Medicine and Health Sciences Commons^™

Magnetic Resonance Imaging Findings In Bipartite Medial Cuneiform - A Potential Pitfall In Diagnosis Of Midfoot Injuries: A Case Series., Ilan Elias, Sachin Dheer, Adam C Zoga, Steven M Raikin, William B Morrison

Department of Radiology Faculty Papers

INTRODUCTION: The bipartite medial cuneiform is an uncommon developmental osseous variant in the midfoot. To our knowledge, Magnetic Resonance Imaging (MRI) characteristics of a non-symptomatic bipartite medial cuneiform have not been described in the orthopaedic literature. It is important for orthopaedic foot and ankle surgeons, musculoskeletal radiologists, and for podiatrists to identify this osseous variant as it may be mistakenly diagnosed as a fracture or not recognized as a source of non-traumatic or traumatic foot pain, which may sometimes even require surgical treatment. CASE PRESENTATIONS: In this report, we describe the characteristics of three cases of bipartite medial cuneiform on …

Inguinal Hernia Repair At The Aga Khan Hospital, Nairobi: Practice And Preference Discordance, Ronald Wasike, Abdulkarim Abdallah

General Surgery, East Africa

Objectives: To review the current hernia repair methods at the Aga Khan University Hospital (AKUH) and relate to the preferred method of choice for groin hernia repair among the practicing general surgeons.

Design: An audit from retrospective practices.

Setting: A tertiary referral hospital, Aga Khan University Hospital, Nairobi.

Subjects: All elective adult hernia repairs performed at the Aga Khan University Hospital, Nairobi between 2004-5 by all surgeons with admitting privileges were reviewed. The methods of repair were noted. A questionnaire was also availed to the admitting surgeons to indicate their preferred method, and this was correlated with the audit results. …

Anaesthetic Management Of Tracheal Reconstruction Using Jet Ventilation, Khalid, Samad, Faisal Shamim, Muhammad Sohail Awan, Muhammad Qamarul Hoda

Department of Anaesthesia

No abstract provided.

Effect Of Single Dose Magnesium On Arrhythmias In Patients Undergoing Coronary Artery Bypass Surgery, M Hamid, Rs Kamal, Sa Sami, F Atiq, A Shafquat, Hi Naqvi, Fazal Hameed Khan

Department of Anaesthesia

OBJECTIVE: To evaluate the safety and role of prophylactic administration of magnesium in preventing arrhythmias.
METHOD: This double blind randomized placebo controlled clinical trial was conducted at Aga Khan University Hospital on coronary artery bypass surgery patients. All patients were connected to holter monitor before induction of anaesthesia and this monitoring continued for 24 hours. Study drug containing either 2-grams of magnesium or normal saline was given after intubation. Levels of serum magnesium was checked preoperatively and then in ICU at 0, 6, 12, and 24 hours. Independent t-test and chi square test were used for analysis. Statistical significance was …

Hiv, Hepatitis B And Hepatitis C Coinfection In Kenya, Reena Shah, Jane Karuru, Mark Nelson, Justin Stebbing

Internal Medicine, East Africa

There are few data regarding hepatitis and HIV coinfection in Africa. In 378 HIV seropositive individuals in Nairobi, 23 (6%) were hepatitis B virus (HBV) and HIV coinfected, four (1%) were hepatitis C virus (HCV) and HIV coinfected and one patient was infected with all three viruses. Coinfected individuals were more likely to be men and older; a lack of HBV vaccination was a risk factor for HIV/HBV coinfection (PU0.001) and tenofovir containing regimens appeared most effective at reducing HBV viral load.

P1: Effect Of Age, Oestradiol Levels And Endometrial Thickness On Determining Success Of Frozen Embryo Transfers, Alfred Murage, Maybeth Jamieson, Robin Yates, Isabel Traynor, Helen Lyall, Scott Nelson

Obstetrics and Gynaecology, East Africa

Introduction: Frozen-thawed embryo transfer (FET) is a widely used technique, with replacement of embryos during natural menstrual cycles or in cycles constructed by exogenous steroids having similar outcomes in many series. Multiple factors have been proposed to have a positive influence on the success rate of FET, including increased endometrial thickness, younger maternal age and lower circulating oestradiol. The impact of these variables in the context of constructed cycles, using GnRH agonists to facilitate suppression of ovarian function prior to exogenous steroid administration, is not known. The aim of this study was to determine the predictive ability of these indices …

Racial Differences In Birth Outcomes: The Role Of General, Pregnancy, And Racism Stress, Tyan Parker Dominguez, Christine Dunkel Schetter, Laura M. Glynn, Calvin J. Hobel, Curt A. Sandman

Psychology Faculty Articles and Research

Objective: This study examined the role of psychosocial stress in racial differences in birth outcomes.

Design: Maternal health, sociodemographic factors, and 3 forms of stress (general stress, pregnancy stress, and perceived racism) were assessed prospectively in a sample of 51 African American and 73 non-Hispanic White pregnant women.

Main Outcome Measures: The outcomes of interest were birth weight and gestational age at delivery. Only predictive models of birth weight were tested as the groups did not differ significantly in gestational age.

Results: Perceived racism and indicators of general stress were correlated with birth weight and tested in regression analyses. In …

Timing Of Fetal Exposure To Stress Hormones: Effects On Newborn Physical And Neuromuscular Maturation, Lauren M. Ellman, Christine Dunkel Schetter, Calvin J. Hobel, Aleksandra Chicz-Demet, Laura M. Glynn, Curt A. Sandman

Psychology Faculty Articles and Research

The purpose of the study was to determine the specific periods during pregnancy in which human fetal exposure to stress hormones affects newborn physical and neuromuscular maturation. Blood was collected from 158 women at 15, 19, 25, and 31 weeks' gestation. Levels of placental corticotropin-releasing hormone (CRH) and maternal cortisol were determined from plasma. Newborns were evaluated with the New Ballard Maturation Score. Results indicated that increases in maternal cortisol at 15, 19, and 25 weeks and increases in placental CRH at 31 weeks were significantly associated with decreases in infant maturation among mates (even after con trolling for length …

Stress And Blood Pressure During Pregnancy: Racial Differences And Associations With Birthweight, Clayton J. Hilmert, Christine Dunkel Schetter, Tyan Parker Dominguez, Cleopatra M. Abdou, Calvin J. Hobel, Laura M. Glynn, Curt A. Sandman

Psychology Faculty Articles and Research

OBJECTIVE: To extend findings that African American women report greater stress during pregnancy, have higher blood pressure (BP), and are twice as likely to have low birthweight infants relative to white women. This study examines a) racial differences in associations between stress and BP during pregnancy, and b) the combined effects of stress and BP on infant birthweight in a sample of 170 African American and white women.

METHODS: A prospective, longitudinal study of pregnant women was conducted in which measures of BP, stress, and other relevant variables were collected. Multiple measures of systolic and diastolic BP were taken at …

Beliefs, Perceptions, And Preferences For Treatment In Latinas With Breast Cancer, Barbara Ann Kreling

Walden Dissertations and Doctoral Studies

Research documents that breast cancer is the leading cause of death in Latina females. The exact numbers are unknown, but studies reveal that Latinas with breast cancer underuse recommended follow-up chemotherapy, decreasing their rates of survival. Although several factors may be responsible, cultural influences are a possible barrier. However, there is a gap in the literature about how culture affects decisions about breast cancer treatment. This focused ethnographic study examined the role of cultural beliefs and perceptions in the decision-making process for Latina women about whether or not to receive chemotherapy following a breast cancer diagnosis. Drawing from Douglas' cultural …

In-Vivo Delivery Of Dna Vaccines Using Metallo-Lipid Nanoparticles, Clarissa Sara Gomez

Open Access Theses & Dissertations

There has been a rapidly growing area of research in the design and synthesis of molecules that self-organize in water to form functional nanosystems and due to the high interest in the area metal ligand complexes were tested as drug delivery systems with a Leishmania vaccine. Herein, we present the design, synthesis and functional activity of Cu(II) and Zn(II) complexes that self-assemble in water to form spherical nanoscale structures that exhibit an affinity to bind DNA and deliver it into eukaryotic cells with a high percent efficiency in-vitro. In order to assess the effectiveness of these nanoparticles to deliver DNA …

Impact Of Training In Clinical And Microscopy Diagnosis Of Childhood Malaria On Antimalarial Drug Prescription And Health Outcome At Primary Health Care Level In Tanzania: A Randomized Controlled Trial, B. Ngasala, M. Mubi, M. Warsame, M.G. Petzold, A.Y. Massele, L.L. Gustafsson, G. Tomson, Zul Premji, A. Bjorkman

Pathology, East Africa

Background: Prescribing antimalarial medicines based on parasite confirmed diagnosis of malaria is critical to rational drug use and optimal outcome of febrile illness. The impact of microscopy-based versus clinical-based diagnosis of childhood malaria was assessed at primary health care (PHC) facilities using a cluster randomized controlled training intervention trial.

Methods: Sixteen PHC facilities in rural Tanzania were randomly allocated to training of health staff in clinical algorithm plus microscopy (Arm-I, n = 5) or clinical algorithm only (Arm-II, n = 5) or no training (Arm-III, n = 6). Febrile under-five children presenting at these facilities were assessed, treated and scheduled …

Causes, Magnitude And Management Of Burns In Under-Fives In District Hospitals In Dar Es Salaam, Tanzania., M. Justin-Temu, G. Rimoy, Zul Premji, G. Matemu

Pathology, East Africa

Objectives: To determine the causes, magnitude and management of burns in children under five years of age who were admitted in the district hospitals of Dar es Salaam City, Tanzania.

Methods: In this study, a total of 204 under fives were enrolled. Questionnaires were used to elicit if the parent/caretaker had the knowledge of the cause of the burns, what was done immediately after burn injury, first aid given immediately after burn, source of the knowledge of first aid and when the child was taken to the hospital. Also the questionnaire was cited with data on the management of burns …

The Content Of African Diets Is Adequate To Achieve Optimal Efficacy With Fixed-Dose Artemether-Lumefantrine: A Review Of The Evidence, Zul Premji, S. Abdulla, B. Ogutu, A. Ndong, C.O. Falade, I. Sagara, N. Mulure, O. Nwaiwu, G. Kokwaro

Pathology, East Africa

A fixed-dose combination of artemether-lumefantrine (AL, Coartem®) has shown high efficacy, good tolerability and cost-effectiveness in adults and children with uncomplicated malaria caused by Plasmodium falciparum. Lumefantrine bioavailability is enhanced by food, particularly fat. As the fat content of sub-Saharan African meals is approximately a third that of Western countries, it raises the question of whether fat consumption by African patients is sufficient for good efficacy. Data from healthy volunteers have indicated that drinking 36 mL soya milk (containing only 1.2 g of fat) results in 90% of the lumefantrine absorption obtained with 500 mL milk (16 g fat). African …

Conclusions And Recommendations Of A Who Expert Consultation Meeting On Iron Supplementation For Infants And Young Children In Malaria Endemic Areas [Conclusions Et Recommandations À L'Issue De La Consultation De L'Oms Sur La Lutte Contre La Carence Martiale Chez Le Nourrisson Et Le Jeune Enfant Dans Les Pays D'Endémie Palustre], L. Allen, R.E. Black, N. Brandes, G. Brittenham, G. Chazot, C Chunming, J. Crawley, B. De Benoist, N. Dalmiya, I. Darnton-Hill, K. Dewey, S. El-Arifeen, O. Fontaine, C. Geissler, H. Haberle, P. Harvey, J. Hasler, C. Hershko, R. Hurrell, M.A. Juma, B. Lonnerdal, B. Lozoff, S. Lynch, H. Martines Salgado, E. Mclean, J. Metz, S. Oppenheimer, Zul Premji, A. Prentice, M. Ramsan, C. Ratledge, R. Stoltzfus, J. Tielsch

Pathology, East Africa

This article presents the results of an expert consultation meeting aimed at evaluating the safety and public health implications of administering supplemental iron to infants and young children in malaria-endemic areas. Participants at this meeting that took place in Lyon, France on June 12-14, 2006 reached consensus on several important issues related to iron supplementation for infants and young children in malaria-endemic areas. The conclusions in this report apply specifically to regions where malaria is endemic.

Off-Label Psychopharmacologic Prescribing For Children: History Supports Close Clinical Monitoring., Julie M Zito, Albert T Derivan, Christopher J Kratochvil, Daniel J Safer, Joerg M Fegert, Laurence L Greenhill

Department of Psychiatry and Human Behavior Faculty Papers

The review presents pediatric adverse drug events from a historical perspective and focuses on selected safety issues associated with off-label use of medications for the psychiatric treatment of youth. Clinical monitoring procedures for major psychotropic drug classes are reviewed. Prior studies suggest that systematic treatment monitoring is warranted so as to both minimize risk of unexpected adverse events and exposures to ineffective treatments. Clinical trials to establish the efficacy and safety of drugs currently being used off-label in the pediatric population are needed. In the meantime, clinicians should consider the existing evidence-base for these drugs and institute close clinical monitoring.

Fine Needle Aspiration Biopsy Of Intraoral And Oropharyngeal Mass Lesions, Husain A. Saleh, Lewis Clayman, Haitham Masri

Wayne State University Associated BioMed Central Scholarship

Abstract

Background

Fine needle aspiration (FNA) biopsy has been rarely used in oral and oropharyngeal lesions. The goal of this study was to assess the value and accuracy of FNA biopsy in the diagnosis of oral and oropharyngeal lesions particularly in regards to discriminating benign from malignant tumors.

Methods

Sixteen cases of FNA biopsies obtained of various intraoral and oropharyngeal masses or lesions performed at our institution during the eight-year period from 1998 to 2006 were retrospectively reviewed. The aspiration cytologic diagnoses were correlated with the histologic examination of the corresponding resected lesions.

Results

Sixteen cases of intraoral lesions evaluated …

Dependence In Prestroke Mobility Predicts Adverse Outcomes Among Patients With Acute Ischemic Stroke, Mary I. Dallas, Shari Rone-Adams, John L. Echternach, Lawrence M. Bass, Dawn M. Bravata

Rehabilitation Sciences Faculty Publications

Background and Purpose - Stroke survivors are commonly dependent in activities of daily living; however, the relation between prestroke mobility impairment and poststroke outcomes is poorly understood. The primary objective of this study was to evaluate the association between prestroke mobility impairment and 4 poststroke outcomes. The secondary objective was to evaluate the association between prestroke mobility impairment and a plan for physical therapy.

Methods - This was a secondary analysis of the National Stroke Project data, a retrospective cohort of Medicare beneficiaries who were hospitalized with an acute ischemic stroke (1998 to 2001). Logistic-regression modeling was used to examine …

Application Of In Vivo Induced Antigen Technology (Iviat) To Bacillus Anthracis, Sean M Rollins, Amanda Peppercorn, John S Young, Melissa Drysdale, Andrea Baresch, Margaret V Bikowski, David A Ashford, Conrad P Quinn, Martin Handfield, Jeffrey D Hillman, C Rick Lyons, Theresa M Koehler, Stephen B Calderwood, Edward T Ryan

Faculty, Staff and Student Publications

In vivo induced antigen technology (IVIAT) is an immuno-screening technique that identifies bacterial antigens expressed during infection and not during standard in vitro culturing conditions. We applied IVIAT to Bacillus anthracis and identified PagA, seven members of a N-acetylmuramoyl-L-alanine amidase autolysin family, three P60 family lipoproteins, two transporters, spore cortex lytic protein SleB, a penicillin binding protein, a putative prophage holin, respiratory nitrate reductase NarG, and three proteins of unknown function. Using quantitative real-time PCR comparing RNA isolated from in vitro cultured B. anthracis to RNA isolated from BALB/c mice infected with virulent Ames strain B. anthracis, we confirmed induced …

Primary Drug Resistance To Anti-Tuberculous Drugs In Karachi, Arshad Javaid, Nadim Rizvi, Mosavir Ansari, Ashraf Sadiq, Iqbal Sher Burki, Nadeem Ur Rehman, Rumina Hasan, Afia Zafar

Department of Pathology and Laboratory Medicine

Objective: To assess the frequency of primary drug resistance among newly diagnosed tuberculosis cases in Karachi.
Study Design: Cross-sectional study.
Place and Duration of Study: Multicentric study involving various TB clinics and treatment centres of Karachi between April to December 2005.
Methodology: The frequency of drug resistance among new TB patients was evaluated using a non-probability convenient sampling methodology. Sputum sample was obtained from 140 newly diagnosed sputum smear-positive patients of pulmonary tuberculosis from various centres of Karachi. Sensitivities were performed by proportion method.
Results: Fifteen (11.5%) samples in 130 eligible patients showed primary resistance to one …

Embolization Of An Intracranial Arteriovenous Malformation Followed By Immediate Surgical Resection: A Case Report, Imaad Ur Rehman, Tanveer Ul Haq, Rashid Jooma, Muhammad Azeemuddin, Zafar Sajjad

Department of Radiology

Intracranial arteriovenous malformations (AVMs) are now a recognized entity because of improvements in imaging diagnosis. They are relatively uncommon but can cause serious neurological symptoms or death. We report a case of a 22- year-old man who presented with left parietal hemorrhage and on cerebral angiography was found to have a small AVM in the left middle cerebral artery (MCA) territory. Glue embolization followed by immediate surgical resection of the AVM was carried out, resulting in complete cure.

Large Scale Variation In Enterococcus Faecalis Illustrated By The Genome Analysis Of Strain Og1rf, Agathe Bourgogne, Danielle A Garsin, Xiang Qin, Kavindra V Singh, Jouko Sillanpaa, Shailaja Yerrapragada, Yan Ding, Shannon Dugan-Rocha, Christian Buhay, Hua Shen, Guan Chen, Gabrielle Williams, Donna Muzny, Arash Maadani, Kristina A Fox, Jason Gioia, Lei Chen, Yue Shang, Cesar A Arias, Sreedhar R Nallapareddy, Meng Zhao, Vittal P Prakash, Shahreen Chowdhury, Huaiyang Jiang, Richard A Gibbs, Barbara E Murray, Sarah K Highlander, George M Weinstock

Faculty, Staff and Student Publications

BACKGROUND: Enterococcus faecalis has emerged as a major hospital pathogen. To explore its diversity, we sequenced E. faecalis strain OG1RF, which is commonly used for molecular manipulation and virulence studies.

RESULTS: The 2,739,625 base pair chromosome of OG1RF was found to contain approximately 232 kilobases unique to this strain compared to V583, the only publicly available sequenced strain. Almost no mobile genetic elements were found in OG1RF. The 64 areas of divergence were classified into three categories. First, OG1RF carries 39 unique regions, including 2 CRISPR loci and a new WxL locus. Second, we found nine replacements where a sequence …

Juvenile Onset Central Nervous System Folate Deficiency And Rheumatoid Arthritis, Mary Kay Koenig, Maria Perez, Sheldon Rothenberg, Ian J Butler

Faculty, Staff and Student Publications

Isolated cerebral folate deficiency was detected in a 13-year-old girl with cognitive and motor difficulties and juvenile rheumatoid arthritis. Her serum contains autoantibodies that block membrane-bound folate receptors that are on the choroid plexus and diminish the uptake of folate into the spinal fluid. Whereas her serum folate exceeded 21 ng/mL, her spinal fluid contained 3.2 ng/mL of 5-methyltetrahydrofolate as a consequence of the autoantibodies diminishing the uptake of this folate.

Cyan Fluorescent Protein Expression In Ganglion And Amacrine Cells In A Thy1-Cfp Transgenic Mouse Retina, Iona D Raymond, Alejandro Vila, Uyen-Chi N Huynh, Nicholas C Brecha

Faculty, Staff and Student Publications

PURPOSE: To characterize cyan fluorescent protein (CFP) expression in the retina of the thy1-CFP (B6.Cg-Tg(Thy1-CFP)23Jrs/J) transgenic mouse line.

METHODS: CFP expression was characterized using morphometric methods and immunohistochemistry with antibodies to neurofilament light (NF-L), neuronal nuclei (NeuN), POU-domain protein (Brn3a) and calretinin, which immunolabel ganglion cells, and syntaxin 1 (HPC-1), glutamate decarboxylase 67 (GAD(67)), GABA plasma membrane transporter-1 (GAT-1), and choline acetyltransferase (ChAT), which immunolabel amacrine cells.

RESULTS: CFP was extensively expressed in the inner retina, primarily in the inner plexiform layer (IPL), ganglion cell layer (GCL), nerve fiber layer, and optic nerve. CFP fluorescent cell bodies were in all …

Living Past Your Expiration Date: A Phenomenological Study Of Living With Stage Iv Cancer Longer Than Expected, Cynthia Levine

Antioch University Dissertations & Theses

More treatment options exist today for persons diagnosed with terminal cancerextending lives longer than expected though there is little known about the psychosocial needs or resources for these individuals. This study describes the experience of living past the expiration date and still living with Stage IV cancer. A transcendental phenomenological approach was used to elucidate vivid expressions of this experience in a sample population of five Caucasian women. The women survived beyond their prognoses of an earlier expiration are not close to imminent death and are still living with incurable breast cancer metastases. The aim of this phenomenological inquiry is …

Poetic Leadership, A Territory Of Aesthetic Consciousness And Change, R. Amrit Kasten-Daryanani

Antioch University Dissertations & Theses

Poetic leadership is a new theoretical construct that views leadership as an activity that unites a lyrical intellect with keenly felt emotion for the purpose of producing changes in the consciousness of self and others. This change begins within the interiority of self, moving surely to broader realms of one's surroundings and society, provoking movement that impacts the developing potential of the individual and the cultural milieu in which they exist. Emotion is the primary trace into consciousness used in this dissertation, which serves to unite experiences of the heart with experiences of the mind. The unification of these disparate …

Maldi Mass Spectrometry Imaging For The Discovery Of Prostate Carcinoma Biomarkers, Lisa Harris Cazares

Theses and Dissertations in Biomedical Sciences

The elucidation of new biological markers of prostate cancer (PCa) should aid in the detection, and prognosis of this disease. Diagnostic decision making by pathologists in prostate cancer is highly dependent on tissue morphology. The ability to localize disease-specific molecular changes in tissue would help improve this critical pathology decision making process. Direct profiling of proteins in tissue sections using MALDI imaging mass spectrometry (MALDI-IMS) has the power to link molecular detail to morphological and pathological changes, enhancing the ability to identify candidates for new specific biomarkers. However, critical questions remain regarding the integration of this technique with clinical decision …

Messenger Rna Half-Life Measurements In Mammalian Cells, Chyi-Ying A Chen, Nader Ezzeddine, Ann-Bin Shyu

Faculty, Staff and Student Publications

The recognition of the importance of mRNA turnover in regulating eukaryotic gene expression has mandated the development of reliable, rigorous, and "user-friendly" methods to accurately measure changes in mRNA stability in mammalian cells. Frequently, mRNA stability is studied indirectly by analyzing the steady-state level of mRNA in the cytoplasm; in this case, changes in mRNA abundance are assumed to reflect only mRNA degradation, an assumption that is not always correct. Although direct measurements of mRNA decay rate can be performed with kinetic labeling techniques and transcriptional inhibitors, these techniques often introduce significant changes in cell physiology. Furthermore, many critical mechanistic …

The Role Of Sse1 In The De Novo Formation And Variant Determination Of The [Psi+] Prion, Jaou-Chen Huang

Faculty, Staff and Student Publications

In several species, a family of nuclear receptors, the peroxisome proliferator-activated receptors (PPARs) composed of three isotypes, is expressed in somatic cells and germ cells of the ovary as well as the testis. Invalidation of these receptors in mice or stimulation of these receptors in vivo or in vitro showed that each receptor has physiological roles in the gamete maturation or the embryo development. In addition, synthetic PPAR gamma ligands are recently used to induce ovulation in women with polycystic ovary disease. These results reveal the positive actions of PPAR in reproduction. On the other hand, xenobiotics molecules (in herbicides, …

Genes In Glucose Metabolism And Association With Spina Bifida, Christina M Davidson, Hope Northrup, Terri M King, Jack M Fletcher, Irene Townsend, Gayle H Tyerman, Kit Sing Au

Faculty, Staff and Student Publications

The authors test single nucleotide polymorphisms (SNPs) in coding sequences of 12 candidate genes involved in glucose metabolism and obesity for associations with spina bifida. Genotyping was performed on 507 children with spina bifida and their parents plus anonymous control DNAs from Hispanic and Caucasian individuals. The transmission disequilibrium test was performed to test for genetic associations between transmission of alleles and spina bifida in the offspring (P < .05). A statistically significant association between Lys481 of HK1 (G allele), Arg109Lys of LEPR (G allele), and Pro196 of GLUT1 (A allele) was found ( P = .019, .039, and .040, respectively). Three SNPs on 3 genes involved with glucose metabolism and obesity may be associated with increased susceptibility to spina bifida.