Medical Specialties Commons^™

Exosomes In Transmission And Blocking Of Arthropod-Borne Flaviviral Infection And Pathogenesis, Wenshuo Zhou

Biomedical Sciences Theses & Dissertations

Vector-borne diseases (VBDs) are human illnesses that are transmitted by vectors such as ticks, mosquitoes, and fleas. These arthropods transmit infectious pathogens such as viruses, protozoa, and bacteria, to humans during their blood-feeding. According to the estimation of the WHO, billions of people are affected by VBDs worldwide, and about 700,000 deaths are reported annually. Currently, very few reliable VBDs control approaches and vaccines available to treat various VBDs. Additionally, approaches to control arthropod’ proliferation and migration are difficult to develop. Furthermore, molecular determinants and mechanisms for the transmission are poorly understood. This work describes two studies identifying the novel …

Compliance Of Hand Written Transfusion Requisition Form And Improvement After Online Request - A Clinical Audit, Nadia Nasir, Mohammad Usman Shaikh, Natasha Ali, Shabneez Hussain

Department of Pathology and Laboratory Medicine

Objective: To assess the compliance of healthcare personnel with regard to sending completely filled transfusion requisition forms.
Methods: The audit was conducted at Aga Khan University Hospital, Karachi, and comprised requisition slips received at the hospital blood bank from September 2014 to February 2015. The British Committee for Standards in Haematology guidelines was used as the standard. Percentage of each variable on the proforma was analsyed. Rating Results: The audit and the re-audit both comprised 1000 transfusion requisition forms each. In the audit, The sum of total scores of all the transfusion requisition forms was 4911, indicating a compliance rate …

Retroperitoneal Isolated Enteric Duplication Cyst, Fariha Fazal, Patricia Okiro

General Surgery, East Africa

Enteric duplication cysts are rare congenital malformations of the gastrointestinal tract with an estimated incidence of 1:100,000 live births. Fewer still are isolated enteric duplication cysts (IEDC). Accurate diagnosis and timely excision of IEDCs can help in avoiding possible complications including bleeding from gastric mucosa and malignant transformation later in life. Currently, in the paediatric population, there are twenty reported cases in the literature worldwide. Of these, only three have been described in the retro peritoneum. We present a retroperitoneal IEDC, which was juxtaposed to the inferior vena cava. To the best of our knowledge, this has not been reported …

A Case Series Of Hyponatremia And Management In Hospitalized Patients, Jake N. Cho, Rebecca Ong, Izuchukwu Nwakoby

Nephrology

No abstract provided.

Comparison Of Clinical Presentation And Out-Comes Of Chikungunya And Dengue Virus Infections In Patients With Acute Undifferentiated Febrile Illness From The Sindh Region Of Pakistan, Uzma Shahid, Joveria Farooqi, Kelli L. Barr, Syed Faisal Mahmood, Bushra Jamil, Kehkashan Imtiaz, Zahida Azizullah, Faisal Malik, Dhani Prakoso, Maureen T. Long, E. Khan

Department of Pathology and Laboratory Medicine

Background: Arboviruses are a cause of acute febrile illness and outbreaks worldwide. Recent outbreaks of Chikungunya virus (CHIKV) in dengue endemic areas have alarmed clinicians as unique clinical features differentiating CHIKV from Dengue virus (DENV) are limited. This has complicated diagnostic efforts especially in resource limited countries where lab testing is not easily available. Therefore, it is essential to analyse and compare clinical features of laboratory confirmed cases to assist clinicians in suspecting possible CHIKV infection at time of clinical presentation.
Methodology: A prospective point prevalence study was conducted, with the hypothesis that not all patients presenting with clinical suspicion …

Combating Antibiotic Resistance Using Guidelines And Enhanced Stewardship In Kenya: A Protocol For An Implementation Science Approach, Jesse Gitaka, Moses Kamita, Dominic Mureithi, Davies Ndegwa, Moses Masika, Geoffrey Omuse, Moses Ngari, Francis Makokha, Peter Mwaura, Ronald Mathai, Francis Muregi, Matilu Mwau

Pathology, East Africa

Introduction: Antimicrobial resistance (AMR) is a growing problem globally especially in Sub-Saharan Africa including Kenya. Without any intervention, lower/middle-income countries (LMICs) will be most affected due to already higher AMR levels compared with higher income countries and due to the far higher burden of diseases in the LMICs. Studies have consistently shown that inappropriate use of antimicrobials is the major driver of AMR. To address this challenge, hospitals are now implementing antibiotic stewardship programmes (ASPs), which have been shown to achieve reduced antibiotic usage, to decrease the prevalence of resistance and lead to significant economic benefits. However, the implementation of …

Labrad : Vol 46, Issue 1 - March 2020, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• Role of Immunofluorescence Studies in the Diagnosis of Autoimmune Disorders
• Cystathionine Beta-Synthase Deficiency
• Treatment of Factor VIII Inhibitor
• Effective Internal Communication in Laboratories
• Digital Breast Tomosynthesis
• Overview of Common Myeloproliferative Neoplasms
• Clinical Significance of free Androgen Index (FAI)
• Radiology Quiz
• The Best of the Past
• Section Of Histopathology: Newer Horizons
• A Webinar Series ‘Rare Links’
• A Look into the Eye can Unleash Vital Diagnostic Pearls for 32 Rare Disorders
• Lab & Rad Mesh up for the Early Recognition of Rare Disorders
• Polaroid

Post Tuberculosis Treatment Infectious Complications, Desmond Hsu, Muhammad Irfan, Kauser Jabeen, Nousheen Iqbal, Rumina Hasan, Giovanni Battista Migliori, Alimuddin Zumla, Dina Visca, Rosella Centis, Simon Tiberi

Department of Pathology and Laboratory Medicine

Following greater attention and follow-up of patients with treated pulmonary tuberculosis (TB), it has emerged that infections are more likely to occur in this cohort of patients. This comes as no surprise, as pulmonary TB is a destructive process that leads to cicatrization, alteration of parenchyma, bronchiectasis, and scarring of the lung, with reduction of lung volumes and an impact on pulmonary function. In addition to relapse and re-infection with TB, other pathogens are increasingly recognized in post-TB patients. This paper serves as a summary and guide on how to approach the post-TB patient with new signs and symptoms of …

Non-Tuberculous Mycobacterial Infections-A Neglected And Emerging Problem, Imran Ahmed, Simon Tiberi, Joveria Farooqi, Kauser Jabeen, Dorothy Yeboah-Manu, Giovanni Battista Migliori, Rumina Hasan

Department of Pathology and Laboratory Medicine

Non-tuberculous mycobacteria (NTM) are ubiquitous dwellers of environmental niches and are an established cause of natural and nosocomial infections. The incidence of NTM infections is rising owing to a growing population of immunocompromised and vulnerable individuals, complex medical and surgical procedures, as well as increased awareness and diagnostic capabilities. The prevalence of different NTM varies between continents, regions, and countries. The true global burden of pulmonary and extrapulmonary disease is unknown and estimates are subject to under and/or over-estimation. Diagnosis requires confirmation by isolation of NTM along with clinical and radiological criteria, which may be suboptimal at all levels. Susceptibility …

Ewing Sarcoma Of Larynx: A Rare Case In A 5-Year-Old Boy, Hamdan Ahmed Pasha, Shayan Khalid, Muhammad Wasif, Moghira Siddiqui, Nasir Ud Din

Section of Otolaryngology, Head & Neck Surgery

Ewing Sarcoma of the head and neck region is an extremely rare entity. Treatment usually involves surgery, chemotherapy and radiotherapy in varying sequences. We present the third case to date of Ewing sarcoma of the larynx in a paediatric population. A 5-year-old boy presented to emergency room with acute respiratory distress. Computerized tomography scan showed a mass in the supraglottis; he was intubated using videolaryngoscope and tracheostomy was avoided, mass was removed by cold dissection. Final histopathologic examination revealed Ewing sarcoma. Further workup showed no systemic metastasis. Patient was advised adjuvant therapy which the family refused. Currently he is doing …

Worldwide Network For Blood And Marrow Transplantation (Wbmt) Recommendations For Establishing A Hematopoietic Stem Cell Transplantation Program In Countries With Limited Resources (Part Ii): Clinical, Technical And Socio-Economic Considerations, M Aljurf, D Weisdorf, S K. Hashmi, A Nassar, E Gluckman, M Mohty, D Rizzo, M Pasquini, M Hamadani, Salman Adil

Section of Haematology/Oncology

The development of hematopoietic stem cell transplantation (HSCT) programs can face significant challenges in most developing countries because such endeavors must compete with other government health care priorities, including the delivery of basic services. While this is may be a limiting factor, these countries should prioritize development of the needed expertise to offer state of the art treatments including transplantation, by providing financial, technological, legal, ethical and other needed support. This would prove beneficial in providing successful programs customized to the needs of their population, and potentially provide long-term cost-savings by circumventing the need for their citizens to seek care …

Isolated Forefoot Juvenile Xanthogranuloma: Unique Case Study And Treatment In A Pediatric Patient, Brian Derner Dpm, Kristine Hoffman, Amy Storfa Md, Dustin Kruse Dpm, Paul A. Stone Dpm, Facfas

Podiatry

Juvenile xanthogranulomas (JXG) are a benign histiocytic cell proliferative disorder in early childhood. They most commonly present within the first two years of life with papular or nodular changes to the skin on the head, neck or upper trunk. Xanthogranulomas are mostly self-limiting, can be singular or multiple, and rarely can infer a systemic disease process1. The purpose of this study was to publish a unique finding of an extra-tendinous solitary mass in an otherwise healthy 17-year old, with surgical and medical treatment after diagnosis.

B Cells Migrate Into Remote Brain Areas And Support Neurogenesis And Functional Recovery After Focal Stroke In Mice, Sterling B. Ortega, Vanessa O. Torres, Sarah E. Latchney, Cody W. Whoolery, Ibrahim Z. Noorbhai, Katie Poinsatte, Uma M. Selvaraj, Monica A. Benson, Anouk J. M. Meeuwissen, Erik J. Plautz, Xiangmei Kong, Denise M. Ramirez, Apoorva D. Ajay, Julian P. Meeks, Mark P. Goldberg, Nancy L. Monson, Amelia J. Eisch, Ann M. Stowe

Neurology Faculty Publications

Lymphocytes infiltrate the stroke core and penumbra and often exacerbate cellular injury. B cells, however, are lymphocytes that do not contribute to acute pathology but can support recovery. B cell adoptive transfer to mice reduced infarct volumes 3 and 7 d after transient middle cerebral artery occlusion (tMCAo), independent of changing immune populations in recipient mice. Testing a direct neurotrophic effect, B cells cocultured with mixed cortical cells protected neurons and maintained dendritic arborization after oxygen-glucose deprivation. Whole-brain volumetric serial two-photon tomography (STPT) and a custom-developed image analysis pipeline visualized and quantified poststroke B cell diapedesis throughout the brain, including …

Hierarchical Clustering Analyses Of Plasma Proteins In Subjects With Cardiovascular Risk Factors Identify Informative Subsets Based On Differential Levels Of Angiogenic And Inflammatory Biomarkers, Zachary Winder, Tiffany L. Sudduth, David W. Fardo, Qiang Cheng, Larry B. Goldstein, Peter T. Nelson, Frederick A. Schmitt, Gregory A. Jicha, Donna M. Wilcock

Sanders-Brown Center on Aging Faculty Publications

Agglomerative hierarchical clustering analysis (HCA) is a commonly used unsupervised machine learning approach for identifying informative natural clusters of observations. HCA is performed by calculating a pairwise dissimilarity matrix and then clustering similar observations until all observations are grouped within a cluster. Verifying the empirical clusters produced by HCA is complex and not well studied in biomedical applications. Here, we demonstrate the comparability of a novel HCA technique with one that was used in previous biomedical applications while applying both techniques to plasma angiogenic (FGF, FLT, PIGF, Tie-2, VEGF, VEGF-D) and inflammatory (MMP1, MMP3, MMP9, IL8, TNFα) protein data to …

Urinary Bladder Metastasis From Breast Cancer: A Rare Cause Of Hematuria, Samuel Gitau, Allan Njau, Sitna Mwanzi

Imaging & Diagnostic Radiology, East Africa

Breast cancer is the most common cancer in women globally as well as in Kenya. The most common sites of metastases reported include the bones, liver and lung. Metastasis to the urinary bladder is relatively uncommon with only a few case reports in literature. It can therefore be easily overlooked as a cause of hematuria in these patients. We describe a rare case of a patient with breast cancer who presented with urinary bladder metastasis as a late complication of her illness.

Point-Of-Care Hpv Molecular Diagnostics For A Test-And-Treat Model In High-Risk Hiv Populations, Shahin Sayed, Michael Chung, Marleen Temmerman

Pathology, East Africa

Strategies for cervical cancer prevention and control in low-income and middle-income countries (LMICs) require concerted efforts to improve screening and access to treatment, especially in high-risk HIV populations. LMICs bear the largest burden of HIV infection, human papillomavirus (HPV) infection is common among HIV-infected women, risk of cervical cancer is increased in women with HIV/AIDS, and HIV clinics provide opportunities to screen and treat for cervical cancer in this population.

A Multicenter Case Control Study Of Association Of Vitamin D With Breast Cancer Among Women In Karachi, Pakistan, Uzma Shamsi, Shaista Khan, Syed Iqbal Azam, Aysha Habib, Amir Maqbool, Mohammad Hanif, Tiffany Gill, Romaina Iqbal, David Callen

Community Health Sciences

Background: The prevalence of vitamin D inadequacy and breast cancer are both high among women living in Karachi, Pakistan.
Methods: A matched case control study was conducted in two hospitals of Karachi, Pakistan to evaluate the association of vitamin D (serum 25-hydroxyvitamin D) concentrations, vitamin D supplementation and sun exposure with breast cancer among Pakistani women. A total of 411 newly diagnosed histologically confirmed primary breast cancer cases were enrolled and 784 controls, free of breast and any other cancers, were matched by age (year of birth ± 5 years), residence in the same geographic area and study site. Information …

Utility Of Ultrasound And Mammography In Detection Of Negative Axillary Nodal Metastasis In Breast Cancer, Anam Khan, Imrana Masroor, Kumail Khandwala, Summar Un-Nisa Abbasi, Muhammad Usman Tariq

Department of Radiology

Objective: The status of axillary lymph nodes is one of the most important prognostic factors in patients with breast cancer. A precise noninvasive evaluation of axillary lymph node status preoperatively, although challenging, is vital for optimization of the treatment plan for patients. The objective of our study was to assess the utility of ultrasound and mammography in detecting the absence of axillary lymph nodal metastasis in patients of breast cancer, taking histopathology as gold standard.
Methods: A cross-sectional study was conducted in the Department of Radiology, Aga Khan University Hospital, Karachi. All female patients between 20 and 95 years of …

Carcinoma In Situ Involving Sclerosing Adenosis On Core Biopsy: Diagnostic Pearls To Aid The Practicing Clinician And Avoid Overtreatment, Dana Richards, Alberto A. Ayala, Yun Wu, Lavinia P. Middleton

Pathology and Laboratory Medicine Faculty Publications

INTRODUCTION: Involvement of pre-existing benign lesions by ductal carcinoma in situ (DCIS) or lobular neoplasia (LN) can present difficult diagnostic challenges, and can easily cause misdiagnosis of invasive carcinoma and over-management of localized disease. Our objective was to gather the largest case series of DCIS and LN involving sclerosing adenosis (SA), and to report the characteristic features of these lesions, in order to provide histologic criteria for the diagnostician.

METHODS: Our database was searched for core biopsy material diagnosed as carcinoma in situ involving adenosis. Glass slides and pathology reports were reviewed. The cases were studied for salient features, and …

Ass1 Overexpression: A Hallmark Of Sonic Hedgehog Hepatocellular Adenomas; Recommendations For Clinical Practice., M. Sala, D. Gonzales, T. Leste-Lasserre, N. Dugot-Senant, V. Paradis, S. Di Tommaso, J. Dupuy, V. Pitard, C. Fan, F. Saltel, +26 Additional Authors

Journal Articles

Until recently, 10% of hepatocellular adenomas (HCAs) remained unclassified (UHCA). Among the UHCAs, the sonic hedgehog HCA (shHCA) was defined by focal deletions that fuse the promoter of Inhibin beta E chain with GLI1. Prostaglandin D2 synthase was proposed as immunomarker. In parallel, our previous work using proteomic analysis showed that most UHCAs constitute a homogeneous subtype associated with overexpression of argininosuccinate synthase (ASS1). To clarify the use of ASS1 in the HCA classification and avoid misinterpretations of the immunohistochemical staining, the aims of this work were to study (1) the link between shHCA and ASS1 overexpression and (2) the …

The Value Proposition For Pathologists: A Population Health Approach, B. S. Ducatman, A. M. Ducatman, J. M. Crawford, M. Laposata, F. Sanfilippo

Journal Articles

© The Author(s) 2020. The transition to a value-based payment system offers pathologists the opportunity to play an increased role in population health by improving outcomes and safety as well as reducing costs. Although laboratory testing itself accounts for a small portion of health-care spending, laboratory data have significant downstream effects in patient management as well as diagnosis. Pathologists currently are heavily engaged in precision medicine, use of laboratory and pathology test results (including autopsy data) to reduce diagnostic errors, and play leading roles in diagnostic management teams. Additionally, pathologists can use aggregate laboratory data to monitor the health of …

Molecular Pathology Economics 101: An Overview Of Molecular Diagnostics Coding, Coverage, And Reimbursement A Report Of The Association For Molecular Pathology, A. N. Sireci, J. L. Patel, L. Joseph, M. C. Hiemenz, O. C. Rosca, S. K. Caughron, S. A. Thibault-Sennett, T. L. Burke, D. L. Aisner

Journal Articles

No abstract provided.

Histopathologic Evaluation Of Placentas After Diagnosis Of Maternal Severe Acute Respiratory Syndrome Coronavirus 2 Infection., M. Gulersen, L. Prasannan, H. Tam Tam, C. N. Metz, B. Rochelson, N. Meirowitz, W. Shan, M. Edelman, K. A. Millington

Journal Articles

Background: The impact of maternal severe acute respiratory syndrome coronavirus 2 infection on placental histopathology is not well known.

Objective: To determine if any significant placental histopathologic changes occur after the diagnosis of severe acute respiratory syndrome coronavirus 2 infection during pregnancy and whether these changes are correlated with the presence or absence of symptoms associated with the infection.

Study Design: A retrospective cohort study of women diagnosed as having severe acute respiratory syndrome coronavirus 2 infection who delivered at a single center from April 9, 2020 to April 27, 2020, and had placental specimens reviewed by the Department of …

Analytical And Clinical Comparison Of Three Nucleic Acid Amplification Tests For Sars-Cov-2 Detection., E Smith, W Zhen, R Manji, D Schron, S Duong, Gj Berry

Journal Articles

No abstract provided.

Rapid Emergence Of Sars-Cov-2 In The Greater New York Metropolitan Area: Geolocation, Demographics, Positivity Rates, And Hospitalization For 46,793 Persons Tested By Northwell Health., S. B. Reichberg, P. P. Mitra, A. Haghamad, G. Ramrattan, J. M. Crawford, G. J. Berry, K. W. Davidson, A. Drach, S. Duong, S. Juretschko, N. I. Maria, Y. Yang, Y. C. Ziemba, Northwell Covid-19 Research Consortium

Journal Articles

BACKGROUND:In March 2020, the greater New York metropolitan area became an epicenter for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The initial evolution of case incidence has not been well characterized. METHODS:Northwell Health Laboratories tested 46,793 persons for SARS-CoV-2 from March 4 through April 10. The primary outcome measure was a positive reverse-transcription-polymerase-chain-reaction (RT-PCR) test for SARS-CoV-2. The secondary outcomes included patient age, sex, and race if stated; dates the specimen was obtained and the test result; clinical practice site sources; geo-location of patient residence; and hospitalization. RESULTS:From March 8 through April 10, a total of 26,735 of 46,793 …

Development Of A New Multiplex Real-Time Rt-Pcr Assay For Severe Acute Respiratory Syndrome Coronavirus 2 (Sars-Cov-2) Detection., W. Zhen, G. J. Berry

Journal Articles

This research describes the development of a new multiplex real-time RT-PCR test for detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with primers designed to amplify a 108 bp target on the spike surface glycoprotein (S gene) and a hydrolysis TaqMan probe designed to specifically detect SARS-CoV-2. The limit of detection (LOD) and clinical performance of this new assay were evaluated. A LOD study with inactivated virus exhibited performance equal to the modified CDC assay, with a final LOD of 1301 ± 13 genome equivalents/mL for the Northwell Health Laboratories laboratory-developed test (NWHL LDT) versus 1249 ± 14 genome …

Clinical Evaluation Of Three Sample-To-Answer Platforms For The Detection Of Sars-Cov-2, W Zhen, E Smith, R Manji, D Schron, Gj Berry

Journal Articles

No abstract provided.

Histopathological Evaluation Of Placentas After Diagnosis Of Maternal Sars-Cov-2 Infection., M. Gulersen, L. Prasannan, H. T. Tam, C. N. Metz, B. Rochelson, N. Meirowitz, W. Shan, M. Edelman, K. A. Millington

Journal Articles

Background:The impact of maternal SARS-CoV-2 infection on placental histopathology is not well known. Objectives:To determine if significant placental histopathological changes occur after diagnosis of SARS-CoV-2 infection in pregnancy and whether these changes are correlated with the presence or absence of symptoms associated with infection. Study Design:Retrospective cohort study of women diagnosed with SARS-CoV-2 infection who delivered at a single center from April 9th to April 27th, 2020, and had placental specimens reviewed by pathology. Women with singleton gestations and laboratory-confirmed SARS-CoV-2 infection were eligible for inclusion. Historical controls selected from a cohort of women who delivered 6 months prior to …

Multiple Myeloma In A Young Female Presenting With Neurological Symptoms., M. Lee, X. Zhang, V. Nguyen, M. Hartley-Brown

Journal Articles

Background:Multiple myeloma is overall the 14th most common malignancy but is rarely seen in those younger than 35 years. Those in the younger age group have been shown to have a more aggressive course but reportedly have had similar responses to treatment compared to older cohorts. Extramedullary plasmacytomas are discrete soft tissue masses of neoplastic monoclonal plasma cells that often occur in patients with multiple myeloma. Case:This case entails a young female with new diagnosis of multiple myeloma and multiple extramedullary plasmacytomas presenting with neurological symptoms. She was treated with CyBorD regimen but was refractory and progressed. Treatment was changed …

Molecular Testing For Acute Respiratory Tract Infections: Clinical And Diagnostic Recommendations From The Idsa's Diagnostics Committee., K. E. Hanson, M. M. Azar, R. Banerjee, A. Chou, R. C. Colgrove, C. C. Ginocchio, M. K. Hayden, M. Holodiny, S. Jain, Diagnostics Committee Of The Infectious Diseases S, +4 Additional Authors

Journal Articles

The clinical signs and symptoms of acute respiratory tract infections (RTIs) are not pathogen specific. Highly sensitive and specific nucleic acid amplification tests have become the diagnostic reference standard for viruses and translation of bacterial assays from basic research to routine clinical practice represents an exciting advance in respiratory medicine. Most recently, molecular diagnostics have played an essential role in the global health response to the novel coronavirus pandemic. How best to use newer molecular tests for RTI in combination with clinical judNorthwell Healthnt and traditional methods can be bewildering given the plethora of available assays and rapidly evolving technologies. …