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Hashmi S, Shaheen M, Adil S, Ahmed P, Ahmed S, Ben Abdeljelil N, Alabdulwahab A, Albeihany A, Aldaama S, Al-Khabori M, Alkindi S, Almohareb F, Alsaeed A, Alseraihy A, Alshemari S, Ayas M, Chaudhri N, Da'na W, Dennison D, ElQuessar A, Elhaddad A, Ibrahim A, Hashem H, Jastaniah W, Mawardi H, Nassar A, Satti T, Torjemane L, Tabbara K, El Solh H, Albeirouti B, Aljurf M. Unique aspects of Graft-versus-host-disease management in the Eastern Mediterranean region: Report from the Eastern Mediterranean blood and marrow transplantation group: Special report. Hematol Oncol Stem Cell Ther 2023; 16:303-306. [PMID: 32413418 DOI: 10.1016/j.hemonc.2020.04.003] [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] [Received: 03/18/2020] [Revised: 04/02/2020] [Accepted: 04/10/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
- Shahrukh Hashmi
- Department of Adult Hematology and Stem Cell Transplantation, KFSHRC, Riyadh, Saudi Arabia
- Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Marwan Shaheen
- Department of Adult Hematology and Stem Cell Transplantation, KFSHRC, Riyadh, Saudi Arabia
| | - Salman Adil
- Aga Khan University Hospital, Karachi, Pakistan
| | - Parvez Ahmed
- Quaid-e-Azam International Hospital, Islamabad, Pakistan
| | - Syed Ahmed
- Department of Adult Hematology and Stem Cell Transplantation, KFSHRC, Riyadh, Saudi Arabia
| | | | | | | | - Saad Aldaama
- King Fahad Specialist Hospital, Dammam, Saudi Arabia
| | | | | | - Fahad Almohareb
- Department of Adult Hematology and Stem Cell Transplantation, KFSHRC, Riyadh, Saudi Arabia
| | - Ahmed Alsaeed
- King Abdulaziz Medical City-National Guard Hospital, Jeddah, Saudi Arabia
| | - Amal Alseraihy
- Pediatric Hematology & Oncology, KFSHRC, Riyadh, Saudi Arabia
| | | | - Mouhab Ayas
- Pediatric Hematology & Oncology, KFSHRC, Riyadh, Saudi Arabia
| | - Naeem Chaudhri
- Department of Adult Hematology and Stem Cell Transplantation, KFSHRC, Riyadh, Saudi Arabia
| | | | | | - Asma ElQuessar
- Hematology, pediatric oncology, Ibn Rochd University Hospital, University of Hassan II, Casablanca, Morocco
| | | | - Ahmad Ibrahim
- Makassed Hospital, Lebanese University, Lebanon
- Middle East Hospital, Lebanese University, Lebanon
| | | | - Wasil Jastaniah
- King Abdulaziz Medical City-National Guard Hospital, Jeddah, Saudi Arabia
| | - Hani Mawardi
- King Abdulaziz University, Faculty of Dentistry, Jeddah, Saudi Arabia
| | - Amr Nassar
- Prince Sultan Military Medical Center, Riyadh, Saudi Arabia
| | - Tariq Satti
- National Institute of Blood and Marrow Transplant, Rawalpindi, Pakistan
| | | | | | - Hassan El Solh
- Pediatric Hematology & Oncology, KFSHRC, Riyadh, Saudi Arabia
| | - Bassim Albeirouti
- King Faisal Specialist Hospital & Research Centre, Jeddah, Saudi Arabia
| | - Mahmoud Aljurf
- Department of Adult Hematology and Stem Cell Transplantation, KFSHRC, Riyadh, Saudi Arabia
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Hamadani H, Bihaqi SFA, Salahuddin M, Khan AA, Sheikh IU, Haq Z, Banday MT, Adil S. The Kashmir duck: an important poultry genetic resource of India. WORLD POULTRY SCI J 2023. [DOI: 10.1080/00439339.2023.2175345] [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: 03/22/2023]
Affiliation(s)
- Henna Hamadani
- Division of Livestock Production and Management, Sher-e-Kashmir University of Agricultural Sciences and Technology of Kashmir, Srinagar, India
| | - S. F. A. Bihaqi
- Division of Livestock Production and Management, Sher-e-Kashmir University of Agricultural Sciences and Technology of Kashmir, Srinagar, India
| | - M. Salahuddin
- Division of Livestock Products Technology, Sher-e-Kashmir University of Agricultural Sciences and Technology of Kashmir, Srinagar, India
| | - A. A. Khan
- Division of Livestock Production and Management, Sher-e-Kashmir University of Agricultural Sciences and Technology of Kashmir, Srinagar, India
| | - I. U. Sheikh
- Division of Livestock Production and Management, Sher-e-Kashmir University of Agricultural Sciences and Technology of Kashmir, Srinagar, India
| | - Z. Haq
- Division of Livestock Production and Management, Sher-e-Kashmir University of Agricultural Sciences and Technology of Kashmir, Srinagar, India
| | - M. T. Banday
- Division of Livestock Production and Management, Sher-e-Kashmir University of Agricultural Sciences and Technology of Kashmir, Srinagar, India
| | - S. Adil
- Division of Livestock Production and Management, Sher-e-Kashmir University of Agricultural Sciences and Technology of Kashmir, Srinagar, India
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Maclachlan H, Castelletti S, Bhatia R, Chatrath N, Fyazz S, Marwaha S, Thurdnampetch K, Gilchrist J, Adil S, Chang V, Basu J, Miles C, Sharma S, Papadakis M. Prevalence and outcomes of WPW pattern in the young: a report from a nationwide cardiac screening programme. Eur J Prev Cardiol 2022. [DOI: 10.1093/eurjpc/zwac056.280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Individuals with accessory pathways, also referred as the Wolff-Parkinson-White pattern (WPWp), are usually asymptomatic and fatal arrhythmias may be the first presentation. Risk stratification is recommended, with electrophysiological study (EPS) being the gold standard. Catheter ablation offers a widely available, curative option, and provides incentive for screening, particularly in high-risk populations such as athletes.
Purpose
We sought to assess the prevalence, real-world clinical practice and outcomes of WPWp in young individuals identified through a nationwide cardiac screening programme.
Method
Between 2008 and 2018, 113,209 consecutive individuals (14 to 35 years old, 38% female) underwent cardiac screening with a health questionnaire, 12-lead electrocardiogram (ECG) and cardiology consultation. Individuals with suspected cardiac disease were referred for further investigations as necessary. Clinical outcomes were obtained via an online questionnaire and matched de-identified records from the Office of National Statistics database. Individuals were classified as elite athletes, non-elite athletes and non-athletes.
Results
A total of 214 (0.2%) individuals were referred for secondary evaluation with a suspected WPWp (Figure 1). Clinical outcomes were unavailable for 30 (14%) individuals. Follow-up confirmed an additional 13 individuals with a WPWp who were deemed to have normal investigations at screening, of which 8 (61%) had reported cardiovascular symptoms on their HQ and, in retrospect, 4 (30%) demonstrated subtle WPWp on their ECG. A WPWp was confirmed in 187 individuals (0.2%), of which 149 (80%) individuals were considered non-athletes, 114 (61%) reported cardiovascular symptoms, 116 (62%) underwent risk stratification with an EPS and 95 (43%) underwent catheter ablation. Report of palpitation was significantly greater in non-athletes than athletes (p=0.034). In asymptomatic individuals, those engaging in sports at elite level were more likely to be referred for an EPS (p=0.04). Four adverse cardiac events were reported over a follow up period of 7.4 years (IQR 4.9 to 9.2), including 3 individuals (16 years, 20 years, 40 years) with life-threatening arrhythmic events (LAE) requiring cardioversion, and 1 individual (20 years) with sudden cardiac death. Of these 4 individuals, only 1 with a LAE had undergone risk stratification with EPS.
Conclusions
The incidence of SCD in this young screened population was 0.72 per 1000 person-years. Clinical practice was variable and EPS was not offered to a significant proportion of patients, despite inadequate non-invasive risk stratification. The indication to EPS was driven by the athletic status in the asymptomatic individuals. The WPW syndrome may manifest with subtle ECG changes, posing a diagnostic challenge to interpreting physicians.
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Affiliation(s)
- H Maclachlan
- St George's Healthcare NHS Trust, Cardiology Clinical Academic Group, St. George's, University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - S Castelletti
- Istituto Auxologico Italiano IRCCS, Cardiomyopathy Unit and department of Cardiovascular, Neural and Metabolic Science, MIlan, Italy
| | - R Bhatia
- St George's Healthcare NHS Trust, Cardiology Clinical Academic Group, St. George's, University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - N Chatrath
- St George's Healthcare NHS Trust, Cardiology Clinical Academic Group, St. George's, University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - S Fyazz
- St George's Healthcare NHS Trust, Cardiology Clinical Academic Group, St. George's, University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - S Marwaha
- St George's Healthcare NHS Trust, Cardiology Clinical Academic Group, St. George's, University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - K Thurdnampetch
- St George's Healthcare NHS Trust, Cardiology Clinical Academic Group, St. George's, University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - J Gilchrist
- St George's Healthcare NHS Trust, Cardiology Clinical Academic Group, St. George's, University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - S Adil
- St George's Healthcare NHS Trust, Cardiology Clinical Academic Group, St. George's, University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - V Chang
- St George's Healthcare NHS Trust, Cardiology Clinical Academic Group, St. George's, University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - J Basu
- St George's Healthcare NHS Trust, Cardiology Clinical Academic Group, St. George's, University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - C Miles
- St George's Healthcare NHS Trust, Cardiology Clinical Academic Group, St. George's, University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - S Sharma
- St George's Healthcare NHS Trust, Cardiology Clinical Academic Group, St. George's, University of London, London, United Kingdom of Great Britain & Northern Ireland
| | - M Papadakis
- St George's Healthcare NHS Trust, Cardiology Clinical Academic Group, St. George's, University of London, London, United Kingdom of Great Britain & Northern Ireland
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Hirniak J, Hussein F, Seyedzenouzi G, Adil S, Vaghela M, Liu G, Asif A, Churchill T, Zargaran A. 1695 Undergraduate Cardiothoracic Surgery: Pumping Up Knowledge and Inspiration with High-Fidelity Simulation. Br J Surg 2021. [DOI: 10.1093/bjs/znab259.921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Introduction
Alongside declining ST3 applications, cardiothoracic surgery (CTS) is underrepresented in the medical curriculum with 90% of medical students reporting no exposure to the specialty in medical school placements. This may result in clinicians having difficulties recognising emergency presentations, with subsequent referrals made inappropriately.
Method
A simulation course involving teaching around common CTS conditions and procedures was delivered by CTS trainees to undergraduate medical students (n = 50). This involved both theory and high-fidelity simulations of coronary anastomoses using cardiac surgical equipment on porcine hearts and ureters. Delegates were given pre and post-test questionnaires, and another at six-weeks to test knowledge retention. Results were statistically analysed using paired and independent sample t-tests.
Results
Delegates demonstrated significant improvements in post-test knowledge of 56% (p<0.01), and sustained improvement of 51% (p<0.01) six-weeks later compared to baseline. 64% of delegates reported an increased interest in pursuing CTS as a career; 40% reported improved confidence performing a coronary anastomosis.
Conclusions
Immediate and long-term knowledge retention of key CTS concepts and ability to assess common CTS pathological scenarios were demonstrated in this study. CTS simulation therefore represents an effective mechanism by which key concepts can be taught to undergraduate medical students, whilst enhancing interest in pursuing CTS as a career. As an educational adjunct, simulation can help bridge the gap between taught theory and applied practice, with the potential to empower future doctors to make more informed referrals and management decisions.
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Affiliation(s)
- J Hirniak
- St George’s, University of London, London, United Kingdom
| | - F Hussein
- St George’s, University of London, London, United Kingdom
| | - G Seyedzenouzi
- St George’s, University of London, London, United Kingdom
| | - S Adil
- St George’s, University of London, London, United Kingdom
| | - M Vaghela
- Brighton and Sussex Medical School, Brighton, United Kingdom
| | - G Liu
- Anglia Ruskin University School of Medicine, Essex, United Kingdom
| | - A Asif
- University of Leicester Medical School, Leicester, United Kingdom
| | - T Churchill
- St George’s, University of London, London, United Kingdom
| | - A Zargaran
- St Thomas’ Hospital, London, United Kingdom
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Shaikh SA, Ahmed N, Adil S, Jamali AR. A prospective evaluation of clinical and functional outcome of single bundle anatomic anterior cruciate ligament reconstruction with hamstrings autograft. J PAK MED ASSOC 2021; 70:2476-2480. [PMID: 33475569 DOI: 10.47391/jpma.678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
A case series was conducted at the Department of Orthopaedic surgery, Jinnah Postgraduate Medical Centre, Karachi, from July 2016 to June 2018, to evaluate the functional and clinical outcome of arthroscopic anatomic anterior cruciate ligament (ACL) reconstruction with hamstrings autograft. Patients aged 17 years and above with anterior cruciate ligament (ACL) injuries of duration three months or older, diagnosed on history and clinical examination and confirmed on Magnetic Resonance Imaging were prospectively recruited from outpatient department. Patients with multiligamentous injury were excluded. Information on patient's demographics such as age, duration of injury and mechanism of injury were recorded. In addition, graft length and diameter, associated injuries of lateral or medical menisci were noted peroperatively. Patients were followed for a minimum of 12 months. The functional outcomes were assessed through lysholm knee score, and Tegner activity scale. Clinical outcome was assessed with loss of motion in flexion and extension and residual laxity using Lachman test. Paired sample t-test was applied to compare mean scores pre and post-operatively. The study findings reveal that arthroscopic anatomic Anterior Cruciate Ligament reconstruction using quadruple strand hamstring tendon autograft was an effective method of treatment for the ACL-deficient knee with improved clinical and functional status.
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Affiliation(s)
- Saeed Ahmed Shaikh
- Department of Orthopedics, Jinnah Post Graduate Medical Center, Karachi, Pakistan
| | | | | | - Allah Rakhio Jamali
- Department of Orthopedics, Jinnah Post Graduate Medical Center, Karachi, Pakistan
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Abbasi AM, Adil S, Moiz B. Spontaneous splenic rupture - An uncommon complication of chronic myelomonocytic leukemia. Leuk Res Rep 2020; 14:100205. [PMID: 32551226 PMCID: PMC7287228 DOI: 10.1016/j.lrr.2020.100205] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 04/27/2020] [Accepted: 05/10/2020] [Indexed: 11/29/2022] Open
Affiliation(s)
| | - Salman Adil
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, 75300, Pakistan
| | - Bushra Moiz
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, 75300, Pakistan
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Ali N, Altaf B, Shaikh MU, Adil S. Outcome of Aplastic Anemia Using Combined G-CSF Primed Blood and Bone Marrow Stem Cells – a Retrospective Analysis. Biol Blood Marrow Transplant 2020. [DOI: 10.1016/j.bbmt.2019.12.206] [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: 12/01/2022]
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Shabbir-Moosajee M, Jehangir S, Sawani S, Muhammed T, Ali N, Sheikh U, Adil S. Safety and efficacy of bendamustine in the conditioning regimen for autologous stem cell transplantation in patients with relapsed/refractory lymphoma. Blood Res 2019; 54:108-113. [PMID: 31309088 PMCID: PMC6614092 DOI: 10.5045/br.2019.54.2.108] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2018] [Revised: 12/18/2018] [Accepted: 12/26/2018] [Indexed: 11/17/2022] Open
Abstract
Background Bendamustine is an attractive option for the management of both de novo and relapsed lymphomas. It is being increasingly used in the conditioning regimen for autologous stem cell transplantation (SCT) and can be an alternative to the traditionally-used carmustine. In this study, we aimed to determine the safety and efficacy of bendamustine in the conditioning regimen for autologous SCT in refractory/relapsed lymphomas. Methods We designed a descriptive study to evaluate bendamustine in combination with etoposide, cytarabine, and melphalan (BeEAM) in the conditioning regimen for autologous SCT. Results Fourteen patients (median age, 28 yr) with Hodgkin's lymphoma (HL) (N=8), non-Hodgkin's lymphomas (NHL) (N=5), or peripheral T-cell lymphoma, not otherwise specified (PTCL NOS) (N=1) were included in the study. A median number of 5.95×106 CD34+ cells/kg were transfused. Median times to absolute neutrophil count and platelet engraftment were 17 days and 24 days, respectively. The 100-day transplantation mortality rate was 28% (4 patients). Eight patients (57.14%) had GII-III acute kidney injury, four patients (28.5%) had GIII-IV hyperbilirubinemia, and twelve patients (85%) had GII-III diarrhea. After 3 months, 37% (5 patients) and 21.4% (3 patients) demonstrated complete response and partial response, respectively. The median follow-up was 5.5 months (15 days–19 mo). At the final follow-up, 7 patients (50%) were alive and in CR. Conclusion Our study showed that bendamustine is a potentially toxic agent in the conditioning regimen for autologous SCT, resulting in significant liver, kidney, and gastrointestinal toxicity. Further studies are required to assess its safety and efficacy at reduced doses.
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Affiliation(s)
- Munira Shabbir-Moosajee
- Hematology/Oncology and Bone Marrow Transplantation, Aga Khan University Hospital, Karachi, Pakistan
| | - Samad Jehangir
- Department of Oncology, Aga Khan University Hospital, Karachi, Pakistan
| | - Sobiya Sawani
- Department of Community Health Sciences, Aga Khan University Hospital, Karachi, Pakistan
| | - Tariq Muhammed
- Department of Oncology, Aga Khan University Hospital, Karachi, Pakistan
| | - Natasha Ali
- Hematology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Usman Sheikh
- Hematology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Salman Adil
- Hematology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
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Magray SN, Wani SA, Kashoo ZA, Bhat MA, Adil S, Farooq S, Rather MA, Kabli ZA, Banday MT, Nishikawa Y. Serological diversity, molecular characterisation and antimicrobial sensitivity of avian pathogenic Escherichia coli (APEC) isolates from broiler chickens in Kashmir, India. Anim Prod Sci 2019. [DOI: 10.1071/an17065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The present study has determined the serological diversity, virulence-gene profile and in vitro antibiogram of avian pathogenic Escherichia coli (APEC) isolates from broiler chickens in India suspected to have died of colibacillosis. The virulence-gene profile of APEC was compared with that of the Escherichia coli isolates from faeces of apparently healthy chickens, called avian faecal E. coli (AFEC). In total, 90 representative isolates of APEC and 63 isolates of AFEC were investigated in the present study. The APEC were typed into 19 serogroups, while some isolates were rough and could not be typed. Most prevalent serogroup was O2 (24.44%). Among the eight virulence genes studied, the prevalence of seven genes (iss, iucD, tsh, cva/cvi, irp2, papC and vat) was significantly higher in APEC than in AFEC isolates. However, there was no significant difference between APEC and AFEC isolates for possession of astA gene. The most frequent gene detected among the two groups of organisms was iss, which was present in 98.88% and 44.44% of APEC and AFEC isolates respectively. The in vitro antibiogram showed that the majority (96.6%) of APEC isolates were resistant to tetracycline, while 82.2% were resistant to cephalexin, 78.8% to cotrimoxazole, 68.8% to streptomycin and 63.3% to ampicillin. However, most of them (84.45%) were sensitive to gentamicin. Thus, it is concluded that APEC from the broiler chickens carried putative virulence genes that attributed to their pathogenicity. Furthermore, the majority of APEC isolates were found to be multi-drug resistant, which, in addition to leading treatment failures in poultry, poses a public health threat.
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Zahid N, Ahmed R, Adil S, Ather H. An unusual presentation of diffuse large B-cell lymphoma with ureteric involvement: A case report. IJU Case Rep 2019; 2:5-8. [PMID: 32743360 PMCID: PMC7292142 DOI: 10.1002/iju5.12024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 10/02/2018] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Non-Hodgkin's lymphomas are a heterogeneous group of malignancies in the lymphoid system and ureteric involvement by non-Hodgkin's lymphoma is very rare. CASE PRESENTATION We present a 37-year-old male, presenting with lower urinary tract symptoms and right flank pain. Initially, he presented with lower urinary tract symptoms without having any evidence of urinary tract infection and was managed for nonspecific cystitis. His ureteral histopathology report indicated a diffused infiltration by malignant lymphoid cells and the final diagnosis revealed diffuse large B-cell lymphoma. His positron-emission tomography scan indicated stage 4 disease with skeletal involvement and he was then treated by rituximab, cyclophosphamide, liposomal doxorubicin, vincristine, and methylprednisolone chemotherapy. Later, he was also diagnosed with central nervous system lymphoma and died during his stay in the hospital. CONCLUSION Primary diffuse large B-cell lymphoma of the ureter is extremely rare; however, it should be considered in the differential diagnosis for patients presenting with obstructive uropathy as its early detection is crucial for diagnostic and therapeutic treatment.
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Affiliation(s)
- Nida Zahid
- Department of SurgeryAga Khan UniversityKarachiPakistan
| | - Rashida Ahmed
- Department of Pathology and Laboratory MedicineAga Khan UniversityKarachiPakistan
| | - Salman Adil
- Department of Pathology and Laboratory MedicineAga Khan UniversityKarachiPakistan
| | - Hammad Ather
- Department of SurgeryAga Khan UniversityKarachiPakistan
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Baldomero H, Aljurf M, Zaidi SZA, Hashmi SK, Ghavamzadeh A, Elhaddad A, Hamladji RM, Ahmed P, Torjemane L, Abboud M, Tbakhi A, Khabori MA, El Quessar A, Bazuaye N, Bekadja MA, Adil S, Fahmy O, Ramzi M, Ibrahim A, Alseraihy A, Ben Abdejalil N, Sarhan M, Huneini MA, Mahmal L, ElSolh H, Hussain F, Nassar A, Al-Hashmi H, Hamidieh AA, Pasquini M, Kodera Y, Kröger N, Mohty M, Jaimovich G, Rolon JM, Paulson K, Greinix H, Weisdorf D, Horowitz M, Nunez J, Gratwohl A, Passweg J, Koh M, Szer J, Niederwieser D, Novitzky N. Narrowing the gap for hematopoietic stem cell transplantation in the East-Mediterranean/African region: comparison with global HSCT indications and trends. Bone Marrow Transplant 2018; 54:402-417. [PMID: 30082852 DOI: 10.1038/s41409-018-0275-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Revised: 03/31/2018] [Accepted: 04/03/2018] [Indexed: 11/09/2022]
Abstract
Hematopoietic Stem Cell Transplantation (HSCT) activity was evaluated in the African (AFR)/EMRO region and compared to the global activity for the years 2006-2013. Data were obtained from 1570 teams in the 6 WHO continental regions. Of these, 29 (1.85%) of all teams were active in 12 of the 68 AFR/EMRO countries. They reported 2.331 (3.3%) of the worldwide 71.036 HSCT, and a transplant rate of 32.8 (TR; HSCT/10 million inhabitants; worldwide 128.5). This reflects still the lowest regional TR despite an increase of 90% since 2006. HSCT activity in AFR/EMRO countries was characterized by a higher use of allogeneic compared to autologous HSCT, an almost exclusive use of family donors, including haploidentical family donors. These findings contrast with the prevalence of autologous over allogeneic HSCT, and a higher frequency of unrelated HSCT in other parts of the world. Of note, the increase by 200% in HSCT for hemoglobinopathies from 2006 to 2013 (72 per year) in the AFR/EMRO region. This reflects the specific role of HSCT for these disease categories with high prevalence and incidence in the AFR/EMRO region. This report provides information for the competent authorities to foster adequate infrastructure. It urges transplant organization to optimize their cooperation.
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Affiliation(s)
- Helen Baldomero
- Department of Medicine, WBMT Global Survey Office, Hematology, University Hospital, Basel, Switzerland
| | - Mahmoud Aljurf
- Department of Hematology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Syed Z A Zaidi
- Department of Adult Hematology and BMT, Comprehensive Cancer Center, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Shahrukh K Hashmi
- Department of Hematology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Ardeshir Ghavamzadeh
- Tehran University of Medical Sciences, Hematology, Oncology and SCT Research Center, Tehran, Iran
| | - Alaa Elhaddad
- National Cancer Institute, Cairo University, Cairo, Egypt
| | | | - Parvez Ahmed
- Armed Forces Institute of Transplantation, Rawalpindi, Pakistan
| | - Lamia Torjemane
- Center National de Greffe de Moelle Osseuse de Tunis, Tunis, Tunisia
| | - Miguel Abboud
- American University Beirut Medical Center, Beirut, Lebanon
| | | | | | | | - Nosa Bazuaye
- University of Benin Teaching Hospital, Benin, Nigeria
| | | | - Salman Adil
- Aga Khan University Hospital, Karachi, Pakistan
| | - Omar Fahmy
- Nasser Institute, Cairo University, Cairo, Egypt
| | - Mani Ramzi
- Shiraz University of Medical Sciences, Shiraz, Iran
| | | | - Amal Alseraihy
- Department of Hematology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | | | | | | | | | - Hassan ElSolh
- Department of Hematology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Fazal Hussain
- Department of Hematology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Amr Nassar
- National Cancer Institute, Cairo University, Cairo, Egypt
| | | | - Amir Ali Hamidieh
- Tehran University of Medical Sciences, Hematology, Oncology and SCT Research Center, Tehran, Iran
| | - Marcelo Pasquini
- Center for International Blood and Marrow Transplant Research (CIBMTR), Milwaukee, WI, USA
| | - Yoshihisa Kodera
- Asia-Pacific Blood and Marrow Transplantation Group, Aichi Medical University, Nagakute, Japan
| | - Nicolaus Kröger
- Department of Stem Cell Transplantation, University Hospital, Hamburg, Germany
| | - Mohamed Mohty
- The European Blood and Marrow Transplant Group (EBMT), Hôpital Saint-Antoine, Paris, France
| | | | | | - Kristjan Paulson
- Faculty of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Hildegard Greinix
- Division of Hematology, Medical University of Graz, LKH-Univ. Klinikum Graz, Graz, Austria
| | | | - Mary Horowitz
- King Fahad Specialist Hospital, Damman, Saudi Arabia
| | | | - Alois Gratwohl
- Department of Medicine, WBMT Global Survey Office, Hematology, University Hospital, Basel, Switzerland
| | - Jacob Passweg
- Department of Medicine, WBMT Global Survey Office, Hematology, University Hospital, Basel, Switzerland
| | - Mickey Koh
- St George's Hospital and Medical School, London, UK
| | - Jeff Szer
- Clinical Haematology, Royal Melbourne Hospital, Melbourne, VIC, Australia
| | - Dietger Niederwieser
- Department of Hematology and Medical Oncology, University Hospital, Leipzig, Germany.
| | - Nicolas Novitzky
- African Blood and Marrow Transplantation Society, Bern, South Africa
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Hashmi SK, Srivastava A, Rasheed W, Adil S, Wu T, Jagasia M, Nassar A, Hwang WY, Hamidieh AA, Greinix HT, Pasquini MC, Apperley JF, Aljurf M. Cost and quality issues in establishing hematopoietic cell transplant program in developing countries. Hematol Oncol Stem Cell Ther 2017; 10:167-172. [DOI: 10.1016/j.hemonc.2017.05.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2017] [Accepted: 05/16/2017] [Indexed: 01/10/2023] Open
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Akram S, Adil S, El Majed N, Toor S, Al Mazrouei K, Al Zaabi A, Saleem I. P128 Prevalence and risk factors for bronchiectasis in adult patients-A single center experience from United Arab Emirates. Chest 2017. [DOI: 10.1016/j.chest.2017.04.028] [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: 11/26/2022] Open
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Shakeel I, Khan AA, Qureshi S, Mir MS, Adil S, Wani B. Effect of post-hatch delay in feeding on performance and blood biochemistry of chabro chicken. Appl Biol Res 2017. [DOI: 10.5958/0974-4517.2017.00007.6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Manzoor A, Patoo R, Khaliq T, Nazir T, Adil S, Mehraj M, Najar M. Effect of body condition-score on serum biochemical profile and body morphometry in crossbred dairy cattle. Appl Biol Res 2017. [DOI: 10.5958/0974-4517.2017.00014.3] [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: 10/19/2022]
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Hussein AA, Hamidieh AA, Elhaddad A, Ramzi M, Othman TB, Hussain F, Dennison D, Ahmed P, Abboud M, Al-Ahmari A, Wahadneh A, Fathy J, Bekadja MA, Al-Kindi S, Benchekroun S, Ibrahim A, Behfar M, Samra M, Ladeb S, Adil S, El-Solh H, Ayas M, Aljurf M, Ghavamzadeh A, Al-Seraihy A. First report of pediatric hematopoietic stem cell transplantation activities in the eastern mediterranean region from 1984 to 2011: on behalf of the pediatric cancer working committee of the eastern mediterranean blood and marrow transplantation group. Bone Marrow Transplant 2016; 52:120-125. [PMID: 27618684 DOI: 10.1038/bmt.2016.209] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Revised: 07/02/2016] [Accepted: 07/11/2016] [Indexed: 12/18/2022]
Abstract
To describe the hematopoietic stem cell transplantation (HSCT) activities for children in the Eastern Mediterranean (EM) region, data on transplants performed for children less than 18 years of age between 1984 and 2011 in eight EM countries (Egypt, Iran, Jordan, Lebanon, Oman, Pakistan, Saudi Arabia and Tunisia) were collected. A total of 5187 transplants were performed, of which 4513 (87%) were allogeneic and 674 (13%) were autologous. Overall, the indications for transplantation were malignant diseases in 1736 (38.5%) and non-malignant in 2777 (61.5%) patients. A myeloablative conditioning regimen was used in 88% of the allografts. Bone marrow (BM) was the most frequent source of stem cells (56.2%), although an increasing use of PBSC was observed in the last decade. The stem cell source of autologous HSCT has shifted over time from BM to PBSC, and 80.9% of autologous HSCTs were from PBSCs. The donors for allogeneic transplants were matched-related in 94.5% of the cases, and unrelated transplants, mainly cord blood (99%) in 239 (5.5%) cases. This is the first report to describe the pediatric HSCT activities in EM countries. Non-malignant disorders are the main indication for allogeneic transplantation. Frequency of alternate donor transplantation is low.
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Affiliation(s)
- A A Hussein
- Bone Marrow and Stem Cell Transplantation Program, King Hussein Cancer Center, Amman, Jordan
| | - A A Hamidieh
- Hematology, Oncology and SCT Research Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - A Elhaddad
- National Cancer Institute, Cairo University, Cairo, Egypt
| | - M Ramzi
- Shiraz University of Medical Science, Shiraz, Islamic Republic of Iran
| | - T B Othman
- Center National de Greffe de Moelle Osseuse de Tunis, Tunis, Tunisia
| | - F Hussain
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - D Dennison
- Sultan Qaboos University Hospital, Muscat, Oman
| | - P Ahmed
- Armed Forces Bone Marrow Transplant Center, Rawalpindi, Pakistan
| | - M Abboud
- American University Beirut Medical Center, Beirut, Lebanon
| | - A Al-Ahmari
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - A Wahadneh
- Queen Rania Al-Abdullah Children Hospital-King Hussein Medical Center, Amman, Jordan
| | - J Fathy
- National Cancer Institute, Cairo University, Cairo, Egypt
| | - M-A Bekadja
- Oran University-1st November Hospital, Oran, Algeria
| | - S Al-Kindi
- Sultan Qaboos University Hospital, Muscat, Oman
| | - S Benchekroun
- Service d'Hematologie et Oncologie Pediatrique, Casablanca, Morocco
| | - A Ibrahim
- Makassed General Hospital, Beirut, Lebanon
| | - M Behfar
- Hematology, Oncology and SCT Research Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - M Samra
- National Cancer Institute, Cairo University, Cairo, Egypt
| | - S Ladeb
- Center National de Greffe de Moelle Osseuse de Tunis, Tunis, Tunisia
| | - S Adil
- Aga Khan University Hospital, Karachi, Pakistan
| | - H El-Solh
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - M Ayas
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - M Aljurf
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
| | - A Ghavamzadeh
- Hematology, Oncology and SCT Research Center, Tehran University of Medical Sciences, Tehran, Islamic Republic of Iran
| | - A Al-Seraihy
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Ali N, Shaikh MU, Adil S. An Analysis of Blood Utilization for Stem Cell Transplant Patients in a Tertiary Care Hospital. Biol Blood Marrow Transplant 2016. [DOI: 10.1016/j.bbmt.2015.11.737] [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: 10/22/2022]
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Rashid A, Khurshid M, Shaikh U, Adil S. Chromosomal abnormalities in primary myelodysplastic syndrome. J Coll Physicians Surg Pak 2016; 24:632-5. [PMID: 25233965 DOI: 09.2014/jcpsp.632635] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 05/05/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To determine the frequency of cytogenetic abnormalities in patients diagnosed as primary myelodysplastic syndrome (MDS) using conventional karyotyping. STUDY DESIGN Case series. PLACE AND DURATION OF STUDY The Clinical Laboratory, The Aga Khan University Hospital, Karachi, between January 2006 - June 2012. METHODOLOGY Patients of all ages and either gender who fulfilled WHO criteria for MDS were included. Cytogenetic analysis was conducted at the time of diagnosis. Patients who had secondary MDS were excluded from analysis. Chromosome identification and karyotype description was done according to the International System for Chromosome Nomenclature (ISCN, 1995) and described as frequency percentage. RESULTS Out of the 122 cases of MDS, 71 patients had their karyotype done at the time of diagnosis, including 42 males (59.2%) and 29 females (40.8%) with median age of 60 years. Forty one (57.7%) showed normal karyotype and 30 (42.3%) showed clonal karyotypic abnormalities at diagnosis. Out of which 14 (19.7%) had single, 11 (15.5%) had complex and 6 (8.5%) had double cytogenetic abnormalities. The common abnormalities found were: trisomy 8 in 7 cases (9.9%), -7/del (7q) in 3 cases (4.2%), -Y and complex 5q in 2 cases (2.8%) each, complex trisomy 8, del 11q , inversion 9, trisomy 19 and del 20q were found in 1 case (1.4%) each. Other abnormalities were found in 11 cases (15.5%). CONCLUSION Trisomy 8 was the most common disorder/abnormality found in this study population followed by the complex cytogenetics.
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Affiliation(s)
- Anila Rashid
- Department of Pathology and Microbiology, The Aga Khan University Hospital, Karachi
| | - Mohammad Khurshid
- Department of Oncology and Haematology, The Aga Khan University Hospital, Karachi
| | - Usman Shaikh
- Department of Pathology and Microbiology, The Aga Khan University Hospital, Karachi
| | - Salman Adil
- Department of Pathology and Microbiology, The Aga Khan University Hospital, Karachi
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Shakeel I, Khan AA, Qureshi S, Adil S, Wani BM, Din MM, Amin U. Stress Levels, Mortality, Intestinal Morphometry and Histomorphology of Chabro Broiler Birds Subjected to Varying Degrees of Post Hatch Delay in Feeding. Pak J Biol Sci 2016; 19:331-337. [PMID: 29023019 DOI: 10.3923/pjbs.2016.331.337] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND AND OBJECTIVE Kashmir is a part of Jammu and Kashmir State of India where a large chunk of day old chicks are procured from outside the state and these chicks are transported across a distance of hundreds of kilometers over a period of several days. The long distance transport without any access to feed not only subjects the birds to early life stress but also affects their gut morphological development. Therefore, a study was conducted to evaluate the effect of delayed feeding on stress levels, mortality, intestinal morphometry and histomorphology of chabro broiler chicken. MATERIALS AND METHODS A total of 400 day old chabro chicks were randomly divided into 5 groups, each group comprising of four replicates of 20 birds. Chicks allotted to group-1 (G 1) were offered feed at hatchery itself whereas feeding in groups G 2, G 3, G 4 and G 5 were initiated at the farm after the delay of 12, 24, 48 and 72 h, respectively. RESULTS The results revealed that the heterophil count showed a steady increase from G 1-G 5 and significantly (p<0.05) higher count was found in G 3, G 4 and G 5 compared to G 1. However, the lymphocyte count showed a steady decrease as delay in feeding increased. H:L ratio followed a regular increase from G 1-G 5 and was significantly (p<0.05) higher in G 3, G 4 and G 5 compared to G 1. An overall mortality of 13% was recorded during the trial and all of it occurred during first 2 weeks. The highest overall mortality of 22.50±3.23% was recorded in group G 5 followed by 17.50±6.61% in G 4. The villus height of duodenum and jejunum was significantly (p<0.05) higher in G 2, G 3, G 4 and G 5 as compared to G 1. Crypt depth and muscular is thickness of duodenum was significantly (p>0.05) lower in G 4 and G 5 compared to G 1. CONCLUSION The duration of post hatch feeding delay gradually increased the stress level and mortality of birds and also decreased the length of different segments of small intestine in birds. No adverse effect on histomorphology was observed at the end of trial. Feeding at hatchery itself or feeding during transportation of birds would be a viable strategy to overcome the negative effects of delayed feeding in chicken.
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Affiliation(s)
- Irfan Shakeel
- Centre for Research on Poultry, Division of Livestock Production and Management, Faculty of Veterinary Sciences and Animal Husbandry, Shuhama, SKUAST-K, Kashmir, India
| | - Azmat Alam Khan
- Centre for Research on Poultry, Division of Livestock Production and Management, Faculty of Veterinary Sciences and Animal Husbandry, Shuhama, SKUAST-K, Kashmir, India
| | - Saim Qureshi
- Centre for Research on Poultry, Division of Livestock Production and Management, Faculty of Veterinary Sciences and Animal Husbandry, Shuhama, SKUAST-K, Kashmir, India
| | - S Adil
- Centre for Research on Poultry, Division of Livestock Production and Management, Faculty of Veterinary Sciences and Animal Husbandry, Shuhama, SKUAST-K, Kashmir, India
| | - B M Wani
- Division of Veterinary Pathology, Faculty of Veterinary Sciences and Animal Husbandry, Shuhama, SKUAST-K, Kashmir, India
| | - Mir Mehraj Din
- Faculty of Veterinary Sciences and Animal Husbandry, Shuhama, SKUAST-K, Kashmir, India
| | - Umer Amin
- Division of Veterinary Pathology, Faculty of Veterinary Sciences and Animal Husbandry, Shuhama, SKUAST-K, Kashmir, India
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Qureshi S, Banday M, Shakeel I, Adil S, Khan A. Effect of Raw and Enzyme-Treated Dandelion Leaves and Fenugreek Seed Supplemented Diet on Gut Microflora of Broiler Chicken. Appl Biol Res 2016. [DOI: 10.5958/0974-4517.2016.00012.4] [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: 10/21/2022]
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Yang CFJ, Meyerhoff R, Anderson K, Adil S, Hartwig M, Harpole D, D'Amico T, Berry M. F-092IMPACT OF PATIENT SELECTION AND TREATMENT STRATEGIES ON OUTCOMES AFTER LOBECTOMY FOR BIOPSY-PROVEN STAGE IIIA pN2 NON-SMALL CELL LUNG CANCER. Interact Cardiovasc Thorac Surg 2015. [DOI: 10.1093/icvts/ivv204.92] [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: 11/13/2022] Open
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Madi D, Adil S. Platlet transfusion in dengue fever: use or misuse? Int J Infect Dis 2014. [DOI: 10.1016/j.ijid.2014.03.1331] [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: 10/25/2022] Open
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Moiz B, Moatter T, Shaikh U, Adil S, Ali N, Mahar F, Shamsuddin N, Khurshid M. Estimating window period blood donations for human immunodeficiency virus Type 1, hepatitis C virus, and hepatitis B virus by nucleic acid amplification testing in Southern Pakistan. Transfusion 2014; 54:1652-9. [PMID: 24383918 DOI: 10.1111/trf.12521] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2013] [Revised: 10/18/2013] [Accepted: 10/19/2013] [Indexed: 12/15/2022]
Abstract
BACKGROUND Recently, strategic planning was initiated by the National Blood Transfusion Services Pakistan to improve its blood bank facilities. Emphasis has been placed on appropriate screening of blood products. Located in the southern region, Aga Khan University Hospital is a 700-bed tertiary care academic institute with comprehensive blood banking. Screening of blood donors has been based on verbal screening and serologic testing to date. Additionally, the need of implementing nucleic acid testing (NAT) was considered in 2011 because of an upsurge in hepatitis epidemiology. The aim of this study was to analyze the efficacy of this additional donor screening program and to evaluate the impact of NAT on the yield and residual risk of transfusion-transmissible viral infections. STUDY DESIGN AND METHODS A total of 42,830 blood donations collected between 2011 and 2012 were screened for routine serologic assays. Only serologically negative donors (n=41,304) were tested for NAT. The frequency of viral infections was evaluated through serologic techniques and NAT yield for viral agents was estimated for computing window period donors. Residual risk per million donors was computed for viral infections in seronegative blood donors. RESULTS Serologic work-up showed 1571 abnormal screening results in 1526 blood donors with the following results: hepatitis C virus antibodies (anti-HCV; n=708), hepatitis B surface antigen (n=555), human immunodeficiency virus antibodies (anti-HIV; n=29), malaria (n=30), VDRL (n=249), and coinfection (n=45). Thirty-five NAT-reactive samples were identified: HIV-1, one; HCV, 27; and hepatitis B virus (HBV), seven. Incident rates per 10(5) donors were highest for HCV (453.3) followed by HBV (171.5) and HIV (72.2). Calculated residual risk per million donors was highest at 1 in 10,900 for HBV, intermediate at 1 in 13,900 for HCV, and least at 1 in 62,600 for HIV. CONCLUSION Incidence rates and estimated residual risk indicate that the current risk of transfusion-transmitted viral infections attributable to blood donation is relatively high in this country. The study recommends the parallel use of both serology and NAT screening of donated blood in countries that have high seroprevalence of these viral infections.
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Affiliation(s)
- Bushra Moiz
- Section of Molecular Pathology, Department of Pathology and Microbiology, The Aga Khan University Hospital, Karachi, Pakistan
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Ali N, Moiz B, Silat H, Rehan A, Adil S. Improved outcome of myeloma related bone pain with oral analgesics and bisphosphonate therapy: A single-center experience from Pakistan. Progress in Palliative Care 2013. [DOI: 10.1179/1743291x13y.0000000070] [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: 10/31/2022]
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Abstract
The association between epidermolysis bullosa (EB) and pyloric atresia (PA) is rare but well documented. Herein, we report a case of EB associated with congenital PA. A female baby, weighing 1480 g, was born vaginally to a 31-year-old gravida 7 lady at 33 weeks of gestation. Polyhydramnios was detected on antenatal assessment. The parents were non-consanguineous Saudis with no family history of significant illness. At birth, well-demarcated areas of peeled skin were present over knees, left leg and periumbilical region. Systemic examination revealed no other abnormality. On second day, the patient developed recurrent vomiting and abdominal distension. An abdominal X-ray revealed a single gastric gas bubble suggesting pyloric obstruction. Following gastroduodenostomy, the baby developed severe sepsis with multiorgan dysfunction and expired on 25th day of life. Skin biopsy showed cleavage within lamina lucida.
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Ahmed SOA, Ghavamzadeh A, Zaidi SZ, Baldomero H, Pasquini MC, Hussain F, Alimoghaddam K, Almohareb F, Ayas M, Hamidieh A, Mahmoud HK, Elhaddad A, Ben Othman T, Abdelkefi A, Sarhan M, Abdel-Rahman F, Adil S, Alkindi S, Bazarbachi A, Benchekroun S, Niederwieser D, Horowitz M, Gratwohl A, El Solh H, Aljurf M. Trends of hematopoietic stem cell transplantation in the Eastern Mediterranean region, 1984-2007. Biol Blood Marrow Transplant 2011; 17:1352-61. [PMID: 21440654 PMCID: PMC3371191 DOI: 10.1016/j.bbmt.2011.01.019] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2010] [Accepted: 01/14/2011] [Indexed: 12/01/2022]
Abstract
Hematopoietic stem cell transplantation (HSCT) activity was surveyed in the 9 countries in the World Health Organization Eastern Mediterranean region that reported transplantation activity. Between the years of 1984 and 2007, 7933 transplantations were performed. The number of HSCTs per year has continued to increase, with a plateau in allogeneic HSCT (allo-HSCT) between 2005 and 2007. Overall, a greater proportion of transplantations were allo-HSCT (n = 5761, 77%) compared with autologous HSCT (ASCT) (n = 2172, 23%). Of 5761 allo-HSCT, acute leukemia constituted the main indication (n = 2124, 37%). There was a significant proportion of allo-HSCT for bone marrow failures (n = 1001, 17%) and hemoglobinopathies (n = 885, 15%). The rate of unrelated donor transplantations remained low, with only 2 matched unrelated donor allo-HSCTs reported. One hundred umbilical cord blood transplantations were reported (0.017% of allo-HSCT). Peripheral blood stem cells were the main source of graft in allo-HSCT, and peripheral blood stem cells increasingly constitute the main source of hematopoietic stem cells overall. Reduced-intensity conditioning was utilized in 5.7% of allografts over the surveyed period. ASCT numbers continue to increase. There has been a shift in the indication for ASCT from acute leukemia to lymphoproliferative disorders (45%), followed by myeloma (26%). The survey reflects transplantation activity according to the unique health settings of this region. Notable differences in transplantation practices as reported to the European Group for Blood and Marrow Transplantation over recent years are highlighted.
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Affiliation(s)
- Syed O A Ahmed
- King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia
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Wali R, Fadoo Z, Adil S, Naqvi MA. Aplastic anemia: clinicohaematological features, treatment and outcome analysis. J Coll Physicians Surg Pak 2011; 21:219-22. [PMID: 21453618 DOI: 04.2011/jcpsp.219222] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Accepted: 02/26/2011] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To determine the clinicohaematological features, treatment and outcome of children diagnosed with aplastic anemia at a single institution. STUDY DESIGN Observational study. PLACE AND DURATION OF STUDY The Aga Khan University Hospital, Karachi, from January 1999 till December 2008. METHODOLOGY Medical records of children aged less than 15 years of age diagnosed with aplastic anemia were reviewed. Clinicohaematological features, treatment and its response to therapy and outcome were recorded. Results were described in percentages. RESULTS Ninety patients were diagnosed to have aplastic anemia (AA); 65 were male during the study period. Age ranged from 1 to 15 years. Fever in 65 patients (72.2%), pallor in 53 (58.8%), skin bleeding in 49 (54.4%) and epistaxis in 31(34.4%) were the most common and frequent presenting features. Congenital (Fanconi's) anemia was found in 15 (16.6%) and acquired idiopathic in 75 (83.4%) of patients. Very severe aplastic anemia (VSAA) was seen in 29 (32.2%), 26 (28.9%) had severe AA and 17 (18.9%) had moderate AA. Eight patients (8.9%) underwent haematopoietic stem cell transplantation (HSCT), 12 (13.3%) received immunosuppressive therapy (IST) and 70 patients (77.7%) received other and supportive therapy. Five (62.5%) patients showed complete response to HSCT and 3 (37.5%) failed to engraft. IST showed complete response in 3 (25%), partial response in 5 (41.6%) and no response in 4 (33.3%). Twenty two patients (24.4%) expired either due to infection in 16 (72.7%, fungal in 6, bacterial in 10) and intracranial haemorrhage in 6 (27.3%) cases. CONCLUSION Majority of cases with AA were acquired and idiopathic in etiology. VSAA and SAA were frequent. Response to HSCT and IST was sub-optimal.
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Affiliation(s)
- Rabia Wali
- Department of Paediatrics and Child Health, The Aga Khan University Hospital, Karachi.
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Shaikh AJ, Bawany SA, Masood N, Khan AA, Abbasi AN, Niamutullah SN, Zaidi A, Adil S, Kumar S. Incidence and impact of baseline electrolyte abnormalities in patients admitted with chemotherapy induced febrile neutropenia. J Cancer 2011; 2:62-6. [PMID: 21326626 PMCID: PMC3039222 DOI: 10.7150/jca.2.62] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2010] [Accepted: 01/06/2011] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Febrile neutropenia (FN) and myelosupression remain a challenging oncologic medical emergency and dose limiting toxicity associated with chemotherapy for cancers. Various factors are known to affect the outcomes for patients diagnosed with FN. Electrolyte abnormalities have commonly been observed, but the real incidence and their impact has been only scarcely studied in literature. METHODS This was a prospective, observational study. A total of two hundred and fifteen (215) patients admitted between January 2007 and August 2008 were included. Analysis of data was made using SPSS version16.0.Toxicity profile was graded according to CTC version 3.0. RESULTS Almost equal number of FN was observed in both solid tumors and hematological cancers with almost equal gender distribution. Of all 83.5% patients demonstrated some electrolyte abnormalities. All grades combined, hypokalemia was seen in 48% of patients, with 51.4% having grade I, 33.3% grade III and 15.2% G IV (life threatening) hypokalemia. Hyponatremia of all grades was seen in 67.9% patients, of them 60.3% had Grade I, 33.3% grade III and 0.7% patients had grade IV hyponatremia. Hypomagnesaemia (70 patients assessed) was seen in 54.3% patient, 94.7% having grade I decline. Average length of stay for patients who received IV electrolyte replacement was 6.3 days compared to 4.9 days in those who did not. Out of 90 patients who required special care unit 75 had electrolyte abnormalities, of 15 patients who expired 13 had electrolyte abnormalities CONCLUSION This analysis, which is first of its kind, suggests that decline in electrolyte levels is frequently observed in patients presenting with FN. These abnormalities can have independent negative impact on the outcome for such patients. Special attention should be paid to electrolyte imbalance right from the outset.
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Affiliation(s)
- Asim Jamal Shaikh
- 1. Department of medicine, Section of Hematology and Oncology, The Aga Khan University Hospital, Karachi, Pakistan
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Sajid R, Siddiqui SH, Shaikh U, Adil S. Clinicopathologic spectrum of Waldenström's macroglobulinemia: a single center experience. INDIAN J PATHOL MICR 2010; 53:490-3. [PMID: 20699509 DOI: 10.4103/0377-4929.68288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Waldenström's Macroglobulinemia (WM) is a B cell neoplasm characterized by infiltration of the bone marrow by a lymphoplasmacytic infiltrate and an IgM monoclonal gammopathy. We report a 15-year review of patients diagnosed with WM at our center. A total of 18 patients were diagnosed and treated at our center during the study period. Neurological symptoms were seen in almost 95% while B symptoms were present in almost 80% of patients. More than two-thirds of patients were anemic at the time of presentation and more than 90% showed bone marrow infiltration with lymphoplasmacytoid cells. Anemia, B symptoms, splenomegaly and neurological symptoms were the primary reasons in the majority of patients to initiate treatment. Chlorambucil was the primary treatment in more than half the patients followed by CVP. The median overall survival in all patients was 29 months (range 22-81 months). WM is a rare disorder and novel therapeutic modalities need to be identified to improve survival in these patients.
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Affiliation(s)
- Raihan Sajid
- Section of Hematology, Department of Pathology and Microbiology, The Aga Khan University, Stadium Road, Karachi 748 00, Pakistan
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Sajid R, Ghani F, Adil S, Khurshid M. Oral iron chelation therapy with deferiprone in patients with Thalassemia Major. J PAK MED ASSOC 2009; 59:388-390. [PMID: 19534375] [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: 05/27/2023]
Abstract
OBJECTIVE To determine the efficacy and adverse effects of deferiprone in patients with Thalassemia Major. METHODS A prospective case series study was conducted at the Fatimid Foundation Blood Bank and Haematological Diseases center Lahore. A total of 87 patients entered into the study between September 2005 and November 2006. Deferiprone was given at subsidized rates at a dose of 75/mg/day for seven days. Physical examination and initial Laboratory investigations were done in all patients at the start of the study. Physical and laboratory data were filled on a questionnaire and analyzed using SPSS version 10.0. RESULTS Eighty seven patients with mean age of 10.0 +/- 4.33 years (range 4-27 years) were included in the study. Mean follow up was 8 +/- 3.94 months (range 2-12 months). The mean Ferritin at the start of study was 4656 +/- 2052.5 ug/L (range 1200-14630 ug/L) and at the end of study period was 4139 +/- 1710.4 ug/L (range 749-8961) (p < 0.001). Adverse events were joint pains in 10% patients, gastrointestinal symptoms in 11% and no adverse events in 79% patients. There was no evidence of agranulocytosis in any patient. CONCLUSION Deferiprone was well tolerated, had few adverse effects and was effective in lowering the patient's serum ferritin level.
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Affiliation(s)
- Raihan Sajid
- Department of Pathology and Microbiology, The Aga Khan University, Stadium Road, Karachi, Pakistan
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Lal A, Kumar P, Bhurgri Y, Rizvi N, Shaikh AJ, Adil S, Masood N, Virwani M. Factors influencing in-hospital length of stay and mortality in cancer patients suffering from febrile neutropenia. J Clin Oncol 2009. [DOI: 10.1200/jco.2009.27.15_suppl.e20716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
e20716 Background: Febrile neutropenia (FN) is a major complication of chemotherapy, costly in terms of morbidity, mortality and associated financial expenditure. The present study was conducted with the goal of highlighting FN as a serious problem in Pakistan, with the longer term objective of improved cancer survival, reduction in length of stay (LOS) in hospital, morbidity, mortality and costs in our existing developing country scenario. Methods: A cross-sectional descriptive study was conducted on patients, >18 years, admitted with FN as a consequence of chemotherapy at a referral hospital in Karachi from 1st September 2006 to 30th April 2007. Results: A total of 80 patients [43 (53.8%) males and 37 (46.2%) females] were selected. The mean age was 47.4 (SD ±16.6; range 18–79) years. Sixty eight patients (86%) were < 65 years, 50% were < 50 years. Overall, in hospital mortality was 11%; 4% for patients on granulocyte colony stimulating factor (G-CSF) prophylaxis as against 20% for those without. The cause of death was either pneumonia or septic shock. Mean LOS was 7.53 (SD ±3.8; range 2–17) days. Hematological malignancies, older age, severity of dehydration, pneumonia and culture positivity were significantly associated with LOS and death. Those above 50 years of age were 1.5 times as likely to be hospitalized longer and > three times as likely to die. Bacteremia conferred a 5-fold and pneumonia an 8-fold increase in the risk of death. Conclusions: The results of this study indicate that age, vital instability, dehydration, high creatinine, culture positivity and hematological malignancies are high risk factors in chemotherapy induced FN. Identification of FN risk factors with poor outcomes may help in devising protocols for modified dosage or including GCFs initially. This may help reduce the cost of cancer care as well as mortality and morbidity. Prospective studies of FN in multiple centers in Pakistan may be beneficial in evaluating these risk factors further. No significant financial relationships to disclose.
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Affiliation(s)
- A. Lal
- Aga Khan University Hospital, Karachi, Pakistan; Y Bhurgri, N Rizvi,P Kumar, Asim J Shaikh, S Adil, N Masood; New Mexico Cancer Center, Albuquerque, NM
| | - P. Kumar
- Aga Khan University Hospital, Karachi, Pakistan; Y Bhurgri, N Rizvi,P Kumar, Asim J Shaikh, S Adil, N Masood; New Mexico Cancer Center, Albuquerque, NM
| | - Y. Bhurgri
- Aga Khan University Hospital, Karachi, Pakistan; Y Bhurgri, N Rizvi,P Kumar, Asim J Shaikh, S Adil, N Masood; New Mexico Cancer Center, Albuquerque, NM
| | - N. Rizvi
- Aga Khan University Hospital, Karachi, Pakistan; Y Bhurgri, N Rizvi,P Kumar, Asim J Shaikh, S Adil, N Masood; New Mexico Cancer Center, Albuquerque, NM
| | - A. J. Shaikh
- Aga Khan University Hospital, Karachi, Pakistan; Y Bhurgri, N Rizvi,P Kumar, Asim J Shaikh, S Adil, N Masood; New Mexico Cancer Center, Albuquerque, NM
| | - S. Adil
- Aga Khan University Hospital, Karachi, Pakistan; Y Bhurgri, N Rizvi,P Kumar, Asim J Shaikh, S Adil, N Masood; New Mexico Cancer Center, Albuquerque, NM
| | - N. Masood
- Aga Khan University Hospital, Karachi, Pakistan; Y Bhurgri, N Rizvi,P Kumar, Asim J Shaikh, S Adil, N Masood; New Mexico Cancer Center, Albuquerque, NM
| | - M. Virwani
- Aga Khan University Hospital, Karachi, Pakistan; Y Bhurgri, N Rizvi,P Kumar, Asim J Shaikh, S Adil, N Masood; New Mexico Cancer Center, Albuquerque, NM
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Kamal A, Adil S, Tamboli J, Siddardha B, Murthy U. Synthesis of Coumarin linked Naphthalimide Conjugates as Potential Anticancer and Antimicrobial Agents. LETT DRUG DES DISCOV 2009. [DOI: 10.2174/157018009787847855] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Ali N, Moiz B, Shaikh U, Adil S, Rizvi B, Rahman Y. Diagnostic tool for Glanzmann's thrombasthenia clinicopathologic spectrum. J Coll Physicians Surg Pak 2008; 18:91-4. [PMID: 18454893 DOI: 02.2008/jcpsp.9194] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 04/05/2007] [Accepted: 12/12/2007] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To platelet aggregometry and describe the clinical spectrum of Glanzmann's thrombasthenia diagnosed by platelet aggregometry. STUDY DESIGN A case-series. PLACE AND DURATION OF STUDY This study was carried out at the clinical laboratories at the Aga Khan University Hospital, Karachi from January 2003 to January 2006. PATIENTS AND METHODS All patients irrespective of age and gender presenting with bleeding symptoms and having normal platelet count were evaluated. Demographic details, relevant clinical history along with results of complete blood count, bleeding time and platelet aggregation studies were retrieved through computerized data base and evaluated for the diagnosis of Glanzmann's thrombasthenia. RESULTS During the study period, 50 out of 2317 patients (2.2%) were diagnosed as Glanzmann's thrombasthenia by platelet aggregometry with male to female ratio of 0.85:1 and median age of 10.2 years (ranging from 3 months to 27 years). Common symptoms were epistaxis, oral and gingival bleed, bleeding from minor cuts and trauma that were observed in 46% of the patients; while 18%, 8% and 10% of them also complained of bruising, hematuria and bleeding per rectum respectively. Majority i.e. 86% had a bleeding time greater than 10 minutes. All patients had received blood or blood products for their bleeding episodes. CONCLUSION Platelet aggregometry is a useful diagnostic modality for the assessment of Glanzmann's thrombasthenia. The disorder presents with muco-cutaneous bleeding and was found to be a common cause of bleeding in our setup.
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Affiliation(s)
- Natasha Ali
- Department of Pathology and Microbiology, Aga Khan University Hospital, Stadium Road, Karachi
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Lal A, Bhurgri Y, Vaziri I, Rizvi NB, Sadaf A, Sartajuddin S, Islam M, Kumar P, Adil S, Kakepoto GN, Masood N, Khurshed M, Alidina A. Extranodal non-Hodgkin's lymphomas--a retrospective review of clinico-pathologic features and outcomes in comparison with nodal non-Hodgkin's lymphomas. Asian Pac J Cancer Prev 2008; 9:453-458. [PMID: 19004134] [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: 05/27/2023] Open
Abstract
OBJECTIVE The primary objective of this study was to analyze the anatomic distribution, clinical features and outcome of Diffuse large B-cell lymphoma (DLBCL) patients according to the primary site (extranodal vs. nodal) with applicability of International Prognostic Index (IPI). METHODOLOGY A retrospective review (1988 to 2004) of 557 cases of DLBC. RESULTS The median age was 48.7 +/- 15.3 years; M:F ratio was 2:1. The distribution according to the primary site was: lymph node (N-NHL), 322 cases (58%) of which 145(44%) were stage IV, 76(23%) stage III, 60 (18%) stage II and 47 (15%) stage I. The extra nodal sites (EN-NHL) 235 (42%) cases included gastro-intestinal tract (44%), upper aerodigestive tract (19%), bones (8%), spine (5%), and unusual sites less than 3% each as breast, CNS, testis, lungs and skin. The median survival rate was 4.8 years and 6.3 years in N-NHL and EN-NHL respectively. In the latter this varied greatly depending on the primary site and stage of disease at presentation. In the univariate analysis factors associated with good prognosis were: age less than 60 years, early stage (I-II), extranodal involvement primarily gastric or bone, 0-1 extranodal site, 0-1 performance status, lack of B symptoms and normal LDH level. In the multivariate analysis age, performance status, stage of disease and level of LDH were the main variables predicting overall survival; no nodal or extranodal site maintained their prognostic value. CONCLUSION Patients with EN-NHL present more frequently with early stage disease then those with N-NHL; overall survival in both groups largely depended on IPI and not on the site of origin of the malignancy.
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MESH Headings
- Adult
- Analysis of Variance
- Biopsy, Needle
- Cohort Studies
- Confidence Intervals
- Disease-Free Survival
- Female
- Humans
- Immunohistochemistry
- Kaplan-Meier Estimate
- Lymph Nodes/pathology
- Lymphoma, Extranodal NK-T-Cell/mortality
- Lymphoma, Extranodal NK-T-Cell/pathology
- Lymphoma, Extranodal NK-T-Cell/therapy
- Lymphoma, Large B-Cell, Diffuse/mortality
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/therapy
- Lymphoma, Non-Hodgkin/mortality
- Lymphoma, Non-Hodgkin/pathology
- Lymphoma, Non-Hodgkin/therapy
- Male
- Middle Aged
- Neoplasm Invasiveness/pathology
- Odds Ratio
- Pakistan
- Probability
- Prognosis
- Proportional Hazards Models
- Retrospective Studies
- Risk Assessment
- Survival Analysis
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Affiliation(s)
- Amar Lal
- Division of Medical Oncology and Hematology, Aga Khan University, Karachi, Pakistan
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Irfan S, Idrees F, Mehraj V, Habib F, Adil S, Hasan R. Emergence of Carbapenem resistant Gram negative and vancomycin resistant Gram positive organisms in bacteremic isolates of febrile neutropenic patients: a descriptive study. BMC Infect Dis 2008; 8:80. [PMID: 18541017 PMCID: PMC2442601 DOI: 10.1186/1471-2334-8-80] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2008] [Accepted: 06/09/2008] [Indexed: 11/10/2022] Open
Abstract
Background This study was conducted to evaluate drug resistance amongst bacteremic isolates of febrile neutropenic patients with particular emphasis on emergence of carbapenem resistant Gram negative bacteria and vancomycin resistant Enterococcus species. Methods A descriptive study was performed by reviewing the blood culture reports from febrile neutropenic patients during the two study periods i.e., 1999–00 and 2001–06. Blood cultures were performed using BACTEC 9240 automated system. Isolates were identified and antibiotic sensitivities were done using standard microbiological procedures. Results Seven twenty six febrile neutropenic patients were admitted during the study period. A total of 5840 blood cultures were received, off these 1048 (18%) were culture positive. Amongst these, 557 (53%) grew Gram positive bacteria, 442 (42%) grew Gram negative bacteria, 43 (4%) fungi and 6 (1%) anaerobes. Sixty (5.7%) out of 1048 positive blood cultures were polymicrobial. In the Gram negative bacteria, Enterobacteriaceae was the predominant group; E. coli was the most frequently isolated organism in both study periods. Amongst non- Enterobacteriaceae group, Pseudomonas aeruginosa was the commonest organism isolated during first study period followed by Acinetobacter spp. However, during the second period Acinetobacter species was the most frequent pathogen. Enterobacteriaceae group showed higher statistically significant resistance in the second study period against ceftriaxone, quinolone and piperacillin/tazobactam, whilst no resistance observed against imipenem/meropenem. The susceptibility pattern of Acinetobacter species shifted from sensitive to highly resistant one with significant p values against ceftriaxone, quinolone, piperacillin/tazobactam and imipenem/meropenem. Amongst Gram positive bacteria, MRSA isolation rate remained static, vancomycin resistant Enterococcus species emerged in second study period while no Staphylococcus species resistant to vancomycin was noted. Conclusion This rising trend of highly resistant organisms stresses the increasing importance of continuous surveillance system and stewardship of antibiotics as strategies in the overall management of patients with febrile neutropenia.
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Affiliation(s)
- Seema Irfan
- Department of Pathology & Microbiology, The Aga Khan University, Karachi, Pakistan.
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Kamal A, Adil S, Tamboli J, Siddardha B, Murthy U. Synthesis and Anticancer Activity of Phthalimido and Naphthalimido Substituted Dihydropyrimidone Conjugates. LETT DRUG DES DISCOV 2008. [DOI: 10.2174/157018008784619933] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Lal A, Bhurgri Y, Rizvi N, Virwani M, Memon RU, Saeed W, Sardar MR, Kumar P, Shaikh AJ, Adil S, Masood N, Khurshed M. Factors influencing in-hospital length of stay and mortality in cancer patients suffering from febrile neutropenia. Asian Pac J Cancer Prev 2008; 9:303-308. [PMID: 18712980] [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: 05/26/2023] Open
Abstract
INTRODUCTION Febrile neutropenia (FN) is a major complication of chemotherapy, costly in terms of morbidity, mortality and associated financial expenditure. The present study was conducted with the goal of highlighting FN as a serious problem in Pakistan, with the longer term objective of improved cancer survival, reduction in length of stay (LOS) in hospital, morbidity, mortality and costs in our existing developing country scenario. METHODS A cross-sectional descriptive study was conducted on patients, > or =18 years, admitted with FN as a consequence of chemotherapy at a referral hospital in Karachi from 1st September 2006 to 30th April 2007. RESULTS A total of 80 patients [43 (53.8%) males and 37 (46.2%) females] were selected. The mean age was 47.4 (SD +/-16.6; range 18-79) years. Sixty eight patients (86%) were < or = 65 years, 50% were < or = 50 years. Overall, inhospital mortality was 11%; 4% for patients on granulocyte colony stimulating factor (G-CSF) prophylaxis as against 20% for those without. The cause of death was either pneumonia or septic shock. Mean LOS was 7.53 (SD +/-3.8; range 2-17) days. Hematological malignancies, older age, severity of dehydration, pneumonia and culture positivity were significantly associated with LOS and death. Those above 50 years of age were 1.5 times as likely to be hospitalized longer and > three times as likely to die. Bacteremia conferred a 5-fold and pneumonia an 8-fold increase in the risk of death. CONCLUSION The results of this study indicate that age, vital instability, dehydration, high creatinine, culture positivity and hematological malignancies are high risk factors in chemotherapy induced FN. Identification of FN risk factors with poor outcomes may help in devising protocols for modified dosage or including GCFs initially. This may help reduce the cost of cancer care as well as mortality and morbidity. Prospective studies of FN in multiple centers in Pakistan may be beneficial in evaluating these risk factors further.
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Affiliation(s)
- Amar Lal
- Section of Medical Oncology and Hematology, Department of Medicine, Aga Khan University Hospital, Karachi
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Irfan M, Hashmi K, Adil S, Shamsi T, Farzana T, Ansari S, Panjwani V, Ahmed P, Khan B. Beta-thalassaemia major: bone marrow versus peripheral blood stem cell transplantation. J PAK MED ASSOC 2008; 58:107-110. [PMID: 18517111] [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: 05/26/2023]
Abstract
OBJECTIVE To compare PBSCT with BMT in Thalassaemia patients in terms of rejection, non-rejection mortality, disease free survival and overall survival. METHODS Fifty six patients were transplanted from September 2000 - July 2005. Twenty nine underwent BMT and 27 received PBSCT. Most patients were intensely transfused to keep minimum haemoglobin of 12 gm/dl and received desferioxamine, 24 hours infusion, before transplantation. Pesaro class I (n-20) and class II (n-20) received conditioning with standard Bu/Cy. Of class III (n-16), ALG was added to standard Bu/Cy in 9 who received PBSCT and 7, who received BM, were conditioned with Hydrea 20-30 mg / kg (day - 45 to -11), Azathioprin 2-3 mg / kg (day - 45 to day -11), Fludarabine 25 mg / kg (day -17 to -13) followed by Bu14 / Cy 200 started on day - 10. Triple immunosuppression was used for whole PBSC group and class III-BM group. For others, a GvHD prophylaxis comprised of MTX and cyclosporine only. MNC dose infused was > 4 x 10(8)/kg (range 4.8-8.2) recipient weight in PBSC patients and for BM its range was 1.6 - 5.2 MNC / kg. All patients received G-CSF 5mg / kg / day, from day + 5, till ANC > 0.5 x 109 / I. Median age of the donor was 8.6 years. All recipients and donors were genotypically HLA matched except in one. PBSC were harvested on day 5 of G-CSF administration. Follow up ranged from 273 - 2088 days. RESULTS Median age for BM and PBSC group was 5.2 and 6.9 years. Engraftment was achieved in all cases. Median time to ANC of 0.5 x 10(9)/ I in BMT / PBSCT patients was 13 / 10 days (range 11-19 / 9 - 15) and for platelets of 20 x 10(9) / I it was 17 / 14 days (range 14 - 28 / 12 - 19). aGvHD (grade II - IV) was seen in 30% / 26% cases in BMT / PBSCT group. Incidence and severity of chronic GvHD was not statistically different in two groups (BM-24% & PBSC -30%). Six patients rejected the graft. Of the four who rejected the graft from class III, 3 were from PBSC group. DFS in risk classes of the two groups was not significant. Overall survival / disease free survival for the BM and PBSC group as on December 2005 was 73% / 65% and 67% / 55%. CONCLUSION This study shows that major outcomes with PBSCT are not statistically different from BMT. Rejection and disease free survival in class 3 patients who received intensified immuno-suppression and large doses of PBSC is comparable to BM group who were conditioned according to newer Lucrali protocol.
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Ali S, Adil S, Khurshid M, Shafqat S. Cryptogenic middle cerebral artery infarction in pure red cell aplasia. J Stroke Cerebrovasc Dis 2007; 12:285-7. [PMID: 17903942 DOI: 10.1016/j.jstrokecerebrovasdis.2003.09.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2003] [Revised: 09/05/2003] [Accepted: 09/09/2003] [Indexed: 11/20/2022] Open
Abstract
Pure red cell aplasia (PRCA) is a rare hematological disorder characterized by an isolated depletion of erythroid precursors with preservation of other cell lines. Neurological concomitants are not a recognized feature. We report a case of unexplained middle cerebral artery infarction in a 32-year-old woman with PRCA. This concurrence may reflect a predisposition to ischemic stroke in patients with PRCA.
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Affiliation(s)
- Sajjad Ali
- Section of Neurology, Aga Khan University Medical College, Karachi, Pakistan
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Affiliation(s)
- Bushra Moiz
- Department of Pathology and Microbiology, Blood Bank, Aga Khan University Hospital, Karachi, Pakistan.
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Mansoor S, Siddiqui I, Adil S, Nabi Kakepoto G, Fatmi Z, Ghani F. Anion gap among patients of multiple myeloma and normal individuals. Clin Biochem 2006; 40:226-9. [PMID: 17156769 DOI: 10.1016/j.clinbiochem.2006.10.011] [Citation(s) in RCA: 13] [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] [Received: 06/28/2006] [Revised: 09/29/2006] [Accepted: 10/03/2006] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To compare the Anion gap between patients of multiple myeloma and normal individuals presenting at a tertiary care hospital. DESIGN AND METHODS This is a matched case-control study conducted at Aga Khan University Hospital, Karachi, from July 10, 2004 to April 30, 2006. The anion gap (AG) from the medical records of the 82 diagnosed cases of multiple myeloma (MM) and 104 controls were compared. Immunoglobulins (IgG and IgA) were measured by array nephelometric assay. Staging for MM patients were performed based on Salmon-Durie method. AGs were compared by independent sample t-test. Pearson coefficient of correlation was used to correlate paraprotein IgG concentration and anion gap. RESULTS : Of the 186 study subjects (82 cases and 104 controls), 70% were males and 30% were females. The mean ages of MM and controls were 59.68+/-11.94 and 60+/-9.2 years respectively. There was a significant difference in mean AG, 11.2+/-1.7 mmol/L in control group (p<0.001) compared to 6.8+/-4.6 mmol/L for IgG MM and 8.4+/-4.37 mmol/L for IgA MM patients. Multiple myeloma patients stratified by clinical stages had anion gap of 8.7+/-1.7 in stage I, 7.93+/-0.47 in stage II and 5.65+/-0.31 in stage III. A significant correlation was found in IgG myeloma when anion gap was expressed as a function of the serum monoclonal protein concentration. CONCLUSION The anion gap is significantly lower in multiple myeloma patients compared to controls. Lowered anion gap is more specific feature of the IgG type MM. We suggest that correlation of AG with the disease severity and with paraproteins concentration could potentially be useful in monitoring patients for disease progression. However, longitudinal studies are required to confirm the utility of anion gap in monitoring patients with MM.
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Affiliation(s)
- Shireen Mansoor
- Department of Pathology and Microbiology, The Aga Khan University and Hospital, P.O. Box 3500, Karachi 74800, Pakistan.
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Lal A, Adil S, Masood N. Extranodal NHL- A retrospective review of clinico-pathologic features and outcome and comparison with nodal NHL. Single institution experience years: 1988–2004. J Clin Oncol 2006. [DOI: 10.1200/jco.2006.24.18_suppl.17542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
17542 Background: Non-Hodgkin’s lymphoma (NHL) arising in an extra nodal (EN) site is not uncommon and its natural history and treatment is clearly characterized in the literature. Data on EN-NHL and comparison with N-NHL with relation to survival and prognostic factors is scarce in our part of the world. The primary objective of this study was to analyze the anatomic distribution, clinical features and outcome of DLBCL patients according to the primary site with applicability of International Prognostic Index (IPI). Methods: From 1988 to 2004, 557 patients were analyzed for the clinico-pathologic characteristics, treatment outcome and prognostic factors affecting overall survival. Results: Median age was 48.7 ± 15.3 years ; the M: F ratio was 2:1. The distribution according to the primary site was: lymph node, 322 cases (58%) of these 145 cases (44%) stage IV, 76 cases (23%) Stage III, 60 cases (18%) stage II and 47 cases(15%) stage I ; and EN sites, 235 (42%), including GIT (44%) followed by upper aerodigestive tract (19%), bones (08%), spine (05%), and 3% each as breast, CNS, testis,lungs. The median survival rate was 4.8 and 6.3 years in NL and ENL respectively vary according to primary site/stage of the lymphoma. In the univariate analysis age less than 60 years, early stage I-II, extra nodal involvement primarily gastric or bone, 0–1 extra nodal site, 0–1 PS, lack of B symptoms, normal LDH level has been associated with good prognosis. In the multivariate analysis age, PS, stage and level of LDH were the main variables to predict OS; no nodal or extranodal site maintained their prognostic value. Conclusion: Our data correspond with series from west increasing incidence extranodal lymphoma due to improved diagnostic techniques and superior results with chemotherapy by preserving the organ. Few patients with bowel obstruction or cord compression lymphoma required surgery for diagnosis or relief of symptoms. There is significant difference from western data in histologies DLBC-NHL is the most common histologies in our study. Overall survival patients with EN-NHL were similar to nodal NH-Lymphoma but largely depended on IPI. No significant financial relationships to disclose.
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Affiliation(s)
- A. Lal
- Aga Khan University, Karachi, Pakistan
| | - S. Adil
- Aga Khan University, Karachi, Pakistan
| | - N. Masood
- Aga Khan University, Karachi, Pakistan
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Mansoor S, Siddiqui I, Adil S, Kakapeto GN, Fatmi Z. Frequency of hypercalcemia in patients of multiple myeloma in Karachi. J Coll Physicians Surg Pak 2005; 15:409-12. [PMID: 16197869 DOI: 07.2005/jcpsp.409412] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/29/2004] [Accepted: 04/18/2005] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To determine the frequency of hypercalcemia and skeletal abnormalities in multiple myeloma patients. DESIGN Cross-sectional study. PLACE AND DURATION OF STUDY Study was conducted from January 1999 to July 2004 at the Aga Khan University Hospital (AKUH), a tertiary care hospital in Karachi, Pakistan. PATIENTS AND METHODS Medical records of all the diagnosed cases of multiple myeloma at their presentation to hospital were reviewed. The frequency of hypercalcemia and skeletal lesions was calculated. Independent sample t-test and chi-square test as appropriate, was applied to calculate the difference in parameters between normocalcemic and hypercalcemic patients. RESULTS Sixty-seven percent patients were males and 33% were females. The mean age was 61-/+11 years. Of the 105 study patients, 51.2% had hypercalcemia (S.Ca >2.64 mmol/l). Radiological survey showed different levels of skeletal involvement in 89.8% of patients. It was also found that 94.3% of hypercalcemic patients had skeletal lesions, out of which 20% had advanced (stage 3) bone lesions. Also noteworthy was the fact that 84.6% of normocalcemic patients had mild /moderate (stage 1 and 2) skeletal lesions. CONCLUSION There was higher frequency of hypercalcemia in multiple myeloma patients in this series. Skeletal lesions were present in significant number of these patients. It is suggested that patients with multiple myeloma should be checked for serum corrected calcium and radiological surveys be included in routine workup for early detection and prevention of hypercalcemia and skeletal lesions.
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Affiliation(s)
- Shireen Mansoor
- Department of Pathology and Microbiology, The Aga Khan University Hospital, Karachi.
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Abstract
BACKGROUND AND AIMS The global epidemiology of hepatitis delta virus (HDV) infection is changing. This study was performed to determine the epidemiology and clinical impact of hepatitis delta in Pakistan. METHODS Countrywide data was collected from 1994 to 2001. A total of 8721 patients were tested for hepatitis delta antibody. A subset of 97 hepatitis delta antibody reactive inpatients with chronic liver disease were compared to 97 patients admitted with liver disease due to hepatitis B alone. RESULTS Of the 8721 patients tested, 1444 (16.6%) were reactive for hepatitis delta antibody. Most were males (87.4%, P < 0.001) and younger (mean age 31 years, P < 0.001) compared to HDV non-reactive patients. Prevalence of delta infection was highest in the rural (range 25-60%) compared to the urban population (range 6.5-11%). Analysis of the inpatient data showed that delta infected patients had significantly less severe clinical liver disease and a trend towards lesser development of hepatocellular carcinoma compared to delta negative patients. CONCLUSIONS (i) HDV infection is present in 16.6% of hepatitis B infected patients in Pakistan, most commonly in younger males living in rural areas; and (ii) delta virus infected patients have less severe clinical liver disease compared to delta negative, hepatitis B patients.
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Affiliation(s)
- Khalid Mumtaz
- Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan
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Akhtar S, Younus M, Adil S, Hassan F, Jafri SH. Epidemiologic study of chronic hepatitis B virus infection in male volunteer blood donors in Karachi, Pakistan. BMC Gastroenterol 2005; 5:26. [PMID: 16086833 PMCID: PMC1208878 DOI: 10.1186/1471-230x-5-26] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2005] [Accepted: 08/08/2005] [Indexed: 11/26/2022] Open
Abstract
Background The magnitude of chronic infection with hepatitis B virus (HBV) varies substantially between the countries. A better understanding of incidence and/ or prevalence of HBV infection and associated risk factors provides insight into the transmission of this infection in the community. The purpose of this investigation was to estimate the prevalence of and to identify the risk factors associated with chronic infection with HBV, as assessed by HBV surface antigen (HBsAg) positivity, in asymptomatic volunteer male blood donors in Karachi, Pakistan. Methods Consecutive blood donations made at the two large blood banks between January 1, 1998 and December 31, 2002 were assessed to estimate the prevalence of HBsAg positivity. To evaluate the potential risk factors, a case-control study design was implemented; cases (HBsAg positives) and controls (HBsAg negatives), were recruited between October 15, 2001 and March 15, 2002. A pre-tested structured questionnaire was administered through trained interviewers to collect the data on hypothesized risk factors for HBV infection. Sera were tested for HBsAg using commercially available kits for enzyme linked Immunosorbant assay-III. Results HBsAg prevalence in the male volunteer blood donors was 2.0 % (7048/351309). Multivariate logistic regression analysis showed that after adjusting for age and ethnicity, cases were significantly more likely than controls to have received dental treatment from un-qualified dental care provider (adjusted odds ratio (OR) = 9.8; 95% confidence interval (CI): 2.1, 46.1), have received 1–5 injections (adjusted OR = 3.3; 95% CI: 1.1, 9.6), more than 5 injections (adjusted OR = 1.4; 95% CI: 1.4, 12.7) during the last five years or have received injection through a glass syringe (adjusted OR = 9.4; 95% CI: 2.6, 34.3). Injury resulted in bleeding during shaving from barbers (adjusted OR = 2.3; 95% CI: 1.1, 4.8) was also significant predictor of HBsAg positivity. Conclusion Prevalence of HBsAg positivity in the male volunteer blood donors in Karachi was 2%. Infection control measures in health-care settings including safe injection practices and proper sterilization techniques of medical instruments and education of barbers about the significance of sterilization of their instruments may reduce the burden of HBV infection in this and similar settings. There is also an urgent need of developing locally relevant guidelines for counseling and management of HBsAg positive blood donors.
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Affiliation(s)
- Saeed Akhtar
- Department of Community Medicine and Behavioral Sciences, Faculty of Medicine, Kuwait University PO Box 24923, Safat 13110, Kuwait
- Department of Community Health Sciences, Aga Khan University, Karachi 74800, Pakistan
| | - Muhammad Younus
- Department of Community Health Sciences, Aga Khan University, Karachi 74800, Pakistan
| | - Salman Adil
- Department of Pathology and Microbiology, Aga Khan University, Karachi 74800, Pakistan
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Affiliation(s)
- Saeed Akhtar
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
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