Medical Specialties Commons^™

Barriers And Challenges To Mental Health Care In Pakistan, Fatima Siddiqui, Qurat Ul Ain Khan

Pakistan Journal of Neurological Sciences (PJNS)

World Health Organization (WHO) defines health as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity"(1). Despite being a global health-related burden, and a major cause of morbidity worldwide including Pakistan, mental health diseases are an overlooked entity in our country. In Pakistan, we have seen a rapid improvement in the treatment of conditions related to physical health over the course of years, but mental health issues are still being given limited priority. Pakistan is the 6th most populated country in the world with a current estimated population of 210 million …

Self-Concept, Self- Affirmation And Psychological Distress In Women With Polycystic Ovarian Syndrome (Pcos), Zeenash Mazhar Dar, Muhammad Nasar Iqbal, Muhammad Rafiq, Shahyan Qamar, Fatima Javed

Pakistan Journal of Neurological Sciences (PJNS)

To study the relationship among self-concept, self- affirmation and psychological distress in females having Polycystic Ovary Syndrome (PCOS).

In this correlational study one hundred patients with polycystic ovarian syndrome participated with age ranging from 21-40 years. Self-Concept questionnaire, self-Affirmation scale, and Kessler psychological distress scale were used to collect data

The results of this study revealed that negative-self-concept has significantly positive relationship with psychological distress. Multiple regression revealed that positive self-concept negatively predicted psychological distress in females having polycystic ovarian disease. Independent sample t=test revealed that psychological distress is more in married women (M= 32.96, SD=8.60) as compared to single …

Current Status Of Non-Disease Modifying Gene Therapy In Parkinson’S Disease, Muhammad Shariq Shaikh, Syed Ahsan Ali, Dureshahwar Kanwar

Pakistan Journal of Neurological Sciences (PJNS)

Parkinson’s disease (PD) is a chronic progressive neurological disorder characterized by bradykinesia, tremor, muscular rigidity, and postural instability. The world-wide prevalence is expected to rise further with increasing mean age. Theoretically, if all desired elements required for dopamine synthesis are functionally available, need for exogenous L-DOPA administration can be eliminated or markedly reduced. However, lack of effective long-term treatment has led to extensive gene therapy research focusing both on disease modifying as well as non-disease modifying aspects. Since genetic lesions are found in both familial as well as sporadic PD cases, the principle of introducing a normal gene to cure …

Coronavirus Disease 2019 (Covid-19): Multisystem Review Of Pathophysiology, Tanveer Mir, Talal Almas, Jasmeet Kaur, Mohammed Faisaluddin, David Song, Waqas Ullah, Sahil Mamtani, Hiba Rauf, Sunita Yadav, Sharaad Latchana, Nara Miriam Michaelson, Michael Connerney, Yasar Sattar

Division of Internal Medicine Faculty Papers & Presentations

Abstract Coronavirus disease-19 (COVID-19) pandemic is associated with high morbidity and mortality. COVID-19, which is caused by the Severe Acute Respiratory Syndrome Coronavirus-2 (SARS CoV-2), affects multiple organ systems through a myriad of mechanisms. Afflicted patients present with a vast constellation of symptoms, from asymptomatic disease to life-threatening complications. The most common manifestations pertain to mild pulmonary symptoms, which can progress to respiratory distress syndrome and venous thromboembolism. However, in patients with renal failure, life-threatening cardiac abnormalities can ensue. Various mechanisms such as viral entry through Angiotensin receptor (ACE) affecting multiple organs and thus releasing pro-inflammatory markers have been postulated. …

Making Hospitals Health Promotive, Shelina Bhamani, Areeba Zainab Makhdoom

Department of Obstetrics & Gynaecology

No abstract provided.

Safe Thrombolysis During Pregnancy For Recurrent Acute Ischaemic Stroke Due To Concomitant Isolated Left Ventricular Non-Compaction And Bilateral Foetal Posterior Communicating Arteries, Fatimah Juma, Mzee Ngunga, Wangari Siika, Dilraj Sokhi

Internal Medicine, East Africa

Isolated left ventricular non-compaction (ILVNC) is a rare congenital cardiomyopathy and is associated with arrhythmias, heart failure and thromboembolism including ischaemic stroke. Pregnancy is a relative contraindication to thrombolysis for acute ischaemic stroke, although case reports suggest the treatment can be given in selected cases. We report a case of recurrent cryptogenic strokes in a 36-year-old female who was thrombolysed with good outcome at 37 weeks’ gestation and was eventually found to have ILVNC as the cause. She had a predilection to recurrent posterior circulatory strokes due to foetal posterior communicating arteries. To our knowledge this is the first case …

Istent Versus Istent Inject Implantation Combined With Phacoemulsification In Open Angle Glaucoma., Wesam Shamseldin Shalaby, Sophia S. Lam, Amirmohsen Arbabi, Jonathan S. Myers, Marlene R. Moster, Natasha N. Kolomeyer, Reza Razeghinejad, Aakriti Garg Shukla, Tarek R. Hussein, Tarek M. Eid, Said M. Shalaby, Daniel Lee

Wills Eye Hospital Papers

Purpose: To compare the outcomes of iStent vs. iStent inject implantation combined with phacoemulsification.

Methods: This single center retrospective comparative case series included subjects with open angle glaucoma who underwent iStent or iStent inject implantation combined with phacoemulsification with ≥1 year follow-up. The main outcome measures were in-group and between-group changes in intraocular pressure (IOP) and medication number, proportion of eyes that achieved IOP ≤15 mmHg, and surgical success defined as 20% IOP reduction from baseline at 6/12 months. Univariate/multivariate regression analyses were done to identify predictors of surgical failure.

Results: One hundred ninety-seven eyes of 148 patients were included …

Indications For A "Surgery First" Approach For The Treatment Of Lower Extremity Arterial Disease, Mohineesh Kumar, Steven D. Rimar, Graham W. Long, Diane M. Studzinski, O W. Brown

Conference Presentation Abstracts

No abstract provided.

Evaluation Of Serum Calcium Differences In Hypertensive Crises And Control Patients: A Randomly Matched Case-Control Study, Ifeanyi Chukwu O. Onor, Rose M. Duchane, Casey J. Payne, Hannah Naquin Lambert, De Maurian M. Mitchner, Robbie A. Beyl, Anh T. Nguyen, Sarah E. Bilbe, Andrea Arriaga White, Mariah W. Johnson, Amber I. Faciane, Emmanuel Kouagou, Stephanie A. Hymel, Bria M. Wates, Asia D. Sanders, Phillip C.B. Vo, Jordan D. Bates, Raven J. Spooner, Christopher J. Gillard, John I. Okogbaa, Daniel F. Sarpong, Rim M. Hadgu, Samuel C. Okpechi, Gabriel I. Onor, Michael C. Okoronkwo, Mihran V. Naljayan, Shane G. Guillory, Shane E. Sanne

School of Medicine Faculty Publications

The role of calcium in blood pressure has been widely studied among hypertensive patients; however, no study has explored the role of calcium in hypertensive crises. The primary objective of this study is to evaluate the differences in serum calcium levels between hypertensive crises patients and a 1:1 random matched controls (age-, sex-, race-, diabetes, and body mass index matched). This study is a single-center, retrospective, chart review, case-control study of patients with hypertensive crises (case group) and patients without hypertensive crises (control group). Patients were included in the case group if they were 18 years of age or older …

Multiprong Control Of Glioblastoma Multiforme Invasiveness: Blockade Of Pro-Inflammatory Signaling, Anti-Angiogenesis, And Homeostasis Restoration, Nicolas G. Bazan, Madigan M. Reid, Valerie A.Cruz Flores, Juan E. Gallo, William Lewis, Ludmila Belayev

School of Medicine Faculty Publications

Glioblastoma multiforme (GBM) is the most invasive type of glial tumor with poor overall survival, despite advances in surgical resection, chemotherapy, and radiation. One of the main challenges in treating GBM is related to the tumor’s location, complex and heterogeneous biology, and high invasiveness. To meet the demand for oxygen and nutrients, growing tumors induce new blood vessels growth. Antibodies directed against vascular endothelial growth factor (VEGF), which promotes angiogenesis, have been developed to limit tumor growth. Bevacizumab (Avastin), an anti-VEGF monoclonal antibody, is the first approved angiogenesis inhibitor with therapeutic promise. However, it has limited efficacy, likely due to …

Microrna‐146a‐5p, Neurotropic Viral Infection And Prion Disease (Prd), Aileen I. Pogue, Walter J. Lukiw

School of Medicine Faculty Publications

The human brain and central nervous system (CNS) harbor a select sub‐group of potentially pathogenic microRNAs (miRNAs), including a well‐characterized NF‐kB‐sensitive Homo sapiens microRNA hsa‐miRNA‐146a‐5p (miRNA‐146a). miRNA‐146a is significantly over-expressed in progressive and often lethal viral‐ and prion‐mediated and related neurological syndromes associated with progressive inflammatory neurodegeneration. These include ~18 different viral‐induced encephalopathies for which data are available, at least ~10 known prion diseases (PrD) of animals and humans, Alzheimer’s disease (AD) and other sporadic and progressive age‐related neurological disorders. Despite the apparent lack of nucleic acids in prions, both DNA‐ and RNA‐containing viruses along with prions significantly induce miRNA‐146a …

Preference For Fruits And Vegetables Is Linked To Plate Waste Among Preschool Children, Betty Izumi, Carmen Byker Shanks, Allison Milodragovich, Erin Smith, Lacy Stephens, Selena Ahmed

OHSU-PSU School of Public Health Faculty Publications and Presentations

Background: A large portion of preschool-aged children in the United States (US) do not consume enough fruits and vegetables (FV). It is important for childcare providers to know what food choices children in their care are making at mealtime and how to encourage them to eat more FV. The objective of this pilot study was to examine the relationship between FV preference and plate waste among pre-school aged children in a childcare setting using a rapid assessment tool.

Methods: The rapid assessment tool was first pilot tested with 23 children and revised. A repeated cross-sectional design was carried out for …

An Approach To Faculty Development For Underrepresented Minorities In Medicine., Juan Robles, Tanya Anim, Maria Harsha Wusu, Krys E. Foster, Yury Parra, Octavia Amaechi, Kari-Claudia Allen, Jose E. Rodríguez, Kendall M. Campbell, Dmitry Tumin, Judy Washington

Department of Family & Community Medicine Faculty Papers

OBJECTIVES: The diversity of the US physician workforce lags significantly behind the population, and the disparities in academic medicine are even greater, with underrepresented in medicine (URM) physicians accounting for only 6.8% of all US medical school faculty. We describe a "for URM by URM" pilot approach to faculty development for junior URM Family Medicine physicians that targets unique challenges faced by URM faculty.

METHODS: A year-long fellowship was created for junior URM academic clinician faculty with funding through the Society of Teachers of Family Medicine Project Fund. Seven junior faculty applied and were accepted to participate in the fellowship, …

Efficient Killing Of Tumor Cells By Car-T Cells Requires Greater Number Of Engaged Cars Than Tcrs, Nadia Anikeeva, Sergey Panteleev, Nicholas W Mazzanti, Mizue Terai, Takami Sato, Yuri Sykulev

Department of Microbiology and Immunology Faculty Papers

Although CAR-T cells are widely used to treat cancer, efficiency of CAR-T cell cytolytic responses has not been carefully examined. We engineered CAR specific for HMW-MAA (highmolecular- weight melanoma-associated antigen) and evaluated potency of CD8+ CAR-T cells to release cytolytic granules and to kill tissue-derived melanoma cells, which express different levels of HMW-MAA. CAR-T cells efficiently killed melanoma cells expressing high level of HMW-MAA, but not melanoma cells with lower levels of HMW-MAA. The same melanoma cells presenting significantly lower level of stimulatory peptide- MHC ligand were readily lysed by T cells transduced with genes encoding α,β-TCR specific for the …

Apathy And Brain Atrophy During The First Year Of Moderate-Severe Traumatic Brain Injury: A Longitudinal Study, Gulnaz Kudoiarova

Dissertations, Theses, and Capstone Projects

Apathy, defined as disinterest and loss of motivation, is a common complication after moderate-severe traumatic brain injury (msTBI). The existing body of research in various neurological and neurodegenerative disorders suggests that apathetic symptoms may be associated with variation in the volume of the brain regions such as dorsal anterior cingulate cortex and ventral striatum. However, the longitudinal pattern of TBI-induced atrophy in these key regions and its relationship with apathy symptoms remain to be demonstrated. The current study aimed to describe the atrophy pattern in the anterior cingulate gyrus (ACG) and the nucleus accumbens (NAc; part of ventral striatum) after …

Longitudinal Changes Of Regional Myelin Water Fraction During First Year After Moderate-To-Severe Diffuse Traumatic Brain Injury, Likowsky L. Desir

Dissertations, Theses, and Capstone Projects

Traumatic brain injury (TBI) is a worldwide health issue with a highly heterogeneous disease characterization, including widespread white matter damage in the brain. Most non-invasive white matter imaging methods currently available, including diffusion tensor imaging (DTI), cannot reliably measure the degree of neurodegeneration due to various confounds, making it challenging to select an endpoint measure for neuroprotective clinical trials. The present study investigates longitudinal white matter changes, measured by a novel imaging metric, apparent myelin water fraction (aMWF), and its relationship with neuropsychological measures during the first year after TBI. Data from 15 adult patients with moderate-to-severe TBI and 30 …

Umbilical Access In Laparoscopic Surgery In Infants Less Than 3 Months: Single Institution Retrospective Review, James Fraser, Kayla B. Briggs, Wendy Jo Svetanoff, Rebecca M. Rentea, Pablo Aguayo, David Juang, Jason D. Fraser, Charles L. Snyder, Richard J. Hendrickson, Shawn D. St Peter, Tolulope A. Oyetunji

Presentations

PURPOSE: Umbilical access in laparoscopic surgery has been cited as a potential factor for increased complications in low birth weight infants and those less than three months old. Previous series noted a self-reported complication rate of 10.6% among 329 pediatric surgeons via anonymous survey, citing carbon dioxide (CO2) embolism as the most common complication. We report four-year outcomes with blunt transumbilical laparoscopic access to examine the safety of this technique. METHODS: Following IRB approval, a retrospective database of patients less than three months of age who underwent laparoscopic pyloromyotomy or inguinal hernia repair from 2016-2019 at a tertiary care academic …

How Much Time Do General Surgical Pathologists Spend On Diagnostic Data Entry?, Zhenhong Qu, Lanjin Zhang, Xianzhong Ding, Kausar Jabbar

Conference Presentation Abstracts

Context: As many pathology institutions have eliminated transcription service by office assistants, pathologists assume the task of diagnostic data entry (DDE) into pathology reports in the laboratory information system. This is not a trivial undertaking, yet tangible data are lacking on how much DDE adds to the workload of pathologists. Without such data, it is very difficult to assess the financial benefit of such a task shift and establish benchmarks. Design: Four practicing pathologists covering a general surgical pathology service in 3 institutions with different laboratory information systems were selected for their dominant DDE method (speech recognition, pre-text, or manual …

The Surgical Treatment Of Cervical Myelopathy In Patients Who Ambulate Independently, Ambulate With Assistive Devices, Or Are Wheelchair Bound: A Michigan Spine Surgery Improvement Collaborative Study, Rafid Kasir, Lonni Schultz, Richard W. Easton, Victor Chang, Jad Khalil

Conference Presentation Abstracts

We examine whether wheelchair bound patients undergoing cervical spine surgery for cervical myelopathy have improvement in patient-reported outcome measures.

A Review Of Fixed Drug Eruption With A Special Focus On Generalized Bullous Fixed Drug Eruption., Hannah J. Anderson, Jason B. Lee, Md

Department of Dermatology and Cutaneous Biology Faculty Papers

Fixed drug eruption (FDE) is a cutaneous adverse drug reaction characterized by the onset of rash at a fixed location on the body each time a specific medication is ingested. With each recurrence, the eruption can involve additional sites. Lesions can have overlying vesicles and/or bullae, and when they cover a significant percentage of body surface area, the eruption is referred to as generalized bullous fixed drug eruption (GBFDE). Due to the widespread skin denudation that can be seen in this condition, GBFDE may be confused clinically with Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN). While treatments described for GBFDE include supportive …

Neutrophil-Rich, Noncollagenous 16a Domain-Negative Bullous Pemphigoid Associated With Psoriasis, Morgan E Sussman, Shoshana K Grossman, Sylvia Hsu, Jason B. Lee, Kiran Motaparthi

Department of Dermatology and Cutaneous Biology Faculty Papers

No abstract provided.

The Pnpla3 Rs738409 Variant But Not Mboat7 Rs641738 Is A Risk Factor For Nonalcoholic Fatty Liver Disease In Obese U.S. Children Of Hispanic Ethnicity, Sana Mansoor, Anshu Maheshwari, Matthew D. Di Guglielmo, Katryn Furuya, Makala Wang, Erin Crowgey, Zarela Molle-Rios, Zhaoping He

Department of Pediatrics Faculty Papers

Purpose: The rs641738 C>T in membrane-bound O-acyltransferase domain-containing protein 7 (MBOAT7) is implicated, along with the rs738409 C>G polymorphism in patatin-like phospholipase domain-containing protein 3 (PNPLA3), in nonalcoholic fatty liver disease (NAFLD). The association of these polymorphisms and NAFLD are investigated in Hispanic children with obesity.

Methods: Obese children with and without NAFLD were enrolled at a pediatric tertiary care health system and genotyped for MBOAT7 rs641738 C>T and PNPLA3 rs738409 C>G. NAFLD was characterized by the ultrasonographic presence of hepatic steatosis along with persistently elevated liver enzymes. Genetic variants and demographic and biochemical data were …

Cross-Sectional Analysis Of Baseline Visual Parameters In Subjects Recruited Into The Rescue And Reverse Nd4-Lhon Gene Therapy Studies, Mark Moster, Robert C Sergott, Nancy J Newman, Patrick Yu-Wai-Man, Valerio Carelli, Molly Scannell Bryan, Gerard Smits, Valérie Biousse, Catherine Vignal-Clermont, Thomas Klopstock, Alfredo A Sadun, Adam A. Debusk, Michele Carbonelli, Rabih Hage, Siegfried Priglinger, Rustum Karanjia, Laure Blouin, Magali Taiel, Barrett Katz, José Alain Sahel

Wills Eye Hospital Papers

OBJECTIVE: This report presents a cross-sectional analysis of the baseline characteristics of subjects with Leber hereditary optic neuropathy enrolled in the gene therapy trials RESCUE and REVERSE, to illustrate the evolution of visual parameters over the first year after vision loss.

METHODS: RESCUE and REVERSE were 2 phase III clinical trials designed to assess the efficacy of rAAV2/2-ND4 gene therapy in ND4-LHON subjects. At enrollment, subjects had vision loss for ≤6 months in RESCUE, and between 6 and 12 months in REVERSE. Functional visual parameters (best-corrected visual acuity [BCVA], contrast sensitivity [CS], and Humphrey Visual Field [HVF]) and structural parameters …

Long-Term Follow-Up After Unilateral Intravitreal Gene Therapy For Leber Hereditary Optic Neuropathy: The Restore Study, Valérie Biousse, Nancy J Newman, Patrick Yu-Wai-Man, Valerio Carelli, Mark Moster, Catherine Vignal-Clermont, Thomas Klopstock, Alfredo A Sadun, Robert C Sergott, Rabih Hage, Simona Esposti, Chiara La Morgia, Claudia Priglinger, Rustum Karanja, Laure Blouin, Magali Taiel, José-Alain Sahel

Wills Eye Hospital Papers

BACKGROUND: RESCUE and REVERSE were 2 Phase 3 clinical trials that assessed the efficacy and safety of intravitreal gene therapy with lenadogene nolparvovec (rAAV2/2-ND4) for the treatment of Leber hereditary optic neuropathy (LHON). RESTORE is the long-term follow-up study of subjects treated in the RESCUE and REVERSE trials.

METHODS: In RESCUE and REVERSE, 76 subjects with LHON because of the m.11778 G>A mutation in the mitochondrial gene ND4 received a single unilateral intravitreal injection of lenadogene nolparvovec. After 96 weeks, 61 subjects were enrolled in the long-term follow-up study RESTORE. The best-corrected visual acuity (BCVA) was assessed over a …

Sudden Cardiac Death In Athletes, Darren C Tsang, Mark S Link

The Texas Heart Institute Journal

No abstract provided.

Avoidance Of St-Segment-Elevation Myocardial Infarction Treatment For >1 Week Due To Covid-19 Fears, Rahul V Annabathula, Gregory J Sinner, Talal S Alnabelsi, Rachel P Goodwin, Vincent L Sorrell

The Texas Heart Institute Journal

During the coronavirus disease 2019 (COVID-19) pandemic, social distancing guidelines have negatively affected the care-seeking behavior of patients with chronic medical conditions, including those with cardiovascular disease. We report the case of a 60-year-old man with vague gastrointestinal symptoms who waited more than 1 week to seek treatment for fear of COVID-19 infection. On presentation at another hospital, he was found to have had an anterior myocardial infarction, and he underwent percutaneous coronary intervention to stent an occluded proximal left anterior descending coronary artery. Subsequently, the patient experienced refractory cardiogenic shock and, during his transfer to our hospital, refractory ventricular …

Cheyne-Stokes Respiration In A 17-Year-Old Boy Awaiting Heart Transplantation, Nooralam A Rai, Aliva De, Carin Lamm

The Texas Heart Institute Journal

Cheyne-Stokes respiration is a pattern of alternating central apnea and hyperpnea. It is well described in adults with congestive heart failure, but not in children.

We report the case of a 17-year-old boy whose systolic heart failure was complicated by Cheyne-Stokes respiration. He was given supportive therapy until heart transplant, after which his Cheyne-Stokes respiration clinically resolved. Clinicians should be aware of this uncommon condition in pediatric and adolescent patients who have advanced heart failure and irregular breathing.

Takayasu Arteritis: A Rare Cause Of Chronic Headache, Linda Barasa, Adil Salyani, Jillo Bika, Fred Otieno, Dilraj Sokhi

Internal Medicine, East Africa

Chronic headache can be a presenting manifestation of Takayasu arteritis, although patients usually have other characteristic features. A thorough clinical assessment remains key in the evaluation of chronic headache.

Multisite Pain Is Highly Prevalent In Children With Functional Abdominal Pain Disorders And Is Associated With Increased Morbidity, Bruno P Chumpitazi, Tonya M Palermo, John M Hollier, Mariella M Self, Danita Czyzewski, Erica M Weidler, Margaret Heitkemper, Robert J Shulman

Children’s Nutrition Research Center Staff Publications

Objectives: To characterize the types of multisite pain experienced by children with functional abdominal pain disorders (FAPDs) and to examine differences in psychosocial distress, functional disability, and health-related quality of life in children with multisite pain vs abdominal pain alone.

Study design: Cross-sectional study of children ages 7-17 years (n = 406) with pediatric Rome III FAPDs recruited from both primary and tertiary care between January 2009 and June 2018. Subjects completed 14-day pain and stool diaries, as well as validated questionnaires assessing abdominal and nonabdominal pain symptoms, anxiety, depression, functional disability, and health-related quality of life.

Results: In total, …

The Role Of Gip Receptor In The Cns For The Pathogenesis Of Obesity, Makoto Fukuda

Children’s Nutrition Research Center Staff Publications

Glucose-dependent insulinotropic polypeptide (GIP) (also known as gastric inhibitory polypeptide) is a hormone produced in the upper gut and secreted to the circulation in response to the ingestion of foods, especially fatty foods. Growing evidence supports the physiological and pharmacological relevance of GIP in obesity. In an obesity setting, inhibition of endogenous GIP or its receptor leads to decreased energy intake, increased energy expenditure, or both, eventually causing weight loss. Further, supraphysiological dosing of exogenous long-lasting GIP agonists alters energy balance and has a marked antiobesity effect. This remarkable yet paradoxical antiobesity effect is suggested to occur primarily via the …