Medical Specialties Commons^™

Assessing Technologies For Information-Seeking On Prostate Cancer Screening By Low-Income Men, Susan W. Mcroy, Emily M. Cramer, Hayeon Song

Journal of Patient-Centered Research and Reviews

Purpose: This paper presents a multipart investigation of the benefits and challenges in deploying automated question-answering as an alternative to web-based searching to provide information about prostate cancer screening for low-income men age 40 years and older.

Methods: The study comprised: 1) a survey assessing current use of the Internet, mobile phones and texting; 2) a controlled observational study of both web-based searching and automated question-answering for information about prostate cancer; and 3) a formative field study in which subjects interacted with a health department nurse using text messages.

Results: Survey results suggest the target population has greater access to, …

Recurrent Aphthous Stomatitis: Diagnosis And Management In Primary Care, Jillian Hudson

Journal of Patient-Centered Research and Reviews

Recurrent aphthous stomatitis (canker sores) is a very common oral condition that remains incompletely understood. Presentation has been well-classified into minor, major or herpetiform subcategories based on clinical features, but exact etiology is unknown. Because etiology is unclear, treatments are primarily empiric and aimed at symptom reduction rather than prevention or cure. However, there are several methods, both topical and systemic, that can be easily and affordably utilized in the primary care setting.

Autoantibodies To The Ny-Eso-1 Tumor Antigen In Metastatic Melanoma: Sialylation Of The Fc Region Of Immunoglobulin G Induces Differential Expression Signatures Of Inflammatory Molecules During Dendritic Cell Differentiation And Maturation, Martin Oaks, Nathaniel Rein, John O. Richards, James Shaffer

Journal of Patient-Centered Research and Reviews

Purpose: We tested the hypothesis that different glycoforms of antibodies from patients with metastatic melanoma have different functional effects on human dendritic cell differentiation and maturation.

Methods: Antibodies to the cancer antigen NY-ESO-1 were affinity-purified from patients with melanoma and further fractionated into different glycoforms by lectin chromatography. Sialic acid-rich and sialic acid-poor fractions of these immunoglobulin G antibodies (IgG) were added to dendritic cell cultures during both differentiation and maturation, and the resulting cellular messenger RNA (mRNA) and culture supernatants were tested by microarray and enzyme-linked immunoassay for molecules related to inflammatory pathways.

Results: We identified unique mRNA and …

Which Clinical Guidelines Should Be Implemented For Management Of Osteopenia In Primary Care? A Clin-Iq, Turia Hollingsworth

Journal of Patient-Centered Research and Reviews

Literature review was conducted to determine clinical guidelines for osteopenia management of immunocompetent patients in the primary care setting. It was concluded that pharmacological treatment should be offered to patients with osteopenia if they are considered high risk, which can be determined by utilizing the World Health Organization Fracture Risk Assessment Tool (FRAX^®) to evaluate 10-year risk. Patients with a calculated hip fracture probability of at least 3% or those with probability of 20% or more for all osteoporotic fractures may be offered bisphosphonate therapy.

Medical Education Digest, Vol. 16 No. 6 (November/December 2014), Nova Southeastern University

Medical Education Digest

No abstract provided.

The Translational Biology Of Remyelination: Past, Present, And Future, Robin J.M. Franklin, Vittorio Gallo

Pediatrics Faculty Publications

Amongst neurological diseases, multiple sclerosis (MS) presents an attractive target for regenerative medicine. This is because the primary pathology, the loss of myelin-forming oligodendrocytes, can be followed by a spontaneous and efficient regenerative process called remyelination. While cell transplantation approaches have been explored as a means of replacing lost oligodendrocytes, more recently therapeutic approaches that target the endogenous regenerative process have been favored. This is in large part due to our increasing understanding of (1) the cell types within the adult brain that are able to generate new oligodendrocytes, (2) the mechanisms and pathways by which this achieved, and (3) …

Vitamin A, Vitamin E, Iron And Zinc Status In A Cohort Of Hiv-Infected Mothers And Their Uninfected Infants, Jacqueline Pontes Monteiro, Maria Leticia Santos Cruz, Marisa Marcia Mussi-Pinhata, Roberta Garcia Salomao, Alceu Jordao Junior, Jennifer S. Read, Jose Henrique Da Silva Pilotto, Rachel Ann Cohen, Sonia Karolina Stoszek, George Kelly Siberry

Pediatrics Faculty Publications

Introduction

We hypothesized that nutritional deficiency would be common in a cohort of postpartum, human immunodeficiency virus (HIV)-infected women and their infants.

Methods

Weight and height, as well as blood concentrations of retinol, α-tocopherol, ferritin, hemoglobin, and zinc, were measured in mothers after delivery and in their infants at birth and at 6-12 weeks and six months of age. Retinol and α-tocopherol levels were quantified by high performance liquid chromatography, and zinc levels were measured by atomic absorption spectrophotometry. The maternal body mass index during pregnancy was adjusted for gestational age (adjBMI).

Results

Among the 97 women 19.6% were underweight. …

Psychosocial Factors In Sports Injury Rehabilitation And Return To Play, Leslie W. Podlog, John Heil, Stefanie Podlog (Nee Schulte)

Athletic Training Collection

This article discusses the principles and practices that guide psychological intervention with injury, and encourages a psychological approach to injury for clinicians. Part 1 reviews the research literature, and serves as a foundation for the review of clinical practices in part 2. Examination of the research literature highlights 4 areas: (1) psychological factors influencing rehabilitation, (2) social factors affecting rehabilitation, (3) performance concerns among returning athletes, and (4) tools/inventories for assessing psychological readiness to return. A synopsis of an injury intervention plan is provided, and the influence of pain and fear in the rehabilitation process is described.

Management Of Severe Hyponatremia: Infusion Of Hypertonic Saline And Desmopressin Or Infusion Of Vasopressin Inhibitors?, Antonios H. Tzamaloukas Md, Joseph I. Shapiro Md, Dominic S. Raj Md, Glen H. Murata Md, Robert H. Glew Phd, Deepak Malhotra Md, Phd

Pharmaceutical Science and Research

Rapid correction of severe hyponatremia carries the risk of osmotic demyelination. Two recently introduced methods of correction of hyponatremia have diametrically opposite effects on aquaresis. Inhibitors of vasopressin V2 receptor (vaptans) lead to the production of dilute urine, whereas infusion of desmopressin causes urinary concentration. Identification of the category of hyponatremia that will benefit from one or the other treatment is critical. In general, vaptans are effective in hyponatremias presenting with concentrated urine and, with the exception of hypovolemic hyponatremia, can be used as their primary treatment. Desmopressin is effective in hyponatremias presenting with dilute urine or developing urinary dilution …

Education And Training For Suicide Prevention In India, Amresh Srivastava

Data and Test Instruments

No abstract provided.

Atrx Is Required For Maintenance Of The Neuroprogenitor Cell Pool In The Embryonic Mouse Brain, Kieran Ritchie, L Ashley Watson, Benjamin Davidson, Yan Jiang, Nathalie G. Bérubé

Paediatrics Publications

Mutations in the alpha-thalassemia mental retardation X-linked (ATRX) gene cause a spectrum of abnormalities including intellectual disability, developmental delay, seizures, and microcephaly. The ATRX protein is highly enriched at heterochromatic repetitive sequences adjacent to the centromere, and ATRX depletion results in chromosome congression, segregation, and cohesion defects. Here, we show that Cre-mediated inactivation of Atrx in the embryonic mouse (Mus musculus) brain results in expansion of cerebral cortical layer VI, and a concurrent thinning of layers II-IV. We observed increased cell cycle exit during early-mid neurogenesis, and a depletion of apical progenitors by late neurogenesis in the Atrx-null neocortex, explaining …

Exploiting High-Throughput Cell Line Drug Screening Studies To Identify Candidate Therapeutic Agents In Head And Neck Cancer, Anthony C Nichols, Morgan Black, John Yoo, Nicole Pinto, Andrew Fernandes, Benjamin Haibe-Kains, Paul C Boutros, John W Barrett

Oncology Publications

BACKGROUND: There is an urgent need for better therapeutics in head and neck squamous cell cancer (HNSCC) to improve survival and decrease treatment morbidity. Recent advances in high-throughput drug screening techniques and next-generation sequencing have identified new therapeutic targets in other cancer types, but an HNSCC-specific study has not yet been carried out. We have exploited data from two large-scale cell line projects to clearly describe the mutational and copy number status of HNSCC cell lines and identify candidate drugs with elevated efficacy in HNSCC.

METHODS: The genetic landscape of 42 HNSCC cell lines including mutational and copy number data …

Bmp4 And Lgl1 Are Down Regulated In An Ovine Model Of Congenital Diaphragmatic Hernia, Heather M A Emmerton-Coughlin, K Kathryn Martin, Jacky S S Chiu, Lin Zhao, Leslie A Scott, Timothy R H Regnault, Andreana Bütter

Surgery Publications

BACKGROUND/PURPOSE: The molecular pathophysiology of lung hypoplasia in congenital diaphragmatic hernia (CDH) remains poorly understood. The Wnt signaling pathway and downstream targets, such as bone morphogenetic proteins (BMP) 4 and other factors such as late gestation lung protein 1 (LGL1), are essential to normal lung development. Nitrofen-induced hypoplastic CDH rodent lungs demonstrate down regulation of the Wnt pathway including BMP4 and reduced LGL1 expression. The aim of the current study was to examine the molecular pathophysiology associated with a surgically induced CDH in an ovine model.

METHODS: Left thoracotomy was performed at 80 days in 14 fetal sheep; CDH was …

Antibiotic Prophylaxis And Reflux: Critical Review And Assessment, Bernarda Viteri Baquerizo, Craig A. Peters

Urology Faculty Publications

The use of continuous antibiotic prophylaxis (CAP) was critical in the evolution of vesicoureteral reflux (VUR) from a condition in which surgery was the standard of treatment to its becoming a medically managed condition. The efficacy of antibiotic prophylaxis in the management of VUR has been challenged in recent years, and significant confusion exists as to its clinical value. This review summarizes the critical factors in the history, use, and investigation of antibiotic prophylaxis in VUR. This review provides suggestions for assessing the potential clinical utility of prophylaxis.

Coagulopathy In Newborns With Hypoxic Ischemic Encephalopathy (Hie) Treated With Therapeutic Hypothermia: A Retrospective Case-Control Study, Katie R. Forman, Yaser A. Diab, Edward C.C. Wong, Stephen Baumgart, Naomi L. Luban, An Nguyen Massaro

Pediatrics Faculty Publications

Background

Newborns with hypoxic ischemic encephalopathy (HIE) are at risk for coagulopathy due to systemic oxygen deprivation. Additionally, therapeutic hypothermia (TH) slows enzymatic activity of the coagulation cascade, leading to constitutive prolongation of routinely assessed coagulation studies. The level of laboratory abnormality that predicts bleeding is unclear, leading to varying transfusion therapy practices.

Methods

HIE infants treated with TH between 2008–2012 were included in this retrospective study. Initial, minimum (min) and maximum (max) values of International Normalized Ratio (INR), activated partial thromboplastin time (aPTT), fibrinogen (Fib) and platelet (PLT) count (measured twice daily during TH) were collected. Bleeding was defined …

The Impact Of Polio Eradication On Routine Immunization And Primary Health Care: A Mixed-Methods Study, Svea Closser, Kelly Cox, Thomas M. Parris, R Matthew Landis, Judith Justice, Ranjani Gopinath, Kenneth Maes, Hailom Banteyerga Amaha, Ismaila Zango Mohammed, Rashid Jooma

Section of Neurosurgery

Background: After 2 decades of focused efforts to eradicate polio, the impact of eradication activities on health systems continues to be controversial. This study evaluated the impact of polio eradication activities on routine immunization (RI) and primary healthcare (PHC).
Methods: Quantitative analysis assessed the effects of polio eradication campaigns on RI and maternal healthcare coverage. A systematic qualitative analysis in 7 countries in South Asia and sub-Saharan Africa assessed impacts of polio eradication activities on key health system functions, using data from interviews, participant observation, and document review.
Results: Our quantitative analysis did not find compelling evidence of widespread and …

Robert Edward Gross (1905-1988): Ligation Of A Patent Ductus Arteriosus And The Birth Of A Specialty., Alexander V. Chalphin, Bs, Charles J. Yeo, Md, Scott W. Cowan, Md, Stacey Milan, Md

Department of Surgery Gibbon Society Historical Profiles

The early 20th century saw an explosion in surgical expertise. Specialties dedicated to delicate organs such as the heart and vulnerable populations, like children, were in their infancy. Dr. William E. Ladd, the father of pediatric surgery, founded the first dedicated department of pediatric surgery at Boston Children’s Hospital in 1910. At the time, attempts at cardiac surgery almost universally ended in death of the patient. The first successful surgical treatment of the cardiac valves would not occur for another 15 years, and the great vessels would remain out of reach for decades more. Dr. Robert E. Gross, the shy …

Hormone Whodunit: Clues For Solving The Case Of Intratumor Androgen Production., Karen E Knudsen

Department of Cancer Biology Faculty Papers

One of the key mechanisms by which prostate cancer cells evade hormone therapy is through intratumor testosterone production. New evidence points toward androstenedione as a potential precursor of intratumor androgen production and furthers nomination of AKR1C3 as a therapeutic target in advanced disease. Clin Cancer Res; 20(21); 5343-5. ©2014 AACR.

Evidence-Informed Guidelines For Pediatric Pandemic Planning And Response, Ginny Sprang, James J. Clark, Miriam Silman, Phyllis W. Leigh, Candice M. Jackson, A. Scott Lajoie

Center on Trauma and Children Reports

From the executive summary:

Pandemic events are unpredictable and inevitable. When they occur, the impact is both all-encompassing and asymmetrical; each pandemic targets specific, vulnerable populations, but ultimately impacts individuals, families and communities throughout the world. Regardless of origin or circumstances, the next pandemic will certainly count infants, children, and adolescents among its most vulnerable targets. As evidenced by the 2009 H1N1 influenza pandemic, children may be at higher risk than populations more typically seen as susceptible to pandemic illness (the elderly, those with weakened immune systems, etc.). Children also can function as disease vectors, spreading the virus through their …

Neonatal Magnesium Levels Correlate With Motor Outcomes In Premature Infants: A Long-Term Retrospective Cohort Study, Elizabeth Doll, Jacob Wilkes, Lawrence J. Cook, E. Kent Korgenski, Roger G. Faix, Bradley A. Yoder, Rajendu Srivastava, Catherine M.T. Sherwin, Michael G. Spigarelli, Erin A.S. Clark, Joshua L. Bonkowsky

Pediatrics Faculty Publications

OBJECTIVE:

Chronic neurological deficits are a significant complication of preterm birth. Magnesium supplementation has been suggested to have neuroprotective function in the developing brain. Our objective was to determine whether higher neonatal serum magnesium levels were associated with better long-term neurodevelopmental outcomes in very-low birth weight infants.

STUDY DESIGN:

A retrospective cohort of 75 preterm infants (<1500 g, gestational age <27 weeks) had follow-up for the outcomes of abnormal motor exam and for epilepsy. Average total serum magnesium level in the neonate during the period of prematurity was the main independent variable assessed, tested using a Wilcoxon rank-sum test.

RESULTS:

Higher average serum magnesium level was associated with a statistically significant decreased risk for abnormal motor exam (p = 0.037). A lower risk for epilepsy in the group with higher magnesium level did not reach statistical significance (p = 0.06).

CONCLUSION:

This …

Effects Of Polypharmacy On Adverse Drug Reactions Among Geriatric Outpatients At A Tertiary Care Hospital In Karachi: A Prospective Cohort Study., Bilal Ahmed, Kashmira Nanji, Rakshinda Mujeeb, Muhammad Junaid Patel

Department of Medicine

Background: Adverse drug reactions (ADRs) present a challenging and expensive public health problem. Polypharmacy is defined according to the WHO criteria as the, ‘‘concurrent use of five or more different prescription medication’’. Elderly are more prone to adverse reactions due to comorbid conditions, longer lists of medications and sensitivity to drug effects. The aim of the study is to estimate the incidence and strength of association of ADRs due to polypharmacy among the geriatric cohort attending outpatient clinics at a tertiary care center.

Methods: A hospital based prospective cohort study was conducted at ambulatory care clinics of Aga Khan University …

Clinical Course And Outcome Of Acute Severe Asthma (Status Asthmaticus) In Adults., Ali Khawaja, Hira Shahzad, Murtaza Kazmi, Ali Bin Sarwar Zubairi

Department of Medicine

Objective: To evaluate the clinical course and outcomes in patients with acute severe asthma in a tertiary care setting.
Methods: The retrospective cross-sectional study was conducted at the Aga Khan University Hospital, Karachi, and comprised data of patients of age 16 and above who were admitted with a diagnosis of acute severe asthma from January 2000 to December 2013.These patients had undergone clinical evaluation to assess the severity of illness as well as the complications and eventual outcomes. SPSS 16 was used for statistical analysis.
Results: Of the 50 patients in the study, 41 (82%) were females. The overall mean …

Vascular Ehlers-Danlos Syndrome: A Rare Disorder Presenting With Focal Convulsions, Shakeel Ahmed, Syed Rehan Ali, Naila Nadeem, Muhammad Hamid

Department of Paediatrics and Child Health

Vascular Ehlers-Danlos Syndrome (VEDS), previously called Ehlers-Danlos syndrome type-IV, is a heterogeneous group of heritable connective tissue disorders characterized by thin, translucent skin, easy bruising, arterial, intestinal, and/or uterine fragility. There is large vessel involvement that leads to arterial rupture often preceded by aneurysm, arteriovenous fistulae, or dissection. Noninvasive imaging studies such as CT angiography and MR angiography are preferred as diagnostic studies for this condition. We are reporting a 4 years old girl who was presented with right sided unilateral convulsions and hypertension. CT angiogram showed stenosis with post-stenotic dilatation of coeliac and superior mesenteric arteries. There were extensive …

Labrad : Vol 40, Issue 2 - November 2014, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• Significance of HLA Typing in Transplant Medicine
• Role of Protocol Renal Biopsies in Transplant Patients
• Blood Product Utilization in Haematopoietic Stem Cell Transplant Recipients
• Use of Magic Marker “C4d” in the Diagnosis of Acute Antibody Mediated Rejection in Renal Transplant Patients
• Coagulopathy in Renal Transplantation
• Therapeutic Drug Monitoring of Cyclosporine
• Signifi cance of CMV antigenemia Assay In Renal Transplant Patients
• Pretransplant Serological Evaluation
• Importance of Monitoring Cytomegalovirus (CMV) and BKV (Polyomavirus) Infection in Renal Transplant Patients

Use Of Antenatal Corticosteroids And Tocolytic Drugs In Preterm Births In 29 Countries: An Analysis Of The Who Multicountry Survey On Maternal And Newborn Health, Joshua P. Vogel, João Paulo Souza, A Metin Gülmezoglu, Rintaro Mori, Pisake Lumbiganon, Zahida Qureshi, Guillermo Carroli, Malinee Laopaiboon, Bukola Fawole, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Despite the global burden of morbidity and mortality associated with preterm birth, little evidence is available for use of antenatal corticosteroids and tocolytic drugs in preterm births in low-income and middle-income countries. We analysed data from the WHO Multicountry Survey on Maternal and Newborn Health (WHOMCS) to assess coverage for these interventions in preterm deliveries.

Methods: WHOMCS is a facility-based, cross-sectional survey database of birth outcomes in 359 facilities in 29 countries, with data collected prospectively from May 1, 2010, to Dec 31, 2011. For this analysis, we included deliveries after 22 weeks’ gestation and we excluded births that …

One-Year Evaluation Of The Impact Of An Emergency Obstetric And Neonatal Care Training Program In Western Kenya, Rachel F. Spitzer, Sarah Jane Steele, David Caloia, Julie Thorne, Alan D. Bocking, Astrid Christoffersen-Deb, Aaron Yarmoshuk, Loise Maina, Johanna Sitters, Elkanah Omenge

Obstetrics and Gynaecology, East Africa

Objective: To determine the impact of introducing an emergency obstetric and neonatal care training program on maternal and perinatal morbidity and mortality at Moi Teaching and Referral Hospital, Eldoret, Kenya.

Methods: A prospective chart review was conducted of all deliveries during the 3-month period (November 2009 to January 2010) before the introduction of the Advances in Labor and Risk Management International Program (AIP), and in the 3-month period (August–November 2011) 1 year after the introduction of the AIP. All women who were admitted and delivered after 28 weeks of pregnancy were included. The primary outcome was the direct obstetric case …

Oncolog, Volume 59, Number 11-12, November-December 2014, Bryan Tutt, Sunita Patterson, S. Moreau

OncoLog MD Anderson's Report to Physicians (All issues) Archives

• Striving to Improve Treatments for Uveal Melanoma: Although primary uveal melanoma can be effectively treated with radiation or surgery, patients with metastatic disease-or those at high risk for metastases-have few proven options. But specialists in medical oncology, radiation oncology, ophthalmology, surgery, and traditional research are working to improve those options
• Beyond Diabetes: Metformin May Have Broad Utility in Cancer: Metformin, an inexpensive drug that has been prescribed for diabetes for decades, may also be useful in preventing or treating several types of cancer
• HOUSE CALL: Smoking Cessation-Medications help smokers quit
• INBRIEF: Vaccine Explored to Reduce Risk of HER2-Positive Breast Cancer …

Hypoxic Stress Induces, But Cannot Sustain Trophoblast Stem Cell Differentiation To Labyrinthine Placenta Due To Mitochondrial Insufficiency, Yufen Xie, Sichang Zhou, Zhongliang Jiang, Jing Dai, Elizabeth E. Puscheck, Icksoo Lee, Graham Parker, Maik Hüttemann, Daniel A. Rappolee

Department of Obstetrics and Gynecology Research Publications

Dysfunctional stem cell differentiation into placental lineages is associated with gestational diseases. Of the differentiated lineages available to trophoblast stem cells (TSC), elevated O2 and mitochondrial function are necessary to placental lineages at the maternal–placental surface and important in the etiology of preeclampsia. TSC lineage imbalance leads to embryonic failure during uterine implantation. Stress at implantation exacerbates stem cell depletion by decreasing proliferation and increasing differentiation. In an implantation site O2 is normally ~ 2%. In culture, exposure to 2% O2 and fibroblast growth factor 4 (FGF4) enabled the highest mouse TSC multipotency and proliferation. In contrast, hypoxic stress (0.5% …

Department Of Surgery Update, November/December 2014, Wright State University Department Of Surgery

Department of Surgery Updates

A four page newsletter created by the Department of Surgery documenting changes to the department. This issue for November and December of 2014 contains a message from the chair, pictures from the ACS Alumni Reception, a list of important dates, committee meetings, a list of presentations and more.

Low Vision Depression Prevention Trial In Age-Related Macular Degeneration: A Randomized Clinical Trial., Barry W. Rovner, Robin J Casten, Mark T Hegel, Robert W Massof, Benjamin E Leiby, Allen C Ho, William S Tasman

Department of Psychiatry and Human Behavior Faculty Papers

PURPOSE: To compare the efficacy of behavior activation (BA) + low vision rehabilitation (LVR) with supportive therapy (ST) + LVR to prevent depressive disorders in patients with age-related macular degeneration (AMD).

DESIGN: Single-masked, attention-controlled, randomized, clinical trial with outcome assessment at 4 months.

PARTICIPANTS: Patients with AMD and subsyndromal depressive symptoms attending retina practices (n = 188).

INTERVENTIONS: Before randomization, all subjects had 2 outpatient LVR visits, and were then randomized to in-home BA+LVR or ST+LVR. Behavior activation is a structured behavioral treatment that aims to increase adaptive behaviors and achieve valued goals. Supportive therapy is a nondirective, psychological treatment …