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Iftikhar H, Saleem M, O'Brien F. Retraction Note: Anaphylaxis secondary to citric acid allergy in End Stage Renal Disease patient. CEN Case Rep 2024:10.1007/s13730-024-00877-z. [PMID: 38592602 DOI: 10.1007/s13730-024-00877-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024] Open
Affiliation(s)
- Hassaan Iftikhar
- Division of Nephrology, Washington University School of Medicine in Saint Louis, 660 S Euclid Avenue, St Louis, MO, 63110, USA.
| | - Maryam Saleem
- Division of Nephrology, Washington University School of Medicine in Saint Louis, 660 S Euclid Avenue, St Louis, MO, 63110, USA
| | - Frank O'Brien
- Division of Nephrology, Washington University School of Medicine in Saint Louis, 660 S Euclid Avenue, St Louis, MO, 63110, USA
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Iftikhar H, Saleem M, O'Brien F. Anaphylaxis secondary to citric acid allergy in End Stage Renal Disease patient. CEN Case Rep 2024; 13:125-127. [PMID: 37498514 PMCID: PMC10982184 DOI: 10.1007/s13730-023-00812-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 07/16/2023] [Indexed: 07/28/2023] Open
Abstract
Dialysis reactions are not uncommon in End Stage Renal Disease (ESRD) patients who are undergoing in-center hemodialysis. Here we report the first case of anaphylaxis related to citric acid solutions used for dialysis machine disinfection and descaling. The patient developed repeated episodes of anaphylactic reactions during hemodialysis only in the inpatient setting leading to respiratory failure needing intubation and anaphylactic shock. This had failed to resolve despite using various combinations of different dialysis machines and dialyzer membranes and only resolved after the elimination of citric acid from the dialysis circuit. This case highlights the importance of different allergens in dialysis circuits and emphasizes the importance of looking for alternative reasons for dialyzer reactions.
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Affiliation(s)
- Hassaan Iftikhar
- Division of Nephrology, Washington University School of Medicine in Saint Louis, 660 S Euclid Avenue, St Louis, MO, 63110, USA.
| | - Maryam Saleem
- Division of Nephrology, Washington University School of Medicine in Saint Louis, 660 S Euclid Avenue, St Louis, MO, 63110, USA
| | - Frank O'Brien
- Division of Nephrology, Washington University School of Medicine in Saint Louis, 660 S Euclid Avenue, St Louis, MO, 63110, USA
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Sharif A, Shah NA, Rauf A, Hadayat N, Gul A, Nawaz G, Sakhi S, Iqbal M, Khan MR, Shah AA, Azam N, Iftikhar H, Shah SA, Bahadur S, Hussain F, Shuaib M. Ethnomedicinal uses of plants for various diseases in the remote areas of Changa Manga Forest, Pakistan. BRAZ J BIOL 2024; 84:e255916. [DOI: 10.1590/1519-6984.255916] [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: 08/31/2021] [Accepted: 02/01/2022] [Indexed: 11/22/2022] Open
Abstract
Abstract This study aims at reporting the indigenous knowledge of the medicinal flora from the inhabitants of surroundings of the World’s largest artificial planted forest “Changa Manga”, Pakistan. Data were collected by direct interviews and group meetings from 81 inhabitants including 32 local healers having information regarding the use of indigenous medicinal plants over a period of one year. Different statistical tools were applied to analyze the data including Frequency citation (FC), Relative frequency citation (RFC), Use Value, Factor of informants consensus and fidelity level. This study reported 73 plant species belonging to 37 plant families and 46 genera. The majority of plant species belong to compositae family. The most commonly used medicinal plants were P. hysterophorus L., P. dactylifera L., S. indicum L, P. harmala L., P. emblica L., and A. indica A.Juss. The greatest number of species was used to cure gastrointestinal disorders. The highest fidelity level (68.18%) was of E. helioscopia to cure gastrointestinal disorders. Maximum fresh uses (17) were reported by C. dactylon (L.) Pars. While the highest number of species reporting fresh uses in similar number was 13. In this study, five novel plants are being reported for the first time in Pakistan for their ethnomedicinal worth. Our data reflect unique usage of the medicinal plants in the study area. The statistical tools used in the study proved useful in pointing the most important and disease category specific plants. High use value plant and the new reported medicinal plants might prove an important source of the isolation of pharmacologically active compounds.
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Affiliation(s)
| | | | - A. Rauf
- University of AWAKUM, Pakistan
| | | | - A. Gul
- Hazara University, Pakistan
| | - G. Nawaz
- Kohat University of Science and Technology, Pakistan
| | | | | | | | - A. A. Shah
- Jazan University, Kingdom of Saudi Arabia
| | - N. Azam
- University of Peshawar, Pakistan
| | | | - S. A. Shah
- National University of Medical Sciences, Pakistan
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Keleher E, Iftikhar H, Schulz LF, McCanny P, Austin D, Stewart A, O'Regan W, Hallbäck M, Wallin M, Aneman A. Capnodynamic monitoring of lung volume and pulmonary blood flow during alveolar recruitment: a prospective observational study in postoperative cardiac patients. J Clin Monit Comput 2023; 37:1463-1472. [PMID: 37243954 DOI: 10.1007/s10877-023-01033-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 05/08/2023] [Indexed: 05/29/2023]
Abstract
Alveolar recruitment manoeuvres may mitigate ventilation and perfusion mismatch after cardiac surgery. Monitoring the efficacy of recruitment manoeuvres should provide concurrent information on pulmonary and cardiac changes. This study in postoperative cardiac patients applied capnodynamic monitoring of changes in end-expiratory lung volume and effective pulmonary blood flow. Alveolar recruitment was performed by incremental increases in positive end-expiratory pressure (PEEP) to a maximum of 15 cmH2O from a baseline of 5 cmH2O over 30 min. The change in systemic oxygen delivery index after the recruitment manoeuvre was used to identify responders (> 10% increase) with all other changes (≤ 10%) denoting non-responders. Mixed factor ANOVA using Bonferroni correction for multiple comparisons was used to denote significant changes (p < 0.05) reported as mean differences and 95% CI. Changes in end-expiratory lung volume and effective pulmonary blood flow were correlated using Pearson's regression. Twenty-seven (42%) of 64 patients were responders increasing oxygen delivery index by 172 (95% CI 61-2984) mL min-1 m-2 (p < 0.001). End-expiratory lung volume increased by 549 (95% CI 220-1116) mL (p = 0.042) in responders associated with an increase in effective pulmonary blood flow of 1140 (95% CI 435-2146) mL min-1 (p = 0.012) compared to non-responders. A positive correlation (r = 0.79, 95% CI 0.5-0.90, p < 0.001) between increased end-expiratory lung volume and effective pulmonary blood flow was only observed in responders. Changes in oxygen delivery index after lung recruitment were correlated to changes in end-expiratory lung volume (r = 0.39, 95% CI 0.16-0.59, p = 0.002) and effective pulmonary blood flow (r = 0.60, 95% CI 0.41-0.74, p < 0.001). Capnodynamic monitoring of end-expiratory lung volume and effective pulmonary blood flow early in postoperative cardiac patients identified a characteristic parallel increase in both lung volume and perfusion after the recruitment manoeuvre in patients with a significant increase in oxygen delivery.Trial registration This study was registered on ClinicalTrials.gov (NCT05082168, 18th of October 2021).
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Affiliation(s)
- E Keleher
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - H Iftikhar
- Faculty of Medicine, University of New South Wales, Sydney, NSW, Australia
| | - L F Schulz
- Intensive Care Unit, Liverpool Hospital, South Western Sydney Local Health District, Sydney, NSW, Australia
| | - P McCanny
- Intensive Care Unit, Liverpool Hospital, South Western Sydney Local Health District, Sydney, NSW, Australia
| | - D Austin
- Intensive Care Unit, Liverpool Hospital, South Western Sydney Local Health District, Sydney, NSW, Australia
| | - A Stewart
- Intensive Care Unit, Liverpool Hospital, South Western Sydney Local Health District, Sydney, NSW, Australia
| | - W O'Regan
- Intensive Care Unit, Liverpool Hospital, South Western Sydney Local Health District, Sydney, NSW, Australia
| | | | - M Wallin
- Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
| | - A Aneman
- Intensive Care Unit, Liverpool Hospital, South Western Sydney Local Health District, Sydney, NSW, Australia.
- Southwestern Clinical School, University of New South Wales, Sydney, NSW, Australia.
- Ingham Institute for Applied Medical Research, Sydney, NSW, Australia.
- Intensive Care Unit, Liverpool Hospital, Locked Bag 7103, Liverpool BC, NSW, 1871, Australia.
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Saleem M, Iftikhar H. Anti-phospholipase A2 Receptor Antibody-Negative Membranous Nephropathy in Pregnancy. Cureus 2023; 15:e42827. [PMID: 37664313 PMCID: PMC10473257 DOI: 10.7759/cureus.42827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/31/2023] [Indexed: 09/05/2023] Open
Abstract
Nephrotic syndrome in pregnancy is associated with challenges for both patients and physicians. Early recognition is crucial, and when appropriate, renal biopsy should be considered to differentiate preeclampsia from other causes of glomerulopathies. Pregnancy in a woman with nephrotic syndrome is high risk, and more data are needed to highlight pregnancy outcomes.
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Affiliation(s)
- Maryam Saleem
- Nephrology, Ohio Valley Nephrology Associates, Owensboro, USA
- Nephrology, Washington University School of Medicine, St. Louis, USA
- Internal Medicine, Waterbury Hospital, Waterbury, USA
| | - Hassaan Iftikhar
- Nephrology, Ohio Valley Nephrology Associates, Owensboro, USA
- Nephrology, Washington University School of Medicine, St. Louis, USA
- Internal Medicine, Saint Francis Medical Center, Trenton, USA
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Saleem M, Maqsood M, Iftikhar H, Haria D, Arif H. Peritoneal Dialysis-Related Recurrent Rhodococcus corynebacterioides Peritonitis: A Case Report and Review of Literature. Cureus 2023; 15:e43423. [PMID: 37706134 PMCID: PMC10497068 DOI: 10.7759/cureus.43423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/13/2023] [Indexed: 09/15/2023] Open
Abstract
Rhodococcus corynebacterioides is a Gram-positive bacterium known to cause bacteremia and oligoarthritis. There have been only a few case reports in the literature that describe its association with peritoneal dialysis (PD)-related peritonitis. We report a case of recurrent peritonitis caused by R. corynebacterioides. The patient presented with abdominal pain, and PD fluid analysis was positive for infection, with cultures growing R. corynebacterioides. The patient was treated with multiple courses of intraperitoneal antibiotics due to recurrent episodes of PD-associated peritonitis from this bacterium, ultimately necessitating the removal of the PD catheter and the transition to hemodialysis.
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Affiliation(s)
- Maryam Saleem
- Nephrology, Ohio Valley Nephrology Associates, Owensboro, USA
- Nephrology, Washington University School of Medicine, St. Louis, USA
- Internal Medicine, Waterbury Hospital, Waterbury, USA
| | - Maryam Maqsood
- Internal Medicine, Mayo Hospital, Lahore, PAK
- Internal Medicine, King Edward Medical University, Lahore, PAK
| | - Hassaan Iftikhar
- Nephrology, Ohio Valley Nephrology Associates, Owensboro, USA
- Nephrology, Washington University School of Medicine, St. Louis, USA
- Internal Medicine, Saint Francis Medical Center, Trenton, USA
| | - Dhiren Haria
- Nephrology, Ohio Valley Nephrology Associates, Owensboro, USA
| | - Hamza Arif
- Nephrology, Ohio Valley Nephrology Associates, Owensboro, USA
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Saleem M, Shahjahan K, Iftikhar H. Idiopathic Oxalate Nephropathy Leading to End-Stage Kidney Disease: A Case Report. Cureus 2023; 15:e42402. [PMID: 37621792 PMCID: PMC10446903 DOI: 10.7759/cureus.42402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/23/2023] [Indexed: 08/26/2023] Open
Abstract
Oxalate nephropathy represents a frequently overlooked etiology of renal failure, characterized by the deposition of calcium oxalate crystals within the renal parenchyma. This progressive form of kidney disease is marked by a significant increase in serum creatinine (Cr) level accompanied by evidence of oxalate crystal deposition on renal biopsy causing tubular obstruction and tubular injury leading to fibrosis. In all instances of oxalate nephropathy, examination of stones consistently exhibits multiple birefringent calcium oxalate crystals under polarized light. This case report details the clinical course of a patient who initially presented with progressively worsening renal function and ultimately developed end-stage kidney disease (ESKD) as a consequence of idiopathic hyperoxaluria.
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Affiliation(s)
- Maryam Saleem
- Nephrology, Ohio Valley Nephrology Associates, Owensboro, USA
- Nephrology, Washington University School of Medicine, St. Louis, USA
- Internal Medicine, Waterbury Hospital, Waterbury, USA
| | | | - Hassaan Iftikhar
- Nephrology, Washington University School of Medicine, Saint Louis, USA
- Internal Medicine, Saint Francis Medical Center, Trenton, USA
- Nephrology, Ohio Valley Nephrology Associates, Owensboro, USA
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Iftikhar H, Saleem M, Naeem HS, Fatima D. Synthetic Cannabinoids and ST-Elevated Myocardial Infarction: A Case Report and Literature Review. Cureus 2023; 15:e39236. [PMID: 37337483 PMCID: PMC10277166 DOI: 10.7759/cureus.39236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/19/2023] [Indexed: 06/21/2023] Open
Abstract
The use of synthetic cannabinoids and marijuana has been known to be associated with myocardial infarction and coronary vasospasms according to a few case reports published for the pediatric population. The data on the use of synthetic cannabinoids and myocardial infarction in adults however is limited. The adverse effects of these so-called designer drugs have been far-reaching. Here, we describe a case of an adult male with ST-elevated myocardial infarction diagnosed secondary to smoking synthetic cannabinoids.
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Affiliation(s)
- Hassaan Iftikhar
- Nephrology, Ohio Valley Nephrology Associates, Owensboro, USA
- Internal Medicine, Saint Francis Medical Center, Trenton, USA
- Nephrology, Washington University School of Medicine, Saint Louis, USA
| | - Maryam Saleem
- Nephrology, Ohio Valley Nephrology Associates, Owensboro, USA
- Nephrology, Washington University School of Medicine, Saint Louis, USA
- Internal Medicine, Waterbury Hospital, Waterbury, USA
| | - Hafiz S Naeem
- Internal Medicine, Saint Francis Medical Center, Trenton, USA
| | - Dania Fatima
- Internal Medicine, Nishtar Medical College, Multan, PAK
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Karim M, Qureshi B, Hafiz A, Ali N, Abrar S, Iftikhar H, Abbasi A. PO-0962 Evaluation of anxiety and depression in head and neck cancer patients during radiotherapy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07413-2] [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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Sulaiman A, Lutfi A, Ikram M, Fatimi S, Bin Pervez M, Shamim F, Abbas SA, Iftikhar H. Tracheomalacia after thyroidectomy for retrosternal goitres requiring sternotomy- a myth or reality? Ann R Coll Surg Engl 2021; 103:504-507. [PMID: 34192497 DOI: 10.1308/rcsann.2021.0014] [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] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Tracheomalacia after thyroidectomy is not well understood. Reports on tracheomalacia are conflicting, with some suggesting a high rate and other large cohorts in which no tracheomalacia is reported. The aim of our study was to assess the incidence and factors associated with tracheomalacia after thyroidectomy in patients with retrosternal goitres requiring sternotomy at a high-volume tertiary care referral centre. METHODS A longitudinal cohort study was conducted from January 2011 to December 2019. All adult patients who underwent thyroidectomy with sternotomy were included. Tracheomalacia was considered when tracheal rings were soft compared with other parts (proximal or distal) of the trachea and required either tracheostomy or resection with anastomosis. The decision to perform a tracheostomy or to administer continuous or bilevel positive airway pressure postoperatively was made depending on the degree of tracheomalacia. Logistic regression analysis was used to assess factors associated with tracheomalacia. RESULTS We evaluated 40 patients who underwent thyroidectomy with sternotomy. The mean age of our cohort was 48.7 ± 11.3 years and the population was predominantly female (67.5%). One patient required tracheal resection with anastomosis, and two patients required tracheostomy. Multivariable logistic regression analysis did not reveal any patient- or thyroid-related factor significantly associated with the development of tracheomalacia in our cohort. CONCLUSIONS The incidence of tracheomalacia after thyroidectomy with sternotomy appears to be very low. However, the occurrence of tracheomalacia after thyroidectomy in cases of large goitre is possible and hence worrisome.
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Affiliation(s)
- A Sulaiman
- Aga Khan University Hospital, Karachi, Pakistan
| | - A Lutfi
- Aga Khan University Hospital, Karachi, Pakistan
| | - M Ikram
- Aga Khan University Hospital, Karachi, Pakistan
| | - S Fatimi
- Aga Khan University Hospital, Karachi, Pakistan
| | | | - F Shamim
- Aga Khan University Hospital, Karachi, Pakistan
| | - S A Abbas
- Aga Khan University Hospital, Karachi, Pakistan
| | - H Iftikhar
- Aga Khan University Hospital, Karachi, Pakistan
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Iftikhar H, Ikram M. Coiling of internal carotid through 'eye of the needle' internal jugular vein: a dual great vessel anomaly. Ann R Coll Surg Engl 2021; 103:e156-e158. [PMID: 33682429 DOI: 10.1308/rcsann.2020.7074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A variation in the usual course of great vessels during neck dissection can predispose them to inadvertent iatrogenic injury, which can lead to massive bleeding. We present a case of a male patient with oral squamous cell carcinoma who underwent inferior maxillectomy and supra-omohyoid neck dissection. Lateral coiling of the extracranial internal carotid artery was seen through fenestration of the internal jugular vein. Anomalies of great vessels in the neck are rare. Variation in the course of any of these vessels can prove to be catastrophic if control is not achieved. Careful study of radiographic imaging with special consideration given to the course of great vessels in the neck should be undertaken prior to neck surgeries.
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Affiliation(s)
- H Iftikhar
- Aga Khan University Hospital, Karachi, Pakistan
| | - M Ikram
- Aga Khan University Hospital, Karachi, Pakistan
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Gupta A, Fatemi A, Ducatman B, Khayyata S, Iftikhar H, Nair G. Pulmonary Capillaritis: The Breakdown of the Histologic Features. Am J Clin Pathol 2020. [DOI: 10.1093/ajcp/aqaa161.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction/Objective
Capillary inflammation (capillaritis) is rarely the primary pathologic cause of pulmonary hemorrhage. It may coexist with vasculitis. The aim of this study is to investigate the specificity of five histologic features of pulmonary capillaritis previously described by Mark and Ramirez (discussed below). They are usually treated with corticosteroids and cyclophosphamide or azathioprine.
Methods
A retrospective review of patients with a pathologic diagnosis of capillaritis in open lung biopsies was done. The diagnosis was confirmed by two expert pulmonary pathologists. The slides were reviewed and compared to a control group, who also underwent open lung biopsies for clinical suggestion of pulmonary hemorrhage and no pathologic diagnosis of capillaritis. Cases with malignant neoplasms, large and medium size vasculitis syndromes, and diffuse alveolar damage (DAD) were excluded. The five pathologic features of capillaritis were evaluated and scored as negative (0), focal (1+) and moderate to diffuse (2+) in both groups.
Results
Five cases of pulmonary capillaritis and five cases in control group were identified. The etiology of pulmonary capillaritis in the five identified cases included autoimmune diseases, pulmonary hypertension, non-specific interstitial pneumonia, and idiopathic capillaritis. The average score for the morphologic features of capillaritis versus the control group were as follows: Interstitial erythrocytes and/or hemosiderin (2+ vs 2+), fibrinoid necrosis of capillary walls (2+vs 0), intraalveolar septal capillary occlusion by fibrin thrombi (1+ vs 0), neutrophils and nuclear dust in the interstitium, in the fibrin, and in the adjacent alveolar spaces (2+ vs 1+), and fibrin clots attached to interalveolar septa in a sessile manner (2+ vs 1+).
Conclusion
In this small study, we can conclude that fibrinous necrosis is the most specific finding for pulmonary capillaritis while interstitial erythrocytes and/or hemosiderin is least specific. Therefore, in the presence of fibrinous necrosis; in addition to other supporting features; a pathologist is more inclined to communicate a diagnosis of pulmonary capillaritis to the clinicians.
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Affiliation(s)
- A Gupta
- Pathology, Beaumont Hospital, Troy, Michigan, UNITED STATES
| | - A Fatemi
- Pathology, Beaumont Hospital, Troy, Michigan, UNITED STATES
| | - B Ducatman
- Pathology, Beaumont Hospital, Troy, Michigan, UNITED STATES
| | - S Khayyata
- Pathology, Beaumont Hospital, Troy, Michigan, UNITED STATES
| | - H Iftikhar
- Beaumont Hospital, Royal Oak, Michigan, UNITED STATES
| | - G Nair
- Beaumont Hospital, Royal Oak, Michigan, UNITED STATES
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Iftikhar H, Rozi S, Zahid N, Awan MS, Nathani KR. Lymph node ratio as a prognostic marker of oral tongue squamous cell carcinoma: a cohort study. Ann R Coll Surg Engl 2020; 102:726-732. [PMID: 32808800 DOI: 10.1308/rcsann.2020.0173] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Lymph node metastasis is a poor prognostic indicator and is well established in tongue squamous cell carcinoma. Based on the current staging system, accurate risk stratification is difficult. There is thus a need to evaluate an alternate method for predicting recurrence and survival. The objective of the study was to evaluate lymph node ratio as a prognostic marker as compared with N-staging for tongue squamous cell carcinoma. MATERIALS AND METHODS We conducted a retrospective cohort study with 56 patients with a lymph node ratio greater than 0.012 (exposed) and 74 patients with a lymph node ratio less than 0.012 (unexposed). Overall five-year survival and disease-free survival were assessed. The Cox proportional hazard model was used to analyse lymph node ratio as a predictor of outcome, together with other covariates. RESULTS A total of 130 patients were included in the study. Patients with lymph node ratio greater than 0.012 had a poor overall five-year (mean survival time 52.1 months vs 38.1 months) and disease-free survival (mean survival time 53.6 months vs 39.2 months). The hazard of death among patients with a lymph node ratio greater than 0.012 was 3.24 times higher than the hazard of death among patients with a lymph node ratio less than 0.012 (95% confidence interval 1.82-5.77). DISCUSSION Lymph node ratio is a superior prognostic marker compared with the currently used American Joint Committee on Cancer N-staging. Our findings also suggest that the margin status (involved) of the primary tumour resection adversely affects prognosis.
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Affiliation(s)
- H Iftikhar
- Aga Khan University Hospital, Karachi, Pakistan
| | - S Rozi
- Aga Khan University Hospital, Karachi, Pakistan
| | - N Zahid
- Aga Khan University Hospital, Karachi, Pakistan
| | - M S Awan
- Aga Khan University Hospital, Karachi, Pakistan
| | - K R Nathani
- Aga Khan University Hospital, Karachi, Pakistan
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Iftikhar H, Sohail Awan M, Usman M, Khoja A, Khan W. Discordance between fine-needle aspiration cytology and histopathology in patients with mucoepidermoid carcinoma of parotid gland. Ann R Coll Surg Engl 2020; 102:340-342. [PMID: 32159383 DOI: 10.1308/rcsann.2020.0022] [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] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Fine-needle aspiration cytology (FNAC) is an important diagnostic tool used preoperatively for the diagnosis of parotid lump. Mucoepidermoid carcinoma comprises 5-10% of all salivary gland tumours. It poses a diagnostic challenge on FNAC with high false negative rate. The objective of this study was to evaluate the discordance between cytology/FNAC and histopathology in patients with mucoepidermoid carcinoma. MATERIAL AND METHODS A cross-sectional study was conducted from 1 January 2010 to 31 December 2014. Patients aged 18 years and above with FNAC or histopathology suggestive of mucoepidermoid carcinoma were identified. FNAC when compared with histology (gold standard) was classified into true positive (presence of mucoepidermoid carcinoma correctly diagnosed on FNAC), true negative (absence of mucoepidermoid carcinoma correctly diagnosed on FNAC), false positive (FNAC incorrectly diagnosed mucoepidermoid carcinoma), false negative (FNAC failed to diagnose mucoepidermoid carcinoma). RESULTS A total of 16 patients fulfilled our eligibility criteria. Seven cytological samples were true positive (ie correctly diagnosed mucoepidermoid carcinoma by FNAC), eight cytological specimens were false negative (ie could not pick up mucoepidermoid carcinoma on FNAC). One case was false positive on cytology (ie diagnosed mucoepidermoid carcinoma on FNAC but was reported to be Warthin's tumour on histopathology) and none were true negative. CONCLUSION FNAC is not reliable for diagnosis of mucoepidermoid carcinoma. More than 50% of our patients had discordant results between cytology and histology. We recommend a high index of suspicion for mucoepidermoid carcinoma given the poor yield of cytology.
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Affiliation(s)
- H Iftikhar
- Department of Otolaryngology/Head and Neck Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - M Sohail Awan
- Department of Otolaryngology/Head and Neck Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - M Usman
- Department of Pathology, Aga Khan University Hospital, Karachi, Pakistan
| | - A Khoja
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - W Khan
- PNS Shifa Hospital, Karachi, Pakistan
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Iftikhar H, Saleem M, Kaji A. A Case Report of IgA Nephropathy Coexisting with Focal Segmental Glomerulosclerosis. Cureus 2019; 11:e5040. [PMID: 31501732 PMCID: PMC6721872 DOI: 10.7759/cureus.5040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
IgA nephropathy is a condition characterized by deposition of IgA immunoglobulin in the glomerulus. This condition is fairly common in Western countries. The disease spectrum is broad and it varies case to case. The cases of IgA nephropathy associated with focal segmental glomerulosclerosis are rare. Our case report is about a young male who developed rapid onset IgA nephropathy leading to end stage renal disease (ESRD).
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Abstract
Primary hyperparathyroidism (PHPT) is the third most common endocrine disorder after diabetes and thyroid disease. Most cases of hyperparathyroidism remain clinically silent. The clinical manifestations of hypercalcemia captured in the classic medical student mnemonic of “stones, bones, groans, and psychic moans” are often not found. Sometimes patients can present with unique complications. This case describes perforated peptic ulcer as the first presentation of primary hyperparathyroidism.
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Abstract
Acetaminophen is one of the most common analgesic medications available over the counter. Acetaminophen overdose can cause both hepatic and renal injuries. The literature suggests the incidence of acute kidney injury is around 2% - 10% in those with acetaminophen overdose. We report a case of acute kidney injury from acetaminophen overdose requiring hemodialysis.
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Affiliation(s)
- Maryam Saleem
- Internal Medicine, Waterbury Hospital, Waterbury, USA
| | - Hassaan Iftikhar
- Internal Medicine, St. Francis Medical Center, Seton Hall University, Trenton, USA
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18
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Iftikhar H, Saleem M, Kaji A. Pernicious Anemia Presenting as Non-ST-elevated Myocardial Infarction and Depression. Cureus 2019; 11:e4870. [PMID: 31417815 PMCID: PMC6687429 DOI: 10.7759/cureus.4870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Pernicious anemia (PA) is a common cause of megaloblastic anemia throughout the world, especially in Northern European whites. This disease is characterized by the deficiency of vitamin B12 due to the presence of anti-intrinsic factor and anti-parietal cell antibodies which inhibit the absorption of the vitamin B12. In cases of severe vitamin B12 deficiency, patients can suffer debilitating complications such as described in our case.
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Affiliation(s)
- Hassaan Iftikhar
- Internal Medicine, St. Francis Medical Center, Seton Hall University, Trenton, USA
| | - Maryam Saleem
- Internal Medicine, Waterbury Hospital, Waterbury, USA
| | - Anand Kaji
- Internal Medicine, St. Francis Medical Center, Seton Hall University, Trenton, USA
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19
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Saleem M, Iftikhar H. Linear IgA Disease: A Rare Complication of Vancomycin. Cureus 2019; 11:e4848. [PMID: 31410331 PMCID: PMC6684112 DOI: 10.7759/cureus.4848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Linear immunoglobulin A (IgA) bullous dermatosis, also known as linear IgA disease, is a rare disorder with an incidence of about 0.5 to 2.3 cases per million individuals per year. In most of the cases, the cause is unknown; however, 50% of the cases are drug-induced. The disease has bimodal age predilection and occurs in children up to the age of 10 years and in adults usually after the age of 60 years. Common drugs that have been known to cause this disease include vancomycin, lithium, amiodarone, captopril, and some of the nonsteroidal anti-inflammatory agents. We report a case of linear IgA disease secondary to vancomycin.
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20
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Iftikhar H, Saleem M, Nadeem M, Caplan J, Kaji A. A Presentation of Twiddler's Syndrome with Underlying Ratchet Mechanism. Cureus 2019; 11:e4060. [PMID: 31016087 PMCID: PMC6464292 DOI: 10.7759/cureus.4060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 02/13/2019] [Indexed: 11/25/2022] Open
Abstract
Twiddler's syndrome, reel syndrome, and ratchet phenomenon are rare causes of pacemaker lead displacement. The presentation of Twiddler's syndrome with underlying ratchet mechanism is quite rarely reported in literature. In this case report we present a 63-year-old male with a history of non-ischemic cardiomyopathy who had his biventricular implantable cardioverter defibrillator leads dislodged and presented as sub-acute exacerbation of heart failure. This case highlights the underlying mechanism of twiddler's syndrome, its clinical presentation, management, and prevention.
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Affiliation(s)
- Hassaan Iftikhar
- Internal Medicine, Seton Hall University-St. Francis Medical Center, Trenton, USA
| | - Maryam Saleem
- Internal Medicine, Waterbury Hospital, Waterbury, USA
| | - Muhammad Nadeem
- Internal Medicine, Seton Hall University-St. Francis Medical Center, Trenton, USA
| | - John Caplan
- Cardiology, Seton Hall University-St. Francis Medical Center, Trenton, USA
| | - Anand Kaji
- Internal Medicine, Seton Hall University-St. Francis Medical Center, Trenton, USA
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21
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Abstract
Metformin is a first-line biguanide agent for the treatment of diabetes mellitus. It has been known to be associated with lactic acidosis. This side effect especially worsens when being used with other medications affecting the kidney such as angiotensin-converting enzyme inhibitors (ACEi) and loop diuretics. This is a case of a 63-year-old male who suffered from metformin-induced lactic acidosis and underwent hemodialysis for treatment.
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Affiliation(s)
- Hassaan Iftikhar
- Internal Medicine, Seton Hall University-St. Francis Medical Center, Trenton, USA
| | - Maryam Saleem
- Internal Medicine, Waterbury Hospital, Waterbury, USA
| | - Anand Kaji
- Internal Medicine, Seton Hall University-St. Francis Medical Center, Trenton, USA
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22
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O'Connell N, Iftikhar H, Srinivasan G, Radhakrishnan J. Efficacy of palliative treatments in renal cancer: A retrospective observational study in a district general hospital in the UK. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx661.002] [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: 11/14/2022] Open
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