Medical Specialties Commons^™

A Rare But Life Threatening Case Of Labile Blood Pressures In Pregnancy, Kelsey Carrio, Aarti Aggarwal, Susan Mcgroarty

Rowan-Virtua Research Day

Pheochromocytoma is a rare but life threatening adrenal secreting tumor. The infrequency with which it is encountered makes pheochromocytoma, especially in pregnancy, a formidable diagnostic challenge.

Although a pheochromocytoma is rare, it is good to keep it in differential diagnosis as a possible cause of labile BP with headaches and significant orthostatic BP. It is critical to recognize this condition to institute an appropriate therapy & surgical intervention to prevent mortality.

Metastatic Breast Cancer Presenting As Painless Jaundice, Daniel S. Wilen, Donald J. Mcmahon, Brian J. Blair, Joanne Kaiser-Smith, Darshan B. Roy

Rowan-Virtua Research Day

Breast cancer is the most commonly diagnosed cancer in women in the United States. Treatment options are wide-­‐ ranging based on a multitude of factors, including extent of disease and receptor positivity. Following treatment, a relapse-­‐free interval ≥ 2 years carries a more favorable prognosis.

We present a case involving a female with history of breast cancer and relapse-­free interval of 15 years who unfortunately presented with metastatic disease involving the liver, bone, and lymph nodes.

Development Of Novel Dual Inhibitor Of Chemokine Receptor 4 And Mcl-1 Against Multiple Myeloma, Kuntal Bhowmick, Kristy K. Patel, Suman Pathi, Subash Jonnalagadda, Tulin Budak-Alpdogan, Manoj K. Pandey

Rowan-Virtua Research Day

Multiple myeloma (MM) is a neoplastic plasma-cell disorder. This is characterized by clonal proliferation of malignant plasma cells in the bone-marrow (BM) microenvironment, monoclonal protein in blood or urine, and associated organ dysfunction. The treatment options approved by FDA are immune-modulatory agents, proteasome inhibitors, and autologous stem cell transplantation (ASCT). Unfortunately, MM remains uniformly fatal owing to intrinsic or acquired drug resistance and the median survival time is 3 to 5 years. Thus, there is a great need for novel strategies to combat MM.

The intimate relationship of myeloma cells to BM microenvironment is “hallmark of myeloma”. The homing of …

The Synergistic Effects Of Saxagliptin And Metformin On Cd34+ Endothelial Progenitor Cells In Early Type 2 Diabetes Patients: A Randomized Clinical Trial., Fiona J Dore, Cleyton C Domingues, Neeki Ahmadi, Nabanita Kundu, Yana Kropotova, Sara Houston, Carol Rouphael, Aytan Mammadova, Linda Witkin, Anamil Khiyami, Richard L Amdur, Sabyasachi Sen

Surgery Faculty Publications

AIMS: Type 2 diabetes is associated with endothelial dysfunction leading to cardiovascular disease. CD34+ endothelial Progenitor Cells (EPCs) are responsible for endothelial repair and neo-angiogenesis and can be used as a cardiovascular disease risk biomarker. This study investigated whether the addition of saxagliptin, a DPP-IV inhibitor, to metformin, may reduce cardiovascular disease risk in addition to improving glycemic control in Type 2 diabetes patients.

METHODS: In 12 week, double-blind, randomized placebo-controlled trial, 42 subjects already taking metformin 1-2 grams/day were randomized to placebo or saxagliptin 5 mg. Subjects aged 40-70 years with diabetes for < 10 years, with no known cardiovascular disease, BMI 25-39.9, HbA1C 6-9% were included. We evaluated EPCs number, function, surface markers and gene expression, in addition to arterial stiffness, blood biochemistries, resting energy expenditure, and body composition parameters. A mixed model regression to examine saxagliptin vs placebo, accounting for within-subject autocorrelation, was done with SAS (p < 0.05).

RESULTS: Although there was no significant …

Melodic Contour Identification And Speech Recognition By School-Aged Children, Michael P. Morikawa

Dissertations, 2014-2019

Using the Sung Speech Corpus (SSC), which encompasses a single database that contains musical pitch, timbre variations and speech information in identification tasks, the current study aimed to explore the development of normal-hearing children’s ability to use the pitch and timbre cues. Thirteen normal hearing children were recruited for the study ages ranging from 7 to 16 years old. Participants were separated into two separate groups: Younger (7-9) and Older (10-16). Musical Experience was taken into account as well. The Angel Sound ™ program was utilized for testing which was adopted from previous studies, most recently Crew, Galvin, and Fu …

Fifteen Years Experience Of Managing Penetrating Extra-Peritoneal Rectal Injuries, Tanzeela Gala, Noman Shahzad, Ahmed Ibrahim Edhi, Fareed Ahmed Shaikh, Hasnain Zafar

Section of General Surgery

Background: Although civilian injuries are generally less severe, they nevertheless remain a challenging problem for the surgeons. In isolated rectal injury patients, though proximal diversion, pre-sacral drainage, distal rectal wash-out and wound debridement are the various surgical options employed in various combinations, the optimum strategy especially for civilian injuries remains unknown. We reviewed our experience of managing penetrating extra peritoneal rectal injuries.
Methods: We conducted a Retrospective review of Adult patients with penetrating extra-peritoneal rectal injuries. Follow-up information of at least one month was needed for early post-operative complications.
Results: A total number of fifteen patients met …

Integration Of Mental Health Into Primary Healthcare: Perceptions Of Stakeholders In Pakistan, Syed S. Hussain, Murad M. Khan Dr., Raisa B. Gul, Nargis Asad

Department of Psychiatry

Background: In Pakistan, there is high prevalence of mental health disorders, but mental health services to address these are not well developed. To provide effective mental health services, the World Health Organization emphasizes the integration of mental health into primary health care (PHC).
Objectives: This study aimed to assess the views of key stakeholders about integration of mental health into PHC in Karachi, Pakistan.
Methods: A qualitative, exploratory study was conducted between June and September 2013 among 15 decision-making (from the Department of Health) and implementation-level stakeholders (mental health and public health professionals and primary care staff) from both the …

Tumor Cure By Radiation Therapy And Checkpoint Inhibitors Depends On Pre-Existing Immunity., Marka R Crittenden, Lauren Zebertavage, Gwen Kramer, Shelly Bambina, David Friedman, Victoria Troesch, Tiffany Blair, Jason R Baird, Alejandro F Alice, Michael J Gough

Articles, Abstracts, and Reports

Radiation therapy is a source of tumor antigen release that has the potential to serve as an endogenous tumor vaccination event. In preclinical models radiation therapy synergizes with checkpoint inhibitors to cure tumors via CD8 T cell responses. To evaluate the immune response initiated by radiation therapy, we used a range of approaches to block the pre-existing immune response artifact initiated by tumor implantation. We demonstrate that blocking immune responses at tumor implantation blocks development of a tumor-resident antigen specific T cell population and prevents tumor cure by radiation therapy combined with checkpoint immunotherapy. These data demonstrate that this treatment …

Synchronous Gastric And Duodenal Metastases From Head And Neck Squamous Cell Carcinoma: A Unique Presentation Of Upper Gastrointestinal Bleeding., Nicholas P. Tarangelo, Charles Andrew Kistler, Zachary Daitch, Wei Jiang, Daniel M. Quirk

Department of Medicine Faculty Papers

Metastatic disease to the stomach or duodenum is an infrequent diagnosis, and head and neck squamous cell carcinoma (HNSCC) is one of the least common primary malignancies that lead to gastric or duodenal metastases. We report the case of a 65-year-old man with human immunodeficiency virus infection and previously diagnosed HNSCC who presented with melena. The patient had a percutaneous endoscopic gastrostomy tube placed 3 months prior to his presentation. Laboratory testing was significant for normocytic anemia and a digital rectal examination was positive for melena. Esophagogastroduodenoscopy revealed numerous cratered nodules with contact bleeding in the stomach as well as …

Intimate Partner Violence, Forced First Sex And Adverse Pregnancy Outcomes In A Sample Of Zimbabwean Women Accessing Maternal And Child Health Care, Simukai Shamu, Stephen Munjanja, Christina Zarowsky, Patience Shamu, Marleen Temmerman, Naeemah Abrahams

Obstetrics and Gynaecology, East Africa

Background: Intimate partner violence (IPV) remains a serious problem with a wide range of health consequences including poor maternal and newborn health outcomes. We assessed the relationship between IPV, forced first sex (FFS) and maternal and newborn health outcomes.

Methods: A cross sectional study was conducted with 2042 women aged 15–49 years attending postnatal care at six clinics in Harare, Zimbabwe, 2011. Women were interviewed on IPV while maternal and newborn health data were abstracted from clinic records. We conducted logistic regression models to assess the relationship between forced first sex (FFS), IPV (lifetime, in the last 12 months and …

Does Courtesy Bias Affect How Clients Report On Objective And Subjective Measures Of Family Planning Service Quality? A Comparison Between Facility- And Home-Based Interviews, Waqas Hameed, Muhammad Ishaque, Xaher Gul, Junaid-Ur-Rehman Siddiqui, Sharmeen Hussain, Wajahat Hussain, Aftab Ahmed, Asma Balal

Community Health Sciences

Purpose: Despite a general understanding that exit interviews being conducted at service providers' facilities may influence clients' responses favorably to health professionals, there is very little evidence available that demonstrates the extent to which this problem exists. This study aimed at assessing and comparing clients' perceptions of the quality of family planning services and their satisfaction levels between facility- and home-based interviews.
Methods: A cross-sectional survey was conducted among clients receiving family planning services across three service delivery channels - nongovernmental organization (NGO) clinics, social franchise (SF) centers, and outreach camps. The survey took place from December 2015 to January …

Nontypeable Haemophilus Influenzae Meningitis In The Context Of Endoscopic Endonasal Surgery – A Case Report., Ricky Buckshaw Do, Casey Judge Do, Jennifer Strow Do

Department of Medicine

No abstract provided.

Treating Adhd With Suggestion: Neurofeedback And Placebo Therapeutics, Robert T. Thibault, Samuel Vassière, Jay A. Olson, Amir Raz

Psychology Faculty Articles and Research

Objective: We propose that clinicians can use suggestion to help treat conditions such as ADHD. Methods: We use EEG neurofeedback as a case study, alongside evidence from a recent pilot experiment utilizing a sham MRI scanner to highlight the therapeutic potential of suggestion-based treatments. Results: The medical literature demonstrates that many practitioners already prescribe treatments that hardly outperform placebo comparators. Moreover, the sham MRI experiment showed that, even with full disclosure of the procedure, suggestion alone can reduce the symptomatology of ADHD. Conclusion: Non-deceptive suggestion-based treatments, especially those drawing on accessories from neuroscience, may offer a safe complement and potential …

Department Of Surgery Update, March 2018, Wright State University Department Of Surgery

Department of Surgery Updates

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

Design And Development Of A Phantom For Tomosynthesis With Potential For Automated Analysis Via The Cloud., David Goodenough, Josh Levy, Hildur Olafsdottir, Ingvi Olafsson

Radiology Faculty Publications

This paper describes Development of a Phantom for Tomosynthesis with Potential for Automated Analysis via the Cloud. Several studies are underway to investigate the effectiveness of Tomosynthesis Mammographic Image Screening, including the large TMIST project as funded by the National Cancer Institute https://www.cancer.gov/about-cancer/treatment/clinical-trials/nci-supported/tmist. The development of the phantom described in this paper follows initiatives from the FDA, the AAPM TG245 task group, and European Reference Organization (EUREF) for Quality Assured Breast Screening and Diagnostic Services Committee report noting, that no formal endorsement nor recommendation for use has been sought, or granted by any of these groups. This paper reports on …

The Comparison Of Spectral Domain Optical Coherence Tomography (Sd-Oct) To Histopathology In A Patient With Diffuse Macular Drusen, Harold Salmons, Ralph Eagle, Md

Department of Pathology Honors Program Student Research Symposium

Background: Spectral Domain Optical Coherence Tomography (SD-OCT) has become a gold standard technique in ophthalmologic practice, and has revolutionized the diagnosis and treatment of retinal disease. As SD-OCT uses low interference interferometry and mathematical algorithms to produce detailed theoretical cross-sectional images of the retina, it is crucial to examine correlations between SD-OCT images and their corresponding histopathologic slides.

Methods: In the present study, careful correlative light microscopy was performed on the eye that was enucleated from an elderly patient who had a uveal melanoma and early agerelated macular degeneration evident clinically as soft drusen. SD-OCT was performed prior to enucleation …

Precision Medicine For Crc Patients In The Veteran Population: State-Of-The-Art, Challenges And Research Directions., Shyam S Mohapatra, Surinder K Batra, Srinivas Bharadwaj, Michael Bouvet, Bard Cosman, Ajay Goel, Wilma Jogunoori, Michael J Kelley, Lopa Mishra, Bibhuti Mishra, Subhra Mohapatra, Bhaumik Patel, Joseph R Pisegna, Jean-Pierre Raufman, Shuyun Rao, Hemant Roy, Maren Scheuner, Satish Singh, Gitanjali Vidyarthi, Jon White

Surgery Faculty Publications

Colorectal cancer (CRC) accounts for ~9% of all cancers in the Veteran population, a fact which has focused a great deal of the attention of the VA's research and development efforts. A field-based meeting of CRC experts was convened to discuss both challenges and opportunities in precision medicine for CRC. This group, designated as the VA Colorectal Cancer Cell-genomics Consortium (VA4C), discussed advances in CRC biology, biomarkers, and imaging for early detection and prevention. There was also a discussion of precision treatment involving fluorescence-guided surgery, targeted chemotherapies and immunotherapies, and personalized cancer treatment approaches. The overarching goal was to identify …

The Small Rna Complement Of Adult Schistosoma Haematobium., Andreas J Stroehlein, Neil D Young, Pasi K Korhonen, Ross S Hall, Aaron R Jex, Bonnie L Webster, David Rollinson, Paul J Brindley, Robin B Gasser

Microbiology, Immunology, and Tropical Medicine Faculty Publications

BACKGROUND: Blood flukes of the genus Schistosoma cause schistosomiasis-a neglected tropical disease (NTD) that affects more than 200 million people worldwide. Studies of schistosome genomes have improved our understanding of the molecular biology of flatworms, but most of them have focused largely on protein-coding genes. Small non-coding RNAs (sncRNAs) have been explored in selected schistosome species and are suggested to play essential roles in the post-transcriptional regulation of genes, and in modulating flatworm-host interactions. However, genome-wide small RNA data are currently lacking for key schistosomes including Schistosoma haematobium-the causative agent of urogenital schistosomiasis of humans.

METHODOLOGY: MicroRNAs (miRNAs) and other …

Amygdala Corticofugal Input Shapes Mitral Cell Responses In The Accessory Olfactory Bulb, Livio Oboti, Eleonora Russo, Tuyen Tran, Daniel Durstewitz, Joshua G. Corbin

Pediatrics Faculty Publications

Interconnections between the olfactory bulb and the amygdala are a major pathway for triggering strong behavioral responses to a variety of odorants. However, while this broad mapping has been established, the patterns of amygdala feedback connectivity and the influence on olfactory circuitry remain unknown. Here, using a combination of neuronal tracing approaches, we dissect the connectivity of a cortical amygdala [posteromedial cortical nucleus (PmCo)] feedback circuit innervating the mouse accessory olfactory bulb. Optogenetic activation of PmCo feedback mainly results in feedforward mitral cell (MC) inhibition through direct excitation of GABAergic granule cells. In addition, LED-driven activity of corticofugal afferents increases …

Tracking The Trajectory Of Resident Learning Through The Lens Of Self-Determination Theory., Susan E. Hansen Ma, Nicole L. Defenbaugh Phd, Susan S. Mathieu Md, Linda Garufi Md, Med, Julie Dostal Md

Department of Family Medicine

No abstract provided.

Hiv-1 Tat Expression And Sulphamethoxazole Hydroxylamine Mediated Oxidative Stress Alter The Disulfide Proteome In Jurkat T Cells, Kemi Adeyanju, John R. Bend, Michael J. Rieder, Gregory A. Dekaban

Paediatrics Publications

Background

Adverse drug reactions (ADRs) are a significant problem for HIV patients, with the risk of developing ADRs increasing as the infection progresses to AIDS. However, the pathophysiology underlying ADRs remains unknown. Sulphamethoxazole (SMX) via its active metabolite SMX-hydroxlyamine, when used prophylactically for pneumocystis pneumonia in HIV-positive individuals, is responsible for a high incidence of ADRs. We previously demonstrated that the HIV infection and, more specifically, that the HIV-1 Tat protein can exacerbate SMX-HA-mediated ADRs. In the current study, Jurkat T cell lines expressing Tat and its deletion mutants were used to determine the effect of Tat on the thiol …

An Analysis Of The Effect Of Statins On The Risk Of Non-Hodgkin's Lymphoma In The Women's Health Initiative Cohort., Pinkal Desai, Robert Wallace, Matthew L Anderson, Barbara V Howard, Roberta Ray, Chunyuan Wu, Monika Safford, Lisa W Martin, Nicolas Schlecht, Simin Liu, Dominic Cirillo, Allison Jay, Joann E Manson, Michael S Simon

Medicine Faculty Publications

Statins have been shown to induce a phosphoprotein signature that modifies MYC (myelocytomatosis viral oncogene) activation and to have anti-inflammatory activity that may impact the risk of Non-Hodgkin's lymphoma (NHL). We analyzed the relationship between statins and risk of NHL using data from the Women's Health Initiative (WHI). The study population included 161,563 postmenopausal women ages 50-79 years from which 712 cases of NHL were diagnosed after 10.8 years of follow-up. Information on statin use and other risk factors was collected by self- and interviewer-administered questionnaires. Multivariable-adjusted HR and 95% CI evaluating the relationship between statin use at baseline, as …

Oxidative Stress And Cardiovascular Risk In Type 1 Diabetes Mellitus: Insights From The Dcct/Edic Study, W. Wilson Tang, P. Mcgee, John M. Lachin, D. Li, B. Hoogwerf, S. Hazen, +Several Additional Authors

Epidemiology Faculty Publications

Background--Hyperglycemia leading to increased oxidative stress is implicated in the increased risk for the development of macrovascular and microvascular complications in patients with type 1 diabetes mellitus. Methods and Results--A random subcohort of 349 participants was selected from the DCCT/EDIC (Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications) cohort. This included 320 controls and 29 cardiovascular disease cases that were augmented with 98 additional known cases to yield a case cohort of 447 participants (320 controls, 127 cases). Biosamples from DCCT baseline, year 1, and closeout of DCCT, and 1 to 2 years post-DCCT (EDIC years 1 and …

Sensitivity And Specificity Of Ct Scan In Small Bowel Obstruction Among Children, Huma Faiz Haleopota, Muhammad Arif Mateen Khan, Noman Shahzad

Section of Paediatric Surgery

Objective: To determine the sensitivity and specificity of computed tomography scan for diagnosing small bowel obstruction among children.
Methods: The retrospective diagnostic test accuracy study was carried out at the Aga Khan University Hospital, Karachi, and comprised data of all patients aged 2-16 years who presented with clinical features of small bowel obstruction and underwent computed tomography scan of abdomen from January 2001 to December 2015Data was analyzed using SPSS19.
Results: Of the 98 subjects, 65(66.0%) were males and 33(34.0%) were females. Overall mean age of the patients was 7.67±4.33 years and mean duration of symptoms was 2.84±1.17 days. …

Expression Of Androgen Receptor And Cancer Stem Cell Markers (Cd44 +/Cd24 - And Aldh1 +): Prognostic Implications In Invasive Breast Cancer, Nazia Riaz, Romana Idress, Sadia Habib, Iqbal Azam Syed, El Nasir Lalani

Section of General Surgery

Background: Androgen receptor (AR) has emerged as a significant prognostic marker in early breast cancer (BCa). Association of AR with cancer stem cell (CSC) markers in BCa is unknown. Aim of the present study was to evaluate the immunohistochemical expression of AR, CD44, CD24 and ALDH1 in a cohort of Pakistani patients diagnosed with invasive BCa and to correlate the expression with 5- year disease free survival.
Patients and methods: We evaluated immunohistochemical expression AR, CD44, CD24 and ALDH1 in formalin fixed paraffin embedded archival blocks of 166 cases of primary invasive BCa (stage I-III) and correlated the expression with …

Descriptive Epidemiology Of Karachi Road Traffic Crash Mortality In 2015, Rashid Jooma, Masood Ali Shaikh

Section of Neurosurgery

The Karachi city's Road Traffic Injury Research and Prevention Center (RTIRPC), collects Road Traffic Crash (RTC) data on injuries and fatalities from three major public and private hospitals' emergency departments. In the year 2015, 1021 deaths were recorded; with 871 (85.3%) deaths in males. Cumulatively, 286 (28.0%) deaths were recorded in the 21-30year age group, and for 198 (19.4%) RTC fatal victims, the primary vehicle involved was motorbike. Highest number of fatalities were recorded in the month of January i.e. 153 (15.0%), while the lowest number was recorded for June, with 47 (4.6%) fatalities. RTIRPC is a unique surveillance system …

Extraction And Analysis Of Vector Flow Imaging Data In A Pediatric Population, Bailey Stinnett

Biomedical Engineering Undergraduate Honors Theses

Vector flow imaging (VFI) is a new ultrasound technology that provides real time, angle-independent visualization of flow velocities in the heart and great vessels. Thus far, VFI has been used for superficial applications due to the limited penetration depth of available transducer probes; however, this depth in smaller pediatric patients enables adequate aortic views. In this project, VFI was used to study pediatric aortic stenosis (PAS)—a congenital heart defect that results in the narrowing of the aorta and/or aortic valve. The decision to refer PAS patients for surgical or catheter-based intervention is initially based on Doppler ultrasound. VFI is potentially …

A Care Bundle Including Antenatal Corticosteroids Reduces Preterm Infant Mortality In Tanzania A Low Resource Country, Augustine Massawe, Hussein Kidanto, Robert Moshiro, Edna Majaliwa, Flora Chacha, Aisa Shayo, Paschal Mdoe, Prisca Ringia, Mary Azayo, Georgina Msemo

Faculty of Health Sciences, East Africa

Background Preterm neonatal mortality (NM) has remained high and unchanged for many years in Tanzania, a resource-limited country. Major causes of mortality include birth asphyxia, respiratory insufficiency and infections. Antenatal corticosteroids (ACS) have been shown to significantly reduce mortality in developed countries. There is inconsistent use of ACS in Tanzania.

Objective To determine whether implementation of a care bundle that includes ACS, maternal antibiotics (MA), neonatal antibiotics (NA) and avoidance of moderate hypothermia (temperature < 36°C) targeting infants of estimated gestational age (EGA) 28 to 34 6/7 weeks would reduce NM (< 7 days) by 35%.

Methods A Pre (September 2014 to May 2015) and Post (June 2015 to June 2017) Implementation strategy was used and introduced at three University-affiliated and one …

Intermittent Fetal Heart Rate Monitoring Using A Fetoscope Or Hand Held Doppler In Rural Tanzania: A Randomized Controlled Trial, Paschal Francis Mdoe, Hege Ersdal, Estomih Mduma, Jeffrey M. Perlman, Robert Moshiro, Peter Wangwe, Hussein Kidanto

Faculty of Health Sciences, East Africa

Background: Neonatal mortality is a global challenge, with an estimated 1.3 million intrapartum stillbirths in 2015. The majority of these were found in low resource settings with limited options to intrapartum fetal heart monitoring devices. This trial compared frequency of abnormal fetal heart rate (FHR) detection and adverse perinatal outcomes (i.e. fresh stillbirths, 24-h neonatal deaths, admission to neonatal care unit) among women intermittently assessed by Doppler or fetoscope in a rural low-resource setting.

Methods: This was an open-label randomized controlled trial conducted at Haydom Lutheran Hospital from March 2013 through August 2015. Inclusion criteria were; women in labor, …

Factors Affecting Inpatient Mortality In Elderly People With Acute Kidney Injury, Muhammad Mabood Khalil, Safia Awan, Rabeea Azmat, Muhammad Ashhad Ullah Khalil, Nazish Naseer,, Jackson Tan

Section of Nephrology

Background: Acute Kidney Injury (AKI) is common in elderly people (EP). There is paucity of data on predictor of mortality in EP with AKI.
Objective: This study was done to know more about factors associated with inpatient mortality in EP with AKI.
Methods: We retrospectively reviewed medical records of patients aged 65 years or above hospitalized with a diagnosis of AKI at Aga Khan University Hospital, Karachi, between January 2005 and December 2010. Binary logistic regression models were constructed to identify factors associated with mortality in EP with AKI.
Results: 431 patients had AKI, with 341 (79.1%) having stage I …