Medical Specialties Commons^™

The Causes, Treatment, And Outcome Of Acute Heart Failure In 1006 Africans From 9 Countries, Albertino Damasceno, Bongani M. Mayosi, Mahmoud Sani, Okechukwu S. Ogah, Charles Mondo, Dike Ojji, Anastase Dzudie, Charles Kouam Kouam, Ahmed Suliman, Neshaad Schrueder, Gerald Yonga, Serigne Abdou Ba, Fikru Maru, Bekele Alemayehu, Christopher Edwards, Beth A. Davison, Gad Cotter, Karen Sliwa

Internal Medicine, East Africa

Background: Acute heart failure (AHF) in sub-Saharan Africa has not been well characterized. Therefore,wesought to describe the characteristics, treatment, and outcomes of patients admitted with AHF in sub-Saharan Africa.

Methods: The Sub-Saharan Africa Survey of Heart Failure (THESUS–HF) was a prospective, multicenter, observational survey of patients with AHF admitted to 12 university hospitals in 9 countries. Among patients presenting with AHF, we determined the causes, treatment, and outcomes during 6 months of follow-up.

Results: From July 1, 2007, to June 30, 2010, we enrolled 1006 patients presenting with AHF. Mean (SD) age was 52.3 (18.3) years, 511 (50.8%) were women, …

Medical Education Digest, Vol. 14 No. 5 (September/October 2012), Nova Southeastern University

Medical Education Digest

No abstract provided.

Randomized Comparison Of Two Internet-Supported Natural Family Planning Methods (Final Efficacy Results), Richard J. Fehring

Randomized Comparison of Two Internet-Supported Methods of Natural Family Planning

Both Internet provided NFP methods were effective with correct use but the electronic hormonal monitoring method was statistically better with a typical use of only 7 unintended pregnancies per 100 women over 12 months of use compared with 19 with the traditional cervical mucus monitoring method.

Satisfaction of using the hormonal method increased over time but motivation decreased, i.e., they had a desire to achieve a pregnancy.

A high discontinuation rate contributed to the limitation of the study.

However, this Internet based method of providing NFP with professional support is efficient and effective for select motivated couples.

The Use Of Mobile Phone Cameras In Guiding Treatment Decisions For Laceration Care, Neal Sikka, Michael Pirri, Katrina Norbury Carlin, Ryan Strauss, Faisal Rahimi, Jesse M. Pines

Emergency Medicine Faculty Publications

Objectives: Mobile phone technology may be useful in helping to guide medical decisions for lacerations. We examined whether emergency department (ED) provider opinions on which lacerations require repair differed using mobile phone–generated images compared with in-person evaluations.

Subjects and Methods: Patients presenting to an urban ED for initial and follow-up laceration care were prospectively enrolled. Patients took four mobile phone pictures of their laceration and provided a medical history. Cases were reviewed by ED providers who assessed image quality and made a recommendation about whether the laceration needed repair. The same provider then assessed the patient in-person. Concordant decision-making between …

Cystatin C For The Assessment Of Gfr In Neonates With Congenital Renal Anomalies, Guido Filler, Joanne Grimmer, Shih Han Susan Huang, Erika Bariciak

Paediatrics Publications

No abstract provided.

Feasibility Of Implementing Pulse Oximetry Screening For Congenital Heart Disease In A Community Hospital., Elizabeth A. Bradshaw, Sandra Cuzzi, S. C. Kiernan, N. Nagel, Jeffrey A. Becker, Gerard R. Martin

Pediatrics Faculty Publications

Objective:

Pulse oximetry has been recognized as a promising screening tool for critical congenital heart disease (CCHD). The aim of this research was to study the feasibility of implementation in a community hospital setting.

Study Design:

Meetings were conducted to determine an implementation plan. Pulse oximetry was performed on the right hand and foot after 24h of age. Newborns with a saturation 95% or a 3% difference were considered to have a positive screen. Screening barriers, screening time and ability to effectively screen all eligible newborns were noted.

Result:

From January 2009 through May 2010, of 6841 eligible newborns, 6745 …

Complications Of Total Hip Replacement, Kashif Abbas, Ghulam Murtaza, Masood Umer, Haroon Rashid, Irfan Qadir

Section of Orthopaedic Surgery

Objective: To determine the factors causing complications in unilateral total hip replacement.
Study Design: Analytical study.
Place and Duration of Study: The Aga Khan University Hospital, Karachi, between 2000 and 2010.
Methodology: During the study period, 199 patients underwent elective unilateral total hip replacement at the Aga Khan University Hospital. Patients were divided into two groups on the basis of postoperative complications within 30 days of surgery. Significant factors at 5% significance level on univariate analysis were further analyzed by multivariate logistic regression.
Results: Postoperative complications occurred in 39 patients (19.6%); dislocation being most common in 13 patients (6.5%), followed …

The Training Of A 'Stone Doctor', Jamsheer J. Talati

Section of Urology

Objective: To propose alternative models of training for doctors treating patients with stones, and to identify their relative value, as such doctors are trained through urology programmes which sometimes cannot be expanded to meet the need, are short of teachers, too comprehensive and lengthy. This review explores new pathways for training to provide competence in the care of patients with stones.
Methods: Previous reports were identified and existing training models collectively categorised as Model 1. Three alternative models were constructed and compared in the context of advantages, acceptability, feasibility, educational impact and applicability in different geosocio-political contexts.
Results: In Model …

Baron Guillaume Dupuytren: When Brilliance Combats Professionalism., Sean M. Devitt, Md, Charles J. Yeo, Md, Pinckney J. Maxwell, Iv, Md

Department of Surgery Gibbon Society Historical Profiles

Baron Guilluame Dupuytren was a French anatomist and surgeon who practiced during the 1800s and is considered by some to be the most brilliant and gifted surgeons of his time. His contributions to the field of surgery are quite extensive, yet his eccentric personality and attitude toward his colleagues, students, and patients raises a very interesting question: could Dr. Dupuytren (Fig. 1) and his many contributions to the field of surgery have thrived in today’s era of professionalism? The concept of professionalism is emphasized to medical students starting from day one of their medical training. How would Dr. Dupuytren, an …

Urinary Stone Disease: Great Progress With Promise For The Future., Demetrius H. Bagley

Department of Urology Faculty Papers

Urinary calculus disease has been a scourge on mankind since ancient times. Research in the field has been hampered by lack of funds and the lack of cachet with the public such as seen with cancer or heart disease. In recent years there have been marked changes led by urologists in the diagnosis, treatment and long-term management of calculi.

Ureteroscopic Treatment Of Larger Renal Calculi (>2 Cm)., Demetrius H. Bagley, Kelly A. Healy, Nir Kleinmann

Department of Urology Faculty Papers

OBJECTIVES: To evaluate the current status of ureteroscopic lithotripsy (UL) for treating renal calculi of >2 cm, as advances in flexible ureteroscope design, accessory instrumentation and lithotrites have revolutionised the treatment of urinary calculi. While previously reserved for ureteric and small renal calculi, UL has gained an increasing role in the selective management of larger renal stone burdens.

METHODS: We searched the available databases, including PubMed, Google Scholar, and Scopus, for relevant reports in English, and the article bibliographies to identify additional relevant articles. Keywords included ureteroscopy, lithotripsy, renal calculi, and calculi >2 cm. Retrieved articles were reviewed to consider …

Non-Diabetic Renal Disease In Patients With Type-2 Diabetes Mellitus, Sonia Yaqub, Waqar Kashif, Syed Ather Hussain

Section of Nephrology

Diabetic nephropathy (DN) is the leading cause of end-stage renal disease in diabetics worldwide, yet most patients with type-2 diabetes mellitus are not formally evaluated with a renal biopsy. The diagnosis is almost always based on clinical grounds. A wide spectrum of non-diabetic renal disease (NDRD) is reported to occur in patients with type-2 diabetes. It has been estimated that up to one-third of all diabetic patients who present with proteinuria are suffering from NDRD. The aim of this analysis was to evaluate the prevalence and etiology of NDRD in patients with type-2 diabetes. We retrospectively reviewed the medical records …

Biosynthetic Pathways And The Role Of The Mas Receptor In The Effects Of Angiotensin-(1-7) In Smooth Muscles., Marcio Augusto Fressatto De Godoy, Larissa Pernomian, Ana Maria De Oliveira, Satish Rattan

Department of Medicine Faculty Papers

Ang-(1-7) is produced via degradation of Ang II by the human angiotensin converting enzyme, also known as ACE2. In the cardiovascular system, Ang-(1-7) has been shown to produce effects that are opposite to those of Ang II. These include smooth muscle relaxation and cardioprotection. While the roles of Ang-(1-7) in other systems are currently topic of intense research, functional data suggest a relaxation action in gastrointestinal smooth muscles in a way that corroborates the results obtained from vascular tissues. However, more studies are necessary to determine a relevant role for Ang-(1-7) in the gastrointestinal system. The Ang-(1-7) actions are mediated …

Re-Implantation Of Suboptimal Prostate Seed Implantation: Technique With Intraoperative Treatment Planning., Laura Doyle, Adam J Hesney, Katherine L Chapman, Haisong Liu, Perry R Weiner, Adam Dicker, Yan Yu, Timothy Showalter

Department of Radiation Oncology Faculty Papers

PURPOSE: Post-implant dosimetry following prostate seed implantation (PSI) occasionally reveals suboptimal dosimetric coverage of the gland. Published reports of re-implantation techniques have focused on earlier-generation techniques, including preplanned approaches and stranded seeds. The purpose of this case report is to describe a customizable approach to perform corrective re-implantation using loose seeds and intraoperative planning technique.

MATERIAL AND METHODS: This case report describes a 63-year-old male with favorable risk prostate adenocarcinoma receiving PSI. Thirty day post-implant dosimetric evaluation revealed suboptimal coverage of the base of the gland. Using guidance from post-implant CT-images and real-time planning, the patient received a corrective re-implantation …

Oncolog, Volume 57, Number 09, September 2012, Zach Bohannan, Sunita Patterson

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

• Stereotactic Body Radiation Therapy Achieves High Control Rates in Lung Cancer: Stereotactic body radiation (SBRT), a relatively new treatment modality, has recently become a very successful treatment-and may even exceeded the effectiveness of surgery-for early-stage lung cancer
• Inflammatory Breast Cancer: Clinical Challenge, Research Enigma- Inflammatory breast cancer (IBC) stands apart from other cancers of the breast in its unusual clinical presentation, its aggressiveness, and its poor prognosis. Researchers and clinicians are working to clarify what distinguishes IBC from other breast cancers and to discover treatments that improve patient outcomes
• HOUSE CALL: Reducing Cancer-Causing Chemicals in Outdoor Cooking: Tips for healthy …

Functional Results And Outcomes After Repair Of Proximal Hamstring Avulsions., Steven B Cohen, Ashwin Rangavajjula, Dharmesh Vyas, James P Bradley

Rothman Institute Papers

BACKGROUND: The purpose of this study was to assess postsurgical outcomes in active patients after primary repair of acute and chronic proximal hamstring tears.

HYPOTHESIS: Surgical treatment of both acute and chronic proximal hamstring avulsion injuries would result in improved patient outcomes using validated outcome scores and a hamstring-specific questionnaire, and operative repair of these injuries results in excellent outcomes with a high level of patient satisfaction, pain relief, and return to function.

STUDY DESIGN: Case series; Level of evidence, 4.

METHODS: Fifty-two patients who underwent proximal hamstring repair (26 male and 26 female; average age, 47.7 years) completed the …

25(Oh)D3 And Cardiovascular Risk Factors In Female Nonhuman Primates., Matthew J Jorgensen, Lawrence L Rudel, Matthew Nudy, Jay R Kaplan, Thomas B Clarkson, Nicholas M Pajewski, Peter F Schnatz

Division of Internal Medicine Faculty Papers & Presentations

OBJECTIVE: To determine if interindividual differences in plasma concentrations of 25-hydroxyvitamin D(3) (25(OH)D(3)) have pathophysiologic significance, we evaluated a cohort of female monkeys, seeking to identify associations with clinically relevant cardiovascular risk factors, including age, abdominal obesity (waist circumference), and high-density lipoprotein cholesterol (HDL-C).

METHODS: One hundred fifty-five female vervet monkeys (Chlorocebus aethiops sabaeus) aged 3-25 years consumed a typical western diet for 7-8 weeks that provided a woman's equivalent of approximately 1000 IU/day of vitamin D(3). Measurements of vitamin D(3) and HDL-C concentrations, as well as waist circumference, were obtained.

RESULTS: Among young monkeys (aged 3-5 years), compared to …

Arthroscopic Ulnar Nerve Identification During Posterior Elbow Arthroscopy, Srinath Kamineni, David Anthony Hamilton Jr.

Orthopaedic Surgery and Sports Medicine Faculty Publications

Elbow arthroscopy has increased in popularity in the past 10 years for both diagnostic and therapeutic purposes. A major limiting factor faced by the elbow arthroscopist is the close proximity of the neurovasculature to the working field, with the risk of iatrogenic injury. Many arthroscopic procedures are less extensive than their open equivalents because of an inability to consistently and safely eliminate the risk of neural and vascular injury. Many open procedures in the posterior compartment of the elbow joint are not routinely performed arthroscopically. The primary reason for this restriction in arthroscopic practice is the locality of the posteromedially …

Atovaquone Ameliorate Gastrointestinal Toxoplasmosis Complications In A Pregnancy Model, Helieh S. Oz, Thomas Tobin

Physiology Faculty Publications

Background: Toxoplasma is an important source of foodborne hospitalization with no safe and effective therapy against chronic or congenital Toxopalsmosis. Atovaquone is a drug of choice but not approved for use in congenital Toxoplasmosis. We hypothesized atovaquone to be safe and effective against feto-maternal Toxoplasmosis.

Material/Methods: Programmed pregnant mice were i.p. infected with 50–2400 Tachyzoites from Type II strain (clone PTG). Dams were treated daily with atovaquone or sham and monitored for pain, and complications.

Results: Dams developed pain related abdominal hypersensitivity (allodynia) to mechanical stimuli in a Tachyzoites dose dependent manner. Infected dams were anemic and exhibited ascities and …

The Effect Of Vessel Depth, Diameter, And Location On Ultrasound-Guided Peripheral Intravenous Catheter Longevity., J Matthew Fields, Anthony J Dean, Raleigh W Todman, Arthur K Au, Kenton L Anderson, Bon S Ku, Jesse M Pines, Nova L Panebianco

Department of Emergency Medicine Faculty Papers

INTRODUCTION: Ultrasound-guided peripheral intravenous catheters (USGPIVs) have been observed to have poor durability. The current study sets out to determine whether vessel characteristics (depth, diameter, and location) predict USGPIV longevity.

METHODS: A secondary analysis was performed on a prospectively gathered database of patients who underwent USGPIV placement in an urban, tertiary care emergency department. All patients in the database had a 20-gauge, 48-mm-long catheter placed under ultrasound guidance. The time and reason for USGPIV removal were extracted by retrospective chart review. A Kaplan-Meier survival analysis was performed.

RESULTS: After 48 hours from USGPIV placement, 32% (48/151) had failed prematurely, 24% …

A Clinical Prediction Model For Long-Term Functional Outcome After Traumatic Spinal Cord Injury Based On Acute Clinical And Imaging Factors., Jefferson R Wilson, Robert G Grossman, Ralph F Frankowski, Alexander Kiss, Aileen M Davis, Abhaya V Kulkarni, James S Harrop, Bizhan Aarabi, Alexander Vaccaro, Charles H Tator, Marcel Dvorak, Christopher I Shaffrey, Susan Harkema, James D Guest, Michael G Fehlings

Department of Neurosurgery Faculty Papers

To improve clinicians' ability to predict outcome after spinal cord injury (SCI) and to help classify patients within clinical trials, we have created a novel prediction model relating acute clinical and imaging information to functional outcome at 1 year. Data were obtained from two large prospective SCI datasets. Functional independence measure (FIM) motor score at 1 year follow-up was the primary outcome, and functional independence (score ≥ 6 for each FIM motor item) was the secondary outcome. A linear regression model was created with the primary outcome modeled relative to clinical and imaging predictors obtained within 3 days of injury. …

Herpes Simplex Virus 34.5 Interferes With Autophagosome Maturation And Antigen Presentation In Dendritic Cells, Philipe A. M. Gobeil, David A. Leib

Dartmouth Scholarship

The cellular autophagy response induced by herpes simplex virus 1 (HSV-1) is countered by the viral γ34.5 protein. γ34.5 modulates autophagy by binding to the host autophagy protein Beclin-1 and through this binding inhibits the formation of autophagosomes in fibroblasts and neurons. In contrast, in this study dendritic cells (DCs) infected with HSV-1 showed an accumulation of autophagosomes and of the long-lived protein p62. No such accumulations were observed in DCs infected with a γ34.5-null virus or a virus lacking the Beclin-binding domain (BBD) of γ34.5. To explore this further, we established stably transduced DC lines to show that γ34.5 …

Common Respiratory Issues In Ambulatory Obstetrics., Kelly M Orzechowski, Richard C Miller

Department of Obstetrics and Gynecology Faculty Papers

This article reviews the diagnosis and management of the most common respiratory conditions complicating pregnancy--asthma and influenza. We also review strategies for smoking cessation in pregnancy as, in addition to exacerbating all other pulmonary conditions, smoking is the most modifiable risk factor for poor pregnancy outcome. Moreover, the obstetrician frequently encounters each of these conditions in the ambulatory setting. A thorough knowledge of the normal pregnancy-induced physiological respiratory changes combined with a comprehensive understanding of how to manage these conditions, will provide the obstetrician with the armamentarium needed to optimize health outcomes for mothers and their fetuses.

Choroidal Neovascularization Regression On Fluorescein Angiography After Vegf Blockade., Diana V. Do, Lark Greenwald, Mohamed Ibrahim, Yasir J. Sepah, Quan Dong Nguyen

Journal Articles: Ophthalmology

BACKGROUND: Intravitreal vascular endothelial growth factor (VEGF) inhibitors stabilize vision in a majority of patients with neovascular age-related macular degeneration (AMD) and can improve vision in almost 40% of patients. However, some individuals who respond to anti-VEGF treatment still lose vision due to the formation of geographic atrophy (GA). While optical coherence tomography is often the primary imaging modality used, fluorescein angiography (FA) can provide useful information on GA development after choroidal neovascularization (CNV) regression.

METHODS: A retrospective chart review was conducted to evaluate the changes seen on FA over a 47-month period for 3 patients with neovascular AMD treated …

Characterization Of Macular Lesions In Punctate Inner Choroidopathy With Spectral Domain Optical Coherence Tomography., Roomasa Channa, Mohamed Ibrahim, Yasir J. Sepah, Peykan Turkcuoglu, Jeong Hee Lee, Afsheen Khwaja, Elham Hatef, Millena Bittencourt, Jangwon Heo, Diana V. Do, Quan Dong Nguyen

Journal Articles: Ophthalmology

PURPOSE: Punctate inner choroidopathy (PIC) is an ocular inflammatory disease. Spectral domain optical coherence tomography (SD-OCT) allows detailed visualization of retinal and choroidal structures. We aimed to describe the retinal changes on SD-OCT associated with PIC lesions localized in the macula.

METHODS: Retrospective case series: PIC lesions not associated with choroidal neovascularization (CNV) and captured by macular SD-OCT scans were identified and characterized.

RESULTS: Twenty-seven PIC lesions from seven patients (eight eyes) were identified and classified into four categories according to disease activity and temporal changes. Among clinically inactive patients, two main patterns were noted on OCT: (1) retinal pigment …

Isolated Endogenous Nocardia Endophthalmitis After Immunosuppression., Lisa Y. Chen, Muge R. Kesen, Abdalhossein Ghafourian, Quan Dong Nguyen, Charles G. Eberhart, Diana V. Do

Journal Articles: Ophthalmology

PURPOSE: This study is aimed to report a case of endogenous Nocardia endophthalmitis in the setting of immunosuppression from chronic steroid use.

METHODS: A case report was conducted.

RESULTS: A 79-year-old woman presented with decreased vision with floaters in the left eye. Ophthalmic examination revealed severe inflammation in the anterior chamber, vitreous opacities, and retinal detachment. Vitreous cultures grew Nocardia farcinica without any systemic foci of infection found during further workup. The patient was treated with intravitreal amikacin and oral trimethoprim-sulfamethoxazole, and her retinal detachment was later repaired in the operating room. The patient has since remained stable with no …

Dermatofibroma: A Curious Tumor., Lawrence Parish, Shideh Yazdanian, W Clark Lambert, Peter C Lambert

Department of Dermatology and Cutaneous Biology Faculty Papers

A tumor, such as a dermatofibroma, causes consternation among many patients, but it rarely creates problems on its own. Also called a histiocytoma, it remains one of the most common mesenchymal growths. Its etiology is unknown with the previous theory that it is a dermal response to injury, such as an insect bite, being challenged. As much as patients like to blame spiders or other arthropods for traumatizing an arm or leg, no definitive explanation is available for its etiology.

Parvalbumin In Fish Skin-Derived Gelatin: Is There A Risk For Fish Allergic Consumers?, S. J. Koppelman, Julie A. Nordlee, P.-W. Lee, R. P. Happe, M. Hessing, R. Norland, T. Manning, R. Deschene, G. A. H. De Jong, Steve L. Taylor

Department of Food Science and Technology: Faculty Publications

The major allergen parvalbumin was purified from cod muscle tissues, and polyclonal antibodies were raised toward it. The antibodies were tested for specificity, and an enzyme-linked immunosorbent assay (ELISA) was developed using these antibodies. The ELISA was applied to measure parvalbumin in cod skin, the starting material for fish gelatin made from deep sea, wild fish. The ELISA was sufficiently sensitive (LLOQ = 0.8 ng ml^–1 in extracts, corresponding to 0.02 μg of parvalbumin per g of tissue) and did not cross-react with common food constituents. Fish gelatin, wine, and beer, matrices for the potential use of this ELISA, …

Effectiveness Of A Peer-Led Hiv Prevention Intervention In Secondary Schools In Rwanda: Results From A Non-Randomized Controlled Trial, Kristien Michielsen, Roxanne Beauclair, Wim Delva, Kristien Roelens, Ronan Van Rossem, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: While the HIV epidemic is levelling off in sub-Saharan Africa, it remains at an unacceptably high level. Young people aged 15-24 years remain particularly vulnerable, resulting in a regional HIV prevalence of 1.4% in young men and 3.3% in young women. This study assesses the effectiveness of a peer-led HIV prevention intervention in secondary schools in Rwanda on young people’s sexual behavior, HIV knowledge and attitudes.

Methods: In a non-randomized longitudinal controlled trial, fourteen schools were selected in two neighboring districts in Rwanda Bugesera (intervention) and Rwamagana (control). Students (n= 1950) in eight intervention and six control schools participated …

Genetics For The Ophthalmologist., Karthikeyan A Sadagopan, Jenina Capasso, Alex V Levin

Wills Eye Hospital Papers

The eye has played a major role in human genomics including gene therapy. It is the fourth most common organ system after integument (skin, hair and nails), nervous system, and musculoskeletal system to be involved in genetic disorders. The eye is involved in single gene disorders and those caused by multifactorial etiology. Retinoblastoma was the first human cancer gene to be cloned. Leber hereditary optic neuropathy was the first mitochondrial disorder described. X-Linked red-green color deficiency was the first X-linked disorder described. The eye, unlike any other body organ, allows directly visualization of genetic phenomena such as skewed X-inactivation in …