Medical Specialties Commons^™

Clinical Spectrum And Factors Impacting Outcome Of Candida Auris: A Single Center Study From Pakistan, Muneeba Ahsan Sayeed, Joveria Farooqi, Kauser Jabeen, Safia Awan, S Mahmood

Section of Internal Medicine

Background: An outbreak of Candida auris began globally in 2014 including Pakistan and since then it has emerged as a nosocomial multi-drug resistant pathogen. The aim of this study was to assess the clinical spectrum and outcome of patients, from a single center in Pakistan, in whom C. auris was isolated.

Methods: A retrospective study was conducted on 92 patients; ≥16 years with at least one culture positive for C. auris, at the Aga Khan University Hospital Karachi, Pakistan from Sept 2014-Mar 2017.Demographics, clinical history, management and outcome were studied. A logistic regression model was used to identify the risk …

Increasing Adult's Awareness Of The Importance Of End-Of-Life Care Discussions, Taylor Gardner

Capstone Projects and Master's Theses

For many American families, end-of-life care is often not discussed, until advanced illness or injury has fully disrupted everyday life. There are many benefits to discussing end-of-life care prior to any medical complications. Research has shown that individuals who plan their end-of-life processes with a hospice service provider and family members report a higher quality of death than individuals receiving common health care during their final six months of life. In order to make families and friends more comfortable with end-of-life discussions, I will conduct two one-hour educational sessions to students at California State University, Monterey Bay.

Is A Varicocelectomy Beneficial In The Era Of Assisted Reproductive Technologies?, Chukwuka Oscar Nnoli

Physician Assistant Scholarly Project Papers

Clinical varicoceles are the most frequent physical finding associated with infertile men and impaired semen parameters. There is evidence that suggests varicocele repair improves semen parameter and increases the chances of natural pregnancy. Today, varicocele repair is often combined with assisted reproductive techniques (ART) such as intrauterine insemination (IUI), in Vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). In this literature review, data examining whether varicocelectomy before ART leads to improved pregnancy outcomes is reviewed. Current data suggest that there is a significant clinical benefit when correcting a varicocele in oligospermic men before IVF/ICSI. Similarly, men with non-obstructive azoospermia also …

Comparing Rates Of Macrosomia And Neonatal Hypoglycemia Of Differing Treatment Modalities Of Gestational Diabetes Mellitus, Ashleigh Milbrath

Physician Assistant Scholarly Project Papers

Gestational diabetes mellitus (GDM) is a known potential complication that can occur during pregnancy. Unmanaged GDM can result in maternal hyperglycemia, which can cause increased neonatal complications, two of which are macrosomia and neonatal hypoglycemia. To prevent maternal hyperglycemia, treatment of GDM typically begins with dietary changes, home glucose monitoring, increased exercise patterns and other lifestyle modifications. However, if maternal hyperglycemia persists after two weeks of maternal lifestyle modifications, there are not current best practice guidelines established for the treatment of GDM. Historically, subcutaneous multiple daily dosed insulin (MDI) has been the gold standard for treatment after lifestyle modification. However, …

Aspirin Use Following Preeclampsia To Prevent Future Cardiovascular Outcomes, Kristi Bohlig

Physician Assistant Scholarly Project Papers

Abstract Introduction: Preeclampsia during pregnancy warrants therapy with low dose aspirin. The purpose of this review is to investigate whether these women are at increased future risk for cardiovascular morbidity and mortality, and if aspirin therapy should be continued following the puerperium to prevent future cardiovascular events. Research Questions: Do women who had preeclampsia during pregnancy, have increased future cardiovascular morbidity and mortality? Does continued aspirin use in postpartum women, who had preeclampsia during pregnancy, decrease future cardiovascular morbidity and mortality outcomes? Research Methods: Literature review was conducted utilizing CINAHL, Dynamed plus and PubMed databases. Discussion: It is found that …

Cultural Work In Addressing Conflicts And Violence In Traumatized Communities, Eugen Koh

New England Journal of Public Policy

There is a growing appreciation that conflict and violence in many communities have their origins in a history of traumatic experiences. Why this link exists and how it comes about is still unclear. We have no unified psychology of traumatized communities, and little is known about how to address these traumatic origins collectively in these communities. This article proposes a psychodynamic model of collective trauma and a psychoanalytically informed approach to working with traumatized communities to address their issues of conflict and violence. It highlights the impact of collective trauma on the culture of a community, which is its collective …

Aortic Valve Opening And Closure: The Clover Dynamics., Emmanuel Lansac, Hou-Sen Lim, Yu Shomura, Khee Hiang Lim, Nolan T Rice, Isabelle Di Centa, Pouya Youssefi, Wolfgang Goetz, Carlos M G Duran

Articles, Abstracts, and Reports

Background: Systolic aortic root expansion is reported to facilitate valve opening, but the precise dynamics remain unknown. A sonometric study with a high data sampling rate (200 to 800 Hz) was conducted in an acute ovine model to better understand the timing, mechanisms, and shape of aortic valve opening and closure.

Methods: Eighteen piezoelectric crystals were implanted in 8 sheep at each annular base, commissures, sinus of Valsalva, sinotubular junction, nodulus of Arantius, and ascending aorta (AA). Geometric changes were time related to pressures and flows.

Results: The aortic root was hemodynamically divided into left ventricular (LV) and aortic compartments …

Experience With Acute Diaphragmatic Trauma And Multiple Rib Fractures Using Routine Thoracoscopy., Ledford Powell, Jacob Chai, Aaliyah Shaikh, Almaas Shaikh

Articles, Abstracts, and Reports

Background: Diaphragmatic injury is mostly caused by blunt or penetrating traumas. It is an uncommon diagnosis and therefore carries the risk of being misdiagnosed or delayed in diagnosis. In our institution, we perform routine thoracoscopy for the management of patients with traumatic rib fractures. We have noted several cases of occult diaphragmatic injuries and hypothesize that these injuries may be more of a penetrating injury from rib fractures as opposed to the high velocity blunt trauma typically associated with diaphragmatic injuries.

Methods: A retrospective review of medical records was performed on all patients admitted to our facility with rib fractures …

Predator Journals: An Urgent And Global Problem., Karsten Wiechert, Jeffrey C Wang, Jens R Chapman

Articles, Abstracts, and Reports

No abstract provided.

Erratum. Sodium-Glucose Cotransporter 2 Inhibition And Diabetic Kidney Disease. Diabetes 2019;68:248-257., Radica Alicic, Joshua J Neumiller, Emily J Cox, Brad P Dieter, Katherine Tuttle

Articles, Abstracts, and Reports

No abstract provided.

Management Of Acute Traumatic Central Cord Syndrome: A Narrative Review., Srikanth N Divi, Gregory D Schroeder, John J Mangan, Madeline Tadley, Wyatt L Ramey, Jetan H Badhiwala, Michael G Fehlings, F Cumhur Oner, Frank Kandziora, Lorin M Benneker, Emiliano N Vialle, Shanmuganathan Rajasekaran, Jens R Chapman, Alexander R Vaccaro

Articles, Abstracts, and Reports

Study Design: Narrative review.

Objectives: To provide an updated overview of the management of acute traumatic central cord syndrome (ATCCS).

Methods: A comprehensive narrative review of the literature was done to identify evidence-based treatment strategies for patients diagnosed with ATCCS.

Results: ATCCS is the most commonly encountered subtype of incomplete spinal cord injury and is characterized by worse sensory and motor function in the upper extremities compared with the lower extremities. It is most commonly seen in the setting of trauma such as motor vehicles or falls in elderly patients. The operative management of this injury has been historically variable …

Diagnostic Accuracy Of Diffusion Weighted Mri In Differentiating Benign And Malignant Meningiomas, Din Muhammad Sohu, Saba Sohail, Rehana Shaikh

Department of Radiology

Objective: To determine the diagnostic accuracy of DWI in differentiating benign and malignant meningiomas keeping histopathology as gold standard.
Methods: This was a descriptive analytical study conducted at Radiology Department, DUHS/Dr. Ruth K. M. Pfau Civil Hospital Karachi, from August 2016 to March 2018.It included152 patients clinically suspected of meningioma on conventional neuroimaging. Imaging features of DWI were compared with histopathology findings. The diagnostic accuracy of DWI was calculated in terms of sensitivity, specificity, accuracy, PPV and NPV using histopathology as gold standard.
Results: There were 59 male and 93 female patients with mean age of 55.38±9.8 years. Mean duration …

Differential Iron Regulatory Genetics In 2d & 3d Culture Of Breast Cancer Cells, Tyler Hanna, Suzy Torti Ph. D, Frank Torti M.D., Mph, Nicole Farra Ph. D.

Honors Scholar Theses

The iron regulatory axis has consistently been shown to be perturbed in cancer cell lines relative to non-cancerous cell lines. As cancer cells rapidly divide and grow, they require iron to fuel many intracellular processes, including DNA replication and protein synthesis. Three-dimensional cell culture is an increasingly popular method of culture that purportedly more accurately mimics the in vivo microenvironment of cancers over traditional two-dimensional culture. This project was prompted by previous lab results to investigate differential iron regulatory gene expression in 2D and 3D spheroid culture models. We replicated the findings that the gene hepcidin is induced in 3D …

Seeing Eye To Eye: A Machine Learning Approach To Automated Saccade Analysis, Maigh Attre

Honors Scholar Theses

Abnormal ocular motility is a common manifestation of many underlying pathologies particularly those that are neurological. Dynamics of saccades, when the eye rapidly changes its point of fixation, have been characterized for many neurological disorders including concussions, traumatic brain injuries (TBI), and Parkinson’s disease. However, widespread saccade analysis for diagnostic and research purposes requires the recognition of certain eye movement parameters. Key information such as velocity and duration must be determined from data based on a wide set of patients’ characteristics that may range in eye shapes and iris, hair and skin pigmentation [36]. Previous work on saccade analysis has …

P-Value Worship: Is The Idol Significant?, Joseph R Dettori, Daniel C Norvell, Jens R Chapman

Articles, Abstracts, and Reports

No abstract provided.

How Infant Positioning Impacts Hip Motion And The Associated Implications For Babies With Hip Dysplasia, Lauren Buchele

Biomedical Engineering Undergraduate Honors Theses

Developmental dysplasia of the hip (DDH) refers to a group of disorders, ranging from slight instability (Grades 1-3) to a severe dislocation (Grade 4) of the femoral head from the acetabulum [1]. In order to treat DDH in infants, a reduction procedure and the use of a lower body harness to secure the hip joint as the bones and ligaments re-form properly is typically prescribed. The Pavlik Harness is currently the “gold-standard” orthopedic device used to place hips in proper positioning. However, little research has been reported on the biomechanical affects during use of these device types.

Although the Pavlik …

An Integrative Approach To Mindfulness-Based Symptom Management For Myalgic Encephalomyelitis/Chronic Fatigue Syndrome, Lisa Barer

Mindfulness Studies Theses

Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a chronic health condition; its etiology is poorly understood, and treatment options are limited to management of symptoms. Current recommended treatment options are controversial, and evidence of effectiveness is limited. This paper proposes a novel model for symptom management of ME/CFS using mindfulness-based interventions, cognitive behavioural therapy (CBT), and relaxation techniques. A comprehensive review of available evidence is used to support this approach. The idea is that, working synergistically, these three approaches, grounded by mindfulness-based principles, can address many of the symptoms of the illness and help patients better cope and manage their day-to-day …

Mild Cognitive Deficits From Cancer Treatments, Jason Tse

Books, Presentations, Posters, Etc.

No abstract provided.

Clinical Decision Making: A Case Study Of The Effects Of Evidence Based Medicine And Past Empirical Experience In The Emergency Department, Olivia Zeman-Renner

Theses/Capstones/Creative Projects

With a growing number of medical malpractice suits and the passage of policy that focuses on patient advocacy, an emphasis has been placed on research regarding the decision-making processes of physicians in everyday practices. Over the past decades, scholars have looked to specific clinical decision-making philosophies, how they can be implemented into practice, and the effects of such implementation, but little research has been done into the culmination of decision-making philosophies on a day-to-day basis. By focusing on single-case study of a Midwestern Emergency Department and asking Attending physicians to self-report their decision-making philosophies, this study serves as a transition …

Prevalence Of Suspicious Mammographic Calcification In Newly Diagnosed Breast Cancer Patients At The Aga Khan University Hospital, Nairobi., Mariam Abdullahi Omar

Master of Medicine in Imaging and Diagnostic Radiology

Introduction: The most common cancer affecting women in Kenya is breast cancer with an incidence of 40.3 per 100 000 at risk population in 2018(1) while Nairobi has a higher incidence of (ASR 51.7 per 100,000) (2).This constitutes a major public health problem so early diagnosis plays a major role in mortality reduction and improving prognosis of breast cancer(3). Mammography is the most sensitive technique for detecting non palpable lesions. Over the decades it has been shown that in the USA there has been significant reduction in breast cancer mortality by 40% due to screening mammogram (4). On mammography the …

The Predictive Value Of Urine Dipstick Glucose Test In The Screening For Gestational Diabetes Mellitus In A Tertiary Private Hospital In Kenya, Janet Maranga

Master of Medicine in Clinical Pathology

Background: Worldwide, there is no consensus on the best approach to diagnose gestational diabetes mellitus (GDM) and though oral glucose tolerance testing (OGTT) is considered the gold standard, practices in the administration and interpretation of the test differ depending on the guidelines in use. Previous studies have questioned the utility of glycosuria as a screening test for GDM. Since the studies were conducted, there have been diagnostic threshold changes that might impact its utility. Justification: Diagnostic cut-offs of OGTT used in GDM diagnosis have evolved over time necessitating re-evaluation of glycosuria. The study was aimed at re-assessing the utility of …

A Review Of First Year Fellow Endoscopic Skills And Time To Proficiency, Antoinette Adjowa O. Walker, Dalya El Tawil, Jennifer Colombo, Nicholas Clark, Kimberly J. Reid

Posters

Through this quality improvement project, we have assessed the current fellows' upper endoscopy skill level during their first year and determined that the time to achieving proficiency is significantly longer than desired. The goal is to prepare new fellows for endoscopy prior to the beginning of their rotations with a curriculum that includes assigned reading materials, videos, and simulated endoscopic cases, to promote safety and increase satisfaction of patients by improving the readiness, skill level, and the confidence of first year inexperienced fellows.

Who Codes In The Nicu: An Analysis Of Demographics And Factors That Place Neonates At Higher/Lower Risk Of A Serious Code Event And Prognosis Post-Code, Danielle N. Gonzales, Ashley K. Sherman, Jennifer Dremann, Staci Elliott, Amelia Gute, Amber Bellinghausen, Jessica Brunkhorst, Danielle Reed

Posters

This study analyzed resuscitation events in a level IV neonatal intensive care unit from 2012-2017 to determine whether there are identifiable differences between those who have a rapid response event and those with a short or long code and determine factors post-event that may impact survival to discharge.

Dehydrated Hereditary Stomatocytosis Causing Sever Ascites Leading To Pulmonary Hypoplasia And Respiratory Insufficiency In A Neonate, Michael D. Mcdowell Jr, Christopher M. Oermann

Posters

Care Presentation: EM is a 32.5-week EGA infant who was born with sever congenital ascites (following repeated prenatal paracentesis) identified on prenatal ultrasound. Initial chest-abdomen imaging is shown in Figure 1. He required CPAP at delivery but was weaned of high flow nasal cannula with intermittent episodes of prolonged intubation during repeat paracentesis. Paracentesis demonstrated simple ascites rather than chylous fluid. Lymphangiograms demonstrated transient lymphatic leakage with resolution. Genetic evaluation revealed a pathogenic mutation in the PIEZO 1 gene for autosomal dominant DHS. This disorder had reduced penetrance and variable expressivity and symptoms range for absence of clinical features to …

Gonadotropin Releasing Hormone (Gnrh) Agonist Improves Hyperandrogenism In An Adolescent Female With A Novel Insulin Receptor Gene Mutation, Emily Paprocki, Romina Barral, Heidi Vanden Brink, Maria E. Lujan, Tania S. Burgert

Posters

We describe a case of an adolescent female with Type A insulin resistance whose severe hirsutism and hyperandrogenism were improved with leuprolide, despite extreme hyperinsulinemia. Ovarian volume decreased in association with the resolution of hyperandrogenism, consistent with ovarian size reflecting hyperandrogenism in adolescents.

This case allowed us to examine the frequently debated bidirectional relationship between insulin and hyperandrogenism, often deemed independent of gonadotropin activity.

Fetal Ventricular Measurement In Determination For Intrauterine Closure Of Myelomeningoceles, Paige Lundy, Emanuel Vlastos, Paul A. Grabb

Posters

Prenatal closure of myelomeningoceles for fetuses with ventricular width of greater than 15 mm at the time of intrauterine screening (19-25 weeks) has been discouraged, but little is documented regarding the details of ventricle measurement, modality, and timing. This study concludes that ultrasound and MRI provide different results in regards to fetal ventricle size. If treatment recommendations are going to be offered or withheld based on the 15 mm "rule" the method of fetal imaging must be taken into account.

“-Itis & -Itis”: Immune Checkpoint Inhibitors Toxicity Management, Timothy E. Byun

Books, Presentations, Posters, Etc.

No abstract provided.

Doxycycline Didn’T Cure The Fever! An Interesting Case Of Large Granular Lymphocytic (Lgl) Leukemia With Secondary Hemophagocytic Lymphohistiocytosis (Hlh)., Dayan Ojeda Damas, Ayesha Hamid, Kevin Wu, Michael Lapelusa, Nabeel Sarhill, Henry Kwang

School of Medicine Publications

HLH: A rare association with LGL Leukemia Dayan Ojeda-Damas MD, Ayesha Hamid MD, Kevin Wu MD, Michael Lapelusa MS-3, Nabeel Sarhill MD, Henry Kwang MD University of Texas Rio Grande Valley. Internal Medicine Residency at Valley Baptist Medical Center. Harlingen, TX Introduction Hemophagocytic lymphohistiocytosis (HLH) is a potentially fatal syndrome characterized by excessive immune activation. It is diagnosed in patients of all ages and is classified as either primary from gene mutations or secondary from various triggers. We present an interesting case of HLH in a patient with large granular lymphocytic leukemia (LGL). Presentation A 53-year-old female with a questionable …

Diagnostic Accuracy Of Multi-Parametric Mri In Diagnosis Of Clinically Significant Prostate Cancer, Mariah Obino

Master of Medicine in Imaging and Diagnostic Radiology

Background: Traditionally, the diagnosis of prostate cancer has been based on an elevated prostate specific antigen or an abnormal digital rectal examination and confirmed histologically following prostate biopsy. This has led to a number of men without cancer or with clinically insignificant disease undergoing unwarranted prostate biopsies and suffering consequent complications. Pre-biopsy multi-parametric MRI plays a vital role in determining men with clinically significant cancer who need biopsy and those with a negative MRI who can safely avoid an unwarranted biopsy. Whereas studies on the value of multi-parametric MRI have been done elsewhere, there is variation in prevalence of prostate …

Pediatric Ppi Use And Fractures, Nathan R. Fleishman, Troy Richardson, Thomas M. Attard

Posters

This study compared the rate of fracture among pediatric patients exposed to proton pump inhibitors to the rate among patients without exposure, and also considered the fracture location among children exposed to proton pump inhibitors.