1
|
Shah MR, Khan SN, Fatima S, Yao L, Yuan H, Ullah S, Ainuddin J, Zeng C, Zheng Y, Sahar N, Anwar S, Zhu M, Ma C, Kumari K, Wang W, Liu R. A randomized, double-blind, positive-controlled, Phase-II clinical trial to evaluate efficacy and safety of Fuke Qianjin capsule in Pakistani patients with pelvic inflammatory disease. Front Pharmacol 2024; 15:1287321. [PMID: 38584600 PMCID: PMC10995302 DOI: 10.3389/fphar.2024.1287321] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Accepted: 02/27/2024] [Indexed: 04/09/2024] Open
Abstract
Ethnopharmacological relevance: Pelvic inflammatory disease (PID) is a frequently occurring gynecological disorder mainly caused by the inflammation of a woman's upper genital tract. Generally, antibiotics are used for treating PID, but prolonged use poses potential risks of gut bacterial imbalance, bacterial resistance, super bacteria production, and associated adverse reactions. Traditional Chinese medicine (TCM) has shown unique advantages in various ailments and has received widespread clinical research attention. Fuke Qianjin (FUKE) capsule is an approved National Medical Products Administration (NMPA License No. Z20020024) Chinese herbal prescription that has been widely used individually or in combination with other Western medicines for the treatment of various gynecological inflammatory diseases, including chronic cervicitis, endometritis, and chronic PID. Aim: This clinical trial was designed to assess the safety and efficacy of FUKE capsule in mild-to-moderate symptomatic PID patients. Materials and methods: This phase 2, randomized, double-blind, positive controlled clinical trial was conducted in mild-to-moderate symptomatic PID patients at a single center in Pakistan from 21 September 2021 to 11 March 2022. Eligible female participants were randomly assigned to a test and a control group with a ratio of 1:1. The test group subjects received two metronidazole (METRO) tablets and one doxycycline hyclate (DOXY) simulant at a time, twice daily for 14 days, and two Fuke Qianjin (FUKE) capsules, three times a day after a meal for 28 days. Subjects in the control group received two METRO tablets and one DOXY tablet at a time, twice daily for 14 days, and two FUKE simulant capsules, three times a day after meal for 28 days. The primary efficacy outcome was an improvement in pelvic pain symptoms assessed through a visual analog scale (VAS). The secondary outcomes were the improvement in secondary efficacy symptoms like local physical signs, clinical assessment of leucorrhea and cervical secretions through laboratory examination, and improvement in the maximum area of pelvic effusion assessed through gynecological ultrasound after the treatment. The safety outcomes were assessed through vital signs, laboratory tests, electrocardiogram findings, and adverse events/serious adverse events. Results: A total of 198 subjects with active PID were randomly assigned to a test group (n = 99) and a control group (n = 99). The baseline characteristics of the subjects in the two groups were similar. In the intention-to-treat analysis, the primary efficacy was 84.9% for the test group and 71.6% for the control group, with a statistically significant difference (p = 0.0370; 95% CI -0.2568 to -0.0088). The secondary clinical efficacy was 88.4% for the test group and 82.7% for the control group, with no significant difference (p = 0.2977; 95% CI -0.1632 to 0.0501). The improvement in local physical signs was 95.8% for the test group and 76.9% for the control group, with no significant difference (p = 0.0542; 95% CI -0.3697 to -0.0085). The inter-group non-inferiority comparison showed that the upper limit of the 95% CI was less than 0.15 and thus met the non-inferiority requirements of the test group to the control group. The results of clinical signs of leucorrhea and cervical secretions showed that there was no difference in the rate of improvement between the test and control groups, indicating that FUKE was non-inferior to DOXY. A total of 14 adverse events in eight subjects were observed in the trial, with an incidence rate of 4.7%. Four subjects in each group experienced seven adverse events with 4.5% and 4.8% incidence rates of adverse reactions in the test and control groups, with no statistically significant differences (p = 0.2001). No serious adverse events occurred in the trial. Conclusion: The results of this trial indicate that the test drug (Fuke Qianjin capsule) is non-inferior to the control drug (doxycycline hyclate tablet) in treating mild-to-moderate PID patients with comparable efficacy, safety, and tolerability to the control drug. Clinical Trial Registration: www.clinicaltrials.gov, identifier NCT04723069.
Collapse
Affiliation(s)
- Muhammad Raza Shah
- Center for Bioequivalence Studies and Clinical Research, Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, Pakistan
| | - Sehrosh Naz Khan
- Center for Bioequivalence Studies and Clinical Research, Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, Pakistan
| | - Samreen Fatima
- Center for Bioequivalence Studies and Clinical Research, Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, Pakistan
| | - Liangyuan Yao
- Qianjin Research Institute, Zhuzhou Qianjin Pharmaceutical Co., Ltd., Zhuzhou, China
| | - Hongbo Yuan
- Qianjin Research Institute, Zhuzhou Qianjin Pharmaceutical Co., Ltd., Zhuzhou, China
| | - Shafi Ullah
- Center for Bioequivalence Studies and Clinical Research, Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, Pakistan
| | - Jahanara Ainuddin
- Obstetrics and Gynecology Department, Dow International Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Changqing Zeng
- Qianjin Research Institute, Zhuzhou Qianjin Pharmaceutical Co., Ltd., Zhuzhou, China
| | - Yiyang Zheng
- Qianjin Research Institute, Zhuzhou Qianjin Pharmaceutical Co., Ltd., Zhuzhou, China
| | | | | | - Meijun Zhu
- Qianjin Research Institute, Zhuzhou Qianjin Pharmaceutical Co., Ltd., Zhuzhou, China
| | - Cun Ma
- Qianjin Research Institute, Zhuzhou Qianjin Pharmaceutical Co., Ltd., Zhuzhou, China
| | | | - Wei Wang
- Center for Bioequivalence Studies and Clinical Research, Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, Pakistan
- TCM and Ethnomedicine Innovation & Development International Laboratory, Innovative Materia Medica Research Institute, School of Pharmacy, Hunan University of Chinese Medicine, Changsha, China
| | - Ruihuan Liu
- Qianjin Research Institute, Zhuzhou Qianjin Pharmaceutical Co., Ltd., Zhuzhou, China
| |
Collapse
|
2
|
Shah MR, Fatima S, Khan SN, Shafiullah, Azam Z, Shaikh H, Majid S, Chengdong H, Daijun Z, Wang W. The safety and efficacy of Houtou Jianweiling tablet in patients with chronic non-atrophic gastritis: a double-blind, non-inferiority, randomized controlled trial. Front Pharmacol 2024; 15:1293272. [PMID: 38440179 PMCID: PMC10911090 DOI: 10.3389/fphar.2024.1293272] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/29/2024] [Indexed: 03/06/2024] Open
Abstract
Background: Common symptoms of Chronic Non-atrophic Gastritis (CNAG) include nausea, stomach distension, and abdominal pain. The Houtou Jianweiling Tablet (HTJWT) is a chinese patent medicine (CN1368229A) and it has been used clinically for more than 20 years with proven clinical efficacy in treating CNAG, prompted us to establish the clinical efficacy and safety of HTJWT on patients with mild to moderate CNAG symptoms in Pakistani population. Methods: This phase II, double-blind, randomized, parallel-controlled trial was conducted in a single center between November 2022 and February 2023 in Pakistan. In a ratio of 1:1, total 240 CNAG patients with erosion identified by pathological biopsy and gastroscopy were randomly assigned to control (Omeprazole) group (n = 120) and the treatment (HTJWT) group (n = 120). Patients in the treatment group received orally four HTJWT (0.38g/tablet), three times a day and one placebo of Omeprazole enteric-coated tablet prior to breakfast, daily. On the other hand, patients in the control group received one Omeprazole enteric-coated tablet (20 mg/tablet) prior to breakfast and four placebo of HTJWT, thrice a day. The patients consumed the investigated drugs (i.e., treatment and control) treatment regimen was followed for a duration of 28 days. The safety of the patients were evaluated through adverse events, serious adverse events and laboratory tests such as blood biochemistry, urine analysis, liver and renal function tests. Vital signs like; blood pressure, pulse rate, body temperature, respiratory rate for all the patients were recorded. The cardiac status of the patients were assessed through electrocardiogram (ECG). The primary efficacy indicators were the improvement rate of gastric distention and gastralgia as the main clinical symptoms. Secondary indicators were visual analogue score (VAS); improvement rate of secondary clinical symptoms and signs; improvement rate of total clinical signs and symptoms; the disappearance/remission rate of Gastric pain and, remission/disappearance time of gastric distension; and the negative conversion rate of Helicobacter pylori (H. pylori). The outcomes among each group were compared using the chi-square test. Results: Patients in both groups had good drug compliance (80%-120%), and there was no statistically significant difference in the patients' baseline characteristics. The clinical improvement rate was found to be 91.1% in the treatment group and 91.0% in the control group with negligible variation among the two groups (p = 0.9824; 95% confidence interval: -0.0781-0.0798). Similarly, hardly no difference was found in the negative conversion rate of H. pylori between the treatment group and the control group (i.e., 70.1% and 71.8% respectively, p = 0.8125). There were no significant differences in respiratory rate, vital signs, blood pressure, laboratory results for blood biochemistry, urine analysis, liver and renal function tests between the two groups. The ECG assessment carried out for the treatment and control group revealed no considerable difference. Margin variation in the disappearance time of gastric pain (p = 0.1860) and remission rate (p = 0.5784) between the two groups were observed. The control group exhibited a faster remission period for gastrointestinal discomfort indications as compared to treatment group (p = 0.0430). Only one patient in the control group experienced mild to moderate adverse events, namely,; epigastric pain and dyspepsia. The results were consistent with the intention-to-treat and per-protocol analysis that included patients who were 100% compliant to the assigned therapy. Conclusion: The lower limit of confidence interval (CI, 95%) for the differences in the effective rate between the treatment and the control groups was found to be -0.0781 which is greater than -0.15, hence the treatment group is non-inferior to the control group. The therapeutic dosage used in the trial and treatment period did not cause any significant adverse event, and there were no obvious changes in the ECG profile, vital signs and biochemistry of the patients. Based on the clinical efficacy evaluation and reported adverse events, it can be concluded that the HTJWT is a safe and effective traditional chinese medicine for the treatment of patients suffering from chronic non-atrophic gastritis with mild to moderate symptoms. Clinical Trial Registration: [www.clinicaltrials.gov], identifier [NCT04672018].
Collapse
Affiliation(s)
- Muhammad Raza Shah
- Center for Bioequivalence Studies and Clinical Research, Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, Pakistan
| | - Samreen Fatima
- Center for Bioequivalence Studies and Clinical Research, Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, Pakistan
| | - Sehrosh Naz Khan
- Center for Bioequivalence Studies and Clinical Research, Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, Pakistan
| | - Shafiullah
- Center for Bioequivalence Studies and Clinical Research, Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, Pakistan
| | - Zahid Azam
- National Institute of Liver & GI Diseases (NILGID), DOW University of Health Sciences, Karachi, Sindh, Pakistan
| | - Hafeezullah Shaikh
- National Institute of Liver & GI Diseases (NILGID), DOW University of Health Sciences, Karachi, Sindh, Pakistan
| | - Shahid Majid
- The Indus Hospital Karachi, Karachi, Sindh, Pakistan
| | - He Chengdong
- Hunan Xinhui Pharmaceutical Co., Ltd., Changsha, Hunan, China
| | - Zhou Daijun
- Hunan Xinhui Pharmaceutical Co., Ltd., Changsha, Hunan, China
| | - Wei Wang
- TCM and Ethnomedicine Innovation & Development International Laboratory, School of Pharmacy, Hunan University of Chinese Medicine, Changsha, China
| |
Collapse
|
3
|
Khan S, Rafiq K, Khabir MN, Khan MB, Khan SN, Khattak A, Attaullah S. Toxoplasma gondii in lactating animals: potential risk to milk consuming population in Khyber Pakhtunkhwa. BRAZ J BIOL 2023; 83:e267369. [PMID: 36790276 DOI: 10.1590/1519-6984.267369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 01/15/2023] [Indexed: 02/16/2023] Open
Abstract
Toxoplasma gondii is an intracellular zoonotic protozoan parasite usually infects human and animal worldwide. This study aimed to analyze the sero-prevalence of T. gondii in blood of lactating animals and human living in close proximity and also to detect Toxoplasma DNA in unpasteurized milk of the studied animals. A total of 233 blood and milk samples were collected from lactating animals, and 735 blood samples were taken from humans in District Upper Dir, Khyber Pakhtunkhwa, Pakistan. The blood samples were analyzed through ELISA while the milk samples were analyzed by PCR for the presence of T. gondii DNA. A standard questionnaire was introduced to collect the data from the participants. In animals, the reported sero-prevalence was 32.18% for IgM, 17.16% for IgG, and 6.4% for both IgM and IgG. The reported positivity for T. gondii DNA in milk was 14.44%, 34.8%, 20%, and 26% in sheep, goats, cows, and buffaloes, respectively. In the human blood samples, 9.8% were found positive for IgM and 11.2% for IgG while none of the samples was found positive for both IgM and IgG. Overall sero-prevalence reported in females was significantly higher than the male (p<0.05) poor hygiene condition (p < 0.0001) were the significant risk factors associated with T. gondii infections in animals. In conclusion, T. gondii infection is prevalent in lactating animals and humans using their raw milk in the study area. It is suggested that raw milk should be considered as a vehicle for the transmission of T. gondii to humans. Proper pasteurization of milk is very useful in limiting the transmission of infection. Awareness and control programs should be implemented to prevent the infection.
Collapse
Affiliation(s)
- S Khan
- University of Peshawar, Department of Zoology, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - K Rafiq
- University of Peshawar, Department of Zoology, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - M N Khabir
- University of Peshawar, Department of Zoology, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - M B Khan
- University of Peshawar, Department of Zoology, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - S N Khan
- Kohat University of Science and Technology Kohat, Department of Zoology, Kohat, Khyber Pakhtunkhwa, Pakistan
| | - A Khattak
- University of Peshawar, Department of Zoology, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - S Attaullah
- Islamia College Peshawar, Department of Zoology, Peshawar, Khyber Pakhtunkhwa, Pakistan
| |
Collapse
|
4
|
Khattak A, Khan S, Ali I, Gul A, Khabir MN, Javed B, Adnan M, Khan SN, Attaullah S. Burden and distribution of dengue infection in Pakistan (2000-19): a review. BRAZ J BIOL 2023; 84:e267982. [PMID: 37075435 DOI: 10.1590/1519-6984.267982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 02/22/2023] [Indexed: 04/21/2023] Open
Abstract
The goal of this study is to review the overall prevalence, burden, and distribution of the dengue disease in Pakistan from 2000 to 2019. Literature was searched using different search engines like Google scholar, PubMed, etc. providing the keywords "Dengue disease/infection, Dengue virus, DENV, DF/DHF/ DSS Pakistan". All the published research papers/reports on the dengue virus over the period 2000 to 2019 were studied and selected data were summarized using MS Excel for windows such as total cases, age wise, gender, DENV serotype distribution, total DHF, and DSS patients. The literature providing insufficient data was excluded. The total number of cases reported during 2000-19 were 201,269. The maximum number of cases during the mentioned literature survey period was reported in Khyber Pakhtunkhwa (KP) (23.3%) followed by Punjab (3.8%) and Sindh (1.9%). The majority of dengue-infected cases were reported as Dengue fever (74.4%) followed by DHF (24.1%) and DSS (1.5%). Overall the deaths during the mentioned literature survey were 1082, of which the maximum mortalities were reported from KP (N=248) followed by Punjab (N=220). DENV remains a major public health problem in Pakistan and seems to remain endemic for a long time. The total prevalence of dengue infection is increased accordingly with time from 2000 to 2019. Moreover, all the four serotypes exist in Pakistan with increased mortalities.
Collapse
Affiliation(s)
- A Khattak
- University of Peshawar, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
| | - S Khan
- University of Peshawar, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
| | - I Ali
- Gulf University for Science and Technology, Center for Applied Mathematics and Bioinformatics, Mubarak Al-Abdullah, Kuwait
- COMSATS University, Department of Biosciences, Islamabad, Pakistan
| | - A Gul
- University of Peshawar, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
| | - M N Khabir
- University of Peshawar, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
| | - B Javed
- University of Peshawar, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
| | - M Adnan
- University of Peshawar, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
| | - S N Khan
- Kohat University of Science and Technology, Department of Zoology, Kohat, Pakistan
| | - S Attaullah
- Islamia College Peshawar, Department of Zoology, Peshawar, Pakistan
| |
Collapse
|
5
|
Shah MR, Fatima S, Khan SN, Ullah S, Himani G, Wan K, Lin T, Lau JYN, Liu Q, Lam DSC. Jinhua Qinggan granules for non-hospitalized COVID-19 patients: A double-blind, placebo-controlled, and randomized controlled trial. Front Med (Lausanne) 2022; 9:928468. [PMID: 35979216 PMCID: PMC9376460 DOI: 10.3389/fmed.2022.928468] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 07/04/2022] [Indexed: 11/14/2022] Open
Abstract
Background Key findings from the World Health Organization Expert Meeting on Evaluation of Traditional Chinese Medicine (TCM) in treating coronavirus disease 2019 (COVID-19) reported that TCMs are beneficial, particularly for mild-to-moderate cases. The efficacy of Jinhua Qinggan granules (JHQG) in COVID-19 patients with mild symptoms has yet to be clearly defined. Methods We conducted a phase 2/3, double-blind, randomized, placebo-controlled trial to evaluate the efficacy and safety of treatment with JHQG in mild, non-hospitalized, laboratory-confirmed COVID-19 patients. Participants were randomly assigned to receive 5 g/sacket of JHQG or placebo granules orally thrice daily for 10 days. The primary outcomes were the improvement in clinical symptoms and a proportion tested negative on viral polymerase chain reaction (PCR) after treatment. Secondary outcomes were the time to recover from clinical symptoms and changes in white blood cells (WBC) and acute phase reactants (C-reactive protein (CRP) and ferritin) on the 10th day after treatment initiation. Results A total of 300 patients were randomly assigned to receive JHQG (150 patients) and placebo (150 patients). Baseline characteristics were similar in the two groups. In the modified intention-to-treat analysis, JHQG showed greater clinical efficacy (82.67%) on the 10th day of the trial compared with the placebo group (10.74%; rate difference: 71.93%; 95% CI 64.09–79.76). The proportion of patients with a negative PCR after treatment was comparable (rate difference: −4.67%; 95% CI −15.76 to 6.42). In contrast, all changes in WBC, ferritin, and CRP levels showed a statistically significant decline in JHQG (P ≤ 0.044) after treatment, but not the latter in placebo (P = 0.077). The median time to recovery of COVID-19-related symptoms including cough, sputum, sore throat, dyspnea, headache, nasal obstruction, fatigue, and myalgia was shorter in the JHQG group compared to the placebo group (P < 0.001 for all). Three patients experienced mild-to-moderate adverse events (AEs) duringthe treatment period in the JHQG group. Findings were similar between the modified intention-to-treat and the per-protocol analysis that included only patients who reported 100% adherence to the assigned regimen. Conclusion Based on the time to recover from the COVID-19-related symptoms and AEs, it is concluded that JHQG is a safe and effective TCM for symptomatic relief of patients with mild COVID-19. A symptomatic improvement in the JHQG group patients was observed and JHQG use would have important public health implications in such patients. Clinical Trial Registration The Trial was prospectively registered on www.clinicaltrials.gov with registration number: NCT04723524.
Collapse
Affiliation(s)
- Muhammad Raza Shah
- Center for Bioequivalence Studies and Clinical Research, Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, Pakistan
- *Correspondence: Muhammad Raza Shah
| | - Samreen Fatima
- Center for Bioequivalence Studies and Clinical Research, Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, Pakistan
| | - Sehrosh Naz Khan
- Center for Bioequivalence Studies and Clinical Research, Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, Pakistan
| | - Shafi Ullah
- Center for Bioequivalence Studies and Clinical Research, Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences, University of Karachi, Karachi, Pakistan
| | | | - Kelvin Wan
- School of Chinese Medicine of Hong Kong, Baptist University, Kowloon, Hong Kong SAR, China
| | - Timothy Lin
- School of Chinese Medicine of Hong Kong, Baptist University, Kowloon, Hong Kong SAR, China
| | - Johnson Y. N. Lau
- School of Chinese Medicine of Hong Kong, Baptist University, Kowloon, Hong Kong SAR, China
| | - Qingquan Liu
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing, China
- Qingquan Liu
| | - Dennis S. C. Lam
- School of Chinese Medicine of Hong Kong, Baptist University, Kowloon, Hong Kong SAR, China
- Dennis S. C. Lam
| |
Collapse
|
6
|
Ali S, Khan S, Khan SN, Rauf M, Khan MF, Majid A, Dawar FU, Akbar NU, Ullah R, Bari A, Khan MY. Molecular detection and prevalence of Rotavirus with acute gastroenteritis among the children of rural and urban areas. BRAZ J BIOL 2021; 83:e244365. [PMID: 34932615 DOI: 10.1590/1519-6984.244365] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 04/19/2021] [Indexed: 11/22/2022] Open
Abstract
Rotavirus is the main infective agent of acute gastroenteritis (AGE) in children under the age of five years and causing significant morbidity as well as mortality throughout the world. The study was carried out to detect the prevalence rate, genotypes strain and risk factors of Rotavirus among the children of rural and urban areas of district Bannu Khyber Pakhtunkhwa Pakistan. A total of 180 stool samples were collected from children under the age of 5 years from two major hospitals of Bannu from January to December (2015). The samples were analyzed by Reverse-transcriptase Polymerase Chain Reaction (RT-PCR) for the detection of Rotavirus, positive samples were further processed for genotyping (G and P type) through specific PCR. Of the total, 41 (23%) samples were positive for Rotavirus. The most prevalent G genotypes found were: G3, G8, G9 (each 29%), followed by G10 (15%), and G11 (10%). Whereas the prevalent P genotypes were: P-8 (25%), P-4 and P-10 (each 20%), P-9 (15%), followed by P-6 and P-11 (each 10%). Moreover, Rotavirus infection was more prevalent in summer (23.73%) and winter (22.7%) than spring (20%) and autumn (21.4%). Rotavirus infection exhibited high frequency in June (14%), October (8%) and November (6%). It is concluded that Rotavirus is more prevalent in children and various genotypes (G and P) of Rotavirus are present in the study area. Lack of studies, awareness and rarer testing of Rotavirus are the principal reasons of virus prevalence in district Bannu, Pakistan.
Collapse
Affiliation(s)
- S Ali
- Kohat University of Science e Technology Kohat, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
| | - S Khan
- University of Peshawar, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
| | - S N Khan
- Kohat University of Science e Technology Kohat, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
| | - M Rauf
- Kohat University of Science e Technology Kohat, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
| | - M F Khan
- University of Hazara Dhodial, Department of Zoology, Mansehra, Khyber Pakhtunkhwa, Pakistan
| | - A Majid
- Kohat University of Science e Technology Kohat, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
| | - F U Dawar
- Kohat University of Science e Technology Kohat, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
| | - N Ul Akbar
- Kohat University of Science e Technology Kohat, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
| | - R Ullah
- College of Pharmacy, Department of Pharmacognosy, King Saud University Riyadh, Riyadh, Saudi Arabia
| | - A Bari
- King Saud University Riyadh, College of Pharmacy, Department of Pharmaceutical Chemistry, Riyadh, Saudi Arabia
| | - M Y Khan
- Lancaster University, Lancaster Environmental Centre, Lancaster, United Kingdon
| |
Collapse
|
7
|
Khan RA, Ullah Z, Zaman IU, Khan MS, Mahmood S, Akhtar N, Khan MF, Yasmin S, Saqlain M, Rehman AU, Aksar N, Khan SN, Hussain SS. Population distribution and habitat analysis of Rufous treepie (Dendrocitta vagabunda) in Abbottabad, Pakistan. BRAZ J BIOL 2021; 83:e247018. [PMID: 34431914 DOI: 10.1590/1519-6984.247018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 02/10/2021] [Indexed: 11/21/2022] Open
Abstract
The Rufous treepie (Dendrocitta vagabunda) belongs to family corvidae, order Passeriformes which includes about 100 species. The current study was conducted to gather information about the Population distribution and habitat analysis of D. vagabunda at District Abbottabad, Pakistan. The data were collected on monthly basis both morning and evening times (2018-2019). "The ''Point count Method" was used for population estimation and ''Quadrates Method" for habitat analysis of study area. The result shows an average month-wise population density of D. vagabunda was maximum at Jhangra 0.14±0.039/ha, whereas minimum at Havelian 0.11±0.022/ha. There was no significant difference (p>0.05) among monthly population densities of D. vagabunda, however, a significant difference (p<0.05) was found between morning and evening times population of the specie. The present study revealed that importance value index (IVI) of plants species at Sherwan, Bakot, Havelian, Langra and Jhangra were 59.6±12.6, 50.1±6.9, 53.4±6.3, 66.8±10 and 60.1±7.7. Likewise, the frequency of shrubs at Sherwan, Bakot, Havelian, Langra and Jhangra were 33.3±4.2, 45±9.4, 46.7±8.2, 55.6±22.2 and 37.5±8.5. Similarly, the frequency of herbs at Sherwan, Bakot, Havelian, Langra and Jhangra were 40.4±6.0, 37.5±5.6, 53.3±7.4, 48.5±5.2 and 46.9±7.4 respectively. Our results show the study area as suitable habitat for D. vagabunda.
Collapse
Affiliation(s)
- R A Khan
- Hazara University Mansehra, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
| | - Z Ullah
- Hazara University, Department of Zoology, Sub-Campus Battagram, Khyber Pakhtunkhwa, Pakistan
| | - I Uz Zaman
- Khyber Pakhtunkhwa Wildlife Department, Pakistan
| | - M S Khan
- University of Swabi, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
| | - S Mahmood
- Hazara University Mansehra, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
| | - N Akhtar
- Hazara University, Department of Zoology, Sub-Campus Battagram, Khyber Pakhtunkhwa, Pakistan
| | - M F Khan
- Hazara University Mansehra, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
| | - S Yasmin
- Hazara University Mansehra, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
| | - M Saqlain
- Horizon Degree College Chakwal, Department of Zoology, Pakistan
| | - A Ur Rehman
- Hazara University Mansehra, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
| | - N Aksar
- Hazara University Mansehra, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
| | - S N Khan
- Hazara University Mansehra, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
| | - S S Hussain
- Hazara University Mansehra, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
| |
Collapse
|
8
|
Sharif N, Ahmed D, Mahmood RT, Qasim Z, Khan SN, Jabbar A, Khattak AA, Asad MJ, Ahmed W, Khan MM, Awan UA, Zaman N, Habiba U, Noureen S, Alghamdi HA. Comparison of different diagnostic modalities for isolation of Mycobacterium Tuberculosis among suspected tuberculous lymphadenitis patients. BRAZ J BIOL 2021; 83:e244311. [PMID: 34431905 DOI: 10.1590/1519-6984.244311] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/18/2021] [Indexed: 01/17/2023] Open
Abstract
Tuberculosis is a communicable disease with high morbidity and mortality rates in developing countries. The study's primary objective is to compare conventional methods such as acid-fast bacillus (AFB) culture and microscopy with rapid diagnostic methods. The secondary objective is to compare histopathological and microbiological findings in suspected patients with tubercular lymphadenitis. A total of 111 samples (August 2018 to September 2019) of lymph nodes were processed for AFB microscopy, AFB cultures, drug-susceptibility testing (DST), histopathology, and Xpert Mycobacterium Tuberculosis (MTB)/resistance to Rifampin (RIF) assays. Out of 111 lymph node samples, 6 (5.4%) were positive for AFB smear microscopy, 84 (75.6%) were positive for AFB culture, 80 (70.7%) were positive on Gene Xpert, and 102 (91.8%) were indicative of tuberculosis for histopathology studies. Mycobacteria growth indicator tube (MGIT) culture positivity was 84 (75.6%) higher than solid Lowenstein-Jensen (LJ) culture 74 (66.6%). Positive cultures underwent phenotypic DST. Two cases were Multidrug-resistant (MDR) on DST, while three cases were Rifampicin resistant on Gene Xpert. The sensitivity of Genexpert was (62%) against the conventional AFB culture method. The poor performance of conventional lymphadenitis diagnostic methods requires early and accurate diagnostic methodology. Xpert MTB/RIF test can help in the treatment of multidrug-resistant TB cases. Nonetheless, rapid and conventional methods should be used for complete isolation of Mycobacterium tuberculosis.
Collapse
Affiliation(s)
- N Sharif
- The University of Haripur, Department of Medical Laboratory Technology, Haripur, Khyber Pakhtunkhwa, Pakistan
| | - D Ahmed
- The University of Haripur, Department of Medical Laboratory Technology, Haripur, Khyber Pakhtunkhwa, Pakistan
| | - R T Mahmood
- Mirpur University of Science and Technology - MUST, Department of Biotechnology, Mirpur (AJK), Pakistan
| | - Z Qasim
- Divisional Headquaters Teaching Hospital, Department of Pathology, Mirpur AJ&K, Pakistan
| | - S N Khan
- The University of Haripur, Department of Medical Laboratory Technology, Haripur, Khyber Pakhtunkhwa, Pakistan
| | - A Jabbar
- The University of Haripur, Department of Medical Laboratory Technology, Haripur, Khyber Pakhtunkhwa, Pakistan
| | - A A Khattak
- The University of Haripur, Department of Medical Laboratory Technology, Haripur, Khyber Pakhtunkhwa, Pakistan
| | - M J Asad
- University Institute of Biochemistry and Biotechnology, PMAS-Arid Agriculture University Rawalpindi, Rawalpindi, Punjab, Pakistan
| | - W Ahmed
- The University of Haripur, Department of Microbiology, Haripur, Khyber Pakhtunkhwa, Pakistan
| | - M M Khan
- The University of Haripur, Department of Microbiology, Haripur, Khyber Pakhtunkhwa, Pakistan
| | - U A Awan
- The University of Haripur, Department of Medical Laboratory Technology, Haripur, Khyber Pakhtunkhwa, Pakistan
| | - N Zaman
- University of Swat, Centre for Biotechnology and Microbiology, KPK, Pakistan
| | - U Habiba
- The University of Haripur, Department of Forestry and Wildlife Management, Haripur, Khyber Pakhtunkhwa, Pakistan
| | - S Noureen
- The University of Haripur, Department of Forestry and Wildlife Management, Haripur, Khyber Pakhtunkhwa, Pakistan
| | - H A Alghamdi
- King Khalid University, College of Sciences, Department of Biology, Abha, Saudi Arabia
| |
Collapse
|
9
|
Yaqoob M, Khan S, Atta S, Khan SN. Current trends of Hepatitis C virus genotypes and associated risk factors in hemophilia patients in Pakistan. Trop Biomed 2020; 37:1000-1007. [PMID: 33612752 DOI: 10.47665/tb.37.4.1000] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Hemophilia is a rare bleeding disorder that needs plasma or clotting factor concentrate transfusion. Therefore chances of blood-borne pathogens like HCV transmission increase due to high prevalence in healthy donors. This study was aimed to determine the prevalence of HCV genotypes and associated risk factors in hemophilia patients of Khyber Pakhtunkhwa, Pakistan. Blood samples and data were collected from 672 hemophiliacs after proper consent obtained from each patient. Samples were analyzed for anti-HCV, HCV RNA and HCV genotype/s detection. Of the total, 22.32% (150) were anti-HCV positive, of which HCV RNA was detected in 18.45% (124) individuals. HCV genotype 3a was found with significantly higher prevalence (p<0.05) (19.35%) as compared to 2a (16.13%) and 1a (12.90%). HCV-3b and HCV-4 were found each in 3.22% samples. Dual infection of genotypes was found in 22.58% of individuals and 22.58% HCV RNA positive sampels were not typed. A total of 572 (85.12%) subjects had hemophilia A and 100 (14.88%) had hemophilia B. In hemophiliacs A the most dominant genotype was 3a (19.27%) while in hemophilia B, genotype 1a was prevalent (26.67%). Whole blood and plasma transfusion were observed as the main risk factors of HCV. It is concluded that HCV genotype 3a and 2a are prevalent in hemophilia patients of Khyber Pakhtunkhwa Pakistan and the main risk factor observed was an unscreened whole blood transfusion.
Collapse
Affiliation(s)
- M Yaqoob
- Department of Zoology, University of Peshawar Khyber Pakhtunkwa Pakistan
| | - S Khan
- Department of Zoology, University of Peshawar Khyber Pakhtunkwa Pakistan
| | - S Atta
- Department of Zoology, Islamia College Peshawar Khyber Pakhtunkwa Pakistan
| | - S N Khan
- Department of Zoology, Kohat University of Science and Technology Kohat Khyber Pakhtunkwa Pakistan
| |
Collapse
|
10
|
Fayyaz S, Ahmed D, Khalid S, Khan SN, Shah MR, Choudhary MI. Synthesis of vildagliptin conjugated metal nanoparticles for type II diabetes control: targeting the DPP-IV enzyme. NEW J CHEM 2020. [DOI: 10.1039/d0nj04202a] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Diabetes is one of the most prevalent diseases worldwide.
Collapse
Affiliation(s)
- Sharmeen Fayyaz
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences
- University of Karachi
- Karachi-75270
- Pakistan
| | - Dania Ahmed
- H. E. J. Research Institute of Chemistry, International Center for Chemical and Biological Sciences
- University of Karachi
- Karachi-75270
- Pakistan
- Department of Biotechnology
| | - Sadia Khalid
- H. E. J. Research Institute of Chemistry, International Center for Chemical and Biological Sciences
- University of Karachi
- Karachi-75270
- Pakistan
| | - Sehrosh Naz Khan
- H. E. J. Research Institute of Chemistry, International Center for Chemical and Biological Sciences
- University of Karachi
- Karachi-75270
- Pakistan
| | - M. Raza Shah
- H. E. J. Research Institute of Chemistry, International Center for Chemical and Biological Sciences
- University of Karachi
- Karachi-75270
- Pakistan
| | - M. Iqbal Choudhary
- Dr. Panjwani Center for Molecular Medicine and Drug Research, International Center for Chemical and Biological Sciences
- University of Karachi
- Karachi-75270
- Pakistan
- H. E. J. Research Institute of Chemistry, International Center for Chemical and Biological Sciences
| |
Collapse
|
11
|
Malik AT, Li M, Scharschmidt TJ, Khan SN. Revision of an infected total hip arthroplasty: the need for the adjustment of risk in bundled payment models for revision arthroplasty. Bone Joint J 2019; 101-B:547-551. [PMID: 31039000 DOI: 10.1302/0301-620x.101b5.bjj-2018-1038.r1] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The aim of this study was to investigate the differences in 30-day outcomes between patients undergoing revision for an infected total hip arthroplasty (THA) compared with an aseptic revision THA. PATIENTS AND METHODS This was a retrospective review of prospectively collected data from the American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database, between 2012 and 2017, using Current Procedural Terminology (CPT) codes for patients undergoing a revision THA (27134, 27137, 27138). International Classification of Diseases Ninth Revision/Tenth Revision (ICD-9-CM, ICD-10-CM) diagnosis codes for infection of an implant or device were used to identify patients undergoing an infected revision THA. CPT-27132 coupled with ICD-9-CM/ICD-10-CM codes for infection were used to identify patients undergoing a two-stage revision. A total of 13 556 patients were included; 1606 (11.8%) underwent a revision THA due to infection and there were 11 951 (88.2%) aseptic revisions. RESULTS Patients undergoing an infected revision had a significantly greater length of stay of more than three days (p < 0.001), higher odds of any 30-day complication (p < 0.001), readmission within 30 days (p < 0.001), 30-day reoperations (p < 0.001), and discharge to a destination other than the patient's home (p < 0.001). CONCLUSION The findings suggest the need for enhanced risk adjustment based on the indication of revision THA prior to setting prices in bundled payment models of total joint arthroplasty. This risk adjustment should be used to reduce the chance of financial disincentives in clinical practice. Cite this article: Bone Joint J 2019;101-B:547-551.
Collapse
Affiliation(s)
- A T Malik
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - M Li
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - T J Scharschmidt
- Department of Orthopaedics, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - S N Khan
- Division of Spine Surgery, Columbus, Ohio, USA.,Department of Integrated Systems Engineering Clinical Faculty, Spine Research Institute, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| |
Collapse
|
12
|
Bhatti FU, Mehmood A, Latief N, Zahra S, Cho H, Khan SN, Riazuddin S. Vitamin E protects rat mesenchymal stem cells against hydrogen peroxide-induced oxidative stress in vitro and improves their therapeutic potential in surgically-induced rat model of osteoarthritis. Osteoarthritis Cartilage 2017; 25:321-331. [PMID: 27693502 DOI: 10.1016/j.joca.2016.09.014] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [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: 02/25/2016] [Revised: 09/04/2016] [Accepted: 09/23/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Oxidative stress is a major obstacle against cartilage repair in osteoarthritis (OA). Anti-oxidant agents can play a vital role in addressing this issue. We evaluated the effect of Vitamin E preconditioning in improving the potential of mesenchymal stem cells (MSCs) to confer resistance against oxidative stress prevailing during OA. METHODS Vitamin E pretreated MSCs were exposed to oxidative stress in vitro by hydrogen peroxide (H2O2) and also implanted in surgically-induced rat model of OA. Analysis was done in terms of cell proliferation, apoptosis, cytotoxicity, chondrogenesis and repair of cartilage tissue. RESULTS Vitamin E pretreatment enabled MSCs to counteract H2O2-induced oxidative stress in vitro. Proliferative markers, proliferating cell nuclear antigen (PCNA) and Ki67 were up-regulated, along with the increase in the viability of MSCs. Expression of transforming growth factor-beta (TGFβ) was also increased. Reduction of apoptosis, expression of vascular endothelial growth factor (VEGF) and caspase 3 (Casp3) genes, and lactate dehydrogenase (LDH) release were also observed. Transplantation of Vitamin E pretreated MSCs resulted in increased proteoglycan contents of cartilage matrix. Increased expression of chondrogenic markers, Aggrecan (Acan) and collagen type-II alpha (Col2a1) accompanied by decreased expression of collagen type-I alpha (Col1a1) resulted in increased differentiation index that signifies the formation of hyaline cartilage. Further, there was an increased expression of PCNA and TGFβ genes along with a decreased expression of Casp3 and VEGF genes with increased histological score. CONCLUSION Taken together results of this study demonstrated that Vitamin E pretreated MSCs have an improved ability to impede the progression of OA and thus increased potential to treat OA.
Collapse
Affiliation(s)
- F U Bhatti
- National Centre of Excellence in Molecular Biology, 87-West Canal Bank Road, University of the Punjab, Lahore, Pakistan; University of Tennessee Health Science Center-Campbell Clinic, Memphis, TN, USA.
| | - A Mehmood
- National Centre of Excellence in Molecular Biology, 87-West Canal Bank Road, University of the Punjab, Lahore, Pakistan.
| | - N Latief
- National Centre of Excellence in Molecular Biology, 87-West Canal Bank Road, University of the Punjab, Lahore, Pakistan.
| | - S Zahra
- National Centre of Excellence in Molecular Biology, 87-West Canal Bank Road, University of the Punjab, Lahore, Pakistan.
| | - H Cho
- University of Tennessee Health Science Center-Campbell Clinic, Memphis, TN, USA; Veterans Affairs Medical Center, Memphis, TN, USA.
| | - S N Khan
- National Centre of Excellence in Molecular Biology, 87-West Canal Bank Road, University of the Punjab, Lahore, Pakistan.
| | - S Riazuddin
- National Centre of Excellence in Molecular Biology, 87-West Canal Bank Road, University of the Punjab, Lahore, Pakistan; Allama Iqbal Medical College, University of Health Sciences, Lahore, Pakistan.
| |
Collapse
|
13
|
Maranhao B, Biswas P, Duncan JL, Branham KE, Silva GA, Naeem MA, Khan SN, Riazuddin S, Hejtmancik JF, Heckenlively JR, Riazuddin SA, Lee PL, Ayyagari R. exomeSuite: Whole exome sequence variant filtering tool for rapid identification of putative disease causing SNVs/indels. Genomics 2014; 103:169-76. [PMID: 24603341 DOI: 10.1016/j.ygeno.2014.02.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [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: 03/06/2013] [Revised: 02/19/2014] [Accepted: 02/24/2014] [Indexed: 12/30/2022]
Abstract
Exome and whole-genome analyses powered by next-generation sequencing (NGS) have become invaluable tools in identifying causal mutations responsible for Mendelian disorders. Given that individual exomes contain several thousand single nucleotide variants and insertions/deletions, it remains a challenge to analyze large numbers of variants from multiple exomes to identify causal alleles associated with inherited conditions. To this end, we have developed user-friendly software that analyzes variant calls from multiple individuals to facilitate identification of causal mutations. The software, termed exomeSuite, filters for putative causative variants of monogenic diseases inherited in one of three forms: dominant, recessive caused by a homozygous variant, or recessive caused by two compound heterozygous variants. In addition, exomeSuite can perform homozygosity mapping and analyze the variant data of multiple unrelated individuals. Here we demonstrate that filtering of variants with exomeSuite reduces datasets to a fraction of a percent of their original size. To the best of our knowledge this is the first freely available software developed to analyze variant data from multiple individuals that rapidly assimilates and filters large data sets based on pattern of inheritance.
Collapse
Affiliation(s)
- B Maranhao
- Department of Ophthalmology, University of California, San Diego, UC Jacobs Retina Center, 9415 Campus Point Drive, La Jolla, CA 92037-0946, USA; Department of Bioengineering, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA.
| | - P Biswas
- Department of Ophthalmology, University of California, San Diego, UC Jacobs Retina Center, 9415 Campus Point Drive, La Jolla, CA 92037-0946, USA.
| | - J L Duncan
- Department of Ophthalmology, University of California San Francisco, San Francisco, CA 94143, USA.
| | - K E Branham
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, MI 48109, USA.
| | - G A Silva
- Department of Ophthalmology, University of California, San Diego, UC Jacobs Retina Center, 9415 Campus Point Drive, La Jolla, CA 92037-0946, USA; Department of Bioengineering, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA; Neurosciences Graduate Program, University of California, San Diego, 9500 Gilman Drive, La Jolla, CA 92093, USA.
| | - M A Naeem
- National Centre of Excellence in Molecular Biology, University of the Punjab, Lahore, Pakistan
| | - S N Khan
- National Centre of Excellence in Molecular Biology, University of the Punjab, Lahore, Pakistan
| | - S Riazuddin
- National Centre of Excellence in Molecular Biology, University of the Punjab, Lahore, Pakistan
| | - J F Hejtmancik
- Ophthalmic Genetics and Visual Function Branch, National Institutes of Health, Bethesda, MD 20892, USA.
| | - J R Heckenlively
- Department of Ophthalmology and Visual Sciences, University of Michigan Medical School, Ann Arbor, MI 48109, USA.
| | - S A Riazuddin
- National Centre of Excellence in Molecular Biology, University of the Punjab, Lahore, Pakistan; The Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA
| | - P L Lee
- Department of Ophthalmology, University of California, San Diego, UC Jacobs Retina Center, 9415 Campus Point Drive, La Jolla, CA 92037-0946, USA.
| | - R Ayyagari
- Department of Ophthalmology, University of California, San Diego, UC Jacobs Retina Center, 9415 Campus Point Drive, La Jolla, CA 92037-0946, USA.
| |
Collapse
|
14
|
Khan SN, Jankowska AM, Mahfouz R, Dunbar AJ, Sugimoto Y, Hosono N, Hu Z, Cheriyath V, Vatolin S, Przychodzen B, Reu FJ, Saunthararajah Y, O'Keefe C, Sekeres MA, List AF, Moliterno AR, McDevitt MA, Maciejewski JP, Makishima H. Multiple mechanisms deregulate EZH2 and histone H3 lysine 27 epigenetic changes in myeloid malignancies. Leukemia 2013; 27:1301-9. [PMID: 23486531 DOI: 10.1038/leu.2013.80] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Polycomb repressive complex 2 (PRC2) is involved in trimethylation of histone H3 lysine 27 (H3K27), chromatin condensation and transcriptional repression. The silencing function of PRC2 complex is mostly attributed to its intrinsic activity for methylating H3K27. Unlike in B-cell lymphomas, enhancer of zeste homolog 2 (EZH2) mutations in myeloid malignancies are inactivating/hypomorphic. When we assessed the mutational status in myeloid malignancies (N=469 cases examined), we found EZH2 and EED/SUZ12 mutations in 8% and 3.3% of cases, respectively. In addition to mutant cases, reduced EZH2 expression was also found in 78% cases with hemizygous deletion (-7/del7q cases involving EZH2 locus) and 41% of cases with diploid chromosome 7, most interestingly cases with spliceosomal mutations (U2AF1/SRSF2 mutations; 63% of cases). EZH2 mutations were characterized by decreased H3K27 trimethylation and increased chromatin relaxation at specific gene loci accompanied by higher transcriptional activity. One of the major downstream target is HOX gene family, involved in the regulation of stem cell self-renewal. HOXA9 was found to be overexpressed in cases with decreased EZH2 expression either by EZH2/spliceosomal mutations or because of -7/del7q. In summary, our results suggest that loss of gene repression through a variety of mutations resulting in reduced H3K27 trimethylation may contribute to leukemogenesis.
Collapse
Affiliation(s)
- S N Khan
- Department of Translational Hematology and Oncology Research, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH 44195, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Nguyen KL, Khan SN, Moriarty J, Mohajer K, Renella P, Satou G, Ayad I, Patel S, Boechat I, Finn P. Cardiac MR imaging and MR angiography in pediatric congenital heart disease: a comparison between 1.5T and 3.0T. J Cardiovasc Magn Reson 2013. [PMCID: PMC3560072 DOI: 10.1186/1532-429x-15-s1-w27] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
16
|
Khan SN, DaSilva C, Renella P, Satou G, Ayad I, Patel S, Boechat I, Finn P. CEMRA in neonatal and pediatric congenital vascular diseases at 1.5T and 3.0T: comparison of an intravascular contrast agent (Gadofosveset) with an extracellular agent (Gadopentetate Dimeglumine). J Cardiovasc Magn Reson 2013. [PMCID: PMC3560090 DOI: 10.1186/1532-429x-15-s1-w32] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
17
|
Khan SN, Meehan C, Plotnik A, Ayad I, Patel S, Boechat I, Finn P. Contrast enhanced magnetic resonance angiography in children: initial experience at 3.0 Tesla. J Cardiovasc Magn Reson 2013. [PMCID: PMC3560065 DOI: 10.1186/1532-429x-15-s1-w36] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
18
|
Kim MG, Lamsal J, Heitmann TW, Tucker GS, Pratt DK, Khan SN, Lee YB, Alam A, Thaler A, Ni N, Ran S, Bud'ko SL, Marty KJ, Lumsden MD, Canfield PC, Harmon BN, Johnson DD, Kreyssig A, McQueeney RJ, Goldman AI. Effects of transition metal substitutions on the incommensurability and spin fluctuations in BaFe2As2 by elastic and inelastic neutron scattering. Phys Rev Lett 2012; 109:167003. [PMID: 23215117 DOI: 10.1103/physrevlett.109.167003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Indexed: 06/01/2023]
Abstract
The spin fluctuation spectra from nonsuperconducting Cu-substituted, and superconducting Co-substituted, BaFe(2)As(2) are compared quantitatively by inelastic neutron scattering measurements and are found to be indistinguishable. Whereas diffraction studies show the appearance of incommensurate spin-density wave order in Co and Ni substituted samples, the magnetic phase diagram for Cu substitution does not display incommensurate order, demonstrating that simple electron counting based on rigid-band concepts is invalid. These results, supported by theoretical calculations, suggest that substitutional impurity effects in the Fe plane play a significant role in controlling magnetism and the appearance of superconductivity, with Cu distinguished by enhanced impurity scattering and split-band behavior.
Collapse
Affiliation(s)
- M G Kim
- Ames Laboratory, U.S. DOE, Ames, Iowa 50011, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Ali RA, Rehman AU, Khan SN, Husnain T, Riazuddin S, Friedman TB, Ahmed ZM, Riazuddin S. DFNB86, a novel autosomal recessive non-syndromic deafness locus on chromosome 16p13.3. Clin Genet 2011; 81:498-500. [PMID: 22211675 DOI: 10.1111/j.1399-0004.2011.01729.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
20
|
Khan SN, Murray P, McCormick L, Sharples LS, Salahshouri P, Scott J, Schofield PM. Paramedic-led prehospital thrombolysis is safe and effective: the East Anglian experience. Emerg Med J 2009; 26:452-5. [PMID: 19465626 DOI: 10.1136/emj.2008.062729] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Prehospital thrombolysis has been shown to improve patient outcomes in clinical trials and this has been confirmed in the ongoing large national myocardial infarction registry (Myocardial Infarction National Audit Project; MINAP) reports. This paper describes a system to improve the delivery of prehospital thrombolysis and the associated governance requirements to gain maximum patient benefit. METHODS Demographic data were prospectively collected on all patients treated by the East Anglian Ambulance Trust with bolus thrombolytics for a presumed diagnosis of ST elevation myocardial infarction between November 2003 and February 2007. Survival status was determined from the NHS strategic tracing service. RESULTS 1062 patients (mean age 64.0 years (SD 10.6), 795 men) were treated in this time period. There were 71 deaths in this group, with actuarial survival of 93.9% (SE 0.9%) at 30 days, 91.7% (SE 1.0%) at 6 months and 90.8% (SE 1.1%) at 12 months after treatment. Age and cardiac arrest were most strongly associated with mortality (both p<0.001). Twelve (1.2%) patients received thrombolysis that on review was considered inappropriate. There were no deaths in this subgroup. CONCLUSIONS Prehospital thrombolysis can be administered safely by ambulance staff supported by a Trust clinical support system with excellent clinical outcomes.
Collapse
Affiliation(s)
- S N Khan
- Department of Cardiology, Papworth Hospital, Papworth Everard, Cambridge, UK
| | | | | | | | | | | | | |
Collapse
|
21
|
Dyer MT, Goldsmith KA, Khan SN, Sharples LD, Freeman C, Hardy I, Buxton MJ, Schofield PM. Clinical and cost-effectiveness analysis of an open label, single-centre, randomised trial of spinal cord stimulation (SCS) versus percutaneous myocardial laser revascularisation (PMR) in patients with refractory angina pectoris: The SPiRiT trial. Trials 2008; 9:40. [PMID: 18590536 PMCID: PMC2481243 DOI: 10.1186/1745-6215-9-40] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [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: 03/25/2008] [Accepted: 06/30/2008] [Indexed: 11/16/2022] Open
Abstract
Background Patients with refractory angina have significant morbidity. This study aimed to compare two of the treatment options, Spinal Cord Stimulation (SCS) and Percutaneous Myocardial Laser Revascularisation (PMR) in terms of clinical outcomes and cost-effectiveness. Methods Eligible patients were randomised to PMR or SCS and followed up for exercise tolerance time (ETT), Canadian Cardiovascular Society (CCS) classification and the quality of life measures SF-36, Seattle Angina Questionnaire and the EuroQoL at 3, 12 and 24 months. Utilities were calculated using the EQ-5D and these and costs were compared between groups. The incremental cost-effectiveness ratio (ICER) per QALY for SCS compared to PMR was also calculated. Results At 24 months post-randomisation, patients that had SCS and PMR had similar ETT (mean difference 0.05, 95% CI -2.08, 2.18, p = 0.96) and there was no difference in CCS classification or quality of life outcomes. The difference in overall mean costs when comparing SCS to PMR was GBP5,520 (95% CI GBP1,966 to GBP8,613; p < 0.01) and the ICER of using SCS was GBP46,000 per QALY. Conclusion Outcomes after SCS did not differ appreciably from those after PMR, with the former procedure being less cost-effective as currently applied. Larger studies could clarify which patients would most benefit from SCS, potentially increasing cost-effectiveness. Trial registration Current Controlled Trials ISRCTN09648950
Collapse
Affiliation(s)
- M T Dyer
- Health Economics Research Group, Brunel University, Uxbridge, Middlesex, UK.
| | | | | | | | | | | | | | | |
Collapse
|
22
|
Abstract
Usher syndrome (USH) is a hereditary disorder associated with sensorineural hearing impairment, progressive loss of vision attributable to retinitis pigmentosa (RP) and variable vestibular function. Three clinical types have been described with type I (USH1) being the most severe. To date, six USH1 loci have been reported. We ascertained two large Pakistani consanguineous families segregating profound hearing loss, vestibular dysfunction, and RP, the defining features of USH1. In these families, we excluded linkage of USH to the 11 known USH loci and subsequently performed a genome-wide linkage screen. We found a novel USH1 locus designated USH1H that mapped to chromosome 15q22-23 in a 4.92-cM interval. This locus overlaps the non-syndromic deafness locus DFNB48 raising the possibility that the two disorders may be caused by allelic mutations.
Collapse
Affiliation(s)
- Z M Ahmed
- Section on Human Genetics, Laboratory of Molecular Genetics, National Institute on Deafness and Other Communication Disorders, National Institutes of Health, Rockville, MD 20850, USA
| | | | | | | | | | | |
Collapse
|
23
|
Khan SN, Stirling AJ. Controversial topics in surgery: degenerative disc disease: disc replacement. Against. Ann R Coll Surg Engl 2007; 89:6-11. [PMID: 17326280] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023] Open
Affiliation(s)
- S N Khan
- Department of Spinal Surgery, The Royal Orthopaedic Hospital, Birmingham, UK
| | | |
Collapse
|
24
|
Shabbir MI, Ahmed ZM, Khan SY, Riazuddin S, Waryah AM, Khan SN, Camps RD, Ghosh M, Kabra M, Belyantseva IA, Friedman TB, Riazuddin S. Mutations of human TMHS cause recessively inherited non-syndromic hearing loss. J Med Genet 2006; 43:634-40. [PMID: 16459341 PMCID: PMC2564584 DOI: 10.1136/jmg.2005.039834] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Approximately half the cases of prelingual hearing loss are caused by genetic factors. Identification of genes causing deafness is a crucial first step in understanding the normal function of these genes in the auditory system. Recently, a mutant allele of Tmhs was reported to be associated with deafness and circling behaviour in the hurry-scurry mouse. Tmhs encodes a predicted tetraspan protein of unknown function, which is expressed in inner ear hair cells. The human homologue of Tmhs is located on chromosome 6p. OBJECTIVE To determine the cause of deafness in four consanguineous families segregating recessive deafness linked to markers on chromosome 6p21.1-p22.3 defining a novel DFNB locus. RESULTS A novel locus for non-syndromic deafness DFNB67 was mapped in an interval of approximately 28.51 cM on human chromosome 6p21.1-p22.3. DNA sequence analysis of TMHS revealed a homozygous frameshift mutation (246delC) and a missense mutation (Y127C) in affected individuals of two families segregating non-syndromic deafness, one of which showed significant evidence of linkage to markers in the DFNB67 interval. The localisation of mTMHS in developing mouse inner ear hair cells was refined and found to be expressed briefly from E16.5 to P3. CONCLUSIONS These findings establish the importance of TMHS for normal sound transduction in humans.
Collapse
Affiliation(s)
- M I Shabbir
- National Centre of Excellence in Molecular Biology, Punjab University, Thokar Niaz Baig, Lahore, Pakistan
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
25
|
Mason WTM, Khan SN, James CL, Chesser TJS, Ward AJ. Complications of temporary and definitive external fixation of pelvic ring injuries. Injury 2005; 36:599-604. [PMID: 15826617 DOI: 10.1016/j.injury.2004.11.016] [Citation(s) in RCA: 109] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2004] [Revised: 11/16/2004] [Accepted: 11/16/2004] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To determine the incidence of complications of external fixation in pelvic ring injuries, comparing fixator use for temporary and definitive treatment. DESIGN Retrospective case-note review. SETTING A regional centre for pelvic trauma in the UK. PATIENTS 100 consecutive patients. INTERVENTION All patients were treated with pelvic external fixation for a pelvic ring injury. RESULTS In 52 patients, external fixation was intended for use as the definitive treatment of the pelvic ring injury and was maintained for a mean duration of 60 days (17-113). In 48 patients, it was used temporarily for a mean duration of 8 days (1-20) before internal fixation of the pelvic ring. The complication rate for definitive and temporary fixators was 62 and 21%, respectively. Pin-site infection occurred in 50% of definitive fixators and 13% of temporary fixators but rarely led to more serious complications. In five patients, the definitive management was changed as a result of a complication of the external fixator. The commonest cause for revision of either fixator was aseptic pin loosening. Revision for loose pins in eight patients was associated with the use of two pins in each iliac crest rather than three. CONCLUSIONS The temporary use of external fixation is safe and effective, but use for definitive treatment is associated with a high rate of infection and aseptic pin loosening.
Collapse
Affiliation(s)
- W T M Mason
- Pelvic & Acetabular Reconstruction Unit, Department of Orthopaedics and Trauma, North Bristol NHS Trust, Frenchay Hospital, Bristol, BS16 1LE, UK.
| | | | | | | | | |
Collapse
|
26
|
Naz S, Griffith AJ, Riazuddin S, Hampton LL, Battey JF, Khan SN, Riazuddin S, Wilcox ER, Friedman TB. Mutations of ESPN cause autosomal recessive deafness and vestibular dysfunction. J Med Genet 2004; 41:591-5. [PMID: 15286153 PMCID: PMC1735855 DOI: 10.1136/jmg.2004.018523] [Citation(s) in RCA: 93] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We mapped a human deafness locus DFNB36 to chromosome 1p36.3 in two consanguineous families segregating recessively inherited deafness and vestibular areflexia. This phenotype co-segregates with either of two frameshift mutations, 1988delAGAG and 2469delGTCA, in ESPN, which encodes a calcium-insensitive actin-bundling protein called espin. A recessive mutation of ESPN is known to cause hearing loss and vestibular dysfunction in the jerker mouse. Our results establish espin as an essential protein for hearing and vestibular function in humans. The abnormal vestibular phenotype associated with ESPN mutations will be a useful clinical marker for refining the differential diagnosis of non-syndromic deafness.
Collapse
Affiliation(s)
- S Naz
- Section on Human Genetics, LMG, NIDCD, NIH, Rockville, MD 20850, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Abstract
Claims for personal injury after whiplash injury cost the economy of the United Kingdom more than pound 3 billion per year, yet only very few patients have radiologically demonstrable pathology. Those sustaining fractures of the cervical spine have been subjected to greater force and may reasonably be expected to have worse symptoms than those with whiplash injuries. Using the neck disability index as the outcome measure, we compared pain and functional disability in four groups of patients who had suffered injury to the cervical spine. After a mean follow-up of 3.5 years, patients who had sustained fractures of the cervical spine had significantly lower levels of pain and disability than those who had received whiplash injuries and were pursuing compensation (p < 0.01), but had similar levels to those whiplash sufferers who had settled litigation or had never sought compensation. Functional recovery after neck injury was unrelated to the physical insult. The increased morbidity in whiplash patients is likely to be psychological and is associated with litigation.
Collapse
Affiliation(s)
- C C Joslin
- Southmead Hospital, Bristol, England, UK
| | | | | |
Collapse
|
28
|
Abstract
BACKGROUND During aortic aneurysm surgery, cross-clamping can lead to inadequate blood supply to the spinal cord resulting in neurological deficit. Cerebrospinal fluid drainage (CSFD) may increase the perfusion pressure to the spinal cord and hence reduce the risk of ischaemic spinal cord injury. OBJECTIVES To determine the effect of CSFD during thoracic and thoracoabdominal aortic aneurysm (TAAA) surgery on the risk of developing spinal cord injury. SEARCH STRATEGY The reviewers searched the Cochrane Peripheral Vascular Diseases Group Specialised Trials Register (last searched October 2003), the Cochrane Central Register of Controlled Trials (CENTRAL) database (last searched Issue 4, 2003), MEDLINE and EMBASE, and reference lists of relevant articles. Recent conference proceedings were scanned. SELECTION CRITERIA Randomised trials involving CSFD during thoracic and TAAA surgery. DATA COLLECTION AND ANALYSIS Both reviewers assessed the quality of trials independently. One reviewer (SNK) extracted data and the other reviewer (GS) verified the data. MAIN RESULTS Three trials, with a total of 287 participants operated on for type I or II TAAA, were included. In the first trial of 98 patients, neurological deficits in the lower extremities occurred in 14 (30%) CSFD and 17 (33%) controls. The deficit was observed within 24 hours of the operation in 21 (68%), and from 3 to 22 days in 10 (32%). CSFD did not have a significant benefit in preventing ischaemic injury to the spinal cord. The second trial of 33 patients used a combination of CSFD and intrathecal papaverine. It showed a statistically significant reduction in the rate of postoperative neurological deficit (p = 0.039), compared to controls. Analysis was undertaken after only one third of the estimated sample size had entered the trial. In the third trial TAAA repair was performed on 145 patients. CSFD was initiated during the operation and continued for 48 hours after surgery. Paraplegia or paraparesis occurred in 9 of 74 patients (12.2%) in the control group versus 2 of 82 patients (2.7%) with CSFD (p = 0.03). Overall, CSFD resulted in an 80% reduction in the relative risk of postoperative deficits. Meta-analysis showed an odds ratio (OR) of 0.48 (0.25 to 0.92; confidence interval (CI) 95%). For CSFD trials only OR was 0.57 (0.28 to 1.17) and for intention-to-treat in CSFD only studies OR remained unchanged. REVIEWER'S CONCLUSIONS There are limited data supporting the role of CSFD in thoracic and thoracoabdominal aneurysm surgery for prevention of neurological injury. Further clinical and experimental studies are indicated.
Collapse
Affiliation(s)
- S N Khan
- Dept. of Surgery, University of Newcastle upon Tyne, Framlington Place, Newcastle upon Tyne, UK, NE2 4HH
| | | |
Collapse
|
29
|
Abstract
Objective: To review current approaches to investigation and management of Paget-Schroetter syndrome (PSS). Methods: Relevant clinical studies and reports were searched for using MEDLINE and Embase databases and cross-referenced articles. Articles were extracted using keywords by the two authors independently. Principal findings: There is growing evidence of functional or positional anatomical defects, which lead to subtle intimal injury and a tendency for recurrence or poor outcome. Management of PSS remains controversial. Anticoagulation as a stand-alone treatment has lost favour. Active treatment with thrombolysis followed by consideration of thoracic decompression is recommended by most in the recent literature. Thrombolytic therapy appears to be a safe and efficacious method of establishing immediate patency of the axillary/subclavian vein. The timing and indications of decompression surgery are yet to be defined clearly. There are no randomized trials of treatment or management strategies in PSS. Conclusions: Treatment of PSS remains contentious. Most authors recommend active treatment with thrombolysis followed by thoracic decompression. Multicentre randomized trials are needed.
Collapse
|
30
|
Park GR, Khan SN. Murder and the ICU. Ugeskr Laeger 2002; 19:621-3. [PMID: 12243283 DOI: 10.1017/s0265021502001023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
|
31
|
Zheng F, Sandhu HS, Cammisa FP, Girardi FP, Khan SN. Predictors of functional outcome in elderly patients undergoing posterior lumbar spine surgery. J Spinal Disord 2001; 14:518-21. [PMID: 11723404 DOI: 10.1097/00002517-200112000-00011] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
To ascertain the predictors of functional outcome in elderly patients undergoing posterior lumbar spinal decompression and fusion, a modified low back outcome score questionnaire survey in 83 elderly patients (49 men, 34 women) was carried out at our hospital. The average follow-up was 35.8 months (range: 22-57 months). The outcomes were as follows: excellent to good, 83%; fair, 7%; and poor, 10%. Multiple regression analysis revealed that significant predictors of unfavorable outcome included coexistence of other bone and joint degenerative disorders (p < 0.001) and history of heart disease (p < 0.01). Patients who had undergone previous lumbar surgery had significantly lower modified low back outcome score than those without previous lumbar spine surgery (p < 0.05). The modified low back outcome score questionnaire system is a reliable method in elderly patients.
Collapse
Affiliation(s)
- F Zheng
- Spine Service, Hospital for Special Surgery, New York, New York 10021, USA
| | | | | | | | | |
Collapse
|
32
|
Old JM, Khan SN, Verma I, Fucharoen S, Kleanthous M, Ioannou P, Kotea N, Fisher C, Riazuddin S, Saxena R, Winichagoon P, Kyriacou K, Al-Quobaili F, Khan B. A multi-center study in order to further define the molecular basis of beta-thalassemia in Thailand, Pakistan, Sri Lanka, Mauritius, Syria, and India, and to develop a simple molecular diagnostic strategy by amplification refractory mutation system-polymerase chain reaction. Hemoglobin 2001; 25:397-407. [PMID: 11791873 DOI: 10.1081/hem-100107877] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.2] [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: 11/03/2022]
Abstract
The spectrum of the beta-thalassemia mutations of Thailand, Pakistan, India, Sri Lanka, Mauritius and Syria has been further characterized by a multi-center study of 1,235 transfusion-dependent patients, and the mutations discovered used to assess the fidelity of a simple diagnostic strategy. A total of 44 beta-thalassemia mutations were identified either by allele-specific oligonucleotide hybridization, amplification with allele-specific primers, or DNA sequencing of amplified product. The results confirm and extend earlier findings for Thailand, Pakistan, India, Mauritius and Syria. This is the first detailed report of the spectrum of mutations for Sri Lanka. Two novel mutations were identified, codon 55 (-A) and IVS-I-129 (A-->C), both found in Sri Lankan patients. Two beta-thalassemia mutations were found to coexist in one beta-globin gene: Sri Lankan patients homozygous for the beta0 codon 16 (-C) frameshift were also homozygous for the beta+ codon 10 (C-->A) mutation. Studies of Sri Lankan, Pakistani, and Indian carriers suggest the codon 10 (C-->A) mutation is just a rare polymorphism on an ancestral allele, on which the beta0 codon 16 (-C) mutation has arisen. Each country was found to have only a few common mutations accounting for 70% or more of the beta-thalassemia alleles. A panel of primers to diagnose the majority of the mutations by the amplification refractory mutation system was developed, enabling a simple molecular diagnostic strategy to be introduced for each country participating in the multi-center study.
Collapse
Affiliation(s)
- J M Old
- National Haemoglobinopathy Reference Laboratory, Weatherall Institute of Molecular Medicine, John Radcliffe Hospital, Headington, Oxford, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Sandhu HS, Khan SN, Suh DY, Boden SD. Demineralized bone matrix, bone morphogenetic proteins, and animal models of spine fusion: an overview. Eur Spine J 2001; 10 Suppl 2:S122-31. [PMID: 11716009 PMCID: PMC3611543 DOI: 10.1007/s005860100303] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Preclinical investigations on the use of bone morphogenetic proteins (BMP) in the spine have yielded promising results. This has led to the preliminary introduction of these growth factors in controlled clinical trials. Initial data made available suggest that these differentiating factors will play a major role in the treatment of spinal disorders in the future. This article reviews key preclinical studies and their results that formed the basis for introduction into clinical trials. Non-primate and non-human primate models of spine fusion with BMP are reviewed objectively, and important issues regarding carrier, dose, and site of implantation are discussed. Finally, exciting new gene therapy research is discussed, with comments made on its applicability for the future.
Collapse
Affiliation(s)
- H S Sandhu
- Spinal Surgical Service, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, NY 10021, USA.
| | | | | | | |
Collapse
|
34
|
Abstract
OBJECTIVE Differences in dental decay and disease amongst socioeconomic groups are thought to derive, in part, from variations in dietary practices and differences in education. The aim of this exploratory study was to examine whether differences in motivating factors affecting food choice could be found in a comparison of two groups at very different ends of the social spectrum: dentists and porters/cleaners. DESIGN A convenience sample of 100 people (51 porters/cleaners and 49 dentists) working in the dental school at a university in the North West of England were approached to interview face-to-face and complete the Food Choice Questionnaire (FCQ), a previously validated measure designed to assess nine main factors relevant to peoples' food choices. A sample size of 100 was chosen because it was adequate to test validity (using a two-group Chi-square test with a 0.050 two sided significance). RESULTS Findings were analysed using independent sample t-test and multiple linear regression. Results indicated significant differences between porters/cleaners and dentists in terms of their motives for food choice on six of the nine FCQ factors. These included convenience (p < 0.001), natural content (p < 0.05), price (p < 0.005), familiarity (p < .0001), mood (p < 0.03) and ethical concern (p < 0.01). Porters/cleaners tended to rate the factors covenience, price, mood and familiarity more highly, whereas dentists did the same for natural content and ethical concern. CONCLUSIONS Awareness of the differences in motivational factors affecting food choice between different social groups is important to dental practitioners who are being taught to play an increasing role in health promotion. If dental practitioners are to partake meaningfully in such a role, it is necessary for them to be aware not only of their own motives in food selection, but also of the way in which those motives may differ from those of their clients.
Collapse
|
35
|
Abstract
Osteosarcoma is the most frequently occurring primary malignant tumor of bone, especially in adolescence. Treatment involves either limb salvage surgery or amputation with neoadjuvant chemotherapy. This review article discusses the current treatment modalities for osteosarcoma and also compares the gait patterns and psychosocial profiles of patients treated with either limb salvage surgery or amputation for osteosarcoma. Contemporary orthopedic literature on therapeutic options for osteosarcoma patients is reviewed. Background information on the basic principles of kinesiology, with emphasis on studies of gait pattern differences among patients treated with limb salvage versus amputation, is presented. Finally, several studies of the psychologic profiles of patients after these two procedures for osteosarcoma are reviewed. Trends in contemporary orthopedic literature suggest that functional outcomes, in terms of kinesiologic parameters, are comparable for patients treated with either limb salvage or amputation. Both sets of patients reported quality-of-life problems, including difficulty retaining health insurance and finding appropriate employment, social isolation, and poor self-esteem. The management of patients with osteosarcoma includes not only an individualized surgical plan for each patient but also includes awareness of the patients' psychologic and social needs after surgery.
Collapse
Affiliation(s)
- J M Lane
- Department of Orthopedic Surgery, Weill Medical College of Cornell University, Hospital for Special Surgery, New York, New York 10021, USA.
| | | | | | | |
Collapse
|
36
|
Girardi FP, Cammisa FP, Sangani PK, Parvataneni HK, Khan SN, Grewal H, Sandhu HS. Sudden sensorineural hearing loss after spinal surgery under general anesthesia. J Spinal Disord 2001; 14:180-3. [PMID: 11285432 DOI: 10.1097/00002517-200104000-00014] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Two patients, ages 72 and 71, who underwent lumbar decompressive surgery for spinal stenosis, were evaluated for postoperative sudden sensorineural hearing loss (SSHL). After two uncomplicated spinal procedures, both patients developed SSHL immediately after surgery. Hearing loss was moderate to profound in these two patients. None of the patients had a significant otologic history. Nitrous oxide administration, Valsalva maneuvers during general anesthesia, and transient drops in cerebrospinal fluid pressure stemming from spinal decompression may, in some combination, lead to an implosive force on the inner ear, causing SSHL. Further causes of postlumbar surgery SSHL may include microemboli or viral infections. SSHL is a rare but possible complication after nonotologic, noncardiac bypass surgery; only 26 cases of SSHL after this surgery have been reported. We encourage the continued reporting of sudden sensorineural hearing loss after spinal surgery.
Collapse
Affiliation(s)
- F P Girardi
- SpineCare Institute, Hospital for Special Surgery, New York, New York 10021, USA
| | | | | | | | | | | | | |
Collapse
|
37
|
Abstract
Fibrous dysplasia is proliferation of fibrous tissue within the bone marrow causing osteolytic lesions and pathologic fractures. Recently, second generation bisphosphonates have shown promise in the treatment of patients with fibrous dysplasia. In the current study, six patients with fibrous dysplasia were treated with either oral alone or oral and intravenous bisphosphonates. The participants were observed for changes in N-telopeptide, pain score, and radiographic changes. In the current study, the combination bisphosphonate therapy diminished pain, prevented fractures, lowered N-telopeptide values, and led to partial resolution of fibrous dysplasia lesions.
Collapse
Affiliation(s)
- J M Lane
- Weill Medical College of Cornell University, Hospital for Special Surgery, New York, NY 10021, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Abstract
BACKGROUND In 1971 we published a survey of pediatricians' knowledge, attitudes, and practices relative to the field of allergy. This current survey was conducted to determine how these attitudes and practices have changed over the past 27 years. METHODS Our survey, consisting of 17 questions, was sent to 250 board certified pediatricians in the St. Louis area. Seven of the questions were similar to those in the 1971 survey, while the other ten were new questions which we thought were pertinent to the field of allergy currently. RESULTS In 1971, 75% of the pediatricians felt the specialty of allergy had great or moderate importance for the practice of pediatrics compared with 99% in 1998. In 1998, the number of physicians who felt that there was at least some value to skin testing had increased from 1971, although, only 36% felt it had great value. In 1971, 23% of pediatricians performed their own skin tests compared with 3% in 1998. Nine percent indicated that they had never referred a patient to an allergist in 1971, compared with 2% in 1998. Our new questions looked at to whom respondents were more likely to refer patients with: (1) asthma (68% allergy, 27% pulmonary, 4% both), (2) urticaria (53% allergy, 41% dermatology, 2% both), (3) chronic eczema (45% allergy, 50% dermatology, 2% both), and (4) chronic sinusitis (24% allergy, 74% otolaryngology, 2% both). Older physicians placed greater importance on the field of allergy and skin testing and were more likely to refer to an allergist than physicians under the age of 40 years. CONCLUSION Our results indicate that although there has been significant change in 27 years, allergists must be more aggressive in developing the knowledge, attitudes, and practices of physicians relative to the field of allergy.
Collapse
Affiliation(s)
- S N Khan
- Department of Internal Medicine, Saint Louis University School of Medicine, Missouri, USA
| | | |
Collapse
|
39
|
Cammisa FP, Parvataneni HK, Girardi FP, Khan SN, Sandhu HS. Computerized frameless stereotactic image-guided spinal surgery. Bull Hosp Jt Dis 2000; 59:17-26. [PMID: 10789034] [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] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Affiliation(s)
- F P Cammisa
- Spine Care Institute, Hospital for Special Surgery, New York, New York 10021, USA
| | | | | | | | | |
Collapse
|
40
|
Khan SN, Sandhu HS, Parvataneni HK, Girardi FP, Cammisa FP. Bone graft substitutes in spine surgery. Bull Hosp Jt Dis 2000; 59:5-10. [PMID: 10789032] [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] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Affiliation(s)
- S N Khan
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York 10021, USA
| | | | | | | | | |
Collapse
|
41
|
Abstract
Although a cure for spinal cord injuries does not currently exist, advances have been made in the field of spinal cord regeneration. This article discusses the pathophysiology of spinal cord injury, animal models, and strategies for restoration and regeneration of the spinal cord.
Collapse
Affiliation(s)
- F P Girardi
- SpineCare Institute, Hospital for Special Surgery, New York, New York 10021, USA.
| | | | | | | |
Collapse
|
42
|
Abstract
Gene therapy is a novel therapeutic modality for repair and regeneration of musculoskeletal tissues, including the spine. Various methods for therapeutic gene transfer are presented in this article. Several studies in which gene transfer has been used specifically to enhance spine fusion in animal models are reviewed.
Collapse
Affiliation(s)
- S N Khan
- SpineCare Institute, Hospital for Special Surgery, New York, New York 10021, USA
| | | | | | | | | | | |
Collapse
|
43
|
Abstract
Osteoblastic culture models, experimental, and clinical models have revealed that bone growth factors influence cellular activity. Growth factors including bone morphogenetic proteins, transforming growth factor beta, platelet-derived growth factor, insulin-like growth factors I and II, and acidic and basic fibroblast growth factors, are powerful tools for fracture healing and bone grafting. Understanding the role that bone growth factors play in bone repair is necessary to apply these factors in a clinical setting.
Collapse
Affiliation(s)
- S N Khan
- SpineCare Institute, Hospital for Special Surgery, New York, New York 10021, USA
| | | | | |
Collapse
|
44
|
Abstract
Autogenous bone grafting remains the gold standard for osseous reconstruction in clinical practice. It is associated with several limitations. The search for an alternative bone graft substitute with combined osteoinductive, osteoconductive, and osteogenic properties continues. This article highlights the properties of the various bone grafting materials currently available and discusses their efficacy in clinical practice.
Collapse
Affiliation(s)
- S N Khan
- SpineCare Institute, Hospital for Special Surgery, New York, New York 10021, USA
| | | | | |
Collapse
|
45
|
Abstract
Articular cartilage, which enables smooth gliding of joints during skeletal motion, is vulnerable to injuries and degenerative diseases over time. Bone growth factors have a role in the preservation of the cartilage matrix. This article reviews the potential to treat cartilage damage for bone morphogenetic proteins, insulin-like growth factors, hepatocyte growth factor, basic fibroblast growth factor, and transforming growth factor beta.
Collapse
Affiliation(s)
- W J O'Connor
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York 10021, USA
| | | | | | | |
Collapse
|
46
|
Abstract
A current focus of treatment for degenerative disk disease is the restoration of the intervertebral disk. This article summarizes the structure and function of the intervertebral disk, the pathogenesis of its degeneration, and the clinical relevance of degenerative disk disease. Current literature relating to intervertebral disk replacement and regeneration is reviewed.
Collapse
Affiliation(s)
- A D Diwan
- Spine Service, Hospital for Special Surgery, New York, New York 10021, USA
| | | | | | | | | | | |
Collapse
|
47
|
Abstract
Osteoporosis is a disorder of decreased bone mass, microarchitectural deterioration, and fragility fractures. Osteoporosis is widespread and can affect people of all ethnic backgrounds and many older women and men. An essential element in preventing osteoporosis is the achievement of normal peak bone mass. Adequate nutrition, appropriate calcium and vitamin D intake, regular menstrual cycles and a well balanced exercise program of exercise are essential elements in achieving peak bone mass. At menopause women undergo accelerated bone loss. Thereafter, women and men gradually lose bone mass. A loss of one standard deviation give rise to an enhanced twofold risk of spine fractures or a 2.5 risk of hip fracture. Bone mass is determined by dual energy x-ray absorptiometry, quantitative computed tomography scan, and a peripheral ultrasound. Dual energy x-ray absorptiometry has outstanding precision (within 1% to 2%), and has the ability to show the efficacy of drug intervention. Peripheral measurements may identify osteoporosis but only have a 70% correlation with hip and spine bone mass. Dual energy x-ray absorptiometry determines bone mass in a patient but the bone collagen breakdown products (N-telopeptide crosslinks) establish the current rate of bone loss. Major risk factors leading to fragility fracture include low body weight, history of fracture, family history of osteoporosis, and smoking. All individuals should ingest adequate calcium and vitamin D, exercise, and prevent falls. Women with low bone mass, high urinary bone collagen breakdown products, and/or major risk factors should consider hormone replacement therapy or a selective estrogen receptor modulator (Evista), calcitonin and bisphosphonates (alendronate). These agents successfully increase bone mass and limit fracture risk. Men at risk for fragility fractures respond similarly as women to alendronate and calcitonin. Although vertebral compression fractures can occur spontaneously, hip fractures are attributable to low bone mass coupled with a fall. Hence, fall prevention programs in addition to medical treatment are critical in the prevention of fragility fractures.
Collapse
Affiliation(s)
- J M Lane
- Department of Orthopaedic Surgery, Weill Medical College of Cornell University, Hospital for Special Surgery, New York, NY, USA
| | | | | |
Collapse
|
48
|
Abstract
Three rare beta-thalassemia mutations, not reported previously in Asian Indians or the Pakistani population, were identified by single strand conformation polymorphism analysis followed by direct sequencing. Two mutations, IVS-II-848 (C-->A) and initiation codon (ATG-->ACG), were found in the homozygous condition in patients belonging to Balochi and Sindhi ethnic groups of Pakistan, together with heterozygous and homozygous alpha(-3.7) deletions, respectively. A frameshift mutation at codon 44 (-C) was identified in a patient belonging to the Gujrati ethnic group together with IVS-I-1 (G-->T) and a normal complement of four a-globin genes. Haplotype analysis was performed to identify the chromosomal background associated with these mutations, and for tracing the origin and spread of these mutations.
Collapse
Affiliation(s)
- S N Khan
- Centre for Applied Molecular Biology, University of the Punjab Thokar Niaz Baig, Lahore, Pakistan.
| | | | | |
Collapse
|
49
|
Khan SN, Butt FI, Riazuddin S, Galanello R. Hb Sallanches [alpha104(G11)Cys-->Tyr]: a rare alpha2-globin chain variant found in the homozygous state in three members of a Pakistani family. Hemoglobin 2000; 24:31-5. [PMID: 10722113 DOI: 10.3109/03630260009002271] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
We have identified a rare alpha2-globin chain variant, Hb Sallanches [alpha104(G11) Cys-->Tyr], in a Pakistani family having three homozygous patients with transfusion-dependent Hb H disease. This variant, previously reported in a French patient and a West Indian homozygous patient with Hb H disease, is due to a mutation at codon 104 (TGC-->TAC). This is the third case of Hb Sallanches and the first case with three homozygous patients reported in Pakistan. Due to the different ethnic origins of the patients, it is very likely an independent mutation.
Collapse
Affiliation(s)
- S N Khan
- Centre for Applied Molecular Biology, University of the Punjab Thokar Niaz Baig, Lahore, Pakistan.
| | | | | | | |
Collapse
|
50
|
Abstract
Beta-thalassemia is one of the most common inherited hemoglobin disorders in Pakistan. The carrier frequency is estimated to be 5.4%. To determine the spectrum of beta-globin gene defects causing beta-thalassemia, we have analyzed a representative sample of 602 alleles from six ethnic groups in Pakistan; 99.2% alleles were characterized, while 0.8% remained unidentified. The spectrum of mutations is heterogeneous and we have found 19 different mutations in all ethnic groups. The four most common mutations, IVS-I-5 (G-->C) (37.7%), codons 8/9 (+G) (21.1%), the 619 bp deletion (12.4%), and IVS-I-1 (G-->T) (9.5%), account for 80.7% of the alleles. There are differences between the ethnic groups and also between provinces. In the four provinces of Pakistan, the IVS-I-5 (G-->C) mutation is more prevalent in Sindh and Balochistan, bordering India in the south and Iran in the southwest, while the codons 8/9 (+G) mutation is more common in the Punjab and the North West Frontier Province, bordering India in the northeast and Afghanistan, respectively. The 619 bp deletion is high (46%) in Gujratis and Memons residing in the Province of Sindh, neighboring the Indian Gujrat.
Collapse
Affiliation(s)
- S N Khan
- Centre for Applied Molecular Biology, University of the Punjab, Lahore, Pakistan
| | | |
Collapse
|