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JEYALAN V, Ahmed M, Stauss M, So B. POS-295 A SINGLE CENTRE EXPERIENCE OF PLANNED KIDNEY BIOPSIES: ASSESSING SAFETY OF 4 HOUR OBSERVATION VS MORE THAN 6 HOUR OBSERVATION IN A LOW RISK COHORT. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.01.315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Schmid T, Nguyen M, Dombrowsky A, Bicher S, Treibel F, Winter J, Ahmed M, Combs S, Bartzsch S. RADIOBIOLOGICAL MECHANISMS IN MICROBEAM RADIATION THERAPY (MRT). Phys Med 2022. [DOI: 10.1016/s1120-1797(22)01623-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Ahmad N, Hussain SM, Azam SM, Shahzad MM, Noureen A, Yaqoob R, Lateef M, Yawer A, Riaz D, Usman A, Faizan M, Hassan S, Ishtiaq A, Riaz P, Ali A, Amin F, Imran M, Kausar R, Ahmed M, Bashir W, Adnan M, Siddique A, Farooq M, Ahmad S. Effects of Se nanoparticles supplementation on growth performance, hematological parameters and nutrient digestibility of Labeo rohita fingerling fed sunflower meal based diet. BRAZ J BIOL 2022; 84:e253555. [PMID: 35019098 DOI: 10.1590/1519-6984.253555] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/30/2021] [Indexed: 11/22/2022] Open
Abstract
The aim of the present study is to assess the effects of selenium nanoparticles on the growth, hematology and nutrients digestibility of Labeorohita fingerlings. Fingerlings were fed with seven isocaloric sunflower meal-based diet supplemented with different concentrations of nanoparticles naming T1 to T7 (0, 0.5, 1, 1.5, 2, 2.5, and 3 mg/kg), with 5% wet body weight while chromic oxide was used as an indigestible marker. After experimentation for 90 days T3 treated group (1mg/kg -1Se-nano level) showed the best result in hematological parameters (WBC's 7.97 ×103mm-3, RBC's 2.98 ×106 mm-3 and Platelet count 67), nutrient digestibility (crude protein: 74%, ether extract: 76%, gross energy: 70%) and growth performance (weight gain 13.24 g, weight gain% 198, feed conversion ratio 1.5, survival rate 100%) as compared to the other treatment groups. Specific growth rates were found significantly higher in T5 than in other groups. The present study indicated positive effect of 1 mg/kg Se-nanoparticles on growth advancement, hematological parameters, and nutrients digestibility of L. rohita fingerlings.
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Kudrat-E-Khuda CM, Chowdhury AW, Ahmed M, Amin MG, Rahman MA, Khan AM, Paul GK, Siddiqui KR, Karmaker P, Faroque MO, Noor-E-Khuda M, Chowdhury MF, Sarker S. Factors Associated with Delayed Hospital Arrival of Patients Presenting with Acute Myocardial Infarction: A Cross-Sectional Study in Bangladesh. Mymensingh Med J 2022; 31:208-215. [PMID: 34999704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Delay in seeking medical care of the patients with acute myocardial infarction (AMI) could affect the outcome. Therefore, it is important to recognize and reduce pre-hospital in initiating treatment of these patients. The objective of the study was to evaluate the factors associated with delayed hospital arrival of patients with AMI. This cross-sectional study was carried out among 385 patients with AMI attended in the Department of Cardiology, Dhaka Medical College Hospital (DMCH), Dhaka, Bangladesh. The delay in arrival to the hospital was recorded along with socio-demographic data, conditions of the patients during onset and other relevant data. The mean age of the patients 59.7±9.9 years with a male-female ratio of 2.4:1. About 22% of patients with AMI arrived at the hospital within 6 hours of symptoms onset and only around 13% arrived within 2 hours of onset of symptoms. Comparatively younger (p=0.037), unmarried (p=0.008) and Muslim (p=0.008) patients were more likely to present for hospital care sooner (p=0.037). Patients coming from upper middle class of socioeconomic status (p<0.001) and those with college or post college level of education (p<0.001) were more likely to present earlier for hospital care. Prehospital delay was larger in non-manual worker patients (p<0.001) as well as in patients with onset of chest pain during rest period (p<0.001) and while at home (p<0.001). Pre-hospital delay was shorter in patients with onset of chest pain from 12am to 6am and 6am to 12pm (p<0.001). Lack of awareness of AMI symptoms and benefits of its early treatment, long distance and mode of transport were shown as the most common causes of delayed arrival of patients at hospital (p<0.001). This study has identified the factors associated with AMI in context of Bangladesh. Effective measures including increasing awareness of AMI symptoms should be taken for better outcome of the patients.
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Elsharkawy EA, Abou Al-sood MM, El-Fakharany MK, Ahmed M. Assessing and Comparing the Characteristics of CI Engine Powered by Biodiesel–Diesel and Biodiesel–Kerosene Blends. ARABIAN JOURNAL FOR SCIENCE AND ENGINEERING 2021. [DOI: 10.1007/s13369-021-05703-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Adnan A, Ahmed M, Sultana A, Vitone L. 831 Bouveret’s Syndrome (A Gallstone Disease Causing Gastric Outlet Obstruction): A Case Series and Review of Literature. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Bouveret’s syndrome refers to a gastric outlet obstruction due to the impaction of a large gallstone following retrograde migration via a bilio-duodenal fistula. Although no clear management guideline has been formulated, different treatment modalities have been described, including endoscopic stone removal using classical endoscopic devices, like snares and forceps; or fragmentation of stones with new devices, such as laser and extracorporeal shockwave lithotripsy (EWSL).
We report a case series of Bouveret’s syndrome with interesting radiological and endoscopic findings which have been successfully managed either via endoscopic measures such as stone extraction and/or duodenal stenting, or surgical intervention. The report is followed by a literature review including diagnostic and management options of this rare condition. All our patients were elderly with multiple comorbidities. Two patients presented with upper gastro-intestinal bleeding, while the other two presented with abdominal pain and bilious vomiting. The diagnosis was confirmed by computerised tomography (CT) scan and upper gastro-intestinal endoscopy. Endoscopic stone removal was successful in one case. In one patient, stone was fragmented but could not be removed completely, so he was managed via duodenal stent insertion. The other two patients required surgical intervention. One case was complicated by gallstone ileus which required laparotomy and extraction of stones from two sites, while the other required subtotal cholecystectomy, stone extraction and repair of duodenal fistula. The patients recovered well. The diagnosis of Bouveret’s Syndrome is made after performing appropriate imaging studies. The first line management option is endoscopic treatment. If this fails, surgical intervention is recommended.
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Saiyed S, Ahmed M, Winfield M, Briggs C, Amr B. 886 Healing Hands and Thrifty Plans! A Prospective, Cost-Effective Trial in Abscess Management. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Aim
Cutaneous abscesses are ubiquitous presentations requiring surgical drainage in most cases. There is a wide variation across the UK in the surgical practice dealing with such common problem. The aim of this study was to reduce the costs incurred in surgical drainage of acute skin and soft tissue abscess.
Method
This was a prospective, cost-effective study of the expenses incurred in surgical drainage of acute cutaneous and subcutaneous abscesses treated under the general surgeons' care over one year.
Results
A consequential saving of £13,962 was achieved during the study period. Between October 2019 and October 2020, 322 patients with soft tissue abscesses were treated by incision and drainage in general surgery. We calculated a total cost of £55.26 per patient for this routine operation. These expenses were based on basic surgical drapes pack, standard surgical gowns, sterile gloves and obtaining and processing the microbiology specimens. We have designed and implemented a new theatre protocol specifically for this procedure, resulting in a substantial reduction of the costs to £11.90 per patient. The total savings of £13,962 do not include savings caused by abscess drainage under local anaesthesia and does not calculate the savings that occurred due to shorter inpatient stay. These extra savings will be calculated and added later.
Conclusions
Considering the increasing financial burden on the NHS, we could make significant savings of nearly 80% of the operative costs of surgical drainage of a cutaneous abscess. We could achieve that by implementing simple modifications in the current surgical pathways without compromising patients' safety.
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Patel B, Fennelly J, Frazer S, Ahmed M, Granville-Chapman J. 145 Mind the App: A Guide for the Orthopaedic Senior House Officer on Call. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Aim
Many senior house officers (SHOs) have little experience in Trauma and Orthopaedics. While junior doctors are encouraged to seek help from the registrar during on call shifts, they are also dependent on a variety of guidelines to assist in the management of common orthopaedic presentations to the Emergency Department. The main issue is that site-specific guidance is not readily accessible on a single platform.
Method
Smartphone and web-based applications were designed summarising the initial management for such conditions for the SHO on-call to use as a quick reference tool. The efficacy of this was evaluated with questionnaires specific to the rating of the application and by two closed loop audits of BOAST standards for the management of distal radius and ankle fractures.
Results
Pre-app implementation questionnaire ratings revealed a mediocre confidence levels and high stress during an on-call shift. Post-app implementation questionnaires demonstrated the app was useful. Future use was recommended use for new SHOs. All responders felt that this would improve stress levels on call. Closed-loop audits for BOAST guidelines for ankle and distal radius fracture management were completed. Improvements were evident for obtaining appropriate radiographs ankle fractures (50.0% vs 77.8%) and positions of manipulated distal radius fractures (80% vs 100%).
Conclusions
This application proved a useful reference tool for junior staff to aid and initiate the management of common orthopaedic presentations to the emergency department. This tool could be used to improve confidence and ensure timely management of patients from the take.
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Gungadin P, Taib A, Ahmed M, Sultana A. 563 A Rare Case of Small Bowel Obstruction Secondary to Peritoneal Encapsulation, Congenital Adhesional Band and Gallstone Ileus. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Small bowel obstruction can be caused by multiple factors. We describe an unusual case of small bowel obstruction secondary to three rare factors: gallstone ileus, peritoneal encapsulation and congenital adhesional band.
Case Presentation
A seventy-nine-year-old male presented with a four-day history of obstipation and abdominal pain. CT abdomen pelvis revealed small bowel obstruction secondary to gallstone ileus. The patient was managed by laparotomy. The intraoperative findings revealed the presence of a congenital peritoneal encapsulation with an adhesional band and gallstone proximal to the ileo-caecal valve. Although there was some dusky small bowel, this recovered following the release of the band.
Discussion
Peritoneal Encapsulation is a rare congenital pathology resulting in the formation of an accessory peritoneal membrane around the small bowel. This condition is asymptomatic and rarely presents as small bowel obstruction. The diagnosis is often made at laparotomy. There are less than 60 cases reported in literature. Gallstone ileus is another rare entity caused by an inflamed gallbladder adhering to part of the bowel resulting in a fistula.
Conclusions
The rarity of these conditions mean that they are poorly understood. A combination of this triad of gall stone ileus in the presence of peritoneal encapsulation and congenital band has not been reported before. Knowledge of this would raise awareness, facilitate diagnosis and management of patients.
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Ahmed M, Radha S. 1528 Pseudotumour from Corrosive Material of Total Hip Replacement: A Rare Complication with an Unusual Presentation. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Total hip replacements have been performed in the UK since the 1960s, with over 280000 primary hip replacements being conducted between January 2017 – December 2019. The formation of pseudotumours is an uncommon and an unusual long-term complication of total hip replacements. Formed by galvanic corrosion of the metal prosthesis, patients can display an array of symptoms. We herein report a rare presentation of unilateral leg oedema in an elderly female, mimicking deep vein thrombosis. Despite normal metal ion levels, radiological investigations revealed an irregular cystic mass extending into the iliac fossa compressing the neurovascular bundle in the groin. The patient underwent complex revision hip surgery with dual mobility hip replacement and an Exeter stem with excision of the pseudotumour. This case highlights the importance of appropriate workup for these patients and the involvement of a multidisciplinary team.
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Adnan A, Ahmed M, Vaz O, Sultana A. 865 Reducing Delays in Cholecystectomy Surgery of Patients Admitted with Gallstone-Related Disease Within Gold Standard Time Frame Set Out By NICE. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
As per NICE guidelines, Cholecystectomy Quality Improvement Collaborative (Chole-QuIC) aims for 80% of eligible patients with gallstone-related disease to receive their cholecystectomy within 8 days of presentation1. Only 63.6% of eligible patients at East Lancashire Hospitals NHS Trust (ELHT) had their surgery within the target time. This project was done to identify the reasons behind ELHT not achieving the set target and to implement changes to overcome this.
Method
This was a retrospective review of a prospectively collected data of 444 patients from the ELHT Chole-QuIC database (July 2019-November 2020). Data were analysed in three periods: initial period (July 2019-November 2019), pre-COVID-19 period (December 2019-February 2020), COVID-19 period (March 2020-November 2020). Time to surgery was established. If the 8-day target was not met, reasons behind the delay were recorded.
Results
During the first cycle, the main reasons delays included the patients being temporarily unfit (13.8%), insufficient theatre capacity (13.8%) and variations in treatment plans (11.32%). 8% of patients had re-admissions related to their gallstone disease. Changes were implemented forward included a clear local gallstone disease management pathway and CholeQuIC referral system, increasing theatre capacity, and allocating pre-operative assessment slots. Gold standard cholecystectomy target period improved from 63.6% to 67.4% within three months of changes. However, the figure drastically reduced during the COVID-19 pandemic (36.3%) as elective surgeries were temporarily suspended.
Conclusions
The implementation of a gallstone disease management pathway, a coordinated referral system and additional theatre capacity contributed to the increase in cholecystectomies that were performed within the 8-day national target period.
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Adnan A, Sange S, Ahmed M, Kanchustambam S. 1137 Improving the Use of Pre-Operative Skin Antiseptics (Chlorhexidine Pink and Betadine) To Reduce Umbilical Port Site Infections Following Laparoscopic Cholecystectomy and Appendicectomy. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Approximately 8% of patients who undergo laparoscopic surgery develop port site infections1. This would negatively impact recovery and increase rates of readmission. Patients’ skin is a major source of pathogens that results in surgical site infection (SSI). Therefore, optimisation of antiseptic skin preparations may decrease postoperative umbilical port site infection (UPSI).
Method
A retrospective analysis of 226 cases from August 2019 till October 2020 at East Lancashire Hospital NHS Trust was performed. The first cycle included 122 patients (58 cholecystectomies and 64 appendicectomies), and a further 104 patients (51 cholecystectomies and 53 appendicectomies) after emphasising on using chlorhexidine pink as skin preparation. The presence of UPSIs within 30 days post-surgery was recorded.
Results
In the first cycle, the local preparation that was used in patients with UPSI was chlorhexidine pink (21.4%) and betadine (78.6%). The surgical team were then educated regarding the benefits of chlorhexidine pink over betadine as local skin preparation. In the second cycle, 63.3% used chlorhexidine pink and 36.7% used betadine. After the above implementation, there was a reduction in the rate of UPSI (18.0% to 15.7%) and readmission rates (7.2% to 5.9%) in patients who had undergone laparoscopic cholecystectomy. In patients who had undergone laparoscopic appendicectomy, a similar trend in UPSI rates was identified as well (7.1% to 5.5%) and readmission rates (5.5% to 1.9%).
Conclusions
The incidence of UPSI was reduced with the use of chlorhexidine pink compared to betadine. This may have contributed to the decrease in UPSI cases and led to a reduction in re-admission rates.
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Erhabor O, Mohammad SY, Bello L, Onuigwe FU, Abdulrahman Y, Zama I, Buhari H, Bagudo A, Ibrahim K, Ahmed M, Udomah FP, Adias TC, Erhabor T, Okara GC. Prevalence of some hepatitis B virus markers among pregnant women attending antenatal clinic in Specialist Hospital Sokoto Nigeria. Hum Antibodies 2021; 28:233-243. [PMID: 32333583 DOI: 10.3233/hab-200412] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Hepatitis B virus infection is a global public health problem. The virus has infected more than one-third of the global population. It has been estimated that 360 million chronic carriers are living around the world with a high risk for developing cirrhosis, hepatic carcinoma and hepatic failure. OBJECTIVE The aim of this study was to determine the prevalence of some hepatitis B markers among pregnant women attending antenatal clinic in Sokoto Specialist Hospital, Nigeria. METHODS The hepatitis testing was carried out using the Skytec-Rapid Diagnostic HBV-5 rapid kit (Skytec-Rapid Diagnostic, USA). The kit is based on lateral flow chromatographic immunoassay for the qualitative detection of HBsAg, HBsAb, HBeAg, HBeAb, and HBcAb in human serum or plasma. Panel format can conveniently test for five targets at once and utilizes all markers to help distinguish between acute and chronic infections. RESULTS Out of 117 pregnant women tested, 15 were positive for HBsAg (12.8%), 6 positive for HBsAb (5.1%), 1 for HBeAg (0.9%), 14 tested positive for HBeAb (12.0%), and 14 tested for HBcAb (12.0%). The prevalence of HBsAg, HBsAb, HBeAg, HBcAb and HBcAb was compared based on ethnicity. HBsAb was significantly higher among the Hausa ethnic group (p= 0.001). The prevalence of HBsAb, HBeAg, HBcAb and HBcAb was not affected by ethnicity (p> 0.05). The prevalence of HBsAg, HBsAb, HBeAg, HBcAb and HBcAb was compared based on age. Infection by the hepatitis B virus markers was higher among young adult and middle age groups. The difference was however not statistically significant (p> 0.05). The prevalence of HBsAg, HBsAb, HBeAg, HBcAb and HBcAb was compared based on the educational status, previous history of blood transfusion, jaundice, employment status and previous history of still births among the pregnant subjects. There were no statistically significant differences in the prevalence of Hepatitis B virus markers (p> 0.05). CONCLUSION The study observed a high prevalence of various hepatitis B viral markers among pregnant women attending antenatal care in Specialist Hospital Sokoto. There is need for routine screening of all pregnant women and infants born to hepatitis B positive mothers. Government and non-governmental organizations should intensify efforts to enlighten the general population on the public health importance of the disease and the importance of hepatitis screening. There is also need for the development of a treatment protocol for the management of pregnant women positive for hepatitis B to prevent mother to child transmission. There is an urgent need for the implementation of evidenced-based best practice of providing universal vaccination against hepatitis B for all hepatitis B negative women of child bearing age in particular and all Nigerians in general.
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Uribe-Diaz S, Nazeer N, Jaime J, Vargas-Bermúdez DS, Yitbarek A, Ahmed M, Rodríguez-Lecompte JC. Folic acid enhances proinflammatory and antiviral molecular pathways in chicken B-lymphocytes infected with a mild infectious bursal disease virus. Br Poult Sci 2021; 63:1-13. [PMID: 34287101 DOI: 10.1080/00071668.2021.1958298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
1. This study evaluated the effect of folic acid (FA) supplementation on the proinflammatory and antiviral molecular pathways of B-lymphocytes infected with a modified live IBDV (ST-12) mild vaccine strain during a timed post-infection analysis.2. A chicken B-lymphocytes (DT-40) cell line was cultured in triplicate at a concentration of 5 × 105 cells per well in 24-well plates; and was divided into three groups: 1: No virus, FA; 2: Virus, no FA; 3: Virus + FA at a concentration of 3.96 mM. The experiment was repeated three times.3. Cells in groups 2 and 3 were infected with a modified live IBDV (ST-12) mild vaccine strain at one multiplicity of infection (MOI: 1). After 1 hour of virus adsorption, samples were collected at 0, 3, 6, 12, 24 and 36 hours post-infection (hpi).4. The modified live IBDV (ST-12) mild vaccine strain triggered a B-lymphocyte specific immune response associated with the upregulation of genes involved in virus recognition (Igß), virus sensing (TLR-2, TLR-3, TLR-4 and MDA5), signal transduction and regulation (TRIF, MyD88 and IRF7), and the antiviral effector molecules (IFN-α, OAS, PKR, and viperin).5. FA supplementation modulated IBDV replication and regulated the proinflammatory and antiviral downstream molecular pathways.6. In conclusion, the low virulent pathotype serotype I modified live IBDV (ST-12) mild vaccine strain was able to trigger and mount an immune response in chicken B-lymphocytes without affecting B-cell viability. FA supplementation modulated B lymphocytes response and improved their innate immune proinflammatory and antiviral response molecular pathways.
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Winter J, Kraus K, Ahmed M, Combs S, Wilkens J, Bartzsch S. PD-0933 Microbeam radiotherapy planning for a clinical lung tumor case. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07212-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Clarke S, Alves F, Martins N, Ahmed M, Sanchez L, Donovan J, Kouranos V, Wechalekar K. Blood ketone measurement as a test for dietary compliance in cardiac sarcoid patients undergoing 18f-fluorodeoxyglucose positron emission tomography. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeab111.074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Imaging with 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET) is used as part of diagnosis and monitoring response to therapy in patients with cardiac sarcoidosis. In order to supress myocardial uptake of 18F-FDG patients prepare with a low carbohydrate diet followed by an 18-hour overnight fast. Failure to comply with the protocol results in diffuse myocardial 18F-FDG uptake which confounds diagnostic interpretation.
Purpose
To assess if point of care blood ketones could be used as a marker of dietary compliance and association with suppression of myocardial 18F-FDG uptake on PET scan.
Method
Patients (n = 26, 57 ± 4 years, 65% Male) from a single centre were instructed to follow standard preparation protocol prior to 18F-FDG PET/CT. After confirmation of dietary compliance, blood glucose and blood ketones were recorded using point of care devices. Images were graded based on the pattern of myocardial 18F-FDG uptake.
Results
There was no clear correlation between blood ketones in relation to dietary compliance or myocardial 18F-fluorodeoxyglucose uptake. In those with myocardial 18F-FDG uptake maximum standardized uptake value (SUV max) within the myocardium ranged from 2.3 to 9.8 (Mean 5.3) and ketone from 0.1 – 0.7 (normal <0.6).
Non-diabetic patients and those on steroids achieved adequate fasting glucose without significant rise in blood ketones. 60% of diabetic patients demonstrated mildly elevated ketones between 0.6-1.5mmol/L.
Conclusion
Current protocol with low carbohydrate diet and 18-hour fast achieves adequate quality of images in majority of patients, without significant change in blood ketones. Therefore, blood ketones cannot be used to confirm dietary compliance. Diabetic patients on insulin may benefit from ketone measurement due to risk of diabetic ketoacidosis.
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Zribi A, Ben Nasr S, Ahmed M, Fendri S, Balti M, Mansouri N, Bizid S, Haddauoi A. P-8 Nutritional status among colorectal cancer patients in Tunisia. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Akhtar MU, Hifzulrahman, Saadullah M, Pasha TN, Abdullah M, Ahmed M, Shahbakht RM, Haque MN. Effects of prepartum dietary protein level and feed intake on postpartum lactation performance and feeding behavior of multiparous Holstein dairy cows. J Dairy Sci 2021; 104:9886-9901. [PMID: 34218915 DOI: 10.3168/jds.2021-20218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 05/23/2021] [Indexed: 11/19/2022]
Abstract
An experiment was conducted to determine the effects of low and high metabolizable protein (MP) diets when fed for ad libitum and controlled intake during the prepartum period on postpartum lactation performance and feeding behavior of dairy cows. Thirty-six multiparous Holstein cows were blocked by parity, expected calving date, and previous lactation milk yield at -21 d relative to expected calving and were randomly assigned to 1 of 4 close-up period dietary treatments providing low MP (LMP) or high MP (HMP) diets with controlled intake (CNI) or ad libitum intake (ALI). The concentrations of MP were 65 and 90 g/kg dry matter for LMP and HMP diets, respectively, whereas intake was controlled to supply 100 and 160% of the NRC (2001) energy requirements for CNI and ALI groups, respectively. The concentration of net energy for lactation (NEL) in the treatment diets was 1.50 Mcal/kg. All cows were fed a similar lactation diet after calving (1.50 Mcal/kg of NEL and 83.3 g/kg of MP). The HMP diet increased dry matter intake during the first 3 wk and tended to increase dry matter intake over the 9 wk of lactation. Meal size and eating rate increased in the ALI cows during the prepartum period. Meal frequency increased with the HMP diet during the postpartum period. Milk yield increased by 15.2% with the HMP diet over the 9 wk of lactation. The HMP diet increased energy-corrected milk (ECM) yield in CNI versus ALI cows, whereas the LMP diet increased ECM yield in ALI versus CNI cows over the 9 wk of lactation. The increase in ECM yield of LMP-ALI versus LMP-CNI cows was supported by greater body condition loss and serum β-hydroxybutyrate over the 9 wk of lactation. Taken together, these data indicate that prepartum controlled intake of a high protein diet can provide the benefits of both strategies.
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Mahbub-Uz-Zaman K, Debnath D, Khalil MM, Tahmid MS, Monir S, Munmun ST, Jannat T, Samaruk R, Sharmi TZ, Debnath D, Dey S, Ahmed M, Ahmad F, Debnath CR. Socio-demographic Profile of COVID-19 Patients and Difficulties Faced by Them while Testing RT-PCR: A Multi-center Cross-sectional Study. Mymensingh Med J 2021; 30:796-802. [PMID: 34226470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
This study was aimed to find out the socio-demographic profiles as well as difficulties of Reverse transcription polymerase chain reaction (RT-PCR) testing faced by Coronavirus Disease 2019 (COVID-19) patients. This cross-sectional study was conducted from 10th August to 7th September 2020. Data were collected by telephone interview using a pre-designed questionnaire after taking verbal consent from the participants. Out of 281 COVID-19 patients, 279 were diagnosed by RT-PCR; 10.3% were asymptomatic. Off them 67.6%were males, 24% were hospital staffs. Majority (66.2%) were from the non-city corporation area. History of recent contact with known COVID-19 patients was present in 56.9% cases. Fever (78.3%) and cough (58%) were the most common symptoms. One third of the patients faced difficulty to test RT-PCR for COVID-19. Sixteen percent patients complained of difficulty of getting serial for testing, the maximum waiting time was one week before giving samples. Thirty patients (10.8%) had to wait longer than usual time after reaching the center before giving sample. Hospital staffs were unable to co-operate in 2.5% of the patients while difficulty of managing transport to the hospital for suspected COVID-19 patient was an issue in 2.2% of the patients. Though testing was more difficult in city corporation areas (p=0.028), delay of getting test result was less (p<0.001). Maximum delay of getting test result was 10 days. Finding out the difficulties of COVID-19 testing will help to point out the issues behind these and will help to take necessary steps to tackle this matter. Testing rate can be increased to contain this highly contagious virus in this densely populated country.
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Melliti R, Zribi A, Ben Nasr S, Ahmed M, Fendri S, Balti M, Mansouri N, Bizid S, Haddauoi A. P-9 Prognostic role of preoperative inflammation parameters in predicting postoperative complications of colorectal cancer surgery. Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.05.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Nazeer N, Uribe-Diaz S, Rodriguez-Lecompte JC, Ahmed M. Antimicrobial peptides as an alternative to relieve antimicrobial growth promoters in poultry. Br Poult Sci 2021; 62:672-685. [PMID: 33908289 DOI: 10.1080/00071668.2021.1919993] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
1. This review describes different classes of antimicrobial peptides (AMP) found in the gastrointestinal (GI) tract of avian species, and their antimicrobial and immunomodulatory activities. The potential benefits of synthetic AMP in poultry production are examined, in the context of the use of AMP as alternatives to antimicrobial growth promoters (AGP).2. Since the mid-1950s, antibiotic growth promoters (AGP) have been used in feed at low prophylactic doses to modulate the homoeostasis of intestinal microbiota, decreasing the risk of intestinal dysbacteriosis and the growth of pathogens within the avian gut. Over the last three decades, AGP have faced major regulatory restrictions due to concerns of generating antimicrobial resistance (AMR). It is now well documented that the rate of infectious disease outbreaks is higher in flocks that are not fed prophylactic antibiotics, resulting in a compensatory increase in antimicrobial use for therapeutic purposes.3. Endogenous natural AMP production is associated with the presence of microbiota and their interaction with the intestinal epithelial and lamina propria lymphoid cells. Their antimicrobial activity shapes the beneficial microbiota population and controls intestinal pathogens such Clostridium and Salmonella spp., and stimulates the development and maturation of the local immune system.4. Similar to AGP, AMP can establish a well-balanced gut beneficial microbiota for adequate immune-competence, animal health and high growth performance parameters such as feed intake, daily weight, feed conversion and accumulated mortality.5. Antimicrobial proteins and peptides constitute an essential part of the innate immune system of all organisms and protect the host from invading pathogenic bacteria, viruses, fungi, and parasites by interacting with the negatively charged pathogen membranes.
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Omara M, Ali S, Ahmed M. Accuracy of midface advancement using patient-specific surgical guides and pre-bent plates versus conventional interocclusal wafers and conventional plate fixation in quadrangular Le Forte II osteotomy. A randomised controlled trial. Br J Oral Maxillofac Surg 2021; 59:1253-1258. [PMID: 34503857 DOI: 10.1016/j.bjoms.2021.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/03/2021] [Indexed: 10/21/2022]
Abstract
The aim of this study was to assess the accuracy of quadrangular Le Fort II osteotomy and midface advancement utilising digitally fabricated surgical guides with pre-bent plates compared with conventional interocclusal wafers. Twenty patients with midface deficiency were allocated randomly to two groups: patient-specific surgical guides and pre-bent titanium miniplates were utilised in the study group, while conventional interocclusal wafers with intraoperatively adapted titanium miniplates were utilised in the control group. The accuracy of virtual planning was assessed in both groups using computed tomography (CT). Both groups showed accurate transfer of the plan, but the computer-guided group showed significantly greater accuracy and a shorter surgical time than the conventional group. The use of patient-specific surgical guides and pre-bent plates represents a promising computer-guided approach especially for inexperienced surgeons. Nevertheless, a major limitation is increased overall cost compared with the conventional approach.
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Hashmi Z, Ahmed R, Zafar T, Ahmed M, Yousaf N, Chaudhary K, Islam R, Aljarad F, Madanur M. 950 Experience of Inguinal Mesh Hernioplasty Under Local Anaesthesia: A 3-Year Experience in A Teaching Hospital. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.592] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Objective
To prove Inguinal mesh hernioplasty under L/A is safe and acceptable. Helps with post-operative pain and enables rapid recovery as a day case.
Method
All patients who underwent inguinal hernia repair under local anaesthesia were retrospectively analysed in our hospital between July 2014- July 2017. Clinical judgement was used for inclusion and exclusion parameters.
Results
From July 2014- July 2017, 260 patients were included in study who underwent Inguinal mesh hernioplasty under L/A. ASA grade for all patients ranged between I-III. The mean age was 37 (20-65). Intraoperatively (9.1) 3.5% patients had problems such as pain, hypotension or sweating. About (86.3%) 224 patients were discharged home the same day and remaining stayed overnight for less than 24 hours. Hematoma was seen in 5 (1.92%) patients, Urinary retention in 2 (0.7%) patients, Wound infection seen in 24(9.2%) patients, Readmission in 10 (3.8%) patients. Chronic groin pain was seen in 10 (3.9%) patients and no recurrence on 6 months follow up.
Conclusions
Our results showed that this procedure is feasible under L/A and can be performed safely. It showed satisfactory acceptance by the operating surgeon and patient, without significant perioperative issues. It is reliable and showed shorter hospital stay.
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Subbiah Ponniah H, Ahmed M, Edwards T, Cobb J, Dean E, Clark C, Logishetty K. 905 How to prioritise patients and safely resume elective surgery during the Covid-19 pandemic. Br J Surg 2021. [PMCID: PMC8135653 DOI: 10.1093/bjs/znab134.095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Introduction
There are now over 2.5 million NHS patients awaiting elective surgery, with the most in orthopaedics. We present an algorithm and results for safely and equitably restarting surgery at COVID-light sites.
Method
An MDT applied the COVID-19 Algorithm for Resuming Elective Surgery (CARES) on 1169 patients awaiting elective orthopaedic surgery. It assessed safety, procedural efficacy, and biopsychosocial factors, to prioritise patients. They were assigned to five categories and underwent surgery at one of three COVID-light sites (1. access to HDU/ITU/Paediatrics/specialist equipment, 2. an NHS elective surgical unit and 3. a private elective surgical unit).
Results
21 ‘Urgent’ patients received expedited care; 118 were Level 1/2; 222 were Level 3; 808 were Level 4. In 6 weeks, 355 surgeries were performed, with Urgent and Level 1/2 cases performed soonest (mean 18 days, p < 0.001). 33 high-risk/complex/paediatric patients had surgery at Site 1 and the rest at Sites 2 and 3. No patients contracted COVID-19 within 2 weeks of surgery.
Conclusions
We validated a widely generalisable model to facilitate resumption of elective surgery in COVID-light sites. It enabled surgery for patients in most suffering, undergoing the most efficacious procedures and/or at highest risk of deterioration, without compromising patient-safety.
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Bhojwani A, Ahmed M, Mahmood F, Sellahewa C, Desai C. 888 Challenges in The Management of Lower Gastrointestinal Bleeding in General Surgery: Developing Consistent Practice and Application of BSG Guidelines. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Lower gastrointestinal bleeding (LGIB) accounts for 3% of all surgical referrals in the UK, with an in-hospital mortality of 3.4%. The BSG 2019 guidelines recommend risk stratification as per Oakland scoring, inpatient lower GI endoscopy for admissions and CT-angiography for unstable patients. This study evaluates the delivery of these outcomes in a district hospital setting.
Method
Retrospective audit assessing all acute LGI bleed admissions from 01-07-2019 to 28-02-2020 at Russells Hall Hospital. Shock Index (SI) and Oakland score used to stratify patients into unstable, stable-major and stable-minor LGIB. Compliance with BSG standards was assessed by review of investigations and emergent patient management.
Results
143 patients (Median age = 70years) evaluated, with 64 admissions having no formal risk stratification (OAKLAND-score) documented. Only 12 admissions underwent inpatient LGI endoscopy with sigmoid diverticulosis the most common pathology (39.3%). CT-angiogram was the initial investigation for 75% of patients admitted with unstable LGIB.
Conclusions
OAKLAND-scoring is a sensitive tool to stratify LGIB patients based on clinical parameters. Application of BSG-2019 guidelines and developing consistency in management is challenged by the lack of routine access to LGI endoscopy and tools to manage bleeding endoscopically.
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