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Garg SK, Kaur G, Haider Z, Rodriquez E, Beatson C, Snell-Bergeon J. Efficacy of Semaglutide in Overweight and Obese Patients with Type 1 Diabetes. Diabetes Technol Ther 2024; 26:184-189. [PMID: 38444317 DOI: 10.1089/dia.2023.0490] [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] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Abstract
Introduction: More than two-thirds of patients with type 1 diabetes (T1D) are overweight (OW) and/or obese (OB) in the USA and Western Europe, resulting in insulin resistance as in type 2 diabetes. None of the currently available glucagon like polypeptide 1 (GLP-1) analogs are approved for patients with T1D. A higher dose of semaglutide has been approved by the Food and Drug Administration (FDA) for subjects with body mass index (BMI) >27 kg/m2. We evaluated the real-world use of semaglutide in patients with T1D. Methods: This was a retrospective chart review study of 50 OW or OB patients with T1D who were initiated on semaglutide and followed for 1 year. The control group comprised of 50 computer-matched patients (for sex, race, weight, BMI, and diabetes duration) during a similar time period and were not on any weight loss medications. Results: Most patients (92%) were non-Hispanic white in both arms. Mean ± standard deviation (SD) age and duration of diabetes were 42 ± 11 and 27 ± 12 years, respectively. The continuous glucose monitors (CGM), insulin pump use, baseline BMI and body weight were also similar in the two groups. Baseline glycosylated hemoglobin (HbA1c) was insignificantly lower in the semaglutide group (7.6% vs. 8.2%, respectively; P = non-significant [NS]). Total daily insulin dose (TDD) and insulin dose per kg body weight were higher in the semaglutide group at baseline with no difference in basal or prandial insulin dose. There were significantly greater declines in mean (±SD), BMI (7.9% ± 2.6%), body weight (15.9 lbs ± 5.4 lbs), HbA1c, CGM glucose SD and coefficient of variation (CV), and increase in CGM time in range (TIR) in the semaglutide group compared to the control group with no difference in insulin dose changes, time above range (TAR), or time below range (TBR). Conclusions: We conclude that use of semaglutide in patients who are OW and/or OB with T1D was effective in lowering body weight and BMI, and improving glycemic metrics in this pilot real-world study. We strongly recommend performing prospective, large-randomized clinical trials with newer GLP-1 analogs like semaglutide and tirzepatide (twin-cretin) for subjects with T1D associated with OW and/or OB.
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Affiliation(s)
- Satish K Garg
- Barbara Davis Center for Diabetes, Department of Medicine and Pediatrics, University of Colorado Denver, Aurora, Colorado, USA
| | - Gurleen Kaur
- Barbara Davis Center for Diabetes, Department of Medicine and Pediatrics, University of Colorado Denver, Aurora, Colorado, USA
| | - Zehra Haider
- Barbara Davis Center for Diabetes, Department of Medicine and Pediatrics, University of Colorado Denver, Aurora, Colorado, USA
| | - Erika Rodriquez
- Barbara Davis Center for Diabetes, Department of Medicine and Pediatrics, University of Colorado Denver, Aurora, Colorado, USA
| | - Christie Beatson
- Barbara Davis Center for Diabetes, Department of Medicine and Pediatrics, University of Colorado Denver, Aurora, Colorado, USA
| | - Janet Snell-Bergeon
- Barbara Davis Center for Diabetes, Department of Medicine and Pediatrics, University of Colorado Denver, Aurora, Colorado, USA
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Haider Z, Qamer S, Kanwal S, Manzoor S, Naeem M, Uddin J, Liaqat T, Parveen A, Khan A, Al-Harrasi A. Assessment of essential minerals and physico-chemical analysis of floral origins fresh honey produced by Apis mellifera. BRAZ J BIOL 2024; 84:e263534. [DOI: 10.1590/1519-6984.263534] [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: 03/24/2022] [Accepted: 06/02/2022] [Indexed: 11/22/2022] Open
Abstract
Abstract Honey is one of the best nutritious substances in the world, having different services in the body functions regulation. Ten elements (K, Na, Ca, Co, Cr, Mn, Mo, Ni, Pb, Se) from honey samples were analyzed from 80 different locations of Punjab and ten floras. The aim of the present study was to determine the quality and quantity of minerals and Physico-chemical analysis in honey. A flame photometer was used to measure the concentration of major minerals (K, Ca and Na). The concentration of micro minerals (Co, Cr, Mn, Mo, Ni, Pb and Se) was analyzed using Atomic Absorption Spectrometer. The concentration of macro-elements obtained was as follow (in ppm): K (166-1732), Na (107-418) and Ca (07-99), while the concentration of microelements (in ppm) Co (1-2), Cr (>1), Mn (<1), Mo (1.818), Ni (1.911), Pb (<1) and Se (1.968). The most abundant minerals were potassium, calcium and sodium, ranging between 396-810.5, 17.5-640.63 and 169.88-238.62 ppm, respectively. However, the trace mineral elements of honey were obtained in the order of decreasing Se > Co > Ni > Pb > Cr > Mo > Mn. The findings showed that all the heavy metals like Co, Cr, Ni and Pb were present in trace amounts and close to International Honey Quality Standard. The result of given honey samples represented highest value of moisture (31.23%), color (80 mm pfund), pH (8.23), acidity (72.02 meq/kg), electrical conductivity (0.85 ms/cm) and ash contents (0.83%).
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Affiliation(s)
- Z. Haider
- Government College University, Pakistan
| | - S. Qamer
- Government College University, Pakistan
| | | | | | | | - J. Uddin
- King Khalid University, Saudi Arabia
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Smedby KE, Wästerlid T, Tham E, Haider Z, Joelsson J, Thorvaldsdottir B, Krstic A, Wahlin BE, Foroughi-Asl H, Karlsson C, Eloranta S, Saft L, Palma M, Kwiecinska A, Hansson L, Österborg A, Wirta V, Rassidakis G, Sander B, Sonnevi K, Rosenquist R. The BioLymph study - implementing precision medicine approaches in lymphoma diagnostics, treatment and follow-up: feasibility and first results. Acta Oncol 2023; 62:560-564. [PMID: 37415362 DOI: 10.1080/0284186x.2023.2218556] [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: 02/08/2023] [Accepted: 05/16/2023] [Indexed: 07/08/2023]
Affiliation(s)
- K E Smedby
- Dept of Hematology, Karolinska University Hospital Solna, Sweden
- Dept of Medicine Solna, div of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - T Wästerlid
- Dept of Hematology, Karolinska University Hospital Solna, Sweden
- Dept of Medicine Solna, div of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - E Tham
- Dept of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Dept of Clinical Genetics, Karolinska University Hospital Solna, Stockholm, Sweden
| | - Z Haider
- Dept of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - J Joelsson
- Dept of Hematology, Karolinska University Hospital Solna, Sweden
- Dept of Medicine Solna, div of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - B Thorvaldsdottir
- Dept of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - A Krstic
- Dept of Clinical Genetics, Karolinska University Hospital Solna, Stockholm, Sweden
| | - B E Wahlin
- Dept of Hematology, Karolinska University Hospital Solna, Sweden
- Dept of Medicine Huddinge, Karolinska Institutet
| | | | - C Karlsson
- Dept of Hematology, Karolinska University Hospital Solna, Sweden
- Dept of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - S Eloranta
- Dept of Medicine Solna, div of Clinical Epidemiology, Karolinska Institutet, Stockholm, Sweden
| | - L Saft
- Dept of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - M Palma
- Dept of Hematology, Karolinska University Hospital Solna, Sweden
- Dept of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - A Kwiecinska
- Dept of Clinical Pathology and Cancer Diagnostics, Karolinska University Laboratory, Solna and Huddinge, Sweden
| | - L Hansson
- Dept of Hematology, Karolinska University Hospital Solna, Sweden
- Dept of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - A Österborg
- Dept of Hematology, Karolinska University Hospital Solna, Sweden
- Dept of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - V Wirta
- Science for Life Laboratory, Dept of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
- Science for Life Laboratory, Royal Insititute of Technology, Stockholm, Sweden
- Genomic Medicine Center Karolinska, Karolinska University Hospital, Stockholm, Sweden
| | - G Rassidakis
- Dept of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
- Dept of Clinical Pathology and Cancer Diagnostics, Karolinska University Laboratory, Solna and Huddinge, Sweden
| | - B Sander
- Dept of Clinical Pathology and Cancer Diagnostics, Karolinska University Laboratory, Solna and Huddinge, Sweden
- Dept of Laboratory Medicine, Karolinska Institutet Stockholm, Sweden
| | - K Sonnevi
- Dept of Hematology, Karolinska University Hospital Solna, Sweden
- Dept of Medicine Huddinge, Karolinska Institutet
| | - R Rosenquist
- Dept of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
- Dept of Clinical Genetics, Karolinska University Hospital Solna, Stockholm, Sweden
- Genomic Medicine Center Karolinska, Karolinska University Hospital, Stockholm, Sweden
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Idrees M, Khan AM, Lee SH, Kang SM, Kang J, Haider Z, Joo MD, Kong IK. 156 Cycloastragenol activation of telomerase reverse transcriptase improves β-Klotho expression and attenuates age-related malfunctioning in ovarian tissues. Reprod Fertil Dev 2022. [DOI: 10.1071/rdv35n2ab156] [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: 12/12/2022] Open
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Sharma V, Haider Z, Hunter A. The modified Brunelli procedure: a simple passage for the flexor carpi radialis tendon graft. Ann R Coll Surg Engl 2018; 100:1. [PMID: 29658334 PMCID: PMC6204524 DOI: 10.1308/rcsann.2018.0082] [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: 02/28/2024] Open
Affiliation(s)
| | - Z Haider
- University College London Hospitals NHS Foundation Trust, UK
| | - A Hunter
- University College London Hospitals NHS Foundation Trust, UK
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Zhu K, Hossain SMC, Panhwar F, Haider Z, Hu P, Zhao G. Water-transport and Intracellular Ice Formation of Porcine Adipose-derived Stem Cells during Freezing. Cryo Letters 2018; 39:263-268. [PMID: 30963172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Water transport and intracellular ice formation are important processes that relate to cryoinjury of cells upon freezing. To date, no study is reported on the characteristics of water transport and intracellular ice formation in porcine adipose-derived stem cells (pADSC). OBJECTIVE To study water transport and intracellular ice formation upon freezing of pADSCs at different cooling rates. MATERIALS AND METHODS The pADSCs were isolated using collagenase digestion from a subcutaneous adipose tissue of a 28-day-old Landrace pig. Freeze experiments were performed in a gas tight chamber of cryomicroscopy stage at different cooling rates between 40°C and -150°C. RESULTS Water permeability coefficient Lpg and the activation energy ELP decrease with increasing cooling rates for pADSCs. The probability of intracellular ice formation increases with increasing cooling rates, being 0.35, 0.4 and 0.5 for cooling rates at 20, 30 and 60 °C/min respectively. CONCLUSION Based on the characteristics of water transport and intracellular ice formation in pADSCs, slow freezing is perhaps more suitable for pADSC cryopreservation.
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Affiliation(s)
- K Zhu
- Department of Electronic Science & Technology, University of Science and Technology of China, Hefei, China
| | - S M C Hossain
- Department of Electronic Science & Technology, University of Science and Technology of China, Hefei, China
| | - F Panhwar
- Department of Electronic Science & Technology, University of Science and Technology of China, Hefei, China
| | - Z Haider
- Department of Electronic Science & Technology, University of Science and Technology of China, Hefei, China
| | - P Hu
- Department of Thermal Science & Energy Engineering, University of Science and Technology of China, Hefei, China.
| | - G Zhao
- Department of Electronic Science & Technology, University of Science and Technology of China, Hefei, China.
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Memon K, Cheng Y, Panhwar F, Chen ZR, Haider Z, Afridi S, Hu P, Zhao G. A Low-cost Easy-to-Fabricate Sandwich-Structured Microdevice for Controllable Removal of Extracellular Cryoprotective Agents with High Efficiency. Cryo Letters 2018; 39:7-13. [PMID: 29734411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
UNLABELLED BACKGROUND: Osmotic shock upon the addition and removal of cryoprotectant agent (CPA) is a major source of cell damage during cryopreservation. OBJECTIVE Microfluidic device offers a new platform for CPA loading and unloading. The micro scale dimension makes possible to perform a detailed analysis and controllable removal of CPA with many advantages. MATERIALS AND METHODS A microfluidic device was developed for extracting dimethyl sulfoxide (DMSO) from the sample streamline. The device has two parallel channels separated by a polytetrafluoroethylene (PTFE) membrane and serves as the stable environment for CPA removal. A diffusion-based simulation model was used to characterize the CPA extraction. To support the experimental design and device optimization we developed analogous scheme to simulate by COMSOL Multiphysics. RESULTS AND CONCUSION The device can extract cryoprotectant in a mesoscale volume from cells and simplify the post-thaw sample handling. It has sufficient control on loading/unloading of CPAs by controlling the flow rate of cell stream/wash stream solutions via syringe pumps. Compared to other customary devices, this device is easy to fabricate and assemble, with features of high precision, reusability and low cost.
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Affiliation(s)
- K Memon
- Department of Electronic Science and Technology, University of Science and Technology of China
| | - Y Cheng
- Department of Electronic Science and Technology, University of Science and Technology of China
| | - F Panhwar
- Department of Electronic Science and Technology, University of Science and Technology of China
| | - Z R Chen
- Department of Electronic Science and Technology, University of Science and Technology of China
| | - Z Haider
- Department of Electronic Science and Technology, University of Science and Technology of China
| | - S Afridi
- Department of Precision Instruments, Tsinghua University Graduate School at Shenzhen, Shenzhen, China
| | - P Hu
- Department of Thermal Science and Energy Engineering, University of Science and Technology of China, Hefei, China
| | - G Zhao
- Department of Electronic Science and Technology, University of Science and Technology of China, Hefei; Anhui Provincial Engineering Technology Research Center for Biopreservation and Artificial Organs, Hefei, China. or
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Haider Z, Nour M, Tsoronis C, Lorenzi B. Assessing patient knowledge of the bariatric protocol peri-surgery. Int J Surg 2016. [DOI: 10.1016/j.ijsu.2016.08.431] [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: 10/20/2022]
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10
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Mamun SMA, Haider Z, Talukder QI, Zahangir NM. A Case of Benign Giant, Schwannoma and Review of literature. Pulse (Basel) 2014. [DOI: 10.3329/pulse.v6i1-2.20350] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Though variety of benign and malignant tumors of peripheral nerve origin can occur in the mediastinum, benign schwannoma is the most common neurogenic tumor in the mediastinum Schwannoma is a non cancerous (benign) tumor that involves the Schwann cells in the protective covering of nerves, called the myelin sheath. Schwannoma is the common neurogenic tumor in the mediastinum. They are most often asymptomatic but sometimes accompanied by bloody pleural effusion. Herein, we report a case of giant, benign schwannoma presented with minimum symptoms of back pain and occasional chest pain. The case is reported here along with a literature review. DOI: http://dx.doi.org/10.3329/pulse.v6i1-2.20350 Pulse Vol.6 January-December 2013 p.48-50
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Zahangir NM, Nazmul M, Khan TMNS, Chowdury RA, Haider Z. Rare Vascular Surgery in Apollo Hospitals, Dhaka - Right Popletial to Dorsalis pedis Artery Anastomosis and Axillary Bi Femoral Bi Poplileal Bypass Grafting - limb salvage procedure. Pulse (Basel) 2014. [DOI: 10.3329/pulse.v5i2.20270] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Bypass grafts to the dorsalis pedis artery provide excellent revascularization to ischemic foot. It is a durable and effective procedure for limb salvage. Axillo femoral-popliteal procedure offers a reasonable alternative in high-risk patients. We are reporting 2 cases of such procedures from Apollo hospitals, Dhaka. Right Popletial to Dorsalis pedis artery anastomosis was done in a 32 years old man. Interposition venous graft was done from the right popliteal artery to dorsalis pedis artery. Axillo-Bi Femoral-Bi Poplileal Bypass Grafting: was done in a 59 years old man. Knitted fabric strength graft was used. Both the patients were doing well in postoperative period. DOI: http://dx.doi.org/10.3329/pulse.v5i2.20270 Pulse Vol.5 July 2011 p.65-71
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Sajid MS, Leaver C, Haider Z, Worthington T, Karanjia N, Singh KK. Routine on-table cholangiography during cholecystectomy: a systematic review. Ann R Coll Surg Engl 2012; 94:375-80. [PMID: 22943325 PMCID: PMC3954316 DOI: 10.1308/003588412x13373405385331] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2011] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION The aim of this review was to systemically analyse trials evaluating the efficacy of routine on-table cholangiography (R-OTC) versus no on-table cholangiography (N-OTC) in patients undergoing cholecystectomy. METHODS Randomised trials evaluating R-OTC versus N-OTC in patients undergoing cholecystectomy were selected and analysed. RESULTS Four trials (1 randomised controlled trial on open cholecystectomy and 3 on laparoscopic cholecystectomy) encompassing 860 patients undergoing cholecystectomy with and without R-OTC were retrieved. There were 427 patients in the R-OTC group and 433 patients in the N-OTC group. There was no significant heterogeneity among trials. Therefore, in the fixed effects model, N-OTC did not increase the risk (p=0.53) of common bile duct (CBD) injury, and it was associated with shorter operative time (p<0.00001) and fewer peri-operative complications (p<0.04). R-OTC was superior in terms of peri-operative CBD stone detection (p<0.006) and it reduced readmission (p<0.03) for retained CBD stones. CONCLUSIONS N-OTC is associated with shorter operative time and fewer peri-operative complications, and it is comparable to R-OTC in terms of CBD injury risk during cholecystectomy. R-OTC is helpful for peri-operative CBD stone detection and there is therefore reduced readmission for retained CBD stones. The N-OTC approach may be adopted routinely for patients undergoing laparoscopic cholecystectomy providing there are no clinical, biochemical or radiological features suggestive of CBD stones. However, a major multicentre randomised controlled trial is required to validate this conclusion.
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Affiliation(s)
- M S Sajid
- Western Sussex Hospitals NHS Trust, UK.
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Affiliation(s)
- Zehra Haider
- Resident in Internal Medicine, Mayo School of Graduate Medical Education, Rochester, MN
| | - Constantine Tsigrelis
- Fellow in Infectious Diseases, Mayo School of Graduate Medical Education, Rochester, MN
| | - Larry M. Baddour
- Adviser to resident and fellow and Consultant in Infectious Diseases, Mayo Clinic, Rochester, MN
- Individual reprints of this article are not available. Address correspondence to Larry M. Baddour, MD, Division of Infectious Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905 ().
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Condous G, Van Calster B, Kirk E, Haider Z, Timmerman D, Van Huffel S, Bourne T. Prediction of ectopic pregnancy in women with a pregnancy of unknown location. Ultrasound Obstet Gynecol 2007; 29:680-7. [PMID: 17486691 DOI: 10.1002/uog.4015] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
OBJECTIVE We have previously published on the use of mathematical Model M1 to predict ectopic pregnancy in women with no signs of intra- or extrauterine pregnancy. The aim of this study was to improve on the performance of this model for the detection of developing ectopic pregnancies in women with pregnancies of unknown location (PULs). We therefore generated and evaluated a new logistic regression model from simple hormonal data and compared it with Model M1. METHODS Data were collected prospectively from women classified as having a PUL. These women were followed until the diagnosis was established as: a failing PUL, an intrauterine pregnancy (IUP) or an ectopic pregnancy. A multinomial logistic regression model, Model M4, was developed on 201 training cases and it was tested prospectively on another 175 women with a PUL. M4 performance was evaluated using receiver-operating characteristics (ROC) curves and compared with Model M1 based on the human chorionic gonadotropin (hCG) ratio alone. RESULTS A total of 376 women with a PUL were recruited into this study: 201 in the training set (109 (54.2%) with a failing PUL, 76 (37.8%) with an IUP and 12 (6.0%) with an ectopic pregnancy; four with a persisting PUL were excluded from analysis) and 175 in the test set (94 (53.7%) with a failing PUL, 64 (36.6%) with an IUP and 15 (8.6%) with an ectopic pregnancy; two with a persisting PUL were excluded from analysis). The log serum hCG average ((hCG 0 h + hCG 48 h)/2) and the hCG ratio (hCG 48 h/hCG 0 h) were encoded as variables following multivariate analysis of the basic data. The new Model M4 contained the log of the hCG average, the hCG ratio and its quadratic effect. In the prediction of ectopic pregnancy, M4 gave an area under the ROC curve (AUC) of 0.900 and M1 gave an AUC of 0.842 (P = 0.0303). CONCLUSIONS Although Model M4 is superior to Model M1 when comparing the AUCs for prediction of developing ectopic pregnancies in a PUL population, in real terms this model did not result in substantially more pregnancies being classified correctly as developing ectopic pregnancies. Prospective multicenter studies are needed to assess the diagnostic performance of such models in different populations.
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Affiliation(s)
- G Condous
- Early Pregnancy, Gynaecological Ultrasound and MAS Unit, Department of Obstetrics and Gynaecology, St. George's Hospital Medical School, University of London, London, UK.
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Kirk E, Condous G, Van Calster B, Haider Z, Van Huffel S, Timmerman D, Bourne T. A validation of the most commonly used protocol to predict the success of single-dose methotrexate in the treatment of ectopic pregnancy. Hum Reprod 2006; 22:858-63. [PMID: 17088266 DOI: 10.1093/humrep/del433] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Currently, the likely success of single-dose methotrexate (MTX) (50 mg/m(2)) for the treatment of ectopic pregnancy is indicated by a >15% decrease in hCG from days 4-7 after administration. The aim of this study was to assess this protocol and to develop new rules that could be used to predict the outcome at an earlier stage. METHODS Data were collected prospectively. Women receiving MTX for an ectopic pregnancy had serum hCG and progesterone levels checked on days 1, 3, 4, 5 and 7. Other factors including age, gestational age, previous obstetric history and ultrasound findings were recorded. The women were followed up until the outcome of medical management was known. Univariate analysis was performed to determine the benefit of the '15% day 4-7 rule', as well as to develop new rules, which potentially could be used to predict the likelihood of success before 7 days. Historical and ultrasound variables were also analysed to identify the significant variables associated with successful conservative management. RESULTS The success rate of single-dose MTX was 68.1% (47/69). A second dose was required in 18.8% (13/69) of cases, and it was successful in 84.6% (11/13). The 15% day 4-7 rule correctly predicted the outcome in 90.3% of cases [sensitivity 93.0%, specificity 84.2%, positive predictive value (PPV) 93.0% and negative predictive value (NPV) 84.2%, Fisher exact test P-value < 0.0001]. New rules were developed based on the percentage change day 4-5 and logistic regression models incorporating day 5 hCG levels and ultrasound findings. These new rules did not outperform the current 15% day 4-7 rule. CONCLUSIONS We have confirmed that a 15% decrease in serum hCG between day 4 and day 7 is a very good indicator of the likely success of MTX. The development of new rules did not significantly improve our ability to predict a successful outcome at an earlier stage.
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Affiliation(s)
- E Kirk
- Department of Obstetrics & Gynaecology, Early Pregnancy, Gynaecological Ultrasound and MAS Unit, St George's, University of London, London, UK.
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Haider Z, Condous G, Khalid A, Kirk E, Mukri F, Van Calster B, Timmerman D, Bourne T. Impact of the availability of sonography in the acute gynecology unit. Ultrasound Obstet Gynecol 2006; 28:207-13. [PMID: 16807944 DOI: 10.1002/uog.2801] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
OBJECTIVE The initial assessment of acute gynecology patients is usually based on history and clinical examination and does not involve ultrasound. The aim of this study was to investigate the impact of the availability of transvaginal sonography at the time of initial assessment of the emergency gynecology patient. METHODS This was a prospective observational study carried out over a 5-month period in the acute gynecology unit of an inner London teaching hospital. Women were assessed in the routine manner by history-taking and clinical examination and questionnaires were completed by the doctors, including details of the intention to treat. Transvaginal ultrasound examinations were then performed and a second diagnosis and management plan were made utilizing the extra information from the scan. The plans for clinical management before and after the ultrasound examination were compared. RESULTS We originally recruited 1000 consecutive women to the study. The mean age was 31.1 (SD, 9.81) years. Complete data were available for 920 (92%). 84 (9.1%) women did not require a scan. Of the 521 women with a positive pregnancy test, 75.6% were reassured immediately that their pregnancy was intrauterine. 143 women (27.4%) were given the diagnosis of a suspected ectopic pregnancy before sonography, compared with 29 (5.6%) after. Following the ultrasound examination there was a change in clinical management in 54.1% of the women with a positive pregnancy test and a reduction in admissions (including inpatient theater admissions) (from 40.3% to 17.1%) and outpatient follow-up examinations (from 41.1% to 35.5%). In 90 (23.8%) non-pregnant women a significant ovarian cyst (> 5 cm) was suspected clinically; 28/90 (31.1%) were confirmed on sonography. Following the ultrasound examination there was a change in clinical management for 38.1% of non-pregnant women and a reduction in admissions (from 37.1% to 19.4%) and outpatient follow-up examinations (from 25.7% to 18.1%). CONCLUSION It appears that the availability of transvaginal sonography at the time of initial assessment of emergency gynecology patients improves diagnostic accuracy and reduces unnecessary admissions and follow-up examinations.
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Affiliation(s)
- Z Haider
- Acute Gynaecology Unit, St. George's Hospital, London, UK.
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Kirk E, Condous G, Haider Z, Syed A, Ojha K, Bourne T. The conservative management of cervical ectopic pregnancies. Ultrasound Obstet Gynecol 2006; 27:430-7. [PMID: 16514619 DOI: 10.1002/uog.2693] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE To evaluate the role of conservative management in the treatment of cervical ectopic pregnancies. METHODS This was a retrospective analysis of all cervical ectopic pregnancies diagnosed in women attending our early pregnancy unit between April 1997 and September 2004 inclusive. The diagnosis of cervical ectopic pregnancy was made using transvaginal ultrasound. Clinical and demographic data were recorded in all cases. Serum human chorionic gonadotropin levels were measured at presentation and monitored subsequently to determine the rate of successful resolution. Conservative management was in the form of medical or expectant management. Medical management involved administration of systemic or intra-amniotic methotrexate, with or without intra-amniotic potassium chloride. Systemic methotrexate was either a single dose of 50 mg/m2 or an alternate-day regimen of methotrexate at 1 mg/kg (days 1,3,5) with folinic acid rescue (days 2,4,6). If intra-amniotic treatment was required, this was either 50 mg methotrexate or 5 mmol/L potassium chloride. RESULTS Seven cervical ectopic pregnancies were diagnosed during the study period. Three cases were managed successfully with a single dose of methotrexate. One case was managed successfully using a multiple-dose methotrexate regimen. Another case failed medical management with both the single- and multiple-dose regimens but was successfully treated after potassium chloride was given intra-amniotically under ultrasound guidance. One case was successfully treated with intra-amniotic methotrexate and another was managed expectantly. There was no associated morbidity or mortality during the study period. We also performed a review of the current literature. CONCLUSION The conservative management of cervical ectopic pregnancy is effective and safe.
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Affiliation(s)
- E Kirk
- Early Pregnancy, Gynaecological Ultrasound and MAS Unit, St George's Hospital Medical School, London, UK.
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Kirk E, Condous G, Haider Z, Lu C, Van Huffel S, Timmerman D, Bourne T. The practical application of a mathematical model to predict the outcome of pregnancies of unknown location. Ultrasound Obstet Gynecol 2006; 27:311-5. [PMID: 16456845 DOI: 10.1002/uog.2702] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
OBJECTIVE A logistic regression model has been developed previously to predict which pregnancies of unknown location (PULs) become ectopics. This model was based on the human chorionic gonadotropin (hCG) ratio (hCG 48 h/hCG 0 h). The aim of this study was to evaluate the model in an early pregnancy clinical setting. METHODS This was a prospective non-interventional observational study. Women classified as having a PUL had serum hCG and progesterone levels taken at presentation and 48 h later. At 48 h, nurse practitioners in the early pregnancy unit gave their subjective assessment of the likely pregnancy outcome based upon existing strategies to predict the outcome of PULs and their own previous experience. This was used as the basis for the clinical management of the women. The hormonal data were then entered into the model, which was available on the clinic computer in the form of a Microsoft Excel package, and the predicted outcome according to this model was recorded for each case. The model was weighted in favor of detecting an ectopic pregnancy at the expense of failing PULs and intrauterine pregnancies. All women were followed up until the final true diagnosis was established: a failing PUL, an intrauterine pregnancy or an ectopic pregnancy. The predicted outcome according to the model was compared with that of the subjective assessment of the expert operator and the true outcome after follow-up. RESULTS Data were obtained from 357 women classified as having PULs. The final clinical outcomes were: 162 (45.4%) failing PULs, 166 (46.5%) intrauterine pregnancies and 29 (8.1%) ectopic pregnancies. Subjective assessment utilizing current strategies gave sensitivities of 79.3%, 92.8% and 87.0% for the detection of ectopic pregnancy, intrauterine pregnancy and failing PUL, respectively. The model detected ectopic pregnancy, intrauterine pregnancy and failing PUL with sensitivities of 82.8%, 86.8% and 73.5%, respectively. There were no adverse outcomes. CONCLUSION This logistic regression model, based on the hCG ratio, can be used to predict the outcome of PULs, especially the ectopic pregnancies, with a high degree of certainty. It compares favorably with subjective assessment by experienced operators using current strategies to predict the outcome of PULs. The model can be used by those with limited knowledge or understanding of the behavior of serum biochemistry in the first trimester and in turn aid in the classification of PULs into those at low and those at high risk of ectopic pregnancy at 48 h.
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Affiliation(s)
- E Kirk
- Early Pregnancy, Gynaecological Ultrasound and MAS Unit, St George's Hospital, London, UK.
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Abstract
Budd-Chiari syndrome (BCS) is characterized by obstruction of the hepatic venous outflow tract. Therapeutic options for BCS are limited. We report a case of a 21-year-old woman with protein S and C deficiency with gross ascites. Treatment with transjugular intrahepatic portosystemic shunt (TIPS) was attempted, which revealed occluded hepatic veins, so transcaval TIPS was performed. No serious procedure-related complication occurred. After successful shunt creation, the patient's symptoms subsided and she was discharged and followed up for 6 months.
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Affiliation(s)
- T Ul Haq
- Department of Radiology, The Aga Khan University Hospital, Karachi, Pakistan
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Abstract
BACKGROUND Gastrointestinal complications after cardiac surgery remain a significant problem despite improvements in pre-operative, operative and post-operative care. The pathophysiology is uncertain, and their prevention remains suboptimal. This prospective, randomised study was designed to define the role of cardiopulmonary bypass (CPB) and cardioplegic arrest in the pathogenesis of gastrointestinal complications following coronary artery surgery. METHODS AND RESULTS Three hundred patients were prospectively randomised to (1) on-pump conventional coronary artery surgery [150 patients, 114 men, mean age 64 (45-75 years)] with mild hypothermic (32c) CPB and cardioplegic arrest of the heart or (2) off-pump surgery [150 patients, 113 men, mean age 64 (38-66) years] on the beating heart. The association of perioperative factors with gastrointestinal complications was investigated by univariate analysis. Significant variables were then included into a stepwise logistic regression model to ascertain their independent influence on the occurrence of gastrointestinal complications. There were no significant baseline differences between the groups. Eleven patients in the on-pump group and one patient in the off-pump group had post-operative gastrointestinal complications. Univariate analysis showed that CPB inclusive of cardioplegic arrest, left ventricular ejection fraction <50%, emergency surgery, prolonged aortic cross clamp and CPB time, post-operative low cardiac output syndrome, post-operative inotropic requirement, new onset atrial fibrillation (AF), excessive post-operative blood loss and redo thoracotomy <24 hours were predictors of gastrointestinal complications after coronary artery surgery (all p<0.05). However, stepwise multivariate regression analysis identified CPB inclusive of cardioplegic arrest as the only predictor of post-operative gastrointestinal complications (OR7.4; CI 3.4-17.9). CONCLUSIONS Cardiopulmonary bypass, inclusive of cardioplegic arrest, is the main independent predictor of post-operative gastrointestinal complications in patients undergoing coronary revascularisation.
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Affiliation(s)
- S G Raja
- Department of Cardiovascular Surgery, Mayo Hospital, Lahore, Pakistan
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Abstract
OBJECTIVES Dual endoscopy is frequently performed on the same day in patients whose stools are found to be positive on fecal occult blood testing (FOBT). This is often done to localize the potential sources of GI bleed. The diagnostic yield of same day dual upper endoscopy (EGD) and lower endoscopy (colonoscopy) for the detection of positive FOBT is uncertain. In the era of cost-efficient medical practice, we investigated whether a more evidence-based and structured approach could be used to guide physicians to the workup of patients who present with positive FOBT. METHODS We performed a retrospective analysis of 309 patients, and 260 patients from this population met our inclusion criteria. Inclusion criteria included FOBT without acute GI hemorrhage, hematochezia, or melena. Patients were required to have had EGD and colonoscopy within the same day (<24 h). RESULTS Of 260 patients, a total of 135 (52%) patients had positive findings on colonoscopy and a total of 42 (16.1%) patients had positive findings on EGD. Sixteen (6.1%) had positive EGD and negative colonoscopy; 109 (42%) had positive colonoscopy and negative EGD; and 26 (10%) had positive findings on both EGD and colonoscopy. CONCLUSIONS Colonoscopy should be chosen as the initial procedure of choice in the evaluation of patients who present with positive FOBT. Same day dual endoscopy does not seem to be cost-effective.
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Affiliation(s)
- M Ali
- New York Medical College, Department of Medicine, Saint Vincent's Catholic Medical Center, Staten Island, New York 10310, USA
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Babar MM, Rashid A, Jan M, Munir M, Haider Z. Rational prescription of medicines--a study of indoor patients at a tertiary care hospital. J Ayub Med Coll Abbottabad 2001; 13:17-8. [PMID: 11732214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
Abstract
BACKGROUND A study was conducted at Ayub Teaching Hospital, Abbottabad, a tertiary hospital, to know whether drugs are prescribed rationally keeping in mind indications, interactions, contraindications, proper dosage and economy of the patient. METHODS The study was a descriptive case study. Records of 200 patients admitted in various units of the hospital were analysed by a panel of pharmacologists and conclusions drawn. RESULTS It was found that only 52% of patients receive prescriptions that were rationale in all aspects. Where as in rest of the patients the rationale could be challenged. CONCLUSION This study stresses the need for more concentrated and dedicated effort towards prescription of medicines.
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Affiliation(s)
- M M Babar
- Pharmacology Department, Ayub Medical College, Abbottabad
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Affiliation(s)
- A S Kent
- Department of Obstetrics and Gynaecology, St. Richard's Hospital, Chichester, West Sussex, UK
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Rehman K, Khan AA, Haider Z, Shahzad A, Iqbal J, Khan RU, Ahmad S, Siddiqui A, Syed SH. Prevalence of seromarkers of HBV and HCV in health care personnel and apparently healthy blood donors. J PAK MED ASSOC 1996; 46:152-4. [PMID: 8993043] [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: 02/03/2023]
Abstract
Ninety-five health care workers and 91 controls were screened for seromarkers of both HBV (HBsAg, HBeAg, Anti-HBc) and HCV (anti-HCV) by ELISA. The control group showed a much higher frequency of seromarkers for both the viruses. HBsAg was positive in 5% of study group (health care personnel) and 14% of controls. Anti-HBc as a marker of past HBV-exposure was positive in 28% of study group as compared to 36% of controls. Overall, 33% of study group and 48% of control showed one or the other marker of HBV Anti-HCV was positive in 4% of study group and 14% of controls. This study suggests that health care workers are not particularly a high risk group as compared to rest of the population.
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Affiliation(s)
- K Rehman
- Department of Medicine, Services Hospital, Lahore
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Alvaro RE, Rehan V, de Almeida V, Haider Z, Robertson M, Jansen A, Cates DB, Rigatto H. Specificity of a placental factor inhibiting breathing in fetal sheep. Reprod Fertil Dev 1996; 8:423-9. [PMID: 8795106 DOI: 10.1071/rd9960423] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
We have found previously that the infusion of a placental extract inhibits breathing induced by 100% O2 plus umbilical cord occlusion in the fetal sheep, suggesting that a placental factor is responsible for the inhibition of fetal breathing. To test whether this factor is specific to the placenta and whether it also inhibits spontaneous fetal breathing (occurring in the absence of cord occlusion), we administered extracts from the placenta, muscle and liver of the pregnant ewe, extracts of fetal liver, and Krebs solution to 16 chronically instrumented fetal sheep at 135 +/- 5 days of gestation. Infusions were made during low-voltage electrocortical activity, 5 to 15 min after a switch from high voltage, when breathing was well established. Within 90 s of the infusion of the placental extract in the carotid artery of the fetus, breathing decreased in 79% (33/42) of the experiments and was completely abolished in 71% (30/42) of them (P < 0.0001 compared with the other infusates). No apnoeas were observed with the Krebs solution (0/19) and the maternal muscle (0/20). Extracts of maternal and fetal liver abolished breathing in only 17% (4/23) and 21% (6/29) of the experiments respectively (NS compared with Krebs solution). There were no significant changes in blood gas tensions, pH, blood pressure and heart rate associated with the infusion of the extracts. The electrocortical activity (ECoG) switched from low to high voltage in 50% of the experiments using placental extract compared with 0% with Krebs solution and maternal muscle, and with 9% and 17% with maternal and fetal liver respectively (P < 0.005). Breathing output (integral of EMGdi x f) during and after the infusions significantly decreased only with the placental extract. These findings indicate the presence of a factor produced by the placenta which inhibits fetal breathing and may be responsible for the normal inhibition of breathing observed in fetal life.
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Affiliation(s)
- R E Alvaro
- Department of Pediatrics, University of Manitoba, Winnipeg, Canada
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de Almeida V, Alvaro R, al-Alaiyan S, Haider Z, Rehan V, Cates D, Nowaczyk B, Kwiatkowski K, Rigatto H. Prevalence and characterization of spontaneous oral breathing in preterm infants. Am J Perinatol 1995; 12:185-8. [PMID: 7612092 DOI: 10.1055/s-2007-994448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Oral breathing is an important defense mechanism, yet its prevalence and relationship to behavioral activities have not been studied in preterm infants. We tested the hypothesis that oral breathing is rare in these infants and likely to be restricted to periods of body movements. Ten healthy preterm infants (birthweight 1300 +/- 100 g [SE]; gestational age 29 +/- 1 weeks; postnatal age 36 +/- 7 days) were studied. Ventilation was measured with a nose piece and screen flowmeter. Oral breathing was detected with a carbon dioxide sampler at the mouth. Movements were classified according to intensity into type I (localized, minor signal distortion) and type II (generalized, moderate signal distortion). Oral breathing was present 10% of the time, with a mean duration of 27 +/- 3 seconds. Of 104 episodes of oral breathing, 13 (13%) occurred during type I movement, 89 (86%; p < 0.01) during type II, and 2 (2%) in the absence of movement. The delay from beginning of movements to the beginning of oral breathing was 20 +/- 3 seconds. Nasal minute ventilation decreased from 0.203 +/- 0.013 L.min-1.kg-1 during movements in the absence of oral breathing to 0.167 +/- 0.013 L.min-1.kg-1 during movements plus oral breathing (p = 0.017). In 496 type I and II movements, the prevalence of oral breathing was 21 of 165 (13%) in quiet sleep, 37 of 194 (19%) in rapid eye movement sleep, 6 of 12 (50%) in transitional sleep, and 44 of 125 (35%) in indeterminate sleep (p < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- V de Almeida
- University of Manitoba, Department of Pediatrics, Winnipeg, Canada
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deAlmeida VL, Alvaro RA, Haider Z, Rehan V, Nowaczyk B, Cates D, Kwiatkowski K, Rigatto H. The effect of nasal occlusion on the initiation of oral breathing in preterm infants. Pediatr Pulmonol 1994; 18:374-8. [PMID: 7892072 DOI: 10.1002/ppul.1950180606] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
The ability to switch from nasal to oral breathing in response to nasal obstruction is crucial for survival, and has been suggested to be an important mechanism in preventing sudden infant death syndrome (SIDS). To know whether the ability to switch from nasal to oral breathing is uniformly present during the early neonatal period, we examined the effects of slow and fast nasal occlusions on the establishment of oral breathing in preterm infants. Slow occlusions were used to mimic more closely occlusions occurring spontaneously. We studied 17 healthy preterm infants [birth weight, 1830 +/- 27 g (mean +/- SE); study weight, 1800 +/- 109 g; gestational age, 32 +/- 1 weeks; postnatal age, 12 +/- 2 days]. We used a nosepiece with a nasal occluder and a flow-through system to measure ventilation. A CO2 sampling catheter at the mouth was used to detect oral breathing. Of 58 occlusions, 29 were slow [resistance increasing slowly from 0 to infinite (occlusion)], and 29 were fast (infinite elastance applied in < 1 sec). Oral breathing was always established following slow and fast occlusions. In 44% of the slow occlusions, oral breathing started before complete occlusion. Arousal was observed in 12/58 (17%) of all occlusions, occurring primarily after initiation of oral breathing. Oxygen saturation and respiratory rate decreased significantly following occlusions, from 96 +/- 0.6 to 87 +/- 1.2% and 49 +/- 2.8 to 38 +/- 2 breaths/min, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- V L deAlmeida
- Department of Pediatrics, University of Manitoba, Winnipeg, Canada
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Haider Z, Khan AA, Rehman K, Janjua MI, Iqbal J, Chishti MA, Qayyum A, Hasnain S, Shahzad A. Sero-diagnosis for viral hepatitis in 93 patients admitted with acute hepatitis in three different teaching hospitals in Lahore. J PAK MED ASSOC 1994; 44:182-4. [PMID: 7996663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Serodiagnosis was done in 93 patients admitted with acute viral hepatitis (AVH) to three teaching hospitals in Lahore. Five (5.4%) had hepatitis A, 39 (41.9%) hepatitis B (2 of these were anti delta positive) [see erratum notice], 44 (47.3%) probable hepatitis E and 3(3.2%) had HAV/HBV co-infection. Antibody to hepatitis C (anti HCV) was detected in 6 patients (6.4%); 2 with HBV and 4 with probable HEV infection. Excluding 39 patients with hepatitis B and 3 with HBV as part of co-infection, there was evidence of previous HBV infection in 39 out of the remaining 51 patients. In the subset of 6 children, 3 had hepatitis A and 3 hepatitis E. Of these, 5 had evidence of previous exposure to HBV and one was also positive for anti HCV. Our results are suggestive of a strong background of HBV infection raising concern about its chronic sequelae in the community.
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Affiliation(s)
- Z Haider
- Department of Gastroenterology, Shaikh Zayed Hospital, Lahore
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Haider Z, Bano KA. Experience with anti-hypertensive drug therapy in a hypertension clinic--1972-1983. A retrospective analysis. J PAK MED ASSOC 1990; 40:91-3. [PMID: 1981083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Retrospective experience with drug therapy in 747 patients with essential hypertension registered from 1972-1983 is reported. Five hundred patients were seen between 1972 to 1978 and 247 between 1979-1983; the latter group was characterised by the use of beta blockers as first line drugs. Hypertension was graded according to level of diastolic blood pressure as mild, moderate and moderately severe or severe in 423, 211, and 113 patients, respectively. The overall response to treatment at 6 months was satisfactory in 66.2% of mild, 50.2% of moderate and 58.4% of severe grades of hypertension. A large number of patients in both the groups having varying grades of severity needed at least 2 to 3 drugs for the control of hypertension. The side effects of drugs were generally mild which included general weakness with diuretics; skin rash, nasal congestion and pruritus with methyldopa; cold extremities with beta blockers and palpitations with prazosin.
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Affiliation(s)
- Z Haider
- PMRC Research Centre, Fatima Jinnah Medical College, Lahore
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Haider Z, Bano KA. Prevalence of obesity in patients with essential hypertension of varying severity. J PAK MED ASSOC 1985; 35:354-7. [PMID: 3937908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Haider Z, Bano KA. Clinical evaluation of 'Tenormin' (Atenolol) in hypertension. J PAK MED ASSOC 1984; 34:13-6. [PMID: 6423846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
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Haider Z, Obaidullah S. Clinical diabetes mellitus in Pakistan. J Trop Med Hyg 1981; 84:155-8. [PMID: 7265345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
The profile of clinical diabetes in Pakistani patients was studied by doing a retrospective analysis of 1000 patients registered in a diabetic clinic between 1972 and 1976. There was a female preponderance, and 50% of the patients were overweight. The distribution of patients in the two major types of diabetes was: juvenile, 22(2.2%), and maturity onset type, 948(94.8%); 37 patients amongst the latter group had the onset of diabetes at a younger age and 129 were underweight. In the remaining 30 patients (3%), diabetes mellitus was insulin dependent showing relative insulin resistance without any tendency to ketosis. The major complications of diabetes and associated conditions included ischaemic heart disease (8.5%), retinopathy (11%), nephropathy (8.6%), neuropathy (17.9%), hypertension (26.4%) and cataracts (16.4%). In contrast to the experience in western countries, peripheral vascular disease was rare being present in only one patient (0.1%). There were only three patients with cerebrovascular disease of which two had associated hypertension. It may be of interest to monitor the changes in the profile of diabetes in those migrating from this subcontinent to more temperate areas.
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Usman S, Bano KA, Haider Z, Rana IA, Sajjad R. Study of blood pressure pattern and screening for glycosuria in urban and rural population--a pilot study. J PAK MED ASSOC 1981; 31:138-45. [PMID: 6792394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Haider Z, Din FU, Aslam M. Early maturity onset diabetes mellitus presenting as episodes of hypoglycaemia. J PAK MED ASSOC 1981; 31:129-30. [PMID: 6792391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Aslam M, ud Din F, Obaidullah S, Haider Z. Study of plasma insulin and glucose profile in obese and non-obese normal controls and diabetic subjects. J PAK MED ASSOC 1981; 31:39-42. [PMID: 6785485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Haider Z, Obaidullah S, ud Din F. A prospective follow up study of patients with newly diagnosed maturity onset diabetes mellitus. J PAK MED ASSOC 1981; 31:35-8. [PMID: 6785484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Haider Z, Obaidullah S, Din FU, Saleem M. A study of newly diagnosed obese diabetics. J PAK MED ASSOC 1981; 31:8-10. [PMID: 6782274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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Haider Z, Obaidullah S, Maqbool K. Hypertension in Pakistani patients with diabetes mellitus. J Trop Med Hyg 1980; 83:251-3. [PMID: 7441802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
In a retrospective analysis of 1000 diabetic patients attending an out-patient clinic in a Lahore Hospital, hypertension was present in 26 x 4 per cent. There was a female preponderance in the overall group and the male; female ratio was similar in the sub group with hypertension. In our assessment the overall contribution of diabetic renal disease to the prevalence of hypertension was unimpressive. The hypertension was mild in a vast majority of patients.
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Haider Z, Bano KA. A follow up study of patients with mild and moderate hypertension. J PAK MED ASSOC 1980; 30:227-30. [PMID: 6777516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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40
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Bano KA, Haider Z, Rana IA. Study of blood pressure in women taking oral contraceptives. J PAK MED ASSOC 1980; 30:157-9. [PMID: 6777519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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41
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Fayyaz A, Haider Z, Moeen KZ, Shahid M. Obscure hepatomegaly in clinical practice--a clinicopathological study. J PAK MED ASSOC 1980; 30:84-7. [PMID: 6771429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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42
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Haider Z, Bano KA, Usman S, Din FU, Rana IA. Blood lipids in non-obese patients with newly diagnosed diabetes mellitus and untreated hypertension. J PAK MED ASSOC 1980; 30:57-60. [PMID: 6770123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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43
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Naseer R, Obaidullah S, Haider Z. Urinary tract infection in diabetics. J PAK MED ASSOC 1980; 30:2-5. [PMID: 6767055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
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44
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Haider Z, Bano KA, Usman S, Maqbool K, Saleem M. Serum uric acid values in hypertension. J Pak Med Assoc 1979; 29:234-6. [PMID: 118268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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45
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Haider Z, Bano KA, Uddin F. Liver function profile in patients taking methyldopa. J Pak Med Assoc 1978; 28:98-100. [PMID: 100634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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46
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Chohan RI, ud Din F, Bano KA, Haider Z. Changes in blood lipids during anti-hypertensive treatment. J Pak Med Assoc 1978; 28:68-70. [PMID: 99529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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47
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Haider Z, Fayyaz A, Ud Din F, Maqbool K. Screening for diabetes mellitus in Pakistani patients with acute and chronic liver disease. J Trop Med Hyg 1978; 81:103-5. [PMID: 660710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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48
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Haider Z, Obaidullah S, Ud Din F, Zubair M, Saleem M. Prevalence of coronary heart disease in Pakistani patients suffering from maturity onset diabetes mellitus. J Trop Med Hyg 1978; 81:98-102. [PMID: 660715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
In a group of 500 ambulant Pakistani patients suffering from diabetes mellitus, electrocardiographic evidence of coronary heart disease was present in 45 (9%). The frequency was higher in the males (12.1%) as compared to females (7.2%). The male diabetics with coronary heart disease had significantly high mean serum cholesterol values as compared to those without it. A positive family history of ischaemic heart disease, and the presence of small vessel disease as well as hypertension were more frequently associated with coronary heart disease. The overall frequency of hypertension was 21.2 per cent in this group of diabetics.
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49
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Haider Z, Rasul A, Moeen KZ. Hepatomegaly in diabetes mellitus. J Pak Med Assoc 1978; 28:42-4. [PMID: 100626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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50
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Haider Z, Fayyaz A. Latex agglutination test for amoebiasis in Pakistani patients with chronic 'obscure' liver enlargements. J Trop Med Hyg 1978; 81:13-5. [PMID: 204801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The latex agglutination test for amoebiasis was done in 50 Pakistani patients in whom a clinical diagnosis of chronic non-supparative amoebic hepatitis was made on the basis of liver enlargement associated with chronic recurrent abdominal disturbance. The serological test was negative in 32 (64%) and positive in 18 (36%). Examination of stool specimens showed a higher frequency of E. histolytica in serology positive patients. The liver biopsy findings were variable and included normal histology in 40 percent and non-specific changes in another 34 per cent of the patients. There was evidence of early abscess formation in one patient with a strongly positive serological reaction. Chronic liver enlargements in this region form a heterogenous group and the existence of chronic non-suppurative amoebic hepatitis as a clinico-pathological entity remains doubtful.
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