Medical Specialties Commons^™

Role Of Surgery In Cerebral Venous Sinus Thrombosis, S. Ather Enam

Department of Surgery Docs

Cerebral venous sinus thrombosis (CVST) usually is taken care of by medical management or neuro-interventional vascular techniques. Some cases of CVST may take a malignant course if the intracranial pressure increases excessively. This increase in pressure is because of oedema in brain tissue due to impediment in venous return and/or intracerebral haemorrhage. Neurosurgical experience has shown remarkable recovery in these moribund patients if appropriate surgical intervention is done within reasonable time. Emergent decompressive craniotomy or other neurosurgical interventions are the only appropriate treatment in these malignant forms of CVST to prevent mortality and severe morbidity.

Cerebral Venous System Anatomy, Muhammad Azeem Uddin, Tanveer Ul Haq, Muhammad Zafar Rafique

Department of Radiology

Cerebral venous system can be divided into a superficial and a deep system. The. superficial system comprises of sagittal sinuses and cortical veins and these drain superficial surfaces of both cerebral hemispheres. The deep system comprises of lateral sinus, straight sinus and sigmoid sinus along with draining deeper cortical veins. Both these systems mostly drain themselves into internal jugular veins. The veins draining the brain do not follow the same course as the arteries that supply it. Generally, venous blood drains to the nearest venous sinus, except in the case of that draining from the deepest structures, which drain to …

Cerebral Venous Thrombosis: Recent Advances And Need For An Asian Registry, Mohammad Wasay, Ayeesha K. Kamal

Department of Medicine

No abstract provided.

Mechanism Of Neuronal Injury In Cerebral Venous Thrombosis, Uzma Usman, Mohammad Wasay

Department of Medicine

The impact of CVT on the brain is wide spectrum, ranging from completely normal parenchyma to brain oedema and/or haemorrhage. Multiple factors relate to neuronal injury in CVT including; dural sinus pressure, increased venous flow velocities, collateralization of venous channels, rate of occlusion, development of cytotoxic and vasogenic oedema, recanalization and accelerated myelination. It is suggested that recanalization of occluded vein, as well as, the presence or absence and the efficiency of intracranial venous collaterals, may have an impact on the extent of brain tissue damage and hence the prognosis of acute CVT.

Complications Associated With Cerebral Venous Thrombosis., Fazeel Mukhtar Siddiqui,, Ayeesha Kamran Kamal

Department of Medicine

Although CVT is associated with a good outcome in the majority of cases, it may be complicated by numerous unique and sometimes rare complications. The purpose of this review is to discuss the acute and chronic complications of CVT in greater detail. Awareness may lead to a more aggressive approach in those in which these complications are anticipated and perhaps avoided.
The complications of CVT may be temporally divided into those unique to the acute stage and those that are associated with the chronic stage of CVT. They are venous infarction and haemorrhage, subarachnoid haemorrhage, a rapid progression and pulmonary …

Heparin In The Treatment Of Cerebral Venous Thrombosis., Saad Shafqat, Ayeesha Kamran Kamal, Mohammad Wasay

Department of Medicine

Cerebral venous thrombosis (CVT) is a potentially life-threatening condition requiring rapid diagnosis and urgent treatment. Heparin anticoagulation is the time-honoured treatment, and is advocated in all cases of CVT, irrespective of etiology or presence of haemorrhage. The supportive evidence is largely observational; data from randomized placebo-controlled trials shows a nonsignificant trend favouring heparin. Current practice is to begin heparin (unfractionated or low-molecular weight) immediately on confirmation of the diagnosis. Newer antithrombotic agents such as ximelagatran may offer advantages over heparin and need to be investigated in the treatment of CVT.

Pathophysiology Of Cerebral Venous Thrombosis--An Overview., Ahmed Itrat, Sana Shoukat, Ayeesha Kamran Kamal

Department of Medicine

Cerebral venous sinus thrombosis is a disorder with a unique pathophysiology which needs to be described. A Medline search of all articles detailing pathophysiology of CVST was done, using keywords: cerebral venous thrombosis and pathophysiology. In addition, major texts were reviewed for additional references. The pathophysiology of CVST depends on two interconnected events, local signs due to venous infarct, e.g., hemiparesis and global signs due to raised ICP from an obstructed venous system--papilloedema and isolated intracranial hypertension being one of them. Pathophysiology of CVST is diverse and makes it easier to understand the diversity of clinical presentations.

Incidence And Epidemiology Of Cerebral Venous Thrombosis., Fazeel Mukhtar Siddiqui, Ayeesha Kamran Kamal

Department of Medicine

Cerebral venous sinus thrombosis is a disorder whose epidemiology has changed over the past few decades. It is no longer regarded as a uniformly fatal disease. CVST is not a rare disorder. It may have a differential geographic distribution with a higher incidence in the Asian world. It is a disease of neonates, younger women and men, often a hypercoagulable state, either acquired (e.g., cancer) or a genetic prothrombotic condition may be present. Outcome is not uniformly dismal and prognostic criteria that detect patients with a poor outcome have become available from prospective studies. There is a paucity of well …

Treatment Of Solid Organ Transplant Recipients With Autologous Epstein Barr Virus-Specific Cytotoxic T Lymphocytes (Ctls), Lan Zhang, Teresita Lopez, Adrian P. Gee, Yu-Feng Lin, Ruben E. Quiros-Tejeira, Petra Reinke, Stephan Schubert, Stephen Gottschalk, Milton J. Finegold, Malcolm K. Brenner, Cliona M. Rooney, Helen E. Heslop

Faculty, Staff and Students Publications

We have investigated the in vivo safety, efficacy, and persistence of autologous Epstein Barr virus (EBV)-specific cytotoxic T lymphocytes (CTLs) for the treatment of solid organ transplant (SOT) recipients at high risk for EBV-associated posttransplantation lymphoproliferative disease (PTLD). EBV-CTLs generated from 35 patients expanded with normal kinetics contained both CD8 and CD4 lymphocytes and produced significant specific killing of autologous EBV-transformed B lymphoblastoid cell lines (LCLs). Twelve SOT recipients at high risk for PTLD, or with active disease, received autologous CTL infusions without toxicity. Real-time polymerase chain reaction (PCR) monitoring of EBV-DNA showed a transient increase in plasma EBV-DNA suggestive …

Carah's Bookshelf

CenterPieces

Occupational Therapy and Dementia Care: The Home Environmental Skills-Building Program for Individuals and Families

by Laura N. Gitlin, PhD and Mary Corcoran, PhD, OTR/L with contributors, published by AOTA Press, the American Occupational Therapy Association, Inc.

ISBN: 1569002037

Based on over 15 years of research, the book presents the Home Environmental Skill-building Program (ESP), an evidence-based intervention to support families and persons with dementia and enhance quality of life. The book provides the theoretical and empirical evidence for the program and describes its protocols in depth.

Physical Function in Older Adults: A Comprehensive Guide to Its Meaning and Measurement

by …

Download The Pdf Of The Full Issue

CenterPieces

For easy printing, the full newsletter is available as a single PDF.

We Are Seeking Participants For The Following Studies

CenterPieces

Title: Experience of Suffering in Old Age

Funding Source: National Institute on Aging

Principal Investigator: Helen K. Black, PhD

Target population: Philadelphia area residents over the age of 80 years old.

This 4-year study examines the experience of suffering and its relation to health, gender, and ethnicity among community dwelling elders aged 80+ using the open-ended interview schedule as its primary tool. This project explores through qualitative research the under-studied construct of suffering in later life and how suffering affects mental, physical and spiritual health.

Participants are interviewed in their homes on three occasions and are paid for their interviews. …

New Award: Carah And Germantown's Center In The Park Awarded $2.2 Million To Study Mental Health Of Older African-American Adults

CenterPieces

Why do older African-Americans tend to report less depression than Whites although they have poorer health and higher rates of chronic illness?

Research from the past 15 years consistently shows health disparities between Whites and minorities in the United States. African-Americans, in particular, are at higher risk than Caucasians for serious health conditions such as stroke, diabetes, cancer, cardiovascular disease and mild cognitive impairment. These chronic conditions typically contribute to depression in elders as a whole. However, the rates of depression for African-Americans are unclear with many studies reporting lower depression than in Whites and others reporting the reverse.

This …

Project Able Featured By Reuters Health Service

CenterPieces

CARAH's randomized trial, Project ABLE (Advancing Better Living for Elders), funded by the National Institute on Aging, and published in the May, 2006 issue of the Journal of the American Geriatric Society, was recently featured by Reuters Health service, the world's leading provider of medical and healthcare news.

This study tested a six-month intervention in which people received four 90-minute visits with an occupational therapist, as well as one 20-minute telephone contact, and one 90-minute physical therapy visit and home modifications provided by the Philadelphia Corporation for Aging. Of 319 men and women 70 years of age and older, half …

Geriatric Education Update

CenterPieces

Despite extensive government cutbacks in funding for aging research and elimination of federal support for geriatric and gerontological training, Jefferson has launched exciting new programs in this area. The year-old Division of Geriatric Medicine, housed within the Dept. of Family and Community Medicine, is under the directorship of Dr. Christine Arenson. In collaboration with CARAH, the Dept. of Occupational Therapy and the Dept. of Nursing, the Division has received funding for a Geriatric Education Center. In addition to Drs. Arenson and Gitlin, participants in this initiative include Dr. Cecelia Borden (Dept. of Nursing), Stephen Kern (Dept. of Occupational Therapy), Nancy …

2005 Dementia Conference Attracts Record Turn Out

CenterPieces

The 6th annual Dementia Management Conference - "New Directions in Providing Care to Patients and their Families" - was held on February 4, 2005 in the Bluemle Auditorium. This successful conference was co-sponsored by the Center for Applied Research on Aging and Health, Thomas Jefferson University Hospital and the Farber Institute for Neurosciences. In attendance were over 115 health care professionals, including physicians, nurses, occupational and physical therapists, social workers, researchers, and family members.

Attendees had the opportunity to learn from and ask questions of a panel of nationally recognized experts in the field of Alzheimer’s disease and related dementias. …

Message From Dean Erdman, James B. Erdman

CenterPieces

Congratulations to the Center and its Director, Dr. Laura Gitlin, on the inaugural issue of CARAH’s newsletter. In our discussions of the development of CARAH, one of the principal goals of the Center is its educational mission as is clear from the other information contained in this publication. Committed as the Center’s research professionals are to improving the health and quality of life of our seniors, it is not enough to conduct research that has the potential to provide significant help and support for patients and their caregivers. Those findings must also be disseminated, must be translated into action, must …

Graduating "Seniors" Of Center In The Park's Harvest Health Program

CenterPieces

"I have been to many health classes but none like this. This class was great and well organized."

"When I wake up I start exercising in bed. The Harvest Health classes have motivated me. I am now exercising 6 days a week."

"I use a motorized wheelchair, and I walk only a few steps. Thanks to the support from my classmates and the instructors, I achieved my action plan and am now walking in the corridor at Center in the Park. The program has motivated me to achieve my goals."

These are the accolades that Project Director Delores Palmer hears …

Message From Dr. Laura Gitlin, Director Of Carah, Laura N. Gitlin

CenterPieces

Welcome to the first issue of CenterPieces, the newsletter of the Center for Applied Research on Aging and Health.

Aging is a highly personal phenomenon. It obviously affects each of us on an individual, familia, and socio-political-economic level. Only a short 50 years ago, aging was viewed as a disease rather than a natural and important stage of human development. Although older people are at increased risk for heart disease, cancer, stroke, falls and cognitive impairments, more so than any other age group, new scientific breakthroughs show that frailty and physical and cognitive decline is a complex phenomenon and not …

Sixty-Four-Slice Multidetector Computed Tomography: The Future Of Ed Cardiac Care, Alexander T. Limkakeng, Ethan Halpern, Kevin M. Takakuwa

Department of Radiology Faculty Papers

Multidetector computed tomography (MDCT) imaging, a technological advance over traditional CT, is a promising possible alternative to cardiac catheterization for evaluating patients with chest pain in the emergency department (ED). In comparison with traditional CT, MDCT offers increased spatial and temporal resolution that allows reliable visualization of the coronary arteries. In addition, a "triple scan," which includes evaluation for pulmonary embolism and thoracic aortic dissection, can be incorporated into a single study. This test will enable emergency physicians to rapidly evaluate patients for life-threatening illnesses and may allow safer and earlier discharges of many patients with chest pain in comparison …

P5l Mutation In Ank Results In An Increase In Extracellular Inorganic Pyrophosphate During Proliferation And Nonmineralizing Hypertrophy In Stably Transduced Atdc5 Cells, Raihana Zaka, David Stokes, Arnold S. Dion, Anna Kusnierz, Fei Han, Charlene J. Williams

Center for Translational Medicine Faculty Papers

Ank is a multipass transmembrane protein that regulates the cellular transport of inorganic pyrophosphate. In the progressive ankylosis (ank) mouse, a premature termination mutation at glutamic acid 440 results in a phenotype characterized by inappropriate deposition of basic calcium phosphate crystals in skeletal tissues. Mutations in the amino terminus of ANKH, the human homolog of Ank, result in familial calcium pyrophosphate dihydrate deposition disease. It has been hypothesized that these mutations result in a gain-of-function with respect to the elaboration of extracellular inorganic pyrophosphate. To explore this issue in a mineralization-competent system, we stably transduced ATDC5 cells with wild-type Ank …

Navigating Adolescence With A Chronic Health Condition: A Perspective On The Psychological Effects Of Hair-An Syndrome On Adolescent Girls, Kimberly K. Mcclanahan, Hatim A. Omar

Pediatrics Faculty Publications

HAIR-AN syndrome is a subphenotype of polycystic ovary syndrome and is characterized by acne, obesity, hirsutism, and acanthosis nigricans. It usually manifests in early adolescence, a time of significant developmental change in females across physical, cognitive, social, and emotional domains. We contend that adolescent development for females is difficult, even in the best of circumstances, and having a chronic health condition, like HAIR-AN syndrome, will likely impact the afflicted individual's development and psychological well-being. While many researchers have discussed the long-term health effects of HAIR-AN and similar disorders, little has been written about the potential psychological sequelae of HAIR-AN on …

Diagnostic Dilemma Of Abdominal Tuberculosis In Non-Hiv Patients: An Ongoing Challenge For Physicians, Rustam Khan, Shahab Abid, Wasim Jafri, Zaigham Abbas, Khalid Hameed, Zubair Ahmad

Section of Gastroenterology

AIM: To assess the clinical features, yield of the diagnostic tests and outcome of abdominal tuberculosis in non-HIV patients.Methods: Adult patients with discharge diagnosis of abdominal tuberculosis (based upon; positive microbiology, histo-pathology, imaging or response to trial of anti TB drugs) during the period 1999 to 2004 were analyzed. Patient's characteristics, laboratory investigations, radiological, endoscopic and surgical findings were evaluated. Abdominal site involved (intestinal, peritoneal, visceral, and nodal) and response to treatment was also noted.Results: There were 209 patients enrolled. One hundred and twenty-three (59%) were females. Symptoms were abdominal pain 194 (93%), fever 134 (64%), night sweats 99 (48%), …

Keeping Alive The "Jazba", Murad M. Khan

Department of Psychiatry

No abstract provided.

Child Health And Survival In The Eastern Mediterranean Region, Zulfiqar A. Bhutta, Asim Belgaumi, Rab Mohammad Abdur, Zein Karrar, Mohamed Khashaba, Nezha Mouane

Department of Paediatrics and Child Health

No abstract provided.

Celecoxib Decreases Prostaglandin E2 Concentrations In Nipple Aspirate Fluid From High Risk Postmenopausal Women And Women With Breast Cancer, Edward R. Sauter, Wenyi Quin, Lisa Schlatter, John E. Hewett, John T. Flynn

Department of Molecular Physiology and Biophysics Faculty Papers

Background

Celecoxib inhibits PGE2 production in cancerous tissue. We previously reported that PGE2 levels in nipple aspirate fluid (NAF) and plasma were not decreased in women at increased breast cancer risk who received celecoxib 200 mg twice daily (bid). The endpoints of the current study were to determine if a short course of celecoxib 400 mg bid would decrease PGE2 levels in women 1) at increased breast cancer risk, and 2) with established breast cancer.

Methods

NAF and plasma samples were collected before, 2 weeks after taking celecoxib 400 mg bid, and two weeks after washout from 26 women who …

Effects Of A Personified Guide On Adherence To An Online Program For Alcohol Abusers., Daniel Z Lieberman

Psychiatry and Behavioral Sciences Faculty Publications

The quality of the therapeutic alliance has robust effects on the outcome of psychotherapy and psychopharmacologic interventions. Automated behavioral health programs that are being developed to increase access to mental health treatment are administered in the absence of direct human participation, thereby precluding the development of a traditional therapeutic relationship. The aim of this study was to develop a personified guide designed to stimulate reactions similar to those experienced in a therapeutic relationship, and evaluate the effect of the guide on adherence to and satisfaction with an online alcohol use evaluation program. After completing a battery of four standard questionnaires …

Treatment Of Spinal Tuberculosis: Role Of Surgical Intervention, Ather Enam, Ahmed Ali Shah

Section of Neurosurgery

The treatment of tuberculosis of the spine (Pott's disease) is essentially conservative and a vast majority of patients can be successfully managed on antituberculo us therapy (ATT) alone.1 Surgery is indicated in a few specific cases where deformity of spine, pain, or neurological compromise is becoming a serious issue. In cases where surgery is indicated the benefits are almost immediate and excellent. Tuberculosis (TB) is one of the leading causes of infectious disease-related deaths in under-developed countries and it has had a resurgence in developed countries as well. The most common site of bony dissemination of this disease is in …

Polymorphism Of Hla-Dr And Hla-Dq In Rheumatoid Arthritis Patients And Clinical Response To Methotrexate--A Hospital-Based Study, Azra Arif I Ali, Tariq Moatter, Jawed Altaf Baig, Ahmed Iqbal, Azmat Hussain, Mohammad Perwaiz Iqbal

Department of Biological & Biomedical Sciences

Objective: To investigate the frequency and distribution of DRB1 and DQB1 alleles in Patients with rheumatoid arthritis (RA) and analyze the relationship between clinical response to methotrexate (MTX) and the HLA-DR and HLA-DQ genotypes in these patients.
Methods: In this case-control study, the HLA-DRB1 and HLA-DQB1 polymorphism in 91 RA patients and 91 healthy controls was done using polymerase chain reaction and sequence specific primers.
Results: There was no statistical difference in frequencies of HLA-DRB1*03, DRB1*04, DRB1*07, DRB1*10, DRB1*11, DRB1*12, DRB1*13, DRB1*14, DRB1*15 and DRB1*16 genotypes between patients and controls. However, DRB1*01 was found to be significantly more common (p=0.015) …

Health And Needs Assessment Of Geriatric Patients: Results Of A Survey At A Teaching Hospital In Karachi, Syed Nabeel Zafar, Hammad Ashraf Ganatra, Sarah Tehseen, Waris Qidwai

Department of Family Medicine

Objective: To study the health and needs of geriatric patients

Methods: A questionnaire based survey of patients visiting the out-patient department of Aga Khan University was carried out. Ethical requirements were met and included administration of informed consent and provision of confidentiality to patients. Convenience sampling was used without any randomization for interviews. Epi-info and SPSS software were used for data management.

Results: Four hundred and two (402) subjects above the age of 65 were surveyed. Most of the subjects were retired (40.5%) married (76.4%) men (69.7%). Ages ranged from 65 to 90 years, the mean being 70.57 years and …