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Etzion O, Hamid S, Lurie Y, Gane EJ, Yardeni D, Duehren S, Bader N, Nevo-Shor A, Channa SM, Cotler SJ, Mawani M, Parkash O, Dahari H, Choong I, Glenn JS. Treatment of chronic hepatitis D with peginterferon lambda-the phase 2 LIMT-1 clinical trial. Hepatology 2023; 77:2093-2103. [PMID: 36800850 PMCID: PMC10187621 DOI: 10.1097/hep.0000000000000309] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 12/13/2022] [Accepted: 01/06/2023] [Indexed: 02/22/2023]
Abstract
BACKGROUND AND AIMS HDV infection leads to the most aggressive form of human viral hepatitis for which there is no FDA-approved therapy. PEG IFN-lambda-1a (Lambda) has previously demonstrated a good tolerability profile in HBV and HCV patients compared to PEG IFN-alfa. The goal of Phase 2 LIMT-1 trial was to evaluate the safety and efficacy of Lambda monotherapy in patients with HDV. APPROACH AND RESULTS An open-label study of Lambda 120 or 180 mcg, administered once weekly by subcutaneous injections for 48 weeks, followed by 24 weeks of posttreatment follow-up. Thirty-three patients were allocated to Lambda 180 mcg (n=14) or 120 mcg (n=19). Baseline mean values: HDV RNA 4.1 log10 IU/mL (SD±1.4); ALT 106 IU/L (35-364); and bilirubin 0.5 mg/dL (0.2-1.2). Intention-to-treat rates of virologic response to Lambda 180 mcg and 120 mcg, 24 weeks following treatment cessation were 5 of 14(36%) and 3 of 19 (16%), respectively. The posttreatment response rate of 50% was seen in low BL viral load (≤4 log10) on 180 mcg. Common on-treatment adverse events included flu-like symptoms and elevated transaminase levels. Eight (24%) cases of hyperbilirubinemia with or without liver enzyme elevation, leading to drug discontinuation, were mainly observed in the Pakistani cohort. The clinical course was uneventful, and all responded favorably to dose reduction or discontinuation. CONCLUSIONS Treatment with Lambda in patients with chronic HDV may result in virologic response during and following treatment cessation. Clinical phase 3 development of Lambda for this rare and serious disease is ongoing.
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Affiliation(s)
- Ohad Etzion
- Department of Gastroenterology and Liver Diseases, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Saeed Hamid
- Aga Khan University and Hospital, Karachi, Pakistan
| | - Yoav Lurie
- Shaare Zedek Medical Center, Jerusalem, Israel
| | | | - David Yardeni
- Department of Gastroenterology and Liver Diseases, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Sarah Duehren
- Division of Hepatology, Department of Medicine, The Program for Experimental and Theoretical Modeling, Loyola University Medical Center, Maywood, Illinois, USA
| | - Nimrah Bader
- Aga Khan University and Hospital, Karachi, Pakistan
| | - Anat Nevo-Shor
- Department of Gastroenterology and Liver Diseases, Soroka University Medical Center, Beer-Sheva, Israel
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Saleh Muhammad Channa
- Department of Gastroenterology, Ghulam Muhammad Mahar Medical College, Sukkur, Pakistan
| | - Scott J. Cotler
- Division of Hepatology, Department of Medicine, The Program for Experimental and Theoretical Modeling, Loyola University Medical Center, Maywood, Illinois, USA
| | - Minaz Mawani
- Aga Khan University and Hospital, Karachi, Pakistan
| | - Om Parkash
- Aga Khan University and Hospital, Karachi, Pakistan
| | - Harel Dahari
- Division of Hepatology, Department of Medicine, The Program for Experimental and Theoretical Modeling, Loyola University Medical Center, Maywood, Illinois, USA
| | - Ingrid Choong
- Eiger BioPharmaceuticals, Inc., Palo Alto, California, USA
| | - Jeffrey S. Glenn
- Departments of Medicine (Division of Gastroenterology and Hepatology) and Microbiology and Immunology, Stanford University School of Medicine, Stanford, California, USA
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Madhoun MF, Bader N, Ali I, Yohannan B, Grossen A, Nadeem M, Corredine TJ, Harty R. Factors Associated with Difficulty Maintaining Insufflation of the Colon During Endoscopy. Dig Dis Sci 2023; 68:202-207. [PMID: 35759158 DOI: 10.1007/s10620-022-07592-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 03/24/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Insufflation of the colon allows for adequate visualization of the mucosal tissue and advancement of the endoscope during colonoscopy. Most colonoscopies are performed with sedation to mitigate discomfort and enhance the colonoscopy experience for both the patient and the endoscopist. AIM We aimed to evaluate factors associated with difficulty maintaining insufflation. METHODS A cross-sectional study of individuals undergoing colonoscopy at the Oklahoma City Veterans Affairs Medical Center was performed. Experiencing difficulty maintaining air insufflation during colonoscopy was assessed with a questionnaire completed by the performing endoscopist at the end of procedure. Information regarding procedure times, sedation used, demographics, comorbidities, surgical history, and medications used was extracted from the medical record. A multivariate regression analysis was performed to identify factors associated with difficulty maintaining air insufflation. A P value < 0.05 was considered significant. RESULTS 996 Patients were included for the analysis. Difficulty with insufflation was reported in 240 (24%) colonoscopies; mean age of 63.8 ± 10.4 years old and 13% were female. Fellow trainees were involved in 669 (67%) colonoscopies. Older age (OR 1.02, P 0.03, CI [1.00-1.04]), diabetes (OR 1.5, 95% CI [1.03, 2.05]), fellow's involvement (OR 2.6. (95% CI [1.68, 4.09]), total procedure time (OR 1.02, 95% CI [1.00, 1.03]), mean number of adenomas (OR 1.05, 95% CI [1.00, 1.09]), and MAC use (OR 2.6, 95% CI [1.80, 3.85]) were independent predictors for difficulty in maintaining air insufflation. CONCLUSION Our findings suggest that endoscopists should be cognizant of colon insufflation issues in older, diabetic patients undergoing colonoscopies under deep sedation, particularly if prolonged procedure is anticipated or encountered.
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Affiliation(s)
- Mohammad F Madhoun
- Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.,Veterans Affairs Medical Center, Oklahoma City, OK, USA.,Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Nimrah Bader
- Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
| | - Ijlal Ali
- Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.,Veterans Affairs Medical Center, Oklahoma City, OK, USA.,Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Bryce Yohannan
- Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Alyssa Grossen
- Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Mahum Nadeem
- Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Thomas J Corredine
- Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.,Veterans Affairs Medical Center, Oklahoma City, OK, USA.,Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Richard Harty
- Division of Digestive Diseases and Nutrition, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.,Veterans Affairs Medical Center, Oklahoma City, OK, USA.,Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Zuberi BF, Rasheed T, Ali FS, Bader N, Sadaf R. Assessment of frailty in cirrhosis using bedside measures and its correlation with Child-Turcotte-Pugh, MELD & MELD-Na Scores. Pak J Med Sci 2022; 38:1086-1092. [PMID: 35799712 PMCID: PMC9247761 DOI: 10.12669/pjms.38.5.5545] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 01/28/2022] [Accepted: 02/15/2022] [Indexed: 11/24/2022] Open
Abstract
Objectives: To assess frailty in cirrhotic by calculating Liver Frailty Index (LFI) using bedside clinical tests and correlate it with Child-Turcotte-Pugh (CTP), MELD, MELD Na, Fib- 4 and Transient Elastography (TE) scores Methods: This cross-sectional observational comparative study was carried out in Dr Ruth KM Pfau Civil Hospital, Karachi from August 2020 to September 2021. Patients were subjected to three performance-based testing including dominant hand grip strength (HGS), Chair to Stand (CTS) Time & Three Position Balance (TPB). LFI was calculated using the online LFI calculator, available at http://liverfrailtyindex.ucsf.edu and classified as ‘Robust’ if LFI <3.2, ‘Prefrail’ LFI between 3.2 and 4.4, and ‘Frail’ as LFI ≥4.5. Correlation of frailty with MELD, MELD-Na and CTP Scores was done. Means of MELD & MELD-Na Scores and CTP scores were calculated in all 3 classes of frailty using one way ANOVA. A p-value of ≤.05 was taken as significant. Results: Out of 118 patients, 62 (52.5%) were males. Mean MELD score was 11.4 ±3.3, MELD-Na was 15.97 ±8.54, CTP 8.25 ±2.21, Fib-4 was 2.79 ±1.034 and TE score was 18.20 ±9.17. Mean LFI was 3.87 ±1.07; mean HGS was 18.12 ±4.68; mean of CTS was 9.62 ±3.55. LFI Class distribution in our cohort showed Robust were 36 (30.5%), Prefrail 34 (28.8%) and Frail were 48 (40.8%). Correlation of all these variables with LFI showed significant correlation with LFI, but highest correlation coefficient was seen with MELD-Na. Conclusion: Significant correlation between frailty score in cirrhotic with cirrhosis severity scores highlights the need for frequently assessing LFI in all cirrhotic at regular follow up visits.
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Affiliation(s)
- Bader Faiyaz Zuberi
- Bader Faiyaz Zuberi FCPS, Meritorious Professor, Department of Medicine/Gastroenterology, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
- Correspondence: Dr. Bader Faiyaz Zuberi C-404, Al-Habib Pride, CL-8/5, Civil Lines, Karachi, Pakistan. E-mail:
| | - Tazeen Rasheed
- Tazeen Rasheed FCPS, Assistant Professor, Department of Medicine/Gastroenterology, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Faiza Sadaqat Ali
- Faiza Sadaqat Ali FCPS, Senior Registrar, Department of Medicine/Gastroenterology, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Nimrah Bader
- Nimrah Bader MD, Geriatric Medicine Fellow, University of Miami/Jackson Health System, Miami, FL, USA
| | - Rabia Sadaf
- Rabia Sadaf FCPS, Consultant, Dr Ruth KM Pfau Civil Hospital, Karachi, Pakistan
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Empting E, Bader N, Oettel M. Interplay of orientational order and roughness in simulated thin film growth of anisotropically interacting particles. Phys Rev E 2022; 105:045306. [PMID: 35590594 DOI: 10.1103/physreve.105.045306] [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: 12/09/2021] [Accepted: 03/29/2022] [Indexed: 06/15/2023]
Abstract
Roughness and orientational order in thin films of anisotropic particles are investigated using kinetic Monte Carlo simulations on a cubic lattice. Anisotropic next-neighbor interactions between the lattice particles were chosen to mimic the effects of shape anisotropy in the interactions of disk- or rodlike molecules with van der Waals attractions. Increasing anisotropy leads first to a preferred orientation in the film (which is close to the corresponding equilibrium transition) while the qualitative mode of roughness evolution (known from isotropic systems) does not change. At strong anisotropies, an effective step-edge (Ehrlich-Schwoebel) barrier appears and a nonequilibrium roughening effect is found, accompanied by reordering in the film which can be interpreted as the nucleation and growth of domains of lying-down disks or rods. The information on order and roughness is combined into a diagram of dynamic growth modes.
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Affiliation(s)
- E Empting
- Institut für Angewandte Physik, Universität Tübingen, Auf der Morgenstelle 10, 72076 Tübingen, Germany
| | - N Bader
- Institut für Angewandte Physik, Universität Tübingen, Auf der Morgenstelle 10, 72076 Tübingen, Germany
| | - M Oettel
- Institut für Angewandte Physik, Universität Tübingen, Auf der Morgenstelle 10, 72076 Tübingen, Germany
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Zuberi BF, Ali FS, Rasheed T, Bader N, Hussain SM, Saleem A. Comparison of Vonoprazan and Amoxicillin Dual Therapy with Standard Triple Therapy with Proton Pump Inhibitor for Helicobacter Pylori eradication: A Randomized Control Trial. Pak J Med Sci 2022; 38:965-969. [PMID: 35634610 PMCID: PMC9121978 DOI: 10.12669/pjms.38.4.5436] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [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: 10/03/2021] [Accepted: 02/05/2022] [Indexed: 12/04/2022] Open
Abstract
Objectives: To compare the efficacy of Vonoprazan based dual treatment versus PPI based treatment for the eradication of Helicobacter pylori infection. Methods: A randomized controlled trial was conducted in Department of Medicine/Gastroenterology Ruth KM Pfau Civil Hospital, DMC during the period of 22 June to 21 September 2021. Sample size was calculated as 96 in each Group. All patients of age 18-75 years with Helicobacter Pylori Infection were inducted and randomly allocated to two groups. Group-A: were given Capsule Amoxicillin 1 gm; Tablet Clarithromycin 500 mg; Capsule Omeprazole 20 mg all medications were given twice daily for two weeks. Group-B were given Capsule Amoxicillin 1 gm; Tablet Vonoprazan 20 mg (Vonozon©, m/s Getz Pharma, Pakistan) twice daily for two weeks. Confirmation of Hp eradication was done by stool Hp antigen test four weeks after completion of treatment. Nine and four patients were lost to follow-up in Group-A & B respectively. Analysis was conducted on 87 patients in Group-A and 92 patients in Group-B. Results: Out of eighty-seven patients in Group-A and ninety-two patients in Group-B, 73 (83.9%) patients in Group-A and 86 (93.5%) patients in Group-B had negative H pylori result respectively after treatment (p = .042). Significantly higher frequencies of adverse events were observed in Group-A as compared to Group-B in nausea/vomiting (p = .035) and bloating (p = .045). Conclusion: VA-dual provides an acceptable eradication rate with fewer adverse events.
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Affiliation(s)
- Bader Faiyaz Zuberi
- Bader Faiyaz Zuberi FCPS, Meritorious Professor, Department of Medicine/Gastroenterology, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Faiza Sadaqat Ali
- Faiza Sadaqat Ali FCPS, Senior Registrar, Department of Medicine/Gastroenterology, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Tazeen Rasheed
- Tazeen Rasheed FCPS, Associate Professor, Department of Medicine/Gastroenterology, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Nimrah Bader
- Nimrah Bader MD, PGY-4 Geriatric Medicine Fellow, University of Miami/Jackson Health System, Miami, FL, USA
| | - Sana Muhammad Hussain
- Sana Muhammad Hussain PG Trainee, Department of Medicine/Gastroenterology, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Anoshia Saleem
- Anoshia Saleem FCSP (Gastro), Consultant, Dr Ruth KM Pfau Civil Hospital Karachi, Pakistan
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Manla Y, Bader N, Bajwa G, Gobolos L, Alsindi F, Hamour I, Ghalib H, Al Badarin F. Early impact of COVID-19 pandemic on heart transplant volumes in Asia and Oceania: results from the Global Observatory on Donation and Transplantation (GODT). Eur Heart J 2022. [PMCID: PMC9383357 DOI: 10.1093/eurheartj/ehab849.137] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Funding Acknowledgements Type of funding sources: None. Introduction Massive demand for healthcare services worldwide following the emergence of coronavirus disease 2019 (COVID-19) has limited the availability of healthcare resources needed for certain high-complexity procedures, including orthotopic heart transplantation (OHT). Whereas the negative impact of COVID-19 pandemic on several elective procedures has been well-documented, data on regional changes in OHT volumes after COVID-19 are limited. Therefore, we aimed to quantify the impact of COVID-19 pandemic on OHT volumes in Asia and Oceania. Methods Using data from the Global Observatory on Donation and Transplantation (GODT), the world"s most comprehensive source of data on organ donation and transplantation, we recorded the number of OHT procedures performed in years 2019 (pre-COVID-19 era) and 2020 (COVID-19 era). The analysis was limited to countries with reported OHT data within Asia and Oceania (Australia, China, India, Iran, Israel, Japan, New Zealand, Russian Federation, Saudi Arabia, Thailand, Turkey, and the United Arab Emirates). OHT rates were reported for each country per million population (PMP), and change in the COVID-19 era was reported as percentage of the pre-COVID-19 rates. The association of total COVID-19 cases with relative reduction in OHT was evaluated using linear regression. Results Across the Asia/Oceania region, number of OHT in COVID-19 era (median 0.64 procedures PMP, IQR 0.28, 2.15) was significantly lower compared with the pre-COVID-19 era (median 1.18 procedures PMP, IQR 0.49, 2.50), with a median change of -0.29 (IQR -0.70, -0.08; P = 0.04). The impact of COVID-19 on OHT was most pronounced in Turkey, United Arab Emirates, and India, where OHT volumes decreased by 75.4%, 60.8%, and 53%, respectively. Country-level reduction in OHT volumes was not associated with total number of COVID-19 cases during the year 2020 in that country (r = 0.31; P-value = 0.3). Conclusion The number of heart transplants during the early phase of COVID-19 pandemic significantly decreased in most countries of the Asia/Oceania region. Furthermore, the change in OHT volumes did not correlate with the total number of recorded COVID-19 cases, suggesting the pandemic’s impact on OHT numbers extended beyond limiting availability of resources. Identifying factors leading to OHT deferral during COVID-19 pandemic will advance our understanding of the pandemic’s true impact on the care of advanced heart failure patients in the region.
Abstract Figure. ![]()
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Affiliation(s)
- Y Manla
- Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - N Bader
- Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - G Bajwa
- Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - L Gobolos
- Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - F Alsindi
- Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - I Hamour
- Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - H Ghalib
- Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - F Al Badarin
- Cleveland Clinic, Abu Dhabi, United Arab Emirates
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Ali FS, Bader N, Zuberi BF, Rasheed T. Are we missing varices by implementing Baveno-VI recommendation of not screening patients with Compensated Advanced Chronic Liver Disease? Pak J Med Sci 2022; 38:1-8. [PMID: 35035392 PMCID: PMC8713224 DOI: 10.12669/pjms.38.1.4796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2021] [Accepted: 08/30/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES This study aimed to validate Baveno-VI recommendations for variceal screening in cACLD in our region and proposed our own cutoff values. METHODS Prospective cross-sectional study was conducted on cACLD patients from August 2020 till April 2021. Patients segregated into Group-A, having Liver stiffness measurement (LSM) of ≥ 20 kPa and platelet of ≤ 150 × 109 cells/L; and Group-B having LSM of < 20 kPa and PLT of > 150 × 109 cells/L. Gastroscopic findings were segregated into three categories, VNT, Varices Not Needing Treatment (VNNT) and No Varix (NV). ROC plots were generated for LSM and Platelet for VNT for sensitivity, specificity, Negative and Positive Predictive Values were calculated. RESULTS A total of 134 patients of cACLD were included. Group-A had 72 (53.7%) patients and Group-B had 62 (46.3%) patients. Group-A had 6 (8.3%) NV; 18 (25.0%) VNNT and 48 (66.7%) VNT. Group-B had 26 (41.9%) NV, 24 (38.7%) VNNT and 12 (19.4%) VNT. The sensitivity of 66.7%, specificity of 80.6% and NPV of 67.56% was obtained. Thus 19.4% VNT were missed on following Baveno VI recommendations. ROC in our study suggested cutoff value of 11.5 kPa with sensitivity of 100% and 1-sepcifity pf 78% (AUROC = 0.865; p < .001) of LSM below which screening gastroscopy could be avoided. The positive and negative predicted values for 84.85% and 100% respectively. Cut off value of platelet count for VNNT came out to be ≥ 97.5 × 109 cells/L with AUROC 0.891 (p < .001), having sensitivity of 100 % and 1-specificity of 83.3%. CONCLUSIONS Substantial number of VNT in cACLD patients are missed by following Baveno-VI recommendations and these needs to be revised on regional basis.
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Affiliation(s)
- Faiza Sadaqat Ali
- Faiza Sadaqat Ali, FCPS. Department of Medicine/Gastroenterology, Dow University of Health Sciences, Karachi, Pakistan
| | - Nimrah Bader
- Nimrah Bader, MBBS, MD. Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Bader Faiyaz Zuberi
- Bader Faiyaz Zuberi, FCPS. Department of Medicine/Gastroenterology, Dow University of Health Sciences, Karachi, Pakistan
| | - Tazeen Rasheed
- Tazeen Rasheed, FCPS. Department of Medicine/Gastroenterology, Dow University of Health Sciences, Karachi, Pakistan
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Bader N, Khattab M, Farah F. Severe reinfection with severe acute respiratory syndrome coronavirus 2 in a nursing home resident: a case report. J Med Case Rep 2021; 15:392. [PMID: 34284812 PMCID: PMC8290381 DOI: 10.1186/s13256-021-02958-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/14/2021] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The topic of natural immunity related to severe acute respiratory syndrome coronavirus 2 remains controversial. Although evidence suggests postinfection immunity can be achieved, there have been reported cases of reinfection with similar or milder symptoms. Information on severe disease manifestation during reinfection is not known. We present a case of reinfection with a more severe presentation as compared with the initial infection. CASE REPORT We describe a white male patient from a nursing home who was reinfected with severe acute respiratory syndrome coronavirus 2 with severe disease manifesting as dyspnea, fevers, and encephalopathy with hypoxemic respiratory failure requiring intubation, elevated inflammatory markers, and lung infiltrates on imaging, after initially testing positive with mild symptoms 2 months prior to presentation. Notably, severe acute respiratory syndrome coronavirus 2 antibodies were detected, which indicated this was a coronavirus disease 2019 reinfection. After treatment with remdesivir, dexamethasone, and convalescent plasma, he was subsequently extubated and discharged home after 2 weeks. CONCLUSION It is not clear whether an initial infection with severe acute respiratory syndrome coronavirus 2 and recovery provides prolonged immunity beyond 2 months. Furthermore, even if antibodies are present, it does not guarantee an attenuated course during reinfection. Therefore, vaccination plays an important role in prevention. Long-term cohort studies will be needed to study the factors behind reinfection.
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Affiliation(s)
- Nimrah Bader
- Department of Internal Medicine, University of Oklahoma Health Sciences Center, 800 Stanton L Young Blvd, Suite 6300, Oklahoma City, OK 73104 USA
| | - Mahmood Khattab
- Department of Internal Medicine, University of Oklahoma Health Sciences Center, 800 Stanton L Young Blvd, Suite 6300, Oklahoma City, OK 73104 USA
| | - Fahmi Farah
- Baylor Scott & White, Heart and Vascular Hospital, 7100 Oakmont Blvd, Suite 201, Fort Worth, Dallas, TX 76132 USA
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Zuberi FF, Bader N, Rasheed T, Zuberi BF. Association between insulin resistance and BMI with FEV 1 in non-hypoxemic COPD out-patients. Clin Respir J 2021; 15:513-521. [PMID: 33497542 DOI: 10.1111/crj.13336] [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] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Revised: 05/26/2020] [Accepted: 01/21/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study was conducted to determine the impact of insulin resistance using Homeostatic Model Assessment of Insulin Resistance (HOMA-IR) score and BMI in non-hypoxemic out-patients with COPD on FEV1 using linear and polynomial regressions and to determine their correlation. METHODS COPD patients of both genders were included after informed consent. Fasting blood sugar and serum insulin were done to calculate HOMA-IR, which were segregated into two groups of ≥ 3 and < 3 labeled insulin resistance present and absent, these were compared with BMI. Patients were segregated into GOLD Grade 1-4 per GOLD Guidelines and compared with HOMA-IR and BMI. Curve and linear regressions, multivariate and univariate analysis of HOMA-IR with BMI, FVC, and FEV1 were done. RESULTS A total of 273 subjects were inducted after informed consent. There was a linear correlation between HOMA-IR and BMI (r2 0.498, P < 0.001) and nonlinear correlation between HOMA-IR and FEV1 (r2 0. 617, P < 0.001) which showed little evidence of association above FEV1 > 60 predicted, but a clear negative association below that. Significant increase in HOMA-IR was seen from GOLD-2 to 3 and from GOLD-3 to 4 classes. The impact of HOMA-IR on FEV1 was 49.9% (P < 0.001) on FVC was 43.7%. CONCLUSIONS The results indicate that there is a high prevalence of IR in non-hypoxemic COPD. A nonlinear association is present between FEV1 and HOMA-IR which is most evident with FEV1 <60% predicted.
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Affiliation(s)
- Faisal Faiyaz Zuberi
- Department of Pulmonology, Ojha Institute of Chest Disease, Dow University of Health Sciences, Karachi, Pakistan
| | - Nimrah Bader
- Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Tazeen Rasheed
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Bader Faiyaz Zuberi
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
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Zuberi FF, Zuberi BF, Ali FS, Bader N. Muscle weakness assessment in non-hypoxemic COPD out-patients at tertiary care hospitals. Pak J Med Sci 2021; 37:536-542. [PMID: 33679946 PMCID: PMC7931309 DOI: 10.12669/pjms.37.2.3127] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective: To determine frequency of Muscle Weakness in Non-Hypoxemic COPD out-patients and Comparison with age matched non-COPD Controls. Methods: This cross-sectional study was conducted at OPD of Ojha Institute of Chest Diseases and Medicine, Dow University of Health Sciences, Karachi, Pakistan, during the period 8th September 2019 till 30th May 2020. Patients of both genders aged 25-70 years who were satisfying GOLD criteria for COPD and having SpO2 ≥ 94% were included. An age matched control group was added as control. Hand Grip Strength (HGS) and Chair to Stand time (CST) were recorded. Results: Two hundred fifty-six patients were inducted with aged and BMI matched group of non-COPD Control patients in ratio of 1:2 (n = 128). Comparison of HGS between Control and COPD Groups showed significant weakness in COPD group. Significant weakness in lower limbs in COPD Group with longer timings to complete the task. Mean FEV1 had significant low values in COPD Group. Age correlated negatively with HGS & positively with CST. BMI correlated positively with FEV1 and CST but negatively with HGS. HGS correlated positively with FEV1 and no correlation was found with CST. No correlation was found of CST with FEV1. Conclusion: Muscle weakness in COPD patients was shown by simple validated bedside tools. The older COPD patients had less HGS and were slower in doing CST whereas those COPD ones who had higher FEV1 had more HGS.
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Affiliation(s)
- Faisal Faiyaz Zuberi
- Faisal Faiyaz Zuberi, Ojha Institute of Chest Diseases, Dow University of Health Sciences, Karachi, Pakistan
| | - Bader Faiyaz Zuberi
- Bader Faiyaz Zuberi, Department of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Faiza Sadaqat Ali
- Faiza Sadaqat Ali, Department of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Nimrah Bader
- Nimrah Bader, Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Shaikh MA, Punshi A, Talreja ML, Rasheed T, Bader N, Zuberi BF. Comparison of within 7 Day All-Cause Mortality among HDU Patients with Modified Early Warning Score of ≥5 with those with Score of <5. Pak J Med Sci 2021; 37:515-519. [PMID: 33679942 PMCID: PMC7931294 DOI: 10.12669/pjms.37.2.2832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective To compare 7-Day All-Cause Mortality among HDU Patients with Modified Early Warning Score of ≥5 with Those with Score of <5. Methods All patients of age more than 18 years, of either gender admitted in HDU of Medical Unit-II, CHK between September 2019 to February 2020 were included. MEWS was calculated for each patient at time of admission. Patients with MEWS score of ≥5 were allocated to Group-A and those with score of <5 were allocated to Group-B. Patients were followed for seven days and outcome status of alive, expired or discharged was noted. Results Total of 336 patients were selected out of which 168 patients was inducted in Group-A and 168 patients in Group-B. MEWS Score in patients who expired was significantly higher (Mdn=11) than in those who survived (Mdn=4), p <.001. 7-day mortality in Group-A was 62 (39.9%) while in Group-B was 40 (23.8%). ROC was plotted of MEWS Score for mortality, it showed significant area under curve of 68.4% (p <.001, 95% CI = .62 to .75). MEWS Score of 3.5 showed sensitivity of 89.2% and specificity of 65%. Conclusion Our results show that MEWS has a positive trend to predict mortality. MEWS score of 3.5 is suggested cut off based on ROC in our study.
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Affiliation(s)
- Majid Ahmed Shaikh
- Majid Ahmed Shaikh, FCPS, Department of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Avinash Punshi
- Avinash Punshi, FCPS, Department of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Mohan Lal Talreja
- Mohan Lal Talreja, MRCP, Department of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Tazeen Rasheed
- Tazeen Rasheed, FCPS, Department of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Nimrah Bader
- Nimrah Bader, Department of Internal Medicine University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Bader Faiyaz Zuberi
- Bader Faiyaz Zuberi, FCPS, Department of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
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Ali FS, Bader N, Zuberi BF, Banu S. Frequency of silent carotid artery stenosis in diabetics and its associated factors: An analysis in tertiary care hospital. Pak J Med Sci 2020; 36:1270-1274. [PMID: 32968392 PMCID: PMC7501028 DOI: 10.12669/pjms.36.6.2306] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Objective: To estimate frequency of silent carotid artery stenosis and its associated factors in diabetic patients attending a tertiary care hospital. Methods: This cross-sectional study was conducted in tertiary care Civil Hospital, Karachi from March 2019 to September 2019,. A total of 166 patients with Diabetes Mellitus were included in this study. Brief history was taken for the duration of DM, treatment, and smoking habits. Carotid artery stenosis (CAS) wafrs measured by Doppler ultrasound of right and left common, internal, and external carotid arteries. Results: Frequency of silent carotid artery stenosis (CAS) in diabetic patients was observed in 28.92% (48/166) cases. The mean age ±SD of the patients was 54.8 ±7.96 years. 27 (22.29%) patients were smoker and all were male. Out of 166 diabetic patients, 59 (35.54%) were treated with insulin and 107 (64.46%) were treated with oral hypoglycemic. Conclusion: Substantial number of diabetic patients with increasing age, increased duration of diabetes and smoking habits have significant silent Silent Carotid Artery Stenosis (CAS).
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Affiliation(s)
- Faiza Sadaqat Ali
- Faiza Sadaqat Ali, FCPS. Senior Registrar, Medical Unit-II, Dow Medical College, Karachi, Pakistan
- Correspondence: Dr. Faiza Sadaqat Ali, 307, Crown Heights, Block 4, Gulshan e Iqbal, Karachi, Pakistan. E-mail:
| | - Nimrah Bader
- Nimrah Bader, MD. R-II, Oklahoma State University Medical Center, Oklahoma City, OK, USA
| | - Bader Faiyaz Zuberi
- Prof. Bader Faiyaz Zuberi, FCPS. Medical Unit-II, Dow Medical College, Karachi, Pakistan
| | - Sabiha Banu
- Sabiha Banu, FCPS. Endocrinology Fellow, Internal Medicine Department, Aga Khan University, Karachi, Pakistan
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Bader N, Mirza L. Euglycemic Diabetic Ketoacidosis in a 27 year-old female patient with type-1-Diabetes treated with sodium-glucose cotransporter-2 (SGLT2) inhibitor Canagliflozin. Pak J Med Sci 2016; 32:786-8. [PMID: 27375734 PMCID: PMC4928443 DOI: 10.12669/pjms.323.9201] [Citation(s) in RCA: 13] [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] [Indexed: 11/30/2022] Open
Abstract
We are reporting a timely case of atypical euglycemic diabetic ketoacidosis in a type 1 diabetic patient treated with sodium-glucose cotransporter-2 (SGLT-2) inhibitor canagliflozin. The clinical history, physical examination findings and laboratory values are described. Other causes of acidosis such as salicylate toxicity or alcohol intoxication were excluded. Ketoacidosis resolved after increasing dextrose and insulin doses supporting the hypothesis that SGLT-2 inhibitors may lead to hypoinsulinemia. Euglycemic ketoacidosis did not recur in our patient after discontinuing canagliflozin. We recommend reserving SGLT2 inhibitor therapy to type 2 diabetics, discontinuing medication and treating patients presenting with ketoacidosis due to SGLT-2 inhibitors with higher concentrations of dextrose with appropriate doses of insulin to help resolve acidosis.
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Affiliation(s)
- Nimrah Bader
- Nimrah Bader, Medical Student. Aga Khan University Hospital, Karachi, Pakistan
| | - Lubna Mirza
- Lubna Mirza, MD. Norman Regional Hospital, Norman, Oklahoma, USA
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Fatima SS, Butt Z, Bader N, Pathan AZ, Hussain S, Iqbal NT. Role of multifunctional Chemerin in obesity and preclinical diabetes. Obes Res Clin Pract 2015; 9:507-12. [PMID: 25666091 DOI: 10.1016/j.orcp.2015.01.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 01/14/2015] [Accepted: 01/16/2015] [Indexed: 10/24/2022]
Abstract
BACKGROUND "Chemerin" is a multifuntional peptide involved in lipid and glucose metabolism. Elevated levels of this peptide have been associated with insulin resistance and systemic inflammation. This study aims to identify whether Chemerin along with other inflammatory markers (TNFα and hsCRP) can discriminate subjects with subclinical diabetes. METHODOLOGY/FINDINGS Fifty-two asymptomatic healthy volunteers and 22 chronic diabetics (T2DM) were enrolled in a cross sectional study design. They were subjected to a 75 g oral glucose tolerance test [OGTT (2-h glucose>200 mg/dL)] and were then classified as either newly diagnosed diabetics (NDM) (n=23) or healthy controls (n=29). Our results showed a higher Chemerin level in NDM (p<0.01; MWU) compared to controls and previously diagnosed DM. Using ROC analysis, Chemerin level in NDM and T2DM had AUC of 0.963 and 0.764 respectively, compared to healthy controls. We suggest that the cut off of 13.7 ng/ml of Chemerin can discriminate 73% of NDM subjects with impaired glucose level with 91% and 96% of sensitivity and specificity respectively. Elevated serum Chemerin in NDM group is a surrogate of impairment in glucose metabolism in obese individual. CONCLUSIONS Chemerin along with other inflammatory biomarkers suggest an ongoing inflammatory process in a high risk obese group that indicates a pre-diabetic state.
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Affiliation(s)
- Syeda Sadia Fatima
- Department of Biological and Biomedical Sciences, Aga Khan University, Stadium Road, Karachi 74800, Pakistan
| | - Zoya Butt
- Aga Khan University Medical College, Aga Khan University, Stadium Road, Karachi 74800, Pakistan
| | - Nimrah Bader
- Aga Khan University Medical College, Aga Khan University, Stadium Road, Karachi 74800, Pakistan
| | - Aly Zaheer Pathan
- Aga Khan University Medical College, Aga Khan University, Stadium Road, Karachi 74800, Pakistan
| | - Sheraz Hussain
- Aga Khan University Medical College, Aga Khan University, Stadium Road, Karachi 74800, Pakistan
| | - Najeeha Talat Iqbal
- Department of Biological and Biomedical Sciences, Aga Khan University, Stadium Road, Karachi 74800, Pakistan; Department of Paediatrics & Child Health, Aga Khan University, Stadium Road, Karachi 74800, Pakistan.
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Zuberi BF, Zuberi FF, Bader N, Alvi H, Salahuddin J. Comparison of British Thoracic Society and American Thoracic Society reintroduction guidelines for anti-tuberculous therapy induced liver injury. J PAK MED ASSOC 2014; 64:896-899. [PMID: 25252514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To compare the efficacy of British Thoracic Society and American Thoracic Society guidelines for reintroduction of anti-tuberculous therapy after drug-induced liver injury, and to assess the ease of administration of each guideline on a scale of 1-10. METHODS The randomised prospective interventional study was conducted at the Department of Medicine and Pulmonology, Dow University of Health Sciences, Karachi, from December 2011 to November 2013. Patients with anti-tuberculous therapy drug-induced liver injury were selected. Hepatotoxic anti-tuberculous therapy was stopped and modified anti-tuberculous therapy was started. Patients were followed weekly till clinical and biochemical parameters got stabilised. After stabilisation, the patients were randomised to one of the two groups to receive re-introduction of anti-tuberculous therapy under the guidelines of British Thoracic Society (Group I) or those of American Thoracic Society (Group II). Means of the groups were analysed by Student's t test and proportions were compared by chi-square test. Multivariate analysis was done for age, body mass index and serum albumin for recurrence of drug-induced liver injury after the re-introduction. P value < 0.05 was taken as significant. RESULTS Of the total 325 patients, 163 (50.15%) were in Group I, while 162 (49.84%) were in Group II. The frequency of recurrence of drug-induced liver injury in Group I was 16 (9.8%) and in Group II it was 18 (11.1%).There was no statistically significant difference between the two groups (p < 0.7). Age was positively related with drug-induced liver injury, while body mass index and serum albumin were negatively associated. CONCLUSION There was no significant difference between the two major guidelines though the American Thoracic Society guideline was easier to follow.
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Müller M, Bosy-Westphal A, Dilba B, Bader N, Korth O. Energieverbrauch und Energiebedarf gesunder Menschen. Aktuel Ernahrungsmed 2006. [DOI: 10.1055/s-2006-932600] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Abstract
The iodine supply in Germany has improved throughout the last decade, albeit with enormous differences between individuals and regions. In the Thuringian city of Jena, analyses of the iodine content of human milk have been undertaken regularly since 1982. Significantly increasing iodine concentrations in human and cow's milk have been found. Therefore, the current situation and the effectiveness of measures to prevent iodine deficiency demands re-evaluation. The iodine content of human milk from 32 lactating mothers was analysed on the 5th day (mean) postpartum and mothers' dietary iodine intake during the last two months of pregnancy was assessed by means of a food frequency questionnaire. To corroborate the assumption that the increasing iodine levels of cow's milk are one of the main reasons for the improved iodine supply, the iodine concentration of 34 cow's milk bulk-samples was also determined. Both human and cow's milk samples were analysed by the ICP-MS method. Twenty women took iodine supplements (mean daily intake = 175 microg). The average daily iodine intake of the 20 supplemented and 12 non-supplemented women was 258 microg and 116 microg, respectively. Daily iodine intake from food and beverages was significantly lower in supplemented women (83 microg/day). The average iodine content of human milk was 169 +/- 88 microg/l with a range of 33 - 348 microg/l. This content is two times higher than levels from 1994 in the same area. There was no difference in the human milk iodine content between mothers taking supplements and those who did not. Cow's milk samples showed a mean iodine concentration of 178 +/- 131 microg/l (range 48 - 661 microg/l).
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Affiliation(s)
- N Bader
- Institute of Nutrition, Friedrich Schiller University Jena, Jena, Germany
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Christgau M, Bader N, Felden A, Gradl J, Wenzel A, Schmalz G. Guided tissue regeneration in intrabony defects using an experimental bioresorbable polydioxanon (PDS) membrane. A 24-month split-mouth study. J Clin Periodontol 2002; 29:710-23. [PMID: 12390568 DOI: 10.1034/j.1600-051x.2002.290808.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
AIM The comparison of the clinical, radiographic, and microbiological healing results in deep intrabony defects following GTR therapy with two different bioresorbable membranes in a prospective split-mouth design. MATERIAL AND METHODS 31 pairs of contralateral intrabony defects were randomly treated with either an experimental Polydioxanon (PDS) membrane or a Polylactic acid (PLA) matrix barrier. After 6, 12 and 24 months, healing results were assessed using clinical examinations (REC, PPD, CAL, vertical relative attachment gain V-rAG), quantitative digital subtraction radiography (amount and area of bone density changes), and microbiological analysis. RESULTS Postoperative membrane exposures occurred in 14 PDS and 2 PLA treated sites. 6, 12 and 24 months p.o., both membranes provided a significant gain in CAL [median values: 6 months (PDS vs. PLA: 3.0 vs. 3.0 mm); 12 and 24 months (PDS vs. PLA: 4.0 vs. 4.0 mm)], which corresponded to a V-rAG of 57.1% (PDS) vs. 62.5% (PLA) after 24 months. PDS and PLA treated sites revealed significant bone density gain 6, 12 and 24 months after surgery. 38.8% (PDS) vs. 41.8% (PLA) of the initial defect areas showed bone density gain. While the gain in bone density was significantly greater in PDS than in PLA sites, neither CAL gain nor the area of bone density changes revealed significant differences. Microbiological culture revealed similar bacterial loads in PDS and PLA sites during the first 12 months. CONCLUSION This 24-month study indicates that the PDS and PLA membranes can provide similar favorable regeneration results in deep intrabony periodontal defects, although considerably more postoperative membrane exposures have to be expected in PDS treated sites.
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Affiliation(s)
- M Christgau
- Department of Operative Dentistry and Periodontology, University of Regensburg, Regensburg, Germany.
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Abstract
This prospective split-mouth study was designed to compare the clinical and radiographic healing results in intrabony periodontal defects 12 months after GTR therapy with 2 different bioresorbable barriers. The study comprised 25 healthy patients with one pair of contralaterally located intrabony defects with a probing pocket depth of > or = 6 mm and radiographic evidence of angular bone loss of > or = 4 mm. The 2 defects of each patient were randomized for treatment either with polylactic acid (PLA) membranes or with polyglactin-910 (PG-910) membranes. The patients received systemic doxycycline (100 mg/d) for 11 days postoperatively. One blinded examiner recorded the following clinical parameters using a pressure calibrated probe at baseline and after 12 months: papillary bleeding index (PBI), gingival recession (REC), probing pocket depth (PPD), and probing attachment level (PAL). The vertical relative attachment gain (V-rAG) was calculated as a % of the PAL gain related to the maximum possible attachment gain (expressed by the intraoperatively measured depth of the osseous defect). Geometrically standardized intraoral radiographs were quantitatively evaluated for bone changes (density, area) in the defect region using digital subtraction radiography (DSR). Clinical and radiographic data were statistically analyzed using the Wilcoxon-signed-rank test (alpha=0.05). Postoperative membrane exposures occurred in 9 PLA and 13 PG-910 treated sites. After 12 months of healing, both barrier types provided significant PPD reductions and PAL gain [median (25/75 percentile)]: deltaPPD [PLA: 3.0 (2.0/4.0) mm; PG-910: 3.0 (2.0/4.5) mm]; deltaPAL [PLA: 3.0 (2.5/4.0) mm; PG-910: 2.0 (1.0/4.0) mm]. V-rAG amounted to 60% in PLA sites and 54% in PG-910 sites. DSR revealed significant bone density gain after 12 months. 58.3% of the initial defect area in PLA sites and 54.0% of the initial defect area in PG-910 sites showed bone density gain. Neither clinical nor radiographic data revealed any significant difference between the 2 barrier types after 12 months. In conclusion, this 12-month study demonstrated that PLA and PG-910 membranes provided similar favorable regeneration results in deep intrabony periodontal defects.
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Affiliation(s)
- M Christgau
- Department of Operative Dentistry and Periodontology, University of Regensburg, Germany
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Abstract
The goal of this investigation was to evaluate the effect of postoperative exposure of two different bioresorbable membranes on the guided tissue regeneration (GTR) healing results compared to nonexposed sites. In each of 25 patients one pair of contralateral intrabony lesions was treated either with polylactic acid (PLA) or polyglactin 910 (PG-910) membranes. Postoperative exposure occurred in 9 PLA and 13 PG-910 sites. Standardized clinical [papillary bleeding index (PBI), gingival recession (REC), probing pocket depth (PPD), probing attachment level (PAL)] and radiographic examinations (digital subtraction radiography) were performed immediately before (baseline) and 6 and 12 months postoperatively (p.o.). Subgingival bacterial samples from surgical sites were evaluated by culture at baseline, 6 weeks, and 6 and 12 months p.o. Six months after surgery the changes (delta) of REC were significantly (P < or = 0.05) greater in exposed than in nonexposed sites, independently of the membrane material (median): exposed sites, delta REC = -1 mm; nonexposed sites, delta REC = 0.0 mm. However, 12 months p.o. no significant differences were found due to a decrease in the initial recessions in exposed sites. Although a higher percentage of exposed than nonexposed sites harbored periodontal pathogens 6 weeks p.o. at the gingiva-faced membrane surface, membrane exposure did not have a significant negative effect on delta PPD, delta PAL, or radiographic bone density changes 6 and 12 months p.o. Both membranes showed significant gains in PAL and bone density in both exposed and nonexposed sites. In conclusion, this study demonstrates that with consistent infection control the postoperative exposure of PLA and PG-910 membranes has no significant negative effect on the regeneration outcome, although higher initial gingival recessions must be expected than in the nonexposed sites. However, in exposed sites plaque and infection control were clearly impeded by the rough, exposed membrane surfaces and by the initially negative gingival morphology.
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Affiliation(s)
- M Christgau
- Department of Operative Dentistry and Periodontology, University of Regensburg, Germany
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Bader N. Retaining freedom of choice in a managed care plan. Bus Health 1993; 11:62-4, 66. [PMID: 10129590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
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Bader N. Michigan groups battle for better heart care. Bus Health 1993; 11:66, 68. [PMID: 10171522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Bader N. Partial hospitalization: when less is more. Bus Health 1992; 10:48-50, 52, 54-5. [PMID: 10171281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
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Bartels H, Weiser HF, Hölscher M, Bader N, von Clarmann M. [Treatment guidelines in intestinal burns]. Leber Magen Darm 1987; 17:274-6, 279-81. [PMID: 3669855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Intestinal burns due to ingestion of acids or alkaline materials still put the physician in a difficult position because until now it is not possible to correlate the amount of ingested material to the extent of damage that can be expected. Furthermore, there are no objective criteria to determine the depth of the burn. Diagnosis is based on endoscopy. Mild, moderate and severe damage can be differentiated endoscopically. Mild and moderate burns are not operated upon primarily. Surgery is indicated with moderate burns whenever complications occur during intensive care treatment, and generally with severe corrosive burns. Operative management depends on intraoperative findings.
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Affiliation(s)
- H Bartels
- Chirurgische Klinik und Poliklinik der Technischen Universität München
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