Medical Specialties Commons^™

Extensive Mediastinal Aspergillosis Presenting With Dyspnoea And Cardiac Tamponade Symptoms, Syed F Mustafa, Hamza Ar Khan, Saulat H. Fatimi

Department of Surgery Docs

No abstract provided.

Increasing Usage Of Rapid Diagnostics For Dengue Virus Detection In Pakistan, Zahra Hasan, Saher Razzak, Muhammad Farhan, Maryam Rahim, Nazneen Islam, Azra Samreen, E. Khan

Department of Pathology and Laboratory Medicine

No abstract provided.

Atypical Teratoid/ Rhabdoid Tumor Of Brain: A Clinicopathologic Study Of Eleven Patients And Review Of Literature, Nasir Ud Din, Abrar Barakzai, Aisha Memon, Sheema Hasan, Zubair Ahmad

Department of Pathology and Laboratory Medicine

Creative Commons Attribution LicenseBackground: Atypical teratoid/ rhabdoid tumor (AT/RT) is a rare aggressive embryonal central nervous system(CNS) tumor of infancy and early childhood. Majority of the cases arise in the posterior fossa, and remaining in thecerebrum. Aims: To analyze the clinicopathologic features of AT/RT on a cohort of cases. Materials and methods:All reported cases of AT/RT at the Department of Pathology and Laboratory Medicine, Aga Khan University Hospital(AKUH) from 2007 to 2016 were reviewed for clinical and pathological features. Immunohistochemical stain for INI-1was performed in all 11 cases. Follow up was obtained. Results: A total of 11 cases were identified. …

Enterobius Vermicularis In Tubo-Ovarian Abscess: A Rare And Interesting Incidental Finding - A Case Report, Faryal Saleem, Faizan Malik, Saira Fatima

Department of Pathology and Laboratory Medicine

Enterobius vermicularis is a common intestinal nematode; however, rare extraintestinal Enterobius infections have been reported from different parts of the world. Here, we present a case of tubo-ovarian abscess in an otherwise healthy young sexually active female with no known comorbids with history of on and off lower abdominal pain for one year and high grade fever for one month. On the basis of further workup and radiological evaluation, a preoperative diagnosis of right sided tubo-ovarian abscess was made and salpingo-oophorectomy was performed laproscopically in July 2015. Histopathology of the resected tissue revealed necrosis and in one area Enterobius vermicularis …

Selective Screening For Organic Acidurias And Amino Acidopathies In Pakistani Children, Noreen Abbas Sherazi, Aysha Habib Khan, Lena Jafri, Azeema Jamil, Nasir Ali Khan, Bushra Afroze

Department of Pathology and Laboratory Medicine

Objective: To determine the frequency of organic acidurais (OA) and amino acidopathies (AA) in selected high-risk patients screened in two years.
Study Design: Retrospective Observational study.
Place and Duration of Study: The Aga Khan University Hospital (AKUH), Karachi, from January 2013 to December 2014.
Methodology: Patients with OA and AA were included in the study and patients with IMDs other than OA and AA were excluded. Amino acids and organic acids were analyzed on high performance liquid chromatography and gas chromatography-mass spectrometry respectively. Clinical data and chromatograms of patients screened for IMDs were reviewed by chemical pathologist and metabolic physician. …

High Acuity Readmission Risk Pediatric Screen Tool (Harrps), Sarah Bradshaw, Anita Powell

Presentations

Podium Presentation on Quality Improvement Project: Implementing Use of HARRPS Tool

Objectives:

• Describe the development of an evidence-based pediatric risk screen tool for inpatient admissions
• Articulate how formal Continuous Quality Process Improvement (CQPI) methods were utilized during implementation
• Discuss lessons learned and next steps

Review Article: Pathogenesis And Clinical Manifestations Of Gastrointestinal Involvement In Systemic Sclerosis., Sumit Kumar, Jagmohan Singh, Satish Rattan, Anthony J. Dimarino, Sidney Cohen, Sergio A. Jimenez

Department of Dermatology and Cutaneous Biology Faculty Papers

BACKGROUND: Gastrointestinal tract (GIT) involvement is a common cause of debilitating symptoms in patients with systemic sclerosis (SSc). There are no disease modifying therapies for this condition and the treatment remains symptomatic, largely owing to the lack of a clear understanding of its pathogenesis.

AIMS: To investigate novel aspects of the pathogenesis of gastrointestinal involvement in SSc. To summarise existing knowledge regarding the cardinal clinical gastrointestinal manifestations of SSc and its pathogenesis, emphasising recent investigations that may be valuable in identifying potentially novel therapeutic targets.

METHODS: Electronic (PubMed/Medline) and manual Google search.

RESULTS: The GIT is the most common internal …

Anterior Cervical Infection: Presentation And Incidence Of An Uncommon Postoperative Complication., George M. Ghobrial, James S. Harrop, Rick C. Sasso, Chadi A. Tannoury, Tony Tannoury, Zachary A. Smith, Wellington K. Hsu, Paul M. Arnold, Michael G. Fehlings, Thomas E. Mroz, Anthony F. De Giacomo, Bruce C. Jobse, Ra'kerry K. Rahman, Sara E. Thompson, K Daniel Riew

Department of Neurosurgery Faculty Papers

STUDY DESIGN: Retrospective multi-institutional case series.

OBJECTIVE: The anterior cervical discectomy and fusion (ACDF) affords the surgeon the flexibility to treat a variety of cervical pathologies, with the majority being for degenerative and traumatic indications. Limited data in the literature describe the presentation and true incidence of postoperative surgical site infections.

METHODS: A retrospective multicenter case series study was conducted involving 21 high-volume surgical centers from the AOSpine North America Clinical Research Network, selected for their excellence in spine care and clinical research infrastructure and experience. Medical records for 17 625 patients who received cervical spine surgery (levels from C2 …

A Rare Case Of Vascular Ring And Coarctation Of The Aorta In Association With Charge Syndrome, Jonathan B Wagner, Joshua Q Knowlton, Peter Pastuszko, Sanket S Shah

The Texas Heart Institute Journal

A male neonate presented with CHARGE syndrome, a multiorgan genetic disorder involving the Coloboma of the eyes, congenital Heart defects, nasal choanal Atresia, growth and development Retardation, Genitourinary disorders, and Ear anomalies and deafness. Moreover, he had a rare case of vascular ring—consisting of a right aortic arch with retroesophageal brachiocephalic artery—combined with coarctation of the mid-aortic arch. He underwent both vascular ring and aortic arch repair at our institution.

To our knowledge, this is the 4th documented case of this exceedingly rare type of aortic arch anomaly combined with aortic arch obstruction. Moreover, it is the first confirmed case …

Diet And Polycystic Kidney Disease: A Pilot Intervention Study., Jacob M. Taylor, Jill M. Hamilton-Reeves, Debra K. Sullivan, Cheryl A. Gibson, Catherine Creed, Susan E. Carlson, Donald E. Wesson, Jared J. Grantham

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND & AIMS: Dietary sodium, protein, acid precursors, and water have been linked to cyst growth in polycystic kidney disease; yet, no studies in patients have examined the feasibility of using a dietary intervention that controls all of these factors. The aim of this study was to determine if a diet, appropriate for persons of most ages, reduces the excretion of sodium, urea, acid, and decreases mean urine osmolality while gaining acceptance by patients with autosomal dominant polycystic kidney disease (ADPKD).

METHODS: Twelve adults with ADPKD enrolled in a pre-post pilot feasibility study and served as their own controls. Individuals …

Maximizing Health Outcomes In A Medical Home For Children With Medical Complexity: The Beacon Program., Ingrid Larson, Amber Hoffman, Michael Artman

Manuscripts, Articles, Book Chapters and Other Papers

No abstract provided.

Clinician-Performed Bedside Ultrasound In Improving Diagnostic Accuracy In Patients Presenting To The Ed With Acute Dyspnea., Dimitrios Papanagnou, Michael Secko, John Gullett, Michael Stone, Shahriar Zehtabchi

Department of Emergency Medicine Faculty Papers

INTRODUCTION: Diagnosing acute dyspnea is a critical action performed by emergency physicians (EP). It has been shown that ultrasound (US) can be incorporated into the work-up of the dyspneic patient; but there is little data demonstrating its effect on decision-making. We sought to examine the impact of a bedside, clinician-performed cardiopulmonary US protocol on the clinical impression of EPs evaluating dyspneic patients, and to measure the change in physician confidence with the leading diagnosis before and after US.

METHODS: We conducted a prospective observational study of EPs treating adult patients with undifferentiated dyspnea in an urban academic center, excluding those …

Cerebrovascular Accident Survival: Strategies Of Flight Nursing And Aeromedical Transport, Alexis Caudle

Senior Honors Theses

Cerebrovascular accidents (CVA), known as strokes, are a leading cause of death worldwide. The delivery and timing of treatment for CVAs is a critical factor in restoring health to the patient. One of the variables in recovery is the method of transport used in bringing the patient to a health care facility. Aeromedical transport remains a valuable resource to achieve full recovery in stroke patients. An ongoing debate of risk versus benefit of helicopter emergency services will be included as well as examination of variables including location, time, physiology of the flight, and the patient’s condition to be scrutinized. In …

A Case Series On Nutrition In Hip Fracture Patients: A Mismatch Between Needs And Dietary Intake, Njalalle Baraza, Eamon Ramhamadany, Thomas Laios

General Surgery, East Africa

Hip fractures are common in the United Kingdom with an overall estimated annual incidence of 100 fractures per 10,000 of the population for males and 81 per 10,000 for females [1], and with an ageing population this figure is set to rise [2]. From recent estimates, this costs the British tax payer over £750,000,000 a year, with over half this amount spent in social care of the patients recovering from the fracture [3]. Elderly hip fracture patients often have co-morbidities and mortality in the first year can be as high as 33% [4].

Ultrasound-Guided Vascular Access: An Evolving Standard Of Care Clinical Practice, Which Is Extremely Under-Utilized In Pakistan, Mohammad Irfan Akhtar, Mohammad Hamid, Fauzia Minai

Department of Anaesthesia

No abstract provided.

Transcatheter Aortic Valve Implantation In A Patient With Unicuspid Aortic Valve, Angelo Nascimbene, Pranav Loyalka, Igor D Gregoric, Ricardo Bellera, Maan Malahfji, Marija Petrovic, Biswajit Kar

The Texas Heart Institute Journal

Transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic valves has been successfully performed, but there is a lack of published experience in percutaneous treatment of patients with unicuspid valves and severe aortic stenosis. We describe a case of TAVR in such a patient.

A 31-year-old woman with Turner syndrome—who had undergone coarctation repair via subclavian flap at age 7 days and an aortic valvotomy at age 6 weeks—presented with severe symptomatic aortic stenosis. She was deemed inoperable because of her severe pulmonary hypertension and numerous comorbidities; consequently, a 20-mm Edwards Sapien 3 Transcatheter Heart Valve was offered for …

Prolonged Sinus Pauses Upon Termination Of Paroxysmal Atrial Fibrillation: Abnormal Right Atrial Electrophysiologic And Electroanatomic Findings, Zhengyu Bao, Hongwu Chen, Bing Yang, Michael Shehata, Weizhu Ju, Fengxiang Zhang, Gang Yang, Kai Gu, Mingfang Li, Kejiang Cao, Xunzhang Wang, Minglong Chen

The Texas Heart Institute Journal

The efficacy of pulmonary vein antral isolation for patients with prolonged sinus pauses (PSP) on termination of atrial fibrillation has been reported. We studied the right atrial (RA) electrophysiologic and electroanatomic characteristics in such patients.

Forty patients underwent electroanatomic mapping of the RA: 13 had PSP (group A), 13 had no PSP (group B), and 14 had paroxysmal supraventricular tachycardia (control group C). Group A had longer P-wave durations in lead II than did groups B and C (115.5 ± 15.4 vs 99.5 ± 10.9 vs 96.5 ± 10.4 ms; P=0.001), and RA activation times (106.8 ± 13.8 vs …

Nina Braunwald: A Female Pioneer In Cardiac Surgery, Nikhil Sabharwal, Harmanjit Dev, Hassiba Smail, David C Mcgiffin, Pankaj Saxena

The Texas Heart Institute Journal

Nina Starr Braunwald, the first female cardiac surgeon, made headlines during a time when almost all specialty surgeons were men.

Women have typically been deterred from entering surgical specialties, in part because of their traditional dual burden of managing their households and careers. Instead, female medical students and junior doctors have tended to be more attracted to medical specialties. This was the reality during Dr. Braunwald's venture into medicine in 1949. However, she never allowed negative ideas to keep her from joining a surgical training program.

Under the mentorship of the prominent cardiac surgeons Charles Hufnagel and Andrew Morrow, Dr. …

What Makes A Medical Journal Successful? Five Crucial Components, Herbert L Fred

The Texas Heart Institute Journal

No abstract provided.

Bomb Blast In A Tertiary Care Hospital, The Challenges Faced During Management Of Victims In A Resource Limited Country, Rizwan Sultan, Hasnain Zafar, Umar B, Khabir Ahmed

Department of Surgery Docs

Abstract Introduction: A bomb blast in a hospital results in a many fold increase in the casualties. The affected health care in the region is the next challenge faced by the administration of the city. We discuss the challenges faced after a bomb blast in the civil hospital of Quetta, Pakistan on 8 August 2016. Methods: A retrospective review of the medical records of patients who were transferred by air to the Aga Khan University Hospital Karachi over a period of 86 h after the blast in Quetta. Results: Seventy-five patients were received in three separate waves; those received in …

The Many Guises Of Primary Hyperparathyroidism… An Unchanged Scenario, Tasnim Ahsan, Uzma Erum, K. M. Inam Pal, Rukhshanda Jabeen, Saima Ghaus Qureeshi, Urooj Lal Rehman, Zeenat Banu

Department of Surgery Docs

Abstract

OBJECTIVE:

To study the causes, characteristics and outcome of treatment of patients with primary hyperparathyroidism.

METHODS:

This retrospective cohort analysis was conducted at the Jinnah Postgraduate Medical Centre, Karachi, and comprised data of patients with primary hyperparathyroidism between 2004 and 2014. .SPSS 17 was used for data analysis.

RESULTS:

Of the 25 patients,1(4%)was male and 24(96%) were female. The overall mean age was 41.72±15.9 years, with a mean duration of symptoms of 4.1±3.3 years. The mean pre-operative parathyroid hormone level was 879.48±793.51 pg/ml. Skeletal manifestations were reported in 17(68%) patients, whereas 4(16%) patients had renal stone disease. Besides, 2(8.0%) …

Identificando Los Limites Del Acceso A La Salud Reproductiva: Un Análisis Sobre Las Experiencias Vividas Por Las Mujeres Guaraníes Con Los Servicios De La Salud Reproductiva En La Villa 31 De Buenos Aires, Amelia Mitchell

Independent Study Project (ISP) Collection

In order to serve the ‘public’, public health services must be accessible to everyone, without discrimination based on race, gender, social class, or geographic location, among other facets of identity. Reproductive health services, in particular, are a key service that must be adequately supplied in order to guarantee the health and wellbeing of a population. Reproductive healthcare not only allows individuals to decide if and when they wish to have a child, it also contributes to cancer prevention and the detrimental effects of sexually transmitted diseases. This investigation examines the experiences of Guaraní women that live within “Villa 31” of …

Expectations For Treatment In Pediatric Weight Management And Relationship To Attrition., Erinn T. Rhodes, Richard E. Boles, Kimberly Chin, Amy Christison, Elizabeth Getzoff Testa, Kimberly Guion, Mary Jane Hawkins, Carter R. Petty, Bethany Sallinen Gaffka, Melissa Santos, Laura Shaffer, Jared Tucker, Sarah Hampl

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Attrition in pediatric weight management negatively impacts treatment outcomes. A potentially modifiable contributor to attrition is unmet family expectations. This study aimed to evaluate the association between adolescent and parent/guardian treatment expectations and attrition.

PATIENTS AND METHODS: A prospective, nonrandomized, uncontrolled, single-arm pilot trial was conducted among 12 pediatric weight management programs in the Children's Hospital Association's FOCUS on a Fitter Future collaborative. Parents/guardians and adolescents completed an expectations/goals survey at their initial visit, with categories including healthier food/drinks, physical activity/exercise, family support/behavior, and weight management goals. Attrition was assessed at 3 months.

RESULTS: From January to August 2013, …

Evaluating Parents' Self-Efficacy For Diabetes Management In Pediatric Type 1 Diabetes., Amy E. Noser, Susana R. Patton, Jason Van Allen, Michael B. Nelson, Mark A. Clements

Manuscripts, Articles, Book Chapters and Other Papers

Objective: To examine the factor structure and construct validity of the Maternal Self-Efficacy for Diabetes Management Scale (MSED) in 135 youth ( Mage  = 13.50  ±  1.83 years), with type 1 diabetes mellitus.

Method: The study used exploratory factor analysis (EFA) to examine the factor structure and correlations to examine relationships among MSED factors and select parent and child diabetes-related health behaviors and outcomes.

Results: EFA identified an 11-item three-factor solution (χ 2 (25, n  = 133)  = 40.22, p  < .03, RMSEA = 0.07, CFI = 0.98, TLI = 0.97), with factors corresponding to parents' perceived ability to manage their child's diabetes (MSED-M), problem-solve issues surrounding glycemic control (MSED-P), and teach their child about diabetes care (MSED-T). Correlational analyses revealed significant associations between the MSED-M and MSED-T and parent-reported optimism and youth's diabetes-specific self-efficacy. The MSED-T was also associated with glycated hemoglobin and self-monitoring blood glucose.

Conclusions: Results provide preliminary evidence for the reliability and validity of a three-factor solution of the MSED.

The Randomized, Controlled Trial Of Late Surfactant: Effects On Respiratory Outcomes At 1-Year Corrected Age., Roberta L. Keller, Eric C. Eichenwald, Anna Maria Hibbs, Elizabeth E. Rogers, Katherine C. Wai, Dennis M. Black, Philip L. Ballard, Jeanette M. Asselin, William E Truog, Jeffrey D. Merrill, Mark C. Mammel, Robin H. Steinhorn, Rita M. Ryan, David J. Durand, Catherine M. Bendel, Ellen M. Bendel-Stenzel, Sherry E. Courtney, Ramasubbareddy Dhanireddy, Mark L. Hudak, Frances R. Koch, Dennis E. Mayock, Victor J. Mckay, Jennifer Helderman, Nicolas F. Porta, Rajan Wadhawan, Lisa Palermo, Roberta A. Ballard, Tolsurf Study Group

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVE: To determine the effects of late surfactant on respiratory outcomes determined at 1-year corrected age in the Trial of Late Surfactant (TOLSURF), which randomized newborns of extremely low gestational age (≤28 weeks' gestational age) ventilated at 7-14 days to late surfactant and inhaled nitric oxide vs inhaled nitric oxide-alone (control).

STUDY DESIGN: Caregivers were surveyed in a double-blinded manner at 3, 6, 9, and 12 months' corrected age to collect information on respiratory resource use (infant medication use, home support, and hospitalization). Infants were classified for composite outcomes of pulmonary morbidity (no PM, determined in infants with no reported …

Genomic Contraindications For Heart Transplantation., Danton S. Char, Gabriel Lázaro-Muñoz, Aliessa Barnes, David Magnus, Michael J. Deem, John Lantos

Manuscripts, Articles, Book Chapters and Other Papers

Genome sequencing raises new ethical challenges. Decoding the genome produces new forms of diagnostic and prognostic information; however, the information is often difficult to interpret. The connection between most genetic variants and their phenotypic manifestations is not understood. This scenario is particularly true for disorders that are not associated with an autosomal genetic variant. The analytic uncertainty is compounded by moral uncertainty about how, exactly, the results of genomic testing should influence clinical decisions. In this Ethics Rounds, we present a case in which genomic findings seemed to play a role in deciding whether a patient was to be listed …

Increasing Ed Use Of Jet Injection Of Lidocaine For Iv-Related Pain Management., Shobhit Jain, Mary A. Hegenbarth, Sharon Humiston, Erin Gunter, Lynn Anson, Joan Giovanni

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND AND OBJECTIVE: Venipuncture is a leading cause of procedural pain for children. Jet injection of lidocaine (JIL; J-Tip) has been demonstrated to be effective in controlling intravenous (IV) placement-related pain and, due to its rapid onset, is particularly suited to emergency department (ED) use. Our objective was to increase JIL use with IV placements in our ED from 11% at baseline to 50% within 12 months.

METHODS: We initiated the project at our urban, tertiary pediatric ED in July 2014. We surveyed medical and nursing teams to identify barriers to JIL use. We initiated changes at monthly intervals: (1) …

Fine-Mapping The Mhc Locus In Juvenile Idiopathic Arthritis (Jia) Reveals Genetic Heterogeneity Corresponding To Distinct Adult Inflammatory Arthritic Diseases., A Hinks, J Bowes, J Cobb, H C. Ainsworth, M C. Marion, M E. Comeau, M Sudman, B Han, Juvenile Arthritis Consortium For Immunochip, Mara L. Becker, J F. Bohnsack, P I W De Bakker, J P. Haas, M Hazen, D J. Lovell, P A. Nigrovic, E Nordal, M Punnaro, A M. Rosenberg, M Rygg, S L. Smith, C A. Wise, V Videm, L R. Wedderburn, A Yarwood, R S M Yeung, S Prahalad, C D. Langefeld, S Raychaudhuri, S D. Thompson, W Thomson

Manuscripts, Articles, Book Chapters and Other Papers

OBJECTIVES: Juvenile idiopathic arthritis (JIA) is a heterogeneous group of diseases, comprising seven categories. Genetic data could potentially be used to help redefine JIA categories and improve the current classification system. The human leucocyte antigen (HLA) region is strongly associated with JIA. Fine-mapping of the region was performed to look for similarities and differences in HLA associations between the JIA categories and define correspondences with adult inflammatory arthritides.

METHODS: Dense genotype data from the HLA region, from the Immunochip array for 5043 JIA cases and 14 390 controls, were used to impute single-nucleotide polymorphisms, HLA classical alleles and amino acids. …

State Emergency Department Opioid Guidelines: Current Status., Robert I Broida, Tanner Gronowski, Andrew F Kalnow, Andrew G Little, Christopher M Lloyd

Trauma and Acute Care Articles

INTRODUCTION: The purpose of this study was to evaluate and categorize current state-sponsored opioid guidelines for the practice of emergency medicine (EM).

METHODS: We conducted a comprehensive search of EM-specific opioid prescribing guidelines and/or policies in each state to determine current state involvement in EM opioid prescribing, as well as to evaluate some of the specifics of each guideline or policy. The search was conducted using an online query and a follow-up email request to each state chapter of ACEP.

RESULTS: We found that 17 states had emergency department-specific guidelines. We further organized the guidelines into four categories: limiting prescriptions …

The Significance Of So-Called Equivocal Immunohistochemical Staining For Cytomegalovirus In Colorectal Biopsies, David A Johnson, Philip O Katz, David Armstrong, Henry Cohen, Brendan C Delaney, Colin W Howden, Peter Katelaris, Radu I Tutuian, Donald O Castell

Faculty, Staff and Student Publications

The availability of over-the-counter (OTC) proton pump inhibitors (PPIs) for the short-term (2 weeks) management of frequent heartburn (≥2 days/week) has increased markedly, yet evidence-based recommendations have not been developed. A panel of nine international experts in gastroesophageal reflux disease developed consensus statements regarding the risks and benefits of OTC PPIs using a modified Delphi process. Consensus (based on ≥80% approval) was reached through multiple rounds of remote voting and a final round of live voting. To identify relevant data, the available literature was searched and summarized. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) system terminology was used to …