Medical Specialties Commons^™

Drug-Coated Balloon Treatment Of Femoropopliteal Lesions Typically Excluded From Clinical Trials: 12-Month Findings From The In.Pact Global Study., Gary M Ansel, Marianne Brodmann, Koen Keirse, Antonio Micari, Michael R Jaff, Krishna Rocha-Singh, Eric J Fernandez, Hong Wang, Thomas Zeller, In.Pact Global Study Investigators

Heart and Vascular Articles

PURPOSE: To report a post hoc analysis comparing outcomes between subjects who would have been included in the IN.PACT SFA randomized controlled trial vs those who would have been excluded.

METHODS: The 1406 subjects enrolled in the IN.PACT Global Study ( ClinicalTrials.gov identifier NCT01609296) were retrospectively assigned to a standard-use group (n=281) based on the inclusion and exclusion criteria from the randomized IN.PACT SFA trial; the remaining 1125 patients were assigned to the broader-use group. Freedom from clinically-driven target lesion revascularization (CD-TLR) was evaluated at 12 months. The composite primary safety endpoint was freedom from 30-day device- and procedure-related death …

Labrad : Vol 44, Issue 3 - December 2018, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• CD20 Negative B-Cell Lymphomas
• Quantification of Monoclonal Protein
• A Quick Guide to Immunofixation Electrophoresis
• Autologous Bone Marrow Transplantation at AKU
• Judicious Use of Immunohistochemistry & Ancillary Techniques in Precise Categorization of Lymphoproliferative Disorders

Cumulative Fluid Balance As A Major Predictor Of Clinical Outcome In Patients Admitted To Surgical Intensive Care Unit, Muhammad Sohaib, Madiha Hashmi, Faisal Shamim, Fazal Hameed Khan

Department of Anaesthesia

Objective: Fluid balance remains a highly controversial topic in the critical care field, and there is no consensus about the amount of fluid required by critically ill patients.In this study, the objective was to find the relationship between fluid balance and in hospital mortality in critically ill surgical patients.Our secondary objective was to identify the association between use of colloid and acute kidney injury and use of blood products and development of ARDS.
Study Design: The medical records of adult patients admitted to a surgical intensive care unit (ICU) >48 hours, from Aug 2014 toFeb 2016 (18 months) were reviewed …

Administrative Barriers To Compliance With The 2010 Ncaa Policy On Concussion Management, Tyler Norman

Dissertations

Concussions and concussion management in sport have become a polarizing public health issue. The best concussion assessment practices and “return-to-play” guidelines have been debated in both the scientific arena and in the media. At risk is the health of the athletes when proper diagnosis and treatment are not accurate for this potentially devastating injury.

Recent research estimates that approximately 1.6 – 3.8 million sport-related concussions occur each year in the United States (Brady, 2011), which can lead to chronic disease, swelling of the brain, cognitive impairment, chronic headaches, mood disorders, depression, blurred vision, double vision, cranial hemorrhaging and death if …

Morphometric Characteristics And Time To Hatch As Efficacious Indicators For Potential Nanotoxicity Assay In Zebrafish, Seyed-Mohammadreza Samaee, Nafiseh Manteghi, Robert A. Yokel, Mohammad Reza Mohajeri-Tehrani

Pharmaceutical Sciences Faculty Publications

Although the effects of nano-sized titania (nTiO₂) on hatching events (change in hatching time and total hatching) in zebrafish have been reported, additional consequences of nTiO₂ exposure (i.e., the effects of nTiO₂-induced changes in hatching events and morphometric parameters on embryo-larvae development and survivability) have not been reported. To address this knowledge gap, embryos 4 h postfertilization were exposed to nTiO₂ (0, 0.01, 10, and 1000 μg/mL) for 220 h. Hatching rate (58, 82, and 106 h postexposure [hpe]), survival rate (8 times from 34 to 202 hpe), and 21 morphometric characteristics (8 times …

Using The Engagedmd Multimedia Platform To Improve Informed Consent For Ovulation Induction, Intrauterine Insemination, And In Vitro Fertilization, Jody L. Madeira, Jennifer Rehbein, Mindy S. Christianson, Miryoung Lee, J. Preston Parry, Guido Pennings, Steven R. Lindheim Md

Articles by Maurer Faculty

Objective: To study patient and provider feedback on how a multimedia platform (EngagedMD) helps patients to understand the risks and consequences of in vitro fertilization (IVF), ovulation induction (OI), and intrauterine insemination (IUI) treatments and the impact of the informed consent process.

Design: Prospective survey study.

Setting: IVF units in the United States.

Patient(s): Six-thousand three-hundred and thirty-three patients who viewed the multimedia platform before IVF or OI-IUI treatment at 13 U.S. IVF centers and 128 providers.

Intervention(s): Quantitative survey with 17 questions.

Main Outcome Measure(s): Assessment of the impact of a multimedia platform on patient anxiety, comprehension, and satisfaction …

Trends And Costs Of External Electrical Bone Stimulators And Grafting Materials In Anterior Lumbar Interbody Fusion., Anthony D'Oro, Zorica Buser, Darrel Scott Brodke, Jong-Beom Park, Sangwook Tim Yoon, Jim Aimen Youssef, Hans-Joerg Meisel, Kristen Radcliff, Patrick Hsieh, Jeffrey Chun Wang

Rothman Institute Papers

STUDY DESIGN: Retrospective review.

PURPOSE: To identify the trends in stimulator use, pair those trends with various grafting materials, and determine the influence of stimulators on the risk of revision surgery.

OVERVIEW OF LITERATURE: A large number of studies has reported beneficial effects of electromagnetic energy in healing long bone fractures. However, there are few clinical studies regarding the use of electrical stimulators in spinal fusion.

METHODS: We used insurance billing codes to identify patients with lumbar disc degeneration who underwent anterior lumbar interbody fusion (ALIF). Comparisons between patients who did and did not receive electrical stimulators following surgery were …

Clinical Outcomes After Four-Level Anterior Cervical Discectomy And Fusion., Tyler M Kreitz, Douglas A Hollern, Eric M. Padegimas, Gregory D. Schroeder, Christopher K Kepler, Alexander Vaccaro, Md, Phd, Alan S Hilibrand

Rothman Institute Papers

Study Design: Retrospective cohort study.

Objectives: Anterior cervical discectomy and fusion (ACDF) demonstrates reliable improvement in neurologic symptoms associated with anterior compression of the cervical spine. There is a paucity of data on outcomes following 4-level ACDFs. The purpose of this study was to evaluate clinical outcomes for patients undergoing 4-level ACDF.

Methods: All 4-level ACDFs with at least 1-year clinical follow-up were identified. Clinical outcomes, including fusion rates, neurologic outcomes, and reoperation rates were determined.

Results: Retrospective review of our institutional database revealed 25 patients who underwent 4-level ACDF with at least 1-year clinical follow-up. Average age was 57.5 …

A Cost Analysis Of Carpal Tunnel Release Surgery Performed Wide Awake Versus Under Sedation., Todd H. Alter, William J. Warrender, Frederic E. Liss, Asif M. Ilyas

Rothman Institute Papers

BACKGROUND: Hand surgery under local anesthesia only has been used more frequently in recent years. The purpose of this study was to compare perioperative time and cost for carpal tunnel release performed under local anesthesia ("wide-awake local anesthesia no tourniquet," or WALANT) only to carpal tunnel release performed under intravenous sedation.

METHODS: A retrospective comparison of intraoperative (operating room) surgical time and postoperative (postanesthesia care unit) time for consecutive carpal tunnel release procedures performed under both intravenous sedation and wide-awake local anesthesia was undertaken. All operations were performed by the same surgeon using the same mini-open surgical technique. A cost …

Levels Of Par-1 Kinase Determine The Localization Of Bruchpilot At The Drosophila Neuromuscular Junction Synapses., Kara R. Barber, Martin Hruska, Keegan M. Bush, Jade A. Martinez, Hong Fei, Irwin B. Levitan, Matthew B. Dalva, Yogesh P. Wairkar

Farber Institute for Neuroscience Faculty Papers

Functional synaptic networks are compromised in many neurodevelopmental and neurodegenerative diseases. While the mechanisms of axonal transport and localization of synaptic vesicles and mitochondria are relatively well studied, little is known about the mechanisms that regulate the localization of proteins that localize to active zones. Recent finding suggests that mechanisms involved in transporting proteins destined to active zones are distinct from those that transport synaptic vesicles or mitochondria. Here we report that localization of BRP-an essential active zone scaffolding protein in Drosophila, depends on the precise balance of neuronal Par-1 kinase. Disruption of Par-1 levels leads to excess accumulation of …

Effect Of Psychological Distress On The Emerging Cause Of Infertility, Faiza Kausar

Journal of Asian Midwives (JAM)

Background: Infertility is a growing issue of the recent era, and it represents significant crises for most couples. Psychological distress has often been suggested as a cause of unexplained infertility. Male infertility accounts for 40% of all infertility problems, while female infertility accounts for 40% of all infertility problems; others are unexplained. Previous studies have indicated that stress and depression negatively impact various infertility parameters in both partners. To determine the relationship between infertility and psychological distress and the level of different types of stress among infertile couples, and to relate the significant stressors responsible for worsening infertility or …

Impact Of Sepsis And Non-Communicable Diseases On Prognostic Models To Predict The Outcome Of Hospitalized Chronic Liver Disease Patients, Fakhar Qazi, Shahab Abid, Preet Ayoub Shaikh, Safia Awan

Section of Gastroenterology

AIM: To evaluate the impact of sepsis and non-communicable diseases (NCDs) on the outcome of decompensated chronic liver disease(CLD) patients.

Methods: In this cross-sectional study, medical records of patients with CLD admitted to the Gastroenterology unit at the Aga Khan University Hospital were reviewed. Patients older than 18 years with decompensation of CLD (i.e., jaundice, ascites, encephalopathy, and/or upper gastrointestinal bleed) as the primary reason for admission were included, while those who were admitted for reasons other than decompensation of CLD were excluded. Each patient was followed for 6 wk after index admission to assess mortality, prolonged hospital …

The Hungry Cancer Patient: A Case Of Money Ill Spent., Allison Zibelli

Kimmel Cancer Center Papers, Presentations, and Grand Rounds

No abstract provided.

Prenatal Cervical Cancer Screening Using Visual Inspection With Acetic Acid In A Low Resource Setting, Vincent Nyaboga Oyiengo, Elkanah Omenge, Peter Muhandale Itsura, Philip Kipkirui Tonui, Benjamin Elly Odongo, Emmanuel Wekesa Wamalwa

Obstetrics and Gynaecology, East Africa

Purpose: Cervical cancer is one of the most common malignancies among women in low resource setting. The objective of this study was to assess the acceptability of prenatal cervical cancer screening using visual inspection with acetic acid (VIA) in a low resource setting.

Methods: This was a cross-sectional study conducted at Moi Teaching and Referral Hospital. Over a period of 12 months, we enrolled 331 women who were attending antenatal care clinic with a gestation of age of less than 22 weeks. We screened them for cervical cancer by applying 5% acetic acid to the cervix (VIA Method). Visualization of …

Uptake Of Three Doses Of Hpv Vaccine By Primary School Girls In Eldoret, Kenya; A Prospective Cohort Study In A Malaria Endemic Setting, Hillary Mabeya, Sonia Menon, Steven Weyers, Violet Naanyu, Emily Mwaliko, Elijah Kirop, Elkanah Omenge, Heleen Vermandere, Davy Vanden Broeck

Obstetrics and Gynaecology, East Africa

Background: All women are potentially at risk of developing cervical cancer at some point in their life, yet it is avoidable cause of death among women in Sub- Saharan Africa with a world incidence of 530,000 every year. It is the 4th commonest cancer affecting women worldwide with over 260,000 deaths reported in 2012. Low resource settings account for over 75% of the global cervical cancer burden. Uptake of HPV vaccination is limited in the developing world. WHO recommended that 2 doses of HPV vaccine could be given to young girls, based on studies in developed countries. However in Africa …

Clopidogrel Versus Newer P2y12 Antagonists For Percutaneous Coronary Intervention In Patients With Out-Of-Hospital Cardiac Arrest Managed With Therapeutic Hypothermia: A Meta-Analysis, Ayman Elbadawi, Islam Y. Elgendy, Ahmed H. Mohamed, Kirolos Barssoum, Erfan Alotaki, Gbolahan O. Ogunbayo, Khaled M. Ziada

Internal Medicine Faculty Publications

Introduction: The impact of therapeutic hypothermia (TH) on outcomes of percutaneous coronary intervention (PCI) and the optimal antiplatelet treatment remains debatable.

Methods: Electronic databases were searched for randomized trials and observational studies to evaluate the available clinical evidence comparing the use of clopidogrel versus newer P2Y12 antagonists in cases of TH after PCI. The primary outcome was in-hospital definite stent thrombosis while the secondary outcomes were in-hospital mortality and major bleeding. Fixed-effects risk ratios (RRs) were estimated using Mantel–Haenszel method.

Results: The final analysis included five studies with a total of 290 patients. There was no difference in the incidence …

Early Identification Of Depression In Patients With Pediatric Epilepsy, Erin Fecske, Paul Glasier, Lines Vargas Collado, Elizabeth Rende

Posters

Describes the use of the Neurological Disorders Depression Inventory-Epilepsy-Youth (NDDI-E-Y) in adolescent patients in a comprehensive epilepsy center to identify patients who need referral for mental health care.

Seven Decades Of Vitamin D Research In Pakistan : Too Little, Too Much Or Just Right!, Aysha Habib Khan

Department of Pathology and Laboratory Medicine

No abstract provided.

Clinician Perspectives On Factors Affecting Shared Decision Making About Lung Cancer Screening, Mohammad Abubaker-Sharif, Melissa Dicarlo, Mph, Ms, Ronald E. Myers, Phd, Dsw

Phase 1

Background/Objective. In 2015, the Centers for Medicare and Medicaid Services (CMS) announced coverage for annual lung cancer screening (LCS) with low dose computed tomography (LDCT) for individuals who are 55 to 77 years of age, have > 30 pack years of smoking history, and undergo shared decision making (SDM) prior to screening. Most referrals for LCS are initiated in primary care. Currently, little is known about how primary care physicians view SDM and barriers in practice to SDM about LCS. This study aimed to gather information to help fill these knowledge gaps.

Methods. I worked with senior leadership in …

Patient Perceptions And Expectations About Postoperative Analgesia, Carrie Mok, Nirmal Shah, Do, Stephen F. Goldberg, Md, Amir C. Dayan, Md, Marc Torjman, Phd, Jaime L. Baratta, Md

Phase 1

Introduction

Opioid overdose deaths have nearly quadrupled since 1999. Nearly 2 out of 3 persons being prescribed medications are prescribed an opioid. Physicians may be prescribing opioids for more than what is required for postoperative pain control, leading to increased risk for opioid abuse and addiction. Patient perceptions of perioperative pain medications are poorly understood.

Objective

This survey aims to understand patient expectations of perioperative analgesics.

Methods

Following IRB approval, patients 18 years of age or older, were given a 13-question survey prior to their surgery at Thomas Jefferson University Hospital, to evaluate the perception of pain medications, medication efficacy, …

A Comparison Of Screening, Prevention, And Management For Hepatitis B Patients Between The Us And Chinese Healthcare Systems, Thomas Chen, James D. Plumb, Md

Phase 1

Introduction: Hepatitis B (HBV) is a complex disease entity with potentially serious outcomes, including developing hepatocellular carcinoma (HCC). HBV is estimated to be responsible for about 50-80% of HCC cases worldwide, and 75-95% of HCC cases in HBV endemic regions.¹ HBV and HCC are great concerns especially in East Asian countries like China. In China, HCC ranks as the 2^nd most common cancer and 2^nd in cancer mortality, both behind only lung cancer.¹ China is considered an endemic HBV region, with about 100-150 million people infected. In comparison, only an estimated 550,000-2 million people are chronically …

Opioid-Prescribing Practices For Post-Operative Patients In Otolaryngology: A Multiphasic Quality Improvement Project In A Single Large Institution, Zachary Gandee, Sophia Dang, Alexander N. Duffy, Jonathan C. Li, Tanvi Rana, Brittany Gunville, Tingting Zhan, Elizabeth Cottrill, Md, David Cognetti, Md

Phase 1

Objectives:

In otolaryngology, postoperative pain management lacks evidence-based guidelines. We investigated opioid prescription and consumption for common procedures to develop prescribing guidelines at our institution.

Study Design:

Prospective, survey study.

Methods:

Patients who underwent surgery between July and September were given surveys upon discharge and at first follow-up visit. We assessed opioid usage and pain using the visual analog scale and opioid consumption throughout the postoperative period. Opioid prescriptions were converted to a standardized unit of 5 mg Oxycodone pills for reporting. Four procedures (transoral robotic surgery resection [TORS], sialendoscopy, parathyroidectomy/thyroidectomy, and parotidectomy) were selected for isolated analysis.

Results: …

The Impact Of Mental Health On Cancer Preventative Screenings, Chelsea Edirisuriya, Amy Leader, Phd

Phase 1

Among the mental health population of the United States, overall preventative health services, such as cancer screening rates, are remarkably low. Additionally, there is a significant 30% higher mortality rate due to cancer in psychiatric patients. This project established if there are disparities in cancer screening rates between the general population and the mental health population of Southeastern Pennsylvania. The project analyzed and compared the differences in cancer screenings for colorectal, breast, and cervical cancer among those currently diagnosed with a mental condition and the general population. Through p-value and Pearson chi-square statistical analysis of the Community Health Data Base …

Care Of Adult Cancer Survivors, Kelsey Kloosterman

Doctoral Projects

As innovative cancer treatments emerge, more people are surviving cancer. Cancer survivors have multiple and unique healthcare needs due to their cancer and cancer treatments. Communication among those treating the cancer, primary care providers, and cancer survivors is necessary to coordinate care once treatment is finished. The development of a survivorship care plan that is reviewed with the cancer survivor is intended to facilitate communication among all stakeholders. This quality improvement project examined current practice in a survivorship clinic in a Midwestern health system cancer center that cares for a variety of types of cancer patients. By reviewing evidence in …

Legal Principles And Seminal Legal Cases In Oocyte Donation, Jody L. Madeira, Susan L. Crockin

Articles by Maurer Faculty

Oocyte donation has played an increasingly important role in assisted reproductive technologies since the early 1980s. Over the past 30 years, unique legal standards have evolved to address issues in the oocyte donation procedure itself as well as the disputes over issues, such as parentage, that inevitably arise with new technologies, particularly for individuals seeking to build nontraditional families. This essay will explore oocyte donation's legal aspects as well as seminal law concerning the procedure, including statutory law (uniform and model provisions and enacted state laws) and selected judicial opinions concerning surrogacy and parentage, testing of oocyte donors, mix-ups of …

Dementia- Is It High Time To Replace The Term In Neurological Nosology?, Qurat Ul Ain Khan

Pakistan Journal of Neurological Sciences (PJNS)

Dementia is a term used universally by clinicians and researchers for cognitive impairment that affects a person’s ability to function ((1). This is the term used by the American Academy of Neurology (AAN) in their nosology. Diagnostic and Statistical Manual of Mental Disorders V (DSM V) has replaced the term with Major Neurocognitive Disorder (2). The term HIV- associated dementia (HAD) was also replaced by HIV- associated neurocognitive disorder (HAND) by the AAN AIDS Task force

Non Availability Of Antiepileptic Medications, Farida Jan

Pakistan Journal of Neurological Sciences (PJNS)

It was the best of times, it was the worst of times” quoting Charles Dickens, I feel living in an era very similar to those times, with an ever widening gap between the different economical classes in our society. With the relative improvement in Health services across Pakistan may over the last 70 years and the absolute disastrous growth of 2.4% in population within the last decade, there is still a lot of disparity between the health care demand and supply for common man.1

Awareness And Approach To Headache: A Survey Of Family Physicians In Pakistan, Abdul Malik, Safia Awan, Aziz Sonawalla, Fayyaz Ahmed, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

Headache is one of the most common complaints in the general population and the most common symptom for a neurology out-patient visit. According to the WHO, the prevalence of adults complaining of recent headache (at least one episode within the last year) is 47%. Despite the large burden of disease, headaches are often overlooked, underdiagnosed and under-resourced. There are several reasons that include lack of awareness among the general public and healthcare professionals and lack of training at both undergraduate and post-graduate level. There is limited data available from many third world countries including Pakistan. Family Physicians (FPs) equivalent to …

Awareness Of Stroke Among General Practitioners, Waleed Shahzad, Hafiza Faiza Mushtaq, Tehmina Inayat, Muhammad Hassan, Haris Majid Rajput, Mazhar Badshah

Pakistan Journal of Neurological Sciences (PJNS)

Stroke is the 2nd leading cause of death and 3rd leading cause of disability after cancer and ischemic heart disease. The recognition of acute stroke symptoms and knowledge about timely and prompt referral of a patient for possible thrombolysis is a need of time for which general practitioners (as they have to be the first responders many a times across Pakistan) need to be equipped with the advance knowledge about stroke treatment.

Azygos Anterior Cerebral Artery Causing Bifrontal Infarcts: A Case Report, Abdul Khaliq, Palwasha Gul, Pari Gul

Pakistan Journal of Neurological Sciences (PJNS)

The azygos anterior cerebral artery (AACA) is an uncommon anatomical variant. There is absence of the anterior communicating artery (ACom) and bilateral anterior cerebral arteries (ACA) form a common trunk and travels superiorly in the interhemispheric fissure. It can result in bilateral frontal infarcts in case of thromboembolism. Therefore its correct diagnosis is of grave importance for better patient clinical outcome. Cerebrovascular infarction is a common condition, however simultaneous symmetrical bilateral infarction secondary to arterial occlusion is a rare entity. We report a case of a 50 years male with thromboembolic event in azygos anterior cerebral artery resulting in bifrontal …