Medical Specialties Commons^™

Effects Of Older Donor Age And Cold Ischemic Time On Long-Term Outcomes Of Heart Transplantation, Heidi J Reich, Jon A Kobashigawa, Tamar Aintablian, Danny Ramzy, Michelle M Kittleson, Fardad Esmailian

The Texas Heart Institute Journal

Using older donor hearts in cardiac transplantation may lead to inferior outcomes: older donors have more comorbidities that reduce graft quality, including coronary artery disease, hypertension, diabetes mellitus, and dyslipidemia. Shorter cold ischemic times might overcome the detrimental effect of older donor age. We examined the relationship between donor allograft age and cold ischemic time on the long-term outcomes of heart transplant recipients. rom 1994 through 2010, surgeons at our hospital performed 745 heart transplantations. We retrospectively classified these cases by donor ages of(younger) and ≥50 years (older), then by cold ischemic times of(short), 120 to 240 min (intermediate), and …

Impact Of Direct Acting Antivirals On Occurrence And Recurrence Of Hepatocellular Carcinoma: Biologically Plausible Or An Epiphenomenon?, Amna Subhan Butt, Fatima Sharif, Shahab Abid

Section of Gastroenterology

Hepatocellular carcinoma (HCC) is a major cause of morbidity and mortality worldwide. Chronic hepatitis C virus infection (HCV) is the most common cause of HCC in many European countries, Japan and Pakistan. Introduction of the new direct acting antivirals (DAAs) has revolutionized the management of HCV worldwide, with high rates of sustained virologic response in patients who could not have tolerated the previous interferon based treatments. However, recently there have been reports raising caution about the long term effects of DAAs, particularly a possible increased risk of HCC. Therefore this review explores the current molecular studies as well as clinical …

Human Factors And Simulation In Emergency Medicine, Emily M. Hayden, Ambrose H. Wong, Jeremy Ackerman, Margaret K. Sande, Charles Lei, Leo Kobayashi, Michael Cassara, Dylan D. Cooper, Kimberly Perry, William E. Lewandowski, Mark W. Scerbo

Psychology Faculty Publications

This consensus group from the 2017 Academic Emergency Medicine Consensus Conference "Catalyzing System Change through Health Care Simulation: Systems, Competency, and Outcomes" held in Orlando, Florida, on May 16, 2017, focused on the use of human factors (HF) and simulation in the field of emergency medicine (EM). The HF discipline is often underutilized within EM but has significant potential in improving the interface between technologies and individuals in the field. The discussion explored the domain of HF, its benefits in medicine, how simulation can be a catalyst for HF work in EM, and how EM can collaborate with HF professionals …

Reassessing The Duration Of The Second Stage Of Labor In Relation To Maternal And Neonatal Morbidity., Katherine L. Grantz, Rajeshwari Sundaram, Ling Ma, Stefanie Hinkle, Vincenzo Berghella, Matthew K. Hoffman, Uma M. Reddy

Department of Obstetrics and Gynecology Faculty Papers

OBJECTIVE: To assess the morbidity associated with continuing the second-stage duration of labor, weighing the probability of spontaneous vaginal birth without morbidity compared with birth with serious maternal or neonatal complications.

METHODS: In a retrospective cohort, we analyzed singleton, vertex births at 36 weeks of gestation or greater without prior cesarean delivery (n=43,810 nulliparous and 59,605 multiparous women). We calculated rates of spontaneous vaginal birth and composite serious maternal or neonatal complications. Results were stratified by parity (nulliparous or multiparous) and epidural status (yes or no). Competing risks models were created for 1) spontaneous vaginal birth with no morbidity, 2) …

Frequency Of Macroprolactin In Hyperprolactinemia, Aysha Habib Khan, Noreen Abbas Sherazi, Mirza Zain Baig

Department of Pathology and Laboratory Medicine

Objective: To determine the frequency of Macroprolactin (MaPRL) in patients with increased total prolactin and its clinical and financial impact.
Study Design: Cross-sectional study.
Place and Duration of Study: Section of Clinical Chemistry, Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi, from March to May 2015. Methodology: Patients with high total prolactin were screened by polyethylene glycol (PEG) precipitation for determination of MaPRL. Clinical history, imaging work-ups, and cost incurred in further investigations were collected by telephonic interview after verbal consent. Patients were stratified into true hyperprolactinemia and macroprolactinemia after PEG treatment, based on monomeric prolactin …

Multiple System Atrophy - The Cerebellar Type With “Hot Cross Bun Sign” On Mri, Rehana Shaikh, Saba Sohail, Nasreen Naz

Department of Radiology

Multiple system atrophy (MSA) is an adult onset, progressive, idiopathic neurodegenerative disease that clinically manifest as MSA-C with cerebellar signs predominant, MSA-P with Parkinsonian features predominant and MSA-A with autonomic signs and symptoms. MRI has an important role in its diagnosis with a characteristic finding described as "hot cross bun" sign seen in MSA of cerebellar type (MSA-C). We have seen two cases of MSA-C referred to Radiology Department, Civil Hospital Karachi in February 2017 and March 2017 who presented with difficulty in walking and speech and foecal and urinary incontinence. The MRI showed atrophy of pons, cerebellum and middle …

Genomic And Cellular Studies Establish The Pathogenesis And Cellular Mechanisms Of Disease-Causing Mutations In Families With Autosomal Recessive Disorders, Nesreen Khalid Ahmad Al Jezawi

Dissertations

The majority of the reported genetic disorders in the UAE population are of the autosomal recessive type, which is mainly due to high rates of consanguinity within the UAE national population, and within a significant proportion of other UAE expatriate communities; such as Arabs and Pakistanis. It is estimated that more than 50% of all marriages among Emiratis occur between biologically related couples, with first cousin marriages being the highest. That could be attributed to sociocultural values in the region. Successful management of genetic diseases can be achieved by the implementation of effective preventative programs that could help reduce the …

Cd20 Expression And Effects On Outcome Of Relapsed/ Refractory Diffuse Large B Cell Lymphoma After Treatment With Rituximab, Afshan Asghar Rasheed, Adeel Samad, Ahmed Raheem, Samina Ismail Hirani, Shabbir Shabbir- Moosajee

Section of Haematology/Oncology

Introduction: Down regulation of CD20 expression has been reported in diffuse large B cell lymphoma (DLBCL)). Therefore, it is important to determine whether chemotherapy with rituximab induces CD20 down regulation and effects survival. Objectives: To determine the incidence of down regulation of CD20 expression in relapsed DLBCL after treatment with rituximab and to compare outcomes and assess pattern of relapse between CD20 negative and CD20 positive cases. Methodology: We retrospectively reviewed patients with relapsed DLBCL who received rituximab in the first line setting at Aga Khan University Hospital between January 2007 and December 2014. Data were recorded on predesigned questionnaires, …

Pregnancy Outcomes Among Women With An Unintended Pregnancy: Findings From A Prospective Registry In Rural Pakistan, Sumera Aziz Ali, Shiyam Sunder Tikmani, Margo S. Harrison, Sarah Saleem, Robert L. Goldenberg, Elizabeth M. Mcclure, Omrana Pasha

Community Health Sciences

Background: Unintended pregnancies are an important public health issue in both developed and developing countries. An unintended pregnancy may affect maternal health seeking behavior during the antenatal and postpartum periods, which can adversely affect perinatal outcomes. Aim: The specific aim of our study was to measure antepartum, intrapartum, and postpartum pregnancy outcomes among women with unintended pregnancies in a rural Pakistani population.
Methods: Using a prospective maternal and newborn health registry in Thatta Pakistan, we evaluated temporal associations between unintended pregnancy and several dimensions of health seeking behavior including: antenatal care, preference for private versus government facility for antenatal care, …

Very Late Occurrence Of Complete Heart Block Without Preexisting Atrioventricular Conduction Abnormalities: A Rare Complication After Transaortic Valvular Replacement., Nagesh Chopra, Matthew S Tong, Steven J Yakubov

Heart and Vascular Articles

No abstract provided.

Quality Of Care Of Treatment For Uncomplicated Severe Acute Malnutrition Provided By Lady Health Workers In Pakistan, Eleanor Rogers, Muhammad Ali, Shahid Fazal, Deepak Kumar, Saul Guerrero, Imtiaz Hussain, Sajid Bashir Soofi, Jose Luis Alvarez Morán

Department of Paediatrics and Child Health

Objective: To assess the quality of care provided by lady health workers (LHW) managing cases of uncomplicated severe acute malnutrition (SAM) in the community.
Design: Cross-sectional quality-of-care study.
Setting: The feasibility of the implementation of screening and treatment for uncomplicated SAM in the community by LHW was tested in Sindh Province, Pakistan. An observational, clinical prospective multicentre cohort study compared the LHW-delivered care with the existing outpatient health facility model.
Subjects: LHW implementing treatment for uncomplicated SAM in the community.
Results: Oedema was diagnosed conducted correctly for 87·5 % of children; weight and mid upper-arm circumference were measured correctly for …

High Smad7 And P-Smad2,3 Expression Is Associated With Environmental Enteropathy In Children, Sana Syed, Vincenzo Dinallo, Najeeha Talat Iqbal, Laura Di Iorio, Davide Di Fusco, Shan Guleria, Beatrice C. Amadi, Kamran Sadiq, Christopher Moskaluk, Syed Asad Ali

Department of Paediatrics and Child Health

Enteropathies such as Crohn's disease are associated with enteric inflammation characterized by impaired TGF-β signaling, decreased expression of phosphorylated (p)-SMAD2,3 and increased expression of SMAD7 (an inhibitor of SMAD3 phosphorylation). Environmental enteropathy (EE) is an acquired inflammatory disease of the small intestine (SI), which is associated with linear growth disruption, cognitive deficits, and reduced oral vaccine responsiveness in childrenp-SMAD2,3 levels (using Western blotting) in EE duodenal biopsies (N = 19 children, 7 from Pakistan, 12 from Zambia) and comparing these with healthy controls (Ctl) and celiac disease (CD) patients from Italy. Densitometric analysis of immunoblots showed that EE SI biopsies …

Comparison Of New Metrics For Assessment Of Risks Of Occupational Noise, Wisam Al-Dayyeni, Jun Qin

Journal of Applied Sciences and Arts

Noise induced hearing loss (NIHL) is one of the most common occupational related health problems worldwide. Exposure to excessive noise is the major avoidable cause of permanent hearing loss. The conventional metrics for noise evaluation cannot accurately assess the exposure risks to high-level complex noise, which commonly occurs in many industrial and military fields. Recently, we have developed two advanced models, an adaptive weighting (F-weighting) and a complex velocity level (CVL) auditory fatigue model, to evaluate the risks of occupational noise. In this study, we compared performances of five noise assessment metrics, including F-weighted sound pressure level (SPL) LFeq, CVL …

Disconnect Between Genes Associated With Ischemic Heart Disease And Targets Of Ischemic Heart Disease Treatments, C Mary Schooling, J. V. Huang, J. V. Zhao, M.K. Kwok, S. L. Au Yeung, S. L. Lin

Publications and Research

Background: Development of pharmacological treatments to mitigate ischemic heart disease (IHD) has encompassed disappointing results and expensive failures, which has discouraged investment in new approaches to prevention and control.Newtreatments aremost likely to be successful if they act on genetically validated targets. We assessed whether existing pharmacological treatments for IHD reduction are acting on genetically validated targets and whether all such targets for IHD are currently being exploited. Methods: Genes associatedwith IHDwere obtained fromthe loci of single nucleotide polymorphisms reported in either of two recent genome wide association studies supplemented by a gene-based analysis (accounting for linkage disequilibrium) of CARDIoGRAMplusC4D 1000 …

Complications Of Subcutaneous Contraception: A Review., Rebecca C Ramdhan, Emily Simonds, Charlotte Wilson, Marios Loukas, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

Over 62 million women in the United States are of childbearing age and 60% of them use contraception. Subcutaneous contraceptives include implantable contraceptives and subcutaneous injections. Implantable contraception involves subdermal time-release of synthetic progestin, which allows for several years of continuous, highly effective contraception. Its main effects are inhibition of ovulation and thickening of the cervical mucus. Many complications have been associated with subcutaneous contraception, including menstrual disturbances, headache, weight gain, acne, dizziness, mood disturbances, nausea, lower abdominal pain, hair loss, loss of libido, pain at the implant site, neuropathy, and follicular cysts. Using standard search engines, the complications of …

Amine Containing Analogs Of Sulindac For Cancer Prevention, Bini Mathew, Judith V. Hobrath, Michele C. Connelly, R. Kiplin Guy, Robert C. Reynolds

Pharmaceutical Sciences Faculty Publications

Background:

Sulindac belongs to the chemically diverse family of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) that effectively prevent adenomatous colorectal polyps and colon cancer, especially in patients with familial adenomatous polyposis. Sulindac sulfide amide (SSA), an amide analog of sulindac sulfide, shows insignificant COX-related activity and toxicity while enhancing anticancer activity in vitro and demonstrating in vivo xenograft activity.

Objective:

Develop structure-activity relationships in the sulindac amine series and identify analogs with promising anticancer activities.

Method:

A series of sulindac amine analogs were designed and synthesized and then further modified in a “libraries from libraries” approach to produce amide, sulfonamide and N,N-disubstituted …

A Model For Investigating Developmental Eye Repair In Xenopus Laevis, Cindy X. Kha, Philip H. Son, Julia Lauper, Kelly Ai-Sun Tseng

Life Sciences Faculty Research

Vertebrate eye development is complex and requires early interactions between neuroectoderm and surface ectoderm during embryogenesis. In the African clawed frog, Xenopus laevis, individual eye tissues such as the retina and lens can undergo regeneration. However, it has been reported that removal of either the specified eye field at the neurula stage or the eye during tadpole stage does not induce replacement. Here we describe a model for investigating Xenopus developmental eye repair. We found that tailbud embryos can readily regrow eyes after surgical removal of over 83% of the specified eye and lens tissues. The regrown eye reached a …

Analysis Of The Pathomechanism And Treatment Of Migraines Related To The Role Of The Neuropeptide Cgrp, Marvi S. Qureshi

The Pegasus Review: UCF Undergraduate Research Journal

Migraines are a type of headache that specifically act on only one side of the head, although about 30% of patients with migraines may experience a bilateral headache. Migraines are brain disorders that typically involve issues of sensory processing taking place in the brainstem. Possible causation has been linked to blood vessels, blood flow, and oxygen levels in the brain. Migraines can be described in three phases, all of which have a common neuropeptide known as the calcitonin gene related peptide (CGRP). CGRP increases in plasma have been linked to migraine headaches, and specific treatment plans have been tailored to …

The Prevalence Of Human Papillomavirus In Pediatric Tonsils: A Systematic Review Of The Literature, Monika Wojtera, Josee Paradis, Murad Husein, Anthony C Nichols, John W Barrett, Marina I Salvadori, Julie E Strychowsky

Paediatrics Publications

Background

HPV-related head and neck cancer rates have been increasing in recent years, with the tonsils being the most commonly affected site. However, the current rate of HPV infection in the pediatric population remains poorly defined. The objective of this study was to systematically review and evaluate the prevalence and distribution of HPV in the tonsils of pediatric patients undergoing routine tonsillectomy.

Methods and Results

The literature was searched using PubMed, EMBASE, Scopus, CINAHL, Cochrane Library, and ProQuest Dissertations & Theses Global databases (inception to December 2017) by two independent review authors. Inclusion criteria included articles which evaluated the prevalence …

What Did We Learn About Vads In 2017?, Maya Guglin

The VAD Journal

No abstract provided.

Ependymomas Overexpress Chemoresistance And Dna Repair-Related Proteins., Sherise D Ferguson, Shouhao Zhou, Joanne Xiu, Yuuri Hashimoto, Nader Sanai, Lyndon Kim, Santosh Kesari, John De Groot, David Spetzler, Amy B Heimberger

Articles, Abstracts, and Reports

Background: After surgery and radiation, treatment options for ependymoma are few making recurrence a challenging issue. Specifically, the efficacy of chemotherapy at recurrence is limited. We performed molecular profiling on a cohort of ependymoma cases in order to uncover therapeutic targets and to elucidate the molecular mechanisms contributing to treatment resistance.

Results: This ependymoma cohort showed minimal alterations in gene amplifications and mutations but had high expression rates of DNA synthesis and repair enzymes such as RRM1 (47%), ERCC1 (48%), TOPO1 (62%) and class III β-tublin (TUBB3) (57%), which are also all associated with chemoresistance. This cohort also had high …

Horse-Related Injuries: Causes, Preventability, And Where Educational Efforts Should Be Focused, Fernanda Camargo, William R. Gombeski Jr., Polly Barger, Connie Jehlik, Holly Wiemers, James Mead, Amy Lawyer

Animal and Food Sciences Faculty Publications

A high percentage of equestrians will experience accidents, with different degrees of severity, throughout their riding careers. Horse-related injuries have the highest likelihood of requiring hospitalization based on individuals visiting US emergency departments. Studies have shown that the majority of injured riders said they could have prevented the accident and the injury was due to rider/handler error. Therefore, equestrians reported their injuries, and a panel of experts analyzed these reports to better understand the causes, how to prevent, and where to invest educational resources to generate a reduction in horse-related accidents. The majority of riders reported intermediate riding skills, most …

Implementing A Mobile Health System To Integrate The Treatment Of Addiction Into Primary Care: A Hybrid Implementation-Effectiveness Study, Andrew Quanbeck, David H. Gustafson, Lisa A. Marsch, Ming-Yuan Chih, Rachel Kornfield, Fiona Mctavish, Roberta Johnson, Randall T. Brown, Marie-Louise Mares, Dhavan V. Shah

Health and Clinical Sciences Faculty Publications

Background: Despite the near ubiquity of mobile phones, little research has been conducted on the implementation of mobile health (mHealth) apps to treat patients in primary care. Although primary care clinicians routinely treat chronic conditions such as asthma and diabetes, they rarely treat addiction, a common chronic condition. Instead, addiction is most often treated in the US health care system, if it is treated at all, in a separate behavioral health system. mHealth could help integrate addiction treatment in primary care.

Objective: The objective of this paper was to report the effects of implementing an mHealth system for addiction in …

Similar Neural Responses Predict Friendship, Carolyn Parkinson, Adam M. Kleinbaum, Thalia Wheatley

Dartmouth Scholarship

Human social networks are overwhelmingly homophilous: individuals tend to befriend others who are similar to them in terms of a range of physical attributes (e.g., age, gender). Do similarities among friends reflect deeper similarities in how we perceive, interpret, and respond to the world? To test whether friendship, and more generally, social network proximity, is associated with increased similarity of real-time mental responding, we used functional magnetic resonance imaging to scan subjects’ brains during free viewing of naturalistic movies. Here we show evidence for neural homophily: neural responses when viewing audiovisual movies are exceptionally similar among friends, and that similarity …

Facilitating Factors And Barriers To Weight Management In Women: Physician Perspectives, Renee E. Walker, Jennifer Kusch, Jennifer T. Fink, David A. Nelson, George Morris Iii, Jessica Skalla, Ron A. Cisler

Journal of Patient-Centered Research and Reviews

Purpose: The complexity of addressing overweight and obesity in women has been an ongoing public health and health care challenge. While the mechanism for addressing overweight and obesity in women remains unclear, it has been speculated that disparities in overweight and obesity by race and gender contribute to the complexity. The purpose of the present study was to examine perceptions of primary care physicians when discussing weight management with their patients.

Methods: We conducted focus group discussions exploring facilitators and barriers to discussing weight management and weight loss among women patients. Participants included 18 family medicine and internal medicine physicians …

In-Home Delivery Of Constraint-Induced Movement Therapy Via Virtual Reality Gaming, Alexandra L. Borstad, Roger Crawfis, Kala Phillips, Linda Pax Lowes, David Maung, Ryan Mcpherson, Amelia Siles, Lise Worthen-Chaudhari, Lynne V. Gauthier

Journal of Patient-Centered Research and Reviews

Purpose: People with chronic hemiparesis are frequently dissatisfied with the recovery of their hand and arm, yet many lack access to effective treatments. Constraint-induced movement therapy (CI therapy) effectively increases arm function and spontaneous use in persons with chronic hemiparesis. The purpose of this study was to determine the feasibility and measure safety and outcomes of an in-home model of delivering CI therapy using a custom, avatar-based virtual reality game.

Methods: Seventeen individuals with chronic hemiparesis participated in this pretest/posttest quasi-experimental design study. The 10-day intervention had three components: 1) high-repetition motor practice using virtual reality gaming; 2) constraint of …

Hepatitis B Virus Infection In Tanzania: Current Status And Challenges, Semvua B. Kilonzo, Daniel W. Gunda, Bonaventura C.T. Mpondo, Fatma Bakshi, Hyasinta Jaka

Internal Medicine, East Africa

Hepatitis B is one of the most common infectious diseases in the world with high prevalence in most of sub-Saharan Africa countries. The complexity in its diagnosis and treatment poses a significant management challenge in the resource-limited settings including Tanzania, where most of the tests and drugs are either unavailable or unaffordable. This mini review aims at demonstrating the current status of the disease in the country and discussing the concomitant challenges in diagnosis, treatment, and prevention.

Imagine A World …, David A. Nelson

Journal of Patient-Centered Research and Reviews

The author and issue editor introduces the second half of Journal of Patient-Centered Research and Reviews’ two-part series on health disparities and inequities in the United States. The chasm between an ideal health care system and the current reality may appear vast, and closing it insurmountable at times, but acknowledging and working to address the many health conditions that disproportionately affect specific patient populations is one step health providers and researchers can take toward closing the gap.

Challenges Of Refugee Health Care: Perspectives Of Medical Interpreters, Case Managers, And Pharmacists, Fabiana Kotovicz, Anne Getzin, Thy Vo

Journal of Patient-Centered Research and Reviews

Purpose: Our objective was to identify perceived challenges in the provision of health care for refugees from the perspective of medical interpreters, case managers, and pharmacists working with refugee patients in Milwaukee, Wisconsin.

Methods: Two 60-minute focus groups were performed exploring challenges in refugee health care using a literature-based semi-structured protocol. Focus groups were transcribed and de-identified prior to independent analysis by two of the investigators. Using a memoing-process qualitative approach, major concepts, cross-cutting themes, and subthemes were established and ultimately developed a narrative. The project protocol was approved as not human subject research by the local institutional review board. …

Community Health, Advocacy, And Managing Populations (Champ) Longitudinal Residency Education And Evaluation, Kjersti E. Knox, Will Lehmann, Joseph Vogelgesang, Deborah Simpson

Journal of Patient-Centered Research and Reviews

Purpose: Longitudinal education initiatives designed to prepare residents to address health disparities and social determinants of health (SDH) are needed. This report addresses this gap by describing a family medicine residency’s Community Health, Advocacy, and Managing Populations (CHAMP) curriculum and its evaluation by learners, faculty, and community partners. The CHAMP longitudinal curriculum is explicitly designed to prepare residents to address health disparities and SDH. We report early outcomes, including community partner feedback, of this innovative curriculum.

Methods: Data were obtained through standardized rotation evaluations, thematic analysis of structured group and individual interviews, and aggregated competency milestone data. Kirkpatrick’s four-level model …