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Khan MS, Rahman-Shepherd A, Noor MN, Siddiqui AR, Goodman C, Wiseman V, Isani AK, Aftab W, Sharif S, Shakoor S, Siddiqi S, Hasan R. "Caught In Each Other's Traps": Factors Perpetuating Incentive-Linked Prescribing Deals Between Physicians and the Pharmaceutical Industry. Int J Health Policy Manag 2024. [PMID: 38618843 DOI: 10.34172/ijhpm.2024.8213] [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: 07/25/2023] [Accepted: 03/16/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Despite known adverse impacts on patients and health systems, 'incentive-linked prescribing', which describes the prescribing of medicines that result in personal benefits for the prescriber, remains a widespread and hidden impediment to quality of healthcare. We investigated factors perpetuating incentive-linked prescribing among primary care physicians in for-profit practices (referred to as private doctors), using Pakistan as a case study. METHODS Our mixed-methods study synthesised insights from a survey of 419 systematically samples private doctors and 68 semi-structured interviews with private doctors (n=28), pharmaceutical sales representatives (n=12), and provincial and national policy actors (n=28). For the survey, we built a verified database of all registered private doctors within Karachi, Pakistan's most populous city, administered an electronic questionnaire in-person and descriptively analysed the data. Semi-structured interviews incorporated a vignette-based exercise and data was analysed using an interpretive approach. RESULTS Our survey showed that 90% of private doctors met pharmaceutical sales representatives weekly. Three interlinked factors perpetuating incentive-linked prescribing we identified were: gaps in understanding of conflicts of interest and loss of values among doctors; financial pressures on doctors operating in a (largely) privately financed health-system, exacerbated by competition with unqualified healthcare providers; and aggressive incentivisation by pharmaceutical companies, linked to low political will to regulate and an over-saturated pharmaceutical market. CONCLUSION Regular interactions between pharmaceutical companies and private doctors are normalised in our study setting, and progress on regulating these is hindered by the substantial role of incentive-linked prescribing in the financial success of physicians and the pharmaceutical industry employees. A first step towards addressing the entrenchment of incentive-linked prescribing may be to reduce opposition to restrictions on incentivisation of physicians from stakeholders within the pharmaceutical industry, physicians themselves, and policymakers concerned about curtailing growth of the pharmaceutical industry.
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Affiliation(s)
- Mishal Sameer Khan
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Afifah Rahman-Shepherd
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Muhammad Naveed Noor
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | | | - Catherine Goodman
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Virginia Wiseman
- Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK
- The Kirby Institute, University of New South Wales, Sydney, NSW, Australia
| | | | - Wafa Aftab
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Sabeen Sharif
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Sadia Shakoor
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - Sameen Siddiqi
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Rumina Hasan
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
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Mirnezami AH, Drami I, Glyn T, Sutton PA, Tiernan J, Behrenbruch C, Guerra G, Waters PS, Woodward N, Applin S, Charles SJ, Rose SA, Denys A, Pape E, van Ramshorst GH, Baker D, Bignall E, Blair I, Davis P, Edwards T, Jackson K, Leendertse PG, Love-Mott E, MacKenzie L, Martens F, Meredith D, Nettleton SE, Trotman MP, van Hecke JJM, Weemaes AMJ, Abecasis N, Angenete E, Aziz O, Bacalbasa N, Barton D, Baseckas G, Beggs A, Brown K, Buchwald P, Burling D, Burns E, Caycedo-Marulanda A, Chang GJ, Coyne PE, Croner RS, Daniels IR, Denost QD, Drozdov E, Eglinton T, Espín-Basany E, Evans MD, Flatmark K, Folkesson J, Frizelle FA, Gallego MA, Gil-Moreno A, Goffredo P, Griffiths B, Gwenaël F, Harris DA, Iversen LH, Kandaswamy GV, Kazi M, Kelly ME, Kokelaar R, Kusters M, Langheinrich MC, Larach T, Lydrup ML, Lyons A, Mann C, McDermott FD, Monson JRT, Neeff H, Negoi I, Ng JL, Nicolaou M, Palmer G, Parnaby C, Pellino G, Peterson AC, Quyn A, Rogers A, Rothbarth J, Abu Saadeh F, Saklani A, Sammour T, Sayyed R, Smart NJ, Smith T, Sorrentino L, Steele SR, Stitzenberg K, Taylor C, Teras J, Thanapal MR, Thorgersen E, Vasquez-Jimenez W, Waller J, Weber K, Wolthuis A, Winter DC, Brangan G, Vimalachandran D, Aalbers AGJ, Abdul Aziz N, Abraham-Nordling M, Akiyoshi T, Alahmadi R, Alberda W, Albert M, Andric M, Angeles M, Antoniou A, Armitage J, Auer R, Austin KK, Aytac E, Baker RP, Bali M, Baransi S, Bebington B, Bedford M, Bednarski BK, Beets GL, Berg PL, Bergzoll C, Biondo S, Boyle K, Bordeianou L, Brecelj E, Bremers AB, Brunner M, Bui A, Burgess A, Burger JWA, Campain N, Carvalhal S, Castro L, Ceelen W, Chan KKL, Chew MH, Chok AK, Chong P, Christensen HK, Clouston H, Collins D, Colquhoun AJ, Constantinides J, Corr A, Coscia M, Cosimelli M, Cotsoglou C, Damjanovic L, Davies M, Davies RJ, Delaney CP, de Wilt JHW, Deutsch C, Dietz D, Domingo S, Dozois EJ, Duff M, Egger E, Enrique-Navascues JM, Espín-Basany E, Eyjólfsdóttir B, Fahy M, Fearnhead NS, Fichtner-Feigl S, Fleming F, Flor B, Foskett K, Funder J, García-Granero E, García-Sabrido JL, Gargiulo M, Gava VG, Gentilini L, George ML, George V, Georgiou P, Ghosh A, Ghouti L, Giner F, Ginther N, Glover T, Golda T, Gomez CM, Harris C, Hagemans JAW, Hanchanale V, Harji DP, Helbren C, Helewa RM, Hellawell G, Heriot AG, Hochman D, Hohenberger W, Holm T, Holmström A, Hompes R, Hornung B, Hurton S, Hyun E, Ito M, Jenkins JT, Jourand K, Kaffenberger S, Kapur S, Kanemitsu Y, Kaufman M, Kelley SR, Keller DS, Kersting S, Ketelaers SHJ, Khan MS, Khaw J, Kim H, Kim HJ, Kiran R, Koh CE, Kok NFM, Kontovounisios C, Kose F, Koutra M, Kraft M, Kristensen HØ, Kumar S, Lago V, Lakkis Z, Lampe B, Larsen SG, Larson DW, Law WL, Laurberg S, Lee PJ, Limbert M, Loria A, Lynch AC, Mackintosh M, Mantyh C, Mathis KL, Margues CFS, Martinez A, Martling A, Meijerink WJHJ, Merchea A, Merkel S, Mehta AM, McArthur DR, McCormick JJ, McGrath JS, McPhee A, Maciel J, Malde S, Manfredelli S, Mikalauskas S, Modest D, Morton JR, Mullaney TG, Navarro AS, Neto JWM, Nguyen B, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, Nordkamp S, O’Dwyer ST, Paarnio K, Pappou E, Park J, Patsouras D, Peacock O, Pfeffer F, Piqeur F, Pinson J, Poggioli G, Proud D, Quinn M, Oliver A, Radwan RW, Rajendran N, Rao C, Rasheed S, Rasmussen PC, Rausa E, Regenbogen SE, Reims HM, Renehan A, Rintala J, Rocha R, Rochester M, Rohila J, Rottoli M, Roxburgh C, Rutten HJT, Safar B, Sagar PM, Sahai A, Schizas AMP, Schwarzkopf E, Scripcariu D, Scripcariu V, Seifert G, Selvasekar C, Shaban M, Shaikh I, Shida D, Simpson A, Skeie-Jensen T, Smart P, Smith JJ, Solbakken AM, Solomon MJ, Sørensen MM, Spasojevic M, Steffens D, Stocchi L, Stylianides NA, Swartling T, Sumrien H, Swartking T, Takala H, Tan EJ, Taylor D, Tejedor P, Tekin A, Tekkis PP, Thaysen HV, Thurairaja R, Toh EL, Tsarkov P, Tolenaar J, Tsukada Y, Tsukamoto S, Tuech JJ, Turner G, Turner WH, Tuynman JB, Valente M, van Rees J, van Zoggel D, Vásquez-Jiménez W, Verhoef C, Vierimaa M, Vizzielli G, Voogt ELK, Uehara K, Wakeman C, Warrier S, Wasmuth HH, Weiser MR, Westney OL, Wheeler JMD, Wild J, Wilson M, Yano H, Yip B, Yip J, Yoo RN, Zappa MA. The empty pelvis syndrome: a core data set from the PelvEx collaborative. Br J Surg 2024; 111:znae042. [PMID: 38456677 PMCID: PMC10921833 DOI: 10.1093/bjs/znae042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/15/2024] [Indexed: 03/09/2024]
Abstract
BACKGROUND Empty pelvis syndrome (EPS) is a significant source of morbidity following pelvic exenteration (PE), but is undefined. EPS outcome reporting and descriptors of radicality of PE are inconsistent; therefore, the best approaches for prevention are unknown. To facilitate future research into EPS, the aim of this study is to define a measurable core outcome set, core descriptor set and written definition for EPS. Consensus on strategies to mitigate EPS was also explored. METHOD Three-stage consensus methodology was used: longlisting with systematic review, healthcare professional event, patient engagement, and Delphi-piloting; shortlisting with two rounds of modified Delphi; and a confirmatory stage using a modified nominal group technique. This included a selection of measurement instruments, and iterative generation of a written EPS definition. RESULTS One hundred and three and 119 participants took part in the modified Delphi and consensus meetings, respectively. This encompassed international patient and healthcare professional representation with multidisciplinary input. Seventy statements were longlisted, seven core outcomes (bowel obstruction, enteroperineal fistula, chronic perineal sinus, infected pelvic collection, bowel obstruction, morbidity from reconstruction, re-intervention, and quality of life), and four core descriptors (magnitude of surgery, radiotherapy-induced damage, methods of reconstruction, and changes in volume of pelvic dead space) reached consensus-where applicable, measurement of these outcomes and descriptors was defined. A written definition for EPS was agreed. CONCLUSIONS EPS is an area of unmet research and clinical need. This study provides an agreed definition and core data set for EPS to facilitate further research.
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Tariq M, Badshah F, Khan NU, Zafar MI, De Los Ríos-Escalante PR, Ibáñez-Arancibia E, Mehnaz S, Mubashir M, Khan MS, Khan MS, Rafiq N, Shaheen N, Saeed S, Ben Said M. Assessment of Babesia spp. prevalence in various domestic animals across Southern Punjab, Pakistan. BRAZ J BIOL 2024; 84:e277636. [PMID: 38422286 DOI: 10.1590/1519-6984.277636] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 01/10/2024] [Indexed: 03/02/2024] Open
Abstract
Parasitic diseases, notably babesiosis, exert a substantial impact on the global cattle industry, posing challenges to commerce, economies, and human health. This study, conducted in Southern Punjab, Pakistan, aimed to assess the prevalence of Babesia spp. across various livestock species using microscopic and PCR methods. A total of 180 blood samples (60 from each district) were systematically collected from apparently healthy animals, with 36 samples obtained from each domestic animal species, including camel, cattle, buffalo, goat, and sheep, noting that 12 samples were collected from each district for each animal species. Overall prevalence was determined to be 32.8% (59/180), with varying rates among species: 25.0% in cattle, 41.66% in buffalo, 30.55% in goats, 33.3% in sheep, and 33.3% in camels. Microscopic examination revealed slightly varied infection rates among large and small domestic animals (22.2%), while PCR results indicated a 32.8% overall infection rate in both large and small domestic animals, with no statistical significance. District-wise analysis showed regional variations, with Muzaffargarh recording a prevalence rate of 23.33% through microscopic examination, while Lodhran and Bahawalpur recorded 21.67%. PCR results revealed higher rates (38.33%, 26.67%, and 33.33%, respectively), underlining the importance of employing PCR for accurate detection. Examining ruminant types, large ruminants exhibited a 32.4% infection rate, while small domestic animals showed 33.3%, with no significant difference (p=0.897). District-wise prevalence showcased significant variation, with Muzaffargarh demonstrating a 25% prevalence, Lodhran 22%, and Bahawalpur 22%, through microscopic examination. PCR results displayed 38.33%, 27%, and 33.3%, respectively, with no statistical significance. Detailed analysis of individual districts highlighted variations in infection rates among camels, cattle, buffalo, goats, and sheep. The binomial test indicated significant differences through microscopic analysis (P=0.011) but non-significant variations through PCR (P=0.065), emphasizing the precision of PCR. Regional variations in prevalence, notably with Punjab exhibiting the highest frequency (33.87%) and KPK the lowest (13.24%), suggest potential influences from varying veterinary practices and environmental factors. This study underscores the pivotal role of PCR alongside microscopy for accurate babesiosis diagnosis. These findings contribute to the broader understanding of babesiosis prevalence, emphasizing the necessity of advanced molecular techniques for informed control measures.
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Affiliation(s)
- M Tariq
- Cholistan University of Veterinary and Animal Sciences, Department of Zoology, Bahawalpur, Pakistan
| | - F Badshah
- Abdul Wali Khan University, Department of Zoology, Mardan, Pakistan
| | - N U Khan
- Abdul Wali Khan University, Collage of Veterinary Science, Mardan, Pakistan
| | - M I Zafar
- Cholistan University of Veterinary and Animal Sciences, Department of Zoology, Bahawalpur, Pakistan
| | - P R De Los Ríos-Escalante
- Universidad Católica de Temuco, Facultad de Recursos Naturales, Departamento de Ciencias Biológicas y Químicas, Temuco, Chile
- Universidad Católica de Temuco, Nucleo de Estudios Ambientales, Temuco, Chile
| | - E Ibáñez-Arancibia
- Universidad Católica de Temuco, Facultad de Recursos Naturales, Departamento de Ciencias Biológicas y Químicas, Temuco, Chile
- Universidad de la Frontera, Programa de Doctorado en Ciencias Mención Biología Celular y Molecular Aplicada, Temuco, Chile
- Universidad de la Frontera, Facultad de Ingeniería y Ciencias, Departamento de Ingeniería Química, Laboratorio de Ingeniería, Biotecnología y Bioquímica Aplicada - LIBBA, Temuco, Chile
| | - S Mehnaz
- University of Agriculture, Faculty of Veterinary Sciences, Department of Parasitology, Faisalabad, Pakistan
| | - M Mubashir
- Cholistan University of Veterinary and Animal Sciences, Department of Zoology, Bahawalpur, Pakistan
| | - M S Khan
- Cholistan University of Veterinary and Animal Sciences, Department of Zoology, Bahawalpur, Pakistan
| | - M S Khan
- Abdul Wali Khan University, Department of Zoology, Mardan, Pakistan
| | - N Rafiq
- Abdul Wali Khan University, Department of Zoology, Mardan, Pakistan
| | - N Shaheen
- University of Peshawar, Department of Zoology, Peshawar, Pakistan
| | - S Saeed
- The Islamia University of Bahawalpur, Bahawalpur, Pakistan
| | - M Ben Said
- University of Manouba, Higher Institute of Biotechnology of Sidi Thabet, Department of Basic Sciences, Manouba, Tunisia
- University of Manouba, National School of Veterinary Medicine of Sidi Thabet, Laboratory of Microbiology, Manouba, Tunisia
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Khan MS, Mamun AA, Khan MSI, Sathi FA, Paul SK, Nasrim SA, Haque N, Arafa P, Nila SS, Roy S, Nahar A. Antimicrobial Susceptibility Patterns of Bacterial Isolates from Blood Culture of Pediatric Patients with Suspected Sepsis at a Tertiary Care Hospital in Mymensingh, Bangladesh. Mymensingh Med J 2024; 33:49-61. [PMID: 38163773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
Sepsis is a serious, life-threatening condition, occurring when an infectious agent invades the body, resulting in systemic inflammatory response syndrome (SIRS). Neonates and children are among the most vulnerable population groups of developing sepsis because of their weak immune barrier. Despite major advances in prevention, diagnosis and treatment of bacterial infections, invasive infections followed by sepsis remain one of the leading causes of childhood mortality. The aim of this study was to identify bacterial agents and antimicrobial resistance patterns of aerobic bacteria among children suspected of having sepsis. This cross-sectional descriptive type of observational study was conducted in the Department of Microbiology, Mymensingh Medical College, Bangladesh from March 2021 to February 2022. Blood samples were collected from pediatric patients, suspected of having sepsis referred from inpatient facility of department of Neonatology and Pediatrics, Mymensingh Medical College Hospital (MMCH). Blood samples were inoculated into BacT/ALERT PF Plus bottles followed by sub-culture of positive samples in blood agar, MacConkey agar and chocolate agar plates. Isolated bacteria were identified by routine biochemical tests. Antimicrobial resistance pattern of all isolated bacteria was seen by disk diffusion method. MIC of vancomycin by agar dilution method was determined for isolated S. aureus and Coagulase negative Staphylococci (CoNS). The prevalence of pediatric sepsis was 31.82% with highest isolation rate 35.55% among neonates. The isolation rate of gram-positive bacteria was 62.50% where S. aureus was the most common isolate 32.15% followed by CoNS 30.36%. Out of 21 gram-negative bacteria, Pseudomonas spp. was the most frequent isolate 7(33.33%), all of which were resistant to cefuroxime, ceftriaxone and ceftazidime along with all klebsiella and Acinetobacter isolates. Out of 18 S. aureus isolates, 94.44%, 88.89% and 66.67% were resistant to Azithromycin, Penicillin-G and Ciprofloxacin respectively. The MIC of Vancomycin by agar dilution method was observed <2μg/ml against all isolated S. aureus and CoNS. All the Gram-positive isolates were sensitive to Linezolid and Vancomycin. Early detection of bacteria followed by antimicrobial susceptibility test can help by selection of appropriate antibiotic and prevent spread of infection.
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Affiliation(s)
- M S Khan
- Dr Md Shahed Khan, Lecturer, Oral Microbiology, Mymensingh Medical College (MMC), Mymensingh, Bangladesh; E-mail:
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Lee ACK, Iversen BG, Lynes S, Rahman-Shepherd A, Erondu NA, Khan MS, Tegnell A, Yelewa M, Arnesen TM, Gudo ES, Macicame I, Cuamba L, Auma VO, Ocom F, Ario AR, Sartaj M, Wilson A, Siddiqua A, Nadon C, MacVinish S, Watson H, Wilburn J, Pyone T. The state of integrated disease surveillance in seven countries: a synthesis report. Public Health 2023; 225:141-146. [PMID: 37925838 DOI: 10.1016/j.puhe.2023.10.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 09/05/2023] [Accepted: 10/03/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES Integrated disease surveillance (IDS) offers the potential for better use of surveillance data to guide responses to public health threats. However, the extent of IDS implementation worldwide is unknown. This study sought to understand how IDS is operationalized, identify implementation challenges and barriers, and identify opportunities for development. STUDY DESIGN Synthesis of qualitative studies undertaken in seven countries. METHODS Thirty-four focus group discussions and 48 key informant interviews were undertaken in Pakistan, Mozambique, Malawi, Uganda, Sweden, Canada, and England, with data collection led by the respective national public health institutes. Data were thematically analysed using a conceptual framework that covered governance, system and structure, core functions, finance and resourcing requirements. Emerging themes were then synthesised across countries for comparisons. RESULTS None of the countries studied had fully integrated surveillance systems. Surveillance was often fragmented, and the conceptualization of integration varied. Barriers and facilitators identified included: 1) the need for clarity of purpose to guide integration activities; 2) challenges arising from unclear or shared ownership; 3) incompatibility of existing IT systems and surveillance infrastructure; 4) workforce and skills requirements; 5) legal environment to facilitate data sharing between agencies; and 6) resourcing to drive integration. In countries dependent on external funding, the focus on single diseases limited integration and created parallel systems. CONCLUSIONS A plurality of surveillance systems exists globally with varying levels of maturity. While development of an international framework and standards are urgently needed to guide integration efforts, these must be tailored to country contexts and guided by their overarching purpose.
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Affiliation(s)
- A C K Lee
- UK Health Security Agency, and the University of Sheffield, UK.
| | - B G Iversen
- Norwegian Institute of Public Health, Norway
| | - S Lynes
- International Association of National Public Health Institutes, Belgium
| | | | - N A Erondu
- Global Institute for Disease Elimination, United Arab Emirates
| | - M S Khan
- London School of Hygiene and Tropical Medicine, UK; Aga Khan University, Pakistan
| | | | - M Yelewa
- Public Health Institute of Malawi, Malawi
| | - T M Arnesen
- Norwegian Institute of Public Health, Norway
| | - E S Gudo
- National Institute of Health, Mozambique
| | - I Macicame
- National Institute of Health, Mozambique
| | - L Cuamba
- National Institute of Health, Mozambique
| | - V O Auma
- Uganda National Institute of Public Health, Uganda
| | - F Ocom
- Uganda National Institute of Public Health, Uganda
| | - A R Ario
- Uganda National Institute of Public Health, Uganda
| | - M Sartaj
- UK Health Security Agency, Pakistan
| | | | - A Siddiqua
- Public Health Agency Canada, Canada and McMaster University, Canada
| | - C Nadon
- Public Health Agency Canada, Canada
| | | | | | | | - T Pyone
- World Health Organization, Geneva, Switzerland
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Leclercq N, Marshall L, Weekers T, Basu P, Benda D, Bevk D, Bhattacharya R, Bogusch P, Bontšutšnaja A, Bortolotti L, Cabirol N, Calderón-Uraga E, Carvalho R, Castro S, Chatterjee S, De La Cruz Alquicira M, de Miranda JR, Dirilgen T, Dorchin A, Dorji K, Drepper B, Flaminio S, Gailis J, Galloni M, Gaspar H, Gikungu MW, Hatteland BA, Hinojosa-Diaz I, Hostinská L, Howlett BG, Hung KLJ, Hutchinson L, Jesus RO, Karklina N, Khan MS, Loureiro J, Men X, Molenberg JM, Mudri-Stojnić S, Nikolic P, Normandin E, Osterman J, Ouyang F, Oygarden AS, Ozolina-Pole L, Ozols N, Parra Saldivar A, Paxton RJ, Pitts-Singer T, Poveda K, Prendergast K, Quaranta M, Read SFJ, Reinhardt S, Rojas-Oropeza M, Ruiz C, Rundlöf M, Sade A, Sandberg C, Sgolastra F, Shah SF, Shebl MA, Soon V, Stanley DA, Straka J, Theodorou P, Tobajas E, Vaca-Uribe JL, Vera A, Villagra CA, Williams MK, Wolowski M, Wood TJ, Yan Z, Zhang Q, Vereecken NJ. Global taxonomic, functional, and phylogenetic diversity of bees in apple orchards. Sci Total Environ 2023; 901:165933. [PMID: 37536603 DOI: 10.1016/j.scitotenv.2023.165933] [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] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 07/27/2023] [Accepted: 07/29/2023] [Indexed: 08/05/2023]
Abstract
An essential prerequisite to safeguard pollinator species is characterisation of the multifaceted diversity of crop pollinators and identification of the drivers of pollinator community changes across biogeographical gradients. The extent to which intensive agriculture is associated with the homogenisation of biological communities at large spatial scales remains poorly understood. In this study, we investigated diversity drivers for 644 bee species/morphospecies in 177 commercial apple orchards across 33 countries and four global biogeographical biomes. Our findings reveal significant taxonomic dissimilarity among biogeographical zones. Interestingly, despite this dissimilarity, species from different zones share similar higher-level phylogenetic groups and similar ecological and behavioural traits (i.e. functional traits), likely due to habitat filtering caused by perennial monoculture systems managed intensively for crop production. Honey bee species dominated orchard communities, while other managed/manageable and wild species were collected in lower numbers. Moreover, the presence of herbaceous, uncultivated open areas and organic management practices were associated with increased wild bee diversity. Overall, our study sheds light on the importance of large-scale analyses contributing to the emerging fields of functional and phylogenetic diversity, which can be related to ecosystem function to promote biodiversity as a key asset in agroecosystems in the face of global change pressures.
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Affiliation(s)
- N Leclercq
- Agroecology Lab, Université Libre de Bruxelles (ULB), Boulevard du Triomphe CP 264/02, B-1050 Brussels, Belgium.
| | - L Marshall
- Agroecology Lab, Université Libre de Bruxelles (ULB), Boulevard du Triomphe CP 264/02, B-1050 Brussels, Belgium; Naturalis Biodiversity Center, Darwinweg 2, 2333 CR, Leiden, Netherlands
| | - T Weekers
- Agroecology Lab, Université Libre de Bruxelles (ULB), Boulevard du Triomphe CP 264/02, B-1050 Brussels, Belgium
| | - P Basu
- Centre for Pollination Studies, University of Calcutta, Kolkata, India
| | - D Benda
- Department of Zoology, Faculty of Science, Charles University, Prague, Czech Republic; Department of Entomology, National Museum, Prague, Czech Republic
| | - D Bevk
- Department of Organisms and Ecosystems Research, National Institute of Biology, Ljubljana, Slovenia
| | - R Bhattacharya
- Centre for Pollination Studies, University of Calcutta, Kolkata, India
| | - P Bogusch
- Department of Biology, Faculty of Science, University of Hradec Králové, Hradec Králové, Czech Republic
| | - A Bontšutšnaja
- Institute of Agricultural and Environmental Sciences, Estonian University of Life Sciences, Tartu, Estonia
| | - L Bortolotti
- CREA Research Centre for Agriculture and Environment, Bologna, Italy
| | - N Cabirol
- Department of Ecology and Natural Resources, Faculty of Science, UNAM, México City, Mexico
| | - E Calderón-Uraga
- Department of Ecology and Natural Resources, Faculty of Science, UNAM, México City, Mexico
| | - R Carvalho
- Centre for Functional Ecology, Associate Laboratory TERRA, Department of Life Sciences, University of Coimbra, Coimbra, Portugal
| | - S Castro
- Centre for Functional Ecology, Associate Laboratory TERRA, Department of Life Sciences, University of Coimbra, Coimbra, Portugal
| | - S Chatterjee
- Centre for Pollination Studies, University of Calcutta, Kolkata, India
| | - M De La Cruz Alquicira
- Department of Ecology and Natural Resources, Faculty of Science, UNAM, México City, Mexico
| | - J R de Miranda
- Department of Ecology, Swedish University of Agricultural Sciences, Uppsala, 750 05, Sweden
| | - T Dirilgen
- School of Agriculture and Food Science and Earth Institute, University College Dublin, Belfield, Dublin 4, Ireland
| | - A Dorchin
- Laboratory of Zoology, Université de Mons, Mons, Belgium; The Steinhardt Museum of Natural History, Tel Aviv University, 69978 Tel Aviv, Israel; Department of Entomology, Royal Museum for Central Africa, Tervuren, Belgium
| | - K Dorji
- College of Natural Resources, Royal University of Bhutan, Punakha, Bhutan
| | - B Drepper
- Division of Forest, Nature and Landscape, University of Leuven, Leuven, Belgium
| | - S Flaminio
- CREA Research Centre for Agriculture and Environment, Bologna, Italy; Laboratory of Zoology, Université de Mons, Mons, Belgium
| | - J Gailis
- Institute for Plant Protection Research Agrihorts, Latvia University of Life Sciences and Technologies, Jelgava, Latvia
| | - M Galloni
- Department of Biological, Geological, and Environmental Sciences, University of Bologna, Bologna, Italy
| | - H Gaspar
- Centre for Functional Ecology, Associate Laboratory TERRA, Department of Life Sciences, University of Coimbra, Coimbra, Portugal
| | - M W Gikungu
- Department of Zoology, National Museums of Kenya, Nairobi, Kenya
| | - B A Hatteland
- Division for Biotechnology and Plant Health, Norwegian Institute of Bioeconomy Research, Aas, Norway; Department of Biological Sciences, University of Bergen, Bergen, Norway
| | - I Hinojosa-Diaz
- Department of Zoology, Institute of Biology, UNAM, México City, Mexico
| | - L Hostinská
- Department of Biology, Faculty of Science, University of Hradec Králové, Hradec Králové, Czech Republic
| | - B G Howlett
- The New Zealand Institute for Plant & Food Research Limited, Lincoln, Canterbury, New Zealand
| | - K-L J Hung
- Department of Ecology and Evolutionary Biology, University of Toronto, Toronto, ON M5S 3B2, Canada; Oklahoma Biological Survey, University of Oklahoma, Norman, OK 73019, USA
| | - L Hutchinson
- School of Agriculture, Policy and Development, University of Reading, Reading, United Kingdom
| | - R O Jesus
- Graduate Program in Ecology, State University of Campinas, Campinas, São Paulo, Brazil
| | - N Karklina
- Institute for Plant Protection Research Agrihorts, Latvia University of Life Sciences and Technologies, Jelgava, Latvia
| | - M S Khan
- Department of Entomology, University of Agriculture, Peshawar, Pakistan
| | - J Loureiro
- Centre for Functional Ecology, Associate Laboratory TERRA, Department of Life Sciences, University of Coimbra, Coimbra, Portugal
| | - X Men
- Institute of Plant Protection, Shandong Academy of Agricultural Sciences/Shandong Provincial Key Laboratory of Plant Virology,Jinan 250100, China
| | - J-M Molenberg
- Agroecology Lab, Université Libre de Bruxelles (ULB), Boulevard du Triomphe CP 264/02, B-1050 Brussels, Belgium
| | - S Mudri-Stojnić
- Department of Biology and Ecology, Faculty of Sciences, University of Novi Sad, Trg Dositeja Obradovića 2, 21000 Novi Sad, Serbia
| | - P Nikolic
- Faculty of Agriculture, University of Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - E Normandin
- Centre sur la biodiversité, Département des sciences biologiques, Université de Montréal, QC, Québec H1X 2B2, Canada
| | - J Osterman
- General Zoology, Institute for Biology, Martin Luther University Halle-Wittenberg, Hoher Weg 8, 06120 Halle (Saale), Germany; Nature Conservation and Landscape Ecology, University of Freiburg, Tennenbacherstrasse 4, 79106, Freiburg im Breisgau, Germany
| | - F Ouyang
- State Key Laboratory of Integrated Management of Pest Insects and Rodents, Institute of Zoology, Chinese Academy of Sciences, Beijing 100101, China
| | - A S Oygarden
- Department of Natural Sciences and Environmental Health, University of South-Eastern Norway, Bø, Norway
| | - L Ozolina-Pole
- Institute for Plant Protection Research Agrihorts, Latvia University of Life Sciences and Technologies, Jelgava, Latvia
| | - N Ozols
- Institute for Plant Protection Research Agrihorts, Latvia University of Life Sciences and Technologies, Jelgava, Latvia
| | - A Parra Saldivar
- Instituto de Entomología, Universidad Metropolitana de Ciencias de la Educación (UMCE), Santiago, Chile
| | - R J Paxton
- General Zoology, Institute for Biology, Martin Luther University Halle-Wittenberg, Hoher Weg 8, 06120 Halle (Saale), Germany
| | - T Pitts-Singer
- USDA Agricultural Research Service, Pollinating Insects Research Unit, Logan, UT 84322, USA
| | - K Poveda
- Department of Entomology, Cornell University, 4126 Comstock Hall, Ithaca, NY 14853, USA
| | - K Prendergast
- Molecular and Life Sciences, Curtin University, Bentley, WA 6102, Australia
| | - M Quaranta
- CREA Research Centre for Agriculture and Environment, Bologna, Italy
| | - S F J Read
- The New Zealand Institute for Plant & Food Research Limited, Lincoln, Canterbury, New Zealand
| | - S Reinhardt
- Department of Natural Sciences and Environmental Health, University of South-Eastern Norway, Bø, Norway
| | - M Rojas-Oropeza
- Department of Ecology and Natural Resources, Faculty of Science, UNAM, México City, Mexico
| | - C Ruiz
- Departamento Biología Animal, Edafología y Geología, Facultad de Ciencias, Universidad de La Laguna, La Laguna, 38206, Tenerife, Spain
| | - M Rundlöf
- Department of Biology, Lund University, Lund, Sweden
| | - A Sade
- Department of Evolutionary and Environmental Biology, University of Haifa, Mt. Carmel, 31905 Haifa, Israel
| | - C Sandberg
- Department of Biology, Lund University, Lund, Sweden; Calluna AB, Husargatan 3, Malmö, 211 28, Sweden
| | - F Sgolastra
- Department of Agricultural and Food Sciences, University of Bologna, Bologna, Italy
| | - S F Shah
- Department of Entomology, University of Agriculture, Peshawar, Pakistan
| | - M A Shebl
- Department of Plant Protection, Faculty of Agriculture, Suez Canal University, Ismailia 41522, Egypt
| | - V Soon
- Natural History Museum and Botanical Garden, University of Tartu, Vanemuise 46, 51003 Tartu, Estonia
| | - D A Stanley
- School of Agriculture and Food Science and Earth Institute, University College Dublin, Belfield, Dublin 4, Ireland
| | - J Straka
- Department of Zoology, Faculty of Science, Charles University, Prague, Czech Republic
| | - P Theodorou
- General Zoology, Institute for Biology, Martin Luther University Halle-Wittenberg, Hoher Weg 8, 06120 Halle (Saale), Germany
| | - E Tobajas
- Department of Biology, Lund University, Lund, Sweden; Department of Animal Biology, University of Salamanca, Campus Miguel de Unamuno, Salamanca, 37007, Spain
| | - J L Vaca-Uribe
- Laboratorio de Investigaciones en Abejas LABUN, Departamento de Biología, Facultad de Ciencias, Universidad Nacional de Colombia, Bogotá,111321, Colombia
| | - A Vera
- Departamento de Biología, Universidad Metropolitana de Ciencias de la Educación (UMCE), Santiago, Chile
| | - C A Villagra
- Instituto de Entomología, Universidad Metropolitana de Ciencias de la Educación (UMCE), Santiago, Chile
| | - M-K Williams
- Department of Biology, Utah State University, Logan, UT 84322, USA
| | - M Wolowski
- Institute of Natural Sciences, Federal University of Alfenas, Alfenas, Minas Gerais, Brazil
| | - T J Wood
- Laboratory of Zoology, Université de Mons, Mons, Belgium
| | - Z Yan
- State Key Laboratory of Integrated Management of Pest Insects and Rodents, Institute of Zoology, Chinese Academy of Sciences, Beijing 100101, China
| | - Q Zhang
- Beijing Biodiversity Conservation Research Center/Beijing Milu Ecological Research Center, Beijing 100076, China
| | - N J Vereecken
- Agroecology Lab, Université Libre de Bruxelles (ULB), Boulevard du Triomphe CP 264/02, B-1050 Brussels, Belgium
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West CT, West MA, Mirnezami AH, Drami I, Denys A, Glyn T, Sutton PA, Tiernan J, Behrenbruch C, Guerra G, Waters PS, Woodward N, Applin S, Charles SJ, Rose SA, Pape E, van Ramshorst GH, Aalbers AGJ, Abdul AN, Abecasis N, Abraham-Nordling M, Akiyoshi T, Alahmadi R, Alberda W, Albert M, Andric M, Angeles M, Angenete E, Antoniou A, Armitage J, Auer R, Austin KK, Aytac E, Aziz O, Bacalbasa N, Baker RP, Bali M, Baransi S, Baseckas G, Bebington B, Bedford M, Bednarski BK, Beets GL, Berg PL, Bergzoll C, Biondo S, Boyle K, Bordeianou L, Brecelj E, Bremers AB, Brown K, Brunner M, Buchwald P, Bui A, Burgess A, Burger JWA, Burling D, Burns E, Campain N, Carvalhal S, Castro L, Caycedo-Marulanda A, Ceelen W, Chan KKL, Chang GJ, Chew MH, Chok AK, Chong P, Christensen HK, Clouston H, Collins D, Colquhoun AJ, Constantinides J, Corr A, Coscia M, Cosimelli M, Cotsoglou C, Coyne PE, Croner RS, Damjanovic L, Daniels IR, Davies M, Davies RJ, Delaney CP, de Wilt JHW, Denost QD, Deutsch C, Dietz D, Domingo S, Dozois EJ, Drozdov E, Duff M, Egger E, Eglinton T, Enrique-Navascues JM, Espín-Basany E, Evans MD, Eyjólfsdóttir B, Fahy M, Fearnhead NS, Fichtner-Feigl S, Flatmark K, Fleming F, Flor B, Folkesson J, Foskett K, Frizelle FA, Funder J, Gallego MA, García-Granero E, García-Sabrido JL, Gargiulo M, Gava VG, Gentilini L, George ML, George V, Georgiou P, Ghosh A, Ghouti L, Gil-Moreno A, Giner F, Ginther N, Glover T, Goffredo P, Golda T, Gomez CM, Griffiths B, Gwenaël F, Harris C, Harris DA, Hagemans JAW, Hanchanale V, Harji DP, Helbren C, Helewa RM, Hellawell G, Heriot AG, Hochman D, Hohenberger W, Holm T, Holmström A, Hompes R, Hornung B, Hurton S, Hyun E, Ito M, Iversen LH, Jenkins JT, Jourand K, Kaffenberger S, Kandaswamy GV, Kapur S, Kanemitsu Y, Kaufman M, Kazi M, Kelley SR, Keller DS, Kelly ME, Kersting S, Ketelaers SHJ, Khan MS, Khaw J, Kim H, Kim HJ, Kiran R, Koh CE, Kok NFM, Kokelaar R, Kontovounisios C, Kose F, Koutra M, Kraft M, Kristensen HØ, Kumar S, Kusters M, Lago V, Lakkis Z, Lampe B, Langheinrich MC, Larach T, Larsen SG, Larson DW, Law WL, Laurberg S, Lee PJ, Limbert M, Loria A, Lydrup ML, Lyons A, Lynch AC, Mackintosh M, Mann C, Mantyh C, Mathis KL, Margues CFS, Martinez A, Martling A, Meijerink WJHJ, Merchea A, Merkel S, Mehta AM, McArthur DR, McCormick JJ, McDermott FD, McGrath JS, McPhee A, Maciel J, Malde S, Manfredelli S, Mikalauskas S, Modest D, Monson JRT, Morton JR, Mullaney TG, Navarro AS, Neeff H, Negoi I, Neto JWM, Nguyen B, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, Nordkamp S, O’Dwyer ST, Paarnio K, Palmer G, Pappou E, Park J, Patsouras D, Peacock A, Pellino G, Peterson AC, Pfeffer F, Piqeur F, Pinson J, Poggioli G, Proud D, Quinn M, Oliver A, Quyn A, Radwan RW, Rajendran N, Rao C, Rasheed S, Rasmussen PC, Rausa E, Regenbogen SE, Reims HM, Renehan A, Rintala J, Rocha R, Rochester M, Rohila J, Rothbarth J, Rottoli M, Roxburgh C, Rutten HJT, Safar B, Sagar PM, Sahai A, Saklani A, Sammour T, Sayyed R, Schizas AMP, Schwarzkopf E, Scripcariu D, Scripcariu V, Seifert G, Selvasekar C, Shaban M, Shaikh I, Shida D, Simpson A, Skeie-Jensen T, Smart NJ, Smart P, Smith JJ, Smith T, Solbakken AM, Solomon MJ, Sørensen MM, Spasojevic M, Steele SR, Steffens D, Stitzenberg K, Stocchi L, Stylianides NA, Swartling T, Sumrien H, Swartking T, Takala H, Tan EJ, Taylor C, Taylor D, Tejedor P, Tekin A, Tekkis PP, Teras J, Thanapal MR, Thaysen HV, Thorgersen E, Thurairaja R, Toh EL, Tsarkov P, Tolenaar J, Tsukada Y, Tsukamoto S, Tuech JJ, Turner G, Turner WH, Tuynman JB, Valente M, van Rees J, van Zoggel D, Vásquez-Jiménez W, Verhoef C, Vierimaa M, Vizzielli G, Voogt ELK, Uehara K, Wakeman C, Warrier S, Wasmuth HH, Weber K, Weiser MR, Westney OL, Wheeler JMD, Wild J, Wilson M, Wolthuis A, Yano H, Yip B, Yip J, Yoo RN, Zappa MA, Winter DC. Empty pelvis syndrome: PelvEx Collaborative guideline proposal. Br J Surg 2023; 110:1730-1731. [PMID: 37757457 PMCID: PMC10805575 DOI: 10.1093/bjs/znad301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/22/2023] [Accepted: 08/28/2023] [Indexed: 09/29/2023]
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Khan MS. Medicine and the Law. S Afr Med J 2023; 113:18-19. [PMID: 37882132 DOI: 10.7196/samj.2023.v113i9.759] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Indexed: 10/27/2023] Open
Abstract
There is a plethora of literature that suggests that a failure by a medical practitioner to obtain informed consent from a patient amounts to assault. Assault is a loaded concept in South African (SA) law, and has applicability to both criminal and civil law. When one thinks of the term 'assault', it is normally associated with a criminal activity. It is well documented that a civil case can be levelled against a medical practitioner who fails to obtain informed consent from a patient. However, the criminal law aspect has not been explored in the same level of detail. This article aims to delve deeper into this aspect by outlining the requirements for assault as defined by the SA common law, and to evaluate whether a criminal offence has actually been committed by a medical practitioner in the event that proper informed consent was not obtained.
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Affiliation(s)
- M S Khan
- Attorney of the High Court of South Africa; Lecturer, Steve Biko Centre for Bioethics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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Alam MM, Biplob JA, Sathi FA, Nila SS, Paul A, Khanam J, Chowdhury CS, Khan MS. Ear Infections by Non albicans Candida Species with Isolation of Rare Drug Resistant Species in a Tertiary Care Hospital of Bangladesh. Mymensingh Med J 2023; 32:644-648. [PMID: 37391953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
Otomycosis, a fungal infection of external ear, is challenging for both patients and otolaryngologist as it requires long term treatment and follow up. Candida spp. is second common organism causing otomycosis with Aspergillus being first. Among Candida species, C. albicans is considered as most common but in recent years there is increasing incidence of Non albicans Candida (NAC) species with greater resistance and recurrence. This descriptive type of observational study was planned to determine the species distribution and antifungal susceptibility of Candida spp. causing otomycosis. From March 2021 to February 2022, 60 patients clinically suspected of Candida associated otomycosis at Mymensingh Medical College Hospital, Bangladesh were enrolled. Specimens were taken by an otorhinolaryngologist. After culture and microscopic examination, isolated Candida species were identified by phenotypic and genotypic method and antifungal susceptibility was determined at Department of Microbiology, Mymensingh Medical College. From 60 samples 18(30.0%) were positive for Candida on microscopy and culture. Of the isolates, C. albicans were 2(11.11%) and Non albicans Candida (NAC) 16(88.89%). Five different NAC species were identified of which C. parapsilosis was predominant 5(27.77%) followed by C. tropicalis 4(22.22%) and C. famata 3(16.67%). Rare species of C. ciferrii 2(11.11)%, Kodamaea ohmeri 2(11.11%) were isolated. Candida spp. showed highest resistance to Clotrimazole 8(44.0%) followed by Itraconazole 6(33.0%), Nystatin 4(22.0%) and Fluconazole 3(17.0%). C. ciferrii and Kodamaea ohmeri showed resistance to all antifungals except Nystatin. Outcomes from this study showed a different picture of species distribution, with isolation of rare and emerging drug resistant threatening species like C. ciferri and Kodamea ohmeri which necessitates more detailed survey.
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Affiliation(s)
- M M Alam
- Dr Mohammad Monirul Alam, Assistant Professor, Department of ENT, Mymensingh Medical College (MMC), Mymensingh, Bangladesh; E-mail:
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Sathi FA, Alam MM, Paul SK, Nasrin SA, Ahmed S, Haque N, Khan MS, Mamun AA, Khan S, Arafa P. Species Identification and Antifungal Susceptibility Pattern of Candida Isolates in Patients with Vulvovaginitis from Mymensingh, Bangladesh. Mymensingh Med J 2023; 32:638-643. [PMID: 37391952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2023]
Abstract
Vulvovaginal Candidiasis (VVC), a frequent and cumbersome reproductive tract infection affects women's physical and mental health. Although Candida albicans was reported as the most common agent of VVC yet, recently there are significant changes in the pattern of Candida species causing VVC with varying antifungal susceptibility pattern. Therefore this cross-sectional, descriptive type of observational study conducted to identify the spectrum of Candida species associated with VVC and assesses their antifungal susceptibility pattern from March 2021 to February 2022. High vaginal swabs from 175 patients clinically suspected of VVC were collected and cultured on Sabouraud dextrose agar with Chloramphenicol. Species were identified by phenotypic methods like- germ tube test, sub-culture in chromogenic agar media and genotypic methods like- Polymerase chain reaction (PCR), Restriction fragment length polymorphism (RFLP). Antifungal susceptibility was done by disk diffusion method. Out of 175 patients, 52(29.7%) were positive for Candida species. Of the isolates- C. albicans 34(65.0%), Non albicans Candida (NAC) 18(35.0%). Among NAC, C. glabrata 5(9.6%), C. tropicalis 5(9.6%), C. parapsilosis 4(7.7%) and each of C. krusei, C. kefyr, C. ciferrii, C. dubliniensis were 1(1.9%). On susceptibility testing highest resistance was to Clotrimazole 31.0% followed by Nystatin 13.0%, Itraconazole 12.0% and Fluconazole 10.0%. Resistance to azole was higher in NAC than in albicans. Of these patients, 16(31.0%) had history of recurrent VVC (RVVC) of which 12(75.0%) were by NAC, predominantly C. glabrata 5(32.0%). The results showed the increasing incidence of NAC associated vaginitis with higher resistance and recurrence that should be considered in gynecology clinics.
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Affiliation(s)
- F A Sathi
- Dr Fardousi Akter Sathi, Lecturer, Department of Microbiology, Mymensingh Medical College (MMC), Mymensingh, Bangladesh; E-mail:
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Dasgupta S, Samad A, Howlader SS, Choudhury DI, Hossain A, Khan MS, Hasan MR, Talukder QI, Rahman MK. Complete Heparin Reversal by Protamine during Off-Pump Coronary Artery Bypass Surgery (OPCAB): A Necessity or Myth? Mymensingh Med J 2023; 32:421-429. [PMID: 37002753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
In our country majority of the coronary artery bypass surgery (CABG) are done off-pump and was reported having excellent clinical outcome along with cost efficiency by various investigators. Heparin is commonly used as most effective anticoagulant, and protamine sulfate is now generally used to reverse the anticoagulant action of heparin. While under dosing of protamine may result in incomplete heparin reversal and prolonged anticoagulation, protamine overdosing is associated with impaired clot formation exerted by the intrinsic anti-coagulation properties of protamine itself, moreover protamine administration is associated with mild to severe cardiovascular and pulmonary complications. Apart from traditional full neutralization of heparin now-a-days, half dose protamine was also introduced showing good outcome regarding lower activated clotting time (ACT), overall, less surgical bleeding with less transfusion. This comparative study was designed to detect differences between traditional and decreased protamine dosing in Off-Pump Coronary Artery Bypass (OPCAB) surgery. Four hundred (400) patients who underwent Off-Pump Coronary Artery Bypass Surgery (OPCAB) surgery at our institution over a period of 12 months were analyzed and were divided into two groups. Group A- received 0.5mg of protamine per 100 unit of heparin; Group B-received 1.0mg of protamine per 100 unit of heparin. ACT, blood loss, hemoglobin and platelet count units of blood and blood product transfusion requirements, clinical outcome and hospital stay were assessed in each patient. This study showed that 0.5mg of protamine per 100 unit of heparin was always able to reverse the anticoagulant effect of heparin with no significant difference in hemodynamic parameters, amount of blood loss and requirements of blood transfusion in between the groups. A standard protamine dosing formula (protamine-heparin at ratio of 1:1) adequate for on-pump cardiac surgical procedures significantly overestimates protamine requirements for OPCAB. Patients treated with decreased protamine do not appear to have adverse outcomes in terms of post-operative bleeding.
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Affiliation(s)
- S Dasgupta
- Dr Saikat Das Gupta, Associate Consultant, Department of Cardiac Surgery, Square Hospitals Ltd, Dhaka, Bangladesh; E-mail:
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Hamid A, Yimer W, Oshunbade A, Khan MS, Kamimura D, Kipchumba RK, Pandey A, Clark D, Mentz R, Fox ER, Berry J, Stacey B, Shah A, Correa A, Virani SS, Butler J, Hall ME. Trajectory of high sensitivity c-reactive protein and incident heart failure in black adults: the jackson heart study. Am J Med Sci 2023. [DOI: 10.1016/s0002-9629(23)00630-4] [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: 01/28/2023]
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Fahy MR, Kelly ME, Aalbers AGJ, Abdul Aziz N, Abecasis N, Abraham-Nordling M, Akiyoshi T, Alberda W, Albert M, Andric M, Angeles MA, Angenete E, Antoniou A, Auer R, Austin KK, Aytac E, Aziz O, Bacalbasa N, Baker RP, Bali M, Baransi S, Baseckas G, Bebington B, Bedford M, Bednarski BK, Beets GL, Berg PL, Bergzoll C, Beynon J, Biondo S, Boyle K, Bordeianou L, Brecelj E, Bremers AB, Brunner M, Buchwald P, Bui A, Burgess A, Burger JWA, Burling D, Burns E, Campain N, Carvalhal S, Castro L, Caycedo-Marulanda A, Ceelan W, Chan KKL, Chang GJ, Chang M, Chew MH, Chok AY, Chong P, Clouston H, Codd M, Collins D, Colquhoun AJ, Constantinides J, Corr A, Coscia M, Cosimelli M, Cotsoglou C, Coyne PE, Croner RS, Damjanovich L, Daniels IR, Davies M, Delaney CP, de Wilt JHW, Denost Q, Deutsch C, Dietz D, Domingo S, Dozois EJ, Drozdov E, Duff M, Eglinton T, Enriquez-Navascues JM, Espín-Basany E, Evans MD, Eyjólfsdóttir B, Fearnhead NS, Ferron G, Flatmark K, Fleming FJ, Flor B, Folkesson J, Frizelle FA, Funder J, Gallego MA, Gargiulo M, García-Granero E, García-Sabrido JL, Gargiulo M, Gava VG, Gentilini L, George ML, George V, Georgiou P, Ghosh A, Ghouti L, Gil-Moreno A, Giner F, Ginther DN, Glyn T, Glynn R, Golda T, Griffiths B, Harris DA, Hagemans JAW, Hanchanale V, Harji DP, Helewa RM, Hellawell G, Heriot AG, Hochman D, Hohenberger W, Holm T, Hompes R, Hornung B, Hurton S, Hyun E, Ito M, Iversen LH, Jenkins JT, Jourand K, Kaffenberger S, Kandaswamy GV, Kapur S, Kanemitsu Y, Kazi M, Kelley SR, Keller DS, Ketelaers SHJ, Khan MS, Kiran RP, Kim H, Kim HJ, Koh CE, Kok NFM, Kokelaar R, Kontovounisios C, Kose F, Koutra M, Kristensen HØ, Kroon HM, Kumar S, Kusters M, Lago V, Lampe B, Lakkis Z, Larach JT, Larkin JO, Larsen SG, Larson DW, Law WL, Lee PJ, Limbert M, Loria A, Lydrup ML, Lyons A, Lynch AC, Maciel J, Manfredelli S, Mann C, Mantyh C, Mathis KL, Marques CFS, Martinez A, Martling A, Mehigan BJ, Meijerink WJHJ, Merchea A, Merkel S, Mehta AM, Mikalauskas S, McArthur DR, McCormick JJ, McCormick P, McDermott FD, McGrath JS, Malde S, Mirnezami A, Monson JRT, Navarro AS, Negoi I, Neto JWM, Ng JL, Nguyen B, Nielsen MB, Nieuwenhuijzen GAP, Nilsson PJ, Nordkamp S, Nugent T, Oliver A, O’Dwyer ST, O’Sullivan NJ, Paarnio K, Palmer G, Pappou E, Park J, Patsouras D, Peacock O, Pellino G, Peterson AC, Pinson J, Poggioli G, Proud D, Quinn M, Quyn A, Rajendran N, Radwan RW, Rajendran N, Rao C, Rasheed S, Rausa E, Regenbogen SE, Reims HM, Renehan A, Rintala J, Rocha R, Rochester M, Rohila J, Rothbarth J, Rottoli M, Roxburgh C, Rutten HJT, Safar B, Sagar PM, Sahai A, Saklani A, Sammour T, Sayyed R, Schizas AMP, Schwarzkopf E, Scripcariu D, Scripcariu V, Selvasekar C, Shaikh I, Simpson A, Skeie-Jensen T, Smart NJ, Smart P, Smith JJ, Solbakken AM, Solomon MJ, Sørensen MM, Sorrentino L, Steele SR, Steffens D, Stitzenberg K, Stocchi L, Stylianides NA, Swartling T, Spasojevic M, Sumrien H, Sutton PA, Swartking T, Takala H, Tan EJ, Taylor C, Tekin A, Tekkis PP, Teras J, Thaysen HV, Thurairaja R, Thorgersen EB, Toh EL, Tsarkov P, Tsukada Y, Tsukamoto S, Tuech JJ, Turner WH, Tuynman JB, Valente M, van Ramshorst GH, van Zoggel D, Vasquez-Jimenez W, Vather R, Verhoef C, Vierimaa M, Vizzielli G, Voogt ELK, Uehara K, Urrejola G, Wakeman C, Warrier SK, Wasmuth HH, Waters PS, Weber K, Weiser MR, Wheeler JMD, Wild J, Williams A, Wilson M, Wolthuis A, Yano H, Yip B, Yip J, Yoo RN, Zappa MA, Winter DC. Minimum standards of pelvic exenterative practice: PelvEx Collaborative guideline. Br J Surg 2022; 109:1251-1263. [PMID: 36170347 DOI: 10.1093/bjs/znac317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 07/18/2022] [Accepted: 08/18/2022] [Indexed: 12/31/2022]
Abstract
This document outlines the important aspects of caring for patients who have been diagnosed with advanced pelvic cancer. It is primarily aimed at those who are establishing a service that adequately caters to this patient group. The relevant literature has been summarized and an attempt made to simplify the approach to management of these complex cases.
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Khan MS. How does South African law handle cases involving baby swapping? S Afr Med J 2022; 112:516. [PMID: 36214392] [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] [Received: 08/02/2022] [Indexed: 06/16/2023] Open
Abstract
Cases of baby swapping in South Africa (SA) are very rare. In 1996 the first of these cases, Clinton-Parker v Administrator, Transvaal; Dawkins v Administrator, Transvaal, appeared before our courts. The parties in that instance decided to keep the babies who had been erroneously given to them, but the plaintiffs were awarded compensation for the emotional shock and injury they endured as the result of the defendant's negligence. In recent times we had the case of Child Law v NN and NS (GP), where the parties also decided to keep the children who had been erroneously given to them by the hospital staff. These scenarios, while difficult, have had amicable conclusions, with the parents electing not to pursue custody of their natural children. The situation would be more complex if either of the parties were to decide that they want their natural child back. A number of questions are pertinent here, and will guide the discussion in this article. Is it as simple as both of the 'psychological' parents returning the babies to their natural parents? Do the parents have a claim against the hospital staff? Unfortunately there is not a wealth of legal precedent to assist the SA courts in this regard. The article explores the jurisprudence that speaks to baby swapping, in an attempt to provide clarity and assistance in resolving these difficult cases.
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Affiliation(s)
- M S Khan
- Attorney of the High Court of South Africa; Lecturer, Steve Biko Centre for Bioethics, School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
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15
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Khan Z, Sharawi SE, Khan MS, Suleman, Xing LX, Haroon, Ali S, Ahmed N. Prevalence of insect pests on maize crop in District Mansehra, Khyber Pakhtunkhwa, Pakistan. BRAZ J BIOL 2022; 84:e259217. [PMID: 35544791 DOI: 10.1590/1519-6984.259217] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/04/2022] [Indexed: 11/22/2022] Open
Abstract
The maize crop is used as food for humans, livestock and poultries forms, it is also used in bread making, corn flakes, corn syrup, corn starch and corn oils. The field study consisted of one experimental trial, about the incidence of that insect pest complex on maize cultivar Azam during the Kharif season 2020 at the Agricultural, Research Station, Baffa, Mansehra. The trial was laid out in the Randomized Complete Block Design (RCBD), and then it was divided into three replications. The result obtained from the trial showed that a number of the pest species were recorded during the experimental period; however, the population was noticed at a low level. The obtained insect species were corn leaf aphid (6.90 ± 5.5) per square inch, corn leafhopper (1.32 ± 0.63), maize stem borer (0.63 ± 0.29), corn flea beetle (0.43 ± 0.28), Thrips (0.38 ± 0.22), Hairy caterpillar (0.21 ± 0.22), Grasshopper (0.17 ± 0.11) and shoot fly (0.11 ± 0.08) throughout the season.
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Affiliation(s)
- Z Khan
- University of Swabi, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
- Hazara University Mansehra, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
- Agriculture Research Station, Baffa, Mansehra, Khyber Pakhtunkhwa, Pakistan
| | - S E Sharawi
- King Abdul-Aziz University,Department of Biology, Jeddah, Saudi Arabia
| | - M S Khan
- University of Swabi, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
- Hazara University Mansehra, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
| | - Suleman
- University of Swabi, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
- Hazara University Mansehra, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
| | - L-X Xing
- Northwest University, College of Life Sciences, Xi'an, China
| | - Haroon
- Hazara University Mansehra, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
- Northwest University, College of Life Sciences, Xi'an, China
| | - S Ali
- University of Agriculture Dera Ismail Khan, Department of Entomology, Faculty of Agriculture Sciences, Khyber Pakhtunkhwa, Pakistan
- University of Swabi, Department of Agriculture, Khyber Pakhtunkhwa, Pakistan
| | - N Ahmed
- University of Swabi, Department of Agriculture, Khyber Pakhtunkhwa, Pakistan
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16
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Khan Z, Khan MS, Bawazeer S, Bawazeer N, Suleman, Irfan M, Rauf A, Su XH, Xing LX. A comprehensive review on the documented characteristics of four Reticulitermes termites (Rhinotermitidae, Blattodea) of China. BRAZ J BIOL 2022; 84:e256354. [PMID: 35319619 DOI: 10.1590/1519-6984.256354] [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: 09/14/2021] [Accepted: 01/11/2022] [Indexed: 11/22/2022] Open
Abstract
Termites are known as social insects worldwide. Presently in China 473 species, 44 genera and 4 families of termites have been reported. Of them, 111 Reticulitermes species are widely spread in different zones of China. The dispersion flight season of these Chinese Reticulitermes species are usually started from February to June, but in some regions different species are distributed, sharing their boundaries and having overlapping flight seasons. These reasons become important sources of hybridization between two different heterospecific populations of termites. It was confirmed that the fertilized eggs and unfertilized eggs of some Reticulitermes termites have the capacity of cleavage. While the unfertilized eggs of R. aculabialis, R. chinensis and R. labralis cleaved normally and the only R. aculabialis unfertilized eggs develop in embryos. While, the R. flaviceps and R. chinensis were observed with their abnormal embryonic development, and not hatching of eggs parthenogenetically. They were reported more threatening to Chinese resources as they propagate with parthenogenesis, hybridization and sexual reproduction. Eggshell and macrophiles of eggs play important roles in species identification and control. Although, they are severe pests and cause a wide range of damages to wooden structures and products in homes, buildings, building materials, trees, crops, and forests in China's Mainland.
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Affiliation(s)
- Z Khan
- Northwest University, College of Life Sciences, Xi'an, China.,University of Swabi, Zoology Department, Khyber Pakhtunkhwa, Pakistan
| | - M S Khan
- University of Swabi, Zoology Department, Khyber Pakhtunkhwa, Pakistan
| | - S Bawazeer
- Umm Al-Qura University, Faculty of Pharmacy, Department of Pharmacognosy, Makkah, Kingdom of Saudi Arabia
| | - N Bawazeer
- Minister of Interior General Directorate of Prison's Health, Pharmacy Department, Kingdom of Saudi Arabia
| | - Suleman
- University of Swabi, Zoology Department, Khyber Pakhtunkhwa, Pakistan
| | - M Irfan
- Abdul Wali Khan University, Department of Botany, Mardan, Pakistan.,University of Swabi, Department of Botany, Swabi, Pakistan.,Missouri Botanical Garden, St. Louis, MO, U.S.A
| | - A Rauf
- University of Swabi, Department of Chemistry, Anbar, Khyber Pakhtunkhwa, Pakistan
| | - X-H Su
- Northwest University, College of Life Sciences, Xi'an, China.,Northwest University, Shaanxi Key Laboratory for Animal Conservation, Xi'an, China.,Northwest University, Key Laboratory of Resource Biology and Biotechnology, Xi'an, China
| | - L-X Xing
- Northwest University, College of Life Sciences, Xi'an, China.,Northwest University, Shaanxi Key Laboratory for Animal Conservation, Xi'an, China.,Northwest University, Key Laboratory of Resource Biology and Biotechnology, Xi'an, China
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17
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Aslam MW, Wajid M, Waheed A, Ahmad S, Jafar K, Akmal H, Khan T, Maqsud MS, Khan MS. Revision of some mensural measurements, food preference, and haematological parameters in breeding pairs of blue rock pigeon, Columba livia sampled from punjab Pakistan. BRAZ J BIOL 2021; 83:e252059. [PMID: 34669810 DOI: 10.1590/1519-6984.252059] [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: 05/11/2021] [Accepted: 06/18/2021] [Indexed: 11/22/2022] Open
Abstract
The present study describes the haematological profile, feeding preference, and comparison of morphometric characters of blue rock pigeon (Columba livia) breeding pairs. For this purpose, 25 pairs (25 samples per sex) were sampled through Mist nets from district Okara and Bahawalnagar, Punjab, Pakistan. Birds were then anaesthetized with a combination of ketamine HCL (10 mg/kg) and diazepam (0.2 mg/kg) and subjected to morphometric measurements. 5µL blood also was taken from the jugular vein of each anaesthetized bird for haematological analysis. Few pairs were also dissected to remove gastrointestinal tracts (GITs) for food preferences. Results revealed that there are no significant differences in the haematological parameters and feeding preference of breeding pairs of Columba livia. The gut analysis further revealed, the major portion of gut contents consisted of pea and corn in most of the pairs. Regarding the mensural measurements, significant differences were recorded in the body weight, length of the longest primary feather, and chest circumference, whereas the rest of the studied parameters remain nonsignificant between sexes. So, it is concluded that apart from 3 morphometric parameters (body weight, length of longest primary feather and chest circumference), both sexes are alike in term of morphometry, haematology and food preference.
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Affiliation(s)
- M W Aslam
- University of Okara, Faculty of Life Sciences, Department of Zoology, Okara, Pakistan
| | - M Wajid
- University of Okara, Faculty of Life Sciences, Department of Zoology, Okara, Pakistan
| | - A Waheed
- University of Okara, Faculty of Life Sciences, Department of Zoology, Okara, Pakistan
| | - S Ahmad
- University of Okara, Faculty of Life Sciences, Department of Zoology, Okara, Pakistan
| | - K Jafar
- University of Okara, Faculty of Life Sciences, Department of Zoology, Okara, Pakistan
| | - H Akmal
- University of Okara, Faculty of Life Sciences, Department of Zoology, Okara, Pakistan
| | - T Khan
- University of Okara, Faculty of Life Sciences, Department of Zoology, Okara, Pakistan
| | - M S Maqsud
- University of Okara, Faculty of Life Sciences, Department of Zoology, Okara, Pakistan
| | - M S Khan
- University of Okara, Faculty of Life Sciences, Department of Zoology, Okara, Pakistan
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Malde S, Grover S, Raj S, Yuan C, Nair R, Thurairaja R, Khan MS. 728 A Systematic Review of The Efficacy and Safety of Outpatient Bladder Tumour Ablation. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
The management of recurrent non-muscle-invasive bladder cancer (NMIBC) typically requires repeated transurethral resections under general anaesthesia. This is costly and results in poor health-related quality-of-life for patients. Outpatient-based laser ablation and diathermy to recurrent tumours could reduce morbidity and cost of managing NMIBC. This systematic review evaluates the safety and efficacy of outpatient-based diathermy or laser ablation for recurrent NMIBC.
Method
The EMBASE, MEDLINE and Cochrane Library were searched until June 2020. All studies evaluating the use of outpatient diathermy or laser ablation for NMIBC were included. The quality of evidence and risk of bias were assessed using the GRADE and ROBINS-I tools, respectively.
Results
From 1328 studies identified, 17 studies (1584 patients) were included. Overall, the majority of tumours (80%) were low-grade (G1 and G2). Laser ablation and diathermy resulted in a mean recurrence rate of 47% and 40% at 20-31 months follow-up, respectively, with a mean progression rate of 3-11%. Both procedures were well-tolerated with low pain scores (mean score of 1) and low periprocedural complication rates. However, the overall quality of evidence of low.
Conclusions
This review demonstrates that both procedures have good short-term efficacy in patients with low-grade NMIBC. The procedures are well-tolerated with low complication rates and importantly, reduce the need for intervention under general anaesthesia. These findings can aid patient counselling regarding less invasive treatment options, avoiding the morbidity of transurethral resection. Future randomised studies with standardised risk stratification and outcome measures are required to add to the quality of evidence.
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Affiliation(s)
- S Malde
- Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - S Grover
- King's College London, London, United Kingdom
| | - S Raj
- King's College London, London, United Kingdom
| | - C Yuan
- Department of Medicine, Health Science Centre, McMaster University, Hamilton, ON, Canada
| | - R Nair
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - R Thurairaja
- Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
| | - M S Khan
- Department of Urology, Guy’s and St Thomas’ NHS Foundation Trust, London, United Kingdom
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Grover S, Raj S, Russell B, Thomas K, Nair R, Thurairaja R, Khan MS, Malde S. 733 Long-Term Outcomes of Outpatient Laser Ablation for Recurrent Non-Muscle Invasive Bladder Cancer: A Retrospective Cohort Study. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.1092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
Non-muscle-invasive bladder cancer (NMIBC) is the most prevalent form of bladder cancer, predominantly affecting the elderly population. The most common treatment for recurrent NMIBC is transurethral resection of the bladder tumour (TURBT), which carries a risk of perioperative morbidity and mortality in this often-co-morbid population. Outpatient laser ablation of low-grade NMIBC recurrences is a minimally invasive treatment option, but long-term efficacy is poorly reported.
Method
We retrospectively reviewed the case notes of all patients treated with Holmium:YAG laser ablation from 2008-2016. Data regarding patient demographics, original histology, dates of procedures, follow-up time, recurrence, progression, and complications were recorded.
Results
A total of 199 procedures were performed on 97 patients (mean age of 83.56), 73 (75.3%) of which originally had low-grade (G1 or G2) tumours. Overall, 55 (56.7%) patients developed tumour recurrence at long-term follow-up (mean 5.36 years), and only 9 (9.3%) patients had tumour progression to a higher stage or grade, but there was no progression to muscle-invasive disease. The median recurrence-free, progression-free and overall survival times were 1.69 years (95% CI 1.20-2.25), 5.70 years (95% CI 4.10-7.60) and 7.60 years (95% CI 4.90-8.70), respectively. No patients required emergency inpatient admission after laser ablation for any associated complications.
Conclusions
Office-based Holmium: YAG laser ablation is an oncologically-safe method of managing recurrent low-grade non-muscle-invasive bladder cancer in the long-term, with no patients progressing to muscle-invasive disease. Furthermore, the procedure is safe, and no significant complications were seen in this elderly and co-morbid population.
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Affiliation(s)
- S Grover
- Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - S Raj
- Faculty of Life Sciences & Medicine, King's College London, London, United Kingdom
| | - B Russell
- Translational Oncology and Urology Research, King's College London, London, United Kingdom
| | - K Thomas
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - R Nair
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - R Thurairaja
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - M S Khan
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - S Malde
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
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20
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Khan RA, Ullah Z, Zaman IU, Khan MS, Mahmood S, Akhtar N, Khan MF, Yasmin S, Saqlain M, Rehman AU, Aksar N, Khan SN, Hussain SS. Population distribution and habitat analysis of Rufous treepie (Dendrocitta vagabunda) in Abbottabad, Pakistan. BRAZ J BIOL 2021; 83:e247018. [PMID: 34431914 DOI: 10.1590/1519-6984.247018] [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: 12/27/2020] [Accepted: 02/10/2021] [Indexed: 11/21/2022] Open
Abstract
The Rufous treepie (Dendrocitta vagabunda) belongs to family corvidae, order Passeriformes which includes about 100 species. The current study was conducted to gather information about the Population distribution and habitat analysis of D. vagabunda at District Abbottabad, Pakistan. The data were collected on monthly basis both morning and evening times (2018-2019). "The ''Point count Method" was used for population estimation and ''Quadrates Method" for habitat analysis of study area. The result shows an average month-wise population density of D. vagabunda was maximum at Jhangra 0.14±0.039/ha, whereas minimum at Havelian 0.11±0.022/ha. There was no significant difference (p>0.05) among monthly population densities of D. vagabunda, however, a significant difference (p<0.05) was found between morning and evening times population of the specie. The present study revealed that importance value index (IVI) of plants species at Sherwan, Bakot, Havelian, Langra and Jhangra were 59.6±12.6, 50.1±6.9, 53.4±6.3, 66.8±10 and 60.1±7.7. Likewise, the frequency of shrubs at Sherwan, Bakot, Havelian, Langra and Jhangra were 33.3±4.2, 45±9.4, 46.7±8.2, 55.6±22.2 and 37.5±8.5. Similarly, the frequency of herbs at Sherwan, Bakot, Havelian, Langra and Jhangra were 40.4±6.0, 37.5±5.6, 53.3±7.4, 48.5±5.2 and 46.9±7.4 respectively. Our results show the study area as suitable habitat for D. vagabunda.
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Affiliation(s)
- R A Khan
- Hazara University Mansehra, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
| | - Z Ullah
- Hazara University, Department of Zoology, Sub-Campus Battagram, Khyber Pakhtunkhwa, Pakistan
| | - I Uz Zaman
- Khyber Pakhtunkhwa Wildlife Department, Pakistan
| | - M S Khan
- University of Swabi, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
| | - S Mahmood
- Hazara University Mansehra, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
| | - N Akhtar
- Hazara University, Department of Zoology, Sub-Campus Battagram, Khyber Pakhtunkhwa, Pakistan
| | - M F Khan
- Hazara University Mansehra, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
| | - S Yasmin
- Hazara University Mansehra, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
| | - M Saqlain
- Horizon Degree College Chakwal, Department of Zoology, Pakistan
| | - A Ur Rehman
- Hazara University Mansehra, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
| | - N Aksar
- Hazara University Mansehra, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
| | - S N Khan
- Hazara University Mansehra, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
| | - S S Hussain
- Hazara University Mansehra, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
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21
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Munch MW, Granholm A, Myatra SN, Vijayaraghavan BKT, Cronhjort M, Wahlin RR, Jakob SM, Cioccari L, Kjær MN, Vesterlund GK, Meyhoff TS, Helleberg M, Møller MH, Benfield T, Venkatesh B, Hammond N, Micallef S, Bassi A, John O, Jha V, Kristiansen KT, Ulrik CS, Jørgensen VL, Smitt M, Bestle MH, Andreasen AS, Poulsen LM, Rasmussen BS, Brøchner AC, Strøm T, Møller A, Khan MS, Padmanaban A, Divatia JV, Saseedharan S, Borawake K, Kapadia F, Dixit S, Chawla R, Shukla U, Amin P, Chew MS, Gluud C, Lange T, Perner A. Higher vs lower doses of dexamethasone in patients with COVID-19 and severe hypoxia (COVID STEROID 2) trial: Protocol and statistical analysis plan. Acta Anaesthesiol Scand 2021; 65:834-845. [PMID: 33583034 PMCID: PMC8014264 DOI: 10.1111/aas.13795] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 01/31/2021] [Indexed: 12/29/2022]
Abstract
Background The coronavirus disease 2019 (COVID‐19) pandemic has resulted in millions of deaths and overburdened healthcare systems worldwide. Systemic low‐dose corticosteroids have proven clinical benefit in patients with severe COVID‐19. Higher doses of corticosteroids are used in other inflammatory lung diseases and may offer additional clinical benefits in COVID‐19. At present, the balance between benefits and harms of higher vs. lower doses of corticosteroids for patients with COVID‐19 is unclear. Methods The COVID STEROID 2 trial is an investigator‐initiated, international, parallel‐grouped, blinded, centrally randomised and stratified clinical trial assessing higher (12 mg) vs. lower (6 mg) doses of dexamethasone for adults with COVID‐19 and severe hypoxia. We plan to enrol 1,000 patients in Denmark, Sweden, Switzerland and India. The primary outcome is days alive without life support (invasive mechanical ventilation, circulatory support or renal replacement therapy) at day 28. Secondary outcomes include serious adverse reactions at day 28; all‐cause mortality at day 28, 90 and 180; days alive without life support at day 90; days alive and out of hospital at day 90; and health‐related quality of life at day 180. The primary outcome will be analysed using the Kryger Jensen and Lange test adjusted for stratification variables and reported as adjusted mean differences and median differences. The full statistical analysis plan is outlined in this protocol. Discussion The COVID STEROID 2 trial will provide evidence on the optimal dosing of systemic corticosteroids for COVID‐19 patients with severe hypoxia with important implications for patients, their relatives and society.
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Affiliation(s)
- MW Munch
- Department of Intensive Care, Rigshospitalet University of Copenhagen Copenhagen Denmark
- Collaboration for Research in Intensive Care (CRIC) Copenhagen Denmark
| | - Anders Granholm
- Department of Intensive Care, Rigshospitalet University of Copenhagen Copenhagen Denmark
- Collaboration for Research in Intensive Care (CRIC) Copenhagen Denmark
| | - SN Myatra
- Department of Anaesthesia Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute Mumbai India
| | - BKT Vijayaraghavan
- Department of Critical Care Apollo Hospitals Chennai India
- Chennai Critical Care Consultants Chennai India
- The George Institute for Global Health, University of New South Wales New Delhi India
| | - Maria Cronhjort
- Department of Clinical Science and Education, Södersjukhuset Karolinska Institutet Stockholm Sweden
| | - RR Wahlin
- Department of Clinical Science and Education, Södersjukhuset Karolinska Institutet Stockholm Sweden
| | - Stephan M. Jakob
- Department of Intensive Care Medicine Inselspital, Bern University Hospital, University of Bern Bern Switzerland
| | - Luca Cioccari
- Department of Intensive Care Medicine Inselspital, Bern University Hospital, University of Bern Bern Switzerland
| | - MN Kjær
- Department of Intensive Care, Rigshospitalet University of Copenhagen Copenhagen Denmark
- Collaboration for Research in Intensive Care (CRIC) Copenhagen Denmark
| | - GK Vesterlund
- Department of Intensive Care, Rigshospitalet University of Copenhagen Copenhagen Denmark
- Collaboration for Research in Intensive Care (CRIC) Copenhagen Denmark
| | - TS Meyhoff
- Department of Intensive Care, Rigshospitalet University of Copenhagen Copenhagen Denmark
- Collaboration for Research in Intensive Care (CRIC) Copenhagen Denmark
| | - Marie Helleberg
- Department of Infectious Diseases, Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - MH Møller
- Department of Intensive Care, Rigshospitalet University of Copenhagen Copenhagen Denmark
- Collaboration for Research in Intensive Care (CRIC) Copenhagen Denmark
| | - Thomas Benfield
- Department of Infectious Diseases, Center of Research & Disruption of Infectious Diseases Copenhagen University Hospital – Amager and Hvidovre Copenhagen Denmark
| | - Balasubramanian Venkatesh
- The George Institute for Global Health, University of New South Wales Sydney New South Wales Australia
| | - Naomi Hammond
- The George Institute for Global Health, University of New South Wales Sydney New South Wales Australia
| | - Sharon Micallef
- The George Institute for Global Health, University of New South Wales Sydney New South Wales Australia
| | - Abhinav Bassi
- The George Institute for Global Health, University of New South Wales New Delhi India
| | - Oommen John
- The George Institute for Global Health, University of New South Wales New Delhi India
- Prasanna School of Public Health Manipal Academy of Higher Education Manipal India
| | - Vivekanand Jha
- The George Institute for Global Health, University of New South Wales New Delhi India
- Prasanna School of Public Health Manipal Academy of Higher Education Manipal India
- School of Public Health Imperial College London London UK
| | - KT Kristiansen
- Department of Anaesthesia and Intensive Care Hvidovre Hospital, University of Copenhagen Copenhagen Denmark
| | - CS Ulrik
- Department of Respiratory Medicine Hvidovre Hospital, University of Copenhagen Copenhagen Denmark
| | - VL Jørgensen
- Department of Thoracic Anaesthesiology, Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Margit Smitt
- Department of Neuroanaesthesiology, Rigshospitalet University of Copenhagen Copenhagen Denmark
| | - Morten H. Bestle
- Department of Anaesthesiology and Intensive Care Copenhagen University Hospital Nordsjælland Denmark
- Department of Clinical Medicine University of Copenhagen Copenhagen Denmark
| | - AS Andreasen
- Department of Anaesthesia and Intensive Care Herlev Hospital, University of Copenhagen Copenhagen Denmark
| | - LM Poulsen
- Department of Anaesthesiology Zealand University Hospital Copenhagen Denmark
| | - BS Rasmussen
- Collaboration for Research in Intensive Care (CRIC) Copenhagen Denmark
- Department of Anaesthesia and Intensive Care Aalborg University Hospital Aalborg Denmark
| | - AC Brøchner
- Department of Anaesthesia and Intensive Care Kolding Hospital Kolding Denmark
| | - Thomas Strøm
- Department of Anaesthesia and Critical Care Medicine Odense University Hospital Odense C Denmark
- Department of Anaesthesia and Critical Care Medicine Hospital Sønderjylland, University Hospital of Southern Denmark Odense Denmark
| | - Anders Møller
- Department of Anaesthesia and Intensive Care Næstved‐Slagelse‐Ringsted Hospital Slagelse Denmark
| | - MS Khan
- Department of Critical Care Medicine Rajendra Institute of Medical Sciences Ranchi India
| | - Ajay Padmanaban
- Department of Critical Care Apollo Hospitals Chennai India
- Chennai Critical Care Consultants Chennai India
| | - JV Divatia
- Department of Anaesthesia Critical Care and Pain, Tata Memorial Hospital, Homi Bhabha National Institute Mumbai India
| | | | - Kapil Borawake
- Department of Intensive Care Vishwaraj Hospital Pune India
| | - Farhad Kapadia
- Section of Critical Care, Department of Medicine Hinduja Hospital Mahim, Mumbai India
| | - Subhal Dixit
- Department of Critical Care Medicine Sanjeevan Hospital Pune Maharashtra India
| | - Rajesh Chawla
- Department of Respiratory and Critical Care Medicine Indraprastha Apollo Hospital New Delhi India
| | - Urvi Shukla
- Intensive Care Unit and Emergency Services Symbiosis University Hospital and Research Centre Lavale, Pune India
| | - Pravin Amin
- Department of Critical Care Medicine Bombay Hospital Institute of Medical Sciences Mumbai India
| | - Michelle S. Chew
- Department of Anesthesiology and Intensive Care, Biomedical and Clinical Sciences Linköping University Linköping Sweden
| | - Christian Gluud
- Copenhagen Trial Unit, Centre for Clinical Intervention Research Capital Region of Denmark, Rigshospitalet, Copenhagen University Hospital Copenhagen Denmark
| | - Theis Lange
- Department of Public Health, Section of Biostatistics University of Copenhagen Copenhagen Denmark
| | - Anders Perner
- Department of Intensive Care, Rigshospitalet University of Copenhagen Copenhagen Denmark
- Collaboration for Research in Intensive Care (CRIC) Copenhagen Denmark
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Brewin MP, Hijazi Y, Pope-Jones S, Exton RJ, Khan MS. Free tissue transfer for burns reconstruction: A single-site experience. Burns 2020; 46:1660-1667. [PMID: 32451129 DOI: 10.1016/j.burns.2020.04.001] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 03/30/2020] [Accepted: 04/02/2020] [Indexed: 11/15/2022]
Abstract
This study reviews free tissue transfer (FTT) surgery for both acute wound and reconstructive scar management of burn injuries at a UK burns unit over a 10-year period. Thirty eight patients underwent 46 FTTs, or free flaps, as part of their burn injury pathway. For the cohort of patients, there was one flap failure, which occurred for a secondary scar reconstruction. It is noted that FTT was successful for all seven acute or primary interventions. Anterolateral thigh flap was the most frequently performed (57%); followed by parascapular flaps (22%) of which 43% were pre-expanded. A method of pre-expansion for neck contractures and a novel technique of anchoring this flap to the pre-tracheal fascia are described here. This can provide the patient with good neck contouring by using the capsule to hitch the flap into a good position. It is clear that further work is required to study the prevention of hypertrophic scarring that can occur at the interface between flap and adjacent skin, where occurrence rate in this cohort was 17%. It is proposed that FTT now provides a viable solution both to the coverage of complex burn wounds and to the revision of scar contractures. Consensus over an FTT protocol for the primary management of open burn wounds is seen as the logical next step for this surgical intervention.
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Affiliation(s)
- M P Brewin
- Department of Plastic and Reconstructive and Burns Surgery, Salisbury NHS Foundation Trust, Odstock Road, Salisbury SP2 8BJ, United Kingdom.
| | - Y Hijazi
- Department of Plastic and Reconstructive and Burns Surgery, Salisbury NHS Foundation Trust, Odstock Road, Salisbury SP2 8BJ, United Kingdom
| | - S Pope-Jones
- Department of Plastic and Reconstructive and Burns Surgery, Salisbury NHS Foundation Trust, Odstock Road, Salisbury SP2 8BJ, United Kingdom
| | - R J Exton
- Department of Plastic and Reconstructive and Burns Surgery, Salisbury NHS Foundation Trust, Odstock Road, Salisbury SP2 8BJ, United Kingdom
| | - M S Khan
- Department of Plastic and Reconstructive and Burns Surgery, Salisbury NHS Foundation Trust, Odstock Road, Salisbury SP2 8BJ, United Kingdom
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Khan MS, Khan M, Aivaz O. Transient acantholytic dermatosis in a patient with prostate cancer. Dermatol Online J 2020; 26:13030/qt02s0n1zr. [PMID: 32239889] [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] [Received: 03/26/2020] [Accepted: 03/26/2020] [Indexed: 06/11/2023] Open
Abstract
Transient acantholytic dermatosis (TAD) is a relatively common entity that has been also noted to occur in patients with cancer. Herein, we describe a case of transient acantholytic dermatosis occurring in a patient with a history of prostate cancer status post radiation, now being treated with combination therapy with pembrolizumab and carboplatin-pemetrexed for advanced lung adenocarcinoma. Our case emphasizes the importance of being cognizant of TAD and its associations, particularly in cancer patients.
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Affiliation(s)
| | - M Khan
- Foundation University Medical College, Islamabad
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Mahmood M, Avula S, Patti DK, Khan MS, Singh H. P1731 Multiple floating thrombi in aortic arch leading to acute stroke: A case report and systematic review of literature. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.1092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Around 10-15% of acute cerebrovascular events occur in young adults with age less than 40 years. Trans-oesophageal echocardiogram (TOE) is routinely performed to rule out any cardio-embolic source in patients with ischemic stroke. TOE has shown to significantly change management strategy in up to 16.7% of stroke cases. We report a rare case of recurrent stroke in a young female who was found to have multiple mobile thrombi in aortic arch on TOE. We also report systematic review of literature of similar cases to highlight the management strategies.
Case Presentation
A 38-year-old female presented with one-week history of right upper and lower extremity paresthesia along with headache. Physical examination was unremarkable for any focal neurological deficits at time of initial evaluation. She had pertinent history of acute stroke two years ago associated with non-occlusive left common carotid artery thrombus for which she was previously on anticoagulation with rivaroxaban. The anticoagulation, however, was stopped five months ago after repeat imaging revealed complete resolution of thrombus. Electrocardiogram showed normal sinus rhythm without any other significant abnormality. CT head showed no acute bleeding or infarct. MRI brain showed scattered infarcts in right cerebral hemisphere and left cerebellar hemisphere. CT angiography of head and neck showed multiple small nodular and linear pedunculated thrombi in distal arch of aorta (see Figure 2). TOE was then performed which confirmed two pedunculated and mobile echogenic masses, largest measuring 0.9 x 0.6 cm, in the distal aortic arch (see Figure 1). TOE did not show intracardiac source of embolism. Laboratory testing for thrombophilia was negative for Factor V and Prothrombin gene mutation and heterozygous positive for Methylenetetrahydrofolate reductase (MTHFR)-677T gene. She was also found to have elevated homocysteine levels. She was restarted on anticoagulation with rivaroxaban.
Discussion and Conclusion
Young patients with stroke should undergo detailed investigation to rule out hypercoagulable pathology and cardiovascular embolic source. This should also include multimodality imaging including TOE in the selected patients. During TOE examination, a particular attention should be paid for evaluation of aortic source of thombo-embolism. Our patient was heterozygous for MTHFR-66T gene which is associated with decreassed activity of MTHFR by 35 % with elevated homocysteine levels. Treatment of floating aortic thrombus is still controversial. Anticoagulation is suggested as primary modality by multiple authors who reported complete resolution of thrombus. Other option includes surgical thrombectomy. Our patient was treated with anticoagulation alone due to hypercoagulable state and small size of thrombi.
Abstract P1731 Figure.
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Affiliation(s)
- M Mahmood
- Mercy-Health St Vincent Medical Center, Cardiovascular Fellowship, Toledo, United States of America
| | - S Avula
- Mercy-Health St Vincent Medical Center, Cardiovascular Fellowship, Toledo, United States of America
| | - D K Patti
- Mercy-Health St Vincent Medical Center, Internal Medicine Residency, Toledo, United States of America
| | - M S Khan
- Mercy-Health St Vincent Medical Center, Internal Medicine Residency, Toledo, United States of America
| | - H Singh
- Mercy-Health St Vincent Medical Center, Cardiovascular Fellowship, Toledo, United States of America
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Khan MS, Ibrahim SM, Adamu AA, Rahman MBA, Bakar MZA, Noordin MM, Loqman MY. Pre-grafting histological studies of skin grafts cryopreserved in α helix antarctic yeast oriented antifreeze peptide (Afp1m). Cryobiology 2019; 92:26-33. [PMID: 31580830 DOI: 10.1016/j.cryobiol.2019.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Revised: 09/27/2019] [Accepted: 09/28/2019] [Indexed: 10/25/2022]
Abstract
A number of living creatures in the Antarctic region have developed characteristic adaptation of cold weather by producing antifreeze proteins (AFP). Antifreeze peptide (Afp1m) fragment have been designed in the sequence of strings from native proteins. The objectives of this study were to assess the properties of Afp1m to cryopreserve skin graft at the temperature of -10 °C and -20 °C and to assess sub-zero injuries in Afp1m cryopreserved skin graft using light microscopic techniques. In the present study, a process was developed to cryopreserve Sprague-Dawley (SD) rat skin grafts with antifreeze peptide, Afp1m, α-helix peptide fragment derived from Glaciozyma antractica yeast. Its viability assessed by different microscopic techniques. This study also described the damages caused by subzero temperatures (-10 and -20 °C) on tissue cryopreserved in different concentrations of Afp1m (0.5, 1, 2, 5 and 10 mg/mL) for 72 h. Histological scores of epidermis, dermis and hypodermis of cryopreserved skin grafts showed highly significant difference (p < 0.01) among the different concentrations at -10 and -20 °C. In conclusion, the integrity of cryopreserved skin grafts with lower concentrations of Afp1m (0.5, 1 and 2 mg/mL) or at -20 °C was not maintained. The present study attested that Afp1m is a good cryoprotective agent for the cryopreservation of skin graft. Higher Afp1m concentrations (5 and 10 mg/mL) at -10 °C found to be suitable for the future in vivo study using (SD) rat skin grafts.
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Affiliation(s)
- M S Khan
- Department of Companion Animal Medicine and Surgery, Faculty of Veterinary Medicine, Universiti Putra, Malaysia; Department of Basic Veterinary Sciences, Faculty of Veterinary and Animal Sciences, Gomal University D.I.Khan, Pakistan
| | - S M Ibrahim
- Department of Companion Animal Medicine and Surgery, Faculty of Veterinary Medicine, Universiti Putra, Malaysia; Department of Surgery and Theriogenology, College of Veterinary Medicine, University of Mosul, Iraq
| | - A A Adamu
- Department of Companion Animal Medicine and Surgery, Faculty of Veterinary Medicine, Universiti Putra, Malaysia
| | - M B A Rahman
- Department of Chemistry, Faculty of Science, Universiti Putra, Malaysia
| | - M Z Abu Bakar
- Department of Pre-Clinical Veterinary Studies, Faculty of Veterinary Medicine, Universiti Putra, Malaysia
| | - M M Noordin
- Department of Veterinary Pathology and Microbiology, Faculty of Veterinary Medicine, Universiti Putra, Malaysia
| | - M Y Loqman
- Department of Companion Animal Medicine and Surgery, Faculty of Veterinary Medicine, Universiti Putra, Malaysia.
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Connelly TM, Khan MS, Alzamzami M, Cooke F. An evaluation of the quality and content of web-based stoma information. Colorectal Dis 2019; 21:349-356. [PMID: 30472797 DOI: 10.1111/codi.14497] [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] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2018] [Accepted: 10/23/2018] [Indexed: 02/08/2023]
Abstract
AIM Although the internet is commonly the first port of call for medical information, it provides unregulated data of variable quality. We aimed to evaluate commonly accessed web-based information on intestinal stomas using validated and novel scoring systems. METHOD The keywords 'stoma', 'colostomy', 'ileostomy' and 'bowel bag' were entered into the most commonly used internet search engines (Google, Bing and Yahoo). The first ten websites from each search were analysed using the validated Journal of the American Medical Association (JAMA) benchmark criteria and DISCERN scoring systems. A novel stoma-specific score was devised and applied. RESULTS Forty-three unique websites were identified. The majority (49%) were from nonprofit or governmental agencies and 9% were from commercial entities. The mean total DISCERN score for all websites was 42.4 ± 10.2 (maximum possible score = 75). The mean JAMA and stoma-specific scores were 2.1 ± 1.0 (maximum possible score = 4) and 12.9 ± 6.1 (maximum possible score = 27). The lowest JAMA scores were in the category of attribution, with 70% of websites lacking references for the information provided. A total of 88% displayed disclosure/paid advertiser information. Surgery was described in 67%. An image or diagram was provided in 58% and in 72% a stoma therapist/nurse was mentioned. Information on when to seek medical help was provided in 51%. CONCLUSION Web-based information on stomas is of variable content and quality. Authorship and information sources are often unclear. Only half provided information on when to seek medical help for complications including high output and dehydration. These findings should be highlighted to patients who utilize the internet to obtain information on stomas.
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Affiliation(s)
- T M Connelly
- Department of Colorectal Surgery, University Hospital Waterford, Waterford, Ireland
| | - M S Khan
- Department of Surgery, University Hospital Waterford, Waterford, Ireland
| | - M Alzamzami
- Department of Surgery, University Hospital Waterford, Waterford, Ireland
| | - F Cooke
- Department of Colorectal Surgery, University Hospital Waterford, Waterford, Ireland
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Khan MS, Lakha F, Tan MMJ, Singh SR, Quek RYC, Han E, Tan SM, Haldane V, Gea-Sánchez M, Legido-Quigley H. More talk than action: gender and ethnic diversity in leading public health universities. Lancet 2019; 393:594-600. [PMID: 30739695 DOI: 10.1016/s0140-6736(18)32609-6] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 10/05/2018] [Accepted: 10/17/2018] [Indexed: 11/18/2022]
Abstract
Improving the career progression of women and ethnic minorities in public health universities has been a longstanding challenge, which we believe might be addressed by including staff diversity data in university rankings. We present findings from a mixed methods investigation of gender-related and ethnicity-related differences in career progression at the 15 highest ranked social sciences and public health universities in the world, including an analysis of the intersection between sex and ethnicity. Our study revealed that clear gender and ethnic disparities remain at the most senior academic positions, despite numerous diversity policies and action plans reported. In all universities, representation of women declined between middle and senior academic levels, despite women outnumbering men at the junior level. Ethnic-minority women might have a magnified disadvantage because ethnic-minority academics constitute a small proportion of junior-level positions and the proportion of ethnic-minority women declines along the seniority pathway.
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Affiliation(s)
- Mishal Sameer Khan
- Communicable Diseases Policy Research Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Fatim Lakha
- Communicable Diseases Policy Research Group, London School of Hygiene & Tropical Medicine, London, UK
| | - Melisa Mei Jin Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | | | | | - Emeline Han
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - See Mieng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Victoria Haldane
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Montserrat Gea-Sánchez
- Department of Nursing and Physiotherapy, Health-Care Research Group (GRECS), Institute of Biomedical Research of Lleida (IRBLleida), Lleida, Spain; Grup d'Estudis Societat, Salut, Educació, Cultura (GESEC), Institut de Desenvolupament Social i Territorial (INDEST), University of Lleida, Lleida, Spain
| | - Helena Legido-Quigley
- Department of Global Health and Development, London School of Hygiene & Tropical Medicine, London, UK; Saw Swee Hock School of Public Health, National University of Singapore, Singapore.
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Abstract
AIMS Many authors have reported a shorter treatment time when using trifocal bone transport (TFT) rather than bifocal bone transport (BFT) in the management of long segmental tibial bone defects. However, the difference in the incidence of additional procedures, the true complications, and the final results have not been investigated. PATIENTS AND METHODS A total of 86 consecutive patients with a long tibial bone defect (≥ 8 cm), who were treated between January 2008 and January 2015, were retrospectively reviewed. A total of 45 were treated by BFT and 41 by TFT. The median age of the 45 patients in the BFT group was 43 years (interquartile range (IQR) 23 to 54). RESULTS The size of the bone defect was significantly longer (p = 0.005), the number of previous operations was significantly higher (p < 0.001), the operating time was significantly longer (p < 0.001), and the bone transport distance was significantly increased (p = 0.017) in the TFT group. However, the external fixation time (p < 0.001), the healing index (p < 0.001), the number of additional procedures (p = 0.013), and the number of true complications (p < 0.001) were significantly reduced in this group. Both groups achieved highly satisfactory bone and functional results. CONCLUSION TFT can significantly reduce the treatment time, the number of additional surgical procedures, and true complications compared with BFT in the treatment of long segmental tibial bone defects.
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Affiliation(s)
- M A Catagni
- Medical School, University of Milan, Milan, Italy; Director of the Ilizarov Unit, Mangioni Hospital, Lecco, Italy
| | - W Azzam
- Department of Orthopaedic Surgery and Traumatology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - F Guerreschi
- Department of Orthopaedic Surgery and Traumatology, Alessandro Manzoni Hospital, Lecco, Italy
| | - L Lovisetti
- Villa Aprica Clinical Institute, Como, Italy
| | - P Poli
- Department of Orthopaedic Surgery and Traumatology, Alessandro Manzoni Hospital, Lecco, Italy
| | - M S Khan
- Isra University Hospital, Hyderabad, Pakistan
| | - L M Di Giacomo
- Division of Orthopaedics and Trauma Surgery, University of Perugia, S. Maria della Misericordia Hospital, Perugia, Italy
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Khan MS, Dighe K, Wang Z, Srivastava I, Daza E, Schwartz-Dual AS, Ghannam J, Misra SK, Pan D. Detection of prostate specific antigen (PSA) in human saliva using an ultra-sensitive nanocomposite of graphene nanoplatelets with diblock-co-polymers and Au electrodes. Analyst 2019; 143:1094-1103. [PMID: 29387841 DOI: 10.1039/c7an01932g] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Prostate-specific antigen (PSA) is a commonly used biomarker for the detection of prostate cancer (PCa) and there are numerous data available for its invasive detection in the serum and whole blood. In this work, an electrochemical sensing method was devised to detect traces of PSA in human saliva using a hybrid nanocomposite of graphene nanoplatelets with diblock co-polymers and Au electrodes (GRP-PS67-b-PAA27-Au). The pure graphitic composition on filter paper provides significantly high electrical and thermal conductivity while PS67-b-PAA27 makes an amphiphilic bridge between GRP units. The sensor utilizes the binding of an anti-PSA antibody with an antigen-PSA to act as a resistor in a circuit providing an impedance change that in turn allows for the detection and quantification of PSA in saliva samples. A miniaturized electrical impedance analyzer was interfaced with a sensor chip and the data were recorded in real-time using a Bluetooth-enabled module. This fully integrated and optimized sensing device exhibited a wide PSA range of detection from 0.1 pg mL-1 to 100 ng mL-1 (R2 = 0.963) with a lower limit of detection of 40 fg mL-1. The performance of the biosensor chip was validated with an enzyme-linked immunosorbent assay technique with a regression coefficient as high as 0.940. The advantages of the newly developed saliva-PSA electrical biosensor over previously reported serum-PSA electrochemical biosensors include a faster response time (3-5 min) to achieve a stable electrical signal for PSA detection, high selectivity, improved sensitivity, no additional requirement of a redox electrolyte for electron exchange and excellent shelf life. The presented sensor is aimed for clinical commercialization to detect PSA in human saliva.
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Affiliation(s)
- M S Khan
- Bioengineering Department, University of Illinois at Urbana-Champaign, Urbana, IL 61801, USA.
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Sumi SA, Sultana SZ, Mannan S, Paul UK, Khan MS, Faruque MO, Rahman M, Sultana N, Khan NJ, Jabeen L, Jannat T, Bose SK. Variations in the Position of Vermiform Appendix in Bangladeshi People. Mymensingh Med J 2019; 28:54-59. [PMID: 30755551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
This cross sectional descriptive study was performed on 70 postmortem vermiform appendices (male 34 and female 36) to find out the various positions of vermiform appendix of Bangladeshi people. The specimens were collected from autopsy laboratory of the Department of Forensic Medicine, Mymensingh Medical College, Mymensingh, Bangladesh by purposive sampling technique from October 2016 to March 2017. The collected samples were divided into four age groups. They were Group A (upto 20 years), Group B (21 to 40 years), Group C (41 to 60 years) and Group D (above 60 years). Dissection was performed according to standard autopsy technique. During postmortem examination abdominal cavity was routinely exposed by classical midline incision from xiphoid process to the symphysis pubis and a semicircular incision around the umbilicus and the flaps were reflected to give a good view of the abdominal cavity along with its contents and then the taeniae coli of the caecum were identified. The three taeniae coli of the caecum converge at the base of the appendix and become its longitudinal muscle coat. The anterior caecal taeniae coli acts as the best guide for identification of the vermiform appendix. The relation of the base of the appendix to the caecum is constant but the position of the vermiform appendix, which is variable, was studied in relation to caecum and the terminal part of the ileum. Accordingly the position of the vermiform appendix was noted either retrocaecal, pelvic, preileal or postileal, subcaecal. All data were recorded in the predesigned data sheet, analyzed by SPSS program (version 21, 2012) and compared with the findings of other national and international studies and standard text books. Among 70 specimens, 44(62.9%) vermiform appendices were retrocaecal in position. The next common position was pelvic which was in 22(31.4%) specimen followed by postileal in 3(4.3%) specimen and subcaecal was observed only in 1(1.4%) specimen. In this study in all age groups incidence of retrocaecal vermiform appendix was highest and it was about 67.6%, 50%, 69.2% and 72.7% in Group A, B, C, D respectively. Pelvic position was 7.1%, 46.9%, 23.1% and 27.3% in Group A, B, C, D respectively. Subcaecal vermiform appendix was absent in Group A, B and Group D. On the other hand postileal vermiform appendix was absent in Group C and Group D. The findings of this study may help the physician and the surgeons for proper diagnosis, management and treatment of disease of vermiform appendix.
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Affiliation(s)
- S A Sumi
- Dr Sharmin Akter Sumi, M Phil Student Thesis Part Complete, Department of Anatomy, Mymensingh Medical College (MMC), Mymensingh, Bangladesh
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Khan MS, Rahlves M, Lachmayer R, Roth B. Polymer-based diffractive optical elements for rear end automotive applications: design and fabrication process. Appl Opt 2018; 57:9106-9113. [PMID: 30461900 DOI: 10.1364/ao.57.009106] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 09/26/2018] [Indexed: 06/09/2023]
Abstract
Advances in illumination technology in the automotive industry are heading toward the use of coherent sources for adaptable and high-resolution head lamps as well as interior and rear-end lights. We present a cost-effective method to fabricate and design laser-based lighting systems for the rear end in automobiles and other vehicles. The design relies on using binary gratings to generate a desired intensity distribution. For cost-effective fabrication, an optical maskless UV lithography system that employs a spatial light modulator (SLM) for projection of the desired structure onto photoresist is introduced. To replicate the structures onto polymers like poly(methyl methacrylate) (PMMA), we use polydimethylsiloxane soft stamps and a hot embossing system. The experimental results show that the proposed design and fabrication process is promising for high-resolution rear-end lights that might be employed to project symbols or information to guide road users in future.
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Khan MS, Ning Y, Jinou C, Hutchison C, Yoong J, Lin X, Coker RJ. Are global tuberculosis control targets overlooking an essential indicator? Prolonged delays to diagnosis despite high case detection rates in Yunnan, China. Health Policy Plan 2018; 32:i15-i21. [PMID: 29028224 DOI: 10.1093/heapol/czx046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2017] [Indexed: 11/14/2022] Open
Abstract
Delay in treating active tuberculosis (TB) impedes disease control by allowing ongoing transmission, and may explain the unexpectedly modest declines in global TB incidence. Even though China has achieved TB control targets under the global Directly Observed Treatment, Short course (DOTS) strategy, TB prevalence in western provinces, including Yunnan, is not decreasing. This cross-sectional study investigates whether prolonged delay in identifying and correctly treating TB patients, which is not routinely monitored, persists even when there is a well-functioning TB control programme and global targets are being met. Records of adult smear-positive pulmonary TB patients diagnosed with between 2006 and 2013 were extracted from the Yunnan Centre for Disease Control electronic database, which contains information on the entire population of TB patients managed across 129 diagnostic centres. Delay was investigated at three stages: delay to DOTS facility (period between symptom onset and first visit to at a CDC unit providing standardized treatment); delay to TB confirmation (period between reaching a CDC unit and confirmation of smear-positive TB) and delay to treatment (period between confirmation of TB and initiation of treatment). Data from 76 486 patients was analysed. Delay to reaching a DOTS facility was by far the largest contributor to total delay to treatment initiation. The median delay to reaching a DOTS facility, to TB confirmation and to treatment was 57 days (IQR 25-112), 2 days (IQR 1-6) and 1 day (IQR 0-1) respectively. Prolonged delays to reaching a facility providing standardized TB care occurred in a substantial subset of the population despite all TB control targets being met; overall, 32% (24 676) of patients experienced a delay of more than 90 days to reaching a DOTS facility. Policies that focus on reducing delays in accessing appropriate health services, rather than only on increasing overall case-detection rates, may result in greater progress towards reducing TB incidence.
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Affiliation(s)
- M S Khan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore.,Communicable Diseases Policy Research Group, London School of Hygiene and Tropical Medicine London, UK
| | - Y Ning
- Communicable Diseases Policy Research Group, London School of Hygiene and Tropical Medicine London, UK.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - C Jinou
- Yunnan Provincial Centres for Disease Control and Prevention, Yunnan, China
| | - C Hutchison
- Communicable Diseases Policy Research Group, London School of Hygiene and Tropical Medicine London, UK
| | - J Yoong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore.,Yunnan Provincial Centres for Disease Control and Prevention, Yunnan, China
| | - X Lin
- Center for Economic and Social Research, University of Southern California, Los Angeles, CA, USA
| | - R J Coker
- Communicable Diseases Policy Research Group, London School of Hygiene and Tropical Medicine London, UK.,Faculty of Public Health, Mahidol University, Bangkok, Thailand
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Sidharta SD, Yin JDC, Yoong JSY, Khan MS. High use of private providers for first healthcare seeking by drug-resistant tuberculosis patients: a cross-sectional study in Yangon, Myanmar. BMC Health Serv Res 2018; 18:276. [PMID: 29642905 PMCID: PMC5896038 DOI: 10.1186/s12913-018-3077-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [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: 09/12/2017] [Accepted: 03/28/2018] [Indexed: 11/10/2022] Open
Abstract
Background Drug resistance is a growing challenge to tuberculosis (TB) control worldwide, but particularly salient to countries such as Myanmar, where the health system is fragmented across the public and private sector. A recent systematic review has identified a critical lack of evidence for local policymaking, particularly in relation to drivers of drug-resistance that could be the target of preventative efforts. To address this gap from a health systems perspective, our study investigates the healthcare-seeking behavior and preferences of recently diagnosed patients with drug-resistant tuberculosis (DR-TB), focusing on the use of private versus public healthcare providers. Methods The study was conducted in ten townships across Yangon with high DR-TB burden. Patients newly-diagnosed with DR-TB by GeneXpert were enrolled, and data on healthcare-seeking behavior and socio-economic characteristics were collected from patient records and interviews. A descriptive analysis of healthcare-seeking behavior was followed by the investigation of relationships between socio-economic factors and type of provider visited upon first feeling unwell, through univariate logistic regressions. Results Of 202 participants, only 8% reported first seeking care at public facilities, while 88% reported seeking care at private facilities upon first feeling unwell. Participants aged 25–34 (Odds Ratio = 0.33 [0.12–0.95]) and males (Odds Ratio = 0.39 [0.20–0.75]) were less likely to visit a private clinic or hospital than those aged 18–24 and females, respectively. In contrast, participants with higher income were more likely to utilize private providers. Prior to DR-TB diagnosis, 86% of participants took medications from private providers. After DR-TB diagnosis, only 7% of participants continued to take medications from private providers. Conclusion In urban Myanmar, most patients shifted to being managed exclusively in the public sector after being formally diagnosed with DR-TB. However, since the vast majority of DR-TB patients first visited private providers in the period leading to diagnosis, related issues such as unregulated quality of care, potential delays to diagnosis, and lack of care continuity may greatly influence the emergence of drug-resistance. A greater understanding of the health system and these healthcare-seeking behaviors may simultaneously strengthen TB control programmes and reduce government and out-of-pocket expenditures on the management of DR-TB.
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Affiliation(s)
- Sucitro Dwijayana Sidharta
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Jason Dean-Chen Yin
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore
| | - Joanne Su-Yin Yoong
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, #10-01, Singapore, 117549, Singapore.,Center for Economic and Social Research, University of Southern California, 1909 K St NW, Suite 530, Washington, DC, 20006-1101, USA
| | - Mishal Sameer Khan
- London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
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Shah M, Aydin A, Moran A, Khan MS, Dasgupta P, Ahmed K. The role of cognitive training in endourology: a randomised controlled trial. Actas Urol Esp 2018; 42:163-169. [PMID: 29292040 DOI: 10.1016/j.acuro.2017.06.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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: 05/09/2017] [Revised: 06/24/2017] [Accepted: 06/27/2017] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Cognitive training is an important training modality which allows the user to rehearse a procedure without physically carrying it out. This has led to recent interests to incorporate cognitive training within surgical education but research is currently limited. The use of cognitive training in surgery is not clear-cut and so this study aimed to determine whether, relative to a control condition, the use of cognitive training improves technical surgical skills on a ureteroscopy simulator, and if so whether one cognitive training method is superior. METHODS This prospective, comparative study recruited 59 medical students and randomised them to one of three groups: control- simulation training only (n=20), flashcards cognitive training group (n=20) or mental imagery cognitive training group (n=19). All participants completed three tasks at baseline on the URO Mentor simulator followed by the cognitive intervention if randomised to receive it. Participants then returned to perform an assessment task on the simulator. Outcome measures from the URO Mentor performance report was used for analysis and a quantitative survey was given to all participants to assess usefulness of training received. RESULTS This study showed cognitive training to have minimal effects on technical skills of participants. The mental imagery group had fewer laser misfires in the assessment task when compared to both control and flashcards group (P=.017, P=.036, respectively). The flashcards group rated their preparation to be most useful when compared to control (P=.0125). Other parameters analysed between the groups did not reach statistical significance. Cognitive training was found to be feasible and cost effective when carried out in addition to simulation training. CONCLUSION This study has shown that the role of cognitive training within acquisition of surgical skills is minimal and that no form of cognitive training was superior to another. Further research needs to be done to evaluate other ways of performing cognitive training.
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Affiliation(s)
- M Shah
- MRC Centre for Transplantation, King's College London, Londres, Reino Unido
| | - A Aydin
- MRC Centre for Transplantation, King's College London, Londres, Reino Unido
| | - A Moran
- School of Psychology, University College Dublin, Dublín, Irlanda
| | - M S Khan
- MRC Centre for Transplantation, King's College London, Londres, Reino Unido; Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, Londres, Reino Unido
| | - P Dasgupta
- MRC Centre for Transplantation, King's College London, Londres, Reino Unido; Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, Londres, Reino Unido
| | - K Ahmed
- MRC Centre for Transplantation, King's College London, Londres, Reino Unido; Department of Urology, Guy's and St. Thomas' NHS Foundation Trust, Londres, Reino Unido.
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Nazar M, Khan MS, Ijaz M, Anjum AA, Sana S, Setyawan EMN, Saleem MI, Ahmad I. Prevalence of Degnala disease in bovine along with screening of toxigenic fungi isolated from contaminated rice straw. J BIOL REG HOMEOS AG 2018; 32:269-274. [PMID: 29685005] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Toxigenic potential of different candidate fungi, isolated from rice straw feed of Degnala disease affected bovines was analyzed along with species, age, gender and seasonal prevalence. Of 1,536 cases, 104 (6.77%) showed positive signs with a significant association (p less than 0.05) between this disease and rice straw feeding, in buffaloes, and bovine aged over 1 year in the winter season. Complete blood count showed a marked increase in erythrocyte sedimentation rate and all white blood cells numbers, except lymphocytes in positive cases. There was a significant increase (p less than 0.05) in alanine amino transferase, aspirate amino transferase and alkaline phosphatase in the liver function test. At the same time, an increased value of creatinine was noted in the renal function test. For isolation and screening of toxigenic fungi, rice straw samples (n=40) being fed to the positive cases were processed further, and 85 fungal isolates were found, mainly of Aspergillus (57), Penicillium (10), Fusarium (04), Zygomycetes (03), Curvularia (01) and unidentified (10). All isolated fungi were subjected for mycotoxin production and only 11 showed mycotoxin-producing capability (including Aspergillus, Penicillium and Fusarium isolates) analyzed by thin layer chromatography and quantified through high performance liquid chromatography. It is concluded that all the fungi contaminating rice straw feed of Degnala affected animals were not toxigenic. This work will help in establishing major mycotoxin-producing fungi leading to the probable cause of Degnala disease in bovine.
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Affiliation(s)
- M Nazar
- University of Veterinary and Animal Sciences, Lahore, Pakistan
- Department of Theriogenology and Biotechnology, College of Veterinary Medicine, Seoul National University, Seoul, Korea
| | - M S Khan
- University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - M Ijaz
- University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - A A Anjum
- University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - S Sana
- University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - E M N Setyawan
- Department of Theriogenology and Biotechnology, College of Veterinary Medicine, Seoul National University, Seoul, Korea
| | - M I Saleem
- CMS Department, University of Agriculture, Faisalabad, Pakistan
| | - I Ahmad
- Faculty of Veterinary and Animal Sciences, University of the Poonch, Rawalakot Azad Jammu and Kashmir, Pakistan
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Wu S, Legido-Quigley H, Spencer J, Coker RJ, Khan MS. Designing evaluation studies to optimally inform policy: what factors do policy-makers in China consider when making resource allocation decisions on healthcare worker training programmes? Health Res Policy Syst 2018; 16:16. [PMID: 29471840 PMCID: PMC5824449 DOI: 10.1186/s12961-018-0292-2] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Accepted: 01/30/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND In light of the gap in evidence to inform future resource allocation decisions about healthcare provider (HCP) training in low- and middle-income countries (LMICs), and the considerable donor investments being made towards training interventions, evaluation studies that are optimally designed to inform local policy-makers are needed. The aim of our study is to understand what features of HCP training evaluation studies are important for decision-making by policy-makers in LMICs. We investigate the extent to which evaluations based on the widely used Kirkpatrick model - focusing on direct outcomes of training, namely reaction of trainees, learning, behaviour change and improvements in programmatic health indicators - align with policy-makers' evidence needs for resource allocation decisions. We use China as a case study where resource allocation decisions about potential scale-up (using domestic funding) are being made about an externally funded pilot HCP training programme. METHODS Qualitative data were collected from high-level officials involved in resource allocation at the national and provincial level in China through ten face-to-face, in-depth interviews and two focus group discussions consisting of ten participants each. Data were analysed manually using an interpretive thematic analysis approach. RESULTS Our study indicates that Chinese officials not only consider information about the direct outcomes of a training programme, as captured in the Kirkpatrick model, but also need information on the resources required to implement the training, the wider or indirect impacts of training, and the sustainability and scalability to other settings within the country. In addition to considering findings presented in evaluation studies, we found that Chinese policy-makers pay close attention to whether the evaluations were robust and to the composition of the evaluation team. CONCLUSIONS Our qualitative study indicates that training programme evaluations that focus narrowly on direct training outcomes may not provide sufficient information for policy-makers to make decisions on future training programmes. Based on our findings, we have developed an evidence-based framework, which incorporates but expands beyond the Kirkpatrick model, to provide conceptual and practical guidance that aids in the design of training programme evaluations better suited to meet the information needs of policy-makers and to inform policy decisions.
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Affiliation(s)
- Shishi Wu
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Singapore, 117549 Singapore
| | - Helena Legido-Quigley
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Singapore, 117549 Singapore
- Communicable Diseases Policy Research Group, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT United Kingdom
| | - Julia Spencer
- Communicable Diseases Policy Research Group, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT United Kingdom
| | - Richard James Coker
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2 #10-01, Singapore, 117549 Singapore
- Communicable Diseases Policy Research Group, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT United Kingdom
- Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - Mishal Sameer Khan
- Communicable Diseases Policy Research Group, London School of Hygiene & Tropical Medicine, Keppel St, London, WC1E 7HT United Kingdom
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James R, Khim K, Boudarene L, Yoong J, Phalla C, Saint S, Koeut P, Mao TE, Coker R, Khan MS. Tuberculosis active case finding in Cambodia: a pragmatic, cost-effectiveness comparison of three implementation models. BMC Infect Dis 2017; 17:580. [PMID: 28830372 PMCID: PMC5568199 DOI: 10.1186/s12879-017-2670-8] [Citation(s) in RCA: 11] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Accepted: 08/07/2017] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Globally, almost 40% of tuberculosis (TB) patients remain undiagnosed, and those that are diagnosed often experience prolonged delays before initiating correct treatment, leading to ongoing transmission. While there is a push for active case finding (ACF) to improve early detection and treatment of TB, there is extremely limited evidence about the relative cost-effectiveness of different ACF implementation models. Cambodia presents a unique opportunity for addressing this gap in evidence as ACF has been implemented using different models, but no comparisons have been conducted. The objective of our study is to contribute to knowledge and methodology on comparing cost-effectiveness of alternative ACF implementation models from the health service perspective, using programmatic data, in order to inform national policy and practice. METHODS We retrospectively compared three distinct ACF implementation models - door to door symptom screening in urban slums, checking contacts of TB patients, and door to door symptom screening focusing on rural populations aged above 55 - in terms of the number of new bacteriologically-positive pulmonary TB cases diagnosed and the cost of implementation assuming activities are conducted by the national TB program of Cambodia. We calculated the cost per additional case detected using the alternative ACF models. RESULTS Our analysis, which is the first of its kind for TB, revealed that the ACF model based on door to door screening in poor urban areas of Phnom Penh was the most cost-effective (249 USD per case detected, 737 cases diagnosed), followed by the model based on testing contacts of TB patients (308 USD per case detected, 807 cases diagnosed), and symptomatic screening of older rural populations (316 USD per case detected, 397 cases diagnosed). CONCLUSIONS Our study provides new evidence on the relative effectiveness and economics of three implementation models for enhanced TB case finding, in line with calls for data from 'routine conditions' to be included in disease control program strategic planning. Such cost-effectiveness comparisons are essential to inform resource allocation decisions of national policy makers in resource constraint settings. We applied a novel, pragmatic methodological approach, which was designed to provide results that are directly relevant to policy makers, costing the interventions from Cambodia's national TB program's perspective and using case finding data from implementation activities, rather than experimental settings.
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Affiliation(s)
- Richard James
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | | | - Lydia Boudarene
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Joanne Yoong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Center for Economic and Social Research, University of Southern California, 635 Downey Way, VPD, Los Angeles, CA, 90089, USA
| | - Chea Phalla
- University of Health Science, Phnom Penh, Cambodia
| | - Saly Saint
- National Center for Tuberculosis and Leprosy Control, Phnom Penh, Cambodia
| | - Pichenda Koeut
- National Center for Tuberculosis and Leprosy Control, Phnom Penh, Cambodia
| | - Tan Eang Mao
- National Center for Tuberculosis and Leprosy Control, Phnom Penh, Cambodia
| | - Richard Coker
- Communicable Diseases Policy Research Group, London School of Hygiene & Tropical Medicine, Bangkok, Thailand.,Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - Mishal Sameer Khan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore. .,Communicable Diseases Policy Research Group, London School of Hygiene & Tropical Medicine, Bangkok, Thailand.
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Khan MS, Séron O, Thuillier G, Thévenot O, Gournay P, Piquemal F. Development of a programmable standard of ultra-low capacitance values. Rev Sci Instrum 2017; 88:055109. [PMID: 28571446 DOI: 10.1063/1.4983337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A set of ultra-low value capacitance standards together with a programmable coaxial multiplexer (mux) have been developed. The mux allows the connection of these capacitances in parallel configuration and they together form the programmable capacitance standard. It is capable of producing decadic standard capacitances from 10 aF to at least 0.1 pF, which are later used to calibrate commercial precision capacitance bridges. This paper describes the realization and the characterization of this standard together with results obtained during the calibration of Andeen-Hagerling AH2700A bridges with a maximum uncertainty of 0.8 aF for all the capacitances generated ranging from 10 aF to 0.1 pF, at 1 kHz. These latter could be then integrated to functionalized AFMs or probe stations for quantitative capacitance measurements. Sources of uncertainties of the programmable capacitance standard, such as parasitic effects due to stray impedances, are evaluated and a method to overcome these hindrances is also discussed.
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Affiliation(s)
- M S Khan
- Laboratoire National de Métrologie et d'Essais (LNE), 29, Avenue Roger Hennequin, 78197 Trappes, Cedex, France
| | - O Séron
- Laboratoire National de Métrologie et d'Essais (LNE), 29, Avenue Roger Hennequin, 78197 Trappes, Cedex, France
| | - G Thuillier
- Laboratoire National de Métrologie et d'Essais (LNE), 29, Avenue Roger Hennequin, 78197 Trappes, Cedex, France
| | - O Thévenot
- Laboratoire National de Métrologie et d'Essais (LNE), 29, Avenue Roger Hennequin, 78197 Trappes, Cedex, France
| | - P Gournay
- Bureau International des Poids et Mesures (BIPM), Pavillon de Breteuil, 92312 Sèvres, Cedex, France
| | - F Piquemal
- Laboratoire National de Métrologie et d'Essais (LNE), 29, Avenue Roger Hennequin, 78197 Trappes, Cedex, France
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Hutchison C, Khan MS, Yoong J, Lin X, Coker RJ. Financial barriers and coping strategies: a qualitative study of accessing multidrug-resistant tuberculosis and tuberculosis care in Yunnan, China. BMC Public Health 2017; 17:221. [PMID: 28222724 PMCID: PMC5320743 DOI: 10.1186/s12889-017-4089-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Accepted: 01/30/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Tuberculosis (TB) and multidrug-resistance tuberculosis (MDR-TB) pose serious challenges to global health, particularly in China, which has the second highest case burden in the world. Disparities in access to care for the poorest, rural TB patients may be exacerbated for MDR-TB patients, although this has not been investigated widely. We examine whether certain patient groups experience different barriers to accessing TB services, whether there are added challenges for patients with MDR-TB, and how patients and health providers cope in Yunnan, a mountainous province in China with a largely rural population and high TB burden. METHODS Using a qualitative study design, we conducted five focus group discussions and 47 in-depth interviews with purposively sampled TB and MDR-TB patients and healthcare providers in Mandarin, between August 2014 and May 2015. Field-notes and interview transcripts were analysed via a combination of open and thematic coding. RESULTS Patients and healthcare providers consistently cited financial constraints as the most common barriers to accessing care. Rural residents, farmers and ethnic minorities were the most vulnerable to these barriers, and patients with MDR-TB reported a higher financial burden owing to the centralisation and longer duration of treatment. Support in the form of free or subsidised treatment and medical insurance, was deemed essential but inadequate for alleviating financial barriers to patients. Most patients coped by selling their assets or borrowing money from family members, which often strained relationships. Notably, some healthcare providers themselves reported making financial and other contributions to assist patients, but recognised these practices as unsustainable. CONCLUSIONS Financial constraints were identified by TB and MDR-TB patients and health care professionals as the most pervasive barrier to care. Barriers appeared to be magnified for ethnic minorities and patients coming from rural areas, especially those with MDR-TB. To reduce financial barriers and improve treatment outcomes, there is a need for further research into the total costs of seeking and accessing TB and MDR-TB care. This will enable better assessment and targeting of appropriate financial support for identified vulnerable groups and geographic development of relevant services.
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Affiliation(s)
- C Hutchison
- London School of Hygiene and Tropical Medicine, London, UK
| | - M S Khan
- London School of Hygiene and Tropical Medicine, London, UK.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - J Yoong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Centre for Economic and Social Research, University of Southern California, Los Angeles, USA
| | - X Lin
- Yunnan Center for Disease Control and Prevention, Kunming, China.
| | - R J Coker
- London School of Hygiene and Tropical Medicine, London, UK.,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.,Faculty of Public Health, Mahidol University, Bangkok, Thailand
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Naseer O, Khan JA, Khan MS, Omer MO, Chishti GA, Sohail ML, Saleem MU. Comparative Efficacy of Silymarin and Choline Chloride (Liver Tonics) in Preventing the Effects of Aflatoxin B1 in Bovine Calves. Pol J Vet Sci 2017; 19:545-551. [PMID: 27760040 DOI: 10.1515/pjvs-2016-0068] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aflatoxins are secondary metabolites produced by Aspergillus spp. which are injurious to animals and humans The aim of this study was to determine the effects of aflatoxin B1 (AFB1) on Average Daily Feed Intake (ADFI), Average Daily Weight Gain (ADWG), haematological and serum biochemical responses of Bovine Calves and to determine the comparative efficacy of two different liver tonics against AFB1. Twenty seven calves were selected from herd and divided into 3 groups. All calves were fed with 1.0 mg/kg AFB1 for a period of 10 days. After that they were fed with liver tonics: Silymarin fed at a rate of 600 mg/kg and Choline chloride 500 mg/kg for 7 days. The results indicate that the ADFI and ADWG of AFB1 treated calves decreased significantly. Serum levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), blood urea nitrogen (BUN) and creatinine significantly increased due to AFB1. In haematology the total erythrocyte count (TEC), total leukocyte count (TLC), haemoglobin concentration (HGB), haematocrit levels (HCT), mean corpuscular haemoglobin (MCH), mean corpuscular volume (MCV) and mean corpuscular haemoglobin concentration (MCHC), lymphocyte %, neutrophil % and monocyte % significantly decreased in AFB1 treated calves after 10 days of feeding. Both liver tonics significantly (p<0.05) improved all the parameters, including ADFI, ADWG, hematologial and serum biochemical test. However, Silymarin comparatively more efficiently ameliorate the effects induced by AFB1 than choline chloride.
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Iqbal MZAN, Khan MS. A novel DNase like compound that inhibits virus propagation from Asian Green Mussel, Perna viridis (Linn.). Indian J Exp Biol 2016; 54:816-821. [PMID: 30183177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Viral diseases are not only responsible for health related issues but also exert pressure on the State economy. Tropical and subtropical countries have more prevalence of virus associated pathological conditions such as chickenpox, adenovirus related infections, dengue, chickengunya, infectious mononucleosis, etc. Treatment options with effective antiviral drugs are limited and are unfortunately not free from undesirable effects. The Asian Green Mussel, Perna viridis (Linn.) (Mytilidae) are not only important for their evolutionary significance, high caloric index, ecological role in the sequestration of environmental pollutants especially heavy metals, but also are potential source for extraction of therapeutic and bioactive compounds. On the other hand, generally in bivalves, virus mediated mortality is not uncommon. In this study, we made a maiden attempt of exploring DNAse like bioactivity for natural non-protenacious compound(s) extracted from P. viridis. Crude Methanol Extract (CME) of soft tissue of P. viridis and subsequently its partially purified component (PPC) possess exceptional ability to degrade indiscriminately both low and high molecular weight DNAs. In vitro digestions for1, 2 and 3 h with CME and PPC were found to be comparable to commercial (Sigma-Aldrich) enzyme, DNase I. Bioactive assays conducted to evaluate antimicrobial property, have shown that CME and PPC exclusively inhibit viral propagation. Nonetheless, CME & PPC have no effect on the propagation of bacteria (0 mm ZOI). These results indicate the possibility of a source of potential antiviral drug against DNA Group I viruses. Although our study does not provide any data to correlate to any physiological functions of these substances but provides a clue towards an important role in the biology of mussels. Any conclusion at this stage is premature. However, taking into consideration the significantly high virus mediated mortality in bivalves and the antiviral bioactivity of these substances, it appears that mussels have evolved some mechanisms to counteract some viruses.
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Abstract
Asymmetric innervation of the myocardium, especially a predominance of sympathetic innervation, may establish conditions whereby electrical instability could result. Using a swine animal model, we studied the effect of right cardiac vagal denervation on the variability of R-R and Q-T intervals. Newborn pigs were assigned randomly to two groups: sham-operated controls (C), or denervation of the right cardiac vagus nerve (RCVX). EKGs were recorded weekly until the two groups exhibited significant heart rate differences. Analysis of the EKG included measurements of R-R and Q-T intervals and corrected Q-T intervals (QTc). Poincaré plots were used to display age-related differences in R-R and Q-T intervals. For RCVX animals, decreased QTc and R-R intervals were noted at 6 and 7 weeks after denervation, respectively. Unexpectedly, one RCVX animal exhibited marked sudden pauses in sinus rhythm. These data indicated that reduced vagal cardiac modulation during development might alter cardiac electrical stability in conscious swine.
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Affiliation(s)
- M S Khan
- Department of Pediatrics, SUNY Health Science Center Hospital, New York 11203, USA
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Thiessen JD, Shams E, Stortz G, Schellenberg G, Bishop D, Khan MS, Kozlowski P, Retière F, Sossi V, Thompson CJ, Goertzen AL. MR-compatibility of a high-resolution small animal PET insert operating inside a 7 T MRI. Phys Med Biol 2016; 61:7934-7956. [DOI: 10.1088/0031-9155/61/22/7934] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Roberts KJ, Karkhanis S, Pitchaimuthu M, Khan MS, Hodson J, Zia Z, Mehrzad H, Marudanayagam R, Muiesan P, Isaac J, Mirza D, Sutcliffe RP. Comparison of preoperative CT-based imaging parameters to predict postoperative pancreatic fistula. Clin Radiol 2016; 71:986-992. [PMID: 27426676 DOI: 10.1016/j.crad.2016.06.108] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 06/04/2016] [Accepted: 06/08/2016] [Indexed: 12/12/2022]
Abstract
AIM To review all reported methods of preoperative computed tomography (CT) in one patient cohort and to identify which were the strongest to predict postoperative pancreatic fistula (POPF) after pancreatoduodenectomy. MATERIALS AND METHODS Consecutive patients undergoing pancreatoduodenectomy were included if they had unenhanced CT images for review. Eighteen variables and two scores were tested. Receiver operator characteristics (ROC) were explored. RESULTS POPF affected 26 of 107 patients (24.3%). Nine variables were significantly related to POPF with pancreatic duct width having the largest area under the ROC curve (AUROC; 0.808, p<0.001). An obese body habitus was associated with POPF with six of nine related variables using data from CT images associated with POPF; of these intra-abdominal wall thickness yielded the largest AUROC (0.713, p=0.001). This corresponded to the finding that body mass index (BMI) was related to POPF (AUROC 0.705, p=0.002). The largest AUROC of all was associated with one of the predictive scores (0.828, p<0.001). Substituting BMI for intra-abdominal wall thickness in this score yielded a non-significant increase to predict POPF (AUROC 0.840, p=0.676). None of the assessments of organ density (in Hounsfield Units) were associated with POPF. CONCLUSION Data from preoperative CT imaging provides valuable information regarding a patient's risk of POPF. Obesity as assessed by CT images strongly relates to POPF, but the largest single risk factor for POPF is a narrow pancreatic duct.
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Affiliation(s)
- K J Roberts
- Department of HPB Surgery, University Hospitals Birmingham NHS Trust, Edgbaston B15 2TH, UK
| | - S Karkhanis
- Department of HPB Surgery, University Hospitals Birmingham NHS Trust, Edgbaston B15 2TH, UK.
| | - M Pitchaimuthu
- Department of HPB Surgery, University Hospitals Birmingham NHS Trust, Edgbaston B15 2TH, UK
| | - M S Khan
- Department of HPB Surgery, University Hospitals Birmingham NHS Trust, Edgbaston B15 2TH, UK
| | - J Hodson
- Department of HPB Surgery, University Hospitals Birmingham NHS Trust, Edgbaston B15 2TH, UK
| | - Z Zia
- Department of HPB Surgery, University Hospitals Birmingham NHS Trust, Edgbaston B15 2TH, UK
| | - H Mehrzad
- Department of HPB Surgery, University Hospitals Birmingham NHS Trust, Edgbaston B15 2TH, UK
| | - R Marudanayagam
- Department of HPB Surgery, University Hospitals Birmingham NHS Trust, Edgbaston B15 2TH, UK
| | - P Muiesan
- Department of HPB Surgery, University Hospitals Birmingham NHS Trust, Edgbaston B15 2TH, UK
| | - J Isaac
- Department of HPB Surgery, University Hospitals Birmingham NHS Trust, Edgbaston B15 2TH, UK
| | - D Mirza
- Department of HPB Surgery, University Hospitals Birmingham NHS Trust, Edgbaston B15 2TH, UK
| | - R P Sutcliffe
- Department of HPB Surgery, University Hospitals Birmingham NHS Trust, Edgbaston B15 2TH, UK
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Abstract
BACKGROUND Bovine tuberculosis (bTB) remains a public health threat in low-income countries. Data on human tuberculosis (TB) due to Mycobacterium bovis are poorly documented in developing countries. AIMS To determine the occurrence of active pulmonary TB due to M. bovis in abattoir workers, butchers, livestock farmers and veterinarians and to document their knowledge and practices regarding bTB. METHODS A cross-sectional study of abattoir workers, butchers, livestock farmers, veterinary doctors and veterinary assistants, which obtained data on socio-demographic conditions, knowledge and practices regarding TB. Sputum samples were collected from respondents with a chronic cough. The chi-squared test was used for statistical analysis. RESULTS A total of 141 abattoir workers, 317 butchers, 50 livestock farmers, five veterinary doctors and three veterinary assistants took part. Four out of 16 abattoir workers and 1 out of 50 livestock farmers were positive for M. bovis by PCR analysis. Duration of work as an abattoir worker was significantly associated (P < 0.05) with prevalence of zoonotic TB. The knowledge of abattoir workers, butchers, livestock farmers and veterinary assistants regarding transmission of bTB from animals to humans and the symptoms of TB in humans was very poor. Most of these workers did not use protective equipment and appropriate safe working techniques and were considered at high risk of acquiring zoonotic TB. CONCLUSIONS Zoonotic TB is a significant public health issue among professionally exposed groups in Peshawar, Pakistan and suggests a need for further detailed investigations of the disease in this and similar areas.
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Affiliation(s)
- I Khattak
- Department of Epidemiology and Public Health, University of Veterinary and Animal Sciences, Lahore 5400, Pakistan,
| | - M H Mushtaq
- Department of Epidemiology and Public Health, University of Veterinary and Animal Sciences, Lahore 5400, Pakistan
| | - M U D Ahmad
- Department of Epidemiology and Public Health, University of Veterinary and Animal Sciences, Lahore 5400, Pakistan
| | - M S Khan
- Department of Clinical Medicine and Surgery, University of Veterinary and Animal Sciences, Lahore 5400, Pakistan
| | - J Haider
- Center for Biotechnology and Microbiology, University of Swat, Swat 19200, Pakistan
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Khan MS, Khine TM, Hutchison C, Coker RJ, Hane KM, Innes AL, Aung S. Are current case-finding methods under-diagnosing tuberculosis among women in Myanmar? An analysis of operational data from Yangon and the nationwide prevalence survey. BMC Infect Dis 2016; 16:110. [PMID: 26940910 PMCID: PMC4778364 DOI: 10.1186/s12879-016-1429-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 02/10/2016] [Indexed: 12/04/2022] Open
Abstract
Background Although there is a large increase in investment for tuberculosis control in Myanmar, there are few operational analyses to inform policies. Only 34 % of nationally reported cases are from women. In this study, we investigate sex differences in tuberculosis diagnoses in Myanmar in order to identify potential health systems barriers that may be driving lower tuberculosis case finding among women. Methods From October 2014 to March 2015, we systematically collected data on all new adult smear positive tuberculosis cases in ten township health centres across Yangon, the largest city in Myanmar, to produce an electronic tuberculosis database. We conducted a descriptive cross-sectional analysis of sex differences in tuberculosis diagnoses at the township health centres. We also analysed national prevalence survey data to calculate additional case finding in men and women by using sputum culture when smear microscopy was negative, and estimated the sex-specific impact of using a more sensitive diagnostic tool at township health centres. Results Overall, only 514 (30 %) out of 1371 new smear positive tuberculosis patients diagnosed at the township health centres were female. The proportion of female patients varied by township (from 21 % to 37 %, p = 0.0172), month of diagnosis (37 % in February 2015 and 23 % in March 2015 p = 0.0004) and age group (26 % in 25–64 years and 49 % in 18–25 years, p < 0.0001). Smear microscopy grading of sputum specimens was not substantially different between sexes. The prevalence survey analysis indicated that the use of a more sensitive diagnostic tool could result in the proportion of females diagnosed at township health centres increasing to 36 % from 30 %. Conclusions Our study, which is the first to systematically compile and analyse routine operational data from tuberculosis diagnostic centres in Myanmar, found that substantially fewer women than men were diagnosed in all study townships. The sex ratio of newly diagnosed cases varied by age group, month of diagnosis and township of diagnosis. Low sensitivity of tuberculosis diagnosis may lead to a potential under-diagnosis of tuberculosis among women.
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Affiliation(s)
- M S Khan
- Communicable Diseases Policy Research Group, London School of Hygiene and Tropical Medicine, Satharanauskwisit Building, 420/1 Rajwithi Road, Bangkok, 10400, Thailand. .,Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
| | - T M Khine
- National Tuberculosis Programme, Yangon, Myanmar
| | - C Hutchison
- Communicable Diseases Policy Research Group, London School of Hygiene and Tropical Medicine, Satharanauskwisit Building, 420/1 Rajwithi Road, Bangkok, 10400, Thailand
| | - R J Coker
- Communicable Diseases Policy Research Group, London School of Hygiene and Tropical Medicine, Satharanauskwisit Building, 420/1 Rajwithi Road, Bangkok, 10400, Thailand.,Faculty of Public Health, Mahidol University, Bangkok, Thailand
| | - K M Hane
- Family Health International Myanmar Office, Yangon, Myanmar
| | - A L Innes
- Family Health International Asia Pacific Regional Office, Bangkok, Thailand
| | - S Aung
- National Tuberculosis Programme, Yangon, Myanmar
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48
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Konto M, Fufa GI, Zakaria A, Tukur SM, Watanabe M, Ola-Fadunsin SD, Khan MS, Shettima YM, Babjee SMA. Tick fauna of Malaysian red jungle fowl (Gallus gallus) in Bangi, Malaysia. Vet World 2015; 8:1167-71. [PMID: 27047012 PMCID: PMC4774650 DOI: 10.14202/vetworld.2015.1167-1171] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 08/24/2015] [Accepted: 09/03/2015] [Indexed: 11/16/2022] Open
Abstract
Aim: The red jungle fowl is generally considered as one of the endangered Asian wild Galleopheasants due to man-made encroachment of their habitats, coupled with the effect of disease and disease causing organisms like ticks and tick-borne infections. This study aimed to determine the tick fauna of the red jungle fowl and their predilection sites based on developmental stages. Materials and Methods: A total of 33 jungle fowls were sampled for this study from Bangi area of Selangor State, Peninsular Malaysian. The birds were captured using a locally made trap made-up of loops and bites. Ticks present on their bodies were detached using fine forceps and identified morphologically under a dissecting microscope. Results: 91% of the jungle fowls were infested with ticks, all of which belongs to the species Haemaphysalis wellingtoni. The ear region appeared to be the most common predilection site (63%) for all the developmental stages in which the larval stages are solely restricted to that region. Nymphal and adult stages were distributed on the comb, wattle, and facial region in addition to the ear region. Conclusion: This study was the first in its kind and showed a high prevalence of tick infestation among jungle fowls. H. wellingtoni was known to be a vector in transmission of many tick-borne pathogens. Therefore, there is the need for further investigation to identify the various pathogens associated with this tick.
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Affiliation(s)
- M Konto
- Department of Companion Animal Medicine and Surgery, Faculty of Veterinary Medicine, Universiti Putra Malaysia, Serdang, Malaysia; Department of Microbiology and Parasitology, Faculty of Veterinary Medicine, University of Maiduguri, Nigeria
| | - G I Fufa
- Department of Veterinary Laboratory Diagnostics, Faculty of Veterinary Medicine, Universiti Putra Malaysia, Serdang, Malaysia
| | - A Zakaria
- Department of Veterinary Laboratory Diagnostics, Faculty of Veterinary Medicine, Universiti Putra Malaysia, Serdang, Malaysia
| | - S M Tukur
- Department of Companion Animal Medicine and Surgery, Faculty of Veterinary Medicine, Universiti Putra Malaysia, Serdang, Malaysia; Department of Microbiology and Parasitology, Faculty of Veterinary Medicine, University of Maiduguri, Nigeria
| | - M Watanabe
- Department of Veterinary Laboratory Diagnostics, Faculty of Veterinary Medicine, Universiti Putra Malaysia, Serdang, Malaysia
| | - S D Ola-Fadunsin
- Department of Veterinary Laboratory Diagnostics, Faculty of Veterinary Medicine, Universiti Putra Malaysia, Serdang, Malaysia
| | - M S Khan
- Department of Companion Animal Medicine and Surgery, Faculty of Veterinary Medicine, Universiti Putra Malaysia, Serdang, Malaysia; Department of Bio Sciences, Gomal College of Veterinary Sciences, Gomal University, Dera Ismail Khan, Pakistan
| | - Y M Shettima
- Department of Microbiology and Parasitology, Faculty of Veterinary Medicine, University of Maiduguri, Nigeria
| | - S M A Babjee
- Department of Veterinary Laboratory Diagnostics, Faculty of Veterinary Medicine, Universiti Putra Malaysia, Serdang, Malaysia
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Cresswell J, Mariappan P, Thomas SA, Khan MS, Johnson MI, Fowler S. Radical cystectomy: Analysis of trends in UK practice 2004–2012, from the British Association of Urological Surgeons’ (BAUS) Section of Oncology Dataset. Journal of Clinical Urology 2015. [DOI: 10.1177/2051415815595325] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: To analyse the British Association of Urological Surgeons’ (BAUS) radical cystectomy (RC) dataset, to examine the trends in patient selection, use of neoadjuvant chemotherapy (NAC) and operative technique. Methods: Data for RC were entered into a database voluntarily, by operating surgeons. A comparison was made to the Hospital Episode Statistics (HES) data, to estimate the proportion of cases captured by the dataset. Results: From 2004 to 2012, data was collected on 5321 patients undergoing RC. This constituted 37.1% of all HES RC cases during the corresponding time period. Notable trends were: An increasing use of NAC, the introduction of minimally-invasive surgery (23.5% in 2012), a dramatic reduction in blood transfusion rates and the increasing yields from lymph node dissection. The ileal conduit urinary diversion predominated as the urinary diversion of choice (80% of cases). Conclusions: This analysis of a large multi-centre dataset provides insight into RC practice in the UK, over 8 years. The major weaknesses of the study were that only one-third of cases were recorded and that outcome data was very limited. Mandatory publication of outcome data from 2016 should increase the recording of cases and provide material for a more complete analysis.
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Affiliation(s)
- J Cresswell
- Department of Urology, James Cook University Hospital, Middlesbrough, UK
| | - P Mariappan
- Department of Urology, Western General Hospital, Edinburgh, Scotland, UK
| | - SA Thomas
- Department of Urology, Royal Derby Hospital, UK
| | - MS Khan
- Department of Urology, Guy’s Hospital, London, UK
| | - MI Johnson
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK
| | - S Fowler
- British Association of Urological Surgeons, London, UK
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Siddiqui S, Ahmad E, Gupta M, Rawat V, Shivnath N, Banerjee M, Khan MS, Arshad M. Cissus quadrangularis Linn exerts dose-dependent biphasic effects: osteogenic and anti-proliferative, through modulating ROS, cell cycle and Runx2 gene expression in primary rat osteoblasts. Cell Prolif 2015; 48:443-54. [PMID: 26079044 DOI: 10.1111/cpr.12195] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 04/02/2015] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES This report highlights phytoconstituents present in Cissus quadrangularis (CQ) extract and examines biphasic (proliferative and anti-proliferative) effects of its extract on bone cell proliferation, differentiation, mineralization, ROS generation, cell cycle progression and Runx2 gene expression in primary rat osteoblasts. MATERIALS AND METHODS Phytoconstituents were identified using gas chromatography-mass spectroscopy (GC-MS). Osteoblasts were exposed to different concentrations (10-100 μg/ml) of CQ extract and cell proliferation and cell differentiation were investigated at different periods of time. Subsequently, intracellular ROS intensity, apoptosis and matrix mineralization of osteoblasts were evaluated. We performed flow cytometry for DNA content and real-time PCR for Runx2 gene expression analysis. RESULTS CQ extract's approximately 40 bioactive compounds of fatty acids, hydrocarbons, vitamins and steroidal derivatives were identified. Osteoblasts exposed to varying concentrations of extract exhibited biphasic variation in cell proliferation and differentiation as a function of dose and time. Moreover, lower concentrations (10-50 μg/ml) of extract slightly reduced ROS intensity, although they enhanced matrix mineralization, DNA content in S phase of the cell cycle, and levels of Runx2 expression. However, higher concentrations (75-100 μg/ml) considerably induced the ROS intensity and nuclear condensation in osteoblasts, while it reduced mineralization level, proportion of cells in S phase and Runx2 level of the osteogenic gene. CONCLUSIONS These findings suggest that CQ extract revealed concentration-dependent biphasic effects, which would contribute notably to future assessment of pre-clinical efficacy and safety studies.
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Affiliation(s)
- S Siddiqui
- Molecular Endocrinology Laboratory, Department of Zoology, University of Lucknow, Lucknow, Uttar Pradesh, 226007, India
| | - E Ahmad
- Department of Biological Sciences, School of Pharmaceutical Sciences, Sao Paulo State University - UNESP, Araraquara, Sao Paulo, 14801-902, Brazil
| | - M Gupta
- Molecular Endocrinology Laboratory, Department of Zoology, University of Lucknow, Lucknow, Uttar Pradesh, 226007, India
| | - V Rawat
- Molecular Endocrinology Laboratory, Department of Zoology, University of Lucknow, Lucknow, Uttar Pradesh, 226007, India
| | - N Shivnath
- Molecular Endocrinology Laboratory, Department of Zoology, University of Lucknow, Lucknow, Uttar Pradesh, 226007, India
| | - M Banerjee
- Molecular & Human Genetics Laboratory, Department of Zoology, University of Lucknow, Lucknow, Uttar Pradesh, 226007, India
| | - M S Khan
- Department of Biosciences, Integral University, Lucknow, Uttar Pradesh, 226007, India
| | - M Arshad
- Molecular Endocrinology Laboratory, Department of Zoology, University of Lucknow, Lucknow, Uttar Pradesh, 226007, India
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