Medical Specialties Commons^™

Prepubertal Office Gynecology, Hatim A. Omar, Wendy Jackson, Amit M. Deokar

Pediatrics Faculty Publications

Clinical presentation and complaints of the vulvo-vaginal area are quite prevalent in the pediatric population and the primary care providers the first individuals called upon to evaluate the patients. One of the most difficult tasks for an individual that rarely performs the genitourinary examination is performing one on a pediatric patient. This chapter has been written to aid the primary care provider in successful examination, documentation and diagnosis.

Ovarian Tumors In Children And Adolescents, Linah Al-Alem, Amit M. Deokar, Rebecca Timme, Hatim A. Omar

Pediatrics Faculty Publications

Ovarian tumors are uncommon in the child and adolescent population, but given that cancer is a leading cause of death even in this age group it is important for the general practice physician to be aware of the signs and symptoms. These can include abdominal pain, increased abdominal girth, a palpable mass on pelvic or abdominal exam, nausea and vomiting, decreased appetite, weight loss, constipation, back pain, leg cramps, dyspareunia, urinary symptoms, abnormal uterine bleeding, and ascites, to name a few. The types of gynecological tumors seen in adults are also seen in children except in differing frequencies. The most …

Contraception, Donald E. Greydanus, Hatim A. Omar, Lyubov A. Matytsina, Artemis Tsitsika

Pediatrics Faculty Publications

Contraception is an important concept for sexually active adolescent females to understand who do not wish to become pregnant. This chapter reviews important, effective, and safe contraceptive methods that can be used by female youth. These methods include abstinence, oral contraception, contraceptive patch. mini-pills, emergency contraceptives, injectable contraception (DMPA), implants (lmplanon), intravaginal ring, vaginal barrier contraceptives, intrauterine devices, and natural family planning. Promotion of sexual responsibility should be the charge of health professionals caring for adolescents and young adults.

Breast Disorders In Children And Adolescents, Donald E. Greydanus, Hatim A. Omar, Lyubov A. Matytsina, Artemis Tsitsika

Pediatrics Faculty Publications

Concerns about problems of the breast are often noted in adolescents and their parents. This review discusses issues and disorders of the breast in children and adolescents, starting with basic principles of embryology and adolescent breast development. Concepts that are covered include congenital breast disorders, abnormal timing of breast development, breast asymmetry, underdeveloped breasts, breast atrophy, tuberous breasts, mammary hyperplasia, fibroadenoma, giant fibroadenoma, cystosarcoma phyllodes, intraductal breast papilloma, adenocarcinoma, mastitis, traumatic breast disorders, benign breast disease, fibrocystic change, mastalgia, gynocomastia, and galactorrhea. A number of figures are provided illustrating breast pathology. Clinicians caring for children and adolescents are encouraged to …

Menstrual Disorders In Adolescent Females, Donald E. Greydanus, Hatim A. Omar, Artemis Tsitsika, Dilip R. Patel

Pediatrics Faculty Publications

Onset of menstruation (i.e., menarche) is a determining event of the adolescent female signifying the progress of puberty, which in the majotity of cases is visibly initiated with thelarche (onset of breast development or breast buds). Menarche usually occurs during the earlier time of the second decade of life and ends with menopause, typically in the 5th decade of life. The adolescent can present with a wide variety of menstrual dilemmas and disorders which will be discussed in this chapter.

No Association Of Obesity And Type 2 Diabetes Mellitus Related Genetic Variants With Colon Cancer, Cheryl L. Thompson, Sarah J. Plummer, Thomas C. Tucker, Graham Casey, Li Li

Markey Cancer Center Faculty Publications

Background: Obesity and type 2 diabetes mellitus (T2D) are known risk factors for colon cancer. Recent reports from a number of genome wide association studies (GWAS) have identified several single nucleotide polymorphisms (SNPs) associated with obesity and T2D. Here we tested the hypothesis that these SNPs may also be associated with risk of colon cancer.

Methods: We genotyped nine SNPs reported in GWAS of obesity and/or T2D, including SNPs in HHEX, KCNJ11, SLC30A8, FTO, CDKN2, CDKAL1, TCF2, and the rs9300039 SNP in an intergenic region, in 561 colon cancer cases and 721 population controls.

Results: None of these SNPs were …

Modulation Of Outer Hair Cell Electromotility By Cochlear Supporting Cells And Gap Junctions, Ning Yu, Hong-Bo Zhao

Surgery Faculty Publications

Outer hair cell (OHC) or prestin-based electromotility is an active cochlear amplifier in the mammalian inner ear that can increase hearing sensitivity and frequency selectivity. In situ, Deiters supporting cells are well-coupled by gap junctions and constrain OHCs standing on the basilar membrane. Here, we report that both electrical and mechanical stimulations in Deiters cells (DCs) can modulate OHC electromotility. There was no direct electrical conductance between the DCs and the OHCs. However, depolarization in DCs reduced OHC electromotility associated nonlinear capacitance (NLC) and distortion products. Increase in the turgor pressure of DCs also shifted OHC NLC to the negative …

Brazilian Adolescents Infected By Hiv: Epidemiologic Characteristics And Adherence To Treatment, Julia K. C. Machado, Maria J. C. Sant'anna, Veronica Coates, Flavia J. Almeida, Eitan N. Berezin, Hatim A. Omar

Pediatrics Faculty Publications

Over the last 3 decades since the first AIDS cases appeared, we have witnessed great progress in therapeutic methodologies that have transformed the evolution of the disease from debilitating and fatal, into chronic and controllable. HIV-infected children are arriving at adolescence and bringing specific challenges, not only to themselves, but also to their families and caregivers. This retrospective study sets forth epidemiological and treatment characteristics of 46 HIV-infected adolescents followed in a specialized university service relating said characteristics to therapy adherence assessed through a combination of three indirect methods. Therapy adherence did not reveal any association with either epidemiologic characteristics …

Ethnic Disparities In Cervical Cancer Survival Among Texas Women, Ann L. Coker, Christopher P. Desimone, Katherine S. Eggleston, Arica L. White, Melanie Williams

CRVAW Faculty Journal Articles

Objective: The aim of this work was to determine whether minority women are more likely to die of cervical cancer. A population-based cohort study was performed using Texas Cancer Registry (TCR) data from 1998 to 2002.

Methods: A total of 5,166 women with cervical cancer were identified during 1998–2002 through the TCR. Measures of socioeconomic status (SES) and urbanization were created using census block group-level data. Multilevel logistic regression was used to calculate the odds of dying from cervical cancer by race, and Cox proportional hazards modeling was used for cervical cancer-specific survival analysis.

Results: After adjusting for age, SES, …

Methods And Animal Model For Analyzing Age-Related Macular Degeneration, Jayakrishna Ambati

Ophthalmology and Visual Science Faculty Patents

Methods for testing candidate drugs for treatment of age-related macular degeneration are provided. Ccl2-deficient, and Ccr2-deficient mice are used to determine the effect of candidate drugs and treatments on development of age-related macular degeneration. Also provided is a Ccl2-deficient, Ccr2-deficient dual knockout mouse, which is a useful animal model for age-related macular degeneration.

Sexuality And Persons With Down Syndrome. A Study From Brazil, Bruna Marques Bononi, Maria José Carvalho Sant'anna, André Chao Vasconcellos De Oliveira, Tadeu Silveira Renattini, Carla Franchi Pinto, Maria Lúcia Passarelli, Verônica Coates, Hatim A. Omar

Pediatrics Faculty Publications

In recent years, important gains and changes have been observed in the life of teenagers with Down syndrome (DS) with increased inclusion into society. This review will discuss adolescence and sexuality in teenagers with DS from a descriptive study of 50 patients with DS between the ages of 10 and 20 years. The mean age was 13.5 years, 50% females; 86% went to school with 62.2% in school for over six years. Of the patients that attended school, 60% went to special education school and only 10% read and wrote correctly. In an evaluation of autonomy, 66% took showers, 78% …

Vegf-A As An Inhibitor Of Angiogenesis And Methods Of Using Same, Jayakrishna Ambati

Ophthalmology and Visual Science Faculty Patents

The invention relates to methods and compositions for the treatment or prevention of ocular angiogenesis and neovascularization associated with neovascular disease. Administration of vascular endothelial growth factor (VEGF)-A into the eye when macrophage infiltration is reduced inhibits ocular angiogenesis.

Hibernation-Like State Induced By An Opioid Peptide Protects Against Experimental Stroke, Cesar V. Borlongan, Teruo Hayashi, Peter R. Oeltgen, Tsung-Ping Su, Yun Wang

Pathology and Laboratory Medicine Faculty Publications

BACKGROUND: Delta opioid peptide [D-ala2,D-leU5]enkephalin (DADLE) induces hibernation in summer ground squirrels, and enhances preservation and survival of isolated or transplanted lungs and hearts. In the present study, we investigated the protective effect of DADLE in the central nervous system.

RESULTS: Adult Sprague-Dawley rats were pretreated with DADLE (4 mg/kg every 2 h x 4 injections, i.p.) or saline prior to unilateral occlusion of the middle cerebral artery (MCA). Daily behavioral tests revealed that ischemic animals treated with DADLE did not show any significant behavioral dysfunctions compared with saline-treated ischemic animals. Opioid antagonists only transiently inhibited the protective effect of …

Weight Gain Associated With Hormonal Contraception Use In Adolescents Is Not Different From Control, Abdel Salous, Valerie Jones, Maria Melguizo Castro, Linah Al-Alem, Hatim A. Omar

Pediatrics Faculty Publications

The use of hormonal contraception is commonly associated with weight gain. The purpose of this retrospective study was to explore the association between the use of hormonal contraception and weight change in an outpatient adolescent patient population in Lexington, Kentucky. Data were gathered from the charts of 259 adolescent female patients seen in an outpatient adolescent clinic for up to 72 months. At the initial visit, all patients were evaluated for risk-taking behavior and received preventive counseling. Patients were categorized as either contraception users or non-users (control group). Contraception users were subdivided into Depot Medroxyprogesterone Acetate (DMPA) user group or …

It Is More Than Just A Reproductive Healthcare Visit: Experiences From An Adolescent Medicine Clinic, Marlene B. Huff, Kimberly K. Mcclanahan, Heather A. Brown, Hatim A. Omar

Pediatrics Faculty Publications

The gynecologist may be the only physician that an adolescent depends on for primary and reproductive healthcare services. Because adolescent females often make personal healthcare decisions without the benefit of supportive parents/caregivers, it is imperative that the gynecologist understands the developmental issues encountered during this phase of life. The objective of this study is to identify cited complaints of adolescent females seeking reproductive care and, thus, provide gynecologists with needed information about the medical/mental health issues that may be encountered during routine reproductive care exams. The study group was adolescent females between the ages of 12 and 20 years old. …

Human Cerebral Neuropathology Of Type 2 Diabetes Mellitus, Peter T. Nelson, Charles D. Smith, Erin L. Abner, Frederick A. Schmitt, Stephen W. Scheff, Gregory J. Davis, Jeffrey N. Keller, Gregory A. Jicha, Daron Davis, Wang-Xia Wang, Adria Hartman, Douglas G. Katz, William R. Markesbery

Pathology and Laboratory Medicine Faculty Publications

The cerebral neuropathology of Type 2 diabetes (CNDM2) has not been positively defined. This review includes a description of CNDM2 research from before the ‘Pubmed Era’. Recent neuroimaging studies have focused on cerebrovascular and white matter pathology. These and prior studies about cerebrovascular histopathology in diabetes are reviewed. Evidence is also described for and against the link between CNDM2 and Alzheimer's disease pathogenesis. To study this matter directly, we evaluated data from University of Kentucky Alzheimer's Disease Center (UK ADC) patients recruited while non-demented and followed longitudinally. Of patients who had come to autopsy (N = 234), 139 met …

Addressing Cervical Cancer In Central Appalachia, Baretta R. Casey, Richard A. Crosby, Wallace Bates, Tonya D. Godsey, Mark B. Dignan

Center of Excellence in Rural Health Presentations

Rural women, particularly those residing in Appalachia, have some of the nation’s highest cervical cancer mortality rates. With support from federal and private grants, the University of Kentucky Center for Excellence in Rural Health-Hazard is attempting to address this issue. Eastern Kentucky-based researchers are surveying 18- to 26-year-old female community health center patients and college students about their risk factors for the disease, and then offering them free Gardasil, a vaccine against the virus that causes most cervical cancer cases.

Compositions And Methods For Detecting And Treating Atherosclerosis, Nancy R. Webb, Frederick C. De Beer

Internal Medicine Faculty Patents

Methods for detecting atherosclerotic plaque and quantifying the amount of Group V sPLA₂ in plasma are disclosed. These methods can be used to assess the risk of cardiovascular pathology in a patient.

Impact Of Poor Quality Of Life On Adolescents In Rural Kentucky: A Brief Report, Hatim A. Omar, Søren Ventegodt, Joav Merrick

Pediatrics Faculty Publications

In many rural areas in Kentucky, adolescents lack the basic assets for a good quality of life, such as having caring adults, a safe place and useful activities after school. Methods: Analysis of data from middle and high school students referred to a comprehensive school based health promotion center (SBHPC). Results: From august 2006 to February 2008, a total of 382 students (200 female, 182 male, aged 12-18 years) were referred to the SBHPC for help. Only two (0.5%) students had two parents living with them and 12 (3.1%) had safe, organized after school activities. 19.9% of the total were …

Use Of Clopidogrel In The Reduction Of Myocardial Damage During Percutaneous Coronary Intervention, Arijit Dasgupta, Debabrata Mukherjee

Gill Heart & Vascular Institute Faculty Publications

It is estimated that approximately a quarter of patients undergoing coronary intervention may have significant post-procedural creatinine (CK)/creatinine kinase myocardial band (CK-MB) elevations and approximately half may have post-procedural troponin elevations. Current data suggest that periprocedural infarction is associated with short-, intermediate-, and long-term adverse outcomes, most notably mortality. This review examines the role of clopidogrel in decreasing periprocedural myonecrosis following percutaneous coronary intervention (PCI). Clopidogrel is an important pharmacologic agent used to reduce myocardial infarction post-coronary intervention as assessed directly by the evaluation of cardiac biomarkers and indirectly by the evaluation of short-term ischemic events. The optimal dose of …

Trends In Mental Health Of An Adolescent Medicine Clinic Patient Population, Abdel Salous, Linah Al-Alem, Hatim A. Omar

Pediatrics Faculty Publications

The correlation between exposure to forms of violence and development of mental disorders in victims is well established. The purpose of this paper was to identify mental health problems in an adolescent medicine clinic population in Lexington, KY and to investigate potential correlation of mental disorders with psychosocial factors. Data were gathered from the charts of 169 adolescent clinic patients (age 10-22) seen in the clinic for mental health care and analyzed using Excel. Of the patient population, 68% were urban, whereas 32% were rural. In terms of gender, 40% of the patients were male and 60% were female, 80% …

Discovering The Complexities Of Adolescent Compliance To Treatment, Megan Song, Hatim A. Omar

Pediatrics Faculty Publications

To explore the challenges faced in enhancing adolescent treatment compliance and to understand the roles of key players in this endeavor: the adolescent, parent and healthcare provider. Obtaining compliance from adolescents requires collaboration from the adolescent, caregiver and provider and depends on well-established relationships between each person in the triad: adolescent-provider, adolescent-caregiver, and caregiver-provider. Ensuring and improving adherence to treatment by adolescents is a challenging task but crucial to overall health outcomes. It requires the collaboration of the adolescent, parent and physician to create the optimal treatment plan, specifically tailored to the adolescent. For the clinician, maintaining good communication and …

The Role Of Nf-Κb In Pparα-Mediated Hepatocarcinogenesis, Howard P. Glauert, Karen Calfee-Mason, Yixin Li, Vani Nilakantan, Michelle L. Twaroski, Job Tharappel, Brett T. Spear

Graduate Center for Nutritional Sciences Faculty Publications

In this review, the role of NF-kappaB in the induction of hepatocarcinogenesis by peroxisome proliferators is examined. The administration of peroxisome proliferators for more than a three-day period leads to the activation of NF-kappaB in the livers of rats and mice. On the other hand, peroxisome proliferator activated receptor-alpha (PPARalpha) activation in non-hepatic tissues can lead to the inhibition of NF-kappaB activation. Several lines of evidence support the hypothesis that the activation of NF-kappaB by peroxisome proliferators in the liver is mediated by oxidative stress. The role of NF-kappaB in peroxisome proliferator-induced hepatocarcinogenesis has been examined using NF-kappaB knockout models. …

Hyperandrogenism And Obesity: Ominous Co-Morbidities, Amit M. Deokar, Shawn J. Smith, Amanda J. Goodwin, Hatim A. Omar

Pediatrics Faculty Publications

This review has a two-fold objective. One, it addresses the association of hyperandrogenism and obesity and the complex metabolic derangements that are part of the problem. Clinical management of these co-morbidities is challenging and complex. Second, this article will aid health care providers with the key features to an early diagnosis and intervention to decrease the morbidities in the short as well as long term. Method: Systematic review of articles and information on the topic of interest that were published in the last 15 years. Conclusion: Obesity and hyperandrogenism are integral parts of Metabolic Syndrome/Polycystic Ovarian Syndrome (PCOS)/Hyperandrogenism, Insulin resistance, …

Overweight Children And Adolescents: Impact On Psychological And Social Development, Kimberly K. Mcclanahan, Marlene B. Huff, Hatim A. Omar

Pediatrics Faculty Publications

The global epidemic of childhood and adolescent overweight has become a major public health concern. Not only are these youth more likely to become obese as adults, and thus more prone to obesity-related diseases than their non overweight peers, they are also likely to suffer emotional and social effects associated with overweight. Overweight in youth has been linked to depression, low self-esteem, eating disorders, negative body image, and stigma. It appears to be bi-directional in nature, with overweight sometimes predicting certain psychological effects and psychosocial issues sometimes predicting overweight. Effective assessment and treatment of psychological and mental health issues in …

Violence Against Women Raises Risk Of Cervical Cancer, Ann L. Coker, Claudia Hopenhayn, Christopher P. Desimone, Heather M. Bush, Leslie Crofford

CRVAW Faculty Journal Articles

Background: An emerging literature suggests that violence against women (VAW), particularly sexual violence, may increase the risk of acquiring a sexually transmitted infection (STI) and, therefore, may be associated with cervical cancer development. The purpose of this cross-sectional analysis was to determine if women who had experienced violence had higher prevalence rates of invasive cervical cancer.

Methods: Women aged 18–88 who joined the Kentucky Women’s Health Registry (2006–2007) and completed a questionnaire were included in the sample. Multivariate logistic regression analyses were used to adjust odds ratio (OR) for confounders (e.g., age, education, current marital status, lifetime illegal drug use, …

Hpv Vaccine Acceptance Among Latina Mothers By Hpv Status, Maureen Sanderson, Ann L. Coker, Katherine S. Eggleston, Maria E. Fernandez, Concepcion D. Arrastia, Mary Kay Fadden

CRVAW Faculty Journal Articles

Objective: We investigated whether Latina mothers who were and were not human papillomavirus (HPV) positive differed in their knowledge and acceptance of the HPV vaccine for their children.

Methods: We conducted a cross–sectional survey among women aged 18–64 years between April 2007 and April 2008. Data collectors conducted in-person interviews in community clinics with 215 HPV-negative women and 190 HPV-positive women (with respective response rates of 64% and 84%). Most (83%) HPV-positive women were recruited at dysplasia clinics. Although no HPV-negative women were recruited at dysplasia clinics, they were recruited at other low-income public and private clinics.

Results: After adjustment …

Breast Cancer Screening In Women Exposed In Utero To Diethylstilbestrol, Elizabeth A. Camp, Ann L. Coker, Stanley J. Robboy, Kenneth L. Noller, Karen J. Goodman, Linda T. Titus-Ernstoff, Elizabeth E. Hatch, Arthur L. Herbst, Rebecca Troisi, Raymond H. Kaufman, Ervin Adam

CRVAW Faculty Journal Articles

Purpose: To determine if women exposed in utero to diethylstilbestrol (DES) are more likely than unexposed women to receive recommended or additional breast cancer screening examinations.

Methods: 1994 Diethylstilbestrol-Adenosis (DESAD) cohort data are used to assess the degree of recommended compliance of breast cancer screenings found in 3140 DES-exposed and 826 unexposed women. Participants were enrolled at four sites: Houston, Boston, Rochester, and Los Angeles. Logistic regression modeling was used to analyze mailed questionnaire data that included reported frequency over the preceding 5 years (1990–1994) of breast-self examinations (BSEs), clinical breast examinations (CBEs), and mammograms.

Results: DES-exposed women exceeded annual …

Ethnic Disparities In Cervical Cancer Survival Among Medicare Eligible Women In A Multiethnic Population, Ann L. Coker, Katherine S. Eggleston, Xianglin L. Du, Lois Ramondetta

CRVAW Faculty Journal Articles

To determine predictors of cervical cancer survival by socioeconomic status (SES), urbanization, race/ethnicity, comorbid conditions, and treatment among elderly Medicare-eligible women whose conditions were diagnosed with cervical cancer in a multiethnic population.

Methods: A total of 538 women with cervical cancer aged 65 years or older were identified from 1999 to 2001 from the Texas Cancer Registry and were linked with the state Medicare data and Texas Vital Records to determine survival times. All women had similar access to care through Medicare fee-for-services insurance. A composite measure of SES was created using census tract-level data as was urbanization. Treatment and …

Obesity And Contraception, Donald E. Greydanus, Hatim A. Omar, Artemis Tsitsika

Pediatrics Faculty Publications

All sexually active youth, whether obese or normal weight, should be offered counseling regarding contraception and appropriate contraceptive methods. However, obese youth who are sexually active may be less likely than their normal weight peers to use contraceptives correctly. Methods of contraception for obese adolescents are reviewed in this discussion. Combined oral contraceptives (COCs) and the contraceptive patch have higher failure rates in obese versus normal weight females, though failure rates are lower than noted with barrier contraceptives. The risk for venous thrombosis is higher in obese youth on COCs. Progestin-only pills and the levonorgestrel intrauterine system appear to be …