Diseases Commons^™

Optical Coherence Tomography Based Indices In Predicting Functional Outcome Of Macular Hole Surgery: A Retrospective Chart Review, Haroon Tayyab, Rehman Siddiqui, Sana Jahangir, Shiraz Hashmi

Section of Ophthalmology

Objectives: The objective of this study was to assess the utility of novel macular hole indices of Optical Coherence Tomography (OCT) and predicting the functional outcome of surgery.
Methods: This was a retrospective chart review of 28 eyes who underwent surgery for idiopathic Full Thickness Macular Hole (FTMH) at The Aga Khan University Hospital (AKUH), Karachi from January 2016 to March 2020. Data of preoperative OCTs were recovered from data server of OCT machine. Measurements of the pre-operative OCTs were calculated using caliper function of OCT software by two independent technicians. Parameters included Macular Hole Index (MHI), Traction Hole Index …

Spontaneous Closure Of Full Thickness Macular Hole In The Presence Of An Epiretinal Membrane In A Vitrectomised Eye: A Case Report, Rehman Siddiqui, Muhammad Umar Fawad, Nida Ahsan

Section of Ophthalmology

We report the case of a spontaneous closure of full thickness macular hole (FTMH) in the presence of an epiretinal membrane (ERM) in a previously vitrectomised eye. The patient had undergone vitrectomy for rhegmatogenous retinal detachment and developed an ERM two weeks after the surgery, which converted into a FTMH after one week. Eight months after the vitrectomy, spontaneous closure of FTMH was observed with an improvement in best-corrected visual acuity (BCVA) from 20/200 to 20/40. The patient was followed up for four years, and the FTMH remained closed. Spontaneous closure of FTMH is possible even in the presence of …

Cardiovascular Fellow-In-Training Feedback On Virtual And Simulator-Based Learning Experience During Covid-19 Pandemic In A Low To Middle Income Country - A Cross-Sectional Study, Pirbhat Shams, Intisar Ahmed, Hunaina Shahab, Zehra Kadani, Aisal Khan, Marvi Shams, Yawer Saeed, Syedah Saira Bokhari, Aamir Hameed Khan

Section of Cardiology

Background: COVID-19 pandemic has introduced us to a greater need of virtual learning platforms and has resulted in less clinical exposure for fellows-in-training. Virtual and simulator-based learning is not widely available in LMIC. It is imperative to analyze feedback of CV fellow-in-training regarding this mode of learning before large scale implementation.
Methodology: This was an observational study conducted between July-August 2020. A multicentered survey was conducted. Survey questionnaire was disseminated to FIT (fellow-in-training) via Google Forms. The questionnaire contained a total of 24 questions about virtual and simulator-based learning during the pandemic.
Results: A total of 68 FIT responded to …

Third Trimester Plasma Metabolites Associated With Gestational Diabetes: An Ancillary Analysis Of The Healthy Beginnings Trial, Rodrigo D. Rosario

Master's Theses

Introduction: Gestational Diabetes Mellitus (GDM) results in complications affecting both mother and child. The implementation of metabolomics to assess metabolite alterations is needed to better understand its etiology. Prior research by our lab in first trimester samples of GDM patients indicated altered fatty acid utilization and purine degradation products.

Objective: Metabolomics analysis was conducted on third trimester (28 -35 weeks) plasma samples to observe differences associated with GDM.

Methods: Fifty samples taken from the Healthy Beginnings trial and their corresponding data were included in the study. Plasma samples were analyzed using UPLC-MS with metabolomic assays for primary metabolomics, aminomics, and …

High Shear Stress Enhances Endothelial Permeability In The Presence Of The Risk Haplotype At 9p21.3, Evan L. Tang, Evan M. Masutami, Benjamin Yeoman, Jessica Fung, Rachel Lian, Brenda Ngo, Aditya Kumar, Jesse K. Placone, Valentina Lo Sardo, Adam J. Engler

Physics & Engineering Faculty Publications

Single nucleotide polymorphisms (SNPs) are exceedingly common in non-coding loci, and while they are significantly associated with a myriad of diseases, their specific impact on cellular dysfunction remains unclear. Here, we show that when exposed to external stressors, the presence of risk SNPs in the 9p21.3 coronary artery disease (CAD) risk locus increases endothelial monolayer and microvessel dysfunction. Endothelial cells (ECs) derived from induced pluripotent stem cells of patients carrying the risk haplotype (R/R WT) differentiated similarly to their non-risk and isogenic knockout (R/R KO) counterparts. Monolayers exhibited greater permeability and reactive oxygen species signaling when the risk haplotype was …

The Practice Of Burch Colposuspension Versus Mid Urethral Slings For The Treatment Of Stress Urinary Incontinence In Developing Country, Saida Abrar, Lubna Razzak, Raheela Mohsin Rizvi

Department of Obstetrics & Gynaecology

Objectives: To compare the effectiveness and complications of Burch colposuspension and Mid Urethral Slings (MUS) for the treatment of Stress Urinary Incontinence (SUI).
Methods: We conducted a cross-sectional study of 162 patients who underwent surgery for SUI with Burch colposuspension (n=40), tension free vaginal tape (TVT) (n= 59) or transobturator tape (TOT) (n=63), from 2006 to 2014 at the Aga Khan University Hospital- Karachi. All three groups were assessed in terms of demographics, cure rates, intraoperative and postoperative complications at one and five years using incontinence impact questionnaire-short form-7 (IIQ-7) and urogenital distress inventory -short form-6 (UDI-6).
Results: Mean age …

Role Of Sodium-Glucose Cotransporter-2 Inhibitors In Readmissions For Congestive Heart Failure, Joseph Keryakos, Robert Kranz, Rachel Propst, Jena Rathert, Kelli Semerad

Faculty Work Comprehensive List

Background: Patients with type II diabetes are at major risk for cardiovascular disease. Sodium-glucose cotransporter-2 inhibitors (SGLT-2 inhibitors) have demonstrated benefit for these patients. The purpose of this study is to determine whether SGLT-2 inhibitors significantly reduce heart failure readmission rates and improve outcomes in patients with congestive heart failure (CHF).

Methods: Patient data was pulled on CHF patients with an active prescription for an SGLT-2 inhibitor, and it was analyzed using Fischer’s Exact tests and two-tailed t-tests. The primary outcome was a 6-month hospital readmission rate due to CHF while taking SGLT-2 inhibitors. Secondary outcomes included 6-month …

Investigating Rurality As A Risk Factor For State And Trait Hopelessness In Hospitalized Patients With Ischemic Heart Disease, Deb Bomgaars, Gwenneth A. Jensen, Lynn L. White, Kristin M. Vande Griend, Angela Kroeze Visser, Madison P. Goodyke, Anna Luong, Nathan L. Tintle, Susan L. Dunn

Faculty Work Comprehensive List

Background

Rurality and hopelessness are each associated with increased mortality in adults with ischemic heart disease (IHD), yet there is no known research examining rurality as a risk factor for hopelessness in patients with IHD. This study evaluated rurality as a risk factor for state and trait hopelessness in adults hospitalized with IHD in samples drawn from the Great Lakes and Great Plains regions of the United States.

Methods and Results

A descriptive cross‐sectional design was used. Data were collected from 628 patients hospitalized for IHD in the Great Lakes (n=516) and Great Plains (n=112). Rural–Urban Commuting Area codes were …

Making Hospitals Health Promotive, Shelina Bhamani, Areeba Zainab Makhdoom

Department of Obstetrics & Gynaecology

No abstract provided.

Assesment Of Antibiotic Resistant Gene Expression In Clinical Isolates Of Pseudomonas Aeruginosa, Dustin Esmond

Biology Theses

Increasing prevalence of nosocomial infections by antimicrobial resistant pathogens resulting in higher mortality rates and financial burden is of great concern. Pseudomonas aeruginosa represents one of six highly virulent “ESKAPE” pathogens that exhibit considerable intrinsic drug resistance as well as mechanisms for acquiring further resistance. As many of these mechanisms are regulated through gene expression, we sought to identify regulatory strategies and patterns at play in 23 clinical isolates collected from Baku, Azerbaijan and Tyler, Texas, USA. Real-time quantitative polymerase chain reaction was performed on six gene targets implicated in resistance and contrasted with antibiotic phenotypes. We found AmpC cephalosporinase …

Devastating Effect Of Untreated Facial Squamous Cell Carcinoma, Nasim Khalfe, Ya Xu, Elizabeth May Schuele, Doris Lin

Faculty, Staff and Students Publications

Skin cancer develops primarily on areas of sun-exposed skin and can typically be treated if caught early. Here, we present a case of a 57-year-old man who presented with an extremely large facial squamous cell carcinoma with resulting perineural invasion and metastasis to parotid lymph nodes because he was unable to obtain timely treatment.

Treatment Options For Managing Obesity In Chronic Kidney Disease, Vishnu P Parvathareddy, Krishiv M Ella, Maulin Shah, Sankar D Navaneethan

Faculty, Staff and Students Publications

PURPOSE OF REVIEW: Obesity is a risk factor for the development and progression of chronic kidney disease (CKD). In this review, we provide a comprehensive overview of various management options (lifestyle intervention, medications, and bariatric surgery) to address obesity in those with CKD.

RECENT FINDINGS: Few clinical trials have examined the benefits of lifestyle modifications in those with preexisting CKD and suggest potential renal and cardiovascular benefits in this population. Yet, superiority of different dietary regimen to facilitate weight loss in CKD is unclear. Although medications could offer short-term benefits and assist weight loss, their safety and long-term benefits warrant …

Continuous-Flow Left Ventricular Assist Device Support In Patients With Ischemic Versus Nonischemic Cardiomyopathy, Brendan P Chou, Andre Critsinelis, Harveen K Lamba, Gregory Long, Andrew B Civitello, Reynolds M Delgado, Subhasis Chatterjee

Faculty, Staff and Students Publications

To determine whether the cause of cardiomyopathy affects outcomes in patients who undergo continuous-flow left ventricular assist device support, we compared postimplant adverse events and survival between patients with ischemic and nonischemic cardiomyopathy. The inclusion criteria for the ischemic group were a history of myocardial infarction or revascularization (coronary artery bypass grafting or percutaneous coronary intervention), ≥75% stenosis of the left main or proximal left anterior descending coronary artery, or ≥75% stenosis of ≥2 epicardial vessels. From November 2003 through March 2016, 526 patients underwent device support: 256 (48.7%) in the ischemic group and 270 (51.3%) in the nonischemic group. …

Transcatheter Pulmonic Valve Implantation In Adult Patients With Prior Congenital Heart Surgery, Zachary A Spigel, Iki Adachi, Ziyad M Binsalamah, Dhaval Parekh, Athar M Qureshi

Faculty, Staff and Students Publications

BACKGROUND: Transcatheter pulmonary valve replacement (TPVR) is now an established modality for pulmonary valve replacement in suitable candidates. We aim to describe our experience with TPVR in adults.

METHODS: This is a descriptive study of all TPVR performed in adults with congenital heart disease at a single institution from 2010-2020. All adult patients (defined as 18 years old or older at TPVR) were included. Time-to-event outcomes were described using Kaplan-Meier estimates with 95% confidence intervals (CIs).

RESULTS: Out of a total of 200 patients that had undergone TPVR, 81 patients (57% male) met the inclusion criteria, with a median age …

A Simplified Approach To Identification Of Risk Status In Patients With Atherosclerotic Cardiovascular Disease, Aparna Sajja, Hsin-Fang Li, Kateri J Spinelli, Amir Ali, Salim S Virani, Seth S Martin, Ty J Gluckman

Faculty, Staff and Students Publications

OBJECTIVE: The 2018 American Heart Association/American College of Cardiology (AHA/ACC) Blood Cholesterol Guideline recommendation to classify patients with atherosclerotic cardiovascular disease (ASCVD) as very high-risk (VHR) vs not-VHR (NVHR) has important implications for escalation of medical therapy. We aimed to define the prevalence and clinical characteristics of these two groups within a large multi-state healthcare system and develop a simpler means to assist clinicians in identifying VHR patients using classification and regression tree (CART) analysis.

METHODS: We performed a retrospective analysis of all patients in a 28-hospital US healthcare system in 2018. ICD-10 codes were used to define the ASCVD …

Sudden Cardiac Death In Athletes, Darren C Tsang, Mark S Link

The Texas Heart Institute Journal

No abstract provided.

Avoidance Of St-Segment-Elevation Myocardial Infarction Treatment For >1 Week Due To Covid-19 Fears, Rahul V Annabathula, Gregory J Sinner, Talal S Alnabelsi, Rachel P Goodwin, Vincent L Sorrell

The Texas Heart Institute Journal

During the coronavirus disease 2019 (COVID-19) pandemic, social distancing guidelines have negatively affected the care-seeking behavior of patients with chronic medical conditions, including those with cardiovascular disease. We report the case of a 60-year-old man with vague gastrointestinal symptoms who waited more than 1 week to seek treatment for fear of COVID-19 infection. On presentation at another hospital, he was found to have had an anterior myocardial infarction, and he underwent percutaneous coronary intervention to stent an occluded proximal left anterior descending coronary artery. Subsequently, the patient experienced refractory cardiogenic shock and, during his transfer to our hospital, refractory ventricular …

Cheyne-Stokes Respiration In A 17-Year-Old Boy Awaiting Heart Transplantation, Nooralam A Rai, Aliva De, Carin Lamm

The Texas Heart Institute Journal

Cheyne-Stokes respiration is a pattern of alternating central apnea and hyperpnea. It is well described in adults with congestive heart failure, but not in children.

We report the case of a 17-year-old boy whose systolic heart failure was complicated by Cheyne-Stokes respiration. He was given supportive therapy until heart transplant, after which his Cheyne-Stokes respiration clinically resolved. Clinicians should be aware of this uncommon condition in pediatric and adolescent patients who have advanced heart failure and irregular breathing.

Hiv-1 Viral Protein R Couples Metabolic Inflexibility With White Adipose Tissue Thermogenesis, Neeti Agarwal, Dinakar Iyer, Pradip Saha, Aaron R Cox, Yan Xia, Netanya S Utay, Anoma Somasundaram, Ulrich Schubert, Jordan E Lake, Sean M Hartig, Ashok Balasubramanyam

Faculty, Staff and Students Publications

Persons living with HIV (PLWH) manifest chronic disorders of brown and white adipose tissues that lead to diabetes and metabolic syndrome. The mechanisms that link viral factors to defective adipose tissue function and abnormal energy balance in PLWH remain incompletely understood. Here, we explored how the HIV accessory protein viral protein R (Vpr) contributes to adaptive thermogenesis in two mouse models and human adipose tissues. Uncoupling protein 1 (UCP1) gene expression was strongly increased in subcutaneous white adipose tissue (WAT) biopsy specimens from PLWH and in subcutaneous WAT of the Vpr mice, with nearly equivalent mRNA copy number. Histology and …

Structure And Dynamics Of Photoreceptor Sensory Cilia, Theodore G Wensel, Valencia L Potter, Abigail Moye, Zhixian Zhang, Michael A Robichaux

Faculty, Staff and Students Publications

The rod and cone photoreceptor cells of the vertebrate retina have highly specialized structures that enable them to carry out their function of light detection over a broad range of illumination intensities with optimized spatial and temporal resolution. Most prominent are their unusually large sensory cilia, consisting of outer segments packed with photosensitive disc membranes, a connecting cilium with many features reminiscent of the primary cilium transition zone, and a pair of centrioles forming a basal body which serves as the platform upon which the ciliary axoneme is assembled. These structures form a highway through which an enormous flux of …

Interpreting Covid-19 Deaths Among Nursing Home Residents In The Us: The Changing Role Of Facility Quality Over Time, Debasree Das Gupta, Uma Kelekar, Sidney C. Turner, Anupam A. Sule, Taya G. Jerman

Kinesiology and Health Science Faculty Publications

A report published last year by the Centers for Medicare & Medicaid Services (CMS) highlighted that COVID-19 case counts are more likely to be high in lower quality nursing homes than in higher quality ones. Since then, multiple studies have examined this association with a handful also exploring the role of facility quality in explaining resident deaths from the virus. Despite this wide interest, no previous study has investigated how the relation between quality and COVID-19 mortality among nursing home residents may have changed, if at all, over the progression of the pandemic. This understanding is indeed lacking given that …

Diabetes Detection And Prevention In Dermatology, Alexandra Ngo, Luise Froessl, John Wesley Mcwhorter, William Brett Perkison, Rajani Katta

Faculty, Staff and Student Publications

We are currently in the midst of an international epidemic of diabetes mellitus (DM) and prediabetes. The prevalence of DM in the United States is estimated at 9.4% of the population across all ages, while an estimated 1 in 3 Americans (33.9%) has prediabetes. According to the WHO, about 60 million people suffer from diabetes in the European Region. Dermatologists may play an important role in tackling this epidemic via efforts to improve early detection of both diabetes and prediabetes. Dermatologists often treat patients with, or at risk of, diabetes. This includes patients who present with cutaneous manifestations such as …

Medical And Device Therapy For Stroke Prevention In Patients With Atrial Fibrillation, Sophia Huang, Payam Safavi-Naeini, Abdi Rasekh

The Texas Heart Institute Journal

No abstract provided.

Endoleaks: Current Concepts And Treatments - A Narrative Review, Zia Ur Rehman

Department of Surgery Docs

Endoleaks are the most common complications following endovascular aneurysm repair. Depending upon their origin, there are five types of endoleaks, types I-V, which can also be classified as direct and indirect endoleaks. Direct endoleaks (type I and III) have higher risk of aneurysm rupture due to rapid sac expansion, and require immediate correction. Indirect endoleaks ( type II, IV and V) have a relatively benign course compared to direct endoleaks. Most of them resolve with time and very few need interventions upon sac enlargement. Type V endotension is a special situation where there is sac enlargement despite no demonstrable endoleak. …

Voices From A Prison Pandemic: Lives Lost From Covid-19 At Lakeland Correctional, Kimberly Thomas

Articles

Coronavirus tore through jails and prisons like wildfire. In some states, more than half of the people incarcerated there tested positive for COVID-19; nearly 400,000 people in prison across the United States have tested positive. For people in prison, COVID-19 brought the loss of close friends, solitary confinement, loss of connection with family and programming, lack of information, and fear of contracting the virus. It has also reminded those who are incarcerated of the one-dimensional way in which people in prison are perceived. As stated by one collaborator, Cory Souders, "[s]o many men and women who come to prison are …

Predicting Lymph Node Metastasis In Non-Small Cell Lung Cancer: Prospective External And Temporal Validation Of The Hal And Homer Models, Gabriela Martinez-Zayas, Francisco A Almeida, Lonny Yarmus, Daniel Steinfort, Donald R Lazarus, Michael J Simoff, Timothy Saettele, Septimiu Murgu, Tarek Dammad, D Kevin Duong, Lakshmi Mudambi, Joshua J Filner, Sofia Molina, Carlos Aravena, Jeffrey Thiboutot, Asha Bonney, Adriana M Rueda, Labib G Debiane, D Kyle Hogarth, Harmeet Bedi, Mark Deffebach, Ala-Eddin S Sagar, Joseph Cicenia, Diana H Yu, Avi Cohen, Laura Frye, Horiana B Grosu, Thomas Gildea, David Feller-Kopman, Roberto F Casal, Michael Machuzak, Muhammad H Arain, Sonali Sethi, George A Eapen, Louis Lam, Carlos A Jimenez, Manuel Ribeiro, Laila Z Noor, Atul Mehta, Juhee Song, Humberto Choi, Junsheng Ma, Liang Li, David E Ost

Faculty, Staff and Students Publications

BACKGROUND: Two models, the Help with the Assessment of Adenopathy in Lung cancer (HAL) and Help with Oncologic Mediastinal Evaluation for Radiation (HOMER), were recently developed to estimate the probability of nodal disease in patients with non-small cell lung cancer (NSCLC) as determined by endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA). The objective of this study was to prospectively externally validate both models at multiple centers.

RESEARCH QUESTION: Are the HAL and HOMER models valid across multiple centers?

STUDY DESIGN AND METHODS: This multicenter prospective observational cohort study enrolled consecutive patients with PET-CT clinical-radiographic stages T1-3, N0-3, M0 NSCLC undergoing EBUS-TBNA staging. …

Use Of Human Tissue Stem Cell-Derived Organoid Cultures To Model Enterohepatic Circulation, Sarah E Blutt, Sue E Crawford, Carolyn Bomidi, Xi-Lei Zeng, James R Broughman, Matthew Robertson, Cristian Coarfa, Mary Elizabeth M Tessier, Tor Savidge, F Blaine Hollinger, Steven A Curley, Mark Donowitz, Mary K Estes

Faculty, Staff and Students Publications

The use of human tissue stem cell-derived organoids has advanced our knowledge of human physiological and pathophysiological processes that are unable to be studied using other model systems. Increased understanding of human epithelial tissues including intestine, stomach, liver, pancreas, lung, and brain have been achieved using organoids. However, it is not yet clear whether these cultures recapitulate in vivo organ-to-organ signaling or communication. In this work, we demonstrate that mature stem cell-derived intestinal and liver organoid cultures each express functional molecules that modulate bile acid uptake and recycling. These organoid cultures can be physically coupled in a Transwell system and …

Food Addiction And Obesity, Lisa Ling

Electronic Theses and Dissertations

The obesity rate in the U.S. adult population has increased to epidemic levels despite attempts to decrease obesity through evidence-based knowledge, clinical practice guidelines, medical interventions, and individual efforts. For certain individuals, food addiction behaviors such as food cravings, loss of control, and binge eating contribute to obesity and require a different approach to care. Little work has been done on adding the possibility of food addiction to obesity screening and treatment. This study utilized a quasi-experimental quantitative pre- and postsurvey research design based on Lewin’s change theory. Nurse practitioners were surveyed regarding the provider’s perceptions, attitudes, and beliefs about …

Hemodynamic Outcomes After Valve-In-Valve Transcatheter Aortic Valve Replacement: A Single-Center Experience, R Yazan Kherallah, Srikanth Koneru, Zvonimir Krajcer, Ourania Preventza, Kathryn G Dougherty, Melissa L Mccormack, Briana T Costello, Stephanie Coulter, Neil E Strickman, Juan Carlos Plana Gomez, Ali Mortazavi, Jose G Díez, James J Livesay, Joseph S Coselli, Guilherme V Silva

Faculty, Staff and Students Publications

BACKGROUND: Valve-in-valve transcatheter aortic valve replacement (ViV-TAVR) has emerged as a safe, effective alternative to redo aortic valve surgery in high-risk patients with degenerated surgical bioprosthetic valves. However, ViV-TAVR has been associated high postprocedural valvular gradients, compared with TAVR for native-valve aortic stenosis.

METHODS: We performed a retrospective study of all patients who underwent ViV-TAVR for a degenerated aortic valve bioprosthesis between January 1, 2013 and March 31, 2019 at our center. The primary outcome was postprocedural mean aortic valve gradient. Outcomes were compared across surgical valve type (stented versus stentless), surgical valve internal diameter (≤19 versus >19 mm), and …

A Narrative Review Of Interstitial Lung Disease In Anti-Synthetase Syndrome: A Clinical Approach, Naina Sawal, Sanjay Mukhopadhyay, Sheetal Rayancha, Alastair Moore, Puneet Garcha, Anupam Kumar, Viren Kaul

Faculty, Staff and Students Publications

Anti-synthetase syndrome (AS) is a rare autoimmune disorder characterized by the presence of aminoacyl-transfer RNA synthetase antibodies in conjunction with clinical features such as interstitial lung disease (ILD), Raynaud's phenomenon, nonerosive arthritis, and myopathy. AS distinguishes itself from other inflammatory myopathies by its significant lung involvement and rapidly progressive interstitial lung disease (AS-ILD), therefore the management of AS-ILD requires careful clinical, serologic and radiologic assessment. Glucocorticoids are considered the mainstay of therapy; however, additional immunosuppressive agents are often required to achieve disease control. Patient prognosis is highly dependent on early diagnosis and symptom recognition as the antibody profile is thought …