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Circadian Rhythms In Patients With St-Elevation Myocardial Infarction, Richard Aplin Md, Dr Holmes Md, Fv Acquirre

Articles

BACKGROUND:

Circadian rhythms with regard to time of symptom onset for patients with acute myocardial infarction have been observed, although their relationship to outcomes has been debated. We evaluated these rhythms in patients with ST-elevation myocardial infarction as a function of the 24-hour circadian cycle.

METHODS AND RESULTS:

The relationship between onset of symptoms during the 24-hour circadian cycle and prehospital delays from symptom onset to hospital arrival, timeliness of reperfusion, and in-hospital death was assessed in 2143 patients with ST-elevation myocardial infarction presenting from 2004-2008 at 1 of 3 tertiary-care healthcare ST-elevation myocardial infarction systems. There was …

Health Related Quality Of Life Changes Among Users Of Depot Medroxyprogesterone Acetate (Dmpa) For Contraception, Sikolia Wanyonyi

Master of Medicine in Obstetrics and Gynecology

Background: Contraceptive use is often a lifestyle choice that could impact on the quality of life. Depot medroxyprogesterone acetate (DMPA), like any other contraceptive method has other effects besides fertility control. Understanding how these impacts on the quality of life could assist in client counseling, eventually leading to informed choices. Objective: To determine health related quality of life changes associated with the use of DMPA for contraception. Methods: A longitudinal observational study was carried out between December 2008 and September 2009 at family planning clinics at the Aga Khan University Hospital and Family Health Options, Kenya (FHOK) after institutional and …

Sweat Rates, Sweat Sodium Concentrations, And Sodium Losses In 3 Groups Of Professional Football Players, Sandra Fowkes-Godek, Chris Peduzzi, Richard Burkholder, Steve Condon, Gary Dorshimer, Arthur R. Bartolozzi

Sports Medicine Faculty Publications

No abstract provided.

Small Molecule Inhibition Of Macrophage Tnf-A Release, Razwana Wahdat

Seton Hall University Dissertations and Theses (ETDs)

Tumor Necrosis Factor Alpha (TNF-a) is a vital pro-inflammatory cytokine produced in response to the activation ofthe innate immune response via the Toll-like receptor signal transduction pathway. This thesis explores the release and inhibition of TNF-a from RAW 264.7 mouse macrophages and human U937 cells that have been exposed to a potent activator of innate immunity. Using lipopolysaccharide (LPS), a Gram negative bacterial endotoxin, in the presence or absence of proinflammatory cytokine interferon 'Y (IFN-y) as activators ofthe TLR-4 pathway, a robust release ofTNF­ a was observed. Co-incubation of stimulated macrophages with the tyrosine phosphatase inhibitor, sodium vanadate, resulted in …

Is There An Association Of Giardiasis With Beta-Thalassemia Minor?, Javed Yakoob, Wasim Jafri, Hizbullah Shaikh

Section of Gastroenterology

Beta–thalassemia minor is a symptomless carrier state of a hemoglobinopathy which predisposes to bacterial infections. We report three cases presenting with giardiasis, a parasitic infection of gastrointestinal tract caused by Giardia lamblia. Patients presented with recurrent diarrhea and abdominal pain for over a year. An esophagogastroduodenoscopy finding varied from normal to acute duodenitis. Duodenal biopsy demonstrated changes consistent with mild chronic non-specific inflammation with G. lamblia trophozoites. All three patients were diagnosed as β -thalassemia minor hemoglobin electrophoresis. They were treated with Diloxanide furoate 500 mg and Metronidazole 400mg three times daily for five days. Their symptoms resolved and a …

New Intravenous Antibiotics: A Focused Pharmacotherapy Update, Kathryn A. Connor

Pharmacy Faculty/Staff Publications

Infections due to multidrug-resistant pathogens are increasing throughout the world, in particular due to the emergence of resistant Staphylococcus aureus, vancomycin-resistant enterococcus (VRE) penicillin-resistant Streptococcus pneumonia, multidrug-resistant (MDR) Pseudomonas and Acinetobacter spp, extended-spectrum β-lactamase- (ESBL) producing enteric organisms, etc. These serious pathogens are a major cause of severe hospital and community-acquired infections and are associated with high morbidity and mortality. Several new parenteral antibiotics have been approved in the past several years to help treat these infections, including telavancin, doripenem, tigecycline and daptomycin. This article reviews the pharmacology and limitations of these new antibiotics in treating infections in …

The Effectiveness Of Training Nurses In Breast Cancer Awareness At A Tertiary Hospital: An Experimental Study, Miriam Mutebi

Master of Medicine in General Surgery

Background: Breast cancer is characterized by late presentation and significant morbidity and mortality in developing countries. Breast screening aids in early detection of breast cancer. The nursing health worker is uniquely placed to provide advocacy and screening in a resource limited environment. Objectives: To assess the effectiveness of an abbreviated training program in breast cancer awareness on nurses at a tertiary hospital, the Aga Khan University Hospital, Nairobi. Methods: Using a statistical tool, the Solomon Model, 79 nurses were identified and divided into experimental and control groups. An abbreviated training intervention in breast cancer awareness was administered to the experimental …

A Randomized Controlled Trial Of The Effect Of Additional Ultrasound Therapy To Analgesia Treatment Protocol For Acute Low Back Pain At Akuh (N), Shamshudin Mohammedali

Master of Medicine in General Surgery

Background: Acute low back pain is a common condition that is encountered by many physicians. Varied treatments are instituted in its management with no defined standard protocol in our institution. Additional physiotherapy has had minimal impact in terms of pain control and the time to return to work in the available literature. Controversy remains regarding effectiveness of ultrasound physiotherapy and its role in management of acute low back pain. Objective: To investigate the effectiveness of the addition of ultrasound physiotherapy to analgesia in patients with acute low back pain at the Aga Khan University Hospital, Nairobi. Methods: A randomized controlled …

Obesity And Shift Work In The General Population, Robin Eberly, Harvey Feldman

Internet Journal of Allied Health Sciences and Practice

Purpose: This narrative review examines the hypothesis that shift work contributes to the major public health problem of obesity and suggests ways in which weight gain might be prevented in those who must work at times outside of the conventional 8-hour daytime work period. Methods: A comprehensive literature review was performed using several relevant electronic databases and print journals. Results: Those who do shift work are at a greater risk for weight gain than those who work daytime hours. The exact mechanism by which this occurs is unknown, although eating and exercise habits as well as the disruption in circadian …

A Randomised Comparative Trial Of Seven Versus Fourteen Day Triple Therapy For Helicobacter Pylori Eradication At The Aga Khan University Hospital, Nairobi, Ahmed Sokwala

Master of Medicine in Internal Medicine

Background: Helicobacter is associated with a number of important upper gastrointestinal conditions including chronic gastritis, peptic ulcer disease, and gastric malignancy. Proton pump inhibitor -based triple therapies are considered the standard regimens for Helicobacter pylori eradication, but the optimal duration of these regimens is still controversial. Local studies are required to evaluate the H. pylori eradication rates in a country for adequate eradication to prevent H. pylori infection and complications Objectives: The main objective of this study was to compare 7 day and 14 day regimens and determine the optimum duration of triple therapy for H. pylori eradication. Methods: A …

Positioning Techniques To Reduce The Occurrence Of Dequervain’S Tendonitis In Nursing Mothers, Alison Virzi

Dissertations, Masters Theses, Capstones, and Culminating Projects

DeQuervain's tendonitis is an inflammation of two tendons: the extensor pollicis brevis and the abductor pollicis longus as they cross in the first dorsal compartment of the wrist. Symptoms include pain, swelling along the radial aspect of the wrist, and a decrease in thumb motion. A positive Finkelstein's test at examination is seen. Frequently it is caused by repetitively gripping, lifting, and positioning the wrist in flexion, ulnar deviation with thumb extension. It is a common diagnosis in women, referred to as "washerwoman's syndrome". It is also common for new mothers to experience due to the demands their wrists are …

Postoperative Complications Of Powered Intracapsular Tonsillectomy And Monopolar Electrocautery Tonsillectomy In Teens Versus Adults., Douglas R Johnston, Michael Gaslin, Maurits Boon, Edmund Pribitkin, David Rosen

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

OBJECTIVES: This study was performed to determine whether teens have different rates of posttonsillectomy hemorrhage, admission for dehydration, or recurrent tonsillitis compared to adults. Specifically, these parameters were compared within two groups: patients who underwent powered intracapsular tonsillectomy (PIT) and those who underwent monopolar electrocautery tonsillectomy (MET).

METHODS: In a retrospective review of 579 patients at least 12 years of age from January 2000 to July 2006 in a tertiary referral center, outcome measures of reoperation for hemorrhage, readmission or emergency room visit for dehydration, and postoperative tonsillitis were compared for 200 patients 12 to 19 years of age and …

Thai Patients' Experiences Of End-Stage Renal Disease: A Path Through An Unknown World, Chuleeporn Piyasut Phd

Dissertations

The purpose of the study was to explore how Thai end-stage renal disease (ESRD) patients manage the challenges of living with hemodialysis. The participants were Thai ESRD patients, who were receiving hemodialysis in one of the central provinces in Thailand. A grounded theory approach was employed in this study as it focuses on social processes grounded in individual experiences of participants in the study. The participants included 30 ESRD patients, aged 26-75, who had been undergoing hemodialysis from 6 months to 12 years. Individual in-depth interviews were audio-recorded and transcribed. Data were analyzed by using Atlas.ti. Data analysis revealed "a …

Influence Of Blood Contamination On Bond Strength Of A Self-Etching System, Ellen Cristina De Carvalho Mendonça, Samuel Nilo Vieira, Fernando Aparecido Kawaguchi, John Powers, Adriana Bona Matos

Faculty, Staff and Student Publications

OBJECTIVES: To detect the influence of blood contamination (BC) on the bond strength (BS) of a self-etching bonding system (SES) to enamel and dentine.

METHODS: 25 human molars were longitudinally sectioned on the mesio-distal axis in order to obtain 50 specimens, which were embedded in acrylic resin. At first, the specimens were ground to expose a flat surface of enamel, and a bond strength test was performed. Afterwards, the samples were ground again in order to obtain a flat surface of dentine. Ten groups (total: n=100) were assigned according to substrate (enamel and dentine), step in the bonding sequence when …

Is There An Optimal Management For Localized Prostate Cancer?, Jaspreet Singh, Edouard J. Trabulsi, Leonard G. Gomella

Department of Urology Faculty Papers

Widespread screening with prostate-specific antigen (PSA) has led to a significant increase in the detection of early stage, clinically localized prostate cancer (CaP). Various ­treatment options for localized CaP are discussed in this review article including active ­surveillance, radical prostatectomy, radiation therapy, and cyrotherapy. The paucity of high-level evidence adds a considerable amount of controversy when choosing the “optimal” ­intervention, for both the treating physician and the patient. The long time course of CaP intervention outcomes, combined with continuing modifications in treatments, further complicate the ­matter. Lacking randomized trials that compare treatment options, this review article attempts to summarize the …

Prescriptions For Excellence In Health Care Issue 9 Summer 2010 Download Full Pdf

Prescriptions for Excellence in Health Care Newsletter Supplement

No abstract provided.

Late Onset Postpneumonectomy Empyema Presenting 24 Years After Pneumonectomy, Saulat Hasnain Fatimi, Umair Khalid, Sanna Fatima, Taimur Saleem

Section of Cardiothoracic Surgery

Empyema is a devastating complication that is rarely seen in the postpneumonectomy setting. A 56-year-old man presented to us 24 years after pneumonectomy with a 15 days history of chest pain and shortness of breath. Physical examination revealed a fluctuant swelling at the thoracotomy site. Computed tomography scan showed a large fluid density mass in the left pneumonectomy space. Needle aspiration and video assisted thoracoscopic surgery was carried out and culture of the aspirated fluid grew Pseudomonas aeruginosa. The patient was discharged with the chest tubes in place. At 2 months follow-up, the patient presented with fever and continuous copious …

Giant Unresectable Lymphangioma Of The Trunk Managed Via Intra-Tumour Injections Of Bleomycin, Umair Khalid, Saulat Hasnain Fatimi, Taimur Saleem

Section of Cardiothoracic Surgery

Surgical excision was once considered the mainstay of treatment for lymphangiomas. However, that paradigm is now changing with sclerotherapy emerging as a viable alternative. A 22-year-old girl presented with a mucopurulent and painful discharge from an extensive wound in the trunk. Chest roentogram showed a large soft tissue abnormality with multiple calcifications in the right upper abdomen and lower thorax. Magnetic resonance imaging revealed an extensive lobulated mass measuring 27 x 19 cm. Due to the extensive involvement of tissues, surgical excision did not appear to be a favourable option in this case. Local injections of bleomycin were successfully administered; …

The Influence Of Psychosocial Factors On Academic Performance Of Adolescents: A Quality Assurance Project, Saleema A. Gulzar, Tazeen S. Ali, Amina Aijaz, Neesha Hussain

School of Nursing & Midwifery

Adolescence is a time of rapid psychological and physiological changes and is associated with anxiety and mental distress. This project looks at the potential of school-based programs to reduce these negative effects of academic performance in both the short- and long-term. This study was conducted in a private school in Karachi, Pakistan between October 1998 and December 2006 on 305 students with low academic performance. Results show that students scoring low grades had a mean of 55 + 2.8 and postintervention score of 56 + 2.6. The intervention package significantly created a difference in reducing the number of students receiving …

Mechanisms Of Augmented Coronary Artery Constriction Following Exposure To Diesel Exhaust, Tom W. Cherng

Biomedical Sciences ETDs

Numerous epidemiology studies demonstrate that acute increases in air pollutants correlate with an increase in cardiovascular disease-related mortality. The pollutant diesel exhaust (DE) has been shown to impair both flow-mediated and agonist-induced dilation of the brachial artery, used as a surrogate for coronary artery function. It is speculated that enhanced sensitivity to the endogenous vasoconstrictor ET-1 impairs cardiac blood flow and contributes to the immediate onset of myocardial ischemia and infarction in humans following DE exposure. In addition, impaired endothelium-dependent dilation can be improved with the restoration of nitric oxide (NO) synthase (NOS) activity. We therefore sought to determine the …

The Role Of Bcl-2 Modifying Factor (Bmf) In Airway Epithelial Cell Death, Amelia H. T. Unione

Biomedical Sciences ETDs

One of the components that obstruct the airway in asthma is the sudden and increased secretion of mucus from metaplastic mucous cells in small airways. Because previous studies have shown that the resolution of mucous cell metaplasia (MCM) during prolonged exposure of mice to allergen is mediated by IFN gamma and the Bcl-2 family of proteins, we investigated the regulation and the role of a pro-apoptotic BH3 domain-only protein, Bmf, in airway epithelial cells (AECs) treated with IFN gamma. We hypothesize that Bmf is crucial for IFN gamma-induced cell death. Our findings show that IFN gamma suppressed Bmf expression in …

- Immunosupression Of T-Dependent Antibody Responses By Polycyclic Aromatic Hydrocarbons And Arsenic In Spleen Cells From C57bl/6j Mice, Qian Li

Biomedical Sciences ETDs

Polycyclic aromatic hydrocarbons (PAHs) and arsenic are both toxic contaminants that are widely distributed in the environment. Previous studies have shown that certain levels of PAHs and arsenic exposure individually can lead to immune suppression and carcinogenesis. Co-exposures to these two classes of chemicals are commonly seen in the environment. However, no previous studies have evaluated the immunotoxicity following simultaneous exposure to both arsenic and PAHs. Therefore, the purpose of this study was to define the immunotoxicity of selected PAHs and arsenic in a murine spleen cell system, and to elucidate possible toxicological mechanisms. Spleen cells were isolated from male …

Changes In C-Myb Activity During Proliferation, Anita M. Quintana

Biomedical Sciences ETDs

c-myb encodes a transcription factor and is the cellular parent of the v-myb oncogene, which causes acute myeloid leukemia in chickens and mice. Truncation or deletion can unmask the oncogenic potential of the human c-myb gene and recent reports have established that the human c-myb locus is subject to translocation and duplication in human pediatric T-ALL. c-Myb is expressed in all proliferating hematopoietic progenitor cells and has been implicated in some solid tumors, such as breast and colon. Evidence suggests that c-Myb activity is cell type specific and cell cycle dependent. For example, c-Myb interacts with cyclin D1 and CDK6 …

Characterization Of Subspecies B1 Human Adenovirus Orf E3-10.9k, Kathryn Marie Frietze

Biomedical Sciences ETDs

Subspecies B1 human adenoviruses (HAdVs) are important causes of acute respiratory disease in pediatric and military recruit populations. Although extensive epidemiological data document the genetic diversity of these human pathogens, little is known about the relevance of this genetic diversity on the pathogenesis and fitness of subspecies B1 HAdVs. Additionally, the unique molecular biology of these pathogens is understudied compared to the species C HAdV serotypes 2 and 5. One of the uniquely diverse regions of the HAdV genomes is the early region 3 (E3) transcription unit. These genes are implicated in pathogenesis, host-species specificity, and the modulation of the …

Clinical And Economic Impact Of Infusion Reactions In Patients With Colorectal Cancer Treated With Cetuximab., K A Foley, P F Wang, B L Barber, S R Long, J E Bagalman, V Wagner, X Song, Z Zhao

College of Population Health Faculty Papers

BACKGROUND: Systemic agents in cancer treatment were often associated with possible infusion reactions (IRs). This study estimated the incidence of IRs requiring medical intervention and assessed the clinical and economic impacts of IRs in patients with colorectal cancer (CRC) treated with cetuximab.

PATIENTS AND METHODS: Details on patients with CRC receiving cetuximab in 2004-2006 were extracted from a large USA administrative claims database. IRs were identified based on the occurrence of outpatient treatment, emergency room (ER) visit, and/or hospitalization for hypersensitivity and allergic reactions. Multivariate regressions were used to examine potential risk factors and quantify the economic impact of IRs. …

Situational Analysis Of Household Energy And Biomass Use And Associated Health Burden Of Indoor Air Pollution And Mitigation Efforts In Pakistan, Zafar Fatmi, Asma Rahman, Ambreen Kazi, Muhammad Masood Kadir, Nalini Sathiakumar

Community Health Sciences

Biomass fuel burning leads to high levels of suspended particulate matter and hazardous chemicals in the indoor environment in countries where it is in common use, contributing significantly to indoor air pollution (IAP). A situational analysis of household energy and biomass use and associated health effects of IAP was conducted by reviewing published and un-published literature about the situation in Pakistan. In addition to attempt to quantify the burden of ill health due to IAP, this paper also appraises the mitigation measures undertaken to avert the problem in Pakistan. Unfortunately, IAP is still not a recognized environmental hazard in Pakistan …

A Case Of Miller Fisher Syndrome With Multiple Cranial Nerves Enhancement On Mri, S Petcharunpaisan, S. Lerdlum

Chulalongkorn Medical Journal

Miller Fisher syndrome is a clinical variant of Guillain-Barre syndrome with classic triad of ophthalmoplegia, ataxia and areflexia which there were some reports of multiple cranial nerves enhancement on MRI. We report a case of 66-year-old male presenting with headache and numbness of hands and feet, then gradual developed bilateral diplopia, ptosis, decreased deep tendon reflex and impaired tandem gait. Post contrast MRI showed multiple cranial nerves enhancement. Miller Fisher syndrome was diagnosed based on clinical triad and electrophysiologic evidence of polyneuropathy involved axon and myelin. We suggested that thin slice section of the post contrast MRI is likely to …

Exploring Online Sexually Explicit Material: What Is The Relationship To Sexual Coercion?, Valerie Gonsalves

Department of Psychology: Dissertations, Theses, and Student Research

With the popularity of the Internet, it is easy to access sexually explicit material. Past research has demonstrated that exposure to sexually explicit material in traditional formats (i.e. magazines and videos) may have an influence on male attitudes and behaviors towards females, but these effects appear to be minimal and dissipate over the long term. Though the body of literature examining Internet sexually explicit material is smaller, researchers have found little to no effects on attitudes or aggressive behaviors immediately after exposure. However, research regarding exposure to online sexually explicit material has not included forensically relevant variables.

Previous research has …

A Comparison Of Rank Ordered Professional Attributes By Clinical Supervisors And Allied Health Students, Julie Freeman, Janet L. Rogers

Internet Journal of Allied Health Sciences and Practice

The concept of professionalism in the field of allied health has been defined to delineate professional behaviors and values. The term "professional attributes" describes a set of behaviors believed to encompass professionalism. Clinical performance instruments attempt to evaluate professional behavior of allied health students. However, deficiencies in professionalism are difficult to identify and quantify making the problem troublesome to address. The purpose of this study was to identify differences in perceptions between clinical supervisors and allied health students as they relate to the rank order of importance of “professional attributes” required for effective clinical practice. The results of a “professional …

Range Of Active Hip Motion In Low Back Pain Patients And Apparently Healthy Controls, Babatunde O. A. Adegoke, O. A. Fapojuwo

Internet Journal of Allied Health Sciences and Practice

Purpose: Findings from previous studies on hip mobility in individuals with low back pain (LBP) have been equivocal and focused almost exclusively on hip rotation. This study compared active range of hip motion and classified its asymmetry in male subjects with and without LBP. Method: The ex-post facto study involved 30 male patients with LBP and 30 age and sex-matched controls. Active ranges of motion (AROM) of both hip joints of subjects in both groups were measured with a universal goniometer and grouped into different pattern categories based on the presence or absence of a difference of 10° or more …