Medical Specialties Commons^™

Typhoid And Paratyphoid Cost Of Illness In Pakistan: Patient And Health Facility Costs From The Surveillance For Enteric Fever In Asia Project Ii, Nelly Mejia, Farah Naz Qamar, Mohammad Tahir Yousafzai, Jamal Raza, Denise O. Garrett, Kashmira Date, Taiwo Abimbola, Sarah W. Pallas

Department of Paediatrics and Child Health

Background: The objective of this study was to estimate the cost of illness from enteric fever (typhoid and paratyphoid) at selected sites in Pakistan.
Methods: We implemented a cost-of-illness study in 4 hospitals as part of the Surveillance for Enteric Fever in Asia Project (SEAP) II in Pakistan. From the patient and caregiver perspective, we collected direct medical, nonmedical, and indirect costs per case of enteric fever incurred since illness onset by phone after enrollment and 6 weeks later. From the health care provider perspective, we collected data on quantities and prices of resources used at 3 of the hospitals, …

Healthcare Utilization Patterns For Acute Febrile Illness In Bangladesh, Nepal, And Pakistan: Results From The Surveillance For Enteric Fever In Asia Project, Jason R. Andrews, Krista Vaidya, Shampa Saha, Mohammad Tahir Yousafzai, Caitlin Hemlock, Ashley Longley, Kristen Aiemjoy, Alexander T. Yu, Isaac I. Bogoch, Farah Naz Qamar

Department of Paediatrics and Child Health

Background: Characterizing healthcare-seeking patterns for acute febrile illness is critical for generating population-based enteric fever incidence estimates from facility-based surveillance data.
Methods: We used a hybrid model in the Surveillance for Enteric Fever in Asia Project (SEAP) to assess incidence of enteric fever at 6 study hospitals in 3 countries. We recruited individuals presenting to the hospitals and obtained blood cultures to evaluate for enteric fever. For this analysis, we undertook cluster random household surveys in Dhaka, Bangladesh (2 sites); Karachi, Pakistan; Kathmandu, Nepal; and Kavrepalanchok, Nepal between January 2017 and February 2019, to ascertain care-seeking behavior for individuals with …

Challenges For Dementia Care And Research In Pakistan, Fatima Siddiqui, Qurat Khan, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

Dementia is a syndrome characterized by a decline in cognition and memory severe enough to interfere with daily life activities and is one of the major causes of disability and dependency in elderly worldwide with Alzheimer’s disease being the most common cause of dementia (1). 703 million individuals (9% of the world’s population) are more than 65 years of age and this number will double by the end of 2050 reaching 1.5 billion (16% of the world’s population) (2). Ageing has been the fastest in Eastern and South Eastern countries (3). Despite being a global health priority, with significant social …

Epidemiology Of Staphylococcus Aureus Infections In Kenya: Current State, Gaps And Opportunities, Justin Nyasinga, Geoffrey Omuse, John Njenga, Andrew Nyerere, Shima Abdulgader, Mae Newton, Andrew Whitelaw, Gunturu Revathi

Pathology, East Africa

Staphylococcus aureus has maintained its clinical relevance as a major cause of hospital and community acquired infections globally with a high burden of antimicrobial resistance (AMR). Though reported, the burden of infection, antimicrobial resistance and molecular epidemiology of S. aureus are not well defined in Kenya. This descriptive review evaluated reported data on the detection and characterization of S. aureus infections in Kenya. Published data between 2000 and 2020 were evaluated. S. aureus isolation frequencies varied from 1% in blood specimens to 52.6% among skin and soft tissues infections while MRSA rates ranged from 1% to 84.1%. While penicillin resistance …

Early Marriage And Early Childbearing In South Asia: Trends, Inequalities, And Drivers From 2005 To 2018, Samuel Scott, Phuong Hong Nguyen, Sumanta Neupane, Priyanjana Pramanik, Priya Nanda, Zulfiqar Ahmed Bhutta, Kaosar Afsana, Purnima Menon

Woman and Child Health

Early marriage (EM) and early childbearing (ECB) have far-reaching consequences. This study describes the prevalence, trends, inequalities, and drivers of EM and ECB in South Asia using eight rounds of Demographic and Health Survey data across 13 years. We report the percentage of ever-married women aged 20-24 years (n = 105,150) married before 18 years (EM) and with a live birth before 20 years (ECB). Relative trends were examined using average annual rate of reduction (AARR). Inequalities were examined by geography, marital household wealth, residence, and education. Sociodemographic drivers of changes for EM were assessed using regression decomposition analyses. We …

Label-Free Optical Biomarkers Detect Early Calcific Aortic Valve Disease In A Wild-Type Mouse Model, Ishita Tandon, Shelby Johns, Alan Woessner, Jessica Perez, Delaney Cross, Asya Ozkizilcik, Timothy Muldoon, Srikanth Vallurupalli, Muralidhar Padala, Kyle P. Quinn, Kartik Balachandran

Biomedical Engineering Faculty Publications and Presentations

Background

Calcific aortic valve disease (CAVD) pathophysiology is a complex, multistage process, usually diagnosed at advanced stages after significant anatomical and hemodynamic changes in the valve. Early detection of disease progression is thus pivotal in the development of prevention and mitigation strategies. In this study, we developed a diet-based, non-genetically modified mouse model for early CAVD progression, and explored the utility of two-photon excited fluorescence (TPEF) microscopy for early detection of CAVD progression. TPEF imaging provides label-free, non-invasive, quantitative metrics with the potential to correlate with multiple stages of CAVD pathophysiology including calcium deposition, collagen remodeling and osteogenic differentiation.

Methods …

The Cardiovascular Outcomes, Heart Failure And Kidney Disease Trials Tell That The Time To Use Sodium Glucose Cotransporter 2 Inhibitors Is Now., Michael E Johansen, Christos Argyropoulos

Heart and Vascular Articles

Sodium glucose contrasporter 2 inhibitors (SGLT2i) were initially introduced as a novel class of modestly effective antiglycemics. Over the last 5 years, multiple members of this class have been examined for their cardiovascular safety, effects on heart failure with reduced ejection fraction (HFrEF) and chronic kidney disease (CKD) in diverse populations with or without diabetes type 2. The plethora of studies and outcomes examined make it difficult for the practitioner to track the entirety of the evidence. SGLT2i improve cardiorenal outcomes and have a beneficial risk benefit ratio across populations with cardiovascular disease, HFrEF and kidney disease. In this quantitative …

Lyme Disease: A Cause Of Polymorphic Ventricular Tachycardia., Jordan Luli, Ishmail Saccoh, Elston Johnson, Eugene Fu, Steven Nelson, Anish Amin

Heart and Vascular Articles

No abstract provided.

A Signal Detection Framework For Evaluating The Effects Of Feedback On Stroke Recognition, Jordan D. Bailey

Dissertations

The impact of stroke on the lives of individuals and the healthcare system is considerable. Damage from stroke can be reduced if the treatment is administered at the appropriate time so early recognition is essential. One problem is that strokes present in a variety of ways that sometimes do not fit into the Facial drooping, Arm weakness, Speech difficulties and Time (FAST; American Heart Association, 2019) acronym. Signal detection is one way to measure decision making under conditions of uncertainty (e.g., discriminating stroke symptoms and risk factors from other symptoms, and non-risk factors). The methodology also allows us to consider …

Cardiac Electrophysiology: Exploring Racial And Gender Outcomes Of Treatment Of Paroxysmal And Persistent Atrial Fibrillation Using Sotalol And Dofetilide, Nicole Lanette Bradford-Love

Dissertations

Purpose

The purpose of this study is to explore the association between gender and racial lines in the conversion and sustainment of normal sinus rhythm (NSR) from paroxysmal atrial fibrillation (PAF) and persistent atrial fibrillation using the anti-arrhythmic drugs (AADs) sotalol and dofetilide.

Methods

A secondary data analysis was performed to assess the relationships of the independent and dependent variables listed above. Using SPSS v. 24 descriptive statistics were obtained and initially evaluated for accuracy with histograms. A cross-tabulation frequency table was produced to determine the number of variables that fell into each dependent category. Following this, the frequencies were …

Nurses' Attitudes Toward Physician-Assisted Suicide, Cheyenne Star Lowrey-Lagrone

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Physician-assisted suicide, or PAS, is end-of-life option in which patients self-administer physician-prescribed lethal medication to end their life. Nurses' own interpretations and understandings of the legalities, ethical dilemmas, and factors that influence their attitudes can be analyzed to determine the nurses’ role in the support or opposition of the practice. Although nurses do not have an active role in PAS, they play a pivotal role in patient advocacy and education. This paper analyzes the factors that contribute to nurses’ attitudes toward the practice, along with the benefits of education of this topic going forth.

Prevention Of Pediatric Mortality Associated With Malaria: An Exhaustive Literature Review, Taylor Mosley

The Eleanor Mann School of Nursing Undergraduate Honors Theses

Malaria, a disease that is preventable yet frequently fatal, disproportionately affects pediatric African populations at a rate that results in a child under the age of 5 dying every two minutes. Since 1955, the World Health Organization has contributed to a significant reduction in the morbidity and mortality of malaria; however, progress has stalled in recent years. In some countries, particularly those in sub-Saharan Africa, cases have increased since 2015. This literature review seeks to identify factors associated with this incline, as well as what interventions can have the greatest impact to prevent pediatric mortality in areas with the largest …

Rigorous Hand Hygiene Practices Among Health Care Workers Reduce Hospital-Associated Infections During The Covid-19 Pandemic, Rozina Roshan, Anam Shahil Feroz, Zohra Rafique, Nazleen Virani

Section of Internal Medicine

The experiences of these recent months have left us with as many new questions as they have given us new solutions. The main question that infection prevention and control department is having these days is "Why have hospital-associated infections (HAIs) reduced during COVID-19 pandemic?" What is the one unique strategy that has brought decline in increasing HAIs? Would it be appropriate to say that rigorous hand hygiene practices among health care workers (HCWs) have reduced HAIs in a tertiary care hospital of Pakistan? This commentary is written to understand the effect of rigorous hand hygiene among HCWs on number of …

Improving Code Response Time Through Strategic Positioning Of Nursing House Supervisors: Results Of A Nurse-Led Intervention, Noah R. Zanville, Paula T. Smith, Albis A. Aguiar, Joan Simon-Smith, Jessenia Menendez, Alice J. Cockerel, Rosalina P. Butao, Marguerite Rowell

Nursing & Health Sciences Research Journal

Background: In many settings, the nursing house supervisors (NHS) are a critical part of the entity’s code response team. To date, much of the research on code response has focused on improving response times through staff-focused interventions such as simulation training. However, use of data to determine where to physically place NHS in the building to optimize code response times has received little attention, especially in an outpatient oncology setting.

Purpose: To test whether using data on code frequency/location to strategically position NHS could reduce mean code response times in large (450,000-ft2) outpatient cancer center.

Methods: Data on code volume, …

Understanding Radiation Resistance In Head And Neck Tumor Xenografts Using Diffuse Reflectance And Raman Spectroscopy, Sina Dadgar

Graduate Theses and Dissertations

Each year, 800,000 new patients are diagnosed with head and neck squamous cell carcinoma (HNSCC), a majority of whom are treated with a combination of daily fractions of radiation and weekly chemotherapy sessions for up to seven weeks. Current methods to evaluate treatment response of individual patients are limited to anatomical measurements of tumor burden using CT scan or MRI 4-8 weeks after completion of treatment. However, earlier knowledge of radiation-response prior to or at early days after commencement of therapy can aid oncologist with escalating and de-escalating treatment plans for exceptionally non-responding and responding patients. Such a knowledge can …

Target Treatment With Stereotactic Radiation For Recurrent Gliomas, Ayesha Ali, Victor E. Chen, Claire Zurlo, James M Taylor, Christian Fernandez, Wenyin Shi

Department of Radiation Oncology Faculty Papers

High grade gliomas (HGG) have a propensity to recur locally and have poor outcomes. As such, safe and effective treatment is paramount. Target treatment with stereotactic radiation allows safe re-irradiation through minimizing normal brain tissue radiation due to its high precision. In this review, we evaluated the clinical experiences using SRS and FSRT for re-irradiation in HGG. We report the radiobiological advantages and disadvantages of both modalities as well as the safety and efficacy published in current literature.

A Narrative Review On The Basic And Clinical Aspects Of The Novel Sars-Cov-2, The Etiologic Agent Of Covid-19., Joseph Hokello, Adhikarimayum Lakhikumar Sharma, Girish C. Shukla, Mudit Tyagi

Center for Translational Medicine Faculty Papers

The novel SARS-CoV-2 is responsible for causing the ongoing outbreak of coronavirus disease 19 (COVID-19), a systemic infection in humans. Ever since it was first detected in December 2019, the number of confirmed cases has continued to increase. Within a short period, this disease has become a global issue, and therefore it is characterized as a pandemic. The current understanding and explanations are based on epidemiological, clinical and physiological observations. Besides, it remains a great challenge, as much remains to be understood about this new disease-causing virus. Therefore, we seek to provide an overview of SARS-CoV-2, including its classification, origin, …

Initiating A Geriatric Clinical Practicum In The Midst Of A Pandemic, April Wood

Faculty Research, Scholarly, and Creative Activity

No abstract provided.

The Link Between Heart Disease In Low Socioeconomic Communities In America, Khristopher Chea

Nursing | Senior Theses

As a future medical professional in the healthcare field, we continue to see patients admitted for cardiovascular issues. Cardiovascular diseases (CVDs) remain the leading cause of mortality among adults living in the U.S. despite advances in treatment throughout the past century. A number of risk factors such as hypertension, obesity, smoking, and physical inactivity contribute to the significant rise of cardiovascular disease. Research data suggests that there is correlation between cardiovascular disease, low socioeconomic status, and diet. According to the American Phycological Association socioeconomic status is measured by income, educational status, and occupation, and has been shown to be closely …

The Effects Of Moderate-Severe Plaque Psoriasis On Patient Well-Being And Prevention Of Flares, Glenn Devera

Nursing | Senior Theses

Psoriasis is a chronic skin condition that is indicated by red, patchy and scaly skin that can be painful when irritated. Patients with psoriasis have an increased risk for a number of chronic diseases. Despite the expansion of treatments for moderate-to-severe psoriasis over the last decade, patients may still find that treatment strategies are not as successful, leaving them dissatisfied with their treatments. A relationship built upon trust between the nurse and the patient diagnosed with psoriasis may serve to help ensure optimal care. A comprehensive literature review was performed and found that best practices for patient management need to …

Clinical Outcomes Of Superior Capsular Reconstruction For Massive, Irreparable Rotator Cuff Tears: A Systematic Review Comparing Acellular Dermal Allograft And Autograft Fascia Lata, Tyler J. Smith, Anirudh K. Gowd, John Kunkel, Lisa Kaplin, John B. Hubbard, Kevin E. Coates, Benjamin R. Graves, Brian R. Waterman

Orthopedic Surgery Resident Research

Purpose: To investigate clinical outcomes after superior capsular reconstruction (SCR) for the treatment of massive and/or irreparable rotator cuff tears treated with either allograft or autograft. Methods: Using the Preferred Reporting Items for Systematic Reviews and Meta Analyses (PRISMA) guidelines, in April 2020 a systematic review was performed using PubMed, MEDLINE, EMBASE, and Cochrane databases. Clinical studies were assessed for patient-reported outcomes and range of motion, comparing dermal allografts to fascia lata autografts, with a minimum follow-up of 12 months. Results: A total of 16 clinical studies involving 598 patients (606 shoulders) were included for data analysis, with a weighted …

Botox Injection To Treat Strabismus After Infant Botulism Type B Infection, Sarah G Bonaffini, Victoria Cocozza, Jing Jin

Ophthalmology Resident Research

Purpose: The significance of botulinum toxin to ophthalmologists is twofold. Botulism, a medical emergency, frequently presents with ocular findings including blurred vision, diplopia, ptosis, and photophobia as a result of the neurotoxin produced by Clostridium botulinum. However, botulinum toxins also have therapeutic uses for medical conditions including strabismus. The safety and efficacy of Botulinum toxin A in patients with a history of botulism has not been reported.

Observations: We report a 9-week-old infant, diagnosed with type B toxin positive infant botulism treated with human botulism immune globulin, who developed a large angle exotropia. The infant was treated with intramuscular injections …

Analysis Of Racial/Ethnic Disparities And Language Barriers In Radiation Therapy, Carrie Warner

Honors Projects

It is important for every patient within healthcare to have access to and receive quality care no matter their race, ethnicity, and/or primary language. Focusing on cancer care in the United States, there are racial and ethnic disparities as well as language barriers, both within the English language itself and with foreign languages, that prevent patients from receiving high quality care. This meta-analysis provides evidence of current disparities within healthcare that can be applied to the radiation oncology department and reveals suggestions for advancements including the use of language-concordant physicians and medical interpreters. Some of the policies, plans, and resources …

An Exploratory On Partial Anomalous Pulmonary Venous Return (Papvr), Gabriella Pitingaro

Honors Projects

This exploratory gives insight into Partial Anomalous Pulmonary Venous Return (PAPVR). The paper goes into depth explaining more detail about the congenital heart defect, the embryology surrounding it, and how much is still left to be discovered. With PAPVR's rarity (0.4-0.7% of the population), not much is known. Hypocritically, since PAPVR often goes undetected, our numbers for cases are estimated to be an underestimated value. The paper also goes into a specific case study regarding the celebrity Amy Grant and her experience with PAPVR and how it has affected her life and career.

Lyopreserved Amniotic Membrane Is Cellularly And Clinically Similar To Cryopreserved Construct For Treating Foot Ulcers, Kathryn E. Davis, Amanda L. Killeen, David Farrar, Katherine M. Raspovic, Zachary D. Berriman-Rozen, Matthew Malone, Lawrence A. Lavery

School of Podiatric Medicine Publications

We compared cellular viability between cryopreserved and lyopreserved amniotic membranes and clinical outcomes of the lyopreserved construct in a prospective cohort study of 40 patients with neuropathic foot ulcers. Patients received weekly application of lyopreserved membrane for 12 weeks with standard weekly debridement and offloading. We evaluated the proportion of foot ulcers that closed, time to closure, closure trajectories, and infection during therapy. We used chi-square tests for dichotomous variables and independent t-tests for continuous variables with an alpha of α = .10. Cellular viability was equivalent between cryo- and lyopreserved amniotic tissues. Clinically, 48% of subjects' wounds closed in …

The Effect Of Continuous Diffusion Of Oxygen Treatment On Cytokines, Perfusion, Bacterial Load, And Healing In Patients With Diabetic Foot Ulcers, Lawrence A. Lavery, Amanda L. Killeen, David Farrar, Yucel Akgul, Peter A. Crisologo, Matthew Malone, Kathryn E. Davis

School of Podiatric Medicine Publications

To evaluate continuous diffusion of oxygen therapy (CDO) on cytokines, perfusion, and bacterial load in diabetic foot ulcers we evaluated 23 patients for 3 weeks. Tissues biopsies were obtained at each visit to evaluate cytokines and quantitative bacterial cultures. Perfusion was measured with hyperspectral imaging and transcutaneous oxygen. We used paired T tests to compare continuous variables and independent T tests to compare healers and nonhealers. There was an increase from baseline to week 1 in TGF-β (P = .008), TNF-α (P = .014), VEGF (P = .008), PDGF (P = .087), and IGF-1 (P …

Neural Correlates Of Social Pain In Psychological Disorders: Implications For Educational Settings, Skye E. Johnson

Honors Projects

Pain has long been defined as a multidimensional construct; in past research, not only have the physical and sensory aspects of pain been investigated, but also the cognitive and emotional aspects, which include the experience of social pain. This experience is generally accepted to be very distressing and can have adverse effects on one's mental health, especially for those with neurological disorders. In my paper, I examine the effects of social pain on brain activity in individuals with autism spectrum disorder (ASD) and borderline personality disorder (BPD) as compared to those who are neurotypical. This research finds that while neurotypical …

Promoting Positive Birth Experiences: Supporting Pregnant And Lactating Women During The Covid-19 Crisis, Marina Baig, Shelina Bhamani, Zohra Kurji, Lumaan Sheikh, Rozina Karmaliani

Journal of Asian Midwives (JAM)

The World Health Organization (WHO) declared the COVID-19 outbreak a public health emergency of international concern, in January 2020. While international organizations and governments strive to strengthen the world’s emergency response mechanism to combat the pandemic, the public in general faces anxiety and fear. One of the most vulnerable groups is pregnant and lactating women. The pandemic has given rise to many apprehensions about the state of their health and well-being as well as that of their unborn or newly born child. A live Facebook session was conducted by a group of experts from a private university in Karachi, Pakistan, …

What Can Covid-19 Teach Us About Using Ai In Pandemics?, Krzysztof Laudanski, Gregory Shea, Matthew Dimeglio, Mariana Rastrepo, Cassie Solomon

Division of Internal Medicine Faculty Papers & Presentations

The COVID-19 pandemic put significant strain on societies and their resources, with the healthcare system and workers being particularly affected. Artificial Intelligence (AI) offers the unique possibility of improving the response to a pandemic as it emerges and evolves. Here, we utilize the WHO framework of a pandemic evolution to analyze the various AI applications. Specifically, we analyzed AI from the perspective of all five domains of the WHO pandemic response. To effectively review the current scattered literature, we organized a sample of relevant literature from various professional and popular resources. The article concludes with a consideration of AI's weaknesses …

Contraceptive And Reproductive Health Practices Of Unmarried Women Globally, 1999 To 2018: Systematic Review And Meta-Analysis, Meng-Yao Wang, Marleen Temmerman, Wei-Hong Zhang, Yu Fan, Yi Mu, Si-Ping Mo, Ai Zheng, Jin-Ke Li

Obstetrics and Gynaecology, East Africa

Background: Premarital sex practices and contraceptive prevalence rate (CPR) among unmarried women worldwide remain unclear, even though unmarried women tend to have multiple sex partners over time, which makes their sexual behaviors particularly important to the sexual and reproductive health of society more broadly.

Methods: We searched the MEDLINE, PubMed, and Google Scholar databases for relevant articles published between January 1, 1999 and December 31, 2018. Data on prevalence of premarital sexual intercourse, use of highly prevalent contraceptive methods, as well as CPR overall and at first sexual intercourse were extracted and estimated using a DerSimonian- Laird random effects model. …