Medical Specialties Commons^™

Non-Traumatic Aortic Emergencies - Experience From A Tertiary Care Centre In, Nadeem Khan Ullah Khan, Junaid A. Razzak, Hasanat Sharif, Saqib Hamid Qazi

Department of Emergency Medicine

Objective: To review the incidence, clinical presentation and outcome of Non traumatic Aortic emergencies in a tertiary care hospital and its evaluation in the Emergency department (ED).
Methods: We conducted a retrospective review of cases presented to the ED at Aga Khan University Hospital during 15 year period (1988 - 2002) who had final diagnosis of Aortic Dissection or Ruptured Aortic Aneurysm. Patients without confirmatory investigations were excluded. We aimed at looking for the incidence, clinical presentation, evaluation in the ED and final outcome.
Results: Of the 12 cases, 7 had aortic dissection while the remaining 5 had ruptured aortic …

Disaster Drill At A University Hospital, Rifat Rehmani

Department of Emergency Medicine

The course of a disaster drill held on 23 October 2001 at Aga Khan University, Karachi is reported. The Hospital Emergency Plan was put to trial on that day. Volunteers were invited to become simulated casualties in the drill. Briefing seminars had been conducted with the key players of the hospital. The scenario was a man-made type disaster. A 747 jumbo jet with 200 passengers had crashed at the end of the runway at Quaid-e-Azam International Airport while taking off in a thunderstorm. Fifty casualties were sent to Emergency Room by ambulance. The Plan was activated and relevant units were …

A Preliminary Study Of 24-Hour Post-Cesarean Patient Controlled Analgesia: Postoperative Pain Reports And Morphine Requests/Utilization Are Greater In Abstaining Smokers Than Non-Smokers, Alan P. Marco, Mark K. Greenwald, Michael S. Higgins

Anesthesiology Faculty Publications

Previous clinical studies have not examined the relationship between nicotine abstinence and opioid use for postoperative analgesia. This may be important because tobacco smokers are routinely required to abstain from smoking just before and during acute post-surgical recovery. This study investigated IV morphine self-administration [patient controlled analgesia (PCA)], subjective pain/drug effects and other measures during post-operative (elective Cesarean section) recovery.

These preliminary data suggest that a history of nicotine use and/or short-term nicotine abstinence can modulate morphine use and analgesia during post-operative recovery. These procedures provide a model for studying patterns and determinants of analgesic self-administration in medical settings.

Pediatric Window Falls: Not Just A Problem For Kids In High Rises, Nora L. Vish, E C. Powell, D Wiltsek, K M. Sheehan

Pediatrics Faculty Publications

Abstract

Background: Window falls are a frequent cause of injury (15/100 000) among Chicago preschool children. In Boston and New York, public health efforts have successfully decreased window fall injuries. Local data are needed to develop appropriate interventions for Chicago.

Objective: To describe the housing characteristics and types of injuries among children who fell from windows treated in a Chicago pediatric trauma center.

Methods: Children treated in a pediatric trauma center for injuries related to window falls between 1995 and 2002 were identified retrospectively. We reviewed family demographics, the circumstances of the fall, and types of injuries. Site visits were …

Tale Of A Woman With Stomatitis And Response Of Health Care System, Waris Qidwai

Department of Family Medicine

A 55 year-old housewife presented to the Family Medicine Clinic due to recurrent oral ulcers for a year. She also had generalized itching, weakness, anorexia and abdominal distension after meals. She had visited several practitioners including family physicians and sub-specialists but a diagnosis was not reached. She was diagnosed to have Lichen Planus and Hepatitis C at family practice clinic. Since a health care system does not properly exist, patients seek treatment from sub-specialists without first consulting a primary care practitioner. This report identifies a failure in health care system and it is also recommended that all patients should be …

Liberty Or Death: Maryland Improves Upon The Model State Emergency Health Powers Act, Franklin H. Alden Jr.

Journal of Health Care Law and Policy

No abstract provided.

Informed Consent And Public Health: Are They Compatible When It Comes To Vaccines?, Wendy E. Parmet

Journal of Health Care Law and Policy

No abstract provided.

Characteristics Of Patients With Guillain Barre Syndrome At A Tertiary Care Centre In Pakistan, 1995-2003, Mohammad Yawar Yakoob, Aisha Rahman, Bushra Jamil, Nadir Ali Syed

Department of Medicine

Objective: To study the clinical presentation, hospital course and outcome of patients admitted with Guillain Barre Syndrome (GBS) to a tertiary care hospital in Karachi, Pakistan.
Methods: The charts of patients conforming to International Classification of Diseases (ICD) code 9.0, for GBS, from September 1995 to January 2003 were reviewed. Clinical data was recorded on a standardized questionnaire, which included patients' age, sex, antecedent events, neurological signs and symptoms and ventilation requirement. The hospital course was analyzed, including nosocomial infections, therapy given and the functional status of patients, using the Rankin scale (0-6). Standard SPSS 11.5 software (Windows) …

Menke's Kinky Hair Syndrome--A Rare Medical Condition., Yaseer Al-Bita, Azam J. Samdani, Tania Azam

Department of Medicine

The case of a 16-month-old boy is described who had typical clinical and radiological features and was proven biochemically to be a case of Menke's disease. Clinical manifestations began in the first few months with hypothermia, hypotonia, seizures and death occurring at the age of 18 months.

Improving Clinical Practice Using Clinical Decision Support Systems: A Systematic Review Of Trials To Identify Features Critical To Success, Kensaku Kawamoto, Caitlin A. Houlihan, E. Andrew Balas, David F. Lobach

School of Medical Diagnostics & Translational Sciences Publications

Objective To identify features of clinical decision support systems critical for improving clinical practice. Design Systematic review of randomised controlled trials.
Data sources Literature searches via Medline, CINAHL, and the Cochrane Controlled Trials Register up to 2003; and searches of reference lists of included studies and relevant reviews.
Study selection Studies had to evaluate the ability of decision support systems to improve clinical practice.
Data extraction Studies were assessed for statistically and clinically significant improvement in clinical practice and for the presence of 15 decision support system features whose importance had been repeatedly suggested in the literature.
Results Seventy studies …

Cardiogenic Shock After Dipyridamole Administration For Myocardial Perfusion Imaging, Fahim H. Jafary, Nageeb Basir, Adnan Amin, Nasiruddin Ahmed

Section of Cardiology

No abstract provided.

Efficacy And Safety Of Artemether-Lumefantrine (Coartem®) Tablets (Six-Dose Regimen) In African Infants And Children With Acute, Uncomplicated Falciparum Malaria, C. Falade, M. Makanga, Zul Premji, C.E. Ortmann, M. Stockmeyer, P. Ibarra De Palacios

Pathology, East Africa

Approximately one million children die from malaria each year. A recently approved artemisinin-based tablet, Coartem (co-artemether), comprising artemether 120 mg plus lumefantrine 20 mg, given in four doses, provides effective antimalarial treatment for children in many sub-Saharan countries. However, this regimen is considered insufficient for non-immune infants and in areas where multidrug-resistant Plasmodium falciparum predominates. This open-label study assessed the efficacy and safety of co-artemether administered to 310 African children weighing 5-25 kg, with acute, uncomplicated falciparum malaria. Six doses of co-artemether were given over 3 days, with follow-up at 7, 14 and 28 days. Treatment rapidly cleared parasitemia and …

Plasma Zinc Concentrations Are Depressed During The Acute Phase Response In Children With Falciparum Malaria, C. Duggan, W.B. Macleod, N.F. Krebs, J.L. Westcott, W.W. Fawzi, Zul Premji, V. Mwanakasale, J.L. Simon, K. Yeboah-Antwi, D.H. Hamer

Pathology, East Africa

Plasma concentrations of some micronutrients are altered in the setting of acute infectious or inflammatory stress. Previous studies have provided conflicting evidence concerning the extent and direction of changes in plasma zinc concentrations during the acute phase response. We carried out an observational cohort study in 689 children enrolled in a randomized trial of zinc supplementation during acute falciparum malaria in order to evaluate the relation between plasma zinc concentration and the acute phase response. Plasma zinc was measured by atomic absorption spectrophotometry. On admission, 70% of all subjects had low plasma zinc (<9.2 μmol/L). Multivariate analysis of predictors of admission plasma zinc showed that admission C-reactive protein (CRP), parasite density, and study site were the most important predictors. Predictors of changes in plasma zinc from admission to 72 h included baseline CRP, change in CRP, treatment group, study site, and baseline zinc concentration. In children with acute malaria infection, baseline plasma zinc concentrations were very low and were inversely correlated with CRP (r = -0.24, P < 0.0001) and the degree of parasitemia (r = -0.19, P < 0.0001). Even when CRP and time were taken into account, zinc supplementation increased plasma zinc concentration from admission to 72 h. When available, plasma zinc concentrations should be interpreted with concurrent measures of the acute phase response such as CRP. In children whose age, diet, and/or nutritional status place them at risk of zinc deficiency, those with low plasma zinc levels should be supplemented with oral zinc and followed for clinical and/or biochemical response. © 2005 American Society for Nutritional Sciences.

Habitat Characterization And Spatial Distribution Of Anopheles Sp. Mosquito Larvae In Dar Es Salaam (Tanzania) During An Extended Dry Period, M.A. Sattler, D. Mtasiwa, M. Kiama, Zul Premji, M. Tanner, G.F. Killeen, C. Lengeler

Pathology, East Africa

Introduction: By 2030, more than 50% of the African population will live in urban areas. Controlling malaria reduces the disease burden and further improves economic development. As a complement to treated nets and prompt access to treatment, measures targeted against the larval stage of Anopheles sp. mosquitoes are a promising strategy for urban areas. However, a precise knowledge of the geographic location and potentially of ecological characteristics of breeding sites is of major importance for such interventions.

Methods: In total 151 km2 of central Dar es Salaam, the biggest city of Tanzania, were systematically searched for open mosquito breeding sites. …

Simulations Of Nanopore Formation And Phosphatidylserine Externalization In Lipid Membranes Subjected To A High-Intensity, Ultrashort Electric Pulse, Q. Hu, R. P. Joshi, K. H. Schoenbach

Bioelectrics Publications

A combined MD simulator and time dependent Laplace solver are used to analyze the electrically driven phosphatidylserine externalization process in cells. Time dependent details of nanopore formation at cell membranes in response to a high-intensity (100kV∕cm), ultrashort (10ns) electric pulse are also probed. Our results show that nanosized pores could typically be formed within about 5ns. These predictions are in very good agreement with recent experimental data. It is also demonstrated that defect formation and PS externalization in membranes should begin on the anode side. Finally, the simulations confirm that PS externalization is a nanopore facilitated event, rather than the …

Deference, Denial, And Exclusion: Men Talk About Contraception And Unintended Pregnancy, Scott D. Johnson, Lindy B. Williams

Rhetoric and Communication Studies Faculty Publications

Individual in-depth interviews were conducted with 20 men, ages 21-48, who have fathered at least one unintended pregnancy. The goal of the interviews was to explore the experiences of these men with unintended pregnancy, their communication with partners and others, contraceptive beliefs and practices, their relationships with their partners, and the outcomes and consequences of the unintended pregnancies. This essay describes results derived from their comments regarding their contraceptive practices and the pregnancy-outcome decisions, with thematic analysis used to identify prominent themes from participant comments. Two strong themes, "deference" and "denial," and one lesser theme, "exclusion," emerged from participant responses. …

Drug Related Critical Incidents, F A. Khan, M Q. Hoda

Department of Anaesthesia

Drug related incidents are a common form of reported medical errors. This paper reviews the critical incidents related to drug errors reported from the main operating theatre suite in a teaching hospital in a developing country from January 1997 to December 2002. Each report was evaluated individually by two reviewers using a structured process. During this period, 44 874 anaesthetics were administered; 768 critical incidents were reported, 165 (21%) of which were related to drug errors. Underdosage, side-effect/drug reaction and syringe swap were the most common. A total of 76% were classified as preventable; 56% due to human error and …

Outcome For Hospitalized Road Trauma Patients At A Tertiary Hospital In Kenya, Hassan Saidi, William Macharia, John Ating'a

Paediatrics and Child Health, East Africa

Background: The developing world continues to experience a disproportionate burden of injury. About one half of injury deaths are due to motor vehicle collisions. Road traffic fatalities per 10,000 vehicles are ten to 20 times higher in Africa compared to Europe.

Patients and Methods: 233 patients were consecutively analyzed. Injury acuity was determined by calculating Injury Severity Scores (ISS) for each patient. Information on the care and treatment outcome was obtained from patient interviews, case notes and discharge summaries. Data analysis was performed using the SPSS version 10.0 statistical software.

Results: Injury accounted for 48.8% of all emergency hospitalizations into …

Clioquinol And Pyrrolidine Dithiocarbamate Complex With Copper To Form Proteasome Inhibitors And Apoptosis Inducers In Human Breast Cancer Cells, Kenyon G. Daniel, Di Chen, Shirley Orlu, Qiuzhi Cui, Fred R. Miller, Q Ping Dou

Wayne State University Associated BioMed Central Scholarship

Abstract

Introduction

A physiological feature of many tumor tissues and cells is the tendency to accumulate high concentrations of copper. While the precise role of copper in tumors is cryptic, copper, but not other trace metals, is required for angiogenesis. We have recently reported that organic copper-containing compounds, including 8-hydroxyquinoline-copper(II) and 5,7-dichloro-8-hydroxyquinoline-copper(II), comprise a novel class of proteasome inhibitors and tumor cell apoptosis inducers. In the current study, we investigate whether clioquinol (CQ), an analog of 8-hydroxyquinoline and an Alzheimer's disease drug, and pyrrolidine dithiocarbamate (PDTC), a known copper-binding compound and antioxidant, can interact with copper to form cancer-specific proteasome …

Medium From Irradiated Cells Induces A Dose Dependent Expression Of Mitochondrial Changes And Bcl2 Responses In Unirradiated Human Keratinocytes, Paula Maguire, Carmel Mothersill, C. Seymour, Fiona Lyng

Articles

Exposure of unirradiated human keratinocytes to irradiated cell conditioned medium (ICCM) is known to cause a cascade of events that leads to reproductive death and apoptosis. This study investigates the effect of ICCM on clonogenic survival, mitochondrial mass and BCL2 expression in unirradiated keratinocytes. Exposure to 5 mGy, 0.5 Gy and 5 Gy ICCM resulted in a significant decrease in clonogenic survival. Human keratinocytes incubated with ICCM containing an antioxidant, N-acetylcysteine, showed no significant decrease in clonogenic survival. HPV-G cells incubated with ICCM containing a caspase 9 inhibitor showed no significant decrease in clonogenic survival when the ICCM dose was …

Oncolog, Volume 50, Number 01, January 2005, Rachel Williams, Dawn Chalaire, Caren E. Blinka, Angelina Esparza, Allen W. Burton Md

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

• New Perspectives on Brain Metastasis
• Out of the Darkroom
• Equity and Health
• House Call: Blood and Platelet Donors Give Life
• DiaLog: Cancer Pain Control in the New Millennium, by Allen W. Burton, MD, Section Chief, Cancer Pain Management Department of Anesthesiology and Pain Medicine

Digest Of The Philadelphia College Of Osteopathic Medicine (Winter 2005), Philadelphia College Of Osteopathic Medicine

Digest

The Winter 2005 issue of the Digest of the Philadelphia College of Osteopathic Medicine includes the following articles:

• Opening Remarks
• On the Cover: Stan
• PCOM Updates and Kudos
• Building Confidence & Competence
• Recognizing Leadership, Loyalty, Service
• Compassionate Callings
• Healthcare Centers: Hubs for Research & Medical Outreach
• Class Notes
• In Memoriam
• My Turn
• PCOM Events

Heart Rate Variability In Non-Apneic Snorers And Controls Before And After Continuous Positive Airway Pressure, Gregory J. Gates, Susan E. Mateika, Jason H. Mateika

Wayne State University Associated BioMed Central Scholarship

Abstract

Background

We hypothesized that sympathetic nervous system activity (SNSA) is increased and parasympathetic nervous system activity (PNSA) is decreased during non-rapid eye movement (NREM) sleep in non-apneic, otherwise healthy, snoring individuals compared to control. Moreover, we hypothesized that these alterations in snoring individuals would be more evident during non-snoring than snoring when compared to control.

Methods

To test these hypotheses, heart rate variability was used to measure PNSA and SNSA in 11 normotensive non-apneic snorers and 12 control subjects before and 7-days after adapting to nasal continuous positive airway pressure (nCPAP).

Results

Our results showed that SNSA was increased …

The Role Of Aromatase Inhibitors In Ameliorating Deleterious Effects Of Ovarian Stimulation On Outcome Of Infertility Treatment, Mohamed Fm Mitwally, Robert F. Casper, Michael P. Diamond

Wayne State University Associated BioMed Central Scholarship

Abstract

Clinical utilization of ovulation stimulation to facilitate the ability of a couple to conceive has not only provided a valuable therapeutic approach, but has also yielded extensive information on the physiology of ovarian follicular recruitment, endometrial receptivity and early embryo competency. One of the consequences of the use of fertility enhancing agents for ovarian stimulation has been the creation of a hyperestrogenic state, which may influence each of these parameters. Use of aromatase inhibitors reduces hyperestrogenism inevitably attained during ovarian stimulation. In addition, the adjunct use of aromatase inhibitors during ovarian stimulation reduces amount of gonadotropins required for optimum …

Gene Expression Profiling Revealed Novel Mechanism Of Action Of Taxotere And Furtulon In Prostate Cancer Cells, Yiwei Li, Maha Hussain, Sarah H. Sarkar, James Eliason, Ran Li, Fazlul H. Sarkar

Wayne State University Associated BioMed Central Scholarship

Abstract

Background

Both Taxotere and Capecitabine have shown anti-cancer activity against various cancers including prostate cancer. In combination, Taxotere plus Capecitabine has demonstrated higher anti-cancer activity in advanced breast cancers. However, the molecular mechanisms of action of Taxotere and Capecitabine have not been fully elucidated in prostate cancer.

Methods

The total RNA from PC3 and LNCaP prostate cells untreated and treated with 2 nM Taxotere, 110 μM Furtulon (active metabolite of Capecitabine), or 1 nM Taxotere plus 50 μM Furtulon for 6, 36, and 72 hours, was subjected to Affymetrix Human Genome U133A Array analysis. Real-time PCR and Western Blot …

Childhood Cancer Among Arab Americans In Southeast Michigan, Hadi Sawaf, Adonis Lorenzana, George Dombi, Merlin Hamre, Kendra Schwartz

FMPHS Faculty Publications

Cancer is relatively rare among children, yet it remains an important public concern. Childhood cancer ranks second as a cause of death after accidents. Population-based data such as Surveillance, Epidemiology, and End Results (SEER) program of the National Cancer Institute create an opportunity to study the effect of ethnic background on the incidence and mortality of cancer. Studies on migrants have been widely used to infer the relative importance of environmental factors versus inherited factors and have proved valuable in developing population-specific interventions. Unfortunately, information on cancer occurrence among Arab Americans is lacking because of incomplete reporting of nationality and …

Ceftriaxone Or Hiv Associated Angio-Oedema? Case Report, William Macharia, C. Mbaabu, L. Wachira, S.O.M. Muhudhia, G. Moniz

Paediatrics and Child Health, East Africa

Angio-oedema may be hereditary or acquired and is characterised by episodes of potentially life threatening localised tissue oedema and swelling resulting from deficiency of compliment pathway C1 esterase inhibitor. Acquired angio-oedema is about ten times less frequent than the hereditary type and has been associated with immune-deficiency disorders, malignancies and exposure to specific medications and food substances. We present a case of seven year old, human immune-deficiency virus positive girl, who developed gross swelling of the tongue and neck while on treatment for pneumococcal meningitis with ceftriaxone. Difficulties in arriving at a definitive diagnosis of angio-oedema in a resource poor …

Female Athletes And Performance-Enhancer Usage, Barbara Kay Fralinger

Seton Hall University Dissertations and Theses (ETDs)

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Primaquine-Induced Hemolytic Anemia: Hemotoxicity Of 5-Hydroxyprimaquine (5-Hpq), Zachary Scott Bowman

MUSC Theses and Dissertations

Primaquine is an important antimalarial agent because of its activity against exoerythrocytic forms of Plasmodium sp. Methemoglobinemia and hemolytic anemia, however, are dose-limiting side effects of primaquine therapy. These hemotoxic effects are believed to be mediated by metabolites, though the identity of the toxic specie(s) and the mechanism underlying hemotoxicity have remained unclear. Previous studies showed that an N-hydroxylated metabolite of primaquine, 6-methoxy-8- hydroxylaminoquinoline, was capable of mediating primaquine-induced hemotoxicity. The present studies were undertaken to investigate the hemolytic mechanism of 5-hydroxyprimaquine (5-HPQ), a phenolic metabolite that has been detected in experimental animals. 5-HPQ was synthesized, isolated by flash chromatography …

Palm Is Expressed In Both Developing And Adult Mouse Lens And Retina., Meryl Castellini, Louise V Wolf, Bharesh K Chauhan, Deni S Galileo, Manfred W Kilimann, Ales Cvekl, Melinda K Duncan

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

BACKGROUND: Paralemmin (Palm) is a prenyl-palmitoyl anchored membrane protein that can drive membrane and process formation in neurons. Earlier studies have shown brain preferred Palm expression, although this protein is a major water insoluble protein in chicken lens fiber cells and the Palm gene may be regulated by Pax6. METHODS: The expression profile of Palm protein in the embryonic, newborn and adult mouse eye as well as dissociated retinal neurons was determined by confocal immunofluorescence. The relative mRNA levels of Palm, Palmdelphin (PalmD) and paralemmin2 (Palm2) in the lens and retina were determined by real time rt-PCR. RESULTS: In the …