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Hasan R, Khan OS, Aftabuddin M, Razzaque AM, Chowdhury GA. A Case of Massive Pleural Effusion: Pleurodesis by Bleomycin. Mymensingh Med J 2016; 25:374-378. [PMID: 27277376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Malignant pleural effusion is a common complication of primary and metastatic pleural malignancies. Pleurodesis for the management of malignant pleural effusion is intended to achieve symphysis between parietal and visceral pleura, and to prevent relapse of pleural effusion. Many chemical agents are tried to induce inflammation and damage of the pleural mesothelial layer to achieve this symphysis. Hemorrhagic pleural effusion, especially in the right hemithorax commonly occurs as presentation of primary and metastatic pleural malignancies. This case reports massive right-sided hemorrhagic pleural effusion as the sole manifestation of primary lung cancer in a 45 year old man. Patient attended our department of thoracic surgery complaining of cough, shortness of breath and right sided chest pain. A chest X-ray and chest computer tomography (CT) radiograph shows right sided massive pleural effusion. Right sided tube thoracotomy done. Pleural fluid study was done. Fluid for cytopathology was positive for malignant cell. Computed tomography guided fine needle aspiration cytology from right lung lesion was also done. Diagnosis was as small cell carcinoma. Pleural effusion resolved after 9(th) post operative day of chest tube insertion. Bleomycin pleurodesis was done. Day after pleurodesis intra thoracic tube was removed and patient was discharged from hospital on 10(th) Post operative day with an advice to attend the oncology department for further treatment. The protocol of tube thoracostomy and chemical pleurodesis was almost always successful in giving symptomatic relief of respiratory distress for a considerable period of time. However, chemical pleurodesis is not possible in all cases of malignant pleural effusion because it has got potential complication including death.
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Hasan R, Bianco B, Trebelev A. TIPS constraint: assessing clinical outcomes of the parallel stent reduction technique. J Vasc Interv Radiol 2016. [DOI: 10.1016/j.jvir.2015.12.139] [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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Peng SL, Pinho M, Lu H, Magadan A, Hasan R, Warach S, Luby M, Cheng B, Thomalla G, Shang T. Abstract WP55: Predicting Malignant Edema in MCA Infarct Using MRI and MR Perfusion Parameters. Stroke 2016. [DOI: 10.1161/str.47.suppl_1.wp55] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction:
Malignant edema in large MCA infarct (MMI) is known for high rate of mortality and morbidity. Hemicraniectomy was showed to decrease mortality but not improve functional outcome. Further studies are required for better patient selection for surgery. Among several clinical biomarkers, DWI lesion volume > 82 ml within 6 hours from symptoms onset is the most used predictor for MMI. There is also evidence suggesting brain edema is correspond with severity of tissue ischemia, which could be measured by semiquantitative cerebral blood volume (CBV) and cerebral blood flow (CBF) on MRP map. We hypothesized that DWI volume combining with MRP parameters could provide more predictive value.
Methods:
Patients in MMI-MRI study (a prospective, multicenter, observational MRI/MRP study of MCA ischemic stroke within 6 hours of symptom onset) and STIR (Stroke Imaging Repository) were included if they met the inclusion criteria: age ≥ 18, MCA infarct with NIHSS ≥ 15, and MRI/MRP study within 12 hours from symptoms onset. Patients underwent thrombectomy, with poor quality images or without follow up images, with bilateral strokes, or developed hemorrhagic transformation were excluded. MMI was defined as NIHSS score >18 with suppressed level of consciousness, and at least 2/3 of the MCA territory infarct on follow-up MRI or CT.
Results:
Of 89 patients included, 17 (19.1%) developed MMI. A malignant edema predicting score (MEPS) of maximum three points was developed: one point for DWI lesion volume > 82 ml, one point for more than 40% of DWI volume with CBV < 40% of contralateral normal side, and one point for more than 50% DWI volume with CBF < 30% of contralateral normal side. The threshold of a DWI lesion volume > 82 ml predicted malignant edema with sensitivity (0.65, 95% CI 0.39-0.85), specificity (0.86, 95% CI 0.75-0.93), positive predictive value (0.52, 95% CI 0.30-0.74), and negative predictive value (0.91, 95% CI 0.81-0.96). MEPS ≥ 2 predicted malignant edema with sensitivity (0.65, 95% CI 0.39-0.85), specificity (0.98, 95% CI 0.91-1.00), PPV (0.92, 95% CI 0.60-1.00), and NPV (0.92, 95% CI 0.83-0.97).
Conclusions:
DWI volume is reliable in predicting MMI. The addition of information on tissue ischemia in a multivariate score improves the prediction of MMI over DWI alone.
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Tee AH, Hasan R, Mclaughlin KE, Keenan DJM, Datta S. Is pre-operative haemoglobin A1c level a successful predictor of adverse outcome after cardiac surgery? J Cardiothorac Surg 2015. [PMCID: PMC4695747 DOI: 10.1186/1749-8090-10-s1-a328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Alsawi M, Amer T, Hutton R, Hasan R, Biju D, Clark R, Little B. Transperitoneal laparoscopic nephrectomy with intact specimen extraction via pfannenstiel nephrectomy (PFN) versus extended port site extraction (EPS): preliminary experience in an unselected population. Int J Surg 2015. [DOI: 10.1016/j.ijsu.2015.07.590] [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]
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Ilayperuma I, Nanayakkara BG, Hasan R, Uluwitiya SM, Palahepitiya KN. Coracobrachialis muscle: morphology, morphometry and gender differences. Surg Radiol Anat 2015; 38:335-40. [PMID: 26464302 DOI: 10.1007/s00276-015-1564-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Accepted: 10/01/2015] [Indexed: 10/23/2022]
Abstract
PURPOSE Coracobrachialis (CBM) is a complex muscle with a wide range of variations in its morphology and innervation. The goal of this study was to elucidate the morphology, morphometry, gender differences of CBM and precise anatomical position of the musculocutaneous nerve (MCN) with reference to surrounding anatomical landmarks in an adult Sri Lankan population. METHOD Cadaveric upper limbs (n = 312) were examined for the proximal and distal attachments, length, width, thickness of CBM and its relationship with the MCN. RESULTS The CBM originated from the tip of the coracoid process of the scapula and lateral, posterior and medial aspects of the tendon of short head of biceps brachii. Gender differences were observed in all morphometrical parameters of CBM. In 83.33 %, MCN perforated the CBM. In 50 % the MCN pierced the middle one-third of CBM while none pierced the lower one-third. The distance from the coracoid process to the point of entry of MCN into CBM (distance P) was 50.62 mm. A positive correlation was observed between the arm length and distance P indicating that arm length provides an accurate and reliable means of gauging the distance P of an individual. CONCLUSION The present study provides new evidence pertaining to the origin of CBM. Further, it was revealed that the predicted distance P of any upper extremity can be calculated by dividing the arm length by 5. Precise anatomical location of MCN in relation to CBM using unequivocal and well-defined anatomical landmarks will be imperative in modern surgical procedures.
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Chin YT, Hasan R, Qamruddin A. 16S rRNA PCR for the diagnosis of culture-negative Bartonella quintana endocarditis: the importance of sample type. Indian J Med Microbiol 2015; 33:185-6. [PMID: 25560036 DOI: 10.4103/0255-0857.148429] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
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Kamal SMM, Hossain A, Sultana S, Begum V, Haque N, Ahmed J, Rahman TMA, Hyder KA, Hossain S, Rahman M, Ahsan CR, Chowdhury RA, Aung KJM, Islam A, Hasan R, Van Deun A. Anti-tuberculosis drug resistance in Bangladesh: reflections from the first nationwide survey. Int J Tuberc Lung Dis 2015; 19:151-6. [PMID: 25574912 DOI: 10.5588/ijtld.14.0200] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To determine the prevalence of tuberculosis (TB) drug resistance in Bangladesh. DESIGN Weighted cluster sampling among smear-positive cases, and standard culture and drug susceptibility testing on solid medium were used. RESULTS Of 1480 patients enrolled during 2011, 12 falsified multidrug-resistant TB (MDR-TB) patients were excluded. Analysis included 1340 cases (90.5% of those enrolled) with valid results and known treatment antecedents. Of 1049 new cases, 12.3% (95%CI 9.3-16.1) had strains resistant to any of the first-line drugs tested, and 1.4% (95%CI 0.7-2.5) were MDR-TB. Among the 291 previously treated cases, this was respectively 43.2% (95%CI 37.1-49.5) and 28.5% (95%CI 23.5-34.1). History of previous anti-tuberculosis treatment was the only predictive factor for first-line drug resistance (OR 34.9). Among the MDR-TB patients, 19.2% (95%CI 11.3-30.5; exclusively previously treated) also showed resistance to ofloxacin. Resistance to kanamycin was not detected. CONCLUSION Although MDR-TB prevalence was relatively low, transmission of MDR-TB may be increasing in Bangladesh. MDR-TB with fluoroquinolone resistance is rapidly rising. Integrating the private sector should be made high priority given the excessive proportion of MDR-TB retreatment cases in large cities. TB control programmes and donors should avoid applying undue pressure towards meeting global targets, which can lead to corruption of data even in national surveys.
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Shakoor S, Malik F, Hasan R. High proportion of multidrug resistant Mycobacterium tuberculosis among children in Pakistan. Int J Mycobacteriol 2015. [DOI: 10.1016/j.ijmyco.2014.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Irfan S, Jabeen K, Irfan M, Rao N, Azizullah Z, Hasan R. Safe and cost-effective treatment response monitoring of MDR pulmonary tuberculosis by using micro colony broth culture method. Int J Mycobacteriol 2015. [DOI: 10.1016/j.ijmyco.2014.10.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Alam MM, Mia MNH, Hasan R, Shahinuzzaman M, Islam MK, Uddin KMN. Study of Structural and Morphological Properties of Vacuum Coated Copper (Cu) Metal Thin Film. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/msa.2015.68077] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Verdolini R, Atkar R, Clayton N, Hasan R, Stefanato CM. Catamenial dermatoses: has anyone ever considered prostaglandins? Clin Exp Dermatol 2014; 39:509-12. [DOI: 10.1111/ced.12333] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2013] [Indexed: 11/27/2022]
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Masood M, Romano M, Haft J, Hasan R, Aaronson K, Pagani F. Effectiveness of Continuous Flow Left Ventricular Assist Device Exchange for Recurrence of Major Drive Line and Pump Pocket Infection. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.535] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Masood M, Knott K, Haft J, Hasan R, Romano M, Aaronson K, Pagani F. Assessment of Blood Pressure Measurements in Patients with Continuous Flow Left Ventricular Assist Devices: Arterial Line vs. Doppler Opening Pressure vs. Double-Cuff Oscillatory Sphygmomanometer. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Masood M, Wang L, Romano M, Haft J, Hasan R, Aaronson K, Pagani F. Efficacy of Intravenous Tissue Plasminogen Activator (tPA) in Treatment of Device Thrombus in Continuous Flow Left Ventricular Assist Devices with Centrifugal Design. J Heart Lung Transplant 2014. [DOI: 10.1016/j.healun.2014.01.354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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Ahsan AI, Hasan R, Jamal N. Auditory neuropathy: A case report and review of literature. BANGLADESH JOURNAL OF OTORHINOLARYNGOLOGY 2014. [DOI: 10.3329/bjo.v19i2.17638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Auditory Neuropathy (AN), also known as Auditory Dyssynchrony(AD) is a very often missed diagnosis in clinical practice. In AN, sound enters the inner ear normally but the transmission of signals from inner ear to brain is impaired. Due to the lack of advanced audiological test facilities in Bangladesh, mostly AN remains undiagnosed. Here we described a 25 years old male, presented with difficulty in understanding speech for last 10 years. On audiologic evaluation, bilateral moderate sensorineural hearing loss was found on Pure tone audiogram (PTA). Speech discrimination scores were poor and disproportionate to his hearing threshold. Presence of Otoacoustic emission (OAE) revealed the normal function of cochlea. Conversely, absence of Auditory brainstem response (ABR) confirmed the definite dysfunction at auditory neural pathway and hence, the diagnosis of AN was confirmed. Since AN is an underdiagnosed condition in Bangladesh, otolaryngologists should be aware of this clinical entity. All the suspected cases should be referred to specialized centers, where advanced audiological facilities are available. DOI: http://dx.doi.org/10.3329/bjo.v19i2.17638 Bangladesh J Otorhinolaryngol 2013; 19(2): 135-139
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Garg S, Hasan R, Scahill S, Babar ZUD. Investigating inspection practices of pharmaceutical manufacturing facilities in selected Arab countries: views of inspectors and pharmaceutical industry employees. EASTERN MEDITERRANEAN HEALTH JOURNAL 2013. [DOI: 10.26719/2013.19.11.919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Garg S, Hasan R, Scahill S, Babar ZUD. Investigating inspection practices of pharmaceutical manufacturing facilities in selected Arab countries: views of inspectors and pharmaceutical industry employees. EASTERN MEDITERRANEAN HEALTH JOURNAL = LA REVUE DE SANTE DE LA MEDITERRANEE ORIENTALE = AL-MAJALLAH AL-SIHHIYAH LI-SHARQ AL-MUTAWASSIT 2013; 19:919-929. [PMID: 24673082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
There are few studies that explore inspection practices of pharmaceutical facilities from the viewpoint of inspectors and industry employees. In this descriptive, cross-sectional study, inspectors and quality assurance staff from 4 Arab countries--the United Arab Emirates, Saudi Arabia, Egypt and Jordan--were surveyed about their inspection practices and views. There was considerable variation in inspection practices across countries and between the inspectorate and quality assurance staff within countries. Divergence was found in views associated with payment mechanisms. There was mutual agreement by both groups that inspectors were in short supply and that they needed to be better trained. Inspectors appeared to have less authority than expected in order to control pharmaceutical manufacturing and marketing activities. Compounding this was a dearth of policy which would support a more uniform and systematic approach to the inspection process within and across countries.
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Datta S, Hasan R. 157-I * PSEUDO-ANEURYSM OF THE RIGHT INTERNAL MAMMARY ARTERY IN A PATIENT WITH STERNAL WOUND INFECTION. Interact Cardiovasc Thorac Surg 2013. [DOI: 10.1093/icvts/ivt372.157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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70
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Manoly I, McAnelly S, Mahadevan V, Clarke B, Hasan R. 149-I * TRANSCATHETER VALVE IMPLANTATION FOR NATIVE MITRAL VALVE DISEASE: ANOTHER MILESTONE BY THE HEART TEAM. Interact Cardiovasc Thorac Surg 2013. [DOI: 10.1093/icvts/ivt372.149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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71
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Khan M, Khan M, Hasan R, Godfrey Faussett P. Unusual sex differences in tuberculosis notifications across Pakistan and the role of environmental factors. EASTERN MEDITERRANEAN HEALTH JOURNAL 2013. [DOI: 10.26719/2013.19.9.821] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Khan MS, Khan MS, Hasan R, Godfrey-Faussett P. Unusual sex differences in tuberculosis notifications across Pakistan and the role of environmental factors. EASTERN MEDITERRANEAN HEALTH JOURNAL = LA REVUE DE SANTE DE LA MEDITERRANEE ORIENTALE = AL-MAJALLAH AL-SIHHIYAH LI-SHARQ AL-MUTAWASSIT 2013; 19:821-825. [PMID: 24313046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
In developing countries, only one-third of new tuberculosis cases notified are from women. It is not clear whether tuberculosis incidence is lower in women than men, or whether notification figures reflect under-detection of tuberculosis in women. Pakistan, however, presents an unusual pattern of sex differences in tuberculosis notifications. While 2 of the 4 provinces (Sindh and Punjab) report more notifications from men (female to male ratios 0.81 and 0.89 respectively in 2009), the other 2 provinces (Khyber-Pakhtunkhwa and Balochistan) consistently report higher numbers of smear-positive tuberculosis notifications from women than men (1.37 and 1.40). No other country is known to have such a large variation in the sex ratios of notifications across regions. Large variations in female to male smear-positive notification ratios in different settings across a single country may indicate that environmental factors, rather than endogenous biological factors, are important in influencing the observed sex differences in tuberculosis notifications.
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Ferwana M, Firwana B, Hasan R, Al-Mallah MH, Kim S, Montori VM, Murad MH. Pioglitazone and risk of bladder cancer: a meta-analysis of controlled studies. Diabet Med 2013; 30:1026-32. [PMID: 23350856 DOI: 10.1111/dme.12144] [Citation(s) in RCA: 111] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/23/2013] [Indexed: 01/08/2023]
Abstract
AIMS Pioglitazone, a thiazolidinedione, was approved for treatment of Type 2 diabetes. However, several observational studies suggest an association of pioglitazone with an increased risk of bladder cancer in patients with diabetes. Therefore, we sought to perform a systematic review and meta-analysis to evaluate the magnitude of this association and the quality of the supporting evidence. METHODS Electronic databases were queried to identify controlled studies of pioglitazone that measured the risk of bladder cancer. RESULTS Six studies involving 215 142 patients using pioglitazone were included, with a median period of follow-up of 44 months. The hazard of developing bladder cancer was significantly higher in patients using pioglitazone (hazard ratio 1.23; 95% CI 1.09-1.39; I² = 0%) compared with control groups. The risk of bias was moderate across the six studies. Considering an incidence rate of 20.8 per 100 000 person years, the number needed to harm was five additional cases of bladder cancer per 100 000 person years. CONCLUSIONS Patients treated with pioglitazone have a slight increased risk of bladder cancer compared to general population. Patient involvement and weighing treatment benefits versus risks should be discussed with patient toward shared decision. Patients with type 2 diabetes with risk factors, such as family history, smoking, or exposure to certain forms of chemotherapy may need to consider other anti-hyperglycemic agents. Also, pioglitazone should be discontinued in type 2 diabetes patients with newly diagnosed bladder cancer.
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Krishnan M, Manoly I, Karunaratne D, Hoschtitzky A, Hasan R. Surgical valve in valve implantation in pregnancy… a dilemma in the management of mechanical valves. J Cardiothorac Surg 2013. [PMCID: PMC3844736 DOI: 10.1186/1749-8090-8-s1-o69] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Farooqi JQ, Jabeen K, Saeed N, Iqbal N, Malik B, Lockhart SR, Zafar A, Brandt ME, Hasan R. Invasive candidiasis in Pakistan: clinical characteristics, species distribution and antifungal susceptibility. J Med Microbiol 2012; 62:259-268. [PMID: 23105021 DOI: 10.1099/jmm.0.048785-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
This study reports for the first time, to our knowledge, descriptive epidemiological data for 188 invasive Candida isolates from Pakistan, including species identification and antifungal susceptibility against fluconazole, itraconazole, voriconazole, caspofungin, micafungin, anidulafungin and amphotericin. Risk factors for invasive candidiasis (IC) were determined for 96 patients from Karachi, Pakistan. In adults and neonates, Candida tropicalis (38 and 36 %, respectively) was the most common species, followed in adults by Candida parapsilosis (17.8 %), Candida glabrata (15.9 %) and Candida albicans (12.3 %). C. albicans (21 %) was the second most common in neonates. In children, C. albicans (31.9 %), C. tropicalis (26.4 %) and C. parapsilosis (19.4 %) were the most common. C. albicans IC was significantly associated with paediatric age [crude odds ratio (COR) 3.46, 95 % confidence interval (CI) 1.63-7.32]. Rare species made up 17.5 % of the total isolates studied. Resistance to fluconazole was seen in C. glabrata (15 .0%) and Candida krusei (100 .0%). Only one isolate (C. glabrata) was resistant to all three echinocandins. Low MICs of fluconazole for 98 % (184/188) of isolates tested support its continued use as an empiric therapy for IC. Non-C. albicans IC was associated with the use of β-lactam inhibitor combinations (COR 3.16, 95 % CI 1.05-9.57). Use of healthcare devices was documented in 85.4 % of IC patients, whilst 75 .0% had been admitted to special care units. Surprisingly, 66.7 % of patients with IC were not obviously immunosuppressed. The high frequency of modifiable risk factors in this population indicates that candidaemia can be reduced with stringent antibiotic and infection control measures. These data will be useful for empiric selection of antifungals in Karachi, and contribute to global assessments of antifungal resistance.
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