Medical Specialties Commons^™

Retrieval Analysis Of Necropsy Total Hip Replacements: Considerations Beyond The Implant, Julie Alyse Lowell

Theses and Dissertations (ETD)

Introduction. Total hip arthroplasty (THA) surgery is one of the most commonly performed and successful orthopedic procedures in the United States. More than 300,000 primary THAs and 40,000 revision THAs performed in the United States every year. While the need for revision surgeries can stem from a variety of causes, there have been, to the author’s knowledge, no studies attempting to correlate the concentrations of certain inflammatory cytokines to metal ion concentrations found in the tissue surrounding the implant, amount of polyethylene wear, or strength of the interface of the modular taper. The purpose of this study was to begin …

Improving Vaccination Rates In Adults With Type Ii Diabetes In A Family Practice Setting: An Evidence-Based Quality Improvement Project, Ronda Gottlieb

Doctor of Nursing Practice

The purpose of this evidenced-based quality improvement project is to implement processes to facilitate providers’ adherence to the American Diabetes Association (2017), American Association of Clinical Endocrinologist (2015), and American College of Endocrinology (2015) immunization guidelines for adults with type II diabetes. Presently, diabetes is the 7th leading cause of death in the United States contributing to serious complications throughout the body as a result of poor glucose control. Adults with diabetes are at increased susceptibility to infectious disease because of hyperglycemia, poor glucose control, and decreased immunity. A protocol was created using The Four Pillars Transformation Program ™ to …

Dopamine Levels In The Brain Of Rat Models Of Human Rheumatoid Arthritis, Amelia Stinson

Theses & Dissertations

Research Focus. Rheumatoid arthritis (RA) is a chronic, debilitating, autoimmune disease that causes the destruction of bone tissue and the articular structures of joints. At least 30% of RA patient populations have cognitive impairment. Acidic dopamine (DA) is the principal neuroimmunotransmitter that links the central nervous system and peripheral nervous system together. The aim of the present study was to determine the levels of DA and its two acidic metabolites: 3,4-dihydroxyphenylacetic acid (DOPAC) and homovanillic acid (HVA) in arthritic induced rats, and whether their levels vary across four different parts of the brain: amygdala (AMG), front cerebral cortex (CX), hippocampus …

National Trends In Admission And In-Hospital Mortality Of Patients With Heart Failure In The United States (2001–2014), Emmanuel Akintoye, Alexandros Briasoulis, Alexander Egbe, Shannon M. Dunlay, Sudhir Kushwaha, Diane Levine, Luis Afonso, Dariush Mozaffarian, Jarrett Weinberger

Internal Medicine Faculty Publications

Background-—To investigate heart failure (HF) hospitalization trends in the United States and change in trends after publication of management guidelines.

Methods and Results-—Using data from the National Inpatient Sample and the US Census Bureau, annual national estimates in HF admissions and in-hospital mortality were estimated for years 2001 to 2014, during which an estimated 57.4 million HF-associated admissions occurred. Rates (95% confidence intervals) of admissions and in-hospital mortality among primary HF hospitalizations declined by an average annual rate of 3% (2.5%–3.5%) and 3.5% (2.9%–4.0%), respectively. Compared with 2001 to 2005, the average annual rate of decline in primary HF admissions …

Confirmation That Mat1a P.Ala259val Mutation Causes Autosomal Dominant Hypermethioninemia, M J. Muriello, S Viall, T Bottiglieri, K Cusmano-Ozog, C R. Ferreira

Pediatrics Faculty Publications

Methionine adenosyltransferase (MAT) I/III deficiency is an inborn error of metabolism caused by mutations in MAT1A, encoding the catalytic subunit of MAT responsible for the synthesis of S-adenosylmethionine, and is characterized by persistent hypermethioninemia. While historically considered a recessive disorder, a milder autosomal dominant form of MAT I/III deficiency occurs, though only the most common mutation p.Arg264His has ample evidence to prove dominant inheritance. We report a case of hypermethioninemia caused by the p.Ala259Val substitution and provide evidence of autosomal dominant inheritance by showing both maternal inheritance of the mutation and concomitant hypermethioninemia. The p.Ala259Val mutation falls in the …

Building Collaborative Research To Drive Improvement Of West Virginia Health Outcomes, Sally L. Hodder Md, Gary O. Rankin Phd

Pharmaceutical Science and Research

Mortality rates in Appalachia have not declined in recent years as they have for the remainder of the US. Appalachian mortality rates have actually increased. Most counties of southern West Virginia have mortality rates well in excess of the US average. West Virginia ranks at or near the bottom in most U.S. chronic disease categories, with the highest rate of drug overdose deaths and near the highest rates of cancer and cardiovascular mortality. And yet, West Virginia has many dedicated heath care providers, committed to the care of their patients. The West Virginia Clinical and Translational Science Institute (WVCTSI) seeks …

Nutritional Supplement Practices Of Professional Ugandan Athletes: A Cross-Sectional Study, Haruna Muwonge, Haruna Muwonge, Robert Zavuga, Peninnah Kabenge, Timothy Makubuya

Educator Preparation & Leadership Faculty Works

BackgroundThe use of nutritional supplements (NS) places athletes at great risk for inadvertent doping. Due to the paucity of data on supplement use, this study aimed to determine the proportion of Ugandan athletes using nutritional supplements and to investigate the athletes’ motivation to use these supplements.MethodsA cross-sectional study was conducted in which an interviewer-administered questionnaire was used to collect data from 359 professional athletes participating in individual (boxing, cycling, athletics) and team (basketball, rugby, football, netball, and volleyball) sports. The data were categorized, and a Chi-square test was used for statistical analysis.ResultsOf the 359 athletes, 48 (13.4%) used nutritional supplements. …

Non-Pathological Bilious Vomiting Complicating Therapeutic Hypothermia For Hypoxic Ischaemic Encephalopathy In Neonates: A Retrospective Cohort Study, Julie Hukui, Sarah Jones, Kevin Coughlin, Simon Levin, Jennifer Ruth Foster

Paediatrics Publications

Objective Therapeutic hypothermia (TH) for moderate-to-severe neonatal hypoxic ischaemic encephalopathy (HIE) is generally described as safe. We performed this study to determine the incidence of bilious vomiting or bilious drainage (BVD) attributable to TH in this population. Design A single-centre, retrospective cohort study. Setting Neonatal and paediatric intensive care units (NICU and PICU) of a single tertiary care centre. Patients All newborns with HIE who met criteria for TH between 2009 and 2014. Interventions Cases were matched 1:1 for unit of care (NICU vs PICU), gestational age, gender, and Sarnat score with historic controls who did not receive TH. Groups …

Subanesthetic Ketamine For Postoperative Analgesia: An Evidenced-Based Project, Jeremy Vance

Doctoral Projects

Roughly 100 million surgical procedures are performed in the United States (U.S.) each year and more than 80% of these patients experience acute postoperative pain. Pain costs the U.S. an estimated $560 to $635 billion annually and is a significant contributor to national rates of mortality, morbidity, and disability. Despite these findings, patients continue to receive suboptimal postoperative pain relief.

The adjunct administration of subanesthetic ketamine is opioid-sparing and can improve the effectiveness of a multimodal pain management approach. This project used an exploratory descriptive design to examine how an evidence-based presentation impacted the clinical practice of certified registered nurse …

X-Linked Hypomyelination With Spondylometaphyseal Dysplasia (H-Smd) Associated With Mutations In Aifm1., Noriko Miyake, Nicole I Wolf, Ferdy K Cayami, Joanna Crawford, Annette Bley, Dorothy Bulas, Ryan J Taft, Adeline Vanderver, +Several Additional Authors

Neurology Faculty Publications

An X-linked condition characterized by the combination of hypomyelinating leukodystrophy and spondylometaphyseal dysplasia (H-SMD) has been observed in only four families, with linkage to Xq25-27, and recent genetic characterization in two families with a common AIFM1 mutation. In our study, 12 patients (6 families) with H-SMD were identified and underwent comprehensive assessment accompanied by whole-exome sequencing (WES). Pedigree analysis in all families was consistent with X-linked recessive inheritance. Presentation typically occurred between 12 and 36 months. In addition to the two disease-defining features of spondylometaphyseal dysplasia and hypomyelination on MRI, common clinical signs and symptoms included motor deterioration, spasticity, tremor, …

Plasma Fibroblast Growth Factor-21 Levels In Patients With Inborn Errors Of Metabolism, Brian Kirmse, Juan Cabrera-Luque, Omar Ayyub, Kristina Cusmano-Ozog, Kimberly A. Chapman, Marshall L. Summar

Pediatrics Faculty Publications

Fibroblast growth factor-21 (FGF21) levels are elevated in patients with primary mitochondrial disorders but have not been studied in patients with inborn errors of metabolism (IEM) known to have secondary mitochondrial dysfunction. We measured plasma FGF21 by ELISA in patients with and without IEM. FGF21 levels were higher in patients with IEM compared to without IEM (370 pg/dL vs. 0–65 pg/dL). Further study of FGF21 as a biomarker in IEM is warranted.

Significant Correlation Between Regional Tissue Oxygen Saturation And Vital Signs Of Critically Ill Infants, Beri Massa-Buck, Virginia Amendola, Reagan Mccloskey, Khodayar Rais-Bahrami

Pediatrics Faculty Publications

Background: Near-infrared spectroscopy (NIRS) has been used to noninvasively measure specific tissue oxygen saturation (StO2) continuously. Cerebral autoregulation status can be derived from NIRS and arterial blood pressure. The relationship of both cerebral and somatic StO2, fractional tissue oxygen extraction (FTOE), and cerebro-splanchnic oxygenation ratio (CSOR) to measured vital signs parameters for NICU patients has not been well studied.

Objective: Determine if significant relationships between brain and somatic StO2, brain and somatic FTOE, and CSOR parameters to vital signs for neonates exist. Assess relationship between pressure passivity index, cerebral autoregulation and mean blood pressure (MBP).

Design/Methods: Neonates weighing <5 >kg, preferentially …

Survival Benefit Of Surgery In Recurrent Glioblastoma Multiforme, Usama Khalid Choudry, Saad Akhtar Khan, Muhammad Shahzad Shamim

Section of Neurosurgery

There is an ongoing debate regarding role of surgery for recurrent glioblastoma multiforme (GBM). Older literature hinted at only modest survival benefits with surgery and a high rate of morbidity. However, more recent literature suggests better survival that may be attributed to better surgical techniques and better options in adjuvant treatment. Herein the authors review recent literature with regards to the possible role of surgery in recurrent GBM and also look into the key factors impacting second surgery.

National Estimates Of Genetic Testing In Women With A History Of Breast Or Ovarian Cancer., Christopher P Childers, Kimberly K Childers, Melinda Maggard-Gibbons, James Macinko

Articles, Abstracts, and Reports

Purpose In the United States, 3.8 million women have a history of breast (BC) or ovarian cancer (OC). Up to 15% of cases are attributable to heritable mutations, which, if identified, provide critical knowledge for treatment and preventive care. It is unknown how many patients who are at high risk for these mutations have not been tested and how rates vary by risk criteria. Methods We used pooled cross-sectional data from three Cancer Control Modules (2005, 2010, 2015) of the National Health Interview Survey, a national in-person household interview survey. Eligible patients were adult females with a history of BC …

Incidence Of Cognitively Defined Late-Onset Alzheimer's Dementia Subgroups From A Prospective Cohort Study., Paul K Crane, Emily Trittschuh, Shubhabrata Mukherjee, Andrew J Saykin, R Elizabeth Sanders, Eric B Larson, Susan M Mccurry, Wayne Mccormick, J D Bowen, Thomas Grabowski, Mackenzie Moore, Julianna Bauman, Alden L Gross, C Dirk Keene, Thomas D Bird, Laura E Gibbons, Jesse Mez

Articles, Abstracts, and Reports

INTRODUCTION: There may be biologically relevant heterogeneity within typical late-onset Alzheimer's dementia.

METHODS: We analyzed cognitive data from people with incident late-onset Alzheimer's dementia from a prospective cohort study. We determined individual averages across memory, visuospatial functioning, language, and executive functioning. We identified domains with substantial impairments relative to that average. We compared demographic, neuropathology, and genetic findings across groups defined by relative impairments.

RESULTS: During 32,286 person-years of follow-up, 869 people developed Alzheimer's dementia. There were 393 (48%) with no domain with substantial relative impairments. Some participants had isolated relative impairments in memory (148, 18%), visuospatial functioning (117, 14%), …

Neurological Burden In Baluchistan Province, Pakistan, Mohammad Saleem Barech

Pakistan Journal of Neurological Sciences (PJNS)

Total population of Balochistan is about13.16 million, while there are only nine qualified Neurologists in the whole province who look after not only neurological disorders of the province, but also patients from nearby countries like Afghanistan and Iran. The common neurological disorders are Stroke, Neuropathies, Myopathies, Epilepsy, Migraine, SSPE, Multiple Sclerosis, Meningitis, Myasthenia Gravis, Parkinson's disease and infectious diseases especially Tuberculosis, which is very common.

Correlation Of Duration Of Diabetes With Upper Limb Musculoskeletal Problems, Hazim Brohi, Rajesh Kumar, Aqiba Surfaraz, Tahira Parveen, M Usman, Syed Ijlal Ahmed

Pakistan Journal of Neurological Sciences (PJNS)

Long standing uncontrolled diabetes is associated with many clinical problems and it frequently involves hands and shoulder causing stenosing tenosynovitis (trigger finger), Dupuytren's contracture, carpal tunnel syndrome, limited joint mobility and shoulder capsulitis. The prevalence of hand symptoms has been variable in different studies. Data from our part of world is scares. Our study aimed at looking at frequency of these hand symptoms with duration of the diabetes.

Depression In Stroke Patients; A Cross Sectional Study Highlighting The Association Of Stroke On Age And Gender Basis., Saira Abbas, Naila Naeem Shahbaz, Muhammad Amir Umer, Sumera Rafat Umer, Asfia Irfan, Adnan Anwar

Pakistan Journal of Neurological Sciences (PJNS)

Stroke is the second leading cause of death. Depressive disorder is characterized by period of sad mood and anhedonia occurring for two consecutive weeks. Among stroke survivors, the consequence of physical and psychological changes can be devastating. One of those psychological changes is post-stroke depression (PSD). Stroke itself has debilitating morbidity and superimposed PSD further decreases the quality of life of patients and impairs recovery. This study leads us to know the magnitude of post stroke depression.

Dopamine Responsive Dystonia(Drd) In A 25 Year Old Lady, Samar Iltaf Pechuho, Abdul Rahman Soomro, Alam Ibrahim Siddiqui, Tufail Ahmed Pechuho, Imran Ali Gopang

Pakistan Journal of Neurological Sciences (PJNS)

Dopamine responsive dystonia (DRD) is a dystonic syndrome of childhood, usually affecting gait. It presents with walking difficulties, spasticity or dystonia with a characteristic diurnal variation and MRI brain scan is normal in it. It may however develop into Parkinsonism later, which shows dramatic therapeutic response to levodopa. A 25 year old lady presented with difficulty in walking along with weakness and stiffness of both legs at Neurology OPD of Chandka Medical College Hospital,Larkana. After reaching at proper diagnosis of DRD, treatment was started. As a result of which, she showed dramatic improvement and was able to return back to …

A Rare Case Of Becker Disease In A 7 Year Old Boy, Prem Chand, Rozmeen Badruddin Husein, Fazal M. Arain

Pakistan Journal of Neurological Sciences (PJNS)

Becker Disease is an autosomal recessive version of the rare congenital disorder called Myotonia Congenita. Due to the rarity of Becker Disease, the genetic and pathological basis of this disease have not been studied well and possible diagnostic methods and techniques are yet to be explored. The existing method of diagnosis of such a case is predominantly dependent on the clinical examination. More work and studies need to be done on the diagnostic aspect of this disease to discover newer diagnostic methods for this disease, which are more reliable and specific. In order to develop better diagnostic methods for the …

Epidemiological Data Of Neurological Disorders In Pakistan And Neighboring Countries: A Review, Ghulam Hussain, Azhar Rasul, Haseeb Anwar, Muhammad Umar Sohail, Syed Kashif Shahid Kamran, Shahid Mahmood Baig, Asghar Shabbir, Javed Iqbal

Pakistan Journal of Neurological Sciences (PJNS)

Neurological disorders are the impairments of nervous system and are an important and growing cause of morbidity, mortality, and disability. In addition to health costs, those suffering from these conditions are also frequently victimized of stigmatization and discrimination. Stigmatization further minimizes the patients' access to treatment and social activities. These disorders, therefore, require special attention particularly in developing countries where unfortunately, the burden of these disorders remains largely unrecognized. Moreover, the burden imposed by such chronic neurological conditions in general can be expected to be particularly devastating in poor populations. These conditions are emerging as severe public health concerns in …

5th National Headache Update, Abdul Malik

Pakistan Journal of Neurological Sciences (PJNS)

Headache is one of the most common disorders worldwide. On the World Health Organization's ranking of causes of disability, this would bring headache disorders into the 10 most disabling conditions for both genders, and into the five most disabling for women. The prevalence of headache disorders in Pakistan is high, and would be at least on par with that reported in other parts of the world, although a recent epidemiological survey suggests that the prevalence of migraines could be as high as 22%, almost twice that noted in the international literature. Over the years, the Pakistan Headache Society (PHS) has …

Trends In Spinal Surgery For Pott's Disease (2000-2016): An Overview And Bibliometric Study., Christian Fisahn, Fernando Alonso, Ghazwan A Hasan, R Shane Tubbs, Joseph R Dettori, Thomas A Schildhauer, Tarush Rustagi

Articles, Abstracts, and Reports

Study Design: Systematic review.

Objectives: (1) What are the surgical indications? Have they changed over time since the year 2000? (2) What is the current surgical approaches of choice? Have they changed over time since the year 2000? Do they vary by geographical region? (3) What are the most common outcome measures following surgery?

Methods: Electronic databases and reference lists of key articles were searched from database inception from January 1, 2000 to December 31, 2016 to identify studies specifically evaluating surgical indications, current surgical approaches, and outcome measures for spinal tuberculosis.

Results: Six randomized controlled trials were identified from …

Management Of Undernutrition And Failure To Thrive In Children With Congenital Heart Disease In Low- And Middle-Income Countries, Andrew C. Argent, Rakhi Balachandran, Balu Vaidyanathan, Amina Khan, R. Krishna Kumar

Section of Cardiology

Poor growth with underweight for age, decreased length/height for age, and underweight-for-height are all relatively common in children with CHD. The underlying causes of this failure to thrive may be multifactorial, including innate growth potential, severity of cardiac disease, increased energy requirements, decreased nutritional intake, malabsorption, and poor utilisation of absorbed nutrition. These factors are particularly common and severe in low- and middle-income countries. Although nutrition should be carefully assessed in all patients, failure of growth is not a contraindication to surgical repair, and patients should receive surgical repair where indicated as soon as possible. Close attention should be paid …

Decoding Critical Long Non-Coding Rna In Ovarian Cancer Epithelial-To-Mesenchymal Transition., Ramkrishna Mitra, Xi Chen, Evan J. Greenawalt, Ujjwal Maulik, Wei Jiang, Zhongming Zhao, Christine M. Eischen

Department of Cancer Biology Faculty Papers

Long non-coding RNA (lncRNA) are emerging as contributors to malignancies. Little is understood about the contribution of lncRNA to epithelial-to-mesenchymal transition (EMT), which correlates with metastasis. Ovarian cancer is usually diagnosed after metastasis. Here we report an integrated analysis of >700 ovarian cancer molecular profiles, including genomic data sets, from four patient cohorts identifying lncRNA DNM3OS, MEG3, and MIAT overexpression and their reproducible gene regulation in ovarian cancer EMT. Genome-wide mapping shows 73% of MEG3-regulated EMT-linked pathway genes contain MEG3 binding sites. DNM3OS overexpression, but not MEG3 or MIAT, significantly correlates to worse overall patient survival. DNM3OS knockdown results in …

Implementing Evidence-Based Opioid Prescription Practices In A Primary Care Setting, Cyril Gaiennie

Doctor of Nursing Practice

The use and misuse of opioid pain medication has reached epidemic proportions in the United States. More than 16,000 people die each year due to the misuse or abuse of prescription opioid medications, which is more than from heroin, cocaine, and benzodiazepines combined. The purpose of this evidence-based practice project is to establish processes enabling a primary care clinic to implement and adhere to the 2016 Centers for Disease Control’s guidelines for opioid prescription practices in the primary care setting. A retrospective chart review conducted prior to implementation of the guidelines demonstrated that four of six of the CDC’s recommendations …

Improving Hpv Vaccination Series Initiation Rates And Compliance Among Indigent Women In South Texas, Ages 19-26, Through Provider Recommendation And Additional Clinic Funding: A Quality Improvement Project, Lacey Cudd

Doctor of Nursing Practice

The purpose of this quality improvement project was to increase human papillomavirus vaccination series initiation rates among indigent women, ages 19-26, at a clinic in South Texas. The human papillomavirus is a sexually transmitted infection that has been associated with multiple types of cancers. Each year, approximately 6.2 million cases of the human papillomavirus infection are diagnosed; as many as 75% of all new infections occur among females 18-26 years of age. The human papillomavirus vaccination has a high efficacy in regards to cancer prevention, preventing as many as 76% of cancers with only one dose. The project included educating …

Improving Early Child Developmental Screenings In A Primary Care Setting: A Quality Improvement Project, Marlischa Jackson

Doctor of Nursing Practice

A dramatic growth of physical, motor, cognitive, communication, emotional, and social development will occur during the 3 years of life. Of children ages 3-17 years of age, 13% have some type of developmental or behavioral condition that goes undiagnosed before the age of 10. Children with multiple health and social risk factors, or those with chronic health disorders, are at greater risk to develop early child delays or disabilities. In the U. S., developmental screenings are only completed 21% of the time during well-child visits. Therefore, the purpose of this quality improvement project was to increase the adherence of health …

Initiating Hpv Co-Testing For Women Aged 30-65 In An Ob/Gyn Practice Setting, Stephen Cavazos

Doctor of Nursing Practice

The purpose of this project was to improve the rate of successful human papilloma virus (HPV) screening in a small Texas based Women's Health clinic through a co-testing method. The intended goal was to increase the rate of HPV screening, from a 73% baseline, to 95% over a 10-week period for women between the ages of 30-65 years old. Approximately 79 million American women are currently infected with HPV, and 14 million people contract it every year. Seventy percent of cervical cancers today are caused by HPV, leading to approximately 12,820 new diagnoses of invasive cervical cancer predicted for 2017, …

Nadph Oxidase 5 (Nox5)-Induced Reactive Oxygen Signaling Modulates Normoxic Hif-1Α And P27, Smitha Antony, Guojian Jiang, Yongzhong Wu, Jennifer L Meitzler, Hala R Makhlouf, Diana C Haines, Donna Butcher, Dave S B Hoon, Jiuping Ji, Yiping Zhang, Agnes Juhasz, Jiamo Lu, Han Liu, Iris Dahan, Mariam Konate, Krishnendu K Roy, James H Doroshow

Articles, Abstracts, and Reports

NADPH oxidase 5 (NOX5) generated reactive oxygen species (ROS) have been implicated in signaling cascades that regulate cancer cell proliferation. To evaluate and validate NOX5 expression in human tumors, we screened a broad range of tissue microarrays (TMAs), and report substantial overexpression of NOX5 in malignant melanoma and cancers of the prostate, breast, and ovary. In human UACC-257 melanoma cells that possesses high levels of functional endogenous NOX5, overexpression of NOX5 resulted in enhanced cell growth, increased numbers of BrdU positive cells, and increased γ-H2AX levels. Additionally, NOX5-overexpressing (stable and inducible) UACC-257 cells demonstrated increased normoxic HIF-1α expression and decreased …