Medicine and Health Sciences Commons^™

Efficacy Of Hydroxychloroquine And Tocilizumab In Patients With Covid-19: Single-Center Retrospective Chart Review., Sohaib Roomi, Waqas Ullah, Faizan Ahmed, Soban Farooq, Usama Sadiq, Asad Chohan, Munnam Jafar, Maryum Saddique, Shristi Khanal, Robert Watson, Margot Boigon

Abington Jefferson Health Papers

BACKGROUND: During the initial phases of the COVID-19 pandemic, there was an unfounded fervor surrounding the use of hydroxychloroquine (HCQ) and tocilizumab (TCZ); however, evidence on their efficacy and safety have been controversial.

OBJECTIVE: The purpose of this study is to evaluate the overall clinical effectiveness of HCQ and TCZ in patients with COVID-19. We hypothesize that HCQ and TCZ use in these patients will be associated with a reduction in in-hospital mortality, upgrade to intensive medical care, invasive mechanical ventilation, or acute renal failure needing dialysis.

METHODS: A retrospective cohort study was performed to determine the impact of HCQ …

How I Treat Acute And Persistent Sickle Cell Pain., Samir K. Ballas

Cardeza Foundation for Hematologic Research

Sickle pain is the hallmark of sickle cell disease (SCD). It could be acute, persistent/relapsing, chronic, or neuropathic. Although there is a general consensus that pain is a major manifestation of SCD, there is a controversy as to the types of pain and their interrelationship between acute, chronic, relapsing, persistent, etc. This report first reviews the general approach to the management of acute vaso-occlusive crisis (VOC) pain, including education, counseling, pharmacotherapy, non-pharmacotherapy, and fluid therapy. This is followed by the presentation of five patients that represent typical issues that are commonly encountered in the management of patients with SCD. These …

Blood-Brain Barrier: Mechanisms Governing Permeability And Interaction With Peripherally Acting Μ-Opioid Receptor Antagonists., Eugene R. Viscusi, Andrew R Viscusi

Department of Anesthesiology Faculty Papers

The blood-brain barrier (BBB) describes the unique properties of endothelial cells (ECs) that line the central nervous system (CNS) microvasculature. The BBB supports CNS homeostasis via EC-associated transport of ions, nutrients, proteins and waste products between the brain and blood. These transport mechanisms also serve as physiological barriers to pathogens, toxins and xenobiotics to prevent them from contacting neural tissue. The mechanisms that govern BBB permeability pose a challenge to drug design for CNS disorders, including pain, but can be exploited to limit the effects of a drug to the periphery, as in the design of the peripherally acting μ-opioid …

Parental Intent To Initiate And Complete The Human Papillomavirus Vaccine Series In The Usa: A Nationwide, Cross-Sectional Survey, Kalyani Sonawane, Yenan Zhu, Jane R Montealegre, David R Lairson, Cici Bauer, Lindy U Mcgee, Anna R Giuliano, Ashish A Deshmukh

Faculty, Staff and Student Publications

BACKGROUND: Human papillomavirus (HPV) vaccine uptake among US adolescents is primarily dependent on the intent of their parents. to the best of our knowledge, an analysis quantifying parental intent to initiate and complete the HPV vaccine series in the USA at both the national and state level has not been done. We aim to estimate parental intent to initiate and complete the HPV vaccine series at the national-level and state-level and to identify reasons for lack of intent to initiate and complete the vaccine series.

METHODS: This cross-sectional study uses data from the adolescent component of the 2017-18 National Immunization …

Mast Cells As A Surrogate Marker For Diagnosis Of Persistent Eosinophilic Esophagitis., Subhashree Mallika Krishnan, Ping Zhang, Zhenhong Qu

Articles

Context: Histologically, the hallmark of active eosinophilic esophagitis (EoE) is the presence of intraepithelial eosinophils (iEos). Recently, studies have evaluated the etiologic role of intraepithelial mast cells (iMCs) in pathogenesis of EoE and residual disease. We aimed to evaluate diagnostic and prognostic value of iMCs in EoE by its prevalence in esophageal biopsy cases in association with presence of iEos and/or lymphocytes. Design: Esophageal biopsy cases were prospectively reviewed for presence of iEos, lymphocytes, and/or iMCs. An experienced gastroenterology pathologist at our institution quantitated the number of inflammatory cells. Immunohistochemistry (CD117) was used to highlight iMCs. Unpaired Student t test …

Global Strategies And Local Implementation Of Health And Health-Related Sdgs: Lessons From Consultation In Countries Across Five Regions, Sameen Siddiqi, Wafa Aftab, Fahad Javaid Siddiqui, Luis Huicho, Roman Mogilevskii, Peter Friberg, Johanna Lindgren-Garcia, Sara Causevic, Anil Khamis, Mashal Murad Shah, Zulfiqar Ahmed Bhutta

Community Health Sciences

Evidence on early achievements, challenges and opportunities would help low-income and middle-income countries (LMICs) accelerate implementation of health and health-related sustainable development goals (HHSDGs). A series of country-specific and multicountry consultative meetings were conducted during 2018-2019 that involved 15 countries across five regions to determine the status of implementation of HHSDGs. Almost 120 representatives from health and non-health sectors participated. The assessment relied on a multidomain analytical framework drawing on existing public health policy frameworks. During the first 5 years of the sustainable development goals (SDGs) era, participating LMICs from South and Central Asia, East Africa and Latin America demonstrated …

Inspire : Vol 3, Issue 9, Department Of Medicine

INSPIRE – Department of Medicine Archives

Content

• Message From the Chair
• Medicine at National and International Forums
• Building Research Programmes:Perspectives from outstanding mentors- AKU, Duke Collaboration
• First National Webinar on Covid-19 and Skin
• In Depth- Section- featuring Dr Adil Aziz Featured Faculty: Prof Amna Subhan Butt “…Be the best version of yourself …”
• Publications

Inspire : Vol 3, Issue 9, Department Of Medicine

INSPIRE – Department of Medicine Archives

Content

• Message From the Chair
• Medicine at National and International Forums
• Building Research Programmes:Perspectives from outstanding mentors- AKU, Duke Collaboration
• First National Webinar on Covid-19 and Skin
• In Depth- Section- featuring Dr Adil Aziz
• Featured Faculty: Prof Amna Subhan Butt “…Be the best version of yourself …”
• Publications

Primary Hyperparathyroidism: Experience From A Tertiary Care Centre In Pakistan, Tehseen Fatima, Bhagwan Das, Saadia Sattar, Najmul Islam

Section of Diabetes, Endocrinology and Metabolism

Objective: To study the clinical, biochemical and radiological features and management outcomes of patients with primary hyperparathyroidism.
Methods: This retrospective study was conducted at the Aga Khan University Hospital, Karachi, Pakistan and comprised data of patients with primary hyperparathyroidism from 2008 to 2017.
Results: Out of 103 patients, 83(80.6%) were female. Overall mean age was 59.3±16.2 years. Musculoskeletal manifestations were seen in 60(58.3%) patients and renal manifestations in 28(27.2%). Ostieits fibrosa cystica was found in 04(3.88%) patients. Overall, Ultrasound neck and sestamibi scan localized the lesion in 66 (64.1%) and 77 (76.2%) patients respectively. Among 79 patients who underwent surgery, …

Frequency Of Silent Carotid Artery Stenosis In Diabetics And Its Associated Factors: An Analysis In Tertiary Care Hospital, Faiza Sadaqat Ali, Nimrah Bader, Bader Faiyaz Zuberi, Sabiha Banu

Section of Diabetes, Endocrinology and Metabolism

Objective: To estimate frequency of silent carotid artery stenosis and its associated factors in diabetic patients attending a tertiary care hospital.
Methods: This cross-sectional study was conducted in tertiary care Civil Hospital, Karachi from March 2019 to September 2019,. A total of 166 patients with Diabetes Mellitus were included in this study. Brief history was taken for the duration of DM, treatment, and smoking habits. Carotid artery stenosis (CAS) wafrs measured by Doppler ultrasound of right and left common, internal, and external carotid arteries.
Results: Frequency of silent carotid artery stenosis (CAS) in diabetic patients was observed in 28.92% (48/166) …

The Effects Of Music Intervention On Pain And Anxiety In The Immediate Postoperative Period In Adults Undergoing Total Knee Arthroplastyand Total Hip Arthroplasty, Peggy Olson, Mary Waldo

Books, Presentations, Posters, Etc.

No abstract provided.

Promoting Resident Emotional Health Meaningful Connections: An Evaluation Of A Wellness Game, Bruce St. Amour, William B. Dehart

Journal of Wellness

Introduction

Physician wellness is a topic of significant national interest. Physician burnout is at its highest point during residency and is linked to many negative outcomes. The Core Emotional Needs are a useful framework to guide thinking toward wellness in residents: connection and acceptance, healthy autonomy and performance, reasonable limits, and healthy responsibility and standards. We examined the efficacy of a game (“Well, For Me…”) designed to improve social connection and acceptance among residents to reduce social isolation. We hypothesized that this activity would be viewed positively by the residents as an intervention to improve resident wellness.

Methods

Participants …

Severity Of Disease From Covid-19 In Patients With Obesity And Mafld: Is There An Association?, Muhammad Kamran, Wasim Jafri

Section of Gastroenterology

No abstract provided.

Relationships Between Professional Development And Attitudes, Knowledge, And Skills In Play Therapy Among Counselors, Cynthia Ann Anderson

Dissertations

Most counselors receive inadequate training in play therapy, through university counselor education programs, to counsel children using the method, which leaves novice counselors searching for workshops, institutes, conferences, or self-training to effectively meet the mental health needs of children with play therapy. In this first-of-its-kind study, the researcher investigated relationships between professional development and play therapy among working counselors and measured attitudes, knowledge and skills, and types of training in play therapy. A nonrandom sample of counselors were recruited from relevant online sources in this quantitative study. Attitudes, knowledge, and skills were measured by the self-reported Revised Play Therapy Attitude-Knowledge-Skills …

Donor Families’ Experiences From Initial Loss Forward: An Interpretative Phenomenological Analysis, Linda Sue Meeker

Dissertations

The purpose of this study was to examine the lives of those who have consented to organ donation at the time of an unexpected death of a loved one. The qualitative data illuminated participants’ experiences as members of donor families as they shared their observations and experiences from the initial loss forward. The participants in this study included eight women and one man who were the primary next-of-kin and the individual who provided consent to donate the organs. The results indicated that there are steps in the care of these families that could be improved, allowing for better care of …

Acute Toxicity And Local Response Using Three Fractions Of High Dose Rate (Hdr) Brachytherapy For Curative Treatment Of Carcinoma Cervix, Nasir Ali, Bilal Mazhar Qureshi, Ahmed Nadeem Abbasi, Asim Hafiz, Benazir Mir, Abdul Qadir Jangda

Department of Radiation Oncology

To determine the acute vaginal mucosal toxicity and clinical response of cervical cancer after definitive treatment with external beam radiotherapy (EBRT) and three fractions each of 8 Fray (Gy) high dose rate intracavitary brachytherapy (HDR-BT).
Study design: Descriptive study.
Place and duration: Radiation Oncology Section, Department of Oncology, The Aga Khan University Hospital, Karachi, Pakistan from January 2008 till December 2015.
Methodology: Protocol was formulated for carcinoma cervix to complete treatment in 7 weeks. Patients were treated with chemotherapy and pelvic EBRT to a total dose of 45 Gy/25 fractions, followed by three intracavitary HDR brachytherapy fractions of 8 Gy …

Comparison Of Sars-Cov-2 Detection From Nasopharyngeal Swab Samples By The Roche Cobas 6800 Sars-Cov-2 Test And A Laboratory-Developed Real-Time Rt-Pcr Test, Elisabet Pujadas, Nnaemeka Ibeh, Matthew M Hernandez, Aneta Waluszko, Tatyana Sidorenko, Vanessa Flores, Biana Shiffrin, Numthip Chiu, Alicia Young-Francois, Michael D Nowak, Alberto E Paniz-Mondolfi, Emilia M Sordillo, Carlos Cordon-Cardo, Jane Houldsworth, Melissa R Gitman

Faculty, Staff and Student Publications

The urgent need to implement and rapidly expand testing for severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection has led to the development of multiple assays. How these tests perform relative to one another is poorly understood. We evaluated the concordance between the Roche Diagnostics cobas 6800 SARS-CoV-2 test and a laboratory-developed test (LDT) real-time reverse transcription-polymerase chain reaction based on a modified Centers for Disease Control and Prevention protocol, for the detection of SARS-CoV-2 in samples submitted to the Clinical Laboratories of the Mount Sinai Health System. A total of 1006 nasopharyngeal swabs in universal transport medium from persons under …

Yttrium-90 Selective Internal Radiotherapy As Bridge To Curative Hepatectomy For Recurrent Malignant Solid Pseudopapillary Neoplasm Of Pancreas: Case Report And Review Of Literature, Adam R Dyas, David Thor Johnson, Erin Rubin, Richard D Schulick, Piyush Kumar Sharma

Faculty, Staff and Student Publications

Recurrent malignant solid pseudopapillary neoplasms of the pancreas (SPNP) are rare tumors with unpredictable clinical and histopathological features. There is a lack of consensus regarding utilization of adjuvant modalities in conjunction with or in lieu of curative metastatectomy. We present a remarkable case where Yttrium-90 selective internal radiation therapy (Y-90 SIRT) was successfully utilized to elucidate underlying tumor biology and aid resection of a large multifocal recurrent metastatic SPNP in the right hemi-liver of a 59-year-old female. Thus, in cases where curative metastatectomy remains the treatment goal in management of recurrent and/or metastatic SPNPs, Y-90 SIRT is a safe and …

Extracorporeal Membrane Oxygenation Utility In Postpartum Patients, Bindu Akkanti, Ismael A Salas De Armas, Ayaaz K Sachedina, Jennifer M Sunny, Mahmoud Samy Ahmed, Avaleen Kaur, Kha T Dinh, Rahat Hussain, Sachin Kumar, Sriram Nathan, Marwan Jumean, Manish K Patel, Mehmet H Akay, Jayeshkumar A Patel, Barbi Witz, John Zaki, Igor Banjac, Lisa Janowiak, Igor D Gregoric, Biswajit Kar

Faculty, Staff and Student Publications

Although extracorporeal membrane oxygenation (ECMO) has been used in many different populations, its use in pregnant or postpartum patients has not been widely studied. This article reviews the ECMO experience in this population at a large urban hospital. Electronic medical records for all pregnant or postpartum patients who required ECMO between 2012 and 2019 were retrospectively reviewed. Data on clinical characteristics, outcomes, and complications were gathered. Comparisons between survivors and nonsurvivors were completed. Ten postpartum patients were identified. The patients presented as follows: four with cardiac arrest, one with a massive pulmonary embolism, three with acute respiratory distress syndrome (ARDS), …

Loss Of Uncoupling Protein 3 Attenuates Western Diet-Induced Obesity, Systemic Inflammation, And Insulin Resistance In Rats, Tyler M Lomax, Sadia Ashraf, Gizem Yilmaz, Romain Harmancey

Faculty, Staff and Student Publications

OBJECTIVE: Uncoupling protein 3 (UCP3) is a mitochondrial carrier related to fatty acid metabolism. Although gene variants of UCP3 are associated with human obesity, their contribution to increased adiposity remains unclear. This study investigated the impact that loss of UCP3 has on diet-induced obesity in rats.

METHODS: Male UCP3 knockout rats (ucp3

RESULTS: Loss of UCP3 decreased fat mass gain, white adipocytes size, and systemic inflammation. The ucp3

CONCLUSIONS: Loss of UCP3 partially protects rats from diet-induced obesity. This phenotype is related to induction of a compensatory antioxidant mechanism and prevention of iBAT whitening.

Resveratrol And Tumor Microenvironment: Mechanistic Basis And Therapeutic Targets, Wamidh H. Talib, Ahmad Riyad Alsayed, Faten Farhan, Lina T. Al Kury

All Works

© 2020 by the authors. Licensee MDPI, Basel, Switzerland. Resveratrol (3,40,5 trihydroxystilbene) is a naturally occurring non-flavonoid polyphenol. It has various pharmacological effects including antioxidant, anti-diabetic, anti-inflammatory and anti-cancer. Many studies have given special attention to different aspects of resveratrol anti-cancer properties and proved its high efficiency in targeting multiple cancer hallmarks. Tumor microenvironment has a critical role in cancer development and progression. Tumor cells coordinate with a cast of normal cells to aid the malignant behavior of cancer. Many cancer supporting players were detected in tumor microenvironment. These players include blood and lymphatic vessels, infiltrating immune cells, stromal fibroblasts …

Coronavirus: Pandemics, Artificial Intelligence And Personal Data: How To Manage Pandemics Using Ai And What That Means For Personal Data Protection, Warren B. Chik

Research Collection Yong Pung How School Of Law

This chapter discusses the hearing of essential and urgent court matters in the Singapore courts during the COVID-19 pandemic. On 27 march 2020, the Singapore judiciary notified courst users that remote hearings were to be implemented for certain types of hearings by means of video and telephone conferencing facilities. Court users were also provided with indicative lists of matters which might be considered essential and urgent.

Covid‐19 Crisis And Its Impact On Trustees And Beneficiaries, Man Yip

Research Collection Yong Pung How School Of Law

The COVID-19 pandemic has been described by Prime Minister Lee Hsien Loong as the “crisis of our generation”. We have to swiftly adjust to a new “normal” characterised by safety measures, travel restrictions, economic downturn and uncertainties in the days ahead. What is the new “normal” for trustees and beneficiaries? How should they respond to the legal and practical uncertainties in these challenging times? This commentary discusses two categories of uncertainties for trustees and beneficiaries: (1) uncertainty relating to trust investments; and (2) uncertainty relating to day-to-day administration.

Taking Disputes Online In A Pandemic-Stricken World: Do We Necessarily Lose More Than We Gain?, Dorcas Quek Anderson

Research Collection Yong Pung How School Of Law

Online dispute resolution (ODR) used to be a secondary feature of the courts, arbitration institutions and mediation providers. ODR systems involving problem diagnosis, facilitation and online adjudication were primarily utilised for low value claims and not extended to all legal claims. Private mediation was largely conducted only on online platforms to bridge physical distances. However, the COVID pandemic has very abruptly compelled the courts and other dispute resolution practitioners to shift face-to-face processes to the virtual environment. ODR is likely to be the mainstream, and no longer the alternative, way of managing disputes in the immediate future.

The rapid migration …

Singapore’S Covid-19 General Election: Political Breakthrough Amid A Generational Crisis?, Eugene K. B. Tan

Research Collection Yong Pung How School Of Law

In the 13th general election since independence, the ruling People’s Action Party (PAP) – which has governed Singapore since 1959 – won 83 out of 93 seats, with a popular vote share of 61.24%, its third lowest on record. The Workers’ Party (WP) won 10 seats, including an unprecedented two multi-member electoral constituencies, cementing its standing as the leading opposition party. Not only did this outcome fall short of the strong mandate the PAP had sought, it was arguably its worst electoral performance since independence as the PAP’s control of elected seats dipped below 90% for the first time. In …

Developing Role Models In Clinical Settings: A Qualitative Study Of Medical Students, Residents And Clinical Teachers, Sonia Ijaz Haider, Roger Christopher Gill, Qamar Riaz

Department for Educational Development

Objective: To explore how positive role modelling attributes can be developed in students, residents and clinical teachers.
Methods: The qualitative study using focus group discussions was held at Aga Khan University, Karachi from March to May 2018, and comprised medical students, residents and clinical teachers. Overall 11 focus group discussions were conducted till data saturation was achieved. Content analysis was used to analyse the data which was transcribed verbatim.
Results: Of the 116 subjects, 60(51.7%) were medical students, 35(30.2%) were residents and 21(18%) were clinical teachers. Of the 11 focus group discussions, 4(36.5%) each were held with the students and …

Corona Crisis And Inequality: Why Management Research Needs A Societal Turn, Hari Bapuji, Charmi Patel, Gokhan Ertug, David G. Allen

Research Collection Lee Kong Chian School Of Business

As the world struggles to deal with the COVID-19 pandemic, the stark inequalities in our societies have been laid bare, and the interplay between organizations and societies has also become evident yet again. This crisis underscores the need for management scholars to take a societal turn and examine how organizational practices interact with societal economic inequality. To illustrate this approach, we discuss organizational practices – corporate social responsibility, work design, recruitment and selection, and compensation management – that can contribute to the normalization, reinforcement, and reduction of economic inequalities in society. We conclude by calling on scholars of inequality, as …

Restore Your Sense Of Control — Despite The Pandemic, Eric M. Anicich, Trevor A. Foulk, Merrick R. Osborne, Jake Gale, Michael Schaerer

Research Collection Lee Kong Chian School Of Business

The coronavirus pandemic has wrought unprecedented levels of personal and professional upheaval upon many employees. It may irrevocably transform how we work, communicate, eat, shop, date, and travel. Clearly, these are not “normal” times. And yet, society continues to move forward.

Dynamic Incorporation Of Multiple In Silico Functional Annotations Empowers Rare Variant Association Analysis Of Large Whole-Genome Sequencing Studies At Scale, Xihao Li, Zilin Li, Hufeng Zhou, Sheila M. Gaynor, Yaowu Liu, Han Chen, John Blangero, Joanne E. Curran, Michael Mahaney, Juan M. Peralta

School of Medicine Publications

Large-scale whole-genome sequencing studies have enabled the analysis of rare variants (RVs) associated with complex phenotypes. Commonly used RV association tests have limited scope to leverage variant functions. We propose STAAR (variant-set test for association using annotation information), a scalable and powerful RV association test method that effectively incorporates both variant categories and multiple complementary annotations using a dynamic weighting scheme. For the latter, we introduce 'annotation principal components', multidimensional summaries of in silico variant annotations. STAAR accounts for population structure and relatedness and is scalable for analyzing very large cohort and biobank whole-genome sequencing studies of continuous and dichotomous …

Postinfectious Cerebellar Syndrome With Paraneoplastic Antibodies: An Association Or Coincidence?, Sajid Hameed, Mukesh Kumar, Pal Satyajit Singh Athwal, Sukhmanii Kahlon, Nimit Dalal

Section of Neurology

Cerebellar ataxia has a very broad differential diagnosis in adults, including paraneoplastic and postinfectious etiologies. We report a case of a 56-year-old male presented with right-sided cerebellar dysfunction preceded by fever and headache. He was diagnosed with subacute postinfectious cerebellar ataxia. Blood serology showed the presence of anti-amphiphysin and anti-Ri (ANNA-2, antineuronal nuclear autoantibody type 2) antibodies, which have a known association with cerebellar syndrome. The patient subsequently improved with the steroids. Although no evidence of an underlying tumor was found in the patient, the presence of the paraneoplastic antibodies remains a mystery. We suggest a probable association of these …