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Chao CJ, Agasthi P, Barry T, Chiang CC, Wang P, Ashraf H, Mookadam F, Seri AR, Venepally N, Allam M, Pujari SH, Sriramoju A, Sleem M, Alsidawi S, Eleid M, Beohar N, Fortuin FD, Yang EH, Rihal CS, Holmes DR, Arsanjani R. Using Artificial Intelligence in Predicting Ischemic Stroke Events After Percutaneous Coronary Intervention. J Invasive Cardiol 2023; 35:E297-E311. [PMID: 37410747] [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] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
BACKGROUND Ischemic stroke (IS) is an uncommon but severe complication in patients undergoing percutaneous coronary intervention (PCI). Despite significant morbidity and economic cost associated with post PCI IS, a validated risk prediction model is not currently available. AIMS We aim to develop a machine learning model that predicts IS after PCI. METHODS We analyzed data from Mayo Clinic CathPCI registry from 2003 to 2018. Baseline clinical and demographic data, electrocardiography (ECG), intra/post-procedural data, and echocardiographic variables were abstracted. A random forest (RF) machine learning model and a logistic regression (LR) model were developed. The receiver operator characteristic (ROC) analysis was used to assess model performance in predicting IS at 6-month, 1-, 2-, and 5-years post-PCI. RESULTS A total of 17,356 patients were included in the final analysis. The mean age of this cohort was 66.9 ± 12.5 years, and 70.7% were male. Post-PCI IS was noted in 109 patients (.6%) at 6 months, 132 patients (.8%) at 1 year, 175 patients (1%) at 2 years, and 264 patients (1.5%) at 5 years. The area under the curve of the RF model was superior to the LR model in predicting ischemic stroke at 6 months, 1-, 2-, and 5-years. Periprocedural stroke was the strongest predictor of IS post discharge. CONCLUSIONS The RF model accurately predicts short- and long-term risk of IS and outperforms logistic regression analysis in patients undergoing PCI. Patients with periprocedural stroke may benefit from aggressive management to reduce the future risk of IS.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Reza Arsanjani
- Associate Professor of Medicine, Director, Echocardiography Lab, Department of Cardiovascular Diseases, Mayo Clinic Arizona, Scottsdale, Arizona.
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2
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Alam NH, Faruque AS, Ashraf H, Chisti MJ, Ahmed T, Sultana M, Khalequzzaman M, Ali S, Ahmed S, Nasrin S, Tariqujjaman M, Haque KE, Amin R, Mollah AH, Kabir L, Shahidullah M, Khanam W, Islam K, Kim M, Vandenent M, Duke T, Gyr N, Fuchs GJ. Effectiveness, safety and economic viability of daycare versus usual hospital care management of severe pneumonia with or without malnutrition in children using the existing health system of Bangladesh: a cluster randomised controlled trial. EClinicalMedicine 2023; 60:102023. [PMID: 37304498 PMCID: PMC10250158 DOI: 10.1016/j.eclinm.2023.102023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Revised: 05/11/2023] [Accepted: 05/11/2023] [Indexed: 06/13/2023] Open
Abstract
Background We aimed to define clinical and cost-effectiveness of a Day Care Approach (DCA) alternative to Usual Care (UC, comparison group) within the Bangladesh health system to manage severe childhood pneumonia. Methods This was a cluster randomised controlled trial in urban Dhaka and rural Bangladesh between November 1, 2015 and March 23, 2019. Children aged 2-59 months with severe pneumonia with or without malnutrition received DCA or UC. The DCA treatment settings comprised of urban primary health care clinics run by NGO under Dhaka South City Corporation and in rural Union health and family welfare centres under the Ministry of Health and Family welfare Services. The UC treatment settings were hospitals in these respective areas. Primary outcome was treatment failure (persistence of pneumonia symptoms, referral or death). We performed both intention-to-treat and per-protocol analysis for treatment failure. Registered at www.ClinicalTrials.gov, NCT02669654. Findings In total 3211 children were enrolled, 1739 in DCA and 1472 in UC; primary outcome data were available in 1682 and 1357 in DCA and UC, respectively. Treatment failure rate was 9.6% among children in DCA (167 of 1739) and 13.5% in the UC (198 of 1472) (group difference, -3.9 percentage point; 95% confidence interval (CI), -4.8 to -1.5, p = 0.165). Treatment success within the health care systems [DCA plus referral vs. UC plus referral, 1587/1739 (91.3%) vs. 1283/1472 (87.2%), group difference 4.1 percentage point, 95% CI, 3.7 to 4.1, p = 0.160)] was better in DCA. One child each in UC of both urban and rural sites died within day 6 after admission. Average cost of treatment per child was US$94.2 (95% CI, 92.2 to 96.3) and US$184.8 (95% CI, 178.6 to 190.9) for DCA and UC, respectively. Interpretation In our population of children with severe pneumonia with or without malnutrition, >90% were successfully treated at Day care Clinics at 50% lower cost. A modest investment to upgrade Day care facilities may provide a cost-effective, accessible alternative to hospital management. Funding UNICEF, Botnar Foundation, UBS Optimus Foundation, and EAGLE Foundation, Switzerland.
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Affiliation(s)
- Nur H. Alam
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Abu S. Faruque
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Hasan Ashraf
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | | | - Tahmeed Ahmed
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Marufa Sultana
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | | | - Shahjahan Ali
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Shahnawaz Ahmed
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Sabiha Nasrin
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | - Md Tariqujjaman
- Nutrition and Clinical Services Division, icddr,b, Dhaka, Bangladesh
| | | | - Ruhul Amin
- Dhaka Shishu Hospital, Dhaka, Bangladesh
| | | | - Lutful Kabir
- Sir Salimullah Medical College Hospital, Dhaka, Bangladesh
| | | | - Wahida Khanam
- Institute of Child and Mother Health, Matuail, Dhaka, Bangladesh
| | - Khaleda Islam
- Primary Health Care, Ministry of Health and Family Planning, Government of Bangladesh, Bangladesh
| | | | | | - Trevor Duke
- Melbourne Children Hospital, Melbourne, Australia
| | | | - George J. Fuchs
- College of Medicine and College of Public Health, University of Kentucky, USA
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3
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Agasthi P, Ashraf H, Pujari SH, Girardo M, Tseng A, Mookadam F, Venepally N, Buras MR, Abraham B, Khetarpal BK, Allam M, MD SKM, Eleid MF, Greason KL, Beohar N, Sweeney J, Fortuin D, Holmes DRJ, Arsanjani R. Prediction of permanent pacemaker implantation after transcatheter aortic valve replacement: The role of machine learning. World J Cardiol 2023; 15:95-105. [PMID: 37033682 PMCID: PMC10074998 DOI: 10.4330/wjc.v15.i3.95] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 01/04/2023] [Accepted: 03/01/2023] [Indexed: 03/21/2023] Open
Abstract
BACKGROUND Atrioventricular block requiring permanent pacemaker (PPM) implantation is an important complication of transcatheter aortic valve replacement (TAVR). Application of machine learning could potentially be used to predict pre-procedural risk for PPM.
AIM To apply machine learning to be used to predict pre-procedural risk for PPM.
METHODS A retrospective study of 1200 patients who underwent TAVR (January 2014-December 2017) was performed. 964 patients without prior PPM were included for a 30-d analysis and 657 patients without PPM requirement through 30 d were included for a 1-year analysis. After the exclusion of variables with near-zero variance or ≥ 50% missing data, 167 variables were included in the random forest gradient boosting algorithm (GBM) optimized using 5-fold cross-validations repeated 10 times. The receiver operator curve (ROC) for the GBM model and PPM risk score models were calculated to predict the risk of PPM at 30 d and 1 year.
RESULTS Of 964 patients included in the 30-d analysis without prior PPM, 19.6% required PPM post-TAVR. The mean age of patients was 80.9 ± 8.7 years. 42.1 % were female. Of 657 patients included in the 1-year analysis, the mean age of the patients was 80.7 ± 8.2. Of those, 42.6% of patients were female and 26.7% required PPM at 1-year post-TAVR. The area under ROC to predict 30-d and 1-year risk of PPM for the GBM model (0.66 and 0.72) was superior to that of the PPM risk score (0.55 and 0.54) with a P value < 0.001.
CONCLUSION The GBM model has good discrimination and calibration in identifying patients at high risk of PPM post-TAVR.
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Affiliation(s)
- Pradyumna Agasthi
- Department of Cardiology, Mayo Clinic, Phoenix, AZ 85054, United States
| | - Hasan Ashraf
- Department of Cardiology, Mayo Clinic, Phoenix, AZ 85054, United States
| | - Sai Harika Pujari
- Department of Internal Medicine, The Brooklyn Hospital Center, Brooklyn, NY 11201, United States
| | - Marlene Girardo
- Department of Biostatistics, Mayo Clinic, Phoenix, AZ 85054, United States
| | - Andrew Tseng
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, United States
| | - Farouk Mookadam
- Department of Cardiology, Mayo Clinic, Phoenix, AZ 85054, United States
| | - Nithin Venepally
- Department of Cardiology, Mayo Clinic, Phoenix, AZ 85054, United States
| | - Matthew R Buras
- Department of Statistics, Mayo Clinic, Phoenix, AZ 85054, United States
| | - Bishoy Abraham
- Department of Cardiology, Mayo Clinic, Phoenix, AZ 85054, United States
| | | | - Mohamed Allam
- Department of Cardiology, Mayo Clinic, Phoenix, AZ 85054, United States
| | - Siva K Mulpuru MD
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, United States
| | - Mackram F Eleid
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, United States
| | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN 55905, United States
| | - Nirat Beohar
- Mount Sinai Medical Center, Columbia University, Miami Beach, FL 33138, United States
| | - John Sweeney
- Department of Cardiology, Mayo Clinic, Phoenix, AZ 85054, United States
| | - David Fortuin
- Department of Cardiology, Mayo Clinic, Phoenix, AZ 85054, United States
| | - David R Jr Holmes
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, United States
| | - Reza Arsanjani
- Department of Cardiology, Mayo Clinic, Phoenix, AZ 85054, United States
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Agasthi P, Sridhara S, Rattanawong P, Venepally N, Chao CJ, Ashraf H, Pujari SH, Allam M, Almader-Douglas D, Alla Y, Kumar A, Mookadam F, Packer DL, Holmes DR, Hagler DJ, Fortuin FD, Arsanjani R. Safety and efficacy of balloon angioplasty compared to stent-based-strategies with pulmonary vein stenosis: A systematic review and meta-analysis. World J Cardiol 2023; 15:64-75. [PMID: 36911751 PMCID: PMC9993931 DOI: 10.4330/wjc.v15.i2.64] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/17/2022] [Accepted: 02/08/2023] [Indexed: 02/21/2023] Open
Abstract
BACKGROUND Pulmonary vein stenosis (PVS) is an uncommon but known cause of morbidity and mortality in adults and children and can be managed with percutaneous re-vascularization strategies of pulmonary vein balloon angioplasty (PBA) or pulmonary vein stent implantation (PSI).
AIM To study the safety and efficacy outcomes of PBA vs PSI in all patient categories with PVS.
METHODS We performed a literature search of all studies comparing outcomes of patients evaluated by PBA vs PSI for PVS. We selected all published studies comparing PBA vs PSI for PVS with reported outcomes of restenosis and procedure-related complications in all patient categories. In adults, PVS following atrial fibrillation ablation and in children PVS related to congenital etiology or post-procedural PVS following total or partial anomalous pulmonary venous return repair were included. The patient-centered outcomes were risk of restenosis requiring re-intervention and procedural-related complications. The meta-analysis was performed by computing odds ratios (ORs) using the random effects model based on underlying statistical heterogeneity.
RESULTS Eight observational studies treating 768 severe PVS in 487 patients met our inclusion criteria. The age range of patients was 6 months to 70 years and 67% were males. The primary outcome of the re-stenosis requiring re-intervention occurred in 196 of 325 veins in the PBA group and 111 of 443 veins in the PSI group. Compared to PSI, PBA was associated with a significantly increased risk of re-stenosis (OR 2.91, 95%CI: 1.15-7.37, P = 0.025, I2 = 79.2%). Secondary outcomes of the procedure-related complications occurred in 7 of 122 patients in the PBA group and 6 of 69 in the PSI group. There were no statistically significant differences in the safety outcomes between the two groups (OR: 0.94, 95%CI: 0.23-3.76, P = 0.929), I2 = 0.0%).
CONCLUSION Across all patient categories with PVS, PSI is associated with reduced risk of re-intervention and is as safe as PBA and should be considered first-line therapy for PVS.
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Affiliation(s)
- Pradyumna Agasthi
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Srilekha Sridhara
- Department of Internal Medicine, Banner Heart Hospital, Mesa, AZ 85054, United States
| | - Pattara Rattanawong
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Nithin Venepally
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Chieh-Ju Chao
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Hasan Ashraf
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Sai Harika Pujari
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Mohamed Allam
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | | | - Yamini Alla
- Department of Medicine, Bronx Lebanon Hospital, Bronx, NY 10457, United States
| | - Amit Kumar
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Farouk Mookadam
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Douglas L Packer
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, United States
| | - David R Holmes Jr
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, United States
| | - Donald J Hagler
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, United States
| | - Floyd David Fortuin
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
| | - Reza Arsanjani
- Department of Cardiovascular Diseases, Mayo Clinic, Scottsdale, AZ 85259, United States
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Qazi S, Ashraf H, Qadri S, Amin D, Mushtaq A, Mushtaq A, Rasheed U. To do or not to do? Is acetylsalicylic acid a safe drug to continue in bipolar turp? Eur Urol 2023. [DOI: 10.1016/s0302-2838(23)00070-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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Dreher A, Yusuf R, Ashraf H, Ahmed SAKS, Gao W, Strümpell C, Loerbroks A. Workplace stressors and their association with hair cortisol concentrations among ready-made garment workers in Bangladesh: A cross-sectional study. J Occup Health 2023; 65:e12426. [PMID: 37752694 PMCID: PMC10522888 DOI: 10.1002/1348-9585.12426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 08/29/2023] [Accepted: 09/07/2023] [Indexed: 09/28/2023] Open
Abstract
OBJECTIVES Psychosocial working conditions of ready-made garment (RMG) workers have been associated with poorer self-reported health outcomes. However, no such research has been done with respect to physiological markers that are considered to reflect stress. We consequently aimed to investigate associations of psychosocial working conditions with such a marker, that is, hair cortisol, among RMG workers in Bangladesh. METHODS We conducted semi-structured face-to-face interviews in labor colonies in the Mirpur area, Dhaka, Bangladesh, in February and March 2021 with individuals identifying as garment workers. The interview inquired after various workplace stressors and resources (i.e., workplace support, workplace bullying, vertical trust, beneficial leadership, work-family conflict, and financial issues including savings, debts, financial obligations, and financial support). In addition, hair samples of 2 cm length were collected from participants. Hair cortisol concentrations (HCC) were determined based on liquid chromatography-tandem mass spectrometry (LC-MS/MS). Linear regression models were run to detect possible associations of workplace stressors and resources with HCC. RESULTS In total, data of 576 participants were included in the analysis (71.9% female, mean age = 25.9 years). Mean HCC was 4.4 pg/mg (standard deviation = 2.1 pg/mg). The sole variable significantly associated with increased HCC was "having to keep your job to support your children or spouse financially" (β = 0.28 [95% confidence interval 0.02-0.55]). CONCLUSIONS The sole workplace stressor significantly associated with increased HCC was the necessity to keep one's job to support children or spouse financially. This observation can, however, barely be disentangled from the fact that one has children/a spouse.
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Affiliation(s)
- Annegret Dreher
- Faculty of Medicine, Institute of Occupational, Social, and Environmental Medicine, Centre for Health and SocietyHeinrich‐Heine‐University DüsseldorfDüsseldorfGermany
| | - Rita Yusuf
- International Center for Biotechnology and Health (ICBH), Center for Health Population and Development (CHPD)Independent UniversityDhakaBangladesh
| | - Hasan Ashraf
- Department of AnthropologyJahangirnagar UniversityDhakaBangladesh
| | - Syed A. K. Shifat Ahmed
- International Center for Biotechnology and Health (ICBH), Center for Health Population and Development (CHPD)Independent UniversityDhakaBangladesh
| | - Wei Gao
- Faculty of Psychology, Chair of Biological PsychologyTechnical University DresdenDresdenGermany
| | - Christian Strümpell
- Institute of Social and Cultural AnthropologyUniversity of HamburgHamburgGermany
| | - Adrian Loerbroks
- Faculty of Medicine, Institute of Occupational, Social, and Environmental Medicine, Centre for Health and SocietyHeinrich‐Heine‐University DüsseldorfDüsseldorfGermany
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Dreher A, Yusuf R, Ashraf H, Ahmed SAKS, Strümpell C, Loerbroks A. Work-family conflict, financial issues and their association with self-reported health complaints among ready-made garment workers in Bangladesh: a cross-sectional study. Int Arch Occup Environ Health 2022; 96:483-496. [PMID: 36480083 PMCID: PMC9734729 DOI: 10.1007/s00420-022-01942-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 11/30/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVES This study aims to quantify the degree of work-family conflict (WFC) and financial issues among ready-made garment (RMG) workers in Bangladesh and to investigate their potential associations with self-reported health outcomes. METHODS We conducted a cross-sectional survey among 1118 RMG workers in labor colonies in Dhaka, Bangladesh, in February and March 2021. Descriptive analyses were performed to characterize WFC (i.e., family life disturbing the job or facing problems in family due to the job) and financial issues (i.e., savings, debt, financial obligations, financial support). We ran multivariable Poisson regression models to examine possible associations between WFC and financial issues and workers' health (self-reported general health and 10 specific health complaints). RESULTS We found low levels of WFC, low levels of savings, moderate levels of debt, and high levels of financial obligations: virtually all workers agreed they had to keep their job to financially support their spouse, children or other relatives. Only about a third of workers expected they would be able to receive financial support in case of a job loss. Work-family conflict was positively associated with poor health but not consistently with specific symptoms. Financial support was negatively associated, whereas being indebted was weakly positively associated with poor health. CONCLUSIONS Our findings suggest low levels of WFC among RMG workers but high levels of financial obligations. Work-family conflict was positively associated with poor health, but not consistently with specific symptoms. Being indebted was weakly positively associated with poor health. Future prospective studies are needed to confirm these findings.
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Affiliation(s)
- Annegret Dreher
- Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf, Germany
| | - Rita Yusuf
- International Center for Biotechnology and Health (ICBH), Center for Health Population and Development (CHPD), Independent University, Dhaka, Bangladesh
| | - Hasan Ashraf
- Department of Anthropology, Jahangirnagar University, Dhaka, Bangladesh
| | - Syed A K Shifat Ahmed
- International Center for Biotechnology and Health (ICBH), Center for Health Population and Development (CHPD), Independent University, Dhaka, Bangladesh
| | - Christian Strümpell
- Institute of Social and Cultural Anthropology, University of Hamburg, Hamburg, Germany
| | - Adrian Loerbroks
- Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Düsseldorf, Germany
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Dreher A, Yusuf R, Ashraf H, Ahmed SAKS, Strümpell C, Loerbroks A. Social stressors and social resources at work and their association with self-reported health complaints among ready-made garment workers in Bangladesh: a cross-sectional study. BMC Public Health 2022; 22:1793. [PMID: 36131265 PMCID: PMC9492303 DOI: 10.1186/s12889-022-14173-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 09/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Bangladesh is one of the world's largest garment exporters. Physical working conditions of garment workers are precarious and known to largely affect their health. Research on garment workers' psychosocial working conditions, however, is scarce. We aimed to quantify psychosocial working conditions of garment workers and possible associations with workers' health. METHODS We conducted a cross-sectional survey among 1,118 ready-made garment (RMG) workers in labor colonies in Dhaka, Bangladesh, in February 2021. Descriptive analyses were performed to characterize social stressors (e.g., being bullied at work, poor leadership) and social resources at work (e.g., receiving support at work, vertical trust between management and employees, beneficial leadership) and workers' health (self-reported overall health and 10 specific health complaints). To examine links of social stressors and social resources with self-reported health outcomes we ran multivariable Poisson regression models yielding prevalence ratios (PR) and 95% confidence intervals (CI). RESULTS We found low to moderate levels of workplace bullying and high levels of poor leadership (i.e., supervisors not caring about workers' problems). We also found high levels of social support, vertical trust and beneficial leadership (i.e., supervisors taking decisions free of bias). Garment workers frequently suffered from health complaints, first and foremost headache (68.3%), cold (55.3%), and back pain (50.7%). Health outcomes were poorer among workers who reported to be bullied at work versus not bullied (e.g., PR 1.55 [95% CI 1.32-1.92] for poor self-reported health when bullied by colleagues) and health was better among those reporting to feel supported versus unsupported (e.g., PR 0.61 [0.52-0.71] for poor self-reported health when supported by supervisor). Perceived vertical trust between workers and management was weakly associated with better health. Leadership behavior did not display a consistent pattern. CONCLUSIONS Our findings suggest that working conditions of RMG workers are rather good (e.g., characterized by low levels of bullying and high levels of support, vertical trust and beneficial leadership). The majority of workers reported good or very good health, although health complaints were frequently mentioned, first and foremost headache, cold, and back pain. Associations between psychosocial working conditions and health indicate worse working conditions being associated with poorer health.
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Affiliation(s)
- Annegret Dreher
- Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany
| | - Rita Yusuf
- International Center for Biotechnology and Health (ICBH), Center for Health Population and Development (CHPD), Independent University, Plot #16, Block B, Aftabuddin Ahmed Road, Bashundhara R/A, Dhaka, 1229, Bangladesh
| | - Hasan Ashraf
- Department of Anthropology, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
| | - Syed A K Shifat Ahmed
- International Center for Biotechnology and Health (ICBH), Center for Health Population and Development (CHPD), Independent University, Plot #16, Block B, Aftabuddin Ahmed Road, Bashundhara R/A, Dhaka, 1229, Bangladesh
| | - Christian Strümpell
- Institute of Social and Cultural Anthropology, University of Hamburg, Edmund-Siemers-Allee 1, West, 20146, Hamburg, Germany
| | - Adrian Loerbroks
- Institute of Occupational, Social, and Environmental Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
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Dreher A, Yusuf R, Ashraf H, Ahmed SAKS, Strümpell C, Loerbroks A. Der Zusammenhang zwischen sozialen Stressoren und sozialen Ressourcen
am Arbeitsplatz sowie Work-Family-Conflict mit schlechter Gesundheit bei
Beschäftigen in Textilfabriken in Bangladesch: Eine
Querschnittsstudie. Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- A Dreher
- Heinrich-Heine-Universität Düsseldorf, Institut
für Arbeits-, Sozial- und Umweltmedizin, Düsseldorf,
Deutschland
| | - R Yusuf
- Independent University, International Center for Biotechnology and
Health (ICBH), Center for Health Population and Development (CHPD), Dhaka,
Bangladesch
| | - H Ashraf
- Jahangirnagar University, Department of Anthropology, Dhaka,
Bangladesch
| | - SAKS Ahmed
- Independent University, International Center for Biotechnology and
Health (ICBH), Center for Health Population and Development (CHPD), Dhaka,
Bangladesch
| | - C Strümpell
- Universität Hamburg, Institut für Ethnologie, Hamburg,
Deutschland
| | - A Loerbroks
- Heinrich-Heine-Universität Düsseldorf, Institut
für Arbeits-, Sozial- und Umweltmedizin, Düsseldorf,
Deutschland
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Ashraf H, Minaskeian N, Sell-Dotin K, El Masry HZ. Combined endocardial and epicardial ablation of drug-refractory ventricular tachycardia by direct ventricular puncture. HeartRhythm Case Rep 2021; 7:840-843. [PMID: 34987972 PMCID: PMC8695292 DOI: 10.1016/j.hrcr.2021.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Rashid H, Gala T, Ain Q, Ashraf H, Vesamia S, Vig S. 1358 Does A COVID Protected Hospital Within A COVID Hospital Enable Elective Care and Training Opportunities? Br J Surg 2021. [PMCID: PMC8524575 DOI: 10.1093/bjs/znab259.502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Elective care in the UK came to a standstill with the advent of the COVID-19 pandemic. A restart could only be enabled with ‘green site’ separation and a ‘covid protected’ zone. A ‘hospital within the hospital’ concept was developed including 9 elective theatres, 28 ring fenced elective beds, a surgical enhanced care unit, a canteen, and a separated entrance. This model was underpinned with PPE, enhanced infection control and guidance for staff. The study documented the ability to recover elective activity and therefore provide a training environment for surgical trainees. Method Data was collected weekly (7/20 to 1/21) through the business informatics system with regard to theatres cases completed compared to the activity achieved in the 11-theatre elective estate pre COVID-19. Results Pre COVID-19, an average of 263 cases were completed per week. In the first week of operation, 31% of theatre capacity was achieved. By week 7, 106% of pre COVID was recorded and 130% by week 11. This was maintained until the impact of the second wave where activity has reduced to 50% but is not anticipated to reduce further as local anaesthetic and blocks maybe utilised. Conclusions This ‘hospital within the hospital’ has enabled elective care to return to above normal levels, with increased efficiencies. This has enabled a rapid return to a training environment for trainees disheartened with deployment to critical care in the first wave.
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Affiliation(s)
- H Rashid
- Croydon University Hospital, London, United Kingdom
| | - T Gala
- Croydon University Hospital, London, United Kingdom
| | - Q Ain
- Croydon University Hospital, London, United Kingdom
| | - H Ashraf
- Croydon University Hospital, London, United Kingdom
| | - S Vesamia
- Croydon University Hospital, London, United Kingdom
| | - S Vig
- Croydon University Hospital, London, United Kingdom
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12
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Ain Q, Solanki P, Georgi T, Gala T, Ashraf H, Kelleher D, Vig S. 845 Diabetic Foot Care Services in COVID-19 Era – A University Hospital Multi specialty Team Experience. Br J Surg 2021. [PMCID: PMC8524504 DOI: 10.1093/bjs/znab259.481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Introduction
Multidisciplinary foot care services contribute to the reduction in amputations from foot ulceration secondary to diabetes. The COVID-19 pandemic pressurised services and required a pause of elective care. This study reports the patient’s experience of foot care provision during the first wave where self-care, virtual appointments and patient directed appointments were utilised.
Method
Diabetic foot patients were retrospectively identified over a one-month period booked for MDT care (in hospital, OPD, diabetic foot clinic, community podiatry clinic or at home). All patients>16 years of age diagnosed with a new or previous diabetic foot ulcer or post-operative foot wound were included. Data was collated via a patient survey form and descriptive statistics were used to characterize the study population and responses.
Results
63 patients were identified (1/10 – 30/10) with data collated from 51 respondents (81%). 78% (40/51) were male. Median age was 69 years (IQR 59–76). 86% were comfortable attending a hospital appointment. 92% reported continuing to receive an appropriate level of care. All of the patients felt well supported and knew how to access the foot care service. 29% utilised virtual care. 82% (42/51) considered face to face appointments were more suitable for follow up rather than virtual/phone appointments.
Conclusions
It was possible to continue to provide safe diabetic foot care despite the COVID-19 pandemic but careful patient selection and communication is the key.
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Affiliation(s)
- Q Ain
- Croydon University Hospital, London, United Kingdom
| | - P Solanki
- Croydon University Hospital, London, United Kingdom
| | - T Georgi
- Croydon University Hospital, London, United Kingdom
| | - T Gala
- Croydon University Hospital, London, United Kingdom
| | - H Ashraf
- Croydon University Hospital, London, United Kingdom
| | - D Kelleher
- Croydon University Hospital, London, United Kingdom
| | - S Vig
- Croydon University Hospital, London, United Kingdom
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13
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Ashraf H, Anderson RG, Anderson DJ, Moug SJ. Feasibility of a perioperative smartphone application in colorectal surgery. Br J Surg 2021; 108:e282-e283. [PMID: 34409440 DOI: 10.1093/bjs/znab143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 04/03/2021] [Indexed: 11/13/2022]
Affiliation(s)
- H Ashraf
- University of Glasgow, Glasgow, UK
| | - R G Anderson
- Department of Surgery, Royal Alexandra Hospital, Paisley, UK
| | - D J Anderson
- Department of Surgery, Royal Alexandra Hospital, Paisley, UK
| | - S J Moug
- Department of Surgery, Royal Alexandra Hospital, University of Glasgow, Paisley, UK
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Dreher A, Yusuf R, Ashraf H, Shifat Ahmed SA, Strümpell C, Loerbroks A. Psychosocial stressors among Bangladesh’s ready-made garment workers: a pilot study. Das Gesundheitswesen 2021. [DOI: 10.1055/s-0041-1732100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- A Dreher
- Institute of Occupational, Social, and Environmental Medicine, University of Düsseldorf
| | - R Yusuf
- School of Life Sciences, Independent University Bangladesh
| | - H Ashraf
- Department of Anthropology, Jahangirnagar University
| | | | - C Strümpell
- Institute of Social and Cultural Anthropology, University of Hamburg
| | - A Loerbroks
- Institute of Occupational, Social, and Environmental Medicine, University of Düsseldorf
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15
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Ashraf H, Fortuin FD, Sweeney JP, Rosenthal JL, Arsanjani R. Percutaneous mitral valve repair with MitraClip as an effective bridge to transplant. Eur Heart J Cardiovasc Imaging 2021; 22:e13. [PMID: 32810199 DOI: 10.1093/ehjci/jeaa213] [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: 11/14/2022] Open
Affiliation(s)
- Hasan Ashraf
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - F David Fortuin
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - John P Sweeney
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Julie L Rosenthal
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Reza Arsanjani
- Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA
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16
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Ashraf H, Agasthi P, Shanbhag A, Mehta RA, Rattanawong P, Allam M, Pujari SH, Mookadam F, Freeman WK, Srivathsan K, Sorajja D, Shen WK, Noseworthy PA, Yang EH, Masry HZE, Yao X, Mulpuru SK, Beohar N, Holmes DR, Arsanjani R. Long-Term Clinical Outcomes of Underdosed Direct Oral Anticoagulants in Patients with Atrial Fibrillation and Atrial Flutter. Am J Med 2021; 134:788-796. [PMID: 33444586 DOI: 10.1016/j.amjmed.2020.12.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 12/12/2020] [Accepted: 12/14/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although direct oral anticoagulants (DOACs) have been shown to be effective at reducing the risk of stroke in patients with atrial fibrillation/flutter (AF), they are sometimes underdosed off-label to mitigate their associated higher bleeding risk. We sought to evaluate frequency and clinical outcomes of inappropriate underdosing of DOACS in patients with AF. METHODS We conducted a study of subjects with AF who had a clinical indication for stroke prophylaxis (with a congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke or transient ischemic attack, vascular disease, age 65 to 47 years, sex category [CHA2DS2-VASc] of 2 or greater) and were prescribed 1 of the 4 clinically approved DOACs (apixaban, rivaroxaban, dabigatran, or edoxaban). We compared all-cause mortality, composite of stroke and systemic embolism, composite of myocardial infarction (MI), acute coronary syndromes (ACS), and coronary revascularization, and major bleeding between patients appropriately dosed and inappropriately underdosed. RESULTS A total of 8125 patients met inclusion criteria, with a mean follow up of 2.2 ± 2 years. Of those, 1724 patients (21.2%) were inappropriately dosed. After adjusting for baseline variables, there was no difference in all-cause mortality, risk of stroke or systemic embolism, International Society on Thrombosis and Haemostasis (ISTH) major bleeding, or composite of myocardial infarction, acute coronary syndromes, or coronary revascularization between patients appropriately dosed and inappropriately underdosed. In subgroup analysis, only apixaban demonstrated an increased incidence all-cause mortality (hazard ratio [HR] 1.24, 95% confidence interval [CI] 1.03-1.49) with inappropriate underdosing. There was no difference in the remaining clinical outcomes noted on subgroup analysis. CONCLUSION Underdosing of DOACs did not minimize risk of bleeding, systemic embolization or all-cause mortality in patients with AF. Inappropriate underdosing with apixaban in particular was associated with increased all-cause mortality.
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Affiliation(s)
- Hasan Ashraf
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix Ariz.
| | | | - Anusha Shanbhag
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix Ariz
| | - Ramila A Mehta
- Department of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minn
| | | | - Mohamed Allam
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix Ariz
| | | | - Farouk Mookadam
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix Ariz
| | | | | | - Dan Sorajja
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix Ariz
| | - Win-Kuang Shen
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix Ariz
| | | | - Eric H Yang
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix Ariz
| | | | - Xiaoxi Yao
- Department of Health Care Policy and Research, Mayo Clinic, Rochester, Minn
| | - Siva K Mulpuru
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn
| | - Nirat Beohar
- Division of Cardiology, Mount Sinai Medical Center, Miami, Fla
| | - David R Holmes
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn
| | - Reza Arsanjani
- Department of Cardiovascular Diseases, Mayo Clinic, Phoenix Ariz
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17
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Rattanawong P, Kewcharoen J, Kanitsoraphan C, Barry T, Shanbhag A, Ko Ko NL, Vutthikraivit W, Home M, Agasthi P, Ashraf H, Shimizu W, Shen WK. Does the Age of Sudden Cardiac Death in Family Members Matter in Brugada Syndrome? J Am Heart Assoc 2021; 10:e019788. [PMID: 34013737 PMCID: PMC8483509 DOI: 10.1161/jaha.120.019788] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Brugada syndrome is an inherited cardiac channelopathy associated with major arrhythmic events (MAEs). The presence of a positive family history of sudden cardiac death (SCD) as a risk predictor of MAE remains controversial. We aimed to examine the association between family history of SCD and MAEs stratified by age of SCD with a systematic review and meta-analysis. Methods and Results We searched the databases of MEDLINE and EMBASE from January 1992 to January 2020. Data from each study were combined using the random-effects model. Fitted metaregression was performed to evaluate the association between the age of SCD in families and the risk of MAE. Twenty-two studies from 2004 to 2019 were included in this meta-analysis involving 3386 patients with Brugada syndrome. The overall family history of SCD was not associated with increased risk of MAE in Brugada syndrome (pooled odds ratio [OR], 1.11; 95% CI, 0.82-1.51; P=0.489, I2=45.0%). However, a history of SCD in family members of age younger than 40 years of age did increase the risk of MAE by ≈2-fold (pooled OR, 2.03; 95% CI, 1.11-3.73; P=0.022, I2=0.0%). When stratified by the age of cut point at 50, 45, 40, and 35 years old, a history of SCD in younger family member was significantly associated with a higher risk of MAE (pooled OR, 0.49, 1.30, 1.51, and 2.97, respectively; P=0.046). Conclusions A history of SCD among family members of age younger than 40 years was associated with a higher risk of MAE.
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Affiliation(s)
- Pattara Rattanawong
- Department of Cardiovascular Medicine Mayo Clinic Phoenix AZ.,Faculty of Medicine Ramathibodi Hospital Mahidol University Bangkok Thailand
| | - Jakrin Kewcharoen
- University of Hawaii Internal Medicine Residency Program Honolulu HI
| | | | - Timothy Barry
- Department of Cardiovascular Medicine Mayo Clinic Phoenix AZ
| | - Anusha Shanbhag
- Department of Cardiovascular Medicine Mayo Clinic Phoenix AZ
| | - Nway L Ko Ko
- Department of Cardiovascular Medicine Mayo Clinic Phoenix AZ
| | - Wasawat Vutthikraivit
- Division of Cardiovascular Medicine Department of Internal Medicine University of Iowa IA
| | | | | | - Hasan Ashraf
- Department of Cardiovascular Medicine Mayo Clinic Phoenix AZ
| | - Wataru Shimizu
- Department of Cardiovascular Medicine Graduate School of Medicine Nippon Medical School Tokyo Japan
| | - Win-Kuang Shen
- Department of Cardiovascular Medicine Mayo Clinic Phoenix AZ
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18
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Ashraf H, Sodergren M, Mylonas G, Darzi A. 837 The Identification of Gaze Behaviour and Physiological Markers Associated With Making An Error During Laparoscopic Cholecystectomy. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Introduction
Adverse surgical events remain at an unacceptably high level despite multiple global safety initiatives being introduced. As yet, however there is no conclusive evidence to identify whether physiological markers can be used to predict whether a surgeon will make an error
Method
Surgeons were asked to complete a simulated laparoscopic cholecystectomy task while physiological metrics and gaze behaviour was tracked. LightGBM and CatBoost were used to predict the physiological metric most useful in predicting whether a surgeon was about to make an error. The binary task used a boolean value of “does an error occur in the next 5 seconds” as the dependent variable, while the multiclass task classified the severity of error (0, 1, 2, 3).
Results
Autocorrelation with lag (eventually calculated with a lag of timestep 2) measured the tendency of this timeseries to correlate with itself. The degree of correlation, or lack of correlation, and sudden changes in correlation over time were gleaned from this feature.
Conclusions
Skin conductance was most likely to successfully predict impending error. However when gaze features were added, overall model performance improved by 6.4%. The potential for reduction in surgical error rate and improvement in patient safety are important factors to consider.
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Affiliation(s)
- H Ashraf
- Imperial College, London, United Kingdom
| | | | - G Mylonas
- Imperial College, London, United Kingdom
| | - A Darzi
- Imperial College, London, United Kingdom
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19
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Agasthi P, Ashraf H, Pujari SH, Girardo ME, Tseng A, Mookadam F, Venepally NR, Buras M, Khetarpal BK, Allam M, Eleid MF, Greason KL, Beohar N, Siegel RJ, Sweeney J, Fortuin FD, Holmes DR, Arsanjani R. Artificial Intelligence Trumps TAVI2-SCORE and CoreValve Score in Predicting 1-Year Mortality Post-Transcatheter Aortic Valve Replacement. Cardiovascular Revascularization Medicine 2021; 24:33-41. [DOI: 10.1016/j.carrev.2020.08.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/07/2020] [Accepted: 08/10/2020] [Indexed: 01/19/2023]
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20
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Shahzad MI, Anwar S, Ashraf H, Manzoor A, Naseer M, Rani U, Aslam Z, Saba N, Kamran Z, Ali S, Aslam J, Arshad M. Antiviral activities of Cholistani plants against common poultry viruses. Trop Biomed 2020; 37:1129-1140. [PMID: 33612765 DOI: 10.47665/tb.37.4.1129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Herbal medicines are becoming more popular and acceptable day by day due to their effectiveness, limited side effects, and cost-effectiveness. Cholistani plants are reported as a rich source of antibacterial, antifungal, antiprotozoal, antioxidant, and anticancer agents. The current study has evaluated antiviral potential of selected Cholistani plants. The whole plants were collected, ground and used in extract formation with n-hexane, ethyl acetate and n-butanol. All the extracts were concentrated by using a rotary evaporator and concentrate was finally dissolved in an appropriate vol of the same solvent. All of the extracts were tested for their antiviral potential by using 9-11 days old chick embryonated eggs. Each extract was tested against the Avian Influenza virus H9N2 strain (AIV), New Castle Disease virus Lasoota strain (NDV), Infectious bronchitis virus (IBV) and an Infectious bursal disease virus (IBDV). Hemagglutination test (HA) and Indirect Hemagglutination (IHA) tests were performed for different viruses. The overall order of the antiviral potential of Cholistani plants against viruses was NDV>IBV>IBDV>AIV. In terms of antiviral activity from extracts, the order of activity was n-butanol>ethyl acetate>n-hexane. The medicinal plants Achyranthes aspera, Neuroda procumbens, Panicum antidotale, Ochthochloa compressa and Suaeda fruticose were very effective against all four poultry viruses through their extracts. The low IC50 values of these extracts confirm the high antiviral potential against these viruses. It is worth to mention that Achyranthes aspera was found positive against IBDV through all its extracts which overcome the problem of unavailability of any known drug against IBDV. In short, the study proved that Cholistani plants are rich source of antiviral agent and their extracts can be used as good source of antiviral drugs both in crude and in purified form.
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Affiliation(s)
- M I Shahzad
- Department of Biochemistry and Biotechnology. The Islamia University of Bahawalpur, Pakistan
| | - S Anwar
- Department of Botany. The Govt Sadiq College Women University, Bahawalpur, Pakistan. Pakistan
| | - H Ashraf
- Department of Botany. The Govt Sadiq College Women University, Bahawalpur, Pakistan. Pakistan
| | - A Manzoor
- Department of Botany. The Govt Sadiq College Women University, Bahawalpur, Pakistan. Pakistan
| | - M Naseer
- Department of Botany. The Govt Sadiq College Women University, Bahawalpur, Pakistan. Pakistan
| | - U Rani
- Department of Botany. The Govt Sadiq College Women University, Bahawalpur, Pakistan. Pakistan
| | - Z Aslam
- Department of Botany. The Govt Sadiq College Women University, Bahawalpur, Pakistan. Pakistan
| | - N Saba
- Department of Botany. The Govt Sadiq College Women University, Bahawalpur, Pakistan. Pakistan
| | - Z Kamran
- University college of Veterinary and Animal Sciences, The Islamia University, Bahawalpur
| | - S Ali
- Govt. poultry farm, Model Town A, Bahawalpur. Pakistan
| | - J Aslam
- Department of Biochemistry and Biotechnology. The Islamia University of Bahawalpur, Pakistan
| | - M Arshad
- Department of Biochemistry, College of Veterinary and Animal Sciences, Jhang Campus, UVAS Lahore, Pakistan
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21
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Agasthi P, Chao CJ, Siegel RJ, Pujari SH, Mookadam F, Venepally NR, Wang P, Ashraf H, Marcotte F, Brown L, Semkiv OI, Fath AR, Allam MNA, Jokerst CE, Arsanjani R. Comparison of echocardiographic parameters with cardiac magnetic resonance imaging in the assessment of right ventricular function. Echocardiography 2020; 37:1792-1802. [PMID: 33012034 DOI: 10.1111/echo.14877] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 06/09/2020] [Revised: 08/27/2020] [Accepted: 09/12/2020] [Indexed: 02/06/2023] Open
Abstract
INTRODUCTION The right ventricle (RV) strain measured by speckle tracking (RVS) is an echocardiographic parameter used to assess RV function. We compared RVS to RV fractional area change (FAC%), tricuspid annular plane systolic excursion (TAPSE) and Doppler tissue imaging-derived peak systolic velocity (S') in the assessment of right ventricular (RV) systolic function measured using cardiac magnetic resonance imaging (MRI). METHODS We enrolled consecutive patients who underwent cardiac MRI between Jan 2012 and Dec 2017 and a transthoracic echocardiogram (TTE) within 1 month of the MRI with no interval event. Baseline clinical characteristics and MRI parameters were extracted from chart review. Echocardiographic parameters were measured prospectively. TTE parameters including RVS, TAPSE, S', and FAC% were tested for accuracy to identify impaired RV EF (EF < 45% & <30%) using receiver operator curves. RESULTS The study cohort included 500 patients with mean age 55 years ± 18 and peak tricuspid regurgitation velocity 2.7 ± 1.4 m/s. The area under ROC for RVS was 0.69 (95% CI 0.63-0.75) and 0.78 (95% CI 0.70-0.88) to predict RVEF < 45% & RVEF < 30%, respectively. The RV FAC% had second highest accuracy of predicting RVEF among all the TTE parameters tested in study. CONCLUSION Right ventricular strain is the most accurate echocardiographic method to detect impaired right ventricular systolic function when using MRI as the gold standard.
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Affiliation(s)
- Pradyumna Agasthi
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Chieh-Ju Chao
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Robert J Siegel
- Department of Cardiology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Sai Harika Pujari
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Farouk Mookadam
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Nithin R Venepally
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Panwen Wang
- Department of Health Sciences Research, Mayo Clinic Arizona, Scottsdale, AZ, USA
| | - Hasan Ashraf
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Francois Marcotte
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Lisa Brown
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Oksana I Semkiv
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Ayman R Fath
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA
| | - Mohamed N A Allam
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA
| | | | - Reza Arsanjani
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, Phoenix, AZ, USA
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22
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Ashraf H, Lee H, Tran KH, Agasthi P, Keddis MT, Unzek S, Narayanasamy H, Wilansky S. Prevalence and Outcomes of Pericardial Effusion in Kidney Transplant Candidates. Am J Cardiol 2020; 132:140-146. [PMID: 32773224 DOI: 10.1016/j.amjcard.2020.07.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 07/03/2020] [Accepted: 07/08/2020] [Indexed: 10/23/2022]
Abstract
Pericardial disease is a recognized manifestation of cardiovascular disease in the end-stage renal disease (ESRD) population, and can manifest as pericardial effusion, though the prognosis of pericardial disease in ESRD patients is unclear. In the modern era of renal replacement therapy, little is known about the prevalence and the implications of pericardial effusion in ESRD patients, its echocardiographic characteristics, and risk factors. We conducted a retrospective chart review on subjects > than 18 years of age with known ESRD who were undergoing outpatient evaluation for renal transplantation at Mayo Clinic Arizona between January 2001 and December 2015 and had baseline echocardiogram completed within 3 months of their initial evaluation. Patients with moderate sized pericardial effusions or larger were identified. The pericardial effusion cohort was age and gender matched with a cohort of patients with ESRD without pericardial effusion in a 1:2 fashion. 54 patients with moderate or greater sized pericardial effusion out of 2,820 patients that fit our inclusion criteria, corresponding to a prevalence of 1.9%. A total of 41 patients or 75.9%, had a moderate sized effusion. A total of 13 patients, or 24.1% had a large sized effusion, 7 of whom had tamponade physiology on echocardiography. The presence and size of the effusion was not predictive for worse outcomes. Hemodialysis duration was protective, but no other factors were predictive or protective in the development of moderate sized or larger pericardial effusions, including echocardiographic parameters.
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23
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Ashraf H, Fortuin FD, Sweeney J, DeValeria PA, Lanza LA, Ramsay G, Maranzano P, Patrick L, Scott LR. Development of advanced conduction disturbances following balloon-expandable transcatheter aortic valve replacement leads to poorer clinical outcomes. J Arrhythm 2020; 36:755-761. [PMID: 32782650 PMCID: PMC7411204 DOI: 10.1002/joa3.12383] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 05/20/2020] [Accepted: 05/26/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Transcatheter aortic valve replacement (TAVR) is a reliable method of treating patients with severe aortic stenosis, but is associated with postprocedure conduction defects. OBJECTIVE The purpose of this study was to compare clinical outcomes in patients who developed advanced conduction defects post-TAVR to those who did not. METHODS We conducted a retrospective chart review of 243 patients who underwent balloon-expandable TAVR with the Edwards Sapien valve to determine the incidence of advanced conduction defects in our cohort. We compared clinical outcomes including overall mortality, improvement in symptomatology, and improvement in left ventricular ejection fraction. RESULTS Among the 243 patients included in the study, 9.1% (22/243) required permanent pacemaker (PPM); 19.8% (48/243) developed left bundle branch block (LBBB), and 71.2% (173/243) did not develop any permanent advanced conduction defects. Overall 1-year mortality was similar across all three groups. There was significant improvement in New York Heart Association functional capacity of all groups post-TAVR, but this was much less in the PPM group (45.5% vs 68.8%, P = .04). Postprocedure from TAVR, patients with LBBB or PM were less likely to have improvement in their ejection fraction (net loss of -0.7% for LBBB and -5.7% for PPM compared to a net gain of 2.3% for no-LBBB/PM (P = .02). CONCLUSION Patients who develop LBBB or require PM post-TAVR with Edwards Sapien valves are less likely to improve New York Heart Association functional capacity and more likely to have no improvement or deterioration of their pre-TAVR left ventricular ejection fraction.
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Affiliation(s)
- Hasan Ashraf
- Department of Cardiovascular MedicineMayo ClinicPhoenixAZUSA
| | | | - John Sweeney
- Department of Cardiovascular MedicineMayo ClinicPhoenixAZUSA
| | | | - Louis A. Lanza
- Department of Cardiovascular SurgeryMayo ClinicPhoenixAZUSA
| | - Gary Ramsay
- Department of Cardiovascular MedicineMayo ClinicPhoenixAZUSA
| | - Pedro Maranzano
- Department of Cardiovascular MedicineMayo ClinicPhoenixAZUSA
| | - Lorna Patrick
- Department of Cardiovascular MedicineMayo ClinicPhoenixAZUSA
| | - Luis R. Scott
- Department of Cardiovascular MedicineMayo ClinicPhoenixAZUSA
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Alam NH, Ashraf H, Ahmed T, Jahan N, Gyr N. Randomised trial showed that rapid rehydration of severely malnourished children with dehydrating diarrhoea was as safe and effective as slow rehydration. Acta Paediatr 2020; 109:1473-1484. [PMID: 31828841 DOI: 10.1111/apa.15134] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 09/01/2018] [Revised: 09/08/2019] [Accepted: 12/09/2019] [Indexed: 01/04/2023]
Abstract
AIM This study evaluated the effectiveness and safety of rapid and slow rehydration in children aged 6-60 months with dehydrating diarrhoea and severe malnutrition. METHODS A randomised controlled trial was conducted from July 2011 to March 2014 at the International Centre for Diarrhoeal Disease Research Bangladesh. We included children with weight for age and, or, weight for length Z-scores of less than -3 or with bipedal oedema and acute diarrhoea with severe dehydration. The children received intravenous fluid at different rates: 105 rapidly over six hours and 103 slowly over the 12 hours recommended by the World Health Organization. RESULTS All the children were successfully rehydrated. The admittance weights were similar for the slow and rapid groups: 8.4 kg and 8.3 kg. After 24 hours, the mean percentage weight gain was 8.5% and 9.0%, respectively. This confirmed that most of the children had been suffering from severe dehydration on admission. The respective proportions of children who received unscheduled intravenous fluid were 18% and 17%. None developed fluid overload or heart failure and most recovered normal renal function after rehydration. CONCLUSION Rapid rehydration saved time, was as safe as slow rehydration and was a better option for dehydrating diarrhoea and severe malnutrition.
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Affiliation(s)
- Nur H. Alam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) Dhaka Bangladesh
| | - Hasan Ashraf
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) Dhaka Bangladesh
| | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) Dhaka Bangladesh
| | - Nishat Jahan
- Department of Pharmacy University of Asia Pacific Dhaka Bangladesh
| | - Niklaus Gyr
- Faculty of Medicine University of Basel Basel Switzerland
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Agasthi P, Lee JZ, Pujari SH, Tseng AS, Shipman J, Almader-Douglas D, Ashraf H, Mookadam F, Fortuin FD, Beohar N, Arsanjani R, Mulpuru SK. P473Safety and efficacy of direct oral anticoagulants compared to vitamin K antagonists in patients with atrial fibrillation undergoing percutaneous coronary interventions: A meta-analysis. Europace 2020. [DOI: 10.1093/europace/euaa162.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Coronary artery disease (CAD) and atrial fibrillation (AF) are commonly associated. Co-treatment with multiple anti-thrombotic agents can increase the risk of bleeding.
Purpose
We sought to evaluate patient-centered outcomes in patients with AF on double therapy with direct oral anticoagulants (DOACs) compared to patients with standard triple therapy, [a vitamin K antagonist (VKA) plus dual antiplatelet therapy].
Methods
We performed an extensive systematic review of the literature and meta-analysis of randomized controlled trials reporting outcomes of patients receiving double therapy with DOACs compared to triple therapy with VKAs in patients with AF undergoing percutaneous coronary intervention (PCI). Patient-centered outcomes were the International Society of Thrombosis and Hemostasis (ISTH) major or clinically relevant non-major bleeding (CRNB), all-cause mortality, major adverse cardiovascular events (MACE), myocardial infarction, stent thrombosis, and stroke.
Results
Four randomized controlled trials (9602 patients) met our inclusion criteria. Compared to VKAs, DOACs were associated with significantly lower ISTH major bleeding/ CRNB (RR - 0.75, 95% CI: 0.67-0.82, p < 0.00001, I2 = 11%). There were no statistically significant differences in the efficacy outcomes, including myocardial infarction (RR- 0.99, 95% CI :0.79-1.25, p = 0.96, I2 = 0%), stent thrombosis (RR - 0.97, 95% CI: 0.6-1.55, p = 0.89, I2 = 0%), ischemic stroke (RR - 0.76, 95% CI: 0.5-1.15, p = 0.19, I2 = 0%), all-cause mortality (RR - 1.06, 95% CI: 0.85-1.31, p = 0.61, I2 = 0%) and MACE (RR - 1.06, 95% CI: 0.91-1.22, p = 0.97, I2 = 0%).
Conclusion
Compared with triple therapy with VKAS, double therapy with DOACs is associated with a reduced risk of bleeding and is as effective in patients with AF undergoing PCI.
Abstract Figure.
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Affiliation(s)
- P Agasthi
- Mayo Clinic, Phoenix, United States of America
| | - J Z Lee
- Mayo Clinic, Rochester, United States of America
| | - S H Pujari
- Mayo Clinic, Phoenix, United States of America
| | - A S Tseng
- Mayo Clinic, Rochester, United States of America
| | - J Shipman
- Mayo Clinic, Phoenix, United States of America
| | | | - H Ashraf
- Mayo Clinic, Phoenix, United States of America
| | - F Mookadam
- Mayo Clinic, Phoenix, United States of America
| | - F D Fortuin
- Mayo Clinic, Phoenix, United States of America
| | - N Beohar
- Mount Sinai Medical Center, Cardiovascular Diseases, Miami Beach, United States of America
| | - R Arsanjani
- Mayo Clinic, Phoenix, United States of America
| | - S K Mulpuru
- Mayo Clinic, Rochester, United States of America
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Agasthi P, Pujari SH, Mookadam F, Venepally NR, Ashraf H, Fortuin FD, Wang P, Allam M, Sweeney J, Eleid M, Pollak P, Greason KL, Beohar N, Arsanjani R. Resting Cardiac Efficiency Affects Survival Following Transcatheter Aortic Valve Replacement. Cardiovasc Revasc Med 2020; 21:1327-1333. [PMID: 32317228 DOI: 10.1016/j.carrev.2020.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2019] [Revised: 03/15/2020] [Accepted: 04/09/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Cardiac power to left ventricular mass (LVM) ratio, also termed cardiac efficiency (CE), reflects the rate of cardiac work delivered to the potential energy stored in LVM. We sought to assess the association between baseline resting CE and survival post transcatheter aortic valve replacement (TAVR). METHODS We retrospectively extracted data of patients who received TAVR in the Mayo Clinic Foundation with follow up data available at 1 year. Cardiac output was measured using Doppler echocardiography at baseline. CE was calculated using the formula, (cardiac output × mean arterial blood pressure)/(451 × LVM × 100) W/100 g. Survival score analysis was performed to identify cut off value for CE to identify the maximum difference in mortality in the study cohort. Patients were subsequently divided into 2 groups CE < 0.38 W/100 g and CE ≥ 0.38 W/100 g. Survival was determined using Kaplan-Meier method. RESULTS We included 954 patients in the final analysis. CE in group1 vs group 2 was 0.31 ± 0.05 W/100 g vs 0.59 ± 0.18 W/100 g. Patients in group1 were more likely to be male, had a higher prevalence of atrial fibrillation, prior myocardial infarction, mitral and tricuspid regurgitation. They also had a higher STS risk score, NYHA functional class, and lower aortic valve area. The remainder of the baseline characteristics was similar in both groups. A lower CE was associated with higher 1-year mortality following TAVR based on multivariate analysis. (Group1: 22.18% vs Group 2: 9.89%, p < .0001). CONCLUSION In our cohort, a low baseline CE (<0.38 W/100 g) conferred higher mortality risk following TAVR.
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Affiliation(s)
- Pradyumna Agasthi
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ, United States of America.
| | - Sai Harika Pujari
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ, United States of America
| | - Farouk Mookadam
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ, United States of America
| | - Nithin R Venepally
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ, United States of America
| | - Hasan Ashraf
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ, United States of America
| | - Floyd David Fortuin
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ, United States of America
| | - Panwen Wang
- Department of Health Sciences Research, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ, United States of America
| | - Mohamed Allam
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ, United States of America
| | - John Sweeney
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ, United States of America
| | - Mackram Eleid
- Department of Cardiovascular Diseases, Mayo Clinic Rochester, Rochester, MN, United States of America
| | - Peter Pollak
- Department of Cardiovascular Diseases, Mayo Clinic Florida, 4500 San Pablo Rd S, Jacksonville, FL, United States of America
| | - Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic Rochester, 200 1st St SW, Rochester, MN, United States of America
| | - Nirat Beohar
- Columbia University Division of Cardiology, Mount Sinai Medical Center, 4300 Alton Rd, Miami Beach, FL, United States of America
| | - Reza Arsanjani
- Department of Cardiovascular Diseases, Mayo Clinic Arizona, 5777 E Mayo Blvd, Phoenix, AZ, United States of America
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Faraz A, Ashraf H, Singhal S, Hussain F, Jaiswal J. P47 Correlation of Neurophysiological parameters with HRV in patients of Diabetic peripheral neuropathy. A cross sectional study. Clin Neurophysiol 2020. [DOI: 10.1016/j.clinph.2019.12.053] [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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Agasthi P, Lee JZ, Pujari SH, Tseng AS, Shipman J, Almader‐Douglas D, Ashraf H, Mookadam F, Fortuin FD, Beohar N, Arsanjani R, Mulpuru S. Safety and efficacy of direct oral anticoagulants compared to Vitamin K antagonists postpercutaneous coronary interventions in patients with atrial fibrillation: A systematic review and meta-analysis. J Arrhythm 2020; 36:271-279. [PMID: 32256873 PMCID: PMC7132188 DOI: 10.1002/joa3.12292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 11/28/2019] [Accepted: 12/09/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Atrial fibrillation (AF) and coronary artery disease (CAD) are commonly associated. Cotreatment with multiple antithrombotic agents can increase the risk of bleeding. We sought to evaluate patient-centered outcomes in patients with AF on double therapy with direct oral anticoagulants (DOACs) compared to patients with standard triple therapy, [a vitamin K antagonist (VKA) plus dual antiplatelet therapy]. METHODS We performed a literature search of randomized controlled trials (RCTs) reporting outcomes of patients receiving double therapy with DOACs compared to triple therapy with VKAs in patients with AF undergoing percutaneous coronary intervention (PCI). Patient-centered outcomes were the International Society of Thrombosis and Hemostasis (ISTH) major or clinically relevant nonmajor bleeding (CRNB), all-cause mortality, major adverse cardiovascular events (MACE), stent thrombosis, myocardial infarction, and stroke. RESULTS Four RCTs (9602 patients) met our inclusion criteria. Compared to VKAs, DOACs were associated with significantly lower ISTH major bleeding/ CRNB (RR: 0.75, 95% CI: 0.67-0.82, P < .00001, I 2 = 11%). There were no statistically significant differences in the efficacy outcomes, including myocardial infarction (RR: 0.99, 95% CI :0.79-1.25, P = .96), stent thrombosis (RR: 0.97, 95% CI: 0.6-1.55, P = .89), ischemic stroke (RR: 0.76, 95% CI: 0.5-1.15, P = .19), all-cause mortality (RR: 1.06, 95% CI: 0.85-1.31, P = .61), and MACE (RR: 1.06, 95% CI: 0.91-1.22, P = .97). CONCLUSION Compared with triple therapy with VKAS, double therapy with DOACs is associated with a reduced risk of bleeding and is as effective in patients with AF undergoing PCI.
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Affiliation(s)
| | - Justin Z. Lee
- Department of Cardiovascular DiseasesMayo ClinicRochesterMNUSA
| | | | - Andrew S. Tseng
- Department of Cardiovascular DiseasesMayo ClinicRochesterMNUSA
| | - Justin Shipman
- Department of Cardiovascular DiseasesMayo ClinicPhoenixAZUSA
| | | | - Hasan Ashraf
- Department of Cardiovascular DiseasesMayo ClinicPhoenixAZUSA
| | - Farouk Mookadam
- Department of Cardiovascular DiseasesMayo ClinicPhoenixAZUSA
| | | | - Nirat Beohar
- Department of Cardiovascular DiseasesMount Sinai Medical CenterMiamiFLUSA
| | - Reza Arsanjani
- Department of Cardiovascular DiseasesMayo ClinicPhoenixAZUSA
| | - Siva Mulpuru
- Department of Cardiovascular DiseasesMayo ClinicRochesterMNUSA
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Abstract
Transthoracic echocardiography plays a pivotal role in the diagnosis of complications, evaluation of hemodynamics, and management of patients with surgically repaired congenital heart disease. Late complications of surgically corrected tetralogy of Fallot (TOF), the most common cyanotic congenital heart disease, include pulmonary regurgitation (PR), ventricular septal defect (VSD) patch leakage, and residual right ventricular outflow tract obstruction. We present a case of severe PR secondary to Bartonella endocarditis in an adult with a history of repaired TOF in which echocardiography was instrumental in the diagnosis of severe PR, residual VSD, and a right-to-left shunt through an unsuspected patent foramen ovale.
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Affiliation(s)
- Hasan Ashraf
- Department of Cardiology, Mayo Clinic, Scottsdale, AZ, USA.,Department of Internal Medicine, Indiana University, Indianapolis, IN, USA
| | - Kruti Pandya
- Department of Cardiovascular Medicine, University of California, Davis, California, USA
| | - Matthew Wack
- Department of Infectious Disease, Indiana University Health Physicians, Indianapolis, IN, USA
| | - Stephen Sawada
- Department of Cardiology, Krannert Institute of Cardiology, Indianapolis, IN, USA
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Ashraf H, Alam NH, Sultana M, Jahan SA, Begum N, Farzana S, Chisti MJ, Kamal M, Shamsuzzaman A, Ahmed T, Khan JAM, Fuchs GJ, Duke T, Gyr N. Day clinic vs. hospital care of pneumonia and severe malnutrition in children under five: a randomised trial. Trop Med Int Health 2019; 24:922-931. [PMID: 31046165 DOI: 10.1111/tmi.13242] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 10/26/2022]
Abstract
OBJECTIVES To evaluate the clinical outcomes and costs of managing pneumonia and severe malnutrition in a day clinic (DC) management model (outpatient) vs. hospital care (inpatient). METHODS Randomised clinical trial where children aged 2 months to 5 years with pneumonia and severe malnutrition were randomly allocated to DC or inpatient hospital care. We used block randomisation of variable length from 8 to 20 and produced computer-generated random numbers that were assigned to one of the two interventions. Successful management was defined as resolution of clinical signs of pneumonia and being discharged from the model of care (DC or hospital) without need for referral to a hospital (DC), or referral to another hospital. All the children in both DC and hospital received intramuscular ceftriaxone, daily nutrition support and micronutrients. RESULTS Four hundred and seventy children were randomly assigned to either DC or hospital care. Successful management was achieved for 184 of 235 (78.3%) by DC alone, vs. 201 of 235 (85.5%) by hospital inpatient care [RR (95% CI) = 0.79 (0.65-0.97), P = 0.02]. During 6 months of follow-up, 30/235 (12.8%) in the DC group and 36/235 (15.3%) required readmission to hospital in the hospital care group [RR (95% CI) = 0.89 (0.67-1.18), P = 0.21]. The average overall healthcare and societal cost was 34% lower in DC (US$ 188 ± 11.7) than in hospital (US$ 285 ± 13.6) (P < 0.001), and costs for households were 33% lower. CONCLUSIONS There was a 7% greater probability of successful management of pneumonia and severe malnutrition when inpatient hospital care rather than the outpatient day clinic care was the initial method of care. However, where timely referral mechanisms were in place, 94% of children with pneumonia and severe malnutrition were successfully managed initially in a day clinic, and costs were substantially lower than with hospital admission.
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Affiliation(s)
- Hasan Ashraf
- icddr,b, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Nur H Alam
- icddr,b, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Marufa Sultana
- icddr,b, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Selina A Jahan
- icddr,b, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Nurshad Begum
- icddr,b, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Sharmin Farzana
- icddr,b, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Mohammod J Chisti
- icddr,b, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Mohiuddin Kamal
- Radda Maternal and Child Health Family Planning Centre, Dhaka, Bangladesh
| | - Abu Shamsuzzaman
- Institute of Child Health and Shishu, Sasthya Foundation Hospital, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- icddr,b, International Centre for Diarrhoeal Disease Research, Bangladesh
| | - Jahangir A M Khan
- icddr,b, International Centre for Diarrhoeal Disease Research, Bangladesh.,Department of Clinical Sciences, Liverpool School of Tropical Medicine, UK
| | - George J Fuchs
- Department of Pediatrics, University of Kentucky College of Medicine, Lexington, Kentucky, USA
| | - Trevor Duke
- Centre for International Child Health, University of Melbourne, Melbourne, Australia
| | - Niklaus Gyr
- Faculty of Medicine, University of Basel, Basel, Switzerland
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Saeed A, Larik FA, Jabeen F, Mehfooz H, Ghumro SA, El-Seedi HR, Ali M, Channar PA, Ashraf H. Synthesis, Antibacterial and Antileishmanial Activity, Cytotoxicity, and Molecular Docking of New Heteroleptic Copper(I) Complexes with Thiourea Ligands and Triphenylphosphine. RUSS J GEN CHEM+ 2018. [DOI: 10.1134/s1070363218030246] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Gualeni B, Coulman S, Shah D, Eng P, Ashraf H, Vescovo P, Blayney G, Piveteau LD, Guy O, Birchall J. Minimally invasive and targeted therapeutic cell delivery to the skin using microneedle devices. Br J Dermatol 2018; 178:731-739. [DOI: 10.1111/bjd.15923] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/28/2017] [Indexed: 12/21/2022]
Affiliation(s)
- B. Gualeni
- School of Pharmacy and Pharmaceutical Sciences; Redwood Building; Cardiff University; Cardiff CF10 3NB U.K
- Extraject Technologies Ltd; Cardiff Medicentre, Heath Park; Cardiff CF14 4UJ U.K
| | - S.A. Coulman
- School of Pharmacy and Pharmaceutical Sciences; Redwood Building; Cardiff University; Cardiff CF10 3NB U.K
- Extraject Technologies Ltd; Cardiff Medicentre, Heath Park; Cardiff CF14 4UJ U.K
| | - D. Shah
- The Hillingdon Hospital NHS Foundation Trust; Pield Heath Road Uxbridge UB8 3NN U.K
| | - P.F. Eng
- Centre for NanoHealth; College of Engineering; Swansea University; Swansea SA2 8PQ U.K
| | - H. Ashraf
- SPTS Technologies; Ringland Way Newport NP18 2TA U.K
| | - P. Vescovo
- Debiotech SA; Avenue de Sévelin 28 1004 Lausanne Switzerland
| | - G.J. Blayney
- Centre for NanoHealth; College of Engineering; Swansea University; Swansea SA2 8PQ U.K
| | - L.-D. Piveteau
- Debiotech SA; Avenue de Sévelin 28 1004 Lausanne Switzerland
| | - O.J. Guy
- Centre for NanoHealth; College of Engineering; Swansea University; Swansea SA2 8PQ U.K
| | - J.C. Birchall
- School of Pharmacy and Pharmaceutical Sciences; Redwood Building; Cardiff University; Cardiff CF10 3NB U.K
- Extraject Technologies Ltd; Cardiff Medicentre, Heath Park; Cardiff CF14 4UJ U.K
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Erridge S, Ashraf H, Purkayastha S, Darzi A, Sodergren MH. Comparison of gaze behaviour of trainee and experienced surgeons during laparoscopic gastric bypass. Br J Surg 2017; 105:287-294. [DOI: 10.1002/bjs.10672] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Revised: 05/04/2017] [Accepted: 07/11/2017] [Indexed: 01/13/2023]
Abstract
Abstract
Background
Eye tracking presents a novel tool that could be used to profile skill levels in surgery objectively. The primary aim of this study was to identify differences in gaze behaviour between expert and junior surgeons performing a laparoscopic Roux-en-Y gastric bypass (LRYGB) for obesity.
Methods
This prospective observational study used a lightweight eye-tracking apparatus to determine the difference in gaze behaviours between expert (more than 75 procedures) and junior (75 or fewer procedures) surgeons at defined stages of LRYGB. Primary endpoints were normalized dwell time and fixation frequency. Secondary endpoints were blink rate, maximum pupil size and rate of pupil change.
Results
A total of 20 procedures (12 junior, 8 expert) were analysed. Compared with juniors, experts showed a prolonged dwell time on the screen during angle of His dissection (median (range) 91·20 (83·40–94·40) versus 68·95 (59·80–87·60) per cent; P = 0·001), formation of the retrogastric tunnel (91·50 (85·80–95·50) versus 73·60 (34·60–90·50) per cent; P = 0·001) and gastric pouch formation (86·95 (83·60–90·20) versus 67·60 (37·10–80·00) per cent P < 0·001). Juniors had a greater blink frequency throughout all recorded segments (P < 0·010) and had a larger maximum pupil size during all recorded operative segments (P < 0·010). Rate of pupil change was greater in juniors in all analysed segments (P < 0·010).
Conclusion
These results suggest that experts display more focused attention on significant stimuli, alongside experiencing a reduced mental workload and having increased concentration. This has the potential for future use in validation of surgical skill in high-stakes assessment.
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Affiliation(s)
- S Erridge
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - H Ashraf
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - S Purkayastha
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - A Darzi
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - M H Sodergren
- Department of Surgery and Cancer, Imperial College London, London, UK
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Saghir Z, Ashraf H, Pedersen J, Mortensen J. P3.13-011 Use of Volume Growth and Fluor-Deoxy-Glucose Positron Emission Tomography in Evaluating Indeterminate Lung Nodules in Lung Cancer Screening. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1746] [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: 10/18/2022]
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Saeedi O, Ashraf H, Slade EP, Medoff DR, Li L, Friedman DS, Kreyenbuhl J. Trends in Prevalence of Diagnosed Ocular Disease and Utilization of Eye Care Services in American Veterans. Am J Ophthalmol 2017; 173:70-75. [PMID: 27702620 DOI: 10.1016/j.ajo.2016.09.030] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [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: 06/02/2016] [Revised: 09/23/2016] [Accepted: 09/23/2016] [Indexed: 11/17/2022]
Abstract
PURPOSE To assess trends in prevalence of diagnosed ocular disease and use of eye care services in the Veterans Affairs (VA) health care system. DESIGN Prevalence study. METHODS We performed a retrospective study of all eligible veterans in the VA Capitol Health Care Network from 2007 to 2011. The VA database was used to abstract demographic and socioeconomic variables, including age, race, sex, marital status, service connection, prescription copay, homelessness, and VA facility. Primary outcome measures were the prevalence of diagnosed ocular disease and use of eye care. Ocular diagnoses were determined by International Classification of Diseases, 9th revision codes and use by prescription medication fills, visits to eye care clinics, and cataract surgery frequency. RESULTS The average age of veterans ranged from 59.8-60.9, most veterans were male (88.1-89.8%), and there was a high proportion of African Americans (29.5-30%). The prevalence of all ocular diagnoses increased from 20.5% in 2007 to 23.3% in 2011 (P < .01), a 13.7% increase. Similarly, the prevalence of diagnosed cataract increased by 35.7% (P = .02) from 7.1% in 2007 to 9.6% in 2011. Diagnosed glaucoma prevalence increased by 9.4% (P = .03) from 6.7 to 7.4%. The percent of patients seen in eye clinics increased 11.6%% in the 5-year study period to 24.0% in fiscal year 2011 (P = .05). The use of ophthalmic medications increased 20% (P < .01). The rate of cataract surgery did not change significantly during the study period. CONCLUSIONS The prevalence of diagnosed eye conditions among American Veterans is increasing, as is the use of eye care services. Cataract surgery rates did not increase, which may indicate a need to increase availability of these services.
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Affiliation(s)
- Osamah Saeedi
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, Baltimore, Maryland.
| | - Hasan Ashraf
- Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Eric P Slade
- Department of Psychiatry, Division of Psychiatric Services Research, University of Maryland School of Medicine, Baltimore, Maryland; Veterans Affairs Capitol Healthcare Network Mental Illness Research, Education, and Clinical Center, Baltimore, Maryland
| | - Deborah R Medoff
- Department of Psychiatry, Division of Psychiatric Services Research, University of Maryland School of Medicine, Baltimore, Maryland; Veterans Affairs Capitol Healthcare Network Mental Illness Research, Education, and Clinical Center, Baltimore, Maryland
| | - Lan Li
- Department of Psychiatry, Division of Psychiatric Services Research, University of Maryland School of Medicine, Baltimore, Maryland
| | - David S Friedman
- Glaucoma Center of Excellence, Wilmer Eye Institute, Johns Hopkins University, Baltimore, Maryland
| | - Julie Kreyenbuhl
- Department of Psychiatry, Division of Psychiatric Services Research, University of Maryland School of Medicine, Baltimore, Maryland; Veterans Affairs Capitol Healthcare Network Mental Illness Research, Education, and Clinical Center, Baltimore, Maryland
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Thorgeirsson TE, Steinberg S, Reginsson GW, Bjornsdottir G, Rafnar T, Jonsdottir I, Helgadottir A, Gretarsdottir S, Helgadottir H, Jonsson S, Matthiasson SE, Gislason T, Tyrfingsson T, Gudbjartsson T, Isaksson HJ, Hardardottir H, Sigvaldason A, Kiemeney LA, Haugen A, Zienolddiny S, Wolf HJ, Franklin WA, Panadero A, Mayordomo JI, Hall IP, Rönmark E, Lundbäck B, Dirksen A, Ashraf H, Pedersen JH, Masson G, Sulem P, Thorsteinsdottir U, Gudbjartsson DF, Stefansson K. A rare missense mutation in CHRNA4 associates with smoking behavior and its consequences. Mol Psychiatry 2016; 21:594-600. [PMID: 26952864 PMCID: PMC5414061 DOI: 10.1038/mp.2016.13] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Revised: 12/17/2015] [Accepted: 01/04/2016] [Indexed: 11/22/2022]
Abstract
Using Icelandic whole-genome sequence data and an imputation approach we searched for rare sequence variants in CHRNA4 and tested them for association with nicotine dependence. We show that carriers of a rare missense variant (allele frequency=0.24%) within CHRNA4, encoding an R336C substitution, have greater risk of nicotine addiction than non-carriers as assessed by the Fagerstrom Test for Nicotine Dependence (P=1.2 × 10(-4)). The variant also confers risk of several serious smoking-related diseases previously shown to be associated with the D398N substitution in CHRNA5. We observed odds ratios (ORs) of 1.7-2.3 for lung cancer (LC; P=4.0 × 10(-4)), chronic obstructive pulmonary disease (COPD; P=9.3 × 10(-4)), peripheral artery disease (PAD; P=0.090) and abdominal aortic aneurysms (AAAs; P=0.12), and the variant associates strongly with the early-onset forms of LC (OR=4.49, P=2.2 × 10(-4)), COPD (OR=3.22, P=2.9 × 10(-4)), PAD (OR=3.47, P=9.2 × 10(-3)) and AAA (OR=6.44, P=6.3 × 10(-3)). Joint analysis of the four smoking-related diseases reveals significant association (P=6.8 × 10(-5)), particularly for early-onset cases (P=2.1 × 10(-7)). Our results are in agreement with functional studies showing that the human α4β2 isoform of the channel containing R336C has less sensitivity for its agonists than the wild-type form following nicotine incubation.
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Affiliation(s)
- T E Thorgeirsson
- deCODE genetics/Amgen, Reykjavik, Iceland,deCODE genetics/Amgen, Sturlugata 8, Reykjavik IS-101, Iceland. E-mail: or
| | | | | | | | - T Rafnar
- deCODE genetics/Amgen, Reykjavik, Iceland
| | - I Jonsdottir
- deCODE genetics/Amgen, Reykjavik, Iceland,Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | | | | | | | - S Jonsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland,Department of Respiratory Medicine, Landspitali University Hospital, Reykjavik, Iceland
| | | | - T Gislason
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland,Department of Respiratory Medicine, Landspitali University Hospital, Reykjavik, Iceland
| | - T Tyrfingsson
- SAA National Center of Addiction Medicine, Reykjavik, Iceland
| | - T Gudbjartsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland,Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland
| | - H J Isaksson
- Department of Pathology, Landspitali University Hospital, Reykjavik, Iceland
| | - H Hardardottir
- Department of Respiratory Medicine, Landspitali University Hospital, Reykjavik, Iceland
| | - A Sigvaldason
- Department of Respiratory Medicine, Landspitali University Hospital, Reykjavik, Iceland
| | - L A Kiemeney
- Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands,Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - A Haugen
- Department for the Chemical and Biological Work Environment, National Institute of Occupational Health, Oslo, Norway
| | - S Zienolddiny
- Department for the Chemical and Biological Work Environment, National Institute of Occupational Health, Oslo, Norway
| | - H J Wolf
- Community & Behavioral Health, Colorado School of Public Health, University of Colorado Denver, Aurora, CO, USA
| | - W A Franklin
- Department of Pathology, University of Colorado Denver, Aurora, CO, USA
| | - A Panadero
- Division of Medical Oncology, Hospital Ciudad de Coria, Coria, Spain
| | - J I Mayordomo
- Division of Medical Oncology, University of Colorado School of Medicine, Denver, CO, USA
| | - I P Hall
- Division of Respiratory Medicine, Queens Medical Centre, University of Nottingham, Nottingham, UK
| | - E Rönmark
- The OLIN studies, Department of Medicine, Sunderby Central Hospital of Norrbotten, Luleå, Sweden,Faculty of Medicine, Department of Public Health and Clinical Medicine, Occupational and Environmental Medicine, Umeå University, Umeå, Sweden
| | - B Lundbäck
- The OLIN studies, Department of Medicine, Sunderby Central Hospital of Norrbotten, Luleå, Sweden,Krefting Research Centre, Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - A Dirksen
- Department of Respiratory Medicine, Gentofte Hospital, Copenhagen University, Hellerup, Denmark
| | - H Ashraf
- Department of Respiratory Medicine, Gentofte Hospital, Copenhagen University, Hellerup, Denmark,Centre for Diagnostic Imaging—Thoracic Section, Akershus University Hospital, Loerenskog, Norway
| | - J H Pedersen
- Department of Thoracic Surgery RT, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - G Masson
- deCODE genetics/Amgen, Reykjavik, Iceland
| | - P Sulem
- deCODE genetics/Amgen, Reykjavik, Iceland
| | | | | | - K Stefansson
- deCODE genetics/Amgen, Reykjavik, Iceland,Faculty of Medicine, University of Iceland, Reykjavik, Iceland,deCODE genetics/Amgen, Sturlugata 8, Reykjavik IS-101, Iceland. E-mail: or
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Saeedi O, Ashraf H, Malouf M, Slade EP, Medoff DR, Li L, Kreyenbuhl J. Prevalence of diagnosed ocular disease in veterans with serious mental illness. Gen Hosp Psychiatry 2016; 43:1-5. [PMID: 27796250 PMCID: PMC5111362 DOI: 10.1016/j.genhosppsych.2016.08.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [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: 04/08/2016] [Revised: 08/02/2016] [Accepted: 08/11/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To compare the prevalence of diagnosed ocular disease and eye disease treatment between Veteran's Administration (VA) patients with and without serious mental illness (SMI). METHODS Retrospective comparison of diagnosed ocular disease and treatment prevalence among patients with and without diagnosed SMI in fiscal year 2011 in the VA Capitol Health Care System (VISN 5). RESULTS We identified 6462 VA patients with SMI and 137,933 without SMI. The prevalence of diagnosed ocular disease was 22.7% in SMI patients and 35.4% in non-SMI patients (P<.001). Those with SMI had a higher prevalence of glaucoma (10.2% vs. 7.1%, P<.0001), cataract (12.6% vs. 9.2%, P<.0001) and dry eye (4.0% vs. 2.7%, P<.0001). Less than half (34.3%) of SMI subjects had been seen in ophthalmology or optometry vs. 23.0% of controls (P<.0001). CONCLUSION VA patients with SMI have a greater prevalence of diagnosed ocular disease, particularly cataract, glaucoma and dry eye. While SMI patients utilize eye care services at a higher rate than the general VA population, the majority of subjects with SMI do not get recommended annual eye examinations. More consistent annual ocular screening among VA patients with SMI may be indicated.
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Affiliation(s)
- Osamah Saeedi
- Department of Ophthalmology and Visual Sciences, University of Maryland School of Medicine, 419 W. Redwood Street, Suite 470, Baltimore, MD 21201, USA.
| | - Hasan Ashraf
- Indiana University School of Medicine, Department of Internal Medicine, 340 W 10th St #6200, Indianapolis, IN 46202, USA
| | - Marc Malouf
- Malouf Eye Center 4400 Telfair Blvd, Camp Springs, MD 20746, Camp Springs, MD, USA
| | - Eric P. Slade
- VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), 10 N Greene Street, Baltimore, MD 21201, USA, University of Maryland School of Medicine, Department of Psychiatry, Division of Psychiatric Services Research, 110 South Paca St., 4th Floor, Baltimore, MD 21201, USA
| | - Deborah R. Medoff
- VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), 10 N Greene Street, Baltimore, MD 21201, USA, University of Maryland School of Medicine, Department of Psychiatry, Division of Psychiatric Services Research, 110 South Paca St., 4th Floor, Baltimore, MD 21201, USA
| | - Lan Li
- University of Maryland School of Medicine, Department of Psychiatry, Division of Psychiatric Services Research, 110 South Paca St., 4th Floor, Baltimore, MD 21201, USA
| | - Julie Kreyenbuhl
- VA Capitol Healthcare Network (VISN 5) Mental Illness Research, Education, and Clinical Center (MIRECC), 10 N Greene Street, Baltimore, MD 21201, USA, University of Maryland School of Medicine, Department of Psychiatry, Division of Psychiatric Services Research, 110 South Paca St., 4th Floor, Baltimore, MD 21201, USA
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Chisti MJ, Salam MA, Smith JH, Ahmed T, Pietroni MAC, Shahunja KM, Shahid ASMSB, Faruque ASG, Ashraf H, Bardhan PK, Graham SM, Duke T. Bubble continuous positive airway pressure for children with severe pneumonia and hypoxaemia in Bangladesh: an open, randomised controlled trial. Lancet 2015; 386:1057-65. [PMID: 26296950 DOI: 10.1016/s0140-6736(15)60249-5] [Citation(s) in RCA: 176] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND In developing countries, mortality in children with very severe pneumonia is high, even with the provision of appropriate antibiotics, standard oxygen therapy, and other supportive care. We assessed whether oxygen therapy delivered by bubble continuous positive airway pressure (CPAP) improved outcomes compared with standard low-flow and high-flow oxygen therapies. METHODS This open, randomised, controlled trial took place in Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh. We randomly assigned children younger than 5 years with severe pneumonia and hypoxaemia to receive oxygen therapy by either bubble CPAP (5 L/min starting at a CPAP level of 5 cm H2O), standard low-flow nasal cannula (2 L/min), or high-flow nasal cannula (2 L/kg per min up to the maximum of 12 L/min). Randomisation was done with use of the permuted block methods (block size of 15 patients) and Fisher and Yates tables of random permutations. The primary outcome was treatment failure (ie, clinical failure, intubation and mechanical ventilation, death, or termination of hospital stay against medical advice) after more than 1 h of treatment. Primary and safety analyses were by intention to treat. We did two interim analyses and stopped the trial after the second interim analysis on Aug 3, 2013, as directed by the data safety and monitoring board. This trial is registered at ClinicalTrials.gov, number NCT01396759. FINDINGS Between Aug 4, 2011, and July 17, 2013, 225 eligible children were recruited. We randomly allocated 79 (35%) children to receive oxygen therapy by bubble CPAP, 67 (30%) to low-flow oxygen therapy, and 79 (35%) to high-flow oxygen therapy. Treatment failed for 31 (14%) children, of whom five (6%) had received bubble CPAP, 16 (24%) had received low-flow oxygen therapy, and ten (13%) had received high-flow oxygen therapy. Significantly fewer children in the bubble CPAP group had treatment failure than in the low-flow oxygen therapy group (relative risk [RR] 0·27, 99·7% CI 0·07-0·99; p=0·0026). No difference in treatment failure was noted between patients in the bubble CPAP and those in the high-flow oxygen therapy group (RR 0·50, 99·7% 0·11-2·29; p=0·175). 23 (10%) children died. Three (4%) children died in the bubble CPAP group, ten (15%) children died in the low-flow oxygen therapy group, and ten (13%) children died in the high-flow oxygen therapy group. Children who received oxygen by bubble CPAP had significantly lower rates of death than the children who received oxygen by low-flow oxygen therapy (RR 0·25, 95% CI 0·07-0·89; p=0·022). INTERPRETATION Oxygen therapy delivered by bubble CPAP improved outcomes in Bangladeshi children with very severe pneumonia and hypoxaemia compared with standard low-flow oxygen therapy. Use of bubble CPAP oxygen therapy could have a large effect in hospitals in developing countries where the only respiratory support for severe childhood pneumonia and hypoxaemia is low-flow oxygen therapy. The trial was stopped early because of higher mortality in the low-flow oxygen group than in the bubble CPAP group, and we acknowledge that the early cessation of the trial reduces the certainty of the findings. Further research is needed to test the feasibility of scaling up bubble CPAP in district hospitals and to improve bubble CPAP delivery technology. FUNDING International Centre for Diarrhoeal Disease Research, Bangladesh, and Centre for International Child Health, University of Melbourne.
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Affiliation(s)
- Mohammod J Chisti
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh; Centre for International Child Health, The University of Melbourne Department of Paediatrics, Murdoch Children's Research Institute and Intensive Care Unit, Royal Children's Hospital, Melbourne, VIC, Australia
| | - Mohammed A Salam
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Jonathan H Smith
- Portex Unit of Paediatric Anaesthesia, UCL Institute of Child Health, London, UK
| | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | | | - K M Shahunja
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Abu S M S B Shahid
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Abu S G Faruque
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Hasan Ashraf
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Pradip K Bardhan
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Stephen M Graham
- Centre for International Child Health, The University of Melbourne Department of Paediatrics, Murdoch Children's Research Institute and Intensive Care Unit, Royal Children's Hospital, Melbourne, VIC, Australia; International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Trevor Duke
- Centre for International Child Health, The University of Melbourne Department of Paediatrics, Murdoch Children's Research Institute and Intensive Care Unit, Royal Children's Hospital, Melbourne, VIC, Australia.
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Shahunja KM, Salam MA, Ahmed T, Bardhan PK, Sarker SA, Ashraf H, Faruque ASG, Hossain MI, Islam MM, Das SK, Sharifuzzaman M, Bin Shahid ASMS, Sarker MHR, Chisti MJ. Bacterial Isolates from Tracheal Aspirates and their Anti-microbial Susceptibility in Mechanically-Ventilated Children with Pneumonia Admitted to an Urban Critical Care Ward. ACTA ACUST UNITED AC 2015. [DOI: 10.3329/bccj.v2i2.24081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Background and Aims: Data on Bacterial isolates from tracheal aspirates in children with severe pneumonia requiring intubation and mechanical ventilation especially in developing countries are very limited. We examined the microbial spectrum of bacteria isolated from tracheal aspirate of those children. The antibiotic susceptibility profiles of those bacteria were also examined.Methods: We evaluated the data of all mechanically ventilated children aged 0-59 months admitted to Intensive Care Unit (ICU) of Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) between August 2009 and July 2013 having their tracheal aspirate culture done. Data were extracted from electronic medical records of the Dhaka Hospital.Results: Among 836 admitted pneumonia children in the ICU, we identified 35 children who fulfilled the inclusion criteria. Among them 34 (97%) had positive bacterial growths: Klebseilla species in 14 (40%), Escherichia coli in 11 (31%), Acinetobacter in 8 (23%) and Streptococcus species in 8 (23%). Additionally, Enterococcus, Staphylococcus aureus, Pseudominas and Proteus species were identified in 6 (17%), 4 (11%), and 2 (6%) of the children respectively. The susceptibility of the gram-negatives, except Klebseilla, to ampicillin, cotrimoxazole, gentamycin, ciprofloxacin, azithromycin, and ceftriaxone ranged from 0- 54%, while that for ceftazidime and amikacin ranged from 12-80%. The sensitivity of Klebseilla to these antibiotics ranged from 0-100%.Conclusions: Our data suggests that gram-negative bacteria, Klebseilla followed by Escherichia coli, and Acenetobacter are the predominant bacteria associated with severe pneumonia in ventilated children. The increased number of infections caused by Gram-negative bacteria is being accompanied by rising rates of multi-drug resistance which underscores the importance of aggressive antimicrobial therapy in the management of such children.Bangladesh Crit Care J September 2014; 2 (2): 60-64
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Alam NH, Ashraf H, Kamruzzaman M, Ahmed T, Islam S, Olesen MK, Gyr N, Meier R. Efficacy of partially hydrolyzed guar gum (PHGG) supplemented modified oral rehydration solution in the treatment of severely malnourished children with watery diarrhoea: a randomised double-blind controlled trial. J Health Popul Nutr 2015; 34:3. [PMID: 26825757 PMCID: PMC5026008 DOI: 10.1186/s41043-015-0003-3] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/13/2014] [Accepted: 11/01/2014] [Indexed: 05/12/2023]
Abstract
OBJECTIVES To examine whether PHGG added ORS reduce duration of diarrhoea, stool output and enhance weight gain. METHODS In a double-blind controlled clinical trial, 126 malnourished children (weight for length/weight for age < -3 Z-score with or without pedal edema), aged 6 - 36 months with acute diarrhoea <7 days were studied in two treatment groups; 63 received modified WHO ORS (Na 75, K 40, Cl 87, citrate 7, glucose 90 mmol/L) with PHGG 15 g/L (study group); 63 received modified WHO ORS without PHGG (control). Other treatments were similar in both groups. The study protocol was approved by Ethics Committee of icddr,b; the study was carried out at the Dhaka Hospital. RESULTS The mean duration of diarrhoea (h) was significantly shorter in children of the study group (Study vs. control, mean ± SD, 57 ± 31 vs. 75 ± 39, p = 0.01). Although there was a trend in stool weight reduction in children receiving ORS with PHGG (study vs. control, stool weight (g), mean ± SD; 1(st) 24 hour, 854.03 ± 532.15 vs. 949.11 ± 544.33, p = 0.32; 2(nd) 24 hour, 579.84 ± 466.01 vs. 761.26 ± 631.64, p = 0.069; 3(rd) 24 hour, 385.87 ± 454.09 vs. 495.73 ± 487.61, p = 0.196), especially in 2(nd) 24 h period, the difference was not statistically significant. The mean time (day) to attain weight for length 80% of NCHS median without edema was significantly shorter in the study group (study vs. control, mean ± SD, 4.5 ± 2.6 vs. 5.7 ± 2.8, p = 0.027). CONCLUSION PHGG added to ORS substantially reduced duration of diarrhoea. It also enhanced weight gain. Further studies might substantiate to establish its beneficial effect. CLINICAL TRIAL REGISTRATION NUMBER NCT01821586.
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Affiliation(s)
- Nur Haque Alam
- International Centre for Diarrheal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh.
| | - Hasan Ashraf
- International Centre for Diarrheal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh.
| | - Mohammad Kamruzzaman
- International Centre for Diarrheal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh.
| | - Tahmeed Ahmed
- International Centre for Diarrheal Disease Research Bangladesh (icddr,b), Dhaka, Bangladesh.
| | - Sufia Islam
- Department of Pharmacy, East West University, Dhaka, Bangladesh.
| | | | - Niklaus Gyr
- Department of Internal Medicine, University Hospital, Basel, Switzerland.
| | - Remy Meier
- Department of Gastroenterology, Hepatology and Nutrition, Kantonsspital, Liestal, Switzerland.
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Steinisch M, Yusuf R, Li J, Stalder T, Bosch JA, Rahman O, Strümpell C, Ashraf H, Fischer JE, Loerbroks A. Work stress and hair cortisol levels among workers in a Bangladeshi ready-made garment factory - Results from a cross-sectional study. Psychoneuroendocrinology 2014; 50:20-7. [PMID: 25199982 DOI: 10.1016/j.psyneuen.2014.08.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Revised: 08/02/2014] [Accepted: 08/02/2014] [Indexed: 01/09/2023]
Abstract
Evidence on the association of work stress with cortisol levels is inconsistent and mostly stems from Western countries, with limited generalizability to other regions of the world. These inconsistencies may partly be due to methodological limitations associated with the measurement of cortisol secretion in saliva, serum or urine. The present study set out to explore associations of work stress with long-term integrated cortisol levels in hair among 175 workers of an export oriented ready-made garment (RMG) factory in Dhaka, Bangladesh. Work-related demands (WD), interpersonal resources (IR) and work-related values (WV) were assessed using a psychometrically evaluated interview. WD consisted of four items on physical demands, time pressure, worries about mistakes and exposure to abusive language. IR comprised five items addressing support, recognition, adequate payment, workers' trust in the management, and the management's trust in workers, as perceived by the workers. WV captured job security, promotion prospects and job latitude by three items. Hair cortisol concentrations (HCC) were analyzed by liquid chromatography-mass spectrometry. Stepwise multivariable linear regression models (backward elimination of predictors) were used to estimate associations of HCC with the three work stress components. For significant work stress component(s), further multivariable linear regression analyses were conducted to explore whether, and if so, which individual item(s) contributed most. The mean HCC equaled 3.27 (SD 2.58) pg/mg. HCC were found to be significantly associated with WV (beta=0.209, p=0.021). Additional analyses of the three WV items revealed that this association was largely driven the item on "promotion prospects" (beta=0.230, p=0.007) implying that the perception of good promotion prospects was associated with higher HCC. The finding of elevated HCC with good promotion prospects may initially seem counter-intuitive, but is supported by research documenting that job promotion may result in poorer mental well-being. Moreover, being promoted in the Bangladeshi RMG industry may represent a stressful experience: job promotions are rare in this setting and are associated with the need to meet exceptional job-related demands. Further research from ethnic and culturally diverse occupational settings is needed to test this hypothesis, to shed light on the reproducibility of our findings and to improve our understanding of the psychobiological implications of psychosocial working conditions across cultures and contexts.
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Affiliation(s)
- Maria Steinisch
- Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, Heidelberg University, Ludolf-Krehl-Str. 7-11, 68167 Mannheim, Germany; Cluster of Excellence "Asia and Europe in a Global Context, Shifting Asymmetries in Cultural Flows", Heidelberg University, Voßstr. 2, 69115 Heidelberg, Germany
| | - Rita Yusuf
- Centre for Health, Population and Development, Independent University, Bangladesh, Plot #16, Block B, Aftabuddin Ahmed Road, Bashundhara R/A, Dhaka 1229, Bangladesh; School of Life Sciences, Independent University, Bangladesh, Plot #16, Block B, Aftabuddin Ahmed Road, Bashundhara R/A, Dhaka 1229, Bangladesh
| | - Jian Li
- Institute of Occupational and Social Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany
| | - Tobias Stalder
- Department of Psychology, Technical University of Dresden, 01062 Dresden, Germany
| | - Jos A Bosch
- Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, Heidelberg University, Ludolf-Krehl-Str. 7-11, 68167 Mannheim, Germany; Department of Psychology, University of Amsterdam, Weesperplein 4, 1018 XA Amsterdam, The Netherlands
| | - Omar Rahman
- Centre for Health, Population and Development, Independent University, Bangladesh, Plot #16, Block B, Aftabuddin Ahmed Road, Bashundhara R/A, Dhaka 1229, Bangladesh; School of Public Health, Independent University, Bangladesh, Plot #16, Block B, Aftabuddin Ahmed Road, Bashundhara R/A, Dhaka 1229, Bangladesh
| | - Christian Strümpell
- Cluster of Excellence "Asia and Europe in a Global Context, Shifting Asymmetries in Cultural Flows", Heidelberg University, Voßstr. 2, 69115 Heidelberg, Germany; Department of Anthropology, South Asia Institute, Heidelberg University, Im Neuenheimer Feld 330, 69120 Heidelberg, Germany
| | - Hasan Ashraf
- Cluster of Excellence "Asia and Europe in a Global Context, Shifting Asymmetries in Cultural Flows", Heidelberg University, Voßstr. 2, 69115 Heidelberg, Germany; Department of Anthropology, South Asia Institute, Heidelberg University, Im Neuenheimer Feld 330, 69120 Heidelberg, Germany; Health, Care and Body Programme Group, Amsterdam Institute of Social Science Research, University of Amsterdam, Kloveniersburgwal 48, 1012 CX Amsterdam, The Netherlands
| | - Joachim E Fischer
- Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, Heidelberg University, Ludolf-Krehl-Str. 7-11, 68167 Mannheim, Germany; Cluster of Excellence "Asia and Europe in a Global Context, Shifting Asymmetries in Cultural Flows", Heidelberg University, Voßstr. 2, 69115 Heidelberg, Germany
| | - Adrian Loerbroks
- Mannheim Institute of Public Health, Social and Preventive Medicine, Mannheim Medical Faculty, Heidelberg University, Ludolf-Krehl-Str. 7-11, 68167 Mannheim, Germany; Cluster of Excellence "Asia and Europe in a Global Context, Shifting Asymmetries in Cultural Flows", Heidelberg University, Voßstr. 2, 69115 Heidelberg, Germany; Institute of Occupational and Social Medicine, Centre for Health and Society, Faculty of Medicine, University of Düsseldorf, Moorenstraße 5, 40225 Düsseldorf, Germany.
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Ashraf H, Alam NH, Chisti MJ, Salam MA, Ahmed T, Gyr N. Observational follow-up study on a cohort of children with severe pneumonia after discharge from a day-care clinic in Dhaka, Bangladesh. J Health Popul Nutr 2014; 32:183-189. [PMID: 25076656 PMCID: PMC4216955] [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] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Compliance, morbidity, mortality, and hospitalization during fortnightly follow-up were evaluated by an observational study on a cohort of children with severe and very severe pneumonia after day-care treatment at an urban clinic. The primary outcome measures were proportions of success (compliance) and failure (non-compliance) of follow-up visits at the day-care clinic. In total, 251 children were followed up, with median (IQR) age of 5.0 (3.0-9.0) months, and their compliance dropped from 92% at the first to 85% at the sixth visit. Cough (28%), fever (20%), and rapid breathing (13%) were common morbidities. Successful follow-up visits were possible in 180 (95.2%) and 56 (90.3%) of the children with severe and very severe pneumonia respectively. Eleven (4.4%) needed hospitalization, and four (1.6%) died. Majority (approximately 90%) of the children could be successfully followed up; some failed to attend their scheduled follow-up visits due to hospitalization and death. The common morbidities indicate the importance of follow-up for detecting medical problems and early treatment, thus reducing risk of death.
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Affiliation(s)
- Hasan Ashraf
- Centre for Nutrition and Food Security (CNFS), icddr,b, GPO Box 128, Dhaka 1000, Bangladesh
| | - Nur H. Alam
- Centre for Nutrition and Food Security (CNFS), icddr,b, GPO Box 128, Dhaka 1000, Bangladesh
| | - Mohammod J. Chisti
- Centre for Nutrition and Food Security (CNFS), icddr,b, GPO Box 128, Dhaka 1000, Bangladesh
| | - Mohammed A. Salam
- Centre for Nutrition and Food Security (CNFS), icddr,b, GPO Box 128, Dhaka 1000, Bangladesh
| | - Tahmeed Ahmed
- Centre for Nutrition and Food Security (CNFS), icddr,b, GPO Box 128, Dhaka 1000, Bangladesh
| | - Niklaus Gyr
- Department of Internal Medicine, University of Basel, Switzerland
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Chisti MJ, Salam MA, Ashraf H, Faruque ASG, Bardhan PK, Shahid ASMSB, Shahunja KM, Das SK, Ahmed T. Prevalence, clinical predictors, and outcome of hypocalcaemia in severely-malnourished under-five children admitted to an urban hospital in Bangladesh: a case-control study. J Health Popul Nutr 2014; 32:270-275. [PMID: 25076664 PMCID: PMC4216963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Hypocalcaemia is common in severely-malnourished children and is often associated with fatal outcome. There is very limited information on the clinical predicting factors of hypocalcaemia in hospitalized severely-malnourished under-five children. Our objective was to evaluate the prevalence, clinical predicting factors, and outcome of hypocalcaemia in such children. In this case-control study, all severely-malnourished under-five children (n=333) admitted to the Longer Stay Ward (LSW), High Dependency Unit (HDU), and Intensive Care Unit (ICU) of the Dhaka Hospital of icddr,b between April 2011 and April 2012, who also had their total serum calcium estimated, were enrolled. Those who presented with hypocalcaemia (serum calcium <2.12 mmol/L) constituted the cases (n=87), and those admitted without hypocalcaemia (n=246) constituted the control group in our analysis. The prevalence of hypocalcaemia among severely-malnourished under-five children was 26% (87/333). The fatality rate among cases was significantly higher than that in the controls (17% vs 5%; p < 0.001). Using logistic regression analysis, after adjusting for potential confounders, such as vomiting, abdominal distension, and diastolic hypotension, we identified acute watery diarrhoea (AWD) (OR 2.19, 95% CI 1.08-4.43, p = 0.030), convulsion on admission (OR 21.86, 95% CI 2.57-185.86, p = 0.005), and lethargy (OR 2.70, 95% CI 1.633-5.46, p = 0.006) as independent predictors of hypocalcaemia in severely-malnourished children. It is concluded, severely-malnourished children presenting with hypocalcaemia have an increased risk of death than those without hypocalcaemia. AWD, convulsion, and lethargy assessed on admission to hospital are the clinical predictors of hypocalcaemia in such children. Presence of these features in hospitalized children with severe acute malnutrition (SAM) should alert clinicians about the possibility of hypocalcaemia and may help undertake potential preventive measures, such as calcium supplementation, in addition to other aspects of management of such children, especially in the resource-poor settings.
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Chisti MJ, Graham SM, Duke T, Ahmed T, Ashraf H, Faruque ASG, La Vincente S, Banu S, Raqib R, Salam MA. A prospective study of the prevalence of tuberculosis and bacteraemia in Bangladeshi children with severe malnutrition and pneumonia including an evaluation of Xpert MTB/RIF assay. PLoS One 2014; 9:e93776. [PMID: 24695758 PMCID: PMC3973596 DOI: 10.1371/journal.pone.0093776] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2013] [Accepted: 03/10/2014] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Severe malnutrition is a risk factor for pneumonia due to a wide range of pathogens but aetiological data are limited and the role of Mycobacterium tuberculosis is uncertain. METHODS We prospectively investigated severely malnourished young children (<5 years) with radiological pneumonia admitted over a 15-month period. Investigations included blood culture, sputa for microscopy and mycobacterial culture. Xpert MTB/RIF assay was introduced during the study. Study children were followed for 12 weeks following their discharge from the hospital. RESULTS 405 eligible children were enrolled, with a median age of 10 months. Bacterial pathogens were isolated from blood culture in 18 (4.4%) children, of which 72% were Gram negatives. Tuberculosis was confirmed microbiologically in 7% (27/396) of children that provided sputum - 10 by culture, 21 by Xpert MTB/RIF assay, and 4 by both tests. The diagnostic yield from induced sputum was 6% compared to 3.5% from gastric aspirate. Sixty (16%) additional children had tuberculosis diagnosed clinically that was not microbiologically confirmed. Most confirmed tuberculosis cases did not have a positive contact history or positive tuberculin test. The sensitivity and specificity of Xpert MTB/RIF assay compared to culture was 67% (95% CI: 24-94) and 92% (95% CI: 87-95) respectively. Overall case-fatality rate was 17% and half of the deaths occurred in home following discharge from the hospital. CONCLUSION AND SIGNIFICANCE TB was common in severely malnourished Bangladeshi children with pneumonia. X-pert MTB/RIF assay provided higher case detection rate compared to sputum microscopy and culture. The high mortality among the study children underscores the need for further research aimed at improved case detection and management for better outcomes.
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Affiliation(s)
- Mohammod Jobayer Chisti
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
- Centre for International Child Health, The University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children’s Hospital, Melbourne, Australia
| | - Stephen M. Graham
- Centre for International Child Health, The University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children’s Hospital, Melbourne, Australia
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - Trevor Duke
- Centre for International Child Health, The University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children’s Hospital, Melbourne, Australia
| | - Tahmeed Ahmed
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Hasan Ashraf
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | | | - Sophie La Vincente
- Centre for International Child Health, The University of Melbourne Department of Paediatrics and Murdoch Childrens Research Institute, Royal Children’s Hospital, Melbourne, Australia
| | - Sayera Banu
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Rubhana Raqib
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Mohammed Abdus Salam
- International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
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Chisti MJ, Salam MA, Ashraf H, Faruque ASG, Bardhan PK, Hossain MI, Shahid ASMSB, Shahunja KM, Das SK, Imran G, Ahmed T. Clinical risk factors of death from pneumonia in children with severe acute malnutrition in an urban critical care ward of Bangladesh. PLoS One 2013; 8:e73728. [PMID: 24040043 PMCID: PMC3767805 DOI: 10.1371/journal.pone.0073728] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Accepted: 07/22/2013] [Indexed: 01/08/2023] Open
Abstract
Background Risks of death are high when children with pneumonia also have severe acute malnutrition (SAM) as a co-morbidity. However, there is limited published information on risk factors of death from pneumonia in SAM children. We evaluated clinically identifiable factors associated with death in under-five children who were hospitalized for the management of pneumonia and SAM. Methods For this unmatched case-control design, SAM children of either sex, aged 0–59 months, admitted to the Dhaka Hospital of the International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b) during April 2011 to July 2012 with radiological pneumonia were studied. The SAM children with pneumonia who had fatal outcome constituted the cases (n = 35), and randomly selected SAM children with pneumonia who survived constituted controls (n = 105). Results The median (inter-quartile range) age (months) was comparable among the cases and the controls [8.0 (4.9, 11.0) vs. 9.7 (5.0, 18.0); p = 0.210)]. In logistic regression analysis, after adjusting for potential confounders, such as vomiting, abnormal mental status, and systolic hypotension (<70 mm of Hg) in absence of dehydration, fatal cases of severely malnourished under-five children with pneumonia were more often hypoxemic (OR = 23.15, 95% CI = 4.38–122.42), had clinical dehydration (some/severe) (OR = 9.48, 95% CI = 2.42–37.19), abdominal distension at admission (OR = 4.41, 95% CI = 1.12–16.52), and received blood transfusion (OR = 5.50, 95% CI = 1.21–24.99) for the management of crystalloid resistant systolic hypotension. Conclusion and Significance We identified hypoxemia, clinical dehydration, and abdominal distension as the independent predictors of death in SAM children with pneumonia. SAM children with pneumonia who required blood transfusion for the management of crystalloid resistant systolic hypotension were also at risk for death. Thus, early identification and prompt management of these simple clinically recognizable predictors of death and discourage the use of blood transfusion for the management of crystalloid resistant systolic hypotension may help reduce deaths in such population.
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Affiliation(s)
- Mohammod Jobayer Chisti
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Dhaka Hospital, icddr,b, Dhaka, Bangladesh
- * E-mail:
| | | | - Hasan Ashraf
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Dhaka Hospital, icddr,b, Dhaka, Bangladesh
| | - Abu S. G. Faruque
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Pradip Kumar Bardhan
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Dhaka Hospital, icddr,b, Dhaka, Bangladesh
| | - Md Iqbal Hossain
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
- Dhaka Hospital, icddr,b, Dhaka, Bangladesh
| | - Abu S. M. S. B. Shahid
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - K. M. Shahunja
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Sumon Kumar Das
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
| | - Gazi Imran
- Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh
| | - Tahmeed Ahmed
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh
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Chisti MJ, Ahmed T, Pietroni MAC, Faruque ASG, Ashraf H, Bardhan PK, Hossain I, Das SK, Salam MA. Pulmonary tuberculosis in severely-malnourished or HIV-infected children with pneumonia: a review. J Health Popul Nutr 2013; 31:308-13. [PMID: 24288943 PMCID: PMC3805879 DOI: 10.3329/jhpn.v31i3.16516] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Presentation of pulmonary tuberculosis (PTB) as acute pneumonia in severely-malnourished and HIV-positive children has received very little attention, although this is very important in the management of pneumonia in children living in communities where TB is highly endemic. Our aim was to identify confirmed TB in children with acute pneumonia and HIV infection and/or severe acute malnutrition (SAM) (weight-for-length/height or weight-for-age z score <-3 of the WHO median, or presence of nutritional oedema). We conducted a literature search, using PubMed and Web of Science in April 2013 for the period from January 1974 through April 2013. We included only those studies that reported confirmed TB identified by acid fast bacilli (AFB) through smear microscopy, or by culture-positive specimens from children with acute pneumonia and SAM and/or HIV infection. The specimens were collected either from induced sputum (IS), or gastric lavage (GL), or broncho-alveolar lavage (BAL), or percutaneous lung aspirates (LA). Pneumonia was defined as the radiological evidence of lobar or patchy consolidation and/or clinical evidence of severe/ very severe pneumonia according to the WHO criteria of acute respiratory infection. A total of 17 studies met our search criteria but 6 were relevant for our review. Eleven studies were excluded as those did not assess the HIV status of the children or specify the nutritional status of the children with acute pneumonia and TB. We identified only 747 under-five children from the six relevant studies that determined a tubercular aetiology of acute pneumonia in children with SAM and/or positive HIV status. Three studies were reported from South Africa and one each from the Gambia, Ethiopia, and Thailand where 610, 90, 35, and 12 children were enrolled and 64 (10%), 23 (26%), 5 (14%), and 1 (8%) children were identified with active TB respectively, with a total of 93 (12%) children with active TB. Among 610 HIV-infected children in three studies from South Africa and 137 SAM children from other studies, 64 (10%) and 29 (21%) isolates of M. tuberculosis were identified respectively. Children from South Africa were infected with HIV without specification of their nutritional status whereas children from other countries had SAM but without indication of their HIV status. Our review of the existing data suggests that pulmonary tuberculosis may be more common than it is generally suspected in children with acute pneumonia and SAM, or HIV infection. Because of the scarcity of data, there is an urgent need to investigate PTB as one of the potential aetiologies of acute pneumonia in these children in a carefully-conducted larger study, especially outside Africa.
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Chisti MJ, Salam MA, Ashraf H, Faruque ASG, Bardhan PK, Das SK, Shahunja KM, Shahid ASMSB, Ahmed T. Clinical signs of radiologic pneumonia in under-five hypokalemic diarrheal children admitted to an urban hospital in bangladesh. PLoS One 2013; 8:e71911. [PMID: 23951267 PMCID: PMC3741193 DOI: 10.1371/journal.pone.0071911] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Accepted: 07/04/2013] [Indexed: 11/25/2022] Open
Abstract
Background Clinical signs of pneumonia are often veiled in under-five diarrheal children presenting with hypokalemia, making clinical diagnosis of pneumonia very difficult in such population. However, there is no published report that describes the influences of hypokalemia on the clinical signs of pneumonia in diarrheal children. Our objective was to assess the influences of hypokalemia, and their outcome in such children. Methods We prospectively enrolled all under-five diarrheal children (n = 180) admitted to the Special Care Ward of the Dhaka Hospital of icddr,b from September-December 2007 with radiological pneumonia who also had their serum potassium estimated. We compared the clinical features and outcome of the diarrheal children having pneumonia with (cases = 55) and without hypokalemia (controls = 125). Results The case-fatality among the cases was 2 times higher compared to the controls, but the difference was not statistically significant (p = 0.202). In logistic regression analysis, after adjusting for potential confounders such as age of the patient, clinical dehydration, severe wasting, abnormally sleepy, lower chest wall in-drawing, nasal flaring and inability to drink on admission, under-five diarrheal children with pneumonia who presented with nutritional edema had 3 times more risk to have hypokalemia compared to those without nutritional edema (OR = 2.76, 95% CI = 1.01–7.51) and these hypokalemic children were 64% less likely to present with fast breathing (OR = 0.36, 95% CI = 0.17–0.74). Conclusion and significance The results of our analysis are simple but may have great public health implications and underscore the importance of diligent assessment for pneumonia in under-five diarrheal children having risk of hypokalemia as in children with nutritional edema even in absence of fast breathing, a useful sign of pneumonia. This may help for early initiation of first dose of parental antibiotics along with potassium supplementation before referral to tertiary hospitals by health workers to combat probability of deaths in such population especially in resource limited settings.
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Affiliation(s)
- Mohammod Jobayer Chisti
- Centre for Nutrition & Food Security (CNFS), International Centre for Diarhoeal Disease Research, Bangladesh (icddr,b), Dhaka, Bangladesh.
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Moemenbellah-Fard MD, Benafshi O, Rafinejad J, Ashraf H. Tick-borne relapsing fever in a new highland endemic focus of western Iran. Annals of Tropical Medicine & Parasitology 2013; 103:529-37. [DOI: 10.1179/136485909x451852] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
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Ghasemi M, Ashraf H, Koushyar H, Mousavifar N. The cycle characteristics of clomiphene with clomiphene and menotropins in polycystic ovary syndrome and non polycystic ovary syndrome infertile patients. Minerva Ginecol 2013; 65:311-317. [PMID: 23689174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
AIM This study compares the cycle characteristics of clomiphene (CC) with CC+HMG (Human Menopausal Gonadotropin or Menotropins) in Polycystic Ovary Syndrome (PCOS) and non-PCOS infertile patients. METHODS Patients were treated by CC + minimal HMg protocol. The cancellation rate, the mean number of different follicle sizes and endometrial thickness and pattern were compared. RESULTS The cancelled cycles due to non-responsiveness were significantly higher in CC compared to CC+ minimal HMg protocol. PCOS patients are significantly nonresponsive in CC cycle and hyperresponsive in CC+ minimal HMg cycles. The mean number of different sizes of follicles and the endometrial thickness were significantly higher in CC+ minimal HMg. PCOS patients were significantly different from non-PCOS regarding the number of mature follicle and endometrial thickness. The pregnancy rate was 11% (10.2% in non-PCOS and 12.2% in PCOS). CONCLUSION CC+ minimal HMg is a viable alternative to HMg /FSH only protocol in CC failure or resistant patients, and its efficacy can be mostly attributed to improvement of endometrial quality and increase in follicle number. Moreover, due to high cancellation of PCOS patients treated by this protocol, seemingly other alternatives should be found; perhaps sequential letrozole+HMg/FSH that have been shown to improve the ovarian response in this group of patients.
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Affiliation(s)
- M Ghasemi
- Department of Gynecology and Obstetrics, Faculty of Medicine, Zahedan University of Medical Sciences Zahedan, Iran
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