Medicine and Health Sciences Commons^™

Psychological Stress Among Family Practice Patients Visiting A Teaching Hospital In Karachi, Waris Qidwai, Malika Kassamali

Department of Family Medicine

Objective: To study psychological stress among family practice patients to highlight its importance.
Design: A cross sectional study. Setting: Family Practice Center of Aga Khan University Hospital, Karachi - Pakistan, in July 2003. Patients and Methods: Family practice patients were interviewed without using any systematic randomization. A questionnaire was developed that included data on demographic profile of the patient and questions on patient perceptions whether they were in stress or not, the degree of stress if perceived to be present and its causes including need to seek medical help. They were simultaneously administered a stress screening questionnaire that …

Castleman's Disease -- A Rare Disease Of Lymph Nodes, Mohammad Zakiullah, Zafaruddin Khan, Riaz Qureshi, Suhail Muzaffar

Department of Family Medicine

Castleman's disease is a rare disorder of unknown etiology and different clinical manifestations, occurring in young adults (usually prior to age 30 years). In this case report we present one such case who was a 16 years old male with abdominal pain, weight loss, cervical lymph adenopathy and hepatosplenomegaly. Lymph node biopsy revealed hyaline-vascular type of Castleman's disease. He was put on chemotherapy but was lost to follow-up.

Effect Of A Paediatric Incentive Spacer And Reinforcement Of Inhalation Technique Training In Preschool Children, Jasminka Murdzoska

Theses : Honours

Incorrect inhaled drug delivery technique is a common problem in paediatric asthma [1-4]. Previously, device technique training has been shown to significantly improve inhaler skills, using subjective methods, namely check-list analysis [5-8]. However, more objective measures are needed to examine more comprehensively the effect of training in preschool children and parents. Resistance to regular asthma therapy is also a frequent problem when attempting to treat young children. Reasoning with young children can be very difficult and parents often have to struggle with their child to achieve compliance [2]. The Funhaler spacer (FH) (Funhaler™; InfaMed, Australia) has been developed in an …

Retrospective Evaluation Of The Rockall Risk Scoring System In Patients With Nonvariceal Upper Gastrointestinal Hemorrhage At A Community Hospital, Mona D. Patel

Master's Theses and Doctoral Dissertations

Despite advances in diagnosis and treatment of patients with upper gastrointestinal hemorrhage (UGIH), the majority of hospitals do not risk-stratify patients with UGIH. One of the major challenges in triaging patients with nonvariceal UGIH is identifying patients’ who are at low risk. We retrospectively identified Rockall scores of 160 patients and the proportion of low-risk patients seen in the Emergency Department at Saint Joseph Mercy Hospital (SJMH) over a one-year period. Additionally, we determined adverse outcomes and healthcare resources utilized and evaluated whether certain antiplatelet agents, anticoagulants, and NSAIDS affected the Rockall scores. The Rockall scoring system identified 21% of …

Spectrum Of Neurological Involvement In Adult Patients With Bacterial Endocarditis, Faisal Wasim Ismail, Muhammad Tariq, Mahboob Alam, Raymond A Smego

Section of Internal Medicine

Objective: To describe the spectrum of neurological involvement, and document in-hospital mortality in adult patients with bacterial endocarditis.
Design: Descriptive, non-interventional.
Place and duration of study: Department of Gastroenterology, The Aga Khan University Hospital, Karachi from November 1999 to October 2002.
Patients and methods: Patients were enrolled from the emergency and outpatient departments, using purposive, non-probability sampling, provided they fulfilled pre-defined inclusion and exclusion criteria. Case records of patients admitted to hospital with a diagnosis of bacterial endocarditis were prospectively analyzed. Data was entered and analyzed on SPSS 11. Frequency, Mean, Mode and Percentage were calculated.
Results: Neurological complications were …

Innate Antiviral Response Targets Hiv-1 Release By The Induction Of Ubiquitin-Like Protein Isg15, Atsushi Okumura, Gengshi Lu, Ian Pitha-Rowe, Paula M. Pitha

Dartmouth Scholarship

The goal of this study was to elucidate the molecular mechanism by which type I IFN inhibits assembly and release of HIV-1 virions. Our study revealed that the IFN-induced ubiquitin-like protein ISG15 mimics the IFN effect and inhibits release of HIV-1 virions without having any effect on the synthesis of HIV-1 proteins in the cells. ISG15 expression specifically inhibited ubiquitination of Gag and Tsg101 and disrupted the interaction of the Gag L domain with Tsg101, but conjugation of ISG15 to Gag or Tsg101 was not detected. The inhibition of Gag-Tsg101 interaction was also detected in HIV-1 infected, IFN-treated cells. Elimination …

The Use Of The Tripartite Model Of Attitudes To Explain Ems Providers' Attitudes About The Ems Agenda For The Future, Carolyn Angela Rinaca

Health Services Research Dissertations

A dynamic and revolutionary health care system compels the Nation to develop a more cohesive, unified healthcare workforce. The Emergency Medical Services (EMS) profession has contributed to this development with the publication of the EMS Agenda for the Future. The EMS Agenda for the Future describes the future direction for emergency medical services agencies and organizations within the nation. It is a vision that integrates EMS systems with other health care professions. The EMS Agenda for the Future is designed to assist EMS professionals in realizing their full potential for proficiency and contributes to the development of the EMS profession. …

Engendering Student Empathy For Disabled Clients With Urinary Incontinence Through Experiential Learning, Karen A. Karlowicz, Kay L. Palmer

Ellmer School of Nursing Faculty Publications

As part of a rehabilitation clinical course for senior baccalaureate nursing students, a disability-incontinence experiential learning activity is required. The assignment is intended to familiarize students with some of the challenges encountered by a client with mobility problems, including continence management issues using disposable undergarments. Wearing the undergarments dry and wet while being confined to a wheelchair provides insight and promotes empathy for patients with bladder control problems.

Unplanned Prolonged Postanaesthesia Care Unit Length Of Stay And Factors Affecting It, Khalid Samad, Mueenullah Khan, Hameedullah, Fauzia A. Khan, Mohammad Hamid, Fazal Hameed Khan

Department of Anaesthesia

Objective: To identify the factors that prolong the length of stay in the post anaesthesia care unit (PACU).
Methods: This audit was conducted in the PACU of a university hospital. A special form was designed and filled for those patients who stayed unplanned in the PACU for more than two hours. All patients who were admitted to the PACU after surgery were included. Patients undergoing cardiothoracic surgery, those directly shifted to ICU and cases done under local anaesthesia were excluded. Data was collected for 20 months by a designated recovery nurse for all included patients including those admitted …

The Role Of Prophylactic Intra-Aortic Balloon Pump Counterpulsation (Iabp) In Emergency Non-Cardiac Surgery, Khalid Samad, Fauzia Anis Khan

Department of Anaesthesia

Patients with recent myocardial infarction (MI), congestive heart failure, severe angina, or uncorrected multivessel coronary artery disease are at increased risk of cardiac complications after urgent major non-cardiac surgery. Although invasive haemodynamic monitoring and preoperative optimization of cardiac status may lead to some reduction in the rate of perioperative cardiac events, the mortality from such events still remains high. The use of an intra-aortic balloon pump (IABP) may play a role in such patients by improving the function of the injured heart. We report our experience with the use of perioperative IABP in a patient with unstable angina and recent …

Classification And Risk Stratification Of Invasive Breast Carcinomas Using A Real-Time Quantitative Rt-Pcr Assay., Laurent Perreard, Cheng Fan, John F Quackenbush, Michael Mullins, Nicholas P Gauthier, Edward Nelson, Mary Mone, Heidi Hansen, Saundra S Buys, Karen Rasmussen, Alejandra Ruiz Orrico, Donna Dreher, Rhonda Walters, Joel Parker, Zhiyuan Hu, Xiaping He, Juan P Palazzo, Olufunmilayo I Olopade, Aniko Szabo, Charles M Perou, Philip S Bernard

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

INTRODUCTION: Predicting the clinical course of breast cancer is often difficult because it is a diverse disease comprised of many biological subtypes. Gene expression profiling by microarray analysis has identified breast cancer signatures that are important for prognosis and treatment. In the current article, we use microarray analysis and a real-time quantitative reverse-transcription (qRT)-PCR assay to risk-stratify breast cancers based on biological 'intrinsic' subtypes and proliferation. METHODS: Gene sets were selected from microarray data to assess proliferation and to classify breast cancers into four different molecular subtypes, designated Luminal, Normal-like, HER2+/ER-, and Basal-like. One-hundred and twenty-three breast samples (117 invasive …

Paired-Pulse Depression At Photoreceptor Synapses., Katalin Rabl, Lucia Cadetti, Wallace B. Thoreson

Journal Articles: Ophthalmology

Synaptic depression produced by repetitive stimulation is likely to be particularly important in shaping responses of second-order retinal neurons at the tonically active photoreceptor synapse. We analyzed the time course and mechanisms of synaptic depression at rod and cone synapses using paired-pulse protocols involving two complementary measurements of exocytosis: (1) paired whole-cell recordings of the postsynaptic current (PSC) in second-order retinal neurons and (2) capacitance measurements of vesicular membrane fusion in rods and cones. PSCs in ON bipolar, OFF bipolar, and horizontal cells evoked by stimulation of either rods or cones recovered from paired-pulse depression (PPD) at rates similar to …

Coping Processes Of Couples Experiencing Infertility, Brennan Peterson, Christopher R. Newton, Karen H. Rosen, Robert S. Shulman

Psychology Faculty Articles and Research

This study explored the coping processes of couples experiencing infertility. Participants included 420 couples referred for advanced reproductive treatments. Couples were divided into groups based on the frequency of their use of eight coping strategies. Findings suggest that coping processes, which are beneficial to individuals, may be problematic for one's partner. Couples where men used high amounts of distancing, while their partner used low amounts of distancing, reported higher levels of distress when compared to couples in the other groups. Conversely, couples with women who used high amounts of self-controlling coping, when paired with men who used low amounts of …

Development Of An Audio Visual Tool For Medical Training At Kennedy Space Center, Rimawi, Nidal El

Browse all Theses and Dissertations

As part of an effort to improve efficiency of space-flight medical support at Kennedy Space Center, a training video was created to replace a series of lectures given before a launch or landing of the Space Shuttle. The video was designed to familiarize volunteer physicians from around the country with the specific emergency response protocols for a Space Shuttle launch or landing emergency at Kennedy Space Center. The methods used were consistent with standard film making techniques as outlined in several film making texts. The Production was divided into three phases; A pre-production phase wherein the research, screenwriting and production …

Significance Of Cytogenetic Abnormalities In Acute Myeloid Leukaemia, Mahadev S. Harani, Salman Adil, Ghulam Nabi Kakepoto, Zahida Khilji, Usman Shaikh, Mohammad Khurshid

Department of Pathology and Laboratory Medicine

Objective: To evaluate the role of karyotype in acute myeloid leukaemia (AML) as a predictor of response to induction chemotherapy.
Methods: A cross-sectional study was carried out at the department of Pathology and Oncology, Aga Khan University Karachi from January 2003 to January 2005. Newly diagnosed patients with denovo AML admitted to the hospital were included in the study. Diagnosis of AML was based on FAB criteria, immunophenotyping and cytogenetic studies. They were treated according to standard protocols (combination of anthracycline and cytarabine -3+7) and those who had acute promyelocytic leukaemia additionally received all- trans retinoic acid (ATRA). …

Clinico-Pathologic Features Of Chronic Myeloid Leukemia And Risk Stratification According To Sokal Score, Naveen Naz Syed, Mikal Usman, Gulnaz Khaliq, Salman Adil, Mohammad Khurshid

Department of Pathology and Laboratory Medicine

To compile the clinical and haematological parameters of chronic myeloid leukemia (CML) and risk stratification according to Sokal score in our population. A descriptive analysis. The Aga Khan University Hospital, during the period from August 1997 to August 2005. All patients with diagnosis of chronic myeloid leukemia treated as outpatient in haematology clinic, or admitted in haem-oncology wards in The Aga Khan University Hospital were included. Records were retrospectively analyzed for clinicopathologic features. Risk groups were assigned as per Sokal scoring. During the 8 years study period, 245 patients with chronic myeloid leukemia were analyzed, the median age of presentation …

Design Clues From Functional Constraints And Broadly Neutralizing Antibodies, Tongqing Zhou, Ling Xu, Barna Dey, Ann J. Hessell, Shahzad Majeed, Donald Van Ryk, Shi-Hua Xiang, Xinzhen Yang, Mei-Yun Zhang, Michael B. Zwick, James Arthos, Dennis R. Burton, Dimiter S. Dimitrov, Joseph Sodroski, Richard Wyatt, Gary J. Nabel, Peter D. Kwong

Nebraska Center for Virology: Faculty Publications

No abstract provided.

Cross-Subtype T-Cell Immune Responses Induced By A Human Immunodeficiency Virus Type 1 Group M Consensus Env Immunogen, Eric A. Weaver, Zenaido T. Camacho, Fatiha Moukdar, Hua-Xin Liao, Ben-Jiang Ma, Mark Muldoon, James Theiler, Gary J. Nabel, Norman L. Letvin, Bette T. Korber, Beatrice H. Hahn, Barton F. Haynes, Feng Gao, Zhongjing Lu

Nebraska Center for Virology: Faculty Publications

The genetic diversity among globally circulating human immunodeficiency virus type 1 (HIV-1) strains is a serious challenge for HIV-1 vaccine design. We have generated a synthetic group M consensus env gene (CON6) for induction of cross-subtype immune responses and report here a comparative study of T-cell responses to this and natural strain env immunogens in a murine model. Three different strains of mice were immunized with CON6 as well as subtype A, B, or C env immunogens, using a DNA prime-recombinant vaccinia virus boost strategy. T-cell epitopes were mapped by gamma interferon enzyme-linked immunospot analysis using five overlapping Env peptide …

Perforated Meckel's Diverticulitis Presenting As A Mesenteric Abscess: Case Report, Ronald Wasike, Hassan Saidi

General Surgery, East Africa

Only 2% of patients with Meckel’s diverticulae (MD) will manifest clinical problems. Diverticulitis occurs in approximately 10-20% of patients with symptomatic MD and more often in the elderly population. We report a case of Meckels diverticulitis presenting with perforation and mesenteric abscess in a young African man. The authors present information on diagnostic pitfalls and advise a lower threshold for consideration of MD as a differential diagnosis of acute right iliac fossa pain especially when the CT scan denotes a normal appendix in a male patient.

Gender Differences In How Men And Women Referred With In Vitro Fertilization (Ivf) Cope With Infertility Stress, Brennan Peterson, C. R. Newton, K. H. Rosen, G. E. Skaggs

Psychology Faculty Articles and Research

Men and women use a variety of coping strategies to manage stress associated with infertility. While previous research has helped us understand these coping processes, questions remain about gender differences in coping and the nature of the relationship between coping and specific types of infertility stress. Methods: This study examined the coping behaviors of 1,026 (520 women, 506 men) consecutively referred patients at a Universityaffiliated teaching hospital. Participants completed the Ways of Coping Questionnaire, Fertility Problem Inventory, and the Dyadic Adjustment Scale. Results: Women used proportionately greater amounts of confrontive coping, accepting responsibility, seeking social support, and escape/avoidance when compared …

Breast Cancer Risk Factor Knowledge Among Nurses In Teaching Hospitals Of Karachi, Pakistan: A Cross-Sectional Study, Faiza Ahmed, Sadia Mahmud, Juanita Hatcher, Shaista M. Khan

Community Health Sciences

Background: Breast cancer is the most common cancer among women in both the developed and the developing world. The incidence of breast cancer in Karachi, Pakistan is 69.1 per 100,000 with breast cancer presentation in stages III and IV being common (>or= 50%). The most pragmatic solution to early detection lies in breast cancer education of women. Nurses constitute a special group having characteristics most suited for disseminating breast cancer information to the women. We assessed the level of knowledge of breast cancer risk factors among registered female nurses in teaching hospitals of Karachi. We also identified whether selected …

Migrating Foreign Body In The Thyroid Gland, An Unusual Case, Tatheer Zohra, Mubasher Ikram, Moghira Iqbal, Shabbir Akhtar, Seyed Akbar Abbas

Section of Otolaryngology, Head & Neck Surgery

In literature various cases have been described where foreign bodies ingested were lodged in the upper aero digestive tract, but only few of these foreign bodies perforate the oesophagus and an even fewer migrate extraluminally.1 If untreated, they may result in life threatening suppurative or vascular complications. Exploration of the neck via an external approach to remove the foreign body is the recommended treatment. The CT scan utilizing fine cuts is invaluable in localizing the foreign body for exploration. Oesophageal penetration and migration of oesophageal foreign bodies into the thyroid gland is extremely rare with only occasional case reports appearing …

Fine Needle Aspiration Cytology Of Thyroid Nodule: Diagnostic Accuracy And Pitfalls, Saeed A. Mahar, Akhtar Husain, Najmul Islam

Section of Diabetes, Endocrinology and Metabolism

Background: To evaluate the utility of FNAC in patients with Thyroid Nodule.

Methods: Records of all patients treated surgically for thyroid nodule(s) at Aga Khan University Hospital from January 2000 to December 2004 were reviewed. The patients who had pre operative FNAC as first line of the evaluation and the final post operative histopathology report available were included in the study.

Results: 125 patients (90 female 35 male) had thyroid surgery. The cytological diagnosis was made according to following categories: Benign, Follicular lesion, Malignant and Inadequate sampling. Among 63 "Benign cases", 57 were benign and 6 turned out …

Acceptability And Outcomes Of The Percutaneous Endoscopic Gastrostomy (Peg) Tube Placement--Patients' And Care Givers' Perspectives, Muhammad K. Anis, Shahab Abid, Wasim Jafri, Zaigham Abbas, Hasnain A. Shah, Saeed Hamid, Rozina Wasaya

Section of Gastroenterology

Background: Percutaneous endoscopic gastrostomy tube has now become a preferred option for the long-term nutritional support device for patients with dysphagia. There is a considerable debate about the health issues related to the quality of life of these patients. Our aim of the study was to assess the outcome and perspectives of patients/care givers, about the acceptability of percutaneous endoscopic gastrostomy tube placement.

Methods: This descriptive analytic study conducted in patients, who have undergone percutaneous endoscopic gastrostomy tube placement during January 1998 till December 2004. Medical records of these patients were evaluated for their demographic characteristics, underlying diagnosis, indications …

Automatic Colonic Polyp Detection Using Multiobjective Evolutionary Techniques, Jiang Li, Adam Huang, Jianhua Yao, Ingmar Bitter, Nicholas Petrick, Ronald M. Summers, Perry J. Pickhardt, J. Richard Choi

Electrical & Computer Engineering Faculty Publications

Colonie polyps appear like elliptical protrusions on the inner wall of the colon. Curvature based features for colonie polyp detection have proved to be successful in several computer-aided diagnostic CT colonography (CTC) systems. Some simple thresholds are set for those features for creating initial polyp candidates, sophisticated classification scheme are then applied on these polyp candidates to reduce false positives. There are two objective functions, the number of missed polyps and false positive rate, that need to be minimized when setting those thresholds. These two objectives conflict and it is usually difficult to optimize them both by a gradient search. …

Relationship Between Antipyretic Effects And Cytokine Levels In Uncomplicated Falciparum Malaria During Different Treatment Regimes, Elisabeth Hugosson, Scott M. Montgomery, Zul Premji, Marita Troye-Blomberg, Anders Bjorkman

Pathology, East Africa

We have previously shown that both chloroquine and paracetamol (acetaminophen) have antipyretic activity during treatment of acute uncomplicated Plasmodium falciparum malaria in children 1-4 years old. Here, we studied if this effect was accompanied by changes in plasma cytokine levels. The 104 children were treated with either chloroquine or sulfadoxine/pyrimethamine (SP) alone, SP + chloroquine or SP + paracetamol for 4 days. Cytokine levels were determined days 0, 2 and 3, body temperature every sixth hour until 72 h and parasitemia once daily for 4 days. At admission, body temperature correlated with levels of IL-10, IFN-γ and IL-6, and parasitemia …

Psycho-Social Consequences Of Secondary Infertility In Karachi., Neelofar Sami, Tazeen Saeed Ali

Community Health Sciences

OBJECTIVE:

To explore the experiences of social consequences among women suffering from secondary infertility.

METHODS:

Descriptive case series of 400 women with secondary infertility attending tertiary care hospitals in Karachi, Pakistan.

RESULTS:

More than two thirds (67.7%) of women stated that their inability to give live births or give birth to sons had resulted in marital dissonance. The respondents had been threatened for divorce (20%), husband's remarrying (38%) or to be returned to their parent's home (26%) by their in laws or husbands. Majority (68%) of the women threatened did not have any live births. However, those who had live …

3,3′-Diindolylmethane And Paclitaxel Act Synergistically To Promote Apoptosis In Her2/Neu Human Breast Cancer Cells, Kandace P. Mcguire, N. Ngoubilly, M. Neavyn, Susan Lanza-Jacoby

Department of Surgery Faculty Papers

Background. HER2/neu positive breast tumors are difficult to treat. About 25 to 30% of invasive breast tumors overexpress the HER2/neu oncogene. These tumors are aggressive and become resistant to chemotherapeutic drugs. 3,3′-diindolylmethane (DIM), the active metabolite of indole-3-carbinol, a naturally occurring compound found in cruciferous vegetables, has been found to have anti-cancer properties in both humans and animals. DIM has been shown to induce cell cycle arrest and apoptosis in animal breast cancer models. Because HER2/neu overexpression confers resistance to paclitaxel, and DIM has anti-tumor effects, we hypothesized that DIM will enhance the cytotoxic effects of paclitaxel, a common …

Analysis Of Epstein-Barr Virus Reservoirs In Paired Blood And Breast Cancer Primary Biopsy Specimens By Real Time Pcr., R Serene Perkins, Katherine Sahm, Cindy Marando, Diana Dickson-Witmer, Gregory R Pahnke, Mark Mitchell, Nicholas J Petrelli, Irving M Berkowitz, Patricia Soteropoulos, Virginie M Aris, Stephen P Dunn, Leslie J Krueger

Department of Surgery Faculty Papers

INTRODUCTION: Epstein-Barr virus (EBV) is present in over 90% of the world's population. This infection is considered benign, even though in limited cases EBV is associated with infectious and neoplastic conditions. Over the past decade, the EBV association with breast cancer has been constantly debated. Adding to this clinical and biological uncertainty, different techniques gave contradictory results for the presence of EBV in breast carcinoma specimens. In this study, minor groove binding (MGB)-TaqMan real time PCR was used to detect the presence of EBV DNA in both peripheral blood and tumor samples of selected patients. METHODS: Peripheral blood and breast …

The Earliest Dipodomyine Heteromyid In North America And The Phylogenetic Relationships Of Geomorph Rodent, Steven J Norris

Faculty, Staff and Student Publications

The proteome of the spirochete bacterium Borrelia burgdorferi, the tick-borne agent of Lyme disease, has been characterized by two different approaches using mass spectrometry, providing a launching point for future studies on the dramatic changes in protein expression that occur during transmission of the bacterium between ticks and mammals.