Medical Specialties Commons^™

Reduced Cardioprotective Action Of Adiponectin In High-Fat Diet-Induced Type Ii Diabetic Mice And Its Underlying Mechanisms., Wei Yi, Yang Sun, Erhe Gao, Xufeng Wei, Wayne Bond Lau, Qijun Zheng, Yajing Wang, Yuexing Yuan, Xiaoliang Wang, Ling Tao, Rong Li, Walter Koch, Xin-Liang Ma

Department of Emergency Medicine Faculty Papers

Diabetes exacerbates ischemic heart disease morbidity and mortality via incompletely understood mechanisms. Although adiponectin (APN) reduces myocardial ischemia/reperfusion (MI/R) injury in nondiabetic animals, whether APN's cardioprotective actions are altered in diabetes, a pathologic condition with endogenously reduced APN, has never been investigated. High-fat diet (HD)-induced diabetic mice and normal diet (ND) controls were subjected to MI via coronary artery ligation, and given vehicle or APN globular domain (gAPN, 2 μg/g) 10 min before reperfusion. Compared to ND mice (where gAPN exerted pronounced cardioprotection), HD mice manifested greater MI/R injury, and a tripled gAPN dose was requisite to achieve cardioprotective extent …

Advanced Glycation End Products Accelerate Ischemia/Reperfusion Injury Through Receptor Of Advanced End Product/Nitrative Thioredoxin Inactivation In Cardiac Microvascular Endothelial Cells., Yi Liu, Yanzhuo Ma, Rutao Wang, Chenhai Xia, Rongqing Zhang, Kun Lian, Ronghua Luan, Lu Sun, Lu Yang, Wayne B Lau, Haichang Wang, Ling Tao

Department of Emergency Medicine Faculty Papers

The advanced glycation end products (AGEs) are associated with increased cardiac endothelial injury. However, no causative link has been established between increased AGEs and enhanced endothelial injury after ischemia/reperfusion. More importantly, the molecular mechanisms by which AGEs may increase endothelial injury remain unknown. Adult rat cardiac microvascular endothelial cells (CMECs) were isolated and incubated with AGE-modified bovine serum albumin (BSA) or BSA. After AGE-BSA or BSA preculture, CMECs were subjected to simulated ischemia (SI)/reperfusion (R). AGE-BSA increased SI/R injury as evidenced by enhanced lactate dehydrogenase release and caspase-3 activity. Moreover, AGE-BSA significantly increased SI/R-induced oxidative/nitrative stress in CMECs (as measured …

Systemic Adiponectin Malfunction As A Risk Factor For Cardiovascular Disease., Wayne Bond Lau, Ling Tao, Yajing Wang, Rong Li, Xin L Ma

Department of Emergency Medicine Faculty Papers

Adiponectin (Ad) is an abundant protein hormone regulatory of numerous metabolic processes. The 30 kDa protein originates from adipose tissue, with full-length and globular domain circulatory forms. A collagenous domain within Ad leads to spontaneous self-assemblage into various oligomeric isoforms, including trimers, hexamers, and high-molecular-weight multimers. Two membrane-spanning receptors for Ad have been identified, with differing concentration distribution in various body tissues. The major intracellular pathway activated by Ad includes phosphorylation of AMP-activated protein kinase, which is responsible for many of Ad's metabolic regulatory, anti-inflammatory, vascular protective, and anti-ischemic properties. Additionally, several AMP-activated protein kinase-independent mechanisms responsible for Ad's anti-inflammatory …

Spontaneous Celiac Artery Dissection: A Rare Cause Of Abdominal Pain., John Ashurst Do, Paul Myers Do, Elizabeth M. Evans Do

Department of Emergency Medicine

No abstract provided.

Tropical Medicine: A Clinical Text, 8th Edition, Revised And Expanded, Kevin M. Cahill, M.D.

Institute of International Humanitarian Affairs

The history of tropical medicine is as dramatic as the story of humankind. It has its own myths and legends, including tales of epidemics that destroyed whole civilizations. Today, with silent stealth, tropical diseases still claim more lives than all the current wars combined. Having had the privilege of working throughout Africa, Asia, and Latin America, as well as in the great medical centers of Europe and the United States, the author presents the details essential for understanding pathogenesis, clinical manifestations, therapy, and prevention of the major tropical diseases. The text, now in its eighth edition, has been used for …

Road Traffic Injuries In Rawalpindi City, Pakistan., Umar Farooq, Junaid Ali Bhatti, M. Siddiq, M. Majeed, N. Malik, Junaid Razzak, M. M. Khan

Department of Emergency Medicine

Data on road traffic accident (RTA) injuries and their outcome are scarce in Pakistan. This study assessed patterns of RTA injuries reported in Rawalpindi city using standard surveillance methods. All RTA injury patients presenting to emergency departments of 3 tertiary care facilities from July 2007 to June 2008 were included. RTA injuries (n = 19 828) accounted for 31.7% of all injuries. Among children aged 0-14 years females suffered twice as many RTA injuries as males (21.3% versus 11.4%), whereas this trend reversed for the age group 15-24 years (41.9% versus 21.7%). One-fifth of injuries were either fractures or concussion. …

Malignant Psoas Abscess Or Pseudomyxoma Extraperitonei, Amber Mehmood, Kiran Ejaz, Turab Ibrahim Pishori

Department of Emergency Medicine

Primary adenocarcinoma of appendix is an uncommon gastrointestinal malignancy. Similarly, Psoas abscess is an entity, which sometimes requires extensive work-up to reach a diagnosis. Combined presentation of these two rare conditions is not only exceptional, but also diagnostically challenging. We present a case of a lady who presented with recurrent UTI secondary to right sided ureteric obstruction, referred right hip joint pain resulting from a Psoas abscess, which eventually turned out to be a consequence of metastatic adenocarcinoma of appendix, causing pseudomyxoma extraperitonei, with simultaneous intraperitoneal deposits.

Dynamic Alteration Of Adiponectin/Adiponectin Receptor Expression And Its Impact On Myocardial Ischemia/Reperfusion In Type 1 Diabetic Mice., Yanzhuo Ma, Yi Liu, Shaowei Liu, Yan Qu, Rutao Wang, Chenhai Xia, Haifeng Pei, Kun Lian, Tao Yin, Xiaoyan Lu, Lu Sun, Lu Yang, Yanjie Cao, Wayne Bond Lau, Erhe Gao, Haichang Wang, Ling Tao

Department of Emergency Medicine Faculty Papers

The present study determined the dynamic change of adiponectin (APN, a cardioprotective adipokine), its receptor expression, and their impact upon myocardial ischemia/reperfusion (MI/R) injury during type 1 diabetes mellitus (T1DM) progression, and involved underlying mechanisms. Diabetic state was induced in mice via multiple intraperitoneal injections of low-dose streptozotocin. The dynamic change of plasma APN concentration and cardiac APN receptor-1 and -2 (AdipoR1/2) expression were assessed immediately after diabetes onset (0 wk) and 1, 3, 5, and 7 wk thereafter. Indicators of MI/R injury (infarct size, apoptosis, and LDH release) were determined at 0, 1, and 7 wk of DM duration. …

Urinary Nitrate Might Be An Early Biomarker For Pediatric Acute Kidney Injury In The Emergency Department, Asad Mian, Yue Du, Harsha K Garg, Chantal Caviness, Stuart L Goldstein, Nathan S Bryan

Department of Emergency Medicine

NO is involved in normal kidney function and perturbed in acute kidney injury (AKI). We hypothesized that urinary concentration of NO metabolites, nitrite, and nitrate would be lower in children with early AKI presenting to the emergency department (ED), when serum creatinine (SCr) was uninformative. Patients up to 19 y were recruited if they had a urinalysis and SCr obtained for routine care. Primary outcome, AKI, was defined by pediatric Risk, Injury, Failure, Loss of function, End-stage renal disease (pRIFLE) criteria. Urinary nitrite and nitrate were determined by HPLC. A total of 252 patients were enrolled, the majority (93%) of …

Telemedicine And Advanced Technology Research Center: Quarterly Report, April 18th, 2011 To July 17th, 2011, Bea Babbitt

Telemedicine & Advanced Technology Research Center

Development of a P.O.I. and a Blended Learning Ecology for use in Combat Lifesaver Skills Training for the Army.

Application Of Geographical Information System (Gis) For Mapping Road Traffic Injuries Using Existing Source Of Data In Karachi, Pakistan--A Pilot Study, Junsid Razzak, Uzma R. Khan, Sabeena Jalal

Department of Emergency Medicine

OBJECTIVE: To assess the feasibility of using Geographical Information System for mapping of road traffic injuries with an existing data source in a developing country.

METHODS: The study was a retrospectives case series of road traffic injury cases registered with the medico-legal office located in the three major trauma centers in Karachi for the period of January 1, 2004 till December 31st, 2004. Spatial data analysis was performed using ARCVIEW 3.1.

RESULTS: Out of 3650 of all road traffic injury, only 3% had locations detailed and accurate enough allowing mapping on a GIS map in the first attempt. Even after …

Development Of A P.O.I. And A Blended Learning Ecology For Use In Combat Lifesaver Skills Training For The Army, Bea Babbitt

Telemedicine & Advanced Technology Research Center

The primary purpose of the project, as originally conceived, was to design and implement a series of applied research studies to validate the effectiveness of a blended learning ecology in the teaching of life saving medical skills to US Army combat military personnel. The project has since undergone several changes to include changing the focus to the development of a Program of Instruction (POI) for Combat Lifesaver Skills (CLS). Additionally, the CLS course content was integrated with Personal Response Systems (PRS) to promote the learning outcomes outlined in the POI, and 2 eLearning Modules were created to further reinforce content. …

System-Wide Deployment Of Color Coded Pediatric Resuscitation Carts Supported By In Situ Simulation, Deborah Arnold Msn, Rn, Cmsrn, Jayne Febbraro Msn Rn Crnp, William Bond Md, Ms, Michele Dunstan, Margaret J. Chorazak, Melissa B. Walsh Bs, K Walker, T Dietz

Department of Education

No abstract provided.

Religious Experiences Shrink Part Of The Brain, Andrew Newberg, M.D.

Marcus Institute of Integrative Health Faculty Papers

A study links life-changing religious experiences, like being born again, with atrophy in the hippocampus.

The article, “Religious factors and hippocampal atrophy in late life,” by Amy Owen and colleagues at Duke University represents an important advance in our growing understanding of the relationship between the brain and religion. The study showed greater atrophy in the hippocampus in individuals who identify with specific religious groups as well as those with no religious affiliation. It is a surprising result, given that many prior studies have shown religion to have potentially beneficial effects on brain function, anxiety, and depression.

Investigation Of Emergency Medical Technicians Practice And Beliefs Regarding The Recognition And Treatment Of Exertional Heat Stroke, Kristin Applegate

Master's Theses

Context: Current Evidence Based Practice (EBP) supports the use of rectal thermometry (T_re) for an accurate diagnosis and cold water-immersion (CWI) for the treatment of Exertional Heat Stroke (EHS) for an optimal outcome. Emergency Medical Services (EMS) play a critical role for the diagnosis and treatment of EHS as they may be the first to arrive on scene, however there is limited data regarding their implementation of EBP.  Objective: Investigate current practice regarding EHS by EMS professionals and explore the relationship that exists between EMS and Athletic Trainers (ATs).  Design: A basic qualitative design using in-person focus groups. …

Emergency Physicians' Perspectives On The Usability Of Health Information Exchange, Shirley A. Thorn

Theses and Dissertations (ETD)

Emergency physicians are key users of health information exchanges (HIE). Understanding their perspectives on the usability of HIE is important if the full potential of the HIE is to be achieved. The literature identified that emergency physician experiences with HIEs are unexplored areas requiring further studies. The purpose of this study using grounded theory methods was to understand the perspectives of emergency physicians concerning the usability of HIEs. The fundamental question was how do emergency physicians use the HIE in making clinical decisions?

Rich and thick data were collected from 15 emergency physicians in four urban hospitals in the mid-south …

Telemedicine And Advanced Technology Research Center: Quarterly Report, January 18, 2010 To April 17, 2011, Bea Babbitt

Telemedicine & Advanced Technology Research Center

Development of a P.O.I. and a Blended Learning Ecology for use in Combat Lifesaver Skills Training for the Army.

Hypertension As A Chief Complaint In The Emergency Department, Steven P. Frei Md, David B. Burmeister Do, Facep, Jesse F. Coil Do

Department of Emergency Medicine

No abstract provided.

Differences In Police, Ambulance, And Emergency Department Reporting Of Traffic Injuries On Karachi-Hala Road, Pakistan, Junaid Ali Bhatti, Junaid Razzak, Emmanuel Lagarde, Louis Rachid Salmi

Department of Emergency Medicine

Background

Research undertaken in developing countries has assessed discrepancies in police reporting of Road Traffic Injury (RTI) for urban settings only. The objective of this study was to assess differences in RTI reporting across police, ambulance, and hospital Emergency Department (ED) datasets on an interurban road section in Pakistan.

Methods

The study setting was the 196-km long Karachi-Hala road section. RTIs reported to the police, Edhi Ambulance Service (EAS), and five hospital EDs in Karachi during 2008 (Jan to Dec) were compared in terms of road user involved (pedestrians, motorcyclists, four-wheeled vehicle occupants) and outcome (died or injured). Further, records …

Negative Pressure Pulmonary Oedema: A Rare Complication Following General Anaesthesia, Zeeshan Waheed, Javaid Khan

Section of Pulmonary & Critical Care

An important cause of pulmonary oedema is Negative Pressure Pulmonary Oedema (NPPE) which characteristically develops soon after extubation from an endo-tracheal intubation. In this case report we identified a case of previously healthy man who was intubated for General Anaesthesia for extraction of impacted molar tooth. Soon after extubation he developed severe respiratory distress. Immediate diagnosis of NPPE secondary to post extubation laryngospasm was made. He was promptly treated with 100 percent oxygen via CPAP (continuous positive airway pressure) mask and within an hour he markedly improved and subsequently became asymptomatic. NPPE is an important cause of morbidity and need …

Emergency Medicine Residents As Teachers, Julie K. Wachtel Do, Mph, Marna Rayl Greenberg Do, Mph, Amy B. Smith Phd, Kevin R. Weaver Do, Bryan G. Kane Md

Department of Emergency Medicine

No abstract provided.

A Trial Of Simulated Breech Delivery Skills Retention For Ob/Gyn And Ed Residents, Cj Sultana, R. Hall

Department of Obstetrics and Gynecology Faculty Papers

Conclusion:

A pilot study showed that simulation using video and high fidelity simulators can substitute for clinical experience for teaching breech delivery with retention of skills at one and three month intervals.

Involvement Of Medical Students And Fresh Medical Graduates Of Karachi, Pakistan In Research, Kiran Ejaz, Muhammad Shahid Shamim, Muhammad Shahzad Shamim, Syed Abid Hussain

Department of Emergency Medicine

OBJECTIVE: To study the involvement in research, of final year medical students and fresh graduates of Karachi, Pakistan and to identify the factors influencing their interest in medical research.

METHODS: A cross-sectional, questionnaire based study was conducted in 2007-2008. Five institutes representing the private and public hospitals in the city were selected by cluster sampling. Final year medical students and fresh graduates were included. Descriptive statistics were charted using SPSS v.16 after double data entry.

RESULTS: Out of 378, 186 (49%) participants had journal reading habits due to the requirement of their institution. Mostly, 157 (41%) undergraduates had already participated …

Apotransferrin Protects Cortical Neurons From Hemoglobin Toxicity, Jing Chen-Roetling, Lifen Chen, Raymond F. Regan

Department of Emergency Medicine Faculty Papers

The protective effect of iron chelators in experimental models of intracerebral hemorrhage suggests that nonheme iron may contribute to injury to perihematomal cells. Therapy with high affinity iron chelators is limited by their toxicity, which may be due in part to sequestration of metals in an inaccessible complex. Transferrin is unique in chelating iron with very high affinity while delivering it to cells as needed via receptor-mediated endocytosis. However, its efficacy against iron-mediated neuronal injury has never been described, and was therefore evaluated in this study using an established cell culture model of hemoglobin neurotoxicity. At concentrations similar to that …

Telemedicine And Advanced Technology Research Center: Quarterly Report, October 17, 2010 To January 17, 2011, Bea Babbitt

Telemedicine & Advanced Technology Research Center

Development of a P.O.I. and a Blended Learning Ecology for use in Combat Lifesaver Skills Training for the Army.

Ventricular Tachyarrhythmias After Cardiac Arrest In Public Versus At Home, Myron L. Weisfeldt, Siobahn Everson-Stewart, Colleen Sitlani, Thomas Rea, Tom P. Aufderheide, Diane L. Atkins, Blair Bigham, Steven C. Brooks, Christopher Foerster, Randal Gray, Joseph P. Ornato, Judy Powell, Peter J. Kudenchuk, Laurie J. Morrison

Emergency Medicine Publications

Background

The incidence of ventricular fibrillation or pulseless ventricular tachycardia as the first recorded rhythm after out-of-hospital cardiac arrest has unexpectedly declined. The success of bystander-deployed automated external defibrillators (AEDs) in public settings suggests that this may be the more common initial rhythm when outof-hospital cardiac arrest occurs in public. We conducted a study to determine whether the location of the arrest, the type of arrhythmia, and the probability of survival are associated.

Methods

Between 2005 and 2007, we conducted a prospective cohort study of out-of-hospital cardiac arrest in adults in 10 North American communities. We assessed the frequencies of …

Early Versus Later Rhythm Analysis In Patients With Out-Of-Hospital Cardiac Arrest, Ian G. Stiell, Graham Nichol, Brian G. Leroux, Thomas D. Rea, Joseph P. Ornato, Judy Powell, James Christenson, Clifton W. Callaway, Peter J. Kudenchuk, Tom P. Aufderheide, Ahamed H. Idris, Mohamud R. Daya, Henry E. Wang, Laurie J. Morrison, Daniel Davis, Douglas Andrusiek, Shannon Stephens, Sheldon Cheskes, Robert H. Schmicker, Ray Fowler, Christian Vaillancourt, David Hostler, Dana Zive, Ronald G. Pirrallo, Gary M. Vilke, George Sopko, Myron Weisfeldt

Emergency Medicine Publications

Background

In a departure from the previous strategy of immediate defibrillation, the 2005 resuscitation guidelines from the American Heart Association–International Liaison Committee on Resuscitation suggested that emergency medical service (EMS) personnel could provide 2 minutes of cardiopulmonary resuscitation (CPR) before the first analysis of cardiac rhythm. We compared the strategy of a brief period of CPR with early analysis of rhythm with the strategy of a longer period of CPR with delayed analysis of rhythm.

Methods

We conducted a cluster-randomized trial involving adults with out-of-hospital cardiac arrest at 10 Resuscitation Outcomes Consortium sites in the United States and Canada. Patients …

A Trial Of An Impedance Threshold Device In Out-Of-Hospital Cardiac Arrest, Tom P. Aufderheide, Graham Nichol, Thomas D. Rea, Siobhan P. Brown, Brian G. Leroux, Paul E. Pepe, Peter J. Kudenchuk, Jim Christenson, Mohamud R. Daya, Paul Dorian, Clifton W. Callaway, Ahamed H. Idris, Douglas Andrusiek, Shannon W. Stephens, David Hostler, Daniel Davis, James V. Dunford, Ronald G. Pirrallo, Ian G. Stiell, Catherine M. Clement, Alan Craig, Lois Van Ottingham, Terri A. Schmidt, Henry E. Wang, Myron L. Weistfeldt, Joseph P. Ornato, George Sopko

Emergency Medicine Publications

Background

The impedance threshold device (ITD) is designed to enhance venous return and cardiac output during cardiopulmonary resuscitation (CPR) by increasing the degree of negative intrathoracic pressure. Previous studies have suggested that the use of an ITD during CPR may improve survival rates after cardiac arrest.

Methods

We compared the use of an active ITD with that of a sham ITD in patients with out-ofhospital cardiac arrest who underwent standard CPR at 10 sites in the United States and Canada. Patients, investigators, study coordinators, and all care providers were unaware of the treatment assignments. The primary outcome was survival to …

Requirement Of Argininosuccinate Lyase For Systemic Nitric Oxide Production, Ayelet Erez, Sandesh Cs. Nagamani, Oleg A. Shchelochkov, Muralidhar H. Premkumar, Philippe M. Campeau Campeau, Yuqing Chen, Harsha K. Garg, Li Li, Asad Mian, Terry K. Bertin, Jennifer O. Black, Heng Zeng, Yaoping Tang, Anilkumar K. Reddy, Marshall Summar, William E. O’Brien, David G. Harrison, William E. Mitch, Juan C. Marini, Judy L. Aschner, Nathan S. Bryan, Brendan Lee

Department of Emergency Medicine

Nitric oxide (NO) is crucial in diverse physiological and pathological processes. We show that a hypomorphic mouse model of argininosuccinate lyase (encoded by Asl) deficiency has a distinct phenotype of multiorgan dysfunction and NO deficiency. Loss of Asl in both humans and mice leads to reduced NO synthesis, owing to both decreased endogenous arginine synthesis and an impaired ability to use extracellular arginine for NO production. Administration of nitrite, which can be converted into NO in vivo, rescued the manifestations of NO deficiency in hypomorphic Asl mice, and a nitric oxide synthase (NOS)-independent NO donor restored NO-dependent vascular reactivity in …

The State Of Emergency Care In The Republic Of Kenya, Benjamin Wachira, Ian Martin

Family Medicine, East Africa

Approximately 580,000 km2 in size, the Republic of Kenya is as big as Botswana but only half the size of countries like South Africa, Mali, and Angola. Kenya is comprised of eight provinces: Central, Coast, Eastern, Nairobi, North Eastern, Nyanza, Rift Valley, and Western. The 2009 census revealed a population of over 38 million people, with a population density of approximately 66 persons per square kilometre. Majority of the population (68%) lives in rural areas, as compared with the sub-Saharan African average of approximately 62%. With a gross domestic product (GDP) per capita of US $1,600 in 2010, Kenya is …