1
|
Shehata M, Al Hosani I, Ahmed I, Abu Alkas H, Khaddam O, Aljanahi AA, Al Ahmad M, Al Tiniji K, Singh Y, Malik T. Factors Associated With Short-Term Complications After Percutaneous Endoscopic Gastrostomy Tube Insertion: A Retrospective Cohort Study. Cureus 2024; 16:e55741. [PMID: 38463403 PMCID: PMC10920060 DOI: 10.7759/cureus.55741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2024] [Indexed: 03/12/2024] Open
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) tube placement is generally safe but is associated with a range of complications. Minor complications include infections, granuloma formation, leakage, and blockages, while major complications encompass aspiration pneumonia, hemorrhage, and more serious conditions such as necrotizing fasciitis and colonic fistula. AIM This study aimed to assess the rate of short-term complications within one month of endoscopic PEG insertion, focusing on their correlation with patient characteristics. METHODOLOGY This retrospective cohort study analyzed data from patients who underwent PEG insertion between January 2020 and December 2022. It evaluated the incidence of complications in relation to variables such as the indication for the procedure, the patient's immune status, albumin and CRP levels, and the setting of the procedure (inpatient vs. outpatient). RESULTS The study included 121 patients, with a mean age of 69.73 years, comprising 71 males (58.7%) and 50 females (41.3%). Neurological indications accounted for 64.5% of the cases. Notably, 67.8% of the patients were immunocompromised. Within 30 days of PEG insertion, 16.5% experienced complications, including GI bleeding (4.1%), infection at the PEG site (11.6%), and peritonitis (0.8%). Complications were significantly higher in immunocompromised patients and those with non-neurological indications. Higher serum albumin and lower CRP levels were associated with fewer complications, though the association was not statistically significant. CONCLUSION The study highlights that gastrostomy site infection is the most common short-term complication following PEG insertion. Immune status and the reason for PEG insertion emerged as key factors influencing the likelihood of complications.
Collapse
Affiliation(s)
- Mostafa Shehata
- Gastroenterology, Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, ARE
| | - Ibrahim Al Hosani
- Gastroenterology, Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, ARE
| | - Ishtiaq Ahmed
- Gastroenterology, Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, ARE
| | - Heba Abu Alkas
- Gastroenterology, Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, ARE
| | - Omar Khaddam
- Internal Medicine, Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, ARE
| | | | - Maryam Al Ahmad
- Gastroenterology, Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, ARE
| | - Khalifa Al Tiniji
- Gastroenterology, Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, ARE
| | | | - Talha Malik
- Gastroenterology, Mayo Clinic, Jacksonville, USA
| |
Collapse
|
2
|
Santiago P, Coelho-Prabhu N, Lennon R, Rui S, Rajauria P, Friton J, Raffals LE, Deepali F, Daoud N, Farraye FA, Tuck J, Malik T, Leleiko NS, Shapiro J, Shah SA, Sands BE, Ungaro RC. Baseline Clinical Factors Are Associated With Risk of Complications in Crohn's Disease: Appraisal of the American Gastroenterological Association Clinical Care Pathway. Am J Gastroenterol 2024; 119:147-154. [PMID: 37713528 DOI: 10.14309/ajg.0000000000002498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 08/18/2023] [Indexed: 09/17/2023]
Abstract
INTRODUCTION The American Gastroenterological Association (AGA) has compiled risk factors that may be predictive of disease complications in Crohn's disease (CD) and ulcerative colitis (UC). The aim of this study was to evaluate the performance of the AGA risk factors for risk stratification in UC and CD. METHODS We included participants of 2 cohorts: the Ocean State Crohn's and Colitis Area Registry cohort and the Mayo Clinic cohort. Baseline clinical risk factors were extracted according to the AGA pathway. Our primary end point was defined as follows: (i) any inflammatory bowel disease related-hospitalization, (ii) any inflammatory bowel disease-related bowel surgery, or (iii) any progression of disease. We analyzed the association of the number of AGA risk factors with our end point. Statistical multivariable modeling was performed with Cox proportional hazards model. RESULTS A total of 412 patients with CD were included. Comparing ≥3 risk factors with 0-1 risk factor, we found a significantly increased risk of complications in both the Ocean State Crohn's and Colitis Area Registry cohort (hazard ratio [HR] 2.75, 95% confidence interval 1.71-4.41) and Mayo Clinic cohort (HR 2.07, 95% confidence interval 1.11-3.84). Diagnosis at younger age (HR 2.07), perianal disease (HR 1.99), and B2/B3 behavior (HR 1.92) were significantly associated with disease complications. We did not observe a consistent association between number of risk factors nor any specific individual risk factors and risk of disease complications in the 265 patients with UC included. DISCUSSION We found a significant association between the number of AGA risk factors and the risk of disease complication in CD; this association was not significant in UC. The presence of ≥ 3 risk factors in CD leads to the highest risk of complications. The AGA care pathway is a useful tool to stratify patients who are at higher risk of disease complications in patients with CD.
Collapse
Affiliation(s)
- Priscila Santiago
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Ryan Lennon
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Shumin Rui
- The Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Palak Rajauria
- The Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jessica Friton
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Laura E Raffals
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Fnu Deepali
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Nader Daoud
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Francis A Farraye
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Jaclyn Tuck
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Talha Malik
- Division of Gastroenterology and Hepatology, Mayo Clinic, Scottsdale, Arizona, USA
| | - Neal S Leleiko
- Division of Pediatric Gastroenterology, Department of Pediatrics, Columbia University Medical Center, New York, New York, USA
| | - Jason Shapiro
- Department of Pediatric Gastroenterology, Warren Alpert Medical School of Brown University, Providence
| | - Samir A Shah
- Division of Gastroenterology, Warren Alpert Medical School of Brown University, Providence
| | - Bruce E Sands
- The Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ryan C Ungaro
- The Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| |
Collapse
|
3
|
Campbell E, McLaren O, Sheldon A, Rock B, Bracey TS, Malik T, Reddy VM. A two-centre experience of tonsil biopsies in the investigation of patients with tonsillar asymmetry. Ann R Coll Surg Engl 2024; 106:41-44. [PMID: 36688848 PMCID: PMC10757879 DOI: 10.1308/rcsann.2022.0122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2022] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION We aim to evaluate our experience of tonsil biopsies in the investigation of patients presenting with asymmetrical tonsils. METHODS A two-centre retrospective analysis of all patients who underwent histology sampling of the palatine tonsils between 1 January 2013 and 31 December 2018 was completed. Data collected included patient demographics, method of obtaining tonsil tissue, histological diagnosis and need for repeat tissue sampling. A follow-up period of 36 months was allowed to establish whether any patients re-presented with missed diagnoses. RESULTS In total, 937 patients were included for analysis: 375 (40.0%) had a biopsy, of which 191 (50.9%) were performed in clinic. The mean duration from initial appointment with the ear, nose and throat clinic to tissue sample collection was 17.6 days (range 0-327 days) for all biopsies, reducing to 0.2 days (range 0-17 days) for biopsies performed in clinic. This was significantly shorter than for tonsillectomies (mean 38.9 days, range 0-444 days; p<0.05). Of the patients who underwent tonsil biopsy, six (1.6%) had malignancy that was not unequivocally diagnosed on initial biopsy. In all six patients, prior clinical suspicion was high, and repeat tissue sampling was undertaken on receipt of negative histology results. CONCLUSIONS Tonsil biopsy is a viable alternative to tonsillectomy for histology in the assessment of tonsil asymmetry. Tonsil biopsy in the outpatient setting has reduced surgical morbidity, significantly less delay in diagnosis, less inconvenience for patients and lower healthcare costs compared with formal tonsillectomy. Although tonsil biopsies should not be used in isolation, they can be useful in the investigation of patients presenting with tonsillar asymmetry.
Collapse
Affiliation(s)
| | - O McLaren
- University Hospitals Plymouth NHS Trust, UK
| | - A Sheldon
- University Hospitals Plymouth NHS Trust, UK
| | - B Rock
- Royal Cornwall Hospital NHS Trust, UK
| | - TS Bracey
- Royal Cornwall Hospital NHS Trust, UK
- University Hospitals Plymouth NHS Trust, UK
| | - T Malik
- University Hospitals Plymouth NHS Trust, UK
| | - VM Reddy
- Royal Cornwall Hospital NHS Trust, UK
| |
Collapse
|
4
|
Elzayat H, Malik T, Al-Awadhi H, Taha M, Elghazali G, Al-Marzooq F. Deciphering salivary microbiome signature in Crohn's disease patients with different factors contributing to dysbiosis. Sci Rep 2023; 13:19198. [PMID: 37932491 PMCID: PMC10628307 DOI: 10.1038/s41598-023-46714-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/03/2023] [Indexed: 11/08/2023] Open
Abstract
Crohn's disease (CD) is a chronic inflammatory bowel disease. An imbalanced microbiome (dysbiosis) can predispose to many diseases including CD. The role of oral dysbiosis in CD is poorly understood. We aimed to explore microbiome signature and dysbiosis of the salivary microbiome in CD patients, and correlate microbiota changes to the level of inflammation. Saliva samples were collected from healthy controls (HC) and CD patients (n = 40 per group). Salivary microbiome was analyzed by sequencing the entire 16S rRNA gene. Inflammatory biomarkers (C-reactive protein and calprotectin) were measured and correlated with microbiome diversity. Five dominant species were significantly enriched in CD, namely Veillonella dispar, Megasphaera stantonii, Prevotella jejuni, Dolosigranulum pigrum and Lactobacillus backii. Oral health had a significant impact on the microbiome since various significant features were cariogenic as Streptococcus mutans or periopathogenic such as Fusobacterium periodonticum. Furthermore, disease activity, duration and frequency of relapses impacted the oral microbiota. Treatment with monoclonal antibodies led to the emergence of a unique species called Simonsiella muelleri. Combining immunomodulatory agents with monoclonal antibodies significantly increased multiple pathogenic species such as Salmonella enterica, Escherichia coli, Klebsiella pneumoniae and Pseudomonas aeruginosa. Loss of diversity in CD was shown by multiple diversity indices. There was a significant negative correlation between gut inflammatory biomarkers (particularly calprotectin) and α-diversity, suggesting more inflammation associated with diversity loss in CD. Salivary dysbiosis was evident in CD patients, with unique microbiota signatures and perturbed species that can serve as disease biomarkers or potential targets for microbiota modulation. The interplay of various factors collectively contributed to dysbiosis, although each factor probably had a unique effect on the microbiome. The emergence of pathogenic bacteria in the oral cavity of CD patients is alarming since they can disturb gut homeostasis and induce inflammation by swallowing, or hematogenous spread of microbiota, their metabolites, or generated inflammatory mediators.
Collapse
Affiliation(s)
- Hala Elzayat
- Department of Medical Microbiology and Immunology, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 15551, Al Ain, UAE
| | - Talha Malik
- Department of Medicine, Sheikh Shakhbout Medical City, Abu Dhabi, UAE
| | - Haifa Al-Awadhi
- Department of Pediatric Gastroenterology, Tawam Hospital, Al Ain, UAE
| | - Mazen Taha
- Department of Internal Medicine, Tawam Hospital, Al Ain, UAE
| | - Gehad Elghazali
- Department of Medical Microbiology and Immunology, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 15551, Al Ain, UAE
- Department of Immunology, Sheikh Khalifa Medical City, Union71-Purehealth, Abu Dhabi, UAE
| | - Farah Al-Marzooq
- Department of Medical Microbiology and Immunology, College of Medicine and Health Sciences, United Arab Emirates University, P.O. Box 15551, Al Ain, UAE.
- Zayed Center for Health Sciences, United Arab Emirates University, Al Ain, UAE.
| |
Collapse
|
5
|
Mortensen MR, Alouda M, Bond Z, Burcharth J, Finne KF, Jensen TK, Lolle I, Malik T, Ngo-Stuyt L, Nielsen LBJ, Olausson M, Skovsen AP, Tolver MA, Smith HG. One-year outcomes following operative or non-operative management of adhesional small bowel obstruction. BJS Open 2023; 7:zrad103. [PMID: 37837353 PMCID: PMC10576245 DOI: 10.1093/bjsopen/zrad103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 08/01/2023] [Accepted: 08/23/2023] [Indexed: 10/16/2023] Open
Abstract
BACKGROUND A trial of initial non-operative management is recommended in stable patients with adhesional small bowel obstruction. However, recent retrospective studies have suggested that early operative management may be of benefit in reducing subsequent recurrences. This study aimed to compare recurrence rates and survival in patients with adhesional small bowel obstruction treated operatively or non-operatively. METHODS This was a prospective cohort study conducted at six acute hospitals in Denmark, including consecutive patients admitted with adhesional small bowel obstruction over a 4-month interval. Patients were stratified into two groups according to their treatment (operative versus non-operative) and followed up for 1 year after their index admission. Primary outcomes were recurrence of small bowel obstruction and overall survival within 1 year of index admission. RESULTS A total of 201 patients were included, 118 (58.7 per cent) of whom were treated operatively during their index admission. Patients undergoing operative treatment had significantly better 1-year recurrence-free survival compared with patients managed non-operatively (operative 92.5 per cent versus non-operative 66.6 per cent, P <0.001). However, when the length of index admission was taken into account, patients treated non-operatively spent significantly less time admitted to hospital in the first year (median 3 days non-operative versus 6 days operative, P <0.001). On multivariable analysis, operative treatment was associated with decreased risks of recurrence (HR 0.22 (95 per cent c.i. 0.10-0.48), P <0.001) but an increased all-cause mortality rate (HR 2.48 (95 per cent c.i. 1.13-5.46), P = 0.024). CONCLUSION Operative treatment of adhesional small bowel obstruction is associated with reduced risks of recurrence but increased risk of death in the first year after admission. REGISTRATION NUMBER NCT04750811 (http://www.clinicaltrials.gov).prior (registration date: 11 February 2021).
Collapse
Affiliation(s)
- Marie R Mortensen
- Digestive Disease Center, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mohammad Alouda
- Department of Gastrointestinal and Hepatic Diseases, Surgical Division, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Zara Bond
- Department of Surgery, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Burcharth
- Department of Gastrointestinal and Hepatic Diseases, Surgical Division, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Katrine F Finne
- Department of Surgery, Nordsjællands Hospital, University of Copenhagen, Hillerød, Denmark
| | - Thomas K Jensen
- Department of Gastrointestinal and Hepatic Diseases, Surgical Division, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Ida Lolle
- Department of Surgery, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Talha Malik
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark
| | - Loan Ngo-Stuyt
- Department of Surgery, Sjælland University Hospital, Køge, Denmark
| | - Liv B J Nielsen
- Digestive Disease Center, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Maria Olausson
- Department of Surgery, Sjælland University Hospital, Køge, Denmark
| | - Anders P Skovsen
- Department of Surgery, Nordsjællands Hospital, University of Copenhagen, Hillerød, Denmark
| | - Mette A Tolver
- Department of Surgery, Sjælland University Hospital, Køge, Denmark
| | - Henry G Smith
- Digestive Disease Center, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark
| |
Collapse
|
6
|
Nielsen LBJ, Ærenlund MP, Alouda M, Azzam M, Bjerke T, Burcharth J, Dibbern CB, Jensen TK, Jordhøj JQ, Lolle I, Malik T, Ngo-Stuyt L, Nielsen EØ, Olausson M, Skovsen AP, Tolver MA, Smith HG. Real-world accuracy of computed tomography in patients admitted with small bowel obstruction: a multicentre prospective cohort study. Langenbecks Arch Surg 2023; 408:341. [PMID: 37642708 PMCID: PMC10465641 DOI: 10.1007/s00423-023-03084-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE Small bowel obstruction (SBO) is a common surgical emergency. Previous studies have shown the value computed tomography (CT) scanning in both confirming this diagnosis and identifying indications for urgent surgical intervention, such as strangulated bowel or closed loop obstructions. However, most of the literature is based on retrospective expert review of previous imaging and little data regarding the real-time accuracy of CT reporting is available. Here, we investigated the real-world accuracy of CT reporting in patients admitted with SBO. METHODS This was a multicentre prospective study including consecutive patients admitted with SBO. The primary outcomes were the sensitivity and specificity of CT scanning for bowel obstruction with ischaemia and closed loop obstruction. Data were retrieved from the original CT reports written by on-call radiologists and compared with operative findings. RESULTS One hundred seventy-six patients were included, all of whom underwent CT scanning with intravenous contrast followed by operative management of SBO. Bowel obstruction with ischaemia was noted in 20 patients, with a sensitivity and specificity of CT scanning of 40.0% and 85.5%, respectively. Closed loop obstructions were noted in 26 patients, with a sensitivity and specificity of CT scanning of 23.1% and 98.0%, respectively. CONCLUSIONS The real-world accuracy of CT scanning appears to be lower than previously reported in the literature. Strategies to address this could include the development of standardised reporting schemas and to increase the surgeon's own familiarity with relevant CT features in patients admitted with SBO.
Collapse
Affiliation(s)
- L B J Nielsen
- Abdominalcenter K, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark
| | - M P Ærenlund
- Department of Gastrointestinal and Hepatic Diseases, Surgical Division, Copenhagen University Hospital - Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - M Alouda
- Department of Gastrointestinal and Hepatic Diseases, Surgical Division, Copenhagen University Hospital - Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - M Azzam
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark
| | - T Bjerke
- Abdominalcenter K, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark
| | - J Burcharth
- Department of Gastrointestinal and Hepatic Diseases, Surgical Division, Copenhagen University Hospital - Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - C B Dibbern
- Department of Surgery, Nordsjællands Hospital, University of Copenhagen, Copenhagen, Denmark
| | - T K Jensen
- Department of Gastrointestinal and Hepatic Diseases, Surgical Division, Copenhagen University Hospital - Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - J Q Jordhøj
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark
| | - I Lolle
- Department of Surgery, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - T Malik
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark
| | - L Ngo-Stuyt
- Department of Surgery, Zealand University Hospital, Koge, Denmark
| | - E Ø Nielsen
- Department of Surgery, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - M Olausson
- Department of Surgery, Zealand University Hospital, Koge, Denmark
| | - A P Skovsen
- Department of Surgery, Nordsjællands Hospital, University of Copenhagen, Copenhagen, Denmark
| | - M A Tolver
- Department of Surgery, Zealand University Hospital, Koge, Denmark
| | - H G Smith
- Abdominalcenter K, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark.
- Department of Surgery, Slagelse Hospital, Slagelse, Denmark.
| |
Collapse
|
7
|
Mahmoud AA, Abdelhay A, Khamis A, Mostafa M, Shehadah A, Mohamed MS, Eltaher B, Malik T. Hemophagocytic lymphohistiocytosis in inflammatory bowel disease: a nationwide analysis. Ann Hematol 2023:10.1007/s00277-023-05223-4. [PMID: 37093242 DOI: 10.1007/s00277-023-05223-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Accepted: 04/10/2023] [Indexed: 04/25/2023]
Abstract
Hemophagocytic lymphohistiocytosis (HLH) is a rare but life-threatening immune dysregulation disease. Patients with inflammatory bowel disease (IBD) can become profoundly immunocompromised due to immunosuppressive therapy, hence increasing the risk of viral infections that can trigger HLH. However, data on the association between IBD and HLH remains limited. We used data from the National Inpatient Sample (2012-2019) utilizing International Classification of Diseases (ICD)-9 or ICD-10 codes to identify individuals with IBD, either Crohn's disease (CD) or ulcerative colitis (UC), and HLH. The primary outcome was to compare the prevalence of HLH among patients with IBD with those without IBD. Secondary outcomes included in-hospital mortality, mean hospital length of stay, and description of HLH-associated triggers in IBD patients. A total of 513,322 hospitalizations included a diagnosis of IBD, 188,297 had UC and 325,025 had CD. Compared to the general population, patients with IBD were older (median age of 52 vs. 49 years, p < 0.05), more likely to be male, and of Asian/Pacific Islander descent, and had a higher median household income. There was also a higher prevalence of liver disease, autoimmune diseases, tobacco abuse, and hypothyroidism (all had p-value of < 0.001) in IBD patients. There were 94 hospitalizations identified with a diagnosis of HLH in IBD patients. Compared to patients without IBD, patients with IBD had increased odds of developing HLH (0.02% vs 0.01%, p-value < 0.001). After adjusting for various demographic characteristics, co-morbidities, and HLH-related conditions, IBD was an independent predictor for developing HLH (adjusted OR, 2.3; 95% CI, 1.847-2.866, p-value of < 0.001). There was no statistical difference between CD and UC in the odds of developing HLH. Compared to IBD patients without HLH, patients with IBD and HLH had a lower mean age at diagnosis (38 vs 52, p-value of < 0.001), higher in-hospital mortality (14.9% vs 1.5%, p-value of < 0.001), and longer mean hospital length of stay (days) (17 vs 5.4, p-value of < 0.001). Prevalence of different HLH-associated illnesses was identified in HLH patient's discharge data. Lymphoma was the most common associated malignancy (18.1%) and cytomegalovirus infection was the most common associated infection (16.0%). Our population-based study suggests that IBD is independently associated with developing HLH. Early recognition of IBD patients presenting with features suggestive of HLH is warranted to aide early diagnosis and aggressive treatment.
Collapse
Affiliation(s)
- Amir A Mahmoud
- Department of Internal Medicine, Rochester General Hospital, 1425 Portland Ave, Rochester, NY, 14621, USA.
| | - Ali Abdelhay
- Department of Internal Medicine, Rochester General Hospital, 1425 Portland Ave, Rochester, NY, 14621, USA
| | - Alia Khamis
- Office of Scientific Affairs and Research, King Hussein Cancer Center, Amman, Jordan
| | - Mariam Mostafa
- Department of Internal Medicine, Rochester General Hospital, 1425 Portland Ave, Rochester, NY, 14621, USA
| | - Ahmed Shehadah
- Department of Internal Medicine, Rochester General Hospital, 1425 Portland Ave, Rochester, NY, 14621, USA
| | - Mohamed Salah Mohamed
- Department of Internal Medicine, Rochester General Hospital, 1425 Portland Ave, Rochester, NY, 14621, USA
| | - Basant Eltaher
- Department of Hematology and Bone Marrow Transplant, Ain Shams University Faculty of Medicine, Cairo, Egypt
| | - Talha Malik
- Department of Gastroenterology and Hepatology, Mayo Clinic, Phoenix, AZ, USA
| |
Collapse
|
8
|
Lynn J, Malik T, Keller C, Lang A, Rana A. Allograft Discard Risk Index for Pediatric Heart Transplantation. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
|
9
|
Guerrero Vinsard D, Bruining DH, East JE, Ebner D, Kane SV, Kisiel JB, Leighton JA, Lennon RJ, Loftus EV, Malik T, Picco M, Raffals L, Ramos GP, Santiago P, Coelho-Prabhu N. Interobserver agreement of the modified Paris classification and histology prediction of colorectal lesions in patients with inflammatory bowel disease. Gastrointest Endosc 2023; 97:790-798.e2. [PMID: 36402202 DOI: 10.1016/j.gie.2022.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 10/10/2022] [Accepted: 11/07/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIMS SCENIC (International Consensus Statement on Surveillance and Management of Dysplasia in IBD) guidelines recommend that visible dysplasia in patients with longstanding inflammatory bowel disease (IBD) should be endoscopically characterized using a modified Paris classification. This study aimed to determine the interobserver agreement (IOA) of the modified Paris classification and endoscopists' accuracy for pathology prediction of IBD visible lesions. METHODS One hundred deidentified endoscopic still images and 30 videos of IBD visible colorectal lesions were graded by 10 senior and 4 trainee endoscopists from 5 tertiary care centers. Endoscopists were asked to assign 4 classifications for each image: the standard Paris classification, modified Paris classification, pathology prediction, and lesion border. Agreement was measured using Light's kappa coefficient. Consensus of ratings was assessed according to strict majority. RESULTS The overall Light's kappa for all study endpoints was between .32 and .49. In a subgroup analysis between junior and senior endoscopists, Light's kappa continued to be less than .6 with a slightly higher agreement among juniors. Lesions with the lowest agreement and no consensus were mostly classified as Is, IIa, and mixed Paris classification and sessile and superficial elevated for modified Paris classification. Endoscopist accuracy for prediction of dysplastic, nondysplastic, and serrated pathology was 77%, 56%, and 30%, respectively. There was a strong association (P < .001) between the given morphology classification and the predicted pathology with Ip lesions carrying a much lower expectation of dysplasia than Is/IIc/III and mixed lesions. The agreement for border prediction was .5 for junior and .3 for senior endoscopists. CONCLUSIONS This study demonstrates very low IOA for Paris and modified Paris classifications and low accuracy and IOA for lesion histopathology prediction. Revisions of these classifications are required to create a clinically useful risk stratification tool and enable eventual application of augmented intelligence tools.
Collapse
Affiliation(s)
| | - David H Bruining
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - James E East
- Division of Gastroenterology and Hepatology, Mayo Clinic Healthcare, London, UK
| | - Derek Ebner
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Sunanda V Kane
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - John B Kisiel
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Ryan J Lennon
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, USA
| | - Edward V Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Talha Malik
- Division of Gastroenterology and Hepatology, Mayo Clinic, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Michael Picco
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Laura Raffals
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Guilherme P Ramos
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | - Priscila Santiago
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, USA
| | | |
Collapse
|
10
|
Malik T, Miggins J, Reul R, Rana A. Are We Discarding too Many DCD Lung Allografts for the Wrong Reasons? J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.1563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023] Open
|
11
|
Walkden A, Cantin P, Malik T. Ultrasound-guided wire localisation to aid excision of cervical nodes. Ann R Coll Surg Engl 2023; 105:384. [PMID: 35446713 PMCID: PMC10066651 DOI: 10.1308/rcsann.2021.0351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/19/2021] [Indexed: 11/22/2022] Open
Affiliation(s)
- A Walkden
- Royal Cornwall Hospitals NHS Trust, UK
| | - P Cantin
- University Hospitals Plymouth NHS Trust, UK
| | - T Malik
- University Hospitals Plymouth NHS Trust, UK
| |
Collapse
|
12
|
Malik T. Laparoscopy in aiding diagnosis of Miliary tuberculosis presented with atypical abdominal pain. AKUT 2022; 5:3-6. [DOI: 10.7146/akut.v5i1.125929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
Tuberculosis is a major cause of morbidity and mortality in developing countries.Abdominal tuberculosis remains diagnostically challenging due to its nonspecific nature mimicking many other common conditions, which may delay appropriate therapy, but in turn may result in performing laparoscopy, which can be a useful diagnostic tool in diagnosing tuberculosis and initiating treatment at a early stage.
Collapse
|
13
|
Saade MC, Wehbe H, Mourad FH, Hosni M, Francis FF, Makki M, Binion DG, Tamim H, Farraye FA, Malik T, Hashash JG. Significance of granulomas in the outcomes of Crohn’s disease patients. Ann Gastroenterol 2022; 35:503-508. [PMID: 36061154 PMCID: PMC9399581 DOI: 10.20524/aog.2022.0730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 05/01/2022] [Indexed: 11/11/2022] Open
Abstract
Background Methods Results Conclusions
Collapse
Affiliation(s)
- Marie Christelle Saade
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon (Marie Christelle Saade, Hisham Wehbe, Fadi H. Mourad, Mohammad Hosni, Fadi F. Francis, Jana G. Hashash)
| | - Hisham Wehbe
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon (Marie Christelle Saade, Hisham Wehbe, Fadi H. Mourad, Mohammad Hosni, Fadi F. Francis, Jana G. Hashash)
- Department of Internal Medicine, Indiana University School of Medicine, Indiana, IN (Hisham Wehbe)
| | - Fadi H. Mourad
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon (Marie Christelle Saade, Hisham Wehbe, Fadi H. Mourad, Mohammad Hosni, Fadi F. Francis, Jana G. Hashash)
| | - Mohammad Hosni
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon (Marie Christelle Saade, Hisham Wehbe, Fadi H. Mourad, Mohammad Hosni, Fadi F. Francis, Jana G. Hashash)
| | - Fadi F. Francis
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon (Marie Christelle Saade, Hisham Wehbe, Fadi H. Mourad, Mohammad Hosni, Fadi F. Francis, Jana G. Hashash)
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA (Fadi F. Francis, David G. Binion)
| | - Maha Makki
- Department of Internal Medicine, Clinical Research Institute, American University of Beirut, Beirut, Lebanon (Maha Makki, Hani Tamim)
| | - David G. Binion
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, PA, USA (Fadi F. Francis, David G. Binion)
| | - Hani Tamim
- Department of Internal Medicine, Clinical Research Institute, American University of Beirut, Beirut, Lebanon (Maha Makki, Hani Tamim)
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia (Hani Tamim)
| | - Francis A. Farraye
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA (Francis A. Farraye, Jana G. Hashash)
| | - Talha Malik
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Abu Dhabi, United Arab Emirates (Talha Malik)
| | - Jana G. Hashash
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon (Marie Christelle Saade, Hisham Wehbe, Fadi H. Mourad, Mohammad Hosni, Fadi F. Francis, Jana G. Hashash)
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Mayo Clinic, Jacksonville, FL, USA (Francis A. Farraye, Jana G. Hashash)
- Correspondence to: Jana G. Hashash, MD, MSc, Senior Associate Consultant, Inflammatory Bowel Disease Center, Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, FL, USA, e-mail:
| |
Collapse
|
14
|
Aldhaleei W, Almessabi A, Wallace M, Malik T. P034 State of Health Maintenance Among IBD Patients at a Tertiary Care Center in Abu Dhabi, United Arab Emirates. Am J Gastroenterol 2021; 116:S8-S9. [DOI: 10.14309/01.ajg.0000798736.44273.fa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
BACKGROUND:
Crohn’s disease (CD) and ulcerative colitis (UC) are inflammatory bowel diseases (IBD) affecting 6.8 million persons globally. Treatment of IBD focuses largely on immune suppression or modulation using corticosteroids, aminosalicylates, thiopurines, or biologic agents. These agents are effective but most of them pose a risk of infections, cancers, and osteoporosis. Many of these complications can be prevented by implementing vaccination, cancer screening, and bone health programs. Despite the progress in IBD care, recent data suggest that many IBD patients do not get preventative services. Previous studies have examined rates of vaccinations and other health maintenance metrics in North America and Europe where IBD patients are mainly of European and African descent. In comparison, Middle Eastern and Asian descent persons comprise the majority of the IBD population in Abu Dhabi, the capital city of United Arab Emirates (UAE), a major country in the Gulf region of the Middle East. Little is known to date about the state of IBD preventative care in this region. We sought to assess the proportion of patients with IBD that underwent recommended vaccinations, cancer screening (surveillance colonoscopy, PAP smear, annual skin examination), and bone health evaluation at Sheikh Shakhbout Medical City (SSMC), the largest tertiary care hospital in Abu Dhabi.
METHODS:
This study was a retrospective case series of adult IBD patients (>18 years) seen in the outpatient setting at SSMC from 2019 to 2020. Patients were identified based on ICD-10 codes for IBD [K50.90, K50.00, K51.90, and K50.80] as well as administrative/pharmacy records of the IBD agents (e.g. infliximab). Proportions were assessed using simple summary statistics and one sample proportion 95% confidence intervals were calculated.
RESULTS:
A total of 55 IBD patients were identified in our study with the majority being males (76.3%). The mean age was 31.6 years. Sixty-nine percent had Crohn’s. Most of the patients were on infliximab (58.1%), followed by vedolizumab, ustekinumab, and adalimumab. The proportion of patients who received vaccinations was as follows; HAV (67%, 95% CI 28-100%), HBV (50%, 95% CI 28-72%), pneumococcal 23 (20%, 95% CI 9.4-31%), pneumococcal 13 (18.2%, 95% CI 8-28%) and influenza vaccine (16.4%, 95% CI 7-26%). Moreover, the study showed that the proportion of IBD patients who underwent recommended colonoscopy surveillance was 91% (95% CI 79-100%) and the proportion of women IBD patients who had recommended PAP smear was 30%, (95% CI 2-58%). Regarding bone health, the proportion who underwent DXA bone scans was 36%, (95% CI 24-49%) However, the compliance rate of the Tdap, HPV and Zoster vaccinations, and annual skin examination were poor warranting further quality improvement studies.
CONCLUSION:
This study revealed that the state of health maintenance among IBD patients seen at our facility before 2021 was largely dismal. Efforts are being taken to improve the proportion of patients who receive recommended vaccinations including annual influenza, pneumococcal 13 and 23, HPV, Zoster, and COVID-19 vaccines. Furthermore, there is a focus on bone health and skin cancer examinations with plans to calculate, report, and publish health maintenance data annually.
Collapse
Affiliation(s)
- Wafa Aldhaleei
- Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | | | - Michael Wallace
- Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Talha Malik
- Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| |
Collapse
|
15
|
Pisipati S, Lizaola-Mayo B, Pai R, Malik T, Horsley-Silva J. S2458 Can SARS-CoV-2 Enterocolitis Trigger New Onset Inflammatory Bowel Disease ? Am J Gastroenterol 2021; 116:S1038-S1039. [DOI: 10.14309/01.ajg.0000783364.92130.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
|
16
|
Deb A, Sukarom I, Park J, Yang G, Johnson K, Malik T. PIN14 Health and Economic IMPACT of 15-Valent Pneumococcal Conjugate Vaccine (V114) Serotypes in Adults 65 YEARS and Older in Korea. Value Health Reg Issues 2020. [DOI: 10.1016/j.vhri.2020.07.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
17
|
Deb A, Sukarom I, Mears G, Johnson K, Malik T. PIN12 Health and Economic IMPACT of 15-Valent Pneumococcal Conjugate Vaccine (V114) Serotypes in Adults 70 YEARS and Older in Australia. Value Health Reg Issues 2020. [DOI: 10.1016/j.vhri.2020.07.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
18
|
Malik T, Malas O, Thompson A. Ultrasound guided L5-S1 placement of labor epidural does not improve dermatomal block in parturients. Int J Obstet Anesth 2018; 38:52-58. [PMID: 30551813 DOI: 10.1016/j.ijoa.2018.11.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2018] [Revised: 10/01/2018] [Accepted: 11/12/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Based on their experience or training, anesthesiologists typically use the iliac crest as a landmark to choose the L3-4 or L2-3 interspace for labor epidural catheter placement. There is no evidence-based recommendation to guide the exact placement. We hypothesized that lower placement of the catheter would lead to a higher incidence of S2 dermatomal block and improved analgesia in late labor and at delivery. METHODS One-hundred parturients requesting epidural analgesia were randomly assigned to receive ultrasound-guided L5-S1 epidural catheter placement (experimental group) or non-ultrasound-guided higher lumbar interspace placement (control group). The primary outcome was the incidence of S2 block 30 minutes after administering 10 mL 0.125% bupivacaine. Secondary outcomes were average pain throughout labor and maximum pain during labor or during delivery. RESULTS Forty-nine subjects were enrolled in control group and 47 in the experimental group. The primary endpoint did not significantly differ between groups (control group 81% vs experimental group 91%, P=0.24). The secondary endpoints were not significantly different: pain relief after 30 minutes (mean pain score 1.4 in the control group vs 1.9 in the experimental group, P=0.2) and pain at delivery (mean score 4 in the control group vs 3.9 in the experimental group, P=0.6). CONCLUSION Placement of an epidural catheter at the L5-S1 interspace using ultrasound did not improve sacral sensory block coverage when compared with an epidural catheter placed at a higher lumbar interspace, without using ultrasound guidance.
Collapse
Affiliation(s)
- T Malik
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, United States of America.
| | - O Malas
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, United States of America
| | - A Thompson
- Department of Anesthesia and Critical Care, University of Chicago, Chicago, United States of America
| |
Collapse
|
19
|
Malik T, Hooson T. Urgent referrals for suspected head and neck cancer – Is the two-week rule being implemented effectively? Int J Surg 2018. [DOI: 10.1016/j.ijsu.2018.05.263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
20
|
Allamneni C, Venkata K, Xie F, DeLoach L, Malik T. P138 COMPARATIVE EFFECTIVENESS OF VEDOLIZUMAB VS. INFLIXIMAB INDUCTION THERAPY IN ULCERATIVE COLITIS: EXPERIENCE OF A REAL-WORLD COHORT AT A TERTIARY IBD CENTER. Inflamm Bowel Dis 2018; 24:S49-S50. [DOI: 10.1093/ibd/izy037.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
|
21
|
Davis A, Wales P, Razik F, Malik T, Stephens D, Schuh S. 162: The Big Score & Prediction of Mortality in Pediatric Trauma. Paediatr Child Health 2015. [DOI: 10.1093/pch/20.5.e92b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
22
|
Juneau J, Kodali S, Malik T, Tsai W, Booth D, McGuire B. Functional Status of Patients With Cirrhosis Does Not Differ Among Etiologies of Cirrhosis Based on the Six-Minute Walk Test (6MWT). Am J Gastroenterol 2014; 109:S150. [DOI: 10.14309/00000434-201410002-00507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
|
23
|
Smith I, Manne A, Juneau J, Kodali S, Malik T, Weber F. SMA Syndrome with Suspected Gastric Inlet Patch. Am J Gastroenterol 2013; 108:S287-S288. [DOI: 10.14309/00000434-201310001-00964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
|
24
|
Sommer C, Malik T, Pierce MJ, Mannon P. Active Disease before Crohnʼs Surgery Predicts Need for Future Operations. Am J Gastroenterol 2013; 108:S551. [DOI: 10.14309/00000434-201310001-01823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
|
25
|
Edwards A, Nelson G, Malik T, Dasher C. Angioedema with Airway Compromise during Upper Endoscopy. Am J Gastroenterol 2013; 108:S453. [DOI: 10.14309/00000434-201310001-01518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
|
26
|
Smith I, Juneau J, Malik T, Torrazza E, Kodali S, Weber F. Predictors of Outcome of Rectovaginal Fistula Surgery in Women with Crohnʼs Disease. Am J Gastroenterol 2013; 108:S522. [DOI: 10.14309/00000434-201310001-01730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
|
27
|
Malik T, Smith I, Juneau J, Khan A, Manne A, McGwin G, Weber F. Obesity and Outcome of Rectocutaneous Fistula Surgery in Patients with Crohnʼs Disease. Am J Gastroenterol 2013; 108:S555. [DOI: 10.14309/00000434-201310001-01837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
|
28
|
Sommer C, Malik T, Pierce MJ, Mannon P. Younger Age and Post-op Complications Increase Likelihood of Repeat Crohnʼs Surgery Despite Biologic Use. Am J Gastroenterol 2013; 108:S557. [DOI: 10.14309/00000434-201310001-01845] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
|
29
|
Kakati D, Bosshardt C, Beyer R, Malik T, Weber F. Rates of Hospitalization among African-American versus Caucasian-American Patients with Crohnʼs Disease Seen at a Tertiary Care Center. Am J Gastroenterol 2013; 108:S521. [DOI: 10.14309/00000434-201310001-01728] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
|
30
|
Pandey D, Malik T, Banik R. Validated HPTLC Method for Quantification of Variability in Content of Oleanolic Acid in Different Variety of Lantana camara. ACTA ACUST UNITED AC 2013. [DOI: 10.5567/pharmacologia.2013.126.131] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|
31
|
Malik T, Singh A, Khan A, Manne A, Mannon P. Health Care Disparity and IBD Outcomes: Does Insurance Status Affect Measures of Disease Activity in Crohn Disease? Am J Gastroenterol 2012; 107:S692-S693. [DOI: 10.14309/00000434-201210001-01708] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
|
32
|
Buell L, Malik T, Weber F. Colorectal Foreign Body: A “Bottleneck” in the Sigmoid. Am J Gastroenterol 2012; 107:S555. [DOI: 10.14309/00000434-201210001-01395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
|
33
|
Malik T, Haleem D. 3.352 EFFECTS OF GREEN TEA EXTRACT (GTE) ON HALOPERIDOL (HAL) INDUCED NEUROLEPTIC ANXIETY SYNDROME (NAS) AND PARKINSONISM IN RATS. Parkinsonism Relat Disord 2012. [DOI: 10.1016/s1353-8020(11)70985-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
34
|
Abstract
An enormous amount of pathoetiologic information continues to accrue from animal models of inflammatory bowel disease and study of the gut microbiome that is providing expanded insight into the causes and mechanisms of inflammatory bowel diseases. This knowledge is being translated into new therapeutics that are being tested in Crohn's and ulcerative colitis patients with an aim to enhance treatment responses by moving away from immunosuppression and toward immunomodulation. In the last decade, the frontier of emerging IBD therapy has been dominated by biological agents that specifically target pro-inflammatory cytokines most notably tumor necrosis factor-alpha. However, it is clear that the gaps in therapy (primary and secondary non-response and the potential for drug side effects and intolerances) continue. To fill these gaps, various approaches are being employed to develop novel strategies, from inhibiting additional pro-inflammatory cytokines to focusing on blocking inflammatory cell trafficking, decreasing inflammatory cell mass, enhancing regulatory cell function and reinforcing epithelial barrier function. To these ends, aggressive and innovative research is being pursued to develop more robust treatment strategies and identify key molecular targets.
Collapse
Affiliation(s)
- Talha Malik
- Division of Gastroenterology/Hepatology, University of Alabama at Birmingham, Birmingham, Alabama 35924, USA
| | | |
Collapse
|
35
|
Vernon K, Malik T, Botto M, Pickering M. A new model of atypical haemolytic uraemic syndrome. Mol Immunol 2011. [DOI: 10.1016/j.molimm.2011.06.258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
36
|
Malik T, Inusah S, Gutierrez A. Clinical Presentation, Treatment and Outcome of Ulcerative Colitis in African American vs. Caucasian American Patients. Am J Gastroenterol 2010; 105:S478. [DOI: 10.14309/00000434-201010001-01299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
|
37
|
Malik T, Haleem D. P1.047 Effects of green tea on haloperidol-induced anxiety, tardive dyskinesia and central serotonin dopamine metabolism: a model study. Parkinsonism Relat Disord 2009. [DOI: 10.1016/s1353-8020(09)70169-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
38
|
Malik T, Haleem D, Hasan S, Pervez S, Fatima T. P3.020 Protective effects of Nigella sativa on the neuronal alterations of the striatum induced by haloperidol. Parkinsonism Relat Disord 2009. [DOI: 10.1016/s1353-8020(09)70584-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
39
|
Malik T, McGuire B, Gutierrez A. Autoimmune Hepatitis-Primary Sclerosing Cholangitis Overlap Syndrome Complicated by Crohnʼs Disease. Am J Gastroenterol 2009; 104:S357. [DOI: 10.14309/00000434-200910003-00970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
|
40
|
Malik T, Drelichman E, Oster R, Gutierrez A. Predictors of Fistula Formation and Successful Closure in Crohnʼs vs. Idiopathic Perianal Fistulas. Am J Gastroenterol 2009; 104:S443. [DOI: 10.14309/00000434-200910003-01197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
|
41
|
Malik T, Peter S, Jhala N, Gutierrez A. Crohnʼs Disease Complicated by Collagenous Colitis. Am J Gastroenterol 2009; 104:S366. [DOI: 10.14309/00000434-200910003-00996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
|
42
|
Malik T, Hotte C, Oster R, Gutierrez A. Role of BMI in Predicting Outcome of Surgical Intervention in Crohnʼs Disease. Am J Gastroenterol 2009; 104:S483-S484. [DOI: 10.14309/00000434-200910003-01296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
|
43
|
Chandra AK, Bhattacharjee A, Malik T, Ghosh S. Etiological factors for the persistence of endemic goiter in selected areas of Siddharthnagar district in Eastern Uttar Pradesh, India. J Pediatr Endocrinol Metab 2009; 22:317-25. [PMID: 19554805 DOI: 10.1515/jpem.2009.22.4.317] [Citation(s) in RCA: 5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM To assess the prevalence of goiter, state of iodine nutrition of the population, consumption pattern of common goitrogenic food, and distribution of iodine through edible salt in selected CD Blocks of Siddharthnagar district in Eastern Uttar Pradesh. METHODS Goiter survey among 1,862 school children, aged 6-12 years, of both sexes, and analysis of iodine (I) and thiocyanate (SCN) in 240 urine samples, and iodine content in 210 edible salt samples collected from the selected study areas. RESULTS The prevalence of goiter was 26.3% (grade 1: 23.2%; grade 2: 3.1%). Median urinary iodine level was 6.0 microg/dl, and 42% had concentration < 5 microg/dl. Mean (SD) urinary SCN was 0.75 (0.4) mg/dl. Only17.1% of salt samples had iodine level > 15 ppm; 82.9% had < 15 ppm. CONCLUSION Consumption of inadequately iodized salt and cyanogenic plant foods containing goitrogenic/anti-thyroidal substances by the people of the studied region are possible reasons for the persistence of goiter during the post salt iodination phase.
Collapse
Affiliation(s)
- A K Chandra
- Endocrinology and Reproductive Physiology Laboratory, Department of Physiology, University College of Science and Technology, University of Calcutta, West Bengal, India.
| | | | | | | |
Collapse
|
44
|
Chandra AK, Bhattacharjee A, Malik T, Ghosh S. Goiter prevalence and iodine nutritional status of school children in a sub-Himalayan Tarai region of eastern Uttar Pradesh. Indian Pediatr 2008; 45:469-474. [PMID: 18599931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
OBJECTIVES The present work was undertaken to evaluate the prevalence of goiter, state of iodine nutrition of the population, distribution of iodine through edible salt, bioavailability of iodine, consumption of common goitrogenic food that generally interfere with iodine nutrition in Naugarh sub-division of Siddharthnagar district in Uttar Pradesh, India. SETTING Five areas were selected from 5 Community Development (CD) Blocks taking one from each by purposive sampling method. In each area, Primary and Junior high schools were selected by simple random sampling to get representative target population. METHODS Clinical goiter survey was conducted in 1663 school-aged children from both sexes (6-12 yrs), along with the biochemical analysis of iodine (I) and thiocyanate (SCN) in 200 urine samples, iodine content in 175 edible salt samples and 20 water samples collected from the selected study areas. RESULTS The studied region is severely affected by Iodine deficiency disorders (IDD) as goiter prevalence is 30.2% (grade 1: 27.1% grade 2:3.1%). Median urinary iodine level was 96 microg/L indicating biochemical iodine deficiency. The mean urinary thiocyanate was 0.810+/-0.490 mg/dL and mean of I/SCN ratios in all the studied areas were above the critical level of 7. However, 22% of the individual had I/SCN ratio <or=7 indicating their susceptibility for the development of goiter. Only 12.6% of the salt samples had adequate iodine i.e., >or=15 ppm while iodine content in drinking water varied between 7.5-10.7 microg/L. CONCLUSION Iodine deficiency is the primary cause, however the consumption of cyanogenic food may have important role for the persistence of IDD in the studied region during post salt iodization phase.
Collapse
Affiliation(s)
- A K Chandra
- Endocrinology and Reproductive Physiology Laboratory, Department of Physiology, University College of Science and Technology, University of Calcutta, Kolkata, West Bengal, India.
| | | | | | | |
Collapse
|
45
|
Affiliation(s)
- O Judd
- Department of Otolaryngology, Derriford Hospital, Plymouth, United Kingdom.
| | | | | |
Collapse
|
46
|
Affiliation(s)
- O Judd
- Department of Otolaryngology, Derriford Hospital, Plymouth, United Kingdom.
| | | | | |
Collapse
|
47
|
Abstract
Nodular fasciitis is an unusual benign reactive process affecting superficial and deep fascia. Its rapid growth, rich cellularity, high mitotic activity and poorly circumscribed nature result in it being easily misdiagnosed as a sarcomatous lesion. Three cases of nodular fasciitis presenting as neck lumps are reported. They were successfully treated with local excision, with no signs of recurrence following two years of follow up. This paper describes the clinical presentation and microscopic features of this rare benign lesion and it emphasizes the need for accurate histopathology and clinical suspicion, if inappropriate aggressive management is to be avoided.
Collapse
Affiliation(s)
- P Silva
- Department of Head and Neck Surgery, Christie Hospital, Manchester M20 4BX, UK.
| | | | | | | | | |
Collapse
|
48
|
Mousa A, Malik T, Beauford R, Faries P, Kent K, Fogler R. A canine model to study the significance and hemodynamics of polyurethane foam in type II endoleak. J Surg Res 2006. [DOI: 10.1016/j.jss.2005.11.312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
49
|
Malik T. Select bibliography on HIV/AIDS : 1991-2002 Talha Malik. Social Change 2002; 32:212-234. [DOI: 10.1177/004908570203200413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Affiliation(s)
- Talha Malik
- Librarian, Institute of Social Studies Trust, Upper Ground Floor, Zone VI, India
Habitat Centre, Lodhi Road, New Deihi-110 003
| |
Collapse
|
50
|
Abstract
Endolymphatic sac tumours (ELST) are rare tumours of the petrous temporal bone. They may arise sporadically or be associated with von Hippel-Lindau disease. Their differential diagnosis is discussed. We present the clinical and histopathological features of two new patients with ELST and outline the management of their condition. In addition, we review a third case previously reported as a choroid plexus papilloma in which the histology has been re-assessed and the diagnosis changed to ELST. The controversy regarding the cellular origins of adenomatous tumours of the temporal bone is highlighted.
Collapse
Affiliation(s)
- D A Luff
- Department of Otolaryngology, Head and Neck Surgery, Manchester Royal Infirmary, UK.
| | | | | | | | | |
Collapse
|