Medical Specialties Commons^™

Dermatofibrosarcoma Protuberans: An Unusual Case Of Neck Swelling, Naeem Sultan Ali, Maliha Kazi, Beena Umar, Mumtaz Jamshed Khan

Section of Otolaryngology, Head & Neck Surgery

Dermatofibrosarcoma protuberans (DFSP) is a relatively intermediate to low grade malignant tumour with high proclivity for local recurrence if excised inadequately. It is a locally aggressive tumour and despite sharing some histological features with fibrohistiocytic tumours, it tends to grow in a more infiltrative manner. We are reporting this rare tumour in a 30-year-old woman where the diagnosis of DFSP was confirmed histologically and by positive immunomarkers at immunohistochemistry.

Antenatal Care And The Occurrence Of Low Birth Weight Delivery Among Women In Remote Mountainous Region Of Chitral, Pakistan, Z. Ahmed, S. Khoja, Suha S. Tirmizi

Obstetrics and Gynaecology, East Africa

Objective: Low birth weight (LBW) is closely associated with perinatal morbidity and bears an increased risk for subsequent infant morbidity. The study aimed to assess low birth weight delivery factors among women in Chitral, Pakistan.

Methodology: Mixed Methodology was adopted. Structured data collection tool was used to collect information from medical records of 1316 mothers, followed by interviews and focus group discussions to understand the causes and their remedies. The main outcome measure was infants born with low birth weight LBW (<2.5kg).

Result: There was a significant association between the occurrence of low birth weight and maternal education, paternal education, …

Pain Assessment And Management In Different Wards Of A Tertiary Care Hospital, Anwar Ul Huda, Mohammad Hamid, Saboor Ahmed, Syed Muhammad Baqir, Aysha Almas

Department of Emergency Medicine

OBJECTIVE:

To assess the pain management by medical team, emergency room (ER) team and Acute Pain team in a tertiary care hospital.

METHODS:

The cross-sectional study was done in Medical Ward, Surgical Ward and Emergency Room of Aga Khan University, Karachi, in March-April 2010. The assigned research medical officer visited the three locations every day and selected patients by way of convenient sampling. The study comprised 75 patients; 25 each in three groups. Information was collected on patient's demographics, general characteristics, type of drugs and modalities used. Specific queries about pain were sorted out like adequacy of pain assessment done …

Rethinking Hiv-Exposure Crimes, Margo Kaplan

Indiana Law Journal

This Article challenges the current legislative and scholarly approaches to HIV-exposure crimes and proposes an alternative framework to address their flaws. Twenty-four states criminalize consensual sexual activities of people with HIV. Current statutes and the scholarship that supports them focus on HIV-positive status, sexual activity, and knowledge of HIV-positive status as proxies for risk, mental state, and consent to risk. As a result, they are dramatically over- and underinclusive and stigmatize individuals living with HIV. Criminalization should be limited to circumstances in which a defendant exposed her partner to a substantial degree of unassumed risk and did so with a …

The Effect Of Genetic Background And Dose On Non-Targeted Effects Of Radiation, Sarah Irons, Virginia Sierra, Deborah Bowler, Kim Chapman, Stefania Militi, Fiona Lyng, Munira Kadhim

Articles

Purpose: This work investigates the hypothesis that genetic background plays a significant role in the signalling mechanisms underlying induction and perpetuation of genomic instability following radiation exposure.

Materials and methods: Bone marrow from two strains of mice (CBA and C57) were exposed to a range of X-ray doses (0, 0.01, 0.1, 1 and 3 Gy). Different cellular signalling endpoints: Apoptosis, cytokine levels and calcium flux, were evaluated at 2 h, 24 h and 7 d post-irradiation to assess immediate and delayed effects.

Results: In CBA (radiosensitive) elevated apoptosis levels were observed at 24 h post X-irradiation, and …

Oncolog, Volume 57, Number 10, October 2012, Jill Delsigne, Sunni Hosemann

OncoLog MD Anderson's Report to Physicians (All issues) Archives

• Treatments May Alleviate and Reverse Central Nervous System Radiation Necrosis: Although radiation therapy is effective against many tumors of the brain and spine, it also damages normal tissue
• INBRIEF: Bevacizumab With High-Dose Chemotherapy Shows Promise for Cisplatin-Refractory Germ Cell Tumors
• Compass: Early-Stage Testicular Cancer-Postsurgical treatment varies according to tumor stage and histology
• HOUSE CALL: Online Cancer Support Networks-Patients and caregivers find support online

Digest Of The Philadelphia College Of Osteopathic Medicine (Fall 2012), Philadelphia College Of Osteopathic Medicine

Digest

The Fall 2012 issue of the Digest of the Philadelphia College of Osteopathic Medicine includes the following articles:

• Message from the President
• PCOM Updates
• Development News
• Protecting Human Rights
• Relieving Suffering
• On Leaders and Legacies
• Profiles of Nine PCOM Alumni Who Influence Osteopathic Medical Education
• Pharmacists’ Changing Role: From Behind the Counter to Direct Patient Care
• PCOM School of Pharmacy Is Preparing Students to Practice as Part of the Healthcare Team
• Class Notes
• In Memoriam
• My Turn Essay
• The Fund for PCOM

Ulnar Tunnel Syndrome., Abdo Bachoura, Sidney M Jacoby

Department of Orthopaedic Surgery Faculty Papers

Ulnar tunnel syndrome could be broadly defined as a compressive neuropathy of the ulnar nerve at the level of the wrist. The ulnar tunnel, or Guyon's canal, has a complex and variable anatomy. Various factors may precipitate the onset of ulnar tunnel syndrome. Patient presentation depends on the anatomic zone of ulnar nerve compression: zone I compression, motor and sensory signs and symptoms; zone II compression, isolated motor deficits; and zone III compression; purely sensory deficits. Conservative treatment such as activity modification may be helpful, but often, surgical exploration of the ulnar tunnel with subsequent ulnar nerve decompression is indicated.

Low Rate Of Infection Control In Enterococcal Periprosthetic Joint Infections., Mohammad R Rasouli, Mohan S Tripathi, Robert Kenyon, Nathan Wetters, Craig J Della Valle, Javad Parvizi

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Enterococcal periprosthetic joint infections (PJIs) are rare after joint arthroplasty. These cases are usually reported in series of PJIs caused by other pathogens. Because few studies have focused only on enterococcal PJIs, management and control of infection of these cases have not yet been well defined.

QUESTIONS/PURPOSES: We asked (1) what is the proportion of enterococcal PJI in our institutes; and (2) what is the rate of infection control in these cases?

METHODS: We respectively identified 22 and 14 joints with monomicrobial and polymicrobial PJI, respectively, caused by enterococcus. The diagnosis of PJI was made based on the presence …

Neuro-Rehabilitation In The Developing World, Nirmal Surya Dr.

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

The Evolution Of Cranioplasty: A Review Of Graft Types, Storage Options And Operative Technique, Pooja Kanhya Lal, Muhammad Shahzad Shamim

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Predictive Value Of Alpha-Fetoprotein In The Long-Term Risk Of Developing Hepatocellular Carcinoma In Patients With Hepatitis B Virus Infection--Results From A Clinic-Based Longitudinal Cohort., Hie-Won Hann, Xiaoying Fu, Ronald E. Myers, Richard Hann, Shaogui Wan, Su Hee Kim, Natalie Au, Jinliang Xing, Hushan Yang

Division of Gastroenterology and Hepatology Faculty Papers

BACKGROUND: Although serum level of alpha-fetoprotein (AFP) has long been used to complement imaging tests in the screening and diagnosis of hepatocellular carcinoma (HCC), whether it can be used as a predictive marker of long-term risk for developing HCC in patients with hepatitis B virus (HBV) has not been extensively evaluated and thus remains controversial.

METHODS: We retrospectively conducted a clinic-based longitudinal cohort study including 617 Korean American patients with HBV who had been followed for up to 22 years (median follow-up time, 6.2 years) to evaluate the association between baseline serum AFP level and the long-term risk of HCC. …

Characterization Of Secretory Sphingomyelinase Activity, Lipoprotein Sphingolipid Content And Ldl Aggregation In Ldlr-/- Mice Fed On A High-Fat Diet, Gergana M. Deevska, Manjula Sunkara, Andrew J. Morris, Mariana N. Nikolova‑Karakashian

Physiology Faculty Publications

The propensity of LDLs (low-density lipoproteins) for aggregation and/or oxidation has been linked to their sphingolipid content, specifically the levels of SM (sphingomyelin) and ceramide. To investigate this association in vivo, ldlr (LDL receptor)-null mice (ldlr-/-) were fed on a modified (atherogenic) diet containing saturated fats and cholesterol. The diet led to significantly elevated SM content in all serum lipoproteins. In contrast, ceramide increased only in the LDL particles. MS-based analyses of the lipid acyl chain composition revealed a marked elevation in C16:0 fatty acid in SM and ceramide, consistent with the prevalence of palmitic acid in the modified diet. …

Good Knowledge About Hypertension Is Linked To Better Control Of Hypertension; A Multicentre Cross Sectional Study In Karachi, Pakistan, Aysha Almas, Saniya Siraj Godil, Saima Lalani, Zahra Aziz Samani, Aamir Hameed

Section of Internal Medicine

Back Ground: According to the National Health survey only 3% of the population has controlled hypertension. This study was designed to elucidate the knowledge about hypertension in hypertensive patients at three tertiary care centers in Karachi. Secondly we sought to compare the knowledge of those with uncontrolled hypertension and controlled hypertension.

Methods: It was a cross-sectional study conducted at The Aga Khan University hospital (AKUH), Ziauddin Hospital (ZH) and Civil hospital, Karachi (CHK. All diagnosed Hypertensive patients (both inpatients and outpatients) coming to a tertiary care hospital in Pakistan aged > 18 years were included. Patients were categorized into 2 groups: …

Higher Scrotal Uptake Ratio Of (99m)Tc-Mdp On Bone Scans In Newly Diagnosed Prostate Cancer : A Reliable Indicator Of Pelvic Node Metastasis., Maseeh Uz Zaman, Nosheen Fatima, Zafar Sajjad, Ibrahim Hashmi, Khalid Khan

Department of Radiology

Abstract

OBJECTIVE:

Pelvic lymph node dissection (PLND) is the gold standard procedure for nodal staging in prostate cancer (PC) but less commonly used due to its invasiveness. More commonly computerized tomography (CT) and magnetic resonance imaging (MRI) are used although these have limited sensitivities and specificities. The aim of this study was to find out the correlation between higher scrotal uptake ratio (SUR) of (99m)Tc-methylene diphosphonate (MDP) on bone scan and pelvic nodemetastasis in patients with PC at high risk for nodal metastasis.

METHODS:

This was a retrospective study which included 68 biopsy proven newly diagnosed PC patients who had …

Accuracy Of Self-Reported Sun Exposure And Sun Protection Behavior, Joel J. Hillhouse, Robert Turrisi, James Jaccard, June K. Robinson

ETSU Faculty Works

The objective of this study was to compare the accuracy of self-reported skin cancer risk outcome measures proposed as standards by prevention experts to aggregated estimates of behavior from weekly diaries. Weekly electronic diaries of ultraviolet radiation (UVR) behaviors, initially validated by comparison with daily electronic diaries, were used to assess the accuracy of commonly used end-of-summer self-reported measures among 250 adults. Results revealed low biases, and good correspondence between simple open-ended self-reported estimates of days outside, hours outside, sunbathing days and hours, and days outside when not protected by either sunscreen, long-sleeved shirts, hats, or shade. Rating scale measures …

The Alternative Crosstalk Between Rage And Nitrative Thioredoxin Inactivation During Diabetic Myocardial Ischemia-Reperfusion Injury., Yi Liu, Yan Qu, Rutao Wang, Yanzhuo Ma, Chenhai Xia, Chao Gao, Jingyi Liu, Kun Lian, Aibing Xu, Xiaoyan Lu, Lu Sun, Lu Yang, Wayne B. Lau, Erhe Gao, Walter Koch, Haichang Wang, Ling Tao

Department of Emergency Medicine Faculty Papers

The receptor for advanced glycation end products (RAGE) and thioredoxin (Trx) play opposing roles in diabetic myocardial ischemia-reperfusion (MI/R) injury. We recently demonstrated nitrative modification of Trx leads to its inactivation and loss of cardioprotection. The present study is to determine the relationship between augmented RAGE expression and diminished Trx activity pertaining to exacerbated MI/R injury in the diabetic heart. The diabetic state was induced in mice by multiple intraperitoneal low-dose streptozotocin injections. RAGE small-interfering RNA (siRNA) or soluble RAGE (sRAGE, a RAGE decoy) was via intramyocardial and intraperitoneal injection before MI/R, respectively. Mice were subjected to 30 min of …

Hepatocellular Carcinoma In Pakistan: Where Do We Stand?, Amna Subhan Butt, Zaigham Abbas, Wasim Jafri

Section of Gastroenterology

Context: From the 1970s till the mid 1990s, hepatitis B was the most common etiological factor for hepatocellular carcinoma (HCC) in Pakistan. Afterwards, a shift in HCC etiology was observed with a steady rise in hepatitis C virus (HCV) related HCC cases. HCV-3a, which is the most prevalent genotype, is also most frequent in HCV related HCC. There was an increase in the proportion of non-B non-C (NBNC) HCC cases as well, which might be attributed to an increase in non-alcoholic fatty liver disease.
Evidence Acquisition: The age-standardized rate for HCC is 7.64/100 000 in males and 2.8/100 000 in …

Mongolian Women's Voices: A Case Study On Maternal Healthcare, Pregnancy, And Birth In Ulaanbaatar's Public Hospitals, Amelia Olmsted

Independent Study Project (ISP) Collection

Mongolia is a country undergoing an incredible amount of change. Last year, in 2011, they had the fastest growing economy in the world, with a 17.2% increase in their GDP, according to the World Bank. A mere 22 years ago, Mongolia was a communist country, and today they are a parliamentary democracy. The country has opened itself up to the rest of the world and a free market economy, and experienced a very drastic shift in this direction in the early 1990's. Many Mongolians will tell you that the mindset of Mongolia's citizens has made a drastic shift since communism …

Awareness Of Type Ii Diabetes In The Developing World: Case Study In Binh Du’O’Ng, Vietnam, Anna Hong Le

Independent Study Project (ISP) Collection

Vietnam’s rapid economic development after 1986 forever changed the lifestyle of the Vietnamese. Economic development has highly impacted behavior, “changing from a traditional lifestyle to an industrial lifestyle [increasing] noncommunicable diseases (NCDs) : diabetes, overweight, high blood pressure, and high cholesterol disorders” (Danh, Personal Interview). With the increase of NCDs within the country, it is important to focus on awareness education that motivates the population especially those living in the urban sector to practice healthy behaviors. This study project focuses on the evaluating the reach and effectiveness of current diabetes awareness educational materials. One week was spent in Ha Noi, …

Nucleic Acid And Non-Nucleic Acid-Based Reprogramming Of Adult Limbal Progenitors To Pluripotency, Sowmya Parameswaran, Sudha Balasubramanian, Norbert Babai, Carolina B. Deldebbio, Donald W. Harms, Channabasavaiah B. Gurumurthy, Mahendra S. Rao, J. Graham Sharp, Iqbal Ahmad

Journal Articles: Ophthalmology

Reprogramming somatic cells to a pluripotent state by nucleic acid based (NAB) approaches, involving the ectopic expression of transcription factors, has emerged as a standard method. We recently demonstrated that limbal progenitors that regenerate cornea are reprogrammable to pluripotency by a non-NAB approach through simple manipulation of microenvironment thus extending the possible therapeutic use of these readily accessible cells beyond the proven treatment of corneal diseases and injury. Therefore, to determine the validity and robustness of non-cell autonomous reprogramming of limbal progenitors for a wider clinical use, here, we have compared their reprogramming by non-NAB and NAB approaches. We observed …

Orientation-Invariant Ecg-Based Virtual Pathology Stethoscope Tracking For Standardized Patient Heart Auscultation, Nahom B. Kidane

Computational Modeling & Simulation Engineering Theses & Dissertations

Cardiac auscultation (CA), the act of listening to the heart sounds, is a critical physician's skill that provides substantial information for diagnosing many cardiovascular disorders; therefore, competent training can be a key for accurate and reliable diagnosis. The teaching of CA has been an area of recognized importance since the inception of the stethoscope. However, recent changes in health-care, such as limited student access to patients and higher reliance on competing technologies have made it challenging to teach bedside CA techniques.

Over the past few decades, standardized patients (SPs), individuals trained to portray real patients, have been widely used for …

Pulmonary Complications In Patients With Severe Brain Injury., Kiwon Lee, Fred Rincon

Department of Neurology Faculty Papers

Pulmonary complications are prevalent in the critically ill neurological population. Respiratory failure, pneumonia, acute lung injury and the acute respiratory distress syndrome (ALI/ARDS), pulmonary edema, pulmonary contusions and pneumo/hemothorax, and pulmonary embolism are frequently encountered in the setting of severe brain injury. Direct brain injury, depressed level of consciousness and inability to protect the airway, disruption of natural defense barriers, decreased mobility, and secondary neurological insults inherent to severe brain injury are the main cause of pulmonary complications in critically ill neurological patients. Prevention strategies and current and future therapies need to be implemented to avoid and treat the development …

Comparison Of Upper Lip Bite Test With Mallampati Test In The Prediction Of Difficult Intubation At A Tertiary Care Hospital Of Pakistan, Muhammad Asghar Ali, Muhammad Qamar-Ul-Hoda, Khalid Samad

Department of Anaesthesia

Objective: To determine the accuracy of the Upper lip bite test and Mallampati test in predicting difficult endotracheal intubation.Methods: The cross-sectional study was conducted at the Aga Khan University Hospital, a tertiary care facility in Karachi, Pakistan. Between June 1,2007 and May 31, 2008, 324 adult patients undergoing elective surgeries requiring general anaesthesia with endotracheal intubations were enrolled. Pre-operatively upper lip bite test and Mallampati test were performed for the assessment of airway by a specifically trained observer. Laryngoscopic view was rated by using Cormack and Lehane laryngoscopic grading once the patient was fully anaesthetised using standard anaesthesia technique. Completed …

Visual Function After Correction Of Distance Refractive Error With Ready-Made And Custom Spectacles: A Randomized Clinical Trial., Christopher J. Brady, Andrea C Villanti, Monica Gandhi, David S Friedman, Lisa Keay

Wills Eye Hospital Papers

PURPOSE: To evaluate patient-reported outcome measures with the use of ready-made spectacles (RMS) and custom spectacles (CS) in an adult population in India with uncorrected refractive error (URE).

DESIGN: Prospective, double-masked, randomized trial with 1-month follow-up.

PARTICIPANTS: A total of 363 adults aged 18 to 45 years with ≥1 diopter (D) of URE (RMS, n = 183; CS, n = 180).

INTERVENTION: All participants received complete refraction and were randomized to receive CS (full sphero-cylindrical correction) or RMS based on the spherical equivalent for the eye with lower refractive error but limited to the powers in the RMS inventory.

MAIN …

Neurosteroid-Mediated Regulation Of Brain Innate Immunity In Hiv/Aids: Dhea-S Suppresses Neurovirulence, Amber Paul, Ferdinand G. Maingat, Maria J. Polyak, Pornpun Vivithanaporn, Farshid Noorbakhsh, Samir Ahboucha, Glen B. Baker, Keir Pearson, Christopher Power

Publications

Neurosteroids are cholesterol-derived molecules synthesized within the brain, which exert trophic and protective actions. Infection by human and feline immunodeficiency viruses (HIV and FIV, respectively) causes neuroinflammation and neurodegeneration, leading to neurological deficits. Secretion of neuroinflammatory host and viral factors by glia and infiltrating leukocytes mediates the principal neuropathogenic mechanisms during, although the effect of neurosteroids on these processes is unknown. We investigated the interactions between neurosteroid mediated effects and lentivirus infection outcomes. Analyses of HIV-infected uninfected human brains disclosed a reduction in neurosteroid synthesis enzyme expression. Human neurons exposed to supernatants from HIV macrophages exhibited suppressed enzyme expression without …

Early Abnormal Sponteneous Activity Findings In Axonal Variant Of Guillain Barre Syndrome: Is This A New Variant Of Guillain Barre Syndrome?, Ghulam Shabbir Dr., Asad Ullah Dr., M.A. Lakhair Dr., Ali Majid Dr., Emran Rashid Dr.

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Acute Quadriparesis Due To Acute Demyelinating Polyneuropathy In A Patient Newly Diagnosed As A Case Of B -Cell Lymphoma- An Unusual Presentation. A Case Report With Review Of Literature, Sardar M. Alam, Haroon Khan, Rafi Ud Din, Faiqa Filza, Tariq Khan

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Transfusion Therapy As A Sole Treatment Option In A Thalassemia Patient With Acute Paraplegia – A Case Report And Review Of Literature, Sana Rashid

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Delayed Diagnosis Of Hand Injuries In Polytrauma Patients (Poster), Joshua M. Adkinson Md, Muhammad Shuja Shafqat Md, Sherrine Eid Mph, Marshall G. Miles Do

Department of Surgery

No abstract provided.