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Lambrakis K, Khan E, van den Merkhof A, Papendick C, Chuang A, Zhai Y, Eng-Frost J, Rocheleau S, Lehman SJ, Blyth A, Briffa T, Quinn S, French JK, Cullen L, Chew DP. Impacts of high sensitivity troponin T reporting on care and outcomes in clinical practice: Interactions between low troponin concentrations and participant sex within two randomized clinical trials. Int J Cardiol 2023; 393:131396. [PMID: 37769972 DOI: 10.1016/j.ijcard.2023.131396] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 09/10/2023] [Accepted: 09/22/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND The impacts of high sensitivity cardiac troponin (hs-cTn) reporting on downstream interventions amongst suspected acute coronary syndrome (ACS) in the emergency department (ED), especially amongst those with newly identified hs-cTn elevations and in consideration of well-established sex-related disparities, has not been critically evaluated to date. This investigation explores the impact of hs-cTnT reporting on care and outcomes, particularly by participant sex. METHODS Two similarly ED-based randomized controlled trials conducted between July 2011 to March 2013 (n = 1988) and August 2015 to April 2019 (n = 3378) were comparatively evaluated. Clinical outcomes were adjudicated to the Fourth Universal Definition of MI. Changes in practice were assessed at 30 days, and death or MI were explored to 12 months. RESULTS The HS-Troponin study demonstrated no difference in death or MI with unmasking amongst those with hs-cTnT <30 ng/L, whereas the RAPID TnT study demonstrated a significantly higher rate. In RAPID TnT, there was significant increase in death or MI associated with unmasking for females with hs-cTnT <30 ng/L (masked: 11[1.5%], unmasked: 25[3.4%],HR: 2.27,95%C.I.:1.87-2.77,P < 0.001). Less cardiac stress testing with unmasking amongst those <30 ng/L was observed in males in both studies, which was significant in RAPID TnT (masked: 92[12.0%], unmasked: 55[7.0%], P = 0.008). In RAPID TnT, significantly higher rates of angiography in males were observed with unmasking, with no such changes amongst females <30 ng/L (masked: 28[3.7%], unmasked: 51[6.5%],P = 0.01). CONCLUSION Compared with males, there were no evident impacts on downstream practices for females with unmasking in RAPID TnT, likely representing missed opportunities to reduce late death or MI.
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Affiliation(s)
- Kristina Lambrakis
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, Australia; South Australian Department of Health, Adelaide, Australia.
| | - Ehsan Khan
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, Australia; South Australian Department of Health, Adelaide, Australia
| | - Anke van den Merkhof
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, Australia; Faculty of Medical Sciences, University of Groningen, the Netherlands
| | - Cynthia Papendick
- South Australian Department of Health, Adelaide, Australia; School of Medicine, University of Adelaide, Adelaide, Australia
| | - Anthony Chuang
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, Australia; South Australian Department of Health, Adelaide, Australia
| | - Yuze Zhai
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, Australia
| | | | | | - Sam J Lehman
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, Australia; South Australian Department of Health, Adelaide, Australia
| | - Andrew Blyth
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, Australia; South Australian Department of Health, Adelaide, Australia
| | - Tom Briffa
- School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Stephen Quinn
- Department of Statistics, Data Science and Epidemiology, Swinburne University of Technology, Melbourne, Australia
| | - John K French
- Department of Cardiology, Liverpool Hospital, University of New South Wales, Sydney, Australia
| | - Louise Cullen
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia; School of Public Health, Queensland University of Technology, Brisbane, Australia; School of Medicine, University of Queensland, Brisbane, Australia
| | - Derek P Chew
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, Australia; South Australian Department of Health, Adelaide, Australia
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Klykken C, Khan E, Karlsen C, Reed AK, Attramadal KJK, Olsen RE, Boissonnot L. Nephrocalcinosis in juvenile farmed Atlantic Salmon (Salmo salar) may be linked to osmoregulatory stress. J Fish Dis 2023; 46:943-956. [PMID: 37269206 DOI: 10.1111/jfd.13815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/12/2023] [Accepted: 05/17/2023] [Indexed: 06/04/2023]
Abstract
Nephrocalcinosis is a widespread challenge in intensive production of salmon smolt. There is however no consensus on its aetiology, which makes it problematic to implement proper measures to limit its development. We performed a survey of nephrocalcinosis prevalence and environmental factors in 11 different hatcheries in Mid-Norway as well as a 6-month monitoring in one of the hatcheries. A multivariate analysis indicated that the most influencing factor for the prevalence of nephrocalcinosis was the supplementation of sea water during smolt production. In the 6-month monitoring, the hatchery introduced salinity in the production water prior to the change in day length. Mismatch in those environmental signals may increase the risk for developing nephrocalcinosis. Salinity fluctuations prior to smoltification can cause osmotic stress and result in unbalanced levels of ions in fish blood. This was clearly illustrated in our study, as the fish experienced chronic hypercalcaemia and hypermagnesaemia. Both magnesium and calcium are excreted over the kidneys and it is possible that their prolonged, elevated levels in plasma resulted in an oversaturation of the urine when finally excreted. This again could have led to the aggregation of calcium deposits within the kidney. This study indicates a relationship between osmotic stress induced by salinity changes in juvenile Atlantic salmon and the development of nephrocalcinosis. Other factors that may affect the severity of nephrocalcinosis are currently subjects for discussion.
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Affiliation(s)
- C Klykken
- Aqua Kompetanse AS, Flatanger, Norway
- Department of Biology, Faculty of Science and Technology, Norwegian University of Science and Technology, Trondheim, Norway
| | - E Khan
- Department of Biotechnology and Food Science, Faculty of Science and Technology, Norwegian University of Science and Technology, Trondheim, Norway
| | - C Karlsen
- Aqua Kompetanse AS, Flatanger, Norway
| | - A K Reed
- Pharmaq Analytiq AS, Bergen, Norway
| | - K J K Attramadal
- Department of Biotechnology and Food Science, Faculty of Science and Technology, Norwegian University of Science and Technology, Trondheim, Norway
| | - R E Olsen
- Department of Biology, Faculty of Science and Technology, Norwegian University of Science and Technology, Trondheim, Norway
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Kumar M, Lal S, Khan E. Managing Post Operative Nausea and Vomiting and Perineal Itching A Slow and Steady Solution. Ir Med J 2023; 116:822. [PMID: 37606540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 08/23/2023]
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Rocheleau S, Eng-Frost J, Lambrakis K, Khan E, Chiang B, Wattchow N, Steele S, Lorensini S, Lehman SJ, Papendick C, Chew DP. Twelve-Month Outcomes of Patients With Myocardial Injury not Due to Type-1 Myocardial Infarction. Heart Lung Circ 2023; 32:978-985. [PMID: 37225600 DOI: 10.1016/j.hlc.2023.04.299] [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: 08/21/2022] [Revised: 03/14/2023] [Accepted: 04/20/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Diagnosis of acute myocardial infarction (AMI) requires a combination of elevated cardiac troponins, and clinical or echocardiographic evidence of coronary ischaemia. Identification of patients with a high likelihood of coronary plaque rupture (Type 1 myocardial infarction [MI]) is crucial as it is these patients for whom coronary intervention has been well-established to provide benefit and reduce subsequent coronary ischemic events. However, high-sensitivity cardiac troponin (hs-cTn) assays have increasingly identified patients with hs-cTn elevations not due to Type 1 MI where recommendations for ongoing care are currently limited. Understanding the profile and clinical outcomes for these patients may inform the development of an emerging evidence-base. METHODS Using two previously published studies (hs-cTnT study n=1,937, RAPID-TnT study n=3,270) and the Fourth Universal Definition of MI, index presentations of patients to South Australian emergency departments with suspected AMI, defined by high sensitivity cardiac troponin T (hs-cTnT) greater than the upper reference limit (14 ng/L) and without obvious corresponding ischaemia on electrocardiogram (ECG), were classified as either Type 1 MI (T1MI), Type 2 MI (T2MI), acute myocardial injury (AI), or chronic myocardial injury (CI). Patients with non-elevated hs-cTnT (defined as <14 ng/L) were excluded. Outcomes assessed included death, MI, unstable angina, and non-coronary cardiovascular events within 12 months. RESULTS In total, 1,192 patients comprising 164 (13.8%) T1MI, 173 (14.5%) T2MI/AI, and 855 (71.7%) CI were included. The rate of death or recurrent acute coronary syndrome was greatest in patients with T1MI, but also occurred with moderate frequency in Type 2 MI/AI and CI (T1MI: 32/164 [19.5%]; T2MI/AI: 24/173 [13.1%]; CI:116/885 [13.6%]; p=0.008). Of all the deaths observed, 74% occurred among those with an initial index diagnostic classification of CI. After adjusting for age, gender and baseline comorbidities, the relative hazard ratios for non-coronary cardiovascular readmissions were similar across all groups: Type 2 MI/AI: 1.30 (95% confidence interval 0.99-1.72, p=0.062); CI: 1.10 (95% confidence interval 0.61-2.00, p=0.75). CONCLUSIONS Non-T1MI accounted for the majority of patients presenting with elevated hs-cTnT without ischaemia on ECG. Patients with T1MI had the highest rates of death or recurrent AMI; however patients with T2MI/AI and CI experienced a substantial rate of non-coronary cardiovascular re-hospitalisations.
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Affiliation(s)
- Simon Rocheleau
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, SA, Australia
| | - Joanne Eng-Frost
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, SA, Australia
| | - Kristina Lambrakis
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, SA, Australia; South Australian Department of Health, Adelaide, SA, Australia
| | - Ehsan Khan
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, SA, Australia
| | - Brian Chiang
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, SA, Australia
| | - Naomi Wattchow
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, SA, Australia
| | - Simon Steele
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, SA, Australia
| | - Scott Lorensini
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, SA, Australia
| | - Sam J Lehman
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, SA, Australia; South Australian Health and Medical Research Institute, Adelaide, SA, Australia
| | | | - Derek P Chew
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, SA, Australia; South Australian Health and Medical Research Institute, Adelaide, SA, Australia; South Australian Department of Health, Adelaide, SA, Australia.
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Eng-Frost J, Rocheleau S, Lambrakis K, Khan E, van den Merkhof A, Papendick C, Lehman S, Chiang B, Wattchow N, Steele S, Lorensini S, McCann M, George K, Vaile J, De Pasquale C, French J, Chew D. Contrasting the potential benefits of early invasive coronary angiography in acute and chronic myocardial injury patterns. PLoS One 2023; 18:e0286157. [PMID: 37319181 PMCID: PMC10270641 DOI: 10.1371/journal.pone.0286157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2022] [Accepted: 05/10/2023] [Indexed: 06/17/2023] Open
Abstract
BACKGROUND In cases of evolving myocardial injury not definitively attributed to coronary ischaemia precipitated by plaque rupture, referral for invasive coronary angiography (ICA) may be influenced by observed troponin profiles. We sought to explore association between early ICA and elevated high-sensitivity troponin T (hs-cTnT) concentrations with and without dynamic changes, to examine if there may be a hs-cTnT threshold associated with benefit from an initial ICA strategy. METHODS Using published studies (hs-cTnT study n = 1937, RAPID-TnT study n = 3270) and the Fourth Universal Definition of Myocardial Infarction (MI), index presentations of patients with hs-cTnT concentrations 5-14ng/L were classified as 'non-elevated' (NE). Hs-cTnT greater than upper reference limit (14ng/L) were classified as 'elevated hs-cTnT with dynamic change' (encompassing acute myocardial injury, Type 1 MI, and Type 2 MI), or 'non-dynamic hs-cTnT elevation' (chronic myocardial injury). Patients with hs-cTnT <5ng/L and/or eGFR<15mmol/L/1.73m2 were excluded. ICA was performed within 30 days of admission. Primary outcome was defined as composite endpoint of death, MI, or unstable angina at 12 months. RESULTS Altogether, 3620 patients comprising 837 (23.1%) with non-dynamic hs-cTnT elevations and 332 (9.2%) with dynamic hs-cTnT elevations were included. Primary outcome was significantly higher with dynamic and non-dynamic hs-cTnT elevations (Dynamic: HR: 4.13 95%CI:2.92-5.82; p<0.001 Non-dynamic: HR: 2.39 95% confidence interval [CI]:1.74-3.28, p<0.001). Hs-cTnT thresholds where benefit from initial ICA strategy appeared to emerge was observed at 110ng/L and 50ng/L in dynamic and non-dynamic elevations, respectively. CONCLUSION Early ICA appears to portend benefit in hs-cTnT elevations with and without dynamic changes, and at lower hs-cTnT threshold in non-dynamic hs-cTnT elevation. Differences compel further investigation.
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Affiliation(s)
- Joanne Eng-Frost
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, Australia
- Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, Australia
| | - Simon Rocheleau
- Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, Australia
| | - Kristina Lambrakis
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, Australia
- Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, Australia
| | - Ehsan Khan
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, Australia
- Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, Australia
| | - Anke van den Merkhof
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, Australia
- Faculty of Medical Sciences, University of Groningen, Groningen, Netherlands
| | | | - Sam Lehman
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, Australia
- Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, Australia
| | - Brian Chiang
- Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, Australia
| | - Naomi Wattchow
- Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, Australia
| | - Simon Steele
- Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, Australia
| | - Scott Lorensini
- Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, Australia
| | - Michael McCann
- Department of Cardiology, Fiona Stanley Hospital, Perth, Australia
| | - Kate George
- Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, Australia
| | - Julian Vaile
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, Australia
- Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, Australia
| | - Carmine De Pasquale
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, Australia
- Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, Australia
| | - John French
- Department of Cardiology, Liverpool Hospital, Sydney, Australia
| | - Derek Chew
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, Australia
- Department of Cardiovascular Medicine, Flinders Medical Centre, Adelaide, Australia
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Thanapholsart J, Khan E, Lee GA. A Current Review of the Uses of Bioelectrical Impedance Analysis and Bioelectrical Impedance Vector Analysis in Acute and Chronic Heart Failure Patients: An Under-valued Resource? Biol Res Nurs 2023; 25:240-249. [PMID: 36342073 PMCID: PMC10021121 DOI: 10.1177/10998004221132838] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND There is a need to detect and prevent fluid overload and malnutrition in heart failure. Bioelectrical impedance analysis and bioelectrical impedance vector analysis are medical instruments that can advance heart failure management by generating values of body composition and body water, assisting clinicians to detect fluid and nutritional status. However, there is a lack of evidence to summarise how they have been used among heart failure patients. METHOD A systematic search was conducted. RESULT Two hundred and four papers were screened. Forty-eight papers were reviewed, and 46 papers were included in this review. The literature shows that bioelectrical impedance analysis and bioelectrical impedance vector analysis were mostly used to assess fluid and nutritional status, together with diagnostic and prognostic values. Contraindication of using BIA and implications for practice are also demonstrated. CONCLUSION The findings suggest that bioelectrical impedance vector analysis is superior to bioelectrical impedance analysis when assessing hydration/nutritional status in heart failure. Assessing a patient using bioelectrical impedance analysis /bioelectrical impedance vector analysis, together with natriuretic peptide -heart failure biomarkers, increases the diagnostic accuracy of heart failure. Further studies are required to examine the cost effectiveness of using these instruments in clinical practice.
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Affiliation(s)
- Jenjiratchaya Thanapholsart
- Division of Applied Technologies for Clinical Care, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, 4616King's College London, London, UK
| | - Ehsan Khan
- Department of Adult Nursing, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, 4616King's College London, London, UK
| | - Geraldine A Lee
- Division of Applied Technologies for Clinical Care, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, 4616King's College London, London, UK
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Hoppe K, Khan E, Meybohm P, Riese T. Mechanical power of ventilation and driving pressure: two undervalued parameters for pre extracorporeal membrane oxygenation ventilation and during daily management? Crit Care 2023; 27:111. [PMID: 36915183 PMCID: PMC10010963 DOI: 10.1186/s13054-023-04375-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 02/19/2023] [Indexed: 03/15/2023] Open
Abstract
The current ARDS guidelines highly recommend lung protective ventilation which include plateau pressure (Pplat < 30 cm H2O), positive end expiratory pressure (PEEP > 5 cm H2O) and tidal volume (Vt of 6 ml/kg) of predicted body weight. In contrast, the ELSO guidelines suggest the evaluation of an indication of veno-venous extracorporeal membrane oxygenation (ECMO) due to hypoxemic or hypercapnic respiratory failure or as bridge to lung transplantation. Finally, these recommendations remain a wide range of scope of interpretation. However, particularly patients with moderate-severe to severe ARDS might benefit from strict adherence to lung protective ventilation strategies. Subsequently, we discuss whether extended physiological ventilation parameter analysis might be relevant for indication of ECMO support and can be implemented during the daily routine evaluation of ARDS patients. Particularly, this viewpoint focus on driving pressure and mechanical power.
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Affiliation(s)
- K Hoppe
- University Hospital Würzburg, Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Oberdürrbacher Str. 6, 97080, Würzburg, Germany.
| | - E Khan
- University Hospital Würzburg, Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - P Meybohm
- University Hospital Würzburg, Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
| | - T Riese
- University Hospital Würzburg, Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Oberdürrbacher Str. 6, 97080, Würzburg, Germany
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Almutairi M, Simpson A, Khan E, Dickinson T. The value of social media use in improving nursing students' engagement: A systematic review. Nurse Educ Pract 2022; 64:103455. [PMID: 36182729 DOI: 10.1016/j.nepr.2022.103455] [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: 03/06/2022] [Revised: 09/11/2022] [Accepted: 09/15/2022] [Indexed: 10/14/2022]
Abstract
AIM This systematic review was undertaken to investigate the impact of social media use in relation to student engagement in nursing education. BACKGROUND The availability of social media has transformed global connectivity within education systems. Social media has been used in various educational contexts. The widespread use of social media has prompted a demand for a better understanding of how it might be used in nursing education. While research has previously explored the positive effects of using social media on a range of learning outcomes in nursing education, studies have not specifically focused on how these positive features have an impact on students' engagement as a vital component of successful learning. DESIGN This review uses the Joanna Briggs Institute approach to conducting systematic reviews and follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for reporting a systematic review. METHODS Following predefined inclusion criteria, a search of electronic databases was performed using a three-step strategy to identify relevant studies. The following databases were searched: Cumulative Index of Nursing and Allied Health Literature (CINAHL), Education Resources Information Centre (ERIC), MEDLINE and PubMed. A further manual search was performed to identify potentially relevant articles. The included studies were assessed for methodological quality by all reviewers using the Mixed Methods Appraisal Tool. NVivo software was used for organising data and developing themes. RESULTS Data from sixteen studies with different designs were extracted and thematically synthesised. The synthesised findings yielded five themes: 1) interaction and communication; 2) managing stress; 3) positive online community; 4) time spent; and 5) digital literacy and e-professionalism. CONCLUSIONS This review reveals that using social media to support nursing students' learning has positive benefits in terms of promoting several aspects of their engagement, such as rapid interaction and communication. Further empirical studies, however, should aim to measure social media's effects on nursing students' engagement with their courses and their academic attainment.
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Affiliation(s)
- Malak Almutairi
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK; Nursing Directorate, Ministry of Health, Riyadh, Saudi Arabia.
| | - Alan Simpson
- Professor of Mental Health Nursing, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK.
| | - Ehsan Khan
- Senior Lecturer in Nursing Education, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK.
| | - Tommy Dickinson
- Reader in Nursing Education, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, James Clerk Maxwell Building, 57 Waterloo Road, London SE1 8WA, UK.
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Shi B, Klopot A, Mahi T, Buiter S, Khan E, Budunova I, White BEP. 425 Acute inflammatory cytokines differentially effect epidermal barrier expression and function. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.05.434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Pollack B, Popiel P, Drugge E, Bibi M, Pollack S, Friedman R, Alishahian L, Bielawski A, Sacks A, Lebron K, Phillips D, Rubino S, Toaff M, Khan R, Khan E, Marioutina M, Gorgy M, Grimes C. Impact of permanent versus absorbable suture in vaginal suspension surgery for apical pelvic organ prolapse. Am J Obstet Gynecol 2022. [DOI: 10.1016/j.ajog.2021.12.135] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Khan E, Lambrakis K, Nazir SA, Chuang A, Halabi A, Tiver K, Briffa T, Cullen LA, Horsfall M, French JK, Sun BC, Chew DP. Implementation of more sensitive cardiac troponin T assay in a state-wide health service. Int J Cardiol 2022; 347:66-72. [PMID: 34774641 DOI: 10.1016/j.ijcard.2021.11.013] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/30/2021] [Accepted: 11/07/2021] [Indexed: 11/29/2022]
Abstract
AIMS Explore the impact of deploying high-sensitivity (hs) cardiac troponin T (cTnT) assay across a state-wide health service. METHODS AND RESULTS Presentations to emergency departments of six tertiary hospitals between January 2008 and August 2019 were included; standard cTnT assay was superseded by hs-cTnT in June 2011 without changing the reference range (≥30 ng/L reported as elevated), despite cTnT level of 30 ng/L being equivalent to ∼44 ng/L with hs-cTnT. Clinical outcomes were captured using state-wide linked health records. Interrupted time series analyses were used adjusted for seasonality and multiple co-morbidities using propensity score matching allowing for correlation within hospitals. In total, 614,847 presentations had ≥1 troponin measurement. Clinical ordering of troponin decreased throughout the study with no increase in elevated measurements amongst those tested with hs-cTnT. Small but statistically significant changes in index myocardial infarction (MI) diagnosis (-0.36%/year, 95%CI [confidence interval]:-0.48, -0.24,p < 0.001) and invasive coronary angiography (0.12%/year,95%CI:0, 0.24,p = 0.02) were seen, with no impact on death/MI at 30 days or 3-year survival in episodes of care (EOCs) with elevated cTnT after hs-cTnT implementation. Length of stay (LOS) was shorter among those with an elevated hs-cTnT (-4.44 h/year, 95%CI:-5.27, -3.60, p < 0.001). Non-elevated cTnT EOCs demonstrated shorter total LOS and improved 3-year survival (adjusted hazard ratio:0.90, 95%CI:0.83, 0.97,p = 0.008) although death/MI at 30 days was unchanged using hs-cTnT. CONCLUSION Widespread implementation of hs-cTnT without altering clinical thresholds reported to clinicians provided significantly shorter LOS without a clinically significant impact on clinical outcomes. A safer cohort with non-elevated cTnT was identified by hs-cTnT compared to the standard cTnT assay.
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Affiliation(s)
- Ehsan Khan
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, Australia; South Australian Department of Health, Adelaide, Australia
| | - Kristina Lambrakis
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, Australia; South Australian Department of Health, Adelaide, Australia
| | - Sheraz A Nazir
- Department of Cardiology, University Hospitals of Coventry & Warwickshire NHS Trust, Coventry, CV2 2DX, UK; Department of Cardiovascular Sciences, University of Leicester and the National Institute for Health for Research (NIHR) Leicester Cardiovascular Biomedical Research Centre, Glenfield Hospital, Leicester LE3 9QF, UK
| | - Anthony Chuang
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, Australia; South Australian Department of Health, Adelaide, Australia
| | - Amera Halabi
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, Australia; South Australian Department of Health, Adelaide, Australia
| | - Kathryn Tiver
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, Australia; South Australian Department of Health, Adelaide, Australia
| | - Tom Briffa
- School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Louise A Cullen
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Brisbane, Australia; School of Public Health, Queensland University of Technology, Brisbane, Australia; School of Medicine, University of Queensland, Brisbane, Australia
| | - Matthew Horsfall
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, Australia; South Australian Department of Health, Adelaide, Australia
| | - John K French
- Department of Cardiology, Liverpool Hospital, University of New South Wales, Sydney, Australia
| | - Benjamin C Sun
- Center for Policy Research-Emergency Medicine, Department of Emergency Medicine, Oregon Health and Science University, Portland, OR, United States of America
| | - Derek P Chew
- College of Medicine & Public Health, Flinders University of South Australia, Adelaide, Australia; South Australian Health and Medical Research Institute, Adelaide, Australia; South Australian Department of Health, Adelaide, Australia.
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Rahman HU, Khatoon N, Arshad S, Masood Z, Ahmad B, Khan W, Rafiq N, Khan MI, Kabir M, Haq ZU, Kamal I, Khan E, Rashid M, Haq AU, Garedaghi Y. Prevalence of intestinal nematodes infection in school children of urban areas of district Lower Dir, Pakistan. BRAZ J BIOL 2022; 82:e244158. [DOI: 10.1590/1519-6984.244158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 02/21/2021] [Indexed: 12/23/2022] Open
Abstract
Abstract Intestinal parasitism is the main cause of disease all over the world and described as a significant community health problem. The current study intended to find out the occurrence and identification of hazard factors linked with IPIs among 4-12 years aged shool-age children residing in Lower Dir district, Pakistan during 2019 - 2020. A cross-sectional school-based study was conducted using a pre-arranged pre-tested survey. Anthropometric data and stool collection were done to obtain the findings. The direct wet mount preparation in saline/iodine/methods was used for stool examination. Data were investigated using the GraphPad Prism 5. A total of 400 children studied (mean age of 8.6±3.6 years) the total incidence rate for the intestinal parasitic disease was established to be 71.75%. Of the 400 children studied, the overall prevalence rate for intestinal parasitic infections was found to 71.75% Ascaris lumbricoides (33.1%), Trichuris trichiura (1.04%), E. vermicularis (1.39%), Hookworm (19.86%) were identified in children living in the study area. We concluded that there is a mass scale campaigns were required to generate alertness about health and sanitation in children and the need for the development of effective poverty control programs because deworming (killing of worm with drugs) alone is not adequate to control parasitic infections.
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Affiliation(s)
| | | | | | - Z. Masood
- Sardar Bahadur Khan women University, Pakistan
| | - B. Ahmad
- University of Malakand, Pakistan
| | - W. Khan
- University of Malakand, Pakistan
| | - N. Rafiq
- Abdul Wali Khan University Mardan, Pakistan
| | - M. I. Khan
- Abdul Wali Khan University Mardan, Pakistan
| | - M. Kabir
- University of Sargodha, Pakistan
| | - Z. Ul Haq
- Hazara University Mansehra, Pakistan
| | - I. Kamal
- Hazara University Mansehra, Pakistan
| | - E. Khan
- Government Degree College, Pakistan
| | | | - A. ul Haq
- Shaheed Benazir Bhutto University, Pakistan
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Khan E, Lambrakis K, Liao Z, Gerlach J, Verjans J, Dykes L, Chew D. Developing a Machine Learning (ML) Model for Digital Phenotyping of Myocardial Infarction (MI) and Injury Amongst Patients Presenting With Suspected Acute Coronary Syndrome (ACS). Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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14
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Khan E, Lambrakis K, Briffa T, Cullen L, Karnon J, Papendick C, Quinn S, Tideman P, Van Den Hengel A, Verjans J, Chew D. Re-Engineering the Clinical Approach to Suspected Cardiac Chest Pain Assessment in the Emergency Department by Expediting Research Evidence to Practice Using Artificial Intelligence (RAPIDx AI) – A Cluster Randomised Clinical Trial Design. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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15
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Rocheleau S, Eng-Frost J, Khan E, Lambrakis K, Steele S, Lorensini S, Chiang B, Wattchow N, Lehman S, Chew D. Twelve-Month Outcomes of Patients With Myocardial Injury Not Due to Type 1 Myocardial Infarction. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.06.398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
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16
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Mercier F, Zhao J, Ebran JP, Khan E, Nikšić T, Vretenar D. Microscopic Description of 2α Decay in ^{212}Po and ^{224}Ra Isotopes. Phys Rev Lett 2021; 127:012501. [PMID: 34270302 DOI: 10.1103/physrevlett.127.012501] [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] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 05/11/2021] [Accepted: 06/08/2021] [Indexed: 06/13/2023]
Abstract
A microscopic calculation of half-lives for both the α and 2α decays of ^{212}Po and ^{224}Ra is performed, using a self-consistent framework based on energy density functionals. A relativistic density functional and a separable pairing interaction of finite range are used to compute axially symmetric deformation energy surfaces as functions of quadrupole, octupole, and hexadecapole collective coordinates. Dynamical least-action paths are determined, that trace the α and 2α emission from the equilibrium deformation to the point of scission. The calculated half-lives for the α decay of ^{212}Po and ^{224}Ra are in good agreement with data. A new decay mode, the symmetric 2α emission, is predicted with half-lives of the order of those observed for cluster emission.
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Affiliation(s)
- F Mercier
- IJCLab, Université Paris-Saclay, CNRS/IN2P3, 91405 Orsay Cedex, France
| | - J Zhao
- Center for Circuits and Systems, Peng Cheng Laboratory, Shenzhen 518055, China
| | - J-P Ebran
- CEA, DAM, DIF, F-91297 Arpajon, France
- Université Paris-Saclay, CEA, Laboratoire Matière en Conditions Extrêmes, 91680 Bruyères-le-Châtel, France
| | - E Khan
- IJCLab, Université Paris-Saclay, CNRS/IN2P3, 91405 Orsay Cedex, France
| | - T Nikšić
- Physics Department, Faculty of Science, University of Zagreb, 10000 Zagreb, Croatia
| | - D Vretenar
- Physics Department, Faculty of Science, University of Zagreb, 10000 Zagreb, Croatia
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17
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Khan E, Lambrakis K, Blyth A, Seshadri A, Edmonds MJR, Briffa T, Cullen LA, Quinn S, Horsfall M, Morton E, French JK, Papendick C, Nelson AJ, Chew DP. Classification performance of clinical risk scoring in suspected acute coronary syndrome beyond a rule-out troponin profile. Eur Heart J Acute Cardiovasc Care 2021; 10:1038-1047. [PMID: 34195809 DOI: 10.1093/ehjacc/zuab040] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Revised: 05/19/2021] [Accepted: 05/22/2021] [Indexed: 11/15/2022]
Abstract
AIMS High-sensitivity cardiac troponin strategies can provide risk stratification in patients with suspected acute coronary syndrome (ACS) in the emergency department (ED). This study evaluated whether clinical risk scoring improves the classification performance of a rule-out profile in suspected ACS. METHODS AND RESULTS Patients presenting to ED with suspected ACS as part of the RAPID-TnT trial randomized to the intervention arm were included. Results ≥5 ng/L were available for all participants in this analysis. We evaluated the Thrombolysis In Myocardial Infarction (TIMI) risk score, History ECG Age Risk factors Troponin (HEART) score, and Emergency Department Assessment of Chest pain Score (EDACS) in addition to a rule-out profile based on the 0/1-h high-sensitivity cardiac troponin T protocol (<5 ng/L or ≤12 ng/L and a change of <3 ng/L at 1-h) using test performance parameters focusing on low-risk groups to identify the primary endpoint (TIMI ≤ 1, HEART ≤ 3, EDACS < 16). Primary endpoint was a composite of type 1/2 myocardial infarction (MI) at index presentation and all-cause mortality or type 1/2 MI at 30 days. A total of 3378 participants were enrolled between August 2015 and April 2019 of which 108 were ineligible/withdrew consent (intervention arm: n = 1638). Sensitivity, specificity, negative predictive value (NPV), and area under the curve (AUC) of the rule-out profile was 94.4%, 76.8%, 99.6%, and 0.86, respectively with 72.9% identified as 'low-risk'. Adding the clinical risk scores did not improve the sensitivity, NPV, or AUC with significantly lower specificity and 'low-risk' classified participants. CONCLUSIONS Addition of clinical risk scores to rule-out profile did not demonstrate improved classification performance for identifying the composite of type 1/2 MI at index presentation and all-cause mortality or type 1/2 MI at 30 days. CLINICAL TRIALS REGISTRATION URL: https://www.anzctr.org.au. Reg. No. ACTRN12615001379505.
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Affiliation(s)
- Ehsan Khan
- College of Medicine & Public Health, Flinders University, Sturt Road, Bedford Park, SA 5042, Australia
- South Australian Department of Health, 11 Hindmarsh Square, Adelaide, SA 5000, Australia
| | - Kristina Lambrakis
- College of Medicine & Public Health, Flinders University, Sturt Road, Bedford Park, SA 5042, Australia
- South Australian Department of Health, 11 Hindmarsh Square, Adelaide, SA 5000, Australia
| | - Andrew Blyth
- College of Medicine & Public Health, Flinders University, Sturt Road, Bedford Park, SA 5042, Australia
- South Australian Department of Health, 11 Hindmarsh Square, Adelaide, SA 5000, Australia
| | - Anil Seshadri
- College of Medicine & Public Health, Flinders University, Sturt Road, Bedford Park, SA 5042, Australia
- South Australian Department of Health, 11 Hindmarsh Square, Adelaide, SA 5000, Australia
| | - Michael J R Edmonds
- South Australian Department of Health, 11 Hindmarsh Square, Adelaide, SA 5000, Australia
| | - Tom Briffa
- School of Population and Global Health, University of Western Australia, Clifton Street, Nedlands, Perth, WA 6009, Australia
| | - Louise A Cullen
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Brisbane, QLD 4029, Australia
- School of Public Health, Queensland University of Technology, George Street, Brisbane, QLD 4000, Australia
- School of Medicine, University of Queensland, St Lucia, Brisbane, QLD 4072, Australia
| | - Stephen Quinn
- Department of Statistics, Swinburne University of Technology, John Street, Hawthorne, Melbourne, VIC 3122, Australia
- Department of Health Science and Biostatistics, Swinburne University of Technology, John Street, Hawthorne, Melbourne, VIC 3122, Australia
| | - Matthew Horsfall
- College of Medicine & Public Health, Flinders University, Sturt Road, Bedford Park, SA 5042, Australia
- South Australian Department of Health, 11 Hindmarsh Square, Adelaide, SA 5000, Australia
| | - Erin Morton
- College of Medicine & Public Health, Flinders University, Sturt Road, Bedford Park, SA 5042, Australia
| | - John K French
- Department of Cardiology, Liverpool Hospital, Elizabeth & Goulburn Street, Liverpool, Sydney, NSW 2170, Australia
| | - Cynthia Papendick
- School of Population and Global Health, University of Western Australia, Clifton Street, Nedlands, Perth, WA 6009, Australia
| | - Adam J Nelson
- South Australian Department of Health, 11 Hindmarsh Square, Adelaide, SA 5000, Australia
- South Australian Health and Medical Research Institute, North Terrace, Adelaide, SA 5000, Australia
- School of Medicine, University of Adelaide, North Terrrace, Adelaide, SA 5000, Australia
| | - Derek P Chew
- College of Medicine & Public Health, Flinders University, Sturt Road, Bedford Park, SA 5042, Australia
- South Australian Department of Health, 11 Hindmarsh Square, Adelaide, SA 5000, Australia
- School of Population and Global Health, University of Western Australia, Clifton Street, Nedlands, Perth, WA 6009, Australia
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18
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Lambrakis K, Papendick C, French JK, Quinn S, Blyth A, Seshadri A, Edmonds MJR, Chuang A, Khan E, Nelson AJ, Wright D, Horsfall M, Morton E, Karnon J, Briffa T, Cullen LA, Chew DP. Late Outcomes of the RAPID-TnT Randomized Controlled Trial: 0/1-Hour High-Sensitivity Troponin T Protocol in Suspected ACS. Circulation 2021; 144:113-125. [PMID: 33998255 DOI: 10.1161/circulationaha.121.055009] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND High-sensitivity troponin assays are increasingly being adopted to expedite evaluation of patients with suspected acute coronary syndromes. Few direct comparisons have examined whether the enhanced performance of these assays at low concentrations leads to changes in care that improves longer-term outcomes. This study evaluated late outcomes of participants managed under an unmasked 0/1-hour high-sensitivity cardiac troponin T (hs-cTnT) protocol compared with a 0/3-hour masked hs-cTnT protocol. METHODS We conducted a multicenter prospective patient-level randomized comparison of care informed by unmasked 0/1-hour hs-cTnT protocol (reported to <5 ng/L) versus standard practice masked hs-cTnT testing (reported to ≤29 ng/L) assessed at 0/3 hours and followed participants for 12 months. Participants included were those presenting to metropolitan emergency departments with suspected acute coronary syndromes, without ECG evidence of coronary ischemia. The primary end point was time to all-cause death or myocardial infarction using Cox proportional hazards models adjusted for clustering within hospitals. RESULTS Between August 2015 and April 2019, we randomized 3378 participants, of whom 108 withdrew, resulting in 12-month follow-up for 3270 participants (masked: 1632; unmasked: 1638). Among these, 2993 (91.5%) had an initial troponin concentration of ≤29 ng/L. Deployment of the 0/1-hour hs-cTnT protocol was associated with reductions in functional testing. Over 12-month follow-up, there was no difference in invasive coronary angiography (0/1-hour unmasked: 232/1638 [14.2%]; 0/3-hour masked: 202/1632 [12.4%]; P=0.13), although an increase was seen among patients with hs-cTnT levels within the masked range (0/1-hour unmasked arm: 168/1507 [11.2%]; 0/3-hour masked arm: 124/1486 [8.3%]; P=0.010). By 12 months, all-cause death and myocardial infarction did not differ between study arms overall (0/1-hour: 82/1638 [5.0%] versus 0/3-hour: 62/1632 [3.8%]; hazard ratio, 1.32 [95% CI, 0.95-1.83]; P=0.10). Among participants with initial troponin T concentrations ≤29 ng/L, unmasked hs-cTnT reporting was associated with an increase in death or myocardial infarction (0/1-hour: 55/1507 [3.7%] versus 0/3-hour: 34/1486 [2.3%]; hazard ratio, 1.60 [95% CI, 1.05-2.46]; P=0.030). CONCLUSIONS Unmasked hs-cTnT reporting deployed within a 0/1-hour protocol did not reduce ischemic events over 12-month follow-up. Changes in practice associated with the implementation of this protocol may be associated with an increase in death and myocardial infarction among those with newly identified troponin elevations. Registration: URL: https://www.anzctr.org.au; Unique identifier: ACTRN12615001379505.
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Affiliation(s)
- Kristina Lambrakis
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide (K.L., A.B., A.S., A.C., E.K., E.M., J.K., D.P.C.)
- South Australian Department of Health, Adelaide (K.L., C.P., A.B., A.S., M.J.R.E., A.C., E.K., A.J.N., D.W., M.H., D.P.C.)
| | - Cynthia Papendick
- South Australian Department of Health, Adelaide (K.L., C.P., A.B., A.S., M.J.R.E., A.C., E.K., A.J.N., D.W., M.H., D.P.C.)
- School of Medicine, University of Adelaide, Australia (C.P., A.J.N.)
| | - John K French
- Department of Cardiology, Liverpool Hospital, University of New South Wales, Sydney, Australia (J.K.F.)
| | - Stephen Quinn
- Department of Statistics, Data Science and Epidemiology (S.Q.), Swinburne University of Technology, Melbourne, Australia
| | - Andrew Blyth
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide (K.L., A.B., A.S., A.C., E.K., E.M., J.K., D.P.C.)
- South Australian Department of Health, Adelaide (K.L., C.P., A.B., A.S., M.J.R.E., A.C., E.K., A.J.N., D.W., M.H., D.P.C.)
| | - Anil Seshadri
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide (K.L., A.B., A.S., A.C., E.K., E.M., J.K., D.P.C.)
- South Australian Department of Health, Adelaide (K.L., C.P., A.B., A.S., M.J.R.E., A.C., E.K., A.J.N., D.W., M.H., D.P.C.)
| | - Michael J R Edmonds
- South Australian Department of Health, Adelaide (K.L., C.P., A.B., A.S., M.J.R.E., A.C., E.K., A.J.N., D.W., M.H., D.P.C.)
| | - Anthony Chuang
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide (K.L., A.B., A.S., A.C., E.K., E.M., J.K., D.P.C.)
- South Australian Department of Health, Adelaide (K.L., C.P., A.B., A.S., M.J.R.E., A.C., E.K., A.J.N., D.W., M.H., D.P.C.)
| | - Ehsan Khan
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide (K.L., A.B., A.S., A.C., E.K., E.M., J.K., D.P.C.)
- South Australian Department of Health, Adelaide (K.L., C.P., A.B., A.S., M.J.R.E., A.C., E.K., A.J.N., D.W., M.H., D.P.C.)
| | - Adam J Nelson
- South Australian Department of Health, Adelaide (K.L., C.P., A.B., A.S., M.J.R.E., A.C., E.K., A.J.N., D.W., M.H., D.P.C.)
- School of Medicine, University of Adelaide, Australia (C.P., A.J.N.)
| | - Deborah Wright
- South Australian Department of Health, Adelaide (K.L., C.P., A.B., A.S., M.J.R.E., A.C., E.K., A.J.N., D.W., M.H., D.P.C.)
| | - Matthew Horsfall
- South Australian Department of Health, Adelaide (K.L., C.P., A.B., A.S., M.J.R.E., A.C., E.K., A.J.N., D.W., M.H., D.P.C.)
| | - Erin Morton
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide (K.L., A.B., A.S., A.C., E.K., E.M., J.K., D.P.C.)
| | - Jonathan Karnon
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide (K.L., A.B., A.S., A.C., E.K., E.M., J.K., D.P.C.)
| | - Tom Briffa
- School of Population and Global Health, University of Western Australia, Perth (T.B.)
| | - Louise A Cullen
- Emergency and Trauma Centre, Royal Brisbane and Women's Hospital, Australia (L.A.C.)
- School of Public Health, Queensland University of Technology, Brisbane, Australia (L.A.C.)
- School of Medicine, University of Queensland, Brisbane, Australia (L.A.C.)
| | - Derek P Chew
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide (K.L., A.B., A.S., A.C., E.K., E.M., J.K., D.P.C.)
- South Australian Health and Medical Research Institute, Adelaide (D.P.C.)
- South Australian Department of Health, Adelaide (K.L., C.P., A.B., A.S., M.J.R.E., A.C., E.K., A.J.N., D.W., M.H., D.P.C.)
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19
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Chuang A(MY, Nguyen MT, Khan E, Jones D, Horsfall M, Lehman S, Smilowitz NR, Lambrakis K, Than M, Vaile J, Sinhal A, French JK, Chew DP. Troponin elevation pattern and subsequent cardiac and non-cardiac outcomes: Implementing the Fourth Universal Definition of Myocardial Infarction and high-sensitivity troponin at a population level. PLoS One 2021; 16:e0248289. [PMID: 33711079 PMCID: PMC7954292 DOI: 10.1371/journal.pone.0248289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 02/23/2021] [Indexed: 01/19/2023] Open
Abstract
Background The Fourth Universal Definition of Myocardial Infarction (MI) differentiates MI from myocardial injury. We characterised the temporal course of cardiac and non-cardiac outcomes associated with MI, acute and chronic myocardial injury. Methods We included all patients presenting to public emergency departments in South Australia between June 2011–Sept 2019. Episodes of care (EOCs) were classified into 5 groups based on high-sensitivity troponin-T (hs-cTnT) and diagnostic codes: 1) Acute MI [rise/fall in hs-cTnT and primary diagnosis of acute coronary syndrome], 2) Acute myocardial injury with coronary artery disease (CAD) [rise/fall in hs-cTnT and diagnosis of CAD], 3) Acute myocardial injury without CAD [rise/fall in hs-cTnT without diagnosis of CAD], 4) Chronic myocardial injury [elevated hs-cTnT without rise/fall], and 5) No myocardial injury. Multivariable flexible parametric models were used to characterize the temporal hazard of death, MI, heart failure (HF), and ventricular arrhythmia. Results 372,310 EOCs (218,878 individuals) were included: acute MI (19,052 [5.12%]), acute myocardial injury with CAD (6,928 [1.86%]), acute myocardial injury without CAD (32,231 [8.66%]), chronic myocardial injury (55,056 [14.79%]), and no myocardial injury (259,043 [69.58%]). We observed an early hazard of MI and HF after acute MI and acute myocardial injury with CAD. In contrast, subsequent MI risk was lower and more constant in patients with acute injury without CAD or chronic injury. All patterns of myocardial injury were associated with significantly higher risk of all-cause mortality and ventricular arrhythmia. Conclusions Different patterns of myocardial injury were associated with divergent profiles of subsequent cardiac and non-cardiac risk. The therapeutic approach and modifiability of such excess risks require further research.
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Affiliation(s)
- Anthony (Ming-yu) Chuang
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, Australia
- Department of Cardiovascular Medicine, Southern Adelaide Local Health Network, Adelaide, Australia
- * E-mail:
| | - Mau T. Nguyen
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, Australia
- Department of Cardiovascular Medicine, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Ehsan Khan
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, Australia
- Department of Cardiovascular Medicine, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Dylan Jones
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, Australia
- Department of Cardiovascular Medicine, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Matthew Horsfall
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, Australia
| | - Sam Lehman
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, Australia
- Department of Cardiovascular Medicine, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Nathaniel R. Smilowitz
- Division of Cardiology, Department of Medicine, New York University School of Medicine, New York City, New York, United States of America
| | - Kristina Lambrakis
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, Australia
- Department of Cardiovascular Medicine, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Martin Than
- Department of Emergency Medicine, Christchurch Hospital, Christchurch, New Zealand
| | - Julian Vaile
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, Australia
- Department of Cardiovascular Medicine, Southern Adelaide Local Health Network, Adelaide, Australia
| | - Ajay Sinhal
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, Australia
- Department of Cardiovascular Medicine, Southern Adelaide Local Health Network, Adelaide, Australia
| | - John K. French
- South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
- Western Sydney University, Sydney, Australia
| | - Derek P. Chew
- College of Medicine and Public Health, Flinders University of South Australia, Adelaide, Australia
- Department of Cardiovascular Medicine, Southern Adelaide Local Health Network, Adelaide, Australia
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20
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Abstract
Heart failure as a comorbidity in the older population with COVID-19 poses an additional threat to those affected. Patients with both COVID-19 and heart failure share similar risk factors, which result in magnification of pathological outcomes. These include a common inflammatory pathology and related coagulopathy. Both illnesses pose a risk of arrhythmia. Polypharmacy further complicates safe drug administration and worsens the risk of medication-induced arrhythmia. Additionally, both conditions present challenges regarding attaining and maintaining an appropriate nutritional state. Exploration of the interplay between these factors demonstrates the gravity of the co-existence of these conditions and helps understand the difficulties faced when caring for this patient group. Although care provided to COVID-19 patients is primarily related to symptom presentation, based on the analysis conducted, there are some recommendations for practice in relation to evidence and guidelines when managing heart failure patients in primary care within the context of the COVID-19 pandemic.
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Affiliation(s)
- Ehsan Khan
- Senior Lecturer in Nurse Education, Department of Adult Nursing, King's College London
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21
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Imtiaz K, Azizullah Z, Farooqi J, Prakoso D, Mehmood F, Jamil B, Barr K, Long M, Khan E. Is dengue the only arbovirus circulating in Pakistan? Report from southern region of the country. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.1344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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22
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Koentges C, Khan E, Birkle S, Hoelscher M, Pfeil K, Gollmer J, Hoffmann M, Bode C, Zirlik A, Bugger H. Sirtuin 4 contributes to heart failure development by increasing mitochondrial oxidative stress. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.3602] [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: 11/14/2022] Open
Abstract
Abstract
Sirtuin 4 (SIRT4) is a mitochondrial NAD+-dependent deacylase which inhibits the oxidation of glucose and fatty acids, and has been implicated in the regulation of oxidative stress. Given the importance of cardiac energy depletion and ROS during heart failure development, we aimed to define the role of SIRT4 in the development of heart failure. Mice with deletion (SIRT4−/−) or overexpression (SIRT4 TG) of SIRT4 were subjected to transverse aortic constriction (TAC) for 12 weeks or underwent sham procedures. Using echocardiography, ejection fraction (EF) was not different between SIRT4 TG and WT mice subjected to sham operations. In contrast, TAC induced a more pronounced decrease in EF (35% vs. 51%; p<0.05), and a more pronounced increase in LV endsystolic diameter (4.5mm vs. 3.6mm; p<0.05) and myocardial fibrosis (2.2-fold; p<0.05) in SIRT4 TG mice compared to WT mice. Myocardial levels of the lipid peroxidation product 4-hydroxynonenal were increased in WT mice following TAC and were synergistically increased in SIRT4 TG mice following TAC (+66% vs. WT TAC; p<0.05). Administration of the mitochondria-targeted antioxidant MitoQ normalized 4-hydroxynonenal levels, markedly attenuated the decline in EF and almost normalized endsystolic LV diameter in SIRT4 TG mice following TAC. Cardiac function and morphology were unaffected in SIRT4−/− mice during normal or increased workload conditions. Thus, while SIRT4 is not required to maintain cardiac function even in response to increased energy demands, increased expression of SIRT4 accelerates the development of heart failure following TAC, at least in part due to increased mitochondrial oxidative stress.
Funding Acknowledgement
Type of funding source: Public grant(s) – National budget only. Main funding source(s): German Research Foundation
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Affiliation(s)
- C Koentges
- Heart Center Freiburg University, Cardiology and Angiology I, Freiburg, Germany
| | - E Khan
- Heart Center Freiburg University, Cardiology and Angiology I, Freiburg, Germany
| | - S Birkle
- Heart Center Freiburg University, Cardiology and Angiology I, Freiburg, Germany
| | - M Hoelscher
- Heart Center Freiburg University, Cardiology and Angiology I, Freiburg, Germany
| | - K Pfeil
- Medical University of Graz, Department of Cardiology, Graz, Austria
| | - J Gollmer
- Medical University of Graz, Department of Cardiology, Graz, Austria
| | - M.M Hoffmann
- University Hospital of Freiburg, Institute for Clinical Chemistry and Laboratory Medicine, Freiburg, Germany
| | - C Bode
- Heart Center Freiburg University, Cardiology and Angiology I, Freiburg, Germany
| | - A Zirlik
- Medical University of Graz, Department of Cardiology, Graz, Austria
| | - H Bugger
- Medical University of Graz, Department of Cardiology, Graz, Austria
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Shar ZH, Shar HH, Jatoi A, Sherazi STH, Mahesar SA, Khan E, Phanwar QK. Natural co-occurrence of Fusarium toxins in poultry feed and its ingredients. J Verbrauch Lebensm 2020. [DOI: 10.1007/s00003-020-01292-z] [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: 12/01/2022]
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Masterson A, Lee G, Khan E, Titchener K, Doyle-Blunden J, Metcalfe A, Tee S, Bliss J. Redefining the role of the nurse academic in practice: A pilot study. Nurse Educ Pract 2020; 44:102750. [PMID: 32259729 DOI: 10.1016/j.nepr.2020.102750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 12/04/2018] [Accepted: 02/26/2020] [Indexed: 10/24/2022]
Abstract
Worldwide, health services are interested in supporting the speedy adoption of research findings into practice. To promote the translation of research into practice, a university in the South of England along with a partner NHS Trust piloted a new role - Translation Fellow (TF). This article describes and analyses the experience of implementing this role. It outlines the successes achieved as a result of this partnership between a university and a healthcare organisation as well as describing the challenges involved in establishing such a role. The successes included submitting a joint abstract to a conference; collaboratively developing articles for publication; organizing a visit overseas to compare similar services; co-designing a database to assist in collecting data for service planning and research, and setting up a 'one click access' web space populated with evidence informed material to support the work of the clinical staff. The pilot acted as a proof of concept in which the TF role demonstrated its potential. Additional roles are already being established in other services in the locality and the role merits wider discussion and testing nationally.
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Affiliation(s)
- Abigail Masterson
- Director Abi Masterson Consulting Ltd, Clinton House, Humber Street, Bloxham, OX15 4LZ, UK.
| | - Geraldine Lee
- Senior Lecturer & MSc Advanced Practice Programme Lead, Florence, Nightingale Faculty of Nursing & Midwifery, King's College London, Room 2.16, 2nd Floor, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, UK.
| | - Ehsan Khan
- Room 39, 1st Floor, James Clerk Maxwell Building, 57 Waterloo Road, London, SE1 8WA, UK.
| | - Karen Titchener
- Director Hospital at Home (Huntsman at Home Program), Adjunct Assistant Professor College of Nursing, Huntsman Cancer Institute, University of Utah, USA.
| | | | - Alison Metcalfe
- Sheffield Hallam University, Collegiate Crescent, Sheffield, S10 2BP, UK
| | - Stephen Tee
- PFHEA Executive Dean and Professor of Nurse Education Principal Fellow of the Higher Education Academy and National Teaching Fellow Faculty of Health and Social Sciences Bournemouth University Royal London House, Christchurch Road Bournemouth, BH1 3LT, UK.
| | - Julie Bliss
- Senior Lecturer in Post Registration Education, 1.38a James Clerk Maxwell Building, Waterloo, UK.
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Abstract
Online resources are expected within healthcare education, and a plethora of online or technology-based delivery methods are available. Reusable learning objects (RLOs) are a form of digitally supported education that can be used multiple times in various locations; they are especially favoured by nurses. Little is understood about the issues involved in their creation. This article examines the development of an RLO in respiratory physiology for first-year nurses and how those creating it worked together. Feedback during the development of the RLO was gathered over 1 year from academics, technologists and students. Issues that arose included variations and misunderstanding regarding terminology and academics' not appreciating the time it took to develop the resource and its potential. Practical matters included sourcing royalty-free or in-house images, record-keeping and version control, and addressing production logic in case developers moved to other projects. It is important to include students during the design process rather than in just evaluating the final product because user experience and navigation have to be considered together with pedagogical content. Addressing these issues when developing an RLO will help streamline the process and generate a student-focused output.
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Affiliation(s)
- Ehsan Khan
- Senior Lecturer in nurse Education, King's College London, Florence Nightingale Faculty of Nursing and Midwifery
| | - Maggie Tarling
- At the time of writing was Lecturer, City University, School of Health Sciences, London, now retired
| | - Ian Calder
- Learning Technologist, Aberdeen Business School, Robert Gordon University, Aberdeen
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Alam B, Nayab T, Bugshan AS, Gad MM, Khan E, Ali S. Scientific trends on research on denture stomatitis based on Scopus database: A bibliometric analysis. J Clin Exp Dent 2020; 15:e217-e224. [PMID: 37008244 PMCID: PMC10062459 DOI: 10.4317/jced.60249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 01/27/2023] [Indexed: 02/20/2023] Open
Abstract
Background Denture stomatitis is a clinical condition that affects people who wear removable maxillary dentures. It causes redness, soreness, and erythema and ultimately affects the general condition of the patient. The objective of this study was to analyze the leading countries, journals, organizations, and authors and the frequently used keywords associated with denture stomatitis. Material and Methods A bibliometric analysis of publications indexed in the Scopus database was conducted, and the article titles, abstracts, and keywords were analyzed using the VOSviewer software. Denture stomatitis-related publications from 1960 to 2021 were collected. This study included only research papers published in English with "article" as the paper type and dentistry as the subject area. Results Data from a total of 461 articles and 10 different journals were obtained. The papers were published in 64 different countries. Brazil and the United States of America were the top contributing countries, and the University of Sydney was the leading organization. Papers published in the Journal of Oral Rehabilitation received the highest number of citations, while author Gordon Ramage from the University of Glasgow received the highest number of citations. Conclusions The bibliometric analysis revealed that the number of denture stomatitis-related publications indexed in the Scopus database is increasing globally. Since 2007, there has been an increase in research interest regarding denture stomatitis, with more publications from several countries expected to be published in different journals. Key words:Bibliometric analysis, denture, candida, VOSviewer, maxilla.
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Chuang A, Lehman S, Horsfall M, Hancock D, Jones D, Khan E, Bekeris R, Dykes L, Chew D. MYOCARDIAL INFARCTION, MYOCARDIAL INJURY, AND SUBSEQUENT CLINICAL EVENTS: A POPULATION WIDE STUDY USING THE 4TH UNIVERSAL DEFINITION OF MYOCARDIAL INFARCTION. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)33675-7] [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: 11/25/2022]
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Swan A, Wai TS, Mugwagwa G, Khan E, Lau G, Joseph M. Global Longitudinal Strain in Exercise Stress Echo; are there Different Responses Based on Cardiac Risk? Heart Lung Circ 2019. [DOI: 10.1016/j.hlc.2019.06.272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Khan E, Chuang A, Halabi A, Tiver K, Horsfall M, Briffa T, Sun B, Cullen L, French J, Chew D. P2713Impact of routine implementation of high sensitivity troponin in a state-wide health service. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- E Khan
- Flinders Medical Centre and Flinders University, Cardiology, Adelaide, Australia
| | - A Chuang
- Flinders Medical Centre and Flinders University, Cardiology, Adelaide, Australia
| | - A Halabi
- Flinders Medical Centre and Flinders University, Cardiology, Adelaide, Australia
| | - K Tiver
- Flinders Medical Centre and Flinders University, Cardiology, Adelaide, Australia
| | - M Horsfall
- Flinders Medical Centre and Flinders University, Cardiology, Adelaide, Australia
| | - T Briffa
- The University of Western Australia, Perth, Australia
| | - B Sun
- Oregon Health & Science University, Portland, United States of America
| | - L Cullen
- University of Queensland, Brisbane, Australia
| | - J French
- Liverpool Hospital, Sydney, Australia
| | - D Chew
- Flinders Medical Centre and Flinders University, Cardiology, Adelaide, Australia
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Khan E, Brieger D, Amerena J, Atherton JJ, Chew DP, Farshid A, Ilton M, Juergens CP, Kangaharan N, Rajaratnam R, Sweeny A, Walters DL, Chow CK. Differences in management and outcomes for men and women with ST‐elevation myocardial infarction. Med J Aust 2018; 209:118-123. [DOI: 10.5694/mja17.01109] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2017] [Accepted: 03/08/2018] [Indexed: 12/21/2022]
Affiliation(s)
| | | | | | | | - Derek P Chew
- Flinders Medical Centre, Adelaide, SA
- Flinders University, Adelaide, SA
| | | | | | | | | | | | - Amy Sweeny
- Gold Coast University Hospital, Gold Coast, QLD
| | | | - Clara K Chow
- Westmead Applied Research Centre, University of Sydney, Sydney, NSW
- Westmead Hospital, Sydney, NSW
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Thakkar J, Redfern J, Khan E, Atkins E, Ha J, Vo K, Thiagalingam A, Chow CK. Healthcare resource utilisation by patients with coronary heart disease receiving a lifestyle-focused text message support program: an analysis from the TEXT ME study. Aust J Prim Health 2018; 24:256-262. [PMID: 29789100 DOI: 10.1071/py17130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2017] [Accepted: 02/19/2018] [Indexed: 11/23/2022]
Abstract
The 'Tobacco, Exercise and Diet Messages' (TEXT ME) study was a 6-month, single-centre randomised clinical trial (RCT) that found a text message support program improved levels of cardiovascular risk factors in patients with coronary heart disease (CHD). The current analyses examined whether receipt of text messages influenced participants' engagement with conventional healthcare resources. The TEXT ME study database (N=710) was linked with routinely collected health department databases. Number of doctor consultations, investigations and cardiac medication prescriptions in the two study groups were compared. The most frequently accessed health service was consultations with a General Practitioner (mean 7.1, s.d. 5.4). The numbers of medical consultations, biochemical tests or cardiac-specific investigations were similar between the study groups. There was at least one prescription registered for statin, ACEI/ARBs and β-blockers in 79, 66 and 50% of patients respectively, with similar refill rates in both the study groups. The study identified TEXT ME text messaging program did not increase use of Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) captured healthcare services. The observed benefits of TEXT ME reflect direct effects of intervention independent of conventional healthcare resource engagement.
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Affiliation(s)
- Jay Thakkar
- The University of Sydney, Sydney, NSW 2006, Australia
| | - Julie Redfern
- The University of Sydney, Sydney, NSW 2006, Australia
| | - Ehsan Khan
- The University of Sydney, Sydney, NSW 2006, Australia
| | - Emily Atkins
- The University of Sydney, Sydney, NSW 2006, Australia
| | - Jeffrey Ha
- Westmead Hospital, Westmead, NSW 2145, Australia
| | - Kha Vo
- The George Institute for Global Health, Camperdown, NSW 2050, Australia
| | | | - Clara K Chow
- The University of Sydney, Sydney, NSW 2006, Australia
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33
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Bars HPL, Guerlin C, Lasseri RD, Ebran JP, Bailey QG, Bize S, Khan E, Wolf P. Lorentz-symmetry test at Planck-scale suppression with a spin-polarized 133 Cs cold atom clock. IEEE Trans Ultrason Ferroelectr Freq Control 2018; 65:945-949. [PMID: 29994363 DOI: 10.1109/tuffc.2018.2805354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
We present the results of a Local Lorentz Invariance (LLI) test performed with the 133Cs cold atom clock FO2 [1], hosted at SYRTE. Such test, relating the frequency shift between 133Cs hyperfine Zeeman substates to the Lorentz violating coefficients of the Standard Model Extension (SME), has already been realized in [2] and led to state-of-the-art constraints on several SME proton coefficients. In this second analysis we used an improved model, based on a second order Lorentz transformation and a SCRMF nuclear model, which enables us to extend the scope of the analysis from purely proton to both proton and neutron coefficients. We have also become sensitive to the isotropic coefficient ~cTT, another SME coefficient that was not constrained in [2]. The resulting limits on SME coefficients improve by up to 13 orders of magnitude the present maximal sensitivities for laboratory tests and reach the generally expected suppression scales at which signatures of Lorentz violation could appear [3].
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Tara S, Swan A, Lau G, Gunton J, Khan E, Joseph M. Automated Function Imaging in Exercise Stress Echocardiography of Low-Risk Patients. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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35
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Harwood T, Khan E, Niang P, Mustafa A, Kangaharan N, Ilton M. An Article on Investigative Pitfalls in Pulmonary Hypertension. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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36
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Shakoor S, Khan E, Mir F, Malik FR, Jamil B. Secular trends of Streptococcus pyogenes sepsis in Pakistan and analysis of clinical features in a hospitalized cohort. Trop Biomed 2017; 34:648-656. [PMID: 33592933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Streptococcus pyogenes or Group A Streptococcus (GAS) is a re-emerging pathogen of significant public health importance. We present trends in GAS blood cultures over a 10 year period in Pakistan and characteristics of hospitalized patients with GAS sepsis over three years at a tertiary care hospital in Karachi, Pakistan. Blood cultures positive for GAS from 2004 -2014 were recorded at the clinical microbiology laboratory of the Aga Khan University and studied for trends in positivity rates. Medical records of patients hospitalized at the Aga Khan University hospital from 2012-2014 were also examined for clinical features and outcomes. GAS trends show a steady rate of blood culture positivity over 11 years, with higher rates in those >50 years, and seasonality favouring winter months. Case fatality rate in the hospitalized cohort was 34.1% (n= 14; of 41 patients). Malignancy predominated as the underlying predisposing factor among the 15-49 age group. Presence of sepsis was an independent predictor of mortality in GAS bacteremia. Studies of GAS trends in developing regions are important to inform changing epidemiology. GAS septic shock continues to have high case fatality despite antibiotic treatment. Early recognition, aggressive, goal-directed therapy for sepsis and prevention are possible control measures to prevent high mortality.
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Affiliation(s)
- S Shakoor
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - E Khan
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - F Mir
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - F R Malik
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - B Jamil
- Department of Medicine, Aga Khan University, Karachi, Pakistan
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Abstract
Successful remediation of oil-contaminated agricultural land may include the goal of returning the land to prespill levels of agricultural productivity. This productivity may be measured by crop yield, quality, and safety, all of which are influenced by soil characteristics. This research was conducted to determine if these metrics are affected in hard red spring wheat ( L. cultivar Barlow) when grown in soils treated by ex situ thermal desorption (TD) compared with wheat grown in native topsoil (TS). Additionally, TD soils were mixed with TS at various ratios to assess the effectiveness of soil mixing as a procedure for enhancing productivity. In two greenhouse studies, TD soils alone produced similar amounts of grain and biomass as TS, although grain protein in TD soils was 22% (±7%) lower. After mixing TS into TD soils, the mean biomass and grain yield were reduced by up to 60%, but grain protein increased. These trends are likely the result of nutrient availability determined by soil organic matter and nutrient cycling performed by soil microorganisms. Thermal desorption soil had 84% (±2%) lower soil organic carbon than TS, and cumulative respiration was greatly reduced (66 ± 2%). From a food safety perspective, grain from TD soils did not show increased uptake of polycyclic aromatic hydrocarbons. Overall, this research suggests that TD soils are capable of producing safe, high-quality grain yields.
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Sarin R, Khandrika L, Hanitha R, Avula A, Batra M, Kaul S, Raj H, Shivkumar S, Gupta S, Khan E, Bhandari T, Prasad S, Reddy VA, Swarnalata G, Bakre M, Chatterjee S, Jain J. Epidemiological and survival analysis of triple-negative breast cancer cases in a retrospective multicenter study. Indian J Cancer 2017; 53:353-359. [PMID: 28244455 DOI: 10.4103/0019-509x.200682] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION This is a retrospective study with data collected from breast cancer cases from five major Apollo Hospitals across India, as part of a biobanking process. One aspect of our study focused specifically on data from triple-negative breast cancer (TNBC) cases. The aim of this study was to analyze epidemiology, treatment options, and survival of the patients with TNBC. Our goal was to draw conclusions on the preponderance of the disease and also to understand the outcomes using the existing therapy options. MATERIALS AND METHODS Data were collected after due ethical clearances and were coded with regard to patient identifiers to protect patient privacy. Data were not only from the various departments of the respective hospitals and the treating physicians but also from the follow-up made by hospital staff and social workers. RESULTS About 20% of all cases of breast cancer comprised TNBC. Although the disease is generally thought to be an early onset disease, there was no major difference in the median age of diagnosis of TNBC compared to other breast cancer cases. More than 85% of the TNBC cases were of early stage disease with <4% of the cases of metastatic cancer. Data on follow-up were somewhat sporadic as a good number of cases were lost to follow-up, but from the available data, recurrence rate was about 11%. Death, when it occurred, was mostly in the early periods of treatment with 35% of the events occurring before 3 years. The overall survival rates beyond 3 years were more than 86%. CONCLUSIONS Data and sample collection are an ongoing process, so we expect this data set to be enriched with more cases and longer duration of follow-up in a year. Preliminary analysis sheds light on the potential of such a collection both for understanding the epidemiology of the disease and also for conducting future studies with an eye toward improving treatment outcomes.
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Affiliation(s)
- R Sarin
- Indraprastha Apollo Hospitals, New Delhi, India
| | - L Khandrika
- Sapien Biosciences Pvt. Ltd., Hyderabad, Telangana, India
| | - Rnm Hanitha
- Sapien Biosciences Pvt. Ltd., Hyderabad, Telangana, India
| | - A Avula
- Sapien Biosciences Pvt. Ltd., Hyderabad, Telangana, India
| | - M Batra
- Sapien Biosciences Pvt. Ltd., Hyderabad, Telangana, India
| | - S Kaul
- Indraprastha Apollo Hospitals, New Delhi, India
| | - H Raj
- Apollo Speciality Hospital, Chennai, Tamil Nadu, India
| | - S Shivkumar
- Apollo Hospital Enterprises, Bengaluru, Karnataka, India
| | - S Gupta
- Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
| | - E Khan
- Apollo Gleneagles Hospitals, Kolkata, West Bengal, India
| | - Tps Bhandari
- Apollo Hospital Enterprises, Hyderabad, Telangana, India
| | - Svss Prasad
- Apollo Hospital Enterprises, Hyderabad, Telangana, India
| | - V A Reddy
- Apollo Hospital Enterprises, Hyderabad, Telangana, India
| | - G Swarnalata
- Apollo Hospital Enterprises, Hyderabad, Telangana, India
| | - M Bakre
- OncoStem Diagnostics Pvt. Ltd., Bengaluru, Karnataka, India
| | | | - J Jain
- Indraprastha Apollo Hospitals, New Delhi, India
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Erdem H, Inan A, Guven E, Hargreaves S, Larsen L, Shehata G, Pernicova E, Khan E, Bastakova L, Namani S, Harxhi A, Roganovic T, Lakatos B, Uysal S, Sipahi OR, Crisan A, Miftode E, Stebel R, Jegorovic B, Fehér Z, Jekkel C, Pandak N, Moravveji A, Yilmaz H, Khalifa A, Musabak U, Yilmaz S, Jouhar A, Oztoprak N, Argemi X, Baldeyrou M, Bellaud G, Moroti RV, Hasbun R, Salazar L, Tekin R, Canestri A, Čalkić L, Praticò L, Yilmaz-Karadag F, Santos L, Pinto A, Kaptan F, Bossi P, Aron J, Duissenova A, Shopayeva G, Utaganov B, Grgic S, Ersoz G, Wu AKL, Lung KC, Bruzsa A, Radic LB, Kahraman H, Momen-Heravi M, Kulzhanova S, Rigo F, Konkayeva M, Smagulova Z, Tang T, Chan P, Ahmetagic S, Porobic-Jahic H, Moradi F, Kaya S, Cag Y, Bohr A, Artuk C, Celik I, Amsilli M, Gul HC, Cascio A, Lanzafame M, Nassar M. The burden and epidemiology of community-acquired central nervous system infections: a multinational study. Eur J Clin Microbiol Infect Dis 2017; 36:1595-1611. [PMID: 28397100 DOI: 10.1007/s10096-017-2973-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [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: 02/12/2017] [Accepted: 03/22/2017] [Indexed: 12/11/2022]
Abstract
Risk assessment of central nervous system (CNS) infection patients is of key importance in predicting likely pathogens. However, data are lacking on the epidemiology globally. We performed a multicenter study to understand the burden of community-acquired CNS (CA-CNS) infections between 2012 and 2014. A total of 2583 patients with CA-CNS infections were included from 37 referral centers in 20 countries. Of these, 477 (18.5%) patients survived with sequelae and 227 (8.8%) died, and 1879 (72.7%) patients were discharged with complete cure. The most frequent infecting pathogens in this study were Streptococcus pneumoniae (n = 206, 8%) and Mycobacterium tuberculosis (n = 152, 5.9%). Varicella zoster virus and Listeria were other common pathogens in the elderly. Although staphylococci and Listeria resulted in frequent infections in immunocompromised patients, cryptococci were leading pathogens in human immunodeficiency virus (HIV)-positive individuals. Among the patients with any proven etiology, 96 (8.9%) patients presented with clinical features of a chronic CNS disease. Neurosyphilis, neurobrucellosis, neuroborreliosis, and CNS tuberculosis had a predilection to present chronic courses. Listeria monocytogenes, Staphylococcus aureus, M. tuberculosis, and S. pneumoniae were the most fatal forms, while sequelae were significantly higher for herpes simplex virus type 1 (p < 0.05 for all). Tackling the high burden of CNS infections globally can only be achieved with effective pneumococcal immunization and strategies to eliminate tuberculosis, and more must be done to improve diagnostic capacity.
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Affiliation(s)
- H Erdem
- Principal Coordinator of ID-IRI, Ankara, Turkey.
- Department of Infectious Diseases and Clinical Microbiology, Gulhane Medical Academy, 06010, Etlik, Ankara, Turkey.
| | - A Inan
- Department of Infectious Diseases and Clinical Microbiology, Haydarpasa Numune Training and Research Hospital, Istanbul, Turkey
| | - E Guven
- Beytepe Murat Erdi Eker State Hospital, Ankara, Turkey
| | - S Hargreaves
- International Health Unit, Section of Infectious Diseases and Immunity, Commonwealth Building, Hammersmith Campus, Imperial College London, London, UK
| | - L Larsen
- Department of Infectious Diseases Q, Odense University Hospital, Odense, Denmark
| | - G Shehata
- Department of Neurology and Psychiatry, Assiut University Hospital, Assiut, Egypt
| | - E Pernicova
- Avenier, Centres for Vaccination and Travel Medicine, Prague, Czech Republic
- Faculty Hospital Brno, Department of Infectious Diseases, Brno, Czech Republic
| | - E Khan
- Shifa International Hospital, Islamabad, Pakistan
| | - L Bastakova
- Faculty Hospital Brno, Department of Infectious Diseases and Masaryk University Faculty of Medicine, Brno, Czech Republic
| | - S Namani
- Infectious Diseases Clinic, University Clinical Center of Kosovo, Prishtina, Kosovo
| | - A Harxhi
- Service of Infectious Disease, University Hospital Center of Tirana, Tirana, Albania
| | - T Roganovic
- Infectious Diseases Clinic, University Hospital Clinical Center Banja Luka, Banja Luka, Bosnia and Herzegovina
| | - B Lakatos
- Department of Infectious Diseases, Saint Laszlo Hospital, Budapest, Hungary
| | - S Uysal
- Department of Infectious Diseases and Clinical Microbiology, Seyfi Demirsoy State Hospital, Buca, İzmir, Turkey
| | - O R Sipahi
- Department of Infectious Diseases and Clinical Microbiology, Ege University School of Medicine, Izmir, Turkey
| | - A Crisan
- Department of Infectious Diseases, Victor Babes University of Medicine and Pharmacy, Timisoara, Romania
| | - E Miftode
- Hospital of Infectious Diseases, Gr. T. Popa University of Medicine and Pharmacy, Iasi, Romania
| | - R Stebel
- Faculty Hospital Brno, Department of Infectious Diseases and Masaryk University Faculty of Medicine, Brno, Czech Republic
| | - B Jegorovic
- Clinic for Infectious and Tropical Diseases, Clinical Centre of Serbia, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
| | - Z Fehér
- Department of Infectious Diseases, Markusovszky University Teaching Hospital, Szombathely, Hungary
| | - C Jekkel
- Department of Infectious Diseases, Saint Laszlo Hospital, Budapest, Hungary
| | - N Pandak
- General Hospital Slavonski Brod, Department for Infectious Diseases, School of Medicine, University of Split, Split, Croatia
| | - A Moravveji
- Social Determinants of Health Research Center, Department of Community Medicine, Kashan University of Medical Sciences, Kashan, Iran
| | - H Yilmaz
- Department of Infectious Diseases and Clinical Microbiology, Ondokuz Mayis University School of Medicine, Samsun, Turkey
| | - A Khalifa
- Department of Neurology, Damascus Hospital, Damascus, Syria
| | - U Musabak
- Department of Immunology and Allergy, Losante Hospital, Ankara, Turkey
| | - S Yilmaz
- Gulhane Medical Academy, Blood Bank, Clinical Microbiology Division, Ankara, Turkey
| | - A Jouhar
- Department of Neurology, Damascus Hospital, Damascus, Syria
| | - N Oztoprak
- Antalya Education and Research Hospital, Antalya, Turkey
| | - X Argemi
- Infectious Diseases Department, Nouvel Hôpital Civil, Strasbourg, France
| | - M Baldeyrou
- Infectious Diseases Department, Nouvel Hôpital Civil, Strasbourg, France
| | - G Bellaud
- Department of Infectious Diseases, Tenon University Hospital, Paris, France
| | - R V Moroti
- Carol Davila University of Medicine and Pharmacy and Matei Bals National Institute for Infectious Diseases, Bucharest, Romania
| | - R Hasbun
- Medical School, Department of Infectious Diseases, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - L Salazar
- Medical School, Department of Infectious Diseases, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - R Tekin
- Department of Infectious Diseases and Clinical Microbiology, Dicle University School of Medicine, Diyarbakir, Turkey
| | - A Canestri
- Department of Infectious Diseases, Tenon University Hospital, Paris, France
| | - L Čalkić
- Department of Infectious Diseases, Zenica Cantonal Hospital, Zenica, Bosnia and Herzegovina
| | - L Praticò
- University Division of Infectious and Tropical Diseases, Piazza Spedali Civili, 25123, Brescia, Italy
| | - F Yilmaz-Karadag
- Goztepe Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Medeniyet University, Istanbul, Turkey
| | - L Santos
- Infectious Diseases Service, Centro Hospitalar São João and Faculty of Medicine, University of Porto, Porto, Portugal
| | - A Pinto
- Infectious Diseases Service, Centro Hospitalar São João and Faculty of Medicine, University of Porto, Porto, Portugal
| | - F Kaptan
- Department of Infectious Diseases and Clinical Microbiology, Katip Celebi University School of Medicine, Izmir, Turkey
| | - P Bossi
- Department Maladies Infectieuses, Institut Pasteur de Paris-HPA, Paris, France
| | - J Aron
- Department Maladies Infectieuses, Institut Pasteur de Paris-HPA, Paris, France
| | - A Duissenova
- Department of Infectious and Tropical Diseases, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - G Shopayeva
- Department of Infectious and Tropical Diseases, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - B Utaganov
- Department of Infectious and Tropical Diseases, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
| | - S Grgic
- Clinic for Infectious Diseases, University Hospital of Mostar, Mostar, Bosnia and Herzegovina
| | - G Ersoz
- Department of Infectious Diseases and Clinical Microbiology, Mersin University School of Medicine, Mersin, Turkey
| | - A K L Wu
- Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
| | - K C Lung
- Department of Clinical Pathology, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, China
| | - A Bruzsa
- Department of Infectious Diseases, Saint Laszlo Hospital, Budapest, Hungary
| | - L B Radic
- Department of Infectious Diseases, General Hospital Dubrovnik, Dubrovnik, Croatia
| | - H Kahraman
- Department of Infectious Diseases and Clinical Microbiology, Ege University School of Medicine, Izmir, Turkey
| | - M Momen-Heravi
- Department of Infectious Diseases, Social Determinants of Health Research Center, Kashan University of Medical Sciences, Kashan, Iran
| | - S Kulzhanova
- Department of Infectious Diseases, Astana Medical University, Astana, Kazakhstan
| | - F Rigo
- Unit of Infectious Diseases, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - M Konkayeva
- Department of Infectious Diseases, Astana Medical University, Astana, Kazakhstan
| | - Z Smagulova
- Department of Infectious Diseases, Astana Medical University, Astana, Kazakhstan
| | - T Tang
- Infectious Diseases Team, Department of Medicine, Queen Elizabeth Hospital, Hong Kong, China
| | - P Chan
- Neurology Team, Department of Medicine, Queen Elizabeth Hospital, Hong Kong, China
| | - S Ahmetagic
- University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - H Porobic-Jahic
- University Clinical Center Tuzla, Tuzla, Bosnia and Herzegovina
| | - F Moradi
- Infectious and Tropical Diseases Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran
| | - S Kaya
- Department of Infectious Diseases and Clinical Microbiology, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Y Cag
- School of Medicine, Department of Infectious Diseases and Clinical Microbiology, Medeniyet University, Istanbul, Turkey
| | - A Bohr
- Institute of Inflammation Research, Department of Infectious Diseases and Rheumatology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - C Artuk
- Department of Infectious Diseases and Clinical Microbiology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - I Celik
- Department of Infectious Diseases and Clinical Microbiology, Kayseri Training and Research Hospital, Kayseri, Turkey
| | - M Amsilli
- Infectious Diseases Unit, CHU Bicètre, Paris, France
| | - H C Gul
- Department of Infectious Diseases and Clinical Microbiology, Gulhane Training and Research Hospital, Ankara, Turkey
| | - A Cascio
- Department of Health Promotion Sciences and Mother and Child Care "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - M Lanzafame
- Unit of Infectious Diseases, Azienda Ospedaliera Universitaria Integrata, Verona, Italy
| | - M Nassar
- Infection Control Department, Saudi German Hospital Group, Jeddah, Saudi Arabia
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Mal PB, Farooqi J, Irfan S, Hughes MA, Khan E. Reduced susceptibility to chlorhexidine disinfectant among New Delhi metallo-beta-lactamase-1 positive Enterobacteriaceae and other multidrug-resistant organisms: Report from a tertiary care hospital in Karachi, Pakistan. Indian J Med Microbiol 2017; 34:346-9. [PMID: 27514958 DOI: 10.4103/0255-0857.188338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
We analysed susceptibility of multidrug-resistant organisms (MDROs) including New Delhi metallo-beta-lactamase-1 positive Enterobacteriaceae to chlorhexidine and compared results to their susceptible counterparts. Susceptibilities of chlorhexidine digluconate in a standard (CHX-S) preparation and two commercial disinfectants containing different CHX concentrations (2% w/v and 4% w/w) were performed. MDROs had narrower range of higher CHX-S minimum inhibitory concentrations (MICs) as compared to pan-sensitive organisms. The MIC values for commercial disinfectants products for MDROs were many folds higher (20-600 times), than CHX-S for in vitro use. Increasing antibiotic resistance among bacterial isolates can be an indirect marker of reduced susceptibility to chlorhexidine in hospital setting.
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Affiliation(s)
- P B Mal
- Department of Pathology and Laboratory Medicine, Section of Clinical Microbiology, Aga Khan University, Karachi - 74800, Pakistan
| | - J Farooqi
- Department of Pathology and Laboratory Medicine, Section of Clinical Microbiology, Aga Khan University, Karachi - 74800, Pakistan
| | - S Irfan
- Department of Pathology and Laboratory Medicine, Section of Clinical Microbiology, Aga Khan University, Karachi - 74800, Pakistan
| | - M A Hughes
- Department of Medicine, Division of Infectious Diseases, University of Virginia 22908, USA
| | - E Khan
- Department of Pathology and Laboratory Medicine, Section of Clinical Microbiology, Aga Khan University, Karachi - 74800, Pakistan
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41
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Chuang M, Halabi A, Horsfall M, Sinhal A, Depasquale C, Vaile J, Khan E, Jones D, Chew D. Invasive Management of Acute Coronary Syndrome: Interaction with Competing Risks. Heart Lung Circ 2017. [DOI: 10.1016/j.hlc.2017.06.388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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42
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Khan E, Shukla A, Jadav N, Telford R, Ayala AP, Tandon P, Vangala VR. Study of molecular structure, chemical reactivity and H-bonding interactions in the cocrystal of nitrofurantoin with urea. NEW J CHEM 2017. [DOI: 10.1039/c7nj01345k] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The cocrystal of nitrofurantoin with urea (C8H6N4O5)·(CH4N2O), a non-ionic supramolecular complex, has been studied.
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Affiliation(s)
- E. Khan
- Department of Physics
- University of Lucknow
- Lucknow 226 007
- India
| | - A. Shukla
- Department of Physics
- University of Lucknow
- Lucknow 226 007
- India
| | - N. Jadav
- Centre for Pharmaceutical Engineering Science and School of Pharmacy and Medical Sciences
- University of Bradford
- Bradford
- UK
| | - R. Telford
- School of Chemistry and Biosciences
- University of Bradford
- Bradford
- UK
| | - A. P. Ayala
- Departamento de Física
- Universidade Federal do Ceará
- Fortaleza
- Brazil
| | - P. Tandon
- Department of Physics
- University of Lucknow
- Lucknow 226 007
- India
| | - V. R. Vangala
- Centre for Pharmaceutical Engineering Science and School of Pharmacy and Medical Sciences
- University of Bradford
- Bradford
- UK
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43
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Khan E, Ambrose NL, Ahnström J, Kiprianos AP, Stanford MR, Eleftheriou D, Brogan PA, Mason JC, Johns M, Laffan MA, Haskard DO. A low balance between microparticles expressing tissue factor pathway inhibitor and tissue factor is associated with thrombosis in Behçet's Syndrome. Sci Rep 2016; 6:38104. [PMID: 27924945 PMCID: PMC5141484 DOI: 10.1038/srep38104] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 10/26/2016] [Indexed: 12/14/2022] Open
Abstract
Thrombosis is common in Behçet's Syndrome (BS), and there is a need for better biomarkers for risk assessment. As microparticles expressing Tissue Factor (TF) can contribute to thrombosis in preclinical models, we investigated whether plasma microparticles expressing Tissue Factor (TF) are increased in BS. We compared blood plasma from 72 healthy controls with that from 88 BS patients (21 with a history of thrombosis (Th+) and 67 without (Th-). Using flow cytometry, we found that the total plasma MP numbers were increased in BS compared to HC, as were MPs expressing TF and Tissue Factor Pathway Inhibitor (TFPI) (all p < 0.0001). Amongst BS patients, the Th+ group had increased total and TF positive MP numbers (both p ≤ 0.0002) compared to the Th- group, but had a lower proportion of TFPI positive MPs (p < 0.05). Consequently, the ratio of TFPI positive to TF positive MP counts (TFPI/TF) was significantly lower in Th+ versus Th- BS patients (p = 0.0002), and no patient with a TFPI/TF MP ratio >0.7 had a history of clinical thrombosis. We conclude that TF-expressing MP are increased in BS and that an imbalance between microparticulate TF and TFPI may predispose to thrombosis.
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Affiliation(s)
- E Khan
- Vascular Sciences Section, National Heart and Lung Institute, Imperial College, London, UK
| | - N L Ambrose
- Vascular Sciences Section, National Heart and Lung Institute, Imperial College, London, UK
| | - J Ahnström
- Centre for Haematology, Department of Medicine, Imperial College, London, UK
| | - A P Kiprianos
- Vascular Sciences Section, National Heart and Lung Institute, Imperial College, London, UK
| | - M R Stanford
- Department of Ophthalmology, King's College, London, UK
| | - D Eleftheriou
- Institute of Child Heath, University College, London, UK
| | - P A Brogan
- Institute of Child Heath, University College, London, UK
| | - J C Mason
- Vascular Sciences Section, National Heart and Lung Institute, Imperial College, London, UK
| | - M Johns
- Vascular Sciences Section, National Heart and Lung Institute, Imperial College, London, UK
| | - M A Laffan
- Centre for Haematology, Department of Medicine, Imperial College, London, UK
| | - D O Haskard
- Vascular Sciences Section, National Heart and Lung Institute, Imperial College, London, UK
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44
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Bartlett M, Klimis H, Khan E, Patel M, Thiagalingam A, Altman M, Wynne D, Denniss R, Chow C. A Pilot of a Heart Failure Stabilisation Clinic. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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45
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Chuard D, Anthonipillai V, Dendale R, Nauraye C, Khan E, Mabit C, De Marzi L, Narici L. Mechanisms of phosphene generation in ocular proton therapy as related to space radiation exposure. Life Sci Space Res (Amst) 2016; 10:23-28. [PMID: 27662784 DOI: 10.1016/j.lssr.2016.06.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 06/15/2016] [Accepted: 06/23/2016] [Indexed: 06/06/2023]
Abstract
Particle therapy provides an opportunity to study the human response to space radiation in ground-based facilities. On this basis, a study of light flashes analogous to astronauts' phosphenes reported by patients undergoing ocular proton therapy has been undertaken. The influence of treatment parameters on phosphene generation was investigated for 430 patients treated for a choroidal melanoma at the proton therapy centre of the Institut Curie (ICPO) in Orsay, France, between 2008 and 2011. 60% of them report light flashes, which are predominantly (74%) blue. An analysis of variables describing the patient's physiology, properties of the tumour and dose distribution shows that two groups of tumour and beam variables are correlated with phosphene occurrence. Physiology is found to have no influence on flash triggering. Detailed correlation study eventually suggests a possible twofold mechanism of phosphene generation based on (i) indirect Cerenkov light in the bulk of the eye due to nuclear interactions and radioactive decay and (ii) direct excitation of the nerve fibres in the back of the eye and/or radical excess near the retina.
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Affiliation(s)
- D Chuard
- Institut de Physique Nucléaire IN2P3/CNRS, Univ. Paris-Sud, Orsay, France.
| | - V Anthonipillai
- Institut de Physique Nucléaire IN2P3/CNRS, Univ. Paris-Sud, Orsay, France
| | - R Dendale
- Institut Curie - Centre de Protonthérapie, Campus universitaire, Orsay, France
| | - C Nauraye
- Institut Curie - Centre de Protonthérapie, Campus universitaire, Orsay, France
| | - E Khan
- Institut de Physique Nucléaire IN2P3/CNRS, Univ. Paris-Sud, Orsay, France
| | - C Mabit
- Institut Curie - Centre de Protonthérapie, Campus universitaire, Orsay, France
| | - L De Marzi
- Institut Curie - Centre de Protonthérapie, Campus universitaire, Orsay, France
| | - L Narici
- Department of Physics, University of Rome 'Tor Vergata', Rome, Italy
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46
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Khan E, Brieger D, Amerena J, Atherton J, Farshid A, Ilton M, Juergens C, Kangaharan N, Rajaratnam R, Sweeney A, Walters D, Chow C. Gender Differences in Hospital Management of ST-Elevation Myocardial Infarction Patients. Heart Lung Circ 2016. [DOI: 10.1016/j.hlc.2016.06.105] [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: 11/29/2022]
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47
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Irfan S, Fasih N, Ghanchi NK, Khan E. Isolation frequency and susceptibility pattern of non-O1 and non-O139 Vibrio cholerae in a tertiary health care laboratory, 1999-2012. East Mediterr Health J 2016; 22:142-7. [PMID: 27180742 DOI: 10.26719/2016.22.2.142] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2014] [Accepted: 11/24/2015] [Indexed: 11/09/2022]
Abstract
In the past decade the importance of non-O1 and non-O139 strains of Vibrio cholerae has been highlighted globally. This study aimed to evaluate the frequency and antimicrobial susceptibility profile of non-O1 and non-O139 V. cholerae in Pakistan. Data of stool specimens yielding growth of non-O1 and non-O139 V. cholerae isolated at a national referral laboratory from 1999 to 2012 were retrospectively analysed and evaluated for resistance to ampicillin, tetracycline, chloramphenicol, co-trimoxazole and ofloxacin. A total of 95 800 stool samples submitted over 1999-2012 yielded 3668 strains of V. cholerae, of which 6% were non-O1 and non-O139 V. cholerae. A high isolation rate was found in the summer season, with a peak in the year 2003. Antimicrobial susceptibility data revealed increasing resistance to co-trimoxazole and ampicillin, but strains remained highly susceptible to ofloxacin. Active surveillance of serotypes and antimicrobial susceptibility is essential to predict future epidemics and define measures to curtail the disease.
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Affiliation(s)
- S Irfan
- Department of Pathology and Microbiology, Aga Khan University Hospital, Karachi, Pakistan
| | - N Fasih
- Department of Pathology and Microbiology, Aga Khan University Hospital, Karachi, Pakistan
| | - N K Ghanchi
- Department of Pathology and Microbiology, Aga Khan University Hospital, Karachi, Pakistan
| | - E Khan
- Department of Pathology and Microbiology, Aga Khan University Hospital, Karachi, Pakistan
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48
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Ambrose N, Khan E, Ravindran R, Lightstone L, Abraham S, Botto M, Johns M, Haskard DO. The exaggerated inflammatory response in Behçet's syndrome: identification of dysfunctional post-transcriptional regulation of the IFN-γ/CXCL10 IP-10 pathway. Clin Exp Immunol 2015; 181:427-33. [PMID: 25982097 DOI: 10.1111/cei.12655] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/27/2015] [Indexed: 12/20/2022] Open
Abstract
The mechanisms underlying the exaggerated inflammatory response in Behçet's syndrome (BS) remain poorly understood. We investigated the response of CD14(+) blood monocytes to interferon (IFN)-γ, focusing on the chemokine CXCL10. Chemokine synthesis and release were analysed at a protein and mRNA level following stimulation with IFN-γ. Findings in BS patients were compared with 25 healthy controls (HC), 15 rheumatoid arthritis (RA) and 15 systemic lupus erythematosus (SLE) disease control patients. BS monocytes produced significantly more CXCL10 protein than HC monocytes from 2 h following IFN-γ stimulation, despite equivalent quantities of mRNA, suggesting more efficient translation. This was significantly more pronounced in BS with high disease activity and in those with ocular and neurological clinical manifestations. The imbalance between CXCL10 protein and mRNA expression was not observed in either RA or SLE patients, and was not seen with other chemokines studied (CXCL9, CXCL11 and CCL2). Furthermore, BS monocytes treated with an alternative stimulant (LPS) did not show abnormal tumour necrosis factor (TNF)-α release. Sucrose density gradients to segregate monocyte CXCL10 mRNA into free RNA or polysome-associated RNA showed equal proportions in BS and HC samples, suggesting that the difference between BS and HC may be due to reduced negative control of CXCL10 translation in BS at a post-initiation level. We conclude that BS monocytes have dysfunctional post-transcriptional regulation of CXCL10 mRNA, resulting in over-expression of CXCL10 protein upon IFN-γ stimulation. As CXCL10 is a chemokine that recruits mononuclear cells, this abnormality may contribute to the exaggerated inflammatory responses that characterizes BS.
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Affiliation(s)
- N Ambrose
- Vascular Sciences Section, National Heart and Lung Institute, Imperial College, London, UK
| | - E Khan
- Vascular Sciences Section, National Heart and Lung Institute, Imperial College, London, UK
| | - R Ravindran
- Vascular Sciences Section, National Heart and Lung Institute, Imperial College, London, UK
| | - L Lightstone
- Division of Immunology and Inflammation, Imperial College, London, UK
| | - S Abraham
- Division of Immunology and Inflammation, Imperial College, London, UK
| | - M Botto
- Division of Immunology and Inflammation, Imperial College, London, UK
| | - M Johns
- Vascular Sciences Section, National Heart and Lung Institute, Imperial College, London, UK
| | - D O Haskard
- Vascular Sciences Section, National Heart and Lung Institute, Imperial College, London, UK
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49
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Khan E, Loh M. Association between post-operative mean arterial pressure and perioperative troponin rise in elderly patients undergoing surgical repair for neck of femur fractures. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.058] [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: 11/30/2022]
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50
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Mooney J, Hillis G, Lee V, Khan E, Halliwell R, Vicaretti M, Moncrieff C, Chow C. Cardiac assessment prior to non-cardiac surgery. Heart Lung Circ 2015. [DOI: 10.1016/j.hlc.2015.06.616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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