Medical Specialties Commons^™

Boerhaave's Syndrome: A Diagnostic Dilemma In The Emergency Room, Ab Zubairi, I Khalid, Saulat H. Fatimi, J Hussain, N Salahuddin

Department of Medicine

Boerhaave's syndrome is a potential lethal condition which presents not only a diagnostic but also a therapeutic challenge. Errors in diagnosis are usually caused by unawareness of its varied and atypical presentations. All clinicians need to be aware of this lethal disease, its frequent unusual presentations and the importance of early diagnosis.

Maximum Tolerable Dose Of Cyclophosphamide And Azathioprine In Pakistani Patients With Primary Renal Disease, S S. Ali, M A. Rabbani, S S M Moinuddin, Salim S. Virani, F Farooque, A Salam, A Ahmad

Section of Nephrology

Objective: The immunosuppressive regimens, at present, mainly rely on western guidelines that were derived from studies conducted in western populations. No such study exists for South Asian population, which is home to almost two billion people different in both genetics and environment from west. Locally derived thresholds for side effects markedly different from western figures may warrant re-adjustment of current local immunosuppressive regimens that are at present based largely on western guidelines. In order to define optimum dose for Cyclophosphamide (CYC) and Azathioprine (AZA) based immunosuppressive therapy, we conducted this study to find out maximum tolerable doses of azathioprine (AZA) …

Therapeutic Efficacy Of Sulfadoxine-Pyrimethamine And Prevalence Of Resistance Markers In Tanzania Prior To Revision Of Malaria Treatment Policy: Plasmodium Falciparum Dihydrofolate Reductase And Dihydropteroate Synthase Mutations In Monitoring In Vivo Resistance, K. Mugittu, M. Ndejembi, A. Malisa, M. Lemnge, Zul Premji, A. Mwita, W. Nkya, J. Kataraihya, S. Abdulla, H.-P. Beck, H. Mshinda

Pathology, East Africa

Prior to the 2001 malarial treatment policy change in Tanzania, we conducted trials to assess the efficacy of sulfadoxine-pyrimethamine (SP) and the usefulness of molecular markers in monitoring resistance. A total of 383 uncomplicated Plasmodium falciparum malaria patients (between 6 and 59 months old) were treated with SP and their responses were assessed. Mutations in the P. falciparum dihydrofolate reductase (pfdhfr) and dihydropteroate synthase (pfdhps) genes in admission day blood samples were analyzed. Results indicated that 85.6% of the patients showed an adequate clinical response, 9.7% an early treatment failure, and 4.7% a late treatment failure. The quintuple mutant genotype …

Increased Risk For Aplastic Anemia And Myelodysplastic Syndrome In Individuals Lacking Glutathione S-Transferase Genes, Joanne F. Sutton, Michael Stacey, William G. Kearns, Thomas S. Roeg, Neal S. Young, Johnson M. Liu

Bioelectrics Publications

BACKGROUND: Aplastic anemia (AA) and myelodysplastic syndrome (MDS) are marrow failure states that may be associated with chromosomal instability. An absence of the glutathione S-transferase (GST) enzyme may genetically predispose individuals to AA or MDS. PROCEDURE AND RESULTS: To test this hypothesis, we determined the GSTM1 and GSTT1 genotypes in a total of 196 patients using multiplex PCR. The GSTT1 null genotype was found to be overrepresented in Caucasian, Asian, and Hispanic patients with either AA or MDS. We confirmed a difference in the expected frequency of the GSTM1 null genotype in Caucasian MDS patients. The double null GSTM1/GSTT1 …

Oral Contrast-Enhanced Ct Cholangiography--An Initial Experience, I Naseem, J Rees

Department of Radiology

Objective: To describe our experience of CT (Computed tomographic) Cholangiography examination for detection of choledocholithiasis at the Aga Khan University Hospital (AKUH) Karachi Pakistan.Methods: Seven patients underwent helical CT cholangiography for suspected choledocholithiasis. Iopanoic acid (6 grams) was administered orally 8-12 hours before acquisition of a helical CT cholangiogram. Three-dimensional reconstructions and curved multiplanar reformations were generated from a set of axial source images.Results: Our patients had no adverse reactions to iopanoic acid. The degree of biliary opacification was sufficient to perform three-dimensional and curved planar reformations in 5 patients. In two patients, the biliary tree was not opacified. Both …

Ionizing Radiation Induces A Stress Response In Primary Cultures Of Rainbow Trout Skin, Fiona Lyng, M. Lyons-Alcantara, P. Owell, Sharon Ni Shuilleabhain, Colin Seymour, D. Cottell, Carmel Mothersill

Articles

Fish skin is very vulnerable to damage from physical and chemical pollutants because it is in direct contact with the aquatic environment. In this study, the effect of g radiation on primary cultures of rainbow trout skin was investigated. Primary cultures containing two cell types, epidermal cells and goblet mucous cells, were exposed to doses ranging from 0.5–15 Gy 60Co g radiation. Expression of PCNA, c-myc and BCL2 was investigated as well as growth and levels of apoptosis and necrosis. Morphological and functional changes were also studied. The irradiated cultures showed evidence of a dose-dependent increase in necrosis and enhanced …

Mammographic Criteria For Determining The Diagnostic Value Of Microcalcifications In The Detection Of Early Breast Cancer, M Yunus, N Ahmed, I Masroor, J Yaqoob

Department of Radiology

Objective: To evaluate the importance of microcalcifications in the detection of breast carcinoma in conventional mammography.Methods: This prospective study was carried out at Aga Khan University Hospital (AKUH). Mammograms of 68 patients with microcalcifications were evaluated. Craniocaudal and oblique views of both breasts were acquired on routine basis with cone compression and magnified views when required.Results: Among 68 patients with microcalcifications, 61 (89%) had clustered microcalcifications while 7 patients (10.29%) had scattered microcalcifications. Microcalcifications can occur in benign and malignant diseases. While evaluating clustered microcalcifications, few criteria have been established to determine malignant clustered microcalcifications, these include specific and nonspecific …

Oncolog, Volume 49, Number 01, January 2004, David Galloway, Katie Prout Matias, Karin M.E.H. Gwyn Md, Richard L. Theriault Do

OncoLog MD Anderson's Report to Physicians (All issues) Archives

• Pregnancy and Cancer Treatment Often Are Not Mutually Exclusive
• Studies of the Viral Origins of Some Cancers Lead to New Prevention, Treatment Strategies
• House Call: Cancer and Your Weight
• DiaLog: Treating Breast Cancer during Pregnancy, by Karin M.E.H. Gwyn, MD, Assistant Professor, and Richard L. Theriault, DO, Professor, Department of Breast Medical Oncology

Healing Wounds, Instilling Hope: The Tanzanian Partnership Against Obstetric Fistula, Thoraya Ahmed Obaid, Erica Chong

Poverty, Gender, and Youth

This edition of Quality/Calidad/Qualité describes a partnership formed to combat obstetric fistula in Tanzania. The Bugando Medical Center, the Women’s Dignity Project, the Tanzania Midwives Association, and the government cooperated on an extensive program for surgical repair, prevention, and policy research and activities. Lessons learned: 1) Fistula programs need to address social as well as medical issues. 2) Most repairs are successful, making an enormous difference in women’s lives. 3) Relatively little funding is necessary to start up a fistula program. 4) Fistula programs are vehicles for broader conversations about gender and poverty.

Guérir Les Blessures, Faire Naître L’Espoir: Le Partenariat Tanzanien Contre La Fistule Obstétricale, Thoraya Ahmed Obaid, Erica Chong

Poverty, Gender, and Youth

This edition of Quality/Calidad/Qualité describes a partnership formed to combat obstetric fistula in Tanzania. The Bugando Medical Center, the Women’s Dignity Project, the Tanzania Midwives Association, and the government cooperated on an extensive program for surgical repair, prevention, and policy research and activities. Lessons learned: 1) Fistula programs need to address social as well as medical issues. 2) Most repairs are successful, making an enormous difference in women’s lives. 3) Relatively little funding is necessary to start up a fistula program. 4) Fistula programs are vehicles for broader conversations about gender and poverty.

Digest Of The Philadelphia College Of Osteopathic Medicine (Winter 2004), Philadelphia College Of Osteopathic Medicine

Digest

The Winter 2004 issue of the Digest of the Philadelphia College of Osteopathic Medicine includes the following articles:

• Opening Remarks
• PCOM Updates
• 5 Point Plan
• In Memoriam Albert F. D’Alonzo, DO ’56
• Stem Cell Research
• The O. J. Snyder Memorial Medal Recipient
• Mason W. Pressly Memorial Medal Recipient
• The Closing of Parkview Hospital
• Cover Story: It’s our Move: Creating Training Opportunities in a Shrinking Health Care Delivery System
• Class Notes
• In Memoriam
• My Turn
• PCOM Alumni Weekend 2004
• PCOM Events

Physician Assistant Class Of 2004, Philadelphia College Of Osteopathic Medicine

All Yearbooks

Includes Accomplishments, National Physician Assistant Day, Physician Assistant Olympics, Challenge Bowl, Classroom candids, Retreat at Camp Ockanickon,

Role Of Estrogens In The Secondary Hormonal Manipulation Of Hormone Refractory Prostate Cancer, Khurram M. Siddiqui, Farhat Abbas, Syed Raziuddin Biyabani, Muhammad Hammad Ather, Jamsheer J. Talati

Section of Urology

Objective: To evaluate the role of Estrogens (Honvan) in the secondary hormonal manipulation of patients with hormone refractory prostate cancer (HRCP). Methods: Twelve patients diagnosed as hormone refractory prostate cancer received intravenous estrogens for six days (Fosfestrol, a synthetic phosphorylated estrogen derivative), followed by a maintenance oral dose of 120 mg thrice daily as second line hormonal treatment. During the treatment they were given deep venous thrombosis prophylaxis. Their stage at initial presentation, primary treatment, mode of androgen ablation, prostate specific antigen (PSA) level, duration of remission prior of HRPC status, PSA doubling time before and after estrogen treatment were …

Back To The Future: The Future Of Long-Term Care In Massachusetts, Deborah H. Thomson, John J. Ford

Gerontology Institute Publications

The state of Massachusetts, like the rest of the United States, is facing an approaching crisis in long-term care. Over the next few decades the number of Massachusetts residents age 65 and older will soar. As these numbers increase, so will the need for long-term care.

Massachusetts is ill prepared to provide the services that will be needed. Our current system of health care benefits leaves many elders with gaps in coverage. Those individuals who need long-term services often impoverish themselves and their spouses before the state pays for their care. Others languish on waiting lists to receive services. Our …

Human Chorionic Gonadotropin Administration Is Associated With High Pregnancy Rates During Ovarian Stimulation And Timed Intercourse Or Intrauterine Insemination, Mohamed F. Mitwally, Sonya Abdel-Razeq, Robert F. Casper

Wayne State University Associated BioMed Central Scholarship

Abstract

Background

There are different factors that influence treatment outcome after ovarian stimulation and timed-intercourse or intrauterine insemination (IUI). After patient age, it has been suggested that timing of insemination in relation to ovulation is probably the most important variable affecting the success of treatment. The objective of this study is to study the value of human chorionic gonadotropin (hCG) administration and occurrence of luteinizing hormone (LH) surge in timing insemination on the treatment outcome after follicular monitoring with timed-intercourse or intrauterine insemination, with or without ovarian stimulation.

Methods

Retrospective analysis of 2000 consecutive completed treatment cycles (637 timed-intercourse and …

Low Dose Intravenous Minocycline Is Neuroprotective After Middle Cerebral Artery Occlusion-Reperfusion In Rats, Lin Xu, Susan C. Fagan, Jennifer L. Waller, David Edwards, Cesar V. Borlongan, Jianqing Zheng, William D. Hill, Giora Feuerstein, David C. Hess

Wayne State University Associated BioMed Central Scholarship

Abstract

Background

Minocycline, a semi-synthetic tetracycline antibiotic, is an effective neuroprotective agent in animal models of cerebral ischemia when given in high doses intraperitoneally. The aim of this study was to determine if minocycline was effective at reducing infarct size in a Temporary Middle Cerebral Artery Occlusion model (TMCAO) when given at lower intravenous (IV) doses that correspond to human clinical exposure regimens.

Methods

Rats underwent 90 minutes of TMCAO. Minocycline or saline placebo was administered IV starting at 4, 5, or 6 hours post TMCAO. Infarct volume and neurofunctional tests were carried out at 24 hr after TMCAO using …

Effect Of Four-Day Psyllium Supplementation On Bowel Preparation For Colonoscopy:A Prospective Double Blind Randomized Trial [Isrctn76623768], Walter A. Salwen, Marc D. Basson

Wayne State University Associated BioMed Central Scholarship

Abstract

Background

Patients with new onset constipation or presumed hemorrhoid bleeding frequently require the use of both fiber supplements and diagnostic colonoscopy. We sought to determine whether preliminary fiber supplementation would alter the tolerability or efficacy of a standard bowel preparation for colonoscopy

Methods

A prospective, double blind, randomized trial was designed to compare a short course of a psyllium-based supplement versus placebo prior to a colon lavage. Patients were given an unlabeled canister of powder, and instructed to take 1 tablespoon with 8 oz of water bid for 4 days before colonoscopy. A 4-liter polyethylene based glycol lavage was …

Characterization Of Insulin-Like Growth Factor Binding Protein-2 Secretion In Mouse Mesangial Cells, Marianne Ellen Albert

MUSC Theses and Dissertations

Dysregulation of the insulin-like growth factor (IGF) system plays a key role in the hyperproliferative state seen in diabetic complications. Enhanced IGF-I activity plays a causal role in diabetic glomerulosclerosis (DG) by stimulating mesangial cell proliferation, secretion and hypertrophy. Other alterations of the IGF system may include increased IGF-I receptor (IGF-IR) and increased IGF binding protein (IGFBP) expression. The IGFBP family consists of six soluble binding proteins, IGFBP 1-6, which have higher affinities for the IGFs than the IGF-IR, resulting in blocking IGF access to the IGF-IR. Since the IGFBPs primarily function to inhibit IGF action, we hypothesize that overexpression …

Tissue Kallikrein In Cardiac Remodeling And Renal Damage In Genetic And Salt-Induced Hypertension Rat Models, Grant Anderson Bledsoe

MUSC Theses and Dissertations

Abnormalities of the tissue kallikrein-kinin system have been identified in the pathogenesis of hypertension and cardiac and renal diseases. The purpose of this study was to investigate the effect of exogenous tissue kallikrein gene delivery on heart and kidney injury in pressure overload and volume overload hypertension using spontaneously hypertensive rats (SHR) and Dahl salt-sensitive (DSS) rats. In order to examine the role of kallikrein in cardiac protection, adenovirus encoding the human tissue kallikrein gene was injected intravenously into SHR. Expression of recombinant human tissue kallikrein was identified in rat serum by ELISA and heart and kidney tissue by RT-PCR/Southern …

Is An Excretory Urogram Mandatory In Patients With Small To Medium-Sized Renal And Ureteric Stones Treated By Extra Corporeal Shock Wave Lithotripsy?, Hammad Ather, Nuzhat Faruqui, Sobia Akhtar, M Nasir Sulaiman

Section of Urology

Background: An intravenous urogram (IVU) has traditionally been considered mandatory before treating renal and ureteric stones by extracorporeal shock wave lithotripsy (ESWL). This study was designed to see whether there is a difference in complications and the need for ancillary procedures in patients managed by ESWL for renal and ureteric calculi, according to preoperative imaging technique.
Methods: This retrospective study compared 133 patients undergoing ESWL from January 2001 to July 2002. Patients were divided into three groups according to the preoperative imaging technique used: i) IVU; ii) non-contrast enhanced helical computed tomography (UHCT); and iii) ultrasound (US) + X-ray …

Albumin Enhanced Morphometric Image Analysis In Cll., Matthew A. Lunning, Vincent E. Zenger, Ricardo Dreyfuss, Maryalice Stetler-Stevenson, Margaret E. Rick, Therese A. White, Wyndham H. Wilson, Gerald E. Marti

Journal Articles: Oncology and Hematology

BACKGROUND: The heterogeneity of lymphocytes from patients with chronic lymphocytic leukemia (CLL) and blood film artifacts make morphologic subclassification of this disease difficult.

METHODS: We reviewed paired blood films prepared from ethylene-diamine-tetraacetic acid (ETDA) samples with and without bovine serum albumin (BSA) from 82 CLL patients. Group 1 adhered to NCCLS specifications for the preparations of EDTA blood films. Group 2 consisted of blood films containing EDTA and a 1:12 dilution of 22% BSA. Eight patients were selected for digital photomicroscopy and statistical analysis. Approximately 100 lymphocytes from each slide were digitally captured.

RESULTS: The mean cell area +/- standard …

Pre-Treatment Measures Of Impulsivity, Aggression And Sensation Seeking Are Associated With Treatment Outcome For African-American Cocaine-Dependent Patients., Ashwin A. Patkar, Heather W. Murray, Paolo Mannelli, Edward Gottheil, Stephen P. Weinstein, Michael J. Vergare

Department of Psychiatry and Human Behavior Faculty Papers

We investigated whether measures of impulsivity, aggression and sensation seeking differed between cocaine-dependent subjects and controls, and whether these measures were related to treatment-outcome for cocaine patients. Pre-treatment assessments of impulsivity (Barratt Impulsivity Scale [BIS]), aggression (Buss-Durkee Hostility Inventory [BDHI]) and sensation seeking (Zuckerman Sensation Seeking Scale [SSS]) were obtained for 141 African-American cocaine-dependent patients entering a 12-week, intensive outpatient treatment program and 60 controls. The outcome measures were number of negative urine drug screens, days in treatment, dropout rates and number of treatment sessions. Cocaine patients reported significantly higher scores on the SSS, the BIS and the BDHI than …

Effects Of 8 Weeks Of Flexibility And Resistance Training In Older Adults With Type 2 Diabetes, Matthew T. Herriot, Sheri R. Colberg, Henri K. Parson, Tanja Nunnold, Aaron I. Vinik

Human Movement Studies & Special Education Faculty Publications

(First paragraph) Flexibility is often downplayed as unimportant to fitness. However, flexibility training is imperative to maintain full range of motion (ROM) of joints, particularly in individuals with type 2 diabetes, who may experience limited joint mobility due to glycation of joint structures (1). Maladies such as “frozen shoulder” are common complaints in type 2 diabetes (2).

Testing The Effectiveness Of Integrating Community-Based Approaches For Encouraging Abandonment Of Female Genital Cutting Into Care's Reproductive Health Programs In Ethiopia And Kenya, Jane Chege, Ian Askew, Susan Igras, Jacinta Muteshi-Strachan

Reproductive Health

CARE International, with technical support from the Frontiers in Reproductive Health Program completed a study in Ethiopia and Kenya designed to test the effectiveness of education activities using behavior change communication (BCC) approaches and advocacy activities by religious and other key leaders to abandon female genital cutting (FGC). In Ethiopia, the increased knowledge of harmful FGC effects and human rights issues translated to a positive attitude in support of FGC abandonment and an intention not to cut their daughters in the future. In Kenya, the analysis indicated mixed results in attitude and intended behavior change.

Experience From A Community-Based Education Program In Burkina Faso: The Tostan Program, Djingri Ouoba, Zakari Congo, Nafissatou J. Diop, Molly Melching, Baya Banza, Georges Guiella, Inge Baumgarten

Reproductive Health

This study describes a project that tested the feasibility and effectiveness of replicating the village empowerment program (VEP) developed by the Senegalese NGO, TOSTAN, in Burkina Faso. Although originally developed for empowering women, the program implemented in Burkina Faso also involved men because of their key role in such decisions. Frontiers in Reproductive Health, with funding from USAID and the GTZ Supra Regional Project for the Elimination of FGC, supported the adaptation, implementation, and evaluation of the VEP model in 23 villages in the province of Bazega/Zoundwéogo. In the existing social climate among the Burkinabé, where there is widespread awareness …

Medicalization Of Female Genital Cutting Among The Abagusii In Nyanza Province, Kenya, Carolyne Njue, Ian Askew

Reproductive Health

This study sought to understand the role that health providers play in the medicalization of female genital cutting (FGC) among the Abagusii community in western Kenya, among whom the practice continues to be almost universal. Interviews with service providers and their clients revealed an overwhelming belief that FGC fulfills a traditional cultural obligation among the Abagusii, and that it limits a woman’s sexual desire and confers respect on girls. New approaches are needed within this community to present FGC as violating human rights and national laws, as well as threatening girls’ and women’s health. The study recommends measures such as …

Encuestas De Voluntad De Pago Para Fijar Precios De Productos Y Servicios De Salud Reproductiva: Manual De Usuarios, Karen G. Fleischman Foreit, James R. Foreit

Reproductive Health

Social programs need to balance volume (coverage) and income (sustainability). The law of supply and demand states that we can not obtain coverage and support at the same time, because when prices rise, demand decreases. This manual presents willingness-to-pay (WTP) surveys that allow program managers to simulate changes in demand related to price, without actually changing prices. The Population Council, with The Futures Group International, developed these surveys that can be used for existing and new products and services, collect responses from clients with no formal education with sensitivity to their individual characteristics, and provide conservative estimates that accurately predict …

Female Circumcision In Indonesia. Extent, Implications And Possible Interventions To Uphold Women's Health Rights, Meiwita P. Budiharsana, Lila Amaliah, Budi Utomo

Reproductive Health

In Indonesia, the practice of female circumcision (FC) has long existed, but information concerning where and how it is carried out has been limited. The specific aims of the study conducted by the Population Council Jakarta were to provide research-based information on FC customary practices and their socio-cultural determinants, and if possible, to assess any long-term physical and psychological consequences. Study findings indicate that in general Muslim communities support the continuation of FC practice, because they perceive it as both a societal custom and a religious duty. The report strongly recommends that key donor agencies pressure the Ministry of Health …

Social Integration Of Older Immigrants In 21st Century America, Janet Wilmoth

Center for Policy Research

There are various reasons for the burgeoning interest in detailed research into the determinants of social well-being among older immigrants in this country. As a result of shifting federal government policies, the total volume of immigrants has increased significantly, the countries from which they migrate have changed, and more immigrant families have brought their parents into the United States than ever before. Consequently, the older adult population is becoming more diverse due in part to the aging-in-place of younger immigrants and an increasing number of immigrants who are older upon arrival in the United States. These trends create challenges for …

Duration Data From The National Long-Term Care Survey: Foundation For A Dynamic Multiple-Indicator Model Of Adl Dependency, James N. Laditka, Douglas A. Wolf

Center for Policy Research

This report describes preparation of data from the National Long-Term Care Survey (NLTCS) fur use in a dynamic multiple-indicator model of dependency in Activities of Daily Living (ADLs). The data set described makes use of all functional status information available across four NLTCS waves for six ADLs, including information from screening interviews, detailed interviews in the community, and institutional interviews. Importantly, it also captures all available information elicited from respondents about the *duration* of any impairment in these ADLs. The data was prepared as described in this report to enable the calculation of improved estimates of the probabilities that an …