoma At Presentation Following The Peak Of The Pandemic: A Covid-19 Cancer Canary In A Coal Mine, Ryan Lamm, Md, Walker Lyons, Md, Winnie So, Rn, Alliric I. Willis, Md, Facs, Msph

Department of Surgery Faculty Papers

Background: For melanoma patients, timely identification and tumor thickness are directly correlated with outcomes. COVID-19 impacted both patients' ability and desire to see physicians. We sought to identify whether the pandemic correlated with changes in melanoma thickness at presentation and subsequent treatment timeline.

Methods: Retrospective chart review was performed on patients who underwent surgery for melanoma in an academic center surgical oncology practice from May 2019 to September 2021. Patients were split into two cohorts: "pre-pandemic" from May 2019 to May 2020 and "pandemic," after May 2020, representing when these patients received their initial diagnostic biopsy. Demographic and melanoma-specific variables …

Estimating The Pre- And Post-Diagnosis Costs Of Tuberculosis For Adults In Pakistan: Household Economic Impact And Costs Mitigating Strategies, Shama Razzaq, Aysha Zahidie, Zafar Fatmi

Community Health Sciences

Background: Despite free tuberculosis (TB) care in Pakistan, patients still have to bear high costs, which push them into poverty. This study estimated the pre- and post-diagnosis costs households bear for TB care, and investigated coping mechanisms among adults ≥ 18 years in Karachi, Pakistan.
Methods: We conducted a cross-sectional study comprising of 516 TB patients identified with completion of at least one month intensive treatment from four public sector health facilities from two institutes in Karachi, Pakistan. A standardized questionnaire to estimate patient's costs was administered. The study outcomes were direct medical and non-medical costs, and indirect costs. The …

Tuberculous Pericarditis, Chun Kit Wong, Yeuk Chi Choi

Journal of the Hong Kong College of Cardiology

Tuberculous (TB) pericarditis, a severe extrapulmonary manifestation of Mycobacterium tuberculosis, is notorious for its challenging presentation. We report a case of effusive-constrictive pericarditis due to tuberculosis infection.

Right Atrial Mass With Inflow Obstruction In A Patient With Igg4-Related Disease, Shek Joyce, Wu Lok Yi, Wong Chun Kit, Lu Jianlin, Lam Wai Lung William, Mak Wai Man Vivien, Chan Ngai Yin

Journal of the Hong Kong College of Cardiology

Cardiac tumour is a rare cause of heart failure. We report a case of right atrial mass found in a patient with known immunoglobulinG4-related disease (IgG4-RD), who presented with right heart failure, renal impairment and thrombocytopenia. Multimodal investigations were performed to reach the diagnosis of diffuse large B-cell lymphoma with cardiac involvement. Chemotherapy was initiated in an attempt for disease control. We highlight the potential link between IgG4-related disease and lymphoma.

Cardiac Involvement Related To Covid-19 Infection And Vaccination In Children And Adolescents – Hong Kong’S Perspective, Sabrina Tsao, Gilbert T. Chua, Mike Yw Kwan, Ian Chi Kei Wong, Kelvin Kai Wang To, Janette Kwok, Bill H Chan, Joshua Sung Chih Wong, Patrick Ip, Yu Lung Lau

Journal of the Hong Kong College of Cardiology

Myocarditis and Pericarditis have many virological and immunological causes. This article described the SARS-CoV involvement to the heart in children and adolescents, also the entity Multisystem Inflammatory Syndrome in Children (MIS-C), a rare but severe consequence of SARS-CoV2 infection. Hong Kong case definition of MIS-C was listed. The consensus from overseas experts was that MIS-C should be managed by multidisciplinary team with a structured long-term follow-up to monitor the functioning of various organs and ascertain the prognosis. The side effect mRNA vaccination causing myocarditis and pericarditis is also concern of paediatricians worldwide. Hong Kong published local epidemiology of acute myocarditis …

The Utility Of Has-Bled Score In Predicting The Bleeding Risk Of Atrial Fibrillation Patients Undergoing Percutaneous Coronary Intervention Receiving Anticoagulation And Dual Anti-Platelet Therapy: A Single Center Retrospective Cohort Study, Luk Yin Cheung Adrian, Chan Chi Lin Jaclyn

Journal of the Hong Kong College of Cardiology

Background The Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly and Drugs/alcohol (HAS-BLED) score is a validated bleeding risk prediction tool in patients with atrial fibrillation taking oral anticoagulation. Its predictive value in patients with atrial fibrillation undergoing percutaneous coronary intervention receiving combination of anticoagulation and antiplatelet therapy is unknown. This retrospective cohort study sought to validate the accuracy of HAS-BLED score in predicting the bleeding risk in patients with atrial fibrillation who underwent percutaneous coronary intervention receiving both anticoagulation and dual antiplatelet therapy. Method We calculated HAS-BLED score in 186 patients with AF …

Prognostic Nutritional Index As A Predictor Of Prognosis In Patients With Chronic Limb Threatening Ischemia Who Underwent Endovascular Revascularization Therapy, Wai Kin Chi, Gm Tan, Bryan Py Yan

Journal of the Hong Kong College of Cardiology

BACKGROUND/INTRODUCTION: Patients with chronic limb-threatening ischemia (CLTI) have poor prognosis. Prognostic nutritional index (PNI) is an established independent predictor of adverse outcome in various chronic illnesses. The use of PNI in patients with CLTI has not been studied.

PURPOSE: To evaluate the impact of PNI on 12-month adverse cardiovascular and limb outcomes in CLTI patients after endovascular revascularization therapy (ERT).

METHODS: 270 consecutive patients with CLTI (mean age 73.7±11.9 years; 53% male) who underwent ERT at a single tertiary referral hospital between January 2009 and October 2016 were prospectively enrolled and analyzed. Patients were grouped by tertiles of PNI (lowest …

Usefulness Of Computed Tomography Parameters In Predicting The Clinical Outcomes Of Acute Aortic Dissection, Eleanor Wei Sze Lee, Kwok Hin Yiu, Willis Chun Wai Lam, Cyrus Yiu Kwan Ko, Sung Yee Wong, Kin Wing Chan

Journal of the Hong Kong College of Cardiology

Background

Acute aortic dissection is a potentially life-threatening condition among patients presenting with chest pain to emergency department. Without a prompt diagnosis and treatment, it carries high mortality and morbidity. Computed tomography (CT) of thorax and abdomen is one of the commonly used non-invasive investigation modalities for diagnosis of acute aortic dissection. Apart from making a diagnosis, there are a number of parameters in the CT images that may be helpful in providing prognostic information. In this study, prognostic values of these parameters in predicting both short term and intermediate term clinical outcomes of acute aortic dissection will be evaluated. …

Effect Of Low Body Mass Index In Outcome Of Micra Leadless Pacemaker Implantation, Mark Tsz Kin Tam, Anna Kin Yin Chan, Alex Chi Kin Au, Lily Cheung, Gary Chin Pang Chan, Joseph Yat Sun Chan

Journal of the Hong Kong College of Cardiology

Background

Implantation of Micra transcatheter pacing system (TPS) requires introduction of a large caliber delivery catheter into patient’s venous system and right heart. While the investigational device exemption study population had a mean body mass index (BMI) of 27.6kg/m2, implantation outcome in patients with small body size requires further investigation. This study sort to evaluate the effect of low BMI in outcome of Micra TPS implantation Method

Consecutive patients undergoing Micra TPS implantation between 19 September 2015 and 24 May 2018 in a single tertiary referral center were studied. Procedure efficacy outcome was defined as successful implantation with threshold being …

The Risk Is Small: Implant Complications Of Leadless Pacemakers Are Related To Body Size, Chu-Pak Lau

Journal of the Hong Kong College of Cardiology

No abstract provided.

Functional, Diagnostic And Therapeutic Aspects Of Bile, Monjur Ahmed

Division of Gastroenterology and Hepatology Faculty Papers

Bile is a unique body fluid synthesized in our liver. Enterohepatic circulation preserves bile in our body through its efficient synthesis, transport, absorption, and reuptake. Bile is the main excretory route for bile salts, bilirubin, and potentially harmful exogenous lipophilic substances. The primary way of eliminating cholesterol is bile. Although bile has many organic and inorganic contents, bile acid is the most physiologically active component. Bile acids have a multitude of critical physiologic functions in our body. These include emulsification of dietary fat, absorption of fat and fat-soluble vitamins, maintaining glucose, lipid, and energy homeostasis, sustenance of intestinal epithelial integrity …