Medical Specialties Commons^™

Development And Validation Of Standard And Real Patient Gallstone Library Using Fourier Transform Infra-Red Spectroscopy, Lena Jafri, Muhammad Abbas Abid, Humera Asif, Syed Bilal Hashmi, Hafsa Majid, Farooq Ghani, Sibtain Ahmed, Imran Siddiqui, Aysha Habib

Department of Pathology and Laboratory Medicine

Background: Analysis of the constituents of gallstones using various spectroscopic techniques assists in identification of the pathogenesis of gallstones. In the current study, using Fourier Transform Infra-Red (FTIR) Spectroscopy, a Gallstone Standard Library (GSL) and a Gallstone Real Patients' Library (GRPL) were developed and validated for gallstone composition analysis.
Methods: The study was conducted at the Department of Pathology & Laboratory Medicine, Aga Khan University, Pakistan. Pure standards (cholesterol, calcium carbonate, bilirubin and bile salts) and gallstone specimens were analyzed using FTIR Nicolet iS-5 Spectrometer from Thermo Fisher Scientific, USA. Thermo Scientific™ QCheck™ algorithm, embedded within the OMNIC™ software, was …

Efficacy And Safety Of Direct Oral Anticoagulants With And Without Aspirin: A Systematic Review And Meta-Analysis, Talal Almas, Adeena Musheer, Arooba Ejaz, Fahd Niaz Shaikh, Anousheh Awais Paracha, Fizza Raza, Maryam Sarwar Khan, Fahad Masood, Faiza Siddiqui, Muhammad Hasnain Mankani

Medical College Documents

Background: Various anticoagulant therapies are prescribed to patients under physicians' discretion and recently Direct Oral Anticoagulants(DOAC) have been under trials to evaluate their safety and efficacy. In addition to this, the regimen of DOACs and Aspirin is of keen interest as researchers continue to find an optimal regimen to treat blood clots in patients. This study is a systematic review and meta-analysis of randomized controlled trials and observational studies that asses the safety and efficacy of DOAC with and without Aspirin.
Methods: We queried MEDLINE and Cochrane CENTRAL from their inception to April 2021, for published and randomized controlled …

Practical Needs And Considerations For Refugees And Other Forcibly Displaced Persons With Neurological Disorders: Recommendations Using A Modified Delphi Approach, Shawheen Rezaei, Foksouna Sakadi, Fu-Liong Hiew, Ildefonso Rodriguez-Leyva, Jera Kruja, Mohammad Wasay, Osheik Abuasha Seidi, Saad Abdel-Aziz, Shahriar Nafissi, Farrah Mateen

Section of Neurology

Background: There are >70 million forcibly displaced people worldwide, including refugees, internally displaced persons, and asylum seekers. While the health needs of forcibly displaced people have been characterized in the literature, more still needs to be done globally to translate this knowledge into effective policies and actions, particularly in neurology.
Methods: In 2020, a global network of published experts on neurological disease and refugees was convened. Nine physician experts from nine countries (2 low, 1 lower-middle income, 5 upper-middle, 1 high income) with experience treating displaced people originating from 18 countries participated in three survey and two discussion rounds in …

Idiopathic Midaortic Syndrome, David Saul, Rahul Nikam, Vinay Kandula, Achala Donuru

Department of Radiology Faculty Papers

Midaortic syndrome (MAS) is characterized by narrowing of the descending aorta between the distal aortic arch and the aortic bifurcation. We present the case of a 4-year-old male presenting with a murmur and diagnosed with MAS. He was treated with a thoracoabdominal bypass graft.

You’Re Testing My Patients: Clinicians’ Preferences For Structured Reporting And Measurement Data, Davit Meliksetyan, Allan Brazier, Adela Pouzar, Sayf Al-Katib

Conference Presentation Abstracts

No abstract provided.

Dpo: Diffuse Pulmonary Ossification - A Diagnostic Challenge, Gaetano Rea, Giuliana Giacobbe, Danila Caroppo, Silvia Iovine, Roberta Lieto, Marialuisa Bocchino, Tullio Valente, Angelantonio Maglio, Alessandro Vatrella

Translational Medicine @ UniSa

Diffuse pulmonary ossification (DPO) is a rare condition of DLD (diffuse lung disease) characterized by the presence of metaplastic ectopic bone in the lungs and is less frequent in patients without a clear background of lung diseases. DPO is characterized by very small calcific nodules, often with bone mature located in both lungs and often in peripheral areas of the lungs. Two patterns of DPO have been recognized dendriform and nodular. The dendriform type is less common and is characterized by a coral-like network of bone spiculae along the alveolar septa and is often related to interstitial fibrosis or chronic …

Cloud-Based Ultrasound System: Feasibility And Potential, Ji-Bin Liu

Department of Radiology Faculty Papers

No abstract provided.

High Cd44 Immunoexpression Correlates With Poor Overall Survival: Assessing The Role Of Cancer Stem Cell Markers In Oral Squamous Cell Carcinoma Patients From The High-Risk Population Of Pakistan, Yumna Mirza, Syed Adnan Ali, Hasnain Ahmed Farooqui, Hammad A. Kayani, Romana Idress, Mohammad Sohail Awan

Department of Surgery Docs

Oral squamous cell carcinoma (OSCC) is a top-ranked cancer in the Pakistani population, and patient survival has remained unchanged at ∼50% for several decades. Recent advances have claimed that a subset of tumour cells, called cancer stem cells (CSCs), are responsible for tumour progression, treatment resistance, and metastasis, which leads to a poor prognosis. This study investigated the impact of CSC markers expression on overall survival (OS) and disease-free survival (DFS) of OSCC patients. Materials and Methods. Immunohistochemistry was used to evaluate CD44, CD133, L1CAM, and SOX2 expression in a well-characterized cohort of 100 Pakistani patients with primary treatment …

Single Center Retrospective Review Of Post-Laparotomy Ct Abdomen And Pelvis Findings And Trends, Dylan C. Steffey, Emad A. Chishti, Maximo J. Acevedo, Luis F. Acosta, James T. Lee

Radiology Faculty Publications

Purpose: To identify common findings visualized on CT following damage control laparotomy, including post-surgical changes and additional injuries, and to determine change in frequency of post-laparotomy CT at our institution over time.

Methods: Single institution, IRB-Exempt, retrospective review of the University of Kentucky trauma registry from 1/2006 to 2/2019 for all trauma patients undergoing exploratory laparotomy initially and subsequently undergoing CT of the abdomen and pelvis within 24 hours. Operative findings from surgical operation notes and findings reported on post-laparotomy CT were recorded, including vascular and solid organ injuries, operative changes, free intraperitoneal fluid/air, and retroperitoneal findings. Next steps in …

Combined Transhepatic And Transjugular Approach For Mechanical Thrombectomy Of Massive Tips Thrombosis, Jack B. Newcomer, Emad A. Chishti, Driss Raissi

Radiology Faculty Publications

Transjugular intrahepatic portosystemic shunt (TIPS) is a well-validated decompressive therapy option to manage ascites and variceal bleeding secondary to portal hypertension. Complications following TIPS procedures include hepatic encephalopathy, liver failure, and TIPS dysfunction. TIPS dysfunction is due to occlusion or stenosis of the TIPS shunt and can be caused by acute or chronic thrombosis. TIPS thrombosis is often treated with mechanical thrombectomy or catheter-directed thrombolytic therapy. Most cases of in-stent occlusion can be treated via a transjugular approach with recanalization or placement of additional stents. We present a case of a 72-year-old female who presented with worsening ascites 17 months …

A Case Report Of Minimally Invasive Percutaneous Ultrasound Guided Tuberculous Iliopsoas Abscess Drainage In An Immunocompromised Patient, Allyzain Ismail, Neelam Ismail, Athar Ali, Shabbir Adamjee, Ahmed Jusabani, Zainab Fidaali

General Surgery, East Africa

Introduction and importance: Iliopsoas abscess is a collection of pus that presents with nonspecific features with often delays in diagnosis however cause significant morbidity and mortality with Mycobacterium tuberculosis to be considered as causative agent in at risk individuals in tuberculous endemic regions. Management involves drainage and initiation of adequate antibiotics with radiological guided percutaneous approach considered the appropriate initial approach.

Case presentation: 50-year-old immunosuppressed presenting with left iliopsoas abscess who underwent ultrasound guided drainage and placement of pigtail catheter successfully without the need for open surgical drainage. Our experience of interventional radiology for diagnosis of causative agent and treatment …

Male Breast Cancer: The Three Decades' Experience Of A Tertiary Care Hospital In A Lower-Middle Income Country, Sana Zeeshan, Muhammad Tayyab, Fatima Shaukat, Muhammad Usman Tariq, Nargis Khan, Lubna Vohra

Section of General Surgery

Introduction Male breast cancer is uncommon and managed on the guidelines of female breast cancer due to tumor rarity. We sought to identify the incidence, clinicopathological features, and survival of all male breast cancer patients managed in our hospital. Methods A retrospective cross-sectional study was conducted at Aga Khan University Hospital (AKUH), Karachi, Pakistan, from January 1986 to December 2018. Demographic data, treatment records, and follow-up data of all male breast cancer patients who were treated at AKUH was reviewed. Results Thirty-eight out of 42 patients who presented over a period of 32 years were included. The mean age was …

Covid-19 Associated Myelin Oligodendrocyte Glycoprotein Antibody-Associated Disease (Mogad), Evan Palamara, Ay-Ming Wang, Samir E. Noujaim, Kathleen A. Barry, Suleiman Kojan, M Mazen Al-Hakim, Richard Silbergleit

Conference Presentation Abstracts

No abstract provided.

Dear Radiologist: Cure My Disc Bulge, But Please Don’T Miss My Spinal Tumor!, A Dearden, J Ghannam, A M Wang

Conference Presentation Abstracts

No abstract provided.

Aapm Medical Physics Practice Guideline 12.A: Fluoroscopy Dose Management, Ryan F. Fisher, Kimberly E. Applegate, Lindsey K. Berkowitz, Olav Christianson, Jaydev K. Dave, Lindsay Deweese, Nichole Harris, Mary Ellen Jafari, A. Kyle Jones, Robert J. Kobistek, Brendan Loughran, Loren Marous, Donald L. Miller, Beth Schueler, Bryan C. Schwarz, Adam Springer, Kevin A. Wunderle

Radiology Faculty Publications

No abstract provided.

Dna-Pkcs: A Targetable Protumorigenic Protein Kinase., Emanuela Dylgjeri, Karen E Knudsen

Department of Cancer Biology Faculty Papers

DNA-dependent protein kinase catalytic subunit (DNA-PKcs) is a pleiotropic protein kinase that plays critical roles in cellular processes fundamental to cancer. DNA-PKcs expression and activity are frequently deregulated in multiple hematologic and solid tumors and have been tightly linked to poor outcome. Given the potentially influential role of DNA-PKcs in cancer development and progression, therapeutic targeting of this kinase is being tested in preclinical and clinical settings. This review summarizes the latest advances in the field, providing a comprehensive discussion of DNA-PKcs functions in cancer and an update on the clinical assessment of DNA-PK inhibitors in cancer therapy.

Cerebral Blood Flow And Brain Functional Connectivity Changes In Older Adults Participating In A Mindfulness-Based Stress Reduction Program, Aleeze Sattar Moss, Diane K. Reibel, Nancy Wintering, Faezeh Vedaei, Hannah Porter, Mohsen Khosravi, Justin Heholt, M. Alizadeh, Feroze Mohamed, Andrew B. Newberg

Department of Radiology Faculty Papers

There is a growing interest in the potential beneficial effects of mindfulness meditation training in protecting against age-related physical, emotional, and cognitive decline. The current prospective, single-center, single-arm study investigated if functional magnetic resonance imaging-based changes in cerebral blood flow and brain functional connectivity could be observed in 11 elderly adults (mean age 79) after participation in a Mindfulness-Based Stress Reduction (MBSR) program. The results showed significantly (p < 0.05) altered cerebral blood flow and functional connectivity in the cingulate gyrus, limbic structures, and subregions of the temporal and frontal lobes, similar to findings of other meditation-related studies in younger populations. Furthermore, these changes were also associated with significant improvements in depression symptoms. This study suggests that the MBSR program can potentially modify cerebral blood flow and connectivity in this population.

Manual Loop In Laparoscopic Appendectomy: A Retrospective Cohort Study And Literature Review, Priyanka Ramesh, Aniqa Saeed, Muniza Nusrat, Sehrish Batool, Hina Khan, Ghulam Murtaza

Section of Urology

Objectives: To determine the incidence of complications [Surgical site infection (SSI), intra-abdominal abscess (IAA), stump leak] related to stump ligation with manual loop of sliding extracorporeal suture knot in laparoscopic appendectomy.
Methods: This cohort study was conducted on patients who underwent laparoscopic appendectomy from June 2014 to November 2020 performed by the same surgeon with almost similar technique. Stump was ligated with manual loops, applied by the surgeon or trainee or both (one by surgeon and other by trainee). SSI and IAA were classified according to Centers for Disease Control and Prevention (CDC) criteria.
Results: Total 120 patients were included …

A Bibliometric Analysis Of The Studies On Dental Implant Failure, Farhan Raza Khan, Syed Murtaza Raza Kazmi, Yusra Fahim Siddiqui

Section of Dental-Oral Maxillofacial Surgery

Objective: To identify top 30 studies related to dental implant failures based on bibliometric analysis.
Methods: The bibliometric study was conducted at Aga Khan University, Karachi from April 2021 to June 2021 and comprised database search on Google Scholar used key words "dental implant failures" for studies published between 1990 and 2020. The selected studies were reviewed based on citation count for which the cut-off date was June 1, 2021.
Results: The top 30 papers on dental implant failures had median citation count of 153 (range: 41-1583. Most of the studies were retrospective 11(36.7%), followed by literature reviews 6(20%). The …

Avoidable And Unavoidable Repeat Breast Core Needle Biopsies, Xiaoqin Wang, Fara Shikoh, Mauro Hanaoka, Aurela Clark

Radiology Faculty Publications

Background: Breast core needle biopsies are not perfect and could miss cancer. The need for a repeat breast core biopsy is not uncommon and can occur for a multitude of reasons. Radiologists should carefully correlate the pathology results with imaging features after each breast biopsy and must recognize why certain core biopsies must be repeated to avoid missed or delayed cancer diagnosis. In this review, we discuss the main reasons for repeat core biopsies via case presentation with radiological images and pathological correlation. This review will help multidisciplinary breast care team recognize when to repeat a biopsy to reduce false …

Understanding Deep Learning - Challenges And Prospects, Niha Adnan, Fahad Umer

Department of Surgery Docs

The developments in Artificial Intelligence have been on the rise since its advent. The advancements in this field have been the innovative research area across a wide range of industries, making its incorporation in dentistry inevitable. Artificial Intelligence techniques are making serious progress in the diagnostic and treatment planning aspects of dental clinical practice. This will ultimately help in the elimination of subjectivity and human error that are often part of radiographic interpretations, and will improve the overall efficiency of the process. The various types of Artificial Intelligence algorithms that exist today make the understanding of their application quite complex. …

Vitamin B12 Deficiency In Nitrous Oxide Abuse, Colby Jones, Jordan Verlare, Reehan Ali

Articles

33yo F presents to ED with numbness & tingling in hands, feet for 10 days. History of recreational drug use, including nitrous oxide 'whippets.' Unremarkable Head CT was obtained.

Blood Flow Restriction Training After Patellar Instability (Brains Trial), Benjamin D. Brightwell, Austin V. Stone, Xiaojuan Li, Peter A. Hardy, Katherine L. Thompson, Brian W. Noehren, Cale A. Jacobs

Orthopaedic Surgery and Sports Medicine Faculty Publications

Background

Patellar instability is a common and understudied condition that disproportionally affects athletes and military personnel. The rate of post-traumatic osteoarthritis that develops following a patellar dislocation can be up to 50% of individuals 5–15 years after injury. Conservative treatment is the standard of care for patellar instability however, there are no evidence-informed rehabilitation guidelines in the scientific literature. The purpose of this study is to assess the effectiveness of blood-flow restriction training (BFRT) for patellar instability. Our hypotheses are that this strategy will improve patient-reported outcomes and accelerate restoration of symmetric strength and knee biomechanics necessary to safely return …

Short Chain Fatty Acids Taken At Time Of Thrombectomy In Acute Ischemic Stroke Patients Are Independent Of Stroke Severity But Associated With Inflammatory Markers And Worse Symptoms At Discharge, Nicholas Henry, Jacqueline A. Frank, Christopher J. Mclouth, Amanda L. Trout, Andrew J. Morris, Jianzhong Chen, Ann M. Stowe, Justin F. Fraser, Keith R. Pennypacker

Behavioral Science Faculty Publications

Introduction: Short chain fatty acids (SCFA) are gut microbiota-derived metabolites that contribute to the gut-brain axis and may impact stroke outcomes following gut dysbiosis. We evaluated plasma SCFA concentrations against stroke severity parameters and identified SCFA-associated protein networks.

Methods: The Blood and Clot Thrombectomy Registry and Collaboration (BACTRAC), a continuously enrolling tissue bank, was used to obtain stroke samples. Arterial blood distal and proximal to the thrombus was obtained from Acute Ischemic Stroke (AIS) Patients (n=53) during thrombectomy. Patient demographics, stroke presentation and outcome parameters were reported. The SCFAs were isolated from proximal plasma via chemical derivatization UHPLC coupled tandem …

Identification Of Chronic Mild Traumatic Brain Injury Using Resting State Functional Mri And Machine Learning Techniques, Faezeh Vedaei, Najmeh Mashhadi, George Zabrecky, Daniel A. Monti, Emily Navarreto, Chloe Hriso, Nancy Wintering, Andrew B. Newberg, Feroze Mohamed

Department of Radiology Faculty Papers

Mild traumatic brain injury (mTBI) is a major public health concern that can result in a broad spectrum of short-term and long-term symptoms. Recently, machine learning (ML) algorithms have been used in neuroscience research for diagnostics and prognostic assessment of brain disorders. The present study aimed to develop an automatic classifier to distinguish patients suffering from chronic mTBI from healthy controls (HCs) utilizing multilevel metrics of resting-state functional magnetic resonance imaging (rs-fMRI). Sixty mTBI patients and forty HCs were enrolled and allocated to training and testing datasets with a ratio of 80:20. Several rs-fMRI metrics including fractional amplitude of low-frequency …

Association Between Exposure To Radioactive Iodine After The Chernobyl Accident And Thyroid Volume In Belarus 10-15 Years Later, Ekaterina Chirikova, Robert J Mcconnell, Patrick O'Kane, Vasilina Yauseyenka, Mark P Little, Victor Minenko, Vladimir Drozdovitch, Ilya Veyalkin, Maureen Hatch, June M Chan, Chiung-Yu Huang, Kiyohiko Mabuchi, Elizabeth K Cahoon, Alexander Rozhko, Lydia B Zablotska

Department of Radiology Faculty Papers

Background: While there is a robust literature on environmental exposure to iodine-131 (131I) in childhood and adolescence and the risk of thyroid cancer and benign nodules, little is known about its effects on thyroid volume.

Methods: To assess the effect of 131I dose to the thyroid on the volume of the thyroid gland, we examined the data from the baseline screening of the Belarusian-American Cohort Study of residents of Belarus who were exposed to the Chernobyl fallout at ages ≤18 years. Thyroid dose estimates were based on individual thyroid activity measurements made shortly after the accident and dosimetric data from …

Evidence-Based Cardiovascular Magnetic Resonance Cost-Effectiveness Calculator For The Detection Of Significant Coronary Artery Disease, Ankur Pandya, Yuan-Jui Yu, Yin Ge, Eike Nagel, Raymond Y. Kwong, Rafidah Abu Bakar, John D. Grizzard, Alexander E. Merkler, Ntobeko Ntusi, Steffen E. Peterson, Nina Rashedi, Juerg Schwitter, Joseph B. Selvanayagam, James A. White, James Carr, Subha V. Raman, Orlando P. Simonetti, Chiara Bucciarelli-Ducci, Lilia M. Sierra-Galan, Victor A. Ferrari, Mona Bhatia, Sebastian Kelle

Radiology Publications

Background
Although prior reports have evaluated the clinical and cost impacts of cardiovascular magnetic resonance (CMR) for low-to-intermediate-risk patients with suspected significant coronary artery disease (CAD), the cost-effectiveness of CMR compared to relevant comparators remains poorly understood. We aimed to summarize the cost-effectiveness literature on CMR for CAD and create a cost-effectiveness calculator, useable worldwide, to approximate the cost-per-quality-adjusted-life-year (QALY) of CMR and relevant comparators with context-specific patient-level and system-level inputs.

Methods
We searched the Tufts Cost-Effectiveness Analysis Registry and PubMed for cost-per-QALY or cost-per-life-year-saved studies of CMR to detect significant CAD. We also developed a linear regression meta-model (CMR …

Prone Versus Supine Position For Breast Cancer Treatment, Alexis Wychock

Student Research Poster Presentations 2022

This project explains the two most common positions to treat breast cancer: prone and supine. Radiation therapy, breast cancer, complications of radiation therapy to the breast, and the new set-up for prone positioning called Crawl Couch are also discussed on the poster. Breast cancer is the second most common cancer in women in the United States. Men can also develop breast cancer, but it is less common. Supine is performed utilizing deep inspiration breath hold and the prone is completed using free breathing. Prone and supine are the two positions used but some researchers found a better way to treat …

Clinical Indication Appropriateness Of Bilateral Lower Extremity Venous Exams, Kristina Horan, Breana Doyle

Student Research Poster Presentations 2022

The purpose of this study was to evaluate the appropriateness of bilateral lower extremity venous exam orders. The study encompassed final reports of 216 bilateral lower extremity venous exams that took place in December 2021 from three separate medical facilities. The Centers for Medicare and Medicaid Services (CMS) Appropriate Use Guidelines for Non-Invasive Vascular Studies were used to determine if the exams were ordered appropriately. The results were 159 duplex exams were ordered appropriately and 57 were not appropriate. The findings concluded that a majority of the bilateral lower extremity venous exams were ordered appropriately.

Fever Of Unknown Origin: A Grave Diagnosis, Ryan Miller, Richard Allen

South Atlantic Division GME Research Day 2022

No abstract provided.