Medical Specialties Commons^™

Giant Multiple Intra-Abdominal Hydatid Cysts, Naila Nadeem, Hassan Khan, Saulat H. Fatimi, Mohammad Nadeemd Ahmad

Section of Cardiothoracic Surgery

No abstract provided.

Hypoxic Preconditioning Of Embryonic Stem Cells: A Novel Transplantation Strategy To Improve Recovery After Stroke, Michelle Hedrick Theus

MUSC Theses and Dissertations

Embryonic stem (ES) cell transplantation therapy offers a novel therapeutic alternative for ameliorating the pathologic consequences of cerebral ischemia. The success of ES cell transplantation therapy relies not only on initial survival in the post-ischemic brain but also on whether or not these cells will reliably differentiate into the appropriate neuronal phenotypes required for cerebral repair. To address both issues, the present study investigates the neural differentiation of retinoic acid treated ES cells and how activating signaling pathways common in response to hypoxia can impact their usefulness as graft material intended to repair, replace and restore function after stroke. These …

Reproductive Health Update Trainings For Health Workers In North Eastern Province, Garissa, Kenya Ministry Of Health, Population Council

Reproductive Health

The Somali community living in Kenya has practiced the severest form of female genital mutilation/cutting (FGM/C), infibulation, for centuries. To understand the context within which the practice takes place, and how its complications are managed, FRONTIERS undertook a diagnostic study in North Eastern Province and in the Eastleigh area of Nairobi. The study found that the health system is ill equipped to serve women who have been cut, and particularly infibulated women who are pregnant and delivering, stemming from an overall weakness in the availability and quality of maternal and neonatal heath services. Specific recommendations could strengthen these services so …

Strategies For Encouraging The Abandonment Of Female Genital Cutting In West Africa: Experiences From Senegal, Burkina Faso, And Mali, Nafissatou J. Diop, Ian Askew

Reproductive Health

This article explores efforts to encourage abandonment of female genital cutting (FGC) in Senegal, Burkina Faso, and Mali. The strategy of encouraging traditional practitioners to stop performing FGC is not effective as community-level support for the practice remains high. Training health staff significantly improved healthcare providers' levels of knowledge about FGC and its complications. Consequently, it was recommended that such training be incorporated into preservice medical training. The use of community-based strategies like the Village Education Program (VEP) showed the most promise, as their multifaceted approach addresses knowledge, attitudes, actions, and communal support in an integrated manner. The way forward …

Guide To A Successful Pregnancy: A Resource Manual For Pregnant And Parenting Young Women In Las Vegas, Nevada Institute For Children's Research And Policy Reports

Nevada Institute for Children's Research and Policy Reports

A Guide to a Successful Pregnancy.

• Are you Pregnant? Taking a pregnancy test
• First steps of Pregnancy: Options of pregnancy, health plans, obtaining medical care such as a doctor
• Months 1, 2, 3: Maintaining a healthy diet, what you should stay away from, exercise, symptoms of danger, and normal symptoms of pregnancy
• Months 4, 5, 6: Following a routine, classes available during pregnancy, normal pregnancy symptoms
• Months 7, 8, 9: Following a routine, normal pregnancy symptoms
• Labor and Delivery: Symptoms of labor, symptoms of danger
• Parenting: Normal symptoms after birth, Routine to follow to return to normal state, Breast feeding …

The Corbett Pain Scale: A Multidimensional Pain Scale For Adult Intensive Care Patients, Gina M. Corbett

Theses and Dissertations

There are no reliable tools that evaluate pain in adult critical care patients who cannot communicate as a result of sedation or illness. This was an observational study in which postoperative cardiothoracic intensive care patients were assessed for pain using both the newly devised Corbett Pain Scale (CPS) and the Numerical Pain Scale (NPS). The CPS was evaluated for content validity, criterion validity, construct validity, test re-test reliability and internal consistency. Thirteen male and seven female patients (n=20) were enrolled and underwent a maximum of five pain assessments each. The mean total scores of the CPS (.740, SD+1.03) and the …

Functional Redistribution Of Hippocampal Cannabinoid Cb1 Receptors In The Rat Pilocarpine Model Of Acquired Epilepsy, Katherine Winslow Falenski

Theses and Dissertations

Cannabinoids, such as the marijuana derivative Δ9-THC, are known to have CBl receptor-mediated anticonvulsant effects in several animal models of seizures and epilepsy, including the rat pilocarpine model of acquired epilepsy. However, the distribution of CBl receptor expression and function in brains of epileptic rats has not been characterized. Therefore, this dissertation was initiated to evaluate the effect of epileptogenesis on the distribution and function of the endogenous CBI receptor system in the rat pilocarpine model, a well-established model of acquired temporal lobe epilepsy. Using immunohistochemistry, we demonstrated that chronically epileptic rats exhibit a unique, long-term, and specific redistribution of …

Pharmacological Studies Of Nicotine And Galantamine Effects On Age Associated Memory Impairment And The Neurotrophic System In Aged Female Rats, Kristen L. French

MUSC Theses and Dissertations

Nicotine and Galantamine were studied for their pharmacological effects on age associated memory impairment (AAMI) and the neurotrophin system in the aged female F344 rat. Nicotine was found to have dose dependent effects on cognition in the 24 month old rat. A low dose of nicotine improved both working and reference memory (WM, RM) performance on the water radial arm maze and also improved the ability of aged rats to handle an increasing WM load. A high dose did not improve WM and caused deficits in RM, and high cotinine levels in these subjects correlated with worse performance. Nicotine treatment …

Small B Cell Non-Hodgkins Lymphoma In Pakistan, Kanwal Aftab, Yasmin Bhurgri, Shahid Pervez

Department of Pathology and Laboratory Medicine

Objective: To study the pattern of small B cell lymphomas in Pakistan.

Methods: This descriptive study was carried out at the Aga Khan University Hospital pathology department including 1721 cases of Non-Hodgkins Lymphoma (NHL) diagnosed during a period of five years (1998-2002) and classified according to REAL/WHO classification. The antibodies used included Leukocyte Common Antigen (LCA), Pan B (CD20, CD79a), Pan T (UCHL-1), Bcl 2, Mib 1(Ki 67) and Cyclin D1 (Dako, Denmark).

Results: Out of the 1721 NHL cases, only 140 (8.1%) could be categorized as small B-cell NHL. The study group comprised small lymphocytic lymphoma/chronic lymphocytic leukemia (58 …

Massive Primary Postpartum Haemorrhage: Setting Up Standards Of Care, Lumaan Sheikh, Nadeem F. Zuberi, Rubab Riaz, Javed H. Rizvi

Department of Obstetrics & Gynaecology

Objective: To review practice of massive primary postpartum haemorrhage management and develop a protocol.
Methods: Cross-sectional study conducted at the Department of Obstetrics and Gynaecology at Aga Khan University Hospital, Karachi between January 1, 2003 and July 31, 2004. Women with primary postpartum haemorrhage and had blood loss >1000ml were included in the study. Medical record files of these women were reviewed for maternal mortality and morbidities which included mode of delivery, possible cause of postpartum haemorrhage, supportive, medical and surgical interventions.
Results: Approximately 3% (140/4881) of women had primary postpartum haemorrhage. 'Near miss' cases with blood loss …

Analyse De L'Evolution De La Pratique De L'Excision Au Burkina Faso: L'Environment Institutionel, Politique Et Programmatique De La Lutte Contre La Pratique De L'Excision, Nafissatou J. Diop, Zakari Congo, Aina Ouedraogo, Alphosine Sawadogo, Lydia Saloucou, Ida Tamini

Reproductive Health

La présente analyse du projet Frontiers du Population Council fait un tour historique des événements majeurs de la lutte contre la pratique de l’excision au Burkina Faso avant d’aborder les conventions internationales auxquelles le pays a adhéré ainsi que les textes nationaux adoptés en ce qui concerne les droits de l’homme, spécifiquement le droit des femmes et des enfants. Elle analyse également l’application de la loi à travers l’évolution des cas de condamnation depuis l’adoption de la loi. Enfin, elle s’intéressera à quelques programmes d’intervention mis en place en identifiant les acquis et les limites. Ce travail fait partie d’une …

Primary Repair Of An Esophageal Rupture Using Pleural Flap, Saulat H. Fatimi, Sadaf Sheikh, Asif Anwar Ali

Section of Cardiothoracic Surgery

Esophageal perforation remains an important thoracic emergency. Aggressive operative therapy remains the mainstay for treatment. A case of esophageal perforation, consequent upon impacted food bolus, is presented. An 80 years old female, with multiple comorbidities, presented with dysphagia and right sided chest pain, who had a distal esophageal tear, secondary to accidental meat ball ingestion. Rigid esophagoscopy showed complete occlusion of the distal esophagus with a meat ball. Right thoracotomy was performed, which showed perforated esophagus with large meat ball protruding from it. Endoscopic removal of the food particles was done, and the rupture was repaired using a pleural flap. …

Aspergilloma In A Patient With No Previous History Of Chronic Lung Disease, Sadaf Sheikh, Saulat H. Fatimi

Section of Cardiothoracic Surgery

Patients with aspergilloma should undergo surgical treatment, because there is a risk of sudden life threatening hemoptysis and because there is no effective alternate medical therapy. We report a case of aspergilloma in a 47 year old man with no past history of tuberculosis presented with the complaint of hemoptysis for two weeks. It was diagnosed radiologically and treated with left upper lobectomy. Post operative course was complicated by cardiorhythmic disorder.

Fulminant Hepatic Failure Bridged To Liver Transplantation With Molecular Adsorbent Recirculating System: A Single Center Experience, Cataldo Doria Md, Lucio Mandala Md, Victor L. Scott Md, Salvatore Gruttadauria Md, Ignazio R. Marino Md

Department of Surgery Faculty Papers

Purpose: We herein describe the clinical course of a consecutive series of fulminant hepatic failure patients treated with molecular adsorbent recirculating system, a cell-free albumin dialysis technique. From November 2000 to September 2002, 7 adult patients age 22-61 (median 41), one male (14.2%), and 6 females (85.7%), affected by fulminant hepatic failure, underwent 7 courses (1 to 5 session each, six hours in duration) of extracorporeal support using the molecular adsorbent recirculating system technique. Pre and post treatment blood glucose, liver function tests, ammonia, arterial lactate, electrolytes, hemodynamic parameters, arterial blood gases, liver histology, Glasgow Coma Scale, and coagulation studies, …

Private Drug Sellers Education In Improving Prescribing Practices, Waris Qidwai, Mukesh Kumar Krishanani, Saman Hashmi, Rubina Abu Ali

Department of Family Medicine

OBJECTIVE: To determine the education of private drug sellers as an intervention tool in promoting rational use of medicines for diarrhoea at private drug outlets in a rural setting.
PLACE AND DURATION OF STUDY: The study was conducted at Mithi, Tharparkar in rural Sindh in August 2005.
PATIENTS AND METHODS: Diarrhea was selected to study drug-prescribing habit of private drug sellers. Evidence-based guidelines for control of diarrhea were developed along with simulation cases and keys. In phase-1, simulators were sent to 6 private drug sellers and their prescription was noted. After phase-1, 3 private drug sellers were educated …

Low Blood Pressure Syndrome: A Myth Or A Reality? Results Of A Patient's Survey At A Teaching Hospital In Karachi, Waris Qidwai, Bheesham Tara Chand

Department of Family Medicine

Objective: To study patient’s knowledge, perceptions attitude and practice with regard to low blood pressure.
Design: A Questionnaire-based survey.
Settings: Family Practice Center, Aga Khan University Hospital, Karachi, Pakistan, in June 2004.
Main outcome measures: Low blood pressure is a disease, causes and treatment of low blood pressure, patient ever suffered from low blood pressure, low blood pressure can be diagnosed with BP apparatus, without apparatus and stress can cause low blood pressure.
Results: A 110 patients were interviewed. Majority of the subjects were educated young married men, well placed socio-economically. A majority (73%) of the …

Psychological Stress Among Family Practice Patients Visiting A Teaching Hospital In Karachi, Waris Qidwai, Malika Kassamali

Department of Family Medicine

Objective: To study psychological stress among family practice patients to highlight its importance.
Design: A cross sectional study. Setting: Family Practice Center of Aga Khan University Hospital, Karachi - Pakistan, in July 2003. Patients and Methods: Family practice patients were interviewed without using any systematic randomization. A questionnaire was developed that included data on demographic profile of the patient and questions on patient perceptions whether they were in stress or not, the degree of stress if perceived to be present and its causes including need to seek medical help. They were simultaneously administered a stress screening questionnaire that …

Castleman's Disease -- A Rare Disease Of Lymph Nodes, Mohammad Zakiullah, Zafaruddin Khan, Riaz Qureshi, Suhail Muzaffar

Department of Family Medicine

Castleman's disease is a rare disorder of unknown etiology and different clinical manifestations, occurring in young adults (usually prior to age 30 years). In this case report we present one such case who was a 16 years old male with abdominal pain, weight loss, cervical lymph adenopathy and hepatosplenomegaly. Lymph node biopsy revealed hyaline-vascular type of Castleman's disease. He was put on chemotherapy but was lost to follow-up.

Effect Of A Paediatric Incentive Spacer And Reinforcement Of Inhalation Technique Training In Preschool Children, Jasminka Murdzoska

Theses : Honours

Incorrect inhaled drug delivery technique is a common problem in paediatric asthma [1-4]. Previously, device technique training has been shown to significantly improve inhaler skills, using subjective methods, namely check-list analysis [5-8]. However, more objective measures are needed to examine more comprehensively the effect of training in preschool children and parents. Resistance to regular asthma therapy is also a frequent problem when attempting to treat young children. Reasoning with young children can be very difficult and parents often have to struggle with their child to achieve compliance [2]. The Funhaler spacer (FH) (Funhaler™; InfaMed, Australia) has been developed in an …

Retrospective Evaluation Of The Rockall Risk Scoring System In Patients With Nonvariceal Upper Gastrointestinal Hemorrhage At A Community Hospital, Mona D. Patel

Master's Theses and Doctoral Dissertations

Despite advances in diagnosis and treatment of patients with upper gastrointestinal hemorrhage (UGIH), the majority of hospitals do not risk-stratify patients with UGIH. One of the major challenges in triaging patients with nonvariceal UGIH is identifying patients’ who are at low risk. We retrospectively identified Rockall scores of 160 patients and the proportion of low-risk patients seen in the Emergency Department at Saint Joseph Mercy Hospital (SJMH) over a one-year period. Additionally, we determined adverse outcomes and healthcare resources utilized and evaluated whether certain antiplatelet agents, anticoagulants, and NSAIDS affected the Rockall scores. The Rockall scoring system identified 21% of …

Spectrum Of Neurological Involvement In Adult Patients With Bacterial Endocarditis, Faisal Wasim Ismail, Muhammad Tariq, Mahboob Alam, Raymond A Smego

Section of Internal Medicine

Objective: To describe the spectrum of neurological involvement, and document in-hospital mortality in adult patients with bacterial endocarditis.
Design: Descriptive, non-interventional.
Place and duration of study: Department of Gastroenterology, The Aga Khan University Hospital, Karachi from November 1999 to October 2002.
Patients and methods: Patients were enrolled from the emergency and outpatient departments, using purposive, non-probability sampling, provided they fulfilled pre-defined inclusion and exclusion criteria. Case records of patients admitted to hospital with a diagnosis of bacterial endocarditis were prospectively analyzed. Data was entered and analyzed on SPSS 11. Frequency, Mean, Mode and Percentage were calculated.
Results: Neurological complications were …

Innate Antiviral Response Targets Hiv-1 Release By The Induction Of Ubiquitin-Like Protein Isg15, Atsushi Okumura, Gengshi Lu, Ian Pitha-Rowe, Paula M. Pitha

Dartmouth Scholarship

The goal of this study was to elucidate the molecular mechanism by which type I IFN inhibits assembly and release of HIV-1 virions. Our study revealed that the IFN-induced ubiquitin-like protein ISG15 mimics the IFN effect and inhibits release of HIV-1 virions without having any effect on the synthesis of HIV-1 proteins in the cells. ISG15 expression specifically inhibited ubiquitination of Gag and Tsg101 and disrupted the interaction of the Gag L domain with Tsg101, but conjugation of ISG15 to Gag or Tsg101 was not detected. The inhibition of Gag-Tsg101 interaction was also detected in HIV-1 infected, IFN-treated cells. Elimination …

The Use Of The Tripartite Model Of Attitudes To Explain Ems Providers' Attitudes About The Ems Agenda For The Future, Carolyn Angela Rinaca

Health Services Research Dissertations

A dynamic and revolutionary health care system compels the Nation to develop a more cohesive, unified healthcare workforce. The Emergency Medical Services (EMS) profession has contributed to this development with the publication of the EMS Agenda for the Future. The EMS Agenda for the Future describes the future direction for emergency medical services agencies and organizations within the nation. It is a vision that integrates EMS systems with other health care professions. The EMS Agenda for the Future is designed to assist EMS professionals in realizing their full potential for proficiency and contributes to the development of the EMS profession. …

The Use Of Proteomic Technologies To Identify Serum Glycoproteins For The Early Detection Of Liver And Prostate Cancers, Elizabeth Ellen Schwegler

Theses and Dissertations in Biomedical Sciences

The application of proteomic technologies to identify serum glycoproteins is an emerging technique to identify new biomarkers indicative of disease severity. Many of these newly evolving protein-profiling methodologies have evolved from previous global protein expression profiling studies such as those involving SELDI-TOF-MS technologies. Though the SELDI approach could distinguish disease from normal by utilizing protein patterns as shown herein with the HCC study of chapter II, it was unable to offer sequence information on the selected peaks, and did not have the ability to analyze the entire dynamic range of the serum/plasma proteome. To address these deficiencies, new strategies that …

Understanding The Nature Of Surgical Excellence Using A Competency Modeling Approach, Hope S. Hanner-Bailey

Psychology Theses & Dissertations

Currently, a thorough description of the knowledge, skills, abilities, and other personal characteristics (KSAOs) that distinguish an exceptional surgeon does not exist. This knowledge is pertinent to the development of selection, training, and performance assessment methods that can be used to develop high performing surgeons. Expert surgeons from around the country were recruited to participate in an interview to discuss the KSAOs (i.e., the competencies) needed to be exceptional in the field. A smaller number of novice surgeons were also interviewed. The expert interview data were distilled into a competency model that consists of ten competencies and patterns within the …

Engendering Student Empathy For Disabled Clients With Urinary Incontinence Through Experiential Learning, Karen A. Karlowicz, Kay L. Palmer

Ellmer School of Nursing Faculty Publications

As part of a rehabilitation clinical course for senior baccalaureate nursing students, a disability-incontinence experiential learning activity is required. The assignment is intended to familiarize students with some of the challenges encountered by a client with mobility problems, including continence management issues using disposable undergarments. Wearing the undergarments dry and wet while being confined to a wheelchair provides insight and promotes empathy for patients with bladder control problems.

Unplanned Prolonged Postanaesthesia Care Unit Length Of Stay And Factors Affecting It, Khalid Samad, Mueenullah Khan, Hameedullah, Fauzia A. Khan, Mohammad Hamid, Fazal Hameed Khan

Department of Anaesthesia

Objective: To identify the factors that prolong the length of stay in the post anaesthesia care unit (PACU).
Methods: This audit was conducted in the PACU of a university hospital. A special form was designed and filled for those patients who stayed unplanned in the PACU for more than two hours. All patients who were admitted to the PACU after surgery were included. Patients undergoing cardiothoracic surgery, those directly shifted to ICU and cases done under local anaesthesia were excluded. Data was collected for 20 months by a designated recovery nurse for all included patients including those admitted …

The Role Of Prophylactic Intra-Aortic Balloon Pump Counterpulsation (Iabp) In Emergency Non-Cardiac Surgery, Khalid Samad, Fauzia Anis Khan

Department of Anaesthesia

Patients with recent myocardial infarction (MI), congestive heart failure, severe angina, or uncorrected multivessel coronary artery disease are at increased risk of cardiac complications after urgent major non-cardiac surgery. Although invasive haemodynamic monitoring and preoperative optimization of cardiac status may lead to some reduction in the rate of perioperative cardiac events, the mortality from such events still remains high. The use of an intra-aortic balloon pump (IABP) may play a role in such patients by improving the function of the injured heart. We report our experience with the use of perioperative IABP in a patient with unstable angina and recent …

Classification And Risk Stratification Of Invasive Breast Carcinomas Using A Real-Time Quantitative Rt-Pcr Assay., Laurent Perreard, Cheng Fan, John F Quackenbush, Michael Mullins, Nicholas P Gauthier, Edward Nelson, Mary Mone, Heidi Hansen, Saundra S Buys, Karen Rasmussen, Alejandra Ruiz Orrico, Donna Dreher, Rhonda Walters, Joel Parker, Zhiyuan Hu, Xiaping He, Juan P Palazzo, Olufunmilayo I Olopade, Aniko Szabo, Charles M Perou, Philip S Bernard

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

INTRODUCTION: Predicting the clinical course of breast cancer is often difficult because it is a diverse disease comprised of many biological subtypes. Gene expression profiling by microarray analysis has identified breast cancer signatures that are important for prognosis and treatment. In the current article, we use microarray analysis and a real-time quantitative reverse-transcription (qRT)-PCR assay to risk-stratify breast cancers based on biological 'intrinsic' subtypes and proliferation. METHODS: Gene sets were selected from microarray data to assess proliferation and to classify breast cancers into four different molecular subtypes, designated Luminal, Normal-like, HER2+/ER-, and Basal-like. One-hundred and twenty-three breast samples (117 invasive …

Paired-Pulse Depression At Photoreceptor Synapses., Katalin Rabl, Lucia Cadetti, Wallace B. Thoreson

Journal Articles: Ophthalmology

Synaptic depression produced by repetitive stimulation is likely to be particularly important in shaping responses of second-order retinal neurons at the tonically active photoreceptor synapse. We analyzed the time course and mechanisms of synaptic depression at rod and cone synapses using paired-pulse protocols involving two complementary measurements of exocytosis: (1) paired whole-cell recordings of the postsynaptic current (PSC) in second-order retinal neurons and (2) capacitance measurements of vesicular membrane fusion in rods and cones. PSCs in ON bipolar, OFF bipolar, and horizontal cells evoked by stimulation of either rods or cones recovered from paired-pulse depression (PPD) at rates similar to …