1
|
Smith T, Zaidi A, Brown CVM, Pino-Chavez G, Bowen T, Meran S, Fraser D, Chavez R, Khalid U. Robust Rat and Mouse Models of Bilateral Renal Ischemia Reperfusion Injury. In Vivo 2024; 38:1049-1057. [PMID: 38688639 PMCID: PMC11059907 DOI: 10.21873/invivo.13538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 02/05/2024] [Accepted: 02/12/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND/AIM Acute and chronic kidney diseases are a major contributor to morbidity and mortality worldwide, with no specific treatments currently available for these. To enable understanding the pathophysiology of and testing novel treatments for acute and chronic kidney disease, a suitable in vivo model of kidney disease is essential. In this article, we describe two reliable rodent models (rats and mice) of efficacious kidney injury displaying acute to chronic kidney injury progression, which is also reversible through novel therapeutic strategies such as ischemic preconditioning (IPC). MATERIALS AND METHODS We utilized adult male Lewis rats and adult male wildtype (C57BL/6) mice, performed a midline laparotomy, and induced warm ischemia to both kidneys by bilateral clamping of both renal vascular pedicles for a set time, to mimic the hypoxic etiology of disease commonly found in kidney injury. RESULTS Bilateral ischemia reperfusion injury caused marked structural and functional kidney injury as exemplified by histology damage scores, serum creatinine levels, and kidney injury biomarker levels in both rodents. Furthermore, this effect displayed a dose-dependent response in the mouse model. CONCLUSION These rodent models of bilateral kidney IRI are reliable, reproducible, and enable detailed mechanistic study of the underlying pathophysiology of both acute and chronic kidney disease. They have been carefully optimised for single operator use with a strong track record of training both surgically trained and surgically naïve operators.
Collapse
Affiliation(s)
- Tanya Smith
- Wales Kidney Research Unit, Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, U.K.;
- Department of Anesthetics, Cardiff & Vale University Health Board, University Hospital of Wales, Cardiff, U.K
| | - Aeliya Zaidi
- Wales Kidney Research Unit, Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, U.K
- Cardiff Transplant Unit, Nephrology & Transplant Directorate, Cardiff & Vale University Health Board, University Hospital of Wales, Cardiff, U.K
| | - Charlotte Victoria Maynard Brown
- Wales Kidney Research Unit, Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, U.K
- Cardiff Transplant Unit, Nephrology & Transplant Directorate, Cardiff & Vale University Health Board, University Hospital of Wales, Cardiff, U.K
| | - Gilda Pino-Chavez
- Wales Kidney Research Unit, Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, U.K
| | - Timothy Bowen
- Wales Kidney Research Unit, Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, U.K
| | - Soma Meran
- Wales Kidney Research Unit, Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, U.K
| | - Donald Fraser
- Wales Kidney Research Unit, Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, U.K
| | - Rafael Chavez
- Wales Kidney Research Unit, Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, U.K
- Cardiff Transplant Unit, Nephrology & Transplant Directorate, Cardiff & Vale University Health Board, University Hospital of Wales, Cardiff, U.K
| | - Usman Khalid
- Wales Kidney Research Unit, Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, U.K.;
- Cardiff Transplant Unit, Nephrology & Transplant Directorate, Cardiff & Vale University Health Board, University Hospital of Wales, Cardiff, U.K
| |
Collapse
|
2
|
Herbert GL, Robinson DBT, Powell AG, Abdelrahman T, Khalid U, Lewis WG. Economic cost-utility analysis of stage-directed oesophageal cancer treatment. BJS Open 2024; 8:zrad159. [PMID: 38557866 PMCID: PMC11058869 DOI: 10.1093/bjsopen/zrad159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 11/14/2023] [Accepted: 12/01/2023] [Indexed: 04/04/2024] Open
Affiliation(s)
- Geraint L Herbert
- Health Education and Improvement Wales, Tŷ Dysgu, Cefn Coed, Nantgarw, UK
- Department of Surgery, University Hospital of Wales, Heath Park Way, Cardiff, UK
- School of Medicine, Cardiff University, Cardiff, UK
- Department of Surgery, Aneurin Bevan University Health Board, Grange University Hospital, Caerleon Road, Llanfrechfa, Cwmbran, UK
| | - David B T Robinson
- Health Education and Improvement Wales, Tŷ Dysgu, Cefn Coed, Nantgarw, UK
- Department of Surgery, University Hospital of Wales, Heath Park Way, Cardiff, UK
| | - Arfon G Powell
- Greater Manchester Oesophagogastric Surgery Unit, Salford Royal Hospital, Stott Lane, Salford, UK
| | - Tarig Abdelrahman
- Department of Surgery, University Hospital of Wales, Heath Park Way, Cardiff, UK
| | - Usman Khalid
- Health Education and Improvement Wales, Tŷ Dysgu, Cefn Coed, Nantgarw, UK
- Department of Surgery, University Hospital of Wales, Heath Park Way, Cardiff, UK
- School of Medicine, Cardiff University, Cardiff, UK
- Wales Kidney Research Unit, Division of Infection and Immunity, Cardiff University School of Medicine, Cardiff, UK
| | - Wyn G Lewis
- Health Education and Improvement Wales, Tŷ Dysgu, Cefn Coed, Nantgarw, UK
- Department of Surgery, University Hospital of Wales, Heath Park Way, Cardiff, UK
- School of Medicine, Cardiff University, Cardiff, UK
- Department of Surgery, Aneurin Bevan University Health Board, Grange University Hospital, Caerleon Road, Llanfrechfa, Cwmbran, UK
| |
Collapse
|
3
|
Uchikov P, Khalid U, Kraev K, Hristov B, Kraeva M, Tenchev T, Chakarov D, Sandeva M, Dragusheva S, Taneva D, Batashki A. Artificial Intelligence in the Diagnosis of Colorectal Cancer: A Literature Review. Diagnostics (Basel) 2024; 14:528. [PMID: 38472999 DOI: 10.3390/diagnostics14050528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND The aim of this review is to explore the role of artificial intelligence in the diagnosis of colorectal cancer, how it impacts CRC morbidity and mortality, and why its role in clinical medicine is limited. METHODS A targeted, non-systematic review of the published literature relating to colorectal cancer diagnosis was performed with PubMed databases that were scouted to help provide a more defined understanding of the recent advances regarding artificial intelligence and their impact on colorectal-related morbidity and mortality. Articles were included if deemed relevant and including information associated with the keywords. RESULTS The advancements in artificial intelligence have been significant in facilitating an earlier diagnosis of CRC. In this review, we focused on evaluating genomic biomarkers, the integration of instruments with artificial intelligence, MR and hyperspectral imaging, and the architecture of neural networks. We found that these neural networks seem practical and yield positive results in initial testing. Furthermore, we explored the use of deep-learning-based majority voting methods, such as bag of words and PAHLI, in improving diagnostic accuracy in colorectal cancer detection. Alongside this, the autonomous and expansive learning ability of artificial intelligence, coupled with its ability to extract increasingly complex features from images or videos without human reliance, highlight its impact in the diagnostic sector. Despite this, as most of the research involves a small sample of patients, a diversification of patient data is needed to enhance cohort stratification for a more sensitive and specific neural model. We also examined the successful application of artificial intelligence in predicting microsatellite instability, showcasing its potential in stratifying patients for targeted therapies. CONCLUSIONS Since its commencement in colorectal cancer, artificial intelligence has revealed a multitude of functionalities and augmentations in the diagnostic sector of CRC. Given its early implementation, its clinical application remains a fair way away, but with steady research dedicated to improving neural architecture and expanding its applicational range, there is hope that these advanced neural software could directly impact the early diagnosis of CRC. The true promise of artificial intelligence, extending beyond the medical sector, lies in its potential to significantly influence the future landscape of CRC's morbidity and mortality.
Collapse
Affiliation(s)
- Petar Uchikov
- Department of Special Surgery, Faculty of Medicine, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria
| | - Usman Khalid
- Faculty of Medicine, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria
| | - Krasimir Kraev
- Department of Propaedeutics of Internal Diseases "Prof. Dr. Anton Mitov", Faculty of Medicine, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria
| | - Bozhidar Hristov
- Section "Gastroenterology", Second Department of Internal Diseases, Medical Faculty, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria
| | - Maria Kraeva
- Department of Otorhinolaryngology, Medical Faculty, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria
| | - Tihomir Tenchev
- Department of Special Surgery, Faculty of Medicine, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria
| | - Dzhevdet Chakarov
- Department of Propaedeutics of Surgical Diseases, Section of General Surgery, Faculty of Medicine, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria
| | - Milena Sandeva
- Department of Midwifery, Faculty of Public Health, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria
| | - Snezhanka Dragusheva
- Department of Nursing Care, Faculty of Public Health, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria
| | - Daniela Taneva
- Department of Nursing Care, Faculty of Public Health, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria
| | - Atanas Batashki
- Department of Special Surgery, Faculty of Medicine, Medical University of Plovdiv, 4002 Plovdiv, Bulgaria
| |
Collapse
|
4
|
Khalid U, Khoja AH, Daood SS, Khan WUH, Din IU, Al-Anazi A, Petrillo A. Experimental and numerical techniques to evaluate coal/biomass fly ash blend characteristics and potentials. Sci Total Environ 2024; 912:169218. [PMID: 38092215 DOI: 10.1016/j.scitotenv.2023.169218] [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] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Revised: 11/19/2023] [Accepted: 12/06/2023] [Indexed: 12/21/2023]
Abstract
Fossil and renewable fuels are used by industrial units that produce energy-intensive products. Competitive fuel pricing encourages these fuel sources' usage globally, particularly in developing nations, which leads to large volumes of byproducts like fly ash among thermal power plant operators. The elements and compounds found in coal fly ash (CFA) and biomass fly ash (BFA) can be utilized through several engineering applications. This study aims to assess typical CFA and BFA samples quantitatively and qualitatively via techniques such as ultimate analysis (CH-S), Fourier transform infrared spectroscopy (FTIR), thermogravimetric analysis (TGA), X-ray diffraction (XRD), X-ray fluorescence (XRF) elemental analysis, and ash fusion temperature (AFT), to anticipate the ideal ratios of coal to biomass blends for combustion applications while adhering to environmental regulations. The optimal blend, consisting of 75 % CFA and 25 % BFA, exhibited improved carbon (C%) and hydrogen (H%) percentages, increasing from 2.5 % to 4.67 % and from 0 % to 0.12 %, respectively. These improvements were further confirmed by the observed functional groups in FTIR, indicating a rising trend in both carbon and hydroxyl groups from BFA to CFA. XRF and XRD also confirmed it and TGA also showed optimum mass loss (ML%) behavior of 14.55 % for 75CFA + 25BFA. According to slagging and fouling indices, the values of RB/A, Rs, and Fu indicate a reduction in slagging and fouling issues through the blending of CFA with BFA. Simultaneously, the fusion temperature increased from 1181 °C to 1207 °C. CFA was found to increase the AFT of the BFA from 1197 °C to 1247 °C, mitigating their propensity. This suggests that a blend of 75CFA + 25BFA results in lower to medium range of slagging and fouling. However, AFI and BAI indicate a slightly higher range. AFT analysis further validates the conclusions drawn from the indices. The ternary phase diagram shows that the ash's melting point increases in the optimum blend. This is attributed to a reduced content of K2O (<15 %) and increased proportions of >50 % CaO and SiO2, effectively inhibiting slagging, agglomeration, and deposition. Meanwhile, the blend maintains a medium level of acidity and susceptively to corrosion, as observed in the case of 75CFA + 25BFA. The identification of optimal blend ratios can be anticipated to offer essential solutions for future research, aiming to ensure smooth industrial operations and regulatory compliance in power plants.
Collapse
Affiliation(s)
- Usman Khalid
- Fossil Fuels Laboratory, Department of Thermal Energy Engineering, U.S.-Pakistan Centre for Advanced Studies in Energy (USPCAS-E), National University of Sciences & Technology (NUST), Sector H-12, Islamabad 44000, Pakistan
| | - Asif Hussain Khoja
- Fossil Fuels Laboratory, Department of Thermal Energy Engineering, U.S.-Pakistan Centre for Advanced Studies in Energy (USPCAS-E), National University of Sciences & Technology (NUST), Sector H-12, Islamabad 44000, Pakistan.
| | - Syed Sheraz Daood
- Institute of Energy and Environmental Engineering, Faculty of Electrical, Energy & Environmental Engineering, University of the Punjab, Quaid-e-Azam Campus, Lahore, Pakistan; Energy Engineering Research and Development Centre, Faculty of Electrical, Energy & Environmental Engineering, University of the Punjab, Quaid-e-Azam Campus, Lahore, Pakistan.
| | - Waqar Ul Habib Khan
- Fossil Fuels Laboratory, Department of Thermal Energy Engineering, U.S.-Pakistan Centre for Advanced Studies in Energy (USPCAS-E), National University of Sciences & Technology (NUST), Sector H-12, Islamabad 44000, Pakistan
| | - Israf Ud Din
- Faculty of Science and Arts, Department of Chemistry, King Khalid University, Muhayil, Asir, Saudi Arabia
| | - Abdulaziz Al-Anazi
- Department of Chemical Engineering, College of Engineering, King Saud University, P. O. Box 800, Riyadh 11421, Saudi Arabia.
| | - Antonella Petrillo
- Department of Engineering, University of Naples "Parthenope", Isola C4, Centro Direzionale Napoli, Napoli, NA 80143, Italy.
| |
Collapse
|
5
|
Ajantha P, Puri MM, Tayal D, Khalid U. Urinary lipoarabinomannan in individuals with sputum-negative pulmonary tuberculosis. Indian J Med Res 2024; 159:206-212. [PMID: 38577859 PMCID: PMC11050756 DOI: 10.4103/ijmr.ijmr_2074_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Indexed: 04/06/2024] Open
Abstract
BACKGROUND OBJECTIVES Tuberculosis (TB) is a major global cause of ill health. Sputum microscopy for confirmation of presumptive pulmonary TB (PTB) has a reportedly low sensitivity of 22-43 per cent for single smear and up to 60 per cent under optimal conditions. National TB Elimination Programme in India recommends the use of cartridge-based nucleic acid amplification test (CBNAAT) and culture for microbiological confirmation in presumptive PTB individuals with sputum smear negative test. The use of lateral flow urine lipoarabinomannan (LF-LAM) is usually recommended for the diagnosis of TB in HIV-positive individuals with low CD4 counts or those who are seriously ill. The objective of this study was to detect urinary LAM using cage nanotechnology that does not require a physiologic or immunologic consequence of HIV infection for LAM quantification in human urine in 50 HIV-seronegative sputum smear-negative PTB individuals. METHODS To study the diagnostic value of urinary LAM in sputum smear negative PTB individuals, a cage based nanotechnology ELISA technique was used for urinary LAM in three different groups of participants. Fifty smears negative PTB clinically diagnosed, 15 smear positive PTB and 15 post TB sequel individuals. Sputum was tested by smear, CBNAAT, and culture along with urine LAM before treatment. The results were interpreted by ROC curve in comparison to the standard tests like CBNAAT and culture. RESULTS The mean urinary LAM value was 0.84 ng/ml in 37 culture-positive [Mycobacterium tuberculosis (M.tb)] and 0.49 ng/ml in 13 culture-negative (M.tb) smear-negative individuals with PTB, respectively. In 47 smear-negative PTB cases with microbiologically confirmed TB by CBNAAT, the mean urinary LAM was 0.76 ng/ml. The mean urinary LAM in post-TB sequel individuals was 0.47 ng/ml. As per the receiver operating characteristic curve, cut-off value of urinary LAM in individuals with smear-negative PTB microbiologically confirmed by: (i) CBNAAT was 0.695 ng/ml and (ii) culture was 0.615 ng/ml. INTERPRETATION CONCLUSIONS The findings of this study suggest that individuals with smear-negative PTB and a urinary LAM value of >0.615 ng/ml were most likely to have microbiological confirmed TB while those with a LAM value <0.615 ng/ml >0.478 ng/ml are less likely and those with a value <0.478 ng/ml are unlikely to have microbiological confirmed TB.
Collapse
Affiliation(s)
- P. Ajantha
- Department of TB and Chest, National Institute of Tuberculosis & Respiratory Diseases, New Delhi, India
| | - Man Mohan Puri
- Department of TB and Chest, National Institute of Tuberculosis & Respiratory Diseases, New Delhi, India
| | - Devika Tayal
- Department of Bio-chemistry, National Institute of Tuberculosis & Respiratory Diseases, New Delhi, India
| | - U. Khalid
- Department of Epidemiology, National Institute of Tuberculosis & Respiratory Diseases, New Delhi, India
| |
Collapse
|
6
|
Koimtzis G, Geropoulos G, Chalklin C, Karniadakis I, Szabo L, Ilham MA, Stephens M, Asderakis A, Khalid U. The influence of socioeconomic deprivation on outcomes in transplant patients infected with SARS-CoV-2 in Wales. Clin Transplant 2024; 38:e15245. [PMID: 38289884 DOI: 10.1111/ctr.15245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 01/03/2024] [Accepted: 01/08/2024] [Indexed: 02/01/2024]
Abstract
INTRODUCTION SARS-CoV-2 infection has had a significant impact on vulnerable individuals including transplant patients. Socioeconomic deprivation negatively affects outcomes of many health conditions. The aim of this study was to evaluate the effect of socioeconomic deprivation on the incidence and severity of SARS-CoV-2 infection among Welsh transplant patients. METHODS This study is a retrospective, cross-sectional study on the transplant population of Wales. The Welsh Index of Multiple Deprivation (WIMD) was used to assess the influence of socioeconomic deprivation on outcomes of Welsh transplant patients who developed SARS-CoV-2 infection. Outcome measures were the incidence of SARS-CoV-2 infection, rates of hospital and ICU admission, development of acute kidney injury (AKI) and mortality. A logistic binomial regression analysis was used to correlate the various risk factors with the incidence of SARS-CoV-2 infection. RESULTS Two hundred and sixty-six (25%) of regular follow up patients had SARS-CoV-2 infection; of these 55 (20.7%) were admitted, 15 (5.6%) to ICU, 37 (13.9%) developed AKI, and 23 (8.6%) died. In a regression analysis, patients of younger age were associated with more (p = .001) and those with SPK (simultaneous pancreas kidney) transplant less chance of infection (p = .038), whereas social deprivation was not associated with the chance of infection (p = .14). In regression analysis increased social deprivation was associated with higher chance of AKI post SARS-CoV-2 (p = .049). CONCLUSIONS Socioeconomic deprivation did not affect the rates or severity of SARS-CoV-2 infection apart from the degree of AKI in Welsh Transplant patients. Adherence to the preventive measures for this high-risk population must continue to remain a priority.
Collapse
Affiliation(s)
- Georgios Koimtzis
- Cardiff Transplant Unit, Cardiff & Vale University Health Board, University Hospital of Wales, Cardiff, UK
| | - Georgios Geropoulos
- Cardiff Transplant Unit, Cardiff & Vale University Health Board, University Hospital of Wales, Cardiff, UK
| | - Christopher Chalklin
- Cardiff Transplant Unit, Cardiff & Vale University Health Board, University Hospital of Wales, Cardiff, UK
| | - Ioannis Karniadakis
- Cardiff Transplant Unit, Cardiff & Vale University Health Board, University Hospital of Wales, Cardiff, UK
| | - Laszlo Szabo
- Cardiff Transplant Unit, Cardiff & Vale University Health Board, University Hospital of Wales, Cardiff, UK
| | - Mohammed Adel Ilham
- Cardiff Transplant Unit, Cardiff & Vale University Health Board, University Hospital of Wales, Cardiff, UK
| | - Michael Stephens
- Cardiff Transplant Unit, Cardiff & Vale University Health Board, University Hospital of Wales, Cardiff, UK
| | - Argiris Asderakis
- Cardiff Transplant Unit, Cardiff & Vale University Health Board, University Hospital of Wales, Cardiff, UK
- Wales Kidney Research Unit, Division of Infection and Immunity, Cardiff University, Cardiff, UK
| | - Usman Khalid
- Cardiff Transplant Unit, Cardiff & Vale University Health Board, University Hospital of Wales, Cardiff, UK
- Wales Kidney Research Unit, Division of Infection and Immunity, Cardiff University, Cardiff, UK
| |
Collapse
|
7
|
Khalid U, Uchikov P, Hristov B, Kraev K, Koleva-Ivanova M, Kraeva M, Batashki A, Taneva D, Doykov M, Uchikov A. Surgical Innovations in Tracheal Reconstruction: A Review on Synthetic Material Fabrication. Medicina (Kaunas) 2023; 60:40. [PMID: 38256300 PMCID: PMC10820818 DOI: 10.3390/medicina60010040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 12/19/2023] [Accepted: 12/22/2023] [Indexed: 01/24/2024]
Abstract
Background and Objectives: The aim of this review is to explore the recent surgical innovations in tracheal reconstruction by evaluating the uses of synthetic material fabrication when dealing with tracheomalacia or stenotic pathologies, then discussing the challenges holding back these innovations. Materials and Methods: A targeted non-systematic review of published literature relating to tracheal reconstruction was performed within the PubMed database to help identify how synthetic materials are utilised to innovate tracheal reconstruction. Results: The advancements in 3D printing to aid synthetic material fabrication have unveiled promising alternatives to conventional approaches. Achieving successful tracheal reconstruction through this technology demands that the 3D models exhibit biocompatibility with neighbouring tracheal elements by encompassing vasculature, chondral foundation, and immunocompatibility. Tracheal reconstruction has employed grafts and scaffolds, showing a promising beginning in vivo. Concurrently, the integration of resorbable models and stem cell therapy serves to underscore their viability and application in the context of tracheal pathologies. Despite this, certain barriers hinder its advancement in surgery. The intricate tracheal structure has posed a challenge for researchers seeking novel approaches to support its growth and regeneration. Conclusions: The potential of synthetic material fabrication has shown promising outcomes in initial studies involving smaller animals. Yet, to fully realise the applicability of these innovative developments, research must progress toward clinical trials. These trials would ascertain the anatomical and physiological effects on the human body, enabling a thorough evaluation of post-operative outcomes and any potential complications linked to the materials or cells implanted in the trachea.
Collapse
Affiliation(s)
- Usman Khalid
- Medical Faculty, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria
| | - Petar Uchikov
- Department of Special Surgery, Faculty of Medicine, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria
| | - Bozhidar Hristov
- Section "Gastroenterology", Second Department of Internal Diseases, Medical Faculty, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria
| | - Krasimir Kraev
- Department of Propedeutics of Internal Diseases, Medical Faculty, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria
| | - Maria Koleva-Ivanova
- Department of General and Clinical Pathology, Faculty of Medicine, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria
| | - Maria Kraeva
- Department of Otorhynolaryngology, Medical Faculty, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria
| | - Atanas Batashki
- Department of Special Surgery, Faculty of Medicine, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria
| | - Daniela Taneva
- Department of Nursing Care, Faculty of Public Health, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria
| | - Mladen Doykov
- Department of Urology and General Medicine, Medical Faculty, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria
| | - Angel Uchikov
- Department of Special Surgery, Faculty of Medicine, Medical University of Plovdiv, 4000 Plovdiv, Bulgaria
| |
Collapse
|
8
|
Okafor L, Khalid U. COVID-19 economic stimulus packages, tourism industry and external debt: The influence of extreme poverty. PLoS One 2023; 18:e0287384. [PMID: 37643183 PMCID: PMC10464963 DOI: 10.1371/journal.pone.0287384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 06/05/2023] [Indexed: 08/31/2023] Open
Abstract
The COVID-19 outbreak has had a catastrophic effect on the tourism sector and poverty alleviation efforts. This is especially the case, given the crucial role the tourism sector plays in poverty alleviation and the generation of foreign exchange earnings. This study investigates the moderating influence of extreme poverty on the underlying link between the size of the tourism industry and COVID-19 Economic Stimulus Packages (ESPs) while accounting for the influence of external debt. The results show that tourism-dependent economies with a larger share of individuals living in extreme poverty introduced larger ESPs to cushion the impacts of the COVID-19 outbreak. In addition, economies with larger external debt have less fiscal and monetary leeway to alleviate the negative effects of the COVID-19 outbreak.
Collapse
Affiliation(s)
- Luke Okafor
- School of Economics, University of Nottingham Malaysia, Semenyih, Selangor, Malaysia
| | - Usman Khalid
- Department of Innovation in Government & Society, College of Business and Economics, United Arab Emirates University, Al Ain, United Arab Emirates
| |
Collapse
|
9
|
Abdullah M, Iqbal J, Ur Rehman MS, Khalid U, Mateen F, Arshad SN, Al-Sehemi AG, Algarni H, Al-Hartomy OA, Fazal T. Removal of ceftriaxone sodium antibiotic from pharmaceutical wastewater using an activated carbon based TiO 2 composite: Adsorption and photocatalytic degradation evaluation. Chemosphere 2023; 317:137834. [PMID: 36640968 DOI: 10.1016/j.chemosphere.2023.137834] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 12/13/2022] [Accepted: 01/10/2023] [Indexed: 06/17/2023]
Abstract
The water pollution becomes a serious concern for the sustainability of ecosystems due to the existence of pharmaceutical products (ceftriaxone (CEF) antibiotic). Even in low concentration of CEF has lethal effects on ecosystem and human health. To remove CEF, TiO2 is considered as an effective and efficient nanoparticles, however its performance is reduced due to wider energy gap and rapid recombination of charge carriers. In this study, activated carbon based TiO2 (ACT-X) heterogeneous nanocomposites were synthesized to improve the intrinsic properties of TiO2 and their adsorption-photocatalytic performance for the removal of CEF. The characterization results revealed that ACT-X composites have slower recombination of charge carriers, lower energy band gap (3.05 eV), and better light absorption under visible region of light. From ACT-X composites, the ACT-4 photocatalyst has achieved highest photocatalytic degradation (99.6%) and COD removal up (99.2%). The results of radical scavengers showed that photocatalytic degradation of CEF is mainly occurred due to superoxide and hydroxyl radicals. Meanwhile, the reusability of ACT-4 up to five cycles shows more than 80% photocatalytic degradation, which make the process more economical. The highest experimental adsorption capacity is achieved up to 844.8 mg g-1 using ACT-4. The favorable and multilayer heterogeneous adsorption is carried out according to the well-fitted data with pseudo-second-order and Freundlich models, respectively. These results indicate that the carbon-based TiO2 composites can be used as a green, stable, efficient, effective, reusable, renewable, and sustainable photocatalyst to eliminate the pharmaceutical pollutants (antibiotics) via adsorption and photocatalytic degradation processes.
Collapse
Affiliation(s)
- Muneeb Abdullah
- Institute of Chemical and Environmental Engineering (ICEE), Khwaja Fareed University of Engineering and Information Technology, Rahim Yar Khan, 64200, Pakistan
| | - Javed Iqbal
- Institute of Chemical and Environmental Engineering (ICEE), Khwaja Fareed University of Engineering and Information Technology, Rahim Yar Khan, 64200, Pakistan.
| | - Muhammad Saif Ur Rehman
- Office of Research, Innovation, and Commercialization (ORIC), Khwaja Fareed University of Engineering and Information Technology, Rahim Yar Khan, 64200, Pakistan
| | - Usman Khalid
- Institute of Chemical and Environmental Engineering (ICEE), Khwaja Fareed University of Engineering and Information Technology, Rahim Yar Khan, 64200, Pakistan
| | - Fahad Mateen
- Department of Chemical Engineering and Materials Science, Michigan State University, East Lansing, MI, 48824, USA
| | - Salman Noshear Arshad
- Department of Chemistry and Chemical Engineering, Syed Babar Ali School of Science and Engineering, Lahore University of Management Science (LUMS), Lahore, 54792, Pakistan
| | - Abdullah G Al-Sehemi
- Research Center for Advanced Materials Science (RCAMS), King Khalid University, Abha, 61413, Saudi Arabia; Department of Chemistry, College of Science, King Khalid University, Abha, 61413, Saudi Arabia
| | - Hamed Algarni
- Research Center for Advanced Materials Science (RCAMS), King Khalid University, Abha, 61413, Saudi Arabia; Department of Physics, Faculty of Science, King Khalid University, Abha 61413, Saudi Arabia
| | - Omar A Al-Hartomy
- Department of Physics, Faculty of Science, King Abdulaziz University, Jeddah, 21589, Saudi Arabia
| | - Tahir Fazal
- Institute of Chemical and Environmental Engineering (ICEE), Khwaja Fareed University of Engineering and Information Technology, Rahim Yar Khan, 64200, Pakistan.
| |
Collapse
|
10
|
Khalid U, Dimov D, Vlaykova T. Matrix metalloproteinases in COVID-19: underlying significance. BIOTECHNOL BIOTEC EQ 2023. [DOI: 10.1080/13102818.2023.2186137] [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: 03/16/2023] Open
Affiliation(s)
- Usman Khalid
- Faculty of Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria
| | - Dimo Dimov
- Department of Medical Chemistry and Biochemistry, Faculty of Medicine, Trakia University, Stara Zagora, Bulgaria
| | - Tatyana Vlaykova
- Department of Medical Chemistry and Biochemistry, Faculty of Medicine, Trakia University, Stara Zagora, Bulgaria
- Department of Medical Biochemistry, Faculty of Pharmacy, Medical University of Plovdiv, Plovdiv, Bulgaria
| |
Collapse
|
11
|
Vellar K, Khalid U, Coleman M. Quality improvement through audit: Zuclopenthixol acetate prescribing, monitoring and patient outcomes in a regional health service. Australas Psychiatry 2023; 31:27-33. [PMID: 36772936 DOI: 10.1177/10398562231154311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
OBJECTIVE Prescribers' expectations of Zuclopethixol Acetate's (ZA) efficacy and tolerability are shaped by clinical experience and organisational culture; however, these expectations may not be consistent with current evidence and best practice. METHODS Quality improvement project (QIP) through a process audit of ZA prescribing, monitoring and patient outcomes (adverse events) in order to identify issues requiring intervention to align with service standards and practices. RESULTS QIP interventions resulted in a statistically significant shift in psychiatrist oversight, identifying high dose ZA with adverse outcomes and cessation of prescribing/administration within the Emergency Department. Clinically significant changes in patterns of prescribing were observed between pre-post intervention audits. CONCLUSION Entrenching an evidence-based QIP approach to clinical practice can effect clinically significant patterns of practice change to improve safe prescribing and drug monitoring.
Collapse
Affiliation(s)
- Kane Vellar
- 1137Northern Territory Health Department, Darwin, NT, Australia
| | - Usman Khalid
- 1137Northern Territory Health Department, Darwin, NT, Australia
| | - Mathew Coleman
- 94265WA Country Health Service, Albany, WA, Australia; The Rural Clinical School of WA, 569387University of Western Australia, Crawley, WA, Australia; and 117610Telethon Kids Institute, Nedlands, WA, Australia
| |
Collapse
|
12
|
Kosiborod MN, Bhatta M, Davies M, Deanfield JE, Garvey WT, Khalid U, Kushner R, Rubino DM, Zeuthen N, Verma S. Semaglutide improves cardiometabolic risk factors in adults with overweight or obesity: STEP 1 and 4 exploratory analyses. Diabetes Obes Metab 2023; 25:468-478. [PMID: 36200477 PMCID: PMC10092593 DOI: 10.1111/dom.14890] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 09/23/2022] [Accepted: 10/03/2022] [Indexed: 02/02/2023]
Abstract
AIMS Evaluate the effects of once-weekly subcutaneous semaglutide 2.4 mg on cardiometabolic risk factors in people with overweight/obesity without diabetes in the STEP 1 and 4 trials. MATERIALS AND METHODS STEP 1 and 4 were phase III, 68-week, placebo-controlled trials of once-weekly semaglutide 2.4 mg combined with lifestyle intervention; STEP 4 had a 20-week semaglutide run-in and 48-week randomized withdrawal period. Participants had a body mass index ≥30 kg/m2 or ≥27 kg/m2 with one or more weight-related comorbidity, without diabetes. Pre-specified endpoints were changes in waist circumference, systolic/diastolic blood pressure (SBP/DBP), lipids, fasting plasma glucose (FPG), fasting serum insulin and antihypertensive/lipid-lowering medication use. Post-hoc assessments included non-high-density lipoprotein (HDL) cholesterol, homeostatic model assessment of insulin resistance (HOMA-IR; STEP 1 only), atherosclerotic cardiovascular disease (ASCVD) risk (American College of Cardiology/American Heart Association algorithm; STEP 1 only) and cardiometabolic risk factors by weight loss achieved (<5%, 5% to <10%, 10% to <15%, or ≥15%) (STEP 1 only). RESULTS Of the 1961 participants in STEP 1 and 803 in STEP 4, most had one or more complication/comorbidity at baseline, with dyslipidaemia and hypertension most prevalent. In STEP 1, reductions in waist circumference, SBP, DBP, FPG, fasting serum insulin, lipids and HOMA-IR were greater with semaglutide versus placebo (p ≤ .001). Reductions in SBP, non-HDL cholesterol, low-density lipoprotein cholesterol and FPG were generally greater with semaglutide than placebo within weight-loss categories. Non-significant ASCVD risk reductions were observed with semaglutide versus placebo (p > .05). In STEP 4, improvements in waist circumference, SBP, FPG, fasting serum insulin and lipids during the semaglutide run-in (week 0-20) were maintained over week 20-68 with continued semaglutide, but deteriorated following the switch to placebo (p < .001 [week 20-68]). Net reductions in antihypertensive/lipid-lowering medication use occurred with semaglutide versus placebo (both trials). CONCLUSIONS Semaglutide may improve cardiometabolic risk factors and reduce antihypertensive/lipid-lowering medication use versus placebo in adults with overweight/obesity without diabetes. These potential benefits were not maintained after treatment discontinuation. CLINICALTRIALS GOV NUMBERS STEP 1 NCT03548935, STEP 4 NCT03548987.
Collapse
Affiliation(s)
- Mikhail N. Kosiborod
- Department of Cardiovascular DiseaseSaint Luke's Mid America Heart Institute and University of Missouri‐Kansas City School of MedicineKansas CityMissouriUSA
| | | | - Melanie Davies
- Diabetes Research CentreUniversity of LeicesterLeicesterUK
- NIHR Leicester Biomedical Research CentreLeicesterUK
| | - John E. Deanfield
- Institute of Cardiovascular ScienceUniversity College LondonLondonUK
| | - W. Timothy Garvey
- Department of Nutrition SciencesUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | | | - Robert Kushner
- Division of Endocrinology, Feinberg School of MedicineNorthwestern UniversityChicagoIllinoisUSA
| | - Domenica M. Rubino
- Washington Center for Weight Management and ResearchArlingtonVirginiaUSA
| | | | - Subodh Verma
- Division of Cardiac Surgery, Li Ka Shing Knowledge Institute of St Michael's Hospital, Unity Health TorontoUniversity of TorontoTorontoOntarioCanada
| |
Collapse
|
13
|
Gupta S, Mahesh S, Koimtzis G, Chalklin C, Ilham MA, Elker D, Stephens MR, Khalid U. 742 Quality of Operative Notes for Renal Transplant Surgery - Is Our Documentation Satisfactory? Br J Surg 2022. [DOI: 10.1093/bjs/znac269.032] [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: 11/07/2022]
Abstract
Abstract
Introduction
Operation notes are essential in providing details of the procedure undertaken. The Royal College of Surgeons (RCS) Good Surgical Practice (GSP) guidelines recommend a checklist of 18 documentation items. Although these guidelines are useful, their broad and non-specific nature provides limitations to fields like transplantation, where additional information is needed. Ghoneima et al recommended transplant specific GSP checklist of 32 criteria for operation notes in transplantation. Our aim is to evaluate renal transplantation operation notes against these criteria.
Method
A retrospective audit of renal transplant operation notes was undertaken within Cardiff Transplant Unit between October 2020–2021. Notes were reviewed against new transplant specific GSP checklist.
Results
A total of 85 renal transplants were performed by 8 Consultant Surgeons. Sixty-two (73%) operation notes were hand-written and 23 (27%) electronically typed. Eleven standards had documentation compliance of >95% (e.g., date, surgeons’ names, recipient blood vessels, incision, allograft vascular anatomy, perfusion timings, closure, signature, etc).
Some important transplant-specific information (e.g., primary renal disease, details of current renal replacement therapy, reperfusion characteristics, donor details (e.g., age, comorbidities), HLA mismatch, prosthesis (ureteric stent) details) were poorly documented (0–27% documentation compliance). Antibiotic and DVT prophylaxis documentation was also very poor (1–30%). Post-operative instructions did not record target blood pressure (0%) and postoperative potassium and ultrasound scan instructions were recorded in 65% of notes.
Discussion
Clear documentation is important for good surgical practice. This study highlights the need for a transplant-specific operation notes template, to not only improve the documentation but to standardize the key information recorded for every transplant performed.
Collapse
Affiliation(s)
- S Gupta
- Cardiff Transplant Unit, University Hospital of Wales , Cardiff , United Kingdom
| | - S Mahesh
- Cardiff University , Cardiff , United Kingdom
| | - G Koimtzis
- Cardiff Transplant Unit, University Hospital of Wales , Cardiff , United Kingdom
| | - C Chalklin
- Cardiff Transplant Unit, University Hospital of Wales , Cardiff , United Kingdom
| | - MA Ilham
- Cardiff Transplant Unit, University Hospital of Wales , Cardiff , United Kingdom
| | - D Elker
- Cardiff Transplant Unit, University Hospital of Wales , Cardiff , United Kingdom
| | - MR Stephens
- Cardiff Transplant Unit, University Hospital of Wales , Cardiff , United Kingdom
| | - U Khalid
- Cardiff Transplant Unit, University Hospital of Wales , Cardiff , United Kingdom
| |
Collapse
|
14
|
Asderakis A, Khalid U, Koimtzis G, Ponsford MJ, Szabo L, Chalklin C, Bramhall K, Grant L, Moat SJ, Humphreys IR, Jolles SR. An Analysis of Serological Response and Infection Outcomes Following Oxford-AstraZeneca (AZD1222) and Pfizer-BioNTech (mRNA BNT162b2) SARS-CoV-2 Vaccines in Kidney and Kidney-pancreas Transplants. Transplantation 2022; 106:1421-1429. [PMID: 35283457 PMCID: PMC9213057 DOI: 10.1097/tp.0000000000004105] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Revised: 01/26/2022] [Accepted: 01/26/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 is associated with high mortality among transplant recipients. Comparative data that define humoral responses to the Oxford-AstraZeneca (AZ) and BNT162b2 (Pfizer-BioNTech) vaccines are limited. METHODS We recruited 920 kidney transplant patients receiving at least 1 dose of severe acute respiratory syndrome coronavirus 2 vaccine, excluding patients with virus pre-exposure. Serological status was determined with the COVID-SeroKlir ELISA (Kantaro-EKF Diagnostics). Patients with a corrected antibody level of <0.7 AU/mL were considered seronegative. RESULTS Four hundred ninety-five AZ and 141 Pfizer patients had a sample analyzed after first dose and 593 after second dose (346 AZ versus 247 Pfizer). After first dose, 25.7% of patients seroconverted (26.6% AZ, 22.8% Pfizer). After second dose, 148 (42.8%) of AZ seroconverted compared with 130 (52.6%) of Pfizer (P = 0.02; hazard ratio, 1.48; 95% confidence interval, 1.07-2.06). When negative responders were excluded, Pfizer patients were shown to have significantly higher response than AZ patients (median 2.6 versus 1.78 AU/mL, P = 0.005).Patients on mycophenolate had a reduced seroconversion rate (42.2% versus 61.4%; P < 0.001; hazard ratio, 2.17) and reduced antibody levels (0.47 versus 1.22 AU/mL, P = 0.001), and this effect was dose dependent (P = 0.05). Prednisolone reduced the seroconversion from 58.2% to 43.6% (P = 0.03) among Pfizer but not AZ recipients. Regression analysis showed that antibody levels were reduced by older age (P = 0.002), mycophenolate (P < 0.001), AZ vaccine (versus Pfizer, P = 0.001), and male gender (P = 0.02). Sixteen of 17 serious postvaccine infections occurred to patients who did not seroconvert. CONCLUSIONS Both seroconversion and antibody levels are lower in AZ compared with Pfizer vaccinated recipients following 2 vaccine doses. Mycophenolate was associated with lower antibody responses in a dose-dependent manner. Serious postvaccine infections occurred among seronegative recipients.
Collapse
Affiliation(s)
- Argiris Asderakis
- Cardiff Transplant Unit, University Hospital of Wales, Cardiff, United Kingdom
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Usman Khalid
- Cardiff Transplant Unit, University Hospital of Wales, Cardiff, United Kingdom
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Georgios Koimtzis
- Cardiff Transplant Unit, University Hospital of Wales, Cardiff, United Kingdom
| | - Mark J. Ponsford
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, United Kingdom
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, United Kingdom
| | - Laszlo Szabo
- Cardiff Transplant Unit, University Hospital of Wales, Cardiff, United Kingdom
| | | | - Kathryn Bramhall
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, United Kingdom
| | - Leanne Grant
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, United Kingdom
| | - Stuart J. Moat
- Department of Medical Biochemistry, Immunology, and Toxicology, University Hospital of Wales, Cardiff, United Kingdom
| | - Ian R. Humphreys
- Division of Infection and Immunity, School of Medicine, Cardiff University, Cardiff, United Kingdom
| | - Stephen R. Jolles
- Immunodeficiency Centre for Wales, University Hospital of Wales, Cardiff, United Kingdom
| |
Collapse
|
15
|
Chalklin CG, Koimtzis G, Khalid U, Carrington-Windo E, Elker D, Asderakis A. SARS-CoV-2 Infection Can Lead to an Increase in Tacrolimus Levels in Renal Transplant Patients: A Cohort Study. Transpl Int 2022; 35:10127. [PMID: 35387396 PMCID: PMC8977848 DOI: 10.3389/ti.2022.10127] [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] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 02/16/2022] [Indexed: 11/13/2022]
Abstract
The aim of this study is to evaluate the effect of SARS-CoV-2 infection on serum tacrolimus levels. Tacrolimus levels of 34 transplant patients diagnosed with SARS-CoV-2 in 2020 were compared with their pre-infection values and those of a control group with alternative infections. 20 out of 34 (59%) had high levels. At diagnosis, median tacrolimus level in the SARS-CoV-2 cohort was 9.6 μg/L (2.7-23) compared to 7.9 μg/L in the control group (p = 0.07, 95% CI for difference -0.3-5.8). The ratio of post-infection to pre-infection tacrolimus values was higher in the SARS-CoV-2 group (1.7) compared to the control group (1.25, p = 0.018, 95% CI for difference 0.08-0.89). The acute kidney injury rate was 65% (13 of 20) in SARS-CoV-2 patients with a level >8 μg/dl, compared to 29% (4 of 14) in those with lower levels (p = 0.037). Median length of stay was 10 days among SARS-CoV-2 infected patients with high tacrolimus levels compared to 0 days in the rest (p = 0.04). Four patients with high levels died compared to 2 in the control group. Clinicians should be aware of this potential effect on tacrolimus levels and take appropriate measures.
Collapse
Affiliation(s)
- Christopher G Chalklin
- Cardiff Transplant Unit, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | - Georgios Koimtzis
- Cardiff Transplant Unit, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | - Usman Khalid
- Cardiff Transplant Unit, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, United Kingdom.,College of Medicine, Infection and Immunity, Cardiff University, Cardiff, United Kingdom
| | - Eliot Carrington-Windo
- Cardiff Transplant Unit, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | - Doruk Elker
- Cardiff Transplant Unit, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, United Kingdom
| | - Argiris Asderakis
- Cardiff Transplant Unit, University Hospital of Wales, Cardiff and Vale University Health Board, Cardiff, United Kingdom.,College of Medicine, Infection and Immunity, Cardiff University, Cardiff, United Kingdom
| |
Collapse
|
16
|
Affiliation(s)
- Robert Parker
- Top End Mental Health Services, Casuarina, NT, Australia
| | - Kane Vellar
- Top End Mental Health Services, Casuarina, NT, Australia
| | - Usman Khalid
- Top End Mental Health Services, Casuarina, NT, Australia
| | - Daniel Wood
- Top End Mental Health Services, Casuarina, NT, Australia
| |
Collapse
|
17
|
Kadowaki T, Isendahl J, Khalid U, Lee SY, Nishida T, Ogawa W, Tobe K, Yamauchi T, Lim S. Semaglutide once a week in adults with overweight or obesity, with or without type 2 diabetes in an east Asian population (STEP 6): a randomised, double-blind, double-dummy, placebo-controlled, phase 3a trial. Lancet Diabetes Endocrinol 2022; 10:193-206. [PMID: 35131037 DOI: 10.1016/s2213-8587(22)00008-0] [Citation(s) in RCA: 69] [Impact Index Per Article: 34.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 12/23/2021] [Accepted: 12/23/2021] [Indexed: 02/06/2023]
Abstract
BACKGROUND Semaglutide 2·4 mg once weekly has been investigated for weight management in global populations. Differences exist between Asian and non-Asian populations in terms of body composition and definitions of obesity. In the Semaglutide Treatment Effect in People with obesity (STEP) 6 trial, we assessed the effect of semaglutide versus placebo for weight management in adults from east Asia with obesity, with or without type 2 diabetes. METHODS This randomised, double-blind, double-dummy, placebo-controlled, phase 3a superiority trial was done at 28 outpatient clinics in Japan and South Korea. Eligible participants were adults (aged ≥18 years in South Korea; ≥20 years in Japan) with a BMI of at least 27·0 kg/m2 with two or more weight-related comorbidities or a BMI of 35·0 kg/m2 or more with one or more weight-related comorbidity (one comorbidity had to be either hypertension, dyslipidaemia, or, in Japan only, type 2 diabetes) who had at least one self-reported unsuccessful dietary attempt to lose bodyweight. Participants were randomly assigned (4:1:2:1) to once-weekly subcutaneous semaglutide 2·4 mg or matching placebo, or semaglutide 1·7 mg or matching placebo, plus lifestyle recommendations for 68 weeks. Data for the placebo groups were pooled in statistical analyses. The primary endpoints were percentage change in bodyweight from baseline at week 68 and the proportion of participants who had achieved a reduction of at least 5% of baseline bodyweight at week 68. Change in abdominal visceral fat area was assessed as a supportive secondary endpoint using computed tomography scanning in a subset of participants. Efficacy outcomes were assessed in the full analysis set, which included all randomly assigned participants according to the intention-to-treat principle. Safety was assessed in all participants who received at least one dose of the study drug. This trial was registered with ClinicalTrials.gov, NCT03811574. FINDINGS Between Jan 21, 2019 and June 4, 2019, 437 participants were screened, of whom 401 were randomly assigned to semaglutide 2·4 mg (n=199), semaglutide 1·7 mg (n=101), or placebo (n=101) and included in the intention-to-treat analysis. Estimated mean change in bodyweight from baseline to week 68 was -13·2% (SEM 0·5) in the semaglutide 2·4 mg group and -9·6% (0·8) in the semaglutide 1·7 mg group versus -2·1% (0·8) in the placebo group (estimated treatment difference [ETD] -11·1 percentage points [95% CI -12·9 to -9·2] for semaglutide 2·4 mg vs placebo; -7·5 percentage points [95% CI -9·6 to -5·4] for semaglutide 1·7 mg vs placebo; both p<0·0001). At week 68, a larger proportion of participants had achieved a 5% or higher reduction in baseline bodyweight in the semaglutide 2·4 mg group (160 [83%] of 193 participants) and semaglutide 1·7 mg group (71 [72%] of 98 participants) than in the placebo group (21 [21%] of 100 participants); odds ratio [OR] 21·7 [95% CI 11·3 to 41·9] for semaglutide 2·4 mg vs placebo; OR 11·1 [95% CI 5·5 to 22·2] for semaglutide 1·7 mg vs placebo; both p<0·0001). Abdominal visceral fat area was reduced by 40·0% (SEM 2·6) among participants in the semaglutide 2·4 mg group and 22·2% (3·7) among participants in the semaglutide 1·7 mg group versus 6·9% (3·8) in the placebo group (ETD -33·2% [95% CI -42·1 to -24·2] for semaglutide 2·4 mg vs placebo; -15·3% [95% CI -25·6 to -4·9] for semaglutide 1·7 mg vs placebo). 171 (86%) of 199 participants in the semaglutide 2·4 mg group, 82 (82%) of 100 participants in the semaglutide 1·7 mg group, and 80 (79%) of 101 participants in the placebo group reported adverse events. Gastrointestinal disorders, which were mostly mild to moderate, were reported in 118 (59%) of 199 participants in the semaglutide 2·4 mg group, 64 (64%) of 100 participants in the semaglutide 1·7 mg group, and 30 (30%) of 101 participants in the placebo group. Adverse events leading to trial product discontinuation occurred in five (3%) of 199 participants in the semaglutide 2·4 mg group, three (3%) of 100 participants in the semaglutide 1·7 mg group, and one (1%) of 101 participants in the placebo group. INTERPRETATION Adults from east Asia with obesity, with or without type 2 diabetes, given semaglutide 2·4 mg once a week had superior and clinically meaningful reductions in bodyweight, and greater reductions in abdominal visceral fat area compared with placebo, representing a promising treatment option for weight management in this population. FUNDING Novo Nordisk. TRANSLATIONS For the Korean and Japanese translations of the abstract see Supplementary Materials section.
Collapse
Affiliation(s)
| | | | | | - Sang Yeoup Lee
- Family Medicine Clinic and Biomedical Research Institute, Pusan National University Yangsan Hospital, Yangsan, South Korea; Department of Medical Education, Pusan National University School of Medicine, Yangsan, South Korea
| | | | - Wataru Ogawa
- Department of Internal Medicine, Division of Diabetes and Endocrinology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazuyuki Tobe
- First Department of Internal Medicine, Graduate School of Medicine and Pharmaceutical Science for Research, University of Toyama, Toyama, Japan
| | - Toshimasa Yamauchi
- Department of Diabetes and Metabolic Diseases, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Soo Lim
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, South Korea.
| | | |
Collapse
|
18
|
Shafiullah M, Khalid U, Chaudhry SM. Do stock markets play a role in determining COVID-19 economic stimulus? A cross-country analysis. World Econ 2022; 45:386-408. [PMID: 34230757 PMCID: PMC8250644 DOI: 10.1111/twec.13130] [Citation(s) in RCA: 2] [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] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 03/27/2021] [Accepted: 03/29/2021] [Indexed: 06/13/2023]
Abstract
This paper makes an innovative contribution to the extant literature by analysing the determinants of economic stimulus packages implemented by governments in response to the COVID-19 pandemic. In particular, we explore whether stock market declines observed in many countries can predict the size of COVID-19 stimulus packages. Moreover, we explore whether a country's level of income can augment the underlying relationship between stock market declines and stimulus packages. The findings reveal that a larger stock market decline results in a larger stimulus package; however, this effect is only observed in countries that have an income level greater than the mean and/or median per capita gross domestic product (GDP). Moreover, our results show that monetary policy is more responsive to a stock market decline than fiscal policy. Thus, our results underscore the importance of international donor agencies such as the World Bank and International Monetary Fund (IMF) in supporting less affluent countries in coping with the adverse impacts of the COVID-19 pandemic on their economies.
Collapse
Affiliation(s)
| | - Usman Khalid
- Department of Innovation in Government & SocietyCollege of Business and EconomicsUnited Arab Emirates UniversityAl AinUnited Arab Emirates
| | - Sajid M. Chaudhry
- Economics, Finance & Entrepreneurship GroupAston Business SchoolAston UniversityBirminghamUK
| |
Collapse
|
19
|
Khan AS, Khan MK, Zubair M, Khan S, Khalid U, Sultan K. Hemodialysis Catheter-Related Infections: Incidence in Temporary Catheters locked with Vancomycin and Heparin vs. Heparin-only. JPRI 2022. [DOI: 10.9734/jpri/2022/v34i4b35400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Background: The increasing incidence of end stage renal disease (ESRD) patients initiating hemodialysis (HD) through a temporary HD catheter has caused the rise in catheter related infections and associated morbidity and mortality. An antibiotic lock solution (ALS) for the prevention of catheter-related bacteraemia is a promising strategy. The present randomized control study has evaluated the efficacy and safety of vancomycin as an ALS in 54 patients who required temporary double lumen catheters for HD.
Methods: The patients were randomized to receive either (A) an ALS (vancomycin 5 mg/ml + heparin 5000 IU/ml) – group A; or (B) unfractionated heparin (5000 IU/ml) alone as a catheter lock control – group B. The study duration was of three months and was conducted at the Department of Nephrology, PIMS, Islamabad.
Results: The primary endpoint of the study was catheter related blood stream infection (CRBSI). The vancomycin group (A) had one episode of infection (CRBSI rate = 1.23/1000 days) compared with six episodes in the heparin-locked control group (B) (CRBSI rate = 8.55/1000 days). Mean catheter survival was significantly (p<0.05) more in group A (30.48 ± 5.7days) compared to group B (26 ± 6.5 days). No thrombotic episodes or side effects were recorded.
Conclusion: Vancomycin appeared to be a safe and effective ALS, preventing CRBSI and increasing survival of catheter in HD patients.
Collapse
|
20
|
Rubino DM, Greenway FL, Khalid U, O’Neil PM, Rosenstock J, Sørrig R, Wadden TA, Wizert A, Garvey WT. Effect of Weekly Subcutaneous Semaglutide vs Daily Liraglutide on Body Weight in Adults With Overweight or Obesity Without Diabetes: The STEP 8 Randomized Clinical Trial. JAMA 2022; 327:138-150. [PMID: 35015037 PMCID: PMC8753508 DOI: 10.1001/jama.2021.23619] [Citation(s) in RCA: 233] [Impact Index Per Article: 116.5] [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: 12/24/2022]
Abstract
IMPORTANCE Phase 3 trials have not compared semaglutide and liraglutide, glucagon-like peptide-1 analogues available for weight management. OBJECTIVE To compare the efficacy and adverse event profiles of once-weekly subcutaneous semaglutide, 2.4 mg, vs once-daily subcutaneous liraglutide, 3.0 mg (both with diet and physical activity), in people with overweight or obesity. DESIGN, SETTING, AND PARTICIPANTS Randomized, open-label, 68-week, phase 3b trial conducted at 19 US sites from September 2019 (enrollment: September 11-November 26) to May 2021 (end of follow-up: May 11) in adults with body mass index of 30 or greater or 27 or greater with 1 or more weight-related comorbidities, without diabetes (N = 338). INTERVENTIONS Participants were randomized (3:1:3:1) to receive once-weekly subcutaneous semaglutide, 2.4 mg (16-week escalation; n = 126), or matching placebo, or once-daily subcutaneous liraglutide, 3.0 mg (4-week escalation; n = 127), or matching placebo, plus diet and physical activity. Participants unable to tolerate 2.4 mg of semaglutide could receive 1.7 mg; participants unable to tolerate 3.0 mg of liraglutide discontinued treatment and could restart the 4-week titration. Placebo groups were pooled (n = 85). MAIN OUTCOMES AND MEASURES The primary end point was percentage change in body weight, and confirmatory secondary end points were achievement of 10% or more, 15% or more, and 20% or more weight loss, assessed for semaglutide vs liraglutide at week 68. Semaglutide vs liraglutide comparisons were open-label, with active treatment groups double-blinded against matched placebo groups. Comparisons of active treatments vs pooled placebo were supportive secondary end points. RESULTS Of 338 randomized participants (mean [SD] age, 49 [13] years; 265 women [78.4%]; mean [SD] body weight, 104.5 [23.8] kg; mean [SD] body mass index, 37.5 [6.8]), 319 (94.4%) completed the trial, and 271 (80.2%) completed treatment. The mean weight change from baseline was -15.8% with semaglutide vs -6.4% with liraglutide (difference, -9.4 percentage points [95% CI, -12.0 to -6.8]; P < .001); weight change with pooled placebo was -1.9%. Participants had significantly greater odds of achieving 10% or more, 15% or more, and 20% or more weight loss with semaglutide vs liraglutide (70.9% of participants vs 25.6% [odds ratio, 6.3 {95% CI, 3.5 to 11.2}], 55.6% vs 12.0% [odds ratio, 7.9 {95% CI, 4.1 to 15.4}], and 38.5% vs 6.0% [odds ratio, 8.2 {95% CI, 3.5 to 19.1}], respectively; all P < .001). Proportions of participants discontinuing treatment for any reason were 13.5% with semaglutide and 27.6% with liraglutide. Gastrointestinal adverse events were reported by 84.1% with semaglutide and 82.7% with liraglutide. CONCLUSIONS AND RELEVANCE Among adults with overweight or obesity without diabetes, once-weekly subcutaneous semaglutide compared with once-daily subcutaneous liraglutide, added to counseling for diet and physical activity, resulted in significantly greater weight loss at 68 weeks. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04074161.
Collapse
Affiliation(s)
- Domenica M. Rubino
- Washington Center for Weight Management and Research, Arlington, Virginia
| | - Frank L. Greenway
- Pennington Biomedical Research Center, Louisiana State University System, Baton Rouge
| | | | - Patrick M. O’Neil
- Weight Management Center, Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, Charleston
| | | | | | - Thomas A. Wadden
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia
| | | | - W. Timothy Garvey
- Department of Nutrition Sciences, University of Alabama at Birmingham
| |
Collapse
|
21
|
Khalid U, Akram MJ, Abu Bakar M, Butt FM, Ashraf MB. Elucidating the Etiologies of 18F-fluorodeoxyglucose-Avid Mediastinal Lymph Nodes Among Cancer Patients in a Tuberculosis-Endemic Region Using Endobronchial Ultrasound. Cureus 2021; 13:e19339. [PMID: 34909300 PMCID: PMC8651531 DOI: 10.7759/cureus.19339] [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] [Accepted: 11/07/2021] [Indexed: 12/25/2022] Open
Abstract
Background Non-malignant conditions, including infections (such as tuberculosis [TB]), can mimic malignancy with regards to their uptake of 18F-fluorodeoxyglucose (18F-FDG) tracer utilized for positron emission tomography-computed tomography (PET-CT) scan, as part of the diagnostic and staging workup of cancer patients. This poses a diagnostic challenge, for which tissue sampling is decisive. In this study, we aimed to determine the underlying etiologies of 18F-FDG-avid mediastinal lymph nodes among cancer patients in a TB-endemic demographic using endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) and the respective sensitivity and specificity of PET-CT and EBUS in diagnosing malignancy. Methodology In this retrospective cross-sectional study, we analyzed the data of all cancer patients with 18F-FDG-avid mediastinal lymphadenopathy on diagnostic PET imaging, who later underwent EBUS-TBNA between July 2013 and December 2018 at our center. Logistic regression analysis was used to determine the relative risk of lymph node characteristics with malignant TBNA cytology, based on which a risk stratification model was formulated. Results A total of 178 patients were included in this study, comprising predominantly males (60.7%). The primary malignancy was lung cancer in 33 (18.5%) patients, while 145 (81.5%) had non-lung cancer. A total of 214 18F-FDG lymph nodes were sampled, out of which TBNA revealed malignant cytology in only 44 (20.6%). The final diagnosis was malignancy, TB, and sarcoidosis in 42 (23.6%), 16 (9%), and 12 (6.7%) patients, respectively. Among the remaining, 98 (55%) patients were determined to have only reactive lymphadenopathy, of which 24 (24.5%) had nodal anthracosis, while TBNA was inadequate for the diagnosis in 10 (5.6%) patients. An increased risk of malignancy was associated with the size of lymph node [odds ratio (OR): 1.58 (confidence interval (CI): 1.19, 2.11; p = 0.001], the standard uptake value (SUV) of the lymph node on PET-CT [OR: 1.30 (CI: 1.15, 1.45); p = 0.001], and with primary lung malignancy [OR: 4.44 (CI: 1.96, 10.06); p = 0.001]. At an SUV cut-off value of 6.0, PET-CT had the sensitivity, specificity, positive predictive value, and negative predictive value of 73%, 70%, 49.3%, and 91.8%, respectively, for diagnosing malignancy, while the same for EBUS was estimated to be 93.3%, 100%, 100%, and 97%, respectively. Conclusions In addition to TB, benign etiologies including nodal anthracosis and sarcoidosis predominate as causes of 18F-FDG-avid mediastinal lymphadenopathy in cancer patients of a TB-endemic demographic. The predictable risk of malignancy on PET imaging increases with nodal size, SUV, and lung primary malignancy; however, EBUS clearly demonstrates a higher sensitivity.
Collapse
Affiliation(s)
- Usman Khalid
- Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Muhammad J Akram
- Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Muhammad Abu Bakar
- Cancer Registry, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Faheem M Butt
- Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Mohammad B Ashraf
- Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| |
Collapse
|
22
|
Ang KL, Asderakis A, Ilham MA, Elker D, Zaidi A, Ablorsu E, Khalid U. Pancreas Donor Risk Index and Preprocurement Pancreas Suitability Score for Prediction of Pancreas Transplant Outcomes. EXP CLIN TRANSPLANT 2021; 19:1197-1203. [PMID: 34812710 DOI: 10.6002/ect.2021.0263] [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: 11/05/2022]
Abstract
OBJECTIVES The Pancreas Donor Risk Index and Preprocurement Pancreas Suitability Score were designed to assist in the evaluation of pancreases for transplant. Preprocurement Pancreas Suitability Score <17 and PancreasDonor Risk Index ≤1.57 were deemed ideal.We aimed to determine the ability ofthese scores to predict pancreas transplant outcomes. MATERIALS AND METHODS The Pancreas Donor Risk Index and the Preprocurement Pancreas Suitability Score were retrospectively calculated from a prospectively maintained database of consecutive pancreas transplants performed during a 13-year period (December 2004 to November 2017). Outcomes measuredwere rejection rate, graft and patient survival, and duration of hospital stay. RESULTS Of 159 pancreas transplants (108 simultaneous pancreas and kidney transplants, 33 pancreas after kidney transplants, 18 pancreas-only transplants), full data were available for 155 (97%) to calculate Pancreas Donor Risk Indexes and 129 (81%) to calculate Preprocurement Pancreas Suitability Scores. Fortyseven patients (30%) experienced at least 1 episode of acute rejection. We calculated Pancreas Donor Risk Indexes for 155 patients, and 19 (23%) and 27 (38%) were in the ≤1.57 and >1.57 groups, respectively (P = .047). We calculated Preprocurement Pancreas Suitability Scores for 129 patients, and 12 (21%) and 27 (32%) were in the <17 and ≥17 groups, respectively (P = .202). Donor age and recipientfemale sex were the main predictors forrejection (binary logistic regression, P < .05). One-year graft survival rates were 95% and 81% forthe ≤1.57 and >1.57 PancreasDonor Risk Index groups,respectively, and 95% and 80% forthe <17 and ≥17 Preprocurement Pancreas Suitability Score groups, respectively (not significant). CONCLUSIONS Pancreas Donor Risk Index and Preprocurement Pancreas Suitability Score were not helpful to predict graft/patient survival in our population. A higher Pancreas Donor Risk Index was associated with higher risk of graft rejection. Further studies with larger cohorts are required.
Collapse
Affiliation(s)
- Ky-Leigh Ang
- From the Cardiff Transplant Unit, University Hospital of Wales, Heath Park, Cardiff, United Kingdom
| | | | | | | | | | | | | |
Collapse
|
23
|
Baig E, Shah M, Bajwa MH, Laghari AA, Akhunzada NZ, Bin-Anis S, Khalid U, Qadeer N, Lutfi A, Tahir I, Bajwa R, Rashid H, Sadia H, Ghazi K, Gillani M, Siddiqi S, Enam SA. EPID-19. CONDUCTING A NATIONWIDE BRAIN TUMOR EPIDEMIOLOGY STUDY IN AN LMIC: A MULTI-INSTITUTIONAL EXPERIENCE. Neuro Oncol 2021. [PMCID: PMC8689958 DOI: 10.1093/neuonc/noab196.352] [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: 11/29/2022] Open
Abstract
Very little research has been conducted on brain tumor epidemiology in Pakistan and a few studies that do exist provide regional data only. Conducting population based epidemiological studies in low-and-middle income countries (LMICs) like Pakistan can be particularly challenging due to limited resources, poor clinical and research infrastructure, unreliable or incomplete hospital records and a lack of standardization across the health care system. Population-wide studies and registries play an important role in cancer epidemiology and can help identify the current magnitude of cancer burden and its likely future evolution, allowing for better planning of prevention, diagnosis, management, and rehabilitation. This paper describes our experience in designing and conducting Pakistan Brain Tumor Epidemiology Study (PBTES), a first-ever nationwide study carried out to assess the distribution of brain tumors in Pakistan. In addition to the aforementioned obstacles, we were also faced with the global health crisis caused by the COVID-19 pandemic and had to promptly adjust our study accordingly. Other investigators conducting epidemiological studies in LMICs with similarly challenging and constricting settings could benefit from our experiences.
Collapse
Affiliation(s)
- Erum Baig
- Aga Khan University Hospital, Rawalpindi, Pakistan
| | - Mashal Shah
- Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | | | | | | | - Saad Bin-Anis
- Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan
| | - Usman Khalid
- Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Namra Qadeer
- Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Areeb Lutfi
- Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Izza Tahir
- Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Rameen Bajwa
- Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | | | - Haleema Sadia
- Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Kinzah Ghazi
- Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | | | | | | |
Collapse
|
24
|
Bajwa MH, Imran N, Shah M, Baig E, Laghari AA, Bin-Anis S, Akhunzada NZ, Gilani J, Jawed N, Khalid U, Qadeer N, Lutfi A, Tahir I, Bajwa R, Rashid H, Sadia H, Ghazi K, Gillani M, Consortium PBT, Siddiqi S, Enam SA. EPID-05. TREATMENT PATTERNS OF GLIOMAS: AN EPIDEMIOLOGICAL STUDY. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
INTRODUCTION
Gliomas are the most common malignant brain tumors of the central nervous system in adults. Specialized treatment modalities have improved morbidity and mortality within high-income countries. In lower- and middle-income countries (LMICs), the overall mortality rate is still seen to be alarmingly high. As there is a shortage of statistical data available regarding the epidemiology of these tumors and their management within the country, the objective of this study is to define the landscape of treatment patterns and current epidemiological data regarding gliomas in Pakistan.
METHODS
As part of the Pakistan Brain Tumor Epidemiology Study (PBTES), data was collected from major neurosurgical centers across the country, consisting of 35 hospitals in all 4 provinces. Our retrospective study looked at patients who underwent surgical procedures for gliomas in 2019, where a surgical pathology was available. The data was collated and analyzed using appropriate statistical methods.
RESULTS
791 patients with gliomas were identified (61.8 % in public sector hospitals, 39.1% in private sector). The most common histopathological subtypes were glioblastoma (33.5%), followed by astrocytoma (18.8%) and oligodendroglioma (11.9%). Gender distribution was skewed towards men (65%). The most commonly performed initial surgical procedure was gross total resection (50% in public hospitals, 41% in private hospitals). Private institution hospitals performed surgical biopsies as the first surgical procedure (23%) more often than public hospitals (9%). Regarding adjuvant treatments, only 26% of patients were given chemotherapy, and there was no data regarding 53% of patients. Similarly, only 15% of patients received radiation therapy, and there was no data for 60% of patients.
CONCLUSIONS
Our study was able to identify the gaps in glioma management within Pakistan, particularly with regards to chemoradiotherapy. Identifying these unmet needs is the first step in developing comprehensive care for glioma patients.
Collapse
Affiliation(s)
| | - Noor Imran
- Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Mashal Shah
- Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Erum Baig
- Aga Khan University Hospital, Rawalpindi, Pakistan
| | | | - Saad Bin-Anis
- Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan
| | | | | | - Noyan Jawed
- Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Usman Khalid
- Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Namra Qadeer
- Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Areeb Lutfi
- Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Izza Tahir
- Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Rameen Bajwa
- Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | | | - Haleema Sadia
- Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Kinzah Ghazi
- Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | | | | | | | | |
Collapse
|
25
|
Shah M, Baig E, Bajwa MH, Laghari AA, Bin-Anis S, Akhunzada NZ, Gilani J, Jawed N, Khalid U, Qadeer N, Lutfi A, Tahir I, Bajwa R, Rashid H, Sadia H, Ghazi K, Gillani M, Azam I, Shamsi U, Consortium PBT, Siddiqi S, Enam SA. EPID-23. THE PAKISTAN BRAIN TUMOR EPIDEMIOLOGY STUDY: PAVING THE WAY FOR A NATIONAL BRAIN TUMOR REGISTRY. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.356] [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: 11/14/2022] Open
Abstract
Abstract
INTRODUCTION
In Pakistan, brain tumor epidemiology has been examined in single-centre studies or as part of general cancer registries, which are limited by catchment area, age group, or are not specific to brain tumors. The Pakistan Society of Neuro-Oncology conducted a nationwide study to assess the distribution of brain tumor distribution and associated risk factors. This unfunded study explores data from across Pakistan and serves as a potential model for LMICs to emulate.
METHODS
A cross-sectional study was designed to include patients diagnosed with brain tumors in major neurosurgical centers in Pakistan retrospectively from January-December 2019. Patients, both alive and deceased, with a radiological diagnosis of a brain tumor were included. Data were recorded on a comprehensive online form from 35 centers, encompassing an estimated 85% of all the brain tumor patients seeking initial treatment by a neurosurgeon from the public and private sectors. Data collection was split into three regions: Sindh and Balochistan; Punjab; and Khyber Pakhtunkhwa and Islamabad. Data collection occurred between August 2020 and January 2021.
RESULTS
A total of 2750 brain tumor cases were recorded of which 1897 (69%) were diagnosed in the private sector hospitals. MRIs were a more common radiological study compared to CT scans. 2666 surgeries were performed, 174 individuals underwent chemotherapy and 479 underwent radiation therapy; approximately two-thirds of the patients that require adjuvant treatment are not able to receive it. Gliomas were the most common tumor, while pineal tumors were the least common. Findings indicate a low metastasis frequency and few females seeking care.
CONCLUSION
The study shows that brain tumors are mostly diagnosed and operated on in the private sector; the public sector should be more engaged. The study also highlights that despite inconsistencies in hospital records for brain tumor patients, reliable information can be collected in LMIC settings.
Collapse
Affiliation(s)
- Mashal Shah
- Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Erum Baig
- Aga Khan University Hospital, Rawalpindi, Pakistan
| | | | | | - Saad Bin-Anis
- Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan
| | | | | | - Noyan Jawed
- Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Usman Khalid
- Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Namra Qadeer
- Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Areeb Lutfi
- Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Izza Tahir
- Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Rameen Bajwa
- Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | | | - Haleema Sadia
- Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Kinzah Ghazi
- Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | | | - Iqbal Azam
- Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | - Uzma Shamsi
- Aga Khan University Hospital, Karachi, Sindh, Pakistan
| | | | | | | |
Collapse
|
26
|
Bajwa MH, Shah M, Baig E, Tahir I, Ghazi K, Bajwa R, Laghari AA, Bin-Anis S, Akhunzada NZ, Gilani J, Jawed N, Khalid U, Qadeer N, Lutfi A, Rashid H, Sadia H, Gillani M, Consortium PBT, Siddiqi S, Enam SA. EPID-25. DISTANCE TRAVELED FOR BRAIN TUMOR CARE IN PAKISTAN: AN LMIC PERSPECTIVE. Neuro Oncol 2021. [DOI: 10.1093/neuonc/noab196.358] [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: 11/14/2022] Open
Abstract
Abstract
INTRODUCTION
Global oncology development within LMICs (low- and middle-income countries) requires bridging gaps in healthcare systems. Brain tumor care in Pakistan is currently sparse and concentrated in urban centers. Distance traveled to a hospital dictates a patient’s access to care, neurosurgical access, and continuity of care through adjuvant chemoradiotherapy and primary care providers can be disrupted if patients cannot overcome the barriers due to extensive distances traveled.
METHODS
Data was collected as part of the Pakistan Brain Tumor Epidemiology Study (PBTES) regarding patients with brain tumors who underwent surgical procedures in 2019 at private and public major neurosurgical centers across Pakistan. Using patient addresses, we used a mapping software to calculate the distance traveled by each patient to the primary hospital. Analysis was done using appropriate statistical methods.
RESULTS
Out of 2403 patients, the mean distance traveled across the country was 240 km. The longest distance traveled within Pakistan was from Skardu to Karachi (2002 km) for resection of a pituitary adenoma (28 hours via car). Only 48% of patients were able to reach their primary hospital within 50 km. 52% of patients had to travel more than 50 km, and 18% had to travel upwards of 500 km to reach their primary hospital. Additionally, 101 patients traveled to Pakistan from other countries for brain tumor surgery (98 patients from Afghanistan [mean distance traveled: 723.6 km], 3 patients from Syria, Oman, and Sudan).
CONCLUSION
Prior studies have described a cut-off of 50 km as an acceptable limit for distance from the primary hospital in cancer patients for optimal follow-up and outcomes, which is achieved by only 48% of brain tumor patients in Pakistan. Most patients have poor access to surgical care for brain tumors, further compounded by repeat traveling for follow-ups and chemoradiotherapy.
Collapse
Affiliation(s)
| | - Mashal Shah
- Aga Khan University Hospital, Rawalpindi, Pakistan
| | - Erum Baig
- Aga Khan University Hospital, Karachi, Pakistan
| | - Izza Tahir
- Aga Khan University Hospital, Karachi, Pakistan
| | | | | | | | - Saad Bin-Anis
- Shaukat Khanum Memorial Cancer Hospital, Lahore, Pakistan
| | | | | | - Noyan Jawed
- Aga Khan University Hospital, Karachi, Pakistan
| | | | | | - Areeb Lutfi
- Aga Khan University Hospital, Karachi, Pakistan
| | | | | | | | | | | | | |
Collapse
|
27
|
Mahmood K, Shamim A, Khan MU, Alam T, Khalid U, Jaffery AU. ANAESTHESIOLOGY AS A FUTURE SPECIALTY. PAFMJ 2021. [DOI: 10.51253/pafmj.v71i4.3464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Objective: To ascertain the various aspects directing the undergraduates at Quetta Institute of medical sciences towards anesthesiology as future profession/specialization.
Study Design: Cross sectional study.
Place and Duration of Study: Quetta Institute of Medical Sciences, Quetta Pakistan, from Mar to Apr 2019.
Methodology: Study was conducted among final year medical students with the help of a printed questionnaire consisting of 15 Multiple Choice Questions. The questionnaire provided the required database to explore various factors that influence undergraduates to select their future specialization based on demography and specialty preferences.
Results: A total of 65 undergraduates completed the response sheet. While 45 (68.8%) participants were females and 20 (31.2%) were males, 62 (95.4%) were single (unmarried or divorced) and had no children 63 (96.9%). Medicine proved to be the most favourate specialty with 20 (31.4%) student opting for it whereas anesthesiology was chosen by 4 (6.1%) students.
Conclusion: Anesthesiology still remains a less popular choice among the medical students of Pakistan particularly Quetta Institute of Medical Sciences due to multifaceted factors. Inferior prestige of the specialty was the most significant factor in deciding against anaesthesiology.
Collapse
|
28
|
Sattar MU, Palaniappan S, Lokman A, Shah N, Riaz Z, Khalid U. User experience design in virtual reality medical training application. J PAK MED ASSOC 2021; 71:1730-1735. [PMID: 34410236 DOI: 10.5455/jpma.22992] [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] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the effects of design parameters on the user experience of virtual reality medical training. Methods The quantitative study was conducted at Punjab (Pakistan) from July 2018 to October 2018, and comprised final year students from eight medical colleges in Pakistan. Each respondent was given to experience laparoscopy operation in text, video and virtual reality-based learning methodologies. User experience and usefulness was assessed against a pre-validated scale and compared with the three learning methodologies. RESULTS Of the 87, students, 50(57.5%) were male and 37(42.5%) were female. The overall mean age was 22.5±4 years. Result of virtual reality was better than others (p<0.05). Data was analysed using SPSS 20. CONCLUSIONS Virtual reality-based learning provided better user experience than traditional learning methodologies.
Collapse
Affiliation(s)
| | | | - Asiah Lokman
- Malaysia University of Science and Technology, Malaysia
| | - Nauman Shah
- University of Management and Technology, Lahore, Pakistan
| | - Zurabia Riaz
- University of Management and Technology, Lahore, Pakistan
| | - Usman Khalid
- University of Management and Technology, Lahore, Pakistan
| |
Collapse
|
29
|
Akram MJ, Khalid U, Abu Bakar M, Butt FM, Ashraf MB. Sarcoidosis: epidemiology, characteristics, and outcomes over 10 years - a single-center study in Pakistan. Expert Rev Respir Med 2021; 16:133-143. [PMID: 34402372 DOI: 10.1080/17476348.2021.1924062] [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] [Indexed: 10/20/2022]
Abstract
Background: Sarcoidosis is a multisystem granulomatous inflammatory disease which remains under-diagnosed in a tuberculosis endemic region such as Pakistan.Rationale: To determine the distribution, clinical characteristics, diagnostic and treatment modalities and the disease course in the Pakistani population.Methods: A cross-sectional review of sarcoidosis patients from Jan-1,2010 to Dec-31,2019 was done. Multivariable logistic and cox-regression models were used to identify the independent risk-factors associated with disease relapse. Kaplan-Meier curves were used to assess the DFS.Results: 222 patients, with mean age 44 ± 12 years, predominantly females (57.7%) and mean BMI 29 ± 6 were diagnosed sarcoidosis. Significant co-morbidities affected 36.5%, 90% were nonsmokers, and 50.3% belonged to moderate SES. Total 178 (80.2%) were symptomatic with 115 (51.8%) having multi-organ involvement. Stage-I radiological disease was predominant (52.5%). Histopathological diagnosis was obtained in 161 (72.5%) patients. Out of 113 mediastinal lymph-nodes, NNGI was present in 99, with highest yield in Station-07 (68.6%). Treatment was instituted in 108/178 (60.7%) symptomatic patients with steroids alone and in 26 (14.6%) with S+IS, with better clinical and radiological response duration in patients receiving steroid monotherapy (p-values=0.01 and 0.001,respectively, along with overall higher survival time (p-value = 0.04). Risk factors identified for relapse included high SES (AOR5.52;95%CI(1.10-28.40),0.04), steroid monotherapy (AOR0.22; 95%CI(0.10-0.87),0.03), symptomatic response after one year (AOR3.40; 95%CI(1.02-11.10),0.04), and radiological response duration (AOR1.10; 95%CI(1.05-1.20),0.04).Conclusion: Sarcoidosis is a dynamic disease with a variable clinical and geographical spectrum but good overall prognosis.
Collapse
Affiliation(s)
- Muhammad Junaid Akram
- Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Usman Khalid
- Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Muhammad Abu Bakar
- Department of Cancer Registry and Clinical Data Management, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Faheem Mahmood Butt
- Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Mohammad Bilal Ashraf
- Pulmonology & Critical Care Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| |
Collapse
|
30
|
Khalid U, Akram MJ, Butt FM, Ashraf MB, Khan F. The Clinicopathological Features of Mediastinal Tuberculous Lymphadenitis in Cancer Patients and the Diagnostic Role of Endobronchial Ultrasound. Cureus 2021; 13:e15837. [PMID: 34327075 PMCID: PMC8301277 DOI: 10.7759/cureus.15837] [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] [Accepted: 06/22/2021] [Indexed: 12/15/2022] Open
Abstract
Introduction Mediastinal lymphadenopathy in cancer patients can be of both malignant and non-malignant (including infectious) etiology. Tuberculosis (TB) is an important differential in this regard, particularly in regions with high TB endemicity. Objectives To determine the incidence and clinical characteristics of mediastinal tuberculous lymphadenitis (MTBLA) in cancer patients of a TB-endemic region, and the diagnostic role of endobronchial ultrasound (EBUS) guided transbronchial needle aspiration (TBNA) in such patients, utilizing both cytopathological and microbiological parameters for diagnosing TB. Materials and methods We retrospectively analyzed the relevant clinical data of all cancer patients diagnosed with MTBLA after undergoing EBUS-TBNA at our center, between July 2013 till July 2018 (total five years). The diagnostic yield, sensitivity and specificity of cytopathological and microbiological investigations (including TB culture and Mycobacterium tuberculosis Gene Xpert assay) for diagnosis of MTBLA were determined. Results Of the total 493 cancer patients, MTBLA was diagnosed in 54 (11%), with mean age of 48 ± 12 years, and predominantly male gender (59.3%). Thirty-three (61.1%) patients were clinically asymptomatic at the time of presentation, while cough was reported by 13 (24.7%) patients and weight loss, shortness of breath and fever by only six (11.1%), six (11.1%) and five (9.2%) patients, respectively. Total 53% had an underlying gastrointestinal malignancy. Chest imaging revealed bilateral versus unilateral hilar lymph node enlargement in 32 (59.3%) against 22 (40.7%) patients, respectively, while only 14 (25.9%) had accompanying lung parenchymal findings. Granulomatous TBNA cytology was detected in 41 (77.3%) patients, giving a diagnostic yield of 70.3% for MTBLA, with an estimated sensitivity and specificity of 79.2% and 99%, respectively. TB culture and Gene Xpert had a respective sensitivity of 48% and 53%, with the combined diagnostic yield of 64.8%. Treatment response was achieved in 51 (94%) patients, based on which EBUS was estimated to have sensitivity and specificity of 89% and 99% respectively, with no reported complications. Conclusion Mediastinal TB can have diverse manifestations among cancer patients and can often be clinically occult, with overlapping radiological impressions. EBUS-TBNA can serve as a safe and reliable diagnostic tool in this regard.
Collapse
Affiliation(s)
- Usman Khalid
- Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Muhammad J Akram
- Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Faheem M Butt
- Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Mohammad B Ashraf
- Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Faheem Khan
- Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| |
Collapse
|
31
|
Sabah TK, El Hitti E, Karmarkar R, Khalid U. Reply to: 'global attitudes in the management of acute appendicitis during COVID-19 pandemic: ACIE Appy study'. Br J Surg 2021; 108:e312. [PMID: 33982053 PMCID: PMC8194645 DOI: 10.1093/bjs/znab181] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 04/15/2021] [Indexed: 12/05/2022]
Affiliation(s)
- T K Sabah
- Cardiff Transplant Unit, University Hospital of Wales, Cardiff, UK.,Princess of Wales Hospital, General Surgery, Bridgend, UK
| | - E El Hitti
- Princess of Wales Hospital, General Surgery, Bridgend, UK
| | - R Karmarkar
- Princess of Wales Hospital, General Surgery, Bridgend, UK
| | - U Khalid
- Cardiff Transplant Unit, University Hospital of Wales, Cardiff, UK
| |
Collapse
|
32
|
Kosiborod M, Bhatta M, Davies M, Deanfield J, Garvey T, Khalid U, Kushner R, Rubino DM, Zeuthen N, Verma S. TREATMENT WITH SEMAGLUTIDE 2.4 MG LEADS TO IMPROVEMENTS IN CARDIOMETABOLIC RISK FACTORS IN THE STEP 1 TRIAL. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02982-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
33
|
Verma S, Bhatta M, Davies M, Deanfield J, Garvey T, Jensen C, Khalid U, Kushner R, Rubino DM, Kosiborod M. CONTINUED TREATMENT WITH SEMAGLUTIDE 2.4 MG LEADS TO SUSTAINED IMPROVEMENTS IN CARDIOMETABOLIC RISK FACTORS IN THE STEP 4 TRIAL. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)02965-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
34
|
Majeed K, Shaukat N, Muazzam MA, Khalid U, Zafar J, . S. COMPARISON OF SUBCOSTAL TRANSVERSUS ABDOMINIS PLANE BLOCK WITH PORT SITE INFILTRATION OF LOCAL ANAESTHESIA IN LAPAROSCOPIC CHOLECYSTECTOMY. PAFMJ 2021. [DOI: 10.51253/pafmj.v71i2.3338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Objective: To compare the efficacy of ultrasound guided subcostaltransversus abdominis plane block and port site infiltration of local anaesthesia in patients undergoing laparoscopic cholecystectomy.
Study Design: Comparative cross sectional study.
Place and Duration of Study: Anesthesiology department, Pak Emirates Military Hospital, Rawalpindi, from Jan to Jun 2019.
Methodology: A sample size of 62 patients calculated by World Health Organization calculator were randomized in a doubleblind study to undergo Sub costal transversus abdominis plane block or port site infiltration by non-probability, consecutive sampling into two equal groups. Group A received sub costal transversus abdominis plane block and group B local anaesthetic. Postoperative pain perception was measured using visual analogue scale.
Results: The mean age of patients in group A was 33.39 ± 8.91 years and in group B was 33.77 ± 8.45 years. Out of 62 patients 38 (61.29%) were males and 24 (38.71%) were females. Mean pain score in group A (ultrasound guided sub costal transversus abdominis plane block) was 1.61 ± 0.91 while in group B (port site infiltration of local anaesthetic) was 3.61 ± 1.05 (p-value 0.0001).
Conclusion: The mean pain score was less following use of ultrasound guided sub costal transversus abdominis plane block in patients undergoing laparoscopic cholecystectomy as compared to port site infiltration of local anaesthesia.
Collapse
|
35
|
Tahir M, Imran M, Nawaz F, Shahid M, Naeem MA, Ahmad I, Akram M, Khalid U, Farooq ABU, Bakhat HF, Kamran M, Shah ZA. Effects of Bacillus sp. MR-1/2 and magnetite nanoparticles on yield improvement of rice by urea fertilizer under different watering regimes. J Appl Microbiol 2021; 131:2433-2447. [PMID: 33896080 DOI: 10.1111/jam.15110] [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: 02/12/2021] [Revised: 04/17/2021] [Accepted: 04/17/2021] [Indexed: 11/27/2022]
Abstract
AIMS The present research aimed to examine the use of magnetite nanoparticles (MNPs) in combination with phyto-beneficial rhizobacterium (PhBR) for improvement of applied N recovery (ANR) from urea fertilizer in rice grown under deficient and optimum watering conditions. METHODS AND RESULTS The Bacillus sp. MR-1/2 was positive for acetylene reduction, phosphate solubilization and ACC deaminase activity at temperature ranges 35-45°C. In a pot experiment, urea, MNPs and Bacillus sp. MR-1/2 were applied either alone or in combination to rice plants grown in pots under water deficit and optimal watering conditions. Combined application of urea, MNPs and Bacillus sp. MR-1/2 increased the plant N content and ANR by 27 and 65%, respectively, over their respective control values in rice grown under optimum watering conditions, whereas these increases were 27 and 41%, respectively, in rice grown under water deficit conditions. This treatment also increased the kernel weight and plant dry matter by 36 and 60%, respectively, over control (urea alone) values in rice grown under water deficit conditions, whereas these increases were 31 and 21·8%, respectively, in rice grown under optimum watering conditions. Values of malondialdehyde (MDA) contents, ascorbate peroxidase (APX), catalase and ethylene concentration were higher in control treatment under both the watering regimes. The application of Bacillus sp. MR-1/2 either alone or in combination with MNPs and urea reduced MDA contents, APX, catalase and ethylene production in the rice plants. CONCLUSION The combined application of MNPs+Bacillus sp. MR-1/2 reduced the N losses from applied urea, increased N uptake and ANR in rice, decreased MDA contents, APX and catalase activity and ethylene level in rice grown under deficit and optimum water conditions. SIGNIFICANCE AND IMPACT OF THE STUDY The application of MNPs together with Bacillus sp. MR-1/2 may help to increase ANR and rice productivity under water deficit conditions with low cost of production.
Collapse
Affiliation(s)
- M Tahir
- Department of Environmental Sciences, COMSATS University Islamabad, Vehari Campus, Punjab, Pakistan
| | - M Imran
- Department of Environmental Sciences, COMSATS University Islamabad, Vehari Campus, Punjab, Pakistan
| | - F Nawaz
- Department of Agronomy, Bahauddin Zakariya University, Multan, Pakistan
| | - M Shahid
- Department of Bioinformatics and Biotechnology, Government College University, Faisalabad, Pakistan
| | - M A Naeem
- Department of Environmental Sciences, COMSATS University Islamabad, Vehari Campus, Punjab, Pakistan
| | - I Ahmad
- Department of Environmental Sciences, COMSATS University Islamabad, Vehari Campus, Punjab, Pakistan
| | - M Akram
- Department of Environmental Sciences, COMSATS University Islamabad, Vehari Campus, Punjab, Pakistan
| | - U Khalid
- Department of Agronomy, Bahauddin Zakariya University, Multan, Pakistan
| | - A B U Farooq
- Department of Environmental Sciences, COMSATS University Islamabad, Vehari Campus, Punjab, Pakistan
| | - H F Bakhat
- Department of Environmental Sciences, COMSATS University Islamabad, Vehari Campus, Punjab, Pakistan
| | - M Kamran
- Department of Environmental Sciences, COMSATS University Islamabad, Vehari Campus, Punjab, Pakistan
| | - Z A Shah
- Department of Environmental Sciences, COMSATS University Islamabad, Vehari Campus, Punjab, Pakistan
| |
Collapse
|
36
|
Khalid U, Mushtaq R, Khan AZ, Mahmood F. Probing the impact of transformational leadership on job embeddedness: the moderating role of job characteristics. MRR 2021. [DOI: 10.1108/mrr-05-2020-0260] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
This paper aims to evaluate how transformational leadership can increase job embeddedness in their employees that persuade them to stay in their organization and how this relationship is contingent upon the job characteristics.
Design/methodology/approach
Sample of 328 useable responses was available for analysis. Questionnaires were distributed to the employees who are working in different Pakistani organizations. Regression analysis was used to test for hypotheses.
Findings
The findings support that there is a significant impact of transformational leadership for shaping job embeddedness, and the results endorsed the role of job characteristics as a moderator in describing the relationship of transformational leadership and job embeddedness. Transformational leaders would motivate employees to work together in productive manners in challenging work settings.
Originality/value
This paper makes three key contributions to the literature on job design. First, this inquiry shows that a strong link does exist between transformational leadership in creating organizational job embeddedness. Second, it highlights how job characteristics of highly challenging work settings may shape employees’ job embeddedness. Third, this paper offers a novel perspective in leadership research by incorporating high challenging work setting (i.e. job characteristics) as moderator. Managers may get new insight by opting for transformational leaders' attributes and concentrating on high challenging work settings for creating embeddedness in employees to prolong their stay with the job and firm.
Collapse
|
37
|
Randall J, Hook A, Grubb CM, Ellis N, Wellington J, Hemmad A, Zerdelis A, Geers B, Sykes B, Auty C, Vinchenzo C, Thorburn C, Asogbon D, Granger E, Boagey H, Raphael J, Patel K, Bhargava K, Dolley MK, Maden M, Shah M, Lee Q, Vaidya R, Sehdev S, Barai S, Roche S, Khalid U, Harrison J, Codling D. Dementia patients have greater anti-cholinergic drug burden on discharge from hospital: A multicentre cross-sectional study. Eur Psychiatry 2021. [PMCID: PMC9476103 DOI: 10.1192/j.eurpsy.2021.1127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
IntroductionAnticholinergic medications block cholinergic transmission. The central effects of anticholinergic drugs can be particularly marked in patients with dementia. Furthermore, anticholinergics antagonise the effects of cholinesterase inhibitors, the main dementia treatment.ObjectivesThis study aimed to assess anticholinergic drug prescribing among dementia patients before and after admission to UK acute hospitals.Methods352 patients with dementia were included from 17 hospitals in the UK. All were admitted to surgical, medical or Care of the Elderly wards in 2019. Information about patients’ prescriptions were recorded on a standardised form. An evidence-based online calculator was used to calculate the anticholinergic drug burden of each patient. The correlation between two subgroups upon admission and discharge was tested with Spearman’s Rank Correlation.ResultsTable 1 shows patient demographics. On admission, 37.8% of patients had an anticholinergic burden score ≥1 and 5.68% ≥3. At discharge, 43.2% of patients had an anticholinergic burden score ≥1 and 9.1% ≥3. The increase was statistically significant (rho 0.688; p=2.2x10-16). The most common group of anticholinergic medications prescribed at discharge were psychotropics (see Figure 1). Among patients prescribed cholinesterase inhibitors, 44.9% were also taking anticholinergic medications.ConclusionsThis multicentre cross-sectional study found that people with dementia are frequently prescribed anticholinergic drugs, even if also taking cholinesterase inhibitors, and are significantly more likely to be discharged with a higher anticholinergic drug burden than on admission to hospital.Conflict of interestThis project was planned and executed by the authors on behalf of SPARC (Student Psychiatry Audit and Research Collaborative). We thank the National Student Association of Medical Research for allowing us use of the Enketo platform. Judith Harrison was su
Collapse
|
38
|
Sabah TK, Khalid U, Ilham MA, Ablorsu E, Szabo L, Griffin S, Chavez R, Asderakis A. Induction with ATG in DCD kidney transplantation; efficacy and relation of dose and cell markers on delayed graft function and renal function. Transpl Immunol 2021; 66:101388. [PMID: 33775865 DOI: 10.1016/j.trim.2021.101388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 11/30/2022]
Abstract
AIM We aimed to analyse the efficacy of the Thymoglobulin dose used for induction in controlled DCD kidneys, and its initial impact on blood cell and CD3 count, as predictors of efficacy. METHODS 140 DCD patients who received ATG induction, were analysed. Intended dose was 1.25 mg/kg/day over 5 days, rounded to nearest 25 mg and not exceeding 125 mg/dose. Outcomes included the total dose in relation with rejection, DGF, graft survival, eGFR. The cell count response to ATG was assessed as predictors of outcome. RESULTS Graft survival, was 96.2%, 92.4%, 85% at 1, 3 and 5 years. Rejection was 7% at 1 year and associated with eGFR at 3 (p = 0.003) and 5 years. ATG dose was not predictive of rejection but was associated with the day5 leucocyte and lymphocyte count (p < 0.001) and negatively with DGF (p = 0.05). In 31 patients day3 CD3 count was available and it was associated with rejection (p = 0.002), less DGF (p = 0.09), and 3 years eGFR (p = 0.01). CONCLUSION Thymoglobulin provides excellent results in DCD kidneys that do not significantly differ with small dose variations. In higher doses it reduces DGF. Lymphocytes and CD3 count, may be useful surrogate markers of efficacy and outcome.
Collapse
Affiliation(s)
- Tarique Karim Sabah
- Cardiff Transplant Unit, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom.
| | - Usman Khalid
- Cardiff Transplant Unit, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom.
| | - Mohamed Adel Ilham
- Cardiff Transplant Unit, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom.
| | - Elijah Ablorsu
- Cardiff Transplant Unit, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom.
| | - Laszlo Szabo
- Cardiff Transplant Unit, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom.
| | - Sian Griffin
- Cardiff Transplant Unit, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom.
| | - Rafael Chavez
- Cardiff Transplant Unit, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom.
| | - Argiris Asderakis
- Cardiff Transplant Unit, University Hospital of Wales, Heath Park, Cardiff CF14 4XW, United Kingdom.
| |
Collapse
|
39
|
Shafiullah M, Khalid U, Shahbaz M. Does meat consumption exacerbate greenhouse gas emissions? Evidence from US data. Environ Sci Pollut Res Int 2021; 28:11415-11429. [PMID: 33118073 DOI: 10.1007/s11356-020-11331-9] [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] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Accepted: 10/18/2020] [Indexed: 06/11/2023]
Abstract
This study empirically investigates the effect of meat consumption on greenhouse gas emissions (carbon dioxide, methane, and nitrous oxide) in the USA. The impact of meat consumption on greenhouse gas emissions is examined by controlling for economic growth and energy consumption. The empirical analysis finds that all these variables are cointegrated for the long run. Moreover, meat consumption aggravates greenhouse gas emissions. Specifically, meat consumption (except for beef) has a U-shaped relationship with carbon emissions and an inverted U-shaped relationship with methane and nitrous oxide emissions. The causality analysis indicates a unidirectional causality running from meat consumption to greenhouse gas emissions. These empirical findings indicate that the US livestock sector has the potential to become more environmentally friendly with careful policy formulation and implementation.
Collapse
Affiliation(s)
- Muhammad Shafiullah
- School of Economics, University of Nottingham Malaysia, Jalan Broga, 43500, Semenyih, Selangor, Malaysia.
| | - Usman Khalid
- Department of Innovation in Government & Society, College of Business and Economics, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Muhammad Shahbaz
- School of Management and Economics, Beijing Institute of Technology, Beijing, China
- Department of Land Economy, University of Cambridge, Cambridge, UK
| |
Collapse
|
40
|
Khalid U, Majeed K, Yasmeen M, Mehmood K, Muazzam MA, Rehmani J. EFFICACY OF TAP BLOCK AND PLACEBO FOR PAIN IN PATIENTS UNDERGOING CSECTION SURGERY. PAFMJ 2021. [DOI: 10.51253/pafmj.v71i1.2720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Objective: To compare efficacy of transversus abdominis plane block and placebo for pain in patients undergoing C-section surgery.
Study Design: Comparative cross-sectional study.
Place and Duration of Study: Department of Anaesthesiology, Combined Military Hospital Quetta, from Apr toOct 2018.
Methodology: A sample size of 200 patients calculated by WHO calculator undergoing Elective C-section andof age 20-40 year were randomized in a double blind study to undergo transversus abdominis plane block orplacebo group in two equal groups. Group A received block as placebo and group B with Bupivacaine. Resultsrecorded and analysed there-after for conclusion.
Results: The mean age of patients in group A was 29.98 ± 5.18 years and in group B was 29.68 ± 5.43 years (pvalue ≤0.01). Majority of the patients 141 (70.50%) were between 31 to 40 years of age. Out of 200 patients, 108 (54.0%) were ASA I and 92 (46.0%) were ASA II (p-value ≤0.01). Mean body mass index was 25.20 ± 2.28 kg/m2 (p-value ≤0.01). Meantime for the first analgesia in the patients undergoing elective C-section in group A (placebo group) was 4.96 ± 1.44 hours while in group B (transversus abdominis plane block group) was 11.24 ± 1.83 hours (p-value ≤0.01).
Conclusion: This study concluded that meantime for the first analgesia was found longer in TransversusAbdominis plane block for post-operative pain management in patients undergoing elective C-section.
Collapse
|
41
|
Ali L, Akhter A, Saeed M, Khalid U, Rehmani J. COMPARISON OF INTRAVENOUS LIGNOCAINE VS NALBUPHINE IN ATTENUATION OF HEMODYNAMIC RESPONSE TO AWAKE TRACHEAL EXTUBATION IN ENT SURGERIES. PAFMJ 2021. [DOI: 10.51253/pafmj.v71isuppl-1.2355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Objective: To compare intravenous lignocaine vs. intravenous nalbuphine in terms of mean change in heart rate and mean arterial pressures (MAP) during awake tracheal extubation.
Study Design: Randomized control trial.
Place and Duration of Study: Main Operation Theatre, Combined Military Hospital Rawalpindi, from May 2016to Dec 2016.
Methodology: After approval of the study by the institution’s research ethics committee, the patients meetinginclusion criteria were assigned randomly to one of the two groups by lottery method. On return of spontaneous ventilation, patients in group L received intravenous lignocaine 1.5 mg/kg while group N patients received intravenous Nalbuphine 0.2mg/kg. Data recorded immediately (T1) and 5min after (T2) extubation.
Results: After stratification of data in terms of age, gender, duration of surgery and ASA classification, evaluation of hemodynamic parameters (HR and MAP) between the two groups was done. The mean change in HR in group L was 6.66 ± 1.53 bpm and in group N was 4.43 ± 1.35. The mean change in MAP in group L was 4.90 ± 1.49 mm of Hg and in group N was 3.23 ± 1.33. p-value in both parameters was found to be less than 0.05 and thus declared significant.Conclusion: We concluded that intravenous nalbuphine, in the dose of 0.2mg/kg, is a better attenuator ofhemodynamic response to extubation as compared to intravenous lignocaine and provides better stability ofHeart rate and Mean arterial Pressure.
Collapse
|
42
|
Ang KL, Chalklin C, Khalid U. Reply to: "COVID19 and education: restructuring after the pandemic". Transpl Int 2021; 34:588-589. [PMID: 33377237 DOI: 10.1111/tri.13810] [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: 10/22/2022]
Affiliation(s)
- Ky-Leigh Ang
- Cardiff Transplant Unit, Department of Nephrology & Transplant Surgery, University Hospital of Wales, Cardiff, UK
| | - Christopher Chalklin
- Cardiff Transplant Unit, Department of Nephrology & Transplant Surgery, University Hospital of Wales, Cardiff, UK
| | - Usman Khalid
- Cardiff Transplant Unit, Department of Nephrology & Transplant Surgery, University Hospital of Wales, Cardiff, UK
| |
Collapse
|
43
|
Akram MJ, Khalid U, Ashraf MB, Bakar MA, Butt FM, Khan F. Predicting the survival in patients with malignant pleural effusion undergoing indwelling pleural catheter insertion. Ann Thorac Med 2021; 15:223-229. [PMID: 33381237 PMCID: PMC7720744 DOI: 10.4103/atm.atm_289_20] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [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: 05/23/2020] [Accepted: 07/03/2020] [Indexed: 11/05/2022] Open
Abstract
CONTEXT: Malignant pleural effusion (MPE) is a common comorbid condition in advanced malignancies with variable survival. AIMS: The aim of this study was to predict the survival in patients with MPE undergoing indwelling pleural catheter (IPC) insertion. SETTINGS AND DESIGN: This was a cross-sectional study conducted at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan. METHODS: One hundred and ten patients with MPE who underwent IPC insertion from January 2011 to December 2019 were reviewed. Kaplan–Meier method was used to determine the overall survival (OS) of the patient's cohort with respect to LENT score. STATISTICAL ANALYSIS USED: The IBM SPSS version 20 was used for statistical analysis. RESULTS: We retrospectively reviewed 110 patients who underwent IPC insertion for MPE, with a mean age of 49 ± 15 years. 76 (69.1%) patients were females, of which majority 59 (53.6%) had a primary diagnosis of breast cancer. The LENT score was used for risk stratification, and Kaplan–Meier survival curves were used to predict the OS. The proportion of patients with low-risk LENT score had 91%, 58%, and 29% survival, the moderate-risk group had 76%, 52%, and 14% survival, and in the high-risk group, 61%, 15%, and 0% patients survived at 1, 3, and 6 months, respectively. In addition, there was a statistically significant survival difference (P = 0.05) in patients who received chemotherapy pre- and post-IPC insertion. CONCLUSIONS: LENT score seems to be an easy and attainable tool, capable of predicting the survival of the patients with MPE quite accurately. It can be helpful in palliating the symptoms of patients with advanced malignancies by modifying the treatment strategies.
Collapse
Affiliation(s)
- Muhammad Junaid Akram
- Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Usman Khalid
- Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | | | - Muhammad Abu Bakar
- Department of Cancer Registry and Clinical Data Management, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Faheem Mahmood Butt
- Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Faheem Khan
- Royal Blackburn Teaching Hospital, East Lancashire Hospitals, NHS Trust, England, UK
| |
Collapse
|
44
|
Khalid U, Ilham MA, Szabo L, Saunders E, McMillan S, Stephens MR. Arterio-venous fistula surgery can be safely delivered in the COVID-19 pandemic era. J Vasc Access 2020; 23:330-332. [PMID: 33356795 DOI: 10.1177/1129729820983166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Usman Khalid
- Vascular Access Service, Cardiff & Vale University Health Board, University Hospital of Wales, Cardiff, UK
| | - Mohamed Adel Ilham
- Vascular Access Service, Cardiff & Vale University Health Board, University Hospital of Wales, Cardiff, UK
| | - Laszlo Szabo
- Vascular Access Service, Cardiff & Vale University Health Board, University Hospital of Wales, Cardiff, UK
| | - Elaine Saunders
- Vascular Access Service, Cardiff & Vale University Health Board, University Hospital of Wales, Cardiff, UK
| | - Sarah McMillan
- Vascular Access Service, Cardiff & Vale University Health Board, University Hospital of Wales, Cardiff, UK
| | - Michael Robert Stephens
- Vascular Access Service, Cardiff & Vale University Health Board, University Hospital of Wales, Cardiff, UK
| |
Collapse
|
45
|
Khalid U, Ilham MA, Nagaraja P, Elker D, Asderakis A. SARS-CoV-2 in Kidney Transplant and Waitlisted Patients During the First Peak: The Welsh Experience. Transplant Proc 2020; 53:1154-1159. [PMID: 33478747 PMCID: PMC7834026 DOI: 10.1016/j.transproceed.2020.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Accepted: 12/11/2020] [Indexed: 12/18/2022]
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) global pandemic has led to many health care services, including transplantation, being temporarily suspended. For transplantation to safely recommence, there is a need to understand the effects of SARS-CoV-2 in transplant and waitlist patients. We identified 21 patients with proven SARS-CoV-2 infection (13 transplant; 8 waitlist) during the first peak of coronavirus disease 2019 in Wales. Median patient age was 57 years (range, 24-69), 62% were male, and all were white. Median body mass index was 29 kg/m2 (range, 22-42), and 81% had 1 or more significant comorbidities. Median time from transplant to SARS-CoV-2 infection was 135 months (range, 9-356) and median time since being listed was 17.5 months (range, 5-69) for waitlisted patients. Seventeen patients were admitted to the hospital (81%), 18% (n = 3) in intensive care unit, and 5 patients died (4 transplant recipients and 1 waitlist patient; 24%). Two of the 4 transplant patients who died had recent malignancy. Although the mortality of hospitalized transplant patients was high, their infection rate of 0.87% meant that the overall mortality of transplant patients due to SARS-CoV-2 was low and comparable to that of patients on the waitlist. These data provide confidence in restarting the transplant program, provided that a series of measures aiming to avoid infections in newly transplanted patients are taken.
Collapse
Affiliation(s)
- Usman Khalid
- Cardiff Transplant Unit, Cardiff & Vale University Health Board, University Hospital of Wales, Heath Park, Cardiff, Wales, UK
| | - Mohamed A Ilham
- Cardiff Transplant Unit, Cardiff & Vale University Health Board, University Hospital of Wales, Heath Park, Cardiff, Wales, UK
| | - Pramod Nagaraja
- Cardiff Transplant Unit, Cardiff & Vale University Health Board, University Hospital of Wales, Heath Park, Cardiff, Wales, UK
| | - Doruk Elker
- Cardiff Transplant Unit, Cardiff & Vale University Health Board, University Hospital of Wales, Heath Park, Cardiff, Wales, UK
| | - Argiris Asderakis
- Cardiff Transplant Unit, Cardiff & Vale University Health Board, University Hospital of Wales, Heath Park, Cardiff, Wales, UK.
| |
Collapse
|
46
|
Berger I, Simpson S, Friedberg JS, Culligan MJ, Wileyto EP, Alley EW, Sterman D, Patel AM, Khalid U, Simone CB, Cengel KA, Katz SI, Roshkovan L. CT for detection of malignant posterior intercostal lymph nodes in patients undergoing pre-operative staging for malignant pleural mesothelioma. Lung Cancer 2020; 152:34-38. [PMID: 33341086 DOI: 10.1016/j.lungcan.2020.12.003] [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: 05/15/2020] [Revised: 09/06/2020] [Accepted: 12/01/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Recent evidence suggests that patients with malignant pleural mesothelioma (MPM) undergoing extended pleurectomy/decortication (eP/D) with metastasis to the posterior intercostal lymph nodes (PILN) have a worse prognosis. In this study, we determine if MPM PILN metastasis can be reliably detected on computed tomography (CT). MATERIALS AND METHODS Preoperative staging CT exams were reviewed for the presence of PILN in MPM patients undergoing eP/D between 2007-2013 with surgical sampling of their PILN. CT images were reviewed by two thoracic radiologists blinded to clinical records, including operative pathology reports. The number and short axis size of PILN were recorded and correlated with surgical pathology. Statistical analysis examined the value of preoperative CT to detect metastatic PILN. RESULTS Of 36 patients that underwent eP/D with PILN sampling had preoperative CT images for review. At surgery, 22 of these patients had metastatic PILN and 14 had benign PILN. The positive and negative predictive values for one or more nodes seen on preoperative CT were 60 % and 38 % respectively. The number of PILN on preoperative CT did not predict metastasis (p = 0.40) with an average of 2 PILN seen, regardless of PILN pathology. The average nodal short axis size was 4.6 mm and 4.8 mm for benign and malignant PILN, respectively, and PILN short axis size did not predict metastasis (p = 0.39). There was little inter-observer variability between the size and number of nodes detected by each radiologist. CONCLUSIONS CT does not reliably identify metastatic PILN on preoperative CT for patients with MPM undergoing extended pleurectomy/decortication.
Collapse
Affiliation(s)
- I Berger
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Scott Simpson
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - J S Friedberg
- University of Maryland School of Medicine, Baltimore, MD, USA
| | | | - E Paul Wileyto
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Evan W Alley
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - D Sterman
- NYU School of Medicine, New York, NY, USA
| | - Akash M Patel
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - U Khalid
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - C B Simone
- New York Proton Center and Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Keith A Cengel
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Sharyn I Katz
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| | - L Roshkovan
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.
| |
Collapse
|
47
|
Scale T, Khalid U, Griffin S. Management of the patient who has had a kidney transplant in the medical assessment unit. Br J Hosp Med (Lond) 2020; 81:1-9. [PMID: 33263479 DOI: 10.12968/hmed.2020.0416] [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] [Indexed: 11/11/2022]
Abstract
The number of people with kidney transplants has increased rapidly over the last 20 years. They are often medically complex and have a significant need for both routine and urgent care. Patients who have received a kidney transplant can be challenging to manage in the medical assessment unit. They are vulnerable to infections and acute kidney injury; disease presentation and course may be atypical and they are at risk of rapid deterioration. This review describes a systematic approach to their assessment and management and highlights specific considerations to be borne in mind.
Collapse
Affiliation(s)
- Timothy Scale
- Department of Nephrology and Transplantation, University Hospital of Wales, Cardiff, UK
| | - Usman Khalid
- Department of Nephrology and Transplantation, University Hospital of Wales, Cardiff, UK
| | - Siân Griffin
- Department of Nephrology and Transplantation, University Hospital of Wales, Cardiff, UK
| |
Collapse
|
48
|
Khalid U, Akram MJ, Butt FM, Ashraf MB, Khan F. The Diagnostic Utility and Clinical Implications of Bronchoalveolar Lavage in Cancer Patients With Febrile Neutropenia and Lung Infiltrates. Cureus 2020; 12:e10268. [PMID: 33042706 PMCID: PMC7538025 DOI: 10.7759/cureus.10268] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Febrile neutropenia (FN) is a dreaded complication of cancer chemotherapy and frequently associated with respiratory infections. Flexible bronchoscopy (FB) serves as a useful diagnostic tool in this regard. Objective To determine the diagnostic yield, safety and clinical implications of bronchoalveolar lavage (BAL) in cancer patients with FN, having lung infiltrates on radiographic chest imaging. Methods We reviewed medical records of FN patients who underwent FB at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, from July 2015 till July 2018. The culture yield of BAL, resultant change of management and outcome over the subsequent 30 days were retrospectively analysed. Statistical Package for Social Sciences (SPSS) version 20 (IBM Corp., Armonk, NY) was used for data analysis. Results Ninety FN patients, with mean age 26 ± 18 years and predominantly males (65.6%, n = 59) were included in the study. Seventy-seven (85.6%) had hematological and 13 (14.4%) solid organ malignancy. The mean absolute neutrophil count was 0.20 +/- 0.36/ µL. BAL cultures were diagnostic in 40 (44%) patients; the etiology was bacterial, fungal and mixed in 25 (62.5%), 14 (35%) and one (2.5%) patient, respectively. All patients were on empirical antibiotics prior to bronchoscopy: 32 (35.6%) on antibacterial alone and 58 (64.4%) on antibacterial plus antifungal therapy. Change of management occurred in 51 (56.7%) patients after BAL results, including de-escalation from dual antibiotics in 28 (55%) and initiation of new culture sensitive antibiotic in 23 (45%). FB-associated complications developed in three (5.6%) non-intensive care patients (ICU), including transient hypoxia in two and minor hemoptysis in one patient, while five (14.8%) mechanically ventilated patients in ICU experienced worsening of oxygenation parameters within 48 hours. Overall, 24 (26.7%) patients died. Mortality was 3.7% in non-ICU and 69% in ICU setting and significantly higher in patients with fungal pneumonias (p-value 0.01) and with prolonged neutropenia (p-value 0.001). Conclusions BAL is a safe diagnostic tool for FN patients with lung infiltrates, with minimal complications and sufficient diagnostic yield to improve diagnosis and management of such patients.
Collapse
Affiliation(s)
- Usman Khalid
- Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Muhammad J Akram
- Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Faheem M Butt
- Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Mohammad B Ashraf
- Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Faheem Khan
- Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| |
Collapse
|
49
|
Akram MJ, Khalid U, Bakar MA, Butt FM, Ashraf MB, Khan F. Indications and clinical outcomes of indwelling pleural catheter placement in patients with malignant pleural effusion in a cancer setting hospital. Clin Respir J 2020; 14:1040-1049. [PMID: 32750225 DOI: 10.1111/crj.13239] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 07/11/2020] [Accepted: 07/27/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND The placement of indwelling pleural catheters (IPC) is an effective outpatient approach for the management of malignant pleural effusions (MPE). AIMS The indications and outcome of IPC in patients with MPE. Risk stratifications, prevention and management of IPC-related complications. METHODS We retrospectively reviewed the clinical data of patients with MPE who underwent IPC insertion from July 2011 to July 2019. The multivariable logistic regression model was used to identify the independent risk factors associated with IPC infection and the Kaplan-Meier method to determine the overall survival. RESULTS A total of 102 patients underwent IPC insertion during the stipulated period and the mean age was 50.49 ± 14.36 years. Seventy-one (69.6%) were females. The indications were Trap Lung in 38 (37.3%), failed talc pleurodesis in 28 (27.5%) and as a primary intervention in 36 (35.3%). The infection rate was 25.5%, of which 65.4% patients had nosocomial infections. Post-IPC overall median survival time was 9.0 ± 2.50 weeks with highest in patients with trap lung (18 ± 1.50 weeks). In multivariable analysis, following variables were identified as a significant independent risk factor for IPC infection: Multiloculated MPE (AOR 2.80; 95%CI (1.00-9.93), 0.04), trap lung (AOR 7.57; 95%CI (1.39-41.25), 0.01), febrile neutropenia (FN) (AOR 28.55; 95%CI (4.23-19.74), 0.001), IPC domiciliary education (AOR 0.18; 95%CI (0.05-0.66), 0.001) and length of hospital stay (AOR 1.16; 95%CI (1.01-1.33), 0.03). CONCLUSION IPC insertion is an effective management for MPE with reasonable survival benefits. Infection is the most common complication, of which mostly are nosocomial infections with higher incidence in multiloculated effusions, trap lung, FN and with lack of domiciliary IPC care education.
Collapse
Affiliation(s)
- Muhammad Junaid Akram
- Fellow College of Physicians and Surgeons Pakistan (Internal Medicine), Member of Royal College of Physician United Kingdom, Fellow Pulmonology, Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Usman Khalid
- Fellow College of Physicians and Surgeons Pakistan (Internal Medicine), Fellow Pulmonology, Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Muhammad Abu Bakar
- BS (Hons), M.Sc. Epidemiology and Biostatistics (South Africa) Biostatistician and Cancer Epidemiologist, Department of Cancer Registry and Clinical Data Management, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Faheem Mahmood Butt
- Diplomate American Board of Internal Medicine and Pulmonology. Consultant Pulmonology, Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Mohammad Bilal Ashraf
- Diplomate American Board of internal medicine, Pulmonology and Critical Care, Consultant Pulmonology & Critical Care Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Faheem Khan
- Fellow of College of Chest Physicians, Member Royal College of Physicians Ireland, Consultant Pulmonology, Shaukat Khanum Memorial Cancer Hospital & Research Center, Lahore, Pakistan
| |
Collapse
|
50
|
Akram MJ, Khalid U, Abu Bakar M, Ashraf MB, Butt FM, Khan F. Indications and clinical outcomes of fully covered self-expandable metallic tracheobronchial stents in patients with malignant airway diseases. Expert Rev Respir Med 2020; 14:1173-1181. [PMID: 32664764 DOI: 10.1080/17476348.2020.1796642] [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] [Indexed: 10/23/2022]
Abstract
BACKGROUND Airway stenting is an efficacious approach in management of malignant airway disease (MAD) with improvement in survival outcome. OBJECTIVE To determine the indications and long-term clinical outcomes of tracheobronchial stenting in patients with MAD. METHODS A cross-sectional review of 51 patients who underwent airway stenting from June 2011 to June 2019 was done. Paired t-test was used to compare mean difference of clinical characteristics between pre- and post-airway stenting. Kaplan-Meier curves were used to assess overall survival. RESULTS A total of 51 patients had stent insertion with mean age 46.63±17.10years including 27(52.9%) females. Mainly 37(72.5%) patients had esophageal and 06(11.8%) had lung cancer. The main indications were bronchial stenosis 18(35.3%), tracheal stenosis 11(21.6%) and Tracheo-esophageal/bronchial fistula 13(25.5%). Obstruction was intrinsic, extrinsic and mixed in 20(39.2%), 13(25.5%) and 5(9.8%) patients, respectively. There was statistically significant mean difference in pre- and post-procedure oxygen saturation (mean (M)=89.8, standard deviation (SD)=6.70 vs M =95.5,SD=2.54.p =0.001) and performance status (M =3.65,SD =0.6 vs M =2.59, SD=0.83.p =0.001). Overall median survival was 16±3.44 weeks, highest amongst patients with intrinsic obstruction (27±6.51 weeks). CONCLUSION Airway stenting is an effective endoscopic procedure to re-establish airway patency in MAD with minimal complications..
Collapse
Affiliation(s)
- Muhammad Junaid Akram
- Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center , Lahore, Pakistan
| | - Usman Khalid
- Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center , Lahore, Pakistan
| | - Muhammad Abu Bakar
- Department of Cancer Registry and Clinical Data Management, Shaukat Khanum Memorial Cancer Hospital and Research Center , Lahore, Pakistan
| | - Mohammad Bilal Ashraf
- Consultant Pulmonology & Critical Care Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center , Lahore, Pakistan
| | - Faheem Mehmood Butt
- Consultant Pulmonology, Shaukat Khanum Memorial Cancer Hospital & Research Center , Lahore, Pakistan
| | - Faheem Khan
- Consultant Pulmonology, Shaukat Khanum Memorial Cancer Hospital & Research Center , Lahore, Pakistan
| |
Collapse
|