1
|
Halfter K, Schubert-Fritschle G, Röder F, Kim M, Werner J, Belka C, Wolff H, Agha A, Fuchs M, Friess H, Combs S, Häussler B, Engel J, Schlesinger-Raab A. Advances in rectal cancer: Real-world evidence suggests limited gains in prognosis for elderly patients. Cancer Epidemiol 2023; 86:102440. [PMID: 37572415 DOI: 10.1016/j.canep.2023.102440] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 07/26/2023] [Accepted: 08/07/2023] [Indexed: 08/14/2023]
Abstract
BACKGROUND Rectal cancer treatment has improved considerably due to the introduction of total meso-rectal excision, radio-chemotherapy, and high-resolution imaging. The aim of this observational cohort study was to quantify the effectiveness of these advances using high-quality data from a representative cohort of patients. METHODS 20 281 non-metastasized cases retrieved from the Munich Cancer Registry database were divided into three time periods corresponding to before (1988-1997), partial (1998-2007), and full implementation (2008-2019) of clinical advances. Early-onset (<50 yrs.), middle-aged, elderly patient subgroups (> 70 yrs.) were compared. The overall effectiveness of evidence-based guideline adherence was also examined. RESULTS Median survival improved by 1.5 yrs. from the first to the last time period. Relative survival increased from 74.9% (5-yr 95%CI[73.3 - 76.6]) to 79.2% (95%CI[77.8 - 80.5]). The incidence of locoregional recurrences was reduced dramatically by more than half (5-yr 17.7% (95%CI[16.5 - 18.8]); 6.7% (95%CI[6.1 - 7.3])). Gains in 5-yr relative survival were limited to early-onset and middle-aged patients with no significant improvement seen in elderly patients (Female 68.6% [63.9 - 73.3] to 67.6% [64.0 - 71.2]; Male 71.7% [65.9 - 77.4] to 74.0% [70.8 - 77.2]). CONCLUSIONS Real-world evidence suggests that recent treatment advances have lead to an increase in prognosis for rectal cancer patients. However, more effort should be made to improve the implementation of new developments in elderly patients. Especially considering, that these cases represent a growing majority of diagnosed patients.
Collapse
Affiliation(s)
- K Halfter
- Institute of Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, Ludwig-Maximilians-University (LMU), Marchioninistraße 15, 81377 Munich, Germany.
| | - G Schubert-Fritschle
- Institute of Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, Ludwig-Maximilians-University (LMU), Marchioninistraße 15, 81377 Munich, Germany
| | - F Röder
- Department of Radiotherapy and Radiation Oncology, Paracelsus Medical University Salzburg, Landeskrankenhaus, Müller Hauptstraße 48, 5020 Salzburg, Austria
| | - M Kim
- Department of Surgery, Clinic Munich-Neuperlach Hospital, Oskar-Maria-Graf-Ring 51, 81737 Munich, Germany
| | - J Werner
- Department of General, Visceral, and Transplantation Surgery, University Hospital, Ludwig-Maximilians-University (LMU), Marchioninistraße 15, 81377 Munich, Germany
| | - C Belka
- Department of Radiation Oncology, University Hospital, Ludwig-Maximilians-University (LMU), Marchioninistraße 15, 81377 Munich, Germany
| | - H Wolff
- Department of Radiology, Nuclear Medicine and Radiotherapy, Radiology Munich, Burgstraße 7, 80331 Munich, Germany
| | - A Agha
- Department of General, Visceral, Endocrine and Minimal-Invasive Surgery, Clinic Munich-Bogenhausen, Englschalkinger Straße 77, 81925 Munich, Germany
| | - M Fuchs
- Department of Gastroenterology, Hepatology, and Gastrointestinal-Oncology, Clinic Munich-Bogenhausen, Englschalkinger Straße 77, 81925 Munich, Germany
| | - H Friess
- Department General Surgery, Klinikum rechts der Isar, Technical University Munich (TUM) School of Medicine, Ismaninger Straße 22, 81675 Munich, Germany
| | - S Combs
- Department of Radiation Oncology, Klinikum rechts der Isar, Technical University Munich (TUM) School of Medicine, Ismaninger Straße 22, 81675 Munich, Germany
| | - B Häussler
- Strahlentherapie Klinikum Harlaching, Sanatoriumsplatz 2, 81545 München, Germany
| | - J Engel
- Institute of Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, Ludwig-Maximilians-University (LMU), Marchioninistraße 15, 81377 Munich, Germany
| | - A Schlesinger-Raab
- Institute of Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, Ludwig-Maximilians-University (LMU), Marchioninistraße 15, 81377 Munich, Germany
| |
Collapse
|
2
|
Agha A, Basu A, Hanif W. Burnout in diabetes and endocrinology specialist registrars across England, Scotland and Wales in the pre-COVID era. Prim Care Diabetes 2022; 16:515-518. [PMID: 35667990 DOI: 10.1016/j.pcd.2022.05.005] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 05/11/2022] [Accepted: 05/22/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND Presence of either emotional exhaustion, depersonalization or lack of personal accomplishment define Burnout Syndrome which may lead to decreased workforce productivity, increased absenteeism, depression and medical errors as well as decreased patient satisfaction. OBJECTIVE The aim of this study was to assess the frequency of burnout syndrome among Diabetes Specialist Registrars across England, Scotland and Wales and to identify any self-reported factors which may be contributory to burnout. METHODS Over 430 Diabetes Specialist Registrars were invited to anonymously participate in an electronic survey which used Maslach Burnout Inventory and selfreporting questionnaire to identify burnout and contributory factors. RESULTS In this pre-pandemic times study, Burnout was identified in 61 (57.5%; n = 106) respondents using Maslach burnout cut-off scores. 45.2% (48/106) participants had scored high in Emotional Exhaustion, while lack of personal accomplishment and depersonalization was seen in 24.5% (26/106) and 21.6% (23/106) of the respondents respectively. The commonest self-reported stressors by participants were "General Internal Medicine workload" 60.4% (64/106) followed by "Lack of specialty training" 36.8% (39/106) and "Lack of audit/research/Continuing Professional Development time" 10.8% (11/106) CONCLUSION: Burnout syndrome is frequent among the participating Diabetes Specialist Registrars and urgent steps may be required address this problem nationally to ensure that these physicians remain physically and mentally healthy, especially after the pandemic.
Collapse
Affiliation(s)
- A Agha
- Queens Hospital Burton on Trent, University Hospitals of Derby and Burton, UK; College of Medicine & Health Sciences, United Arab Emirates University, United Arab Emirates.
| | - A Basu
- City and Sandwell Hospitals Birmingham, UK
| | - W Hanif
- Queen Elizabeth Hospital, University Hospitals Birmingham, UK
| |
Collapse
|
3
|
Forde H, Davenport C, Rochfort KD, Wallace RG, Durkan E, Agha A, Thompson CJ, Tormey WT, O'Gorman DJ, Cummins PM, Smith D. Serum OPG/TRAIL ratio predicts the presence of cardiovascular disease in people with type 2 diabetes mellitus. Diabetes Res Clin Pract 2022; 189:109936. [PMID: 35662613 DOI: 10.1016/j.diabres.2022.109936] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 04/28/2022] [Accepted: 05/30/2022] [Indexed: 11/19/2022]
Abstract
AIMS Cardiovascular disease (CVD) is the leading cause of mortality in type 2 diabetes mellitus (T2DM). Epidemiological studies suggest serum Osteoprotegrin (OPG)/Tumour-necrosis-factor-related-apoptosis-inducing- ligand (TRAIL) ratio may be a useful marker of cardiovascular risk. This study aimed to compare serum levels of TRAIL, OPG and OPG/TRAIL ratio in people with T2DM, with and without a history of CVD, and controls; and to determine which of these indices, if any, predict cardiovascular risk. METHODS In this single centre observational study of 133 participants, people with T2DM, with and without a history of a cardiovascular event in the last 5 years, were recruited along with a control cohort without T2DM or CVD. Demographic information and anthropometric measurements were recorded. Blood samples were taken and OPG and TRAIL were measured using ELISA. RESULTS People with T2DM and CVD had higher OPG/TRAIL ratios compared to controls or those with a new diagnosis of T2DM. After adjustment for potential confounding factors, OPG/TRAIL ratio was significantly associated with the presence of CVD in people with T2DM and an OPG/TRAIL ratio cut-off > 38.6 predicted the presence of CVD in this cohort with a sensitivity of 80% and specificity of 82%. CONCLUSION This study suggests that OPG/TRAIL ratio may have a role as a biomarker of CVD in people with T2DM.
Collapse
Affiliation(s)
- H Forde
- Department of Endocrinology, Beaumont Hospital and RCSI Medical School, Beaumont, Dublin 9, Ireland; School of Biotechnology, Dublin City University, Glasnevin, Dublin 9, Ireland.
| | - C Davenport
- Department of Endocrinology, Beaumont Hospital and RCSI Medical School, Beaumont, Dublin 9, Ireland; School of Biotechnology, Dublin City University, Glasnevin, Dublin 9, Ireland
| | - K D Rochfort
- School of Nursing, Psychotherapy, and Community Health, Dublin City University, Glasnevin, Dublin 9, Ireland
| | - R G Wallace
- School of Biotechnology, Dublin City University, Glasnevin, Dublin 9, Ireland
| | - E Durkan
- School of Health and Human Performance, Dublin City University, Glasnevin, Dublin 9, Ireland
| | - A Agha
- Department of Endocrinology, Beaumont Hospital and RCSI Medical School, Beaumont, Dublin 9, Ireland
| | - C J Thompson
- Department of Endocrinology, Beaumont Hospital and RCSI Medical School, Beaumont, Dublin 9, Ireland
| | - W T Tormey
- Department of Chemical Pathology, Beaumont Hospital, Beaumont, Dublin 9, Ireland
| | - D J O'Gorman
- School of Health and Human Performance, Dublin City University, Glasnevin, Dublin 9, Ireland; National Institute for Cellular Biotechnology, Dublin City University, Glasnevin, Dublin 9, Ireland
| | - P M Cummins
- School of Biotechnology, Dublin City University, Glasnevin, Dublin 9, Ireland
| | - D Smith
- Department of Endocrinology, Beaumont Hospital and RCSI Medical School, Beaumont, Dublin 9, Ireland
| |
Collapse
|
4
|
Agha A, Ajmal F, Khurshid A, Soomro AA, Farrukh N, Iftikhar N. Prevalence of HIV among pregnant women in three HIV-affected districts in Sindh, Pakistan. J PAK MED ASSOC 2021; 71(Suppl 4):S11-S15. [PMID: 34469423 DOI: 10.47391/jpma.0002] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To conduct a community-based cross-sectional survey to determine the prevalence of human immunodeficiency virus (HIV) among pregnant women in taluka Ratodero, Larkana, and two adjacent talukas: Sajawal, district Kambar Shahdadkot and Garhi Yasin, district Shikarpur. Methods The study was conducted among pregnant women in the three talukas of rural Sindh: Ratodero, Garhi Yasin, and Sajawal, from October 16, 2020 - December 23, 2020. A total of 1,157 pregnant women were interviewed at their homes and tested using the AlereTM HIV Combo rapid finger prick test. The study captured women's sociodemographic, economic, and health characteristics, including age, education, employment, number of children, home or hospital delivery, antenatal care use, antenatal trimester, history of blood transfusion, and HIV test result. Descriptive statistics were calculated: percentages for categorical variables and mean ± standard deviation (SD) for continuous variables. RESULTS It was found that 0.35% (4/1,157) of women were HIV-positive, of which 3 were in Ratodero, Larkana, and 1 was in Garhi Yasin, Shikarpur. The average age of women was 28.7 ± 4.0 years. Most of the women (n=1067; 92.2%) did not attend a school, and 99.0% (n=1145) had never had a formal job. The average gestational age was 7.6 (±2.2) months. More than three-quarters of the women participating in the study (n=894; 77.3%) were not registered with a formal healthcare facility for antenatal care. CONCLUSIONS Considering several HIV sub-epidemics in Larkana in the past decade, HIV infection among pregnant women has remained low in Larkana and adjacent districts.
Collapse
Affiliation(s)
- Ajmal Agha
- University of South Carolina, Columbia, USA
| | | | | | | | | | | |
Collapse
|
5
|
Flannery C, Agha A. 46, XX Male Disorder of Sexual Development. Ir Med J 2021; 114:243. [PMID: 37556122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 08/10/2023]
Abstract
Presentation A 47-year-old male was referred to endocrinology with a 9-year history of primary hypogonadism. Baseline testosterone was 4.3 nmol/L (RR 8-30) with an elevated follicle stimulating hormone (17.5 IU/L) and luteinizing hormone (15.2 mIU/ml). He had a short stature with bilateral small pre-pubertal testicles. Diagnosis Karyotyping showed 46 XX, making a diagnosis of 46, XX male disorder of sexual development. Fluorescence in situ hybridization analysis identified the presence of a translocated sex-determining region Y gene. Treatment Testosterone replacement therapy (testogel). Monitoring blood markers affected by testosterone therapy and metabolic risk factors. Conclusion Primary hypogonadism in males can be divided into congenital and acquired causes. 46, XX male disorder of sexual development is a rare congenital cause, with an incidence of approximately 1 in 20,000 newborn males. This case report highlights the value of karyotyping in the workup for primary hypogonadism.
Collapse
|
6
|
Chu Q, Agha A, Devost N, Walton RN, Ghosh S, Ho C. Biopsy on progression in patients with EGFR mutation-positive advanced non-small-cell lung cancer-a Canadian experience. ACTA ACUST UNITED AC 2020; 27:27-33. [PMID: 32218657 DOI: 10.3747/co.27.5347] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Epidermal growth factor receptor (egfr) tyrosine kinase inhibitors (tkis) are standard therapy for patients with advanced or metastatic non-small-cell lung cancer harbouring an EGFR mutation. Upon progression, 50%-60% develop a secondary T790M mutation. Recent trials demonstrated outcome improvement with osimertinib compared with standard platinum-based chemotherapy as second-line therapy for patients with secondary T790M mutation. To identify T790M, a biopsy of the tumour or, more recently, plasma is necessary. This retrospective study aimed to evaluate biopsy procedures and mutational analysis at 2 Canadian cancer centres. Methods In a retrospective review of patients who were approached to enrol in the aura2, aura3, or astris studies, demographics, eligibility for rebiopsy upon progression after an egfr tki, rebiopsy methods and complications, number of rebiopsies, and incidence of the T790M mutation were collected. Results Of 84 patients considered for trial enrolment, 80 signed a consent. In 78 patients who underwent rebiopsy, computed tomography or ultrasonography guidance were the most common methods used. The most common biopsy sites were lung and lymph nodes. The median number of rebiopsies performed to find a T790M mutation was 2. Only 9% of patients experienced complications. Of samples obtained, 74% were adequate for testing after initial rebiopsy. A T790M mutation was found in 47 patients, of whom 44 were enrolled on a trial. After multiple rebiopsies, only 5% of samples were inadequate for molecular analysis. Conclusions In the Canadian setting, the acceptance of rebiopsy on progression was high. Multiple rebiopsies were clinically feasible and could increase the yield for T790M mutation. The incidence of complications was low despite the most common site for rebiopsy being lung.
Collapse
Affiliation(s)
- Q Chu
- Cross Cancer Institute, Alberta Health Services, Edmonton, AB
| | - A Agha
- BC Cancer-Vancouver Centre, Vancouver, BC
| | - N Devost
- AstraZeneca Canada, Mississauga, ON
| | | | - S Ghosh
- Cross Cancer Institute, Alberta Health Services, Edmonton, AB
| | - C Ho
- BC Cancer-Vancouver Centre, Vancouver, BC
| |
Collapse
|
7
|
Lee M, Gill C, Serauto Canache A, Donisan T, Balanescu D, Marah N, Stone D, Stone J, Boone D, Cervoni Curet F, Agha A, Iliescu C, Palaskas N. P678Pericardiocentesis in thrombocytopenic cancer patients. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0284] [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: 11/14/2022] Open
Abstract
Abstract
Background
Pericardial effusion is a known complication in cancer patients, resulting in chest pain, cardiac tamponade, and cardiogenic shock. Although technological advances allow for early detection, treatment options are limited for those also suffering from thrombocytopenia.
Purpose
Our study aims to evaluate survivorship of thrombocytopenic cancer patients who underwent pericardiocentesis.
Methods
From 2008 to 2019, we assessed overall mortality and follow-up post-pericardiocentesis in cancer patients with concurrent thrombocytopenia (<150,000 cells/microliter) at our cancer center. Thrombocytopenia grading was determined on the procedure day via serology platelet cell count with the following thresholds: Grade 1 (<50x103 cells/mL), Grade 2 (51–100x103 cells/mL), and Grade 3 (101–149x103 cells/mL).
Results
In 137 patients, we identified 65 (47%) patients with Grade 1, 30 (22%) with Grade 2, and 42 (31%) with Grade 3 thrombocytopenia. The calculated platelet count average was 66x103 cells/mL, median was 59x103 cells/mL, and range was 6 to 147x103 cells/mL. Of note, 7 (5%) patients had platelets <10x103 cells/mL. One patient developed a hematoma at the percutaneous site of pericardial drain, no other complications were noted. Kaplan Meier survival analysis by log-rank (mantel-cox) showed statistical significance (p=0.025). Comparatively, the cumulative survival of patients at 30 days was 63% in Grade 1, 67% in Grade 2, and 83% in Grade 3 patients. At one year, it was 26% in Grade 1, 37% in Grade 2, and 48% in Grade 3 patients.
Conclusion
Pericardiocentesis offers rapid symptomatic relief and can be life-saving in cardiac tamponade. In cancer patients, the development of pericardial effusions and thrombocytopenia increases due to the underlying malignancy and cancer therapeutics. Although thrombocytopenia is thought to increase peri-procedural risks, in this cohort there was only one minor complication and this occurred in Grade 2 thrombocytopenia. For thrombocytopenic cancer patients suffering from large pericardial effusions, high pre-operative risk scores often exclude them from receiving surgical pericardial windows. Although mortality was higher in severe thrombocytopenia, this is likely due to the competing risk of more severe cancer; there were no complications with Grade 1 thrombocytopenia. Especially noteworthy, no complications in those with platelets <10,000 cells/uL. Our study shows that in this population of patients, pericardiocentesis is a feasible intervention with low complication rate to help improve quality of life and potentially life-saving treatment.
Collapse
Affiliation(s)
- M Lee
- University of Texas MD Anderson Cancer Center, Houston, United States of America
| | - C Gill
- University of Texas MD Anderson Cancer Center, Houston, United States of America
| | - A Serauto Canache
- University of Texas MD Anderson Cancer Center, Houston, United States of America
| | - T Donisan
- University of Texas MD Anderson Cancer Center, Houston, United States of America
| | - D Balanescu
- University of Texas MD Anderson Cancer Center, Houston, United States of America
| | - N Marah
- University of Texas MD Anderson Cancer Center, Houston, United States of America
| | - D Stone
- University of Texas MD Anderson Cancer Center, Houston, United States of America
| | - J Stone
- University of Texas MD Anderson Cancer Center, Houston, United States of America
| | - D Boone
- University of Texas MD Anderson Cancer Center, Houston, United States of America
| | - F Cervoni Curet
- University of Texas MD Anderson Cancer Center, Houston, United States of America
| | - A Agha
- University of Texas MD Anderson Cancer Center, Houston, United States of America
| | - C Iliescu
- University of Texas MD Anderson Cancer Center, Houston, United States of America
| | - N Palaskas
- University of Texas MD Anderson Cancer Center, Houston, United States of America
| |
Collapse
|
8
|
Iesalnieks I, Agha A. [Preoperative imaging for colorectal cancer: surgeons' perspective]. Radiologe 2019; 59:786-790. [PMID: 31414151 DOI: 10.1007/s00117-019-00582-4] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Preoperative radiological diagnostics in patients with colorectal cancer has several objectives. The diagnostic localization of the colonic tumor is essential for planning the resection. The radiologically suspected infiltration of neighboring structures may lead to the decision for neoadjuvant treatment. In patients with rectal carcinomas, the T and N stages, the distance to the circumference resection margin (CRM), and the penetration of the tumor into the mesentery must be determined. This crucial to determine whether the patient should undergo neoadjuvant treatment. Prior to the planned relocation of an upstream stoma, radiological diagnostics may be added to clinical and endoscopic assessment but should not be routinely used.
Collapse
Affiliation(s)
- I Iesalnieks
- Klinik für Allgemein‑, Viszeral‑, Endokrine und Minimal-invasive Chirurgie, München Klinik Bogenhausen, Englschalkinger Str. 77, 81925, München, Deutschland.
| | - A Agha
- Klinik für Allgemein‑, Viszeral‑, Endokrine und Minimal-invasive Chirurgie, München Klinik Bogenhausen, Englschalkinger Str. 77, 81925, München, Deutschland
| |
Collapse
|
9
|
Affiliation(s)
- H Dralle
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Sektion Endokrine Chirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
| | - K Kols
- Schlichtungsstelle für Arzthaftpflichtfragen der norddeutschen Ärztekammern, Hans-Böckler-Allee 3, 30173, Hannover, Deutschland.
| | - A Agha
- Klinik für Allgemein‑, Viszeral‑, Endokrine und Minimal-invasive Chirurgie, Städtisches Klinikum München Bogenhausen, Englschalkinger Str. 77, 81925, München, Deutschland.
| | - M Sohn
- Klinik für Allgemein‑, Viszeral‑, Endokrine und Minimal-invasive Chirurgie, Städtisches Klinikum München Bogenhausen, Englschalkinger Str. 77, 81925, München, Deutschland.
| | - I Gockel
- Klinik für Viszeral‑, Transplantations‑, Thorax- und Gefäßchirurgie, Universitätsklinikum Leipzig, Liebigstr. 20, 04103, Leipzig, Deutschland.
| | - M Lainka
- Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Sektion Gefäßchirurgie, Universitätsklinikum Essen, Hufelandstr. 55, 45147, Essen, Deutschland.
| |
Collapse
|
10
|
Sohn M, Iesalnieks I, Agha A, Steiner P, Hochrein A, Pratschke J, Ritschl P, Aigner F. Perforated Diverticulitis with Generalized Peritonitis: Low Stoma Rate Using a "Damage Control Strategy". World J Surg 2018. [PMID: 29541823 DOI: 10.1007/s00268-018-4585-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [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: 01/01/2023]
Abstract
PURPOSE Optimal surgical management of perforated diverticulitis of the sigmoid colon has yet to be clearly defined. The purpose of this study was to evaluate efficacy of a "Damage Control Strategy" (DCS). MATERIALS AND METHODS Patients with perforated diverticulitis of the sigmoid colon complicated by generalized peritonitis (Hinchey III and IV) surgically treated according to a damage control strategy between May 2011 and February 2017 were enrolled in the present multicenter retrospective cohort study. Data were collected at three surgical centers. DCS comprises a two-stage concept: [1] limited resection of the perforated colon segment with oral and aboral blind closure during the emergency procedure and [2] definitive reconstruction at scheduled second laparotomy (anastomosis ∓ loop ileostomy or a Hartmann's procedure) after 24-48 h. RESULTS Fifty-eight patients were included into the analysis [W:M 28:30, median age 70.1 years (30-92)]. Eleven patients (19%) initially presented with fecal peritonitis (Hinchey IV) and 47 patients with purulent peritonitis (Hinchey III). An anastomosis could be created during the second procedure in 48 patients (83%), 14 of those received an additional loop ileostomy. In the remaining ten patients (n = 17%), an end colostomy was created at second laparotomy. A fecal diversion was performed in five patients to treat anastomotic complications. Thus, altogether, 29 patients (50%) had stoma at the end of the hospital stay. The postoperative mortality was 9% (n = 5), and median postoperative hospital stay was 18.5 days (3-66). At the end of the follow-up, 44 of 53 surviving patients were stoma free (83%). CONCLUSION The use of the Damage Control strategy leads to a comparatively low stoma rate in patients suffering from perforated diverticulitis with generalized peritonitis.
Collapse
Affiliation(s)
- Maximilian Sohn
- Klinik für Allgemein-, Viszeral-, Endokrine- und minimalinvasive Chirurgie, Klinikum Bogenhausen, Städtisches Klinikum München GmbH, Englschalkinger Strasse 77, 81925, Munich, Germany.
| | - I Iesalnieks
- Klinik für Allgemein-, Viszeral-, Endokrine- und minimalinvasive Chirurgie, Klinikum Bogenhausen, Städtisches Klinikum München GmbH, Englschalkinger Strasse 77, 81925, Munich, Germany
| | - A Agha
- Klinik für Allgemein-, Viszeral-, Endokrine- und minimalinvasive Chirurgie, Klinikum Bogenhausen, Städtisches Klinikum München GmbH, Englschalkinger Strasse 77, 81925, Munich, Germany
| | - P Steiner
- Klinik für Allgemein, Viszeral- und Gefäßchirurgie-, Klinikum Harlaching, Städtisches Klinikum München GmbH, Munich, Germany
| | | | - J Pratschke
- Chirurgische Klinik, Charité - Universitätsmedizin Berlin, Campus Charité Mitte|Campus Virchow-Klinikum, Berlin, Germany
| | - P Ritschl
- Chirurgische Klinik, Charité - Universitätsmedizin Berlin, Campus Charité Mitte|Campus Virchow-Klinikum, Berlin, Germany
| | - F Aigner
- Chirurgische Klinik, Charité - Universitätsmedizin Berlin, Campus Charité Mitte|Campus Virchow-Klinikum, Berlin, Germany
| |
Collapse
|
11
|
Chu QC, Agha A, Devost N, Walton R, Ghosh S, Ho C. Biopsy on progression in EGFR mutation positive (EGFRm) advanced non-small cell lung cancer (aNSCLC) patients (pts): A Canadian experience. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy292.082] [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: 11/12/2022] Open
|
12
|
Sohn M, Agha A, Trum E, Moser C, Iesalnieks I, Gundling F, Aigner F, Ritschl P. Frequency of metachronous polyps and adenocarcinoma in the interposed colon after esophagectomy in adults. coloproctology 2018; 40:349-351. [DOI: 10.1007/s00053-018-0280-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
|
13
|
Affiliation(s)
- A Garrahy
- Department of Endocrinology, Beaumont Hospital, Beaumont, Dublin 9, Ireland.
| | - A Agha
- Department of Endocrinology, Beaumont Hospital and RCSI Medical School, Beaumont, Dublin 9, Ireland.
| |
Collapse
|
14
|
Marienhagen J, Agha A, Rozeboom S, Bachmeier E, Schlitt H, Eilles C, Schönberger J. Papillary microcarcinoma and papillary cancer of the thyroid ≤1cm. Nuklearmedizin 2017. [DOI: 10.1160/nukmed-0059] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Summary
Aims: Major controversies exist regarding the treatment of papillary microcarcinoma of the thyroid (PMC). Prior to 2003 PMC was defined by the WHO as a papillary carcinoma of 1cm or less in diameter. In 2004 that definition changed, with the new classification requiring that the tumour also must be found incidentally. Patients, methods: In this study we reviewed the clinical records of 67 patients with papillary tumours of the thyroid ≤1 cm, taking into account the new WHO definition (54 pts. with incidentally found PMC, median age: 53 years, 13 pts. with suspicion of thyroid neoplasm before resection, median age: 38 years). Clinical presentation, surgical treatment, further therapy and follow-up are presented. Results: Median tumour size was 7 mm in both groups (1.10 mm). Multicentric tumours were found in 15 pts. (22%), 8 had more than one PMC on the same side, and 7 displayed PMC bilaterally. Eleven (16%) of the primary tumors had metastatic involvement of regional lymph nodes at the time of initial surgery or during follow-up. Two patients showed distant metastases. No correlation between tumour size and multifocality or the presence of lymph node metastases could be seen. The gender of patients was the only significant independent variable for all patients; age and lymph node involvement was significantly different between incidentally and non-incidentally found PMC. Conclusions: Despite the majority of patients with PMC having an excellent outcome, there are also cases showing an unfavorable course. Currently no predictive parameter exists to anticipate the course and long-term outcome for an individual patient. Until this problem is solved, each patient should have the option to decide for him or herself whether to be treated similarly or differently than for conventional thyroid cancer.
Collapse
|
15
|
Samo RN, Agha A, Shah SA, Altaf A, Memon A, Blevins M, Qian HZ, Vermund SH. Risk Factors for Loss to Follow-Up among People Who Inject Drugs in a Risk Reduction Program at Karachi, Pakistan. A Case-Cohort Study. PLoS One 2016; 11:e0147912. [PMID: 26840414 PMCID: PMC4739707 DOI: 10.1371/journal.pone.0147912] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Accepted: 01/11/2016] [Indexed: 11/18/2022] Open
Abstract
INTRODUCTION Retention of male people who inject drugs (PWIDs) is a major challenge for harm reduction programs that include sterile needle/syringe exchange in resource-limited settings like Pakistan. We assessed the risk factors for loss to follow-up among male PWIDs enrolled in a risk reduction program in Karachi, Pakistan. METHODS We conducted a prospective cohort study among 636 HIV-uninfected male PWIDs enrolled during March-June 2009 in a harm reduction program for the estimation of incidence rate. At 24 months post-enrollment, clients who had dropped out of the program were defined as lost to follow-up and included as cases for case-cohort study. RESULTS The median age of the participants was 29 years (interquartile range: 23-36). Active outreach accounted for 76% (483/636) of cohort recruits. Loss to follow-up at 24 months was 25.5% (162/636). In multivariable logistic regression, younger age (AOR: 0.97, 95% CI: 0.92-0.99, p = 0.028), clients from other provinces than Sindh (AOR: 1.49, 95% CI: 1.01-2.22, p = 0.046), having no formal education (AOR: 3.44, 95% CI: 2.35-4.90, p<0.001), a history of incarceration (AOR: 1.68, 95% CI: 1.14-2.46, p<0.008), and being homeless (AOR: 1.47, 95% CI: 1.00-2.19, p<0.049) were associated with loss to follow-up. CONCLUSIONS Our cohort retained 74.5% of male PWIDs in Karachi for 24 months. Its loss to follow up rate suggested substantial ongoing programmatic challenges. Programmatic enhancements are needed for the highest risk male PWIDs, i.e., younger men, men not from Sindh Province, men who are poorly educated, formerly incarcerated, and/or homeless.
Collapse
Affiliation(s)
- Rab Nawaz Samo
- Polio Eradication Initiative, World Health Organization, Larkana, Pakistan
- * E-mail:
| | - Ajmal Agha
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | | | - Arshad Altaf
- Bridge Consultants Foundation, Karachi, Pakistan
| | | | - Meridith Blevins
- Vanderbilt Institute for Global Health & Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Han-Zhu Qian
- Vanderbilt Institute for Global Health & Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Sten H. Vermund
- Vanderbilt Institute for Global Health & Department of Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| |
Collapse
|
16
|
Woeste G, Juratli MA, Habbe N, Hannes S, El Youzouri H, Bechstein WO, Trombetta F, Moscato R, Ciamporcero T, Ghiglione F, Morino M, Tahir S, Baldjiev T, Goshev G, Pachoov N, Eftimov E, Kovachevski S, Smirnoff A, Roth JS, Wennergren J, Plymale MA, Zachem A, Davenport DL, Mangiante G, Passeri V, deManzoni G, Kaufmann R, Jairam AP, Mulder IM, Wu Z, Verhelst J, Vennix S, Giessen LJX, Jeekel J, Lange JF, Di Cerbo F, Ikhlawi K, Baladov M, Agha A, Iesalnieks I, Franklin M, Hernandez M, Glass J, Glover M, Gruber-Blum S, Fortelny R, May C, Glaser K, Redl H, Petter-Puchner A, Grossi J, Cavazzola LT, Tezza SLT, Nery LA, Zortea J, Roll S, Gorganchian F, Santa Maria V, Zuvela M, Galun D, Petrovic J, Micev M, Palibrk I, Bidzic N, Colozzi S, Clementi M, Cianca G, Giuliani A, Carlei F, Schietroma M, Amicucci G, Chung M, Cerasani N, Meyer J, Bulian DR, Heiss MM, Kocaay AF, Eker T, Celik SU, Akyol C, Cakmak A. Topic: Abdominal Wall Hernia - Abdominal wall closure. Hernia 2015; 19 Suppl 1:S198-205. [PMID: 26518800 DOI: 10.1007/bf03355349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- G Woeste
- Department of Surgery, Goethe university, Frankfurt, Germany
| | - M A Juratli
- Department of Surgery, Goethe university, Frankfurt, Germany
| | - N Habbe
- Department of Surgery, Goethe university, Frankfurt, Germany
| | - S Hannes
- Department of Surgery, Goethe university, Frankfurt, Germany
| | - H El Youzouri
- Department of Surgery, Goethe university, Frankfurt, Germany
| | - W O Bechstein
- Department of Surgery, Goethe university, Frankfurt, Germany
| | - F Trombetta
- SCDU General Surgery 1, University of Turin, Company City Hospital and Healht Science of Turin, Turin, Italy
| | - R Moscato
- SCDU General Surgery 1, University of Turin, Company City Hospital and Healht Science of Turin, Turin, Italy
| | - T Ciamporcero
- SCDU General Surgery 1, University of Turin, Company City Hospital and Healht Science of Turin, Turin, Italy
| | - F Ghiglione
- SCDU General Surgery 1, University of Turin, Company City Hospital and Healht Science of Turin, Turin, Italy
| | - M Morino
- SCDU General Surgery 1, University of Turin, Company City Hospital and Healht Science of Turin, Turin, Italy
| | - S Tahir
- University Surgical Clinic St. Naum Ohridski, Skopje, R. of Macedonia, European Union
| | - T Baldjiev
- General Hospital, Strumica, Public Health Organization, Strumica, R. of Macedonia, European Union
| | - G Goshev
- General Hospital, Strumica, Public Health Organization, Strumica, R. of Macedonia, European Union
| | - N Pachoov
- General Hospital, Strumica, Public Health Organization, Strumica, R. of Macedonia, European Union
| | - E Eftimov
- General Hospital, Strumica, Public Health Organization, Strumica, R. of Macedonia, European Union
| | - S Kovachevski
- General Hospital, Strumica, Public Health Organization, Strumica, R. of Macedonia, European Union
| | | | - J S Roth
- Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - J Wennergren
- Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - M A Plymale
- Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - A Zachem
- Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - D L Davenport
- Department of Surgery, University of Kentucky, Lexington, KY, USA
| | - G Mangiante
- Upper Digestive Surgery, University of Verona, Verona, Italy
| | | | | | - R Kaufmann
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - A P Jairam
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - I M Mulder
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
- Department of Surgery, Academic Medical Center, Amsterdam, Netherlands
| | - Z Wu
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - J Verhelst
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - S Vennix
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
- Department of Surgery, Academic Medical Center, Amsterdam, Netherlands
| | - L J X Giessen
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | - J Jeekel
- Department of Neuroscience, Erasmus University Medical Center, Rotterdam, Netherlands
| | - J F Lange
- Department of Surgery, Erasmus University Medical Center, Rotterdam, Netherlands
| | | | - K Ikhlawi
- Marienhospital Gelsenkirchen, Gelsenkirchen, Germany
| | - M Baladov
- Marienhospital Gelsenkirchen, Gelsenkirchen, Germany
| | - A Agha
- Klinikum Bogenhausen, Munich, Germany
| | | | - M Franklin
- Texas endosurgery Institute, San Antonio, USA
| | - M Hernandez
- Texas endosurgery Institute, San Antonio, USA
| | - J Glass
- Texas endosurgery Institute, San Antonio, USA
| | - M Glover
- Texas endosurgery Institute, San Antonio, USA
| | - S Gruber-Blum
- Department of General, Visceral and Oncologic Surgery, Wilhelminenspital, Vienna, Austria
| | - R Fortelny
- Department of General, Visceral and Oncologic Surgery, Wilhelminenspital, Vienna, Austria
| | - C May
- Department of General, Visceral and Oncologic Surgery, Wilhelminenspital, Vienna, Austria
| | - K Glaser
- Department of General, Visceral and Oncologic Surgery, Wilhelminenspital, Vienna, Austria
| | - H Redl
- Cluster of Tissue engeneering, Ludwig Boltzmann Institute of Traumatology, Vienna, Austria
| | - A Petter-Puchner
- Department of General, Visceral and Oncologic Surgery, Wilhelminenspital, Vienna, Austria
| | - J Grossi
- Brazilian lutern hospital, Canoas, Brazil
| | | | | | | | | | | | - F Gorganchian
- Departamento de Cirugia, Instituto de Investigaciones Medicas A. Lanari, Caba, Argentina
| | - V Santa Maria
- Departamento de Cirugia, Instituto de Investigaciones Medicas A. Lanari, Caba, Argentina
| | - M Zuvela
- Clinical center of Serbia, University Clinic for Digestive Surgery, Belgrade, Serbia
- Medical School, University of Belgrade, Belgrade, Serbia
| | - D Galun
- Clinical center of Serbia, University Clinic for Digestive Surgery, Belgrade, Serbia
- Medical School, University of Belgrade, Belgrade, Serbia
| | - J Petrovic
- Clinical center of Serbia, University Clinic for Digestive Surgery, Belgrade, Serbia
| | - M Micev
- Clinical center of Serbia, University Clinic for Digestive Surgery, Belgrade, Serbia
- Medical School, University of Belgrade, Belgrade, Serbia
| | - I Palibrk
- Clinical center of Serbia, University Clinic for Digestive Surgery, Belgrade, Serbia
- Medical School, University of Belgrade, Belgrade, Serbia
| | - N Bidzic
- Clinical center of Serbia, University Clinic for Digestive Surgery, Belgrade, Serbia
| | - S Colozzi
- Ospedale Civile San Salvatore, L'Aquila, Italy
| | | | | | | | | | | | | | - M Chung
- Gil Medical Center, Gachon University, Incheon, South Korea
| | - N Cerasani
- Department of Abdominal-, Vascular and Transplant Surgery, Cologne-Merheim Medical Center University of Witten/Herdecke, Cologne, Germany
| | - J Meyer
- Department of Abdominal-, Vascular and Transplant Surgery, Cologne-Merheim Medical Center University of Witten/Herdecke, Cologne, Germany
| | - D R Bulian
- Department of Abdominal-, Vascular and Transplant Surgery, Cologne-Merheim Medical Center University of Witten/Herdecke, Cologne, Germany
| | - M M Heiss
- Department of Abdominal-, Vascular and Transplant Surgery, Cologne-Merheim Medical Center University of Witten/Herdecke, Cologne, Germany
| | - A F Kocaay
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - T Eker
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - S U Celik
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - C Akyol
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| | - A Cakmak
- Department of General Surgery, Ankara University School of Medicine, Ankara, Turkey
| |
Collapse
|
17
|
Schleder S, Janke M, Agha A, Schacherer D, Hornung M, Schlitt H, Stroszczynski C, Schreyer A, Jung E. Preoperative differentiation of thyroid adenomas and thyroid carcinomas using high resolution contrast-enhanced ultrasound (CEUS). Clin Hemorheol Microcirc 2015; 61:13-22. [DOI: 10.3233/ch-141848] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- S. Schleder
- Department of Radiology, University Hospital Regensburg, Germany
| | - M. Janke
- Department of Radiology, University Hospital Regensburg, Germany
| | - A. Agha
- Department of Surgery, University Hospital Regensburg, Germany
| | - D. Schacherer
- Department of Internal Medicine I, University Hospital Regensburg, Germany
| | - M. Hornung
- Department of Surgery, University Hospital Regensburg, Germany
| | - H.J. Schlitt
- Department of Surgery, University Hospital Regensburg, Germany
| | - C. Stroszczynski
- Department of Radiology, University Hospital Regensburg, Germany
| | - A.G. Schreyer
- Department of Radiology, University Hospital Regensburg, Germany
| | - E.M. Jung
- Department of Radiology, University Hospital Regensburg, Germany
| |
Collapse
|
18
|
Miller C, Ratcliffe S, Agha A, Schreiber C. The many roads traveled to obtain treatment for early pregnancy loss. Contraception 2015. [DOI: 10.1016/j.contraception.2015.06.225] [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]
|
19
|
Noctor E, Gupta S, Brown T, Farrell M, Javadpour M, Costigan C, Agha A. Paediatric cyclical Cushing's disease due to corticotroph cell hyperplasia. BMC Endocr Disord 2015; 15:27. [PMID: 26063496 PMCID: PMC4464624 DOI: 10.1186/s12902-015-0024-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2015] [Accepted: 06/01/2015] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Cushing's disease is very rare in the paediatric population. Although uncommon, corticotroph hyperplasia causing Cushing's syndrome has been described in the adult population, but appears to be extremely rare in children. Likewise, cyclical cortisol hypersecretion, while accounting for 15 % of adult cases of Cushing's disease, has only rarely been described in the paediatric population. Here, we describe a very rare case of a 13-year old boy with cyclical cortisol hypersecretion secondary to corticotroph cell hyperplasia. CASE PRESENTATION The case is that of a 13-year old boy, presenting with a long history of symptoms and signs suggestive of hypercortisolism, who was found to have cyclical ACTH-dependent hypercortisolism following dynamic pituitary testing and serial late-night salivary cortisol measurements. The patient underwent endoscopic transsphenoidal resection of the pituitary. Early surgical remission was confirmed by undetectable post-operative morning plasma cortisol levels. Histology and immunocytochemistry of the resected pituitary tissue showed extensive corticotroph cell hyperplasia. CONCLUSION This report describes a rare case of cyclical Cushing's disease secondary to corticotroph hyperplasia in a paediatric patient. This highlights the challenging and varied nature of Cushing's disease and its diagnosis, and the need to keep a differential diagnosis in mind during the diagnostic process.
Collapse
Affiliation(s)
- E Noctor
- Department of Endocrinology and Neurosurgery, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.
| | - S Gupta
- Department of Endocrinology and Neurosurgery, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.
| | - T Brown
- Department of Endocrinology and Neurosurgery, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.
| | - M Farrell
- Department of Neuropathology, Beaumont Hospital, Dublin, Ireland.
| | - M Javadpour
- Department of Neurosurgery, Beaumont Hospital, Dublin, Ireland.
| | - C Costigan
- Department of Paediatric Endocrinology, Our Lady's Hospital for Sick Children, Dublin, Ireland.
| | - A Agha
- Department of Endocrinology and Neurosurgery, Beaumont Hospital, Beaumont Road, Dublin 9, Ireland.
| |
Collapse
|
20
|
Coats W, Pedigo K, Noble G, Glispin C, Agha A, Bazaldua A, Aranoff M, Bennett H, Crowling A, Gonzales N, Montoux A, Espinoza A, Almazan S, Allman C, Kaye C, Allman J, Crane B, Villegas A, Broughton B, McDonald R. Modeling of the PTF1‐L/Foxa2 Transcription Factor Complex Controlling Pancreatic Development. FASEB J 2015. [DOI: 10.1096/fasebj.29.1_supplement.lb56] [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] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ward Coats
- Molecular BiologyUT Southwestern Medical CenterDallasTXUnited States
| | - K Pedigo
- Molecular BiologyUT Southwestern Medical CenterDallasTXUnited States
| | - G Noble
- Molecular BiologyUT Southwestern Medical CenterDallasTXUnited States
| | - C Glispin
- Molecular BiologyUT Southwestern Medical CenterDallasTXUnited States
| | - A Agha
- Molecular BiologyUT Southwestern Medical CenterDallasTXUnited States
| | - A Bazaldua
- Molecular BiologyUT Southwestern Medical CenterDallasTXUnited States
| | - M Aranoff
- Molecular BiologyUT Southwestern Medical CenterDallasTXUnited States
| | - H Bennett
- Molecular BiologyUT Southwestern Medical CenterDallasTXUnited States
| | - A Crowling
- Molecular BiologyUT Southwestern Medical CenterDallasTXUnited States
| | - N Gonzales
- Molecular BiologyUT Southwestern Medical CenterDallasTXUnited States
| | - A Montoux
- Molecular BiologyUT Southwestern Medical CenterDallasTXUnited States
| | - A Espinoza
- Molecular BiologyUT Southwestern Medical CenterDallasTXUnited States
| | - S Almazan
- Molecular BiologyUT Southwestern Medical CenterDallasTXUnited States
| | - C Allman
- Molecular BiologyUT Southwestern Medical CenterDallasTXUnited States
| | - C Kaye
- Molecular BiologyUT Southwestern Medical CenterDallasTXUnited States
| | - J Allman
- Molecular BiologyUT Southwestern Medical CenterDallasTXUnited States
| | - B Crane
- Molecular BiologyUT Southwestern Medical CenterDallasTXUnited States
| | - A Villegas
- Molecular BiologyUT Southwestern Medical CenterDallasTXUnited States
| | - B Broughton
- Molecular BiologyUT Southwestern Medical CenterDallasTXUnited States
| | - Ray McDonald
- Molecular BiologyUT Southwestern Medical CenterDallasTXUnited States
| |
Collapse
|
21
|
Gundling F, Tiller M, Agha A, Schepp W, Iesalnieks I. Successful autologous fecal transplantation for chronic diversion colitis. Tech Coloproctol 2014; 19:51-2. [PMID: 25300242 DOI: 10.1007/s10151-014-1220-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Accepted: 09/15/2014] [Indexed: 12/20/2022]
Affiliation(s)
- F Gundling
- Department of Gastroenterology, Hepatology and Gastrointestinal Oncology, Academic Teaching Hospital Bogenhausen, Technical University of Munich, Englschalkinger Straße 77, 81925, Munich, Germany,
| | | | | | | | | |
Collapse
|
22
|
Neff K, Donegan D, MacMahon J, O'Hanlon C, Keane N, Agha A, Thompson C, Smith D. Management of parenteral nutrition associated hyperglycaemia: a comparison of subcutaneous and intravenous insulin regimen. Ir Med J 2014; 107:141-143. [PMID: 24908857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
PN is associated with significant hyperglycaemia, which may be detrimental to clinical outcome. There are few data on the management of this phenomenon outside of intensive care units. In our unit, we studied the efficacy of protocol-based intravenous insulin delivery as compared to subcutaneous insulin prescribed individually outside of the critical care setting. In a retrospective review over a two-year period, we compared patients with PN-associated hyperglycaemia who had received both modes of insulin therapy. A total of 122 who developed PN-associated hyperglycaemia were identified. Those on the intravenous insulin regimen were within glycaemic target for more time than those on the subcutaneous regimen (62% Vs 43%, p = 0.008). We therefore conclude that outside of the critical care setting, intravenous insulin delivers better glycaemic control and should therefore be considered optimum therapy for patients with PN-associated hyperglycaemia.
Collapse
|
23
|
Mohr A, Thiel A, Hahnel A, Manka M, Agha A, Müller M, Schacherer D, Girlich C. [A 43-year-old patient with character changes, recurrent impaired consciousness and retrograde amnesia]. Internist (Berl) 2014; 55:84-7. [PMID: 24429640 DOI: 10.1007/s00108-013-3407-4] [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: 11/21/2022]
Abstract
A 43-year-old male patient with recurring impaired consciousness and retrograde amnesia was admitted to the department of neurology. During the neurological evaluation no pathological findings could initially be revealed but one day the patient was confused again and presented with inadequate behavior: at this time a blood glucose value of 40 mg/dl was measured. For further evaluation the patient was transferred to our department. As the reason for the impaired consciousness was suspected to be of neuroglucopenic origin a rapid adrenocorticotropic hormone (ACTH) stimulation test was first performed to rule out adrenal insufficiency. For further evaluation a fasting test was conducted: after 48 h an episode with neuroglucopenic symptoms occurred again which disappeared after intravenous administration of glucose. The laboratory results of glucose, insulin and c-peptide determined at this point in time led to the diagnosis of an insulinoma. By ultrasound examination a hypoechogenic lesion 1.5 cm in size could be shown in the head of the pancreas and was confirmed by magnetic resonance imaging (MRI). After duodenum-preserving partial pancreatic head resection with enucleation of the insulinoma no further neuroglucopenic symptoms occurred.
Collapse
Affiliation(s)
- A Mohr
- Klinik und Poliklinik für Innere Medizin I, Universitätsklinikum Regensburg, 93042, Regensburg, Deutschland,
| | | | | | | | | | | | | | | |
Collapse
|
24
|
Samo RN, Altaf A, Agha A, Pasha O, Rozi S, Memon A, Azam S, Blevins M, Vermund SH, Shah SA. High HIV incidence among persons who inject drugs in Pakistan: greater risk with needle sharing and injecting frequently among the homeless. PLoS One 2013; 8:e81715. [PMID: 24358123 PMCID: PMC3864804 DOI: 10.1371/journal.pone.0081715] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 10/26/2013] [Indexed: 11/18/2022] Open
Abstract
Background The incidence of HIV among persons who inject drugs (PWIDU) has fallen in many nations, likely due to successes of clean needle/syringe exchange and substance abuse treatment and service programs. However in Pakistan, prevalence rates for PWID have risen dramatically. In several cities, prevalence exceeded 20% by 2009 compared to a 2003 baseline of just 0.5%. However, no cohort study of PWID has ever been conducted. Methods We enrolled a cohort of 636 HIV seronegative PWID registered with three drop-in centers that focus on risk reduction and basic social services in Karachi. Recruitment began in 2009 (March to June) and PWID were followed for two years. We measured incidence rates and risk factors associated with HIV seroconversion. Results Incidence of HIV was 12.4 per 100 person-years (95% exact Poisson confidence interval [CI]: 10.3–14.9). We followed 474 of 636 HIV seronegative persons (74.5%) for two years, an annual loss to follow-up of <13 per 100 person years. In multivariable Cox regression analysis, HIV seroconversion was associated with non-Muslim religion (Adjusted risk ratio [ARR] = 1.7, 95%CI:1.4, 2.7, p = 0.03), sharing of syringes (ARR = 2.3, 95%CI:1.5, 3.3, p<0.0001), being homeless (ARR = 1.7, 95%CI:1.1, 2.5, p = 0.009), and daily injection of drugs (ARR = 1.1, 95%CI:1.0, 1.3, p = 0.04). Conclusions Even though all members of the cohort of PWID were attending risk reduction programs, the HIV incidence rate was very high in Karachi from 2009–2011. The project budget was low, yet we were able to retain three-quarters of the population over two years. Absence of opiate substitution therapy and incomplete needle/syringe exchange coverage undermines success in HIV risk reduction.
Collapse
Affiliation(s)
- Rab Nawaz Samo
- Bridge Consultants Foundation, Karachi, Pakistan
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Arshad Altaf
- Bridge Consultants Foundation, Karachi, Pakistan
- * E-mail:
| | - Ajmal Agha
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Omrana Pasha
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Shafquat Rozi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | | | | | - Meridith Blevins
- Vanderbilt Institute for Global Health and Departments of Biostatistics & Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Sten H. Vermund
- Vanderbilt Institute for Global Health and Departments of Biostatistics & Pediatrics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | | |
Collapse
|
25
|
Wiggermann P, Zeman F, Niessen C, Agha A, Trabold B, Stroszczynski C, Jung EM. Percutaneous irreversible electroporation (IRE) of hepatic malignant tumours: contrast-enhanced ultrasound (CEUS) findings. Clin Hemorheol Microcirc 2013; 52:417-27. [PMID: 22986756 DOI: 10.3233/ch-2012-1615] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE The aim of this study is to describe the image findings of contrast-enhanced ultrasound (CEUS) after irreversible electroporation (IRE), and to assess its usefulness in relation to the evaluation of the ablation status using a dynamic recording of the microvascularisation. MATERIAL AND METHOD In this prospectively designed study, a percutaneous IRE was performed for the treatment of malignant hepatic lesions in a total of 15 patients following the interdisciplinary diagnosis. The lesions were documented using CEUS before, immediately after and 20 minutes after the ablation. The acquired CEUS image data was subsequently independently retrospectively evaluated by 2 experienced radiologists and assessed in relation to microvascularisation using a 5 point scale. RESULTS Using CEUS, a significant reduction in the microcirculation of the lesions, both centrally and marginally, could be detected following IRE (p < 0.001 and p < 0.001). The mean evaluation of the central microcirculation was reduced from 3.13 ± 1.38 to 0.47 ± 0.64 (p < 0.01). For the peripheral area of the lesion and the ablation margin, there was a reduction of 3.37 ± 1.13 to 1.57 ± 0.46 (p = 0.001). There was no significant reduction in the macrocirculation. CONCLUSION Within the framework of this study, it could be demonstrated that, in the course of IRE, a rapid significant reduction of the microcirculation in the ablation area occurred.
Collapse
Affiliation(s)
- P Wiggermann
- Department of Radiology, University Regensburg Medical Center, Regensburg, Germany.
| | | | | | | | | | | | | |
Collapse
|
26
|
Behan LA, O'Sullivan EP, Glynn N, Woods C, Crowley RK, Tun TK, Smith D, Thompson CJ, Agha A. Serum prolactin concentration at presentation of non-functioning pituitary macroadenomas. J Endocrinol Invest 2013; 36:508-14. [PMID: 23385474 DOI: 10.3275/8815] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Serum PRL levels at presentation may be useful in distinguishing between disconnection hyperprolactinemia in non-secretory pituitary adenomas and prolactinomas in order to guide appropriate therapy; however, there is a debate regarding the discriminatory PRL thresholds. We aimed to examine PRL concentrations at presentation in a cohort of histologically proven non-functioning pituitary adenomas (NFPA). DESIGN AND METHODS Retrospective case note analysis was performed. Clinical, biochemical, histopathological and radiological data were recorded and analyzed. Complete data were available for 250 subjects with NFPA. RESULTS Of the study population, 44.8% were hyperprolactinemic at presentation, 55.3% of whom were female. Of those with hyperprolactinemia, 73.2% had PRL<1000 mIU/l on presentation, 24.1% had PRL between 1000 and 1999 mIU/l. Only 2.7% (no.=3 females, 1.2% whole cohort) had PRL>2000 mIU/l (94.3 ng/ml), 2 of whom were pregnant. No male subject and no subjects with an intrasellar macroadenoma had serum PRL>1000 mIU/l (47.2 ng/ml). Overall, serum PRL was not higher among 43 subjects taking medications known to raise PRL. CONCLUSIONS Our data support recent evidence that the serum PRL concentration is rarely >1000 mIU/l in males, or >2000 mIU/l in females, with non-functioning macroadenomas and that, once other contributing factors to the hyperprolactinemia have been excluded, a trial of dopamine agonist therapy for such lesions is indicated.
Collapse
Affiliation(s)
- L A Behan
- Division of Neuro-endocrinology, Beaumont Hospital and the RCSI Medical School, Beaumont Road, Dublin 9, Ireland
| | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Göcze I, Herzog R, Graf BM, Agha A, Schlitt HJ, Pfister K, Jung E, Bein T. Contrast-enhanced ultrasonography in the ICU: promising tool or exciting toy? Crit Care 2013. [PMCID: PMC3642456 DOI: 10.1186/cc12123] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
28
|
Schleder S, Dendl LM, Pawlik M, Friedrich C, Ott C, Agha A, Wiggermann P, Stroszczynski C, Schreyer AG. [MR enterography sequence evaluation for patients with Crohn's disease]. ROFO-FORTSCHR RONTG 2013; 185:440-5. [PMID: 23440646 DOI: 10.1055/s-0032-1330516] [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: 10/27/2022]
Abstract
PURPOSE To evaluate a routine MR enterography (MRE) protocol for patients with Crohn's disease (CD) in order to assess and rank the subjectively most important sequences regarding diagnostic decisions. MATERIALS AND METHODS We prospectively examined 84 patients (42 male) with known CD using a coronal T2 / T1-weighted balanced SSFP (TrueFISP), axial T2-weighted single shot TSE (HASTE) as well as an axial T1-weighted gradient-echo sequence (2D-FLASH) before intravenous contrast application and a 2D-FLASH sequence with axial and coronal orientation after intravenous contrast application. 4 experienced radiologists subjectively evaluated the sequences independently using a scale between 1 and 5 (1 = excellent; 5 = non-diagnostic) regarding their diagnostic significance for a final radiologic decision. The ranking of the different sequences was statistically tested by the Friedman analysis. RESULTS The following ranking was found: HASTE sequences were ranked prior to contrast-enhanced axial gradient-echo (2D-FLASH). The third to fifth ranking was TrueFISP, the axial contrast-enhanced 2D-FLASH and the 2D-FLASH without contrast, respectively. Differences between the first and second rank were significant (p < 0.05), and all other differences were highly significant (p < 0.01). CONCLUSION The stable and fast T2-weighted MR sequences without intravenous contrast represented by axial HASTE and coronal TrueFISP were ranked as number 1 and 3. The examination protocol should be completed by a coronal T1-weighted gradient-echo-sequence after contrast injection, which can be supplemented by an axial acquisition. The T1-weighted gradient-echo sequence without contrast could be omitted.
Collapse
Affiliation(s)
- S Schleder
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Regensburg, Germany.
| | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Abstract
Karachi is the only mega city in the world with persistent poliovirus transmission. We determined routine childhood immunization rates in Karachi and identified predictors of vaccine completion. A population-based cross-sectional survey was conducted in Karachi between August and September 2008. Data on demographics, socioeconomic, and DTP3 vaccination status in children 12 to 23 months old were collected. Logistic regression was used to identify predictors of vaccination completion. Overall, 1401 participants were approached; 1391 consented to participate. Of these, 1038 (75%) were completely vaccinated. Punjabi families had the highest DTP3 coverage (82%), followed by Urdu-speaking families (79%). Pashtun (67%) and Bengali (48%) families had the lowest vaccine coverage. Children of mothers with ≥12 years of schooling (OR = 25.4; 95% CI = 5.7-113.1) were most likely to be vaccinated. A quarter of study participants were unvaccinated. Targeted strategies for boosting DTP3 rates in communities with low immunization coverage are essential for polio eradication in Karachi.
Collapse
|
30
|
Agha A, Jung E, Janke M, Hornung M, Georgieva M, Schlitt H, Schreyer A, Strosczcynski C, Schleder S. Preoperative diagnosis of thyroid adenomas using high resolution contrast-enhanced ultrasound (CEUS). Clin Hemorheol Microcirc 2013; 55:403-9. [DOI: 10.3233/ch-131777] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- A. Agha
- Department of Surgery, University Hospital Regensburg, Regensburg, Germany
| | - E.M. Jung
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - M. Janke
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - M. Hornung
- Department of Surgery, University Hospital Regensburg, Regensburg, Germany
| | - M. Georgieva
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - H.J. Schlitt
- Department of Surgery, University Hospital Regensburg, Regensburg, Germany
| | - A.G. Schreyer
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - C. Strosczcynski
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - S. Schleder
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| |
Collapse
|
31
|
Agha A, Makris D. Biocatalytic characteristics, product formation and putative pathway ofP-coumaric acid oxidation by a crude peroxidase from onion. Acta Alimentaria 2012. [DOI: 10.1556/aalim.41.2012.3.2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
|
32
|
Khowaja SS, Tharani AJ, Agha A, Karamaliani RS. Women trafficking: causes, concerns, care! J PAK MED ASSOC 2012; 62:835-838. [PMID: 23862261] [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: 06/02/2023]
Abstract
Pakistan is both a country of origin and destination as far as women trafficking is concerned. Poverty, gender discrimination, lack of education, and ignorance about legal rights are some of the underlying causes. Available data suggest several areas of concern, like, for instance: direct health effects, maladaptive coping leading to the use of illicit drugs, and inaccessibility to healthcare facilities. Therefore, numerous interventions would be required at three levels: the prevention of trafficking, the protection of victims and the prosecution of the traffickers.
Collapse
|
33
|
Egger L, Fikentscher T, Poschenrieder F, Röhrl S, Friedrich C, Schill G, Agha A, Hoffstetter P, Überbacher C, Stroszczynski C, Schreyer AG. [Clinical significance of conventional follow-through examinations of the gastrointestinal passage in a university hospital]. ROFO-FORTSCHR RONTG 2012; 184:893-8. [PMID: 22711251 DOI: 10.1055/s-0032-1312848] [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: 10/27/2022]
Abstract
PURPOSE The follow-through examination (FTE) is still a widely used radiological method. Modern sectional imaging techniques (CT, MRI, sonography) are established routine examinations offering a wider range of information. In this context the study tries to answer the question of the current significance of FTE of the gastrointestinal tract. MATERIALS AND METHODS We retrospectively analyzed data of 300 patients, who had undergone FTE between 2001 and 2009 in a university hospital. The medical history, current anamnesis and the therapeutic consequences of the examination for each patient were evaluated based on radiological reports and electronic medical files. RESULTS The most frequent indication to perform the examination was an uncertain gastrointestinal passage or/and the exclusion of stenosis (70%). In 10% of all FTEs there were complications which led to examination abortion in 2% of cases. In patients who underwent surgery of the abdomen, the examination was performed 8 days (median) after surgery. In 35% of these patients, FTE was done within the first 6 days after surgery. 87% of the patients received further diagnostics before getting pharmacotherapy or surgery. None of the analyzed patients had been operated on after an FTE of the abdomen without being investigated by another diagnostic method. The average radiation exposure was 7 mSv. CONCLUSION Considering the wide availability of modern sectional imaging methods that are usually necessary for taking significant therapeutic steps, the indication for FTE examinations of the gastrointestinal tract should be very restrictive. The relatively high radiation exposure supports this suggestion.
Collapse
Affiliation(s)
- L Egger
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Regensburg.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Iesalnieks I, Dederichs F, Kilger A, Schlitt HJ, Agha A. [Postoperative morbidity after bowel resections in patients with Crohn's disease: risk, management strategies, prevention]. Z Gastroenterol 2012; 50:595-600. [PMID: 22660995 DOI: 10.1055/s-0031-1299462] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The postoperative morbidity rate following bowel resections for Crohn's disease is higher than for other benign disease. The incidence of postoperative intraabdominal septic complications (anastomotic leak, bowel fistula, intraabdominal abscess, peritonitis) is 5 - 30 %. Preoperative weight loss, prolonged refractory symptoms and penetrating disease behaviour are significant determinants of postoperative complication risk. Preoperative enteral nutrition, antibiotics, percutaneous abscess drainage and cessation of steroids might reduce the risk of surgery, however, more evidence is needed. The intake of immunosuppressive agents (mainly, azathioprine) can be continued perioperatively. The occurrence of postoperative intraabdominal septic complications is associated with an increased risk of surgical recurrence in patients with terminal ileitis, however, the long-term prognosis could be improved in the latter patients by secondary fecal diversion. There is no association between postoperative morbidity and long-term outcome in patients with Crohn's colitis.
Collapse
Affiliation(s)
- I Iesalnieks
- Abteilung für Allgemein- und Viszeralchirurgie, Marienhospital Gelsenkirchen.
| | | | | | | | | |
Collapse
|
35
|
Altaf A, Agha A, Holte-McKinzie M, Abbas Q, Jafri SB, Emmanuel F. Size estimation, HIV prevalence and risk behaviours of female sex workers in Pakistan. J PAK MED ASSOC 2012; 62:551-557. [PMID: 22755338] [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: 06/01/2023]
Abstract
OBJECTIVE To provide size estimation and to determine risky behaviours and HIV prevalence among female sex workers in Pakistan, which has progressed from a low to concentrated level of HIV epidemic. METHODS A cross-sectional study (geographic mapping and integrated behavioural and biological survey-IBBS) was conducted between August 2005 to January 2006 in Karachi, Hyderabad and Sukkur. A detailed questionnaire and dry blood spot (DBS) specimen for HIV testing were collected by trained interviewers after informed consent. The study was ethically approved by review boards in Canada and Pakistan. RESULTS About 14,900 female sex workers were estimated to be functional in Sindh. A total of 1158 of them were interviewed for the study. Average age of sex workers was 27.4 +/- 6.7 years, and the majority 787 (67.9%) were married, and uneducated 764 (65.9%). Sindhi (26.4%) was the predominant ethnicity. Mean number of paid clients was 2.1 +/- 1.2. three workers were confirmed HIV positive (0.75%, 95 percent CI 0.2-2.2%) from Karachi. Condom use at last sexual act was highest (68%) among brothel-based workers from Karachi, and the lowest in Sukkur where only 1.3% street-based workers reported using a condom at last sexual act. Overall use of illicit drugs through injections was negligible. CONCLUSION HIV prevalence among female sex workers in Sindh, Pakistan is low but risky behaviours are present. Well organised service delivery programmes can help promoting safer practices.
Collapse
Affiliation(s)
- Arshad Altaf
- Canada-Pakistan HIV/AIDS Surveillance Project of Canadian International Development Agency, Sindh & National AIDS Control Programme, Karachi & Islamabad.
| | | | | | | | | | | |
Collapse
|
36
|
Georgieva M, Hornung M, Agha A, Stroszczynski C, Jung EM. Hochauflösende Kontrastmittelsonographie (CEUS) und Elastographie zur Detektion und Charakterisierung von Schilddrüssenkarzinomen im Vergleich zur OP: Erste Ergebnisse. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1311177] [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]
|
37
|
Hoffstetter P, Schleder S, Jung EM, Götz A, Uller W, Müller-Wille R, Wiggermann P, Agha A, Stroszczynski C, Schreyer AG. Konventionelle Abdomenübersichtsaufnahmen - welchen klinischen Nutzen hat die Aufnahme in Rückenlage. ROFO-FORTSCHR RONTG 2012. [DOI: 10.1055/s-0032-1311431] [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]
|
38
|
Hannon MJ, Orr C, Moran C, Behan LA, Agha A, Ball SG, Thompson CJ. Anterior hypopituitarism is rare and autoimmune disease is common in adults with idiopathic central diabetes insipidus. Clin Endocrinol (Oxf) 2012; 76:725-8. [PMID: 22026638 DOI: 10.1111/j.1365-2265.2011.04270.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [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: 11/27/2022]
Abstract
OBJECTIVE Central diabetes insipidus is a rare clinical condition with a heterogenous aetiology. Up to 40% of cases are classified as idiopathic, although many of these are thought to have an autoimmune basis. Published data have suggested that anterior hypopituitarism is common in childhood-onset idiopathic diabetes insipidus. We aimed to assess the incidence of anterior hypopituitarism in a cohort of adult patients with idiopathic diabetes insipidus. DESIGN AND PATIENTS We performed a retrospective review of the databases of two pituitary investigation units. This identified 39 patients with idiopathic diabetes insipidus. All had undergone magnetic resonance imaging scanning and dynamic pituitary testing (either insulin tolerance testing or GHRH/arginine and short synacthen testing) to assess anterior pituitary function. RESULTS One patient had partial growth hormone deficiency; no other anterior pituitary hormonal deficits were found. Thirty-three percent had at least one autoimmune disease in addition to central diabetes insipidus. CONCLUSIONS Our data suggest that anterior hypopituitarism is rare in adult idiopathic diabetes insipidus. Routine screening of these patients for anterior hypopituitarism may not, therefore, be indicated. The significant prevalence of autoimmune disease in this cohort supports the hypothesis that idiopathic diabetes insipidus may have an autoimmune aetiology.
Collapse
Affiliation(s)
- M J Hannon
- Academic Department of Endocrinology, Beaumont Hospital/RCSI Medical School, Dublin, Ireland.
| | | | | | | | | | | | | |
Collapse
|
39
|
Altaf A, Zahidie A, Agha A. Comparing risk factors of HIV among hijra sex workers in Larkana and other cities of Pakistan: an analytical cross sectional study. BMC Public Health 2012; 12:279. [PMID: 22490045 PMCID: PMC3418161 DOI: 10.1186/1471-2458-12-279] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2011] [Accepted: 04/10/2012] [Indexed: 01/28/2023] Open
Abstract
Background In 2005, Pakistan was first labeled as a country with concentrated epidemic of Human Immunodeficiency Virus (HIV). This was revealed through second generation surveillance conducted by HIV/AIDS Surveillance Project (HASP). While injection drug users (IDUs) were driving the epidemic, subsequent surveys showed that Hijra (transgender) sex workers (HSWs) were emerging as the second most vulnerable group with an average national prevalence of 6.4%. An exceptionally high prevalence (27.6%) was found in Larkana, which is a small town on the right bank of river Indus near the ruins of Mohenjo-Daro in the province of Sindh. This paper presents the risk factors associated with high prevalence of HIV among HSWs in Larkana as compared to other cities of the country. Methods Data were extracted for secondary analysis from 2008 Integrated behavioral and biological survey (IBBS) to compare HSWs living in Larkana with those living in other cities including Karachi and Hyderabad in Sindh; Lahore and Faisalabad in Punjab; and Peshawar in Khyber Pakhtunkhwa provinces. After descriptive analysis, univariate and multivariate analyses were performed to identify risk factors. P value of 0.25 or less was used to include factors in multivariate analysis. Results We compared 199 HSWs from Larkana with 420 HSWs from other cities. The average age of HSWs in Larkana was 26.42 (±5.4) years. Majority were Sindhi speaking (80%), uneducated (68%) and unmarried (97%). In univariate analysis, factors associated with higher prevalence of HIV in Larkana included younger age i.e. 20–24 years (OR: 5.8, CI: 2.809–12.15), being unmarried (OR: 2.4, CI: 1.0–5.7), sex work as the only mode of income (OR: 5.5, CI: 3.70–8.2) and longer duration of being involved in sex work 5–10 years (OR: 3.3, CI: 1.7–6.12). In multivariate logistic regression the HSWs from Larkana were more likely to lack knowledge regarding preventive measures against HIV (OR 11.9, CI: 3.4–41.08) and were more prone to use of alcohol during anal intercourse (OR: 6.3, CI: 2.77–17.797). Conclusion Outreach programs focusing on safer sexual practices and VCT are urgently needed to address the upsurge of HIV among HSWs in Larkana.
Collapse
Affiliation(s)
- Arshad Altaf
- Department of Community Health Sciences, The Aga Khan University, Karachi, Pakistan
| | | | | |
Collapse
|
40
|
Khowaja AR, Karmaliani R, Mistry R, Agha A. Transition towards health promoting hospitals: adapting a global framework to Pakistan. East Mediterr Health J 2012; 17:738-43. [PMID: 22256406 DOI: 10.26719/2011.17.10.738] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The World Health Organization encourages hospitals to become Health Promoting Hospitals (HPH) but adapting this concept to Pakistan has not been investigated. We explore perceptions of healthcare stakeholders about strategies and a priority action-plan to encourage HPHs in Pakistan. We conducted a qualitative study in 2007 where key-informant interviews and focus group discussions were held with healthcare stakeholders in Karachi. Thematic analysis was done and emerging themes were categorized. The HPH core components were perceived as the "standard framework"; however more emphasis was placed on priority actions as to satisfy "basic needs" of patients, staff and the community. This included basic facilities of comfort, health, hygiene, safety, security and emotional support. A change in the traditional mindset from cure to care and identification of key personnel, awareness-raising and cooperation would strengthen advocacy efforts for HPH in Pakistan.
Collapse
Affiliation(s)
- A R Khowaja
- Department of Paediatrics & Child Health, Aga Khan University Karachi, Pakistan.
| | | | | | | |
Collapse
|
41
|
Mylotte D, Kavanagh GF, Peace AJ, Tedesco AF, Carmody D, O'Reilly M, Foley DP, Thompson CJ, Agha A, Smith D, Kenny D. Platelet reactivity in type 2 diabetes mellitus: a comparative analysis with survivors of myocardial infarction and the role of glycaemic control. Platelets 2011; 23:439-46. [PMID: 22150374 DOI: 10.3109/09537104.2011.634932] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
UNLABELLED Patients with type 2 diabetes mellitus exhibit considerable platelet dysfunction, though this is poorly characterized in patients with diabetes taking aspirin for the primary prevention of cardiovascular events. We sought to compare platelet function in this patient population with that of a high-risk group of non-diabetic subjects with a history of previous myocardial infarction (MI), and to assess whether glycaemic control impacts on platelet function. METHODS Platelet aggregation was measured in response to incremental concentrations of five platelet agonists using light transmission aggregometry. All patients were taking aspirin, and aspirin insensitivity was defined as ≥ 20% arachidonic acid (AA) mediated aggregation. Patients with diabetes were divided according to glycaemic control (HbA(1c)): optimal ≤ 6.5, good 6.6-7.4 and suboptimal ≥ 7.5%. RESULTS In total, 85 patients with type 2 diabetes and 35 non-diabetic patients with previous MI were recruited. Compared to MI patients, diabetes patients had increased aggregation in response to multiple concentrations of epinephrine, collagen, adenosine diphosphate and AA. Aspirin insensitivity was more common in type 2 diabetes (15% vs. 0%, p=0.037). Platelet aggregation was increased in response to several agonists patients with suboptimal glycaemic control compared to patients with optimal control. Aspirin insensitivity was also more common in patients with suboptimal glycaemic control compared to those with good or optimal control (26.0% vs. 8.3% vs. 4%, p=0.04). CONCLUSION Patients with type 2 diabetes mellitus, without proven vascular disease, exhibit platelet dysfunction and have increased platelet aggregation and aspirin insensitivity compared to non-diabetic patients with previous MI. Platelet dysfunction in diabetes is more severe in patients with suboptimal glycaemic control.
Collapse
Affiliation(s)
- D Mylotte
- Department of Molecular and Cellular Therapeutics, The Royal College of Surgeons in Ireland , Dublin , Ireland.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Hoffstetter P, Schleder S, Jung EM, Götz A, Uller W, Müller-Wille R, Wiggermann P, Agha A, Stroszczynski C, Schreyer AG. [Plain abdominal radiograph - is there any additional clinical value based on the supine projection?]. Dtsch Med Wochenschr 2011; 136:2589-93. [PMID: 22160951 DOI: 10.1055/s-0031-1292851] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND To assess the diagnostic value of an additionally acquired plain abdominal radiograph in supine position. MATERIALS AND METHODS Two experienced radiologists evaluated retrospectively 2148 consecutive patients having plain abdominal radiographs acquired in a tertiary care center. There were 1385 patients having an erect view and 763 patients with a left lateral decubitus view. All patients had a second examination in supine position. First the radiographs in erect or decubitus view were evaluated regarding the presence and details of pathological changes. After 4 weeks all radiographs including the supine view were evaluated again. Next to pathological changes the additional value of the supine projection was assessed. The results were compared and the additional diagnostic value using the supine view was noted. RESULTS We evaluated 2148 patients having a plain abdominal radiograph (1325 men, 823 women, mean 58.9 years, range 15-96 years). The average age within the group acquired with left decubitus view was 61.1 years, while patients having an erect view had a mean age of 57.0 years. For the first evaluation we found pathological changes in 10.5% (decubitus view: 13.1%, erect view 9.5%; p = 0.01). The most frequent diagnosis was ileus (7.7%) followed by abdominal free air (2.4%). The results were confirmed during the second reading in 99.2%. In 3.5% (decubitus view 5.8%, erect view 2.2%) more anatomical structures were depicted considering the supine projection and the decubitus/erect projections. The anatomical information was in no case relevant for the diagnosis. CONCLUSION Having the information of an supine view additionally to an decubitus/erect view increases the depiction of anatomical structures up to 5.8%. Nevertheless there was no additional diagnostic relevant information based on the supine view.
Collapse
Affiliation(s)
- P Hoffstetter
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Bad Abbach.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
43
|
Behan LA, Draman MS, Moran C, King T, Crowley RK, O'Sullivan EP, Smith D, Thompson CJ, Agha A. Secondary resistance to cabergoline therapy in a macroprolactinoma: a case report and literature review. Pituitary 2011; 14:362-6. [PMID: 19191028 DOI: 10.1007/s11102-009-0168-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [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: 10/21/2022]
Abstract
Primary resistance to dopamine agonists occurs in 10-15% of prolactinomas but secondary resistance following initial biochemical and anti-proliferative response is very rare and has only been hitherto described in four previous cases, two with bromocriptine and two with cabergoline. We describe a case of a 57-year-old woman who presented with a large macroprolactinoma with suprasellar extension. She was initially treated with bromocriptine therapy with a resolution of symptoms, marked reduction in prolactin concentration and complete tumour shrinkage; a response which was subsequently maintained on cabergoline. After 8 years of dopamine agonist therapy, her prolactin concentration began to rise and there was symptomatic recurrence of her tumour despite escalating doses of cabergoline up to 6 mg weekly. Non-compliance was outruled by observed inpatient drug administration. The patient underwent surgical debulking followed by radiotherapy with good response. This case adds to the previous two cases of secondary resistance to cabergoline therapy in prolactinomas a marked initial response. While the mechanism of secondary resistance remains unknown and not possible to predict, close observation of prolactinoma patients on treatment is necessary.
Collapse
Affiliation(s)
- L A Behan
- Department of Academic Endocrinology and Diabetes, Beaumont Hospital and RCSI Medical School, Dublin 9, Ireland.
| | | | | | | | | | | | | | | | | |
Collapse
|
44
|
Tanriverdi F, Agha A, Aimaretti G, Casanueva FF, Kelestimur F, Klose M, Masel BE, Pereira AM, Popovic V, Schneider HJ. Manifesto for the current understanding and management of traumatic brain injury-induced hypopituitarism. J Endocrinol Invest 2011; 34:541-3. [PMID: 21697650 DOI: 10.3275/7805] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Traumatic brain injury (TBI)-induced hypopituitarism remains a relevant medical problem, because it may affect a significant proportion of the population. In the last decade important studies have been published investigating pituitary dysfunction after TBI. Recently, a group of experts gathered and revisited the topic of TBI-induced hypopituitarism. During the 2-day meeting, the main issues of this topic were presented and discussed, and current understanding and management of TBI-induced hypopituitarism are summarized here.
Collapse
Affiliation(s)
- F Tanriverdi
- Erciyes University Medical School, Department of Endocrinology, Kayseri, Turkey.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Ajmal F, Agha A, Zareen N, Karim MS. Knowledge, attitudes and practices (KAP) regarding sexuality, sexual behaviors and contraceptives among college/university students in Karachi, Pakistan. J Coll Physicians Surg Pak 2011; 21:164-8. [PMID: 21419024 DOI: 03.2011/jcpsp.164168] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 07/29/2010] [Accepted: 01/30/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess the knowledge, attitudes and practices regarding sexuality, high risk sexual behaviors and methods of contraception, among college/university students of Karachi, Pakistan. STUDY DESIGN Cross-sectional observational study. PLACE AND DURATION OF STUDY Higher Education Commission-recognized government and private colleges/universities in Karachi from 2005-2006. METHODOLOGY Two colleges/universities were randomly selected from each category i.e. government medical, government non-medical and private medical and non-medical colleges/universities. Three stage cluster sampling was employed to draw a representative sample of students. A self administered questionnaire was used to elicit information on knowledge, attitudes and practices regarding high risk sexual behaviors, methods of contraception and sources to obtain information about sexual issues. RESULTS A total of 957 students were interviewed. They comprised 542 (56.6%) males and 415 (43.4%) females with mean age of 21 ± 1.8 years. Bivariate analysis showed that students enrolled in medical colleges/universities were less likely to watch adult films (O.R. 0.7, CI; 0.5-0.9) to acquire sex related knowledge and go out on dates (O.R. 0.6, CI; 0.4- 0.8). Similarly, medical students were less likely to consider contraception as being against Islamic teachings (O.R. 0.7, CI; 0.5-0.9). CONCLUSION The curricula of non-medical studies at undergraduate level should include education regarding sexual health and contraception.
Collapse
Affiliation(s)
- Fozia Ajmal
- Department of Radiology, The Aga Khan University Hospital, Karachi.
| | | | | | | |
Collapse
|
46
|
Crowley RK, Woods C, Fleming M, Rogers B, Behan LA, O'Sullivan EP, Kane T, Agha A, Smith D, Costello RW, Thompson CJ. Somnolence in adult craniopharyngioma patients is a common, heterogeneous condition that is potentially treatable. Clin Endocrinol (Oxf) 2011; 74:750-5. [PMID: 21521265 DOI: 10.1111/j.1365-2265.2011.03993.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [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: 11/28/2022]
Abstract
CONTEXT AND OBJECTIVE Somnolence and obesity are prevalent in craniopharyngioma patients. We hypothesized that somnolence was because of obstructive sleep apnoea in craniopharyngioma patients. DESIGN, PATIENTS AND MEASUREMENTS We assessed prevalence of somnolence and sleep apnoea in 28 craniopharyngioma and 23 obese controls attending a tertiary referral centre, by means of the Epworth Sleepiness Score (ESS) and polysomnography. All subjects with sleep apnoea were offered continuous positive airway pressure therapy (CPAP) or modafinil. All craniopharyngioma patients, with unexplained somnolence, were offered modafinil. RESULTS Somnolence was reported by 20/28 (71·5%) craniopharyngioma patients and 4/23 (17%) obese subjects (P < 0·001). Median ESS was 7·5 (IQR 6, 10·7) in craniopharyngioma patients and 4·0 (4,8) in controls, P < 0·01. Eleven somnolent craniopharyngioma patients had obstructive sleep apnoea, in whom treatment led to a reduction in ESS by 6·4 ± 1·4, P = 0·01. Among the remaining nine patients, five were offered modafinil therapy, of whom four had benefit, three were not compliant with hormone replacement, and one died before intervention. There was no difference in the prevalence of obstructive sleep apnoea between craniopharyngioma (n = 13, 46%) and obese subjects (n = 14, 61%, P = 0·4). Body mass index (BMI) does not correlate with apnoea hypopnoea index [apnoea - hypopnoea index (AHI), r = 0·25, P = 0·08], which suggests that obesity alone does not explain the prevalence of sleep apnoea in craniopharyngioma patients. CONCLUSIONS Somnolence is common in craniopharyngioma patients and in the majority is because of obstructive sleep apnoea. An additional group of somnolent craniopharyngioma patients benefits from modafinil.
Collapse
Affiliation(s)
- R K Crowley
- Department of Academic Endocrinology, Beaumont Hospital, Dublin 9, Ireland
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Iesalnieks I, Obermeier F, Agha A, Schlitt HJ. [Creation of a second enterostomy in patients with Crohn's disease and multiple small bowel lesions]. Zentralbl Chir 2011; 138 Suppl 2:e105-7. [PMID: 21594817 DOI: 10.1055/s-0031-1271459] [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] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- I Iesalnieks
- Marienhospital Gelsenkirchen, Chirurgie, Gelsenkirchen, Deutschland
| | - F Obermeier
- Praxiszentrum an der Alten Mälzerei, Innere Medizin, Regensburg, Deutschland
| | - A Agha
- Universitätsklinikum Regensburg, Chirurgie, Regensburg, Deutschland
| | - H J Schlitt
- Marienhospital Gelsenkirchen, Chirurgie, Gelsenkirchen, Deutschland
| |
Collapse
|
48
|
Sheikh S, Ali A, Zaidi AKM, Agha A, Khowaja A, Allana S, Qureshi S, Azam I. Measles susceptibility in children in Karachi, Pakistan. Vaccine 2011; 29:3419-23. [PMID: 21396902 PMCID: PMC3082702 DOI: 10.1016/j.vaccine.2011.02.087] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2010] [Revised: 01/19/2011] [Accepted: 02/24/2011] [Indexed: 10/18/2022]
Abstract
Measles, despite being vaccine preventable is still a major public health problem in many developing countries. We estimated the proportion of measles susceptible children in Karachi, the largest metropolitan city of Pakistan, one year after the nationwide measles supplementary immunization activity (SIA) of 2007-2008. Oral fluid specimens of 504 randomly selected children from Karachi, aged 12-59 months were collected to detect measles IgG antibodies. Measles antibodies were detected in only 55% children. The proportion of children whose families reported receiving a single or two doses of measles vaccine were 78% and 12% respectively. Only 3% of parents reported that their child received measles vaccine through the SIA. Among the reported single dose measles vaccine recipients, 58% had serologic immunity against measles while among the reported two dose measles vaccine recipients, 64% had evidence of measles immunity. Urgent strengthening of routine immunization services and high quality mass vaccination campaigns against measles are recommended to achieve measles elimination in Pakistan.
Collapse
Affiliation(s)
- Sana Sheikh
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Asad Ali
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Anita K. M. Zaidi
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Ajmal Agha
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Asif Khowaja
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Salim Allana
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Shahida Qureshi
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Iqbal Azam
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| |
Collapse
|
49
|
Owais A, Hanif B, Siddiqui AR, Agha A, Zaidi AKM. Does improving maternal knowledge of vaccines impact infant immunization rates? A community-based randomized-controlled trial in Karachi, Pakistan. BMC Public Health 2011; 11:239. [PMID: 21496343 PMCID: PMC3094245 DOI: 10.1186/1471-2458-11-239] [Citation(s) in RCA: 106] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Accepted: 04/17/2011] [Indexed: 11/17/2022] Open
Abstract
Background In Pakistan, only 59-73% of children 12-23 months of age are fully immunized. This randomized, controlled trial was conducted to assess the impact of a low-literacy immunization promotion educational intervention for mothers living in low-income communities of Karachi on infant immunization completion rates. Methods Three hundred and sixty-six mother-infant pairs, with infants aged ≤ 6 weeks, were enrolled and randomized into either the intervention or control arm between August - November 2008. The intervention, administered by trained community health workers, consisted of three targeted pictorial messages regarding vaccines. The control group received general health promotion messages based on Pakistan's Lady Health Worker program curriculum. Assessment of DPT/Hepatitis B vaccine completion (3 doses) was conducted 4-months after enrollment. A Poisson regression model was used to estimate effect of the intervention. The multivariable Poisson regression model included maternal education, paternal occupation, ownership of home, cooking fuel used at home, place of residence, the child's immunization status at enrollment, and mother's perception about the impact of immunization on child's health. Results Baseline characteristics among the two groups were similar. At 4 month assessment, among 179 mother-infant pairs in the intervention group, 129 (72.1%) had received all 3 doses of DPT/Hepatitis B vaccine, whereas in the control group 92/178 (51.7%) had received all 3 doses. Multivariable analysis revealed a significant improvement of 39% (adjusted RR = 1.39; 95% CI: 1.06-1.81) in DPT-3/Hepatitis B completion rates in the intervention group. Conclusion A simple educational intervention designed for low-literate populations, improved DPT-3/Hepatitis B vaccine completion rates by 39%. These findings have important implications for improving routine immunization rates in Pakistan.
Collapse
Affiliation(s)
- Aatekah Owais
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | | | | | | | | |
Collapse
|
50
|
Shafqat G, Agha A, Masror I, Rehan M, Afzal S. Dynamic contrast enhanced MRI breast for lesion detection and characterization with histopathological co relation: preliminary experience at tertiary care hospital. J PAK MED ASSOC 2011; 61:252-255. [PMID: 21465939] [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: 05/30/2023]
Abstract
OBJECTIVE To determine the morphological and enhancement characteristics significantly associated with malignant breast lesions on dynamic contrast enhanced MRI by considering the histopathological findings as a gold standard. METHODS A retrospective analysis was performed on 70 patients who underwent MRI breast during the study period because of suspicious mammographic abnormalities. MR imaging was performed on 1.5 tesla machine with dynamic contrast enhancement by using dedicated breast coil. MR Images of breast were evaluated on a workstation and reported on the basis of morphological appearance of lesion and time activity curves. Histopathological analysis of the lesion was done either after mastectomy or biopsy. About 66 MR suspicious lesions were biopsied in 58 patients. RESULTS Total number of MRI breast performed from Jan 2007-June 2009 for suspicious abnormality was 70. Histopathology of 66 lesions was available in 58 patients. Twelve patients were lost to follow. On multiple logistic regression analysis, lesions with irregular margins and strong heterogeneous enhancement were associated with higher odd of malignancy than lesions with smooth margins and homogenous enhancement. The next most important feature was the qualitative assessment of kinetic curve. Type 111 and 11 curves showed significant association with malignancy with higher odd values and 95% CI. The sensitivity, specificity, positive and negative predictive values of MRI for breast lesions was found to be 94%, 85%, 90%, and 82% respectively. Overall accuracy of MRI breast was 90%. CONCLUSION On dynamic contrast enhanced MR imaging morphological appearance of lesion and qualitative assessment of time activity curves are two major factors for differentiation of breast lesion as benign or malignant.
Collapse
Affiliation(s)
- Gulnaz Shafqat
- Department of Radiology, Aga Khan University Hospital, Karachi
| | | | | | | | | |
Collapse
|