Nitric oxide-releasing nonsteroidal anti-inflammatory drugs (NO-NSAIDs), consisting of a known no... more Nitric oxide-releasing nonsteroidal anti-inflammatory drugs (NO-NSAIDs), consisting of a known nonsteroidal anti-inflammatory drug (NSAID) and a nitric oxide (NO)-releasing group, are reported safer than NSAIDS: To assess their potential in colon cancer chemoprevention, we studied in vitro the effect of NO-aspirin, NO-sulindac, and NO-ibuprofen on colonocyte kinetics. These three NO-NSAIDs reduced the growth of cultured HT-29 colon adenocarcinoma cells much more effectively than the corresponding NSAIDs; e.g., at 24 h, their IC(50) values were as follows: (a) aspirin, >5000 microM; (b) NO-aspirin, 1 microM; (c) sulindac, 750 microM; (d) NO-sulindac, 150 microM; (e) ibuprofen, >1000 microM; and (f) NO-ibuprofen, 42 microM. This effect was due to inhibition of proliferation and induction of apoptosis and perhaps to the induction of novel cell changes, characterized by extensive DNA degradation. NO-NSAIDs also blocked the G(0)-G(1) to S cell cycle transition. Their superior effectiveness compared with traditional NSAIDs, combined with their reported safety, makes them promising candidates for chemopreventive agents against colon cancer.
The newly discovered SEN D and SEN H viruses are transmitted parenterally and can cause post-tran... more The newly discovered SEN D and SEN H viruses are transmitted parenterally and can cause post-transfusion hepatitis. We assessed whether coinfection of patients with chronic hepatitis C and SEN D or SEN H correlates with the outcome of treatment with interferon and ribavirin. Of 31 patients with hepatitis C studied, six were positive for SEN D and seven for SEN H (one was positive for both). All of those positive for SEN D and five of those positive for SEN H failed to respond to therapy. Overall response (RNA titre and alanine aminotransferase concentration after treatment) was lower in SEN-infected patients than uninfected patients (p=0.025). We conclude that coinfection with SEN viruses is frequent in chronic hepatitis C patients and might adversely affect the outcome of treatment with interferon and ribavirin.
The newly discovered SEN D and SEN H viruses are transmitted parenterally and can cause post-tran... more The newly discovered SEN D and SEN H viruses are transmitted parenterally and can cause post-transfusion hepatitis. We assessed whether coinfection of patients with chronic hepatitis C and SEN D or SEN H correlates with the outcome of treatment with interferon and ribavirin. Of 31 patients with hepatitis C studied, six were positive for SEN D and seven for SEN H (one was positive for both). All of those positive for SEN D and five of those positive for SEN H failed to respond to therapy. Overall response (RNA titre and alanine aminotransferase concentration after treatment) was lower in SEN-infected patients than uninfected patients (p=0.025). We conclude that coinfection with SEN viruses is frequent in chronic hepatitis C patients and might adversely affect the outcome of treatment with interferon and ribavirin.
The effect of erectile dysfunction potentially interferes with men’s self esteem, confidence, rel... more The effect of erectile dysfunction potentially interferes with men’s self esteem, confidence, relationship, and overall sense of well being. The problem is increasing in all segments of the sexually active male population and affects both men and his partner. In younger man increase is attributed to substance abuse, such as recreation drugs and alcohol.The older population is living longer, fuller lives and expects to remain sexually active, regardless of any existing medical conditions. Stress factors associated with modern life styles are affecting men of all ages and contribute greatly to the overall causes of erectile failure. Early identification, behavior modification and increased therapeutic options may improve patient’s outcome. By improving the knowledge and therapeutic options, it may be possible to identify patients at risk of erectile dysfunction and thus to lead a normal healthy life. Keeping this fact in mind and a high prevalence of erectile dysfunction, this Pilot s...
Hypothesis: We hypothesized that identification of individual knowledge needs will lead to better... more Hypothesis: We hypothesized that identification of individual knowledge needs will lead to better learning assessment outcome among clinicians and will promote selfdirected learning activities, ultimately leading to an expedited professional competence. Research Objectives: The primary objective of our study is to explore the feasibility of utilizing a web based integrated clinical knowledge and literature management platform to capture point of care learning needs by providing easy access to literature resources, tools to promote literature appraisal skills and a web space for personal knowledge repository for life long self-directed learning. Methods: We designed and implemented a web based integrated clinical learning and knowledge management platform, named as Clinical Pearl and hosted at www.clinicalpearl.com. A beta testing was conducted with residents, students and physicians to assess the features and hypothesis among these clinicians. Results: Our study showed that a point ...
Objectives Training in evidence based medicine practice is a mandatory core competency of practic... more Objectives Training in evidence based medicine practice is a mandatory core competency of practice based learning and improvement (PBLI) of ACGME standards.Reflective medical education is a triggering point for self-directed learning at the point of care in wards, clinics and in operating rooms to capture patient specific clinical queries. Both these skills can be taught through a longitudinal curriculum which emphasizes on patient and learner-centered education. However, there is no formal longitudinal curriculum to teach reflective learning and evidence-based medicine to medical students and trainees in a clinically integrated learning environment during multiyear training. Web based certification training is a growing trend to demonstrate commitment to professionalism, and offers a formal training to meet the standards for self-directed learning for professional development Method Our objective is to implement a web based longitudinal curriculum for certified training in evidence-based medicine. We plan to customized specialty based longitudinal training in evidence based medicine practicing skills. Furthermore, our goal is to identify the areas of insufficient or poor evidence in each specialty to emphasize the training in skills in appraising and interpreting evidence type in the hierarchy of evidence-based medicine resource’s pyramid. EBM curriculum will include longitudinal training both in inpatient and outpatient setting to capture all relevant point of care patient centered clinical queries mapped to specialty topics of insufficient evidence. A built-in knowledge resource, multi modal teaching methods including small group teaching, e- learning and journal club will ensure a comprehensive training in EBM. The ultimate outcome will be a certified training in evidence-based medicine at the conclusion of the residency training for life long evidence-based practice. Results We have implemented a web-based EBM curriculum platform hosted at www.ebmcentral.net . Preliminary testing at various workshops have been conducted with positive feedback. Beta study results showed that web based longitudinal curriculum provides an excellent opportunity to train students, resident and faculty in practicing evidence-based medicine through a formal longitudinal EBM curriculum. A clinically integrated curriculum along with innovative EBM tools provides a simulated article reading and appraisal training. A point of care query capturing tool and meta search engine for EBM resources provides a convenient platform to trigger self-directed point of care learning for EBM cycle. Self-directed web-based assignments along with both summative and formative assessment ensure a continuous growth of required competencies in longitudinal curriculum timeline. Lastly, research dissemination through a collaborative crowd research environment to synthesize research evidence such as systematic review is also integrated. Conclusions We have conceived and implemented a web based longitudinal curriculum for a certified training in evidence-based medicine i.e Certified evidence-based medicine practitioner (CEBMP). Our platform has provided preliminary supportive evidence of enhancing reflective learning, knowledge gaps and needs assessment, and clinically integrated formal training in evidence-based medicine. A personal knowledge repository along with acquired skills of evidence-based medicine including question formulation, information mastery, critical appraisal, research synthesis and interpretation provides a foundation for lifelong self-directed learning for evidence-based practice. We plan to conduct a randomized clinical trial to assess the role of our longitudinal curriculum in providing certified training in evidence-based medicine to medical students, residents and faculty.
Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery, 2002
Vertebral artery dissection resulting in stroke is rare in children. We report here on a 7-year-o... more Vertebral artery dissection resulting in stroke is rare in children. We report here on a 7-year-old boy with Klippel-Feil abnormality, who presented with a pontine infarction after a supervised swimming session. Evaluation after a second acute neurological event included a formal cerebral angiogram, which revealed a complete upper basilar artery occlusion and right vertebral arterial dissection. Cervical spine radiographs demonstrated an associated fusion of the C2 and C3 vertebrae. Anticoagulation therapy was initiated, and the neurological deficits associated with the pontine infarction resolved. Anticoagulation was discontinued after 6 months of therapy, with no recurrence of symptoms. Vertebral artery dissection may rarely be associated with Klippel-Feil abnormality in children.
Vertebral artery dissection (VAD) has been infrequently recognized in children. The authors have ... more Vertebral artery dissection (VAD) has been infrequently recognized in children. The authors have reviewed 68 reported cases of VAD in children in the existing literature. An association between routine types of neck movement in sports and the evolution of VAD was recognized in half of the reported cases. Boys outnumbered girls by a ratio of 6.6 to 1, in contrast to adults, for whom the male to female ratio is approximately equal (1.3 to 1). Neck pain, one of the hallmark symptoms of VAD in adults, was infrequently noted in this young population (12%). Most children presented with various combinations of symptoms and signs, including ataxia (53%), headache (38%) and vomiting (34%). Eye signs or symptoms were noted in 72% of patients, and paresis/paralysis of one or more extremity occurred in 54%. Angiography was the method most frequently used to diagnose VAD (63/68; 93%). Magnetic resonance angiography (MRA) revealed pathognomonic signs of VAD in only 3 out of 13 patients evaluated (23%). In this series of 68 patients, 48 reports failed to indicate whether or not a cervical X-ray was performed, but in the 20 patients for whom such information was recorded, half had skeletal abnormalities in the occipital/atlas/axis region. The most common treatments were antiplatelet therapy (n = 15) and anticoagulation with (n = 8) or without (n = 7) supplemental antiplatelet therapy. Asymptomatic recovery occurred in 12 of the 15 patients (80%) who received antiplatelet therapy compared with 4 of the 15 patients (27%) who received anticoagulation therapy with or without antiplatelet therapy. There is a very high incidence of associated cervical anomalies in children with VAD. Further studies are required to determine if noninvasive examinations such as magnetic resonance imaging, ultrasonography, computed tomography angiography and MRA could replace angiography as the modality of choice in establishing the diagnosis of VAD in children. The role of different therapies for children presenting with symptoms related to VAD is unclear.
Nitric oxide-releasing nonsteroidal anti-inflammatory drugs (NO-NSAIDs), consisting of a known no... more Nitric oxide-releasing nonsteroidal anti-inflammatory drugs (NO-NSAIDs), consisting of a known nonsteroidal anti-inflammatory drug (NSAID) and a nitric oxide (NO)-releasing group, are reported safer than NSAIDS: To assess their potential in colon cancer chemoprevention, we studied in vitro the effect of NO-aspirin, NO-sulindac, and NO-ibuprofen on colonocyte kinetics. These three NO-NSAIDs reduced the growth of cultured HT-29 colon adenocarcinoma cells much more effectively than the corresponding NSAIDs; e.g., at 24 h, their IC(50) values were as follows: (a) aspirin, >5000 microM; (b) NO-aspirin, 1 microM; (c) sulindac, 750 microM; (d) NO-sulindac, 150 microM; (e) ibuprofen, >1000 microM; and (f) NO-ibuprofen, 42 microM. This effect was due to inhibition of proliferation and induction of apoptosis and perhaps to the induction of novel cell changes, characterized by extensive DNA degradation. NO-NSAIDs also blocked the G(0)-G(1) to S cell cycle transition. Their superior effectiveness compared with traditional NSAIDs, combined with their reported safety, makes them promising candidates for chemopreventive agents against colon cancer.
The newly discovered SEN D and SEN H viruses are transmitted parenterally and can cause post-tran... more The newly discovered SEN D and SEN H viruses are transmitted parenterally and can cause post-transfusion hepatitis. We assessed whether coinfection of patients with chronic hepatitis C and SEN D or SEN H correlates with the outcome of treatment with interferon and ribavirin. Of 31 patients with hepatitis C studied, six were positive for SEN D and seven for SEN H (one was positive for both). All of those positive for SEN D and five of those positive for SEN H failed to respond to therapy. Overall response (RNA titre and alanine aminotransferase concentration after treatment) was lower in SEN-infected patients than uninfected patients (p=0.025). We conclude that coinfection with SEN viruses is frequent in chronic hepatitis C patients and might adversely affect the outcome of treatment with interferon and ribavirin.
The newly discovered SEN D and SEN H viruses are transmitted parenterally and can cause post-tran... more The newly discovered SEN D and SEN H viruses are transmitted parenterally and can cause post-transfusion hepatitis. We assessed whether coinfection of patients with chronic hepatitis C and SEN D or SEN H correlates with the outcome of treatment with interferon and ribavirin. Of 31 patients with hepatitis C studied, six were positive for SEN D and seven for SEN H (one was positive for both). All of those positive for SEN D and five of those positive for SEN H failed to respond to therapy. Overall response (RNA titre and alanine aminotransferase concentration after treatment) was lower in SEN-infected patients than uninfected patients (p=0.025). We conclude that coinfection with SEN viruses is frequent in chronic hepatitis C patients and might adversely affect the outcome of treatment with interferon and ribavirin.
The effect of erectile dysfunction potentially interferes with men’s self esteem, confidence, rel... more The effect of erectile dysfunction potentially interferes with men’s self esteem, confidence, relationship, and overall sense of well being. The problem is increasing in all segments of the sexually active male population and affects both men and his partner. In younger man increase is attributed to substance abuse, such as recreation drugs and alcohol.The older population is living longer, fuller lives and expects to remain sexually active, regardless of any existing medical conditions. Stress factors associated with modern life styles are affecting men of all ages and contribute greatly to the overall causes of erectile failure. Early identification, behavior modification and increased therapeutic options may improve patient’s outcome. By improving the knowledge and therapeutic options, it may be possible to identify patients at risk of erectile dysfunction and thus to lead a normal healthy life. Keeping this fact in mind and a high prevalence of erectile dysfunction, this Pilot s...
Hypothesis: We hypothesized that identification of individual knowledge needs will lead to better... more Hypothesis: We hypothesized that identification of individual knowledge needs will lead to better learning assessment outcome among clinicians and will promote selfdirected learning activities, ultimately leading to an expedited professional competence. Research Objectives: The primary objective of our study is to explore the feasibility of utilizing a web based integrated clinical knowledge and literature management platform to capture point of care learning needs by providing easy access to literature resources, tools to promote literature appraisal skills and a web space for personal knowledge repository for life long self-directed learning. Methods: We designed and implemented a web based integrated clinical learning and knowledge management platform, named as Clinical Pearl and hosted at www.clinicalpearl.com. A beta testing was conducted with residents, students and physicians to assess the features and hypothesis among these clinicians. Results: Our study showed that a point ...
Objectives Training in evidence based medicine practice is a mandatory core competency of practic... more Objectives Training in evidence based medicine practice is a mandatory core competency of practice based learning and improvement (PBLI) of ACGME standards.Reflective medical education is a triggering point for self-directed learning at the point of care in wards, clinics and in operating rooms to capture patient specific clinical queries. Both these skills can be taught through a longitudinal curriculum which emphasizes on patient and learner-centered education. However, there is no formal longitudinal curriculum to teach reflective learning and evidence-based medicine to medical students and trainees in a clinically integrated learning environment during multiyear training. Web based certification training is a growing trend to demonstrate commitment to professionalism, and offers a formal training to meet the standards for self-directed learning for professional development Method Our objective is to implement a web based longitudinal curriculum for certified training in evidence-based medicine. We plan to customized specialty based longitudinal training in evidence based medicine practicing skills. Furthermore, our goal is to identify the areas of insufficient or poor evidence in each specialty to emphasize the training in skills in appraising and interpreting evidence type in the hierarchy of evidence-based medicine resource’s pyramid. EBM curriculum will include longitudinal training both in inpatient and outpatient setting to capture all relevant point of care patient centered clinical queries mapped to specialty topics of insufficient evidence. A built-in knowledge resource, multi modal teaching methods including small group teaching, e- learning and journal club will ensure a comprehensive training in EBM. The ultimate outcome will be a certified training in evidence-based medicine at the conclusion of the residency training for life long evidence-based practice. Results We have implemented a web-based EBM curriculum platform hosted at www.ebmcentral.net . Preliminary testing at various workshops have been conducted with positive feedback. Beta study results showed that web based longitudinal curriculum provides an excellent opportunity to train students, resident and faculty in practicing evidence-based medicine through a formal longitudinal EBM curriculum. A clinically integrated curriculum along with innovative EBM tools provides a simulated article reading and appraisal training. A point of care query capturing tool and meta search engine for EBM resources provides a convenient platform to trigger self-directed point of care learning for EBM cycle. Self-directed web-based assignments along with both summative and formative assessment ensure a continuous growth of required competencies in longitudinal curriculum timeline. Lastly, research dissemination through a collaborative crowd research environment to synthesize research evidence such as systematic review is also integrated. Conclusions We have conceived and implemented a web based longitudinal curriculum for a certified training in evidence-based medicine i.e Certified evidence-based medicine practitioner (CEBMP). Our platform has provided preliminary supportive evidence of enhancing reflective learning, knowledge gaps and needs assessment, and clinically integrated formal training in evidence-based medicine. A personal knowledge repository along with acquired skills of evidence-based medicine including question formulation, information mastery, critical appraisal, research synthesis and interpretation provides a foundation for lifelong self-directed learning for evidence-based practice. We plan to conduct a randomized clinical trial to assess the role of our longitudinal curriculum in providing certified training in evidence-based medicine to medical students, residents and faculty.
Child's nervous system : ChNS : official journal of the International Society for Pediatric Neurosurgery, 2002
Vertebral artery dissection resulting in stroke is rare in children. We report here on a 7-year-o... more Vertebral artery dissection resulting in stroke is rare in children. We report here on a 7-year-old boy with Klippel-Feil abnormality, who presented with a pontine infarction after a supervised swimming session. Evaluation after a second acute neurological event included a formal cerebral angiogram, which revealed a complete upper basilar artery occlusion and right vertebral arterial dissection. Cervical spine radiographs demonstrated an associated fusion of the C2 and C3 vertebrae. Anticoagulation therapy was initiated, and the neurological deficits associated with the pontine infarction resolved. Anticoagulation was discontinued after 6 months of therapy, with no recurrence of symptoms. Vertebral artery dissection may rarely be associated with Klippel-Feil abnormality in children.
Vertebral artery dissection (VAD) has been infrequently recognized in children. The authors have ... more Vertebral artery dissection (VAD) has been infrequently recognized in children. The authors have reviewed 68 reported cases of VAD in children in the existing literature. An association between routine types of neck movement in sports and the evolution of VAD was recognized in half of the reported cases. Boys outnumbered girls by a ratio of 6.6 to 1, in contrast to adults, for whom the male to female ratio is approximately equal (1.3 to 1). Neck pain, one of the hallmark symptoms of VAD in adults, was infrequently noted in this young population (12%). Most children presented with various combinations of symptoms and signs, including ataxia (53%), headache (38%) and vomiting (34%). Eye signs or symptoms were noted in 72% of patients, and paresis/paralysis of one or more extremity occurred in 54%. Angiography was the method most frequently used to diagnose VAD (63/68; 93%). Magnetic resonance angiography (MRA) revealed pathognomonic signs of VAD in only 3 out of 13 patients evaluated (23%). In this series of 68 patients, 48 reports failed to indicate whether or not a cervical X-ray was performed, but in the 20 patients for whom such information was recorded, half had skeletal abnormalities in the occipital/atlas/axis region. The most common treatments were antiplatelet therapy (n = 15) and anticoagulation with (n = 8) or without (n = 7) supplemental antiplatelet therapy. Asymptomatic recovery occurred in 12 of the 15 patients (80%) who received antiplatelet therapy compared with 4 of the 15 patients (27%) who received anticoagulation therapy with or without antiplatelet therapy. There is a very high incidence of associated cervical anomalies in children with VAD. Further studies are required to determine if noninvasive examinations such as magnetic resonance imaging, ultrasonography, computed tomography angiography and MRA could replace angiography as the modality of choice in establishing the diagnosis of VAD in children. The role of different therapies for children presenting with symptoms related to VAD is unclear.
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