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Noor S, Rasooly AJ, Alikozai SM, Jalalzai T, Haidary AM, Nasir N, Noor S, Farooqi M, Mansoori H. Hypokalemic periodic paralysis in a teenage boy after an intense period of exercise: A rare case report. Clin Case Rep 2023; 11:e8201. [PMID: 38028058 PMCID: PMC10645604 DOI: 10.1002/ccr3.8201] [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] [Received: 07/18/2023] [Revised: 10/19/2023] [Accepted: 10/30/2023] [Indexed: 12/01/2023] Open
Abstract
Key Clinical Messages Diagnosis of rare even can be missed due to less familiarity with the disorder.In patients with muscle weakness, infectious causes are prioritized.Electrolyte profile not only identifies the problem, but also prevents unnecessary workup. Abstract In underdeveloped countries, diagnosis of rare disorders is usually delayed due to less familiarity of the clinicians to such disorders. As a result, infectious and inflammatory causes for an ailment are prioritized as compared to non-infectious etiologies. Hypokalemic periodic paralysis (PP) is a rare disorder, characterized by episodic muscle weakness that can rarely be associated with life-threatening cardiac arrhythmia. A teenage Afghan boy presented to the emergency department with an acute flaccid paralysis, that started 1 h after intense exercise The weakness involved both, the upper and lower extremities. Laboratory investigations, led to the impression of hypokalemic PP, precipitated by intense exercise. Accordingly, intravenous potassium chloride infusion diluted with normal saline led to the complete resolution of paralysis as well as correction of electrocardiographic changes. The list of differential diagnosis for flaccid muscle paralysis is wide, which generally requires a extensive investigations, but in hypokalemic PP, a cardinal electrolytes profile can lead towards early diagnosis. High degree of clinical suspicion with appropriate history taking and physical examination helps with the immediate identification and management of this disorder.
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Affiliation(s)
- Sahar Noor
- Department of Pediatrics MedicineFrench Medical Institute for Mothers and Children (FMIC)KabulAfghanistan
| | - Abdul Jamil Rasooly
- Department of Pediatrics MedicineFrench Medical Institute for Mothers and Children (FMIC)KabulAfghanistan
| | - Sultan Mahmood Alikozai
- Department of Pediatrics MedicineFrench Medical Institute for Mothers and Children (FMIC)KabulAfghanistan
| | - Tooryalai Jalalzai
- Department of Pediatrics MedicineFrench Medical Institute for Mothers and Children (FMIC)KabulAfghanistan
| | - Ahmed Maseh Haidary
- Department of PathologyFrench Medical Institute for Mothers and Children (FMIC)KabulAfghanistan
| | - Najla Nasir
- Department of MedicineRabia Balkhi HospitalKabulAfghanistan
| | - Sarah Noor
- Department of Hemato‐OncologyAli Abad Teaching HospitalKabulAfghanistan
| | - Masooma Farooqi
- Department of CardiologyFrench Medical Institute for Mothers and Children (FMIC)KabulAfghanistan
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Noor S, Haidary AM, Yosufzai AW, Niazai M, Noor S, Nasir N, Shinwari A, Saadaat R. Demographic and clinical characteristics of acute myeloid leukaemia diagnosed and treated at the tertiary level in Afghanistan. Br J Haematol 2023; 203:404-410. [PMID: 37609793 DOI: 10.1111/bjh.19029] [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] [Received: 06/08/2023] [Revised: 07/19/2023] [Accepted: 07/24/2023] [Indexed: 08/24/2023]
Abstract
A retrospective case series design was conducted to elucidate the demographic features of acute myeloid leukaemia in Afghanistan. This study was conducted at Jamhuriat Hospital and French Medical Institute for Mothers and Children, Kabul, Afghanistan. A total of 203 patients with AML diagnosed and managed at Jamhuriat Hospital from 1 March 2018 to 31 March 2020, were included in the current study. The median age at diagnosis was 27 years. Housewives represented the largest subset of patients from an occupational point of view constituting 37.44% of the total sample population and 81.72% of the female population, followed by 20.69% patients who were students of which 14.77% were male and 5.91% were female, and 17.24% were farmers, which constituted 31.81% of the male population. Similarly, 69.95% of individuals presented with infection, 57.14% presented with bone tenderness, 46.3% presented with bleeding tendencies, 55.66% had hepatomegaly and/or splenomegaly, and 27.58% of patients had lymphadenopathy. Considering the chemotherapeutic regime, 64.53% of the individuals received standard 7 + 3 (cytarabine + daunorubicin) induction regimen, 10.68% of those received 5 + 2 re-induction chemotherapy (cytarabine + daunorubicin). 10.84% who were diagnosed with acute promyelocytic leukaemia received all-trans-retinoic acid + arsenic trioxide, while 5.42% of patients defaulted chemotherapy. High prevalence was noted in young individuals. Similarly, a high proportion of patients were constituted by housewives.
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Affiliation(s)
- Sarah Noor
- Department of Haemato-Oncology, Jamhuriat Hospital, Kabul, Afghanistan
| | - Ahmed Maseh Haidary
- Department of Pathology, French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan
| | | | - Mirajan Niazai
- Department of Haemato-Oncology, Jamhuriat Hospital, Kabul, Afghanistan
| | - Sahar Noor
- Department of Paediatric Medicine, French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan
| | - Najla Nasir
- Department of Medicine, Rabia Balkhi Women's Hospital, Kabul, Afghanistan
| | - Ayub Shinwari
- Department of Haemato-Oncology, Jamhuriat Hospital, Kabul, Afghanistan
| | - Ramin Saadaat
- Department of Pathology, French Medical Institute for Mothers and Children (FMIC), Kabul, Afghanistan
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Noor S, Hakimzada N, Safi N, Alikozai SM, Rasooli AJ, Jalalzai T, Siddiqui Q, Sestani AJ, Nasir N, Noor S, Haidary AM, Khalid S. Albright hereditary osteodystrophy: Delay in the diagnosis of a rare disorder due to restricted medical services. Clin Case Rep 2023; 11:e6841. [PMID: 36694647 PMCID: PMC9842773 DOI: 10.1002/ccr3.6841] [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: 10/06/2022] [Revised: 12/08/2022] [Accepted: 12/17/2022] [Indexed: 01/18/2023] Open
Abstract
A teenage Afghan girl presented with seizure. Clinical features and laboratory investigations revealed elevated serum parathormone, high phosphate levels with low serum calcium. In third-world countries, diagnosis of rare disorders, such as Albright hereditary osteodystrophy (AHO), can usually be delayed due to scarcity of standard medical and diagnostic services.
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Affiliation(s)
- Sahar Noor
- Department of Paediatric MedicineFrench Medical Institute for Mothers and Children (FMIC) KabulKabulAfghanistan
| | - Nasrin Hakimzada
- Department of Paediatric MedicineFrench Medical Institute for Mothers and Children (FMIC) KabulKabulAfghanistan
| | - Nijatullah Safi
- Department of Paediatric MedicineFrench Medical Institute for Mothers and Children (FMIC) KabulKabulAfghanistan
| | - Sultan Mahmood Alikozai
- Department of Paediatric MedicineFrench Medical Institute for Mothers and Children (FMIC) KabulKabulAfghanistan
| | - Abdul Jamil Rasooli
- Department of Paediatric MedicineFrench Medical Institute for Mothers and Children (FMIC) KabulKabulAfghanistan
| | - Tooryalai Jalalzai
- Department of Paediatric MedicineFrench Medical Institute for Mothers and Children (FMIC) KabulKabulAfghanistan
| | - Qais Siddiqui
- Department of Paediatric MedicineFrench Medical Institute for Mothers and Children (FMIC) KabulKabulAfghanistan
| | - Ahmad Jalil Sestani
- Department of Paediatric MedicineFrench Medical Institute for Mothers and Children (FMIC) KabulKabulAfghanistan
| | - Najla Nasir
- Department of MedicineRabia Balkhi HospitalKabulAfghanistan
| | - Sarah Noor
- Department of OncologyAli Abad HospitalKabulAfghanistan
| | - Ahmed Maseh Haidary
- Department of PathologyFrench Medical Institute for Mothers and Children (FMIC) KabulKabulAfghanistan
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Saadaat R, Abdul-Ghafar J, Hanifi AN, Khalid S, Khairy AL, Ibrahimkhil AS, Malakzai HA, Esmat E, Haidari M, Hussaini N, Nasir N, Noor S, Haidary AM. Risk factors associated with esophageal cancers, diagnosed at tertiary level in Afghanistan: a descriptive cross-sectional study. BMC Cancer 2022; 22:1112. [PMID: 36316690 PMCID: PMC9623968 DOI: 10.1186/s12885-022-10228-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 10/18/2022] [Accepted: 10/25/2022] [Indexed: 12/24/2022] Open
Abstract
Background: Worldwide, esophageal cancer (EC) is a common cancer in term of incidence and mortality and is the 4th common cancer in Afghanistan. Current study aimed to evaluate the profile of risk factors for EC among patients diagnosed at tertiary level in Afghanistan. Methodology: A descriptive cross-sectional study was carried out between January 2019 up to February 2021 including all esophageal cancers diagnosed at pathology department of French Medical Institute for Mothers and Children, Afghanistan. Result: 240 diagnosed cases were analyzed, in which 59.40% of squamous cell carcinoma and 41.07% Adenocarcinoma. Both histopathological type of were predominantly diagnosed in males. The majority of the patients were residents of rural areas. More than 80% of the patients were illiterate with only less than 2% completing higher education. Majority of the patients were laborers and farmers while less than 10% were employed. According to income assessment, more than 80% were from low-income household, the rest from middle-income and none from high-income family. Oral snuff consumption was noted in 33.9% of squamous cell carcinoma patients and 40% adenocarcinoma patients whereas, family history of esophageal cancer was observed in 37.8% and 36.7% in both types of carcinomas, respectively. More than 60% of both types of carcinomas patients were hot tea drinkers. Conclusion: Current study demonstrated that most patients diagnosed with esophageal cancers were male, uneducated, belongs to low-income groups, lives in rural areas. These findings suggest distribution of esophageal cancer in specific socioeconomic groups, clearly demonstrating the need further analytical study. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-10228-9.
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Affiliation(s)
- Ramin Saadaat
- grid.512938.40000 0004 9128 0254Department of Pathology and Clinical Laboratory, French Medical Institute for Mother and Children (FMIC), Kabul, Afghanistan
| | - Jamshid Abdul-Ghafar
- grid.512938.40000 0004 9128 0254Department of Pathology and Clinical Laboratory, French Medical Institute for Mother and Children (FMIC), Kabul, Afghanistan
| | - Ahmed Nasir Hanifi
- grid.490670.cCentral Public Health Laboratory, Ministry of Public Health, Kabul, Afghanistan
| | | | - Abdul Latif Khairy
- grid.512938.40000 0004 9128 0254Department of Pathology and Clinical Laboratory, French Medical Institute for Mother and Children (FMIC), Kabul, Afghanistan
| | - Abdul Sami Ibrahimkhil
- grid.490670.cCentral Public Health Laboratory, Ministry of Public Health, Kabul, Afghanistan
| | - Haider Ali Malakzai
- grid.512938.40000 0004 9128 0254Department of Pathology and Clinical Laboratory, French Medical Institute for Mother and Children (FMIC), Kabul, Afghanistan
| | - Esmatullah Esmat
- grid.512938.40000 0004 9128 0254Department of Pathology and Clinical Laboratory, French Medical Institute for Mother and Children (FMIC), Kabul, Afghanistan
| | - Mujtaba Haidari
- grid.512938.40000 0004 9128 0254Department of Pathology and Clinical Laboratory, French Medical Institute for Mother and Children (FMIC), Kabul, Afghanistan
| | - Nasrin Hussaini
- grid.512938.40000 0004 9128 0254Department of Pathology and Clinical Laboratory, French Medical Institute for Mother and Children (FMIC), Kabul, Afghanistan
| | - Najla Nasir
- Gastro-enterology unit, Department of Medicine, Rabia Balkhi Hospital, Kabul, Afghanistan
| | - Sarah Noor
- Department of Oncology, Ali Abad Hospital, Kabul, Afghanistan
| | - Ahmed Maseh Haidary
- grid.512938.40000 0004 9128 0254Department of Pathology and Clinical Laboratory, French Medical Institute for Mother and Children (FMIC), Kabul, Afghanistan
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Haidary AM, Saadaat R, Abdul‐Ghafar J, Rahmani S, Noor S, Noor S, Nasir N, Ahmad M, Zahier AS, Zahier R, Malakzai HA, Ibrahimkhil AS, Sharif S, Baryali T, Mohib I, Saqib AH, Azma RZ. Acute lymphoblastic leukemia with clonal evolution due to delay in chemotherapy: A report of a case. eJHaem 2022; 3:1013-1017. [PMID: 36051042 PMCID: PMC9421991 DOI: 10.1002/jha2.483] [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] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/05/2022] [Accepted: 05/11/2022] [Indexed: 11/22/2022]
Abstract
Clonal evolution in acute leukemias is one of the most important factors that leads to therapeutic failure and disease relapse. Delay in therapeutic intervention is one of the reasons that leads toward clonal evolution. In this report, we present a case of acute lymphoblastic leukemia in which therapeutic delay resulted in clonal evolution that was detected by conventional karyotyping and was responsible for non‐responsiveness of the disease to conventional chemotherapy. A 17‐year‐old boy presented with generalized body aches, rapidly progressive pallor and lethargy. Bone marrow analysis was consistent with the diagnosis of B‐cell ALL. Karyotypic analysis revealed 46, XY male karyotype. The patient left the hospital due to financial reasons and after 40 days came back to the hospital. Repeated bone marrow analysis including cytogenetic studies revealed presence of three different clones of blast cells: one clone showed 46, XY with del(9p) and t (11;14), second clone showed 46, XY with del(7q) and del(9p), and the third clone showed 46, XY normal karyotype. The patient did not respond to chemotherapy and died within 1 week of induction chemotherapy (HyperCVAD‐A). Timely diagnosis and institution of chemotherapy in acute leukemias patients is the key to prevent clonal evolution and thus resistance of the disease to therapeutic interventions.
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Affiliation(s)
- Ahmed Maseh Haidary
- Department of Pathology and Clinical Laboratory French Medical Institute for Mothers and Children Kabul Afghanistan
| | - Ramin Saadaat
- Department of Pathology and Clinical Laboratory French Medical Institute for Mothers and Children Kabul Afghanistan
| | - Jamshid Abdul‐Ghafar
- Department of Pathology and Clinical Laboratory French Medical Institute for Mothers and Children Kabul Afghanistan
| | - Soma Rahmani
- Department of Pathology and Clinical Laboratory French Medical Institute for Mothers and Children Kabul Afghanistan
| | - Sarah Noor
- Department of Haemato‐Oncology Ali Abad Hospital Kabul Afghanistan
| | - Sahar Noor
- Department of Paediatric Medicine French Medical Institute for Mothers and Children Kabul Afghanistan
| | - Najla Nasir
- Department of Internal Medicine Rabia Balkhi Hospital Kabul Afghanistan
| | - Maryam Ahmad
- Department of Pathology and Clinical Laboratory French Medical Institute for Mothers and Children Kabul Afghanistan
| | | | - Rohullah Zahier
- Department of Internal Medicine Istiqlal Hospital Kabul Afghanistan
| | - Haider Ali Malakzai
- Department of Pathology and Clinical Laboratory French Medical Institute for Mothers and Children Kabul Afghanistan
| | - Abdul Sami Ibrahimkhil
- Department of Pathology and Clinical Laboratory French Medical Institute for Mothers and Children Kabul Afghanistan
| | - Samuel Sharif
- Department of Pathology and Clinical Laboratory French Medical Institute for Mothers and Children Kabul Afghanistan
| | - Tawab Baryali
- Department of Quality Assurance French Medical Institute for Mothers and Children Kabul Afghanistan
| | - Inamullah Mohib
- Department of Pathology and Clinical Laboratory French Medical Institute for Mothers and Children Kabul Afghanistan
| | - Abdul Hadi Saqib
- Department of Pathology and Clinical Laboratory French Medical Institute for Mothers and Children Kabul Afghanistan
| | - Raja Zahratul Azma
- Faculty of Medicine Department of Pathology Universiti Kebangsaan Malaysia Kuala Lumpur Malaysia
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Haidary AM, Noor S, Noor S, Ahmad M, Yousufzai AW, Saadaat R, Ahmed ZA, Rasooli AJ, Zahier AS, Malakzai HA, Ibrahimkhil AS, Sharif S, Anwari MS, Saqib AH, Baryali T, Nasir N. Rare additional chromosomal abnormalities in acute promyelocytic leukaemia resulting in rapidly fatal disease: report of a case. eJHaem 2022; 3:218-222. [PMID: 35846222 PMCID: PMC9175789 DOI: 10.1002/jha2.349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/04/2021] [Accepted: 11/08/2021] [Indexed: 12/17/2022]
Abstract
Background Acute promyelocytic leukaemia results from reciprocal translocation between the long arms of chromosomes 15 and 17. This translocation leads to the formation of chimeric gene, which is both the diagnostic marker as well as the therapeutic target of the disease. Additional chromosomal abnormalities are randomly encountered either at diagnosis or during therapy. Here, we present a case of acute promyelocytic leukaemia that had a rare cytogenetic profile at diagnosis. Case presentation Our patient was a 14‐year‐old boy, who presented with characteristic clinical and morphological features of acute promyelocytic leukaemia. Karyotypic analysis revealed trisomy of chromosome 8 with deletion of 9p in addition to t(15;17). The patient passed away within the first 8 h of presentation while receiving conventional chemotherapy and haemodynamic resuscitation. Conclusion Our patient presented with a rare cytogenetic profile and rapidly progressive disease. According to our extensive literature search, this was the first case of acute promyelocytic leukaemia having pathognomonic t(15;17) along with trisomy 8 and 9q deletion.
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Affiliation(s)
- Ahmed Maseh Haidary
- Department of Pathology and Clinical Laboratory French Medical Institute for Mothers and Children (FMIC) Kabul Afghanistan
| | - Sarah Noor
- Department of Haemato‐Oncology Ali‐Abad Teaching Hospital Kabul Afghanistan
| | - Sahar Noor
- Department of Paediatric Medicine French Medical Institute for Mothers and Children (FMIC) Kabul Afghanistan
| | - Maryam Ahmad
- Department of Pathology and Clinical Laboratory French Medical Institute for Mothers and Children (FMIC) Kabul Afghanistan
| | | | - Ramin Saadaat
- Department of Pathology and Clinical Laboratory French Medical Institute for Mothers and Children (FMIC) Kabul Afghanistan
| | - Zeeshan Ansar Ahmed
- Department of Pathology and Laboratory Services Agha Khan University Karachi Pakistan
| | - Abdul Jamil Rasooli
- Department of Paediatric Medicine French Medical Institute for Mothers and Children (FMIC) Kabul Afghanistan
| | | | - Haider Ali Malakzai
- Department of Pathology and Clinical Laboratory French Medical Institute for Mothers and Children (FMIC) Kabul Afghanistan
| | - Abdul Sami Ibrahimkhil
- Department of Pathology and Clinical Laboratory French Medical Institute for Mothers and Children (FMIC) Kabul Afghanistan
| | - Samuel Sharif
- Department of Pathology and Clinical Laboratory French Medical Institute for Mothers and Children (FMIC) Kabul Afghanistan
| | - Mohammad Sarwar Anwari
- Department of Pathology and Clinical Laboratory French Medical Institute for Mothers and Children (FMIC) Kabul Afghanistan
| | - Abdul Hadi Saqib
- Department of Pathology and Clinical Laboratory French Medical Institute for Mothers and Children (FMIC) Kabul Afghanistan
| | - Tawab Baryali
- Department of Quality French Medical Institute for Mothers and Children Kabul Afghanistan
| | - Najla Nasir
- Department of Internal Medicine Rabia Balkhi Hospital Kabul Afghanistan
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Haggenmüller B, Kloth C, Gräter T, Schmidt SA, Beer M, Appelt F, Formentini A, Nasir N, Vogele D. [Space-occupying lesion of the pancreaticoduodenal junction after blunt abdominal trauma in a young patient]. Radiologe 2021; 62:51-56. [PMID: 34524481 DOI: 10.1007/s00117-021-00915-2] [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] [Accepted: 08/24/2021] [Indexed: 10/20/2022]
Affiliation(s)
- B Haggenmüller
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
| | - C Kloth
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
| | - T Gräter
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
| | - S A Schmidt
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
| | - M Beer
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
| | - F Appelt
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland
| | - A Formentini
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - N Nasir
- Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Ulm, Ulm, Deutschland
| | - D Vogele
- Klinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Ulm, Albert-Einstein-Allee 23, 89081, Ulm, Deutschland.
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Irfan M, Jabeen K, Hussain M, Farooqi J, Rashid NH, Nasir N, Hasan Z. Invasive pulmonary aspergillosis in patients with severe influenza. Int J Tuberc Lung Dis 2021; 24:1205-1207. [PMID: 33172529 DOI: 10.5588/ijtld.20.0472] [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: 11/10/2022] Open
Affiliation(s)
- M Irfan
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - K Jabeen
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - M Hussain
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - J Farooqi
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
| | - N H Rashid
- Section of Pulmonary and Critical Care Medicine, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - N Nasir
- Section of Infectious Diseases, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Z Hasan
- Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan
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Nasir N, Ahsan M, Jamil B. Ralstonia pickettii bacteremia: An emerging infection in a Tertiary care hospital setting. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.11.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Coffey E, Shaker H, Absar M, Nasir N. Management of early breast cancer in women over 90: A 10 year experience. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz240.028] [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: 11/12/2022] Open
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Basnet M, Quinn A, Noor H, Rana D, Thiryayi S, Shelton D, Al-Habba S, Narine N, McGrath S, Chandran U, Doran H, Joseph L, Bishop P, Chaturvedi A, Ganjifrockwala A, Paiva-Correia A, Saravana R, Nasir N, Nonaka D, Wallace A, Crosbie P, Bayman N, Blackhall F. 53: A survey of regional practice affecting small sample diagnosis and tissue managment of lung carcinoma samples, with development of a local guideline. Lung Cancer 2017. [DOI: 10.1016/s0169-5002(17)30103-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mahmood ND, Mamat SS, Kamisan FH, Yahya F, Kamarolzaman MFF, Nasir N, Mohtarrudin N, Tohid SFM, Zakaria ZA. Amelioration of paracetamol-induced hepatotoxicity in rat by the administration of methanol extract of Muntingia calabura L. leaves. Biomed Res Int 2014; 2014:695678. [PMID: 24868543 PMCID: PMC4017787 DOI: 10.1155/2014/695678] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 03/15/2014] [Accepted: 03/25/2014] [Indexed: 12/30/2022]
Abstract
Muntingia calabura L. is a tropical plant species that belongs to the Elaeocarpaceae family. The present study is aimed at determining the hepatoprotective activity of methanol extract of M. calabura leaves (MEMC) using two models of liver injury in rats. Rats were divided into five groups (n=6) and received 10% DMSO (negative control), 50 mg/kg N-acetylcysteine (NAC; positive control), or MEMC (50, 250, and 500 mg/kg) orally once daily for 7 days and on the 8th day were subjected to the hepatotoxic induction using paracetamol (PCM). The blood and liver tissues were collected and subjected to biochemical and microscopical analysis. The extract was also subjected to antioxidant study using the 2,2-diphenyl-1-picrylhydrazyl-(DPPH) and superoxide anion-radical scavenging assays. At the same time, oxygen radical antioxidant capacity (ORAC) and total phenolic content were also determined. From the histological observation, lymphocyte infiltration and marked necrosis were observed in PCM-treated groups (negative control), whereas maintenance of hepatic structure was observed in group pretreated with N-acetylcysteine and MEMC. Hepatotoxic rats pretreated with NAC or MEMC exhibited significant decrease (P<0.05) in ALT and AST enzymes level. Moreover, the extract also exhibited good antioxidant activity. In conclusion, MEMC exerts potential hepatoprotective activity that could be partly attributed to its antioxidant activity and, thus warrants further investigations.
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Affiliation(s)
- N. D. Mahmood
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), 43400 Serdang, Selangor, Malaysia
| | - S. S. Mamat
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), 43400 Serdang, Selangor, Malaysia
| | - F. H. Kamisan
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), 43400 Serdang, Selangor, Malaysia
| | - F. Yahya
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), 43400 Serdang, Selangor, Malaysia
| | - M. F. F. Kamarolzaman
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), 43400 Serdang, Selangor, Malaysia
| | - N. Nasir
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), 43400 Serdang, Selangor, Malaysia
| | - N. Mohtarrudin
- Department of Pathology, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400 Serdang, Selangor, Malaysia
| | - S. F. Md. Tohid
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), 43400 Serdang, Selangor, Malaysia
| | - Z. A. Zakaria
- Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia (UPM), 43400 Serdang, Selangor, Malaysia
- Integrative Pharmacogenomic Institute, Universiti Teknologi MARA, Level 7, FF3 Building, 42300 Bandar Puncak Alam, Selangor, Malaysia
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Nasir N, Dharma A, Efdi M, Eliesti F. Natural product of wild Zingiberaceae Elettariopsis slahmong: biopesticide to control the vector of banana blood disease bacterium in West Sumatera, Indonesia. Commun Agric Appl Biol Sci 2013; 78:497-505. [PMID: 25151825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Banana is one of the most important food crops in Indonesia. Its production is greater than any other agricultural commodity. With the population of 230 million in 2010, banana was consumed up to three million tons in this country. However, Banana Blood Disease Bacterium (BDB), one of the most devastating banana pathogens in the world, which is only found in Indonesia, threatens not only the growth of this plant but also the lives and the livelihoods for most of the Indonesian society. BDB is caused by a lethal bacteria, Ralstonia solanacearum Phylotype-4, which infects a wide range of bananas, from bananas used for consumption to wild bananas. In West Sumatera, the disease killed 1.40% of bananas in 1998, and then increased dramatically to 37.9% in 2003. The total banana production dropped to 62% in this province. The search for controlling the vector has led to the pre-investigation of Wild Zingiberaceae Elettariopsis slahmong C.K. Lim which has a stink bug odour similar to a methidathion insecticide. The plant was collected around the conservation area of Lembah Anal in West Sumatra. The goal of this study was to investigate the effectiveness of natural insecticides compound contained in E. slahmong against D. melanogaster. This study tested the effect of E. slahmong on the mortality, anti-feedant and repellent levels against Drosophila melanogaster, the vector of BDB. The essential oil of E. slahmong was obtained by steam distillation of fresh rhizomes, pseudo stems and leaves. We found that the extract of E. slahmong significantly affected the mortality of D. melanogaster of 30-40% and also acted as an antifeedant (with success rate of 73-93%) and repellent (with success rate of 99-99.6%). The long- term objective of this study is to develop green biopesticide to control BDB in Indonesia, based on an environmentally friendly pest management.
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Mahboob S, Farooq M, Mahmood S, Nasir N, Sultana S, Chaudhry A, Al-Akel A, Al-Balawi HA, Al-Misned F, Al-Ghanim K. Phylogenetic Relationship of Cultured and Wild Labeo rohitaand Cirrhinus mrigalaBased on Muscles Proteins Profile in Different Weight Groups: A New Tool in Phylogenetic Analysis. International Journal of Food Properties 2012. [DOI: 10.1080/10942912.2010.511752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Nasir N, Mahmood F. Comparison of mortality in respiratory versus non-respiratory acinetobacter infections. Int J Infect Dis 2012. [DOI: 10.1016/j.ijid.2012.05.847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
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Nasir N, Yahya N, Akhtar M, Kashif M, Shafie A, Daud H, Zaid H. Magnitude Verses Offset Study with EM Transmitter in Different Resistive Medium. ACTA ACUST UNITED AC 2011. [DOI: 10.3923/jas.2011.1309.1314] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Nasir N, Grytsiv A, Melnychenko-Koblyuk N, Rogl P, Bauer E, Lackner R, Royanian E, Giester G, Saccone A. Clathrates Ba(8){Zn,Cd}(x)Si(46-x), x∼7: synthesis, crystal structure and thermoelectric properties. J Phys Condens Matter 2009; 21:385404. [PMID: 21832369 DOI: 10.1088/0953-8984/21/38/385404] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Novel ternary type-I clathrate compounds Ba(8){Zn,Cd}(x)Si(46-x), x∼7 have been synthesized from the elements by melting and reacting in quartz ampoules. Structural investigations for both compounds, i.e. x-ray single-crystal data at 300, 200 and 100 K for Ba(8)Zn(7)Si(39) and Rietveld data for Ba(8)Cd(7)Si(39), confirm cubic primitive symmetry consistent with the space group type [Formula: see text] (a(Ba(8)Zn(7)Si(39)) = 1.043 72(1) nm; a(Ba(8)Cd(7)Si(39)) = 1.058 66(3) nm). Whereas for Ba(8)Zn(7)Si(39) site 16i is completely occupied by Si atoms, a random atom distribution with different Zn/Si ratio exists for the two sites, 6d (0.77Zn+0.23Si) and 24k (0.91Si+0.09Zn). No vacancies are encountered and all atom sites are fully occupied. This atom distribution is independent of temperature. Rietveld refinements for Ba(8)Cd(7)Si(39) show that the 6d site is fully occupied by Cd atoms, leaving only the 24k site for a random occupation (0.96Si+0.04Cd) consistent with the chemical formula Ba(8)Cd(7)Si(39). The temperature-dependent x-ray spectra for Ba(8)Zn(7)Si(39) define an Einstein mode, Θ(E,U33) = 80 K. Studies of transport properties show electrons as the majority charge carriers in the system. Although the Cd- and Zn-based samples are isoelectronic, a significantly different electronic transport points towards substantial differences in the electronic density of states in both cases.
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Affiliation(s)
- N Nasir
- Institute of Physical Chemistry, University of Vienna, A-1090 Wien, Austria
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Nasir N, Aquilina K, Ryder DQ, Marks CJ, Keohane C. Garré's chronic diffuse sclerosing osteomyelitis of the sacrum: a rare condition mimicking malignancy. Br J Neurosurg 2009; 20:415-9. [PMID: 17439095 DOI: 10.1080/02688690601046819] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [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: 01/24/2023]
Abstract
Garré's chronic diffuse sclerosing osteomyelitis (DSOM) is a rare disease that occurs most commonly in the mandible. We present a case of sacral DSOM that simulated an expanding destructive sacral tumour. Treatment was conducted on the basis of the available experience with the mandibular form of the disease, with partial symptomatic relief, but progressive sclerosis of the sacral lesion. To the best of our knowledge, this is the first case initially presenting in the sacrum. As an osteolytic expanding lesion simulating malignancy, it is important to recognize this entity in the sacrum.
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Affiliation(s)
- N Nasir
- Department of Neuropathology, Cork University Hospital, Wilton, Cork, Ireland
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Hasan Z, Jamil B, Khan J, Ali R, Khan MA, Nasir N, Yusuf MS, Jamil S, Irfan M, Hussain R. Relationship between circulating levels of IFN-gamma, IL-10, CXCL9 and CCL2 in pulmonary and extrapulmonary tuberculosis is dependent on disease severity. Scand J Immunol 2009; 69:259-67. [PMID: 19281538 DOI: 10.1111/j.1365-3083.2008.02217.x] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Protection against Mycobacterium tuberculosis infection is dependent on T cell and macrophage activation regulated by cytokines. Cytokines and chemokines produced at disease sites may be released into circulation. Data available on circulating cytokines in tuberculosis (TB) is mostly on pulmonary TB (PTB) with limited information on extrapulmonary disease (EPul-TB). We measured interferon-gamma (IFN-gamma), interkeukin-10 (IL-10), CXCL9 and CCL2 in sera of patients (n = 80) including; PTB (n = 42), EPul-TB (n = 38) and BCG vaccinated healthy endemic controls (EC, n = 42). EPul-TB patients comprised those with less severe (LNTB) or severe (SevTB) disease. Serum IFN-gamma, IL-10 and CXCL9 levels were significantly greater while CCL2 was reduced in TB patients as compared with EC. IFN-gamma was significantly greater in PTB as compared with LNTB (P = 0.002) and SevTB (P = 0.029). CXCL9 was greater in PTB as compared with LNTB (P = 0.009). In contrast, CCL2 levels were reduced in PTB as compared with LNTB (P = 0.021) and SevTB (P = 0.024). A Spearman's rank correlation analysis determined a positive association between IFN-gamma and IL-10 (rho = 0.473, P = 0.002) and IFN-gamma and CXCL9 (rho = 0.403, P = 0.008) in the PTB group. However, in SevTB, only IFN-gamma and CXCL9 were positively associated (rho = 0.529, P = 0.016). Systemic levels of cytokines are reflective of local responses at disease sites. Therefore, our data suggests that in PTB increased IFN-gamma and CXCL9 balanced by IL-10 may result in a more effective cell mediated response in the host. However, elevated inflammatory chemokines CXCL9 and CCL2 in severe EPul-TB without concomitant down modulatory cytokines may exacerbate disease related pathology and hamper restriction of M. tuberculosis infection.
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Affiliation(s)
- Z Hasan
- Department of Pathology and Microbiology, The Aga Khan University, Karachi, Pakistan.
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Oliveira G, Thohan V, Koerner M, Loebe M, Noon G, Nasir N, Torre-Amione G. 168. J Heart Lung Transplant 2006. [DOI: 10.1016/j.healun.2005.11.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Abstract
AIMS To compare the frequency of residual tumour in the cavity wall in patients with positive resection margins undergoing either immediate re-excision (IR) at the time of surgery or delayed re-excision (DR) to investigate the effects of recent surgery on the detection of residual disease. METHODS Records of 125 patients who had undergone wide local excision with positive margins were examined. In 64 patients re-excision was performed immediately and in 61 it was delayed by 13-69 days. The presence or absence of residual disease in the re-excision specimens was recorded. RESULTS Residual tumour was detected in 40/64 (62%) and 20/61 (33%) DR specimens (P<0.001). DR specimens contained areas of fibrosis, fat necrosis and foreign body giant cell changes. CONCLUSIONS The detection of residual disease is significantly lower in DR compared to IR specimens. Local repair mechanisms may account for this difference.
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Affiliation(s)
- N Nasir
- Department of Oncoplastic Breast Surgery, Oncoplastic Breast Unit, Royal Hampshire County Hospital, Romsey Road, Winchester SO22 5DG, UK
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Affiliation(s)
- T Satyadas
- Royal Free Hospital and University Medical School, London, United Kingdom
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Nasir N, Pittaway PA, Pegg KG. Effect of organic amendments and solarisation on Fusarium wilt in susceptible banana plantlets, transplanted into naturally infested soil. ACTA ACUST UNITED AC 2003. [DOI: 10.1071/ar02099] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Despite extensive research since pathogenicity was first established in 1919, no cultural or chemical control strategy has proven effective against Fusarium wilt of bananas. The efficacy of cultural control is attributed to the suppression of pathogen activity. Yet, amending naturally infested soil with aged chicken manure has been shown to enhance disease severity, without any change in the activity of the pathogen Fusarium oxysporum f. sp. cubense (Foc) in the soil. In this study, the effect of amending soil with composted sawdust, and of solarising soil, was compared with the effect of amending soil with chicken manure. Bioassays comparing the activity of Foc in the soil with the extent of invasion of banana pseudostem tissue by Foc were used to investigate why strategies targetting pathogen survival have not proven successful in controlling this disease.The enhancement of Foc invasion of the banana plantlets was reproduced with the addition of chicken manure to the naturally infested soil. However, changes in the activity of Foc in the soil were not associated with changes in the frequency of invasion of the plantlets. Invasion of banana pseudostems in the sawdust and solarisation treatments was not significantly different from invasion in the respective control treatments, despite a reduction in the activity of Foc in the sawdust-amended soil and an enhancement in the solarised soil. Moreover, the increase in Foc activity in the solarised soil recorded during the bioassays occurred despite the effectiveness of solarisation in reducing the survival of Foc in pre-colonised banana root tips buried in the soil. Changes in the frequency of invasion were associated with changes in the availability of mineral nitrogen, particularly ammonium N. These results suggest that the physiological response of banana cultivars to ammonium N may be associated with their susceptibility to Fusarium wilt. Accordingly, cultural strategies for controlling Panama disease will only be effective if they enhance the ability of the host to resist invasion.
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Satyadas T, Odorfin O, Nasir N, Akle CA. Missing ring pull. Postgrad Med J 2002; 78:512. [PMID: 12357009 PMCID: PMC1742489 DOI: 10.1136/pmj.78.923.512] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
Tailgut cysts are rare congenital abnormalities in the retrocaecal/presacral region. Clinical diagnosis is difficult and delayed and they can present in childhood and adult life with a variety of clinical symptoms and complications. Differential diagnoses include, rectal duplication cysts, cystic teratoma, epidermal cyst, anal gland cyst and anal gland carcinoma. Magnetic resonance imaging has recently become the modality of choice to image these cysts. Although Tailgut cysts rarely undergo malignant transformation, early surgical resection is presently considered the treatment of choice. Here we report the case of a 34 year old gentleman with a Tailgut cyst associated with a Pilonidal sinus, and review of the literature. We believe that the high incidence of complications associated with operations in the presacral region should be weighed against the generally benign course of these lesions, especially with the quality of modern imaging technology.
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Affiliation(s)
- T Satyadas
- Royal Free Hospital and University Medical School, London, UK, The London Clinic, London, UK, St Mark's Hospital, London, UK
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Satyadas T, Nasir N, Bradpiece HA. Wandering spleen: case report and literature review. J R Coll Surg Edinb 2002; 47:512-4. [PMID: 12018698] [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: 02/25/2023]
Abstract
We report a case of a 17-year-old patient who presented with a 'wandering spleen.' Management options were influenced by her being a Jehovah's Witness.
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Affiliation(s)
- T Satyadas
- University Department of Surgery, Royal Free Hospital and University Medical School, London, UK
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Evans RW, Nasir N. Case report: Dr. Lecter's convulsive syncope. MedGenMed 2001; 3:7. [PMID: 11976606] [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] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Affiliation(s)
- R W Evans
- University of Texas at Houston Medical School, Houston, USA.
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Abstract
OBJECTIVES The objective of the study was to determine whether the occurrence of shocks for ventricular tachyarrhythmias during therapy with implantable cardioverter-defibrillators (ICD) is predictive of shortened survival. BACKGROUND Ventricular tachyarrhythmias eliciting shocks are often associated with depressed ventricular function, making assessment of shocks as an independent risk factor difficult. METHODS Consecutive patients (n = 421) with a mean follow-up of 756+/-523 days were classified into those who had received no shock (n = 262) or either one of two shock types, defined as single (n = 111) or multiple shocks (n = 48) per arrhythmia episode. Endpoints were all-cause and cardiac deaths. A survival analysis using a stepwise proportional hazards model evaluated the influence of two primary variables, shock type and left ventricular ejection fraction (LVEF <35% or >35%). Covariates analyzed were age, gender, NYHA Class, coronary artery disease, myocardial infarction, coronary revascularization, defibrillation threshold and tachyarrhythmia inducibility. RESULTS The most complete model retained LVEF (p = 0.005) and age (p = 0.023) for the comparison of any shock versus no shock (p = 0.031). The occurrence of any versus no shock, or of multiple versus single shocks significantly decreased survival at four years, and these differences persisted after adjustment for LVEF. In the LVEF subgroups <35% and <25%, occurrence of multiple versus no shock more than doubled the risk of death. Compared with the most favorable group LVEF > or =35% and no shock, risk in the group multiple shocks and LVEF <35% was increased 16-fold. CONCLUSIONS In defibrillator recipients, shocks act as potent predictors of survival independent of several other risk factors, particularly ejection fraction.
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Affiliation(s)
- A Pacifico
- Texas Arrhythmia Institute, Houston 77030, USA.
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Pacifico A, Cedillo-Salazar FR, Nasir N, Doyle TK, Henry PD. Conscious sedation with combined hypnotic agents for implantation of implantable cardioverter-defibrillators. J Am Coll Cardiol 1997; 30:769-73. [PMID: 9283538 DOI: 10.1016/s0735-1097(97)00225-8] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The objective of this study was to evaluate the feasibility, safety and efficacy of placing implantable cardioverter-defibrillators (ICDs) in the electrophysiology laboratory using conscious sedation with combined hypnotic agents and deep sedation with etomidate. BACKGROUND Implantable cardioverter-defibrillators with transvenous leads permit the use of simplified implantation techniques similar to those used for the insertion of permanent pacemakers. However, implantation of ICDs without general anesthesia has thus far gained limited acceptance. METHODS In 162 patients, conscious sedation during ICD placement was achieved with combined intravenous midazolam, morphine and promethazine (Phenergan). Intravenous etomidate was administered to induce deep sedation for defibrillation threshold testing. First-time implantations were in the prepectoral position (n = 142), but some patients with preexisting devices received abdominal implants (n = 20). The results were compared with those of concurrent patients (n = 56) who received prepectoral implants under propofol anesthesia administered by an attending anesthesiologist. RESULTS The anesthetic protocol was implemented without major intraoperative complications. During deep sedation with etomidate, episodes of apnea, hypoxia or arterial hypotension requiring therapeutic intervention did not occur. During a mean (+/-SD) follow-up period of 257 +/- 140 days (median 227, range 14 to 482), there were, among the 162 patients, a total of two nonsudden cardiac deaths-one 71 days and the other 157 days after the operation. There were two nonsudden deaths in the concurrent control subjects (n = 56)-one 13 days and the other 110 days after the operation. CONCLUSIONS Implantation of ICDs under conscious sedation with combined hypnotic agents and deep sedation with etomidate is a safe and effective procedure with low perioperative morbidity and low long-term complication rates.
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Affiliation(s)
- A Pacifico
- Texas Arrhythmia Institute, Houston 77030, USA.
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Nasir N, Cedillo-Salazar FR, Doyle TK, Henry PD, Pacifico A. Effect of preexisting epicardial patch electrodes on defibrillation thresholds of unipolar defibrillators. Am J Cardiol 1997; 79:1408-9. [PMID: 9165170 DOI: 10.1016/s0002-9149(97)00152-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The question is addressed whether patients with thoracotomy defibrillators and failing epicardial electrodes can be effectively treated with the implantation of prepectoral unipolar ("active can") defibrillators. Results indicate that abandoned epicardial patches in the pathway of unipolar defibrillation currents do not affect defibrillation thresholds and active can efficacy.
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Affiliation(s)
- N Nasir
- Texas Arrhythmia Institute, Houston 77030, USA
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Abstract
The database of the registry for an implantable cardioverter defibrillator was analyzed to determine the efficacy and safety of antitachycardia pacing for the termination of ventricular tachycardia. In 22,339 episodes treated, termination occurred in 94% and acceleration in only 1.4%.
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Affiliation(s)
- N Nasir
- The Texas Arrhythmia Institute, Houston 77030, USA
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Pacifico A, Wheelan KR, Nasir N, Wells PJ, Doyle TK, Johnson SA, Henry PD. Long-term follow-up of cardioverter-defibrillator implanted under conscious sedation in prepectoral subfascial position. Circulation 1997; 95:946-50. [PMID: 9054755 DOI: 10.1161/01.cir.95.4.946] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Implantable cardioverter-defibrillators (ICDs) with intravenous electrode systems and downsized generators can be implanted by use of operative techniques similar to those employed for the insertion of permanent pacemakers. However, the safety, efficacy, and long-term follow-up of simplified implantation procedures remain to be evaluated. This report is a prospective long-term evaluation of nonselected patients receiving ICDs in the prepectoral subfascial position under conscious sedation. METHODS AND RESULTS Clinical characteristics of the 231 consecutive patients included a mean age of 63 years, a male-to-female ratio of 6.4, a left ventricular ejection fraction of 0.34, a mild-to-moderate heart failure in 91%, coronary artery disease in 84%, and a history of aborted sudden cardiac death or refractory ventricular tachyarrhythmias. Insertion of transvenous leads and prepectoral subfascial ICD implantation were performed in electrophysiology laboratories under local anesthesia and conscious sedation with intravenous midazolam and propofol. Successful implantation in all patients (operation time, 80 +/- 32 minutes, mean +/- SD) irrespective of body size and skin thickness was free of major complications, including need for emergency intubation. After surgery, 1 pocket hematoma, 1 seroma, and 1 pneumothorax required treatment. There was no operative or first-month mortality. During long-term follow-up averaging 453 +/- 296 days, six leads required repositioning, but pocket erosions or infections did not occur. First-year total survival was 97%. CONCLUSIONS Implantation under conscious sedation of ICDs in the prepectoral subfascial position is a safe and effective procedure with low operative and postoperative morbidity and favorable long-term outcome.
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Affiliation(s)
- A Pacifico
- Texas Arrhythmia Institute, Houston 77030, USA
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Zaim S, Zaim B, Rottman J, Mendoza I, Nasir N, Pacifico A. Characterization of spontaneous recurrent ventricular arrhythmias detected by electrogram-storing defibrillators in sudden cardiac death survivors with no inducible ventricular arrhythmias at baseline electrophysiologic testing. Am Heart J 1996; 132:274-9. [PMID: 8701887 DOI: 10.1016/s0002-8703(96)90422-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
This retrospective study characterized the recurring ventricular arrhythmias with an electrogram-storing defibrillator in survivors of sudden cardiac death who had no inducible sustained ventricular arrhythmias at baseline electrophysiologic testing (EPS). The study group was composed of 24 selected patients with documented ventricular fibrillation (VF) without need of revascularization or chronic antiarrhythmic therapy. The EPS protocol usually consisted of three extrastimuli at two drive cycles at two right ventricular sites. Nonischemic cardiomyopathy was the most frequent structural abnormality (n = 11) followed by coronary artery disease (n = 7). The mean ejection fraction was 0.37 +/- 0.13. Cardiac status did not appear to change during a mean follow-up period of 16.4 +/- 12.5 months, and eight (33%) patients received appropriate shocks in that time period. On the basis of intracardiac electrograms, 7 (88%) patients experienced VF and 1 (12%) patient had ventricular tachycardia as the first recurring arrhythmia. Four patients had additional recurrences and all were VF episodes. VF was usually present from the onset of the arrhythmia. In addition, 9 (38%) patients had nonsustained ventricular arrhythmias that were solely VF in 6 (67%). In conclusion, VF of sudden onset was the most frequent recurring sustained ventricular arrhythmia in this group.
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Affiliation(s)
- S Zaim
- Hahnemann University Hospital, Philadelphia, Pa, USA
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Nasir N, Swarna US, Boahene KA, Doyle TK, Pacifico A. Therapy of Sustained Ventricular Arrhythmias With Amiodarone: Prediction of Efficacy With Serial Electrophysiologic Studies. J Cardiovasc Pharmacol Ther 1996; 1:123-132. [PMID: 10684409 DOI: 10.1177/107424849600100206] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [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: 11/15/2022]
Abstract
BACKGROUND: Programmed electrical stimulation early during amiodarone therapy has poor prognostic capabilities; and persistent inducibility has been associated with a favorable outcome in a majority of patients. These observations result from studies that differed significantly in methodology. METHODS AND RESULTS: The authors prospectively enrolled 121 patients in a standardized amiodarone dosing protocol in which amiodarone was the only antiarrhythmic agent. Electrophysiologic testing was done after 2 and 6 weeks to determine noninducibility, predictive value, and the significance of drug-induced prolongation of tachycardia cycle length. The mean age of the patients in the study was 63.2 +/- 11.5 years, and their ejection fraction was 32.8 +/- 11.9%. Coronary artery disease was present in 103 (85%). At 2 weeks 17 patients (14%) were no longer inducible, whereas 104 patients (86%) remained inducible. Patients in these groups were similar in age and ejection fraction. During follow-up evaluation, recurrences (35% vs 24%; P =.44) and sudden death (12% vs 13.5%) were similar in the two groups. Thirty-five of 95 patients (32%) with sustained monomorphic ventricular tachycardia had more than 100 ms prolongation of their cycle length, which was hemodynamically well tolerated (partial response), but 60 did not (nonresponse). Patients with a partial response were older (66.5 vs 61.1 years; P =.02) and had longer QRS durations (143.2 vs 129.4 ms; P =.03). They also had increased recurrences (37% vs 17%; P =.01) and more sudden deaths (23% vs 8%; P =.02). At 6 weeks 11 of 76 patients studied were noninducible. They had a lower recurrence rate than those who remained inducible (8% vs 27%; P =.02) but a similar number of sudden deaths (8% vs 16%; P =.27). Thirty-two patients partially responded, and 31 patients did not respond. During follow-up examination these two groups had a similar number of recurrences (25% vs 29%; P =.76) and sudden deaths (16% vs 16%). CONCLUSIONS: Noninducibility at 2 or 6 weeks of amiodarone therapy did not identify patients at low risk of sudden death. In inducible patients, tachycardia cycle length prolongation, even when well tolerated, was not a marker for favorable outcome. Electrophysiologically guided therapy, therefore, offers little benefit over empiric amiodarone.
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Affiliation(s)
- N Nasir
- The Texas Arrhythmia Institute, Houston, Texas, USA
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Nasir N, Taylor A, Doyle TK, Pacifico A. Evaluation of intravenous lidocaine for the termination of sustained monomorphic ventricular tachycardia in patients with coronary artery disease with or without healed myocardial infarction. Am J Cardiol 1994; 74:1183-6. [PMID: 7977086 DOI: 10.1016/0002-9149(94)90544-4] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Prospective evaluations of intravenous lidocaine as therapy for sustained monomorphic ventricular tachycardia (VT) in the absence of acute myocardial infarction are lacking. Lidocaine has been promulgated as first-line therapy in patients with VT, but studies evaluating its efficacy in the electrophysiology laboratory suggest that it has poor effects in terminating or preventing induction of VT. Thus, this study sought to evaluate the clinical effectiveness of lidocaine in 3 cohorts with induced or spontaneous VT. One hundred twenty-eight patients with stable VT, occurring either spontaneously or induced at the time of electrophysiologic study either in the baseline state or at the time of pharmacologic testing, were evaluated. The response rate to lidocaine therapy as manifested by termination of VT was the primary goal of the study. Of these patients, 10 (8%) had termination of VT after lidocaine therapy. There were no significant differences in age, ejection fraction, VT cycle length, and mean dose of lidocaine between responders and 118 nonresponders. There were no serious side effects or adverse events (death, myocardial infarction, angina, or congestive heart failure). Lidocaine, although safe, is ineffective in terminating stable VT not associated with acute myocardial infarction.
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Affiliation(s)
- N Nasir
- Cardiac Electrophysiology Unit, Methodist Hospital, Houston, Texas 77030
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Abstract
Eosinophilic pulmonary infiltration is an uncommon presentation from cocaine abuse. We present a patient with migratory pulmonary infiltrates and eosinophilia consistent with Löffler's syndrome. Our review uncovered two other similar patients. The importance of early recognition is stressed in our report. Either abstinence from cocaine usage and/or steroids result in resolution of this illness.
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Affiliation(s)
- S Nadeem
- Department of Medicine, St. Mary's Hospital, Rochester, NY
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Nasir N, Doyle TK, Wheeler SH, Pacifico A. Usefulness of Holter monitoring in predicting efficacy of amiodarone therapy for sustained ventricular tachycardia associated with coronary artery disease. Am J Cardiol 1994; 73:554-8. [PMID: 7511872 DOI: 10.1016/0002-9149(94)90332-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The ability of Holter monitoring to predict clinical events during amiodarone therapy was evaluated in 83 patients with coronary artery disease and inducible monomorphic ventricular tachycardia. Sixty-four patients (77%) had significant ventricular ectopy activity (> or = 10 ventricular premature complexes [VPCs]/hour) at baseline, and 19 (23%) did not; patients were similar in age (63 and 65 years, respectively; p = 0.24) and ejection fraction (31 and 32%, respectively; p = 0.75). Over a mean of 23 +/- 17 months, there was no difference in arrhythmia recurrence (33 and 26%; p = 0.89) or sudden death (16 and 20%; p = 0.94) in patients with and without significant ectopy, respectively. In patients with significant ectopy, amiodarone decreased VPC frequency from baseline to 2 weeks, but not from 2 to 6 weeks. Forty-two patients had > 85% reduction in ectopy at 2 weeks; 20 patients did not. However, this reduction of simple VPCs did not predict a decrease in arrhythmic recurrence (29 vs 40%; p = 0.59) nor sudden death (25 vs 11%; p = 0.56) in patients with and without VPC suppression, respectively. Forty-five patients had Holter monitoring at 6 weeks. Twenty-one patients (47%) had > 95% suppression of ectopy, and 24 did not. Neither the recurrence (38 vs 38%; p = 0.54) nor sudden death (33 vs 13%; p = 0.45) rate was predicted by the degree of VPC suppression. Amiodarone is a powerful suppressant of VPCs, but Holter suppression of this ectopic activity is not predictive of clinical outcome.
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Affiliation(s)
- N Nasir
- Cardiac Electrophysiology Unit, Methodist Hospital, Houston, Texas 77030
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Ahmed A, Salahuddin N, Ahsan T, Afsar S, Nasir N, Farooqui S, Chaoudri AN, Akhtar MA, Agha I, Nagi N. Enoxacin in the treatment of typhoid fever. Clin Ther 1992; 14:825-8. [PMID: 1286490] [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: 12/26/2022]
Abstract
Enoxacin 400 mg twice daily was given orally to 40 patients who had Salmonella typhi- or Salmonella paratyphi-positive blood or bone marrow cultures. One patient was switched to parenteral therapy within 48 hours of study enrollment, but the remaining 39 patients were given enoxacin for 10 to 14 days. All 39 patients were cured by enoxacin, even though 23 (58.9%) strains were resistant to cotrimoxazole and 16 (41%) strains were multiply resistant to ampicillin, chloramphenicol, and cotrimoxazole. No adverse events necessitated the interruption of therapy. In this study, enoxacin was well tolerated and efficacious in the treatment of typhoid fever.
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Affiliation(s)
- A Ahmed
- Aga Khan University Hospital, Karachi, Pakistan
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