Medical Specialties Commons^™

Evaluation Of Kidney Injury Molecule-1 As A Disease Progression Biomarker In Diabetic Nephropathy, Fatima Abid Khan, Syeda Sadia Fatima, Ghulam Mustafa Khan, Sana Shahid

Department of Biological & Biomedical Sciences

Background & Objective: Kidney Injury Molecule-1 (KIM-1) is a peptide whose release into circulation is specific to tubular injury. This study aimed to estimate levels of kidney injury molecule-1 in diabetic patients with and without kidney disease. And evaluate the role of KIM-1 as an early screening marker of progressive kidney injury.
Methods: This follow-up study included n=85 subjects from the diabetic clinic of Jinnah Post Graduate Medical Center (JPMC) in collaboration with Aga Khan University from November 2016 till September 2017. They were divided as: i) Group A1 (n=30) participants with diabetes for <5 years without microalbuminuria ii) Group A2 (n= 30) subjects with diabetes for 6-10 years with microalbuminuria; iii) Group B (n=25) subjects as healthy control group. All study participants were followed for 6 months and their blood glucose, urea, creatinine, electrolytes, albuminuria and serum KIM-1 were assayed.
Results: High KIM-1 at baseline was …

Visual And Treatment Outcomes Of Tubercular Uveitis: A Prospective Case Series From A Referral Hospital In Pakistan, Muhammad Ishaq Ghauri, Nousheen Iqbal, Syeda Urooj Riaz, Muhammad Irfan, Ajeet Kumar, Muhamad Shariq Mukarram

Section of Pulmonary & Critical Care

Objective: Pakistan is the fifth highest TB burden country. Tuberculous uveitis (TbU) is a form of extrapulmonary TB, that is not uncommon in high burden country but very limited data is available on its outcome. The aim of the study is to assess the outcome of TbU with anti-tuberculous treatment (ATT).

Results: A prospective study was conducted at Jinnah Medical College Hospital (JMCH) Karachi, Pakistan from July to December 2017. Patients with suspected TbU were started on standard ATT chemotherapy for 12 months. Their response was assessed via slit lamp examination and visual acuity at 1, 3, 6 and 12 …

When An Infected Meniscus Portends A Perforated Viscus, Michelle Hannon, Stephen Zachariah, Neha Bansal Etherington, Anusha Govind, Devin Weber, Bryan Hess

Division of Infectious Diseases and Environmental Medicine Faculty Papers

A 59-year-old woman with a status of post–renal transplant 7 years prior for autosomal dominant polycystic kidney disease on tacrolimus and mycophenolate mofetil presented with subacute left knee and right wrist pain. She received local steroid injections to both areas as an outpatient without improvement in her symptoms. She had recently traveled to India, her home country, to visit relatives. Aspiration of the knee revealed 4+ acid fast bacilli on smear, and she was taken for surgical debridement. She was started on empiric antibiotics for presumed infection with rapidly growing mycobacteria. Her course was complicated by acute onset abdominal pain …

Ossification Of The Cruciform Ligament Of Atlas; A Rare Cause Of Cervical Myelopathy: Case Report And Review Of Literature, Muhammad Waqas Saeed Baqai, Gohar Javed, Mirza Zain Baig

Section of Neurosurgery

We present a case of cervical myelopathy secondary to ossification of the cruciform ligament (also known as cruciate ligament). This is a rare phenomenon that, to the best of our knowledge, has only been reported 16 times previously in literature. We have added a review of literature after our case presentation. We hope that by doing so, we may aid clinicians reach early diagnosis so as to be able to better manage this rare disease.

Perianal Necrotizing Fasciitis With Retroperitoneal Extension: A Case Report From Pakistan, Mirza Zain Baig, Abeer Aziz, Umme E Hani Abdullah, Muhammad Salman Khalil, Sumiya Abbasi

Section of Neurosurgery

Necrotizing fasciitis is a rare but potentially fatal condition. It is defined as a rapidly spreading infection of the subcutaneous soft tissue. Extension into the retroperitoneum may further complicate this deadly condition. We report a case of a 45-year-old gentleman who presented to our institute with perianal necrotizing fasciitis with extension into the retroperitoneum. He was managed with antibiotics and prompt surgical debridement. Our patient had a positive outcome which may be due to the fact that we had a high clinical suspicion, on the basis of which we opted for early operative management rather than delaying definitive treatment by …

Clinical Emergency Care Research In Low-Income And Middle-Income Countries: Opportunities And Challenges, Adam R. Aluisio, Shahan Waheed, Peter Cameron, Jermey Hess, Shevin Jacob, Niranjan Kissoon, Adam C. Levine, Asad Mian, Shammi Ramlakhan, Hendry R. Sawe, Junaid Razzak

Department of Emergency Medicine

Disease processes that frequently require emergency care constitute approximately 50% of the total disease burden in low-income and middle-income countries (LMICs). Many LMICs continue to deal with emergencies caused by communicable disease states such as pneumonia, diarrhoea, malaria and meningitis, while also experiencing a marked increase in non-communicable diseases, such as cardiovascular diseases, diabetes mellitus and trauma. For many of these states, emergency care interventions have been developed through research in high-income countries (HICs) and advances in care have been achieved. However, in LMICs, clinical research, especially interventional trials, in emergency care are rare. Furthermore, there exists minimal research on …

Consumer Prices For Surgical Management Of Ankle Arthritis: Limited Availability And Wide Variability., Niall A Smyth, Brody J Dawkins, Joshua P Goldstein, Jonathan R Kaplan, Lew C Schon, Amiethab A Aiyer

Articles, Abstracts, and Reports

Background: Healthcare costs for the surgical management of ankle arthritis continue to rise. Patients are generally unaware of the prices of the services they use. Understanding the costs associated with surgical management of ankle arthritis is an important facet of patient care. The purposes of this study were to (1) determine the access to the surgical cost of total ankle arthroplasty (TAAs) and ankle arthrodesis and (2) the variability of the price between the two procedures.

Methods: Fifty foot and ankle centers (25 academic, 25 private) that perform TAAs and ankle arthrodeses were contacted using a standardized patient script. The …

Invasive Cryptococcal Meningitis Presenting As A Skull Base Mass In An Immunocompetent Host: A Case Report., Joshua Prickett, Juan J Altafulla, Anna Knisely, Zachary Litvack

Articles, Abstracts, and Reports

No abstract provided.

Global Spinal Deformity From The Upper Cervical Perspective. What Is "Abnormal" In The Upper Cervical Spine?, Peter G Passias, Haddy Alas, Renaud Lafage, Bassel G Diebo, Irene Chern, Christopher P Ames, Paul Park, Khoi D Than, Alan H Daniels, D Kojo Hamilton, Douglas C Burton, Robert A Hart, Shay Bess, Breton G Line, Eric O Klineberg, Christopher I Shaffrey, Justin S Smith, Frank J Schwab, Virginie Lafage

Articles, Abstracts, and Reports

Hypothesis: Reciprocal changes in the upper cervical spine correlate with adult TL deformity modifiers.

Design: This was a retrospective review.

Introduction: The upper cervical spine has remarkable adaptability to wide ranges of thoracolumbar (TL) deformity.

Methods: Patients >18 years with adult spinal deformity (ASD) and complete radiographic data at baseline (BL) and 1 year were identified. Patients were grouped into component types of the Roussouly classification system (Type 1: Pelvic incidence [PI]

Results: A total of 343 ASD patients were analyzed. When grouped by BL Schwab and Roussouly, Group

Conclusions: Our study suggests that upper cervical alignment remains relatively stable …

Comparison Of Asymmetric Reaming Versus A Posteriorly Augmented Component For Posterior Glenoid Wear And Retroversion: A Radiographic Study., Jia-Wei Kevin Ko, Usman Ali Syed, Jonathan D Barlow, Scott Paxton, Bryan J Loeffler, Ocean Thakar, Grant Jamgochian, Joseph A Abboud, Charles L Getz, Gerald R Williams

Articles, Abstracts, and Reports

Background: Managing posterior glenoid wear and retroversion remains a challenge in shoulder arthroplasty. Correcting glenoid version through asymmetric reaming (AR) with placement of a standard glenoid component and the use of posteriorly augmented glenoid (PAG) components are two methods used to address this problem. Our objective is to report the radiographic outcomes of patients with posterior glenoid wear and/or retroversion treated with either approach.

Methods: Patients with posterior glenoid wear and a minimum of 15 degrees of retroversion, treated with AR and standard glenoid component or with a PAG component (3 mm, 5 mm, or 7 mm posterior augmentation), were …

The Current State Of Molecular Testing In The Treatment Of Patients With Solid Tumors, 2019., Wafik S El-Deiry, Richard M Goldberg, Heinz-Josef Lenz, Anthony F Shields, Geoffrey T Gibney, Antoinette R Tan, Jubilee Brown, Burton Eisenberg, Elisabeth I Heath, Surasak Phuphanich, Edward Kim, Andrew J Brenner, John L Marshall

Articles, Abstracts, and Reports

The world of molecular profiling has undergone revolutionary changes over the last few years as knowledge, technology, and even standard clinical practice have evolved. Broad molecular profiling is now nearly essential for all patients with metastatic solid tumors. New agents have been approved based on molecular testing instead of tumor site of origin. Molecular profiling methodologies have likewise changed such that tests that were performed on patients a few years ago are no longer complete and possibly inaccurate today. As with all rapid change, medical providers can quickly fall behind or struggle to find up-to-date sources to ensure he or …

The Impact Of Osteotomy Grade And Location On Regional And Global Alignment Following Cervical Deformity Surgery., Peter G Passias, Samantha R Horn, Tina Raman, Avery E Brown, Virginie Lafage, Renaud Lafage, Justin S Smith, Cole A Bortz, Frank A Segreto, Katherine E Pierce, Haddy Alas, Breton G Line, Bassel G Diebo, Alan H Daniels, Han Jo Kim, Alex Soroceanu, Gregory M Mundis, Themistocles S Protopsaltis, Eric O Klineberg, Douglas C Burton, Robert A Hart, Frank J Schwab, Shay Bess, Christopher I Shaffrey, Christopher P Ames

Articles, Abstracts, and Reports

Introduction: Correction of cervical deformity (CD) often involves different types of osteotomies to address sagittal malalignment. This study assessed the relationship between osteotomy grade and vertebral level on alignment and clinical outcomes.

Methods: Retrospective review of a multi-center prospectively collected CD database. CD was defined as at least one of the following: C2-C7 Cobb >10°, cervical lordosis (CL) >10°, C2-C7 sagittal vertical axis (cSVA) >4 cm, and chin-brow vertical angle > 25°. Patients were evaluated for level and type of cervical osteotomy.

Results: 86 CD patients were included (61.4 ± 10.6 years, 66.3% female, body mass index 29.1 kg/m

Conclusions: CD …

Diagnosis Of Non-Small Cell Lung Cancer For Early Stage Asymptomatic Patients., Cherylle Goebel, Christopher L Louden, Robert Mckenna, Osita Onugha, Andrew Wachtel, Thomas Long

Articles, Abstracts, and Reports

BACKGROUND/AIM: In 2016 in the United States, 7 of 10 patients were estimated to die following lung cancer diagnosis. This is due to a lack of a reliable screening method that detects early-stage lung cancer. Our aim is to accurately detect early stage lung cancer using algorithms and protein biomarkers.

PATIENTS AND METHODS: A total of 1,479 human plasma samples were processed using a multiplex immunoassay platform. 82 biomarkers and 6 algorithms were explored. There were 351 NSCLC samples (90.3% Stage I, 2.3% Stage II, and 7.4% Stage III/IV).

RESULTS: We identified 33 protein biomarkers and developed a classifier using …

A Novel Mutation In The Choroideremia Gene In A Turkish Family., Mustafa Iftikhar, Yulia Wolfson, Simrat Sodhi, Bushra Usmani, Hendrik P. N. Scholl, Syed M.A. Shah

Medical College Documents

Choroideremia is an X-linked recessive genetic disorder caused by mutations in the CHM gene. It is a rare retinal dystrophy that manifests as nyctalopia and vision loss, progressing to blindness in later stages. We report a 21-year Turkish man who presented with nyctalopia for the past 4-5 years. His mother and maternal grandmother had similar, but less pronounced complaints. Fundus examination revealed pigmentary changes and retinal atrophy in both eyes. Optical coherence tomography showed outer retinal loss, with central island of preserved autofluorescence surrounded by absent autofluorescence on fundus autofluorescence examination. Goldmann visual fields were constricted. Microperimetry detected retinal sensitivity …

Labrad : Vol 45, Issue 2 - July 2019, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• Novel Molecular Technique for Identifying Respiratory Tract Pathogens
• Role of Serum Galactomannan (GM) Assay in Diagnosing Invasive Aspergillosis (IA)
• Factor VIII Inhibitor – A Diagnostic Approach
• PET/CT Hybrid Imaging Technology at Aga Khan University Hospital
• Diagnostic Tests for Von Willebrand Disease
• Iron Deficiency Anemia
• Sweat Testing for Diagnosis of Cystic Fibrosis
• Flow Cytometric Identification of Abnormal B-Cells
• Direct Immunofluorescence in Bullous Skin Disorders
• Radiology-Pathology Correlation; Orthopedic Pathology
• Fecal Elastase: A Marker For Exocrine Pancreatic Function
• Edward Syndrome: Rare Autosomal Aneuploidy
• Sirolimus in Renal Transplant
• Latest Trends in Clinical Laboratory Science Technology
• Radiology-Neuropathology Correlation
• Nuchal Translucency Scan
• Bio-risk Management System in …

Perioperative Glycemic Control And Its Outcome In Patients Following Open Heart Surgery, Khalid M Siddiqui, Muhammad Ali Asghar, Muhammad F. Khan, Fazal Wahab Khan

Department of Anaesthesia

Background: Diabetes is not uncommon in patients requiring cardiac surgery. These patients have a higher incidence of morbidity and mortality. Subsequently, diabetes represents a major medico-economic problem in both developed and developing countries. This study was designed to observe the association between glycemic control and outcome of patients after open heart surgery in adult population.
Materials and methods: Data was collected retrospectively in all patients who underwent open cardiac surgery (coronary artery bypass grafting, valve, or bypass grafting with valve surgery) and survived 72 hours postoperatively and had diabetes. The study was conducted from January 2015 to December 2016.
Results: …

Recognition Of Antibiotic Resistance In Spontaneous Bacterial Peritonitis Caused By Escherichia Coli In Liver Cirrhotic Patients In Civil Hospital Karachi, Pooja D. Kirplani, Laila Tul Qadar, Rohan Kumar Ochani, Zahid Ali Memon, Syeda Anjala Tahir, Khalid Imran, Naresh Kumar Seetlani, Amanullah Abbasi, Mahaish Kumar, Piyar Ali

Section of Internal Medicine

Introduction Spontaneous bacterial peritonitis (SBP) is the most common life-threatening infection in patients with ascites due to liver cirrhosis. The infection is most commonly caused by the bacterium Escherichia coli, commonly referred to as E. coli. Over the past few years, the incidence of antimicrobial resistance against E. coli has risen drastically, leading to increased morbidity and mortality. Methods This cross-sectional study was conducted to determine the pattern of resistance using variations of antibiotics against E. coli, to prevent its empirical usage and initiate an appropriate target antibiotic therapy. The data were collected from May 2017 to October 2017 and …

Horizontal Rna Transfer Goes Deep: Platelet Consumption And Microrna Utilization By Vascular Smooth Muscle Cells., Lawrence E. Goldfinger, Leonard C. Edelstein

Department of Medicine Faculty Papers

No abstract provided.

Early Experience With Cap-Assisted Endoscopic Pancreatic Necrosectomy: A Technique To Enhance Safe Tissue Extraction And Decrease Interventions., Nishant Puri, Alexander Hallac, Wichit Srikureja

Articles, Abstracts, and Reports

No abstract provided.

Innovative Use Of Mesh Bolster For Adult Morgagni Hernia Repair., Nabiel Azar, Robert Azar, Katie Robertson, Priya Gupta

Articles, Abstracts, and Reports

Morgagni hernia is a rare type of congenital diaphragmatic hernia caused by lack of fusion of the pleuroperitoneal membrane anteriorly leading to a defect in the foramen of Morgagni. These are rare hernias and typically present early in life. Those that do not get repaired during infancy or adolescence often present later in life with variable symptoms including obstruction, incarceration, strangulation, pulmonary symptoms, chest pain, etc. Herein we present an adult case that was found incidentally after a screening computerized tomography (CT) chest scan was done for history of smoking. There are two unique aspects to this case: first, given …

Survivin Is A Prognostic Marker And Therapeutic Target For Extranodal, Nasal-Type Natural Killer/T Cell Lymphoma., Li Zhang, Yi Wei, Xiaowei Yan, Na Li, Haolan Song, Li Yang, Yang Wu, Yu-Feng Xi, Hua-Wei Weng, Jian-Hua Li, Edward H Lin, Li-Qun Zou

Articles, Abstracts, and Reports

Background: The relationship between survivin and extranodal, nasal-type natural killer/T cell lymphoma (ENKTCL) was unclearly established yet. We here studied the potential prognostic roles of survivin and its implication as a target in ENKTCL therapy.

Methods: ENKTCL patients' peripheral blood were collected and tested by ELISA. ENKTCL cell lines were cultured with or without survivin inhibitor and tested by MTT and Flow cytometry. According to the gene expression profiles from the ArrayExpress Archive under E-TABM-702, survivin co-regulated cluster was established by Coupled Two-way Clustering Algorithm.

Results: Seventeen point six percent of total 17 ENKTCL patients were serum survivin-positive. These patients …

Program Evaluation Of The Impact Of Sensory Room Activities On Student Readiness In Muskegon County, Mary C. Spyhalski

Education

There is a lack of research regarding the effect of sensory room interventions and equipment on student’s school readiness, as well as a lack of research regarding documentation and monitoring the effectiveness of sensory rooms. This is a problem for occupational therapists and teachers implementing sensory interventions that are not backed by research (Stephenson & Carter, 2011). Occupational therapists in Muskegon County Northern Service Unit (NSU) have determined a need to collect data on the impact of sensory room interventions on student readiness for school-day activities within their district. Program evaluations are needed in order to gather data that discusses …

Global Occupational Therapists’ Health And Wellness Interventions With Community-Dwelling Older Adults, Catherine Keegin, Lyndsey Lehman, Hannah Meier, Megan Weinberg

Older Adult

Rationale: The profession of occupational therapy (OT) has an opportunity to positively impact health and wellness for community-dwelling older adults with the approaching global increase of the aging population (He, Goodkind, & Kowal, 2016). Objective: The purpose of this study was to explore occupational therapists’ use of health promotion and wellness approaches to facilitate healthy aging with community-dwelling older adults in a global context. Results: Four qualitative themes were uncovered: perceptions of older adults, safety, the role of OT, and preventive versus reactive care. Participants with 10 or more years of experience addressed spirituality in practice more often than those …

Exploring The Connections Between The Presence Of Developmental Trauma And Clinical Reasoning: The Lived Experience Of Pediatric Occupational Therapists, Gwendolyn R. Blake, Briar E. Plantinga, Julie Shafer

Pediatrics

Background: Developmental trauma is a current issue facing the nation. It adversely affects participation in occupations across the lifespan. This paper examines how the clinical reasoning of practicing pediatric occupational therapists changes when treating clients who have experienced developmental trauma.

Methods: A phenomenological approach was applied using multiple cases. Four individuals, who identified as working with clients with developmental trauma, were interviewed using a series of semi-structured and open-ended questions on their experience treating these clients.

Results: Narrative transcripts were reviewed by the authors and organized into themes of performance patterns of the therapist and the context of developmental trauma …

Does Prior Anterior Cruciate Ligament Reconstruction Affect Outcomes Of Subsequent Total Knee Arthroplasty? A Systematic Review., Zaira S. Chaudhry, Hytham S. Salem, James J. Purtill, Sommer Hammoud

Rothman Institute Papers

Background: Anterior cruciate ligament injury may accelerate knee osteoarthritis, and patients with a history of anterior cruciate ligament reconstruction (ACLR) tend to undergo total knee arthroplasty (TKA) at a greater rate than patients without a history of ACLR.

Purpose: To compare clinical outcomes of TKA in patients with and without a history of ACLR through a systematic review.

Study Design: Systematic review; Level of evidence, 3.

Methods: A comprehensive search of the PubMed (MEDLINE), Cochrane Central, and SPORTDiscus databases from inception through November 2018 was performed to identify studies directly comparing outcomes of TKA between patients with and without a …

The Benefits And Accessibility Of Integrative Exercise In Geriatric Populations, Elizabeth Nisper

Honors Projects

There are many physical and mental benefits of conventional exercise and they have been well-studied. However, integrative exercise practices aim to encompass more than physical fitness. There is also a spiritual/ethical component when taking into account aspects such as meditation and mindfulness. By examining a number of different health domains, we can study whether the benefits of yoga and tai chi extend beyond the benefits of exercise more broadly. While the short-term physical fitness benefits of other cardio and strength training may exceed those of integrative practices, yoga and tai chi appear to be equally as beneficial in the long …

Effective Recruitment Strategies To Attract Orthopaedic Surgeons To Rural Nebraska, Carmen A. M. Pavlik

Undergraduate Research Journal

Rural communities have difficulty establishing and maintaining a quality healthcare workforce. Twenty percent of Americans compose the rural populations in this country, but only nine percent of physicians practice in these rural areas. From 2000 to 2020, the demand for orthopaedic physicians is expected to increase by 23%, mainly due to the aging population of the United States. Although the demand for orthopaedic surgeons to these underserved, aging rural populations is increasing, there is a shortage which continues to grow in rural areas. One possible driving force of this shortage could be the recruitment strategies exercised by the healthcare managers …

Position Statement:Emerging Genetic Therapies For Rare Disorders, Pauline Samia, Adam Kirton, Russell Dale, Silvia Tenembaum, Chahnez Charfi Triki, Anaita Hegde, Richard Idro, Jo M. Wilmshurst, Ingrid Tein, Haluk Topaloğlu

Paediatrics and Child Health, East Africa

Emerging genetic therapies for rare disorders at high cost, cannot realistically address the global burden of disease. Stakeholders must develop new pathways to ensure safe, fair and sustainable provision of such therapies.

The Write Stuff - Summer 2019 (Vol. 16, No. 3), Research Medical Library

Write Stuff 2019

• Using Research Resource Identifiers (RRIDs) to enhance rigor and reproducibility
• Court ruling sheds light on publishing giant OMICS International
• Manuscript presentation tips to improve the peer review process
• How to insert Greek letters, symbols, and other special characters in Word documents
• Changes to Plan S give researchers and publishers time to adapt
• Unusual terms used in scientific writing and publishing: Hanging indent

Expression Of Integrin And Tgfbi In Human Retinal Pericytes, Andrew T C Tsin, Brenda Su, Laura Valdez, Edgar Serrato

School of Medicine Publications

Purpose: The aim for this study is to investigate the expression of integrin α3, β1 and TGF-β induced protein (TGFBI) and the secretion of TGFBI by primary culture of human retinal pericytes (pHRP). Evidence suggests that chronic diabetes associate with HRP apoptosis leading to the development of diabetic retinopathy.

Methods: pHRP (Cell Systems) were cultured in complete media (15mM glucose) in a humidified, 5% CO2, 37°C condition. Cells were seeded at passage 6 to 8 into a 24 well-plate with coverslips or P10 dishes. Cells (85% confluence) media were then replaced by DMEM media with euglycemic glucose (5.5mM) or hyperglycemic …