Medical Specialties Commons^™

Assessing The Long-Term Effects Of Brief Behavioral Health Treatment In Primary Care Patients, Debbie Gomez

Graduate Theses and Dissertations

Although increasingly studies show brief behavioral health services are effective for primary care patients (Bridges et al., 2013; Bryan, Morrow, & Appolonio, 2009; Corso et al., 2012; Gomez et al., 2014), there is a paucity of research exploring the long-term effects of these interventions (e.g., Ray-Sannerud, 2012). The primary aim of the current study was to explore long-term effectiveness. Specifically, the current study 1) examined whether reductions in patient global distress following brief behavioral health care services were maintained long-term, 2) evaluated whether improvements were reliable and not due to regression to the mean effects, and 3) explored medical cost …

The Effects Of Continuous Insulin Pump Therapy On Glycemic Control In Pregnant Type 1 Diabetics, Kimberly Kelsey

Senior Theses

Type 1 Diabetics have various ways of managing their diabetes that have been studied for their effectiveness. Pregnancy in the Type 1 Diabetic has been understudied. It is known that Diabetics in general have poorer pregnancy outcomes because of poor glycemic control. This coupled with the fact that the body needs 3-4 times more insulin as pregnancy comes to an end makes managing blood glucose levels challenging for diabetics (Lowdermilk, 2016, p. 689). For the Type 1 Diabetic, there are two main ways to control diabetes: multiple daily injections using at least two type of insulin and continuous subcutaneous insulin …

High Burden Of Subclinical Lead Toxicity After Phase Out Of Lead From Petroleum In Pakistan, Hafsa Majid, Aysha Habib Khan, Nadeem Ullah Khan, Imran Siddiqui, Farooq Ghani, Lena Jafri

Department of Pathology and Laboratory Medicine

Objective: To evaluate the frequency of subclinical lead toxicity.
Study design: Cross-sectional study.
Place and duration of study: Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi, from January 2011 to December 2014.
Methodology: Analysis of laboratory data for blood lead levels (BLL) was performed. Lead was tested by atomic absorption spectrometer. For all subjects, only initial test results were included while the results of repeated testing were excluded. Exemption was sought from institutional ethical review committee. BLL of 2-10 ug/dl and 10-70 ug/dl in children and adults, respectively were taken as subclinical lead toxicity.
Result: Amongst …

Cost And Quality Issues In Establishing Hematopoietic Cell Transplant Program In Developing Countries, Shahrukh K. Hashmi, Alok Srivastava, Walid Rasheed, Salman Adil, Tong Wu, Madan Jagasia, Amr Nassar, William Y. K. Hwang, Amir Ali Hamidieh, Hildegard T. Greinix

Section of Haematology/Oncology

The hematopoietic cell transplant (HCT) activity has grown significantly over the past two decades in both developing and developed countries. Many challenges arise in establishing new HCT programs in developing countries, due to scarcity of resources and manpower in expertise in HCT. While cost issues can potentially hinder establishment of new HCT programs in certain regions, the focus on quality and value should be included in the general vision of leadership before establishing an HCT program. The main challenge in most developing countries is the lack of trained/qualified personnel, enormous start-up costs for a tertiary care center, and quality maintenance. …

Evaluating The Therapeutic Efficacy Of Restoring Wild-Type P53 Activity In P53-Mutant Tumors, Connie A. Larsson

Dissertations and Theses (Open Access)

The p53 transcription factor is the most frequently altered in human cancers usually via missense mutations that undermine its transcriptional activity. Clinically, TP53 mutations have been shown to be remarkably predictive of refractoriness to treatment, resulting in poor outcome. Consequently, the development of p53 pathway activating agents is rapidly evolving and gaining more attention in cancer therapeutics research, with several small molecule compounds currently in preclinical and clinical trials. However, it remains largely unknown what types or proportions of p53-mutant tumors will respond to p53 restoration-based therapies.

Using a mouse model of Li Fraumeni syndrome, we genetically restored wild-type …

Graft And Mesh Use In Vaginal Surgery, Raheela Mohsin Rizvi, Novera G. Chughtai

Department of Obstetrics & Gynaecology

Pelvic organ prolapse and urinary incontinence are among the most common chronic disorders in women. These are common problems whose pathogenesis remains unclear. As life expectancy increases, significantly greater number of women now present with pelvic organ prolapse and urinary incontinence requiring surgical intervention. Currently, the lifetime risk of undergoing prolapse or continence surgery is one in 11, and up to 30% of patients will require repeat reconstructive surgery and repeat surgery for incontinence in 10%. In an attempt to improve surgical outcomes and to preserve vaginal capacity and coital function, a number of synthetic and biological prostheses have been …

Pharygeal Cervicobrachial Variant Of Guillian -Barre Syndrome, Hazim Brohi, Marium Mustaqeem, Sundus Khan

Pakistan Journal of Neurological Sciences (PJNS)

Guilain-Barre Syndrome (GBS) is a common cause of Neuro-muscular paralysis with a spectrum of clinical and electrophysiology variants. We present a case of thePharyneo-cervico-brachial type. A 25 yr old male came to the Medical OPD with the complains of one day history of upper limb weakness and decreased flexion of the neck , which was progressively worsening, along-with associated shortness of breath. His systemic inquiry and past medical/surgical histories were insignificant. Physical exam correlated withthe diagnostic criteria of PCB variant of GBS. Diagnosis was confirmed on EMG/NCS,which showed axonal neuropathy involving axillay and musculocutaneousnerve, along with absent F –waves latencies …

New Oral Anticoagulants (Noacs) For Cerebral Venous Thrombosis, Maria Khan, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

Cerebral venous thrombosis (CVT) is a relatively rare condition that results from thrombosis of the superficial or deep venous sinuses of the brain. The first ever reported case of the condition was back in 1825 and this was diagnosed at autopsy. It took more than 150 years before imaging modalities were developed that could diagnose cases earlier. With the advent of CT and MR venogram, the diagnosis has become much easier and is contributing to a larger number of cases being picked up. Despite that the incidence in Western literature stays low at 1.3-1.6 cases per 100,000 people. Middle Eastern …

Early Electrophysiological Findings In Guillain Barre Syndrome, Hazim Brohi, Rajesh Kumar, Sadia Mubarak, Muhammmad Anees Mumtaz

Pakistan Journal of Neurological Sciences (PJNS)

Early electrophysiological testing is more important as early abnormalities can be obtained even in the first week. However the electrical abnormalities may not be that prominently evident for definitive diagnosis in the first 2 weeks. However at times the decision of treatment has to be taken early. Research is required to look at different electrophysiological parameter which could give clue for an earlier diagnosis. The aim of our study is to determine early electrophysiological parameters with in first week to identify GBS at earliest.

Burden And Pattern Of Neurological Diseases Seen In Neurology Department Of A Tertiary Care Hospital In Baluchistan, Wazir Akbar, Noor Ahmed Khosa, Abdul Bari Nasar

Pakistan Journal of Neurological Sciences (PJNS)

Neurologic disorders represent a major burden of disease globally. These are common and represent a major public health problem. The spectrum of diseases ranges from non communicable disorders like stroke and neurodegenerative disorders to central nervous system infections. The burden of neurological diseases may be on the increase especially in developing countries. Improved outcome in these settings may require appreciation of the spectrum of neurological diseases and the impediments to their management.The pattern of neurological admissions in hospital varies amongst different regions of the world and this depends on many factors including the regional burden of neurological disorders.

Dementia Survey Among Attendees Of A Dementia Awareness Event In Karachi, Pakistan, Qurat Ul Ain Khan, Yusra Hanif Khan, Mohammad Zaman Khan, Shireen Najam

Pakistan Journal of Neurological Sciences (PJNS)

There is little information available about peoples'knowledgeregarding symptoms of dementia, dementia diagnosis, and care arrangementsfor dementia patients in Pakistan. Aims: We aimed to find out if patients with dementia and their caregivers were aware of diagnosis, the most common and most distressing symptoms, and care arrangement for these patients.

The Role Of Mucin-Educated Platelet Activation In Tumor Invasiveness: An Unfolding Concern In The Realm Of Cancer Biology, Akbar Shoukat Ali, Arzoo Ajaz

Department of Obstetrics & Gynaecology

Metastasis is a complex and well-coordinated phenotypic transformation of cancer cells governed by aberrant genetic and molecular pathways. It has been approved as the most consistent cause of cancer death. With emerging insight into the genomics, transcriptomics and proteomics, progress has been made and reasonably large number of molecular pathways of metastasis has been forwarded, but our understanding of precise underlying molecular mechanisms remains largely scarce. It has been well-known for around a decade and more that platelets are intriguingly contributing to the cancer metastasis. However, it is only recently that cancer cells can activate platelets have started to become …

Preserving And Restoring Bone With Continuous Insulin Infusion Therapy In A Mouse Model Of Type 1 Diabetes, Jeffry S. Nyman, Evangelia Kalaitzoglou, R. Clay Bunn, Sasidhar Uppuganti, Kathryn M. Thrailkill, John L. Fowlkes

Barnstable Brown Diabetes Center Faculty Publications

Those with type 1 diabetes (T1D) are more likely to suffer a fracture than age- and sex-matched individuals without diabetes, despite daily insulin therapy. In rodent studies examining the effect of bone- or glucose-targeting therapies on preventing the T1D-related decrease in bone strength, insulin co-therapy is often not included, despite the known importance of insulin signaling to bone mass accrual. Therefore, working toward a relevant pre-clinical model of diabetic bone disease, we assessed the effect of continuous subcutaneous insulin infusion (CSII) therapy at escalating doses on preserving bone and the effect of delayed CSII on rescuing the T1D-related bone deterioration …

Home Visiting: Discovering What Works For Increasing Referrals, Theresa Cruz, Leona Woelk, Ivy Cervantes

Reports & Documents

The purpose of this work was to identify barriers providers may experience with regard to referring patients to home visiting (HV) programs and to determine potential intervention strategies that could be used to increase provider referrals, initially in Bernalillo County.

Common Tdp1 Polymorphisms In Relation To Survival Among Small Cell Lung Cancer Patients: A Multicenter Study From The International Lung Cancer Consortium, Pawadee Lohavanichbutr, Lori C. Sakoda, Christopher I. Amos, Susanne M. Arnold, David C. Christiani, Michael P. A. Davies, John K. Field, Eric B. Haura, Rayjean J Hung, Takashi Kohno, Maria Teresa Landi, Geoffrey Liu, Yi Liu, Michael W. Marcus, Grainne M. O'Kane, Matthew B. Schabath, Kouya Shiraishi, Stacey A. Slone, Adonina Tardón, Ping Yang, Kazushi Yoshida, Ruyang Zhang, Xuchen Zong, Gary E. Goodman, Noel S. Weiss, Chu Chen

Internal Medicine Faculty Publications

Background—DNA topoisomerase inhibitors are commonly used for treating small-cell lung cancer (SCLC). Tyrosyl-DNA phosphodiesterase (TDP1) repairs DNA damage caused by this class of drugs and may therefore influence treatment outcome. In this study, we investigated whether common TDP1 single-nucleotide polymorphisms (SNP) are associated with overall survival among SCLC patients.

Methods—Two TDP1 SNPs (rs942190 and rs2401863) were analyzed in 890 patients from 10 studies in the International Lung Cancer Consortium (ILCCO). The Kaplan–Meier method and Cox regression analyses were used to evaluate genotype associations with overall mortality at 36 months postdiagnosis, adjusting for age, sex, race, and tumor stage. …

Negative Outcomes Of Teen Sexual Activity: Is There A Regional Effect?, Hannah Latta, Said Shahtahmasebi, Hatim A. Omar

Pediatrics Faculty Publications

A recent victory with respect to teen sexual behavior is the reduction of the national teen birth rate. In 1991, there were 61.8 births per 1000 females aged 15-19. By 2014, this rate plummeted to 24.2 births per 1000 adolescent females. Averages, however, do not reflect state-level variation. For example, in 2014, Kentucky reported 35.3 births per 1000 adolescent females, while New York reported a teen birth rates of 16.1 births per 1000 adolescent females. This report asks: are these discrepancies due to regional factors, and are these differences statistically significant? To examine rural and urban differences in outcomes of …

Skeletal Muscle Hypertrophy, Maximal Strength, And Rate Of Force Development: Effects Of Resistance Training Loading Strategy, Kevin M. Carroll, Jake R. Bernard, Michael H. Stone

ETSU Faculty Works

Abstract available in the Annual Coaches and Sport Science College.

How We Close The Gaps: Our Interprofessional Team Approach To Meeting Quality Measures, Peter Blockhurst, William Buselmeier, Mckenzie Calhoun, Paige Gilbert-Green, Jesse Gilbreath, Erin Harris, Amy Lawrence

ETSU Faculty Works

• Define the role/function of an interprofessional team in the management of complex outpatients.
• Identify the types of patients that would benefit most from a team-based approach.
• Implement elements of our team-based patient care model into individual practices.

Sustained Sensitizing Effects Of Tumor Necrosis Factor Alpha On Sensory Nerves In Lung And Airways, Ruei-Lung Lin, Qihai Gu, Mehdi Khosravi, Lu-Yuan Lee

Physiology Faculty Publications

Tumor necrosis factor alpha (TNFα) plays a significant role in the pathogenesis of airway inflammatory diseases. Inhalation of aerosolized TNFα induced airway hyperresponsiveness accompanied by airway inflammation in healthy human subjects, but the underlying mechanism is not fully understood. We recently reported a series of studies aimed to investigate if TNFα elevates the sensitivity of vagal bronchopulmonary sensory nerves in a mouse model; these studies are summarized in this mini-review. Our results showed that intratracheal instillation of TNFα induced pronounced airway inflammation 24 hours later, as illustrated by infiltration of eosinophils and neutrophils and the release of inflammatory mediators and …

Comparative Effectiveness And Safety Of Empagliflozin On Cardiovascular Mortality And Morbidity In Adults With Type 2 Diabetes, Wilbert S. Aronow, Tatyana Shamliyan

NYMC Faculty Publications

Background: Based on a single placebo-controlled randomized clinical trial, empagliflozin is licensed to reduce cardiovascular death in diabetes and comorbid cardiovascular disease. Methods: We examined the comparative effectiveness of empagliflozin on mortality and cardiovascular morbidity in type 2 diabetes. We conducted random-effects direct frequentist meta-analyses of aggregate data and appraised the quality of evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. Our search in PubMed, EMBASE, the Cochrane Library, clinicaltrials.gov, and PharmaPendium up to May 2017 identified 11 meta-analyses, multiple publications, and unpublished data from 29 randomized controlled trials (RCTs). Results: Empagliflozin reduces all-cause mortality [relative …

Masked Hypertension, Wilbert S. Aronow

NYMC Faculty Publications

No abstract provided.

High-Volume Forced Diuresis With Matched Hydration Using The Renalguard System To Prevent Contrast-Induced Nephropathy: A Meta-Analysis Of Randomized Trials, Rahman Shah, Sarah J. Wood, Sajjad A. Khan, Amina Chaudhry, M. Rehan Khan, Mohamed S. Morsy

Section of Internal Medicine

Background: Contrast-induced nephropathy (CIN) is a well-recognized complication of coronary angiography that is associated with poor outcomes. Several small randomized controlled trials (RCTs) have recently shown that in patients with chronic kidney disease (CKD), furosemide-induced forced diuresis with matched hydration using the RenalGuard system can prevent its occurrence. However, individual studies have been underpowered and thus cannot show significant differences in major clinical endpoints.
Hypothesis: Forced diuresis with matched hydration using the RenalGuard system improves clinical outcomes in patients undergoing coronary angiography.
Methods: Scientific databases and websites were searched for relevant RCTs. The pooled risk ratios were calculated using random-effects …

Successful Reversal Of Furosemide-Induced Secondary Hyperparathyroidism With Cinacalcet., Tarak Srivastava, Shahryar Jafri, William E. Truog, Judith Sebestyen Vansickle, Winston M. Manimtim, Uri S. Alon

Manuscripts, Articles, Book Chapters and Other Papers

Secondary hyperparathyroidism (SHPT) is a rare complication of furosemide therapy that can occur in patients treated with the loop diuretic for a long period of time. We report a 6-month-old 28-weeks premature infant treated chronically with furosemide for his bronchopulmonary dysplasia, who developed hypocalcemia and severe SHPT, adversely affecting his bones. Discontinuation of the loop diuretic and the addition of supplemental calcium and calcitriol only partially reversed the SHPT, bringing serum parathyroid hormone level down from 553 to 238 pg/mL. After introduction of the calcimimetic Cinacalcet, we observed a sustained normalization of parathyroid hormone concentration at 27 to 63 pg/mL …

Are Hylan Injections More Effective In Reducing Stiffness In Primary Knee Osteoarthritis Compared To Hyaluronic Acid Derivative Injections?, Jordan S. Hood

PCOM Physician Assistant Studies Student Scholarship

No abstract provided.

Is Oral Aloe Vera Effective In Reducing Symptoms In Adults With Irritable Bowel Syndrome (Ibs)?, Chelsey J. Gebhardt

PCOM Physician Assistant Studies Student Scholarship

Objective: The objective of this EBM review is to determine whether or not “Is oral aloe vera effective in reducing symptoms in adults with Irritable Bowel Syndrome (IBS) symptoms?”

Study Design: Systematic review of three English, randomized, controlled, double-blind studies, including one cross-over study, were selected based on their relevance to the clinical question. The studies were published in 2006, 2011, and 2015.

Data Sources: Three RCTs analyzing the effects on IBS symptoms of drinking aloe vera daily compared to a placebo drink were found using PubMed.

Outcomes Measured: Various patient-reported IBS symptom questionnaires were utilized …

Are Tart Cherry Supplements Effective On Reducing Muscle Soreness And Perception Of Pain In Young, Healthy Males Following High Intensity Resistance Training?, Alyssa Davis

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not tart cherry supplements are effective at alleviating muscle soreness and pain following high resistance training.

STUDY DESIGN: Review of two double blind randomized control trials, and one crossover randomized control trial. All three studies were published in English between 2006-2015.

DATA SOURCES: Two double blind randomized control trials and one crossover randomized control trial found using Cochrane and PubMed.

OUTCOMES MEASURED: The outcomes measured were muscle soreness and perception of pain. They were measured using a pressure-pain threshold and 10 point pain …

Does Fecal Microbiota Transplantation Cause Clinical Remission In Patients With Ulcerative Colitis?, Amandeep Singh

PCOM Physician Assistant Studies Student Scholarship

Objective: The objective of this selective EBM review is to determine whether or not “Does Fecal Microbiota Transplantation cause Clinical Remission in Patients with Ulcerative Colitis?”

Study Design: Review of three English language primary studies published in 2015.

Data Sources: Two randomized control trials and a cohort study determining if fecal microbiota transplantation does lead to clinical remission of Ulcerative Colitis were found by using PubMed and Cochrane databases.

Outcome(s) Measured: The outcomes measured in all three studies were patient oriented evidence that matters which is clinical remission. The outcomes in the Moayyedi et al. was …

Is Weight Loss An Effective Treatment Of Pain Symptoms Related To Knee Joint Osteoarthritis In Obese Adults?, Samantha Sokol

PCOM Physician Assistant Studies Student Scholarship

Objective: The objective of this selective EBM review is to determine whether or not weight loss is an effective treatment of pain symptoms related to knee joint osteoarthritis in obese adults.

Study Design: Systematic review of 2 randomized-controlled trials and 1 cohort study. All three articles were published in English between 2011-2015.

Data Sources: Two randomized, un-blinded, controlled studies and one cohort found using Pubmed.

Outcomes Measured: Each study evaluated change in pain symptoms related to knee osteoarthritis in obese adults as compared to weight loss.

Results: Studies showed that weight loss lead to a …

Is Mdma-Assisted Psychotherapy An Effective Treatment For Posttraumatic Stress Disorder (Ptsd)?, Joey Rudd

PCOM Physician Assistant Studies Student Scholarship

Objective: The objective of this selective EBM review is to determine whether or not MDMA-assisted psychotherapy is an effective treatment for posttraumatic stress disorder (PTSD).

Study Design: Systematic review of three published, randomized controlled trials (double-blind, placebo-controlled) between 2008-2013.

Data Sources: All articles used were published in English, in peer-reviewed journals, and found using PubMed/MEDLINE and Cochrane Review databases.

Outcomes Measured: The primary outcome measure in all three studies was the severity of PTSD symptoms. The primary outcome measure was assessed using the Clinician-Administered PTSD Scale (CAPS) and the Severity of Symptoms Scale for PTSD (SSSPTSD). …

Does Music Therapy Intervention Have An Effect On The Emotional Behavior Of Alzheimer Patients?, Alexandra P. Lahurd

PCOM Physician Assistant Studies Student Scholarship

OBJECTIVE: The objective of this selective EBM review is to determine whether or not music therapy intervention have an effect on emotional behavior of Alzheimer patients. Behavior variables measuring are agitation and anxiety.

STUDY DESIGN: Systematic review of two randomized, controlled trials published in 2009 and 2014, respectively, and one randomized control case study published in 2006.

DATA SOURCE: Three published studies comparing music therapy intervention on behavioral modifications with Alzheimer patients were found using PubMed and Medline

OUTCOMES MEASURES: All three studies measure behavior in Alzheimer patients based on a variety of well validated …