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Franco NF, Lau NS, Liu WM, Rahim A, Fadia M, Chua YJ, Jain A, Yip D, Gananadha S. Outcomes of patients with gallbladder cancer presenting with acute cholecystitis. Langenbecks Arch Surg 2024; 409:73. [PMID: 38393412 PMCID: PMC10891216 DOI: 10.1007/s00423-024-03261-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 02/14/2024] [Indexed: 02/25/2024]
Abstract
The main purpose of this study is to explore the outcomes of patients found to have gallbladder cancer during investigation and diagnosis of acute cholecystitis. The incidence of primary gallbladder cancer co-existing in acute cholecystitis is not well defined in the literature, with anecdotal reports suggesting that they experience worse outcomes than patients with gallbladder cancer found incidentally. METHODS A retrospective review of all patients with gallbladder cancer managed at the Canberra Health Service between 1998 and May 2022 were identified and reviewed. RESULTS A total of 65 patients were diagnosed with primary gallbladder cancer during the study period with a mean age of 70.4 years (SD 11.4, range 59-81.8 years) and a female preponderance (74% versus 26%) with a ratio of 2.8. Twenty (31%) patients presented with acute calculus cholecystitis and were found to have a primary gallbladder cancer. This group of patients were older and predominantly female, but the difference was not statistically significant. The overall 5-year survival in the cohort was 20% (stage 1 63%, stage 2 23%, stage 3 16%, and stage 4 0%). There was no statistically significant difference in survival between those who presented with acute cholecystitis vs other presentations. CONCLUSIONS A third of the patients with gallbladder cancer presented with acute cholecystitis. There was no statistically significant difference in survival in those with bile spillage during cholecystectomy as well those presenting with acute cholecystitis.
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Affiliation(s)
- Nunzio F Franco
- Department of Surgery, Canberra Health Services, Canberra, Australia.
- School of Medicine and Psychology, Australian National University, Canberra, Australia.
| | - Ngee-Soon Lau
- Department of Surgery, Canberra Health Services, Canberra, Australia
| | - Wai M Liu
- School of Medicine and Psychology, Australian National University, Canberra, Australia
- Research School of Finance, Actuarial studies and Statistics, Australian National University, Canberra, Australia
| | - Aadil Rahim
- Department of Surgery, Canberra Health Services, Canberra, Australia
| | - Mitali Fadia
- Department of Anatomical Pathology, Canberra Health Services, Canberra, Australia
| | - Yu Jo Chua
- Department of Medical Oncology, Canberra Health Services, Canberra, Australia
| | - Ankit Jain
- Department of Medical Oncology, Canberra Health Services, Canberra, Australia
| | - Desmond Yip
- School of Medicine and Psychology, Australian National University, Canberra, Australia
- Department of Medical Oncology, Canberra Health Services, Canberra, Australia
| | - Sivakumar Gananadha
- Department of Surgery, Canberra Health Services, Canberra, Australia
- School of Medicine and Psychology, Australian National University, Canberra, Australia
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Islam MR, Biswas S, Mowla SGM, Banik GC, Ahmed HU, Rahim A, Tanveer T, Amin MR, Azad KAK. Mental Health Assessment of Health Care Providers of Bangladesh during Covid-19 Pandemic: A Cross-Sectional Web-Based Study. Mymensingh Med J 2024; 33:247-253. [PMID: 38163800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
SARS COV 2 raised immense agony to everyone. As health care workers remains direct contact with patients, they are vulnerable to mental health disorder. The study was done to identify mental health status of health care providers of Bangladesh. It was a cross sectional web based survey among health care providers of bangladesh. A structured web based questionnaire was prepared both in Bangla and English version for better understanding. Total 2594 health care workers responded to online survey. Male were 1303(50.2%) and female were 1291(49.8%). Occupational demography shows 98.5% were physicians. Mean value of patient health questionnaire 9 (PHQ9) and generalized anxiety disorder (GAD) were 8.43±6.082 and 8.27±5.234 respectively among healthcare providers. To overcome anxiety and depression, 93.4% of HCW didn't receive any psychological material and 85.6% HCW didn't find physiological resources even through media. Despite many lacking, healthcare workers were resilient in our study.
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Affiliation(s)
- M R Islam
- Professor Mohammad Rafiqul Islam, Professor of Medicine, Shaheed Suhrawardy Medical College, Dhaka, Bangladesh; E-mail:
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Lim H, Shi M, Rahim A, Vardy L. 598 The polyamines spermidine and spermine are essential regulators of epidermal differentiation and cell migration during wound healing. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Rahim A, Frahm-Jensen G. Missing cervical vertebrae. ANZ J Surg 2021; 92:1935-1937. [PMID: 34854524 DOI: 10.1111/ans.17402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 11/18/2021] [Accepted: 11/20/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Aadil Rahim
- Department of Vascular Surgery, The Canberra Hospital, Garran, Australian Capital Territory, Australia
| | - Gert Frahm-Jensen
- Department of Vascular Surgery, The Canberra Hospital, Garran, Australian Capital Territory, Australia
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Jan T, Gul S, Khan A, Pervez S, Noor A, Amin H, Bibi S, Nawaz MA, Rahim A, Ahmad MS, Azam R, Ullah H. Range of factors in the reduction of hyperhydricity associated with in vitro shoots of Salvia santolinifolia Bioss. BRAZ J BIOL 2021; 83:e246904. [PMID: 34706025 DOI: 10.1590/1519-6984.246904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Accepted: 07/05/2021] [Indexed: 11/22/2022] Open
Abstract
Hyperhydricity is a serious physiological disorder and affects In vitro propagation of many plants and as well of Salvia santolinifolia. The donor material to initiate the in vitro culture was the callus taken from the in vitro shoots produced on Murashig and Skoogs (MS) medium at 4.0 mg/l BA. This callus formed numerous hyperhydric shoots on culturing upon the medium of the same composition. The aim was to systematically evaluate the effect of cytokinins (Benzyladnine (BA) and N6-(-2-isopentenyl) adenine (2iP), culture vessels magnitude, medium solidification, source of nitrogen and calcium chloride for the alleviation of hyperhydricity. In the tissue cultures of S. santolinifolia BA and 2iP induced severe hyperhydricity, when other factors i.e. culture vessels magnitude and a suitable concentration of agar, ammonium nitrate (NH4NO3), potassium nitrate (KNO3) & calcium chloride (CaCl2.2H2O) were not optimized. After 30 days' culture, we observed 83.82% hyperhydric shoots at increased level (1.5 mg/l 2iP) and 81.59% at decreased levels (1.0 mg/l 2iP). On the other hand, hyperhydricity percentage at decreased (0.4%) and at increased (0.8%) levels of agar were 72.37% and 39.08%, respectively. MS medium modification with NH4NO3 (412 mg/l), KNO3 (475 mg/l) and CaCl2.2H2O (880 mg/l) was found the best medium to reduced hyperhydricity (23.6%).
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Affiliation(s)
- T Jan
- University of Malakand, Department of Botany, Plant Tissue Culture Laboratory, Dir lower, Khyber Pakhtunkhwa, Pakistan
| | - S Gul
- University of Malakand, Department of Botany, Plant Tissue Culture Laboratory, Dir lower, Khyber Pakhtunkhwa, Pakistan
| | - A Khan
- University of Lakki Marwat, Department of Biological Sciences, Khyber Pakhtunkhwa, Pakistan
| | - S Pervez
- Shaheed Benazir Bhutto Women University, Department of Biochemistry, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - A Noor
- Karakoram International University, Department of Biological Sciences, Gilgit-Baltistan, Pakistan
| | - H Amin
- University of Malakand, Department of Botany, Plant Tissue Culture Laboratory, Dir lower, Khyber Pakhtunkhwa, Pakistan
| | - S Bibi
- University of Malakand, Department of Botany, Plant Tissue Culture Laboratory, Dir lower, Khyber Pakhtunkhwa, Pakistan
| | - M A Nawaz
- Shaheed Benazir Bhutto University, Department of Biotechnology, Sheringal, Dir Upper, Pakistan
| | - A Rahim
- University of Malakand, Department of Zoology, Dir lower, Khyber Pakhtunkhwa, Pakistan
| | - M S Ahmad
- University of Malakand, Department of Botany, Plant Tissue Culture Laboratory, Dir lower, Khyber Pakhtunkhwa, Pakistan
| | - R Azam
- University of Malakand, Department of Botany, Plant Tissue Culture Laboratory, Dir lower, Khyber Pakhtunkhwa, Pakistan
| | - H Ullah
- University of Malakand, Department of Botany, Plant Tissue Culture Laboratory, Dir lower, Khyber Pakhtunkhwa, Pakistan
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Ilahi I, Yousafzai AM, Attaullah M, Haq TU, Rahim A, Khan W, Khan AA, Ullah S, Jan T, Khan MM, Rahim G, Zaman N. Mosquitocidal activities of Chenopodium botrys whole plant n-hexane extract against Culex quinquefasciatus. BRAZ J BIOL 2021; 83:e240842. [PMID: 34550279 DOI: 10.1590/1519-6984.240842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Accepted: 12/21/2020] [Indexed: 11/22/2022] Open
Abstract
This research aimed to investigate various mosquitocidal activities of Chenopodium botrys whole- plant n-hexane extract against Culex quinquefasciatus. The extract showed remarkable larvicidal, pupicidal, adulticidal, oviposition deterrent and adult emergence inhibitory activities against Cx. quinquefasciatus. During the larvicidal and pupicidal activities, the 24-hour lethal concentration (LC50) of extract against 2nd instar larvae, 4th instar larvae and pupae were 324.6, 495.6 and 950.8 ppm, respectively. During the CDC (Centers for Disease Control and Prevention) bottle bioassay for adulticidal activity, the median knockdown times (KDT50) at 1.25% concentration was 123.4 minutes. During the filter paper impregnation bioassay for adulticidal activity, the KDT50 value at 0.138 mg/cm2 concentration was 48.6 minutes. The extract was fractionated into 14 fractions through silica gel column chromatography which were then combined into six fractions on the basis of similar retention factor (Rf) value. These fractions were screened for adulticidal activity by applying CDC bottle bioassay. The fraction obtained through 60:40 to 50:50% n-hexanes-chloroform mobile phase with 0.5 Rf value showed 100% adulticidal activity at 0.2% concentration. During oviposition deterrent activity, the highest concentration (1000 ppm) showed 71.3 ± 4.4% effective repellence and 0.6 ± 0.1 oviposition activity index. During adult emergence inhibition activity, the median emergence inhibition (EI50) value was 312.3 ppm. From the outcome of the present investigation, it is concluded that the n-hexane extract of C. botrys whole- plant possesses strong larvicidal, pupicidal, adulticidal, oviposition deterrent and adult emergence inhibitory activities against Cx. quinquefasciatus.
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Affiliation(s)
- I Ilahi
- University of Malakand, Department of Zoology, Chakdara, Dir Lower, Khyber Pakhtunkhwa, Pakistan.,Islamia College Peshawar, Department of Zoology, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - A M Yousafzai
- Islamia College Peshawar, Department of Zoology, Peshawar, Khyber Pakhtunkhwa, Pakistan
| | - M Attaullah
- University of Malakand, Department of Zoology, Chakdara, Dir Lower, Khyber Pakhtunkhwa, Pakistan
| | - T U Haq
- University of Malakand, Department of Biotechnology, Chakdara, Dir Lower, Khyber Pakhtunkhwa, Pakistan
| | - A Rahim
- University of Malakand, Department of Zoology, Chakdara, Dir Lower, Khyber Pakhtunkhwa, Pakistan
| | - W Khan
- University of Malakand, Department of Zoology, Chakdara, Dir Lower, Khyber Pakhtunkhwa, Pakistan
| | - A A Khan
- University of Malakand, Department of Biotechnology, Chakdara, Dir Lower, Khyber Pakhtunkhwa, Pakistan
| | - S Ullah
- University of Malakand, Department of Botany, Chakdara, Dir Lower, Khyber Pakhtunkhwa, Pakistan
| | - T Jan
- University of Malakand, Department of Botany, Chakdara, Dir Lower, Khyber Pakhtunkhwa, Pakistan
| | - M M Khan
- The University of Haripur, Department of Microbiology, Haripur, Khyber Pakhtunkhwa, Pakistan
| | - G Rahim
- University of Malakand, Department of Botany, Chakdara, Dir Lower, Khyber Pakhtunkhwa, Pakistan
| | - N Zaman
- University of Swat, Centre for Biotechnology and Microbiology, Swat, Khyber Pakhtunkhwa, Pakistan
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Ahmad B, Ilahi I, Yousafzai AM, Attaullah M, Rahim A, Naz D, Hazrat A, Batiha GES, Nassan MA, Khalil AAK. Protective effects of Zizyphus oxyphyla on liver and kidney related serum biomarkers in (CCl4) intoxicate rabbits. BRAZ J BIOL 2021; 83:e246980. [PMID: 34468522 DOI: 10.1590/1519-6984.246980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 04/13/2021] [Indexed: 11/22/2022] Open
Abstract
The study was aimed to evaluate the therapeutic effects of Zizyphus oxyphyla leaves methanolic (ZOX-LME), on serum liver, kidney and hematology along with other serum parameters in Carbon tetrachloride (CCl4) intoxicated rabbits. Experimental animals were divided into five groups, six rabbits in each. These were: group NC (normal control), group, TC (toxic control) and group ST i.e. silymarine administered group at dose rate (50) mg/kg body weight (BW). Group ET1 and group ET2 treated with (ZOX-LME) at dose 200 mg/kg BW and 400 mg/kg BW. CCl4 administration caused significant (P> 0.05) impairment in serum liver enzymes, blood factors and other serum indices. Treatment with (ZOX-LME) significantly (P<0.05) reduced and normalized the levels of serum alanine transaminase (ALT) aspartate transaminase (AST) and alkaline phosphatase (ALP) and hematological indices. Also significant (P< 0.05) reduction was observed in creatinine, urea, uric acid, blood urea nitrogen (BUN), and albumin and glucose concentrations. The altered levels of lipid profile and serum electrolytes (Ca, Mg, Cl, Na, K, and P) were significantly (P<0.05) change toward normal levels with (ZOX-LME) feeding. In addition (ZOX-LME) ingestion caused significant improvement in GSH, GST and CAT levels, while reducing the TBARS levels, exhibited antioxidant capacity. Also (ZOX-LME) showed increase inhibition against percent scavenging of 2, 2-diphenile-1-picrylehydrazyle (DPPH) free radical. Significant (P<0.05) normalizing effects were observed with high dose 400 mg/kg BW of (ZOX-LME and were equivalent to silymarine administered groups. The histological study of liver supported the hepatoprotective and renal curative activity of (ZOX-LME).
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Affiliation(s)
- B Ahmad
- University of Malakand, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
| | - I Ilahi
- University of Malakand, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
| | - A M Yousafzai
- Islamia College, Department of Zoology, Peshawar, Pakistan
| | - M Attaullah
- University of Malakand, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
| | - A Rahim
- University of Malakand, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
| | - D Naz
- University of Malakand, Department of Zoology, Khyber Pakhtunkhwa, Pakistan
| | - A Hazrat
- University of Malakand, Departments of Botany, Khyber Pakhtunkhwa, Pakistan
| | - G E-S Batiha
- Damanhour University, Faculty of Veterinary Medicine, Department of Pharmacology and Therapeutics, Damanhour, AlBeheira, Egypt
| | - M A Nassan
- Taif University, Turabah University College, Department of Clinical Laboratory Sciences, Taif, Saudi Arabia
| | - A A K Khalil
- National University of Medical Sciences, Department of Biological Sciences, Rawalpindi, Pakistan
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Asri SA, Rahim A, Rahmad IN. Pelatihan Pembuatan Media Pembelajaran Matematika di SD Negeri Jatimekar 02. Pri Abd :J P M 2021; 1:20-25. [DOI: 10.37478/abdika.v1i1.938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
In general, elementary school age children (SD) are experiencing development at their thinking level, elementary school children's thinking stages are still not formal and are still concrete in nature. Therefore, the teacher must present material that is real so that elementary students can understand the concept completely. Based on the results of interviews with several mathematics teachers and principals, information was obtained that mathematics learning is carried out very rarely using media, especially in the form of props or other innovative media. Regarding the above problems, we are interested in conducting training through a community service program entitled "PKM Training on Making Mathematics Learning Media at SDN Jatimekar 02." This PKM is carried out in the form of three meetings training. The training participants were a number of teachers at SDN Jatimekar 02 Pagi. The presentation material in this service activity is: (1) The concept of learning media that is in accordance with the characteristics of Mathematics subjects along with examples of implementation in learning (2) Making learning implementation plans (RPP) with appropriate learning media (3) Simulation of implementing cooperative learning media in learning, and (4) assessment of learning using instructional media. Based on the results of the evaluation, 28 out of 32 participants understood the concept of learning media well, 25 participants were able to develop plans for implementing learning using media, and 30 participants were able to use media when learning in class.
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Singh VK, Rathore KS, Khan G, Rahim A, Rashid A, Chauhan S. Clinical and Radiological Study of Serum Fluoride in Relation to Knee Osteoarthritis. Malays Orthop J 2021; 14:151-154. [PMID: 33403076 PMCID: PMC7751991 DOI: 10.5704/moj.2011.023] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Fluorosis has been associated with an increased risk of degenerative changes in the knee. Multiple studies have found an association between arthritis and elevated fluoride levels. We aim to delineate if elevated fluoride level has any direct correlation with the degree of radiological grading and clinical symptoms in knee arthritis. Materials and Methods A cross-sectional study of 80 knee arthritis patients was conducted from February 2017 to April 2018. Serum fluoride levels were measured and patient's pain scores, WOMAC scores and radiological grading were correlated with the elevated fluoride levels. Results In our study, 30 out of 80 patients had increased serum fluoride level. Statistically significant differences were noted in VAS score, WOMAC score and Kellgren and Lawrence radiological grades between patients with normal serum fluoride level and those with elevated fluoride level. Conclusion There is an increased risk of knee arthritis in patients with elevated blood fluoride levels and patients with increased fluoride levels are associated with more severe symptoms and radiographic disease.
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Affiliation(s)
- V K Singh
- Department of Orthopaedics, NIMS Medical College and Hospital, Jaipur, India
| | - K S Rathore
- Department of Orthopaedics, NIMS Medical College and Hospital, Jaipur, India
| | - G Khan
- Department of Orthopaedics, NIMS Medical College and Hospital, Jaipur, India
| | - A Rahim
- Department of Orthopaedics, NIMS Medical College and Hospital, Jaipur, India
| | - A Rashid
- Department of Orthopaedics, NIMS Medical College and Hospital, Jaipur, India
| | - S Chauhan
- Department of Orthopaedics, NIMS Medical College and Hospital, Jaipur, India
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Roshni M, Rahim A. Small group discussions as an effective teaching-learning methodology for learning the principles of family medicine among 2 nd-year MBBS students. J Family Med Prim Care 2020; 9:2248-2252. [PMID: 32754482 PMCID: PMC7380748 DOI: 10.4103/jfmpc.jfmpc_1228_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 03/06/2020] [Accepted: 03/14/2020] [Indexed: 12/03/2022] Open
Abstract
Teaching methodology has a great impact on the learning outcomes in an undergraduate's education.
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Al Sergani H, Alamro B, Al Admawi M, Rahim A, Vriz O, Elmahi I, Galzerano D, Fadel B, Di Michele S, Colivicchi F. P860 Multimodality imaging of multiple recurrent myxomas: the role of three dimensional echocardiography. Eur Heart J Cardiovasc Imaging 2020. [DOI: 10.1093/ehjci/jez319.505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
A 33-year-old lady who underwent left atrial myxoma resection was found to have on a 3 years follow up transthoracic echocardiography (E) a multilobular mass in the right atrium.
A 2D transesophageal echocardiogram (TEE) was performed. Two Multi-lobulated masses were seen in the right atrium(RA); one bigger attached by a peduncle to the atrial wall in between the interatrial septum (IAS) and the superior vena cava and one smaller attached to the inferior RA wall; a remnant likely a suture was seen on the right side of the fossa ovalis; another small mass was noted on the left atrial (LA) side of the IAS; a small mass attached close to the posteromedial commissure and P3 scallop of the mitral valve was also detected. The RA mass was partially protruding into the tricuspid valve during diastole with no significant obstruction to flow.
Three dimensional TEE allows an anatomical imaging able to identify the peduncles of two right atrial masses and three LA masses that were confirmed at surgery and consistent with cardiac myxoma at histopathology : one close the previous resection area, one at the opening of the LAA (panel A, white arrow) and one close to the posterior commissure of mitral valve (panel B, yellow arrow) and that were not seen by 2D. Magnetic resonance imaging (MRI) with contrast identified and showed opacification of : two masses in the RA with the pedicles ; - one mass on the LA side of interatrial septum; - one mass close to mitral valve posterior commissure ; however it was not able to detect the small mass close to the LAA.
In our case 2D Echocardiography and MRI were able to identify 4 of the 5 recurrences found at surgery. 3D TEE was the only technique able to identify all 5 lesions. MRI is considered the gold standard for detecting cardiac tumor masses; however, even after careful review, it was not possible to identify the presence of the mass close to LAA. In particular 3D TEE was able to image the left atrial masses by an "en face view" of the left atrium from above. In addition, the unique 2D planes in unconventional views allow a more clear identifications of the peduncles of the masses in the right atrium. The identification of the peduncles is mainstay for the diagnosis of recurrent myxomas and exclude other tumors like metastasis or sarcomas. In fact multiple recurrence are very rare in particular if we consider that are in the two atria. Genetic tests for Carney complex were negative. The MRI allowed to confirm the vascularization of the contrast and to identify the peduncles of two masses in the right atrium.
A multimodality imaging is able to correctly detect recurrent myxomas by identifying the anatomical features and the vascularization and lead to the diagnosis ; 3DE was the only technique able to correctly identify all the recurrent myxomas and and its use has the potential for being considered the key adjunctive modality for the anatomy when advanced surgical plan is required.
Abstract P860 Figure.
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Affiliation(s)
- H Al Sergani
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - B Alamro
- King Faisal Specialist Hospital & Research Centre and Alfaisal University, College of Medicine, Riyadh, Saudi Arabia
| | - M Al Admawi
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - A Rahim
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - O Vriz
- King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - I Elmahi
- Alfaisal University, College of Medicine , Riyadh, Saudi Arabia
| | - D Galzerano
- King Faisal Specialist Hospital & Research Centre and Alfaisal University, College of Medicine, Riyadh, Saudi Arabia
| | - B Fadel
- King Faisal Specialist Hospital & Research Centre and Alfaisal University, College of Medicine, Riyadh, Saudi Arabia
| | - S Di Michele
- San Filippo Neri Hospital, Cardiology , Rome, Italy
| | - F Colivicchi
- San Filippo Neri Hospital, Cardiology , Rome, Italy
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Akhlaq A, Ghanchi NK, Usmani B, Shahzad R, Rahim A, Wasay M, Beg MA. Neurological complications in patients with Plasmodium vivax malaria from Karachi, Pakistan. J R Coll Physicians Edinb 2019; 48:198-201. [PMID: 30191906 DOI: 10.4997/jrcpe.2018.302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Malaria remains an endemic disease in Pakistan with an estimated healthcare burden of 1.6 million cases annually, with Plasmodium vivax accounting for 67% of reported cases. P. vivax is the most common species causing malaria outside of Africa, with approximately 13.8 million reported cases worldwide. METHOD We report a series of P. vivax cases with cerebral involvement that presented at Aga Khan University Hospital, Karachi, Pakistan. RESULTS The majority of the patients presented with high-grade fever accompanied by projectile vomiting and abnormal behaviour, seizures, shock and unconsciousness. Seven of 801 patients with P. vivax monoinfection presented or developed cerebral complications. P. vivax infections were diagnosed based on peripheral smears and rapid diagnostic testing. CONCLUSION P. vivax infection can lead to severe complications, although not with the frequency of Plasmodium falciparum infection. Current cases highlight an increasing trend of cerebral complications caused by P. vivax.
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Affiliation(s)
- A Akhlaq
- Medical College, Aga Khan University Hospital, Karachi, Pakistan
| | - N K Ghanchi
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - B Usmani
- Medical College, Aga Khan University Hospital, Karachi, Pakistan
| | - R Shahzad
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - A Rahim
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - M Wasay
- Section of Neurology, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - M A Beg
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi PO 3500, Pakistan,
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Khan J, Tariq M, Muhammad M, H. Mehmood M, Ullah I, Raziq A, Akbar F, Saqib M, Rahim A, Niaz A. Kinetic and thermodynamic study of oxidative degradation of acid yellow 17 dye by Fenton-like process: Effect of HCO3−, CO32−, Cl− and SO42− on dye degradation. B CHEM SOC ETHIOPIA 2019. [DOI: 10.4314/bcse.v33i2.5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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Khattak SK, Mustafa SH, Zaman H, Rahim A, Ali SM, Zaib Z. Compliance to Antihypertensive Medication: A Tertiary Care Study. Mymensingh Med J 2019; 28:668-672. [PMID: 31391442] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Hypertension is a global health problem and affects more than one billion people worldwide. Long term hypertension is associated with grave complications and therefore maintaining blood pressure within normal range is essential and ensuring patient's drug compliance is an important sector of patient care. Therefore, the purpose of our study was to find out the causes of poor compliance to antihypertensive medications. This cross sectional study was carried out in Medical Department of Ayub Teaching Hospital Abbottabad, Pakistan from 1st September 2017 to 30th October 2018. One hundred ninety three (193) patients were included through non probability consecutive sampling and were divided into two groups on the basis of compliance. The data was collected with the help of a structured questionnaire and analyzed using SPSS 20. Out of 193 hypertensive patients, 88(45.6%) were male while 105(54.4%) were females, with minimum age of 24 years and maximum age of 95 years and mean age of 61.98±12.81SD. Minimum duration of hypertension was 5 months and maximum was 30 years with mean duration of hypertension and standard deviation (SD) of 6.26±6.51 years. One hundred & Twenty (62.2%) patients were non-compliant, while 73(37.8%) were compliant to medication. Forgetfulness of medicine 85(70.8%) and non-affordability 62(52.5%) were the most common causes of noncompliance. This study documented a significantly higher proportion of medication non-adherence among hypertensive patients, with drug forgetfulness and affordability being found as the most common cause.
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Affiliation(s)
- S K Khattak
- Dr Sabir Khan Khattak, House Officer, Department of Internal Medicine, Ayub Teaching Hospital, Abbottabad, Pakistan; E-mail:
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Singh A, Bhakat M, Mohanty TK, Mondal S, Yadav SK, Kumar P, Kumar R, Rahim A, Sinha R, Shah N. Effect of Tris-egg Yolk, Soya Milk, and Liposome-based Extenders on Sahiwal (Bos indicus) Sperm Quality during Pre- and Post-Cryopreservation Stages. Cryo Letters 2019; 40:94-102. [PMID: 31017609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Even though there are plenty of semen cryopreservation extenders available, their adoption is limited. Although normal tris-based egg yolk (EYC) extender is widely used, it leads to compromised post-thaw sperm quality. OBJECTIVE To find a standard semen extender, six different semen extenders were validated. METHODS In a split study, six aliquots of zebu cattle fresh semen ejaculate were cryopreserved in extenders containing egg yolk obtained from hen which was reared either in 1) normal, 2) omega-3 enriched, and 3) herbal enriched diet supplementation, and egg yolk free extenders such as 4) soya lecithin, 5) Bioxcell and 6) Optixcell. RESULT Significantly poor sperm quality and kinematics were observed in extender containing herbal egg yolk. However, omega-3 enriched egg yolk extender was on par with EYC. Among all extenders, soya lecithin and bioxcell have shown better sperm quality. Sperm motility was significantly higher in semen extended in liposome-based extender Optixcell. CONCULSION Optixcell can be considered as a standard extender for cattle semen cryopreservation to maintain adequate sperm quality required for artificial insemination.
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Affiliation(s)
- A Singh
- Artificial Breeding Research Centre, ICAR-National Dairy Research Institute, Karnal-132001 (Haryana) India
| | - M Bhakat
- Artificial Breeding Research Centre, ICAR-National Dairy Research Institute, Karnal-132001 (Haryana) India.
| | - Tushar Kumar Mohanty
- Artificial Breeding Research Centre, ICAR-National Dairy Research Institute, Karnal-132001 (Haryana) India
| | - S Mondal
- Artificial Breeding Research Centre, ICAR-National Dairy Research Institute, Karnal-132001 (Haryana) India
| | - S K Yadav
- Artificial Breeding Research Centre, ICAR-National Dairy Research Institute, Karnal-132001 (Haryana) India
| | - P Kumar
- Division of Dairy Microbiology, ICAR-National Dairy Research Institute-132001
| | - R Kumar
- Artificial Breeding Research Centre, ICAR-National Dairy Research Institute, Karnal-132001 (Haryana) India
| | - A Rahim
- Artificial Breeding Research Centre, ICAR-National Dairy Research Institute, Karnal-132001 (Haryana) India
| | - R Sinha
- Artificial Breeding Research Centre, ICAR-National Dairy Research Institute, Karnal-132001 (Haryana) India
| | - N Shah
- Artificial Breeding Research Centre, ICAR-National Dairy Research Institute, Karnal-132001 (Haryana) India
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Rahim A, Baird-Gunning J, Ashton DE, Angstmann T, Lahoria R. Acute Sheehan Syndrome Manifesting as Unremitting Headache. Neurohospitalist 2018; 8:NP1-NP2. [PMID: 29977451 DOI: 10.1177/1941874417715977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Aadil Rahim
- The Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Jonathan Baird-Gunning
- The Canberra Hospital, Canberra, Australian Capital Territory, Australia.,ANU Medical School, The Australian National University, Australian Capital Territory, Australia
| | - David E Ashton
- The Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Tobias Angstmann
- The Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Rajat Lahoria
- The Canberra Hospital, Canberra, Australian Capital Territory, Australia.,JCSMR, Australian National University, Canberra, Australian Capital Territory, Australia
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Moosavi V, Paymard M, Rahim A, Shahnam A, Pathak R, Abhayaratna W. Assessment of Patients With Syncope in a Level-6 Hospital: A Quality Improvement Project. Heart Lung Circ 2018. [DOI: 10.1016/j.hlc.2018.06.575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Bishist R, Raina VS, Bhakat M, Mohanty TK, Lone SA, Sinha R, Rahim A, Paray AR. Effect of Varying Osmolarity of Tris Extender on Seminal Attributes of Buffalo during Refrigeration. ACTA ACUST UNITED AC 2018. [DOI: 10.5455/ijlr.20180327052829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Khan AA, Ashraf A, Singh R, Rahim A, Rostom W, Hussain M, Renner I, Collins NJ. Incidence, time of occurrence and response to heart failure therapy in patients with anthracycline cardiotoxicity. Intern Med J 2017; 47:104-109. [PMID: 27800661 DOI: 10.1111/imj.13305] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 10/06/2016] [Accepted: 10/24/2016] [Indexed: 11/30/2022]
Abstract
BACKGROUND Anthracyclines are commonly used chemotherapeutic medications. AIM In the current analysis, we evaluated all-cause mortality and incidence, timing and response to medical therapy of anthracycline cardiotoxicity. METHODS Left ventricular ejection fraction (LVEF) was serially assessed using gated heart pool scan/echocardiography in patients receiving anthracycline-based chemotherapy from January 2009 to December 2014. RESULTS A total of 1204 patients was administered anthracyclines during the study period. During a median follow up of 32 (interquartile range: 15-58) months, all-cause mortality was 38% (n = 463), with the incidence of cardiotoxicity 10.2% (n = 123). Only 15.4% (n = 19) patients required heart failure hospitalisation, with 48% (n = 59) of patients commenced on beta blockade therapy and/or angiotensin-converting enzyme inhibitors. The majority of patients (73.2%, n = 90) experienced cardiotoxicity within 1 year of anthracycline initiation. The proportion of patients with complete, partial and no LVEF recovery were 16.3% (n = 20), 29.3% (n = 36) and 54.4% (n = 67) respectively. Mortality was higher in the cardiotoxicity group (49% vs 37%, P < 0.01). History of coronary artery disease, leukaemia, idarubicin use and high cumulative anthracycline dose were predictors of cardiotoxicity. CONCLUSIONS Cardiotoxicity after anthracycline use predictably occurs within the first year of therapy and is dose-related, with variable degrees of recovery. While the need for hospitalisation for heart failure was uncommon, medical therapy appears underutilised, suggesting there may be a role for improved surveillance and early initiation of treatment.
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Affiliation(s)
- Arshad A Khan
- Cardiovascular Department, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Asma Ashraf
- Cardiovascular Department, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Rajinder Singh
- Cardiovascular Department, John Hunter Hospital, Newcastle, New South Wales, Australia
| | - Aadil Rahim
- Department of Statistics, University of Newcastle, Newcastle, New South Wales, Australia
| | - Walid Rostom
- Department of Statistics, University of Newcastle, Newcastle, New South Wales, Australia
| | - Mumtaz Hussain
- Department of Statistics, University of Newcastle, Newcastle, New South Wales, Australia
| | - Ian Renner
- Department of Statistics, University of Newcastle, Newcastle, New South Wales, Australia
| | - Nicholas J Collins
- Cardiovascular Department, John Hunter Hospital, Newcastle, New South Wales, Australia
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Zhang X, Khan AA, Haq EU, Rahim A, Hu D, Attia J, Oldmeadow C, Ma X, Ding R, Boyle AJ. Increasing mortality from ischaemic heart disease in China from 2004 to 2010: disproportionate rise in rural areas and elderly subjects. 438 million person-years follow-up. Eur Heart J Qual Care Clin Outcomes 2016; 3:47-52. [DOI: 10.1093/ehjqcco/qcw041] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Indexed: 12/18/2022]
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Das AK, Kumar S, Rahim A. Estimating microsatellite based genetic diversity in Rhode Island Red chicken. Iran J Vet Res 2015; 16:274-277. [PMID: 27175188 PMCID: PMC4782697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 05/04/2015] [Accepted: 05/26/2015] [Indexed: 06/05/2023]
Abstract
This study aimed to estimate microsatellite based genetic diversity in two lines (the selected RIR(S) and control line RIR(C)) of Rhode Island Red (RIR) chicken. Genomic DNA of 24 randomly selected birds maintained at Central Avian Research Institute (India) and 24 microsatellite markers were used. Microsatellite alleles were determined on 6% urea-PAGE, recorded using GelDoc system and the samples were genotyped. Nei's heterozygosity and Botstein's polymorphic information content (PIC) at each microsatellite locus were estimated. Wright's fixation indices and gene flow were estimated using POPGENE software. All the microsatellite loci were polymorphic and the estimated PIC ranged from 0.3648 (MCW0059) to 0.7819 (ADL0267) in RIR(S) and from 0.2392 (MCW0059) to 0.8620 (ADL0136) in RIR(C). Most of the loci were highly informative (PIC>0.50) in the both lines, except for five loci in RIR(S) and six loci in RIR(C) line. Nei's heterozygosity per locus ranged from 0.4800 (MCW0059) to 0.8056 (ADL0267) in RIR(S) and from 0.2778 (MCW0059) to 0.875 (ADL0136) in RIR(C). Out of 24 loci, 15 (62.5%) in RIR(S) and 14 loci (58.33%) in RIR(C) revealed moderate to high negative FIS index indicating heterozygote excess for these loci in corresponding lines, but the rest revealed positive FIS indicating heterozygosity deficiency. A mean FIS across the both lines indicated overall 10.77% heterozygosity deficit and a mean FIT indicated 17.19% inbreeding co-efficient favoring homozygosity over the two lines. The mean FST indicated that 10.18% of the microsatellite variation between the two lines was due to their genetic difference.
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Affiliation(s)
- A. K Das
- Molecular Genetics Laboratory, Avian Genetics and Breeding Division, Central Avian Research Institute, Izatnagar 243122, Bareilly, Uttar Pradesh, India
| | - S Kumar
- Molecular Genetics Laboratory, Avian Genetics and Breeding Division, Central Avian Research Institute, Izatnagar 243122, Bareilly, Uttar Pradesh, India
| | - A Rahim
- Molecular Genetics Laboratory, Avian Genetics and Breeding Division, Central Avian Research Institute, Izatnagar 243122, Bareilly, Uttar Pradesh, India
- Ph.D. Student in Animal Genetics and Breeding, Division of Animal Genetics, Indian Veterinary Research Institute, Izatnagar 243122, Bareilly, Uttar Pradesh, India
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Khan A, Ghani T, Rahim A, Rahman MM. Changing trends in incidence and indications of caesarean section. Mymensingh Med J 2014; 23:52-55. [PMID: 24584373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Caesarean section is most frequently performed major operation in obstetrics. The rate of caesarean section has been increasing both in developed and developing countries in the past decade. This study was done to find out the change of sociodemographic condition of respondents, identify the different types & rate of caesarean section indications, the outcome of different indications, estimate the rate of caesarean section proportion of the elective & emergency indications and evaluate the complications of caesarean sections. This is a cross-sectional study of randomly selected 130 cases of lower caesarean section done at Sir Salimullah Medical College & Mitford Hospital, Dhaka from March 2006 to August 2006. In this study 80(61.5%) cases underwent emergency caesarean section and in 50(38.5%) cases elective caesarean section had done. Among indications of caesarean section repeat section scores the top of the list. No maternal mortality case recorded in this study. This study shows high incidence of caesarean section which does not reflect the picture of total population of Bangladesh.
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Affiliation(s)
- A Khan
- Dr Afroza Khan, Consultant (Gynae), Upazilla Health Complex, Hajigong, Chandpur, Bangladesh
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Leon JA, Mamani NC, Rahim A, Gomez LE, Silva MAPD, Gusev GM. Transferring Few-Layer Graphene Sheets on Hexagonal Boron Nitride Substrates for Fabrication of Graphene Devices. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/graphene.2014.33005] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Abstract
BACKGROUND Antiphospholipid syndrome (APS) is defined as the presence of venous or arterial thrombosis, and/or recurrent miscarriage with evidence of antiphospholipid antibodies (aPL). In both primary and secondary APS, ocular and neurophthalmic manifestations such as retinal arteritis, retinal venous occlusion, ischemic optic neuropathy, transient loss of vision - amaurosis fugax, diplopia have been reported. MATERIALS AND METHODS We present an unusual case of APS in a healthy 24-year old male who had isolated ocular presentation with recurrent right periocular oedema and non-healing ulceration of the biopsy site without systemic involvement. Ocular examinations and investigations including inflammatory markers were normal. CONCLUSION Atypical presentations of APS may result in initial difficulty in making diagnosis.
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Affiliation(s)
- A Rahim
- University Hospital Leicester, Leicester, Leicester, UK.
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Siddiqi S, Nafi-Valencia E, Siddiqi S, Rahim A. 129 A NOVEL THREE-PROTEIN COMPLEX REGULATES IN VITRO VTV-GOLGI FUSION. ATHEROSCLEROSIS SUPP 2011. [DOI: 10.1016/s1567-5688(11)70130-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Rahim A, Mathew AJ. Perennial impression of an emerging arbovirus on the epidemiology of rheumatic diseases in South India: Insights from the COPCORD study. J Postgrad Med 2011; 57:226-8. [DOI: 10.4103/0022-3859.85219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Rahim A, Devroey P, Diedrich K, Al-Hasani S. Cancellation of fresh embryo transfer: A future perspective. Middle East Fertility Society Journal 2010. [DOI: 10.1016/j.mefs.2010.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Abstract
BACKGROUND The high prevalence of both hypovitaminosis D and type 2 diabetes (T2DM) in the Asian community is well recognised, but the impact of diabetes on vitamin D status and vice versa, has not been well reported. AIMS To determine the prevalence of hypovitaminosis D in Asian patients with T2DM and its impact on glycaemic control. METHODS A cross-sectional study was conducted in a tertiary referral centre in the UK. Two hundred and ten Asian patients aged more than 40 years were included (170 with and 40 without T2DM). Each had a standard bone profile (serum calcium, phosphate and alkaline phosphatase), serum parathyroid hormone and 25-hydroxycholecalciferol. RESULTS The prevalence of low serum 25-hydroxyvitamin D (< 50 nmol/l) was high in the group as a whole (> 80%) and more common in diabetics compared with controls (83% vs. 70%; p = 0.07). This was particularly so in men (82.5% vs. 57.9%; p = 0.02). HbA1c was higher in women with vitamin D deficiency (< 12.5 nmol/l) (8.11 +/- 1.11% vs. 7.33 +/- 1.32%, p = 0.046). In logistic regression analysis, T2DM was an independent predictor of hypovitaminosis D. In linear regression analysis, vitamin D deficiency was independently related to HbA1c in women with T2DM. CONCLUSIONS Hypovitaminosis D remains a major public health issue in the Asian population and is exaggerated in patients with T2DM. The fact that vitamin D deficient women had higher HbA1c levels raises the possibility that vitamin D replacement may improve glycaemic control.
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Affiliation(s)
- A A Tahrani
- School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK.
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Rahim A, Alhani F, Ahmadi F, Gholyaf M, Akhoond M. Effects of a continuous care model on perceived quality of life of spouses of haemodialysis patients. East Mediterr Health J 2009. [DOI: 10.26719/2009.15.4.944] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Rahim A, Alhani F, Ahmadi F, Gholyaf M, Akhoond MR. Effects of a continuous care model on perceived quality of life of spouses of haemodialysis patients. East Mediterr Health J 2009; 15:944-950. [PMID: 20187546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We carried out a semi-experimental study with simple randomized sampling to study the effects of applying a continuous care model on the quality of life of 36 spouses of haemodialysis patients in Hamedan, Islamic Republic of Iran. Participants took part in group discussions and training on the continuous care approach and completed the Perceived Quality Of Life (PQOL) questionnaire before and after the intervention. Mean scores on the physical, social and cognitive dimensions, as well as happiness and total scores significantly increased after the intervention. Applying a continuous care model has positive effects on the caregivers of chronic patients.
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Affiliation(s)
- A Rahim
- Department of Nursing, Tarbiat Modares University, Tehran, Islamic Republic of Iran
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Mujahid SA, Rahim A, Hussain S, Farooq M. Measurements of natural radioactivity and radon exhalation rates from different brands of cement used in Pakistan. Radiat Prot Dosimetry 2008; 130:206-212. [PMID: 18285318 DOI: 10.1093/rpd/ncm497] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
The measurement of activity due to the naturally occurring radionuclide has been carried out in different brands of cement available in Pakistan. The gamma spectra of the collected samples were obtained using high-purity germanium detector and analysed for the presence of 232Th, 238U and 40K. The assessment of radiological hazards due to these radionuclides has also been made. The studies concerning the determination of radon-exhalation rates from these samples of cement were also carried out using CR-39 based NRPB radon dosimeters. The range of activity concentrations were found for 226Ra (from 25.10 +/- 1.55 to 52.60 +/- 3.20 Bq kg(-1)), 232Th (from 10.30 +/- 0.65 to 30.40 +/- 1.70 Bq kg(-1)) and 40K (from 17.25 +/- 1.55 to 292.95 +/- 23.05 Bq kg(-1)). The estimated value of radium equivalent concentration was from 11.16 +/- 2.60 to 114.98 +/- 7.11 Bq kg(-1). The calculated absorbed dose rate in air and the annual effective dose were in the range from 18.54 +/- 1.17 to 52.90 +/- 3.31 nGy h(-1) and 0.09 +/- 0.01 to 0.26 +/- 0.02 mSv, respectively. The external and internal hazard indices were in the range from 0.11 +/- 0.01 to 0.31 +/- 0.02 and 0.18 +/- 0.01 to 0.45 +/- 0.03, respectively. The radon exhalation rates from different brands of cement were found in the range from 3.3 +/- 0.7 to 8.1 +/- 1.7 mBq kg(-1) h(-1).
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Affiliation(s)
- S A Mujahid
- Environmental Radiation Laboratory, Physics Division, PINSTECH, P.O. Nilore, Islamabad, Pakistan.
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Abstract
The authors describe the case of 49-year-old female teacher who had sustained severe facial lacerations following a minor fall on the kerb. The severe shearing force by which the flap was ripped off the forehead caused complete ptosis and complete failure of elevation of the left eye, which was presumed to be due to mechanical damage to the superior rectus and levator complex. The management by a multidisciplinary approach and clinical course of the patient are described with documentary photographs. This presentation is meant to highlight an unusual case of severe facial trauma resulting from a minor injury, and its successful management with gratifying results for both patient and the surgeon.
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Affiliation(s)
- A Paul
- Department of Ophthalmology, Chesterfield Royal Hospital, Chesterfield, UK
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Das SN, Alam MR, Islam N, Rahman MH, Sutradhar SR, Rahman S, Khan GK, Rahim A, Haq SA. Placebo controlled trial of methotrexate in systemic sclerosis. Mymensingh Med J 2005; 14:71-4. [PMID: 15695960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Eighteen adult patients of systemic sclerosis were included in this prospective study from Rheumatology Clinic of Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka during the period of July 1997 to December 1999 to observe the effectiveness of treatment with methotrexate (MTX) versus placebo. Among the eighteen patients 9 patients were randomly assigned to MTX and 9 to placebo therapy. Nine patients were dropped out (6 in placebo and 3 in the MTX group), because of toxicity and non-compliance. Clinical improvement following treatment was observed in 33.33% of the patient in MTX group but none in placebo group, but this difference was not statistically significant. Anorexia, nausea and occasional vomiting were common side effects in MTX group and subsided in most cases with the passage of time despite the continuation of therapy.
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Affiliation(s)
- S N Das
- Sir Salimullah Medical College, Dhaka
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Abstract
PURPOSE To evaluate children 6 years old and younger, lactating mothers, and women of childbearing age for vitamin A deficiency in the districts of Kabul City, Afghanistan. METHODS A set number of patients selected randomly in all 13 districts of the city limits were examined between August and September 2000 for ocular signs of vitamin A deficiency. RESULTS Night blindness, Bitot's spot, corneal ulceration, and corneal scars were seen in increased amounts as defined by the World Health Organization among the sampled population. CONCLUSIONS Vitamin A deficiency is a moderate to severe public health problem in children and lactating mothers in Kabul City, Afghanistan.
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Affiliation(s)
- Lisa D Mihora
- University of Tennessee--Chattanooga Unit, Department of Ophthalmology, 975 East Street, Chattanooga, TN 37403, USA.
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Waddington SN, Buckley SMK, Bernloehr C, Bossow S, Ungerechts G, Cook T, Gregory L, Rahim A, Themis M, Neubert WJ, Coutelle C, Lauer UM, Bitzer M. Reduced toxicity of F-deficient Sendai virus vector in the mouse fetus. Gene Ther 2004; 11:599-608. [PMID: 14724676 DOI: 10.1038/sj.gt.3302205] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Current concerns over insertional mutagenesis by retroviral vectors mitigate investigations into alternative, potentially persistent gene therapy vector systems not dependent on genomic integration, such as Sendai virus vectors (SeVV). Prenatal gene therapy requires efficient gene delivery to several tissues, which may not be achievable by somatic gene transfer to the adult. Initially, to test the potential and tropism of the SeVV for gene delivery to fetal tissues, first-generation (replication- and propagation-competent) recombinant SeVV, expressing beta-galactosidase was introduced into late gestation immunocompetent mice via the amniotic and peritoneal cavities and the yolk sac vessels. At 2 days, this resulted in very high levels of expression particularly in the airway epithelium, mesothelium and vascular endothelium, respectively. However, as expected, substantial vector toxicity was observed. The efficiency of gene transfer and the level of gene expression were then examined using a second-generation SeVV. The second generation was developed to be still capable of cytoplasmic RNA replication and therefore high-level gene expression, but incapable of vector spread due to lack of the gene for viral F-protein. Vector was introduced into the fetal amniotic and peritoneal cavities, intravascularly, intramuscularly and intraspinally; at 2 days, expression was observed in the airway epithelia, peritoneal mesothelia, unidentified cells in the gut wall, locally at the site of muscle injection and in the dorsal root ganglia, respectively. Mortality was dramatically diminished compared with the first-generation vector.
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Affiliation(s)
- S N Waddington
- Gene Therapy Research Group, Section of Cell and Molecular Biology, Sir Alexander Fleming Building, Imperial College Road, Imperial College of Science, Technology and Medicine, London, UK
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Lissett CA, Saleem S, Rahim A, Brennan BM, Shalet SM. The impact of irradiation on growth hormone responsiveness to provocative agents is stimulus dependent: results in 161 individuals with radiation damage to the somatotropic axis. J Clin Endocrinol Metab 2001; 86:663-8. [PMID: 11158028 DOI: 10.1210/jcem.86.2.7235] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
GH provocative tests remain the mainstay for the diagnosis of GH deficiency and at present the insulin tolerance test (ITT) is the gold standard. There are, however, a variety of other stimulation tests used in clinical practice. Each necessitates the use of a specific cut-off derived from normative data, but there remains a widely held view that the implications from a "failed" test are independent of the nature of the stimulus. We sought to examine whether this is the case in individuals with evidence of radiation damage to the somatotropic axis. One hundred and sixty-one nonacromegalic patients were identified who had undergone an arginine stimulation test (AST) and an ITT within a 3-month period as part of routine testing between 1975 and 1999. They were divided into those tested before (n = 81; 48 males) and those tested after (n = 80; 36 males) completion of growth and puberty. Patients were considered for inclusion in the study if they had a history of cranial irradiation and a GH response to one provocative test of less than 8 microg/L, taken as indicating that some damage to the GH axis may have occurred. The patients were compared with 2 control groups. The first comprised 35 adults (18 males) and the second consisted of 16 prepubertal children (10 males). The median peak (range) GH response to the ITT was significantly greater (P < 0.0001) than that to the AST in the adult controls: 24.9 (4.1--76.9) vs. 12.2 (0.88--35.0) microg/L, respectively. However, in the patients the GH responses were similar (P = 0.28): 2.2 (0.2--25.7) vs. 1.4 (0.2--12.8) microg/L to the ITT and AST, respectively. In contrast to the pattern seen in the adult controls, the response to an ITT in childhood controls was of similar magnitude (P = 0.5) to that to the AST: 17.5 (8.1--40.0) vs. 19.4 (7.3--53.8) microg/L, respectively. However in the patients, the GH response to the AST was greater than that to the ITT (P < 0.0001): 4.3 (0.7--17.2) vs. 3.0 (0.4--18.1) microg/L, respectively. In summary, we have shown that the impact of irradiation on GH responsiveness to provocative agents is stimulus dependent. The GH response to an AST appears to be more resistant to the effects of irradiation than that to the ITT. When investigating the impact of irradiation on GH secretory status, the GH response to an AST may be a less sensitive guide to the functional ability of the GH axis.
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Affiliation(s)
- C A Lissett
- Department of Endocrinology, Christie Hospital National Health Service Trust, Manchester, United Kingdom M20 4BX
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Abstract
Due to persistent qualitative abnormalities in GH secretion following treatment, and lack of a sensitive marker of GHD in mid-adult life it is extremely difficult to diagnose GHD in treated acromegalic patients. The diagnosis of GHD in patients with pituitary disease relies on provocative tests of GH reserve. Arginine releases GH by reducing somatostatin inhibition of GH release, whereas GH secretagogues (GHS) affect GH release by direct stimulation of the GHS receptor, though an intact GH releasing hormone (GHRH) axis is a prerequisite. The peak GH response to insulin-induced hypoglycaemia and arginine in acromegalic patients, in whom basal serum GH levels of less than 5 mU/l have been achieved, is greatly diminished in those treated by hypothalamo-pituitary irradiation. We aimed to study the response of successfully treated acromegalic patients to the growth hormone secretagogue hexarelin in view of its different putative mechanism of action, and in addition, to determine whether it has any value in the diagnosis of GH deficiency in this subset of patients. Nineteen acromegalic patients, in whom mean serum GH levels below 5 mU/l have been achieved through treatment, were recruited. Eight of the patients had been treated by surgery alone (Group A) and 11 had received primary or postoperative irradiation (Group B). All patients underwent 20 min blood sampling to provide a 24-h GH profile. Serum IGF-I was measured from a sample drawn between 0900 h and 1000 h. On a second visit arginine 20 g/m2 was infused over 30 min, blood samples were taken before commencing the infusion and at 30-min intervals thereafter for 180 min. At the final visit hexarelin 1.5 mcg/kg was administered as an intravenous bolus at t = 0. Blood was drawn at 15-min intervals from - 30 to 180 min. All patients in group A showed an increment in serum GH following hexarelin (DeltaGHHEX) > 20 mU/l, a normal response to arginine, and a mean 24-h GH > 0.5 mU/l. In group B only 4/11 achieved a DeltaGHHEX > 20 mU/l, 5/11 producing a response of < 2 mU/l. Four of the five patients with a DeltaGHHEX < 2 mU/l were also demonstrated to have a mean 24-h GH of < 0.5 mU/l and serum IGF-I SDS < + 0.5. All four patients in Group B who achieved a DeltaGHHEX > 20 mU/l, were observed to show an absent or minimal GH response to arginine. Despite loss of the GH response to arginine, the DeltaGHHEX is retained in a proportion of those patients in whom "safe" GH levels were achieved following irradiation. From the putative mechanisms of action of these provocative agents a plausible explanation would be that the GHRH axis is more resilient than endogenous somatostatin-secreting neurones to radiation-induced damage. Furthermore, GH secretagogues may have a role, in combination with serum IGF-I levels, in the diagnosis of GH deficiency in treated acromegaly.
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Affiliation(s)
- R D Murray
- Department of Endocrinology, Christie Hospital NHS Trust, Wilmslow Road, Manchester, M20 4BX, UK
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Abstract
No cancer incidence data from Pakistan have been published in the 5 decades since independence. Incidence data for the period 1995-1997 from the population of the Karachi South district (1.7 million) are presented here. A total of 4,268 new cancer cases were registered during this period: 2,160 cases in males and 2,108 cases in females. Overall, 95.3% of the incident cases were microscopically verified. The incidence rates for all cancers combined were 80.5 per 100,000 (crude) and 136.7 per 100,000 (age- standardised rates [ASR]) for males and 91.8 (crude) and 163.2 per 100,000 (ASR) for females. In males, lung cancer (ASR 20.3) was the most frequently recorded malignancy followed by oral cavity (ASR 13.8) and larynx cancer (ASR 8.6). In females, breast was the most common site of cancer, accounting for one third of female cancers (ASR 51.7), followed by oral cavity (ASR 14.1) and ovarian cancer (ASR 10.2). Karachi reports the highest incidence of breast cancer for any Asian population, except Jews in Israel. Tobacco smoking is estimated to be responsible for 40% of cancers in males and tobacco chewing for a further substantial proportion of head and neck cancers.
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Affiliation(s)
- Y Bhurgri
- Department of Pathology, Dow Medical College, Karachi Cancer Registry, Government of Sindh, Pakistan
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Murray RD, Brennan BM, Rahim A, Shalet SM. Survivors of childhood cancer: long-term endocrine and metabolic problems dwarf the growth disturbance. Acta Paediatr Suppl 1999; 88:5-12. [PMID: 10626538 DOI: 10.1111/j.1651-2227.1999.tb14396.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
The long-term effects of radiotherapy and chemotherapy are becoming increasingly recognized as the cure rates of certain childhood malignancies improve. The endocrine system is particularly sensitive to cancer therapies. Long-term survivors of childhood cancer who received cranial irradiation have been shown to have lower than predicted height, an increased prevalence of obesity and reductions in strength, exercise tolerance, bone mineral density, quality of life and academic achievement. Growth hormone deficiency (GHD) is the most frequent endocrine deficiency observed following cranial irradiation. Adults with GHD resulting from primary hypothalamic-pituitary disease during childhood have been shown to exhibit a clinical picture similar to that described in long-term survivors of childhood cancer: increased fat mass and reduced lean mass, strength, exercise tolerance, bone mineral density and quality of life. This review considers the possible contribution of GHD to the adverse sequelae observed in long-term survivors of childhood malignancy and includes our preliminary experience in treating 14 adults with GHD resulting from the treatment of childhood malignancies.
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Affiliation(s)
- R D Murray
- Department of Endocrinology, Christie Hospital, Manchester, UK
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Abstract
OBJECTIVE The diagnosis of GH deficiency in adults relies on the results of GH provocative testing. Whilst in some patients the testing strategy is clear, this is not the case in all patients. The objective of this study was to further examine the concordance between the GH responses to two different provocative stimuli, to correlate this with the number of additional pituitary hormone deficits, and to produce guidelines as to which patients require two GH provocative tests and which require only one. STUDY DESIGN AND PATIENTS The results of GH provocative tests were reviewed in 103 patients (mean age 28 years, 48 male), with documented or potential hypothalamic-pituitary disease and 35 normal volunteers (mean age 21 years, 18 male). All patients and normal volunteers underwent an insulin tolerance test (ITT) and an arginine stimulation test (AST). Severe GH deficiency was defined as a GH response to an ITT of < 5 mU/l and a GH response to an AST of < 2 mU/l, utilizing data from previous studies in this unit. Patients were divided into four groups according to the number of anterior pituitary hormone deficits present other than possible GH deficiency: no other pituitary hormone deficits (GHD0) or one, two or three other hormone deficits (GHD1, GHD2 or GHD3). RESULTS The 103 patients were divided between the four groups as follows: 69 (67%) in GHD0, 15 (14. 6%) in GHD1, six (5.8%) in GHD2, and 13 (12.6%) in GHD3. There was a significant decline in the median GH peak to both the ITT and the AST with increasing numbers of other pituitary hormone deficits (P < 0.0001). If the magnitude of the difference between each individual's GH response to the ITT and AST is plotted against the mean GH value a clear trend is seen (Spearmans rank correlation = 0. 88, P < 0.0001) indicating that the magnitude of the difference between the GH responses to an ITT and AST increases with the underlying mean GH value. These data allow the estimation of the median ITT/AST ratio as 1.17 (CI 0.98, 1.39). None of the control subjects and 14.1% (10), 26.7% (four), 83% (five) and 92.3% (12) of groups GHD0, 1, 2 and 3, respectively, had severe GHD. The concordance between the AST and ITT (percent of patients in whom both tests confirmed or refuted the biochemical diagnosis of severe GHD) was 100%, 76.8%, 66.6%, 83.3%, and 92.3% in the controls, GHD0, 1, 2, and 3, respectively. Thus, 16/69 GHD0, 5/15 GHD1, 1/6 GHD2 and 1/13 GHD3 patients were misclassified by one or other test. CONCLUSION We have demonstrated that a constant ratio links the GH response to an ITT and AST in an individual, rather than a constant difference, and that the difference between the GH responses to two provocative stimuli is greater in those patients with milder degrees of GH deficiency or insufficiency. These patients tend to have one or no additional pituitary hormone deficits and may be misclassified if a single GH provocative test is performed. We suggest that whilst a single GH provocative test can be used with confidence in patients with two or three additional pituitary hormone deficits, in patients with suspected isolated GH deficiency or with only one additional pituitary hormone deficit, two GH provocative tests should be performed.
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Affiliation(s)
- C A Lissett
- Department of Endocrinology, Christie Hospital NHS Trust, Manchester, UK
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Murray RD, Skillicorn CJ, Howell SJ, Lissett CA, Rahim A, Smethurst LE, Shalet SM. Influences on quality of life in GH deficient adults and their effect on response to treatment. Clin Endocrinol (Oxf) 1999; 51:565-73. [PMID: 10594517 DOI: 10.1046/j.1365-2265.1999.00838.x] [Citation(s) in RCA: 70] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Studies of the effect of GH on quality of life (QOL) in growth hormone deficient (GHD) adults have reported conflicting results. Recently, however, we have demonstrated that by selecting only those patients with impaired QOL the efficacy of GH replacement on QOL can be greatly improved. The improvement in QOL was observed to correlate significantly with that recorded before commencing GH therapy. This study aims to assess if demographic variables affect QOL in untreated GHD adults or the improvement in QOL following GH therapy. DESIGN An open study of GH replacement, initiating treatment with a dose of 0.8 IU/day and titrating the dose by 0.4 IU increments to normalize the IGF-I SDS between - 2.0 and + 2.0 SD of the age related normal range. PATIENTS 65 severely GHD patients (peak GH < 9 mU/l to provocative testing), mean age 38.7 (range 17-72) years. Inclusion criterion was that of subjectively poor quality of life on clinical interview. MEASUREMENTS Blood was taken for insulin-like growth factor 1 (IGF-I). The Psychological General Well-Being Schedule (PGWB) and Adult Growth Hormone Deficiency Assessment (AGHDA) self-rating questionnaires were used to assess quality of life at baseline, three and eight months after commencing GH. RESULTS The patients were subgrouped on the basis of gender, age of onset of GHD, pathology and presence of additional pituitary hormone deficits. The cohort consisted of 40 females and 25 males, 45 of adult-onset (AO) and 20 of childhood-onset (CO). GH deficiency resulted from a hypothalamo-pituitary pathology, or treatment thereof, in 36 patients and as a result of cranial irradiation for a primary brain tumour or prophylaxis in acute lymphoblastic leukaemia in 29 patients. Isolated GH deficiency (IGHD) was present in 25 patients, and 32 patients were demonstrated to have at least two additional pituitary hormone deficits (MPHD). No significant difference was detected between baseline PGWB scores of the subgroups. Multiple linear regression analysis revealed the age of onset of GHD to be a significant determinant of both the baseline PGWB (P = 0.05) and AGHDA (P = 0.025) scores, AO patients perceiving the greater distress. A significant improvement, from baseline, in both QOL scores was observed in all subgroups at three months, and in all subgroups at eight months except IGHD, where a trend towards improvement in the AGHDA score was observed but failed to reach significance. The mean improvement in the PGWB following GH therapy was not significantly different between subgroups. Multiple linear regression analysis confirmed baseline PGWB and AGHDA scores to be the most important variable in prediction of the level of improvement in respective scores following GH therapy. Age of onset was also observed to be a significant determinant of the PGWB scores following GH therapy (P = 0.02), the CO cohort experiencing the greater improvement. A similar relationship between age of onset and AGHDA scores was not observed (P = 0.22). CONCLUSIONS Baseline QOL as assessed by self-rating questionnaires is influenced by the age of onset of the GH deficiency, adult onset patients expressing the greater distress. Improvements in QOL scores are influenced by both baseline score and to a lesser extent the age of onset of GHD, the greater improvement being observed in childhood onset patients. The degree of improvement was observed to be independent of gender, pathology and number of pituitary hormone deficits. In a cohort selected by subjectively impaired QOL, we have demonstrated childhood onset GHD patients perceive themselves to have less impairment of QOL pretreatment. In contrast to previous data in unselected cohorts, however, we have shown that those childhood onset GHD patients in whom QOL is significantly reduced, show a capacity for improvement that is equal to, if not greater, than that seen in adult onset-GHD patients.
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Affiliation(s)
- R D Murray
- Department of Endocrinology, Christie Hospital, Manchester, UK
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Bhurgri Y, Bhurgri A, Rahim A, Bhutto K, Pinjani PK, Usman A, Hasan SH. The pattern of malignancies in Karachi (1995 to 1996). J PAK MED ASSOC 1999; 49:157-61. [PMID: 10599201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
OBJECTIVE To determine the cancer pattern of the city of Karachi for the years 1995-1996. METHODS The Karachi Cancer Registry, established in 1995 by the Government of Sindh, in collaboration with the IARC is an active registry. The staff collect the data pertaining to cancer patients and record it on the registry forms. Hospitals in Karachi, district south as well as some of the hospitals in other districts of the city, where patients are likely to go for treatment or diagnosis are visited. People residing in the district for more than six months prior to the onset of the malignancy were considered "residents". All the cases diagnosed on or after 1st January 1995 till 31st December 1996 were considered for analysis. RESULTS In the years 1995-96, the most common cancer sites among males were cancers of the lung, oral cavity and lymph nodes. For females, breast cancer ranked first, followed by cancer of the oral cavity and ovary. The age standardized rate for all cancers was 96.3 per 100,000 in males and 96.9 per 100,000 in females. At this early stage of registration we assume that the registry has a missing rate of approximately 20-25%. CONCLUSION The pattern of malignancies in Karachi is similar to the western countries, with lung and breast being the commonest tumors amongst the males and females respectively. The Asian countries have stomach/lung/oral cavity/liver as the commonest tumors amongst the males and cervix/breast amongst the females. Pakistan being a Muslim country, the incidence of cervical cancer showed an expected low figure.
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Affiliation(s)
- Y Bhurgri
- Department of Pathology, Dow Medical College, Karachi
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Murray RD, Skillicorn CJ, Howell SJ, Lissett CA, Rahim A, Shalet SM. Dose titration and patient selection increases the efficacy of GH replacement in severely GH deficient adults. Clin Endocrinol (Oxf) 1999; 50:749-57. [PMID: 10468947 DOI: 10.1046/j.1365-2265.1999.00722.x] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE Previous studies of GH replacement in adults have used unselected cohorts of GH deficient (GHD) adults and weight-based dosing regimens resulting in supraphysiological serum IGF-I levels and a high frequency of side-effects and withdrawal from these studies. By choosing patients with a high level of morbidity at baseline and using a low dose GH titration regimen we aimed to avoid over-replacement and increase the efficacy of treatment. DESIGN An open study of GH replacement, initiating treatment with a dose of 0. 8 U/day and titrating the dose by 0.4 U increments to normalize the IGF-I SDS between - 2.0 and + 2.0 SD of the age-related normal range. PATIENTS 65 severely GHD patients (peak GH < 9 mU/l to provocative testing), 25 males, of mixed adult and childhood-onset and mean age 38.7 (range 17-72) years. Inclusion criterion was that of subjectively poor quality of life on clinical interview. MEASUREMENTS Height, weight, waist and hip circumference were measured to allow calculation of body mass index (BMI) and waist-hip ratio (WHR). Bone mineral density (BMD) was measured by dual X-ray absorptiometry (DEXA). Serum haemoglobin A1C (HbA1C), lipid profile and insulin like growth factor 1 (IGF-I) were measured. The Psychological General Well-Being Schedule (PGWB) and Adult Growth Hormone Deficiency Assessment (AGHDA) self-rating questionnaires (SRQ) were used to assess quality of life. RESULTS Baseline characteristics were consistent with those previously described in severely GHD adults; mean IGF-I SDS - 2.4 (+/- 2.7), BMI 28.8 (+/- 5. 4) kg/m2, total cholesterol 6.17 (+/- 1.2) mmol/l, reduced BMD z-scores at the lumbar spine (- 0.8 +/- 1.2) and femoral neck (- 0. 44 +/- 1.4), and SRQ scores considerably lower than reported in previous studies of GH deficient adults and normal controls. Following initiation of GH serum IGF-I SDS was increased significantly from baseline to a mean level of 0.15 +/- 2.7 (P < 0. 001) and 0.31 +/- 2.0 (P < 0.001) at three and eight months, respectively. The mean PGWB score increased from 59.7 +/- 19.9 to 75. 8 +/- 15.0 (P < 0.001) and 73.7 +/- 19.5 (P = 0.001) at three and eight months, respectively. An increase of 14 points represents the largest improvement in quality of life, using this index, that has been reported in GHD adults. The mean AGHDA score also demonstrated considerable improvement, falling from 15.3 +/- 6.0 to 10.4 +/- 6.2 (P < 0.001) and 9.8 +/- 6.5 (P < 0.001) at three and eight months, respectively. The changes observed in both the PGWB and AGHDA scores between baseline and at both three and eight months were shown to correlate significantly with the respective baseline score. A significantly greater improvement was observed in the PGWB following GH replacement in those with a baseline PGWB score of < 60 than in those with a score > 60. This observation was significant at both three (27.1 vs 6.7, P = 0.0001) and eight (25.6 vs 3.3, P = 0.0003) months. All PGWB subscales showed significant improvement though that of vitality was of greatest magnitude. A strong correlation was observed between the generic and disease-specific SRQ (r = - 0.73, P < 0.001). CONCLUSIONS The observed improvement in quality of life in GH deficient adults is proportional to the degree of impairment before commencing therapy. The use of low-dose titration and selection of a population with greater morbidity reduces the occurrence of over-replacement and increases the efficacy of treatment. This allows direction of resources to those in greatest need.
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Affiliation(s)
- R D Murray
- Department of Endocrinology, Christie Hospital, Manchester, UK
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46
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Abstract
Bone mineral density (BMD), serum osteocalcin and type I collagen C-telopeptide (ICTP) were assessed in a cohort of 31 (16 males) adults who had received cranial irradiation in childhood as part of their treatment for acute lymphoblastic leukaemia (ALL). Markers of bone turnover were compared with those of 35 age and body mass index (BMI) matched young adults (18 male). Growth hormone status had previously been determined using an insulin tolerance test and arginine stimulation test. Eight patients were classified as severe growth hormone deficiency (group 1), 12 patients as growth hormone insufficient (group 2) and 11 patients as normal (group 3). Vertebral trabecular BMD, lumbar spine and femoral neck integral BMD and forearm cortical bone mineral content (BMC) was measured 17.8 (6.8-28.6) years after cranial irradiation and was expressed as Z (standard deviation) scores. There was a significant reduction in vertebral trabecular BMD (median Z score -1.25, P < 0.001), in lumbar spine integral BMD (median Z score -0.74, P = 0.001), in forearm cortical BMC (median Z score -1.35, P < 0.001), and less so in femoral neck integral BMD (median Z score -0.43, P = 0.03). There was no difference among the growth hormone status groups for the following BMD measurements: vertebral trabecular BMD, lumbar spine integral BMD or femoral neck integral BMD (P = 0.8, P = 0.96 and P = 0.4 respectively). There was only a marginal significant difference for BMD at the wrist between growth hormone status groups (P = 0.04). There was no correlation between the BMD measurements with time since or age at diagnosis and no difference in markers of bone turnover between patients and controls; median serum osteocalcin 13.3 and 12.0 ng ml (P = 0.7), respectively, and for ICTP 5.0 and 4.9 microg L (P = 0.67) respectively. In conclusion, there is a highly significant reduction in BMD in young adults following treatment for ALL in childhood. The reduction in BMD affects both trabecular and cortical bone but did not seem to be related to time since diagnosis, age at diagnosis, or current growth hormone status. Possible explanations include a direct effect of chemotherapy, steroids or both on bone during childhood and hence an effect on the accretion of bone mass. In view of the risk of fractures in patients with osteopenia, adults treated for ALL in childhood may be at an increased risk of bone fractures later in life irrespective of the underlying cause of the osteopenia and thus intervention should be considered.
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Affiliation(s)
- B M Brennan
- Department of Paediatric Oncology, Royal Manchester Children's Hospital, Manchester, UK
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Maheshwari HG, Rahim A, Shalet SM, Baumann G. Selective lack of growth hormone (GH) response to the GH-releasing peptide hexarelin in patients with GH-releasing hormone receptor deficiency. J Clin Endocrinol Metab 1999; 84:956-9. [PMID: 10084578 DOI: 10.1210/jcem.84.3.5523] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The mechanism of the synergistic relationship between GH-releasing peptide (GHRP) and GHRH with respect to GH secretion is poorly understood. We report the response to hexarelin, a potent GHRP, in patients affected with a homozygous mutation in the GHRH receptor gene, with consequent GHRH resistance and GH-deficient dwarfism. This newly described syndrome is the human homolog of the little (lit/lit) mouse. Intravenous administration of hexarelin (2 microg/kg) to four male adult patients (dwarfs of Sindh) resulted in a complete lack of elevation in plasma GH levels (< 1 ng/mL), an at least 50- to 100-fold deviation from the normal response. In contrast, plasma PRL, ACTH, and cortisol levels rose in a normal manner in response to hexarelin. We conclude that an intact GHRH signaling system is critical for GHRPs to exert their effect on GH release, but that the GHRH system is not necessary for the effect of GHRP on PRL and ACTH secretion. Hexarelin (and probably other GHRPs) are not effective agents for the treatment of patients with GHRH resistance due to GHRH receptor deficiency.
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Affiliation(s)
- H G Maheshwari
- Center for Endocrinology, Metabolism, and Molecular Medicine, Department of Medicine, Northwestern University Medical School, Chicago, Illinois 60611, USA
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Brennan BM, Rahim A, Blum WF, Adams JA, Eden OB, Shalet SM. Hyperleptinaemia in young adults following cranial irradiation in childhood: growth hormone deficiency or leptin insensitivity? Clin Endocrinol (Oxf) 1999; 50:163-9. [PMID: 10396357 DOI: 10.1046/j.1365-2265.1999.00622.x] [Citation(s) in RCA: 91] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE In order to explore the mechanism of obesity in long-term survivors of childhood leukaemia, fat mass, lean body mass and serum leptin were assessed in a cohort of 32 (17 males) adults who had received cranial irradiation (XRT) in childhood as part of their treatment for acute lymphobiastic leukaemia (ALL), and compared with 35 age and body mass index (BMI) matched young adults (18 male). DESIGN Thirty-one patients and 18 controls had fat mass and lean body mass assessed by dual x-ray absorptiometry (DEXA), using a lunar DPX-L scanner. Serum leptin concentrations were also measured in 27 patients and all controls. Growth hormone status had previously been determined using an insulin tolerance test and arginine stimulation test. Nine patients were classified as severe growth hormone (GH) deficient (group 1), 12 patients as GH insufficient (group 2) and 11 patients as normal (group 3). RESULTS BMI and absolute fat mass were not significantly different between the patients and controls regardless of their gender (P = 0.1 and P = 0.14 respectively). In contrast, absolute lean mass was significantly reduced (P < 0.01) and leptin concentrations were significantly increased (P < 0.001) in patients compared with controls. BMI, fat mass and leptin concentrations but not lean mass were significantly different between the three GH status groups (P < 0.01, P < 0.01, P = 0.004, and P = 0.67 respectively). When leptin concentrations were expressed per unit of fat mass, they were increased in the patients compared with the controls (P = 0.03) with significant differences between the GH status groups (P = 0.004), being significantly higher in the severe GH deficient group. CONCLUSIONS Young adults who receive cranial irradiation in childhood are prone to GH deficiency and hyperleptinaemia. The pathophysiological significance of the hyperleptinaemia remains to be established but it has occurred either as a consequence of radiation induced hypothalamic damage or GH deficiency.
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Affiliation(s)
- B M Brennan
- Department of Paediatric Oncology, Royal Manchester Children's Hospital, UK
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Abstract
OBJECTIVE With the development of growth hormone (GH) releasing agents and their use in human subjects, it is clear that these agents are not specific for GH release. More recent studies in humans have demonstrated acute increases in adrenocorticotrophic hormone (ACTH), cortisol and prolactin (PRL) after boluses of intravenous or subcutaneous GHRPs. The potential adverse effects of repeated episodes of transient hyperprolactinaemia and hypercortisolaemia during long-term therapy with growth hormone releasing peptides (GHRPs) and similar agents have raised concern. We have therefore assessed the impact of chronic hexarelin administration on the pituitary-adrenal axis and serum prolactin levels. DESIGN Each subject received twice-daily subcutaneous hexarelin therapy (1.5 micrograms/kg body weight) for 16 weeks. The ACTH, cortisol and PRL responses to the morning subcutaneous injection of hexarelin were assessed. Hexarelin was administered at time 0 and blood samples were taken at -10, 0, 10, 20, 30, 40, 50, 60, 90, 120, 170 and 180 min. The ACTH and PRL responses were assessed at baseline and after 16 weeks of therapy. The cortisol response was assessed at baseline, 16 weeks and also 4 weeks after completion of hexarelin therapy. Basal levels of cortisol binding globulin (CBG), 24-h urinary free cortisol (UFC) estimations, thyroid stimulating hormone (TSH) and total thyroxine (TT4) were performed at baseline, weeks 16 and 20. RESULTS The mean (+/- SEM) area under the cortisol curve (AUCCORT) at baseline, week 16 and week 20 were 1506 (+/- 77) nmol/l/h, 1222 (+/- 92) nmol/l/h and 1586 (+/- 58) nmol/l/h, respectively. There was a significant change in AUCCORT over the study period (P = 0.008). Compared with baseline, AUCCOPRT had decreased significantly (P < 0.05) after 16 weeks of hexarelin therapy. Four weeks after completion of hexarelin therapy, the AUCCORT increased significantly compared with AUCCORT at week 16 (P < 0.01) and was no longer significantly different from baseline values. There were no significant changes in UFC (P = 0.3), basal cortisol measurements (P = 0.19), area under the ACTH curve (AUCACTH) (P = 0.24) or CBG (P = 0.6) over the study period. The mean (+/- SEM) area under the PRL curve (AUCPRL) at the baseline and week 16 were 624 (+/- 82) mU/l/h and 641 (+/- 83) mU/l/h, respectively. There was no significant change in AUCPRL over the study period (P = 0.35). CONCLUSION The present study demonstrates clearly that in this hexarelin dosage regimen, over-stimulation of the pituitary adrenal axis and prolactin secretion do not occur. In fact the impact of chronic hexarelin therapy on the pituitary-adrenal axis, i.e. decreased AUCCORT, contradict the findings reported after acute hexarelin administration and cannot be explained by changes in CBG. The lack of change in UFC, however, suggests that these changes are unlikely to be of clinical significance although the underlying mechanism requires further study.
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Affiliation(s)
- A Rahim
- Department of Endocrinology, Christie Hospital, Withington, Manchester, UK
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Bhurgri Y, Rahim A, Bhutto K, Bhurgri A, Pinjani PK, Usman A, Hassan SH. Incidence of carcinoma of the oral cavity in Karachi--district south. J PAK MED ASSOC 1998; 48:321-5. [PMID: 10323050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
Globally oral cancer is one of the ten common cancers. In some parts of the world, including the Indian sub-continent oral cancer is a major problem. The two year data of the Karachi Cancer Registry, showed oral cancer was the second most common malignancy in the males as well as in the females. The most common malignancy amongst the males being the carcinoma of the lungs and amongst the females, carcinoma of the breast. The annual incidence rate of oral cancer was 4.1 per 100,000 annually for the males and 4.0 per 100,000 annually for the females.
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Affiliation(s)
- Y Bhurgri
- Karachi Cancer Registry, Department of Pathology, Dow Medical College, Karachi
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