Medical Specialties Commons^™

Can Doctors Change? Attempts To Improve Adherence To The 2013 Statin Guidelines For Diabetic Patients At An Urban Academic Family Medicine Clinic, Marshall Miller, Md, Victoria Rose, Md, Jill Kropa, Md, Rina Edi, Md, Margaret Crenshaw, Md, Emily Levy, Md, Christopher Hwang, Md, Elizabeth Collins, Md, Danielle Dang, Md, Lori Atkinson, Md

Department of Family & Community Medicine Presentations and Grand Rounds

In November 2013 new statin guidelines were released. Generally, physicians are slow to adopt new guidelines and adherence to new guidelines often remains low even years after they have been issued. In this study, multiple interventions, including patient handouts, email reminders, and education sessions were implemented to increase adherence with new statin prescribing guidelines in a large urban practice. The numbers of prescriptions were analyzed for 6 weeks prior to and 6 weeks after the interventions. Statin prescribing in diabetic patients not already on a statin pre-intervention was 11.7% and post-intervention was 13.0% (p-value 0.5936). There was a small increase …

Respiratory Function Amongst Asymptomatic Hiv Positive And Hiv Negative Clients At Aga Khan University Hospital, Nairobi, Noah Kipkemei Murbiy

Master of Medicine in Internal Medicine

Background: Spirometry is used to asses respiratory function abnormalities. This is usually in reference to a validated normal range unique to a particular gender, race, age, weight and height. Majority of persons are usually asymptomatic until the expected FEV1 has decreased by 50%. Early intervention on the abnormalities even in this asymptomatic group has been shown to retard the rate of pulmonary deterioration. An unpublished audit at the Aga Khan University Hospital, Nairobi, revealed that majority of newly diagnosed HIV positive persons were admitted at the Critical Care Units with a pulmonary cause which later resulted in poor outcomes. This …

Pannexin1 Channels Dominate Atp Release In The Cochlea Ensuring Endocochlear Potential And Auditory Receptor Potential Generation And Hearing, Jin Chen, Yan Zhu, Chun Liang, Jing Chen, Hong-Bo Zhao

Otolaryngology--Head & Neck Surgery Faculty Publications

Pannexin1 (Panx1) is a gap junction gene in vertebrates whose proteins mainly function as non-junctional channels on the cell surface. Panx1 channels can release ATP under physiological conditions and play critical roles in many physiological and pathological processes. Here, we report that Panx1 deficiency can reduce ATP release and endocochlear potential (EP) generation in the cochlea inducing hearing loss. Panx1 extensively expresses in the cochlea, including the cochlear lateral wall. We found that deletion of Panx1 in the cochlear lateral wall almost abolished ATP release under physiological conditions. Positive EP is a driving force for current through hair cells to …

Multiparametric Mr Enterography Without The Use Of Antiperistaltic Agents: Performance And Interpretation, Amelia M. Wnorowski, Md, Flavius Guglielmo, Md, Robert Ford, Md, Donald G. Mitchell, Md

Department of Radiology Faculty Papers

Purpose

To describe how to perform and interpret MR enterography (MRE) without using antiperistaltic agents.

Klf4-Sqstm1/P62-Associated Prosurvival Autophagy Contributes To Carfilzomib Resistance In Multiple Myeloma Models., Irene Riz, Teresa S. Hawley, Robert G. Hawley

Anatomy and Regenerative Biology Faculty Publications

Multiple myeloma (MM) is an incurable clonal plasma cell malignancy. Because of a high rate of immunoglobulin synthesis, the endoplasmic reticulum of MM cells is subjected to elevated basal levels of stress. Consequently, proteasome inhibitors, which exacerbate this stress by inhibiting ubiquitin-proteasome-mediated protein degradation, are an important new class of chemotherapeutic agents being used to combat this disease. However, MM cells still develop resistance to proteasome inhibitors such as carfilzomib. Toward this end, we have established carfilzomib-resistant derivatives of MM cell lines. We found that resistance to carfilzomib was associated with elevated levels of prosurvival autophagy, and Kruppel-like factor 4 …

Combination Of Id2 Knockdown Whole Tumor Cells And Checkpoint Blockade: A Potent Vaccine Strategy In A Mouse Neuroblastoma Model., Lina Chakrabarti, Clifford Morgan, Anthony D. Sandler

Surgery Faculty Publications

Tumor vaccines have held much promise, but to date have demonstrated little clinical success. This lack of success is conceivably due to poor tumor antigen presentation combined with immuno-suppressive mechanisms exploited by the tumor itself. Knock down of Inhibitor of differentiation protein 2 (Id2-kd) in mouse neuroblastoma whole tumor cells rendered these cells immunogenic. Id2-kd neuroblastoma (Neuro2a) cells (Id2-kd N2a) failed to grow in most immune competent mice and these mice subsequently developed immunity against further wild-type Neuro2a tumor cell challenge. Id2-kd N2a cells grew aggressively in immune-compromised hosts, thereby establishing the immunogenicity of these cells. Therapeutic vaccination with Id2-kd …

Anesthesia For Deep Brain Stimulation In Traumatic Brain Injury-Induced Hemidystonia., Jill M Jani, Chima O Oluigbo, Srijaya K Reddy

Anesthesiology and Critical Care Medicine Faculty Publications

Deep brain stimulation in an awake patient presents several unique challenges to the anesthesiologist. It is important to understand the various stages of the procedure and the complexities of anesthetic management in order to have a successful surgical outcome and provide a safe environment for the patient.

Letter To The Editor: Perianeurysmal Edema, Archie Defillo Md, Jerone Kennedy Md

Articles

No abstract provided.

The Cognition-Enhancing Effects Of Psychostimulants Involve Direct Action In The Prefrontal Cortex, Robert C. Spencer, David M. Devilbiss, Craig Berridge

Rowan-Virtua School of Osteopathic Medicine Departmental Research

Psychostimulants are highly effective in the treatment of attention-deficit/hyperactivity disorder. The clinical efficacy of these drugs is strongly linked to their ability to improve cognition dependent on the prefrontal cortex (PFC) and extended frontostriatal circuit. The procognitive actions of psychostimulants are only associated with low doses. Surprisingly, despite nearly 80 years of clinical use, the neurobiology of the procognitive actions of psychostimulants has only recently been systematically investigated. Findings from this research unambiguously demonstrate that the cognition-enhancing effects of psychostimulants involve the preferential elevation of catecholamines in the PFC and the subsequent activation of norepinephrine α2 and dopamine D1 receptors. …

Department Of Surgery Update, June 2015, Wright State University Department Of Surgery

Department of Surgery Updates

A three page newsletter created by the Department of Surgery documenting changes to the department. This issue contains a message from the chair, a list of important dates, committee meetings, scholarly activity and more.

Alterations In Dna Methylation May Be The Key To Early Detection And Treatment Of Schistosomal Bladder Cancer, Simon L. Conti, Jared Honeycutt, Justin I. Odegaard, Mark L. Gonzalgo, Michael H. Hsieh

Urology Faculty Publications

No abstract provided.

Retinoic Acid And The Development Of The Endoderm, Gregory M. Kelly, Thomas A. Drysdale

Paediatrics Publications

Retinoic acid (RA) is an important signaling molecule in the development of the endoderm and an important molecule in protocols used to generate endodermal cell types from stem cells. In this review, we describe the RA signaling pathway and its role in the patterning and specification of the extra embryonic endoderm and different endodermal organs. The formation of endoderm is an ancient evolutionary feature and RA signaling appears to have coevolved with the vertebrate lineage. Towards that end, we describe how RA participates in many regulatory networks required for the formation of extraembryonic structures as well as the organs of …

Long Non-Coding Rna Malat1 Regulates Hyperglycaemia Induced Inflammatory Process In The Endothelial Cells., Prasanth Puthanveetil, Shali Chen, Biao Feng, Anirudh Gautam, Subrata Chakrabarti

Pathology Publications

To examine whether the long non-coding RNA (lncRNA) metastasis associated lung adenocarcinoma transcript 1 (MALAT1) is altered in the endothelial cells in response to glucose and the significance of such alteration. We incubated human umbilical vein endothelial cells with media containing various glucose levels. We found an increase in MALAT1 expression peaking after 12 hrs of incubation in high glucose. This increase was associated with parallel increase in serum amyloid antigen 3 (SAA3), an inflammatory ligand and target of MALAT1 and was further accompanied by increase in mRNAs and proteins of inflammatory mediators, tumour necrosis factor alpha (TNF-α) and interleukin …

Differential Effects Of Cold Atmospheric Plasma In The Treatment Of Malignant Glioma, Alan Siu, Olga Volotskova, Xiaoqian Cheng, Siri S. Khalsa, Ka Bian, Ferid Murad, Michael Keidar, Jonathan H. Sherman

Neurological Surgery Faculty Publications

Objective

Cold atmospheric plasma (CAP) has recently been shown to selectively target cancer cells with minimal effects on normal cells. We systematically assessed the effects of CAP in the treatment of glioblastoma.

Methods

Three glioma cell lines, normal astrocytes, and endothelial cell lines were treated with CAP. The effects of CAP were then characterized for viability, cytotoxicity/apoptosis, and cell cycle effects. Statistical significance was determined with student's t-test.

Results

CAP treatment decreases viability of glioma cells in a dose dependent manner, with the ID50 between 90-120 seconds for all glioma cell lines. Treatment with CAP for more than 120 seconds …

An Uncommon Clinical Presentation Of Relapsing Dilated Cardiomyopathy With Identification Of Sequence Variations In Mynpc3, Kcnh2 And Mitochondrial Trna Cysteine, M. J. Guillen Sacoto, Kimberly A. Chapman, D. Heath, M. B. Seprish, Dina Zand

Pediatrics Faculty Publications

We describe a young girl with dilated cardiomyopathy, long QT syndrome, and possible energy deficiency. Two major sequence changes were identified by whole exome sequencing (WES) and mitochondrial DNA analysis that were interpreted as potentially causative. Changes were identified in the KCNH2 gene and mitochondrial tRNA for cysteine. A variation was also seen in MYPBC3. Since the launch of WES as a clinically available technology in 2010, there has been concern regarding the identification of variants unrelated to the patient's phenotype. However, in cases where targeted sequencing fails to explain the clinical presentation, the underlying etiology could be more complex …

Computed Tomography-Guided Biopsy For Potts Disease: An Institutional Experience From An Endemic Developing Country, Muhammad Waqas, Mohsin Qadeer, Faizuddin Faiz, Mohammad Ali Alvi, Muhammad Ehsan Bari

Section of Neurosurgery

Study design: A retrospective chart review.
Purpose: In endemic resource poor countries like Pakistan, most patients are diagnosed and treated for Potts disease on clinical and radiological grounds without a routine biopsy. The purpose of this study was to evaluate the use and effect of computed tomography (CT)-guided biopsy in the management of Potts disease since the technique is becoming increasingly available.
Overview of literature: CT-guided biopsy of spinal lesions is routinely performed. Literature on the utility of the technique in endemic resource poor countries is little.
Methods: This study was conducted at the Neurosurgery section of Aga Khan University …

Hyperhomocysteinemia - An Unidentified Risk Factor For Stroke In Our Population, Sabaa Asif, Bashir A Soomro, Kanwal Sartaj, Shafaq Alvi

Pakistan Journal of Neurological Sciences (PJNS)

Introduction:
Various studies show that moderate elevation of plasma homocysteine level has been associated with increased risk for cardiovascular and cerebrovascular disease.

Objective:
To observe the frequency of increased homocysteine level in ischemic stroke patients; and its association with other risk factors.

Methodology:
Observational pilot study was conducted on a sample of 75 ischemic stroke patients, enrolled regardless of their age, gender and comorbidities, at Ziauddin university hospital, Karachi. Fasting serum homocysteine, folate and vitamin B12 levels were measured. Results were interpreted using spss 20.0.

Results and Discussion:
Mean homocysteine level in our population was 19.51 (SD: 11.47)micromol/l. …

Stress Induced Hyperglycemia In Stroke Patients, Aziz U Rehman, Ajeet Kumar, Salma Razzaque, Ashok Kumar, M. Ishaq Ghauri

Pakistan Journal of Neurological Sciences (PJNS)

Background:
Stroke is the third most common cause of death in developed countries and second most common cause of death worldwide. High proportion of patients may develop hyperglycemia after an acute stress such as stroke or myocardial infarction even in the absence of preexisting diagnosis of diabetes mellitus. Prolonged stress hyperglycemia in ischemic stroke increases the risk of in-hospital 28- day mortality, especially in non-diabetic patients.

Aims and objectives:
To determine the frequency of stress-induced hyperglycemia in non-diabetic patients with ischemic or hemorrhagic stroke.

Subjects and methods:
A total of 255 patients admitted with acute stroke, fulfilling the inclusion …

Efficacy Of Memantine In Treating Patients With Migraine And Tension-Type Headache, Sameen Khalid, Bashir A Soomro, Samreen Mahmood, Aamer Abbass

Pakistan Journal of Neurological Sciences (PJNS)

Objective:
To assess the efficacy of Memantine as a preventive and therapeutic intervention for migraine and tension-type headache.

Methods:
This clinical trial was conducted over a period of 3 months. A total of 44 subjects, with diagnosed migraine and/or tension-type headache, presenting to a private neurology clinic in Karachi, Pakistan were selected through purposive sampling technique. Patients were treated with incremental doses of Memantine. Adult patients belonging to both genders were included in the study. Data was analyzed using SPSS version 16.0 and associations were made using Chi square test with p-value of less than 0.05 taken as significant. …

Marburg Variant Of Multiple Sclerosis; A Diagnostic And Therapeutic Challenge, Sadia Imtiaz, Maimoona Siddiqui, Arsalan Ahmad Md

Pakistan Journal of Neurological Sciences (PJNS)

Marburg variant of multiple sclerosis (MS) is a highly aggressive, fulminant demyelinating disease with very high morbidity and mortality. Early diagnosis and aggressive management is vital to limit severe disability and improve the outcome. We present a case of 35 years old male who presented with rapidly progressive demyelinating illness, leading to bed bound status over the course of a month. He was treated aggressively with intravenous (IV) steroids, plasma exchange (PLEX) and Mitoxantrone (MTX), leading to a remarkable recovery.

Encephalopathy With Behavioral And Psychiatric Features–Firstantibody Proven Case Of Anti-Nmda Receptor Encephalitis From Pakistan, Rabel Khalid Memon, Maimoona Siddiqui, Rizwanullah Khan

Pakistan Journal of Neurological Sciences (PJNS)

Background:
Anti-N-methyl-D-aspartate (NMDA) receptor encephalitis is associated with psychiatric symptoms, memory disturbances, seizures, dyskinesia, and catatonia along with other constellation of symptoms. It is more common in females and usually associated with underlying ovarian teratoma. Treatment involves immunosuppression. This is the first antibody proven case from Pakistan.

Case Report:
A 16 year old girl with a short history of sore throat and no other prior illness, presented with 12 day history of behavioral changes (can you please describe some behavioral changes?) and seizures, followed by decreased responsiveness, involuntary limb movements and facial grimacing. She also had intermittent high grade fever …

9th Annual Neurology Research Day 2015 Abstracts Shifa International Hospital, Islamabad

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Alton Ochsner, Md (1896-1981): Surgical Pioneer And Legacy Linking Smoking And Disease., Christina L. Costantino, Md, Jordan M. Winter, Md, Charles J. Yeo, Md, Scott W. Cowan, Md

Department of Surgery Gibbon Society Historical Profiles

Edward William Alton Ochsner kept a plain, metal card file in which he recorded close to 50 years worth of medical experiences, research, and insights. The most populated topics were filed as "Cancer, Lung" and "Cancer, Bronchogenic." These reflected his areas of greatest interest, for which he would go on to produce groundbreaking work. Of his many lifetime accomplishments, he is perhaps best known for being the first to report a link between cigarette smoking and lung cancer. This was just one of the many ways in which Ochsner worked to effect social change. The establishment of the Ochsner Health …

Dicer1 Regulated Let-7 Expression Levels In P53-Induced Cancer Repression Requires Cyclin D1., Xin Sun, Shou-Ching Tang, Chongwen Xu, Chenguang Wang, Sida Qin, Ning Du, Jian Liu, Yiwen Zhang, Xiang Li, Gang Luo, Jie Zhou, Fei Xu, Hong Ren

Department of Cancer Biology Faculty Papers

Let-7 miRNAs act as tumour suppressors by directly binding to the 3'UTRs of downstream gene products. The regulatory role of let-7 in downstream gene expression has gained much interest in the cancer research community, as it controls multiple biological functions and determines cell fates. For example, one target of the let-7 family is cyclin D1, which promotes G0/S cell cycle progression and oncogenesis, was correlated with endoribonuclease DICER1, another target of let-7. Down-regulated let-7 has been identified in many types of tumours, suggesting a feedback loop may exist between let-7 and cyclin D1. A potential player in the proposed feedback …

Galectin-1: A Biomarker Of Surgical Stress In Murine Model Of Cardiac Surgery, Satwat Hashmi, Suhail Al-Salam

Department of Biological & Biomedical Sciences

Galectin-1 (GAL-1) belongs to the family of β-galactoside-binding lectins. It regulates cell-cell and cell-matrix interactions, the immune response, apoptosis, cell cycle, RNA splicing and neoplastic transformation. We investigate the effect of heart manipulation secondary to cardiac surgery on the level of GAL-1 in murine heart and plasma. Male C57B6/J mice were used for adopted model of cardiac surgery. Heart samples were processed for immunohistochemical and immunofluorescent labeling, Enzyme linked immunosorbent assay and quantitative RT-PCR to identify GAL-1 levels in the heart and plasma during the first 24 hours following cardiac surgery. There is significant increase of GAL-1 in the LV …

Thyroxine Replacement In Patients On Parenteral Nutrition: A Clinical Conundrum, Abdul Rehman, Noor Ul-Ain Baloch, Muhammad Awais

Department of Biological & Biomedical Sciences

No abstract provided.

Intensive Transition Team - Analysis Of Program Impacts, Bill J. Wright, Keri B Vartanian, Megan Holtorf

Articles, Abstracts, and Reports

No abstract provided.

Predictive Performance Of A Vancomycin Population Pharmacokinetic Model In Neonates, Chris Stockmann, Adam L. Hersh, Jessica K. Roberts, Jiraganya Bhongsatiern, E. Kent Korgenski, Michael G. Spigarelli, Catherine M.T. Sherwin, Adam Frymoyer

Pediatrics Faculty Publications

Introduction

The pharmacokinetics of vancomycin are highly variable among neonates, which makes dosing challenging in this population. However, adequate drug exposure is critical, especially when treating methicillin-resistant Staphylococcus aureus (MRSA) infections. Utilization of population pharmacokinetic models and Bayesian methods offers the potential for developing individualized therapeutic approaches. To meet this need, a neonatal vancomycin population pharmacokinetic model was recently published. The current study sought to externally evaluate the predictive performance and generalizability of this model.

Methods

A retrospective chart review of neonates who received vancomycin and had ≥1 peak and ≥1 trough concentrations at five Intermountain Healthcare neonatal intensive care …

The Significance Of Macrocephaly Or Enlarging Head Circumference In Infants With The Triad: Further Evidence Of Mimics Of Shaken Baby Syndrome, David Miller, Patrick Barnes, Marvin E. Miller

Pediatrics Faculty Publications

Infants with the triad (neurologic dysfunction, subdural hematoma [SDH], and retinal hemorrhage) are often diagnosed as victims of shaken baby syndrome. Medical conditions/predisposing factors to developing the triad are often dismissed: short falls, birth-related SDH that enlarges, macrocephaly, sinus/cortical vein thrombosis, and others. Six infants with the triad are described in which child abuse was diagnosed, but parents denied wrongdoing. All 6 had either macrocephaly or enlarging head circumference, which suggested medical explanations. Three infants incurred short falls, 1 had a difficult delivery in which there was likely a rebleed of a birth-related SDH, 1 had a spontaneous SDH associated …

An Ex Vivo Approach To Complex Renal Artery Aneurysm Repair, Noah T. Scherrer, Roberto Gedaly, Ramakrishna Venkatesh, Michael A. Winkler, Eleftherios S. Xenos

Surgery Faculty Publications

Ex vivo repair technique for a complex renal artery aneurysm may have several advantages. Smaller incision size and use of minimally invasive techniques may decrease incisional morbidity and improve recovery time, especially in patients with a high body mass index. Improved visualization afforded by back-table methods may also be valuable when repair of aneurysms involving multiple branches is necessary. We report of a successful case of laparoscopic nephrectomy, followed by back-table aneurysmorrhaphy and autotransplant, in a patient with a renal artery aneurysm.