Medical Specialties Commons^™

Residual Renal Function Calculated From Serum Cystatin C Measurements And Knowledge Of The Weekly Standard Kt/V Urea, Shih Han Huang, Guido Filler, Robert M. Lindsay

Paediatrics Publications

No abstract provided.

Cardiac Failure Following Inadvertent Administration Of High-Dose Epinephrine Subcutaneously, Kim A. Tran, Douglas D. Fraser, Krista Hawrylyshyn, Kambiz Norozi

Paediatrics Publications

Our aim is to report the consequences of epinephrine toxicity leading to cardiac failure in a child and the successful management with dopamine and milrinone. A previously healthy 13-year-old girl undergoing a left tympanomastoidectomy was inadvertently administered 10 mL of 1:1000 epinephrine subcutaneously (0.175 mg/kg) on the left post auricular region in lieu of lidocaine. She developed sudden supraventricular tachycardia, hypertension and flash pulmonary edema. She was initially treated with propofol, nitrogycerin and increased peak end-expiratory pressure. Within 4 h, she remained tachycardic, but was hypotensive with an increased central venous pressure. Electrocardiogram and echocardiogram investigations showed ST changes indicative …

The Long And Short Of It: The Role Of Telomeres In Fetal Origins Of Adult Disease., Stephanie E Hallows, Timothy Regnault, Dean H Betts

Paediatrics Publications

Placental insufficiency, maternal malnutrition, and other causes of intrauterine growth restriction (IUGR) can significantly affect short-term growth and long-term health. Following IUGR, there is an increased risk for cardiovascular disease and Type 2 Diabetes. The etiology of these diseases is beginning to be elucidated, and premature aging or cellular senescence through increased oxidative stress and DNA damage to telomeric ends may be initiators of these disease processes. This paper will explore the areas where telomere and telomerase biology can have significant effects on various tissues in the body in IUGR outcomes.

Medical Physics Staffing For Radiation Oncology: A Decade Of Experience In Ontario, Canada., Jerry J. Battista Dr., Brenda G Clark, Michael S Patterson, Luc Beaulieu, Michael B Sharpe, L John Schreiner, Miller S Macpherson, Jacob Van Dyk

Oncology Publications

The January 2010 articles in The New York Times generated intense focus on patient safety in radiation treatment, with physics staffing identified frequently as a critical factor for consistent quality assurance. The purpose of this work is to review our experience with medical physics staffing, and to propose a transparent and flexible staffing algorithm for general use. Guided by documented times required per routine procedure, we have developed a robust algorithm to estimate physics staffing needs according to center-specific workload for medical physicists and associated support staff, in a manner we believe is adaptable to an evolving radiotherapy practice. We …

Patient- And Population-Level Health Consequences Of Discontinuing Antiretroviral Therapy In Settings With Inadequate Hiv Treatment Availability, April D. Kimmel, Stephen C. Resch, Xavier Anglaret, Norman Daniels, Sue J. Goldie, Christine Daniel, Angela Y. Wong, Kenneth A. Freedberg, Milton C. Weinstein

Health Policy Publications

Background

In resource-limited settings, HIV budgets are flattening or decreasing. A policy of discontinuing antiretroviral therapy (ART) after HIV treatment failure was modeled to highlight trade-offs among competing policy goals of optimizing individual and population health outcomes.

Methods

In settings with two available ART regimens, we assessed two strategies: (1) continue ART after second-line failure (Status Quo) and (2) discontinue ART after second-line failure (Alternative). A computer model simulated outcomes for a single cohort of newly detected, HIV-infected individuals. Projections were fed into a population-level model allowing multiple cohorts to compete for ART with constraints on treatment capacity. In the …

Optimal Strategy For Prophylactic Cranial Irradiation In Limited Stage Small Cell Lung Cancer, Edward Yu, Patricia Tai, Avi Assouline, Kurian Joseph

Data and Test Instruments

No abstract provided.

The Life Of John Wishart (1850-1926): Study Of An Academic Surgical Career Prior To The Flexner Report., Emily Claydon, Vivian Mcalister

Data and Test Instruments

BACKGROUND: The 1910 Flexner Report on Medical Education in the United States and Canada is often taken as the point when medical schools in North America took on their modern form. However, many fundamental advances in surgery, such as anesthesia and asepsis, predated the report by decades. To understand the contribution of educators in this earlier period, we investigated the forgotten career of John Wishart, founding Professor of Surgery at Western University, London Ontario. METHODS: Archives at the University of Western Ontario, University of Toronto, London City Library, and Wellington County Museum were searched for material about Wishart and his …

Children's Mercy Hospital Annual Report 2011, Children's Mercy Hospital

Children's Mercy Annual Reports

Annual report for The Children's Mercy Hospital in Kansas City MO, a pediatric medical center.

Early Events In Herpes Simplex Virus Lifecycle With Implications For An Infection Of Lifetime, Sarah Salameh '12, Urmi Sheth '12, Deepak Shukla

Student Publications & Research

Affecting a large percentage of human population herpes simplex virus (HSV) types -1 and -2 mainly cause oral, ocular, and genital diseases. Infection begins with viral entry into a host cell, which may be preceded by viral “surfing” along filopodia. Viral glycoproteins then bind to one or more of several cell surface receptors, such as herpesvirus entry mediator (HVEM), nectin-1, 3-O sulfated heparan sulfate (3-OS HS), paired immunoglobulin-like receptor, and non-muscle myosin-IIA. At least five viral envelope glycoproteins participate in entry and these include gB, gC, gD and gH-gL. Post-entry, these glycoproteins may also facilitate cell-to-cell spread of the virus, …

The Fit-Hansa Demonstrates Reliability And Convergent Validity Of Functional Performance In Patients With Shoulder Disorders, Prajyot Kumta, Joy C. Macdermid, Saurabh Mehta, Paul W. Stratford

Physical Therapy Faculty Research

Study

DesignPsychometric study design.

Objectives

To assess the test-retest reliability and convergent validity of the Functional Impairment Test-Hand and Neck/Shoulder/Arm (FIT-HaNSA) in patients with shoulder disorders.

Background

Performance tests that assess functional ability of patients with shoulder disorders can provide useful information for making clinical or return-to-activity decisions. No performance-based shoulder test has yet demonstrated sufficient relevance or clinical measurement properties. The FIT-HaNSA examines upper extremity performance during repetitive tasks that emphasize shoulder reaching and static postures and, therefore, has greater relevance for assessing performance.

Methods

Thirty-six patients with shoulder disorders and 65 healthy controls were recruited for the study. …

Effective Non-Viral Delivery Of Sirna To Acute Myeloid Leukemia Cells With Lipid-Substituted Polyethylenimines, Breanne Landry

Pharmacy Faculty Articles and Research

Use of small interfering RNA (siRNA) is a promising approach for AML treatment as the siRNA molecule can be designed to specifically target proteins that contribute to aberrant cell proliferation in this disease. However, a clinical-relevant means of delivering siRNA molecules must be developed, as the cellular delivery of siRNA is problematic. Here, we report amphiphilic carriers combining a cationic polymer (2 kDa polyethyleneimine, PEI2) with lipophilic moieties to facilitate intracellular delivery of siRNA to AML cell lines. Complete binding of siRNA by the designed carriers was achieved at a polymer:siRNA ratio of ~0.5 and led to siRNA/polymer complexes of …

Neuroimaging Of Tumefactive Multiple Sclerosis With Atypical Features, Rohit Koppula, Andrew J. Degnan, Mark Ghassibi, Peter Duggan, Robert Jones, Lucien M. Levy

Radiology Faculty Publications

Tumefactive demyelinating lesions or tumefactive multiple sclerosis constitute a unique presentation of demyelinating disease which frequently mimics intracranial neoplasm, infection or other, non-demyelinating intracranial pathology. Consequently, these lesions, which are larger than typical multiple sclerosis plaques and generally characterized by certain magnetic resonance imaging features including edema and incomplete ring enhancement, pose a serious diagnostic challenge that frequently prompts biopsy in initial evaluation. Biopsy can be averted when imaging features for tumefactive multiple sclerosis are seen on MRI. Herein, we present a biopsy-proven case of tumefactive multiple sclerosis with atypical imaging features, evaluated using magnetic resonance and diffusion tensor imaging.

Network Insights On Oxaliplatin Anti-Cancer Mechanisms, Osama M. Alian, Asfar S. Azmi, Ramzi M. Mohammad

Wayne State University Associated BioMed Central Scholarship

Abstract

Oxaliplatin has been a crucial component of combination therapies since admission into the clinic causing modest gains in survival across multiple malignancies. However, oxaliplatin functions in a non-targeted manner, posing a difficulty in ascertaining precise efficacy mechanisms. While previously thought to only affect DNA repair mechanisms, Platinum-protein adducts (Pt-Protein) far outnumber Pt-DNA adducts leaving a big part of oxaliplatin function unknown. Through preliminary network modeling of high throughput data, this article critically reviews the efficacy of oxaliplatin as well as proposes a better model for enhanced efficacy based on a network approach. In our study, not only oxaliplatin’s function …

Acr Appropriateness Criteria®  Resectable Rectal Cancer, William E. Jones Iii, Charles R. Thomas Jr, Joseph M. Herman, May Abdel-Wahab, Nilofer Azad, William Blackstock, Prajnan Das, Karyn A. Goodman, Theodore S. Hong, Salma K. Jabbour, Andre A. Konski, Albert C. Koong, Miguel Rodriguez-Bigas, William Small Jr, Jennifer Zook, W Suh

Wayne State University Associated BioMed Central Scholarship

Abstract

The management of resectable rectal cancer continues to be guided by clinical trials and advances in technique. Although surgical advances including total mesorectal excision continue to decrease rates of local recurrence, the management of locally advanced disease (T3-T4 or N+) benefits from a multimodality approach including neoadjuvant concomitant chemotherapy and radiation. Circumferential resection margin, which can be determined preoperatively via MRI, is prognostic. Toxicity associated with radiation therapy is decreased by placing the patient in the prone position on a belly board, however for patients who cannot tolerate prone positioning, IMRT decreases the volume of normal tissue irradiated. The …

Erlin2 Promotes Breast Cancer Cell Survival By Modulating Endoplasmic Reticulum Stress Pathways, Guohui Wang, Gang Liu, Xiaogang Wang, Seema Sethi, Rouba Ali-Fehmi, Judith Abrams, Ze Zheng, Kezhong Zhang, Stephen Ethier, Zeng-Quan Yang

Wayne State University Associated BioMed Central Scholarship

Abstract

Background

Amplification of the 8p11-12 region has been found in approximately 15% of human breast cancer and is associated with poor prognosis. Previous genomic analysis has led us to identify the endoplasmic reticulum (ER) lipid raft-associated 2 (ERLIN2) gene as one of the candidate oncogenes within the 8p11-12 amplicon in human breast cancer, particularly in the luminal subtype. ERLIN2, an ER membrane protein, has recently been identified as a novel mediator of ER-associated degradation. Yet, the biological roles of ERLIN2 and molecular mechanisms by which ERLIN2 coordinates ER pathways in breast carcinogenesis remain unclear.

Methods

We established the MCF10A-ERLIN2 …

Hemicrania Continua Headache In A Veteran With Post Traumatic Stress Disorder And Major Depressive Disorder Without Traumatic Brain Injury, Brandon A. Kohrt, Erica Duncan

Psychiatry and Behavioral Sciences Faculty Publications

Hemicrania continua is a headache characterized by chronic unremitting unilateral pain associated with ipsilateral autonomic findings. This type of headache responds to high-flow oxygen and indomethacin. This case report describes a male veteran with posttraumatic stress disorder (PTSD) and major depressive disorder who suffers from comorbid hemicrania continua. The psychiatric symptoms were recalcitrant to psychopharmacological intervention. However, when the patient's hemicrania continua was treated appropriately, the patient's psychiatric symptoms also abated. This case demonstrates the need to address physical comorbidities that may exacerbate psychiatric disorders, such as PTSD.

Type 2 Diabetes And Insomnia: Impact On Metabolic Control, Cheryl Lee Tannas

Wayne State University Dissertations

Diabetes is one of the most serious health challenges in the United States, affecting nearly 21 million Americans. The goal of diabetes management is to maintain the blood glucose close to normal to prevent diabetic complications and therefore extending life expectancy and improving quality of life. Research now indicates a relationship of the quantity and quality of sleep to glycemic control in type 2 diabetics. No research on the impact of insomnia on diabetes prevention and/or management was found in the literature. The purpose of this 11 week intervention study was to examine the effects of participation in Cognitive Behavioral …

Managing Soft Tissue Sarcomas In A Developing Country: Are Prognostic Factors Similar To Those Of Developed World?, Irfan Qadir, Masood Umer, Hafiz Muhammad Umer, Nasir Uddin, Farrok Karson, Muhammad Sharoz Rabbani

Section of Orthopaedic Surgery

Background: Managing soft tissue sarcomas (STS) in a developing country with limited financial resources and a poor health referral system is a challenge. Presenting late, these extremity STS are prone to recurrence despite apparently complete resection. This study aimed to explore and compare the impact of clinico-pathological factors on recurrence and survival in Pakistan with the corresponding figures quoted from the developed world.
Methods: An institutional review was performed on all patients with primary STS of the extremities operated on between 1994 and 2008. The prognostic influence of clinical, pathologic, and treatment variables on local recurrence free survival (LRFS), metastasis …

Skeletal Manifestations Of Scurvy: A Case Report From Dubai, Shahryar Noordin, Naveed Baloch, Muhammad Sohail Salat, Abdul Rashid Memon, Tashfeen Ahmad

Section of Orthopaedic Surgery

Introduction: Nutritional deficiencies are rarely reported in developed countries. We report a child of Pakistani origin brought up in Dubai who developed skeletal manifestations of scurvy due to peculiar dietary habits.
Case Presentation: A 4.5 year old boy presented with pain and swelling of multiple joints for three months and inability to walk for two months. Dietary history was significant for exclusive meat intake for the preceding two years. On examination the child's height and weight were below the 5th percentile for his age. He was pale and tachycardic. There was significant swelling and tenderness over the wrist, knee and …

Duhamel's Procedure For Adult Hirschsprung's Disease, Mehreen Adhi, Salma Khan, Hasnain Zafar, Muhammad Arshad

Section of General Surgery

An adult presented with chronic constipation and abdominal mass. Clinical features, abdominal radiographs and barium enema revealed features consistent with Hirschsprung's disease. Full-thickness rectal biopsy was planned, but patient was lost to follow-up and presented 3 years later with intestinal obstruction. Exploratory laparotomy with resection of affected sigmoid colon and end colostomy were performed. Sequential rectal biopsies were obtained during the procedure to confirm the diagnosis. Later, Duhamel's procedure with a diverting loop ileostomy was successfully performed. Ileostomy reversal was done thereafter. There was complete resolution of symptoms and dramatic improvement in bowel function.

Current Exercise Behaviors Of Breast Cancer Patients Diagnosed With Chemotherapy-Induced Peripheral Neuropathy, Karen Y. Wonders, Daniel G. Drury

Health Sciences Faculty Publications

Introduction: Chemotherapy-induced peripheral neuropathy (CIPN) is a common, dose-limiting effect of cancer therapy. The neuropathic pain associated with CIPN often has negative implications on an individual’s quality of life (QOL) and has long been recognized as one of the more difficult types of pain to treat. Treatment of neuropathic pain due to CIPN often requires a multidisciplinary approach, with much attention focused on the use of pharmacological therapies. However, in most instances, these agents have been shown to have additional negative side effects for cancer patients. Thus, other interventions that address the symptoms of CIPN should be considered. One such …

A Case Report: Familial Glucocorticoid Deficiency Associated With Familial Focal Segmental Glomerulosclerosis, Nanik Ram, Ali Asghar, Najmul Islam

Section of Diabetes, Endocrinology and Metabolism

Background: Familial glucocorticoid deficiency (FGD) is a rare autosomal recessive disorder characterized by isolated glucocorticoid deficiency in the presence of normal plasma renin and aldosterone level. Focal segmental glomerulosclerosis (FSGS) is a form of glomerular disease associated with proteinuria and nephritic syndrome. This is the first case of familial glucocorticoid deficiency associated with familial focal segmental glomerulosclerosis.

Case Presentation: An eight month old boy presented with increased genital pigmentation. Initial investigation revealed that he was glucocorticoid deficient and was started on hydrocortisone and fludrocortisone with a diagnosis of primary adrenal insufficiency. Later fludrocortisone was withdrawn and he was diagnosed to …

A Qualitative Study Using Traditional Community Assemblies To Investigate Community Perspectives On Informed Consent And Research Participation In Western Kenya, Rachel Vreeman, Eunice Kamaara, Allan Kamanda, David Ayuku, Winstone Nyandiko, Lukoye Atwoli, Samuel Ayaya, Peter Gisore, Michael Scanlon, Paula Braitstein

Paediatrics and Child Health, East Africa

Background: International collaborators face challenges in the design and implementation of ethical biomedical research. Evaluating community understanding of research and processes like informed consent may enable researchers to better protect research participants in a particular setting; however, there exist few studies examining community perspectives in health research, particularly in resource-limited settings, or strategies for engaging the community in research processes. Our goal was to inform ethical research practice in a biomedical research setting in western Kenya and similar resource-limited settings.

Methods: We sought to use mabaraza, traditional East African community assemblies, in a qualitative study to understand community perspectives on …

Community Perspectives On Research Consent Involving Vulnerable Children In Western Kenya, Rachel Vreeman, Eunice Kamaara, Allan Kamanda, David Ayuku, Winstone Nyandiko, Lukoye Atwoli, Samuel Ayaya, Peter Gisore, Michael Scanlon, Paula Braitstein

Paediatrics and Child Health, East Africa

Involving vulnerable pediatric populations in international research requires culturally appropriate ethical protections. We sought to use mabaraza, traditional East African community assemblies, to understand how a community in western Kenya viewed participation of children in health research and informed consent and assent processes. Results from 108 participants revealed generally positive attitudes towards involving vulnerable children in research, largely because they assumed children would directly benefit. Consent from parents or guardians was understood as necessary for participation while gaining child assent was not. They felt other caregivers,community leaders, and even community assemblies could participate in the consent process. Community members believed …

Preterm Birth And The Perception Of Risk Among African Americans, Gwendolyn Simpson Norman

Wayne State University Dissertations

Background: African American women deliver preterm at a rate that is two to three times that of their white counterparts, and after decades of research, this disparity in birth outcomes still remains unexplained. While factors including income, education, neighborhood conditions, infection and stress have all been associated with prematurity, no combination of these factors has explained why the disparity persists. Recently, however, racism-specific stress has emerged as a possible factor contributing to this disparity. This study was designed to learn how preterm birth was explained by African Americans directly impacted by prematurity. Methods: Interviews were conducted with African American women …

Differential Expression Of Metabolic Genes In Tumor And Stromal Components Of Primary And Metastatic Loci In Pancreatic Adenocarcinoma., Nina V. Chaika, Fang Yu, Vinee Purohit, Kamiya Mehla, Audrey J. Lazenby, Dominick J. Dimaio, Judy M. Anderson, Jen Jen Yeh, Keith R. Johnson, Michael A. Hollingsworth, Pankaj K. Singh

Journal Articles: Eppley Institute

BACKGROUND: Pancreatic cancer is the fourth leading cause of cancer related deaths in the United States with a five-year survival rate of 6%. It is characterized by extremely aggressive tumor growth rate and high incidence of metastasis. One of the most common and profound biochemical phenotypes of animal and human cancer cells is their ability to metabolize glucose at high rates, even under aerobic conditions. However, the contribution of metabolic interrelationships between tumor cells and cells of the surrounding microenvironment to the progression of cancer is not well understood. We evaluated differential expression of metabolic genes and, hence, metabolic pathways …

Comparison Of Time Domain And Spectral Domain Optical Coherence Tomography In Measurement Of Macular Thickness In Macular Edema Secondary To Diabetic Retinopathy And Retinal Vein Occlusion., Elham Hatef, Afsheen Khwaja, Zubir Rentiya, Mohamed Ibrahim, Matthew Shulman, Peykan Turkcuoglu, Yasir J. Sepah, Jianmin Wang, Roomasa Channa, Millena Bittencourt, Abeer Akhtar, Jangwon Heo, Diana V. Do, Quan Dong Nguyen

Journal Articles: Ophthalmology

Purpose. To evaluate macular thickness, agreement, and intraclass repeatability in three optical coherence tomography (OCT) devices: the time domain (TD) Stratus OCT and two spectral domain (SD) OCTs, Spectralis and Cirrus SD-OCT, in eyes with macular edema secondary to diabetic retinopathy (DR) and retinal vein occlusion (VO). Methods. In a prospective observational study at a university-based retina practice, retinal thickness tomography was performed simultaneously for fifty-eight patients (91 eyes) with DR and VO employing a time domain and two spectral domain OCTs. Agreement in macular measurements was assessed by constructing Bland-Altman plots. Intraclass repeatability was assessed by intraclass correlation coefficients …

Post-Cataract Outcomes In Patients With Noninfectious Posterior Uveitis Treated With The Fluocinolone Acetonide Intravitreal Implant., John D. Sheppard, Quan Dong Nguyen, Dale W. Usner, Timothy L. Comstock

Journal Articles: Ophthalmology

PURPOSE: To describe visual acuity (VA) and inflammation following cataract surgery in eyes with noninfectious posterior uveitis (NIPU) that were being treated with a fluocinolone acetonide (FA) intravitreal implant compared with those that were not.

DESIGN: Post hoc, subgroup analysis of data from a 3-year, dose-masked, randomized, multicenter trial evaluating the FA implant for the treatment of NIPU.

PARTICIPANTS AND CONTROLS: The subset of eyes that underwent cataract surgery during the 3-year trial. Eyes were either implanted with a 0.59- or a 2.1-mg FA implant, or, in the case of affected fellow eyes, received standard-of-care local treatment.

MAIN OUTCOME MEASURES: …

Persistent Systemic Inflammation Is Associated With Poor Clinical Outcomes In Copd: A Novel Phenotype, Alvar Agustí, Lisa D. Edwards, Stephen I. Rennard, William Macnee, Ruth Tal-Singer, Bruce E. Miller, Jørgen Vestbo, David A. Lomas, Peter M.A. Calverley, Emiel Wouters, Courtney Crim, Julie C. Yates, Edwin K. Silverman, Harvey O. Coxson, Per Bakke, Ruth J. Mayer, Bartolome Celli, Evaluation Of Copd Longitudinally To Identify Predictive Surrogate Endpoints (Eclipse) Investigators

Journal Articles: Pulmonary & Critical Care Med

BACKGROUND: Because chronic obstructive pulmonary disease (COPD) is a heterogeneous condition, the identification of specific clinical phenotypes is key to developing more effective therapies. To explore if the persistence of systemic inflammation is associated with poor clinical outcomes in COPD we assessed patients recruited to the well-characterized ECLIPSE cohort (NCT00292552).

METHODS AND FINDINGS: Six inflammatory biomarkers in peripheral blood (white blood cells (WBC) count and CRP, IL-6, IL-8, fibrinogen and TNF-α levels) were quantified in 1,755 COPD patients, 297 smokers with normal spirometry and 202 non-smoker controls that were followed-up for three years. We found that, at baseline, 30% of …

Hypertension In A Young Boy: An Energy Drink Effect, Asma Usman, Ambreen Jawaid

Department of Family Medicine

Background: Use of energy drinks has significantly increased in recent times. Besides athletes, teenagers and students are among the most common consumers. However, popularity is also increasing among the younger and older age groups. Most of the users believe that they are a good source of instant energy and are unaware of its high Caffeine content resulting in harmful effects on health.Case Presentation: We report the case of a young boy who presented with palpitations and high blood pressure as a result of energy drinks usage. He had been consuming a "Sting" energy drink on regular basis while studying …