Medical Specialties Commons^™

Acute Post-Operative Pain Management: Preventing Overuse Of Opioids, Alison Hirsch

Theses and Graduate Projects

Background: Surgical pain management with opioids is common. The use of multimodal analgesia has been proposed in order to provide opioid-sparing regimens and improve pain control post-operatively. Inadequate control of surgical pain can lead to development of chronic pain. Furthermore, studies have linked acute surgical opioid use to increased risk of long-term use. Long-term opioid use has undesirable, life-altering consequences, including physical dependence and addiction which may lead to overdose or death. Use of a variety of medications in the operative setting can lead to synergistic or additive effects on pain control, thus decreasing post-operative opioid consumption.

Methods: A literature …

The Impact Of Breastfeeding Interventions On Breastfeeding Behavior, Ryan D. Steele

Theses and Graduate Projects

Breast milk is the natural first food for all infants, and breastfeeding provides multiple benefits for both the mother and child. However, breastfeeding rates in the United States are far from optimal, despite these benefits. There are multiple complex and interrelated reasons for the suboptimal breastfeeding rates, and multiple interventions have been completed with the goal of obtaining optimal breastfeeding rates. This literature review examines the efficacy of these breastfeeding interventions, specifically examining whether antenatal breastfeeding education was associated with increased breastfeeding initiation and duration relative to individualized support. Results of the literature review suggest that a combination of antenatal …

Does Music Therapy Decrease Agitation In Patients With Dementia?, Clinton Billhorn

Theses and Graduate Projects

Dementia is an encompassing word that includes specific symptoms which alter a patient’s problem-solving ability, decision making capacity, and personality.1 Personality changes, otherwise known as Behavioral and Psychotic Symptoms of Dementia (BPSD) can have negative impacts on caregivers and families. BPSD can include agitation, depression, elation, and hallucinations. Music therapy has been proposed as a non-pharmacologic treatment for BPSD in patients with dementia. This research is intended to identify whether or not music therapy decreases agitation in patients with dementia. Although evidence for efficacy varies, there are no side effects in the literature. Widespread use may provide an increase in …

The Future Of 5-Fluorouracil Treatment Of Colorectal Cancer: Translating A Better Understanding Into Improved Patient Care, Nathan Smits

Theses and Graduate Projects

5-fluorouracil (5-FU) is a pyrimidine analog that has been successfully employed in anticancer therapy for over forty years. Over the past several decades, researchers have characterized its cellular and clinical pharmacology and uncovered multiple mechanisms of action, which include the inhibition of thymidylate synthase (TS) and incorporation of its metabolites into DNA and RNA. The purpose of this quantitative systemic review was to summarize and evaluate what is known of these mechanisms to determine which are of most significance in the anticancer effects of 5-FU in metastatic colorectal cancer (mCRC) patients. A literature search of peer-reviewed articles dating back to …

Sprengel's Deformity, Muhammad Younus Khan Durrani, Amir Humza Sohail, Inamullah Khan, Pervaiz Hashmi

Section of Orthopaedic Surgery

Various shoulder bone deformities have been identified in the pediatric age group, with the most common being undescended scapula. Sprengel's deformity is dysplasia and malposition of the scapula, especially in the supraspinatus portion, mainly due to abnormal descent in the embryonic period. The clavicle is shorter and has a different contour. In some patients cervical spine deformities are also noted. This is a case of 3 years old girl presented to the clinic with difficulty in abducting right shoulder and sleeping with an internal rotation of the right arm. With physical examinations and radiological investigations sprengel's deformity was diagnosed. Sprengel's …

Role Of Extent Of Resection On Quality Of Life In Patients With Newly Diagnosed Gbm, Usama Khalid Choudry, Huzaifa Ismail Shaikh, Areeba Nisar, Saad Akhtar Khan, Muhammad Shahzad Shamim

Section of Orthopaedic Surgery

Glioblastomas known for their adverse outcomes are most reportedly managed by surgical resection. Studies on the impact of (Extent of Resection) EOR against Quality of Life (QOL) are very limited. We have collected data from recent studies in this review to extract a general consensus among the neurosurgeons regarding the EOR. Key parameters like functional independence, neurocognitive improvements and global health status have been explored in the context of QOL. The currently available data suggests that an increased EOR may help improve QOL in GBM patients. With the help of recent advancements it may be possible to attain a better …

Primary Total Hip Arthroplasty: Staying Out Of Trouble Intraoperatively, Shahryar Noordin, Riaz Hussain Lakdawala, Bassam A. Masri

Section of Orthopaedic Surgery

Total hip Arthroplasty is one of the most successful and commonly performed procedures in Orthopaedic Surgery. Meticulous preoperative planning allows to surgeon anticipate potential problems to reduce postoperative complications and optimize patient outcomes. Currently, the posterior approach is the most common approach utilized in the United States. In order to prevent errors in stem version, especially with cementless fixation, the entry point should be posterior, and the initial entry point should be aligned in the correct anteversion as this will determine the ultimate version of the stem. Preoperative evaluation should asses for true and apparent lengths. For successful osseointegration of …

Congenital Prepubic Sinus: An Aborted Dorsal Urethral Duplication Or A Cloacal Remnant?, Zafar Nazir, Muhammad Arif Mateen Khan, Javaria Qamar

Section of Paediatric Surgery

Background: Congenital Prepubic Sinus (CPS) is an uncommon urogenital anomaly characterized by a blind tract between the skin over the pubis to anterior of the urinary bladder, Urethra or umbilicus. We report four such cases to emphasize varied clinical presentation and embryological conundrum.
Methods: Following Ethical Review Committee (ERC) approval, medical records of pediatric patients (<16 >years) presenting with CPS (identified through operating room records and Hospital Information Management System (HIMS) between 1994 and 2018 were reviewed for demographics, clinical presentation, investigations including histopathology, management and outcome.
Results: Four cases of CPS, 3 females and 1 male, age range …

Effect Of Low-Intensity Long-Duration Ultrasound On The Symptomatic Relief Of Knee Osteoarthritis: A Randomized, Placebo-Controlled Double-Blind Study, Dominic Klyve, Ralph Ortiz, Davie O. Draper, Thomas M. Best

Mathematics Faculty Scholarship

Background: Wearable long-duration low-intensity ultrasound is an emerging non-invasive and non-narcotic therapy for the daily treatment of musculoskeletal pain. The aim of this randomized, double-blind, placebo-controlled study was to examine whether long-duration low-intensity ultrasound was effective in treating pain and improving function in patients with knee osteoarthritis. Methods: Ninety patients with moderate to severe knee pain and radiographically confirmed knee osteoarthritis (Kellgren-Lawrence grade I/II) were randomized for treatment with active (n = 55) or placebo (n = 35) devices applied daily to the treated knee. Investigators and subjects were blinded to treatment groups. Ultrasound (3 MHz, 0.132 W/cm2, 1.3 W) …

Adherence Mechanism Analysis: The Role Of Prsa Gene In Lactobacillus Acidophilus And Other Infectious Microorganisms, Nujuma Moussa

AUCTUS: The Journal of Undergraduate Research and Creative Scholarship

No abstract provided.

Trauma Treatment For Children In The Child Welfare System, The Rees-Jones Center For Foster Care Excellence

White Papers and Policy Briefs

Children involved in the child welfare system almost universally have experienced trauma, and many have experienced complex trauma. Research has shown that early intervention, treatment, and positive caregiving can reduce damage to the brain caused by trauma. Children coming into care should be screened to determine their trauma histories and related symptoms. Based on the outcomes of screenings and assessments, trauma-specific, evidence-based treatments or interventions should be provided.

For questions about this publication or others, please email [email protected]

childrens.com/fostercare

Reducing Discard Blood Draw Volumes From Subcutaneously Implanted Ports (Port) In Patients With End Stage Renal Disease (Esrd), Uttam Garg, Tyson Moore, Renita Trujillo, Penny Monachino, Amy Wiebold, Angela Ferguson, Gabor Oroszi, Vimal Chadha

Posters

Background
•To monitor clinical status, dialysis and transplant patients with ESRD frequently require blood draws.
•To preserve their veins and to avoid frequent intravenous access, these patients, especially young children, require PORT placement.
•The PORT is flushed with saline and filled with heparinized saline to prevent blood clotting between blood draws.
•To avoid contamination from PORT fluids, a fixed amount of blood is withdrawn and discarded before the blood sample is drawn for laboratory analyses. Currently, the recommended discard blood volume is 5 mL (five times the reservoir volume of most PORTs and attached catheters.)
•The volume of discarded blood …

The Identification And Segmentation Of Astrocytoma Prior To Critical Mass, By Means Of A Volumetric/Subregion Regression Analysis Of Normal And Neoplastic Brain Tissue, Lyn Higgins

Electronic Theses and Dissertations

As the underlying cause of Glioblastoma Multiforme (GBM) is presently unclear, this research implements a new approach to identifying and segmenting plausible instances of GBM prior to critical mass. Grade-IV Astrocytoma, or GBM, is an aggressive and malignant cancer arising from star-shaped glial cells, or astrocytes, where the astrocytes, functionally, assist in the support and protection of neurons within the central nervous system and spinal cord. Subsequently, our motivation for researching the ability to recognize GBM is that the underlying cause of the mutation is presently unclear, leading to the operative that GBM is only detectable through a combination of …

Pre-Albumin As A Marker For Predicting Weight Loss In Hospitalised Children, Del-Rossi Sean Quadros, Rose Kamenwa, Samuel Akech, William Macharia

Paediatrics and Child Health, East Africa

Objectives: This study sought to determine the diagnostic utility of serum pre-albumin in predicting weight loss in hospitalised children.

Design: A hospital-based longitudinal survey was carried out between December 2013 and February 2014.

Setting: Aga Khan University Hospital, Nairobi, Kenya, a tertiary care hospital.

Subjects: A total of 170 children aged 29 days to 15 years who met the inclusion criteria were included in the study.

Outcome measures: Serum pre-albumin levels and weight were measured at admission and repeated after 48–96 h. Sensitivity, specificity, and positive and negative predictive values were calculated to determine the diagnostic utility of serum pre-albumin …

Phosphoinositide 3-Kinase Signaling Pathway In Pancreatic Ductal Adenocarcinoma Progression, Pathogenesis, And Therapeutics, Divya Murthy, Kuldeep S. Attri, Pankaj K. Singh

Journal Articles: Eppley Institute

Pancreatic ductal adenocarcinoma (PDAC) is a highly aggressive malignancy characterized by its sudden manifestation, rapid progression, poor prognosis, and limited therapeutic options. Genetic alterations in key signaling pathways found in early pancreatic lesions are pivotal for the development and progression of pancreatic intraepithelial neoplastic lesions into invasive carcinomas. More than 90% of PDAC tumors harbor driver mutations in K-Ras that activate various downstream effector-signaling pathways, including the phosphoinositide-3-kinase (PI3K) pathway. The PI3K pathway also responds to stimuli from various growth factor receptors present on the cancer cell surface that, in turn, modulate downstream signaling cascades. Thus, the inositide signaling acts …

Aminoglycosides Rapidly Inhibit Nad(P)H Metabolism Increasing Reactive Oxygen Species And Cochlear Cell Demise, Danielle E. Desa, Michael G. Nichols, Heather Jensen Smith

Journal Articles: Eppley Institute

Despite causing permanent hearing loss by damaging inner ear sensory cells, aminoglycosides (AGs) remain one of the most widely used classes of antibiotics in the world. Although the mechanisms of cochlear sensory cell damage are not fully known, reactive oxygen species (ROS) are clearly implicated. Mitochondrial-specific ROS formation was evaluated in acutely cultured murine cochlear explants exposed to gentamicin (GM), a representative ototoxic AG antibiotic. Superoxide (O2·-) and hydrogen peroxide (H2O2) were measured using MitoSOX Red and Dihydrorhodamine 123, respectively, in sensory and supporting cells. A 1-h GM exposure significantly increased O2·- formation in IHCs and increased H2O2 formation in …

Met Receptor Inhibitor Su11274 Localizes In The Endoplasmic Reticulum, Edwin J. Wiest, Heather Jensen Smith, Michael A. Hollingsworth

Journal Articles: Eppley Institute

We discovered that SU11274, a class I c-Met inhibitor, fluoresces when excited by 488 nm laser light and showed rapid specific accumulation in distinct subcellular compartments. Given that SU11274 reduces cancer cell viability, we exploited these newly identified spectral properties to determine SU11274 intracellular distribution and accumulation in human pancreatic cancer cells. The aim of the studies reported here was to identify organelle(s) to which SU11274 is trafficked. We conclude that SU11274 rapidly and predominantly accumulates in the endoplasmic reticulum.

Abnormal T Cell Frequencies, Including Cytomegalovirus-Associated Expansions, Distinguish Seroconverted Subjects At Risk For Type 1 Diabetes, Robert Z. Harms, Kristina M. Lorenzo-Arteaga, Katie R. Ostlund, Victoria B. Smith, Lynette M. Smith, Peter Gottlieb, Nora Sarvetnick

Journal Articles: Surgery

We analyzed T cell subsets from cryopreserved PBMC obtained from the TrialNet Pathway to Prevention archives. We compared subjects who had previously seroconverted for one or more autoantibodies with non-seroconverted, autoantibody negative individuals. We observed a reduced frequency of MAIT cells among seroconverted subjects. Seroconverted subjects also possessed decreased frequencies of CCR4-expressing CD4 T cells, including a regulatory-like subset. Interestingly, we found an elevation of CD57+, CD28-, CD127-, CD27- CD8 T cells (SLEC) among seroconverted subjects that was most pronounced among those that progressed to disease. The frequency of these SLEC was strongly correlated with CMV IgG abundance among seroconverted …

Inter-Vendor Reproducibility Of Left And Right Ventricular Cardiovascular Magnetic Resonance Myocardial Feature-Tracking, Roman Johannes Gertz, Torben Lange, Johannes Tammo Kowallick, Sören Jan Backhaus, Michael Steinmetz, Wieland Staab, Shelby Kutty, Gerd Hasenfuß, Joachim Lotz, Andreas Schuster

Journal Articles: Cardiology

AIM: Since cardiovascular magnetic resonance feature-tracking (CMR-FT) has been demonstrated to be of incremental clinical merit we investigated the interchangeability of global left and right ventricular strain parameters between different CMR-FT software solutions.

MATERIAL AND METHODS: CMR-cine images of 10 patients without significant reduction in LVEF and RVEF and 10 patients with a significantly impaired systolic function were analyzed using two different types of FT-software (TomTec, Germany; QStrain, Netherlands). Global longitudinal strains (LV GLS, RV GLS), global left ventricular circumferential (GCS) and radial strains (GRS) were assessed. Differences in intra- and inter-observer variability within and between software types based on …

Elevated Pressure Increases Ca2+ Influx Through Ampa Receptors In Select Populations Of Retinal Ganglion Cells, Xiangyi Wen, Asia L. Cahill, Cody Barta, Wallace B. Thoreson, Scott Nawy

Journal Articles: Ophthalmology

The predominate type of AMPA receptor expressed in the CNS is impermeable to Ca²⁺ (CI-AMPAR). However, some AMPA receptors are permeable to Ca²⁺ (CP-AMPAR) and play important roles in development, plasticity and disease. In the retina, ganglion cells (RGCs) are targets of disease including glaucoma and diabetic retinopathy, but there are many types of RGCs and not all types are targeted equally. In the present study, we sought to determine if there are differences in expression of AMPARs amongst RGC subtypes, and if these differences might contribute to differential vulnerability in a model of stress. Using cultured RGCs …

Baseline Patient Characteristics Associated With Response To Biologic Therapy In Patients With Psoriatic Arthritis Enrolled In The Corrona Psoriatic Arthritis/Spondyloarthritis Registry., Philip Mease, Chitra Karki, Mei Liu, Arthur Kavanaugh, Christopher T Ritchlin, Doquyen Hoa Huynh, Jacqueline B Palmer, Jeffrey D Greenberg

Articles, Abstracts, and Reports

Objectives: To compare baseline characteristics between patients with psoriatic arthritis (PsA) who achieved and did not achieve minimal disease activity (MDA) with biologic therapy in the US-based Corrona Psoriatic Arthritis/Spondyloarthritis Registry.

Methods: Patients with PsA aged ≥18 years enrolled between March 2013 and March 2016 who were receiving biologics at enrolment (baseline), not in MDA and had ≥2 follow-up visits were included. Patients were classified as those who remained on their index biologic and achieved MDA at the second follow-up visit (MDA achievers (MDA-A)) and those who did not (MDA non-achievers (MDA-NA)). Demographics, clinical characteristics, patient-reported outcomes and medication history …

Outcomes Of Cataract Surgery At Teaching Hospital In Karachi, Shaukat Ali Chhipa, Mustafa Kamal Junejo

Section of Ophthalmology

Objective: To assess outcomes of cataract surgery at a tertiary care hospital in Karachi.
Methods: This retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised data of patients who underwent cataract surgery from January 2011 to December 2015. The data was collected using guidelines based on World Health Organisation systems for quality monitoring. Postoperative follow-up was done at 1 day, 1 week, 4 weeks and after 12 weeks. Visual acuity was recorded as good (6/6-6/18), borderline (6/18-6/60) and poor (<6/60). Intraoperative and postoperative complications were also noted.
Results: Of the 570 patient chartsreviewed, 527(92.45%) were included in the study. Among them, 302(57.4%) were females …

The Effects Of A Cognitive Training Program For Cognitively Intact Older Adults, Caroline Kinskey

All Graduate Theses, Dissertations, and Other Capstone Projects

Cognitive training is a term used to describe programs that provide guided practice on tasks requiring different cognitive abilities such as memory or language. It is assumed that regular practice will improve or maintain functioning in a particular cognitive domain (e.g., memory) and those results will generalize beyond the context of training. Results have been mixed in the existing literature that has evaluated the potential benefits of cognitive training on cognitive and emotional functioning in cognitively intact older adults. This study investigated the effectiveness of a cognitive training program for older adults with no to very minimal cognitive decline. Nine …

Perinatal Residents' Perceptions Of Confidence Gained Through Their Preceptors, Veritta Henderson

Walden Dissertations and Doctoral Studies

The importance of preceptorships, as a mechanism to transfer knowledge of evidence-based nursing practices and developing confidence in nurses, is well-known. However, the effectiveness of preceptorships to develop confidence in perinatal nurses who provide safe care to childbearing women is unknown. Guided by Kolb's model of experiential learning and using a narrative analysis approach, this study examined perinatal nurse residents' perceptions of experiences that enhanced learning and developed confidence during preceptorship. Twenty nurses who completed a perinatal nurse residency of 18 weeks or more in the past 12 months participated in audiotaped, structured interviews. Their answers were transcribed and data …

Midtrimester Transvaginal Ultrasound Cervical Length In Diamniotic Twin Pregnancies According To Chorionicity, Amanda Roman, Gabriele Saccone, Carolynn M. Dude, Danielle A. Peress, Giuseppe Maria Maruotti, Andrew Ward, Hannah Anastasio, Lorraine Dugoff, Pasquale Martinelli, Vincenzo Berghella

Department of Obstetrics and Gynecology Posters

Objective

To compare the mean and additional midtrimester TVCL screening cut offs in monochorionic diamniotic (MC/DA) twins and dichorionic diamniotic (DC/DA) twins and to assess the relationship between the TVCL values and spontaneous preterm birth (SPTB).

Twin Pregnancies And Incidence Of Spontaneous Preterm Delivery Stratified By Chorionicity, Amanda Roman, Gabriele Saccone, Yury Cruz, Giuseppe Maruotti, Mohamed Satti, Pasquale Martinelli, Vincenzo Berghella

Department of Obstetrics and Gynecology Posters

Objective: To identify the incidence of spontaneous preterm birth (SPTB) and indications for delivery in women with twin pregnancy stratified by chorionicity (monochorionic diamniotic and dichorionic diamniotic pregnancy).

Study Design: Multicenter retrospective cohort of all consecutive twin gestations from 2010 to 2017. They were stratified by chorionicity monochorionic diamniotic and dichorionic diamniotic pregnancy: Primary outcome was SPTB < 37 weeks. Secondary outcome was SPTB at <34, 32, and <28 weeks, gestational age at delivery and indications for delivery: maternal and fetal. Analysis: t-test, Fisher’s exact test and multivariable logistic regression.

Results: 510 women with twin pregnancies were identified. 158 (30.9%) were monochorionic diamniotic pregnancies, and 352 (69.0%) were dichorionic pregnancies. The gestational age at delivery was significantly shorter in the monochorionic compared to the dichorionic group of about 2 weeks (MD -2.20 weeks, …

Impact Of New “Triple I” Classification On The Incidence Of Clinical Chorioamnionitis And Antibiotic Use In Neonates, Amanda Roman, Yury Cruz, Amy J. Sloane, David Carola, Dorothy Mcelewee, Vincenzo Berghella, Zubair H. Aghai

Department of Obstetrics and Gynecology Posters

Objective

To evaluate the impact of the new classification “Triple I” on the incidence of chorioamnionitis during labor, need of antibiotics and diagnosis of neonatal sepsis.

Maternal Activity Level In Patients With Preterm Premature Rupture Of Membranes: A Prospective Observational Cohort Study, Amanda Roman, Nathan Watters, Denise Moses, Jenny Reisner, Andrea French, Alexis Gimovsky, Caroline Pessel, Burton Rochelson, Neil Seligman, Vincenzo Berghella

Department of Obstetrics and Gynecology Posters

Objective: To evaluate the level of maternal physical activity effect on the perinatal outcomes of women with preterm premature rupture of membranes (PPROM)

Study Design: This is a pilot, prospective, observational multicenter cohort study. We approached patients admitted between 23 0/7 weeks to 32 0/7 weeks gestation with confirmed PPROM between January of 2014 and June of 2017 All patients received corticosteroids and latency antibiotics. Enrollment was done on third day of admission. Delivery occurred at 34 weeks per protocol via induction of labor or cesarean section as obstetrically indicated; or sooner if chorioamnionitis was diagnosed or spontaneous preterm labor …

Predictors Of Preterm Birth After Physical Exam Indicated Cerclage In Singleton Pregnancies, Amanda Roman, Gabriele Saccone, Sarah Pachtman, Yury Cruz, Burt Rochelson, Adiel Fleischer, Pasquale Martinelli, Vincenzo Berghella

Department of Obstetrics and Gynecology Posters

Objective

To evaluate the predictors of preterm birth <32 weeks in women that underwent physical exam indicated cerclage (PEIC) in singleton pregnancy.

Novel Extra-Thoracic Vats Minimally Invasive Technique For Management Of Multiple Rib Fractures., Natalie N Merchant, Osita Onugha

Articles, Abstracts, and Reports

We report an elderly patient with chronic obstructive pulmonary disease (COPD), Alzheimer's disease and early dementia who presented with multiple displaced rib fractures of left ribs 4 through 9 with flail segments of ribs 4 through 8 and an associated traumatic pneumatocele from rib puncture of the left upper lobe. The decision to treat this patient operatively was based on the presence of flail chest, the patient's age, baseline co-morbidities and limited physiological reserve. Surgical rib fixation is traditionally performed with a thoracotomy incision and open exposure for extra-thoracic rib fixation, however, this patient underwent chest wall stabilization using an …