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Mohamed Rouse MH, Aziz A, Abdullah B, Abdul Kadir A, Wan Mohammad WMZ, Abd Mutalib NS. Development, validation, and evaluation of allergic rhinitis symptoms and impact assessment (ARSIA) questionnaire. Med J Malaysia 2023; 78:857-864. [PMID: 38159918] [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] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
INTRODUCTION Allergic rhinitis (AR) is an inflammatory disease of the nasal mucosa. It is among the most common diseases globally and usually persists throughout life. Allergic Rhinitis and Its Impact on Asthma (ARIA) is a wellestablished guideline applicable to AR and was updated regularly since 2001, aiming to improve the care for AR patients. We proposed a new questionnaire that addresses the severity of allergic rhinitis symptoms, specifically nasal symptoms, and its impact on quality of life in terms of specific vital activities such as sleeping, working, school performance, leisure, or sport, based on the ARIA guideline. The objective was to develop, validate and evaluate Allergic Rhinitis Symptoms and Impact Assessment (ARSIA) questionnaire among allergic rhinitis patients in Hospital Sultan Abdul Halim, Sungai Petani (HSAH), and Hospital Universiti Sains Malaysia (HUSM). MATERIALS AND METHODS This is a prospective observational study to develop, validate and evaluate the ARSIA questionnaire based on ARIA guidelines. The sample will be obtained from the list of patients under follow-up in the ORL clinic HSAH and HUSM with ages of 18 to 60 years, patients clinically diagnosed with allergic rhinitis, and with positive skin prick test. RESULTS A total of 150 patients with a positive skin prick test participated in this study. In the 'nasal symptom' and 'impact on daily activities' domains, calculated Cronbach's alpha shows a value of 0.878 and 0.811 respectively. The inter-item correlation was calculated to analyse internal consistency reliability. Items B3 and B4 were dropped from the questionnaire as both showed a low correlation with other items. New Cronbach's alpha for the daily activities domain was 0.830, which showed better internal consistency reliability. All of the items were analysed for sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV). Clinician diagnosis from the proforma was used as a comparison to the participant's responses. In the analysis, a cut-off points of 12 was used to classify the patient's nasal symptoms into intermittent or persistent, with a sensitivity of 75%, specificity of 86%, PPV of 95%, and NPV of 51%. Whereas, a cut-off point of 15 was used to classify the rhinitis impact on daily activities into mild or moderate/severe, with a sensitivity of 58%, specificity of 100%, PPV of 100%, and NPV of 42%. The only item in the 'control' domain has been dropped out following a consensus of experts and judgement as it has not been used in the clinician diagnosis and thus, is unable to test for sensitivity, specificity, PPV, and NPV. CONCLUSION This newly developed, validated, and evaluated questionnaire is a good tool for the evaluation of allergic rhinitis symptoms and their impact on daily activities. It is important to understand that AR symptoms could have a significant impact on daily activities. Although further study and testing are needed, it provides an initial means for evaluating the patient condition and control level, as well as patients' perception of their rhinitis control.
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Affiliation(s)
- M H Mohamed Rouse
- Hospital Sultan Abdul Halim, Department of Otorhinolaryngology-Head & Neck Surgery, Sungai Petani, Kedah, Malaysia
| | - A Aziz
- Universiti Sains Malaysia Health Campus, School of Medical Sciences, Department of Otorhinolaryngology-Head & Neck Surgery, Kubang Kerian, Kelantan, Malaysia.
| | - B Abdullah
- Universiti Sains Malaysia Health Campus, School of Medical Sciences, Department of Otorhinolaryngology-Head & Neck Surgery, Kubang Kerian, Kelantan, Malaysia
| | - A Abdul Kadir
- Universiti Sains Malaysia Health Campus, School of Medical Sciences, Department of Family Medicine, Kubang Kerian, Kelantan, Malaysia
| | - W M Z Wan Mohammad
- Universiti Sains Malaysia Health Campus, School of Medical Sciences, Department of Community Medicine, Kubang Kerian, Kelantan, Malaysia
| | - N S Abd Mutalib
- Hospital Sultan Abdul Halim, Department of Otorhinolaryngology-Head & Neck Surgery, Sungai Petani, Kedah, Malaysia
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Milelli R, Aziz A, Denis D, David T. [A severe unilateral corneal ectasia in children]. J Fr Ophtalmol 2023; 46:1244-1246. [PMID: 37978029 DOI: 10.1016/j.jfo.2023.05.033] [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: 03/08/2023] [Revised: 05/12/2023] [Accepted: 05/18/2023] [Indexed: 11/19/2023]
Abstract
PURPOSE We report a case of unilateral Terrien's marginal degeneration in a 14-year-old girl. CLINICAL CASE Slit-lamp examination of the affected eye revealed 360° circumferential lipid deposits with 6mm of superior limbal distension, superficial neovascularization, a zone of corneal thinning from 3:00 to 9:00 with a zone of corneomalacia at 11:00. The remainder of the cornea was clear, without fluorescein staining or anterior chamber reaction. DISCUSSION Terrien's marginal degeneration (TMD) is typically known to occur bilaterally in men over the age of 40. Terrien's degeneration must be differentiated from other causes of peripheral corneal thinning; the primary differential diagnosis is Fuchs' marginal keratitis. Other causes of corneal thinning must be ruled out, including Mooren's ulcer. In Terrien's degeneration, there is no central mined edge in the thinning sulcus, the epithelium remains intact, and affected patients do not present with pain. Other differential diagnoses include pellucid marginal degeneration and sulcus degeneration, which are characterized by the absence of lipid infiltrates associated with the central region of the thinning zone, thus distinguishing them from TMD. CONCLUSION It is important to keep in mind that Terrien's marginal degeneration can occur in children.
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Affiliation(s)
| | - A Aziz
- CHU du Nord, Marseille, France
| | - D Denis
- CHU du Nord, Marseille, France
| | - T David
- CHU du Nord, Marseille, France
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Desira M, Gabison E, Jacomet PV, Denis D, Dalmas F, David T, Aziz A. A new treatment changes the game: An innovative management of a child suffering from severe ligneous conjunctivitis with type 1 plasminogen deficiency. Ocul Surf 2023; 30:320-321. [PMID: 37992996 DOI: 10.1016/j.jtos.2023.11.001] [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] [Received: 10/30/2023] [Accepted: 11/06/2023] [Indexed: 11/24/2023]
Affiliation(s)
- M Desira
- Hôpital Nord, Ophthalmology Department, Aix Marseille Université, France.
| | | | | | - D Denis
- Hôpital Nord, Ophthalmology Department, Aix Marseille Université, France
| | - F Dalmas
- Hôpital Nord, Ophthalmology Department, Aix Marseille Université, France
| | - T David
- Hôpital Nord, Ophthalmology Department, Aix Marseille Université, France
| | - A Aziz
- Hôpital Nord, Ophthalmology Department, Aix Marseille Université, France
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Mhatli A, Denis D, Lesueur A, Hugo J, David T, Aziz A. [Painful anisocoria in a five-year-old child: A rare diagnosis which must not be missed]. J Fr Ophtalmol 2023:S0181-5512(23)00226-7. [PMID: 37121825 DOI: 10.1016/j.jfo.2023.01.029] [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] [Received: 11/08/2022] [Revised: 01/30/2023] [Accepted: 01/30/2023] [Indexed: 05/02/2023]
Abstract
Congenital ectropion uveae (CEU) is a rare anomaly of the embryonic development of the anterior segment of the eye. We report the case of a 5-year-old child with an undiagnosed CEU who was treated urgently for an acute angle closure attack. CASE DESCRIPTION A 5-year-old child was referred urgently for evaluation of anisocoria with mydriasis of the right eye and severe headache. Brain imaging with contrast injection was initially performed in the pediatric emergency department and ruled out central nervous system pathology. The initial examination of the right eye revealed an intraocular pressure (IOP) of 37mmHg, corneal edema, congenital ectropion uveae, mydriasis with pupillary block, a closed angle on gonioscopy, and a clear lens. The examination of the left eye was unremarkable, with no visible CEU. The initial management consisted of medical treatment with topical glaucoma drops and miotics and acetazolamide at 10mg/kg/d. Re-evaluation under general anesthesia showed persistent mydriasis and no resolution of the pupillary block. Filtering surgery was performed in the absence of a complete response to medical treatment, allowing control of IOP without drops and complete regression of the corneal edema. DISCUSSION CEU is a rare malformation, and pressure complications represent an insignificant proportion of pediatric glaucoma cases. The acute presentation of acute angle closure in this potentially blinding short-term setting, however, makes detection and management difficult in very young children in a great deal of pain. Only one similar case has been reported in the pediatric literature. CONCLUSION Acute angle closure complicating CEU is exceptional and difficult to diagnose in a pediatric context. Parents of children with this predisposing condition should be informed of the need to consult urgently when clinical signs of elevated intraocular pressure appear.
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Affiliation(s)
- A Mhatli
- Centre hospitalier universitaire de l'hôpital Nord, chemin des Bourrely, 13015 Marseille, France.
| | - D Denis
- Centre hospitalier universitaire de l'hôpital Nord, chemin des Bourrely, 13015 Marseille, France
| | - A Lesueur
- Centre hospitalier universitaire de l'hôpital Nord, chemin des Bourrely, 13015 Marseille, France
| | - J Hugo
- Centre hospitalier universitaire de l'hôpital Nord, chemin des Bourrely, 13015 Marseille, France
| | - T David
- Centre hospitalier universitaire de l'hôpital Nord, chemin des Bourrely, 13015 Marseille, France
| | - A Aziz
- Centre hospitalier universitaire de l'hôpital Nord, chemin des Bourrely, 13015 Marseille, France
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Ninet L, Denis D, Aziz A. Axenfeld anomaly with persistent pupillary membrane. J Fr Ophtalmol 2023; 46:424-425. [PMID: 36863901 DOI: 10.1016/j.jfo.2022.09.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 09/04/2022] [Accepted: 09/12/2022] [Indexed: 03/04/2023]
Affiliation(s)
- L Ninet
- Service d'ophtalmologie, université Aix-Marseille, hôpital Nord, chemin des Bourrely, 13015 Marseille, France.
| | - D Denis
- Service d'ophtalmologie, université Aix-Marseille, hôpital Nord, chemin des Bourrely, 13015 Marseille, France
| | - A Aziz
- Service d'ophtalmologie, université Aix-Marseille, hôpital Nord, chemin des Bourrely, 13015 Marseille, France
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Fleetwood VA, Falls C, Ohman J, Aziz A, Stalter L, Leverson G, Welch B, Kaufman DB, Al-Adra DP, Odorico JS. Post-pancreatic transplant enteric leaks: The role of the salvage operation. Am J Transplant 2022; 22:2052-2063. [PMID: 35593379 DOI: 10.1111/ajt.17094] [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] [Received: 10/11/2021] [Revised: 05/12/2022] [Accepted: 05/12/2022] [Indexed: 01/25/2023]
Abstract
Enteric drainage in pancreas transplantation is complicated by an enteric leak in 5%-8%, frequently necessitating pancreatectomy. Pancreatic salvage outcomes are not well studied. Risk factors for enteric leak were examined and outcomes of attempted graft salvage were compared to immediate pancreatectomy. Pancreas transplants performed between 1995 and 2018 were reviewed. Donor, recipient, and organ variables including demographics, donor type, ischemic time, kidney donor profile index, and pancreas donor risk index were analyzed. Among 1153 patients, 33 experienced enteric leaks (2.9%). Donors of allografts that developed leak were older (37.9y vs. 29.0y, p = .001), had higher KDPI (37% vs. 24%, p < .001), higher pancreas donor risk index (1.83 vs. 1.32, p < .001), and longer cold ischemic time (16.5 vs. 14.8 h, p = .03). Intra-abdominal abscess and higher blood loss decreased the chance of successful salvage. Enteric leak increased 6-month graft loss risk (HR 13.9[CI 8.5-22.9], p < .001). However, 50% (n = 12) of allografts undergoing attempted salvage survived long-term. After 6 months of pancreas graft survival, salvage and non-leak groups had similar 5-year graft survival (82.5% vs. 81.5%) and mortality (90.9% vs. 93.5%). Enteric leaks remain a challenging complication. Pancreatic allograft salvage can be attempted in suitable patients and accomplished in 50% of cases without significantly increased graft failure or mortality risk.
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Affiliation(s)
- Vidya A Fleetwood
- Center for Abdominal Transplantation, Saint Louis University, St. Louis, Missouri, USA.,Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Cody Falls
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Jakob Ohman
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Antony Aziz
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Lily Stalter
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Glen Leverson
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Bridget Welch
- Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Dixon B Kaufman
- Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.,University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - David P Al-Adra
- Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.,University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Jon S Odorico
- Division of Transplantation, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA.,University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Soria F, Pradere B, Hurle R, D'Andrea D, Albisinni S, Diamand R, Laukhtina E, Di Trapani E, Aziz A, Krajewski W, Teoh J, Mari A, Moschini M, Chiancone F, Autorino R, Porreca A, Marchioni M, Liguori G, Lucarelli G, Busetto G, Foschi N, Antonelli A, Bove P, Russo G, Crisan N, Borghesi M, Boeri L, Veccia A, Greco F, Longo N, De Cobelli O, Shariat S, Gontero P, Ferro M. Radical Nephroureterectomy Tetrafecta: A Proposal Reporting Surgical Strategy Quality at Surgery. EUR UROL SUPPL 2022; 42:1-8. [PMID: 35911084 PMCID: PMC9334825 DOI: 10.1016/j.euros.2022.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2022] [Indexed: 11/22/2022] Open
Abstract
Background Standardized methods for reporting surgical quality have been described for all the major urological procedures apart from radical nephroureterectomy (RNU). Objective To propose a tetrafecta criterion for assessing the quality of RNU based on a consensus panel within the Young Association of Urology (YAU) Urothelial Group, and to test the impact of this tetrafecta in a multicenter, large contemporary cohort of patients treated with RNU for upper tract urothelial carcinoma (UTUC). Design, setting, and participants This was a retrospective analysis of 1765 patients with UTUC treated between 2000 and 2021. Outcome measurements and statistical analysis We interviewed the YAU Urothelial Group to propose and score a list of items to be included in the “RNU-fecta.” A ranking was generated for the criteria with the highest sum score. These criteria were applied to a large multicenter cohort of patients. Kaplan-Meier curves were built to evaluate differences in overall survival (OS) rates between groups, and a multivariable logistic regression model was used to find the predictors of achieving the RNU tetrafecta. Results and limitations The criteria with the highest score included three surgical items such as negative soft tissue surgical margins, bladder cuff excision, lymph node dissection according to guideline recommendations, and one oncological item defined by the absence of any recurrence in ≤12 mo. These items formed the RNU tetrafecta. Within a median follow-up of 30 mo, 52.6% of patients achieved the RNU tetrafecta. The 5-yr OS rates were significantly higher for patients achieving tetrafecta than for their counterparts (76% vs 51%). Younger age, lower body mass index, and robotic approach were found to be independent predictors of tetrafecta achievement. Conversely, a higher Eastern Cooperative Oncology Group score, higher clinical stage, and bladder cancer history were inversely associated with tetrafecta. Conclusions Herein, we present a “tetrafecta” composite endpoint that may serve as a potential tool to assess the overall quality of the RNU procedure. Pending external validation, this tool could allow a comparison between surgical series and may be useful for assessing the learning curve of the procedure as well as for evaluating the impact of new technologies in the field. Patient summary In this study, a tetrafecta criterion was developed for assessing the surgical quality of radical nephroureterectomy in patients with upper tract urothelial carcinoma. Patients who achieved tetrafecta had higher 5-yr overall survival rates than those who did not.
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Aziz A, O'Donnell H, Harris DG, Jung HS, DiMusto P. Evaluation of a Standardized Protocol for Medical Management of Uncomplicated Acute Type B Aortic Dissection. J Vasc Surg 2022; 76:639-644.e2. [PMID: 35550395 DOI: 10.1016/j.jvs.2022.03.882] [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] [Received: 01/13/2022] [Accepted: 03/23/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The goals of medical management for uncomplicated acute type B aortic dissection are to prevent expansion of the false lumen and malperfusion syndrome. This is accomplished with antihypertensive agents, but medication selection and titration are typically provider dependent. Given the paucity of data on evidence-based management of this population, we hypothesized that a standardized type B aortic dissection medical management protocol would reduce resource utilization and costs, without compromising patient outcomes. METHODS A multidisciplinary team developed a goal-directed protocol to standardize the medical management of uncomplicated acute type B aortic dissection, with an emphasis on early initiation of oral medications, weaning of anti-hypertensive infusions and frequent assessment for de-escalation of care. Implementation was in April 2018. A retrospective review of acute type B aortic dissection patients presenting to our institution from April 2016- April 2020 was performed. Patients requiring aortic or peripheral intervention were excluded. Included patients were analyzed based on treatment before or after protocol implementation. Patient demographics, systolic blood pressure, presence of acute kidney injury at presentation, length of stay, cost metrics, and 30-day mortality were compared. RESULTS 39 patients were included, 21 pre- and 18 post-protocol implementation. Baseline demographics, systolic blood pressure, and presence of acute kidney injury at presentation were similar between the groups. Post-protocol patients had shorter total (8.6 vs 5.5 days, p=.02) and intensive care unit (3.2 vs 1.8 days, p=.002) length of stay. The protocol was associated with significantly decreased total hospital ($38,928 vs $28,066, p=.04), total variable ($23,115 vs $15,627, p=0.02), and pharmacy ($5,094 vs $1,181, p<.001) costs, while inpatient care costs ($15,152 vs $11,467, p=.09) trended down. Post-protocol patients required fewer oral antihypertensive agents at discharge (3.8 vs 2.7, p=.005). No significant difference in 30-day mortality was observed. CONCLUSIONS A goal directed protocol reduces resource utilization and costs without compromising early mortality rates for patients with uncomplicated acute type B aortic dissection. Such a strategy may have broader application in medical management of acute aortic syndromes.
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Affiliation(s)
- Antony Aziz
- University Of Wisconsin- Department of Surgery.
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Ito T, Butler JR, Noguchi D, Ha M, Aziz A, Agopian VG, DiNorcia J, Yersiz H, Farmer DG, Busuttil RW, Hong JC, Kaldas FM. A 3-Decade, Single-Center Experience of Liver Transplantation for Cholangiocarcinoma: Impact of Era, Tumor Size, Location, and Neoadjuvant Therapy. Liver Transpl 2022; 28:386-396. [PMID: 34482610 DOI: 10.1002/lt.26285] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [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] [Received: 02/04/2021] [Revised: 08/14/2021] [Accepted: 08/18/2021] [Indexed: 12/13/2022]
Abstract
Liver transplantation (LT) for cholangiocarcinoma (CCA) remains limited to a small number of centers. Although the role of neoadjuvant therapy (NAT) has been explored over time, an in-depth analysis of NAT strategies remains limited. Furthermore, controversy exists regarding acceptable tumor size during patient selection for LT. This study explores the impact of era, tumor size, and NAT strategy on LT outcomes for CCA. We conducted a retrospective review of 53 patients with CCA treated with LT from 1985 to 2019; 19 hilar CCA (hCCA) and 30 intrahepatic CCA (iCCA) were included. The relative contributions of varying NAT (neoadjuvant chemotherapy [NAC], neoadjuvant local therapy [NALT], and combined NAC and NALT [NACLT]) as well as the implication of tumor size and era were analyzed. The primary endpoint was overall survival (OS). Compared with the old era (1985-2007), 5-year OS in patients who underwent LT in the recent era (2008-2019) showed a superior trend. The 5-year OS from initial treatment in patients receiving NACLT for hCCA and iCCA were 88% and 100% versus 9% and 41% in patients without it, respectively (P = 0.01 for hCCA; P = 0.02 for iCCA), whereas NAC or NALT alone did not show significant differences in OS versus no NAT (P > 0.05). Although 33 patients had large-size tumors (hCCA ≥ 30 mm, n = 12, or iCCA ≥ 50 mm, n = 21), tumor size had no impact on survival outcomes. Outcomes of LT for CCA seem to have improved over time. Multimodal NAT is associated with improved survival in LT for both iCCA and hCCA regardless of tumor size.
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Affiliation(s)
- Takahiro Ito
- The UCLA Division of Liver and Pancreas Transplantation, Department of Surgery, University of California Los Angeles, Los Angeles, CA
| | - James R Butler
- The UCLA Division of Liver and Pancreas Transplantation, Department of Surgery, University of California Los Angeles, Los Angeles, CA
| | - Daisuke Noguchi
- The UCLA Division of Liver and Pancreas Transplantation, Department of Surgery, University of California Los Angeles, Los Angeles, CA
| | - Minah Ha
- The UCLA Division of Liver and Pancreas Transplantation, Department of Surgery, University of California Los Angeles, Los Angeles, CA
| | - Antony Aziz
- The UCLA Division of Liver and Pancreas Transplantation, Department of Surgery, University of California Los Angeles, Los Angeles, CA
| | - Vatche G Agopian
- The UCLA Division of Liver and Pancreas Transplantation, Department of Surgery, University of California Los Angeles, Los Angeles, CA
| | - Joseph DiNorcia
- The UCLA Division of Liver and Pancreas Transplantation, Department of Surgery, University of California Los Angeles, Los Angeles, CA
| | - Hasan Yersiz
- The UCLA Division of Liver and Pancreas Transplantation, Department of Surgery, University of California Los Angeles, Los Angeles, CA
| | - Douglas G Farmer
- The UCLA Division of Liver and Pancreas Transplantation, Department of Surgery, University of California Los Angeles, Los Angeles, CA
| | - Ronald W Busuttil
- The UCLA Division of Liver and Pancreas Transplantation, Department of Surgery, University of California Los Angeles, Los Angeles, CA
| | - Johnny C Hong
- Division of Transplant Surgery, Department of Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Fady M Kaldas
- The UCLA Division of Liver and Pancreas Transplantation, Department of Surgery, University of California Los Angeles, Los Angeles, CA
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Auta HS, Abioye OP, Aransiola SA, Bala JD, Chukwuemeka VI, Hassan A, Aziz A, Fauziah SH. Enhanced microbial degradation of PET and PS microplastics under natural conditions in mangrove environment. J Environ Manage 2022; 304:114273. [PMID: 34902688 DOI: 10.1016/j.jenvman.2021.114273] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 12/05/2021] [Accepted: 12/08/2021] [Indexed: 06/14/2023]
Abstract
In-situ bioremediation of mangrove soil contaminated with polyethylene terephthalate (PET) and polystyrene (PS) microplastics was investigated using indigenous microbial consortium with adequate capacity to degrade the plastics. Eight (8) bacteria were isolated from plastic/microplastic-inundated mangrove soil and screened for the ability to degrade PET and PS microplastics. Optical density at 600 nm and colony forming unit counts were measured to evaluate the growth response of the microbes in the presence of PS and PET microplastics at different times of exposure. Structural and surface changes that occurred post biodegradation on the microplastics were determined through EDS and SEM analysis. The obtained results demonstrated the elongation and disappearance of peaks, suggesting that the microbial consortium could modify both types of microplastics. The overall results of the microplastic degradation showed varied degrees of weight loss after 90 experimental days, with the treated plot recorded 18% weight loss. The augmented soil was increased in the concentrations of Si S, and Fe and decreased in the concentrations of C, O, Na, Mg, Al, Cl, and K after bioremediation.
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Affiliation(s)
- H S Auta
- Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia; Centre for Research in Waste Management, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia; Department of Microbiology, Federal University of Technology, Minna, Nigeria
| | - O P Abioye
- Department of Microbiology, Federal University of Technology, Minna, Nigeria
| | - S A Aransiola
- Bioresources Development Centre, National Biotechnology Development Agency, Ogbomoso, Nigeria.
| | - J D Bala
- Department of Microbiology, Federal University of Technology, Minna, Nigeria
| | - V I Chukwuemeka
- Department of Animal Biology, Federal University of Technology, Minna, Nigeria
| | - A Hassan
- Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia; Centre for Research in Waste Management, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia; Department of Biological Sciences, Federal University, Kashere, Gombe, Nigeria
| | - A Aziz
- Faculty of Marine Sciences, Lasbela University of Agriculture, Water & Marine Sciences, Uthal, Balochistan, Pakistan
| | - S H Fauziah
- Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia; Centre for Research in Waste Management, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
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Ullah H, Khan F, Taha M, Rahim F, Sarfraz M, Aziz A, Ullah S, Khan MU, Ullah M. New Thiazole-Bearing Oxadiazole Derivatives: Synthesis, Thymidine Phosphorylase Inhibitory Potential, and Molecular Docking Study. Russ J Org Chem 2022. [DOI: 10.1134/s1070428021120150] [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: 11/23/2022]
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Ling OP, Ardani MR, Baharun N, Aziz A, Rezan SA. Synthesis of multi-hollow flake like ZnO nanostructures via facile hydrothermal technique. INORG NANO-MET CHEM 2022. [DOI: 10.1080/24701556.2021.2025083] [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)
- O. P. Ling
- School of Materials and Mineral Resources Engineering, Universiti Sains Malaysia, Nibong Tebal, Malaysia
| | - M. R. Ardani
- School of Materials and Mineral Resources Engineering, Universiti Sains Malaysia, Nibong Tebal, Malaysia
| | - N. Baharun
- School of Materials and Mineral Resources Engineering, Universiti Sains Malaysia, Nibong Tebal, Malaysia
| | - A. Aziz
- School of Materials and Mineral Resources Engineering, Universiti Sains Malaysia, Nibong Tebal, Malaysia
| | - S. A. Rezan
- School of Materials and Mineral Resources Engineering, Universiti Sains Malaysia, Nibong Tebal, Malaysia
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Khan B, Ullah A, Khan MA, Amin A, Iqbal M, Khan S, Ateeq M, Aman K, Aziz A, Khattak MNK, Nadeem T, Munir N, Khan S, Ali Q. Anti-hyperglycemic and anti-hyperlipidemic effects of a methanolic extract of Debregeasia salicifolia in Alloxan-induced diabetic albino mice. BRAZ J BIOL 2021; 84:e251046. [PMID: 34932675 DOI: 10.1590/1519-6984.251046] [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] [Received: 04/14/2021] [Accepted: 08/20/2021] [Indexed: 11/21/2022] Open
Abstract
Diabetes mellitus (DM), an endocrine syndrome characterized by high blood glucose levels due to abrogated insulin activity. The existing treatments for DM have side effects and varying degrees of efficacy. Therefore, it is paramount that novel approaches be developed to enhance the management of DM. Therapeutic plants have been accredited as having comparatively high efficacy with fewer adverse effects. The current study aims to elucidate the phytochemical profile, anti-hyperlipidemic, and anti-diabetic effects of methanolic extract D. salicifolia (leaves) in Alloxan-induced diabetic mice. Alloxan was injected intraperitoneally (150 mg kg-1, b.w), to induced diabetes in mice. The mice were divided into three groups (n=10). Group 1 (normal control) received normal food and purified water, Group II (diabetic control) received regular feed and clean water and group III (diabetic treated) received a methanolic extract of the plant (300 mg kg-1) for 28 days with a typical diet and clean water throughout the experiment. Blood samples were collected to checked serum glucose and concentration of LDL, TC, TG. The extract demonstrated significant antihyperglycemic activity (P<0.05), whereas improvements in mice's body weight and lipid profiles were observed after treatment with the extract. This study establishes that the extract has high efficacy with comparatively less toxicity that can be used for DM management.
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Affiliation(s)
- B Khan
- Dalian Medical University Liaoning, Department of Physiology, Dalian, China
| | - A Ullah
- Department of Health and Biological Sciences, Abasyn University Peshawar, Khyber Pakhtunkhwa Pakistan
| | - M A Khan
- Hong Kong University of Science and Technology, Division of Life Science, Center for Cancer Research and State Key Lab for Molecular Neuroscience, Clear Water Bay, China
| | - A Amin
- Hong Kong Baptist University, School of Chinese Medicine and Department of Biology, Hong Kong, China
| | - M Iqbal
- Department of Botany, Shaheed Benazir Bhutto Women university Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - S Khan
- Institute of microbiology and biotechnology, Bacha Khan University Charsada
| | - M Ateeq
- Institute of biological sciences, Sarhad university of science and information technology Peshawar, Khyber Pakhtunkhwa Pakistan
| | - K Aman
- Department of Health and Biological Sciences, Abasyn University Peshawar, Khyber Pakhtunkhwa Pakistan
| | - A Aziz
- Institute of biological sciences, Sarhad university of science and information technology Peshawar, Khyber Pakhtunkhwa Pakistan
| | - M N K Khattak
- University of Sharjah, Department of Applied Biology, College of Sciences, Sharjah, United Arab Emirates
| | - T Nadeem
- University of the Punjab, Centre of Excellence in Molecular Biology, Lahore, Punjab, Pakistan
| | - N Munir
- Center of biotechnology and microbiology, University of Peshawar, Khyber Pakhtunkhwa Pakistan
| | - S Khan
- Department of biotechnology, university of swabi, Khyber Pakhtunkhwa Pakistan
| | - Q Ali
- The University of Lahore, Institute of Molecular Biology and Biotechnology, Lahore, Punjab, Pakistan
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14
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Kandiah R, Aziz A, Nik Min NFA, Rahim MR, Zawawi N, Sayuti KA, Nadarajah S, Mohamad I. Lichenoid uvula mass as a rare cause of hot potato voice and progressive dysphagia. Malays J Pathol 2021; 43:457-461. [PMID: 34958068] [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] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Lichenoid uvula mass is an unusual entity and the clinicopathologic entities are important for the diagnosis. In this case report, we report an elderly lady presented with dysphagia and "hot potato voice" due to a lichenoid uvula mass. Apart from muffled voice, the other associated symptoms are dysphagia, sore throat, globus pharyngeus and snoring. She was a non-smoker, and not on any medications except for hypertension and dyslipidaemia. Apart from the enlarged uvula, other parts of the oral cavity, oropharynx and larynx were normal. She has no other signs such as cutaneous lesions. The mass was excised under general anaesthesia followed by resolution of symptoms. Awareness of this entity, the clinical and histopathological features should be highlighted to differentiate it from other diagnosis.
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Affiliation(s)
- R Kandiah
- Universiti Sains Malaysia, School of Medical Sciences, Department of Otorhinolaryngology-Head & Neck Surgery, Health Campus, Kota Bharu, Kelantan, Malaysia
| | - A Aziz
- Universiti Sains Malaysia, School of Medical Sciences, Department of Otorhinolaryngology-Head & Neck Surgery, Health Campus, Kota Bharu, Kelantan, Malaysia
| | - N F A Nik Min
- Universiti Sains Malaysia, School of Medical Sciences, Department of Pathology, Health Campus, Kota Bharu, Kelantan, Malaysia
| | - M R Rahim
- Universiti Sains Malaysia, School of Medical Sciences, Department of Radiology, Health Campus, Kota Bharu, Kelantan, Malaysia
| | - N Zawawi
- Universiti Sains Malaysia, School of Medical Sciences, Department of Pathology, Health Campus, Kota Bharu, Kelantan, Malaysia
| | - K A Sayuti
- Universiti Sains Malaysia, School of Medical Sciences, Department of Radiology, Health Campus, Kota Bharu, Kelantan, Malaysia
| | - S Nadarajah
- Trafalgar Memorial Hospital, Department of Otorhinolaryngology, Oakville, Ontario Canada
| | - I Mohamad
- Universiti Sains Malaysia, School of Medical Sciences, Department of Otorhinolaryngology-Head & Neck Surgery, Health Campus, Kota Bharu, Kelantan, Malaysia.
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15
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Ejupi A, Aziz A, Ong P, Shafi BH, Lange T, Sechtem U, Prescott E. Proteomic biomarker profiles and vascular dysfunction in angina with no obstructive coronary artery disease. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Coronary vascular dysfunction is a common cause of symptoms in patients with angina and no obstructed coronary arteries (ANOCA). Several endotypes have been defined but there are big gaps in our understanding of the underlying pathophysiology. Proteomic analyses may improve the understanding of the pathophysiology.
Purpose
Exploratory approach to 1) compare the proteomic biomarker profile across different types of vascular dysfunction in ANOCA and 2) assess the value of prediction models with protein biomarkers for vascular dysfunction in ANOCA.
Methods
We included 107 angina patients without previous coronary artery disease, left ventricular ejection fraction >45% and no obstructive coronary artery disease (CAD) (<50% stenosis of epicardial vessels) on coronary angiography. Three types of vascular dysfunction were assessed: 1) Vasomotor dysfunction (VMD) defined as epicardial or microvascular vasospasm on acetylcholine provocation, 2) Coronary microvascular dysfunction (CMD) defined as coronary flow velocity reserve (CFVR) ≤2.5 on echocardiography of the LAD on adenosine stimulation and 3) Reactive Hyperaemia Index (RHI) ≤1.67 as a measure of peripheral endothelial dysfunction. Blood samples were analysed for 184 protein biomarkers related to cardiovascular disease. Correlations between biomarkers and results of vascular function assessments were analysed with Pearson's correlation coefficient and visualized with volcano plots. Significantly correlated biomarkers (p<0.05) were tested in prediction models for their incremental value over age and gender with C-statistics.
Results
CFVR was correlated to 24 biomarkers before (figure 1a) and 2 biomarkers after adjustment for age and gender. The basic prediction model had AUC of 0.68 and was not significantly improved by adding biomarkers (figure 2a). RHI was correlated to 27 biomarkers before (figure 1b) and 10 biomarkers after adjustment for age and gender. The clinical prediction model was significantly improved (p=0.037) by adding TRAIL R2 and IL-18, in addition to age and gender, with an AUC of 84.4 (figure 2b). VMD was correlated to 14 biomarkers before (figure 1c) and 6 biomarkers after adjustment for age and gender. The prediction model was significantly improved (p=0.011) by adding HSP-27, RARRES-2 and SERPINA-12 in addition to age and gender in prediction of VMD with an AUC of 85.4 (figure 2c).
Conclusion
Several biomarkers were associated with vascular dysfunction in ANOCA patients with little overlap between different endotypes. We identified biomarkers that may contribute to the understanding of the underlying pathophysiology and have applications for screening. Results need to be confirmed in larger studies.
Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): Department of Cardiology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Denmark.Department of Cardiology and Angiology, Robert Bosch Krankenhaus, Stuttgart, Germany
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Affiliation(s)
- A Ejupi
- Bispebjerg University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - A Aziz
- Odense University Hospital, Department of Cardiology, Odense, Denmark
| | - P Ong
- Robert Bosch Hospital, Department of Cardiology and Angiology, Stuttgart, Germany
| | - B H Shafi
- Bispebjerg University Hospital, Department of Cardiology, Copenhagen, Denmark
| | - T Lange
- University of Copenhagen, Department of Public Health, Copenhagen, Denmark
| | - U Sechtem
- Robert Bosch Hospital, Department of Cardiology and Angiology, Stuttgart, Germany
| | - E Prescott
- Bispebjerg University Hospital, Department of Cardiology, Copenhagen, Denmark
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16
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Aziz A, O'Donnell H, Harris DG, Jung HS, DiMusto P. Evaluation of a Standardized Protocol for Medical Management of Uncomplicated Acute Type B Aortic Dissection. J Vasc Surg 2021. [DOI: 10.1016/j.jvs.2021.07.136] [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: 11/25/2022]
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17
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Hashim H, Aziz A, Tyrrell B, Leung R, Brass N, Dorsch M. INITIAL EXPERIENCE WITH THE USE OF INTRAVASCULAR LITHOTRIPSY FOR CORONARY CALCIUM MODIFICATION. Can J Cardiol 2021. [DOI: 10.1016/j.cjca.2021.07.076] [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: 10/20/2022] Open
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18
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Ullah H, Ullah H, Taha M, Khan F, Rahim F, Uddin I, Sarfraz M, Shah SAA, Aziz A, Mubeen S. Synthesis, In Vitro α-Amylase Activity, and Molecular Docking
Study of New Benzimidazole Derivatives. Russ J Org Chem 2021. [DOI: 10.1134/s1070428021060130] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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19
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Soria F, Hurle R, D’Andrea D, Albisinni S, Laukhtina E, Pradere B, Di Trapani E, Aziz A, Krajewski W, Teoh J, Mari A, Moschini M, Autorino R, Porreca A, Marchioni M, Liguori G, Lucarelli G, Busetto G, Antonelli A, Russo G, Crisan N, Veccia A, De Cobelli O, Gontero P, Ferro M. Radical nephroureterectomy pentafecta: A proposal for standardisation of oncologic outcomes reporting following open, laparoscopic or robot-assisted radical nephroureterectomy. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01168-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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20
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Anwar MM, Fayyaz F, Aziz A, Mahmood MR. Socio-Ecological and Ethical Economic Demand of Urban Parks in Gujrat City, Punjab, Pakistan. Arid Ecosyst 2021. [DOI: 10.1134/s2079096121020037] [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: 11/22/2022]
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21
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Chen G, Aziz A, Sharova T, Rozhkova E, Yang L, Lau N, Botchkarev V, Muegge K, Sharov A. 139 Heterochromatin maintenance is crucial for terminal keratinocyte differentiation and inhibition of inflammatory responses in the epidermis. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.158] [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: 10/21/2022]
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22
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Saad-Ilyas M, Zehra U, Khan UU, Mohammad I, Muhammad R, Aziz A. Orthopaedic Practices and Surgeries during COVID-19 in Pakistan - A Survey Based Study. Malays Orthop J 2021; 15:72-78. [PMID: 33880151 PMCID: PMC8043628 DOI: 10.5704/moj.2103.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introduction: The study aimed to target the current practices of the orthopaedic community in outpatient (OPD), emergency (ER) and surgical services (OT) during COVID-19. Material and method: This study surveyed 303 orthopaedic surgeons from all over Pakistan. The survey had 30 questions targeting the setup of outpatient, emergency and operation services in orthopaedic departments of different hospitals in Pakistan. Result: A total of 302 surgeons were included from 53 cities all over Pakistan. Between 35-48% of the respondents reported lack of availability of standard operating procedures in OPD, ER and in OT. Majority of the respondents noted that their OPD and surgical practice had been affected to some degree and 69% of the surgeons were only doing trauma surgery. This trend was higher in younger consultants of less than 45 years of age (p<0.001). Almost two-third of the surgeons, mostly senior (p=0.03) were using surgical masks as the only protective measure during various practices of OPD, ER and OT, while most of the setups were not assessing patients even for signs and symptoms of COVID. Almost 89% of the orthopaedic community is facing definite to mild stress during this pandemic and this has significantly affected the senior surgeons (p=0.01). Conclusion: Our study highlighted that COVID-19 has resulted in marked changes to the practices of the majority of Pakistani orthopaedic surgeons. Despite a sharp upsurge in the number of cases and mortality due to COVID-19, guidelines were still lacking at most of the settings and a substantial percentage of the orthopaedic community were not following adequate safety measures while attending to patients.
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Affiliation(s)
- M Saad-Ilyas
- Department of Orthopaedics & Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan
| | - U Zehra
- Department of Anatomy, University of Health Sciences, Lahore, Pakistan
| | - U U Khan
- Department of Orthopaedic, Kabir Medical College, Peshawar, Pakistan
| | - I Mohammad
- Trauma Centre, Makhdoom Aali, Tehsil Dunyapur, Pakistan
| | - R Muhammad
- Department of Orthopaedics, Chandka Medical College, Larkana, Pakistan
| | - A Aziz
- Department of Orthopaedics & Spine Surgery, Ghurki Trust Teaching Hospital, Lahore, Pakistan
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23
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Sosa RA, Terry AQ, Kaldas FM, Jin YP, Rossetti M, Ito T, Li F, Ahn RS, Naini BV, Groysberg VM, Zheng Y, Aziz A, Nevarez-Mejia J, Zarrinpar A, Busuttil RW, Gjertson DW, Kupiec-Weglinski JW, Reed EF. Disulfide High-Mobility Group Box 1 Drives Ischemia-Reperfusion Injury in Human Liver Transplantation. Hepatology 2021; 73:1158-1175. [PMID: 32426849 PMCID: PMC8722704 DOI: 10.1002/hep.31324] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Revised: 04/16/2020] [Accepted: 04/19/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIMS Sterile inflammation is a major clinical concern during ischemia-reperfusion injury (IRI) triggered by traumatic events, including stroke, myocardial infarction, and solid organ transplantation. Despite high-mobility group box 1 (HMGB1) clearly being involved in sterile inflammation, its role is controversial because of a paucity of patient-focused research. APPROACH AND RESULTS Here, we examined the role of HMGB1 oxidation states in human IRI following liver transplantation. Portal blood immediately following allograft reperfusion (liver flush; LF) had increased total HMGB1, but only LF from patients with histopathological IRI had increased disulfide-HMGB1 and induced Toll-like receptor 4-dependent tumor necrosis factor alpha production by macrophages. Disulfide HMGB1 levels increased concomitantly with IRI severity. IRI+ prereperfusion biopsies contained macrophages with hyperacetylated, lysosomal disulfide-HMGB1 that increased postreperfusion at sites of injury, paralleling increased histone acetyltransferase general transcription factor IIIC subunit 4 and decreased histone deacetylase 5 expression. Purified disulfide-HMGB1 or IRI+ blood stimulated further production of disulfide-HMGB1 and increased proinflammatory molecule and cytokine expression in macrophages through a positive feedback loop. CONCLUSIONS These data identify disulfide-HMGB1 as a mechanistic biomarker of, and therapeutic target for, minimizing sterile inflammation during human liver IRI.
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Affiliation(s)
- Rebecca A. Sosa
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Allyson Q. Terry
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Fady M. Kaldas
- Dumont-UCLA Transplantation Center, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Yi-Ping Jin
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Maura Rossetti
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Takahiro Ito
- Dumont-UCLA Transplantation Center, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Fang Li
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Richard S. Ahn
- Institute of Quantitative and Computational Biosciences, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Bita V. Naini
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Victoria M. Groysberg
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Ying Zheng
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Antony Aziz
- Dumont-UCLA Transplantation Center, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Jessica Nevarez-Mejia
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Ali Zarrinpar
- Dumont-UCLA Transplantation Center, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Ronald W. Busuttil
- Dumont-UCLA Transplantation Center, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - David W. Gjertson
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
- Department of Biostatistics, School of Public Health at UCLA, Los Angeles, CA, 90095, USA
| | - Jerzy W. Kupiec-Weglinski
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
- Dumont-UCLA Transplantation Center, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
| | - Elaine F. Reed
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, 90095, USA
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24
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Chieng CY, Davies A, Aziz A, Lowe D, Rogers SN. Health related quality of life and patient concerns in patients with osteoradionecrosis. Br J Oral Maxillofac Surg 2021; 59:1061-1066. [PMID: 34325946 DOI: 10.1016/j.bjoms.2021.02.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 02/18/2021] [Indexed: 11/25/2022]
Abstract
The number of patients presenting with osteoradionecrosis (ORN) is likely to increase in future and health related quality of life (HRQOL) is a key outcome. This study aimed to report patient concerns and HRQOL in an osteoradionecrosis cohort over 12 years. Patients attended routine follow-up clinics between 2008 to 2020, where patient reported outcome (PRO) assessment was used before consultations as standard practice. The two PROs were the Patient Concerns Inventory (PCI) and the University of Washington quality of life questionnaire (UW-QOL v4). The study sample comprised 109 patients with ORN seen in 445 clinics when PCI and UW-QOL were used. At clinic, patients were in one of six ORN states: before ORN (26 with data), at diagnosis (12), and following treatment either improved (27), progressed (46), stable (63) or resolved (37). Worst HRQOL outcomes were reported in the progressive group with 50% reporting overall QOL as less than good. Pain was a major dysfunction (63%) as was physical and social-emotional functioning and this group reported many PCI issues, median (IQR) 7 (4-11). Kaplan-Meier estimates of survival with 95% CI after diagnosis with ORN were 96% (90-99%) at 12 months, 89% (81-94%) at 24 months and 73% (61-82%) at 60 months. This study indicates that ORN is a chronic condition with long-term survivorship consequences. More data through cohort studies and trials are needed to assist in decision making for individual patients.
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Affiliation(s)
- C Y Chieng
- Regional Maxillofacial Unit, Aintree University Hospital, Lower Lane, Liverpool, UK.
| | - A Davies
- Regional Maxillofacial Unit, Aintree University Hospital, Lower Lane, Liverpool, UK.
| | - A Aziz
- Regional Maxillofacial Unit, Aintree University Hospital, Lower Lane, Liverpool, UK.
| | - D Lowe
- Astraglobe Ltd, Congleton, Cheshire, UK.
| | - S N Rogers
- Faculty of Health and Social Care, Edge Hill University, Ormskirk, L39 4QP, UK; Liverpool Head and Neck Centre, Liverpool University Hospital Aintree, Liverpool, UK.
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25
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Guorgui J, Ito T, Markovic D, Aziz A, Younan S, Severance A, Lu M, Lee J, DiNorcia J, Agopian VG, Farmer DG, Busuttil RW, Kaldas FM. The impact of marijuana use on liver transplant recipients: A 900 patient single center experience. Clin Transplant 2021; 35:e14215. [PMID: 33406299 DOI: 10.1111/ctr.14215] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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: 06/11/2020] [Revised: 09/16/2020] [Accepted: 12/21/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Increased societal prevalence of marijuana continues to challenge liver transplant (LT) programs. This study aimed to examine the potential effects of marijuana use on outcomes. METHODS This retrospective study included recipients who underwent LT between 1/2012 and 6/2018. According to pre-LT marijuana use, patients were classified into recent (≤6 months of LT), former (chronic use but not ≤6 months), or non-users. Additionally, the impact of post-LT marijuana use on survival was assessed. RESULTS Of 926 eligible patients, 184 were pre-LT marijuana users (42 recent; 142 former) (median follow-up: 30.3 months). Pre-users were more likely to be male, White, and have histories of tobacco, alcohol, and illicit drug use. Additionally, recent users were of higher acuity, with higher MELD and requiring ICU admission. Patient survival at 1-year was 89% in non-users, 94% (HR: 0.494, 95% CI: 0.239-1.022 vs. non-users) in former users, and 83% (HR: 1.516, 95% CI: 0.701-3.282) in recent users. Post-operative complications in pre-LT users and the survival analysis for post-LT marijuana users vs. non-users did not show significance. CONCLUSIONS Our results demonstrated that marijuana use did not have an adverse impact on post-LT outcomes; however, further studies utilizing larger cohorts are warranted.
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Affiliation(s)
- Jacob Guorgui
- Department of Surgery, The Dumont-UCLA Transplant and Liver Cancer, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Takahiro Ito
- Department of Surgery, The Dumont-UCLA Transplant and Liver Cancer, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Daniela Markovic
- Department of Medicine Statics, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Antony Aziz
- Department of Surgery, The Dumont-UCLA Transplant and Liver Cancer, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Stephanie Younan
- Department of Surgery, The Dumont-UCLA Transplant and Liver Cancer, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Alyscia Severance
- Department of Surgery, The Dumont-UCLA Transplant and Liver Cancer, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Michelle Lu
- Department of Surgery, The Dumont-UCLA Transplant and Liver Cancer, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jane Lee
- Department of Surgery, The Dumont-UCLA Transplant and Liver Cancer, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Joseph DiNorcia
- Department of Surgery, The Dumont-UCLA Transplant and Liver Cancer, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Vatche G Agopian
- Department of Surgery, The Dumont-UCLA Transplant and Liver Cancer, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Douglas G Farmer
- Department of Surgery, The Dumont-UCLA Transplant and Liver Cancer, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Ronald W Busuttil
- Department of Surgery, The Dumont-UCLA Transplant and Liver Cancer, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Fady M Kaldas
- Department of Surgery, The Dumont-UCLA Transplant and Liver Cancer, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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26
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Ito T, Naini BV, Markovic D, Aziz A, Younan S, Lu M, Hirao H, Kadono K, Kojima H, DiNorcia J, Agopian VG, Yersiz H, Farmer DG, Busuttil RW, Kupiec-Weglinski JW, Kaldas FM. Ischemia-reperfusion injury and its relationship with early allograft dysfunction in liver transplant patients. Am J Transplant 2021; 21:614-625. [PMID: 32713098 DOI: 10.1111/ajt.16219] [Citation(s) in RCA: 64] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 07/14/2020] [Accepted: 07/14/2020] [Indexed: 02/06/2023]
Abstract
Ischemia-reperfusion injury (IRI) is believed to contribute to graft dysfunction after liver transplantation (LT). However, studies on IRI and the impact of early allograft dysfunction (EAD) in IRI grafts are limited. Histological IRI was graded in 506 grafts from patients who had undergone LT and classified based on IRI severity (no, minimal, mild, moderate, and severe). Of the 506 grafts, 87.4% had IRI (no: 12.6%, minimal: 38.1%, mild: 35.4%, moderate: 13.0%, and severe: 0.8%). IRI severity correlated with the incidence of EAD and graft survival at 6 months. Longer cold/warm ischemia time, recipient/donor hypertension, and having a male donor were identified as independent risk factors for moderate to severe IRI. Among 70 grafts with moderate to severe IRI, 42.9% of grafts developed EAD, and grafts with EAD had significantly inferior survival compared to grafts without EAD. Longer cold ischemia time and large droplet macrovesicular steatosis (≥20%) were identified as independent risk factors for EAD. Our study demonstrated that increased IRI severity was correlated with inferior short-term graft outcomes. Careful consideration of IRI risk factors during donor-recipient matching may assist in optimizing graft utilization and LT outcomes. Furthermore, identification of risk factors of IRI-associated EAD may guide patient management and possible timely graft replacement.
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Affiliation(s)
- Takahiro Ito
- The Dumont-UCLA Liver Transplant Center, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Bita V Naini
- Department of Pathology, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Daniela Markovic
- Department of Medicine Statistics, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Antony Aziz
- The Dumont-UCLA Liver Transplant Center, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Stephanie Younan
- The Dumont-UCLA Liver Transplant Center, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Michelle Lu
- The Dumont-UCLA Liver Transplant Center, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Hirofumi Hirao
- The Dumont-UCLA Liver Transplant Center, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Kentaro Kadono
- The Dumont-UCLA Liver Transplant Center, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Hidenobu Kojima
- The Dumont-UCLA Liver Transplant Center, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Joseph DiNorcia
- The Dumont-UCLA Liver Transplant Center, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Vatche G Agopian
- The Dumont-UCLA Liver Transplant Center, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Hasan Yersiz
- The Dumont-UCLA Liver Transplant Center, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Douglas G Farmer
- The Dumont-UCLA Liver Transplant Center, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Ronald W Busuttil
- The Dumont-UCLA Liver Transplant Center, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jerzy W Kupiec-Weglinski
- The Dumont-UCLA Liver Transplant Center, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Fady M Kaldas
- The Dumont-UCLA Liver Transplant Center, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Deaton C, Forsyth F, Mant J, Edwards D, Hobbs R, Taylor C, Aziz A, Schiff R, Odone J, Zaman J. Characteristics and health status of patients with and without confirmed HFpEF. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Aims
Patients with heart failure with preserved ejection fraction (HFpEF) are usually older and multi-morbid and diagnosis can be challenging. The aims of this cohort study were to confirm diagnosis of HFpEF in patients with possible HFpEF recruited from primary care, to compare characteristics and health status between those with and without HFpEF, and to determine factors associated with health status in patients with HFpEF.
Methods
Patients with presumed HFpEF were recruited from primary care practices and underwent clinical assessment and diagnostic evaluation as part of a longitudinal cohort study. Health status was measured by Montreal Cognitive Assessment (MOCA), 6-minute walk test, symptoms, and the Kansas City Cardiomyopathy Questionnaire (KCCQ), and quality of life (QoL) by EQ-5D-5L visual analogue scale (VAS).
Results
151 patients (mean age 78.5±8.6 years, 40% women, mean EF 56% + 9.4) were recruited and 93 (61.6%) were confirmed HFpEF (those without HFpEF had other HF and cardiac diagnoses). Patients with and without HFpEF did not differ by age, MOCA, blood pressure, heart rate, NYHA class, proportion with atrial fibrillation, Charlson Comorbidity Index, or NT-ProBNP levels. Patients with HFpEF were more likely to be women, overweight or obese, frail, and to be more functionally impaired by 6 minute walk distance and gait speed than those without. Although not statistically significant, patients with HFpEF had clinically significant differences (>5 points) on the physical limitations, symptom burden and clinical summary subscales of the KCCQ, but did not differ by other subscales or by EQ-5D-5L VAS (70±17 vs 73±19, p=0.385). More patients with HFpEF reported daytime dyspnoea (63% vs 46%, p=0.035) and fatigue (81% vs 61%, p=0.008), but not other symptoms compared to those without HFpEF. For both groups BMI was moderately negatively correlated with KCCQ subscale scores, and 6 minute walk distance was positively correlated with KCCQ subscales.
Conclusions
Nearly 40% were not confirmed as HFpEF indicating the challenges of diagnosis. Patients with confirmed HFpEF differed by sex, overweight/obesity, frailty, functional impairment, and symptoms but not by age or comorbidities from those without HFpEF. These differences were reflected in some subscale scores of the KCCQ, but not how patients reported their quality of life on the KCCQ QoL subscale and EQ-5D-5L VAS. Older patients with HFpEF reported relatively high QoL despite poor health status by functional impairment, frailty and symptoms.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): National Institute of Health Research School of Primary Care Research
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Affiliation(s)
- C Deaton
- University of Cambridge, Public Health and Primary Care, Cambridge, United Kingdom
| | - F Forsyth
- University of Cambridge, Public Health and Primary Care, Cambridge, United Kingdom
| | - J Mant
- University of Cambridge, Public Health and Primary Care, Cambridge, United Kingdom
| | - D Edwards
- University of Cambridge, Public Health and Primary Care, Cambridge, United Kingdom
| | - R Hobbs
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | - C Taylor
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | - A Aziz
- University of Oxford, Nuffield Department of Primary Care Health Sciences, Oxford, United Kingdom
| | - R Schiff
- Guys and St Thomas Hospital, London, United Kingdom
| | - J Odone
- Guys and St Thomas Hospital, London, United Kingdom
| | - J Zaman
- James Paget University Hospital, Great Yarmouth, United Kingdom
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Schroder J, Michelsen M, Mygind N, Frestad D, Suhrs H, Bove K, Aziz A, Hansen H, Hansen P, Gustafsson I, Kastrup J, Prescott E. Coronary flow velocity reserve predicts adverse outcome in patients with angina and no obstructive coronary artery disease. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Many patients with angina do not have obstructive coronary artery disease (CAD) when evaluated with coronary angiography. It is unknown whether echocardiographic coronary flow velocity reserve (CFVR) predicts an adverse outcome in these subjects. Previous CFVR studies have included heterogeneous patient subtypes both with and without CAD.
Purpose
To assess whether reduced CFVR predicts adverse outcome in women with angina and no CAD.
Methods
We evaluated 1853 women with angina and a coronary angiogram without stenosis. Exclusion criteria were previous myocardial infarction, coronary revascularisation, heart failure or valvular disease. Coronary microvascular function was assessed by echocardiographic CFVR. All patients were followed up for major adverse cardiovascular events.
Results
CFVR was obtained in 1681 patients (91%), median CFVR was 2.33 (IQR 2.00–2.74). During a median follow-up of 4.48 years, 96 adverse events occurred (acute myocardial infarction: 25; heart failure: 21; revascularisation: 8; stroke: 32; cardiovascular death: 10). In univariate Cox regression, CFVR (hazard ratio [HR] 2.04 [95% CI 1.39–2.94] per unit decrease in CFVR; p<0.001), hypertension (HR 2.29 [95% CI 1.46–3.59]; p<0.001) and diabetes (HR 2.13 [95% CI 1.31–3.45]; p=0.002) were associated with adverse outcome. These associations remained in age-adjusted multivariable regression. Exploratory analyses identified CFVR=2.24 as the optimal discriminating threshold. Stratification according to reduced CFVR and hypertension identified subgroups with better, intermediate and worse outcome (Figure 1). Outcome analyses excluding stroke yielded similar results.
Conclusion
Impaired CFVR predicts adverse outcome in women with angina and no CAD. Integrating CFVR and hypertension identifies high-risk patients.
Funding Acknowledgement
Type of funding source: Foundation. Main funding source(s): The Danish Heart Foundation
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Affiliation(s)
- J Schroder
- Bispebjerg University Hospital, Cardiology, Copenhagen, Denmark
| | - M.M Michelsen
- Bispebjerg University Hospital, Cardiology, Copenhagen, Denmark
| | - N.D Mygind
- Bispebjerg University Hospital, Cardiology, Copenhagen, Denmark
| | - D Frestad
- Hvidorve Hospital, Cardiology, Copenhagen, Denmark
| | - H.E Suhrs
- Bispebjerg University Hospital, Cardiology, Copenhagen, Denmark
| | - K.B Bove
- Bispebjerg University Hospital, Cardiology, Copenhagen, Denmark
| | - A Aziz
- Odense University Hospital, Cardiology, Odense, Denmark
| | - H.S Hansen
- Odense University Hospital, Cardiology, Odense, Denmark
| | - P.R Hansen
- Gentofte University Hospital, Cardiology, Copenhagen, Denmark
| | - I Gustafsson
- Bispebjerg University Hospital, Cardiology, Copenhagen, Denmark
| | - J Kastrup
- Rigshospitalet - Copenhagen University Hospital, Copenhagen, Denmark
| | - E Prescott
- Bispebjerg University Hospital, Cardiology, Copenhagen, Denmark
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Abstract
The world will never be the same after the current COVID-19 pandemic. We may have to live with the coronavirus for a long time. The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has resulted in a major burden on the global health system and economy. This report describes the current COVID-19 landscape and its socioeconomic implications. Despite the concerns for second waves of infection, gradual lifting of lockdown restrictions has occurred worldwide to relieve economic pressures and likely contributes towards possibly surging of outbreak although region wise variation exists due to several other biological factors, such as testing capacity and basic healthcare facilities among susceptible population within that region. Different prediction models have been put forth to forecast the spread of the current outbreak. However, it is challenging to perceive the precise changes happening in the real world as every time dynamics differ same as other epidemics cannot possibly be exactly superimposed to COVID-19. Currently, to decrypt the conundrum for effective antiviral drug against SARS-CoV-2 is in full swing. Due to high rate of mortality and it expeditiously spread is it decisive to understand the biological properties, clinical characteristics, epidemiology, evolution, pathogenesis for vaccine development and pathogenicity studies against the viral curb. Instant diagnostic and adequate therapeutics serve as a major intervention for the management of pandemic containment. Our study aims to analyze the impact of current measures and to suggest appropriate administrative strategic planning rather than to make somewhat authentic prediction in relation to the current scenario. Our predictive analysis study should be helpful against prevention, cure and control of the current outbreak of COVID-19 till the availability of cure or vaccine.
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Affiliation(s)
- A Khurshid
- DOW Research Institute of Biotechnology and Biomedical Sciences, DOW College of Biotechnology, DOW University of Health Sciences, Karachi, Pakistan.
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Dobé T, Ouzaid I, Califano G, Von Rundstedt F, Albisinni S, Aziz A, Di Trapani E, Hendricksen K, Krajewski W, Mari A, Moschini M, Necchi A, Moon A, Poyet C, Pradère B, Rink M, Roghmann F, Sargos P, Seiler R, Xylinas E. Défaut d’adoption de l’instillation intravésicale postopératoire précoce de chimiothérapie après néphro-urétérectomie totale. Prog Urol 2020. [DOI: 10.1016/j.purol.2020.07.215] [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: 11/28/2022]
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31
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Ito T, Botros M, Aziz A, Guorgui JG, Agopian VG, Farmer DG, Busuttil RW, Kaldas FM. Nonanastomotic Biliary Strictures After Liver Transplantation. Am Surg 2020; 86:1363-1367. [PMID: 33125271 DOI: 10.1177/0003134820964461] [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: 12/14/2022]
Abstract
Biliary strictures constitute a major source of morbidity and mortality following liver transplantation (LT). However, studies on the impact of nonanastomotic biliary strictures (NABS) on grafts after LT are limited. 649 patients who underwent LT between January 2013 and June 2017 at our center were retrospectively analyzed and 2.6% (n = 17) of the recipients developed NABS following LT. There were no differences between recipients with and without NABS in indication of LT, graft ischemia time, and type of biliary anastomosis. The incidence of post-LT hepatic artery thrombosis (HAT) (odds ratio [OR]: 15.75, P < .001) and the use of livers from donation after cardiac death (DCD) donors (OR: 8.292, P = .004) were identified as independent significant predictors of NABS by multivariate analysis. Graft survival in those with NABS was significantly worse than in patients without NABS (1-, 3-, and 5-years survival: 64.7%, 57.5%, 0%, vs. 89.8%, 84.0%, 76.4%, P < .001). In conclusion, while the incidence of NABS in our study was relatively low compared to previous reports, NABS was still found to be associated with poor graft survival. Special attention should be paid to NABS occurrence in grafts that develop HAT as well as those from DCD donors.
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Affiliation(s)
- Takahiro Ito
- Department of Surgery, The Dumont-UCLA Liver Transplant Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Mina Botros
- Department of Surgery, The Dumont-UCLA Liver Transplant Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Antony Aziz
- Department of Surgery, The Dumont-UCLA Liver Transplant Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jacob G Guorgui
- Department of Surgery, The Dumont-UCLA Liver Transplant Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Vatche G Agopian
- Department of Surgery, The Dumont-UCLA Liver Transplant Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Douglas G Farmer
- Department of Surgery, The Dumont-UCLA Liver Transplant Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Ronald W Busuttil
- Department of Surgery, The Dumont-UCLA Liver Transplant Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Fady M Kaldas
- Department of Surgery, The Dumont-UCLA Liver Transplant Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Aziz A, Ito T, Younan S, DiNorcia J, Agopian VG, Farmer DG, Busuttil RW, Kaldas FM. The Impact of Previous Abdominal Surgery in a High-Acuity Liver Transplant Population. J Surg Res 2020; 258:405-413. [PMID: 33109401 DOI: 10.1016/j.jss.2020.08.064] [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] [Received: 03/03/2020] [Revised: 08/04/2020] [Accepted: 08/25/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND It is not uncommon for liver transplant (LT) recipients to have had previous abdominal surgery (PAS) preceding transplant. The impact of PAS on morbidity and mortality in LT patients remains unclear. In this study, we investigated the correlation between PAS and LT outcomes in a high-acuity patient population. MATERIALS AND METHODS This is a single-center retrospective review of 936 adult primary LT recipients between 2012 and 2018. Patients were divided based on PAS history. PAS was subdivided into upper abdominal surgery (UAS) and lower abdominal surgery (LAS). UAS was separated into high-impact UAS and low-impact UAS. Finally, we studied patients with PAS ≤90 d versus PAS >90 d. RESULTS Extensive adhesiolysis was the only significant perioperative factor between the PAS group (n = 367) and the non-PAS group (n = 569) (P < 0.001). Red blood cell (RBC) transfusion (20U versus 17U, P = 0.044) and abdominal packing (24.2% versus 13.3%, P = 0.008) were significantly higher in the UAS group (n = 186) versus the LAS group (n = 181). Patients with high-impact UAS required greater RBC (P = 0.021) and fresh frozen plasma transfusion (P = 0.005), and arterial conduits (P = 0.016) during LT. Compared with recipients with PAS >90 d (n = 338), recipients with PAS ≤90 d (n = 29) had significantly higher RBC transfusion (P = 0.046), fresh frozen plasma transfusion (P = 0.022), and abdominal packing (P = 0.025). No differences in patient and graft survival was observed. CONCLUSIONS These findings suggest that, with appropriate care in the perioperative setting, PAS is not a contraindication to successful LT. Careful consideration is warranted when risk stratifying patients with multiple comorbidities who had PAS, especially those with UAS or PAS ≤90 d.
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Affiliation(s)
- Antony Aziz
- Division of Liver and Pancreas Transplantation, Department of Surgery, The Dumont-UCLA Transplant and Liver Cancer Centers, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Takahiro Ito
- Division of Liver and Pancreas Transplantation, Department of Surgery, The Dumont-UCLA Transplant and Liver Cancer Centers, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Stephanie Younan
- Division of Liver and Pancreas Transplantation, Department of Surgery, The Dumont-UCLA Transplant and Liver Cancer Centers, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Joseph DiNorcia
- Division of Liver and Pancreas Transplantation, Department of Surgery, The Dumont-UCLA Transplant and Liver Cancer Centers, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Vatche G Agopian
- Division of Liver and Pancreas Transplantation, Department of Surgery, The Dumont-UCLA Transplant and Liver Cancer Centers, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Douglas G Farmer
- Division of Liver and Pancreas Transplantation, Department of Surgery, The Dumont-UCLA Transplant and Liver Cancer Centers, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Ronald W Busuttil
- Division of Liver and Pancreas Transplantation, Department of Surgery, The Dumont-UCLA Transplant and Liver Cancer Centers, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Fady M Kaldas
- Division of Liver and Pancreas Transplantation, Department of Surgery, The Dumont-UCLA Transplant and Liver Cancer Centers, David Geffen School of Medicine at UCLA, Los Angeles, CA.
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33
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Zamboni S, Baumeister P, Aziz A, Poyet C, Simeone C, Antonelli A, Roghmann F, Meraney A, Konety B, Montorsi F, Gallina A, Briganti A, Gandaglia G, Zaffuto E, Simone G, Karnes R, Hendricksen K, Voskuilen C, Mattei A, Afferi L, Rink M, Necchi A, Shariat S, Xylinas E, Moschini M. Adjuvant chemotherapy is ineffective in patients with bladder cancer and variant histology treated with radical cystectomy. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33657-0] [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] Open
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34
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Carando R, Pradere B, Afferi L, Marra G, Aziz A, Roghmann F, Krajewski W, Di Bona C, Alvarez-Maestro M, Pagliarulo V, Xylinas E, Moschini M. The role of device-assisted therapies in the management of non-muscle invasive bladder cancer: A systematic review. Prog Urol 2020; 30:322-331. [PMID: 32279953 DOI: 10.1016/j.purol.2020.03.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 01/05/2020] [Revised: 02/15/2020] [Accepted: 03/12/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Despite optimal treatment, patients affected by non-muscle invasive bladder cancer (NMIBC) suffer from high risk of recurrence and progression. Intravescical device assisted therapies such as radiofrequency induced thermochemotherapeutic effect (RITE) and electromotive drug administration (EMDA) have shown promising effect in enhancing the effect of intravescical chemotherapies. The aim of the study was to assess clinical outcomes of these two devices in non-muscle invasive bladder cancer. METHODS A systematic literature review was performed in December 2019 using the Medline, Embase, and Web of Science databases. Only articles published in the last 10 years were considered (2009-2019). The articles were selected using the following keywords association: "bladder cancer" AND "EMDA' AND "synergo" AND "hyperchemotherapy" AND "electromotive drug administration", AND "radiofrequency induced thermochemotherapeutic" AND "RITE". RESULTS We found 16 studies published in the last ten years regarding the efficacy of RITE (12 studies) and EMDA (4 studies) in the treatment of NMIBC. Both RITE and EMDA showed promising results in the treatment of intermediate and high risk NMIBC as well as in patients affected by recurrent BCa after BCG failure. In high-risk BCG naïve NMIBC patients treated with EMDA recurrence and progression rates were 68% and 95%, respectively. Considering RITE, recurrence and progression range rates were 43%-88% and 62%-97%, respectively. Discordance results were reported regarding its effect on patients with carcinoma in situ. However, only few studies could be compared since differences exist regarding inclusion criteria with high patients' heterogeneity. Considering recurrence after BCG, recurrence and progression range rates were 29%-29.2% and 62%-83% for RITE and 25% and 75% for EMDA, respectively. CONCLUSION Delivery of intravescical hyperthermia seems to enhance the normal effect of intravescical chemotherapy instillation. Although prospective trials supported its effect on both BCG naïve and BCG failure patients, data are urgently required to validate these findings and to understand its effect on patients with carcinoma in situ. LEVEL OF PROOF 3.
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Affiliation(s)
- R Carando
- Clinica Luganese Moncucco, Lugano, Switzerland; Clinica S. Anna, Swiss Medical Group, Sorengo, Switzerland; Clinica Santa Chiara, Locarno, Switzerland; Department of Urology, Luzerner Kantonsspital, Spitalstrasse, 6000 Luzern, Switzerland.
| | - B Pradere
- Department of Urology, Centre Hospitalier Universitaire Tours, Tours, France; Department of Urology, Vienna General Hospital, Medical University of Vienna, Vienna, Austria
| | - L Afferi
- Department of Urology, Luzerner Kantonsspital, Spitalstrasse, 6000 Luzern, Switzerland
| | - G Marra
- Division of Urology, Department of Surgical Sciences, University of Studies of Torino, Turin, Italy
| | - A Aziz
- Department of Urology, University Medical Center Rostock, Rostock, Germany
| | - F Roghmann
- Department of Urology, Marien Hospital Herne, Ruhr-University Bochum, Herne, Germany
| | - W Krajewski
- Department of Urology and Oncologic Urology, Wrocław Medical University, Wroclaw, Poland
| | - C Di Bona
- Department of Urology, Luzerner Kantonsspital, Spitalstrasse, 6000 Luzern, Switzerland
| | - M Alvarez-Maestro
- Instituto de Investigación Hospital Universitario La Paz (IdiPAZ), Madrid, Spain
| | - V Pagliarulo
- Department of Urology, University "Aldo Moro", Bari, Italy
| | - E Xylinas
- Department of Urology Bichat Hospital, Paris Descartes University, Paris, France
| | - M Moschini
- Department of Urology, Luzerner Kantonsspital, Spitalstrasse, 6000 Luzern, Switzerland
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35
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Aziz A, Md Daud MK. Primary middle ear tuberculosis mimicking cholesteatoma. Malays Fam Physician 2020; 15:44-46. [PMID: 32284804 PMCID: PMC7136677] [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] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Tuberculous granuloma in the middle ear is an unusual entity. Herein, we report a case with short presentation of otitis media with mastoid abscess but with a CT scan showing widespread bone destruction. The cause was determined to be middle ear tuberculosis. Awareness of this entity is important, as it may cause a delay in referral to an otorhinolaryngology specialist and, subsequently, a delay in initiating treatment. Therefore, it should be considered in the differential diagnosis, especially when the usual treatment fails to produce the desired result.
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Affiliation(s)
- A Aziz
- Department of Otorhinolaryngology School of Medical Sciences Universiti Sains Malaysia Malaysia
| | - M K Md Daud
- Department of Otorhinolaryngology School of Medical Sciences Universiti Sains Malaysia Malaysia
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36
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Kaldas FM, Korayem IM, Russell TA, Agopian VG, Aziz A, DiNorcia J, Farmer DG, Yersiz H, Hiatt JR, Busuttil RW. Assessment of Anastomotic Biliary Complications in Adult Patients Undergoing High-Acuity Liver Transplant. JAMA Surg 2020; 154:431-439. [PMID: 30758485 DOI: 10.1001/jamasurg.2018.5527] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Importance Anastomotic biliary complications (ABCs) constitute the most common technical complications in liver transplant (LT). Given the ever-increasing acuity of LT, identification of factors contributing to ABCs is essential to minimize morbidity and optimize outcomes. A detailed analysis in a patient population undergoing high-acuity LT is lacking. Objective To evaluate the rate of, risk factors for, and outcomes of ABCs and acuity level in LT recipients. Design, Setting, and Participants This retrospective cohort study included adult LT recipients from January 1, 2013, through June 30, 2016, at a single large urban transplant center. Patients were followed up for at least 12 months after LT until June 30, 2017. Of 520 consecutive adult patients undergoing LT, 509 LTs in 503 patients were included. Data were analyzed from May 1 through September 13, 2017. Exposure Liver transplant. Main Outcomes and Measures Any complications occurring at the level of the biliary reconstruction. Results Among the 503 transplant recipients undergoing 509 LTs included in the analysis (62.3% male; median age, 58 years [interquartile range {IQR}, 50-63 years), median follow-up was 24 months (IQR, 16-34 months). Overall patient and graft survival at 1 year were 91.1% and 90.3%, respectively. The median Model for End-stage Liver Disease (MELD) score was 35 (IQR, 15-40) for the entire cohort. T tubes were used in 199 LTs (39.1%) during initial bile duct reconstruction. Overall incidence of ABCs included 103 LTs (20.2%). Anastomotic leak occurred in 25 LTs (4.9%) and stricture, 77 (15.1%). Exit-site leak in T tubes occurred in 36 (7.1%) and T tube obstruction in 16 (3.1%). Seventeen patients with ABCs required surgical revision of bile duct reconstruction. Multivariate analysis revealed the following 7 independent risk factors for ABCs: recipient hepatic artery thrombosis (odds ratio [OR], 12.41; 95% CI, 2.37-64.87; P = .003), second LT (OR, 4.05; 95% CI, 1.13-14.50; P = .03), recipient hepatic artery stenosis (OR, 3.81; 95% CI, 1.30-11.17; P = .02), donor hypertension (OR, 2.79; 95% CI, 1.27-6.11; P = .01), recipients with hepatocellular carcinoma (OR, 2.66; 95% CI, 1.23-5.74; P = .01), donor death due to anoxia (OR, 2.61; 95% CI, 1.13-6.03; P = .03), and use of nonabsorbable suture material for biliary reconstruction (OR, 2.45; 95% CI, 1.09-5.54; P = .03). Conclusions and Relevance This large, single-center series identified physiologic and anatomical independent risk factors contributing to ABCs after high-acuity LT. Careful consideration of these factors could guide perioperative management and mitigate potentially preventable ABCs.
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Affiliation(s)
- Fady M Kaldas
- Dumont-UCLA (University of California, Los Angeles) Transplant and Liver Cancer Center, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine, UCLA
| | - Islam M Korayem
- Dumont-UCLA (University of California, Los Angeles) Transplant and Liver Cancer Center, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine, UCLA.,Hepato-Pancreato-Biliary Surgery Unit, Department of Surgery, Faculty of Medicine, University of Alexandria, Alexandria, Egypt
| | - Tara A Russell
- Dumont-UCLA (University of California, Los Angeles) Transplant and Liver Cancer Center, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine, UCLA
| | - Vatche G Agopian
- Dumont-UCLA (University of California, Los Angeles) Transplant and Liver Cancer Center, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine, UCLA
| | - Antony Aziz
- Dumont-UCLA (University of California, Los Angeles) Transplant and Liver Cancer Center, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine, UCLA
| | - Joseph DiNorcia
- Dumont-UCLA (University of California, Los Angeles) Transplant and Liver Cancer Center, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine, UCLA
| | - Douglas G Farmer
- Dumont-UCLA (University of California, Los Angeles) Transplant and Liver Cancer Center, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine, UCLA
| | - Hasan Yersiz
- Dumont-UCLA (University of California, Los Angeles) Transplant and Liver Cancer Center, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine, UCLA
| | - Jonathan R Hiatt
- Dumont-UCLA (University of California, Los Angeles) Transplant and Liver Cancer Center, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine, UCLA
| | - Ronald W Busuttil
- Dumont-UCLA (University of California, Los Angeles) Transplant and Liver Cancer Center, Division of Liver and Pancreas Transplantation, Department of Surgery, David Geffen School of Medicine, UCLA
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El Mokadem M, Abd El Hady Y, Aziz A. P2643Antiproteinuric efficacy of ACE inhibitors, selective MRAs and ACE inhibitor/selective MRA combination therapy in diabetic hypertensives with microalbuminuria. Eur Heart J 2019; 40. [DOI: 10.1093/eurheartj/ehz748.0964] [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: 09/02/2023] Open
Abstract
Abstract
Background
There is increasing evidence suggesting use of Mineralocorticoid Receptor Antagonists (MRA) in combination with Angiotensin Converting Enzyme Inhibitors (ACEI) or Angiotensin Receptor Blockers (ARB) to have a protective effect on chronic kidney disease patients.
Purpose
The aim of our study was to compare the antiproteinuric efficacy of ACEI monotherapy, Selective MRA monotherapy and their combination in mildly hypertensive patients with type 2 diabetes mellitus (DM) and microalbuminuria.
Methods
Seventy five patients with established diagnosis of type 2 DM, mild hypertension (systolic BP 140–159 mmHg and/or diastolic BP 90–99 mmHg) and microalbuminuria (30–299mg/g) were randomly assigned to one of three groups of therapy; ramipril 10 mg monotherapy (25 patients), eplerenone 50 mg monotherapy (25 patients) and eplerenone/ramipril 50/10 mg combination therapy (25 patients).The duration of the study was 24 weeks. All patients had measurement of blood pressure, urinary albumin/creatinine ratio, renal function tests and serum K level at baseline and at the end of the study after 24 weeks. All patients were followed up monthly till the end of the study for detection of side effects and/or treatment failure.
Results
Both ramipril and eplerenone monotherapy significantly reduced microalbuminuria after 24 weeks nearly to the same extent (37% and 38% respectively) without significant difference between both groups (P=0.95). There was more significant reduction of microalbuminuria in the eplerenone/ramipril combination group (60%) compared with ramipril and eplerenone monotherapy groups (P=0.0001).All groups showed significant reduction of both systolic and diastolic BP with more significant reduction of systolic BP in combination group compared with monotherapy groups (P<0.0001).There was insignificant elevation of serum potassium level among the three groups with slightly higher non significant incidence of sustained hyperkalemia in combination group (P=0.5). All groups showed insignificant changes in serum creatinine and estimated glomerular filtration rate.
Conclusion
Addition of eplerenone (selective MRA) to an ACE inhibitor may confer further antiproteinuric benefit with low risk of hyperkalemia compared with MRA or ACEI monotherapy.
Acknowledgement/Funding
None
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Affiliation(s)
- M El Mokadem
- Beni-Suef University hospital- faculty of medicine, cardiology, Beni-Suef, Egypt
| | - Y Abd El Hady
- Beni-Suef University hospital- faculty of medicine, cardiology, Beni-Suef, Egypt
| | - A Aziz
- Sohag general hospital, Cardiology, Sohag, Egypt
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Elmekkawi A, Maulidi H, Mak W, Aziz A, Lee KS. Outcomes of upper extremity versus lower extremity placed peripherally inserted central catheters in a medical-surgical neonatal intensive care unit1. J Neonatal Perinatal Med 2019; 12:57-63. [PMID: 30149479 DOI: 10.3233/npm-1817] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [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
OBJECTIVE To compare outcomes of peripherally inserted central catheters (PICCs) placed in the upper extremity (UE) versus the lower extremity (LE) in a quaternary medical-surgical neonatal intensive care unit (NICU). RESULTS We analyzed a total of 365 PICCs of which 250 (68%) were removed for end of therapy and 115 (32%) were removed due to complications. Patients who had UE insertions compared to LE insertions were of lower gestational age (median (IQR)), 30 (26, 35) vs. 32 (27, 37) weeks respectively (p = 0.014). UE PICCs were more likely to be removed due to complications compared to LE PICCs (39.9% vs. 26.4%, RR 1.51, 95% CI 1.12 -2.03, p = 0.007). UE PICCs were more likely than LE PICCs to be removed for the complications of malposition, dislodgement, and pleural or pericardial effusions; while LE PICCs were more likely to be removed for phlebitis. There were no differences in the rates of sepsis at 13.0% vs. 12.8% for UE vs. LE respectively, or causal organisms for sepsis. Survival analysis demonstrated that LE PICCs had a longer time to removal for a complication (p = 0.031). CONCLUSIONS LE compared with UE PICCs were not associated with worse outcomes in a medical-surgical neonatal population that included a significant proportion of full-term neonates, and provide a valuable alternate site for central venous access. Increased awareness of the types of complications for UE compared with LE PICCs may help focus preventive and surveillance efforts based on PICC location, to improve safety and minimize the complications of NICU PICCs.
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Affiliation(s)
- A Elmekkawi
- Hospital for Sick Children, Toronto, ON, Canada.,Department of Paediatrics, Queen's University, Kingston, ON, Canada
| | - H Maulidi
- Hospital for Sick Children, Toronto, ON, Canada
| | - W Mak
- Hospital for Sick Children, Toronto, ON, Canada
| | - A Aziz
- Hospital for Sick Children, Toronto, ON, Canada
| | - K-S Lee
- Hospital for Sick Children, Toronto, ON, Canada.,Department of Pediatrics, University of Toronto, Toronto, ON, Canada
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Affiliation(s)
- G. Zaman
- Department of Animal Genetics and Breeding, College of Veterinary Science, Assam Agricultural University, Khanapara, Guwahati-781022, India
| | - R.N. Goswami
- Department of Animal Genetics and Breeding, College of Veterinary Science, Assam Agricultural University, Khanapara, Guwahati-781022, India
| | - A. Aziz
- Department of Animal Genetics and Breeding, College of Veterinary Science, Assam Agricultural University, Khanapara, Guwahati-781022, India
| | - N. Nahardeka
- Department of Animal Genetics and Breeding, College of Veterinary Science, Assam Agricultural University, Khanapara, Guwahati-781022, India
| | - T.C. Roy
- Department of Animal Genetics and Breeding, College of Veterinary Science, Assam Agricultural University, Khanapara, Guwahati-781022, India
| | - J.D. Mahanta
- Department of Animal Genetics and Breeding, College of Veterinary Science, Assam Agricultural University, Khanapara, Guwahati-781022, India
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Wang E, Aziz A, Danner M, Yung T, Ayoob M, Lei S, Rashid A, Dritschilo A, Lischalk J, Collins B, Lynch J, Suy S, Aghdam N, Collins S. Patterns of Recurrence Following Stereotactic Body Radiation Therapy for Localized Prostate Cancer. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1782] [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: 10/26/2022]
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41
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Sarma L, Nahardeka N, Goswami RN, Aziz A, Zaman G, Das A, Akhtar F. Non-genetic factors affecting pre-weaning growth and morphometric traits in Assam Hill goat. Vet World 2019; 12:1327-1331. [PMID: 31641315 PMCID: PMC6755395 DOI: 10.14202/vetworld.2019.1327-1331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 07/09/2019] [Indexed: 11/20/2022] Open
Abstract
Aim: This study aimed to determine the genetic and non-genetic factors affecting pre-weaning body weight (BW) and morphometry in Assam Hill goat along with the genetic parameters. Materials and Methods: The detailed information in respect of BW and body measurements of 960 animals at birth and 3 months of age belonging to three different populations of Assam Hill goat maintained at field units, namely, Batabari, Nahira, and Tetelia under “All India Coordinated Research Project on Goat Improvement” were utilized in the present study. The data were analyzed using least squares technique. Results: The least squares means for BW, height at withers (HW), heart girth (HG), and body length (BL) were 1.166±0.008 kg, 26.198±0.070 cm, 26.695±0.096 cm, and 29.482±0.119 cm at birth and 4.590±0.083 kg, 36.850±0.105 cm, 40.741±0.115 cm, and 39.703±0.108 cm at 3 months of age, respectively. Location had a significant effect on BW, HW, and BL at both birth and 3 months and on HG at 3 months of age. Season of birth exerted significant effect only on BL at birth, whereas the significant effect of sex was observed on HG and BL at 3 months of age. The heritability estimates for BW and body measurements were moderate indicating the scope of selection. The phenotypic and genetic correlations among BWs and body measurements at birth and 3 months of age were positive in direction and high in magnitude. Conclusion: On the basis of the present findings, it could be concluded that the weaning weight of kids can be considered for the selection of parent stock to increase productivity and eventually the economic efficiency. Further, animals with higher body measurements at initial phases of growth will perform better with respect to even BW at later stages of growth.
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Affiliation(s)
- L Sarma
- Department of Animal Genetics and Breeding, College of Veterinary Sciences, Assam Agricultural University, Guwahati, Assam, India
| | - N Nahardeka
- Goat Research Station, Assam Agricultural University, Burnihat -793101, Assam, India
| | - R N Goswami
- Department of Animal Genetics and Breeding, College of Veterinary Sciences, Assam Agricultural University, Guwahati, Assam, India
| | - A Aziz
- Department of Animal Genetics and Breeding, College of Veterinary Sciences, Assam Agricultural University, Guwahati, Assam, India
| | - G Zaman
- Department of Animal Genetics and Breeding, College of Veterinary Sciences, Assam Agricultural University, Guwahati, Assam, India
| | - A Das
- Department of Animal Genetics and Breeding, College of Veterinary Sciences, Assam Agricultural University, Guwahati, Assam, India
| | - F Akhtar
- Goat Research Station, Assam Agricultural University, Burnihat -793101, Assam, India
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Nakamura K, Kageyama S, Ito T, Hirao H, Kadono K, Aziz A, Dery KJ, Everly MJ, Taura K, Uemoto S, Farmer DG, Kaldas FM, Busuttil RW, Kupiec-Weglinski JW. Antibiotic pretreatment alleviates liver transplant damage in mice and humans. J Clin Invest 2019; 129:3420-3434. [PMID: 31329160 DOI: 10.1172/jci127550] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [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: 01/19/2019] [Accepted: 05/21/2019] [Indexed: 12/13/2022] Open
Abstract
Although modifications of gut microbiota with antibiotics (Abx) influence mouse skin and cardiac allografts, its role in orthotopic liver transplantation (OLT) remains unknown. We aimed to determine whether and how recipient Abx pretreatment may affect hepatic ischemia-reperfusion injury (IRI) and OLT outcomes. Mice (C57BL/6) with or without Abx treatment (10 days) were transplanted with allogeneic (BALB/c) cold-stored (18 hours) livers, followed by liver and blood sampling (6 hours). We divided 264 human OLT recipients on the basis of duration of pre-OLT Abx treatment into control (Abx-free/Abx <10 days; n = 108) and Abx treatment (Abx ≥10days; n = 156) groups; OLT biopsy (Bx) samples were collected 2 hours after OLT (n = 52). Abx in mice mitigated IRI-stressed OLT (IRI-OLT), decreased CCAAT/enhancer-binding protein homologous protein (CHOP) (endoplasmic reticulum [ER] stress), enhanced LC3B (autophagy), and inhibited inflammation, whereas it increased serum prostaglandin E2 (PGE2) and hepatic PGE2 receptor 4 (EP4) expression. PGE2 increased EP4, suppressed CHOP, and induced autophagosome formation in hepatocyte cultures in an EP4-dependent manner. An EP4 antagonist restored CHOP, suppressed LC3B, and recreated IRI-OLT. Remarkably, human recipients of Abx treatment plus OLT (Abx-OLT), despite severe pretransplantation clinical acuity, had higher EP4 and LC3B levels but lower CHOP levels, which coincided with improved hepatocellular function (serum aspartate aminotransferase/serum aspartate aminotransferase [sALT/sAST]) and a decreased incidence of early allograft dysfunction (EAD). Multivariate analysis identified "Abx-free/Abx <10 days" as a predictive factor of EAD. This study documents the benefits of Abx pretreatment in liver transplant recipients, identifies ER stress and autophagy regulation by the PGE2/EP4 axis as a homeostatic underpinning, and points to the microbiome as a therapeutic target in OLT.
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Affiliation(s)
- Kojiro Nakamura
- Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Shoichi Kageyama
- Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Takahiro Ito
- Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Hirofumi Hirao
- Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Kentaro Kadono
- Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Antony Aziz
- Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Kenneth J Dery
- Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | | | - Kojiro Taura
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinji Uemoto
- Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Douglas G Farmer
- Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Fady M Kaldas
- Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Ronald W Busuttil
- Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Jerzy W Kupiec-Weglinski
- Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, California, USA
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Kadono K, Dery KJ, Hirao H, Ito T, Kageyama S, Nakamura K, Oncel D, Aziz A, Kaldas FM, Busuttil RW, Kupiec-Weglinski JW. Heme Oxygenase-1 dictates innate - adaptive immune phenotype in human liver transplantation. Arch Biochem Biophys 2019; 671:162-166. [PMID: 31299184 DOI: 10.1016/j.abb.2019.07.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 07/03/2019] [Accepted: 07/08/2019] [Indexed: 12/19/2022]
Abstract
Liver transplantation (LT) has become the standard of care for patients with end-stage liver disease and those with hepatic malignancies, while adaptive immune-dominated graft rejection remains a major challenge. Despite potent anti-inflammatory and cytoprotective functions of heme oxygenase-1 (HO-1) overexpression upon innate immune-driven hepatic ischemia reperfusion injury, its role in adaptive immune cell-driven responses remains to be elucidated. We analyzed human biopsies from LT recipients (n = 55) to determine putative association between HO-1 levels and adaptive/co-stimulatory gene expression programs in LT. HO-1 expression negatively correlated with innate (CD68, Cathepsin G, TLR4, CXCL10), adaptive (CD4, CD8, IL17) and co-stimulatory (CD28, CD80, CD86) molecules at the graft site. LT recipients with high HO-1 expression showed a trend towards improved overall survival. By demonstrating the association between graft HO-1 levels and adaptive/co-stimulatory gene programs, our study provides important insights to the role of HO-1 signaling in LT patients.
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Affiliation(s)
- Kentaro Kadono
- The Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Kenneth J Dery
- The Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Hirofumi Hirao
- The Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Takahiro Ito
- The Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Shoichi Kageyama
- The Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Kojiro Nakamura
- The Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Damla Oncel
- The Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Antony Aziz
- The Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Fady M Kaldas
- The Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Ronald W Busuttil
- The Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA
| | - Jerzy W Kupiec-Weglinski
- The Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at UCLA, Los Angeles, CA 90095, USA.
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Chen G, Aziz A, Botchkarev V, Muegge K, Sharov A. 350 Chromatin remodelling ATFase Lsh maintains DNA methylation at constitutive heterochromatin and prevents activation of silent transposable elements in epidermal keratinocytes. J Invest Dermatol 2019. [DOI: 10.1016/j.jid.2019.03.426] [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: 10/27/2022]
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Denis D, Hugo J, Beylerian M, Ramtohul P, Aziz A, Matonti F, Lebranchu P. [Congenital abnormalities of the optic disc]. J Fr Ophtalmol 2019; 42:778-789. [PMID: 30935696 DOI: 10.1016/j.jfo.2018.09.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [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: 07/16/2018] [Revised: 09/03/2018] [Accepted: 09/10/2018] [Indexed: 10/27/2022]
Abstract
Congenital abnormalities of the optic disc are not uncommon in clinical practice and should be recognized. Size abnormalities of the optic disc include optic disc aplasia, hypoplasia, megalopapilla, and optic disc cupping in prematurity. Among congenital excavations of the optic disc head, morning glory disc anomaly and optic disc pit can be complicated by serous retinal detachment; the papillorenal disc is an association of bilateral optic disc cupping and renal hypoplasia which should be ruled out; optic disc coloboma is caused by an abnormal closure of the embryonic fissure and can be complicated by choroidal neovascularization and retinal detachment. Other abnormalities that will be discussed are congenital tilted disc syndrome, duplicity of the optic disc head, congenital pigmentation of the optic disc head and myelinated retinal nerve fibers. All of these abnormalities can be associated with syndromes and neurological diseases, as well as other potentially blinding ophthalmological defects which can be secondarily complicated by amblyopia, strabismus and nystagmus. Thus, they should be recognized in order to plan for appropriate follow-up.
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Affiliation(s)
- D Denis
- Service d'ophtalmologie, hôpital Nord, centre hospitalier universitaire de l'hôpital Nord, chemin des Bourrely, 13015 Marseille, France.
| | - J Hugo
- Service d'ophtalmologie, hôpital Nord, centre hospitalier universitaire de l'hôpital Nord, chemin des Bourrely, 13015 Marseille, France
| | - M Beylerian
- Service d'ophtalmologie, hôpital Nord, centre hospitalier universitaire de l'hôpital Nord, chemin des Bourrely, 13015 Marseille, France
| | - P Ramtohul
- Service d'ophtalmologie, hôpital Nord, centre hospitalier universitaire de l'hôpital Nord, chemin des Bourrely, 13015 Marseille, France
| | - A Aziz
- Service d'ophtalmologie, hôpital Nord, centre hospitalier universitaire de l'hôpital Nord, chemin des Bourrely, 13015 Marseille, France
| | - F Matonti
- Service d'ophtalmologie, hôpital Nord, centre hospitalier universitaire de l'hôpital Nord, chemin des Bourrely, 13015 Marseille, France
| | - P Lebranchu
- Hôtel-Dieu, 1 place Alexis-Ricordeau, 44000 Nantes, France
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Affiliation(s)
- Antony Aziz
- Gastroenterology, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
| | - Rebecca Reynolds
- Gastroenterology, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
| | - Claire Bull
- Gastroenterology, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
| | - Karen Street
- Gastroenterology, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
| | - Branita Mills
- Gastroenterology, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
| | | | - Jeremy Hyde
- Patient Representative Lead, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
| | - Azhar Ansari
- Gastroenterology, Surrey and Sussex Healthcare NHS Trust, Redhill, UK
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Aziz A, Reynolds R, Ansari A. PROCESS AND SYSTEMS: A population-based model of care for people with inflammatory bowel disease - patient-reported outcomes. Future Healthc J 2019; 6:30-35. [PMID: 31098583 PMCID: PMC6520085 DOI: 10.7861/futurehosp.6-1-30] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
The NHS was not designed to provide ongoing support for people with long-term conditions. Conventional outpatient care relies on a diary-based appointment system, with regular follow-up offered to patients with a chronic disorder, not always tailored to clinical need. In contrast, at East Surrey Hospital, open access to the inflammatory bowel disease (IBD) service through telephone, email and a web-based portal known as Patients Know Best is offered to all people with IBD, putting them at the centre of the care pathway. This guides and directs those with the greatest clinical need to the clinician with the most appropriate clinical expertise to provide high quality consistent care. Over a 3 month period in 2015, the service avoided 20 hospital admissions, 34 emergency department attendances and 110 outpatient appointments. There is a demonstrable improvement in perception of IBD control and in the patient activation measure, with 66% of those who have used the open access service demonstrating medium to high levels of activation, compared with 11% in those new to the service.
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Kageyama S, Hirao H, Nakamura K, Ke B, Zhang M, Ito T, Aziz A, Oncel D, Kaldas FM, Busuttil RW, Sosa RA, Reed EF, Araujo JA, Kupiec-Weglinski JW. Recipient HO-1 inducibility is essential for posttransplant hepatic HO-1 expression and graft protection: From bench-to-bedside. Am J Transplant 2019; 19:356-367. [PMID: 30059195 PMCID: PMC6349504 DOI: 10.1111/ajt.15043] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [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: 04/20/2018] [Revised: 07/10/2018] [Accepted: 07/18/2018] [Indexed: 01/25/2023]
Abstract
By documenting potent antioxidative and anti-inflammatory functions, preclinical studies encourage heme oxygenase-1 (HO-1)-inducing regimens in clinical orthotopic liver transplantation (OLT). We aimed to determine the importance of recipient-derived HO-1 in murine and human OLTs. Hepatic biopsies from 51 OLT patients were screened for HO-1 expression (Western blots) prior to put-in (basal) and post reperfusion (stressed) and correlated with the hepatocellular function. In parallel, livers from HO-1 proficient mice (WT; C57/BL6), subjected to ex vivo cold storage (18 hour), were transplanted to syngeneic myeloid HO-1 deficient (mHO-1 KO) or FLOX (control) hosts, and sampled postreperfusion (6 hour). In human OLT, posttransplant but not pretransplant HO-1 expression correlated negatively with ALT levels (P = .0178). High posttransplant but not pretransplant HO-1 expression trended with improved OLT survival. Compared with controls, livers transplanted into mHO-1 KO recipient mice had decreased HO-1 levels, exacerbated hepatic damage/frequency of TUNEL+ cells, increased mRNA levels coding for TNFα/CXCL1/CXCL2/CXCL10, higher frequency of Ly6G+/4HN+ neutrophils; and enhanced MPO activity. Peritoneal neutrophils from mHO-1 KO mice exhibited higher CellRox+ ratio and increased TNFα/CXCL1/CXCL2/CXCL10 expression. By demonstrating the importance of posttransplant recipient HO-1 phenotype in hepatic macrophage/neutrophil regulation and function, this translational study identifies recipient HO-1 inducibility as a novel biomarker of ischemic stress resistance in OLT.
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Affiliation(s)
- Shoichi Kageyama
- The Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at University of California, Los Angeles, CA 90095
| | - Hirofumi Hirao
- The Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at University of California, Los Angeles, CA 90095
| | - Kojiro Nakamura
- The Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at University of California, Los Angeles, CA 90095
| | - Bibo Ke
- The Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at University of California, Los Angeles, CA 90095
| | - Min Zhang
- Department of Medicine, Division of Cardiology, David Geffen School of Medicine at University of California, Los Angeles, CA 90095
| | - Takahiro Ito
- The Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at University of California, Los Angeles, CA 90095
| | - Antony Aziz
- The Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at University of California, Los Angeles, CA 90095
| | - Damla Oncel
- The Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at University of California, Los Angeles, CA 90095
| | - Fady M. Kaldas
- The Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at University of California, Los Angeles, CA 90095
| | - Ronald W. Busuttil
- The Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at University of California, Los Angeles, CA 90095
| | - Rebecca A. Sosa
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA 90095
| | - Elaine F. Reed
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA 90095
| | - Jesus A. Araujo
- Department of Medicine, Division of Cardiology, David Geffen School of Medicine at University of California, Los Angeles, CA 90095
| | - Jerzy W. Kupiec-Weglinski
- The Dumont-UCLA Transplantation Center, Department of Surgery, Division of Liver and Pancreas Transplantation, David Geffen School of Medicine at University of California, Los Angeles, CA 90095
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Aziz A, Agamuthu P, Fauziah SH. Effective removal of p-tert-Butylphenol and Pyridine, 3-(1-methyl-2-pyrrolidinyl)-, (S)- from landfill leachate using locust bean gum. Waste Manag Res 2018; 36:1146-1156. [PMID: 30067147 DOI: 10.1177/0734242x18789062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
The widespread distribution of persistent organic pollutants (POPs) in landfill leachate is problematic due to their acute toxicity, carcinogenicity and genotoxicity effects, which could be detrimental to public health and ecological systems. The objective of this study was to evaluate the effective removal of POPs - namely, p-tert-Butylphenol and Pyridine, 3-(1-methyl-2-pyrrolidinyl)-, (S)- - from landfill leachate using locust bean gum (LBG), and in comparison with commonly used alum. The response surface methodology coupled with a Box-Behnken design was employed to optimize the operating factors for optimal POPs removal. A quadratic polynomial model was fitted into the data with the R2 values of 0.97 and 0.96 for the removal of p-tert-Butylphenol and Pyridine, 3-(1-methyl-2-pyrrolidinyl), (S)-, respectively. The physicochemical characteristics of the flocs produced by LBG and alum were evaluated with Fourier Transform Infrared (FTIR) spectroscopy and Scanning Electron Microscopy (SEM). The infrared spectra of LBG-treated floc were identical with LBG powder, but there was some variation in the peaks of the functional groups, signifying the chemical interactions between flocculants and pollutant particles resulting from POPs removal. The results showed that p-tert-Butylphenol and Pyridine, 3-(1-methyl-2-pyrrolidinyl)-, (S)- obtained 96% and 100% removal using 500 mg/L of LBG at pH 4. pH have a significant effect on POPs removal in leachate. It is estimated that treating one million gallons of leachate using alum (at 1 g/L dosage) would cost US$39, and using LBG (at 500 mg/L dosage) would cost US$2. LBG is eco-friendly, biodegradable and non-toxic and, hence, strongly recommended as an alternative to inorganic coagulants for the treatment of POPs in landfill leachate.
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Affiliation(s)
- A Aziz
- 1 Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
- 2 Faculty of Marine Sciences, Lasbela University of Agriculture, Water and Marine Sciences, Uthal, Pakistan
- 3 Center for Research in Waste Management, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
| | - P Agamuthu
- 1 Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
- 3 Center for Research in Waste Management, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
| | - S H Fauziah
- 1 Institute of Biological Sciences, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
- 3 Center for Research in Waste Management, Faculty of Science, University of Malaya, Kuala Lumpur, Malaysia
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Yanny B, Saab S, Durazo F, Latt N, Mitry A, Mikhail MM, Hanna RM, Aziz A, Sahota A. Eight-Week Hepatitis C Treatment with New Direct Acting Antivirals Has a Better Safety Profile While Being Effective in the Treatment-Naïve Geriatric Population Without Liver Cirrhosis and Hepatitis C Virus-RNA < 6 Million IU/mL. Dig Dis Sci 2018; 63:3480-3486. [PMID: 30259281 DOI: 10.1007/s10620-018-5283-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 03/02/2018] [Accepted: 09/11/2018] [Indexed: 01/19/2023]
Abstract
AIM Results of recent studies have confirmed the efficacy of an 8-week course of ledipasvir/sofosbuvir (LDV/SOF) in patients who are non-cirrhotics, native to treatment, are infected with hepatitis C (HCV) genotype 1, and have HCV viral load < 6 million IU/mL. However, there are limited data on a shortened treatment course in patients who are over the age of 65. METHODS A retrospective study was performed to examine the safety, tolerability, and sustained viral response rates (SVR) of the 8-week LDV/SOF therapy compared to the 12-week LDV/SOF therapy among non-cirrhotic, treatment-naïve, genotype 1 HCV patients with viral load < 6 million IU/mL who are 65 years of age or older. RESULTS A total of 454 patients were identified of which 182 non-cirrhotic, genotype 1 HCV-RNA < 6 million IU/mL patients received the 8-week LDV/SOF treatment and 272 received the 12-week LDV/SOF treatment. Mean [± standard deviation (SD)] aspartate aminotransferase to platelet ratio index score for the entire cohort was 0.45 ± 0.03. The mean (± SD) age for the 8-week treatment was 69.7 (± 7) years, 54.7% male and 45.3% female. The mean (± SD) age of the 12-week treatment was 71.7 (± 3) years, 56.4% male and 43.6% female. Overall, SVR-12 for the 8-week regimen was 93% and SVR-12 for the 12-week regimen was 95%. For the 182 treated with the 8-week LDV/SOF treatment, there were no serious adverse events requiring hospitalization or signs of liver failure requiring transplantation. Overall, the 8-week treatment patient cohort experienced less fatigue, headache, dry mouth, and diarrhea. This finding was statistically significant with a P value < 0.001. CONCLUSION Eight-week LDV/SOF therapy in treatment-naive, non-cirrhotic, genotype 1 HCV patients with RNA < 6 million IU/mL was found safe, better tolerated, effective, and required less upfront cost when compared with the 12-week LDV/SOF treatment regimen in properly selected geriatric population.
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Affiliation(s)
- Beshoy Yanny
- Department of Medicine, University of California Los Angeles, 200 Medical Plaza, Suite 214, Los Angeles, CA, 90095, USA. .,Department of Surgery, University of California Los Angeles, Los Angeles, CA, USA.
| | - Sammy Saab
- Department of Medicine, University of California Los Angeles, 200 Medical Plaza, Suite 214, Los Angeles, CA, 90095, USA.,Department of Surgery, University of California Los Angeles, Los Angeles, CA, USA
| | - Francisco Durazo
- Department of Medicine, University of California Los Angeles, 200 Medical Plaza, Suite 214, Los Angeles, CA, 90095, USA.,Department of Surgery, University of California Los Angeles, Los Angeles, CA, USA
| | - Nyan Latt
- Ochsner Clinic Foundation, Jefferson, USA
| | | | - Mira Moris Mikhail
- Department of Nephrology, University of California Los Angeles, Los Angeles, CA, USA.,Biological Science, Biola University, La Mirada, USA
| | - Ramy M Hanna
- Department of Medicine, University of California Los Angeles, 200 Medical Plaza, Suite 214, Los Angeles, CA, 90095, USA.,Department of Nephrology, University of California Los Angeles, Los Angeles, CA, USA.,Biological Science, Biola University, La Mirada, USA
| | - Antony Aziz
- Department of Medicine, University of California Los Angeles, 200 Medical Plaza, Suite 214, Los Angeles, CA, 90095, USA.,Department of Surgery, University of California Los Angeles, Los Angeles, CA, USA
| | - Amandeep Sahota
- Department of Medicine, Kaiser Permanente Los Angeles Medical Center, Los Angeles, USA.,Department of Gastroenterology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, USA.,Department of Transplant Hepatology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, USA
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