Medical Specialties Commons^™

Is Omalizumab A Safe And Effective Treatment For Chronic Urticaria?, Ashley L. Davis

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not omalizumab is a safe and effective treatment for chronic urticaria.

STUDY DESIGN: Review of two randomized controlled studies and one crossover study. All three studies are published in English between 2008-2011.

DATA SOURCES: Two randomized, double blind, placebo controlled studies and one crossover study found using PubMed and EBSCOhost.

OUTCOMES MEASURED: Each trial measured the duration, size, number and/or intensity of wheals. This was done by using the urticaria activity score (UAS). Quality of life was also measured using Dermatology Life Quality Index (DLQI), …

Is Noninhaled Intranasal Carbon Dioxide Gas A Safe And Effective Treatment For Improvement Of Nasal Symptoms Of Allergic Rhinitis?, Andrew R. Couchara

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not noninhaled intranasal carbon dioxide (CO2) gas is a safe and effective treatment for improvement of nasal symptoms of allergic rhinitis.

STUDY DESIGN: Systematic review of three randomized controlled trials published in 2008, 2011, and 2011.

DATA SOURCES: Three randomized controlled trials published after 2007 were obtained using PubMed.

OUTCOMES MEASURED: Number of sneezes and severity of nasal symptoms (nasal congestion, rhinorrhea) were recorded by subjects using an ordinal scale to obtain a Total Nasal Symptom Score (TNSS). Scores recorded before and after treatment were compared to …

Is The Use Of Honey An Effective Dressing Option For The Treatment Of Diabetic Foot Ulcers?, Michelle A. Wimmer

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this systematic review is to determine whether or not honey could be used as an effective topical treatment for diabetic foot ulcers in diabetic patients.

STUDY DESIGN: Review of three primary journal articles published in English between the years of 2008 and 2010.

DATA SOURCES: Two Randomized Controlled Trials comparing honey as a treatment for diabetic foot ulcers to either previous failed treatments or Povidone Iodine Solution, and a pilot prospective study, exploring the effectiveness of PEDYPHAR a royal jelly ointment. All articles were found using Pubmed, OVID and Cochrane Database.

OUTCOMES MEASURED …

Is Local Infiltration Analgesia (Lia) A Safe And Effective Method For Post-Operative Pain Management After A Unilateral Total Knee Arthroplasty (Tka)?, Brooke A. Bonnette

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this systematic review is to determine whether or not local infiltration analgesia (LIA) is a safe and effective method for post-operative pain management after a unilateral total knee arthroplasty (TKA).
STUDY DESIGN: Review of three English language primary studies published in 2010 and 2011.

DATA SOURCES: Three randomized controlled trials comparing local infiltration analgesia to three separate controls: epidural analgesia, placebo infiltration and femoral nerve block found using PubMed.

OUTCOMES MEASURED: Clinical outcome was measured by total morphine use postoperatively and average knee pain intensity at rest and upon movement postoperatively. Total morphine use …

What Is The Effectiveness Of Onabotulinumtoxina (Botox®) In Reducing The Number Of Chronic Migraines (Cm) In Patients 18-65 Years Old?, Kristin A. Beddingfield

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not onabotulinumtoxinA (Botox®) is effective in reducing the number of chronic migraines (CM) in patients 18-65 years old? Study Design: Review of three published, double blind randomized controlled trials were used for this review, which were found on PubMed; were selected based on their relevance to the clinical question and if they included patient oriented outcomes.

OUTCOMES MEASURED: The outcomes measured were headache/migraine free days measured by >50% responder rate analysis, the Treatment Responder Rate based on Physician Global Assessment, and total adverse events reported by …

Is Phlogenzym Effective In Reducing Moderate To Severe Osteoarthritis Pain In Adults?, Vanessa K. Wood

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not Phlogenzym (or ERC) effective in reducing moderate to severe osteoarthritis pain in adults.

STUDY DESIGN: Review of three randomized controlled trials in the English language from 2001 to 2006.

DATA SOURCES: Two double blind RCTs and one open RCT was found using Cochrane Library EBM Online Database, Ovid Medline, and PubMed Online.

OUTCOMES MEASURED: Each of the three studies measured for pain at rest, pain with motion, and restricted function at baseline assessing efficacy using the Lequesne’s Algofunctional Index, visual analog scales, and …

Is Topiramate Effective In Preventing Pediatric Migraines?, Krystina Zeliff

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not Topiramate is effective in the prevention of pediatric migraines.
Study Design: Review of three English language randomized control trials published in 2005, 2007, and 2009.

DATA SOURCES: Three double-blind, placebo-controlled, randomized trials comparing various doses of Topiramate to placebo were found using PubMed, OVID, and Cochrane Library databases.

OUTCOME(S) MEASURED: The frequency of migraines in patients under the age of 18 years old was documented with headache diaries. The patient’s parent would record the number, severity, duration, associated symptoms, and use of acute …

Does Parent And Therapist Delivered Qigong Massage Therapy Decrease Sensory And Self-Regulation Impairments In Children Ages 3-6 Years Old With Autism?, Lisa A. White

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not parent and therapist delivered Qigong massage therapy decreases sensory and self-regulation impairments in children ages 3-6 years old with autism.

STUDY DESIGN: Reviewed three English primary studies published in 2005, 2009 and 2011.

DATA SOURCES: All studies were randomized controlled trials that compared a group of children with autism who received Qigong massage treatments to a controlled group of children with autism who did not receive the treatments. All studies were found using PubMED and Cochrane research databases.

OUTCOMES MEASURED: Overall reduction …

Does Neonatal Massage Lead To Reduced Stress Behavior In Medically Stable Preterm Infants In The Nicu?, Sarah E. Werner

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not neonatal massage leads to reduced stress behavior in medically stable preterm infants in the NICU.

STUDY DESIGN: Review of three English language primary studies published in 1996, 2005 and 2007.

DATA SOURCES: Three randomized control trials comparing stress behavior in preterm infants receiving massage to a control group that did not receive massage were found using PubMed and Medline databases.

OUTCOMES MEASURED: Researcher recorded stress behavior as behavioral distress activity and motor activity via direct observations and a time sampling method. Motor …

Is High Dose Radioactive Iodine-131 More Effective Than Low Dose Iodine-131 In The Therapy Of Patients With Hyperthyroidism?, Tyler L. Warnecke

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not high dose radioactive iodine-131 is more effective than low dose iodine-131 in the therapy of patients with hyperthyroidism.

STUDY DESIGN: The review included three primary English language studies that were peer reviewed articles published in 2003, 2010 and 2011.

DATA SOURCES: This paper evaluates three randomized control trials (one prospective randomized and two comparative randomized) looking at the effectiveness of high dose and low dose radioactive iodine-131 for the treatment of hyperthyroidism.

OUTCOMES MEASURED: Each study examined patients being treated with high …

Is Transdermal Glyceryl Trinitrate A Safe And Effective Treatment For Primary Dysmenorrhea?, Sarah E. Visich

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective evidence based medicine review is to determine whether or not transdermal glyceryl trinitrate is a safe and effective treatment for primary dysmenorrhea.

STUDY DESIGN: Review of two English language randomized control trials (RCTs) published in 1996 and 1999 and one English language pilot study in 1997.

DATA SOURCES: Two double-blind, randomized, placebo-controlled cross-over studies and one pilot study comparing transdermal glyceryl trinitrate to placebo were found using PubMed, Medline and OVID.

OUTCOME MEASURED: Outcomes measured were based on pain intensity scores (PID) assessed on a visual analog scale and the …

Does Etravirine Decrease Central Nervous System (Cns)/Neuropsychiatric (Nps) Adverse Events Compared To Efavirenz, In Hiv Positive Patients?, Angelo D. T. Smith

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not Etravirine (ETR) decreases adverse reactions on the central nervous system (CNS) compared to Efavirenz (EFV) in Human Immunodeficiency Virus (HIV) positive patients.

STUDY DESIGN: Review of three, English language, primary randomized controlled trial studies published in 2011.

DATA SOURCES: Three randomized controlled trials studying the possible decrease of ADR’s in HIV positive patients who are taking Efavirenz compared to study medication Etravirine.

OUTCOME(S) MEASURED: Outcomes measured were by surveys from patients that assess the development or cessation of CNS ADR’s. The self …

In Adults With Acute Diarrhea, Which Treatment Is More Effective Between Loperamide And Racecadotril?, Lorena A. Castillo

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine which treatment is more effective between loperamide and racecadotril to treat acute diarrhea in adults.

STUDY DESIGN: Review of three English language primary randomized controlled studies published from 1999-2005.

DATA SOURCES: First study was a RCT that was double blinded, double placebo, parallel study group and second and third study was RCT single blinded, comparative parallel group that all compared efficacy of loperamide and racecadotril. These were all found by using PubMed, COCHRANE and NCBI.

OUTCOMES MEASURED: Each of the studies measured the efficacy of each …

Characterization Of Brer Interaction With The Bile Response Promoters Breab And Brer In Vibrio Cholerae, Francisca A. Cerda-Maira, Gabriela Kovacikova, Brooke A. Jude, Karen Skorupski, Ronald Taylor

Dartmouth Scholarship

The Vibrio cholerae BreR protein is a transcriptional repressor of the breAB efflux system operon, which encodes proteins involved in bile resistance. In a previous study (F. A. Cerda-Maira, C. S. Ringelberg, and R. K. Taylor, J. Bacteriol. 190:7441-7452, 2008), we used gel mobility shift assays to determine that BreR binds at two independent binding sites at the breAB promoter and a single site at its own promoter. Here it is shown, by DNase I footprinting and site-directed mutagenesis, that BreR is able to bind at a distal and a proximal site in the breAB promoter. However, only one of …

Expression And Regulation Of Map Kinase Phosphatases 1 And 2 In Breast Cancer Tamoxifen Sensitivity, Kelly Haagenson

Wayne State University Dissertations

ABSTRACT

EXPRESSION AND REGULATION OF MAP KINASE PHOSPHATASES 1 and 2 IN BREAST CANCER TAMOXIFEN SENSITIVITY

by

KELLY K. HAAGENSON

May 2013

Advisor: Dr. Malathy Shekhar

Co-Advisor: Dr. Gen Sheng Wu

Major: Cancer Biology

Degree: Doctor of Philosophy

The deregulation of cell signaling is a very important component in the development and progression of cancer. One group of signaling molecules that has been implicated in these processes is the Mitogen-Activated Protein Kinase (MAPK) family which consists of three major branches in mammalian cells: ERK, JNK and p38. The activity of these kinases has wide-ranging effects within the cell and must …

Advanced Augmented Reality Telestration Techniques With Applications In Laparoscopic And Robotic Surgery, Stephen Dworzecki

Wayne State University Dissertations

The art of teaching laparoscopic or robotic surgery currently has a primary reliance on an expert surgeon tutoring a student during a live surgery. During these operations, surgeons are viewing the inside of the body through a manipulatable camera. Due to the viewpoint translation and narrow field of view, these techniques have a substantial learning curve in order to gain the mastery necessary to operate safely. In addition to moving and rotating the camera, the surgeon must also manipulate tools inserted into the body. These tools are only visible on camera, and pass through a pivot point on the body …

Analysis Of The Structure And Function Of A Timp-1/Cd63 Complex And Its Relationship To An Mt1-Mmp/Cd63 Complex, Richard B. Warner

Wayne State University Dissertations

The relationship of the extra-cellular matrix (ECM) and secreted proteins to intra-cellular functions has an important impact on disease progression. The tissue inhibitors of metalloproteinases (TIMPs), of which there are four, are known for their broad metalloprotease inhibitory abilities. TIMP-1 has been widely studied as an inhibitor of matrix metalloproteinases (MMPs) and therefore as a molecule that prevents ECM degradation and proteolytic cleavage of extra-cellular molecules, processes thought to be critical for tumor invasion and metastasis. However, TIMP-1 has shown in the clinic to have increased expression in cases of disease progression; especially, it is associated with poor prognosis in …

Scheduling In Mohs Micrographic Surgery Clinics, Stephen Vincent Steidle

Open Access Theses

Mohs Micrographic Surgery (MMS) is a surgical method used for the excision of aggressive skin cancers in areas of high cosmetic importance, such as the face and hands. The practice has been gaining popularity worldwide for its low recurrence rates and cosmetic results. Current clinics though are plagued by extreme wait times and an overall poor patient experience. In this paper we look to explore this problem by applying systems engineering principles including optimization and scheduling with the goal of improving the patient experience. Currently, little literature exists exploring the difficulties associated with scheduling for MMS clinic which primarily revolve …

A Genome-Wide Methylation Study On Essential Hypertension In Young African American Males., Xiaoling Wang, Bonita Falkner, Haidong Zhu, Huidong Shi, Shaoyong Su, Xiaojing Xu, Ashok Kumar Sharma, Yanbin Dong, Frank Treiber, Bernard Gutin, Gregory Harshfield, Harold Snieder

Department of Medicine Faculty Papers

OBJECTIVE: There is emerging evidence from animal studies suggesting a key role for methylation in the pathogenesis of essential hypertension. However, to date, very few studies have investigated the role of methylation in the development of human hypertension, and none has taken a genome-wide approach. Based on the recent studies that highlight the involvement of inflammation in the development of hypertension, we hypothesize that changes in DNA methylation of leukocytes are involved in the pathogenesis of hypertension.

METHOD & RESULTS: We conducted a genome-wide methylation analysis on 8 hypertensive cases and 8 normotensive age-matched controls aged 14-23 years and performed …

A Multicenter, Prospective Study Of A New Fully Covered Expandable Metal Biliary Stent For The Palliative Treatment Of Malignant Bile Duct Obstruction., Bret T Petersen, Michel Kahaleh, Richard A Kozarek, David E. Loren, Kapil Gupta, Thomas E. Kowalski, Martin Freeman, Yang K Chen, Malcolm S Branch, Steven Edmundowicz, Michael Gluck, Kenneth Binmoeller, Todd H Baron, Raj J Shah, Timothy Kinney, William Ross, Paul Jowell, David Carr-Locke

Division of Gastroenterology and Hepatology Faculty Papers

Background and Study Aims. Endoscopic placement of self-expanding metal stents (SEMSs) is indicated for palliation of inoperable malignant biliary obstruction. A fully covered biliary SEMS (WallFlex Biliary RX Boston Scientific, Natick, USA) was assessed for palliation of extrahepatic malignant biliary obstruction. Patients and Methods. 58 patients were included in this prospective, multicenter series conducted under an FDA-approved IDE. Main outcome measurements included (1) absence of stent occlusion within six months or until death, whichever occurred first and (2) technical success, need for reintervention, bilirubin levels, stent patency, time to stent occlusion, and adverse events. Results. Technical success was achieved in …

Cost Effective Improvement In The Protocol For Detection Of Haemoglobin Variants –A Step Forward In Quality Assurance, Natasha Ali, Mohammad Khurshid

Department of Pathology and Laboratory Medicine

Background: We report the results of a cost effective improvement in the protocol for detection of haemoglobin variants which incorporates the findings of peripheral blood film along with the results of HPLC.
Findings: A total of n = 10,844 samples were received from January 2011 till August 2011. Diagnosis of haemoglobinopathy was made in n = 1123 samples while other abnormalities included iron deficiency anaemia, megaloblastic anaemia, malarial parasite, autoimmune haemolytic anaemia and G6PD deficiency (n = 2473).
Conclusion: We diagnosed 23% of abnormalities other than haemoglobinopathy by reviewing peripheral smear of samples received for detection of …

Mixed Salmonella Infection: A Case Series From Pakistan, Binish Arif Sultan, Naima Fasih, Saba Qaiser, Erum Khan, Afia Zafar, Seema Irfan

Department of Pathology and Laboratory Medicine

Enteric fever remains a major health problem in the developing world, including Pakistan. Poor sanitation and hygienic conditions are the major predisposing factors. Salmonella infection with different strains in the same patient has rarely been reported previously. We are reporting two cases of bacteraemia with simultaneous detection of two strains of Salmonella in a single episode of infection. In both the cases, 2 different serotypes of Salmonella were causing bacteraemia leading to fever. In highly endemic area, one must be aware of mixed Salmonella infections as inappropriate diagnosis of such infections may lead to treatment failure.

Clinicopathological Spectrum Of Ovarian Sex Cord-Stromal Tumors; 20years' Retrospective Study In A Developing Country, Saroona Haroon, Aleena Zia, Romana Idrees, Aisha Memon, Saira Fatima, Naila Kayani

Department of Pathology and Laboratory Medicine

Background:
Ovarian sex cord stromal tumors are rare neoplasms as compared to epithelial tumors. No large study has been done in Pakistan to find out the frequencies of various sex cord stromal tumors and their clinicopathological behavior in our region. The purpose of our study was to determine the various histological patterns and clinical features of ovarian sex cord stromal tumors along with follow-up in our set-up.
Methods:
It is a retrospective observational study. The study was conducted in section of Histopathology, Aga Khan University Hospital, Karachi, Pakistan. All reported cases of sex cord stromal tumors of ovary during 1992 …

Frequency And Outcome Of Graft Versus Host Disease After Stem Cell Transplantation: A Six-Year Experience From A Tertiary Care Center In Pakistan, Natasha Ali, Salman Naseem Adil, Mohammad Usman Shaikh, Nehal Masood

Department of Pathology and Laboratory Medicine

Objective: The objective of this study was to evaluate the frequency and outcome of graft versus host disease after stem cell transplantation for various haematological disorders in Pakistan.
Materials and Methods: Pretransplant workup of the patient and donor was performed. Mobilization was done with G-CSF 300 mu g twice daily for five day. Standard GvHD prophylaxis was done with methotrexate 15mg/m(2) on day +1 followed by 10mg/m(2) on days +3 and +6 and cyclosporine. Grading was done according to the Glucksberg classification.
Results: A total of 153 transplants were done from April 2004 to December 2011. Out of these were …

Identification Of Non-Tuberculous Mycobacteria Isolated From Clinical Specimens At A Tertiary Care Hospital: A Cross-Sectional Study, Imran Ahmed, Kauser Jabeen, Rumina Hasan

Department of Pathology and Laboratory Medicine

Background:
Non-tuberculous mycobacteria (NTM) are opportunistic pathogens in immuno-compromised patients. They are also increasingly recognized as pathogens in immuno-competent individuals. Globally, an increase in NTM isolation is being reported with a varied geographic prevalence of different species around the world. There is lack of data on species distribution of these organisms from Pakistan. Treatment options differ according to the species isolated and its susceptibility profile. Knowledge of local species variation would help targeted therapy. This study was performed to determine frequencies of different NTM species isolated from various clinical specimens submitted at a tertiary care hospital laboratory.
Methods:
NTM isolated …

Overview Of Benign And Malignant Prostatic Disease In Pakistani Patients: A Clinical And Histopathological Perspective, Huma Arshad, Zubair Ahmad

Department of Pathology and Laboratory Medicine

Background: To present the overall clinical and histological perspective of benign and malignant prostatic disease as seen in our practice in the Section of Histopathology, Department of Pathology and Microbiology, Aga Khan University Hospital, Karachi, Pakistan.
Materials and Methods: All consecutive prostate specimens (transurethral resection or TUR, enucleation, needle biopsies) received between July 1, 2012 and December 31, 2012 were included in the study.
Results: Of the total of 785 cases, 621 (79.1%) were TUR specimens, 80 (10.2%) enucleation specimens, and 84 (10.7%) needle biopsies. Some 595 (75.8%) were benign, while 190 (24.2%) were malignant. Mean weight of BPH specimens …

Peripheral T-Cell Lymphoma Presenting As Testicular Mass; A Diagnostic Challenge, Saroona Haroon, Arsalan Ahmed

Department of Pathology and Laboratory Medicine

Background: T-cell lymphomas involve the testis infrequently, which deserve special attention because of the poor prognosis and the need to make an appropriate diagnosis, which could lead to a better therapeutic strategy.
Case Presentation: A 40-year-old man presented with right testicular swelling for past three months. The swelling was painless, hard and rubbery. Testicular ultrasound showed diffuse increase in size of the testicle, with alteration in its echogenicity. The patient underwent orchidectomy, and based on histopathological and immunohistochemical tests, a peripheral T-cell lymphoma, not otherwise specified was diagnosed.
Conclusion: Testicular peripheral T-cell lymphomas are rare and aggressive cancers, with clinical …

Prevalence Of Drug Resistance Associated Mutations In Plasmodium Vivax Against Sulphadoxine-Pyrimethamine In Southern Pakistan, Afsheen Raza, Najia K. Ghanchi, Muhammad Shahzeb Khan, Mohammad Asim Beg

Department of Pathology and Laboratory Medicine

Background: In Pakistan, Plasmodium vivax and Plasmodium falciparum co-exist and usage of sulphadoxine-pyrimethamine (SP) against P. falciparum exposes P. vivax to the drug leading to generation of resistant alleles. The main aim of this study was to investigate frequency distribution of drug resistance associated mutations in pvdhfr, pvdhps genes and provide baseline molecular epidemiological data on SP-associated resistance in P. vivax from southern Pakistan.
Methods: From January 2008 to May 2009, a total of 150 samples were collected from patients tested slide-positive for P. vivax, at the Aga Khan University Hospital, Karachi, or its collection units located in Baluchistan and …

Oesophageal Duplication Cyst Presenting As Haemoptysis, Noureen Afzal, Syeda Ezz-E-Rukhshan Adil, Ammara Mushtaq, Arshalooz Rahman, Muneer Amanullah

Department of Paediatrics and Child Health

Duplications of the alimentary tract include a variety of cysts, diverticula, and tubular malformations, all believed to have embryological origin. The cysts are most commonly found in children, and the diagnosis is made in infancy in the majority of patients. We report a case of a two-and-a-half year old child, presenting with the history of repeated episodes of haematemesis. Upper GI endoscopy was unremarkable and the chest x-ray showed no pathology. Computed tomography (CT) angiogram revealed soft tissue density lesion in the right chest at the level of T6. Right thoracotomy suggested a cystic mass close to the oesophagus which …

Inhibitory Effect Of Matrine On Blood-Brain Barrier Disruption For The Treatment Of Experimental Autoimmune Encephalomyelitis., Su Zhang, Quan-Cheng Kan, Yuming Xu, Guang-Xian Zhang, Lin Zhu

Department of Neurology Faculty Papers

Dysfunction of the blood-brain barrier (BBB) is a primary characteristic of experimental autoimmune encephalomyelitis (EAE), an experimental model of multiple sclerosis (MS). Matrine (MAT), a quinolizidine alkaloid derived from the herb Radix Sophorae Flave, has been recently found to suppress clinical EAE and CNS inflammation. However, whether this effect of MAT is through protecting the integrity and function of the BBB is not known. In the present study, we show that MAT treatment had a therapeutic effect comparable to dexamethasone (DEX) in EAE rats, with reduced Evans Blue extravasation, increased expression of collagen IV, the major component of the basement …