Medical Specialties Commons^™

Acr Appropriateness Criteria® Staging And Follow-Up Of Primary Vaginal Cancer., Aoife Kilcoyne, Ravi V Gottumukkala, Stella K Kang, Esma A. Akin, Carlin Hauck, Nicole M Hindman, Chenchan Huang, Namita Khanna, Rajmohan Paspulati, Gaiane M Rauch, Tamer Said, Atul B Shinagare, Erica B Stein, Aradhana M Venkatesan, Katherine E Maturen

Radiology Faculty Publications

No abstract provided.

All In The Family: Child And Adolescent Weight Loss Surgery In The Context Of Parental Weight Loss Surgery., Eleanor R. Mackey, Megan M York, Evan P. Nadler

Pediatrics Faculty Publications

No abstract provided.

2021 Paces Expert Consensus Statement On The Indications And Management Of Cardiovascular Implantable Electronic Devices In Pediatric Patients: Executive Summary., Michael J Silka, Maully J Shah, Jennifer N Avari Silva, Seshadri Balaji, Cheyenne M Beach, Monica N Benjamin, Charles I. Berul, Bryan Cannon, Frank Cecchin, Mitchell I Cohen, Aarti S Dalal, Brynn E Dechert, Anne Foster, Roman Gebauer, M Cecilia Gonzalez Corcia, Prince J Kannankeril, Peter P Karpawich, Jeffery J Kim, Mani Ram Krishna, Peter Kubuš, Martin J Lapage, Douglas Y Mah, Lindsey Malloy-Walton, Aya Miyazaki, Kara S Motonaga, Mary C Niu, Melissa Olen, Thomas Paul, Eric Rosenthal, Elizabeth V Saarel, Massimo Stefano Silvetti, Elizabeth A Stephenson, Reina B Tan, John Triedman, Nicholas H Von Bergen, Philip L Wackel

Pediatrics Faculty Publications

No abstract provided.

Nanomedicine In The Treatment Of Glioblastoma, Syeda Kubra Kishwar Jafri, Syed Sarmad Bukhari, Muhammad Shahzad Shamim

Section of Neurosurgery

The current standard of care in glioblastoma management is surgery followed by chemotherapy and radiotherapy. Temozolomide is an alkylating agent most commonly used with a few other second line options. The efficacy of systemic chemotherapy in brain malignancies is limited due to the nature of the blood-brain barrier. Nanomedicine offers one avenue of improving drug delivery to these tumours in a more focussed and effective way in higher doses than currently possible, while simultaneously reducing systemic toxicity.

Endometriosis And Pelvic Pain In The Adolescent: Delayed Diagnosis Leading To Long-Term Suffering And The Need For Intervention, Latashia-Lika Lelea

OB-GYN

No abstract available.

Patterns In Change Of Opioid Overdose Death Rate With The Day Of The Week And Their Implications, William R. Duan, Dennis J. Hand

Department of Psychiatry and Human Behavior Posters

The objective of this study was to investigate the dependencies of opioid overdose death rates on the day of the week and understand the implications of the dependencies Understanding and presenting the dependencies is useful for first responders and for health care system resource planning It can provide additional insights in the opioid epidemic and should be considered in prevention efforts

Effects Of Using Different Death Rate Metrics On The Analysis Of Drug-Overdose Death Rates And Socioeconomical Factors, William R. Duan, Dennis J. Hand

Department of Psychiatry and Human Behavior Posters

Age-adjusted death rate (AADR) and raw death rate (RDD) used in drugoverdose studies typically involves death-record data and populationsurvey data. Difference can exist between the two data sources, leading to the so-called dual data-source error. Proportionate mortality avoids the error; however, no studies have been done comparing the conclusions drawn using the different metrics. The objective of this study is to evaluate the differences and merits of using different death-rate metrics in overdose analysis.

Endoxifen: A New Hope For Bipolar Disorder, Muneeba Amin, Alviya Shafique, Muhammad Yusuf Hafiz

Department of Psychiatry

No abstract provided.

Alcohol And Illicit Drug Use Among Young People Living With Hiv Compared To Their Uninfected Peers From The Kenyan Coast: Prevalence And Risk Indicators, Moses K. Nyongesa, Paul Mwangi, Michael Kinuthia, Amin S. Hassan, Hans M. Koot, Pim Cuijpers, Charles R. J. C. Newton, Amina Abubakar

Institute for Human Development, East Africa

Background: In sub-Saharan Africa, there is paucity of research on substance use patterns among young people living with HIV (YLWH). To address the gap, we sought to: i) determine the prevalence of substance use, specifically alcohol and illicit drug use, among YLWH compared to their HIV-uninfected peers; ii) investigate the independent association between young people’s HIV infection status and substance use; iii) investigate the risk indicators for substance use among these young people.

Methods: Between November 2018 and September 2019, a cross-sectional study was conducted at the Kenyan coast recruiting 819 young people aged 18–24 years (407 HIV-positive). …

Covid-19 Vaccination In Individuals With Cystic Fibrosis At A Pediatric Cystic Fibrosis Center, Christopher M. Oermann, Claire Elson, Ellen Meier, Paula Capel, Jessica Haynes, Michelle Fischer, Stephanie Duehlmeyer

Posters

Background: Observational data suggest that most people with cystic fibrosis (PwCF) who contract COVID-19 have outcomes similar to those of the general population, although PwCF who are older or have CF-related diabetes, poor lung function, or a history of lung transplantation may be at greater risk for more severe disease. Therefore, the CF Foundation advocates for PwCF to discuss vaccination with care teams. At present, the FDA has authorized emergency use of 3 COVID-19 vaccines. ACIP/CDC guidance allows each state to determine vaccine distribution based on an individual’s exposure and risk for severe disease. This study describes the attitudes of …

Ketamine For Refractory Chronic Migraine: An Observational Pilot Study And Metabolite Analysis., Eric S. Schwenk, Marc C. Torjman, Ruin Moaddel, Jacqueline Lovett, Daniel Katz, William Denk, Clinton Lauritsen, Stephen D. Silberstein, Irving W. Wainer

Department of Anesthesiology Faculty Papers

Patients with refractory chronic migraine have substantial disability and have failed many acute and preventive medications. When aggressive intravenous therapy is indicated, both lidocaine and (R,S)-ketamine infusions have been used successfully to provide relief. Retrospective studies have shown that both agents may be associated with short-term analgesia. In this prospective, observational pilot study of 6 patients, we compared the effects of lidocaine and (R,S)-ketamine infusions and performed metabolite analyses of (R,S)-ketamine to determine its metabolic profile in this population. One of (R,S)-ketamine's metabolites, (2R,6R)-hydroxynorketamine, has been shown in animal studies to reduce pain, but human studies in patients undergoing continuous …

Optic Disc Pit Maculopathy Leading To Vision Loss In A Pediatric Patient, Allyson Hall

Posters

This case will review optic disc pit maculopathy in children and treatments available. An emphasis in vision rehabilitation will be discussed as any visual insult during this development period can lead to long-term visual consequences.

Optimizing Oral Glucose Tolerance Test Completion At A Pediatric Cystic Fibrosis Care Center: A 10-Year Continuing Quality Improvement Effort, Christopher M. Oermann, Paula Capel, Jessica Haynes, Michelle Fischer, Jill Kohmetscher

Posters

Background: Cystic fibrosis–related diabetes (CFRD) is a common comorbidity among people with CF (PwCF). It is associated with weight loss, protein catabolism, lung function decline, and increased mortality. Nutritional status and pulmonary function begin to decline in PwCF several years before the diagnosis of CFRD. Early CFRD detection and aggressive insulin therapy have been shown to reduce the mortality gap between PwCF who have CFRD and those who do not. The Clinical Care Guidelines for Cystic Fibrosis–Related Diabetes recommend annual screening for people with CF starting at age 10 [1]. Methods: In 2011, team members at Children’s Mercy Kansas City …

Evaluation Of The Outcomes Of Trimethoprim-Sulfamethoxazole Oral Challenges In The Pediatric Population, Hannah N. Neuhaus, Salman Aljubran

Posters

Introduction: Trimethoprim-sulfamethoxazole allergy can complicate treatment for various infections. While trimethoprim-sulfamethoxazole hypersensitivity, desensitization/oral challenges are frequently reported in adults, data is limited on the outcomes/safety of oral challenges to trimethoprim-sulfamethoxazole in Pediatrics. The goal of this study was to characterize the outcomes and safety of trimethoprim-sulfamethoxazole oral challenges in Pediatrics.

Methods: An IRB-exempt retrospective chart review was performed of pediatric patients who underwent oral challenge to trimethoprim-sulfamethoxazole in Allergy Clinic over the last 12 years. We assessed characteristics including age, sex, reaction (IgE-mediated/non-IgE-mediated/indeterminate), skin testing, challenge outcome and complications to draw a conclusion regarding the overall safety of the procedure …

Unintended Pregnancy And The Associated Factors Among Pregnant Females: Sukh Survey-Karachi, Pakistan, Shama Razzaq, Saleem Jessani, Narjis Rizvi, Sarah Saleem

Community Health Sciences

Objective: Unintended pregnancy has become a substantially growing reproductive health concern in South Asian region. The objective of this survey was to assess the magnitude of unintended pregnancy along with its correlates among currently pregnant women residing in Karachi.
Methods: A community based, multistage, cross-sectional study was carried out among 612 currently pregnant women from squatter settlements of Karachi, inquiring for "unintended pregnancy", outcome of interest. Multivariable logistic analysis was done using SPSS v.19 to determine associated factors.
Results: Of 612 pregnant women interviewed, 168(27.4%) reported their pregnancies as unintended. The multivariable regression identified a high likelihood of unintended pregnancy …

Anal Human Papillomavirus Infection Among Men Who Have Sex With Men And Transgender Women Living With And Without Hiv In Pakistan: Findings From A Cross-Sectional Study, Muslima Ejaz, Soren Andersson, Salma Batool, Tazeen Saeed Ali, Anna Mia Ekström

Community Health Sciences

Objectives: The aim of this study was to determine the prevalence of infection, genotypes and risk factors for human papillomavirus (HPV) among men who have sex with men (MSM) and transgender women living with and without HIV in Pakistan. Anal infection with HPV is very common worldwide among MSM, particularly among MSM living with HIV. The high prevalence of HIV among MSM and male-to-female transgendered individuals in Pakistan is a significant health concern since access to screening and health-seeking is often delayed in this stigmatised key population.
Design: This cross-sectional study was conducted between March 2016 and November 2017.
Participants, …

Molecular Mechanism Of Action Of The Natural Polyphenolic Compound And The P300 Inhibitor “Carnosol” Against The Triple Negative Breast Cance, Halima Ali Mohammed Salem Alsamri

Dissertations

Carnosol, a naturally occurring Phyto polyphenol found in sage, oregano, and rosemary, has been extensively studied by our laboratory for its anticancer effects in various types of cancer. In human Triple-Negative Breast Cancer (TNBC), carnosol was shown to inhibit cellular viability, colony growth, induced cell cycle arrest, autophagy, and apoptosis. Nonetheless, very little is known about the molecular mechanism of action. In the current study, the ability of carnosol to inhibit metastasis and tumour growth was examined. Wound healing and invasion assays revealed that carnosol inhibited migration and invasion at non-cytotoxic concentrations of MDA-MB-231 cells. Also, carnosol was found to …

Features On Cardiac Magnetic Resonance Imaging And Accuracy Of Echocardiographic Findings For Diagnosing Constrictive Pericarditis, Salik Ur Rehman Iqbal, Fateh Ali Tipoo Sultan

Section of Cardiology

Constrictive pericarditis is a rare disease with a difficult diagnosis. Cardiac magnetic resonance (CMR) imaging data of Aga Khan University Hospital from January 2011 to March 2020 was retrospectively reviewed and patients with the diagnosis of constrictive pericarditis were included. A total of 22 patients were included with the mean age of 46±16 years and majority 17(77%) were male. The most common findings on transthoracic echo were significant respiratory variation in mitral and tricuspid inflow velocities in 20(91%), and septal annular e'>9 in 10 (86%). The most common finding on CMR was respiratory septal shift in 22(100%), followed by …

Who Will Be The Caretakers Of Peripheral Arterial Disease?, Claudie Sheahan

School of Medicine Faculty Publications

No abstract provided.

Clinical Outcomes Of Physiologically-Guided Revascularisation, Nasir Rahman, Ghufran Adnan, Awais Farhad, Jamshed Ali, Ihsan Ullah

Section of Cardiology

Objective: To assess the clinical outcomes of revascularisation based on fractional flow reserve (FFR) and/or instantaneous wave-free ratio (iFR).
Study design: Descriptive study.
Place and duration of study: Department of Medicine, The Aga Khan University Hospital, Karachi from January 2012 to January 2020.
Methodology: A cohort of patients having moderate to severe coronary stenosis, undergoing coronary revascularisation based on invasive physiological assessment (FFR or iFR) were assessed. The participants were divided into the revascularisation-deferred group and the revascularization-performed group, based on the physiological results. Cox-proportional hazard model building was done, using a stepwise approach by assessing all plausible interactions and …

Covid-19 Bbibp-Corv Vaccine And Transient Heart Block - A Phenomenon By Chance Or A Possible Correlation - A Case Report, Pirbhat Shams, Jamshed Ali, Sheema Saadia, Aamir Hameed Khan, Fateh Ali Tipoo Sultan, Javed Tai

Section of Cardiology

Importance: Bradyarrhythmia during COVID19 illness carries prognostic significance. Electrophysiological side effects of COVID19 vaccine remain largely unknown. It is imperative to report nature of cardiovascular side effects of the vaccine.
Case presentation: An 80 years-old-man presented with complains of dizziness, trepidation and shortness of breath following his first shot of COVID-19 BBIBP-CorV (Sino-pharm). ECG on arrival showed 2:1 atrioventricular block with an underlying old left bundle branch block. The AV block changed into Mobitz type-I over the course of next 2 days and into a sinus 1:1 conduction on fourth day of presentation. However, our patient underwent permanent pacemaker implantation …

Development Of A Financial Toxicity Screening Tool For Radiation Oncology: A Secondary Analysis Of A Pilot Prospective Patient-Reported Outcomes Study, Rahul N Prasad, Tejash Patel, Scott W Keith, Harriet Eldredge-Hindy, Scot A Fisher, Joshua D Palmer

Department of Radiation Oncology Faculty Papers

Purpose: Financial toxicity is highly prevalent in oncology. Early identification of at-risk patients is essential because financial toxicity is associated with inferior outcomes. Validated general oncology screening tools are cumbersome and not specific to challenges related to radiation therapy, such as daily treatments. In the population of radiation oncology patients, no standardized, validated, rapid screening tool exists. We sought to develop a rapid, no-cost, and reliable financial-toxicity screening tool for clinical radiation oncology.

Methods and materials: We retrospectively analyzed data from a prospective survey study conducted at a large referral center with a heterogeneous population. Before treatment, a 25-item modified …

Evaluation Of A Contactless Neonatal Physiological Monitor In Nairobi, Kenya, Dee Wang, William Macharia, Roseline Ochieng, Dorothy Chomba, Yifat S. Hadida, Roman Karasik, Dustin Dunsmuir, Jesse Coleman, Guohai Zhou, Amy Sarah Ginsburg, J Mark Ansermino

Paediatrics and Child Health, East Africa

Background: Globally, 2.5 million neonates died in 2018, accounting for 46% of under-5 deaths. Multiparameter continuous physiological monitoring (MCPM) of neonates allows for early detection and treatment of life-threatening health problems. However, neonatal monitoring technology is largely unavailable in low-resource settings.

Methods: In four evaluation rounds, we prospectively compared the accuracy of the EarlySense under-mattress device to the Masimo Rad-97 pulse CO-oximeter with capnography reference device for heart rate (HR) and respiratory rate (RR) measurements in neonates in Kenya. EarlySense algorithm optimisations were made between evaluation rounds. In each evaluation round, we compared 200 randomly selected epochs of data using …

Vancomycin Auc Monitoring In Individuals With Cystic Fibrosis At A Pediatric Institution, Christopher M. Oermann, Stephanie Duehlmeyer, Ellen Meier, Claire Elson

Posters

Vancomycin AUC monitoring in individuals with cystic fibrosis at a pediatric institution S. Duehlmeyer1, C. Oermann1, E. Meier1, E. Elson1. 1Pulmonology, Children’s Mercy Kansas City, Kansas City, USA Background: Antibiotic therapy is essential for the treatment of cystic fibrosis (CF) lung infections. Methicillin-resistant Staphylococcus aureus (MRSA) infects 20% to 25% of people with CF (PwCF) and is associated with increased morbidity. Treatment of pulmonary exacerbations (PEs) often requires hospitalization including respiratory treatments and intravenous (IV) antimicrobials. IV vancomycin, which is commonly used for MRSA infections, requires serum concentration monitoring to ensure efficacy and minimize toxicity. Previous guidelines recommended trough concentrations …

Impact Of Early Tracheostomy On Neurodevelopmental Outcome In Infants With Severe Bronchopulmonary Dysplasia Exposed To Postnatal Steroids, Amjad Taha, Gangaram Akangire, Janelle R. Noel-Macdonnell, Tiffany Willis, Winston Manimtim

Posters

No abstract provided.

Cost-Effectiveness Of Recombinant Zoster Vaccine For Vaccinating Immunocompromised Adults Against Herpes Zoster In The United States, Desmond Curran, Ahmed Salem, Stephane Lorenc, Brandon Patterson, Justin Carrico, Katherine A. Hicks, Elizabeth M. La, Sara Poston, Christopher F. Carpenter

Conference Presentation Abstracts

Background. Individuals who are immunocompromised (IC) due to disease or therapy are at increased risk of herpes zoster (HZ), with HZ cases in IC populations also resulting in increased health care resource use and costs as compared with the immunocompetent population. This study assesses the cost-effectiveness of recombinant zoster vaccine (RZV) versus no vaccine for the prevention of HZ in IC adults aged ≥ 18 years in the United States (US). Methods. A Markov model with a one-year cycle length was developed to follow a hypothetical cohort of one million IC individuals for a 30-year time horizon. The model estimates …

Optimization Of Neurite Tracing And Further Characterization Of Human Monocyte-Derived-Neuronal-Like Cells, Alfredo Bellon, Tuna Hasoglu, Mallory Peterson, Katherine Gao, Michael Chen, Elisabeta Blandin, Alonso Cortez-Resendiz, Gary Clawson, Liyi Elliot Hong

Department of Psychiatry and Human Behavior Faculty Papers

Deficits in neuronal structure are consistently associated with neurodevelopmental illnesses such as autism and schizophrenia. Nonetheless, the inability to access neurons from clinical patients has limited the study of early neurostructural changes directly in patients’ cells. This obstacle has been circumvented by differentiating stem cells into neurons, although the most used methodologies are time consuming. Therefore, we recently developed a relatively rapid (~20 days) protocol for transdifferentiating human circulating monocytes into neuronal-like cells. These monocyte-derived-neuronal-like cells (MDNCs) express several genes and proteins considered neuronal markers, such as MAP-2 and PSD-95. In addition, these cells conduct electrical activity. We have also …

Performance In Mortality Prediction Of Saps 3 And Mpm-Iii Scores Among Adult Patients Admitted To The Icu Of A Private Tertiary Referral Hospital In Tanzania: A Retrospective Cohort Study, Nadeem Kassam, Eric Aghan, Samina Somji, Omar Aziz, James Orwa, Salim R. Surani

Internal Medicine, East Africa

Background: Illness predictive scoring systems are significant and meaningful adjuncts of patient management in the Intensive Care Unit (ICU). They assist in predicting patient outcomes, improve clinical decision making and provide insight into the effectiveness of care and management of patients while optimizing the use of hospital resources. We evaluated mortality predictive performance of Simplified Acute Physiology Score (SAPS 3) and Mortality Probability Models (MPM0-III) and compared their performance in predicting outcome as well as identifying disease pattern and factors associated with increased mortality.

Methods: This was a retrospective cohort study of adult patients admitted to the ICU of the …

Factors Associated With Surgeon Recommendation For Additional Cast Immobilization Of A Ct-Verified Nondisplaced Scaphoid Waist Fracture, Anne Eve J. Bulstra, Tom J. Crijns, Stein J. Janssen, Geert A. Buijze, David Ring, Ruurd L. Jaarsma, Gino M.M.J. Kerkhoffs, Miryam C. Obdeijn, Job N. Doornberg, A. Peters, A. B. Spoor, Abhay Shrivastava, Aakash Chauhan, Adam Shafritz, Asif M. Ilyas, Anne J.H. Vochteloo, Andrew John Powell, Alberto Pérez Castillo, Alexandre Leme Godoy-Santos, Amparo Gomez Gelvez, Andrea Bauer, Antonio Barquet, Anze Kristan, Ante Prkic, Axel Jubel, Boj Mirck, B. E. Kreis, H. Brent Bamberger, William Dias Belangero, Bernard F. Hearon, Bradley Palmer

Orthopaedic Surgery Faculty Publications

Introduction: Data from clinical trials suggest that CT-confirmed nondisplaced scaphoid waist fractures heal with less than the conventional 8-12 weeks of immobilization. Barriers to adopting shorter immobilization times in clinical practice may include a strong influence of fracture tenderness and radiographic appearance on decision-making. This study aimed to investigate (1) the degree to which surgeons use fracture tenderness and radiographic appearance of union, among other factors, to decide whether or not to recommend additional cast immobilization after 8 or 12 weeks of immobilization; (2) identify surgeon factors associated with the decision to continue cast immobilization after 8 or 12 weeks. …

A Prospective Examination Of Sex Differences In Posttraumatic Autonomic Functioning., Antonia V Seligowski, Elizabeth R Steuber, Rebecca Hinrichs, Mariam H Reda, Charis N Wiltshire, Cassandra P Wanna, Sterling J Winters, Karlye A Phillips, Stacey L House, Francesca L Beaudoin, Xinming An, Jennifer S Stevens, Donglin Zeng, Thomas C Neylan, Gari D Clifford, Sarah D Linnstaedt, Laura T Germine, Kenneth A Bollen, Guia Guffanti, Scott L Rauch, John P Haran, Alan B Storrow, Christopher Lewandowski, Paul I Musey, Phyllis L Hendry, Sophia Sheikh, Christopher W Jones, Brittany E Punches, Michael C Kurz, Vishnu P Murty, Meghan E Mcgrath, Lauren A Hudak, Jose L Pascual, Mark J Seamon, Elizabeth M Datner, Anna Marie Chang, Claire Pearson, David A Peak, Roland C Merchant, Robert M Domeier, Niels K Rathlev, Brian J O'Neil, Leon D Sanchez, Steven E Bruce, Mark W Miller, Robert H Pietrzak, Jutta Joormann, Deanna M Barch, Diego A Pizzagalli, John F Sheridan, Beatriz Luna, Steven E Harte, James M Elliott, Karestan C Koenen, Ronald C Kessler, Samuel A Mclean, Kerry J Ressler, Tanja Jovanovic

Department of Emergency Medicine Faculty Papers

Background: Cross-sectional studies have found that individuals with posttraumatic stress disorder (PTSD) exhibit deficits in autonomic functioning. While PTSD rates are twice as high in women compared to men, sex differences in autonomic functioning are relatively unknown among trauma-exposed populations. The current study used a prospective design to examine sex differences in posttraumatic autonomic functioning.

Methods: 192 participants were recruited from emergency departments following trauma exposure (

Results: 2-week systolic BP was significantly higher in men, while 2-week HR was significantly higher in women, and a sex by PTSD interaction suggested that women who developed PTSD demonstrated the highest HR …