Diseases Commons^™

Stroke In Young Adults: Current Trends, Opportunities For Prevention And Pathways Forward, Tamer Yahya, Mohammad Hashim Jilani, Safi U. Khan, Reed Mszar, Syed Zawahir Hassan, Michael J. Blaha, Ron Blankstein, Salim S. Virani, Michelle C. Johansen

Office of the Provost

Cardiovascular disease remains a major contributor to morbidity and mortality in the US and elsewhere, and stroke is a leading cause of disability worldwide. Despite recent success in diminishing stroke incidence in the general US population, in parallel there is now a concerning propensity for strokes to happen at younger ages. Specifically, the incidence of stroke for US adults 20-44 years of age increased from 17 per 100,000 US adults in 1993 to 28 per 100,000 in 2015. Occurrence of strokes in young adults is particularly problematic as these patients are often affected by physical disability, depression, cognitive impairment and …

Perspectives In A Pandemic, Kevin M. Cahill M.D.

International Affairs

Perspectives in a Pandemic is a series of enlightening essays written by Kevin M. Cahill, M.D., providing a unique insight into the early phase of the COVID-19 pandemic. Dr. Cahill draws on his extensive experiences in earlier epidemics, natural disasters, and armed conflicts to offer lessons, wisdom, guidance, and support to frontline workers. While he wrote the essays as weekly reflections in the early months of the pandemic for the thousands of humanitarian-relief workers he has trained around the world, this book is a must-read for anyone seeking to understand and make some sense of the complexities and chaos inevitable …

Ua12/2/1 College Heights Herald, Vol. 96, No. 3, Wku Student Affairs

WKU Administration Documents

WKU campus newspaper reporting campus, athletic and Bowling Green, Kentucky news. This issue contains articles:

• Reynolds, Easton. Coping with Crisis – Hurricane Katrina, COVID-19
• Bunton, Gabrielle. Students Adjust to Hybrid Classes During COVID-19 Pandemic
• Latimer, Jacob. WKU Student Lorena Silva Releases Springhouse
• Celebration Despite Separation
• Stack, Madalyn. Editorial Cartoon re: Zoom Meetings
• Marshall, Olivia. Navigating My Sorority in a Global Pandemic – Delta Zeta
• Warner, Casey. Review: Bowling Green Punk-rock Duo Releases Album – Dos Cobros
• Kieser, Nick. WKU Coaches Adapt to Postponed Season – Soccer, Volleyball
• Warner, Casey. Piggy-T – Tyrell Pigrome, Football
• Gaylord, Kaden. Support the Players – …

Acute And Chronic Dosing Of A High-Affinity Rat/Mouse Chimeric Transferrin Receptor Antibody In Mice, Demi M. Castellanos, Jiahong Sun, Joshua Yang, Weijun Ou, Alexander C. Zambon, William M. Pardridge, Rachita K. Sumbria

Pharmacy Faculty Articles and Research

Non-invasive brain delivery of neurotherapeutics is challenging due to the blood-brain barrier. The revived interest in transferrin receptor antibodies (TfRMAbs) as brain drug-delivery vectors has revealed the effect of dosing regimen, valency, and affinity on brain uptake, TfR expression, and Fc-effector function side effects. These studies have primarily used monovalent TfRMAbs with a human constant region following acute intravenous dosing in mice. The effects of a high-affinity bivalent TfRMAb with a murine constant region, without a fusion partner, following extravascular dosing in mice are, however, not well characterized. Here we elucidate the plasma pharmacokinetics and safety of a high-affinity bivalent …

Factors Affecting The Characterization Of Post-Exertional Malaise Derived From Patient Input, Carly S. Holtzman, Claire Fisher, Shaun Bhatia, Leonard A. Jason

Journal of Health Disparities Research and Practice

The National Institutes of Health/Center for Disease Control and Prevention (NIH/CDC) Common Data Elements (CDE) established a post-exertional malaise (PEM) workgroup with the task of describing PEM and recommending a standardized way of assessing it in patients with myalgic encephalomyelitis and chronic fatigue syndrome (ME/CFS). As a stigmatized group, patients with ME/CFS are in need of instruments which can properly describe their symptomatic experiences, which can help reduce the disparity between illness seriousness and appropriate attention from healthcare. The current study explored attitudes and preferences among 115 patients with ME/CFS who participated in the creation of a patient-driven instrument to …

A Lung Cancer Screening Personalized Decision-Aid Improves Knowledge And Reduces Decisional Conflict Among A Diverse Population Of Smokers At An Urban Academic Medical Center, Madeline Kaufman, Nilan Schnure, Andrea Nicholson, Frank Leone, Carmen Guerra

Journal of Health Disparities Research and Practice

Introduction: Few lung cancer screening decision aids have been tested in diverse populations. The study objective was to determine whether the online decision aid www.shouldiscreen.com impacts knowledge of and decisional conflict around lung cancer screening in a diverse population.

Methods: Eligible patients had significant smoking histories, were at increased risk for lung cancer (ages 45-80, >20 pack-years, smoking within last 15 years) and had no history of prior lung cancer or screening. Data was collected and analyzed in 2017.

Results: 40 patients were enrolled: 80% were female, 62.5% black, 33% white, and 48% had a high school …

Effect Of High Glucose On Ocular Surface Epithelial Cell Barrier And Tight Junction Proteins, Saleh M. Alfuraih, Ashley Barbarino, Christopher Ross, Kiumars Shamloo, Vishal Jhanji, Miao Zhang, Ajay Sharma

Pharmacy Faculty Articles and Research

PURPOSE. Patients with diabetes mellitus are reported to have ocular surface defects, impaired ocular surface barrier function, and a higher incidence of corneal and conjunctival infections. Tight junctions are critical for ocular surface barrier function. The present study was designed to investigate the effect of high glucose exposure on human corneal and conjunctival epithelial cell barrier function and tight junction proteins.

METHODS. Human corneal and conjunctival epithelial cells were exposed to 15 mM and 30 mM glucose for 24 and 72 hours. The barrier function was measured using transepithelial electrical resistance (TEER). The cell migration was quantified using scratch assay. …

Ua12/2/1 College Heights Herald, Vol. 96, No. 2, Wku Student Affairs

WKU Administration Documents

WKU campus newspaper reporting campus, athletic and Bowling Green, Kentucky news. This issue contains articles:

• Collins, Michael. Rough Start – COVID-19
• Thornton, Maggie. What a WKU Student Learned from Her Experience with COVID-19
• Harkreader, Dylan & Debra Murray. Programs That Rely On Hands-on Learning Adapt to Virtual Courses
• Meyer-Thornton, Zane. Keep It Going
• Hurst, Courtney, Robin Lester & Trenton Peyton. What Is Intercultural Student Engagement Center?
• Sisler, Julie. WKU Grad Student: It’s On the Administration, Not the Students
• Kieser, Nick. Football Takes Precautions to Kick Off Season COVID-Free
• Warner, Casey: Setting Up – Football
• Gaylord, Kaden. Making It Safe to …

Musculoskeletal Tumours Throughout History And Beyond: Clinical Features, Imaging, Staging And Biopsy, Akbar Jaleel Zubairi, Obada Hussein Hasan, Mohammad Mustafa, Masood Umer

Section of Orthopaedic Surgery

Background: Over the last century, there has been a remarkable development in the study of bone and soft tissue sarcomas. This is primarily due to the improved knowledge of the nature of these lesions and the improved imaging technology. In literature there are many protocols that are being used and all of them have reported various advantages and disadvantages of each technique used. However, there is no set guideline and whatever has been proposed has been developed on the basis of the experience of different centres and different surgeons.
Objective: The current systematic review was planned to thoroughly evaluate the …

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.

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 …

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 …

Guidance For Contemporary Use Of Biologics In Management Of Chronic Rhinosinusitis With Nasal Polyps: Discussion From A National Institutes Of Health-Sponsored Workshop, Lauren T Roland, Timothy L Smith, Rodney J Schlosser, Zachary M Soler, Anju T Peters, Tanya M Laidlaw, Benjamin S Bleier, Vijay Ramakrishnan, Elina Toskala, David W Kennedy, Amber U Luong

Faculty, Staff and Student Publications

BACKGROUND: Biologic medications are emerging as options for treating chronic rhinosinusitis with nasal polyps (CRSwNP). Several questions remain regarding patient selection, indications, clinical efficacy, and cost effectiveness.

METHODS: In November 2019, a group of physicians and scientists gathered to consider strategies for future studies regarding biologics. During the discussion, gaps in knowledge highlighted a need for a consensus on the present day use of biologics in polyp patients.

RESULTS: The goal of this guideline is to propose recommendations for the current use of biologics in CRSwNP as new evidence continues to emerge and inform practice.

CONCLUSION: We suggest that physicians …

Brucellosis In Pakistan: A Neglected Zoonotic Disease, Meesha Iqbal, Zafar Fatmi, Mumtaz Ali Khan

Community Health Sciences

Brucellosis is a zoonotic disease; endemic but neglected in the South Asian countries including Pakistan. It causes economic loss to the livestock sector and leads to systemic infection in humans. Brucellosis was neglected in Pakistan since long. According to the Staged Tool for the Elimination of Brucellosis (STEB), Pakistan carries a grim landscape of the disease with no structured control activities. This article describes the five-year national brucellosis control strategic plan (2018-2023) formulated by the government of Pakistan using the one-health approach for the prevention and control of disease across the country. The plan incorporates components of surveillance, research, diagnostic …

Urdu Translation And Validation Of Premature Ejaculation Diagnostic Tool (Pedt), Muhibullah Bangash, Wajahat Aziz, Mohammad Shoaib, Hammad Ather

Section of Urology

Objective: To validate an Urdu translation of premature ejaculation diagnostic tool (PEDT) by analyzing the association of this diagnostic tool with the clinical diagnosis of premature ejaculation (PE) and intravaginal ejaculatory latency time (IELT).
Methods: This cross-sectional study was conducted at the urology section of the Aga Khan University Hospital, Karachi, for six months duration, from July 2018 to December 2018. In our study 108 subjects, aged 20 to 50 years, who were in a stable sexual relationship (heterosexual) for a minimum duration of six months, were asked to fill the Urdu version of PEDT, 61 with PE and 47 …

Prognostic Factors In Patients With Salivary Gland Malignancy: A Retrospective Cohort Study, Moghira Iqbaluddin Siddiqui, Haissan Iftikhar, Umar Farooq Bhatti, Mubasher Ikram

Section of Otolaryngology, Head & Neck Surgery

Our objective was to determine the factors affecting the prognosis in patients with major salivary gland malignancy presenting to Aga Khan University Hospital in Karachi. Retrospective cohort study was carried out at our center on patients diagnosed and treated for salivary gland cancers. Presentation and treatment offered was reviewed from medical charts. Telephonic interviews were conducted to assess the survival of patients who were lost to follow-up. Log rank test was used to compare the mean survival times. A total of 36 patients were included in the study. The mean age was 45.1 +/- 14.6 years. Majority were male 21 …

Taking It To Heart: Trauma And Cardiovascular Risk In Court-Involved People Of Color, Tanya Erazo

Dissertations, Theses, and Capstone Projects

Research supports that racial disparities in health persist in the United States, with cardiovascular risk and cardiovascular disease remaining particularly high in low-income, communities of color (U.S. Department of Health and Human Services: Centers for Disease Control and Prevention, 2013; Winkleby, Jatulis, Frank, & Fortmann, 1992). Public health literature often focuses on sociodemographic variables when assessing for health disparities without considering trauma or forensic populations. This dissertation provides an overview of literature that examines cardiovascular disease and its relationship to trauma, particularly in low-income, communities of color, and forensic populations. Although the dissertation culminates in providing results for an investigation …

Genomic Instability And The Oncohistone H3k27m Drive Gliomagenesis In A Murine Model, Lee J. Pribyl

Theses and Dissertations (ETD)

Maintaining genome stability is crucial for human health and it is of particular importance in neural cells during early brain development. Genome maintenance occurs at two broad stages; surveillance during DNA replication and DNA damage repair in differentiating and mature cells. Neural cells are particularly sensitive to DNA strand breaks and defective DNA damage responses can result in detrimental effects on the nervous system, including cancer. Multiple DNA repair pathways play critical roles in preventing DNA damage accumulation in stem and neural progenitor cells. The mechanisms that protect progenitor genomes also suppress DNA mutations that can result in cancer. A …

Frequency Of Intraoperative Hypotension After The Induction Of Anesthesia In Hypertensive Patients With Preoperative Angiotensin-Converting Enzyme Inhibitors, Fahad Salim, Fazal Hameed Khan, Muhammad Nasir, Rashid Ali, Ayesha Iqbal, Amir Raza

Department of Anaesthesia

Introduction: The renin-angiotensin-aldosterone system (RAAS) is an important target in the treatment of hypertension. Angiotensin-converting enzyme (ACE) inhibitors block the conversion of angiotensin I to angiotensin II. ACE inhibitors not only treat hypertension but also decrease morbidity and mortality in heart failure patients and in patients with acute myocardial infarction. The discontinuation of ACE inhibitors before the surgery is still controversial. To assess the current magnitude of the problem in our population, we aimed to conduct this study, which evaluated the frequency of intraoperative hypotension after the induction of anesthesia in controlled hypertensive patients with preoperative ACE inhibitors.
Material and …

Tuberculosis Of The Flexor Carpi Radialis Muscle - A Case Report, Shah Fahad, Naveed Baloch, Nasir Ud Din

Section of Orthopaedic Surgery

Tuberculosis involving almost any organ of the body is a major problem in developing countries. The most commonly affected site in tuberculosis is the lung. Of the extra pulmonary tuberculosis, musculoskeletal involvement accounts for 1-5% of the cases. Muscular involvement in tuberculosis is a rare manifestation of extra pulmonary tuberculosis. Unusual presentations often go undetected and are associated with a diagnostic and therapeutic delay. This case report presents tuberculosis of the flexor carpi radialis.

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) …

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.

Frequency And Outcome Of Meconium Aspiration Syndrome In Babies Born With Meconium-Stained Liquor At Secondary Care Hospital In Pakistan: A Case Series Study, Abdul Moeed, Heeramani Lohana, Sarwat Urooj, Sheraz Ahmed, Khalil Ahmed, Khadija N Humayun

Department of Paediatrics and Child Health

Background: Meconium aspiration syndrome (MAS) in the newborn is characterized by hypoxia, hypercapnia, and acidosis. MAS is a leading cause of morbidity and mortality in neonates. The primary objective of this study was to estimate the frequency of meconium aspiration syndrome (MAP) in babies born with meconium-stained liquor. The secondary outcome was to estimate the meconium aspiration syndrome; in terms of hospital stay, complications, and mortality.
Methods: The study was done at Aga Khan Maternal and Child Care Centre, Hyderabad, Pakistan. Study design was case series and the duration of the study was of 6 months. All patients who fulfilled …

Early Transplantation In Acute On Chronic Liver Failure: Who And When, Nadim Mahmud, Ruben Hernaez, Tiffany Wu, Vinay Sundaram

Faculty, Staff and Students Publications

PURPOSE OF REVIEW: Acute on chronic liver failure (ACLF) is a unique syndrome that afflicts patients with chronic liver disease and results in high short-term mortality, > 50% at 28 days in patients with severe ACLF (grade 3, ACLF-3). Given this prognosis, there is an urgent need to understand risk factors for this condition, as well as selection criteria for patients who may benefit from liver transplantation (LT).

RECENT FINDINGS: Several studies have identified risk factors for developing ACLF, including higher model for end-stage liver disease score, anemia, and morbid obesity, as well ACLF mortality, such as infection, increasing organ failures, …

Mtor-Initiated Metabolic Switch And Degeneration In The Retinal Pigment Epithelium, Young-Mi Go, Jing Zhang, Jolyn Fernandes, Christopher Litwin, Rui Chen, Theodore G Wensel, Dean P Jones, Jiyang Cai, Yan Chen

Faculty, Staff and Students Publications

The retinal pigment epithelium (RPE) is a particularly vulnerable tissue to age-dependent degeneration. Over the life span, the RPE develops an expanded endo-lysosomal compartment to maintain the high efficiency of phagocytosis and degradation of photoreceptor outer segments (POS) necessary for photoreceptor survival. As the assembly and activation of the mechanistic target of rapamycin complex 1 (mTORC1) occur on the lysosome surface, increased lysosome mass with aging leads to higher mTORC1 activity. The functional consequences of hyperactive mTORC1 in the RPE are unclear. In the current study, we used integrated high-resolution metabolomic and genomic approaches to examine mice with RPE-specific deletion …

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

Faculty, Staff and Students Publications

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 …

The De Winter Ecg Pattern: Distribution And Morphology Of St Depression, Zhong-Qun Zhan, Yang Li, Li-Hong Han, Kjell C Nikus, Yochai Birnbaum, Adrian Baranchuk

Faculty, Staff and Students Publications

BACKGROUND: The reported positive predictive value (PPV) for the "de Winter ECG pattern" to predict an acute left anterior descending artery (LAD) lesion is inconsistent. Besides, the morphology of upsloping or nonupsloping ST depression (STD) may have different significance of severity and prognostication.

METHODS: We searched the MEDLINE database using "de Winter" or "junctional ST-depression with tall symmetrical T-waves" or "tall T wave" or "STEMI equivalent" as the item up to March 2020. We compared the ECG differences between the different culprit arteries and various morphological STD.

RESULTS: A total of 70 patients with analyzable ECGs were included. In 60 …

Early Aggressive Hydration Is Associated With Decreased Opioid Use And Readmission In Mild Acute Pancreatitis, Shreyans Doshi, Hong Liang, Hale Z. Toklu, Selina Fritze, Sue-Wei Luu

HCA Healthcare Journal of Medicine

Background: Acute pancreatitis (AP) is one of the most common causes of hospital admissions due to gastrointestinal disorders. No pharmacologic agents have been proven to impact the prognosis, and the treatment still remains supportive with intravenous fluids for hydration. Although early hydration has been recommended for the management of mild AP, there is no consensus on the type, rate, and amount of the fluid replacement.

Objective: In this study, we aimed to investigate the outcome of aggressive hydration in patients with AP.

Methods: Retrospective data from patients admitted to 12 hospitals (2015–2017) was used for analysis. Five hundred patients who …

Investigation Of A Peculiar Case Of Childhood Lymphadenopathy, Chade Aribo, Alonso Al, Allison Woodall, Tommy Y. Kim

HCA Healthcare Journal of Medicine

Introduction: Lymphadenopathy is a common physical finding often associated with an infectious etiology. We present a case of a patient with generalized cervical and supraclavicular lymphadenopathy diagnosed with a rare malignancy. Health care providers should be aware of some uncommon historical or physical examination findings that warrant further investigation.

Clinical Findings: A 16-year-old female presented to the emergency department with 3 days of a fever, congestion and sore throat with swelling around the jaw. Her physical examination findings included bilateral mandibular swelling and generalized cervical lymphadenopathy with palpable supraclavicular lymph nodes.

Outcomes: Complete blood count showed pancytopenia with a white …