1
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Omrani AS, Abujarir SH, Ben Abid F, Shaar SH, Yilmaz M, Shaukat A, Alsamawi MS, Elgara MS, Alghazzawi MI, Shunnar KM, Zaqout A, Aldeeb YM, Alfouzan W, Almaslamani MA. Switch to oral antibiotics in Gram-negative bacteraemia: a randomized, open-label, clinical trial. Clin Microbiol Infect 2024; 30:492-498. [PMID: 37858867 DOI: 10.1016/j.cmi.2023.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 10/11/2023] [Accepted: 10/12/2023] [Indexed: 10/21/2023]
Abstract
OBJECTIVES To evaluate the safety and efficacy of switching from intravenous (IV) to oral antimicrobial therapy in patients with Enterobacterales bacteraemia, after completion of 3-5 days of microbiologically active IV therapy. METHODS A multicentre, open-label, randomized trial of adults with monomicrobial Enterobacterales bacteraemia caused by a strain susceptible to ≥1 oral beta-lactam, quinolone, or trimethoprim/sulfamethoxazole. Inclusion criteria included completion of 3-5 days of microbiologically active IV therapy, being afebrile and haemodynamically stable for ≥48 hours, and absence of an uncontrolled source of infection. Pregnancy, endocarditis, and neurological infections were exclusion criteria. Randomization, stratified by urinary source of bacteraemia, was to continue IV (IV Group) or to switch to oral therapy (Oral Group). Agents and duration of therapy were determined by the treating physicians. The primary endpoint was treatment failure, defined as death, need for additional antimicrobial therapy, microbiological relapse, or infection-related re-admission within 90 days. Non-inferiority threshold was set at 10% in the 95% CI for the difference in the proportion with treatment failure between the Oral and IV Groups in the modified intention-to-treat population. The protocol was registered at ClinicalTrials.gov (NCT04146922). RESULTS In the modified intention-to-treat population, treatment failure occurred in 21 of 82 (25.6%) in the IV Group, and 18 of 83 (21.7%) in the Oral Group (risk difference -3.7%, 95% CI -16.6% to 9.2%). The proportions of subjects with any adverse events (AE), serious AE, or AE leading to treatment discontinuation were comparable. DISCUSSION In patients with Enterobacterales bacteraemia, oral switch, after initial IV antimicrobial therapy, clinical stability, and source control, is non-inferior to continuing IV therapy.
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Affiliation(s)
- Ali S Omrani
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar; Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar; Qatar University College of Medicine, Doha, Qatar.
| | - Sulieman H Abujarir
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar; Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Fatma Ben Abid
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar; Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Shahd H Shaar
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar
| | - Mesut Yilmaz
- Department of Infectious Diseases and Microbiology, Istanbul Medipol University, Istanbul, Turkiye
| | - Adila Shaukat
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar; Division of Infectious Diseases, Department of Medicine, Al Wakra Hospital, Hamad Medical Corporation, Al Wakra, Qatar
| | - Mussad S Alsamawi
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar; Division of Infectious Diseases, Department of Medicine, Al Khor Hospital, Hamad Medical Corporation, Al Khor, Qatar
| | - Mohamed S Elgara
- Division of Internal Medicine, Department of Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed Islam Alghazzawi
- Division of Internal Medicine, Department of Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Khaled M Shunnar
- Division of Internal Medicine, Department of Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ahmed Zaqout
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar; Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Yasser M Aldeeb
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar; Division of Infectious Diseases, Department of Medicine, Al Khor Hospital, Hamad Medical Corporation, Al Khor, Qatar
| | - Wadha Alfouzan
- Department of Microbiology, Farwania Hospital, Kuwait City, Kuwait; Faculty of Medicine, Kuwait University, Kuwait City, Kuwait
| | - Muna A Almaslamani
- Communicable Diseases Center, Hamad Medical Corporation, Doha, Qatar; Division of Infectious Diseases, Department of Medicine, Hamad Medical Corporation, Doha, Qatar
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2
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Shaukat A, Marsh TL, Crockett SD, Syngal S, Bresalier RS, Brenner DE. Low Prevalence of Screen-Detected Colorectal Cancer in an Average-Risk Population: The New Normal. Clin Gastroenterol Hepatol 2022; 20:2650-2652.e1. [PMID: 34547437 PMCID: PMC8934307 DOI: 10.1016/j.cgh.2021.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/18/2021] [Accepted: 09/14/2021] [Indexed: 02/07/2023]
Abstract
Prior studies have reported the prevalence of colorectal cancer (CRC) in average-risk screening population ages 50-75 to be 0.7%-1.0%.1,2 However, no estimates from studies enrolling individuals undergoing screening colonoscopy have been reported. The experience of ongoing studies enrolling average-risk individuals is that the prevalence rates are substantially lower. A 2020 study from a community-based cohort undergoing CRC screening with fecal immunochemical testing followed by diagnostic colonoscopy reported a CRC prevalence rate of 1.46 per 1000, or 0.15%.3 The aim of our study is to report the screen-detected prevalence of CRC and advanced neoplasia in average-risk asymptomatic individuals from selected academic and community medical centers in the United States, Canada, and Germany and describe associated risk factors.
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Affiliation(s)
- A Shaukat
- Division of Gastroenterology, Department of Medicine, NYU Langone Grossman School of Medicine, New York, New York.
| | - T L Marsh
- Department of Biostatistics, Fred Hutchinson Cancer Center, Seattle, Washington
| | - S D Crockett
- Department of Medicine, University of North Carolina, Chapel Hill, North Carolina
| | - S Syngal
- Brigham and Women's Hospital, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - R S Bresalier
- Department of Gastroenterology, Hepatology and Nutrition, MD Anderson Cancer Center, Houston, Texas
| | - D E Brenner
- Department of Medicine, University of Michigan, Ann Arbor, Michigan
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3
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Shittu SA, Athar S, Shaukat A, Alansari L. Chorioamnionitis and neonatal sepsis due to extended-spectrum beta-lactamase-producing Escherichia coli infection: a case report. Clin Case Rep 2021; 9:e05078. [PMID: 34849226 PMCID: PMC8609183 DOI: 10.1002/ccr3.5078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/15/2021] [Accepted: 10/22/2021] [Indexed: 11/24/2022] Open
Abstract
Chorioamnionitis is an acute inflammation of the membranes and chorion of the placenta typically due to ascending polymicrobial infection in the setting of membrane rupture. It is a common complication of pregnancy associated with significant maternal, perinatal, and long-term adverse outcomes. We present a case of placental infection leading to preterm delivery, severe neonatal sepsis, maternal wound infection, postnatal readmission, and prolonged hospital stay. This virulent infection was caused by multidrug-resistant extended-spectrum beta-lactamase (ESBL)-producing Escherichia Coli (E. Coli), which represent a major worldwide threat according to the Centre for Disease Control and Prevention (CDC). It was managed with appropriate antibiotic therapy, patient-centered approach, and multidisciplinary team involvement that led to favourable maternal and neonatal outcome.
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Affiliation(s)
- Saheed Akinola Shittu
- Department of Obstetrics and GynaecologyAl Wakra HospitalHamad Medical CorporationDohaQatar
| | - Sufia Athar
- Department of Obstetrics and GynaecologyAl Wakra HospitalHamad Medical CorporationDohaQatar
| | - Adila Shaukat
- Infectious Disease UnitDivision of MedicineAl Wakra HospitalHamad Medical CorporationDohaQatar
| | - Lolwa Alansari
- Department of Obstetrics and GynaecologyAl Wakra HospitalHamad Medical CorporationDohaQatar
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4
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Ellithy M, Mitwally H, Saad M, Mathias R, Shaukat A, Elzeer H, Hassan Koya S, Mahmood Z, Gazwi K. Mortality incidence among critically ill burn patients infected with multidrug-resistant organisms: A retrospective cohort study. Scars Burn Heal 2021; 7:20595131211015133. [PMID: 34104480 PMCID: PMC8155764 DOI: 10.1177/20595131211015133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Many risk factors have been reported to increase mortality among burn patients. Previously, a higher mortality incidence was reported in acute burn patients infected with multidrug-resistant organisms (MDROs) when compared to patients infected with non-MDROs. However, considering this as an independent risk factor for mortality in acute burn patients is not yet confirmed. METHODS We conducted an observational retrospective study in Qatar. We included adult patients admitted to the surgical intensive care unit (ICU) between January 2015 and December 2017 with burn injuries involving either at least 15% of the total body surface area (TBSA) or less than 15% with facial involvement. All patients developed infection with a positive culture of either MDRO or non-MDRO. The primary outcome was in-hospital mortality. Other outcomes included days of mechanical ventilation, ICU, length of stay in hospital, and requirement of vasoactive agents. RESULTS Fifty-eight patients were included in the final analysis: 33 patients in the MDRO group and 25 patients in the non-MDRO group. Six patients (18.2%) died in the MDRO group versus four patients (16%) in the non-MDRO group (P = 1). No significant difference was observed between the two groups with regard to the ICU length of stay. However, there was a trend towards increased median length of stay in hospital in the MDRO group: 62 days versus 45 days in the non-MDRO group (P = 0.057). No significant differences were observed in the other outcomes. CONCLUSION In severely burned patients, infection with MDRO was not associated with increased mortality. There was a trend towards increased hospitalisation in MDRO-infected patients. Further studies with a larger sample size are needed to confirm these results. LAY SUMMARY Many factors affect mortality in burn patients admitted to the intensive care unit, such as age, total body surface area involved in the injury, and others. In this retrospective study, we evaluated whether wound infection with a bacterial organism resistant to multiple classes of antibiotics (multidrug-resistant) is considered an independent risk factor for mortality in critically ill burn patients. We included 58 patients requiring intensive care admission with burn injuries involving 15% or more of the total body surface area or less than 15% but with facial involvement. A total of 33 patients were infected with multidrug-resistant organisms (MDROs) and 25 patients with non-MDROs. Six patients (18.2%) from the MDRO group died versus four (16%) in the non-MDRO group. The MDRO group required a longer stay in hospital and an average of one more day on a mechanical ventilator. We concluded that wound infection with MDROs might not increase mortality when compared to wound infection with non-MDROs, although other studies with a larger number of patients involved need to be conducted to validate these results.
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Affiliation(s)
- Moustafa Ellithy
- Department of Critical Care, Hazm
Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Hassan Mitwally
- Department of Pharmacy,
Al-Wakra-Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mohamed Saad
- Department of Pharmacy,
Al-Wakra-Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ranjan Mathias
- Department of Anesthesiology/Critical
Care, Al-Wakra-Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Adila Shaukat
- Department of Medicine-Infectious
Diseases, Al-Wakra Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Hani Elzeer
- Critical Care Departement, Al-Wakra
Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Sunil Hassan Koya
- Critical Care Departement, Al-Wakra
Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Zia Mahmood
- Department of Anesthesiology/Critical
Care, Al-Wakra Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Khaled Gazwi
- Critical Care Departement, Al-Wakra
Hospital, Hamad Medical Corporation, Doha, Qatar
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5
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Shaukat A, Al Ansari N, Al Wali W, Karic E, El Madhoun I, Mitwally H, Hamed M, Alutra-Visan F. Experience of treating Candida auris cases at a general hospital in the state of Qatar. IDCases 2020; 23:e01007. [PMID: 33299794 PMCID: PMC7702000 DOI: 10.1016/j.idcr.2020.e01007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 11/09/2020] [Indexed: 11/22/2022] Open
Abstract
Candida. auris can cause invasive infections, including bloodstream, urinary tract, skin and ssoft tissue and lower respiratory tract infections. Identification of C. auris requires specialized laboratory methods. C. auris is associated with high morbidity and mortality. C. auris isolates were resistant to the common antifungal agents such as fluconazole and amphotericin B.
Background and objectives So far there have been no studies on Candida auris in Qatar. This study aimed to describe the clinical spectrum and outcome of C. auris infection in patients admitted to a general hospital in Qatar. Methods We conducted this descriptive observational study in a general hospital in Qatar. We have involved all patients with C. auris infection and colonization admitted to a general hospital from December 2018 to August 2019. Results We identified 13 patients with confirmed C.auris infection/colonization, of which five cases represented an actual C. auris infection, while the remaining eight cases were considered as colonization. The mean age of the patients with infection was 76.6 ± 8.4 years, while the mean age of the patients with colonization was 66.4 ± 24.7 years. Among the individuals clinically infected with C. auris, two had urinary tract infections, one had candidemia, one acquired soft tissue infection, and one had a lower respiratory tract infection. All strains of C. auris were susceptible to echinocandins, flucytosine, and posaconazole while resistance to fluconazole and amphotericin B. Of the patients with C. auris infection who received systemic antifungal therapy, three (60%) died during antifungal therapy. Conclusion Our study showed that C. auris can cause a wide variety of invasive infections, including bloodstream infection, urinary tract infection, skin infection, and lower respiratory tract infections, especially in critically ill patients. In addition, our isolates showed resistance to the most common antifungal agents such as fluconazole and amphotericin B.
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Affiliation(s)
- Adila Shaukat
- Infectious Disease Section, Department of Medicine, Al Wakra Hospital, Hamad Medical Corporation (HMC), Qatar
| | - Nasir Al Ansari
- Infection Prevention and Control Department, Al Wakra Hospital, HMC, Qatar
| | - Walid Al Wali
- Department of Laboratory Medicine and Pathology, HMC, Qatar
| | - Edin Karic
- Critical Care Dept, Al Wakra Hospital, HMC, Qatar
| | | | | | | | - Feah Alutra-Visan
- Infection Prevention and Control Department, Al Wakra Hospital, HMC, Qatar
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6
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Ford T, Yii E, Morrow A, Sidik N, Good R, Rocchiccioli J, McEntegart M, Watkins S, Eteiba H, Shaukat A, Lindsay M, Robertson K, Hood S, Oldroyd K, Berry C. Angina, quality of life and prognosis: prospective comparison of patients undergoing invasive management. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1361] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Angina is associated with impaired quality of life and an adverse prognosis.
Purpose
Prospectively evaluate quality of life and clinical outcomes in patients with angina undergoing invasive coronary angiography according to endotype: symptoms and/or signs of ischaemia and no obstructive coronary artery disease (INOCA) compared to obstructive coronary artery disease subjects managed by medical therapy, revascularization with percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) surgery, respectively.
Methods
We conducted a prospective clinical evaluation of patients with angina undergoing clinically indicated invasive management (NCT03193294). Symptom severity and quality of life were assessed at baseline and repeated after 6 months. Comparisons between treatment groups were based on analysis of covariance general linear models adjusting for baseline score, sex, and cardiovascular risk. INOCA subjects were considered as one diagnostic group and not all subjects had invasive vasoreactivity testing.
Results
391 patients (mean age 62±10 years, 52% female) were enrolled over 12 months and classified into one of four groups: INOCA (N=185; 47%), obstructive CAD treated by PCI (N=126; 32%), obstructive CAD treated by CABG (N=48; 12%) and obstructive CAD managed with medical therapy (N=32; 8%). After adjusting for between group differences and overall risk, INOCA subjects had worse angina and worse treatment response at follow up (21% and 27% reduction in angina score compared to CAD patients revascularized with PCI and CABG respectively). INOCA subjects had numerically lower treatment response than CAD patients managed with medications (6.4 units, −12%; P=0.181). Population baseline mean Seattle Angina Questionnaire (SAQ) frequency score (60±26) and SAQ summary score (52.5±19) were similar between groups. The absolute difference was 6.4 units versus medically managed CAD (95% CI: −3.0 to 15.9; P=0.181), 11.3 units versus the CAD group undergoing PCI (6.1 to 16.5; P<0.001) and 14.3 units versus CABG (6.2 to 22.3; P=0.001). INOCA subjects had overall reduced quality of life (EQ5D index) and increased psychological distress scores versus all CAD groups at 6 months. During longer-term follow-up (median 18 months), 23 (6%) MACE events occurred with no differences between the groups (Kaplan Meier log-rank P=0.890).
Conclusion(s)
Patients with INOCA had more severe angina symptoms reflecting worse quality of life and treatment response at 6 months with similar MACE as CAD subjects even after adjustment for confounding factors. This study highlights the need for evidence-based antianginal therapies and disease-modifying treatments for angina patients regardless of the presence of obstructive coronary disease.
Figure 1
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): This work was funded by the British Heart Foundation (PG/17/2532884; RE/13/5/30177; RE/18/6134217)
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Affiliation(s)
- T.J Ford
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Cardiology, Glasgow, United Kingdom
| | - E Yii
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Cardiology, Glasgow, United Kingdom
| | - A Morrow
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Cardiology, Glasgow, United Kingdom
| | - N Sidik
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Cardiology, Glasgow, United Kingdom
| | - R Good
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | | | - M McEntegart
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Cardiology, Glasgow, United Kingdom
| | - S Watkins
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Cardiology, Glasgow, United Kingdom
| | - H Eteiba
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Cardiology, Glasgow, United Kingdom
| | - A Shaukat
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - M.M Lindsay
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - K Robertson
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - S Hood
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - K.G Oldroyd
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Cardiology, Glasgow, United Kingdom
| | - C Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Cardiology, Glasgow, United Kingdom
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Bajaj JS, Brenner DM, Cai Q, Cash BD, Crowell M, DiBaise J, Gallegos-Orozco JF, Gardner TB, Gyawali CP, Ha C, Holtmann G, Jamil LH, Kaplan GG, Karsan HA, Kinoshita Y, Lebwohl B, Leontiadis GI, Lichtenstein GR, Longstreth GF, Muthusamy VR, Oxentenko AS, Pimentel M, Pisegna JR, Rubenstein JH, Russo MW, Saini SD, Samadder NJ, Shaukat A, Simren M, Stevens T, Valdovinos M, Vargas H, Spiegel B, Lacy BE. Major Trends in Gastroenterology and Hepatology Between 2010 and 2019: An Overview of Advances From the Past Decade Selected by the Editorial Board of The American Journal of Gastroenterology. Am J Gastroenterol 2020; 115:1007-1018. [PMID: 32618649 DOI: 10.14309/ajg.0000000000000709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- J S Bajaj
- Virginia Commonwealth University and McGuire VA Medical Center, Richmond, Virginia, USA
| | - D M Brenner
- Northwestern University, Chicago Illinois, USA
| | - Q Cai
- Emory University, Atlanta, Georgia, USA
| | - B D Cash
- McGovern Medical School, Houston, Texas, USA
| | - M Crowell
- Mayo Clinic, Scottsdale, Arizona, USA
| | - J DiBaise
- Mayo Clinic, Scottsdale, Arizona, USA
| | | | - T B Gardner
- Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA
| | - C P Gyawali
- Division of Gastroenterology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - C Ha
- Inflammatory Bowel Diseases Center, Cedars-Sinai Medical Center, Los Angeles CA, USA
| | - G Holtmann
- University of Queensland, Brisbane, Australia, USA
| | - L H Jamil
- Beaumont Health-Royal Oak, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, USA
| | - G G Kaplan
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - H A Karsan
- Atlanta Gastroenterology Associates and Emory University, Atlanta, Georgia, USA
| | - Y Kinoshita
- Steel Memorial Hirohata Hospital and Himeji Brain and Heart Center, Himeji, Japan
| | - B Lebwohl
- Columbia University Irving Medical Center, New York, New York, USA
| | | | | | - G F Longstreth
- Kaiser Permanente Southern California, San Diego, California, USA
| | - V R Muthusamy
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | | | - M Pimentel
- Inflammatory Bowel Diseases Center, Cedars-Sinai Medical Center, Los Angeles CA, USA
| | - J R Pisegna
- Department of Veterans Affairs, VA Greater Los Angeles Healthcare System and David Geffen School of Medicine at UCLA Los Angeles, California, USA
| | - J H Rubenstein
- Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA
- Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | - M W Russo
- Carolinas Medical Center-Atrium Health, Charlotte, North Carolina, USA
| | - S D Saini
- Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan, USA
- Division of Gastroenterology, University of Michigan Medical School, Ann Arbor, Michigan, USA
| | | | - A Shaukat
- Minneapolis Veterans Affairs Medical Center and University of Minnesota, Minneapolis, Minnesota, USA
| | - M Simren
- Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - T Stevens
- Cleveland Clinic, Cleveland, Ohio, USA
| | - M Valdovinos
- Instituto Nacional de Ciencias Médicas y Nutricion S.Z., Mexico City, Mexico
| | - H Vargas
- Mayo Clinic, Scottsdale, Arizona, USA
| | - B Spiegel
- Inflammatory Bowel Diseases Center, Cedars-Sinai Medical Center, Los Angeles CA, USA
| | - B E Lacy
- Mayo Clinic, Jacksonville, Florida, USA
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8
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Song KY, Henn AJ, Gravely AA, Mesa H, Sultan S, Shaheen NJ, Shaukat A, Hanson BJ. Persistent confirmed low-grade dysplasia in Barrett's esophagus is a risk factor for progression to high-grade dysplasia and adenocarcinoma in a US Veterans cohort. Dis Esophagus 2020; 33:5528455. [PMID: 31274147 DOI: 10.1093/dote/doz061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2019] [Revised: 04/29/2019] [Accepted: 05/31/2019] [Indexed: 12/11/2022]
Abstract
Patients with Barrett's esophagus (BE) and low-grade dysplasia (LGD) are at increased risk of esophageal adenocarcinoma (EAC), although many regress to nondysplastic BE. This has significant clinical importance for patients being considered for endoscopic eradication therapy. Our aim is to determine the risk for progression in patients with confirmed persistent LGD. We performed a single-center retrospective cohort study of patients with BE and confirmed LGD between 2006 and 2016. Confirmed LGD was defined as LGD diagnosed by consensus conference with an expert GI pathologist or review by an expert GI pathologist and persistence as LGD present on subsequent endoscopic biopsy. The primary outcome was the incidence rate of HGD (high-grade dysplasia)/EAC. Secondary outcomes included risk factors for dysplastic progression. Risk factors for progression were assessed using univariate and multivariate analysis with logistic regression. Of 69 patients (mean age 65.2 years) with confirmed LGD were included. In total, 16 of 69 patients (23.2%) with LGD developed HGD/EAC during a median follow-up of 3.74 years (IQR, 1.24-5.45). For persistent confirmed LGD, the rate was 6.44 (95% confidence interval (CI), 2.61-13.40) compared to 2.61 cases per 100 patient-years (95% CI, 0.83-6.30) for nonpersistent LGD. Persistent LGD was found in only 29% of patients. Persistent LGD was an independent risk factor for the development of HGD/EAC (OR 4.18; [95% CI, 1.03-17.1]). Persistent confirmed LGD, present in only 1/3 of patients, was an independent risk factor for the development of HGD/EAC. Persistence LGD may be useful in decision making regarding the management of BE.
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Affiliation(s)
| | - A J Henn
- Division of Gastroenterology, and University of Minnesota
| | | | - H Mesa
- Department of Laboratory Medicine, Minneapolis VA Health Care System, and Pathology, Minneapolis Veteran Affairs Health Care System
| | - S Sultan
- Division of Gastroenterology, and University of Minnesota.,Section of Gastroenterology, Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - N J Shaheen
- Division of Gastroenterology and Hepatology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - A Shaukat
- Division of Gastroenterology, and University of Minnesota.,Section of Gastroenterology, Minneapolis VA Health Care System, Minneapolis, Minnesota
| | - B J Hanson
- Division of Gastroenterology, and University of Minnesota.,Section of Gastroenterology, Minneapolis VA Health Care System, Minneapolis, Minnesota
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9
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Maznyczka A, McCartney P, Oldroyd KG, McEntegart M, Lindsay M, Eteiba H, Rocchiccioli P, Good R, Shaukat A, Kodoth V, Greenwood J, Robertson K, Cotton J, McConnachie A, Berry C. P2707Invasive coronary physiology during primary percutaneous coronary intervention in patients treated with intracoronary alteplase or placebo: the double-blind T-TIME physiology substudy. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.1024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Impaired microcirculatory reperfusion worsens prognosis post-primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI). Intracoronary (IC) alteplase targets persisting thrombus post-reperfusion & distal embolisation. In the T-TIME trial microvascular obstruction on cardiac magnetic resonance (CMR) did not differ with IC alteplase vs placebo.
Purpose
To prospectively determine if index of microcirculatory resistance (IMR) is lower & coronary flow reserve (CFR) or resistive reserve ratio (RRR) are higher (improved) with IC alteplase, & to provide mechanistic insights.
Methods
A pre-planned substudy of the main protocol. From 2016–2017, STEMI patients from 3 UK hospitals ≤6 hrs ischaemic time were randomised in a 1:1:1 dose-ranging, double-blind design. Following standard care reperfusion, alteplase (10 or 20mg) or placebo was infused over 5–10 mins proximal to the culprit lesion pre-stenting. IMR (primary outcome), CFR & RRR (secondary outcomes) were measured in the culprit artery post-PCI. Physiology results were obscured from clinicians acquiring the data, to maintain blinding. CMR was performed 2 days & 3 months post-STEMI. Subgroup analyses were prespecified including by ischaemic time (<2 hours, 2–4 hrs, >4 hrs) & IMR threshold >32.
Results
In 144 patients (mean age 59 yrs, 80% male), IMR, CFR or RRR post-PCI did not differ with alteplase vs placebo (Table). Patients with ischaemic time <2 hrs had a dose related increase in CFR (placebo 1.2 [IQR 1.1–1.7], alteplase 10mg 1.4 [IQR 1.0–1.8], alteplase 20mg 2.0 [IQR 1.8–2.3] p=0.01 for interaction) & RRR (placebo 1.5 [IQR 1.3–1.9], alteplase 10mg 1.6 [1.1–2.2], alteplase 20mg 2.2 [2.0–2.6], p=0.03 for interaction). In subjects with post-PCI IMR>32, % ST-resolution at 60 mins was worse with alteplase 10mg vs placebo (23.1±53.9 vs 50.9±31.5) & in those with IMR≤32% ST-resolution at 60 mins was better with alteplase 20mg vs placebo (68.0±30.7 vs 39.1±43.2), p=0.002 for interaction. The CMR findings in the substudy & overall trial populations were consistent.
Main results Placebo Alteplase 10mg Alteplase 20mg (n=53) (n=41) (n=50) IMR, median (IQR) 33.0 (17.0–57.0) 22.0 (17.0–42.0) 37.0 (20.0–57.8) p=0.15 p=0.78 CFR, median (IQR) 1.3 (1.1–1.8) 1.4 (1.1–1.9) 1.5 (1.1–2.0) p=0.92 p=0.74 RRR, median (IQR) 1.6 (1.3–2.2) 1.6 (1.4–2.6) 1.8 (1.3–2.4) p=0.69 p=0.81 P-values for comparison of alteplase with placebo.
Conclusions
In acute STEMI with ischaemic time ≤6 hrs, IMR, CFR or RRR post-PCI did not differ with alteplase vs placebo. In those with shorter ischaemic times (<2 hrs) CFR & RRR, but not IMR, were improved with alteplase. We observed interactions between alteplase dose, ischaemic time & mechanisms of effect.
Acknowledgement/Funding
Dr Maznyczka is funded by a fellowship from the British Heart Foundation (FS/16/74/32573). T-TIME was funded by grant 12/170/4 from NIHR-EME
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Affiliation(s)
- A Maznyczka
- University of Glasgow, Glasgow, United Kingdom
| | - P McCartney
- University of Glasgow, Glasgow, United Kingdom
| | - K G Oldroyd
- University of Glasgow, Glasgow, United Kingdom
| | - M McEntegart
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - M Lindsay
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - H Eteiba
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - P Rocchiccioli
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - R Good
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - A Shaukat
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - V Kodoth
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - J Greenwood
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - K Robertson
- Golden Jubilee National Hospital, Glasgow, United Kingdom
| | - J Cotton
- New Cross Hospital, Wolverhampton, United Kingdom
| | | | - C Berry
- University of Glasgow, Glasgow, United Kingdom
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10
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Cacciottolo TM, Perikari A, van der Klaauw A, Henning E, Stadler LKJ, Keogh J, Farooqi IS, Tenin G, Keavney B, Ryan E, Budd R, Bewley M, Coelho P, Rumsey W, Sanchez Y, McCafferty J, Dockrell D, Walmsley S, Whyte M, Liu Y, Choy MK, Tenin G, Abraham S, Black G, Keavney B, Ford T, Stanley B, Good R, Rocchiccioli P, McEntegart M, Watkins S, Eteiba H, Shaukat A, Lindsay M, Robertson K, Hood S, McGeoch R, McDade R, Sidik N, McCartney P, Corcoran D, Collison D, Rush C, McConnachie A, Touyz R, Oldroyd K, Berry C, Gazdagh G, Diver L, Marshall J, McGowan R, Ahmed F, Tobias E, Curtis E, Parsons C, Maslin K, D'Angelo S, Moon R, Crozier S, Gossiel F, Bishop N, Kennedy S, Papageorghiou A, Fraser R, Gandhi S, Prentice A, Inskip H, Godfrey K, Schoenmakers I, Javaid MK, Eastell R, Cooper C, Harvey N, Watt ER, Howden A, Mirchandani A, Coelho P, Hukelmann JL, Sadiku P, Plant TM, Cantrell DA, Whyte MKB, Walmsley SR, Mordi I, Forteath C, Wong A, Mohan M, Palmer C, Doney A, Rena G, Lang C, Gray EH, Azarian S, Riva A, Edwards H, McPhail MJW, Williams R, Chokshi S, Patel VC, Edwards LA, Page D, Miossec M, Williams S, Monaghan R, Fotiou E, Santibanez-Koref M, Keavney B, Badat M, Mettananda S, Hua P, Schwessinger R, Hughes J, Higgs D, Davies J. Scientific Business Abstracts of the 113th Annual Meeting of the Association of Physicians of Great Britain and Ireland. QJM 2019; 112:724-729. [PMID: 31505685 DOI: 10.1093/qjmed/hcz175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - A Perikari
- University of Cambridge Metabolic Research Laboratories
| | | | - E Henning
- University of Cambridge Metabolic Research Laboratories
| | - L K J Stadler
- University of Cambridge Metabolic Research Laboratories
| | - J Keogh
- University of Cambridge Metabolic Research Laboratories
| | - I S Farooqi
- University of Cambridge Metabolic Research Laboratories
| | - G Tenin
- From University of Manchester
| | | | - E Ryan
- Department of Respiratory Medicine, Centre for Inflammation Research, University of Edinburgh
| | - R Budd
- Department of Infection Immunity and Cardiovascular Disease, The Florey Institute for Host-Pathogen Interactions, University of Sheffield
| | - M Bewley
- Department of Infection Immunity and Cardiovascular Disease, The Florey Institute for Host-Pathogen Interactions, University of Sheffield
| | - P Coelho
- Department of Respiratory Medicine, Centre for Inflammation Research, University of Edinburgh
| | - W Rumsey
- Stress and Repair Discovery Performance Unit, Respiratory Therapy Area
| | - Y Sanchez
- Stress and Repair Discovery Performance Unit, Respiratory Therapy Area
| | - J McCafferty
- Department of Respiratory Medicine, Centre for Inflammation Research, University of Edinburgh
| | - D Dockrell
- Department of Respiratory Medicine, Centre for Inflammation Research, University of Edinburgh
| | - S Walmsley
- Department of Respiratory Medicine, Centre for Inflammation Research, University of Edinburgh
| | - M Whyte
- Department of Respiratory Medicine, Centre for Inflammation Research, University of Edinburgh
| | - Y Liu
- From the University of Manchester
| | - M-K Choy
- From the University of Manchester
| | - G Tenin
- From the University of Manchester
| | | | - G Black
- From the University of Manchester
| | | | - T Ford
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | | | - R Good
- Golden Jubilee National Hospital
| | - P Rocchiccioli
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | - M McEntegart
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | | | - H Eteiba
- Golden Jubilee National Hospital
| | | | | | | | - S Hood
- Golden Jubilee National Hospital
| | | | - R McDade
- Golden Jubilee National Hospital
| | - N Sidik
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | - P McCartney
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | - D Corcoran
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | - D Collison
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | - C Rush
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | | | - R Touyz
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
| | - K Oldroyd
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | - Colin Berry
- BHF Centre of Excellence in Vascular Science and Medicine, University of Glasgow
- Golden Jubilee National Hospital
| | - G Gazdagh
- School of Medicine, Dentistry & Nursing, College of Medical, Veterinary and Life Sciences, University of Glasgow
| | - L Diver
- West of Scotland Regional Genetics Service, Laboratory Medicine Building, Queen Elizabeth University Hospital
| | - J Marshall
- Institute of Cancer Sciences, College of Medical, Veterinary and Life Sciences, University of Glasgow
| | - R McGowan
- West of Scotland Regional Genetics Service, Laboratory Medicine Building, Queen Elizabeth University Hospital
| | - F Ahmed
- Developmental Endocrinology Research Group, Royal Hospital for Children, University of Glasgow
| | - E Tobias
- Academic Unit of Medical Genetics and Clinical Pathology, Laboratory Medicine Building, Queen Elizabeth University Hospital, University of Glasgow
| | - E Curtis
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | - C Parsons
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | - K Maslin
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | - S D'Angelo
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | - R Moon
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | - S Crozier
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | - F Gossiel
- Academic Unit of Bone Metabolism, University of Sheffield
| | - N Bishop
- Academic Unit of Child Health, University of Sheffield
| | - S Kennedy
- Nuffield Department of Women's & Reproductive Health, John Radcliffe Hospital, University of Oxford
| | - A Papageorghiou
- Nuffield Department of Women's & Reproductive Health, John Radcliffe Hospital, University of Oxford
| | - R Fraser
- Department of Obstetrics and Gynaecology, Sheffield Hospitals NHS Trust, University of Sheffield
| | - S Gandhi
- Department of Obstetrics and Gynaecology, Sheffield Hospitals NHS Trust, University of Sheffield
| | | | - H Inskip
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | - K Godfrey
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | - I Schoenmakers
- Department of Medicine, Faculty of Medicine and Health Sciences, University of East Anglia
| | - M K Javaid
- NIHR Oxford Biomedical Research Centre, University of Oxford
| | - R Eastell
- Academic Unit of Bone Metabolism, University of Sheffield
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | - N Harvey
- MRC Lifecourse Epidemiology Unit, University of Southampton
| | | | - A Howden
- School of Life Sciences, University of Dundee
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - E H Gray
- Institute of Hepatology, Foundation for Liver Research
- School of Immunology and Microbial Sciences, King's College London
| | - S Azarian
- Institute of Hepatology, Foundation for Liver Research
| | - A Riva
- Institute of Hepatology, Foundation for Liver Research
- School of Immunology and Microbial Sciences, King's College London
| | - H Edwards
- Institute of Hepatology, Foundation for Liver Research
- School of Immunology and Microbial Sciences, King's College London
| | - M J W McPhail
- School of Immunology and Microbial Sciences, King's College London
- Institute of Liver Studies & Transplantation, King's College Hospital
| | - R Williams
- Institute of Hepatology, Foundation for Liver Research
- School of Immunology and Microbial Sciences, King's College London
| | - S Chokshi
- Institute of Hepatology, Foundation for Liver Research
- School of Immunology and Microbial Sciences, King's College London
| | - V C Patel
- Institute of Hepatology, Foundation for Liver Research
- School of Immunology and Microbial Sciences, King's College London
- Institute of Liver Studies & Transplantation, King's College Hospital
| | - L A Edwards
- Institute of Hepatology, Foundation for Liver Research
- School of Immunology and Microbial Sciences, King's College London
| | - D Page
- University of Manchester
- Manchester Metropolitan University
| | - M Miossec
- Manchester Metropolitan University
- University of Newcastle
| | | | | | | | | | | | - M Badat
- MRC Molecular Haematology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital
| | - S Mettananda
- Department of Paediatrics, Faculty of Medicine, University of Kelaniya
| | - P Hua
- MRC Molecular Haematology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital
| | - R Schwessinger
- MRC Molecular Haematology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital
| | - J Hughes
- MRC Molecular Haematology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital
| | - D Higgs
- MRC Molecular Haematology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital
| | - J Davies
- MRC Molecular Haematology Unit, MRC Weatherall Institute of Molecular Medicine, University of Oxford, John Radcliffe Hospital
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11
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Abstract
Despite the high prevalence of tuberculosis (TB) in developing countries, primary pancreatic TB is a rare entity. We present a case of pancreatic TB in an immunocompetent patient who was found to have pancreatic mass resembling malignancy. A 40-year-old Indian male presented to the medical emergency room with complaints of abdominal pain and fever for 2 weeks' duration. He had a history of unintentional weight loss of about 20 pounds in the past 2 months. There was no significant history of exposure to TB patient. Family history was unremarkable for any malignancy. On examination, the significant finding was epigastric tenderness. He was thoroughly investigated, his purified protein derivative and QuantiFERON were negative. Chest X-ray was unremarkable. Computed tomography scan abdomen was performed that revealed large heterogenous necrotic mass in the lesser sac likely arising from pancreatic body with possible infiltration of the stomach, left lobe of the liver and encasing celiac vessels and portal vein with multiple peripancreatic and retroperitoneal necrotic lymph nodes. Endoscopic ultrasound with fine-needle aspiration of pancreatic mass was done, biopsy specimen revealed the presence of inflammation with no evidence of malignancy. TB polymerase chain reaction and culture came positive for Mycobacterium tuberculosis. He was started on antituberculosis treatment with isoniazid, rifampicin, pyrazinamide, and ethambutol with a plan to continue for total 6 months. However, follow-up of the patient could not be done as he traveled back to his home country.
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Affiliation(s)
- Maisa Ali
- Department of Medicine, Division of Infectious Diseases, Hamad Medical Corporation, Doha, Qatar
| | - Adila Shaukat
- Department of Medicine, Division of Infectious Diseases, Hamad Medical Corporation, Doha, Qatar
| | | | - Muna Al-Maslamani
- Department of Medicine, Division of Infectious Diseases, Hamad Medical Corporation; Weill Cornell Medicine, Doha, Qatar
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12
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Chauhan A, Lalor T, Watson S, Adams D, Farrah TE, Anand A, Kimmitt R, Mills NL, Webb DJ, Dhaun N, Kalla R, Adams A, Vatn S, Bonfliglio F, Nimmo E, Kennedy N, Ventham N, Vatn M, Ricanek P, Halfvarson J, Soderhollm J, Pierik M, Torkvist L, Gomollon F, Gut I, Jahnsen J, Satsangi J, Body R, Almashali M, McDowell G, Taylor P, Lacey A, Rees A, Dayan C, Lazarus J, Nelson S, Okosieme O, Corcoran D, Young R, Ciadella P, McCartney P, Bajrangee A, Hennigan B, Collison D, Carrick D, Shaukat A, Good R, Watkins S, McEntegart M, Watt J, Welsh P, Sattar N, McConnachie A, Oldroyd K, Berry C, Parks T, Auckland K, Mentzer AJ, Kado J, Mirabel MM, Kauwe JK, Robson KJ, Mittal B, Steer AC, Hill AVS, Akbar M, Forrester M, Virlan AT, Gilmour A, Wallace C, Paterson C, Reid D, Siebert S, Porter D, Liversidge J, McInnes I, Goodyear C, Athwal V, Pritchett J, Zaitoun A, Irving W, Guha IN, Hanley NA, Hanley KP, Briggs T, Reynolds J, Rice G, Bondet V, Bruce E, Crow Y, Duffy D, Parker B, Bruce I, Martin K, Pritchett J, Aoibheann Mullan M, Llewellyn J, Athwal V, Zeef L, Farrow S, Streuli C, Henderson N, Friedman S, Hanley N, Hanley KP. Scientific Business Abstracts of the 112th Annual Meeting of the Association of Physicians of Great Britain and Ireland. QJM 2018; 111:920-924. [PMID: 31222346 DOI: 10.1093/qjmed/hcy193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - T Lalor
- From the University of Birmingham
| | - S Watson
- From the University of Birmingham
| | - D Adams
- From the University of Birmingham
| | - T E Farrah
- From the University/British Heart Foundation Centre of Research Excellence, University of Edinburgh
| | - A Anand
- From the University/British Heart Foundation Centre of Research Excellence, University of Edinburgh
| | - R Kimmitt
- From the University/British Heart Foundation Centre of Research Excellence, University of Edinburgh
| | - N L Mills
- From the University/British Heart Foundation Centre of Research Excellence, University of Edinburgh
| | - D J Webb
- From the University/British Heart Foundation Centre of Research Excellence, University of Edinburgh
| | - N Dhaun
- From the University/British Heart Foundation Centre of Research Excellence, University of Edinburgh
| | - R Kalla
- From the University of Edinburgh
| | - A Adams
- From the University of Edinburgh
| | - S Vatn
- Akerhshus University Hospital
| | | | - E Nimmo
- From the University of Edinburgh
| | | | | | | | | | | | | | - M Pierik
- Maastricht University Medical Centre
| | | | | | | | | | | | - R Body
- From the University of Manchester
| | - M Almashali
- Manchester University Hospitals Foundation NHS Trust
| | | | | | | | - A Rees
- From the Cardiff University
| | | | | | | | | | - D Corcoran
- From the British Heart Foundation (BHF), Glasgow Cardiovascular Research Centre, University of Glasgow
| | - R Young
- Robertson Centre for Biostatistics, University of Glasgow
| | - P Ciadella
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital
| | - P McCartney
- From the British Heart Foundation (BHF), Glasgow Cardiovascular Research Centre, University of Glasgow
| | - A Bajrangee
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital
| | - B Hennigan
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital
| | - D Collison
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital
| | - D Carrick
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital
| | - A Shaukat
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital
| | - R Good
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital
| | - S Watkins
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital
| | - M McEntegart
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital
| | - J Watt
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital
| | - P Welsh
- From the British Heart Foundation (BHF), Glasgow Cardiovascular Research Centre, University of Glasgow
| | - N Sattar
- From the British Heart Foundation (BHF), Glasgow Cardiovascular Research Centre, University of Glasgow
| | - A McConnachie
- Robertson Centre for Biostatistics, University of Glasgow
| | - K Oldroyd
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital
| | - C Berry
- From the British Heart Foundation (BHF), Glasgow Cardiovascular Research Centre, University of Glasgow
| | - T Parks
- From the London School of Hygiene and Tropical Medicine
- University of Oxford
| | | | | | - J Kado
- Fiji Islands Ministry of Health and Medical Services
| | - M M Mirabel
- French National Institute of Health and Medical Research
| | | | | | - B Mittal
- Babasaheb Bhimrao Ambedkar University
| | - A C Steer
- Murdoch Children's Research Institute
| | | | - M Akbar
- From the Institute of Infection, Immunity & Inflammation, University of Glasgow
| | - M Forrester
- Division of Applied Medicine, School of Medicine and Dentistry, University of Aberdeen
| | - A T Virlan
- From the Institute of Infection, Immunity & Inflammation, University of Glasgow
| | - A Gilmour
- From the Institute of Infection, Immunity & Inflammation, University of Glasgow
| | - C Wallace
- Division of Applied Medicine, School of Medicine and Dentistry, University of Aberdeen
| | - C Paterson
- From the Institute of Infection, Immunity & Inflammation, University of Glasgow
| | - D Reid
- Division of Applied Medicine, School of Medicine and Dentistry, University of Aberdeen
| | - S Siebert
- From the Institute of Infection, Immunity & Inflammation, University of Glasgow
| | - D Porter
- From the Institute of Infection, Immunity & Inflammation, University of Glasgow
| | - J Liversidge
- Division of Applied Medicine, School of Medicine and Dentistry, University of Aberdeen
| | - I McInnes
- From the Institute of Infection, Immunity & Inflammation, University of Glasgow
| | - C Goodyear
- From the Institute of Infection, Immunity & Inflammation, University of Glasgow
| | - V Athwal
- From the Manchester University Foundation NHS Trust
- University of Manchester
| | | | | | | | | | - N A Hanley
- From the Manchester University Foundation NHS Trust
- University of Manchester
| | | | - T Briggs
- From the Manchester Centre of Genomic Medicine, University of Manchester
| | - J Reynolds
- Division of Musculoskeletal & Dermatological Sciences, University of Manchester
| | - G Rice
- From the Manchester Centre of Genomic Medicine, University of Manchester
| | - V Bondet
- Immunobiology of Dendritic Cells, Institut Pasteur
| | - E Bruce
- Division of Musculoskeletal & Dermatological Sciences, University of Manchester
| | - Y Crow
- Laboratory of Neurogenetics and Neuroinflammation, INSERM UMR1163, Institut Imagine
| | - D Duffy
- Immunobiology of Dendritic Cells, Institut Pasteur
| | - B Parker
- Division of Musculoskeletal & Dermatological Sciences, University of Manchester
| | - I Bruce
- Division of Musculoskeletal & Dermatological Sciences, University of Manchester
| | - K Martin
- From the University of Manchester
| | | | | | | | - V Athwal
- From the University of Manchester
| | - L Zeef
- From the University of Manchester
| | - S Farrow
- From the University of Manchester
- Respiratory Therapy Area, GlaxoSmithKline
| | | | | | | | - N Hanley
- From the University of Manchester
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13
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Al-Wali W, Deshmukh A, Hamed M, Shaukat A. Death certification reforms are an opportunity for wider quality improvement. BMJ 2018; 362:k3240. [PMID: 30068657 DOI: 10.1136/bmj.k3240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Walid Al-Wali
- Section of Medical Microbiology, Department of Laboratory Medicine and Pathology and Infectious Diseases Unit, Hamad General Hospital and Al-Wakra Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Anand Deshmukh
- Section of Medical Microbiology, Department of Laboratory Medicine and Pathology and Infectious Diseases Unit, Hamad General Hospital and Al-Wakra Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Manal Hamed
- Section of Medical Microbiology, Department of Laboratory Medicine and Pathology and Infectious Diseases Unit, Hamad General Hospital and Al-Wakra Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
| | - Adila Shaukat
- Section of Medical Microbiology, Department of Laboratory Medicine and Pathology and Infectious Diseases Unit, Hamad General Hospital and Al-Wakra Hospital, Hamad Medical Corporation, PO Box 3050, Doha, Qatar
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14
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Ford TJ, Layland J, Stanley B, Carberry J, May VTY, Eteiba H, Lindsay MM, Petrie MC, Watkins S, Shaukat A, Oldroyd KG, Curzen N, McConnachie A, McEntegart M, Berry C. P6432Overlooked prognostic markers in NSTEMI: insights from the BHF FAMOUS-NSTEMI trial. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- T J Ford
- Golden Jubilee National Hospital, Interventional Cardiology, Glasgow, United Kingdom
| | - J Layland
- St Vincent's Hospital, Melbourne, Australia
| | - B Stanley
- University of Glasgow, Glasgow, United Kingdom
| | - J Carberry
- Golden Jubilee National Hospital, Interventional Cardiology, Glasgow, United Kingdom
| | - V T Y May
- Golden Jubilee National Hospital, Interventional Cardiology, Glasgow, United Kingdom
| | - H Eteiba
- Golden Jubilee National Hospital, Interventional Cardiology, Glasgow, United Kingdom
| | - M M Lindsay
- Golden Jubilee National Hospital, Interventional Cardiology, Glasgow, United Kingdom
| | - M C Petrie
- Golden Jubilee National Hospital, Interventional Cardiology, Glasgow, United Kingdom
| | - S Watkins
- Golden Jubilee National Hospital, Interventional Cardiology, Glasgow, United Kingdom
| | - A Shaukat
- Golden Jubilee National Hospital, Interventional Cardiology, Glasgow, United Kingdom
| | - K G Oldroyd
- Golden Jubilee National Hospital, Interventional Cardiology, Glasgow, United Kingdom
| | - N Curzen
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | | | - M McEntegart
- Golden Jubilee National Hospital, Interventional Cardiology, Glasgow, United Kingdom
| | - C Berry
- Golden Jubilee National Hospital, Interventional Cardiology, Glasgow, United Kingdom
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15
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Corcoran D, Young R, Cialdella P, McCartney P, Bajrangee A, Hennigan B, Collison D, Carrick D, Shaukat A, Good R, Watkins S, McEntegart M, Watt J, Welsh P, Sattar N, McConnachie A, Oldroyd KG, Berry C. The effects of remote ischaemic preconditioning on coronary artery function in patients with stable coronary artery disease. Int J Cardiol 2018; 252:24-30. [PMID: 29249435 PMCID: PMC5761717 DOI: 10.1016/j.ijcard.2017.10.082] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2017] [Revised: 10/09/2017] [Accepted: 10/19/2017] [Indexed: 01/06/2023]
Abstract
Background Remote ischaemic preconditioning (RIPC) is a cardioprotective intervention invoking intermittent periods of ischaemia in a tissue or organ remote from the heart. The mechanisms of this effect are incompletely understood. We hypothesised that RIPC might enhance coronary vasodilatation by an endothelium-dependent mechanism. Methods We performed a prospective, randomised, sham-controlled, blinded clinical trial. Patients with stable coronary artery disease (CAD) undergoing elective invasive management were prospectively enrolled, and randomised to RIPC or sham (1:1) prior to angiography. Endothelial-dependent vasodilator function was assessed in a non-target coronary artery with intracoronary infusion of incremental acetylcholine doses (10− 6, 10− 5, 10− 4 mol/l). Venous blood was sampled pre- and post-RIPC or sham, and analysed for circulating markers of endothelial function. Coronary luminal diameter was assessed by quantitative coronary angiography. The primary outcome was the between-group difference in the mean percentage change in coronary luminal diameter following the maximal acetylcholine dose (Clinicaltrials.gov identifier: NCT02666235). Results 75 patients were enrolled. Following angiography, 60 patients (mean ± SD age 57.5 ± 8.5 years; 80% male) were eligible and completed the protocol (n = 30 RIPC, n = 30 sham). The mean percentage change in coronary luminal diameter was − 13.3 ± 22.3% and − 2.0 ± 17.2% in the sham and RIPC groups respectively (difference 11.32%, 95%CI: 1.2– 21.4, p = 0.032). This remained significant when age and sex were included as covariates (difference 11.01%, 95%CI: 1.01– 21.0, p = 0.035). There were no between-group differences in endothelial-independent vasodilation, ECG parameters or circulating markers of endothelial function. Conclusions RIPC attenuates the extent of vasoconstriction induced by intracoronary acetylcholine infusion. This endothelium-dependent mechanism may contribute to the cardioprotective effects of RIPC.
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Affiliation(s)
- D Corcoran
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Scotland, UK; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, Scotland, UK
| | - R Young
- Robertson Centre for Biostatistics, University of Glasgow, Scotland, UK
| | - P Cialdella
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, Scotland, UK
| | - P McCartney
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Scotland, UK; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, Scotland, UK
| | - A Bajrangee
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, Scotland, UK
| | - B Hennigan
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Scotland, UK; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, Scotland, UK
| | - D Collison
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Scotland, UK
| | - D Carrick
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, Scotland, UK
| | - A Shaukat
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, Scotland, UK
| | - R Good
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, Scotland, UK
| | - S Watkins
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, Scotland, UK
| | - M McEntegart
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, Scotland, UK
| | - J Watt
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, Scotland, UK
| | - P Welsh
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Scotland, UK
| | - N Sattar
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Scotland, UK
| | - A McConnachie
- Robertson Centre for Biostatistics, University of Glasgow, Scotland, UK
| | - K G Oldroyd
- West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, Scotland, UK
| | - C Berry
- British Heart Foundation Glasgow Cardiovascular Research Centre, University of Glasgow, Scotland, UK; West of Scotland Heart and Lung Centre, Golden Jubilee National Hospital, Glasgow, Scotland, UK.
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Umar S, Ahmad M, Ahmad I, Zubair M, Umar Z, Qureshi AS, Manzoor A, Murtaza A, Shaukat A. Correlation of biochemical constituents of seminal plasma with semen quality in Teddy goat (Capra hircus) bucks. Andrologia 2017; 50. [PMID: 29230840 DOI: 10.1111/and.12940] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/09/2017] [Indexed: 11/30/2022] Open
Abstract
This study was planned to determine the relationship between semen quality parameters and the levels of biochemical constituents of seminal plasma of Teddy (Capra hircus) buck semen. For this purpose, semen ejaculates were collected from five mature healthy Teddy bucks. All the experimental bucks were kept under natural environmental conditions. Semen was collected twice in a week for the duration of 6 weeks by Artificial Vagina (AV) in the breeding season (February-April). Two successive ejaculates of single buck were pooled at time of collection, and a total of 60 semen samples were processed for semen analysis. Sperm per cent motility, sperm concentration, dead sperm percentage, morphological abnormal spermatozoa, plasma membrane integrity were correlated with biochemical constituents of seminal plasma. The mean per cent motility (89.18% ± 0.37%), sperm concentration (1.86 ± 0.04 × 109 /ml), dead sperm percentage (8.08% ± 0.29%), morphological abnormal spermatozoa (6.05% ± 0.29%) and plasma membrane integrity (88.22% ± 0.34%) were recorded. The seminal plasma contained Na+ (144.12 ± 1.59 mEq/L), K+ (27.38 ± 0.49 mEq/L), Cl- (65.73 ± 0.45 mEq/L), Ca++ (9.34 ± 0.22 mg/dl), P (19.32 ± 0.97 mg/dl), aspartate aminotransferase (AST; 26.48 ± 1.30 IU/L), alanine aminotransferase (ALT; 168.47 ± 5.18 IU/L), lactate dehydrogenase (LDH; 215.98 ± 6.06 IU/L), albumin (1.90 ± 0.10 g/dl), globulins (2.08 ± 0.11 g/dl) and total protein (3.98 ± 0.20 g/dl). The collected data were analysed by applying Pearson's correlation coefficients. Dead sperm percentage had negative correlation with sodium (r = -.278, p < .05), albumin (r = -.294, p < .05), globulin (r = -.266, p < .05) and total protein (r = -.295, p < .05). Phosphorus was negatively associated with sperm concentration (r = -.262, p < .05). AST was negatively correlated with plasma membrane integrity (r = -.292, p < .05). It was concluded that most of the semen quality parameters of Teddy bucks were positively correlated with biochemical constituents, but opposite trends were found in case of dead sperm percentage. The seminal biochemical constituents dynamically interact with each other.
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Affiliation(s)
- S Umar
- Department of Theriogenology, University of Agriculture, Faisalabad, Pakistan
| | - M Ahmad
- UCV&AS, The Islamia University of Bahawalpur, Pakistan
| | - I Ahmad
- Department of Theriogenology, University of Agriculture, Faisalabad, Pakistan
| | - M Zubair
- Department of Theriogenology, University of Agriculture, Faisalabad, Pakistan
| | - Z Umar
- Department of Anatomy, University of Agriculture, Faisalabad, Pakistan
| | - A S Qureshi
- Department of Anatomy, University of Agriculture, Faisalabad, Pakistan
| | - A Manzoor
- Department of CMS, University of Agriculture, Faisalabad, Pakistan
| | - A Murtaza
- Department of Theriogenology, University of Agriculture, Faisalabad, Pakistan
| | - A Shaukat
- Department of CMS, University of Agriculture, Faisalabad, Pakistan
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17
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Ali M, Shaukat A, Farrag A, Kandil M, Mohammad B, Ansari J, Ali A, Wahid M. Response to induction chemotherapy with cisplatin and docetaxel in nasopharyngeal carcinoma and its correlation to overall survival: Tertiary centre experience in the Middle Eastern population. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx665.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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18
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Ansari J, Ali M, Alomair A, Mohammed Ali A, Murshid E, Shaukat A, Batubara E, Bashir F, Farrag A, Hussein K, Alhamad A. Concurrent immuno-radiotherapy in lung and renal cancer- a new treatment paradigm. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx376.064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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19
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Fanari Z, Gunasekaran P, Shaukat A, Thapa J, Persad P, Hammamo S, Dawn B, Wiley M, Weintraub W, Doorey A, Tadros P. P1636Utility and safety of pressure wires use in hemodynamic assessment of paradoxical low flow low gradient aortic stenosis. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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20
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Fanari Z, Gunasekaran P, Shaukat A, Wiley M, Dawn B, Weintraub W, Tadros P, Marshall E. P1646Paradoxical low flow low gradient severe aortic stenosis with preserved left ventricular ejection fraction. impact of medical, transcatheter and surgical management. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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21
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Rolain JM, Loucif L, Al-Maslamani M, Elmagboul E, Al-Ansari N, Taj-Aldeen S, Shaukat A, Ahmedullah H, Hamed M. Emergence of multidrug-resistant Acinetobacter baumannii producing OXA-23 Carbapenemase in Qatar. New Microbes New Infect 2016; 11:47-51. [PMID: 27054039 PMCID: PMC4802191 DOI: 10.1016/j.nmni.2016.02.006] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 02/16/2016] [Accepted: 02/16/2016] [Indexed: 11/03/2022] Open
Abstract
The objective of our study was to describe the molecular support of carbapenem resistance from randomly selected clinical isolates of multidrug-resistant (MDR) Acinetobacter baumannii as a pilot study from the Hamad Medical Corporation (HMC), Qatar. Results of our report will be used to study carbapenemases using molecular techniques in all isolated MDR A. baumannii. Forty-eight MDR A. baumannii were randomly selected from isolates preserved at HMC. Identification of all isolates was confirmed by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry. Antibiotic resistance was tested phenotypically by Phoenix and confirmed by Etest. The molecular support of carbapenemases (bla OXA-23, bla OXA-24, bla OXA-58, bla NDM) was investigated by real-time PCR. The epidemiologic relatedness of the isolates was verified by phylogenetic analysis based on partial sequences of CsuE and bla OXA-51 genes. All 48 isolates were identified as A. baumannii and were confirmed to be resistant to most antibiotics, especially meropenem, imipenems, ciprofloxacin, levofloxacin, amikacin, gentamicin and most of the β-lactams; they were sensitive to colistin. All the isolates were positive for bla OXA-23 and negative for the other tested carbapenemase genes. Clonality analysis demonstrated that different lineages were actually circulating in Qatar; and we suggest that an outbreak occurred in the medical intensive care unit of HMC between 2011 and 2012. Here we report the emergence of MDR A. baumannii producing the carbapenemase OXA-23 in Qatar.
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Affiliation(s)
- J-M Rolain
- Unité de Recherche sur les Maladies infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS7278, IRD 198, INSERM 1905, IHU Méditerranée Infection, Faculté de Médecine et de Pharmacie, Université de la méditerranée, Marseille, France
| | - L Loucif
- Unité de Recherche sur les Maladies infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS7278, IRD 198, INSERM 1905, IHU Méditerranée Infection, Faculté de Médecine et de Pharmacie, Université de la méditerranée, Marseille, France; Laboratoire de biotechnologie des molecules bioactives et de la physiopathologie cellulaire, Université El Hadj Lakhdar, Batna, Algeria
| | - M Al-Maslamani
- Hamad Medical Corporation, Department of Microbiology and Infectious Diseases, Doha, Qatar
| | - E Elmagboul
- Hamad Medical Corporation, Department of Microbiology and Infectious Diseases, Doha, Qatar
| | - N Al-Ansari
- Hamad Medical Corporation, Department of Microbiology and Infectious Diseases, Doha, Qatar
| | - S Taj-Aldeen
- Hamad Medical Corporation, Department of Microbiology and Infectious Diseases, Doha, Qatar
| | - A Shaukat
- Hamad Medical Corporation, Department of Microbiology and Infectious Diseases, Doha, Qatar
| | - H Ahmedullah
- Hamad Medical Corporation, Department of Microbiology and Infectious Diseases, Doha, Qatar
| | - M Hamed
- Unité de Recherche sur les Maladies infectieuses et Tropicales Emergentes (URMITE), UM63, CNRS7278, IRD 198, INSERM 1905, IHU Méditerranée Infection, Faculté de Médecine et de Pharmacie, Université de la méditerranée, Marseille, France; Hamad Medical Corporation, Department of Microbiology and Infectious Diseases, Doha, Qatar
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22
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Sharma V, Jadhav ST, Harcombe AA, Kelly PA, Mozid A, Bagnall A, Richardson J, Egred M, McEntegart M, Shaukat A, Oldroyd K, Vishwanathan G, Rana O, Talwar S, McPherson M, Strange JW, Hanratty CG, Walsh SJ, Spratt JC, Smith WHT. Impact of proctoring on success rates for percutaneous revascularisation of coronary chronic total occlusions. Open Heart 2015; 2:e000228. [PMID: 25852949 PMCID: PMC4379886 DOI: 10.1136/openhrt-2014-000228] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 01/30/2015] [Accepted: 03/04/2015] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVE To assess the impact of proctoring for chronic total occlusion (CTO) percutaneous coronary intervention (PCI) in six UK centres. METHODS We retrospectively analysed 587 CTO procedures from six UK centres and compared success rates of operators who had received proctorship with success rates of the same operators before proctorship (pre-proctored) and operators in the same institutions who had not been proctored (non-proctored). There were 232 patients in the pre-proctored/non-proctored group and 355 patients in the post-proctored group. Complexity was assessed by calculating the Japanese CTO (JCTO) score for each case. RESULTS CTO PCI success was greater in the post-proctored compared with the pre-proctored/non-proctored group (77.5% vs 62.1%, p<0.0001). In more complex cases where JCTO≥2, the difference in success was greater (70.7% vs 49.5%, p=0.0003). After proctoring, there was an increase in CTO PCI activity in centres from 2.5% to 3.5%, p<0.0001 (as a proportion of total PCI), and the proportion of very difficult cases with JCTO score ≥3 increased from 15.3% (35/229) to 29.7% (105/354), p<0.0001. CONCLUSIONS Proctoring resulted in an increase in procedural success for CTO PCI, an increase in complex CTO PCI and an increase in total CTO PCI activity. Proctoring may be a valuable way to improve access to CTO PCI and the likelihood of procedural success.
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Affiliation(s)
- Vinoda Sharma
- Trent Cardiac Centre, Nottingham City Hospital , Nottingham , UK
| | - S T Jadhav
- Trent Cardiac Centre, Nottingham City Hospital , Nottingham , UK
| | - A A Harcombe
- Trent Cardiac Centre, Nottingham City Hospital , Nottingham , UK
| | - P A Kelly
- The Essex Cardiothoracic Centre , Essex , UK
| | - A Mozid
- The Essex Cardiothoracic Centre , Essex , UK
| | - A Bagnall
- Freeman Hospital , Newcastle upon Tyne , UK
| | | | - M Egred
- Freeman Hospital , Newcastle upon Tyne , UK
| | - M McEntegart
- Golden Jubilee National Hospital , Clydebank , UK
| | - A Shaukat
- Golden Jubilee National Hospital , Clydebank , UK
| | - K Oldroyd
- Golden Jubilee National Hospital , Clydebank , UK
| | | | - O Rana
- Royal Bournemouth Hospital , Bournemouth , UK
| | - S Talwar
- Royal Bournemouth Hospital , Bournemouth , UK
| | | | | | | | - S J Walsh
- Belfast City Hospital , Belfast , UK
| | - J C Spratt
- Forth Valley Royal Hospital , Larbert , UK
| | - W H T Smith
- Trent Cardiac Centre, Nottingham City Hospital , Nottingham , UK
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23
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Alay-e-Abbas SM, Shaukat A. First-principles study of thermodynamic stability and the electronic properties of intrinsic vacancy defects in barium hafnate. J Phys Condens Matter 2014; 26:435501. [PMID: 25300032 DOI: 10.1088/0953-8984/26/43/435501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The formation of intrinsic vacancy defects in barium hafnate, BaHfO3 and their corresponding electronic structures have been investigated using first-principles calculations. The thermodynamics of pristine and vacancy defects containing barium hafnate have been analyzed. Formation energies for neutral and fully charged Ba, Hf and O vacancies have been evaluated for determining their stability with respect to different chemical environments. From the calculated electronic structure and density of states, it is found that cation deficient barium hafnate is hole-doped, while the incorporation of oxygen vacancy retains the insulating nature of this material. The defect reaction energies for partial and full Schottky reactions are also computed, which controls the properties of non-stoichiometric barium hafnate.
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Affiliation(s)
- S M Alay-e-Abbas
- Department of Physics, University of Sargodha, 40100 Sargodha, Pakistan. Department of Physics, GC University Faisalabad, Allama Iqbal Road, 38000 Faisalabad, Pakistan
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24
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Bloomer K, McIntosh D, Smith S, Padda H, Glegg M, Aitken A, Shaukat A. EP-1520 RADIOTHERAPY FOR LOCALLY ADVANCED PANCREATIC CANCER: A TREATMENT PLANNING COMPARISON STUDY. Radiother Oncol 2012. [DOI: 10.1016/s0167-8140(12)71853-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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25
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McIntosh D, Shaukat A. Chemotherapy followed by chemoradiotherapy for locally advanced non-metastatic pancreatic cancer - a new paradigm? Clin Oncol (R Coll Radiol) 2010; 22:390. [PMID: 20359871 DOI: 10.1016/j.clon.2010.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2010] [Accepted: 03/08/2010] [Indexed: 11/26/2022]
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26
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Saeed Y, Shaukat A, Nazir S, Ikram N, Hussain Reshak A. First principles calculations of electronic structure and magnetic properties of Cr-based magnetic semiconductors Al1−xCrxX (X=N, P, As, Sb). J SOLID STATE CHEM 2010. [DOI: 10.1016/j.jssc.2009.10.018] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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27
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Nazir S, Ikram N, Tanveer M, Shaukat A, Saeed Y, Reshak AH. Spin-polarized structural, electronic, and magnetic properties of diluted magnetic semiconductors Cd(1-x)Mn(x)S and Cd(1-x)Mn(x)Se in zinc blende phase. J Phys Chem A 2009; 113:6022-7. [PMID: 19438272 DOI: 10.1021/jp900698q] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We studied the structural, spin-polarized electronic band structures, density of states, and magnetic properties of the diluted magnetic semiconductors (DMSs) Cd(1-x)Mn(x)S and Cd(1-x)Mn(x)Se in zinc blende phase (B3) with 25% Mn by using the ab initio method. The calculations were performed by using the full potential linearized augmented plane wave plus local orbitals (FP-L/APW+lo) method within the spin-polarized density functional theory and the local spin density approximation (LSDA). Calculated electronic band structures and the density of states of these DMSs are discussed in terms of the contribution of Mn 3d(5)4s(2), Cd 4d(10)5s(2), S 3s(2)3p(4), and Se 4s(2)4p(4) partial density of states and we also compute the local magnetic moments. We estimated the spin-exchange splitting energies, Delta(x)(d) and Delta(x)(p-d), produced by the Mn 3d states, and we found that the effective potential for the minority spin is more attractive than that for the majority spin. We determine the s-d exchange constant N(0)alpha and p-d exchange constant N(0)beta, which resembles a typical magneto-optical experiment. The calculated total magnetic moment is found to be 5.0020 and 5.00013 mu(B) for Cd(1-x)Mn(x)S and Cd(1-x)Mn(x)Se, respectively. These values indicate that every Mn impurity adds no hole carriers to the perfect CdS and CdSe crystals. Moreover, we found that p-d hybridization reduces the local magnetic moment of Mn from its free space charge value of 5.0micro(B) and produces small local magnetic moments on the nonmagnetic Cd and S sites.
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Affiliation(s)
- S Nazir
- Centre for Solid State Physics, University of the Punjab, Quaid-e-Azam Campus, Lahore 54590, Pakistan
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28
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Krishnan B, Shaukat A, Chakravorty I. Fatal Haemoptysis in a Young Man with Tuberculous Mediastinal Lymphadenitis. Respiration 2008; 77:333-6. [DOI: 10.1159/000114447] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2007] [Accepted: 11/10/2007] [Indexed: 11/19/2022] Open
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29
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Yassin MA, Shaukat A, Errayes MM, Saleh MM. Pravastatin Induced Myopathy. Qatar Med J 2007. [DOI: 10.5339/qmj.2007.2.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Lipid-lowering agents such as HMG-CoA reductase inhibitors (also known as statin drugs) are generally well tolerated. But a recognized side effect still can happen, We report a case of 47-year-old Iraqi male patient previously known hypothyroid, was not on replacement therapy, as he did not appear after his thyroid functions was checked came in with severe body pain for 10 months got worse in the last three months, started on lipostat (ten months ago) found to have myopathy as evident by high CPK which improved gradually clinically and biochemical after stopping lipostat.
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Affiliation(s)
- M. A. Yassin
- Hematology Department, Al Amal Hospital and Department of Medicine Hamad Medical Corporation, Doha, Qatar
- Department of Medicine Hamad Medical Corporation, Doha, Qatar
| | - A. Shaukat
- Department of Medicine Hamad Medical Corporation, Doha, Qatar
| | - M. M. Errayes
- Department of Medicine Hamad Medical Corporation, Doha, Qatar
| | - M. M. Saleh
- Department of Medicine Hamad Medical Corporation, Doha, Qatar
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30
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Sivaramalingam M, Shaukat A, MacLaren V, Yosef H. Adjuvant Treatment of Gastric and Oesophago-gastric Junction Adenocarcinoma — a Glasgow Experience. Clin Oncol (R Coll Radiol) 2007. [DOI: 10.1016/j.clon.2007.01.419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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31
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Tripp P, Malhotra HK, Javle M, Shaukat A, Russo R, De Boer S, Podgorsak M, Nava H, Yang GY. Cardiac function after chemoradiation for esophageal cancer: comparison of heart dose-volume histogram parameters to multiple gated acquisition scan changes. Dis Esophagus 2005; 18:400-5. [PMID: 16336612 DOI: 10.1111/j.1442-2050.2005.00523.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In this paper we determine if preoperative chemoradiation for locally advanced esophageal cancer leads to changes in cardiac ejection fraction. This is a retrospective review of 20 patients treated at our institution for esophageal cancer between 2000 and 2002. Multiple gated acquisition cardiac scans were obtained before and after platinum-based chemoradiation (50.4 Gy). Dose-volume histograms for heart, left ventricle and left anterior descending artery were analyzed. Outcomes assessed included pre- and postchemoradiation ejection fraction ratio and percentage change in ejection fraction postchemoradiation. A statistically significant difference was found between median prechemoradiation ejection fraction (59%) and postchemoradiation ejection fraction (54%) (P = 0.01), but the magnitude of the difference was not clinically significant. Median percentage volume of heart receiving more than 20, 30 and 40 Gy were 61.5%, 58.5% and 53.5%, respectively. Our data showed a clinically insignificant decline in ejection fraction following chemoradiation for esophageal cancer. We did not observe statistically or clinically significant associations between radiation dose to heart, left ventricle or left anterior descending artery and postchemoradiation ejection fraction.
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Affiliation(s)
- P Tripp
- Department of Radiation Oncology, Roswell Park Cancer Institute, Buffalo, New York 14263, USA
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Shaukat A, Mortazavi A, Demmy T, Nava H, Wilkinson N, Yang G, Kepner J, Javle M. Should preoperative, post-chemoradiotherapy endoscopy be routine for esophageal cancer patients? Dis Esophagus 2004; 17:129-35. [PMID: 15230725 DOI: 10.1111/j.1442-2050.2004.00389.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Chemoradiation therapy is used widely for locoregional esophageal cancer. Patients with persistent disease may benefit from surgery. Preoperative esophagoscopy can identify persistent tumor but its accuracy is uncertain. The primary objective of this study is to assess the extent of agreement between esophagoscopy and surgical pathology in patients treated with neoadjuvant chemoradiation. A retrospective chart review of patients who underwent chemoradiation, preoperative endoscopy and surgery from January 1996 to December 2002 was performed. Cohen's kappa statistic was used to measure the degree of agreement between findings at endoscopic biopsy and surgical pathology. Thirty cases were identified. All patients received chemoradiation followed by surgical resection. There was insufficient agreement between tumor size (kappa 0.25, standard error 0.17, P = 0.07) and appearance (kappa 0.19, standard error 0.18, P = 0.14). Preoperative endoscopy revealed atypia/inflammation in 15 cases and dysplasia in eight. Of these 23 cases, 11 were adenocarcinomas at surgery. Only nine patients had concurrence between surgical pathology and endoscopy. The positive and negative predictive values of esophagoscopy for identifying residual tumor were 100% and 11%, respectively. Our data suggests that after chemoradiation, esophagoscopy is unreliable for excluding residual disease. The roles of other modalities need to be explored.
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Affiliation(s)
- A Shaukat
- Department of Medicine, School of Medicine and Biomedical Sciences, State University of New York, NY, USA
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Hahn T, Rondeau C, Shaukat A, Jupudy V, Miller A, Alam AR, Baer MR, Bambach B, Bernstein Z, Chanan-Khan AA, Czuczman MS, Slack J, Wetzler M, Mookerjee BK, Silva J, McCarthy PL. Acute renal failure requiring dialysis after allogeneic blood and marrow transplantation identifies very poor prognosis patients. Bone Marrow Transplant 2003; 32:405-10. [PMID: 12900777 DOI: 10.1038/sj.bmt.1704144] [Citation(s) in RCA: 63] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
We examined the incidence, risk factors and associated mortality of acute renal failure requiring dialysis (Renal Bearman Grade [BG] 3) in a 3-year cohort of 97 consecutive allogeneic blood and marrow transplantation (alloBMT) patients. In all, 20 (21%) developed Renal BG3 (all died by day +132) and 77 (79%) developed renal insufficiency (Renal BG1-2). Renal BG3 was a contributing or primary cause of death in 18 (90%) patients who continued to require dialysis at time of death. The two Renal BG3 patients whose deaths were not related to renal failure died on day +103 of hemorrhage and day +132 of underlying disease. By univariate analysis, age, unrelated donor, veno-occlusive disease (VOD) and grade III-IV acute graft-versus-host disease with hepatic involvement were significantly associated with Renal BG3. The multivariate model of time to Renal BG3 determined only a prior diagnosis of severe acute GVHD (RR=4.1, 95% CI 1.6-10.3, P=0.003) and VOD (RR=9.1, 95% CI 3.5-23.7, P<0.001) as significant independent predictors. Renal BG3 is generally considered a conditioning regimen-related toxicity. This study demonstrates that Renal BG3 is most commonly a complication of hepatic co-morbidities after allogeneic blood and marrow transplantation and identifies patients with a very poor prognosis.
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Affiliation(s)
- T Hahn
- Department of Medicine, Roswell Park Cancer Institute, Buffalo, NY 14263, USA
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Chotani RA, Shaukat A. Practicing prevention: handwashing. J PAK MED ASSOC 2002; 52:368-74. [PMID: 12481679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Affiliation(s)
- R A Chotani
- Departments of Emergency Medicine and International Health, Schools of Medicine and Public Health, John Hopkins University, Baltimore, USA
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Argani P, Shaukat A, Kaushal M, Wilentz RE, Su GH, Sohn TA, Yeo CJ, Cameron JL, Kern SE, Hruban RH. Differing rates of loss of DPC4 expression and of p53 overexpression among carcinomas of the proximal and distal bile ducts. Cancer 2001. [PMID: 11283934 DOI: 10.1002/1097-0142(20010401)91] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Biliary tract carcinomas are clinically heterogeneous. It is not known if molecular heterogeneity underlies the clinical differences. METHODS The authors evaluated 128 bile duct carcinomas, 88 of the distal common bile duct and 40 of more proximal origin (28 perihilar carcinomas, 12 intrahepatic carcinomas), immunohistochemically for abnormalities in the expression of the products of the DPC4 and p53 tumor-suppressor genes. Prognostic factors were evaluated in the series of distal bile duct carcinomas for which follow-up information was available. RESULTS The authors found that a significantly higher percentage of distal bile duct carcinomas (55%) demonstrated loss of DPC4 expression than did the proximal bile duct carcinomas (15%; P < 0.001). They also found that a significantly higher percentage of the distal tumors abnormally expressed the p53 gene product (51% vs. 26%; P < 0.001). Among the distal common bile duct carcinomas, the presence of poorly differentiated histology correlated with decreased survival in multivariate analysis, while labeling for p53 or Dpc4, margin status, lymph node status, and tumor dimension did not correlate significantly with survival. CONCLUSIONS These results demonstrate that abnormalities in DPC4 and p53 gene expression are frequent in distal common bile duct carcinomas, just as they are in pancreatic ductal adenocarcinoma, suggesting that these two tumor types might share a similar molecular pathogenesis. They also show that proximal and distal bile duct carcinomas have different patterns of inactivation of tumor-suppressor genes, indicating that they often arise through different molecular mechanisms likely reflecting their differing etiologies.
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Affiliation(s)
- P Argani
- Department of Pathology, The Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
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Hashim R, Khan FA, Khan DA, Shaukat A. Prevalence of macrovascular complications in diabetics of WAH, District Rawalpindi. J PAK MED ASSOC 1999; 49:8-11. [PMID: 10463008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/13/2023]
Abstract
OBJECTIVE To determine the prevalence of macrovascular complications in diabetic subjects with relation to age duration of diabetes and metabolic control. SETTING Primary care centres of WAH, District Rawalpindi cross sectional population based study. METHODS A total of 805 known diabetics (380 males and 425 females) were studied. Relevant history, detailed physician examination and ECG were done to assess the presence of ischaemic heart disease, stroke and diabetic foot complications. Their diabetic control was assessed by estimation of their plasma glucose and glycosylated haemoglobin. RESULTS The prevalence of macrovascular complications was as follows: Ischaemic heart disease 19.8% (female 4.7%, males 7.8%), cerebrovascular disease 6.2% (females 4.7%, males 22.1%) and diabetic foot complications 2.1%. The macrovascular complications increased with age, duration of diabetes and were more prevalent in uncontrolled diabetics having glycosylated haemoglobin > 8.6%. CONCLUSION Prevalence of macrovascular complication in our population is higher as compared to the West probably due to better management and diabetic care in those countries.
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Affiliation(s)
- R Hashim
- Department of Pathology, CMH, Bahawalpur
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Meloni F, Serra M, Shaukat A. Comparative theoretical studies of charge-density distribution in GaAs, GaP, InAs and InSb. Acta Crystallogr A 1984. [DOI: 10.1107/s0108767384094903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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