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Zafar A, Khan MJ, Abu J, Naeem A. Revolutionizing cancer care strategies: immunotherapy, gene therapy, and molecular targeted therapy. Mol Biol Rep 2024; 51:219. [PMID: 38281269 PMCID: PMC10822809 DOI: 10.1007/s11033-023-09096-8] [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: 08/18/2023] [Accepted: 12/04/2023] [Indexed: 01/30/2024]
Abstract
Despite the availability of technological advances in traditional anti-cancer therapies, there is a need for more precise and targeted cancer treatment strategies. The wide-ranging shortfalls of conventional anticancer therapies such as systematic toxicity, compromised life quality, and limited to severe side effects are major areas of concern of conventional cancer treatment approaches. Owing to the expansion of knowledge and technological advancements in the field of cancer biology, more innovative and safe anti-cancerous approaches such as immune therapy, gene therapy and targeted therapy are rapidly evolving with the aim to address the limitations of conventional therapies. The concept of immunotherapy began with the capability of coley toxins to stimulate toll-like receptors of immune cells to provoke an immune response against cancers. With an in-depth understating of the molecular mechanisms of carcinogenesis and their relationship to disease prognosis, molecular targeted therapy approaches, that inhibit or stimulate specific cancer-promoting or cancer-inhibitory molecules respectively, have offered promising outcomes. In this review, we evaluate the achievement and challenges of these technically advanced therapies with the aim of presenting the overall progress and perspective of each approach.
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Affiliation(s)
- Aasma Zafar
- Department of Biosciences, COMSATS University, Islamabad, 45550, Pakistan
| | | | - Junaid Abu
- Hazm Mebaireek General Hospital, Hamad Medical Corporation, P.O. Box 3050, Doha, Qatar
| | - Aisha Naeem
- Qatar University Health, Qatar University, P.O. Box 2713, Doha, Qatar.
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Zafar A, Khan MJ, Naeem A. MDM2- an indispensable player in tumorigenesis. Mol Biol Rep 2023; 50:6871-6883. [PMID: 37314603 PMCID: PMC10374471 DOI: 10.1007/s11033-023-08512-3] [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: 12/31/2022] [Accepted: 05/10/2023] [Indexed: 06/15/2023]
Abstract
Murine double minute 2 (MDM2) is a well-recognized molecule for its oncogenic potential. Since its identification, various cancer-promoting roles of MDM2 such as growth stimulation, sustained angiogenesis, metabolic reprogramming, apoptosis evasion, metastasis, and immunosuppression have been established. Alterations in the expression levels of MDM2 occur in multiple types of cancers resulting in uncontrolled proliferation. The cellular processes are modulated by MDM2 through transcription, post-translational modifications, protein degradation, binding to cofactors, and subcellular localization. In this review, we discuss the precise role of deregulated MDM2 levels in modulating cellular functions to promote cancer growth. Moreover, we also briefly discuss the role of MDM2 in inducing resistance against anti-cancerous therapies thus limiting the benefits of cancerous treatment.
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Affiliation(s)
- Aasma Zafar
- Department of Biosciences, COMSATS University, Islamabad, 45550 Pakistan
| | | | - Aisha Naeem
- Department of Oncology, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, 20057 Washington, DC U.S
- Qatar University Health, Qatar University, P.O. Box 2713, Doha, Qatar
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Naveed M, Ul Ain N, Aziz T, Shabbir MA, Saleem A, Zafar A, Ghulam N, Alharbi M, Alshammari A, Alasmari AF. Side chain inset of neurogenerative amino acids to metalloproteins: a therapeutic signature for huntingtin protein in Huntington's disease. Eur Rev Med Pharmacol Sci 2023; 27:6831-6842. [PMID: 37522694 DOI: 10.26355/eurrev_202307_33154] [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: 08/01/2023]
Abstract
OBJECTIVE Huntington's disease is a dominant autosomal inherited neurodegenerative disease that results in progressive impairment, characterized by dementia, chorea, and behavioral and cognitive decline. The objective of this study was to investigate the potential activity of metalloproteins against the huntingtin protein using various insertion-based engineering computational methods. Metalloproteins, metal protein complexes involved in important biochemical and physiological processes, were explored as potential drug candidates for Huntington's disease. MATERIALS AND METHODS A total of 18 metalloproteins were selected as drug candidates and studied to assess their potential inhibitory effects on the huntingtin protein. The screening process was based on the lowest binding energy. The metalloprotein with the lowest docking score was chosen for side chain insertion of neurogenerative amino acids. The engineered metalloprotein was then evaluated based on physiochemical properties, allergenicity, toxicity, and surface accessibility. Cloning and expression analysis was performed to further investigate its potential as a therapeutic agent. RESULTS The metalloprotein chosen for side chain insertion, cytochrome C oxidase, showed promising results. It was computed as a probable non-allergen and exhibited no toxic domains, indicating its non-toxic nature. Additionally, it demonstrated a strong binding affinity with the huntingtin protein, with a binding energy of -1,253.3 Kcal/mol. CONCLUSIONS Metal-based proteins, when engineered with additional neurogenerative amino acids, hold potential as drug candidates for treating neurodegenerative diseases such as Huntington's disease. The successful development of these engineered metalloproteins could offer therapeutic advantages. Further testing, both in vitro and in vivo, is necessary to evaluate their efficacy and validate their potential activity as novel drugs for the treatment of neurodegenerative diseases.
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Affiliation(s)
- M Naveed
- Department of Biotechnology, Faculty of Life Sciences, University of Central Punjab, Lahore, Pakistan.
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Harakuni SU, Somannavar MS, Ghanchi NK, Ahmed I, Zafar A, Kim J, Tikmani SS, Hwang K, Saleem S, Goudar SS, Dhaded S, Guruprasad G, Yasmin H, Yogeshkumar S, Aceituno A, Silver RM, McClure EM, Goldenberg RL. Pathogens identified in the internal tissues and placentas of stillbirths: results from the prospective, observational PURPOSe study. BJOG 2023. [PMID: 37069731 DOI: 10.1111/1471-0528.17479] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 11/18/2022] [Accepted: 12/06/2022] [Indexed: 04/19/2023]
Abstract
OBJECTIVE To examine internal organ tissues and placentas of stillbirths for various pathogens. DESIGN Prospective, observational study. SETTINGS Three study hospitals in India and a large maternity hospital in Pakistan. POPULATION Stillborn infants delivered in a study hospital. METHODS A prospective observational study. MAIN OUTCOME MEASURES Organisms identified by pathogen polymerase chain reaction (PCR) in internal organs and placental tissues of stillbirths. RESULTS Of 2437 stillbirth internal tissues, 8.3% (95% CI 7.2-9.4) were positive. Organisms were most commonly detected in brain (12.3%), cerebrospinal fluid (CSF) (9.5%) and whole blood (8.4%). Ureaplasma urealyticum/parvum was the organism most frequently detected in at least one internal organ (6.4% of stillbirths and 2% of all tissues). Escherichia coli/Shigella was the next most common (4.1% one or more internal organ tissue sample and 1.3% of tissue samples), followed by Staphylococcus aureus in at least one internal organ tissue (1.9% and 0.9% of all tissues). None of the other organisms was found in more than 1.4% of the tissue samples in stillbirths or more than 0.6% of the internal tissues examined. In the placenta tissue, membrane or cord blood combined, 42.8% (95% CI 40.2-45.3) had at least one organism identified, with U. urealyticum/parvum representing the most commonly identified (27.8%). CONCLUSIONS In about 8% of stillbirths, there was evidence of a pathogen in an internal organ. Ureaplasma urealyticum/parvum was the most common organism found in the placenta and in the internal tissues, especially in the fetal brain.
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Affiliation(s)
- S U Harakuni
- KLE Academy of Higher Education and Researchs, J N Medical College, Belagavi, India
| | - M S Somannavar
- KLE Academy of Higher Education and Researchs, J N Medical College, Belagavi, India
| | | | - I Ahmed
- Aga Khan University, Karachi, Pakistan
| | - A Zafar
- Aga Khan University, Karachi, Pakistan
| | - J Kim
- RTI International, Durham, North Carolina, USA
| | | | - K Hwang
- RTI International, Durham, North Carolina, USA
| | - S Saleem
- Aga Khan University, Karachi, Pakistan
- RTI International, Durham, North Carolina, USA
| | - S S Goudar
- KLE Academy of Higher Education and Researchs, J N Medical College, Belagavi, India
| | - S Dhaded
- KLE Academy of Higher Education and Researchs, J N Medical College, Belagavi, India
| | - G Guruprasad
- Bapuji Educational Association's J.J.M. Medical College, Davangere, India
| | - H Yasmin
- Jinnah Postgraduate Medical Centre, Karachi, Pakistan
| | - S Yogeshkumar
- KLE Academy of Higher Education and Researchs, J N Medical College, Belagavi, India
| | - A Aceituno
- RTI International, Durham, North Carolina, USA
| | - R M Silver
- University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - E M McClure
- RTI International, Durham, North Carolina, USA
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Petkov V, Rao TD, Zafar A, Abeykoon AMM, Fletcher E, Peng J, Mao ZQ, Ke X. Lattice distortions and the metal-insulator transition in pure and Ti-substituted Ca 3Ru 2O 7. J Phys Condens Matter 2022; 51:015402. [PMID: 36301709 DOI: 10.1088/1361-648x/ac9dda] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/13/2022] [Accepted: 10/26/2022] [Indexed: 06/16/2023]
Abstract
We report pair distribution function studies on the relationship between the metal-insulator transition (MIT) and lattice distortions in pure and Ti-substituted bilayer Ca3Ru2O7. Structural refinements performed as a function of temperature, magnetic field and length scale reveal the presence of lattice distortions not only within but also orthogonal to the bilayers. Because of the distortions, the local and average crystal structure differ across a broad temperature region extending from room temperature to temperatures below the MIT. The coexistence of distinct lattice distortions is likely to be behind the marked structural flexibility of Ca3Ru2O7under external stimuli. This observation highlights the ubiquity of lattice distortions in an archetypal Mott system and calls for similar studies on other families of strongly correlated materials.
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Affiliation(s)
- V Petkov
- Department of Physics, Central Michigan University, Mt. Pleasant, MI 48858, United States of America
| | - T Durga Rao
- Department of Physics, Central Michigan University, Mt. Pleasant, MI 48858, United States of America
- Department of Physics, GITAM, Visakhapatnam, Andhra Pradesh 530045, India
| | - A Zafar
- Department of Physics, Central Michigan University, Mt. Pleasant, MI 48858, United States of America
| | - A M Milinda Abeykoon
- Photon Sciences Division, Brookhaven National Laboratory, Upton, NY 11973, United States of America
| | - E Fletcher
- Department Physics and Astronomy, Michigan State University, East Lansing, MI 48824, United States of America
| | - J Peng
- School of Physics, Southeast University, Nanjin, People's Republic of China
| | - Z Q Mao
- Department of Physics, Pennsylvania State University, University Park, State College, PA 16802, United States of America
| | - X Ke
- Department Physics and Astronomy, Michigan State University, East Lansing, MI 48824, United States of America
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Drobni Z, Gong J, Raghu V, Zafar A, Gongora C, Quinaglia T, Suero-Abreu G, Gilman H, Gao X, Sullivan R, Merkely B, Reynolds K, Neilan T. Association between immune checkpoint inhibitors and vascular endothelial growth factor targeted therapy with cardiovascular events. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2585] [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: 11/15/2022] Open
Abstract
Abstract
Background
The use of immune checkpoint inhibitors (ICI) has been associated with a 3-fold higher risk for cardiovascular events as compared to cancer patients who did not receive ICI. Therapies targeting vascular endothelial growth factor (VEGF) have also been associated with a wide range of cardiovascular events. The combination use of ICIs and VEGF inhibitors is currently approved as a treatment for patients with renal-cell carcinoma, hepatocellular carcinoma, non-small cell lung cancer, and endometrial cancer. Data are lacking whether the combination of ICIs and VEGF-targeted therapy is associated with an additional increase in cardiovascular events.
Purpose
To evaluate whether the combination use of ICI and VEGF targeted therapies are associated with a higher risk of cardiovascular events as compared to ICI therapy alone, we performed a retrospective matched case-control study.
Methods
Cases received both ICI and VEGF-targeted therapy (n=157), and control patients (n=157) only received ICI therapy. The primary outcome was a composite of cardiovascular events (myocardial infarction, coronary revascularization, ischemic stroke, deep venous thrombosis, and pulmonary embolism). Patients were censored at time of first event or at last date of follow up. Cox proportional hazard regression analysis was performed to calculate hazard ratio (HR) with 95% confidence interval (CI), counting only the first cardiovascular event.
Results
Baseline characteristics for the cases and controls are shown in Table 1. Overall cases (combination ICI and VEGF inhibitor) and controls (ICI alone) were not different with respect to age, type of cancer, and a prior history of any cardiovascular event. Cases received more ICI cycles as compared to controls (median of 7 [4–17] cycles vs. 4 [2–10] cycles, P<0.001). Cases also had a longer follow-up time (334 [127–663] days vs. 201 [60–564] days, P=0.008) as compared to the control group. As compared to ICI alone, a similar risk for a composite cardiovascular event was observed in those who received both ICI and VEGF-targeted therapy (HR, 0.70 [95% CI, 0.39–1.25]; P=0.23, Table 1). In total, 21/157 patients had a composite cardiovascular event among the cases, who received the combination of ICI and VEGF inhibitor (9 DVT, one MI, 9 PE, two ischemic strokes) as compared to 25/157 among the controls, who received ICI alone (14 DVT, 3 MI, 7 PE, one ischemic stroke). The median time to event was not different between the two groups (126 [98–260] days vs. 145 [28–205] days, P=0.47).
Conclusion
We found that among 157 patients who received a combination of ICI and VEGF-targeted therapy and 157 matched control patients who only received ICI therapy, the risk for cardiovascular events was not different between the two groups.
Funding Acknowledgement
Type of funding sources: Public grant(s) – EU funding.
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Affiliation(s)
- Z Drobni
- Semmelweis University , Budapest , Hungary
| | - J Gong
- Mass General Hopital (MGH), Cardiovascular Imaging Research Center (CIRC), Department of Radiology and Division of Cardiology , Boston , United States of America
| | - V Raghu
- Mass General Hopital (MGH), Cardiovascular Imaging Research Center (CIRC), Department of Radiology and Division of Cardiology , Boston , United States of America
| | - A Zafar
- Mass General Hopital (MGH), Cardiovascular Imaging Research Center (CIRC), Department of Radiology and Division of Cardiology , Boston , United States of America
| | - C Gongora
- Mass General Hopital (MGH), Cardiovascular Imaging Research Center (CIRC), Department of Radiology and Division of Cardiology , Boston , United States of America
| | - T Quinaglia
- Mass General Hopital (MGH), Cardiovascular Imaging Research Center (CIRC), Department of Radiology and Division of Cardiology , Boston , United States of America
| | - G Suero-Abreu
- Mass General Hopital (MGH), Cardiovascular Imaging Research Center (CIRC), Department of Radiology and Division of Cardiology , Boston , United States of America
| | - H Gilman
- Mass General Hopital (MGH), Cardiovascular Imaging Research Center (CIRC), Department of Radiology and Division of Cardiology , Boston , United States of America
| | - X Gao
- Massachusetts General Hospital, Division of Oncology and Hematology, Department of Medicine , Boston , United States of America
| | - R Sullivan
- Massachusetts General Hospital, Division of Oncology and Hematology, Department of Medicine , Boston , United States of America
| | - B Merkely
- Semmelweis University , Budapest , Hungary
| | - K Reynolds
- Massachusetts General Hospital, Division of Oncology and Hematology, Department of Medicine , Boston , United States of America
| | - T Neilan
- Mass General Hopital (MGH), Cardiovascular Imaging Research Center (CIRC), Department of Radiology and Division of Cardiology , Boston , United States of America
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Bäßler FS, Zafar A, Mayer G, Schultz JH. Barriers to access cancer screening and treatment services in
Germany. Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753813] [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: 12/12/2022]
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Mayer G, Hummel S, Zafar A, Schultz JH. Konzepte der Personalisierung in der Behandlung psychischer
Erkrankungen: Ein Herangehensmodell für ein Scoping Review und erste
Ergebnisse. Das Gesundheitswesen 2022. [DOI: 10.1055/s-0042-1753749] [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: 12/12/2022]
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Baessler F, Zafar A. Barriers to access cancer screening and treatment services in Germany. Eur Psychiatry 2022. [PMCID: PMC9562960 DOI: 10.1192/j.eurpsy.2022.561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Introduction individual attitudes and structural inadequacies act as major barriers towards non-utilization of cancer screening and treatment offers in many high-income countries with subsidized public healthcare. Objectives Our interdisciplinary research group at Heidelberg University is studying the underlying individual perceptions, attitudes and experiences of age- and gender-specific barriers against cancer-related medical and psychosocial offers available in Germany. Methods We designed a mixed-methods, sequential explanatory study using two quantitative instruments to determine the most important age- and gender-specific barriers for non-patients and cancer patients and survivors. In the second phase, semi-structured interviews will be conducted via selective sampling to record participant opinions, experiences and expectations of using cancer-related health services. Results We expect to identify and explain important personal barriers and facilitators related to the use of cancer screening and treatment offers. Further interviews with stakeholders in cancer healthcare, such as physicians, nurses and self-help groups will be conducted to complement data from the service-providers’ point of view. The results will be analyzed with behavioral and sociocultural theories to gain a deeper understanding of perceived and experienced barriers in accessing cancer care in Germany and to formulate recommendations for prospective targeted approaches and interventions. Conclusions Our findings will be useful for facilitating knowledge transfer and policy dissemination to increase public awareness about cancer offers and improve participation rates. The results will be also used to develop an interprofessional teaching module in the medical curriculum as well as prepare and implement advanced training courses for medical professionals certified by the State Medical Association. Disclosure This study is funded by Strube Stiftung Stuttgart.
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Uzair M, Kaleem I, Arshad M, Ali RS, Zafar A, Iqbal M, Bashir S. Will weather stem the spread of the COVID-19 in Pakistan? Eur Rev Med Pharmacol Sci 2022; 26:305-311. [PMID: 35049013 DOI: 10.26355/eurrev_202201_27782] [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: 06/14/2023]
Abstract
The pandemic of COVID-19 started spreading more exponentially across Pakistan since the end of February 2020. Numerous models and factors have been used to estimate predictions of the prevalence and severity of COVID-19 infections around the globe. While many factors play a role in the spread of COVID-19, climate and weather conditions are considered key elements in the transmission of COVID-19. Many researchers believe that recent increases in COVID-19 cases correlate strongly with local temperatures and factors (such as humidity, weather conditions, etc.) related to it. In this manuscript we test the hypothesis that SARS-CoV-2 spread is temperature-dependent by using the available data derived from Pakistan. The present review focuses on the relationship between temperature and COVID-19, examining the virus's viability and infectivity under various conditions. Our findings indicate that the trough and crest of the COVID-19 wave observed in 2020 are likely to repeat in the summer and winter of 2021, respectively. In Pakistan, temperatures, and humidity significantly affect the COVID-19 transmission and incidence. Like other types of beta-coronaviruses (ß-CoVs), the spread of COVID-19 may depend upon a great deal on temperature.
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Affiliation(s)
- M Uzair
- Department of Biological Sciences, Faculty of Basic and Applied Sciences, International Islamic University Islamabad, Islamabad, Pakistan.
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Gong J, Drobni ZD, Zafar A, Quinaglia T, Hartmann SE, Gilman HK, Raghu VK, Gongora C, Alvi R, Zubiri L, Nohria A, Sullivan RJ, Reynolds KL, Zlotoff DA, Neilan TG. Pericardial disease in patients treated with immune checkpoint inhibitors. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1833] [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: 11/13/2022] Open
Abstract
Abstract
Background
There are limited data on the occurrence, associations and outcomes of pericardial effusions and pericarditis after treatment with immune checkpoint inhibitors (ICIs).
Purpose
To evaluate incidence of pericardial disease in patients treated with an ICI.
Methods
This was a retrospective study at a single academic center that compared 2842 consecutive patients who received ICIs with 2699 age- and cancer-type matched patients with metastatic disease who did not receive ICI (design 1). A pericardial event was defined as a composite outcome of pericarditis and new or worsening moderate or large pericardial effusion. The endpoints were obtained through chart review and were blindly adjudicated. To identify risk factors associated with a pericardial event, in a second analysis, we also compared patients who developed an event on an ICI to patients treated with an ICI who did not develop a pericardial event (design 2). Cox proportional hazard model and logistical regression analysis were performed to study the association between ICI use and pericardial disease as well as pericardial disease and mortality. An additional 6-week landmark analysis was performed to account for lead-time bias.
Results
There were 42 pericardial events in the patients treated with ICI (n=2842) over 193 days (interquartile range 64 to 411) with an incidence rate of 1.57 events per 100 person-years. There was a 4-fold increase in the risk for pericarditis or a pericardial effusion among patients on an ICI compared to controls not treated with ICI after adjusting for potential confounders (hazard ratio [HR] 4.37, 95% confidence interval [CI] 2.09–9.14, p<0.001). Patients who developed pericardial disease while on an ICI had a trend for increased all-cause mortality (HR 1.53, 95% CI 0.99–2.36, p=0.05) compared to those who did not develop pericardial disease. When comparing those who developed pericardial disease after ICI treatment to those who did not, a higher dose of corticosteroid pre-ICI (>0.7 mg/kg prednisone) was associated with increased risk of pericardial disease (HR 2.56, 95% CI 1.00–6.57, p=0.049).
Conclusions
ICI use was associated with an increased risk for development of pericardial disease among cancer patients and a pericardial event on an ICI was associated with a trend towards increased mortality.
Funding Acknowledgement
Type of funding sources: Public Institution(s). Main funding source(s): National Institutes of Health/National Heart, Lung, and Blood Institute; a gift from A. Curt Greer and Pamela Kohlberg
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Affiliation(s)
- J Gong
- Brigham and Women'S Hospital, Harvard Medical School, Department of Medicine, Boston, United States of America
| | - Z D Drobni
- Massachusetts General Hospital - Harvard Medical School, Cardiovascular Imaging Research Center, Department of Radiology and Division of Cardiology, Boston, United States of America
| | - A Zafar
- Massachusetts General Hospital - Harvard Medical School, Cardiovascular Imaging Research Center, Department of Radiology and Division of Cardiology, Boston, United States of America
| | - T Quinaglia
- Massachusetts General Hospital - Harvard Medical School, Cardiovascular Imaging Research Center, Department of Radiology and Division of Cardiology, Boston, United States of America
| | - S E Hartmann
- Massachusetts General Hospital - Harvard Medical School, Cardiovascular Imaging Research Center, Department of Radiology and Division of Cardiology, Boston, United States of America
| | - H K Gilman
- Massachusetts General Hospital - Harvard Medical School, Cardiovascular Imaging Research Center, Department of Radiology and Division of Cardiology, Boston, United States of America
| | - V K Raghu
- Massachusetts General Hospital - Harvard Medical School, Cardiovascular Imaging Research Center, Department of Radiology and Division of Cardiology, Boston, United States of America
| | - C Gongora
- Massachusetts General Hospital - Harvard Medical School, Cardiovascular Imaging Research Center, Department of Radiology and Division of Cardiology, Boston, United States of America
| | - R Alvi
- Massachusetts General Hospital - Harvard Medical School, Cardiovascular Imaging Research Center, Department of Radiology and Division of Cardiology, Boston, United States of America
| | - L Zubiri
- Massachusetts General Hospital, Division of Oncology and Hematology, Department of Medicine, Boston, United States of America
| | - A Nohria
- Brigham and Women'S Hospital, Harvard Medical School, Cardio-Oncology Program, Division of Cardiovascular Medicine, Boston, United States of America
| | - R J Sullivan
- Massachusetts General Hospital, Division of Oncology and Hematology, Department of Medicine, Boston, United States of America
| | - K L Reynolds
- Massachusetts General Hospital - Harvard Medical School, Cardiovascular Imaging Research Center, Department of Radiology and Division of Cardiology, Boston, United States of America
| | - D A Zlotoff
- Massachusetts General Hospital - Harvard Medical School, Cardio-Oncology Program, Division of Cardiology, Department of Medicine, Boston, United States of America
| | - T G Neilan
- Massachusetts General Hospital - Harvard Medical School, Cardiovascular Imaging Research Center, Department of Radiology and Division of Cardiology, Boston, United States of America
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12
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Zafar A, Galloway E. 441 Management of Intracapsular Hip Fractures During Unprecedented COVID Times In A DGH. Br J Surg 2021. [PMCID: PMC8524584 DOI: 10.1093/bjs/znab259.461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Aim NICE published eligibility criteria for Total Hip Replacement (THR) vs Hemiarthroplasty for intracapsular hip fractures. COVID-19 resulted in the BOA publishing emergency guidelines regarding management of patients eligible for THR. If the available surgeon does not routinely perform hip arthroplasty, the patient should undergo a hemiarthroplasty to maximise theatre efficiency and minimise hospital stay. This project will compare Kings Mill Hospitals compliance with these new guidelines. Method Retrospective data was collected over a two-month period (24/03/20 – 22/05/20) from patients with intracapsular hip fractures. Notes and records allowed us to determine suitability for THR using NICE guidelines. National statistics were taken from the National Hip Fracture Database. The standards for this project consist of the NICE guidelines for Hip Fracture management and the BOA standards for Trauma and Orthopaedics - Management of patients with urgent orthopaedic conditions and trauma during the coronavirus pandemic’. Results 51 patients were included in this audit. THR compliance dropped during the peak months of COVID 35% to 21.4%. Length of acute admissions stay decreased from 10 days to 8 days. Compared to the national averages, Kings Mills THR compliance rate was 27.3% vs 18.3%. 54.5% of eligible patients were operated on by THR performing consultants but received Hemiarthroplasty's Conclusions Some patients were eligible for THR according to the BOA guidelines (1) however received Hemiarthroplasty’s. Better identification may increase guideline compliance. Introduction of a new table in the clerking booklet will be implemented and Re-audited to evaluate effectiveness.
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Affiliation(s)
- A Zafar
- Sherwood Forest Trust, Mansfeild, United Kingdom
| | - E Galloway
- Nottingham University Hospitals, Nottingham, United Kingdom
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Yaqub S, Khokhar M, Zafar A, Goraya A, Niazi Z, Ishaq S. 105P A comparative study of cisplatin plus adriamycin compared with cyclophosphamide plus adriamycin in patients with untreated metastatic triple-negative breast cancer (TNBC). Ann Oncol 2021. [DOI: 10.1016/j.annonc.2021.03.119] [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: 10/21/2022] Open
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Mabray MC, Starcevich J, Hallstrom J, Robinson M, Bartlett M, Nelson J, Zafar A, Kim H, Morrison L, Hart BL. High Prevalence of Spinal Cord Cavernous Malformations in the Familial Cerebral Cavernous Malformations Type 1 Cohort. AJNR Am J Neuroradiol 2020; 41:1126-1130. [PMID: 32467184 DOI: 10.3174/ajnr.a6584] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 03/19/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND AND PURPOSE Cavernous malformations occur most often in the brain but can occur in the spinal cord. Small studies of patients with familial cerebral cavernous malformations suggested a prevalence of spinal cord cavernous malformations of 20%-42%. We aimed to review our familial cohort and prospectively estimate the prevalence of spinal cord cavernous malformations. MATERIALS AND METHODS We initially reviewed our familial cerebral cavernous malformations cohort for spinal cord cavernous malformations and reviewed clinical spine MR imaging examinations for sequence sensitivity. We then prospectively performed research MR imaging of the spinal cord in 29 patients from the familial cohort to estimate the prevalence. RESULTS Gradient-based sequences identified the most spinal cord cavernous malformations on clinical MR images, forming the basis for developing our screening MR imaging. Screening spinal cord MR imaging demonstrated a prevalence of 72.4%, and a positive correlation with patient age and number of cerebral cavernous malformations. CONCLUSIONS Spinal cord cavernous malformations occur commonly in the familial cerebral cavernous malformation population. Gradient-based sequences are the most sensitive and should be used when spinal cord cavernous malformations are suspected. This study establishes the prevalence in the familial population at around 70% and supports the idea that this condition is a progressive systemic disease that affects the entire central nervous system.
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Affiliation(s)
- M C Mabray
- From the Departments of Radiology (M.C.M., J.S., J.H., B.L.H.)
| | - J Starcevich
- From the Departments of Radiology (M.C.M., J.S., J.H., B.L.H.)
| | - J Hallstrom
- From the Departments of Radiology (M.C.M., J.S., J.H., B.L.H.)
| | - M Robinson
- Neurology (M.R., M.B., A.Z., L.M.), University of New Mexico Health Sciences Center, University of New Mexico, Albuquerque, New Mexico
| | - M Bartlett
- Neurology (M.R., M.B., A.Z., L.M.), University of New Mexico Health Sciences Center, University of New Mexico, Albuquerque, New Mexico
| | - J Nelson
- Departments of Anesthesia and Perioperative Care, Center for Cerebrovascular Research (J.N., H.K.)
| | - A Zafar
- Neurology (M.R., M.B., A.Z., L.M.), University of New Mexico Health Sciences Center, University of New Mexico, Albuquerque, New Mexico
| | - H Kim
- Departments of Anesthesia and Perioperative Care, Center for Cerebrovascular Research (J.N., H.K.).,Epidemiology and Biostatistics (H.K.), University of California San Francisco, San Francisco, California
| | - L Morrison
- Neurology (M.R., M.B., A.Z., L.M.), University of New Mexico Health Sciences Center, University of New Mexico, Albuquerque, New Mexico
| | - B L Hart
- From the Departments of Radiology (M.C.M., J.S., J.H., B.L.H.)
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Chepanova AA, Li-Zhulanov NS, Sukhikh AS, Zafar A, Reynisson J, Zakharenko AL, Zakharova OD, Korchagina DV, Volcho KP, Salakhutdinov NF, Lavrik OI. Effective Inhibitors of Tyrosyl-DNA Phosphodiesterase 1 Based on Monoterpenoids as Potential Agents for Antitumor Therapy. Russ J Bioorg Chem 2020. [DOI: 10.1134/s1068162019060104] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Zafar A, Rushton N. Extruded collagen fibres and biphasic collagen sponge for rotator cuff tendon repair application: an ovine in vitro study. Muscles Ligaments Tendons J 2019. [DOI: 10.32098/mltj.04.2018.13] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- A. Zafar
- Orthopaedics, Orthopaedic Research Unit, University of Cambridge, Cambridge, UK
| | - N. Rushton
- Orthopaedics, Orthopaedic Research Unit, University of Cambridge, Cambridge, UK
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Bibi S, Zafar A, Anwar S, Farooqui B, Qureshi H. Laboratory Based Surveillance of Pneumococcal Serotypes causing Invasive and Non-Invasive Infections in Karachi, Pakistan. J Infect Public Health 2019. [DOI: 10.1016/j.jiph.2018.10.070] [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: 11/30/2022] Open
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18
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Zakharenko AL, Luzina OA, Sokolov DN, Kaledin VI, Nikolin VP, Popova NA, Patel J, Zakharova OD, Chepanova AA, Zafar A, Reynisson J, Leung E, Leung IKH, Volcho KP, Salakhutdinov NF, Lavrik OI. Novel tyrosyl-DNA phosphodiesterase 1 inhibitors enhance the therapeutic impact of topoteсan on in vivo tumor models. Eur J Med Chem 2018; 161:581-593. [PMID: 30396105 DOI: 10.1016/j.ejmech.2018.10.055] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2018] [Revised: 10/18/2018] [Accepted: 10/22/2018] [Indexed: 02/07/2023]
Abstract
The druggability of the tyrosyl-DNA phosphodiesterase 1 (Tdp1) enzyme was investigated in conjunction with topoisomerase 1 inhibition. A novel class of thiazole, aminothiazole and hydrazonothiazole usnic acid derivatives was synthesized and evaluated as Tdp1 inhibitors and their ability to sensitize tumors to topotecan, a topoisomerase inhibitor in clinical use. Of all the compounds tested, four hydrazinothiazole derivatives, 20c, 20d, 20h and 20i, inhibited the enzyme in the nanomolar range. The activity of the compounds was verified by affinity experiments as well as supported by molecular modelling. The most effective Tdp1 inhibitor, 20d, was ton-toxic and increased the effect of topotecan both in vitro and in vivo in the Lewis lung carcinoma model. Furthermore, 20d showed significant increase in the antitumor and antimetastatic effect of topotecan in mice. The results presented here justify compound 20d to be considered as a drug lead for antitumor therapy.
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Affiliation(s)
- A L Zakharenko
- Novosibirsk Institute of Chemical Biology and Fundamental Medicine, Siberian Branch of the Russian Academy of Sciences, 8, Akademika Lavrentieva Ave., Novosibirsk, 630090, Russian Federation
| | - O A Luzina
- N. N. Vorozhtsov Novosibirsk Institute of Organic Chemistry, Siberian Branch of the Russian Academy of Sciences, 9, Akademika Lavrentieva Ave., Novosibirsk, 630090, Russian Federation
| | - D N Sokolov
- N. N. Vorozhtsov Novosibirsk Institute of Organic Chemistry, Siberian Branch of the Russian Academy of Sciences, 9, Akademika Lavrentieva Ave., Novosibirsk, 630090, Russian Federation
| | - V I Kaledin
- Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences, 10, Akademika Lavrentieva Ave., Novosibirsk, 630090, Russian Federation
| | - V P Nikolin
- Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences, 10, Akademika Lavrentieva Ave., Novosibirsk, 630090, Russian Federation
| | - N A Popova
- Institute of Cytology and Genetics, Siberian Branch of the Russian Academy of Sciences, 10, Akademika Lavrentieva Ave., Novosibirsk, 630090, Russian Federation; Novosibirsk State University, Pirogova str. 1, Novosibirsk, 630090, Russian Federation
| | - J Patel
- School of Chemical Sciences, The University of Auckland, New Zealand
| | - O D Zakharova
- Novosibirsk Institute of Chemical Biology and Fundamental Medicine, Siberian Branch of the Russian Academy of Sciences, 8, Akademika Lavrentieva Ave., Novosibirsk, 630090, Russian Federation
| | - A A Chepanova
- Novosibirsk Institute of Chemical Biology and Fundamental Medicine, Siberian Branch of the Russian Academy of Sciences, 8, Akademika Lavrentieva Ave., Novosibirsk, 630090, Russian Federation
| | - A Zafar
- School of Chemical Sciences, The University of Auckland, New Zealand
| | - J Reynisson
- School of Chemical Sciences, The University of Auckland, New Zealand
| | - E Leung
- Auckland Cancer Society Research Centre and Department of Molecular Medicine and Pathology, The University of Auckland, New Zealand
| | - I K H Leung
- School of Chemical Sciences, The University of Auckland, New Zealand
| | - K P Volcho
- N. N. Vorozhtsov Novosibirsk Institute of Organic Chemistry, Siberian Branch of the Russian Academy of Sciences, 9, Akademika Lavrentieva Ave., Novosibirsk, 630090, Russian Federation; Novosibirsk State University, Pirogova str. 1, Novosibirsk, 630090, Russian Federation
| | - N F Salakhutdinov
- N. N. Vorozhtsov Novosibirsk Institute of Organic Chemistry, Siberian Branch of the Russian Academy of Sciences, 9, Akademika Lavrentieva Ave., Novosibirsk, 630090, Russian Federation; Novosibirsk State University, Pirogova str. 1, Novosibirsk, 630090, Russian Federation
| | - O I Lavrik
- Novosibirsk Institute of Chemical Biology and Fundamental Medicine, Siberian Branch of the Russian Academy of Sciences, 8, Akademika Lavrentieva Ave., Novosibirsk, 630090, Russian Federation; Novosibirsk State University, Pirogova str. 1, Novosibirsk, 630090, Russian Federation.
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Singal M, Zafar A, Tbakhi B, Jadhav N, Alweis R, Bhavsar H. Assessment of knowledge and attitudes towards safety events reporting among residents in a community health system. J Community Hosp Intern Med Perspect 2018; 8:253-259. [PMID: 30357000 PMCID: PMC6197008 DOI: 10.1080/20009666.2018.1527670] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Accepted: 09/13/2018] [Indexed: 11/17/2022] Open
Abstract
Background: Resident physicians are known to be infrequent reporters of patient safety events (PSE). Previous studies assessing barriers to resident PSE reporting have not considered possible cultural barriers faced by international medical graduates (IMG). This study aimed to assess the knowledge and attitudes of residents regarding PSE and possible barriers contributing to poor resident reporting. Methods: A cross sectional survey of all house staff undergoing post-graduate residency training at two independent community hospital based academic medical centers was conducted through an online questionnaire. Sample case vignettes were created to assess the residents’ ability to identify safety events and classify them as near miss, adverse events or sentinel events and decide whether they were reportable. Results: The Reporting of PSE increased significantly by year of residency training (p < 0.005), with time taken to file a PSE being the strongest perceived barrier. There was no difference in PSE reporting between IMG’s and non- IMG’s. We identified major knowledge gaps with only 73.9%, 79.6% and 94.3% of respondents correctly identifying sentinel events, adverse events, and near misses, respectively. 58.1% of respondents did not think near misses were reportable. Conclusions: A lack of knowledge is the most important barrier towards PSE reporting. A different cultural background and lack of previous exposure to patient safety report by IMGs is not a significant barrier towards safety event reporting. In the short-term, it appears that focusing limited institutional resources on education rather than acculturation issues would have the greatest benefit.
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Affiliation(s)
- M Singal
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - A Zafar
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - B Tbakhi
- Department of Internal Medicine, Unity Hospital, Rochester, NY, USA
| | - N Jadhav
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - R Alweis
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
| | - H Bhavsar
- Department of Internal Medicine, Rochester General Hospital, Rochester, NY, USA
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20
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Faizan M, Anwar S, Kashif R, Saleem R, Javed H, Zafar A, Hameed A, Taj M, Maysam H, Miguela C, Rathore A, Sadiq M, Gonzalez M, Zaidi A. Improvement in Infection Prevention and Control Measures at The Children Hospital, Lahore. A My Child Matters Collaborative Project. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.90400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Overcrowding, lack of operational funds, and healthcare associated infections are major challenges at the Children Hospital Lahore, a public healthcare facility in Pakistan with 900 new pediatric cancer admissions annually. In 2014, a collaboration between My Child Matters (MCM), St. Jude Global Infectious Diseases Program (SJ-GID), and our institution was established to address these issues. Aim: To describe the effect of a collaborative improvement strategy on the infection prevention and control (IPC) standards in a pediatric oncology unit in a resource-limited setting. Methods: Our study was a prospective before-and-after study. We compare the WHO Hand Hygiene Self-Assessment Framework (HHSAF) and 4 modules of the St. Jude modified Infection Control Assessment Tool (ICAT) scores. Our strategy included: (1) creating a multidisciplinary team of pediatric hematology-oncology, infectious disease physicians, nurses, microbiologist, and a data manager, (2) engaging on monthly online IPC mentoring sessions with the SJ-GID and MCM mentors, (3) performing daily inpatient healthcare associated (HAI) surveillance rounds, and (4) providing regular hand hygiene training and compliance audits. Results: Our hand hygiene facility level per WHO scores increased from “Inadequate” during the baseline assessment to “Intermediate/Consolidation” by the end of 3-year implementation (122 vs 352 HHSAF scores). The sink: bed and hand sanitizer: bed ratios improved to 1:6 and 1:1 respectively. Six washrooms were added to our unit. ICAT general infection control module increased by 40% (45 vs 78 ICAT score) and hygiene compliance improved by 20% from baseline. Identification of HAI increased from baseline (4.07 vs 8.7 infections per 1000 patient days). A 25% of the isolates were multidrug-resistant microorganisms. Conclusion: Implementing a collaborative improvement strategy improved the IPC standards in our pediatric cancer center. The increase of HAI might be a result of a better surveillance and laboratory identification. Further targeted interventions should be develop to decrease HAI rates and infection-related morbidity and mortality in our population.
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Affiliation(s)
- M. Faizan
- The Children Hospital and Institute of Child Health, Department of Pediatric Hematology/Oncology, Lahore, Pakistan
| | - S. Anwar
- The Children Hospital and Institute of Child Health, Department of Pediatric Hematology/Oncology, Lahore, Pakistan
| | - R.U.A. Kashif
- The Children Hospital and Institute of Child Health, Department of Pediatric Hematology/Oncology, Lahore, Pakistan
| | - R. Saleem
- The Children Hospital and Institute of Child Health, Department of Pediatric Hematology/Oncology, Lahore, Pakistan
| | - H. Javed
- The Children Hospital and Institute of Child Health, Department of Pediatric Microbiology, Lahore, Pakistan
| | - A. Zafar
- The Children Hospital and Institute of Child Health, Department of Pediatric Microbiology, Lahore, Pakistan
| | - A. Hameed
- The Children Hospital and Institute of Child Health, Department of Pediatric Hematology/Oncology, Lahore, Pakistan
| | - M. Taj
- Royal Marsden Hospital, Department of Paediatric Oncology, London, United Kingdom
| | - H. Maysam
- St. Jude Children's Research Hospital, Department of Global Pediatric Medicine, Memphis, TN
| | - C. Miguela
- St. Jude Children's Research Hospital, Department of Global Pediatric Medicine, Memphis, TN
- St. Jude Children's Research Hospital, Department of Pediatric Infectious Disease, Memphis, TN
| | - A.W. Rathore
- The Children Hospital and Institute of Child Health, Department of Pediatric Medicine, Lahore, Pakistan
| | - M. Sadiq
- The Children Hospital and Institute of Child Health, Department of Pediatric Cardiology, Lahore, Pakistan
| | - M. Gonzalez
- St. Jude Children's Research Hospital, Department of Global Pediatric Medicine, Memphis, TN
| | - A. Zaidi
- St. Jude Children's Research Hospital, Department of Global Pediatric Medicine, Memphis, TN
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Zafar A. A review of 500 patients with acute stroke admitted to the University Hospital of Saudi Arabia. Similarities and differences compared with the published literature. Funct Neurol 2018; 33:73-79. [PMID: 29984684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Published studies have shown differences in types and underlying mechanisms of stroke between different regions of the world. There is a lack of published literature describing the characteristics of acute stroke in Saudi Arabia. The aim of this study was to identify different types and associated risk factors among acute stroke patients in Saudi Arabia. In this descriptive study, records of 500 patients with acute stroke were included. Acute stroke was classified as ischemic stroke, intracerebral hemorrhage, cerebral venous sinus thrombosis or subarachnoid hemorrhage. The TOAST classification was used to categorize ischemic stroke. Ischemic stroke was found to be the most common type (86.6%). The patients included comprised 326 (65.2%) males and 174 (34.8%) females. Small vessel occlusive disease was the most common etiology of ischemic stroke. The males had a lower mean age than the females (p=0.00). The results of our study are largely in agreement with published literature, although a few differences emerged which need to be verified through further prospective multicenter studies.
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22
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Zafar A. 226 LCI correlation with FEV1, MMEF75-25 and RV/TLC for decline in airways function in CF children. J Cyst Fibros 2017. [DOI: 10.1016/s1569-1993(17)30571-4] [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: 10/19/2022]
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23
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Zafar A, Seretis C, Feretis M, Karandikar S, Williams SC, Goldstein M, Chapman M. Comparative study of magnetic resonance defaecography and evacuation proctography in the evaluation of obstructed defaecation. Colorectal Dis 2017; 19:O204-O209. [PMID: 28304122 DOI: 10.1111/codi.13657] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 02/13/2017] [Indexed: 12/13/2022]
Abstract
AIM Obstructed defaecation syndrome is a common condition of multifactorial aetiology and requires specialized evaluation. Accurate and reproducible pelvic floor imaging is imperative for multidisciplinary decision-making. Evacuation proctography (EP) and magnetic resonance defaecography (MRD) are the main imaging modalities used to assess dynamic pelvic floor function. The aim of this prospective study was to compare the findings and acceptability of MRD and EP in the same cohort of patients. METHOD This was a prospective comparative study of MRD vs EP in 55 patients with obstructed defaecation syndrome in a single National Health Service Foundation Trust. RESULTS Fifty-five patients were recruited and underwent both EP and MRD. Detection rates for rectocoele were similar (82% vs 73%, P = 0.227), but EP revealed a significantly higher number of trapping rectocoeles compared to MRD (75% vs 31%, P < 0.001). EP detected more rectal intussusceptions than MRD (56% vs 35%, P = 0.023). MRD appeared to underestimate the size of the identified rectocoele, although it detected a significant number of anatomical abnormalities in the middle and anterior pelvic compartment not seen on EP (1.8% enterocoele, 9% peritoneocoele and 20% cystocoele). Patients achieved higher rates of expulsion of rectal contrast during EP compared to MRD, but this difference was not significant (76% vs 64% in MRD, P = 0.092). Of the two studies, patients preferred MRD. CONCLUSIONS MRD provides a global assessment of pelvic floor function and anatomical abnormality. MRD is better tolerated by patients but it is not as sensitive as EP in detecting trapping rectocoeles and intussusceptions.
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Affiliation(s)
- A Zafar
- Department of General and Colorectal Surgery, Heart of England NHS Trust, Birmingham, UK
| | - C Seretis
- Department of General and Colorectal Surgery, Heart of England NHS Trust, Birmingham, UK
| | - M Feretis
- Department of General and Colorectal Surgery, Heart of England NHS Trust, Birmingham, UK
| | - S Karandikar
- Department of General and Colorectal Surgery, Heart of England NHS Trust, Birmingham, UK
| | - S C Williams
- Department of Radiology, Heart of England NHS Trust, Birmingham, UK
| | - M Goldstein
- Department of Radiology, Heart of England NHS Trust, Birmingham, UK
| | - M Chapman
- Department of General and Colorectal Surgery, Heart of England NHS Trust, Birmingham, UK
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Javaid A, Hasan R, Zafar A, Chaudry MA, Qayyum S, Qadeer E, Shaheen Z, Agha N, Rizvi N, Afridi MZ, Chima MK, Khan AR, Ghafoor A, Khan S, Awan SR, Akhtar S, Choudry K, Iqbal ZH, Ansarie M, Ahmad N. Pattern of first- and second-line drug resistance among pulmonary tuberculosis retreatment cases in Pakistan. Int J Tuberc Lung Dis 2017; 21:303-308. [PMID: 28225340 DOI: 10.5588/ijtld.16.0444] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Drug resistance in general, and multidrug-resistant tuberculosis (MDR-TB) in particular, threatens global tuberculosis (TB) control efforts. Population-based estimates of drug resistance are needed to develop strategies for controlling drug-resistant TB in Pakistan. OBJECTIVE To obtain population-based data on Mycobacterium tuberculosis drug resistance in Pakistan. METHODS To obtain drug resistance data, we conducted a population-based study of TB cases in all provinces of Pakistan. We performed culture and drug susceptibility testing on M. tuberculosis isolates from patients with a prior history of anti-tuberculosis treatment (retreatment cases) from all over the country. RESULTS Of 544 isolates from previously treated cases, 289 (53.1%) were susceptible to all first-line drugs, 255 (46.9%) were resistant to at least one anti-tuberculosis drug and 132 (24.3%) were MDR-TB. Among MDR-TB isolates, 47.0% were ofloxacin (OFX) resistant. Extensively drug-resistant TB was found in two (0.4%) isolates. CONCLUSION Prevalence of drug resistance in retreatment isolates was high. The alarmingly high prevalence of OFX resistance among MDR-TB isolates may threaten the success of efforts to control and treat MDR-TB.
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Affiliation(s)
- A Javaid
- Department of Pulmonology, Postgraduate Medical Institute, Lady Reading Hospital, Peshawar
| | - R Hasan
- Department of Microbiology, Agha Khan University, Karachi
| | - A Zafar
- Department of Microbiology, Agha Khan University, Karachi
| | | | - S Qayyum
- Ojha Institute of Chest Disease, Karachi
| | - E Qadeer
- National TB Control Programme, Islamabad
| | - Z Shaheen
- Department of Pulmonology, Nishtar Medical College, Multan
| | - N Agha
- Fatima Jinnah Chest Hospital, Quetta
| | - N Rizvi
- Department of Chest Medicine, Jinnah Postgraduate Medical Centre, Karachi
| | | | - M K Chima
- Department of Pulmonology, Services Hospital, Lahore
| | - A R Khan
- Department of Pulmonology, Ayub Medical College, Abbottabad
| | | | - S Khan
- Department of Chest Medicine, Lahore General Hospital, Lahore
| | | | - S Akhtar
- Department of Medicine, Ziauddin University, Karachi
| | - K Choudry
- Department of Pulmonology, King Edward Medical University, Lahore
| | - Z H Iqbal
- Department of Pulmonology, Allama Iqbal Medical College, Lahore
| | - M Ansarie
- Orthopaedic and Medical Institute, Karachi, Pakistan
| | - N Ahmad
- Discipline of Clinical Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia
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Zheng T, Wu ZT, Nan HY, Yu YF, Zafar A, Yan ZZ, Lu JP, Ni ZH. Layer-number dependent and structural defect related optical properties of InSe. RSC Adv 2017. [DOI: 10.1039/c7ra09370e] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
We present systematic investigations on the layer-dependent optical properties of InSe and modify its excitonic states by electron beam irradiation.
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Affiliation(s)
- T. Zheng
- School of Physics
- Southeast University
- Nanjing 211189
- China
| | - Z. T. Wu
- School of Physics
- Southeast University
- Nanjing 211189
- China
| | - H. Y. Nan
- School of Physics
- Southeast University
- Nanjing 211189
- China
| | - Y. F. Yu
- School of Physics
- Southeast University
- Nanjing 211189
- China
| | - A. Zafar
- School of Physics
- Southeast University
- Nanjing 211189
- China
| | - Z. Z. Yan
- School of Physics
- Southeast University
- Nanjing 211189
- China
| | - J. P. Lu
- School of Physics
- Southeast University
- Nanjing 211189
- China
| | - Z. H. Ni
- School of Physics
- Southeast University
- Nanjing 211189
- China
- State Key Laboratory for Modification of Chemical Fibers and Polymer Materials
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Zafar A, Hasan R, Nizamuddin S, Mahmood N, Mukhtar S, Ali F, Morrissey I, Barker K, Torumkuney D. Antibiotic susceptibility in Streptococcus pneumoniae, Haemophilus influenzae and Streptococcus pyogenes in Pakistan: a review of results from the Survey of Antibiotic Resistance (SOAR) 2002-15. J Antimicrob Chemother 2016; 71 Suppl 1:i103-9. [PMID: 27048578 DOI: 10.1093/jac/dkw076] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To investigate changes in the antibiotic susceptibility of Streptococcus pneumoniae, Haemophilus influenzae and Streptococcus pyogenes from the Survey of Antibiotic Resistance (SOAR) in community-acquired respiratory tract infections (CA-RTIs) between 2002 and 2015 in Pakistan. METHODS This is a review based on previously published studies from 2002-03, 2004-06 and 2007-09 and also new data from 2014-15. Susceptibility was determined by Etest(®) or disc diffusion according to CLSI and pharmacokinetic/pharmacodynamic (PK/PD) breakpoints. RESULTS A total of 706 isolates from CA-RTIs comprising 381 S. pneumoniae, 230 H. influenzae and 95 S. pyogenes were collected between 2002 and 2015 and tested against a range of antibiotics. Antibiotic resistance in S. pneumoniae rose steeply from 2002 to 2009, with isolates non-susceptible to penicillin and macrolides increasing from 10% to 34.1% and from 13%-14% to 29.7%, respectively. Susceptibility to amoxicillin/clavulanic acid (and by inference amoxicillin) remained between 99.4% and 100% from 2002 to 2015. Over the years, the prevalence of susceptibility to cefuroxime was 98%-100% among S. pneumoniae. Resistance in S. pneumoniae to some older antibiotics between 2007 and 2009 was high (86.8% for trimethoprim/sulfamethoxazole and 57.2% for tetracycline). Between 2002 and 2015, ampicillin resistance (β-lactamase-positive strains) among H. influenzae has remained low (between 2.6% and 3.2%) and almost unchanged over the years (H. influenzae was not tested during 2004-06). For S. pyogenes isolates, macrolide resistance reached 22%; however, susceptibility to penicillin, amoxicillin/clavulanic acid and cefuroxime remained stable at 100%. CONCLUSIONS In S. pneumoniae from Pakistan, there has been a clear reduction in susceptibility to key antibiotics since 2002, but not to amoxicillin/clavulanic acid (amoxicillin) or cefuroxime. However, susceptibility in H. influenzae has remained stable. Local antibiotic susceptibility/resistance data are essential to support informed prescribing for CA-RTIs and other infections.
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Affiliation(s)
- A Zafar
- Aga Khan University Hospital, Department of Pathology and Laboratory Medicine, Section of Microbiology, Karachi, Pakistan
| | - R Hasan
- Aga Khan University Hospital, Department of Pathology and Laboratory Medicine, Section of Microbiology, Karachi, Pakistan
| | - S Nizamuddin
- Shaukat Khanum Memorial Cancer Hospital and Research Center, Department of Microbiology, 7A, Block R-3, Johar Town, Lahore, Pakistan
| | - N Mahmood
- Shaukat Khanum Memorial Cancer Hospital and Research Center, Department of Microbiology, 7A, Block R-3, Johar Town, Lahore, Pakistan
| | - S Mukhtar
- Shaukat Khanum Memorial Cancer Hospital and Research Center, Department of Microbiology, 7A, Block R-3, Johar Town, Lahore, Pakistan
| | - F Ali
- GlaxoSmithKline Pakistan, 35 Dockyard Road, West Wharf, Karachi 74000, Pakistan
| | - I Morrissey
- IHMA Europe Sàrl, 9a route de la Corniche, Epalinges 1066, Switzerland
| | - K Barker
- GlaxoSmithKline, 980 Great West Road, Brentford, Middlesex TW8 9GS, UK
| | - D Torumkuney
- GlaxoSmithKline, 980 Great West Road, Brentford, Middlesex TW8 9GS, UK
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Jadoon N, Hussain M, Sulehri F, Zafar A, Ijaz A. 82P Risk factors for breast cancer: A case-control study among post-menopausal women in Pakistan. Ann Oncol 2016. [DOI: 10.1093/annonc/mdw575.021] [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: 11/13/2022] Open
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Jadoon N, Hussain M, Sulehri F, Zafar A, Ijaz A. 82P Risk factors for breast cancer: A case-control study among post-menopausal women in Pakistan. Ann Oncol 2016. [DOI: 10.1016/s0923-7534(21)00242-8] [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: 10/22/2022] Open
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Abstract
Clomiphene citrate is widely used by the female population for the management of a wide array of medical conditions especially those related to ovulation, but its use in male population remains controversial. Efficacy of clomiphene is not well established in male hypogonadism and infertility. Its side effects and complications are also poorly studied or reported. We present a case of a man with infertility issues for which he started receiving clomiphene citrate 3 weeks before presenting with progressive symptoms of headache, vomiting, transient blurred vision and diplopia, which eventually turned out to be the symptoms of intracranial venous thrombosis. After excluding the common causes of intracranial venous thrombosis and hypercoagulable state, clomiphene citrate seems the most likely culprit.
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Affiliation(s)
- M Zahid
- Department of Medicine, Hamad General Hospital, Doha, Qatar
| | - A Arshad
- Department of Medicine, Hamad General Hospital, Doha, Qatar
| | - A Zafar
- Department of Medicine, Hamad General Hospital, Doha, Qatar
| | - D Al-Mohannadi
- Department of Medicine, Hamad General Hospital, Doha, Qatar
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Martin EH, Zafar A, Caughman JBO, Isler RC, Bell GL. Applications of Doppler-free saturation spectroscopy for edge physics studies (invited). Rev Sci Instrum 2016; 87:11E402. [PMID: 27910367 DOI: 10.1063/1.4961287] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Doppler-free saturation spectroscopy provides a very powerful method to obtain detailed information about the electronic structure of the atom through measurement of the spectral line profile. This is achieved through a significant decrease in the Doppler broadening and essentially an elimination of the instrument broadening inherent to passive spectroscopic techniques. In this paper we present the technique and associated physics of Doppler-free saturation spectroscopy in addition to how one selects the appropriate transition. Simulations of Hδ spectra are presented to illustrate the increased sensitivity to both electric field and electron density measurements.
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Affiliation(s)
- E H Martin
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - A Zafar
- Department of Nuclear Engineering, North Carolina State University, Raleigh, North Carolina 27695, USA
| | - J B O Caughman
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - R C Isler
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
| | - G L Bell
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37831, USA
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Zafar A, Martin EH, Shannon SC, Isler RC, Caughman JBO. A temporally and spatially resolved electron density diagnostic method for the edge plasma based on Stark broadening. Rev Sci Instrum 2016; 87:11E505. [PMID: 27910427 DOI: 10.1063/1.4955484] [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] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
An electron density diagnostic (≥1010 cm-3) capable of high temporal (ms) and spatial (mm) resolution is currently under development at Oak Ridge National Laboratory. The diagnostic is based on measuring the Stark broadened, Doppler-free spectral line profile of the n = 6-2 hydrogen Balmer series transition. The profile is then fit to a fully quantum mechanical model including the appropriate electric and magnetic field operators. The quasi-static approach used to calculate the Doppler-free spectral line profile is outlined here and the results from the model are presented for H-δ spectra for electron densities of 1010-1013 cm-3. The profile shows complex behavior due to the interaction between the magnetic substates of the atom.
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Affiliation(s)
- A Zafar
- Department of Nuclear Engineering, North Carolina State University, Raleigh, North Carolina 27695, USA
| | - E H Martin
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
| | - S C Shannon
- Department of Nuclear Engineering, North Carolina State University, Raleigh, North Carolina 27695, USA
| | - R C Isler
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
| | - J B O Caughman
- Oak Ridge National Laboratory, Oak Ridge, Tennessee 37830, USA
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Khunti K, Gillies CL, Dallosso H, Brady EM, Gray LJ, Kilgallen G, Willis A, Zafar A, Davies MJ. Assessment of response rates and yields for Two opportunistic Tools for Early detection of Non-diabetic hyperglycaemia and Diabetes (ATTEND). A randomised controlled trial and cost-effectiveness analysis. Diabetes Res Clin Pract 2016; 118:12-20. [PMID: 27485852 DOI: 10.1016/j.diabres.2016.04.054] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2016] [Revised: 04/28/2016] [Accepted: 04/30/2016] [Indexed: 01/09/2023]
Abstract
AIMS To assess the opportunistic use in primary care of a computer risk score versus a self-assessment risk score for undiagnosed type 2 diabetes. METHODS We conducted a randomised controlled trial in 11 primary care practices in the UK. 577 patients aged 40-75years with no current diagnosis of type 2 diabetes were recruited to a computer based risk score (Leicester Practice Computer Risk Score (LPCRS)) or a patient self-assessment score (Leicester Self-Assessment Score (LSAS)). RESULTS The rate of self-referral blood tests was significantly higher for the LPCRS compared to the LSAS, 118.98 (95% CI: 102.85, 137.64) per 1000 high-risk patient years of follow-up compared to 92.14 (95% CI: 78.25, 108.49), p=0.022. Combined rate of diagnosis of type 2 diabetes and those at risk of developing the disease (i.e. impaired glucose tolerance (IGT) or impaired fasting glucose (IFG)) was similar between the two arms, 15.12 (95% CI: 9.11, 25.08) per 1000 high-risk patient years for LPCRS compared to 14.72 (95% CI: 9.59, 22.57) for the LSAS, p=0.699. For the base case scenario the cost per new case of type 2 diabetes diagnosed was lower for the LPCRS compared to the LSAS, £168 (95% Credible Interval (CrI): 76, 364), and £352 (95% CrI: 109, 1148), respectively. CONCLUSIONS Compared to a self-assessment risk score, a computer based risk score resulted in greater attendance to an initial blood test and is potentially more cost-effective.
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Affiliation(s)
- K Khunti
- Leicester Diabetes Centre, University of Leicester, Leicester, UK.
| | - C L Gillies
- Leicester Diabetes Centre, University of Leicester, Leicester, UK; Department of Health Sciences, University of Leicester, Leicester, UK
| | - H Dallosso
- Leicester Diabetes Centre, University of Leicester, Leicester, UK
| | - E M Brady
- Leicester Diabetes Centre, University of Leicester, Leicester, UK
| | - L J Gray
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - G Kilgallen
- Leicester Diabetes Centre, University of Leicester, Leicester, UK
| | - A Willis
- Leicester Diabetes Centre, University of Leicester, Leicester, UK
| | - A Zafar
- Leicester Diabetes Centre, University of Leicester, Leicester, UK
| | - M J Davies
- Leicester Diabetes Centre, University of Leicester, Leicester, UK
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Hardy K, Wu F, Tu W, Zafar A, Boulding T, McCuaig R, Sutton CR, Theodoratos A, Rao S. Identification of chromatin accessibility domains in human breast cancer stem cells. Nucleus 2016; 7:50-67. [PMID: 26962893 PMCID: PMC4916893 DOI: 10.1080/19491034.2016.1150392] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Epithelial-to-mesenchymal transition (EMT) is physiological in embryogenesis and wound healing but also associated with the formation of cancer stem cells (CSCs). Many EMT signaling pathways are implicated in CSC formation, but the precise underlying mechanisms of CSC formation remain elusive. We have previously demonstrated that PKC is critical for EMT induction and CSC formation in inducible breast EMT/CSC models. Here, we used formaldehyde-assisted isolation of regulatory elements-sequencing (FAIRE-seq) to investigate DNA accessibility changes after PKC activation and determine how they influence EMT and CSC formation. During EMT, DNA accessibility principally increased in regions distant from transcription start sites, low in CpG content, and enriched with chromatin enhancer marks. ChIP-sequencing revealed that a subset of these regions changed from poised to active enhancers upon stimulation, with some even more acteylated in CSCs. While regions with increased accessibility were enriched for FOX, AP-1, TEAD, and TFAP2 motifs, those containing FOX and AP-1 motif were associated with increased expression of CSC-associated genes, while those with TFAP2 were associated with genes with increased expression in non-CSCs. Silencing of 2 members of the FOX family, FOXN2 and FOXQ1, repressed CSCs and the mesenchymal phenotype and inhibited the CSC gene signature. These novel, PKC-induced DNA accessibility regions help explain how the epigenomic plasticity of cells undergoing EMT leads to CSC gene activation.
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Affiliation(s)
- K Hardy
- a HRI, Faculty of ESTeM, University of Canberra , Bruce , Australia
| | - F Wu
- a HRI, Faculty of ESTeM, University of Canberra , Bruce , Australia
| | - W Tu
- a HRI, Faculty of ESTeM, University of Canberra , Bruce , Australia
| | - A Zafar
- a HRI, Faculty of ESTeM, University of Canberra , Bruce , Australia
| | - T Boulding
- a HRI, Faculty of ESTeM, University of Canberra , Bruce , Australia
| | - R McCuaig
- a HRI, Faculty of ESTeM, University of Canberra , Bruce , Australia
| | - C R Sutton
- a HRI, Faculty of ESTeM, University of Canberra , Bruce , Australia
| | - A Theodoratos
- b JCSMR, Australian National University , Canberra, Australia
| | - S Rao
- a HRI, Faculty of ESTeM, University of Canberra , Bruce , Australia
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Zafar A, Williamson M. P46 Dextrocardia and right atrial isomerism associated with congenital trifurcation of trachea. Heart 2016. [DOI: 10.1136/heartjnl-2016-309377.46] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Boyle E, Gowey A, Zafar A, Burke P, Kavanagh E, Abdulrahim O. Vascular Trauma – Unusual Mechanisms of Injury. Eur J Vasc Endovasc Surg 2015. [DOI: 10.1016/j.ejvs.2015.06.094] [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: 10/23/2022]
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Manzoor SA, Mirza SN, Zubair M, Nouman W, Hussain SB, Mehmood S, Irshad A, Sarwar N, Ammar A, Iqbal MF, Asim A, Chattha MU, Chattha MB, Zafar A, Abid R. Estimating genetic potential of biofuel forest hardwoods to withstand metal toxicity in industrial effluent under dry tropical conditions. Genet Mol Res 2015; 14:9543-54. [PMID: 26345887 DOI: 10.4238/2015.august.14.17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Biofuel tree species are recognized as a promising alternative source of fuel to conventional forms. Additionally, these tree species are also effective in accumulating toxic heavy metals present in some industrial effluents. In developing countries such as Pakistan, the use of biofuel tree species is gaining popularity not only for harvesting economical and environmentally friendly biofuel, but also to sequester poisonous heavy metals from industrial wastewater. This study was aimed at evaluating the genetic potential of two biofuel species, namely, Jatropha curcas and Pongamia pinnata, to grow when irrigated with industrial effluent from the Pak-Arab Fertilizer Factory Multan, Southern Punjab, Pakistan. The growth performances of one-year-old seedlings of both species were compared in soil with adverse physiochemical properties. It was found that J. curcas was better able to withstand the toxicity of the heavy metals present in the fertilizer factory effluent. J. curcas showed maximum gain in height, diameter, and biomass production in soil irrigated with 75% concentrated industrial effluent. In contrast, P. pinnata showed a significant reduction in growth in soil irrigated with more than 50% concentrated industrial effluent, indicating that this species is less tolerant to higher toxicity levels of industrial effluent. This study identifies J. curcas as a promising biofuel tree species that can be grown using industrial wastewater.
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Affiliation(s)
- S A Manzoor
- Department of Forestry, Range and Wildlife Management, Bahaudddin Zakariya University, Multan, Punjab, Pakistan
| | - S N Mirza
- Department of Forestry & Range Management, Pir Mehar Ali Shah-Arid Agriculture University, Rawalpindi, Punjab, Pakistan
| | - M Zubair
- Department of Forestry, Range and Wildlife Management, Bahaudddin Zakariya University, Multan, Punjab, Pakistan
| | - W Nouman
- Department of Forestry, Range and Wildlife Management, Bahaudddin Zakariya University, Multan, Punjab, Pakistan
| | - S B Hussain
- Department of Plant Breeding & Genetics, Bahaudddin Zakariya University, Multan, Punjab, Pakistan
| | - S Mehmood
- Institute of Pure and Applied Biology, Bahauddin Zakariya University, Multan, Punjab, Pakistan
| | - A Irshad
- Regional Agricultural Research Institute Bahawalpur, Punjab, Pakistan
| | - N Sarwar
- Department of Agronomy, Bahauddin Zakariya University, Multan, Punjab, Pakistan
| | - A Ammar
- Regional Agricultural Research Institute Bahawalpur, Punjab, Pakistan
| | - M F Iqbal
- Department of Soil Science, Bahauddin Zakariya University, Multan, Punjab, Pakistan
| | - A Asim
- Department of Horticulture, Bahauddin Zakariya Univeristy, Multan, Punjab, Pakistan
| | - M U Chattha
- Department of Agronomy, University of Agriculture Faisalabad, Punjab, Pakistan
| | - M B Chattha
- Institute of Agricultural Sciences, Punjab University, Lahore, Pakistan
| | - A Zafar
- Regional Agricultural Research Institute Bahawalpur, Punjab, Pakistan
| | - R Abid
- Institute of Pure and Applied Biology, Bahauddin Zakariya University, Multan, Punjab, Pakistan
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Zafar A, Stone MA, Davies MJ, Khunti K. Acknowledging and allocating responsibility for clinical inertia in the management of Type 2 diabetes in primary care: a qualitative study. Diabet Med 2015; 32:407-13. [PMID: 25251768 DOI: 10.1111/dme.12592] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [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] [Accepted: 09/10/2014] [Indexed: 12/29/2022]
Abstract
AIMS Failure to intensify treatment in patients with Type 2 diabetes with suboptimal blood glucose control has been termed clinical inertia and has been shown to contribute to poorer patient outcomes. We aimed to identify and explore perceptions about clinical inertia from the perspective of primary healthcare providers. METHODS A qualitative study was conducted in Leicestershire and Northamptonshire, UK. Purposive sampling was based on healthcare providers working in primary care settings with 'higher' and 'lower' target achievement based on routine data. Twenty semi-structured interviews were conducted, face-to-face or by telephone. Thematic analysis was informed by the constant comparative approach. RESULTS An important broad theme that emerged during the analysis was related to attribution and explanation of responsibility for clinical inertia. This included general willingness to accept a degree of responsibility for clinical inertia. In some cases, however, participants had inaccurate perceptions about levels of target achievement in their primary care centres, as indicated by routine data. Participants sought to lessen their own sense of accountability by highlighting patient-level barriers such as comorbidities and human fallibility, and also system-level barriers, particularly time constraints. Perceptions about ways of addressing the problem of clinical inertia were not seen as straightforward, further emphasizing a complex and cumulative pattern of barriers. CONCLUSIONS In order to understand and address the problem of clinical inertia, provider, patient- and system-level barriers should be considered together rather than as separate issues. Acknowledgement of responsibility should be regarded positively as a motivator for change.
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Affiliation(s)
- A Zafar
- Diabetes Research Unit, Leicester Diabetes Centre, Leicester, UK
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Abstract
Monophasic X-type Mn- and Cr-doped Ba–Co ferrites, synthesized by co-precipitation, catalytically decomposed N2O gas while remaining stable at 1000 K.
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Affiliation(s)
- B. Ul-ain
- Nanoscience and Catalysis Division
- National Centre for Physics
- Islamabad
- Pakistan
| | - A. Zafar
- Department of Chemistry
- Quaid-i-Azam University
- Islamabad
- Pakistan
| | - S. Ahmed
- Department of Chemistry
- Quaid-i-Azam University
- Islamabad
- Pakistan
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Sayal P, Zafar A, Ramsewak S, Yousefpour A. Reconstructive Techniques in Skull Base Surgery for Head and Neck Malignancies. Skull Base Surg 2014. [DOI: 10.1055/s-0034-1384090] [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: 10/20/2022]
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Musani SA, Essani RR, Khowaja RM, Alwani NR, Lakhani S, Zafar A. P286: Decreasing nosocomial exposures of tuberculosis to healthcare workers at emergency department in a tertiary care hospital in Karachi, Pakistan. Antimicrob Resist Infect Control 2013. [PMCID: PMC3688037 DOI: 10.1186/2047-2994-2-s1-p286] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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Zafar A, Schjødt-Thomsen J, Sodhi R, Goacher R, de Kubber D. Investigation of the ageing effects on phenol-urea-formaldehyde binder and alkanol amine-acid anhydride binder coated mineral fibres. Polym Degrad Stab 2013. [DOI: 10.1016/j.polymdegradstab.2012.09.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Irfan S, Ahmad A, Guhar D, Khan E, Malik F, Mahmood S, Zafar A. Fluoroquinolone and macrolide co-resistance in clinical isolates of Campylobacter species: a 15-year study in Karachi, Pakistan. East Mediterr Health J 2012; 16:1226-30. [PMID: 24988396 DOI: 10.26719/2010.16.12.1226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Accepted: 03/05/2009] [Indexed: 11/09/2022]
Abstract
Fluoroquinolone and macrolide antibiotics are generally considered as first-line drugs for the treatment of severe campylobacteriosis. This study was conducted to analyse the trend of erythromycin and ofloxacin resistance among Campylobacter spp. isolated from stool specimens over a period of 15 years (1992-2007) at The Aga Khan University clinical laboratory in Karachi, Pakistan. A total of 83 396 stool specimens were processed, with a 14% isolation rate for enteric pathogens. The isolation rate of Campylobacter spp. was low during 1992-93 (6%-13%), peaked in 1996 (46%), then ranged from 20% to 40%. We report a rising trend in ofloxacin resistance, re-emergence of erythromycin resistance and indications of co-resistance to both drugs in clinical isolates of Campylobacter spp.
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Affiliation(s)
- S Irfan
- Department of Pathology & Microbiology, Aga Khan University, Karachi, Pakistan
| | - A Ahmad
- Department of Pathology & Microbiology, Aga Khan University, Karachi, Pakistan
| | - D Guhar
- Department of Pathology & Microbiology, Aga Khan University, Karachi, Pakistan
| | - E Khan
- Department of Pathology & Microbiology, Aga Khan University, Karachi, Pakistan
| | - F Malik
- Department of Pathology & Microbiology, Aga Khan University, Karachi, Pakistan
| | - S Mahmood
- Department of Pathology & Microbiology, Aga Khan University, Karachi, Pakistan
| | - A Zafar
- Department of Pathology & Microbiology, Aga Khan University, Karachi, Pakistan
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Maimaiti N, Zafar A, Amrizal M, Zaleha MI, Saperi S, Aljunid S. Estimating clinical and economic burden of pneumococcal meningitis in Malaysia using Casemix data. BMC Health Serv Res 2012. [PMCID: PMC3503585 DOI: 10.1186/1472-6963-12-s1-o4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Reeza H, Zafar A, Hamzah AJ, Aljunid S. Using alternative programming algorithms and techniques for optimizing performance of the Casemix software. BMC Health Serv Res 2012. [PMCID: PMC3503590 DOI: 10.1186/1472-6963-12-s1-o10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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46
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Farooqi JQ, Jabeen K, Saeed N, Iqbal N, Malik B, Lockhart SR, Zafar A, Brandt ME, Hasan R. Invasive candidiasis in Pakistan: clinical characteristics, species distribution and antifungal susceptibility. J Med Microbiol 2012; 62:259-268. [PMID: 23105021 DOI: 10.1099/jmm.0.048785-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
This study reports for the first time, to our knowledge, descriptive epidemiological data for 188 invasive Candida isolates from Pakistan, including species identification and antifungal susceptibility against fluconazole, itraconazole, voriconazole, caspofungin, micafungin, anidulafungin and amphotericin. Risk factors for invasive candidiasis (IC) were determined for 96 patients from Karachi, Pakistan. In adults and neonates, Candida tropicalis (38 and 36 %, respectively) was the most common species, followed in adults by Candida parapsilosis (17.8 %), Candida glabrata (15.9 %) and Candida albicans (12.3 %). C. albicans (21 %) was the second most common in neonates. In children, C. albicans (31.9 %), C. tropicalis (26.4 %) and C. parapsilosis (19.4 %) were the most common. C. albicans IC was significantly associated with paediatric age [crude odds ratio (COR) 3.46, 95 % confidence interval (CI) 1.63-7.32]. Rare species made up 17.5 % of the total isolates studied. Resistance to fluconazole was seen in C. glabrata (15 .0%) and Candida krusei (100 .0%). Only one isolate (C. glabrata) was resistant to all three echinocandins. Low MICs of fluconazole for 98 % (184/188) of isolates tested support its continued use as an empiric therapy for IC. Non-C. albicans IC was associated with the use of β-lactam inhibitor combinations (COR 3.16, 95 % CI 1.05-9.57). Use of healthcare devices was documented in 85.4 % of IC patients, whilst 75 .0% had been admitted to special care units. Surprisingly, 66.7 % of patients with IC were not obviously immunosuppressed. The high frequency of modifiable risk factors in this population indicates that candidaemia can be reduced with stringent antibiotic and infection control measures. These data will be useful for empiric selection of antifungals in Karachi, and contribute to global assessments of antifungal resistance.
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Affiliation(s)
- J Q Farooqi
- Department of Pathology Microbiology, Aga Khan Hospital Karachi, Pakistan
| | - K Jabeen
- Department of Pathology Microbiology, Aga Khan Hospital Karachi, Pakistan
| | - N Saeed
- Department of Pathology Microbiology, Aga Khan Hospital Karachi, Pakistan
| | - N Iqbal
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - B Malik
- Department of Pathology Microbiology, Aga Khan Hospital Karachi, Pakistan
| | - S R Lockhart
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - A Zafar
- Department of Pathology Microbiology, Aga Khan Hospital Karachi, Pakistan
| | - M E Brandt
- Mycotic Diseases Branch, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - R Hasan
- Department of Pathology Microbiology, Aga Khan Hospital Karachi, Pakistan
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Abstract
AIM The aim of this study was to compare 5-year survival rates in colorectal cancer (CRC) patients who underwent potentially curative surgery before and after the introduction of the 2-week wait (2WW) referral system. METHOD Data were collected retrospectively from a prospectively maintained cancer database for CRC patients who underwent surgery in 1999 (pre-2WW group, n = 150) and 2002 (post-2WW group, n = 126). Patients who presented as an emergency, those who died within 30 days of surgery and those who presented with incurable CRC were excluded. We used the Kaplan-Meier method to plot survival curves and the log rank test to compare survival rates between the two groups. RESULTS The 5-year survival rates in the pre-2WW and post-2WW groups did not differ significantly (71%vs 72%, respectively; P = 0.880). The number of CRC patients who presented via urgent pathways was higher in the post-2WW group than in the pre-2WW group (77%vs 38%, P < 0.001). Further, owing to this change in the referral pattern, the overall delay between referral and treatment was significantly lower in the post-2WW group than in the pre-2WW group (median 76 days vs 115, P = 0.009). CONCLUSION The 2WW referral system for patients with symptoms of CRC does not translate into improved survival. However, more patients with symptomatic CRC are being referred via urgent pathways.
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Affiliation(s)
- A Zafar
- Good Hope Hospital, Heart of England NHS Trust Warley Medical Centre, Kingsway, Oldbury, UK.
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Zafar A, Schjødt-Thomsen J, Sodhi R, Goacher R, Kubber D. X-ray photoelectron spectroscopy and time-of-flight secondary ion mass spectrometry characterization of aging effects on the mineral fibers treated with aminopropylsilane and quaternary ammonium compounds. SURF INTERFACE ANAL 2012. [DOI: 10.1002/sia.4825] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Affiliation(s)
- A. Zafar
- Department of Mechanical and Manufacturing Engineering; Aalborg University; Aalborg; Denmark
| | - J. Schjødt-Thomsen
- Department of Mechanical and Manufacturing Engineering; Aalborg University; Aalborg; Denmark
| | - R. Sodhi
- Department of Chemical Engineering and Applied Chemistry; University of Toronto; Toronto; Canada
| | - R. Goacher
- Department of Chemical Engineering and Applied Chemistry; University of Toronto; Toronto; Canada
| | - D. Kubber
- R&D Department; Rockwool International; Hedehusene; Denmark
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Zafar A, Ali Z. Pattern of magnetic resonance imaging and magnetic resonance venography changes in cerebral venous sinus thrombosis. J Ayub Med Coll Abbottabad 2012; 24:63-67. [PMID: 23855098] [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: 06/02/2023]
Abstract
BACKGROUND Cerebral venous sinus thrombosis is a common but highly under-recognised condition, which is missed not only by general practitioners but also by neurologists. Computerised tomography (CT) or magnetic resonance imaging (MRI) of brain alone is not sufficient to diagnose this condition. Objective of this study was to explore the pattern of magnetic resonance imaging (MRI) and magnetic resonance venography (MRV) changes in cerebral venous sinus thrombosis (CVST). METHODS This was a descriptive study in which 52 cases of cerebral venous sinus thrombosis with special emphasis on their MRI and MRV findings were included. The study was conducted in Neurology Unit, Lady Reading Hospital, Peshawar, Pakistan, from January 2010 to July 2011. All patients suffering from cerebral venous sinus thrombosis were included in the study. Multi-planar/multi-sequential, Tesla 1.5 MRI/MRV time of flight images were done in all cases where there was suspicion of cerebral venous sinus thrombosis. RESULTS Out of 52 patients with cerebral venous sinus thrombosis 41 (78.84%) were female and 11 (21.15%) were male. Mean age was 37 +/- 5 years. Definite risk factors were found in 38 (73.076%) patients with pregnancy, use of oral contraceptives or puerperium being the most frequently found risk factor in 20 (73.076%) patients. Most common complaint was headache found in 41 (78.84%) patients, followed by focal neurological deficits, and altered mental status and seizures. Papilloedema was seen in 20 (38.46%) patients. The cerebral venous sinuses most frequently involved were transverse and sigmoid sinuses in 17 patients (32.69%) while superior sagittal sinus alone in 10 (19.23%) patients. Overall CT brain was normal in 30% and MRI brain in 23.07% patients; however, MRV of these patients revealed CVST. CONCLUSION Imaging plays a primary role in the diagnosis of cerebral venous sinus thrombosis because the clinical picture of CVST is non-specific and highly variable. Thrombosis of cerebral venous system is readily picked-up on MRV even if it is missed by CT scan or MRI.
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Affiliation(s)
- A Zafar
- Department of Neurology, Government Lady Reading Hospital Peshawar, Pakistan.
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Irfan S, Turton JF, Mehraj J, Siddiqui SZ, Haider S, Zafar A, Memon B, Afzal O, Hasan R. Molecular and epidemiological characterisation of clinical isolates of carbapenem-resistant Acinetobacter baumannii from public and private sector intensive care units in Karachi, Pakistan. J Hosp Infect 2011; 78:143-8. [PMID: 21459477 DOI: 10.1016/j.jhin.2011.01.029] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Accepted: 01/25/2011] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to identify molecular and epidemiological characteristics of hospital-acquired carbapenem-resistant Acinetobacter baumannii (CRAB) from two different intensive care unit (ICU) settings in Karachi, Pakistan. A cross-sectional study was performed in the adult ICUs of a private sector tertiary care hospital (PS-ICU) and of a government sector hospital (GS-ICU) between November 2007 and August 2008. Deduplicated CRAB isolates from clinical specimens were examined for carbapenemase and class 1 integrase genes. Isolates were typed using sequence-based multiplex polymerase chain reaction, pulsed-field gel electrophoresis (PFGE) and variable number tandem repeat (VNTR). A total of 50 patients (33 from PS-ICU and 17 from GS-ICU) were recruited. There were statistically significant differences between patients in the two ICUs in terms of mean age, comorbidities, the presence of central venous pressure lines, urinary catheters, and average length of stay. bla(OxA-23-like) acquired-oxacillinase genes were found in 47/50 isolates. Class 1 integrase genes were found in 50% (25/50) of the organisms. The majority of isolates belonged to strains of European clones I and II. PFGE typing grouped the isolates into eight distinct clusters, three of which were found in both hospitals. Most of the isolates within each PFGE cluster shared identical or highly similar VNTR profiles, suggesting close epidemiological association. Irrespective of differences in risk factors and infection control policies and practices, the extent of clonality among CRAB isolates was very similar in both ICU settings.
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Affiliation(s)
- S Irfan
- Department of Pathology & Microbiology, Aga Khan University Hospital, Karachi, Pakistan.
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