Medical Specialties Commons^™

Use Of Ultrasound For Diagnosis Of Pneumonia In Adults, A Review, Dafang Chen, Rodrigo Cavallazzi

The University of Louisville Journal of Respiratory Infections

Pneumonia is a common lung infection with significant morbidity and mortality. Currently, the diagnosis of pneumonia is made by patient history confirmed with chest radiograph or computed tomography. These modalities, however, have limitations including low accuracy, radiation exposure, and high cost. Lung ultrasound has become more prevalent in evaluating pulmonary conditions and has shown to be highly accurate in the diagnosis of pneumonia. The purpose of this review is to discuss sonographic findings associated with pneumonia, techniques used to obtain quality images, and the evidence in literature supporting the use of lung ultrasound in the diagnosis of pneumonia. Numerous studies …

Suprasellar Epidermoid Cyst Originating From The Infundibulum: Case Report And Literature Review., Erin P Mccormack, Justin M Cappuzzo, Zachary Litvack, M Isabel Almira-Suarez, Jonathan S Sherman

Articles, Abstracts, and Reports

Epidermoid cysts account for a small fraction of intracranial brain tumors, most commonly found in the cerebellopontine angle and parasellar cisterns. Here we present a rare case of an epidermoid cyst located in the suprasellar region, specifically originating from the infundibulum. Only one additional case with an epidermoid cyst originating within the pituitary stalk has been previously reported in the literature. The patient in this case presented with headaches, diplopia and blurred vision without any endocrinopathy. The patient's pre-operative evaluation was significant for pseudotumor cerebri, hyponatremia, obesity, and a history of smoking; post-operative course was significant for neurogenic diabetes insipidus.

Comparison Of Mortality And Therapy In Community Acquired Pneumonia, Gina Maki, Daniela Moreno, Anthony Harris, Steven Lawrence, Andrew Masica, Lois Lamerato, Marcus J. Zervos

The University of Louisville Journal of Respiratory Infections

Background: Community associated pneumonia (CAP) is one the most common causes of hospital admissions, exceeding more than one million per year in the United States, contributing to 3.4% of inpatient mortality. Our objective was to compare 30-day mortality using therapies recommended for treatment of CAP.

Methods: A multicenter retrospective analysis from four different hospitals was assessed from 2008 to 2013. The data was obtained from electronic medical records which included more than 70,000 patients. CAP patients were identified using discharge diagnostic codes during the years 2008-2013, as well as receiving therapy with ceftriaxone and azithromycin or a respiratory fluoroquinolone. Demographic …

The Association Of Qsofa, Sofa, And Sirs With Mortality In Emergency Department Pneumonia, Ian D. Mecham, Nathan C. Dean, Emily L. Wilson, Al R. Jephson, Michael J. Lanpsa

The University of Louisville Journal of Respiratory Infections

Objective: To determine the association between 30-day mortality with Systemic Inflammatory Response Syndrome (SIRS), Sequential Organ Failure Assessment (SOFA), and quick SOFA (qSOFA) in emergency department patients with pneumonia. Secondary outcomes included the association of sepsis scores with hospital admission and direct ICU admission.

Methods: This is a secondary analysis of a pneumonia population conducted in the emergency department of 3 tertiary care medical centers and 4 community hospitals. Adult immunocompetent patients diagnosed with pneumonia were included from 3 twelve-month periods spanning December 2009 to October 2015. We generated area under the receiver operating characteristic curve (AUC) values for …

Coping With Chronic Fungal Rhinosinusitis: Diagnosis To Therapy, Veronica Corcino, Leslie Beavin, Shengli Lu, Ashley Ross, Carmen V. Sciortino Jr.

The University of Louisville Journal of Respiratory Infections

No abstract provided.

Hypoglycemic, Hypolipidemic And Antioxidant Effects Of Iridoid Glycosides Extracted From: Corni Fructus: Possible Involvement Of The Pi3k-Akt/Pkb Signaling Pathway, Jiefang Kang, Chen Guo, Rodolfo Thome, Ning Yang, Yuan Zhang, Xing Li, Xiaoyan Cao

Department of Neurology Faculty Papers

Iridoid glycosides (CIG) are the major component of Corni fructus. In this work, we researched the antioxidative, hypoglycemic and lowering blood lipids effects of CIG on diabetic mice induced by a high-fat diet (HFD) and streptozotocin (STZ). Furthermore, to investigate the molecular mechanism of action, the phosphorylation and protein expression of phosphoinositide 3-kinase (PI3K) and its downstream proteins, such as insulin receptor (INSR), protein kinase B (Akt/PKB) and glucose transporter 4 (GLUT4) have been detected. The results showed that CIG significantly improved oral glucose tolerance in diabetic mice. Biochemical indices also revealed that CIG had a positive effect on lipid …

Evaluation Of Hybrid Arc And Volumetric-Modulated Arc Therapy Treatment Plans For Fractionated Stereotactic Intracranial Radiotherapy., Jun Li, David To, Vickie Gunn, Wenyin Shi, Yan Yu, Haisong Lui

Department of Radiation Oncology Faculty Papers

PURPOSE: The study was aimed to compare hybrid arc and volumetric-modulated arc therapy treatment plans for fractionated stereotactic radiotherapy of brain tumors.

METHODS: Treatment plans of 22 patients were studied. Hybrid arc and volumetric-modulated arc therapy plans were generated using Brainlab iPlanDose and Varian Eclipse treatment planning systems, respectively, with 6 MV photon beams on a Varian TrueBeam STx linear accelerator (Palo Alto, CA). Prescription dose was 54 Gy. The fractionation was 1.8 Gy per fraction and 30 fractions in total, or 2 Gy per fraction and 27 fractions in total. Planning target volume ranged from 2.4 to 28.6 cm …

Congenital Zika Virus Infection In Immunocompetent Mice Causes Postnatal Growth Impediment And Neurobehavioral Deficits, Amber M. Paul, Dhiraj Acharya, Biswas Neupane, E. Ashley Thompson, Gabriel Gonzalez-Fernandez, Katherine M. Copeland

Publications

A small percentage of babies born to Zika virus (ZIKV)-infected mothers' manifest severe defects at birth, including microcephaly. Among those who appeared healthy at birth, there are increasing reports of postnatal growth or developmental defects. However, the impact of congenital ZIKV infection in postnatal development is poorly understood. Here, we report that a mild congenital ZIKV-infection in pups born to immunocompetent pregnant mice did not display apparent defects at birth, but manifested postnatal growth impediments and neurobehavioral deficits, which include reduced locomotor and cognitive deficits that persisted into adulthood. We found that the brains of these pups were smaller, had …

Continuous Infusion Of Epoprostenol As Salvage Therapy For Severe Pulmonary Arterial Hypertension, Jenna Rousseau, Jie Chi

Clinical Research in Practice: The Journal of Team Hippocrates

A critical appraisal and clinical application of Barst RJ, Rubin LJ, Long WA, McGoon MD, Rich S. A comparison of continuous intravenous epoprostenol (prostacyclin) with conventional therapy for primary pulmonary hypertension. New Eng J Med. 1996;334(5):296-301. doi: 10.1056/nejm199602013340504

App21 Transgenic Rats Develop Age-Dependent Cognitive Impairment And Microglia Accumulation Within White Matter Tracts., Nina Weishaupt, Qingfan Liu, Sheojung Shin, Ramandeep Singh, Yuksel Agca, Cansu Agca, Vladimir Hachinski, Shawn Narain Whitehead

Paediatrics Publications

Background

Most of the animal models commonly used for preclinical research into Alzheimer's disease (AD) largely fail to address the pathophysiology, including the impact of known risk factors, of the widely diagnosed sporadic form of the disease. Here, we use a transgenic rat (APP21) that does not develop AD-like pathology spontaneously with age, but does develop pathology following vascular stress. To further the potential of this novel rat model as a much-needed pre-clinical animal model of sporadic AD, we characterize APP21 transgenic rats behaviorally and histologically up to 19 months of age.

Methods

The open field test was used as …

Evaluation Of Botulinum Toxin Therapy For Chronic Anal Fissure, Amr Abu El-Ella, Ayman Al-Khaleegy, Khaled Hassan

Journal of Medicine in Scientific Research

Background Chronic anal fissure causes severe anal pain that dramatically impairs patient's quality of life. Despite a poorly understood etiology, anal fissures are characterized by continuous spasms of the internal anal sphincter. The work aims to evaluate the efficacy of botulinum toxin (BTX) local injection in relieving symptoms and healing chronic anal fissure and its complications. We also aim to popularize this simple outpatient technique. Patients and methods Thirty patients diagnosed with chronic anal fissure were included in this study. Each patient received 40 units of BTX. All patients were evaluated for pain, bleeding, and healing of the fissure from …

Emergency Surgery For Prosthetic Mitral Valve Dysfunction: Risk Factors And Technical Consideration, Ahmed Saad, H Hafez, M H. Mazen, Mohamed Refaat Kamar, Tharwat Fakhry

Journal of Medicine in Scientific Research

Objective Prosthetic mitral valve dysfunction remains a devastating complication in heart surgery. This study aims to assess the risk factors and the technical approaches to reach the best way to deal with and improve the outcome in these patients. Patients and methods Between January 2002 and March 2005, 60 patients underwent emergency reoperation for prosthetic mitral valve dysfunction, where 36 (60%) patients were in New York Heart Association class III, and 24 (40%) patients were in New York Heart Association class IV. There were 33 (55%) male and 27 (45%) female patients. The mean age at operation was 32.4 ± …

Endovascular Repair Of Traumatic Subclavian Artery Pseudoaneurysm: A Case Report And Review Of The Literature, Mohamad M. Gouda, Mohamad Taha

Journal of Medicine in Scientific Research

Traumatic subclavian artery injury resulting in pseudoaneurysm formation is relatively uncommon. With the increasing percutaneous arterial interventions utilization worldwide, the number of pseudoaneurysm formation has increased owing to iatrogenic arterial injury. After trauma, injury of subclavian artery early appears, and many complications such as life-threatening bleeding, the creation of pseudoaneurysm, and brachial plexus compression may be caused by the arterial rupture. The presence of large hematoma and pulsatile palpable mass in the supraclavicular region should raise the suspicion of severe vascular injury. Surgical thoracotomy and direct arterial repair traditionally treated subclavian artery pseudoaneurysms. However, significant morbidity is usually associated with …

Validity Of Dual-Energy X-Ray Absorptiometry Scan In Evaluation Of Trunk Fat In Non-Obese Patients With Polycystic Ovary Syndrome, Amir S. M. Melika, Ikram I. Alyan, Osama S. El-Dein

Journal of Medicine in Scientific Research

To detect trunk obesity, which was claimed to be a major cause of insulin resistance, in nonobese patients with polycystic ovary syndrome (PCOS) by using dual-energy X-ray absorptiometry (DEXA) scan. A total of 60 normal weight, with BMI less than 25 kg/m², patients with PCOS were included in the study. DEXA scan was used to assess the body composition of all patients. Metabolic and hormone measurements and cardiovascular risk were determined. All data were collected and compared with 60 healthy controls. Normal-weight patients with PCOS had a higher ratio of total and trunk fat than non-PCOS controls. Moreover, …

Role Of Ankle Peak Systolic Velocity In Predicting Healing Of Diabetic Foot Lesions In Patients With Critical Lower Limb Ischemia, Assem M. Herzallah

Journal of Medicine in Scientific Research

Aim We designed the study for determining if ankle peak systolic velocity (APSV) has value in prediction of healing in diabetic foot lesions in patients with critical lower limb ischemia. APSV is the mean of the peak systolic velocities estimated at the ankle level over the distal tibial arteries. Patient and Methods Patients were included if they had diabetes foot lesions. Such lesions were ulcers, gangrene, or tissue necrosis. In addition, they had nonpalpable pedal pulses. Endpoints were healed or healing foot lesions, revascularization, major amputation, or death. Fifty diabetic limbs were included. Results Twenty-five (50%) limbs with diabetic foot …

Does The Venus De Milo Have A Spinal Deformity?, Kevlian Andrew, Joe Iwanaga, Marios Loukas, Jens Chapman, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

The Venus de Milo, an ancient Greek statue, has been viewed as one of the most celebrated pieces of art in Western culture. It was sculpted during the Hellenistic period between 150 and 50 BC and is believed to be the work of Alexandros of Antioch. The sculpture is thought to depict Aphrodite, the Greek goddess of love and beauty. When assembled, the two halves of the sculpture meet in an almost horizontal line that is purposefully obscured by a roll of garment around the hips. It has been noted that the midline of the statue's face is displaced slightly. …

Estimation Of Insulin-Like Growth Factor-1 As A Biomarker In Nonalcoholic Fatty Liver Disease In Patients With Metabolic Syndrome, Amal E. El-Maghraby, Eman A. Aissa, Hoda El H. Ahmed

Journal of Medicine in Scientific Research

Background Nonalcoholic fatty liver disease (NAFLD) is becoming the most common chronic liver pathology especially in developed countries, ranging from simple liver steatosis to nonalcoholic steatohepatitis. Patients with NAFLD having metabolic syndrome have abnormal liver enzymes that positively correlate with the number of metabolic syndrome components. Abdominal ultrasonography is frequently used in epidemiological studies to detect NAFLD. Insulin-like growth factor (IGF-1) is the critical hormone in the pathophysiology of metabolic syndrome and is associated with cardiovascular disease, diabetes mellitus, and abnormal lipid metabolism. Participants and methods A total of 70 patients, 50 patients having NAFLD by ultrasonography and 20 individuals …

The Relation Between Sarcopenia, Associated Factors, And Disease Activity In Patients With Rheumatoid Arthritis, Ikram I. Alyan

Journal of Medicine in Scientific Research

Aim The aim of this study was to detect the incidence of sarcopenia in patients with rheumatoid arthritis (RA) and study associated factors. Patients and methods Dual-energy X-ray absorptiometry was used to assess the body composition of 80 patients with RA and 80 healthy controls. Sarcopenia was defined as a relative skeletal muscle index of less than 5.5 kg/m² in male and less than 7.26 kg/m² in female patients. BMI, waist circumference, and disease activity score 28 erythrocyte sedimentation rate were used to assess disease activity. Functional disability was measured using Health Assessment Questionnaire, and 4-m gait speed …

Assessment Of Evaluated Pulmonary Vascular Resistance By Isoproterenol Infusion In Patients With Atrial Septal Defects, Amir S. Michael

Journal of Medicine in Scientific Research

Aim and Background Congenital heart diseases constitute a major category of disorders associated with pulmonary hypertension in atrial septal defect there is tendency to repair essentially all large defect except some of those with severe obstructive pulmonary vascular diseases. in this study the isoproterenol is used for assessment of patients with atrial septal defect, with elevated pulmonary / systemic vascular resistance ratio. Methods and Results 100 cases with atrial septal defect, with pulmonary hypertension received isoproterenol infusion. Haemodynamic findings found among all patients with atrial septal defect before and after isoproterenol infusion. There is a significant in pulmonary blood flow …

Assessment Of Value Of Adding Low Dose Of Intermediate-Acting Nondepolarizing Muscle Relaxant To Local Anesthesia And Hyaluronidase Mixture Percaruncular And Peribulbar Anesthesia For High Myopes In Ophthalmic Surgery, Alaa A. Ibrahim, Ashraf A. M. Soliman

Journal of Medicine in Scientific Research

Objective The purpose of this study was to assess thevalue of adding low-dose intermediate-acting nondepolarizing muscle relaxant to local anesthesia and hyaluronidase mixture percaruncular and peribulbar anesthesia for high myopes in ophthalmic surgery. Patients and methods A total of 82 patients with American Society of Anesthesiologists I–III planned for elective ophthalmic surgery with high myopes enrolled in a double-blind comparative study. The atients were randomized into one of the two groups: group A (n = 42) patients received lidocaine, bupivacaine (local anesthesia), hyaluronidase, and atracurium (intermediate-acting nondepolarizing muscle relaxant) percaruncular and peribulbar. Group B patients received local anesthesia, hyaluronidase …

Assessment Of Value Of Epidural Magnesium Sulfate In Postoperative Analgesia After Lower Limb Vascular Surgery, Ashraf A. M. Soliman

Journal of Medicine in Scientific Research

Objective The aim of the study was to assess the value of epidural magnesium sulfate in postoperative analgesia after lower limb vascular surgery. Patients and methods A total of 80 patients planned for elective lower limb vascular surgery were enrolled in a double-blind comparative study. Their ages were between 30 and 60 years and were of ASA physical status I–III. Patients were randomly distributed into two group: group A (n = 40) included patients who received 100-mg magnesium sulfate in 6 ml normal saline 0.9% plus 4 mg morphine epidurally, and group B (n = 40) had patients …

Femoral Tunneled Hemodialysis Catheter As A Permanent Access For Hemodialysis Patients, Ahmed A. Morsi, Assem M. Herzallah, Mohamed T. Y. Madkour, Tarek S. Elshanshoury

Journal of Medicine in Scientific Research

Background Vascular access (VA) remains the cornerstone in HD patients. The survival of the patients becomes risky if approaches like arteriovenous fistulae, grafts, and thoracic tunneled central catheters are used with no benefits. The options become limited to transplantation, dialysis through the peritoneum, and catheter insertion translumbarally or femorally, which in some cases is the only available approach. Methods We are discussing our experience from Mataria Teaching Hospital with 17 patients; in those patients, all the vascular procedures were used with no benefits. We could not perform other options like transplantation or peritoneal dialysis. Hence, we chose femoral tunneled catheters …

A Surprising Incidence Of Mammary Duct Ectasia In Egyptian Female Individuals: A 20-Year Experience, Adel K. Barsoum

Journal of Medicine in Scientific Research

The vast majority of breast pathology is benign. Much attention is given to malignant lesions because breast cancer is the most common malignancy in women. Duct ectasia is one of the benign breast diseases; Haagenson was the first to use the term. It is a widening of the ducts of the breast, a condition that occurs most frequently in women in their fourth and fifth decade of life. American Cancer Society states that mammary duct ectasia does not increase the risk for developing breast cancer, as duct ectasia is considered a nonproliferative disease (cells that have changed but are not …

Laparoscopic Omental Patch Repair For Perforated Peptic Ulcer: An Early Experience From Al-Sahel Teaching Hospital, Amr M. Abulfadle, Ashraf M. Habeeb, Ayman A. Al-Khaleegy, Khaled M. Hassan

Journal of Medicine in Scientific Research

Background Peptic ulceration is a common condition. The most common etiologic factors are drugs use like NSAIDs and infection by Helicobacter pylori. The perforated duodenal ulceration is not an uncommon surgical emergency, ur aim was to show our experience with Laparoscopic omental patch repair for perforated peptic ulcer. Patient and Method In this study, we included 16 patients who underwent laparoscopic repair of perforated duodenal ulcer at our department. The patients were urgently admitted to the emergency department. Result In our study, we have neither morbidity nor mortality. The recorded time for the operation was 72–90 min, and the …

Monocarboxylate Transporter 4 (Mct4) Knockout Mice Have Attenuated 4nqo Induced Carcinogenesis; A Role For Mct4 In Driving Oral Squamous Cell Cancer., Sara Bisetto, Diana Whitaker Menezes, Nicole A. Wilski, Madalina Tuluc, Joseph Curry, Tingting Zhan, Christopher M. Snyder, Ubaldo E. Martinez-Outshoorn, Nancy J. Philp

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Head and neck squamous cell carcinoma (HNSCC) is the 6th most common human cancer and affects approximately 50,000 new patients every year in the US. The major risk factors for HNSCC are tobacco and alcohol consumption as well as oncogenic HPV infections. Despite advances in therapy, the overall survival rate for all-comers is only 50%. Understanding the biology of HNSCC is crucial to identifying new biomarkers, implementing early diagnostic approaches and developing novel therapies. As in several other cancers, HNSCC expresses elevated levels of MCT4, a member of the SLC16 family of monocarboxylate transporters. MCT4 is a H⁺-linked …

Leveraging Pet To Image Folate Receptor Α Therapy Of An Antibody-Drug Conjugate, Christian Brand, Ahmad Sadique, Jacob L. Houghton, Kishore Gangagari, Jose F. Ponte, Jason S. Lewis, Naga Vara Kishore Pillarsetty, Joseph A. Konner, Thomas Reiner

Publications and Research

Background: The folate receptor α (FRα)-targeting antibody-drug conjugate (ADC), IMGN853, shows great antitumor activity against FRα-expressing tumors in vivo, but patient selection and consequently therapy outcome are based on immunohistochemistry. The aim of this study is to develop an antibody-derived immuno-PET imaging agent strategy for targeting FRα in ovarian cancer as a predictor of treatment success. Methods: We developed [89Zr]Zr-DFO-M9346A, a humanized antibody-based radiotracer targeting tumorassociated FRα in the preclinical setting. [89Zr]Zr-DFO-M9346A’s binding ability was tested in an in vitro uptake assay using cell lines with varying FRα expression levels. The diagnostic potential of [89Zr]Zr-M9346A was evaluated in KB and …

Metformin As A Therapeutic Target In Endometrial Cancers., Teresa Lee, Ubaldo E. Martinez-Outshoorn, Russell J. Schilder, Christine H. Kim, Scott D. Richard, Norman G. Rosenblum, Jennifer Johnson

Department of Medical Oncology Faculty Papers

Endometrial cancer is the most common gynecologic malignancy in developed countries. Its increasing incidence is thought to be related in part to the rise of metabolic syndrome, which has been shown to be a risk factor for the development of hyperestrogenic and hyperinsulinemic states. This has consequently lead to an increase in other hormone-responsive cancers as well e.g., breast and ovarian cancer. The correlation between obesity, hyperglycemia, and endometrial cancer has highlighted the important role of metabolism in cancer establishment and persistence. Tumor-mediated reprogramming of the microenvironment and macroenvironment can range from induction of cytokines and growth factors to stimulation …

Bevacizumab: A Rare Cause Of Nonischemic Cardiomyopathy., Oreoluwa Oladiran, Salik Nazir

Reading Hospital Internal Medicine Residency

Left ventricular dysfunction is a rare side effect of bevacizumab occurring in 2-4% of cases. We report the case of a 68-year-old woman who presented to the emergency department (ED) with sudden onset of shortness of breath, orthopnea, and paroxysmal nocturnal dyspnea. She was tachypneic and in respiratory distress. Physical examination revealed jugular venous distention, diffuse expiratory wheeze, and bipedal edema. She had been started on bevacizumab for the treatment of hereditary hemorrhagic telangiectasia 1 month prior to presentation. Laboratory tests revealed BNP of 1697 pg/ml with slightly elevated troponin 0.05 ng/ml. Chest X-ray showed interstitial edema with cardiomegaly, and …

Assessment Of Patient Satisfaction With Primary Health Care At The Family Medicine Centre Of Aga Khan University Hospital, Nairobi, Alvin M. Juma

Master of Medicine in Family Medicine

Background: Patient satisfaction is one of the key indicators by which the quality of healthcare service is evaluated. The World Conference of Family Doctors African Chapter's (WONCA-Africa) encourages Family Medicine practices to regularly assess their patients' satisfaction as one of the criteria for benchmarking and auditing the quality of primary care in Africa. The Kenyan government, in a quest to improve primary care provision, has formulated policy to make family physicians essential players in coordinating and enhancing standards of primary care. Objective: This study aimed to assess patient satisfaction with the quality of primary health care services provided by family …

Overcoming Small Data Limitations In Heart Disease Prediction By Using Surrogate Data, Alfeo Sabay, Laurie Harris, Vivek Bejugama, Karen Jaceldo-Siegl

SMU Data Science Review

In this paper, we present a heart disease prediction use case showing how synthetic data can be used to address privacy concerns and overcome constraints inherent in small medical research data sets. While advanced machine learning algorithms, such as neural networks models, can be implemented to improve prediction accuracy, these require very large data sets which are often not available in medical or clinical research. We examine the use of surrogate data sets comprised of synthetic observations for modeling heart disease prediction. We generate surrogate data, based on the characteristics of original observations, and compare prediction accuracy results achieved from …