Medical Specialties Commons^™

Vital Signs, Spring 2006, Boonshoft School Of Medicine

Vital Signs

A twenty-eight page newsletter created by the Boonshoft School of Medicine to document the current affairs of the school. This issue includes a variety of feature articles, faculty profiles, class notes, and more.

Medical Education Digest, Vol. 8 No. 2 (March/April 2006), Nova Southeastern University

Medical Education Digest

No abstract provided.

Foreword: Anti-Angiogenic Therapy: Maximizing Therapeutic Gain, Adam P. Dicker

Department of Radiation Oncology Faculty Papers

No abstract provided.

Oncolog Volume 51, Number 03, March 2006, Dawn Chalaire, Martha Morrison

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

• What Happens Next? Managing the Care of Long-Term Cancer Survivors
• House Call: Relieving Symptoms with Acupuncture
• 50 Years of OncoLog

Digest Of The Philadelphia College Of Osteopathic Medicine (Spring 2006), Philadelphia College Of Osteopathic Medicine

Digest

The Spring 2006 issue of the Digest of the Philadelphia College of Osteopathic Medicine includes the following articles:

• Opening Remarks
• PCOM Updates and Kudos
• The Business of Being a Doctor
• A Weighty Issue: Obesity Study at PCOM Healthcare Center
• Class Notes
• In Memoriam
• My Turn
• Million Dollar Campaign
• PCOM Events

Life Threatening Mediastinal Haematoma: A Complication Of Central Venous Catheterization, Omer Ashraf, Hasanat Sharif

Section of Cardiothoracic Surgery

Central venous catheterization (CVC) has established risks and benefits in its application as a vascular access source, particularly in situations involving temporary cannulation. We present a rare case of life-threatening mediastinal haematoma resulting from CVC usage. Even though aggressive intervention yielded survival, the patient was left with permanent vocal compromise owing to traumatic palsy of the right recurrent laryngeal nerve. One should be careful in selection of venous access and be aware of alternatives routes.

Visual-Spatial & Visual-Motor Function In Pediatric Heart Transplant Recipients, Stephanine Dianne Griffone

Loma Linda University Electronic Theses, Dissertations & Projects

Heart surgery is commonly used to repair congenital heart defects and to perform heart transplantation. The associated hypoxia before or during the surgery may cause damage in the parasaggital area of the cerebral cortex, with resulting difficulty during tasks requiring visual-spatial and visual-motor skills. This study compares the performance of children who received a heart transplant during infancy to that of nonclinical children with no medical complications on three visual-motor measures, three visual-spatial measures, and two computerized visual-spatial tasks - a Block Design Matching task and a Mental Rotation task. The children who received a heart transplant achieved significantly lower …

Prevalence Of Diabetic Retinopathy Among Individuals Screened Positive For Diabetes In Five Community Based Eye Camps In Northern Karachi Pakistan, Jamal-U- Din, Mohammad Babar Qureshi, Akhtar Jamal Khan, Mohammad Daud Khan, Khabir Ahmed

Department of Surgery Docs

Background: Population-based data on the prevalence of diabetic retinopathy in Pakistan are lacking. We determined the prevalence of diabetic retinopathy among individuals screened positive for diabetes in five community-based eye camps in northern Karachi, Pakistan. Methods: In summer 2002, five community-based eye camps were set up in Karachi, Pakistan’s largest city. All individuals aged 30 years or older who visited the camps were requested to participate in the study. Those who agreed were screened for diabetes and those found to have the disease were referred to an eye hospital for diabetic retinopathy screening. Verbal informed consent was obtained from all …

Zonisamide For Migraine Prophylaxis In Refractory Patients, Avi Ashkenazi, Adam Benlifer, Jason Korenblit, Stephen D. Silberstein

Department of Neurology Faculty Papers

Zonisamide, a new antiepileptic drug, has been approved in the US as adjunctive therapy for the treatment of partial seizures in adults.^1,2 Chemically a sulfonamide analogue, zonisamide is thought to have several mechanisms of action, including a rate-dependent blockade of voltage-gated sodium channels and reduction of ion flow through T-type calcium channels.^3-5 It is also a weak carbonic anhydrase inhibitor. Zonisamide has a favorable pharmacokinetic profile that includes high oral bioavailability and a long half life (63 hours), permitting a once- or twice-daily dosing regimen.⁶

There are only a limited number of current migraine preventive medications that …

Follicular Dendritic Cell Sarcoma Of Lymph Node - A Rare Entity, Safoorah Khalid, Nausheen Yaqoob, Shahid Pervez

Department of Pathology and Laboratory Medicine

Follicular dendritic cells (FDC) are non-lymphoid, non-phagocytic accessory cells in the immune system that are essential for antigen presentation and germinal center reaction regulation1. These cells are CD21+, CD35+, CD1a- and S100 protein + and they show desmosomes ultrastructurally.

The most commonly involved sites by FDC tumors are lymph nodes but may arise at a variety of extranodal sites including oral cavity, tonsil, gastrointestinal tract and liver. Most studies represent single case reports or case series.

Our patient presented with tumor in the lymph nodes. Histology revealed tumor cells with abundant eosinophilic cytoplasm, hyperchromatic and pleomorphic nuclei, and prominent nucleoli. …

Pakistan - Country Profile Of Cancer And Cancer Control 1995-2004, Yasmin Bhurgri, Asif Bhurgri, Sania Nishter, Ashfaq Ahmed, Ahmed Usman, Shahid Pervez, Naila Kayani, Rashida Ahmed, Sheema H. Hassan, Ahmed Riaz, Hadi Bhurgri, Imtiaz Bashir

Department of Pathology and Laboratory Medicine

No abstract provided.

The Impact Of Four Common Lumbar Spine Diagnoses Upon Overall Health Status, Michael A. Pahl, Brian Brislin, Scott Boden, Alan S. Hilibrand, Alexander Vaccaro, Brett Hanscom, Todd J. Albert

Department of Orthopaedic Surgery Faculty Papers

Background Context: The SF-36 health survey has been shown to be a valid instrument when used to measure the self-reported physical and mental health of patients. The impact of lumbar spinal disorders can be assessed as the difference between the SF-36 scale scores and age-and-gender specific population norms.

Purpose: To establish the impact upon the self-reported health status of patients with one of four common lumbar spinal diagnoses.

Study Design: A cross-sectional, observational assessment of the health status of spine patients.

Methods: Data from patients presenting to the participating centers of the National Spine Network with low back pain and/or …

Diagnostic Value Of Chest X-Ray And Echocardiography For Cardiac Tamponade In Post Cardiac Surgery Patients, Mohammad Hamid, Mueen Ullah Khan, Allen C. Bashour

Department of Anaesthesia

Objective: To investigate the effectiveness of X-ray and echocardiography (ECHO) as a diagnostic tool for cardiac tamponade in adult cardiac surgery patients.Methods: Thirty five coronary artery bypass and graft surgery patients who developed cardiac tamponade at Cleveland clinic foundation, were included in this study. Their diagnosis was confirmed at the time of re-exploration in the operating room. These patients were followed retrospectively for demographics, X-ray and echocardiography findings. Abnormal and enlarged cardiac silhouette which was different from first postoperative X-ray was used as radiological criteria for tamponade while echocardiographic diagnosis was left to the discretion of cardiologist.Results: Twenty four males …

Standardization Of Anaesthesia Ready Time And Reasons Of Delay In Induction Of Anaesthesia, Saeed U. Zafar, Fauzia Anees Khan, Mueenullah Khan

Department of Anaesthesia

Objective: Anaesthesia-Ready Time (ART) is the time taken by the anaesthetist to provide sufficient anaesthetic depth for start of surgery. Our aim was to set benchmark timings for ART and compare it with our current practice.Methods: Benchmark ART time of 15 minutes was set for American Society of Anesthesiologists (ASA) class I and II patients, 30 minutes for ASA III and IV patients, 20 minutes for spinal and 30 minutes for epidural anaesthesia. An additional 15 minutes was added for each invasive procedure.Results: Three hundred elective cases were audited. Seventy eight percent of the cases were within benchmark timings. The …

Hepatic And Renal Cytochrome P450 Gene Regulation During Citrobacter Rodentium Infection In Wild-Type And Toll-Like Receptor 4 Mutant Mice, Terrilyn A Richardson, Melanie Sherman, Leposava Antonovic, Sean S Kardar, Henry W Strobel, Daniel Kalman, Edward T Morgan

Faculty, Staff and Student Publications

Citrobacter rodentium is the rodent equivalent of human enteropathogenic Escherichia coli infection. This study investigated regulation of hepatic and renal cytochrome P450 (P450) mRNAs, hepatic P450 proteins, cytokines, and acute phase proteins during C. rodentium infection. Female C3H/HeOuJ (HeOu) and C3H/HeJ (HeJ) mice [which lack functional toll-like receptor 4 (TLR4)] were infected with C. rodentium by oral gavage and sacrificed 6 days later. Hepatic CYP4A10 and 4A14 mRNAs were decreased in HeOu mice (

Surgical Decision Making For Unstable Thoracolumbar Spine Injuries: Results Of A Consensus Panel Review By The Spine Trauma Study Group, Alexander R. Vaccaro, Moe R. Lim, R. John Hurlbert, Ronald A. Lehman, James Harrop, D. Charles Fisher, Marcel Dvorak, D. Greg Anderson, Steven C. Zeiller, Joon Y. Lee, Michael G. Fehlings, F. C. Oner, Spine Trauma Study Group

Department of Orthopaedic Surgery Faculty Papers

Objectives: The optimal surgical approach and treatment of unstable thoracolumbar spine injuries are poorly defined owing to a lack of widely accepted level I clinical literature. This lack of evidence based standards has led to varied practice patterns based on individual surgeon preferences. The purpose of this study was to survey the leaders in the field of spine trauma to define the major characteristics of thoracolumbar injuries that influence their surgical decision making. In the absence of good scientific data, expert consensus opinions may provide surgeons with a practical framework to guide therapy and to conduct future research.

Methods: A …

Loss Of Sparc-Mediated Vegfr-1 Suppression After Injury Reveals A Novel Antiangiogenic Activity Of Vegf-A, Miho Nozaki, Eiji Sakurai, Brian J. Raisler, Judit Z. Baffi, Jassir Witta, Yuichiro Ogura, Rolf A. Brekken, E Helene Sage, Balamurali K. Ambati, Jayakrishna Ambati

Ophthalmology and Visual Science Faculty Publications

VEGF-A promotes angiogenesis in many tissues. Here we report that choroidal neovascularization (CNV) incited by injury was increased by excess VEGF-A before injury but was suppressed by VEGF-A after injury. This unorthodox antiangiogenic effect was mediated via VEGFR-1 activation and VEGFR-2 deactivation, the latter via Src homology domain 2-containing (SH2-containing) tyrosine phosphatase-1 (SHP-1). The VEGFR-1-specific ligand placental growth factor-1 (PlGF-1), but not VEGF-E, which selectively binds VEGFR-2, mimicked these responses. Excess VEGF-A increased CNV before injury because VEGFR-1 activation was silenced by secreted protein, acidic and rich in cysteine (SPARC). The transient decline of SPARC after injury revealed a temporal …

Exploring The Mission Of Primary Care, Martin S. Lipsky, Lisa Sharp

Community Health Faculty Publications and Presentations

Objective: This paper’s objective was to examine the mission statements of the sponsoring boards and professional organizations of the primary care specialties. Methods: Mission statements were obtained from the Web sites of the specialty boards and academies for each of the four primary care specialties of pediatrics, obstetrics-gynecology, general internal medicine, and family medicine. The mission statements were analyzed by two investigators, and the components of each mission statement were identified and categorized. Results: There were 29 distinct characteristics defined among all the mission statements. Three of the four primary care specialty organizations listed 10 components, while the American Academy …

Prophylaxis Of Dvt With Enoxaparin In Patients Undergoing Total Knee Replacement, Abid Ullah Khan Niazi, Masood Umer, Mohammad Umar

Section of Orthopaedic Surgery

Objective: To evaluate the efficacy and safety of the low molecular weight heparin as prophylaxis against thromboembolism following total knee replacement surgery.
Methods: Post-operative bilateral lower extremity colour duplex scan was performed on 55 patients subjected to total knew arthroplasty. The scan was performed 7 days after surgery for detection of DVT. All patients were given Enoxaparin 40mg subcutaneous daily for 2 weeks as prophylaxis against DVT.
Results: Two patients were diagnosed as DVT by color duplex scanning and both were distal but only one was asymptomatic. Another patient developed pulmonary embolism and died subsequently. The major and minor wound …

Long Scarf Injuries, Arshad A. Siddiqui, Muhammad Shahzad Shamim, Rashid Jooma, Ather Enam

Section of Neurosurgery

Long scarf (Dopatta) traditionally worn by females in South-East Asia have been described to make the females prone to sustain specific injuries when they ride pillion on the cycle powered rickshaw or motor bike. Two cases of females have been described.

Selective Serotonin Reuptake Inhibitors In Pediatric Depression: Is The Balance Between Benefits And Risks Favorable?, Christopher J. Kratochvil, Benedetto Vitiello, John Walkup, Graham Emslie, Bruce D. Waslick, Elizabeth B. Weller, William J. Burke, John S. March

Journal Articles: Psychiatry

Recent controversies surrounding the use of selective serotonin reuptake inhibitors (SSRIs) have highlighted the need to reassess potential benefits, as well as potential risks of this class of medications in the treatment of pediatric depression. The recent availability of data from meta-analyses of published and unpublished antidepressant trials, epidemiological studies, and the Treatment for Adolescents with Depression Study (TADS) has facilitated a reanalysis of this risk/benefit relationship. Despite reviewing similar data, various regulatory agencies have arrived at rather disparate conclusions regarding the data, resulting in continued controversy. Although all groups appear to agree that careful assessment, education regarding risks, and …

First Report Of Ophthalmomyaisis Externa In Pakistan, Azam Ali, Agha Hassan Feroze, Paul Ferrar, Asad Abbas, Mohammad Asim Beg

Section of Ophthalmology

Two individuals presented to the Aga Khan University Opthalmology service with foreign-body sensation, pain and redness in one of their eyes. Slit-lamp biomicroscopy revealed tiny larvae crawling around the conjunctival sac. They were mechanically removed under topical anaesthesia and preserved for light microscopy and photography. Comprehensive liaison was established with the Australian Centre for International Agriculture Research for identification of these larvae. Their morphology characterized them as members of fruit-fly, Oestridae family. At least one of them was positively identified as first instar larva of Oestrus ovis. This report describes the first instance of such infections in Southern Pakistan, as …

Description Of Twelve Cases Of Nephrogenic Fibrosing Dermopathy And Review Of The Literature, Fabian A. Mendoza, Carol M. Artlett, Nora Sandorfi, Kevin Latinis, Sonoles Piera-Velazquez, Sergio A. Jimenez

Selected Works of Sergio Jiménez, MD, MACR

ABSTRACT

Objectives: To review the clinical and laboratory features of twelve cases of nephrogenic fibrosing dermopathy (NFD) studied at our institution and of 70 previously described cases in the literature.

Methods: Clinical evaluation and laboratory studies of twelve patients with NFD associated with chronic hemodialysis or peritoneal dialysis for end-stage renal disease and a review of 23 previous publications describing 70 patients with this disease.

Results: Eleven patients undergoing chronic hemodialysis and one patient undergoing chronic peritoneal dialysis for end-stage renal failure developed a severe and progressive cutaneous fibrotic process with woody induration of legs, thighs, hands and forearms, and …

The Million Death Study In India: Cam It Help In Monitoring The Millennium Development Goals?, Zulfiqar A. Bhutta

Department of Paediatrics and Child Health

No abstract provided.

Keeping Their Options Open: Acute Versus Persistent Infections, S. Furukawa, S. L. Kuchma, G. A. O'Toole

Dartmouth Scholarship

No abstract provided.

Maternal And Fetal Complications Of Antiphospholipid Syndrome: A Case Report With Long-Term Follow-Up, Tahira Naru, Mohammad Khurshid, Zafar Nazir

Department of Obstetrics & Gynaecology

We report a case of a 26- year old woman having antiphospholipid syndrome in pregnancy with long-term follow up. She presented with recurrent miscarriages, venous thrombosis, avascular necrosis of femoral head, mid-cerebral artery infarction and skin ulcers. Antiphospholipid syndrome is a recognized disorder of pregnancy. Diagnosis requires a high index of suspicion when evaluating women with recurrent pregnancy losses and vascular thrombosis. A low dose aspirin combined with heparin can reduce morbidity and improves the pregnancy outcome.

Cataract Blindness And Visual Outcome Of Cataract Surgery In A Tribal Area In Pakistan, K M. Anjum, Bilal Mazhar Qureshi, M A. Khan, Azam Ali, Khabir Ahmad

Department of Surgery Docs

Abstract

Aim: To estimate the rates of cataract blindness and cataract surgical coverage and to assess the visual outcome of cataract surgery among individuals aged ⩾50 years in Orakzai Agency, Pakistan.

Methods: 1600 individuals aged ⩾50 years were selected using probability proportional to size sampling. The main outcome measure was bilateral cataract blindness which was defined as visual acuity of <3/60 in the better eye with best available correction and with obvious central lens opacities/absence of red reflex in both eyes.

Results: A total of 1549 people were examined; the coverage rate was 96.8%. Of individuals who were examined, 958 (61.8%) were men. The overall prevalence of bilateral cataract blindness was 4.8% (95% CI: 3.8% to 5.9%). Women had a 2.1-fold …

Comparison Of Two Methods (Precipitation Manual And Fully Automated Enzymatic) For The Analysis Of Hdl And Ldl Cholesterol, Jawaid Jabbar, Imran Siddiqui, Qaiser Raza

Department of Pathology and Laboratory Medicine

Objective:
To compare accuracy and throughput time for the measurement of HDL and LDL cholesterol by manual precipitation and fully automated enzymatic methods.
Methods:
Fifty, serum samples collected over a 4 months period (February - May 2004) were analyzed for HDL and LDL cholesterol by two different methods i.e. precipitation manual and automatic enzymatic method in the section of chemical pathology, Department of Pathology and Microbiology, Aga Khan University Hospital, Karachi Pakistan.
Results:
The mean standard deviation for HDL Cholesterol by precipitation method and automated method were 43.12 +/- 8.97mg/dl and 43.86 +/- 10.34mg/dl respectively (p-value = 0.301). The …

Uterine Perivascular Epithelioid Cell Tumour Presenting As A Cervical Mass, Najamul Sahar Azad, Shahid Pervez, Naila Kayani, Aliya Begum Aziz

Department of Pathology and Laboratory Medicine

Perivascular Epithelioid Cell Tumour (PEComa) also known as myelomelanocytic tumours are uncommon, recently described mesenchymal tumours that include angiomyolipoma, clear cell "sugar" tumour of the lung, lymphangioleiomyoma and tumours composed predominantly of epithelioid cell morphology. A predilection for uterus has been described. However up till now only 14 cases of uterine PEComas have been described. All of these were seen in adult females in the peri and post menopausal age group (from 40-75years), and almost all were located in the region of body of uterus. A single case in the upper cervical region has been reported with uterine PEComatoses. We …

Treponema Denticola In Disseminating Endodontic Infections, F. Foschi, Jacques Izard, H. Sasaki, V. Sambri, C. Prati, R. Müller, P. Stashenko

Department of Food Science and Technology: Faculty Publications

Treponema denticola is a consensus periodontal pathogen that has recently been associated with endodontic pathology. In this study, the effect of mono-infection of the dental pulp with T. denticola and with polymicrobial “red-complex” organisms (RC) (Porphyromonas gingivalis, Tannerella forsythia, and T. denticola) in inducing disseminating infections in wild-type (WT) and severe-combined-immunodeficiency (SCID) mice was analyzed. After 21 days, a high incidence (5/10) of orofacial abscesses was observed in SCID mice mono-infected with T. denticola, whereas abscesses were rare in SCID mice infected with the red-complex organisms or in wild-type mice. Splenomegaly was …