Medicine and Health Sciences Commons^™

Homocysteine Levels In Preterm Infants: Is There An Association With Intraventricular Hemorrhage? A Prospective Cohort Study., Wendy J Sturtz, Kathleen H Leef, Amy B Mackley, Shailja Sharma, Teodoro Bottiglieri, David A Paul

Department of Pediatrics Faculty Papers

BACKGROUND: The purpose of this study was to characterize total homocysteine (tHcy) levels at birth in preterm and term infants and identify associations with intraventricular hemorrhage (IVH) and other neonatal outcomes such as mortality, sepsis, necrotizing enterocolitis, bronchopulmonary dysplasia, and thrombocytopenia. METHODS: 123 infants < 32 weeks gestation admitted to our Level III nursery were enrolled. A group of 25 term infants were enrolled for comparison. Two blood spots collected on filter paper with admission blood drawing were analyzed by a high performance liquid chromatography (HPLC) method. Statistical analysis included ANOVA, Spearman's Rank Order Correlation and Mann-Whitney U test. RESULTS: The median tHcy was 2.75 micromol/L with an interquartile range of 1.34 - 4.96 micromol/L. There was no difference between preterm and term tHcy (median 2.76, IQR 1.25 - 4.8 micromol/L vs median 2.54, IQR 1.55 - 7.85 micromol/L, p = 0.07). There was no statistically significant difference in tHcy in 31 preterm infants with IVH compared to infants without IVH (median 1.96, IQR 1.09 - 4.35 micromol/L vs median 2.96, IQR 1.51 - 4.84 micromol/L, p = 0.43). There was also no statistically significant difference in tHcy in 7 infants with periventricular leukomalacia (PVL) compared to infants without PVL (median 1.55, IQR 0.25 - 3.45 micromol/L vs median 2.85, IQR 1.34 - 4.82 micromol/L, p = 0.07). Male infants had lower tHcy compared to female; prenatal steroids were associated with a higher tHcy. CONCLUSION: In our population of preterm infants, there is no association between IVH and tHcy. Male gender, prenatal steroids and preeclampsia were associated with differences in tHcy levels.

Lateral Wall Protein Content Mediates Alterations In Cochlear Outer Hair Cell Mechanics Before And After Hearing Onset, Heather Jensen Smith, Richard Hallworth

Journal Articles: Eppley Institute

Specialized outer hair cells (OHCs) housed within the mammalian cochlea exhibit active, nonlinear, mechanical responses to auditory stimulation termed electromotility. The extraordinary frequency resolution capacity of the cochlea requires an exquisitely equilibrated mechanical system of sensory and supporting cells. OHC electromotile length change, stiffness, and force generation are responsible for a 100-fold increase in hearing sensitivity by augmenting vibrational input to non-motile sensory inner hair cells. Characterization of OHC mechanics is crucial for understanding and ultimately preventing permanent functional deficits due to overstimulation or as a consequence of various cochlear pathologies. The OHCs' major structural assembly is a highly-specialized lateral …

Family Medicine Predoctoral Education: 30-Something, Howard K. Rabinowitz

Department of Family & Community Medicine Faculty Papers

From the introduction:

The specialty of family medicine is now more than 30 years old. Fitting for its stage of life, family medicine predoctoral education has achieved appropriate maturity and parity with other core clinical departments and has assumed its role and responsibility in medical education within the academic health center. Of course, this wasn’t always true.

The Interplay Of Obesity And Asthma, James Plumb, Rickie Brawer, Nancy Brisbon

Department of Family & Community Medicine Faculty Papers

The relationships, interactions, and association between obesity and asthma are complex, and are active sources of hypotheses and research. An association between obesity and asthma has been reported in many studies, although considerable debate about the existence of the association and its meaning still exists. Potential associative relationships may result from genetics, immune system modifications, and mechanical mechanisms. The rising prevalence of asthma and obesity in children and adults, and the significant morbidity from both, makes it imperative that clinicians recognize the importance of weight management in patients with and without asthma.

Anesthesia Clinical Performance Outcomes: Does Teaching Methodology Make A Difference?, Nina E. Mclain

Theses and Dissertations

Researchers have studied memory recall of crisis-oriented or emotional events in non-educational settings. However, within the health care field, there has been a limited study of the the concept of recall of crisis oriented or emotional events in& health care education. Crisis-oriented events such as natural disasters, acts of bioterroism, and industrial accidents, have been reported to impact memory. Patient safety is a primary focus in anesthesia education, appropriate crisis management is imperative to quality anesthesia care. Due to the critical nature of anesthesia delivery, there is a strong, constant need to develop methods that will enhance, support, and improve …

A Hypothesis-Oriented Algorithm For Symptom-Based Diagnosis By Physical Therapists: Description And Case Series, Courtney D. Few, Todd E. Davenport, Hugh G. Watts

School of Pharmacy Faculty Articles

Study Design: Case series.

Subjects: Two patients referred to physical therapy with a diagnosis of lower back pain (LBP).

Background: The increasing role of physical therapists in primary care settings highlights the skills needed to determine the appropriateness of physical therapy for patients. A hypothesis-oriented algorithm for symptom-based diagnosis was developed for use by physical therapists. The goal of this process is to determine a diagnostic impression to guide decisions regarding patient disposition and physical therapist management. This case series demonstrates the process in two individuals with LBP referred to a community-based outpatient physical therapy clinic.

Diagnosis: Despite the fact …

Evaluation Of Immune Response To Hepatitis B Vaccine In Health Care Workers At A Tertiary Care Hospital In Pakistan: An Observational Prospective Study, Mohammad Zeeshan, Kauser Jabeen, Anita Nausheen Akbar Ali, Ailia Wilayat Ali, Saadia Z Farooqui, Vikram Mehraj, Afia Zafar

Department of Pathology and Laboratory Medicine

Background: Seroconversion rates reported after Hepatitis B virus (HBV) vaccination globally ranges from 85–90%. Health care workers (HCWs) are at high risk of acquiring HBV and non responders' rates after HBV vaccination were not reported previously in Pakistani HCWs. Therefore we evaluated immune response to HBV vaccine in HCWs at a tertiary care hospital in Karachi, Pakistan.
Methods: Descriptive observational study conducted at Aga Khan University from April 2003 to July 2004. Newly HBV vaccinated HCWs were evaluated for immune response by measuring serum Hepatitis B surface antibody (HBsAb) levels, 6 weeks post vaccination.
Results: Initially 666 employees were included …

Antimicrobial Resistance In Neisseria Gonorrhoeae And Limited Treatment Options, Afia Zafar, Kauser Jabeen

Department of Pathology and Laboratory Medicine

No abstract provided.

Functional Interplay Between The B-Box 2 And The B30.2(Spry) Domains Of Trim5Α, Xi Ling, Byeongwoon Song, Shi-Hua Xiang, Joseph Sodroski

Nebraska Center for Virology: Faculty Publications

The retroviral restriction factors, TRIM5α and TRIMCyp, consist of RING and B-box 2 domains separated by a coiled coil from carboxy-terminal domains. These carboxy-terminal domains (the B30.2(SPRY) domain in TRIM5α and the cyclophilin A domain in TRIMCyp) recognize the retroviral capsid. Here we show that some B-box 2 changes in TRIM5α, but not in TRIMCyp, resulted in decreased human immunodeficiency virus (HIV-1) capsid binding. The phenotypic effects of these B-box 2 changes on the restriction of retroviral infection depended on the potency of restriction and the affinity of the TRIM5α interaction with the viral capsid, two properties specified by the …

Characterization Of Human Immunodeficiency Virus Type 1 Monomeric And Trimeric Gp120 Glycoproteins Stabilized In The Cd4-Bound State: Antigenicity, Biophysics, And Immunogenicity, Barna Dey, Marie Pancera, Krisha Svehla, Yuuei Shu, Shi-Hua Xiang, Jeffrey Vainshtein, Yuxing Li, Joseph Sodroski, Peter D. Kwong, John R. Mascola, Richard Wyatt

Nebraska Center for Virology: Faculty Publications

The human immunodeficiency virus type 1 exterior gp120 envelope glycoprotein is highly flexible, and this flexibility may contribute to the inability of monomeric gp120 immunogens to elicit broadly neutralizing antibodies. We previously showed that an S375W modification of a critical interfacial cavity central to the primary receptor binding site, the Phe43 cavity, stabilizes gp120 into the CD4-bound state. However, the immunological effects of this cavity-altering replacement were never tested. Subsequently, we screened other mutations that, along with the S375W alteration, might further stabilize the CD4-bound state. Here, we define a selected second cavity-altering replacement, T257S, and analyze the double mutations …

Georgeoral Immunization Of Rhesus Macaques With Adenoviral Hiv Vaccines Using Enteric-Coated Capsules, George T. Mercier, Pramod N. Nehete, Marco F. Passeri, Bharti N. Nehete, Eric A. Weaver, Nancy Smyth Templeton, Kimberly Schluns, Stephanie S. Buchl, K. Jagannadha Sastry, Michael A. Barry

Nebraska Center for Virology: Faculty Publications

Targeted delivery of vaccine candidates to the gastrointestinal (GI) tract holds potential for mucosal immunization, particularly against mucosal pathogens like the human immunodeficiency virus (HIV). Among the different strategies for achieving targeted release in the GI tract, namely the small intestine, pH sensitive enteric coating polymers have been shown to protect solid oral dosage forms from the harsh digestive environment of the stomach and dissolve relatively rapidly in the small intestine by taking advantage of the luminal pH gradient. We developed an enteric polymethacrylate formulation for coating hydroxy-propyl-methyl-cellulose (HPMC) capsules containing lyophilized Adenoviral type 5 (Ad5) vectors expressing HIV-1 gag …

Lupine Allergy: Not Simply Cross-Reactivity With Peanut Or Soy, Kim A. B. M. Peeters, Julie A. Nordlee, André H. Penninks, Lingyun Chen, Richard E. Goodman, Carla A. F. M. Bruijnzeel-Koomen, Sue L. Hefle, Steve L. Taylor, André C. Knulst

Department of Food Science and Technology: Faculty Publications

Background: Reports of lupine allergy are increasing as its use in food products increases. Lupine allergy might be the consequence of cross-reactivity after sensitization to peanut or other legumes or de novo sensitization. Lupine allergens have not been completely characterized.

Objectives: We sought to identify allergens associated with lupine allergy, evaluate potential cross-reactivity with peanut, and determine eliciting doses (EDs) for lupine allergy by using double-blind, placebo-controlled food challenges.

Methods: Six patients with a history of allergic reactions to lupine flour were evaluated by using skin prick tests, CAP tests, and double-blind, placebo-controlled food challenges. Three of …

Episiotomy And Obstetric Trauma In Nevada: Evidence From Linked Hospital Discharge And Birth Data, Gulzar H. Shah, Joseph A. Greenway, Wei Yang

Nevada Journal of Public Health

Based on the perception that episiotomy prevents obstetric trauma, the procedure is liberally performed in U.S. Hospitals. Using linked Nevada Birth Registry and Nevada Impatient Hospital Discharges (2000 to 2005), we applied descriptive analyses and logistic regression to examine the status of Nevada episiotomy practice and its impact on birth trauma for mothers. Of 106,461 vaginal live births, 26,383 (24.8%) episiotomies were conducted. Obstetric trauma rate declined from 5.2% of vaginal deliveries in 2000 to 4.4% in 2005. After statistically controlling for the effect of other risk factors, zero parity, episiotomy, other instrument assisted deliveries, non-MDs as birth attendants, rural …

Pulmonary Artery Catheter Knotting In A Coronary Artery Bypass Surgery Patient, Mohammad Irfan Akhtar, Mohammad Hamid, Fazal Hameed Khan, Hamid Iqil Naqvi, Amar Gangwani

Department of Anaesthesia

A fifty seven years old female patient came to operating room for coronary artery bypass grafting (CABG) surgery. After induction, invasive monitoring lines were placed. Pulmonary artery catheter (PAC) floated after three attempts and it was wedged at 60cm. Intra operative course was smooth and patient transferred to cardiac intensive care unit (CICU). First chest X-ray revealed PAC knotting in the right ventricle. Vascular surgeon was involved and he removed it through right internal jugular vein under fluoroscopic guidance. Pulmonary arterial catheterization is an invasive procedure. Knotting usually occurs due to excessive advancement of the pulmonary artery catheter beyond the …

Planning An Integrated Disease Surveillance And Response System: A Matrix Of Skills And Activities, Helen N. Perry, Sharon M. Mcdonnell, Wondimagegnehu Alemu, Peter Nsubuga

Dartmouth Scholarship

The threat of a global influenza pandemic and the adoption of the World Health Organization (WHO) International Health Regulations (2005) highlight the value of well-coordinated, functional disease surveillance systems. The resulting demand for timely information challenges public health leaders to design, develop and implement efficient, flexible and comprehensive systems that integrate staff, resources, and information systems to conduct infectious disease surveillance and response. To understand what resources an integrated disease surveillance and response system would require, we analyzed surveillance requirements for 19 priority infectious diseases targeted for an integrated disease surveillance and response strategy in the WHO African region.

Biliary Tract Obstruction In Chronic Pancreatitis, Abdallah Abdulkarim, Jake E. J. Krige, Philippus C. Bornman

General Surgery, East Africa

Bile duct strictures are a common complication in patients with advanced chronic pancreatitis and have a variable clinical presentation ranging from an incidental finding to overt jaundice and cholangitis. The diagnosis is mostly made during investigations for abdominal pain but jaundice may be the initial clinical presentation. The jaundice is typically transient but may be recurrent with a small risk of secondary biliary cirrhosis in longstanding cases. The management of a bile duct stricture is conservative in patients in whom it is an incidental finding as the risk of secondary biliary cirrhosis is negligible.

Initial conservative treatment is advised in …

Reverse Sural Island Flap In Coverage Of Defects Lower Third Of Leg: A Series Of Nine Cases, S. O. Khainga, B. Githae, V. M. Mutiso, Ronald Wasike

General Surgery, East Africa

The distally based sural island flap was first described by Masquelet, et al, in 1992. It is a skin island flap supplied by the vascular axis of the sural nerve. lhe aim of this paper is to demonstrate that it can be applied in coverage of difficult wound in the lower third of the leg. We treated nine patients with nine distally based sural island flaps. All the flaps survived, most of the flaps had venous congestion. The largest flap was 10 x 8 em and Doppler was used in only one flap. This technique is easy and quick to …

Premedication In Surgical Day Care Patients, Saminal Ismail, Fauzia A. Khan, Aliya Ahmed, Khalid A. Shah

Department of Anaesthesia

The purpose of this audit was to find out the efficiency
of our system in providing premedication to surgical day
care patients. This audit was conducted in the Surgical Day
Care (SDC) Unit of a University Hospital. All patients
anaesthetised in the SDC unit on day care basis were included
in this audit. Nursing notes and preoperative orders of all
patients to be anaesthetised were checked to see whether
premedication was given or not and was the timing according
to the orders written. The result showed that out of 205
patients scheduled, twenty (9.7%) patients did not receive
premedication. Only …

Impact Of Antibiotic Restriction On Broad Spectrum Antibiotic Usage In The Icu Of A Developing Country, Shahla Siddiqui, Kashif Hussein, Roshan Manasia, Aijaz Samad, Nawal Salahuddin, Afia Zafar, M. Qamarul Hoda

Department of Anaesthesia

Objective: To reduce rates of nosocomial pneumonia and cost of antibiotic therapy.
Methods: By means of a policy implementation the following broad spectrum antibiotics were restricted to usage in the ICU for 72 hours: Cefepime, Meropenem, Imipenem, Tazocin, Polymixin B and Vancomycin, after an institutional based pharmacy and therapeutic committee approval. The ICU pharmacist would alert the ICU residents or consultants after 48 hours of the computer based antibiotic entry that the order would expire within hours. Telephone approval was obtained followed by a formal consultation if deemed necessary by the ID specialist or primary team. Antibiotic usage was …

Anaesthesia For Interventional Neuroradiology, Aliya Ahmed

Department of Anaesthesia

There have been rapid and significant advances in diagnostic and interventional radiology, including interventional neuroradiology, in recent years. Many intracranial vascular pathologies are being successfully managed by endovascular interventional neuroradiology techniques. These techniques include procedures like embolization of vascular tumours and arterio-venous malformations, coiling of cerebral aneurysms. etc. The support of anaesthesia team is requested for these therapeutic endovascular neuroradiological procedures. The main aims of the anaesthesiologist during any interventional neuroradiology procedure are provision of a physiologically stable and immobile patient, alteration of arterial blood pressure as necessary, and appropriate and timely management of complications. Provision of anaesthesia in remote …

Haemodynamic Response To Tracheal Intubation Via Intubating Laryngeal Mask Airway Versus Direct Laryngoscopic Tracheal Intubation, Naveed Tahir Siddiqui, Fazal Hameed Khan

Department of Anaesthesia

Objective: To compare the haemodynamic response to tracheal intubation using either direct larygoscopy or Intubating Laryngeal Mask Airway.
Methods: This was a prospective randomized controlled trial. One hundred adult ASA-I and ASA - II patients coming to the Anaesthesia Department of Aga Khan University Hospital were randomly divided into two groups. In group- I endotracheal intubation was done with the help of Macintosh laryngoscope while in group-II patients were intubated with the help of the Intubating Laryngeal Mask Airway. Systolic, diastolic, mean arterial blood pressure and heart rate were recorded at baseline, at laryngoscopy and at 1 minute interval for …

Use Of Self Home-Made Diaphragm For Protection Against Pregnancy And Sexually-Transmitted Infections: Case Report., Andrew W. Schroth, Stanley Luchters, M F. Luchters, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

No abstract provided.

Solitary Infantile Myofibromatosis Of The Skull, Farah Naz, Zafar Nazir, Khalid Chishti, Nadeem Aslam, Salman Siddiqui

Department of Surgery Docs

This is the report of a 6 months old boy presenting with a firm, solitary mass on the temporal region, associated with lysis of local bone. Investigations lead to a diagnosis of infantile myofibromatosis (IM). Wide local excision was performed. At one year follow-up, no recurrence was noted.

Prevalence And Predictors Of Smokeless Tobacco Use Among High-School Males In Karachi, Pakistan, S Rozi, S Akhtar

Community Health Sciences

A cross-sectional study was conducted in 3 towns in Karachi, Pakistan to investigate the prevalence of and factors associated with the use of smokeless tobacco among 772 high-school adolescent males. A structured questionnaire collected data on sociodemographic factors and history of cigarette and smokeless tobacco use. Prevalence of smokeless tobacco use (gutka, snuff, niswar) was 16.1% (95% CI: 13.5%-18.9%). On multiple logistic regression analysis, the factors significantly related to smokeless tobacco use among the sample were: attending government school [adjusted odds ratio (OR) 6.3], smoking cigarettes (OR 3.2), not seeing anti-tobacco advertisements (OR 1.5), family history of tobacco use (OR …

Successful Outcome Of A Pregnancy In A Woman With Advanced Cirrhosis Due To Hepatitis B Surface Antigenemia, Delta Super-Infection And Hepatitis C Co-Infection: A Case Report, Amna Subhan, Shahab Abid, Wasim Jafri

Section of Gastroenterology

Pregnancy in women with advanced liver disease is rare. In this paper we described the case of a successful pregnancy in a young woman with advanced cirrhosis due to hepatitis B surface antigenemia, hepatitis delta super-infection and Hepatitis C co-infection. A brief review of the medical literature on pregnancy in women with cirrhosis is also presented.

Sir/Rsna/Cirse Joint Medical Simulation Task Force Strategic Plan: Executive Summary, Derek Gould, Aalpen Patel, Gary Becker, Buddy Conners, John Cardella, Steven Dawson, Craig Glaiberman, David Kessel, Mick Lee, Mark Scerbo

Psychology Faculty Publications

(First paragraph) The Executive Councils of the Society of Interventional Radiology (SIR), Radiological Society of North America (RSNA), and Cardiovascular and Interventional Radiological Society of Europe (CIRSE) have charged their Medical Simulation Task Forces and Work Groups to cooperate to achieve excellence and safety in interventional radiology patient care by jointly recommending and guiding implementation of a robust infrastructure and process to support Interventional Radiology (IR) simulation development, assessment, validation, application, and dissemination.

Variant Merozoite Protein Expression Is Associated With Erythrocyte Invasion Phenotypes In Plasmodium Falciparum Isolates From Tanzania, A.K. Bei, C.D. Membi, J.C. Rayner, M. Mubi, B. Ngasala, A.A. Sultan, Zul Premji, M.T. Duraisingh

Pathology, East Africa

[No abstract available]

Cost Of Diabetes Care In Out-Patient Clinics Of Karachi, Pakistan, Liaquat A. Khowaja, Ali K. Khuwaja, Peter Cosgrove

Community Health Sciences

Background: Diabetes Mellitus (DM) is a growing epidemic and the cost of treating diabetes is largely increasing. The objective of this study was to estimate the cost-of-illness of DM among attendees of out-patient clinics in Karachi, Pakistan. This is the first study conducted from a societal perspective to estimate the cost of managing diabetes in Pakistan.Methods: A prevalence-based 'Cost-of-Illness' study for diabetes care was conducted in six different out-patient clinics of Karachi, Pakistan from July to September 2006. A pre-tested questionnaire was administered to collect the data from 345 randomly selected persons with diabetes.Results: The annual mean direct cost for …

Developmental Variations In Plasma Leptin, Leptin Soluble Receptor And Their Molar Ratio In Healthy Infants, Winston Wk Koo, Mouhanad Hammami, Elaine M. Hockman

Wayne State University Associated BioMed Central Scholarship

Abstract

Background

Leptin and its soluble receptor (sOB-R) are important to regulation of body composition but there are no data on the developmental variations in these plasma variables and their relationship with body composition measurements,

Methods

Weight, length, and body composition (bone, fat and lean mass) by dual energy absorptiometry, and plasma variables were measured in healthy infants at 2, 4, 8 and 12 months.

Results

15 whites and 29 African Americans (21 males and 23 females) with mean birth weight 3357 +/- 45 (SEM) g and gestation of 39.3 +/- 0.17 weeks were studied. The overall Z score for …

Reduction Of Astrogliosis And Microgliosis By Cerebrospinal Fluid Shunting In Experimental Hydrocephalus, Janet M. Miller, James P. Mcallister Ii

Wayne State University Associated BioMed Central Scholarship

Abstract

Background

Reactive gliosis has the potential to alter biomechanical properties of the brain, impede neuronal regeneration and affect plasticity. Determining the onset and progression of reactive astrogliosis and microgliosis due to hydrocephalus is important for designing better clinical treatments.

Methods

Reactive astrogliosis and microgliosis were evaluated as the severity of hydrocephalus increased with age in hydrocephalic H-Tx rats and control littermates. Previous studies have suggested that gliosis may persist after short-term drainage (shunt treatment) of the cerebrospinal fluid. Therefore shunts were placed in 15d hydrocephalic rats that were sacrificed after 6d (21d of age) or after 21d (36d of …