Medical Specialties Commons^™

‘What’S In The Niddk Cdr?’—Public Query Tools For The Niddk Central Data Repository, Huaqin Pan, Mary-Anne Ardini, Vesselina Bakalov, Michael Delatte, Paul Eggers, Laxminarayana Ganapathi, Craig R. Hollingsworth, Joshua Levy, Sheping Li, Joseph Pratt, Norma Pugh, Ying Qin, Rebekah Rasooly, Helen Ray, Jean E. Richardson, Amanda Flynn Riley, Susan M. Rogers, Sylvia Tan, Charles F. Turner, Stacie White, Philip C. Cooley

Publications and Research

The National Institute of Diabetes and Digestive Disease (NIDDK) Central Data Repository (CDR) is a web-enabled resource available to researchers and the general public. The CDR warehouses clinical data and study documentation from NIDDK funded research, including such landmark studies as The Diabetes Control and Complications Trial (DCCT, 1983–93) and the Epidemiology of Diabetes Interventions and Complications (EDIC, 1994–present) follow-up study which has been ongoing for more than 20 years. The CDR also houses data from over 7 million biospecimens representing 2 million subjects. To help users explore the vast amount of data stored in the NIDDK CDR, we developed …

Post-Abortion Care In Pakistan: A National Study, Zeba Sathar, Susheela Singh, Zakir Hussain Shah, Gul Rashida, Iram Kamran, Kanwal Eshai

Reproductive Health

The objectives of this Population Council study were twofold: first to collect information on prevailing practices of abortion and post‐abortion care in Pakistan and, second, to gauge changes in the magnitude and quality of abortion‐related complications and care during the last decade (since the 2002 national study of “Unwanted Pregnancy and Post‐abortion Complications in Pakistan”). The study found that the level of post‐abortion family planning (FP) counseling in both public and private health facilities offering PAC services was inadequate. There has been no improvement over the decade in the level of counseling reported, and, even more disappointingly, only half of …

Retro-Aortic Left Renal Vein, Joann Aichroth, Rdms, Traci B. Fox, Ms, Rt(R), Rdms, Rvt

Department of Radiologic Sciences Faculty Papers

The term retro-aortic left renal vein (RLRV) is defined as the left renal vein coursing posterior to the abdominal aorta. RLRV is an uncommon condition in which the left renal vein passes posterior to the abdominal aorta and anterior to the vertebrae. RLRV may lead to left renal vein hypertension (LRVH) syndrome, which is also known as Nutcracker syndrome. Nutcracker syndrome (NCS) is a condition in which the left renal vein is compressed causing hypertension of the vessel. RLRV and Nutcracker syndrome are vascular anomalies considered to be of clinical importance especially during surgical procedures of the renal vasculature.

Unmet Need And Unintended Pregnancy: The Bigger Picture, Ian Askew

Reproductive Health

No abstract provided.

Hippocampal Neurogenesis And The Brain Repair Response To Brief Stereotaxic Insertion Of A Microneedle, Shijie Song, Shuojing Song, Chuanhai Cao, Xiaoyang Lin, Kunyu Li, Vasyl Sava, Juan Sanchez-Ramos

Neurology Faculty Publications

We tested the hypothesis that transient microinjury to the brain elicits cellular and humoral responses that stimulate hippocampal neurogenesis. Brief stereotaxic insertion and removal of a microneedle into the right hippocampus resulted in (a) significantly increased expression of granulocyte-colony stimulating factor (G-CSF), the chemokine MIP-1a, and the proinflammatory cytokine IL12p40; (b) pronounced activation of microglia and astrocytes; and (c) increase in hippocampal neurogenesis. This study describes immediate and early humoral and cellular mechanisms of the brain’s response to microinjury that will be useful for the investigation of potential neuroprotective and deleterious effects of deep brain stimulation in various neuropsychiatric disorders.

Neuromyelitis Optica In Child: Diagnostic And Therapeutic Challenges, Karolina Dembinski, Maria Gieron-Korthals, Carlos R. Martinez, Lisa Rodriguez

Pediatrics Faculty Publications

Neuromyelitis optica (NMO) is a rare syndrome of severe inflammatory demyelination of the central nervous system, causing attacks of optic neuritis and transverse myelitis. Although uncommon, attention should be given to the proper identification and management of the affected patients. We present a case of a 13-year-old girl with severe neuromyelitis optica. The patient’s initial presentation consisted of encephalopathy and optic neuritis. Approximately 2 months later, coinciding with the weaning of steroid treatment, she presented with ascending paralysis and respiratory failure. She was seropositive for NMO-IgG. Treatment included intravenous immune globulin, steroids, plasmapheresis, and rituximab and was complemented with proper …

Chiral Polarization Scale Of Qcd Vacuum And Spontaneous Chiral Symmetry Breaking, Andrei Alexandru, Ivan Horváth

Anesthesiology Faculty Publications

It has recently been found that dynamics of pure glue QCD supports the low energy band of Dirac modes with local chiral properties qualitatively different from that of a bulk: while bulk modes suppress chirality relative to statistical independence between left and right, the band modes enhance it. The width of such chirally polarized zone – chiral polarization scale Λch – has been shown to be finite in the continuum limit at fixed physical volume. Here we present evidence that Λch remains non–zero also in the infinite volume, and is therefore a dynamical scale in the theory. Our experiments in …

Tracking Transplanted Bone Marrow Stem Cells And Their Effects In The Rat Mcao Stroke Model., Gregory V Goldmacher, Rena Nasser, Daniel Y Lee, Sargon Yigit, Robert Rosenwasser, Lorraine Iacovitti

Farber Institute for Neuroscience Faculty Papers

In this study, rat bone marrow stromal stem cells (BMSCs) were tracked after IV administration to rats with experimental stroke caused by middle cerebral artery occlusion (MCAO). In addition, the effects of BMSC treatment on blood cell composition, brain glia and sensorimotor behavior was studied and compared to that which occurred spontaneously during the normal recovery process after stroke. We found that the vast majority of radiolabeled or fluorescently labeled BMSCs traveled to and remained in peripheral organs (lungs, spleen, liver) 3 days after IV injection in the MCAO rat. Once in the circulation, BMSCs also produced rapid alterations in …

Impairment Of Trkb-Psd-95 Signaling In Angelman Syndrome, Cong Cao, Mengia S. Rioult-Pedotti, Paolo Migani, Crystal J. Yu, Rakesh Tiwari, Keykavous Parang, Mark R. Spaller, Dennis J. Goebel, John Marshall

Pharmacy Faculty Articles and Research

Angelman syndrome (AS) is a neurodevelopment disorder characterized by severe cognitive impairment and a high rate of autism. AS is caused by disrupted neuronal expression of the maternally inherited Ube3A ubiquitin protein ligase, required for the proteasomal degradation of proteins implicated in synaptic plasticity, such as the activity-regulated cytoskeletal-associated protein (Arc/Arg3.1). Mice deficient in maternal Ube3A express elevated levels of Arc in response to synaptic activity, which coincides with severely impaired long-term potentiation (LTP) in the hippocampus and deficits in learning behaviors. In this study, we sought to test whether elevated levels of Arc interfere with brain-derived neurotrophic factor (BDNF) …

Corneal Gene Therapy: Basic Science And Translational Perspective, Rajiv R. Mohan, Jason T. Rodier, Ajay Sharma

Pharmacy Faculty Articles and Research

Corneal blindness is the third leading cause of blindness worldwide. Gene therapy is an emerging technology for corneal blindness due to the accessibility and immune-privileged nature of the cornea, ease of vector administration and visual monitoring, and ability to perform frequent noninvasive corneal assessment. Vision restoration by gene therapy is contingent upon vector and mode of therapeutic gene introduction into targeted cells/tissues. Numerous efficacious vectors, delivery techniques, and approaches have evolved in last decade for developing gene-based interventions for corneal diseases. Maximizing the potential benefits of gene therapy requires efficient and sustained therapeutic gene expression in target cells, low toxicity, …

Mers-Cov - Are We On The Verge Of A Pandemic?, Bushra Jamil, Kiren Habib

Department of Medicine

No abstract provided.

A Double Blind Community-Based Randomized Trial Of Amoxicillin Versus Placebo For Fast Breathing Pneumonia In Children Aged 2-59 Months In Karachi, Pakistan (Retapp), Fyezah Jehan, Muhammad Imran Nisar, Salima Kerai, Nick Brown, Benazir Balouch, Zulfiqar Hyder, Gwen Ambler, Amy Sarah Ginsburg, Anita K. M. Zaidi

Department of Paediatrics and Child Health

Background: Fast breathing pneumonia is characterized by tachypnoea in the absence of danger signs and is mostly viral in etiology. Current guidelines recommend antibiotic therapy for all children with fast breathing pneumonia in resource limited settings, presuming that most pneumonia is bacterial. High quality clinical trial evidence to challenge or support the continued use of antibiotics, as recommended by the World Health Organization is lacking.

Methods/Design: This is a randomized double blinded placebo-controlled non-inferiority trial using parallel assignment with 1:1 allocation ratio, to be conducted in low income squatter settlements of urban Karachi, Pakistan. Children 2-59 months old with fast …

Vitamin D Accelerates Clinical Recovery From Tuberculosis: Results Of The Succinct Study [Supplementary Cholecalciferol In Recovery From Tuberculosis]. A Randomized, Placebo-Controlled, Clinical Trial Of Vitamin D Supplementation In Patients With Pulmonary Tuberculosis'., Nawal Salahuddin, Farheen Ali, Zahra Hasan, Nisar Rao, Masooma Aqeel, Syed Faisal Mahmood

Department of Medicine

BACKGROUND:

Vitamin D enhances host protective immune responses to Mycobacterium tuberculosis by suppressing Interferon-gamma (IFN-g) and reducing disease associated inflammation in the host. The objectives of this study were to determine whether vitamin Dsupplementation to patients with tuberculosis (TB) could influence recovery.

METHODS:

Two hundred and fifty nine patients with pulmonary TB were randomized to receive either 600,000 IU of Intramuscular vitamin D3 or placebo for 2 doses. Assessments were performed at 4, 8 and 12 weeks. Early secreted and T cell activated 6 kDa (ESAT6) and Mycobacterium tuberculosis sonicate (MTBs) antigen induced whole blood stimulated IFN-g responses were measured …

Surgical Outcomes Of Pediatric Patients With Ventricular Septal Defects In A Tertiary Referral Center In Pakistan: A Retrospective Cohort Study, Omair Bushra, Muneer Amanullah, Atiq Mehnaz

Department of Paediatrics and Child Health

Background: The nature of complications and outcomes for Ventricular septal defect (VSD) repair differ between developed and developing countries. Understanding these differences can help optimize patient management according to geographical location.
Objective: The purpose of this study was to investigate the risk factors associated with in-hospital peri- and post-surgical complications of VSD repair in a developing country.
Design: A retrospective cohort study. Setting: A tertiary referral center. Participants: 117 patients under 18 years of age admitted for surgical closure of ventricular septal defect between July 1998 and June 2008.
Main Outcomes: Only patients with isolated VSD or VSD associated with …

Improved Accessibility Of Emergency Obstetrics And Newborn Care (Emonc) Services For Maternal And Newborn Health: A Community Based Project, Ali Turab, Shabina Ariff, Atif Habib, Imran Ahmed, Masawar Hussain, Akhtar Rashid, Zahid Memon, M. Imran Khan, Sajid Soofi, Zulfiqar A Bhutta

Department of Paediatrics and Child Health

Background: Every year an estimated three million neonates die globally and two hundred thousand of these deaths occur in Pakistan. Majority of these neonates die in rural areas of underdeveloped countries from preventable causes (infections, complications related to low birth weight and prematurity). Similarly about three hundred thousand mother died in 2010 and Pakistan is among ten countries where sixty percent burden of these deaths is concentrated. Maternal and neonatal mortality remain to be unacceptably high in Pakistan especially in rural areas where more than half of births occur.
Method/Design: This community based cluster randomized controlled trial will …

Global Epidemiology Of Invasive Meningococcal Disease, Rabab Z. Jafri, Syed Asad Ali, Nancy E. Messonnier, Carol Tevi-Benissan, David Durrheim, Juhani Eskola, Florence Fermon, Keith P. Klugman, Mary Ramsay, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Neisseria meningitidis is one of the leading causes of bacterial meningitis globally and can also cause sepsis, pneumonia, and other manifestations. In countries with high endemic rates, the disease burden places an immense strain on the public health system. The worldwide epidemiology of invasive meningococcal disease (IMD) varies markedly by region and over time. This review summarizes the burden of IMD in different countries and identifies the highest-incidence countries where routine preventive programs against Neisseria meningitidis would be most beneficial in providing protection. Available epidemiological data from the past 20years in World Health Organization and European Centre for Disease Prevention …

Micronutrient Fortification Of Food And Its Impact On Woman And Child Health: A Systematic Review, Jai K. Das, Rehana A. Salam, Rohail Kumar, Zulfiqar A. Bhutta

Department of Paediatrics and Child Health

Background: Vitamins and minerals are essential for growth and metabolism. The World Health Organization estimates that more than 2 billion people are deficient in key vitamins and minerals. Groups most vulnerable to these micronutrient deficiencies are pregnant and lactating women and young children, given their increased demands. Food fortification is one of the strategies that has been used safely and effectively to prevent vitamin and mineral deficiencies.
Methods: A comprehensive search was done to identify all available evidence for the impact of fortification interventions. Studies were included if food was fortified with a single, dual or multiple micronutrients and impact …

Pediatric Medical Traumatic Stress : The Impact On Children, Parents And Staff, Sarah Mcgarry

Theses: Doctorates and Masters

Burns are one of the most painful and traumatising injuries an individual can sustain and constitute a serious global health threat to children. Despite the magnitude of this public health problem, little research has examined the psychological burden of these injuries. This study used a mixed-methods approach to investigate the effect of paediatric medical trauma on children who have sustained a burn, their parents and the healthcare professionals caring for these patients. The paediatric medical traumatic stress model provided a theoretical framework for this study.

Firstly, this study aimed to gain an understanding of the lived experience of children who …

The Identification Of Diagnostic Serological Autoantibodies For Cutaneous Melanoma, Pauline Zaenker

Theses: Doctorates and Masters

Abstract not available.

What Are The New Therapeutic Alternatives To Warfarin In Atrial Fibrillation?, Syed Habibullah Kamran, Ayeesha Kamran Kamal, Syeda Maria Muzammil

Department of Medicine

No abstract provided.

Role Of Human Metapneumovirus, Influenza A Virus And Respiratory Syncytial Virus In Causing Who-Defined Severe Pneumonia In Children In A Developing Country, Asad Ali, Asif Raza Khowaja, Maaman Zahoor Bashir, Fatima Aziz, Sultan Mustafa, Anita Zaidi

Department of Paediatrics and Child Health

Objective: The role of respiratory viruses in causing severe, life threatening pneumonia in children in developing countries is not well established. Our study aims to determine the role of human metapneumovirus (HMPV), influenza A virus and respiratory syncytial virus (RSV) in children, aged 6 weeks to 2 years, hospitalized with WHO defined severe pneumonia (tachypnea plus any general danger sign or chest in-drawing) at a public sector hospital in Karachi, Pakistan.
Methods: This study was conducted from November 2010 to September 2011 at Abbassi Shaheed Hospital, a large public tertiary care hospital in Karachi, Pakistan. Children admitted with WHO-defined severe …

Trends Of Empiric Antibiotic Usage In A Secondary Care Hospital, Karachi, Pakistan, Syed Rehan Ali, Shakeel Ahmed, Heeramani Lohana

Department of Paediatrics and Child Health

Objectives: (1) To determine the indications, frequency, and types of antibiotics used in hospitalized paediatric patients at tertiary care hospital and (2) to evaluate whether the prescribed antibiotics were based on the isolation of organism and their sensitivity. Study Design: Descriptive observational hospital based study.
Results: A total of 131 patients were included over 6 months of study period, in whom antibiotics were prescribed at the time of admission. The majority were between 1 and 5 years of age. M:F ratio was 1:1. Fever was the commonest symptom (in 84% of cases) followed by gastroenteritis. Blood culture was done in …

Quadricuspid Aortic Valve With Aortic Regurgitation: A Rare Echocardiographic Finding., Javed Tai, Abid Laghari, Cyrus Tariq Gill

Department of Medicine

We report on a middle-aged woman treated for chronic hepatitis C virus infection with pegylated interferon. Auscultation revealed a diastolic murmur and the peripheral signs of aortic regurgitation. She had shortness of breath on moderate exertion for the past 4 months, which she attributed to her liver disease. Echocardiogram showed a quadricuspid aortic valve with severe aortic regurgitation. She was referred to a cardiothoracic surgeon for aortic valve replacement (AVR). However, she decided against AVR despite detailed counselling, and opted for medical treatment.

Midterm Results Of Bovine Jugular Vein Conduit For Right Ventricular Outflow Tract Reconstruction, Shazia Samad Mohsin, Maria Tariq Siddiqui, Abdul Sattar Shaikh, Mehnaz Atiq, Muneer Amanullah

Department of Paediatrics and Child Health

Objective: To evaluate the midterm results of Contegra conduit.
Methods: The retrospective study comprised patient record at Aga Khan University Hospital, Karachi, of conduits implanted between May 2007 and June 2012. Data collection was made from the clinical notes and from serial echocardiograms by a single cardiologist. The last followup echocardiography was done at the time of data collection in June 2012. SPSS 19 was used for statistical analysis.
Results: A total of 18 conduits had been implanted (16-22mm) during the study period. Median age at the time of surgery was 9 years (range: 2.5-16 years). Early mortality was seen …

Setting Research Priorities For Preconception Care In Low- And Middle-Income Countries: Aiming To Reduce Maternal And Child Mortality And Morbidity, Sohni Dean, Igor Rudan, Fernando Althabe, Aimee Webb Girard, Christopher Howson, Ana Langer, Joy Lawn, Mary-Elizabeth Reeve, Katherine C. Teela, Mireille Toledano

Department of Paediatrics and Child Health

No abstract provided.

Optic Neuritis Due To Toxoplasmosis: First And Only Manifestation Of Newly Diagnosed Aids, Rajesh Kumar Md, Yehia Y. Mishriki Md

Department of Medicine

No abstract provided.

Merkel Cell Carcinoma, Cynthia L. Bartus Md, Steven Oberlender Md, Phd, Christian W. Oram Do

Department of Medicine

No abstract provided.

Interrupted Aortic Arch In The Adult, Amit Nanavati Md, Matthew W. Martinez, Nainesh Patel Md

Department of Medicine

No abstract provided.

Rapid Door To Balloon Time In The Treatment Of Acute St-Elevation Myocardial Infarction Is Associated With Reduced Length Of Hospital Stay, Amit Nanavati Md, David A. Cox Md, J Patrick Kleaveland Md, Orlando E. Rivera Rn, Nainesh Patel Md

Department of Medicine

No abstract provided.

Blood Glucose Responses To Type, Intensity, Duration, And Timing Of Exercise, Sheri R. Colberg, Manuel J. Hernandez, Fatima Shahzad

Human Movement Studies & Special Education Faculty Publications

[First Paragraph] The Big Blue Test (BBT) is an annual initiative by the Diabetes Hands Foundation to raise awareness of the importance of physical activity in managing diabetes. Individuals with diabetes voluntarily exercise and record self-monitored blood glucose levels. During the 2012 BBT, 5,157 diabetic participants (~90% insulin users) anonymously entered exercise type, intensity, duration, time elapsed since last meal, and blood glucose readings before and after one or more bouts of exercise separately through www.BigBlueTest.org or an Iphone app.