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Sheikh MA, VanAken G, Hyder SN, Giri J. Outpatient Follow-up of Pulmonary Embolism: Putting It all Together. Interv Cardiol Clin 2023; 12:429-441. [PMID: 37290845 DOI: 10.1016/j.iccl.2023.03.009] [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: 06/10/2023]
Abstract
Many patients discharged after an acute pulmonary embolism (PE) admission have inconsistent outpatient follow-up and insufficient workup for chronic complications of PE. A structured outpatient care program is lacking for the different phenotypes of chronic PE, such as chronic thromboembolic disease, chronic thromboembolic pulmonary hypertension, and post-PE syndrome. A dedicated PE follow-up clinic extends the organized, systematic care provided to patients with PE via the PERT (Pulmonary Embolism Response Team) model in the outpatient setting. Such an initiative can standardize follow-up protocols after PE, limit unnecessary testing, and ensure adequate management of chronic complications.
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Affiliation(s)
- Muhammad Adil Sheikh
- Division of Cardiology, Department of Internal Medicine, Southern Illinois University, PO Box 19636, Springfield, IL 62794-9636, USA.
| | - Gabriella VanAken
- University of Michigan School of Medicine, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Syed Nabeel Hyder
- Division of Cardiology, Department of Internal Medicine, University of Michigan, 1500 East Medical Center Drive, Ann Arbor, MI 48109, USA
| | - Jay Giri
- Cardiovascular Medicine Division, Department of Medicine, Hospital of the University of Pennsylvania, 3400 Civic Center Boulevard, Philadelphia, PA 19104, USA
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Sheikh MA, buhnerkempe M, Scaife S, Regmi MR, Patel R, Hegde S. TRANSCATHETER AORTIC VALVE REPLACEMENT IN PATIENTS WITH CARDIAC AMYLOIDOSIS - NATIONAL OUTCOMES AND READMISSIONS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)02688-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Regmi MR, Sheikh MA, Patel R, Hegde S. CHALLENGING CASE OF LOW FLOW LOW GRADIENT AORTIC STENOSIS IN A PATIENT WITH TRANSTHYRETIN CARDIAC AMYLOIDOSIS. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)04229-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Yan YY, Dous YNB, Ouellette HA, Munk PL, Murray N, Mallinson PI, Sheikh MA. Periarticular calcifications. Skeletal Radiol 2022; 51:451-475. [PMID: 34155550 DOI: 10.1007/s00256-021-03842-4] [Citation(s) in RCA: 1] [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: 04/09/2021] [Revised: 06/12/2021] [Accepted: 06/13/2021] [Indexed: 02/02/2023]
Abstract
Periarticular calcification and ossification is a frequent finding on imaging and may sometimes pose a diagnostic challenge. The differential diagnoses for this radiological finding are wide and can be classified into broad groups such as idiopathic, developmental, trauma, burns, infection, tumor, connective tissue disease, crystalline, metabolic, vascular, and foreign bodies. With careful consideration of the clinical and imaging findings as well as awareness of mimickers of periarticular mineralization, the list of differential diagnoses can be narrowed down. This article aims to review the clinical-radiologic findings of periarticular calcified or ossified lesions with relevant imaging illustrations.
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Affiliation(s)
- Y Y Yan
- Department of Radiology, Musculoskeletal Section, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada. .,Department of Radiology, Changi General Hospital, 2 Simei Street 3, Singapore, 529889, Singapore.
| | - Y N Bin Dous
- Department of Radiology, Musculoskeletal Section, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - H A Ouellette
- Department of Radiology, Musculoskeletal Section, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - P L Munk
- Department of Radiology, Musculoskeletal Section, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - N Murray
- Department of Radiology, Musculoskeletal Section, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - P I Mallinson
- Department of Radiology, Musculoskeletal Section, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
| | - M A Sheikh
- Department of Radiology, Musculoskeletal Section, Vancouver General Hospital, University of British Columbia, Vancouver, BC, Canada
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Regmi MR, Sheikh MA, Patel R, Hegde S. PAPILLARY FIBROELASTOMA OF LEFT VENTRICLE APEX. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)04056-6] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Sheikh MA, Deo SV, Ueda P, Altarabsheh S, Elgudin Y, Rubelowsky J, Cmolik B, Hawkins N, McAllister D, Sattar N, Pell J. STEPWISE APPROACH TO LIPID LOWERING IN ‘VERY HIGH RISK’ PATIENTS UNDERGOING CORONARY ARTERY BYPASS SURGERY: A MONTE CARLO SIMULATION. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01952-0] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Sheikh MA, Schrader K, Siddiqui O, Al-Khadra Y, Patel R, Regmi MR, Niaz Z, Kropp R, Missula V, Schiller L, Singanallur P, Sukkari M, Gleason M, Holtz D, Kulkarni AK. SYMPTOMATIC NON-SUSTAINED VENTRICULAR TACHYCARDIA ASSOCIATED WITH RESOLVED MILD COVID-19. J Am Coll Cardiol 2022. [PMCID: PMC8972370 DOI: 10.1016/s0735-1097(22)03334-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Patel R, Desai R, Sheikh MA, Regmi MR, Hegde S. PREVALENCE AND RISK FACTORS ASSOCIATED WITH INTRACARDIAC THROMBUS IN PATIENTS WITH CARDIAC AMYLOIDOSIS. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01556-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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Niaz Z, Kropp R, Schiller L, Singanallur P, Missula V, Schrader K, Sukkari M, Holtz D, Gleason M, Sheikh MA, Patel R, Regmi MR, Kulkarni AK. AN INTERESTING CASE OF CMV MYOPERICARDITIS IN AN IMMUNOCOMPETENT PATIENT. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)03761-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Singanallur P, Kropp R, Gleason M, Sheikh MA, Niaz Z, Schiller L, Missula V, Schrader K, Sukkari M, Patel R, Regmi MR, Holtz D, Kulkarni AK. WHEN A TUMOR IS MORE THAN A TUMOR. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)04215-2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Sheikh MA, Burri MV, Hegde S. TRANSVERSE SINUS FAT SHADOW MIMICKING AS LEFT ATRIAL APPENDAGE MASS - UNVEILED BY MULTIMODALITY IMAGING. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)04103-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Deo S, Sundaram V, Sheikh MA, Sahadevan J, Selvaganesan P, Madan Mohan SK, Rubelowsky J, Elgudin Y, Josephson R, Davierwala PM, Cmolik B. Pre-operative glycaemic control and long-term survival in diabetic patients after coronary artery bypass grafting. Eur J Cardiothorac Surg 2021; 60:1169-1177. [PMID: 33970210 DOI: 10.1093/ejcts/ezab180] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [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: 12/09/2020] [Revised: 02/12/2021] [Accepted: 03/19/2021] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES We analysed the Veteran Affairs data to evaluate the association of pre-operative glycated haemoglobin (HbA1c) and long-term outcome after isolated coronary artery bypass grafting (CABG). METHODS Veterans with diabetes mellitus and isolated CABG (2006-2018) were divided into 4 groups (I: HbA1c <6.5%, II: HbA1c 6.5-8, III 8-10% and IV: HbA1c >10%). The relationship of pre-operative HbA1c and long-term survival was evaluated with a multivariable Cox proportional hazards model and reported as hazard ratios (HR). The cumulative incidence of secondary end-points [myocardial infarction (MI) and repeat revascularization (percutaneous intervention)] for each group was modelled as competing events with cause-specific Cox proportional hazards models. RESULTS Overall, 16 190 patients (mean age 64.9 years, male 98%; insulin dependent 53%) with diabetes mellitus underwent isolated CABG. We observed 19.4%, 45.4%, 27% and 8.2% patients in groups I, II, III and IV, respectively. Patients with HbA1c >10% were the youngest (mean age 60.9 years) and had high rates of Insulin dependence (78%). In patients with HbA1c >10%, improvement in levels was observed in 76%. The median follow-up observed was 5.8 (3.2-8.8) years. Compared to the study mean HbA1c (7.3%), mortality rate increased with HbA1c levels >8%, and especially with pre-operative HbA1c levels >9%. Compared to patients with HbA1c <8%, HbA1c 8-10% and >10% were associated with increased MI (HR 1.24 and HR 1.39, respectively) and need for reintervention (HR 1.20 and HR 1.24, respectively). CONCLUSIONS In patients undergoing CABG, pre-operative HbA1c >8% is associated with the increased risk of mortality and adverse cardiac events.
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Affiliation(s)
- Salil Deo
- Surgical Services, Louis Stokes Cleveland VA Medical Center, VA Northeast Ohio Healthcare System, Cleveland, OH, USA
| | - Varun Sundaram
- Department of Cardiology, Harrington Heart and Vascular Institute, Cleveland Medical Center, University Hospitals, Cleveland, OH, USA.,Division of Cardiology, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Muhammad Adil Sheikh
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Jayakumar Sahadevan
- Division of Cardiology, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | - Padmini Selvaganesan
- Division of Cardiology, Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA
| | | | - Joseph Rubelowsky
- Surgical Services, Louis Stokes Cleveland VA Medical Center, VA Northeast Ohio Healthcare System, Cleveland, OH, USA
| | - Yakov Elgudin
- Surgical Services, Louis Stokes Cleveland VA Medical Center, VA Northeast Ohio Healthcare System, Cleveland, OH, USA
| | - Richard Josephson
- Department of Cardiology, Harrington Heart and Vascular Institute, Cleveland Medical Center, University Hospitals, Cleveland, OH, USA
| | | | - Brian Cmolik
- Surgical Services, Louis Stokes Cleveland VA Medical Center, VA Northeast Ohio Healthcare System, Cleveland, OH, USA
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Deo S, Sahadevan J, Sheikh MA, Selvaganesan P, Mohan SM, Josephson R, Rubelowsky J, Elgudin Y, Cmolik B, Altarabsheh S, Davierwala P, Sundaram V. A NATIONWIDE ANALYSIS OF THE EXTERNAL APPLICABILITY OF THE COMPASS TRIAL IN PATIENTS UNDERGOING CORONARY ARTERY BYPASS SURGERY. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)01513-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Sheikh MA, Kong X, Haymart B, Kaatz S, Krol G, Kozlowski J, Dahu M, Ali M, Almany S, Alexandris-Souphis T, Kline-Rogers E, Froehlich JB, Barnes GD. Comparison of temporary interruption with continuation of direct oral anticoagulants for low bleeding risk procedures. Thromb Res 2021; 203:27-32. [PMID: 33906063 DOI: 10.1016/j.thromres.2021.04.006] [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: 02/15/2021] [Revised: 04/11/2021] [Accepted: 04/12/2021] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Limited data is available on the rates of bleeding and thromboembolic events for patients undergoing low bleeding risk procedures while taking direct oral anticoagulants (DOAC). METHODS Adults taking DOAC in the Michigan Anticoagulation Quality Improvement Initiative (MAQI2) database who underwent a low bleeding risk procedure between May 2015 and Sep 2019 were included. Thirty-day bleeding (of any severity), thromboembolic events, and death were compared between DOAC temporarily interrupted and continued uninterrupted groups. Adverse event rates were compared using an inverse probability weighting propensity score. RESULTS There were 820 patients who underwent 1412 low risk procedures. DOAC therapy was temporarily interrupted in 371 (45.2%) patients (601 [42.6%] procedures) and continued uninterrupted in 449 (54.8%) patients (811 [57.4%] procedures). DOAC patients with temporary interruptions were more likely to have diabetes, prior stroke or TIA, prior bleeding, higher CHA2DS2-VASc, and higher modified HAS-BLED scores. DOAC interruption was common for gastrointestinal endoscopy, electrophysiology device implantation, and cardiac catheterization while it was less common for cardioversion, dermatologic procedures, and subcutaneous injection. After propensity score adjustment, bleeding risk was lower in the DOAC temporary interruption group (OR 0.62, 95% CI 0.41-0.95) as compared to the group with continuous DOAC use. Rates of thromboembolic events and death did not differ significantly between the two groups. CONCLUSIONS DOAC-treated patients undergoing low bleeding risk procedures may experience lower rates of bleeding when DOAC is temporarily interrupted. Prospective studies focused on low bleeding risk procedures are needed to identify the safety DOAC management strategy.
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Affiliation(s)
- Muhammad Adil Sheikh
- Division of Hospital Medicine, University of Michigan, Ann Arbor, MI, United States of America
| | - Xiaowen Kong
- Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, United States of America
| | - Brian Haymart
- Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, United States of America
| | - Scott Kaatz
- Henry Ford Hospital, Detroit, MI, United States of America
| | - Gregory Krol
- Henry Ford Hospital, Detroit, MI, United States of America
| | - Jay Kozlowski
- Cardiology and Vascular Associates, Huron Valley-Sinai Hospital, Commerce Township, MI, United States of America
| | - Musa Dahu
- Spectrum Health System, Grand Rapids, MI, United States of America
| | - Mona Ali
- Beaumont Hospital, Royal Oak, MI, United States of America
| | - Steven Almany
- Beaumont Hospital, Royal Oak, MI, United States of America
| | - Tina Alexandris-Souphis
- Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, United States of America
| | - Eva Kline-Rogers
- Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, United States of America
| | - James B Froehlich
- Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, United States of America
| | - Geoffrey D Barnes
- Frankel Cardiovascular Center, University of Michigan, Ann Arbor, MI, United States of America.
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Sheikh MA, Deo SV, Riaz H, Raza S, Altarabsheh SE, Wilson B, Elgudin Y, Cmolik B, Pelletier M, Markowitz AH. Safety-net hospitals versus non-safety centers and clinical outcomes after trans-catheter aortic valve replacement. Catheter Cardiovasc Interv 2021; 97:E425-E430. [PMID: 32681697 DOI: 10.1002/ccd.29123] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 06/04/2020] [Accepted: 06/08/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To compare post-procedural outcomes of trans-catheter valve replacement (TAVR) among safety-net (SNH) and non-safety net hospitals (non-SNH). BACKGROUND SNH treat a large population of un-insured and low income patients; prior studies report worse outcome at these centers. Results of TAVR at these centers is limited. METHODS Adults undergoing TAVR at hospitals in the US participating in the National In-patient sample (NIS) database from January 2014 to December 2015 were included. A 1:1 propensity-matched cohort of patients operated at SNH and non-SNH institutions was analyzed, on the basis of 16 demographic and clinical co-variates. Main outcome was all-cause post-procedural mortality. Secondary outcomes included stroke, acute kidney injury and length of post-operative stay. RESULTS Between 2014 and 2015, 41,410 patients (mean age 80 ± 0.11 years, 46% female) underwent TAVR at 731 centers; 6,996 (16.80%) procedures were performed at SNH comprising 135/731 (18.4%) of all centers performing TAVR. SNH patients were more likely to be female (49% vs. 46%, p < .001); admitted emergently (31% vs. 21%; p < .001; at the lowest quartile for household income (25% % vs. 20%; p < .001) and from minorities (Blacks 5.9% vs. 3.9%; Hispanic 7.2% vs. 3.2%).Adjusted logistic regression was performed on 6,995 propensity-matched patient pairs. Post-procedural mortality [OR 0.99(0.98-1.007); p = .43], stroke [OR 1.009(0.99-1.02); p = .08], acute kidney injury [OR 0.99(0.96-1.01); p = .5] and overall length of stay (6.9 ± 0.1 vs. 7.1 ± 0.2 days; p = .57) were comparable in both cohorts. CONCLUSION Post-procedural outcomes after TAVR at SNH are comparable to national outcomes and wider adoption of TAVR at SNH may not adversely influence outcomes.
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Affiliation(s)
- Muhammad Adil Sheikh
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Salil V Deo
- Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Haris Riaz
- Division of Cardiovascular Diseases, Cleveland Clinic Foundation, Cleveland, Ohio
| | | | | | - Brigid Wilson
- Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Yakov Elgudin
- Division of Cardiovascular Diseases, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Brian Cmolik
- Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Marc Pelletier
- Division of Cardiac Surgery, University Hospitals, Cleveland, Ohio
| | - Alan H Markowitz
- Division of Cardiac Surgery, University Hospitals, Cleveland, Ohio
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Sheikh MA, Deo SV, Riaz H, Raza S, Altarabsheh SE, Wilson B, Elgudin Y, Cmolik B, Pelletier M, Markowitz AH. Safety-net hospitals versus non-safety centers and clinical outcomes after trans-catheter aortic valve replacement. Catheter Cardiovasc Interv 2021. [PMID: 32681697 DOI: 10.1002/ccd.29123.] [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] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To compare post-procedural outcomes of trans-catheter valve replacement (TAVR) among safety-net (SNH) and non-safety net hospitals (non-SNH). BACKGROUND SNH treat a large population of un-insured and low income patients; prior studies report worse outcome at these centers. Results of TAVR at these centers is limited. METHODS Adults undergoing TAVR at hospitals in the US participating in the National In-patient sample (NIS) database from January 2014 to December 2015 were included. A 1:1 propensity-matched cohort of patients operated at SNH and non-SNH institutions was analyzed, on the basis of 16 demographic and clinical co-variates. Main outcome was all-cause post-procedural mortality. Secondary outcomes included stroke, acute kidney injury and length of post-operative stay. RESULTS Between 2014 and 2015, 41,410 patients (mean age 80 ± 0.11 years, 46% female) underwent TAVR at 731 centers; 6,996 (16.80%) procedures were performed at SNH comprising 135/731 (18.4%) of all centers performing TAVR. SNH patients were more likely to be female (49% vs. 46%, p < .001); admitted emergently (31% vs. 21%; p < .001; at the lowest quartile for household income (25% % vs. 20%; p < .001) and from minorities (Blacks 5.9% vs. 3.9%; Hispanic 7.2% vs. 3.2%).Adjusted logistic regression was performed on 6,995 propensity-matched patient pairs. Post-procedural mortality [OR 0.99(0.98-1.007); p = .43], stroke [OR 1.009(0.99-1.02); p = .08], acute kidney injury [OR 0.99(0.96-1.01); p = .5] and overall length of stay (6.9 ± 0.1 vs. 7.1 ± 0.2 days; p = .57) were comparable in both cohorts. CONCLUSION Post-procedural outcomes after TAVR at SNH are comparable to national outcomes and wider adoption of TAVR at SNH may not adversely influence outcomes.
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Affiliation(s)
- Muhammad Adil Sheikh
- Division of Hospital Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
| | - Salil V Deo
- Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Haris Riaz
- Division of Cardiovascular Diseases, Cleveland Clinic Foundation, Cleveland, Ohio
| | | | | | - Brigid Wilson
- Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Yakov Elgudin
- Division of Cardiovascular Diseases, Cleveland Clinic Foundation, Cleveland, Ohio
| | - Brian Cmolik
- Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio
| | - Marc Pelletier
- Division of Cardiac Surgery, University Hospitals, Cleveland, Ohio
| | - Alan H Markowitz
- Division of Cardiac Surgery, University Hospitals, Cleveland, Ohio
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Hakeem R, Sheikh MA. Beyond transmission: Dire need for integration of nutrition interventions in COVID-19 pandemic-response strategies in Developing Countries like Pakistan. Pak J Med Sci 2020; 36:S85-S89. [PMID: 32582320 PMCID: PMC7306946 DOI: 10.12669/pjms.36.covid19-s4.2784] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Synergistic associations between infection and nutrition are well known. Impact of nutrition interventions on the outcomes have been scientifically assessed and reported. The role of nutrition in limiting the infection related morbidity and mortality does not appear to be a debatable question but nutrition interventions do not appear to be an essential part of current COVID-19 management strategies. Given the nature of pandemic and lack of organism-specific evidence, variability in nutrition interventions and lack of nutrition interventions is not unexpected. However, delay in realization of the crucial need of nutrition interventions to limit the immediate and long term outcomes at personal and community level may aggravate health related issues that can have long term impact on quality of life and economy. Due to existing undernutrition and lack of nutrition related awareness and competence, need for timely and appropriate interventions is much more critical for developing countries. This manuscript highlights the need and feasibility of various nutrition interventions to assure optimum quality of life during and after COVID-19 pandemic. Available evidence provides enough guidance for nutrition interventions that are safe and promise to accrue various degrees of benefits with almost no likelihood of harm. Nutrition interventions suggested by author are: 1) population level efforts for promoting better use of existing resources; 2) quicker augmentation of nutrition status of high risk people and non-hospitalized cases by use of supplement and individualized guidance and 3) nutritional support of sever case by timely and adequate enteral and parenteral feeding.
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Affiliation(s)
- Rubina Hakeem
- Prof. Dr. Rubina Hakeem, Ph.D. (UK) RD (UK). Fellow of Association for Nutrition (FAfN), UK Principal, RLAK Govt. College of Home Economics, Karachi, Pakistan
| | - Muhammad Adil Sheikh
- Muhammad Adil Sheikh, Clinical Assistant Professor Division of Hospital Medicine Department of Internal Medicine University of Michigan Ann Arbor, Michigan. US
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Sheikh MA, Shokr M, Ibrahim W, Cardozo S. Fibrin sheath-associated endovascular infection of the heart: the Trojan horse of indwelling central venous catheters. BMJ Case Rep 2017; 2017:bcr-2016-219060. [PMID: 28420633 DOI: 10.1136/bcr-2016-219060] [Citation(s) in RCA: 2] [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: 11/03/2022] Open
Abstract
Chronic indwelling central venous catheters can result in formation of fibrin sheaths increasing risk of occlusion, thrombosis and infection. Endovascular infection of right-sided heart structures induced by such sheaths is very rare. A 48-year-old woman with end-stage renal disease initially treated for diabetic ketoacidosis developed persistent Staphylococcus epidermidis bacteraemia without an identifiable source. Although transthoracic echocardiography was unremarkable, transoesophageal echocardiography revealed a fibrin sheath and vegetations in superior vena cava-right atrium junction, which was the site of the tip of a central catheter that had been removed 2 months prior, consistent with fibrin sheath-associated endovascular infection. The bacteraemia cleared and clinical improvement was seen with prolonged intravenous vancomycin. In patients with unexplained bacteraemia and history of a central catheter, rare causes of endovascular infections of right-sided heart structures like fibrin sheaths should be considered. These can persist months after catheter removal. Transoesophageal echocardiogram should be used for earlier detection.
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Affiliation(s)
- Muhammad Adil Sheikh
- Internal Medicine, Wayne State University School of Medicine/Detroit Medical Center, Detroit, MI, USA
| | - Mohamed Shokr
- Internal Medicine, Wayne State University School of Medicine/Detroit Medical Center, Detroit, MI, USA
| | - Walid Ibrahim
- Internal Medicine, Wayne State University School of Medicine/Detroit Medical Center, Detroit, MI, USA
| | - Shaun Cardozo
- Cardiology, Wayne State University School of Medicine/Detroit Medical Center, Detroit, MI, USA
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Rehman KA, Khan M, Rehmani A, Taufeeq M, Sheikh MA, Fatima K, Gul S, Riaz H. A META-ANALYSIS OF CARDIOVASCULAR SAFETY OF FDA APPROVED ANTI OBESITY DRUGS. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35057-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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Akintoye E, Briasoulis A, Adegbala O, Sheikh MA, Singh M, Ahmed A, Levine D. REGIONAL VARIATION IN HOSPITALIZATION OUTCOMES AMONG PATIENTS ADMITTED FOR HEART FAILURE IN THE UNITED STATES. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34160-8] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Akintoye E, Briasoulis A, Adegbala O, Sheikh MA, Singh M, Ahmed A, Levine D. SEASONAL VARIATION IN IN-PATIENT MORTALITY, COST OF HOSPITALIZATION AND LENGTH OF STAY IN HEART FAILURE PATIENTS IN THE UNITED STATES. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)34148-7] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Siddiqui F, Sheikh MA, Ashraf S, Forbes T, Afonso L. THINGS TO CONSIDER WHEN SHOPPING FOR A SHUNT: A DIAGNOSTIC CHALLENGE. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35567-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Parveen R, Khan MI, Anjum FM, Sheikh MA. Investigating potential roles of extruded flaxseed and α-tocopherol acetate supplementation for production of healthier broiler meat. Br Poult Sci 2016; 57:566-75. [PMID: 27108741 DOI: 10.1080/00071668.2016.1180669] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
The present study was conducted to evaluate the role of extruded flaxseed (EFS) and α-tocopherol acetate (ATA) for the enhancement of polyunsaturated fatty acids ratio (PUFA) over saturated fatty acids (SFA) in broiler meat as a source of healthier meat. A total of 96 one-d-old Cobb 550 broilers were randomly divided into 8 treatments with three replicates having 4 birds in each. EFS (extruded at 155°C) at 100, 150 and 200 g/kg alone and in combination with ATA at 200 mg/kg were supplemented through normal feed from the third week onward. During the 6-week growth period, body weight gain (BWG), feed intake (FI), feed conversion ratio (FCR) and mortality were recorded. At slaughter, weight of liver, heart and kidney and fat content in breast and leg meat were measured. Fatty acid profiles in breast and leg meat were developed to estimate the PUFA to SFA ratio. The results revealed that FI and FCR changed significantly in all groups and BWG increased in all the supplemented groups. The weight of liver, kidney and heart increased more in the supplemented group containing the maximum level of EFS with ATA compared with single supplementation of EFS. The fat content in breast and leg meat decreased as the inclusion level of EFS increased. The level was low in leg meat compared with breast meat. Mortality decreased in all supplemented groups. The PUFA to SFA ratio was significantly higher in leg meat (3.23) compared with breast meat (1.81) and the study therefore indicates that ATA and EFS supplementation could be used to improve the PUFA to SFA ratio in broiler meat.
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Affiliation(s)
- R Parveen
- a National Institute of Food Science and Technology, University of Agriculture , Faisalabad , Pakistan
| | - M I Khan
- a National Institute of Food Science and Technology, University of Agriculture , Faisalabad , Pakistan
| | - F M Anjum
- a National Institute of Food Science and Technology, University of Agriculture , Faisalabad , Pakistan
| | - M A Sheikh
- b Department of Chemistry and Biochemistry , University of Agriculture , Faisalabad , Pakistan
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Sheikh MA, Hakeem R, Asar F, Shaikh AH. Diabetes education and care in a developing country: observations from Karachi, Pakistan. Prim Care Diabetes 2015; 9:48-53. [PMID: 24938175 DOI: 10.1016/j.pcd.2014.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2013] [Revised: 03/28/2014] [Accepted: 04/12/2014] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To explore the kind of care being received by a sample of middle income group subjects with diabetes in Karachi. DESIGN Cross-sectional. PLACE AND DURATION OF STUDY Raana Liaquat Ali Khan College of Home Economics, Karachi from January 2009 to September 2009. PATIENTS AND METHODS Information was collected from 105 type 2 diabetics through a structured, pre-tested, self administered questionnaire distributed in two colleges only to those students who had any adult onset diabetic in their family. SPSS version 16 was used for data entry and analysis (e.g., chi-square tests). RESULTS The mean duration of diabetes was 8.9 years. Random blood sugar, blood pressure check and urine test for sugar were the most frequently performed tests. Many important diabetes related tests had not been performed even on subjects with duration of diabetes of 10 years or more such as HbA1c had never been performed for 74% of subjects in this class. Test for circulation had never been performed for 93% of subjects with 1 year's diabetes duration and for 62% of subjects with duration of 10 years or more. More than 90% subjects received information about diet and causes of diabetes; >70% had been informed about diabetes complications, foot care, dental care, self monitoring of blood glucose and testing sugar in urine and only 48% had been educated about insulin injections. Physician was the source of this information for more than 70% of subjects. CONCLUSIONS This study has explored insufficient clinical monitoring of diabetes complications and provision of casual diabetes education. These observations highlight the need for provision of appropriate diabetes education, both to health care team and professionals.
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Affiliation(s)
| | - Rubina Hakeem
- Department of Clinical Nutrition, Taibah University, Madinah, Saudi Arabia; Department of Food and Nutrition, Raana Liaquat Ali Khan College of Home Economics, Karachi, Pakistan.
| | - Farzana Asar
- Department of Food and Nutrition, Raana Liaquat Ali Khan College of Home Economics, Karachi, Pakistan.
| | - Abdul Hakeem Shaikh
- Department of Botany, Federal Urdu University of Arts, Science and Technology, Karachi, Pakistan.
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Rehman A, Mazhar A, Sheikh MA, Naeem MM, Bhatti IA. Hepatitis B surface antigen carrier rate in unvaccinated and vaccinated children with thalassaemia major at Bahawal Victoria Hospital, Bahawalpur, Pakistan. East Mediterr Health J 2012; 18:378-81. [PMID: 22768701 DOI: 10.26719/2012.18.4.378] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Screening of blood reduces but does not eliminate the risk of hepatitis B virus (HBV) infection in multi-transfused thalassaemia patients. This study was done to evaluate efficacy of HBV vaccination on hepatitis B virus surface antigen (HBsAg) carrier rate in children with thalassaemia major receiving multiple blood transfusions. In a cohort study conducted at a hospital in Bahawalpur, Pakistan, during 2009-10, children with thalassaemia major aged < 60 months who received more than 24 blood transfusions and were HBsAg negative at the time of first blood transfusion were included. Of 196 unvaccinated children, the seropositive rate was 12.2%; while among 218 children vaccinated during the first year of life via the Pakistan Expanded Programme on Immunization, the seropositive rate was only 0.9%. The HBV vaccine was highly effective in reducing the HBsAg carrier rate in hildren with thalassaemia aged < 5 years.
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Affiliation(s)
- A Rehman
- Department of Paediatrics, Quaid-e-Azam Medical College, Bahawalpur, Pakistan.
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Raza S, Sheikh MA, Hussain MFA, Siddiqui SE, Muhammad R, Aziz S, Qamar S, Saleem MA, Waki N, Faruqi H, Zia A. Dietary modification, body mass index (BMI), blood pressure (BP) and cardiovascular risk in medical students of a government medical college of Karachi. J PAK MED ASSOC 2010; 60:970-974. [PMID: 21375210] [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: 05/30/2023]
Abstract
OBJECTIVE To determine the prevalence of major risk factors including dietary modification, Body Mass Index (BMI), Blood Pressure (BP) and physical activity in medical students of government teaching hospitals of Karachi. METHODS A cross sectional study was conducted on students of Dow Medical College, Karachi, Pakistan through a structured pre-tested questionnaire. Non-probability purposive sampling was used. Smoking, hypertension, family history of cardiovascular disease (CVD), overweight and low physical activity levels are risk factors the presence of which can lead to development of CVD. Prevalence of these risk factors was determined by asking appropriate questions and through measurement of BMI and blood pressure for overweight and hypertension respectively. Awareness of risk factors was determined through knowledge of the effect of various food substances on development of CVD and of adoption of dietary changes keeping in mind the risk of developing CVD. SPSS 16.0 was used for statistical analysis. RESULTS A total of 132 medical students were included in the study of which 57 (43.2%) and 75 (56.8%) were male and female respectively with mean age of 20.85 +/- 1.21 years. About 15.9% of students had elevated blood pressure i.e. > or = 140/90 mmHg. Twenty eight percent of the total students were found to be underweight and 17.4% were overweight, 5% had some history of CVD, 56.8% had family history of CVD, 9.4% were smokers and 29.5% had high physical activity level. About 87.1% had modified their diet for preventing CVD. Most of the students had adequate knowledge about the cardiovascular risk factors CONCLUSION Majority of students were not overweight. A high prevalence of cardiovascular risk factors; family history and elevated blood pressure was present. Awareness in terms of knowledge was satisfactory but implementation in terms of diet modification and adequate physical activity was lacking.
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Affiliation(s)
- Sajjad Raza
- Dow Medical College, Dow University of Health Sciences, Karachi
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Sheikh MA, Fujimura H, Miyagi T, Uechi Y, Yokota T, Yasumura S, Oomori T. Detection and ecological threats of PSII herbicide diuron on coral reefs around the Ryukyu Archipelago, Japan. Mar Pollut Bull 2009; 58:1922-1926. [PMID: 19837441 DOI: 10.1016/j.marpolbul.2009.09.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/23/2009] [Revised: 09/09/2009] [Accepted: 09/09/2009] [Indexed: 05/28/2023]
Affiliation(s)
- M A Sheikh
- Department of Chemistry, University of the Ryukyus, Senbaru 1, Nishihara, Okinawa 903-0213, Japan.
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Sheikh MA. Health practices of health professionals: do doctors practice what they preach? J PAK MED ASSOC 2009; 59:656. [PMID: 19750872] [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: 05/28/2023]
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Luby SP, Gupta SK, Sheikh MA, Johnston RB, Ram PK, Islam MS. Tubewell water quality and predictors of contamination in three flood-prone areas in Bangladesh. J Appl Microbiol 2008; 105:1002-8. [PMID: 18422953 DOI: 10.1111/j.1365-2672.2008.03826.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
AIMS To measure enteric bacterial contamination of tubewells in three flood prone areas in Bangladesh and the relationship of bacteriological contamination with tubewell sanitary inspection scores. METHODS AND RESULTS Microbiologists selected 207 tubewells in three flood prone districts, assessed physical characteristics of the tubewells and collected a single water sample from each tubewell. Tubewell water samples were contaminated with total coliforms (41%, n = 85), thermotolerant coliforms (29%, n = 60) and Escherichia coli (13%, n = 27). Among contaminated wells, the median CFU of contamination per 100 ml was 8 (interquartile range, 2-30) total coliforms, 5 (interquartile range, 2-23) thermotolerant coliforms and 6 (interquartile range, 1-30) E. coli. There was no significant association between tubewell contamination with E. coli, thermotolerant coliforms or total coliforms and a poor sanitary inspection score, though a history of inundation was associated with contamination with both E. coli and thermotolerant coliforms. CONCLUSIONS Tubewells in flood-prone regions of Bangladesh were commonly contaminated with low levels of faecal organisms, contamination that could not be predicted by examining the tubewell's external characteristics. SIGNIFICANCE AND IMPACT OF THE STUDY The forms currently used for sanitary inspection do not identify the most important causes of drinking water contamination in these communities.
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Affiliation(s)
- S P Luby
- International Centre for Diarrhoeal Disease Research, Bangladesh, Mohakhali, Dhaka, Bangladesh.
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Khurshid R, Sheikh MA, Iqbal S. Health of people working/living in the vicinity of an oil-polluted beach near Karachi, Pakistan. East Mediterr Health J 2008; 14:179-182. [PMID: 18557466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
A short-term study was conducted after the oil spillage from the tanker Tasman Spirit to analyse seawater and sand samples taken from Karachi beach for hydrocarbon/organic contents. Blood samples were collected from people who were working or living in the vicinity of the beach. Lymphocyte and eosinophil levels were slightly increased. About 11 people had raised serum glutamic pyruvic transaminase, but this was not significant. Such steps are vital to ensure that there are no long-term hazardous effects of oil on human health.
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Affiliation(s)
- R Khurshid
- Department of Biochemistry, Fatima Jinnah Medical College, Lahore, Pakistan.
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Gupta SK, Sheikh MA, Islam MS, Rahman KS, Jahan N, Rahman MM, Hoekstra RM, Johnston R, Ram PK, Luby S. Usefulness of the hydrogen sulfide test for assessment of water quality in Bangladesh. J Appl Microbiol 2007; 104:388-95. [PMID: 17922823 DOI: 10.1111/j.1365-2672.2007.03562.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM To evaluate the usefulness of the hydrogen sulfide (H(2)S) test for assessing water quality in Bangladesh. METHODS AND RESULTS We tested 382 water samples from a variety of sources using locally produced H(2)S test kits and laboratory-based membrane filtration for the detection of Escherichia coli. Compared with membrane filtration, H(2)S tests, when incubated for 24 h, had both a sensitivity and positive predictive value (PPV) of <40% when analysis was restricted to water samples with E. coli levels below 100 colony forming units (CFU) per 100 ml. In contrast, for E. coli levels from 1000 to 9999 CFU per 100 ml, sensitivity was 94% and PPV 88%; specificity was 97% and negative predictive value was 99%. CONCLUSIONS The hydrogen sulfide test, when incubated at 24 h, is a promising alternative for assessing water quality where E. coli levels may be high. An improved understanding of the incremental impact of contamination level on health is needed to better determine its usefulness. SIGNIFICANCE AND IMPACT OF THE STUDY The hydrogen sulfide test is inexpensive, easy to use and portable. Its use may allow rapid assessment of water quality in situations where cost or logistics prevent use of other testing methods, such as in remote areas or during flood and other natural disasters.
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Affiliation(s)
- S K Gupta
- Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Vohra FA, Sheikh MA. Bisphosphonates: a potential cause of osteonecrosis of jaws. J Coll Physicians Surg Pak 2007; 17:579-80. [PMID: 17903415 DOI: 09.2007/jcpsp.579580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- F A Vohra
- Honorary SHO, Oral and Maxillofacial Surgery, Sandwell and West Birmingham NHS Trust, Birmingham, 79 Chalgrove Crescent,Clayhall, Essex, UK IG5 0LX
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Anim JT, Kehinde EO, Sheikh MA, Prasad A, Mojiminiyi OA, Ali Y, Al-Awadi KA. Serum prostate-specific antigen levels in Middle Eastern men with subclinical prostatitis. Med Princ Pract 2007; 16:53-8. [PMID: 17159365 DOI: 10.1159/000096141] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2005] [Accepted: 04/04/2006] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To investigate the influence of subclinical or histologically diagnosed prostatitis on serum prostate-specific antigen (PSA) in patients investigated for prostatic disease in Kuwait. MATERIALS AND METHODS Serum PSA was assayed in patients investigated for prostatic disease in Mubarak Al-Kabeer Hospital, Kuwait, between December 2002 and December 2004. These included patients undergoing transrectal ultrasound with needle biopsy of the prostate gland and those who were treated with transurethral resection of the prostate or retropubic prostatectomy. The tissue was evaluated for prostatitis as well as the underlying disease, and the type and severity of prostatitis were compared with levels of serum PSA. RESULTS Of the 331 tissue specimens, 18 (5.4%) did not show prostatitis, while 233 (70.4%) with benign prostate and 80 (24.2%) with malignant prostate disease showed prostatitis. Of 270 men with known serum PSA levels, 198 and 72 had benign and malignant prostate disease, respectively. Of the 198, 77 (41%) with benign prostate disease and prostatitis and of the 72, 52 (76%) with malignant prostate disease and prostatitis had serum PSA levels >10 ng/ml. CONCLUSION The data showed that although raised serum PSA is more commonly associated with prostate cancer, subclinical prostatitis is a significant source of high serum PSA in over 40% of men in Kuwait. That local factors may obscure the usefulness of serum PSA as a screening tool suggests the need for a locally applicable paradigm to identify prostate cancer.
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Affiliation(s)
- J T Anim
- Department of Pathology, Faculty of Medicine, Kuwait University, Kuwait.
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Abstract
Superior vena cava (SVC) syndrome is associated with advanced malignancy of the chest. Extensive experience is published in the literature regarding the use of endovascular intervention for symptomatic relief in these individuals with limited survival. Symptomatic SVC obstruction may occur from benign conditions that may not alter life expectancy. There are few data regarding endovascular therapy in this setting. We retrospectively analyzed our experience using endovascular intervention for benign SVC obstruction in 19 patients. In our series, the mean age was 46.4 years; 58% were female and 14/19 cases were due to an intravascular device. All patients experienced symptomatic relief. Median follow-up was 28.8 months. Three patients required secondary procedures to maintain patency. Four patients had procedural complications, which did not affect the outcomes. One patient died from complications of anticoagulation at 24 months. Endovascular procedures aimed at relieving SVC stenosis seem to be effective in patients with benign disease.
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Affiliation(s)
- M A Sheikh
- Section of Vascular Medicine, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA
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Talpur AN, Hasan AT, Sheikh MA. Intraprostatic tissue infection in catheterised patients in comparison to controls. J PAK MED ASSOC 2004; 54:20-4. [PMID: 15058637] [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: 04/29/2023]
Abstract
OBJECTIVE To determine the effect of indwelling urinary catheter on frequency of intraprostatic tissue infection and posto-perative morbidity in patients with benign prostatic hyperplasia undergoing transurethral resection of prostate (TURP). METHODS Frequency of intraprostatic tissue and urinary infection, prevalent organisms, histopathology of prostatic tissue, post-operative morbidity were analyzed for 25 consecutive patients' of clinically diagnosed benign prostatic hyperplasia who underwent TURP in catheterized and non-catheterized groups. RESULTS Patients mean age was 62.2+7.9 years. In non-catheterized group nocturia and frequency were the most common symptoms. Ninety two percent and 28% patients acquired intraprostatic tissue infection in catheterized and non-catheterized group respectively, while 80% of catheterized patients and 24% of the non-catheterized patients had bacteriuria. Catheterized patients had E. coli as prevalent organism both in intaprostatic tissue and urine (34.8% and 40% respectively). E. coli Serratia and enterobacter were equally prevalent in intraprostatic tissue of non-catheterized patients. Enterobacter was the prevalent organism in urine (50%) of these patients. There was no significant difference in the presence of non-specific inflammatory cells in the two groups. Catheterized group showed significantly high frequency of fever >38.5 degrees C and hematuria for more than 24 hours. CONCLUSION Catheterization significantly increases the frequency of intraprostatic tissue infection as well as morbidity of TURP.
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Affiliation(s)
- A N Talpur
- Department of Urological Surgery and Transplantation, Jinnah Postraduate Medical Centre, Karachi
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Hasan AT, Fasihuddin Q, Sheikh MA. Suprapubic cystostomy: urinary tract infection and other short term complications. J PAK MED ASSOC 2002; 52:557-60. [PMID: 12627904] [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: 03/01/2023]
Abstract
AIMS To evaluate the frequency of urinary tract infection in patients with suprapubic cystostomy and other complications of the procedure within 30 days of placement. METHODS Patients characteristics, indication and types of cystostomy and short term (within 30 days); complications were analyzed in 91 patients. Urine analysis and culture was done in all patients to exclude those with urinary tract infection. After 15 and 30 days of the procedure, urine analysis and culture was repeated to evaluate the frequency of urinary tract infection. The prevalence of symptomatic bacteriuria with its organisms was assessed. Antibiotics were given to the postoperative and symptomatic patients and the relationship of antibiotics on the prevention of urinary tract infection was determined. RESULTS Of the 91 cases 88 were males and 3 females. The mean age was 40.52 +/- 18.95 with a range of 15 to 82 years. Obstructive uropathy of lower urinary tract.was present in 81% cases and 17 (18.6%) had history of trauma to urethra. All these cases had per-urethral bleeding on examination while x-ray urethrogram showed grade II or grade III injury of urethra. Eighty two of the procedures were performed per-cutaneously and 7 were converted to open cystostomies due to failure of per-cutaneous approach. Nine patients had exploratory laparotomy. Duration of catheterization was the leading risk factor for urinary tract infection found in 24.1% at 15 days and 97.8% at 30 days. There was low prevalence of symptomatic urinary tract infection. E.Coli was the prevalent organism. Antibiotics did not play a significant role in controlling catheter associated urinary tract infection. Blockage and macroscopic hematuria (self limiting) were the predominant complications encountered. CONCLUSION Duration of catheterization is the leading risk factor for the development of urinary tract infections. Catheter-associated bacteriuria are usually asymptomatic. Macroscopic hematuria and blockage of catheter are frequent which can be managed promptly without surgical intervention.
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Affiliation(s)
- A T Hasan
- Department of Urological Surgery and Transplantation, Jinnah Postgraduate Medical Center, Karachi
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Abstract
Acute limb ischemia secondary to peripheral arterial thrombosis is a relatively uncommon but ominous form of vascular accident. Select inherited and acquired hypercoagulable states appear to contribute to an initial arterial thrombosis and, more importantly, recurrent thrombotic events. Mounting interest in hypercoagulability, the increased availability of hypercoagulable state "profiles," and enhanced ability to identify an abnormality in tested patients have promoted widespread testing. Unfortunately, widespread testing has had a limited beneficial impact on the management of acute limb ischemia. Ideally, costly and specialized testing should be limited to situations in which the results will have a tangible impact on patient care. Clear goals of testing should be determined before testing is performed. This article addresses a practical approach to hypercoagulable state testing in patients with acute limb ischemia with a focus on abnormalities that impact patient management.
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Affiliation(s)
- S R Deitcher
- Section of Clinical Thrombosis, Department of Vascular Medicine, The Cleveland Clinic Foundation, Cleveland, OH 44195, USA
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Sheikh MA, Gomes MP, Bartholomew JR. Images in vascular medicine. Ectopic filter. Vasc Med 2001; 6:63-4. [PMID: 11358163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/16/2023]
Affiliation(s)
- M A Sheikh
- Department of Vascular Medicine, Cleveland Clinic Foundation, OH, USA
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Chiang S, Dar AM, Goyal SM, Sheikh MA, Pedersen JC, Panigrahy B, Senne D, Halvorson DA, Nagaraja KV, Kapur V. A modified enzyme-linked immunosorbent assay for the detection of avian pneumovirus antibodies. J Vet Diagn Invest 2000; 12:381-4. [PMID: 10907873 DOI: 10.1177/104063870001200417] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Avian pneumovirus (APV) infection of turkeys in Minnesota was first confirmed in March 1997. Serum samples (n = 5,194) from 539 submissions to Minnesota Veterinary Diagnostic Laboratory were tested by a modified enzyme-linked immunosorbent assay (ELISA). Of these, 2,528 (48.7%) samples from 269 submissions were positive and 2,666 (51.3%) samples from 270 submissions were negative for APV antibodies. Most positive samples were from Kandiyohi, Stearns, Morrison, and Meeker counties in Minnesota. In addition, 10 samples from South Dakota were positive. The sensitivity and specificity of the ELISA test with anti-chicken and anti-turkey conjugates were compared by testing field and experimental sera. The ELISA test with anti-turkey conjugate was more sensitive than that with anti-chicken conjugate. The ELISA tests with antigens prepared with APV strains isolated from Colorado and Minnesota were also compared. No difference was detectable. Currently, the Minnesota Veterinary Diagnostic Laboratory uses an antigen prepared from the Colorado isolate of APV and a goat anti-turkey conjugate in the ELISA test.
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Affiliation(s)
- S Chiang
- Department of Veterinary Diagnostic Medicine, College of Veterinary Medicine, University of Minnesota, St. Paul 55108, USA
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Sheikh MA, Khan MS, Khatoon A, Arain GM. Incidence of urinary tract infection during pregnancy. East Mediterr Health J 2000; 6:265-71. [PMID: 11556011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Incidence of urinary tract infection (UTI) during pregnancy among Pakistani women was examined. Midstream urine was collected from 250 pregnant and 100 control women and streaked on blood agar and incubated. Growth was considered significant if > or = 10(5)/mL bacteria were present. Among the pregnant women, 28.5% had UTI; 30.0% of controls had UTI. Among the pregnant and control women, 24.4% and 20.0% respectively had UTI symptoms, such as incontinence, nocturia and urgency. Symptoms did not correlate with incidence. Socioeconomic status, personal hygiene, education level, pregnancy duration, postcoital washing, contraceptive use and use of underclothing had no significant association with UTI occurrence. A history of past urological problems was associated with an increased incidence of UTI in pregnancy.
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Affiliation(s)
- M A Sheikh
- Department of Urological Surgery and Transplantation, Jinnah Postgraduate Medical Centre, Karachi, Pakistan
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Dhanjee A, Sheikh MA, Yaqub M, Alam SE. Orelox (cefodoxime) in typhoid fever. J PAK MED ASSOC 1999; 49:148-9. [PMID: 10599198] [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: 02/14/2023]
Abstract
OBJECTIVE To study the efficacy of Orelox (Cefodoxime) in Typhoid fever in children. SETTINGS Open, non-comparative, multicentre study carried out in GP settings in various cities of Pakistan. PATIENTS Children aged 1-15 years were included in the study. Positive Widal test was the only diagnostic inclusion criteria. RESULTS Four centers participated in the study. Of the total 77 patients (51 males and 26 females), 61 (79%) cured, 5 (7%) improved (less severe signs and symptoms) and 11 (14%) failures. CONCLUSION Treatment of typhoid fever in this study showed 86% efficacy in producing clinical responses suggesting that this drug can be effectively and safely used in the treatment of typhoid fever in children.
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Al-Bassam A, Sheikh MA, Al-Smayer S, Al-Boukai A, Al-Damegh S. Congenital H-type anourethral fistula with severe urethral hypoplasia: case report and review of the literature. J Pediatr Surg 1998; 33:1550-3. [PMID: 9802812 DOI: 10.1016/s0022-3468(98)90496-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [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: 11/29/2022]
Abstract
Congenital H-type anourethral fistula with severe urethral hypoplasia and normal anus is an extremely rare variant of anorectal malformations among boys. The authors report a case of a 5-year-old boy who underwent successful management of severe urethral hypoplasia with progressive augmentation by dilating urethra anterior gently and achieving a functionally normal urethra with minimal morbidity. H-type anourethral fistula was excised subsequently through anterior perianal approach.
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Affiliation(s)
- A Al-Bassam
- Department of Surgery, King Khalid University Hospital, Riyadh, Kingdom of Saudi Arabia
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Abstract
Transgenes inserted into the plant genome can become inactive (gene silencing) or result in silencing of homologous cellular genes [homology-dependent gene silencing (HDG silencing)]. In an earlier study we reported HDG silencing of chalcone synthase (CHS) in Arabidopsis. This study concerns genetic revertants of one of the CHS HDG-silencing transgenic homozygotes. Two monogenic recessive trans-acting mutations (hog1 and ddm1) that impair gene silencing and HDG silencing were identified. These mutations reduce genomic DNA methylation and affect the quantity and size of CHS mRNA. These results imply that DNA methylation is necessary for both gene silencing and HDG silencing. Two further monogenic, trans-acting, recessive mutations (sil1 and sil2) reduce gene silencing but not HDG silencing. The existence of this mutant class shows that gene silencing involves genes that are not necessary for HDG silencing. A further mutant (Catt) was isolated and has an attenuated HDG-silencing T-DNA.
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MESH Headings
- Acyltransferases/genetics
- Acyltransferases/metabolism
- Arabidopsis/enzymology
- Arabidopsis/genetics
- Arabidopsis/metabolism
- Crosses, Genetic
- DNA Methylation
- DNA, Bacterial/genetics
- DNA, Ribosomal/genetics
- DNA, Ribosomal/metabolism
- Gene Expression Regulation, Plant/genetics
- Genes, Fungal
- Kanamycin Kinase/genetics
- Kanamycin Kinase/metabolism
- Models, Genetic
- Mutagenesis, Insertional
- RNA, Plant/metabolism
- Sequence Homology, Nucleic Acid
- Sucrose/pharmacology
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Affiliation(s)
- I J Furner
- Department of Genetics, University of Cambridge, Cambridge CB2 3EH, United Kingdom.
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Abstract
Ninety-eight independent transformed (T1) Arabidopsis plants were generated, containing additional copies of the chalcone synthase (CHS) gene. Three T2 generation families (A, B and C) were found that showed reduced anthocyanin biosynthesis, consistent with homology-dependent gene silencing of CHS. Clonal sectors of tissue showing CHS silencing were seen in the early generations. Affected individuals in family A showed only slight silencing, in family C such plants were almost completely silenced, and in family B affected individuals were intermediate. Plants homozygous for a single silencing insert were isolated from each family. Plants homozygous or hemizygous for insert A showed variable penetrance and expressivity of silencing. Self-fertilization of plants hemizygous for the B and C-inserts suggested that these CHS-silencing inserts each behave as single Mendelian dominant traits. The CHS mRNA of the C-insert homozygotes was reduced to undetectable levels. Outcrosses of B- and C-insert homozygotes to wild-type plants resulted in F1 plants that were variegated. This variegation appears to be due to expression of the CHS allele from the wild-type parent, since use of a CHS mutant, tt4, as untransformed parent resulted in uniform green F1 plants. Southern blots revealed a correlation between DNA methylation and CHS silencing. In addition, derivative plants were generated from C-insert homozygotes that had lost the silencing inserts, and these showed a partial reversion towards wild-type phenotype and methylation of the cellular CHS gene at the TT4 locus. This result suggests that the TT4 copy of CHS became methylated during the C-insert-induced silencing and retained methylation and partial silencing after the silencing T-DNA was lost.
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Affiliation(s)
- G J Davies
- Department of Genetics, University of Cambridge, UK
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Homma Y, Kawabe K, Tsukamoto T, Yamanaka H, Okada K, Okajima E, Yoshida O, Kumazawa J, Gu FL, Lee C, Hsu TC, dela Cruz RC, Tantiwang A, Lim PH, Sheikh MA, Bapat SD, Marshall VR, Tajima K, Aso Y. Epidemiologic survey of lower urinary tract symptoms in Asia and Australia using the international prostate symptom score. Int J Urol 1997; 4:40-6. [PMID: 9179665 DOI: 10.1111/j.1442-2042.1997.tb00138.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND The prevalence of lower urinary tract symptoms was determined by survey as an initial step in estimating the significance of benign prostatic hyperplasia (BPH) in Asia and Australia. METHODS The symptom index (0 to 35) and quality-of-life (QOL) index (0 to 6) of the international prostate symptom score were measured in 7588 men in 9 Asian countries and 146 men in Australia. RESULTS The percentages of Asian men considered to be symptomatic (symptom index > or = 8) were 18%, 29%, 40%, and 56% in the age groups of 40 to 49, 50 to 59, 60 to 69, and 70 to 79 years, respectively. For Australian men, these figures were 36%, 33%, and 37% in the 50 to 59, 60 to 69, and 70 to 79 year age groups, respectively. CONCLUSIONS Our estimates indicate that the prevalences of symptomatic men in Asia and Australia are similar to or greater than those in Europe and America, and suggest BPH is similarly common in these areas.
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Affiliation(s)
- Y Homma
- Department of Urology, Tokyo University, Japan
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Abstract
Information based on field observations of Veterinary Officers in nine districts of Punjab, Pakistan showed 11% incidence, 9% mortality and 78% case fatality rates of haemorrhagic septicaemia in buffalo, whereas these values were 4%, 2.5% and 62% in cattle. Disease incidence was higher in 0-24-month-old animals and groups of less than 10 animals. The disease was seasonal, occurring only in rainy seasons of the year, and victims were only cattle and buffalo. The clinical course of the disease was generally 1-2 days. symptoms included high temperature, salivation, swelling of the throat and difficulty in breathing and could result in death. Successful treatment was reported if antibiotics were given at the initial stages of the disease. Various combinations of sulphur drugs and antibiotics were considered more effective. The results of the questionnaire survey suggest that a favourable response was obtained using clamoxyl LA, farmox 15%, vesulong, gentakel and chloramphenicol. Previous vaccination of livestock with the alum-precipitated formalinized broth culture of Pasteurella multocida vaccine (bacterin) was not considered to protect against field outbreaks.
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Affiliation(s)
- M A Sheikh
- Department of Microbiology, College of Veterinary Sciences, Lahore, Pakistan
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Sheikh MA, Tasneem K, Zafar MS, Butt IA, Shakoori AR. Effect of storage on the prevalent alum-precipitated hemorrhagic septicaemia vaccine in Pakistan and preparation of a more efficient oil adjuvant vaccine using dense culture of Pasteurella multocida Roberts type 1 on an improved culture medium. Zentralbl Veterinarmed B 1995; 42:28-34. [PMID: 7483898 DOI: 10.1111/j.1439-0450.1995.tb00678.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Significantly drastic effects of storage on the potency of the alum-precipitated haemorrhagic septicaemia (APHS) vaccine are reported. The APHS vaccine, studied through challenge infection of vaccinated rabbits (post-60 days of vaccination), showed 100% potency when stored at 4 degrees C for 30 days. The potency dropped to 20% when storage period was extended to 60 or more days. At 30 degrees C, the potency reduced by 40, 40 and 60%, respectively, after 30, 60 and 90 days of storage, while, at 37 degrees C, the decrease was 60, 60 and 100% after 30, 60 and 90 days of storage, respectively. In view of this, the oil-adjuvant (OA) HS vaccine was developed by culturing Pasteurella multocida on a medium comprising yeast extract, sucrose, trypticase and sodium bicarbonate, under continuous aeration at 37 degrees C. This gave a far better bacterial count (maximum count 15 x 10(8)/ml) than the conventional APHS vaccine (maximum count 6 x 10(8)/ml). The OAHS vaccine-carrying water-in-oil emulsion remained stable at room temperature for 1 year. The log protection values of the two batches of the OAHS vaccine, studied in mice, were 5.2 and 5.3, as against 1.9 of the APHS vaccine.
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Affiliation(s)
- M A Sheikh
- Department of Microbiology, College of Veterinary Sciences, Lahore, Pakistan
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Gandhi TP, Patel RB, Sheikh MA, Jhala A, Santani DD. Pharmacokinetics of gentamicin in rabbits pretreated with nonsteroidal anti-inflammatory drugs: an interaction study. J Pharm Sci 1994; 83:542-4. [PMID: 8046610 DOI: 10.1002/jps.2600830419] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Interaction between nonsteroidal anti-inflammatory drugs (NSAIDs) and other drugs occurs relatively frequently because of the wide use of NSAIDs. Such interactions with drugs of narrow therapeutic index used in serious disease states may lead to toxicity. Gentamicin toxicity is based on its concentration in serum, and any alteration in pharmacokinetic parameters may lead to gentamicin accumulation in the body and subsequently to severe nephrotoxicity and ototoxicity. To test this hypothesis, the effect of pretreatment with NSAIDs on gentamicin pharmacokinetics was examined in rabbit. Gentamicin sulfate (5 mg/kg) was administered to rabbits pretreated with aspirin (300 mg/kg), ketorolac tromethamine (3 mg/kg), ibuprofen (20 mg/kg), and piroxicam (2 mg/kg) twice a day for 1 week. The pretreatment with NSAIDs had significant effects on the body clearance and maximum concentration. Aspirin, piroxicam and ketorolac tromethamine pretreatment had significant effects on the area under the curve of gentamicin versus time. Aspirin and ketorolac tromethamine pretreatment had significant effects on the half-life of gentamicin. Aspirin had a significant effect on the volume of distribution of gentamicin. These results suggest that pretreatment with NSAIDs alters the pharmacokinetics of gentamicin and leads to accumulation inside the body, which could result in toxicity.
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