Medical Specialties Commons^™

Cardiac Interventions In Patients With Achondroplasia: A Systematic Review., Amrita Sukhavasi, Thomas J O'Malley, Elizabeth J Maynes, Jae Hwan Choi, Jonathan S Gordon, Kevin Phan, Vakhtang Tchantchaleishvili

Jefferson Hospital Staff Papers and Presentations

Patients with achondroplasia and other causes of dwarfism suffer from increased rates of cardiovascular disease relative to the remainder of the population. Few studies have examined these patients when undergoing cardiac surgery or percutaneous intervention. This systematic review examines the literature to determine outcomes following cardiac intervention in this unique population. An electronic search was performed in the English literature to identify all reports of achondroplasia, dwarfism, and cardiac intervention. Of the 5,274 articles identified, 14 articles with 14 cases met inclusion criteria. Patient-level data was extracted and analyzed. Median patient age was 55.5 [interquartile ranges (IQR), 43.8, 59.8] years, …

Neurological Involvement In Covid-19 Infections; Pathophysiology, Presentation And Outcome., Dureshahwar Kanwar, Muhammad Imran, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

Severe acute respiratory syndrome corona virus 2 (SARS CoV 2) seems to display an increasing affinity for the nervous system. The ongoing pandemic has made evident that diverse neurological manifestations may occur with COVID 19. Headache and dizziness remain the most common symptoms however stroke, seizures, encephalopathy, neuropathy and skeletal muscle injury may be seen. An increasing number of patients report initial anosmia and ageusia. Tendency for serious illness is believed to be in the elderly or people with a history of diabetes, high blood pressure and heart disease. Many patients on immunosuppressive therapies such as multiple sclerosis, myasthenia gravis …

Nephron Sparing Surgery For Renal Tumors-Comparison Of Off-Clamp Partial Nephrectomy With Hilar Clamping, Imran K. Jalbani, Syed Muhammad Nazim, Maria Ahmed, Farhat Abbas

Section of Urology

Background and objective: Open partial nephrectomy (PN) is still considered gold standard procedure for T1 localized renal tumors. Conventional technique involves clamping of the renal artery with or without vein however, renal ischemia produces a certain level of damage to the kidneys. This study aims to investigate potential effect of off-clamp vs. hilar clamping PN on renal function.
Methods: This is a retrospective cohort study of patients who underwent unilateral, open partial nephrectomy for renal tumors b/w January 2009 December 2016 at our institution. A total of 90 partial nephrectomies were performed of which 65 cases were eligible for analysis. …

Primary Intracranial Malignant Melanoma, Ummey Hani, Dr Saqib Kamran Bakhshi, Muhammad Shahzad Shamim

Section of Neurosurgery

Primary intracranial malignant melanoma (PIMM) are rare brain tumours; more infrequent than melanomas metastasizing to the brain or those extending to the brain from adjacent structures such as the orbit. Complete surgical excision with adjuvant chemotherapy and radiation remains the mainstay of treatment. Herein, we have reviewed the literature to find the treatment modalities for PIMMs that can lead to longer overall survivals and better patient outcomes.

Primary Sclerosing Cholangitis: Epidemiology, Genetics, Diagnosis, And Current Management., Eric Gochanour, Channa Jayasekera, Kris V Kowdley

Articles, Abstracts, and Reports

http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/15-3-reading-gochanour a video presentation of this article http://aasldpubs.onlinelibrary.wiley.com/hub/journal/10.1002/(ISSN)2046-2484/video/15-3-interview-kowdley an interview with the author.

Enthesitis In Psoriatic Arthritis (Part 3): Clinical Assessment And Management., Philip Mease

Articles, Abstracts, and Reports

Enthesitis is a common clinical feature of PsA, which is characterized by inflammation at the site of insertion of tendons, ligaments and joint capsule fibres into bone. Enthesitis is relatively unique to the spondyloarthritides, setting this group of diseases apart from other rheumatological conditions. The pathophysiological underpinnings of this clinical domain, and the imaging assessment of it, are described in accompanying articles in this supplement. The focus of this article is on the assessment of enthesitis by physical examination, the impact of enthesitis on function and quality of life, the impact of concomitant FM on clinical assessment, and the evidence …

Impact Of Traffic, Poverty And Facility Ownership On Travel Time To Emergency Care In Nairobi, Kenya, Maya S. Fraser, Benjamin Wachira, Abraham D. Flaxman, Aaron Y. Lee, Herbert C. Duber

Emergency Medicine, East Africa

Background: In many low and middle-income countries (LMICs), timely access to emergency healthcare services is limited. In urban settings, traffic can have a significant impact on travel time, leading to life-threatening delays for time-sensitive injuries and medical emergencies. In this study, we examined travel times to hospitals in Nairobi, Kenya, one of the largest and most congested cities in the developing world.

Methods: We used a network approach to estimate average minimum travel times to different types of hospitals (e.g. ownership and level of care) in Nairobi under both congested and uncongested traffic conditions. We also examined the correlation between …

A First-In-Human Phase 1 Dose Escalation Study Of Spartalizumab (Pdr001), An Anti-Pd-1 Antibody, In Patients With Advanced Solid Tumors., Aung Naing, Justin F Gainor, Hans Gelderblom, Patrick M Forde, Marcus O Butler, Chia-Chi Lin, Sunil Sharma, Maria Ochoa De Olza, Andrea Varga, Matthew H Taylor, Jan H M Schellens, Hongqian Wu, Haiying Sun, Antonio P Silva, Jason Faris, Jennifer Mataraza, Scott Cameron, Todd M Bauer

Articles, Abstracts, and Reports

BACKGROUND: Spartalizumab is a humanized IgG4κ monoclonal antibody that binds programmed death-1 (PD-1) and blocks its interaction with PD-L1 and PD-L2. This phase 1/2 study was designed to assess the safety, pharmacokinetics, and preliminary efficacy of spartalizumab in patients with advanced or metastatic solid tumors.

METHODS: In the phase 1 part of the study, 58 patients received spartalizumab, intravenously, at doses of 1, 3, or 10 mg/kg, administered every 2 weeks (Q2W), or 3 or 5 mg/kg every 4 weeks (Q4W).

RESULTS: Patients had a wide range of tumor types, most commonly sarcoma (28%) and metastatic renal cell carcinoma (10%); …

Anomalous Origin Of The Left Coronary Artery From The Pulmonary Artery: A Surgical Certainty, Ayesha Butt, Muhammad Muneer Amanullah, Mehnaz Atiq Ahmed, Asif Hasan, Waris Ahmad

Medical College Documents

This study aims to assess the clinical presentation and the outcomes of a surgical correction of an anomalous origin of the left coronary artery from the pulmonary artery (ALCAPA). A retrospective review was carried out on the charts of six patients admitted for ALCAPA surgery at Aga Khan University Hospital, Karachi from March 2017 to May 2018.Dyspnoea, palpitation, poor feeding, fatiguability, pallor and a murmur of mitral regurgitation were the main presenting features. The pre-operative median left ventricular ejection fraction (LVEF) was 64%. Coronary reimplantation was performed in all the patients with a mitral valve repair being done in only …

An Audit Of 3-Snip Procedures Performed At The Aga Khan University Hospital, Karachi, Pakistan, Rashid Baig, Benish Aslam, Khabir Ahmad

Section of Ophthalmology

Objective: To assess the functional outcome of three-snip punctoplasty procedure for punctal stenosis at a tertiary care hospital.
Methods: The retrospective study was conducted at the Aga Khan University Hospital Karachi, and comprised medical records of all patients aged >18 years who underwent three-snip punctoplasty between January 2013 and December 2017. Data was retrieved on age, gender, diagnosis, signs and symptoms, laterality, date of procedure, resolution of symptoms post procedure, date of last eye followup, symptoms at last follow-up, functional outcome (epiphora at 1 month). SPSS 20 was used for data analysis.
Results: Of the 30 patients, 22(73.3%) were females. …

Narcolepsy :A Review Amongst Sleep Disorders., Muhammad Umer Ahmed, Manahil Jeoffrey, Omer Ahmed

Pakistan Journal of Neurological Sciences (PJNS)

Narcolepsy is a sleep disorder known and studied about from time to time is a sleep disorder characterized by a combination of myriad of symptoms including excessive day time sleepiness with recurrent irresistible sleep attacks , hypnogogic hallucinations ,hypnopompic hallucinations ,sleep paralysis and cataplexy (sudden and bilateral loss of muscle tone.1 Narcolepsy may present it self long with cataplexy or without cataplexy. The pathogenesis behind narcolepsy is found to be due to degeneration of hypocretin/orexin secreting neurones in the central nervous system due to disorder of human leukocyte antigen DQB1*0602.Narcolepsy is a deblitating disorder which causes intense functional impairment and …

Factors Predicting Need For Post-Operative Ventilation After Microsurgical Clipping Of Cerebral Aneurysms – A Multivariate Analysis, Usman Siddiqui, Muhammad Faheem Khan, Saad Bin Anis, Bushra Ahmad, Muhammad Shahzad Shamim, Rida Mitha, Fouzia Anis Khan, Erfan Hussain

Pakistan Journal of Neurological Sciences (PJNS)

Patients with aneurysmal Subarachnoid Hemorrhage (aSAH) frequently require Intensive Care Unit (ICU) beds, pre-operatively and more often, post-operatively due to the need for ventilatory support and specialized monitoring. We aimed to evaluate the frequency of post-operative ventilatory requirement in patients with aSAH and identify the possible predictive factors that might influence the need of post-operative ventilation in these patients. METHODS: We retrospectively identified a five-year data of all patients with aSAH who underwent surgical clipping using a structured proforma. Aneurysm was confirmed by Digital Subtraction Angiography (DSA) or Computerized Tomographic Angiography (CTA).

Continuity Of Care And Outpatient Management For Patients With And At High Risk For Cardiovascular Disease During The Covid-19 Pandemic: A Scientific Statement From The American Society For Preventive Cardiology, Amit Khera, Seth J. Baum, Ty J. Gluckman, Martha Gulati, Seth S. Martin, Erin D. Michos, Ann Marie Navar, Pam R. Taub, Peter P. Toth, Salim S. Virani

Office of the Provost

The coronavirus disease 2019 (COVID-19) pandemic has consumed our healthcare system, with immediate resource focus on the management of high numbers of critically ill patients. Those that fare poorly with COVID-19 infection more commonly have cardiovascular disease (CVD), hypertension and diabetes. There are also several other conditions that raise concern for the welfare of patients with and at high risk for CVD during this pandemic. Traditional ambulatory care is disrupted and many patients are delaying or deferring necessary care, including preventive care. New impediments to medication access and adherence have arisen. Social distancing measures can increase social isolation and alter …

Comparison Of Outcomes Following Minimally Invasive And Open Posterior Cervical Foraminotomy: Description Of Minimally Invasive Technique And Review Of Literature., Andrew Platt, Carter S Gerard, John E O'Toole

Articles, Abstracts, and Reports

Although minimally invasive posterior cervical foraminotomy (MIS-PCF) is frequently employed in the treatment of cervical radiculopathy, there are very few studies directly comparing outcomes between MIS-PCF and open posterior cervical foraminotomy and between MIS-PCF and percutaneous endoscopic (full-endoscopic) posterior cervical foraminotomy (FE-PCF). This study includes a description of technique and systematic review of literature and analysis of clinical studies comparing outcomes between MIS-PCF and open posterior cervical foraminotomy and between MIS-PCF and FE-PCF. Six comparative studies, including one randomized controlled trial were included in analysis. Average operative time ranged from 60.5 to 171 minutes in the open group and 77.65 …

Labrad : Vol 46, Issue 1 - March 2020, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• Role of Immunofluorescence Studies in the Diagnosis of Autoimmune Disorders
• Cystathionine Beta-Synthase Deficiency
• Treatment of Factor VIII Inhibitor
• Effective Internal Communication in Laboratories
• Digital Breast Tomosynthesis
• Overview of Common Myeloproliferative Neoplasms
• Clinical Significance of free Androgen Index (FAI)
• Radiology Quiz
• The Best of the Past
• Section Of Histopathology: Newer Horizons
• A Webinar Series ‘Rare Links’
• A Look into the Eye can Unleash Vital Diagnostic Pearls for 32 Rare Disorders
• Lab & Rad Mesh up for the Early Recognition of Rare Disorders
• Polaroid

Evaluation Of Non-Invasive Continuous Physiological Monitoring Devices For Neonates In Nairobi, Kenya: A Research Protocol, Amy Sarah Ginsburg, Evangelyn Nkwopara, William Macharia, Roseline Ochieng, Mary Waiyego, Guohai Zhou, Roman Karasik, Shuai Xu, J Mark Ansermino

Paediatrics and Child Health, East Africa

Introduction: Continuous physiological monitoring devices are often not available for monitoring high-risk neonates in low-resource settings. Easy-to-use, non-invasive, multiparameter, continuous physiological monitoring devices could be instrumental in providing appropriate care and improving outcomes for high-risk neonates in these low-resource settings.

Methods and analysis: The purpose of this prospective, observational, facility-based evaluation is to provide evidence to establish whether two existing non-invasive, multiparameter, continuous physiological monitoring devices developed by device developers, EarlySense and Sibel, can accurately and reliably measure vital signs in neonates (when compared with verified reference devices). We will also assess the feasibility, usability and acceptability of these devices …

Proximal Tibial Replacement In Revision Knee Arthroplasty For Non-Oncologic Indications., Brianna Fram, Eric B. Smith, Gregory K. Deirmengian, John A. Abraham, John Strony, Michael B. Cross, Danielle Y. Ponzio

Rothman Institute Papers

Proximal tibial metaphyseal bone loss compromises the alignment and fixation of components during revision total knee arthroplasty. In massive, segmental defects with loss of collateral ligamentous support and lack of bone to support the use of prosthetic augments or metaphyseal cones or sleeves, a hinged proximal tibial replacement or a so-called "megaprosthesis" should be available. While proximal tibial replacement is the reconstructive method of choice in the setting of bone tumor resection, applications in non-oncologic joint arthroplasty are rare and may offer an opportunity for limb salvage in dire clinical scenarios with massive proximal tibial bone loss. This report reviews …

Biomimetic Metal-Organic Nanoparticles Prepared With A 3d-Printed Microfluidic Device As A Novel Formulation For Disulfiram-Based Therapy Against Breast Cancer, Ya Chang, Jizong Jiang, Wu Chen, Wen Yang, Lili Chen, Pengyu Chen, Jianzhong Shen, Shizhi Qian, Teng Zhou, Linfeng Wu, Liang Hong, Yongzhuo Huang, Feng Li

Mechanical & Aerospace Engineering Faculty Publications

Disulfiram (DSF) is currently tested in several clinical trials for cancer treatment in combination with cop-per (Cu) ions. Usually, DSF and Cu are administered in two separate formulations. In the body, DSF andCu ions form diethyldithiocarbamate copper complex [Cu(DDC)₂] which has potent antitumor activities.However, the “two formulation” approach often achieved low Cu(DDC)₂ concentration at tumor regions and resulted in compromised anticancer efficacy. Therefore, preformed Cu(DDC)₂ complex administered in a single formulation will have better anticancer efficacy. However, the poor aqueous solubility of Cu(DDC)₂ is a significant challenge for its clinical use. In this work, a …

Our Wicked Problem, John Pourdehnad, Larry M. Starr, Venard Scott Koerwer, Harry Mccloskey

School of Continuing and Professional Studies Coronavirus Papers

The Coronavirus is more than a health problem. It is a “wicked” problem disrupting work, education, travel, politics, financial indicators, and more. This label came about in 1973 to help describe a special class of situations that are volatile, uncertain and ambiguous, often difficult to recognize, and difficult or impossible to solve because of incomplete, contradictory, and changing requirements. There is no clear problem definition due to interdependencies so the problem cannot be fully understood until after the solution comes about.

Our Invisible Enemy, Larry M. Starr, Darshi Mody

School of Continuing and Professional Studies Coronavirus Papers

The novel coronavirus is invisible to the eye because it is microscopic measuring 80-160 nanometers in size; a nanometer is one billionth of a meter.

While we cannot see it in the air or on a surface, millions of us have seen the virus in full color when we discuss it on the local and national TV news, in articles and stories online, and in print media. This is because the virus is routinely pictured and used to attract us to the information being presented. The paradox is that millions of people can now recognize this invisible enemy.

Repeatedly presenting …

Disruptive Effects Of The Coronavirus – Errors Of Commission And Of Omission?, John Pourdehnad, Larry M. Starr, Venard Scott Koerwer, Harry Mccloskey

School of Continuing and Professional Studies Coronavirus Papers

It is increasingly evident that the coronavirus disease, COVID-19, is more than a health problem; it is and will continue to adversely affect work and workplaces, education, families and social engagements, political and environmental dimensions, and financial indicators. Apart from its health ramifications, the crisis is revealing serious challenges in the global supply chain. Those difficulties are, at least in part, consequences of unwise, short-sighted business decisions made over the course of decades to outsource and downsize.

Pandemic Lockdown Must Fail: Save Lives Without Crippling The Economy, Larry Hirschhorn, Phd

School of Continuing and Professional Studies Coronavirus Papers

In the following working paper, I want to make a plea for what I am calling a “reverse quarantine”—quarantining people who are over 65 (who number 52 million), before they get sick. We need to complement this policy with federally funded and locally organized efforts to support seniors in place, drawing on the wellsprings of American pragmatism, the capacity to respond in emergencies, American volunteerism, and neighbor-to-neighbor assistance. We can’t turn quarantine into imprisonment. We must work as hard as we can to create a psychological sense of community at a moment when, paradoxically, social distancing is driving us apart. …

Total Knee Arthroplasty Gap Balancer, Christina Grigorian, Andrew Beckley, Alexandra Rockett

Biomedical Engineering

California Polytechnic State University’s Biomedical Engineering Department worked in conjunction with local San Luis Obispo orthopedic surgeon Dr. Dimitri Delagrammaticas. The goal of the project was to create a surgical tool that assists a surgeon in measuring knee gap distance and balancing collateral ligament tension during a total knee arthroplasty (TKA) surgery. The final product of this project was completed in five months and initially began with understanding our sponsor’s expectations for the device. A portion of time was devoted to conducting research to understand the process of a knee replacement surgery, the requirements of the device, and the limitations …

The Impact Of Post Pcnl Tube Type On Blood Loss And Postoperative Pain, Salman Jamil, Hammad Ather

Section of Urology

Objective: To evaluate the impact of nephrostomy tube type on postoperative pain and blood loss following percutaneous nephrolithotomy (PCNL).
Methods: This is a prospective non-randomized study performed at Aga Khan University Hospital from July 2017 to June 2018. In this study we prospectively studied adult patients (16 to 65 years) who underwent unilateral PCNL. Patients who had nephrostomy with balloon (12Fr Foley's catheter) were compared with patients who had nephrostomy without balloon (12Fr Nelaton™ catheter). STONE Nephrolithometry score was used to assess the stone complexity. Mean pain score at six and 24 hours and mean hemoglobin drop at 24 hours …

Serum Amyloid A Is Not Incorporated Into Hdl During Hdl Biogenesis, Ailing Ji, Xuebing Wang, Victoria P. Noffsinger, Drew Jennings, Maria C. De Beer, Frederick C. De Beer, Lisa R. Tannock, Nancy R. Webb

Saha Cardiovascular Research Center Faculty Publications

Liver-derived serum amyloid A (SAA) is present in plasma where it is mainly associated with HDL and from which it is cleared more rapidly than are the other major HDL-associated apolipoproteins. Although evidence suggests that lipid-free and HDL-associated forms of SAA have different activities, the pathways by which SAA associates and disassociates with HDL are poorly understood. In this study, we investigated SAA lipidation by hepatocytes and how this lipidation relates to the formation of nascent HDL particles. We also examined hepatocyte-mediated clearance of lipid-free and HDL-associated SAA. We prepared hepatocytes from mice injected with lipopolysaccharide or an SAA-expressing adenoviral …

Meeting The Educational Needs Of An Increasingly Diverse Surgical Workforce, Minerva Angelica Romero Arenas

School of Medicine Publications

To the Editor Yeo et al¹ evaluated factors associated with American Board of Surgery (ABS) examination pass rates in a cohort of categorical surgical residents from the internship (2007) to eligibility/certification. They found that first-time ABS pass rate was associated with nonmodifiable factors, such as nonwhite race/ethnicity, sex (women), and having children.¹ Additionally, Hispanic residents were less likely to attempt the ABS examinations at all. We must place these findings in the context of diversity in surgery, or rather, the lack thereof. The cohort included only 55 Hispanic residents, most of whom did pass the ABS examinations (n …

Pediatric Congenital Heart Diseases: Patterns Of Presentation To The Emergency Department Of A Tertiary Care Hospital, Surraiya Bano, Saleem Akhtar, Uzma R. Khan

Department of Emergency Medicine

Objective: To observe presentation of Pediatric congenital cardiac defects to the Emergency Department (ED) of a tertiary care hospital in Pakistan.
Methods: This is a retrospective chart review of patients under the age of 16 years with congenital cardiac defects presenting to the Emergency Department of Aga Khan University Hospital over a period of eighteen months, from January 2012 to June 2013. Study population was divided into two groups; first group constituted children with undiagnosed congenital cardiac defects, whereas second group constituted children with diagnosed congenial cardiac defects presented to ED. In previously diagnose cases each visit was counted as …

Youth Single-Sport Specialization In Professional Baseball Players., Patrick S Buckley, Michael C Ciccotti, Meghan Bishop, Patrick Kane, Stephen Selverian, Dominique Exume, John D'Angelo, William Emper, Kevin B Freedman, Sommer Hammoud, Steven B Cohen, Michael G Ciccotti

Rothman Institute Papers

Background: An increasing number of youth baseball athletes are specializing in playing baseball at younger ages.

Purpose: The purpose of our study was to describe the age and prevalence of single-sport specialization in a cohort of current professional baseball athletes. In addition, we sought to understand the trends surrounding single-sport specialization in professional baseball players raised within and outside the United States (US).

Study Design: Cross-sectional study; Level of evidence, 3.

Methods: A survey was distributed to male professional baseball athletes via individual team athletic trainers. Athletes were asked if and at what age they had chosen to specialize in …

Preface To The Psoriatic Arthritis Supplement., Philip Mease

Articles, Abstracts, and Reports

No abstract provided.

Memote For Standardized Genome-Scale Metabolic Model Testing., Christian Lieven, Moritz E Beber, Brett G Olivier, Frank T Bergmann, Meric Ataman, Parizad Babaei, Jennifer A Bartell, Lars M Blank, Siddharth Chauhan, Kevin Correia, Christian Diener, Andreas Dräger, Birgitta E Ebert, Janaka N Edirisinghe, José P Faria, Adam M Feist, Georgios Fengos, Ronan M T Fleming, Beatriz García-Jiménez, Vassily Hatzimanikatis, Wout Van Helvoirt, Christopher S Henry, Henning Hermjakob, Markus J Herrgård, Ali Kaafarani, Hyun Uk Kim, Zachary King, Steffen Klamt, Edda Klipp, Jasper J Koehorst, Matthias König, Meiyappan Lakshmanan, Dong-Yup Lee, Sang Yup Lee, Sunjae Lee, Nathan E Lewis, Filipe Liu, Hongwu Ma, Daniel Machado, Radhakrishnan Mahadevan, Paulo Maia, Adil Mardinoglu, Gregory L Medlock, Jonathan M Monk, Jens Nielsen, Lars Keld Nielsen, Juan Nogales, Intawat Nookaew, Bernhard O Palsson, Jason A Papin, Kiran R Patil, Mark Poolman, Nathan D Price, Osbaldo Resendis-Antonio, Anne Richelle, Isabel Rocha, Benjamín J Sánchez, Peter J Schaap, Rahuman S Malik Sheriff, Saeed Shoaie, Nikolaus Sonnenschein, Bas Teusink, Paulo Vilaça, Jon Olav Vik, Judith A H Wodke, Joana C Xavier, Qianqian Yuan, Maksim Zakhartsev, Cheng Zhang

Articles, Abstracts, and Reports

No abstract provided.