Medical Specialties Commons^™

Factors Influencing Uptake Of Human Papilloma Virus (Hpv) Vaccine Among Parents Of Adolescent Girls, Irene Nzisa Martin

Master of Medicine in Paediatrics and Child Health

Background: Cervical cancer is one of the most common preventable cancers causing morbidity and mortality in women especially in Sub-Saharan Africa. Three HPV vaccines have been approved for vaccination against HPV globally with Cervarix and Gardasil currently available in Kenya. Despite availability of free HPV vaccination and increased media campaigns the proportion of adolescent girls vaccinated against HPV remains low. Understanding the determinants of HPV vaccine uptake will inform strategies to improve the uptake at Aga Khan University Hospital, Nairobi. Objectives: The aim was to identify the factors influencing HPV vaccine uptake among parents of adolescent girls. The secondary objective …

Stewardship Opportunities For Cervical Lymphadenitis And Deep Neck Space Infections, Aaron Shaw, Brian R. Lee, Lauren Kazmaier, Emily Baker, Tina Dao, Sandra Arnold, Angela Myers

Posters

Background: Cervical lymphadenitis (LAD) and deep neck space abscesses (DNSA) are common pediatric infections caused by similar bacteria. We sought to determine differences in presentation, diagnosis, and treatment between LAD and DNSA to identify antimicrobial and diagnostic stewardship opportunities. Methods: Charts were obtained using ICD9/10 codes for retropharyngeal and parapharyngeal abscessed (DNSA), and LAD between 1/1/10-12/31/20 from two pediatric centers. 1981 charts were identified. Charts were excluded if the diagnosis was not a bacterial infection (e.g. Kawasaki disease), if the LAD was not in the neck, or if caused by less common bacteria (e.g. tuberculosis). Data on presenting signs, symptoms, …

Inverted Appendix Presenting As Abdominal Pain And Lower Gastrointestinal Bleeding, Moises Alatorre-Jimenez, Thomas M. Attard

Posters

Background: Cecal polyps are challenging insofar as the region represents the highest risk of bleeding and perforation during polypectomy . In addition, polypoid lesions in the cecum may represent a morphologically abnormal ileocecal valve or an inverted appendix. Inadvertent polypectomy in those scenarios would lead to serious sequelae including perforation. Case report: Our patient is a 6-year-old male with a background history of prematurity, lactose intolerance, chronic esophagitis, gastritis, constipation, and painless rectal bleeding. He presented with a acute onset diffuse, severe abdominal pain associated with diarrhea that evolved to include hematochezia. At the time of presentation, he required aggressive …

Declining Career Interest In Primary Care In Switzerland And The United States, William Zhang

Independent Study Project (ISP) Collection

Primary care (PC) lies at the center of modern healthcare systems as the primary point of contact between the general public and quality health care. Primary care physicians (PCPs) are known to provide high quality basic care to members of their surrounding community without consuming a large budget, and thus should be a priority for health sector investments. However, the proportion of medical students becoming PCPs is declining across the world, thus putting affordable global health at risk. The U.S. and Switzerland, even with their high health expenditures and advanced healthcare technologies, are no exception to this trend. Analysis of …

Pyemotes Herfsi Dermatitis: A Case Of 17 Year Itch, Christina E. Borchers, Taylor Schaetzle, Samia Borchers

Dermatology Faculty Publications

No abstract provided.

The Effects Of An Interprofessional Education Video On Dermatologists’ Understanding Of The Role Of The Dermatology Certified Nurse Practitioner, Danielle Elaine Spelich

Doctoral Projects

Dermatology-certified nurse practitioners (DCNPs) have validated knowledge of a dermatology core curriculum and have at least 3,000 hours of formal or informal dermatology training (Dermatology Nurse Practitioner Certification Board [DNPCB], n.d.a). With their standardized education and training, DCNPs are meeting the benchmarks set out by dermatologists. Subsequently, DCNPs have become the new gold standard for dermatology advanced practice registered nurses (APRNs).

However, there is no mention of DCNPs by the American Academy of Dermatology (American Academy of Dermatology [AAD], 2022), and personal experience with dermatologists is that they lack knowledge about DCNPs. This lack of knowledge could create an impasse …

Management Of Primary Spontaneous Pneumothorax: A Single Institution Protocol Analysis, Shai Stewart Md, James A. Fraser, Rebecca M. Rentea, Pablo Aguayo, David Juang, Jason D. Fraser, Charles L. Snyder, Richard J. Hendrickson, Tolulope A. Oyetunji, Shawn D. St.Peter

Posters

Management of Primary Spontaneous Pneumothorax in Children: A Single Institution Protocol Analysis

Background: The Midwest Pediatric Surgery Consortium (MWPSC) has suggested a management algorithm to include simple aspiration of primary spontaneous pneumothorax (PSP), failing which, Video-Assisted Thoracoscopic Surgery (VATS) should be considered. We describe our outcomes in patients who have been managed with this suggested protocol.

Methods: An Institutional Review Board (IRB) approved, single institution retrospective analysis was conducted on all patients between 12 and 18 years who were diagnosed with PSP from 2016 to 2022. Initial management consisted of aspiration alone with a 12F Thal-Quick chest tube followed by …

Alterations In The Metabolic Comorbidities Of Youth With Overweight And Obesity During The Covid-19 Pandemic, Safa Farrukh, Erica Wee, Ashley Sherman, Yun Yan

Posters

Background: Childhood obesity rates have continued to increase with the COVID-19 pandemic. However, data are limited on the impact of increasing obesity on associated comorbidities. Methods: We evaluated the progression of overweight- or obesity-associated comorbidities by investigating change in laboratory results pre–COVID-19 pandemic and post–COVID-19 pandemic onset in youth with overweight or obesity. Results: There was no significant BMI progression. There was progression of metabolic comorbidities. HbA1c progression and LDL progression were significantly correlated. HbA1c and LDL progression were significantly associated with older age and Hispanics respectively. Conclusion: The results indicate that despite no significant increase in BMI, youths with …

Two Siblings With Microvillous Inclusion Disease, Moises Alatorre-Jimenez, Brandi Weller, Meike Orlick, William San Pablo

Posters

Introduction: Microvillous Inclusion Disease (MVID) (OMIM#251850) is a rare autosomal recessive condition caused by mutations or deletions mostly in the MYH6 gene but also STX3 and STXBP2 genes. It is characterized by protracted diarrhea with severe congenital alteration of the intestinal epithelium resulting in watery diarrhea, metabolic acidosis, failure to thrive, and permanent malabsorption that normally leads to a lifelong dependency on total parenteral nutrition (TPN) and the eventual possibility of bowel transplantation . Histological hallmarks of MVID in small intestinal biopsies are hypoplastic, atrophic, or disorganized villi without crypt hypertrophy, or immune cell infiltrate and, at the intestinal cellular …

Endoscopic Removal Of Safety Pin From Appendiceal Orifice, Alex Biller, Moises Alatorre-Jimenez, Jeremy Stewart, Ruba A. Abdelhadi

Posters

Introduction: Foreign body ingestion in children is considered a common concern in every Emergency Department worldwide. In the United States, it is estimated that foreign body ingestions cause approximately 1,500 deaths yearly (1). Safety pins ingestions are estimated to be 1% of the foreign body ingestions in children (2). In literature, ingested safety pins have been reported to be lodged mostly in the upper gastrointestinal tract, but a few cases have been reported to be lodged in the appendix (2,3,4). Objective: Recommendations for safety pin ingestions when past the second portion of the duodenum. Case: We report the case of …

Association Between Fetal Abdominal Growth Trajectories, Maternal Metabolite Signatures Early In Pregnancy, And Childhood Growth And Adiposity: Prospective Observational Multinational Interbio-21st Fetal Study, Jose Villar, Roseline Ochieng, Robert B. Gunier, Aris T. Papageorghiou, Stephen Rauch, Rose Mcgready, Julia M. Gauglitz, Fernando C. Barros, Manu Vatish, Michelle Fernandes

Paediatrics and Child Health, East Africa

Background: Obesity predominantly affects populations in high-income countries and those countries facing epidemiological transition. The risk of childhood obesity is increased among infants who had overweight or obesity at birth, but in low-resource settings one in five infants are born small for gestational age. We aimed to study the relationships between: (1) maternal metabolite signatures; (2) fetal abdominal growth; and (3) postnatal growth, adiposity, and neurodevelopment.

Methods: In the prospective, multinational, observational INTERBIO-21st fetal study, conducted in maternity units in Pelotas (Brazil), Nairobi (Kenya), Karachi (Pakistan), Soweto (South Africa), Mae Sot (Thailand), and Oxford (UK), we enrolled women …

Diagnostic Challenge Of Perimenopause Molar Pregnancy In A 52-Year-Old Lady: Case Report, Willbroad Kyejo, Davis Rubagumya, Gregory Ntiyakuze, Nancy Matillya, Munawar Kaguta, Miriam Mgonja, Lynn Moshi

Family Medicine, East Africa

Introduction and importance: Gestational trophoblastic disease is an uncommon group of pregnancy-related dis- orders, with a course of trophoblastic proliferation, including hydatidiform mole (Agha et al., 2020), invasive and metastatic mole, choriocarcinoma, placental-site trophoblastic tumor, and epithelial trophoblastic tumor. Choriocarcinoma and trophoblastic tumor of the placenta are the most important tumors associated with pregnancy.

Case findings: A 52-year-old woman Para 2 Living 3, 3 years post-menopausal presented with prolong per vaginal bleeding for five weeks accompanied by lower abdominal pain. Diagnosis of gestational trophoblastic disease (choriocarcinoma type) was made by using beta HCG, radiology, and histology report. Patient underwent total …

The Association Of Immune And Genomic Biomarkers And Response To Neoadjuvant Chemotherapy In Breast Cancer Patients At Aga Khan University Hospital Nairobi, Catherine Wairimu Mutahi

Master of Medicine in Anatomic Pathology

Introduction: Breast Cancer (BC) is the most diagnosed cancer among women worldwide and in Kenya. It is a highly heterogeneous disease requiring patient specific treatment and strategies to monitor response to therapy, especially in the neoadjuvant (NAC) setting. Currently, there are no reliable markers in use that can predict response to chemotherapy among patients receiving NAC. Tumour Infiltrating Lymphocytes (TILs) and Cell free DNA (cfDNA) are biomarkers that could possibly bridge this gap. However, limited studies have been carried out on the African population. With the increasing mortality rates attributable to BC in Sub-Saharan Africa, coupled with the growing preference …

Giant Thymolipoma In A Child: The Silent Chest Mass, Samuel Otido, Z. Dangor, A Zanini, D. Harrison

Paediatrics and Child Health, East Africa

Thymolipoma is a rare benign anterior mediastinal tumour of thymic origin containing both thymic and mature adipose tissues. In most cases it has a silent course and can grow to large sizes before presenting with respiratory symptoms. We report a case of a giant thymolipoma in a 4-year-old girl treated at Chris Hani Baragwanath Academic Hospital, South Africa.

Quality Of Life Among Cervical Cancer Patients Following Completion Of Chemoradiotherapy At Ocean Road Cancer Institute (Orci) In Tanzania, David H. Mvunta, Furaha August, Nazima Dharsee, Miriam H. Mvunta, Peter Wangwe, Matilda Ngarina, Brenda M. Simba, Hussein Kidanto

Obstetrics and Gynaecology, East Africa

Objective:  Effective cancer treatment involves aggressive chemo-radiotherapy protocols that alter survivors’ quality of life (QOL). This has recently aroused the attention not only to focus on clinical care but rather to be holistic and client-centered, looking beyond morbidity and mortality. The study assessed the QOL and associated factors among patients with cervical cancer (CC) after the completion of chemoradiotherapy.

Methods: A cross-sectional analytical study was conducted at Ocean Road Cancer Institute (ORCI) from September to November 2020. A total of 323 CC patients were interviewed with a structured questionnaire of QOL, the European Organization for Research and Treatment …

Association Of Cerebrovascular Stability Index And Head Circumference Between Infants With And Without Congenital Heart Disease, Nhu N Tran, Michelle Tran, Ashok Panigrahy, Ken M Brady, Jodie K Votava-Smith

Faculty, Staff and Student Publications

Congenital heart disease (CHD) is a common birth defect in the United States. CHD infants are more likely to have smaller head circumference and neurodevelopmental delays; however, the cause is unknown. Altered cerebrovascular hemodynamics may contribute to neurologic abnormalities, such as smaller head circumference, thus we created a novel Cerebrovascular Stability Index (CSI), as a surrogate for cerebral autoregulation. We hypothesized that CHD infants would have an association between CSI and head circumference. We performed a prospective, longitudinal study in CHD infants and healthy controls. We measured CSI and head circumference at 4 time points (newborn, 3, 6, 9 months). …

Low-Dose Immune Tolerance Induction In Children With Severe Hemophilia A With High-Titer Inhibitors: Type Of Factor 8 Mutation And Outcomes, Jie Sun, Zekun Li, Gang Li, Kun Huang, Di Ai, Guoqing Liu, Wanru Yao, Xingjuan Xie, Hao Gu, Yingzi Zhen, Zhenping Chen, Runhui Wu

Faculty, Staff and Student Publications

BACKGROUND: No studies evaluated the role of

OBJECTIVES: To explore the association between

METHODS: Children SHA with high-titer inhibitors who received low-dose ITI therapy at least for 1 year were included in this study. Based on the risk of inhibitor development,

RESULTS: Of 104 children included, 101 had

CONCLUSIONS: Types of

Antineutrophil Cytoplasmic Autoantibody-Associated Glomerulonephritis As A Possible Side Effect Of Covid-19 Vaccination., Edva Noel, Urmiya Rashid, Rizwan Rabbani, Waqas Ahmad Khan, Yves-Smith Benjamin, Iris Lee

Internal Medicine Resident Research

Vaccination is the principal tool aimed at curbing the COVID-19 pandemic that has, so far, affected tens of millions of individuals in the United States. The two available mRNA vaccines developed by Pfizer-BioNTech and Moderna possess high efficacy in preventing infection and illness severity. However, there are multiple side effects associated with these vaccines, some impacting different organs. Renal pathology is variable, with increasing cases of glomerulonephritis being observed. We report a rare acute kidney injury case due to antineutrophil cytoplasmic autoantibody (ANCA)-mediated glomerulonephritis after administering a second dose of the Pfizer-BioNTech mRNA SARS-CoV-2 vaccine. Aggravation and/or development of autoimmunity …

An Update And Report Failure Of Surgical Syndactyly Repair In Harlequin Ichthyosis., Elias H Kahan, Brian Temple, Logan Carr, Elizabeth Zellner

Plastic Surgery Resident Research

Harlequin ichthyosis (HI) is a rare congenital skin disorder caused by irregular epidermal differentiation. Syndactyly in HI is associated with thick hyperkeratotic skin flexion and angulation deformity of the hand and fingers resulting in limited function of the upper extremity. Traditional syndactyly release is limited as full-thickness skin grafts typically used in reconstruction are composed of diseased skin and require donor sites in a patient predisposed for adverse wound healing. This case report is a follow-up to a previous viewpoint written about digital escharotomies in a newborn with HI and outlines a second and fourth webspace syndactyly release with a …

Venous Thromboembolism In Musculoskeletal Oncology Surgery, Ahna Donahue, Keenan Sobol, John A. Abraham

Rothman Institute Papers

Abstract

Venous thromboembolism (VTE), including both deep venous thrombosis (DVT) and pulmonary embolism (PE), is a major complication of musculoskeletal surgery in general, and the risk is heightened in musculoskeletal oncology surgery. Despite the well-known association between cancer and VTE, the mechanism promoting this pathology is not entirely well understood. It is estimated that nearly all cancer patients will experience from some form of VTE, whether or not clinically relevant, during the course of their disease. Nonetheless, numerous studies have analyzed the occurrence and prevention of VTE in patients with cardiovascular disease or suffering trauma, but very few have specifically …

Larger Perioperative Opioid Prescriptions Lead To Prolonged Opioid Use After Hand And Upper Extremity Surgery: A Multicenter Analysis, Clay B Townsend, Justin A Ly, Ryan Judy, Matthew Sherman, Nick Elmer, Christine Conroy, Hesham M Abdelfattah, Mark K Solarz, Katharine Woozley, Asif M Ilyas

Rothman Institute Papers

Introduction: The opioid epidemic remains an ongoing public health crisis. The purpose of this study was to investigate whether surgeons' prescribing patterns of the initial postoperative opioid prescription predispose patients to prolonged opioid use after upper extremity surgery.

Methods: This multicenter retrospective study was done at three academic institutions. Patients who underwent carpal tunnel release, basal joint arthroplasty, and distal radius fracture open reduction and internal fixation over a 1.5-year period were included. Opioid prescription data were obtained from the Pennsylvania Prescription Drug Monitoring Program website.

Results: Postoperatively, 30.1% of the patients (191/634) filled ≥1 additional opioid prescription, and 14.0% …

Alzheimer's Disease, Dylan L. Weber

Student Publications

An overview of the background, etiology, pathophysiology, clinical features, diagnosis, treatment and prevention of Alzheimer's disease.

Expert Search For "Effect Of Preradiation Dental Intervention On Incidence Of Osteoradionecrosis In Patients With Head And Neck Cancer", Kelly K. O'Brien Mslis

Expert Search Strategies

This search strategy was constructed to support the research for the peer reviewed article listed above. Full article abstract:

Background

The purpose of this systematic review was to examine whether dental intervention involving bone or soft-tissue manipulation preradiotherapy (pre-RT) is associated with lower rates of osteoradionecrosis of the jaw (ORNJ) in patients with head and neck cancer (HNC).

Types of Studies Reviewed

The authors included relevant studies from MEDLINE, Embase, and Cochrane Library, including observational studies published from 2007 through 2021 and involving adults who underwent dental intervention pre-RT for HNC. Authors assessed evidence certainty by using the Grading of …

Nasopharyngeal Swabs Gone Wrong: An Unexpected Complication Of A Common Procedure, Moyosoreoluwa Laditan, Riya Kalra, Laurene Reed, Paras Khandhar

Posters

No abstract provided.

Acute Pericarditis And Acute Pleuritis/Empyema Following Submandibular Infection In A Covid-19 Positive Patient - An Autopsy Revealing The Danger Space Of The Neck, Jessica D. Anderson, Seyedalireza Fatemi, Joseph Fullmer, Ping I. Zhang

Posters

Acute pericarditis and empyema are life-threatening complications of severe odontogenic infections; reports of these findings from an autopsy perspective are rare. We report an autopsy case demonstrating infection from the mandibular molars to the pericardium and pleura in a patient following Covid-19 infection

Association Of Isolated Colitis With Non-Steroidal Anti-Inflammatory Drugs Usage, Ashbita Pokharel, Wei Li

Posters

Non-steroidal anti-inflammatory drugs (NSAIDs) have been known to produce various clinical gastrointestinal side-effects and histopathological changes. It has been reported that NSAIDs usage is associated with isolated colitis in periappendiceal orifice region. This study aims to further evaluate the clinicopathologic features of 16 patients with isolated colitis limited to the cecum or peri-appendiceal orifice region.

Cd30 Expression In Cutaneous B-Cell Lymphomas, Olabisi Afolayan-Oloye, Lili Zhao, Trilokraj Tejasvi, May P. Chan, Paul W. Harms, Douglas R. Fullen, Ryan A. Wilcox, Alexandra C. Hristov

Posters

CD30 expression has been infrequently described in cutaneous B-cell lymphomas (CBCL). We examined CD30 expression in reactive lymphoid hyperplasia (RLH) and CBCL and correlated expression with clinicopathologic features.

A Retrospective Review Of Genital Fistula Occurrence In Nine African Countries, Carrie J. Ngongo, Thomas J. I. P. Raassen, Marietta Mahendeka, Ladeisha Lombard, Jos Van Roosmalen, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Female genital fistulas are abnormal communications that lead to urinary and/or fecal incontinence. This analysis compares the characteristics of women with fistulas to understand how countries differ from one another in the circumstances of genital fistula development.

Methods: This retrospective records review evaluated demographics and circumstances of fistula development for 6,787 women who sought fistula treatment between 1994 and 2017 in Tanzania, Uganda, Kenya, Malawi, Rwanda, Somalia, South Sudan, Zambia, and Ethiopia.

Results: Most women developed fistula during childbirth, whether vaginal (3,234/6,787, 47.6%) or by cesarean section (3,262/6,787, 48.1%). Others had fistulas attributable to gynecological surgery …

Diagnostic Accuracy Of High-Sensitivity Cardiac Troponin In The Diagnosis Of Acute Myocardial Infarction At The Aga Khan University Hospital Nairobi, Kenya, Assumpta Wanjiru Chege

Master of Medicine in Clinical Pathology

Methodology: This cross-sectional study was carried out at Aga Khan University Hospital, Nairobi between July 1st 2020 and December 31st 2021. Participants were adults aged 18 years and above presenting to the emergency department with signs and symptoms suggesting an acute myocardial infarction. Patients were identified on the hospital management information system (CARE 2000) using test results for baseline high-sensitivity cardiac troponin I. The final diagnosis as well as secondary clinical data was obtained from both physical and electronic patient medical records. The reference standard for the diagnosis of acute myocardial infarction was taken as the final clinical diagnosis made …

Demographics And Baseline Disease Characteristics Of Patients With Relapsing Multiple Sclerosis From Kenya Participating In The Chimes Trial, Dilraj Sokhi, Juzar Hooker, Mitzi J. Williams, Aisleen Shamshudin, Yuashita Hussein, Peter Betti, Heldah Amariati, Noureen Karimi, Stacey Gondi, Mansoor Saleh

Book Chapters / Conference Papers

No abstract provided.