Medical Specialties Commons^™

Tramadol Versus Nalbuphine In Total Intravenous Anaesthesia For Dilatation And Evacuation, Khalid Maudood Siddiqui, Ursula Chohan

Department of Anaesthesia

Objective: To compare the results of Tramadol with Nalbuphine for dilatation and evacuation with total intravenous anaesthesia technique.Methods: A total of 70 patients (35 in each group) were included in this prospective, double blind randomized study. Intravenous tramadol 1.5 mg/kg and nalbuphine 0.1 mg/kg were compared in total intravenous anaesthesia (TIVA) using a propofol infusion in patients undergoing dilatation and evacuation (D and E). Changes in haemodynamic variables greater than 20% from the base line values were noted.Results: There was no difference found in haemodynamic parameters. There was statistically significant difference found (p < 0.05) in postoperative recovery between the two groups.CONCLUSION: Quality of analgesia was better in nalbuphine group but both drugs provide suitable analgesic supplementation to TIVA.

Toward A Biopsychosocial Understanding Of The Patient-Physician Relationship: An Emerging Dialogue, Herbert M. Adler

Department of Family & Community Medicine Faculty Papers

Complexity theory has been used to view the patient-physician relationship as constituted by complex responsive processes of relating. It describes an emergent, psychosocial relational process through which patients and physicians continually and reciprocally influence each other's behavior and experience. As psychosocial responses are necessarily biopsychosocial responses, patients and physicians must likewise be influencing each other's psychobiology. This mutual influence may be subjectively experienced as empathy, and may be skillfully employed by the clinician to directly improve the patient's psychobiology.

An Unusual Abdominal Mass: Case Report, H. Saidi, U. Mohammed, M. Machoki

General Surgery, East Africa

The causes of intra-abdominal masses associated with chronic abdominal pain range from the benign to malignant; common to bizarre and some raise major medical legal issues. We present a case of a 40-year old African lady who presented with chronic right-sided abdominal pain with an associated mass on the right mid-abdomen. She had had a Caesarian section one year prior to presentation. Antecedent history of surgery and typical imaging features enabled a preoperative diagnosis of abdominal mass secondary to retained surgical gauze.The case illustrates the fallibility of the men and women in the operating theatres and the vital role of …

Pakistani Physicians And The Repatriation Equation, Saad Shafqat, Anita K. M. Zaidi

Section of Neurology

In Pakistan, students who are accepted into medical school are congratulated — only half-jokingly — on three counts: that they will become doctors, that they will become certified by the American Board of Medical Specialties, and that they will soon be living in the United States.

Bleomycin Induced Pneumonitis: A Case Successfully Managed With High-Dose Steroids, Shahid Javed Husain, Ali Bin Sarwar Zubairi, Muhammad Irfan

Department of Medicine

No abstract provided.

Prevalence Of Gastric Varices And Results Of Sclerotherapy With N-Butyl 2 Cyanoacrylate For Controlling Acute Gastric Variceal Bleeding., Mumtaz J Khan, Shahid Majid,, Syed H Shah, Kashif Hameed, Ashfaq Ahmed, Saeed Hamid, Wasim Jafri

Department of Medicine

Aim: To study the prevalence, predictors and control of bleeding following N-butyl 2 cyanoacrylate (NBC) sclerotherapy of gastric varix (GV).

Methods: We analyzed case records of 1436 patients with portal hypertension, who underwent endoscopy during the past five years for variceal screening or upper gastrointestinal (GI) bleeding. Fifty patients with bleeding GV underwent sclerotherapy with a mean of 2 mL NBC for control of bleeding. Outcome parameters were primary hemostasis (bleeding control within the first 48 h), recurrent bleeding (after 48 h of esophagogastro-duodenoscopy) and in-hospital mortality were analyzed.

Results: The prevalence of GV in patients with portal hypertension was …

Phosphorylation Of The Proline-Rich Domain Of Xp95 Modulates Xp95 Interaction With Partner Proteins, Robert E Dejournett, Ryuji Kobayashi, Shujuan Pan, Chuanfen Wu, Laurence D Etkin, Richard B Clark, Oliver Bögler, Jian Kuang

Faculty, Staff and Student Publications

The mammalian adaptor protein Alix [ALG-2 (apoptosis-linked-gene-2 product)-interacting protein X] belongs to a conserved family of proteins that have in common an N-terminal Bro1 domain and a C-terminal PRD (proline-rich domain), both of which mediate partner protein interactions. Following our previous finding that Xp95, the Xenopus orthologue of Alix, undergoes a phosphorylation-dependent gel mobility shift during progesteroneinduced oocyte meiotic maturation, we explored potential regulation of Xp95/Alix by protein phosphorylation in hormone-induced cell cycle re-entry or M-phase induction. By MALDI-TOF (matrix-assisted laser-desorption ionization-time-of-flight) MS analyses and gel mobility-shift assays, Xp95 is phosphorylated at multiple sites within the N-terminal half of the …

The Fate Of The Unexpected Positive Intraoperative Cultures After Revision Total Knee Arthroplasty, Robert L. Barrack, Ajay Aggarwal, R. Stephen J. Burnett, John C. Clohisy, Elie Ghanem, Peter Sharkey, Javad Parvizi

Department of Orthopaedic Surgery Faculty Papers

Of a consecutive series of 692 revision total knees at 3 centers, intraoperative cultures were unexpectedly found to be positive in 41 cases (5.9%). Of the 41, 29 (71%) cases had a single positive intraoperative culture and were determined to be a probable false positive based on absence of any other evidence of infection, of which 5 were treated with extended course of intravenous antibiotics after hospital discharge and the remaining 24 received no further treatment. None of these 24 patients manifested any sign of infection at follow-up, averaging 46 months (range, 24-74 months). Twelve patients were determined to have …

Beta Blocker Specificity: A Building Block Toward Personalized Medicine., Brent R Degeorge, Walter J Koch

Center for Translational Medicine Faculty Papers

Drugs known as beta blockers, which antagonize the beta-adrenergic receptor (beta-AR), are an important component of the treatment regimen for chronic heart failure (HF). However, a significant body of evidence indicates that genetic heterogeneity at the level of the beta(1)-AR may be a factor in explaining the variable responses of HF patients to beta blockade. In this issue of the JCI, Rochais et al. describe how a single amino acid change in beta(1)-AR alters its structural conformation and improves its functional response to carvedilol, a beta blocker currently used in the treatment of HF (see the related article beginning on …

Contrasting Roles Of Neural Firing Rate And Local Field Potentials In Human Memory, A. Ekstrom, Indre Viskontas, M. Kahana, J. Jacobs, K. Upchurch, S. Bookheimer, I. Fried

Psychology

Recording the activity of neurons is a mainstay of animal memory research, while human recordings are generally limited to the activity of large ensembles of cells. The relationship between ensemble activity and neural firing rate during declarative memory processes, however, remains unclear. We recorded neurons and local field potentials (LFPs) simultaneously from the same sites in the human hippocampus and entorhinal cortex (ERC) in patients with implanted intracranial electrodes during a virtual taxi-driver task that also included a memory retrieval component. Neurons increased their firing rate in response to specific passengers or landmarks both during navigation and retrieval. Although we …

Com Outlook Winter 2007, College Of Osteopathic Medicine

COM Outlook

No abstract provided.

Medical Education Digest, Vol. 9 No. 1 (January/February 2007), Nova Southeastern University

Medical Education Digest

No abstract provided.

Enhanced Care Assistant Training To Address The Workforce Crisis In Home Care: Changes Related To Job Satisfaction And Career Commitment, Constance L. Coogle, Iris A. Parham, Rita Jablonski, Jason A. Rachel

Virginia Center on Aging Publications

Changes in job satisfaction and career commitment were observed as a consequence of a geriatric case management training program focusing on skills development among personal care attendants in home care. A comparison of pretraining and posttraining scores uncovered a statistically signifi cant increase in Intrinsic Job Satisfaction scores for participants 18–39 years of age, whereas levels declined among the group of middle aged participants and no change was observed among participants age 52 and older. On the other hand, a statistically signifi cant decline in Extrinsic Job Satisfaction was documented over all participants, but this was found to be primarily …

Re-Imagining The Experience And Study Of Aging, Edward F. Ansello

Director's Editorials from Age in Action

A small group of Japanese and American gerontologists have been working together toward developing a gerontology curriculum that would help people to understand the experience of aging. The group suggested adding business, information technology/communication, and education to the curriculum. The group also acknowledged that a curriculum on aging should include a way to help those of us who are not old to understand the importance for many who are old of the search for the infinite, the true self, the oneness, the spirit, or the divine, at the core of life.

Health Care Reform And Family Caregivers, Edward F. Ansello

Director's Editorials from Age in Action

Health care reform is in the air. Family caregivers need recognition, reinforcement, and a reliable resource of assistance. They need for the Commonwealth to recognize that they are the bedrock of long-term care. Minimizing investment in family caregivers would short circuit any serious effort to improve the health status and care of older Virginians.

Fiscal Year Retrospective, Edward F. Ansello

Director's Editorials from Age in Action

The Virginia Center on Aging relies on the dedication and selflessness of so many collaborating groups, agencies, and individuals to make our work for older Virginians possible. Drawing from official and informal reports from the 2006-2007 fiscal year, we thank them deeply and look forward to continuing these partnerships.

Acute And Chronic Pain Challenges For Arthritis Patients In An Acute Care Setting, Janet M. Bykowski

Case Studies from Age in Action

Educational Objectives

1. Demonstrate the importance of chronic pain management in an acute care environment.

2. Discuss the special impact of co-morbidity of arthritis upon pain management intervention.

3. Provide education to clinicians, patients, and caregivers that would promote an interdisciplinary plan of care for acute and chronic concurrent pain management.

“Powerful Tools For Caregivers”: Teaching Skills That Reduce Stress And Increase Self-Confidence, Ed Rosenberg, Natasha Gouge

Case Studies from Age in Action

Educational Objectives

1. Describe caregiving stress and burnout symptoms and effects experienced by older caregivers.

2. Report implementation and evaluation of the “Powerful Tools for Caregivers” workshop, which is designed to increase knowledge and skills in caring for elders and reduce caregiver stress.

3. Suggest ways to alleviate caregiver burden at both micro and macro levels.

Teens Teaching Alzheimer’S Caregivers To Become Tech- Savvy: The Power Of Community And Intergenerational Partnerships, Ann Bruner Duesing, Marilyn Pace Maxwell

Case Studies from Age in Action

Educational Objectives

1. Describe a successful technology project for Alzheimer’s caregivers in rural, far southwest Virginia which recruited and trained teenagers to teach computer skills to Alzheimer’s caregivers and taught the teenagers about caregiving and the disease.

2. Identify barriers for Alzheimer’s caregivers to learning and using technology to assist and support them in their caregiving, and identify successful ways to address these barriers.

Pace: Program Of All-Inclusive Care For The Elderly, Laura R. Gadsby

Case Studies from Age in Action

Educational Objectives

1. Describe the Program of Allinclusive Care for the Elderly model of care for frail seniors with chronic health care needs.

2. Demonstrate how PACE benefits providers in the delivery of services.

3. Explain how the PACE concept complements Virginia’s Long Term Care Reform, as well as initiatives to develop further the PACE program in Virginia.

College Of Osteopathic Medicine 2007, Nova Southeastern University

Health Professions Divisions Course Catalogs and Course Descriptions

No abstract provided.

Health Professions Division Catalog 2007-2008, Nova Southeastern University

Health Professions Divisions Course Catalogs and Course Descriptions

No abstract provided.

2006 Cancer Care Annual Report, Children's Mercy Hospital

Cancer Center Annual Reports

Annual report of cancer care and oncology services at the Children's Mercy Hospital, Kansas City MO, a pediatric medical center. This report has a focus on tumors of the central nervous system.

Effects Of Retinoic Acid On Beta-Catenin Transcriptional Activity In Melanoma Cells, Fung Chan

Theses, Dissertations and Capstones

Melanoma is the most dangerous form of skin cancer and its incidence has been increasing in the United States. Most melanomas are resistant to current chemotherapies; therefore, understanding the mechanism of melanomagenesis is beneficial to treatment of the diseases. Accumulation of β-catenin has been shown in colon and other cancers, including melanomas, but the transcriptional role of β-catenin in melanomas is still unclear. All-trans retinoic acid (ATRA) is an anti-tumor agent that has an inhibitory effect on β-catenin, but this effect has not been studied in melanomas. It has been shown that Microphthalmia-associated transcription factor (MITF), a melanocyte specific protein, …

Depression: Relationships To Sleep Paralysis And Other Sleep Disturbances In A Community Sample, Mariana Szklo-Coxe, Terry Young, Laurel Finn, Emmanuel Mignot

Community & Environmental Health Faculty Publications

Sleep disturbances are important correlates of depression, with epidemiologic research heretofore focused on insomnia and sleepiness. This epidemiologic study’s aim was to investigate, in a community sample, depression’s relationships to other sleep disturbances: sleep paralysis (SP), hypnagogic/hypnopompic hallucinations (HH), cataplexy – considered rapid eye movement-related disturbances – and automatic behavior (AB). Although typical of narcolepsy, these disturbances are prevalent, albeit under-studied, in the population. Cross-sectional analyses (1998–2002), based on Wisconsin Sleep Cohort Study population-based data from 866 participants (mean age 54, 53% male), examined: depression (Zung Self-Rating Depression Scale), trait anxiety (Spielberger State-Trait Anxiety Inventory, STAI-T ≥ 75th percentile), and …

Modulation Of Radiation Responses By Pre-Exposure To Irradiated Cell Conditioned Medium, Paula Maguire, Carmel Mothersill, B. Mcclean, C. Seymour, Fiona Lyng

Articles

The aim of this study was to investigate whether exposure of HPV-G cells to irradiated cell conditioned medium (ICCM) could induce an adaptive response if the cells were subsequently challenged with a higher ICCM dose. Clonogenic survival and major steps in the cascade leading to apoptosis, such as calcium influx and loss of mitochondrial membrane potential, were examined to determine whether these events could be modified by giving a priming dose of ICCM before the challenge dose. Clonogenic survival data indicated an ICCMinduced adaptive response in HPV-G cells ‘‘primed’’ with 5 mGy or 0.5 Gy ICCM for 24 h and …

Care Patterns And Outcomes For Hospitalized Patients With Diabetes In Nevada, Jay J. Shen

Nevada Journal of Public Health

This study demonstrates substantial differences between Nevada and the national average in patterns of hospital based care in patients with type 2 diabetes. Diabetic patients in Nevada are more likely to be hospitalized through the emergency department, and more likely to be admitted for a condition related to diabetes. Moreover, in Nevada, Medicaid and uninsured patients with diabetes are more likely to experience adverse outcomes then their privately insured counterparts. These differences may be primarily reflective of variances in access to ambulatory care, care seeking behavior, and availability of health services and facilities. Policies promoting expansion of health care benefits …

Clomiphene, Metformin, Or Both For Infertility In The Polycystic Ovary Syndrome, Richard S. Legro, Huiman X. Barnhart, William D. Schlaff, Bruce R. Carr, Michael P. Diamond, Sandra A. Carson, Michael P. Steinkampf, Christos Coutifaris, Peter G. Mcgovern, Nicholas A. Cataldo, Gabriella G. Gosman, John E. Nestler, Linda C. Guidice, Phyllis C. Leppert, Evan R. Myers M.P.H.

Obstetrics and Gynecology Publications

Background

The polycystic ovary syndrome is a common cause of infertility. Clomiphene and insulin sensitizers are used alone and in combination to induce ovulation, but it is unknown whether one approach is superior. Methods We randomly assigned 626 infertile women with the polycystic ovary syndrome to receive clomiphene citrate plus placebo, extended-release metformin plus placebo, or a combination of metformin and clomiphene for up to 6 months. Medication was discontinued when pregnancy was confirmed, and subjects were followed until delivery.

Results

The live-birth rate was 22.5% (47 of 209 subjects) in the clomiphene group, 7.2% (15 of 208) in the …

Department Of Radiology-Annual Executive Summary Report-July 1, 2006 To June 30, 2007, Vijay M. Rao M.D.

Department of Radiology Administrative Documents and Reports

91 page Department of Radiology Annual Executive Summary Report, July 1, 2006 to June 30, 2007, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, United States.

Management Of Anthracycline Extravasation Injuries, David J. Reeves

Scholarship and Professional Work – COPHS

OBJECTIVE: To review the evidence for the management of anthracycline extravasation and determine the optimal treatment of such injuries.

DATA SOURCES: A search of MEDLINE (1966–February 2007) and International Pharmaceutical Abstracts (1970–February 2007) was performed using the search terms anthracyclines and extravasation.

DATA SYNTHESIS: Extravasation of anthracyclines can have devastating effects. After infiltration of these drugs into the interstitial tissue, damage may range from mild erythema and pain to severe tissue necrosis. Many agents have been studied in the management of these injuries; however, few have demonstrated efficacy and treatment remains controversial. Nonpharmacologic modalities shown to limit extravasation injuries include …