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Sharma H, Yuan M, Shakeel I, Radhakrishnan A, Brown S, May J, Zia N, O'Connor K, Hothi SS, Myerson SG, Nadir MA, Steeds RP. Changes in mitral regurgitation following acute myocardial infarction: early and long-term follow-up. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Mitral regurgitation (MR) is commonly observed following acute myocardial infarction (MI). Localised left ventricular (LV) remodelling in the region of papillary muscles together with impaired myocardial contractility promote MR. There is a paucity of long-term follow-up studies to determine whether the severity of MR observed post-MI, changes with time.
Purpose
This study retrospectively followed up patients with MR detected following acute MI (AMI) to investigate changes in MR severity with time and assess for pre-discharge predictors of MR regression or progression.
Methods
Clinical records of 1000 patients admitted with AMI between 2016 and 2017 to a single centre were retrospectively interrogated. One hundred and nine patients met the inclusion criteria of MR on pre-discharge transthoracic echocardiography (TTE) and follow-up TTE scans. Echocardiographic parameters were investigated to determine predictors of progression or regression at follow-up. Patients were divided according to those who had early follow-up TTE (within 1-year) and late follow-up TTE (beyond 1-year).
Results
Early follow-up TTE was performed in 73 patients at a median of 6 (IQR 3–9) months. Patients had a mean age of 69±13 years and were predominantly male 50/73 (68%). At baseline, relative MR severities were: 49/73 (67%) mild MR, 23/73 (32%) moderate MR and 1 (1%) severe MR. At follow-up, MR had completely resolved in 18/73 (23%) patients, while 39/73 (53%) had mild MR, 15/73 (21%) moderate MR and 1 (1%) severe MR. Compared to patients with no resolution of MR, those with completel resolution were younger (mean age 62±16 vs 72±11 years; p=0.015) but there were no other significant differences between the groups. Resolution at early follow-up did not significantly influence long-term mortality rates. Late follow-up TTE was performed in 69 patients at a median 2.4 (IQR 2–3.2) years. Pre-discharge, 49/69 (71%) patients had mild MR and 20/69 (29%) moderate MR. At follow-up, MR had completely resolved in 18/69 (26%), and amongst patients with persistent MR, proportion of severities were: 37/69 (54%) mild MR, 11/69 (16%) moderate MR and 3/69 (4%) severe MR. Patients with progression of mild MR were more likely to have lower left ventricular ejection fraction (LVEF: 47±15 vs 57±12%; p=0.010) and greater indexed left ventricular end-systolic volume (LVESVi: 37±23 vs 25±14 ml/m2; p<0.001) on pre-discharge TTE. Resolution of MR at late follow-up was associated with a reduction in long-term mortality [deaths: 2/55 (3%) vs 3/14 (21%); p=0.022] at a mean follow-up of 4.2 years from MI.
Conclusion
MR observed following AMI completely resolved in approximately one-quarter of patients at 6-month and 2-year follow-up. Progression of mild MR at long-term follow-up appears to be associated with increased mortality and is predicted by lower LVEF and greater LVESVi pre-discharge.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- H Sharma
- University of Birmingham, Birmingham, United Kingdom
| | - M Yuan
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - I Shakeel
- University of Birmingham, Birmingham, United Kingdom
| | | | - S Brown
- University of Birmingham, Birmingham, United Kingdom
| | - J May
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - N Zia
- University of Birmingham, Birmingham, United Kingdom
| | - K O'Connor
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - S S Hothi
- New Cross Hospital, Wolverhampton, United Kingdom
| | - S G Myerson
- University of Oxford Centre for Clinical Magnetic Resonance Research, Oxford, United Kingdom
| | - M A Nadir
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - R P Steeds
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
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Viqar S, Akhtar T, Ikram N, Zia N. Frequency of Hypomagnesaemia following Total and Near-total Thyroidectomy and its relationship with Hypocalcaemia. J Coll Physicians Surg Pak 2021; 31:571-575. [PMID: 34027871 DOI: 10.29271/jcpsp.2021.05.571] [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] [Received: 07/17/2020] [Accepted: 12/01/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine the frequency of hypomagnesaemia in patients undergoing thyroidectomy and evaluate its relationship with postoperative hypocalcaemia. STUDY DESIGN Observational, cross-sectional study. PLACE AND DURATION OF STUDY Surgical Unit 1, Benazir Bhutto Hospital, Rawalpindi, Pakistan from April 2017 to May 2019. METHODOLOGY Preoperative and 24-hour postoperative samples for serum calcium and magnesium of 75 patients undergoing total and near-total thyroidectomy were taken. Postoperative signs and symptoms of hypocalcaemia were documented. Data was analysed on SPSS version 22, using independent and paired t-test, Pearson correlation, linear regression, Chi-square test and Fisher's Exact test. RESULTS Postoperatively 49 (65.3%) patients developed hypocalcaemia and 8 (10.7%) developed hypomagnesaemia. Postoperative hypocalcaemia was significantly associated with hypomagnesaemia (p=0.03) with a significant positive linear correlation. Ten patients (13.3%) developed symptomatic hypocalcaemia; however, it was not associated with postoperative hypomagnesaemia. Postoperative hypocalcaemia and hypomagnesaemia were significantly associated with preoperative calcium level (p = 0.03 and 0.04, respectively). There was significantly lower calcium level in patients with hypomagnesaemia (p = 0.002) and a significant fall in magnesium level in patients developing hypocalcaemia (p = 0.044). CONCLUSION Postoperatively hypocalcaemia was prevalent following thyroidectomy, while hypomagnesaemia was not common. Hypomagnesaemia and a fall in magnesium level after surgery was associated with hypocalcaemia; but not with symptomatic hypocalcaemia. Monitoring of magnesium levels in severe or persistent hypocalcaemia is recommended. While this study proves a relationship between calcium and magnesium, its clinical implication must be further studied. Key Words: Calcium, Magnesium, Postoperative, Hypocalcaemia, Hypomagnesaemia, Thyroidectomy.
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Affiliation(s)
- Sana Viqar
- Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Tasleem Akhtar
- Department of Vascular Surgery, Russells Hall Hospital, Dudley, UK
| | - Nadeem Ikram
- Department of Pathology, Benazir Bhutto Hospital, Rawalpindi, Pakistan
| | - Naeem Zia
- Department of Surgery Unit 1, Benazir Bhutto Hospital, Rawalpindi, Pakistan
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Radhakrishnan A, Sharma H, Brown S, May J, Zia N, Joshi R, George S, Zaphiriou A, Khan S, Doshi S, Ludman PF, Townend JN, Nadir MA. Left ventricular function and clinical heart failure after myocardial infarction revascularized with percutaneous coronary intervention - comparison between STEMI and NSTEMI in modern practice. Eur Heart J Cardiovasc Imaging 2021. [DOI: 10.1093/ehjci/jeaa356.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Introduction
Left ventricular systolic dysfunction (LVSD) is a common consequence of myocardial infarction (MI). Data from historic series identified LVSD in up to 60% of patients post-MI. However, in modern practice, with high-sensitivity cardiac biomarkers leading to early detection of MI and widespread use of early revascularization, the prevalence of LVSD in the acute phase of MI and its impact on subsequent clinical heart failure remains unknown.
Purpose
To ascertain the prevalence of LVSD on pre-discharge echocardiography and its impact on subsequent clinical heart failure after type 1 MI treated with percutaneous coronary intervention (PCI) in a UK tertiary cardiac centre.
Methods
A retrospective electronic patient records review of consecutive patients with type 1 MI treated with PCI between January 2016 - December 2017. Patients treated conservatively or with surgical revascularization were excluded.
Results
1000 consecutive patients were identified and 948/1000 who had an inpatient echocardiogram prior to discharge were included in this analysis – 413 ST elevation MI (STEMI) and 535 non-ST elevation (NSTEMI). Median door to balloon time for STEMI was 42 minutes (IQR 28-79). Median time from symptom onset to intervention for NSTEMI was 3 days (IQR 1-6). LVSD was defined as left ventricular ejection fraction (LVEF) <50% on transthoracic echocardiogram carried out during the hospital episode. LVSD was significantly more prevalent in patients with STEMI compared to NSTEMI (37.4% vs 17.3%, p < 0.001). Median LVEF was significantly lower in the STEMI population (55%, IQR 45-60) compared to patients with NSTEMI (60%, IQR 54-65), p < 0.001. However, rates of clinical heart failure at index presentation with MI did not vary significantly between STEMI and NSTEMI patients (6.1% vs 4.9%, p = 0.414). In stepwise multivariate regression models: age, peak troponin and previous coronary artery bypass grafting were predictors of LVEF, whereas LVEF and previous MI were predictors of clinical heart failure
Patients with LVSD on pre-discharge echocardiography had significantly higher rates of 30-day readmission with heart failure (2.9% vs 0.7%, p = 0.017), 30-day all-cause mortality (6.1% vs 2%, p = 0.001), 30-day cardiac mortality (5.7% vs 1%, p < 0.001) and 2-year all-cause mortality (5.7% vs 1.6%, p = 0.001). However, at 2-years, there was no difference in hospital readmission with heart failure (0.8% vs 0.3%, p = 0.276). There were no significant differences between STEMI and NSTEMI patients for these endpoints.
Conclusions
Early revascularisation with PCI has led to a reduction in the prevalence of early LVSD post-MI compared to historical data. However, the presence of LVSD remains a powerful predictor of adverse clinical outcomes. Despite lower rates of LVSD on pre-discharge echocardiography in patients with NSTEMI compared with STEMI, the incidence of subsequent clinical heart failure is similar. This however may be underestimated due to survival bias.
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Affiliation(s)
- A Radhakrishnan
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - H Sharma
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - S Brown
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - J May
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - N Zia
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - R Joshi
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - S George
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - A Zaphiriou
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - S Khan
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - S Doshi
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - PF Ludman
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - JN Townend
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - MA Nadir
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom of Great Britain & Northern Ireland
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Masood A, Viqar S, Zia N, Ghani MU. Early Oral Feeding Compared With Traditional Postoperative Care in Patients Undergoing Emergency Abdominal Surgery for Perforated Duodenal Ulcer. Cureus 2021; 13:e12553. [PMID: 33564545 PMCID: PMC7863026 DOI: 10.7759/cureus.12553] [Citation(s) in RCA: 5] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Introduction Enhanced recovery after surgery (ERAS) protocols have been widely studied in elective abdominal surgeries with promising outcomes. However, the use of these protocols in emergency abdominal surgeries has not been widely investigated. This study aimed to evaluate ERAS application outcomes via early oral feeding compared to regular postoperative care in patients undergoing perforated duodenal ulcer repairs in emergency abdominal surgeries. Materials and methods We conducted a randomized controlled trial at the Surgical Unit 1 Benazir Bhutto Hospital from August 2018 to December 2019. A total of 42 patients presenting to the emergency department with peritonitis secondary to suspected perforated duodenal ulcer were included in the study. Patients were randomly assigned into two groups. Group A patients followed an ERAS protocol for early oral feeding, and Group B received regular postoperative care (i.e., delayed oral feeding). Our primary outcomes were the length of hospital stay, duodenal repair site leak, the severity of pain (via the visual analog scale), and postoperative ileus duration. Results were analyzed via IBM Statistical Product and Service Solutions (SPSS) Statistics for Windows, Version 20.0 (Armonk, NY: IBM Corp.). and chi-square and independent t-tests were applied. Results Patients who received early oral feeding (Group A) showed a shorter length of hospital stay, lower pain scores, and shorter postoperative ileus duration than patients in the traditional postoperative care group. Also, we noted no duodenal repair site leak in the early oral feeding group. The differences between the two groups were statistically significant (P<0.05). Conclusions Based on our results, ERAS protocols that promote early oral feeding can be applied in patients undergoing emergency abdominal surgery for perforated duodenal repair. Early oral feeding in emergency surgery patients can reduce the patient burden on hospitals. In addition, early oral feeding can promote better outcomes and reduced economic burden for patients.
Keywords: Perforated duodenal ulcer, ERAS protocol, randomized controlled trial, duodenal repair site leak, length of hospital stay, VAS score, postoperative ileus.
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Affiliation(s)
- Ayesha Masood
- General Surgery, California Institute of Behavioral Neurosciences & Psychology, Fairfield, USA.,Surgery, Benazir Bhutto Hospital, Rawalpindi, PAK
| | - Sana Viqar
- Surgery, Rawalpindi Medical University, Rawalpindi, PAK
| | - Naeem Zia
- Surgery, Benazir Bhutto Hospital, Rawalpindi, PAK
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Sharma H, Radhakrishnan A, Brown S, May J, Zia N, Joshi R, Ludman P, Townend J, Doshi S, Khan S, Zaphiriou A, George S, Steeds R, Nadir A. Ischaemic mitral regurgitation: incidence, clinical and angiographic characteristics of 1000 patients with type 1 myocardial infarction undergoing percutaneous coronary intervention. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Previous studies of the incidence and severity of mitral regurgitation (MR) following acute myocardial infarction (MI) were limited by the study population (ST-elevation MI only), by diagnostic methods (lack of multiparametric quantification), or by the time-frame of study (late assessment post-MI). The true incidence of ischaemic MR (IMR) immediately following type 1 MI [non-ST-elevation (NSTEMI) and ST-elevation (STEMI)] patients in the modern era of universal early revascularisation remains unclear. Since even mild IMR confers a poor prognosis, factors which promote or protect against the development of MR require further evaluation.
Purpose
To determine the incidence, clinical and angiographic characteristics of patients with IMR following type 1 MI treated with PCI.
Methods
This was a single-centre study of 1000 consecutive, prospectively recruited patients admitted to the Queen Elizabeth Hospital Birmingham with type 1 MI who underwent PCI. Early inpatient transthoracic echocardiography (TTE) was performed by accredited echocardiographers using standard multiparametric quantification.
Results
MR was observed in 294/1000 patients (29.4%) post-MI, graded as mild (76%), moderate (21%) and severe (3%). Median time from symptom onset to PCI was 1 day (IQR 0–4) and to TTE 2 days (IQR 1–3).
Compared to patients without MR (MR-), those with MR (MR+) were older (73±12 years vs 66±13 years; p<0.001), male (75% vs 64%; p<0.001) and more likely to have a history of hypertension (HTN) (63% vs 55%; p=0.0117), heart failure (HF) (3.4% vs 1.1%; p=0.0140) and previous MI (28% vs 20%; p<0.005). MR+ patients more frequently presented with HF (8.5% vs 4.2%; p=0.0075), lower LV ejection fraction (LVEF) (50±14% vs 55±11%; p<0.001) and higher peak high sensitivity troponin T (765ng/L, IQR 170–3032 vs 400ng/L, IQR 51–1966; p<0.0001).
MR+ patients were more likely to have severe disease in the left circumflex (LCx) (50% vs 33%; p<0.0001) or right coronary artery (RCA) (51% vs 43%; p=0.0135). Incidence of severe disease in the left main stem and left anterior descending artery (LAD) did not significantly differ between the two groups.
Incidence of MR was equal (29%) amongst STEMI (126/431) and NSTEMI (168/569) patients. While the time to revascularisation did not affect the prevalence of MR following STEMI (linear regression analysis of door-to-balloon time in MR+ and MR- patients p=0.843), NSTEMI patients were more likely to develop MR if revascularisation was delayed (linear regression analysis of symptom onset to PCI time MR+ vs MR- p=0.061).
Conclusion
Almost 1/3 of patients with type 1 MI undergoing revascularisation have MR evident on pre-discharge TTE. Factors promoting MR include older age, male sex, HTN, HF, larger non-LAD territory infarct, and depressed LVEF. The incidence of MR following STEMIs and NSTEMIs is equal. Earlier revascularisation is unlikely to reduce MR in STEMI patients but may improve MR prevalence following NSTEMI.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- H Sharma
- University of Birmingham, Birmingham, United Kingdom
| | | | - S Brown
- University of Birmingham, Birmingham, United Kingdom
| | - J May
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - N Zia
- University of Birmingham, Birmingham, United Kingdom
| | - R Joshi
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - P.F Ludman
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - J.N Townend
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - S.N Doshi
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - S.Q Khan
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - A Zaphiriou
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - S George
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - R.P Steeds
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - A Nadir
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
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Sharma H, Radhakrishnan A, Brown S, May J, Zia N, Joshi R, Nightingale P, Ludman P, Townend J, Doshi S, Khan S, Zaphiriou A, George S, Nadir A, Steeds R. Risk stratification on echocardiography and outcome in ischaemic mitral regurgitation. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Ischaemic mitral regurgitation (IMR) confers a poor prognosis. Transcatheter intervention may improve survival but benefit is likely to depend on severity of IMR relative to LV remodelling following myocardial infarction (MI). In theory, those with “discordant” IMR (significant regurgitant volume without severe LV dilatation or impairment), are expected to benefit most from mitral intervention. While subcategorization may help to inform treatment, there are no data on post-MI patients in this respect.
Purpose
To determine the incidence of discordant & concordant IMR categorised on echocardiography post-MI and impact on outcomes.
Methods
1000 consecutive patients admitted to our hospital with myocardial infarction who underwent coronary angioplasty were included. Early inpatient TTE was performed by accredited echocardiographers using standard multiparametric quantification.
Using TTE parameters, 4 subgroups were identified (figure) according to the degree of MR relative to LV remodelling. Thresholds were based on European guidelines (± 2SD from normal) and median value among survivors for vena contracta (VC):
– LVEF: 52% (♂), 54% (♀)
– Indexed LV end diastolic volume (LVEDVi): 74ml/m2 (♂), 61ml/m2 (♀)
– Effective regurgitant orifice area (EROA) ≥0.2cm2
– Regurgitant volume (RVol) ≥30ml
– VC ≥0.5cm
Results
MR was seen in 294/1000 patients (29.4%) with a severity of mild (76%), moderate (21%) and severe (3%). Concordant and discordant IMR were each seen in 16/294 (5%) of IMR patients post-MI.
After a mean follow up of 3.2 years, IMR patients had a 3% rate of heart failure (HF) within 1 year and 19% mortality. Non-survivors had significantly worse IMR (PISA 0.65±0.25cm vs 0.54±0.19cm; p=0.033; VC 0.63±0.25cm vs 0.49±0.18cm; p=0.014), worse LV function (LVEF 44±17% vs 51±13%; p<0.001), larger LV (LVEDVi 67±23ml/m2 vs 60±22ml/m2; p=0.032) and larger indexed LA volume (LAVi) (44±22ml vs 35±15ml; p<0.001). Those with concordant IMR had the worst survival (50%) although almost 1 in 5 of those with discordant MR died within the follow up period (19%). Using multivariable Cox regression, significant predictors of mortality included LVEF (p<0.001; HR 0.96, 0.94–0.98) and LAVi (p<0.001; HR 1.02, 1.01–1.03) but not LVEDVi.
Conclusion
1) Significant predictors of mortality in IMR include LA dilatation and decline in LVEF, but not LV dilatation.
2) Although discordant severe IMR is uncommon following MI, mortality if left untreated remains high. Attention should be paid to early selection of this cohort for intervention.
Funding Acknowledgement
Type of funding source: None
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Affiliation(s)
- H Sharma
- University of Birmingham, Birmingham, United Kingdom
| | | | - S Brown
- University of Birmingham, Birmingham, United Kingdom
| | - J May
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - N Zia
- University of Birmingham, Birmingham, United Kingdom
| | - R Joshi
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - P Nightingale
- University of Birmingham, Birmingham, United Kingdom
| | - P.F Ludman
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - J.N Townend
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - S.N Doshi
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - S.Q Khan
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - A Zaphiriou
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - S George
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - A Nadir
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - R.P Steeds
- Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
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Singla R, Wall D, Anderson S, Zia N, Korte J, Kravets L, McKiernan G, Butler J, Gammilonghi A, Arora J, Wright M, Solomon B, Hicks R, Cain T, Darcy P, Cullinane C, Neeson P, Ramanathan R, Shukla R, Bansal V, Harrison S. First in Human Study of In-vivo Imaging of Ex-Vivo Labelled CAR T Cells with Dual PET-MR. Cytotherapy 2020. [DOI: 10.1016/j.jcyt.2020.04.074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Sharif A, Akhtar T, Akhtar M, Malik I, Hanif M, Zia N. Effect of Prophylactic Ilioinguinal Neurectomy on Postoperative Groin Pain Following Lichenstein Hernioplasty. J Coll Physicians Surg Pak 2019; 29:406-409. [PMID: 31036106 DOI: 10.29271/jcpsp.2019.05.406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/19/2017] [Accepted: 01/18/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To compare mean postoperative pain post-Lichenstein open hernioplasty with and without ilioinguinal neurectomy at six months. STUDY DESIGN Randomised controlled trail. PLACE AND DURATION OF STUDY Surgical Unit-I, Benazir Bhutto Hospital, Rawalpindi, from August 2014 to February 2015. METHODOLOGY Adult male patients with unilateral reducible inguinal hernia, who consented to the study between the age range of 18-80 years, were included. Recurrent, irreducible or strangulated, or large inguinal-scrotal hernia and those with previous abdominal incision, impaired cognition, peripheral neuropathy, limited mobility and females were excluded. Patients were equally randomised to nerve-preservation and excision groups. Mann-Whitney U-test was applied to find out difference in inguinodynia at 1 and 6 months. RESULTS There was significant difference in pain at 1 month in the nerve-preservation group (Md=6.00, IQR=4, n=90) and nerve excision group (Md=3.50, IQR=4, n=90), U=2308.00, z=-5.017, p<.001 and at 6 months in the nerve preservation group (Md=2.00, IQR=1, n=90) and nerve-excision group (Md=0.00, IQR=1, n=90), U=3001.00, z=-3.470, p=0.001. CONCLUSION Prophylactic ilioinguinal neurectomy significantly reduces groin pain at 6 month as compared to nerve preservation group following Lichenstein hernioplasty.
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Affiliation(s)
- Atif Sharif
- Department of Vascular Surgery, Russells Hall Hospital, Dudley, England
| | - Tasleem Akhtar
- Department of Vascular Surgery, Russells Hall Hospital, Dudley, England
| | - Mumtaz Akhtar
- Surgical Unit, Al Nafees Medical College, Islamabad, Pakistan
| | - Irfan Malik
- Surgical Unit, The District Headquarters (DHQ) Hospital, Rawalpindi, Pakistan
| | - Muhammad Hanif
- Surgical Unit-I, Benazir Bhutto Hospital, Rawalpindi, Pakistan
| | - Naeem Zia
- Surgical Unit-I, Benazir Bhutto Hospital, Rawalpindi, Pakistan
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Hameed T, Zia N, Khan HS, Zia A, Ahmed R, Hameed A, Ahmed M, Khan AQ. Analysis Of Level Of Satisfaction Of Postgraduate Trainees On Surgical Floor. J Ayub Med Coll Abbottabad 2019; 31:207-213. [PMID: 31094118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Organizations flourish with a satisfied workforce. There is little known information on demographic characteristics and motivators for job satisfaction among Pakistani postgraduate trainees in surgery. Job satisfaction is predicted by intrinsic motivators (personal growth and perceived ability to work) and extrinsic motivators (perceived social support). Work family interference/enhancement and job stressors (workload and long working hours) also impacts job satisfaction; predicting overall life satisfaction. This study aims at examining life satisfaction predicted by personal and professional characteristics.. METHODS The postgraduate trainees in the public and private hospitals of Rawalpindi and Islamabad were surveyed using validated measures of life satisfaction, personal growth, perceived social support, perceived ability to work, work family interference/enhancement, job stressors, co-workers support, supervisors support, and job satisfaction from September 15 to December 28, 2017. RESULTS Personal growth, perceived ability to work, availability of social support, and work family enhancement positively correlate to job and life satisfaction. Work life interference and job stressors negatively relate to job and life satisfaction. Job satisfaction is also partially mediated by intrinsic and extrinsic motivators on life satisfaction, whereas job stressors weakened the relationship between job satisfaction and life satisfaction. Long working hours is negatively related to job satisfaction and life satisfaction. CONCLUSIONS Life satisfaction is predicted by job satisfaction that is characterized intrinsic and extrinsic motivators. Healthcare organizations face challenge of providing reduced working hours, increased salaries, supportive working environment, and increased supervision to enhance the job satisfaction of employees and to improve the functioning of the healthcare environment.
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Affiliation(s)
- Tahira Hameed
- Surgical Unit I, Benazir Bhutto Hospital, Rawalpindi, Pakistan
| | - Naeem Zia
- Surgical Unit I, Benazir Bhutto Hospital, Rawalpindi, Pakistan
| | | | - Ammarah Zia
- Surgical Unit I, Benazir Bhutto Hospital, Rawalpindi, Pakistan
| | - Rameez Ahmed
- Surgical Unit I, Benazir Bhutto Hospital, Rawalpindi, Pakistan
| | | | - Murtaza Ahmed
- Surgical Unit I, Benazir Bhutto Hospital, Rawalpindi, Pakistan
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Zia N, Latif A, Mashreky S, Al-Ibran E, Hashmi M, Rahman A, Khondoker S, Quraishy M, A Hyder A. 471 Understanding Burn Care Challenges in Resource Constraint Settings: A Qualitative Study from South Asia. J Burn Care Res 2018. [DOI: 10.1093/jbcr/iry006.393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- N Zia
- Johns Hopkins University, Baltimore, MD; Centre for Injury Prevention Research, Dhaka, Bangladesh; Burns Center, Karachi, Pakistan; Aga Khan University, Karachi, Pakistan; National Institute of Burn and Plastic Surgery, Dhaka, Bangladesh; Civil Hospital, Karachi, Pakistan
| | - A Latif
- Johns Hopkins University, Baltimore, MD; Centre for Injury Prevention Research, Dhaka, Bangladesh; Burns Center, Karachi, Pakistan; Aga Khan University, Karachi, Pakistan; National Institute of Burn and Plastic Surgery, Dhaka, Bangladesh; Civil Hospital, Karachi, Pakistan
| | - S Mashreky
- Johns Hopkins University, Baltimore, MD; Centre for Injury Prevention Research, Dhaka, Bangladesh; Burns Center, Karachi, Pakistan; Aga Khan University, Karachi, Pakistan; National Institute of Burn and Plastic Surgery, Dhaka, Bangladesh; Civil Hospital, Karachi, Pakistan
| | - E Al-Ibran
- Johns Hopkins University, Baltimore, MD; Centre for Injury Prevention Research, Dhaka, Bangladesh; Burns Center, Karachi, Pakistan; Aga Khan University, Karachi, Pakistan; National Institute of Burn and Plastic Surgery, Dhaka, Bangladesh; Civil Hospital, Karachi, Pakistan
| | - M Hashmi
- Johns Hopkins University, Baltimore, MD; Centre for Injury Prevention Research, Dhaka, Bangladesh; Burns Center, Karachi, Pakistan; Aga Khan University, Karachi, Pakistan; National Institute of Burn and Plastic Surgery, Dhaka, Bangladesh; Civil Hospital, Karachi, Pakistan
| | - A Rahman
- Johns Hopkins University, Baltimore, MD; Centre for Injury Prevention Research, Dhaka, Bangladesh; Burns Center, Karachi, Pakistan; Aga Khan University, Karachi, Pakistan; National Institute of Burn and Plastic Surgery, Dhaka, Bangladesh; Civil Hospital, Karachi, Pakistan
| | - S Khondoker
- Johns Hopkins University, Baltimore, MD; Centre for Injury Prevention Research, Dhaka, Bangladesh; Burns Center, Karachi, Pakistan; Aga Khan University, Karachi, Pakistan; National Institute of Burn and Plastic Surgery, Dhaka, Bangladesh; Civil Hospital, Karachi, Pakistan
| | - M Quraishy
- Johns Hopkins University, Baltimore, MD; Centre for Injury Prevention Research, Dhaka, Bangladesh; Burns Center, Karachi, Pakistan; Aga Khan University, Karachi, Pakistan; National Institute of Burn and Plastic Surgery, Dhaka, Bangladesh; Civil Hospital, Karachi, Pakistan
| | - A A Hyder
- Johns Hopkins University, Baltimore, MD; Centre for Injury Prevention Research, Dhaka, Bangladesh; Burns Center, Karachi, Pakistan; Aga Khan University, Karachi, Pakistan; National Institute of Burn and Plastic Surgery, Dhaka, Bangladesh; Civil Hospital, Karachi, Pakistan
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Sharif A, Akhtar T, Akhtar M, Zia N. Cystic Pleural Synovial Sarcoma. J Coll Physicians Surg Pak 2016; 26:127-129. [PMID: 28666505] [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] [Received: 09/28/2015] [Accepted: 07/01/2016] [Indexed: 06/07/2023]
Abstract
Fewer than 40 cases of primary pleural synovial sarcoma have been reported so far with only 3 cases of cystic synovial sarcoma including cases originating from sites other than the pleura. Here, we present an exceedingly rare case of cystic synovial sarcoma originating from the mediastinal side of the visceral pleura in a 25-year man presenting with hemoptysis. On contrast-enhanced computed tomography (CT), cystic synovial sarcoma and cystic thymoma were difficult to be distinguished due to mediastinal location. Histopathological examination showed spindled morphology of tumor cells with hypercellularity and nuclear atypia. As these features are associated with both monophasic fibrous synovial sarcoma and type Athymoma, immunohistochemistry was performed. Adiagnosis of synovial sarcoma was confirmed by detection of CD99 and EMAand negativity of other markers. Fluorescence in situhybridization (FISH) was not done. Surgical excision was done and followed by oncology referral.
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Affiliation(s)
- Atif Sharif
- Surgery Unit 1, Benazir Bhutto Hospital, Rawalpindi
| | | | | | - Naeem Zia
- Surgery Unit 1, Benazir Bhutto Hospital, Rawalpindi
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Abstract
Obturator hernia is an uncommon condition. It carries the highest mortality amongst abdominal wall hernias, usually presenting in elderly, multiparous and thin ladies. Meckel diverticulum is a rare cause of intestinal obstruction and its existence in an obturator hernia is extremely rare; our literature search revealed only two reported cases. We report the case of a 70-year-old woman who presented with signs and symptoms of intestinal obstruction and peritonitis. An exploratory laparotomy led to diagnosis of a strangulated obturator hernia. The sac contents included a Meckel diverticulum with a perforation at its base and a loop of the ileum. The ischemic ileal segment including the Meckel diverticulum was resected and a loop ileostomy was created.
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Affiliation(s)
| | - Zain Ul Abideen
- Dr. Zain Ul Abideen, Department of Medicine,, Rawalpindi Medical College,, Holy Family Hospital,, Punjab 44000, Pakistan, 923335565947,
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Murad MF, Ali Q, Nawaz T, Zia N, Jehan F, Rafiq A, Merrell RC, Zafar A. Teleoncology: improving patient outcome through coordinated care. Telemed J E Health 2014; 20:381-4. [PMID: 24621403 DOI: 10.1089/tmj.2013.0100] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION There are few specialized oncology centers in Pakistan. Teleoncology was introduced for weekly tumor case meetings between the surgery departments of Holy Family Hospital and NORI Hospital using videoconferencing. The team of surgeons, radiologists, and histopathologists of Holy Family Hospital and the oncologists from NORI Hospital are now conducting joint regular multidisciplinary meetings weekly for the well-being of patients of the area. The purpose of this study is to describe the infrastructure, consultative process, technical aspects, and initial evaluation of these meetings. MATERIALS AND METHODS The surgical oncology patients are discussed every Friday morning since November 2009. A standardized format was adopted for case discussion in these multidisciplinary meetings. The postgraduate trainee presents the case from either side followed by management plan discussion. The oncologists may request a discussion to plan an intervention at Holy Family Hospital, or the surgeons at Holy Family Hospital may present a case that would benefit from multidisciplinary skills. RESULTS In total, 264 patients were discussed. The mean age of the patients was 51±16.2 years. In 43% of the patients, the joint treatment strategy was refined from the initial proposed treatment. Breast and gastrointestinal tract malignancies were the most common cases, followed by endocrine and skin and soft tissue tumors. CONCLUSIONS Teleoncology services can be extended easily with little addition to existing infrastructure but significantly reduce the stress for families as they deal with this challenging disease. Moreover, they improve the clinical evaluation and management strategies.
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Affiliation(s)
- M Faisal Murad
- 1 Surgical Unit II, Holy Family Hospital , Rawalpindi, Pakistan
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Arif A, Abideen ZU, Zia N, Khan MA, Nawaz T, Malik AZ. Metastatic involvement of the spleen by endometrial adenocarcioma; a rare asylum for a common malignancy: a case report. BMC Res Notes 2013; 6:476. [PMID: 24252257 PMCID: PMC3874625 DOI: 10.1186/1756-0500-6-476] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Accepted: 11/18/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Metastatic involvement of the spleen by solid tumors is a rare clinical entity; those coming from endometrial adenocarcinomas are exceptionally rare. Spleen is an uncommon site for metastatic deposits due to its specific anatomy and microenvironment. Typically, splenic metastasis from endometrial carcinomas present months to years after curative surgery, chemotherapy or radiotherapy. The most common complaint in symptomatic patients is abdominal pain localized to the left hypochondrium. Most however, are asymptomatic only to be picked up on vigilant routine ultrasonography or computerized tomography during follow up. We report the case of a 54-year-old woman who presented to us after 50 months of total abdominal hysterectomy and bilateral salpingo-oophorectomy for an endometrial adenocarcinoma. She had severe abdominal pain localized to the left hypochondrium as the presenting complaint. To the best of our knowledge, this is the 1st case to be reported from Pakistan with 14 cases reported prior to our report. All past cases report the endometroid variant of endometrial adenocarcinoma as the primary tumor and our patient was a victim to the same variant. CASE PRESENTATION A 54-year-old, nulliparous widowed woman presented with severe abdominal pain in the left hypochondrium for the last 4 months. The pain radiated to the left shoulder and was exacerbated with deep breathing. She had a history of total abdominal hysterectomy with bilateral salpingo-oophorectomy done 50 months back for stage 1a endometroid endometrial adenocarcinoma. Clinical examination revealed tenderness in the left hypochondrium but no visceromeglay was appreciable. Ultrasonography and computerized tomography revealed a space-occupying lesion within the spleen with associated splenomegaly. Computed tomography further suggested a large splenic abscess however the patient did not have fever, vomiting or leukocytosis which are the hallmarks of a splenic abscess. A splenectomy was performed for her complaints. On histopathology a metastatic adenocarcinoma was identified consistent with the primary tumor. The tumor was CK7, CA-125 and epithelial membrane antigen positive (EMA). The patient was then referred for further chemotherapy. CONCLUSION From this case we conclude, that although very rare, the spleen is a potential site for metastasis in endometroid endometrial adenocarcinoma. Since most patients are asymptomatic, routine examinations and imaging can identify its presence and avoid complications. If the practice is employed with vigilance, we may expect the clinical event to be diagnosed more frequently. The standard treatment is a classic splenectomy followed by chemotherapy.
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Affiliation(s)
| | - Zain Ul Abideen
- Department of Anesthesia, Pain and Intensive care, Holy Family Hospital, Rawalpindi Medical College, Rawalpindi, Pakistan.
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de Ramirez SS, Khan U, Chandran A, Zia N, Huang C, Razzak J, Hyder A. Caretaker perceptions of childhood home safety and injury risks in Karachi, Pakistan: a qualitative study. Inj Prev 2012. [DOI: 10.1136/injuryprev-2012-040590a.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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Khan U, Hashmi A, Zia N, Awan S, Razzak J. P2-520 Injury- related mortality among women aged 12-49 years: Demographic and Health Survey (DHS) Pakistan. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976m.47] [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: 11/04/2022]
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Khan U, Zia N, Awan S, Khan A. SP5-27 Perception of Pakistani women pillion riders about helmet use: a qualitative study. Journal of Epidemiology & Community Health 2011. [DOI: 10.1136/jech.2011.142976p.63] [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] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Zia N, Khan UR, Razzak JA, Puvanachandra P, Hyder A. SP6-23 Unintentional childhood home injuries: a case study from Karachi, Pakistan. Br J Soc Med 2011. [DOI: 10.1136/jech.2011.142976p.94] [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: 11/03/2022]
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Zia N, Khan UR, Razzak JA, Hyder AA, Sugerman DE, Puvanachandra P. Unintentional childhood injury surveillance in Karachi, Pakistan. Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.498] [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: 11/03/2022]
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Khan UR, Zia N, Razzak JA. Injuries number three killer of children under 5 years: Demographic and Health Survey (DHS) from Pakistan. Inj Prev 2010. [DOI: 10.1136/ip.2010.029215.807] [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: 11/04/2022]
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Qureshi U, Hanif M, Zia N, Khan MM. Role of nasogastric intubation after small bowel anastomosis. J Coll Physicians Surg Pak 2009; 19:354-8. [PMID: 19486573 DOI: 06.2009/jcpsp.354358] [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: 02/16/2008] [Accepted: 02/06/2009] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To determine advantages and disadvantages of postoperative nasogastric intubation after small bowel anastomosis. STUDY DESIGN Quasi experimental. PLACE AND DURATION OF STUDY Surgical Unit-I, Holy Family Hospital, Rawalpindi, from December 2003 to December 2006. METHODOLOGY A total of 112 patients, undergoing small bowel anastomosis were equally divided in group I and II with and without postoperative nasogastric intubation respectively. Variables compared were number of patients having episodes of vomiting, change in abdominal girth, the time for onset of bowel sounds, time to begin per oral fluids, length of hospitalization and postoperative complications. RESULTS In group-I, nasogastric tube was removed on an average after 3.1 days. Average postoperative nasogastric output was 357, 154 and 64 ml/day for day 1, 2 and 3 respectively. There was no statistically significant difference between two groups in abdominal girth before and after operation, frequency of vomiting, time taken for onset of bowel sounds and start of oral sips after operation, frequency of wound infection, anastomotic leak and mortality (p>0.05). Length of postoperative hospital stay and frequency of postoperative respiratory complications were more in group-I as compared to group-II (p<0.05). CONCLUSION Nasogastric decompression does not provide added advantage after small bowel anastomosis.
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Affiliation(s)
- Usman Qureshi
- Department of Surgery, Surgical Unit-I, Holy Family Hospital, Rawalpindi.
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Shaharyar A, Shami N, Zia N, Hafeez M, Rasheed H, Saleem T, Zulfiqar S, Masood AI. Treatment of advanced chemo-refractory epithelial ovarian cancer with aromatase inhibitor. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e16561] [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: 11/20/2022] Open
Abstract
e16561 Background: In advanced epithelial ovarian cancer non-steroidal antiestrogens yields clinical responses in a significant number of patients. This raises the possibility of therapeutic effectiveness of aromatase inhibitors in epithelial ovarian cancer in post menopausal women. Therefore this study was carried out to document the effectiveness of an aromatase inhibitor, in advanced epithelial ovarian cancer patients with unknown hormone receptor status. Methods: From January 2006 to April 2007, a total of 38 patients were enrolled. Patients with histopathologically confirmed advanced epithelial ovarian cancer were included. Other eligibility requirements were: postmenopausal women, failure of third-line chemotherapy, age between 50–70 years, bidimensionally measurable disease, and CA-125 of more than 100 u/mL. An adequate hematologic, hepatic, and renal profile, and ECOG performance of 0–2 was required. Tablet letrozole 2.5 mg orally once daily was given for 03 months. CA-125 and Miller criteria were used for response evaluation. Results: No patient showed the evidence of complete or partial clinical response. Four patients had stable disease for 8 weeks. All patients showed progressive disease on week 12. Conclusions: In this small series no evidence of effectiveness of aromatase inhibitor letrozole in chemo refractory epithelial ovarian cancer is documented in patients with unknown hormone receptor status. It is, therefore, recommended that further study should only be carried out in the selected patient population with documented positive ER/PR hormone receptors. No significant financial relationships to disclose.
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Affiliation(s)
- A. Shaharyar
- King Edward Medical University, Mayo Hospital, Lahore, Pakistan; Lahore Medical & Dental College, Lahore, Pakistan; Nishter Medical College & Hospital, Multan, Pakistan
| | - N. Shami
- King Edward Medical University, Mayo Hospital, Lahore, Pakistan; Lahore Medical & Dental College, Lahore, Pakistan; Nishter Medical College & Hospital, Multan, Pakistan
| | - N. Zia
- King Edward Medical University, Mayo Hospital, Lahore, Pakistan; Lahore Medical & Dental College, Lahore, Pakistan; Nishter Medical College & Hospital, Multan, Pakistan
| | - M. Hafeez
- King Edward Medical University, Mayo Hospital, Lahore, Pakistan; Lahore Medical & Dental College, Lahore, Pakistan; Nishter Medical College & Hospital, Multan, Pakistan
| | - H. Rasheed
- King Edward Medical University, Mayo Hospital, Lahore, Pakistan; Lahore Medical & Dental College, Lahore, Pakistan; Nishter Medical College & Hospital, Multan, Pakistan
| | - T. Saleem
- King Edward Medical University, Mayo Hospital, Lahore, Pakistan; Lahore Medical & Dental College, Lahore, Pakistan; Nishter Medical College & Hospital, Multan, Pakistan
| | - S. Zulfiqar
- King Edward Medical University, Mayo Hospital, Lahore, Pakistan; Lahore Medical & Dental College, Lahore, Pakistan; Nishter Medical College & Hospital, Multan, Pakistan
| | - A. I. Masood
- King Edward Medical University, Mayo Hospital, Lahore, Pakistan; Lahore Medical & Dental College, Lahore, Pakistan; Nishter Medical College & Hospital, Multan, Pakistan
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Hafeez M, Shaharyar A, Zia N, Rasheed H. A phase II feasibility study of cytarabine and idarubicin combination in relapsed or refractory adult acute lymphoblastic leukemia. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e18002] [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: 11/20/2022] Open
Abstract
e18002 Background: Most patients with adult ALL eventually relapse. Salvage regimens in these patients and in patients with primary refractory disease are generally based on cytarabine in combination with other agents. Exact merit of each combination remains undefined as these continue to be tested in non randomized trials. This study was conducted with the objectives to find out the efficacy and toxicity of cytarabine and idarubicin combination. Methods: From December 2006 to March 2008, 30 patients were enrolled in this prospective, nonrandomized single institution phase II feasibility study. It was empirically decided that the study will only be considered feasible if more then ten patients achieve a complete remission. Patients who relapsed during maintenance therapy or were refractory and were at least 16-years-old were considered eligible provided they have received at least vincristine and prednisone as induction. No prior cytarabine was allowed. Cytarabine 100 mg/m2 continuous infusion for seven days along with idarubicin 12 mg/m2 day 1 to 3, IV bolus was given. Bone marrow examination was done 15 days after the completion of chemotherapy. Results: All thirty patients completed planned treatment. Five patients died of infection during treatment. Eleven patients achieved complete remission. All patients relapsed within eight months. Conclusions: The regimen of cytrarabine and idarubicin is feasible and sufficiently effective in relapsed or refractory adult ALL with manageable toxicity. No significant financial relationships to disclose.
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Affiliation(s)
- M. Hafeez
- King Edward Medical University, Mayo Hospital, Lahore, Pakistan
| | - A. Shaharyar
- King Edward Medical University, Mayo Hospital, Lahore, Pakistan
| | - N. Zia
- King Edward Medical University, Mayo Hospital, Lahore, Pakistan
| | - H. Rasheed
- King Edward Medical University, Mayo Hospital, Lahore, Pakistan
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Farooq U, Raza W, Zia N, Hanif M, Khan MM. Classification and management of chest trauma. J Coll Physicians Surg Pak 2006; 16:101-3. [PMID: 16499800 DOI: 2.2006/jcpsp.101103] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/02/2004] [Accepted: 01/10/2006] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To classify the predominant pattern of injuries following blunt and penetrating chest trauma and to assess the adequacy of treatment strategies, complications and mortality associated with such injuries. DESIGN Descriptive study. PLACE AND DURATION OF STUDY Surgical Unit I, Holy Family Hospital, Rawalpindi, from December 2000 to December 2003. PATIENTS AND METHODS One hundred consecutive patients with thoracic trauma either blunt or penetrating, admitted in the ward were evaluated. Their injuries were classified, treatment strategies outlined and complications and mortality were documented on a specially-designed proforma. RESULTS Out of the 100 patients presenting in emergency, 44% presented with blunt and 56% with penetrating trauma. Pneumothorax was detected in 39% of the patients, hemopneumothorax in 29%, hemothorax in 12%, flail chest in 9 %. Two had involvement of the heart and major vessels, 4 % had injury to the diaphragm and 5 % had multiple trauma. During treatment, 3% of all the patients were managed conservatively, 83% of patients required chest intubations, 6% needed ventilatory support and 8 % required thoracotomy. Complications were experienced in 28% of the patients of which 9% had pneumonias, 14% empyema and 5 % suffered from wound infections. The overall mortality was 7 %. CONCLUSION This series showed the pattern of injuries following blunt and penetrating chest trauma. Furthermore, it was found that chest intubation and simple resuscitation was adequate for majority of the cases.
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Affiliation(s)
- Umar Farooq
- Surgical Unit-I, Holy Family Hospital, Rawalpindi.
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Gueli N, Del Nero A, Zia N, Carmenini E, Cacciafesta M. An assessment of the main metabolic variables of cardiovascular risk in a sample population of workers in Rome. Panminerva Med 2001; 43:267-77. [PMID: 11677422] [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: 02/22/2023]
Abstract
BACKGROUND The last few years have seen an increased necessity to assess the cardiovascular risk factors on large samples of the population in Italy. A look at the citizens of a small rural town Brisighella is well known. METHODS Three hundred and five individuals of average age 40.8 years (+/-8.22), recruited between September 1988 and December 1989 (198 men, 107 women) were taken into consideration. Clinical and instrumental investigations were then performed (intern visits with data obtained from primary anthropometric, otorhinolaryngological and ocular variables, heart X-ray, electrocardiogram). The following analyses were also performed: haemochrome, ESR, uricemia, azotemia, glycemia, AST, ALT, bilirubinemia, protein electrophoresis, triglyceridemia, total cholesterol, HDL cholesterol, creatinine level and urine analysis. Women also received PAP-test. Another variable was lifestyle habits which may be considered a risk for cardiovascular disease. Hygienic and diet suggestions were made. After seven years, in 1997, 100 of these individuals (51 men, 49 women - mean age 42.7+/-6.5 years) were chosen at random and administered the same clinical and laboratory examinations as before. RESULTS The analysis of the data show average BMI values 24.07+/-2.7 in men and 22.8+/-2.6 in women, inferior to those found in other Italian investigations. We observed an increase of BMI along with age, despite measures of preventive medicine, in married subjects and along with education and occupation level. Mean values of cholesterol level in men increased between the ages 30 and 39 and stabilised after 40 years; in women they increased only after the 5th decade of life. CONCLUSIONS We observed a direct correlation between the increase of uricemia and triglyceride levels, triglyceride and cholesterol levels, BMI and triglyceride levels conferming the tight bond among these metabolisms and the importance of obesity as a risk factor. Uricemia levels correlate with systolic and diastolic blood pressure.
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Affiliation(s)
- N Gueli
- 1st Institute of Medical Clinics and the Department of Experimental Pathology, University of Rome La Sapienza, Rome, Italy
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Gueli N, del Nero A, Zia N, Carmenini E, Carmenini G. Life habits and cardiovascular risk in a group of bank employees in Rome. Panminerva Med 2000; 42:131-40. [PMID: 10965775] [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: 02/17/2023]
Abstract
BACKGROUND For the past thirty years, many countries, especially the USA, have been performing clinical and laboratory studies to establish the most prominent disease risk factors, in particular those involved in cardiovascular diseases. The main aim of these studies is to reduce disease related risks by intervening at an early age. METHODS We studied 305 patients, 198 males and 107 females, all employees in Rome, mean age 40.8 years (+/- 8.22), enrolled from September 1988 to December 1989. We measured the main anthropometric parameters and performed otolaryngologic and ocular examination, a telecardiogram and an EKG; the following analyses were performed: hemochrome, ESR uric acid, azotemia, glycemia, AST, ALT, gamma GT, bilirubinemia, proteic electrophoresis, triglyceridemia, total cholesterolemia, HDL cholesterolemia, creatinine, urine examination, Pap-Test for women. Lifestyle habits that might be considered cardiovascular disease risk factors were considered and hygienic eating habits were suggested. Seven years later, in 1997, 100 of these patients were randomly selected (51 man and 49 women) and underwent the same clinical and laboratory tests as before. RESULTS The results suggest a deep correlation between lifestyles and the increase of some cardiovascular risk factors. CONCLUSIONS The authors believe that this study can be of some help in guiding future preventive medicine interventions that may be carried out on this population sample.
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Affiliation(s)
- N Gueli
- Department of Experimental Pathology, University of Rome La Sapienza, Italy
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Pranteda G, Gueli N, Innocenzi D, Zia N, Arcieri A, Carmenini G. Ovarian cancer and unilateral naevoid telangiectasia: a rare association. J Exp Clin Cancer Res 1997; 16:71-3. [PMID: 9148864] [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: 02/04/2023]
Abstract
The Authors describe the case of a 58-year-old woman affected by erythematous telangiectasis lesions on the antero-lateral surface of the right hip during papillary serous cystoadenocarcinoma of the right ovary. The diagnosis, based on clinical and histological findings, was unilateral naevoid telangiectasia. After a review of literature the Authors assume a possible role of the oestrogens in the pathogenesis of such infrequent disease.
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Affiliation(s)
- G Pranteda
- Dept. of Dermatology, University of Rome La Sapienza, Italy
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Gueli N, Del Nero A, Zia N, Arcieri A, Casciaro MA, Carmenini G. [Juvenile dyslipidemia as early risk factor for atherosclerosis. Analysis of a sample of school age boys]. Clin Ter 1994; 145:445-55. [PMID: 7720352] [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: 01/26/2023]
Abstract
Atherosclerosis appears already in the first years of life. Several factors may accelerate the age of onset and the gravity of its symptoms. Particular importance is attributed to lipid metabolism in youth. Ther Authors studied the rates of cholesterol, HDL, LDL, triglycerides, apolipoproteins AI and B100, lipoprotein a and several anamnestic and anthropometric parameters in a group of 103 young people of Rome, between 16 and 19 years of age. They processed these data statistically and compared them with those of a similar American group. The results showed a tendency to fatness in the Italian sample, and to dyslipidosis in the American group. Besides, the subjects who had been breast-fed presented higher blood levels of cholesterol and apolipoprotein B100.
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Affiliation(s)
- N Gueli
- Istituto di I Clinica Medica, Università degli Studi di Roma La Sapienza
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Gueli N, Toto A, Zia N, Trua G, Basso N, Carmenini G. [A case of hyperacute systemic lupus erythematosus with hematologic complications in a splenectomized patient]. Clin Ter 1986; 117:427-30. [PMID: 3742964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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