Medicine and Health Sciences Commons^™

Cerebellar Mutism Syndrome After Surgical Resection Of Posterior Fossa Neoplastic Lesions, Saqib Kamran Bakhshi, Rida Mitha, Naureen Mushtaq, Muhammad Shahzad Shamim

Section of Neurosurgery

Cerebellar Mutism Syndrome (CMS) is a well-described clinical entity that complicates surgeries for posterior fossa tumours; more so in children than adults. This review focuses on the current understanding of CMS, its incidence and risk factors. Incidence showed a variable range in retrospective studies due to variety of definitions. Risk factors can be classified as either modifiable including surgical technique, or non-modifiable which include tumour related factors. A positive correlation has been associated between tumour pathology, brain stem invasion and size of tumour at time of presentation with development of CMS.

Localizing An Occult Insulinoma By Selective Calcium Arterial Stimulation Test: First Ever Experience And A New Dimension To Diagnosis In Pakistan, Muhammad Owais Rashid, Sumerah Jabeen, Zareen Kiran,, Khurram Minhas, Muhammad Azeemuddin, Najmul Islam

Section of Diabetes, Endocrinology and Metabolism

Insulinomas are rare, usually benign, solitary tumours accounting for 60% of islet cell tumours. These tumours can be difficult to localize preoperatively due to their small size. We present a challenging case of a 40 year old male with frequent hypoglycaemic spells and endogenous hypoglycaemia who presented as a diagnostic dilemma. Patient had an occult insulinoma with inconclusive CT Abdomen, MRI Abdomen and Octreotide scan. The final localization of the tumour was made by selective arterial calcium stimulation testing (SCAT), done for the first time in Pakistan at Aga Khan University Hospital. This was followed by successful distal pancreatectomy as …

Vitamin D Usage Among Pakistani Population - Too Much Of A Good Thing, Bhagwan Das, Sarah Nadeem

Section of Diabetes, Endocrinology and Metabolism

No abstract provided.

Medicolegal Issues In Neurology Practice In Pakistan, Ismail A Khatri, Maimoona Siddiqui

Pakistan Journal of Neurological Sciences (PJNS)

Neurology despite its challenges have made tremendous improvement in past few decades. At the same time, the rapid advancement of media and internet has changed the traditional doctor-patient relationship into one of a service provider-consumer relationship1. The health service is now considered a commodity, and has become prone to lack of trust and litigation. Medical professionalism is challenged by increasing commercialism and influence of legal system

Neurological Care And Training In The Times Of Covid-19: A Tertiary Care Center Experience, Lubna Ashraf Jafri, Maryam Javed, Ali Sajjad, Dureshahwar Kanwar, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

Resilience in these challenging times of COVID-19 at a professional and personal level is cardinal. Trainees and faculty have had to adapt to this adversity with striking limitations on formal neurological, neurovascular and neurophysiological residencies and fellowships. The revision of schedules and reallocation of assignments to cope with the practical aspects in a teaching tertiary care hospital have been overbearing. Novel structural innovation, testing, communications and supervision to assure a modified yet impactful training educational programme is mandatory and the need of the hour. Healthcare service providers remain at the highest risk of acquiring COVID-19 worldwide. Urgent measures to educate …

Venous Stroke Secondary To Varicella Zoster Virus Infection, Asma Akbar Ladak, Salman Farooq

Pakistan Journal of Neurological Sciences (PJNS)

This is a case of cerebral venous sinus thrombosis (CVST) as a rare complication of varicella Zoster infection. A young male with no significant medical history presented with generalized tonic clonic seizures preceded by vesicular rash on the face diagnosed as Varicella zoster infection. The MRI showed bilaterial superficial hemorrhagic infarcts involving frontal and temporal lobes and MR Venogram was consistent with extensive CVST involving superioir sagittal, right transverse and superficial veins. After initial treatment with antiepileptic and anticoagulant, he showed marked improvement in symptomatology and made complete recovery subsequently with recanalization of sinuses seen on a follow up MRV …

Hepetatis C Virus A Rare Cause Of Cereberal Venous Sinus Thrombosis, Haris Majid Rajput, Iqra Athar, Neelma Naz Khattak, Anam Anis, Mazhar Badshah

Pakistan Journal of Neurological Sciences (PJNS)

Cerebral venous sinus thrombosis is challenging condition because of its variability of underlying pathological causes. Numerous conditions can cause cerebral venous sinus thrombosis (CVST), and often more than one cause can be found in an individual patient. The causes leading to CVST can be classified into two broad categories; infective and non-infective. Among infective causes, chronic hepatitis C infection is considered as one of the extremely rare causes of cerebral venous sinus thrombosis.

Disease Modification Trials In Parkinsons Disease: A Review, Ramla Nayaib Hashmi, Ummul Kiram

Pakistan Journal of Neurological Sciences (PJNS)

Among the common neurological disorders worldwide, Parkinson’s disease has a major share. Currently, only symptomatic therapies are available for it without any approved neuromodulation drugs as all the previously done disease modification trials have failed. There is a dire need for such therapies. Disease modification trials include all types of intervention targeting the degeneration process which underlies the disease process and thus slows it down or the treatment aim to regenerate or replace the neurons which are lost. There are many reasons for the failure of trials. This review emphasize the need for disease modification trials, causes of failure of …

Cerebral Venous Sinus Thrombosis Associated With Coronavirus Infection (Covid-19), Sajid Hameed, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

Coronavirus disease 2019 (COVID-19) is a severe acute respiratory syndrome (SARS) caused by the SARS-CoV-2 coronavirus. Despite its primarily respiratory involvement, an increased propensity for systemic inflammation, neuroinvasion, and thromboembolic events has been reported. This systemic prothrombotic state may predispose to cerebral venous sinus thrombosis (CVST), which is an uncommon cerebrovascular disease with hypercoagulability as one of its important risk factors. We conducted a literature search using the PubMed electronic database and reviewed the published literature for a possible association of CVST with the COVID-19 disease.

A Case Study Of Ovc Case Management Through The Zambia Family (Zamfam) Project—Brief, Population Council

HIV and AIDS

The ZAMFAM program aims to improve the care and resilience of orphans and vulnerable children (OVC) as well as young people living with HIV in Zambia by providing support and protection and by strengthening the capacity of children, families, and the community to better manage the socioeconomic shocks of the HIV/AIDS epidemic. A case study approach was employed to understand actors and perceptions, and to document best practices by the program. This brief summarizes the case study findings. The ZAMFAM program utilized several approaches to improving the well-being of OVC. Services or referrals were provided to beneficiaries through home visitation …

Piloting And Evaluating Family-Centered Hiv Care In Eswatini, Caspian Chouraya, Nobuble Mthethwa, Lynne Mofenson, Philisiwe Khumalo, Lydia Mpango, Munamato Mirira, Rhoderick Machekano, Leila Katirayi, Kim Ashburn

HIV and AIDS

There are substantial gaps in essential services and numerous missed opportunities to engage children in care and provide effective HIV treatment. Although not new, family-centered care models that provide HIV services comprehensively to families as a unit, rather than providing separate services to children and adults, have the potential to address family needs and break down social, physical, and emotional barriers to accessing care. The family-centered care study (FAM-CARE) aims to contribute to our understanding of the role of family-centered care models (FCCM) in improving pediatric HIV outcomes in a sub-Saharan African setting.

Secondary Prevention Of Cardiovascular Diseases In India: Findings From Registries And Large Cohorts, Hasan Rehman, Ankur Kalra, Ajar Kochar, Angad S. Uberoi, Deepak L. Bhatt, Zainab Samad, Salim S. Virani

Section of Cardiology

Several registries and quality improvement initiatives have focused on assessing and improving secondary prevention of CVD in India. While the Treatment and Outcomes of Acute Coronary Syndromes in India (CREATE), Indian Heart Rhythm Society-Atrial Fibrillation (IHRS-AF), and Trivandrum Heart Failure (THF) registries are limited to collecting data, the Tamil Nadu-ST-Segment Elevation Myocardial Infarction (TN-STEMI) program was aimed at examining and improving access to revascularization after an ST-elevation myocardial infarction (STEMI). The Acute Coronary Syndromes: Quality Improvement in Kerala (ACS-QUIK) study recruited hospitals from the Kerala ACS registry to assess a quality improvement kit for patients with ACS while the Practice …

Covid-19-Associated Cns Demyelinating Diseases, Dhanashri Miskin, Md

Department of Neuroscience Faculty Papers

Neurological manifestations of SARS-CoV-2 infection are increasingly being recognized. The most common neurologic symptoms include headache, anosmia, and dysgeusia, but patients may also develop other central nervous system (CNS) diseases.

Analyses Of The Expression, Immunohistochemical Properties And Serodiagnostic Potential Of Schistosoma Japonicum Peroxiredoxin-4, Minh-Anh Dang-Trinh, Jose Ma. M. Angeles, Kharleezelle J. Moendeg, Adrian Miki C. Macalanda, Thu-Thuy Nguyen, Luna Higuchi, Shotaro Nakagun, Masahi Kirinoki, Yuichi Chigusa, Yasuyuki Goto, Shin-Ichiro Kawazu

Biology Faculty Publications

Background

Schistosoma japonicum, which inhabits the mesenteric vein of the mammalian hosts for about 20 to 30 years, is subjected to the oxidative stresses from the host defense mechanism during their intra-mammalian stages. To counteract this host immune attack, the parasite utilizes their antioxidant system for survival inside the host. Peroxiredoxins (Prxs), thiol-specific antioxidant proteins, play an essential role for protecting the parasite against oxidative stress by reducing hydrogen peroxide to water. Only three types of 2-Cys Prxs have been previously characterized in S. japonicum whereas a fourth Prx has been identified for Schistosoma mansoni as Prx-4. A sequence …

Etiology Of Acute Undifferentiated Fever In Patients Presenting To The Emergency Department Of A Tertiary Care Center In Karachi, Pakistan, Noman Ali, Nadeem Ullah Khan, Shahid Shahid, Syed Mustahsan

Department of Emergency Medicine

Objective: Our study aimed at identifying the characteristics and etiology of various causes of acute undifferentiated fever in patients presenting to the emergency department of a tertiary care hospital.
Methods: This was a retrospective study conducted at the department of emergency medicine, Aga Khan University Hospital from January to June 2016. Adult patients presenting to Emergency department with acute undifferentiated fever were enrolled. Descriptive statistics were calculated in terms of mean±SD for continuous variables like age of the patients and duration of fever, whereas frequency and percentage were computed for categorical variables like gender and causes of fever.
Results: A …

Cross-Species Analyses Identify Dlgap2 As A Regulator Of Age-Related Cognitive Decline And Alzheimer's Dementia., Andrew R Ouellette, Sarah M Neuner, Logan Dumitrescu, Laura C. Anderson, Daniel M. Gatti, Emily R Mahoney, Jason A. Bubier, Gary Churchill, Luanne L. Peters, Matthew J Huentelman, Jeremy H Herskowitz, Hyun-Sik Yang, Alexandra N Smith, Christiane Reitz, Brian W Kunkle, Charles C White, Philip L De Jager, Julie A Schneider, David A Bennett, Nicholas T Seyfried, Alzheimer's Disease Genetics Consortium, Elissa J Chesler, Niran Hadad, Timothy J Hohman, Catherine Kaczorowski

Faculty Research 2020

Genetic mechanisms underlying age-related cognitive decline and dementia remain poorly understood. Here, we take advantage of the Diversity Outbred mouse population to utilize quantitative trait loci mapping and identify Dlgap2 as a positional candidate responsible for modifying working memory decline. To evaluate the translational relevance of this finding, we utilize longitudinal cognitive measures from human patients, RNA expression from post-mortem brain tissue, data from a genome-wide association study (GWAS) of Alzheimer's dementia (AD), and GWAS results in African Americans. We find an association between Dlgap2 and AD phenotypes at the variant, gene and protein expression, and methylation levels. Lower cortical …

Gsj Gets A Fresh New Look, Jeffrey C Wang, Jens R Chapman, Karsten Wiechert

Articles, Abstracts, and Reports

No abstract provided.

Efficacy And Safety Of First-Line Avelumab In Patients With Advanced Non-Small Cell Lung Cancer: Results From A Phase Ib Cohort Of The Javelin Solid Tumor Study., Claire F Verschraegen, Guy Jerusalem, Edward F Mcclay, Nicholas Iannotti, Charles H Redfern, Jaafar Bennouna, Franklin L Chen, Karen Kelly, Janice Mehnert, John C Morris, Matthew H Taylor, David Spigel, Ding Wang, Hans Juergen Grote, Dongli Zhou, Neru Munshi, Marcis Bajars, James L Gulley

Articles, Abstracts, and Reports

INTRODUCTION: Avelumab, an antiprogrammed death ligand-1 antibody, is approved as a monotherapy for treatment of metastatic Merkel cell carcinoma and advanced urothelial carcinoma, and in combination with axitinib for advanced renal cell carcinoma. We report the efficacy and safety of first-line avelumab in advanced non-small cell lung cancer (NSCLC).

METHODS: In a phase I expansion cohort of the JAVELIN Solid Tumor trial, patients with treatment-naive, metastatic, or recurrent NSCLC received 10 mg/kg avelumab intravenously every 2 weeks. Endpoints included best overall response, duration of response (DOR), progression-free survival (PFS), overall survival (OS), and safety.

RESULTS: Overall, 156 patients were enrolled …

Defining The Proteolytic Landscape During Enterovirus Infection., Mohsan Saeed, Sebastian Kapell, Nicholas T Hertz, Xianfang Wu, Kierstin Bell, Alison W Ashbrook, Milica Tesic Mark, Henry A Zebroski, Maxwell L Neal, Malin Flodström-Tullberg, Margaret R Macdonald, John D Aitchison, Henrik Molina, Charles M Rice

Articles, Abstracts, and Reports

Viruses cleave cellular proteins to remodel the host proteome. The study of these cleavages has revealed mechanisms of immune evasion, resource exploitation, and pathogenesis. However, the full extent of virus-induced proteolysis in infected cells is unknown, mainly because until recently the technology for a global view of proteolysis within cells was lacking. Here, we report the first comprehensive catalog of proteins cleaved upon enterovirus infection and identify the sites within proteins where the cleavages occur. We employed multiple strategies to confirm protein cleavages and assigned them to one of the two enteroviral proteases. Detailed characterization of one substrate, LSM14A, a …

Trident - Fall 2020, Dugoni School Of Dentistry

Trident

The newsletter of the Pacific Orthodontic Alumni Chapter at University of the Pacific, Arthur A. Dugoni School of Dentistry.

Third-Generation Medium Cross-Linked Polyethylene Demonstrates Very Low Wear In Total Hip Arthroplasty., Omid Jalali, Travis S Scudday, Marie-Claire Fickenscher, Steven L Barnett, Robert S Gorab

Articles, Abstracts, and Reports

Background: Cross-linked polyethylene (XLPE) liners have shown lower wear rates than conventional polyethylene liners in total hip arthroplasty. The primary aim of our study was to report our most recent analysis of wear rates and clinical outcomes of a third-generation XLPE liner. Secondary aims were to investigate the rate of adverse events related to mechanical failure or oxidation of this liner.

Methods: A series of 266 total hip arthroplasties using a specific XLPE liner were retrospectively reviewed. Radiographs were examined to determine linear and volumetric wear rates and presence of osteolysis. Clinical outcomes, revision rates, mechanical failures, and risk factors …

Quantifying Long-Term Health And Economic Outcomes For Survivors Of Group B Streptococcus Invasive Disease In Infancy: Protocol Of A Multi-Country Study In Argentina, India, Kenya, Mozambique And South Africa, Proma Paul, Simon R. Procter, Ziyaad Dangor, Quique Bassat, Amina Abubakar, Sridhar Santhanam, Romina Libster, Bronner P. Gonçalves, Shabir A. Madhi, Azucena Bardají

Institute for Human Development, East Africa

Sepsis and meningitis due to invasive group B Streptococcus (iGBS) disease during early infancy is a leading cause of child mortality. Recent systematic estimates of the worldwide burden of GBS suggested that there are 319,000 cases of infant iGBS disease each year, and an estimated 147,000 stillbirths and young-infant deaths, with the highest burden occurring in Sub-Saharan Africa. The following priority data gaps were highlighted: (1) long-term outcome data after infant iGBS, including mild disability, to calculate quality-adjusted life years (QALYs) or disability-adjusted life years (DALYs) and (2) economic burden for iGBS survivors and their families. Geographic data gaps were …

Neoantigen-Specific Cd4(+) T-Cell Response Is Critical For The Therapeutic Efficacy Of Cryo-Thermal Therapy, Peng Peng, Hong-Ming Hu, Ping Liu, Lisa X Xu

Articles, Abstracts, and Reports

Background: Traditional tumor thermal ablations, such as radiofrequency ablation (RFA) and cryoablation, can result in good local control of tumor, but traditional tumor thermal ablations are limited by poor long-term survival due to the failure of control of distal metastasis. Our previous studies developed a novel cryo-thermal therapy to treat the B16F10 melanoma mouse model. Long-term survival and T-cell-mediated durable antitumor immunity were achieved after cryo-thermal therapy, but whether tumor antigen-specific T-cells were augmented by cryo-thermal therapy was not determined.

Methods: The long-term antitumor therapeutic efficacy of cryo-thermal therapy was performed in B16F10 murine melanoma models. Splenocytes derived from mice …

A Case-Study Of Ovc Case Management Through The Zambia Family (Zamfam) Project, Lyson Phiri, Drosin Mulenga, Nancy Choka, Caila Brander, Nachela Chelwa, Nkomba Kayeyi

HIV and AIDS

Zambia’s HIV prevalence is estimated at 11% among adults aged 15–49 years and 1% among children younger than 15 years. An estimated 10% of Zambia’s population is at high risk of being orphaned or vulnerable due to the HIV epidemic. The Zambia Family (ZAMFAM) project aims to improve the care and resilience of vulnerable populations while supporting HIV epidemic control. ZAMFAM used a case management approach that tracks beneficiaries from identification to graduation. The Population Council conducted a qualitative case study to understand actors and perceptions, and document best practices. Program beneficiaries viewed the ZAMFAM program as having made a …

Abuzimi I Drogës Dhe Ndikimi I Saj Tek Të Rinjët Nga Mosha 16 Deri 20, Albina Gashi

Theses and Dissertations

Një nga problemet mjaft të diskutueshme në ditët e sotme është abuzimi i të rinjëve me lloje të ndryshme të drogave prandaj edhe qëllimi i këtij studimi është të shohim se a kanë njohuri të rinjët e moshës 16 dhe 18 vjeç rreth abuzimit të drogës si dhe ndikimi i përdorimit të drogës tek këta të rinjë.

Ky studimi është realizuar gjatë muajit Gusht ku për shkak të situatës të krijuar nga COVID 19 pyetësori është shpërndarë në mënyrë elektronike në rrjetin social Facebook. Numri i pjesëmarrësve gjithsej në këtë studim ishte 87.

Me anë të Pakos Statistikore të Shkencave …

Kujdesi Infermieror Te Pacientet Me Karcinomë Të Gjirit Në Rajonin E Ferizajit, Amire Ibrahimi

Theses and Dissertations

Kanceri i gjirit zhvillohet nga qelizat e vetë gjirit, kur qelizat në një pjesë të gjirit bëhen anormale dhe fillojnë të rriten dhe të përhapen jashtë kontrollit. Këto qeliza grumbullohen dhe formojnë një tumor i cili shtyp, përhapet dhe shkatërron indin normal të gjirit. Nëse nuk trajtohet, këto qeliza anormale mund të përhapen dhe të dëmtojnë apo të shkatërrojnë indet normale që ndodhen përreth. Ato mund të përhapen gjithashtu, edhe në pjesët më të largëta të trupit nëpërmjet sistemit të qarkullimit të gjakut ose nëpërmjet sistemit limfatik.

Gjatë punimit të këtij punimi janë anketuar gjithsej 253 anketues, prej tyre 91% …

Roli Infermieror Tek Pacientët Diabetik Në Regjionin E Ferizajit, Arlinda Kurti

Theses and Dissertations

Diabeti është një gjendje që dëmton aftësinë e trupit për të përpunuar glukozën në gjak, e njohur ndryshe si sheqeri në gjak. Ajo është një sëmundje kronike që shfaqet kur pankreasi nuk prodhon sasi të mjaftueshme të insulinës, ose kur trupi nuk mund ta shfrytëzojë në mënyrë efikase insulinën e prodhuar nga pankreasi. Insulina është një hormon që rregullon nivelin e sheqerit në gjak. Hiperglikemia, ose niveli i lartë i sheqerit në gjak, është efekt i përbashkët i diabetit të pakontrolluar dhe me kalimin e kohës shkakton dëmtime të rënda të një numri të madh sistemesh në trup, sidomos të …

Roli I Infermierëve Në Përkujdesjen E Fëmijeve Me Enterostomi, Blerona Salihu

Theses and Dissertations

Hyrje: Enterostomia ose stoma, është një procedurë kirurgjikale që përfshin krijimin e një hapjeje artificiale në pjesën e jashtme të trupit me qëllim të zbrazjes së përmbajtjes nga trakti digjestiv. Kjo procedurë zakonisht kryhet kur një sëmundje e traktit digjestiv e bën të vështirë ose të pamundur zbrazjen e natyrshme të përbajtjes nga trakti digjestiv.

Qëllimi i studimit: Ky hulumtim ka për qëllim të analizojë pacientët pediatrik tek të cilët për shkak të sëmundjeve të ndryshme ka qenë i domosdoshëm krijimi i stomës. Përkujdesja infermierore ndaj këtyre pacientëve, menaxhimi i komplikimeve të stomave dhe edukimi i prindërve për mirëmbajtjen e …

Preventiva E Sëmundjeve Ngjitëse Përmes Vaksinimit Dhe Roli Infermieror Në Këtë Proces, Dafina Gashi

Theses and Dissertations

Në vaksinat, antigjenet janë më së shpeshti pjesë e mikroorganizmave, mikroorganizma të vdekur ose të dobësuar, ose toksinave të tyre. Programet e shëndetit publik të vaksinimit masiv kanë bërën kontrollin e sëmundjeve ngjitëse kundër të cilave është duke u luftuar ende. Vaksinimi është suksesi më i madh mjekësor i shekullit të XX-të dhe vaksinimi ka shpëtuar më shumë jetë se çdo ndërhyrje tjetër mjekësore në histori.

Përveç mbrojtjes individuale të arritur me vaksinim, programi optimal i imunizimit dhe zbatimi i tij arrijnë imunitet kolektiv (për sëmundjet njerëzore në njeri, nëse mbulimi i mjaftueshëm i popullsisë arrihet me vaksinim, transmetimi i …

Njohurit E Femrave Rreth Shfaqjes Së Kancerit Të Qafës Së Mitrës, Egzona Luma

Theses and Dissertations

Kanceri i qafës së mitrës është një lloj kanceri që ndodh në qelizat e qafës së mitrës - pjesa e poshtme e mitrës që lidhet me vaginën.

Qëllimi i këtij studimi është vlersimi i njohurive të femrave rreth shfaqjës së kancerit të qafës së mitrës në rajonin e Prishtinës. Në hulumtimin e realizuar janë anketuar 100 femra nga rajoni i Prishtinës tek të cilat janë vlersuar njohuritë e tyre rreth shfaqjës së kancerit të qafës së mitrës, bazuar në rezultatet shohim se në pytjen a keni dëgjuar për kancerin e qafës së mitrës ,56 % e të anketuarave kanë dëgjuar …