Medical Specialties Commons^™

To Determine The Frequency Of Depression In Patients With Primary Epilepsy, Wazir Akber, Noor Ahmed Khosa, Amanullah Sarangzai

Pakistan Journal of Neurological Sciences (PJNS)

Depression is well known common co-morbid psychiatric condition associated with primary epilepsy. This study showed that frequency of depression was 62% in primary epilepsy patient presenting to the Neurology outpatient clinic of a tertiary care hospital. Female gender, high seizures frequency, polytherapy with AEDs and long duration of primary epilepsy were found to be the factors leading to frequent occurrence of depression in primary epilepsy patients Objective: To determine the frequency of depression in patients with primary epilepsy presenting to the Neurology outpatient clinic of Aga Khan University Hospital Karachi.Study Design: Cross-sectional study. Study Setting: Neurology outpatient department at Aga …

Coil Embolization Of Wide Neck Cerebral Aneurysms Using Balloon Remodeling Technique-Initial Experience In Pakistan, Qasim Bashir, Hina Nabi Ahmed

Pakistan Journal of Neurological Sciences (PJNS)

The balloon remodeling technique [BRT] was developed for neuroendovascular treatment of wide-necked cerebral aneurysms. Herein, we describe our initial experience of aneurysm embolization using BRT in Pakistan with the new double-lumen balloon catheters (Sceptor C and Ascent) and Hyperform balloon micro catheter and discuss its benefits.

Clippers (Chronic Lymphocytic Inflammation With Pontine Perivascular Enhancement Responsive To Steroids)–Case Report With Neuroimaging, Abdul Salam, Farah Sana, Rashed Nazir, M. Azhar Saeed, Yasir Iqbal, Arsalan Ahmad

Pakistan Journal of Neurological Sciences (PJNS)

Background: CLIPPERS syndrome (chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids) is an inflammatory disease process primarily involving the pons and adjacent structures. Clinically, the patient may present with cerebellar signs such as dysarthria, gait ataxia and with cranial nerve palsies. It shows good response to steroids / immunosuppressive therapy. Pathologically, there is infiltration of T lymphocytes into the perivascular spaces of brainstem. The disease follows a relapsing and a remitting course and the earlier the treatment is started with high dose steroids and the more prolonged it is, the better the clinical outcome will be.

Sporadic Cjd And Retinitis Punctata Albescansa Case Report And Literature Review, Quratulain Khan, Yusra Hanif Khan

Pakistan Journal of Neurological Sciences (PJNS)

Introduction Sporadic Creutzfeldt-Jakob disease (sCJD) is the most common form of CJD causing 85% of all cases. Various phenotypes of sCJD have been identified including Heidenhain variant which has early and predominant visual symptoms with most pronounced neuropathological changes in occipital lobe. Methodology. We are reporting a case of sCJD with Retinitis Punctata Albescens (RPA), a variant of Retinitis Pigmentosa (RP), which to our knowledge has not been reported before. A 51 year old, married, right handed, Pakistani woman presented with dementia and gait problems for 3 months and visual hallucinations for 2 months. Ophthalmological examination 3 years prior to …

Endovascular Treatment Of Intracranial Aneurysms Using Balloon Remodeling Technique, Wasey Jilani, Tanveer Ul Haq

Pakistan Journal of Neurological Sciences (PJNS)

Endovascular treatment with coils is widely used in the management of intracranial aneurysms. However, this type of treatment can be technically challenging for anatomic reasons, particularly when the neck of the aneurysm is wide or when the dome-to-neck ratio is not favorable. Previous studies described the remodeling technique for extending the indications and feasibility of the endovascular treatment to wide-neck intracranial aneurysms. In remodeling technique, a non-detachable balloon is temporarily inflated in front of the neck of the aneurysm during each coil placement. At the end of the procedure, the remodeling balloon is removed and no device is left in …

Autism- Towards Comprehensive Assessment And Management, Ayesha Mian

Pakistan Journal of Neurological Sciences (PJNS)

Autism is a pervasive, neurodevelopmental disorder characterized by stereotyped movements and impairment in social skills and communication patterns. Prevalence patterns show an increasing burden of about 1 in 150 children affected by the disorder. Most affected individuals have symptoms that interfere greatly with quality of life. Although a burgeoning concern, research on the prevalence, etiological factors and presentation patterns is limited in LAMI countries, leading to a minimal understanding of the disorder at individual, professional and societal level. There is an urgent need to enhance awareness and education to decrease stigma that maybe associated with autism.

Psychiatric Disorders In Neurology, Rizwan Taj, Mamoona Manzoor

Pakistan Journal of Neurological Sciences (PJNS)

Psychiatric disorders (PDs) are very frequent in neurological illnesses. Depression, anxiety and cognitive impairment are frequently seen in many neurological disorders such as stroke, Parkinson disease (PD), epilepsy and multiple sclerosis (MS). In addition, hallucinations, delusions, obsessive-compulsive disorder, sleep disorders, Impulse control disorders (ICDs), somatization, bipolar disorder, behavior problems and psychological problem are also seen. Depression in stroke and epilepsy has bidirectional relationship. Lesion location affects both frequency and severity of depression in stroke patients.

Death Of A Child In The Emergency Department., Patricia O'Malley, Isabel Barata, Sally Snow, American Academy Of Pediatrics Committee On Pediatric Emergency Medicine, American College Of Emergency Physicians Pediatric Emergency Medicine Committee, Gregory P. Conners

Manuscripts, Articles, Book Chapters and Other Papers

The death of a child in the emergency department (ED) is one of the most challenging problems facing ED clinicians. This revised technical report and accompanying policy statement reaffirm principles of patient- and family-centered care. Recent literature is examined regarding family presence, termination of resuscitation, bereavement responsibilities of ED clinicians, support of child fatality review efforts, and other issues inherent in caring for the patient, family, and staff when a child dies in the ED. Appendices are provided that offer an approach to bereavement activities in the ED, carrying out forensic responsibilities while providing compassionate care, communicating the news of …

1,25-Dihydroxyvitamin D Alters Lipid Metabolism And Epithelialto- Mesenchymal Transition In Metastatic Epithelial Breast Cancer Cells, Alle Nicole Barnard

Open Access Theses

Evidence suggests that high vitamin D status (marked by serum 25-hydroxyvitamin D, 25(OH)2 D) is associated with a decreased risk of breast cancer. It has been established that 1,25-dihydroxyvitamin D (1,25(OH) 2 D) can alter glycolysis and the Krebs cycle of breast cancer cells (Jiang et al., 2010; Zheng et al., 2013) but little information is available on 1,25(OH) 2 D's alterations of lipid metabolism in breast cancer cells. Thus, the current research investigates if there was an effect of 1,25(OH) 2 D on proteins that regulate lipid metabolism in MCF10A, MCF10A-ras, MCF10CA1h, and MCF10CA1a epithelial breast cancer cells. While …

Pharmacokinetics And Toxicity Of The Novel Oral Demethylating Agent Zebularine In Laboratory And Tumor Bearing Dogs, Christopher Michael Fulkerson

Open Access Theses

The aim of this thesis is to investigate the pharmacokinetics and toxicity of the novel oral demethylating agent zebularine (zeb) in laboratory dogs and tumor bearing dogs. This thesis focuses on the application of this therapeutic strategy in dogs with naturally occurring invasive transitional cell carcinoma (InvTCC), which serve as a relevant model of the human disease.

DNA hypermethylation in the promoter region is a common epigenetic change in cancer that silences tumor suppressor genes. Zeb is an oral cytidine analog that acts as a demethylating agent. Zeb has been investigated extensively in vitro as well as in mice, rodents …

Shifting Of Vitamin D Deficiency To Hypervitaminosis And Toxicity, Aysha Habib, Hafsa Majid, Romaina Iqbal

Department of Pathology and Laboratory Medicine

No abstract provided.

Tyrosine Kinase Inhibitors In Cancer Therapeutics: Great Expectations From Small Molecules, Zeeshan A Ansar, Tariq Moatter

Department of Pathology and Laboratory Medicine

No abstract provided.

Pregnancy Anxiety And Prenatal Cortisol Trajectories, Heidi S. Kane, Christine Dunkel Schetter, Laura M. Glynn, Calvin J. Hobel, Curt A. Sandman

Psychology Faculty Articles and Research

Pregnancy anxiety is a potent predictor of adverse birth and infant outcomes. The goal of the current study was to examine one potential mechanism whereby these effects may occur by testing associations between pregnancy anxiety and maternal salivary cortisol on 4 occasions during pregnancy in a sample of 448 women. Higher mean levels of pregnancy anxiety over the course of pregnancy predicted steeper increases in cortisol trajectories compared to lower pregnancy anxiety. Significant differences between cortisol trajectories emerged between 30 to 31 weeks of gestation. Results remained significant when adjusted for state anxiety and perceived stress. Neither changes in pregnancy …

Death Of A Child In The Emergency Department., American Academy Of Pediatrics Committee On Pediatric Emergency Medicine, American College Of Emergency Physicians Pediatric Emergency Medicine Committee, Emergency Nurses Association Pediatric Committee, Gregory P. Conners

Manuscripts, Articles, Book Chapters and Other Papers

The American Academy of Pediatrics, American College of Emergency Physicians, and Emergency Nurses Association have collaborated to identify practices and principles to guide the care of children, families, and staff in the challenging and uncommon event of the death of a child in the emergency department in this policy statement and in an accompanying technical report.

Quality Of Life In Patients With Thalassemia Major In A Developing Country., Sarah H. Siddiqui, Ruba Ishtiaq, Faiza Sajid, Raihan Sajid

Department of Medicine

Objective: To determine the problems faced by thalassemic patients in their personal, psychological and social life.

Study Design: A cross-sectional multi-centre survey.

Place and Duration of Study: Karachi, Lahore and Quetta Centres of Fatimid Foundation, from October 2009 to October 2010.

Methodology: An indigenously developed Qualifty of Life (QoL) questionnaire modified from SF-36 questionnaire was administered to 101 transfusion dependent subjects suffering from thalassemia major. Variables were analyzed using SPSS version 15 for descriptive statistics.

Results: The mean age of the subjects was 10.5 years ranging from 6 - 21 years. Less than one third of the patients felt that …

Characterization Of Primary Care Clinicians’ Use Of Genomic And Pharmacogenomic Testing, Brian Stello Md, Heather Bittner-Fagan Md, Mph, Christopher V. Chambers Md, Melanie B. Johnson Mpa, Geoffrey Mills Md, Phd, Michael P. Rosenthal Md, Kyle Shaak Bs

Department of Family Medicine

No abstract provided.

Gendered Violence, Hiv Acquisition, And Clinical/Behavioral Research, Liz Barr, Michele Peake Andrasik, Claire Rappoport, Jessica Mooney, Annet Davis Vogel, Lisa Rossi, Amina Alio

Journal of Health Disparities Research and Practice

HIV incidence and prevalence rates for US women continue to increase, especially among Black and Latina women. In addition, the link between violence and HIV acquisition has been well documented. However, the interaction between violence, HIV risk, and HIV acquisition remains an under-addressed issue in current clinical and behavioral HIV research designs. Because violence against women plays an important role in HIV acquisition and transmission, it is imperative for clinical research to address violence in trial design and implementation. In this article, we discuss the prevalence of violence in women’s lives; the role violence plays in HIV acquisition; and the …

Variability In Eit Images Of Lung Ventilation As A Function Of Electrode Planes And Body Positions, Jie Zhang, Robert Patterson

Radiology Faculty Publications

This study is aimed at investigating the variability in resistivity changes in the lung region as a function of air volume, electrode plane and body position. Six normal subjects (33.8 ± 4.7 years, range from 26 to 37 years) were studied using the Sheffield Electrical Impedance Tomography (EIT) portable system. Three transverse planes at the level of second intercostal space, the level of the xiphisternal joint, and midway between upper and lower locations were chosen for measurements. For each plane, sixteen electrodes were uniformly positioned around the thorax. Data were collected with the breath held at end expiration and after …

Family-Specific, Novel, Deleterious Germline Variants Provide A Rich Resource To Identify Genetic Predispositions For Brcax Familial Breast Cancer., Hongxiu Wen, Yeong C. Kim, Carrie Snyder, Fengxia Xiao, Elizabeth A. Fleissner, Dina Becirovic, Jiangtao Luo, Bradley Downs, Simon Sherman, Kenneth Cowan, Henry T. Lynch, San Ming Wang

Journal Articles: Eppley Institute

BACKGROUND: Genetic predisposition is the primary risk factor for familial breast cancer. For the majority of familial breast cancer, however, the genetic predispositions remain unknown. All newly identified predispositions occur rarely in disease population, and the unknown genetic predispositions are estimated to reach up to total thousands. Family unit is the basic structure of genetics. Because it is an autosomal dominant disease, individuals with a history of familial breast cancer must carry the same genetic predisposition across generations. Therefore, focusing on the cases in lineages of familial breast cancer, rather than pooled cases in disease population, is expected to provide …

Phosphoinositides: Minor Lipids Make A Major Impact On Photoreceptor Cell Functions, Raju V. S. Rajala, Ammaji Rajala, Andrew J. Morris, Robert E. Anderson

Internal Medicine Faculty Publications

Activation of the phosphoinositide (PI) cycle generates the second messengers that control various aspects of cellular signaling. We have previously shown that two PI cycle enzymes, type II phosphatidylinositol 5-phosphate 4-kinase (PIPK IIα) and phosphoinositide 3-kinase (PI3K), are activated through light stimulation. In our earlier studies, we measured enzyme activities, instead of directly measuring the products, due to lack of sensitive analytical techniques. Cells have very low levels of PIs, compared to other lipids, so special techniques and sensitive analytical instruments are necessary for their identification and quantification. There are also other considerations, such as different responses in different cell …

Crohn’S Disease Linked Polymorphisms Associated With Autophagy Contribute To Th17 Cell Induction Through Increasing The Expression Of Il-1Β And Tnf-Α, Daniel Clayton Morse

Pursuit - The Journal of Undergraduate Research at The University of Tennessee

Genome wide association studies (GWAS) have linked polymorphisms in autophagy genes to Crohn’s Disease (CD). Interestingly, recent studies have shown that defective autophagy leads to increased levels of the cytokines IL-1b and TNF-a, which play a critical role in Th17 cell differentiation. This is significant because CD is marked by a Th17 cell mediated inflammatory response. This article examines the manners in which defective expression of autophagy linked proteins, can indirectly amplify and sustain Th17 cell induction through increasing the production of Th17 positively differentiating cytokines (IL-1b and TNF-a) and decreasing the production of a Th17 down regulating cytokine, IL-10.

Il-4 Signaling Drives A Unique Arginase+/Il-1Β+ Microglia Phenotype And Recruits Macrophages To The Inflammatory Cns: Consequences Of Age-Related Deficits In Il-4rα After Traumatic Spinal Cord Injury, Ashley M. Fenn, Jodie C.E. Hall, John C. Gensel, Phillip G. Popovich, Jonathan P. Godbout

Spinal Cord and Brain Injury Research Center Faculty Publications

Alternative activation of microglia/macrophages (M2a) by interleukin (IL)-4 is purported to support intrinsic growth and repair processes after CNS injury. Nonetheless, alternative activation of microglia is poorly understood in vivo, particularly in the context of inflammation, injury, and aging. Here, we show that aged mice (18-19 months) had reduced functional recovery after spinal cord injury (SCI) associated with impaired induction of IL-4 receptor α (IL-4Rα) on microglia. The failure to successfully promote an IL-4/IL-4Rα response in aged mice resulted in attenuated arginase (M2a associated), IL-1β, and chemokine ligand 2 (CCL2) expression, and diminished recruitment of IL-4Rα⁺ macrophages to …

Metastatic Angiosarcoma And Kasabach-Merritt Syndrome, Suleiman Massarweh, Aun Munis, Rouzan Karabakhtsian, Edward Romond, Jessica Moss

Internal Medicine Faculty Publications

Angiosarcomas are exceedingly rare tumors that are often difficult to diagnose. Exceptionally unusual is the presentation of these tumors with Kasabach-Merritt Syndrome, a curious form of intratumoral coagulation that can be impossible to distinguish from intravascular coagulation, which is more common. Instant recognition of this clinical association can help making a prompt diagnosis and timely initiation of therapy.

Correlating Periodontal Disease And Cardiovascular Disease: A Comparative Study Of Research Methodology, Alexandra Hensen

Honors Theses

This meta-analysis compares and contrasts three types of population-based research methodology currently used to analyze correlations between Periodontal disease and Cardiovascular disease, the most wide spread diseases in the Western industrialized world. The three studies that were analyzed in this thesis include: "Gender Differences in the Relationship Between Periodontal Disease, Tooth Loss, and Atherosclerosis," published in the Journal of Stroke and Cerebrovascular Diseases (2013), this was a cross-sectional population-based study; "Periodontal Disease and Mortality in Type 2 Diabetes" published in Diabetes Care (2005), this was a longitudinal population-based study; and "Identification of a Shared Genetic Susceptibility Locus for Coronary Heart …

Enhancing The Quality Of Healthcare Delivery In Refugee Communities With Photo Voice, Timothy M. Daly Do, Nicole Defenbaugh Phd, Brenda Depaula

Department of Family Medicine

No abstract provided.

A Central Role For Carbon-Overflow Pathways In The Modulation Of Bacterial Cell Death., Vinai Chittezham Thomas, Marat Sadykov, Sujata S. Chaudhari, Joselyn Jones, Jennifer L. Endres, Todd J. Widhelm, Jong-Sam Ahn, Randeep S. Jawa, Matthew C. Zimmerman, Kenneth W. Bayles

Journal Articles: Pathology and Microbiology

Similar to developmental programs in eukaryotes, the death of a subpopulation of cells is thought to benefit bacterial biofilm development. However mechanisms that mediate a tight control over cell death are not clearly understood at the population level. Here we reveal that CidR dependent pyruvate oxidase (CidC) and α-acetolactate synthase/decarboxylase (AlsSD) overflow metabolic pathways, which are active during staphylococcal biofilm development, modulate cell death to achieve optimal biofilm biomass. Whereas acetate derived from CidC activity potentiates cell death in cells by a mechanism dependent on intracellular acidification and respiratory inhibition, AlsSD activity effectively counters CidC action by diverting carbon flux …

Immunomodulatory Activity Of Interferon-Beta, Lloyd H. Kasper, Anthony T. Reder

Dartmouth Scholarship

Multiple sclerosis (MS) is a complex disorder of the central nervous system that appears to be driven by a shift in immune functioning toward excess inflammation that results in demyelination and axonal loss. Beta interferons were the first class of disease-modifying therapies to be approved for patients with MS after treatment with this type I interferon improved the course of MS on both clinical and radiological measures in clinical trials. The mechanism of action of interferon-beta appears to be driven by influencing the immune system at many levels, including antigen-presenting cells, T cells, and B cells. One effect of these …

Unique Interdisciplinary Public Health Model Doubles Latent Tuberculosis Infection Treatment Completion Of Refugee Patients In A Large Metropolitan Area, Christine O'Leary, Pharmd, Kevin Scott, Md, Marc Altshuler, Md, Karen Kitagawa-James, Rn, Bsn, Maria Hervada-Paige, Mss

Department of Family & Community Medicine Presentations and Grand Rounds

Background and Purpose:

The Jefferson Center for Refugee Health (JCRH), a component of Jefferson Family Medicine Associates (JFMA), is the first and largest single provider of refugee health in Philadelphia; over 1,000 refugee primary care visits are provided annually. Refugee patients are disproportionately affected by latent tuberculosis infection (LTBI) compared to the general population of the United States; and though treatment of LTBI is highly effective at reducing conversion to active tuberculosis (TB), completion rates among the foreign-born are reported to be less than 50%. To establish baseline LTBI incidence and treatment completion rates for our refugee population, the JCRH …

What's New In Spine Surgery., Keith H Bridwell, Paul A Anderson, Scott D Boden, Han Jo Kim, Alexander Vaccaro, Md, Phd, Jeffrey C Wang

Rothman Institute Papers

No abstract provided.

Targeting The Wnt/Β-Catenin Signaling Pathway In Liver Cancer Stem Cells And Hepatocellular Carcinoma Cell Lines With Fh535, Roberto Gedaly, Roberto Galuppo, Michael F. Daily, Malay B. Shah, Erin Colleen Maynard, Changguo Chen, Xiping Zhang, Karyn A. Esser, Donald A. Cohen, B. Mark Evers, Jieyun Jiang, Brett T. Spear

Surgery Faculty Publications

Activation of the Wnt/β-catenin pathway has been observed in at least 1/3 of hepatocellular carcinomas (HCC), and a significant number of these have mutations in the β-catenin gene. Therefore, effective inhibition of this pathway could provide a novel method to treat HCC. The purposed of this study was to determine whether FH535, which was previously shown to block the β-catenin pathway, could inhibit β-catenin activation of target genes and inhibit proliferation of Liver Cancer Stem Cells (LCSC) and HCC cell lines. Using β-catenin responsive reporter genes, our data indicates that FH535 can inhibit target gene activation by endogenous and exogenously …