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Shah S, Usman A, Zaki S, Qureshi A, Lal K, Uneeb SN, Bari N, Hasnani FB, Shah N, Iqbal SP, Ullah O, Abid S. The role of family and culture in the disclosure of bad news: A multicentre cross-sectional study in Pakistan. PEC Innov 2023; 3:100200. [PMID: 37674774 PMCID: PMC10477806 DOI: 10.1016/j.pecinn.2023.100200] [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] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/26/2023] [Accepted: 08/20/2023] [Indexed: 09/08/2023]
Abstract
Objectives Disclosure of bad news is distressing for patients and family members. Our aim was to assess patients' perceptions and preferences regarding bad news in the health setting. Methods Cross-sectional, multi-centered study supported by an external grant in 15 Government and Private Hospitals across Pakistan. A sample size of 1673 patients and family members was used. Ethics permission/consent was taken from each participating hospital and participant. Responses were compared across provinces, gender, age, education and income. Results >80% patients preferred their relatives to know the diagnosis first and they wanted the news to be disclosed to them by doctors. Significant association between education level, income and preference for wanting to know the diagnosis was found. Reasons for wanting to know the diagnosis included treatment, prognosis and prevention options whereas reasons for not wanting to know included fear of emotions and God's will. Conclusion The majority of Pakistani patients want to be informed and want the family to know first. Preferences for disclosure vary across, age, education and income level. Innovation First countrywide study on this topic. Identifies need for culturally sensitive guidelines that include the family's role in disclosure of bad news.
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Affiliation(s)
- Sameena Shah
- Department of Family Medicine, North Island Hospital Campbell River and District, Island Health, Campbell River, BC, Canada
- Department of Family Medicine, Aga Khan University, Karachi, Pakistan
| | - Asma Usman
- Department of Family Medicine, Aga Khan University, Karachi, Pakistan
| | - Samar Zaki
- Department of Family Medicine, Aga Khan University, Karachi, Pakistan
| | - Asra Qureshi
- Department of Family Medicine, Aga Khan University, Karachi, Pakistan
| | - Karishma Lal
- Aga Khan University Medical College, Karachi, Pakistan
| | | | | | - Fauzia Basaria Hasnani
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
- School of Nursing and Midwifery, Aga Khan University, Karachi, Pakistan
| | - Nasir Shah
- Department of Family Medicine, University of Health Sciences, Lahore, Pakistan
| | - Saima Parwaiz Iqbal
- Division of Family Medicine, Department of Community Health Sciences, Shifa International, Islamabad, Pakistan
| | - Obaid Ullah
- Pakistan Medical Research Council, Peshawar, Pakistan
| | - Sumera Abid
- Pakistan Medical Research Council, Islamabad, Pakistan
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Saeed S, Kashif U, Zaki S, Samad K, Yousuf MZ, Raza M, Jabbar S, I Khan U. Teaching Clinical Skills Using Online Modality through Modified Peyton's Framework: An Experience from a Medical University in Pakistan. J Adv Med Educ Prof 2023; 11:15-23. [PMID: 36685146 PMCID: PMC9846095 DOI: 10.30476/jamp.2022.95986.1669] [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] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/22/2022] [Indexed: 06/17/2023]
Abstract
INTRODUCTION Medical institutions worldwide faced an unprecedented situation during COVID-19 of identifying alternative strategies to sustain the continuum of learning process. This led to several innovations in the traditional medical curriculum. This study explored the effectiveness and feasibility of using the Peyton's framework modified for a virtual platform (Microsoft Teams) for teaching clinical skills to first and second-year medical students at The Aga Khan University, Karachi, Pakistan. METHODS In 2020-2021, the modified Peyton's framework was integrated in the clinical skills (CS) curriculum for all first- and second-year students (N=200). For evaluation, a mixed-method design was used, with pre-and post-session questionnaires. Students' satisfaction was obtained through the standard session evaluation tool of the university. For the qualitative arm, to explore the instructors' experiences, purposive sampling was used (n=8) and a focused group discussion (FGD) was conducted. Finally, performance of the students at the end of year summative Objective Structured Clinical Examination (OSCE) was compared with the students of previous year. Quantitative data were analysed using STATA® version 15.1, using paired t-test to compare the differences in OSCE scores in selected CS stations. A p-value of <0.05 was considered significant for all tests. The FGD was transcribed and analysed through manual content analysis. RESULTS Nine clinical skills (that included history and examination skills) were taught using the virtual platform. There was a significant improvement in post-session questionnaires in seven of these skills (p value <0.01). Session evaluations showed that most students were satisfied with the learning experience. The instructors showed that the online teaching offered a promising platform for teaching history taking skills. The OSCE scores showed mixed results, with significant improvement in two out of four repeated stations by using paired t-test [abdominal exam (87.33 ± 8.99, <0.001); and precordial examination (88.45 ± 8.36, 0.001)]. CONCLUSIONS Modifying Peyton's framework to a virtual platform allowed us to sustain the continuum of clinical education during the COVID-19 pandemic. The results support the use of a blended learning environment for teaching clinical skills.
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Affiliation(s)
- Sana Saeed
- Department of Pediatrics and Child Health and Department for Educational Development, The Aga Khan University, Karachi, Pakistan
| | - Urooj Kashif
- Department of Obstetrics and Gynecology, The Aga Khan University, Karachi, Pakistan
| | - Samar Zaki
- Department of Family Medicine, The Aga Khan University, Karachi, Pakistan
| | - Khalid Samad
- Department of Anesthesiology, The Aga Khan University, Karachi, Pakistan
| | - Muhammad Zuhair Yousuf
- Department of Biological & Biomedical Sciences, The Aga Khan University, Karachi, Pakistan
| | - Mahanoor Raza
- Department of Pediatrics and Child Health and Department for Educational Development, The Aga Khan University, Karachi, Pakistan
| | - Shahjahan Jabbar
- Office of Undergraduate Medical Education, The Aga Khan University, Karachi, Pakistan
| | - Unab I Khan
- Department of Family Medicine, The Aga Khan University, Karachi, Pakistan
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Gwilym BL, Pallmann P, Waldron CA, Thomas-Jones E, Milosevic S, Brookes-Howell L, Harris D, Massey I, Burton J, Stewart P, Samuel K, Jones S, Cox D, Clothier A, Edwards A, Twine CP, Bosanquet DC, Benson R, Birmpili P, Blair R, Bosanquet DC, Dattani N, Dovell G, Forsythe R, Gwilym BL, Hitchman L, Machin M, Nandhra S, Onida S, Preece R, Saratzis A, Shalhoub J, Singh A, Forget P, Gannon M, Celnik A, Duguid M, Campbell A, Duncan K, Renwick B, Moore J, Maresch M, Kamal D, Kabis M, Hatem M, Juszczak M, Dattani N, Travers H, Shalan A, Elsabbagh M, Rocha-Neves J, Pereira-Neves A, Teixeira J, Lyons O, Lim E, Hamdulay K, Makar R, Zaki S, Francis CT, Azer A, Ghatwary-Tantawy T, Elsayed K, Mittapalli D, Melvin R, Barakat H, Taylor J, Veal S, Hamid HKS, Baili E, Kastrisios G, Maltezos C, Maltezos K, Anastasiadou C, Pachi A, Skotsimara A, Saratzis A, Vijaynagar B, Lau S, Velineni R, Bright E, Montague-Johnstone E, Stewart K, King W, Karkos C, Mitka M, Papadimitriou C, Smith G, Chan E, Shalhoub J, Machin M, Agbeko AE, Amoako J, Vijay A, Roditis K, Papaioannou V, Antoniou A, Tsiantoula P, Bessias N, Papas T, Dovell G, Goodchild F, Nandhra S, Rammell J, Dawkins C, Lapolla P, Sapienza P, Brachini G, Mingoli A, Hussey K, Meldrum A, Dearie L, Nair M, Duncan A, Webb B, Klimach S, Hardy T, Guest F, Hopkins L, Contractor U, Clothier A, McBride O, Hallatt M, Forsythe R, Pang D, Tan LE, Altaf N, Wong J, Thurston B, Ash O, Popplewell M, Grewal A, Jones S, Wardle B, Twine C, Ambler G, Condie N, Lam K, Heigberg-Gibbons F, Saha P, Hayes T, Patel S, Black S, Musajee M, Choudhry A, Hammond E, Costanza M, Shaw P, Feghali A, Chawla A, Surowiec S, Encalada RZ, Benson R, Cadwallader C, Clayton P, Van Herzeele I, Geenens M, Vermeir L, Moreels N, Geers S, Jawien A, Arentewicz T, Kontopodis N, Lioudaki S, Tavlas E, Nyktari V, Oberhuber A, Ibrahim A, Neu J, Nierhoff T, Moulakakis K, Kakkos S, Nikolakopoulos K, Papadoulas S, D'Oria M, Lepidi S, Lowry D, Ooi S, Patterson B, Williams S, Elrefaey GH, Gaba KA, Williams GF, Rodriguez DU, Khashram M, Gormley S, Hart O, Suthers E, French S. Short-term risk prediction after major lower limb amputation: PERCEIVE study. Br J Surg 2022; 109:1300-1311. [PMID: 36065602 DOI: 10.1093/bjs/znac309] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 05/06/2022] [Accepted: 07/31/2022] [Indexed: 01/22/2023]
Abstract
BACKGROUND The accuracy with which healthcare professionals (HCPs) and risk prediction tools predict outcomes after major lower limb amputation (MLLA) is uncertain. The aim of this study was to evaluate the accuracy of predicting short-term (30 days after MLLA) mortality, morbidity, and revisional surgery. METHODS The PERCEIVE (PrEdiction of Risk and Communication of outcomE following major lower limb amputation: a collaboratIVE) study was launched on 1 October 2020. It was an international multicentre study, including adults undergoing MLLA for complications of peripheral arterial disease and/or diabetes. Preoperative predictions of 30-day mortality, morbidity, and MLLA revision by surgeons and anaesthetists were recorded. Probabilities from relevant risk prediction tools were calculated. Evaluation of accuracy included measures of discrimination, calibration, and overall performance. RESULTS Some 537 patients were included. HCPs had acceptable discrimination in predicting mortality (931 predictions; C-statistic 0.758) and MLLA revision (565 predictions; C-statistic 0.756), but were poor at predicting morbidity (980 predictions; C-statistic 0.616). They overpredicted the risk of all outcomes. All except three risk prediction tools had worse discrimination than HCPs for predicting mortality (C-statistics 0.789, 0.774, and 0.773); two of these significantly overestimated the risk compared with HCPs. SORT version 2 (the only tool incorporating HCP predictions) demonstrated better calibration and overall performance (Brier score 0.082) than HCPs. Tools predicting morbidity and MLLA revision had poor discrimination (C-statistics 0.520 and 0.679). CONCLUSION Clinicians predicted mortality and MLLA revision well, but predicted morbidity poorly. They overestimated the risk of mortality, morbidity, and MLLA revision. Most short-term risk prediction tools had poorer discrimination or calibration than HCPs. The best method of predicting mortality was a statistical tool that incorporated HCP estimation.
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Affiliation(s)
- Brenig L Gwilym
- South East Wales Vascular Network, Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK
| | | | | | | | | | | | - Debbie Harris
- Centre for Trials Research, Cardiff University, Cardiff, UK
| | - Ian Massey
- Artificial Limb and Appliance Centre, Rookwood Hospital, Cardiff and Vale University Health Board, Cardiff, UK
| | - Jo Burton
- Artificial Limb and Appliance Centre, Rookwood Hospital, Cardiff and Vale University Health Board, Cardiff, UK
| | - Phillippa Stewart
- Artificial Limb and Appliance Centre, Rookwood Hospital, Cardiff and Vale University Health Board, Cardiff, UK
| | - Katie Samuel
- Department of Anaesthesia, North Bristol NHS Trust, Bristol, UK
| | - Sian Jones
- c/o INVOLVE Health and Care Research Wales, Cardiff, UK
| | - David Cox
- c/o INVOLVE Health and Care Research Wales, Cardiff, UK
| | - Annie Clothier
- South East Wales Vascular Network, Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK
| | - Adrian Edwards
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Christopher P Twine
- Bristol, Bath and Weston Vascular Network, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - David C Bosanquet
- South East Wales Vascular Network, Aneurin Bevan University Health Board, Royal Gwent Hospital, Newport, UK
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Mahmood S, Ijaz Haider S, Shahbaz H, Noorali AA, Afzal N, Jiwani A, Zaki S, Iqbal Khan U, Ajani K, Tariq M, Karmaliani R, Haider AH. The impact of COVID-19 safety interventions on creating a controlled environment on campus. Front Public Health 2022; 10:962478. [PMID: 36211705 PMCID: PMC9538787 DOI: 10.3389/fpubh.2022.962478] [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: 06/06/2022] [Accepted: 08/29/2022] [Indexed: 01/24/2023] Open
Abstract
Objectives During COVID-19 the re-opening of educational institutes was frequently debated, however with the decline in the number of COVID-19 cases, The Aga Khan University (AKU) in Karachi, Pakistan opened its campus for medical and nursing students after more than 6 months of closure. To ensure gradual resumption of activities on-campus, a combination of interventions was diligently deployed to minimize student infection rates. Scarce literature exists on students' perceptions regarding decisions implemented by university leadership. The aim of the study was to determine the efficacy of these interventions. Methods We conducted a convergent, parallel, mixed-methods observational study targeting medical and nursing students. An online questionnaire was disseminated to elicit students' degree of (dis)agreement on a four-point Likert scale. Focused group discussions (FGDs) were conducted to comprehend reasons for (dis)agreement. Results Total of 183 students responded to questionnaire (59.0% nursing, 67.8% female), 11 FGDs were conducted with 85 students. Interventions with highest agreement were mandatory face masks policy (94.54%), weekly mandated COVID-testing (92.35%) and students' Academic Bubble (91.26%); highest disagreement was for Sehat Check application (41.53%); and stay strong campaign (40.44%). Four themes emerged from FGDs: Effective safety interventions, Safety interventions with limited effectiveness, Utility of Sehat Check Application and Future recommendations for informing policy. Conclusion It is paramount to seek student-feedback at forefront of university re-opening strategy. Clear communication channels are as important as an administrative response system's robustness. Bidirectional communication channels are fundamental and requisite during ever-changing policies and regulations. Engaging student representatives in decision making or implementation processes (such as "pilot" before "roll-out") would allow any potential issues to be managed early on. Gather real-time anonymous feedback and identify key areas that need further promulgation and those that need to be replaced with more effective ones.
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Affiliation(s)
| | - Sonia Ijaz Haider
- Centre for Medical Education, School of Medicine, Cardiff University, Cardiff, United Kingdom,*Correspondence: Sonia Ijaz Haider
| | - Hamna Shahbaz
- Department of Surgery, Washington University in St. Louis, St. Louis, MO, United States
| | | | - Noreen Afzal
- Department of Family Medicine, Aga Khan University, Karachi, Pakistan
| | - Aziz Jiwani
- Department of Family Medicine, Aga Khan University, Karachi, Pakistan
| | - Samar Zaki
- Department of Family Medicine, Aga Khan University, Karachi, Pakistan
| | - Unab Iqbal Khan
- Department of Family Medicine, Aga Khan University, Karachi, Pakistan
| | | | - Muhammad Tariq
- Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Rozina Karmaliani
- School of Nursing and Midwifery, Aga Khan University, Karachi, Pakistan
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Zaki S, Blaker CL, Little CB. OA foundations - experimental models of osteoarthritis. Osteoarthritis Cartilage 2022; 30:357-380. [PMID: 34536528 DOI: 10.1016/j.joca.2021.03.024] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 03/01/2021] [Accepted: 03/10/2021] [Indexed: 02/02/2023]
Abstract
Osteoarthritis (OA) is increasingly recognised as a disease of diverse phenotypes with variable clinical presentation, progression, and response to therapeutic intervention. This same diversity is readily apparent in the many animal models of OA. However, model selection, study design, and interpretation of resultant findings, are not routinely done in the context of the target human (or veterinary) patient OA sub-population or phenotype. This review discusses the selection and use of animal models of OA in discovery and therapeutic-development research. Beyond evaluation of the different animal models on offer, this review suggests focussing the approach to OA-animal model selection on study objective(s), alignment of available models with OA-patient sub-types, and the resources available to achieve valid and translatable results. How this approach impacts model selection is discussed and an experimental design checklist for selecting the optimal model(s) is proposed. This approach should act as a guide to new researchers and a reminder to those already in the field, as to issues that need to be considered before embarking on in vivo pre-clinical research. The ultimate purpose of using an OA animal model is to provide the best possible evidence if, how, when and where a molecule, pathway, cell or process is important in clinical disease. By definition this requires both model and study outcomes to align with and be predictive of outcomes in patients. Keeping this at the forefront of research using pre-clinical OA models, will go a long way to improving the quality of evidence and its translational value.
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Affiliation(s)
- S Zaki
- Sydney School of Veterinary Science, Faculty of Science, University of Sydney, Australia; Raymond Purves Bone and Joint Research Laboratory, Australia.
| | - C L Blaker
- Raymond Purves Bone and Joint Research Laboratory, Australia; Murray Maxwell Biomechanics Laboratory, The Kolling Institute, University of Sydney Faculty of Medicine and Health, At Royal North Shore Hospital, Australia.
| | - C B Little
- Raymond Purves Bone and Joint Research Laboratory, Australia.
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Zaki S, Moiz J, Bhati P, Menon G. Efficacy of high-intensity interval training on cardiac autonomic modulation in cardiovascular diseases and lifestyle disorders: a systematic review and meta-analysis. Comparative Exercise Physiology 2022. [DOI: 10.3920/cep210009] [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: 11/19/2022]
Abstract
The study aims to investigate the literature on the effect of high-intensity interval training (HIIT) on cardiac autonomic function in individuals with cardiovascular disease (CVD) and lifestyle disorders. We performed electronic database search from CENTRAL, WoS, Scopus, Pubmed, and PEDro up to 25th February 2021. Randomised control trials/quasi-experimental trials/cross-over trials that assessed the effects of HIIT with control/alternative treatment on cardiac autonomic control were included in this review. A total of 11 studies were included for qualitative analysis and among them, 8 were quantitatively analysed. A random-effect model of standardised mean difference (SMD) and mean difference of the respective outcome measures for cardiac autonomic control was determined. The findings of the qualitative analysis revealed the beneficial effects of HIIT on cardiac autonomic modulation. However, the majority of the studies had an unclear or high risk of bias for randomisation, concealment methods, and blinding of participants to the intervention that could have influenced the interpretation of the findings. The SMD revealed a significant effect of HIIT on standard deviation of N-N intervals (SDNN) (ms) [SMD: 0.40, 95% confidence interval (CI): -0.001 to 0.80, P=0.05], high frequency power (HF) (ms2) [0.46, 95% CI: 0.17 to 0.76, P=0.002], and ratio of low and high frequency power, (LF/HF) [-0.80, 95% CI: -1.27 to -0.33, P=0.0008]. In conclusion, HIIT may effectively modulate cardiac autonomic function by increasing parasympathetic dominance, sympathetic withdrawal, and sympathovagal balance in individuals with CVD and lifestyle disorders. The study has a PROSPERO registration number: CRD42021231225
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Affiliation(s)
- S. Zaki
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, 110025, New Delhi, India
| | - J.A. Moiz
- Centre for Physiotherapy and Rehabilitation Sciences, Jamia Millia Islamia, 110025, New Delhi, India
| | - P. Bhati
- Shree Guru Gobind Singh Tricentenary University, Gurugram, 122505, Haryana, India
| | - G.R. Menon
- National Institute of Medical Statistics, Indian Council of Medical Research, 110029, New Delhi, India
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Zaki S, Smith MM, Little CB. Pathology-pain relationships in different osteoarthritis animal model phenotypes: it matters what you measure, when you measure, and how you got there. Osteoarthritis Cartilage 2021; 29:1448-1461. [PMID: 34332049 DOI: 10.1016/j.joca.2021.03.023] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 03/17/2021] [Accepted: 03/31/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine whether osteoarthritis (OA) pain characteristics and mechanistic pathways in pre-clinical models are phenotype-specific. DESIGN Male 11-week-old C57BL6 mice had unilateral medial-meniscal-destabilization (DMM) or antigen-induced-arthritis (AIA), vs sham-surgery/immunised-controls (Sham/Im-CT). Pain behaviour (allodynia, mechanical- and thermal-hyperalgesia, hindlimb static weight-bearing, stride-length) and lumbar dorsal root ganglia (DRG) gene-expression were measured at baseline, day-3, week-1/-2/-4/-8/-16, and pain-behaviour:gene-expression:joint-pathology associations investigated. RESULTS DMM and AIA induced structural OA defined by progressively increasing cartilage erosion, subchondral bone sclerosis and osteophyte size and maturation. All pain-behaviours were modified, with model-specific differences in severity and temporal pattern. Tactile allodynia developed acutely in both models and persisted to week-16. During early-OA (wk4-8) there was; reduced right hindlimb weight-bearing in AIA; thermal-hyperalgesia and reduced stride-length in DMM. During chronic-OA (wk12-16); mechanical-hyperalgesia and reduced right hindlimb weight-bearing were observed in DMM only. There were no associations in either model between different pain-behaviour outcomes. A coordinated DRG-expression profile was observed in sham and Im-CT for all 11 genes tested, but not in AIA and DMM. At wk-16 despite equivalent joint pathology, changes in DRG-expression (Calca, Trpa1, Trpv1, Trpv4) were observed only in DMM. In AIA mechanical-hyperalgesia was associated with Trpv1 (r = -0.79) and Il1b (r = 0.53). In DMM stride-length was associated with Calca, Tac1, Trpv1, Trpv2, Trpv4 and Adamts5 (r = 0.4-0.57). DRG gene-expression change was correlated with subchondral-bone sclerosis in DMM, and cartilage damage in AIA. Positive pain-behaviour:joint-pathology associations were only present in AIA - for synovitis, subchondral-bone resorption, chondrocyte-hypertrophy and cartilage damage. CONCLUSION Pain and peripheral sensory neuronal responses are OA-phenotype-specific with distinct pathology:pain-outcome:molecular-mechanism relationships.
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Affiliation(s)
- S Zaki
- Sydney School of Veterinary Science, Faculty of Science, University of Sydney, Australia; Raymond Purves Bone and Joint Research Laboratory, Kolling Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, at Royal North Shore Hospital, Australia.
| | - M M Smith
- Raymond Purves Bone and Joint Research Laboratory, Kolling Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, at Royal North Shore Hospital, Australia.
| | - C B Little
- Raymond Purves Bone and Joint Research Laboratory, Kolling Institute of Medical Research, Faculty of Medicine and Health, The University of Sydney, at Royal North Shore Hospital, Australia.
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Sumetsky M, Zaki S. Enhancing the impedance matched bandwidth of bottle microresonator signal processing devices. Opt Lett 2021; 46:3227-3230. [PMID: 34197422 DOI: 10.1364/ol.430673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/04/2021] [Indexed: 06/13/2023]
Abstract
Light pulses entering an elongated bottle microresonator (BMR) from a transversely oriented input-output waveguide (microfiber) slowly propagate along the BMR length and bounce between turning points at its constricting edges. To avoid insertion losses and processing errors, a pulse should completely transfer from the waveguide into the BMR and, after being processed, completely return back into the waveguide. For this purpose, the waveguide and BMR should be impedance matched along the pulse bandwidth. Here we show how to enhance the impedance matched bandwidth by optimization of the BMR effective radius variation in a small vicinity of the input-output waveguide.
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Mirza MB, Sulaiman A, Hashmi S, Zaki S, Rehman R, Akbar R. Use of simulation based technology in pre-clinical years improves confidence and satisfaction among medical students. J PAK MED ASSOC 2021; 71:1296-1302. [PMID: 34125799 DOI: 10.47391/jpma.1152] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine perception of medical students about learning from integrated simulated clinical skill sessions as part of the undergraduate curriculum. METHODS The cross-sectional study was conducted at the Centre for Innovation in Medical Education, Aga Khan University (AKU), Karachi, from July 2018 to February 2019, and comprised first year medical students undertaking the Respiration and Circulation module of the curriculum. Quantitative data was collected using a questionnaire and the responses were assessed on a five-point Likert scale. Data was analysed using SPSS 21. Qualitative data was gathered through focused group discussion with students and an in-depth interview with the facilitator conducting the sessions. The data was subjected to thematic analyses. RESULTS Of the 161 subjects, 71(44%) participated in the session I and 90(56%) in the session II. Altogether 68(96%) students in session I and 81(90%) in session II believed integrated sessions to be effective in achieving learning objectives, and 65(92%) in session I and 79(88 %) in session II found them motivating, while 61(86%) in session I and 76(84%) in session II expressed the confidence that they had accomplished learning objectives and felt they had learned practical clinical skills; session I, 59(84%), session II, 73(81%). Qualitative analysis revealed that these sessions enhanced understanding of the subject matter and student engagement. CONCLUSIONS Integrated clinical skills sessions improved students' interest, engagement and confidence. It should be implemented in undergraduate medical teaching curriculum.
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Affiliation(s)
| | - Anjiya Sulaiman
- 5th Year Medical Student, Aga Khan University, Karachi, Pakistan
| | - Satwat Hashmi
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Samar Zaki
- Department of Family Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Rehana Rehman
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
| | - Rozmeen Akbar
- Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan
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Zaki S, Ashrafi M, Balakrishnan A. 948 Visceral Artery Aneurysms- A Single Centre Experience Over 6 Years. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.338] [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
The incidence of visceral artery aneurysms (VAA) varies from 0.01-0.1%. They are significant with a mortality risk of up to 75% if ruptured. Given there are no national guidelines we decided to conduct this study to assess the management of VAA in our trust and recommend local guidelines.
Method
We retrospectively identified patients who had a detected VAA between April 2014 and April 2020. Medical records and relevant imaging were reviewed in detail. MDT outcomes and subsequent mortalities noted.
Results
We identified 62 VAA in 59 patients (23 male), median age 65 years, and mean diameter 18.1 mm. 95 % were detected on CT, the indication was mostly malignancy. MDT outcomes were to continue surveillance for 43 patients with yearly scans, 5 patients had primary surgical repair, 7 patients had endovascular interventions, 1 patient had primary endovascular intervention that failed and required surgical intervention. 7 patients were discharged from follow up due to age and size (12 mm) or VAA completely thrombosed.
Conclusions
In our unit decisions to intervene were based on size > 20mm, rapid increase in size on surveillance, the presence of portal hypertension or possibly the patients’ young age. There were no mortalities linked to VAA.
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Affiliation(s)
- S Zaki
- Countess of Chester NHS Trust, Chester, United Kingdom
| | - M Ashrafi
- Countess of Chester NHS Trust, Chester, United Kingdom
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11
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Zaki S, Hossack M, Makar R. 942 Cost Effectiveness of Percutaneous EVARs Compared to Standard Cut Down. Br J Surg 2021. [DOI: 10.1093/bjs/znab134.336] [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
Percutaneous EVAR (PEVAR) is gaining popularity worldwide. Our aim is to identify whether PEVAR is cost effective compared to open access.
Method
We retrospectively identified patients undergoing EVAR for unruptured AAA over a 4-year period (April 2014- December 2018). Demographic, procedural, and financial data were collected. Exclusion criteria were complex EVARs and EVARs with planned adjunct procedures. Outcome measures were length of stay (LOS), number of Perclose devices used, number of failures, need for adjuncts, theatre time used, and total cost of each.
Results
318 patients (88.4% male) underwent EVAR between January 2015 and October 2018, average age 76.9 years and median maximal aortic diameter 60mm. 61 EVARs were planned for open access, and a sample of the latest 92 consecutive PEVARs were selected to prevent bias. The median LOS following PEVAR was 1 day less (2 vs 3 days). Mean Proglides used were 5. 2.7% of devices failed, and no surgical cut-down was required in this cohort. Mean theatre time used for PEVAR was 179 minutes vs 213 minutes for open access. All considered, PEVARs cost £124 less.
Conclusions
PEVAR is associated with a shorter length of hospital stay and is more cost effective than open access.
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Affiliation(s)
- S Zaki
- Countess of Chester NHS Trust, Chester, United Kingdom
| | - M Hossack
- Countess of Chester NHS Trust, Chester, United Kingdom
| | - R Makar
- Countess of Chester NHS Trust, Chester, United Kingdom
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Eskander J, Khallaf A, Zaki S, Elkawafi M, Makar R. 598 Patients’ Knowledge and Compliance with Government Guidelines for COVID 19. Br J Surg 2021. [PMCID: PMC8135918 DOI: 10.1093/bjs/znab134.071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background Since the outbreak of COVID-19; social distancing and recognized effective precautions were recommended by various governments to fight the viral spread. Our aim was to assess the inpatient knowledge and compliance with the government guidelines during their hospital stay and at their discharge in two different NHS hospitals. Method The study took place in two hospitals: Berrywood hospital, UK and Countess of Chester hospital, UK. We invited inpatients to answer an anonymized questionnaire which was designed to include the contemporary government guidelines. We excluded patients with cognitive impairment and those who were not expected to be discharged within days. Results Out of 209 patients, 50% were male. Patients showed good awareness of the main symptoms of the virus (90%). However, A significant number of patients were not fully aware of the recommended precautions to minimize viral spread (28%) and the method of spread (43%). About 41% did not know the recommended safe distance. Conclusions Despite being aware of the main symptoms of COVID-19, a significant number of patients lack essential information needed to minimize the spread of the virus in the society and hospital. We recommend providing patients with information leaflets and direct advice on admission and discharge.
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Affiliation(s)
- J Eskander
- Berrywood hospital - Northamptonshire Healthcare NHS Foundation Trust, Northampton, United Kingdom
| | - A Khallaf
- Countess of Chester hospital NHS Foundation Trust, Chester, United Kingdom
| | - S Zaki
- Countess of Chester hospital NHS Foundation Trust, Chester, United Kingdom
| | - M Elkawafi
- Countess of Chester hospital NHS Foundation Trust, Chester, United Kingdom
| | - R Makar
- Countess of Chester hospital NHS Foundation Trust, Chester, United Kingdom
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Toropov N, Zaki S, Vartanyan T, Sumetsky M. Microresonator devices lithographically introduced at the optical fiber surface. Opt Lett 2021; 46:1784-1787. [PMID: 33793543 DOI: 10.1364/ol.421104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 03/10/2021] [Indexed: 06/12/2023]
Abstract
We present a simple lithographic method for fabrication of microresonator devices at the optical fiber surface. First, we undress the predetermined surface areas of a fiber segment from the polymer coating with a focused CO2 laser beam. Next, using the remaining coating as a mask, we etch the fiber in a hydrofluoric acid solution. Finally, we completely undress the fiber segment from coating to create a chain of silica bottle microresonators with nanoscale radius variation [surface nanoscale axial photonics (SNAP) microresonators]. We demonstrate the developed method by fabrication of a chain of five 1 mm long and 30 nm high microresonators at the surface of a 125 µm diameter optical fiber and a single 0.5 mm long and 291 nm high microresonator at the surface of a 38 µm diameter fiber. As another application, we fabricate a rectangular 5 mm long SNAP microresonator at the surface of a 38 µm diameter fiber and investigate its performance as a miniature delay line. The propagation of a 100 ps pulse with 1 ns delay, 0.035c velocity, and negligible dispersion is demonstrated. In contrast to previously developed approaches in SNAP technology, the developed method allows the introduction of much larger fiber radius variation ranging from nanoscale to microscale.
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Alzghoul BN, Li P, Zaki S, Patel DC. Bronchoalveolar lavage flow cytometry for the diagnosis of pulmonary post-transplant lymphoproliferative disorder. QJM 2020; 113:813-814. [PMID: 32277822 DOI: 10.1093/qjmed/hcaa124] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Indexed: 11/13/2022] Open
Affiliation(s)
- B N Alzghoul
- From the Pulmonary, Critical Care and Sleep Medicine, University of Florida, 1600 SW Archer Road, Room M452, PO Box 100225, Gainesville, FL 32610-0225, USA
| | - P Li
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, 1600 SW Archer Road, Room M452, PO Box 100225, Gainesville, FL 32610-0225, USA
| | - S Zaki
- Department of Internal Medicine, Florida State University, 600 W College Ave, Tallahassee, FL 32306, USA
| | - D C Patel
- From the Pulmonary, Critical Care and Sleep Medicine, University of Florida, 1600 SW Archer Road, Room M452, PO Box 100225, Gainesville, FL 32610-0225, USA
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Zaki S. TELEMEDICINE DIAGNOSIS OF CAVERNOUS ICA ANEURYSM. Chest 2020. [DOI: 10.1016/j.chest.2020.05.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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16
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McDonald CI, Zaki S. A role for classical music in veterinary practice: does exposure to classical music reduce stress in hospitalised dogs? Aust Vet J 2020; 98:31-36. [DOI: 10.1111/avj.12905] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 11/21/2019] [Accepted: 11/29/2019] [Indexed: 11/27/2022]
Affiliation(s)
- CI McDonald
- Sydney School of Veterinary Science, Faculty of ScienceThe University of Sydney Camperdown New South Wales 2006 Australia
| | - S Zaki
- Sydney School of Veterinary Science, Faculty of ScienceThe University of Sydney Camperdown New South Wales 2006 Australia
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Torky HA, Taha A, Marie H, El-Desouky E, Raslan O, Moussa AA, Ahmad AM, Abo-Louz A, Zaki S, Fares T, Eesa A. Role of topical oxytocin in improving vaginal atrophy in postmenopausal women: a randomized, controlled trial. Climacteric 2018; 21:174-178. [PMID: 29347848 DOI: 10.1080/13697137.2017.1421924] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE AND DESIGN Prospective randomized controlled trial to test the effectiveness of topical oxytocin gel to improve vaginal atrophy in postmenopausal women. PATIENTS AND METHODS A total of 140 postmenopausal women presenting with vaginal atrophy and who satisfied the inclusion and exclusion criteria were randomized into two groups each of 70 patients; they received intravaginal oxytocin gel or placebo gel for 30 days. Serum estrogen level, visual, colposcopic and histological vaginal examination were performed before and after treatment. RESULTS Forty-seven out of 70 women in the oxytocin gel group improved after treatment and none in the placebo group (p = 0.001). Forty-five participants in the oxytocin group and seven in the placebo group reported relief of dyspareunia (p = 0.001). Thirty-four participants in the oxytocin group and seven in the placebo group reported relief of soreness (p = 0.001). There was no significant difference between the circulating levels of estradiol in both groups before and after treatment (p = 0.4 and 0.6 for the oxytocin group and the placebo group, respectively). CONCLUSION Oxytocin gel is useful in the restoration of the vaginal epithelium in cases of postmenopausal atrophic vaginitis. Further studies with a longer follow-up period are required to test the long-term effects of oxytocin as a treatment for vaginal atrophy.
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Affiliation(s)
- H A Torky
- a Department of Obstetrics and Gynecology , October 6th University , Cairo , Egypt
| | - A Taha
- b Department of Obstetrics and Gynecology , Al-Azhar University , Cairo , Egypt
| | - H Marie
- c Department of Obstetrics and Gynecology , Cairo University , Cairo , Egypt
| | - E El-Desouky
- b Department of Obstetrics and Gynecology , Al-Azhar University , Cairo , Egypt
| | - O Raslan
- b Department of Obstetrics and Gynecology , Al-Azhar University , Cairo , Egypt
| | - A A Moussa
- b Department of Obstetrics and Gynecology , Al-Azhar University , Cairo , Egypt
| | - A M Ahmad
- d Department of Obstetrics and Gynecology , Al-Galaa Teaching Hospital , Cairo , Egypt
| | - A Abo-Louz
- a Department of Obstetrics and Gynecology , October 6th University , Cairo , Egypt
| | - S Zaki
- c Department of Obstetrics and Gynecology , Cairo University , Cairo , Egypt
| | - T Fares
- b Department of Obstetrics and Gynecology , Al-Azhar University , Cairo , Egypt
| | - A Eesa
- e Department of Pathology , Cairo University , Cairo , Egypt
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Zaki S, Usman A, Tariq S, Shah S, Azam I, Qidwai W, Nanji K. Frequency and Factors Associated with Adult Immunization in Patients Visiting Family Medicine Clinics at a Tertiary Care Hospital, Karachi. Cureus 2018; 10:e2083. [PMID: 29560296 PMCID: PMC5856407 DOI: 10.7759/cureus.2083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Objective The goal of this study was to determine the frequency and factors associated with adult immunization in patients visiting family medicine clinics at a tertiary care hospital in Karachi. Methods A cross-sectional study was conducted from March 2014 to March 2015 in a tertiary care hospital in Karachi, Pakistan. Participants more than 18 years were invited to participate in the study. A pretested questionnaire was used to collect information. Data were entered and analyzed using IBM SPSS Statistics for Windows, version 19.0 (Armonk, NY: IBM Corp). Results A total of 340 patients were surveyed. The majority of patients were female (69.5%) with a mean age of 35.47 years. The majority were married (61.1%), and 30% of the participants had completed graduation or postgraduate education (20%). Most of the patients believed that vaccines can be used in adults to prevent disease (62.2%). Patients believed that the hepatitis B vaccine, influenza vaccine, and hepatitis A vaccine can be administered to adults (58.1%, 29.9%, 33.8%, respectively). The major sources of their information regarding vaccination in adults were friends or relatives (25%) and media (23.2%). Regarding availability of vaccines, 71.3% thought a hepatitis B vaccine is available, 54.9% thought a tuberculosis vaccine is available, and 49.3% thought a tetanus toxoid vaccine is available. Only 36.4% respondents received any vaccine in adulthood. The majority of patients (62.2%) received the hepatitis B vaccine in adulthood. The major reason given for not receiving vaccines was lack of awareness (62.4%). Conclusion Low adult vaccination coverage rates and awareness, as highlighted by the results of this study, show the dire need to address this major preventive strategy. This information can be utilized to conduct larger community-based surveys, to conduct health awareness sessions in the community, and to educate our doctors regarding the availability and benefits of adult vaccines.
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Affiliation(s)
- Samar Zaki
- Family Medicine, The Aga Khan University
| | - Asma Usman
- Family Medicine, The Aga Khan University
| | | | | | - Iqbal Azam
- Community Health Sciences, The Aga University
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Tayeb H, Alsawwaf Y, Zaki S, Alwasiah R, Kafi S, Badawood L, Baduwilan A, Koeing H. Prevelance and determinants of mind-brain dualism among Saudi medical students. J Neurol Sci 2017. [DOI: 10.1016/j.jns.2017.08.555] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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El-Abd E, El-Tahan R, Fahmy L, Zaki S, Faid W, Sobhi A, Kandil K, El-Kwisky F. Serum metastasin mRNA is an important survival predictor in breast cancer. Br J Biomed Sci 2016; 65:90-4. [DOI: 10.1080/09674845.2008.11732804] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- E. El-Abd
- Molecular Biology Department, Medical Technology Centre, Alexandria University, Cork, Egypt
| | - R. El-Tahan
- Biochemistry Department, Alexandria University, Egypt
| | - L. Fahmy
- Biochemistry Department, Alexandria University, Egypt
| | - S. Zaki
- Oncology Unit, Alexandria University, Egypt
| | - W. Faid
- Surgery Department, Alexandria University, Egypt
| | - A. Sobhi
- Pathology Department, Alexandria University, Egypt
| | - K. Kandil
- Biochemistry Department, Faculty of Science, Alexandria University, Egypt
| | - F. El-Kwisky
- Statistics Department, Medical Research Institute, Alexandria University, Egypt
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Usman A, Bhombal ST, Jawaid A, Zaki S. Energy drinks consumption practices among medical students of a Private sector University of Karachi, Pakistan. J PAK MED ASSOC 2015; 65:1005-1007. [PMID: 26338750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Consumption of energy drinks has become popular among students and athletes over the past few years. To explore the phenomenon, a cross-sectional survey was conducted through a self-administered pilot-tested questionnaire. Frequency of energy drinks consumption was found to be 121(52%) in a sample of 233 medical students. Red bull was the most common brand consumed 101(43%). The major reasons reported for its usage were to gain/replenish energy by 36(15.4%), and studying for examination by 34(14.6%). Television was reported as the major source of information 153(66%) followed by friends 113(48%). There was a high frequency of energy drinks' consumption among medical students of a private university. There is a strong need to create awareness regarding these drinks, especially among adolescents and teenagers.
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Affiliation(s)
- Asma Usman
- Department of Family Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Ambreen Jawaid
- Department of Family Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Samar Zaki
- Department of Family Medicine, Aga Khan University Hospital, Karachi, Pakistan
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Rosado-Odom V, Daoud J, Johnson R, Allen S, Lockhart S, Iqbal N, Shieh WJ, Zaki S, Sharfuddin A. Cutaneous presentation of progressive disseminated histoplasmosis nine years after renal transplantation. Transpl Infect Dis 2013; 15:E64-9. [DOI: 10.1111/tid.12059] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 10/12/2012] [Accepted: 11/23/2012] [Indexed: 12/22/2022]
Affiliation(s)
- V.M. Rosado-Odom
- Department of Medicine; Indiana University School of Medicine; Indianapolis; Indiana; USA
| | - J. Daoud
- Department of Medicine; Indiana University School of Medicine; Indianapolis; Indiana; USA
| | - R. Johnson
- Department of Medicine; Indiana University School of Medicine; Indianapolis; Indiana; USA
| | - S.D. Allen
- Department of Medicine; Indiana University School of Medicine; Indianapolis; Indiana; USA
| | - S.R. Lockhart
- Mycotic Diseases Branch; Centers for Disease Control and Prevention (CDC); Atlanta; Georgia; USA
| | - N. Iqbal
- Mycotic Diseases Branch; Centers for Disease Control and Prevention (CDC); Atlanta; Georgia; USA
| | - W.-J. Shieh
- Infectious Disease Pathology Branch; CDC; Atlanta; Georgia; USA
| | - S. Zaki
- Infectious Disease Pathology Branch; CDC; Atlanta; Georgia; USA
| | - A.A. Sharfuddin
- Department of Medicine; Indiana University School of Medicine; Indianapolis; Indiana; USA
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Bhanji S, Zaki S, Qidwai W, Ishaq M. 156 SOCIODEMOGRAPHIC AND LIFESTYLE DIFFERENCES IN KNOWN HYPERTENSIVES AND NORMOTENSIVES – RESULTS FROM COMMUNITY SCREENING CLINICS. J Hypertens 2012. [DOI: 10.1097/01.hjh.0000419982.76397.70] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Coentrao L, Ribeiro C, Santos-Araujo C, Neto R, Pestana M, Rahman E, Rahman H, Ahmed D, Mousa D, El Bishlawi M, Shibahara H, Shibahara N, Takahashi S, Dupuis E, Duval X, Dornic Q, Bonnal C, Lucet JC, Cerceau O, Randoux C, Balde C, Besson F, Mentre F, Vrtovsnik F, Koutroubas G, Malindretos P, Zagotsis G, Makri P, Syrganis C, Mambelli E, Mancini E, Elia C, Guadagno V, Facchini MG, Zucchelli A, Grazia M, Patregnani L, Santoro A, Stefan G, Stefan G, Stancu S, Capusa C, Ailioaiei OR, Mircescu G, Anwar S, Little C, Kingston R, Diwakar P, Kaikini R, Syrganis C, Koutroubas G, Zagotsis G, Malindretos P, Makri P, Nikolaou E, Loukas G, Sabry A, Alsaran K, Al Sherbeiny S, Abdulkader M, Kwak I, Song S, Seong E, Lee S, Lee D, Kim I, Rhee H, Silva F, Queiros J, Malheiro J, Cabrita A, Rocha A, Bamidis P, Bamidis P, Liaskos C, Chryssogonidis I, Frantzidis C, Papagiannis A, Vrochides D, Lasaridis A, Nikolaidis P, Malindretos P, Kotwal S, Muir C, Hawley C, Snelling P, Gallagher M, Jardine M, Shibata K, Shibata K, Toya Y, Umemura S, Iwamoto T, Ono S, Ikeda E, Kitazawa A, Kuji T, Koguchi N, Satta H, Nishihara M, Kawata S, Kaneda T, Yamada Y, Murakami T, Yanagi M, Yasuda G, Mathieu S, Yves D, Jean-Michel T, Nicolas Q, Jean-Francois C, Ibrahim M, Abdel Salam M, Awadalla A, Bichari W, Zaki S, Roca-Tey R, Samon R, Ibrik O, Roda A, Gonzalez-Oliva JC, Martinez-Cercos R, Viladoms J, Lin CC, Yang WC, Kim YO, Yoon SA, Yun YS, Song HC, Kim BS, Cheong MA, Ogawa T, Kiba T, Okazaki S, Hatano M, Iwanaga M, Noiri C, Matsuda A, Hasegawa H, Mitarai T, DI Napoli A, DI Lallo D, Tazza L, De Cicco C, Salvatori MF, Chicca S, Guasticchi G, Gelev S, Trajceska L, Srbinovska E, Pavleska S, Oncevski A, Dejanov P, Gerasomovska V, Selim G, Sikole A, Wilson S, Mayne T, Krishnan M, Holland J, Volz A, Good L, Nissenson A, Stavroulopoulos A, Aresti V, Maragkakis G, Kyriakides S, Rikker C, Rikker C, Juhasz E, Tornoci L, Tovarosi S, Greguschik J, Mag O, Rosivall L, Golebiowski T, Golebiowski T, Watorek E, Kusztal M, Letachowicz K, Letachowicz W, Madziarska K, Augustyniak Bartosik H, Krajewska M, Weyde W, Klinger M, Capitanini A, Lange S, Cupisti A, Schier T, Gobel G, Bosmuller C, Gruber I, Tiefenthaler M, Shipley T, Adam J, Sweeney D, Fenwick S, Mansy H, Ahmed S, Moore I, Iwamoto T, Shibata K, Yasuda G, Kaneda T, Murakami T, Kuji T, Koguchi N, Satta H, Nishihara M, Kawata S, Yanagi M, Yamada Y, Ono S, Ikeda E, Kitazawa A, Toya Y, Umemura S, Vigeral P, Saksi S, Flamant M, Boulanger H, Kim YO, Yoon SA, Yun YS, Song HC, Kim BS, Park WD, Cheong MA, Nikam M, Tavakoli A, Chemla E, Evans J, Malete H, Matyas L, Mogan I, Lazarides M, Ebner A, Shi Y, Shi Y, Zhang J, Cheng J, Frank LR, Melanie H, Dominique B, Michel G, Ikeda K, Yasuda T, Yotueda H, Nikam M, Ebah L, Jayanti A, Evans J, Kanigicherla D, Summers A, Manley G, Dutton G, Chalmers N, Mitra S, Checherita IA, Niculae A, Radulescu D, David C, Turcu FL, Ciocalteu A, Persic V, Persic V, Buturovic-Ponikvar J, Ponikvar R, Touam M, Touam M, Menoyo V, Drueke T, Rifaat M, Muresan C, Abtahi M, Koochakipour Z, Joly D, Baharani J, Rizvi S, Ng KP, Buzzi L, Sarcina C, Alberghini E, Ferrario F, Baragetti I, Santagostino G, Furiani S, Corghi E, Sarcina C, Terraneo V, Rastelli F, Bacchini G, Pozzi C, Adorati Menegato M, Mortellaro R, Locicero A, Romano A, Manzini PP, Steckiph D, Shintaku S, Kawanishi H, Moriishi M, Bansyodani M, Nakamura S, Saito M, Tsuchiya S, Barros F, Vaz R, Carvalho B, Neto R, Martins P, Pestana M, Likaj E, Likaj E, Seferi S, Rroji M, Idrizi A, Duraku A, Barbullushi M, Thereska N, Shintaku S, Kawanishi H, Moriishi M, Bansyodani M, Nakamura S, Saito M, Tsuchiya S. Vascular access. Nephrol Dial Transplant 2012. [DOI: 10.1093/ndt/gfs226] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Little CB, Zaki S. What constitutes an "animal model of osteoarthritis"--the need for consensus? Osteoarthritis Cartilage 2012; 20:261-7. [PMID: 22321719 DOI: 10.1016/j.joca.2012.01.017] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [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] [Received: 12/05/2011] [Revised: 01/07/2012] [Accepted: 01/17/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To review the use of animal models of osteoarthritis (OA) with regard to their utility for investigation of the mechanisms and regulation of structural pathology and pain. METHODS PubMed searches were conducted using separate clusters of terms to retrieve articles on (i) models of structural joint damage in genetically-modified (GM) mice, and (ii) models of OA joint pain. The papers were reviewed to investigate whether there was evidence that the research outcome was dependent on the model used. RESULTS Out of a total of 109 separate GM mice strains identified in which an effect on OA was reported, 15 had been studied using more than one arthritis model. In 10/15 the same effect of the GM on arthritis was reported in at least two different models. In 5/15 the effect of the GM on arthritis structural pathology was different, and sometimes opposite, when comparing two or more induction methods. A total of 112 publications were retrieved in which pain/disability was examined in a model suggested to represent OA. The induction methods used most commonly to study "OA pain" were distinct from those most often used to investigate the pathophysiology and regulation of structural joint damage. Four papers directly comparing pain mechanisms in different models were identified, with 3/4 describing differences in nociceptive pathways. CONCLUSIONS The available data indicates that the molecular mechanisms of both joint structural damage and pain may be distinct in animal models of OA induced or initiated by different means. This suggests the need to continue using multiple OA animal models but that the subsequent interpretation of the data and its extrapolation to the human condition must be more precise.
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Affiliation(s)
- C B Little
- Raymond Purves Bone and Joint Research Laboratories, Kolling Institute of Medical Research, Institute of Bone and Joint Research, University of Sydney at Royal North Shore Hospital, Level 10 Kolling Building-B6, St Leonards, NSW 2065, Australia.
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Zaki S, Farag S, Elreesh GA, Elkady M, Nosier M, El Abd D. Characterization of bioflocculants produced by bacteria isolated from crude petroleum oil. Int J Environ Sci Technol 2011; 8:831-840. [DOI: 10.1007/bf03326266] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Zaki S, Ismail A, Toppozada M, Ismail A. PP-172 Detection of the relation between the presence of Chlamydial antigen in the cervix of infertile women and the condition of their tubes. Int J Infect Dis 2010. [DOI: 10.1016/s1201-9712(10)60240-8] [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] Open
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Zaki S, Ibrahim A, Abou Zeid S, Metwaly M. OL-020 Clinico-bacteriological studies in Erythema multiforme and the role of Mycoplasma pneumoniae. Int J Infect Dis 2010. [DOI: 10.1016/s1201-9712(10)60026-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Zaki S, Maher A, Lymouna H. PP-026 Cryosurgery for Rhinoscleroma a clinico-bacteriological study. Int J Infect Dis 2010. [DOI: 10.1016/s1201-9712(10)60094-x] [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: 11/15/2022] Open
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Zaki S, Abd El Moety A, Mehasseb M. PP-106 Study of the association of hepatitis B surface antigen and HLA with hepatocellular carcinoma. Int J Infect Dis 2010. [DOI: 10.1016/s1201-9712(10)60174-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Abd El Moety A, Zaher R, Zaki S, Sadek A, Ismail A, Elasy H, El Sawy M. PP-081 Portal bacteraemia in Schistosomal hepatic fibrosis. Int J Infect Dis 2010. [DOI: 10.1016/s1201-9712(10)60149-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Zaki S, Said M, Gazaierly S, Kholeif L, Malaty R. PP-174 Chlamydia trachomatis in cervices of women in late pregnancy. Int J Infect Dis 2010. [DOI: 10.1016/s1201-9712(10)60242-1] [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: 11/28/2022] Open
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Zaki S, Aref M, Hatem N, Sourour R. PP-176 Determination of HLA pattern in paralytic poliomyelitis. Int J Infect Dis 2010. [DOI: 10.1016/s1201-9712(10)60244-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Zaki S, Abd El Moety A, Zaher R, Abou Khatwa M. PP-110 A study of the carriers of hepatitis B surface antigen among patients with schistosomal hepatic fibrosis. Int J Infect Dis 2010. [DOI: 10.1016/s1201-9712(10)60178-6] [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: 11/17/2022] Open
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Abd El Moety H, Abd El Moety A, Zaki S, Abd El Moety A. PP-135 Discovery of the missed link between schistosomiasis and HCV infection. Int J Infect Dis 2010. [DOI: 10.1016/s1201-9712(10)60203-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Ticehurst K, Zaki S, Hunt GB, Macpherson C, Nicholson H. Use of continuous positive airway pressure in the acute management of laryngeal paralysis in a cat. Aust Vet J 2008; 86:395-7. [DOI: 10.1111/j.1751-0813.2008.00350.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Zaki S. Manual of Equine Anaesthesia - Eedited by Doherty T, Valverde A. Aust Vet J 2007. [DOI: 10.1111/j.1751-0813.2007.00208.x] [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: 11/28/2022]
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Abd-El-haleem D, Amara A, Zaki S, Abulhamd A, Abulreesh G. Biosynthesis of biodegradable polyhydroxyalkanotes biopolymers in genetically modified yeasts. Int J Environ Sci Technol 2007; 4:513-520. [DOI: 10.1007/bf03325988] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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40
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Zaki S. Kirk & Bistner's Handbook of Veterinary Procedures and Emergency Treatment. 8 thedn - By Ford RB, Mazzaferro EM. Aust Vet J 2007. [DOI: 10.1111/j.1751-0813.2007.00153.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Abstract
Two ferrets were diagnosed with pneumonia due to Mycobacterium abscessus. Both cases were treated successfully using clarithromycin after positive cultures were obtained via unguided bronchoalveolar lavage. This is the first time M abscessus has been isolated in our laboratory and the first report of this organism causing disease in companion animals in Australia. Underlying respiratory tract disease was thought to be an important factor in the development of the infections. Thorough investigation of chronic lower respiratory tract disease in ferrets is recommended as this species appears predisposed to atypical infections.
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Affiliation(s)
- J A Lunn
- Faculty of Veterinary Science, University of Sydney, New South Wales 2006
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Tan C, Govendir M, Zaki S, Miyake Y, Packiarajah P, Malik R. Evaluation of four warming procedures to minimise heat loss induced by anaesthesia and surgery in dogs. Aust Vet J 2004; 82:65-8. [PMID: 15088962 DOI: 10.1111/j.1751-0813.2004.tb14646.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate the efficiency of four warming procedures, introduced after anaesthetic induction and continued during surgery, in minimising heat loss in anaesthetised dogs. DESIGN Dogs were paired. One of each pair was a control; the other was subjected to one of four warming procedures. METHODS Ninety-six dogs were involved in total. Pairs of dogs were matched for breed, hair length, and type of surgical procedure and placed adjacent to each other in a large temperature-controlled surgical theatre. One dog within each pair was assigned to one of four warming procedures that commenced immediately after anaesthetic induction. Group 1 (11 pairs) were placed on a purpose-designed prewarmed (41 degrees C) electrically heated pad. Group 2 (18 pairs) were placed on a prewarmed electric heat pad (41 degrees C), cocooned by four wrapped water bottles (initially 41 degrees C) and subjected to radiant heat (150 watt lamp placed 50 cm away from the head of the dog). Group 3 (11 pairs) were surrounded by a forced air warming mattress (set at 43 degrees C). Group 4 (8 pairs) were connected via the anaesthetic breathing circuit to a heater/humidifier (set at 41 degrees C). Rectal temperature measurements were recorded every 15 min for the first 3 h of anaesthesia. The fall in rectal temperature of the control dog was subtracted from the fall in temperature of the treatment dog and this measurement was used to assess the efficacy of the various warming procedures. RESULTS The mean rectal temperature of unheated 'control' dogs decreased 1.9 +/- 0.6, 1.4 +/- 0.4 and 1.1 +/- 0.4 degrees C over the first, second and third hour respectively. After 3 h the temperature fall differential for all groups were 0.7 +/- 0.7 (Group 1), 3.1 +/- 1.1 (Group 2), 2.4 +/- 1.1 (Group 3) and 1.0 +/- 1.1 degrees C (Group 4). Thus the group 2 procedure was the most successful in preventing a drop of temperature followed by groups 3, 4 and 1. CONCLUSION Large dogs undergo significant reduction in core body temperature especially during the first 2 h of anaesthesia and surgery. Supplementary warming substantially reduces this fall in body temperature, although certain warming procedures were found to be more effective than others.
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Affiliation(s)
- C Tan
- University Veterinary Centre-Sydney, Faculty of Veterinary Science, The University of Sydney, New South Wales 2006.
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Kakepoto GN, Burney IA, Zaki S, Adil SN, Khurshid M. Long-term outcomes of acute myeloid leukemia in adults in Pakistan. J PAK MED ASSOC 2002; 52:482-6. [PMID: 12553679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
OBJECTIVE To describe the long-term outcomes of Acute Myeloid Leukemia (AML) and to study clinicopathological features at presentation, morphological subtypes and remission rates. METHODS Demographic information, response to therapy and survival of patients (>14 years of age) admitted between January 1988 to August 1996 with acute myeloid leukaemia was retrieved and analysed. RESULTS Seventy-four patients were admitted with a diagnosis of AML during the study period. There were 43 males and 31 females. Age ranged between 15 and 70 years with a mean age of 38 years. The most common presenting feature was fever (67.5%) and the morphological subtype according to French-American-British Group (FAB) criteria was M4. Fifty-five patients received treatment and were evaluable for response and outcomes. Thirty-six (65.4%) patients had complete remission. Sixteen (29.1%) died during the first 28 days after starting induction chemotherapy. The median survival was 11 months. Six (11%) patients (4 females, 2 males) are surviving beyond 4 years (long-term survivors). CONCLUSION Our study suggests that the long-term outcomes of adults with AML are comparable to what has been reported in the literature for patients who do not receive bone marrow transplants.
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Affiliation(s)
- G N Kakepoto
- Department of Pathology, The Aga Khan University Hospital, Karachi
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44
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Zaki S, Burney IA, Khurshid M. Acute myeloid leukemia in children in Pakistan: an audit. J PAK MED ASSOC 2002; 52:247-9. [PMID: 12481633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
OBJECTIVE To see the clinical features and treatment of children with Acute Myeloid Leukemia (AML) in Pakistan. SETTING Tertiary referral at a specialist Hematology/Oncology center. METHODS Retrospective, chart-based review of children (less than 14 years) admitted to the hospital with a diagnosis of AML between January 1987 and August 1997. RESULTS A total of 23 patients were admitted. There were 18 males and 5 females. The mean age was 8 +/- 5 years. M3 was the commonest morphological subtype (43%). Twenty-two percent of the patients presented with hyperleucocytosis (TLC > 100 x 10(9)/L) and 95% with an elevated LDH (> 548 IU/L). Pneumonia at presentation was seen in 29%. Of 23 patients 14 were evaluable for responses. Six patients died early (43%); 3 before starting the chemotherapy and 3 during the induction chemotherapy, 8/11 (73%) patients entered remission. The median survival was 9 months. CONCLUSION The pediatric patients with acute myeloid leukemia present with advanced disease. There is a high early death rate (within 28 days of diagnosis). The long-term outcome was inferior to that reported in the literature.
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Affiliation(s)
- S Zaki
- Department of Family Medicine, Aga Khan University Hospital, Karachi
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45
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Abstract
Peritoneopericardial diaphragmatic hernia is a common incidental finding in cats and is rarely symptomatic. The case report described herein presented with dyspnoea secondary to incarceration of hepatic cysts within the pericardial space of a cat with a peritoneopericardial diaphragmatic hernia.
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Affiliation(s)
- J M Liptak
- University Veterinary Centre, Faculty of Veterinary Science, The University of Sydney, NSW 2006, Australia
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Abd-El-Haleem D, Moawad H, Zaki EA, Zaki S. Molecular characterization of phenol-degrading bacteria isolated from different Egyptian ecosystems. Microb Ecol 2002; 43:217-224. [PMID: 12023728 DOI: 10.1007/s00248-002-2003-2] [Citation(s) in RCA: 15] [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] [Subscribe] [Scholar Register] [Received: 07/26/2001] [Accepted: 12/20/2001] [Indexed: 05/23/2023]
Abstract
Twelve selected phenol-degrading bacterial isolates were obtained on phenol agar plates using culture enrichment technique. Molecular identification of the isolates was performed using eubacterial 16S rRNA PCR specific primers. Based on 16S rDNA sequence analysis, the results revealed that the majority of the isolates (8 out of 12) are affiliated to the g-subdivision of Proteobacteria. Four out of the eight isolates are closely related to the genus Acinetobacter. Molecular heterogeneity among the phenol-degrading isolates was further investigated by using rep-PCR chromosomal fingerprinting and correlated with plasmid and antibiotic profile analysis. Rep-PCR results strongly confirmed that the bacterial isolates from different environmental sites produced different fingerprinting patterns. The mineralization of phenol by all isolates was evaluated using 14C-labeled phenol assay. Phenol mineralization ranged from 55% (W-17) to 0.4% (Sea-9). This was further confirmed by the detection of several monoaromatic and polyaromatic degrading genes, e.g., pheA, MopR, XylE, and NahA. In addition, catalytic enzymes such as catalase and dioxygenase were also monitored.
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Affiliation(s)
- D Abd-El-Haleem
- Environmental Biotechnology Research Department, Genetic Engineering and Biotechnology Research Institute (GEBRI), Mubarak City for Scientific Research and Technology Applications, Research Area-New Burg-Elarab, Alexandria, Egypt.
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Abstract
Information on the pathogenesis and transmissibility of Hendra and Nipah viruses was obtained by comparing their histopathology. Both viruses induced syncytial cells in vascular tissues and they were primarily vasotropic and/or neurotropic, generating interstitial pneumonia or encephalitis. Nipah virus in pigs was also epitheliotropic in respiratory epithelium and thus contagious.
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Affiliation(s)
- P Hooper
- Australian Animal Health Laboratory, CSIRO Livestock Industries, PO Bag 24, 5 Portarlington Road, Geelong, Victoria 3220, Australia
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Jernigan JA, Stephens DS, Ashford DA, Omenaca C, Topiel MS, Galbraith M, Tapper M, Fisk TL, Zaki S, Popovic T, Meyer RF, Quinn CP, Harper SA, Fridkin SK, Sejvar JJ, Shepard CW, McConnell M, Guarner J, Shieh WJ, Malecki JM, Gerberding JL, Hughes JM, Perkins BA. Bioterrorism-related inhalational anthrax: the first 10 cases reported in the United States. Emerg Infect Dis 2001; 7:933-44. [PMID: 11747719 PMCID: PMC2631903 DOI: 10.3201/eid0706.010604] [Citation(s) in RCA: 742] [Impact Index Per Article: 32.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
From October 4 to November 2, 2001, the first 10 confirmed cases of inhalational anthrax caused by intentional release of Bacillus anthracis were identified in the United States. Epidemiologic investigation indicated that the outbreak, in the District of Columbia, Florida, New Jersey, and New York, resulted from intentional delivery of B. anthracis spores through mailed letters or packages. We describe the clinical presentation and course of these cases of bioterrorism-related inhalational anthrax. The median age of patients was 56 years (range 43 to 73 years), 70% were male, and except for one, all were known or believed to have processed, handled, or received letters containing B. anthracis spores. The median incubation period from the time of exposure to onset of symptoms, when known (n=6), was 4 days (range 4 to 6 days). Symptoms at initial presentation included fever or chills (n=10), sweats (n=7), fatigue or malaise (n=10), minimal or nonproductive cough (n=9), dyspnea (n=8), and nausea or vomiting (n=9). The median white blood cell count was 9.8 X 10(3)/mm(3) (range 7.5 to 13.3), often with increased neutrophils and band forms. Nine patients had elevated serum transaminase levels, and six were hypoxic. All 10 patients had abnormal chest X-rays; abnormalities included infiltrates (n=7), pleural effusion (n=8), and mediastinal widening (seven patients). Computed tomography of the chest was performed on eight patients, and mediastinal lymphadenopathy was present in seven. With multidrug antibiotic regimens and supportive care, survival of patients (60%) was markedly higher (<15%) than previously reported.
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Affiliation(s)
- J A Jernigan
- NCID, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
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Hsueh C, Jung SM, Shih SR, Kuo TT, Shieh WJ, Zaki S, Lin TY, Chang LY, Ning HC, Yen DC. Acute encephalomyelitis during an outbreak of enterovirus type 71 infection in Taiwan: report of an autopsy case with pathologic, immunofluorescence, and molecular studies. Mod Pathol 2000; 13:1200-5. [PMID: 11106077 DOI: 10.1038/modpathol.3880222] [Citation(s) in RCA: 86] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We report a fatal case of enterovirus type 71 (EV 71) infection in an 8-year-old girl during a summer outbreak of hand, foot, and mouth disease in 1998 in Taiwan. The clinical course was rapidly progressive, with manifestations of hand, foot, and mouth disease, aseptic meningitis, encephalomyelitis, and pulmonary edema. The patient died 24 hours after admission. Postmortem study revealed extensive inflammation in the meninges and central nervous system and marked pulmonary edema with focal hemorrhage. Brain stem and spinal cord were most severely involved. The inflammatory infiltrates consisted largely of neutrophils involving primarily the gray matter with perivascular lymphocytic cuffing, and neuronophagia. The lungs and heart showed no evidence of inflammation. EV 71 was isolated from the fresh brain tissues and identified by immunofluorescence method with type-specific EV 71 monoclonal antibody. It was also confirmed by neutralization test and reverse-transcriptase polymerase chain reaction with sequence analysis. The present case was the first example in which EV 71 was demonstrated to be the causative agent of fatal encephalomyelitis during its epidemic in Taiwan.
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MESH Headings
- Antigens, Viral/analysis
- Base Sequence
- Child
- Coxsackievirus Infections/epidemiology
- Coxsackievirus Infections/pathology
- Coxsackievirus Infections/virology
- DNA Primers/chemistry
- DNA, Viral/analysis
- Disease Outbreaks
- Encephalitis, Viral/epidemiology
- Encephalitis, Viral/pathology
- Encephalitis, Viral/virology
- Enterovirus/genetics
- Enterovirus/immunology
- Enterovirus/isolation & purification
- Fatal Outcome
- Female
- Fluorescent Antibody Technique, Indirect
- Hand, Foot and Mouth Disease/epidemiology
- Hand, Foot and Mouth Disease/pathology
- Hand, Foot and Mouth Disease/virology
- Humans
- Microscopy, Fluorescence
- Molecular Sequence Data
- Reverse Transcriptase Polymerase Chain Reaction
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Affiliation(s)
- C Hsueh
- Department of Pathology, Chang Gung Memorial Hospital, Tao Yuan, Taiwan
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Swayne DE, Beck JR, Zaki S. Pathogenicity of West Nile virus for turkeys. Avian Dis 2000; 44:932-7. [PMID: 11195649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
In the fall of 1999, West Nile virus (WNV) was isolated during an outbreak of neurologic disease in humans, horses, and wild and zoological birds in New York, Connecticut, and New Jersey. Turkeys could potentially be a large reservoir for WNV because of the high-density turkey farming and the presence of large wild turkey populations in the eastern seaboard of the United States. Little is known about the pathogenicity of WNV in domestic or wild turkeys. Specific-pathogen-free 3-wk-old turkeys were inoculated subcutaneously with 10(3.3) mean tissue culture infective doses of a WNV strain isolated fromthe index case in a New York crow. No clinical signs were observed in the turkeys over the 21 days of the experiment. One turkey died abruptly at 8 days postinoculation (DPI). Many turkeys developed viremia between 2 and 10 DPI, but the average level of virus was very low, less than needed to efficiently infect mosquitos. Low levels of WNV were detected in feces on 4 and 7 DPI, but no virus was isolated from oropharyngeal swabs. WNV wasnot transmitted from WNV-inoculated to contact-exposed turkeys. All WNV-inoculated poults seroconverted on 7 DPI. In the turkey that died, WNV was not isolated from intestine, myocardium, brain, kidney, or cloacal and oropharyngeal swabs, but sparse viral antigen was demonstrated by immunohistochemistry in the heart and spleen. Turkeys in contact with WNV-inoculated turkeys and sham-inoculated controls lacked WNV specific antibodies,and WNV was not isolated from plasma and cloacal and oropharyngeal swabs. These data suggest that WNV lacks the potential to be a major new disease of turkeys and that turkeys will not be a significant amplifying host for infecting mosquitos.
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Affiliation(s)
- D E Swayne
- Southeast Poultry Research Laboratory, USDA/ARS, Athens, GA 30605, USA
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