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Weise M, Bux R, Schlienz T, da Silva N, Weller L, Gronemeyer P, Dobberthien P. Fast track production: Accelerated timeline from vial to bioreactor. CHEM-ING-TECH 2022. [DOI: 10.1002/cite.202255368] [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: 11/07/2022]
Affiliation(s)
- M. Weise
- Boehringer Ingelheim Pharma GmbH & Co. KG Focused Factory Clinical Supply & Transfer Birkendorfer Str. 65 88400 Biberach an der Riß Germany
| | - R. Bux
- Boehringer Ingelheim Pharma GmbH & Co. KG Focused Factory Clinical Supply & Transfer Birkendorfer Str. 65 88400 Biberach an der Riß Germany
| | - T. Schlienz
- Boehringer Ingelheim Pharma GmbH & Co. KG Focused Factory Clinical Supply & Transfer Birkendorfer Str. 65 88400 Biberach an der Riß Germany
| | - N. da Silva
- Boehringer Ingelheim Pharma GmbH & Co. KG Focused Factory Clinical Supply & Transfer Birkendorfer Str. 65 88400 Biberach an der Riß Germany
| | - L. Weller
- Boehringer Ingelheim Pharma GmbH & Co. KG Focused Factory Clinical Supply & Transfer Birkendorfer Str. 65 88400 Biberach an der Riß Germany
| | - P. Gronemeyer
- Boehringer Ingelheim Pharma GmbH & Co. KG Focused Factory Clinical Supply & Transfer Birkendorfer Str. 65 88400 Biberach an der Riß Germany
| | - P. Dobberthien
- Boehringer Ingelheim Pharma GmbH & Co. KG Focused Factory Clinical Supply & Transfer Birkendorfer Str. 65 88400 Biberach an der Riß Germany
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Joubert P, Wishart D, Haince JF, Bach H, Bux R, Tappia P, Ramjiawan B. 912P Metabolomic profiling for the early detection of lung cancer. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.07.1038] [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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Wang Y, Levey AS, Inker LA, Jessani S, Bux R, Samad Z, Yaqub S, Karger AB, Allen JC, Jafar TH. Performance of Serum β2-Microglobulin- and β-Trace Protein-Based Panel Markers and 2021 Creatinine- and Cystatin-Based GFR Estimating Equations in Pakistan. Kidney Med 2022; 4:100444. [PMID: 35402891 PMCID: PMC8988004 DOI: 10.1016/j.xkme.2022.100444] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Yeli Wang
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore.,Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA
| | - Andrew S Levey
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA
| | - Lesley A Inker
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA
| | - Saleem Jessani
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Rasool Bux
- Department of Paediatrics (Division of Women & Child Health), Aga Khan University, Karachi, Pakistan
| | - Zainab Samad
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Sonia Yaqub
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Amy B Karger
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, MN
| | - John C Allen
- Center for Quantitative Medicine, Office of Clinical Sciences, Duke-NUS Medical School, Singapore
| | - Tazeen H Jafar
- Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore.,Department of Medicine, Aga Khan University, Karachi, Pakistan.,Department of Renal Medicine, Singapore General Hospital, Singapore.,Duke Global Health Institute, Duke University, Durham, NC
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Qazi SH, Meerza SSA, Groen RS, Dogar SA, Mirani M, Jamali MK, Khan ZA, Padhani ZA, Bux R, Chahudary IA, Rizvi A, Islam S, Khan S, Ur Rashid RH, Abbas SA, Memon AS, Tabassum S, Dilawar B, Das JK. Assessment of pediatric surgical needs, health-seeking behaviors, and health systems in a rural district of Pakistan. PLOS Glob Public Health 2022; 2:e0000810. [PMID: 36962776 PMCID: PMC10021200 DOI: 10.1371/journal.pgph.0000810] [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] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 12/05/2022] [Indexed: 12/31/2022]
Abstract
Surgical conditions are responsible for up to 15% of total Disability-Adjusted Life Years (DALY) lost globally. Approximately 4.8 billion people have no access to surgical care and this studies aim is to assess the surgical disease burden in children under the age of five years. We used Surgeons OverSeas Assessment of Surgical Need (SOSAS) and Pediatric Personnel, Infrastructure, Procedures, Equipment, and Supplies (PediPIPES) survey tools in Tando Mohammad Khan (TMK). A set of photographs of lesions were also taken for review by experts. All the data was recorded electronically via an android application. The current surgical need was defined as the caregiver's reported surgical problems in their children and the unmet surgical need was defined as a surgical problem for which the respondent did not access care. Descriptive analysis was performed. Information of 6,371 children was collected. The study identified 1,794 children with 3,072 surgical lesions. Categorization of the lesions by the six body regions suggested that head and neck accounted for the greatest number of lesions (55.2%) and the most significant unmet surgical need (16.6%). The chest region had the least unmet surgical need of 5.9%. A large percentage of the lesions were managed at a health care facility, but the treatment essentially consisted of mainly medical management (87%), and surgical treatment was provided for only 11% of lesions. The health facility assessment suggested that trained personnel including surgeons, anesthetic, or trained nurses were only available at one hospital. Basic procedures such as suturing and wound debridement were only performed frequently. This study suggests a high rate of unmet surgical need and a paucity of trained health staff and resources in this rural setting of Pakistan. The government needs to make policies and ensure funding so that proper trained staff and supplies can be ensured at district level.
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Affiliation(s)
- Saqib Hamid Qazi
- Section of Pediatric Surgery, Department of Surgery, Aga Khan University, Karachi, Pakistan
| | | | - Reinou S Groen
- Department of Obstetrics and Gynecology, Alaska Native Medical Center, Anchorage, Alaska
| | - Sohail Asghar Dogar
- Section of Pediatric Surgery, Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Mushtaq Mirani
- Institute for Global Health and Development, Aga Khan University, Karachi, Pakistan
| | - Muhammad Khan Jamali
- Institute for Global Health and Development, Aga Khan University, Karachi, Pakistan
| | - Zahid Ali Khan
- Institute for Global Health and Development, Aga Khan University, Karachi, Pakistan
| | - Zahra Ali Padhani
- Institute for Global Health and Development, Aga Khan University, Karachi, Pakistan
| | - Rasool Bux
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Arjumand Rizvi
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
| | - Saleem Islam
- Department of Pediatric Surgery, University of Florida, Gainesville, Florida, United States of America
| | - Sadaf Khan
- Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Rizwan Haroon Ur Rashid
- Section of Orthopedic Surgery, Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Syed Akbar Abbas
- Section of Head and Neck Surgery, Department of Surgery Aga Khan University, Karachi, Pakistan
| | - Abdul Sami Memon
- Department of Ophthalmology and Visual Sciences, Aga Khan University, Karachi, Pakistan
| | - Sadia Tabassum
- Section of Dermatology, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Bakhtawar Dilawar
- Section of Pediatric Surgery, Department of Surgery, Aga Khan University, Karachi, Pakistan
| | - Jai K Das
- Institute for Global Health and Development, Aga Khan University, Karachi, Pakistan
- Division of Women and Child Health, Aga Khan University Hospital, Karachi, Pakistan
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Wang Y, Levey AS, Inker LA, Jessani S, Bux R, Samad Z, Khan AR, Karger AB, Allen JC, Jafar TH. Performance and Determinants of Serum Creatinine and Cystatin C-Based GFR Estimating Equations in South Asians. Kidney Int Rep 2021; 6:962-975. [PMID: 33912746 PMCID: PMC8071622 DOI: 10.1016/j.ekir.2021.01.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 01/04/2021] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION The creatinine-based Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) estimated glomerular filtration rate (eGFR) equation was calibrated for the general Pakistan population (eGFRcr-PK) to eliminate bias and improve accuracy. Cystatin C-based CKD-EPI equations (eGFRcys and eGFRcr-cys) have not been assessed in this population, and non-GFR determinants of cystatin C are unknown. METHODS We assessed eGFRcys, eGFRcr-cys, and non-GFR determinants of cystatin C in a cross-sectional study of 557 participants (≥40 years of age) from Pakistan. We compared bias (median difference in measured GFR [mGFR] and eGFR), precision (interquartile range [IQR] of differences), accuracy (percentage of eGFR within 30% of mGFR), root mean square error (RMSE), and classification of mGFR <60 ml/min/1.73 m2 (area under the receiver operating characteristic curve [AUC] and net reclassification index [NRI]) among eGFR equations. RESULTS We found that eGFRcys underestimated mGFR (bias, 12.7 ml/min/1.73 m2 [95% confidence interval {CI} 10.7-15.2]). eGFRcr-cys did not improve performance over eGFRcr-PK in precision (P = 0.52), accuracy (P = 0.58), or RMSE (P = 0.49). Results were consistent among subgroups by age, sex, smoking, body mass index (BMI), and eGFR. NRI was 7.31% (95% CI 1.52%-13.1%; P < 0.001) for eGFRcr-cys versus eGFRcr-PK, but AUC was not improved (0.92 [95% CI 0.87-0.96] vs. 0.90 [95% CI 0.86-0.95]; P = 0.056). Non-GFR determinants of higher cystatin C included male sex, smoking, higher BMI and total body fat, and lower lean body mass. CONCLUSION eGFRcys underestimated mGFR in South Asians and eGFRcr-cys did not offer substantial advantage compared with eGFRcr-PK. Future studies are warranted to better understand the large bias in eGFRcys and non-GFR determinants of cystatin C in South Asians.
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Affiliation(s)
- Yeli Wang
- Program in Health Services and Systems Research, Duke–NUS Medical School, Singapore
| | - Andrew S. Levey
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | - Lesley A. Inker
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, Massachusetts, USA
| | - Saleem Jessani
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Rasool Bux
- Department of Pediatrics (Division of Women and Child Health), Aga Khan University, Karachi, Pakistan
| | - Zainab Samad
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Ali Raza Khan
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Amy B. Karger
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, Minnesota, USA
| | - John C. Allen
- Center for Quantitative Medicine, Office of Clinical Sciences, Duke–NUS Medical School, Singapore
| | - Tazeen H. Jafar
- Program in Health Services and Systems Research, Duke–NUS Medical School, Singapore
- Department of Renal Medicine, Singapore General Hospital, Singapore
- Duke Global Health Institute, Duke University, Durham, North Carolina, USA
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Yen K, Bux R. 95. Jahrestagung der Deutschen Gesellschaft für Rechtsmedizin. Rechtsmedizin (Berl) 2016. [DOI: 10.1007/s00194-016-0113-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Jafar TH, Jehan I, Liang F, Barbier S, Islam M, Bux R, Khan AH, Nadkarni N, Poulter N, Chaturvedi N, Ebrahim S. Control of Blood Pressure and Risk Attenuation: Post Trial Follow-Up of Randomized Groups. PLoS One 2015; 10:e0140550. [PMID: 26540210 PMCID: PMC4634976 DOI: 10.1371/journal.pone.0140550] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 09/25/2015] [Indexed: 11/19/2022] Open
Abstract
Background Evidence on long term effectiveness of public health strategies for lowering blood pressure (BP) is scarce. In the Control of Blood Pressure and Risk Attenuation (COBRA) Trial, a 2 x 2 factorial, cluster randomized controlled trial, the combined home health education (HHE) and trained general practitioner (GP) intervention delivered over 2 years was more effective than no intervention (usual care) in lowering systolic BP among adults with hypertension in urban Pakistan. However, it was not clear whether the effect would be sustained after the cessation of intervention. We conducted 7 years follow-up inclusive of 5 years of post intervention period of COBRA trial participants to assess the effectiveness of the interventions on BP during extended follow-up. Methods A total of 1341 individuals 40 years or older with hypertension (systolic BP 140 mm Hg or greater, diastolic BP 90 mm Hg or greater, or already receiving treatment) were followed by trained research staff masked to randomization status. BP was measured thrice with a calibrated automated device (Omron HEM-737 IntelliSense) in the sitting position after 5 minutes of rest. BP measurements were repeated after two weeks. Generalized estimating equations (GEE) were used to analyze the primary outcome of change in systolic BP from baseline to 7- year follow-up. The multivariable model was adjusted for clustering, age at baseline, sex, baseline systolic and diastolic BP, and presence of diabetes. Findings After 7 years of follow-up, systolic BP levels among those randomised to combined HHE plus trained GP intervention were significantly lower (2.1 [4.1–0.1] mm Hg) compared to those randomised to usual care, (P = 0.04). Participants receiving the combined intervention compared to usual care had a greater reduction in LDL-cholesterol (2.7 [4.8 to 0.6] mg/dl. Conclusions The benefit in systolic BP reduction observed in the original cohort assigned to the combined intervention was attenuated but still evident at 7- year follow-up. These findings highlight the potential for scaling-up simple strategies for cardiovascular risk reduction in low- and middle- income countries. Trial Registration ClinicalTrials.gov NCT00327574
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Affiliation(s)
- Tazeen H. Jafar
- Program in Health Services & Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore
- Department of Community Health Science, Aga Khan University, Karachi, Pakistan
- Section of Nephrology, Department of Medicine, Aga Khan University, Karachi, Pakistan
- * E-mail:
| | - Imtiaz Jehan
- Department of Community Health Science, Aga Khan University, Karachi, Pakistan
| | - Feng Liang
- Program in Health Services & Systems Research, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Sylvaine Barbier
- Centre for Quantitative Medicine, Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Muhammad Islam
- Department of Community Health Science, Aga Khan University, Karachi, Pakistan
| | - Rasool Bux
- Department of Community Health Science, Aga Khan University, Karachi, Pakistan
| | - Aamir Hameed Khan
- Section of Cardiology, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Nivedita Nadkarni
- Centre for Quantitative Medicine, Office of Clinical Sciences, Duke-NUS Graduate Medical School, Singapore, Singapore
| | - Neil Poulter
- National Heart & Lung Institute, Imperial College, London, United Kingdom
| | - Nish Chaturvedi
- Institute of Cardiovascular Sciences, University College, London, United Kingdom
| | - Shah Ebrahim
- Department of Non-communicable Disease Epidemiology, London School of Hygiene & Tropical Medicine, London, United Kingdom
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Jessani S, Bux R, Jafar TH. Prevalence, determinants, and management of chronic kidney disease in Karachi, Pakistan - a community based cross-sectional study. BMC Nephrol 2014; 15:90. [PMID: 24927636 PMCID: PMC4065316 DOI: 10.1186/1471-2369-15-90] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [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: 01/31/2014] [Accepted: 06/04/2014] [Indexed: 01/02/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is increasing being recognized as a global public health problem. However, there is dearth of information on the prevalence, determinants, and management of CKD from low- and middle-income countries. The objectives of the study were to determine the 1) prevalence of CKD; 2) socio-demographic and clinical factors associated with CKD; and 3) the existing management of these patients with regards to blood pressure control, and use of antihypertensive medications. METHODS We conducted a cross-sectional study on 2873 participants aged ≥ 40 years in 12 representative communities in Karachi, Pakistan. The primary outcome was clinically significant CKD defined as estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 estimated by CKD-EPI (CKD Epidemiology Collaboration) Pakistan equation (0.686 × CKD-EPI1.059) or urinary albumin to creatinine ratio ≥ 3 mg/mmol (i.e. KDOQI CKD stage G3, A2 or worse). RESULTS The overall prevalence (95% CI) of CKD was 12.5% (11.4 - 13.8%). The factors independently associated with CKD were older age, hypertension, diabetes, elevated systolic blood pressure, raised fasting plasma glucose, raised triglycerides, and history of stroke (p<0.05 for each). About 267 (74.4%, 69.5 - 78.8%) adults with CKD had concomitant hypertension. Of these, 130 (48.7%, 42.6 - 54.9%) were on antihypertensive medications, and less than 20% had their BP controlled to conventional target of ≤ 140/90 mm Hg, and only 16.9% (12.6 - 21.9%) were on blockers of renin-angiotensin system alone or in combination with other drugs. CONCLUSIONS Clinically significant CKD is common among Pakistani adults. The conventional risk factors for CKD and poor control of blood pressure among patients with CKD highlight the need to integrate CKD prevention and management in the primary care infrastructure in Pakistan, and possibly neighbouring countries.
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Affiliation(s)
| | | | - Tazeen H Jafar
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
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Bux R, Bratzke H, Rothschild MA, Lutz FU. Plötzlicher Tod einer 12-Jährigen mit klinisch inapparenter Myokarditis unter psychischer und physischer Belastung. Rechtsmedizin (Berl) 2014. [DOI: 10.1007/s00194-002-0151-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Jessani S, Levey AS, Bux R, Inker LA, Islam M, Chaturvedi N, Mariat C, Schmid CH, Jafar TH. Estimation of GFR in South Asians: a study from the general population in Pakistan. Am J Kidney Dis 2013; 63:49-58. [PMID: 24074822 DOI: 10.1053/j.ajkd.2013.07.023] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2013] [Accepted: 07/25/2013] [Indexed: 02/06/2023]
Abstract
BACKGROUND South Asians are at high risk for chronic kidney disease. However, unlike those in the United States and United Kingdom, laboratories in South Asian countries do not routinely report estimated glomerular filtration rate (eGFR) when serum creatinine is measured. The objectives of the study were to: (1) evaluate the performance of existing GFR estimating equations in South Asians, and (2) modify the existing equations or develop a new equation for use in this population. STUDY DESIGN Cross-sectional population-based study. SETTING & PARTICIPANTS 581 participants 40 years or older were enrolled from 10 randomly selected communities and renal clinics in Karachi. PREDICTORS eGFR, age, sex, serum creatinine level. OUTCOMES Bias (the median difference between measured GFR [mGFR] and eGFR), precision (the IQR of the difference), accuracy (P30; percentage of participants with eGFR within 30% of mGFR), and the root mean squared error reported as cross-validated estimates along with bootstrapped 95% CIs based on 1,000 replications. RESULTS The CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) creatinine equation performed better than the MDRD (Modification of Diet in Renal Disease) Study equation in terms of greater accuracy at P30 (76.1% [95% CI, 72.7%-79.5%] vs 68.0% [95% CI, 64.3%-71.7%]; P < 0.001) and improved precision (IQR, 22.6 [95% CI, 19.9-25.3] vs 28.6 [95% CI, 25.8-31.5] mL/min/1.73 m(2); P < 0.001). However, both equations overestimated mGFR. Applying modification factors for slope and intercept to the CKD-EPI equation to create a CKD-EPI Pakistan equation (such that eGFRCKD-EPI(PK) = 0.686 × eGFRCKD-EPI(1.059)) in order to eliminate bias improved accuracy (P30, 81.6% [95% CI, 78.4%-84.8%]; P < 0.001) comparably to new estimating equations developed using creatinine level and additional variables. LIMITATIONS Lack of external validation data set and few participants with low GFR. CONCLUSIONS The CKD-EPI creatinine equation is more accurate and precise than the MDRD Study equation in estimating GFR in a South Asian population in Karachi. The CKD-EPI Pakistan equation further improves the performance of the CKD-EPI equation in South Asians and could be used for eGFR reporting.
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Affiliation(s)
- Saleem Jessani
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Andrew S Levey
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA
| | - Rasool Bux
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Lesley A Inker
- Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA
| | - Muhammad Islam
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Nish Chaturvedi
- Clinical Epidemiology, National Heart and Lung Institute, Imperial College London, London, United Kingdom
| | - Christophe Mariat
- Service de Néphrologie, Dialyse et Transplantation Rénale, Université de Saint-Etienne, Saint-Etienne, France
| | - Christopher H Schmid
- Center for Evidence Based Medicine and Department of Biostatistics, Brown University, Providence, RI
| | - Tazeen H Jafar
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan; Division of Nephrology, Department of Medicine, Tufts Medical Center, Boston, MA; Section of Nephrology, Department of Medicine, Aga Khan University, Karachi, Pakistan; Health Services & Systems Research, Duke NUS Graduate Medical School, Singapore.
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Jafar TH, Islam M, Bux R, Poulter N, Hatcher J, Chaturvedi N, Ebrahim S, Cosgrove P. Cost-effectiveness of community-based strategies for blood pressure control in a low-income developing country: findings from a cluster-randomized, factorial-controlled trial. Circulation 2011; 124:1615-25. [PMID: 21931077 DOI: 10.1161/circulationaha.111.039990] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [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: 12/15/2022]
Abstract
BACKGROUND Evidence on economically efficient strategies to lower blood pressure (BP) from low- and middle-income countries remains scarce. The Control of Blood Pressure and Risk Attenuation (COBRA) trial randomized 1341 hypertensive subjects in 12 randomly selected communities in Karachi, Pakistan, to 3 intervention programs: (1) combined home health education (HHE) plus trained general practitioner (GP); (2) HHE only; and (3) trained GP only. The comparator was no intervention (or usual care). The reduction in BP was most pronounced in the combined group. The present study examined the cost-effectiveness of these strategies. METHODS AND RESULTS Total costs were assessed at baseline and 2 years to estimate incremental cost-effectiveness ratios based on (1) intervention cost; (2) cost of physician consultation, medications, diagnostics, changes in lifestyle, and productivity loss; and (3) change in systolic BP. Precision of the incremental cost-effectiveness ratio estimates was assessed by 1000 bootstrapping replications. Bayesian probabilistic sensitivity analysis was also performed. The annual costs per participant associated with the combined HHE plus trained GP, HHE alone, and trained GP alone were $3.99, $3.34, and $0.65, respectively. HHE plus trained GP was the most cost-effective intervention, with an incremental cost-effectiveness ratio of $23 (95 confidence interval, 6-99) per mm Hg reduction in systolic BP compared with usual care, and remained so in 97.7 of 1000 bootstrapped replications. CONCLUSIONS The combined intervention of HHE plus trained GP is potentially affordable and more cost-effective for BP control than usual care or either strategy alone in some communities in Pakistan, and possibly other countries in Indochina with similar healthcare infrastructure.
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Affiliation(s)
- Tazeen H Jafar
- Departments of Medicine and Community Health Sciences, Aga Khan University, Stadium Rd, Karachi, Pakistan.
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Jafar TH, Islam M, Jessani S, Bux R, Inker LA, Mariat C, Levey AS. Level and determinants of kidney function in a South Asian population in Pakistan. Am J Kidney Dis 2011; 58:764-72. [PMID: 21840098 DOI: 10.1053/j.ajkd.2011.06.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Accepted: 06/01/2011] [Indexed: 01/21/2023]
Abstract
BACKGROUND People of South Asian origin are at high risk of chronic kidney disease. Some have suggested that the usual level of glomerular filtration rate (GFR) in South Asians may be lower than in populations of European origin. However, measured GFR in a general adult population of South Asian origin has not been studied. DESIGN Cross-sectional observational study. SETTING & PARTICIPANTS 530 patients 40 years or older randomly selected from communities in Karachi, Pakistan, using multistage cluster sampling. Patients with both diabetes and hypertension were excluded. PREDICTOR Age, sex, diabetes, and hypertension. OUTCOME Measured GFR using urinary clearance of inulin. RESULTS Mean age of participants was 49.7 ± 9.5 (standard deviation [SD]) years, 51% were men, 34.9% had hypertension, and 30.5% had diabetes. Mean measured GFR was 94.1 ± 28.6 mL/min/1.73 m(2). GFR was lower by 0.79 ± 0.11 mL/min/1.73 m(2) for each 1-year older age. The 5-year age- and sex-specific mean GFR of the study population generally was within 1 SD of the mean of previously reported values for US adults. Factors independently associated with GFR were younger age (β coefficient, -3.84 [95% CI, -5.46 to -2.21] mL/min/1.73 m(2) per 5 years older), higher serum albumin level (4.58 [95% CI, 0.74-8.42] mL/min/1.73 m(2) per 0.5-g/dL increase), higher fasting plasma glucose level (0.81 [95% CI, 0.44-1.18] mL/min/1.73 m(2) per 10-mg/dL increase), high versus low meat intake (7.81 [95% CI, 1.14-14.48] mL/min/1.73 m(2) for ≥11 vs ≤5 servings/wk), and higher estimated protein intake (1.46 [95% CI, 0.41-2.51] mL/min/1.73 m(2) per 1.0-g/d increase) from urine urea nitrogen. LIMITATIONS Moderate sample size, lack of validation of some items in the dietary assessment for this study population. CONCLUSIONS Mean measured GFR in South Asian adults from the general population in Karachi, Pakistan, is only modestly lower than in European-origin counterparts, with similar age association. This may reflect lower dietary protein intake in South Asians.
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Affiliation(s)
- Tazeen H Jafar
- Clinical Epidemiology Unit, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
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Jafar TH, Islam M, Hatcher J, Hashmi S, Bux R, Khan A, Poulter N, Badruddin S, Chaturvedi N. Community based lifestyle intervention for blood pressure reduction in children and young adults in developing country: cluster randomised controlled trial. BMJ 2010; 340:c2641. [PMID: 20530082 PMCID: PMC2881949 DOI: 10.1136/bmj.c2641] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
OBJECTIVE To assess the effectiveness of a community based lifestyle intervention on blood pressure in children and young adults in a developing country setting. DESIGN Cluster randomised controlled trial. SETTING 12 randomly selected geographical census based clusters in Karachi, Pakistan. PARTICIPANTS 4023 people aged 5-39 years. INTERVENTION Three monthly family based home health education delivered by lay health workers. MAIN OUTCOME MEASURE Change in blood pressure from randomisation to end of follow-up at 2 years. RESULTS Analysed using the intention to treat principle, the change in systolic blood pressure (adjusted for age, sex, and baseline blood pressure) was significant; it increased by 1.5 (95% confidence interval 1.1 to 1.9) mm Hg in the control group and by 0.1 (-0.3 to 0.5) mm Hg in the home health education group (P for difference between groups=0.02). Findings for diastolic blood pressure were similar; the change was 1.5 mm Hg greater in the control group than in the intervention group (P=0.002). CONCLUSIONS Simple, family based home health education delivered by trained lay health workers significantly ameliorated the usual increase in blood pressure with age in children and young adults in the general population of Pakistan, a low income developing country. This strategy is potentially feasible for up-scaling within the existing healthcare systems of Indo-Asia. TRIAL REGISTRATION Clinical trials NCT00327574.
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Affiliation(s)
- Tazeen H Jafar
- Department of Medicine, Aga Khan University, Karachi, Pakistan.
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Jafar TH, Hatcher J, Poulter N, Islam M, Hashmi S, Qadri Z, Bux R, Khan A, Jafary FH, Hameed A, Khan A, Badruddin SH, Chaturvedi N. Community-based interventions to promote blood pressure control in a developing country: a cluster randomized trial. Ann Intern Med 2009; 151:593-601. [PMID: 19884620 DOI: 10.7326/0003-4819-151-9-200911030-00004] [Citation(s) in RCA: 131] [Impact Index Per Article: 8.7] [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: 11/22/2022] Open
Abstract
BACKGROUND Despite convincing evidence that lowering blood pressure decreases cardiovascular morbidity and mortality, the hypertension burden remains high and control rates are poor in developing countries. OBJECTIVE To assess the effectiveness of 2 community-based interventions on blood pressure in hypertensive adults. DESIGN Cluster randomized, 2 x 2 factorial, controlled trial. (ClinicalTrials.gov registration number: NCT00327574) SETTING 12 randomly selected communities in Karachi, Pakistan. PATIENTS 1341 patients 40 years or older with hypertension (systolic blood pressure >or=140 mm Hg, diastolic blood pressure >or=90 mm Hg, or already receiving treatment). MEASUREMENTS Reduction in systolic blood pressure from baseline to end of follow-up at 2 years. INTERVENTION Family-based home health education (HHE) from lay health workers every 3 months and annual training of general practitioners (GPs) in hypertension management. RESULTS The age, sex, and baseline blood pressure-adjusted decrease in systolic blood pressure was significantly greater in the HHE and GP group (10.8 mm Hg [95% CI, 8.9 to 12.8 mm Hg]) than in the GP-only, HHE-only, or no intervention groups (5.8 mm Hg [CI, 3.9 to 7.7 mm Hg] in each; P < 0.001). The interaction between the main effects of GP training and HHE on the primary outcome approached significance (interaction P = 0.004 in intention-to-treat analysis and P = 0.044 in per-protocol analysis). LIMITATIONS Follow-up blood pressure measurements were missing for 22% of patients. No mechanism was detected by which interventions lowered blood pressure. CONCLUSION Family-based HHE delivered by trained lay health workers, coupled with educating GPs on hypertension, can lead to significant blood pressure reductions among patients with hypertension in Pakistan. Both strategies in combination may be feasible for upscaling within the existing health care systems of Indo-Asian countries. PRIMARY FUNDING SOURCE Wellcome Trust.
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Herzog C, Bux R, Krug D, Zangos S, Eichler K, Lehnert T, Ackermann H, Vogl TJ. CT-Dichteverteilungskurven – ein neuer Ansatz zur Differenzierung fortgeschrittener atherosklerotischer Plaques? ROFO-FORTSCHR RONTG 2007. [DOI: 10.1055/s-2007-977079] [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: 10/21/2022]
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Bux R, Stengel PD, Schnabel A. Dermal lesions after post mortem petrol-exposure. Forensic Sci Int 2006; 163:115-8. [PMID: 16376503 DOI: 10.1016/j.forsciint.2005.11.018] [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: 09/30/2005] [Revised: 11/09/2005] [Accepted: 11/16/2005] [Indexed: 10/25/2022]
Abstract
The effect of post mortem contact of the skin with petrol was investigated in 18 corpses with exposure times between 10 min and 24 h. The earliest onset of skin changes was observed within 2 h of exposure. They consisted of swelling and wrinkling with detachment of the upper layers of the skin (positive Nikolski's sign). Histologically the lesions appeared as non-vital acantholyses located in the prickle-cell layer with formation of intra-epidermal bullae. An influence of age and sex could be excluded, the earlier onset of lesions at 22 degrees C than at 4 degrees C was not statistically significant. These findings prove that post mortem petrol exposure may lead to dermal lesions.
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Affiliation(s)
- R Bux
- Centre of Legal Medicine, J.W. Goethe University, Kennedyallee 104, D-60596 Frankfurt am Main, Germany.
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Bux R, Gaus W, Kempken R, Hannapel M, Bisschoph T, Regel J. Neue Wege beim großtechnischen Ernte-Design für die Separation von tierischen Zellkulturen. CHEM-ING-TECH 2006. [DOI: 10.1002/cite.200650468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Bux R, Padosch SA, Ramsthaler F, Schmidt PH. Laryngohyoid fractures after agonal falls: Not always a certain sign of strangulation. Forensic Sci Int 2006; 156:219-22. [PMID: 16024196 DOI: 10.1016/j.forsciint.2005.05.030] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2004] [Revised: 04/01/2005] [Accepted: 05/19/2005] [Indexed: 11/25/2022]
Abstract
Haemorrhagic fractures of the thyroid cartilage and hyoid bone are frequently observed in cases of strangulation and often regarded as evidence for an assault against the neck. In contrast, two cases of laryngohyoid fractures after agonal falls in prone position are presented to draw attention to alternative causes of these injuries with special regard to practical medicolegal casework. A 45-year-old man collapsed at a fairground and died after unsuccessful resuscitation. He showed excoriations at his elbows and right knee, a crush injury at the mentum and his mandibular front teeth were knocked out. The upper parts of the chest and the head showed blue discolouration as a marked sign of congestion due to heart failure. The right coronary artery (RCA) was completely obturated by a 5 cm long post-stenotic thrombus with subsequent myocardial infarction of the lateral part of the left ventricle. Both superior horns of the thyroid cartilage were fractured with surrounding haemorrhage, the skin and muscles of the neck uninjured. In the second case, a 63-year-old woman with a mobility handicap had fallen from a 2m high lifting platform and was found in prone position with her wheelchair on her. Resuscitation efforts were not successful. Autopsy showed signs of blunt external force against head, neck, chest and limbs. Examination of the neck revealed haemorrhage of the right sternocleidomastoid muscle, both superior horns of the thyroid cartilage were fractured, as well as the hyoid bone, with slight haemorrhage of the surrounding soft tissue and mucosa. On the same level, the fifth intervertebral disk was ruptured, without any injury of the spinal cord. These cases demonstrate that laryngohyoid fractures should not be overestimated as unequivocal indication of neck compression and may well be caused by falls, even at ground level.
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Affiliation(s)
- R Bux
- Centre of Legal Medicine, J.W. Goethe-University, Kennedyallee 104, D-60596, Frankfurt am Main, Germany.
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Gurung J, Khan MF, Maataoui A, Herzog C, Bux R, Bratzke H, Ackermann H, Vogl TJ. Multislice CT of the pelvis: dose reduction with regard to image quality using 16-row CT. Eur Radiol 2005; 15:1898-905. [PMID: 15806366 DOI: 10.1007/s00330-005-2720-2] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2004] [Accepted: 02/15/2005] [Indexed: 10/25/2022]
Abstract
To optimize examination protocols of 16-row multi-detector CT (MDCT) of pelvis for dose reduction with regard to image quality. MDCT of pelvis was performed on 12 cadaver specimens with stepwise reduction of tube current from 160 mA (113, 80, 56, 40, 28) to 20 mA at 120 kV. Scan parameters were 16 x 1.5 mm collimation. Reconstructions of axial and coronal images were used for evaluation of cortex, trabeculum, image quality, image noise, acetabulum and iliosacral (ISJ) joints. After data were blinded, evaluation of images was done by three radiologists according to 5-point Likert scale. Accuracy of the observers in sorting films according to dose reduction was determined with kappa coefficient. Mean values of image evaluation were determined. Pronounced deterioration of image quality for all criteria was observed between 80 and 28 mA. Adequate image quality was obtained at 40 mA [effective dose (E): 2.2 mSv, CTDI(w): 2.8 mGy] for criterion detailed definition of acetabulum and ISJ and at 80 mA (E: 4.4 mSv, CTDI(w): 5.6 mGy) for remaining criteria. Moderate agreement was observed between the three observers (kappa coefficient: 0.31). All observers were excellent in arranging images according to decreasing dose. Using 16-row MDCT image quality of pelvis is acceptable at 80 mA and 120 kV. This translates into a dose reduction of 33% of average value of the nationwide survey of the German Roentgen Society (1999) for this type of examination.
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Affiliation(s)
- Jessen Gurung
- Institute for Diagnostic and Interventional Radiology, Johann Wolfgang Goethe University, Theodor-Stern-Kai 7, 60590 Frankfurt am Main, Germany.
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Qidwai W, Mangi AR, Bux R. Life style related risk factors for cardiovascular disease among patients at a teaching hospital in Karachi. J Ayub Med Coll Abbottabad 2005; 17:12-4. [PMID: 16092641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
BACKGROUND Cardiovascular disease is a leading cause for morbidity and mortality all over the world. It is important to study life style related, modifiable cardiovascular risk factors among patients, in order to devise preventive strategies. METHODS We surveyed family practice patients visiting the out-patient clinics of Aga Khan University Hospital, Karachi. The interview was questionnaire-based and recorded the demographic profile of the patients, in addition to information on life style related cardiovascular risk factors. The ethical requirements for the study were met. SPSS computer software was used for data management. RESULTS Fifty patients were surveyed and included 28 (56%) men and 22 (44%) women. Thirty seven (74%) respondents were married, nineteen (38%) had graduate education, twenty five (50%) were in private service, and twelve (24%) were housewives. Twenty six (52%) respondents were overweight or obese. Butter, cream, margarine and red meat was consumed by 17 (34%) and 32 (64%) respondents respectively. White meat, fresh fruits and vegetables were consumed by 30 (60%), 29 (58%) and 38 (76%) respondents respectively. Oil from vegetable sources was used by 49 (98%) respondents. Addition of table salt was found occasionally and always in 18 (36%) and 09 (18%) respondents respectively. Twenty seven (54%) respondents exercised at least twenty minutes, three times a week, while eleven (22%) were current smokers. CONCLUSIONS Life style related modifiable risk factors are prevalent in patients reporting to our hospital. This offers an opportunity for preventive strategies, to prevent cardiovascular disease. Such surveys, followed by interventional strategies, are recommended to be followed by all Primary care facilities.
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Affiliation(s)
- Waris Qidwai
- Family Medicine Department, The Aga Khan University, Karachi, Pakistan.
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Abstract
BACKGROUND This study provides an overview on presymptoms and causes of sport-related death and suggests preventive measures. METHODS 29 436 autopsies of the Centre of Legal Medicine at the University of Frankfurt/Main from 1972 to 2001 were analysed and compared with a control group. RESULTS 96 men (95 %, average age 53.3 years) and 5 women (5 %, average age 36.4 years) were involved in 101 fatalities connected with sports (0.34 % of all autopsies). 78 athletes (77.2 %) died during, 20 (19.8 %) immediately after sport activities. Immediately before death 18 of 50 persons concerned were free of symptoms, twelve complained of nausea and vomiting, seven of vertigo, five of weakness, four of epigastric pain and dyspnoea, three exhibited angina pectoris symptoms. The day before death 7 of 25 athletes had symptoms like angina pectoris, nausea, backache and palpitation. 84 fatalities (83.2 %) were due to coronary heart disease. Seven were due to myocarditis (6.9 %), in four cases (26.7 %) among athletes younger than 36. Among children and adolescents (n = 4) myocarditis, cardiomyopathy and in two cases a valvular defect of the heart were the cause of death. In comparison to controls death in elder athletes due to coronary heart disease and myocardial infarction was high significantly more common and athletes died significantly younger. CONCLUSIONS Further prospective investigations are needed to provide strategies for prevention.
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Affiliation(s)
- R Bux
- Zentrum der Rechtsmedizin, J. W. Goethe-Universität, FFM.
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Gonschorek O, Strecker W, Bux R, Kinzl L, Bühren; V. Early Endotoxemia after Trauma is Influenced by Trauma-Region, Oxygenation and Initial Systemic Blood Pressure. Shock 1994. [DOI: 10.1097/00024382-199409001-00040] [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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Abstract
Vaccines on the basis of mammalian cell cultures are of major importance for human and animal health. Therefore efforts are undertaken for the improved production of more effective vaccines. Of course, the main purpose of all these approaches is to save lives and improve the quality of life for human beings. However, there is also some remarkable effort in the food industry and the associated animal production, especially in the case of some Flaviviridal viruses (BVD), where > 80% of all cattle herds are found to be infected. These viruses can cause tremendous economic losses of calfs and embryos (Ames, 1990). Because of these facts, there is a continuous endeavour for improving the manufacturing of therapeutics or preventing agents such as vaccines for the treatment of cattle. The competitive economic situation and the specific market demands still require effective and high yield production methods, especially in the case of one of the most widespread viral diseases in cattle like BVD (Ames, 1990). We have succeeded in establishing an improved method for the production of BVD on the basis of a continuous fermentation mode, that consist of modifications of the corresponding process and media improvements.
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Affiliation(s)
- W Noe
- Dr. Karl Thomae G.M.B.H., Biberach, Germany
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Strecker W, Gonschorek O, Bux R, Berger D, Kinzl L. [Endotoxin in blood plasma of patients after trauma]. Unfallchirurg 1993; 96:433-7. [PMID: 8378791] [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: 01/30/2023]
Abstract
Depending on the severity of the injury, high endotoxin levels may be found in patients with lung contusion but only slightly increased levels in patients with skull and brain trauma. This difference is highly significant. Patients with multiple injuries and fractures of the extremities as the main diagnosis and with a combination of injuries show a moderate increase in endoxin level on the day of admission. There is no relationship between the injury severity and endotoxemia.
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Affiliation(s)
- W Strecker
- Abteilung für Unfallchirurgie, Universität Ulm
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Abstract
Two cases of penile amputation with the techniques of reanastomosis are presented. Other techniques are briefly reviewed. A microvascular anastomosis of the dorsal vessels or nerves does not appear to be necessary, although gentle thorough reconstruction of the urethra and corpora obviously is.
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