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Ioannidis I, Forssten MP, Mohammad Ismail A, Cao Y, Tennakoon L, Spain DA, Mohseni S. The relationship and predictive value of dementia and frailty for mortality in patients with surgically managed hip fractures. Eur J Trauma Emerg Surg 2024; 50:339-345. [PMID: 37656179 PMCID: PMC11035458 DOI: 10.1007/s00068-023-02356-z] [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: 06/05/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Both dementia and frailty have been associated with worse outcomes in patients with hip fractures. However, the interrelation and predictive value of these two entities has yet to be clarified. The current study aimed to investigate the predictive relationship between dementia, frailty, and in-hospital mortality after hip fracture surgery. METHODS All patients registered in the 2019 National Inpatient Sample Database who were 50 years or older and underwent emergency hip fracture surgery following a traumatic fall were eligible for inclusion. Logistic regression (LR) models were constructed with in-hospital mortality as the response variables. One model was constructed including markers of frailty and one model was constructed excluding markers of frailty [Orthopedic Frailty Score (OFS) and weight loss]. The feature importance of all variables was determined using the permutation importance method. New LR models were then fitted using the top ten most important variables. The area under the receiver-operating characteristic curve (AUC) was used to compare the predictive ability of these models. RESULTS An estimated total of 216,395 patients were included. Dementia was the 7th most important variable for predicting in-hospital mortality. When the OFS and weight loss were included, they replaced dementia in importance. There was no significant difference in the predictive ability of the models when comparing the model that included markers of frailty [AUC for in-hospital mortality (95% CI) 0.79 (0.77-0.81)] with the model that excluded markers of frailty [AUC for in-hospital mortality (95% CI) 0.79 (0.77-0.80)]. CONCLUSION Dementia functions as a surrogate for frailty when predicting in-hospital mortality in hip fracture patients. This finding highlights the importance of early frailty screening for improvement of care pathways and discussions with patients and their families in regard to expected outcomes.
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Affiliation(s)
- Ioannis Ioannidis
- Department of Orthopedic Surgery, Orebro University Hospital, Orebro, Sweden
- School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Maximilian Peter Forssten
- Department of Orthopedic Surgery, Orebro University Hospital, Orebro, Sweden
- School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Ahmad Mohammad Ismail
- Department of Orthopedic Surgery, Orebro University Hospital, Orebro, Sweden
- School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Orebro University, Orebro, Sweden
| | - Lakshika Tennakoon
- Department of Surgery, Section of Trauma and Acute Care Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - David A Spain
- Department of Surgery, Section of Trauma and Acute Care Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Shahin Mohseni
- Department of Orthopedic Surgery, Orebro University Hospital, Orebro, Sweden.
- Division of Trauma, Critical Care & Acute Care Surgery, Department of Surgery, Sheik Shakhbot Medical City Mayo Clinic, Abu Dhabi, United Arab Emirates.
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Mohammad Ismail A, Forssten MP, Hildebrand F, Sarani B, Ioannidis I, Cao Y, Ribeiro MAF, Mohseni S. Cardiac risk stratification and adverse outcomes in surgically managed patients with isolated traumatic spine injuries. Eur J Trauma Emerg Surg 2024; 50:523-530. [PMID: 38170276 PMCID: PMC11035445 DOI: 10.1007/s00068-023-02413-7] [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: 10/02/2023] [Accepted: 11/25/2023] [Indexed: 01/05/2024]
Abstract
INTRODUCTION As the incidence of traumatic spine injuries has been steadily increasing, especially in the elderly, the ability to categorize patients based on their underlying risk for the adverse outcomes could be of great value in clinical decision making. This study aimed to investigate the association between the Revised Cardiac Risk Index (RCRI) and adverse outcomes in patients who have undergone surgery for traumatic spine injuries. METHODS All adult patients (18 years or older) in the 2013-2019 TQIP database with isolated spine injuries resulting from blunt force trauma, who underwent spinal surgery, were eligible for inclusion in the study. The association between the RCRI and in-hospital mortality, cardiopulmonary complications, and failure-to-rescue (FTR) was determined using Poisson regression models with robust standard errors to adjust for potential confounding. RESULTS A total of 39,391 patients were included for further analysis. In the regression model, an RCRI ≥ 3 was associated with a threefold risk of in-hospital mortality [adjusted IRR (95% CI): 3.19 (2.30-4.43), p < 0.001] and cardiopulmonary complications [adjusted IRR (95% CI): 3.27 (2.46-4.34), p < 0.001], as well as a fourfold risk of FTR [adjusted IRR (95% CI): 4.27 (2.59-7.02), p < 0.001], compared to RCRI 0. The risk of all adverse outcomes increased stepwise along with each RCRI score. CONCLUSION The RCRI may be a useful tool for identifying patients with traumatic spine injuries who are at an increased risk of in-hospital mortality, cardiopulmonary complications, and failure-to-rescue after surgery.
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Affiliation(s)
- Ahmad Mohammad Ismail
- School of Medical Sciences, Orebro University, 701 82, Orebro, Sweden
- Department of Orthopedic Surgery, Orebro University Hospital, 701 85, Orebro, Sweden
| | - Maximilian Peter Forssten
- School of Medical Sciences, Orebro University, 701 82, Orebro, Sweden
- Department of Orthopedic Surgery, Orebro University Hospital, 701 85, Orebro, Sweden
| | - Frank Hildebrand
- Department of Orthopedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Babak Sarani
- Center of Trauma and Critical Care, George Washington University, Washington, DC, USA
| | - Ioannis Ioannidis
- School of Medical Sciences, Orebro University, 701 82, Orebro, Sweden
- Department of Orthopedic Surgery, Orebro University Hospital, 701 85, Orebro, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Orebro University, 701 82, Orebro, Sweden
| | - Marcelo A F Ribeiro
- Division of Trauma, Critical Care & Acute Care Surgery, Department of Surgery, Sheikh Shakhbout Medical City, Mayo Clinic, Abu Dhabi, United Arab Emirates
- Pontifical Catholic University of São Paulo, São Paulo, Brazil
- Khalifa University and Gulf Medical University, Abu Dhabi, United Arab Emirates
| | - Shahin Mohseni
- School of Medical Sciences, Orebro University, 701 82, Orebro, Sweden.
- Division of Trauma, Critical Care & Acute Care Surgery, Department of Surgery, Sheikh Shakhbout Medical City, Mayo Clinic, Abu Dhabi, United Arab Emirates.
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Forssten MP, Mohammad Ismail A, Ioannidis I, Ribeiro MAF, Cao Y, Sarani B, Mohseni S. Prioritizing patients for hip fracture surgery: the role of frailty and cardiac risk. Front Surg 2024; 11:1367457. [PMID: 38525320 PMCID: PMC10957751 DOI: 10.3389/fsurg.2024.1367457] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 02/19/2024] [Indexed: 03/26/2024] Open
Abstract
Introduction The number of patients with hip fractures continues to rise as the average age of the population increases. Optimizing outcomes in this cohort is predicated on timely operative repair. The aim of this study was to determine if patients with hip fractures who are frail or have a higher cardiac risk suffer from an increased risk of in-hospital mortality when surgery is postponed >24 h. Methods All patients registered in the 2013-2021 TQIP dataset who were ≥65 years old and underwent surgical fixation of an isolated hip fracture caused by a ground-level fall were included. Adjustment for confounding was performed using inverse probability weighting (IPW) while stratifying for frailty with the Orthopedic Frailty Score (OFS) and cardiac risk using the Revised Cardiac Risk Index (RCRI). The outcome was presented as the absolute risk difference in in-hospital mortality. Results A total of 254,400 patients were included. After IPW, all confounders were balanced. A delay in surgery was associated with an increased risk of in-hospital mortality across all strata, and, as the degree of frailty and cardiac risk increased, so too did the risk of mortality. In patients with OFS ≥4, delaying surgery >24 h was associated with a 2.33 percentage point increase in the absolute mortality rate (95% CI: 0.57-4.09, p = 0.010), resulting in a number needed to harm (NNH) of 43. Furthermore, the absolute risk of mortality increased by 4.65 percentage points in patients with RCRI ≥4 who had their surgery delayed >24 h (95% CI: 0.90-8.40, p = 0.015), resulting in a NNH of 22. For patients with OFS 0 and RCRI 0, the corresponding NNHs when delaying surgery >24 h were 345 and 333, respectively. Conclusion Delaying surgery beyond 24 h from admission increases the risk of mortality for all geriatric hip fracture patients. The magnitude of the negative impact increases with the patient's level of cardiac risk and frailty. Operative intervention should not be delayed based on frailty or cardiac risk.
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Affiliation(s)
- Maximilian Peter Forssten
- Department of Orthopedic Surgery, Faculty of Medicine and Health, Orebro University, Orebro, Sweden
- School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Ahmad Mohammad Ismail
- Department of Orthopedic Surgery, Faculty of Medicine and Health, Orebro University, Orebro, Sweden
- School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Ioannis Ioannidis
- Department of Orthopedic Surgery, Faculty of Medicine and Health, Orebro University, Orebro, Sweden
- School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Marcelo A. F. Ribeiro
- Pontifical Catholic University of São Paulo, São Paulo, Brazil
- Khalifa University and Gulf Medical University, Abu Dhabi, United Arab Emirates
- Department of Surgery, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Orebro University, Orebro, Sweden
| | - Babak Sarani
- Division of Trauma and Acute Care Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, United States
| | - Shahin Mohseni
- School of Medical Sciences, Orebro University, Orebro, Sweden
- Department of Surgery, Sheikh Shakhbout Medical City, Abu Dhabi, United Arab Emirates
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Mohseni S, Forssten MP, Mohammad Ismail A, Cao Y, Hildebrand F, Sarani B, Ribeiro MAF. Investigating the link between frailty and outcomes in geriatric patients with isolated rib fractures. Trauma Surg Acute Care Open 2024; 9:e001206. [PMID: 38347893 PMCID: PMC10860062 DOI: 10.1136/tsaco-2023-001206] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024] Open
Abstract
Background Studies have shown an increased risk of morbidity in elderly patients suffering rib fractures from blunt trauma. The association between frailty and rib fractures on adverse outcomes is still ill-defined. In the current investigation, we sought to delineate the association between frailty, measured using the Orthopedic Frailty Score (OFS), and outcomes in geriatric patients with isolated rib fractures. Methods All geriatric (aged 65 years or older) patients registered in the 2013-2019 Trauma Quality Improvement database with a conservatively managed isolated rib fracture were considered for inclusion. An isolated rib fracture was defined as the presence of ≥1 rib fracture, a thorax Abbreviated Injury Scale (AIS) between 1 and 5, an AIS ≤1 in all other regions, as well as the absence of pneumothorax, hemothorax, or pulmonary contusion. Based on patients' OFS, patients were classified as non-frail (OFS 0), pre-frail (OFS 1), or frail (OFS ≥2). The prevalence ratio (PR) of composite complications, in-hospital mortality, failure-to-rescue (FTR), and intensive care unit (ICU) admission between the OFS groups was determined using Poisson regression models to adjust for potential confounding. Results A total of 65 375 patients met the study's inclusion criteria of whom 60% were non-frail, 29% were pre-frail, and 11% were frail. There was a stepwise increased risk of complications, in-hospital mortality, and FTR from non-frail to pre-frail and frail. Compared with non-frail patients, frail patients exhibited a 87% increased risk of in-hospital mortality [adjusted PR (95% CI): 1.87 (1.52-2.31), p<0.001], a 44% increased risk of complications [adjusted PR (95% CI): 1.44 (1.23-1.67), p<0.001], a doubling in the risk of FTR [adjusted PR (95% CI): 2.08 (1.45-2.98), p<0.001], and a 17% increased risk of ICU admission [adjusted PR (95% CI): 1.17 (1.11-1.23), p<0.001]. Conclusion There is a strong association between frailty, measured using the OFS, and adverse outcomes in geriatric patients managed conservatively for rib fractures.
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Affiliation(s)
- Shahin Mohseni
- Orebro universitet Fakulteten for medicin och halsa, Orebro, Sweden
- Department of Surgery, Sheikh Shakhbout Medical City—Mayo Clinic, Abu Dhabi, UAE
| | - Maximilian Peter Forssten
- Department of Orthopedic Surgery, Orebro University Hospital, Orebro, Sweden
- School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Ahmad Mohammad Ismail
- Department of Orthopedic Surgery, Orebro University Hospital, Orebro, Sweden
- School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Orebro University, Orebro, Sweden
| | - Frank Hildebrand
- Department of Orthopedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Babak Sarani
- George Washington University, Washington, District of Columbia, USA
| | - Marcelo AF Ribeiro
- Department of Surgery, Sheikh Shakhbout Medical City—Mayo Clinic, Abu Dhabi, UAE
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Mohammad Ismail A, Forssten MP, Sarani B, Ribeiro MAF, Chang P, Cao Y, Hildebrand F, Mohseni S. Sex disparities in adverse outcomes after surgically managed isolated traumatic spinal injury. Eur J Trauma Emerg Surg 2024; 50:149-155. [PMID: 37191713 PMCID: PMC10923959 DOI: 10.1007/s00068-023-02275-z] [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: 02/13/2023] [Accepted: 05/02/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Traumatic spinal injury (TSI) encompasses a wide range of injuries affecting the spinal cord, nerve roots, bones, and soft tissues that result in pain, impaired mobility, paralysis, and death. There is some evidence suggesting that women may have different physiological responses to traumatic injury compared to men; therefore, this study aimed to investigate if there are any associations between sex and adverse outcomes following surgically managed isolated TSI. METHODS Using the 2013-2019 TQIP database, all adult patients with isolated TSI, defined as a spine AIS ≥ 2 with an AIS ≤ 1 in all other body regions, resulting from blunt force trauma requiring spinal surgery, were eligible for inclusion in the study. The association between the sex and in-hospital mortality as well as cardiopulmonary and venothromboembolic complications was determined by calculating the risk ratio (RR) after adjusting for potential confounding using inverse probability weighting. RESULTS A total of 43,756 patients were included. After adjusting for potential confounders, female sex was associated with a 37% lower risk of in-hospital mortality [adjusted RR (95% CI): 0.63 (0.57-0.69), p < 0.001], a 27% lower risk of myocardial infarction [adjusted RR (95% CI): 0.73 (0.56-0.95), p = 0.021], a 37% lower risk of cardiac arrest [adjusted RR (95% CI): 0.63 (0.55-0.72), p < 0.001], a 34% lower risk of deep vein thrombosis [adjusted RR (95% CI): 0.66 (0.59-0.74), p < 0.001], a 45% lower risk of pulmonary embolism [adjusted RR (95% CI): 0.55 (0.46-0.65), p < 0.001], a 36% lower risk of acute respiratory distress syndrome [adjusted RR (95% CI): 0.64 (0.54-0.76), p < 0.001], a 34% lower risk of pneumonia [adjusted RR (95% CI): 0.66 (0.60-0.72), p < 0.001], and a 22% lower risk of surgical site infection [adjusted RR (95% CI): 0.78 (0.62-0.98), p < 0.032], compared to male sex. CONCLUSION Female sex is associated with a significantly decreased risk of in-hospital mortality as well as cardiopulmonary and venothromboembolic complications following surgical management of traumatic spinal injuries. Further studies are needed to elucidate the cause of these differences.
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Affiliation(s)
- Ahmad Mohammad Ismail
- Department of Orthopedic Surgery, Orebro University Hospital, 701 85, Orebro, Sweden
- School of Medical Sciences, Orebro University, 702 81, Orebro, Sweden
| | - Maximilian Peter Forssten
- Department of Orthopedic Surgery, Orebro University Hospital, 701 85, Orebro, Sweden
- School of Medical Sciences, Orebro University, 702 81, Orebro, Sweden
| | - Babak Sarani
- Surgery and Emergency Medicine, Center of Trauma and Critical Care, George Washington University, Washington, DC, USA
| | - Marcelo A F Ribeiro
- Surgery, Pontifical Catholic University of São Paulo, São Paulo, Brazil
- Surgery, Khalifa University and Gulf Medical University, Abu Dhabi, United Arab Emirates
- Division of Trauma, Critical Care & Acute Care Surgery, Department of Surgery, Sheikh Shakhbout Medical City, Mayo Clinic, Abu Dhabi, United Arab Emirates
| | - Parker Chang
- Center for Trauma and Critical Care, Department of Surgery, George Washington University, Washington, DC, USA
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, Faculty of Medicine and Health, School of Medical Sciences, Orebro University, 701 82, Orebro, Sweden
| | - Frank Hildebrand
- Department of Orthopedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Shahin Mohseni
- School of Medical Sciences, Orebro University, 702 81, Orebro, Sweden.
- Division of Trauma, Critical Care & Acute Care Surgery, Department of Surgery, Sheikh Shakhbout Medical City, Mayo Clinic, Abu Dhabi, United Arab Emirates.
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Trivedi D, Forssten MP, Cao Y, Ismail AM, Czeiter E, Amrein K, Kobeissy F, Wang KKW, DeSoucy E, Buki A, Mohseni S. Screening Performance of S100 Calcium-Binding Protein B, Glial Fibrillary Acidic Protein, and Ubiquitin C-Terminal Hydrolase L1 for Intracranial Injury Within Six Hours of Injury and Beyond. J Neurotrauma 2024; 41:349-358. [PMID: 38115670 DOI: 10.1089/neu.2023.0322] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023] Open
Abstract
The Scandinavian NeuroTrauma Committee (SNC) guidelines recommend S100 calcium-binding protein B (S100B) as a screening tool for early detection of Traumatic brain injury (TBI) in patients presenting with an initial Glasgow Coma Scale (GCS) of 14-15. The objective of the current study was to compare S100B's diagnostic performance within the recommended 6-h window after injury, compared with glial fibrillary acidic protein (GFAP) and UCH-L1. The secondary outcome of interest was the ability of these biomarkers in detecting traumatic intracranial pathology beyond the 6-h mark. The Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI) core database (2014-2017) was queried for data pertaining to all TBI patients with an initial GCS of 14-15 who had a blood sample taken within 6 h of injury in which the levels of S100B, GFAP, and UCH-L1 were measured. As a subgroup analysis, data involving patients with blood samples taken within 6-9 h and 9-12 h were analyzed separately for diagnostic ability. The diagnostic ability of these biomarkers for detecting any intracranial injury was evaluated based on the area under the receiver operating characteristic curve (AUC). Each biomarker's sensitivity, specificity, and accuracy were also reported at the cutoff that maximized Youden's index. A total of 531 TBI patients with GCS 14-15 on admission had a blood sample taken within 6 h, of whom 24.9% (n = 132) had radiologically confirmed intracranial injury. The AUCs of GFAP (0.86, 95% confidence interval [CI]: 0.82-0.90) and UCH-L1 (0.81, 95% CI: 0.76-0.85) were statistically significantly higher than that of S100B (0.74, 95% CI: 0.69-0.79) during this time. There was no statistically significant difference in the predictive ability of S100B when sampled within 6 h, 6-9 h, and 9-12 h of injury, as the p values were >0.05 when comparing the AUCs. Overlapping AUC 95% CI suggests no benefit of a combined GFAP and UCH-L1 screening tool over GFAP during the time periods studied [0.87 (0.83-0.90) vs. 0.86 (0.82-0.90) when sampled within 6 h of injury, 0.83 (0.78-0.88) vs. 0.83 (0.78-0.89) within 6 to 9 h and 0.81 (0.73-0.88) vs. 0.79 (0.72-0.87) within 9-12 h]. Targeted analysis of the CENTER-TBI core database, with focus on the patient category for which biomarker testing is recommended by the SNC guidelines, revealed that GFAP and UCH-L1 perform superior to S100B in predicting CT-positive intracranial lesions within 6 h of injury. GFAP continued to exhibit superior predictive ability to S100B during the time periods studied. S100B displayed relatively unaltered screening performance beyond the diagnostic timeline provided by SNC guidelines. These findings suggest the need for a reevaluation of the current SNC TBI guidelines.
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Affiliation(s)
- Dhanisha Trivedi
- Department of Neurosurgery, Orebro University Hospital, Orebro, Sweden
- School of Medical Sciences , Orebro University Hospital, Orebro, Sweden
| | | | - Yang Cao
- Clinical Epidemiology and Biostatistics, Orebro University Hospital, Orebro, Sweden
| | | | - Endre Czeiter
- Department of Neurosurgery, University of Pecs, Pecs, Hungary
- Neurotrauma Research Group, Szentágothai Research Center, University of Pecs, Pecs, Hungary
- ELKH-PTE Clinical Neuroscience MR Research Group, University of Pecs, Pecs, Hungary
| | - Krisztina Amrein
- Department of Neurosurgery, University of Pecs, Pecs, Hungary
- Neurotrauma Research Group, Szentágothai Research Center, University of Pecs, Pecs, Hungary
- ELKH-PTE Clinical Neuroscience MR Research Group, University of Pecs, Pecs, Hungary
| | - Firas Kobeissy
- Center for Neurotrauma, Multiomics, and Biomarkers, Department of Neurobiology, Neuroscience Institute, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Kevin K W Wang
- Center for Neurotrauma, Multiomics, and Biomarkers, Department of Neurobiology, Neuroscience Institute, Morehouse School of Medicine, Atlanta, Georgia, USA
| | - Erik DeSoucy
- Division of Trauma, Critical Care, and Acute Care Surgery, Department of Surgery, Sheikh Shakhbout Medical City-Mayo Clinic, Abu Dhabi, United Arab Emirates
| | - Andras Buki
- Department of Neurosurgery, Orebro University Hospital, Orebro, Sweden
- School of Medical Sciences , Orebro University Hospital, Orebro, Sweden
| | - Shahin Mohseni
- School of Medical Sciences , Orebro University Hospital, Orebro, Sweden
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Forssten MP, Sarani B, Mohammad Ismail A, Cao Y, Ribeiro MAF, Hildebrand F, Mohseni S. Adverse outcomes following pelvic fracture: the critical role of frailty. Eur J Trauma Emerg Surg 2023; 49:2623-2631. [PMID: 37644193 PMCID: PMC10728265 DOI: 10.1007/s00068-023-02355-0] [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: 06/05/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023]
Abstract
PURPOSE Pelvic fractures among older adults are associated with an increased risk of adverse outcomes, with frailty likely being a contributing factor. The current study endeavors to describe the association between frailty, measured using the Orthopedic Frailty Score (OFS), and adverse outcomes in geriatric pelvic fracture patients. METHODS All geriatric (65 years or older) patients registered in the 2013-2019 Trauma Quality Improvement Program database with an isolated pelvic fracture following blunt trauma were considered for inclusion. An isolated pelvic fracture was defined as any fracture in the pelvis with a lower extremity AIS ≥ 2, any abdomen AIS, and an AIS ≤ 1 in all other regions. Poisson regression models were employed to determine the association between the OFS and adverse outcomes. RESULTS A total of 66,404 patients were included for further analysis. 52% (N = 34,292) were classified as non-frail (OFS 0), 32% (N = 21,467) were pre-frail (OFS 1), and 16% (N = 10,645) were classified as frail (OFS ≥ 2). Compared to non-frail patients, frail patients exhibited a 88% increased risk of in-hospital mortality [adjusted IRR (95% CI): 1.88 (1.54-2.30), p < 0.001], a 25% increased risk of complications [adjusted IRR (95% CI): 1.25 (1.10-1.42), p < 0.001], a 56% increased risk of failure-to-rescue [adjusted IRR (95% CI): 1.56 (1.14-2.14), p = 0.006], and a 10% increased risk of ICU admission [adjusted IRR (95% CI): 1.10 (1.02-1.18), p = 0.014]. CONCLUSION Frail pelvic fracture patients suffer from a disproportionately increased risk of mortality, complications, failure-to-rescue, and ICU admission. Additional measures are required to mitigate adverse events in this vulnerable patient population.
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Affiliation(s)
- Maximilian Peter Forssten
- School of Medical Sciences, Orebro University, 701 82, Orebro, Sweden
- Department of Orthopedic Surgery, Orebro University Hospital, 701 85, Orebro, Sweden
| | - Babak Sarani
- Center of Trauma and Critical Care, George Washington University, Washington, DC, USA
| | - Ahmad Mohammad Ismail
- School of Medical Sciences, Orebro University, 701 82, Orebro, Sweden
- Department of Orthopedic Surgery, Orebro University Hospital, 701 85, Orebro, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Orebro University, 701 82, Orebro, Sweden
| | - Marcelo A F Ribeiro
- Khalifa University and Gulf Medical University, Abu Dhabi, United Arab Emirates
| | - Frank Hildebrand
- Department of Orthopedics, Trauma and Reconstructive Surgery, University Hospital RWTH Aachen, Pauwelsstrasse 30, 52074, Aachen, Germany
| | - Shahin Mohseni
- School of Medical Sciences, Orebro University, 701 82, Orebro, Sweden.
- Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery, Sheikh Shakhbout Medical City, Mayo Clinic, Abu Dhabi, United Arab Emirates.
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Forssten MP, Cao Y, Mohammad Ismail A, Ioannidis I, Tennakoon L, Spain DA, Mohseni S. Validation of the orthopedic frailty score for measuring frailty in hip fracture patients: a cohort study based on the United States National inpatient sample. Eur J Trauma Emerg Surg 2023; 49:2155-2163. [PMID: 37349513 PMCID: PMC10520138 DOI: 10.1007/s00068-023-02308-7] [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: 05/18/2023] [Accepted: 06/06/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND The Orthopedic Frailty Score (OFS) has been proposed as a tool for measuring frailty in order to predict short-term postoperative mortality in hip fracture patients. This study aims to validate the OFS using a large national patient register to determine its relationship with adverse outcomes as well as length of stay and cost of hospital stay. METHODS All adult patients (18 years or older) registered in the 2019 National Inpatient Sample Database who underwent emergency hip fracture surgery following a traumatic fall were eligible for inclusion. The association between the OFS and mortality, complications, and failure-to-rescue (FTR) was determined using Poisson regression models adjusted for potential confounders. The relationship between the OFS and length of stay and cost of hospital stay was instead determined using a quantile regression model. RESULTS An estimated 227,850 cases met the study inclusion criteria. There was a stepwise increase in the rate of complications, mortality, and FTR for each additional point on the OFS. After adjusting for potential confounding, OFS 4 was associated with an almost ten-fold increase in the risk of in-hospital mortality [adjusted IRR (95% CI): 10.6 (4.02-27.7), p < 0.001], a 38% increased risk of complications [adjusted IRR (95% CI): 1.38 (1.03-1.85), p = 0.032], and an almost 11-fold increase in the risk of FTR [adjusted IRR (95% CI): 11.6 (4.36-30.9), p < 0.001], compared to OFS 0. Patients with OFS 4 also required a day and a half additional care [change in median length of stay (95% CI): 1.52 (0.97-2.08), p < 0.001] as well as cost approximately $5,200 more to manage [change in median cost of stay (95% CI): 5166 (1921-8411), p = 0.002], compared to those with OFS 0. CONCLUSION Patients with an elevated OFS display a substantially increased risk of mortality, complications, and failure-to-rescue as well as a prolonged and more costly hospital stay.
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Affiliation(s)
- Maximilian Peter Forssten
- Department of Orthopedic Surgery, Orebro University Hospital, 701 85 Orebro, Sweden
- School of Medical Sciences, Orebro University, 702 81 Orebro, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Orebro University, 701 82 Orebro, Sweden
| | - Ahmad Mohammad Ismail
- Department of Orthopedic Surgery, Orebro University Hospital, 701 85 Orebro, Sweden
- School of Medical Sciences, Orebro University, 702 81 Orebro, Sweden
| | - Ioannis Ioannidis
- Department of Orthopedic Surgery, Orebro University Hospital, 701 85 Orebro, Sweden
- School of Medical Sciences, Orebro University, 702 81 Orebro, Sweden
| | - Lakshika Tennakoon
- Department of Surgery, Section of Trauma and Acute Care Surgery, Stanford University School of Medicine, Stanford, CA USA
| | - David A. Spain
- Department of Surgery, Section of Trauma and Acute Care Surgery, Stanford University School of Medicine, Stanford, CA USA
| | - Shahin Mohseni
- School of Medical Sciences, Orebro University, 702 81 Orebro, Sweden
- Division of Trauma, Critical Care and Acute Care Surgery, Department of Surgery, Sheik Shakhbout Medical City – Mayo Clinic, Abu Dhabi, United Arab Emirates
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Crous PW, Costa MM, Kandemir H, Vermaas M, Vu D, Zhao L, Arumugam E, Flakus A, Jurjević Ž, Kaliyaperumal M, Mahadevakumar S, Murugadoss R, Shivas RG, Tan YP, Wingfield MJ, Abell SE, Marney TS, Danteswari C, Darmostuk V, Denchev CM, Denchev TT, Etayo J, Gené J, Gunaseelan S, Hubka V, Illescas T, Jansen GM, Kezo K, Kumar S, Larsson E, Mufeeda KT, Piątek M, Rodriguez-Flakus P, Sarma PVSRN, Stryjak-Bogacka M, Torres-Garcia D, Vauras J, Acal DA, Akulov A, Alhudaib K, Asif M, Balashov S, Baral HO, Baturo-Cieśniewska A, Begerow D, Beja-Pereira A, Bianchinotti MV, Bilański P, Chandranayaka S, Chellappan N, Cowan DA, Custódio FA, Czachura P, Delgado G, De Silva NI, Dijksterhuis J, Dueñas M, Eisvand P, Fachada V, Fournier J, Fritsche Y, Fuljer F, Ganga KGG, Guerra MP, Hansen K, Hywel-Jones N, Ismail AM, Jacobs CR, Jankowiak R, Karich A, Kemler M, Kisło K, Klofac W, Krisai-Greilhuber I, Latha KPD, Lebeuf R, Lopes ME, Lumyong S, Maciá-Vicente JG, Maggs-Kölling G, Magistà D, Manimohan P, Martín MP, Mazur E, Mehrabi-Koushki M, Miller AN, Mombert A, Ossowska EA, Patejuk K, Pereira OL, Piskorski S, Plaza M, Podile AR, Polhorský A, Pusz W, Raza M, Ruszkiewicz-Michalska M, Saba M, Sánchez RM, Singh R, Śliwa L, Smith ME, Stefenon VM, Strasiftáková D, Suwannarach N, Szczepańska K, Telleria MT, Tennakoon DS, Thines M, Thorn RG, Urbaniak J, van der Vegte M, Vasan V, Vila-Viçosa C, Voglmayr H, Wrzosek M, Zappelini J, Groenewald JZ. Fungal Planet description sheets: 1550-1613. Persoonia 2023; 51:280-417. [PMID: 38665977 PMCID: PMC11041897 DOI: 10.3767/persoonia.2023.51.08] [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: 09/18/2023] [Accepted: 10/20/2023] [Indexed: 04/28/2024]
Abstract
Novel species of fungi described in this study include those from various countries as follows: Argentina, Neocamarosporium halophilum in leaf spots of Atriplex undulata. Australia, Aschersonia merianiae on scale insect (Coccoidea), Curvularia huamulaniae isolated from air, Hevansia mainiae on dead spider, Ophiocordyceps poecilometigena on Poecilometis sp. Bolivia, Lecanora menthoides on sandstone, in open semi-desert montane areas, Sticta monlueckiorum corticolous in a forest, Trichonectria epimegalosporae on apothecia of corticolous Megalospora sulphurata var. sulphurata, Trichonectria puncteliae on the thallus of Punctelia borreri. Brazil, Catenomargarita pseudocercosporicola (incl. Catenomargarita gen. nov.) hyperparasitic on Pseudocercospora fijiensis on leaves of Musa acuminata, Tulasnella restingae on protocorms and roots of Epidendrum fulgens. Bulgaria, Anthracoidea umbrosae on Carex spp. Croatia, Hymenoscyphus radicis from surface-sterilised, asymptomatic roots of Microthlaspi erraticum, Orbilia multiserpentina on wood of decorticated branches of Quercus pubescens. France, Calosporella punctatispora on dead corticated twigs of Aceropalus. French West Indies (Martinique), Eutypella lechatii on dead corticated palm stem. Germany, Arrhenia alcalinophila on loamy soil. Iceland, Cistella blauvikensis on dead grass (Poaceae). India, Fulvifomes maritimus on living Peltophorum pterocarpum, Fulvifomes natarajanii on dead wood of Prosopis juliflora, Fulvifomes subazonatus on trunk of Azadirachta indica, Macrolepiota bharadwajii on moist soil near the forest, Narcissea delicata on decaying elephant dung, Paramyrothecium indicum on living leaves of Hibiscus hispidissimus, Trichoglossum syamviswanathii on moist soil near the base of a bamboo plantation. Iran, Vacuiphoma astragalicola from stem canker of Astragalus sarcocolla. Malaysia, Neoeriomycopsis fissistigmae (incl. Neoeriomycopsidaceae fam. nov.) on leaf spots on flower Fissistigma sp. Namibia, Exophiala lichenicola lichenicolous on Acarospora cf. luederitzensis. Netherlands, Entoloma occultatum on soil, Extremus caricis on dead leaves of Carex sp., Inocybe pseudomytiliodora on loamy soil. Norway, Inocybe guldeniae on calcareous soil, Inocybe rupestroides on gravelly soil. Pakistan, Hymenagaricus brunneodiscus on soil. Philippines, Ophiocordyceps philippinensis parasitic on Asilus sp. Poland, Hawksworthiomyces ciconiae isolated from Ciconia ciconia nest, Plectosphaerella vigrensis from leaf spots on Impatiens noli-tangere, Xenoramularia epitaxicola from sooty mould community on Taxus baccata. Portugal, Inocybe dagamae on clay soil. Saudi Arabia, Diaporthe jazanensis on branches of Coffea arabica. South Africa, Alternaria moraeae on dead leaves of Moraea sp., Bonitomyces buffels-kloofinus (incl. Bonitomyces gen. nov.) on dead twigs of unknown tree, Constrictochalara koukolii on living leaves of Itea rhamnoides colonised by a Meliola sp., Cylindromonium lichenophilum on Parmelina tiliacea, Gamszarella buffelskloofina (incl. Gamszarella gen. nov.) on dead insect, Isthmosporiella africana (incl. Isthmosporiella gen. nov.) on dead twigs of unknown tree, Nothoeucasphaeria buffelskloofina (incl. Nothoeucasphaeria gen. nov.), on dead twigs of unknown tree, Nothomicrothyrium beaucarneae (incl. Nothomicrothyrium gen. nov.) on dead leaves of Beaucarnea stricta, Paramycosphaerella proteae on living leaves of Protea caffra, Querciphoma foliicola on leaf litter, Rachicladosporium conostomii on dead twigs of Conostomium natalense var. glabrum, Rhamphoriopsis synnematosa on dead twig of unknown tree, Waltergamsia mpumalanga on dead leaves of unknown tree. Spain, Amanita fulvogrisea on limestone soil, in mixed forest, Amanita herculis in open Quercus forest, Vuilleminia beltraniae on Cistus symphytifolius. Sweden, Pachyella pulchella on decaying wood on sand-silt riverbank. Thailand, Deniquelata cassiae on dead stem of Cassia fistula, Stomiopeltis thailandica on dead twigs of Magnolia champaca. Ukraine, Circinaria podoliana on natural limestone outcrops, Neonematogonum carpinicola (incl. Neonematogonum gen. nov.) on dead branches of Carpinus betulus. USA, Exophiala wilsonii water from cooling tower, Hygrophorus aesculeticola on soil in mixed forest, and Neocelosporium aereum from air in a house attic. Morphological and culture characteristics are supported by DNA barcodes. Citation: Crous PW, Costa MM, Kandemir H, et al. 2023. Fungal Planet description sheets: 1550-1613. Persoonia 51: 280-417. doi: 10.3767/persoonia.2023.51.08.
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Affiliation(s)
- P W Crous
- Wasterdijk Fungal Biodiversity Institute, P.O. Box 85167, 3508 AD Utrecht, The Netherlands
- Department of Biochemistry, Genetics and Microbiology, Forestry and Agricultural Biotechnology Institute (FABI), University of Pretoria, Pretoria, South Africa
| | - M M Costa
- Wasterdijk Fungal Biodiversity Institute, P.O. Box 85167, 3508 AD Utrecht, The Netherlands
| | - H Kandemir
- Wasterdijk Fungal Biodiversity Institute, P.O. Box 85167, 3508 AD Utrecht, The Netherlands
| | - M Vermaas
- Wasterdijk Fungal Biodiversity Institute, P.O. Box 85167, 3508 AD Utrecht, The Netherlands
| | - D Vu
- Wasterdijk Fungal Biodiversity Institute, P.O. Box 85167, 3508 AD Utrecht, The Netherlands
| | - L Zhao
- Wasterdijk Fungal Biodiversity Institute, P.O. Box 85167, 3508 AD Utrecht, The Netherlands
| | - E Arumugam
- Centre for Advanced Studies in Botany, University of Madras, Chennai, Tamil Nadu, India
| | - A Flakus
- W. Szafer Institute of Botany, Polish Academy of Sciences, Lubicz 46, PL-31-512 Kraków, Poland
| | - Ž Jurjević
- EMSL Analytical, Inc., 200 Route 130 North, Cinnaminson, NJ 08077 USA
| | - M Kaliyaperumal
- Centre for Advanced Studies in Botany, University of Madras, Chennai, Tamil Nadu, India
| | - S Mahadevakumar
- Forest Pathology Department, Division of Forest Protection, KSCSTE-Kerala Forest Research Institute, Peechi - 680653, Thrissur, Kerala, India
- Botanical Survey of India, Andaman and Nicobar Regional Center, Haddo - 744102, Port Blair, South Andaman, India
| | - R Murugadoss
- Centre for Advanced Studies in Botany, University of Madras, Chennai, Tamil Nadu, India
| | - R G Shivas
- Centre for Crop Health, University of Southern Queensland, Toowoomba 4350, Queensland, Australia
| | - Y P Tan
- Queensland Plant Pathology Herbarium, Department of Agriculture and Fisheries, Dutton Park 4102, Queensland, Australia
| | - M J Wingfield
- Department of Biochemistry, Genetics and Microbiology, Forestry and Agricultural Biotechnology Institute (FABI), University of Pretoria, Pretoria, South Africa
| | - S E Abell
- Australian Tropical Herbarium, James Cook University, Smithfield 4878, Queensland, Australia
| | - T S Marney
- Queensland Plant Pathology Herbarium, Department of Agriculture and Fisheries, Dutton Park 4102, Queensland, Australia
| | - C Danteswari
- Department of Plant Sciences, University of Hyderabad, Hyderabad, Telangana, India
| | - V Darmostuk
- W. Szafer Institute of Botany, Polish Academy of Sciences, Lubicz 46, PL-31-512 Kraków, Poland
| | - C M Denchev
- Institute of Biodiversity and Ecosystem Research, Bulgarian Academy of Sciences, 2 Gagarin St., 1113 Sofia, Bulgaria
| | - T T Denchev
- Institute of Biodiversity and Ecosystem Research, Bulgarian Academy of Sciences, 2 Gagarin St., 1113 Sofia, Bulgaria
| | - J Etayo
- Navarro Villoslada 16, 3° cha., E-31003 Pamplona, Navarra, Spain
| | - J Gené
- Universitat Rovira i Virgili, Facultat de Medicina i Ciéncies de la Salut and IU-RESCAT, Unitat de Micologia i Microbiologia Ambiental, Reus, Catalonia, Spain
| | - S Gunaseelan
- Centre for Advanced Studies in Botany, University of Madras, Chennai, Tamil Nadu, India
| | - V Hubka
- Department of Botany, Faculty of Science, Charles University, Benátská 2, 128 01 Prague 2, Czech Republic
- Institute of Microbiology of the Czech Academy of Sciences, Vídeňská 1083, 14220, Prague, Czech Republic
| | - T Illescas
- Buenos Aires 3 Bajo 1, 14006 Córdoba, Spain
| | - G M Jansen
- Ben Sikkenlaan 9, 6703JC Wageningen, The Netherlands
| | - K Kezo
- Centre for Advanced Studies in Botany, University of Madras, Chennai, Tamil Nadu, India
| | - S Kumar
- Botanical Survey of India, Andaman and Nicobar Regional Center, Haddo - 744102, Port Blair, South Andaman, India
| | - E Larsson
- Biological and Environmental Sciences, University of Gothenburg, and Gothenburg Global Biodiversity Centre, Box 463, SE40530 Göteborg, Sweden
| | - K T Mufeeda
- Botanical Survey of India, Andaman and Nicobar Regional Center, Haddo - 744102, Port Blair, South Andaman, India
| | - M Piątek
- W. Szafer Institute of Botany, Polish Academy of Sciences, Lubicz 46, PL-31-512 Kraków, Poland
| | - P Rodriguez-Flakus
- W. Szafer Institute of Botany, Polish Academy of Sciences, Lubicz 46, PL-31-512 Kraków, Poland
| | - P V S R N Sarma
- Department of Plant Sciences, University of Hyderabad, Hyderabad, Telangana, India
| | - M Stryjak-Bogacka
- W. Szafer Institute of Botany, Polish Academy of Sciences, Lubicz 46, PL-31-512 Kraków, Poland
| | - D Torres-Garcia
- Universitat Rovira i Virgili, Facultat de Medicina i Ciéncies de la Salut and IU-RESCAT, Unitat de Micologia i Microbiologia Ambiental, Reus, Catalonia, Spain
| | - J Vauras
- Biological Collections of Åbo Akademi University, Biodiversity Unit, Herbarium, FI-20014 University of Turku, Finland
| | - D A Acal
- Department of Invertebrate Zoology & Hydrobiology, Faculty of Biology and Environmental Protection, University of Lodz, Banacha 12/16, 90-237 Lodz, Poland
| | - A Akulov
- Department of Mycology and Plant Resistance, V. N. Karazin Kharkiv National University, Maidan Svobody 4, 61022 Kharkiv, Ukraine
| | - K Alhudaib
- Department of Arid Land Agriculture, College of Agricultural and Food Sciences, King Faisal University, Al-Ahsa 31982, Saudi Arabia
- Pests and Plant Diseases Unit, College of Agricultural and Food Sciences, King Faisal University, Al-Ahsa 31982, Saudi Arabia
| | - M Asif
- Department of Plant Sciences, Faculty of Biological Sciences, Quaid-i-Azam University, 45320, Islamabad, Pakistan
| | - S Balashov
- EMSL Analytical, Inc., 200 Route 130 North, Cinnaminson, NJ 08077 USA
| | - H-O Baral
- Blaihofstr. 42, Tübingen, D-72074, Germany
| | - A Baturo-Cieśniewska
- Department of Biology and Plant Protection, Bydgoszcz University of Science and Technology, Al. prof. S. Kaliskiego 7, 85-796 Bydgoszcz, Poland
| | - D Begerow
- Universität Hamburg, Institute of Plant Science and Microbiology, Organismic Botany and Mycology, Ohnhorststraße 18, 22609 Hamburg, Germany
| | - A Beja-Pereira
- BIOPOLIS Program in Genomics, Biodiversity and Land Planning, CIBIO, Campus de Vairão, 4485-661 Vairão, Portugal
- DGAOT, Faculdade de Ciências, Universidade do Porto, Rua Campo Alegre 687, 4169-007 Porto, Portugal
| | - M V Bianchinotti
- CERZOS-UNS-CONICET, Camino La Carrindanga Km 7, CP: 8000, Bahía Blanca, Argentina and Depto. de Biología, Bioquímica y Farmacia, UNS, San Juan 670, CP: 8000, Bahía Blanca, Argentina
| | - P Bilański
- Department of Forest Ecosystems Protection, University of Agriculture in Krakow, Al. 29 Listopada 46, 31-425 Krakow, Poland
| | - S Chandranayaka
- Department of Studies in Biotechnology, University of Mysore, Manasagangotri, Mysuru - 570006, Karnataka, India
| | - N Chellappan
- Centre for Advanced Studies in Botany, University of Madras, Chennai, Tamil Nadu, India
| | - D A Cowan
- Centre for Microbial Ecology and Genomics, Department of Biochemistry, Genetics and Microbiology, University of Pretoria, Private Bag X20, Hatfield 0028, Pretoria, South Africa
| | - F A Custódio
- Departamento de Fitopatologia, Universidade Federal de Viçosa, 36570-900, Viçosa, Minas Gerais, Brazil
| | - P Czachura
- W. Szafer Institute of Botany, Polish Academy of Sciences, Lubicz 46, PL-31-512 Kraków, Poland
| | - G Delgado
- Eurofins Built Environment, 6110 W. 34th St, Houston, TX 77092, USA
| | - N I De Silva
- Department of Biology, Faculty of Science, Chiang Mai University, 50200, Chiang Mai, Thailand
| | - J Dijksterhuis
- Wasterdijk Fungal Biodiversity Institute, P.O. Box 85167, 3508 AD Utrecht, The Netherlands
| | - M Dueñas
- Department of Mycology, Real Jardín Botánico-CSIC, Plaza de Murillo 2, 28014 Madrid, Spain
| | - P Eisvand
- Department of Plant Protection, Faculty of Agriculture, Shahid Chamran University of Ahvaz, Ahvaz, Khuzestan Province, Iran
| | - V Fachada
- Neuromuscular Research Center, University of Jyväskylä, Rautpohjankatu 8, 40700, Jyväskylä, Finland
- MHNC-UP - Museu de História Natural e da Ciência da Universidade do Porto - Herbário PO, Universidade do Porto. Praça Gomes Teixeira, 4099-002, Porto, Portugal
| | | | - Y Fritsche
- Plant Developmental Physiology and Genetics Laboratory, Department of Plant Science, Federal University of Santa Catarina, Florianópolis, Brazil
| | - F Fuljer
- Department of Botany, Faculty of Natural Sciences, Comenius University, Révová 39, 811 02, Bratislava, Slovakia
| | - K G G Ganga
- Department of Botany, University of Calicut, Kerala, 673 635, India
| | - M P Guerra
- Plant Developmental Physiology and Genetics Laboratory, Department of Plant Science, Federal University of Santa Catarina, Florianópolis, Brazil
| | - K Hansen
- Swedish Museum of Natural History, Department of Botany, P.O. Box 50007, SE-104 05 Stockholm, Sweden
| | - N Hywel-Jones
- Zhejiang BioAsia Institute of Life Sciences, Pinghu 31 4200, Zhejiang, People's Republic of China
| | - A M Ismail
- Department of Arid Land Agriculture, College of Agricultural and Food Sciences, King Faisal University, Al-Ahsa 31982, Saudi Arabia
- Pests and Plant Diseases Unit, College of Agricultural and Food Sciences, King Faisal University, Al-Ahsa 31982, Saudi Arabia
- Vegetable Diseases Research Department, Plant Pathology Research Institute, Agricultural Research Center, Giza 12619, Egypt
| | - C R Jacobs
- Nin.Da.Waab.Jig-Walpole Island Heritage Centre, Bkejwanong (Walpole Island First Nation), 2185 River Road North, Walpole Island, Ontario, N8A 4K9, Canada
| | - R Jankowiak
- Department of Forest Ecosystems Protection, University of Agriculture in Krakow, Al. 29 Listopada 46, 31-425 Krakow, Poland
| | - A Karich
- Unit of Bio- and Environmental Sciences, TU Dresden, International Institute Zittau, Markt 23, 02763 Zittau, Germany
| | - M Kemler
- Universität Hamburg, Institute of Plant Science and Microbiology, Organismic Botany and Mycology, Ohnhorststraße 18, 22609 Hamburg, Germany
| | - K Kisło
- University of Warsaw, Botanic Garden, Aleje Ujazdowskie 4, 00-478 Warsaw, Poland
| | - W Klofac
- Mayerhöfen 28, 3074 Michelbach, Austria
| | - I Krisai-Greilhuber
- Department of Botany and Biodiversity Research, University of Vienna, Rennweg 14, 1030 Wien, Austria
| | - K P D Latha
- Department of Botany, University of Calicut, Kerala, 673 635, India
| | - R Lebeuf
- 775, rang du Rapide Nord, Saint-Casimir, Quebec, G0A 3L0, Canada
| | - M E Lopes
- Plant Developmental Physiology and Genetics Laboratory, Department of Plant Science, Federal University of Santa Catarina, Florianópolis, Brazil
| | - S Lumyong
- Department of Biology, Faculty of Science, Chiang Mai University, 50200, Chiang Mai, Thailand
| | - J G Maciá-Vicente
- Plant Ecology and Nature Conservation, Wageningen University & Research, P.O. Box 47, 6700 AA Wageningen, The Netherlands
- Department of Microbial Ecology, Netherlands Institute for Ecology (NIOO-KNAW), P.O. Box 50, 6700 AB Wageningen, The Netherlands
| | - G Maggs-Kölling
- Gobabeb-Namib Research Institute, Walvis Bay, Namibia
- Unit for Environmental Sciences and Management, North-West University, P. Bag X1290, Potchefstroom, 2520, South Africa
| | - D Magistà
- Department of Soil, Plant and Food Sciences, University of Bari A. Moro, 70126, Bari, Italy
- Institute of Sciences of Food Production (ISPA), National Research Council (CNR), 70126, Bari, Italy
| | - P Manimohan
- Department of Botany, University of Calicut, Kerala, 673 635, India
| | - M P Martín
- Department of Mycology, Real Jardín Botánico-CSIC, Plaza de Murillo 2, 28014 Madrid, Spain
| | - E Mazur
- W. Szafer Institute of Botany, Polish Academy of Sciences, Lubicz 46, PL-31-512 Kraków, Poland
| | - M Mehrabi-Koushki
- Department of Plant Protection, Faculty of Agriculture, Shahid Chamran University of Ahvaz, Ahvaz, Khuzestan Province, Iran
- Biotechnology and Bioscience Research Center, Shahid Chamran University of Ahvaz, Ahvaz, Iran
| | - A N Miller
- University of Illinois Urbana-Champaign, Illinois Natural History Survey, 1816 South Oak Street, Champaign, Illinois, 61820, USA
| | - A Mombert
- 3 rue de la craie, 25640 Corcelle-Mieslot, France
| | - E A Ossowska
- Department of Plant Taxonomy and Nature Conservation, Faculty of Biology, University of Gdańsk, Wita Stwosza 59, PL-80-308 Gdańsk, Poland
| | - K Patejuk
- Department of Plant Protection, Wtoctaw University of Environmental and Life Sciences, pl. Grunwaldzki 24a, 50-363 Wtoctaw, Poland
| | - O L Pereira
- Departamento de Fitopatologia, Universidade Federal de Viçosa, 36570-900, Viçosa, Minas Gerais, Brazil
| | - S Piskorski
- Department of Algology and Mycology, Faculty of Biology and Environmental Protection, University of Lodz, Banacha 12/16, 90-237 Lodz, Poland
| | - M Plaza
- La Angostura, 20, 11370 Los Barrios, Cádiz, Spain
| | - A R Podile
- Department of Plant Sciences, University of Hyderabad, Hyderabad, Telangana, India
| | | | - W Pusz
- Department of Plant Protection, Wtoctaw University of Environmental and Life Sciences, pl. Grunwaldzki 24a, 50-363 Wtoctaw, Poland
| | - M Raza
- Key Laboratory of Integrated Pest Management in Crops in Northwestern Oasis, Ministry of Agriculture and Rural Affairs, Institute of Plant Protection, Xinjiang Academy of Agricultural Sciences, Urumqi, Xinjiang 83009, China
| | - M Ruszkiewicz-Michalska
- Department of Algology and Mycology, Faculty of Biology and Environmental Protection, University of Lodz, Banacha 12/16, 90-237 Lodz, Poland
| | - M Saba
- Department of Plant Sciences, Faculty of Biological Sciences, Quaid-i-Azam University, 45320, Islamabad, Pakistan
| | - R M Sánchez
- CERZOS-UNS-CONICET, Camino La Carrindanga Km 7, CP: 8000, Bahía Blanca, Argentina and Depto. de Biología, Bioquímica y Farmacia, UNS, San Juan 670, CP: 8000, Bahía Blanca, Argentina
| | - R Singh
- Centre of Advanced Study in Botany, Institute of Science, Banaras Hindu University, Varanasi - 221005, Uttar Pradesh, India
| | - L Śliwa
- W. Szafer Institute of Botany, Polish Academy of Sciences, Lubicz 46, PL-31-512 Kraków, Poland
| | - M E Smith
- Department of Plant Pathology, University of Florida, Gainesville, FL 32611-0680, USA
| | - V M Stefenon
- Plant Developmental Physiology and Genetics Laboratory, Department of Plant Science, Federal University of Santa Catarina, Florianópolis, Brazil
| | - D Strasiftáková
- Slovak National Museum-Natural History Museum, Vajanského náb. 2, P.O. Box 13, 81006, Bratislava, Slovakia
| | - N Suwannarach
- Department of Biology, Faculty of Science, Chiang Mai University, 50200, Chiang Mai, Thailand
| | - K Szczepańska
- Department of Botany and Plant Ecology, Wroclaw University of Environmental and Life Sciences, pl. Grunwaldzki 24a, PL-50-363 Wroclaw, Poland
| | - M T Telleria
- Department of Mycology, Real Jardín Botánico-CSIC, Plaza de Murillo 2, 28014 Madrid, Spain
| | - D S Tennakoon
- Department of Biology, Faculty of Science, Chiang Mai University, 50200, Chiang Mai, Thailand
| | - M Thines
- Evolutionary Analyses and Biological Archives, Senckenberg Biodiversity and Climate Research Centre (SBiK-F), Senckenberganlage 25, 60325 Frankfurt am Main, Germany
- LOEWE Centre for Translational Biodiversity Genomics, Georg-Voigt-Str. 14-16, 60325 Frankfurt am Main
- Goethe University, Department of Biological Sciences, Institute of Ecology, Evolution, and Diversity, Max-von-Laue-Str. 9, 60483 Frankfurt am Main, Germany
| | - R G Thorn
- Department of Biology, University of Western Ontario, London, Ontario, N6A 5B7, Canada
| | - J Urbaniak
- Department of Botany and Plant Ecology, Wroclaw University of Environmental and Life Sciences, pl. Grunwaldzki 24a, PL-50-363 Wroclaw, Poland
| | | | - V Vasan
- Centre for Advanced Studies in Botany, University of Madras, Chennai, Tamil Nadu, India
| | - C Vila-Viçosa
- BIOPOLIS Program in Genomics, Biodiversity and Land Planning, CIBIO, Campus de Vairão, 4485-661 Vairão, Portugal
- MHNC-UP - Museu de História Natural e da Ciência da Universidade do Porto - Herbário PO, Universidade do Porto. Praça Gomes Teixeira, 4099-002, Porto, Portugal
| | - H Voglmayr
- Department of Botany and Biodiversity Research, University of Vienna, Rennweg 14, 1030 Wien, Austria
| | - M Wrzosek
- University of Warsaw, Botanic Garden, Aleje Ujazdowskie 4, 00-478 Warsaw, Poland
| | - J Zappelini
- Plant Developmental Physiology and Genetics Laboratory, Department of Plant Science, Federal University of Santa Catarina, Florianópolis, Brazil
| | - J Z Groenewald
- Wasterdijk Fungal Biodiversity Institute, P.O. Box 85167, 3508 AD Utrecht, The Netherlands
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10
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Ismail AM, El Desouky FG. Facile assembly of flexible quaternary SnO 2/SrSnO 3/Fe 3O 4/PVDF nanocomposites with tunable optical, electrical, and magnetic properties for promising magneto-optoelectronic applications. Sci Rep 2023; 13:4997. [PMID: 36973326 PMCID: PMC10043276 DOI: 10.1038/s41598-023-32090-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/22/2023] [Indexed: 03/29/2023] Open
Abstract
Facile assembly, co-precipitation, and drop casting procedures have been used to construct SnO2/SrSnO3/Fe3O4/PVDF flexible nanocomposites. SnO2/SrSnO3/Fe3O4 nanocomposites (TSF NCs') have been successfully incorporated into polyvinylidene fluoride polymers (PF), according to the microstructural exploration of the systems, which was revealed by XRD, EDX, and ATR-FTIR analysis. The FESEM and cross-section areas demonstrated that the addition of TSF NCs' to PF porous material enhanced its surface characteristics and decreased its surface roughness. The optical gap was lowered from 3.90 to 3.07 eV, and it was discovered that both the refractive index and optical conductivity had improved when TSF NCs' were incorporated into PF. According to the observations, the supplement ratios have a profound influence on the dielectric properties of the nanocomposites. Moreover, the electrical parameters of TSF/PF nanocomposite are significantly modified. The TSF/PF magnetic nanocomposite has good magnetic reactivity and can be easily extracted from the aqueous solution using an external magnetic field, as demonstrated by VSM. This research has been conducted to obtain TSF/PF nanocomposites to be used in promising magno-optoelectronic applications.
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Affiliation(s)
- A M Ismail
- Spectroscopy Department, Physics Research Institute, National Research Centre, Cairo, 12622, Egypt
| | - Fawzy G El Desouky
- Solid State Physics Department, Physics Research Institute, National Research Centre, Cairo, 12622, Egypt.
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11
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Bass GA, Duffy CC, Kaplan LJ, Sarani B, Martin ND, Ismail AM, Cao Y, Forssten MP, Mohseni S. The revised cardiac risk index is associated with morbidity and mortality independent of injury severity in elderly patients with rib fractures. Injury 2023; 54:56-62. [PMID: 36402584 DOI: 10.1016/j.injury.2022.11.039] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 10/23/2022] [Accepted: 11/10/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Risk factors for mortality and in-hospital morbidity among geriatric patients with traumatic rib fractures remain unclear. Such patients are often frail and demonstrate a high comorbidity burden. Moreover, outcomes anticipated by current rubrics may reflect the influence of multisystem injury or surgery, and thus not apply to isolated injuries in geriatric patients. We hypothesized that the Revised Cardiac Risk Index (RCRI) may assist in risk-stratifying geriatric patients following rib fracture. METHODS All geriatric patients (age ≥65 years) with a conservatively managed rib fracture owing to an isolated thoracic injury (thorax AIS ≥1), in the 2013-2019 TQIP database were assessed including demographics and outcomes. The association between the RCRI and in-hospital morbidity as well as mortality was analyzed using Poisson regression models while adjusting for potential confounders. RESULTS 96,750 geriatric patients sustained rib fractures. Compared to those with RCRI 0, patients with an RCRI score of 1 had a 16% increased risk of in-hospital mortality [adjusted incidence rate ratio (adj-IRR), 95% confidence interval (CI): 1.16 (1.02-1.32), p=0.020]. An RCRI score of 2 [adj-IRR (95% CI): 1.72 (1.44-2.06), p<0.001] or ≥3 [adj-IRR (95% CI): 3.07 (2.31-4.09), p<0.001] was associated with an even greater mortality risk. Those with an increased RCRI also exhibited a higher incidence of myocardial infarction, cardiac arrest, stroke, and acute respiratory distress syndrome. CONCLUSIONS Geriatric patients with rib fractures and an RCRI ≥1 represent a vulnerable and high-risk group. This index may inform the decision to admit for inpatient care and can also guide patient and family counseling as well as computer-based decision-support.
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Affiliation(s)
- Gary Alan Bass
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA; School of Medical Sciences, Orebro University, Orebro, Sweden; Leonard Davis Institute of Health Economics (LDI), University of Pennsylvania, Philadelphia, USA; Center for Peri-Operative Outcomes Research and Transformation (CPORT), University of Pennsylvania, Philadelphia, USA
| | - Caoimhe C Duffy
- Leonard Davis Institute of Health Economics (LDI), University of Pennsylvania, Philadelphia, USA; Center for Peri-Operative Outcomes Research and Transformation (CPORT), University of Pennsylvania, Philadelphia, USA
| | - Lewis J Kaplan
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA; Department of Anesthesia and Critical Care, University of Pennsylvania, Philadelphia, USA; Corporal Michael Cresenscz Veterans Affairs Medical Center (CMCVAMC), Philadelphia, USA
| | - Babak Sarani
- Center for Trauma and Critical Care, George Washington University School of Medicine & Health Sciences, Washington D.C., USA
| | - Niels D Martin
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, Department of Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, USA
| | | | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Orebro University, Orebro, Sweden
| | | | - Shahin Mohseni
- School of Medical Sciences, Orebro University, Orebro, Sweden; Division of Trauma & Emergency Surgery, Department of Surgery, Orebro University Hospital, Orebro, Sweden.
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12
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Forssten MP, Mohammad Ismail A, Ioannidis I, Wretenberg P, Borg T, Cao Y, Ribeiro MAF, Mohseni S. The mortality burden of frailty in hip fracture patients: a nationwide retrospective study of cause-specific mortality. Eur J Trauma Emerg Surg 2022; 49:1467-1475. [PMID: 36571633 DOI: 10.1007/s00068-022-02204-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/18/2022] [Indexed: 12/27/2022]
Abstract
PURPOSE Frailty is a condition characterized by a reduced ability to adapt to external stressors because of a reduced physiologic reserve, which contributes to the high risk of postoperative mortality in hip fracture patients. This study aims to investigate how frailty is associated with the specific causes of mortality in hip fracture patients. METHODS All adult patients in Sweden who suffered a traumatic hip fracture and underwent surgery between 2008 and 2017 were eligible for inclusion. The Orthopedic Hip Frailty Score (OFS) was used to classify patients as non-frail (OFS 0), pre-frail (OFS 1), and frail (OFS ≥ 2). The association between the degree of frailty and both all-cause and cause-specific mortality was determined using Poisson regression models with robust standard errors and presented using incidence rate ratios (IRRs) with corresponding 95% confidence intervals (CIs), adjusted for potential sources of confounding. RESULTS After applying the inclusion and exclusion criteria, 127,305 patients remained for further analysis. 23.9% of patients were non-frail, 27.7% were pre-frail, and 48.3% were frail. Frail patients exhibited a 4 times as high risk of all-cause mortality 30 days [adj. IRR (95% CI): 3.80 (3.36-4.30), p < 0.001] and 90 days postoperatively [adj. IRR (95% CI): 3.88 (3.56-4.23), p < 0.001] as non-frail patients. Of the primary causes of 30-day mortality, frailty was associated with a tripling in the risk of cardiovascular [adj. IRR (95% CI): 3.24 (2.64-3.99), p < 0.001] and respiratory mortality [adj. IRR (95% CI): 2.60 (1.96-3.45), p < 0.001] as well as a five-fold increase in the risk of multiorgan failure [adj. IRR (95% CI): 4.99 (3.95-6.32), p < 0.001]. CONCLUSION Frailty is associated with a significantly increased risk of all-cause and cause-specific mortality at 30 and 90 days postoperatively. Across both timepoints, cardiovascular and respiratory events along with multiorgan failure were the most prevalent causes of mortality.
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Affiliation(s)
- Maximilian Peter Forssten
- Department of Orthopedic Surgery, Orebro University Hospital, 701 85, Orebro, Sweden.,School of Medical Sciences, Orebro University, 702 81, Orebro, Sweden
| | - Ahmad Mohammad Ismail
- Department of Orthopedic Surgery, Orebro University Hospital, 701 85, Orebro, Sweden.,School of Medical Sciences, Orebro University, 702 81, Orebro, Sweden
| | - Ioannis Ioannidis
- Department of Orthopedic Surgery, Orebro University Hospital, 701 85, Orebro, Sweden.,School of Medical Sciences, Orebro University, 702 81, Orebro, Sweden
| | - Per Wretenberg
- Department of Orthopedic Surgery, Orebro University Hospital, 701 85, Orebro, Sweden.,School of Medical Sciences, Orebro University, 702 81, Orebro, Sweden
| | - Tomas Borg
- Department of Orthopedic Surgery, Orebro University Hospital, 701 85, Orebro, Sweden.,School of Medical Sciences, Orebro University, 702 81, Orebro, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Orebro University, 701 82, Orebro, Sweden
| | - Marcelo A F Ribeiro
- Pontifical Catholic University of São Paulo, São Paulo, Brazil.,Trauma, Burns, Critical Care and Acute Care Surgery, Department of Surgery, Sheikh Shakhbout Medical City-Mayo Clinic, Abu Dhabi, United Arab Emirates
| | - Shahin Mohseni
- Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital, 701 85, Orebro, Sweden. .,School of Medical Sciences, Orebro University, 702 81, Orebro, Sweden.
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13
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Mohammad Ismail A, Forssten MP, Bass GA, Trivedi DJ, Ekestubbe L, Ioannidis I, Duffy CC, Peden CJ, Mohseni S. Mode of anesthesia is not associated with outcomes following emergency hip fracture surgery: a population-level cohort study. Trauma Surg Acute Care Open 2022; 7:e000957. [PMID: 36148316 PMCID: PMC9486374 DOI: 10.1136/tsaco-2022-000957] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 08/31/2022] [Indexed: 11/05/2022] Open
Abstract
Background Hip fractures often occur in frail patients with several comorbidities. In those undergoing emergency surgery, determining the optimal anesthesia modality may be challenging, with equipoise concerning outcomes following either spinal or general anesthesia. In this study, we investigated the association between mode of anesthesia and postoperative morbidity and mortality with subgroup analyses. Methods This is a retrospective study using all consecutive adult patients who underwent emergency hip fracture surgery in Orebro County, Sweden, between 2013 and 2017. Patients were extracted from the Swedish National Hip Fracture Registry, and their electronic medical records were reviewed. The association between the type of anesthesia and 30-day and 90-day postoperative mortality, as well as in-hospital severe complications (Clavien-Dindo classification ≥3a), was analyzed using Poisson regression models with robust SEs, while the association with 1-year mortality was analyzed using Cox proportional hazards models. All analyses were adjusted for potential confounders. Results A total of 2437 hip fracture cases were included in the study, of whom 60% received spinal anesthesia. There was no statistically significant difference in the risk of 30-day postoperative mortality (adjusted incident rate ratio (IRR) (95% CI): 0.99 (0.72 to 1.36), p=0.952), 90-day postoperative mortality (adjusted IRR (95% CI): 0.88 (0.70 to 1.11), p=0.281), 1-year postoperative mortality (adjusted HR (95% CI): 0.98 (0.83 to 1.15), p=0.773), or in-hospital severe complications (adjusted IRR (95% CI): 1.24 (0.85 to 1.82), p=0.273), when comparing general and spinal anesthesia. Conclusions Mode of anesthesia during emergency hip fracture surgery was not associated with an increased risk of postoperative mortality or in-hospital severe complications in the study population or any of the investigated subgroups. Level of evidence: Therapeutic/Care Management, level III
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Affiliation(s)
- Ahmad Mohammad Ismail
- Department of Orthopedic Surgery, Orebro University Hospital, Orebro, Sweden.,School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Maximilian Peter Forssten
- Department of Orthopedic Surgery, Orebro University Hospital, Orebro, Sweden.,School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Gary Alan Bass
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Dhanisha Jayesh Trivedi
- School of Medical Sciences, Orebro University, Orebro, Sweden.,Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital, Orebro, Sweden
| | - Lovisa Ekestubbe
- Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital, Orebro, Sweden
| | - Ioannis Ioannidis
- Department of Orthopedic Surgery, Orebro University Hospital, Orebro, Sweden.,School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Caoimhe C Duffy
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Carol J Peden
- Department of Clinical Anesthesiology, University of Southern California Keck School of Medicine, Los Angeles, California, USA.,Department of Anesthesiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shahin Mohseni
- School of Medical Sciences, Orebro University, Orebro, Sweden.,Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital, Orebro, Sweden
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14
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Forssten MP, Cao Y, Trivedi DJ, Ekestubbe L, Borg T, Bass GA, Mohammad Ismail A, Mohseni S. Developing and validating a scoring system for measuring frailty in patients with hip fracture: a novel model for predicting short-term postoperative mortality. Trauma Surg Acute Care Open 2022; 7:e000962. [PMID: 36117728 PMCID: PMC9472206 DOI: 10.1136/tsaco-2022-000962] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Accepted: 08/19/2022] [Indexed: 11/06/2022] Open
Abstract
Objectives Frailty is common among patients with hip fracture and may, in part, contribute to the increased risk of mortality and morbidity after hip fracture surgery. This study aimed to develop a novel frailty score for patients with traumatic hip fracture that could be used to predict postoperative mortality as well as facilitate further research into the role of frailty in patients with hip fracture. Methods The Orthopedic Hip Frailty Score (OFS) was developed using a national dataset, retrieved from the Swedish National Quality Registry for Hip Fractures, that contained all adult patients who underwent surgery for a traumatic hip fracture in Sweden between January 1, 2008 and December 31, 2017. Candidate variables were selected from the Nottingham Hip Fracture Score, Sernbo Score, Charlson Comorbidity Index, 5-factor modified Frailty Index, as well as the Revised Cardiac Risk Index and ranked based on their permutation importance, with the top 5 variables being selected for the score. The OFS was then validated on a local dataset that only included patients from Orebro County, Sweden. Results The national dataset consisted of 126,065 patients. 2365 patients were present in the local dataset. The most important variables for predicting 30-day mortality were congestive heart failure, institutionalization, non-independent functional status, an age ≥85, and a history of malignancy. In the local dataset, the OFS achieved an area under the receiver-operating characteristic curve (95% CI) of 0.77 (0.74 to 0.80) and 0.76 (0.74 to 0.78) when predicting 30-day and 90-day postoperative mortality, respectively. Conclusions The OFS is a significant predictor of short-term postoperative mortality in patients with hip fracture that outperforms, or performs on par with, all other investigated indices. Level of evidence Level III, Prognostic and Epidemiological.
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Affiliation(s)
- Maximilian Peter Forssten
- School of Medical Sciences, Orebro University, Orebro, Sweden.,Department of Orthopedic Surgery, Orebro University Hospital, Orebro, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Dhanisha Jayesh Trivedi
- School of Medical Sciences, Orebro University, Orebro, Sweden.,Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital, Orebro, Sweden
| | | | - Tomas Borg
- School of Medical Sciences, Orebro University, Orebro, Sweden.,Department of Orthopedic Surgery, Orebro University Hospital, Orebro, Sweden
| | - Gary Alan Bass
- School of Medical Sciences, Orebro University, Orebro, Sweden.,Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
| | - Ahmad Mohammad Ismail
- School of Medical Sciences, Orebro University, Orebro, Sweden.,Department of Orthopedic Surgery, Orebro University Hospital, Orebro, Sweden
| | - Shahin Mohseni
- School of Medical Sciences, Orebro University, Orebro, Sweden.,Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital, Orebro, Sweden
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15
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Mohammad Ismail A, Ahl R, Forssten MP, Cao Y, Wretenberg P, Borg T, Mohseni S. The interaction between pre-admission β-blocker therapy, the Revised Cardiac Risk Index, and mortality in geriatric hip fracture patients. J Trauma Acute Care Surg 2022; 92:49-56. [PMID: 34252058 PMCID: PMC8677608 DOI: 10.1097/ta.0000000000003358] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Revised: 06/23/2021] [Accepted: 07/04/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND An association between β-blocker (BB) therapy and a reduced risk of major cardiac events and mortality in patients undergoing surgery for hip fractures has previously been demonstrated. Furthermore, a relationship between an increased Revised Cardiac Risk Index (RCRI) score and a higher risk of postoperative mortality has also been detected. The purpose of the current study was to investigate the interaction between BB therapy and RCRI in relation to 30-day postoperative mortality in geriatric patients after hip fracture surgery. METHODS All patients older than 65 years who underwent primary emergency hip fracture surgery in Sweden between January 1, 2008, and December 31, 2017, except for pathological fractures, were included in this retrospective cohort study. Patients were divided into cohorts based on their RCRI score (RCRI 1, 2, 3, and ≥4) and whether they had ongoing BB therapy at the time of admission. A Poisson regression model with robust standard errors of variance was used, while adjusting for confounders, to evaluate the association between BB therapy, RCRI, and 30-day mortality. RESULTS A total of 126,934 cases met the study inclusion criteria. β-Blocker therapy was associated with a 65% decrease in the risk of 30-day postoperative mortality in the whole study population (adjusted incidence rate ratio [95% confidence interval], 0.35 [0.32-0.38]; p < 0.001). The use of BB also resulted in a significant reduction in 30-day postoperative mortality within all RCRI cohorts. However, the most pronounced effect of BB therapy was seen in patients with an RCRI score greater than 0. CONCLUSION β-Blocker therapy is associated with a reduction in 30-day postoperative mortality, irrespective of RCRI score. Furthermore, patients with an elevated cardiac risk appear to have a greater benefit of BB therapy. LEVEL OF EVIDENCE Therapeutic/care management, level II.
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16
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Forssten MP, Bass GA, Scheufler KM, Mohammad Ismail A, Cao Y, Martin ND, Sarani B, Mohseni S. Mortality risk stratification in isolated severe traumatic brain injury using the revised cardiac risk index. Eur J Trauma Emerg Surg 2021; 48:4481-4488. [PMID: 34839374 DOI: 10.1007/s00068-021-01841-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [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: 10/07/2021] [Accepted: 11/10/2021] [Indexed: 12/01/2022]
Abstract
PURPOSE Traumatic brain injury (TBI) continues to be a significant cause of mortality and morbidity worldwide. As cardiovascular events are among the most common extracranial causes of death after a severe TBI, the Revised Cardiac Risk Index (RCRI) could potentially aid in the risk stratification of this patient population. This investigation aimed to determine the association between the RCRI and in-hospital deaths among isolated severe TBI patients. METHODS All adult patients registered in the TQIP database between 2013 and 2017 who suffered an isolated severe TBI, defined as a head AIS ≥ 3 with an AIS ≤ 1 in all other body regions, were included. Patients were excluded if they had a head AIS of 6. The association between different RCRI scores (0, 1, 2, 3, ≥ 4) and in-hospital mortality was analyzed using a Poisson regression model with robust standard errors while adjusting for potential confounders, with RCRI 0 as the reference. RESULTS 259,399 patients met the study's inclusion criteria. RCRI 2 was associated with a 6% increase in mortality risk [adjusted IRR (95% CI) 1.06 (1.01-1.12), p = 0.027], RCRI 3 was associated with a 17% increased risk of mortality [adjusted IRR (95% CI) 1.17 (1.05-1.31), p = 0.004], and RCRI ≥ 4 was associated with a 46% increased risk of in-hospital mortality [adjusted IRR(95% CI) 1.46 (1.11-1.90), p = 0.006], compared to RCRI 0. CONCLUSION An elevated RCRI ≥ 2 is significantly associated with an increased risk of in-hospital mortality among patients with an isolated severe traumatic brain injury. The simplicity and bedside applicability of the index makes it an attractive choice for risk stratification in this patient population.
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Affiliation(s)
- Maximilian Peter Forssten
- School of Medical Sciences, Orebro University, 702 81, Örebro, Sweden.,Division of Trauma and Emergency Surgery, Orebro University Hospital, 70185, Örebro, Sweden
| | - Gary Alan Bass
- School of Medical Sciences, Orebro University, 702 81, Örebro, Sweden.,Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Kai-Michael Scheufler
- Department of Neurosurgery, Orebro University Hospital, 70185, Örebro, Sweden.,Medical School, Heinrich-Heine University Dusseldorf, Düsseldorf, Germany
| | - Ahmad Mohammad Ismail
- School of Medical Sciences, Orebro University, 702 81, Örebro, Sweden.,Division of Trauma and Emergency Surgery, Orebro University Hospital, 70185, Örebro, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Orebro University, Örebro, Sweden
| | - Niels Douglas Martin
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Babak Sarani
- Division of Trauma and Acute Care Surgery, George Washington University School of Medicine & Health Sciences, Washington, DC, USA
| | - Shahin Mohseni
- School of Medical Sciences, Orebro University, 702 81, Örebro, Sweden. .,Division of Trauma and Emergency Surgery, Orebro University Hospital, 70185, Örebro, Sweden.
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17
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Forssten MP, Mohammad Ismail A, Borg T, Cao Y, Wretenberg P, Bass GA, Mohseni S. The consequences of out-of-hours hip fracture surgery: insights from a retrospective nationwide study. Eur J Trauma Emerg Surg 2021; 48:709-719. [PMID: 34622327 PMCID: PMC9001198 DOI: 10.1007/s00068-021-01804-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 09/28/2021] [Indexed: 12/21/2022]
Abstract
Purpose The study aimed to investigate the association between out-of-hours surgery and postoperative mortality in hip fracture patients. Furthermore, internal fixation and arthroplasty were compared to determine if a difference could be observed in patients operated with these techniques at different times during the day. Methods All patients above 18 of age years in Sweden who underwent hip fracture surgery between 2008 and 2017 were eligible for inclusion. Pathological fractures, non-operatively managed fractures, or cases whose time of surgery was missing were excluded. The cohort was subdivided into on-hour (08:00–17:00) and out-of-hours surgery (17:00–08:00). Poisson regression with adjustments for confounders was used to evaluate the association between out-of-hours surgery and both 30-day and 90-day postoperative mortality. Results Out-of-hours surgery was associated with a 5% increase in the risk of both 30-day [adj. IRR (95% CI) 1.05 (1.00–1.10), p = 0.040] and 90-day [adj. IRR (95% CI) 1.05 (1.01–1.09), p = 0.005] mortality after hip fracture surgery compared to on-hour surgery. There was no statistically significant association between out-of-hours surgery and postoperative mortality among patients who received an internal fixation. Arthroplasties performed out-of-hours were associated with a 13% increase in 30-day postoperative mortality [adj. IRR (95% CI) 1.13 (1.04–1.23), p = 0.005] and an 8% increase in 90-day postoperative mortality [adj. IRR (95% CI) 1.08 (1.01–1.15), p = 0.022] compared to on-hour surgery. Conclusion Out-of-hours surgical intervention is associated with an increase in both 30- and 90-day postoperative mortality among hip fracture patients who received an arthroplasty, but not among patients who underwent internal fixation.
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Affiliation(s)
- Maximilian Peter Forssten
- Department of Orthopedic Surgery, Orebro University Hospital, 701 85 Orebro, Sweden
- School of Medical Sciences, Orebro University, 702 81 Orebro, Sweden
| | - Ahmad Mohammad Ismail
- Department of Orthopedic Surgery, Orebro University Hospital, 701 85 Orebro, Sweden
- School of Medical Sciences, Orebro University, 702 81 Orebro, Sweden
| | - Tomas Borg
- Department of Orthopedic Surgery, Orebro University Hospital, 701 85 Orebro, Sweden
- School of Medical Sciences, Orebro University, 702 81 Orebro, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Orebro University, 701 82 Orebro, Sweden
| | - Per Wretenberg
- Department of Orthopedic Surgery, Orebro University Hospital, 701 85 Orebro, Sweden
- School of Medical Sciences, Orebro University, 702 81 Orebro, Sweden
| | - Gary Alan Bass
- School of Medical Sciences, Orebro University, 702 81 Orebro, Sweden
- Division of Traumatology, Emergency Surgery and Surgical Critical Care, University of Pennsylvania, Philadelphia, USA
| | - Shahin Mohseni
- School of Medical Sciences, Orebro University, 702 81 Orebro, Sweden
- Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital, 701 85 Orebro, Sweden
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Sthaneshwar P, Thambiah SC, Mat Salleh MJ, Nasuruddin DN, Ahmad Zabidi NF, Jelani AM, Ismail AM, Lai LC, Gan GG. Survey on serum protein electrophoresis and recommendations for standardised reporting. Malays J Pathol 2021; 43:281-290. [PMID: 34448792] [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: 06/13/2023]
Abstract
INTRODUCTION Serum protein electrophoresis (SPE) is a well-established laboratory technique. However, reporting of results varies considerably between laboratories. The variation in reporting can cause confusion to the clinician with a potential of adversely impacting patient care. The purpose of the survey was to find out the variation in reporting and to prepare recommendations to the Malaysian laboratories based on the survey to reduce both the variation in reporting between laboratories and the risk of misinterpretation of reports. MATERIALS AND METHODS To determine the extent of variation in reporting of protein electrophoresis results questionnaires were distributed to the pathologists of various laboratories in Malaysia regarding the method, quantification of paraprotein concentrations and immunoglobulin assays, and information regarding current laboratory electrophoresis practices. RESULTS Variation was found in the following reporting practices: (a) screening protocol; (b) reporting of serum albumin; (c) numerical reporting of protein fractions and paraprotein; (d) co-migration of a paraprotein with a normal serum protein; (e) reporting of multiple paraprotein bands (f) appearance of small abnormal band and oligoclonal bands and (g) communication about of interferences. CONCLUSION The pathologists of the country made recommendations on the reporting of protein electrophoresis. Harmonised reporting will reduce inconsistency, variation in reporting, improve the quality of the report and most importantly improve patient care.
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Affiliation(s)
- P Sthaneshwar
- University Malaya, Faculty of Medicine, Department of Pathology, Kuala Lumpur, Malaysia.
| | - S C Thambiah
- Universiti Putra Malaysia, Faculty of Medicine and Health Sciences, Department of Pathology, 43400 UPM Serdang, Selangor, Malaysia
| | - M J Mat Salleh
- Hospital Pulau Pinang, Department of Pathology, Pulau Pinang, Malaysia
| | - D N Nasuruddin
- Universiti Kebangsaan Malaysia, Faculty of Medicine, Department of Pathology, Kuala Lumpur, Malaysia
| | - N F Ahmad Zabidi
- Kuala Lumpur Hospital, Department of Pathology, Kuala Lumpur, Malaysia
| | - A M Jelani
- Universiti Sains Malaysia, School of Medical Sciences, Department of Chemical Pathology, Malaysia
| | - A M Ismail
- Universiti Teknologi MARA, Faculty of Medicine, Sungai Buloh, Selangor, Malaysia
| | - L C Lai
- Gleneagles Hospital, Kuala Lumpur, Malaysia
| | - G G Gan
- University Malaya, Faculty of Medicine, Department of Medicine, Kuala Lumpur, Malaysia
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19
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Forssten MP, Mohammad Ismail A, Borg T, Ahl R, Wretenberg P, Cao Y, Peden CJ, Mohseni S. Postoperative mortality in hip fracture patients stratified by the Revised Cardiac Risk Index: a Swedish nationwide retrospective cohort study. Trauma Surg Acute Care Open 2021; 6:e000778. [PMID: 34395919 PMCID: PMC8314694 DOI: 10.1136/tsaco-2021-000778] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [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: 05/25/2021] [Accepted: 07/06/2021] [Indexed: 12/13/2022] Open
Abstract
Objectives The Revised Cardiac Risk Index (RCRI) is a tool that can be used to evaluate the 30-day risk of postoperative myocardial infarction, cardiac arrest and mortality. This study aims to confirm its association with postoperative mortality in patients who underwent hip fracture surgery. Methods All adults who underwent primary emergency hip fracture surgery in Sweden between January 1, 2008 and December 31, 2017 were included in this study. The database was retrieved by cross-referencing the Swedish National Quality Register for hip fractures with the Swedish National Board of Health and Welfare registers. The outcomes of interest were the association between the RCRI score and mortality at 30 days, 90 days and 1 year postoperatively. Results 134 915 cases were included in the current study. There was a statistically significant linear trend in postoperative mortality with increasing RCRI scores at 30 days, 90 days and 1 year. An RCRI score ≥4 was associated with a 3.1 times greater risk of 30-day postoperative mortality (adjusted incidence rate ratio (IRR) 3.13, p<0.001), a 2.5 times greater risk of 90-day postoperative mortality (adjusted IRR 2.54, p<0.001) and a 2.8 times greater risk of 1-year postoperative mortality (adjusted HR 2.81, p<0.001) compared with that observed with an RCRI score of 0. Conclusion An increasing RCRI score is strongly associated with an elevated risk 30-day, 90-day and 1-year postoperative mortality after primary hip fracture surgery. The objective and easily retrievable nature of the variables included in the RCRI calculation makes it an appealing choice for risk stratification in the clinical setting. Levels of evidence Level III.
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Affiliation(s)
- Maximilian Peter Forssten
- Department of Orthopedic Surgery, Orebro University Hospital, Orebro, Sweden.,School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Ahmad Mohammad Ismail
- Department of Orthopedic Surgery, Orebro University Hospital, Orebro, Sweden.,School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Tomas Borg
- Department of Orthopedic Surgery, Orebro University Hospital, Orebro, Sweden.,School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Rebecka Ahl
- School of Medical Sciences, Orebro University, Orebro, Sweden.,Department of Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Per Wretenberg
- Department of Orthopedic Surgery, Orebro University Hospital, Orebro, Sweden.,School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Carol J Peden
- Department of Clinical Anesthesiology, University of Southern California Keck School of Medicine, Los Angeles, California, USA.,Department of Anesthesiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Shahin Mohseni
- School of Medical Sciences, Orebro University, Orebro, Sweden.,Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital, Orebro, Sweden
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20
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Mohammad Ismail A, Ahl R, Forssten MP, Cao Y, Wretenberg P, Borg T, Mohseni S. Beta-Blocker Therapy Is Associated With Increased 1-Year Survival After Hip Fracture Surgery: A Retrospective Cohort Study. Anesth Analg 2021; 133:1225-1234. [PMID: 34260428 PMCID: PMC8505142 DOI: 10.1213/ane.0000000000005659] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The high mortality rates seen within the first postoperative year after hip fracture surgery have remained relatively unchanged in many countries for the past 15 years. Recent investigations have shown an association between beta-blocker (BB) therapy and a reduction in risk-adjusted mortality within the first 90 days after hip fracture surgery. We hypothesized that preoperative, and continuous postoperative, BB therapy may also be associated with a decrease in mortality within the first year after hip fracture surgery.
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Affiliation(s)
- Ahmad Mohammad Ismail
- From the Department of Orthopedic Surgery, Orebro University Hospital, Orebro, Sweden.,School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Rebecka Ahl
- School of Medical Sciences, Orebro University, Orebro, Sweden.,Department of Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Maximilian Peter Forssten
- From the Department of Orthopedic Surgery, Orebro University Hospital, Orebro, Sweden.,School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Per Wretenberg
- From the Department of Orthopedic Surgery, Orebro University Hospital, Orebro, Sweden.,School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Tomas Borg
- From the Department of Orthopedic Surgery, Orebro University Hospital, Orebro, Sweden.,School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Shahin Mohseni
- School of Medical Sciences, Orebro University, Orebro, Sweden.,Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital, Orebro, Sweden
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21
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Ali H, Tiama TM, Ismail AM. New and efficient NiO/chitosan/polyvinyl alcohol nanocomposites as antibacterial and dye adsorptive films. Int J Biol Macromol 2021; 186:278-288. [PMID: 34246674 DOI: 10.1016/j.ijbiomac.2021.07.055] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 07/03/2021] [Accepted: 07/06/2021] [Indexed: 12/15/2022]
Abstract
The development of composite films with enhanced antibacterial and dye decolorization properties for water treatment has attracted a great attention. In this study, nickel oxide/chitosan/polyvinyl alcohol nanocomposite films containing different weight percentage of NiO nanoparticles with a dual functionality, removal of toxic dye and antibacterial properties, were prepared. Methyl orange (MO) was selected as a target pollutant. Additionally, the antimicrobial activity of the films against two Gram positive bacteria (Staphylococcus aureus and Bacillus cereus) and two Gram negative bacteria (Escherichia coli and Salmonella Typhimurium) was studied. The prepared samples were characterized by XRD, HRTEM, FESEM, ATR-FTIR, UV-Vis spectroscopy, and dielectric measurements. The morphological examination proved that the nanocomposite film has more porous structure compared to the unmodified chitosan/PVA. The antimicrobial tests indicated that the modified chitosan/PVA films have higher activity than pure chitosan/PVA toward all the tested pathogenic bacteria. The impact of the NiO amount (0.5, 1.5, 3, and 5 wt%), contact time (0-150 min), and adsorbent dose (40, 80, and 100 mg) on the removal of MO was studied. Dye adsorption results proved that the incorporation of 5 wt% NiO led to more than 2 fold increase in the dye removal percentage in comparison with the unmodified PVA/chitosan film.
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Affiliation(s)
- Heba Ali
- Physical Chemistry Department, National Research Centre, 33 El Bohouth Street, Dokki, 12622 Giza, Egypt.
| | - Taha M Tiama
- Basic Science Department, October High Institute for Engineering & Technology, Misr University for Science and Technology, 6th October City, Cairo, Egypt
| | - A M Ismail
- Spectroscopy Department, National Research Centre, 33 El Bohouth Street, Dokki, 12622 Giza, Egypt
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22
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Ioannidis I, Mohammad Ismail A, Forssten MP, Cao Y, Bass GA, Borg T, Mohseni S. β-Adrenergic blockade in patients with dementia and hip fracture is associated with decreased postoperative mortality. Eur J Trauma Emerg Surg 2021; 48:1463-1469. [PMID: 34129093 PMCID: PMC9001220 DOI: 10.1007/s00068-021-01723-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 06/05/2021] [Indexed: 11/27/2022]
Abstract
Purpose Dementia, present in 20% of hip fracture patients, is associated with an almost threefold increase in postoperative mortality risk. These patients have a substantially higher incidence of cardiovascular, respiratory, and cerebrovascular mortality after hip fracture surgery compared to patients without dementia. This study aimed to investigate the association between beta-blocker therapy and postoperative mortality in patients with dementia undergoing hip fracture surgery. Methods This nationwide study included all patients in Sweden with the diagnosis of dementia who underwent emergency surgery for a hip fracture between January 2008 and December 2017. Cases where the hip fracture was pathological or conservatively managed were not included. Poisson regression analysis with robust standard errors was performed while controlling for confounders to determine the relationship between beta-blocker therapy and all-cause, as well as cause-specific, postoperative mortality. Results A total of 26,549 patients met the study inclusion criteria, of whom 8258 (31%) had ongoing beta-blocker therapy at time of admission. After adjusting for clinically relevant variables, the incidence of postoperative mortality in patients receiving beta-blocker therapy was decreased by 50% at 30 days [adj. IRR (95% CI) 0.50 (0.45–0.54), p < 0.001] and 34% at 90 days [adj. IRR (95% CI) 0.66 (0.62–0.70), p < 0.001]. Cause-specific mortality analysis demonstrated a significant reduction in the incidence of postoperative cardiovascular, respiratory, and cerebrovascular death within 30 and 90 days postoperatively. Conclusion Beta-blocker therapy is associated with decreased postoperative mortality in hip fracture patients with dementia up to 90 days after surgery. This finding warrants further investigation. Supplementary Information The online version contains supplementary material available at 10.1007/s00068-021-01723-y.
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Affiliation(s)
- Ioannis Ioannidis
- Department of Orthopedic Surgery, Orebro University Hospital, 701 85 Orebro, Sweden
- School of Medical Sciences, Orebro University, 702 81 Orebro, Sweden
| | - Ahmad Mohammad Ismail
- Department of Orthopedic Surgery, Orebro University Hospital, 701 85 Orebro, Sweden
- School of Medical Sciences, Orebro University, 702 81 Orebro, Sweden
| | - Maximilian Peter Forssten
- Department of Orthopedic Surgery, Orebro University Hospital, 701 85 Orebro, Sweden
- School of Medical Sciences, Orebro University, 702 81 Orebro, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Orebro University, 701 82 Orebro, Sweden
| | - Gary Alan Bass
- School of Medical Sciences, Orebro University, 702 81 Orebro, Sweden
- Division of Traumatology, Surgical Critical Care and Emergency Surgery, University of Pennsylvania, Philadelphia, USA
| | - Tomas Borg
- Department of Orthopedic Surgery, Orebro University Hospital, 701 85 Orebro, Sweden
- School of Medical Sciences, Orebro University, 702 81 Orebro, Sweden
| | - Shahin Mohseni
- School of Medical Sciences, Orebro University, 702 81 Orebro, Sweden
- Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital, 701 85 Orebro, Sweden
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23
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Cao Y, Forssten MP, Mohammad Ismail A, Borg T, Ioannidis I, Montgomery S, Mohseni S. Predictive Values of Preoperative Characteristics for 30-Day Mortality in Traumatic Hip Fracture Patients. J Pers Med 2021; 11:353. [PMID: 33924993 PMCID: PMC8146802 DOI: 10.3390/jpm11050353] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [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: 03/02/2021] [Revised: 03/21/2021] [Accepted: 04/23/2021] [Indexed: 12/23/2022] Open
Abstract
Hip fracture patients have a high risk of mortality after surgery, with 30-day postoperative rates as high as 10%. This study aimed to explore the predictive ability of preoperative characteristics in traumatic hip fracture patients as they relate to 30-day postoperative mortality using readily available variables in clinical practice. All adult patients who underwent primary emergency hip fracture surgery in Sweden between 2008 and 2017 were included in the analysis. Associations between the possible predictors and 30-day mortality was performed using a multivariate logistic regression (LR) model; the bidirectional stepwise method was used for variable selection. An LR model and convolutional neural network (CNN) were then fitted for prediction. The relative importance of individual predictors was evaluated using the permutation importance and Gini importance. A total of 134,915 traumatic hip fracture patients were included in the study. The CNN and LR models displayed an acceptable predictive ability for predicting 30-day postoperative mortality using a test dataset, displaying an area under the ROC curve (AUC) of as high as 0.76. The variables with the highest importance in prediction were age, sex, hypertension, dementia, American Society of Anesthesiologists (ASA) classification, and the Revised Cardiac Risk Index (RCRI). Both the CNN and LR models achieved an acceptable performance in identifying patients at risk of mortality 30 days after hip fracture surgery. The most important variables for prediction, based on the variables used in the current study are age, hypertension, dementia, sex, ASA classification, and RCRI.
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Affiliation(s)
- Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, 70182 Örebro, Sweden;
- Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institute, 17177 Stockholm, Sweden
| | - Maximilian Peter Forssten
- Department of Orthopedic Surgery, Orebro University Hospital, 70185 Orebro, Sweden; (M.P.F.); (A.M.I.); (T.B.); (I.I.)
- School of Medical Sciences, Orebro University, 70182 Orebro, Sweden;
| | - Ahmad Mohammad Ismail
- Department of Orthopedic Surgery, Orebro University Hospital, 70185 Orebro, Sweden; (M.P.F.); (A.M.I.); (T.B.); (I.I.)
- School of Medical Sciences, Orebro University, 70182 Orebro, Sweden;
| | - Tomas Borg
- Department of Orthopedic Surgery, Orebro University Hospital, 70185 Orebro, Sweden; (M.P.F.); (A.M.I.); (T.B.); (I.I.)
- School of Medical Sciences, Orebro University, 70182 Orebro, Sweden;
| | - Ioannis Ioannidis
- Department of Orthopedic Surgery, Orebro University Hospital, 70185 Orebro, Sweden; (M.P.F.); (A.M.I.); (T.B.); (I.I.)
- School of Medical Sciences, Orebro University, 70182 Orebro, Sweden;
| | - Scott Montgomery
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, 70182 Örebro, Sweden;
- Clinical Epidemiology Division, Department of Medicine, Karolinska Institutet, 17177 Stockholm, Sweden
- Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK
| | - Shahin Mohseni
- School of Medical Sciences, Orebro University, 70182 Orebro, Sweden;
- Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital, 70185 Orebro, Sweden
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24
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Ioannidis I, Mohammad Ismail A, Forssten MP, Ahl R, Cao Y, Borg T, Mohseni S. The mortality burden in patients with hip fractures and dementia. Eur J Trauma Emerg Surg 2021; 48:2919-2925. [PMID: 33638650 PMCID: PMC9360069 DOI: 10.1007/s00068-021-01612-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 02/05/2021] [Indexed: 12/29/2022]
Abstract
Purpose Dementia is strongly associated with postoperative death in patients subjected to hip fracture surgery. Nevertheless, there is a distinct lack of research investigating the cause of postoperative mortality in patients with dementia. This study aims to investigate the distribution and the risk of cause-specific postoperative mortality in patients with dementia compared to the general hip fracture population. Methods All adults who underwent emergency hip fracture surgery in Sweden between 1/1/2008 and 31/12/2017 were considered for inclusion. Pathological, conservatively managed fractures, and reoperations were excluded. The database was retrieved by cross-referencing the Swedish National Quality Registry for Hip Fracture patients with the Swedish National Board of Health and Welfare quality registers. A Poisson regression model was used to determine the association between dementia and all-cause as well as cause-specific 30-day postoperative mortality. Results 134,915 cases met the inclusion criteria, of which 20% had dementia at the time of surgery. The adjusted risk of all-cause 30-day postoperative mortality was 67% higher in patients with dementia after hip fracture surgery compared to patients without dementia [adj. IRR (95% CI): 1.67 (1.60–1.75), p < 0.001]. The risk of cause-specific mortality was also higher in patients with dementia, with up to a sevenfold increase in the risk cerebrovascular mortality [adj. IRR (95% CI): 7.43 (4.99–11.07), p < 0.001]. Conclusions Hip fracture patients with dementia have a higher risk of death in the first 30 days postoperatively, with a substantially higher risk of mortality due to cardiovascular, respiratory, and cerebrovascular events, compared to patients without dementia.
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Affiliation(s)
- Ioannis Ioannidis
- Department of Orthopedic Surgery, Orebro University Hospital, 701 85 Orebro, Sweden
- School of Medical Sciences, Orebro University, 702 81 Orebro, Sweden
| | - Ahmad Mohammad Ismail
- Department of Orthopedic Surgery, Orebro University Hospital, 701 85 Orebro, Sweden
- School of Medical Sciences, Orebro University, 702 81 Orebro, Sweden
| | - Maximilian Peter Forssten
- Department of Orthopedic Surgery, Orebro University Hospital, 701 85 Orebro, Sweden
- School of Medical Sciences, Orebro University, 702 81 Orebro, Sweden
| | - Rebecka Ahl
- School of Medical Sciences, Orebro University, 702 81 Orebro, Sweden
- Division of Trauma & Emergency Surgery, Department of Surgery, Karolinska University Hospital, 171 76 Stockholm, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Orebro University, 701 82 Orebro, Sweden
| | - Tomas Borg
- Department of Orthopedic Surgery, Orebro University Hospital, 701 85 Orebro, Sweden
- School of Medical Sciences, Orebro University, 702 81 Orebro, Sweden
| | - Shahin Mohseni
- School of Medical Sciences, Orebro University, 702 81 Orebro, Sweden
- Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital, 701 85 Orebro, Sweden
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25
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Ahl R, Mohammad Ismail A, Borg T, Sjölin G, Forssten MP, Cao Y, Wretenberg P, Mohseni S. A nationwide observational cohort study of the relationship between beta-blockade and survival after hip fracture surgery. Eur J Trauma Emerg Surg 2021; 48:743-751. [PMID: 33507317 PMCID: PMC9001555 DOI: 10.1007/s00068-020-01588-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Accepted: 12/27/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE Despite advances in the care of hip fractures, this area of surgery is associated with high postoperative mortality. Downregulating circulating catecholamines, released as a response to traumatic injury and surgical trauma, is believed to reduce the risk of death in noncardiac surgical patients. This effect has not been studied in hip fractures. This study aims to assess whether survival benefits are gained by reducing the effects of the hyper-adrenergic state with beta-blocker therapy in patients undergoing emergency hip fracture surgery. METHODS This is a retrospective nationwide observational cohort study. All adults [Formula: see text] 18 years were identified from the prospectively collected national quality register for hip fractures in Sweden during a 10-year period. Pathological fractures were excluded. The cohort was subdivided into beta-blocker users and non-users. Poisson regression with robust standard errors and adjustments for confounders was used to evaluate 30-day mortality. RESULTS 134,915 patients were included of whom 38.9% had ongoing beta-blocker therapy at the time of surgery. Beta-blocker users were significantly older and less fit for surgery. Crude 30-day all-cause mortality was significantly increased in non-users (10.0% versus 3.7%, p < 0.001). Beta-blocker therapy resulted in a 72% relative risk reduction in 30-day all-cause mortality (incidence rate ratio 0.28, 95% CI 0.26-0.29, p < 0.001) and was independently associated with a reduction in deaths of cardiovascular, respiratory, and cerebrovascular origin and deaths due to sepsis or multiorgan failure. CONCLUSIONS Beta-blockers are associated with significant survival benefits when undergoing emergency hip fracture surgery. Outlined results strongly encourage an interventional design to validate the observed relationship.
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Affiliation(s)
- Rebecka Ahl
- Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden
- Division of Surgery, Department of Clinical Science Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Ahmad Mohammad Ismail
- School of Medical Sciences, Orebro University, Orebro, Sweden
- Department of Orthopedic Surgery, Orebro University Hospital, Orebro, Sweden
| | - Tomas Borg
- School of Medical Sciences, Orebro University, Orebro, Sweden
- Department of Orthopedic Surgery, Orebro University Hospital, Orebro, Sweden
| | - Gabriel Sjölin
- School of Medical Sciences, Orebro University, Orebro, Sweden
- Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital, Orebro, Sweden
| | - Maximilian Peter Forssten
- School of Medical Sciences, Orebro University, Orebro, Sweden
- Department of Orthopedic Surgery, Orebro University Hospital, Orebro, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Orebro University, Orebro, Sweden
| | - Per Wretenberg
- School of Medical Sciences, Orebro University, Orebro, Sweden
- Department of Orthopedic Surgery, Orebro University Hospital, Orebro, Sweden
| | - Shahin Mohseni
- School of Medical Sciences, Orebro University, Orebro, Sweden
- Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital, Orebro, Sweden
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26
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Forssten MP, Mohammad Ismail A, Sjolin G, Ahl R, Wretenberg P, Borg T, Mohseni S. The association between the Revised Cardiac Risk Index and short-term mortality after hip fracture surgery. Eur J Trauma Emerg Surg 2020; 48:1885-1892. [PMID: 32944823 PMCID: PMC9192369 DOI: 10.1007/s00068-020-01488-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Accepted: 09/04/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE The post-operative mortality after hip fracture surgery is high and has remained largely unchanged during the last decades. The Revised Cardiac Risk Index (RCRI) is a tool used to evaluate the 30-day risk of, among other outcomes, post-operative mortality. The aim of this study is to determine the association between the RCRI score and post-operative mortality in patients undergoing hip fracture surgery. METHODS Data was obtained from the national hip fracture register which was cross-referenced with patients' electronic hospital records. All adults who underwent primary emergency hip fracture surgery in Orebro County, Sweden, between January 1, 2013 and December 31, 2017, were included. Patients were divided into two cohorts: low RCRI (score = 0-1) and high RCRI (score ≥ 2). A Poisson regression model was employed to investigate the association between a high RCRI score and 30- and 90-day post-operative mortality. RESULTS A total of 2443 patients, of whom 446 (18%) had a high RCRI score, were included in the current study. When adjusting for age, sex, comorbidities and type of surgery, the incidence of 30-day mortality increased by 46% in the high RCRI cohort (adj. IRR 1.46, 95% CI, 1.10-1.94, p = 0.010). Similar results were observed for 90-day mortality (adj. IRR 1.50, 95% CI, 1.21-1.84, p < 0.001). CONCLUSION The RCRI is applicable to patients that undergo surgery for traumatic hip fractures. A high RCRI score is associated with an increased incidence of both 30- and 90-day post-operative mortality. Future studies to evaluate these findings are needed.
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Affiliation(s)
- Maximilian Peter Forssten
- Department of Orthopedic Surgery, Orebro University Hospital, 701 85 Orebro, Sweden
- School of Medical Sciences, Orebro University, 702 81 Orebro, Sweden
| | - Ahmad Mohammad Ismail
- Department of Orthopedic Surgery, Orebro University Hospital, 701 85 Orebro, Sweden
- School of Medical Sciences, Orebro University, 702 81 Orebro, Sweden
| | - Gabriel Sjolin
- School of Medical Sciences, Orebro University, 702 81 Orebro, Sweden
- Department of Surgery, Orebro University Hospital, 702 81 Orebro, Sweden
| | - Rebecka Ahl
- School of Medical Sciences, Orebro University, 702 81 Orebro, Sweden
- Department of Surgery, Karolinska University Hospital, 171 76 Stockholm, Sweden
- Division of Surgery, CLINTEC, Karolinska Institutet, 171 76 Stockholm, Sweden
| | - Per Wretenberg
- Department of Orthopedic Surgery, Orebro University Hospital, 701 85 Orebro, Sweden
- School of Medical Sciences, Orebro University, 702 81 Orebro, Sweden
| | - Tomas Borg
- Department of Orthopedic Surgery, Orebro University Hospital, 701 85 Orebro, Sweden
- School of Medical Sciences, Orebro University, 702 81 Orebro, Sweden
| | - Shahin Mohseni
- School of Medical Sciences, Orebro University, 702 81 Orebro, Sweden
- Division of Trauma and Emergency Surgery, Department of Surgery, Orebro University Hospital, 701 85 Orebro, Sweden
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El‐Gamal S, Ismail AM. Electrical and optical properties of novel brilliant cresyl blue dye‐doped poly(methyl methacrylate)as selective cut‐offlaser filters. POLYM INT 2020. [DOI: 10.1002/pi.6082] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- S El‐Gamal
- Physics Department, Faculty of Science Northern Border University Arar Kingdom of Saudi Arabia
- Physics Department, Faculty of Education Ain Shams University Cairo Egypt
| | - A M Ismail
- Physics Department, Faculty of Education Ain Shams University Cairo Egypt
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Mohammad Ismail A, Borg T, Sjolin G, Pourlotfi A, Holm S, Cao Y, Wretenberg P, Ahl R, Mohseni S. β-adrenergic blockade is associated with a reduced risk of 90-day mortality after surgery for hip fractures. Trauma Surg Acute Care Open 2020; 5:e000533. [PMID: 32789190 PMCID: PMC7394016 DOI: 10.1136/tsaco-2020-000533] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 06/24/2020] [Accepted: 06/29/2020] [Indexed: 11/03/2022] Open
Abstract
Background There is a significant postoperative mortality risk in patients subjected to surgery for hip fractures. Adrenergic hyperactivity induced by trauma and subsequent surgery is thought to be an important contributor. By downregulating the effect of circulating catecholamines the increased risk of postoperative mortality may be reduced. The aim of the current study is to assess the association between regular β-blocker therapy and postoperative mortality. Methods This cohort study used the prospectively collected Swedish National Quality Registry for hip fractures to identify all patients over 40 years of age subjected to surgery for hip fractures between 2013 and 2017 in Örebro County, Sweden. Patients with ongoing β-blocker therapy at the time of surgery were allocated to the β-blocker-positive cohort. The primary outcome of interest was 90-day postoperative mortality. Risk factors for 90-day mortality were evaluated using Poisson regression analysis. Results A total of 2443 patients were included in this cohort of whom 900 (36.8%) had ongoing β-blocker therapy before surgery. The β-blocker positive group was significantly older, less fit for surgery based on their American Society of Anesthesiologists classification and had a higher prevalence of comorbidities. A significant risk reduction in 90-day mortality was detected in patients receiving β-blockers (adjusted incidence rate ratio=0.82, 95% CI 0.68 to 0.98, p=0.03). Conclusions β-blocker therapy is associated with a significant reduction in 90-day postoperative mortality after hip fracture surgery. Further investigation into this finding is warranted. Level of evidence Therapeutic study, level III; prognostic study, level II.
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Affiliation(s)
- Ahmad Mohammad Ismail
- Department of Orthopedic Surgery, Örebro University Hospital, Örebro, Sweden.,School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Tomas Borg
- Department of Orthopedic Surgery, Örebro University Hospital, Örebro, Sweden.,School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Gabriel Sjolin
- School of Medical Sciences, Örebro University, Örebro, Sweden.,Department of Surgery, Örebro University Hospital, Örebro, Sweden
| | - Arvid Pourlotfi
- School of Medical Sciences, Örebro University, Örebro, Sweden.,Department of Surgery, Örebro University Hospital, Örebro, Sweden
| | - Sebastian Holm
- Department of Orthopedic Surgery, Örebro University Hospital, Örebro, Sweden
| | - Yang Cao
- Clinical Epidemiology and Biostatistics, School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Per Wretenberg
- Department of Orthopedic Surgery, Örebro University Hospital, Örebro, Sweden.,School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Rebecka Ahl
- School of Medical Sciences, Örebro University, Örebro, Sweden.,Division of Trauma and Emergency Surgery, Department of Surgery, Karolinska University Hospital, Stockholm, Sweden.,Division of Surgery, CLINTEC, Karolinska Institutet, Stockholm, Sweden
| | - Shahin Mohseni
- Division of Trauma and Emergency Surgery, Department of Surgery, Örebro University Hospital, Örebro, Sweden
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29
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Fetouh HA, Ismail AM, Hamid HA, Bashier MO. Synthesis of promising nanocomposites from an antitumer and biologically active heterocyclic compound uploaded by clay and chitosan polymers. Int J Biol Macromol 2019; 137:1211-1220. [PMID: 31254576 DOI: 10.1016/j.ijbiomac.2019.06.187] [Citation(s) in RCA: 10] [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] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 06/12/2019] [Accepted: 06/24/2019] [Indexed: 12/01/2022]
Abstract
The innovative nanocomposites (NCs) of antibacterial and antitumor 2-amino-5-S-benzyl-1, 3, 4-thiadiazole (ABMT): binary (NC1): ABMT-clay as well as the ternary (NC2): ABMT-clay-chitosan have been prepared following the top-down approach method. The ABMT molecules have been efficiently uploaded on the inorganic polymer potassium montmorlinite clay polymer (MMT). The NC is homogenously dispersed in the aqueous solutions without crystallization of ABMT. However, the dispersity of the small particle size and the crystallinity of NC1 is greatly enhanced in the presence of the biopolymer chitosan. The nanocomposites showed good non linear optical activity with suitable band gaps indicated the electron confinement in the NC. The loading and entrapment efficiency of ABMT onto MMT reached 89.3% in NC1 during 6 h of contact time with the aqueous solution of pH 6.8. The enhanced redox characteristics of NC1 relative to that of MMT suggested the better biological (antibacterial and antitumor) activity of NC1. Chitosan enhanced the redox and the optical properties of NC1 and its ability to undergo intercharge transfer to any acceptor sites. Hence, chitosan may added synergestic electron donation and, hence antitumor activity to the binary NC1.
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Affiliation(s)
- H A Fetouh
- Department of Chemistry, Faculty of Science, Alexandria University, Ibrahimia, P.O. Box 426, Alexandria 21321, Egypt.
| | - A M Ismail
- Department of Chemistry, Faculty of Science, Alexandria University, Ibrahimia, P.O. Box 426, Alexandria 21321, Egypt
| | - H Abdel Hamid
- Department of Chemistry, Faculty of Science, Alexandria University, Ibrahimia, P.O. Box 426, Alexandria 21321, Egypt
| | - M O Bashier
- Sudanese Standard and Metrology Organization (SSMO), Sudan
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30
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Elfiky AA, Ismail AM. Molecular docking revealed the binding of nucleotide/side inhibitors to Zika viral polymerase solved structures. SAR QSAR Environ Res 2018; 29:409-418. [PMID: 29652194 DOI: 10.1080/1062936x.2018.1454981] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
A new Zika virus (ZIKV) outbreak started in 2015. According to the World Health Organization, 84 countries confirmed ZIKV infection. RNA-dependent RNA polymerase (RdRp) was an appealing target for drug designers during the last two decades. Through molecular docking, we screened 16 nucleotide/side inhibitors against ZIKV RdRp. While the mode of interaction with ZIKV is different from that in the hepatitis C virus (HCV), nucleotide/side inhibitors in this study (mostly anti-HCV) showed promising binding affinities (-6.2 to -9.7 kcal/mol calculated by AutoDock Vina) to ZIKV RdRp. Setrobuvir, YAK and, to a lesser extent, IDX-184 reveal promising results compared to other inhibitors in terms of binding ZIKV RdRp. These candidates would be powerful anti-ZIKV drugs.
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Affiliation(s)
- A A Elfiky
- a Biophysics Department, Faculty of Sciences , Cairo University , Giza , Egypt
- b Quantitative Life Science Department, The Abdus Salam International Center for Theoretical Physics , Strada Costiera , Trieste , Italy
- c Faculty of Pharmacy and Pharmaceutical Sciences , University of Alberta , Edmonton , AB , Canada
| | - A M Ismail
- a Biophysics Department, Faculty of Sciences , Cairo University , Giza , Egypt
- d Biochemistry Department, Faculty of Medicine and Dentistry , University of Alberta , Edmonton , AB , Canada
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31
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Gadalla MA, Huang S, Wang R, Norman RJ, Abdullah SA, El Saman AM, Ismail AM, van Wely M, Mol BWJ. Effect of clomiphene citrate on endometrial thickness, ovulation, pregnancy and live birth in anovulatory women: systematic review and meta-analysis. Ultrasound Obstet Gynecol 2018; 51:64-76. [PMID: 29055102 DOI: 10.1002/uog.18933] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 10/08/2017] [Accepted: 10/11/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES To compare the impact of clomiphene citrate (CC) vs other drug regimens on mid-cycle endometrial thickness (EMT), ovulation, pregnancy and live birth rates in women with World Health Organization (WHO) group II ovulatory disorders. METHODS We searched MEDLINE, EMBASE, Scopus, Web of Science, The Cochrane Central Register of Clinical Trials (CENTRAL) and the non-MEDLINE subset of PubMed from inception to December 2016 and cross-checked references of relevant articles. We included only randomized controlled trials (RCTs) comparing CC used alone vs other drug regimens for ovulation induction in women with WHO group II anovulation. Outcomes were mid-cycle EMT, ovulation, pregnancy and live birth rates. We pooled weighted mean differences (WMD) with 95% confidence intervals (CI) for continuous variables (EMT) and risk ratios (RR) with 95% CI for binary variables (ovulation, pregnancy and live birth rates). RESULTS We retrieved 1718 articles of which 33 RCTs (4349 women, 7210 ovulation induction cycles) were included. In 15 RCTs that compared CC with letrozole, EMT was lower in the CC group (1957 women, 3892 cycles; WMD, -1.39; 95% CI, -2.27 to -0.51; I2 = 100%), ovulation rates after CC and letrozole were comparable (1710 women, 3217 cycles; RR, 0.97; 95% CI, 0.90-1.04; I2 = 47%), while CC led to a lower pregnancy rate (1957 women, 3892 cycles; RR, 0.78; 95% CI, 0.63-0.95; I2 = 43%) and a lower live birth rate (RR, 0.70; 95% CI, 0.49-0.98; I2 = 35%). In two RCTs that compared CC with CC plus metformin, EMT, ovulation and pregnancy rates were comparable (101 women, 140 cycles; WMD, -0.23; 95% CI, -0.92 to 0.45; I2 = 78%; RR, 0.84; 95% CI, 0.67-1.06; I2 = 0%; and RR, 0.79; 95% CI, 0.33-1.87; I2 = 0%). In three studies that compared CC with CC plus N-acetyl cysteine (NAC), EMT was lower in the CC group (340 women, 300 cycles; WMD, -1.51; 95% CI, -1.98 to -1.04; I2 = 45%). In two studies that compared CC with CC + nitric oxide (NO) donor, EMT was lower in the CC group (120 women, 304 cycles; WMD, -1.75; 95% CI, -2.08 to -1.41; I2 = 0%). Compared with CC plus NO donor or NAC, CC showed statistically significant lower ovulation and pregnancy rates. Compared with tamoxifen in three studies, CC showed a tendency towards lower EMT (571 women, 844 cycles; WMD, -1.34; 95% CI, -2.70 to 0.01; I2 = 96%) with comparable ovulation and pregnancy rates. CONCLUSIONS In women with WHO group II ovulatory disorders, ovulation induction with CC might result in lower EMT than other ovulation induction regimens. Whether the lower EMT caused the lower pregnancy and live birth rates remains to be elucidated. Letrozole seems to be beneficial for these women. However, our findings should be interpreted with caution as the quality of evidence was very low. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- M A Gadalla
- Women's Health Hospital, Department of Obstetrics and Gynecology, Assiut University, Assiut, Egypt
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - S Huang
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, Australia
- Reproductive Medicine Centre, Peking University Third Hospital, Beijing, China
| | - R Wang
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - R J Norman
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, Australia
| | - S A Abdullah
- Women's Health Hospital, Department of Obstetrics and Gynecology, Assiut University, Assiut, Egypt
| | - A M El Saman
- Women's Health Hospital, Department of Obstetrics and Gynecology, Assiut University, Assiut, Egypt
| | - A M Ismail
- Women's Health Hospital, Department of Obstetrics and Gynecology, Assiut University, Assiut, Egypt
| | - M van Wely
- Center for Reproductive Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - B W J Mol
- Robinson Research Institute, Adelaide Medical School, University of Adelaide, Adelaide, Australia
- South Australian Health and Medical Research Institute, Adelaide, Australia
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Abstract
Enteroenteric intussusception is a condition in which the full-thickness bowel wall becomes telescoped into the lumen of distal bowel. Intussusception in adult occurs infrequently and varies from childhood intussusception, particularly in its presentation, aetiology and treatment. Duodenoduodenal intussusception is rare because the duodenum is fixed in the retroperitoneal position. It usually occurs secondary to tumour, lipoma, Brunner's gland hamartomatous polyp or adenoma. The diagnosis in adults is usually made at laparotomy, where presentation is with intestinal obstruction. In non-emergency presentation, it may be difficult to arrive at an accurate diagnosis as symptoms may be vague, self-limiting intermittent abdominal pain. Clinical examinations and investigations may not be conclusive and another working diagnosis such as irritable bowel syndrome would be made. We describe a case where a patient initially presented with symptoms mimicking pancreatitis but his symptoms persisted over the course of 2 weeks. When a laparotomy was performed, duodenoduodenal intussusception was discovered and confirmed with histopathology. In this case, a discernible leading point could not be identified.
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Affiliation(s)
- G H Loo
- General Surgery, Bintulu Hospital, Bintulu City , Bintulu , Malaysia
| | | | - S L Lim
- General Surgery, Bintulu Hospital, Bintulu City , Bintulu , Malaysia
| | - A M Ismail
- Pathology Department, Hospital Umum Sarawak , Kuching, Sarawak , Malaysia
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33
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Velay A, Jeulin H, Eschlimann M, Malvé B, Goehringer F, Bensenane M, Frippiat JP, Abraham P, Ismail AM, Murray JM, Combet C, Zoulim F, Bronowicki JP, Schvoerer E. Characterization of hepatitis B virus surface antigen variability and impact on HBs antigen clearance under nucleos(t)ide analogue therapy. J Viral Hepat 2016; 23:387-98. [PMID: 26742490 DOI: 10.1111/jvh.12498] [Citation(s) in RCA: 16] [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: 08/07/2015] [Accepted: 11/01/2015] [Indexed: 12/15/2022]
Abstract
For hepatitis B virus (HBV)-related chronic infection under treatment by nucleos(t)ide analogues (NUCs), HBsAg clearance is the ultimate therapeutic goal but very infrequent. We investigated how HBV envelope protein variability could lead to differential HBsAg clearance on NUCs. For 12 HBV genotype D patients receiving NUCs, six resolvers (HBsAg clearance) were compared to six matched nonresolvers (HBsAg persistence). PreS/S amino acid (aa) sequences were analysed with bioinformatics to predict HBV envelope antigenicity and aa covariance. To enrich our analyses on very rare resolvers, these were compared with other HBV genotype D strains in three characterized clinical cohorts including common chronically infected patients. The sT125M+sP127T combination was observed in four nonresolvers of six, corroborated by aa covariance analysis, associated with a lower predicted antigenicity than sT125T+sP127P. Concordant features within this HBV key functional domain, at positions 125 and 127, were reported from two of the three comparative cohorts. In our hands, a lower ELISA reactivity of HBV-vaccinated mice sera was observed against the sT125M mutant. In the S gene, 56 aa changes in minor variants were detected in non-resolvers, mainly in the major hydrophilic region, vs 28 aa changes in resolvers. Molecular features in patients showing HBsAg persistence on NUCs argue in favour of a different aa pattern in the HBV S gene compared to those showing HBsAg clearance. In nonresolvers, a decrease in HBs 'a' determinant antigenicity and more frequent mutations in the S gene suggest a role for the HBV envelope characteristics in HBsAg persistence.
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Affiliation(s)
- A Velay
- EA 7300 'Stress, Immunité, Pathogènes', Université de Lorraine, Vandoeuvre-les-Nancy, France
| | - H Jeulin
- EA 7300 'Stress, Immunité, Pathogènes', Université de Lorraine, Vandoeuvre-les-Nancy, France.,Laboratoire de Virologie, Centre Hospitalier Universitaire de Nancy, Vandoeuvre-les-Nancy, France
| | - M Eschlimann
- EA 7300 'Stress, Immunité, Pathogènes', Université de Lorraine, Vandoeuvre-les-Nancy, France
| | - B Malvé
- Laboratoire de Virologie, Centre Hospitalier Universitaire de Nancy, Vandoeuvre-les-Nancy, France
| | - F Goehringer
- Service des Maladies Infectieuses et Tropicales, Centre Hospitalier Universitaire de Nancy, Vandoeuvre-les-Nancy, France
| | - M Bensenane
- Service d'Hépato-gastroentérologie, Centre Hospitalier Universitaire de Nancy, Vandoeuvre-les-Nancy, France
| | - J-P Frippiat
- EA 7300 'Stress, Immunité, Pathogènes', Université de Lorraine, Vandoeuvre-les-Nancy, France
| | - P Abraham
- Department of Clinical Virology, Christian Medical College, Vellore, Tamil Nadu, India
| | - A M Ismail
- Department of Clinical Virology, Christian Medical College, Vellore, Tamil Nadu, India
| | - J M Murray
- School of Mathematics and Statistics, UNSW Australia, Sydney, NSW, Australia
| | - C Combet
- Unité Inserm UI1052, Université de Lyon, Lyon, France
| | - F Zoulim
- Unité Inserm UI1052, Université de Lyon, Lyon, France
| | - J-P Bronowicki
- Service d'Hépato-gastroentérologie, Centre Hospitalier Universitaire de Nancy, Vandoeuvre-les-Nancy, France
| | - E Schvoerer
- EA 7300 'Stress, Immunité, Pathogènes', Université de Lorraine, Vandoeuvre-les-Nancy, France.,Laboratoire de Virologie, Centre Hospitalier Universitaire de Nancy, Vandoeuvre-les-Nancy, France
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Singh R, Singh Y, Xalaxo S, Verulkar S, Yadav N, Singh S, Singh N, Prasad KSN, Kondayya K, Rao PVR, Rani MG, Anuradha T, Suraynarayana Y, Sharma PC, Krishnamurthy SL, Sharma SK, Dwivedi JL, Singh AK, Singh PK, Singh NK, Kumar R, Chetia SK, Ahmad T, Rai M, Perraju P, Pande A, Singh DN, Mandal NP, Reddy JN, Singh ON, Katara JL, Marandi B, Swain P, Sarkar RK, Singh DP, Mohapatra T, Padmawathi G, Ram T, Kathiresan RM, Paramsivam K, Nadarajan S, Thirumeni S, Nagarajan M, Singh AK, Vikram P, Kumar A, Septiningshih E, Singh US, Ismail AM, Mackill D, Singh NK. From QTL to variety-harnessing the benefits of QTLs for drought, flood and salt tolerance in mega rice varieties of India through a multi-institutional network. Plant Sci 2016; 242:278-287. [PMID: 26566845 DOI: 10.1016/j.plantsci.2015.08.008] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Revised: 08/10/2015] [Accepted: 08/13/2015] [Indexed: 05/21/2023]
Abstract
Rice is a staple cereal of India cultivated in about 43.5Mha area but with relatively low average productivity. Abiotic factors like drought, flood and salinity affect rice production adversely in more than 50% of this area. Breeding rice varieties with inbuilt tolerance to these stresses offers an economically viable and sustainable option to improve rice productivity. Availability of high quality reference genome sequence of rice, knowledge of exact position of genes/QTLs governing tolerance to abiotic stresses and availability of DNA markers linked to these traits has opened up opportunities for breeders to transfer the favorable alleles into widely grown rice varieties through marker-assisted backcross breeding (MABB). A large multi-institutional project, "From QTL to variety: marker-assisted breeding of abiotic stress tolerant rice varieties with major QTLs for drought, submergence and salt tolerance" was initiated in 2010 with funding support from Department of Biotechnology, Government of India, in collaboration with International Rice Research Institute, Philippines. The main focus of this project is to improve rice productivity in the fragile ecosystems of eastern, northeastern and southern part of the country, which bear the brunt of one or the other abiotic stresses frequently. Seven consistent QTLs for grain yield under drought, namely, qDTY1.1, qDTY2.1, qDTY2.2, qDTY3.1, qDTY3.2, qDTY9.1 and qDTY12.1 are being transferred into submergence tolerant versions of three high yielding mega rice varieties, Swarna-Sub1, Samba Mahsuri-Sub1 and IR 64-Sub1. To address the problem of complete submergence due to flash floods in the major river basins, the Sub1 gene is being transferred into ten highly popular locally adapted rice varieties namely, ADT 39, ADT 46, Bahadur, HUR 105, MTU 1075, Pooja, Pratikshya, Rajendra Mahsuri, Ranjit, and Sarjoo 52. Further, to address the problem of soil salinity, Saltol, a major QTL for salt tolerance is being transferred into seven popular locally adapted rice varieties, namely, ADT 45, CR 1009, Gayatri, MTU 1010, PR 114, Pusa 44 and Sarjoo 52. Genotypic background selection is being done after BC2F2 stage using an in-house designed 50K SNP chip on a set of twenty lines for each combination, identified with phenotypic similarity in the field to the recipient parent. Near-isogenic lines with more than 90% similarity to the recipient parent are now in advanced generation field trials. These climate smart varieties are expected to improve rice productivity in the adverse ecologies and contribute to the farmer's livelihood.
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Affiliation(s)
- Renu Singh
- National Research Centre on Plant Biotechnology, New Delhi, India
| | - Yashi Singh
- National Research Centre on Plant Biotechnology, New Delhi, India
| | - Suchit Xalaxo
- Indira Gandhi Krishi Vishwavidyalaya, Raipur, Chhatisgarh, India
| | - S Verulkar
- Indira Gandhi Krishi Vishwavidyalaya, Raipur, Chhatisgarh, India
| | - Neera Yadav
- National Research Centre on Plant Biotechnology, New Delhi, India
| | - Shweta Singh
- National Research Centre on Plant Biotechnology, New Delhi, India
| | - Nisha Singh
- National Research Centre on Plant Biotechnology, New Delhi, India
| | - K S N Prasad
- Acharya N.G. Ranga Agricultural University, Maruteru, AP, India
| | - K Kondayya
- Acharya N.G. Ranga Agricultural University, Maruteru, AP, India
| | - P V Ramana Rao
- Acharya N.G. Ranga Agricultural University, Maruteru, AP, India
| | - M Girija Rani
- Acharya N.G. Ranga Agricultural University, Maruteru, AP, India
| | - T Anuradha
- Acharya N.G. Ranga Agricultural University, Maruteru, AP, India
| | - Y Suraynarayana
- Acharya N.G. Ranga Agricultural University, Maruteru, AP, India
| | - P C Sharma
- ICAR-Central Soil Salinity Research Institute, Karnal, Haryana, India
| | - S L Krishnamurthy
- ICAR-Central Soil Salinity Research Institute, Karnal, Haryana, India
| | - S K Sharma
- ICAR-Central Soil Salinity Research Institute, Karnal, Haryana, India
| | - J L Dwivedi
- Acharya Narendra Dev University of Agriculture and Technology, Faizabad, UP, India
| | - A K Singh
- Acharya Narendra Dev University of Agriculture and Technology, Faizabad, UP, India
| | - P K Singh
- Banaras Hindu University, Varanasi, UP, India
| | - N K Singh
- Rajendra Agricultural University, Samastipur, Bihar, India
| | - Rajesh Kumar
- Rajendra Agricultural University, Samastipur, Bihar, India
| | - S K Chetia
- Assam Agricultural University, Jorhat, Assam, India
| | - T Ahmad
- Assam Agricultural University, Jorhat, Assam, India
| | - M Rai
- Central Agricultural University, Umiam, Meghalaya, India
| | - P Perraju
- Jawahar Lal Nehru Krishi Vishwavidyalaya, Reewa, MP, India
| | - Anita Pande
- Birsa Agricultural University, Ranchi, Jharkhand, India
| | - D N Singh
- Birsa Agricultural University, Ranchi, Jharkhand, India
| | - N P Mandal
- ICAR-Central Rice Research Institute, Cuttack, Odisha, India
| | - J N Reddy
- ICAR-Central Rice Research Institute, Cuttack, Odisha, India
| | - O N Singh
- ICAR-Central Rice Research Institute, Cuttack, Odisha, India
| | - J L Katara
- ICAR-Central Rice Research Institute, Cuttack, Odisha, India
| | - B Marandi
- ICAR-Central Rice Research Institute, Cuttack, Odisha, India
| | - P Swain
- ICAR-Central Rice Research Institute, Cuttack, Odisha, India
| | - R K Sarkar
- ICAR-Central Rice Research Institute, Cuttack, Odisha, India
| | - D P Singh
- ICAR-Central Rice Research Institute, Cuttack, Odisha, India
| | - T Mohapatra
- ICAR-Central Rice Research Institute, Cuttack, Odisha, India
| | - G Padmawathi
- ICAR-Indian Institute of Rice Research, Hyderabad, India
| | - T Ram
- ICAR-Indian Institute of Rice Research, Hyderabad, India
| | | | - K Paramsivam
- Pandit Jawaharlal Nehru College of Agriculture & Research Institute, Karikal, Puducherry, India
| | - S Nadarajan
- Pandit Jawaharlal Nehru College of Agriculture & Research Institute, Karikal, Puducherry, India
| | - S Thirumeni
- Pandit Jawaharlal Nehru College of Agriculture & Research Institute, Karikal, Puducherry, India
| | - M Nagarajan
- ICAR-Indian Agricultural Research Institute, Aduthurai, TN, India
| | - A K Singh
- ICAR-Indian Agricultural Research Institute, New Delhi, India
| | - Prashant Vikram
- International Rice Research Institute, Los Banos, Philippines
| | - Arvind Kumar
- International Rice Research Institute, Los Banos, Philippines
| | - E Septiningshih
- International Rice Research Institute, Los Banos, Philippines
| | - U S Singh
- International Rice Research Institute, Los Banos, Philippines
| | - A M Ismail
- International Rice Research Institute, Los Banos, Philippines
| | - D Mackill
- International Rice Research Institute, Los Banos, Philippines
| | - Nagendra K Singh
- National Research Centre on Plant Biotechnology, New Delhi, India.
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Ismail AM, Raghavendran A, Sivakumar J, Radhakrishnan M, Rose W, Abraham P. Mother to child transmission of hepatitis B virus: a cause for concern. Indian J Med Microbiol 2015; 33 Suppl:140-3. [PMID: 25657134 DOI: 10.4103/0255-0857.150931] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Mother to child transmission of hepatitis B virus (HBV) is an important public health issue. India introduced HBV vaccine in 10 states as part of its Universal Immunization Program (UIP). Here we show evidence of mother-to-child transmission of HBV in three families from Jharkhand and Bihar states where HBV vaccination is not yet included in the UIP. This report illustrates the need for active screening of HBV in pregnant women and implementation of HBV vaccine across all states in India to reduce the burden of disease.
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Affiliation(s)
| | | | | | | | | | - P Abraham
- Department of Clinical Virology, Christian Medical College, Vellore - 632004, Tamil Nadu, India
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Ismail AM, Ramachandran J, Kannangai R, Abraham P. Antiviral efficacy of adefovir dipivoxil in the treatment of chronic hepatitis B subjects from Indian subcontinent. Indian J Med Microbiol 2014; 32:60-3. [PMID: 24399391 DOI: 10.4103/0255-0857.124312] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Adefovir is one of the therapeutic options for the treatment of chronic hepatitis B. A total of 30 adefovir-experienced subjects with the median treatment duration of 12 (interquartile range (IQR) 6-18) months were studied. Virological response was measured by hepatitis B virus deoxyribonucleic acid (HBV DNA) levels. HBV reverse transcriptase (rt) domains were sequenced for the identification of resistance mutations. Among the 30 subjects, two (7%) showed virological response and 19 (63%) were non-responders. The virological response for the remaining nine (30%) subjects was not determined. On sequence analysis, two subjects were identified with rtI169L and rtA181V mutation after 9 months and 18 months of adefovir treatment, respectively. Though the frequencies of adefovir resistance mutations are low, a large majority of subjects showed non-response. Therefore, adefovir in the management of HBV should be used judiciously.
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Affiliation(s)
| | | | | | - P Abraham
- Departments of Clinical Virology, Christian Medical College, Vellore, Tamil Nadu, India
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Abdel-Naby MA, El-Diwany AI, Shaker HM, Ismail AM. Production and properties of fibrinolytic enzyme fromStreptomyces sp. NRC 411. World J Microbiol Biotechnol 2014; 8:267-9. [PMID: 24425475 DOI: 10.1007/bf01201876] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/1991] [Accepted: 11/01/1991] [Indexed: 11/28/2022]
Abstract
Of 16Streptomyces spp. investigated for the production of extracellular fibrinolytic enzyme, one species was chosen as the most promising producer. Using shaken cultures grown for 7 days, optimal conditions for enzyme production were pH 6.0, 5% (w/v) starch as carbon source, (NH4)2SO4 and soybean flour as nitrogen sources and KH2PO4 at 1.2 g/l. Maximal activity of the crude enzyme was at pH 6.0 and 45°C. Holding the enzyme at 37°C for 2 h decreased the activity by only 10%.
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Affiliation(s)
- M A Abdel-Naby
- Department of Chemistry of Natural Products, National Research Centre, El-Tahrir Street, Dokki-Giza, Egypt
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Parameshwar M, Ismail AM, Matheson M, Knowles S, Molloy EJ. Neonatal meningitis: a diagnostic dilemma. Ir Med J 2012; 105:284. [PMID: 23155921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
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Jothi R, Ismail AM, Senthamarai R, Pal S. A comparative study on the efficacy, safety, and cost-effectiveness of bimatoprost/timolol and dorzolamide/timolol combinations in glaucoma patients. Indian J Pharmacol 2011; 42:362-5. [PMID: 21189906 PMCID: PMC2991693 DOI: 10.4103/0253-7613.71917] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [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: 04/02/2010] [Revised: 06/03/2010] [Accepted: 08/07/2010] [Indexed: 11/06/2022] Open
Abstract
Aim: This study was designed to compare the bimatoprost/timolol combination and dorzolamide/timolol combination in glaucoma for efficacy, safety, and cost-effectiveness in a local population of Trichy in the state of Tamilnadu. Materials and Methods: Eight-week, randomized, parallel group, open-label study was conducted on 48 patients of open angle glaucoma or ocular hypertension. After initial clinical assessment and baseline investigations, bimatoprost/timolol combination (Group A) was prescribed to 22 patients (2 patients lost after initial assessment) and dorzolamide/timolol combination (Group B) to 24 patients. The patients were reviewed after second and eighth weeks for cure rate and adverse drug reaction monitoring. Results: At the end of 8 weeks, the mean reduction in intraocular pressure from baseline was 13.04 mmHg (95% confidence interval (CI): 10.67–14.70) with bimatoprost/timolol combination once daily (P < 0.01) and 9.46 mmHg (95% CI: 7.47–10.5) with dorzolamide/timolol combination twice daily. Both the treatments were safe. Cost-effective range of bimatoprost/timolol combination was lower than that of dorzolamide/timolol combination. Conclusion: The fixed combination of bimatoprost/timolol was slightly more effective than that of dorzolamide/timolol combination in reducing IOP, and both treatments were generally well tolerated. Bimatoprost/timolol combination was more cost-effective (cost-effective analysis) than dorzolamide/timolol combination.
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Affiliation(s)
- R Jothi
- RVS College of Pharmaceutical Sciences, Sulur, Coimbatore-641 402, Tamilnadu, India
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Ismail AM, Samuel P, Eapen CE, Kannangai R, Abraham P. Antiviral resistance mutations and genotype-associated amino acid substitutions in treatment-naïve hepatitis B virus-infected individuals from the Indian subcontinent. Intervirology 2011; 55:36-44. [PMID: 21311172 DOI: 10.1159/000323521] [Citation(s) in RCA: 32] [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] [Received: 05/27/2010] [Accepted: 11/30/2010] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND/AIMS Antiviral resistance is a major challenge to the treatment currently available for hepatitis B virus (HBV). In this study, mutations that may affect the antiviral efficacy in treatment-naïve HBV-infected individuals were analyzed. METHODS Ninety-seven treatment-naïve HBV-infected individuals were included in this study. HBV reverse transcriptase (rt) domains were sequenced and nucleotide differences were compared to GenBank wild-type sequences. Furthermore, HBV genotypes, subgenotypes and subtypes were determined by analyzing surface gene sequences. RESULTS An adefovir-related rtI233V mutation was identified in 4 subjects. The rtS213T lamivudine and entecavir refractory mutant was presented in 3 individuals. Altogether, drug-related, atypical and novel HBVrt amino acid substitutions were seen in 73 positions. The HBV genotypes A, C, D and G were depicted in 15, 21, 60 and 1 individuals, respectively. There were 17 HBVrt amino acid substitutions that are associated with certain genotypes of HBV. Mutations in HBVrt corresponded to established surface gene mutations in 9 patients. CONCLUSION This data shows that antiviral-resistant HBV strains do exist in treatment-naïve individuals in this region. Further studies are essential to characterize the role of HBVrt amino acid substitutions in response to anti-HBV therapy.
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Affiliation(s)
- A M Ismail
- Department of Clinical Virology, Christian Medical College, Vellore, India
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Fletcher GJ, Gnanamony M, Samuel P, Ismail AM, Kannangai R, Daniel D, Eapen CE, Abraham P. Association of mannose-binding lectin polymorphisms and HBV outcome in a South Indian population. Int J Immunogenet 2010; 37:177-84. [PMID: 20193030 DOI: 10.1111/j.1744-313x.2010.00908.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Mannose binding lectin (MBL) is an important innate immune system pattern recognition molecule. The MBL gene polymorphisms are reported to play a crucial role in outcome of hepatitis B virus (HBV) infection. In this study, we ascertained the association of MBL genotypes with HBV outcome in a South Indian population. The MBL gene polymorphisms at codons 52, 54 and 57 of exon I, and promoter polymorphisms at -221 were typed by polymerase chain reaction-sequence specific primer in spontaneously recovered and in chronic HBV group. The allele frequency of codon 52 'C' was significantly higher in chronic HBV group than in the recovered group (98.5% vs. 93.6%; P = 0.003) and codon 52 'T' was significantly higher in recovered group than in the chronic group (6.4% vs. 1.5%; P = 0.003). In multivariate analysis, after adjusting for age, sex and state of origin, codon 52 'CC' and 'CT' genotypes were significantly associated with chronicity and recovery respectively [odds ratio (OR), 0.25; 95% confidence interval (CI), 0.08-0.80, P = 0.02] in co-dominant analyzing models. This was re-affirmed in analysis performed exclusively on Tamil Nadu subjects (OR, 0.23; 95% CI, 0.06-0.93, P = 0.039). The frequency of low/none haplotype (XY/O) was significantly higher in recovered group than in chronic group (15.6% vs 7.5%) and associated with spontaneous recovery (OR, 2.28; 95% CI, 1.04-4.99, P = 0.035). Our results provide preliminary evidence that inheritance of codon 52 genotypes and XY/O haplotype associated with low MBL level substantially determine the outcome of HBV infection in a sympatrically isolated South Indian population.
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Affiliation(s)
- G J Fletcher
- Department of Gastrointestinal Sciences, Christian Medical College, Vellore, Tamil Nadu, India
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Neeraja CN, Maghirang-Rodriguez R, Pamplona A, Heuer S, Collard BCY, Septiningsih EM, Vergara G, Sanchez D, Xu K, Ismail AM, Mackill DJ. A marker-assisted backcross approach for developing submergence-tolerant rice cultivars. Theor Appl Genet 2007; 115:767-76. [PMID: 17657470 DOI: 10.1007/s00122-007-0607-0] [Citation(s) in RCA: 131] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/14/2006] [Accepted: 07/02/2007] [Indexed: 05/04/2023]
Abstract
Submergence stress regularly affects 15 million hectares or more of rainfed lowland rice areas in South and Southeast Asia. A major QTL on chromosome 9, Sub1, has provided the opportunity to apply marker assisted backcrossing (MAB) to develop submergence tolerant versions of rice cultivars that are widely grown in the region. In the present study, molecular markers that were tightly linked with Sub1, flanking Sub1, and unlinked to Sub1 were used to apply foreground, recombinant, and background selection, respectively, in backcrosses between a submergence-tolerant donor and the widely grown recurrent parent Swarna. By the BC(2)F(2) generation a submergence tolerant plant was identified that possessed Swarna type simple sequence repeat (SSR) alleles on all fragments analyzed except the tip segment of rice chromosome 9 that possessed the Sub1 locus. A BC(3)F(2) double recombinant plant was identified that was homozygous for all Swarna type alleles except for an approximately 2.3-3.4 Mb region surrounding the Sub1 locus. The results showed that the mega variety Swarna could be efficiently converted to a submergence tolerant variety in three backcross generations, involving a time of two to three years. Polymorphic markers for foreground and recombinant selection were identified for four other mega varieties to develop a wider range of submergence tolerant varieties to meet the needs of farmers in the flood-prone regions. This approach demonstrates the effective use of marker assisted selection for a major QTL in a molecular breeding program.
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Affiliation(s)
- C N Neeraja
- International Rice Research Institute, DAPO Box 7777, Metro Manila, Philippines
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El-Shalakany AH, Kamel KM, Ismail AM, Salah L, El-Deen Fahmy SS, El-Deen Ammar E. Estrogen and progesterone receptors and telomerase enzyme immunohistochemical detection in gestational trophoblastic tumors. Int J Gynecol Cancer 2006; 16:1918-26. [PMID: 17009992 DOI: 10.1111/j.1525-1438.2006.00718.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
The purpose of this study is to evaluate the immunohistochemical detection of telomerase enzyme and estrogen receptor (ER) and progesterone receptor (PGR) in gestational trophoblastic neoplasia (GTN) and its clinical significance. Formalin-fixed paraffin blocks for 30 patients (24 with molar pregnancy, 3 with choriocarcinoma, and 3 with placental site trophoblastic tumor) as cases and six products of conception samples from patients with incomplete abortion as controls were included in the study. Immunohistochemical detection of the telomerase catalytic protein and ER and PGR was carried out using streptavidin-biotin-peroxidase method. All control tissues were negative for telomerase and ER expression, while five of six were PGR positive. Significant positive telomerase expression was detected in all gestational trophoblastic tumors (three of six partial moles, 12 of 18 complete moles, three of three choriocarcinomas, and two of three placental site trophoblastic tumors). Nine of 24 molar pregnancies were followed by GTN. Molar pregnancies followed by GTN were associated with higher serum beta-hCG (human chorionic gonadotrophic hormone), larger uterine size for gestational age, negative ER expression, negative PGR expression, and positive telomerase expression. All patients with molar pregnancy with negative telomerase expression (9 of 24) showed spontaneous regression after evacuation. Positive telomerase expression and its immunohistochemical detection are associated with the development of GTN. Negative telomerase expression is highly predictive of postmolar spontaneous regression. Patients with molar pregnancies with negative telomerase expression can be saved the long-term follow-up. ER and PGR expression do not show a significantly different pattern in molar tissues, while negative expression is associated with developing GTN. Cautions on the use of postmolar hormonal contraception may be unjustified.
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Affiliation(s)
- A H El-Shalakany
- Gynaecologic Oncology Unit, Ain Shams University Medical School, Cairo, Egypt.
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Ramzisham AR, Sagap I, Ismail AM. Spontaneous rectus sheath haematoma in pregnancy. Med J Malaysia 2003; 58:125-7. [PMID: 14556338] [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: 04/27/2023]
Abstract
Bleeding into the rectus sheath is an uncommon but a well-recognised condition that mimics several other diagnoses of acute abdomen. A wide range of etiology has been proposed in association with this condition. It is often self-limiting, but can lead to unnecessary laparotomy if the diagnosis is not recognised.
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Affiliation(s)
- A R Ramzisham
- Department of Surgery, Hospital University Kebangsaan Malaysia, Jalan Yaacob Latiff, Cheras, 56000 Kuala Lumpur
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Ouédraogo JT, Gowda BS, Jean M, Close TJ, Ehlers JD, Hall AE, Gillaspie AG, Roberts PA, Ismail AM, Bruening G, Gepts P, Timko MP, Belzile FJ. An improved genetic linkage map for cowpea (Vigna unguiculata L.) combining AFLP, RFLP, RAPD, biochemical markers, and biological resistance traits. Genome 2002; 45:175-88. [PMID: 11908660 DOI: 10.1139/g01-102] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
An improved genetic linkage map has been constructed for cowpea (Vigna unguiculata L. Walp.) based on the segregation of various molecular markers and biological resistance traits in a population of 94 recombinant inbred lines (RILs) derived from the cross between 'IT84S-2049' and '524B'. A set of 242 molecular markers, mostly amplified fragment length polymorphism (AFLP), linked to 17 biological resistance traits, resistance genes, and resistance gene analogs (RGAs) were scored for segregation within the parental and recombinant inbred lines. These data were used in conjunction with the 181 random amplified polymorphic DNA (RAPD), restriction fragment length polymorphism (RFLP), AFLP, and biochemical markers previously mapped to construct an integrated linkage map for cowpea. The new genetic map of cowpea consists of 11 linkage groups (LGs) spanning a total of 2670 cM, with an average distance of 6.43 cM between markers. Astonishingly, a large, contiguous portion of LG1 that had been undetected in previous mapping work was discovered. This region, spanning about 580 cM, is composed entirely of AFLP markers (54 in total). In addition to the construction of a new map, molecular markers associated with various biological resistance and (or) tolerance traits, resistance genes, and RGAs were also placed on the map, including markers for resistance to Striga gesnerioides races 1 and 3, CPMV, CPSMV, B1CMV, SBMV, Fusarium wilt, and root-knot nematodes. These markers will be useful for the development of tools for marker-assisted selection in cowpea breeding, as well as for subsequent map-based cloning of the various resistance genes.
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Affiliation(s)
- J T Ouédraogo
- Institut de l'Environnement et de Recherches Agricoles (INERA), Ouagadougou, Burkina Faso
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Hashem AM, Ismail AM, El-Refai MA, Abdel-Fattah AF. Production and properties of beta-mannanase by free and immobilized cells of Aspergillus oryzae NRRL 3488. Cytobios 2002; 105:115-30. [PMID: 11393772] [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: 02/20/2023]
Abstract
Seven fungi were tested for production of mannanases. The highest mannanase activities were produced by Aspergillus oryzae NRRL 3488 after 7 days in static cultures. Mannanases were induced by gum locust bean (1.0%). The highest mannanase activity was produced when a mixture of peptone, urea and ammonium sulphate was used as nitrogen source. Zn2+ or Co2+ favoured enzyme production. The immobilized cells on Ca-alginate and agar were able to produce beta-mannanase for four runs with a slight decrease in the activity. The optimum temperature for enzyme reaction was 50-55 degrees C at pH 6.0. In the absence of substrate the enzyme was thermostable retaining 75% activity for 1 h at 50 degrees C, and 68% activity for 1 h at 60 degrees C.
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Affiliation(s)
- A M Hashem
- Department of Natural and Microbial Products Chemistry, National Research Centre, Dokki, Cairo, Egypt
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Sewelam A, Ismail AM, El Serogy H. Ultrasound biomicroscopy of haptic position after transscleral fixation of posterior chamber intraocular lenses. J Cataract Refract Surg 2001; 27:1418-22. [PMID: 11566525 DOI: 10.1016/s0886-3350(01)00791-x] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE To determine the haptic position of ab externo transsclerally fixated posterior chamber intraocular lenses (PC IOLs) by ultrasound biomicroscopy (UBM). SETTING Mansoura Ophthalmic Center, Mansoura University, Mansoura, Egypt. METHODS Ultrasound biomicroscopy was used to determine the haptic position in relation to the ciliary sulcus, iris, and ciliary body in 20 patients with transsclerally fixated PC IOLs. The patients ranged in age from 10 to 65 years. RESULTS All IOL haptics were easily visualized and imaged by UBM. Of the 40 IOL haptics, 22 (55.0%) were located in the sulcus, 11 (27.5%) anterior to the sulcus, and 7 (17.5%) posterior to the sulcus region. CONCLUSIONS Ab externo scleral fixation of PC IOLs is a blind procedure in most cases. Ultrasound biomicroscopy showed the difficulty in reliably placing the haptics in the ciliary sulcus using this technique. Thus, endoscopic visualization of the iridociliary angle during surgery is recommended.
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Affiliation(s)
- A Sewelam
- Mansoura Ophthalmic Center, Faculty of Medicine, Mansoura University, Mansoura, Egypt
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Abstract
Hot mineral springs in Jordan are very attractive to people who seek physical healing but they are unaware of natural radioactive elements that may be contained in the hot mineral water. The activities of the natural radioactive isotopes were measured and the concentrations of the parents of their natural radioactive series were calculated. The measured radionuclides were 234Th, 226Ra, 214Pb, 214Bi, 228Ac, 228Th, 212Pb, 212Bi and 208Tl. In addition the activities of 235U and 40K were measured. The activities ranged from 0.14 to 34.8 Bq/l, while the concentrations of parent uranium and thorium isotopes ranged from 3.0 x 10(-3) to 0.59 mg/l. The results were compared with those for drinking water.
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Affiliation(s)
- S A Saqan
- Physics Department, Jordan University of Science and Technology, Jordan
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Ismail AM, Hall AE, Close TJ. Allelic variation of a dehydrin gene cosegregates with chilling tolerance during seedling emergence. Proc Natl Acad Sci U S A 1999; 96:13566-70. [PMID: 10557361 PMCID: PMC23988 DOI: 10.1073/pnas.96.23.13566] [Citation(s) in RCA: 117] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Dehydrins (DHNs, LEA D-11) are plant proteins present during environmental stresses associated with dehydration or low temperatures and during seed maturation. Functions of DHNs have not yet been defined. Earlier, we hypothesized that a approximately 35-kDa DHN and membrane properties that reduce electrolyte leakage from seeds confer chilling tolerance during seedling emergence of cowpea (Vigna unguiculata L. Walp.) in an additive and independent manner. Evidence for this hypothesis was not rigorous because it was based on correlations of presence/absence of the DHN and slow electrolyte leakage with chilling tolerance in closely related cowpea lines that have some other genetic differences. Here, we provide more compelling genetic evidence for involvement of the DHN in chilling tolerance of cowpea. We developed near-isogenic lines by backcrossing. We isolated and determined the sequence of a cDNA corresponding to the approximately 35-kDa DHN and used gene-specific oligonucleotides derived from it to test the genetic linkage between the DHN presence/absence trait and the DHN structural gene. We tested for association between the DHN presence/absence trait and both low-temperature seed emergence and electrolyte leakage. We show that allelic differences in the Dhn structural gene map to the same position as the DHN protein presence/absence trait and that the presence of the approximately 35-kDa DHN is indeed associated with chilling tolerance during seedling emergence, independent of electrolyte leakage effects. Two types of allelic variation in the Dhn gene were identified in the protein-coding region, deletion of one Phi-segment from the DHN-negative lines and two single amino acid substitutions.
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Affiliation(s)
- A M Ismail
- Department of Botany and Plant Sciences, University of California, Riverside, CA 92521-0124, USA
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Ismail AM, Hall AE, Close TJ. Purification and partial characterization of a dehydrin involved in chilling tolerance during seedling emergence of cowpea. Plant Physiol 1999; 120:237-44. [PMID: 10318701 PMCID: PMC59256 DOI: 10.1104/pp.120.1.237] [Citation(s) in RCA: 88] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/1998] [Accepted: 01/15/1999] [Indexed: 05/18/2023]
Abstract
Dehydrins are a family of proteins (LEA [late-embryogenesis abundant] D11) commonly induced by environmental stresses associated with low temperature or dehydration and during seed maturation drying. Our previous genetic studies suggested an association of an approximately 35-kD protein (by immunological evidence a dehydrin) with chilling tolerance during emergence of seedlings of cowpea (Vigna unguiculata) line 1393-2-11. In the present study we found that the accumulation of this protein in developing cowpea seeds is coordinated with the start of the dehydration phase of embryo development. We purified this protein from dry seeds of cowpea line 1393-2-11 by using the characteristic high-temperature solubility of dehydrins as an initial enrichment step, which was followed by three chromatography steps involving cation exchange, hydrophobic interaction, and anion exchange. Various characteristics of this protein confirmed that indeed it is a dehydrin, including total amino acid composition, partial amino acid sequencing, and the adoption of alpha-helical structure in the presence of sodium dodecyl sulfate. The propensity of dehydrins to adopt alpha-helical structure in the presence of sodium dodecyl sulfate, together with the apparent polypeptide adhesion property of this cowpea dehydrin, suggests a role in stabilizing other proteins or membranes. Taken together, the genetic, physiological, and physicochemical data are at this stage consistent with a cause-and-effect relationship between the presence in mature seeds of the approximately 35-kD dehydrin, which is the product of a single member of a multigene family, and an increment of chilling tolerance during emergence of cowpea seedlings.
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Affiliation(s)
- A M Ismail
- Department of Botany and Plant Sciences, University of California, Riverside, California 92521-0124, USA
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