Medicine and Health Sciences Commons^™

Paracoccidiomycosis And Hiv/Aids: A Common Problem In An Uncommon Location, Astrid Radermacher Do, Joseph L. Yozviak Do, Facp, Marcelo Gareca Md

Department of Medicine

No abstract provided.

Simple Linear Measurements Of The Normal Liver: Interobserver Agreement And Correlation With Hepatic Volume On Mri, Sachit K. Verma, Kristen Mcclure, Laurence Parker, Donald G. Mitchell, Manisha Verma, Diane Bergin

Department of Radiology Faculty Papers

OBJECTIVE. To retrospectively evaluate interobserver agreement for 4 manually determined linear hepatic measurements on magnetic resonance imaging (MRI) and correlation of these linear measurements with hepatic volume.

MATERIALS AND METHODS. Hepatic linear measurements: midhepatic point craniocaudad (MHP CC), maximum CC to liver tip (Max CC), maximum transverse and MHP anteroposterior (AP) dimensions were performed on 116 patients without liver disease who had 1.5 T MR imaging of the abdomen.Linear measurements: MHP CC, Max CC, maximum transverse, MHP AP dimensions and products of CC with MHP AP dimension were correlated with hepatic volumes. Correlation analysis (Pearson product moment correlation), Student t …

Anxiolytic Effect Of Midazolam Premedication Assessed By Clinical And Platelet Aggregation Profiles, Ehtesham I Khan, Rehana S Kamal, Hameed Ullah

Department of Anaesthesia

BACKGROUND: It is well documented that surgery is associated with increased anxiety, which has an adverse impact on patient's outcome. This study was designed to assess the anxiolytic effect of midazolam in pre-anaesthetic medication by using clinical and platelet aggregation profiles.METHODS: Sixty ASA I and II female patients aged between 35 and 60 years undergoing elective abdominal hysterectomy were randomly divided into two equal groups. Group I received placebo as pre-medication while group II received 0.15 mg/kg midazolam as pre-medication 1 hour preoperatively. They were monitored for visual analogue scale (VAS) for anxiety, observer's anxiety criteria, sedation score, blood pressure, …

Valproate Semisodium Er For Migraine And Cluster Headache Prophylaxis., Brigitte V. Lovell, Michael J. Marmura

Department of Neurology Faculty Papers

IMPORTANCE OF THE FIELD: Migraine and cluster headache (CH) are disabling syndromes that often require prophylactic treatment. Valproate semisodium ER (VPS ER) is FDA-approved for the treatment of epilepsy, acute mania in bipolar disorder and migraine prophylaxis.

AREAS COVERED IN THIS REVIEW: We reviewed literature regarding VPS ER pharmacokinetics and its use in migraine and CH prophylaxis.

WHAT THE READER WILL GAIN: VPS ER is well studied and effective in the preventive treatment of migraine and CH. This article reviews the evidence for its use, describes how to administer and dose this medication, and reviews important safety precautions.

TAKE HOME …

Metabolic Consequences Of Antiepileptic Drugs, Scott Mintzer

Department of Neurology Faculty Papers

Purpose of Review: Chemical properties of the widely used older generation antiepileptic drugs (AEDs) suggest that they might be responsible for a number of medical comorbidities. Recent Findings: AEDs which induce the cytochrome P450 system adversely affect bone, lipid, and gonadal steroid metabolism. Specifically, phenytoin causes loss of bone mass in women, and both phenytoin and carbamazepine produce increases in serum lipids and C-reactive protein, as well as decreases in bioactive testosterone in men. Patients treated with inducing AEDs are at increased risk of fracture. Some contradictory data raise the question of whether bone mass is truly related to enzyme …

Lower-Limb Alignment And Posterior Tibial Slope In Pakistanis: A Radiographic Study, Mujahid Jamil Khattak, Masood Umer, Edward T Davis, Munira Habib, Mehmood Ahmed

Department of Surgery Docs

Abstract

PURPOSE:

To assess the lower-limb alignment and posterior tibial slope in Pakistanis.

METHODS:

40 male and 19 female healthy Pakistanis aged 20 to 45 years were recruited. A full weight-bearing anteroposterior radiograph of the entire lower limb of each subject was obtained. The axial alignment was measured based on the centres of the femoral head, knee, and ankle. The tibiofemoral (TF) angle, knee joint line obliquity angle (angle J), and posterior tibial slope were determined.

RESULTS:

The mean TF angle was more varus in men than women (178.4 degrees vs. 180.0 degrees, p<0.001). The mean angle J was more medially inclined in men than women (93.4 degrees vs. 91.4 degrees, p=0.007). The mean medial tibial slope was greater in women than men (16.0 degrees vs. 12.5 degrees, p<0.001). The posterior tibial slope was greater in women than men (14.1 degrees vs. 12.5 degrees, p=0.02), and was greater than the 5 degrees to 10 degrees commonly reported.

CONCLUSIONS:

Knee alignment and geometry vary …

Molecular Cross Talk Between Misfolded Proteins In Animal Models Of Alzheimer's And Prion Diseases, Rodrigo Morales, Lisbell D Estrada, Rodrigo Diaz-Espinoza, Diego Morales-Scheihing, Maria C Jara, Joaquin Castilla, Claudio Soto

Faculty, Staff and Student Publications

The central event in protein misfolding disorders (PMDs) is the accumulation of a misfolded form of a naturally expressed protein. Despite the diversity of clinical symptoms associated with different PMDs, many similarities in their mechanism suggest that distinct pathologies may cross talk at the molecular level. The main goal of this study was to analyze the interaction of the protein misfolding processes implicated in Alzheimer's and prion diseases. For this purpose, we inoculated prions in an Alzheimer's transgenic mouse model that develop typical amyloid plaques and followed the progression of pathological changes over time. Our findings show a dramatic acceleration …

Synthesis, Biological Evaluation, And Molecular Modeling Studies Of 1-Aryl-1h-Pyrazole-Fused Curcumin Analogues As Anticancer Agents, L Curtis, P Datta, X Liu, N Bogdanova, R Heidelberger, R Janz

Faculty, Staff and Student Publications

Ribbon synapses of the vertebrate retina are specialized synapses that release neurotransmitter by synaptic vesicle exocytosis in a manner that is proportional to the level of depolarization of the cell. This release property is different from conventional neurons, in which the release of neurotransmitter occurs as a short-lived burst triggered by an action potential. Synaptic vesicle exocytosis is a calcium regulated process that is dependent on a set of interacting synaptic proteins that form the so-called SNARE (soluble N-ethylmaleimide sensitive factor attachment protein receptor) complex. Syntaxin 3B has been identified as a specialized SNARE molecule in ribbon synapses of the …

Improving Health Outcomes For Children (Ihoc) In Maine Logic Model For Primary Care Practice Improvement, Cutler Institute Of Health And Social Policy

Population Health & Health Policy

Improving Health Outcomes for Children (IHOC) is a 5-year demonstration grant from the Centers for Medicare & Medicaid Services, and authorized by 401 (d) of the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA).

IHOC works with doctors' offices, practices and other agencies who want to improve health care in Maine and Vermont to:

• Collect and report on the use of evidenced-based child health quality measures
• Expand the Health Information Technology to improve the flow of child health data
• Promote a collaborative child health learning environment

Omega-3 Fatty Acids: Potential Role In The Management Of Early Alzheimer's Disease, Gregory A. Jicha, William R. Markesbery

Sanders-Brown Center on Aging Faculty Publications

Omega-3 fatty acids are essential for brain growth and development. They play an important role throughout life, as critical modulators of neuronal function and regulation of oxidative stress mechanisms, in brain health and disease. Docosahexanoic acid (DHA), the major omega-3 fatty acid found in neurons, has taken on a central role as a target for therapeutic intervention in Alzheimer's disease (AD). A plethora of in vitro, animal model, and human data, gathered over the past decade, highlight the important role DHA may play in the development of a variety of neurological and psychiatric disorders, including AD. Cross sectional and prospective …

Diagnosis Of Enteric Fever In The Emergency Department: A Retrospective Study From Pakistan., Uzma R. Khan, J. Razzak, Ali Faisal Saleem Dr, Adnan Ahmed, Sabeena Jalal

Department of Emergency Medicine

Background:Enteric fever is one of the top differential diagnoses of fever in many parts of the world. Generally, the diagnosis is suspected and treatment is initiated based on clinical and basic laboratory parameters.
Aims: The present study identifies the clinical and laboratory parameters predicting enteric fever in Patients visiting the emergency department of a tertiary care hospital in Pakistan.
Methods:This is a retrospective chart review of all adult Patients with clinically suspected enteric fever admitted to the hospital through the emergency department during a 5-year period (2000-2005).
Results:A total of 421 emergency department Patients were admitted to …

Rbc And Wbc Fatty Acid Composition Following Consumption Of An Omega 3 Supplement: Lessons For Future Clinical Trials, Theodore R. Witte, Alexander J. Salazar, Oscar F. Ballester, W. Elaine Hardman

Biochemistry and Microbiology

Background: Results from increasing numbers of in vitro and in vivo studies have demonstrated that omega 3 fatty acids incorporated in cell culture media or in the diet of the animals can suppress the growth of cancers. When human clinical trials are initiated to determine the ability of omega 3 fatty acids to alter growth or response to chemotherapeutic interventions of cancers, it will be essential to determine the omega 3 intake of individuals in the trial to determine compliance with consumption of the supplement and to correlate with endpoints of efficacy. We wondered if the fatty acid composition of …

Comparison Of A New Opposed Phase Imaging Protocol To The Standard Conventional Mri Protocol In Demonstration Of Lumbar Degenerative Disc Disease At 1.5t., Peter C. Magabe

Master of Medicine in Imaging and Diagnostic Radiology

Purpose: The purpose of the study was to compare diagnostic yield of a new Opposed Phase Imaging protocol [OPI] to the standard conventional MRI protocol [CONV] in demonstration of lumbar degenerative disc disease at 1.5T. Materials and Methods: A total of 102 patients suspected of lumbar disc disease were examined using the two protocols. Images from both protocols were then analyzed independently by two radiologists. Category of disc disease[normal, bulge ,protrusion, extrusion] and anatomic clarity of spinal structures related to disc disease[nerve roots, osteophytes, modic changes and hemangiomas ] were assessed using a standard 4 point scoring scale [1=inadequate,2 =adequate,3=normal …

Trpm7-Mediated Ca2+ Signals Confer Fibrogenesis In Human Atrial Fibrillation, Jianyang Du, Jia Xie, Zheng Zhang, Hiroto Tsujikawa, Daniel Fusco, David Silverman, Bruce Liang, Lixia Yue

UCHC Articles - Research

Rationale—Cardiac fibrosis contributes to pathogenesis of atrial fibrillation (AF), which is the most sustained arrhythmia and a major cause of morbidity and mortality. Although it has been suggested that Ca2+ signals are involved in fibrosis promotion, the molecular basis of Ca2+ signaling mechanisms and how Ca2+ signals contribute to fibrogenesis remain unknown.
Objective—To determine the molecular mechanisms of Ca2+-permeable channel(s) in human atrial fibroblasts, and to investigate how Ca2+ signals contribute to fibrogenesis in human AF.
Methods and Results—We demonstrate that the transient receptor potential melastatin related 7 (TRPM7) is the molecular basis of the major Ca2+-permeable channel in human …

Association Of Depression With Newly Diagnosed Type 2 Diabetes Among Adults Aged Between 25 To 60 Years In Karachi, Pakistan., Shazia Perveen, Muhammad S Otho, Muhammad N Siddiqi, Juanita Hatcher, Ghazala Rafique

Section of Cardiothoracic Surgery

Background:The combination of depression with type 2 diabetes is a public health problem. If diabetes is managed in its initial phase, the morbidity and mortality due to this combination may be prevented at an early stage. Therefore, we aimed to determine the association of depression with newly diagnosed type 2 diabetes among adults aged between 25 to 60 years in Karachi, Pakistan.

Methods:

From July 2006 to September 2007, a matched case control study (n = 592) was conducted in Civil Hospital, Karachi. Incident cases of type 2 diabetes (n = 296) diagnosed within one month were recruited from …

Trends In Salmonella Enteric Serovar Typhi In Nairobi, Kenya From 2004 To 2006, Doris M. Mengo1, Sam Kariuki, Ann W. T. Muigai, Gunturu Revathi

Pathology, East Africa

Background: Typhoid fever is a global health problem. The World Health Organization (WHO) estimates that the current annual global burden of typhoid is approximately 22 million new cases, 5% of which are fatal.

Methodology: To assess the trends in antibiotic resistance in 100 Salmonella enterica serovar Typhi strains were isolated from the blood of patients in Nairobi, Kenya, from 2004 to 2006. All isolates were tested against ampicilin, chloramphenic, nalidixic acid, ciprofloxacin, cotrimoxazole, cefuroxime, cefriaxone, amoxycillin/clavulanic acid, tetracycline and gentamycin. Susceptibility and resistance were determined using MIC and disk diffusion tests.

Results: From 2004 to 2006 a total of 100 …

Hip Fracture Types In Men And Women Change Differently With Age, David A. Tanner, Marita Kloseck, Richard G. Crilly, Bert Chesworth, Jason Gilliland

Health Studies Publications

BACKGROUND: Hip fractures are expensive and a frequent cause of morbidity and mortality in the elderly. In most studies hip fractures have been viewed as a unitary fracture but recently the two main types of fracture (intertrochanteric and subcapital) have been viewed as two fractures with a different etiology and requiring a different approach to prevention. The relative proportion of intertrochanteric fractures increases with age in women. In previous studies no particular pattern in men has been noted. In this study, we explored changes in the relative proportion of the two fracture types with age in the two genders. METHODS: …

New Approaches To Preventing, Diagnosing, And Treating Neonatal Sepsis, Karen Edmond, Anita K. M. Zaidi

Department of Paediatrics and Child Health

No abstract provided.

Electronic Medical Records As A Research Tool: Evaluating Topiramate Use At A Headache Center., Michael J. Marmura, Md, Mary Hopkins, Rn, Msn, Jocelyn Andrel, Msph, William B. Young, Md, David M. Biondi, Do, Marcia F.T. Rupnow, Phd, Robert B. Armstrong, Md

Department of Neurology Faculty Papers

Background.—Electronic medical records (EMRs) are used in large healthcare centers to increase efficiency and accuracy of documentation. These databases may be utilized for clinical research or to describe clinical practices such as medication usage.

Methods.—We conducted a retrospective analysis of EMR data from a headache clinic to evaluate clinician prescription use and dosing patterns of topiramate. The study cohort comprised 4833 unique de-identified records, which were used to determine topiramate dose and persistence of treatment.

Results.—Within the cohort, migraine was the most common headache diagnosis (n = 3753, 77.7%), followed by tension-type headache (n = 338, 7.0%) and cluster or …

Three-Dimensional Structure Of Tropism-Switching Bordetella Bacteriophage, Wei Dai, Asher Hodes, Wong H Hui, Mari Gingery, Jeff F Miller, Z Hong Zhou

Faculty, Staff and Student Publications

Bacteriophage BPP-1, which infects Bordetella species, can switch its specificity by mutations to the ligand-binding surface of its major tropism-determinant protein, Mtd. This targeted mutagenesis results from the activity of a phage-encoded diversity-generating retroelement. Purified Mtd binds its receptor with low affinity, yet BPP-1 binding and infection of Bordettella cells are efficient because of high-avidity binding between phage-associated Mtd and its receptor. Here, using an integrative approach of three-dimensional (3D) structural analyses of the entire phage by cryo-electron tomography and single-prticle cryo-electron microscopy, we provide direct localization of Mtd in the phage and the structural basis of the high-avidity binding …

Medical Education Digest, Vol. 12 No. 2 (March/April 2010), Nova Southeastern University

Medical Education Digest

No abstract provided.

Tips And Tricks For The Trauma Patient., Anthony D Goei, Brian H Ching, Mark W Meyermann, Timothy Nunez, David Sacks

Reading Hospital Interventional Radiology

Interventions on the trauma patient are an essential component of the complete scope of care that is provided to the multiply injured patient today. The active participation by the interventional radiologist along the entire spectrum of clinical care is very important to optimize patient outcomes. Suggestions on how to establish a clinical presence are presented. A few of the newer concepts and terminology applicable to trauma care are reviewed. Tips useful in the trauma room, in the interventional radiology suite, and during the postprocedural period are discussed.

E-Mail Communication In Paediatrics: Ethical And Clinical Considerations, Susan Albersheim

Paediatrics Publications

E-mail has become a commonplace ‘procedure’ in medical practice because it is efficient and inexpensive. However, there are potential misuses and abuses of this form of written communication, with clinical and ethical implications. Common uses of e-mail in paediatics include general communication with colleagues in a professional setting; electronic formal consultation, in which patient confidentiality is paramount; electronic ‘curbside’ consultation, which may be perceived as a formal consultation; electronic discussion groups, which lack peer review; communication with current patients or their parents, which should be limited to simple, nonurgent issues; and communication with individuals seeking medical advice who are not …

Schedule For Ct Image Guidance In Treating Prostate Cancer With Helical Tomotherapy., G Beldjoudi, S Yartsev, G Bauman, Jerry J. Battista Dr., Jacob Van Dyk

Oncology Publications

The aim of this study was to determine the effect of reducing the number of image guidance sessions and patient-specific target margins on the dose distribution in the treatment of prostate cancer with helical tomotherapy. 20 patients with prostate cancer who were treated with helical tomotherapy using daily megavoltage CT (MVCT) imaging before treatment served as the study population. The average geometric shifts applied for set-up corrections, as a result of co-registration of MVCT and planning kilovoltage CT studies over an increasing number of image guidance sessions, were determined. Simulation of the consequences of various imaging scenarios on the dose …

Surgical Response To Catastrophe - Learning From Canada’S Experience Abroad, Vivian Mcalister

Data and Test Instruments

No abstract provided.

The Utility Of Modified Butler-Leggett Criteria For Right Ventricular Hypertrophy In Detection Of Clinically Significant Shunt Ratio In Ostium Secundum-Type Atrial Septal Defect In Adults, Adeel M. Siddiqui, Zainab Samad, Nina Hakacova, James Kinsella, Cary Ward, Michael White, Anna Lisa C. Crowley, Galen S. Wagner, J. Kevin Harrison

Section of Cardiology

Background: This study was performed to test the hypothesis that there exists a correlation between the Butler-Leggett (BL) criterion for right ventricular hypertrophy on the electrocardiogram and the Qp/Qs shunt ratio in adults with ostium secundum atrial septal defects (ASDs).

Methods: Demographic, cardiac catheterization, ASD closure, and electrocardiographic data were acquired on 70 patients with secundum ASDs closed percutaneously. Simple linear regression and logistic regression models were created to test the hypothesis.

Results: The mean Qp/Qs ratio and BL criterion value were 1.61 +/- 0.46 and 0.11 +/- 0.41, respectively. The BL criterion values correlated with shunt ratios (r(2) = …

Clinical Outcome Of Iridotomy With Argon-Yag Laser At A Tertiary Care Center In Karachi, Pakistan, Rashid Baig, Aziz Khan

Section of Ophthalmology

Objective: To assess the the efficacy and early and late complications of Argon-YAG combined laser iridotomy in the outpatient department of a tertiary care hospital.
Methods: This was a prospective observational study conducted at Aga Khan University Hospital Karachi, Pakistan. After detailed history taking and clinical examination, patients who had goniscopically evident closed angles and a positive provocative test were selected for laser iridotomy. They underwent iridotomy using Argon laser followed by YAG laser. The main outcome measures were patency of iridotomy at 6 months, angle grading at 6 months and early and late complications.
Results: Overall 40 eyes of …

Qrs Duration And Echocardiographic Evidence Of Left Ventricular Dyssynchrony In Patients With Left Ventricular Systolic Dysfunction, Hafeez Ahmed, Javed Tai, Sohail Abrar Khan, Muniza Yousuf

Section of Cardiology

Objective: To determine the association between left ventricular (LV) dyssynchrony assessed by tissue Doppler imaging (TDI) in patients with left ventricular ejection fraction (LVEF) < 35% and prolonged ventricular depolarization on electrocardiography.
Study design: A cross-sectional study.
Place and duration of study: The Aga Khan University, Karachi, from June to September 2007.
Methodology: All patients with LVEF < 35% were included. Apical 2-D images were obtained in 4 chamber and 2 chamber views. TDI pulse wave Doppler parameters were measured from these 2 color-coded images. Time interval between the onset of QRS complex and the peak systolic velocity per region was derived. Patients with valvular heart disease, mitral annular calcification, atrial fibrillation and paced rhythm were excluded. Fischer's exact test was used to determine the association between QRS duration and left ventricular dyssynchrony.
Results: A total of 60 patients were included. Twenty one patients had QRS duration of > 120 msec. Out of those 21 patients, a total of 6 patients (28.6%) had evidence of dyssynchrony on TDI. Five patients (23.8%) had dyssynchrony on the basis of basal septal and basal lateral velocity difference (p=0.045) …

Neovascularity Patterns In Breast Carcinoma: Correlation Of Doppler Ultrasound Features With Sonographic Tumour Morphology, Riffat Shaheen, Saba Sohail, Kauser Jahan Siddiqui

Department of Radiology

Objective: To determine the association and correlation between morphologic features of breast cancer on gray scale ultrasound, and vascularity patterns and indices on color and spectral Doppler ultrasound.
Study design: Cross-sectional, analytical study.
Place and duration of study: Department of Radiology, Dow University of Health Sciences and Civil Hospital, Karachi, from August 2006 to June 2007.
Methodology: Fifty adult female patients with histopathological proven breast cancer underwent ultrasound for evaluation of morphologic features on gray scale mode; vascularity patterns on color Doppler scan and flow indices measurement on spectral Doppler ultrasound. Regression analysis was conducted to determine correlation between the …

Ultrasound Visualization Vs. Electrical Nerve Stimulation For Interscalene And Axillary Nerve Block In Upper Extremity Surgery: A Prospective Randomized Trial (Poster), Joseph W. Galassi Md, Jodie Buxbaum Md, J John Collins Md, Dorothy Hartman Md, Michael He Md, Farheen Hussain Ms, Leslie Baga Bsn, Sherrine Eid Mph, Mary Jane Cerrone Msn, Nanette M. Schwann Md

Department of Anesthesiology

No abstract provided.