Medical Specialties Commons^™

To Care Is To Treat, Himanshu Malhotra

Akesis

To Care is to Treat is a reflection of a few experiences from my second and third year that have inspired me to become a palliative care physician.

The Narrative Of My Childhood, Nihit N. Mehta

Akesis

I was a weak child from early on, never able to run or play as much as the other kids in my block. Each month I'd visit doctors, trying my best to recover from common colds and coughs. Luckily, all this changed as I matured and in a way I almost began living a "normal life".

However, when it came to deciding what I wanted to be as an adult, I remembered the sick kid I was and how my doctors were always there for me, helping me "find health." This made me realize that I too, could someday be …

The Descent Down The Step One Rabbit Hole, Katelyn A. Hanson

Akesis

At the start of my second year of medical school I was ecstatic to move away from the study of the normal, healthy human body and to begin to immerse myself in the complex mechanisms behind the pathophysiology of disease. I drew this illustration to connect aspects of my personality with the aspects of medicine I was most excited about exploring deeper. This image was drawn with permanent markers on the cover of a binder dedicated solely to preparing for the first part of the medical licensing exam; I looked at this drawing every day as I drove myself closer …

Laurie's Greenhouse, Elizabeth G. Mcandrew, Kelsey Albert

Akesis

Pottery by: Elizabeth McAndrew

Photography by: Kelsey Albert and Elizabeth McAndrew

Modeling: Laurie the Bird

Materials: Wheel thrown pottery - Cone 10 white clay and dipped glaze (cobalt blue and mossy green). Philodendron Heartleaf Plant. Laurie is a parrotlet, which is the second smallest species of parrot. Photo editing was done directly on the iPhone photo application.

This photo represents beginnings because it includes many elements of my life that I drew toward me in the year that I began my medical career. Living alone for the first time, I bought plants so that I wasn't the only living thing …

Beginnings, Nehal J. Shah

Akesis

The beginning of one thing signifies the end of another – for one to start, another must end. With that said, under karmic and Hindu belief, we are constantly in a cycle of beginnings, and endings, until we achieve “moksha” – true oneness with God. Furthermore, within each cycle, there are four stages of life that one hopes to go through, carrying out the ideal goals and progress of each existence. Therefore, this life ultimately is a new beginning to an old soul – a soul that has traveled and journeyed upon eons of time to find happiness, spirituality, completeness …

Beginnings: A Letter From The Editors, Akesis Editors

Akesis

The editors would like to welcome you to the inaugural issue of Akesis.

Community Emergency Medicine: Benefits And Challenges Of Screening For Elder Abuse In The Emergency Department Of A Developing Country, Muhammad Akbar Baig, Asad Mian, Erfaan Hussain, Shahan Waheed

Department of Emergency Medicine

No abstract provided.

Factors Associated With Tonic-Clonic Seizures In Patients With Drug-Resistant Mesial Temporal Epilepsy., Ali Akbar Asadi-Pooya, Cyrus Rostami, Amin H. Rabiei, Michael R. Sperling

Department of Neurology Faculty Papers

PURPOSE: Among different seizure types, tonic-clonic seizures are more significant because they are more often associated with morbidity. No prior study has been done to investigate risk factors associated with tonic-clonic seizures in patients with mesial temporal epilepsy.

METHODS: In this retrospective study, all drug-resistant mesial temporal epilepsy patients in the database of patients who underwent epilepsy surgery at Jefferson comprehensive epilepsy center were recruited. These patients were prospectively registered in a database from 1986 till 2014. Patients' age, gender, epilepsy risk factors, age at seizure onset, and preoperative seizure type(s) were registered routinely. Potential risk factors associated with experiencing …

Cyclin D1 Silencing Suppresses Tumorigenicity, Impairs Dna Double Strand Break Repair And Thus Radiosensitizes Androgenindependent Prostate Cancer Cells To Dna Damage., F Marampon, G L Gravina, Xiaoming Ju, A Vetuschi, R Sferra, Mathew C Casimiro, S Pompili, C Festuccia, A Colapietro, E Gaudio, E Di Cesare, V Tombolini, Richard Pestell

Department of Cancer Biology Faculty Papers

Patients with hormone-resistant prostate cancer (PCa) have higher biochemical failure rates following radiation therapy (RT). Cyclin D1 deregulated expression in PCa is associated with a more aggressive disease: however its role in radioresistance has not been determined. Cyclin D1 levels in the androgen-independent PC3 and 22Rv1 PCa cells were stably inhibited by infecting with cyclin D1-shRNA. Tumorigenicity and radiosensitivity were investigated using in vitro and in vivo experimental assays. Cyclin D1 silencing interfered with PCa oncogenic phenotype by inducing growth arrest in the G1 phase of cell cycle and reducing soft agar colony formation, migration, invasion in vitro and tumor …

The Incidence Of Early Stage Postoperative Nausea And Vomiting Following The Use Of Nitrous Oxide And Prophylactic Antiemetic Therapy: Implications For Clinical Practice, James Sullivan

Doctoral Projects

Nitrous oxide (N₂O) is a volatile agent currently used during the induction and maintenance of general anesthesia. Since it’s discovery in 1786 by Dr. Priestly, it is the oldest volatile agent to find continued use in current practice (Kossick, 2014). In conjunction with its extensive history is the debate regarding its emetic properties. Numerous studies have investigated the effect of nitrous oxide to produce postoperative nausea and vomiting (PONV) with varying and often conflicting results. Generally speaking, nitrous oxide is theoretically an emetic and is believed to be associated with PONV (Tramer, Moore, & McQuay, 1996). This has …

Cerebral Oximetry Readings In The Sitting Position Versus Supine Position For Patients Undergoing General Anesthesia, Christopher Turner

Doctoral Projects

Problem: Inadequate cerebral blood flow is a significant risk for patients undergoing surgery in the sitting position. Placing the patient in a sitting position may cause a drop in pressure at the level of the brain when compounded with induction and maintenance of general anesthesia. These changes may cause a decrease in cerebral blood flow and oxygenation. Inadequate perfusion for a prolonged period of time could produce negative neurological consequences in the short and long term postoperative period.

Purpose: The purpose of this project is to determine if there is a significant drop in cerebral oximetry, from baseline, when patients …

Intentional And Unintentional Poisoning In Pakistan: A Pilot Study Using The Emergency Departments Surveillance Project., Nadeem Ullah Khan, Ricardo Pérez-Núñez, Nudrat Shamim, Uzma Rahim Khan, Naureen Naseer, Asher Feroze, Junaid Abdul Razzak, Adnan A. Hyder

Department of Emergency Medicine

Background: Acute poisoning is one of the most common reasons for emergency department visits around the world. In Pakistan, the epidemiological data on poisoning is limited due to an under developed poison information surveillance system. We aim to describe the characteristics associated with intentional and unintentional poisoning in Pakistan presenting to emergency departments.
Methods: The data was extracted from the Pakistan National Emergency Department Surveillance (Pak-NEDS) which was an active surveillance conducted between November 2010 and March 2011. All patients, regardless of age, who presented with poisoning to any of Pakistan's seven major tertiary care centers' emergency departments, were included. …

The Pakistan National Emergency Department Surveillance Study (Pak-Neds): Introducing A Pilot Surveillance, Mohammed Umer Mir, Abdulgafoor M. Bachani, Haseeb Khawaja, Shiraz Qayoom Afridi, Sabir Ali, Muhammad Mujeeb Khan, Seemin Jamali, Fareed Ahmed Sumalani, Adnan A. Hyder, Junaid Abdul Razzak

Department of Emergency Medicine

Background: Evidence-based decision making is essential for appropriate prioritization and service provision by healthcare systems. Despite higher demands, data needs for this practice are not met in many cases in low- and middle-income countries because of underdeveloped sources, among other reasons. Emergency departments (EDs) provide an important channel for such information because of their strategic position within healthcare systems. This paper describes the design and pilot test of a national ED based surveillance system suitable for the Pakistani context.
Methods: The Pakistan National Emergency Department Surveillance Study (Pak-NEDS) was pilot tested in the emergency departments of seven major tertiary healthcare …

Pattern Of Fall Injuries In Pakistan: The Pakistan National Emergency Department Surveillance (Pak-Neds) Study., Jabeen Fayyaz, Shirin Wadhwaniya, Hira Shahzad, Asher Feroze, Nukhba Zia, Mohammed Umer Mir, Uzma Rahim Khan, Sumera Iram, Sabir Ali, Junaid Abdul Razzak, Adnan A. Hyder

Department of Emergency Medicine

Background: We aimed to analyse the frequency and patterns of fall-related injuries presenting to the emergency departments (EDs) across Pakistan.
Methods: Pakistan National Emergency Departments surveillance system collected data from November 2010 to March 2011 on a 24/7 basis using a standardized tool in seven major EDs (five public and two private hospitals) in six major cities of Pakistan. For all patients presenting with fall-related injuries, we analysed data by intent with focus on unintentional falls. Simple frequencies were run for basic patient demographics, mechanism of falls, outcomes of fall injuries, mode of arrival to ED, investigations, and procedures with …

Characteristics Of Chest Pain And Its Acute Management In A Low-Middle Income Country: Analysis Of Emergency Department Surveillance Data From Pakistan, Nino Paichadze, Badar Afzal Khan, Nukhba Zia, Rakshinda Mujeeb, Muhammad Mujeeb Khan, Junaid Ali Razzak

Department of Emergency Medicine

Background:

Chest pain is one of the most frequent causes of emergency department (ED) visits in high-income countries. Little is known about chest pain patients presenting to EDs of low- and middle-income countries (LMICs). The objective of this study was to describe the characteristics of chest pain patients presenting to emergency departments (EDs) of Pakistan and to determine the utilization of ED resources in the management of chest pain patients and their outcomes.

Methods:

This study used pilot active surveillance data from seven major EDs in Pakistan. Data were collected on all patients presenting to the EDs of the participating …

How Vital Are The Vital Signs? A Multi-Center Observational Study From Emergency Departments Of Pakistan, Amber Mehmood, Siran He, Waleed Zafar, Mirza Noor Ali Baig, Fareed Ahmed Sumalani, Junaid Razzak

Department of Emergency Medicine

Background: Vital signs play a critical role in prioritizing patients in emergency departments (EDs), and are the foundation of most triage methods and disposition decisions. This study was conducted to determine the frequency of vital signs documentation anytime during emergency department treatment and to explore if abnormal vital signs were associated with the likelihood of admission for a set of common presenting complaints.
Methods: Data were collected over a four-month period from the EDs of seven urban tertiary care hospitals in Pakistan. The variables included age, sex, hospital type (government run vs. private), presenting complaint, ED vital signs, and final …

The Pediatric Disease Spectrum In Emergency Departments Across Pakistan: Data From A Pilot Surveillance System, Huba Atiq, Emaduddin Siddiqui, Surraya Bano, Asher Feroze, Sayyeda Ghazala Kazi, Jabeen Fayyaz, Shivam Gupta, Junaid A. Razzak, Adnan A Hyder, Asad Mian

Department of Emergency Medicine

Background: There is an increasing number of urgently ill and injured children being seen in emergency departments (ED) of developing countries. The pediatric disease burden in EDs across Pakistan is generally unknown. Our main objective was to determine the spectrum of disease and injury among children seen in EDs in Pakistan through a nationwide ED-based surveillance system.
Methods: Through the Pakistan National Emergency Department Surveillance (Pak-NEDS), data were collected from November 2010 to March 2011 in seven major tertiary care centers representing all provinces of Pakistan. These included five public and two private hospitals, with a collective annual census of …

Uncovering The Burden Of Intentional Injuries Among Children And Adolescents In The Emergency Department, Uzma R. Khan, Butool Hisam, Nukhba Zia, Mohammed Umer Mir, Olakunle Alonge, Seemin Jamali, Adnan Hyder, Junaid Abdul Razzak

Department of Emergency Medicine

Introduction: In low- and middle-income countries, injuries are a leading cause of mortality in children. Much work has been done in the context of unintentional injuries but there is limited knowledge about intentional injuries among children. The objective of this paper was to understand the characteristics of children with intentional injuries presenting to emergency departments in Pakistan.
Methods: The data was from the Pakistan National Emergency Departments Surveillance (Pak-NEDS), conducted from November 2010 to March 2011 in seven major emergency departments of Pakistan. Data on 30,937 children under 18 years of age was collected. This paper reports frequency of intentional …

Dead On Arrival In A Low-Income Country: Results From A Multicenter Study In Pakistan, Munawar Khursheed, Junaid Ahmad Bhatti, Fatima Parukh, Asher Feroze, Syed Saad Naeem, Haseeb Khawaja, Junaid Razzak

Department of Emergency Medicine

BACKGROUND:

This study assessed the characteristics of dead on arrival (DOA) patients in Pakistan.

METHODS:

Data about the DOA patients were extracted from Pakistan National Emergency Department Surveillance study (Pak-NEDS). This study recruited all ED patients presenting to seven tertiary care hospitals during a four-month period between November 2010 and March 2011. This study included patients who were declared dead-on-arrival by the ED physician.

RESULTS:

A total of 1,557 DOA patients (7 per 1,000 visits) were included in the Pak-NEDS. Men accounted for two-thirds (64%) of DOA patients. Those aged 20-49 years accounted for about 46% of DOA patients. Nine …

Emergency Care Of Traumatic Brain Injuries In Pakistan: A Multicenter Study, Junaid Ahmad Bhatti, Kent Stevens, Muhammad Umer Mir, Adnan Ali Hyder, Junaid Razzak

Department of Emergency Medicine

Background:

This study assessed factors associated with emergency care outcomes and out-of-pocket treatment costs in traumatic brain injury (TBI) patients in Pakistan.

Methods:

Data on TBI patients were extracted from a four-month surveillance study conducted in the emergency departments (ED) of seven large teaching hospitals. Emergency care access to physicians and imaging facilities were compared with respect to ED outcomes (discharged, admitted or dead). Out-of-pocket treatment costs (in United States dollars [USD]) were compared among different patient strata.

Results:

ED outcomes were available for 1,787 TBI patients. Of them, most were males (79%), aged <25 years (46%) and arrived by ambulances (32%). Nurses or paramedical staff saw almost all patients (95%). Physicians with practice privileges (medical officers, residents or consultants) saw about half (55%) of them. Computerized tomography (CT) scans were performed in two of five patients (40%). Of all, 26% (n = 460) were admitted and 3% died (n = 52). Emergency care factors significantly associated with being admitted or died were arriving by ambulance (adjusted odds ratio [aOR] = 2.37, 95% confidence interval (CI) [95%CI] = 1.78-3.16); seen by medical officer/residents (aOR = 2.11; 95%CI = 1.49-2.99); and had CT scan (aOR = 2.93; 95%CI = 2.25-3.83). Out-of-pocket treatment costs at the ED were reported in 803 patients. Average costs were USD 8, (standard deviation [SD] = 23). Costs were twice as high in those arriving in ambulances (USD 20, SD = 49) or who underwent CT scans (USD 16, SD = 37).

Conclusion:

TBI patients' access to ambulance …

Ambulance Use In Pakistan: An Analysis Of Surveillance Data From Emergency Departments In Pakistan., Nukhba Zia, Hira Shahzad, Syed Muhammad Baqir, Shahab Shaukat, Haris Ahmad, Courtland Robinson, Adnan Ali Hyder, Junaid Razzak

Department of Emergency Medicine

Background:

The utilization of ambulances in low- and middle-income countries is limited. The aim of this study was to ascertain frequency of ambulance use and characteristics of patients brought into emergency departments (EDs) through ambulance and non-ambulance modes of transportation.

Methods:

The Pakistan National Emergency Departments Surveillance (Pak-NEDS) was a pilot active surveillance conducted in seven major tertiary-care EDs in six main cities of Pakistan between November 2010 and March 2011. Univariate and multivariate logistic regression was performed to investigate the factors associated with ambulance use.

Results:

Out of 274,436 patients enrolled in Pak-NEDS, the mode of arrival to the …

Pattern Of Presenting Complaints Recorded As Near-Drowning Events In Emergency Departments: A National Surveillance Study From Pakistan., Siran He, Jeffrey C. Lunnen, Nukhba Zia, Uzma Rahim Khan, Khusro Shamim, Adnan Ali Hyder

Department of Emergency Medicine

Background:

Drowning is a heavy burden on the health systems of many countries, including Pakistan. To date, no effective large-scale surveillance has been in place to estimate rates of drowning and near-drowning in Pakistan. The Pakistan National Emergency Department Surveillance (Pak-NEDS) study aimed to fill this gap.

Method:

Patients who presented with a complaint of “near-drowning” were analyzed to explore patterns of true near-drowning (unintentional) and intentional injuries that led to the “near-drowning” complaint. Bivariate analysis was done to establish patterns among patients treated in emergency departments, including socio-demographic information, injury-related information, accompanying injuries, and emergency department resource utilization.

Result: …

Does The Use Of A Regional Nerve Block Decrease The Incidence Of Post Operative Nausea And Vomiting, Decrease Pain Scores, Or Decrease Discharge Time Compared To General Anesthesia Alone?, Donald Lane Whitney

Doctoral Projects

Problem Statement: The use of regional anesthesia in orthopedic surgeries has been shown to decrease the rate of postoperative nausea and vomiting (PONV), postoperative pain, and decrease postoperative discharge time. However, some healthcare facilities continue to provide anesthesia for these procedures without the use of regional anesthesia techniques.

Purpose: The purpose of this capstone project was to determine if the addition of a regional anesthetic technique would be beneficial to the patient and cost efficient to the healthcare facility.

Methods: A retrospective chart review was conducted and data collected on the population of interest. Inclusion criteria were patients undergoing orthopedic …

A Pilot Study Of Propofol As An Anti-Emetic In Laparoscopic, Gynecologic Surgery Patients, Flem-Flam Aaron Flemister

Doctoral Projects

The goal of this project was to use sub-hypnotic doses of propofol to decrease post operative nausea and vomiting (PONV) rates in the immediate post-operative period in females, ages 18-65, undergoing laparoscopic gynecologic surgery.

PONV is one of the largest complications of anesthesia affecting 20-30% of all surgical patients. Risk factors associated with PONV are female gender, laparoscopy, general anesthesia, opioids, volatile agents, and post-operative pain; all of which are frequently encountered. The incidence of PONV can prolong recovery time, delay discharge, increase patient cost, decrease patient satisfaction, and can cause significant medical complications. Propofol has previously demonstrated anti-emetic properties; …

Recommendations For The Development Of New Hospital Guidelines Due To The Effects Of Antibiotics On Clostridium Difficile Colitis, Megan Kohsel

Honors Theses

Clostridium difficile colitis is an infection that causes inflammation of the colon and diarrhea. This can even lead to death in some cases. The incidence of this infection and its overall effects have been on the rise throughout the last twenty years as antibiotics have been prescribed more frequently. Therefore, it is necessary that the rate of C. difficile infection is lowered by improved guidelines for hospitals, so that fewer people are infected and also that fewer antibiotics are prescribed to avoid the infection with C. difficle.

Burn Injury Characteristics: Findings From Pakistan National Emergency Department Surveillance Study, Emaduddin Siddiqui, Nukhba Zia, Asher Feroze, Safia Awan, Arifa Liaquat Ali, Junaid Razzak, Adnan Hyder, Asad Latif

Department of Emergency Medicine

Background: Burn injury is an important yet under-researched area in Pakistan. The objective of this study was to determine the characteristics and associated outcomes of burn injury patients presenting to major emergency departments in Pakistan.
Methods: Pakistan National Emergency Department Surveillance (Pak-NEDS) was a pilot active surveillance conducted between November 2010 and March 2011. Information related to patient demographics, mode of arrival, cause of burn injury, and outcomes was analyzed for this paper. Data were entered using Epi Info and analyzed using SPSS v.20. Ethical approval was obtained from all participating sites.
Results: There were 403 burn injury patients in …

Effectiveness Of Iterative Interventions To Increase Research Productivity In One Residency Program., Richard Alweis, Suzanne Wenderoth, Anthony A. Donato

Reading Hospital Internal Medicine Residency

BACKGROUND: The Accreditation Council for Graduate Medical Education requires residency programs to expose residents to research opportunities.

OBJECTIVE: The purpose of this study was to assess the impact of a series of iterative interventions to increase scholarly activity in one internal medicine residency.

METHODS: Retrospective analysis of the effectiveness of a series of interventions to increase resident and faculty scholarly productivity over a 14-year period was performed using quality improvement methodology. Outcomes measured were accepted regional and national abstracts and PubMed indexed manuscripts of residents and faculty.

RESULTS: Initially, regional meeting abstracts increased and then were supplanted by national meeting …

Isosorbide Mononitrate In Heart Failure With Preserved Ejection Fraction., Margaret M. Redfield, Kevin J. Anstrom, James A. Levine, Gabe A. Koepp, Barry A. Borlaug, Horng H. Chen, Martin M. Lewinter, Susan M. Joseph, Sanjiv J. Shah, Marc J. Semigran, G. Michael Felker, Robert T. Cole, Gordon R. Reeves, Ryan J. Tedford, W.H. Wilson Tang, Steven E. Mcnulty, Eric J. Velazquez, Monica R Shah, Eugene Braunwald

Division of Cardiology Faculty Papers

BACKGROUND: Nitrates are commonly prescribed to enhance activity tolerance in patients with heart failure and a preserved ejection fraction. We compared the effect of isosorbide mononitrate or placebo on daily activity in such patients.

METHODS: In this multicenter, double-blind, crossover study, 110 patients with heart failure and a preserved ejection fraction were randomly assigned to a 6-week dose-escalation regimen of isosorbide mononitrate (from 30 mg to 60 mg to 120 mg once daily) or placebo, with subsequent crossover to the other group for 6 weeks. The primary end point was the daily activity level, quantified as the average daily accelerometer …

Genetic Modification Of Human Mesenchymal Stem Cells Helps To Reduce Adiposity And Improve Glucose Tolerance In An Obese Diabetic Mouse Model., Sabyasachi Sen, Cleyton C Domingues, Carol Rouphael, Cyril Chou, Chul Kim, Nagendra Yadava

Medicine Faculty Publications

INTRODUCTION: Human mesenchymal stem cells (MSCs) are multipotent cells that can differentiate into fat, muscle, bone and cartilage cells. Exposure of subcutaneous abdominal adipose tissue derived AD-MSCs to high glucose (HG) leads to superoxide accumulation and up-regulation of inflammatory molecules. Our aim was to inquire how HG exposure affects MSCs differentiation and whether the mechanism is reversible.

METHODS: We exposed human adipose tissue derived MSCs to HG (25 mM) and compared it to normal glucose (NG, 5.5 mM) exposed cells at 7, 10 and 14 days. We examined mitochondrial superoxide accumulation (Mitosox-Red), cellular oxygen consumption rate (OCR, Seahorse) and gene …

New Podcast From Radiation Oncology, Daniel G. Kipnis, Msi

Jefferson Digital Commons News

The Department of Radiation Oncology’s first podcast, FAQ: Special focus on the Radiation Oncology Residency Program at Thomas Jefferson University, features a discussion of what separates Jefferson from other residency program and answers commonly asked questions. The podcast is now archived in the Jefferson Digital Commons.