Medical Specialties Commons^™

Lipid Targets In Clinical Practice: Successes, Failures And Lessons To Be Learned, M Dunne, Oscar Mac Ananey, V Maher

Articles

Abstract

INTRODUCTION:

Optimal risk factor control is integral to managing patients with proven coronary heart disease (CHD+) and for those at risk of coronary heart disease (CHD-). The primary aim of the study was to assess the success rate of reaching lipid risk factor targets in a multiple risk factor clinic.

METHODS:

A retrospective audit was conducted in 488 patients (CHD+, n = 112; CHD-, n = 376) who attended the Cardiovascular Risk Factor Clinic at Tallaght Hospital, Dublin in 2009 and 2010.

RESULTS:

Risk factor targets achieved in CHD+ and CHD- patients were LDLc (54/62 %), HDLc (67/67 %), …

Tyrosinase Reactive T Cells Reject Or Edit Established Human Melanomas In Vivo, Telma Raquela Martins Da Palma

MUSC Theses and Dissertations

Adoptive transfer of T cell receptor (TCR) gene transduced T cells can mediate dramatic tumor regressions in melanoma patients. However, improvements in these therapies are needed as most patients either fail to respond to the therapy or eventually experience recurrent disease. To evaluate the therapeutic potential of T cells expressing the high-affinity TIL 1383I TCR for treatment of human melanomas, we developed xenograft models for the malignancy. Human T cells transduced with the TIL 1383I TCR exhibited strong in vitro reactivity against HLA-A2+Tyrosinase+ targets but failed to impact tumor growth in vivo. In contrast, TIL 1383I TCR-expressing murine T cells …

Combination Therapy For Inflammation And Neurodegeneration In Multiple Sclerosis Rodent Model, Nicole Neva Marie Trager

MUSC Theses and Dissertations

Multiple sclerosis (MS) is a complex demyelinating CNS disease that involves both immunologic and neurodegenerative mechanisms of pathophysiology. MS is characterized by lymphocyte infiltration in the CNS resulting in extensive axonal neurodegenerative processes. The current therapies for MS act through either immunomodulatory or immunosuppressive mechanisms; none address both the immune and degenerative arms of the disease. The immunomodulatory agents are generally broad spectrum and non-specific immunosuppression and are associated with significant toxicities. Thus, novel therapies or therapeutic strategies are needed to fully combat both inflammatory and neurodegenerative events that define MS. The animal model experimental autoimmune encephalomyelitis (EAE) is used …

Prevalence And Factors Associated With Depression Among Patients With Epilepsy In A Kenyan Tertiary Care Hospital, Nduku Kiko

Master of Medicine in Internal Medicine

Aim: To determine the prevalence and factors associated with depression in patients with epilepsy at Aga Khan University Hospital Nairobi. Design: Cross-sectional Survey Background: Depression is a recognized common co-morbidity of epilepsy that often goes untreated and has great impact on quality of life of patients and management of patients with epilepsy. Patients and Setting: Patients with epilepsy on follow up at the Aga Khan University Hospital were evaluated for presence and factors associated with depression. Methodology: The study recruited eligible patients with epilepsy who were on follow up in the neurology clinic. Beck Depression Inventory was administered to evaluate …

Early Onset Type 2 Diabetes And Associated Risk Factors, Grace Nyambura Kiraka

Master of Medicine in Clinical Pathology

Background: The incidence of type 2 diabetes in patients below the age of 40 (early onset diabetes) is markedly on the rise and has been linked increased prevalence of risk factors such as the metabolic syndrome and family history of diabetes. Objective: To determine the proportion of patients with type 2 diabetes at Aga Khan University Hospital Nairobi (AKUHN) who have early onset type 2 diabetes and the association of age of onset with risk factors (family history of diabetes, obesity, waist circumference, hypertension, low HDL cholesterol and hypertriglyceridaemia) in this group of patients. Methods: This was a cross sectional …

Primary Antiretroviral Drug Resistance Profiles Among Hiv-1 Therapy Naïve Patients In Two Referral Hospitals In Kenya, Simon Onsongo Nyangena

Master of Medicine in Clinical Pathology

Objective: To characterize antiretroviral drug resistance mutations among drug naïve patients in two referral hospitals in Kenya Background: Acquired immunodeficiency syndrome (AIDS) caused by Human immunodeficiency virus (HIV) was first described in 1982. Since then the virus has spread globally to infect millions of people. HIV was first described in Kenya in the period between 1984/1985. Currently, Kenya has an estimated HIV-1 prevalence of 6.2% with a country population of about 40 million people. With the introduction of antiretroviral drugs, the survival of most HIV patients has been prolonged markedly. However this is greatly threatened by increasing rates of antiretroviral …

Acid Ceramidase Promotes Akt Activation And Nuclear Export Of Pten Through S1p Signaling, Thomas Hendrix Beckham

MUSC Theses and Dissertations

Prostate cancer is a leading cause of cancer and cancer-related mortality in males in the United States. Acid ceramidase is frequently overexpressed in prostate cancer and catalyzes the deacylation of proapoptotic ceramide into sphingosine. Sphingosine is converted by sphingosine kinases into sphingosine 1-phosphate, which promotes numerous pro-cancer phenotypes. Due to the frequent overexpression of acid ceramidase in prostate cancer and its net cancer promoting signaling effects achieved by reducing ceramide and generating sphingosine 1-phosphate, the impact of acid ceramidase, and the lipid profiles it alters, on prostate cancer cell signaling were studied. Here we report the activation of the oncogeneic …

Prevalence Of Vitamin D Deficiency In An Ethnic African Urban Obstetric Population In An Equatorial City Hospital, Raj Hasmukh Dodia

Master of Medicine in Obstetrics and Gynecology

Introduction: Low Vitamin D levels in pregnancy have been associated with an increased risk of gestational diabetes, pre-eclampsia, bacterial vaginosis, preterm birth, disordered fetal skeletal homeostasis, and impaired offspring lung health. As a result, current public health advice in several countries is to universally supplement Vitamin D during pregnancy. Data regarding the Vitamin D levels of the ethnic obstetric population in Kenya are not available; hence recommendations for Vitamin D supplementation have no scientific basis. Objectives of study: This research was carried out to determine the prevalence of deficiency of Vitamin D in ethnic African obstetric patients who had delivered …

Discovery Of Novel Prognostic Biomarkers Of Acute Kidney Injury, Joseph Lee Alge

MUSC Theses and Dissertations

Background: Acute kidney injury is a cause of significant morbidity and mortality in hospitalized patients. Prognostic biomarkers that predict at the time of diagnosis which patients will develop severe AKI and its complications would facilitate timely intervention and could lead to improved outcomes. The urinary proteome is a logical source of candidate biomarkers of kidney injury. Methods: Urine was collected from rodents and human subjects with AKI secondary to diverse etiologies, including cardiac surgery, ischemic/hypoxic injury, and nephrotoxicity. Shotgun proteomics was used to identify candidate biomarkers in four separate discovery phase experiments. These candidates were then verified in a larger …

Value-Based Analysis Of Routine Pathologic Septal And Inferior Turbinate Specimens., James J Daniero, Jaemi S Chu, Brian J O'Hara, Edmund A. Pribitkin

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

This article was presented at the 2012 AAO-HNSF Annual Meeting & OTO EXPO; September 9-12, 2012; Washington, DC.

Objective To determine the frequency and clinical relevance of unanticipated histopathologic results in routine sinonasal surgery and evaluate the necessity for histologic processing of nasal septal cartilage, bone, and inferior turbinate specimens. Study Design Case series with chart review. Setting Tertiary care academic medical center. Subjects and Methods A retrospective review of surgical pathology reports on adult patients undergoing sinonasal surgery during a 5-year period from 2005 to 2010 was performed. All cases with the preoperative diagnosis of sinonasal neoplasia, autoimmune disease, …

Melatonin Supplementation Improves Glycemic Control While Lowering Oxidative Stress In Type 2 Diabetes, Carmine R. Grieco, Sheri R. Colberg, C. Thomas Somma, Andrew G. Thompson, Aaron I. Vinik

Human Movement Studies & Special Education Faculty Publications

The purpose of this investigation was to evaluate the effect of melatonin on glycemic control and oxidative stress (OS) in adults with type 2 diabetes (T2D). Fourteen subjects with T2D (10 female, 4 male; 52.5 ± 5.0 years) were randomly assigned to melatonin (MEL) or placebo groups (PLA) for 42 days, in a crossover design. Subjects ingested 10 mg of MEL or an identical placebo (PLA) 30 minutes prior to sleep. Fasting blood draws occurred at baseline, 42 days, and 84 days. Plasma malondialdehyde, a marker of OS, significantly decreased on MEL (-6.25±2.10 nmol/ml) compared to PLA (0.72±3.30, p=0.028). The …

The Big Blue Test: Effects Of 14 Minutes Of Physical Activity On Blood Glucose Levels, Sheri R. Colberg, Manuel J. Hernandez

Human Movement Studies & Special Education Faculty Publications

[First paragraph] For most with diabetes, physical activity has a blood glucose lowering effect (1). Hypoglycemia (i.e., blood glucose < 65 mg/dL) resulting from exercise is a concern, particularly for insulin users (2).

Quality Of Care And Client Willingness To Pay For Family Planning Services At Marie Stopes International In Burkina Faso, Placide Tapsoba, Dalomi Bahan, Emily Forsyth Queen, Gisele Kaboré, Sally Hughes

Reproductive Health

Many sexual and reproductive health programs operating in a limited-resource setting face a challenging balancing act between making services accessible and affordable to clients, including those most in need, and remaining financially sustainable. To achieve these dual objectives, the Population Council, with Marie Stopes International in Burkina Faso (MSI BF), launched a willingness-to-pay (WTP) study that examined the current situation and numerous pricing options, proposing optimal prices for products and services. The process of implementing the WTP survey was insightful for MSI BF as it provided evidence on client satisfaction with services and willingness to contribute to the cost of …

Access To Emergency Contraception And Safe Abortion Services For Survivors Of Rape And Defilement In Sub-Saharan Africa: A Regional Overview, Jill Thompson, Chi-Chi Undie, Ian Askew

Reproductive Health

No abstract provided.

The Impairment Of Macrophage-To-Feces Reverse Cholesterol Transport During Inflammation Does Not Depend On Serum Amyloid A, Maria C. De Beer, Joanne M. Wroblewski, Victoria P. Noffsinger, Ailing Ji, Jason M. Meyer, Deneys R. Van Der Westhuyzen, Frederick C. De Beer, Nancy R. Webb

Saha Cardiovascular Research Center Faculty Publications

Studies suggest that inflammation impairs reverse cholesterol transport (RCT). We investigated whether serum amyloid A (SAA) contributes to this impairment using an established macrophage-to-feces RCT model. Wild-type (WT) mice and mice deficient in SAA1.1 and SAA2.1 (SAAKO) were injected intraperitoneally with ³H-cholesterol-labeled J774 macrophages 4 hr after administration of LPS or buffered saline. ³H-cholesterol in plasma 4 hr after macrophage injection was significantly reduced in both WT and SAAKO mice injected with LPS, but this was not associated with a reduced capacity of serum from LPS-injected mice to promote macrophage cholesterol efflux in vitro. Hepatic accumulation of ^{3 …}

Comprendre Les Grossesses Non Désirées Au Sénégal: Rapport Du Profil Pays, Kaila Clarke, Mohamadou Sall, Babacar Mane, Nafissatou Diop, Bocar Mamadou Daff

Reproductive Health

Un profil pays a été préparé pour le Sénégal pour compiler et synthétiser les informations disponibles sur la santé de la reproduction, en particulier les grossesses non désirées et par conséquent les besoins non satisfaits en matière de planification familiale. D’importants efforts ont été consentis par l’Etat sénégalais, mais de nombreux obstacles continuent de freiner les progrès réalisés. Un programme national plus cohérent et ciblé est donc nécessaire pour réduire ces obstacles. Dans le même temps, les acteurs non-gouvernementaux devraient poursuivre leurs efforts pour renforcer leur programmation pour produire des effets plus immédiats, tout en assurant une meilleure coordination entre …

Availability, Use And Quality Of Care For Medical Abortion Services—Preliminary Results Of Two Components: Kiis And The Pharmacy Study, Wilson Liambila, Harriet Birungi, Francis Onyango, Brian Mdawida, Vitalis Akora, Thoai Ngo, Kate Reiss

Reproductive Health

No abstract provided.

The Effects Of The A Matter Of Balance Program On Falls, Physical Risks Of Falls, And Psychological Consequences Of Falling Among Older Adults, Tuo Yu Chen

USF Tampa Graduate Theses and Dissertations

The effectiveness of the A Matter of Balance (MOB) program, a multifactorial falls prevention intervention, is uncertain. Although targeting multiple risk factors of falling at the same time seems reasonable and desirable, in that falls are often caused by several risk factors, results from previous studies investigating the effects of multifactorial falls prevention interventions are inconsistent. In addition, research shows that single factor interventions (e.g., exercise) can produce the same effects. The cost-effectiveness of multifactorial falls prevention interventions has varied across studies (e.g., Jenkyn, Hoch, & Speechley, 2012; Tinetti, Baker, et al., 1994). Despite the fact that the American Geriatrics …

Xiaoqinglong Granules As Add-On Therapy For Asthma: Latent Class Analysis Of Symptom Predictors Of Response., Qinglin Zha, Seqi Lin, Chi Zhang, Christopher Chang, Hanrong Xue, Cheng Lu, Miao Jiang, Yan Liu, Zuke Xiao, Weiyou Liu, Yunfei Shang, Jianjian Chen, Minyong Wen, Aiping Lu

Department of Medicine Faculty Papers

Xiaoqinglong granules (XQLG) has been shown to be an effective therapy in asthma animal models. We reviewed the literature and conducted this study to assess the impact of XQLG as an add-on therapy to treatment with fluticasone/salmeterol (seretide) in adult patients with mild-to-moderate, persistent asthma. A total of 178 patients were randomly assigned to receive XQLG and seretide or seretide plus placebo for 90 days. Asthma control was assessed by asthma control test (ACT), symptoms scores, FEV(1), and PEF. Baseline patient-reported Chinese medicine (CM)-specific symptoms were analyzed to determine whether the symptoms may be possible indicators of treatment response by …

Vascular Endothelial Growth Factor (Vegf) Expression In Locally Advanced Prostate Cancer: Secondary Analysis Of Radiation Therapy Oncology Group (Rtog) 8610., Larry Pan, Seunghee Baek, Pamela R Edmonds, Mack Roach, Harvey Wolkov, Satish Shah, Alan Pollack, M Elizabeth Hammond, Adam P Dicker

Department of Radiation Oncology Faculty Papers

BACKGROUND: Angiogenesis is a key element in solid-tumor growth, invasion, and metastasis. VEGF is among the most potent angiogenic factor thus far detected. The aim of the present study is to explore the potential of VEGF (also known as VEGF-A) as a prognostic and predictive biomarker among men with locally advanced prostate cancer.

METHODS: The analysis was performed using patients enrolled on RTOG 8610, a phase III randomized control trial of radiation therapy alone (Arm 1) versus short-term neoadjuvant and concurrent androgen deprivation and radiation therapy (Arm 2) in men with locally advanced prostate carcinoma. Tissue samples were obtained from …

Controversies About Radioactive Iodine-131 Remnant Ablation In Low Risk Thyroid Cancers: Are We Near A Consensus?, Maseeh Uz Zaman, Nosheen Fatima, Ajit Kumar Padhy, Unaiza Zaman

Department of Radiology

Well differentiated thyroid cancers (WDTC), including papillary (80%) and follicular (10%) types, are the most common endocrine cancers globally. Over the last few decades most the diagnosed cases have fallen into low risk categories. Radioactive iodine-131 (RAI) has an established role in reducing recurrence and improving the survival in high risk patients. In patients with primary tumor size <1 >cm, RAI is not recommended by many thyroid societies. However, low risk WDTC has been an arena of major controversies, most importantly the role and dose of adjuvant RAI for remnant ablation to minimize chances of recurrence and improving survival. This review …

Effects Of Intravenous Diclofenac On Postoperative Sore Throat In Patients Undergoing Laparoscopic Surgery At Aga Khan University Hospital, Nairobi: A Prospective, Randomized, Double Blind Controlled Trial, Thang'a P., Dorothy Kamya, Vitalis Mung’Ayi

Anaesthesiology, East Africa

Background: Postoperative sore throat is the commonest complication after endotracheal intubation. The efficacy of intravenous non-steroidal anti-inflammatory drugs in alleviating postoperative sore throat has not been investigated.

Objective: To evaluate the effect of intravenous diclofenac sodium on the occurrence and severity of postoperative sore throat.

Methods: 42 in-patients scheduled for laparoscopic surgery were randomized into two equal groups to receive either a single dose of 75mg intravenous diclofenac sodium in addition to standard treatment taken at our hospital for the prevention of postoperative sore throat or to receive standard treatment only. All patients were interviewed postoperatively at 2, 6 and …

Winning The Battle Against Surgical Site Infections, Lisa Farthing Msn, Rn, Cnor, Michelle Reigard Rn, Cnor

Patient Care Services / Nursing

No abstract provided.

Is Bisphenol-A Exposure During Pregnancy Associated With Blood Glucose Levels Or Diagnosis Of Gestational Diabetes?, Candace A. Robledo, Jennifer D. Peck, Julie A. Stoner, Hélène Carabin, Linda Cowan, Holger M. Koch, Jean R. Goodman

School of Medicine Publications

Recent epidemiological studies indicate bisphenol A (BPA), an estrogenic chemical used in production of epoxy, polycarbonate, and plastic may increase risk of insulin resistance and type 2 diabetes. Exposure to BPA during pregnancy may contribute to development of gestational diabetes mellitus (GDM), a precursor to type 2 diabetes in women. This pilot study examined the association between BPA exposure, fasting blood glucose levels (FBG), and GDM diagnosis during pregnancy. Banked urine samples from 22 cases of GDM and 72 controls were analyzed for total (free BPA + conjugates) urinary BPA concentrations (μg/L). FBG levels (mg/dl) were obtained from 1-h 50-g …

Uterine Fibroid Embolization For Symptomatic Fibroids; Correlation Of Mid-Term Changes In Disease-Specific Symptoms And Magnetic Resonance Imaging Results At A Teaching Hospital In Kenya, John Kiprop Mutai

Master of Medicine in Imaging and Diagnostic Radiology

Background: Uterine fibroid embolization, though a widely available option in high income countries in managing symptomatic fibroids is relatively new in the East African region. It is currently offered at only one tertiary facility for the past three years. The symptom and radiological response in these patients, who literature suggests may have bigger fibroid burden and worse symptoms, is the subject of this study. Objective: Characterization of MRI imaging features in women undergoing uterine fibroid embolization and identification of clinical correlates in an African population. Methods: Patients with symptomatic fibroids who are selected to undergo UFE at the hospital formed …

The Role Of Inflammation In Contrast Induced Nephropathy, Elijah A. Kwasa

Master of Medicine in Imaging and Diagnostic Radiology

Background: Intravenously administered iodinated contrast media are widely and liberally used in daily diagnostic radiological investigations. Contrast-induced nephropathy (CIN) is notable as the third commonest cause of hospital-acquired renal injury. Justification: The global prevalence of CIN from various studies ranges from 2-5% but an incidence of CIN of 12-14% in Kenya was highlighted by a recent study without an explanation for the markedly increased incidence. Intravascular contrast has been demonstrated to commonly cause renal vasoconstriction. However, the low incidence of CIN in the general population infers that contrast alone cannot be a causative insult. This study proposes that inflammatory states, …

Rational Use Of Antibiotics--A Quality Improvement Initiative In Hospital Setting, Sidrah Nausheen, Rabia Hammad, Ambreen Khan

Department of Obstetrics & Gynaecology

Objectives: To minimise irrational use of antibiotics by implementing guidelines for antibiotic usage in obstetrics and Gynaeocology.
Methods: The observational study was conducted from January to December 2010 at the maternity unit of Aga Khan Hospital for Women and children, Kharadar, a secondary care facility in Karachi, Pakistan. Data was collected from medical records related to the study period. Prophylactic antibiotics were given according to the American College of Obstetricians and Gynaecologists recommendation 2009. Surveillance was done by surgical site infection rates and infectious morbidity. Data was analysed on SPSS 13.
Results: Therapeutic antibiotic use was rationalized, reducing the use …

Assessment Of Experimental Animal Model For Training Obstetric Anal Sphincter Injury Techniques, Raheela Mohsin Rizvi

Department of Obstetrics & Gynaecology

The Multiparous Goat Pelvic Model was used to train obstetricians and residents for perineal and anal sphincter anatomy and techniques of repair of Obstetric Anal Sphincter Injuries (OASIs). The purpose of this study was to assess the similarity of this model with human anatomy and the usefulness of goat model for training obstetricians for perineal tears. Six workshops were conducted between June 2009 and December 2010. A total of 90 participants, including 64(70.3%) residents and 26(28.5%) consultants in Obstetrics and Gynaecology, attended hands-on training workshops using experimental goat pelvic model for the repair of perineal tears. Among the consultants, 23 …

A Review Of Comparison Of Complications Of Vaginal Hysterectomy With And Without Concomitant Surgery For Sui: A 5 Years’ Experience At A Tertiary Care Hospital Of Pakistan, Raheela Mohsin Rizvi, Munnazza Akhtar, Nadeem F. Zuberi

Department of Obstetrics & Gynaecology

Objective. The study was performed to review the complications of surgery for POP with or without surgery for SUI. This included the need for second procedure two years after the primary surgery. Study Design. We conducted a retrospective cross-sectional comparative study at the Aga Khan University, Karachi, Pakistan. International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) was used to identify women who underwent vaginal hysterectomy with anterior/posterior repair alone and those with concomitant tension-free vaginal tape surgery for urodynamic stress incontinence. Results. The 28 cases of VH/repair combined with TVT were compared for complications with 430 cases of VH …

Frequent Hypomethylation Of Ptgs2 Gene Promoter In Human Term Placenta, Nuruddin Mohammad, Ahmed Yaqinuddin, Fatima Kakal, Lumaan Sheikh, Rahat Qureshi, Mehreen Soman

Department of Obstetrics & Gynaecology

Background: Gene expression profiles of several tumor suppressor genes are regulated by the methylation and demethylation of their promoters. Here, we aim to identify and quantify the methylation status of four tumor suppressor genes from placentas at term and compare them with the maternal white-blood-cells.

Methods: In order to achieve this objective, DNA enriched from twenty placentas at term and maternal white blood cells was bisulfite-converted and amplified using quantitative real-time methyl-light polymerase chain reaction for the four-genes studied (RASSF1A, APC, RAR-beta, and PTGS2).

Results: Among the four genes examined, RASSF1A, APC and RAR-beta promoter regions were hypermethylated in all …