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Ginther OJ, Pinaffi FLV, Khan FA, Duarte LF, Beg MA. Follicular-phase concentrations of progesterone, estradiol-17β, LH, FSH, and a PGF2α metabolite and daily clustering of prolactin pulses, based on hourly blood sampling and hourly detection of ovulation in heifers. Theriogenology 2013; 79:918-28. [PMID: 23434204 DOI: 10.1016/j.theriogenology.2012.12.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 12/27/2012] [Accepted: 12/27/2012] [Indexed: 12/17/2022]
Abstract
Circulating concentrations of hormones were determined each hour in 13 heifers from the end of the luteolytic period to ovulation (follicular phase, 3.5 days). Diameter of the preovulatory follicle was determined every 8 hours, and the time of ovulation was determined hourly. The diameter of the preovulatory follicle decreased 0.8 ± 0.1 mm/h in heifers when there was 1 to 3 hours between the last two diameter measurements before ovulation. The concentration of progesterone (P4) after the end of the luteolytic period (P4 < 1 ng/mL) changed (P < 0.0001), as shown by a continued decrease until Hour -57 (Hour 0 = ovulation), then was maintained at approximately 0.2 ng/mL until 2 hours before the peak of the LH surge at Hour -26, and then a decrease to 0.1 ng/mL along with a decrease in estradiol-17β. Concentrations of LH gradually increased (P < 0.007) and concentrations of FSH gradually decreased (P < 0.0001) after the end of luteolysis until the beginning nadirs of the respective preovulatory surges. A cluster of prolactin (PRL) pulses occurred (P < 0.0001) each day with approximately 24 hours between the maximum value of successive clusters. Hourly concentrations of a PGF2α metabolite decreased (P < 0.007) until Hour -40, but did not differ among hours thereafter. Novel observations included the gradual increase in LH and decrease in FSH until the beginning of the preovulatory surges and follicle diameter decrease a few hours before ovulation. Results supported the following hypotheses: (1) change in the low circulating P4 concentrations during the follicular phase are temporally associated with change in LH concentrations; and (2) PRL pulses occur in a cluster each day during the follicular phase of the estrous cycle.
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Khan FA, Rice D, Tadros G. The use of supportive observations within an inpatient mental health unit for older people and dilemma of using the Mental Health Act (2007) or the Mental Capacity Act (2005) in England and Wales. J Psychiatr Ment Health Nurs 2013; 20:91-6. [PMID: 22900598 DOI: 10.1111/j.1365-2850.2012.01963.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
In England and Wales the interface between the Mental Capacity Act 2005 (MCA) and Mental Health Act 2007 (MHA) is frequently encountered in mental health practice. In services involving older adults many service users will have cognitive impairment and dementias in some instances with behavioural and psychological symptoms of dementia and assessments regarding their mental capacity to make decisions are frequently required. Service users with these illnesses are admitted to psychiatric wards and occasionally nursed under 'close observations' in order to maintain their safety and that of others. The concepts of 'complete and effective control' which may be exercised by ward staff in these circumstances, and the resulting 'loss of autonomy under supervision and control' must be understood in consideration of whether a 'deprivation of liberty' should ensue, particularly when they do not have mental capacity to make decisions about the observations. The observation policy must clearly delineate the different forms of nursing observations possible e.g. close, constant, intermediate, general etc. to avoid confusion among staff members implementing the observation plan. Various dilemmas and management of such dilemmas concerning the use of MCA 2005, MHA 2007 and observation policies has been discussed in this paper. Nursing staff working in both psychiatric and acute hospitals need training in concepts of MCA 2005, MHA 2007 and Deprivation of Liberty Safeguards.
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Ginther OJ, Pinaffi FLV, Khan FA, Duarte LF, Beg MA. Circadian influence on the preovulatory LH surge, ovulation, and prolactin concentrations in heifers. Theriogenology 2012; 79:528-33. [PMID: 23244766 DOI: 10.1016/j.theriogenology.2012.11.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2012] [Revised: 11/03/2012] [Accepted: 11/05/2012] [Indexed: 11/15/2022]
Abstract
A novel circadian study of the effect of clock hours on the preovulatory LH surge, ovulation, and maximal PRL concentration was done in 13 nontreated Holstein heifers. Hourly blood sampling and hourly ultrasound examinations to detect the hour of ovulation began at 8 and 48 hours, respectively, after CL area (cm(2)) had decreased 15% from the area at 15 days postovulation. The resulting experimental period began at the beginning of postluteolysis (progesterone, <1 ng/mL) and encompassed a mean of 3.5 days until ovulation. The frequency of the peak of the preovulatory LH surge for the three 8-hour periods of a 24-hour day was different (P < 0.02) between 2:00 AM to 9:00 AM (N = 9), 10:00 AM to 5:00 PM (N = 3), and 6:00 PM to 1:00 AM (N = 1). The median was 6:00 AM. The frequency of ovulations for 8-hour periods was different (P < 0.02) between 3:00 AM to 10:00 AM (N = 9), 11:00 AM to 6:00 PM (N = 3), and 7:00 PM to 2:00 AM (N = 1). The median was 7:30 AM. Two or three clusters of PRL pulses occurred during the 3.5 days. Based on all available PRL pulse clusters (N = 36), the clock hours of the maximal concentration/cluster was greater (P < 0.0001) for 9:00 AM to 2:00 PM (N = 33 clusters) than for each of the three other 6-hour periods (N = 0, 1, or 2 per period). The median was 11:30 AM. The hypothesis was supported that the peak of the preovulatory LH surge, ovulation, and maximal PRL concentration during pulse clusters occur with greater frequency during certain clock hours in heifers.
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Pande M, Das GK, Khan FA, Sarkar M, Prasad JK, Pathak MC, Kumar H. Uterine Infection Influences Size and Follicular Fluid Composition of the Largest Follicle in Buffalo (Bubalus bubalis). Reprod Domest Anim 2012; 48:79-84. [DOI: 10.1111/j.1439-0531.2012.02034.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Pugliesi G, Khan FA, Hannan MA, Beg MA, Carvalho GR, Ginther OJ. Inhibition of prostaglandin biosynthesis during postluteolysis and effects on CL regression, prolactin, and ovulation in heifers. Theriogenology 2012; 78:443-54. [PMID: 22578618 DOI: 10.1016/j.theriogenology.2012.02.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 02/16/2012] [Accepted: 02/17/2012] [Indexed: 11/18/2022]
Abstract
The beginning of postluteolysis (progesterone, <1 ng mL(-1)) in heifers was targeted by using 8 h after ultrasonic detection of a 25% decrease in CL area (cm2) and was designated Hour 0. Flunixin meglumine (FM; n=10) to inhibit PGF2α secretion or vehicle (n=9) were given intramuscularly at Hours 0, 4, 8, 16, 24, 32, and 40. The dose of FM was 2.5 mg/kg at each treatment. Blood sampling and measurement of the CL and dominant follicle were done every 8 h beginning 14 days postovulation in each group. Blood samples for detection of pulses of PRL and pulses of a metabolite of PGF2α (PGFM) were obtained every hour for 24 h beginning at Hour 0. Pulse concentrations of both PGFM and PRL were lower in the FM group than in the vehicle group. Concentration of PRL was greatest at the peak of a PGFM pulse. Neither CL area (cm2) nor progesterone concentration differed between groups during Hours 0 to 48 (postluteolysis). Ovulation occurred in nine of nine heifers in the vehicle group and in three of 10 heifers in the FM group. The anovulatory follicles in the FM group grew to 36.2±2.9 mm, and the wall became thickened from apparent luteinization. The hypothesis that PGF2α was involved in the continued P4 decrease and structural CL regression during postluteolysis was not supported. However, the hypotheses that pulses of PGFM and PRL were temporally related and that systemic FM treatment induced an anovulatory follicle were supported.
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Afshan G, Chohan U, Khan FA, Chaudhry N, Khan ZE, Khan AA. Appropriate length of epidural catheter in the epidural space for postoperative analgesia: evaluation by epidurography. Anaesthesia 2011; 66:913-8. [PMID: 21851342 DOI: 10.1111/j.1365-2044.2011.06820.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
In current practice, the length of epidural catheter that should be left in the epidural space is not standardised for effective postoperative analgesia. This prospective, randomised, double-blinded study aimed to determine the most appropriate length of epidural catheter that should be inserted into the epidural space for postoperative analgesia. We recruited 102 women and assigned them into three study groups (3, 5 and 7 cm insertion). An epidural catheter was inserted and epidurography was performed. Postoperatively, mean pain scores, motor and sensory levels, and any complications associated with the epidural catheter were recorded. No statistically significant difference for mean postoperative pain score was found at all study timings. Motor and sensory blockade was also statistically insignificant. Unilateral sensory analgesia developed in one patient in the 7 cm group and epidural catheter dislodgement was observed in four patients in the 3 cm group. In order to minimise catheter-related complications for postoperative analgesia, the most appropriate length that an epidural catheter should be left in the epidural space is 5 cm. You can respond to this article at http://www.anaesthesiacorrespondence.com.
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Khan FA, Das GK, Pande M, Mir RA, Shankar U. Changes in biochemical composition of follicular fluid during reproductive acyclicity in water buffalo (Bubalus bubalis). Anim Reprod Sci 2011; 127:38-42. [PMID: 21840653 DOI: 10.1016/j.anireprosci.2011.07.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Revised: 07/09/2011] [Accepted: 07/25/2011] [Indexed: 11/25/2022]
Abstract
This study describes the changes in biochemical composition of follicular fluid during reproductive acyclicity in buffalo. A total of 73 pairs of ovaries collected from 26 reproductively acyclic and 47 reproductively cyclic buffaloes were used in the investigation. Ovarian follicles were classified into small (5.0-6.9 mm), medium (7.0-9.9 mm) and large (≥10.0 mm) sized categories depending upon their diameter. Follicular fluid was aspirated, processed and assayed for glucose, cholesterol, total protein, acid phosphatase and alkaline phosphatase. Glucose concentration was lesser in reproductively acyclic compared to cyclic buffaloes (19.3 ± 2.59 mg/dl compared to 32.6 ± 2.60 mg/dl; P<0.05), mainly due to difference in concentration between small sized follicles (12.4 ± 2.59 mg/dl compared to 28.0 ± 3.32 mg/dl; P<0.05). Cholesterol concentration was also lesser in reproductively acyclic compared to cyclic buffaloes (32.2 ± 2.14 mg/dl compared to 35.5 ± 2.16 mg/dl; P<0.05) and this was related to the lesser concentration found in large follicles (13.8 ± 3.45 mg/dl compared to 37.2 ± 4.10mg/dl; P<0.001). Total protein and acid phosphatase levels were not affected by either the reproductive cyclicity status or the follicular size (4.9 ± 1.07 g/dl to 6.0 ± 0.28 g/dl and 1.2 ± 0.17 U/dl to 2.5 ± 1.22 U/dl, respectively). An increased alkaline phosphatase activity was, however, observed in reproductively acyclic compared to cyclic buffaloes (27.5 ± 3.08 U/dl compared to 14.0 ± 1.09 U/dl; P<0.0001). In conclusion, results of the present study indicate an alteration in the biochemical composition of follicular fluid during reproductive acyclicity in buffalo. The findings provide further support to the notion that poor nutrition is an important factor triggering reproductive acyclicity in buffalo.
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Khan FA, Nabi SU, Pande M, Das GK, Sarkar M. Bilateral follicular cysts in a water buffalo. Trop Anim Health Prod 2010; 43:539-41. [PMID: 21086160 DOI: 10.1007/s11250-010-9738-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2010] [Indexed: 11/26/2022]
Abstract
The present short communication puts on record a case of bilateral, multiple follicular cysts in a water buffalo along with a detailed description of its ovarian biometry and follicular fluid composition. The ovarian weight and biometrical parameters were much higher than in normal cycling buffaloes. A total of three follicular cysts were observed, two on the right ovary and one on the left ovary, measuring 4.9, 3.0 and 2.6 cm yielding 21, 9 and 5 ml of follicular fluid, respectively. The cystic fluid was deep yellow in colour with a viscous consistency. The follicular fluid concentrations of glucose, total protein, cholesterol, acid phosphatase, calcium, phosphorus and progesterone in all the cysts were within the range reported previously in normal buffalo follicular fluid; however, the alkaline phosphatase concentration in cyst 1 and total bilirubin concentration in cysts 1 and 2 were higher than the values in normal follicular fluid. In contrast, the levels of urea nitrogen in cysts 1 and 3, and oestradiol in cyst 3 were lower than the normal values. All the three follicles had an oestradiol to progesterone ratio less than 1. The results of our study suggest that follicular cysts in buffalo are oestrogenically inactive and have an altered concentration of certain biochemical and hormonal constituents.
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Nawaz S, Khan FA, Tabasum S, Zakria M, Saeed A, Iqbal MZ. Phylogenetic relationships among Saccharum clones in Pakistan revealed by RAPD markers. GENETICS AND MOLECULAR RESEARCH 2010; 9:1673-82. [PMID: 20799164 DOI: 10.4238/vol9-3gmr903] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Forty sugarcane genotypes (clones), including elite lines, commercial cultivars of Saccharum officinarum and S. barberi clones, were fingerprinted with 30 RAPD markers, using a PCR-based marker assay. The genetic distance for RAPD data was determined according to Nei, and relationships between accessions were graphed in a dendrogram. Genetic distance values ranging from 16.2 to 86.3% were observed among the 40 sugarcane accessions. The lowest genetic distance was found between genotypes US-406 and US-186. These two genotypes differed from each other in only 25 bands with 15 different primers. Genotypes Col-54 and CP-72-2086 were the second most similar group, with a genetic distance of 19.46%. The most dissimilar of all the accessions were CP-77-400 and US-133, with a genetic distance of 86.3%. RAPD fingerprints help sugarcane breeders clarify the genetic pedigree of commercial sugarcane varieties and can be used to evaluate the efficiency of conventional breeding methods.
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Nawaz S, Khan FA, Tabasum S, Iqbal MZ, Saeed A. Genetic studies of "noble cane" for identification and exploitation of genetic markers. GENETICS AND MOLECULAR RESEARCH 2010; 9:1011-22. [PMID: 20533196 DOI: 10.4238/vol9-2gmr795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Forty genotypes (clones) of sugarcane, including elite lines, commercial cultivars of Saccharum officinarum and clones of S. barberi were fingerprinted with 50 SSR markers using a PCR-based marker assay. Nei's genetic distances for SSR data were determined and relationships between accessions were portrayed graphically in the form of a dendrogram. Genetic distance values ranging from 0.60 to 1.11 were observed among the 40 sugarcane accessions. The shortest genetic distance of 0.60 was seen between genotypes US-804 and US-130. These two genotypes differed from each other only in 10 bands, with 20 primers. The most dissimilar of the accessions were CP-77-400 and US-133, with a genetic distance of 1.11. SSR fingerprints can help sugarcane breeders to clarify the genetic pedigree of commercial sugarcane varieties and evaluate the efficiency of breeding methods.
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Tabasum S, Khan FA, Nawaz S, Iqbal MZ, Saeed A. DNA profiling of sugarcane genotypes using randomly amplified polymorphic DNA. GENETICS AND MOLECULAR RESEARCH 2010; 9:471-83. [PMID: 20391332 DOI: 10.4238/vol9-1gmr709] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
DNA profiles of 40 sugarcane genotypes were constructed with 30 RAPD markers. Sugarcane genotypes of both Saccharum officinarum and S. barberi were included in this study. Multiple alleles were detected from each RAPD; there was a high level of polymorphism. On average, 7.93 alleles were produced per primer, giving a total of 238 alleles. The genetic distances between these genotypes were assessed with the POPGENE DNA sequence analysis software. A dendrogram was constructed from these data; cultivated species of sugarcane formed clusters with S. barberi genotypes. The 40 genotypes were clustered into two main groups; genetic distances ranged from 20.29 to 64.66%. These RAPD fingerprints will help sugarcane breeders to evaluate the efficiency of current conventional breeding methods and will help characterize the genetic pedigree of commercial sugarcane varieties. These data will also be valuable for conservation and utilization of the genetic resources in germplasm collections.
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Khan FA, Khan A, Azhar FM, Rauf S. Genetic diversity of Saccharum officinarum accessions in Pakistan as revealed by random amplified polymorphic DNA. GENETICS AND MOLECULAR RESEARCH 2009; 8:1376-82. [PMID: 19937582 DOI: 10.4238/vol8-4gmr665] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Genetic diversity of 20 sugarcane accessions in Pakistan was studied using 21 random amplified polymorphic DNA markers. The mean genetic distance between the cultivars was 39.03%, demonstrating that a large part of the genome is similar among the accessions. This probably arises from a lack of parental diversity, with few clones, which are themselves related, contributing to the parentage of these varieties. Among the varieties, none was found to be totally distinct and divergent from the others. We conclude that the current Pakistan commercial varieties have a limited genetic base and that there is a need to diversify commercial sugarcane lines in Pakistan by introducing new germplasm sources.
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Khan DA, Qayyum S, Saleem S, Khan FA. Lead-induced oxidative stress adversely affects health of the occupational workers. Toxicol Ind Health 2009; 24:611-8. [PMID: 19106128 DOI: 10.1177/0748233708098127] [Citation(s) in RCA: 74] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Lead is a persistent toxic metal and associated with impairment of various body functions in occupational workers. The main objective was to determine the lead-induced oxidative stress and adverse health effects by biochemical markers in industrial workers. One hundred and forty-eight males consisting of 87 lead-exposed industrial workers and 61 controls were included. Blood lead level (BLL) was determined on a 3010B ESA lead analyzer. Blood complete counts were done on a hematology analyzer. Biochemical markers including serum uric acid, urea, creatinine, phosphate, alanine aminotransferase (ALT), and gamma glutamyltransferase (GGT) were measured on a Selectra E auto analyzer. Serum malondialdehyde (MDA) was measured spectrophotometrically and C-reactive protein (CRP) on Immulite-1000. Results revealed that lead-exposed workers had significantly high BLLs, median (range), 29.1 (9.0-61.1) microg/dL compared with controls, 8.3 (1.0-21.7) microg/dL. Oxidative stress (MDA, GGT) and inflammatory markers (high-sensitivity CRP) were significantly increased (P < or = 0.05). Blood pressure was raised, whereas hemoglobin was decreased in exposed group (P < or = 0.002). Serum urea, uric acid, phosphate, and ALT were significantly raised in lead-exposed workers (P < or = 0.001). Serum albumin, total proteins, and glomerular filtration rate (GFR) were decreased. Blood lead showed a significant positive correlation with serum GGT (r = 0.63), MDA (r = 0.71), CRP (r = 0.75), urea (r = 0.34), creatinine (r = 0.51), and uric acid (r = 0.29) (P < or = 0.01). It is concluded that lead exposure increases oxidative stress that correlates with adverse changes in hematological, renal, and hepatic function in the occupational workers. Elevated blood lead has positive correlation with oxidative stress, inflammatory and biochemical markers that might be used to detect impairment in the body function in lead exposed workers.
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Siddiqi A, Khan DA, Khan FA, Razzaq A. Therapeutic drug monitoring of amikacin in preterm and term infants. Singapore Med J 2009; 50:486-489. [PMID: 19495517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Amikacin is a commonly-prescribed drug used for the empirical treatment of bacterial infections in neonates. A marked change in the pharmacokinetics of amikacin has been reported during neonatal life. Amikacin has a very narrow therapeutic range and can cause very serious side effects such as nephrotoxicity and ototoxicity. The current therapeutic dose of amikacin, i.e. 15 mg/kg of body weight, may increase the risk of toxicity in preterm infants with immature renal functions. We aimed to determine the frequency of amikacin toxicity in preterm as compared to term infants by measuring its serum trough levels following the administration of the current therapeutic dose. METHODS A comparative study was conducted at the neonatal intensive care unit of the Military Hospital, Rawalpindi, Pakistan. A total of 104 infants (52 term and 52 preterm) receiving amikacin at a dose of 15 mg/kg of their body weight, once daily for bacterial infection, were included. After clinical evaluation, serum creatinine levels were measured at admission and on the third day. Amikacin trough levels were taken after 72 hours of therapy and measured on the TDx Abbot Drug Analyser. RESULTS The gestational age range was 37-40 weeks in term and 29-36 weeks in preterm infants. The term and preterm infants had a median weight of 2.8 kg and 2.1 kg, respectively. The preterm infants had significantly higher median (range) 11.33 (1.50-42.60) ug/ml levels of serum amikacin as compared to 8.5 (2.8-33.0) ug/ml in term infants (p-value is less than 0.01). The preterm infants had a high frequency of toxic 32 (62 percent) and subtherapeutic 12 (23 percent) levels, as compared to 11 (21 percent) and 5 (10 percent) in term infants, respectively. Serum amikacin levels revealed a positive correlation with post-dose serum creatinine (r equals 0.48; p-value is less than 0.05). CONCLUSION This study demonstrated that the current practice of amikacin treatment for bacterial infection needs to be adjusted due to unique pharmacokinetic variability in preterm infants. There is a need for regular therapeutic drug monitoring and renal function assessment in all infants receiving amikacin therapy in order to avoid nephrotoxicity.
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Khan FA, Shukla AN, Joshi SC. Anaemia and cancer treatment: a conceptual change. Singapore Med J 2008; 49:759-764. [PMID: 18946607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Anaemia is the most common haematological abnormality in cancer patients, and unfortunately, it is often under-recognised and undertreated. The aetiopathology of anaemia in cancer patients is complex and is usually multifactorial. There is enough evidence suggesting that tumour hypoxia in anaemic patients has a negative impact on the treatment outcomes in cancer patients. The use of recombinant human erythropoietin is becoming a new standard of care in cancer patients. Various well-controlled studies have shown that the use of erythropoietin (EPO) increases the haemoglobin level, thereby decreasing the need for frequent transfusions and improving the tumour responses, cancer-free survival and quality-of-life parameters in cancer patients. However, a few recent clinical trials failed to replicate the survival benefit. Hence, a free unrestricted use of EPO is to be avoided. The past belief that anaemia does not matter in cancer patients is now considered invalid and is being seriously challenged. This article aims to present some recent findings on the impact of anaemia on outcomes, with discussion on the possible causes and effects. The benefits of the use of EPO analogues in cancer-related anaemia are also presented.
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Hussain AM, Yousuf B, Khan MA, Khan FH, Khan FA. Vasopressin for the management of catecholamine-resistant anaphylactic shock. Singapore Med J 2008; 49:e225-e228. [PMID: 18830525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Severe anaesthetic anaphylaxis is relatively uncommon. Oxygen, fluids and epinephrine are considered to be the mainstay for treatment of cardiovascular collapse and current guidelines for the management of anaphylaxis list only epinephrine as a vasopressor to use in the event of a cardiovascular collapse. Recently, evidence has emerged in the support of the use of vasopressin in cardiopulmonary resuscitation; it is also recommended for the treatment of ventricular fibrillation, septic shock and post-cardiopulmonary bypass distribution shock. Currently, there is no algorithm or guideline for the management of anaphylaxis that include the use of vasopressin. We report a 24-year-old woman who developed severe anaphylactic shock at induction of anaesthesia while undergoing laparoscopic cholecystectomy. Circulation shock was refractory to epinephrine and high doses of pure alpha-agonist phenylephrine and norepinephrine. Single intravenous dose of two units of vasopressin re-established normal circulation and blood pressure.
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Ogunkeye OO, Roluga AI, Khan FA. Resetting the detection level of cord blood thyroid stimulating hormone (TSH) for the diagnosis of congenital hypothyroidism. J Trop Pediatr 2008; 54:74-7. [PMID: 17878179 DOI: 10.1093/tropej/fmm082] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
An appraisal of a 17-year primary thyroid stimulating hormone (TSH) screening programme for the detection of congenital hypothyroidism was carried out to establish the reference interval of cord blood TSH in unaffected infants; the mean cord blood TSH concentration of affected infants and the incidence of congenital hypothyroidism in the Najran province of Saudi Arabia. Our findings show a reference interval of cord blood TSH of 2.0-16.8 mU/l in unaffected infants; a mean cord blood TSH concentration of 399 mU/l in affected infants; a false positive rate for the diagnosis of at-risk infants of 1.02% and a congenital hypothyroidism incidence rate of 34/100 000 (1 : 2931) live births. These findings suggest that there is a need to reset the cord blood TSH concentration for the detection of at-risk infants. We suggest that the detection level of cord blood TSH for the recognition of at-risk infants can be set at 90 mU/l rather than the recommended level of 30 mU/l. This should reduce the false positive rate for detection of infants at risk of congenital hypothyroidism.
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Mabumba ED, Mugyenyi P, Batwala V, Mulogo EM, Mirembe J, Khan FA, Liljestrand J. Widow inheritance and HIV/AIDS in rural Uganda. Trop Doct 2007; 37:229-31. [PMID: 17988488 DOI: 10.1258/004947507782332955] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Despite current efforts to combat HIV/AIDS through behavioural change, ingrained socio-cultural practices such as widow inheritance in south-western Uganda has not changed. Low education, unemployment, dowry, widows' socioeconomic demands and the inheritor's greed for the deceased's wealth, influence widow inheritance. Voluntary counselling and testing is needed for the widows and their inheritors; formal dowry should be removed from marriage and widow inheritance stripped of its sexual component.
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Joshi SC, Khan FA, Pant I, Shukla AN. Role of radiotherapy in early breast cancer: an overview. Int J Health Sci (Qassim) 2007; 1:259-64. [PMID: 21475437 PMCID: PMC3068638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
Radiotherapy has an established role in reducing the local relapses in breast cancer patients. The objective of this review was to investigate whether radiotherapy or its omission after breast surgery has measurable consequences on local tumor recurrence and patient survival. The late excess of cardiac deaths has also been published in various reports but important advances in the delivery of radiotherapy have overcome this problem to the extent that, excess cardiac deaths do not appear to be occurring in more recent trials. In this article some recent data, suggesting that radiotherapy following mastectomy and/or breast conserving surgery has a beneficial effect on survival is reviewed. Omission of radiotherapy is associated with a large increase in risk of ipsilateral breast tumor recurrence and with a small increase in the risk of patient's mortality.
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Abstract
The database of incident forms relating to anaesthesia services in an institutional risk management programme were reviewed for 2003-2005, the aim being to identify any recurring patterns. Incidents were prospectively categorised as relating to attitude/behaviour, communication breakdown, delay in service, or were related to care, cost, environment, equipment, security, administrative process, quality of service or miscellaneous. The total number of anaesthesia-related incidents reported during the period was 287, which related to 0.44% of the total number of anaesthetics administered during the time period. In all, 170 incidents were reported by the department, 96 by internal customers and 21 by external customers. Only 30% of the complaints came from the operating room. Thirty-four per cent of all incidents related to communication, behaviour and delay in service. A requirement to teach communication skills and stress handling formally in anaesthesia training programmes, and at the time of induction of staff into the department, has been identified.
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72
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Khan FA, Hamdani GA. Factors influencing the choice of anesthesia as a career in a developing country. MIDDLE EAST JOURNAL OF ANAESTHESIOLOGY 2007; 19:149-57. [PMID: 17511189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
Career choice in medicine is influenced by several factors. Our aim was to look at reasons for choice of anesthesia as a career in a cohort of doctors applying for the residency training in a university hospital in a developing country. A semi-structured interview form is used in our department and includes a question related to career choice. Each applicant is interviewed by two faculty members independently. All interview forms between 1992 to 2004 were reviewed and the reason for choosing anesthesia was coded in different categories. The sample consisted of 167 applicants and 334 forms. There were 29 females and 138 males. The mean age of the applicants was 28 years. Sixty two percent chose anesthesia because of general interest and nature of the specialty, 24% of these mentioned had no specific reasons, 17% thought the specialty was intellectually challenging, 8% liked the technical aspect, 5% were interested in physiology and pharmacology, 2% liked the operating room environment, and 6% liked the immediate results. The second major group (36%) cited the reason as better economic opportunities. Sixteen percent were influenced by friends or relatives in their choice. Twenty six percent chose anesthesia primarily because of their interest in critical care, pain management or emergency management. Our data indicates that selection of career in anesthesia in our county is strongly related to the nature of specialty and future employment opportunities. A significant number were influenced by family and friends. This pattern is different from that reported from Australia and United States.
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73
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Khan MU, Khan FA. Anaesthesia-related mortality in developing countries. Anaesth Intensive Care 2006; 34:523-4. [PMID: 16918000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/11/2023]
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74
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Kamil SM, Mohamad NH, Narazah MY, Khan FA. Dengue haemorrhagic fever with unusual prolonged thrombocytopaenia. Singapore Med J 2006; 47:332-4. [PMID: 16572249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2023]
Abstract
We describe a case of dengue haemorrhagic fever with prolonged thrombocytopaenia. A 22-year-old Malay man with no prior illness presented with a history of fever and generalised macular rash of four days duration. Initial work-up suggested the diagnosis of dengue haemorrhagic fever based on thrombocytopaenia and positive dengue serology. Patient recovered from acute illness by day ten, and was discharged from the hospital with improving platelet count. He was then noted to have declining platelet count on follow-up and required another hospital admission on day 19 of his illness because of declining platelet count. The patient remained hospitalised till day 44 of his illness and managed with repeated platelet transfusion and supportive care till he recovered spontaneously.
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75
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Abstract
This prospective study was conducted to determine the level of radiation exposure of trainee anaesthetists working in urology, orthopaedics and radiology environments. Anaesthetists wore lithium fluoride thermoluminescent dosimeter (TLD) badges over a 6-month period. The position of badges was standardised at the collar site (TLD1) and at waist level (TLD2). Area specific dosimeters were used and exchanged between anaesthetists. Of a total of 723 procedures, anaesthetists were exposed to radiation in 33% of procedures in orthopaedics, 30% in urology and 39% in radiology. The mean (SD) exposure time to radiation per case was significantly greater in orthopaedics than in urology (9.2 (4) min vs. 4.2 (2) min). The radiation exposure per case was highest in radiology (19.2 (22) min). The net combined exposure over a 6-month period was 0.2177 mSv in urology, 0.4265 mSv in orthopaedics and 3.8457 mSv in radiology. The combined exposure was less than the 20 mSv recommended as the maximum exposure per year. Our data does not support the need for routine dosimetric monitoring of anaesthetists working in the above settings.
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