Asad Sheikh - Academia.edu (original) (raw)

Papers by Asad Sheikh

Research paper thumbnail of Acute social and somatic stress alters cortical metaplasticity probed with non-invasive brain stimulation in humans

International Journal of Psychophysiology

Studying the neuronal mechanisms that govern the cortical adaptations to acute stress is critical... more Studying the neuronal mechanisms that govern the cortical adaptations to acute stress is critical for understanding the development of neuropsychiatric diseases. Homeostatic plasticity stabilizes the neural activity in which a previous synaptic event drives subsequent synaptic plasticity. In this study, we evaluated the effect of acute stress induced with the socially evaluated cold pressor test (SECPT) on cortical metaplasticity in humans using a non-invasive brain stimulation protocol. After being exposed to the SECPT and control stress conditions, 30 healthy participants were tested for cortical metaplasticity assessed with changes in the amplitude of the motor evoked potential (MEP) induced by a single-pulse transcranial magnetic stimulation (TMS). Cortical metaplasticity was induced by combining priming with cathodal tDCS (cTDCS) followed by a sub-threshold 1-Hz repetitive stimulation (rTMS) test session. Our results showed that SECPT induced cardiovascular adaptations (increase in systolic, diastolic blood pressure, and heart rate), indicating that SECPT effectively induced acute stress. Also, in our experiments stimulation of subjects with 1-Hz rTMS after they had undergone the SECPT condition induced inhibition of MEP whereas 1-Hz rTMS administered after the control condition induced a facilitatory (physiologic) response pattern. Here we observed that acute stress impairs homeostatic metaplasticity. The dysfunctional regulation of cortical plastic changes after stress could play a pivotal role in the pathogenesis of neurological and psychiatric diseases.

Research paper thumbnail of The Opioid Crisis: How to Lessen the Burden on Emergency Departments by At-risk Populations

Cureus

Background The opioid crisis in the United States of America has been worsening due to previous s... more Background The opioid crisis in the United States of America has been worsening due to previous sharp increases in opioid prescriptions and a lack of resources available to those affected. Emergency departments (ED) across the nation have been exhausted with a constant influx of patients related to opioid-related issues. Because of limited resources, it is crucial to efficiently distribute rehabilitation and mental wellness efforts amongst those most susceptible to opioid abuse. By identifying common environments and characteristics of the population presenting to ED's for opioid-related issues, we can (1) lessen the economic burden on the healthcare system while (2) increasing the rate of successful treatment for those affected by opioid addiction. Methods Data was obtained regarding ED visits for opioid-related issues at the level of all 50 states from the Healthcare Cost and Utilization Project's (HCUP) State Emergency Department Databases (SEDD) and nationally from the Nationwide Emergency Department Sample (NEDS). Rates of ED admissions for opioidrelated issues were statistically analyzed to identify characteristics of the population that are most at risk for presenting to the ED for opioid-related issues. Results Statistical analysis showed residents of Large Metropolitan areas (M=351.94, p=0.022, CI±42.89), those earning incomes below the 25th percentile (M=359.14, p=0.008, CI ±61.39), and 25-44-year-old population (M=456.71, p=0.001, CI±27.01) to be the most likely subset of the population to report to the ED for opioiduse issues. Conversely, those earning incomes above the 75th percentile were significantly less likely to utilize ED's for opioid-related issues (M=143.10, p=0.026, CI±0.026). Conclusion Results demonstrated that patients between the ages of 25 and 44 were more likely to develop opioid use disorders. This provides an opportunity to educate this population via opioid education centers. Additionally, residents of Large Metropolitan areas would benefit from naloxone distribution centers. Lastly, higher income levels appear to be related to a decrease in ED presentation for opioid abuse. This provides evidence for medication-assisted therapy (MAT) to be provided by low-income insurance plans.

Research paper thumbnail of Treating Bell’s Palsy With Osteopathic Manipulative Medicine: A Case Report

Cureus, 2020

Bell's palsy (BP) occurs when the facial nerve (CN VII) is swollen, inflamed, or compressed, ... more Bell's palsy (BP) occurs when the facial nerve (CN VII) is swollen, inflamed, or compressed, resulting in facial weakness or paralysis; etiology is unknown. BP patients often succumb to a decreased quality of life due to the inability to make facial expressions, increased sensitivity to auditory stimuli, and dysregulation in tear and saliva production. Despite conventional examination and therapy options, the syndrome is majorly regarded as idiopathic and left unresolved for many patients. In this case of a patient with BP, treatment with osteopathic manipulative treatment (OMT) which focused on restoring a normal structure-function relationship resolved the patient’s symptoms. The osteopathic manipulative procedures utilized findings from an osteopathic structural exam and addressed those somatic dysfunctions with OMT. The authors report that the patient's symptoms improved after the application of OMT and without the use of pharmaceuticals. The results of the case study su...

Research paper thumbnail of Circulating Cell-Free DNA to Determine the Fetal RHD Status in All Three Trimesters of Pregnancy

Obstetrics & Gynecology, 2016

Funding for this study was provided by Sequenom, Inc. Sequenom paid fees directly to Baylor Colle... more Funding for this study was provided by Sequenom, Inc. Sequenom paid fees directly to Baylor College of Medicine for salary support for the principal investigator (PI) (K.J.M.) and a central study coordinator, establishment of a web-based data collection tool, patient enrollment fees at the individual participating centers, and consultative fees for an independent statistician to analyze the final data. The study design was undertaken by the PI. All clinical data were entered into a web-based database; Sequenom had no access to the neonatal outcome data. The clinical data and corresponding DNA results generated by Sequenom Laboratories were initially released to the PI and later to an independent statistician. The manuscript was written by the PI with editorial input from all participating authors.

Research paper thumbnail of Cortical blindness post coronary angiogram: A rare but frightening complication

International Journal of Cardiology, 2016

Cortical blindness is a rare but frightening complication following coronary angiogram probably d... more Cortical blindness is a rare but frightening complication following coronary angiogram probably due to contrast penetration in occipital lobes in susceptible individuals [1, 2].

Research paper thumbnail of Importance du placenta humain dans la transmission in utero de l'infection VIH-1 : Evaluation in vitro de 21 souches virales

Reproduction Humaine Et Hormones, 2000

Les souches VIH-1 n'induisant pas la formation de syncytium (NSI) ont ete associees avec la t... more Les souches VIH-1 n'induisant pas la formation de syncytium (NSI) ont ete associees avec la transmission verticale de VIH-1 in utero, et avec l'infection de placentas humains in vitro dans une etude preliminaire utilisant trois souches virales. Pour etablir la relation existant entre le phenotype NSI et SI (induisant la formation de syncytium) de VIH-1 avec l'infection du placenta humain in vitro, nous avons utilise 21 souches differentes, en majorite de type sauvage provenant de bebes infectes in utero, intra-partum ou post-partum. Des explants placentaires villeux, de grossesses a terme non infectees, ont ete incubes durant 24 heures avec chacune des souches virales avant de subir un rincage intensif pour eliminer l'inoculum. Le tissu etait ensuite incube durant trois jours supplementaires. L'infection du tissu placentaire etait determinee par l'ADN viral amplifie par PCR (2 regions, Gag et LTR). Des 21 souches VIH-1, 38 % (8 sur 21) etaient capables d'infecter le tissu placentaire. 75 % etaient des souches NSI (6 sur 8) et 25 % des souches SI (2 sur 8). Sur le total des souches NSI, 40 % (6 sur 15) etaient infectieuses contre 33% (2 sur 6) du total des souches SI. En resume, l'infection VIH-1 du placenta humain a terme n'est pas uniquement dependante du phenotype NSI ou SI du VIH-1. De plus, toutes les souches VIH-1 isolees de bebes infectes in utero n'ont pas infecte les explants placentaires, alors que ces souches infectent les PBMC. D'autres caracteristiques de VIH-1 et du placenta lui-meme pourraient etre des elements importants de l'infectivite du placenta humain par VIH-1.

Research paper thumbnail of 17-HYDROXYPROGESTERONE Caproate for Preterm Rupture of the Membranes: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial

American journal of obstetrics and gynecology, Jan 12, 2015

Preterm rupture of membranes (PROM) is associated with increased risk of preterm birth and neonat... more Preterm rupture of membranes (PROM) is associated with increased risk of preterm birth and neonatal morbidity. Prophylactic 17-hydroxyprogesterone caproate (17OHPc) reduces the risk of preterm birth in some women at risk for preterm birth. We sought to test whether 17OHPc would prolong pregnancy or improve perinatal outcome when given to mothers with preterm rupture of the membranes. This is a multicenter, double-blind, placebo-controlled, randomized clinical trial. The study included singleton pregnancies with gestational ages between 23(0/7) to 30(6/7) weeks at enrollment, documented PROM, and no contraindication to expectant management. Consenting women were randomly assigned to receive weekly intramuscular injections of 17OHPc (250 mg) or placebo. The primary outcome was continuation of pregnancy until a favorable gestational age, defined as either 34(0/7) weeks of gestation or documentation of fetal lung maturity at 32(0/7) to 33(6/7) weeks. The two pre-specified secondary outc...

Research paper thumbnail of Moving Towards the Future of Dyslipidemia Management

Southern Medical Journal, 2010

The practice of clinical cardiology faces the continuous struggle of minimizing recurrent cardiov... more The practice of clinical cardiology faces the continuous struggle of minimizing recurrent cardiovascular events by risk factor modification. Current clinical guidelines assist the practicing physician in these efforts. Two of the primary risk factors are that of cholesterol and overall adverse dyslipidemic burden. Current guidelines are based primarily on low density lipoprotein (LDL) reduction, when in fact the spectra of cholesterol particles are much larger. The role of these particles is a topic of intense investigation although much more data needs to be produced to further clarify their significance in primary cardiovascular events. The article by Alla et al in this month’s issue of the Southern Medical Journal attempts to address some of these pitfalls in the treatment of cholesterol. As the article points out, LDL reduction to targets of 70 for those with known cardiovascular disease is the current practice; however, many of these patients continue to have major cardiovascular events. Thus the non-high density lipoprotein cholesterol (non-HDLc) remnants which are not included in LDL measurements may deserve examination and treatment. The paper provides an excellent review and discussion of this topic. The article goes on to suggest that nonHDLc reduction may lead to cardiovascular event reduction; however, there is no specific evidence to support this hypothesis. Just as the article points out that further reduction in LDL may prove to have minimal effect on event reduction, there is no clear cut evidence to suggest that non-HDLc reduction would do otherwise. There are multiple risk factors that could obviously be confounding the picture, some of which may be superior targets for intervention described in future research. It would be preferable to have outcomes based evidence that non-HDLc reduction would lead to event reduction before adopting routine practice recommendation changes and replacement of LDL directed therapy as the primary goal of lipid management. The article discusses potential therapies for non-HDLc reduction. Currently the treatment for non-HDLc is greatly limited as there are few specific medical therapies currently available over and above LDL specific interventions, and patients often do not practice beneficial lifestyle modifications. If non-HDLc is measured, and we are currently limited as to what can be done with this data, the information will simply be used for risk stratification. It would of immense value if, in fact, there were outcomes based therapies and guidelines that allowed for significant intervention. When this data is available, clinicians may be more comfortable with the utility of non-HDLc reduction therapy based on non-HDLc values. The concept of targeting non-HDLc for cardiovascular risk reduction is not novel. The difficulty lies in developing and verifying outcomes based data regarding its use. As mentioned in the article, small dense LDL, very low density lipoprotein (VLDL), and VLDL remnants have been shown to provide a more accurate surrogate for progressive atherosclerosis than LDL cholesterol alone. Apoloprotein B measurements would be an optimal measure of all the presently recognized atherogenic particles; however, the authors note that there is no streamlined or cost effective method available for these measurements. They present a very reasonable argument for considering non-HDLc as a practical alternative. At present, although non-HDLc is a potentially more attractive target for screening and intervention management of dyslipidemia than LDL cholesterol, the clinician may wish to await definitive data regarding the role of non-HDLc measurement and treatment before changing practice patterns. The present article is a useful and important reminder to the practicing physician to carefully follow the evolving field of lipid management and risk factor modification. From the Section of Cardiovascular Diseases, University of Kansas Medical Center and Hospital, Kansas City, KS. Reprint requests to James L. Vacek, MD, Mid America Cardiology, University of Kansas Hospital and Medical Center 39th and Rainbow Blvd, Kansas City, KS 66160. Email: jlvacek@mac.md Accepted November 25, 2009. Copyright © 2010 by The Southern Medical Association 0038-4348/

Research paper thumbnail of 575: 17-HYDROXYPROGESTERONE Caproate for Preterm Rupture of Membranes: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial

American Journal of Obstetrics and Gynecology, 2015

ABSTRACT Preterm rupture of membranes (PROM) is associated with increased risk of preterm birth a... more ABSTRACT Preterm rupture of membranes (PROM) is associated with increased risk of preterm birth and neonatal morbidity. Prophylactic 17-hydroxyprogesterone caproate (17OHPc) reduces the risk of preterm birth in some women at risk for preterm birth. We sought to test whether 17OHPc would prolong pregnancy or improve perinatal outcome when given to mothers with preterm rupture of the membranes. This is a multicenter, double-blind, placebo-controlled, randomized clinical trial. The study included singleton pregnancies with gestational ages between 23(0/7) to 30(6/7) weeks at enrollment, documented PROM, and no contraindication to expectant management. Consenting women were randomly assigned to receive weekly intramuscular injections of 17OHPc (250 mg) or placebo. The primary outcome was continuation of pregnancy until a favorable gestational age, defined as either 34(0/7) weeks of gestation or documentation of fetal lung maturity at 32(0/7) to 33(6/7) weeks. The two pre-specified secondary outcomes were interval from randomization to delivery and composite adverse perinatal outcome. The planned sample size was 222 total women. From October, 2011 to April, 2014, 152 women were enrolled, 74 randomly allocated to 17OHPc and 78 to placebo. The trial was stopped when results of a planned interim analysis suggested that continuation was futile. The primary outcome was achieved in 3% of the 17OHPc group and 8% of the placebo group (P=0.18). There was no significant between-group difference in the pre-specified secondary outcomes, randomization-to-delivery interval (17.1 ± 16.1 versus 17.0 ± 15.8 days, respectively, P = 0.76) or composite adverse perinatal outcome (63% versus 61%, respectively, P = 0.93). No significant differences were found in other outcomes, including rates of chorioamnionitis, postpartum endometritis, cesarean delivery, individual components of the composite outcome, or prolonged neonatal length of stay. Compared to placebo, weekly 17OHPc did not prolong pregnancy or reduce perinatal morbidity in patients with PROM in this trial. Copyright © 2015 Elsevier Inc. All rights reserved.

Research paper thumbnail of In situ PCR detection of HIV expression in the human placenta

METHODS IN MOLECULAR …, 2000

... 2. Material 2.1. Explant Culture 1. Six-well and 24-well culture plates and Transwell™ insert... more ... 2. Material 2.1. Explant Culture 1. Six-well and 24-well culture plates and Transwell™ inserts (Corning Costar, Cambridge, MA). 2. RPMI 1640 and Hams F-12 (Mediatech, Herndon, VA). Page 2. 76 Sheikh, Polliotti, and Miller ... 10. Chloroform (Amresco, Solon, OH). 2.4. ...

Research paper thumbnail of Vertical transmission of HIV and the role of the placenta

Research paper thumbnail of Effect of Chronic Infusion of Cortisol on Renin Gene Expression and Renin Response to Hemorrhage in Fetal Lambs

Research paper thumbnail of Characterization of Candida Albicans Vertical and Horizontal Transmission in Very Low Birth Weight Infants Using Dna Fingerprinting Techniques ♦ 815

Research paper thumbnail of Use of a Cervicometer in Assessing Cervical Length and Risk of Preterm Birth

Obstetrics & Gynecology, 2014

Although current obstetric practice guidelines suggest cervical length assessment in singletons f... more Although current obstetric practice guidelines suggest cervical length assessment in singletons for preterm birth risk, transvaginal ultrasonography has availability limitations. CerviLenz is a disposable device to measure vaginal cervical length. We sought to determine the threshold CerviLenz measurement with optimal specificity and sensitivity for diagnosis of short cervix by transvaginal ultrasonography and compare the abilities of CerviLenz and transvaginal ultrasonography to predict preterm birth. Women with singleton pregnancies and no cervical anomalies or surgery or premature labor were consented, enrolled, and followed to delivery. Transvaginal ultrasonography and CerviLenz cervical length measurements were obtained by independent examiners at 17-23 weeks of gestation. A central reader certified sonographers and reviewed all transvaginal ultrasound scans. Based on 358 patients, receiver operator curves indicated optimal CerviLenz threshold of 30 mm to detect short cervix (transvaginal ultrasound cervical length at or below 25 mm). CerviLenz detected a short cervix with a negative predictive value (NPV) of 100%, sensitivity of 100%, and specificity of 46% (). Preterm birth before 37 weeks of gestation occurred in 25 (7%) patients. Area under the curve analyses for preterm birth before 28, 32, or 35 weeks of gestation revealed similar results for CerviLenz and transvaginal ultrasonography. For preterm birth before 37 weeks of gestation, CerviLenz had greater sensitivity (60%, transvaginal ultrasonography 16%) and transvaginal ultrasonography had higher specificity (97%, CerviLenz 44%).(Table is included in full-text article.) : At a 30-mm threshold, CerviLenz has high NPV, high sensitivity, and moderate specificity to detect a short cervical length in the second trimester. CerviLenz is similar to transvaginal ultrasonography in prediction of preterm birth at 28-37 weeks of gestation. Based on high NPV, CerviLenz is clinically useful in identifying women not at risk for preterm birth, having potential to substantially reduce the need for transvaginal ultrasound screening in singletons.

Research paper thumbnail of Fetal Echocardiography and the Routine Obstetric Sonogram

Journal of Diagnostic Medical Sonography, 2007

mations on the routine obstetric sonogram examination, it is essential that a complete basic feta... more mations on the routine obstetric sonogram examination, it is essential that a complete basic fetal cardiac evaluation is performed. Competency in the basic cardiac evaluation can be achieved through education, training, and practice. The incidence of congenital heart disease (CHD) is about 4.1/1000 to 12/1000 live births. Many cardiac malformations are incidentally found during a routine obstetric sonogram. For this reason, it is important to identify the majority of fetuses with CHD. Once an abnormality is suspected, the patient can be referred to a maternal fetal medicine specialist and/or pediatric cardiologist for a detailed fetal echocardiogram. From the OB-GYN Department, University of South Alabama, Mobile. Correspondence: Shelly Zimbelman, RT(R)(CT), RDMS, RDCS, University of South Alabama, 1720 Center Street, Suite 101, Mobile, AL 36604. E-mail: szimbelman@usouthal.edu.

Research paper thumbnail of Synthetic Human Calcitonin Gene Related Peptide in Action

Journal of Cardiac Failure, 2010

Research paper thumbnail of HIV-1 infection of human placental villous tissue< i> in vitro</i>

Placenta, 1998

... Subbarao4, Scott S. Keesling5, George R. Lee5, Joseph Caba5, Maurice Panigel5, Richard Reichm... more ... Subbarao4, Scott S. Keesling5, George R. Lee5, Joseph Caba5, Maurice Panigel5, Richard Reichman3, Andr6 J. Nahmias5 and Richard K. Miller1 ... T6th, FD, Mosborg-Petersen, P., Kiss, J., Aboagye-Mathiesen, G., Zdravkovic, M., Hager, H., Aranyosi, J., Lamp6, L. and Ebbesen ...

Research paper thumbnail of Residual disease after neoadjuvant chemotherapy for breast cancer

Research paper thumbnail of Role of the placenta in fetal HIV infection

Research paper thumbnail of The role of the placenta in the vertical transmission of HIV and other infectious agents:: A workshop report

Placenta, 1998

... ROLE OF THE PLACENTA IN THE VERTICAL TRANSMISSION OF HIV AND OTHER INFECTIOUS AGENTS-A Worksh... more ... ROLE OF THE PLACENTA IN THE VERTICAL TRANSMISSION OF HIV AND OTHER INFECTIOUS AGENTS-A Workshop Report - Richard K. Millerl's ... 75, 1461-1468.Zdravkovic, M.,Aboagye-Mathiesen, G., Toth, F., Knudsen, HJ, Hager, H. and Ebbesen, P. (1997) The influence ...

Research paper thumbnail of Acute social and somatic stress alters cortical metaplasticity probed with non-invasive brain stimulation in humans

International Journal of Psychophysiology

Studying the neuronal mechanisms that govern the cortical adaptations to acute stress is critical... more Studying the neuronal mechanisms that govern the cortical adaptations to acute stress is critical for understanding the development of neuropsychiatric diseases. Homeostatic plasticity stabilizes the neural activity in which a previous synaptic event drives subsequent synaptic plasticity. In this study, we evaluated the effect of acute stress induced with the socially evaluated cold pressor test (SECPT) on cortical metaplasticity in humans using a non-invasive brain stimulation protocol. After being exposed to the SECPT and control stress conditions, 30 healthy participants were tested for cortical metaplasticity assessed with changes in the amplitude of the motor evoked potential (MEP) induced by a single-pulse transcranial magnetic stimulation (TMS). Cortical metaplasticity was induced by combining priming with cathodal tDCS (cTDCS) followed by a sub-threshold 1-Hz repetitive stimulation (rTMS) test session. Our results showed that SECPT induced cardiovascular adaptations (increase in systolic, diastolic blood pressure, and heart rate), indicating that SECPT effectively induced acute stress. Also, in our experiments stimulation of subjects with 1-Hz rTMS after they had undergone the SECPT condition induced inhibition of MEP whereas 1-Hz rTMS administered after the control condition induced a facilitatory (physiologic) response pattern. Here we observed that acute stress impairs homeostatic metaplasticity. The dysfunctional regulation of cortical plastic changes after stress could play a pivotal role in the pathogenesis of neurological and psychiatric diseases.

Research paper thumbnail of The Opioid Crisis: How to Lessen the Burden on Emergency Departments by At-risk Populations

Cureus

Background The opioid crisis in the United States of America has been worsening due to previous s... more Background The opioid crisis in the United States of America has been worsening due to previous sharp increases in opioid prescriptions and a lack of resources available to those affected. Emergency departments (ED) across the nation have been exhausted with a constant influx of patients related to opioid-related issues. Because of limited resources, it is crucial to efficiently distribute rehabilitation and mental wellness efforts amongst those most susceptible to opioid abuse. By identifying common environments and characteristics of the population presenting to ED's for opioid-related issues, we can (1) lessen the economic burden on the healthcare system while (2) increasing the rate of successful treatment for those affected by opioid addiction. Methods Data was obtained regarding ED visits for opioid-related issues at the level of all 50 states from the Healthcare Cost and Utilization Project's (HCUP) State Emergency Department Databases (SEDD) and nationally from the Nationwide Emergency Department Sample (NEDS). Rates of ED admissions for opioidrelated issues were statistically analyzed to identify characteristics of the population that are most at risk for presenting to the ED for opioid-related issues. Results Statistical analysis showed residents of Large Metropolitan areas (M=351.94, p=0.022, CI±42.89), those earning incomes below the 25th percentile (M=359.14, p=0.008, CI ±61.39), and 25-44-year-old population (M=456.71, p=0.001, CI±27.01) to be the most likely subset of the population to report to the ED for opioiduse issues. Conversely, those earning incomes above the 75th percentile were significantly less likely to utilize ED's for opioid-related issues (M=143.10, p=0.026, CI±0.026). Conclusion Results demonstrated that patients between the ages of 25 and 44 were more likely to develop opioid use disorders. This provides an opportunity to educate this population via opioid education centers. Additionally, residents of Large Metropolitan areas would benefit from naloxone distribution centers. Lastly, higher income levels appear to be related to a decrease in ED presentation for opioid abuse. This provides evidence for medication-assisted therapy (MAT) to be provided by low-income insurance plans.

Research paper thumbnail of Treating Bell’s Palsy With Osteopathic Manipulative Medicine: A Case Report

Cureus, 2020

Bell's palsy (BP) occurs when the facial nerve (CN VII) is swollen, inflamed, or compressed, ... more Bell's palsy (BP) occurs when the facial nerve (CN VII) is swollen, inflamed, or compressed, resulting in facial weakness or paralysis; etiology is unknown. BP patients often succumb to a decreased quality of life due to the inability to make facial expressions, increased sensitivity to auditory stimuli, and dysregulation in tear and saliva production. Despite conventional examination and therapy options, the syndrome is majorly regarded as idiopathic and left unresolved for many patients. In this case of a patient with BP, treatment with osteopathic manipulative treatment (OMT) which focused on restoring a normal structure-function relationship resolved the patient’s symptoms. The osteopathic manipulative procedures utilized findings from an osteopathic structural exam and addressed those somatic dysfunctions with OMT. The authors report that the patient's symptoms improved after the application of OMT and without the use of pharmaceuticals. The results of the case study su...

Research paper thumbnail of Circulating Cell-Free DNA to Determine the Fetal RHD Status in All Three Trimesters of Pregnancy

Obstetrics & Gynecology, 2016

Funding for this study was provided by Sequenom, Inc. Sequenom paid fees directly to Baylor Colle... more Funding for this study was provided by Sequenom, Inc. Sequenom paid fees directly to Baylor College of Medicine for salary support for the principal investigator (PI) (K.J.M.) and a central study coordinator, establishment of a web-based data collection tool, patient enrollment fees at the individual participating centers, and consultative fees for an independent statistician to analyze the final data. The study design was undertaken by the PI. All clinical data were entered into a web-based database; Sequenom had no access to the neonatal outcome data. The clinical data and corresponding DNA results generated by Sequenom Laboratories were initially released to the PI and later to an independent statistician. The manuscript was written by the PI with editorial input from all participating authors.

Research paper thumbnail of Cortical blindness post coronary angiogram: A rare but frightening complication

International Journal of Cardiology, 2016

Cortical blindness is a rare but frightening complication following coronary angiogram probably d... more Cortical blindness is a rare but frightening complication following coronary angiogram probably due to contrast penetration in occipital lobes in susceptible individuals [1, 2].

Research paper thumbnail of Importance du placenta humain dans la transmission in utero de l'infection VIH-1 : Evaluation in vitro de 21 souches virales

Reproduction Humaine Et Hormones, 2000

Les souches VIH-1 n'induisant pas la formation de syncytium (NSI) ont ete associees avec la t... more Les souches VIH-1 n'induisant pas la formation de syncytium (NSI) ont ete associees avec la transmission verticale de VIH-1 in utero, et avec l'infection de placentas humains in vitro dans une etude preliminaire utilisant trois souches virales. Pour etablir la relation existant entre le phenotype NSI et SI (induisant la formation de syncytium) de VIH-1 avec l'infection du placenta humain in vitro, nous avons utilise 21 souches differentes, en majorite de type sauvage provenant de bebes infectes in utero, intra-partum ou post-partum. Des explants placentaires villeux, de grossesses a terme non infectees, ont ete incubes durant 24 heures avec chacune des souches virales avant de subir un rincage intensif pour eliminer l'inoculum. Le tissu etait ensuite incube durant trois jours supplementaires. L'infection du tissu placentaire etait determinee par l'ADN viral amplifie par PCR (2 regions, Gag et LTR). Des 21 souches VIH-1, 38 % (8 sur 21) etaient capables d'infecter le tissu placentaire. 75 % etaient des souches NSI (6 sur 8) et 25 % des souches SI (2 sur 8). Sur le total des souches NSI, 40 % (6 sur 15) etaient infectieuses contre 33% (2 sur 6) du total des souches SI. En resume, l'infection VIH-1 du placenta humain a terme n'est pas uniquement dependante du phenotype NSI ou SI du VIH-1. De plus, toutes les souches VIH-1 isolees de bebes infectes in utero n'ont pas infecte les explants placentaires, alors que ces souches infectent les PBMC. D'autres caracteristiques de VIH-1 et du placenta lui-meme pourraient etre des elements importants de l'infectivite du placenta humain par VIH-1.

Research paper thumbnail of 17-HYDROXYPROGESTERONE Caproate for Preterm Rupture of the Membranes: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial

American journal of obstetrics and gynecology, Jan 12, 2015

Preterm rupture of membranes (PROM) is associated with increased risk of preterm birth and neonat... more Preterm rupture of membranes (PROM) is associated with increased risk of preterm birth and neonatal morbidity. Prophylactic 17-hydroxyprogesterone caproate (17OHPc) reduces the risk of preterm birth in some women at risk for preterm birth. We sought to test whether 17OHPc would prolong pregnancy or improve perinatal outcome when given to mothers with preterm rupture of the membranes. This is a multicenter, double-blind, placebo-controlled, randomized clinical trial. The study included singleton pregnancies with gestational ages between 23(0/7) to 30(6/7) weeks at enrollment, documented PROM, and no contraindication to expectant management. Consenting women were randomly assigned to receive weekly intramuscular injections of 17OHPc (250 mg) or placebo. The primary outcome was continuation of pregnancy until a favorable gestational age, defined as either 34(0/7) weeks of gestation or documentation of fetal lung maturity at 32(0/7) to 33(6/7) weeks. The two pre-specified secondary outc...

Research paper thumbnail of Moving Towards the Future of Dyslipidemia Management

Southern Medical Journal, 2010

The practice of clinical cardiology faces the continuous struggle of minimizing recurrent cardiov... more The practice of clinical cardiology faces the continuous struggle of minimizing recurrent cardiovascular events by risk factor modification. Current clinical guidelines assist the practicing physician in these efforts. Two of the primary risk factors are that of cholesterol and overall adverse dyslipidemic burden. Current guidelines are based primarily on low density lipoprotein (LDL) reduction, when in fact the spectra of cholesterol particles are much larger. The role of these particles is a topic of intense investigation although much more data needs to be produced to further clarify their significance in primary cardiovascular events. The article by Alla et al in this month’s issue of the Southern Medical Journal attempts to address some of these pitfalls in the treatment of cholesterol. As the article points out, LDL reduction to targets of 70 for those with known cardiovascular disease is the current practice; however, many of these patients continue to have major cardiovascular events. Thus the non-high density lipoprotein cholesterol (non-HDLc) remnants which are not included in LDL measurements may deserve examination and treatment. The paper provides an excellent review and discussion of this topic. The article goes on to suggest that nonHDLc reduction may lead to cardiovascular event reduction; however, there is no specific evidence to support this hypothesis. Just as the article points out that further reduction in LDL may prove to have minimal effect on event reduction, there is no clear cut evidence to suggest that non-HDLc reduction would do otherwise. There are multiple risk factors that could obviously be confounding the picture, some of which may be superior targets for intervention described in future research. It would be preferable to have outcomes based evidence that non-HDLc reduction would lead to event reduction before adopting routine practice recommendation changes and replacement of LDL directed therapy as the primary goal of lipid management. The article discusses potential therapies for non-HDLc reduction. Currently the treatment for non-HDLc is greatly limited as there are few specific medical therapies currently available over and above LDL specific interventions, and patients often do not practice beneficial lifestyle modifications. If non-HDLc is measured, and we are currently limited as to what can be done with this data, the information will simply be used for risk stratification. It would of immense value if, in fact, there were outcomes based therapies and guidelines that allowed for significant intervention. When this data is available, clinicians may be more comfortable with the utility of non-HDLc reduction therapy based on non-HDLc values. The concept of targeting non-HDLc for cardiovascular risk reduction is not novel. The difficulty lies in developing and verifying outcomes based data regarding its use. As mentioned in the article, small dense LDL, very low density lipoprotein (VLDL), and VLDL remnants have been shown to provide a more accurate surrogate for progressive atherosclerosis than LDL cholesterol alone. Apoloprotein B measurements would be an optimal measure of all the presently recognized atherogenic particles; however, the authors note that there is no streamlined or cost effective method available for these measurements. They present a very reasonable argument for considering non-HDLc as a practical alternative. At present, although non-HDLc is a potentially more attractive target for screening and intervention management of dyslipidemia than LDL cholesterol, the clinician may wish to await definitive data regarding the role of non-HDLc measurement and treatment before changing practice patterns. The present article is a useful and important reminder to the practicing physician to carefully follow the evolving field of lipid management and risk factor modification. From the Section of Cardiovascular Diseases, University of Kansas Medical Center and Hospital, Kansas City, KS. Reprint requests to James L. Vacek, MD, Mid America Cardiology, University of Kansas Hospital and Medical Center 39th and Rainbow Blvd, Kansas City, KS 66160. Email: jlvacek@mac.md Accepted November 25, 2009. Copyright © 2010 by The Southern Medical Association 0038-4348/

Research paper thumbnail of 575: 17-HYDROXYPROGESTERONE Caproate for Preterm Rupture of Membranes: A Randomized, Double-Blind, Placebo-Controlled Clinical Trial

American Journal of Obstetrics and Gynecology, 2015

ABSTRACT Preterm rupture of membranes (PROM) is associated with increased risk of preterm birth a... more ABSTRACT Preterm rupture of membranes (PROM) is associated with increased risk of preterm birth and neonatal morbidity. Prophylactic 17-hydroxyprogesterone caproate (17OHPc) reduces the risk of preterm birth in some women at risk for preterm birth. We sought to test whether 17OHPc would prolong pregnancy or improve perinatal outcome when given to mothers with preterm rupture of the membranes. This is a multicenter, double-blind, placebo-controlled, randomized clinical trial. The study included singleton pregnancies with gestational ages between 23(0/7) to 30(6/7) weeks at enrollment, documented PROM, and no contraindication to expectant management. Consenting women were randomly assigned to receive weekly intramuscular injections of 17OHPc (250 mg) or placebo. The primary outcome was continuation of pregnancy until a favorable gestational age, defined as either 34(0/7) weeks of gestation or documentation of fetal lung maturity at 32(0/7) to 33(6/7) weeks. The two pre-specified secondary outcomes were interval from randomization to delivery and composite adverse perinatal outcome. The planned sample size was 222 total women. From October, 2011 to April, 2014, 152 women were enrolled, 74 randomly allocated to 17OHPc and 78 to placebo. The trial was stopped when results of a planned interim analysis suggested that continuation was futile. The primary outcome was achieved in 3% of the 17OHPc group and 8% of the placebo group (P=0.18). There was no significant between-group difference in the pre-specified secondary outcomes, randomization-to-delivery interval (17.1 ± 16.1 versus 17.0 ± 15.8 days, respectively, P = 0.76) or composite adverse perinatal outcome (63% versus 61%, respectively, P = 0.93). No significant differences were found in other outcomes, including rates of chorioamnionitis, postpartum endometritis, cesarean delivery, individual components of the composite outcome, or prolonged neonatal length of stay. Compared to placebo, weekly 17OHPc did not prolong pregnancy or reduce perinatal morbidity in patients with PROM in this trial. Copyright © 2015 Elsevier Inc. All rights reserved.

Research paper thumbnail of In situ PCR detection of HIV expression in the human placenta

METHODS IN MOLECULAR …, 2000

... 2. Material 2.1. Explant Culture 1. Six-well and 24-well culture plates and Transwell™ insert... more ... 2. Material 2.1. Explant Culture 1. Six-well and 24-well culture plates and Transwell™ inserts (Corning Costar, Cambridge, MA). 2. RPMI 1640 and Hams F-12 (Mediatech, Herndon, VA). Page 2. 76 Sheikh, Polliotti, and Miller ... 10. Chloroform (Amresco, Solon, OH). 2.4. ...

Research paper thumbnail of Vertical transmission of HIV and the role of the placenta

Research paper thumbnail of Effect of Chronic Infusion of Cortisol on Renin Gene Expression and Renin Response to Hemorrhage in Fetal Lambs

Research paper thumbnail of Characterization of Candida Albicans Vertical and Horizontal Transmission in Very Low Birth Weight Infants Using Dna Fingerprinting Techniques ♦ 815

Research paper thumbnail of Use of a Cervicometer in Assessing Cervical Length and Risk of Preterm Birth

Obstetrics & Gynecology, 2014

Although current obstetric practice guidelines suggest cervical length assessment in singletons f... more Although current obstetric practice guidelines suggest cervical length assessment in singletons for preterm birth risk, transvaginal ultrasonography has availability limitations. CerviLenz is a disposable device to measure vaginal cervical length. We sought to determine the threshold CerviLenz measurement with optimal specificity and sensitivity for diagnosis of short cervix by transvaginal ultrasonography and compare the abilities of CerviLenz and transvaginal ultrasonography to predict preterm birth. Women with singleton pregnancies and no cervical anomalies or surgery or premature labor were consented, enrolled, and followed to delivery. Transvaginal ultrasonography and CerviLenz cervical length measurements were obtained by independent examiners at 17-23 weeks of gestation. A central reader certified sonographers and reviewed all transvaginal ultrasound scans. Based on 358 patients, receiver operator curves indicated optimal CerviLenz threshold of 30 mm to detect short cervix (transvaginal ultrasound cervical length at or below 25 mm). CerviLenz detected a short cervix with a negative predictive value (NPV) of 100%, sensitivity of 100%, and specificity of 46% (). Preterm birth before 37 weeks of gestation occurred in 25 (7%) patients. Area under the curve analyses for preterm birth before 28, 32, or 35 weeks of gestation revealed similar results for CerviLenz and transvaginal ultrasonography. For preterm birth before 37 weeks of gestation, CerviLenz had greater sensitivity (60%, transvaginal ultrasonography 16%) and transvaginal ultrasonography had higher specificity (97%, CerviLenz 44%).(Table is included in full-text article.) : At a 30-mm threshold, CerviLenz has high NPV, high sensitivity, and moderate specificity to detect a short cervical length in the second trimester. CerviLenz is similar to transvaginal ultrasonography in prediction of preterm birth at 28-37 weeks of gestation. Based on high NPV, CerviLenz is clinically useful in identifying women not at risk for preterm birth, having potential to substantially reduce the need for transvaginal ultrasound screening in singletons.

Research paper thumbnail of Fetal Echocardiography and the Routine Obstetric Sonogram

Journal of Diagnostic Medical Sonography, 2007

mations on the routine obstetric sonogram examination, it is essential that a complete basic feta... more mations on the routine obstetric sonogram examination, it is essential that a complete basic fetal cardiac evaluation is performed. Competency in the basic cardiac evaluation can be achieved through education, training, and practice. The incidence of congenital heart disease (CHD) is about 4.1/1000 to 12/1000 live births. Many cardiac malformations are incidentally found during a routine obstetric sonogram. For this reason, it is important to identify the majority of fetuses with CHD. Once an abnormality is suspected, the patient can be referred to a maternal fetal medicine specialist and/or pediatric cardiologist for a detailed fetal echocardiogram. From the OB-GYN Department, University of South Alabama, Mobile. Correspondence: Shelly Zimbelman, RT(R)(CT), RDMS, RDCS, University of South Alabama, 1720 Center Street, Suite 101, Mobile, AL 36604. E-mail: szimbelman@usouthal.edu.

Research paper thumbnail of Synthetic Human Calcitonin Gene Related Peptide in Action

Journal of Cardiac Failure, 2010

Research paper thumbnail of HIV-1 infection of human placental villous tissue< i> in vitro</i>

Placenta, 1998

... Subbarao4, Scott S. Keesling5, George R. Lee5, Joseph Caba5, Maurice Panigel5, Richard Reichm... more ... Subbarao4, Scott S. Keesling5, George R. Lee5, Joseph Caba5, Maurice Panigel5, Richard Reichman3, Andr6 J. Nahmias5 and Richard K. Miller1 ... T6th, FD, Mosborg-Petersen, P., Kiss, J., Aboagye-Mathiesen, G., Zdravkovic, M., Hager, H., Aranyosi, J., Lamp6, L. and Ebbesen ...

Research paper thumbnail of Residual disease after neoadjuvant chemotherapy for breast cancer

Research paper thumbnail of Role of the placenta in fetal HIV infection

Research paper thumbnail of The role of the placenta in the vertical transmission of HIV and other infectious agents:: A workshop report

Placenta, 1998

... ROLE OF THE PLACENTA IN THE VERTICAL TRANSMISSION OF HIV AND OTHER INFECTIOUS AGENTS-A Worksh... more ... ROLE OF THE PLACENTA IN THE VERTICAL TRANSMISSION OF HIV AND OTHER INFECTIOUS AGENTS-A Workshop Report - Richard K. Millerl's ... 75, 1461-1468.Zdravkovic, M.,Aboagye-Mathiesen, G., Toth, F., Knudsen, HJ, Hager, H. and Ebbesen, P. (1997) The influence ...