Medical Specialties Commons^™

Emergency Medicine Residents As Teachers, Julie K. Wachtel Do, Mph, Marna Rayl Greenberg Do, Mph, Amy B. Smith Phd, Kevin R. Weaver Do, Bryan G. Kane Md

Department of Emergency Medicine

No abstract provided.

Harmonic Scalpel Versus Electrocautery Tonsillectomy: A Comparative Study In Adult Patients, Naeem Sultan Ali, Mubasher Ikram, Shabbir Akhtar, Iqbal Moghira, Ahmad Nawaz, Asif Arain

Section of Otolaryngology, Head & Neck Surgery

OBJECTIVE: To compare harmonic scalpel (HS) tonsillectomy with electrocautery (EC) tonsillectomy in terms of operating time, intra-operative blood loss, post-operative pain and secondary haemorrhage.METHODS: Sixty adult patients subjected to tonsillectomy only, were evaluated in this prospective study. The patients were stratified into 2 groups (30 each) based on the dissecting instrument used (HS vs. EC) at Aga Khan University Hospital Karachi Pakistan from June, 2006 to August, 2008.RESULTS: The mean operative time was less in electrocautery group (EC 3.57 +/- 0.85 minutes Vs HS 4.20 +/- 1.37 minutes; p

A Trial Of Simulated Breech Delivery Skills Retention For Ob/Gyn And Ed Residents, Cj Sultana, R. Hall

Department of Obstetrics and Gynecology Faculty Papers

Conclusion:

A pilot study showed that simulation using video and high fidelity simulators can substitute for clinical experience for teaching breech delivery with retention of skills at one and three month intervals.

Implementing Integrated Primary And Behavioral Healthcare Within A Housing First Program, Lara C. Weinstein, Md, Benjamin Henwood, Lcsw

Department of Family & Community Medicine Presentations and Grand Rounds

At Pathways to Housing-Philadelphia, mental health services to support consumers' independent living are delivered through Assertive Community Treatment (ACT) teams. ACT is an evidence-based mental health intervention known to reduce psychiatric hospitalization and increase housing stability. ACT team members include social workers, substance abuse, counselors, nurses, and psychiatrists, with ideal staff to client ratios of 1 to 10. Through a novel collaboration between the program and the Deparment of Family and Community Medicine at Thomas Jefferson University, a primary-care physician was embedded into the ACT services to form an integrated health-care team.

Porcelain Fused To Metal (Pfm) Crowns And Caries In Adjacent Teeth, Durr-E-Sadaf, Zubair Ahmad

Section of Dental-Oral Maxillofacial Surgery

OBJECTIVE: To assess the discrepancies in marginal integrity and contact points of Porcelain Fused to Metal (PFM) crowns and its association with caries in adjacent teeth.

STUDY DESIGN: Cross-sectional study.

PLACE AND DURATION OF STUDY: Dental Section of the Aga Khan University Hospital, Karachi, from January to August 2009.

METHODOLOGY: Ninety six (96) patients with PFM crowns on maxillary and mandibular premolars and molars were included in this study. Single unit PFM crowns that were part of fixed bridge with at least one natural adjacent tooth were studied. PFM crown with no adjacent tooth or badly broken down teeth were …

Improving Function In Age-Related Macular Degeneration: Design And Methods Of A Randomized Clinical Trial., Barry W Rovner, Robin J Casten, Mark T Hegel, Robert W Massof, Benjamin E Leiby, William S Tasman

Department of Psychiatry and Human Behavior Faculty Papers

Age-Related Macular Degeneration (AMD) is the leading cause of severe vision loss in older adults and impairs the ability to read, drive, and live independently and increases the risk for depression, falls, and earlier mortality. Although new medical treatments have improved AMD's prognosis, vision-related disability remains a major public health problem. Improving Function in AMD (IF-AMD) is a two-group randomized, parallel design, controlled clinical trial that compares the efficacy of Problem-Solving Therapy (PST) with Supportive Therapy (ST) (an attention control treatment) to improve vision function in 240 patients with AMD. PST and ST therapists deliver 6 one-hour respective treatment sessions …

Atrial Fibrillation, Is Warfarin The Only Option For Stroke Prevention?, Maria Khan, Ayeesha Kamran Kamal

Section of Neurology

No abstract provided.

Improving Outcomes For Hispanic Patients Undergoing Peginterferon/Ribavirin Therapy For Chronic Hepatitis C In An Internist-Led, Multidisciplinary, Multi-Cultural Practice: A Unique Application Of The Medical, Joseph L. Yozviak Do, Facp, Orlando J. Penaloza Md, Facp, Judith A. Knoop

Department of Medicine

No abstract provided.

Learning Curve For Robotic-Assisted Laparoscopic Colorectal Surgery, Malak B Bokhari, Chirag B Patel, Diego I Ramos-Valadez, Madhu Ragupathi, Eric M Haas

Faculty, Staff and Student Publications

BACKGROUND: Robotic-assisted laparoscopic surgery (RALS) is evolving as an important surgical approach in the field of colorectal surgery. We aimed to evaluate the learning curve for RALS procedures involving resections of the rectum and rectosigmoid.

METHODS: A series of 50 consecutive RALS procedures were performed between August 2008 and September 2009. Data were entered into a retrospective database and later abstracted for analysis. The surgical procedures included abdominoperineal resection (APR), anterior rectosigmoidectomy (AR), low anterior resection (LAR), and rectopexy (RP). Demographic data and intraoperative parameters including docking time (DT), surgeon console time (SCT), and total operative time (OT) were analyzed. …

Fuzzy Logic: A “Simple” Solution For Complexities In Neurosciences?, Saniya Siraj Godil, Muhammad Shahzad Shamim, Ather Enam, Uvais Qidwai

Medical College Documents

Background: Fuzzy logic is a multi-valued logic which is similar to human thinking and interpretation. It has the potential of combining human heuristics into computer-assisted decision making, which is applicable to individual patients as it takes into account all the factors and complexities of individuals. Fuzzy logic has been applied in all disciplines of medicine in some form and recently its applicability in neurosciences has also gained momentum.
Methods: This review focuses on the use of this concept in various branches of neurosciences including basic neuroscience, neurology, neurosurgery, psychiatry and psychology.
Results: The applicability of fuzzy logic is not limited …

Progenitor Cells As Remote "Bioreactors": Neuroprotection Via Modulation Of The Systemic Inflammatory Response, Peter A Walker, Phillip A Letourneau, Supinder Bedi, Shinil K Shah, Fernando Jimenez, Charles S Cox Jr

Faculty, Staff and Student Publications

Acute central nervous system (CNS) injuries such as spinal cord injury, traumatic brain injury, autoimmune encephalomyelitis, and ischemic stroke are associated with significant morbidity, mortality, and health care costs worldwide. Preliminary research has shown potential neuroprotection associated with adult tissue derived stem/progenitor cell based therapies. While initial research indicated that engraftment and transdifferentiation into neural cells could explain the observed benefit, the exact mechanism remains controversial. A second hypothesis details localized stem/progenitor cell engraftment with alteration of the loco-regional milieu; however, the limited rate of cell engraftment makes this theory less likely. There is a growing amount of preclinical data …

Optimality In Neural Adaptation, Adrienne Fairhall

Systems Science Friday Noon Seminar Series

Nervous systems tune themselves to the statistical structure of the stimuli they encounter. This sensitivity to statistics appears in phenomena ranging over many timescales, from the adaptation of vision to a rapid change in light level to the loss of ability to distinguish the sounds of non-native languages. While multiple neural mechanisms contribute to this on-line learning of stimulus distributions, we show that the intrinsic nonlinearities of single neurons provide them with the ability to represent time-varying stimuli optimally. While such sensitivity to stimulus statistics does not require learning, slower timescales of adaptation are consistent with optimal inference of statistical …

Ethnic Disparity In 21-Hydroxylase Gene Mutations Identified In Pakistani Congenital Adrenal Hyperplasia Patients, Aysha Habib Khan, Muniba Aban, Jamal Raza, Naeem Ul Haq, Abdul Jabbar, Tariq Moatter

Department of Pathology and Laboratory Medicine

Background: Congenital adrenal hyperplasia (CAH) is a group of autosomal recessive disorders caused by defects in the steroid 21 hydroxylase gene (CYP21A2). We studied the spectrum of mutations in CYP21A2 gene in a multi-ethnic population in Pakistan to explore the genetics of CAH.

Methods: A cross sectional study was conducted for the identification of mutations CYP21A2 and their phenotypic associations in CAH using ARMS-PCR assay.

Results: Overall, 29 Patients were analyzed for nine different mutations. The group consisted of two major forms of CAH including 17 salt wasters and 12 simple virilizers. There were 14 phenotypic males and 15 females …

Septic Shock: Current Management And New Therapeutic Frontiers, R. Phillip Dellinger, Md

Division of Pulmonary, Allergy, and Critical Care Medicine Presentations and Grand Rounds

No audio is available for this presentation.

Dr. R. Phillip Dellinger is a Professor of Medicine who holds a faculty appointment in the Division of Pulmonary and Critical Care Medicine at the Robert Wood Johnson School of Medicine, University of Medicine and Dentistry of New Jersey. He is also the Vice-Chair, Department of Medicine and the Director, Medical/Surgical/Cardiovascular Surgical Intensive Care Unit at the Cooper Medical Center in Camden New Jersey. In 2006-2007, he was selected as South Jersey Top Docs by South Jersey Magazine. Dr. Dellinger's interests are in the treatment and outcomes of septic shock.

Parental Control And Monitoring Of Young People's Sexual Behaviour In Rural North-Western Tanzania: Implications For Sexual And Reproductive Health Interventions, Joyce Wamoyi, Angela Fenwick, Mark Urassa, Basia Zaba, William Stones

Obstetrics and Gynaecology, East Africa

Background

Parenting through control and monitoring has been found to have an effect on young people's sexual behaviour. There is a dearth of literature from sub-Saharan Africa on this subject. This paper examines parental control and monitoring and the implications of this on young people's sexual decision making in a rural setting in North-Western Tanzania.

Methods

This study employed an ethnographic research design. Data collection involved 17 focus group discussions and 46 in-depth interviews conducted with young people aged 14-24 years and parents/carers of young people within this age-group. Thematic analysis was conducted with the aid of NVIVO 7 software. …

Phase I Study Of 'Dose-Dense' Pemetrexed Plus Carboplatin/Radiotherapy For Locally Advanced Non-Small Cell Lung Carcinoma., Xinglei Shen, Albert Denittis, Maria Werner-Wasik, Rita Axelrod, Paul Gilman, Thomas Meyer, Joseph Treat, Walter J Curran, Mitchell Machtay

Department of Radiation Oncology Faculty Papers

BACKGROUND: This phase I study investigates the feasibility of carboplatin plus dose-dense (q2-week) pemetrexed given concurrently with radiotherapy (XRT) for locally advanced and oligometastatic non-small cell lung cancer (NSCLC).

METHODS: Eligible patients had Stage III or IV (oligometastatic) NSCLC. Patients received XRT to 63 Gy in standard fractionation. Patients received concurrent carboplatin (AUC = 6) during weeks 1 and 5 of XRT, and pemetrexed during weeks 1, 3, 5, and 7 of XRT. The starting dose level (level 1) of pemetrexed was 300 mg/m2. Following the finding of dose limiting toxicity (DLT) in dose level 1, an amended dose level …

Association Of Depression With Treatment Outcomes In Type 2 Diabetes Mellitus: A Cross-Sectional Study From Karachi, Pakistan, Saman I. Zuberi, Ehsan U. Syed, Junaid A. Bhatti

Section of Diabetes, Endocrinology and Metabolism

Background: To assess the associations of depression with glycemic control and compliance to self-care activities in adult Patients with Type 2 Diabetes Mellitus. Methods: This cross-sectional study was conducted at a tertiary-care hospital in Karachi (Aga Khan University Hospital). Equal numbers of depressed and non-depressed Patients were consecutively recruited from the diabetic clinic. Information on demographic and clinical characteristics was collected in face-to-face interviews and from medical records. Hospital Anxiety Depression Scale (HADS) was used to measure depression. Associations of depressed status (HADS >= 8) with poor glycemic control (Hemoglobin A1c level >= 7%) and compliance to self-care activities were …

Rho Activation Of Mdia Formins Is Modulated By An Interaction With Inverted Formin 2 (Inf2), Hua Sun, Johannes S. Schlondorff, Elizabeth J. Brown, Henry N. Higgs, Martin R. Pollak

Dartmouth Scholarship

Inverted formin 2 (INF2) encodes a member of the diaphanous subfamily of formin proteins. Mutations in INF2 cause human kidney disease characterized by focal and segmental glomerulosclerosis. Disease-causing mutations occur only in the diaphanous inhibitory domain (DID), suggesting specific roles for this domain in the pathogenesis of disease. In a yeast two-hybrid screen, we identified the diaphanous autoregulatory domains (DADs) of the mammalian diaphanous-related formins (mDias) mDia1, mDia2, and mDia 3 as INF2_DID-interacting partners. The mDias are Rho family effectors that regulate actin dynamics. We confirmed in vitro INF2_DID/mDia_DAD binding by biochemical assays, confirmed the in vivo interaction of these …

Intradiploic Epidermoid Cyst Overlying The Torcula: A Surgical Challenge, Amad Naseer Khan, Salema Khalid, Ather Enam

Medical College Documents

Intradiploic tumours are rare, slow growing tumours that can present in many different ways, including a painless lump, tenderness, headache and rarely with focal neurological signs. The authors present the case of a gentleman in whom the tumour presented in an unusual location and presented a surgical challenge. The major take home message from this case report is that an epidermoid cyst overlying the torcula is to be approached with great caution and care and is without doubt a surgical challenge.

Current Management Of Complicated Pneumonia In Children, Sherman J. Alter, Elizabeth H. Ey, Mark Warren, Jeffrey C. Pence

Department of Surgery Faculty Publications

No abstract provided.

Pediatric Ethics Guidelines For Hereditary Medullary Thyroid Cancer, M. Sara Rosenthal, Douglas S. Diekema

Internal Medicine Faculty Publications

Hereditary medullary thyroid cancer is an aggressive cancer for which there is no standard effective systemic therapy, but which can be prevented through genetic screening and prophylactic thyroidectomy. Although this cancer accounts for roughly 17% of all pediatric thyroid cancers, a significant percentage of affected families do not "accept" screening, while many gene carriers delay or refuse prophylactic thyroid surgery for their children. Current genetic screening practices in medullary thyroid cancer are inadequate; more than 50% of index patients with hereditary medullary thyroid cancer present with a thyroid mass; up to 75% have distant metastasis. These proposed pediatric ethics guidelines …

Palinopsia From A Posteriorly Placed Glioma - An Insight Into Its Possible Causes, Amad Naseer Khan, Rakesh Sharma, Salema Khalid, David Mckean, Richard Armstrong, Christopher Kennard

Section of Neurology

Palinopsia is a distortion of processing in the visual system in which images persist or recur after the visual stimulus has been removed. It is a dysfunction of the association areas at the junction of temporal, occipital and parietal lobes and can be triggered by any lesion or dysfunction in this region. Here, the authors report the case of a Patient with a glioma involving this region of the brain, who presented with palinopsia that subsequently disappeared once the tumour was surgically debulked. In the few cases of palinopsia that have been published so far, no such case has ever …

Human Spinal Cord Injury Causes Specific Increases In Surface Expression Of Beta Integrins On Leukocytes, Feng Bao, Christopher S. Bailey, Kevin R. Gurr, Stewart I. Bailey, M. Patricia Rosas-Arellano, Arthur Brown, Gregory A. Dekaban, Lynne C. Weaver

Paediatrics Publications

Spinal cord injury (SCI) activates circulating leukocytes that migrate into the injured cord and bystander organs using adhesion molecule-mediated mechanisms. These cells cause oxidative damage, resulting in secondary injury to the spinal cord, as well as injury to bystander organs. This study was designed to examine, over a 6-h to 2-week period, changes in adhesion molecule surface expression on human peripheral leukocytes after SCI (9 subjects), using as controls 10 uninjured subjects and 6 general trauma patients (trauma controls, TC). Both the percentage of cells expressing a given adhesion molecule and the average level of its expression was quantified for …

Hyperfiltration Affects Accuracy Of Creatinine Egfr Measurement, Shih Han S. Huang, Ajay P. Sharma, Abeer Yasin, Robert M. Lindsay, William F. Clark, Guido Filler

Paediatrics Publications

Background and objectives: Surrogate markers such as creatinine, cystatin C (CysC), and beta trace protein (BTP) have been used to estimate GFR (eGFR). The accuracy of eGFR may be altered with hyperfiltration and differences in filtration fraction (FF). It is hypothesized that the accuracy of creatinine for eGFR may be affected by hyperfiltration and different effective renal plasma flow (ERPF). Design, setting, participants, & measurements: A total of 127 pediatric patients with various renal diseases underwent simultaneous measurements of GFR using 51Cr-EDTA renal scan and ERPF ( 131I-hippurate clearance) to calculate the FF (FF = GFR/ERPF). The eGFRs were calculated …

An Analysis Of The Clinical Practice Of Emergency Medicine In Public Emergency Centres In Kenya, Benjamin W. Wachira

Master of Medicine in Internal Medicine

Objectives: To describe the case mix, interventions, procedures and management of patients in public accident and emergency departments (A&Es) in Kenya. Methods: This was an observational study of patients who presented to 15 A&Es from 1 October to 31 December 2010. The study was conducted across Kenya in two national referral hospitals, five secondary level hospitals, and eight primary level hospitals. All patients presenting alive to the A&E during the 24 hour study period that were seen by a doctor or clinical officer were included in the study. A data collection form was completed by the primary investigator at the …

Carotid Cavernous Fistula In A Patient With Coronary Artery Disease, Omer Ashraf, Syed Shahabuddin, Muhammad Ehsan Bari, Hasanat Sharif

Section of Cardiology

Carotid cavernous fistulas are abnormal communications between the carotid and cavernous vasculature, with potential for serious neurological and ocular sequelae. There is considerable literature on the neuro-radiological management of carotico-cavernous fistula depending upon their flow status. The coronary artery bypass grafting (CABG) for coronary artery disease (CAD) is a well established method of revascularization. However, the association of carotid cavernous fistula in presence of CAD is an infrequent occurrence. We present a case of coronary artery disease scheduled for bypass surgery, developed spontaneous bilateral carotid cavernous fistulas, highlighting a unique aspect of association between coronary and carotid disease.

Involvement Of Medical Students And Fresh Medical Graduates Of Karachi, Pakistan In Research, Kiran Ejaz, Muhammad Shahid Shamim, Muhammad Shahzad Shamim, Syed Abid Hussain

Department of Emergency Medicine

OBJECTIVE: To study the involvement in research, of final year medical students and fresh graduates of Karachi, Pakistan and to identify the factors influencing their interest in medical research.

METHODS: A cross-sectional, questionnaire based study was conducted in 2007-2008. Five institutes representing the private and public hospitals in the city were selected by cluster sampling. Final year medical students and fresh graduates were included. Descriptive statistics were charted using SPSS v.16 after double data entry.

RESULTS: Out of 378, 186 (49%) participants had journal reading habits due to the requirement of their institution. Mostly, 157 (41%) undergraduates had already participated …

Primary Amebic Meningoencephalitis Caused By Naegleria Fowleri, Karachi, Pakistan., Sadia Shakoor, Mohammad Asim Beg,, Syed Faisal Mahmood, Rebecca Bandea, Rama Sriram, Fatima Noman, Farheen Ali,, Govinda S. Visvesvara, Afia Zafar

Department of Medicine

We report 13 cases of Naegleria fowleri primary amebic meningoencephalitis in persons in Karachi, Pakistan, who had no history of aquatic activities. Infection likely occurred through ablution with tap water. An increase in primary amebic meningoencephalitis cases may be attributed to rising temperatures, reduced levels of chlorine in potable water, or deteriorating water distribution systems.

Continuous Ambulatory Peritoneal Dialysis (Capd) Associated Peritonitis In A Child: A Rare Case Of Peritonitis Caused By Sphingomonous Paucimobilis, Arwa Quresh Tambawala, Sadaf Hamid, Iqtidar Khan, Asad Ali

Department of Paediatrics and Child Health

First identified in 1977, Sphingomonous Paucimobilis has emerged as an opportunistic human pathogen. It is primarily known to cause a range of mostly nosocomial, non-life-threatening infections that typically are easily treated by antibiotic therapy. Sources of its isolation linked to clinical disease include blood, spinal fluid and leg ulcers. It has also been reported as a rare cause of peritonitis in patients on continuous ambulatory peritoneal dialysis. We present a case of a child with peritonitis due to this organism. Clinical features, bacteriology and treatment option and response have been discussed.

What Are The Therapeutic Options For Strokes Secondary To Intracranial Large Artery Stenosis?, Maria Khan, Ayeesha Kamran Kamal

Department of Medicine

No abstract provided.