Medical Specialties Commons^™

Seizure Clusters In Drug-Resistant Focal Epilepsy., Ali Akbar Asadi-Pooya, Maromi Nei, Ashwini Sharan, Michael R. Sperling

Department of Neurology Faculty Papers

We investigated clinical factors associated with seizure clustering in patients with drug-resistant focal epilepsy and any association between seizure clustering and outcome after surgery. We performed a retrospective study including patients with a diagnosis of drug-resistant focal epilepsy who underwent epilepsy surgery. Patients were prospectively registered in a database from 1986 until 2015. Seizure cluster was defined as two or more seizures occurring within 2 days. Potential risk factors for seizure clustering were assessed. To investigate any potential association between seizure clusters and seizure outcome after surgery, time to event analysis was used to produce a Kaplan-Meier estimate of seizure …

Capecitabine-Induced Coronary Vasospasm, Danish Henry, Francine Rudzik, Allison Butts, Aju Mathew

Markey Cancer Center Faculty Publications

Capecitabine, an oral prodrug of 5-fluorouracil (5-FU), is approved for early-stage and advanced colorectal cancer and metastatic breast cancer. Cardiotoxicity of 5-FU is well described in the literature. However, cardiac adverse effects of capecitabine are poorly described. We report a case of coronary vasospasm induced by capecitabine. A 41-year-old female with metastatic breast cancer presented with chest pain 3 days after starting capecitabine. The chest pain was relieved by rest and exacerbated by exertion. Her physical examination was unremarkable except for a rapid heart rate of 100 bpm. Electrocardiogram test showed no acute ischemic changes. Troponin tests were negative. CT …

Academic Primer Series: Five Key Papers Fostering Educational Scholarship In Junior Academic Faculty., Teresa M. Chan, Michael Gottlieb, Abra L. Fant, Anne Messman, Daniel W. Robinson, Robert R. Cooney, Dimitrios Papanagnou, Lalena M. Yarris

Department of Emergency Medicine Faculty Papers

INTRODUCTION: Scholarship is an essential part of academic success. Junior faculty members are often unfamiliar with the grounding literature that defines educational scholarship. In this article, the authors aim to summarize five key papers which outline education scholarship in the setting of academic contributions for emerging clinician educators.

METHODS: The authors conducted a consensus-building process to generate a list of key papers that describe the importance and significance of academic scholarship, informed by social media sources. They then used a three-round voting methodology, akin to a Delphi study, to determine the most useful papers.

RESULTS: A summary of the five …

Recurrent Violent Injury: Magnitude, Risk Factors, And Opportunities For Intervention From A Statewide Analysis., Elinore Kaufman, Kristin L. Rising, Md, Ms, Douglas J. Wiebe, David J. Ebler, Marie L. Crandall, M. Kit Delgado

Department of Emergency Medicine Faculty Papers

INTRODUCTION: Although preventing recurrent violent injury is an important component of a public health approach to interpersonal violence and a common focus of violence intervention programs, the true incidence of recurrent violent injury is unknown. Prior studies have reported recurrence rates from 0.8% to 44%, and risk factors for recurrence are not well established.

METHODS: We used a statewide, all-payer database to perform a retrospective cohort study of emergency department visits for injury due to interpersonal violence in Florida, following up patients injured in 2010 for recurrence through 2012. We assessed risk factors for recurrence with multivariable logistic regression and …

Polypharmacy And Potentially Inappropriate Medication Use In Geriatric Oncology., Manvi Sharma, Kah Poh Loh, Ginah Nightingale Pharmd, Bcop, Supriya G. Mohile, Holly M. Holmes

College of Pharmacy Faculty Papers

Polypharmacy is a highly prevalent problem in older persons, and is challenging to assess and improve due to variations in definitions of the problem and the heterogeneous methods of medication review and reduction. The purpose of this review is to summarize evidence regarding the prevalence and impact of polypharmacy in geriatric oncology patients and to provide recommendations for assessment and management. Polypharmacy has somewhat variably been incorporated into geriatric assessment studies in geriatric oncology, and polypharmacy has not been consistently evaluated as a predictor of negative outcomes in patients with cancer. Once screened, interventions for polypharmacy are even more uncertain. …

Bone Mineral Density In Mucopolysaccharidosis Ivb, Francyne Kubaski, Heidi H. Kecskemethy, Howard T. Harcke, Shunji Tomatsu

Department of Radiology Faculty Papers

To date, the only published reports of bone mineral density (BMD) in MPS IV involve patients with MPS IVA; no reports exist describing BMD for MPS IVB. In this prospective study of BMD in three patients with MPS IVB, BMD was acquired by dual-energy X-ray absorptiometry (DXA) at whole body (WB), lumbar spine (LS), and lateral distal femur (LDF). Functional abilities, ambulatory status, medical history, and height z-score were evaluated. Three patients with MPS IVB (two females), aged 17.7, 31.4 and 31.7 years, were evaluated. Every patient was ambulatory and one sustained two fractures caused by trauma. Whole body and …

Geographic And Age-Based Variations In Medicare Reimbursement Among Assh Members., Michael P. Gaspar, Patrick M. Kane, Grace B. Honik, Eon K. Shin, Sidney M. Jacoby, A. Lee Osterman

Department of Orthopaedic Surgery Faculty Papers

Background: The purpose of this study was to investigate how American Society for Surgery of the Hand (ASSH) members' Medicare reimbursement depends on their geographical location and number of years in practice. Methods: Demographic data for surgeons who were active members of the ASSH in 2012 were obtained using information publicly available through the US Centers for Medicare and Medicaid Services (CMS). "Hand-surgeons-per-capita" and average reimbursement per surgeon were calculated for each state. Regression analysis was performed to determine a relationship between (1) each state's average reimbursement versus the number of ASSH members in that state, (2) average reimbursement versus …

Chemical Modification Of Extracellular Matrix By Cold Atmospheric Plasma-Generated Reactive Species Affects Chondrogenesis And Bone Formation., Peter Eisenhauer, Natalie Chernets, You Song, Danil Dobrynin, Nancy Pleshko, Marla J Steinbeck, Theresa A. Freeman

Department of Orthopaedic Surgery Faculty Papers

The goal of this study was to investigate whether cold plasma generated by dielectric barrier discharge (DBD) modifies extracellular matrices (ECM) to influence chondrogenesis and endochondral ossification. Replacement of cartilage by bone during endochondral ossification is essential in fetal skeletal development, bone growth and fracture healing. Regulation of this process by the ECM occurs through matrix remodelling, involving a variety of cell attachment molecules and growth factors, which influence cell morphology and protein expression. The commercially available ECM, Matrigel, was treated with microsecond or nanosecond pulsed (μsp or nsp, respectively) DBD frequencies conditions at the equivalent frequencies (1 kHz) or …

Progestogen-Only Contraceptive Use Among Breastfeeding Women: A Systematic Review., Sharon J. Phillips, Naomi K. Tepper, Nathalie Kapp, Kavita Nanda, Marleen Temmerman, Kathryn M. Curtis

Obstetrics and Gynaecology, East Africa

Background: Postpartum women need effective contraception. Concerns have been raised that use of progestogen-only contraceptives (POCs) may affect breastfeeding performance and infant health outcomes.

Objectives: We investigated the clinical outcomes of breastfeeding duration, initiation of supplemental feeding and weaning, as well as infant outcomes including infant growth, health and development among breastfeeding women using POCs compared with breastfeeding women not using POCs.

Search strategy: We searched the PubMed database for all articles published from database inception through December 2014.

Selection criteria: We included primary research studies of breastfeeding women of any age or parity who received POCs, including progestogen-only pills, …

Bilateral Triad Of Persistent Median Artery, A Bifid Median Nerve And High Origin Of Its Palmar Cutaneous Branch. A Case Report And Clinical Implications, Olutayo Ariyo, John Shea

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

We report the association of a persistent median artery, a bifid median nerve with a rare very high origin palmar cutaneous branch, presenting bilaterally in the upper limb of a 75-year-old female cadaver. The persistent median nerve with a bifid median nerve has been reported in patients presenting with carpal tunnel syndrome. Reports of this neurovascular anomaly occurring in association with a high origin palmar cutaneous branch however, are few. This subset of patients is at risk of inadvertent nerve transection during forearm and wrist surgery. Pre-operative magnetic resonance imaging (MRI) and high resolution sonography (HRS) can be used to …

Comparison Of Hemodynamic Effects And Negative Predictive Value Of Normal Adenosine Gated Myocardial Perfusion Scan With Or Without Caffeine Abstinence, Maseeh Uz Zaman, Nosheen Fatima, Areeba Zaman, Unaiza Zaman, Rabia Tahseen

Department of Radiology

For vasodilator stress, myocardial perfusion imaging (MPI) with at least 12-h caffeine abstinence is recommended, as it attenuates cardiovascular hyperemic response of adenosine and dipyridamole. However, many published conflicting results have shown no significant effect upon perfusion abnormalities in MPI performed without caffeine abstinence. The aim of this study was to compare the hemodynamic changes and negative predictive value (NPV) of normal MPIs with adenosine stress performed with or without caffeine abstinence. This was a prospective study that accrued 50 patients from May 2013 till September 2013 and followed till November 2014. These patients had a normal adenosine-gated MPI (GMPI) …

Pediatric Statin Administration: Navigating A Frontier With Limited Data., Jonathan B. Wagner, Susan M. Abdel-Rahman

Manuscripts, Articles, Book Chapters and Other Papers

Increasingly, children and adolescents with dyslipidemia qualify for pharmacologic intervention. As they are for adults, 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase inhibitors (statins) are the mainstay of pediatric dyslipidemia treatment when lifestyle modifications have failed. Despite the overall success of these drugs, the magnitude of variability in dose-exposure-response profiles contributes to adverse events and treatment failure. In children, the cause of treatment failures remains unclear. This review describes the updated guidelines for screening and management of pediatric dyslipidemia and statin disposition pathway to assist the provider in recognizing scenarios where alterations in dosage may be warranted to meet patients' specific needs.

Health Workers’ Perspectives, Knowledge And Skills Regarding Community Case Management Of Childhood Diarrhoea And Pneumonia: A Qualitative Inquiry For An Implementation Research Project “Nigraan” In District Badin, Sindh, Pakistan, Fauziah Rabbani, Shagufta Perveen, Wafa Aftab, Aysha Zahidie, Kashif Sangrasi, Shamim Ahmad Qazi Ahmad Qazi

Community Health Sciences

BACKGROUND:

Pakistan's Lady Health Worker Programme aims to provide care to children sick with pneumonia and diarrhoea, which continues to cause 27 % under-five mortality in Pakistan. The quality of supervision received by Lady Health Workers (LHWs) in the programme influence their knowledge and skills, in turn impacting their ability to provide care.

METHODS:

This study is part of an implementation research project titled "Nigraan" (an Urdu word meaning supervisor), and explores LHW and Lady Health Supervisor (LHS) perspectives regarding the role of supervision in improving LHWs performance and motivation in district Badin, Sindh, Pakistan. Their knowledge and skills regarding …

Economic Burden Of Mental Illnesses In Pakistan., Ashar Muhammad Malik, Murad Moosa Khan

Community Health Sciences

BACKGROUND:

The economic consequences of mental illnesses are much more than health consequences. In Low and Middle Income Countries (LMIC) the economic impact of mental illnesses is rarely analyzed. This paper attempts to fill the gap in research on economics of mental health in LMIC. We provide economic burden of mental illness in Pakistan that can serve as an argument for reorienting health policy, resource allocation and priority settings.

AIM:

To estimate economic burden of mental illnesses in Pakistan.

METHODS:

The study used prevalence based cost of illnesses approach using bottom-up costing methodology. We used Aga Khan University Hospital, Psychiatry …

Systemic Inflammatory Response Syndrome (Sirs) After Extracorporeal Membrane Oxygenation (Ecmo): Incidence, Risks And Survivals., Karthik Thangappan, Nicholas C. Cavarocchi, Michael Baram, Brandi Thoma, Hitoshi Hirose

Department of Surgery Faculty Papers

INTRODUCTION: Systemic inflammatory response syndrome (SIRS) is frequently observed after extracorporeal membrane oxygenation (ECMO) decannulation; however, these issues have not been investigated well in the past.

METHODS: Retrospective chart review was performed to identify post-ECMO SIRS phenomenon, defined by exhibiting 2/3 of the following criteria: fever, leukocytosis, and escalation of vasopressors. The patients were divided into 2 groups: patients with documented infections (Group I) and patients with true SIRS (Group TS) without any evidence of infection. Survival and pre-, intra- and post-ECMO risk factors were analyzed.

RESULTS: Among 62 ECMO survivors, 37 (60%) patients developed the post-ECMO SIRS phenomenon, including …

Obesity, An Emerging Epidemic In Pakistan-A Review Of Evidence., Sana Tanzil, Tanzil Jamali

Community Health Sciences

BACKGROUND:

In Pakistan, the disease pattern is facing a huge changeover from acute and communicable diseases to the non-communicable diseases. Moreover, an emerging epidemic of obesity is still under recognized in Pakistan. A detailed review and dissemination of the existing knowledge to determine the extent of burden of obesity can help understand this important public health issue.

METHODS:

A detailed literature review was conducted through PubMed search engines, regarding obesity burden in Pakistan. The original peer reviewed research articles, reports of WHO in English language, non-government organizations reports were included in the review. "Obesity AND Pakistan" were used as a …

Peritoneal Lymphomatosis: The Failure Of Occam’S Razor, Ranjit R. Nair Md, Nicole M. Agostino Do, Shereen M F Gheith Md, Usman Shah Md

Department of Medicine

No abstract provided.

World Brain Day 2016: Celebrating Brain Health In An Ageing Population, Mohammad Wasay, Wolfgang Grisold, William Carroll, Raad Shakir

Section of Neurology

No abstract provided.

Non-Psychotropic Cannabinoid Based Therapy Modulates Nociceptive Signaling Molecules, Microglia, And Pain Behavior In A Model Of Post-Concussion Headache, Jarred M. Stratton, Lan Cheng, Ashley L. Tyburski, Jessica Perino, Melanie B. Elliott

Department of Neurosurgery Posters

Background & Objectives

Headache is a common symptom of post-concussion syndrome which may persist in a substantial portion of patients contributing to a poor quality of life and disability. There is a pressing need to develop novel treatments for post-traumatic headache as current treatments have a number of side effects, are contraindicated or lack efficacy. The Elliott laboratory first established models of post-traumatic headache demonstrating sensitization of trigeminal neurons in rodent models of post-traumatic headache using well-known nociceptive and behavioral markers in the pain and migraine fields^1-3. Traumatic brain injury in mice increases expression of calcitonin gene related …

Countdown To 2015 Country Case Studies: What Can Analysis Of National Health Financing Contribute To Understanding Mdg 4 And 5 Progress?, Carlyn Mann, Courtney Ng, Nadia Akseer, Zulfiqar Ahmed Bhutta, Josephine Borghi, Tim Colbourn, Patricia Hernández-Peña, Luis Huicho, Muhammad Ashar Malik, Melisa Ashar Martinez-Alvarez, Spy Munthali, Ahmad Shah Salehi, Mekonnen Tadesse, Mohammed Yassin, Peter Berman

Community Health Sciences

Background

Countdown to 2015 (Countdown) supported countries to produce case studies that examine how and why progress was made toward the Millennium Development Goals (MDGs) 4 and 5. Analysing how health-financing data explains improvements in RMNCH outcomes was one of the components to the case studies.

Methods

This paper presents a descriptive analysis on health financing from six Countdown case studies (Afghanistan, Ethiopia, Malawi, Pakistan, Peru, and Tanzania), supplemented by additional data from global databases and country reports on macroeconomic, health financing, demographic, and RMNCH outcome data as needed. It also examines the effect of other contextual factors presented in …

A Unique Case Of Pulmonary Embolism Presenting As A Paroxysmal Atrial Tachycardia Instigated Only By Recumbency And Stooping., Nagesh Chopra

Heart and Vascular Articles

No abstract provided.

An Unusual Case Of Igg4 Associated Marginal Zone B-Cell Lymphoma Presenting As Subcutaneous Nodules Mimicking Lipomas, Ryan Mayo Md, Ranjit R. Nair Md, Shereen M F Gheith Md, Phd

Department of Medicine

No abstract provided.

Obscure Gastrointestinal Bleeding: A Case Series, Eric Nellis Md, Patrick Hickey Do, Shashin Shah Md, Hiral N. Shah Md

Department of Medicine

No abstract provided.

A Predictive Model For Intensive Chemotherapy Outcomes In Newly Diagnosed Elderly Patients With Aml, Sameer Tolay Md, David F. Claxton Md, Junjia Zhu Md

Department of Medicine

No abstract provided.

Adrenal Incidentaloma In Young – A Gray Zone?, Ranjit R. Nair Md, Stacey Smith Md, Facp

Department of Medicine

No abstract provided.

Application Of Bioinstrumentation In Developing A Pressure Suit For Suborbital Flight, Pedro Llanos, Erik Seedhouse

Publications

This presentation features Embry-Riddle Aeronautical University's U-2 pressure suit. Built to be light and cost-effective, this suit is comfortable, comes in multiple sizes, operates in pressures up to 5 PSID, has an active airflow-based cooling system, and features bio-instrumentation to measure heart rate, breathing rate, skin temperature and other vitals.

The Age-Friendly Cities Project In Bowling Green: A Narrative History, Hannah Ruggles

Mahurin Honors College Capstone Experience/Thesis Projects

An age-friendly city is one that “encourages active ageing by optimizing opportunities for health, participation and security in order to enhance quality of life as people age. In practical terms, an age-friendly city adapts its structures and services to be accessible to and inclusive of older people with varying needs and capacities.” Bowling Green was the seventh city in the US to join the World Health Organization’s Global Network of Age-Friendly Cities and is currently in year three of a five-year project. The developments over the past two years have been guided by the principle that senior residents of Bowling …

Multi-Focal Control Of Mitochondrial Gene Expression By Oncogenic Myc Provides Potential Therapeutic Targets In Cancer., Amanda R. Oran, Clare M. Adams, Xiao-Yong Zhang, Victoria J. Gennaro, Harla K. Pfeiffer, Hestia S. Mellert, Hans E. Seidel, Kirsten Mascioli, Jordan Kaplan, Mahmoud R. Gaballa, Chen Shen, Isidore Rigoutsos, Michael P. King, Justin L Cotney, Jamie J. Arnold, Suresh D. Sharma, Ubaldo E. Martinez-Outshoorn, Christopher R. Vakoc, Lewis A. Chodosh, James E. Thompson, James E. Bradner, Craig E. Cameron, Gerald S. Shadel, Christine M. Eischen, Steven B. Mcmahon

Department of Cancer Biology Faculty Papers

Despite ubiquitous activation in human cancer, essential downstream effector pathways of the MYC transcription factor have been difficult to define and target. Using a structure/function-based approach, we identified the mitochondrial RNA polymerase (POLRMT) locus as a critical downstream target of MYC. The multifunctional POLRMT enzyme controls mitochondrial gene expression, a process required both for mitochondrial function and mitochondrial biogenesis. We further demonstrate that inhibition of this newly defined MYC effector pathway causes robust and selective tumor cell apoptosis, via an acute, checkpoint-like mechanism linked to aberrant electron transport chain complex assembly and mitochondrial reactive oxygen species (ROS) production. Fortuitously, MYC-dependent …

Phase I Dose-Escalation Study Of The Mtor Inhibitor Sirolimus And The Hdac Inhibitor Vorinostat In Patients With Advanced Malignancy., Haeseong Park, Ignacio Garrido-Laguna, Aung Naing, Siqing Fu, Gerald S. Falchook, Sarina A. Piha-Paul, Jennifer J. Wheler, David S. Hong, Apostolia M. Tsimberidou, Vivek Subbiah, Ralph G. Zinner, Ahmed O. Kaseb, Shreyaskumar Patel, Michelle A. Fanale, Vivianne M M. Velez-Bravo, Funda Meric-Bernstam, Razelle Kurzrock, Filip Janku

Department of Medical Oncology Faculty Papers

Preclinical models suggest that histone deacetylase (HDAC) and mammalian target of rapamycin (mTOR) inhibitors have synergistic anticancer activity. We designed a phase I study to determine the safety, maximum tolerated dose (MTD), recommended phase II dose (RP2D), and dose-limiting toxicities (DLTs) of combined mTOR inhibitor sirolimus (1 mg-5 mg PO daily) and HDAC inhibitor vorinostat (100 mg-400 mg PO daily) in patients with advanced cancer. Seventy patients were enrolled and 46 (66%) were evaluable for DLT assessment since they completed cycle 1 without dose modification unless they had DLT. DLTs comprised grade 4 thrombocytopenia (n = 6) and grade 3 …

The Financial And Professional Impact Of Anterior Cruciate Ligament Injuries In National Football League Athletes., Eric S. Secrist, Suneel B. Bhat, Christopher C. Dodson

Rothman Institute Papers

BACKGROUND: Anterior cruciate ligament (ACL) injuries can have negative consequences on the careers of National Football League (NFL) players, however no study has ever analyzed the financial impact of these injuries in this population.

PURPOSE: To quantify the impact of ACL injuries on salary and career length in NFL athletes.

STUDY DESIGN: Cohort study; Level of evidence, 3.

METHODS: Any player in the NFL suffering an ACL injury from 2010 to 2013 was identified using a comprehensive online search. A database of NFL player salaries was used to conduct a matched cohort analysis comparing ACL-injured players with the rest of …