Medical Specialties Commons^™

Factor Xiii Deficiency In Children--Clinical Presentation And Outcome, Zehra Fadoo, Ali Faisal Saleem

Department of Paediatrics and Child Health

OBJECTIVE: To determine the demographic features and clinical outcome of children with Factor XIII deficiency.

STUDY DESIGN: Observational case series.

PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi, from January 1996 to December 2006.

METHODOLOGY: Records of all hospitalized pediatric patients with discharge diagnosis of FXIII D, on the basis of factor XIII assay 5 mol/L urea test were retrospectively reviewed and abstracted on a pre-specified proforma. Demographic features, coagulation profile, family history and outcomes were noted.

RESULTS: A total of 10 charts were reviewed. There were 5 boys and 5 girls. Almost all the children (9/10) …

Changing Patterns And Outcome Of Dengue Infection; Report From A Tertiary Care Hospital In Pakistan, Mohammad Wasay, Roomasa Channa, Maliha Jumani, Afia Zafar

Department of Medicine

Objective: To identify predictors of outcome in patients with Dengue Infections at a tertiary care hospital and to analyze that if pattern of Dengue infection is changing in the past two years.

Methods: We reviewed 225 cases of confirmed dengue virus infection. The diagnosis was confirmed by presence of IgM antibodies against Dengue by ELISA in addition to fever according to WHO criteria.

Results: From years 2000-2004, 30(73%) had Dengue Fever (DF), 10(24%) had Dengue Haemorrhagic Fever (DHF) and 1(2.4%) had Dengue shock syndrome (DSS) while after 2005, 107(58%) had DF, 71(39%) had DHF and 6(3%) had DSS. Six …

Labrad : Vol 33, Issue 3 - September 2008, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• Vitamin D Deficiency: Are We Still Ignoring the Evidence?
• Collection and Transport of Urine for Culture
• Understanding and Interpreting Serum Protein Electrophoresis
• Cystic Fibrosis at a Glance
• What you need to know about Dengue Infection
• CT Colonoscopy: Introduction
• CT Enteroclysis: A New Technique to Evaluate Small Bowel
• CSF-DR: An Important Diagnostic Tool
• G6PD Quantification
• Quality Assurance
• Clinical Laboratory Continuing Medical Education (CME) Seminars
• Meeting Reports

Anaesthetic Management Of A Pregnant Patient For Aortic Valve Replacement, Khalid M Siddiqui, Fazal Hameed Khan

Department of Anaesthesia

Cardiac disease can be encountered during pregnancy with the frequency being 1% to 2% of all pregnant women. Because of the high foetal and relative maternal mortality during surgery, medical management is the first line of treatment. Nevertheless, when medical treatment fails, cardiac surgery becomes necessary. We present the anaesthetic management of a case of Aortic valve disease in a pregnant woman undergoing surgery.

Down-Regulation Of Dnmt3b In Pc3 Cells Effects Locus-Specific Dna Methylation, And Represses Cellular Growth And Migration., Ahmed Yaqinuddin, Sohail A. Qureshi, Romena Qazi, Farhat Abbas

Section of Urology

BACKGROUND:

Aberrations in DNA methylation patterns promote changes in gene expression patterns and are invariably associated with neoplasia. DNA methylation is carried out and maintained by several DNA methyltransferases (DNMTs) among which DNMT1 functions as a maintenance methylase while DNMT3a and 3b serve as de novo enzymes. Although DNMT3b has been shown to preferentially target the methylationof DNA sequences residing in pericentric heterochromatin whether it is involved in gene specific methylation remains an open question. To address this issue, we have silenced the expression of DNMT3b in the prostate-derived PC3 cells through RNA interference and subsequently studied the accompanied cellular …

Perinatal Outcomes In Pregnancy With Asthma, Rashid Zaheer Syed, Ali Bin Sarwar Zubairi, Muhammad Ahsan Zafar, Rahat Qureshi

Department of Obstetrics & Gynaecology

Objective: To examine the relationship between asthmatic pregnancies and selected maternal and neonatal outcomes in a representative cohort.

Methods: A retrospective cohort study was conducted at the Aga Khan University Hospital during the year 2004. A random selection was made of 65 asthmatic and 63 non-asthmatic singleton births. The neonatal outcomes studied were birth weight, premature birth and Apgar scores at 1 and 5 minutes. The maternal outcomes studied were number of hospital admissions, and number of documented UTI during the studied pregnancy and past history of abortions and stillbirths.

Resluts: The mean age of asthmatics and nonasthmatics were 28.0 …

Cephalometric Analysis Using Magnetic Resonance Imaging, Wade A. Williams

Loma Linda University Electronic Theses, Dissertations & Projects

Purpose: The purpose of this study was to determine if T1-weighted 3D magnetic resonance images performed at 3.0 Tesla could be used to conduct routine orthodontic cephalometric analysis.

Methods: Three cranial imaging methods were compared using sixteen non-growing subjects (10 male and 6 female) who were not claustrophobic, did not have any metallic restorations on the distal of first molars, had no medical implants and the female subjects were not pregnant. Sagittal cranial images were produced by three methods: (1) a digital lateral cephalometric (LC) radiograph (Orthophos XG Plus, Sirona^TM, Bensheim, Germany), (2) a 12-inch FOV cone beam …

Anti-Inflammatory Effects Of Ppar-Gamma In Surgical Brain Injury (Sbi), Amy Hyong

Loma Linda University Electronic Theses, Dissertations & Projects

Introduction: Brain injury can be caused by neurosurgical procedures themselves, due to direct trauma, retractor stretch, intraoperative hemorrhage and electrocautery damage. As a result of this surgical brain injury (SBI) postoperative complications such as inflammation, brain edema, and cell death can occur in the susceptible brain areas. Cerebral inflammation is a known contributor to the pathophysiology of brain injury. Following brain injury, the release of inflammatory mediators facilitates the development of BBB breakdown, cerebral edema, oxidative stress and neuronal death, resulting in further tissue damage in the brain and poor neurological outcomes. This study evaluates whether the use of a …

Orthodontic Mini-Implant Failure: Assessing The Relationship To Bone Quality Using Qcbct, Joshua Schneider

Loma Linda University Electronic Theses, Dissertations & Projects

The purpose of this study was to evaluate the cortical bone thickness (mm), cortical bone density (HU), and trabecular bone density (HU) of mini-implants sites in both the maxilla and mandible using QCBCT to determine if they had any effect on mini-implant failure rate. Patient characteristics (age, gender, facial type), mini-implant characteristics (date of placement, manufacturer, length, and diameter), and the mini-implant site (region) were also evaluated. One hundred and six mini-implants in 50 consecutive patients with complete patient records, CBCT information, and T1 radiographs were included in the study. Thirty-four of the 106 mini-implants were considered "failures" resulting in …

Predictive Measures Of Cognitive Outcome In Adults Sustaining Brain Injury, Herminia De La Rosa-Trujillo

Loma Linda University Electronic Theses, Dissertations & Projects

To date, there is no consistent and accurate outcome prediction method for patients with traumatic brain injury (TBI). Commonly used clinical measures such as the Glasgow Coma Scale (GCS) and traditional radiological methods of x-rays and computed tomography (CT) scans do not always accurately predict patient functional outcome. These radiological methods are adequate in determining gross structural anatomical disturbances, however, they are unable to detect more diffuse cellular damage believed to be responsible for the functional impairments evidenced in patients sustaining TBI. Magnetic resonance imaging allows for various non-invasive sequencing techniques that have demonstrated to be a potentially valuable method …

The Comparative Radiopacity Between Primary And Permanent Teeth, Robert C. Lee

Loma Linda University Electronic Theses, Dissertations & Projects

Purpose: This in vitro study compared the radiopacity between human primary and permanent enamel and dentin. It also compared the radiopacity between human anterior and posterior teeth.

Methods: Extracted primary and permanent teeth were used in this study. One mm enamel and one mm dentin slices were cut from each extracted tooth. Radiographs were taken of each enamel and dentin specimen 1 mm in thickness along with an aluminum step-wedge using procedures specified in International Standards Organization (ISO) 4049:2000. A densitometer was used to measure the Optical Density (OD) of the radiographs of the specimen and the accompanying aluminum step-wedge. …

Decreased Expression Of Caveolin 1 In Patients With Systemic Sclerosis: Crucial Role In The Pathogenesis Of Tissue Fibrosis., Francesco Del Galdo, Federica Sotgia, Cecilia J. De Almeida, Jean-Francois Jasmin, Megan Musick, Michael P. Lisanti, Sergio A. Jimenez

Department of Medicine Faculty Papers

OBJECTIVE: Recent studies have implicated caveolin 1 in the regulation of transforming growth factor beta (TGFbeta) downstream signaling. Given the crucial role of TGFbeta in the pathogenesis of systemic sclerosis (SSc), we sought to determine whether caveolin 1 is also involved in the pathogenesis of tissue fibrosis in SSc. We analyzed the expression of CAV1 in affected SSc tissues, studied the effects of lack of expression of CAV1 in vitro and in vivo, and analyzed the effects of restoration of caveolin 1 function on the fibrotic phenotype of SSc fibroblasts in vitro.

METHODS: CAV1 expression in tissues was analyzed by …

Complete Resolution Of Gastric Amyloidosis After Autologous Stem Cell Transplantation., Dinu Cherian, Kristin Braun, Neal Flomenberg, Juan P. Palazzo, David Kastenberg

Division of Gastroenterology and Hepatology Faculty Papers

A 48-year-old female with multiple myeloma (MM) and amyloidosis presented with massive upper gastrointestinal (GI) bleeding one week after autologous stem cell transplantation (autologous-SCT). Esophagogastroduodenoscopy (EGD) demonstrated necrotic, purple, pigmented, friable lesions throughout the stomach (Figure 1a), along with a bleeding ulcer in the cardia (Figure 1b, Video 1) which was successfully treated with epinephrine (1:10,000) injections. Biopsies demonstrated nodular amyloid deposition (Figures 2) which was Congo red positive. The patient had no further hematemesis and was discharged home 4 days later. Ten months after autologous-SCT, EGD revealed a normal stomach (Figure 3, Video 2) with …

Spot Urine Protein: Creatinine Ratio Versus 24 Hour Urine Protein At Various Levels Of Gfr Patients Referred To A Tertiary Care Hospital Of Pakistan, Absar Ali, Naila Asif, Sonia Yaqub, Waqar Kashif, Diamond Merchant, Iffat Yazdant

Department of Pathology and Laboratory Medicine

OBJECTIVE: To determine the correlation of "random single voided urine protein: creatinine ratio" to "twenty four hour urine protein" at different levels of glomerular filtration rate (GFR) in Pakistani population.

METHODS: A total of 107 patients were included in this cross section study. Patients were divided into five groups according to the GFR. Spot urine protein: creatinine ratio and 24 hour urine protein was measured by the standard methods. The correlation coefficient ( r) between the two was calculated in each group separately.

RESULTS: The GFR in groups 1 to 5 was > or =90, 60-89, 30-59, 15-29, and /minute/1.73 m2 …

Experimental Optic Neuritis Induced By A Demyelinating Strain Of Mouse Hepatitis Virus., Kenneth S. Shindler, Lawrence C. Kenyon, Mahasweta Dutt, Susan T. Hingley, Jayasri Das Sarma

Department of Neurology Faculty Papers

Optic neuritis (ON), an inflammatory demyelinating optic nerve disease, occurs in multiple sclerosis (MS). Pathological mechanisms and potential treatments for ON have been studied via experimental autoimmune MS models. However, evidence suggests that virus-induced inflammation is a likely etiology triggering MS and ON; experimental virus-induced ON models are therefore required. We demonstrate that MHV-A59, a mouse hepatitis virus (MHV) strain that causes brain and spinal cord inflammation and demyelination, induces ON by promoting mixed inflammatory cell infiltration. In contrast, MHV-2, a nondemyelinating MHV strain, does not induce ON. Results reveal a reproducible virus-induced ON model important for the evaluation of …

Freedom For The Bulgarian Nurses And A Palestinian Doctor., Lawrence Parish

Department of Dermatology and Cutaneous Biology Faculty Papers

On July 24, 2007, the five Bulgarian nurses and the Palestinian, unjustly accused of infecting Libyan children with the AIDS virus, were freed by the Libyan government. They had spent a tumultuous seven years in prison, much of the time on death row, having been accused of injecting the children with tainted blood they had brought with them. This was not only preposterous but also an impossibility as the particular strain of the AIDS virus had been found in Libya, two years prior. [1]

An Approach To The Failed Ankle Arthrodesis, Steven M. Raikin, Venkat Rampuri

Department of Orthopaedic Surgery Faculty Papers

Ankle arthrodesis remains the gold standard of surgical treatment for advanced ankle joint arthritis. Failure can occur as a result of infection, nonunion or malunion, resulting in pain and poor function. This paper offers a systematic approach to preventing, and managing these problems should they occur. Revision arthrodesis performed with a detailed understanding of the appropriate alignment and mechanics of the ankle joint, combined with meticulous attention to understanding and reversing the cause of the failure can result in successful salvage and restoration of function.

Effect Of Diclofenac Suppository On Tramadol Consumption In Posthysterectomy Pain, Aziza Mohammad Hussain, Fauzia A Khan, Lumaan Sheikh

Department of Anaesthesia

OBJECTIVE: To determine reduction in dose of tramadol and side effects in posthysterectomy patients on addition of diclofenac on rectal suppository.

STUDY DESIGN: Randomized double blinded placebo controlled study.

PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi, Pakistan, from August 2004 to January 2006. Methodology: Seventy ASA I and II females, aged 20 and above, who underwent elective abdominal hysterectomy, were included in this study. Patients received identical looking suppository of either 100 mg diclofenac sodium or placebo after induction of anaesthesia and then 12 hourly for 24 hours. General anaesthesia was standardized and tramadol was given …

Role Of Psoas Compartment And Caudal Epidural Steroid Injection In Spinal Stenosis Patients Associated With Low Back Pain And Lower Limb Radiculopathy, Mueen Ullah Khan, S. Zaki Hussain

Department of Anaesthesia

OBJECTIVE: To study the efficacy, safety and patient satisfaction of psoas compartment and caudal epidural steroid injection in patients with spinal stenosis and lumbosaccral radiculopathy.

METHODS: Patients with a diagnosis of spinal stenosis and lumbosaccral radiculopathy having visual analogue score (VAS) less than five were included in the study. Bilateral psoas compartment and caudal epidural injection was given to all patients. In group-A patients haemodynamics and complications were examined immediately after injection. In group-B the same patients were examined through a questionnaire after eight weeks, for pain relief, duration of pain relief, reduction in painkillers and overall improvement in activities …

Contribution Of The Collagen Adhesin Acm To Pathogenesis Of Enterococcus Faecium In Experimental Endocarditis, Sreedhar R Nallapareddy, Kavindra V Singh, Barbara E Murray

Faculty, Staff and Student Publications

Enterococcus faecium is a multidrug-resistant opportunist causing difficult-to-treat nosocomial infections, including endocarditis, but there are no reports experimentally demonstrating E. faecium virulence determinants. Our previous studies showed that some clinical E. faecium isolates produce a cell wall-anchored collagen adhesin, Acm, and that an isogenic acm deletion mutant of the endocarditis-derived strain TX0082 lost collagen adherence. In this study, we show with a rat endocarditis model that TX0082 Deltaacm::cat is highly attenuated versus wild-type TX0082, both in established (72 h) vegetations (P < 0.0001) and for valve colonization 1 and 3 hours after infection (P or=50-fold reduction relative to an Acm producer) were found in three of these five nonadherent isolates, including the sequenced strain TX0016, by quantitative reverse transcription-PCR, indicating that acm transcription is downregulated in vitro in these isolates. However, examination of TX0016 cells obtained directly from infected rat vegetations by flow cytometry showed that Acm was present on 40% of cells grown during infection. Finally, we demonstrated a significant reduction in E. faecium collagen adherence by affinity-purified anti-Acm antibodies from E. faecium endocarditis patient sera, suggesting that Acm may be a potential immunotarget for strategies to control this emerging pathogen.

A Functional Collagen Adhesin Gene, Acm, In Clinical Isolates Of Enterococcus Faecium Correlates With The Recent Success Of This Emerging Nosocomial Pathogen, Sreedhar R Nallapareddy, Kavindra V Singh, Pablo C Okhuysen, Barbara E Murray

Faculty, Staff and Student Publications

Enterococcus faecium recently evolved from a generally avirulent commensal into a multidrug-resistant health care-associated pathogen causing difficult-to-treat infections, but little is known about the factors responsible for this change. We previously showed that some E. faecium strains express a cell wall-anchored collagen adhesin, Acm. Here we analyzed 90 E. faecium isolates (99% acm(+)) and found that the Acm protein was detected predominantly in clinically derived isolates, while the acm gene was present as a transposon-interrupted pseudogene in 12 of 47 isolates of nonclinical origin. A highly significant association between clinical (versus fecal or food) origin and collagen adherence (P

Recognizing A Dysfunctional Swallowing Pattern Using Surface Electromyography (Semg), Michelle F. Couto

Loma Linda University Electronic Theses, Dissertations & Projects

Purpose: The purpose of this study was to determine if a surface electromyography (sEMG) assessment of swallowing is better at identifying Oral Muscular Dysfunction (OMD) than a clinical evaluation (observation & digital palpation) of swallowing. The assessment was conducted on children ages 9 to 17, who were patients at the Orthodontic Department at Loma Linda University, School of Dentistry. Additionally, the prevalence of a “perceived” swallowing dysfunction was assessed.

Methods: This study included 39 randomly selected subjects from the orthodontic patients at Loma Linda University. Each subject’s “dry” swallow was evaluated using two separate methods: (a) sEMG and (b) digital …

Characteristics Of Tia And Its Management In A Tertiary Care Hospital In Pakistan, Ayeesha Kamal, Farhad Khimani, Rushna Raza, Sahar Zafar, Salman Bandeali, Sayeedullah Jan

Section of Neurology

Background:Transient ischemic attack (TIA) is described as a brief episode of neurological dysfunction caused by focal brain ischemia, with clinical symptoms typically lasting less than an hour, and without evidence of acute infarction. Recent studies depict TIA as a particularly unstable condition. Risk of stroke is greater than 10% in the first 90 days after an index TIA. The presentation, prognosis and intervention for TIA have not been reported in South-Asians in a developing country. Method: A retrospective chart review was done for 158 Patients who were admitted with the diagnosis of TIA, as defined by ICD 9 code …

Misoprostol In Addition To Routine Treatment Of Postpartum Hemorrhage: A Hospital-Based Randomized-Controlled Trial In Karachi, Pakistan., N. F. Zuberi, Jill Durocher, Rozina Sikander, Neelofur Baber, Jennifer Blum, Gijs Walraven

Department of Obstetrics & Gynaecology

Background:Postpartum hemorrhage (PPH) remains a major killer of women worldwide. Standard uterotonic treatments used to control postpartum bleeding do not always work and are not always available. Misoprostol's potential as a treatment option for PPH is increasingly known, but its use remains ad hoc and available evidence does not support the safety or efficacy of one particular regimen. This study aimed to determine the adjunct benefit of misoprostol when combined with standard oxytocics for PPH treatment.

Methods: A randomized controlled trial was conducted in four Karachi hospitals from December 2005 - April 2007 to assess the benefit of a …

Staphylococcus Aureus Pbp4 Is Essential For Β-Lactam Resistance In Community-Acquired Methicillin-Resistant Strains, G Memmi, S R. Filipe, M G. Pinho, Z Fu, Ambrose Cheung

Dartmouth Scholarship

Recent cases of infections caused by community-acquired methicillin-resistant Staphylococcus aureus (MRSA) (CA-MRSA) strains in healthy individuals have raised concerns worldwide. CA-MRSA strains differ from hospital-acquired MRSAs by virtue of their genomic background and increased virulence in animal models.

Association Between Antipsychotics And Weight Gain Among Psychiatric Outpatients In Pakistan: A Retrospective Cohort Study., Syed Ahmer, Rashid A. M Khan, Saleem Perwaiz Iqbal

Department of Psychiatry

Background: It has been known for a long time that use of antipsychotics, particularly atypical antipsychotics, is associated with weight gain and increase in risk of metabolic disturbances. In this study we have tried to find out if use of antipsychotics is associated with increase in weight and body mass index (BMI) in the Pakistani population. Methods: We performed a case note review of all Patients who had been prescribed antipsychotic medication at the psychiatry outPatient clinic of a tertiary care university hospital in Pakistan over a 4-year period. Results: A total of 50% of Patients had a BMI in …

Reuters Health: Factor Vii Curbs Bleeding In Non-Hemophiliac Trauma, Surgical Patients

Data and Test Instruments

Use of recombinant activated factor VII (rFVIIa) reduces the need for blood transfusion in patients without hemophilia and may also reduce mortality, according to pooled data from randomized placebo-controlled trials involving more than 3000 participants, Canadian researchers report. "I had found it to be effective in some combat situations in Afghanistan," senior investigator Dr. Vivian C. McAlister told Reuters Health.

Characterizing And Inhibiting Two Pathways Activated In Glioblastoma Multiforme, Andrea Jydstrup, Sheri L. Holmen

Undergraduate Research Opportunities Program (UROP)

Despite major improvements in imaging, radiation, and surgery, the prognosis for patients with Glioblastoma multiforme (GBM) remains clinically challenging. New treatment strategies are badly needed to reduce the mortality and morbidity associated with this disease. The resistance of these tumors to conventional treatments makes GBM patients ideal candidates for molecularly targeted therapies and several agents are currently being developed(1). Because GBM is genetically heterogeneous, combination therapies or the use of multikinase inhibitors are more likely to achieve the greatest therapeutic benefit(2,3). However, genes that can be productively targeted for effective therapies in patients remain to be identified. The overall objective …

Relationship Of Lactobacillus Casei To Prevention Of Antibiotic Associated Diarrhea Due To Clostridium Difficile, Kayal K. Chandramohan

All-Inclusive List of Electronic Theses and Dissertations

The purpose of this research was to study the effectiveness of Lactobacillus casei in preventing the occurrence of antibiotic associated diarrhea related to Clostridium difficile. Twenty-six patients, above the age of sixty years, who were prescribed antibiotic therapy and admitted to the Rehabilitation or Orthopedics Units at Union Hospital and who met the eligibility criteria were recruited for the study. Equal numbers of patients (13 in each group) were assigned to the Control and the Experimental group based on their admission date to the hospital and their willingness to consume a probiotic yogurt type drink. The patients in the experimental …

Hyponatraemia: Etiology, Management And Outcome, Aasima Yawar, Abdul Jabbar, Naeem Ul Haque, Lubna M Zuberi, Najmul Islam, Jaweed Akhtar

Section of Diabetes, Endocrinology and Metabolism

OBJECTIVE: To determine the etiology of hyponatraemia, the treatment instituted and the outcome of treatment in a tertiary care hospital setting.

STUDY DESIGN: Case series.PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi, between January and June 2004.

METHODOLOGY: Case records of 220 patients admitted to the medical service were identified through computerized hospital patients' data. All patients (3) 15 years with a sodium level on admission of (2) 130 mmol/litre were included. The records of those patients were reviewed for relevant demographic, clinical and laboratory data, in addition to the diagnosis, treatment and outcome of hospitalization. The …