Medical Specialties Commons^™

Neoantigen Screening Identifies Broad Tp53 Mutant Immunogenicity In Patients With Epithelial Cancers., Parisa Malekzadeh, Anna Pasetto, Paul F Robbins, Maria R Parkhurst, Biman C Paria, Li Jia, Jared J Gartner, Victoria Hill, Zhiya Yu, Nicholas P Restifo, Abraham Sachs, Eric Tran, Winifred Lo, Robert Pt Somerville, Steven A Rosenberg, Drew C Deniger

Articles, Abstracts, and Reports

No abstract provided.

Report Of An Inferior Rectal Nerve Variant Arising From The S3 Ventral Ramus., Graham Dupont, Joe Iwanaga, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

In surgical approaches to the perineum in general and anal region specifically, considering the possible variations of the inferior rectal nerve is important for the surgeon. Normally, the inferior rectal nerve originates as a branch of the pudendal nerve. However, during routine dissection, a variant of the inferior rectal nerve was found where it arose directly from the third sacral nerve ventral ramus (S3). Many cases have described the inferior rectal nerve arising independently from the sacral plexus, most commonly from the fourth sacral nerve root (S4); however, few cases have reported the inferior rectal nerve arising from S3. Herein, …

Variant Anatomy Of The Buccal Nerve., Mayank Patel, Joe Iwanaga, Shogo Kikuta, Rod J Oskouian, R Shane Tubbs

Articles, Abstracts, and Reports

Knowledge of the anatomy and variations of the nerves of the oral cavity is important to surgeons who operate this region. Herein, we report a rare case of a buccal nerve with two distinct roots. The anatomy of this case and its clinical applications is discussed.

Value Of Periodic Transcutaneous Daytime Carbon Dioxide Monitoring In Screening For Respiratory Failure In Patients With Amyotrophic Lateral Sclerosis, Muhammad K Rafiq

Pakistan Journal of Neurological Sciences (PJNS)

There is no single test currently available, which can predict respiratory failure in patients with amyotrophic lateral sclerosis (ALS) with high sensitivity and specificity. This study explores the potential use of transcutaneous carbon dioxide (PtcCO2) monitoring in early detection of respiratory failure in ALS.

Prevalence Of Stress And Depression Among University Students Of Karachi, Nida Naseem, Lubna Naz, Nazneen Zehra

Pakistan Journal of Neurological Sciences (PJNS)

Stress is an all-time concerned issue in undergraduate students. Stress levels are high due to workload, pressure of academic and extra-curricular activities and unhealthy lifestyle. Though stress can be beneficial for academic growth but increased magnitude can be harmful for physiological, psychological and social aspects.

Medical Doctors' Offline Computer-Assisted Digital Education: Systematic Review By The Digital Health Education Collaboration, Hayfaa Abdelmageed Wahabi, Samia Ahmed Esmaeil, Khawater Hassan Bahkali, Maher Abdelraheim Titi, Yasser Sami Amer, Amel Ahmed Fayed, Amr Jamal, Nasriah Zakaria, Amna Rehana Siddiqui, Monika Semwal

Community Health Sciences

Background: The widening gap between innovations in the medical field and the dissemination of such information to doctors may affect the quality of care. Offline computer-based digital education (OCDE) may be a potential solution to overcoming the geographical, financial, and temporal obstacles faced by doctors.
Objective: The objectives of this systematic review were to evaluate the effectiveness of OCDE compared with face-to-face learning, no intervention, or other types of digital learning for improving medical doctors' knowledge, cognitive skills, and patient-related outcomes. Secondary objectives were to assess the cost-effectiveness (CE) of OCDE and any adverse effects.
Methods: We searched major bibliographic …

A Pilot Study Identifying Brain-Targeting Adaptive Immunity In Pediatric Extracorporeal Membrane Oxygenation Patients With Acquired Brain Injury, Sterling B. Ortega, Poornima Pandiyan, Jana Windsor, Vanessa O. Torres, Uma M. Selvaraj, Amy Lee, Michael Morriss, Fenghua Tian, Lakshmi Raman, Ann M. Stowe

Neurology Faculty Publications

OBJECTIVES: Extracorporeal membrane oxygenation provides short-term cardiopulmonary life support, but is associated with peripheral innate inflammation, disruptions in cerebral autoregulation, and acquired brain injury. We tested the hypothesis that extracorporeal membrane oxygenation also induces CNS-directed adaptive immune responses which may exacerbate extracorporeal membrane oxygenation-associated brain injury.

DESIGN: A single center prospective observational study.

SETTING: Pediatric and cardiac ICUs at a single tertiary care, academic center.

PATIENTS: Twenty pediatric extracorporeal membrane oxygenation patients (0-14 yr; 13 females, 7 males) and five nonextracorporeal membrane oxygenation Pediatric Logistic Organ Dysfunction score matched patients.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: Venous blood samples were …

Epithelioid Glioblastoma Presenting As Aphasia In A Young Adult With Ovarian Cancer: A Case Report, Megan M. Finneran, Joseph Georges, Michael Kakareka, Ryan Moncman, Miriam Enriquez, Todd Siegal, Gregory Kubicek, Alan Turtz, Steven S. Yocom, H Warren Goldman

PCOM Scholarly Works

Our patient's clinical history and preoperative radiographic evaluation suggested central nervous system (CNS) metastatic disease. Ultimately, final pathology revealed epithelioid glioblastoma (eGBM), a newly classified CNS primary tumor. This reinforces the importance of direct tissue sampling and including eGBM on the differential for young patients with histories of systemic cancer presenting with new CNS lesions.

Femoral Vein Transposition Arteriovenous Fistula Is A Feasible Option In "Selected" Patients As Hemodialysis Access, Zia Ur Rehman, Asfia Arham, Ziad Sophie

Section of Cardiothoracic Surgery

Introduction: Lower extremity hemodialysis access is offered to the patients who have severe central venous stenosis. Femoral vein transposition arteriovenous fistula (FV tAVF) is an alternative to lower leg arteriovenous prosthetic grafts. Its safety and patency is under observation.
Materials and Methods: This is a retrospective review of patients who had FV tAVF between January 2011 and March 2016. Preoperative clinical findings, intraoperative findings, postoperative complications, and patency of the AVF were noted and analyzed.
Results: There were 7 patients who underwent FV tAVF during this study period. Most patients were female (6 : 1), with mean …

Understanding Constipation: A Cross-Sectional Study From A Developing Country Setting, Minaz Mawani, Abdul Azeem, Sakina Gheewala, Nazish Butt, Shahab Abid

Section of Gastroenterology

A cross-sectional study was conducted in the Gastroenterology Clinics of The Aga Khan Hospital and Jinnah Postgraduate Medical Centre in Karachi. All patients complaining of constipation were included. Patients with alarm features were excluded. Interviews were conducted by trained doctors using a structured Rome III based pre-tested questionnaire and Bristol Stool Form Scale. Out of 396 participants, 186 (47.0%) had FC and 209 (52.7%) had IBS-C. Based upon Bristol Stool Form Scale, only 214 (54%) reported to have slow transit constipation (BSS <2). A higher proportion of women reported severe form of constipation as compared to men (81.5%, n=150 vs. 65.1%, n=138 p<0.001). However, a higher percentage of men reported using medications to treat their symptoms (71.2%, n=151 vs. 57.1%, n=105 p=0.003). Proper understanding of patient's symptoms is essential for optimizing individual patient management.

Intravenous Meloxicam For The Treatment Of Moderate To Severe Acute Pain: A Pooled Analysis Of Safety And Opioid-Reducing Effects., Eugene R. Viscusi, Tong J. Gan, Sergio Bergese, Neil Singla, Randall J. Mack, Stewart W. Mccallum, Wei Du, Sue Hobson

Department of Anesthesiology Faculty Papers

BACKGROUND AND OBJECTIVES: To describe the safety and tolerability of intravenous meloxicam compared with placebo across all phase II/III clinical trials.

METHODS: Safety data and opioid use from subjects with moderate to severe postoperative pain who received ≥1 dose of intravenous meloxicam (5-60 mg) or placebo in 1 of 7 studies (4 phase II; 3 phase III) were pooled. Data from intravenous meloxicam 5 mg, 7.5 mg and 15 mg groups were combined (low-dose subset).

RESULTS: A total of 1426 adults (86.6% white; mean age: 45.8 years) received ≥1 dose of meloxicam IV; 517 (77.6% white; mean age: 46.7 years) …

Stress-Induced Epinephrine Enhances Lactate Dehydrogenase A And Promotes Breast Cancer Stem-Like Cells, Bai Cui, Yuanyuan Luo, Pengfei Tian, Fei Peng, Jinxin Lu, Yongliang Yang, Qitong Su, Bing Liu, Jiachuan Yu, Xi Luo, Liu Yin, Wei Cheng, Fan An, Bin He, Dapeng Liang, Sijin Wu, Peng Chu, Luyao Song, Xinyu Liu, Huandong Luo, Binhua P. Zhou

Molecular and Cellular Biochemistry Faculty Publications

Chronic stress triggers activation of the sympathetic nervous system and drives malignancy. Using an immunodeficient murine system, we showed that chronic stress–induced epinephrine promoted breast cancer stem-like properties via lactate dehydrogenase A–dependent (LDHA-dependent) metabolic rewiring. Chronic stress–induced epinephrine activated LDHA to generate lactate, and the adjusted pH directed USP28-mediated deubiquitination and stabilization of MYC. The SLUG promoter was then activated by MYC, which promoted development of breast cancer stem-like traits. Using a drug screen that targeted LDHA, we found that a chronic stress–induced cancer stem-like phenotype could be reversed by vitamin C. These findings demonstrated the critical importance of psychological …

Application Of Tasman Technique For Congenital Absence Of Nasal Cartilage: A Case Report, Dominick Gadaleta, Ryan N. Heffelfinger

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

No abstract provided.

Adult-Onset Still’S Disease Triggered By Pregnancy, Saleem Abdulkarim, Fredrick Otieno, Sayed Karar

Internal Medicine, East Africa

Adult-onset Still’s disease (AOSD) is an inflammatory disorder with arthritis, quotidian fever, evanescent rash, elevated white cell count, elevated ferritin, and abnormal liver function tests. The diagnosis requires the exclusion of other inflammatory, infectious, and malignant conditions. Onset of AOSD, though rare, has been known to occur in pregnancy. We present a 28-year-old woman diagnosed with AOSD at 3 months gestation.

Improving Rural Pediatric Patient Management Through Streamlined High-Volume Patient Clinical Pathways Enhanced By Standardized Nursing Education For Care Confidence, Marie-Cassandre O. Macdonnell

Doctoral Projects

Rural America creates a challenging, poorly financed environment for pediatric health. More than 20 million Americans live in areas with physician shortages too great to meet basic health need (Petlz et al., 2013). In comparing rural versus urban data, rural population experience a 7% higher rate of chronic health conditions (44% versus 37%), increased inpatient costs ($8, 507 versus $7, 174) and higher odds ratios for pediatric 30-day readmission. Findings from Khan et al., (2015) note that hospital readmission rates have higher odds ratios in pediatric patients (95% CI); of Caucasian ethnicity 0.74 [0.65–0.84] to 0.88 [0.79–0.99]); when admitted to …

A Value Analysis Of Microsurgical Lower Extremity Reconstruction Vs. Acellular Urinary Bladder Matrix (Ubm) For Radiation Wounds Of The Lower Extremity, Christopher J. Micallef, Jamie N. Johnson, R. Michael Johnson

Orthopaedic Surgery Faculty Publications

In the USA, external beam radiation is offered to patients as an alternative to surgery for non-melanoma skin cancers. While this technique may be useful in highly specific patient populations, recalcitrant chronic radiation wounds can result. These complex wounds ultimately may require major reconstructive surgery to achieve closure. Porcine urinary bladder matrix (UBM) may be effective in the treatment of radiation wounds and eliminating the need for vascularized tissue transfers. A case report of an elderly male with bilateral radiation wounds of the lower extremity, one extremity treated with free flap reconstruction and the other with porcine urinary bladder matrix, …

Neck Movement During Cervical Transforaminal Epidural Injections And The Position Of The Vertebral Artery: An Anatomical Study., Juan J Altafulla, Emre Yilmaz, Stefan Lachkar, Joe Iwanaga, Jacob Peacock, Zachary Litvack, R Shane Tubbs

Articles, Abstracts, and Reports

Background: Cervical transforaminal epidural steroid injections (CTFESIs) are sometimes performed in patients with cervical radiculopathy secondary to nerve-root compression. Neck movements for patient positioning may include rotation, flexion, and extension. As physicians performing such procedures do not move the neck for fear of injuring the vertebral artery, we performed fluoroscopy and cadaveric dissection to analyze any movement of the vertebral artery during head movement and its relation to the foramina in the setting of CTFESI.

Purpose: To determine cervical rotational positioning for optimized vertebral artery location in the setting of cervical transforaminal epidural steroid injections.

Material and Methods: Four sides …

Posterior Reversible Encephalopathy Syndrome (Pres) Presenting As Transient Complete Visual Loss, Nismat Javed, Sohail Naseem, Mohammad Amer Awan, Shahzad Khan Siddique, Arsalan Ahmad

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Application Of Epley Maneuver In Treating Benign Paroxysmal Positional Vertigo (Bppv), Nasir Yaqoob, Arif Herekar

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Cognitive And Brain Plasticity By Performing Small Scale Brain Activities In Youth, Sonya Arshad, Muhammad Nisar, Mushkbar Fatima, Sadaf Ahmed

Pakistan Journal of Neurological Sciences (PJNS)

Is playing video game really a waste of time? No…!!! It’s merely a simple way of making the brain physiology better, smarter and faster. Great quality games, which are testing, enlightening, and retaining, can make learning charming and compelling. Studies have shown that people who are engaged in playing video games have more grey matter in their brains which results in boosting up their cognitive skills.

Antioxidative Activity Of Clove (Syzygium Aromaticum) Oil Administration In Middle Cerebral Artery Occlusion (Mcao) Models Of Acute Focal Cerebral Ischemia, Hira Jawed, Mufzala Shamim, Sumera Sohail, Uzma Firdous, Nazish Iqbal Khan

Pakistan Journal of Neurological Sciences (PJNS)

Stroke is a multifactorial neurological deficit syndrome. Oxidative stress is the principal underlying pathophysiological mechanism of ischemic stroke associated with neuronal damage and neuroinflammation.

Role Of High-Sensitivity Troponin T As A Sensitive Biomarker For Postoperative Myocardial Infarction And Outcome After Isolated Coronary Artery Bypass Grafting Surgery, Ahmed A. Faragalla, Mamdouh Maher, Rasha H. Mohammed, Wael El-Hakeem, Wael M. Hosam

Journal of Medicine in Scientific Research

Background Uncertainty exists about the diagnosis of post-coronary artery bypass grafting (CABG) Perioperative myocardial infarction (PMI) owing to nonconsensus for elevated biomarkers diagnostic levels and associated criteria. Post-CABG studies concerning high-sensitivity troponin (hs-TnT) and its role in the diagnosis of postoperative MI are few. Aim We are aiming to figure out the diagnostic and prognostic role of hs-TnT in individuals undergoing isolated coronary artery bypass graft surgery and whether it has relations to other diagnostic criteria. Patients and methods A total of 50 patients with multivessel coronary artery disease who elected for isolated CABG were enrolled in the study. Our …

The Use Of Microplates For Fixation Of Mandibular Fractures: A Systematic Review, Magdy M. Zaky, Mohamed F. Shehab, Nabila A. Fayed, Usama S. Hellal

Journal of Medicine in Scientific Research

Background Microplates have thin diameter making them less palpable, more malleable, easily applied, and adaptable to fracture site. In the past, microplates were used in midface fractures only, but we can obtain their benefits in mandibular fractures as well. Objective The aim of this systematic review was to verify the efficiency of microplates either alone or in combination with miniplates for fixation of mandibular fractures in comparison with miniplates. Materials and methods A systematic review was conducted using electronic databases for collecting articles that met the inclusion and exclusion criteria. Data were extracted from each article, and the quality of …

Role Of Sclerostin, Fibroblast Growth Factor-23, And Klotho In Hemodialysis Patients, Ahmed Hassan, Azza A. I. Elmenyawi

Journal of Medicine in Scientific Research

Introduction Chronic kidney disease–mineral bone disorder leads to decreasing bone health. Sclerostin is produced by osteocytes similar to fibroblast growth factor-23 (FGF-23) and might upregulate the FGF-23 production by the osteocyte. FGF-23 may act as a mineralization inhibitor. Klotho serves as an obligate coreceptor for the FGF-23 and represents a marker of chronic kidney disease–mineral bone disorder. Aim We examined the association between serum sclerostin, FGF-23, Klotho, parathyroid hormone, high-sensitivity C-reactive protein (hsCRP), and phosphorus levels in hemodialysis (HD) patients. Patients and methods A total of 63 HD patients in the National Institute of Urology and Nephrology and 20 controls …

Effect Of Different Doses Of Low-Intensity Laser Therapy On Total Active Range Of Motion After Hand Flexor Tendon Repair, Amir A. Saidi, Amir N. Wadee, Eid R. Abd El Azim, Feify A. Badawy, Osama F. Al Balah, Wadida H. Elsayed

Journal of Medicine in Scientific Research

Objective To investigate the difference between the effects of different doses of low-level laser therapy (4 or 1 J/cm²) on the return of hand active range of motion (ROM) after flexor tendon repair. Participants and methods A small trial was conducted on 33 patients with 45 injured fingers of both sexes who underwent primary repair after complete cut of hand flexor tendon. Their age ranged from 20 to 40 years old. They were recruited from the plastic surgery department. The treatment began the first day postoperatively after permission by surgeons using Duran protocol and splinting. Transcutaneous electrical nerve …

Endoscopic Treatment Of Acute Gastric Variceal Bleeding In Patients With Cirrhosis Using Isoamyl-2-Cyanoacrylate, El Saied E. Shabaan, Tarek A. Fouad

Journal of Medicine in Scientific Research

Context Gastric variceal (GV) bleeding is a serious complication in patients with cirrhosis, as it is usually severe with high rate of mortality and rebleeding. Aim The aim of this study was to evaluate the efficacy and safety of endoscopic therapy with isoamyl-2-cyanoacrylate (Amcrylate) in patients with cirrhosis with GV (gastroesophageal varices type 2 and isolated gastric varices type 1) bleeding. Patients and methods We prospectively studied 34 patients with cirrhosis with bleeding GV who were treated with intravariceal injection of isoamyl-2-cyanoacrylate (Amcrylate). Statistical method Data were expressed as the mean ± SD or as number (%) for numerical variables. …

Relationship Between Dietary Intake And Obesity Among A Group Of Primary School-Aged Children In Cairo Governorate, Ahmed S. Marei, Hany H. El-Gazzar, Khaled Elkelany, Mohamed F. Al Soda, Saher A. Khairy, Salwa M. Saleh, Mahmood D. Al-Mendalawi

Journal of Medicine in Scientific Research

No abstract provided.

Carbetocin Versus Oxytocin In Prevention Of Postpartum Hemorrhage In Late Preterm Twin Pregnancy Following Cesarean Section: A Prospective Clinical Study, Ashraf M. Kansouh, Mohamed A. El Naggar

Journal of Medicine in Scientific Research

Objective The objective of this study was to compare effectiveness and safety of carbetocin versus oxytocin infusion in prevention of postpartum hemorrhage (PPH) in women with late preterm twin pregnancy undergoing cesarean section. Patients and methods A prospective clinical study was conducted from June 2014 to August 2015 in Shibin El-Kom and Benha Teaching Hospitals in Egypt that enrolled 175 women with late preterm twin pregnancy undergoing cesarean section. Carbetocin group (n = 90) as a single intravenous bolus was compared with oxytocin (n = 85) 10 IU as six infusions as soon as the second twin was …

Significance Of Matrix Metalloproteinase-9 Expression In The Ectopic Endometrial Tissue Of Women With Endometriosis, Abd Elatif M. Elbalshy, Ashraf M. Kansouh, Samar E. Ghanem

Journal of Medicine in Scientific Research

Background Degradation of the extracellular matrix is a basic step in the formation of endometriosis. The extracellular matrix degradation operated by matrix metalloproteinases (MMPs) Because matrix metalloproteinases (MMPs) are essential in orchestrating proper physiological functioning of the endometrium. MMP-9 is affected by many factors such as prostaglandin E2, tumor necrosis factor-α, interleukin 1β, interferon-γ, and tissue inhibitors of matrix metalloproteinase. Objective The aim of the present study was to evaluate MMP-9 forms in the ectopic and eutopic endometrial tissue of women with endometriosis. Patients and methods The study was carried upon 56 patients. Patients were divided into two groups (study …

Key Role Of Inferior Turbinectomy And Partial Middle Turbinectomy In Endoscopic Surgery For Allergic Fungal Sinusitis: A Comparative Study, Ahmad Mostafa, Essam Fatehy, Mohammad M. Gaballah, Wael A. Alzamil

Journal of Medicine in Scientific Research

Background Proper eradication of allergic fungal sinusitis (AFS) depends on three factors: first is proper preoperative evaluation and mapping via computed tomography and MRI. Second is the availability of adequate surgical tools in experienced hands. Third is the proper postoperative endoscopic follow-up to detect and remove recurrence if possible. Aim To evaluate the role of inferior turbinectomy (IT) and partial middle turbinectomy (PMT) in patients with AFS managed by endoscopic sinus surgery (ESS) for the prevention of recurrence and adequate management of residual disease (postoperative salvage). Patients and methods A prospective, comparative, randomized study conducted from March 2016 to April …