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Malik F, Weisman MH. Sacroiliitis in inflammatory bowel disease. Curr Opin Rheumatol 2024:00002281-990000000-00114. [PMID: 38687285 DOI: 10.1097/bor.0000000000001017] [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: 05/02/2024]
Abstract
PURPOSE OF REVIEW This review summarizes the recent evidence regarding the epidemiology of inflammatory bowel disease (IBD) associated sacroiliitis, including the prevalence, pathogenesis, role of imaging, and therapeutic challenges. RECENT FINDINGS Sacroiliitis is an underappreciated musculoskeletal manifestation of IBD, a chronic inflammatory condition of the gut affecting the younger population. Untreated sacroiliitis can lead to joint destruction and chronic pain, further adding to morbidity in IBD patients. Recent publications suggest sacroiliitis can be detected on abdominal imaging obtained in IBD patients to study bowel disease, but only a small fraction of these patients were seen by rheumatologists. Early detection of IBD-associated sacroiliitis could be achieved by utilization of clinical screening tools in IBD clinics, careful examination of existing computed tomography and MRI studies, and timely referral to rheumatologist for further evaluation and treatment. Current treatment approaches for IBD and sacroiliitis include several targeted biologic therapies, but IBD-associated sacroiliitis has limited options, as these therapies may not overlap in both conditions. SUMMARY With the advances in imaging, sacroiliitis is an increasingly recognized comorbidity in IBD patients. Future studies focusing on this unique patient population will expand our understanding of complex pathophysiology of IBD-associated sacroiliitis and lead to identification of novel targeted therapies for this condition.
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Affiliation(s)
- Fardina Malik
- Division of Rheumatology, New York University Grossman School of Medicine, New York, New York
| | - Michael H Weisman
- Division of Rheumatology, Stanford University School of Medicine, Stanford, California, USA
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Moniruzzaman M, Koli A, Malik F, Islam S. Association between body mass index (BMI) and severity of coronary artery disease in young onset acute coronary syndrome (ACS). Eur Heart J 2023. [DOI: 10.1093/eurheartj/ehac779.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
A high body mass index (BMI) is seems to be associated with an increased incidence of coronary artery disease. If the affected person is young, the consequences are more tragic. There are variable information on the relation of incidence and severity of coronary artery disease in high BMI populations. We have examined the association between BMI and severity of coronary artery disease in young onset Acute Coronary Syndrome (ACS).
Methods
In this prospective observational study a total number of 150 patients, aged ≤45 years presented with acute coronary syndrome were enrolled to analyze association between Body Mass Index (BMI) and severity of coronary artery disease.
Results
The mean BMI in male was 24.6±3.6 and the mean BMI in female was 25.4±3.3. Among the 150 patients, 2(1.3%) was underweight, 78(52%) was normal, 60(40%) was overweight & 10(6.7%) was obese. All underweighted patients were diagnosed as STEMI. Among the normal BMI patients, 18(23.1%) had UA, 12(15.4%) had NSTEMI & 48 (61.5%) had STEMI. Among the overweight patients, 23(38.3%) had UA, 9(15%) had NSTEMI & 28(46.7%) had STEMI. And among the obese patients, 4(40%) had UA, 1 (10%) had NSTEMI & 5(50%) had STEMI. Considering involving coronary artery, left main coronary artery involvement was 0(0%), 6 (7.7%), 5 (8.3%) & 0(0%) in underweight, normal, overweight & obese patients respectively. Left anterior descending coronary artery involvement was 2(100%), 54 (69%), 45 (75%) & 7 (70%) in underweight, normal, overweight & obese patients respectively. Left circumflex coronary artery involvement was 1(50%), 33 (42%), 25 (41.7%) & 1 (9%) in underweight, normal, overweight & obese patients respectively. And right coronary artery involvement was 1(50%), 35 (44.9%), 31 (51.7%) & 5 (50%) in underweight, normal, overweight & obese patients respectively. In underweight patients 1(50%) had SVD and 1 (50%) had TVD. In normal BMI patients 40 (51.3%) had SVD, 11(14.1%) had DVD and 19 (24.4%) had TVD. In overweight patients 27 (45%) had SVD, 15 (25%) had DVD and 13 (21.7%) had TVD. And in obese patients 5 (50%) had SVD, 3(30%) had DVD and 0 (0%) had TVD. In all BMI group SVD was more common.
Conclusion
There is no statistically significant differences in severity of coronary artery in respect to body mass index (BMI), in patients presented with acute coronary syndrome.
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Affiliation(s)
- M Moniruzzaman
- Sheikh Fazilatunnessa Mujib Memorial KPJ Specialized Hospital , Dhaka , Bangladesh
| | - A Koli
- Khwaja Yunus Ali Medical College and Hospital, Medicine , Sirajganj , Bangladesh
| | - F Malik
- National Heart Foundation Hospital & Research Institute, Cardiology , Dhaka , Bangladesh
| | - S Islam
- Khwaja Yunus Ali Medical College and Hospital, Medicine , Sirajganj , Bangladesh
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Malik F, Rossi N, Barker JR, Bernard C, Ayathamattam J. 1186 IMPROVED PERFORMANCE AGAINST SSNAP PARAMETERS FOR THROMBOLYSED STROKE PATIENTS FOLLOWING CHANGES IN PRACTICE. Age Ageing 2023. [DOI: 10.1093/ageing/afac322.107] [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: 01/17/2023] Open
Abstract
Abstract
Background
The CQC inspection of the Royal Lancaster Infirmary (RLI) in May 2021 rated the performance of the stroke department unsatisfactory, leading to a number of changes. A retrospective audit was performed to determine the impact of these changes for thrombolysed stroke patients.
Aim
This retrospective audit assessed the performance of the stroke department at the RLI against the parameters set by the ‘Sentinel Stroke National Audit Program’ (SSNAP), comparing 6-month periods before and after the CQC inspection in May 2021.
Method
Using electronic medical records and SSNAP data, we reviewed every thrombolysed stroke patient at the RLI between November 2020 until April 2021 and from May 2021 until November 2021, assessing 10 parameters and comparing the results with SSNAP targets. Since May 2021, changes to practice introduced included opening a new, larger stroke unit located directly opposite the Emergency Department, ring-fencing stroke beds, doubling the number of stroke specialists and stroke consultants reviewing all suspected stroke patients face-to-face within working hours.
Results
46 patients were thrombolysed with 42 confirmed as having had ischaemic strokes on subsequent MRI imaging. All patients were discussed with a stroke consultant before thrombolysis. Mean time from arrival to CT improved from 51 to 34.5 minutes, admission to stroke unit from 7hr53 to 4hr36 and to thrombolysis from 2hr18 to 1hr22. The number of thrombolysis complications decreased from 5 to 2. Since the changes, the SSNAP grade for stroke unit admission improved from C to A and specialist assessments from E to B.
Conclusion
The changes implemented following the May 2021 CQC inspection have had a positive impact on the care of thrombolysed stroke patients and overall SSNAP grades at RLI. Improvements are still required and the next steps include improving the efficiency of thrombolysis times and further improving SSNAP grades.
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Affiliation(s)
- F Malik
- Royal Lancaster Infirmary Department of Stroke Medicine,
| | - N Rossi
- Royal Lancaster Infirmary Department of Stroke Medicine,
| | - J R Barker
- Royal Lancaster Infirmary Department of Stroke Medicine,
| | - C Bernard
- Royal Lancaster Infirmary Department of Stroke Medicine,
| | - J Ayathamattam
- Royal Lancaster Infirmary Department of Stroke Medicine,
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Maldarelli GA, Metz M, Funez-dePagnier G, Lavergne A, Lai D, Chang A, Malik F, de Vlaminck I, Longman RS. 494. Enteric bacteria are immune-reactive in patients with Crohn's disease with extraintestinal manifestations. Open Forum Infect Dis 2022. [PMCID: PMC9752134 DOI: 10.1093/ofid/ofac492.552] [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: 12/23/2022] Open
Abstract
Background Bacterial constituents of the intestinal microbiota can contribute to local and systemic inflammatory diseases. Crohn's disease (CD), a type of inflammatory bowel disease, can result in extraintestinal manifestations (EIM) including peripheral (CD-SpA) and axial spondyloarthritis (CD-AxSpA). Microbial contributors to CD pathogenesis can be identified by flow cytometric sorting and 16S sequencing of bacteria recognized by mucosal IgA. We expand this technique by incubating fecal samples with autologous sera, capturing bacterial species recognized by circulating IgG in a process called IgG-seq. We hypothesize that these systemically-recognized enteric bacteria are linked to development of CD-EIM. Methods Fecal samples from individuals with CD were sorted into IgG-positive and negative populations. DNA was extracted from each population, 16S sequencing performed, and sequences processed with QIIME2. Intestinal coating index (ICI) was calculated at the genus level. Serum cell-free DNA sequencing (cfDNA) was performed for a subset of samples. Results IgG-seq was conducted on 86 CD, 41 CD-SpA, and 16 CD-AxSpA samples. PCoA analysis demonstrates significant differences in microbiome composition in the three groups (P = 0.013, PERMANOVA). Relative abundances of Escherichia-Shigella and Ruminococcus are positively correlated with joint disease activity. Analysis of IgG ICI for genera present in > 10% of patients demonstrates overrepresentation of Ruminococcus, Escherichia-Shigella, and Bacteroides in IgG-recognized fractions. IgG recognition of bacteria does not cluster specifically by CD or EIM severity. cfDNA sequencing demonstrates no Ruminococcus DNA in serum, whereas E. coli DNA was detected in multiple patient sera. Conclusion IgG-seq is a robust method for identifying immune-reactive enteric bacteria; our results highlight the link between immune response to enteric bacterial genera, such as Escherichia-Shigella and Ruminococcus, and joint disease activity in CD-SpA and CD-AxSpA. While Escherichia-Shigella may induce immunity by breaching the mucosal barrier, the absence of Ruminococcus in serum cfDNA suggests immune activation at barrier sites. Further studies are needed to characterize the strain-specific features that underlie our findings. Disclosures Fardina Malik, MD, Pfizer: Advisor/Consultant Iwijn de Vlaminck, PhD, GenDX: Advisor/Consultant|GenDX: Board Member|Kanvas Biosciences: Board Member|Kanvas Biosciences: Ownership Interest|Karius Inc.: Board Member|Karius Inc.: Ownership Interest|Viracor Eurofins: Advisor/Consultant Randy S. Longman, MD, PhD, Pfizer: Advisor/Consultant.
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Affiliation(s)
| | - Maeva Metz
- Jill Roberts Institute for IBD Research, Weill Cornell Medicine, New York, New York
| | - Gabriela Funez-dePagnier
- Jill Roberts Center for IBD, Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Alexa Lavergne
- Jill Roberts Center for IBD, Division of Gastroenterology and Hepatology, Department of Medicine, Weill Cornell Medicine, New York, New York
| | - Daniel Lai
- Weill Cornell Medical College – Cornell University, New York, New York
| | - Adrienne Chang
- Meinig School of Biomedical Engineering – Cornell University, Ithaca, New York
| | - Fardina Malik
- NYU Grossman School of Medicine, Division of Rheumatology, New York, New York
| | - Iwijn de Vlaminck
- Meinig School of Biomedical Engineering – Cornell University, Ithaca, New York
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Malik F, Wadhwa B. Clinical and Experimental investigation of AKT1/2/3 isoforms indicated non-redundant isoform specific role in driving stemness and Cisplatin resistance in TNBCs. Eur J Cancer 2022. [DOI: 10.1016/s0959-8049(22)01582-9] [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: 11/20/2022]
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MEADE T, Côté J, Lyons L, Twomey P, O'Riordan A, Watson A, O'Regan J, Fitzgerald T, Malik F, Clince M, Teh J, Holian J, Murray P. POS-072 A PROSPECTIVE AUDIT OF THE CLINICAL IMPLEMENTATION OF URINE NEUTROPHIL GELATINASE-ASSOCIATED LIPOCALIN (uNGAL) AS A BIOMARKER OF ACUTE KIDNEY INJURY IN HOSPITALISED PATIENTS. Kidney Int Rep 2022. [DOI: 10.1016/j.ekir.2022.01.081] [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: 11/26/2022] Open
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Malik F, Kalimuddin M, Ishraquzzaman M, Mamun MA, Chowdhury MS, Dutta A, Rahman MH, Kanungo S, Laila N, Choudhury SR. Clinical Presentation, Management and In-Hospital Outcome of COVID-19 among Non-Healthcare Personnel and Healthcare Personnel in a Tertiary Cardiac Care Hospital. Mymensingh Med J 2021; 30:769-779. [PMID: 34226467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The huge numbers of non-healthcare personnel (non-HCP) who get infected by corona virus disease 2019 (COVID-19) not only paralyze health care systems but also put health care personnel (HCP) at potential risk globally. Objective of the study was to compare the Healthcare personnel (HCP) and non-HCP COVID-19 cases. This prospective observational study was carried out in National Heart Foundation Hospital and Research Institute of Bangladesh from March 08, 2020 to July 20, 2020. During this study period all admitted non-HCP who subsequently was diagnosed as COVID-19 positive by rRT-PCR and HCP of this hospital, who experienced fever or respiratory symptoms or came in close contact with COVID-19 patients at home or their workplace and become COVID-19 positive, were included. Out of 320 infected patients, 181(56.6%) patients were non-HCP and 139(43.4%) were HCP. Non-HCP were older than HCP (Mean age: 52.95±13.82 years vs. 34.08±11.11 years; p=0.001). Non-HCP were predominantly male and HCP were predominantly female (73.5% vs. 41% & 26.5% vs. 59%; p=0.001). Non-HCP had more risk factors and co-morbidities than HCP (p=0.001). Typical symptoms of COVID-19 such as fever and cough were prevalent in HCP. More aggressive treatment was required for non-HCP. Non-HCP had more severe disease and higher case fatality rate (9.4% vs. 0.7%; p=0.001) than HCP. Disease severity (OR 0.03, 95% CI 0.01-0.15) and DM (OR 0.09, 95% CI 0.01-0.94) were the independent predictor of mortality. Non-HCP was older in age, predominantly male and had more co-morbidities than HCP. Typical symptoms of COVID-19 were prevalent in HCP. Non-HCP had more severe disease and higher case fatality rate than HCP.
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Affiliation(s)
- F Malik
- Professor Fazila-Tun-Nesa Malik, Professor, Department of Cardiology, National Heart Foundation Hospital & Research Institute (NHFH&RI), Dhaka, Bangladesh; E-mail:
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Levine I, Malik F, Castillo G, Jaros B, Alaia E, Ream J, Scher JU, Hudesman D, Axelrad J. Prevalence, Predictors, and Disease Activity of Sacroiliitis Among Patients with Crohn's Disease. Inflamm Bowel Dis 2021; 27:809-815. [PMID: 32793977 DOI: 10.1093/ibd/izaa198] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Indexed: 12/14/2022]
Abstract
BACKGROUND Sacroiliitis is an inflammatory arthritis of the sacroiliac joints and is associated with inflammatory bowel disease (IBD). Yet, sacroiliitis often goes undiagnosed in IBD, and the clinical association between IBD disease activity and sacroiliitis is not well established. Patients with Crohn's disease (CD) often receive magnetic resonance enterography (MRE) to assess disease activity, affording clinicians the opportunity to evaluate for the presence of sacroiliitis. We aimed to identify the prevalence and disease characteristics associated with sacroiliitis in CD patients undergoing MRE. METHODS All CD patients undergoing MRE for any indication between 2014 and 2018 at an IBD referral center were identified. The MREs were reviewed for the presence of sacroiliitis based on bone marrow edema (BME) and structural lesions. We analyzed demographics, IBD characteristics, clinical and endoscopic disease activity, and management between CD patients with and without sacroiliitis. RESULTS Two hundred fifty-eight patients with CD underwent MRE during the study period. Overall, 17% of patients had MR evidence of sacroiliitis, of whom 73% demonstrated bone marrow edema. Female gender, back pain, and later age of CD diagnosis were associated with sacroiliitis (P = 0.05, P < 0.001, P = 0.04, respectively). Disease location and CD therapy were not associated with sacroiliitis on MRE. Clinical, endoscopic, and radiographic disease activity were not associated with sacroiliitis on MRE. CONCLUSION Sacroiliitis is a common comorbid condition in CD. With limited clinical clues and disease characteristics to suggest sacroiliitis, physicians may utilize MRE to identify sacroiliitis, especially in CD patients with back pain.
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Affiliation(s)
- Irving Levine
- NYU School of Medicine, Department of Medicine, New York, NY, USA
| | - Fardina Malik
- NYU Langone Health, Department of Medicine, Division of Rheumatology, New York, NY, USA
| | - Gabriel Castillo
- NYU School of Medicine, Department of Medicine, New York, NY, USA
| | - Brian Jaros
- NYU School of Medicine, Department of Medicine, New York, NY, USA
| | - Erin Alaia
- NYU Langone Health, Department of Radiology, New York, NY, USA
| | - Justin Ream
- NYU Langone Health, Department of Radiology, New York, NY, USA
| | - Jose U Scher
- NYU Langone Health, Department of Medicine, Division of Rheumatology, New York, NY, USA
| | - David Hudesman
- NYU Langone Health, Department of Medicine, Division of Gastroenterology, New York, NY, USA
| | - Jordan Axelrad
- NYU Langone Health, Department of Medicine, Division of Gastroenterology, New York, NY, USA
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Malik F, Scherl E, Weber U, Carrino JA, Epsten M, Wichuk S, Pedersen SJ, Paschke J, Schwartzman S, Kroeber G, Maksymowych WP, Longman R, Mandl LA. Utility of magnetic resonance imaging in Crohn's associated sacroiliitis: A cross-sectional study. Int J Rheum Dis 2021; 24:582-590. [PMID: 33528900 DOI: 10.1111/1756-185x.14081] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 12/14/2020] [Accepted: 01/09/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Prevalence of sacroiliitis in Crohn's disease (CD) is variable depending on defining criteria. This study utilized standardized sacroiliac joint (SIJ) magnetic resonance imaging (MRI) to identify sacroiliitis in CD patients and its association with clinical and serological markers. METHODS Consecutive adult subjects with CD prospectively enrolled from an inflammatory bowel disease clinic underwent SIJ MRI. Data collected included CD duration, history of joint/back pain, human leukocyte antigen-B27 status, Bath Ankylosing Spondylitis Metrology Index (BASMI), Bath Ankylosing Spondylitis Disease Activity Index, Harvey Bradshaw Index (HBI) for activity of CD, Ankylosing Spondylitis Disease Activity Score, and various serologic markers of inflammation. Three blinded readers reviewed MRIs for active and structural lesions according to the Spondyloarthritis Research Consortium of Canada modules. RESULTS Thirty-three CD patients were enrolled: 76% female, 80% White, median age 36.4 years (interquartile range 27.2-49.0), moderate CD activity (mean HBI 8.8 ± SD 4.5). Nineteen subjects (58%) reported any back pain, 13 of whom had inflammatory back pain. Four subjects (12%) showed sacroiliitis using global approach and 6 (18%) met Assessment of SpondyloArthritis international Society MRI criteria of sacroiliitis. Older age (mean 51.2 ± SD 12.5 vs. 37.2 ± 14; P = .04), history of dactylitis (50.0% vs. 3.4%, P = .03) and worse BASMI (4.1 ± 0.7 vs. 2.4 ± 0.8, P ≤ .001) were associated with MRI sacroiliitis; no serologic measure was associated. CONCLUSION There were 12%-18% of CD patients who had MRI evidence of sacroiliitis, which was not associated with back pain, CD activity or serologic measures. This data suggests that MRI is a useful modality to identify subclinical sacroiliitis in CD patients.
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Affiliation(s)
- Fardina Malik
- Division of Rheumatology, Department of Medicine, NYU School of Medicine, New York, NY, USA
| | - Ellen Scherl
- Weill Cornell Medicine, Jill Roberts Institute for Research in Inflammatory Bowel Disease, New York, NY, USA
| | - Ulrich Weber
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - John A Carrino
- Department of Radiology and Imaging, Hospital for Special Surgery and Weill Cornell Medicine, New York, NY, USA
| | | | | | - Susanne J Pedersen
- Copenhagen Center for Arthritis Research, Rigshospitalet-Glostrup, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Georg Kroeber
- Danish Hospital for Rheumatic Diseases, University Hospital of Southern Denmark, Sønderborg, Denmark
| | - Walter P Maksymowych
- University of Alberta, Edmonton, AB, Canada.,CARE Arthritis, Edmonton, AB, Canada
| | - Randy Longman
- Weill Cornell Medicine, Jill Roberts Institute for Research in Inflammatory Bowel Disease, New York, NY, USA
| | - Lisa A Mandl
- Division of Rheumatology, Department of Medicine, Hospital for Special Surgery, and Weill Cornell Medicine, New York, NY, USA
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Gorelik N, Tamizuddin F, Rodrigues TC, Beltran L, Malik F, Reddy S, Koo J, Subhas N, Gyftopoulos S. Comparison between radiography and magnetic resonance imaging for the detection of sacroiliitis in the initial diagnosis of axial spondyloarthritis: a cost-effectiveness study. Skeletal Radiol 2020; 49:1581-1588. [PMID: 32382977 DOI: 10.1007/s00256-020-03444-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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: 11/16/2019] [Revised: 03/03/2020] [Accepted: 04/05/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The purpose of our study was to determine the cost-effectiveness of radiography and MRI-based imaging strategies for the initial diagnosis of sacroiliitis in a hypothetical population with suspected axial spondyloarthritis. MATERIALS AND METHODS A decision analytic model from the health care system perspective for patients with inflammatory back pain suggestive of axial spondyloarthritis was used to evaluate the incremental cost-effectiveness of 3 imaging strategies for the sacroiliac joints over a 3-year horizon: radiography, MRI, and radiography followed by MRI. Comprehensive literature search and expert opinion provided input data on cost, probability, and utility estimates. The primary effectiveness outcome was quality-adjusted life-years (QALYs), with a willingness-to-pay threshold set to $100,000/QALY gained (2018 American dollars). RESULTS Radiography was the least costly strategy ($46,220). Radiography followed by MRI was the most effective strategy over a 3-year course (2.64 QALYs). Radiography was the most cost-effective strategy. MRI-based and radiography followed by MRI-based strategies were not found to be cost-effective imaging options for this patient population. Radiography remained the most cost-effective strategy over all willingness-to-pay thresholds up to $100,000. CONCLUSION Radiography is the most cost-effective imaging strategy for the initial diagnosis of sacroiliitis in patients with inflammatory back pain suspicious for axial spondyloarthritis.
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Affiliation(s)
- Natalia Gorelik
- Department of Radiology, McGill University Health Center, 1001 Decarie Blvd, Montreal, QC, H4A 3J1, Canada.
| | - Farah Tamizuddin
- New York University School of Medicine, 550 1st Avenue, New York, NY, 10016, USA
| | - Tatiane Cantarelli Rodrigues
- Department of Radiology, Hospital do Coração (HCor) and Teleimagem, Rua Desembargador Eliseu Guilherme 53 - 7th floor, São Paulo, SP, 04004-030, Brazil
| | - Luis Beltran
- Department of Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Fardina Malik
- Department of Rheumatology, NYU School of Medicine, 333 East 38th Street, 4th Floor, New York, NY, 10016, USA
| | - Soumya Reddy
- Department of Rheumatology, NYU School of Medicine, 333 East 38th Street, 4th Floor, New York, NY, 10016, USA
| | - James Koo
- Rusk Rehabilitation, NYU Langone Health, 333 East 38th Street, 5th Floor, New York, NY, 10016, USA
| | - Naveen Subhas
- Department of Radiology, Cleveland Clinic, 9500 Euclid Ave # A21, Cleveland, OH, 44195, USA
| | - Soterios Gyftopoulos
- Department of Radiology, NYU Langone Medical Center, 333 E 38th St, 6th Floor, New York, NY, 10016, USA
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Malik F, Middleton Z, Haque F, Tambe N, Roy R. P-273 Real-world experience of definitive chemoradiation in esophageal cancer: Correlation of tumour length, toxicity and disease control. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.04.355] [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: 11/25/2022] Open
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Tanner K, Malik F, Smith T, Cosgriff R, Medhurst N, Keogh R. P066 Development of an online tool to provide accessible and personalised information on life expectancy in cystic fibrosis. J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30402-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Malik F, Tanner K, Smith T, Cosgriff R, Medhurst N, Keogh R. P065 Perspectives on personalised life expectancy information and how it should be presented: a qualitative study. J Cyst Fibros 2020. [DOI: 10.1016/s1569-1993(20)30401-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: 11/30/2022]
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Qammar M, Malik Z, Malik F, Baig T, Chaudhary AJ. Antibacterial activity of Mg1-xNixO(x=0.5) nano-solid solution; experimental and computational approach. J Mol Struct 2019. [DOI: 10.1016/j.molstruc.2018.11.040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Abstract
SummaryThe intrahepatic kinetics of 111indium-labelled platelets have been studied using dynamic gamma camera scintigraphy immediately following injection. Platelets labelled in saline with mIn-oxine or 111In-acetylacetonate underwent rapidly reversible hepatic sequestration, indicating that they were “activated”. Platelets labelled in plasma with 111In-tropolonate, however, did not display this phenomenon. On the assumption that plasma-labelled platelets display a normal initial bio-distribution, mean intrahepatic platelet transit time, as a factor of the transit time of 99m-Tc labelled red cells, was 1.45 ± SE 0.12 (n = 6), implying the normal presence of a small intrahepatic platelet pool. Unlike the liver, transit through the spleen was not sensitive to the labelling medium; thus the mean intrasplenic transit time of plasma-labelled platelets was 9.3 ± SE 0.7 min (n = 10), and of saline-labelled platelets 9.5 ± SE 0.3 min (n = 8).
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Affiliation(s)
- A M Peters
- The Department of Diagnostic Radiology, Royal Postgraduate Medical School, London, UK
| | - S H Saverymuttu
- The Department of Medicine, Royal Postgraduate Medical School, London, UK
| | - F Malik
- The Department of Diagnostic Radiology, Royal Postgraduate Medical School, London, UK
| | - P W Ind
- The Department of Medicine, Royal Postgraduate Medical School, London, UK
| | - J P Lavender
- The Department of Diagnostic Radiology, Royal Postgraduate Medical School, London, UK
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Chan O, Moore L, Lai B, Jeong E, Nelson L, Malik F, Sykes J, Mathur S, Wu K. WS04.5 Predicting six-minute walk distance in adults with cystic fibrosis during hospitalisation. J Cyst Fibros 2017. [DOI: 10.1016/s1569-1993(17)30179-0] [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: 11/28/2022]
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Riaz H, Finlayson AE, Bashir S, Hussain S, Mahmood S, Malik F, Godman B. Prevalence of Vitamin D deficiency in Pakistan and implications for the future. Expert Rev Clin Pharmacol 2016; 9:329-38. [PMID: 26582317 DOI: 10.1586/17512433.2016.1122519] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS vitamin D deficiency (25-hydroxyvitamin D) affects over one billion people worldwide. Vitamin D deficiency results in progression of osteoporosis as well as other conditions. Previous studies have shown high rates of vitamin D deficiency in Pakistan despite appreciable levels of sunshine. However, none have assessed vitamin D deficiency across all age groups, genders, incomes, and locations to guide future strategies. METHODS Questionnaire and blood sampling among 4830 randomly selected citizens. RESULTS High levels of deficiency among all age groups, genders, income levels, and locations. Amongst the selected citizens, 53.5% had vitamin D deficiency, 31.2% had insufficient vitamin D, and only 15.3% normal vitamin D. CONCLUSION High rates of vitamin D deficiency in Pakistan despite high levels of sunshine and previous Food Acts asking for food fortification with vitamin D. Public health strategies are needed to address high deficiency rates, including food fortification, i.e. nurture, alongside increasing exposure to sunlight, i.e. nature. This will involve all key stakeholder groups.
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Affiliation(s)
- H Riaz
- a Faculty of Pharmacy , Sargodha University , Sargodha , Pakistan
| | - A E Finlayson
- b Green Templeton College , Oxford University , Oxford , UK.,c Nuffield Department of Primary Care Health Sciences , University of Oxford , Oxford , UK
| | - S Bashir
- a Faculty of Pharmacy , Sargodha University , Sargodha , Pakistan
| | - S Hussain
- d Drugs Control and Traditional Medicines Division, National Institute of Health , Islamabad , Pakistan
| | - S Mahmood
- e Quaid-i-Azam University , Islamabad , Pakistan
| | - F Malik
- d Drugs Control and Traditional Medicines Division, National Institute of Health , Islamabad , Pakistan
| | - B Godman
- f Department of Laboratory Medicine, Division of Clinical Pharmacology, Karolinska Institute , Karolinska University Hospital Huddinge , Stockholm , Sweden.,g Strathclyde Institute of Pharmacy and Biomedical Sciences , Strathclyde University , Glasgow , UK
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Mohamedali AM, Gäken J, Ahmed M, Malik F, Smith AE, Best S, Mian S, Gaymes T, Ireland R, Kulasekararaj AG, Mufti GJ. High concordance of genomic and cytogenetic aberrations between peripheral blood and bone marrow in myelodysplastic syndrome (MDS). Leukemia 2015; 29:1928-38. [DOI: 10.1038/leu.2015.110] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Revised: 03/24/2015] [Accepted: 04/16/2015] [Indexed: 12/12/2022]
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Shakoor S, Malik F, Hasan R. High proportion of multidrug resistant Mycobacterium tuberculosis among children in Pakistan. Int J Mycobacteriol 2015. [DOI: 10.1016/j.ijmyco.2014.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Kim G, Ouzounova M, Quraishi AA, Davis A, Tawakkol N, Clouthier SG, Malik F, Paulson AK, D'Angelo RC, Korkaya S, Baker TL, Esen ES, Prat A, Liu S, Kleer CG, Thomas DG, Wicha MS, Korkaya H. SOCS3-mediated regulation of inflammatory cytokines in PTEN and p53 inactivated triple negative breast cancer model. Oncogene 2014; 34:671-80. [PMID: 24531711 PMCID: PMC4285772 DOI: 10.1038/onc.2014.4] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [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: 09/27/2013] [Revised: 12/18/2013] [Accepted: 01/06/2014] [Indexed: 02/07/2023]
Abstract
Somatic mutations or deletions of TP53 and PTEN in ductal carcinoma in situ (DCIS) lesions have been implicated in progression to invasive ductal carcinomas. A recent molecular and mutational analysis of breast cancers revealed that inactivation of tumor suppressors, p53 and PTEN are strongly associated with triple negative breast cancer. In addition, these tumor suppressors play important roles in regulating self-renewal in normal and malignant stem cells. To investigate their role in breast carcinogenesis, we knocked down these genes in human mammary cells and in non-transformed MCF10A cells. p53 and PTEN knockdown synergized to activate pro-inflammatory IL6/Stat3/NF-κB signaling. This resulted in generation of highly metastatic EMT-like cancer stem cells (CSCs) resulting in tumors whose gene expression profile mimicked that found in basal/claudin-low molecular subtype within the triple negative breast tumors. Constitutive activation of this loop in transformed cells was dependent on proteolytic degradation of SOCS3 resulting in low levels of this protein in basal/claudin low cell lines and primary tumors. In non-transformed cells, transient activation of the IL6 inflammatory loop induced SOCS3 expression leading to pathway inactivation. In transformed cells, enforced expression of SOCS3 or interfering with IL6 pathway via IL6R blockade inhibited tumor growth and metastasis in mouse xenograft models. Furthermore, circulating tumor cells were significantly reduced in tumor bearing animals when treated with anti-IL6R antibodies. These studies uncover important connections between inflammation and carcinogenesis and suggest that blocking pro-inflammatory cytokines may be utilized as an attractive strategy to target triple negative breast tumors which currently lacks molecularly targeted therapies.
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Affiliation(s)
- G Kim
- 1] Comprehensive Cancer Center, Department of Internal medicine, University of Michigan, Ann Arbor, MI, USA [2] Department of Pathology, CHA Bundang Medical Center, CHA University, Seongnam 463-712, Gyeonggi, Republic of Korea
| | - M Ouzounova
- Comprehensive Cancer Center, Department of Internal medicine, University of Michigan, Ann Arbor, MI, USA
| | - A A Quraishi
- Comprehensive Cancer Center, Department of Internal medicine, University of Michigan, Ann Arbor, MI, USA
| | - A Davis
- Comprehensive Cancer Center, Department of Internal medicine, University of Michigan, Ann Arbor, MI, USA
| | - N Tawakkol
- Comprehensive Cancer Center, Department of Internal medicine, University of Michigan, Ann Arbor, MI, USA
| | - S G Clouthier
- Comprehensive Cancer Center, Department of Internal medicine, University of Michigan, Ann Arbor, MI, USA
| | - F Malik
- 1] Comprehensive Cancer Center, Department of Internal medicine, University of Michigan, Ann Arbor, MI, USA [2] Department of Cancer Pharmacology, Indian Institute of Integrative Medicine, Jammu, India
| | - A K Paulson
- Comprehensive Cancer Center, Department of Internal medicine, University of Michigan, Ann Arbor, MI, USA
| | - R C D'Angelo
- Comprehensive Cancer Center, Department of Internal medicine, University of Michigan, Ann Arbor, MI, USA
| | - S Korkaya
- Comprehensive Cancer Center, Department of Internal medicine, University of Michigan, Ann Arbor, MI, USA
| | - T L Baker
- Comprehensive Cancer Center, Department of Internal medicine, University of Michigan, Ann Arbor, MI, USA
| | - E S Esen
- Comprehensive Cancer Center, Department of Internal medicine, University of Michigan, Ann Arbor, MI, USA
| | - A Prat
- Translational Genomics Group, Vall d'Hebron Institute of Oncology, Barcelona, Spain
| | - S Liu
- Comprehensive Cancer Center, Department of Internal medicine, University of Michigan, Ann Arbor, MI, USA
| | - C G Kleer
- Department of Pathology, University of Michigan Medical School, Ann Arbor, USA
| | - D G Thomas
- Department of Pathology, University of Michigan Medical School, Ann Arbor, USA
| | - M S Wicha
- Comprehensive Cancer Center, Department of Internal medicine, University of Michigan, Ann Arbor, MI, USA
| | - H Korkaya
- Comprehensive Cancer Center, Department of Internal medicine, University of Michigan, Ann Arbor, MI, USA
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Kumar S, Guru SK, Pathania AS, Kumar A, Bhushan S, Malik F. Autophagy triggered by magnolol derivative negatively regulates angiogenesis. Cell Death Dis 2013; 4:e889. [PMID: 24176847 PMCID: PMC3920944 DOI: 10.1038/cddis.2013.399] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [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: 04/18/2013] [Revised: 07/06/2013] [Accepted: 08/20/2013] [Indexed: 12/19/2022]
Abstract
Angiogenesis has a key role in the tumor progression and metastasis; targeting endothelial cell proliferation has emerged as a promising therapeutic strategy for the prevention of cancer. Previous studies have revealed a complex association between the process of angiogenesis and autophagy and its outcome on tumorigenesis. Autophagy, also known as type-II cell death, has been identified as an alternative way of cell killing in apoptotic-resistant cancer cells. However, its involvement in chemoresistance and tumor promotion is also well known. In this study, we used a derivate of natural product magnolol (Ery5), a potent autophagy inducer, to study the association between the autophagy and angiogenesis in both in vitro and in vivo model system. We found that the robust autophagy triggered by Ery5, inhibited angiogenesis and caused cell death independent of the apoptosis in human umbilical cord vein endothelial cells and PC-3 cells. Ery5 induced autophagy effectively inhibited cell proliferation, migration, invasion and tube formation. We further demonstrated that Ery5-mediated autophagy and subsequent inhibition of angiogenesis was reversed when autophagy was inhibited through 3-methyl adenine and knocking down of key autophagy proteins ATG7 and microtubule-associated protein light chain 3. While evaluating the negative regulation of autophagy on angiogenesis, it was interesting to find that angiogenic environment produced by the treatment of VEGF and CoCl2 remarkably downregulated the autophagy and autophagic cell death induced by Ery5. These studies, while disclosing the vital role of autophagy in the regulation of angiogenesis, also suggest that the potent modulators of autophagy can lead to the development of effective therapeutics in apoptosis-resistant cancer.
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Affiliation(s)
- S Kumar
- 1] Department of Cancer Pharmacology, Indian Institute of Integrative Medicine, Canal Road Jammu, Jammu and Kashmir 180001, India [2] Academy of Scientific and Innovative Research (AcSIR), New Delhi 110001, India
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Ottenheijm C, Buck D, de Winter J, Ferrara C, Piroddi N, Tesi C, Jasper R, Malik F, Meng F, Stienen G, Beggs A, Labeit S, Poggesi C, Lawlor M, Granzier H. P.9.10 Deleting exon 55 from the nebulin gene induces severe muscle weakness in a mouse model for nemaline myopathy. Neuromuscul Disord 2013. [DOI: 10.1016/j.nmd.2013.06.523] [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]
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Abstract
Methotrexate (MTX), an antifolate drug, is the first-line disease-modifying agent for the treatment of rheumatoid arthritis (RA) worldwide. MTX has excellent long-term efficacy, tolerability and safety. Early initiation of MTX in patients with RA controls joint destruction and slows progression of disease. However, the clinical response to MTX and frequency of adverse effects from the drug exhibit marked interpatient variability. Over the past decade, there has been a quest to identify genetic markers that reliably predict MTX efficacy and toxicity and help optimize MTX therapy in RA; that is, the field of MTX pharmacogenetics. This review will summarize key pharmacogenetic studies examining SNPs in the genes encoding enzymes in the MTX cellular pathway and their association with MTX response in RA. As evident from this review, MTX pharmacogenetics in RA remains a muddled field, mostly due to inconsistent results from several small underpowered studies.
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Bausewein C, Malik F, Booth S, Higginson I. Recent developments in managing breathlessness: International researchers' meeting on Breathlessness in London, November 2006. Progress in Palliative Care 2013. [DOI: 10.1179/096992607x236434] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Akram M, Nazar M, Ghaffar A, Malik F, Ali N, Mujahid SA, Rajput MU,   M. Neutron Induced Fission Track Estimation of Uranium Concentration and Its Associated Health Hazards in Drinking Water of the Faisalabad Industrial City. ACTA ACUST UNITED AC 2013. [DOI: 10.4236/wjnst.2013.32009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Irfan S, Ahmad A, Guhar D, Khan E, Malik F, Mahmood S, Zafar A. Fluoroquinolone and macrolide co-resistance in clinical isolates of Campylobacter species: a 15-year study in Karachi, Pakistan. East Mediterr Health J 2012; 16:1226-30. [PMID: 24988396 DOI: 10.26719/2010.16.12.1226] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Accepted: 03/05/2009] [Indexed: 11/09/2022]
Abstract
Fluoroquinolone and macrolide antibiotics are generally considered as first-line drugs for the treatment of severe campylobacteriosis. This study was conducted to analyse the trend of erythromycin and ofloxacin resistance among Campylobacter spp. isolated from stool specimens over a period of 15 years (1992-2007) at The Aga Khan University clinical laboratory in Karachi, Pakistan. A total of 83 396 stool specimens were processed, with a 14% isolation rate for enteric pathogens. The isolation rate of Campylobacter spp. was low during 1992-93 (6%-13%), peaked in 1996 (46%), then ranged from 20% to 40%. We report a rising trend in ofloxacin resistance, re-emergence of erythromycin resistance and indications of co-resistance to both drugs in clinical isolates of Campylobacter spp.
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Affiliation(s)
- S Irfan
- Department of Pathology & Microbiology, Aga Khan University, Karachi, Pakistan
| | - A Ahmad
- Department of Pathology & Microbiology, Aga Khan University, Karachi, Pakistan
| | - D Guhar
- Department of Pathology & Microbiology, Aga Khan University, Karachi, Pakistan
| | - E Khan
- Department of Pathology & Microbiology, Aga Khan University, Karachi, Pakistan
| | - F Malik
- Department of Pathology & Microbiology, Aga Khan University, Karachi, Pakistan
| | - S Mahmood
- Department of Pathology & Microbiology, Aga Khan University, Karachi, Pakistan
| | - A Zafar
- Department of Pathology & Microbiology, Aga Khan University, Karachi, Pakistan
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Abstract
This retrospective study of 9,980 women who delivered at the James Paget Hospital, Norfolk, UK, over 5 years, aimed to primarily determine whether the incidence of hyperemesis gravidarum (HG) is higher in the presence of a female fetus. The results showed that more women with HG had a female fetus compared with women without HG. Also found was that heavy ketonuria was more prevalent in women with a female fetus compared with women with a male fetus, and the mean number of admissions per woman was also higher in women with a female fetus compared with women with a male fetus. It can be concluded that women presenting with HG are more likely to have a female fetus and that women with HG and a female fetus tend to a higher level of ketonuria and an increased number of hospital admissions.
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Affiliation(s)
- M Rashid
- Department of Obstetrics and Gynaecology, James Paget Hospital, Great Yarmouth, UK.
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Malik F, Russell A, Pannirselvam M, Hinken A, Thomsen K, Ardiana A, Godinez G, Jia Z, Saikali K, Chen M, Morgans D, Jasper J. The Fast Skeletal Troponin Activator, CK-2017357, Increases Muscle Function and Survival in SOD1 (G93A) Mice; a Model of ALS (P05.169). Neurology 2012. [DOI: 10.1212/wnl.78.1_meetingabstracts.p05.169] [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] Open
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Malik F, Akram M, Rajput MU. Measurement of natural radioactivity in sand samples collected along the bank of rivers Indus and Kabul in northern Pakistan. Radiat Prot Dosimetry 2011; 143:97-105. [PMID: 21062802 DOI: 10.1093/rpd/ncq356] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Radioactivity is a part of the natural environment. The presence of natural radioactivity in sand and other building materials results in internal and external exposure to the general public. Therefore, it is desirable to determine the concentration of naturally occurring radionuclides, namely (232)Th, (226)Ra and (40)K in sand, bricks and cement which are commonly used as building materials in Pakistan. In this context, sand samples were collected from 18 different locations covering an area of ∼1000 km(2) along the banks of river Indus (Ghazi to Jabba) and river Kabul (Nowshera to Kund) in the northern part of Pakistan, whereas bricks and cement samples were collected from local suppliers of the studied area. In order to measure the specific activities in these samples, a P-type coaxial high-purity germanium-based gamma-ray spectrometer was used. In sand samples, the average specific activities of (226)Ra, (232)Th, and (40)K were found to be 30.5±11.4, 53.2±19.5 and 531±49 Bq kg(-1), whereas in brick samples, specific activities of 30±14, 41±21 and 525±183 Bq kg(-1) were observed, respectively. In cement samples, measured specific activity values were 21±5, 14±3 and 231±30 Bq kg(-1), respectively. Radium equivalent activities were calculated and found to be 143.8±38.6, 124±49.8 and 56.69±7 Bq kg(-1) for sand, brick and cement samples, respectively. The annual mean effective dose for the studied sand samples was found to be 0.40 mSv. External and internal hazard indices were less than unity for all the studied samples. The present results have been compared with those reported in the literature.
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Affiliation(s)
- F Malik
- Physics Division, PINSTECH, P.O. Nilore, Islamabad, Pakistan.
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Topkara VK, Kondareddy S, Malik F, Wang IW, Mann DL, Ewald GA, Moazami N. Infectious complications in patients with left ventricular assist device: etiology and outcomes in the continuous-flow era. Ann Thorac Surg 2010; 90:1270-7. [PMID: 20868826 DOI: 10.1016/j.athoracsur.2010.04.093] [Citation(s) in RCA: 214] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2010] [Revised: 04/21/2010] [Accepted: 04/23/2010] [Indexed: 12/13/2022]
Abstract
BACKGROUND Continuous-flow left ventricular assist devices (LVAD) are increasingly being used in patients with end-stage heart failure and have largely replaced older generation pulsatile devices. While significant rates of infection have been reported in patients with pulsatile device support, incidence and outcomes of this complication for the continuous-flow device patients remain unknown. METHODS Between June 2005 and August 2009, 81 patients were implanted with continuous-flow LVADs at Washington University School of Medicine either as bridge to transplantation or as destination therapy. Outcomes of this study included incidence of postimplantation infection, types of infection, microbiologic profile, and association of postimplantation infections with clinical endpoints. RESULTS Forty-two patients (51.9%) had at least one type of infection on continuous-flow LVAD support with a mean follow-up period of 9.2 ± 9.2 months. Patients who had an infection on LVAD support had a significantly prolonged hospital stay (37.9 ± 32.0 versus 20.7 ± 23.0 days, p = 0.008) and a trend toward increased mortality (33.1% versus 18.7% at 2 years, respectively, log rank p = 0.102) compared with patients who did not. Subgroup analysis revealed that postimplantation sepsis was significantly associated with increased mortality in the continuous-flow LVAD cohort (61.9% versus 18.0% at 2 years, respectively, in septic and nonseptic patients, log rank p = 0.001). The majority of the sepsis cases occurred before hospital discharge, whereas most of the device related infections occurred after discharge. Resistant Staphylococcus and Pseudomonas species were the most common pathogens leading to device- and nondevice-related local infections. Development of driveline or pocket infection had no effect on survival in patients with continuous-flow assist device support (p = 0.193). CONCLUSIONS Even though better clinical outcomes have been achieved with the newer generation continuous-flow devices, infection complications-in particular sepsis-are still a major risk for patients with continuous-flow LVAD implantation. Prevention strategies with aggressive medical and surgical management of infections may increase survival and decrease morbidity among continuous-flow LVAD patients.
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Affiliation(s)
- Veli K Topkara
- Division of Cardiology, Center for Cardiovascular Research, Washington University School of Medicine, St. Louis, Missouri 63110, USA.
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Hernandez-Ilizaliturri FJ, Deeb G, Zinzani PL, Pileri SA, Malik F, Macon WR, Witzig TE, Goy A, Czuczman MS. Response of relapsed/refractory diffuse large B-cell lymphoma (DLBCL) with nongerminal center B-cell phenotype to lenalidomide (L) alone or in combination with rituximab (R). J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.8038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Malik F, Khawar R, Chaudhry HR, Humphreys GW. Emotion recognition and duration of untreated first-episode psychosis among patients in Pakistan. East Asian Arch Psychiatry 2010; 20:31-38. [PMID: 22351808] [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] [Indexed: 05/31/2023]
Abstract
OBJECTIVE To investigate the impact of duration of untreated psychosis on emotion recognition in patients with first-episode psychosis. METHODS A sample of 60 patients with schizophrenia, schizoaffective and substance-induced psychoses were selected from psychiatric inpatients and outpatients of 3 hospitals in Lahore and 1 in Faisalabad, Pakistan. Patients were divided into short (n = 28) and long (n = 32) duration of untreated psychosis groups, according to whether they had had symptoms for < 80 or ≥ 80 weeks, respectively. Emotion recognition ability was assessed with the help of the Urdu version of a computerised experimental FEEL (Facially Expressed Emotion Labeling) test using 6 basic emotional expressions that appeared on a computer screen followed by possible responses. RESULTS Patients with prolonged durations of untreated psychosis showed poorer performance in recognition of facial expressions of emotion than those with short durations of untreated psychosis. This was apparent in general and especially for expressions of anger, surprise, and sadness. First-episode psychosis patients showed higher accuracy rates for recognising positive as opposed to negative emotions. The duration of untreated psychosis correlated positively with positive symptoms of psychosis. Symptom distribution differed across categories of psychosis, but there were similarities in patients with schizophrenia and schizoaffective disorders. CONCLUSIONS These findings support recourse to early detection and intervention strategies in psychosis and provide valuable information on how first-episode psychosis patients behave in complex emotional and social situations.
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Affiliation(s)
- F Malik
- Department of Psychology, GC University, Lahore, Pakistan
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Abstract
Female sexual dysfunction (FSD) incorporates various sexual disorders including hypoactive sexual desire disorder, sexual arousal disorder, orgasmic and sexual pain disorders. Although many strategies have been formulated for the treatment of male sexual problems, FSD remains an area that warrants further research and trial studies to identify the most efficacious treatment options. Research has highlighted numerous pharmacological interventions that have been trialled and found to exhibit positive effects. These include hormonal therapies, prostaglandins, dopaminergic agonists, phosphodiesterase type-5 (PDE-5) inhibitors and melanocortin agonists.
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Affiliation(s)
- K Wylie
- Porterbrook Clinic, Sheffield, UK
| | - F Malik
- Porterbrook Clinic, Sheffield, UK
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Springham S, Malik F, Roshan M, Talebitaher A, Rawat R, Lee P. Ferrofluidic masking of solid state nuclear track detectors during etching. RADIAT MEAS 2009. [DOI: 10.1016/j.radmeas.2009.01.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Khawaja MR, Khawaja MR, Majeed A, Malik F, Merchant KA, Maqsood M, Malik R, Mazahir S, Naqvi H. Prescription pattern of benzodiazepines for inpatients at a tertiary care university hospital in Pakistan. J PAK MED ASSOC 2005; 55:259-63. [PMID: 16045100] [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: 05/03/2023]
Abstract
OBJECTIVE To determine the point prevalence of benzodiazepine prescriptions for inpatients at a tertiary care university hospital in Pakistan and to correlate it with prescription patterns of various specialties, indications and demographic variables of the patients. METHODS This 24-hours point prevalence study was done at The Aga Khan University Hospital, Karachi. By convenient random sampling, 208 inpatients were interviewed. Patients' files were also studied to record the drugs administered. Data was entered into questionnaires and analyzed by SPSS 10.0. RESULTS The point prevalence of the benzodiazepines was 21.2%. It was higher among males than females and among surgical than non-surgical patients. Midazolam was the most commonly used benzodiazepine, followed by Alprazolam and Lorazepam. Pre-anesthesia and psychiatric symptoms were the two most common indications. Oral route was used in 84% patients for drug administration and mean Valium equivalent dosage was 4.86 mg/day. Mean length of prescription was 3 days. Longer duration of hospitalization was a significant predictor of the requirement of benzodiazepine prescription (p-value = 0.020). CONCLUSION Prescription pattern of benzodiazepines at a tertiary care university hospital is similar to that reported in the developed countries through monitoring at various levels by physicians, clinical pharmacist and nursing staff. Data regarding the prescription pattern of benzodiazepines is scarce, and it needs to be expanded to formulate clear guidelines regarding their prescription.
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Uddin SN, Malik F, Bari MA, Siddiqui NI, Khan GK, Rahman S, Sadequzzaman M. Angiographic severity and extent of coronary artery disease in patients with type 2 diabetes mellitus. Mymensingh Med J 2005; 14:32-7. [PMID: 15695951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
Coronary angiographic characteristics of fifty patients with type 2 diabetes mellitus and coronary artery disease (CAD) were compared with fifty non diabetic patients with CAD. Type 2 diabetic patients undergoing clinically indicated elective coronary angiography were individually matched with fifty non diabetic coronary artery disease patients for age, sex and major risk factors. No significant difference was present between the mean age, presenting complains and other coronary risk factors between the two groups. Severity and extent of coronary artery involvement was assessed by a coronary artery score (CAS) using the segmental distribution method for coronary artery lesions and morphometric analysis of atherosclerotic lesion was done. Type 2 diabetic patients had a higher CAS (11.74+/-5.04 vs 8.72+/-4.87; P<0.001) as compared to the non-diabetic patients. Multivessel disease were more prevalent in both the groups (82% vs 68%; P>0.05) but diabetic patients had significantly higher number of triple vessel disease (58% vs. 38%; P<0.001). Normal coronary arteries and single vessel disease were more prevalent in non-diabetic patients (32% vs. 18%; P<0.05). As compared to non-diabetic group diabetic patients had a higher total number of diseased vessels (78.66% vs. 68%; P<0.01), a higher lesion per patient ratio (3.94+/-1.80 vs 3+/-1.67:P<0.001) and more proximal lesions (40.83% vs. 34.70%; P>.05) though not statistically significant. Morphometric analysis of coronary artery lesions revealed that diabetic patients had significantly higher number of multiple irregularity lesions (24.37% vs. 15.33%; P<0.01) and lesions were more obstructive (lesion involving 70-90% of coronary lumen: 70.53.% vs. 57.33%; P<0.05). Though there was no significant difference between the systolic left ventricular function between the two groups but significant higher regional wall motion abnormality was found more in diabetic patients (76%vs 62%; P<0.01). So type 2 diabetic patients had more severe and extensive atherosclerotic lesion in their coronary arteries than the matched non diabetic control on coronary angiography suggesting an independent effect of diabetic mellitus on atherosclerotic process specially in our population.
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Affiliation(s)
- S N Uddin
- Department of Cardiology, Mymensingh Medical College, Mymensingh
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Bari MA, Rahman S, Uddin SN, Malik F, Ahsan SA, Rahman S. Comparison and outcome of commissurotomy by metallic valvotome and balloon commissurotomy. Mymensingh Med J 2005; 14:3-5. [PMID: 15695943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
Abstract
The purpose of this study was to compare the echocardiographic outcome of percutaneous transvenous metallic mitral commissurotomy (PMMC) and Percutaneous transvenous balloon mitral commissurotomy (PTMC). This prospective comparative study was carried out during the period of January 1999 to June 2000 in the department of Cardiology, National Institute of cardiovascular diseases (NICVD) and national heart foundation hospital, Dhaka Bangladesh. Two dimension, M-mode, spectral and colour Doppler studies were done to all patient of mitral stenosis both before and after PMMC and PTMC. The increased in mitral valve area in PMMC was statistically significant than PTMC. (P<0.047).
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Affiliation(s)
- M A Bari
- Mymensingh Medical College, Mymensingh, Bangladesh
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Abstract
This study examined the clinical workload, outcome and direct costs of managing women with sexual dysfunction in an NHS clinic in the UK. A retrospective analysis of a 3-month period showed that of 47 referrals to the clinic, 38 undertook treatment. The therapists' assessments suggested that over 80% of patients improved on treatment. The average cost per patient was pound 472 (compared to pound 335 per annum for erectile dysfunction, which included physician's and drug costs). The average cost by type of practitioner was pound 278 (psychologist), pound 322 (physician), pound 532 (physician and psychologist) and pound 597 (sex therapist). Patients required between 1 and 51 treatment sessions, which were mainly restricted to psychological therapy. Female sexual dysfunction (FSD) represents a significant economic burden to the NHS. Further research on the potential role and cost effectiveness of pharmacological agents for FSD is warranted.
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Affiliation(s)
- D Goldmeier
- JaneWadsworth Sexual Function Clinic, Jefferiss Wing, St Mary's Hospital, Praed Street, London W2 1NY, UK.
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Uddin SN, Siddiqui NI, Bagum F, Malik F, Rahman S, Ali MS. Coronary artery disease in young adults - angiographic profile. Mymensingh Med J 2004; 13:11-5. [PMID: 14747777] [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: 04/28/2023]
Abstract
Angiographic profile of fifty young patients of coronary artery disease aged 40 or under were analysed and compared with those of fifty older patients. Mean age of younger and older group was 36.34 (range 28 to 40 years) and 55.28 (44-74 years) years respectively and most of the patients were male in both the group (92 Vs 94%). Older patients were more diabetes (40 Vs 24%) and hypertensive (38 Vs 60%) but the younger patients had more family history of premature coronary artery disease (50% Vs 24%). The incidence of smoking and dyslipidemia did not vary between the two groups. Older patients had more history of myocardial infarction (69 Vs 58%) but angina were more in young patients (42 Vs 31%). Coronary angiography revealed more number of multivessel disease in older patients (74 Vs 54%) but the younger patients had more normal coronary arteries and single vessel disease (46 vs 26%). Coronary athesclerosis was also extensive in older patients as revealed by the higher coronary score, more involvement of coronary segments, more number of diseased and diffusely involved coronary vessel in older patients. Older patients needed more revasalarization process (74 Vs 60%), more coronary bypass surgery (40 Vs 24%) and had more inoperable vessels (16% Vs 4%) than the younger patients. So the younger patients having less extensive coronary artery athesclerosis with better prognostic probability should be evaluated angiographically for further definitive management in the from of revascularization.
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Uddin SN, Siddiqui NI, Begum F, Malik F, Rahman S. Correlation between severity of coronary artery athesclerosis and duration and severity of diabetes mellitus in type 2 diabetic patients. Mymensingh Med J 2003; 12:85-8. [PMID: 12894038] [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: 03/04/2023]
Abstract
Hundred patients of Type 2 diabetes mellitus with coronary artery disease undergoing diagnostic coronary angiography were studied to determine the relation between the severity and duration of diabetes mellitus and the severity of coronary artery disease. A coronary scoring system using segmental distribution method was used to determine the severity of coronary artery disease and severity of diabetes was assessed by the level of fasting blood glucose within 48 hours of the procedure and also considering the types of treatment received for diabetes mellitus. No significant correlation was demonstrated between the severity of coronary artery disease and the severity (r =.089602; P>0.1) nor the duration (r =0.07865; P> 0.1) of diabetes mellitus on univariate analysis. So the Type 2 diabetic patients had an increased incidence of atherosclerosis in their coronary angiograms did not reflect an angiographically evident progressive coronary artery disease and results of this study suggest that the progress of large vessel coronary athesclerotic disease in diabetes mellitus of adult onset takes place independently of the progress of diabetes mellitus itself.
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Affiliation(s)
- S N Uddin
- Cardiology, Mymensingh Medical College, Bangladesh
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Uddin SN, Begum F, Malik F, Rahman S. Coronary artery disease in young patients: clinical review and risk factor analysis. Mymensingh Med J 2003; 12:3-7. [PMID: 12715632] [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: 03/02/2023]
Abstract
Fifty consecutive younger patients (< or = 40 years) with coronary artery disease, who underwent coronary angiography in National Institute of Cardiovascular Diseases were evaluated clinically and coronary risk factors were analyzed and compared with those of fifty older patients with coronary artery disease. Mean age of younger and older patients were 37.31 and 54.58 years respectively and myocardial infarction was the most common presenting complain in both the groups. Smoking and family history of premature coronary artery disease were more common in younger patients but the older patients were more diabetic and hypertensive. Central obesity and dyslipidemia did not vary between the two groups. Fifty percent of younger patients had one or two modifiable risk factors where sixty four percent of older patients had three or more modifiable risk factors. Forty four percent younger patients had hypercholesterolemia but a majority of patients had either isolated hypertriglyciredemia or decrease high density lipoprotein cholesterol or both with normal total cholesterol level but the total cholesterol and high density lipoprotein cholesterol index were more than 4.5. Younger patients had more number of normal coronary or single vessel diseases but older group had more number of triple vessel diseases. So the higher incidence of non-insulin dependent diabetes mellitus with central obesity suggesting insulin resistance along with unique profile of dyslipidemia, higher incidence of smoking and familial predisposition of premature coronary artery disease may be responsible for higher incidence of coronary artery disease at a premature younger age in this population.
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Smart SC, Knickelbine T, Malik F, Sagar KB. Dobutamine-atropine stress echocardiography for the detection of coronary artery disease in patients with left ventricular hypertrophy. Importance of chamber size and systolic wall stress. Circulation 2000; 101:258-63. [PMID: 10645921 DOI: 10.1161/01.cir.101.3.258] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Left ventricular hypertrophy is a heterogeneous disorder with distinct morphologies. Changes in wall thickness, left ventricular chamber diameter, and mass alter systolic wall stress of the left ventricle and may influence ischemic threshold. Thus, the goal of this study was to investigate the effect of the different patterns of left ventricular hypertrophy on the accuracy of dobutamine-atropine stress echocardiography. METHODS AND RESULTS Three-hundred eighty-six patients underwent multistage dobutamine-atropine stress echocardiography and diagnostic angiography. Echocardiograms were measured for mean and relative wall thicknesses, chamber size, left ventricular mass, and end-systolic wall stress. The patterns of ventricular hypertrophy were concentric hypertrophy (increased wall thickness and mass), eccentric hypertrophy (normal wall thickness and increased mass), and concentric remodeling (increased wall thickness and normal mass). The overall sensitivity, specificity, and accuracy of dobutamine-atropine stress echocardiography for the detection of coronary artery disease were 85%, 87%, and 86%, respectively. Increased left ventricular mass index alone did not affect accuracy. Sensitivity was markedly reduced (36%) only in those with concentric remodeling. The univariate predictors of false-negative studies were single-vessel left circumflex disease, increased wall thickness, small chamber size, hyperdynamic ejection fraction, and left ventricular concentric remodeling. Multivariate predictors were concentric remodeling (P<0.0001; odds ratio, 13.5), left ventricular ejection fraction >2 SD above normal (P<0.0001), and single-vessel left circumflex disease (P<0.0007; odds ratio, 7.6). Sensitivity was excellent in patients with small ventricles and normal wall thickness and in those with normal or large chambers regardless of wall thickness. CONCLUSIONS Dobutamine-atropine stress echocardiography is an accurate test in most patients with left ventricular hypertrophy, but it is insensitive in the small subset with concentric remodeling.
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Affiliation(s)
- S C Smart
- Division of Cardiology, Medical College of Wisconsin, Milwaukee, USA
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Leonard S, Malik F. Osteocarcinoma in a Siamese kitten. Vet Rec 1998; 143:148. [PMID: 9725193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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