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Magier S, Jahandideh D, Pourmorady J, Masoud A. SPLIT-DOSE BOWEL PREPARATION IS SUPERIOR TO STRAIGHT-DOSE IN HOSPITALIZED PATIENTS UNDERGOING INPATIENT COLONOSCOPY. Arq Gastroenterol 2023; 60:39-47. [PMID: 37194778 DOI: 10.1590/s0004-2803.202301000-06] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 12/08/2022] [Indexed: 05/18/2023]
Abstract
BACKGROUND There is a two-fold higher rate of failed colonoscopy secondary to inadequate bowel preparation among hospitalized versus ambulatory patients. Split-dose bowel preparation is widely used in the outpatient setting but has not been generally adapted for use among the inpatient population. OBJECTIVE The aim of this study is to evaluate the effectiveness of split versus single dose polyethylene glycol bowel (PEG) preparation for inpatient colonoscopies and determine additional procedural and patient characteristics that drive inpatient colonoscopy quality. METHODS A retrospective cohort study was performed on 189 patients who underwent inpatient colonoscopy and received 4 liters PEG as either split- or straight-dose during a 6-month period in 2017 at an academic medical center. Bowel preparation quality was assessed using Boston Bowel Preparation Score (BBPS), Aronchick Score, and reported adequacy of preparation. RESULTS Bowel preparation was reported as adequate in 89% of the split-dose group versus 66% in the straight-dose group (P=0.0003). Inadequate bowel preparations were documented in 34.2% of the single-dose group and 10.7% of the split-dose group (P<0.001). Only 40% of patients received split-dose PEG. Mean BBPS was significantly lower in the straight-dose group (Total: 6.32 vs 7.73, P<0.001). CONCLUSION Split-dose bowel preparation is superior to straight-dose preparation across reportable quality metrics for non-screening colonoscopies and was readily performed in the inpatient setting. Interventions should be targeted at shifting the culture of gastroenterologist prescribing practices towards use of split-dose bowel preparation for inpatient colonoscopy.
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Affiliation(s)
- Samantha Magier
- Yale-New Haven Hospital, Yale School of Medicine, United States
| | | | | | - Amir Masoud
- Yale-New Haven Hospital, Yale School of Medicine, United States
- Connecticut Gastroenterology, Hartford Healthcare, United States
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Sanchez MJ, Olivier S, Gediklioglu F, Almeida M, Gaeta M, Nigro M, de la Rosa R, Nguyen M, Lalehzari M, Regala F, Njei B, Deng Y, Ciarleglio M, Masoud A. Chronic opioid use is associated with obstructive and spastic disorders in the esophagus. Neurogastroenterol Motil 2022; 34:e14233. [PMID: 34532898 DOI: 10.1111/nmo.14233] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 07/03/2021] [Accepted: 07/07/2021] [Indexed: 12/20/2022]
Abstract
BACKGROUND AND AIMS Chronic opioid effects on the esophagus are poorly understood. We investigated whether opioids were associated with increased prevalence of esophageal motility disorders. METHODS A retrospective study of all patients undergoing high-resolution manometry (HREM) at the Yale Gastrointestinal Motility Lab between January 2014 and August 2019. Data were extracted from the electronic medical record after studies were reviewed by two motility specialists using the Chicago Classification v.3.0. We compared the manometric results of patients who use opioids to those who do not and adjusted for type and dose of opioids using a 24 h Morphine Milligram Equivalents (MME) scale to compare patients taking low or high amounts of opioids. RESULTS Four manometric abnormalities were significantly different between the opioid and non-opioid users. Achalasia type III, esophagogastric junction outflow obstruction (EGJOO), and distal esophageal spasm (DES) (p < 0.005, p < 0.01, and p < 0.005, respectively) were common among opioid users, whereas ineffective esophageal motility (IEM) was more common among non-opioid users (p < 0.01). The incidence of EGJOO was significantly higher in opioid users compared to non-opioid users (p < 0.001). Lastly, IRP, DCI, and distal latency were significantly different between the two groups. Patients in the high MME group had significantly greater IRP, DCI, and lower distal latency than non-opioids (p < 0.001). Also, achalasia type III and DES were more common in the high but not the low MME group. CONCLUSIONS Opioid use is associated with multiple abnormalities on esophageal motility and these effects may be dose-dependent.
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Affiliation(s)
- Mayra J Sanchez
- Department of Medicine, Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA
| | - Sarah Olivier
- Department of Medicine, Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA
| | - Furkan Gediklioglu
- Department of Medicine, Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA
| | - Mariana Almeida
- Department of Medicine, Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA
| | - Marina Gaeta
- Department of Medicine, Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA
| | - Mariana Nigro
- Hartford Healthcare, Neurogastroenterology and Motility Center, Fairfield, CT, USA
| | - Randolph de la Rosa
- Department of Medicine, Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA
| | - Mytien Nguyen
- Department of Medicine, Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA
| | - Mona Lalehzari
- Department of Medicine, Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA
| | - Francis Regala
- Department of Medicine, Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA
| | - Basile Njei
- Department of Medicine, Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA
| | - Yanhong Deng
- Department of Medicine, Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA
| | - Maria Ciarleglio
- Department of Medicine, Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA
| | - Amir Masoud
- Department of Medicine, Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA
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Kwak YE, Saleh A, Abdelwahed A, Sanchez M, Masoud A. Effectiveness of esophagogastroduodenoscopy in changing treatment outcome in refractory gastro-esophageal reflux disease. Scand J Gastroenterol 2022; 57:124-130. [PMID: 34669534 DOI: 10.1080/00365521.2021.1988141] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND/AIMS The effectiveness of screening esophagogastroduodenoscopy (EGD) for refractory gastroesophageal reflux disease (GERD) symptoms alone has not been validated. METHODS We performed an observational study of patients with refractory GERD who underwent EGD from 2013 to 2016 at a tertiary hospital. Among 928 patients with GERD, we excluded patients with other alarm features, other indications for EGD, history of gastroesophageal surgery, or EGD done for other diagnostic procedures, and identified 301 patients who underwent EGD solely for persistent reflux symptoms such as heartburn or regurgitation. RESULTS Among 301 patients with refractory GERD, 81.4% of patients were taking PPIs. 49.8% of patients had completely normal EGD findings and 33.6% of patients had benign or incidental findings. Two patients (0.6%) had LA grade C or D esophagitis, and 16.3% of patients had irregular Z line or salmon-colored mucosa. 91.0% (122/134) who had a biopsy had normal or benign findings. 4.0% (12/301) of patients had biopsy-proven intestinal metaplasia which is similar to the previously known prevalence of intestinal metaplasia in patients without heartburn (5.6%) and none had dysplasia or malignancy. Male sex was associated with endoscopic intestinal metaplasia suspected lesions in multivariate analysis (OR: 1.96, 95% CI: 1.04-3.70, p = .036) but not biopsy-proven intestinal metaplasia. Elderly age, obesity, alcohol or cigarette consumption, PPI use, GERD duration >3-5 years did not predict endoscopically suspected or biopsy-proven intestinal metaplasia. Only 5% of patients had a pH-impedance study for refractory reflux symptoms. CONCLUSIONS Most patients who underwent EGD for refractory GERD symptoms alone did not have pathological findings requiring a change in management. Screening EGD for patients only with persistent reflux symptoms should not be routinely recommended.
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Affiliation(s)
- Ye Eun Kwak
- Department of Internal Medicine, Yale New Haven Health, Bridgeport Hospital, Bridgeport, CT, USA
| | - Ahmed Saleh
- Department of Internal Medicine, Wayne State University, Detroit, MI, USA
| | | | - Mayra Sanchez
- Department of Internal Medicine, Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA
| | - Amir Masoud
- Department of Internal Medicine, Section of Digestive Diseases, Yale University School of Medicine, New Haven, CT, USA
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Paleti S, Sobani ZA, McCarty TR, Gutta A, Gremida A, Shah R, Nutalapati V, Bazerbachi F, Jesudoss R, Amin S, Okwara C, Kathi PR, Ahmed A, Gessel L, Hung K, Masoud A, Yu J, Mony S, Akshintala V, Jamil L, Nasereddin T, Kochhar G, Vyas N, Saligram S, Garg R, Sandhu D, Benrajab K, Konjeti R, Agnihotri A, Trivedi H, Grunwald M, Mayer I, Mohanty A, Rustagi T. Impact of COVID-19 on gastroenterology fellowship training: a multicenter analysis of endoscopy volumes. Endosc Int Open 2021; 9:E1572-E1578. [PMID: 34540553 PMCID: PMC8445682 DOI: 10.1055/a-1526-1419] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 05/19/2021] [Indexed: 12/02/2022] Open
Abstract
Background and study aims The COVID-19 pandemic has had a profound impact on gastroenterology training programs. We aimed to objectively evaluate procedural training volume and impact of COVID-19 on gastroenterology fellowship programs in the United States. Methods This was a retrospective, multicenter study. Procedure volume data on upper and lower endoscopies performed by gastroenterology fellows was abstracted directly from the electronic medical record. The study period was stratified into 2 time periods: Study Period 1, SP1 (03/15/2020 to 06/30/2020) and Study Period 2, SP2 (07/01/2020 to 12/15/2020). Procedure volumes during SP1 and SP2 were compared to Historic Period 1 (HP1) (03/15/2019 to 06/30/2019) and Historic Period 2 (HP2) (07/01/2019 to 12/15/2019) as historical reference. Results Data from 23 gastroenterology fellowship programs (total procedures = 127,958) with a median of 284 fellows (range 273-289; representing 17.8 % of all trainees in the United States) were collected. Compared to HP1, fellows performed 53.6 % less procedures in SP1 (total volume: 28,808 vs 13,378; mean 105.52 ± 71.94 vs 47.61 ± 41.43 per fellow; P < 0.0001). This reduction was significant across all three training years and for both lower and upper endoscopies ( P < 0.0001). However, the reduction in volume was more pronounced for lower endoscopy compared to upper endoscopy [59.03 % (95 % CI: 58.2-59.86) vs 48.75 % (95 % CI: 47.96-49.54); P < 0.0001]. The procedure volume in SP2 returned to near baseline of HP2 (total volume: 42,497 vs 43,275; mean 147.05 ± 96.36 vs 150.78 ± 99.67; P = 0.65). Conclusions Although there was a significant reduction in fellows' endoscopy volume in the initial stages of the pandemic, adaptive mechanisms have resulted in a return of procedure volume to near baseline without ongoing impact on endoscopy training.
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Affiliation(s)
- Swathi Paleti
- Division of Gastroenterology and Hepatology University of New Mexico, Albuquerque, NM
| | - Zain A. Sobani
- Division of Gastroenterology and Hepatology University of New Mexico, Albuquerque, NM
| | - Thomas R. McCarty
- Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women’s Hospital, Harvard Medical School. Boston, Massachusetts, United States
| | - Aditya Gutta
- Division of Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, United States
| | - Anas Gremida
- Division of Gastroenterology and Hepatology, Washington University School of Medicine, St Louis, Missouri, United States
| | - Raj Shah
- Division of Gastroenterology and Hepatology, Case Western Reserve University School of Medicine, Cleveland, Ohio, United States
| | - Venkat Nutalapati
- Division of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas, United States
| | - Fateh Bazerbachi
- Division of Gastroenterology and Hepatology, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Randhir Jesudoss
- Division of Gastroenterology and Hepatology, University of Iowa, Iowa City, Iowa, United States
| | - Shreya Amin
- Division of Gastroenterology and Hepatology, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Chinemerem Okwara
- Division of Gastroenterology and Hepatology, University of Texas Southwestern Medical Center, Dallas, Texas, United States
| | - Pradeep Reddy Kathi
- Division of Gastroenterology and Hepatology, University of Arizona School of Medicine, Tuscon, Arizona, United States
| | - Ali Ahmed
- Division of Gastroenterology and Hepatology, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama, United States
| | - Luke Gessel
- Division of Gastroenterology and Hepatology, University of Utah, Salt Lake City, Utah, United States
| | - Kenneth Hung
- Division of Gastroenterology and Hepatology, Yale School of Medicine, New Haven, Connecticut, United States
| | - Amir Masoud
- Division of Gastroenterology and Hepatology, Yale School of Medicine, New Haven, Connecticut, United States
| | - Jessica Yu
- Division of Gastroenterology and Hepatology, Oregon Health & Science University, Portland, Oregon, United States
| | - Shruti Mony
- Division of Gastroenterology and Hepatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Venkata Akshintala
- Division of Gastroenterology and Hepatology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Laith Jamil
- Division of Gastroenterology and Hepatology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan, United States
| | - Thayer Nasereddin
- Division of Gastroenterology and Hepatology, Allegheny Health Network, Pittsburgh, Pennsylvania, United States
| | - Gursimran Kochhar
- Division of Gastroenterology and Hepatology, Allegheny Health Network, Pittsburgh, Pennsylvania, United States
| | - Neil Vyas
- Division of Gastroenterology and Hepatology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
| | - Shreyas Saligram
- Division of Gastroenterology and Hepatology, University of Texas Health Science Center at San Antonio, San Antonio, Texas, United States
| | - Rajat Garg
- Division of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio, United States
| | - Dalbir Sandhu
- Division of Gastroenterology and Hepatology, Cleveland Clinic Foundation, Cleveland, Ohio, United States
| | - Karim Benrajab
- Division of Gastroenterology and Hepatology, University of Kentucky, Lexington, Kentucky, United States
| | - Rajesh Konjeti
- Division of Gastroenterology and Hepatology, University of Kentucky, Lexington, Kentucky, United States
| | - Abhishek Agnihotri
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Hirsh Trivedi
- Division of Gastroenterology and Hepatology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, United States
| | - Matthew Grunwald
- Division of Gastroenterology and Hepatology, Maimonides Medical Center, New York, New York, United States
| | - Ira Mayer
- Division of Gastroenterology and Hepatology, Maimonides Medical Center, New York, New York, United States
| | - Arpan Mohanty
- Division of Gastroenterology and Hepatology, Boston University School of Medicine, Boston, Massachusetts, United States
| | - Tarun Rustagi
- Division of Gastroenterology and Hepatology University of New Mexico, Albuquerque, NM
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Simonov M, Abel EE, Skanderson M, Masoud A, Hauser RG, Brandt CA, Wilson FP, Laine L. Use of Proton Pump Inhibitors Increases Risk of Incident Kidney Stones. Clin Gastroenterol Hepatol 2021; 19:72-79.e21. [PMID: 32147588 PMCID: PMC7483196 DOI: 10.1016/j.cgh.2020.02.053] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 02/07/2020] [Accepted: 02/28/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND AND AIMS Proton pump inhibitors (PPIs) are widely prescribed and have effects on gut ion absorption and urinary ion concentrations. PPIs might therefore protect against or contribute to development of kidney stones. We investigated the association between PPI use and kidney stones. METHODS We performed a retrospective study using data from the Women's Veteran's Cohort Study, which comprised men and women, from October 1, 1999 through September 30, 2017. We collected data from 465,891 patients on PPI usage over time, demographics, laboratory results, comorbidities, and medication usage. Time-varying Cox proportional hazards and propensity matching analyses determined risk of PPI use and incident development of kidney stones. Use of histamine-2 receptor antagonists (H2RAs) was measured and levothyroxine use was a negative control exposure. RESULTS PPI use was associated with kidney stones in the unadjusted analysis, with PPI use as a time-varying variable (hazard ratio [HR], 1.74; 95% CI, 1.67-1.82), and persisted in the adjusted analysis (HR, 1.46; CI, 1.38-1.55). The association was maintained in a propensity score-matched subset of PPI users and nonusers (adjusted HR, 1.25; CI 1.19-1.33). Increased dosage of PPI was associated with increased risk of kidney stones (HR, 1.11; CI, 1.09-1.14 for each increase in 30 defined daily doses over a 3-month period). H2RAs were also associated with increased risk (adjusted HR, 1.47; CI 1.31-1.64). We found no association, in adjusted analysis, of levothyroxine use with kidney stones (adjusted HR, 1.06; CI 0.94-1.21). CONCLUSIONS In a large cohort study of veterans, we found PPI use to be associated with a dose-dependent increase in risk of kidney stones. H2RA use also has an association with risk of kidney stones, so acid suppression might be an involved mechanism. The effect is small and should not change prescribing for most patients.
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Affiliation(s)
- Michael Simonov
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut; VA Connecticut Healthcare System, West Haven, Connecticut.
| | - Erica E. Abel
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut,VA Connecticut Healthcare System, West Haven, CT
| | | | - Amir Masoud
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
| | - Ronald G. Hauser
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut,VA Connecticut Healthcare System, West Haven, CT
| | - Cynthia A. Brandt
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut,VA Connecticut Healthcare System, West Haven, CT
| | - Francis P. Wilson
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut,VA Connecticut Healthcare System, West Haven, CT
| | - Loren Laine
- Department of Medicine, Yale University School of Medicine, New Haven, Connecticut,VA Connecticut Healthcare System, West Haven, CT
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Masoud A, Saeed M, Taha M, El-Maadawy M. Uranium adsorption from Bahariya Oasis leach liquor via TOPO impregnated bentonite material; Isothermal, kinetic and thermodynamic studies. Egypt J Chem 2019. [DOI: 10.21608/ejchem.2019.13638.1843] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Wright K, Bihaqi SW, Lahouel A, Masoud A, Mushtaq F, Leso A, Eid A, Zawia NH. Importance of tau in cognitive decline as revealed by developmental exposure to lead. Toxicol Lett 2017; 284:63-69. [PMID: 29203278 DOI: 10.1016/j.toxlet.2017.11.041] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 11/28/2017] [Accepted: 11/30/2017] [Indexed: 12/21/2022]
Abstract
Previous reports by us have determined that developmental exposure to the heavy metal lead (Pb) resulted in cognitive impairment in aging wildtype mice, and a latent induction in biomarkers associated with both the tau and amyloid pathways. However, the relationship between these two pathways and their correlation to cognitive performance needs to be scrutinized. Here, we investigated the impact of developmental Pb (0.2%) exposure on the amyloid and tau pathways in a transgenic mouse model lacking the tau gene. Cognitive function, and levels of intermediates in the amyloid and tau pathways following postnatal Pb exposure were assessed on young adult and mature transgenic mice. No significant difference in behavioral performance, amyloid precursor protein (APP), or amyloid beta (Aβ) levels was observed in transgenic mice exposed to Pb. Regulators of the tau pathway were impacted by the absence of tau, but no additional change was imparted by Pb exposure. These results revealed that developmental Pb exposure does not cause cognitive decline or change the expression of the amyloid pathway in the absence of tau. The essentiality of tau to mediate cognitive decline by environmental perturbations needs further investigation.
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Affiliation(s)
- K Wright
- Department of Cell and Molecular Biology, University of Rhode Island, Kingston Rhode Island, 02881, USA
| | - S W Bihaqi
- George and Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston Rhode Island, 02881, USA
| | - A Lahouel
- Department of Biomedical and Pharmaceutical Sciences, University of Rhode Island, Kingston Rhode Island, 02881, USA
| | - A Masoud
- Department of Biomedical and Pharmaceutical Sciences, University of Rhode Island, Kingston Rhode Island, 02881, USA; Biochemical Technology Program, Faculty of Applied Science, Thamar University, Yemen
| | - F Mushtaq
- Department of Biomedical and Pharmaceutical Sciences, University of Rhode Island, Kingston Rhode Island, 02881, USA
| | - A Leso
- Interdisciplinary Neuroscience Program, University of Rhode Island, Kingston Rhode Island, 02881, USA
| | - A Eid
- Department of Biomedical and Pharmaceutical Sciences, University of Rhode Island, Kingston Rhode Island, 02881, USA; Interdisciplinary Neuroscience Program, University of Rhode Island, Kingston Rhode Island, 02881, USA
| | - N H Zawia
- George and Anne Ryan Institute for Neuroscience, University of Rhode Island, Kingston Rhode Island, 02881, USA; Department of Biomedical and Pharmaceutical Sciences, University of Rhode Island, Kingston Rhode Island, 02881, USA; Interdisciplinary Neuroscience Program, University of Rhode Island, Kingston Rhode Island, 02881, USA.
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Masoud A, Bartoletti S, Khurana A, Velavan P, Morrison L, Khalatbari A, Aggarwal S, Sharma N, Fairbairn T, Gupta D. 16Left atrial appendage occlusion in patients meeting the “commissioning through evaluation” eligibility criteria: high all-cause mortality seen in spite of successful device implant. Europace 2017. [DOI: 10.1093/europace/eux283.025] [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: 11/14/2022] Open
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Sharma P, Balasingham S, Stawiarski K, Rahmani M, Costantino A, Sharma P, Xu M, Masoud A. Burkitt lymphoma as a lead point for jejunojejunal intussusception in a human immunodeficiency virus patient. Clin J Gastroenterol 2017; 10:342-350. [PMID: 28523628 DOI: 10.1007/s12328-017-0747-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 05/05/2017] [Indexed: 11/26/2022]
Abstract
Intussusception is commonly seen in children but is rare in adults and represents only 5% of all intussusceptions causing 1% of intestinal obstructions. More than 50% of these intussusceptions in adults are due to intestinal neoplasms, including malignant lymphoma, e.g., Burkitt lymphoma. These lymphomas are more common in human immunodeficiency virus (HIV)-positive patients than in the general population. We present a case of a young male who was diagnosed with HIV when he developed intestinal obstruction and intussusception secondary to Burkitt lymphoma. He was managed with surgical resection followed by chemotherapy and antiretroviral treatment. HIV patients presenting with acute abdomen pose a diagnostic challenge to clinicians due to a wide range of differential diagnoses including inflammatory, infectious and neoplastic conditions. In a young HIV patient presenting with acute abdomen, intussusception caused by Burkitt lymphoma should be considered in the differential.
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Affiliation(s)
- Prabin Sharma
- Department of Internal Medicine, Yale New Haven Health, Bridgeport Hospital, 267 Grant Street, Bridgeport, CT, 06610, USA.
| | - Shivashanker Balasingham
- Department of Internal Medicine, Yale New Haven Health, Bridgeport Hospital, 267 Grant Street, Bridgeport, CT, 06610, USA
| | - Kristin Stawiarski
- Department of Internal Medicine, Yale New Haven Health, Bridgeport Hospital, 267 Grant Street, Bridgeport, CT, 06610, USA
| | - Mahboubeh Rahmani
- Department of Pathology, Yale New Haven Hospital, 310 Cedar Street LH 108, New Haven, CT, 06520, USA
| | - Antonio Costantino
- Department of Internal Medicine, Yale New Haven Health, Bridgeport Hospital, 267 Grant Street, Bridgeport, CT, 06610, USA
| | - Pranav Sharma
- Department of Radiology, Yale University, Bridgeport Hospital, 267 Grant Street, Bridgeport, CT, 06610, USA
| | - Mina Xu
- Department of Pathology, Yale New Haven Hospital, 310 Cedar Street LH 108, New Haven, CT, 06520, USA
| | - Amir Masoud
- Section of Digestive Diseases, Yale New Haven Hospital, 40 Temple Street, Suite 1A, New Haven, CT, 06510-2715, USA
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Abstract
Organophosphate-induced delayed neuropathy (OPIDN) is a progressive neuropathic disorder that manifests in days to weeks following exposure to an acute dose of organophosphates. The precise mechanism involved in the development of OPIDN is not clear as it develops after many days of the cessation of cholinergic crisis. The present study has been designed to understand the role of oxidative stress in the development of OPIDN, wherein neuropathy was developed by the administration of acute dose of monocrotophos (MCP) or dichlorvos (2,2-dichlorovinyl dimethyl phosphate (DDVP)) to rats. Significant motor deficits in terms of reduced spontaneous locomotor activity and performance on narrow beam test were observed after 14 days of exposure to MCP or DDVP, which persisted even on day 28, suggesting the development of OPIDN. Rats with OPIDN also exhibited an increase in malondialdehyde levels along with a decrease in thiol content in cerebral cortex, cerebellum and brain stem. Concomitantly, the activities of antioxidant enzymes, superoxide dismutase, catalase, glutathione peroxidase and glutathione reductase were reduced in the three brain regions. The biochemical and functional changes were associated with histological alterations in the brain regions studied. The results clearly indicate that the development of OPIDN is mediated in part through an increased oxidative stress and suggest that the strategies aimed at restoration of antioxidant capacity may be beneficial for the individuals with OPIDN-like symptoms.
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Affiliation(s)
- A Masoud
- Department of Biochemistry, Panjab University, Chandigarh, India
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Salameh K, Rahman S, Al-Rifai H, Masoud A, Lutfi S, Abdouh G, Omar F, Khan SUI, Bener A. An analytic study of the trends in perinatal and neonatal mortality rates in the State of Qatar over a 30-year period (1977 to 2007): a comparative study with regional and developed countries. J Perinatol 2009; 29:765-70. [PMID: 19641511 DOI: 10.1038/jp.2009.89] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [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: 11/09/2022]
Abstract
OBJECTIVE This study was designed to analyze the trends and differences in perinatal and neonatal mortality rates in the State of Qatar over a period of 30 years (1977 to 2007), to examine the causes of neonatal deaths and compare them with some regional Gulf states and developed world countries. STUDY DESIGN This is a retrospective study conducted in the Women's Hospital, Hamad Medical Corporation, State of Qatar from 1977 to 2007. METHOD The study included all perinatal and neonatal deaths for the period 1977 to 2007, which were monitored through registers of the Neonatal Intensive Care Unit (NICU), Women's hospital. Cause of death was determined using information from hospital records, including discharge certificates. There is a national database in the Department of Preventive Medicine that records all deaths through death certificates. The missing information for the early years was collected from this database. All causes of deaths were classified in accordance with criteria based on the International Classification of Disease tenth revision (ICD-10). RESULT There was a notable peak in neonatal (14.1), early neonatal (12.5) and perinatal (24.7) mortality rates in 1977. There was a second peak in neonatal (12.1) and late neonatal (7.5) mortality rates in 2000. Over a period of three decades (1977 to 2007), there was a significant decline in mortality rates (P<0.0001). By 2007, the neonatal mortality rate had decreased from 14.1 to 5.1; the early neonatal mortality rate had a dramatic fall from 12.5 to 2.3; and perinatal mortality came down from 24.7 to 10.3. There was no notable reduction in the late neonatal mortality rate in 2007 (2.8) compared with that in 1980 (3.0). The still-birth (8), neonatal (5), early neonatal (2.3) and perinatal (10.3) mortality rates in Qatar were very close to the rates found in developed countries, but lower than the rates in Bahrain and Saudi Arabia. Similar to developed countries, prematurity was the leading cause of neonatal death in Qatar (42.6%), followed by congenital anomalies (28%). CONCLUSION This study revealed that there was a sharp significant decline in neonatal and perinatal mortality rates during the study period in Qatar. The stillbirth, neonatal and perinatal mortality rates in Qatar are comparable with those in some of the developed countries and were lower than those in some of the Gulf countries. The proportion of underweight live births was found constant during the study period. Prematurity was the leading cause of neonatal death, followed by congenital anomalies.
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Affiliation(s)
- K Salameh
- Division of Neonatal Perinatal Medicine Women's Hospital, Hamad Medical Corporation, Doha, Qatar
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Abstract
A 64-year-old man suffered a spontaneous rupture of the esophagus (Boerhaave's syndrome) after an episode of severe retching. He underwent attempted primary repair of the esophageal defect, but unfortunately the repair failed with the development of a persistent esophago-bronchial fistula resistant to extended conservative management. Three hundred and nineteen days after the initial rupture, the fistula was successfully treated with endoscopic placement of fibrin glue. We believe this to be the first reported case of fibrin sealant being used in the treatment of a long-standing fistula resulting from Boerhaave's syndrome.
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Affiliation(s)
- K Harries
- Department of Surgery, Morriston Hospital, Swansea, UK
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14
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Scriven MW, Pye JK, Masoud A, Crumplin MK. The use and impact of a daily general surgical emergency operating list in a district general hospital: a prospective study. Ann R Coll Surg Engl 1995; 77:117-20. [PMID: 7574303] [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: 01/26/2023] Open
Abstract
Daytime emergency operating lists (EOL) have been shown to reduce out-of-hours operating but problems with their introduction have been reported. A six-month prospective study of EOL and unscheduled operations (USO) was undertaken. Two firms use their EOL differently--one including mostly emergencies, the other including a number of urgent elective cases. After the introduction of EOL only 9 per cent of emergency operations were performed after midnight. Including urgent elective cases on the EOL allowed full use of available theatre time but meant that proportionately more emergency operations were unscheduled. A senior surgeon was involved with 75 per cent of EOL and 36 per cent of USO operations, and a senior anaesthetist with 52 per cent of EOL and 14 per cent of USO. Senior anaesthetic involvement would have been greater if there were more senior staff. There had been a marked increase in the number of USO over the four years previous to this study. EOL do reduce out-of-hours operating and allow excellent supervision and therefore training opportunities. Care must be taken with the case mix to balance full use of theatre time with reduction in out-of-hours operating.
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Affiliation(s)
- M W Scriven
- Department of Surgery, Wrexham Maelor Hospital NHS Trust
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15
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Abstract
Four cases of phrenic nerve paralysis complicating chest tube placement in the newborn for pneumothorax are presented. This complication is related to abnormal location of the medial end of the chest tube. It is suggested that on the frontal chest radiograph, the medial end of the chest tube should be no less than 1 cm from the spine.
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Affiliation(s)
- J C Odita
- Department of Radiology, Hamad Medical Corporation, Doha Qatar
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16
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El-Hawey A, Masoud A, Metwally A, El Badrawy N, El Garam A, Roushdi M, Khalil A. The effect of praziquantel therapy on the histopathological and parasitological aspects of experimental schistosomiasis mansoni. J Egypt Soc Parasitol 1983; 13:613-24. [PMID: 6663121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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17
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