Medical Specialties Commons^™

Reactive Oxygen And Nitrogen Species Induce Protein And Dna Modifications Driving Arthrofibrosis Following Total Knee Arthroplasty., Theresa A Freeman, Javad Parvizi, Craig J Della Valle, Marla J Steinbeck

Department of Orthopaedic Surgery Faculty Papers

BACKGROUND: Arthrofibrosis, occurring in 3%-4% of patients following total knee arthroplasty (TKA), is a challenging condition for which there is no defined cause. The hypothesis for this study was that disregulated production of reactive oxygen species (ROS) and nitrogen species (RNS) mediates matrix protein and DNA modifications, which result in excessive fibroblastic proliferation. RESULTS: We found increased numbers of macrophages and lymphocytes, along with elevated amounts of myeloperoxidase (MPO) in arthrofibrotic tissues when compared to control tissues. MPO expression, an enzyme that generates ROS/RNS, is usually limited to neutrophils and some macrophages, but was found by immunohistochemistry to be expressed …

Clinico-Pathologic Characteristics And Treatment Outcomes In Children With Neuroblastoma At The Kenyatta National Hospital, Nairobi., Grace Kitonyi, William Macharia, Otieno Walter Mwanda, R. Pamnani

Paediatrics and Child Health, East Africa

Objective: To determine clinical-pathologic characteristics, treatment modalities and treatment outcomes of children diagnosed with neuroblastoma.

Design: Cross- sectional descriptive study based on secondary data from patient records.

Setting: Records department of Kenyatta National Hospital (KNH), a tertiary teaching and referral hospital based in Nairobi.

Subjects: Children aged 15 years and below, admitted with the diagnosis of neuroblastoma, between January 1997 and December 2005.

Main outcome measures: Presenting clinical features, diagnostic modalities including laboratory and imaging data, treatment modalities, response to treatment and patient survival.

Results: Twenty six patients were eligible for the study; 13 males and 13 females giving a …

Use Of Topical Nsaids In Acute Musculoskeletal Sports Injury: A Brief Review, Amit M. Deokar, Shawn J. Smith, Hatim A. Omar

Pediatrics Faculty Publications

The objective of this chapter is to summarize the current standards of pain management in minor sports-related musculoskeletal injuries. This chapter also addresses the topical form of non-steroidal anti-inflammatory drug as an effective pain management option in an outpatient setting. Design: Quantitive systematic review of randomized controlled trials. Methods: The data was obtained through literature review of articles published in the last 10 years. In addition, FDA information on non-steroidal anti-inflammatory medications was also reviewed. The patient population studied in the articles included children and adults. Conclusion: Current standards of managing pain resulting from sports injuries involve a number of …

Concepts Of Contraception For Adolescents With Obesity: Pathways Of Judicial Moderation, Donald E. Greydanus, Hatim A. Omar, Artemis Tsitsika

Pediatrics Faculty Publications

All sexually active youth, whether obese or normal weight, should be offered counseling regarding contraception and appropriate contraceptive methods. However, obese youth who are sexually active may be less likely than their normal weight peers to use contraceptives correctly. Methods of contraception for obese adolescents are reviewed in this discussion. Combined oral contraceptives (COCs) and the contraceptive patch have higher failure rates in obese versus normal weight females, though failure rates are lower than noted with barrier contraceptives. The risk for venous thrombosis is higher in obese youth on COCs. Progestin-only pills and the levonorgestrel intrauterine system appear to be …

Ethics And Holistic Healthcare Practice, Michael De Vibe, Erica Bell, Joav Merrick, Hatim A. Omar, Søren Ventegodt

Pediatrics Faculty Publications

The paper aims to contribute to integrated discussion of ethics in holistic healthcare. Methods: Noting key aspects of the literature on ethics in holistic healthcare, the authors then focus on describing the working ethical statement for holistic healthcare practitioners produced for the International Society of Holistic Health (ISHH). Ethical principles, aims of holistic practice, and ethical guidelines are presented. The relationship of ethics to quality of care is outlined. Conclusions: The authors conclude that many of the ethical principles and guidelines, as well as expectations of quality and safety, that apply to mainstream healthcare, also apply to holistic practitioners. However, …

Obesity And Hyperandrogenism, Amit M. Deokar, Shawn J. Smith, Amanda J. Goodwin, Hatim A. Omar

Pediatrics Faculty Publications

This chapter has a two-fold objective. One, it addresses the association of hyperandrogenism and obesity and the complex metabolic derangements that are part of the problem. Clinical management of these co-morbidities is challenging and complex. Second, this article will aid health care providers with the key features to an early diagnosis and intervention to decrease the morbidities in the short as well as long term. Method: Systematic review of articles and information on the topic of interest that were published in the last 15 years. Conclusion: Obesity and hyperandrogenism are integral parts of Metabolic Syndrome/Polycystic Ovarian Syndrome (PCOS)/Hyperandrogenism, Insulin resistance, …

Obesity And Lack Of Physical Activity, Hatim A. Omar, Efrat Merrick-Kenig, Joav Merrick

Pediatrics Faculty Publications

Lack of physical activity and overweight status continues to be a significant health problem in the United States. To assess the actual prevalence of these problems, we reviewed data from the School-based Health Promotion Centers in one middle school, and one high school in central Kentucky. A total of 232 6th graders and 607 9th graders were included. A total of 92% of 6th graders and 45% of 9th graders reported complete lack of regular exercise. 37% of 9th graders and 59% of 6th graders had inappropriate nutrition, 47% of 9th graders and 33% of 6th graders had Body Mass …

Psychological And Social Development, Kimberly K. Mcclanahan, Marlene B. Huff, Hatim A. Omar

Pediatrics Faculty Publications

The global epidemic of childhood and adolescent overweight has become a major public health concern. Not only are these youth more likely to become obese as adults, and thus more prone to obesity-related diseases than their non overweight peers, they are also likely to suffer emotional and social effects associated with overweight. Overweight in youth has been linked to depression, low self-esteem, eating disorders, negative body image, and stigma. It appears to be bi-directional in nature, with overweight sometimes predicting certain psychological effects and psychosocial issues sometimes predicting overweight. Effective assessment and treatment of psychological and mental health issues in …

Clinical Profile And Outcome Of Infective Endocarditis At The Aga Khan University Hospital, M. Tariq, Bilal Karim Siddiqui, Atif Jadoon, Mahboob Alam, Sohail Abrar Khan, Mehnaz Atiq, Raymond A Smego

Section of Internal Medicine

Background: The spectrum of infective endocarditis (IE) is significantly different in developed and developing countries. The present study was conducted to study the clinical profile and outcome of infective endocarditis in Pakistan.
Methods: A descriptive cross-sectional study with review of medical records for 188 patients admitted to our teaching hospital with a diagnosis of IE from January 1988 to December 2001. One hundred fifty-nine subjects fulfilled the modified Duke diagnostic criteria.
Results: Definite IE was found in 59.7% (95/159) patients, while the rest had possible IE. One-third of subjects had acute IE 55/159 (34.5%). Subacute IE was found in …

Kawashima Operation: Functional Modification Of Bidirectional Glen Shunt With Left Superior Vena Cava In Single Ventricular Morphology, Syed Shahabuddin, Saulat Fatimi, Mehnaz Atiq, Muneer Amanullah

Section of Cardiothoracic Surgery

Single ventricle physiology offers limited options with significant morbidity and mortality. The Glenn shunt is a mid-stage procedure for the Fontan circulation. With persistent left Superior Vena Cava (SVC) and Azygos continuation of the Inferior Vena Cava (IVC) to the SVC, needs the development of bilateral bidirectional Glenn shunts. Fifteen patients underwent Bidirectional Glen shunt procedure over a period of ten years. Of these two were found to have left SVC along with interrupted IVC and its Azygos continuation to the SVC. These two patients underwent the Kawashima operation. A seven years old girl was admitted via emergency with severe …

Outcome And Factors Associated With Hospital Mortality In Patients With Impaired Left Ventricular Function Undergoing Coronary Artery Bypass Grafting: Where Do We Stand?, Mubashir Zareen Khan, S Perveen, Ja Ansari, Sa Sami, S Furnaz, Saulat H. Fatimi

Section of Cardiothoracic Surgery

Objective: Impaired ventricular function is a known risk factor for mortality after coronary artery bypass grafting however increasingly more patients with impaired ventricular function are referred for surgery. Currently no large data is available from Pakistan regarding this aspect of coronary surgery. Our objectives were to find out the hospital mortality and mid term functional improvement in patients with impaired ventricular function undergoing coronary artery by pass grafting and identify the risk factors for mortality.
Methodology: Retrospective analysis of preoperative, operative and postoperative variables of patients with impaired ventricular function who were operated for isolated first time coronary artery …

Locus Of Control And Adjustment To Vision Loss Among People With Age Related Macular Degeneration, Delinda Stinnette

Walden Dissertations and Doctoral Studies

People aged 65 and older account for 12.8% of the population and for 30% of all visually impaired individuals. Age-related Macular Degeneration (ARMD) has been identified as a significant public health issue, with a potential 8 million Americans at risk. While the literature supports a connection between LOC and adaptation to ARMD, there is a gap in the current literature supporting this relationship even when other factors are controlled (i.e. age, sex, education, type of ARMD, when diagnosed, the use of medical treatments, the use of visual assistance devices, participant engagement in rehabilitation, and depression). The present survey study used …

Assessment, Surgeon, And Society, John Norcini, Jamsheer J Talati

Section of Urology

An increasing public demand to monitor and assure the quality of care provided by physicians and surgeons has been accompanied by a deepening appreciation within the profession of the demands of self-regulation and the need for accountability. To respond to these developments, the public and the profession have turned increasingly to assessment, both to establish initial competence and to ensure that it is maintained throughout a career. Fortunately, this comes at a time when there have been significant advances in the breadth and quality of the assessment tools available. This article provides an overview of the drivers of change in …

Does The Duration Of Type 2 Diabetes Correlate With Changes In Taste Deficits?, Ann T. Mclaughlan

PCOM Biomedical Studies Student Scholarship

The loss of insulin sensitivity in Type 2 diabetes interferes with cellular utilization of glucose. The underlying down-regulation of insulin receptors and the resulting insulin resistance is wide-spread throughout the body. The cardiovascular consequences may be indirectly responsible for decreased taste sensitivity because of diminished perfusion of the taste buds in this patient population. This study utilized an inexpensive, non-invasive technique, electrogustometry, to directly stimulate the taste buds by applying a variable, direct-current stimulus to measure taste receptor thresholds in newly-diagnosed ( < 2 years) and long-standing diagnosed (> 6 years) male and female Type 2 diabetes mellitus subjects. Taste thresholds were elicited by application of an …

The Role Of Abortion In The Last Stage Of Fertility Decline In Vietnam, Bussarawan Teerawichitchainan, Sajeda Amin

Poverty, Gender, and Youth

Vietnam’s rapid fertility decline can be explained by very high rates of contraceptive use and induced abortion, but despite the overall decline, fertility rates vary considerably across the country’s 54 ethnic groups. To explore the prospects for further fertility decline through use of abortion among high-fertility minority populations, this study analyzes unique data from the Vietnam National Health Survey to examine ethnic differentials in prevalence and determinants of abortion and contraception, using a new classification system for ethnicity. The report concludes that providing improved abortion services alone is unlikely to reduce fertility among high-fertility minority groups. Service provision needs to …

Malignant Melanoma Metastatic To The Thyroid Gland: A Case Report And Review Of The Literature., Brian Kung, Md, Saba Aftab, Bs, Moira D. Wood, Md, David Rosen, Md

Department of Otolaryngology - Head and Neck Surgery Faculty Papers

The thyroid gland is a relatively uncommon site for a secondary malignancy; even less common is a case of malignant melanoma metastatic to the thyroid. We describe the case of a 68-year-old man who presented with a neck mass in the posterior triangle. Fine-needle aspiration biopsy (FNAB) identified the mass as a malignant melanoma. The patient had had no known primary skin melanoma. He underwent a left modified radical neck dissection, and the mass was discovered to be a positive lymph node. Postoperatively, he declined to undergo radio- and chemotherapy. Eighteen months later, he returned with a diffusely enlarged thyroid. …

The Effectiveness Of Placing A Mid-Level Provider In Triage As An Intervention To Improve Patient Flow In The Emergency Department, Penney A. Burlingame

MUSC Theses and Dissertations

With increasing scrutiny on the condition of the nation's emergency services and emphasis on patient satisfaction and pay for performance, Emergency Departments (EDs) are examining ways to improve public perceptions of satisfaction and quality. A reduction in ED wait times and left without being seen (LWBS) volumes can have a significant impact on patient satisfaction scores. The purpose of this study is to determine if placement of a mid-level provider in triage to perform medical screening exams (MSEs) will reduce ED wait times, increase efficient patient flow, and increase patient and staff satisfaction. For one hundred sixty nine days, a …

Optimizing Computer-Aided Colonic Polyp Detection For Ct Colonography By Evolving The Pareto Front, Jiang Li, Adam Huang, Jack Tao, Jiamin Liu, Robert L. Van Uitert, Nicholas Petrick, Ronald Summers

Electrical & Computer Engineering Faculty Publications

A multiobjective genetic algorithm is designed to optimize a computer-aided detection (CAD) system for identifying colonic polyps. Colonic polyps appear as elliptical protrusions on the inner surface of the colon. Curvature-based features for colonic polyp detection have proved to be successful in several CT colonography (CTC) CAD systems. Our CTC CAD program uses a sequential classifier to form initial polyp detections on the colon surface. The classifier utilizes a set of thresholds on curvature-based features to cluster suspicious colon surface regions into polyp candidates. The thresholds were previously chosen experimentally by using feature histograms. The chosen thresholds were effective for …

Automatic Diagnosis For Prostate Cancer Using Run-Length Matrix Method, Xiaoyan Sun, Shao-Hui Chuang, Jiang Li, Frederic Mckenzie, Nico Karssemeijer (Ed.), Maryellen L. Giger (Ed.)

Electrical & Computer Engineering Faculty Publications

Prostate cancer is the most common type of cancer and the second leading cause of cancer death among men in US¹. Quantitative assessment of prostate histology provides potential automatic classification of prostate lesions and prediction of response to therapy. Traditionally, prostate cancer diagnosis is made by the analysis of prostate-specific antigen (PSA) levels and histopathological images of biopsy samples under microscopes. In this application, we utilize a texture analysis method based on the run-length matrix for identifying tissue abnormalities in prostate histology. A tissue sample was collected from a radical prostatectomy, H&E fixed, and assessed by a pathologist …

Thoracoscopic Decortication Vs Tube Thoracostomy With Fibrinolysis For Empyema In Children: A Prospective, Randomized Trial., Shawn D. St Peter, Kuojen Tsao, Troy L. Spilde, Scott J. Keckler, Christopher J. Harrison, Mary Anne Jackson, Susan W. Sharp, Walter S. Andrews, Douglas C. Rivard, Frank P. Morello, G W. Holcomb Iii, Daniel J. Ostlie

Manuscripts, Articles, Book Chapters and Other Papers

PURPOSE: Management of empyema has been debated in the literature for decades. Although both primary video-assisted thoracoscopic surgery (VATS) and tube thoracostomy with pleural instillation of fibrinolytics have been shown to result in early resolution when compared to tube thoracostomy alone, there is a lack of comparative data between these modes of management. Therefore, we conducted a prospective, randomized trial comparing VATS to fibrinolytic therapy in children with empyema.

METHODS: After Institutional Review Board approval, children defined as having empyema by either loculation on imaging or more than 10,000 white blood cells/microL were treated with VATS or fibrinolysis. Based on …

Rationale And Design Of A Trial Of Angiotensin-Converting Enzyme Inhibition In Infants With Single Ventricle., Daphne T. Hsu, Seema Mital, Chitra Ravishankar, Renee Margossian, Jennifer S. Li, Lynn A. Sleeper, Richard V. Williams, Jami C. Levine, Brian W. Mccrindle, Andrew M. Atz, Darlene Servedio, Lynn Mahony, Pediatric Heart Network Investigators, Girish S. Shirali

Manuscripts, Articles, Book Chapters and Other Papers

BACKGROUND: Angiotensin converting enzyme (ACE) inhibitors are known to improve clinical outcome and ventricular function in adults with heart failure. Infants with single-ventricle physiology show abnormalities in ventricular function as well as poor growth. The ability of an ACE inhibitor to preserve ventricular function and improve growth in these infants is unknown.

METHODS: The Pediatric Heart Network designed a randomized, double-blind trial to compare outcomes in infants with single-ventricle physiology receiving enalapril or placebo. Neonates < or =45 days old were eligible. The primary outcome is weight-for-age Z-score at 14 months of age. Secondary outcomes include other measures of somatic growth, laboratory and functional measures of heart failure, developmental indices, measures of ventricular size and function, and the relationship of the renin-angiotensin-aldosterone system genotype to the response to enalapril. The incidence and spectrum of adverse events will also be compared between treatment groups.

RESULTS: A total of 1,245 neonates were screened and 533 (43%) were eligible. The consent rate was 43%; 230 subjects were enrolled. Parental reluctance to …

Microrna Expression Profiling Of Male Breast Cancer., Matteo Fassan, Raffaele Baffa, Juan P Palazzo, Joshua Lloyd, Marco Crosariol, Chang-Gong Liu, Stefano Volinia, Hannes Alder, Massimo Rugge, Carlo M Croce, Anne Rosenberg

Department of Urology Faculty Papers

INTRODUCTION : MicroRNAs (miRNAs) are a class of small noncoding RNAs that control gene expression by targeting mRNAs and triggering either translation repression or RNA degradation. Their aberrant expression may be involved in human diseases, including cancer. To test the hypothesis that there is a specific miRNA expression signature which characterizes male breast cancers, we performed miRNA microarray analysis in a series of male breast cancers and compared them with cases of male gynecomastia and female breast cancers. METHODS : Paraffin blocks were obtained at the Department of Pathology of Thomas Jefferson University from 28 male patients including 23 breast …

Elongation Factor 1 Alpha Interacts With Phospho-Akt In Breast Cancer Cells And Regulates Their Proliferation, Survival And Motility., Luisa Pecorari, Oriano Marin, Chiara Silvestri, Olivia Candini, Elena Rossi, Clara Guerzoni, Sara Cattelani, Samanta A Mariani, Francesca Corradini, Giovanna Ferrari-Amorotti, Laura Cortesi, Rita Bussolari, Giuseppe Raschellà, Massimo R Federico, Bruno Calabretta

Kimmel Cancer Center Faculty Papers

BACKGROUND: Akt/PKB is a serine/threonine kinase that has attracted much attention because of its central role in regulating cell proliferation, survival, motility and angiogenesis. Activation of Akt in breast cancer portends aggressive tumour behaviour, resistance to hormone-, chemo-, and radiotherapy-induced apoptosis and it is correlated with decreased overall survival. Recent studies have identified novel tumor-specific substrates of Akt that may provide new diagnostic and prognostic markers and serve as therapeutic targets. This study was undertaken to identify pAkt-interacting proteins and to assess their biological roles in breast cancer cells. RESULTS: We confirmed that one of the pAkt interacting proteins is …

Regulation Of Survivin Gene Expression In The Human Endometrium And Endometrial Cancer, Nancy H. Nabilsi

Dissertations and Theses (Open Access)

In the United States, endometrial cancer is the leading cancer of the female reproductive tract. There are 40,100 new cases and 7,470 deaths from endometrial cancer estimated for 2008 (47). The average five year survival rate for endometrial cancer is 84% however, this figure is substantially lower in patients diagnosed with late stage, advanced disease and much higher for patients diagnosed in early stage disease (47). Endometrial cancer (EC) has been associated with several risk factors including obesity, diabetes, hypertension, previously documented occurrence of hereditary non-polyposis colorectal cancer (HNPCC), and heightened exposure to estrogen (25). As of yet, there has …

Isolated Polyethylene Exchange Versus Acetabular Revision For Polyethylene Wear, Camilo Restrepo, Elie Ghanem, Carrie Houssock, Mathew Austin, Javad Parvizi, William J. Hozack

Department of Orthopaedic Surgery Faculty Papers

Polyethylene wear and osteolysis are not uncommon in THA mid- and long-term. In asymptomatic patients the dilemma faced by the orthopaedic surgeon is whether to revise the cup and risk damage to the supporting columns and even pelvic discontinuity or to perform isolated polyethylene exchange and risk a high rate of postoperative recurrent instability and dislocation that will necessitate further surgery. We retrospectively reviewed 62 patients (67 hips) who underwent revision arthroplasty for polywear and osteolysis. Thirty-six hips had isolated polyethylene exchange, while 31 had full acetabular revision. The minimum followup was 2 years (mean, 2.8 years; range, 2-5 years). …

Llmhs Elderly Services Outreach Program: Lincoln, Lyon & Murray Human Services, Jamie Olson

All Graduate Theses, Dissertations, and Other Capstone Projects

Right now there is a lack of professional and community knowledge regarding the services LLMHS provides to those over age 65. Thus, there are elderly who are in need of help who are not getting connected to a county long term care social worker. The elderly may need help to simply get connected to resources, have questions answered, correct misconceptions about long term care, get recommendations, or assistance paying for home and community based services. There are also many providers and professionals with questions about what LLMHS does and does not do as well as what the assistance programs can …

Direct-To-Consumer Advertising For Erectile Dysfunction Drugs, Karen A. Karlowicz

Ellmer School of Nursing Faculty Publications

The author reflects on direct to consumer advertising which is concerned with erectile dysfunction drugs. She suggests that many people have problems with open discussions of sexual health problems. She argues that urologic nurses should have discussions with pharmaceutical representatives about ways to responsibly educate the public about erectile dysfunction drugs in a manner that is not offensive.

Evaluation Of The Urinary Incontinence Scales© To Measure Change After Experiential Learning: A Pilot Study, Karen A. Karlowicz

Ellmer School of Nursing Faculty Publications

Evaluation of the effectiveness of the Urinary Incontinence Scales© to measure change after student participation in a disability-incontinence experiential learning activity was the focus of this pilot study. A comparison between pretest and posttest scores showed a significant increase in Belief and Practice subscale scores after participation in the experience. However, positive correlations between the variables measured could not be established.

White Paper: Walking Speed: The Sixth Vital Sign, Stacy Fritz, Michelle M. Lusardi

All PTHMS Faculty Publications

Walking speed is "almost the perfect measure." This review summarizes the strong psychometric properties of walking speed and robust evidence for using this clinical measurement. Walking speed is easily measurable, clinically interpretable, and a potentially modifiable risk factor. For these reasons, using WS as the sixth vital sign is both pragmatic and essential.

Posttraumatic Stress Disorder And Other Consequences Of A Picu Admission, Stephanie Ann Stowman

UNLV Theses, Dissertations, Professional Papers, and Capstones

Currently, there is a paucity of literature regarding children's experiences in a pediatric intensive care unit (PICU) relative to caregivers' experiences. Children admitted to a PICU and their caregivers are at risk for various psychopathology. Disorders commonly identified in seriously ill children include depression, anxiety, acute stress disorder, and posttraumatic stress disorder. Caregivers of seriously ill children are at increased risk of depression, generalized anxiety disorder, acute stress disorder, and posttraumatic stress disorder. Researchers often fail to examine all relevant psychopathology and contributing factors and stressors, such as family environment, in seriously ill children and their caregivers. This study assessed …