Medical Specialties Commons^™

Development Of A Blood Test For The Detection Of Cutaneous Malignant Melanoma, Rebecca Slattery

Theses : Honours

Cutaneous Malignant Melanoma is a highly aggressive form of skin cancer that has a tendency to metastasise. In its early stages, the 5-year survival rate of patients is greater than 90% following surgical excision of an in situ tumour. However, following metastasis of the tumour, the 5-year survival rate declines to 5-35%. Due to the correlation between metastasis and declining survival, studies have attempted to identify potential metastasis as early as possible. Molecular markers of melanoma cells in the peripheral blood of CMM patients have been investigated, as the invasion of tumour cells into the blood is one of the …

Is It Time To Redesign Hospice? End-Of-Life Care At The User Interface, David J. Casarett

Center for Policy Research

Hospice is a system of end-of-life care that’s not used to its full potential. That is, hospice is not used in the way that would benefit patients and families as much as it could. My argument is that this is an issue of usability, or ergonomics—the science of design. I illustrate how to take what we have learned from the science of usability to make hospice more accessible and approachable, and to increase hospice use among those who would benefit from it. Underneath this discussion, though, there is a more fundamental question: Can we make hospice more usable or do …

Gastroesophageal Reflux Disease And Fundoplication In Infants And Children, Shawn D. St Peter, G W. Holcomb Iii

Manuscripts, Articles, Book Chapters and Other Papers

Gastroesophageal reflux disease (GERD) can be one of the most distressing conditions developing at different ages in infants and children. The disease itself is a complex process along with ongoing dynamic anatomic and physiologic changes occurring during normal development. Therefore among referring physicians, considerations regarding the role of surgery for GERD in children varies widely depending on individual experiences in managing these patients. These varied opinions result in discrepancies in the operative experience with fundoplication among pediatric surgeons. It is unclear how much of the current opinions stem from published evidence, particularly with regard to the safety and efficacy of …

Pancreatic Operations In Children, An Institutional Experience And Review Of Literature, Varun Puri, Lisa Martin, Shawn D. St Peter, G W. Holcomb Iii, Daniel J. Ostlie

Manuscripts, Articles, Book Chapters and Other Papers

Pancreatic operations are not commonly performed in the pediatric age group. Tumors, chronic pancreatitis, trauma and hyperinsulinemic hypoglycemia are the main diseases leading to pancreatic resections in children. Excluding patients with acute pancreatitis and pseudocysts, over the last 5 years we have performed operations in 11 children for pancreaticoduodenal pathology. The diagnoses encountered were tumors or tumor like conditions (four), angiodysplasia (one), chronic pancreatitis (one), traumatic pancreatic transection (three), traumatic pseudocyst, and neonatal hyperinsulinemic hypoglycemia (one). Operations performed were: pancreaticoduodenectomy (PD) in three patients, subtotal or distal pancreatectomy in six patients, distal pancreaticojejunostomy with oversewing of the proximal pancreatic duct …

Frequency Of Primary Solid Malignant Neoplasms In Both Sexes, As Seen In Our Practice, Zubair Ahmad, Najamul Sahar Azad, Nausheen Yaqoob, Akhtar Husain, Aamir Ahsan, Ambreen Nasir Khan, Rashida Ahmed, Naila Kayani, Shahid Pervez, Sheema H. Hassan

Department of Pathology and Laboratory Medicine

Background: To determine the frequency of various histologic types of primary solid malignant neoplasms in males and females, in our practice, in a large series of surgical biopdies.

Method: A retrospective study of 20,000 consecutive surgical biopsies in the section of Histopathology, Aga Khan University Hospital (AKU), Karachi, in 2004.

Results: Squamous cell carcinoma of oral cavity was the commonest malignant neoplasm in males followed by diffuse Large B cell, Non-Hodgkin's lymphoma and Prostatic adenocarcinoma. In females, infiltrating Ductal carcinoma of the breast was overwhelmingly the commonest malignant neoplasm followed by Squamous cell carcinoma of the oral cavity and esophagus. …

Comparative Predictive Value Of Three Prognostic Markers--S-Phase Fraction, Pcna And Mitotic Count On Axillary Lymph Node Metastasis In Carcinoma Breast, Shahid Pervez, Muhammad Nadeem Khan, Muhammad Israr Nasir

Department of Pathology and Laboratory Medicine

Background: Axillary lymph node metastasis is the single most important prognostic factor in carcinoma of the breast. Therefore, prognostic markers that may reliably predict probability of lymph node (LN) metastases are of great value. This study was conducted to compare the predictive value of two novel prognostic / proliferative markers i.e. S-phase fraction (SPF) and proliferating cell nuclear antigen (PCNA) in parallel with mitotic index.

Methods: Data of consecutive cases of infiltrating ductal carcinoma (IDC) breast diagnosed from July 2003 to July 2004 at the section of the Histopathology, The Aga Khan University Hospital, Karachi, were reviewed. A total of …

Juvenile Ewing Sarcoma Presenting As A Pelvic Mass, Tahira Naru, Fauzia Haq Nawaz, Javed Rizvi

Department of Obstetrics & Gynaecology

A teen aged girl with rapidly developing pelvic mass, associated with weight loss and left leg weakness, was evaluated and found to have Ewing's sarcoma of non-osseous origin from pelvis, which is a rare situation. She was treated by a multidisciplinary approach by surgery, chemotherapy and rehabilitation by physiotherapy to effective response.

Predictability Of Cardiovascular Disease Event Rates By Common Carotid Artery Intima-Media Thickness In The Atherosclerosis Risk In Communties (Aric) Study, Mara Hollander

Loma Linda University Electronic Theses, Dissertations & Projects

Background: Carotid artery intima media thickness (IMT) is a non-invasive reliable predictor of the extent and severity of CVD. There is difficulty acquiring all measurements for validated three-site carotid IMT. More accessible one-site common carotid artery (CCA) IMT has not yet been validated with CVD events.

Purpose: This study will evaluate the diagnostic accuracy of one-site CCA IMT compared to three-site IMT in predicting cardiovascular disease (CVD) events. Assessment of whether the association of incremental one-site CCA IMT to a CVD event is significant with and without adjustment for traditional cardiac risk factors was made.

Methodology: Data from The Atherosclerosis …

Idiopathic Granulomatous Mastitis Masquerading As Carcinoma Of The Breast: A Case Report And Review Of The Literature., Richard Tuli, Brian J O'Hara, Janet Hines, Anne L Rosenberg

Department of Surgery Faculty Papers

BACKGROUND: Idiopathic granulomatous mastitis is an uncommon, benign entity with a diagnosis of exclusion. The typical clinical presentation of idiopathic granulomatous mastitis often mimics infection or malignancy. As a result, histopathological confirmation of idiopathic granulomatous mastitis combined with exclusion of infection, malignancy and other causes of granulomatous disease is absolutely necessary. CASE PRESENTATION: We present a case of a young woman with idiopathic granulomatous mastitis, initially mistaken for mastitis as well as breast carcinoma, and successfully treated with a course of corticosteroids. CONCLUSION: There is no clear clinical consensus regarding the ideal therapeutic management of idiopathic granulomatous mastitis. Treatment options …

Knowledge And Beliefs Of Adolescents Regarding Sexually Transmitted Infections And Hiv/Aids In A Rural District In Pakistan, Hafsa Raheel, Franklin White, Muhammad Masood Kadir, Zafar Fatmi

Community Health Sciences

Objective:

To assess the knowledge and beliefs of adolescents (15-19 years girls and boys) regarding sexually transmitted infections (STIs) and HIV/AIDS.

Methods:

A community based cross-sectional survey was conducted in October 2002 in a rural district (Mirpurkhas) of Sindh province, Pakistan.

Results:

A total of 428 adolescent girls and boys were interviewed. Only 44% correctly named at least one STI, while 55% knew at least two modes of transmission for HIV/AIDS. Adolescents with education greater than or equal to secondary level, those who were able to read the newspaper, possessed electricity in their homes and were allowed to meet their …

Resource Allocation Within The National Aids Control Program Of Pakistan: A Qualitative Assessment Of Decision Maker's Opinions, Sara Husain, Masood Kadir, Zafar Fatmi

Community Health Sciences

Background:

Limited resources, whether public or private, demand prioritisation among competing needs to maximise productivity. With a substantial increase in the number of reported HIV cases, little work has been done to understand how resources have been distributed and what factors may have influenced allocation within the newly introduced Enhanced National AIDS Control Program of Pakistan. The objective of this study was to identify perceptions of decision makers about the process of resource allocation within Pakistan's Enhanced National AIDS Control Program.

Methods:

A qualitative study was undertaken and in-depth interviews of decision makers at provincial and federal levels responsible to …

Recurrent Burner Syndrome Due To Presumed Cervical Spine Osteoblastoma In A Collision Sport Athlete - A Case Report., Ilan Elias, Michael A Pahl, Adam C Zoga, Maurice L Goins, Alexander R Vaccaro

Department of Orthopaedic Surgery Faculty Papers

We present a case of a 35-year-old active rugby player presenting with a history of recurrent burner syndrome thought secondary to an osteoblastoma involving the posterior arch of the atlas. Radiographically, the lesion had features typical for a large osteoid osteoma or osteoblastoma, including osseous expansion, peripheral sclerosis and bony hypertrophy, internal lucency, and even suggestion of a central nidus. The patient subsequently underwent an en bloc resection of the posterior atlas via a standard posterior approach. The surgery revealed very good clinical results. In this report, we will discuss in detail, the presentation, treatment, and return to play recommendations …

Hemicrania Continua-Like Headache Associated With Carotid Dissection May Respond To Indomethacin, Avi Ashkenazi, Muhammad A. Abbas, Dinesh K. Sharma, Stephen D. Silberstein

Department of Neurology Faculty Papers

Hemicrania continua (HC) is an idiopathic, chronic disorder characterized by a continuous, strictly unilateral headache associated with ipsilateral cranial autonomic symptoms. The symptoms of HC typically respond dramatically to indomethacin therapy. We describe a patient with traumatic internal carotid artery (ICA) dissection, who presented with a clinical picture mimicking HC that initially responded to indomethacin. Patients with a clinical picture similar to HC should be managed with a high index of suspicion for a possible cervical arterial dissection.

Knowledge, Attitude And Practice Regarding Immunization Among Family Practice Patients, Waris Qidwai, Syed Sohail Ali, Semi Ayub, Salma Ayub

Department of Family Medicine

Objective: To determine the knowledge, attitude and practices about immunization among family practice patients.
Design: A questionnaire based survey.
Patients and Method: A questionnaire was developed in line with the study objectives. It was administered to patients visiting family physicians, after they were administered, informed consent and assurance with regards to confidentiality was provided. Epi-info and SPSS software was used for data management.
Results: A total of 97 patients were surveyed. The majority were men (59.8%) with a mean age of 29.69 years. Majority was unmarried (51.5%), with graduate and post-graduate education (73%), and in government and …

Metabolic Syndrome: Frequency And Gender Differences At An Out - Patient Clinic, Firdous Jahan, Riaz Qureshi, Tasneem Borhany, Hasan Bin Hamza

Department of Family Medicine

Objective: To determine the frequency of metabolic syndrome among patients attending an out-patient clinic of a teaching hospital and to compare the clinical features regarding metabolic syndrome among males and females.
Study Design: Cross-sectional study.
Place and Duration: Aga Khan University Hospital (AKUH), Executive and Family Medicine Clinics, from December 2004 to April 2005.
Patients and Methods: All adults, above 25 years, attending the clinics for an executive check-up and giving informed consent were included in the study. Data was collected through a structured questionnaire administered to those eligible to participate. Metabolic syndrome was defined according to ATP-III guidelines. …

Acquired Aplastic Anemia: Treatment In A Developing Country., Shaheena Hanif, Farah Naz, Emaduddin Siddiqui, Jamal Raza

Department of Emergency Medicine

Objective:

The aim of this study was to evaluate the clinical presentation of aplastic anemia as well as to assess the efficacy of Cyclosporin -A in patients with aplastic anemia.

Methodology:

This is a hospital based interventional study. During the three year study period, 44 children were enrolled. Mean age was 9.3 years and there was a male predominance.

Results:

Most common clinical presentation was anemia and bleeding. Four children died before therapy was started. Cyclosporin-A was started in 40 patients. Eleven patients died before completion of therapy and three patients were lost to follow-up. Out of 26 patients who …

A Turner Syndrome Neurocognitive Phenotype Maps To Xp22.3., Andrew R Zinn, David Roeltgen, Gerry Stefanatos, Purita Ramos, Frederick F Elder, Harvey Kushner, Karen Kowal, Judith L Ross

Department of Pediatrics Faculty Papers

BACKGROUND: Turner syndrome (TS) is associated with a neurocognitive phenotype that includes selective nonverbal deficits, e.g., impaired visual-spatial abilities. We previously reported evidence that this phenotype results from haploinsufficiency of one or more genes on distal Xp. This inference was based on genotype/phenotype comparisons of individual girls and women with partial Xp deletions, with the neurocognitive phenotype considered a dichotomous trait. We sought to confirm our findings in a large cohort (n = 47) of adult women with partial deletions of Xp or Xq, enriched for subjects with distal Xp deletions. METHODS: Subjects were recruited from North American genetics and …

Optimization Of Biomathematical Model Predictions For Cognitive Performance Impairment In Individuals: Accounting For Unknown Traits And Uncertain States In Homeostatic And Circadian Processes, Hans P. A. Van Dongen, Christopher G. Mott, Jen-Kuang Huang, Daniel J. Mollicone, Frederic D. Mckenzie, David F. Dinges

Mechanical & Aerospace Engineering Faculty Publications

Current biomathematical models of fatigue and performance do not accurately predict cognitive performance for individuals with a priori unknown degrees of trait vulnerability to sleep loss, do not predict performance reliably when initial conditions are uncertain, and do not yield statistically valid estimates of prediction accuracy, These limitations diminish their usefulness for predicting the performance of individuals in operational environments. To overcome these 3 limitations, a novel modeling approach was developed, based on the expansion of a statistical technique called Bayesian forecasting. The expanded Bayesian forecasting procedure was implemented in the two-process model of sleep regulation, which has been used …

Confidence Intervals For Individualized Performance Models, Hans P. A. Van Dongen, Christopher G. Mott, Jen-Kuang Huang, Daniel J. Millicone, Frederic D. Mckenzie, David F. Dinges

Mechanical & Aerospace Engineering Faculty Publications

Commentary on Reifman J; Rajaraman S; Gribok AV. Moving Towards Individualized Performance Models. Sleep 2007;30(9):1081-82.

Breast-Fed Low Birth Weight Premature Infants: A Description Of Nutritional Intake In The First Six Months Of Life, Ksenia Zukowsky

Selected Works of Ksenia Zukowsky, CRNP, PhD

This is a secondary analysis of a larger project entitled "Breast-feeding Services for LBW Infants-Outcomes and Costs" (L. Brown, RN, Ph.D., Principal Investigator), funded by NINR at NIH, (NR 03881). The larger project was a randomized clinical trial, of women planning to breast-feed their LBW infant. The control group received routine breast-feeding care and an intervention group received a structured program of breast-feeding services provided by an advanced practice nurse.

Healthy premature LBW infants from the control group were selected as subjects for this secondary analysis. One question of this secondary analysis was to describe the nutrition of healthy premature …

Infective Endocarditis In Patients With Congenitally Malformed Hearts: Characterization Of The Syndrome In A Developing Country, Bilal K. Siddiqu, M. Tariq, Atif Jadoon, Ghulam Murtaza, Asim Syed, M. Bilal Abid, Maria Qamaruddin, Mehnaz Atiq, Raymond A. Smego

Section of Internal Medicine

Cardiac surgery for correction or palliation of congenital cardiac disease in infancy and childhood remains a privilege that is rarely accessible to two-thirds of the world’s population. This imbalance has created a unique spectrum of illness in patients with underlying congenital cardiac disease and complicating infective endocarditis in developing countries, including Pakistan. In this study, we characterize endocarditis as seen in such patients presenting in Karachi.

We reviewed retrospectively patients admitted to Aga Khan University with underlying congenitally malformed hearts and endocarditis between 1991 and 2004.

We identified 48 patients with endocarditis according to the modified Duke Criterions, with just …

Mid Aortic Syndrome Correction: Anaesthetic Considerations And Management, Mohammad Irfan Akhtar, Mohammad Hamid, Muneer Amanullah, Mubashar Khan, Shahabuddin, Mansoor Ahmed Khan

Department of Anaesthesia

A twelve years old female patient presented with headache off and on and disparity between upper and lower limb pressures. On the basis of history, physical examination and magnetic resonance angiography, the patient was diagnosed as mid aortic syndrome and planned for elective aorto aortic bypass graft surgery through left thoracotomy. Double lumen endotracheal tube was placed for lung isolation and episodes of hypertension during proximal and distal cross clamp were controlled with sodium nitropruside infusion (SNP). Extra pleural catheter was put in at the end of surgery before chest wall closure for postoperative pain control. Both upper and lower …

Emergency Airway Management Of A Patient With Mediastinal Mass, Anwar Ul Huda, Khalid Maudood Siddiqui, Fazal Hameed Khan

Department of Anaesthesia

Appropriate airway management is an essential part of anaesthesiologist's role. Extrinsic airway compression by rapidly growing mediastinal masses represents a therapeutic challenge to anaesthesiologists. We report a case of successful airway management in a patient with obstructed airway. The patient was a middle aged female who presented with severe respiratory distress secondary to a huge mediastinal mass. CT scan showed widened superior mediastinum with circumferential narrowing of trachea and left main bronchus. Her condition continued to deteriorate during her hospital admission, so emergency intubation and tracheostomy was planned. She was intubated with the help of a bougie using size 6 …

Attenuation Of Hypotension Using Phenylephrine During Induction Of Anaesthesia With Propofol, Muhammad Imran, Fazal Hameed Khan, Mansoor Ahmed Khan

Department of Anaesthesia

Objective: To observe if phenylephrine mixed with propofol can attenuate hypotensive effects of propofol during induction of anaesthesia.
Methods: A total number of 135 adult ASA-I and ASA-II patients were divided into three groups. (Group A, B and C). All patients were induced with propofol 2.5 mg per kg. In Group A (control group) patients received propofol mixed with 2cc of 0.9% normal saline. Group B (study group) patients received propofol mixed with 2cc of a solution containing phenylephrine 25µg/cc (total 50µg); Group C (study group) patients received propofol mixed with 2cc of a solution containing phenylephrine 50µg/cc …

Department Of Pathology, Thomas Jefferson University, Identification Of Conserved Gene Expression Features Between Murine Mammary Carcinoma Models And Human Breast Tumors., Jason I Herschkowitz, Karl Simin, Victor J Weigman, Igor Mikaelian, Jerry Usary, Zhiyuan Hu, Karen E Rasmussen, Laundette P Jones, Shahin Assefnia, Subhashini Chandrasekharan, Michael G Backlund, Yuzhi Yin, Andrey I Khramtsov, Roy Bastein, John Quackenbush, Robert I Glazer, Powel H Brown, Jeffrey E Green, Levy Kopelovich, Priscilla A Furth, Juan P Palazzo, Olufunmilayo I Olopade, Philip S Bernard, Gary A Churchill, Terry Van Dyke, Charles M Perou

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

BACKGROUND: Although numerous mouse models of breast carcinomas have been developed, we do not know the extent to which any faithfully represent clinically significant human phenotypes. To address this need, we characterized mammary tumor gene expression profiles from 13 different murine models using DNA microarrays and compared the resulting data to those from human breast tumors. RESULTS: Unsupervised hierarchical clustering analysis showed that six models (TgWAP-Myc, TgMMTV-Neu, TgMMTV-PyMT, TgWAP-Int3, TgWAP-Tag, and TgC3(1)-Tag) yielded tumors with distinctive and homogeneous expression patterns within each strain. However, in each of four other models (TgWAP-T121, TgMMTV-Wnt1, Brca1Co/Co;TgMMTV-Cre;p53+/- and DMBA-induced), tumors with a variety of …

Homocysteine Levels In Preterm Infants: Is There An Association With Intraventricular Hemorrhage? A Prospective Cohort Study., Wendy J Sturtz, Kathleen H Leef, Amy B Mackley, Shailja Sharma, Teodoro Bottiglieri, David A Paul

Department of Pediatrics Faculty Papers

BACKGROUND: The purpose of this study was to characterize total homocysteine (tHcy) levels at birth in preterm and term infants and identify associations with intraventricular hemorrhage (IVH) and other neonatal outcomes such as mortality, sepsis, necrotizing enterocolitis, bronchopulmonary dysplasia, and thrombocytopenia. METHODS: 123 infants < 32 weeks gestation admitted to our Level III nursery were enrolled. A group of 25 term infants were enrolled for comparison. Two blood spots collected on filter paper with admission blood drawing were analyzed by a high performance liquid chromatography (HPLC) method. Statistical analysis included ANOVA, Spearman's Rank Order Correlation and Mann-Whitney U test. RESULTS: The median tHcy was 2.75 micromol/L with an interquartile range of 1.34 - 4.96 micromol/L. There was no difference between preterm and term tHcy (median 2.76, IQR 1.25 - 4.8 micromol/L vs median 2.54, IQR 1.55 - 7.85 micromol/L, p = 0.07). There was no statistically significant difference in tHcy in 31 preterm infants with IVH compared to infants without IVH (median 1.96, IQR 1.09 - 4.35 micromol/L vs median 2.96, IQR 1.51 - 4.84 micromol/L, p = 0.43). There was also no statistically significant difference in tHcy in 7 infants with periventricular leukomalacia (PVL) compared to infants without PVL (median 1.55, IQR 0.25 - 3.45 micromol/L vs median 2.85, IQR 1.34 - 4.82 micromol/L, p = 0.07). Male infants had lower tHcy compared to female; prenatal steroids were associated with a higher tHcy. CONCLUSION: In our population of preterm infants, there is no association between IVH and tHcy. Male gender, prenatal steroids and preeclampsia were associated with differences in tHcy levels.

Lateral Wall Protein Content Mediates Alterations In Cochlear Outer Hair Cell Mechanics Before And After Hearing Onset, Heather Jensen Smith, Richard Hallworth

Journal Articles: Eppley Institute

Specialized outer hair cells (OHCs) housed within the mammalian cochlea exhibit active, nonlinear, mechanical responses to auditory stimulation termed electromotility. The extraordinary frequency resolution capacity of the cochlea requires an exquisitely equilibrated mechanical system of sensory and supporting cells. OHC electromotile length change, stiffness, and force generation are responsible for a 100-fold increase in hearing sensitivity by augmenting vibrational input to non-motile sensory inner hair cells. Characterization of OHC mechanics is crucial for understanding and ultimately preventing permanent functional deficits due to overstimulation or as a consequence of various cochlear pathologies. The OHCs' major structural assembly is a highly-specialized lateral …

Family Medicine Predoctoral Education: 30-Something, Howard K. Rabinowitz

Department of Family & Community Medicine Faculty Papers

From the introduction:

The specialty of family medicine is now more than 30 years old. Fitting for its stage of life, family medicine predoctoral education has achieved appropriate maturity and parity with other core clinical departments and has assumed its role and responsibility in medical education within the academic health center. Of course, this wasn’t always true.

The Interplay Of Obesity And Asthma, James Plumb, Rickie Brawer, Nancy Brisbon

Department of Family & Community Medicine Faculty Papers

The relationships, interactions, and association between obesity and asthma are complex, and are active sources of hypotheses and research. An association between obesity and asthma has been reported in many studies, although considerable debate about the existence of the association and its meaning still exists. Potential associative relationships may result from genetics, immune system modifications, and mechanical mechanisms. The rising prevalence of asthma and obesity in children and adults, and the significant morbidity from both, makes it imperative that clinicians recognize the importance of weight management in patients with and without asthma.

Anesthesia Clinical Performance Outcomes: Does Teaching Methodology Make A Difference?, Nina E. Mclain

Theses and Dissertations

Researchers have studied memory recall of crisis-oriented or emotional events in non-educational settings. However, within the health care field, there has been a limited study of the the concept of recall of crisis oriented or emotional events in& health care education. Crisis-oriented events such as natural disasters, acts of bioterroism, and industrial accidents, have been reported to impact memory. Patient safety is a primary focus in anesthesia education, appropriate crisis management is imperative to quality anesthesia care. Due to the critical nature of anesthesia delivery, there is a strong, constant need to develop methods that will enhance, support, and improve …