Medical Specialties Commons^™

Outcome In Patients With Myasthenia Gravis Managed With Or Without Thymectomy, Safia Bano, Muhammad Athar Javed, Waqas Arshad

Pakistan Journal of Neurological Sciences (PJNS)

Myasthenia gravis is a chronic acquired autoimmune disorder in which autoantibodies are produced against acetylcholine receptors present on neuromuscular junction. It results in neuromuscular transmission blockage hence muscle weakness occurs. Thymus gland is considered as having crucial role in development of these antibodies. Screening patients for thymoma and removal of the thymus gland with surgery has an important aspect in management of disease.

Effect Of Removal Of Auraonce™ Laryngeal Mask In Awake Or Deep Anaesthesia: A Randomized Controlled Trial, Ronald Ombaka, Vitalis Mung’Ayi, David Nekyon, Samina Mir

Anaesthesiology, East Africa

Background: The manufacturer Ambu® recommends that the AuraOnce™ laryngeal mask be removed once the patient is fully awake. Studies have shown benefit in removal of the laryngeal mask airway while a patient is deeply anaesthetized. Current evidence is inconclusive, as to which approach is preferable and safer in adults.

Methods: one hundred and sixteen adult patients were randomly assigned to two groups of 58. For the deep arm; The AuraOnceTM laryngeal mask was removed after attaining an end tidal minimum alveolar concentration of Isoflurane of 1.15%. Occurrence of airway complication(s) (One or more of the following; Airway obstruction requiring airway …

Assessing Physical Activity And Sleep In Axial Spondyloarthritis: Measuring The Gap., Atul Deodhar, Lianne S Gensler, Marina Magrey, Jessica A Walsh, Adam Winseck, Daniel Grant, Philip Mease

Articles, Abstracts, and Reports

Patients with axial spondyloarthritis (axSpA) frequently report pain, stiffness, fatigue, and sleep problems, which may lead to impaired physical activity. The majority of reported-on measures evaluating physical activity and sleep disturbance in axSpA are self-reported questionnaires, which can be impacted by patient recall (reporting bias). One objective measure, polysomnography, has been employed to evaluate sleep in patients with axSpA; however, it is an intrusive measure and cannot be used over the long term. More convenient objective measures are therefore needed to allow for the long-term assessment of both sleep and physical activity in patients' daily lives. Wearable technology that utilizes …

Phase Iib, Randomized, Double-Blind Trial Of Gc4419 Versus Placebo To Reduce Severe Oral Mucositis Due To Concurrent Radiotherapy And Cisplatin For Head And Neck Cancer., Carryn M. Anderson, Christopher M Lee, Deborah P. Saunders, Amarinthia Curtis, Neal Dunlap, Chaitali Nangia, Arielle S. Lee, Sharon M. Gordon, Philip Kovoor, Roberto Arevalo-Araujo, Voichita Bar-Ad, Abhinand Peddada, Kyle Colvett, Douglas Miller, Anshu K. Jain, James Wheeler, Dukagjin Blakaj, Marcelo Bonomi, Sanjiv S. Agarwala, Madhur Garg, Francis Worden, Jon Holmlund, Jeffrey M. Brill, Matt Downs, Stephen T. Sonis, Sanford Katz, John M. Buatti

Department of Radiation Oncology Faculty Papers

PURPOSE: Oral mucositis (OM) remains a common, debilitating toxicity of radiation therapy (RT) for head and neck cancer. The goal of this phase IIb, multi-institutional, randomized, double-blind trial was to compare the efficacy and safety of GC4419, a superoxide dismutase mimetic, with placebo to reduce the duration, incidence, and severity of severe OM (SOM).

PATIENTS AND METHODS: A total of 223 patients (from 44 institutions) with locally advanced oral cavity or oropharynx cancer planned to be treated with definitive or postoperative intensity-modulated RT (IMRT; 60 to 72 Gy [≥ 50 Gy to two or more oral sites]) plus cisplatin (weekly …

Valley Youth House: A Partnership With The Lehigh Valley Health Network Campus Of University Of South Florida Morsani College Of Medicine, Taylor Jarvill, Jeffrey Downen, Brittney Gaudet, Nina Liu, Amy B. Smith Phd, Marna R. Greenberg Do, Mph, Facep

Department of Emergency Medicine

No abstract provided.

Addressing Barriers To Maternal Healthcare For Marshallese Islanders In Northwest Arkansas: An Internship Experience, Victoria Richardson

The Eleanor Mann School of Nursing Undergraduate Honors Theses

The Marshallese community is a rapidly growing population in Northwest Arkansas. Approximately 12,000 people migrated from the Marshall Islands and settled in the state of Arkansas due to the signing of the Compact of Free Association (COFA) in 1986. Although the population in Northwest Arkansas is experiencing rapid growth, there are significant health disparities that coincide with it. Due to vast cultural differences, language barriers, low economic status, and political barriers, the Marshallese community suffers from prenatal health inequalities and poor maternal and fetal outcomes, including low birth-weight infants, premature births, and increased infant mortality. During my internship, I provided …

Examining Pediatric Tourette Syndrome, Alyssa Orlando

Honors Projects

Pediatric Tourette Syndrome is a complex neurological disorder. Many people associate it with swearing, however in reality it is very rarely associated with that. This paper entails my own personal experiene with Tourette Syndrome and examines potential treatment options in the pediatric population.

Pediatric Acute Lymphoblastic Leukemia: A Review, Luke Geierman

Honors Projects

Acute Lymphoblastic Leukemia (ALL) is the most commonly diagnosed pediatric cancer and the most frequent cancer-induced cause of death among young people. Despite this fact, tremendous progress in treating the disease has been made in the last 50 years. This systematic literature review examines the incidence of the disease as well as the importance of risk stratification in treatment planning. The role of genetics in ALL risk stratification, specifically hypodiploidy and hyperdiploidy, is also considered. Finally, current treatment protocols, treatment failure, and the future of research and treatments are all each examined.

A Multiple Comparison Study That Test The Validity Of Varian’S Rapidplan For Prostate Cancer Cases Based On Models Built From Outside Institution., La'rone Reid

Masters Projects

In radiation oncology treatment planning techniques and outcomes can differ from one institution to the next. With knowledge-based planning (KBP) the experience of larger institutions could help smaller institutions who may not have the opportunity to encounter certain types of cancer cases. However, this scenario is only true if the KBP software is consistent with its algorithmic output. Varian's KBP software called Rapid Plan (RP) will be analyzed for algorithmic consistency. This study investigates the validity and consistency of RP models from two different radiation oncology institutions, and compare data to determine RP quality, and consistency when planning prostate cancer …

A Phase 1 Study Of Intravenous Busulfan As A Conditioning Regimen For Multiple Myeloma, Sabarinath V. Radhakrishnan, Michael Boyer, Catherine M. Sherwin, Maurizio Zangari, Guido Tricot

Pediatrics Faculty Publications

The efficacy of melphalan (MEL) 140 mg/m 2 pre-transplant conditioning versus MEL 200 mg/m 2 for the elderly is still debated. We hypothesized that single-agent intravenous busulfan (BU) would show significant anti-myeloma efficacy and be better tolerated by elderly patients. A prospective 3+3 dose escalation study enrolled symptomatic multiple myeloma (MM) patients 65 years or older with SWOG performance 0–2 for treatment with intravenous BU pre-transplant at different administration levels. The primary objective was to determine the maximum tolerated dose (MTD) of BU that could be safely given over the least number of days. All patients, except one, received maintenance …

From Clinical Phenotype To Genotypic Modelling: Incidence And Prevalence Of Recessive Dystrophic Epidermolysis Bullosa (Rdeb), Shaundra Eichstadt, Jean Y. Tang, Daniel C. Solis, M. Peter Marinkovich, Nedra Whitehead, Fang Fang, Stephen W. Erickson, Mary E. Ritchey, Max Colao, Kaye Spratt, Amir Shaygan, Mark Ahn, Kavita Y. Sarin

Engineering and Technology Management Faculty Publications and Presentations

Background: Recessive dystrophic epidermolysis bullosa (RDEB) is an inherited genetic disorder characterized by recurrent and chronic open wounds with significant morbidity, impaired quality of life, and early mortality. RDEB patients demonstrate reduction or structural alteration type VII collagen (C7) owing to mutations in the gene COL7A1, the main component of anchoring fibrils (AF) necessary to maintain epidermal-dermal cohesion. While over 700 alterations in COL7A1 have been reported to cause dystrophic epidermolysis bullosa (DEB), which may be inherited in an autosomal dominant (DDEB) or autosomal recessive pattern (RDEB), the incidence and prevalence of RDEB is not well defined. To date, the …

A Cross-Sectional Analysis Of Factors Associated With Detection Of Oncogenic Human Papillomavirus In Human Immunodeficiency Virus-Infected And Uninfected Kenyan Women, Aaron Ermel, P. Tonui, M. Titus, Y. Tong, N. Wong, J. Ong’Echa, Kapten Muthoka, Stephen Kiptoo, A. Moormann, Elkanah Omenge

Obstetrics and Gynaecology, East Africa

Background: Cervical cancer is caused by oncogenic human papillomaviruses (HPV) and is one of the most common malignancies in women living in sub-Saharan Africa. Women infected with the human immunodeficiency virus (HIV) have a higher incidence of cervical cancer, but the full impact on HPV detection is not well understood, and associations of biological and behavioral factors with oncogenic HPV detection have not been fully examined. Therefore, a study was initiated to investigate factors that are associated with oncogenic HPV detection in Kenyan women.

Methods: Women without cervical dysplasia were enrolled in a longitudinal study. Data from enrollment are presented …

Effect Of Target Controlled Propofol Infusion Versus Intermittent Boluses During Oesophagogastroduodenoscopy: A Randomized Controlled Trial, Catherine Ndosi, Vitalis Mung’Ayi, Ednah Gisore, Samina Mir

Anaesthesiology, East Africa

Background: Propofol is administered as intermittent boluses to achieve deep sedation to facilitate oesophagogastroduodenoscopy. Target controlled infusion (TCI) can be employed for this purpose.

Methods: 176 adults were randomly allocated into two groups of 88 patients. Control group: Received an initial bolus of propofol 1mg/kg, with repeat boluses of 0.25mg/kg. Intervention group: Received an initial target effect-site concentration of 4mcg/ml, followed by maintenance target effect-site concentration of 2.5mcg/ml, titrated by 0.5mcg/ml from baseline infusion rate as needed. Oxygen saturation, blood pressure and heart rate were evaluated immediately before administering the sedative and at 2.50, 5.00, 7.50 and 10.00 minutes. Oxygen …

Dexamethasone As Abortive Treatment For Refractory Seizures Or Status Epilepticus In The Inpatient Setting, Alexander B. Ramos, Roberto A. Cruz, Nicole R. Villemarette-Pittman, Piotr W. Olejniczak, Edward C. Mader Jr.

School of Medicine Publications

Refractory seizures or status epilepticus (RS/SE) continues to be a challenge in the inpatient setting. Failure to abort a seizure with antiepileptic drugs (AEDs) may lead to intubation and treatment with general anesthesia exposing patients to complications, extending hospitalization, and increasing the cost of care. Studies have shown a key role of inflammatory mediators in seizure generation and termination. We describe 4 patients with RS/SE that was aborted when dexamethasone was added to conventional AEDs: a 61-year-old female with temporal lobe epilepsy who presented with delirium, nonconvulsive status epilepticus, and oculomyoclonic status; a 56-year-old female with history of traumatic left …

Efficient And Robust Nk-Cell Transduction With Baboon Envelope Pseudotyped Lentivector., Aurelien B L Colamartino, William Lemieux, Panojot Bifsha, Simon Nicoletti, Nitin Chakravarti, Joaquín Sanz, Hugo Roméro, Silvia Selleri, Kathie Béland, Mélanie Guiot, Camille Tremblay-Laganière, Renée Dicaire, Luis Barreiro, Dean A Lee, Els Verhoeyen, Elie Haddad

Department of Medical Oncology Faculty Papers

NK-cell resistance to transduction is a major technical hurdle for developing NK-cell immunotherapy. By using Baboon envelope pseudotyped lentiviral vectors (BaEV-LVs) encoding eGFP, we obtained a transduction rate of 23.0 ± 6.6% (mean ± SD) in freshly-isolated human NK-cells (FI-NK) and 83.4 ± 10.1% (mean ± SD) in NK-cells obtained from the NK-cell Activation and Expansion System (NKAES), with a sustained transgene expression for at least 21 days. BaEV-LVs outperformed Vesicular Stomatitis Virus type-G (VSV-G)-, RD114- and Measles Virus (MV)- pseudotyped LVs (p < 0.0001). mRNA expression of both BaEV receptors, ASCT1 and ASCT2, was detected in FI-NK and NKAES, with higher expression in NKAES. Transduction with BaEV-LVs encoding for CAR-CD22 resulted in robust CAR-expression on 38.3 ± 23.8% (mean ± SD) of NKAES cells, leading to specific killing of NK-resistant pre-B-ALL-RS4;11 cell line. Using a larger vector encoding a dual CD19/CD22-CAR, we were able to transduce and re-expand dual-CAR-expressing NKAES, even with lower viral titer. These dual-CAR-NK efficiently killed both CD19KO- and CD22KO-RS4;11 cells. Our results suggest that BaEV-LVs may efficiently enable NK-cell biological studies and translation of NK-cell-based immunotherapy to the clinic.

Cultural Diversity In Healthcare [Radiologic Technology], Lorena Maldonado, Theresa Licari

Open Educational Resources

The Cultural Diversity in Healthcare assignment is designed for the SCX 101 Patient care course. This assignment was first implemented in 2011 and has undergone significant revisions in the past few years from individual presentation to collaborative group presentation in 2013 and the connection to the Health Science First Year Seminar (HSF) assignment in 2018. The most recent revisions made were through the Center for Teaching and Learning (CTL) workshop on Global Learning in Fall 2018. Feedback from the CTL seminar led to the inclusion of the Learning Objectives of the assignment and prompts that direct students to relate their …

Rare Presentation Of Cerebral Venous Sinus Thrombosis, Haris Majid Rajput, Anam Anis, Iqra Athar, Neelma Naz Khattak, Hanin Tanich, Mazhar Badshah

Pakistan Journal of Neurological Sciences (PJNS)

We report case of a 16 year old girl with no known co-morbidities, presented with headache, quadriparesis and sudden vision loss. She had pallor and BMI was 33.09kg/m2. She had left 6th nerve palsy, bilateral papilledema and no perception of light. Motor examination showed power of 4/5 in all four limbs with bilateral extensor plantars. Neuroimaging was suggestive of superior saggital sinus thrombosis. CSF opening pressure was 72 cm of water.20 ml CSF was drained leading to improvement in headache and visual acuity. CVST presenting with quadriparesis and visual loss is a rare entity. Common presentations of CVST include headache, …

Cerebral Venous Sinus Thrombosis With Positive Dengue Serology, Sajid Hameed, Owais Hashmat, Mubashar Memon, Muhammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

Dengue fever is a viral febrile illness caused by dengue virus and spread by Aedes mosquito worldwide. It usually manifests as an acute fever associated with body ache, skin rash, and thrombocytopenia. Neurological manifestations are relatively uncommon but well-known. We report a case of a 25-year-old male patient who presented to our hospital with acute febrile illness, headache, and vomiting. Extensive laboratory investigations were done and he was diagnosed with cerebral venous sinus thrombosis. Dengue serology was positive. He was treated with anticoagulation and hydration with complete recovery. The treatment with anticoagulation is challenging due to accompanying thrombocytopenia. Only two …

Culture Bound Syndromes In Pakistan: Implications And Strategic Vision For Health Management, Lamae Zulfiqar, Nazish Idrees, Muhammad Rafiq

Pakistan Journal of Neurological Sciences (PJNS)

Understanding the culture a person belongs to is crucial as it forms the beliefs, values, perspectives, worries and hopes. It can then be used to assess the problems a person goes through and devise a treatment plan with a focus on belief system of a person. Culture bound syndromes are common in every society but are usually overlooked or given less consideration by professionals. These syndromes are belief systems associated with various diseases and disorders and can be very helpful in treatment, if understood in the perspective of a particular person as every syndrome is perceived differently by an individual …

Can Early Orthotic Support And Physical Therapy Improve The Functional Level And Decrease Rate Of Surgical Interventions In Spastic Cerebral Palsy?, Sarfraz Ahmad, Syeda Rahat, Syeda Bushra

Pakistan Journal of Neurological Sciences (PJNS)

cerebral palsy is a disorder of movement and posture that results from a non progressive lesion of brain within 3 years of age. To determine the role of early orthotics and physical therapy in improving the functional status and in decreasing the rate of surgical interventions in management of spastic diplegic cerebral palsy child.

Mental Health Of University Male Students Viewing Internet Pornography: A Qualitative Study, Komal Razzaq, Muhammad Rafiq

Pakistan Journal of Neurological Sciences (PJNS)

This research was carried out to explore psychosocial and mental health issues of adults viewing pornography on the internet. Study Design: For this purpose, a qualitative research design was used. Method: In- depth interviews were conducted with twenty five university male students to explore the psychosocial issues in cases of internet pornography. After gathering the data from participants, a software, NVivo11 Plus was used for data management and analysis. This was also used for labelling and themes and categories generation. Results: After data analysis, main three categories generated on psychosocial issues associated with viewing internet pornography which were psychological issues, …

Rhabdomyolysis Due To Status Epilepticus Causing Acute Renal Failure, Iqra Athar, Neelma Naz Khattak, Haris Majid Rajput, Anam Anis, Hanin Tanich, Mazhar Badshah

Pakistan Journal of Neurological Sciences (PJNS)

Acute renal failure is one of the most common complications of rhabdomyolysis. Rhabdomyolysis is a serious syndrome and should be suspected in patients presenting after direct or indirect muscle injury, seizures, strenuous exercise, crush injuries and ingestion of drug or toxins. Rhabdomyolysis secondary to status epilepticus is a serious complication, leading to life threatening acute renal failure. Therefore, early recognition of risk of rhamdomylosis in status epilepticus and initiation of treatment is important.

Empowerment Of Primary Health Care In An Outreach Resource-Limited District In Punjab: A Strategy For Improving Adherence To Antiepileptic Drug Treatment In Children With Epilepsy., Muhammad Akbar Malik, Arshad Rafique, Ahmad Omar Virk

Pakistan Journal of Neurological Sciences (PJNS)

There is wide acknowledgement of the need for community involvement in the optimal management of children with epilepsy (CWE) in outreach financially constrained districts of the developing countries, but there is scarce data on comprehensive community-based childhood epilepsy treatment programs assessment.

Neurology Training In Pakistan: 2020-2025, Safia Bano, Sarwar Jamil Siddique, Ahsan Numan Numan

Pakistan Journal of Neurological Sciences (PJNS)

As the year 2019 comes to end, many advances in neurology has been occurred over worldwide and is still going on. The emergence of new devices and drugs will help neurologists with additional therapeutic options to optimize the patient care especially in more complex cases. Antibody therapies especially monoclonal antibodies are flooding the landscape in nearly every discipline of neurology is no exception. We watched newer clinical trials, gain FDA approval for use, and many more therapeutic evidence-based interventions enter the pipeline. Neurology in the 20th century has undergone extraordinary changes, particularly in the past few decades. We trace the …

Development And Validation Of Juvenile Criminal Thinking Styles’ Inventory, Fatima Sana, Muhammad Rafiq

Pakistan Journal of Neurological Sciences (PJNS)

The current research explored the styles of criminal thinking among juvenile delinquents in Pakistani cultural context. Initially, 40 juvenile delinquents were interviewed individually to generate an item pool of 34 distinct thought statements. After excluding repetitive items a list of 19 items was piloted on 30 juvenile delinquents as a self-report measure of 5-point rating scale (Juvenile Criminal Thinking Styles’ Inventory). Finally, a sample of 211 juvenile delinquents were given the final list of 19 items, Measure of Criminal Social Identity (Boduszek, Adamson, Shevlin, & Hyland, 2012; Shagufta, 2015), and a demographic form. Principal Component factor analysis determined a three …

Role Of Arginine And/Or Taurine In Protection Against Gentamicin-Induced Nephrotoxicity In Male And Female Rats, Amal H. Emara, Wafaa M. Ismaeil

Journal of Medicine in Scientific Research

Background As a highly effective antibiotic, gentamicin is used in the treatment of serious and life-threatening gram-negative infections. L-arginine (2-amino-5-guanidino-pentanoic acid) has a protective role on renal failure that induced by gentamicin administration and it may decrease the tubular reabsorption of another cationic substance, gentamicin due to its cationic structure. The aim of this study is to determine the influence of gender on nephroprotective effects of L-arginine (Arg) and/or taurine (Tau) on gentamicin (G) induced nephrotoxicity. Methods Adult Sprague-Dawley albino rats of both sexes (150-200 g, 48 male and 48 female), were bred from the animal unit of National Nutrition …

Glutamic Acid Decarboxylase Auto-Antibodies Prevalence Among Patients With Type 2 Diabetes Mellitus And Their Clinical Characteristics In A Sample Of The Egyptian Population, Atef A. Bassyounia, Ayat I. Ghanem, Ghada A. Omar

Journal of Medicine in Scientific Research

Background Patients with latent autoimmune diabetes in adults may develop early loss of β-cell mass. They are often misdiagnosed as having type 2 diabetes mellitus (T2DM). This is because latent autoimmune diabetes in adults condition does share characteristics of both type 1 and T2DM. Aim To estimate the prevalence of unrecognized cases with glutamic acid decarboxylase auto-antibodies (GADA) among patients with T2DM in a sample of the Egyptian population, describing their clinical and laboratory features, and investigating the relationship with chronic complications of diabetes. Settings and design A total of 1515 Egyptian patients previously diagnosed as having T2DM were divided …

Recent Conservative Management Trends In Dealing With Uterine Adnexal Torsion Will Preserve Fertility In Childbearing Women: A Review Of Literature And Case Series, Hossam H. Soliman

Journal of Medicine in Scientific Research

Introduction Uterine adnexal torsion is a rare gynecologic emergency, representing 2.5–7% of all the acute gynecologic surgical conditions. It could lead to adnexal ischemia and necrosis, putting a woman at the risk of a radical surgery, which leads her to lose a uterine adnexa, plummeting her future fertility, and possibility inducing a negative effect of her future marital and family life. Adnexal detorsion associated with cystectomy is a simple maneuver that could spare the woman of losing her ovary; this technique could successfully work even with an apparently necrosed ovary. Aim A review of literature, in addition to a retrospective …

Additive Value Of Intraoperative Hemodynamic Monitoring To Epicardial Echocardiography During Surgical Repair Of Children With Congenital Heart Disease, Ahmed A. Algebaly, Hanan Mohammed Hassan, Rania D. Eldin Abou Shokka

Journal of Medicine in Scientific Research

Aim The aim was to evaluate the additive value of intraoperative hemodynamic monitoring to epicardial echocardiography on the surgical outcome in children undergoing surgical correction of congenial heart disease. Patients and methods This study was conducted on 238 children with congenital heart disease who were enrolled for surgical correction. They were arranged in two groups: group A included 159 children in whom e-echo was used to detect intraoperative residual lesions while group B included 79 patients in whom e-echo and intraoperative hemodynamic monitoring using oxygen saturation step-up and intracardiac pressures after disconnection of cardiopulmonary bypass to detect residual shunt flow …

Surgical Outcomes Of Obstructive Mechanical Valve Thrombosis, Risk Factors, And Comorbidity Analysis, Ahmed Shafeek Ali

Journal of Medicine in Scientific Research

Background Obstructive mechanical valves thrombosis is a life-threatening complication associated with high morbidity and mortality. Although thrombolytic therapy has gained a lot of popularity in recent years, yet the treatment of choice is still controversial. Objective The aim of this study was to evaluate the outcomes of patients who underwent redo valve surgery for obstructive mechanical valve thrombosis. Patients and methods Outcomes of 380 patients who underwent emergency redo surgery for obstructive mechanical valve thrombosis at our institute during a 5-year period (January 2012 to December 2017) were reviewed retrospectively. Clinical symptoms and transthoracic echocardiography were the mainstay in diagnosis. …