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Jabeen N, Ullah W, Khalid J, Samad Z. Estimating antibiotics consumption in a tertiary care hospital in Islamabad using a WHO's defined daily dose methodology. Antimicrob Resist Infect Control 2023; 12:132. [PMID: 37996947 PMCID: PMC10666294 DOI: 10.1186/s13756-023-01311-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Accepted: 09/20/2023] [Indexed: 11/25/2023] Open
Abstract
BACKGROUND Antibiotics have helped to reduce the incidence of common infectious diseases in all modern healthcare systems, but improper use of antibiotics including their overuse and misuse can change the bacteria so much that antibiotics don't work against them. In case of developing imposable selective pressure with regard to the proportion of hospitalized patients who receive antibiotics, the quantity of antibiotics that are prescribed to them, and the proportion of patients who receive antibiotic treatment is one of the major contributors to the rising global health issue of antimicrobial resistance. Concerning the levels of antibiotic consumption in Pakistani hospitals, there is negligible research data available. AIM This study aimed to evaluate five-year inpatient antibiotic use in a tertiary care hospital in Islamabad using the World Health Organization (WHO) Recommended Anatomical Therapeutic Chemical (ATC) Classification / Defined Daily Dose (DDD) methodology. METHOD It was a descriptive study involving a retrospective record review of pharmacy records of antibiotics dispensed (amount in grams) to patients across different specialties of the hospital from January 2017 to December 2021 (i.e., 60 consecutive months). The antibiotic consumption was calculated by using the DDD/100-Bed Days (BDs) formula, and then relative percent change was estimated using Microsoft Excel 2021 edition. RESULT A total of 148,483 (77%) patients who received antibiotics were included in the study out of 193,436 patients admitted in the hospital. Antibiotic consumption trends showed considerable fluctuations over a five-year period. It kept on declining irregularly from 2017 to 2019, inclined vigorously in 2020, and then suddenly dropped to the lowest DDD/100 BDs value (96.02) in the last year of the study. The overall percentage of encounters in which antibiotics were prescribed at tertiary care hospital was 77% which is very high compared to the WHO standard reference value (< 30%). WATCH group antibiotics were prescribed (76%) and consumed more within inpatient settings than Access (12%) and Reserve (12%) antibiotics. CONCLUSION The hospital antibiotic consumption data is well maintained across different inpatient specialties but it is largely non-aligned with WHO AWaRe (Access-Watch-Reserve) antibiotics use and optimization during 2017-2021. Compared to the WHO standard reference figure, the overall percentage of antibiotics encountered was higher by about 47%. Antibiotic consumption trends vary with a slight increase in hospital occupancy rate, with positive relative changes being lower in number but higher in proportion than negative changes. Although the hospital antibiotics policy is in place but seems not to be followed with a high degree of adherence.
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Affiliation(s)
- Naila Jabeen
- Department of Pharmacy Practice, Shifa College of Pharmaceutical Sciences, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Waseem Ullah
- Department of Pharmacy Practice, Shifa College of Pharmaceutical Sciences, Shifa Tameer-e-Millat University, Islamabad, Pakistan.
| | | | - Zia Samad
- National Tuberculosis Control Program, Islamabad Capital Territory, Islamabad, Pakistan
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Khan ZA, Hussain T, Ullah A, Ullah W, Del Ser J, Muhammad K, Sajjad M, Baik SW. Modelling Electricity Consumption During the COVID19 Pandemic: Datasets, Models, Results and a Research Agenda. Energy Build 2023; 294:113204. [PMID: 37342253 PMCID: PMC10226901 DOI: 10.1016/j.enbuild.2023.113204] [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] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/15/2023] [Accepted: 05/25/2023] [Indexed: 06/22/2023]
Abstract
The COVID19 pandemic has impacted the global economy, social activities, and Electricity Consumption (EC), affecting the performance of historical data-based Electricity Load Forecasting (ELF) algorithms. This study thoroughly analyses the pandemic's impact on these models and develop a hybrid model with better prediction accuracy using COVID19 data. Existing datasets are reviewed, and their limited generalization potential for the COVID19 period is highlighted. A dataset of 96 residential customers, comprising 36 and six months before and after the pandemic, is collected, posing significant challenges for current models. The proposed model employs convolutional layers for feature extraction, gated recurrent nets for temporal feature learning, and a self-attention module for feature selection, leading to better generalization for predicting EC patterns. Our proposed model outperforms existing models, as demonstrated by a detailed ablation study using our dataset. For instance, it achieves an average reduction of 0.56% & 3.46% in MSE, 1.5% & 5.07% in RMSE, and 11.81% & 13.19% in MAPE over the pre- and post-pandemic data, respectively. However, further research is required to address the varied nature of the data. These findings have significant implications for improving ELF algorithms during pandemics and other significant events that disrupt historical data patterns.
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Affiliation(s)
| | - Tanveer Hussain
- Institute for Transport Studies, University of Leeds, LS2 9JT Leeds, UK
| | - Amin Ullah
- CoRIS Institute, Oregon State University, Corvallis 97331, OR, USA
| | - Waseem Ullah
- Sejong University, Seoul 143-747, Republic of Korea
| | - Javier Del Ser
- TECNALIA (Basque Research & Technology Alliance - BRTA), P. Tecnologico, Ed. 700, 48160 Derio, Bizkaia, Spain
- University of the Basque Country (UPV/EHU), 48013 Bilbao, Bizkaia, Spain
| | - Khan Muhammad
- Visual Analytics for Knowledge Laboratory (VIS2KNOW Lab), Department of Applied Artificial Intelligence, College of Computing and Informatics, Sungkyunkwan University, Seoul 03063, South Korea
| | - Muhammad Sajjad
- Digital Image Processing Laboratory, Department of Computer Science, Islamia College Peshawar, Peshawar 25000, Pakistan
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Nawaz A, Nielsen S, Mehmood T, Abdullah A, Ahmed A, Ullah W, Khan A. Prescription drug dependence with and without concurrent illicit drug use: a multicenter cross-sectional survey among an addiction treatment seeking population. Front Psychiatry 2023; 14:1133606. [PMID: 37324815 PMCID: PMC10267420 DOI: 10.3389/fpsyt.2023.1133606] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Accepted: 05/15/2023] [Indexed: 06/17/2023] Open
Abstract
Background Dependence on prescription drugs and illicit drugs imposes a global health and social burden. Despite accumulating evidence of prescription drugs and illicit drugs dependence, none of the systematized studies has explored the magnitude of this problem in Pakistan. The aim is to investigate the extent and associated factors of prescription drug dependence (PDD), as opposed to concomitant prescription drug dependence and illicit drug use (PIDU), within a sample of individuals seeking addiction treatment. Methods The cross sectional study was conducted on the sample recruited from three drug treatment centers in Pakistan. Face-to-face interviews were conducted with participants who met ICD-10 criteria for prescription drug dependence. Several aspects like substance use histories, negative health outcomes, patient attitude, pharmacy and physician practices also collected to predict the determinants of (PDD). Binomial logistic regression models examined the factors associated with PDD and PIDU. Results Of the 537 treatment seeking individuals interviewed at baseline, close to one third (178, 33.3%) met criteria for dependence on prescription drugs. The majority of the participants were male (93.3%), average age of 31 years, having urban residence (67.4%). Among participants who met criteria for dependence on prescription drugs (71.9%), reported benzodiazepines as the most frequently used drug, followed by narcotic analgesics (56.8%), cannabis/marijuana (45.5%), and heroin (41.5%). The patients reported alprazolam, buprenorphine, nalbuphine, and pentazocin use as alternatives to illicit drugs. PDD was significantly negatively associated with injectable route (OR = 0.281, 95% CI, 0.079-0.993) and psychotic symptoms (OR = 0.315, 95% CI, 0.100, 0.986). This implies that PDD is less likely to be associated with an injectable route and psychotic symptoms in contrast to PIDU. Pain, depression and sleep disorder were primary reasons for PDD. PDD was associated with the attitude that prescription drugs are safer than illicit drugs (OR = 4.057, 95%CI, 1.254-13.122) and PDD was associated with being on professional terms (i.e., having an established relationship) with pharmaceutical drugs retailers for acquisition of prescription drugs. Discussion and conclusion The study found benzodiazepine and opioid dependence in sub sample of addiction treatment seekers. The results have implications for drug policy and intervention strategies for preventing and treating drug use disorders.
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Affiliation(s)
- Asma Nawaz
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Suzanne Nielsen
- Monash Addiction Research Centre, Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia
| | - Tahir Mehmood
- School of Natural Sciences, National University of Science and Technology, Islamabad, Pakistan
| | | | - Ali Ahmed
- School of Pharmacy, Monash University, Bandar Sunway, Selangor, Malaysia
| | - Waseem Ullah
- Department of Pharmacy Practice, Shifa College of Pharmaceutical Sciences, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Ahmad Khan
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
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Ullah W, Hussain T, Baik SW. Vision transformer attention with multi-reservoir echo state network for anomaly recognition. Inf Process Manag 2023. [DOI: 10.1016/j.ipm.2023.103289] [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: 02/09/2023]
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Liotta M, Ruge M, Zurlo C, Kochar K, Gamero M, Hajduczok A, Ullah W, Brailovsky Y, Rame J, Alvarez R, Massey H, Rajapreyar I. The Achilles' Heel of Heartmate 3?: Development and Hemodynamic Impacts of Aortic Insufficiency. J Heart Lung Transplant 2023. [DOI: 10.1016/j.healun.2023.02.850] [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
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Balquis F, Sohail MF, Hamid H, Ullah W, Khan AH, Shahnaz G. Potential and weak links in the management of tuberculosis by Pakistani private pharmacy staff. Front Public Health 2023; 11:983997. [PMID: 36969650 PMCID: PMC10034968 DOI: 10.3389/fpubh.2023.983997] [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: 07/01/2022] [Accepted: 01/30/2023] [Indexed: 03/12/2023] Open
Abstract
IntroductionThe emergence of MDR-TB is a global threat and an obstacle to the effective control of TB in Pakistan. A lack of proper TB knowledge among the staff in private pharmacies and the sale of compromised quality anti-TB drugs are the main instigators of multidrug-resistant tuberculosis (MDR-TB). Thus, this study was aimed at investigating the quality and storage conditions of fixed-dose combination (FDC) anti-TB drugs along with the awareness of staff working in private pharmacies regarding the identification of potential patients with TB and dispensing the inappropriate treatment regimens contributing to MDR-TB.MethodsThe study is completed in two phases. In phase I a cross-sectional study is performed using two quantitative research designs, i.e., exploratory and descriptive, to evaluate the knowledge of private pharmacy staff. The sample of 218 pharmacies was selected. While in phase II cross sectional survey is conducted in 10 facilities from where FDC anti TB drugs were sampled for analyzing their quality.ResultResults revealed the presence of pharmacists only at 11.5% of pharmacies. Approximately 81% of staff at pharmacies had no awareness of MDR-TB, while 89% of pharmacies had no TB-related informative materials. The staff identified that most of the patients with TB (70%) were of poor socio-economic class, which restricted their purchase of four FDCs only up to 2–3 months. Only 23% were acquainted with the Pakistan National TB Program (NTP). Except for MDR-TB, the results showed a significant correlation between the experiences of staff with TB awareness. Findings from the quality evaluation of four FDC-TB drugs indicated that the dissolution and content assay of rifampicin were not according to the specifications, and overall, 30% of samples failed to comply with specifications. However, the other quality attributes were within the limits.ConclusionIn light of the data, it can be concluded that private pharmacies could be crucial to the effective management of NTP through the timely identification of patients with TB, appropriate disease and therapy-related education and counseling, and proper storage and stock maintenance.
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Affiliation(s)
- Fatima Balquis
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
- Department of Pharmacy Practice, Shifa College of Pharmaceutical Sciences, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Muhammad Farhan Sohail
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
- Riphah Institute of Pharmaceutical Sciences, Riphah International University–Lahore Campus, Lahore, Pakistan
| | - Huma Hamid
- Riphah Institute of Pharmaceutical Sciences, Riphah International University–Islamabad Campus, Islamabad, Pakistan
| | - Waseem Ullah
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
- Department of Pharmacy Practice, Shifa College of Pharmaceutical Sciences, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Amer Hayat Khan
- Discipline of Clinical Pharmacy, School of Pharmaceutical Science, University Sains Malaysia, Gelugor, Penang, Malaysia
| | - Gul Shahnaz
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
- *Correspondence: Gul Shahnaz
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Aslam H, Omar A, Fatima R, Rasool U, Yaqoob A, Ullah W, Khan A, Khan Y, Mallhi T. Treatment outcomes and adverse drug reactions among patients with drug resistant tuberculosis receiving all-oral, long-term regimens: First record viewing report from Pakistan. ASIAN PAC J TROP MED 2023. [DOI: 10.4103/1995-7645.370148] [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: 02/25/2023] Open
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Hussain S, Nawaz A, Hamid M, Ullah W, Khan IN, Afshan M, Rehman A, Nawaz H, Halswick J, Rehman SU, Ahmad S, Muzammal M, Muhammad N, Jan A, Khan S, Windpassinger C, Khan MA. Mutation screening of multiple Pakistani MCPH families revealed novel and recurrent protein-truncating mutations of ASPM. Biotechnol Appl Biochem 2022; 69:2296-2303. [PMID: 34826358 DOI: 10.1002/bab.2286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/11/2021] [Indexed: 12/27/2022]
Abstract
Autosomal primary microcephaly (MCPH) is a heterogenetic disorder that affects brain's cerebral cortex size and leads to a reduction in the cranial vault. Along with the hallmark feature of reduced head circumference, microcephalic patients also exhibit a variable degree of intellectual disability as well. Genetic studies have reported 28 MCPH genes, most of which produce microtubule-associated proteins and are involved in cell division. Herein this study, 14 patients from seven Pashtun origin Pakistani families of primary microcephaly were analyzed. Mutation analysis was performed through targeted Sanger DNA sequencing on the basis of phenotype-linked genetic makeup. Genetic analysis in one family found a novel pathogenic DNA change in the abnormal spindle microtubule assembly (ASPM) gene (NM_018136.4:c.3871dupGA), while the rest of the families revealed recurrent nonsense mutation c.3978G>A (p.Trp1326*) in the same gene. The novel reported frameshift insertion presumably truncates the protein p.(Lys1291Glyfs*14) and deletes the N-terminus domains. Identification of novel ASPM-truncating mutation expands the mutational spectrum of the ASPM gene, while mapping of recurrent mutation c.3978G>A (p.Trp1326*) will aid in establishing its founder effect in the Khyber Pakhtunkhwa (KPK) inhabitant population of Pakistan and should be suggestively screened for premarital counseling of MCPH susceptible families. Most of the recruited families are related to first-degree consanguinity. Hence, all the family elders were counseled to avoid intrafamilial marriages.
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Affiliation(s)
- Sadam Hussain
- Department of Biotechnology and Genetic Engineering, Kohat University of Science and Technology, Kohat, Khyber Pakhtunkhwa, Pakistan
| | - Amjad Nawaz
- Department of Biotechnology and Genetic Engineering, Kohat University of Science and Technology, Kohat, Khyber Pakhtunkhwa, Pakistan
| | - Malaika Hamid
- Department of Biotechnology and Genetic Engineering, Kohat University of Science and Technology, Kohat, Khyber Pakhtunkhwa, Pakistan
| | - Waseem Ullah
- Department of Biotechnology and Genetic Engineering, Kohat University of Science and Technology, Kohat, Khyber Pakhtunkhwa, Pakistan
| | - Iqbal Nawaz Khan
- Department of Biotechnology and Genetic Engineering, Kohat University of Science and Technology, Kohat, Khyber Pakhtunkhwa, Pakistan
| | - Mehak Afshan
- Department of Biotechnology and Genetic Engineering, Kohat University of Science and Technology, Kohat, Khyber Pakhtunkhwa, Pakistan
| | - Adil Rehman
- Department of Biotechnology and Genetic Engineering, Kohat University of Science and Technology, Kohat, Khyber Pakhtunkhwa, Pakistan
| | - Hamid Nawaz
- Department of Biotechnology and Genetic Engineering, Kohat University of Science and Technology, Kohat, Khyber Pakhtunkhwa, Pakistan
| | - Julia Halswick
- Diagnostic and Research Institute of Human Genetics, Medical University of Graz, Graz, Austria
| | - Shoaib-Ur Rehman
- Department of Biotechnology, University of Science and Technology Bannu, Bannu, Khyber Pakhtunkhwa, Pakistan
| | - Sohail Ahmad
- Gomal Centre of Biochemistry and Biotechnology, Gomal University, D. I. Khan, Khyber Pakhtunkhwa, Pakistan
| | - Muhammad Muzammal
- Gomal Centre of Biochemistry and Biotechnology, Gomal University, D. I. Khan, Khyber Pakhtunkhwa, Pakistan
| | - Noor Muhammad
- Department of Biotechnology and Genetic Engineering, Kohat University of Science and Technology, Kohat, Khyber Pakhtunkhwa, Pakistan
| | - Abid Jan
- Department of Biotechnology and Genetic Engineering, Kohat University of Science and Technology, Kohat, Khyber Pakhtunkhwa, Pakistan
| | - Saadullah Khan
- Department of Biotechnology and Genetic Engineering, Kohat University of Science and Technology, Kohat, Khyber Pakhtunkhwa, Pakistan
| | - Christian Windpassinger
- Diagnostic and Research Institute of Human Genetics, Medical University of Graz, Graz, Austria
| | - Muzammil Ahmad Khan
- Gomal Centre of Biochemistry and Biotechnology, Gomal University, D. I. Khan, Khyber Pakhtunkhwa, Pakistan
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Bates A, Paisey JR, Yue A, Banks P, Roberts PR, Ullah W. Establishing safe, effective ablation in the diseased human ventricle: an analysis of generator impedance and electrogram attenuation. Europace 2022. [DOI: 10.1093/europace/euac053.353] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private company. Main funding source(s): Biosense Webster Inc
Background
Predictors of effective and safe lesion delivery in the human left ventricle have not been established. Generator impedance (GI) drop and electrogram (EGM) attenuation are indices which can be used as surrogates for ablation lesion parameters. Tissue pops are a complication of myocardial overheating preceded by a rise in GI and can have adverse consequences.
Purpose
To establish the relationships between Ablation Index (AI), Force Time Integral (FTI) and contact force with GI and EGM attenuation. To establish factors early in ablation that are predictive of a GI rise.
Methods
Patients undergoing ventricular tachycardia ablation were recruited. All ablations were performed with contact force sensing surround flow catheters. Electrograms were collected pre and post ablation, with GI, AI, FTI measured during. Ablations were divided into low (LVM, < 0.50mV), intermediate (IVM, 0.51 – 1.50mV) and normal voltage (NVM, > 1.50mV) based upon pre-ablation bipolar EGM amplitude. Ablations with a 5% rise in GI from maximal drop were noted and predictors of this explored.
Results
In 15 patients, 402 ablations were analysed. Filtered percentage GI drop correlated with AI and FTI, (p < 0.0005, Spearman’s ρ = 0.522 and 0.524) and reached a plateau at 763AI and 713gs, a filtered GI drop of 7.5% (Figure 1). Shallower curves occurred progressively from NVM to IVM to LVM, (p < 0.0005), (Figure 2)
The bipolar EGM significantly attenuated with ablation, (median attenuation 0.14mV, [29.3%], p <0.0005), but percentage attenuation did not correlate with AI or FTI.
Parameters associated with a GI rise during ablation were greater mean CF to maximum GI drop, (p = 0.002), greater initial percentage GI drop at 5 seconds, (p < 0.0005), power of 50W (p = 0.005), and perpendicular orientation, (p = 0.006). Percentage GI drop at 5 seconds was the best predictor of ablations with a GI rise, (AUCROC 0.773; 95% CI 0.708 – 0.838; optimal cut-off 2.44%). Mean contact force to maximum GI drop was a poor predictor of a GI rise (AUCROC 0.647; 95% CI 0.577 – 0.718, optimal cut-off 14.7g).
Conclusion
During left ventricular ablation, AI of 763 and FTI of 713gs should be targeted, with a lower impedance drop observed for more scarred myocardium. A GI drop of <2.5% at 5 seconds and contact force < 15g should be used to optimise ablation safety.
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Affiliation(s)
- A Bates
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom of Great Britain & Northern Ireland
| | - JR Paisey
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom of Great Britain & Northern Ireland
| | - A Yue
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom of Great Britain & Northern Ireland
| | - P Banks
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom of Great Britain & Northern Ireland
| | - PR Roberts
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom of Great Britain & Northern Ireland
| | - W Ullah
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom of Great Britain & Northern Ireland
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Bates A, Naseer MZ, Taylor M, Denham N, Yue A, Das M, Morris GM, Ullah W. UK multi-centre retrospective study of the learning curve and relative performance of the rhythmia high density mapping system for atrial ablation. Europace 2022. [DOI: 10.1093/europace/euac053.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Public hospital(s). Main funding source(s): University Hospital Southampton
Background
Rhythmia HDx® is a novel ultra-high density electroanatomical mapping system using an innovative 64 electrode basket catheter. A learning curve is a recognised phenomenon for any new technology and was examined in this study.
Purpose
Comparison of performance, long-term success, and complications using Rhythmia for atrial ablation in the UK.
Methods
Retrospective data collection from three centres across the UK from the introduction of Rhythmia. Patients were matched with controls who had undergone ablation using the well-established Carto3 mapping system. Assessed were: fluoroscopy, radiofrequency ablation and procedure times; acute and long term success, and complications.
Results
253 study patients with 253 controls were included. Significant correlations existed between procedural efficiency metrics and centre experience for de novo atrial fibrillation (AF) ablation (procedure time, Spearman’s ρ = -0.624; ablation time, ρ = -0.795), and de novo atrial flutter (AFlut) ablation (ablation time, ρ = -0.566; fluoroscopy time, ρ = -0.520). No such correlations existed for redo AF, redo AFlut, de novo atrial tachycardia (AT), or redo AT cases. For de novo AF and AFlut, procedural efficiency metrics were significantly improved after 10 procedures in each centre, (procedure time [AF only, p = 0.001], ablation time [AF, p < 0.0005; AFlut p < 0.0005] and fluoroscopy time [AFlut only, p = 0.0022]), and became comparable to controls (Figures 1 and 2). Acute success and long-term success did not see significant improvement with experience but were comparable to the control group. There was no relationship between experience and complications, which were comparable to Carto3 (3.6% in both groups).
Conclusion
A short learning curve exists with the use of Rhythmia HDx for standardised procedures (de novo AF / AFlut). Procedural performance improves and becomes comparable to Carto3 following 10 cases at each centre. Clinical outcomes at 6 and 12 months, and complications are not affected by this learning curve and remain comparable with controls.
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Affiliation(s)
- A Bates
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom of Great Britain & Northern Ireland
| | - MZ Naseer
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom of Great Britain & Northern Ireland
| | - M Taylor
- Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom of Great Britain & Northern Ireland
| | - N Denham
- Manchester Royal Infirmary, Manchester, United Kingdom of Great Britain & Northern Ireland
| | - A Yue
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom of Great Britain & Northern Ireland
| | - M Das
- Freeman Hospital, Newcastle-Upon-Tyne, United Kingdom of Great Britain & Northern Ireland
| | - GM Morris
- Manchester Royal Infirmary, Manchester, United Kingdom of Great Britain & Northern Ireland
| | - W Ullah
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom of Great Britain & Northern Ireland
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Ulhaq Z, Khan W, Khan MF, Kabir M, Ujjan AA, Ullah W, Masood Z, Khan S, De Los Ríos Escalante P. Prevalence of intestinal parasitic diseases in school children of rural areas of district Lower Dir, Pakistan. BRAZ J BIOL 2021; 82:e243150. [PMID: 34644727 DOI: 10.1590/1519-6984.243150] [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: 09/03/2020] [Accepted: 11/16/2020] [Indexed: 11/21/2022] Open
Abstract
Present study was conducted among school children to recognize the prevalence of IPIs in rural communities of district Dir Lower, Pakistan. A sum of 324 samples of stool were collected (210 boys and 114 girls). Used direct smear method and formol ether sedimentation concentration technique for processing the samples. The result shows that 82% (n=266) were found infected comprised 64.8% male and 35.1% females. Children of the age group 10 to 12 years were found extremely infected 94.2% while 4-6 year age group were having minimum ratio of infection 72%. Current study shows mono parasitism in 50.6% of the students while 22.2% were infected with 2 species and 7.40% were infected with three species of parasites. Seven species of intestinal parasites were reported include Ascaris lumbricoid in male (n=122) 58.0% and in female (n=65) 57.0% followed by Hook worm (n=88) 41.9% and (n=44) 38.5%; Tania saginata (n=44) 20.9% and (n=24) 21.0%; Entrobius vermicularis (n=32) 15.2% and (n=16) 14.0%; Trichuris trichura (n=25) 11.9% and (n=22) 19.2%; Hymenolepis nana (n=24) 11.4% and (n=18) 15.7% and Entameoba histolytica (n=16) 7.61% and (n=14) 12.2% in male and females respectively. The study indicates that most occurring intestinal parasite in the current study were Ascaris lumbricoides 58.0% (n=122) followed by hookworms 41.9% (n=88). Male students were more infected than females in the present study.
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Affiliation(s)
- Z Ulhaq
- Hazara University, Department of Zoology, Mansehra, Pakistan
| | - W Khan
- University of Malakand, Department of Zoology, Malakand, Pakistan
| | - M F Khan
- Hazara University, Department of Zoology, Mansehra, Pakistan
| | - M Kabir
- University of Sargodha, Department of Biological Sciences, Sub campus Bhakkar, Bhakkar-30000, Punjab, Pakistan
| | - A A Ujjan
- University of Sindh, Institute of Plant Sciences, Jamshoro, Pakistan
| | - W Ullah
- Hazara University, Department of Zoology, Mansehra, Pakistan
| | - Z Masood
- Department of Zoology, SBK Women University Quetta, Baluchistan, Pakistan
| | - S Khan
- Hazara University, Department of Zoology, Mansehra, Pakistan
| | - P De Los Ríos Escalante
- Universidad Católica de Temuco, Facultad de Recursos Naturales, Departamento de Ciencias Biológicas y Químicas, Casilla 15-D, Temuco, Chile.,Núcleo de Estudios Ambientales UC Temuco, Casilla, Temuco, Chile
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Kobo O, Khattak S, Lopez-Mattei J, Van Spall H, Graham M, Cheng R, Osman M, Sun L, Ullah W, Fischman D, Roguin A, Mohamed OM, Mamas MA. Trends in cardiovascular mortality of cancer patients in the US over two decades 1999–2019. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Cancer is the second most common cause of death globally after cardiovascular (CV) disease. The present study sought to compare the trends in CV mortality between patients with and without cancer in the US over two decades (1999 to 2019), stratified by sociodemographic factors such as age, sex and geographical location.
Methods
In this retrospective study, the number of deaths, crude- and age-adjusted mortality rates between January 1, 1999, and December 31, 2019, were obtained from the Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC WONDER) data set
Results
We examined a total of 53,422,612 deaths between 1999 and 2019; of which 33.4% were defined as CV mortality and 25.6% had malignancy. During this period, among patients with cancer, the age-adjusted mortality rate dropped by 52%. (Vs, 38% in patients with no malignancy). CV mortality was highest in patients with gastrointestinal and prostate malignancy where CV mortality accounts together for over 40% of all CV mortality in patients with cancer in 1999 and 33.6% in 2019. The age-adjusted CV mortality rate (per 100,000 people) of patients with GI and prostate cancer nearly halved over twenty years from 2.7 to 1.0 and 2.5 to 1.0.
The CV age-adjusted mortality rate dropped more significantly among patients with gastrointestinal, breast, and prostate malignancy than among patients with hematological malignancy (59–63% vs. 41%. We observed that crude CV mortality rates amongst patients with cancer declined over the study period in all age groups but was more prominent among patients over 65 years old than those aged 55–64 and under 55 (51%-55% Vs. 41%, 25%, respectively).Similar reductions in mortality in men and women (54% and 53% reduction) were observed
During the study period the decline in cardiovascular mortality was more prominent in metro areas which led to lower age adjusted CV mortality in Metro compared to non-Metro areas (5.7–6.3 vs 7.2). The decline in age adjusted CV mortality in patients with cancer differed significantly in different states
Conclusions
In our temporal analysis we show a 50% decline in CV mortality in the US over two decades in both male and female patients with cancer, that has exceeded the reduction in CV mortality seen in the non-cancer population. The greatest reductions in CV mortality were observed in patients with GI, breast and prostate malignancies, those residing in metro areas and in patients aged 65 and over.
Funding Acknowledgement
Type of funding sources: None. CV death among cancer patients
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Affiliation(s)
- O Kobo
- Hillel Yaffe Medical Center, Hadera, Israel
| | - S Khattak
- Keele University, Stoke-on-Trent, United Kingdom
| | - J Lopez-Mattei
- University of Texas Health Science Center, Houston, United States of America
| | - H Van Spall
- Population Health Research Institute, Hamilton, Canada
| | - M Graham
- University of Alberta, Edmonton, Canada
| | - R Cheng
- University of Washington, Seattle, United States of America
| | - M Osman
- West Virginia Institute Heart and Vascular Institute, Morgantown, United States of America
| | - L Sun
- University of Ottawa Heart Institute, Ottawa, Canada
| | - W Ullah
- Thomas Jefferson University, Philadelphia, United States of America
| | - D Fischman
- Thomas Jefferson University, Philadelphia, United States of America
| | - A Roguin
- Hillel Yaffe Medical Center, Hadera, Israel
| | - O M Mohamed
- Keele University, Stoke-on-Trent, United Kingdom
| | - M A Mamas
- Keele University, Stoke-on-Trent, United Kingdom
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Ullah W, Wali A, Haq MU, Yaqoob A, Fatima R, Khan GM. Public-Private Mix Models of Tuberculosis Care in Pakistan: A High-Burden Country Perspective. Front Public Health 2021; 9:703631. [PMID: 34447737 PMCID: PMC8383070 DOI: 10.3389/fpubh.2021.703631] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 07/09/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction: Pakistan ranks fifth in the globally estimated burden of tuberculosis (TB) case incidence. Annually, a gap of 241,688 patients with TB exists between estimated TB incidence and actual TB case notification in Pakistan. These undetected/missed TB cases initiate TB care from providers in the private healthcare system who are less motivated to notify patients to the national database that leads to significant underdetection of actual TB cases in the Pakistani community. To engage these private providers in reaching out to missing TB cases, a national implementation trial of the Public–Private Mix (PPM) model was cohesively launched by National TB Control Program (NTP) Pakistan in 2014. The study aims to assess the implementation, contribution, and relative treatment outcomes of cohesively implemented PPM model in comparison to the non-PPM model. Methods: A retrospective record review of all forms (new and relapse) patients with TB notified from July 2015 to June 2016 was conducted both for PPM- and non-PPM models. Results: The PPM model was implemented in 92 districts in total through four different approaches and contributed 25% (81,016 TB cases) to the national TB case notification. The PPM and non-PPM case notification showed a strong statistical difference in proportions among compared variables related to gender (p < 0.001), age group (p < 0.000), and province (p < 0.000). Among PPM approaches, general practitioners and non-governmental-organization facilities achieve a treatment success of 94–95%; private hospitals achieve 82% success, whereas Parastatals are unable to follow more than half of their notified TB cases. Discussion: The PPM model findings in Pakistan are considerably consistent with countries that have prioritized PPM for an increasing trend in the TB case notification to their national TB control programs. Different PPM approaches need to be scaled up in terms of PPM implemented districts, PPM coverage, PPM coverage efficiency, and PPM coverage outcome in the Pakistani healthcare system in the future.
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Affiliation(s)
- Waseem Ullah
- Department of Pharmacy, Quaid-i-Azam University Islamabad, Islamabad, Pakistan.,Department of Pharmacy Practice, Shifa Tameer-e-Millat University Islamabad, Islamabad, Pakistan
| | - Ahmad Wali
- Health Department, Provincial Tuberculosis Control Program Balochistan, Quetta, Pakistan
| | - Mahboob Ul Haq
- Policy Strategy and Drug Management Unit, National Tuberculosis Control Program, Islamabad, Pakistan
| | - Aashifa Yaqoob
- Research Unit, National Tuberculosis Control Program, Islamabad, Pakistan
| | - Razia Fatima
- Research Unit, National Tuberculosis Control Program, Islamabad, Pakistan
| | - Gul Majid Khan
- Department of Pharmacy, Quaid-i-Azam University Islamabad, Islamabad, Pakistan.,Islamia College University, Peshawar, Pakistan
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Karim N, Kozhuharov N, Jarman J, Furniss S, Veasey R, Ullah W, Vouliotis AI, Martin C, Kalla M, Osmanagic A, Ginks M, Pope M, Christian Sitcherling C, Gupta D, Wong T. Safety and acute clinical outcomes of atrial fibrillation catheter ablation in octogenarians: a multicentre evaluation with a matched younger cohort. Europace 2021. [DOI: 10.1093/europace/euab116.235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
OnBehalf
Sven Knecht and the International Octogenarian AF ablation group
Background
Octogenarians are a fast-growing demographic with a high burden of atrial fibrillation (AF). There are limited data on procedural safety and acute outcomes of catheter ablation (CA) for AF in this group.
Purpose
Investigation of complications & outcomes in octogenarians undergoing CA for AF.
Methods
Data on all octogenarian patients who underwent AF ablation at nine European cardiology centres between 2013 and 2019 were retrospectively analysed and matched with control patients aged <80 years. The characteristics used for matching were type of AF, type of procedure (de novo or redo), & the year of procedure.
Results
216 octogenarians (81.9 ± 1.9 years; 52.8% females) underwent an AF ablation procedure, and were matched with 216 patients aged <80 years (62.4 ± 9.5 years, 34.7% females), p <0.001 for both. The proportion of paroxysmal and persistent AF was 43.5% & 56.5% respectively in both groups, and 79.3% of the procedures were de novo. RF ablation made up 75.4% & 75.9% (p = 0.90) procedures in octogenarians and controls respectively. 17 complications occurred in 14 (7.9%) octogenarian patients and 11 in 11 (5.1%) patients in the younger matched cohort (p = 0.07). There were 4.2% & 1.9% major complications (p= 0.17) and 3.7% & 3.2% minor complications (p= 0.77) in the octogenarian & younger cohorts respectively. Complications in octogenarians consisted of groin complications (n = 6), pneumonia (n = 3), pericardial effusion (n = 2), phrenic nerve injury (n = 2), pulmonary oedema (n = 1), gastroparesis (n = 1), stroke (n = 1). Acute procedural success rates were 99.1% & 99.5% (p = 0.62) The complication rates were similar for RF; 6.0% vs 5.4% (p = 0.79) and Cryoballoon; 14.0% vs 4.1% (p = 0.09) in both octogenarians and younger cohort respectively.
Conclusion
In spite of significantly higher overall risk profile of octogenarians undergoing AF ablation, there is no difference in acute procedural success and complication rates as compared to younger patients Catheter ablation of AF in octogenerians Octogenarians n = 216 Matched Controls (aged < 80yrs) n = 216 P value Age (yrs), mean (SD)s 81.9 (1.9) 62.4(9.5) < 0.0001 Females, (%) 52.8 34.7 0.0002 CHA2DS2-VASc, mean (SD) 3.6 (1.2) 1.4 (1.3) < 0.0001 Mean LA size, mm 42.8 ± 8.3mm 45.8 ± 16.2 0.062 Impaired LV function, (%) 23.7 17.9 0.206 IHD, (%) 20.7 5.9 < 0.0001 Procedural time (mins), mean (sd) 150.6 (69.7) 148.9 (64.4) 0.914 All complications, n (%) 17 (7.9) 11 (5.1) 0.073
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Affiliation(s)
- N Karim
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - N Kozhuharov
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - J Jarman
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
| | - S Furniss
- Eastbourne District General Hospital, Eastbourne, United Kingdom of Great Britain & Northern Ireland
| | - R Veasey
- Eastbourne District General Hospital, Eastbourne, United Kingdom of Great Britain & Northern Ireland
| | - W Ullah
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom of Great Britain & Northern Ireland
| | - A-I Vouliotis
- University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom of Great Britain & Northern Ireland
| | - C Martin
- Royal Papworth Hospital NHS Foundation Trust, Cambridge, United Kingdom of Great Britain & Northern Ireland
| | - M Kalla
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - A Osmanagic
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - M Ginks
- John Radcliffe Hospital, Oxford, United Kingdom of Great Britain & Northern Ireland
| | - M Pope
- John Radcliffe Hospital, Oxford, United Kingdom of Great Britain & Northern Ireland
| | | | - D Gupta
- Liverpool Heart and Chest Hospital, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - T Wong
- Royal Brompton Hospital, London, United Kingdom of Great Britain & Northern Ireland
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Ullah W, Ullah A, Hussain T, Khan ZA, Baik SW. An Efficient Anomaly Recognition Framework Using an Attention Residual LSTM in Surveillance Videos. Sensors (Basel) 2021; 21:s21082811. [PMID: 33923712 PMCID: PMC8072779 DOI: 10.3390/s21082811] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/08/2021] [Accepted: 04/12/2021] [Indexed: 11/16/2022]
Abstract
Video anomaly recognition in smart cities is an important computer vision task that plays a vital role in smart surveillance and public safety but is challenging due to its diverse, complex, and infrequent occurrence in real-time surveillance environments. Various deep learning models use significant amounts of training data without generalization abilities and with huge time complexity. To overcome these problems, in the current work, we present an efficient light-weight convolutional neural network (CNN)-based anomaly recognition framework that is functional in a surveillance environment with reduced time complexity. We extract spatial CNN features from a series of video frames and feed them to the proposed residual attention-based long short-term memory (LSTM) network, which can precisely recognize anomalous activity in surveillance videos. The representative CNN features with the residual blocks concept in LSTM for sequence learning prove to be effective for anomaly detection and recognition, validating our model’s effective usage in smart cities video surveillance. Extensive experiments on the real-world benchmark UCF-Crime dataset validate the effectiveness of the proposed model within complex surveillance environments and demonstrate that our proposed model outperforms state-of-the-art models with a 1.77%, 0.76%, and 8.62% increase in accuracy on the UCF-Crime, UMN and Avenue datasets, respectively.
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17
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Ullah W. Examining the Non-linear Relationship between Corporate Governance and Firm Performance in Pakistan. PSSR 2021. [DOI: 10.35484/pssr.2021(5-i)73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
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Ahmad F, Ikram S, Ahmad J, Ullah W, Hassan F, Khattak SU, Irshad Ur Rehman. GASPIDs Versus Non-GASPIDs - Differentiation Based on Machine Learning Approach. Curr Bioinform 2021. [DOI: 10.2174/1574893615999200425225729] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
Peptidases are a group of enzymes which catalyze the cleavage of peptide
bonds. Around 2-3% of the whole genome codes for proteases and about one-third of all known
proteases are serine proteases which are divided into 13 clans and 40 families. They are involved
in diverse physiological roles such as digestion, coagulation of blood, fibrinolysis, processing of
proteins and prohormones, signaling pathways, complement fixation, and have a vital role in the
immune defense system. Based on their functions, they can broadly be divided into two classes;
GASPIDs (Granule Associated Serine Peptidases involved in Immune Defense System) and Non-
GASPIDs. GASPIDs, in particular are involved in immune-associated functions i.e. initiating
apoptosis to kill virally infected and cancerous cells, cytokine modulation for the generation of
inflammatory responses, and direct killing of pathogens through phagosomes.
Methods:
In this study, sequence-based characterization of these two types of serine proteases is
performed. We first identified sequences by analyzing multiple online databases as well as by
analyzing whole genomes of different species from different orthologous and non-orthologous
species. Sequences were identified by devising a distinct criterion to differentiate GASPIDs from
Non-GASPIDs. The translated version of these sequences was then subjected to feature extraction.
Using these distinctive features, we differentiated GASPIDs from Non-GASPIDs by applying
multiple supervised machine learning models.
Results and Conclusion:
Our results show that, among the three classifiers used in this study,
SVM classifier coupled with tripeptide as feature method has shown the best accuracy in
classification of sequences as GASPIDs and Non-GASPIDs.
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Affiliation(s)
- Fawad Ahmad
- Centre of Biotechnology & Microbiology, University of Peshawar, Peshawar, Pakistan
| | - Saima Ikram
- Centre of Biotechnology & Microbiology, University of Peshawar, Peshawar, Pakistan
| | - Jamshaid Ahmad
- Centre of Biotechnology & Microbiology, University of Peshawar, Peshawar, Pakistan
| | - Waseem Ullah
- College of Software Convergence, Sejong University, Seoul, South Korea
| | - Fahad Hassan
- Centre of Biotechnology & Microbiology, University of Peshawar, Peshawar, Pakistan
| | - Saeed Ullah Khattak
- Centre of Biotechnology & Microbiology, University of Peshawar, Peshawar, Pakistan
| | - Irshad Ur Rehman
- Centre of Biotechnology & Microbiology, University of Peshawar, Peshawar, Pakistan
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19
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Sattar Y, Ullah W, Mamtani S, Alraies C. Efficacy of epicardial and endocardial ablation in the prevention of ventricular tachycardia in arrythmogenic right ventricular cardiomyopathy- a meta analysis. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Ventricular tachycardia is a major complication associated with increased risk of sudden cardiac death in arrhythmogenic ventricular cardiomyopathy. Recurrence of VT status post catheter endocardial ablation with conventional mapping is a evolving discussion in management of VT prevention in ARVC. With the evolution of new mapping techniques to locate ectopic foci of VT, a combination of endo- and epicardial catheter ablation have proven to be efficacious in the prevention of frequency of VT recurrence and its duration.
Methods
Using PubMed, Ovid (MEDLINE) and Cochrane database we searched using the MeSH terms including: “arrhythmogenic right ventricular cardiomyopathy”, “arrhythmogenic right ventricular dysplasia”, “monomorphic ventricular tachycardia”, “polymorphic ventricular Tachycardia”, “endocardial catheter ablation”, “epicardial catheter ablation”. The primary outcomes were to assess VT frequency and duration status post endocardial or epicardial or a combination of both types of ablation. The secondary outcome includes sudden cardiac arrest or sudden cardiac death after procedure. ANOVA with post HOC analysis was performed using SPSS v.26 (IBM Corp, NY, USA)
Results
A total of 33 studies included 1437 patients with a mean male=67%. The data analysis showed a mean VT prevention for endocardial ablation was 65%, epicardial 78%, and for combined epi-endocardial was 89% (figure-1). The mean procedural mortality rate was 2%. In order to test the hypothesis that combined epi-endocardial ablation was more successful in the prevention of VT recurrence, we performed a one-way analysis of variance (ANOVA). The analysis was statistically significant F(2,14)=5.879, 95% CI, p=0.014. Post Hoc test (Tukey HSD test) with multiple comparisons indicated that patients who underwent combined epi-endocardial ablation experienced a statistically significant difference in VT prevention of 89% (95% CI p=0.01) compared to only endocardial ablation, mean VT prevention of 65% (95% CI, p=0.189) or only epicardial, mean VT prevention of 78% (95% CI, p=0.353).
Conclusion
With new mapping techniques, use of endocardial, and epicardial ablation is linked to decrease VT frequency, duration, ICD shocks, and sudden cardiac death in patients with ARVC in cohorts with prior failure of antiarrhythmics.
Total VT Prevention across target sites
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- Y Sattar
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - W Ullah
- Abington Memorial Hospital, Abington, United States of America
| | - S Mamtani
- Icahn School of Medicine at Mount Sinai, New York, United States of America
| | - C Alraies
- Wayne State University, Detroit, United States of America
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20
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Das M, Luik A, Shepherd E, Sulkin M, Laughner J, Duffy E, Oesterlein T, Meyer C, Jais P, Duchateau J, Yue A, Ullah W, Garcia-Bolao I. 664Local catheter impedance drop during pulmonary vein isolation predicts conduction block in patients with paroxysmal atrial fibrillation: initial results of the LOCALIZE clinical trial. Europace 2020. [DOI: 10.1093/europace/euaa162.249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Boston Scientific
Background
Radiofrequency (RF) catheter ablation for pulmonary vein isolation (PVI) requires resistively heating cardiac tissue to create conduction block. Creation of an RF lesion results in an impedance drop and the magnitude of this drop depends on the temperature and amount of myocardium being heated. Pre-clinical and clinical evaluation of an advanced local impedance (LI) metric found that greater LI drops were indicative of more effective lesion formation.
Purpose
To evaluate whether LI drop is associated with conduction block after first pass encirclement of the PVs in patients with paroxysmal AF.
Methods
LOCALIZE is an ongoing, single-arm, multi-center clinical trial (clinicaltrials.gov NCT03232645). LOCALIZE consists of an index PVI procedure (results presented here) and a 3-month follow-up mapping procedure. In the index procedure, electroanatomical maps of the left atrium were created and ipsilateral PVs were divided into 8 anatomical segments (n = 16 per patient). PVI was performed using point-by-point ablation with blinding of operators to LI. Following initial encirclement and a 20-minute wait period, coronary sinus-paced electroanatomical maps were created to identify gaps within anatomical segments. Gaps were annotated on the map and subsequently ablated. Mean LI drop within each segment was calculated offline as an estimate of regional RF energy delivery (Figure - Left). The diagnostic accuracy of LI drop for predicting segment block was assessed using receiver operating characteristic (ROC) analysis in segments with inter-lesion spacing ≤6mm.
Results
Forty-seven patients with paroxysmal AF underwent PVI at 5 centers (age 62 ± 11 years, male 55.3%). All patients left the index procedure with all PVs isolated. When blinded to LI (n = 3,064 ablations), median baseline LI was 106 (IQR: 97-115) Ω and median LI drop was 18.4 (12.7-24.9) Ω. After first pass encirclement, blocked segments had a significantly larger LI drop (20.2 [14.6-26.0] Ω) than segments with gaps (10.6 [6.9-15.1] Ω, p < 0.01, Figure - Right). The association between LI drop and block was further evaluated along anatomical anterior/posterior wall thickness differences. Anterior block segments were found to have significantly larger LI drops (21.0 [15.9-27.2] Ω) than posterior block segments (16.6 [12.7-23.7] Ω, p < 0.01). ROC analysis of segments with inter-lesion spacing ≤6mm identified optimal LI cut-off values of 16Ω in anterior segments and 11Ω posteriorly, which had positive predictive values for conduction block of 95.6% and 96.7%, respectively.
Conclusions
The magnitude of LI drop is predictive of acute PVI segment conduction block in patients with paroxysmal AF. The thinner posterior wall required smaller LI drops for block compared to the thicker anterior wall. With inter-lesion spacing of ≤6mm, reaching a LI drop of ≥16Ω anteriorly and ≥11Ω posteriorly was highly predictive of acute segment block in de novo PVI.
Abstract Figure. Local impedance drop in de novo PVI
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Affiliation(s)
- M Das
- Freeman Hospital, Newcastle Upon Tyne, United Kingdom of Great Britain & Northern Ireland
| | - A Luik
- Städtisches Klinikum Karlsruhe, Karlsruhe, Germany
| | - E Shepherd
- Freeman Hospital, Newcastle Upon Tyne, United Kingdom of Great Britain & Northern Ireland
| | - M Sulkin
- Boston Scientific, Arden Hills, United States of America
| | - J Laughner
- Boston Scientific, Arden Hills, United States of America
| | - E Duffy
- Boston Scientific, Arden Hills, United States of America
| | - T Oesterlein
- Boston Scientific, Arden Hills, United States of America
| | - C Meyer
- University Medical Center Hamburg Eppendorf, Hamburg, Germany
| | - P Jais
- Hospital Haut Leveque, Bordeaux, France
| | | | - A Yue
- University of Southampton, Southampton, United Kingdom of Great Britain & Northern Ireland
| | - W Ullah
- University of Southampton, Southampton, United Kingdom of Great Britain & Northern Ireland
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Ullah W, Almansour H, Fatima R, Saini B, Khan GM. Engaging Community Pharmacies in Early Detection of Missing Tuberculosis Patients through Public-Private Mix Intervention in Pakistan. Am J Trop Med Hyg 2020; 103:221-230. [PMID: 32372744 DOI: 10.4269/ajtmh.19-0939] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Globally, Pakistan ranks fifth in terms of missing tuberculosis (TB) patients' burden. Missed TB cases are either undiagnosed or diagnosed but not notified to the national TB database. Public-private mix interventions are contributing significantly to the case detection, diagnosis, and treatment of TB in Pakistan. However, it is estimated that many cases of infected TB patients go undetected. It is likely that these "undiagnosed" active TB cases seek treatment from community pharmacies, among other venues. This study aimed at assessing the feasibility of community pharmacy-based TB case detection. Case detection protocol implementation in three Pakistani districts in a nonrandom selection of pharmacies was followed by a review of routinely maintained prospective records of patients referred from these private community pharmacies to general practitioner (GP) clinics. The study engaged 500 community pharmacies for referring presumptive TB patients to GP clinics. In total, 85% of the engaged pharmacies remained active in providing referrals during the study period. The community pharmacy-referral network achieved an annual referral rate of 3,025 presumptive TB patients and identified 547 active TB cases for the period January-December 2017. Every fifth referral among presumptives presenting and counseled at pharmacies was diagnosed with TB at GP clinics. This contribution was 9% of all new TB cases identified in these districts through all other private venues linked with the Greenstar Social Marketing setup. Identified barriers and facilitators to implementation and cost effectiveness of pharmacy models for TB case detection should be considered if the model were to be scaled up.
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Affiliation(s)
- Waseem Ullah
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.,Greenstar Social Marketing Pakistan Guarantee Limited, Lahore, Pakistan.,Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Hadi Almansour
- School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Razia Fatima
- Chief Research Unit, National Tuberculosis Control Program, Islamabad, Pakistan
| | - Bandana Saini
- The Woolcock Institute of Medical Research, Sydney, Australia.,School of Pharmacy, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Gul Majid Khan
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
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22
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Gerontitis D, Wardley J, Chapman M, Zegard A, Sammut E, Bates M, Waddingham P, Diab I, Chow A, Leyva F, Turley A, Williams I, Ullah W. P5681Improved electrical performance/stability of a novel active fixation coronary sinus lead compared to passive fixation leads: a multi-centre study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz746.0623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
A novel active fixation coronary sinus (CS) lead, Attain Stability, has been released in a bipolar and quadripolar configuration, with the hypothesis it will improve targeted lead positioning and stability independent of vessel anatomy.
Purpose
To compare implant procedure parameters and electrical performance/stability of a novel active fixation lead with passive fixation CS leads.
Methods
This was a retrospective study involving 6 major UK cardiac centres. Patients who received active leads were compared with passive lead recipients in a 1:2 ratio. The primary outcome was total lead displacements (combined macro/micro-displacements, defined as displacements requiring repositioning procedures, or an increase in threshold≥0.5 volts or pulse width≥0.5msec, or a change in pacing polarity). Multivariate analysis was performed to establish predictors of the primary outcome, assessing fixation mechanism (active or passive), number of poles (quad or bipolar), contributing hospital and follow-up duration.
Results
736 patients were included (241 with active leads, 495 with passive leads). There were no group differences in the baseline characteristics with respect to age, gender, EF, NYHA class, and co-morbidities, P>0.05 for all. The primary endpoint rate was 31% (74/241) in the active and 43% (213/495) in the passive fixation group (P=0.002). 6 patients in the active group and 14 in the passive group required CS lead repositioning procedures. The results of the multivariate analysis are presented in the Table. The use of active leads was associated with a significant reduction in lead displacements, odds ratio 0.62 (95% CI 0.43–0.9), P=0.012. There were differences in favour of passive compared with active leads in procedure duration, 120 [96–149] minutes vs 128 [105–155] minutes (P=0.011), and fluoroscopy time, 17 [11–26] minutes vs 18.5 [13–27] minutes (P=0.028). The median duration of follow up was similar (active vs passive): 31 [17–47] weeks vs 34 [16–71] weeks, (P=0.052).
Odds Ratio (95% Confidence Interval) P-value Active fixation CS lead 0.62 (0.43–0.9) 0.012 Quadripolar (rather than Bipolar) lead 1.26 (0.75–2.11) 0.376 Follow-up Duration (weeks) 1.005 (1.001–1.008) 0.025 Also included in the model: contributing hospital, which was significant.
Conclusion
In this large, multi-centre study, active fixation Attain Stability CS leads demonstrated superior electrical performance/stability compared with passive fixation leads, with minimal increases in implant procedure and fluoroscopy times.
Acknowledgement/Funding
None
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Affiliation(s)
- D Gerontitis
- University Hospital Southampton NHS Foundation Trust, Cardiology Department, Southampton, United Kingdom
| | - J Wardley
- Norfolk and Norwich University Hospital, Department of Cardiology, Norwich, United Kingdom
| | - M Chapman
- James Cook University Hospital, Middlesbrough, United Kingdom
| | - A Zegard
- Aston University, Aston Medical Research Institute, Aston Medical School, Birmingham, United Kingdom
| | - E Sammut
- Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - M Bates
- James Cook University Hospital, Middlesbrough, United Kingdom
| | - P Waddingham
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - I Diab
- Bristol Heart Institute, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - A Chow
- Barts Heart Centre, St Bartholomew's Hospital, London, United Kingdom
| | - F Leyva
- Aston University, Aston Medical Research Institute, Aston Medical School, Birmingham, United Kingdom
| | - A Turley
- James Cook University Hospital, Middlesbrough, United Kingdom
| | - I Williams
- Norfolk and Norwich University Hospital, Department of Cardiology, Norwich, United Kingdom
| | - W Ullah
- University Hospital Southampton NHS Foundation Trust, Cardiology Department, Southampton, United Kingdom
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Honarbakhsh S, Schilling RJ, Dhillon G, Ullah W, Keating E, Providencia R, Baker V, Chow A, Earley MJ, Hunter RJ. P1171Validation of a novel mapping system and utility for mapping complex atrial tachycardias. Europace 2018. [DOI: 10.1093/europace/euy015.656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- S Honarbakhsh
- Barts Health NHS Trust, Electrophysiology, London, United Kingdom
| | - R J Schilling
- Barts Health NHS Trust, Electrophysiology, London, United Kingdom
| | - G Dhillon
- Barts Health NHS Trust, Electrophysiology, London, United Kingdom
| | - W Ullah
- Barts Health NHS Trust, Electrophysiology, London, United Kingdom
| | - E Keating
- Barts Health NHS Trust, Electrophysiology, London, United Kingdom
| | - R Providencia
- Barts Health NHS Trust, Electrophysiology, London, United Kingdom
| | - V Baker
- Barts Health NHS Trust, Electrophysiology, London, United Kingdom
| | - A Chow
- Barts Health NHS Trust, Electrophysiology, London, United Kingdom
| | - M J Earley
- Barts Health NHS Trust, Electrophysiology, London, United Kingdom
| | - R J Hunter
- Barts Health NHS Trust, Electrophysiology, London, United Kingdom
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Honarbakhsh S, Hunter RJ, Dhillon G, Ullah W, Keating E, Providencia R, Chow A, Earley MJ, Schilling RJ. Validation of a novel mapping system and utility for mapping complex atrial tachycardias. J Cardiovasc Electrophysiol 2018; 29:395-403. [PMID: 29364554 DOI: 10.1111/jce.13437] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 11/04/2017] [Revised: 11/30/2017] [Accepted: 12/15/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION This study sought to validate a novel wavefront mapping system utilizing whole-chamber basket catheters (CARTOFINDER, Biosense Webster). The system was validated in terms of (1) mapping atrial-paced beats and (2) mapping complex wavefront patterns in atrial tachycardia (AT). METHODS AND RESULTS Patients undergoing catheter ablation for AT and persistent AF were included. A 64-pole-basket catheter was used to acquire unipolar signals that were processed by CARTOFINDER mapping system to generate dynamic wavefront propagation maps. The left atrium was paced from four sites to demonstrate focal activation. ATs were mapped with the mechanism confirmed by conventional mapping, entrainment, and response to ablation. Twenty-two patients were included in the study (16 with AT and 6 with AF initially who terminated to AT during ablation). In total, 172 maps were created with the mapping system. It correctly identified atrial-pacing sites in all paced maps. It accurately mapped 9 focal/microreentrant and 18 macroreentrant ATs both in the left and right atrium. A third and fourth observer independently identified the sites of atrial pacing and the AT mechanism from the CARTOFINDER maps, while being blinded to the conventional activation maps. CONCLUSIONS This novel mapping system was effectively validated by mapping focal activation patterns from atrial-paced beats. The system was also effective in mapping complex wavefront patterns in a range of ATs in patients with scarred atria. The system may therefore be of practical use in the mapping and ablation of AT and could have potential for mapping wavefront activations in AF.
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Affiliation(s)
- S Honarbakhsh
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - R J Hunter
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - G Dhillon
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - W Ullah
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - E Keating
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - R Providencia
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - A Chow
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - M J Earley
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
| | - R J Schilling
- Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, United Kingdom
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Honarbakhsh S, Schilling RJ, Dhillon G, Ullah W, Keating E, Providencia R, Chow A, Earley MJ, Hunter RJ. 6A novel mapping system for panoramic mapping of the left atrium: validation and application to detect and characterise localised sources maintaining AF. Europace 2017. [DOI: 10.1093/europace/eux283.146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Sawhney V, Shaukat M, Volkova E, Yao Q, Jones N, Ullah W, Honarbakhsh S, Lowe M, Lambiaise P, Dhinoja M, Finlay M, Sporton S, Earley MJ, Schilling RJ, Hunter RJ. P1726Catheter ablation for atrial fibrillation on uninterrupted NOACs: a safe approach? Europace 2017. [DOI: 10.1093/ehjci/eux161.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Honarbakhsh S, Ullah W, Keating E, Dhillon G, Finlay M, Earley MJ, Schilling RJ, Hunter RJ. P246Validation of a novel high resolution mapping system for panoramic mapping of the left atrium: potential for mapping drivers in atrial fibrillation. Europace 2017. [DOI: 10.1093/ehjci/eux171.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Ullah W, Schilling RJ, Wong T. Contact Force and Atrial Fibrillation Ablation. J Atr Fibrillation 2016; 8:1282. [PMID: 27909471 DOI: 10.4022/jafib.1282] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 08/20/2015] [Accepted: 08/21/2015] [Indexed: 11/10/2022]
Abstract
Catheters able to measure the force and vector of contact between the catheter tip and myocardium are now available. Pre-clinical work has established that the degree of contact between the radiofrequency ablation catheter and myocardium correlates with the size of the delivered lesion. Excess contact is associated with steam pops and perforation. Catheter contact varies within the left atrium secondary to factors including respiration, location, atrial rhythm and the trans-septal catheter delivery technology used. Compared with procedures performed without contact force (CF)-sensing, the use of this technology has, in some studies, been found to improve complication rates, procedure and fluoroscopy times, and success rates. However, for each of these parameters there are also studies suggesting a lack of difference from the availability of CF data. Nevertheless, CF-sensing technology has been adopted as a standard of care in many institutions. It is likely that use of CF-sensing technology will allow for the optimization of each individual radiofrequency application to maximize efficacy and procedural safety. Recent work has attempted to define what these optimal targets should be, and approaches to do this include assessing for sites of pulmonary vein reconnection after ablation, or comparing the impedance response to ablation. Based on such work, it is apparent that factors including mean CF, force time integral (the area under the force-time curve) and contact stability are important determinants of ablation efficacy. Multicenter prospective randomized data are lacking in this field and required to define the CF parameters required to produce optimal ablation.
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Affiliation(s)
- W Ullah
- Cardiology Research Department, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - R J Schilling
- Cardiology Research Department, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - T Wong
- Cardiology Research Department, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
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Sawhney V, Breitenstein A, Ullah W, Finlay M, Sporton S, Earley M, Chow A, Dhinoja M, Lambiase P, Schilling R, Hunter R. Epicardial catheter ablation for ventricular tachycardia on uninterrupted warfarin: A safe approach for those with a strong indication for peri-procedural anticoagulation? Int J Cardiol 2016; 222:57-61. [DOI: 10.1016/j.ijcard.2016.07.113] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2016] [Revised: 06/27/2016] [Accepted: 07/07/2016] [Indexed: 10/21/2022]
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Raine D, Begg G, Moore J, Taylor E, Buck R, Honarbakhsh S, Yew Ding W, Redfearn D, Opel A, Opel A, Thomas D, Prakash K, Thomas D, Khokhar A, Honarbakhsh S, Tairova S, Getman N, McAloon C, Honarbakhsh S, Shah M, Al-Lawati K, Al-Lawati K, Ensam B, Collins G, Akbar S, Merghani A, Furniss G, Yones E, Vijayashankar SS, Vijayashankar SS, Shariat H, Moss A, Yeoh A, Sadiq A, Taylor R, Edwards T, Nizam ud Din K, Langley P, Shepherd E, Murray S, Lord S, Bourke J, Plein S, Lip G, Tayebjee MH, Owen N, White S, O'Neill M, Hughes L, Carroll S, Moss-Morris R, Baker V, Kirkby C, Patel K, Robinson G, Antoniou S, Richmond L, Ullah W, Hunter R, Finlay M, Earley M, Whitbread M, Schilling R, Cooper R, Modi S, Somani R, Ng A, Hobson N, Caldwell J, Hadjivassilev S, Ang R, Finlay M, Dhinoja M, Earley M, Sporton S, Schilling R, Hunter R, Hadjivassilev S, Earley M, Lambiase P, Turley A, Child N, Linker N, Owens W, James S, Milner J, Tayebjee M, Sibley J, Griffiths A, Meredith T, Basher Y, Betts T, Rajappan K, Lambiase P, Lowe M, Hunter R, Schilling R, Finlay M, Rakhimbaeva G, Akramova N, Getman T, Hamborg T, O'Hare J, Randeva H, Osman F, Srinivasan N, Kirkby C, Firman E, Tobin L, Murphy C, Lowe M, Hunter R, Finlay M, Schilling R, Lambiase P, Mohan P, Salahia G, Lim H, Lim HS, Batchvarov V, Brennan P, Cox A, Muir A, Behr E, Hamill S, Laventure C, Newell S, Gordon B, Bashir K, Chuen J, Foster W, Yusuf S, Osman F, Hayat S, Panagopoulos D, Davies E, Tomlinson D, Haywood G, Mullan J, Kelland N, Horwood A, Connell N, Odams S, Maloney J, Shetty A, Kyriacou A, Sahu J, Lee J, Uzun O, Wong A, Ashtekar S, Uzun O, Wong A, Ashtekar S, Hashemi J, Gazor S, Redfearn D, Song A, Jenkins J, Glancy J, Wilson D, Sammut E, Diab I, Cripps T, Gill A, Abbas S, Enye J, Wahab A, Elshafie S, Ling K, Carey P, Chatterjee D, Timbrell S, Tufail W, Why H, Martos R, Thornley A, James S, Turley A, Bates M, Linker N, Hassan E, Quick J, Cowell R, Ho E. POSTERS (1)59MULTIPOLAR CONTACT MAPPING GUIDED ABLATION OF TEMPORALLY STABLE HIGH FREQUENCY AND COMPLEX FRACTIONATED ATRIAL ELECTROGRAM SITES IN PATIENTS WITH PERSISTENT ATRIAL FIBRILLATION60INTRA-CARDIAC AND PERIPHERAL LEVELS OF BIOCHEMICAL MARKERS OF FIBROSES IN PATIENTS UNDERGOING CATHETER ABLATION FOR ATRIAL FIBRILATION61THE DON'T WAIT TO ANTICOAGULATE PROJECT (DWAC) BY THE WEST OF ENGLAND ACADEMIC HEALTH SCIENCE NETWORK (AHSN) OPTIMISES STROKE PREVENTION FOR PATIENTS WITH ATRIAL FIBRILLATION (AF) WITHIN PRIMARY CARE IN LINE WITH NICE CG180 IN THE WEST OF ENGLAND62ILLNESS AND TREATMENT REPRESENTATIONS, COPING AND DISTRESS: VICIOUS CYCLES OF EVERYDAY EXPERIENCES IN PATIENTS WITH PERSISTENT ATRIAL FIBRILLATION63THE NEEDS OF THE ADOLESCENT LIVING WITH AN INHERITED CARDIAC CONDITION: THE PATIENTS' PERSPECTIVE64SAFETY AND EFFICACY OF PARAMEDIC TREATMENT OF REGULAR SUPRAVENTRICULAR TACHYCARDIA (PARA-SVT)65NATURAL PROGRESSION OF QRS DURATION FOLLOWING IMPLATABLE CARDIOVERTER DEFIBRILLATORS (ICD) - IMPLANTATION66COMPARISON OF EFFICACY OF VOLTAGE DIRECTED CAVOTRICUSPID ISTHMUS ABLATION USING MINI VS CONVENTIONAL ELETRODES67CRYOBALLOON ABLATION (CRYO) FOR ATRIAL FIBRILLATION (AF) CANNOT BE GUIDED BY TEMPERATURE END-POINTS ALONE68MODERATOR BAND ECTOPY UNMASKED BY ADENOSINE AS A CAUSE OF ECTOPIC TRIGGERED IDIOPATHIC VF69EARLY CLINICAL EXPERIENCE WITH TARGETED SITE SELECTION FOR THE WiCS-LV ELECTRODE FOR CRT70DOES VECTOR MAPPING PRIOR TO IMPLANTABLE LOOP RECORDER INSERTION IMPROVE THE DETECTION OF ARRHYTHMIA?71THE ROLE OF SPECKLE TRACKING STRAIN IMAGING IN ASSESSING LEFT VENTRICULAR RESPONSE TO CARDIAC RESYNCHRONISATION THERAPY IN RESPONDERS AND NON-RESPONDERS72EVALUATING PATIENTS' EXPERIENCE AND SATISFACTION OF THE ATRIAL FIBRILLATION ABLATION PROCEDURE: A RETROSPECTIVE ANALYSIS73TROUBLESHOOTING LV LEAD IMPLANTATION - NOVEL “UNIRAIL TECHNIQUE”74SUBCLINICAL ATHEROSCELEROSIS AND COGNITIVE IMPAIRMENT75EFFECT OF LOZARTANE ON DEVELOPMENT OF THE ELECTRICAL INSTABILITY OF THE MYOCARDIUM76THE INTERPLAY BETWEEN BODY COMPOSITION AND LEFT VENTRICULAR REMODELLING IN CARDIAC RESYNCHRONISATION THERAPY77FAMILY SCREENING IN IDIOPATHIC VENTRICULAR FIBRILLATION78MANAGEMENT OF ATRIAL FIBRILLATION IN A LARGE TEACHING HOSPITAL79THE EFFECT OF LEFT VENTRICULAR LEAD POSITION ON SURVIVAL IN PATIENTS WITH BINVENTRICULAR PACEMAKRS/DEFIBRILLATORS80ACUTE DEVICE IMPLANT-RELATED COMPLICATIONS DO NOT INCREASE LATE MORTALITY81ABORTED CARIDAC ARREST AS THE SENTINEL PRESENTATION IN A COHORT OF PATIENTS WITH THE CONCEALED BRUGADA PHENOTYPE82POST-CARDIAC DEVICE IMPLANTATION MOBILISATION ADVICE: A NATIONAL SURVEY83DO RISK SCORES DEVELOPED TO PROTECT ONE-YEAR MORTALITY ACTUALLY HELP IN ACCURATELY SELECTING PATIENTS RECEIVING PRIMARY PREVENTION ICD?84ATRIAL TACHYCARDIA ARISING FROM THE NON-CORONARY AORTIC CUSP85THE EFFECT OF DIFFERENT ATRIAL FIBRILLATION ABLATION STRATEGIES ON SURFACE ECG P WAVE DURATION86PRESCRIBING DRONEDARONE: HOW IS IT DONE ACROSS THE UK AND IS IT SAFE?87A CASE OF WIDE COMPLEX TACHYCARDIA88TRANSITION TO DEDICATED DAY CASE DEVICES - SAFETY AND EFFICACY IN A LARGE VOLUME CENTRE89SEQUENTIAL REGIONAL DOMINANT FREQUENCY MAPPING DURING ATRIAL FIBRILLATION: A NOVEL TEQUNIQUE90ELECTIVE CARDIOVERSION ENERGY PROTOCOLS: A RETROSPECTIVE COMPARISON OF ESCALATION STRATEGIES91THE INCIDENCE OF CLINCALLY RELEVANT HAEMATOMAS WITH PERIOPERATIVE USE OF NEWER P2Y12 INHIBITORS AND INTERRUPTED NOAC THERAPY IN CARDIAC IMPLANTABLE ELECTRONIC DEVICE INSERTION92AN AUDIT OF THE OUTCOMES FOR CHEMICAL AND DIRECT CURRENT CARDIOVERSION FOR ATRIAL FIBRILLATION AT OUR DGH OVER A 3 YEAR DURATION93REAL LIFE ACUTE MANAGEMET OF HAEMODYNAMICALLY TOLERATED MONOMORPHIC VENTRICULAR TACHYCARDIA. ARE WE MAKING EVIDENCE BASED ON DECISIONS?94A SERVICE EVALUATION TO ASSESS THE EFFICACY AND SAFETY OF NOVEL ORAL ANTICOAGULANTS VERSUS WARFARIN FOR ELECTIVE CARDIVERSION IN PATIENTS WITH NON VALVULAR AF IN A NURSE LED CARDIOVERSION SERVICE95PICK UP RATE OF IMPLANTED LOOP RECORDER AT A DISTRICT HOSPITAL. Europace 2016. [DOI: 10.1093/europace/euw273] [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
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Furniss G, Opel A, Hussein A, Pearman C, Grace A, Connelly D, Orlowski A, Banerjee A, McNicholas T, Providencia R, Montañes M, Providencia R, Panagopoulos D, Tomlinson D, Dalrymple-Hay M, Haywood G, Butler A, Ang R, Ullah W, Schwartz R, Fannon M, Finlay M, Hunter R, Schilling R, Das M, Asfour I, Morgan M, Ronayne C, Shaw M, Snowdon R, Gupta D, Todd D, King R, Hall M, Modi S, Mediratta N, Gupta D, Reddy V, Neuzil P, Willems S, Verma A, Heck P, Schilling R, Lambiase P, Hall M, Nicholl B, McQueenie R, Jani BD, McKeag N, Gallacher K, Mair F, Heaton D, Macdonald J, Burnell J, Ryan R, Marshall T, Sutton C, O'Callaghan S, Kenny R, Karim N, Srinivasan N, Ferreira M, Goncalves L, Lambiase P, Toledano M, Field E, Walsh H, Maguire K, Cervi E, Kaski J, Perez Tome M, Pantazis A, Elliott P, Lambiase P, Segal O. ORAL ABSTRACTS (3)EP & Ablation31LEFT ATRIAL POSTERIOR WALL ISOLATION (THE “BOX LESION PATTERN”) IN THE TREATMENT OF ATRIAL FIBRILLATION: A SINGLE CENTRE EXPERIENCE32DAY CASE CRYOBLATION (CRYO) FOR PAROXYSMAL ATRIAL FIBRILLATION (pAF) IN THE DISTRICT GENERAL HOSPITAL IS SAFE AND EFFECTIVE IF DONE IN HIGH VOLUME WITH EXPERIENCED OPERATORS33ABLATION INDEX-GUIDED PULMONARY VEIN ISOLATION FOR ATRIAL FIBRILLATION MAY IMPROVE CLINICAL OUTCOMES IN COMPARISON TO CONTACT FORCE-GUIDED ABLATION34THE PROCEDURAL COMPLICATION RATES AND SHORT-TERM SUCCESS RATES OF THORACOSCOPIC AF ABLATION DURING THE INSTITUTIONAL LEARNING CURVE35INITIAL PROCEDURAL RESULTS FROM DDRAMATIC-SVT STUDY: DD MECHANISM IDENTIFICATION AND LOCALISATION USING DIPOLE DENSITY MAPPING TO GUIDE ABLATION STRATEGY36MORBIDITY AND MORTALITY IN MIDDLE-AGED INDIVIDUALS WITH ATRIAL FIBRILLATION: UK BIOBANK DATAClinical EP37THE GM AHSN AF LANDSCAPE TOOL: A SHARED PUBLIC DATA PLATFORM TO PROMOTE QUALITY IMPROVEMENTS AND IDENTIFY OPPORTUNITIES TO PREVENT AF-RELATED STROKE IN THE DEVOLVED GREATER MANCHESTER HEALTH SYSTEM38REAL WORLD PERSISTENCE, ADHERENCE AND SWITCH-OVER ACROSS ANTICOAGULANTS IN ATRIAL FIBRILLATION-A NATIONAL POPULATION-BASED STUDY39ORTHOSTATIC HYPOTENSION AND ATRIAL FIBRILLATION40PREVALENCE OF SHORT QT AND CRITERIA OF SEVERITY IN A YOUNG ASYMPTOMATIC COHORT41SURFACE ELECTROCARDIOGRAPHIC FEATURES AND PREVALENCE OF ARRHYTHMIAS IN PAEDIATRIC FRIEDREICH'S ATAXIA42RISK STRATIFICATION OF TYPE 1 MYOTONIC DYSTROPHY: IS THE ECG ACCURATE ENOUGH TO SELECT PATIENTS AT RISK OF BRADYARRHYTHMIC EVENTS? Europace 2016. [DOI: 10.1093/europace/euw272] [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: 11/12/2022] Open
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Martin C, Papageorgiou N, Srinivasan N, Luther V, Ang R, Saberwal B, Sawhney V, Martin C, Orini M, Srinivasan N, Bhar-Amato J, Chow A, Lowe M, Simon R, Lambiase P, Providência R, Srinivasan N, Bronis K, Moscoso Costa F, Cavaco D, Adragao P, Tousoulis D, Hunter R, Schilling R, Segal O, Chow A, Rowland E, Lowe M, Lambiase P, Orini M, Providencia R, Simon R, Khan F, Segal O, Ahsan S, Chow A, Lowe M, Schilling R, Taggart P, Lambiase P, Linton N, Jamil-Copley S, Koa-Wing M, Lim P, Qureshi N, Whinnett Z, Davies D, Peters N, Kanagaratnam P, Opel A, Ullah W, Baker V, Finlay M, Dhinoja M, Earley M, Sporton S, Hunter R, Schilling R, Roy A, Perera D, Sporton S, Dhinoja M, Segal O, Lambiase P, Lowe M, Chow A, Hunter R, Rowland E, Khan F, Ezzat V, Providencia R, Earley M, Finlay M, Schilling R, Ahsan S, Bacuetes EB, Wray MW, Dhinoja MD, Earley ME, Schilling RJS, Sporton SS, Curtain J, Gajendragadkar P, Begley D, Fynn S, Grace A, Heck P, Virdee M, Salaunkey K, Agarwal S. MODERATED POSTERS (2)51GLOBAL HIGH DENSITY MAPPING OF RE-ENTRY VULNERABILITY INDEX INDENTIFIES SITES OF RIGHT VENTRICULAR ARRHYTHMIA INITIATION IN BRUGADA SYNDROME AND ARVC52THE ROLE OF ADENOSINE-GUIDED PULMONARY VEIN ISOLATION IN PATIENTS UNDERGOING ATRIAL FIBRILLATION ABLATION:AN UPDATED META-ANALYSIS53FIRST EVIDENT THAT T-PEAK AND TPEAK-TEND CORRELATE WITH RIGHT TO LEFT AND TRANSMURAL DYNAMIC DISPERSION OF REPOLARIZATION IN THE INTACT HUMAN HEART54RIPPLE MAPPING VENTRICULAR SCAR TO CHARACTERIZE CHANNELS SUPPORTING RE-ENTRANT TACHYCARDIA AS A GUIDE TO ABLATION55LONG TERM DURABILITY OF PULMONARY VEIN ISOLATION: INSIGHTS FROM A RANDOMISED TRIAL OF CRYOBALLOON VERSUS RADIOFREQUENCY ABLATION FOR A COMBINED APPROACH56A SINGLE-CENTRE EXPERIENCE OF THE CONVERGENT PROCEDURE FOR THE TREATMENT OF LONG-STANDING PERSISTENT ATRIAL FIBRILLATION57MODERATE SEDATION IN THE CARDIAC ELECTROPHYSIOLOGY LABORATORY: A RETROSPECTIVE ANALYSIS TO ASSESS SAFETY58USE OF GENERAL ANAESTHESIA IN CATHETER ABLATION OF PERSISTENT AF: IMPROVED OUTCOME AND COST EFFECTIVENESS:. Europace 2016. [DOI: 10.1093/europace/euw269] [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
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Honarbakhsh S, Baker V, Kirkby C, Patel K, Robinson G, Antoniou S, Richmond L, Ullah W, Hunter RJ, Finlay M, Earley MJ, Whitbread M, Schilling RJ. Safety and efficacy of paramedic treatment of regular supraventricular tachycardia: a randomised controlled trial. Heart 2016; 103:1413-1418. [PMID: 27613170 DOI: 10.1136/heartjnl-2016-309968] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Revised: 07/27/2016] [Accepted: 08/01/2016] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Supraventricular tachycardias (SVTs) are a common cause of acute hospital presentations. Adenosine is an effective treatment. To date, no studies have directly compared paramedic-with hospital-delivered treatment of acute SVT with adenosine. METHOD Randomised controlled trial comparing the treatment of SVT and discharge by paramedics with conventional emergency department (ED)-based care. Patients were excluded if they had structural heart disease or contraindication to adenosine. Discharge time, follow-up management, costs and patient satisfaction were compared. RESULTS Eighty-six patients were enrolled: 44 were randomised to paramedic-delivered adenosine (PARA) and 42 to conventional care (ED). Of the 37 patients in the PARA group given adenosine, the tachycardia was successfully terminated in 81%. There was a 98% correlation between the paramedics' ECG diagnosis and that of two electrophysiologists. No patients had any documented adverse events in either group. The discharge time was lower in the PARA group than in the ED group (125 min (range 55-9513) vs 222 min (range 72-26 153); p=0.01), and this treatment strategy was more cost-effective (£282 vs £423; p=0.01). The majority of patients preferred this management approach. Being treated and discharged by paramedics did not result in the patients being less likely to receive ongoing management of their arrhythmia and cardiology follow-up. CONCLUSIONS Patients with SVT can effectively and safely be treated with adenosine delivered by trained paramedics. Implementation of paramedic-delivered acute SVT care has the potential to reduce healthcare costs without compromising patient care. TRIAL REGISTRATION NUMBER NCT02216240.
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Affiliation(s)
- S Honarbakhsh
- Cardiovascular Biomedical Research Unit, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - V Baker
- Cardiovascular Biomedical Research Unit, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - C Kirkby
- Cardiovascular Biomedical Research Unit, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - K Patel
- Cardiovascular Biomedical Research Unit, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - G Robinson
- Cardiovascular Biomedical Research Unit, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - S Antoniou
- Cardiovascular Biomedical Research Unit, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - L Richmond
- Cardiovascular Biomedical Research Unit, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - W Ullah
- Cardiovascular Biomedical Research Unit, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - R J Hunter
- Cardiovascular Biomedical Research Unit, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - M Finlay
- Cardiovascular Biomedical Research Unit, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | - M J Earley
- Cardiovascular Biomedical Research Unit, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
| | | | - R J Schilling
- Cardiovascular Biomedical Research Unit, Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London, UK
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Heck P, Luther V, Luther V, Williams S, Schricker A, Zaman J, Ang R, Li X, Aziz S, Sugihara C, Grace A, Reddy V, Neuzil P, Linton N, Koa-Wing M, Lim P, Jamil-Copley S, Whinnett Z, Qureshi N, Ng F, Hayat S, Davies D, Peters N, Kanagaratnam P, Jamil-Copley S, Linton N, Koa-Wing M, Lim P, Hayat S, Ng F, Davies D, Peters N, Kanagaratnam P, Chubb H, Harrison J, Whitaker J, Cooklin M, Rinaldi C, Gill J, Wright M, Plank G, Niederer S, O'Neill M, Zaman J, Baykaner T, Lalani G, Hopper K, Moyeda A, Krummen D, Narayan S, Lalani G, Baykaner T, Swerdlow M, Park S, Krummen D, Wang P, Narayan S, Opel A, Ullah W, Baker V, Finlay M, Dhinoja M, Earley M, Sporton S, Schilling R, Hunter R, Chu G, Almeida T, Vanheusden F, Dastagir N, Salinet J, Stafford P, Schlindwein F, Ng G, Chubb H, Harrison J, Williams S, Whitaker J, Wright M, Schaeffter T, Razavi R, O'Neill M, Barlow N, Owens E, Sallomi D, Furniss S, Sulke N. Mapping & Ablation19Novel global ultrasound imaging and continuous dipole density mapping: initial findings in AF patients20Low voltage functional myocardium is critical in determining the substrate of post-ablation atrial tachycardia: results from a prospective study using ripple mapping distinguishing low-voltage scar from conducting tissue21Ripple mapping of post infarct ventricular scar to identify conduction channels and guide substrate based ablation22Effect of chamber geometry and activation pattern on optimal local activation time sampling density for tachycardia diagnosis25Clinical measures of good basket placement predict successful outcome from atrial fibrillation rotor ablation26Unipolar electrogram amplitude is reduced at rotor sites critical to focal termination of human persistent AF27Cryoballoon versus point by point radiofrequency ablation or a novel combined approach: long term follow up and comparison of patterns of pulmonary vein reconnection between different ablation strategies in a randomised controlled trial28Recurrent high dominant frequency patterns in persistent atrial fibrillation29Optimisation of late gadolinium enhanced (LGE) cmr imaging of atrial ablation scar30Hyperacute and chronic changes in cerebral magnetic resonance images after PVAC, NMARQ and epicardial thoracoscopic surgical ablation for paroxysmal atrial fibrillation. Europace 2015. [DOI: 10.1093/europace/euv326] [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: 11/15/2022] Open
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Ullah W, McLean A, Tayebjee M, Gupta D, Ginks M, Haywood G, O'Neil M, Lambiase P, Schilling R. 72 * Contact force timing reduces pulmonary vein reconnection, early results from the smart AF trial. Europace 2014. [DOI: 10.1093/europace/euu243.6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Ullah W, Hunter RJ, Baker V, Dhinoja MB, Earley MJ, Sporton S, Schilling RJ. 68 * Catheter contact force and human left atrial electrogram parameters in sinus rhythm and atrial fibrillation. Europace 2014. [DOI: 10.1093/europace/euu243.2] [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
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Ullah W, Hunter RJ, Baker V, Dhinoja MB, Earley MJ, Sporton S, Schilling RJ. 48 * Factors affecting catheter contact in the human left atrium and their impact on ablation efficacy. Europace 2014. [DOI: 10.1093/europace/euu240.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Hunter RJ, Lee G, Ullah W, Finlay M, Lovell M, Baker V, McLean A, Dhinoja M, Earley MJ, Sporton S, Schilling RJ. 30 * Use of a contact force sensing catheter with advanced catheter location significantly reduces fluoroscopy time and radiation dose in catheter ablation of atrial fibrillation. Europace 2014. [DOI: 10.1093/europace/euu238.12] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Phan TT, Khan S, Dewhurst M, Lee D, James S, de Belder M, Linker NJ, Thornley A, Turley AJ, Ahmed FZ, Arumugam P, Allen S, Daniels K, Clarke B, Mamas M, James J, Zaidi AM, Ullah W, Hunter R, Lovell M, Dhinoja M, Earley M, Sporton S, Schilling R, Raju H, Hedley P, Arno G, Ware J, Jeffery S, Cook S, Christiansen M, Behr ER, Sohal M, Chen Z, Sammut E, Jackson T, Child N, Wright M, O'Neill M, Cooklin M, Gill J, Carr-White G, Razavi R, Rinaldi CA, Nunn LM, Lopes L, Syrris P, Plagnol V, Firman E, Dalageorgou C, Domingo D, Zorio E, Murday V, Findlay I, Duncan A, Fynn S, White A, Goddard M, Carr-White G, Robert L, Bueser T, Langman C, Bundgaard H, Ferrero-Miliani L, Wheeldon N, O'Beirne A, Suvarna SK, Lowe MD, McKenna WJ, Elliott PM, Lambiase PD. YOUNG INVESTIGATORS COMPETITION, HRC 2013. Europace 2013. [DOI: 10.1093/europace/eut313] [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: 11/12/2022] Open
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Riley G, Hopkins S, Piccini I, Brown N, Fabritz L, Kirchhof P, Raju H, Bevan S, Sheppard MN, Behr ER, Ng FS, Sulkin MS, Peters NS, Efimov IR, Vanheusden FJ, Li X, Chu GS, Almeida TP, Schlindwein FS, Ng GA, Crockford CJ, Ahmed O, Kaba R, Berry R, Dhillon OS, Ullah W, Hunter R, Lovell M, Dhinoja M, Sporton S, Earley MJ, Diab IG, Schilling RJ, Goonewardene M, Heck PM, Begley DA, Fynn S, Virdee M, Grace A, Agarwal SC, Wilson DG, Ahmed N, Nolan R, French A, Frontera A, Duncan ER, Thomas G. MODERATED POSTERS, SESSION 1, HRC 2013. Europace 2013. [DOI: 10.1093/europace/eut317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lee G, Hunter R, Lovell M, Finlay M, Sawhney V, Ullah W, Diab I, Dhinoja M, Earley M, Sporton S, Schilling RJ, Williams SE, Linton NWF, Harrison J, Wright M, O'Neill M, Jamil-Copley S, Linton N, Koa-Wing M, Lim PB, Hayat S, Qureshi N, Whinnett Z, Davies W, Peters N, Francis D, Kanagaratnam P, Jamil-Copley S, Ryan B, Kojodjojo P, Qureshi N, Koa-Wing M, Hayat S, Kyriacou A, Sandler B, Sohaib A, Wright I, Davies W, Peters N, Whinnett Z, Kanagaratnam P, Lim PB, Qureshi NA, Bai W, Ariff B, Williams A, Monro C, Kim S, Jamil-Copley S, Hayat S, Kao-Wing M, Kyriacou A, Sandler B, Fu NS, Kanagaratnam P, Whinnett Z, Davies DW, Lefroy D, Peters NS, Lim PB, Ryan MJ, Ezzat VA, O'Leary J, Bull C, Chow A, Lambiase P, Lowe MD, Anwar AS, Collitt S, Iddon P, Rice N, Dodd M, Dunsdale A, Petkar S, Mudd J, Linker N, Fitzpatrick AP, Fraser S, Choo WK, Padfield G, Rushworth G, Bloe C, Forsyth P, Cross SJ, Leslie SJ, Phan TT, Dewhurst M, Lee D, Williams D, James S, Thornley A, de Belder M, Linker N, Turley A, Campbell NG, Cantor E, Sawhney V, Duncan ER, Demartini C, Baker V, Diab IG, Dhinoja M, Earley MJ, Sporton S, Davies LC, Schilling RJ, Pettit SJ, Randles DA, Shaw M, Hawkins NM, Wright DJ, Lambiase PD, Barr C, Knops R, Neuzil P, Theuns D, Johansen JB, Hood M, Pederson S, Reeve HL, Boersma L. ABSTRACTS FOR ORAL PRESENTATION, SESSION 3, HRC 2013. Europace 2013. [DOI: 10.1093/europace/eut316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Fabritz L, Fortmuller L, Vloumidi E, Yue TY, Syeda F, Kirchhof P, Leube R, Krusche C, Chin SH, Winter J, Brack KE, Ng GA, Ng FS, Holzem KM, Koppel AC, Janks D, Wit AL, Peters NS, Efimov IR, Chowdhury RA, El-Harasis MA, Dupont E, Terracciano CMN, Peters NS, Mellor GJ, Raju H, de Noronha SV, Papadakis M, Sharma S, Behr ER, Sheppard MN, Jamil-Copley S, Bai W, Ariff B, Lim PB, Koa-Wing M, Kyriacou A, Hayat S, Sohaib A, Qureshi N, Sandler B, O'Regan D, Whinnett Z, Davies W, Rueckert D, Kanagaratnam P, Peters N, Lambiase PD, Chow AW, Lowe MD, Segal OR, Ahsan S, de Bono J, Dhaliwal M, Mfuko C, Ng A, Sandilands A, Paisey J, Roberts P, Morgan JM, McCready J, Yue A, Ullah W, Hunter R, Lovell M, Dhinoja M, Sporton S, Earley M, Schilling R, Ghosh J, Martin A, Keech A, Chan KH, Gomes S, Singarayar S, McGuire M, Lee G, Hunter R, Berriman T, Diab I, Kamdar R, Richmond L, Baker V, Goromonzi F, Sawhney V, Duncan E, Unsworth B, Mayet J, Abrams D, Dhinoja M, Sporton S, Earley M, Schilling RJ, Bowers RW, Mulholland V, Balasubramaniam RN, Paisey JR, Sopher SM, Chu GS, Chin SH, Winter J, Armstrong S, Masca N, Almeida TP, Brown PD, Sandilands AJ, Schlindwein FS, Ng GA. ABSTRACTS FOR ORAL PRESENTATION, SESSION 2, HRC 2013. Europace 2013. [DOI: 10.1093/europace/eut315] [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
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Ullah W, Hunter R, Lovell M, Dhillon O, Diab I, Dhinoja M, Earley M, Sporton S, Schilling R. Contact force during ablation of persistent atrial fibrillation and electrogram attenuation. Eur Heart J 2013. [DOI: 10.1093/eurheartj/eht308.p2336] [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: 11/13/2022] Open
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Ullah W. The Author's reply. Heart 2010. [DOI: 10.1136/hrt.2010.205203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Khan AG, Ullah W, Azim A, Ali A. On farm demonstration of various storage methods for urea treated wheat straw. Asian Australas J Anim Sci 1996. [DOI: 10.5713/ajas.1996.281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Ullah W. Hypertension in a mixed community. Bangladesh Med Res Counc Bull 1976; 2:95-99. [PMID: 1037377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Casual blood pressure was studied in a mixed community above 20 years of age and records of hospitalised patients for hypertension and/or its complications were analysed. It was found that about 2 percent of people examined were unaware that they had elevated blood pressure. High incidence of hypertension was found in the age group of 40-50 years in the hospitalised patients.
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