Medical Specialties Commons^™

Effects Of Obesity On The Biomechanics Of Children’S Gait At Different Speeds, Philana-Lee Gouws

UNLV Theses, Dissertations, Professional Papers, and Capstones

The purpose of the study was to investigate the relationship between body mass index (BMI) and spatio-temporal gait characteristics of overweight/obese and non-obese school-aged children (12-14 years) at two different walking speeds. Eighty-four overweight/obese (n=28; age: 13.96 ± 0.79 yrs; mass: 74.8 ± 18.21 kg; height: 159.2 ± 7.1 cm and BMI: 29.28 ± 5.64 kg/m2) and non-obese students (n=56; age: 13.72 ± 0.79 yrs; mass: 51.7 ± 10.2 kg; height: 157.8 ± 8.3 cm and BMI: 20.69 ± 2.74 kg/m2) with no present injuries were recruited. Participants were instructed to walk across an electronic walkway in each of two …

The Use Of The Use Of Negative Pressure Wound Therapy In Vulvar Wounds, E. K. Ricci, Md, J. Brace, Phd, Crn, Bc, Cwocn, Aprn, N. G. Rosenblum, Md, Phd

Department of Obstetrics and Gynecology Faculty Papers

Patients with severe HS or Necrotizing Fasciitis often require extensive surgical debridement.

Traditionally, these wounds have been closed using split-thickness skin grafts with or without the use of the VAC device.

Our case study demonstrates good outcomes using the VAC device alone to achieve complete closure when applied immediately following debridement with frequent VAC changes.

Duration Of Maternal Human Papilloma Virus Infection And Risk Of Spontaneous Preterm Birth, K. Soin, Ms, N. S. Seligman, Md, A. Nnoli, Md, K. Dysart, Md, J. K. Baxter, Md, Mscp

Department of Obstetrics and Gynecology Faculty Papers

Conclusions:

Duration of HPV infection was not a significant risk factor for spontaneous PTB <37 weeks.

Cervical HPV DNA and HPV serology may further delineate the relationship between HPV infection and SPTB <37 weeks.

A larger sample size may be necessary to show a difference.

The 3.5x higher rate of fetal death > 23 weeks in our study (compared to fetal death > 20 weeks in the U.S.) needs further investigation.

Body Mass Index And Cerclage Success, A. Suhag, Md, N. S. Seligman, Md, V. Berghella, Md

Department of Obstetrics and Gynecology Faculty Papers

Conclusions:

Among women with a cerclage, pre-pregnancy BMI was not a significant predictor of SPTB <35 weeks.

There was a non-significant trend toward increased rates of SPTB at all gestational age cutoffs.

Morbidly obese women consistently had worse outcomes than obese and normal/overweight women.

Compared to normal/overweight, GA at delivery decreases by 1 week for obese and 2 weeks for morbidly obese women.

Recent Change In The Incidence Of Cervical Cerclage, Maria Bisulli, Md, Neil S. Seligman, Md, Komal Soin, Ms, Anju Suhag, Md, Vincenzo Berghella, Md

Department of Obstetrics and Gynecology Faculty Papers

Conclusions:

More selective indications for cervical cerclage based on recent randomized studies were associated with decreased cerclage placement.

The decrease in incidence of history-indicated cerclage may be due to the fact that more women with prior PTB are being followed by transvaginal cervical length measurements.

The decrease in incidence of ultrasound-indicated cerclage may be due to the use of 17-hydroxy progesterone caproate in women with PTB.

Evaluating The Impact Of The Guatemalan Nursing Program On Staff, Organizational, And Clinical Outcomes, Sara Williamson Day

Theses and Dissertations (ETD)

There is great disparity between the outcome of childhood cancer in developed and developing countries. Nurses, who comprise the largest group of health care professionals globally, are essential to successful treatment. Pediatric oncology education is generally unavailable for nurses in developing countries. This lack of education is likely to contribute to the disparity in survival rates, as undereducated nurses are unable to meet the demands of pediatric cancer care. A second critical problem in developing countries is the workload of the nurse, with a patient nurse ratio reported as high as 30 patients per one nurse.

In 2006, the quality …

Il-2 Regulation Of Il-24 Expression Leads To Growth Suppression Of Melanoma Cells, Emily Jen

Dissertations and Theses (Open Access)

Melanoma is known to be highly resistant to chemotherapy. Treatment with high dose IL-2 has shown significant clinical benefit in a minority of metastatic melanoma patients and has lead to long term survival in a few cases. However, this treatment is associated with excessive multiorgan toxicities, which severely limits its use. We hypothesize that one mechanism of effective IL-2 therapy is through the direct upregulation of IL-24 production in melanoma tumors and subsequent IL-24 mediated tumor growth suppression.

Five melanoma cell lines were treated with high dose recombinant hIL-2 at 1000U/ml. Three of the cell lines (A375, WM1341, WM793) showed …

First Trimester Screening And Its Impact On Uptake Of Diagnostic Testing, Deanna Darnes

Dissertations and Theses (Open Access)

Introduction: First Trimester Screening (FTS) combines maternal age with fetal nuchal translucency (NT) and maternal analytes to identify pregnancies at an increased risk for Down syndrome and trisomy 18. Though the accuracy of this screening is high, it cannot replace the conclusive accuracy of prenatal diagnostic testing (PDT). Since FTS has been available, a decrease in the number of women who pursue PDT has been observed. This study sought to determine if there has been a significant change in the amount of PDT performed in our clinics, if the type of FTS result affects the patient’s decision regarding PDT, and …

A New Tumor Suppressor Gene Candidate Regulated By The Non-Coding Rna Pca3 In Human Prostate Cancer, Alessandro K. Lee

Dissertations and Theses (Open Access)

Prostate cancer is the second leading cause of cancer-related death and the most common non-skin cancer in men in the USA. Considerable advancements in the practice of medicine have allowed a significant improvement in the diagnosis and treatment of this disease and, in recent years, both incidence and mortality rates have been slightly declining. However, it is still estimated that 1 man in 6 will be diagnosed with prostate cancer during his lifetime, and 1 man in 35 will die of the disease.

In order to identify novel strategies and effective therapeutic approaches in the fight against prostate cancer, it …

Thoracic Radiotherapy Treatment Planning With Cine Pet/Ct, Adam C. Riegel

Dissertations and Theses (Open Access)

Purpose: Respiratory motion causes substantial uncertainty in radiotherapy treatment planning. Four-dimensional computed tomography (4D-CT) is a useful tool to image tumor motion during normal respiration. Treatment margins can be reduced by targeting the motion path of the tumor. The expense and complexity of 4D-CT, however, may be cost-prohibitive at some facilities. We developed an image processing technique to produce images from cine CT that contain significant motion information without 4D-CT. The purpose of this work was to compare cine CT and 4D-CT for the purposes of target delineation and dose calculation, and to explore the role of PET in target …

Reproductive Health Services For Populations At High Risk Of Hiv: Performance Of A Night Clinic In Tete Province, Mozambique, Yves Lafort, Diederike Geelhoed, Luisa Cumba, Carla Das Dores Mosse Lázaro, Wim Delva, Stanley Luchters, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Different models exist to provide HIV/STI services for most-at-risk populations (MARP). Along the Tete traffic corridor in Mozambique, linking Malawi and Zimbabwe, a night clinic opening between 4 and 10 PM was established targeting female sex workers (FSW) and long-distance truck drivers (LDD). The clinic offers free individual education and counselling, condoms, STI care, HIV testing, contraceptive services and outreach peer education. To evaluate this clinic model, we assessed relevance, service utilisation, efficiency and sustainability.

Methods: In 2007-2009, mapping and enumeration of FSW and LDD was conducted; 28 key informants were interviewed; 6 focus group discussions (FGD) were held …

The Assessment Of Disability Related To Vision Performance-Based Measure In Diabetic Retinopathy., Kevin J. Warrian, Luciano L. Lorenzana, Dara Lankaranian, Jyoti Dugar, Sheryl S. Wizov, George L. Spaeth

Wills Eye Hospital Papers

PURPOSE: To validate a third-generation performance-based measure of visual function titled "Assessment of Disability Related to Vision" (ADREV) in a study population of patients with diabetic retinopathy.

DESIGN: Prospective, cross-sectional study.

METHODS: Patients with nonproliferative or proliferative diabetic retinopathy, free from ocular comorbidity, were recruited from a single institute and completed the ADREV, the 25-Item National Eye Institute Visual Functioning Questionnaire (VFQ-25), and a clinical ophthalmic examination. Correlation, regression, and bootstrap analysis were conducted to determine the relationship between ADREV scoring and each of the study's clinical and self-report measures of visual ability, while controlling for potential confounders.

RESULTS: Ninety-one …

Emerging Parasitic Infection Mimicking Functional Bowel Disease, Javed Yakoob, Wasim Jafri, Mohammad Asim Beg, Z Abbas, Shagufta Naz,, Muhammad Islam, A. B. Khalid, Rustam Khan, Zubair Ahmad

Section of Gastroenterology

No abstract provided.

Solid-Organ Transplant Recipients And Breastfeeding While On Immunosuppression, Schweta Arakali, Faith Carlin, Lisa A. Coscia, Carolyn H. Mcgrory, Dawn Armenti, Vincent T. Armenti

Department of Surgery Faculty Papers

Conclusions:

The relatively small amount of drug transferred in breast milk and the lack of reported adverse effects along with the known benefits of breastfeeding may outweigh the risk of drug exposures in the transplant population.

The threshold for determining the level of exposure of an immunosuppressive agent that is acceptable is not known at present.

Continued study and follow-up of all breast-fed transplant recipient offspring is warranted.

Centers are encouraged to report all pregnancies in transplant recipients to the NTRR.

Pregnancy Outcomes In Female Lung Transplant Recipients, Julie Shaner, Faith Carlin, Lisa A. Coscia, Carolyn H. Mcgrory, Dawn Armenti, Vincent T. Armenti

Department of Surgery Faculty Papers

Conclusions:

Female lung recipients appear to face higher risks related to pregnancy when compared to other solid organ transplant recipients.

Although successful pregnancies have been reported in female lung recipients, analyses of larger numbers of cases may help to identify pre-pregnancy factors predictive of adverse outcomes.

Centers are encouraged to report all pregnancies in transplant recipients to the NTPR.

Pregnancy Outcomes With Exposure To The Mycophenolic Acid Products (Mpa), To Dung K. Nguyen, Faith Carlin, Lisa A. Coscia, Dawn Armenti, Vincent T. Armenti

Department of Surgery Faculty Papers

Conclusions:

Reports to NTPR to date continue to reveal an increased incidence of birth defects in transplant recipients maintained on MPA products during gestation compared to those not maintained on these agents.

Structural birth defects consisting of microtia (ear deformity) and facial defects suggest a pattern of malformations.

Evaluation of the higher incidence of non-viable outcomes requires further study in this cohort.

Centers are encouraged to report all pregnancy exposures in transplant recipients to the NTPR.

Pregnancy Outcomes In Pancreas-Kidney Vs. Kidney-Alone Diabetic Female Transplant Recipients, Lyuba Gitman, Faith Carlin, Lisa A. Coscia, Carolyn H. Mcgrory, Dawn Armenti, Vincent T. Armenti

Department of Surgery Faculty Papers

Conclusions:

The high incidences of hypertension, preeclampsia, and infection during pregnancy underscore the high-risk nature of pregnancy in both pancreas-kidney and kidney alone recipients.

Although overall offspring outcomes are similar in both PK and K groups, pregnancy in PK recipients may be associated with higher incidences of maternal infections and overall graft loss.

Centers are encouraged to report all pregnancies in transplant recipients to the NTPR.

Immunosuppressive Therapy For Autoimmune Disease And Pregnancy Outcomes, Karolina Paziana, Faith Carlin, Lisa A. Corcia, Carolyn H. Mcgrory, Dawn Armenti, Vincent T. Armenti

Department of Surgery Faculty Papers

Conclusions:

Cyclosporine exposure during pregnancy in the transplant population does appear to be associated with premature delivery and low infant birthweight.

Data from the NPR show that cyclosporine exposure during pregnancy in women with psoriasis does not appear to be associated with low gestational age or low infant birthweight.

Maternal comorbidities or other factors, such as multiple drug regimens, likely play a role in the higher rates of premature delivery and low birthweight infants in the kidney transplant population.

Further investigation is warranted to evaluate the impact of comorbidities and other factors on pregnancy outcomes of women taking Neoral®.

The Type 1 Insulin-Like Growth Factor Receptor In Hepatocellular Carcinoma Cell Lines, Zhengyu Wei, Phd, Tiziana Deangelis, M.S., Reginald Hurtt, B.S., Renato Baserga, M.D., Cataldo Doria, M.D., Ph.D

Department of Surgery Faculty Papers

Summary:

1. Human HCC cells have higher expression levels of IGF-1R, IRS1, and c-Met.

2. IRS1 interacts with c-Met. The role of IGF-1R in human HCC should be revisited.

3. Lentivirus-mediated shRNA delivery system targeting IGF-1R showed significant suppressive effects on HCC cell growth, promising a potential therapeutic treatment for human HCC.

Surgical Interventions For Malignant Middle Cerebral Infarction--Saving Lives And Functionality Or Increasing Disabled Survivors?, Maria Khan, Ayeesha Kamran Kamal

Section of Neurology

No abstract provided.

Effect Of Indomethacin On Bile Acid-Phospholipid Interactions: Implication For Small Intestinal Injury Induced By Nonsteroidal Anti-Inflammatory Drugs, Yong Zhou, Elizabeth J Dial, Rand Doyen, Lenard M Lichtenberger

Faculty, Staff and Student Publications

The injurious effect of nonsteroidal anti-inflammatory drugs (NSAIDs) in the small intestine was not appreciated until the widespread use of capsule endoscopy. Animal studies found that NSAID-induced small intestinal injury depends on the ability of these drugs to be secreted into the bile. Because the individual toxicity of amphiphilic bile acids and NSAIDs directly correlates with their interactions with phospholipid membranes, we propose that the presence of both NSAIDs and bile acids alters their individual physicochemical properties and enhances the disruptive effect on cell membranes and overall cytotoxicity. We utilized in vitro gastric AGS and intestinal IEC-6 cells and found …

Decision Analytic Model For Evaluation Of Suspected Coronary Disease With Stress Testing And Coronary Ct Angiography., Ethan J Halpern, David Fischman, Michael P Savage, Anish R Koka, Matthew Decaro, David C Levin

Department of Radiology Faculty Papers

RATIONALE AND OBJECTIVES: The aim of this study was to apply a decision analytic model for the evaluation of coronary artery disease (CAD) to define the optimal utilization of coronary computed tomographic angiography (cCTA) and stress testing.

MATERIALS AND METHODS: The model tested in this study assumes that CAD is evaluated with a stress test and/or cCTA and that a patient with positive evaluation results undergoes cardiac catheterization. On the basis of values of sensitivity, specificity, and radiation dose from the published literature and test costs from the Medicare fee schedule, a decision tree model was constructed as a function …

Endoscopic Repair Of High-Flow Cranial Base Defects Using A Bilayer Button., Adam J. Luginbuhl, Peter G. Campbell, James Evans, Marc Rosen

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

OBJECTIVES/HYPOTHESIS: Repair of the skull base still begins with a direct repair of the dural defect. We present a new button closure for primary repair of the dura for high flow defects.

STUDY DESIGN: Retrospective review.

METHODS: We reviewed our 20 cases of primary button grafts and compared the results to the previous 20 high-flow open-cistern cerebrospinal fluid (CSF) cases. Subjects were excluded if they had no violation of the arachnoid space or potential for low-flow CSF leak. The button is constructed so that the inlay portion is at least 25% larger than the dural defect, and the onlay portion …

Loss Of Stromal Caveolin-1 Independently Predicts Poor Disease-Free Survival And Time To Recurrence In Patients With Prostate Cancer, M. Wagner, A. Dasgupta, F. Sotgia, R. B. West, M. P. Lisanti, A. K. Witkiewicz

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

Results:

Of the 167 patients originally included in the study, 43 were either lost to follow up or had insufficient clinical data for comparison. Of the remaining 124 cases, 32 showed loss of stromal Cav-1. Statistical analysis revealed no significant association between stromal Cav-1 loss and the usual markers of disease severity including Gleason grade, stage and presence of metastases. Kaplan-Meier curves showed a significant association between stromal Cav-1 loss and poor disease-free survival and time to recurrence (p<0.05), but no significant association with cancer-specific survival.

Acute Mesenteric, Portal And Inferior Vena Cava (Ivc) Venous Thrombosis: Optimal Outcome Achieved With Anticoagulation, Abdul Rehman Alvi, Shahida Bibi, Zia Ur Rehman, Sameullah Khan Niazi

Department of Surgery Docs

The prevalence and clinical spectrum of acute mesenteric venous thrombosis (AMVT) in Pakistan is largely unknown. The authors report two patients with acute mesenteric, portal and inferior vena cava venous thrombosis confirmed on CT imaging. The diagnoses were established within 24 hours of presentation and both patients were successfully treated with therapeutic heparin during hospital admission and continued on oral warfarin because of hypercoagulable state. The protocol that we currently use is evidence based and is leading to optimal outcome.

Basal Insulin Requirements On Continuous Subcutaneous Insulin Infusion During The First 12 Months After Diagnosis Of Type 1 Diabetes Mellitus., Neesha Ramchandani, Mary Kristine Ellis, Shobhit Jain, Sonal Bhandari, Henry Anhalt, Noel K. Maclaren, Svetlana Ten

Manuscripts, Articles, Book Chapters and Other Papers

INTRODUCTION: While the endogenous first-phase insulin response has disappeared by the time of diagnosis of type 1 diabetes mellitus (T1DM), anecdotal evidence suggests that these patients can continue to have a second-phase insulin response during the first 12 months after diagnosis. We hypothesized that patients who are started on continuous subcutaneous insulin infusion (CSII) at the time of diagnosis of T1DM would have a lower basal insulin requirement than the 40-60% usually expected.

METHODS: We analyzed 38 patients with T1DM, age 9.9 +/- 6.4 years, 71% male, who were started on CSII within the first month of diagnosis.

RESULTS: Average …

Surgical Interventions For Malignant Middle Cerebral Infarction--Saving Lives And Functionality Or Increasing Disabled Survivors?, Maria Khan, Ayeesha Kamran Kamal

Department of Medicine

No abstract provided.

Severity Of Acute Hepatitis And Its Outcome In Patients With Dengue Fever In A Tertiary Care Hospital Karachi, Pakistan (South Asia), Om Parkash, Aysha Almas, Wasim Jafri, Saeed Hamid, J. Akhter, Syed H Shah

Department of Medicine

Background: Liver injury due to dengue viral infection is not uncommon. Acute liver injury is a severe complicating factor in dengue, predisposing to life-threatening hemorrhage, Disseminated Intravascular Coagulation (DIC) and encephalopathy. Therefore we sought to determine the frequency of hepatitis in dengue infection and to compare the outcome (length of stay, in hospital mortality, complications) between patients of Dengue who have mild/moderate (ALT 23-300 IU/L) v/s severe acute hepatitis (ALT > 300 IU/L).

Methods: A Cohort study of inpatients with dengue viral infection done at Aga Khan University Hospital Karachi. All patients (≥ 14 yrs age) admitted with diagnosis of Dengue …

Operative Management Of Unstable Thoracolumbar Burst Fractures, Mujahid Jamil Khattak, Shakir Syed, Riaz Hussain Lakdawala

Department of Surgery Docs

Operative management of unstable burst vertebral fractures is challenging and debatable. This study of such cases was conducted at the Aga Khan Hospital, Karachi from January 1998 to April 2003. All surgically managed spine injuries were reviewed from case notes and operative records. Clinical outcome was assessed by Hanover spine score and correction of kyphosis was measured for radiological assessment. The results were analyzed by Wilcoxon sign rank test for two related samples and p-value < 0.05 was considered significant. Ten patients were identified by inclusion criteria. There was statistically significant difference between mean pre-and postoperative Hanover spine score (p=0.008). Likewise, there was significant difference between mean immediate postoperative and final follow-up kyphosis. (p=0.006). Critical assessment of neurologic and structural extent of injury, proper pre-operative planning and surgical expertise can optimize the outcome of patients

Allred Scoring For Er Reporting And It's Impact In Clearly Distinguishing Er Negative From Er Positive Breast Cancers, Asim Qureshi, Shahid Pervez

Department of Pathology and Laboratory Medicine

Objective: To determine the scoring of Estrogen Receptor (ER) status in carcinoma breast by Allred method that is essentially bimodal and to compare the results with a conventional scoring system.
Materials and Methods: A retrospective, comparative study carried out at Aga Khan University Hospital Section of Histopathology over a period of 18 months i.e. Jan 2005 to June 2006. Anti ER antibody (clone D07) was used for all IHC stains using envision detection system. ER stains of 860 consecutive breast cancer cases were reviewed and rescored by both conventional and Allred method of ER scoring.
Results: Comparison of results showed …