Medicine and Health Sciences Commons^™

T-Cell Activation Is Enhanced By Targeting Il-10 Cytokine Production In Toll-Like Receptor-Stimulated Macrophages, Ryan Walk, Steven Elliott, Felix C. Blanco, Jason A. Snyder, Ashley M. Jacobi, Scott Rose, Mark Behlke, Aliasger Salem, Stanislav Vukmanovic, Anthony D. Sandler

Surgery Faculty Publications

Toll-like receptor (TLR) agonists represent potentially useful cancer vaccine adjuvants in their ability to stimulate antigen-presenting cells (APCs) and subsequently amplify the cytotoxic T-cell response. The purpose of this study was to characterize APC responses to TLR activation and to determine the subsequent effect on lymphocyte activation. We exposed murine primary bone marrow-derived macrophages to increasing concentrations of agonists to TLRs 2, 3, 4, and 9. This resulted in a dose-dependent increase in production of not only tumor necrosis factor–alpha (TNF-α), a surrogate marker of the proinflammatory response, but also interleukin 10 (IL-10), a well-described inhibitory cytokine. Importantly, IL-10 secretion …

Is Chest Tube Insertion With Ultrasound Guidance Safe In Patients Using Clopidogrel?, Wissam Abouzgheib, Yousef R. Shweihat, Nikhil Meena, Thaddeus Barrter

Internal Medicine

Background and objective: Drainage of the pleural space is a common procedure.The safety of chest tube insertion in patients using clopidogrel has not been investigated.

Methods: Ultrasound-guided chest tube insertions performed on 24 patients who were being actively treated with clopidogrel were retrospectively reviewed.

Results: No excessive bleeding occurred in any of these patients.

Conclusions: Given the known effects of clopidogrel on platelet function, these results were interpreted as indicating that clopidogrel therapy is a relative but not an absolute contraindication to chest tube insertion, if an experienced operator places a small-bore tube under ultrasound guidance.

Male Gender Promotes An Increased Inflammatory Response To Lipopolysaccharide In Umbilical Vein Blood., Shunaha Kim-Fine, Timothy Regnault, James S Lee, Sarah A Gimbel, Jill A Greenspoon, Jonathan Fairbairn, Kelly Summers, Barbra De Vrijer

Paediatrics Publications

OBJECTIVES: To establish gender-specific differences in maternal and fetal immune response in healthy human fetuses at term.

METHODS: Forty-five women with elective caesarean sections for uncomplicated singleton pregnancies were recruited for two studies. Using a multiplex biomarker immunoassay system, unstimulated maternal and fetal plasma concentrations of interleukin (IL)-1β, IL-1ra, IL-6, IL-8, macrophage inflammatory protein (MIP)-1α, and tumor necrosis factor (TNF)-α were measured from one study population. Lipopolysaccharide (LPS)-stimulated cytokine response was measured in a second study.

RESULTS: There were no significant gender differences in either maternal or fetal unstimulated plasma cytokine concentrations, but concentrations of the proinflammatory cytokines IL-1β and …

Foleys Protection Caps: Inexpensive Alternative In Ilizarov Fixation, K Abbas, H Rashid

Section of General Surgery

No abstract provided.

Comparison Of Need And Supply Of Syringes For Therapeutic Injections In Pakistan, Adnan Ahmad Khan, Momina Saleem, Huma Qureshi, Rashid Jooma, Ayesha Khan

Section of Neurosurgery

Objectives: To determine the extent of shortfall in syringes by measuring the need from nationally validated sources and comparing it with position on the supply side. This was done in order to contribute to the ongoing national discussions that have focused on increasing syringe supply to curtail syringe reuse.
Methods: Using 'Injections received' data from the Pakistan Demographic Health Survey 2006-7 (N: 5429) and the National Hepatitis Survey (N: 47,043), the study estimated the number of injections received in Pakistan. We matched these against the local syringe production figures from the syringe manufacturers' association and import figures from the Federal …

Improved Quality Of Management Of Eclampsia Patients Through Criteria Based Audit At Muhimbili National Hospital, Dar Es Salaam, Tanzania. Bridging The Quality Gap, Hussein Kidanto, Peter Wangwe, Charles D. Kilewo, Lennarth Nystrom, Gunnila Lindmark

Faculty of Health Sciences, East Africa

Background Criteria-based audits (CBA) have been used to improve clinical management in developed countries, but have only recently been introduced in the developing world. This study discusses the use of a CBA to improve quality of care among eclampsia patients admitted at a University teaching hospital in Dar es Salaam Tanzania.

Objective The prevalence of eclampsia in MNH is high (≈6%) with the majority of cases arriving after start of convulsions. In 2004–2005 the case-fatality rate in eclampsia was 5.1% of all pregnant women admitted for delivery (MNH obstetric data base). A criteria-based audit (CBA) was used to evaluate the …

Effects Of Scleroderma Antibodies And Pooled Human Immunoglobulin On Anal Sphincter And Colonic Smooth Muscle Function., Jagmohan Singh, Sidney Cohen, Vaibhav Mehendiratta, Fabian A. Mendoza, Sergio A. Jimenez, Anthony J. Dimarino, Satish Rattan

Division of Gastroenterology and Hepatology Faculty Papers

BACKGROUND & AIMS: Patients with systemic sclerosis (SSc) have impairments in gastrointestinal smooth muscle function. The disorder has been associated with circulating antibodies to cholinergic muscarinic the type-3 receptor (M(3)-R). We investigated whether it is possible to neutralize these antibodies with pooled human IgGs (pooledhIgG).

METHODS: We studied the effects of IgGs purified from patients with SSc (SScIgGs) on cholinergic nerve stimulation in rat colon tissues. We also examined the effects of SScIgGs on M(3)-R activation by bethanechol (BeCh), M(3)-R occupancy, and receptor binding using immunofluorescence, immunoblot, and enzyme-linked immunosorbent analyses of human internal anal sphincter (IAS) smooth muscle cells, …

John Y. Templeton Iii: Pioneer Of Modern Cardiothoracic Surgery., Jing Li, B.S., Herbert E. Cohn, Md, Charles J. Yeo, Md, Scott W. Cowan, Md

Department of Surgery Gibbon Society Historical Profiles

John Young Templeton III was born in 1917 in Portsmouth, Virginia, and graduated from Jefferson Medical College in 1941. He completed his residency training under Dr. John H. Gibbon, Jr., and was the first resident who worked on Gibbon's heart-lung machine. After his training, he remained at Jefferson as an American Cancer Society fellow and Damon Runyon fellow and went on to become the fourth Samuel D. Gross Professor and Chair of the Department of Surgery in 1967. Dr. Templeton was the recipient of numerous grants and published over 80 papers in the field of cardiothoracic surgery. As a teacher …

Initial Experience With Imacor Htee-Guided Management Of Patients Following Transplant And Mechanical Circulatory Support., Christopher Kang, Hitoshi Hirose, Harold Hasting

Department of Cancer Biology Faculty Papers

We reviewed an initial experience using a miniaturized transesophageal echocardiography (TEE) probe (ImaCor, Garden City, NY) with 3 patients in whom Imacor hTEE intervention was used as a point of care device to manage extracorporeal membrane oxygenation cannula placement, cardiac hemodynamics, and post-op cardiac pathophysiology. The management of transplant or mechanical circulatory support (MCS) patients is especially challenging: transplanted hearts pose unique pathophysiological challenges, and MCS significantly alters pressure-volume-flow relationships. Real-time “hemodynamic” TEE (hTEE) can help provide effective management by direct visualization of cardiac filling and function and help guide hemodynamic management. In our initial experience, hTEE can provide point-of-care …

Trop-2 Inhibits Prostate Cancer Cell Adhesion To Fibronectin Through The Β1 Integrin-Rack1 Axis., Marco Trerotola, Jing Li, Saverio Alberti, Lucia R. Languino

Department of Cancer Biology Faculty Papers

Trop-2 is a transmembrane glycoprotein upregulated in several human carcinomas, including prostate cancer (PrCa). Trop-2 has been suggested to regulate cell-cell adhesion, given its high homology with the other member of the Trop family, Trop-1/EpCAM, and its ability to bind the tight junction proteins claudin-1 and claudin-7. However, a role for Trop-2 in cell adhesion to the extracellular matrix has never been postulated. Here, we show for the first time that Trop-2 expression in PrCa cells correlates with their aggressiveness. Using either shRNA-mediated silencing of Trop-2 in cells that endogenously express it, or ectopic expression of Trop-2 in cells that …

Oncolog, Volume 57, Number 11-12, November - December 2012, Kathryn L. Hale, Amelia Scholtz, Luanne Jorewicz

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

• Research Explores Link Between Thrombocytosis and Cancer: High platelet counts can be an early indicator of cancer, In fact, about one-third of women with ovarian cancer have an abnormally high platelet count at the time of diagnosis. This paraneoplastic thrombocytosis is also seen in patients with cancers of the gastrointestinal tract, lung or breast
• Wide Range of Cancer Treatments May Produce Ocular Complications: Although most ocular side effects of cancer treatment may be transient and reversible, regular ophthalmic examinations and effective doctor-patient communication can help cancer patients avoid permanent damage
• New Software May Provide a Standardized Reporting System for Diagnostic …

Association Between Tumour Volume And Recurrence Of Squamous Cell Carcinoma Of The Head And Neck, Faraz Nasim Kazmi, Amina Adil, Shehzad Ghaffar, Farhan Ahmed

Section of Otolaryngology, Head & Neck Surgery

Objective: To evaluate the prognostic significance of computerized tomography derived tumour volume for squamous cell cancers of the head and neck, treated primarily by surgery.Methods: The retrospective review study comprised 72 patients with head and neck malignancies who were treated primarily by surgery at Aga Khan University Hospital, Karachi, with/without adjuvant. It was done from May 2007 to November 2008. Each patient was followed up for a minimum of one year to check for recurrence. For statistical analysis SPSS 17 was used. Frequencies, cross-tabulations with chi square tests to find associations, binary logistic regression analysis, Cox regression analysis and receiver …

Takotsubo Cardiomyopathy And Catatonia: An Acute Stress Connection?, Lex Denysenko, Md, Rachel Shmuts, Do, Adam Trenton, Do, Ethan J. Halpern, Md, Madeleine Becker, Md

Department of Psychiatry and Human Behavior Faculty Papers

BACKGROUND

•Takotsubo cardiomyopathy (TCM):

•transient left ventricular dysfunction

•ECG changes and symptoms mimicking acute MI

•often precipitated by emotional stressor

•Catatonia is a psychomotor syndrome most commonly seen in mood disorders

•This is the first known reported case of TCM co-occurring with catatonia in the setting of acute psychological trauma and bereavement

A Four Factor Model Of Systems-Based Practices In Psychiatry., Jules M. Ranz, Michael Weinberg, Melissa R. Arbuckle, Joanna Fried, Anthony Carino, Hunter L. Mcquistion, Glen Davis, Donovan Wong, Sosunmolu O. Shoyinka, Benjamin Brody, Kamala D. Sethi, Anna Skiandos, Wesley Sowers, David Stern, Anne Sullivan, Michael J. Vergare

Department of Psychiatry and Human Behavior Faculty Papers

No abstract provided.

Decrease In Central Venous Catheter Placement And Complications Due To Utilization Of Ultrasound-Guided Peripheral Intravenous Catheters, Arthur K Au, Masashi Rotte, Robert Grzybowski, Bon Ku, Jason M. Fields

Department of Emergency Medicine Faculty Papers

Poster presented at: American College of Emergency Physicians (ACEP) conference.

Introduction: -Up to 40% of ED visits include diagnostic blood tests and 26% result in administration of IV fluids necessitating successful peripheral intravenous (IV) catheter placement.1 -There is a subset of patients with difficult IV access (DIVA) in which traditional cannulation methods are unsuccessful resulting in central venous cannulation (CVC). -CVCs have a 5-15 percent complication rate2 and attributable costs per CVC related infection have been estimated at $34,508-$56,000.3 -Ultrasound-guided peripheral IV catheters (USGPIVs) provide a method of potentially decreasing the need for CVC placement, however due to poor durability …

Macrolide And Fluoroquinolone Resistance In Helicobacter Pylori Isolates: An Experience At A Tertiary Care Centre In Pakistan, Sana Rajper, Erum Khan, Zubair Ahmad, Syed Muhammad Zaheer Alam, Adil Akbar, Rumina Hasan

Department of Pathology and Laboratory Medicine

Objective:
To assess fluoroquinolone and clarithromycin susceptibility pattern along with the types of genomic mutations involved in the resistance of Helicobacter pylori isolates.
Methods:
The cross-sectional study was conducted at the Department of Pathology and Microbiology, Aga Khan University Hospital, Karachi, from June 2009 to July 2010, and comprised 162 gastric biopsy samples which were tested with GenoTypeHelicoDR (Hain Lifescience GmbH, Germany), a reverse hybridisation multiplex polymerase chain reaction (PCR) line probe assay (LiPA). Also, 23S rRNA (ribosomal ribonucleic acid) gene was analysed with three-point mutations at A2146G, A2146C and A2147G for clarithromycin, and gyrA gene was analyzed at two …

Diagnostic Utility Of Anti-Citrullinated Protein Antibody And Its Comparison With Rheumatoid Factor In Rheumatoid Arthritis, Aysha Habib, Lena Jafri, M. Ahraz Hussain, Saliha Ishaq

Department of Pathology and Laboratory Medicine

Objective: To assess the diagnostic utility of anti-citrullinated protein antibody (anti-CCP) in rheumatoid arthritis (RA) and compare it with rheumatoid factor (RF). Study Design: Analytical study. Place and Duration of Study: Section of Chemical Pathology, Department of Pathology and Microbiology and Medicine, the Aga Khan University, Karachi, from January to May 2010. Methodology: A review of medical records of patients presenting to the clinics with complaints of muscular or joint pains and who were tested for their serum anti-CCP was done. Inclusion criteria were presence of clinical synovitis in at least one joint and an absence of alternative diagnosis. Patients …

Measuring Parvalbumin Levels In Fish Muscle Tissue: Relevance Of Muscle Locations And Storage Conditions, Poi-Wah Lee, Julie A. Nordlee, Stef J. Koppelman, Joseph L. Baumert, Steve L. Taylor

Department of Food Science and Technology: Faculty Publications

Fish is an allergenic food capable of provoking severe anaphylactic reactions. Parvalbumin is the major allergen identified in fish and frog muscles. Antibodies against fish and frog parvalbumin have been used to quantify parvalbumin levels from fish. However, these antibodies react variably with parvalbumin from different fish species. Several factors might be responsible for this variation including instability of parvalbumin in fish muscle as a result of frozen storage and differential parvalbumin expression in muscles from various locations within the whole fish. We aimed to investigate whether these factors contribute to the previously observed variable immunoreactivity of the anti-parvalbumin antibodies. …

Respiratory Symptoms And Illnesses Among Brick Kiln Workers: A Cross Sectional Study From Rural Districts Of Pakistan, Shiraz Shaikh, Asaad Ahmed Nafees, Vikash Khetpal, Abid Ali Jamali, Abdul Manan Arain, Akram Yousuf

Community Health Sciences

Background: Occupational risk factors are one of the major causes of respiratory illnesses and symptoms, and account for 13% of chronic obstructive pulmonary disease and 11% of asthma worldwide. Majority of brick kilns in Pakistan use wood and coal for baking the bricks which makes the brick kiln workers susceptible to high exposure of air pollution. This study was designed to describe frequency of chronic respiratory symptoms and illnesses and study the association between these symptoms and different types of work.
Methods: This was a questionnaire based cross sectional survey conducted among the brick kiln workers in Larkana and Dadu …

Knowledge Of Patients' Visual Experience During Cataract Surgery: A Survey Of Eye Doctors In Karachi, Pakistan, Mohammad Zain Tauqir, Tanveer Anjum Chaudhry, Sehreen Mumtaz, Khabir Ahmad

Department of Surgery Docs

Abstract

BACKGROUND:

Several recent studies have recommended that ophthalmologists must be aware of the visual sensations (and their associated anxiety/fear) experienced by patients undergoing cataract surgery. We assessed the knowledge of a group of eye doctors in Pakistan regarding these phenomena.

METHODS:

This was a cross-sectional survey. Eye doctors (ophthalmologists, residents and medical officers) attending the Ophthalmological Society of Pakistan Annual Conference 2011, in Karachi were invited to participate in the study. A self-administered structured questionnaire was used to examine their knowledge of visual sensations and their associated anxiety/fear experienced by patients during cataract surgery. Simple frequencies and proportions were …

Knowledge Attitude And Practices Among Urban Women Of Karachi, Pakistan, Regarding Breast Cancer, Zain-Ul-Abedeen Sobani, Zeb Saeed, Hafiza Noor-Ul-Ain Baloch, Amina Majeed, Sana Chaudry, Adil Sheikh, Jalal Umar, Hira Waseem, Murtaza Mirza, Irfan Qadir

Department of Surgery Docs

Objective: To determine the knowledge,attitudes and practices of urban women regarding breast cancer and its available screening modalities.Methods: The cross-sectional, questionnaire-based, descriptive study was conducted in the urban population of Karachi in November 2010. Female attendants (n=373) visiting a tertiary care centre and four of its urban outreach centres during the study period were administered a questionnaire. The answers were then scored with regard to their knowledge. Frequencies and percentages were computed through SPSS 17, and analysis of variance was used to confirm significance.Results: Of the 373 participants with a mean age of 32.4+/-10.9 years, 293 (78.6%) were married, and …

Association Of Gestational Weight Gain And Pre-Pregnancy Body Mass Index With Adverse Pregnancy Outcome, Shama Munim, Humaira Maheen

Department of Obstetrics & Gynaecology

Objective: To determine the association between gestation weight gain (GWG) and adverse pregnancy outcome in a Pakistani population.
Study Design: Analytical study.
Place and Duration of Study: The Aga Khan University, Karachi, from February 2003 to 2007.
Methodology: This study used secondary data of 4,735 women from a large cohort study on fetal growth. Pre-pregnancy BMI was categorized according to the recommendations from the institute of medicine (IOM, 2009) and gestation weight gain (GWG) was noted. Chi-square test was used to find the association of GWG and pre-pregnancy BMI with low birth weight (LBW), preterm delivery, large for gestational age …

Anaesthetic Management Of A Young Patient With Homocystinuria, Ali Asghar, Faiza Mazhar Ali

Department of Anaesthesia

Homocystinuria is a rare autosomal recessive genetic disease. It is caused by a deficiency in cystathionine-b-synthase leading to a defect in methionine metabolism. High levels of plasma homocysteine are associated with vascular injury via mechanisms of oxidative damage, vascular smooth muscle proliferation, promotion of platelet activation and aggregation,and disruption of normal procoagulant-anticoagulant balance favouring thrombosis. This is a case of 8 years old boy, a known case of homocystinuria, who was scheduled for bilateral lensectomy and intraocular lens placement. The major anaesthetic considerations include the development of thromboembolism, need to avoid nitrous oxide in balanced anaesthesia regimen and hypoglycaemia.

Multifocal Venous Thrombosis In Behcet’S Disease, Lena Jafri, Nosheen Nasir, Aysha Almas

Department of Pathology and Laboratory Medicine

Behcet's disease is a multisystem inflammatory vascular disorder with a chronic course characterized by recurrent oral and genital ulcers, eye lesion, arthritis and skin lesions. It has a typically waxing and waning course. The cause and pathogenesis of the disease are unclear and specific treatment is not available. A 39 years old man presented with rash, ocular manifestation and left leg swelling. He was found to have deep venous thrombosis of left leg along with recurrent cerebral venous thrombosis. He was a known case of Behcet's disease since 3 years and had been on anticoagulants since then.

Prevalence Of Body-Focused Repetitive Behaviors In Three Large Medical Colleges Of Karachi: A Cross-Sectional Study., Efaza Umar Siddiqui, Syed Saad Naeem, Haider Naqv, Bilal Ahmed

Department of Medicine

Background: Body-focused repetitive behaviors (BFRBs) that include skin picking (dermatillomania), hair pulling (trichotillomania) and nail biting (onychophagia), lead to harmful physical and psychological sequelae. The objective was to determine the prevalence of BFRBs among students attending three large medical colleges of Karachi. It is imperative to come up with frequency to design strategies to decrease the burden and adverse effects associated with BFRBs among medical students.

Methods: A cross-sectional study was conducted among 210 students attending Aga Khan University, Dow Medical College and Sind Medical College, Karachi, in equal proportion. Data were collected using a pre tested tool, “Habit Questionnaire”. …

Sickle Cell Pain: A Critical Reappraisal., Samir K. Ballas, Kalpna Gupta, Patricia Adams-Graves

Department of Medicine Faculty Papers

Sickle cell pain includes 3 types: acute recurrent painful crises, chronic pain syndromes, and neuropathic pain. The acute painful crisis is the hallmark of the disease and the most common cause of hospitalization and treatment in the emergency department. It evolves through 4 phases: prodromal, initial, established, and resolving. Each acute painful episode is associated with inflammation that worsens with recurrent episodes, often culminating in serious complications and organ damage, such as acute chest syndrome, multiorgan failure, and sudden death. Three pathophysiologic events operate in unison during the prodromal phase of the crisis: vaso-occlusion, inflammation, and nociception. Aborting the acute …

A Kidney For Christmas, Stephen Scholand

The Medicine Forum

When Asmar Lawrence first walked into the small examining room in the Jefferson Hospital Ambulatory Practice (JHAP) Clinic, we both had no idea what the future would hold. It was July, 1998 and I was fresh from medical school. Each week, I looked forward to the JHAP experience to develop my clinical skills and follow patients longitudinally. No longer was my learning prescribed from a textbook, this was the 'real world' of medicine where anything could happen and I was supposed to be in control of it. The long white coat probably helped perpetuate some of that illusion. Fortunately our …

A Pilot Study Of Diabetes Management In The Managed Care Setting, Rachel Wagman

The Medicine Forum

Diabetes mellitus represents a disease entity that primary care providers commonly encounter in the outpatient setting. Patient visits encompass a broad range of concerns, from optimizing management of hyperglycemia to the sequelae of chronic disease. The third National Health and Nutrition Exam Survey, (NHANES III) 1988-1994 has reported the prevalence of diabetes mellitus type 2 in the U.S. adult population at 12.3%. The cost of diabetes in 1998, estimated at $77 billion, is a formidable challenge to the health care community and third-party payers. Historically, Health Maintenance Organizations (HMOs) have encouraged more preventative tests, procedures, and exams to curtail the …

Brachytherapy: A New Weapon Against Coronary Restenosis, Rob Silver

The Medicine Forum

Since its introduction in the late 1970's, coronary angioplasty has become a common procedure for treating coronary atherosclerotic disease. It offers significant improvement in symptoms of coronary artery disease through a less invasive procedure than coronary artery bypass grafting (CABG). Each year, over 500,000 percutaneous transluminal coronary angioplasty (PTCA) procedures are performed in North America alone. In larger epicardial vessels that are 3 millimeters or greater in diameter, a metal stent can be placed during angioplasty to reduce the incidence of restenosis. In fact, stents are now deployed in approximately 80 percent of PTCA procedures. The success rate of PTCA …

Melena With Fever, Monica Patel, Jennifer Wilhelm

The Medicine Forum

The patient is a 62 year old Indian male with a past medical history significant for myasthenia gravis, hypertension, and diabetes mellitus, who presented to an outside hospital with fever, fecal incontinence, and melena. Work up at that hospital was remarkable for elevated liver function tests, heme-positive brown stool and a CT of the abdomen showing a thick ascending colon suggesting possible mass. The patient had an episode of desaturation and fever to 105 degrees Fahrenheit prior to transfer to Thomas Jefferson University Hospital for further evaluation. Upon arrival, the patient was in respiratory distress with oxygen saturation of 70% …