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Majid Z, Khan SA, Hanif FM, Laeeq M, Tasneem AA, Luck NH, Mubarak M. Management of Tacrolimus-Induced Toxicity With Normal Serum Levels After Liver Transplant. EXP CLIN TRANSPLANT 2024; 22:338-341. [PMID: 38385422 DOI: 10.6002/ect.mesot2023.p8] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2024]
Abstract
Drug-induced liver injury after liver transplant occurs in 1.7% of patients. Tacrolimus is an effective immunosuppressant that is used to treat acute rejection. Although rare, it can cause toxicity, which is demonstrated by cholestatic liver injury. Here, we present a case of a young male patient who was diagnosed with Wilson disease, had penicillaminechelating therapy, and underwent living related liver transplant. Within 1 month posttransplant, he developed deranged, predominantly cholestatic pattern liver function tests. Laboratory parameters showed total bilirubin of 1.12 mg/ dL, alanine aminotransferase of 553 IU/L, gammaglutamyltransferase of 624 IU/L, and tacrolimus level of 10.2 ng/mL. After thorough evaluation, a liver biopsy was performed. Liver biopsy showed hepatocellular necrosis with centrilobular cholestasis without any evidence of graft rejection. However, with normal level of tacrolimus, the biopsy was suggestive of drug-induced liver injury. Thus, tacrolimus dose was reduced, resulting in improved liver function tests and patient discharge from the hospital. Tacrolimus is an effective immunosuppressant after liver transplant and has the ability to treat early acute rejection. The patient's liver biopsy showed hepatocellular necrosis with centrilobular cholestasis without any evidence of graft rejection. Cholestatic liver injury after tacrolimus usually resolves after dose reduction or by switching to another agent. With demonstrated tacrolimus-induced toxicity in liver transplant recipients, despite normal serum levels, transplant physicians should keep high index of suspicion regarding toxicity in the posttransplant setting.
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Affiliation(s)
- Zain Majid
- From the Department of Hepato-Gastroenterology, Sindh Institute of Urology and Transplantation (SIUT), Pakistan
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Ahmed MZ, Mahmood M, Langhani J, Zohair M, Virk M, Mubarak M, Akhtar F, Ahmed E. Rosai Dorfman Disease With Extensive Bony Involvement- A Diagnostic Dilemma. J Ayub Med Coll Abbottabad 2023; 35:493-496. [PMID: 38404101 DOI: 10.55519/jamc-03-11450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/27/2024]
Abstract
Previously classified as Non Langerhan cell histiocytosis by the Working Group of Histiocytic Society in 1987 Rosai Dorfman Destombes disease was first described by Destombes in 1965 and later in 1969 by Rosai and Dorfman as a rare histiocytic disorder with sinus histiocytosis and massive lymphadenopathy. They exist in both nodal and extranodal forms. Immunohistochemistry is an essential part of diagnosis to differentiate between Langerhans cell histiocytosis and another malignant histiocytosis. Some overlap has also been reported with IgG4-related diseases. We hereby reflect upon a patient who presented to our facility with pyrexia of unknown origin, the challenges faced to reach a diagnosis and the management offered.
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Affiliation(s)
| | - Madiha Mahmood
- Sindh Institute of Urology and Transplantation Karachi, Pakistan
| | | | - Muhammad Zohair
- Sindh Institute of Urology and Transplantation Karachi, Pakistan
| | - Mahnoor Virk
- Sindh Institute of Urology and Transplantation Karachi, Pakistan
| | - Muhammad Mubarak
- Sindh Institute of Urology and Transplantation Karachi, Pakistan
| | - Fazal Akhtar
- Sindh Institute of Urology and Transplantation Karachi, Pakistan
| | - Ejaz Ahmed
- Sindh Institute of Urology and Transplantation Karachi, Pakistan
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TARIQ T, Ahmed S, Ahmed E, Mubarak M. WCN23-0534 CHARACTERISTICS AND OUTCOMES OF PATIENTS WITH IDIOPATHIC MEMBRANOPROLIFERATIVE GLOMERULONEPHRITIS BASED ON A NEW CLASSIFICATION: A SINGLE CENTER EXPERIENCE. Kidney Int Rep 2023. [DOI: 10.1016/j.ekir.2023.02.155] [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: 03/22/2023] Open
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4
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Schäbitz A, Hillig C, Mubarak M, Jargosch M, Farnoud A, Scala E, Kurzen N, Pilz AC, Bhalla N, Thomas J, Stahle M, Biedermann T, Schmidt-Weber CB, Theis F, Garzorz-Stark N, Eyerich K, Menden MP, Eyerich S. Spatial transcriptomics landscape of lesions from non-communicable inflammatory skin diseases. Nat Commun 2022; 13:7729. [PMID: 36513651 PMCID: PMC9747967 DOI: 10.1038/s41467-022-35319-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/28/2022] [Indexed: 12/15/2022] Open
Abstract
Abundant heterogeneous immune cells infiltrate lesions in chronic inflammatory diseases and characterization of these cells is needed to distinguish disease-promoting from bystander immune cells. Here, we investigate the landscape of non-communicable inflammatory skin diseases (ncISD) by spatial transcriptomics resulting in a large repository of 62,000 spatially defined human cutaneous transcriptomes from 31 patients. Despite the expected immune cell infiltration, we observe rather low numbers of pathogenic disease promoting cytokine transcripts (IFNG, IL13 and IL17A), i.e. >125 times less compared to the mean expression of all other genes over lesional skin sections. Nevertheless, cytokine expression is limited to lesional skin and presented in a disease-specific pattern. Leveraging a density-based spatial clustering method, we identify specific responder gene signatures in direct proximity of cytokines, and confirm that detected cytokine transcripts initiate amplification cascades of up to thousands of specific responder transcripts forming localized epidermal clusters. Thus, within the abundant and heterogeneous infiltrates of ncISD, only a low number of cytokine transcripts and their translated proteins promote disease by initiating an inflammatory amplification cascade in their local microenvironment.
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Affiliation(s)
- A. Schäbitz
- grid.4714.60000 0004 1937 0626Division of Dermatology and Venereology, Department of Medicine Solna, and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - C. Hillig
- grid.4567.00000 0004 0483 2525Institute of Computational Biology, Helmholtz Zentrum München—German Research Centre for Environmental Health, Ingolstädter Landstrasse 1, 85764 Neuherberg, Germany
| | - M. Mubarak
- grid.6936.a0000000123222966Center for Allergy and Environment (ZAUM), Technical University and Helmholtz Center Munich, Biedersteinerstrasse 29, 80802 Munich, Germany
| | - M. Jargosch
- grid.6936.a0000000123222966Center for Allergy and Environment (ZAUM), Technical University and Helmholtz Center Munich, Biedersteinerstrasse 29, 80802 Munich, Germany ,grid.6936.a0000000123222966Department of Dermatology and Allergy, Technical University of Munich, Biedersteinerstrasse 29, 80802 Munich, Germany
| | - A. Farnoud
- grid.4567.00000 0004 0483 2525Institute of Computational Biology, Helmholtz Zentrum München—German Research Centre for Environmental Health, Ingolstädter Landstrasse 1, 85764 Neuherberg, Germany
| | - E. Scala
- grid.4714.60000 0004 1937 0626Division of Dermatology and Venereology, Department of Medicine Solna, and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden ,grid.5963.9Department of Dermatology and Venerology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - N. Kurzen
- grid.6936.a0000000123222966Center for Allergy and Environment (ZAUM), Technical University and Helmholtz Center Munich, Biedersteinerstrasse 29, 80802 Munich, Germany
| | - A. C. Pilz
- grid.6936.a0000000123222966Department of Dermatology and Allergy, Technical University of Munich, Biedersteinerstrasse 29, 80802 Munich, Germany ,grid.5963.9Department of Dermatology and Venerology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - N. Bhalla
- grid.5037.10000000121581746Department of Gene Technology, School of Engineering Sciences in Chemistry, Biotechnology and Health, KTH Royal Institute of Technology, Stockholm, Sweden
| | - J. Thomas
- grid.6936.a0000000123222966Center for Allergy and Environment (ZAUM), Technical University and Helmholtz Center Munich, Biedersteinerstrasse 29, 80802 Munich, Germany
| | - M. Stahle
- grid.4714.60000 0004 1937 0626Division of Dermatology and Venereology, Department of Medicine Solna, and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden
| | - T. Biedermann
- grid.6936.a0000000123222966Department of Dermatology and Allergy, Technical University of Munich, Biedersteinerstrasse 29, 80802 Munich, Germany
| | - C. B. Schmidt-Weber
- grid.6936.a0000000123222966Center for Allergy and Environment (ZAUM), Technical University and Helmholtz Center Munich, Biedersteinerstrasse 29, 80802 Munich, Germany
| | - F. Theis
- grid.4567.00000 0004 0483 2525Institute of Computational Biology, Helmholtz Zentrum München—German Research Centre for Environmental Health, Ingolstädter Landstrasse 1, 85764 Neuherberg, Germany
| | - N. Garzorz-Stark
- grid.4714.60000 0004 1937 0626Division of Dermatology and Venereology, Department of Medicine Solna, and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden ,grid.6936.a0000000123222966Department of Dermatology and Allergy, Technical University of Munich, Biedersteinerstrasse 29, 80802 Munich, Germany
| | - K. Eyerich
- grid.4714.60000 0004 1937 0626Division of Dermatology and Venereology, Department of Medicine Solna, and Center for Molecular Medicine, Karolinska Institutet, Stockholm, Sweden ,grid.5963.9Department of Dermatology and Venerology, Medical Center—University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany ,grid.24381.3c0000 0000 9241 5705Department of Dermatology and Venereology, Unit of Dermatology, Karolinska University Hospital, Stockholm, Sweden
| | - M. P. Menden
- grid.4567.00000 0004 0483 2525Institute of Computational Biology, Helmholtz Zentrum München—German Research Centre for Environmental Health, Ingolstädter Landstrasse 1, 85764 Neuherberg, Germany ,grid.5252.00000 0004 1936 973XDepartment of Biology, Ludwig-Maximilians University, Goßhadernerstrasse 2, Martinsried, 82152 Germany ,grid.452622.5German Center for Diabetes Research (DZD e.V.), Ingolstädter Landstrasse 1, 85764 Neuherberg, Germany
| | - S. Eyerich
- grid.6936.a0000000123222966Center for Allergy and Environment (ZAUM), Technical University and Helmholtz Center Munich, Biedersteinerstrasse 29, 80802 Munich, Germany
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Mubarak M, Jargosch M, Hillig C, Menden M, Eyerich K, Eyerich S. 328 The transcription factor CEBPB is a novel hub gene and multi-functional disease driver in Psoriatic skin inflammation. J Invest Dermatol 2022. [DOI: 10.1016/j.jid.2022.09.341] [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: 11/19/2022]
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Majid Z, Rehman AU, Ismail H, Luck NH, Mubarak M. Pancreatic Tuberculosis mimicking as a Pancreatic Mass Lesion. J Coll Physicians Surg Pak 2022; 32:1486-1488. [PMID: 36377021 DOI: 10.29271/jcpsp.2022.11.1486] [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] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 04/21/2021] [Indexed: 11/22/2022]
Affiliation(s)
- Zain Majid
- Department of Gastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
- Department of Histopathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Adeel Ur Rehman
- Department of Gastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
- Department of Histopathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Hina Ismail
- Department of Gastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
- Department of Histopathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Nasir Hassan Luck
- Department of Gastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
- Department of Histopathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
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Agha S, Kumar P, Bajeer IA, Khatri S, Anwar Lanewala AA, Mubarak M. Knowledge, attitudes and practices towards deceased organ donation among parents of children with End Stage Kidney Disease. J PAK MED ASSOC 2022; 72:504-508. [PMID: 35320233 DOI: 10.47391/jpma.5140] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To assess the knowledge, attitudes, and practices (KAP) towards deceased organ donation (DOD) of the parents/ guardians of children with end stage kidney disease (ESKD). METHODS This cross sectional survey was conducted between April and December 2020. A structured questionnaire was filled to assess the sociodemographic information, knowledge, attitude, and practice about DOD. RESULTS A total of 130 participants with a mean age of 37±7 years were included in the study. Among all, 66 (50.8%) claimed that they had prior knowledge about DOD. However, on further questioning, no one knew who can be the deceased organ donor. Their responses about registration place and permission from religion were positive in 24(36.4%) and 31(47.0%) cases respectively. Regarding attitude, positive responses to willingness to get registered and discussing DOD in social circle were given by 37(56.1%) and 21 (31.8%) participants respectively. Only one participant was registered as donor. The remaining 64(49.2%) participants who had no prior knowledge were given relevant information and were interviewed after one week. Only 24(37.5%) showed willingness to get registered as donors and 06 (9.4%) participants discussed the topic of DOD in their social circle. CONCLUSIONS The results showed that the knowledge, attitudes, and practices of people who are most desperate for transplantation of their children were poor and did not change significantly even after providing them relevant information.
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Affiliation(s)
- Sanaullah Agha
- Department of Paediatric Nephrology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Pawan Kumar
- Department of Paediatric Nephrology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | | | | | - Ali Asghar Anwar Lanewala
- Department of Paediatric Nephrology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Muhammad Mubarak
- Department of Histopathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
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Kumar D, Majid Z, Tasneem AA, Laeeq SM, Luck N, Mubarak M. Primary squamous cell carcinoma of the stomach: a rarity. Gastroenterol Hepatol Bed Bench 2022; 15:290-292. [PMID: 36311959 PMCID: PMC9589136 DOI: 10.22037/ghfbb.v15i3.2609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 07/14/2022] [Indexed: 11/14/2022]
Affiliation(s)
- Danish Kumar
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, SIUT, Karachi, Pakistan
| | - Zain Majid
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, SIUT, Karachi, Pakistan
| | - Abbas Ali Tasneem
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, SIUT, Karachi, Pakistan
| | - Syed Mudassir Laeeq
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, SIUT, Karachi, Pakistan
| | - Nasir Luck
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, SIUT, Karachi, Pakistan
| | - Muhammad Mubarak
- Department of Histopathology, Sindh Institute of Urology and Transplantation, SIUT, Karachi, Pakistan
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Majid Z, Abrar G, Ismail H, Danish M, Mubarak M, Luck N. Intestinal Spirochaetosis-A case series from the developing world. Trop Doct 2021; 52:134-138. [PMID: 34792410 DOI: 10.1177/00494755211049031] [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: 01/10/2023]
Abstract
Spirochaetes comprise a heterogenous group of gram negative, motile, spiral shaped bacteria. Some of these pathogens are known to cause numerous human diseases such as Lyme disease, relapsing fever, syphilis and leptospirosis. However, intestinal spirochetosis is a rare condition. Patients frequently present with long-term complaints of loose stools, abdominal pain and weight loss and rectal bleeding. Hence to establish a diagnosis an endoscopy with biopsy is required. In this article, we describe four such cases, having different ages and socio- economic background, successfully treated with a short course of metronidazole.
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Affiliation(s)
- Zain Majid
- Consultant, Department of Hepato-gastroenterology66810, Sindh Institute of Urology and Transplantation, SIUT, Karachi, Pakistan
| | - Ghazi Abrar
- Post graduate trainee, Department of Hepato-gastroenterology, Sindh Institute of Urology and Transplantation, (SIUT), Karachi, Pakistan
| | - Hina Ismail
- Post graduate trainee, Department of Hepato-gastroenterology, Sindh Institute of Urology and Transplantation, (SIUT), Karachi, Pakistan
| | - Muhammad Danish
- Post graduate trainee, Department of Hepato-gastroenterology, Sindh Institute of Urology and Transplantation, (SIUT), Karachi, Pakistan
| | - Muhammad Mubarak
- Professor, Department of Histopathology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
| | - Nasir Luck
- Professor, Department of Histopathology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
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Ejaz M, Mubarak M, Ali TS, Andersson S, Ekström AM. Human papillomavirus-associated anal squamous intraepithelial lesions in men who have sex with men and transgender women living with and without HIV in Karachi Pakistan: implications for screening and prevention. BMC Infect Dis 2021; 21:1163. [PMID: 34789177 PMCID: PMC8597180 DOI: 10.1186/s12879-021-06850-w] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Accepted: 11/01/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Anal squamous intraepithelial lesions (ASIL), strongly related to human papilloma virus (HPV) infection, is more prevalent among men who have sex with men (MSM). However, no such data are available for Pakistan yet, and neither HPV vaccination nor anal-cytology screening is implemented in Pakistan. The purpose of this first ever study was to assess the prevalence of HPV-related anal cytological abnormalities among MSM and transgender women living with and without HIV infection in Pakistan. METHODS We conducted a cross-sectional study from March 2016 to November 2017 at sexual health centers run by the Perwaaz Trust and the National AIDS Control Program in Karachi. The study enrolled MSM and transgender women aged greater-than-and-equal-to-18-years who reported anal sex in the preceding 6 months. We collected two anal samples for liquid-based cytology and HPV type testing by PCR, and socio-demographic and behavioral data were collected through face-to face interviews. ASIL and its associations with biological and behavioral risk factors were analyzed through Cox regression for prevalence ratios (PR) and corresponding 95% confidence intervals (CIs). RESULTS Out of 271 qualifying participants, 79% were MSM and 21% transgender women. The mean age was 28.8 (± 8) years. Almost 35% (93/271) of the study population had ASIL detected, ASIL was significantly more common among participants living with HIV than in HIV negative ((50/118) 42.4%; vs. (43/153) 28.1%) (p ≤ 0.001). Among ASIL, 66% (61/93) had low-grade squamous intraepithelial lesions (LSIL), and 3.6% (3/93) had high-grade squamous intraepithelial lesions (HSIL). The overall, HPV16 positivity was 35.5% (33/93) among all abnormal anal lesions and all 3 HSIL were HPV16 positive, however, HPV16 positivity could show its association with ASIL detection in univariate model only (PRcrude: 2.11(1.39-3.18)). Moreover, any HR-HPV type (PR 3.04; 95% CI 1.75-5.26), concurrent sexually transmitted infection (STI) (2.13; (1.28-3.55)) and HIV + /HPV + coinfection (1.75; (1.07-2.88)) remained independently associated with ASIL in the multivariate model. CONCLUSIONS Abnormal anal cytology among MSM and transgender is prevalent enough to consider optimal screening regimens. Further studies are required to see if periodic anal cytology can be made part of HIV care and treatment programs among MSM in Pakistan.
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Affiliation(s)
- Muslima Ejaz
- Department of Global Public Health, Global and Sexual Health Research Group, Karolinska Institutet, Widerströmska Huset, Tomtebodavägen 18A, 171 77, Stockholm, Sweden. .,Department of Community Health Sciences, Aga Khan University (AKU), Stadium Road, P.O. Box 3500, Karachi, 74800, Pakistan.
| | - Muhammad Mubarak
- Department of Cytology and Histopathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | | | - Sören Andersson
- Department of Laboratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Anna Mia Ekström
- Department of Global Public Health, Global and Sexual Health Research Group, Karolinska Institutet, Widerströmska Huset, Tomtebodavägen 18A, 171 77, Stockholm, Sweden
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Mubarak M, Awad N. 1062 Are CT-KUB Requests Adequately Completed by Urologists in Emergency Settings? Br J Surg 2021. [DOI: 10.1093/bjs/znab259.119] [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]
Abstract
Abstract
Aim
Imaging requests are an essential communication tool between urologists and radiologists. Poorly completed request forms, especially in acute settings, directly translates to substandard patient care. We aimed to evaluate and improve our request completion practice in emergency settings.
Method
40 randomly selected CT-KUB images were reviewed to assess the completion of clinical background, question, patient data, location, and requester data. A multiple cycle audit followed by minor intra-departmental interventions were carried out over ten months to evaluate compliance. In December 2019, 55% and 52.5% of the requests lacked a good clinical history and question, respectively. The remaining three domains achieved the target of 100%. Subsequently, the literature and the audit data were shared and discussed, and a verbal agreement was made to improve practice.
Result
A re-audit revealed a 22.5% and 2.5% improvement in providing sufficient clinical background and questions. Findings were presented at an informal setting, and feedback was obtained on improving compliance. Simple posters or notices and occasional reminders were found as acceptable approaches. Following the implementation of feedback and orientation for joining junior doctors, a third audit cycle showed a significant improvement in compliance with 90% and 82.5%. A final cycle to assess the maintenance improvements in background and question provision was at a high of 97.5% and 90%.
Conclusions
CT-KUB request completion is essential in emergency settings to ensure optimal patient care. Improving compliance can be achieved using small interventions catered to the department, such as peer-to-peer discussions, reminder posters, and orientations.
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Affiliation(s)
- M Mubarak
- Salmaniya Medical Complex, Manama, Bahrain
| | - N Awad
- Salmaniya Medical Complex, Manama, Bahrain
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Mubarak M, Al Saeed M, Alalawi M. 1059 Confidence and Knowledge of Urethral Catheterization and Complications Amongst Junior Doctors: The Immediate Impact of Peer-Led Clinical Mentorship. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.891] [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: 11/14/2022]
Abstract
Abstract
Aim
Approximately 20% of inpatients have urinary catheters. Deficiencies in knowledge and errors in catheterization techniques can cause short and long-term complications. This study aims to evaluate the short-term benefit of peer-led sessions on the knowledge and confidence of junior doctors in performing urethral catheterizations.
Method
81 Foundation Year doctors participated in a one-hour basic catheterization workshop. Data was collected via a validated questionnaire covering three domains (confidence, procedural knowledge, and knowledge about complications) administered before and after the workshop. Confidence was measured using a 5-point Likert scale; knowledge was assessed through 10 questions about the procedure and three further questions about complications. Data are expressed as mean±standard deviation and were analyzed using SPSS v23.
Result
The majority (96.4%) had performed less than five catheterizations. 21% felt adequately trained to catheterize, 70% believed they would benefit from semi-formal training, and 97.5% found the information covered in the session to be very useful. The average pre-session confidence in performing easy and difficult catheterizations were 3.03±1.05 and 2.01±1, respectively, and increased to 3.7±1 and 3±1.1, respectively, following the session (p < 0.005). Out of a total of 10 points, pre-workshop knowledge assessment scores were 3.9±1.6 and increased to 8.85±1.4 (p < 0.005). Likewise, from a total of three points, the average pre-session knowledge of complications score was 1.75±0.7, which increased to 2.65±0.6 after the session (p < 0.005).
Conclusions
Peer-led mentorship is an important and efficient educational tool. Short sessions have shown to improve the confidence and knowledge of junior doctors in urethral catheterization.
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Affiliation(s)
- M Mubarak
- Salmaniya Medical Complex, Manama, Bahrain
| | - M Al Saeed
- Salmaniya Medical Complex, Manama, Bahrain
| | - M Alalawi
- Salmaniya Medical Complex, Manama, Bahrain
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Mubarak M, Alhamdan O, Alaradi H, Alhindi S. 1067 Neoplasia in Association with a Congenital Anomaly: Wilms Tumor in a Horseshoe Kidney. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.355] [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: 11/14/2022]
Abstract
Abstract
Introduction
Horseshoe malformation is the most common form of fusion defects involving the kidney, whereas Wilm's tumor is the most common primary malignant renal tumor in children. The co-incidence of these two pathologies gives off an incidence rate of 0.48%.
Case Report
This is a case of a two-year-old female who presented early in life with multiple congenital anomalies including congenital heart disease, bilateral aniridia, persistent thrombocytopenia, and sickle cell trait in association with a painless abdominal mass. A CT scan showed a horseshoe kidney. The patient was lost for follow up until the age of two years, in which another CT scan revealed a left lower pole focal cystic mass measuring 5.1x5.3x6.3cm. WAGR syndrome was suspected and confirmed through genetic testing. A multidisciplinary approach was necessary to manage her efficiently due to the numerous co-existing congenital pathologies. The patient underwent six cycles of chemotherapy leading to a 35% reduction in tumor size and a left nephrectomy. She was admitted to the pediatric ICU post-operatively for observation. Histopathological analysis revealed features of stage two stromal type nephroblastoma. Her renal function and urine output were satisfactory throughout the duration of her admission as well as on follow up.
Conclusions
Keeping a high index of suspicion is imperative; individuals with renal anomalies, namely horseshoe kidney in the context of WAGR syndrome, mandate a comprehensive assessment through clinical examination, laboratory workup, and imaging. Though different approaches to standard Wilm's tumor cases have been explored thoroughly, it is crucial to keep in mind the need for multidisciplinary involvement in patients with multiple congenital anomalies.
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Affiliation(s)
- M Mubarak
- Salmaniya Medical Complex, Manama, Bahrain
| | - O Alhamdan
- Bahrain Defense Force Royal Medical Services, Manama, Bahrain
| | - H Alaradi
- Salmaniya Medical Complex, Manama, Bahrain
| | - S Alhindi
- Salmaniya Medical Complex, Manama, Bahrain
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Mansour MM, Mubarak M, Chela H, Ghouri YA. Brain Abscesses in Crohn's Disease as a Complication of Infliximab Therapy. Cureus 2021; 13:e15449. [PMID: 34262801 PMCID: PMC8260198 DOI: 10.7759/cureus.15449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2021] [Indexed: 11/29/2022] Open
Abstract
Infliximab therapy is highly effective in the treatment of Crohn’s disease. Infliximab-induced immunosuppression increases the risk for various infections, including opportunistic infections. We describe a case of brain abscesses as a complication of infliximab therapy in a 65-year-old man. It was elucidated that the brain abscesses developed from the presumed hematogenous spread of bacteria from recently treated paraspinal abscesses. Close attention should be given to patients on infliximab therapy presenting with any neurological sign or symptom to allow for timely diagnosis and prompt management of a potential central nervous system infection.
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Affiliation(s)
- Mahmoud M Mansour
- Internal Medicine, University of Missouri School of Medicine, Columbia, USA
| | - Muhammad Mubarak
- Internal Medicine/Gastroenterology and Hepatology, University of Missouri School of Medicine, Columbia, USA
| | - Harleen Chela
- Internal Medicine/Gastroenterology and Hepatology, University of Missouri School of Medicine, Columbia, USA
| | - Yezaz A Ghouri
- Internal Medicine/Gastroenterology and Hepatology, University of Missouri School of Medicine, Columbia, USA
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Raza Y, Mubarak M, Kazmi S. Role of interleukin 1 polymorphism in H. pylori associated gastric cancer in Pakistan. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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17
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Shad S, Hanif F, ul Haq M, Luck NH, Aziz T, Mubarak M. Frequencies of Common Infectious Organisms Causing Chronic Diarrhea in Renal Transplant Patients. EXP CLIN TRANSPLANT 2019; 17:212-215. [PMID: 30777557 DOI: 10.6002/ect.mesot2018.p69] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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18
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Ehrlich L, O’Brien A, Hall C, White T, Chen L, Wu N, Venter J, Scrushy M, Mubarak M, Meng F, Dostal D, Wu C, Lairmore TC, Alpini G, Glaser S. α7-nAChR Knockout Mice Decreases Biliary Hyperplasia and Liver Fibrosis in Cholestatic Bile Duct-Ligated Mice. Gene Expr 2018; 18:197-207. [PMID: 29580318 PMCID: PMC6190116 DOI: 10.3727/105221618x15216453076707] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
α7-nAChR is a nicotinic acetylcholine receptor [specifically expressed on hepatic stellate cells (HSCs), Kupffer cells, and cholangiocytes] that regulates inflammation and apoptosis in the liver. Thus, targeting α7-nAChR may be therapeutic in biliary diseases. Bile duct ligation (BDL) was performed on wild-type (WT) and α7-nAChR-/- mice. We first evaluated the expression of α7-nAChR by immunohistochemistry (IHC) in liver sections. IHC was also performed to assess intrahepatic bile duct mass (IBDM), and Sirius Red staining was performed to quantify the amount of collagen deposition. Immunofluorescence was performed to assess colocalization of α7-nAChR with bile ducts (costained with CK-19) and HSCs (costained with desmin). The mRNA expression of α7-nAChR, Ki-67/PCNA (proliferation), fibrosis genes (TGF-β1, fibronectin-1, Col1α1, and α-SMA), and inflammatory markers (IL-6, IL-1β, and TNF-α) was measured by real-time PCR. Biliary TGF-β1 and hepatic CD68 (Kupffer cell marker) expression was assessed using IHC. α7-nAChR immunoreactivity was observed in both bile ducts and HSCs and increased following BDL. α7-nAChR-/- BDL mice exhibited decreased (i) bile duct mass, liver fibrosis, and inflammation, and (ii) immunoreactivity of TGF-β1 as well as expression of fibrosis genes compared to WT BDL mice. α7-nAChR activation triggers biliary proliferation and liver fibrosis and may be a therapeutic target in managing extrahepatic biliary obstruction.
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Affiliation(s)
- Laurent Ehrlich
- *Department of Medical Physiology, Baylor Scott & White and Texas A&M University Health Science Center, Temple, TX, USA
| | - April O’Brien
- †Research, Central Texas Veterans Health Care System, Temple, TX, USA
| | - Chad Hall
- ‡Surgery, Baylor Scott & White and Texas A&M University Health Science Center, Temple, TX, USA
| | - Tori White
- †Research, Central Texas Veterans Health Care System, Temple, TX, USA
| | - Lixian Chen
- *Department of Medical Physiology, Baylor Scott & White and Texas A&M University Health Science Center, Temple, TX, USA
| | - Nan Wu
- *Department of Medical Physiology, Baylor Scott & White and Texas A&M University Health Science Center, Temple, TX, USA
| | - Julie Venter
- *Department of Medical Physiology, Baylor Scott & White and Texas A&M University Health Science Center, Temple, TX, USA
| | - Marinda Scrushy
- *Department of Medical Physiology, Baylor Scott & White and Texas A&M University Health Science Center, Temple, TX, USA
| | - Muhammad Mubarak
- *Department of Medical Physiology, Baylor Scott & White and Texas A&M University Health Science Center, Temple, TX, USA
| | - Fanyin Meng
- *Department of Medical Physiology, Baylor Scott & White and Texas A&M University Health Science Center, Temple, TX, USA
- †Research, Central Texas Veterans Health Care System, Temple, TX, USA
- §Gastroenterology, Baylor Scott & White Digestive Disease Research Center, Baylor Scott & White, Temple, TX, USA
| | - David Dostal
- *Department of Medical Physiology, Baylor Scott & White and Texas A&M University Health Science Center, Temple, TX, USA
| | - Chaodong Wu
- ¶Department of Nutrition and Food Science, Texas A&M University, College Station, TX, USA
| | - Terry C. Lairmore
- ‡Surgery, Baylor Scott & White and Texas A&M University Health Science Center, Temple, TX, USA
| | - Gianfranco Alpini
- *Department of Medical Physiology, Baylor Scott & White and Texas A&M University Health Science Center, Temple, TX, USA
- †Research, Central Texas Veterans Health Care System, Temple, TX, USA
- §Gastroenterology, Baylor Scott & White Digestive Disease Research Center, Baylor Scott & White, Temple, TX, USA
| | - Shannon Glaser
- *Department of Medical Physiology, Baylor Scott & White and Texas A&M University Health Science Center, Temple, TX, USA
- †Research, Central Texas Veterans Health Care System, Temple, TX, USA
- §Gastroenterology, Baylor Scott & White Digestive Disease Research Center, Baylor Scott & White, Temple, TX, USA
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Ibrahim M, El-Hakim I, Said R, Soliman D, Mubarak M. FP766ONLINE HEMODIAFILTERATION USE IN CHILDREN: A SINGLE CENTER EXPERIENCE WITH A TWIST. Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy104.fp766] [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: 11/12/2022] Open
Affiliation(s)
| | | | - Ragia Said
- Pediatrics, Ain Shams University, Cairo, Egypt
| | - Dina Soliman
- Clinical Pathology, Ain Shams University, Cairo, Egypt
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Mehmood K, Mubarak M, Dhar M, Rafi M, Kinsella J. Transperineal template-guided prostate saturation biopsies in men with suspicion of prostate cancer: a pilot study from Pakistan. Malays J Pathol 2017; 39:285-288. [PMID: 29279591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Traditionally, transrectal ultrasound (TRUS)-guided biopsies are done for the diagnosis of prostate cancer (PCa) in Pakistan. The transperineal template-guided saturation biopsy (TTSB) approach has been recently introduced in Pakistan and we share diagnostic yields and pathological findings of specimens taken for PCa diagnosis in men with elevated serum total prostate specific antigen (PSA) and negative TRUS-guided prostate biopsies. In all, 16 patients investigated at the Department of Urology, Sindh Institute of Urology and Transplantation (SIUT), underwent TTSB. The mean age of patients was 67.8 ± 8.8 (range: 55 - 84) years. The median PSA was 9.5 (IQR: 7.9 - 19.8) ng/ ml. The duration of symptoms before biopsy ranged from 1 month to 144 months. The prostate was enlarged with mean weight of 73.5 ± 55.5 g. Histopathology revealed PCa in 5 of 16 (31.2%) cases. The Gleason score was 6 (3+3), 7 (3+4) and 8 (4+4) in 1 case each (6.3%) and 10 (5+5) in 2 cases (12.5%). At least two cores were positive in all positive cases. None of the patients required antibiotics post-procedure. In conclusion, the TTSB technique is a promising option for patients with elevated PSA level and negative transrectal prostate biopsies for the detection of PCa in our setting.
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Affiliation(s)
- K Mehmood
- Sindh Institute of Urology and Transplantation, Departments of Radiology, Karachi-74200, Pakistan.
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Mandhwani R, Hanif FM, Ul Haque MM, Wadhwa RK, Hassan Luck N, Mubarak M. Noninvasive Clinical Predictors of Portal Hypertensive Gastropathy in Patients with Liver Cirrhosis. J Transl Int Med 2017; 5:169-173. [PMID: 29085790 DOI: 10.1515/jtim-2017-0025] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Portal hypertensive gastropathy (PHG) is described endoscopically as "mosaic-like appearance" of gastric mucosa with or without the red spots. It can only be diagnosed by upper gastrointestinal (GI) endoscopy. The aim of this study was to determine the diagnostic accuracy of platelet count to spleen diameter ratio (PSR) and right liver lobe diameter to albumin ratio (RLAR) in the detection of PHG using upper GI endoscopy as a gold standard in patients with liver cirrhosis. MATERIAL AND METHODS This cross-sectional study was conducted in the Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi. All consecutive patients with ages 18-65 years who were screened using esophagogastroduodenoscopy (EGD) to exclude esophageal varices were enrolled. At the same time, findings related to PHG were noted. After informed consent, all the patients had blood tests including platelet count and albumin and abdominal ultrasound determining spleen diameter and right liver lobe diameter. RESULTS Out of 111 patients, 59 (53.15%) were males with a mean age of 44 ± 12.61 years. Rate of PHG was observed in 84.68% (94/111) cases confirmed by EGD. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of PSR were 87.23%, 5.88%, 83.67%, 7.69%, and 74.7%, respectively, and those of RLAR were 28.72%, 70.59%, 84.38%, 15.19%, and 35.14%, respectively. CONCLUSION PSR is better predictor of PHG than RLAR but at the expense of relatively lower specificities and NPV likely because of underlying pathophysiology (portal hypertension) which is similar for esophageal varices, PHG, and ascites.
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Affiliation(s)
- Rajesh Mandhwani
- Departments of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Farina M Hanif
- Departments of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Muhammad Manzoor Ul Haque
- Departments of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Rajesh Kumar Wadhwa
- Departments of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Nasir Hassan Luck
- Departments of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Muhammad Mubarak
- Departments of Histopathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
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Majid Z, Ahmed S, Taha Yaseen R, Shahab R, Mubarak M. Treatment and management of CMV duodenitis in a patient with temporal arteritis. Immunopathol Persa 2017. [DOI: 10.15171/ipp.2018.02] [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: 11/09/2022]
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24
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Majid Z, Asif J, Khan S, Mubarak M, Masood I. IgG4-related disease; a newly recognized entity with expanding spectrum. Immunopathol Persa 2017. [DOI: 10.15171/ipp.2017.05] [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: 11/09/2022]
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25
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Raza Y, Khan A, Khan AI, Khan S, Akhter S, Mubarak M, Ahmed A, Kazmi SU. Combination of Interleukin 1 Polymorphism and Helicobacter pylori Infection: an Increased Risk of Gastric Cancer in Pakistani Population. Pathol Oncol Res 2017; 23:873-880. [PMID: 28110439 DOI: 10.1007/s12253-017-0191-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [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: 06/15/2016] [Accepted: 01/09/2017] [Indexed: 02/07/2023]
Abstract
Helicobacter pylori is one of the major risk factors involved in the development ofgastritis and gastric cancer (GC). H. pylori infection leads to increased production of pro-inflammatory cytokines by the host. Carriage of specific polymorphisms in cytokine genes may be associated with host susceptibility to the development of GC. We investigated the role of host genetic factors including polymorphisms of IL-1B and IL-1RN in correlation with gastritis and GC in H. pylori infected Pakistani population. A total of 230 gastritis cases and 100 GC cases were genotyped for IL 1B-511 and IL-1RN penta-allelic variable number of tandem repeats (VNTRs). A combination of IL-1B-511*T and IL-1RN*2 alleles (OR 19.064; 95% CI 2.319-156.7; p = 0.001) in H. pylori infected individuals had markedly increased risk of GC development. In Pakistani population, an increased risk of GC development is associated with the carriage of IL-1B-511*T and IL-1RN*2 alleles. Synergistic effect of H. pylori infection and IL-1B-511*T/IL-1RN*2 genotypes was also observed in association with significantly higher risk of developing GC. Further prospective and large scale studies are needed to establish the clinical impact of these findings.
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Affiliation(s)
- Yasir Raza
- Stem Cell Research Laboratory, Sindh Institute of Urology and Transplantation, Deewan Farooq Medical Complex, Chand Bibi Road, Karachi, Pakistan. .,Immunology and Infectious Diseases Research Laboratory, Department of Microbiology, University of Karachi, Karachi, Pakistan.
| | - Adnan Khan
- Immunology and Infectious Diseases Research Laboratory, Department of Microbiology, University of Karachi, Karachi, Pakistan
| | - Asif Iqbal Khan
- Department of Molecular Pathology, Dow University of Health and Sciences, Karachi, Pakistan
| | - Saeed Khan
- Department of Molecular Pathology, Dow University of Health and Sciences, Karachi, Pakistan
| | - Shakeel Akhter
- Department of Surgery and Medicine, Civil Hospital Karachi, Karachi, Pakistan
| | - Muhammad Mubarak
- Department of Histopathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Ayaz Ahmed
- Dr. Panjwani Center For Molecular Medicine And Drug Research, Karachi, Pakistan
| | - Shahana Urooj Kazmi
- Immunology and Infectious Diseases Research Laboratory, Department of Microbiology, University of Karachi, Karachi, Pakistan
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Raza A, Firasat S, Khaliq S, Khan AR, Mahmood S, Aziz T, Mubarak M, Naqvi SAA, Rizvi SAH, Abid A. Monocyte Chemoattractant Protein-1 (MCP-1/CCL2) Levels and Its Association with Renal Allograft Rejection. Immunol Invest 2016; 46:251-262. [PMID: 27960564 DOI: 10.1080/08820139.2016.1248559] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Ali Raza
- Centre for Human Genetics and Molecular Medicine, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Sadaf Firasat
- Centre for Human Genetics and Molecular Medicine, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Shagufta Khaliq
- Centre for Human Genetics and Molecular Medicine, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
- Department of Human Genetics, University of Health Sciences, Lahore, Pakistan
| | - Abdul Rafay Khan
- Centre for Human Genetics and Molecular Medicine, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Shafaq Mahmood
- Centre for Human Genetics and Molecular Medicine, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Tahir Aziz
- Department of Urology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Muhammad Mubarak
- Department of Histopathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Syed Ali Anwar Naqvi
- Department of Urology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | | | - Aiysha Abid
- Centre for Human Genetics and Molecular Medicine, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
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Hanif FM, Luck NH, Abbas Z, Hassan SM, Shabir S, Mubarak M. Early, non-refractory celiac disease associated with microscopic colitis and splenomegaly. J Coll Physicians Surg Pak 2016; 25 Suppl 1:S14-6. [PMID: 25933449 DOI: 04.2015/jcpsp.s14s16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Accepted: 10/03/2014] [Indexed: 11/11/2022]
Abstract
Celiac Disease (CD), also known as non-Tropical sprue, and Celiac sprue is an immune-mediated disorder, triggered by gluten containing grains in genetically susceptible people. The disease may be diagnosed at any age and can affect many organ systems. Its diagnosis and management can often be challenging. A high index of suspicion is required to diagnose this disease at an early stage in patients presenting with atypical symptomatology and delayed onset. Although serological tests are widely used, duodenal biopsy remains the gold standard for diagnosis of CD. Even though CD affects various body systems, Microscopic Colitis (MC) and refractory sprue are among the main gastrointestinal complications of CD, which are resistant to Gluten-Free Diet (GFD). A thorough and appropriate evaluation is mandatory for an early and accurate diagnosis of these complications. Herein, we report a case of a young female with CD in early phase in concordance with MC and splenomegaly.
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Affiliation(s)
- Farina M Hanif
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation (SIUT), Karachi-74200
| | - Nasir Hassan Luck
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation (SIUT), Karachi-74200
| | - Zaigham Abbas
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation (SIUT), Karachi-74200
| | - Syed Mujahid Hassan
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation (SIUT), Karachi-74200
| | - Sabhita Shabir
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation (SIUT), Karachi-74200
| | - Muhammad Mubarak
- Department of Histopathology, Sindh Institute of Urology and Transplantation (SIUT), Karachi-74200
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Shaija A, Mubarak M, Suchithra TV. Ultrasonication: An effective pre-treatment method for extracting lipid from Salvinia molesta for biodiesel production. REFFIT 2016. [DOI: 10.18799/24056529/2016/3/57] [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] [Subscribe] [Scholar Register] [Indexed: 03/30/2023]
Abstract
Biodiesel is considered as one of the promising alternative fuels for diesel engines due its renewability and environment friendly nature. As the process of lipid extraction from the biomass consumes about 90% of the total energy spent for biodiesel production, an efficient and economic method is very important. The amount of lipid extracted from the biomass could be increased if it is pre-treated before the extraction process. Thiswork was an attempt to compare the various pre-treatment methods before extracting lipids from dried Salvinia molesta (aquatic weed), such as autoclaving, microwaving, ultrasonication, sand, and glass grinding. After each pre-treatment method, Bligh and Dyer’s method was used to measure the total lipid content in percentage dry weight (% dwt), which was then compared with the untreated S. molesta. It was foundexperimentally that the lipid yield was 19.97% dwt for ultrasonication > 16.60% dwt for microwaving > 16.46% dwt for glass grinding >16.26% dwt for sand grindin, > 15.72% dwt for autoclaving > 15.36% dwt for untreated. The one-way ANOVA with Tukey’s test was then used to validate the experimental results and showed that ultrasonication method of pre-treatment was the most efficient and had resulted in the highest lipid yieldamong all the methods used which was followed by the microwaving method. The Taguchi method with L9 orthogonal array was then used for the optimization of ultrasonic assisted pre-treatment method before extracting lipid from S. molesta and showed a maximum lipid of 20.86% using 100% amplitude and sonication time of 15 min. The fatty acid methyl ester (FAME) of S. molesta lipid was analyzed using gas chromatographymass spectroscopy (GCMS) with flame ionization detector. It showed fatty acids such as C14:0, C14:1, C16:0, C16:1, C18:0, C18:1, C20:1, C20:4, C22:0 which contributed 97.38% weight of the total fatty acids. FAME consisted of 63.59% monounsaturated, 33.18% saturated and 0.73% polyunsaturated fatty acids in % weight. The physical properties such as specific gravity, kinematic viscosity, cetane number, flash point, cloud point, pour point, saponification value and iodine value of S. molesta biodiesel, which were estimated based on fatty acid profiles are comparable with ASTM 6751-08 biodiesel standard.
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Mubarak M, Shaija A, Suchithra TV. Optimization of lipid extraction from Salvinia molesta for biodiesel production using RSM and its FAME analysis. Environ Sci Pollut Res Int 2016; 23:14047-14055. [PMID: 27044288 DOI: 10.1007/s11356-016-6343-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2015] [Accepted: 02/21/2016] [Indexed: 06/05/2023]
Abstract
The higher areal productivity and lipid content of microalgae and aquatic weed makes them the best alternative feedstocks for biodiesel production. Hence, an efficient and economic method of extracting lipid or oil from aquatic weed, Salvinia molesta is an important step towards biodiesel production. Since Salvinia molesta is an unexplored feedstock, its total lipid content was first measured as 16 % using Bligh and Dyer's method which was quite sufficient for further investigation. For extracting more amount of lipid from Salvinia molesta, methanol: chloroform in the ratio 2:1 v/v was identified as the most suitable solvent system using Soxhlet apparatus. Based on the literature and the preliminary experimentations, parameters such as solvent to biomass ratio, temperature, and time were identified as significant for lipid extraction. These parameters were then optimized using response surface methodology with central composite design, where experiments were performed using twenty combinations of these extraction parameters with Minitab-17 software. A lipid yield of 92.4 % from Salvinia molesta was obtained with Soxhlet apparatus using methanol and chloroform (2:1 v/v) as solvent system, at the optimized conditions of temperature (85 °C), solvent to biomass ratio (20:1), and time (137 min), whereas a predicted lipid yield of 93.5 % with regression model. Fatty acid methyl ester (FAME) analysis of S. molesta lipid using gas chromatograph mass spectroscopy (GCMS) with flame ionization detector showed that fatty acids such as C16:0, C16:1, C18:1, and C18:2 contributed more than 9 % weight of total fatty acids. FAME consisted of 56.32, 28.08, and 15.59 % weight of monounsaturated, saturated, and polyunsaturated fatty acids, respectively. Higher cetane number and superior oxidation stability of S. molesta FAME could be attributed to its higher monounsaturated content and lower polyunsaturated content as compared to biodiesels produced from C. vulgaris, Sunflower, and Jatropha.
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Affiliation(s)
- M Mubarak
- Mechanical Engineering Department, National Institute of Technology Calicut, Kerala, India
| | - A Shaija
- Mechanical Engineering Department, National Institute of Technology Calicut, Kerala, India.
| | - T V Suchithra
- School of Biotechnology, National Institute of Technology Calicut, Kerala, India
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30
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Affiliation(s)
- M Mubarak
- Department of Histopathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
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Naqvi R, Mubarak M, Ahmed E, Akhtar F, Naqvi A, Rizvi A. Acute tubulointerstitial nephritis/drug induced acute kidney injury; an experience from a single center in Pakistan. J Renal Inj Prev 2016; 5:17-20. [PMID: 27069962 PMCID: PMC4827380 DOI: 10.15171/jrip.2016.04] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 06/23/2015] [Accepted: 02/10/2016] [Indexed: 02/03/2023] Open
Abstract
INTRODUCTION There is no information in literature specifically on the prevalence and clinicopathological characteristics of acute tubulointerstitial nephritis/drug induced acute kidney injury (AKI) from Pakistan. OBJECTIVES We aim to report a series of cases from patients developing AKI after exposure to some medications or finding of interstitial nephritis on histopathology. PATIENTS AND METHODS This is an observational study of patients identified as having AKI after exposure to medications. AKI was defined according to RIFLE criteria and all patients fell from risk to loss category on arrival. On ultrasonography, all patients had normal size non-obstructed kidneys. Renal biopsy findings were consistent with tubule interstitial nephritis. RESULTS Mean age of patients was 36.41 ± 17.40 years. Among total of 155, 80 were male and 75 female. Regarding drugs, most common was exposure to aminoglycoside in 34 (22%) followed by use of non-steroidal anti-inflammatory analgesics in 28, contrast induced agents in 11. Renal biopsy was performed in 58 patients. In half of these, insulting agent was not known and in rest either multiple medications were ingested or there was denial to substance use or recovery was delayed despite discontinuation of responsible medication. Renal replacement therapy was required on arrival in 119/155 (hemodialysis = 115, peritoneal dialysis = 4) cases. Complete renal recovery was observed in 71%, while 7.7% expired during acute phase, partial renal recovery was seen in 15% and 5% disappeared after first discharge from the hospital. CONCLUSION Tubulointerstitial nephritis may occur with many drugs of common use. Early and intensive efforts must be made to consider and then timely correct the injury to the kidney.
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Affiliation(s)
- Rubina Naqvi
- Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Muhammad Mubarak
- Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Ejaz Ahmed
- Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Fazal Akhtar
- Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Anwar Naqvi
- Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - Adib Rizvi
- Sindh Institute of Urology and Transplantation, Karachi, Pakistan
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Qureshi H, Shehzad A, Mohsin R, Sultan G, Laghari R, Mubarak M, Hashmi A, Naqvi S, Rizvi S. Impact of radical nephrectomy on renal functional outcome in patients with no other co-morbidity as determined by 24-h urinary creatinine clearance. African Journal of Urology 2015. [DOI: 10.1016/j.afju.2015.08.001] [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: 01/10/2023] Open
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Rai AA, Butt MO, Laeeq SM, Abbas Z, Luck NH, Hassan SM, Tasneem AA, Mubarak M. Celiac Crisis in Refractory Celiac Disease Type I with Neurological Manifestations: A Diagnostic Dilemma. J Coll Physicians Surg Pak 2015; 25 Suppl 2:S134-6. [PMID: 26522202 DOI: 10.2015/jcpsp.s134s136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2015] [Accepted: 08/11/2015] [Indexed: 01/10/2023]
Abstract
Celiac crisis is a life-threatening condition in which patients have profuse diarrhea and severe metabolic disturbances. Refractory Celiac Disease (RCD) is a rare condition defined as persistence of symptoms despite being on Gluten Free Diet (GFD) for 6 months. Neurological involvement in Celiac Disease (CD) is seen in around 8 - 10% of adult patients; however, it is rare in children. Herein we present a case of an adolescent presenting with neurological symptoms and celiac crisis and diagnosed as RCD, type 1. He was treated with high dose steroids. This case underscores the need to consider RCD in patients presenting in celiac crisis and showing no improvement on GFD.
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Affiliation(s)
- Ayesha Aslam Rai
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation (SIUT), Karachi
| | - Muhammad Osama Butt
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation (SIUT), Karachi
| | - Syed Mudassir Laeeq
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation (SIUT), Karachi
| | - Zaigham Abbas
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation (SIUT), Karachi
| | - Nasir Hasasan Luck
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation (SIUT), Karachi
| | - Syed Mujahid Hassan
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation (SIUT), Karachi
| | - Abbas Ali Tasneem
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation (SIUT), Karachi
| | - Muhammad Mubarak
- Department of Histopathology, Sindh Institute of Urology and Transplantation (SIUT), Karachi
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Hanif FM, Luck NH, Abbas Z, Hassan SM, Shabir S, Mubarak M. An unusual presentation of Ménétrier's Disease. J Coll Physicians Surg Pak 2014; 24 Suppl 3:S183-5. [PMID: 25518766 DOI: 11.2014/jcpsp.s183s185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 03/26/2013] [Accepted: 10/24/2013] [Indexed: 09/29/2022]
Abstract
Ménétrier's Disease (MD) is a rare acquired hypertrophic gastropathy characterized by giant hypertrophic rugal folds, hypochlorhydria, and hypoproteinemia. The definitive etiology of MD is controversial, although infection with Helicobacter pylori (H. pylori) has been implicated in adults. It presents as a constellation of symptoms including epigastric pain, fatigue, vomiting, weight loss, anorexia, and edema. None of these signs and symptoms is specific for the disease. The gastrointestinal symptoms and the degree of hypoalbuminemia can be profound, the latter resulting from the leakage of protein from the gastric lining. The disease is more common in males. Herein, we report a case of a young woman presenting with the chief complaint of peripheral edema with minimal gastrointestinal symptoms, which was diagnosed as MD on endoscopic evaluation and histopathological examination of gastric biopsy. A high index of suspicion is needed to correctly diagnose this condition for its optimal management.
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Affiliation(s)
- Farina Mohammed Hanif
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation (SIUT), Karachi
| | - Nasir Hassan Luck
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation (SIUT), Karachi
| | - Zaigham Abbas
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation (SIUT), Karachi
| | - Syed Mujahid Hassan
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation (SIUT), Karachi
| | - Sabhita Shabir
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation (SIUT), Karachi
| | - Muhammad Mubarak
- Department of Histopathology, Sindh Institute of Urology and Transplantation (SIUT), Karachi
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Shakeel S, Mubarak M, Kazi JI. Frequency and clinicopathological correlations of histopathological variants of pediatric idiopathic focal segmental glomerulosclerosis. Indian J Nephrol 2014; 24:148-53. [PMID: 25120291 PMCID: PMC4127833 DOI: 10.4103/0971-4065.132003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
There is no information on the frequency and clinicopathological correlations of the histopathological variants of primary focal segmental glomerulosclerosis (FSGS) in children presenting with idiopathic nephrotic syndrome (INS) in Pakistan. All consecutive children (≤17 years) who presented with INS, and in whom the histological diagnosis of FSGS was made on renal biopsies, were included in this prospective study. Their clinical, laboratory, and histopathological features at the time of presentation were noted from the case files and the biopsy reports for analysis and clinicopathological correlations. Out of 138 children, 93 (67.4%) were males and 45 (32.6%) were females. The mean age was 8.95 ± 4.14 (range: 1.5-17) years. All had NS, with steroid dependant NS (SDNS) in 45 (32.6%) and steroid resistant NS (SRNS) in 93 (67.4%) cases. Renal dysfunction at the time of presentation was found in six (4.3%) children. Global glomerulosclerosis was found in 68 (49.3%) cases. The mean number of glomeruli involved by segmental scarring was 2.98 ± 2.44. FSGS, not otherwise specified (NOS) was the most prevalent variant, comprising 89.1% of all cases. Collapsing variant comprised 8%, tip variant 1.4%, perihilar 0.7%, and cellular 0.7%. Hyaline arteriolosclerosis was found in 13 (9.4%) cases. Mild interstitial fibrosis/tubular atrophy was found in 95 (68.6%) cases, moderate in 18 (13%), and severe in two (1.4%) cases. In conclusion, FSGS, NOS variant was the highly prevalent variant, while collapsing type was also found in small but significant number of cases. Remaining three variants were distinctly rare in our children.
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Affiliation(s)
- S Shakeel
- Department of Histopathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - M Mubarak
- Department of Histopathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
| | - J I Kazi
- Department of Histopathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
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Rizvi SAH, Sultan S, Zafar MN, Naqvi SAA, Lanewala AA, Hashmi S, Aziz T, Hassan AS, Ali B, Mohsin R, Mubarak M, Farasat S, Akhtar SF, Hashmi A, Hussain M, Hussain Z. Pediatric kidney transplantation in the developing world: challenges and solutions. Am J Transplant 2013; 13:2441-9. [PMID: 23865679 DOI: 10.1111/ajt.12356] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2012] [Revised: 05/07/2013] [Accepted: 05/21/2013] [Indexed: 01/25/2023]
Abstract
The prevalence of pediatric RRT and transplantation are low in developing countries, 6-12 and <1 to 5 per million child population (pmcp), respectively. This is due to low GDP/capita of <$10 000, government expenditure on health of <2.6-9% of GDP and paucity of facilities. The reported incidence of pediatric CKD and ESRD is <1.0-8 and 3.4-35 pmcp, respectively. RRT and transplantation are offered mostly in private centers in cities where HD costs $20-100/session and transplants $10 000-20 000. High costs and long distance to centers results in treatment refusal in up to 35% of the cases. In this backdrop 75-85% of children with ESRD are disfranchised from RRT and transplantation. Our center initiated an integrated dialysis-transplant program funded by a community-government partnership where RRT and transplantation was provided "free of cost" with life long follow-up and medication. Access to free RRT at doorsteps and transplantation lead to societal acceptance of transplantation as the therapy of choice for ESRD. This enabled us to perform 475 pediatric transplants in 25 years with 1- and 5-year graft survival of 96% and 81%, respectively. Our model shows that pediatric transplantation is possible in developing countries when freely available and accessible to all who need it in the public sector.
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Affiliation(s)
- S A H Rizvi
- Department of Urology, Sindh Institute of Urology and Transplantation, Dewan Farooq Medical Complex, Karachi, Pakistan
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Mubarak M. Utility of renal allograft biopsy: An audit of 80 allograft biopsies. Indian J Nephrol 2013; 23:466-7. [PMID: 24339533 PMCID: PMC3841523 DOI: 10.4103/0971-4065.120352] [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: 01/10/2023] Open
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Mubarak M. Toward establishing a renal biopsy registry: A step in the right direction. Indian J Nephrol 2013; 23:159-60. [PMID: 23814411 PMCID: PMC3692138 DOI: 10.4103/0971-4065.111830] [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: 01/10/2023] Open
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Affiliation(s)
- M Mubarak
- Department of Histopathology, Sindh Institute of Urology and Transplantation, Karachi- 74200, Pakistan
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Affiliation(s)
- M Mubarak
- Department of Histopathology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
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Siddiqui AR, Abbas Z, Luck NH, Hassan SM, Aziz T, Mubarak M, Naqvi SA, Rizvi SAH. Experience of fibrosing cholestatic hepatitis with hepatitis C virus in kidney transplant recipients. Transplant Proc 2012; 44:721-4. [PMID: 22483477 DOI: 10.1016/j.transproceed.2011.12.019] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Fibrosing cholestatic hepatitis C (FCH-C) is a rare entity that occurs among immune-compromised patients resulting from the direct hepatotoxicity of a high intracellular viral load along with an ineffective immune system ultimately leading to a fatal outcome. We have describes herein 4 renal transplant recipients who were diagnosed with FCH-C at our institution in the last 8 months. METHODS Four renal transplant recipients presented with jaundice and deteriorating liver function tests. They were diagnosed to display FCH-C based on the presence of hepatitis C virus (HCV) RNA and characteristic liver biopsy findings; there was no evidence of any other cause of cholestasis or biliary obstruction. RESULTS The patients were men of ages 40, 25, 20, and 27 years. The durations after transplantation were 1.5, 10, 1.5 and 2.0 years, respectively. In all cases pretransplantation screening was negative for HCV antibody, HCV RNA, and hepatitis B surface antigen (HBsAg). All 4 patients were infected with genotype 1, whereas case 2 had coinfection with type 3. Cases 1 and 2 who were treated with interferon and ribavirin, showed improvement in cholestasis but did not achieve a rapid virological response. Case 1 developed graft dysfunction secondary to acute cellular rejection at 4 months after initiation of interferon treatment, which was treated with pulse steroids. Interferon-based therapy was stopped prematurely in both cases due to pancytopenia. Case 3 developed florid pyelonephritis and died without receiving therapy for hepatitis C. Case 4 was managed conservatively by decreasing the immunosuppression with regular monitoring. CONCLUSION FCH-C is difficult to treat and shows high morbidity and mortality rates. Treatment is associated with a risk of graft rejection.
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Affiliation(s)
- A R Siddiqui
- Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
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Mubarak M. Comment on "Ten-year experience of pediatric renal biopsies from a single center in Pakistan". Indian J Nephrol 2012; 22:66. [PMID: 22279351 PMCID: PMC3263072 DOI: 10.4103/0971-4065.86409] [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: 01/10/2023] Open
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Rizvi SAH, Naqvi SAA, Zafar MN, Hussain Z, Hashmi A, Hussain M, Akhtar SF, Ahmed E, Aziz T, Sultan G, Sultan S, Mehdi SH, Lal M, Ali B, Mubarak M, Faiq SM. A renal transplantation model for developing countries. Am J Transplant 2011; 11:2302-7. [PMID: 21883911 DOI: 10.1111/j.1600-6143.2011.03712.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The estimated incidence of end-stage renal disease (ESRD) in Pakistan is 100 per million population. Paucity and high costs of renal replacement therapy allows only 10% to get dialysis and 4-5% transplants. Our center, a government organization, started a dialysis and transplant program in 1980s where all services were provided free of charge to all patients. It was based on the concept of community government partnership funded by both partners. The guiding principles were equity, transparency, accountability and development of all facilities under one roof. This partnership has sustained itself for 30 years with an annual budget of $25 million in 2009. Daily 600 patients are dialyzed and weekly 10-12 receive transplants. One- and 5-year graft survival of 3000 transplants is 92% and 85%, respectively. The institute became a focus of transplantation in Pakistan and played a vital role in the campaign against transplant tourism and in promulgation of transplant law of 2007, and also helped to increase altruistic transplants in the country. This model emphasizes that in developing countries specialized centers in government sector are necessary for transplantation to progress and community support can make it available to the common man.
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Affiliation(s)
- S A H Rizvi
- Department of Urology, Sindh Institute of Urology and Transplantation, Civil Hospital, Karachi, Pakistan.
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Mubarak M. The renal histopathological spectrum of patients with nephrotic syndrome: an analysis of 1523 patients in a single Chinese centre. Nephrol Dial Transplant 2011; 26:3419; author reply 3419-20. [DOI: 10.1093/ndt/gfr398] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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Tunio MA, Rafi M, Hashmi A, Mohsin R, Qayyum A, Hasan M, Sattar A, Mubarak M. High-dose-rate intraluminal brachytherapy during preoperative chemoradiation for locally advanced rectal cancers. World J Gastroenterol 2010; 16:4436-42. [PMID: 20845511 PMCID: PMC2941067 DOI: 10.3748/wjg.v16.i35.4436] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To determine the feasibility and safety of high dose rate intraluminal brachytherapy (HDR-ILBT) boost during preoperative chemoradiation for rectal cancer.
METHODS: Between 2008 and 2009, thirty-six patients with locally advanced rectal cancer (≥ T3 or N+), were treated initially with concurrent capecitabine (825 mg/m2 oral twice daily) and pelvic external beam radiotherapy (EBRT) (45 Gy in 25 fractions), then were randomized to group A; HDR-ILBT group (n = 17) to receive 5.5-7 Gy × 2 to gross tumor volume (GTV) and group B; EBRT group (n = 19) to receive 5.4 Gy × 3 fractions to GTV with EBRT. All patients underwent total mesorectal excision.
RESULTS: Grade 3 acute toxicities were registered in 12 patients (70.6%) in group A and in 8 (42.1%) in group B. Complete pathologic response of T stage (ypT0) in group A was registered in 10 patients (58.8%) and in group B, 3 patients (15.8%) had ypT0 (P < 0.0001). Sphincter preservation was reported in 6/9 patients (66.7%) in group A and in 5/10 patients (50%) in group B (P < 0.01). Overall radiological response was 68.15% and 66.04% in Group A and B, respectively. During a median follow up of 18 mo, late grade 1 and 2 sequelae were registered in 3 patients (17.6%) and 4 patients (21.1%) in the groups A and B, respectively.
CONCLUSION: HDR-ILBT was found to be effective dose escalation technique in preoperative chemoradiation for rectal cancers, with higher response rates, downstaging and with manageable acute toxicities.
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Abbas K, Mubarak M, Kazi JI, Muzaffar R. Pattern of morphology in renal biopsies of nephrotic syndrome patients. Correlation with immunoglobulin and complement deposition and serology. J PAK MED ASSOC 2009; 59:540-3. [PMID: 19757701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To determine the morphological pattern in renal biopsies from nephrotic patients and their correlation with immunoglobulin and complement deposition as detected by immunofluorescence microscopy (IMF) and serology to arrive at correct diagnosis of glomerulonephritis (GN). METHODS The study was carried out at the departments of Immunology and Histopathology, Sindh Institute of Urology and Transplantation (SIUT) from April 2007 to March 2008. A total of 200 patients, including children and adults were included. All patients presented with nephrotic syndrome (NS). Clinical and laboratory investigations including serology were noted, renal biopsies performed and studied by light and immunofluorescence microscopy (IMF). RESULTS Of 200 patients, 74 (37%) were children (< or = 18 years) and 126 (63%) adults (> or = 19 years). Mean age of children was 11.34 +/- 4.85 years (range 3-18 years) and that of adults was 35.44 +/- 11.4 years (range: 19-70 years). The total percent change in L/M diagnosis after serological tests was 11.5% and after IMF studies, 23.5%. Combined serologic and IMF studies lead to 35% change in L/M diagnosis of the renal biopsies in nephrotic syndrome patients. CONCLUSION Our results demonstrate that the ancillary techniques of IMF microscopy and serology are indispensable in the elucidation of final specific diagnosis causing nephrotic syndrome in a substantial number of cases and these should be employed routinely in the pathologic evaluation of renal biopsies. The study emphasizes the importance of combined approach in the investigation of renal biopsies in nephrotic syndrome.
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Affiliation(s)
- Khawar Abbas
- Department of Molecular Biology and Immunology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
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Abbas K, Muzaffar R, Zafar MN, Mubarak M, Naqvi SAA, Rizvi SAH. Evaluation of pre transplant T-cell activation status by soluble CD 30 determination. J PAK MED ASSOC 2009; 59:212-5. [PMID: 19402280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To evaluate the utility of serum CD30 (sCD30) levels as predictor of early acute graft rejection in live related renal transplant programme. METHODS This prospective study included 50 consecutive renal transplant recipients who received their first live related renal allograft at the Sindh Institute of Urology and Transplantation (SIUT) between October 2006 and March 2007. Blood samples were obtained one day before transplantation and on the third and fourteenth posttransplant days. Blood samples were also obtained from 50, age and sex matched healthy control individuals. Levels of serum sCD30 were measured by Enzyme Linked Immunosorbent Assay (ELISA). RESULT Donor-recipient blood group matching was identical in all patients. Pre-transplant lymphocyte crossmatch for T and B cells was negative, and panel reactive antibodies (PRA) were 0% for all recipients. The mean age of recipients was 31.6 +/- 10.23 years (range 5 to 55 years), while mean donor age was 32.74 +/- 8.48 years (range 21-50 years). Eleven (22%) recipients and donors were HLA identical while remaining (78%) were one haplotype match. Average serum sCD30 pre-transplant levels (37.8 +/- 4.97U/ml) were significantly higher than those of healthy individual's mean value of 8.48 +/- 4.97 U/ml, (P = 0.001). Eight (16%) patients developed acute rejection episode during this follow up period. Rejections were described and classified according to BANFF 97 classification. CONCLUSION In this small single center study the serum levels of sCD30 did not show any significant difference between rejection and non rejection group in our transplant population.
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Affiliation(s)
- Khawar Abbas
- Department of Molecular Biology and Immunology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan
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Islam S, Tuhina K, Mubarak M, Mondal P. Hydrogenation of various organic substrates using polystyrene anchored orthometallated ruthenium (II) complex as catalyst. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/j.molcata.2008.09.010] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Kazi JI, Mubarak M. Histopathology in present era. J PAK MED ASSOC 2009; 59:1-2. [PMID: 19213366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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