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Zahoor M, Naz S, Amin S, Iftikhar M, Nazir N, Kamran AW, Khan FA. Green Synthesis of Zinc Oxide Nanoparticles Using Monotheca buxifolia Leaf Extract; Their Biological Activities and Use in Fabrication of Nano-Biosensor. Surf Engin Appl Electrochem 2022. [DOI: 10.3103/s106837552205012x] [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: 11/05/2022]
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2
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Rehman G, Khattak I, Hamayun M, Rahman A, Haseeb M, Umar M, Ali S, Iftikhar M, Shams WA, Pervaiz R. Impacts of mining on local fauna of wildlife in District Mardan & District Mohmand Khyber Pakhtunkhwa Pakistan. BRAZ J BIOL 2021; 84:e251733. [PMID: 34932632 DOI: 10.1590/1519-6984.251733] [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: 05/01/2021] [Accepted: 08/30/2021] [Indexed: 11/22/2022] Open
Abstract
Mining is vital for human sustenance and a crucial sector in the state economy. However, its impacts on the environment and biodiversity cannot be underestimated. Which are potent to the attract government's attention. Environment and wildlife are subject to the harmful impacts of mining and its related activities. In this study, districts, namely Mardan and Mohmand have been targeted with respect to mining impacts. The assessment was carried out on wildlife adversely affected by the mining sector. The fauna has been keenly observed to bring the calculated risks and threat perception of the regional wildlife. Total 9 species of mammals, 21 species of birds, were recorded in District Mardan. While in District Mohmand 2 species of mammals, 9 species of birds, and 4 species of reptiles were studied. The Study explored that mining primarily responsible for land degradation. Which lead to food and agriculture losses. Several other factors like blasting, pollution, hunting, deforestation, habitat loss was also observed. Deforestation surfaced one of the major causes for extinction of fauna in the said region. preemptive measures are needed to seize the man-made catastrophe.
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Affiliation(s)
- G Rehman
- Department of Zoology Abdul Wali Khan, University Mardan, KP, Pakistan
| | - I Khattak
- College of Animal Husbandry & Veterinary Sciences Abdul Wali Khan, University Mardan, KP, Pakistan
| | - M Hamayun
- Department of Botany Abdul Wali Khan, University Mardan, KP, Pakistan
| | - A Rahman
- Department of Zoology Abdul Wali Khan, University Mardan, KP, Pakistan
| | - M Haseeb
- Department of Zoology Abdul Wali Khan, University Mardan, KP, Pakistan
| | - M Umar
- Department of Zoology Abdul Wali Khan, University Mardan, KP, Pakistan
| | - S Ali
- Department of Zoology Abdul Wali Khan, University Mardan, KP, Pakistan
| | - M Iftikhar
- Department of Chemistry, University of Swabi, KP, Pakistan
| | - W A Shams
- Department of Zoology Abdul Wali Khan, University Mardan, KP, Pakistan
| | - R Pervaiz
- Department of Zoology Abdul Wali Khan, University Mardan, KP, Pakistan
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3
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Devara J, Iftikhar M, Goda A, Shaik L, Katta R, Egbe A, Connolly H. Left ventricular global longitudinal strain is superior to ejection fraction for prognostication in ebstein anomaly. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1872] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Certain factors such as left ventricular (LV) geometry and loading conditions affect the validity and reliability of LV ejection fraction (LVEF) as a true measure of LV contractility. LV global longitudinal strain (LVGLS) is less sensitive to these factors, and it has superior prognostic performance in patients with acquired heart disease. The purpose of this study was to determine the clinical implications of using LVGLS (instead of LVEF) as the measure of LV systolic function in adults with Ebstein anomaly given the inherent abnormalities of LV geometry and preload in this population.
Methods
Retrospective cohort study of 673 adults with Ebstein anomaly (2003–2018). We hypothesized that LVGLS had a stronger correlation with heart failure indices and transplant-free survival compared to LVEF.
Results
Compared to LVEF, LVGLS had stronger correlations with cardiac index (r=0.46 vs r=0.21, p=0.007), glomerular filtration rate (r=0.57 vs r=0.19, p<0.001), and NT-proBNP (r=−0.64 vs r=−0.41, p=0.01). Of 673 patients, 514 (76%) had normal LV systolic function (LVGLSNormal-LVEFNormal), 87 (13%) had subclinical LV dysfunction (LVGLSLow-LVEFNormal) and 66 (10%) had overt LV dysfunction (LVGLSLow-LVEFLow). Compared to the overt LV dysfunction group, the subclinical LV dysfunction group had similar 10-year transplant-free survival (64% vs 63%, p=0.6), but were less likely to be on heart failure therapy (12% vs 82%, p<0.001). LVGLS (but not LVEF) was the independent predictor of transplant-free survival
Conclusions
LVGLS provided more robust risk stratification and prognostication than LVEF in patients with Ebstein anomaly, and patients with low LVGLS had reduced transplant-free survival regardless of LVEF. The use of LVGLS (rather than LVEF) as the measure of LV systolic function has important clinical implications with regards to initiation of medical and surgical therapies.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- J Devara
- Mayo Clinic, Rochester, United States of America
| | - M Iftikhar
- Mayo Clinic, Rochester, United States of America
| | - A Goda
- Mayo Clinic, Rochester, United States of America
| | - L Shaik
- Mayo Clinic, Rochester, United States of America
| | - R Katta
- Mayo Clinic, Rochester, United States of America
| | - A Egbe
- Mayo Clinic, Rochester, United States of America
| | - H Connolly
- Mayo Clinic, Rochester, United States of America
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4
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Katta R, Goda A, Devara J, Iftikhar M, Shaik L, Egbe A, Connolly H. Prognostic implications of left heart diastolic dysfunction in adults with coarctation of aorta. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Left atrial dysfunction (LAD) and left ventricular diastolic dysfunction (LVDD) has been described in patients with coarctation of aorta (COA). However, it is unknown whether LA function and LV diastolic function indices can be used for prognostication in this population. The purpose of this study was to determine whether LAD and LVDD were associated with mortality in adults with COA. We hypothesized that LA and LV diastolic function indices will predict transplant-free survival in COA patients.
Methods
Retrospective study of COA patients (age ≥18) at Mayo Clinic (2000–2018). LVDD was determined using the 2016 guidelines for LVDD assessment, and LAD was assessed using LA reservoir strain.
Results
Of 721 patients, LV diastolic function could be determined in 635 (88%), while 86 (12%) were classified as indeterminate diastolic function. Of 635 patients, 414 (65%) had no LVDD, while 146 (23%), 53 (8%), and 22 (4%) had grade I/II/III LVDD respectively. The mean LA reservoir strain was −39±11%, and patients were divided into quartiles: top quartile (reference group), mild LAD, moderate LAD, and severe LAD.
Of 635 patients, 49 died and 4 underwent heart transplant. On multivariate analysis, Grade III diastolic dysfunction (but not Grade I and II) was associated with mortality as compared to normal diastolic function. On the other hand, there was an incremental risk of mortality across LA strain quartiles: mild LAD (HR 1.16, 1.04–2.06), moderate LAD (HR 1.75, 1.27–3.58), and severe LAD (HR 3.49, 1.88–7.16). Of the 86 patients with indeterminate diastolic function, LAD was associated with a lower 5-year transplant-free survival as compared to normal LA function (83% vs 91%, p=0.06).
Conclusions
LAD (but not LVDD) was associated with incremental risk of mortality, and thus can be used for prognostication in all patients including those with indeterminate diastolic function. Although the current study did not identify a consistent relationship between LVDD severity classifications and mortality among COA patients, it does not imply that LVDD is benign. Rather it suggests that the conventional criteria for LVDD severity classifications may not be generalizable to every disease subgroup
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- R Katta
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| | - A Goda
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| | - J Devara
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| | - M Iftikhar
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| | - L Shaik
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| | - A Egbe
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
| | - H Connolly
- Mayo Clinic, Cardiovascular Medicine, Rochester, United States of America
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Shaik L, Katta R, Iftikhar M, Goda A, Devara J, Egbe A, Connolly H. Persistent hypertension and left ventricular hypertrophy after repair of native coarctation of aorta in adults. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
There are limited data about outcomes after repair of native coarctation of aorta (COA) in adulthood. The purpose of this study was to describe the procedural outcomes, hemodynamic improvement, regression of LV hypertrophy and cardiovascular events in adults undergoing repair of native COA.
Methods
The primary outcomes were procedural complications, re-interventions, and hemodynamic improvement (residual COA gradient <20 mmHg) after COA repair. The secondary outcomes were improvement in the severity of hypertension, regression of left ventricular mass index (LVMI), and incidence of cardiovascular events (atrial fibrillation, heart failure hospitalization, and cardiovascular death) after COA repair. Clinical and imaging indices were assessed pre-intervention, and at 1-year (Y1) and 3-years (Y3) post-intervention.
Results
A total of 172 patients (age 38 [27–48]) underwent COA repair (surgical 161; transcatheter 11). There were no procedural deaths, and all patients had residual COA gradient <20 mmHg. One patients that received transcatheter stent therapy required re-dilation of stent at 12 months post-intervention. There as a reduction in the prevalence of patients requiring anti-hypertensive therapy from 73% (pre-intervention) to 59% and 64% at Y1 and Y3 respectively. However, 72% and 69% of the patients still had systolic blood pressure >130 mmHg (stage 1 and 2 hypertension) at Y1 and Y3 respectively. As compared to patients without hypertension at Y1, patients with stage 1 and stage 2 hypertension had less robust LVMI regression (% change in LVMI 12±5% vs 9±6% vs 5±3%, p<0.001). Hypertension (HR 1.16, 1.05–1.27) and LVMI regression (HR 0.86, 0.81–0.90) were independently associated with cardiovascular events.
Conclusions
Persistent hypertension was common after repair of native COA in adults. Hypertension (including stage 1 hypertension) was associated with suboptimal regression of LVMI and cardiovascular events. These results are concerning, and highlight the importance of early COA diagnosis and repair, and optimal medical therapy for hypertension after COA repair.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- L Shaik
- Mayo Clinic, Cardiovascular Diseases, Rochester, United States of America
| | - R Katta
- Mayo Clinic, Cardiovascular Diseases, Rochester, United States of America
| | - M Iftikhar
- Mayo Clinic, Cardiovascular Diseases, Rochester, United States of America
| | - A Goda
- Mayo Clinic, Cardiovascular Diseases, Rochester, United States of America
| | - J Devara
- Mayo Clinic, Cardiovascular Diseases, Rochester, United States of America
| | - A Egbe
- Mayo Clinic, Cardiovascular Diseases, Rochester, United States of America
| | - H Connolly
- Mayo Clinic, Cardiovascular Diseases, Rochester, United States of America
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6
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Iftikhar M, Devara J, Shaik L, Katta R, Goda A, Egbe A, Connolly H. Paradoxical increase in ambulatory systolic blood pressure in coarctation of aorta as compared to idiopathic hypertension. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
The relationship between office vs ambulatory blood pressure (BP) indices is well-studied in patients with idiopathic hypertension, and based on these data, it is known that average 24-hour ambulatory BP is typically lower than office BP. However, emerging data show that office systolic BP (SBP) underestimates arterial afterload in patients with coarctation of aorta (COA), and minimal increase in stroke volume during low intensity exercise results in exaggerated rise in SBP as compared to those with idiopathic hypertension. We hypothesized that COA patients will have higher ambulatory SBP and a higher prevalence of masked hypertension compared to patients with idiopathic hypertension.
Methods
Case-control study of 118 COA patients and 118 patients with idiopathic hypertension matched by age, sex, body mass index and office SBP.
Results
Although both groups had similar office SBP (132±17 mmHg) by design, the COA group had paradoxical increases in 24-hour ambulatory SBP (135±14 vs 126±13, p<0.001) and daytime ambulatory SBP (142±16 vs 130±13, p<0.001), and less nocturnal dipping (−3±5 vs −9±4, p<0.001). The COA group also had a higher prevalence of masked hypertension (36 [31%] vs 14 [12%], p<0.001), and worse arterial function indices.
Conclusion
These findings underscore the potential limitations of relying on office SBP for screening/monitoring of hypertension in COA and potential pitfalls in extrapolating idiopathic hypertension guidelines recommendations to the treatment of COA. It also provides rationale for further studies to determine if pharmacologic BP interventions guided by ambulatory BP data will improve clinical outcomes in the COA population.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- M Iftikhar
- Mayo Clinic, Cardiovascular Diseases, Rochester, United States of America
| | - J Devara
- Mayo Clinic, Cardiovascular Diseases, Rochester, United States of America
| | - L Shaik
- Mayo Clinic, Cardiovascular Diseases, Rochester, United States of America
| | - R Katta
- Mayo Clinic, Cardiovascular Diseases, Rochester, United States of America
| | - A Goda
- Mayo Clinic, Cardiovascular Diseases, Rochester, United States of America
| | - A Egbe
- Mayo Clinic, Cardiovascular Diseases, Rochester, United States of America
| | - H Connolly
- Mayo Clinic, Cardiovascular Diseases, Rochester, United States of America
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Snudden C, Carlqvist A, Iftikhar M, Baig F, Ali M. The role of distance-learning partnerships in building local
undergraduate and postgraduate psychiatry capacity in resource-poor
contexts. Ann Glob Health 2016. [DOI: 10.1016/j.aogh.2016.04.240] [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: 11/30/2022] Open
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Carlqvist A, Snudden C, Penfold R, Baig F, Iftikhar M, Ali M. The OxPal Medlink: the use of synchronised distance-learning platforms to
strengthen medical education and healthcare capacity in unstable
environments. Ann Glob Health 2015. [DOI: 10.1016/j.aogh.2015.02.554] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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9
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Quinn AJ, McClune S, Price JH, Iftikhar M, O'connor R, Heasley RN, Moore J. A comparison of two epidural analgesic techniques with respect to the outcome of labour. J OBSTET GYNAECOL 2009. [DOI: 10.3109/01443619309151817] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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10
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Sajid M, Iftikhar M, Rimpel J, Baig M, Woods W. Perforated caecal volvulus: an unusual complication after anterior resection for colorectal carcinoma. Acta Chir Belg 2008; 108:460-1. [PMID: 18807604 DOI: 10.1080/00015458.2008.11680264] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
AIM To discuss an unusual and rare complication of perforated caecal volvulus (CV) following open anterior resection. METHODS A retrospective review of the case notes of a patient. RESULTS CV is a well known but rare cause of bowel obstruction. Chronic constipation, distal colonic obstruction and post-operative ileus are potentially aggravating factors for the development of CV in anatomically susceptible patients. The anatomical susceptibility for CV was noticed during the first operation but prophylactic caecopexy was not performed due to lack of evidence in the literature. This patient developed CV after anterior resection and subsequently underwent a second laparotmy for right hemicolectomy. CONCLUSION CV is a known but rare case of postoperative bowel obstruction. The role of prophylactic caecopexy could be discussed in order to avoid the development of postoperative CV in anatomically susceptible patients.
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Affiliation(s)
- M.S. Sajid
- Department of Colorectal Surgery, Worthing Hospital, Worthing, West Sussex, BN11 2DH, UK
| | - M. Iftikhar
- Department of Colorectal Surgery, Worthing Hospital, Worthing, West Sussex, BN11 2DH, UK
| | - J. Rimpel
- Department of Colorectal Surgery, Worthing Hospital, Worthing, West Sussex, BN11 2DH, UK
| | - M. Baig
- Department of Colorectal Surgery, Worthing Hospital, Worthing, West Sussex, BN11 2DH, UK
| | - W.G.A. Woods
- Department of Colorectal Surgery, Worthing Hospital, Worthing, West Sussex, BN11 2DH, UK
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11
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Abstract
OBJECTIVE The objective of this study was to evaluate the effectiveness of the internet as a source of information for colorectal cancer (CRC). METHOD Six of the most common search engines (Yahoo, Google, MSN search, Alta Vista, Excite and Lycos) were used for the search of the generic term 'CRC'. First 300 links were analysed and classified by information type, provider, readership and commercial orientation. RESULTS The average time delay was 1.70 s before matches were located. A total of 3.2827 million matches on CRC were found using the six search engines ranging from 700 (Excite) to 1 417 000 (Lycos) websites. Approximately 50% of the links were based on information from textbooks or governmental websites. Commercial companies giving information about private hospitals and products provided over 50% of the websites on CRC. The distribution of target readers was uneven, although a majority of websites were delivering CRC information to public and patients. Readability of information was difficult to comprehend by the public. CONCLUSION The internet is becoming an essential tool for disseminating information about CRC to consumers. Half of the links on CRC are commercially oriented, containing information on goods or private health services. Less than 1% information is being provided by professional societies. To provide relevant CRC information, key consensus criteria for evaluating healthcare-related websites have to be established. There is an urgent need for CRC information on the internet to be regulated through the establishment of government-funded organizations (e.g. NHS) or professional societies (e.g. ACPGBI).
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Affiliation(s)
- M S Sajid
- Department of Colorectal Surgery, Worthing Hospital, Worthing, West Sussex, UK.
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12
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Rizvi F, Iftikhar M, George JP. Beneficial effects of fish liver preparations of sea bass (Lates calcarifer) versus gemfibrozil in high fat diet-induced lipid-intolerant rats. J Med Food 2004; 6:123-8. [PMID: 12935323 DOI: 10.1089/109662003322233521] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abnormal lipid metabolism is a main cause of dyslipidemia, which is a major risk factor for coronary heart disease and obesity and is even linked to diabetic-dyslipidemic complications. Fifteen days of high-fat feeding in Charles Foster rats resulted in a significant increase in baseline serum lipid levels accompanied by pronounced dyslipidemia. Treatment with fish liver preparations (FLPs) from sea bass and the standard drug gemfibrozil produced a lowering of serum lipids and glucose levels, along with a fall in very-low-density and low-density lipoprotein and an increase in high-density lipoprotein levels. Simultaneously, reactivation of plasma postheparin lipolytic activity (PHLA) and lecithin:cholesterol acyltransferase (LCAT) activity was also observed. A positive correlation was observed between low-density lipoprotein activity and fecal bile acid excretion, which was enhanced on treatment with FLPs and gemfibrozil, indicating the catabolic process for normal lipids and cholesterol homeostasis. These data suggest that FLPs and gemfibrozil not only lower lipid intolerance but also reduce diabetic-dyslipidemic complications by activating peroxisome proliferator-activated receptors (PPAR).
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Affiliation(s)
- F Rizvi
- Aquatic Environmental Laboratory, Central Institute of Fisheries Education, Versova Mumbai-400061, India.
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13
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Chishty AL, Alvi Y, Iftikhar M, Bhutta TI. Meconium aspiration in neonates: combined obstetric and paediatric intervention improves outcome. J PAK MED ASSOC 1996; 46:104-8. [PMID: 8961699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
All meconium aspiration syndrome cases admitted in the two neonatal units were compared to evaluate the antenatal and natal events including resuscitative measures and outcome of neonates and to confirm the beneficial effects of immediate combined obstetric and paediatric intervention on morbidity and mortality. Neonates managed in nursery at Mayo Hospital (Group 1, n = 44) were delivered at other hospitals and birth centres, underwent resuscitation by obstetricians and/or anaesthetists and then referred. Neonates admitted in the neonatal unit of Lady Willingdon Hospital (Group 2, n = 48) were inborn and resuscitated by paediatric residents. Both groups were comparable for weight, sex, booked status, maturity, history of prolonged labour, fetal distress and Apgar score at 5 minutes. Significant differences were proportion of C-section (62% in Gp 2 v 34% in Gp1), laryngoscopy and tracheal intubation (100% in Gp 2 v 9% in Gp1), time of arrival in the nursery (mean 0.14 hr in Gp 2 v 3.91 hr in Gp 1), persistent cyanosis (43% in Gp 2 v 68% in Gp1), earlier start of feeding (mean 2.4 days in Gp 2 v 3.2 days in group 1) and shorter stay in hospital (2.87 days in Gp 2 v 5 days in Gp 1). 27% cases died in group 2 compared to 47% in group 1 (pvalue = 0.04). Combined immediate obstetric intervention (C-section) and paediatric intervention (laryngoscopy, tracheal intubation, suction, immediate transfer to nursery) led to reduced severity of meconium aspiration syndrome and lower mortality.
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Affiliation(s)
- A L Chishty
- Department of Paediatrics, King Edward Medical College, Lady Willingdon Hospital, Lahore
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14
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Abstract
A case of autoimmune oophoritis is reported. A 41-year-old woman had a total abdominal hysterectomy and bilateral salpingo-oophorectomy for menorrhagia, polymenorrhoea and cystic ovaries. The diagnosis of autoimmune oophoritis was not suspected clinically, and was an unexpected histological finding in the ovaries. The gross and histological appearances of this rare condition are described, and the lymphoid infiltrate characterised by immunocytochemistry. Recognition of this condition by pathologists is important, as there is an associated risk of developing other autoimmune disease, even some years later, necessitating close patient follow-up. In this case serum auto-antibodies to adrenal cortex were detected, indicating a subsequent risk of Addison's disease.
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Affiliation(s)
- J E Somerville
- Department of Histopathology, Belfast City Hospital, N. Ireland
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15
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Wright PM, Iftikhar M, Fitzpatrick KT, Moore J, Thompson W. Vasopressor therapy for hypotension during epidural anesthesia for cesarean section: effects on maternal and fetal flow velocity ratios. Anesth Analg 1992; 75:56-63. [PMID: 1616163 DOI: 10.1213/00000539-199207000-00011] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The purpose of this study was to identify the influence of hypotension as a result of epidural anesthesia and of its treatment with either ephedrine or methoxamine on uteroplacental and umbilical flow velocity ratios and fetal acid-base status. Fifty healthy women with an uncomplicated full-term pregnancy were studied during elective cesarean section under epidural anesthesia. A method of continuously recording flow velocity waveforms was used that allowed the identification of simultaneous values of maternal and fetal Doppler indices related to events during the induction of anesthesia. In 15 patients in whom arterial blood pressure did not decrease, the uteroplacental pulsatility index (UtPI) did not change, but the umbilical pulsatility index (UmPI) decreased from a mean (95% confidence interval) of 0.98 (0.88-1.09) to 0.91 (0.82-0.99) (P less than 0.05). In 32 patients who experienced hypotension of at least 15%, the UtPI increased from 0.82 (0.76-0.89) to 1.04 (0.92-1.17) (P less than 0.01). Treatment with ephedrine had no influence on either the UtPI or UmPI, but treatment with methoxamine resulted in brief increases in the UtPI of 0.47 (0.24-0.69) during the first 5 min after its administration; the increases were brief and resolved within 2 min. The choice of vasopressor drug had no influence on the UtPI recorded just before surgery commenced (final UtPI), but those patients who experienced hypotension had significantly larger final UtPIs (1.02 (0.91-1.10)) than those who never became hypotensive (0.86 (0.72-0.99)), and this was associated with significantly increased placental hydrogen ion gradients. The choice of vasopressor drug appears to be of minor importance compared with the avoidance of hypotension.
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Affiliation(s)
- P M Wright
- Department of Anesthetics, Queen's University of Belfast, Northern Ireland
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