1
|
Nalin A, Pardo DAD, Pitter KL, Sim AJ, Ejaz A, Manne A, Wolfe AR, Williams TM, Bazan JG, Miller ED. Outcomes of Moderately Dose Escalated Hypofractionated Chemoradiation for Pancreatic Cancer. Int J Radiat Oncol Biol Phys 2023; 117:e328. [PMID: 37785161 DOI: 10.1016/j.ijrobp.2023.06.2376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) A modestly hypofractionated course of chemoradiation (CRT) consisting of 36 Gy/15 fractions (F) concurrent with gemcitabine used in PREOPANC and phase II trials has become increasingly common for the treatment of borderline resectable (BR) and locally advanced (LA) pancreatic cancer (PC). Achieving an R0 resection remains a key prognostic factor in PC. We tested whether escalating dose beyond standard dosing (SD) of 36-39 Gy/15 F (or 50-54 Gy/25-30 F) would improve R0 resection rates and outcomes while respecting nearby organs at risk. MATERIALS/METHODS This was a retrospective analysis of consecutive patients at our institution from 2012-2022 with BR/LA PC treated with moderate dose escalated (MDE) (45 Gy/15 F, N = 45) or SD (36-39 Gy/15 F, N = 68 or 50-54 Gy/25-30 F, N = 25) CRT. For MDE, a 5 mm expansion from the duodenum, small bowel, and stomach was created (GI_PRV); PTV was cropped from this structure and prescribed 45 Gy/15 F. The primary endpoint was R0 resection rate with secondary endpoints of cumulative incidence of local progression (LP, recurrence after surgery/imaging progression if no surgery) with death as a competing risk (LP after occurrence of distant metastasis [DM] were still captured), cumulative incidence of DM, and overall survival (OS). Univariable and multivariable competing risks regression analyses were performed to determine the association between baseline covariates and LP. RESULTS We identified 45 patients treated with MDE and 93 treated with SD. Most patients presented with BR disease (55.6% MDE; 54.8% SD) and received neoadjuvant chemotherapy with FOLFIRINOX (98% MDE; 99% SD). All patients in the MDE group and 99% in the SD group received concurrent chemotherapy with gemcitabine used most often (96% MDE; 77% SD). Median follow-up was 17 m (IQR 13-27 m). Surgical resection rates were similar between groups (33.3% MDE vs. 39.8% SD, p = 0.46). Amongst patients that had surgery, R0 resection rates were non-significantly higher in the MDE group (73.3% vs. 47.4%, p = 0.09). Cumulative incidence of LP at 18 m was significantly lower in the MDE group (9.0% vs. 24.8%, p = 0.04). No difference in rates of DM (51.2% MDE vs. 59.6% SD, p = 0.92) or OS at 18 m (53.9% vs. 53.6%, p = 0.89) were observed. On multivariable analysis, MDE (HR = 0.39, p = 0.03) and pancreatic head location (HR = 0.51, p = 0.04) were the only factors independently associated with LP. Rates of grade 2+ gastrointestinal toxicity during CRT (20% MDE vs. 20.9% SD, p = 0.91) and ≤90 days of completing CRT (11.6% MDE vs. 14.8%, p = 0.62) were similar between groups, as were rates of grade 3+ hematologic toxicity (52.3% MDE vs. 41.3% SD, p = 0.23). CONCLUSION In this single institutional study, we found MDE is a simple, safe, and effective strategy associated with improved local control, higher R0 resection rates, and similar toxicity to SD CRT for patients with BR/LA PC. Further prospective data is needed to clarify the role of dose-escalated RT in the management of this lethal malignancy.
Collapse
Affiliation(s)
- A Nalin
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - D A Diaz Pardo
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - K L Pitter
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - A J Sim
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - A Ejaz
- Division of Surgical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - A Manne
- Department of Medical Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | - A R Wolfe
- Department of Radiation Oncology, The University of Arkansas for Medical Sciences, Little Rock, AR
| | - T M Williams
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | - J G Bazan
- Department of Radiation Oncology, City of Hope National Medical Center, Duarte, CA
| | - E D Miller
- Department of Radiation Oncology, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| |
Collapse
|
2
|
Khan ZI, Muhammad FG, Ahmad K, Alrefaei AF, Ahmad T, Ejaz A, Nadeem M, Shahzadi M, Muqaddas H, Mehmood N. Evaluation of potential ecological risk assessment of toxic metal (lead) in contaminated meadows in the vicinity of suburban city: soil vs forages vs livestock. BRAZ J BIOL 2023; 83:e272087. [PMID: 37075434 DOI: 10.1590/1519-6984.272087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 03/20/2023] [Indexed: 04/21/2023] Open
Abstract
Heavy metal toxicity is becoming an increasing concern for environmental, human and animal health. The current research analyzed the lead (Pb) contamination in the food chain under three different irrigation sources (ground, canal, and wastewater). Soil, plant and animal samples were collected from the Jhang district of Pakistan and processed with an atomic absorption spectrophotometer. Lead concentration varied in the samples as: 5.22-10.73 mg/kg in soil, 2.46-10.34 mg/kg in forages and 0.736-2.45 mg/kg in animal samples. The observed lead concentration in forage and animal blood samples was higher than the standard limits. The pollution load index (0.640-1.32) in soil showed that lead contamination mainly took place at the wastewater irrigating sites. Bio-concentration factor values (0.313-1.15) were lower than one in all samples except Zea mays, showing that lead metal was actively taken up by Zea mays tissues from the soil. Enrichment factor values ranged from 0.849-3.12, showing a moderate level of lead enrichment. Daily intake and health risk index varied between 0.004-0.020 mg/kg/day and 0.906-4.99, respectively. All the samples showed maximum lead concentration at the wastewater irrigating site compared to the ground or canal water application sites. These results recommended that consistent application of wastewater for forage irrigation must be avoided to prevent health hazards associated with lead in the animal and human food chain. Government must implement adequate strategies to protect the animal and human health from the harms of toxic heavy metals.
Collapse
Affiliation(s)
- Z I Khan
- University of Sargodha, Department of Botany, Sargodha, Punjab, Pakistan
| | - F G Muhammad
- University of Sargodha, Department of Botany, Sargodha, Punjab, Pakistan
| | - K Ahmad
- University of Sargodha, Department of Botany, Sargodha, Punjab, Pakistan
| | - A F Alrefaei
- King Saud University, College of Science, Department of Zoology, Riyadh, Saudi Arabia
| | - T Ahmad
- Pakki Thatti R&D Farm, Toba Tek Singh, Punjab, Pakistan
| | - A Ejaz
- University of Sargodha, Department of Botany, Sargodha, Punjab, Pakistan
| | - M Nadeem
- University of Sargodha, Institute of Food Science and Nutrition, Sargodha, Punjab, Pakistan
| | - M Shahzadi
- Ghazi University, Department of Plant Breeding and Genetics, Dera Ghazi Khan, Punjab, Pakistan
| | - H Muqaddas
- The Women University Multan, Department of Zoology, Multan, Punjab, Pakistan
| | - N Mehmood
- University of Sargodha, Department of Zoology, Sargodha, Punjab, Pakistan
- University of Sassari, Department of Veterinary Medicine, Sassari, Italy
| |
Collapse
|
3
|
Khan ZI, Liu W, Mubeen I, Alrefaei AF, Alharbi SN, Muhammad FG, Ejaz A, Ahmad K, Nadeem M, Shoukat J, Ashfaq A, Mahpara S, Siddique K, Ashraf MA, Memona H, Batool AI, Munir M, Malik IS, Noorka IR, Ugulu I. Cobalt availability in the soil plant and animal food chain: a study under a peri-urban environment. BRAZ J BIOL 2023; 83:e270256. [PMID: 37018800 DOI: 10.1590/1519-6984.270256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 01/27/2023] [Indexed: 04/07/2023] Open
Abstract
Cobalt metal is considered as an essential trace element for the animals. Present investigation was undertaken in the peri-urban area to analyze the cobalt availability in animal food chain by using different indices. Cow, buffalo and sheep samples along with forage and soil samples were collected from the three different sites of District Jhang and analyzed through atomic absorption spectrophotometer. Cobalt values differed in soil samples as 0.315-0.535 mg/kg, forages as 0.127-0.333 mg/kg and animal samples as 0.364-0.504 mg/kg. Analyzed cobalt concentration in soil, forage and animal samples was found to be deficient in concentration with respect to standard limits. Soil showed the minimum cobalt level in Z. mays while maximum concentration was examined in the forage C. decidua samples. All indices examined in this study has values lesser than 1, representing the safer limits of the cobalt concentration in these samples. Enrichment factor (0.071-0.161 mg/kg) showed the highly deficient amount of cobalt enrichment in this area. Bio-concentration factor (0.392-0.883) and pollution load index (0.035-0.059 mg/kg) values were also lesser than 1 explains that plant and soil samples are not contaminated with cobalt metal. The daily intake and health risk index ranged from 0.00019-0.00064 mg/kg/day and 0.0044-0.0150 mg/kg/day respectively. Among the animals, cobalt availability was maximum (0.0150 mg/kg/day) in the buffaloes that grazed on the C. decidua fodder. Results of this study concluded that cobalt containing fertilizers must be applied on the soil and forages. Animal feed derived from the cobalt containing supplements are supplied to the animals, to fulfill the nutritional requirements of livestock.
Collapse
Affiliation(s)
- Z I Khan
- University of Sargodha, Department of Botany, Sargodha, Pakistan
| | - W Liu
- Fuyang Normal University, Department of Biological Sciences, Fuyang, Anhui, China
| | - I Mubeen
- Zhejiang University, Institute of Biotechnology, State Key Laboratory of Rice Biology, and Ministry of Agriculture Key Laboratory of Molecular Biology of Crop Pathogens and Insects, Hangzhou, China
| | - A F Alrefaei
- King Saud University, College of Science, Department of Zoology, Riyadh, Saudi Arabia
| | - S N Alharbi
- Imperial College London, Department of Surgery and Cancer, London, United Kingdom
| | - F G Muhammad
- University of Sargodha, Department of Botany, Sargodha, Pakistan
| | - A Ejaz
- University of Sargodha, Department of Botany, Sargodha, Pakistan
| | - K Ahmad
- University of Sargodha, Department of Botany, Sargodha, Pakistan
| | - M Nadeem
- University of Sargodha, Institute of Food Science and Nutrition, Sargodha, Pakistan
| | - J Shoukat
- University of Sargodha, Institute of Food Science and Nutrition, Sargodha, Pakistan
| | - A Ashfaq
- University of Sargodha, Department of Botany, Sargodha, Pakistan
| | - S Mahpara
- University of Sargodha, Department of Botany, Sargodha, Pakistan
| | - K Siddique
- School of Life Sciences and Biotechnology, Shanghai Jiao Tong University, Shanghai, China
| | - M A Ashraf
- School of Geographical Sciences, Fujian Normal University, Fuzhou, China
| | - H Memona
- Queen Mary College, Lahore, Pakistan
| | - A I Batool
- University of Sargodha, Department of Zoology, Sargodha, Pakistan
| | - M Munir
- University of Sargodha, Department of Botany, Sargodha, Pakistan
| | - I S Malik
- University of Sargodha, Department of Botany, Sargodha, Pakistan
| | - I R Noorka
- University of Sargodha, College of Agriculture, Sargodha, Pakistan
| | - I Ugulu
- Usak University, Faculty of Education, Usak, Turkey
| |
Collapse
|
4
|
Waqas M, Anwar A, Ejaz A, Malik A. The Efficacy Of Azithromycin Plus Levamisole Vs Azithromycin Alone In The Treatment Of Moderate To Severe Acne. J Ayub Med Coll Abbottabad 2021; 33:408-411. [PMID: 34487647] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
BACKGROUND Acne vulgaris (AV) is an inflammatory disorder of pilosebaceous unit and it affects over 85% of teenagers (peak age 17 years) during some point in their lives. Of these 30% have acne severe enough to require medical treatment. The overall incidence is comparable in both genders. Objective was to compare the efficacy of azithromycin plus levamisole with azithromycin alone in the treatment of moderate to severe acne. It was a single centre randomized controlled trial, conducted at the Department of Dermatology at Military Hospital Rawalpindi. METHODS We selected 118 patients of acne who fulfilled the inclusion criteria from the dermatology outpatient department. Diagnosis was based on clinical features of acne and severity defined using Acne Global Severity Score. The patients were randomly assigned two treatment groups; Patients in group A received Azithromycin 500 mg per day given for 3 days a week plus oral levamisole 150 mg per day was given for 2 days a week for a total of 08 weeks. Group B patients (n= 59) received Azithromycin 500 mg per day given for 3 days a week for a total of 08 weeks. Patients were followed up fortnightly till they completed their treatment. Response to treatment was graded according to the Acne Global Severity Score. Scoring was done at first visit before therapy and after 08 weeks of therapy in both groups. Therapy was considered efficacious if the patients achieved post-therapy reduction of global score below 19 at the end of 8th week of initiation of therapy. RESULTS Among our 118 study cases, we had 38 male patients while 80 were female patients. The study cases had mean age of 20.10±2.65 years. Mean global severity was 31.25±3.41 while 56 (47.5%) had moderate acne and 62 (52.5%) had severe acne. Efficacy was found to be higher in patients receiving Azithromycin plus levamisole combination. CONCLUSIONS Azithromycin plus levamisole was observed as a more effective therapy for the treatment of acne as compared to Azithromycin alone. The study supports the administration of combination therapy for the treatment of Acne to achieve desired outcomes in patients.
Collapse
Affiliation(s)
- Muhammad Waqas
- Department of Medicine, Pak-Emirates Military Hospital Rawalpindi, Pakistan
| | - Ayesha Anwar
- Department of Medicine, Pak-Emirates Military Hospital Rawalpindi, Pakistan
| | - Amer Ejaz
- Department of Medicine, Pak-Emirates Military Hospital Rawalpindi, Pakistan
| | - Anum Malik
- Department of Medicine, Pak-Emirates Military Hospital Rawalpindi, Pakistan
| |
Collapse
|
5
|
Ejaz A, Epperly M, Greenberger J, Huq M, Rubin P. Adipocyte Stem Cells Ameliorate Total Body Irradiation-Induced Hematopoietic Syndrome and Late Radiation Fibrosis. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.1036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
6
|
Ejaz A, Epperly M, Greenberger J, Huq S, Rubin P. Adipocyte Stem Cells Ameliorate Total Body Irradiation Induced Hematopoietic Syndrome and Late Radiation Fibrosis. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
7
|
Kim Y, Bagante F, Gani F, Ejaz A, Xu L, Wasey JO, Johnson DJ, Frank SM, Pawlik TM. Nomogram to predict perioperative blood transfusion for hepatopancreaticobiliary and colorectal surgery. Br J Surg 2016; 103:1173-83. [DOI: 10.1002/bjs.10164] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2015] [Revised: 12/10/2015] [Accepted: 02/17/2016] [Indexed: 01/11/2023]
Abstract
Abstract
Background
Predictive tools assessing risk of transfusion have not been evaluated extensively among patients undergoing complex gastrointestinal surgery. In this study preoperative variables associated with blood transfusion were incorporated into a nomogram to predict transfusion following hepatopancreaticobiliary (HPB) or colorectal surgery.
Methods
A nomogram to predict receipt of perioperative transfusion was developed using a cohort of patients who underwent HPB or colorectal surgery between January 2009 and December 2014. The discriminatory ability of the nomogram was tested using the area under the receiver operating characteristic (ROC) curve and internal validation performed via bootstrap resampling.
Results
Among 4961 patients undergoing either a HPB (56·3 per cent) or colorectal (43·7 per cent) resection, a total of 1549 received at least 1 unit of packed red blood cells, giving a perioperative transfusion rate of 31·2 per cent. On multivariable analysis, age 65 years and over (odds ratio (OR) 1·52), race (versus white: black, OR 1·58; Asian, OR 1·86), preoperative haemoglobin 8·0 g/dl or less (versus over 12·0 g/dl: OR 26·79), preoperative international normalized ratio more than 1·2 (OR 2·44), Charlson co-morbidity index score over 3 (OR 1·86) and procedure type (versus colonic surgery: major hepatectomy, OR 1·71; other pancreatectomy, OR 2·12; rectal surgery, OR 1·39; duodenopancreatectomy, OR 2·65) were associated with a significantly higher risk of transfusion and were included in the nomogram. A nomogram was constructed to predict transfusion using these seven variables. Discrimination and calibration of the nomogram revealed good predictive abilities (area under ROC curve 0·756).
Conclusion
The nomogram predicted blood transfusion in major HPB and colorectal surgery.
Collapse
Affiliation(s)
- Y Kim
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - F Bagante
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - F Gani
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - A Ejaz
- Department of Surgery, University of Illinois Hospital and Health Sciences System, Chicago, Illinois, USA
| | - L Xu
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - J O Wasey
- Department of Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - D J Johnson
- Department of Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - S M Frank
- Department of Anesthesiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - T M Pawlik
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
8
|
Ruparel M, Ejaz A, Chauhan N, Ridge M, Chung D, Succony L, Banka R, Thakrar R, Kumar N, Sage E, Forster M, Janes S, Newsom-Davis T, Ahmad T, Navani N. 23 Characteristics of lung cancer patients diagnosed following emergency admission. Lung Cancer 2016. [DOI: 10.1016/s0169-5002(16)30040-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
9
|
Iftikhar N, Ahmad Ghumman FI, Janjua SA, Ejaz A, Butt UA. Adams-Oliver syndrome. J Coll Physicians Surg Pak 2015; 24 Suppl 2:S76-7. [PMID: 24906278 DOI: 05.2014/jcpsp.s76s77] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 05/29/2012] [Accepted: 04/26/2013] [Indexed: 11/03/2022]
Abstract
A new-born male baby with typical features of Adams-Oliver syndrome (AOS) is described. Adams-Oliver syndrome is the association of aplasia cutis congenita with terminal transverse limb reduction defects with or without cutis marmorata telangiectatica congenita. The patient presented with brachydactyly involving all the digits of his hands and shortening of both big toes along with aplasia cutis on the scalp. There was no systemic involvement. The patient was placed on regular follow-up.
Collapse
Affiliation(s)
- Nadia Iftikhar
- Department of Dermatology, Military Hospital, Rawalpindi
| | | | - Shahbaz A Janjua
- Department of Dermatology, Ayza Skin and Research Centre, Lalamusa, Pakistan
| | - Amer Ejaz
- Department of Dermatology, CMH, Pano Aqil, Rawalpindi
| | | |
Collapse
|
10
|
Spolverato G, Maqsood H, Kim Y, Margonis G, Luo T, Ejaz A, Pawlik TM. Neutrophil-lymphocyte and platelet-lymphocyte ratio in patients after resection for hepato-pancreatico-biliary malignancies. J Surg Oncol 2015; 111:868-74. [PMID: 25865111 DOI: 10.1002/jso.23900] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2014] [Accepted: 02/04/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES We sought to determine whether Neutrophil-lymphocyte ratio (NLR) or platelet-lymphocyte ratio (PLR) were associated with outcomes of patients undergoing surgery for a hepatopancreatico-biliary (HPB) malignancy. METHOD Between 2000 and 2013, 452 patients who underwent an HPB procedure for a malignant indication were identified. Clinicopathological characteristics, NLR, and PLR, as well as short- and long-term outcomes were analyzed. High NLR and PLR were classified using a cut-off value of 5 and 190, respectively, based on ROC curve analysis. RESULTS Patients with low versus high NLR and PLR had similar baseline characteristics with regard to performance status and tumor stage (all P > 0.05). Elevated PLR (HR = 1.40) tends to be association with shorter recurrence-free survival (RFS) (P = 0.05), whereas NLR was not a predictor of shorter RFS. Differently, both elevated NLR (HR = 1.94) and PLR (HR = 1.79) were associated with worse overall survival (OS) (both P < 0.05). Patients with NLR ≥5 and those with PLR ≥190 had a significantly shorter OS compared to patients with NLR <5 and PLR <190, respectively (log-rank test, both P < 0.05). Moreover, patients who had both NLR and PLR elevated had worse OS compared to patients with either one or none inflammatory markers elevated (log-rank P = 0.02). CONCLUSION Elevated NLR and PLR were predictors of worse long-term outcome among patients with HPB malignancy undergoing resection.
Collapse
Affiliation(s)
- G Spolverato
- The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | | | | | | | | | | |
Collapse
|
11
|
Ejaz A, Spolverato G, Kim Y, Frank SM, Pawlik TM. Variation in triggers and use of perioperative blood transfusion in major gastrointestinal surgery. Br J Surg 2014; 101:1424-33. [DOI: 10.1002/bjs.9617] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2014] [Revised: 05/29/2014] [Accepted: 06/18/2014] [Indexed: 12/17/2022]
Abstract
Abstract
Background
The decision to perform intraoperative blood transfusion is subject to a variety of clinical and laboratory factors. This study examined variation in haemoglobin (Hb) triggers and overall utilization of intraoperative blood transfusion, as well the impact of transfusion on perioperative outcomes.
Methods
The study included all patients who underwent pancreatic, hepatic or colorectal resection between 2010 and 2013 at Johns Hopkins Hospital, Baltimore, Maryland. Data on Hb levels that triggered an intraoperative or postoperative transfusion and overall perioperative blood utilization were obtained and analysed.
Results
Intraoperative transfusion was employed in 437 (15·6 per cent) of the 2806 patients identified. Older patients (odds ratio (OR) 1·68), patients with multiple co-morbidities (Charlson co-morbidity score 4 or above; OR 1·66) and those with a lower preoperative Hb level (OR 4·95) were at increased risk of intraoperative blood transfusion (all P < 0·001). The Hb level employed to trigger transfusion varied by sex, race and service (all P < 0·001). A total of 105 patients (24·0 per cent of patients transfused) had an intraoperative transfusion with a liberal Hb trigger (10 g/dl or more); the majority of these patients (78; 74·3 per cent) did not require any additional postoperative transfusion. Patients who received an intraoperative transfusion were at greater risk of perioperative complications (OR 1·55; P = 0·002), although patients transfused with a restrictive Hb trigger (less than 10 g/dl) showed no increased risk of perioperative morbidity compared with those transfused with a liberal Hb trigger (OR 1·22; P = 0·514).
Conclusion
Use of perioperative blood transfusion varies among surgeons and type of operation. Nearly one in four patients received a blood transfusion with a liberal intraoperative transfusion Hb trigger of 10 g/dl or more. Intraoperative blood transfusion was associated with higher risk of perioperative morbidity.
Collapse
Affiliation(s)
- A Ejaz
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
- Department of Surgery, University of Illinois Hospital and Health Sciences System, Chicago, Illinois, USA
| | - G Spolverato
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Y Kim
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - S M Frank
- Department of Anesthesiology/Critical Care Medicine, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - T M Pawlik
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| |
Collapse
|
12
|
Spolverato G, Ejaz A, Hyder O, Kim Y, Pawlik TM. Failure to rescue as a source of variation in hospital mortality after hepatic surgery. Br J Surg 2014; 101:836-46. [PMID: 24760705 DOI: 10.1002/bjs.9492] [Citation(s) in RCA: 83] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2014] [Indexed: 12/13/2022]
Abstract
BACKGROUND The mechanisms that underlie the association between high surgical volume and improved outcomes remain uncertain. This study examined the impact of complications and failure to rescue patients from these complications on mortality following hepatic resection. METHODS The Nationwide Inpatient Sample was used to identify patients who had liver surgery between 2000 and 2010. Hospital volume was stratified into tertiles (low, intermediate and high). Rates of major complications, failure to rescue and mortality following hepatic surgery were compared. RESULTS Some 9874 patients were identified. The major complication rate was 19.6 per cent in low-volume, 19.3 per cent in intermediate-volume and 16.6 per cent in high-volume hospitals (P < 0.001). Most common major complications included respiratory insufficiency or failure (8.8 per cent), acute renal failure (4.2 per cent) and gastrointestinal bleeding (3.9 per cent), with each of these complications being less common in high-volume hospitals (P < 0.050). The incidence of major morbidity following hepatectomy remained the same over the past decade, but failure to rescue patients from these complications decreased (P = 0.011). The overall inpatient mortality rate following liver surgery was 3.2 per cent (3.8, 3.6 and 2.3 per cent for low-, intermediate- and high-volume hospitals respectively; P < 0.001). The rate of failure to rescue (death after a complication) was higher at low- and intermediate-volume hospitals (16.8 and 16.1 per cent respectively) compared with high-volume hospitals (11.8 per cent) (P = 0.032). After accounting for patient and hospital characteristics, patients treated at low-volume hospitals who had a complication were 40 per cent more likely to die than patients with a complication in a high-volume hospital (odds ratio 1.40, 95 per cent confidence interval 1.02 to 1.93). CONCLUSION The risk of death following hepatic surgery is lower at high-volume hospitals. The reduction in mortality appears to be the result of both lower complication rates and a better ability in high-volume hospitals to rescue patients with major complications.
Collapse
Affiliation(s)
- G Spolverato
- Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | | | | | | | | |
Collapse
|
13
|
Sachs T, Ejaz A, Weiss M, Spolverato G, Ahuja N, Makary M, Wolfgang C, Hirose K, Pawlik T. Assessing the Experience in Complex Hepatopancreatobiliary Surgery Among Graduating Chief Residents: Is the Operative Caseload Enough? J Surg Res 2014. [DOI: 10.1016/j.jss.2013.11.439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
14
|
Hörl S, Bánki Z, Huber G, Ejaz A, Windisch D, Muellauer B, Willenbacher E, Steurer M, Stoiber H. Reduction of complement factor H binding to CLL cells improves the induction of rituximab-mediated complement-dependent cytotoxicity. Leukemia 2013; 27:2200-8. [PMID: 23760402 PMCID: PMC3826035 DOI: 10.1038/leu.2013.169] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Revised: 04/23/2013] [Accepted: 05/14/2013] [Indexed: 12/11/2022]
Abstract
A main effector mechanism of rituximab (RTX) is the induction of complement-dependent cytotoxicity (CDC). However, this effector function is limited, because CLL cells are protected from complement-induced damage by regulators of complement activation (RCAs). A prominent RCA in fluid phase is factor H (fH), which has not been investigated in this context yet. Here, we show that fH binds to CLL cells and that human recombinant fH-derived short-consensus repeat 18–20 (hSCR18–20) interferes with this binding. In complement-based lysis assays, CLL cells from therapy-naive patients were differently susceptible to RTX-induced CDC and were defined as CDC responder or CDC non-responder, respectively. In CDC responders, but notably also in non-responders, hSCR18–20 significantly boosted RTX-induced CDC. Killing of the cells was specific for CD20+ cells, whereas CD20− cells were poorly affected. CDC resistance was independent of expression of the membrane-anchored RCAs CD55 and CD59, although blocking of these RCAs further boosted CDC. Thus, inhibition of fH binding by hSCR18–20 sensitizes CLL cells to CDC and may provide a novel strategy for improving RTX-containing immunochemotherapy of CLL patients.
Collapse
Affiliation(s)
- S Hörl
- Division of Virology, Innsbruck Medical University, Innsbruck, Austria
| | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Tober R, Banki Z, Ejaz A, Muik A, Egerer L, von Laer D, Kimpel J. The viral vector vaccine VSV-GP boosts immune response upon repeated applications. Retrovirology 2012. [PMCID: PMC3441870 DOI: 10.1186/1742-4690-9-s2-p301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
|
16
|
Iftikhar N, Ejaz A, Butt UA, Ali S. Aplasia cutis congenita associated with azathioprine. J PAK MED ASSOC 2009; 59:782-784. [PMID: 20361680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Aplasia cutis congenita is a rare skin condition characterized by the absence of localized or widespread areas of skin at birth. We are reporting a variant aplasia cutis congenita, which involved over 90% of the body surface area, which occurred in a baby born to a mother with pemphigus vulgaris who was on oral prednisolone and azathioprine. A case of extensive aplasia cutis congenita was seen and oral intake of azathioprine by the mother during pregnancy was suspected as an etiologic factor. The parents of the patient did not consent for biopsy or autopsy so the histopathological picture was not available and hence involvement of other systems could not be ascertained. Due, to financial constraints some of the investigations which might have helped in assigning the patient to a particular category of aplasia cutis such as karyotyping and CT scan brain could not be carried out.
Collapse
Affiliation(s)
- Nadia Iftikhar
- Department of Dermatology, Military Hospital, Rawalpindi
| | | | | | | |
Collapse
|
17
|
Bari AU, Bari AU, Ejaz A. Fissure leishmaniasis: A new variant of cutaneous leishmaniasis. Dermatol Online J 2009; 15:13. [PMID: 19951631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
Cutaneous leishmaniasis (CL) may appear at unusual sites or present with atypical morphologies. The lip is considered one of the unusual sites and a fissure of the lower lip is an atypical morphology that has not been described in CL. We report two cases of CL who presented as cutaneous fissures (on lower lip in one patient and dorsum of finger in another). They were diagnosed by demonstrating leishmania parasites in skin smear preparations and were treated accordingly.
Collapse
|
18
|
Bari AU, Bari AU, Ejaz A. Fissure leishmaniasis: A new variant of cutaneous leishmaniasis. Dermatol Online J 2009. [DOI: 10.5070/d30cf6q723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
|
19
|
Ejaz A, Iftikhar A, Iftikhar N. Patterns of psoriatic arthritis. J Coll Physicians Surg Pak 2009; 19:553-6. [PMID: 19728939 DOI: 09.2009/jcpsp.553556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 06/20/2008] [Accepted: 05/05/2009] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To describe the clinical patterns of arthritis in psoriasis. STUDY DESIGN Cross-sectional, observational study. PLACE AND DURATION OF STUDY Combined Military Hospital, Kharian Cantonment, Pakistan, from January to December 2007. METHODOLOGY One hundred consecutive patients with psoriasis reporting to dermatology outpatient department were included. Pregnant ladies (due to X-ray hazard) and rheumatoid factor positive patients were excluded. The demographic profile of patients was recorded. Psoriatic arthritis was diagnosed on the basis of Moll and Wright criteria. Standardized examination of axial and peripheral joints was made. The severity of psoriasis was assessed by PASI score. The presence of a clinical type of psoriatic arthritis, enthesitis, dactylitis, and nail changes were noted. X-ray films of involved joints were taken. A statistical analysis using chi-square test and student's t-test were done where applicable. RESULTS The mean age of patients was 39.8+15.8 years. Seventy one percent were males and 29% were females. Forty six percent of the patients gave a history of joint involvement and fulfilled the Moll and Wright criteria. The mean PASI score in non-arthritic patients was 26.8+34.8 and in psoriatic arthritis patients it was 28.4+41.2, p=0.08. Thirteen patients (28.2%) had predominantly axial disease, while the rest had predominantly peripheral disease. Single joint involvement (monoarthritis) was the commonest clinical presentation. Nail involvement was seen in 29% of the patients without arthritis while in patients having arthritis, nail involvement was 74% (p=0.001). CONCLUSION Joint involvement is common in psoriatic patients. However, the criteria of diagnosis lack consensus.
Collapse
Affiliation(s)
- Amer Ejaz
- Department of Dermatology, Combined Military Hospital, Kharian Cantt.
| | | | | |
Collapse
|
20
|
Bila C, Ejaz A, Oberhauser V, Dierich M, Stoiber H, Bánki Z. Complement mediated enhancement of Friend Virus specific CTL response by B cells in vitro. Mol Immunol 2009. [DOI: 10.1016/j.molimm.2009.05.259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
21
|
Banki Z, Ammann C, Ejaz A, Dittmer U, Hasenkrug K, Dierich M, Stoiber H, Wilflingseder D. Role of complement in virus-specific CTL response induced by bone-marrow derived DCs. Mol Immunol 2009. [DOI: 10.1016/j.molimm.2009.05.257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
|
22
|
Ul Bari A, Ejaz A. Rhinophymous leishmaniasis: A new variant. Dermatol Online J 2009; 15:10. [PMID: 19379654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
Abstract
Cutaneous leishmaniasis is known for its wide clinical spectrum. The nose is one of the usual sites where the disease can present in many forms, such as psoriasiform plaques, furunculoid nodules, lupoid plaques, and erysipeloid or mucocutaneous types. We present a new morphology, i.e. rhinophyma-like plaque in an elderly male patient who presented with a large infiltrated plaque involving his nose and the adjoining area of his upper lip. It appeared to be rhinophyma of the nose but was diagnosed as cutaneous leishmaniasis after the demonstration of leishmania parasites in a skin smear preparation; he was treated satisfactorily with antimonials.
Collapse
Affiliation(s)
- Arfan Ul Bari
- Consultant Dermatologist, Combined Military Hospital, Peshawar, Pakistan
| | | |
Collapse
|
23
|
Bari AU, Ejaz A. Rhinophymous leishmaniasis: A new variant. Dermatol Online J 2009. [DOI: 10.5070/d36gg453q7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
|
24
|
Ejaz A, Raza N, Iftikhar N, Iftikhar A, Farooq M. Presentation of early onset psoriasis in comparison with late onset psoriasis: A clinical study from Pakistan. Indian J Dermatol Venereol Leprol 2009; 75:36-40. [DOI: 10.4103/0378-6323.45218] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
25
|
Qadir SNR, Ejaz A, Raza N. Dermatosis neglecta in a case of multiple fractures, shoulder dislocation and radial nerve palsy in a 35-year-old man: a case report. J Med Case Rep 2008; 2:347. [PMID: 19014627 PMCID: PMC2596164 DOI: 10.1186/1752-1947-2-347] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2008] [Accepted: 11/17/2008] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Dermatosis neglecta is an often misdiagnosed and under-diagnosed condition. In dermatosis neglecta, a progressive accumulation of sebum, sweat, keratin and other dirt and debris, occurs due to inadequate local hygiene resulting in a localized hyperpigmented patch or a verrucous plaque. Vigorous rubbing with alcohol-soaked gauze or soap and water results in a complete resolution of the lesion. This is the first case of dermatosis neglecta reported in a patient with multiple traumatic injuries. CASE PRESENTATION We report a case of a 35-year-old male Caucasian of Pakistani origin, with multiple fractures, neurological deficit and immobility sustained in a fall, leading to the development of dermatosis neglecta of the left hand. CONCLUSION Early and prompt clinical recognition of this condition eliminates the need for aggressive diagnostic and therapeutic procedures.
Collapse
Affiliation(s)
| | - Amer Ejaz
- Skin department, Combined Military Hospital, Kharian Cantt, 75500, Pakistan
| | - Naeem Raza
- Skin department, Combined Military Hospital, Kharian Cantt, 75500, Pakistan
| |
Collapse
|
26
|
Jameel K, Ejaz A, Sohail M, Rahman SB. Value of transverse section scalp biopsy in alopecia areata - a clinicopathological correlation. J Coll Physicians Surg Pak 2008; 18:338-41. [PMID: 18760043 DOI: 06.2008/jcpsp.338341] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 03/13/2007] [Accepted: 03/25/2008] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To correlate the histopathological features of alopecia areata with clinical stage by means of transverse sectioned scalp biopsy specimens, in terms of extent and duration of disease. STUDY DESIGN Cross-sectional. PLACE AND DURATION OF STUDY Department of Dermatology, Combined Military Hospital, Kharian Cantonment, Pakistan, from January 2002 to December 2004. PATIENTS AND METHODS Fifty consecutive patients with alopecia areata were included in the study. Four millimeter punch biopsy was taken and representative horizontal sections from lower and upper dermis were examined. Patients were divided according to disease extent i.e. Group I (<25% of scalp surface area), Group II (25 - 75% of scalp surface area) and Group III (>75% of scalp surface area including alopecia totalis and universalis). Patients were also analyzed according to the disease duration, i.e. 0-6 months, > 6-12 months, > 1-5 years and > 5 years. Follicular unit counts and density / mm2, terminal to vellus hair ratio, anagen to telogen ratio, cellular infiltrate and fibrosis were measured to assess the diagnosis and prognosis of disease. Chi-square test was used to assess statistical significance. RESULTS Diagnosis of alopecia areata could be made in 82% of biopsies. Follicular unit counts and density per mm2 decreased with the disease duration (p=0.01). Catagen and telogen hair follicle counts increased with disease duration (p=0.0001). Cellular infiltrate decreased and fibrosis increased with the duration of disease (p=0.0001). Anagen telogen ratio and terminal to vellus hair ratio inverted in long-standing disease. CONCLUSION Transverse section scalp biopsy can help in the diagnosis of alopecia areata and the disease stage can be predicted by analyzing the histopathological findings quantitatively.
Collapse
Affiliation(s)
- Khalid Jameel
- Department of Dermatology, Combined Military Hospital, Kharian Cantt
| | | | | | | |
Collapse
|
27
|
Ejaz A, Raza N, Iftikhar N, Muzzafar F. Comparison of 30% salicylic acid with Jessner's solution for superficial chemical peeling in epidermal melasma. J Coll Physicians Surg Pak 2008; 18:205-8. [PMID: 18474151 DOI: 04.2008/jcpsp.205208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 05/21/2006] [Accepted: 03/06/2008] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To compare the efficacy and safety of Jessner's solution with 30% salicylic acid as superficial chemical peeling agents in treating epidermal melasma in Asian skin. STUDY DESIGN Double blind, randomized, interventional comparative study. PLACE AND DURATION OF STUDY Department of Dermatology, Combined Military Hospital, Malir Cantt, Karachi, from January to December 2004. PATIENTS AND METHODS Sixty consenting patients with epidermal melasma were randomly divided into two groups. Group A was treated with Jessner's solution and Group B with 30% salicylic acid. Baseline Melasma Area Severity Index (MASI) score was noted and peeling started at 2-weekly intervals. Sunscreen in morning and moisturizer at night were prescribed in all patients. MASI score and adverse effects were recorded biweekly. Treatment was stopped at 12 weeks and patients were followed-up at 4 weekly intervals for further 12 weeks. Final MASI score and adverse effects were noted at the end of follow-up period. Mean MASI scores were compared using paired sample t-test and one-way ANOVA. RESULTS Difference in baseline, treatment end and follow-up end MASI scores was not statistically significant between the two groups (p 0.54, 0.26, and 0.55 respectively). On the other hand, within group analysis of difference between pre and posttreatment MASI score was highly significant in both groups (p<0.0001). Adverse effects were mild and comparable in both groups. CONCLUSION Jessner's solution and 30% salicylic acid are equally effective and safe peeling agents for use in epidermal melasma in Asian skin.
Collapse
Affiliation(s)
- Amer Ejaz
- Department of Dermatology, Combined Military Hospital, Kharian Cantonment.
| | | | | | | |
Collapse
|
28
|
Ejaz A, Haqnawaz K, Hussain Z, Butt R, Awan ZI, Bux H. Treatment of uncomplicated plasmodium falciparum malaria with quinine-doxycycline combination therapy. J PAK MED ASSOC 2007; 57:502-505. [PMID: 17990426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To assess the efficacy and tolerability of quinine-doxycycline combination therapy in uncomplicated falciparum malaria in terms of malarial parasite clearance from peripheral blood. METHODS One hundred adult males were included in the study. Malarial parasite counts in peripheral blood films were determined at the time of admission and then 12 hourly until clearance and thereafter weekly for 28 days (4 weeks). Treatment was started with quinine sulphate 10 mg of salt/kg body weight 8 hourly orally for a minimum period of 3 days and maximum of 7 days along with doxycycline 100 mg 12 hourly orally for 7 days. Primary efficacy outcome measure was early treatment failure, whereas secondary efficacy outcome measure was late treatment failure. Tolerability outcome measure was the development of treatment related adverse effects resulting in discontinuation from the study. RESULTS The primary efficacy outcome measure of the study i.e. malarial parasite index declined from a mean of 6.34 (SD +/- 2.83) before treatment to zero at day 7 of treatment. Parasite clearance time was 1-7 days (mean 3.58, SD +/- 1.28). Mean duration of quinine treatment till clearance of malarial parasites was 4.63 days (SD +/- 1.38). Mean duration of fever was 2.96 days (range 1 to 6 days). There was no early or late treatment failure. There was no relapse during the 28 days follow up period. Drug related side effects were mild and did not warrant discontinuation of treatment in any patient. CONCLUSION Quinine-doxycycline combination is effective in southern Pakistan. Randomized controlled trials are needed to further validate the claim.
Collapse
Affiliation(s)
- Amer Ejaz
- Combined Military Hospital, Kharian Cantt, Karachi
| | | | | | | | | | | |
Collapse
|
29
|
Ejaz A, Raza N, Iftikhar N. Recurrent cutaneous leishmaniasis presenting as sporotrichoid abscesses: a rare presentation near Afghanistan border. Dermatol Online J 2007; 13:15. [PMID: 17498434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023] Open
Abstract
Cutaneous leishmaniasis caused by Leishmania tropica and Leishmania major is endemic in Pakistan and is the second most prevalent vector-borne disease in the country (after malaria). We report a case of non-ulcerating, sporotrichoid cutaneous leishmaniasis that recurred 2 years after successful treatment of two typical leishmaniasis ulcers. The patient came from Kohat, a border town in the northwestern region of Pakistan about 50 miles east of Afghanistan. It is important for physicians to be familiar with unusual presentations of this common condition.
Collapse
Affiliation(s)
- Amer Ejaz
- Combined Military Hospital, Kharian Cantt, Pakistan.
| | | | | |
Collapse
|
30
|
Raza N, Ejaz A, Ahmed MK. Knowledge, attitude and practice regarding dandruff among soldiers. J Coll Physicians Surg Pak 2007; 17:128-31. [PMID: 17374295 DOI: 03.2007/jcpsp.128131] [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] [Received: 09/18/2006] [Accepted: 02/10/2007] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To assess the knowledge, attitude and practice regarding dandruff among soldiers. DESIGN Cross-sectional study. PLACE AND DURATION OF STUDY Departments of Dermatology at Combined Military Hospitals, Abbottabad, Malir and Gujranwala from January 2006 to March 2006. PATIENTS AND METHODS Serving male soldiers posted at Abbottabad, Malir and Gujranwala Cantonments were included in the study. Convenience sampling was used to distribute the questionnaire. All soldiers included in the study were asked or assisted by the trained staff to fill the close-ended questionnaire in Urdu, which included information about demographic profile and questions relevant to the objectives of the study. The ethical requirements for the study were fulfilled. SPSS-10 was used for data management. RESULTS A total of 800 serving male soldiers were surveyed. Five hundred and twenty-one soldiers (65.1%) answered yes to dandruff, whereas 279 (34.9%) replied in negative. Dandruff was considered a disease by 433 (83.1%) respondents. Hair fall (n=392, 75.2%) and scalp itching (n=380, 72.9%) were the common symptoms and 330 (63.3%) respondents were embarrassed by dandruff. Bad water (n=93, 17.8%), winter (n=40, 07.6%) and lack of sleep (n=30, 05.7%) were considered the most common causes of dandruff. Majority of the individuals (n=487, 93.4%) used different hair oils and household remedies for the treatment of dandruff. One hundred and fourteen (21.9%) and 50 (09.6%) participants consulted doctors and traditional healers respectively for their dandruff. Advertisements in electronic or print media and wall hoardings etc. influenced 213 (40.9%) respondents to use various anti-dandruff shampoos, hair tonics and oils. CONCLUSION Dandruff is a common problem and there is a need for education programmes and formulation of a policy regarding the positive role of media on health matters.
Collapse
Affiliation(s)
- Naeem Raza
- Department of Dermatology, Combined Military Hospital, Abbottabad.
| | | | | |
Collapse
|
31
|
Raza N, Qadir SNR, Ejaz A. Epidemiology of erythema ab igne at a moderately cold weather station. J PAK MED ASSOC 2007; 57:146-8. [PMID: 17432021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Erythema ab igne is a localized red brown reticular pigmentation, resulting from chronic, repetitive exposure to sub maximal heat, insufficient to cause burn. A study was carried out at the dermatology outpatient department of Combined Military Hospital, Abbottabad during January-April 2005 with the purpose to see frequency of erythema ab igne. Fourteen patients were identified, interviewed and examined in detail. Nine were females, eight of them housewives, and five were males. Age of the patients ranged from 9 to 60 years with a mean of 36.5 +/- 14.8 years. Body Mass Index (BMI) of the patients ranged from 13.5 to 33.5, six of them were in the BMI range of between 25.1 and 30. Nine patients belonged to rural areas. Erythema ab igne was not associated with thyroid disease or any other systemic or psychiatric illness.
Collapse
Affiliation(s)
- Naeem Raza
- Department of Dermatology, Combined Military Hospital, Kharian, Pakistan
| | | | | |
Collapse
|
32
|
Ejaz A, Raza N, Iftikhar N. Recurrent cutaneous leishmaniasis presenting as sporotrichoid abscesses: A rare presentation near Afghanistan border. Dermatol Online J 2007. [DOI: 10.5070/d34zz1k7jx] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
|
33
|
Raza N, Ejaz A. Progressive symmetrical erythrokeratoderma with perioral involvement. J Coll Physicians Surg Pak 2006; 16:729-31. [PMID: 17052427 DOI: 11.2006/jcpsp.729731] [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] [Received: 04/17/2006] [Accepted: 09/18/2006] [Indexed: 11/22/2022]
Abstract
Erythrokeratodermas are inherited or sporadic disorders of keratinization, with many variants. Progressive symmetrical erythrokeratoderma presents as large, erythematous or hyperpigmented, hyperkeratotic, fixed symmetrical plaques over various parts of the body along with many other inconsistent features. Periorificial keratotic lesions have very rarely been reported in progressive symmetrical erythrokeratodermas. We report a 9 years old boy with progressive symmetrical erythrokeratoderma having perioral involvement besides fixed hyperpigmented, keratotic plaques. He was started with oral etretinate but he stopped the treatment due to no-response after two weeks and is presently using topical keratolytics without marked improvement.
Collapse
Affiliation(s)
- Naeem Raza
- Department of Dermatology, Combined Military Hospital, Abbottabad.
| | | |
Collapse
|
34
|
Raza N, Sajid MUD, Ejaz A. Chilblains at Abbottabad, a moderately cold weather station. J Ayub Med Coll Abbottabad 2006; 18:25-8. [PMID: 17348308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
BACKGROUND Chilblains are quite often seen in various parts, in particular cold weather areas of Pakistan. Unfortunately, no studies have so far been carried out in Pakistan, to determine epidemiological aspects of chilblains. The objective of this study was to see the epidemiological patterns of chilblains at a moderately cold weather station. METHODS The study was conducted at Dermatology out patient department of Combined Military Hospital, Abbottabad from 1 Dec 2004 to 31 Mar 2005. All the patients fulfilling clinical criteria for the diagnosis of chilblains were registered. Every patient was interviewed in detail followed by thorough physical examination. Complete Blood Count, Urine Routine Examination and Anti Nuclear Factor were carried out in only those patients, having the disease of more than 3 years duration. A pre-designed proforma was filled separately for each patient. RESULTS Out of 111 patients, 67 (60.4%) males and 44 (39.6%) females were registered with the diagnosis of chilblains. Fifty nine (53.2%) patients were locals and 52 (46.8%) were non locals. Out door workers were 75 (67.6%). Onset in majority of the patients (42.3%) was in the age group 11-20 years. Family history of chilblains was present in 25 (22.5%) patients and 8 patients (7.2%) were smokers. The disease of longer duration was more common in females and locals. CONCLUSION At moderately cold weather areas, out door workers and young adolescents are more likely to develop Chilblains. The disease of longer duration is more common among females and local residents. On the other hand, first episode or the disease of shorter duration is more common among non locals at moderately cold weather stations because of poor acclimatization and inadequate protection.
Collapse
Affiliation(s)
- Naeem Raza
- Combined Military Hospitals, Abbottabad, Pakistan.
| | | | | |
Collapse
|
35
|
Ejaz A, Awan Z. Scrofuloderma neck with chest wall abscess. J Coll Physicians Surg Pak 2006; 16:420-1. [PMID: 16787621 DOI: 6.2006/jcpsp.420421] [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] [Received: 04/27/2005] [Accepted: 05/10/2006] [Indexed: 11/04/2022]
Abstract
Cutaneous tuberculosis (TB) is among the uncommon varieties of tuberculosis but it is also on the rise, commensurate with the general resurgence of the disease. A case of scrofuloderma of neck with tuberculous abscess of anterior chest wall is, hereby, reported. The patient presented with a non-healing ulcer of neck with swelling of anterior chest wall, which responded to antituberculous treatment. This complication of scrofuloderma neck is very rare and should be kept in mind in the differential diagnosis of such lesions.
Collapse
Affiliation(s)
- Amer Ejaz
- Department of Dermatology, Combined Military Hospital, Kharian Cantt.
| | | |
Collapse
|
36
|
Raza N, Ejaz A, Hussain S. Rickets in xeroderma pigmentosum. J Coll Physicians Surg Pak 2006; 15:816-8. [PMID: 16398980 DOI: 12.2005/jcpsp.816818] [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] [Received: 03/29/2005] [Accepted: 09/22/2005] [Indexed: 11/23/2022]
Abstract
Xeroderma pigmentosum patients are advised to strictly avoid sun exposure to prevent ultraviolet-induced DNA damage. We describe a 2 1/2 years old boy having xeroderma pigmentosum, who also developed rickets. He was given one injection of vitamin D along with dietary vitamin D supplements to which he responded. He is being followed- up regularly in outdoor clinic with the advice to the parents to continue dietary vitamin D supplements and to avoid sun exposure.
Collapse
Affiliation(s)
- Naeem Raza
- Department of Dermatology, Combined Military Hospital, Abbottabad.
| | | | | |
Collapse
|
37
|
Raza N, Dar NR, Ejaz A. Simultaneous onset of herpes zoster in a father and son. J Ayub Med Coll Abbottabad 2006; 18:64-5. [PMID: 16773975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The Varicella Zoster virus persists in sensory nerve ganglion cells after chicken pox and gets reactivated to cause herpes zoster after variable periods of time as a result of waning of specific cellular immunity. Susceptible contacts of herpes zoster can develop chicken pox and very rarely herpes zoster. We report an interesting case of a father and his son who developed herpes zoster simultaneously without any obvious common predisposition and discuss the possible underlying mechanism.
Collapse
Affiliation(s)
- Naeem Raza
- Department of Dermatology, Combined Military Hospital, Abbottabad.
| | | | | |
Collapse
|
38
|
Abstract
Cutaneous Leishmaniasis is endemic in certain areas of Pakistan, with the wet form of the disease being the most prevalent. It has a number of morphological variants, which are dependent on the immune status of the host, the subspecies of the Leishmania, and also, to some extent, on the site of involvement. We describe here a case of Leishmaniasis showing two very rare variants, whitlow and paronychial lesions, occurring concurrently with sporotrichoid spread. The patient responded to intramuscular sodium stibogluconate with resolution of the skin lesions.
Collapse
Affiliation(s)
- Nadia Iftikhar
- Department of Dermatology, Military Hospital, Rawalpindi, Pakistan.
| | | | | |
Collapse
|