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Norton BC, Aslam N, Telese A, Papaefthymiou A, Singh S, Sehgal V, Mitchison M, Jansen M, Banks M, Graham D, Haidry R. Risk of metastasis among patients diagnosed with high-risk T1 esophageal adenocarcinoma who underwent endoscopic follow-up. Dis Esophagus 2024:doae027. [PMID: 38580314 DOI: 10.1093/dote/doae027] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Revised: 03/05/2024] [Accepted: 03/19/2024] [Indexed: 04/07/2024]
Abstract
Esophagectomy and lymphadenectomy have been the standard of care for patients at high risk (HR) of lymph node metastasis following a diagnosis of early esophageal adenocarcinoma (OAC) after endoscopic resection (ER). However, recent cohorts suggest lymph node metastasis risk is lower than initially estimated, suggesting organ preservation with close endoscopic follow-up is a viable option. We report on the 3- and 5-year risk of lymph node/distant metastasis among patients diagnosed with early HR-T1 OAC undergoing endoscopic follow-up. Patients diagnosed with HR-T1a or T1b OAC following ER at a tertiary referral center were identified and retrospectively analyzed from clinical records between 2010 and 2021. Patients were included if they underwent endoscopic follow-up after resection and were divided into HR-T1a, low risk (LR)-T1b and HR-T1b cohorts. After ER, 47 patients underwent endoscopic follow-up for early HR OAC. In total, 39 patients had an R0 resection with a combined 3- and 5-year risk of LN/distant metastasis of 6.9% [95% confidence interval (CI): 1.8-25] and 10.9% (95% CI, 3.6-30.2%), respectively. There was no significant difference when stratifying by histopathological subtype (P = 0.64). Among those without persistent luminal disease on follow-up, the 5-year risk was 4.1% (95% CI, 0.6-26.1). Two patients died secondary to OAC with an all-cause 5-year survival of 57.5% (95% CI, 39.5-71.9). The overall risk of LN/distant metastasis for early HR T1 OAC was lower than historically reported. Endoscopic surveillance can be a reasonable approach in highly selected patients with an R0 resection and complete luminal eradication, but clear, evidence-based surveillance guidelines are needed.
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Affiliation(s)
- Benjamin Charles Norton
- Department of Gastroenterology, University College London Hospitals, London, UK
- Centre for Obesity Research, University College London, London, UK
- Department of Gastroenterology, Digestive diseases & Surgery Institute, Cleveland Clinic London, London, UK
| | - Nasar Aslam
- Department of Gastroenterology, University College London Hospitals, London, UK
| | - Andrea Telese
- Department of Gastroenterology, University College London Hospitals, London, UK
- Centre for Obesity Research, University College London, London, UK
| | | | - Shilpi Singh
- Department of Histopathology, University College London Hospitals, London, UK
| | - Vinay Sehgal
- Department of Gastroenterology, University College London Hospitals, London, UK
| | - Miriam Mitchison
- Department of Histopathology, University College London Hospitals, London, UK
| | - Marnix Jansen
- Department of Histopathology, University College London Hospitals, London, UK
| | - Matthew Banks
- Department of Gastroenterology, University College London Hospitals, London, UK
| | - David Graham
- Department of Gastroenterology, University College London Hospitals, London, UK
| | - Rehan Haidry
- Department of Gastroenterology, Digestive diseases & Surgery Institute, Cleveland Clinic London, London, UK
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Papaefthymiou A, Gkolfakis P, Basiliya K, Ramai D, Tziatzios G, Sehgal V, Telese A, Norton B, Aslam N, Johnson G, Haidry R. Success rates of fixation techniques on prevention of esophageal stent migration: a systematic review and meta-analysis. Endoscopy 2024; 56:22-30. [PMID: 37536365 DOI: 10.1055/a-2147-8294] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/05/2023]
Abstract
BACKGROUND Esophageal stenting is an important intervention for managing malignant and benign dysphagia, with stent migration representing a common drawback. This systematic review with meta-analysis aimed to assess the benefit of stent fixation over nonfixation. METHODS A systematic search was performed in MEDLINE, Cochrane, Scopus, and ClinicalTrials.gov databases until January 2023 for comparative studies evaluating the migration rates of esophageal stents with versus without (control) fixation. The primary outcome was migration rate. Secondary outcomes included adverse event rate. A subgroup analysis stratified the results based on different fixation techniques: suturing, over-the-scope (OTS) clipping, and through-the-scope (TTS) clipping. Meta-analysis was based on a random effects model and the results were reported as odds ratios (ORs) with 95 %CIs. RESULTS 10 studies (1014 patients) were included. The rate of stent migration was significantly lower after fixation (OR 0.20, 95 %CI 0.11-0.37; I2 = 59 %, P = 0.01). The adverse event rate was similar between fixation and control groups (OR 0.65, 95 %CI 0.28-1.52; I2 = 55 %, P = 0.06). In the subgroup analysis, all fixation techniques remained superior to nonfixation of stents (suturing OR 0.23, 95 %CI 0.10-0.53; OTS clips OR 0.31, 95 %CI 0.17-0.58; TTS clips OR 0.10, 95 %CI 0.03-0.38); however, only the OTS and TTS clip groups achieved nonsignificant heterogeneity (I2 = 0 %, P = 0.67 and P = 0.73, respectively). No difference between techniques was recorded for migration rates. CONCLUSION Esophageal stent fixation was associated with significantly lower migration rates compared with nonfixation of stents, regardless of fixation technique and stenting indication.
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Affiliation(s)
| | - Paraskevas Gkolfakis
- Department of Gastroenterology, General Hospital of Nea Ionia "Konstantopoulio-Patision", Athens, Greece
- Department of Gastroenterology, Hepatopancreatology and Digestive Oncology, Erasme University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Kirill Basiliya
- Endoscopy Unit, University College London Hospitals, London, United Kingdom
| | - Daryl Ramai
- Gastroenterology and Hepatology, University of Utah Health, Salt Lake City, Utah, United States
| | - Georgios Tziatzios
- Department of Gastroenterology, General Hospital of Nea Ionia "Konstantopoulio-Patision", Athens, Greece
| | - Vinay Sehgal
- Endoscopy Unit, University College London Hospitals, London, United Kingdom
| | - Andrea Telese
- Endoscopy Unit, University College London Hospitals, London, United Kingdom
| | - Benjamin Norton
- Endoscopy Unit, University College London Hospitals, London, United Kingdom
| | - Nasar Aslam
- Endoscopy Unit, University College London Hospitals, London, United Kingdom
| | - Gavin Johnson
- Endoscopy Unit, University College London Hospitals, London, United Kingdom
| | - Rehan Haidry
- Endoscopy Unit, University College London Hospitals, London, United Kingdom
- Cleveland Clinic London, London, United Kingdom
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Papaefthymiou A, Norton B, Telese A, Aslam N, Sehgal V, Haidry R. Peroral endoscopic myotomy to treat epiphrenic diverticulum: a step-by-step video demonstration. Endoscopy 2023; 55:E844-E845. [PMID: 37369244 PMCID: PMC10299864 DOI: 10.1055/a-2106-1183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/29/2023]
Affiliation(s)
| | - Benjamin Norton
- Endoscopy Unit, University College London Hospitals (UCLH), London, United Kingdom
| | - Andrea Telese
- Endoscopy Unit, University College London Hospitals (UCLH), London, United Kingdom
| | - Nasar Aslam
- Endoscopy Unit, University College London Hospitals (UCLH), London, United Kingdom
| | - Vinay Sehgal
- Endoscopy Unit, University College London Hospitals (UCLH), London, United Kingdom
| | - Rehan Haidry
- Endoscopy Unit, University College London Hospitals (UCLH), London, United Kingdom
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Norton B, Aslam N, Papaefthymiou A, Telese A, Murray C, Haidry R. Management of a large percutaneous endoscopic gastrostomy tube-associated gastric ulcer with endoscopic suturing. Endoscopy 2023; 55:E1021-E1022. [PMID: 37647935 PMCID: PMC10468268 DOI: 10.1055/a-2155-4941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Affiliation(s)
- Benjamin Norton
- Digestive Diseases and Surgery Institute, Cleveland Clinic London, London, UK
| | - Nasar Aslam
- Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Apostolis Papaefthymiou
- Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Andrea Telese
- Department of Gastroenterology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Charles Murray
- Digestive Diseases and Surgery Institute, Cleveland Clinic London, London, UK
| | - Rehan Haidry
- Digestive Diseases and Surgery Institute, Cleveland Clinic London, London, UK
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Nash Z, Aslam N, Jurkovic D. Pseudoaneurysm complicating expectantly managed tubal ectopic pregnancy. Ultrasound Obstet Gynecol 2023; 62:749-750. [PMID: 37340628 DOI: 10.1002/uog.26286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 06/22/2023]
Affiliation(s)
- Z Nash
- Gynaecology Diagnostic and Outpatient Treatment Unit, University College London Hospital, London, UK
| | - N Aslam
- Gynaecology Diagnostic and Outpatient Treatment Unit, University College London Hospital, London, UK
| | - D Jurkovic
- Gynaecology Diagnostic and Outpatient Treatment Unit, University College London Hospital, London, UK
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Norton BC, Telese A, Papaefthymiou A, Aslam N, Makaronidis J, Murray C, Haidry R. Metabolic and Bariatric Endoscopy: A Mini-Review. Life (Basel) 2023; 13:1905. [PMID: 37763308 PMCID: PMC10532500 DOI: 10.3390/life13091905] [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: 08/30/2023] [Revised: 09/07/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
We are currently in a worldwide obesity pandemic, which is one of the most significant health problems of the 21st century. As the prevalence of obesity continues to rise, new and innovate treatments are becoming available. Metabolic and bariatric endoscopic procedures are exciting new areas of gastroenterology that have been developed as a direct response to the obesity crisis. These novel interventions offer a potentially reversible, less invasive, safer, and more cost-effective method of tackling obesity compared to traditional bariatric surgery. Minimally invasive endoscopic treatments are not entirely novel, but as technology has rapidly improved, many of the procedures have been proven to be extremely effective for weight loss and metabolic health, based on high-quality clinical trial data. This mini-review examines the existing evidence for the most prominent metabolic and bariatric procedures, followed by a discussion on the future trajectory of this emerging subspecialty.
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Affiliation(s)
- Benjamin Charles Norton
- Digestive Diseases and Surgery Institute, Cleveland Clinic London, 33 Grosvenor Pl, London SW1X 7HY, UK
- Department of Gastroenterology, University College London Hospital Euston Road, London NW1 2BU, UK
- Centre for Obesity Research, Rayne Institute, Department of Medicine, University College London, London WC1E 6BT, UK
| | - Andrea Telese
- Digestive Diseases and Surgery Institute, Cleveland Clinic London, 33 Grosvenor Pl, London SW1X 7HY, UK
- Centre for Obesity Research, Rayne Institute, Department of Medicine, University College London, London WC1E 6BT, UK
| | - Apostolis Papaefthymiou
- Department of Gastroenterology, University College London Hospital Euston Road, London NW1 2BU, UK
| | - Nasar Aslam
- Department of Gastroenterology, University College London Hospital Euston Road, London NW1 2BU, UK
| | - Janine Makaronidis
- Centre for Obesity Research, Rayne Institute, Department of Medicine, University College London, London WC1E 6BT, UK
- Bariatric Centre for Weight Management and Metabolic Surgery, University College London Hospital, London WC1E 6BT, UK
- Department of Endocrinology and Diabetes, University College London Hospital, London WC1E 6BT, UK
- National Institute of Health Research, UCLH Biomedical Research Centre, London W1T 7DN, UK
| | - Charles Murray
- Digestive Diseases and Surgery Institute, Cleveland Clinic London, 33 Grosvenor Pl, London SW1X 7HY, UK
| | - Rehan Haidry
- Digestive Diseases and Surgery Institute, Cleveland Clinic London, 33 Grosvenor Pl, London SW1X 7HY, UK
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Aslam N, Telese A, Sehgal V, Sweis R, Lovat LB, Haidry R. Minimally invasive endoscopic therapies for gastro-oesophageal reflux disease. Frontline Gastroenterol 2023; 14:249-257. [PMID: 37056318 PMCID: PMC10086720 DOI: 10.1136/flgastro-2022-102343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 01/02/2023] [Indexed: 04/15/2023] Open
Abstract
The prevalence of the gastro-oesophageal reflux disease (GORD) in the western world is increasing. Uncontrolled GORD can lead to harmful long-term sequela such as oesophagitis, stricture formation, Barrett's oesophagus and oesophageal adenocarcinoma. Moreover, GORD has been shown to negatively impact quality of life. The current treatment paradigm for GORD consists of lifestyle modification, pharmacological control of gastric acid secretion or antireflux surgery. In recent years, several minimally invasive antireflux endoscopic therapies (ARET) have been developed which may play a role in bridging the unmet therapeutic gap between the medical and surgical treatment options. To ensure optimal patient outcomes following ARET, considered patient selection is crucial, which requires a mechanistic understanding of individual ARET options. Here, we will discuss the differences between ARETs along with an overview of the current evidence base. We also outline future research priorities that will help refine the future role of ARET.
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Affiliation(s)
- Nasar Aslam
- Department of Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Andrea Telese
- Department of Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Vinay Sehgal
- Department of Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Rami Sweis
- Department of Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
| | - Laurence B Lovat
- Department of Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Rehan Haidry
- Department of Gastrointestinal Services, University College London Hospitals NHS Foundation Trust, London, UK
- Division of Surgery and Interventional Science, University College London, London, UK
- Division of Gastroenterology, Cleveland Clinic, London, UK
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Aslam N, Lo SW, Sikafi R, Barnes T, Segal J, Smith PJ, Limdi JK. A review of the therapeutic management of ulcerative colitis. Therap Adv Gastroenterol 2022; 15:17562848221138160. [PMID: 36478780 PMCID: PMC9720837 DOI: 10.1177/17562848221138160] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 10/26/2022] [Indexed: 12/03/2022] Open
Abstract
Ulcerative colitis (UC) is a chronic relapsing and remitting gastrointestinal disorder of uncertain aetiology. The last two decades have seen an expansion in the therapeutic arsenal used to treat UC. This has resulted in improved clinical remission and response rates. Nonetheless, staples in our current medical management originate from trials conducted in the early 20th century. In this review article, we aim to outline the key milestones in the history of the medical management of UC in addition to highlighting promising therapeutic developments for the future.
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Affiliation(s)
| | | | - Rafid Sikafi
- St Mark’s Hospital, London North West University Healthcare NHS Trust, London, UK
| | - Tom Barnes
- Section of IBD – Division of Gastroenterology, Northern Care Alliance NHS Foundation Trust, Salford, UK
| | - Jonathan Segal
- Northern Hospital, Epping, Melbourne, VIC, Australia,Department of Medicine, University of Melbourne, Parkville, VIC, Australia
| | - Philip J Smith
- Department of Gastroenterology, Royal Liverpool Hospital, Liverpool University Hospitals Foundation NHS Trust, Liverpool, UK
| | - Jimmy K Limdi
- Section of IBD – Division of Gastroenterology, Northern Care Alliance NHS Foundation Trust, Manchester, UK,Manchester Academic Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Khan A, Faisal M, Aslam B, Anwar H, Mehmood M, Aslam N, Roobi A, Aslam J, Muzaffar H, Mehmood A, Majeed L, Ahmad N, Haider U. Studying the wnt/beta- catenin and microrna signaling crosstalk in CTNNB1and ABCG2 genes expression in prostate cancer. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02357-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Khan A, Faisal M, Aslam B, Anwar H, Muzaffar H, Roobi A, Aslam N, Majeed L, Ali S, Aslam J, Mehmood M, Tanveer Q, Mahmood A. 39P Understanding the crosstalk between micro-RNA and Wnt signaling cascade associated with the expression level of HOXB13 and SRC genes in female breast cancer. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Liu E, Aslam N, Nigam G, Limdi JK. Tofacitinib and newer JAK inhibitors in inflammatory bowel disease-where we are and where we are going. Drugs Context 2022; 11:2021-11-4. [PMID: 35462642 PMCID: PMC9007061 DOI: 10.7573/dic.2021-11-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 03/04/2022] [Indexed: 11/21/2022] Open
Abstract
Inflammatory bowel diseases, comprising ulcerative colitis (UC) and Crohn's disease, are chronic, immune-mediated and progressive inflammatory disorders affecting the gastrointestinal tract. Tofacitinib is the first oral small-molecule Janus kinase (JAK) inhibitor licensed and approved by the National Institute for Health and Care Excellence (NICE) for use in moderately-to-severely active UC after intolerance, inadequate response, or loss of response to conventional treatment or biologic therapy. The pivotal OCTAVE studies demonstrated the efficacy and safety of tofacitinib for the induction and maintenance of remission in UC. A growing body of evidence from real-world data supports the positive clinical and endoscopic benefits observed with tofacitinib treatment in the OCTAVE trials. This narrative review summarizes the current literature regarding the mechanism of action of tofacitinib, data from registrational trials, emerging real-world evidence, and an overview of the most recent safety evidence. We explore evolving treatment paradigms, including the use of tofacitinib in the COVID-19 era, pregnancy and extraintestinal manifestations, as well as the emerging concept of combining tofacitinib with biological therapy. We will also present a brief overview of the next generation of JAK inhibitors in the pipeline.
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Affiliation(s)
- Eleanor Liu
- Section of IBD – Division of Gastroenterology, Northern Care Alliance NHS Trust, Manchester, UK
| | - Nasar Aslam
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Gaurav Nigam
- Royal Berkshire Hospital NHS Foundation Trust, Reading, UK
- Oxford University Clinical Academic Graduate School, University of Oxford, Oxford, UK
| | - Jimmy K Limdi
- Section of IBD – Division of Gastroenterology, Northern Care Alliance NHS Trust, Manchester, UK
- Manchester Academic Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Aslam N, Hayat S, Ali T, Waseem M, Siddique MH, Afzal M, Muzammil A, Naz G, Sarwar A, Muzammil S. Antiadhesion and antibiofilm potential of Fagonia indica from Cholistan desert against clinical multidrug resistant bacteria. BRAZ J BIOL 2021; 82:e239991. [PMID: 34190801 DOI: 10.1590/1519-6984.239991] [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: 06/23/2020] [Accepted: 11/05/2020] [Indexed: 11/22/2022] Open
Abstract
High resistance to antimicrobials is associated with biofilm formation responsible for infectious microbes to withstand severe conditions. Therefore, new alternatives are necessary as biofilm inhibitors to control infections. In this study, the antimicrobial and antibiofilm activities of Fagonia indica extracts were evaluated against MDR clinical isolates. The extract exhibited its antibiofilm effect by altering adherence and disintegration of bacterial cell wall. Fagonia indica has antibacterial effect as minimum inhibitory concentration (MIC) values ranging from 125 to 500 µg mL-1 and minimum bactericidal concentration (MBC) value was 500-3000 µg mL-1 against multidrug resistant (MDR) clinical isolates. The extract exhibited its antibiofilm effect by altering adherence and disintegration of bacterial cell wall. Fagonia indica had antibacterial effect as minimum inhibitory concentration (MIC) values ranging from 125 to 500 µg mL-1 and minimum bactericidal concentration (MBC) value was 500-3000 µg mL-1 against MDR isolates. The maximum inhibitory effects of Fagonia indica chloroform extract on biofilm formation was observed on Staphylococcus aureus (71.84%) followed by Klebsiella pneumoniae (70.83%) after 48 hrs showing that inhibition is also time dependent. Our results about bacterial cell protein leakage indicated that MDR isolates treated with chloroform extract of Fagonia indica showed maximum protein leakage of K. pneumoniae (59.14 µg mL-1) followed by S. aureus (56.7 µg mL-1). Cell attachment assays indicated that chloroform extract resulted in a 43.5-53.5% inhibition of cell adherence to a polystyrene surface. Our results revealed that extracts of Fagonia indica significantly inhibited biofilm formation among MDR clinical isolates, therefore, could be applied as antimicrobial agents and cost effective biofilm inhibitor against these MDR isolates.
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Affiliation(s)
- N Aslam
- Government College University, Department of Biochemistry, Faisalabad, Pakistan
| | - S Hayat
- Government College University, Department of Microbiology, Faisalabad, Pakistan
| | - T Ali
- Government College University, Department of Biochemistry, Faisalabad, Pakistan.,University of Agriculture, Department of Biochemistry, Faisalabad, Pakistan
| | - M Waseem
- Government College University, Department of Microbiology, Faisalabad, Pakistan
| | - M H Siddique
- Government College University, Department of Bioinformatics and Biotechnology, Faisalabad, Pakistan
| | - M Afzal
- Government College University, Department of Bioinformatics and Biotechnology, Faisalabad, Pakistan
| | - A Muzammil
- Government College University, Department of Bioinformatics and Biotechnology, Faisalabad, Pakistan
| | - G Naz
- Government College University, Department of Microbiology, Faisalabad, Pakistan
| | - A Sarwar
- Government College University, Department of Microbiology, Faisalabad, Pakistan
| | - S Muzammil
- Government College University, Department of Microbiology, Faisalabad, Pakistan
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Nandra R, Rajgor H, Winkworth C, Aslam N. Regional five-year clinical outcomes of 289 consecutive cementless oxford uni-compartmental knee replacements at a non-inventor centre. J Clin Orthop Trauma 2021; 17:176-181. [PMID: 33854945 PMCID: PMC8039718 DOI: 10.1016/j.jcot.2021.03.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 03/16/2021] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Uncemented unicompartmental knee replacement offers a minimally invasive approach, faster rehabilitation and good levels of function, supported by evidence reporting low intra-operative fracture rate and mid-term stability with no implant migration at 5-years. Our aim was to examine the clinical outcomes in 289 consecutive Oxford unicompartmental knee arthroplasties (257 patients), five years post-operatively. METHODS A retrospective study of patients treated between 2008 and 2014 in a non-inventor centre by a single surgeon was performed. Patients with anteromedial bone on bone uni-compartmental arthritis were included. Oxford Knee Scores (OKSs) at last follow-up were recorded, intra-operative complications reported with commentary on revision cases. RESULTS Mean age of patients was 66 years (SD 9.6, 45-88 years). 122 (42%) patients were female and 135 (58%) were male. Patient in our study were ASA 1 (36%), ASA 2 (62%) and ASA 3 (01%). There were no intra-operative complications, particularly tibia fractures during impaction. The average oxford knee score was 40.1 (n = 232, Range 06 to 48, SD 8.46) at an average 6 years and 3 months from surgery, including revised patients. Six patients had their prosthesis revised within five-years of the index surgery. Five-year cumulative implant survival rate was 97.8% (95% CI 97.62 to 97.98, SE 0.09). Indications for revision were: lateral side wear (n = 1); dislocated spacer (n = 4); instability and spacer subluxation (n = 1). Thirteen patients died within five years of surgery Five-year cumulative survival rate was 94.9% (95% CI 94.87 to 94.925, SE 0.013). CONCLUSION The proportion of patients requiring revision at five-years is lower than that generally reported for UKR. These findings add support for the use of the cementless oxford UKR outside the design centre.
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Aslam N, Rashid Z, Mohsin M, Chowdhury D, Sultan Hasan B. P1727 Large coronary artery to pulmonary artery fistula as primary source of pulmonary blood supply in tetralogy of fallot with pulmonary atresia. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.1195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Funding Acknowledgements
Not Applicable
OnBehalf
Not Applicable
Introduction
Pulmonary blood supply in patients of Tetralogy of Fallot with pulmonary atresia is usually from patent arterial duct or major aortopulmonary collaterals (MAPCAs) arising from descending thoracic aorta. We describe a case in which large coronary to pulmonary artery fistula was the primary source of pulmonary blood supply.
Case Report
A 17 years old female was referred to our hospital for diagnostic workup of suspected congenital heart disease. She was previously undiagnosed and now complains of progressive shortness of breath for last few months.
On physical examination she was non-dysmorphic with oxygen saturation of ∼ 77 % in room air, blood pressure of ∼ 117/72 mmHg, pulse rate of ∼ 89 beats per minute and respiratory rate of ∼ 24 breaths per minute. She was clinically cyanosed with grade 3 clubbing and polycythemic. Cardiovascular examination revealed quiet precordium with normally placed apex beat, grade 2 parasternal heave with single second heart sound and grade 3/6 continuous murmur along left mid sternal border.
Twelve lead electrocardiogram (ECG) showed normal sinus rhythm, right axis deviation and right ventricular hypertrophy. There was no evidence of ischemia. Chest X-ray revealed "boat shaped heart" with oligaemic lung fields. Transthoracic echocardiography showed large conoventricular ventricular septal defect with bidirectional flow. There was aortic over-ride with dilated left main coronary artery. No forward flow was seen across right ventricular outflow tract. Considering hugely dilated left main coronary artery, suspicion of coronary to pulmonary artery fistula was made and cardiac computed tomography followed by conventional angiography was done, both confirmed the diagnosis of Tetralogy of Fallot with pulmonary atresia and large coronary artery to main pulmonary artery fistula as a primary pulmonary blood supply. Two small collaterals (MAPCAs) were also identified supplying small part of right and left lungs.
Conclusion
This case highlights unusual source of pulmonary blood supply in Tetralogy of Fallot with pulmonary atresia. Correct pre-operative diagnosis is essential for appropriate surgical planning and better outcome.
Abstract P1727 Figure. TOF-PA with CA to PA Fistula
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Affiliation(s)
- N Aslam
- Aga Khan University, Karachi, Pakistan
| | - Z Rashid
- Aga Khan University, Karachi, Pakistan
| | - M Mohsin
- Aga Khan University, Karachi, Pakistan
| | - D Chowdhury
- Cardiology Care for Children, Lancaster, United States of America
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15
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Wynn PC, Godfrey SS, Aslam N, Warriach HM, Tufail S, Jahan M, Batool Naqvi Z, Latif S, Wang B, McGill DM. Perspectives on the production of milk on small-holder dairy farms and its utilisation in developing countries. Anim Prod Sci 2019. [DOI: 10.1071/an19209] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The profitability of milk production in the developing world varies widely among farming systems. This results from poor animal productivity and an inefficient marketing-chain structure in which farmers seldom profit from their dairying activities. The lack of chilling facilities for milk storage and the need to adulterate the raw product along the market chain to enhance profit margins means that consumers are not well catered for. Co-operative selling of milk, along with the acquisition of higher-quality feeds and veterinary medicines, has boosted the financial resilience of small-holder farming communities worldwide, although, in many regions, the co-operative model has not succeeded largely through a lack of trust between families even within the communities. Commercial reality dictates that farming communities work together to achieve financial sustainability, although the model adopted for each community may differ. Although milk has traditionally provided many consumers with their only source of animal protein, vitamin and minerals, we are now discovering its many other virtues, particularly in relation to cognitive development and memory retention and the provision of antioxidants. The impact of milk-processing technology on some of these remarkable properties requires further investigation to ensure that milk consumers worldwide benefit from these positive attributes.
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16
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Siau K, Hodson J, Ingram R, Baxter A, Widlak MM, Sharratt C, Baker GM, Troth T, Hicken B, Tahir F, Magrabi M, Yousaf N, Grant C, Poon D, Khalil H, Lee HL, White JR, Tan H, Samani S, Hooper P, Ahmed S, Amin M, Mahgoub S, Asghar K, Leet F, Harborne MJ, Polewiczowska B, Khan S, Anjum MR, McFarlane M, Mozdiak E, O'Flynn LD, Blee IC, Molyneux RM, Kurian A, Abbas SN, Abbasi A, Karim A, Yasin A, Khattak F, White J, Ahmed R, Morgan JA, Alleyne L, Alam MA, Palaniyappan N, Rodger VJ, Sawhney P, Aslam N, Okeke T, Lawson A, Cheung D, Reid JP, Awasthi A, Anderson MR, Timothy JR, Pattni S, Ahmad S, Townson G, Shearman J, Giljaca V, Brookes MJ, Disney BR, Guha N, Thomas T, Norman A, Wurm P, Shah A, Fisher NC, Ishaq S, Major G. Time to endoscopy for acute upper gastrointestinal bleeding: Results from a prospective multicentre trainee-led audit. United European Gastroenterol J 2018; 7:199-209. [PMID: 31080604 DOI: 10.1177/2050640618811491] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [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: 08/07/2018] [Accepted: 10/15/2018] [Indexed: 12/24/2022] Open
Abstract
Background Endoscopy within 24 h of admission (early endoscopy) is a quality standard in acute upper gastrointestinal bleeding (AUGIB). We aimed to audit time to endoscopy outcomes and identify factors affecting delayed endoscopy (>24 h of admission). Methods This prospective multicentre audit enrolled patients admitted with AUGIB who underwent inpatient endoscopy between November and December 2017. Analyses were performed to identify factors associated with delayed endoscopy, and to compare patient outcomes, including length of stay and mortality rates, between early and delayed endoscopy groups. Results Across 348 patients from 20 centres, the median time to endoscopy was 21.2 h (IQR 12.0-35.7), comprising median admission to referral and referral to endoscopy times of 8.1 h (IQR 3.7-18.1) and 6.7 h (IQR 3.0-23.1), respectively. Early endoscopy was achieved in 58.9%, although this varied by centre (range: 31.0-87.5%, p = 0.002). On multivariable analysis, lower Glasgow-Blatchford score, delayed referral, admissions between 7:00 and 19:00 hours or via the emergency department were independent predictors of delayed endoscopy. Early endoscopy was associated with reduced length of stay (median difference 1 d; p = 0.004), but not 30-d mortality (p = 0.344). Conclusions The majority of centres did not meet national standards for time to endoscopy. Strategic initiatives involving acute care services may be necessary to improve this outcome.
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Affiliation(s)
- Keith Siau
- Joint Advisory Group on Gastrointestinal Endoscopy, Royal College of Physicians, London, UK.,West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - James Hodson
- Institute of Translational Medicine, University Hospital Birmingham, Birmingham, UK
| | - Richard Ingram
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Andrew Baxter
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Monika M Widlak
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Caroline Sharratt
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Graham M Baker
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Tom Troth
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Ben Hicken
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Faraz Tahir
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Malik Magrabi
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Nouman Yousaf
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Claire Grant
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Dennis Poon
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Hesham Khalil
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Hui Lin Lee
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Jonathan R White
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Huey Tan
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Syazeddy Samani
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Patricia Hooper
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Saeed Ahmed
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Muhammad Amin
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Sara Mahgoub
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Khayal Asghar
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Farique Leet
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Matthew J Harborne
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Beata Polewiczowska
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Sheeba Khan
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Muhammad R Anjum
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Michael McFarlane
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Ella Mozdiak
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Lauren D O'Flynn
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Ilona C Blee
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Rachel M Molyneux
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Ashok Kurian
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Syed N Abbas
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Abdullah Abbasi
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Aadil Karim
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Asif Yasin
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Fawad Khattak
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Josephine White
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Ruhina Ahmed
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - James A Morgan
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Lance Alleyne
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Mohamed A Alam
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Naaventhan Palaniyappan
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Victoria J Rodger
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Paramvir Sawhney
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Nasar Aslam
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Theodore Okeke
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Adam Lawson
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Danny Cheung
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Jeremy P Reid
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Ashish Awasthi
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Mark R Anderson
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Joe R Timothy
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Sanjeev Pattni
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Saqib Ahmad
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Gillian Townson
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Jeremy Shearman
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Vanja Giljaca
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Matthew J Brookes
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Ben R Disney
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Neil Guha
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Titus Thomas
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Anthony Norman
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Peter Wurm
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
| | - Ashit Shah
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Neil C Fisher
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Sauid Ishaq
- West Midlands Research in Gastroenterology Group (WMRIG) collaborative, West Midlands, UK
| | - Giles Major
- Gastroenterology Audit and Research Network East Midlands (GARNet) collaborative, East Midlands, UK
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Sohal PM, Goel A, Gupta D, Aslam N, Sandhu J, Sandhu JS, John EE, Sharma D. Effect of Hemodialysis on Corrected QT Interval and QTc Dispersion. Indian J Nephrol 2018; 28:335-338. [PMID: 30270992 PMCID: PMC6146738 DOI: 10.4103/ijn.ijn_15_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Hemodialysis patients are at higher risk of cardiovascular disease due to traditional and dialysis-related risk factors. Our aim was to study the effects of hemodialysis on the corrected QT interval (QTc) and QTc dispersion in chronic kidney disease (CKD) without clinically manifest heart disease. Two hundred cases of CKD on chronic intermittent hemodialysis of >3 months' duration were included in the study. Twelve-lead electrocardiography and samples for serum creatinine, potassium, calcium, and magnesium were taken before and after dialysis. The mean age of patients was 52.4 ± 17 years with male-to-female ratio of 3:1. QTc interval and QTc dispersion were prolonged in 47% and 59% before and 50% and 89% of patients after hemodialysis, respectively. The mean values of QTc were 433.4 ± 36.9 ms before and 451.4 ± 39.6 ms after hemodialysis (p = 0.001) and the mean values of QTc dispersion were 60.5 ± 19.3 ms before and 81.5 ± 24.4 ms after hemodialysis (p = 0.001). Similar pattern was observed in all etiological groups of CKD, except for QTc dispersion in malignancy-related CKD (p = 0.216). After hemodialysis, there was a significant fall in the mean values of serum potassium (p = 0.001), rise in serum calcium (p = 0.001), and no change in magnesium (p = 0.424). Patients with post hemodialysis QTc dispersion >74 ms had significantly low mean values of serum potassium and calcium as compared to <74 ms group. Large numbers of hemodialysis patients have a prolonged QTc interval and QTc dispersion with a significant increase in the mean values after hemodialysis. There is a significant fall in serum potassium and rise in serum calcium after dialysis.
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Affiliation(s)
- P. M. Sohal
- Department of Nephrology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - A. Goel
- Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - D. Gupta
- Department of Medicine, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - N. Aslam
- Department of Cardiology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - J. Sandhu
- Department of Pathology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - J. S. Sandhu
- Department of Nephrology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - E. E. John
- Department of Nephrology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
| | - D. Sharma
- Department of Nephrology, Dayanand Medical College and Hospital, Ludhiana, Punjab, India
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18
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Abadeer K, Aslam N, Cortese C, Wadei HM. Cytomegalovirus-Induced Polyarteritis Nodosa in a Liver Transplant Recipient. Am J Transplant 2017; 17:3236-3240. [PMID: 28556523 DOI: 10.1111/ajt.14376] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 04/21/2017] [Accepted: 05/11/2017] [Indexed: 01/25/2023]
Abstract
Polyarteritis nodosa (PAN) is a necrotizing vasculitis that has been associated with viral infections, especially hepatitis B virus. We hereby report a case of tissue-invasive cytomegalovirus (CMV)-induced PAN in a liver transplant recipient presenting with acute kidney injury and active urinary sediment. Treatment directed against both PAN and CMV resulted in improvement in kidney function, normalization of urinary indices and resolution of the CMV infection. There was no recurrence of either PAN or CMV after a 3-year follow-up period.
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Affiliation(s)
- K Abadeer
- Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL
| | - N Aslam
- Department of Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Jacksonville, FL
| | - C Cortese
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Jacksonville, FL
| | - H M Wadei
- Department of Transplant, Mayo Clinic, Jacksonville, FL
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19
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Yeaton S, Moorthy A, Rice J, Coghlan D, O'Dwyer L, Green E, Sultan A, Guray S, Mohamad NA, Aslam N, Freedman L. Special care dentistry: how prepared are we? Eur J Dent Educ 2016; 20:9-13. [PMID: 25409761 DOI: 10.1111/eje.12127] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/24/2014] [Indexed: 06/04/2023]
Abstract
AIM To assess and evaluate the confidence of the undergraduate dental team in Irish dental schools regarding their training in the field of special care dentistry (SCD). METHOD A questionnaire was distributed amongst the undergraduate dental teams within Cork University Dental School and Hospital (CUDSH) and Dublin Dental University Hospital (DDUH). The data were analysed to assess for differences between the median responses of the various groups. RESULTS A total of 139 students participated in the study; 82 from DDUH (59 dental science students, seven dental hygiene students and 16 dental nursing students) and 57 from CUDSH (43 dental science students and 14 dental hygiene students). Twenty-two per cent (n = 30) of respondents agreed that their training had been sufficient in providing treatment or assistance for patients requiring SCD. Seventy-five per cent agreed that more emphasis should be placed on clinical training in SCD (n = 76). Thirty-one per cent of students anticipated a high level of confidence in treating patients requiring SCD upon graduation (n = 43), with dental science students feeling the least prepared amongst the dental team. CONCLUSION Confidence levels of the undergraduate dental team were low with regard to SCD. The existing hands-on clinical training in SCD was deemed insufficient by the respondents. Students believed more emphasis should be placed on SCD training in the undergraduate curriculum.
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Affiliation(s)
- S Yeaton
- Division of Child and Public Dental Health, Dublin Dental University Hospital, Dublin, Ireland
| | - A Moorthy
- Division of Child and Public Dental Health, Dublin Dental University Hospital, Dublin, Ireland
| | - J Rice
- Division of Child and Public Dental Health, Dublin Dental University Hospital, Dublin, Ireland
| | - D Coghlan
- Division of Child and Public Dental Health, Dublin Dental University Hospital, Dublin, Ireland
| | - L O'Dwyer
- Division of Child and Public Dental Health, Dublin Dental University Hospital, Dublin, Ireland
| | - E Green
- Division of Child and Public Dental Health, Dublin Dental University Hospital, Dublin, Ireland
| | - A Sultan
- Division of Child and Public Dental Health, Dublin Dental University Hospital, Dublin, Ireland
| | - S Guray
- Division of Child and Public Dental Health, Dublin Dental University Hospital, Dublin, Ireland
| | - N A Mohamad
- Division of Child and Public Dental Health, Dublin Dental University Hospital, Dublin, Ireland
| | - N Aslam
- Division of Child and Public Dental Health, Dublin Dental University Hospital, Dublin, Ireland
| | - L Freedman
- Division of Child and Public Dental Health, Dublin Dental University Hospital, Dublin, Ireland
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20
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Aslam N, Rodrigues I, McGill DM, Warriach HM, Cowling A, Haque A, Wynn PC. Transfer of aflatoxins from naturally contaminated feed to milk of Nili-Ravi buffaloes fed a mycotoxin binder. Anim Prod Sci 2016. [DOI: 10.1071/an14909] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The objectives of this study were to observe the extent of transfer of aflatoxin B1 in feed to the aflatoxin M1 metabolite in milk in Nili-Ravi buffaloes and to evaluate the efficacy of a commercial mycotoxin binder (Mycofix, Biomin Singapore) incorporated into feed to minimise this transfer. Multiparous animals (n = 28) were randomly distributed to four groups corresponding to two treatments each with two levels of aflatoxin B1. Individual animals were exposed to naturally contaminated feed providing a total of 1475 µg/day (Groups A and B) or 2950 µg/day (Groups C and D) of aflatoxin B1. Groups B and D were given 50 g of mycotoxin binder daily mixed with feed whereas Groups A and C were kept as controls. Feed samples were analysed by reverse phase high performance liquid chromatography for aflatoxin B1 and milk samples were evaluated by enzyme-linked immunosorbent assay for the liver metabolite aflatoxin M1. The mean value of total daily aflatoxin M1 excretion for animals fed 2950 µg/day of aflatoxin B1 (112.6 µg/day) was almost double (P < 0.001) than the excretion in buffaloes fed 1475 µg/day (62.2 µg/day). The mean daily concentration of aflatoxin M1 in milk of animals from both treatment groups supplemented with 50 g/day of mycotoxin binder was 76.5 µg/day, nearly 22 µg lower than those without binder at 98.3 µg/day (s.e.d. = 5.99: P < 0.01). The interaction of binder and treatment was not significant i.e. the 50 g/day of binder was able to sequester aflatoxin B1 with the same efficiency in groups fed with high and low concentrations of aflatoxin B1. Carry over was (3.44%) lower (P = 0.001) in animals supplemented with 50 g/day of mycotoxin binder than those fed no binder (4.60%). Thus buffaloes are highly efficient at transferring aflatoxins in feed to the aflatoxin M1 metabolite in milk, whereas mycotoxin binder is capable of alleviating without preventing this contamination risk.
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21
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Singh V, Tandon R, Wander G, Mohan B, Aslam N, Takkar S, Singh B. Cardiac rupture, a clinically predictable complication of acute myocardial infarction: Report of 15 cases with clinico-pathological correlations. Indian Heart J 2014. [DOI: 10.1016/j.ihj.2014.10.346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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22
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Aslam N. Use of cognitive therapy for management of nocturnal panic. J Postgrad Med 2014; 60:206-7. [PMID: 24823528 DOI: 10.4103/0022-3859.132353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- N Aslam
- National Institute of Psychology, Quaid-i-Azam University, Islamabad, Pakistan
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23
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Nawaz Z, Mushtaq F, Mousa D, Rehman E, Sulaiman M, Aslam N, Khawaja N. Pattern of glomerular disease in the Saudi population: a single-center, five-year retrospective study. Saudi J Kidney Dis Transpl 2014; 24:1265-70. [PMID: 24231502 DOI: 10.4103/1319-2442.121288] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Glomerular diseases continue to be the leading cause of end-stage renal disease (ESRD) globally. Hence, it is important to recognize the pattern of glomerular diseases in different geographical areas in order to understand the patho-biology, incidence and progression of the disorder. Published studies from different centers in Saudi Arabia have reported contradicting results. In this retrospective study, we report our experience at the Armed Forces Hospital, Riyadh, Saudi Arabia. A total of 348 native renal biopsies performed at our center on patients with proteinuria >1 g, hematuria and/or renal impairment during a period of 5 years (between January 2005 and December 2009) were studied by a histopathologist using light microscopy, immunofluorescence and electron microscopy, and were categorized. Results showed that primary glomerular disease accounted for 55.1% of all renal biopsies. The most common histological lesion was focal and segmental glomerulosclerosis (FSGS) (27.6%), followed by minimal change disease (MCD) (17.7%) and membrano-proliferative glomerulonephritis (MPGN) (13.0%). Secondary glomerular disease accounted for 37.9% of the glomerular diseases, with lupus nephritis (LN) being the most common lesion (54.5%), followed by hypertensive nephrosclerosis (22%), post-infectious glomerulonephritis (7.5%), diabetic nephropathy (DN) (6.8%) and vasculitides (4.5%). Four percent of all biopsies turned out to be ESRD while biopsy was inadequate in 2.8% of the cases. In conclusion, our study showed that FSGS was the most common primary GN encountered, while LN was the most common secondary GN. We encountered 14 cases of crescentic glomerulonephritis. Also, the prevalence of MPGN, MCD, IgA nephropathy and membranous GN was many folds higher in males when compared with the Western data. We believe that it is mandatory to maintain a Saudi Arabian Renal Biopsy Registry to understand better the pattern of glomerular disease in the Saudi population and to follow any change in trend.
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Affiliation(s)
- Z Nawaz
- Department of Nephrology, Armed Forces Hospital, Riyadh, Saudi Arabia
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24
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Aslam N, Iqbal ZM, Warriach HM, Wynn PC. Pattern of partitioning of aflatoxins from feed to urine and its effect on serum chemistry in Nili-Ravi buffalo heifers. Anim Prod Sci 2014. [DOI: 10.1071/an14302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The objectives of the present study were (1) to monitor the pattern of excretion of aflatoxinM1 in urine after its conversion from aflatoxinB1 and (2) to observe the effects of different levels of aflatoxinB1 in feed on serum concentrations of key metabolites glucose, total protein, cholesterol and urea as indicators of metabolic status. Nili-Ravi buffalo heifers (n = 12) of similar age and weight were randomly distributed to four groups. Animals in Groups A, B and C were offered a contaminated cottonseed cake-based concentrate ration at 0.5%, 1.0% and 1.5% of bodyweight, respectively. Control animals in Group D were fed with aflatoxinB1-free green fodder. Based on the level of contamination of the concentrate ration with aflatoxinB1 (554 µg/kg), Groups A, B and C consumed 953, 2022, 3202 µg of aflatoxinB1 daily. Feed samples were analysed at Romer Laboratories Pty Ltd, Singapore by high performance liquid chromatography. AflatoxinM1 quantification in urine samples was conducted using a competitive enzyme-linked immunosorbent assay with kits supplied by Helica Biosystems, Inc., USA. Serum samples were analysed for concentrations of glucose, total protein, cholesterol and urea using clinical chemistry kits provided by Human diagnostics (HUMAN, Biochemica und Diagnostica mbH, Germany). Carry-over rate of aflatoxinM1 in urine for Groups A, B and C was 15.51%, 15.44% and 14.04% of aflatoxinB1 while there was no detectable aflatoxinM1 in the urine of the control group (D). There was no significant difference in the concentrations of serum glucose, total protein and cholesterol between treatment groups. However, the concentration of serum urea was significantly higher (P < 0.05) in the group offered the highest level of aflatoxinB1-contaminated concentrate. This result suggests that mycotoxicosis may compromise protein metabolism and accretion in affected animals. This leaves open the possibility that high concentrations of aflatoxins in milk may ultimately affect the health status of human milk consumers.
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Kugan R, Aslam N, Bose D, McNally MA. Outcome of arthrodesis of the hindfoot as a salvage procedure for complex ankle pathology using the Ilizarov technique. Bone Joint J 2013; 95-B:371-7. [DOI: 10.1302/0301-620x.95b3.29885] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [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: 01/14/2023]
Abstract
Achieving arthrodesis of the ankle can be difficult in the presence of infection, deformity, poor soft tissues and bone loss. We present a series of 48 patients with complex ankle pathology, treated with the Ilizarov technique. Infection was present in 30 patients and 30 had significant deformity before surgery. Outcome was assessed clinically and with patient-reported outcome measures (Modified American Orthopaedic Foot and Ankle Society (MAOFAS) scale and the Short-Form (SF-36)). Arthrodesis was achieved in 40 patients with the Ilizarov technique alone and in six further patients with additional surgery. Infection was eradicated in all patients at a mean follow-up of 46.6 months (13 to 162). Successful arthrodesis was less likely in those with comorbidities and in tibiocalcaneal fusion compared with tibiotalar fusion. These patients had poor general health scores compared with the normal population before surgery. The mean MAOFAS score improved significantly from 24.3 (0 to 90) pre-operatively to 56.2 (30 to 90) post-operatively, but there was only a modest improvement in general health; the mean SF-36 improved from 44.8 (19 to 66) to 50.1 (21 to 76). There was a major benefit in terms of pain relief. Arthrodesis using the Ilizarov technique is an effective treatment for complex ankle pathology, with good clinical outcomes and eradication of infection. However, even after successful arthrodesis general health scores remain limited. Cite this article: Bone Joint J 2013;95-B:371–7.
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Affiliation(s)
- R. Kugan
- Gloucestershire Royal Hospital, Great
Western Road, Gloucester GL1 3NN, UK
| | - N. Aslam
- Worcestershire Royal Hospital, Charles
Hastings Way, Worcester WR5 1DD, UK
| | - D. Bose
- New Queen Elizabeth Hospital, Mindelsohn
Way, Edgbaston, Birmingham
B15 2WB, UK
| | - M. A. McNally
- Nuffield Orthopaedic Centre, Oxford
University Hospitals NHS Trust, Windmill Road, Oxford
OX3 7HE, UK
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Aslam N. Stuttering among children exposed to (family) high expressed emotion families. Ann Med Health Sci Res 2013; 3:469-70. [PMID: 24116340 PMCID: PMC3793466 DOI: 10.4103/2141-9248.117941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Aslam N, Moran P. M102 PRESACRAL MASS; A DIAGNOSTIC DILEMMA. Int J Gynaecol Obstet 2012. [DOI: 10.1016/s0020-7292(12)61297-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Browne J, Aslam N, Jones E, Flint B, Dzingai J, Fabris G, Billett J, Restrick L, Stern M. P125 Stop smoking as treatment for COPD: quit-interventions of higher intensity and duration are required. Thorax 2011. [DOI: 10.1136/thoraxjnl-2011-201054c.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Robinson B, Zhang J, Thumma J, Gillespie B, Combe C, Fukuhara S, Harambat J, Morgenstern H, Port F, Pisoni R, Collier T, Steenkamp R, Tomson C, Caskey F, Ansell D, Roderick P, Nitsch D, Chanouzas D, Ng KP, Fallouh B, Baharani J, Righetti M, Ferrario G, Serbelloni P, Milani S, Lisi L, Tommasi A, Okuno S, Ishimura E, Yamakawa K, Tsuboniwa N, Norimine K, Kagitani S, Shoji S, Yamakawa T, Nishizawa Y, Inaba M, de Jager DJ, Halbesma N, Krediet RT, Boeschoten EW, le Cessie S, Dekker FW, Grootendorst DC, Miranda AC, Bento D, Madeira J, Cruz J, Saglimbene VM, De berardis G, Pellegrini F, Johnson DW, Craig JC, Hegbrant JBA, Strippoli GFM, Tzanno C, Nisihara F, Stein G, Clesco P, Uezima C, Martins JP, Esposito P, Di Benedetto A, Tinelli C, De Silvestri A, Marcelli D, Dal Canton A, Capurro F, De Mauri A, David P, Navino C, Chiarinotti D, De Leo M, De Leo M, Sato Y, Sato M, Johtoku Y, Appunu K, Baharani J, Kara B, Severova- Andreevska G, Trajceska L, Gelev S, Amitov V, Sikole A, Lomidze M, Rtskhiladze I, Metreveli D, Bartel J, Abramishvili N, Zangurashvili L, Barnova M, Buachidze K, Jashiashvili N, Kankia N, Khitarishvili T, Dzagania T, Tschokhonelidze I, Sarishvili N, Shamanadze A, Amet S, Launay-Vacher V, Stengel B, Castot A, Frances C, Gauvrit JY, Grenier N, Reinhardt G, Clement O, Kreft-Jais C, Janus N, Choukroun G, Laville M, Deray G, Szlanka B, Borbas B, Joseph J, Somers F, Vanga SR, Alscher MD, Rutherford P, De Mauri A, Conte M, Capurro F, David P, De Maria M, Navino C, De Leo M, De Mauri A, Conte M, Capurro F, David P, Chiarinotti D, Navino C, De Leo M, Kan WC, Chien CC, Wang HY, Hwang JC, Wang CJ, Castledine C, Gilg J, Rogers C, Ben-Shlomo Y, Yoav C, Dattolo P, Amidone M, Antognoli G, Michelassi S, Sisca S, Pizzarelli F, Kimber A, Tomson C, Maggs C, Steenkamp R, Smith H, Madziarska K, Weyde W, Kopec W, Penar J, Krajewska M, Klak R, Zukowska Szczechowska E, Gosek K, Golebiowski T, Strempska B, Kusztal M, Klinger M, Ito M, Masakane I, Ito S, Nagasawa J, Liao SC, Lee IN, Cheng CT, Halle MP, Hertig A, Kengue AP, Ashuntantang G, Rondeau E, Ridel C, Selim G, Stojceva-Taneva O, Tozija L, Gelev S, Stojcev N, Dzekova P, Trajcevska L, Severova G, Pavleska S, Sikole A, Paunovic K, Dimitrijevic Z, Paunovic G, Ljubenovic S, Djordjevic V, Stojanovic M, Mitsopoulos E, Tsiatsiou M, Ginikopoulou E, Minasidis I, Kousoula V, Tsikeloudi M, Manou E, Tsakiris D, Ortalda V, Yabarek T, Aslam N, Tomei P, Messa M, Lupo A, Ito S, Masakane I, Kudo K, Ito M, Nagasawa J, Osthus TBH, Amro A, Preljevic V, Leivestad T, Dammen T, Os I, Panocchia N, Di Stasio E, Liberatori M, Tazza L, Bossola M, Wilson R, Smyth M, Copley JB, Hanafusa N, Yamagata K, Nishi H, Nishi S, Iseki K, Tsubakihara Y, Fusaro M, Tripepi G, Crepaldi G, Maggi S, D'Angelo A, Naso A, Plebani M, Vajente N, Giannini S, Calo L, Miozzo D, Cristofaro R, Gallieni M, Hung PH, Shen CH, Hsiao CY, Chiang PC, Hung KY. Epidemiology & outcome in CKD 5D (2). Clin Kidney J 2011. [DOI: 10.1093/ndtplus/4.s2.58] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ali H, Bushra R, Aslam N. Profile of drug users in Karachi City, Pakistan. East Mediterr Health J 2011; 17:41-45. [PMID: 21735800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Drug use has been identified as a major public issue in Pakistan. A descriptive questionnaire survey in Karachi city was made to identify the socioeconomic profile and beliefs and practices of 500 drug users The most commonly used drugs were cocaine (19.0%) and crack-cocaine (15.0%), followed by amphetamine, (11.0%), alcohol, caffeine, barbiturates and benzodiazepines (10.0% each). Key psychological factors leading tc drug use were problems with parental or marital relations or break-up of a relationship (45.0%). Drugs were seer as an escape from stressful life events (28.0%) or feelings of failure (18.2%). Many drug users blamed the origin of their drug use on bad social influences (47.0%) or socioeconomic problems (23.4%). Preventive measures are needed to decrease the rate of drug addiction in Karachi.
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Affiliation(s)
- H Ali
- Ziauddin College of Pharmacy, Ziauddin University, Clifton, Karachi, Pakistan
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Aslam N, Mathew E, Pathak M, Clark J. P920 Is it appropriate for all cervical polyps to be referred to hospital? Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)62406-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Aslam N, Fatima P, Latthe P. O63 Outcome of Mirena Intra-uterine System (IUS) for menstrual problems in adolescents. Int J Gynaecol Obstet 2009. [DOI: 10.1016/s0020-7292(09)60435-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Affiliation(s)
- A Khalil
- Elizabeth Garrett Anderson and Obstetric Hospital, University College Hospitals, London, UK
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Yazbek J, Aslam N, Tailor A, Hillaby K, Raju KS, Jurkovic D. A comparative study of the risk of malignancy index and the ovarian crescent sign for the diagnosis of invasive ovarian cancer. Ultrasound Obstet Gynecol 2006; 28:320-4. [PMID: 16881074 DOI: 10.1002/uog.2842] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
Abstract
OBJECTIVE To compare the value of the risk of malignancy index (RMI) and the ovarian crescent sign (OCS) in the diagnosis of ovarian malignancy. METHODS This was a prospective observational study of women with ultrasonographic diagnosis of an ovarian cyst. The RMI was calculated in all cases using a previously published formula (RMI = U (ultrasound score) x M (menopausal status) x serum CA125 (kU/L)). A value > 200 was considered to be diagnostic of ovarian cancer. The OCS was defined as a rim of visible healthy ovarian tissue in the ipsilateral ovary. Its absence was taken as being diagnostic of invasive cancer. RESULTS A total of 106 consecutive women were included in the study, of whom 92 (86.8%) had a benign ovarian tumor, five (4.7%) had borderline lesions and nine (8.5%) had an invasive ovarian cancer. The absence of an OCS diagnosed invasive ovarian cancer with a sensitivity of 100% (95% CI, 70-100%), specificity of 93% (95% CI, 86-96%), positive predictive value (PPV) of 56%, negative predictive value (NPV) of 100% and positive likelihood ratio (LR+) of 13.86 (95% CI, 6.79-28.29). This compared favorably with a sensitivity of 89% (95% CI, 57-98%), specificity of 92% (95% CI, 85-96%), PPV of 50%, NPV of 99% and LR+ of 10.78 (95% CI, 5.34-21.77), which were achieved using RMI > 200 (P < 0.01). CONCLUSIONS The RMI and the OCS are useful tests for discriminating between invasive and non-invasive ovarian tumors. The application of these tests in a sequential manner might improve the overall accuracy of ovarian cancer diagnosis.
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Affiliation(s)
- J Yazbek
- Early Pregnancy and Gynaecology Assessment Unit, King's College Hospital, London, UK
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Al-Absi AI, Wall BM, Aslam N, Mangold TA, Lamar KD, Wan JY, D'Cruz IA. Predictors of Mortality in End-Stage Renal Disease Patients with Mitral Annulus Calcification. Am J Med Sci 2006; 331:124-30. [PMID: 16538072 DOI: 10.1097/00000441-200603000-00003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Mitral annulus calcification (MAC) is an independent predictor of cardiovascular mortality in the general population. The purpose of the current historical cohort study is to assess risk factors for long-term mortality in end-stage renal disease (ESRD) patients with MAC (n = 30; age, 62 +/- 2 yr), as compared to ESRD patients without MAC (n = 30; age, 63 +/- 2 yr). Additional analysis compared ESRD patients with MAC to non-ESRD patients with MAC (n = 32; age, 66 +/- 2 yr). METHODS The groups included age-matched male patients followed at a single center. Long-term survival was assessed by Kaplan-Meier analysis. Regular and stepwise Cox proportional hazards models were used to determine risk factors for mortality. RESULTS There was a similarly high prevalence of cardiovascular complications, including hypertension, coronary artery disease, left ventricular hypertrophy, atrial fibrillation, and congestive heart failure, in all three groups. Median survival time was significantly longer in non-ESRD patients (90 months), compared with the ESRD with MAC (45 months) and ESRD without MAC (45 months) patients (log-rank test; P < 0.001). With stepwise Cox proportional hazards model, including ESRD patients with MAC and ESRD patients without MAC, increased calcium x phosphate product, decreased serum creatinine concentration, and the presence of coronary artery disease and lower extremity amputations were independent predictors of mortality for patients with ESRD. With stepwise Cox proportional hazards model, including ESRD patients with MAC and non-ESRD patients with MAC, the presence of ESRD, atrial fibrillation, diabetes, aortic valve calcification, coronary artery disease, and tricuspid regurgitation were independent predictors of mortality. CONCLUSION The mortality rate was high in ESRD patients, approximately 15% per year. After accounting for baseline cardiovascular disease and traditional risk factors, the presence of MAC did not confer additional risk for mortality.
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Affiliation(s)
- A I Al-Absi
- Department of Medicine, Divisions of Nephrology and Cardiology, Veterans Affairs Medical Center, Memphis, Tennessee 38104, USA
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Aslam N, Niell HB. 80 CARBOPLATIN AND ETOPOSIDE IN ATTENUATED DOSES CAN BE SAFE AND EFFECTIVE IN ELDERLY OR MEDICALLY INFIRM PATIENTS WITH EXTENSIVE STAGE SMALL CELL LUNG CANCER. J Investig Med 2006. [DOI: 10.2310/6650.2005.x0008.79] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Aslam N, Hani R, Johnson WD, Abell T. 69 A MULTICOMPONENT MODEL CORRELATE WITH DELAYED GASTRIC EMPTYING IN DIABETIC GASTROPARESIS. J Investig Med 2006. [DOI: 10.2310/6650.2005.x0008.68] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Aslam N, Rashed H, Madan AK, Tichansky DS, Cutts T, Johnson WD, Abell T. 185 A MULTICOMPONENT MODEL CAN PREDICT OUTCOME OF RESTRICTIVE SURGERY FOR OBESITY.: Table. J Investig Med 2006. [DOI: 10.2310/6650.2005.x0008.184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Apostolou C, Papavasiliou A, Aslam N, Handley R, Willett K. Preliminary results and technical aspects following stabilisation of fractures around the knee with liss. ACTA ACUST UNITED AC 2005. [DOI: 10.1016/j.injury.2005.02.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Abstract
The purpose of this study was to examine the effects of hyaluronic acid supplementation on chondrocyte metabolism in vitro. The clinical benefits of intra-articular hyaluronic acid injections are thought to occur through improved joint lubrication. Recent findings have shown that exogenous hyaluronic acid is incorporated into articular cartilage where it may have a direct biological effect on chondrocytes through CD44 receptors.Bovine articular chondrocytes were isolated and seeded into alginate constructs. These were cultured in medium containing hyaluronic acid at varying concentrations. Samples were assayed for biochemical and histological changes. There was a dose-dependent response to the exposure of hyaluronic acid to bovine articular chondrocytes in vitro. Low concentrations of hyaluronic acid (0.1 mg/mL and 1 mg/mL) significantly increase DNA, sulphated glycosaminoglycan and hydroxyproline synthesis. Immunohistology confirmed the maintenance of cell phenotype with increased matrix deposition of chondroitin-6-sulphate and collagen type II. These findings confirm a stimulatory effect of hyaluronic acid on chondrocyte metabolism.
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Affiliation(s)
- M Akmal
- Institute of Orthopaedics, Royal Free and University College Medical School, Stanmore, England.
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Aslam N, Wainwright A, Benson MK. The false profile arthrogram in developmental dysplasia of the hip. Hip Int 2005; 15:177-181. [PMID: 28224604 DOI: 10.1177/112070000501500309] [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: 02/04/2023]
Abstract
Arthrography is useful in the evaluation and treatment of developmental dysplasia of the hip. The authors describe the additional diagnostic value obtained from a "false profile" arthrogram. The "false profile" arthrogram allows assessment of anterior acetabulum cover, femoral neck anteversion and hip joint subluxation (instability), which may not be apparent on other views. (Hip International 2005; 15: 177-81).
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Affiliation(s)
- N Aslam
- Nuffield Orthopaedic Centre, Headington, Oxford - UK
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Nagarajah K, Aslam N, McLardy Smith P, McNally M. Iliofemoral distraction and hip reconstruction for the sequelae of a septic dislocated hip with chronic femoral osteomyelitis. ACTA ACUST UNITED AC 2005; 87:863-6. [PMID: 15911675 DOI: 10.1302/0301-620x.87b6.16052] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
We describe a technique of ‘cross-hip distraction’ to reduce a dislocated hip with subsequent reconstruction of the joint for septic arthritis with extensive femoral osteomyelitis. A 27-year-old woman presented with a dislocated, collapsed femoral head and chronic osteomyelitis of the femur. Examination revealed a leg-length discrepancy of 7 cm and an irritable hip. A staged technique was used with primary clearance of osteomyelitis and secondary reconstruction of the hip. A cross-hip monolateral external fixator was used to establish normal anatomy followed by an arthroplasty. A good functional outcome was achieved. The use of cross-hip distraction avoids soft-tissue and nerve damage and achieved improved abductor function before arthroplasty.
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Affiliation(s)
- K Nagarajah
- Nuffield Orthopaedic Centre, Headington, Oxford OX3 7LD, UK.
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Abstract
The purpose of this study was to determine patterns of facial laceration seen in the Accident and Emergency Department and identify how they are related to the mechanism of injury. A retrospective analysis of facial lacerations of an adult presenting to Accident and Emergency department was made over a 6-month period. There were 197 consecutive facial lacerations. The mean age of patients was 46 years. There were 137 male and 60 female patients. The aetiology of lacerations was falls (48%), assaults (11%), hit by an object by accident (21%) and hit stationary object by accident (15%). Mechanism of injury was found to be related to common patterns of laceration. Lacerations affecting the forehead mainly occurred in falls and those affecting the peri-orbital and peri-oral areas in assault. Lacerations were mainly linear, with a mean length of 2.4 cm, and about 75% were precipitated by blunt injury. Identification of common patterns of injury corresponding to a certain mechanism may allow assessment of the difficult or non-compliant patient. Understanding mechanisms of injury will allow safety planners to design safer domestic and workplace environments.
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Affiliation(s)
- S Lo
- Accident and Emergency Department, Wexham Park Hospital, Slough, UK
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Aslam N, Spiteri V, McNab I. Ulnar tunnel syndrome due to anatomical variant of the ulnar artery. Hand Surg 2005; 10:261-4. [PMID: 16568524 DOI: 10.1142/s0218810405002711] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2004] [Accepted: 09/01/2005] [Indexed: 05/08/2023]
Abstract
We report a case of ulnar tunnel syndrome due to an anatomical variant branch of the ulnar artery. Anatomical variants can cause compression not visible on imaging and need to be considered for successful surgical decompression.
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Affiliation(s)
- N Aslam
- Nuffield Orthopaedic Centre, Headington, Oxford, OX3 7LD, UK.
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Abstract
We report a case of multiple schwannomas of the median nerve. Multiple schwannomas can be difficult to diagnose on clinical grounds and can be mistakenly diagnosed as carpal tunnel syndrome or ganglia as in our case. Nerve conduction studies helped locate non-visible tumours. Magnetic resonance imaging (MRI) is useful in the preoperative planning of these tumours. The appearances on scanning however can be sometimes confused for ganglia as in this case. Intraneural dissection of the schwannomas was carried out and the pathology is described.
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Affiliation(s)
- N Aslam
- Department of Orthopaedic Surgery, Northampton General Hospital, Cliftonville Road, Northampton NN1 5BD, UK.
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Abstract
AIM Methicillin resistant staphylococcus aureus (MRSA) colonisation or infection is of particular importance in patients undergoing operations involving implantable materials, such as in orthopaedic surgery. An audit of the perioperative management of orthopaedic patients in the Oxford region was carried out to assess the level of clinician awareness and the uniformity of current guidelines between hospitals. METHODS A postal questionnaire was designed for asking information on various aspects of perioperative management of MRSA patients and was sent to each hospital. RESULTS Responses were obtained from nine of 10 hospitals in the region. The average response rate for each hospital was 75%, and the overall individual response rate was 67.5% (27/40). Seventy-eight per cent of respondents knew that there was a pre-admission screening policy. Fifteen per cent were unaware of any MRSA policy. Forty-four per cent indicated that teicoplanin was used for prophylaxis in implant surgery whilst 44% used vancomycin. Eighteen per cent believed that cefuroxime was used for prophylaxis. Forty-eight per cent of hospitals had an MRSA-free zone for orthopaedic patients. CONCLUSION This study indicates a lack of uniformity in the perioperative management of MRSA-positive patients in the region and a lack of awareness of both MRSA guidelines and their implementation. Uniformity of MRSA guidelines is necessary to allow better clinician awareness and compliance, especially in surgical trainees who are travelling between different training hospitals in the region. Implementation of such a policy with re-audit of subsequent awareness and compliance is proposed.
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Affiliation(s)
- N Aslam
- Northampton General Hospital, Cliftonville Road, Northampton, NN1 5BD, UK.
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