Medical Specialties Commons^™

Peribulbar Injection Of Triamcinolone Acetonide As An Outpatient Clinic Procedure In The Management Of Mild To Moderate Macular Edema, Mohammed S. Ahmed

Journal of Medicine in Scientific Research

Background Diabetic retinopathy is a microvascular complication of diabetes mellitus and is the most common and most blinding ophthalmic complication. Diabetic macular edema (DME) is an essential manifestation of diabetic retinopathy that occurs across all its severity levels. Several intraocular treatment modalities for diabetic eye disease exist, including per-bulbar steroid injections. This study was conducted aiming to study the clinical effect and central macular thickness decrease following an outpatient clinic simple procedure of peribulbar injection of prepared triamcinolone acetonide (TAA) as a single procedure. Patients and methods This study was performed on 100 eligible eyes in 70 consecutive patients. The …

Intravitreal Injection Of Ranibizumab (Lucentis) Versus Pan-Retinal Photocoagulation As A Preoperative Adjuvant Before Vitrectomy In Management Of Proliferative Diabetic Retinopathy, Mohammed S. Ahmed

Journal of Medicine in Scientific Research

Background Diabetic retinopathy is a microvascular complication of diabetes mellitus, and it is the most common ophthalmic complication. Pan-retinal photocoagulation (PRP) has been the standard treatment for proliferative diabetic retinopathy (PDR) and can be used as an adjuvant before vitrectomy but has adverse effects. The use of intravitreal ranibizumab has been suggested as an alternative treatment or an alternative adjuvant before vitrectomy. Aim This study was conducted to study the effect of intravitreal injection of ranibizumab 10 mg/ml (Lucentis) versus PRP as an adjuvant before vitrectomy in the management of PDR. Patients and methods This study was performed on 40 …

Relaxing Retinotomies And Retinectomies In Case Of Proliferative Diabetic Vitreoretinopathies And Tractional Retinal Detachment, Alaa Atteya, Hussam E. O. Elrashidy, Maged Adly

Journal of Medicine in Scientific Research

Introduction Radical anterior vitreous base dissection and lensectomy in combination with inferior 180° retinectomy will improve the anatomic success of complex proliferative diabetic vitreoretinopathies (PVR)-related retinal detachment. Our study aims to describe the anatomical and functional results of pars plana vitrectomy with retinotomies and relaxing retinectomies in patients with tractional retinal detachment in advanced PVR. Patients and methods A case series study was conducted on 28 eyes of patients with tractional retinal detachment with severe PVR. Preoperative and postoperative complications and final visual outcomes were recorded. The follow-up period was 12 months. Results Full reattachment rate was reached intraoperatively in …

Effect Of Repeated Peribulbar Triamcinolone Injection On Corneal Topography In Patients With Thyroid Eye Disease, Hussam E. O. Elrashidy, Laila A. Abulnasr, Nehal O. Elfarouk

Journal of Medicine in Scientific Research

Introduction Studies have shown that repeated peribulbar triamcinolone injections reduce the inflammatory signs of moderate to severe thyroid eye disease (TED). Other studies found that TED was associated with greater with-the-rule corneal astigmatism owing to fibrosis of the soft tissue in the superolateral orbital region. This study aimed to detect the effect of repeated peribulbar triamcinolone injections in patients with moderate to severe TED on corneal topography and astigmatism. Patients and methods A prospective, controlled, and randomized study was conducted that included 30 eyes with moderate to severe TED who underwent repeated peribulbar triamcinolone injections in addition to pretreatment and …

Evaluation Of Posterior Decompressive Lumbar Surgery For Multilevel Lumbar Spinal Canal Stenosis With And Without Fusion, Sameh M. Saleh

Journal of Medicine in Scientific Research

Background There is no consensus regarding the best treatment of patients with multilevel lumbar stenosis. Surgical and invasive procedures are widely used in adults with degenerative lumbar spinal stenosis when conservative treatments fail. However, little is known about the comparative efficacy and safety of these interventions. Aim and objective The aim was to study and evaluate the outcome of surgery for degenerative lumbar canal stenosis (LCS) on a clinical, radiological, and functional basis and to identify whether spinal decompression with fusion has a better effect than decompression alone for patients with degenerative lumbar spinal stenosis or not. Patients and methods …

Tibial Angioplasty In Diabetics, Ihab N. A. Hanna

Journal of Medicine in Scientific Research

Background Diabetics are pron e to develop serious complications such as nephropathy, retinal detachment, and others, and among such complications lies the devastating serious complication of diabetic foot, whether ulceration or diabetic foot infections up till gangrene. This could be attributed to either one or all of the following etiological factors: peripheral vascular disease, peripheral neuropathy, and/or infection owing to impaired immunity. Patients and methods We enrolled 88 diabetic ischemic patients with tibial artery disease confirmed by Duplex. Their mean age was 67 years (54 males and 34 females). Patients were subjected to ipsilateral antegrade transluminal or subintimal tibial angioplasty. …

Great Saphenous Vein Diameter At Different Regions And Its Relation To Reflux, Kareem Hady, Said I. El Mallah, Yahia M. Al-Khateep

Journal of Medicine in Scientific Research

Background Great saphenous vein (GSV) incompetence is involved in most cases of varicose disease. Standard preinterventional assessment is required to decide the treatment modalities. GSV diameter was measured at saphenofemoral junction, proximal thigh, distal thigh, knee, proximal leg, and distal leg. Analysis was done to find at which diameter size the reflux is expected to occur. Patient and methods The study involved 100 limbs from outpatient vascular clinic. GSV diameter was measured at the saphenofemoral junction, the proximal thigh, the distal thigh, below the knee, and mid-leg and correlated with reflux. Results Reflux in the sapheno-femoral junction (SFJ) (group I) …

Predictors Of Mortality In The Neonatal Intensive Care Unit Of El-Galaa Teaching Hospital, Michael W. G. Hany

Journal of Medicine in Scientific Research

Aim Neonatal mortality accounts for most infant mortality. Various factors influence the risk of neonatal mortality. Available estimates of survival and mortality in neonatal intensive care units (NICUs) are needed to provide antenatal counseling and guide management decisions. This study aimed to determine the predictors of admitted neonatal mortality. Patients and methods A retrospective study was done between June 2016 and May 2018 in the NICU of El-Galaa Teaching Hospital to determine the predictors of admitted neonatal mortality. Data were collected as follows: premature rupture of membranes, mode of delivery, multiple or single pregnancy, sex, weight, gestational age (GA), Apgar …

Cultures Of Practice: Specialty-Specific Differences In End-Of-Life Conversations., Andre Morales, Kevan C Schultz, Shasha Gao, Alan Murphy, Amber E Barnato, Joseph B Fanning, Daniel E Hall

Ambulatory and Primary Care Articles

No abstract provided.

Comparison And Interpretability Of Machine Learning Models To Predict Severity Of Chest Injury, Sujay Kulshrestha, Dmitriy Dligach, Cara Joyce, Richard Gonzalez, Ann P. O'Rourke, Joshua M. Glazer, Anne Stey, Jacqueline M. Kruser, Matthew M. Churpek, Majid Afshar

Biostatistics Collaborative Core: Faculty Publications and Other Works

Objective: Trauma quality improvement programs and registries improve care and outcomes for injured patients. Designated trauma centers calculate injury scores using dedicated trauma registrars; however, many injuries arrive at nontrauma centers, leaving a substantial amount of data uncaptured. We propose automated methods to identify severe chest injury using machine learning (ML) and natural language processing (NLP) methods from the electronic health record (EHR) for quality reporting.

Materials and Methods: A level I trauma center was queried for patients presenting after injury between 2014 and 2018. Prediction modeling was performed to classify severe chest injury using a reference dataset labeled by …

Telemedicine: A New Frontier In Clinical Practice, Munazza Asad, Nooresahar, Saniya Sabzwari

Department of Family Medicine

The COVID-19 pandemic has highlighted the important role of telemedicine as a tool for safe healthcare delivery across the world. While its use was more common in the developed world, the developing world has also adopted this strategy. It is important to develop a clear process and contextual guidance for effective use of this strategy for better patient-doctor interaction and its role in teaching/learning of trainees.

Covid-19 Pandemic And Breast Cancer Management: A Retrospective Observational Clinical Study From Pakistan, Lubna Mushtaque Vohra, Dua Jabeen, Narmeen Asif, Abdul Ahad

Section of General Surgery

Background: COVID-19 outbreak has adversely affected care of breast cancer patients world-wide. There is paucity of available data on cancer management in lower-middle income countries during this pandemic, we sought to determine the institutional approach towards management of breast cancer patients and the outcomes during COVID-19 pandemic at our institution.
Materials and methods: Clinicopathological and treatment record of cancer patients who presented to the Breast Clinic from 15th March to 31^st December 2020 was retrieved from the institutional database for this retrospective clinical observational study.
Results: A total of 292 patients were qualified for the analysis in which 206 …

Association Of Vitamin D Deficiency And Disease Activity In Systemic Lupus Erythematosus Patients: Two-Year Follow-Up Study, Ainan Arshad, Saad Bin Zafar Mahmood, Ahmed Ayaz, Adil A. Manji, Akash Kumar Ahuja

Section of Internal Medicine

Objectives: This study aims to determine the prevalence of vitamin D deficiency in Pakistani systemic lupus erythematosus (SLE) patients and the effect of vitamin D deficiency on the severity and outcomes of SLE.
Patients and methods: This retrospective study evaluated SLE patients presenting to our hospital between January 2009 and December 2018. A total of 98 patients (13 males, 85 females; mean age 39.8±14.9 years; range, 16 to 73 years) with vitamin D levels available at the time of diagnosis were included in the study. Disease activity was measured using SLE disease activity score at the time of diagnosis and …

Knowledge And Attitude Towards Identification And Management Of Sepsis Among Resident Physicians In A Tertiary Care Teaching Hospital In Pakistan, Ainan Arshad, Abdul Aziz, Ahmed Ayaz, Syed Maaz Salahuddin, Bushra Jamil

Section of Internal Medicine

This study was conducted to determine the compliance and knowledge of sepsis guidelines among resident physicians in a tertiary care hospital of a developing country. A self-structured validated questionnaire was prepared to evaluate compliance and knowledge of the Surviving Sepsis Campaign (SSC) guidelines. A total of 76 resident physicians completed the questionnaire; out of these, 51 (67%) were from Internal Medicine department and 25 (33%) were from Emergency Medicine department of the Aga Khan University Hospital, Karachi. A total of 71 (93%) participants claimed to be aware of the SSC guidelines but only 20 (26%) considered themselves very knowledgeable on …

Relationships Between Disaccharidase Deficiencies, Duodenal Inflammation And Symptom Profile In Children With Abdominal Pain., Jennifer Colombo, Chance S. Friesen, Uttam Garg, Craig A. Friesen, William San Pablo

Manuscripts, Articles, Book Chapters and Other Papers

Abdominal pain has been associated with disaccharidase deficiencies. While relationships with individual symptoms have been assessed, relationships between disaccharidase deficiencies and symptom complexes or inflammation have not been evaluated in this group. The primary aims of the current study were to assess relationships between disaccharidase deficiency and symptoms or symptom complexes and duodenal inflammation, respectively. Patients with abdominal pain who underwent endoscopy with evaluation of disaccharidase activity levels were identified. After excluding all patients with inflammatory bowel disease, celiac disease, H. pylori, or gross endoscopic lesions, patients were evaluated for disaccharidase deficiency frequency. Disaccharidase were compared between patients with and …

Continuous Chain Of Exporting Wuhan Novel Coronavirus Infection: A Comparison Of Primary And Secondary Step Rates, Rujittika Mungmungpuntipantip, Viroj Wiwanitkit

Journal of Medicine in Scientific Research

No abstract provided.

Redo-Mitral Valve Replacement And Predictors Of Operative Mortality: A Single-Institute Experience, Ahmed M. E. Abdelgawad, Ahmed Abdelaziz

Journal of Medicine in Scientific Research

Background In spite of improved survival of first-time mitral valve replacement (MVR), operative mortality associated with redo-mitral valve surgery is still higher than that of the primary operation. Consequently, more patients require redo-MVR, and studies investigating the operative outcome with current techniques and prostheses are thus needed. Patients and methods This is a nonrandomized prospective study that included 83 patients who underwent redo-MVR with either bioprosthetic or mechanical valves between March 2014 and December 2017 at National Heart Institute. Recorded data were analyzed using the statistical package for social sciences, version 23.0 (IBM SPSS). All preoperative and operative data were …

Comparison Of Short-Leg And Long-Leg Casts For The Treatment Of Distal Third Tibial Shaft Fractures In Children, Scott A. Barnett, Bailli Fontenot, Claudia Leonardi, Joseph A. Gonzales, Dominic Gargiulo, Michael J. Heffernan

School of Medicine Faculty Publications

Background:Long-leg casts (LLCs) are an established treatment for pediatric tibial shaft fractures including fractures involving the distal third. There is a paucity of literature assessing the use of short-leg cast (SLC) for tibial shaft fractures. The purpose of this study was to determine if SLC were as effective as LLC for the treatment of pediatric distal third tibial shaft fractures.Methods:A retrospective review was conducted on consecutive distal third tibial shaft fractures treated at a tertiary pediatric hospital from 2013 to 2018. Exclusion criteria included midshaft and proximal fractures of the tibia, distal fractures that violated the tibial physis or plafond, …

Evaluation Of Serum Ferritin For Prediction Of Severity And Mortality In Covid-19- A Cross Sectional Study, Sibtain Ahmed, Zeeshan Ansar Ahmed, Imran Siddiqui, Naveed Haroon Rashid, Maheen Mansoor, Lena Jafri

Department of Pathology and Laboratory Medicine

Background: Ferritin even though widely recognized as a representative of total body iron stores, its prognostic utility is linked with COVID-19. This study was aimed at evaluation of the association of ferritin with severity in Coronavirus disease 2019 (COVID-19), hospitalized patients and to test the hypothesis that it is an independent predictor of mortality.
Material and methods: This study was conducted at Chemical Pathology, Department of Pathology and Laboratory Medicine, Aga Khan University (AKU), Karachi. Medical records of all in-patients including both genders, and all age groups with documented COVID-19 from 1st March to 10^th August 2020 were reviewed. …

Female Genital Tuberculosis In Pakistan - A Retrospective Review Of 10-Year Laboratory Data And Analysis Of 32 Cases, Tazeen Fatima, Rumina Hasan, Faisal Malik, Imran Ahmed, Linda Alice Bartlett, Michael G. Gravett, Sadia Shakoor

Department of Pathology and Laboratory Medicine

Background: Female genital tuberculosis (FGTB) is an underobserved clinical entity owing to diagnostic challenges stemming from difficulty of obtaining diagnostic specimens and paucibacillary nature of the disease. Yet, FGTB is a cause of infertility, pelvic pain, or menstrual irregularities in high-burden countries. To assess laboratory and microbiology diagnostic utilization for FGTB in Pakistan, we have collected data from 2007 to 2016 to inform the need for improved laboratory diagnostics. The objectives of this study were to determine the proportion of FGTB as culture-confirmed extrapulmonary tuberculosis (EPTB) and to describe the characteristics of women with culture-confirmed FGTB in a nationwide laboratory …

Transfusion-Associated Circulatory Overload (Taco): Significance Of Appropriate Pre-Transfusion Risk Assessment To Prevent Fatal Health Outcomes, Nazish Sana, Muhammad Shariq Shaikh

Department of Pathology and Laboratory Medicine

No abstract provided.

Relationship Of Natural Occlusal Plane With Different Anatomical Landmarks, Mehwish Khan, Syed Murtaza Raza Kazmi, Farhan Raza Khan, Sameer Quraeshi

Section of Dental-Oral Maxillofacial Surgery

Objective: To evaluate the parallelism of natural maxillary occlusal plane with inter-pupillary line and ala-tragus line, and to evaluate the anatomic relationship of natural mandibular occlusal plane with retromolar pad among dentate subjects.
Methods: The cross-sectional study was conducted from September 2017 to February 2018 at Fatima Jinnah Dental College, Karachi, and comprised front and profile photographs of subjects aged 20-28 years while holding the camper's plane against the maxillary occlusal plane. The photographs were imported in a software and an interpupillary line was drawn and the angle with Camper's plane was measured. On both profile pictures, lines were drawn …

Inhibition Of Zika Virus Replication By G-Quadruplex-Binding Ligands, Indian Institute Of Technology Indore, Aryamav Pattnaik, Bikash R. Sahoo, Uma Shankar, Asit K. Pattnaik, Amit Kumar, Debasis Nayak

Nebraska Center for Virology: Faculty Publications

Zika virus (ZIKV), a mosquito-transmitted Flavivirus, emerged in the last decade causing serious diseases and affecting human health globally. Currently, no licensed vaccines or antivirals are available to combat ZIKV, although several vaccine candidates are in the pipeline. In recent years, the presence of non-canonical G-quadruplex (GQ) secondary structures in viral genomes has ignited significant attention as potential targets for antiviral strategy. In this study, we identified several novel conserved potential GQ structures by analyzing published ZIKV genome sequences using an in-house algorithm. Biophysical and biochemical analysis of the RNA sequences containing these potential GQ sequences suggested the existence of …

Umbilical Amnion And Amniotic Membrane Transplantation For Infectious Scleritis And Scleral Melt: A Case Series., Zeba Syed, Christopher J Rapuano

Wills Eye Hospital Papers

Purpose: To report the outcomes of two cases of infectious scleritis with severe scleral thinning managed using combined mechanical debridement, cryopreserved umbilical amnion (UA) and amniotic membrane (AM) grafts, and antimicrobial therapy.

Observations: Two patients presented with severe infectious scleritis with progressive scleral melts secondary to Pseudomonas aeruginosa subsequent to pterygium surgery and intravitreal injection, respectively. Surgical debridement was followed by UA grafting, AM transplantation, and antimicrobial therapy. Epithelialization and vascularization were seen within 1–4 weeks post-operatively. At last follow up of 5–6 months, the structural integrity of the sclera remained preserved with no infection recurrence, graft necrosis, or wound …

Biomechanics Of Circumferential Cervical Fixation Using Posterior Facet Cages: A Cadaveric Study., Bernardo De Andrada Pereira, Joshua Pelta-Heller, Jennifer N Lehrman, Anna G U Sawa, Brian P Kelly

Department of Neurosurgery Faculty Papers

OBJECTIVE: Anterior cervical discectomy and fusion (ACDF) is a common procedure for the treatment of cervical disease. Circumferential procedures are options for multilevel pathology. Potential complications of multilevel anterior procedures are dysphagia and pseudarthrosis, whereas potential complications of posterior surgery include development of cervical kyphosis and postoperative chronic neck pain. The addition of posterior cervical cages (PCCs) to multilevel ACDF is a minimally invasive option to perform circumferential fusion. This study evaluated the biomechanical performance of 3-level circumferential fusion with PCCs as supplemental fixation to anteriorly placed allografts, with and without anterior plate fixation.

METHODS: Nondestructive flexibility tests (1.5 Nm) …

Ispd Guidelines For Peritoneal Dialysis In Acute Kidney Injury: 2020 Update (Paediatrics)., Peter Nourse, Brett Cullis, Fredrick Finkelstein, Alp Numanoglu, Bradley A. Warady, Sampson Antwi, Mignon Mcculloch

Manuscripts, Articles, Book Chapters and Other Papers

1.1 Peritoneal dialysis is a suitable renal replacement therapy modality for treatment of acute kidney injury in children. (1C)2. Access and fluid delivery for acute PD in children.2.1 We recommend a Tenckhoff catheter inserted by a surgeon in the operating theatre as the optimal choice for PD access. (1B) (optimal)2.2 Insertion of a PD catheter with an insertion kit and using Seldinger technique is an acceptable alternative. (1C) (optimal)2.3 Interventional radiological placement of PD catheters combining ultrasound and fluoroscopy is an acceptable alternative. (1D) (optimal)2.4 Rigid …

C1q Complement/Tumor Necrosis Factor-Associated Proteins In Cardiovascular Disease And Covid-19, Yaoli Xie, Zhijun Meng, Jia Gao, Caihong Liu, Jing Wang, Rui Guo, Jianli Zhao, Bernard Lopez, Theodore Christopher, Daniel Lee, Xin-Liang Ma, Yajing Wang

Department of Emergency Medicine Faculty Papers

With continually improving treatment strategies and patient care, the overall mortality of cardiovascular disease (CVD) has been significantly reduced. However, this success is a double-edged sword, as many patients who survive cardiovascular complications will progress towards a chronic disorder over time. A family of adiponectin paralogs designated as C1q complement/tumor necrosis factor (TNF)-associated proteins (CTRPs) has been found to play a role in the development of CVD. CTRPs, which are comprised of 15 members, CTRP1 to CTRP15, are secreted from different organs/tissues and exhibit diverse functions, have attracted increasing attention because of their roles in maintaining inner homeostasis by regulating …

Atg16l1 As A Novel Biomarker And Autophagy Gene For Diabetic Retinopathy., Xinxiao Gao, Yunhui Du, Wayne Bond Lau, Yu Li, Siquan Zhu, Xin-Liang Ma

Department of Emergency Medicine Faculty Papers

Objective: Accumulating evidence suggests the critical role of autophagy in the pathogenesis of diabetic retinopathy (DR). In the current study, we aim to identify autophagy genes involved in DR via microarray analyses.

Methods: Gene microarrays were performed to identify differentially expressed lncRNAs/mRNAs between normal and DR retinas. Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses of lncRNA-coexpressed mRNAs were used to determine the related pathological pathways and biological modules. Real-time polymerase chain reactions (PCR) were conducted to validate the microarray analyses.

Results: A total of 2474 significantly dysregulated lncRNAs and 959 differentially expressed mRNAs were identified in the …

Effect Of Crohn's Disease On Villous Length And Cyp3a4 Expression In The Pediatric Small Intestine., Carrie A. Vyhlidal, Brian D. Chapron, Atif Ahmed, Vivekanand Singh, Rebecca Casini, Valentina Shakhnovich

Manuscripts, Articles, Book Chapters and Other Papers

Changes in absorptive capacity and first-pass metabolism in the small intestine affect oral drug bioavailability. Characterization of such changes as a consequence of inflammation is important for developing physiologically-based pharmacokinetic (PBPK) models for inflammatory bowel disease. We sought to elucidate the impact of small intestinal Crohn's disease (CD) on villous length and CYP3A4 expression in children. Freshly frozen duodenal and terminal ileum (TI) biopsies from 107 children (1-19 years) with and without CD were evaluated for active inflammation. Villous length and CYP3A4 mRNA/protein expression were compared among regions of active and inactive inflammation in CD and controls. A twofold reduction …

Prematurity Blunts The Insulin- And Amino Acid-Induced Stimulation Of Translation Initiation And Protein Synthesis In Skeletal Muscle Of Neonatal Pigs, Marko Rudar, Jane K Naberhuis, Agus Suryawan, Hanh V Nguyen, Barbara Stoll, Candace C Style, Mariatu A Verla, Oluyinka O Olutoye, Douglas G Burrin, Marta L Fiorotto, Teresa A Davis

Children’s Nutrition Research Center Staff Publications

Extrauterine growth restriction in premature infants is largely attributed to reduced lean mass accretion and is associated with long-term morbidities. Previously, we demonstrated that prematurity blunts the feeding-induced stimulation of translation initiation signaling and protein synthesis in skeletal muscle of neonatal pigs. The objective of the current study was to determine whether the blunted feeding response is mediated by reduced responsiveness to insulin, amino acids, or both. Pigs delivered by cesarean section preterm (PT; 103 days,