Medical Specialties Commons^™

Life Style Related Risk Factors For Cardiovascular Disease Among Patients At A Teaching Hospital In Karachi, Waris Qidwai, Ar Mangi, R Bux

Department of Family Medicine

BACKGROUND: Cardiovascular disease is a leading cause for morbidity and mortality all over the world. It is important to study life style related, modifiable cardiovascular risk factors among patients, in order to devise preventive strategies.
METHODS: We surveyed family practice patients visiting the out-patient clinics of Aga Khan University Hospital, Karachi. The interview was questionnaire-based and recorded the demographic profile of the patients, in addition to information on life style related cardiovascular risk factors. The ethical requirements for the study were met. SPSS computer software was used for data management. RESULTS: Fifty patients were surveyed and included …

Characteristics Of Smokers And Their Knowledge About Smoking At A Teaching Hospital In Karachi, Waris Qidwai, N Zahid

Department of Family Medicine

Objective: To study the characteristics of smokers and their knowledge about smoking, among Family Practice Patients, at a teaching hospital in Karachi, Pakistan. Main outcome measures: Age at starting smoking, duration and number of cigarettes smoked, started smoking under influence of friends, colleagues, family members or self motivation, number of friends and colleagues who smoked, whether smoking is unhealthy, and actual chance of harm to an individual due to smoking is very rare or not.
Results: One hundred patients who visited Family Practice Center were interviewed. Sixty one percent were young married men, well educated and either student, …

Primaquine-Induced Hemolytic Anemia: Hemotoxicity Of 5-Hydroxyprimaquine (5-Hpq), Zachary Scott Bowman

MUSC Theses and Dissertations

Primaquine is an important antimalarial agent because of its activity against exoerythrocytic forms of Plasmodium sp. Methemoglobinemia and hemolytic anemia, however, are dose-limiting side effects of primaquine therapy. These hemotoxic effects are believed to be mediated by metabolites, though the identity of the toxic specie(s) and the mechanism underlying hemotoxicity have remained unclear. Previous studies showed that an N-hydroxylated metabolite of primaquine, 6-methoxy-8- hydroxylaminoquinoline, was capable of mediating primaquine-induced hemotoxicity. The present studies were undertaken to investigate the hemolytic mechanism of 5-hydroxyprimaquine (5-HPQ), a phenolic metabolite that has been detected in experimental animals. 5-HPQ was synthesized, isolated by flash chromatography …

Identifying Inaccuracies On Emergency Medicine Residency Applications., Eric D Katz, Lee Shockley, Lawrence Kass, David Howes, Janis P Tupesis, Christopher Weaver, Osman R Sayan, Victoria Hogan, Jason Begue, Diamond Vrocher, Jackie Frazer, Timothy Evans, Gene Hern, Ralph Riviello, Antonio Rivera, Keith Kinoshita, Edward Ferguson

Department of Emergency Medicine Faculty Papers

BACKGROUND: Previous trials have showed a 10-30% rate of inaccuracies on applications to individual residency programs. No studies have attempted to corroborate this on a national level. Attempts by residency programs to diminish the frequency of inaccuracies on applications have not been reported. We seek to clarify the national incidence of inaccuracies on applications to emergency medicine residency programs. METHODS: This is a multi-center, single-blinded, randomized, cohort study of all applicants from LCME accredited schools to involved EM residency programs. Applications were randomly selected to investigate claims of AOA election, advanced degrees and publications. Errors were reported to applicants' deans …

Palm Is Expressed In Both Developing And Adult Mouse Lens And Retina., Meryl Castellini, Louise V Wolf, Bharesh K Chauhan, Deni S Galileo, Manfred W Kilimann, Ales Cvekl, Melinda K Duncan

Department of Pathology, Anatomy, and Cell Biology Faculty Papers

BACKGROUND: Paralemmin (Palm) is a prenyl-palmitoyl anchored membrane protein that can drive membrane and process formation in neurons. Earlier studies have shown brain preferred Palm expression, although this protein is a major water insoluble protein in chicken lens fiber cells and the Palm gene may be regulated by Pax6. METHODS: The expression profile of Palm protein in the embryonic, newborn and adult mouse eye as well as dissociated retinal neurons was determined by confocal immunofluorescence. The relative mRNA levels of Palm, Palmdelphin (PalmD) and paralemmin2 (Palm2) in the lens and retina were determined by real time rt-PCR. RESULTS: In the …

Kutibu Majeraha, Kutia Matumaini: Ushirikiano Wa Watanzania Dhidi Ya Fistula Obstetrikia, Thoraya Ahmed Obaid, Erica Chong

Poverty, Gender, and Youth

This edition of Quality/Calidad/Qualité describes a partnership formed to combat obstetric fistula in Tanzania. The Bugando Medical Center, the Women’s Dignity Project, the Tanzania Midwives Association, and the government cooperated on an extensive program for surgical repair, prevention, and policy research and activities. Lessons learned: 1) Fistula programs need to address social as well as medical issues. 2) Most repairs are successful, making an enormous difference in women’s lives. 3) Relatively little funding is necessary to start up a fistula program. 4) Fistula programs are vehicles for broader conversations about gender and poverty.

Sclerotherapy Plus Octreotide Versus Sclerotherapy Alone In The Management Of Gastro-Oesophageal Variceal Hemorrhage, Hasnain A. Shah, Khalid Mumtaz, Wasim Jafri, Shahab Abid, Saeed Hamid, Ashfaq Ahmad, Zaigham Abbas

Section of Gastroenterology

Background: There are different ways for controlling oesophageal variceal bleed which include pharmacological and endoscopic methods. In this study we compare efficacy of octreotide (50 g/hr for 48 hours) combined with sclerotherapy versus sclerotherapy alone in patients with acute bleeding from gastro-oesophageal varices (GOV).Methods: It was a randomized clinical controlled trial conducted at Aga Khan University Hospital, Karachi, from January 1997 to December 1998. We evaluated the role of octreotide (50 g/hr for 48 hours) combined with sclerotherapy versus sclerotherapy alone in a total of 105 adult cirrhotic patients who had acute bleeding from GOV. Patients were assigned to receive …

Manuscripts Categorization And Their Accreditation, Jamshed Akhtar, Saba Sohail

Department of Radiology

No abstract provided.

Characterization Of The Zona Incerta, Heather Joyce Green

Theses and Dissertations

Parkinson's Disease affects more than 1 million people in the United States with 60,000 new cases being diagnosed each year. Currently, there is no cure for Parkinson's Disease, but there are several treatment options available. Currently the most popular surgical option is Deep Brain Stimulation. Microelectrode recording helps identify nuclei as the microelectrode passes through them. While the firing frequencies of the target nuclei are well defined, other nuclei are not. This study will attempt to characterize the Zona Incerta, which is the structure directly above the Subthalamic Nucleus, a target nucleus. Characterization of the firing frequency of the Zona …

Predicting Postoperative Cardio-Pulmonary Complications By A Test Of Stair Climbing, Nawal Salahuddin, Saulat H. Fatimi, Shehzad Huda, Mohammad Islam, Azam Shafquat

Section of Cardiothoracic Surgery

OBJECTIVE: To assess whether a test of stair climbing ability could be used to predict the risk of developing postoperative cardiopulmonary complications in patients undergoing general anesthesia.
DESIGN: Cohort study.
PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi. The duration of the study was from December 2003 to December 2004. PATIENTS AND METHODS: This study was carried out on consecutive, adult patients presenting for elective thoracic or abdominal surgery under general anesthesia. Pre-operatively, patients were asked to climb a standard staircase. Number of steps climbed was recorded. Those unable to climb stairs due to debilitating …

Conversion From Laparoscopic To Open Cholecystectomy: Multivariate Analysis Of Preoperative Risk Factors, M Tayeb, S A. Raza, M R. Khan, R Azami

Department of Surgery Docs

Background: Laparoscopic cholecystectomy has become the gold standard in the treatment of symptomatic cholelithiasis. Some patients require conversion to open surgery and several preoperative variables have been identified as risk factors that are helpful in predicting the probability of conversion. However, there is a need to devise a risk-scoring system based on the identified risk factors to (a) predict the risk of conversion preoperatively for selected patients, (b) prepare the patient psychologically, (c) arrange operating schedules accordingly, and (d) minimize the procedure-related cost and help overcome financial constraints, which is a significant problem in developing countries.AIM: This study was aimed …

Referred Cutaneous Allodynia In A Migraine Patient Without Simultaneous Headache, Avi Ashkenazi, Carla Lopinto, William B. Young

Department of Neurology Faculty Papers

Cutaneous allodynia is defined as the perception of pain when a non-noxious stimulus is applied to normal skin. This phenomenon has been demonstrated in migraine patients during an acute attack. It is thought to result from central sensitization of neurons in the trigemino-vascular system and may spread to areas beyond that of the referred head pain.

In a recent study, migraine patients demonstrated increased temporal summation to painful mechanical stimuli in their referred head pain area between attacks. This suggests that changes in physiologic properties of nociceptive neurons may occur in migraine patients between attacks.

We describe a migraine patient …

Healing During Physician-Patient Consultation, Waris Qidwai, Ss Ali, S Ayub, S Ayub

Department of Family Medicine

OBJECTIVE: To determine the patient perceptions regarding healing during a physician-patient consultation.
DESIGN: A questionnaire-based survey.
PLACE AND DURATION OF STUDY: Family Practice Center of the Aga Khan University Hospital, Karachi, Pakistan, in June 2004.
PATIENTS AND METHODS: A questionnaire was designed that included the demographic profile of patients comprising age, gender, education and occupation as well as questions in line with the study objective. It was administered to 111 patients, visiting outpatient department of the hospital. Participants were explained the study objective, a written consent was taken and full confidentiality was assured.
RESULTS: The mean age of …

Patient Expectations From An Emergency Medical Service, Waris Qidwai, Ss Ali, M Baqi, S Ayub

Department of Family Medicine

BACKGROUND: Patient expectation survey at the Emergency Medical Services can improve patient satisfaction. A need was established to conduct such a survey in order to recommend its use as a quality improvement tool.
METHODS: The study was conducted on patients visiting the Emergency Medical Services, Aga Khan University, Karachi. A questionnaire was used to collect information on the demographic profile, and expectations of patients. The ethical requirements for conducting the study were met.
RESULTS: A hundred patients were surveyed. The majority was relatively young, married men and women, well educated and better socio-economically placed. The majority of the …

Childhood And Adolescent Obesity: Nationwide Pediatric Healthcare Provider Practices And Their Role In Treatment And Prevention Of The Obesity Epidemic, Alison Farley

MPA/MPP/MPFM Capstone Projects

The purpose of this research is to explore screening and treatment patterns as well as the underlying provider confidence in their decision-making related to the overweight and obese child and adolescent patient. The screening and treatment of obesity in the child and adolescent population are affected by complex social implications and physical side effects. Without a clear consensus on screening, diagnosis and alternative treatment plans, healthcare providers will not maximize the opportunity to provide primary and secondary prevention to the growing epidemic.

Statistical analysis of secondary survey data was conducted to explore screening and treatment patterns as well as the …

A Systematic Review Of Existing National Priorities For Child Health Research In Sub-Saharan Africa, George Swingler, James Irlam, William Macharia, Felix Tietche, Martin Meremikwu

Paediatrics and Child Health, East Africa

Background: We systematically reviewed existing national child health research priorities in Sub-Saharan Africa, and the processes used to determine them.

Methods: Collaborators from a purposive sample of 20 WHO-AFRO Region countries, assisted by key informants from a range of governmental, non-governmental, research and funding organisations and universities, identified and located potentially eligible prioritisation documents. Included documents were those published between 1990 and 2002 from national or nationally accredited institutions describing national health research priorities for child health, alone or as part of a broader report in which children were a clearly identifiable group. Laboratory, clinical, public health and policy research …

Management Outcome Of Residual Common Bile Duct Stones At Aga Khan University Hospital, Muhammad Rizwan Khan, Sameera Naureen, Dildar Hussain, Rizwan Azami

Department of Surgery Docs

Background: The frequency of residual common bile duct (CBD) stones in patients with previous cholecystectomy ranges from 2-10%, and a minimally invasive approach is generally recommended for these patients. This study reviews the experience in the management of residual CBD stones at the Aga Khan University Hospital.Methods: All adult patients diagnosed to have residual CBD stones, from 1993 to 2001, were identified and analyzed in terms of the treatment modality utilized and its associated complications. The role of endoscopic sphincterotomy was particularly analyzed in our set-up.Results: The study population consisted of 66 patients. The mean age was 52 (range:18-84 years) …

The Evaluation Of Rectal Bleeding In Adults, Elizabeth Allen, Christina Nicolaidis, Mark Helfand

School of Social Work Faculty Publications and Presentations

Colon cancer is the third leading cause of cancer-related death in this country.5 The majority of medical societies recommend some form of colon cancer screening for asymptomatic adult patients over age 50. The evaluation of rectal bleeding is different from screening because the risk of serious disease is higher and it is unclear whether early diagnosis and treatment of serious disease results in improved mortality once gross bleeding has occurred. The optimal evaluation strategy for rectal bleeding is unknown. Neither historical information nor the presence or absence of hemorrhoids has been shown to reliably differentiate benign from serious disease.6–11 Fecal …

Global Gene Expression Profiling Of Cells Overexpressing Smc3., Giancarlo Ghiselli, Chang-Gong Liu

Department of Microbiology and Immunology Faculty Papers

BACKGROUND: The Structural Maintenance of Chromosome 3 protein (SMC3) plays an essential role during the sister chromatid separation, is involved in DNA repair and recombination and participates in microtubule-mediated intracellular transport. SMC3 is frequently elevated in human colon carcinoma and overexpression of the protein transforms murine NIH3T3 fibroblasts. In order to gain insight into the mechanism of SMC3-mediated tumorigenesis a gene expression profiling was performed on human 293 cells line stably overexpressing SMC3. RESULTS: Biotinylated complementary RNA (cRNA) was used for hybridization of a cDNAmicroarray chip harboring 18,861 65-mer oligos derived from the published dEST sequences. After filtering, the hybridization …

Replication And Encapsidation Of Papillomaviruses In Saccharomyces Cerevisiae, Peter C. Angeletti

Nebraska Center for Virology: Faculty Publications

Improvements in methodologies to recapitulate and study particular biological functions of the

papillomavirus life cycle have led to great advances in our knowledge of these viruses. Described in

this chapter are techniques that allow low-copy and high-copy replication of full-length human

papillomavirus (HPV) genomes, as well as assembly of virus-like particles, in Saccharomyces

cerevisiae (yeast). This system has several distinct advantages that make it an attractive complement

to the well-established raft-culturing system. First, yeast are inexpensive, rapid, and simple to culture

in the lab. Second, they provide an ever-widening array of genetic tools to analyze HPV functions

—most recently notable, …

Antigenicity And Immunogenicity Of A Synthetic Human Immunodeficiency Virus Type 1 Group M Consensus Envelope Glycoprotein, Feng Gao, Eric A. Weaver, Zhongjing Lu, Yingying Li, Hua-Xin Liao, Benjiang Ma, S. Munir Alam, Richard M. Scearce, Laura L. Sutherland, Jae-Sung Yu, Julie M. Decker, George M. Shaw, David C. Montefiori, Bette T. Korber, Beatrice H. Hahn, Barton F. Haynes

Nebraska Center for Virology: Faculty Publications

Genetic variation of human immunodeficiency virus (HIV-1) represents a major obstacle for AIDS vaccine development. To decrease the genetic distances between candidate immunogens and field virus strains, we have designed and synthesized an artificial group M consensus env gene (CON6 gene) to be equidistant from contemporary HIV-1 subtypes and recombinants. This novel envelope gene expresses a glycoprotein that binds soluble CD4, utilizes CCR5 but not CXCR4 as a coreceptor, and mediates HIV-1 entry. Key linear, conformational, and glycan-dependent monoclonal antibody epitopes are preserved in CON6, and the glycoprotein is recognized equally well by sera from individuals infected with different HIV-1 …

Antigenicity And Immunogenicity Of A Synthetic Human Immunodeficiency Virus Type 1 Group M Consensus Envelope Glycoprotein, Feng Gao, Eric A. Weaver, Zhongjing Lu, Yingying Li, Hua-Xin Liao, Benjiang Ma, S. Munir Alam, Richard M. Scearce, Laura L. Sutherland, Jae-Sung Yu, Julie M. Decker, George M. Shaw, David C. Montefiori, Bette T. Korber, Beatrice H. Hahn, Barton F. Haynes

Nebraska Center for Virology: Faculty Publications

Genetic variation of human immunodeficiency virus (HIV-1) represents a major obstacle for AIDS vaccine development. To decrease the genetic distances between candidate immunogens and field virus strains, we have designed and synthesized an artificial group M consensus env gene (CON6 gene) to be equidistant from contemporary HIV-1 subtypes and recombinants. This novel envelope gene expresses a glycoprotein that binds soluble CD4, utilizes CCR5 but not CXCR4 as a coreceptor, and mediates HIV-1 entry. Key linear, conformational, and glycan-dependent monoclonal antibody epitopes are preserved in CON6, and the glycoprotein is recognized equally well by sera from individuals infected with different HIV-1 …

Potential Roles Of Follicular Dendritic Cell–Associated Osteopontin In Lymphoid Follicle Pathology And Repair And In B Cell Regulation In Hiv-1 And Siv Infection, Qingsheng Li, Jeffrey D. Lifson, Lijie Duan, Timothy Schacker, Cavan Reilly, John V. Carlis, Jacob D. Estes, Ashley T. Haase

Qingsheng Li Publications

Osteopontin is a multifunctional protein with known roles in bone remodeling, wound healing, and normal and pathological immune responses. We showed in microarray studies that osteopontin gene expression is increased in human immunodeficiency virus type 1 (HIV-1)–infected lymphatic tissues after treatment, and we undertook mapping experiments to study osteopontin’s possible functions in this context. We discovered species-specific colocalization of osteopontin with the follicular dendritic cell (FDC) network in lymphatic tissues in HIV-1 and simian immunodeficiency virus infections, and we found that changes in FDC-associated osteopontin covary with changes in lymphoid follicles during acute and late stages of infection and in …

The Pervasive Triad Of Food Security, Gender Inequity And Women's Health: Exploratory Research From Sub-Saharan Africa, A.A. Hyder, S. Maman, J.E. Nyoni, S.A. Khasiani, N. Teoh, Zul Premji, S. Sohani

Pathology, East Africa

Objectives: This study was designed to explore the interactions between food securing activities, health and gender equity from the perspective of rural east African women. The specific objectives were to document the critical interaction among these three issues - food security, gender inequity, women's health within the context of sub-Saharan Africa; to describe the nature of this triad from the perspective of women farmers in Africa; and to propose a framework for linking available interventions to the vicious nature of this triad.

Setting: In-depth interviews and focus group discussions were conducted with rural women farmers in Kwale District, Kenya and …

African American Breast Cancer Health Disparities, Theresa Lynn Gaul

Honors Program Theses

Health disparities are "the differences in the incidence, prevalence, mortality, and burden of cancer and related adverse health conditions that exist among specific population groups in the United States" (National Cancer Institute [NCI], 2002). Racial and ethnic minorities experience serious disparities in health access and outcomes. Disparities in the burden of death and illness experienced by African Americans in particular, as compared with our nation's population as a whole, are particularly striking. There are a variety of factors contributing to these inequalities. The purpose of this report is to examine these factors and the consequential effects on the African American's …

Treatment Of Erectile Dysfunction: A Review Of Literature And National Survey Of Urologists, Mark E. Thomsen

Honors Program Theses

Toe treatment of erectile dysfunction has improved dramatically over the past decade, including the revolutionary introduction of PDE-5 inhibitors (i.e. sildenafil citrate or Viagra). As improved treatments have been presented to the public, an increasing number of men are seeking treatment for ED. This national survey of urologists is intended to address specific questions regarding how urologists make decisions in treating erectile dysfunction. ln addition to conventional areas of interest, such as the impact of side effects and determining the motivation for ED patients to seek treatment, this survey addresses how the treatment of ED relates to the specific condition …

Interleukin-17/Interleukin-17 Receptor-Mediated Signaling Is Important For Generation Of An Optimal Polymorphonuclear Response Against Toxoplasma Gondii Infection, Michelle N. Kelly, Jay K. Kolls, Kyle Happel, Joseph D. Schwartzman

Dartmouth Scholarship

We investigated the role of interleukin-17 (IL-17)/IL-17 receptor (IL-17R)-mediated signaling in the protective immunity against Toxoplasma gondii. IL-17R−/− mice developed a normal adaptive immunity against the parasite. However, increased mortality in the knockout animals can be attributed to a defect in the migration of polymorphonuclear leukocytes to infected sites during early infection.

Men, Muscles, And Body Image: Comparisons Of Competitive Bodybuilders, Weight Trainers, And Athletically Active Controls, T. C. Pickett, R. J. Lewis, T. F. Cash, H. G. Pope

Psychology Faculty Publications

Objectives: To investigate body image and psychosocial adjustment among competitive bodybuilders, non-competitive weight trainers, and athletically active men.

Methods: Participants were 40 men in each of the three groups who were assessed on body composition and multiple facets of body image evaluation, investment and anxiety, eating attitudes, and social self esteem.

Results: Relative to the other two groups, competitive bodybuilders had greater body mass due to fat-free body mass. Although groups did not differ in their situational body image discomfort, competitive bodybuilders and weight trainers had a more positive global appearance evaluation and were more psychologically invested in their physical …

Genetic Networks Controlling Retinal Injury, Felix R Vazquez-Chona, Amna N Khan, Chun K Chan, Anthony N Moore, Pramod K Dash, M Rosario Hernandez, Lu Lu, Elissa J Chesler, Kenneth F Manly, Robert W Williams, Eldon E Geisert

Faculty, Staff and Student Publications

PURPOSE: The present study defines genomic loci underlying coordinate changes in gene expression following retinal injury.

METHODS: A group of acute phase genes expressed in diverse nervous system tissues was defined by combining microarray results from injury studies from rat retina, brain, and spinal cord. Genomic loci regulating the brain expression of acute phase genes were identified using a panel of BXD recombinant inbred (RI) mouse strains. Candidate upstream regulators within a locus were defined using single nucleotide polymorphism databases and promoter motif databases.

RESULTS: The acute phase response of rat retina, brain, and spinal cord was dominated by transcription …

Medical Symptoms Associated With Tobacco Smoking With And Without Marijuana Abuse Among Crack Cocaine-Dependent Patients., Ashwin A. Patkar, Vikas Batra, Paolo Mannelli, Sarah Evers-Casey, Michael J. Vergare, Frank T. Leone

Department of Psychiatry and Human Behavior Faculty Papers

Despite the widespread use of tobacco and marijuana by cocaine abusers, it remains unclear whether combined tobacco and marijuana smoking is more harmful than tobacco smoking alone in cocaine abusers. We investigated the differences in medical symptoms reported among 34 crack cocaine abusers who did not smoke tobacco or marijuana (C), 86 crack cocaine abusers who also smoked tobacco (C + T), and 48 crack abusers who smoked both tobacco and marijuana (C + T + M). Medical symptoms were recorded using a 134-item self-report instrument (MILCOM), and drug use was assessed using the Addiction Severity Index (ASI). After controlling …