Medical Specialties Commons^™

Tumor-Derived Interleukin-10 As A Prognostic Factor In Stage Iii Patients Undergoing Adjuvant Treatment With An Autologous Melanoma Cell Vaccine., Amit Mahipal, Mizue Terai, David Berd, Inna Chervoneva, Kashyap Patel, Michael Mastrangelo, Takami Sato

Department of Medical Oncology Faculty Papers

OBJECTIVES: Interleukin-10 (IL-10) downregulates T-cell-mediated immune responses. We studied the association between IL-10 production by freshly isolated melanoma cell suspensions in vitro and overall survival in patients undergoing adjuvant treatment with a vaccine prepared from the same autologous melanoma cells modified with a hapten, dinitrophenyl (DNP).

METHODS: Forty-four patients with cutaneous melanoma (29 stage III and 15 stage IV) were prospectively evaluated. Tumor cells were extracted from metastatic deposits for production of DNP-modified autologous melanoma cell vaccine. Small aliquots of the melanoma cell suspensions were separated prior to vaccine processing and cultured overnight for IL-10 production. Based on a blind …

Comparison Of Chromogenic Urinary Tract Infection Medium With Cysteine Lactose Electrolyte Deficient Media In A Resource Limited Setting, Saba Qaiser, Muhammad Zeeshan, Kausar Jabeen, Tanwir Ahsan, Afia Zafar

Department of Pathology and Laboratory Medicine

OBJECTIVES: To compare the chromogenic UTI medium (CUM) with cysteine lactose electrolyte deficient medium (CLED) in terms of isolation of uropathogens, turnaround time and cost.

METHODS: A total of 251 urine samples were selected and inoculated on both CLED and CUM, growth was observed after 24 and 48 hours of incubation. Isolates were identified by colony's colour and biochemical tests. Turnaround time for identification and cost was calculated till final identification of microorganisms.

RESULTS: A discrepancy in isolation was observed in seven samples with growth on CUM in 24 hours while in 48 hours on CLED. There was 100% agreement …

Malignant Peripheral Nerve Sheath Tumour Of Maxilla, Naeem Sultan Ali, Montasir Junaid, Kanwal Aftab

Section of Otolaryngology, Head & Neck Surgery

Malignant peripheral nerve sheath tumour (MPNST) is a very rare entity in head and neck with high rate of recurrences and local invasiveness. This tumour is usually found in lower extremities and only 10-12% occur in head and neck region. The diagnosis is considered as the most elusive and difficult among soft tissue sarcomas because of its non specific presentation, both clinically as well as pathologically. This difficulty has now been overcome by immunohistochemistry. We report here a case of MPNST in a 50 years old male with a localized right maxillary growth.

Cerebral Nocardiosis, Rohana Naqi, Humera Ahsan, Muhammad Azeemuddin

Department of Radiology

Localized and multisystem nocardiosis is an opportunistic disease that occurs commonly in immunocompromised patients. Rarely, it is also seen in immunocompetent individuals. The most common disease sites include lung, skin and central nervous system. We report a case of 73 years old man who is a known case of rheumatoid arthritis for more than 15 years and was on Methotrexate and Prednisolone. Now presented with generalized tonic clonic seizures. His Magnetic Resonace Imaging (MRI) scan showed a ring enhancing lesion with mild surrounding oedema in right posterior parietal cortex. Based on the finding, the most probable diagnosis of cerebral abscess …

My Patient Just Had A Transient Ischaemic Attack. Can I Predict His Risk For Stroke? Is Stroke Inevitable Or Preventable?, Maria Khan, Ayeesha Kamran Kamal

Section of Neurology

No abstract provided.

Factors Associated With Serum Brain Natriuretic Peptide Levels After The Fontan Procedure., Andrew M. Atz, Victor Zak, Roger E. Breitbart, Steven D. Colan, Sara K. Pasquali, Daphne T. Hsu, Minmin Lu, Lynn Mahony, Stephen M. Paridon, Michael D. Puchalski, Tal Geva, Brian W. Mccrindle, Pediatric Heart Network Investigators, Girish S. Shirali

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: Although a useful marker of heart failure in adults, the utility of brain natriuretic peptide concentration (BNP) for children after the Fontan procedure is not well studied.

DESIGN: BNP was measured in 510 patients who were 6-18 years old in the Pediatric Heart Network Fontan cross-sectional study at a median of 8.2 years after Fontan. Patients underwent echocardiography, exercise testing, magnetic resonance imaging (MRI) and functional health status questionnaires. Associations of BNP with baseline patient characteristics, medical history and cross-sectional assessment were examined with multivariable linear regression analyses.

RESULTS: The distribution of BNP was highly skewed, median 13.0 pg/mL …

Relationship Between The Quetelet’S Index, Homa-Ir Index And Prostate Size In Patients With Benign Prostatic Hyperplasia At St.Mary’S Hospital In, Timothy Onyuma

Master of Medicine in Anatomic Pathology

Introduction: Benign prostatic hyperplasia is a highly prevalent disease and is considered an inevitable correlate of ageing. Several theories have been advanced in a bid to explain its pathogenesis, the most popular ones relating to sex steroid hormones (1). Currently facets of the metabolic syndrome of which two principal components are insulin resistance and high BMI have been postulated to be related to growth of the prostate (2). Insulin resistance is assessed by the HOMA-IR index. Some studies have demonstrated an association between these indices and the size of the prostate (3). While others have not (4). We set out …

Department Of Radiology-Annual Executive Summary Report-July 1, 2010 To June 30, 2011, Vijay M. Rao, Md

Department of Radiology Administrative Documents and Reports

90 page Department of Radiology Annual Executive Summary Report, July 1, 2010 to June 30, 2011, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States.

Tables of Contents:

Department of Radiology

Chairman, Vice Chairmen 1

Divisions and Directors 1

Committees and Chairmen 1

Radiology Department Faculty Rank 2

Faculty with Secondary Appointments 3

Clinical Divisions 4

Radiology Residents and Fellows 5

Department Organizational Chart 6

Department Administration Chart 7

State of the Department 8

Appendix I: Publications Journal Articles 22

Books and Book Chapters 30

Abstracts 33

Appendix II: Formal Scientific Presentations 44

Appendix III: Honors, Editorial Activities, Service to Regional …

Malignant Lymphoma Subtypes In A Private Hospital In Nairobi: A Retrospective Cross-Sectional Study, Omar A. Sherman

Master of Medicine in Anatomic Pathology

Introduction: Lymphoma diagnosis integrates clinical, morphological, immunophenotypical and molecular genetic features as evident from the World Health Organization (WHO) classification of lymphoid malignancies.(1, 2) Although it is standard practice for histopathology laboratories in developed countries to confirm and further sub classify lymphomas using immunohistochemistry and other molecular techniques, the same is not true for developing countries like Kenya. The reasons that prevent the performance of these tests are the prohibitive costs and inadequate trained personnel. Objectives: The aims of this study were to retrospectively classify lymphomas diagnosed at The Aga Khan University Hospital (AKUHN) Laboratory based on the WHO classification …

The Impact Of A Multimodal Approach To Pre-Emptive Analgesia On Postoperative Pain And Analgesic Requirements For Patients Undergoing Orthopaedic Lower Limb Surgery At The Aga Khan University Hospital, Nairobi: A Single Blind Randomised Controlled Trial, John M. Bugo

Master of Medicine in Anaesthesiology

Study Objective: The aim of this study was to evaluate the postoperative morphine-sparing and pain reducing effects of a preemptive, multimodal, perioperative analgesic regimen incorporating the use of preincisional intrathecal blockade plus parenteral anti-inflammatory agents, in patients undergoing lower limb orthopaedic surgery. Study design: Prospective Single blinded Randomized Controlled Trial. Study setting: The Aga Khan Hospital, Nairobi, Kenya. Methods: 44 ASA physical status 1 and 2 patients undergoing lower limb orthopaedic surgery were randomly allocated into two groups of 22 patients each. Patients in the Intervention group were given a preincisional subarachnoid injection of 15mg hyperbaric Bupivacaine and 25mcg Fentanyl, …

A Randomised Controlled Trial Investigating The Effect Of Adding Fentanyl To Low Dose Bupivacaine In Combined Spinal-Epidural Anaesthesia, Using Epidural Volume Extension Technique In Caesarean Section, Mudola V. Manyano

Master of Medicine in Anaesthesiology

Background: Epidural volume extension (EVE), is a technique whereby a small-dose intrathecal block is enhanced by an epidural injection of physiological saline. This epidural injection exerts a compression effect on the dura, which then leads to a cranial increase in sensory spread of the intrathecal local anaesthetic. The lower dose of local anaesthetic required in the EVE technique has made it possible to avoid the side effects of the conventional dose of local anaesthetic while still having the benefit of adequate anaesthesia. Several studies have been conducted in this area; these studies have either used or omitted fentanyl. The successful …

Prevalence Of Postpartum Depression Using The Edinburgh Postpartum Depression Scale At The Aga Khan University Hospital, Nairobi, Warfa Khadija

Master of Medicine in Obstetrics and Gynecology

Background: Postpartum depression is an illness that affects 10-20% of mothers following delivery; the impact it has on the family, partner and the new born baby is significant. There are insufficient data in Kenya as its rate and severity hence the impact is unknown. Screening could allow earlier treatment of these mothers and prevent the long term effects on the family. Objectives: The primary objective was to identify the prevalence of postpartum depression at the Aga Khan University Hospital and to identify associations between participant’s socio demographics and depression. Methods: Cross sectional study to screen postpartum women six weeks after …

The Use Of Mcv And Mch To Screen For Iron Deficiency In Pregnancy Among Women With Normal Haemoglobin Values, Charles M. Muteshi

Master of Medicine in Obstetrics and Gynecology

Background: Worldwide the commonest cause of anaemia is inadequate nutritional supply manifest as iron deficiency. Iron deficiency affects 25% of the world’s population and up to 50% in the developing world. Most susceptible are women of child bearing age and infants. In pregnancy most iron deficiency is detected when there is already resultant anaemia by measuring the haemoglobin content. It is important to develop a tool that could pick out women who are iron deficient before anaemia ensues. This study aims to determine the predictive ability of red cell mean corpuscular haemoglobin (MCH) and mean corpuscular volume (MCV) in screening …

Hepatitis B Vaccination Rate And Determining Factors Amongst Health Care Workers At Aga Khan University Hospital, Nairobi, Herman Ekea

Master of Medicine in Internal Medicine

Aim: To determine Hepatitis B vaccination rate and determining factors for health care workers (HCWs) at AKUHN. Design: Cross sectional analytical study Study subjects and setting: Aga Khan University Hospital-Nairobi, is a 254 bed tertiary hospital, with 815 HCWs with occupational risk of infection with hepatitis B virus (HBV). The hospital has a HCW vaccination policy and vaccine available to HCWs as part of medical scheme Methodology: Two hundred and sixty six (266) eligible HCWs of all cadres were stratified then randomly recruited after giving informed consent. A questionnaire was then administered to assess knowledge, attitude and practice towards HBV …

Prevalence Of Low Bone Mineral Density Amongst Resident Doctors At The Aga Khan University Hospital, Nairobi, Rose Ndumia

Master of Medicine in Imaging and Diagnostic Radiology

Objective: This was a cross-sectional study carried out amongst resident doctors training at the Aga Khan University Hospital, Nairobi to determine their bone mineral density and investigate for any association between the bone mineral density and the residents’ lifestyle. Methods: 65 randomly selected residents from various departments in the Aga Khan University Hospital, Nairobi, underwent a Dual Energy X-ray Absorptiometry (DXA) scan and filled out questionnaires to assess their physical activity, sunlight exposure and calcium intake. This was carried out between April and June 2011. Results: 65 residents were included in the final analysis. 50 residents (76.9% with a 95% …

The Influence Of Depression On Adherence To Antiretroviral Therapy Among Hiv Infected Patients At Aga Khan University Hospital (Nairobi), Evelyn W. Karanja-Mbugua

Master of Medicine in Internal Medicine

Aim: To determine the influence of depression on adherence to antiretroviral (ARV) therapy among HIV-infected patients. Design: Cross-sectional survey Patients: One hundred and forty HIV-positive patients on treatment with Combination Antiretroviral Therapy selected from the out-patient department of Aga Khan University Hospital took part in the survey. Methodology: Every third patient who was eligible was assessed for adherence to antiretroviral therapy using The Adult AIDS Clinical Trial Group follow up adherence questionnaire followed by screening for depression using the Patient Health Questionnaire 9. Pharmacy data was then retrieved for the same patients and used to assess adherence by the medication …

Stratification Of White Matter Hyperintensities In Young And Middle Age Adults Using Hydrogen Magnetic Resonance (H-Mr) Spectroscopy, M’Mene E. Elvis

Master of Medicine in Imaging and Diagnostic Radiology

Objective: The objective of this study was to stratify white matter hyperintensities on the basis of neuronal integrity in young and middle age adults by comparing the level of N-acetyl aspartate and creatine ratios in white matter hyperintensity lesions and normal appearing white matter using hydrogen magnetic resonance (H-MR) spectroscopy at 1.5 Tesla(T) Methods: Fifty consecutive patients who fulfilled the inclusion criteria aged 18-50yrs who were referred for magnetic resonance imaging(MRI) of the brain at the Radiology department of Aga Khan University Hospital over a six month period between January and June 2011 were included in the study. These patients …

Prevalence Of Nasal Carriage Of Methicillin-Resistant Staphylococcus Aureus In Healthcare Workers At Aga Khan University Hospital, Nairobi, Geoffrey A. Omuse

Master of Medicine in Clinical Pathology

Objective: To establish the prevalence of nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) in healthcare workers (HCW) at Aga Khan University Hospital, Nairobi (AKUHN). Background: Healthcare workers are a major reservoir of MRSA and may play a role in the spread of nosocomial MRSA infections. MRSA can cause significant morbidity and mortality. There is both molecular and epidemiological evidence linking HCW to MRSA outbreaks. Method: A cross sectional study conducted between July and December 2010. Nasal swabs were taken from 246 randomly selected HCW from various departments.MRSA was identified using both phenotypic and genotypic methods. Antibiotic susceptibility testing of all …

Prevalence Of Genital Chlamydia Infection In Urban Women Of Reproductive Age, Ruchika Kohli-Kochhar

Master of Medicine in Clinical Pathology

Background: Chlamydia trachomatis is one of the major causes of sexually transmitted infections throughout the world. It is the primary cause for pelvic inflammatory disease, tubal infertility and ectopic pregnancy in females. Most infections are asymptomatic and remain undetected. The burden of disease in the Kenyan population is not well characterised and few previous studies, done in Kenya, show the prevalence of genital Chlamydia infection in sexually active females. There is a need to define prevalence in our local population as a public health need and to determine whether rapid point-of-care testing should be incorporated as a component of sexually …

Comparison Of Wavelet Compressed Mri Cineloop Images Versus Originally Acquired Non-Modified Mri Images For Detection Of Brain Lesions, Patrice K. Anangwe

Master of Medicine in Imaging and Diagnostic Radiology

Brief background: Image compression has been widely accepted as the solution to the explosion of imaging data since the advent of multiaxial multisequence imaging. However, compromise on diagnostic quality secondary to this modification has been an issue. Many studies have been carried out looking at just noticeable differences but few have been undertaken to look at the difference in ability to detect pathology in original versus cineloop compressed images. This study was done to compare lesion detection ability of cineloop compressed images as compared to original images. Objectives: A comparative study to evaluate detection of brain lesions in wavelet compressed …

Real-World Comparison Of Two Molecular Methods For Detection Of Respiratory Viruses, Syed Asad Ali, James E. Gern, Tina V. Hartert, Kathryn M. Edwards, Marie R. Griffin, E Kathryn Mille, Tebeb Gebretsadik, Tressa Pappas, Wai Ming Lee, John V. Williams

Department of Paediatrics and Child Health

Background: Molecular polymerase chain reaction (PCR) based assays are increasingly used to diagnose viral respiratory infections and conduct epidemiology studies. Molecular assays have generally been evaluated by comparing them to conventional direct fluorescent antibody (DFA) or viral culture techniques, with few published direct comparisons between molecular methods or between institutions. We sought to perform a real-world comparison of two molecular respiratory viral diagnostic methods between two experienced respiratory virus research laboratories.
Methods: We tested nasal and throat swab specimens obtained from 225 infants with respiratory illness for 11 common respiratory viruses using both a multiplex assay (Respiratory MultiCode-PLx Assay [RMA]) …

Lymphomas In Sub-Saharan Africa - What Can We Learn And How Can We Help In Improving Diagnosis, Managing Patients And Fostering Translational Research?, Kikkeri N. Naresh, Martine Raphael, Leona Ayers, Nina Hurwitz, Valeria Calbi, Emily Rogena, Shahin Sayed, Omar Sherman, Hazem A.H. Ibrahim, Stefano Lazzi, Vasileios Mourmouras, Patricia Rince, Jessie Githanga, Bessie Byakika, Emma Moshi, Muheez Durosinmi, Babatunde J. Olasode, Olayiwola A. Oluwasola, Effiong E. Akang, Yetunde Akeno` Va,, Melissa Adde, Ian Magrath, Lorenzo Leoncini

Pathology, East Africa

Approximately 30 000 cases of non-Hodgkin lymphoma (NHL) occur in the equatorial belt of Africa each year. Apart from the fact that Burkitt lymphoma (BL) is very common among children and adolescents in Africa and that an epidemic of human immunodeficiency virus (HIV) infection is currently ongoing in this part of the world, very little is known about lymphomas in Africa. This review provides information regarding the current infrastructure for diagnostics in sub-Saharan Africa. The results on the diagnostic accuracy and on the distribution of different lymphoma subsets in sub-Saharan Africa were based on a review undertaken by a team …

Successful Management Of Aggressive Fibromatosis Of The Neck Using Wide Surgical Excision: A Case Report., Zain A. Sobani, Montasir Junaid, Mumtaz J Khan

Section of Otolaryngology, Head & Neck Surgery

Introduction:Aggressive fibromatosis is a benign tumor, thought to arise from deep musculoaponeurotic structures, rarely found in the head or neck. However, when it does occur in the head and neck region, it tends to be more aggressive and associated with significant morbidity, which may be attributed to the vital vascular, neurological or anatomical structures in close proximity. Case Presentation: We report the case of a 39-year-old Pakistani man who presented with a two-month history of a lump on the right side of his neck. The mass was excised and histopathological analysis revealed a case of aggressive fibromatosis.

Conclusions:

Due …

Beyond Mannequins: A Potpourri Of Enabling Technology For Healthcare Education, Rosalyn P. Scott

Department of Surgery Faculty Publications

No abstract provided.

Multilaboratory Evaluation Of Real-Time Pcr Tests For Hepatitis B Virus Dna Quantification, Angela M. Caliendo, Alexander Valsamakis, James W. Bremer, Andrea Ferreira-Gonzalez, Suzanne Granger, Linda Sabatini, Gregory J. Tsongalis

Dartmouth Scholarship

The performance characteristics of four different assays for hepatitis B virus (HBV) quantification were assessed: the Abbott RealTime HBV IUO, the Roche Cobas AmpliPrep/Cobas TaqMan HBV test, the Roche Cobas TaqMan HBV test with HighPure system, and the Qiagen artus HBV TM ASR. Limit of detection (LOD), linear range, reproducibility, and agreement were determined using a serially diluted plasma sample from a single chronically infected subject. Each assay was tested by at least three laboratories. The LOD of the RealTime and two TaqMan assays was approximately 1.0 log₁₀ IU/ml; for artus HBV (which used the lowest volume of extracted …

Effects Of Diet Type And Supplementation Of Glucosamine, Chondroitin, And Msm On Body Composition, Functional Status, And Markers Of Health In Women With Knee Osteoarthritis Initiating A Resistance-Based Exercise And Weight Loss Program, Teresa Magrans-Courtney, Colin Wilborn, Christopher Rasmussen, Maria Pontes Ferreira, Lori Greenwood, Bill Campbell, Chad M. Kerksick, Erica Nassar, Rui Li, Mike Iosia, Matt Cooke, Kristin Dugan, Darryn Willoughby, Luann Soliah, Richard B. Kreider

Nutrition and Food Science Faculty Research Publications

Background: The purpose of this study was to determine whether sedentary obese women with knee OA initiating an exercise and weight loss program may experience more beneficial changes in body composition, functional capacity, and/or markers of health following a higher protein diet compared to a higher carbohydrate diet with or without GCM supplementation.

Methods: Thirty sedentary women (54 ± 9 yrs, 163 ± 6 cm, 88.6 ± 13 kg, 46.1 ± 3% fat, 33.3 ± 5 kg/m²) with clinically diagnosed knee OA participated in a 14-week exercise and weight loss program. Participants followed an isoenergenic low fat higher …

Analyzing The Impact Of 23 Mg/Day Donepezil On Language Dysfunction In Moderate To Severe Alzheimer's Disease, Steven H. Ferris, Frederick A. Schmitt, Judith Saxton, Sharon Richardson, Joan Mackell, Yijun Sun, Yikang Xu

Sanders-Brown Center on Aging Faculty Publications

INTRODUCTION: Progressive language impairment is among the primary components of cognitive decline in Alzheimer's disease (AD). Because expressive and receptive language help to maintain emotional connections to caregivers and support the management of AD patients' functional needs, language plays a critical role in patients' emotional and physical health. Using data from a large prospective clinical trial comparing two doses of donepezil in patients with moderate to severe AD, we performed a post hoc analysis to determine whether a higher dose of donepezil was associated with greater benefits in language function.

METHODS: In the original randomized, double-blind clinical trial, 1,467 patients …

Virological And Clinical Characteristics Of Hepatitis Delta Virus In South Asia, Khalid Mumtaz, Umair S. Ahmed, Sadik Memon, Ali Khawaja, Muhammad T. Usmani, Tariq Moatter, Saeed Hamid, Wasim Jafri

Section of Gastroenterology

Background & Aims:There is a paucity of data on the impact of hepatitis D virus (HDV) in Patients with hepatitis B virus (HBV) infection from South Asia. We studied the impact of HDV co-infection on virological and clinical characteristics.

Methods: We collected data of 480 Patients with HBsAg positive and a detectable HBV DNA PCR, who presented to the Aga Khan University, Karachi and Isra University in Hyderabad, Pakistan in the last 5 years. HDV co-infection was diagnosed on the basis of anti-HDV. ALT, HBeAg, HBeAb and HBV DNA PCR quantitative levels were checked in all Patients. We divided …

Psychostimulants As Cognitive Enhancers: The Prefrontal Cortex, Catecholamines And Attention Deficit Hyperactivity Disorder, Craig Berridge, David M. Devilbiss

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Psychostimulants exert behavioral-calming and cognition-enhancing actions in the treatment of attention deficit hyperactivity disorder (ADHD). Contrary to early views, extensive research demonstrates that these actions are not unique to ADHD. Specifically, when administered at low and clinically-relevant doses, psychostimulants improve a variety of behavioral and cognitive processes dependent on the prefrontal cortex (PFC) in subjects with and without ADHD. Despite the longstanding clinical use of these drugs, the neural mechanisms underlying their cognition-enhancing/therapeutic actions have only recently begun to be examined. At behaviorally-activating doses, psychostimulants produce large and widespread increases in extracellular levels of brain catecholamines. In contrast, cognition-enhancing doses …

Traumatic Retroclival Epidural Hematoma In Pediatric Patient- Case Report And Review Of Literature, Muhammad Zubair Tahir, S. A. Quadri, Sonia Hanif, Gohar Javed

Section of Neurosurgery

Background: Retroclival epidural hematoma (REDH) is a very rare entity in the practical field of neurosurgery. Only a few cases have been reported in literature. The authors present to you case of a 12-year-old female, a victim of road traffic accident (RTA), who had presented to us with loss of consciousness and seizures.
Case description: Magnetic resonance imaging revealed retroclival hematoma. She was managed on conservative grounds and discharged with assurance of multiple follow-up visits.
Conclusion: Very few cases of REDH have been reported in pediatric population to date. It should be suspected in children with head and neck injuries …