Internal Medicine Commons^™

Biomechanical Comparison Of Hybrid Versus Non Locking Screw Fixation For Midshaft Clavicle Fractures, Joseph T. Cox, J Christopher Gayton, Matthew P. Noyes, Gregory C. Gould, Ronald J. Markert, Michael J. Prayson

Internal Medicine Faculty Publications

Objectives: Recent studies report nonunion rates of up to fifteen percent for nonoperative treatment of displaced, comminuted, or shortened midshaft clavicle fractures. Additionally, authors suggest operative treatment of these comminuted displaced midshaft clavicle fractures leads to a more satisfactory clinical outcome. Biomechanically, clavicle fracture plate fixation has been analyzed for locking versus non-locking screw use, but little evidence on hybrid screw use exists. We hypothesized that fixation of a comminuted midshaft clavicle fracture model with a pre-contoured hybrid screw-plate construct would increase stiffness and load-to-failure compared to a non-locking screw construct. Methods: Fourteen matched pairs of fresh frozen cadaveric clavicles …

Incidence And Risk Factors For Acute Myocardial Injury After Non-Cardiac Surgery At The Aga Khan University Hospital Nairobi, Salim Said Ahmed

Master of Medicine in Internal Medicine

Aim: To determine the incidence and risk factors for acute myocardial injury after non-cardiac surgery at Aga Khan University Hospital Nairobi. Design: Prospective cohort study Background: Myocardial injury is the most common major cardiovascular complication in patients undergoing non-cardiac surgery. Large numbers of intermediate-risk and high-risk cardiac patients will be undergoing surgery as the population grows older, and thus myocardial injury after non-cardiac surgery could be a rising problem. Patients and Setting: Adult participants undergoing intermediate and high risk non-cardiac surgery at the Aga Khan University Hospital Nairobi were evaluated for incidence and risk factors for myocardial injury after non-cardiac …

Comparison Of Cardiometabolic Risk Profile Between Hiv Patients On Art And Those Who Are Art Naïve, Erick Kimani Njenga

Master of Medicine in Internal Medicine

Background: Metabolic syndrome comprises of a set of aggregated risk factors that include: hypertension, central obesity, impaired fasting glucose, hypertriglyceridemia and low HDL-C (1)The is a noted increase in the prevalence of the metabolic syndrome cardiovascular risk factors in the HIV population. Methods: The study is a cross-sectional survey that enrolled 157 HIV positive patients over a 4 month period that were either newly diagnosed (HIV ART naïve) or were on ART from both the inpatient and outpatient setting. Data of their anthropometric, cardiovascular risk factors and clinical characteristics were collected with the aid of a standardized questionnaire and serum …

Prevalence And Clinical Characteristics Of Venous Thromboembolism At The Aga Khan University Hospital, Nairobi, Felix Mutuma Riunga

Master of Medicine in Internal Medicine

Aim: To determine the prevalence of venous thromboembolism in patients presenting to the Aga Khan University Hospital, Radiology Department for lower limb compression ultrasonography with doppler and CT pulmonary angiography. In those found to have venous thromboembolism, the distribution of risk factors as described by Wells, the pattern of clinical presentation, the pattern of initial therapy, the length of hospital stay, major bleeding episodes and in hospital mortality were described. Design: Prospective survey Background: Venous Thromboembolism is a major cause of morbidity and mortality worldwide and its occurrence locally, as well as its clinical characteristics needs to be described in …

High-Intensity Tasks With External Load In Military Applications: A Review, Eric K. O'Neal, Jared H. Hornsby, Kyle J. Kelleran

Human Movement Studies & Special Education Faculty Publications

This article provides a synopsis of the limited investigations examining the impact of external load (EL) on performance of high-intensity tasks under load (HITL), EL training intervention effects on HITL performance, and injuries from EL training. Repetitive lifting tasks and initiation of locomotion, such as rapidly moving from a prone position to sprinting appear to be more hindered by EL than maximal sprinting velocity and may explain why training with EL does not improve obstacle course or prolonged (200-300 yard shuttle) drills. EL training appears to offer very little if any benefit for HITL in lesser trained populations. This contrast …

A Gut Gone To Pot: A Case Of Cannabinoid Hyperemesis Syndrome Due To K2, A Synthetic Cannabinoid., Anene Ukaigwe, Paras Karmacharya, Anthony A. Donato

Reading Hospital Internal Medicine Residency

Cannabinoid Hyperemesis Syndrome (CHS) was first described in 2004. Due to its novelty, CHS is often unrecognized by clinicians leading to expensive workup of these patients with cyclical symptoms. It may take up to 9 years to diagnose CHS. CHS is characterized by cyclical nausea and vomiting, abdominal pain, and an unusual compulsion to take hot showers in the presence of chronic use of cannabinoids. Cannabicyclohexanol is a synthetic cannabinoid, popularly known as K2 spice. It is a popular marijuana alternative among teenagers and young adults since it is readily available as herbal incense. Unlike marijuana, many users know that …

How Patients' Self-Disclosure About Sickle Cell Pain Episodes To Significant Others Relates To Living With Sickle Cell Disease, Valerian J. Derlega, Louis H. Janda, Jeannie Miranda, Ian A. Chen, B. Mitchell Goodman Iii, Wally Smith

Psychology Faculty Publications

Objectives: This cross-sectional study examines to whom and how fully sickle cell disease (SCD) patients talk to others about sickle cell pain, how helpful it is to talk with others about these pain episodes, and the association between talking to others about sickle cell pain episodes and patients' psychological adjustment and coping strategies in managing the disease.

Methods: A convenience sample of 73 African American patients with SCD (30 men and 43 women), were recruited from two SCD clinics at the time of routine medical visits. Most participants had been diagnosed with hemoglobin SS, and they reported an average number …

Nanotechnology And Its Implication In Medical Science, Syed Ahsan Ali, M. Tariq

Department of Medicine

No abstract provided.

Mesenteric Vein Thrombosis In A Patient Heterozygous For Factor V Leiden And G20210a Prothrombin Genotypes., Paras Karmacharya, Madan Raj Aryal, Anthony A. Donato

Reading Hospital Internal Medicine Residency

Mesenteric venous thrombosis (MVT) is a rare but life threatening form of bowel ischemia. It is implicated in 6%-9% of all cases of acute mesenteric ischemia. The proportion of patients with primary (or idiopathic) MVT varies from 0% to 49%, with a decrease in frequency secondary to more recent availability of newer investigations for hypercoagulability. The presence of factor V Leiden (FVL) and prothrombin G20210A mutations (PGM) have been well documented in these cases. However, there have been scarce case reports describing MVT in heterozygotes of both these mutations occurring simultaneously and its implications on long term management. Our case …

Cholera Vaccination Campaign Contributes To Improved Knowledge Regarding Cholera And Improved Practice Relevant To Waterborne Disease In Rural Haiti, Omowunmi Aibana, Molly F Franke, Jessica E Teng, Johanne Hilaire, Max Raymond, Louise C Ivers

Faculty, Staff and Student Publications

BACKGROUND: Haiti's cholera epidemic has been devastating partly due to underlying weak infrastructure and limited clean water and sanitation. A comprehensive approach to cholera control is crucial, yet some have argued that oral cholera vaccination (OCV) might result in reduced hygiene practice among recipients. We evaluated the impact of an OCV campaign on knowledge and health practice in rural Haiti.

METHODOLOGY/PRINCIPAL FINDINGS: We administered baseline surveys on knowledge and practice relevant to cholera and waterborne disease to every 10th household during a census in rural Haiti in February 2012 (N = 811). An OCV campaign occurred from May-June 2012 after …

Clinical Reasoning And Dual Mental Processing In Diagnostic Competence., M. Tariq, Syed Ahsan Ali

Department of Medicine

No abstract provided.

Illuminating The Dark Side--Vitamin D Status In Different Localities Of Karachi, Romaina Iqbal, Lena Jafri, Ali Haroon, Aysha Habib Khan

Department of Medicine

This study was conducted to determine the association between place of residence (grouped into neighbourhoods), and 25-hydroxy D (25[OH]D) levels of individuals of Karachi. Addresses of 4788 individuals tested for 25[OH]D at the clinical laboratory of the Aga Khan University (AKU), Karachi, from January 2007 to June 2008 were reviewed. The neighbourhoods were categorized into ten, based on locality attributes. A high overall prevalence (74%) of vitamin D deficiency (VDD) was observed. There was a significant difference (p-value < 0.01) between mean log 25[OH]D levels amongst neighbourhoods grouped according to distinct housing structure attributes and localities. A high frequency of VDD in all the studied localities of an urban city warrant dietary vitamin D supplementation and food fortification.

Effect Of Mobile Phone Short Message Service On Adherence Rates To Antihypertensives At The Family Medicine Clinic, Barbara Karau

Master of Medicine in Internal Medicine

Background: Systemic arterial hypertension is the main modifiable risk factor for development of cardiovascular disease, which is the number one cause of death in high income countries and is increasingly becoming a cause of concern in Sub-Saharan Africa (1). Awareness, management and overall control of hypertension in Sub-Saharan Africa is poor (2,3). Poor control stems from various causes; one being patient non-adherence with medication, a factor amenable to modification. The use of mobile health for behavioural change from low resource settings is gaining widespread use in management of communicable diseases (4,6). Mobile phone has the potential to significantly influence patients …

Self-Perceived Health Among School Going Adolescents In Pakistan: Influence Of Individual, Parental And Life Style Factors?, Asad Ali Khan Afridi, Komal Motwani, Saleem Khawaja, Adeel Khoja, Zafar Fatmi, Iqbal Azam Syed, Muhammad Masood Kadir

Department of Medicine

BACKGROUND: Adolescents are at substantial risk of acquiring behaviors which might influence their health status. This study was aimed to assess the proportion of school going adolescents (both males and females) with poor self-perceived health and its associated factors.

METHODOLOGY: A cross-sectional study was conducted in three major cities of Pakistan i.e. Karachi, Lahore and Quetta. From each city, six (6) secondary schools were randomly selected (3 public and 3 private). Pre-tested, self-administered questionnaire was distributed to students. Binary logistic regression analysis was conducted to determine independent factors associated with poor self-perceived health.

RESULTS: Approximately 29% adolescents (119/414) reported poor …

Unintentional Childhood Poisoning, Epidemiology And Strategies For The Prevention And Policy Change In Pakistan, Omer Ul Hassan, Hasana Qadri, Umer Mir, Bilal Ahmed

Department of Medicine

Poisoning is the fifth leading cause of unintentional injuries among young children. Agents most commonly ingested by young children include medicines, cleaning substances, hydrocarbons, pesticides and cosmetics. Children with less educated fathers, living in more crowded conditions and from lower income families are more predisposed to unintentional poisoning. Unsafe storage of medicines, chemicals and other hazardous substances is one of the leading reasons for childhood poisoning. Knowledge of parents and caregivers about prevention of poisoning may be the basis to prevent subsequent injuries. This paper is a review of the epidemiology of unintentional poisonings among young children (less than five …

Benzodiazepine Use In Medical Out-Patient Clinics: A Study From A Developing Country, Muhammad Junaid Patel, Syed Ahmer, Faheem Khan, Abdullah Waqar Ahmed Qureshi, Muhammad Farrukh Shehzad, Sania Muzaffar

Section of Internal Medicine

Objective: To estimate the prevalence of Benzodiazepine use in the outpatient setting of general medicine clinics at a single tertiary care centre.

Methods: The prospective prevalence study was conducted in the outpatient setting of Internal Medicine Clinics at Aga Khan University Hospital, Karachi, from November to December 2009. All subjects were interviewed after informed consent and variables were recorded on a specially-designed proforma. Apart from basic demographics and comorbid conditions, duration, frequency and route of benzodiazepine use, as well as the reason and who initiated it was noted. Chi-square test and t test was applied to see the …

Patients' Insight Of Interpreting Prescriptions And Drug Labels--A Cross Sectional Study., Muhammad Junaid Patel, Muhammad Shoaib Khan, Farheen Ali, Zehra Kazmi, Safia Awan, Ayesha Sorathia

Department of Medicine

Background: Errors in consuming drugs are associated with significant morbidity and mortality, besides an impact on the already overburdened health-care system. Misunderstanding drug labels and prescriptions plays an important role in contributing to adverse drug events.

Objective: To evaluate abilities to understand prescriptions and drug labels among patients attending tertiary care hospital in Karachi.

Methods: A cross sectional study was conducted at the Aga Khan University Hospital (AKUH), from January to March 2009. After informed consent, 181 adult patients and their healthy attendants were interviewed at AKUH using a standardized questionnaire, which ascertained patient demographics, factors that might increase exposure …

Website Usage And Weight Loss In A Free Commercial Online Weight Loss Program: Retrospective Cohort Study, Kevin O Hwang, Jing Ning, Amber W Trickey, Christopher N Sciamanna

Faculty, Staff and Student Publications

BACKGROUND: Online weight loss programs are increasingly popular. However, little is known about outcomes and associations with website usage among members of free online weight loss programs.

OBJECTIVE: This retrospective cohort study examined the association between website usage and weight loss among members of a free commercial online weight loss program (SparkPeople).

METHODS: We conducted a retrospective analysis of a systematic random sample of members who joined the program during February 1 to April 30, 2008, and included follow-up data through May 10, 2010. The main outcome was net weight change based on self-reported weight. Measures of website usage included …

Biomarkers Of Maternal And Fetal Exposure To Organochlorine Pesticides Measured In Pregnant Hispanic Women From Brownsville, Texas, Ken Sexton, Jennifer J Salinas, Thomas J Mcdonald, Rose M Z Gowen, Rebecca P Miller, Joseph B Mccormick, Susan P Fisher-Hoch

Faculty, Staff and Student Publications

Biomarkers of organochlorine pesticides were measured in both venous and umbilical cord blood from 35 pregnant Hispanic women living in Brownsville, Texas, USA. Gas chromatography with an electron capture detector was used to analyze specimens for 30 individual pesticides or their metabolites. Results indicate that blood concentrations were relatively low for most individual compounds, but that high-end (upper 10th percentile) values for total DDT were comparatively high. Although health effects associated with measured blood concentrations are uncertain, there is concern that fetal exposure to low levels of these OC compounds, either individually or in combination, might contribute to subsequent health …

Willingness To Undergo A Repeat Liver Biopsy Among Hiv/Hepatitis C Virus-Coinfected And Hepatitis C Virus-Monoinfected Patients, Valerianna K Amorosa, Omowunmi Aibana, Norah J Shire, Zachariah Dorey-Stein, Thomas Ferrara, Joanne Gilmore, Jay R Kostman, Vincent Lo Re

Faculty, Staff and Student Publications

BACKGROUND: Guidelines for chronic hepatitis C virus (HCV) management have recommended that a liver biopsy be repeated at 3-year intervals for HIV/HCV-coinfected patients and 5-year intervals for those with HCV monoinfection to assess fibrosis progression. However, it is unclear if patients are willing to repeat this procedure.

OBJECTIVE: To determine the prevalence and factors, particularly HIV coinfection, associated with willingness to repeat a liver biopsy.

METHODS: A questionnaire was administered to 235 HCV-infected patients (113 with HIV coinfection) between January 2008 and June 2011 who previously underwent liver biopsy. The main outcome was self-reported willingness to repeat the biopsy. The …