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Yu AYX, Austin PC, Jackevicius CA, Chu A, Holodinsky JK, Hill MD, Kamal N, Kumar M, Lee DS, Vyas MV, Joundi RA, Khan NA, Kapral MK, McNaughton CD. Population Trends of New Prescriptions for Antihyperglycemics and Antihypertensives Between 2014 and 2022. J Am Heart Assoc 2024; 13:e034118. [PMID: 38563374 DOI: 10.1161/jaha.123.034118] [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] [Received: 12/20/2023] [Accepted: 03/01/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND In the wake of pandemic-related health decline and health care disruptions, there are concerns that previous gains for cardiovascular risk factors may have stalled or reversed. Population-level excess burden of drug-treated diabetes and hypertension during the pandemic compared with baseline is not well characterized. We evaluated the change in incident prescription claims for antihyperglycemics and antihypertensives before versus during the pandemic. METHODS AND RESULTS In this retrospective, serial, cross-sectional, population-based study, we used interrupted time series analyses to examine changes in the age- and sex-standardized monthly rate of incident prescriptions for antihyperglycemics and antihypertensives in patients aged ≥66 years in Ontario, Canada, before the pandemic (April 2014 to March 2020) compared with during the pandemic (July 2020 to November 2022). Incident claim was defined as the first prescription filled for any medication in these classes. The characteristics of patients with incident prescriptions of antihyperglycemics (n=151 888) or antihypertensives (n=368 123) before the pandemic were comparable with their pandemic counterparts (antihyperglycemics, n=97 015; antihypertensives, n=146 524). Before the pandemic, monthly rates of incident prescriptions were decreasing (-0.03 per 10 000 individuals [95% CI, -0.04 to -0.01] for antihyperglycemics; -0.14 [95% CI, -0.18 to -0.10] for antihypertensives). After July 2020, monthly rates increased (postinterruption trend 0.31 per 10 000 individuals [95% CI, 0.28-0.34] for antihyperglycemics; 0.19 [95% CI, 0.14-0.23] for antihypertensives). CONCLUSIONS Population-level increases in new antihyperglycemic and antihypertensive prescriptions during the pandemic reversed prepandemic declines and were sustained for >2 years. Our findings are concerning for current and future cardiovascular health.
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Affiliation(s)
- Amy Y X Yu
- Department of Medicine (Neurology) University of Toronto, Sunnybrook Health Sciences Centre Toronto ON Canada
- ICES Toronto ON Canada
| | - Peter C Austin
- ICES Toronto ON Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto ON Canada
| | - Cynthia A Jackevicius
- ICES Toronto ON Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto ON Canada
- College of Pharmacy, Western University of Health Sciences Pomona CA
| | | | - Jessalyn K Holodinsky
- Department of Clinical Neurosciences and Hotchkiss Brain Institute University of Calgary AB Canada
- Department of Emergency Medicine University of Calgary AB Canada
- Community Health Sciences University of Calgary AB Canada
| | - Michael D Hill
- Department of Clinical Neurosciences and Hotchkiss Brain Institute University of Calgary AB Canada
- Community Health Sciences University of Calgary AB Canada
| | - Noreen Kamal
- Department of Industrial Engineering Dalhousie University Halifax NS Canada
- Department of Community Health and Epidemiology, Department of Medicine (Neurology) Dalhousie University Halifax NS Canada
| | - Mukesh Kumar
- Department of Industrial Engineering Dalhousie University Halifax NS Canada
| | - Douglas S Lee
- ICES Toronto ON Canada
- Department of Medicine (Cardiology) University of Toronto, University Health Network Toronto ON Canada
| | - Manav V Vyas
- ICES Toronto ON Canada
- Department of Medicine (Neurology) Unity Health Toronto, University of Toronto ON Canada
| | - Raed A Joundi
- Department of Medicine McMaster University Hamilton ON Canada
| | - Nadia A Khan
- Department of Medicine University of British Columbia Vancouver BC Canada
| | - Moira K Kapral
- ICES Toronto ON Canada
- Department of Medicine (General Internal Medicine) University of Toronto, University Health Network Toronto ON Canada
| | - Candace D McNaughton
- ICES Toronto ON Canada
- Department of Medicine (Emergency Medicine) University of Toronto, Sunnybrook Health Sciences Centre Toronto ON Canada
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Tran KC, Freiman S, Chaworth-Musters T, Purkiss S, Foster C, Khan NA, Chan WS. Implementation of a home blood pressure monitoring program for the management of hypertensive disorders of pregnancy, an observational study in British Columbia, Canada. Obstet Med 2024; 17:22-27. [PMID: 38660327 PMCID: PMC11037197 DOI: 10.1177/1753495x231172050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 04/09/2023] [Indexed: 04/26/2024] Open
Abstract
Background COVID-19 pandemic has influenced health care delivery. We conducted an observational study to understand how obstetric medicine (ObM) physicians utilized home blood pressure monitoring (HBPM) to manage hypertension in pregnancy. Methods Pregnant participants with risk factors or diagnosis of hypertensive disorders of pregnancy (HDP) were enrolled, May 2020-December 2021, and provided with validated home blood pressure (BP) monitor. ObM physicians completed questionnaires to elicit how home BP readings were interpreted to manage HDP. Results We enrolled 103 people: 44 antepartum patients (33.5 ± 5 years, gestational age of 24 ± 5 weeks); 59 postpartum patients (35 ± 6 years, enrolled 6 ± 4 days post-partum). ObM physicians used range of home BP readings (70%) for management of HDP. Conclusions HBPM to manage HDP is acceptable and can be used to manage hypertension during pregnancy. Further studies are needed to assess the generalizability of our findings and the safety of HBPM reliance alone in management of HDP.
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Affiliation(s)
- Karen C Tran
- Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, Canada
- Center for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - Sabina Freiman
- Internal Medicine Residency Training Program, University of British Columbia, Vancouver, Canada
| | - Tessa Chaworth-Musters
- Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Susan Purkiss
- Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Colleen Foster
- Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Nadia A Khan
- Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, Canada
- Center for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - Wee Shian Chan
- Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, Canada
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Dhamotharaswamy K, Selvaraj H, Chidambaram K, Dhanasekaran M, Duraisamy K, Khan NA, Thangavel S. An impactful prospective study on pulmonary tuberculosis in geriatric populations besides its clinical outcomes and implications in the Indian subcontinent. Eur Rev Med Pharmacol Sci 2024; 28:269-277. [PMID: 38235878 DOI: 10.26355/eurrev_202401_34913] [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: 01/19/2024]
Abstract
OBJECTIVE Geriatric populations are most at risk for the tuberculosis pandemic, and as people age, the rate of infection rises steadily and drastically. Geriatric individuals frequently experience diagnostic challenges with a wide range of comorbidities, but employing all available standard and novel methods to diagnose any infection is crucial. The prophylactic and therapeutic management for the geriatric population presents a significant difficulty and challenge in assessing an appropriate and effective therapeutic outcome due to prolonged drug therapy and adverse drug reactions. The present study aims to determine the prevalence of tuberculosis in the geriatric population in the Indian subcontinent, its risk factors, clinical outcomes, and adherence to the medication. PATIENTS AND METHODS A prospective observational investigation was conducted in a tertiary care Hospital in Erode, Tamil Nadu, India, from April 2021 to September 2022. A total of 1,014 patients were screened, and 176 participants were selected. The participants were then subjected to medication adherence evaluation, and clinical data was collected. The statistical analysis was performed using SPSS version 20.0. RESULTS Among 176 participants, 135 (76.70%) were old (65-74 age), 37 (21.02%) were very old (75-84 age) TB patients, and 4 (2.27%) patients were extremely old TB patients (>85). Medication adherence was improved from baseline to the end of the study (p≤0.000). 110 patients completed the treatment (62.5%). 41 patients were cured in between treatments (23.29%), 13 patients died during the treatment (7.38%), 9 patients lost their follow-up (5.11%), 3 patients failed to respond to the treatment (1.70%). CONCLUSIONS The effectiveness of therapy critically depends on the patient's medication adherence to anti-TB therapy. In addition to having a higher likelihood of therapy failure, elderly patients did not appropriately respond to the treatment and completely recovered from the infection even after effective pharmacotherapy.
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Affiliation(s)
- K Dhamotharaswamy
- Faculty of Pharmacy, Karpagam Academy of Higher Education, Coimbatore, India.
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Lui S, Dubrofsky L, Khan NA, Tobe SW, Huynh J, Kuyper L, Mathew A, Amin S, Schiffrin EL, Harvey P, Leung AA, Ruzicka M, Mangat B, Reid D, Floras J, Bittman J, Garbutt L, Braam B, Suri R, Hannah-Shmouni F, Prebtani A, Savard S, MacMillan TE, Ruddy TD, Vallee M, Bollu A, Logan A, Padwal R, Ringrose J. Characterizing Hypertension Specialist Care in Canada: A National Survey. CJC Open 2023; 5:907-915. [PMID: 38204853 PMCID: PMC10774075 DOI: 10.1016/j.cjco.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/29/2023] [Indexed: 01/12/2024] Open
Abstract
Background The hypertension specialist often receives referrals of patients with young-onset, severe, difficult-to-control hypertension, patients with hypertensive emergencies, and patients with secondary causes of hypertension. Specialist hypertension care compliments primary care for these complex patients and contributes to an overall hypertension control strategy. The objective of this study was to characterize hypertension centres and the practice patterns of Canadian hypertension specialists. Methods Adult hypertension specialists across Canada were surveyed to describe hypertension centres and specialist practice in Canada, including the following: the patient population managed by hypertension specialists; details on how care is provided; practice pattern variations; and differences in access to specialized hypertension resources across the country. Results The survey response rate was 73.5% from 25 hypertension centres. Most respondents were nephrologists and general internal medicine specialists. Hypertension centres saw between 50 and 2500 patients yearly. A mean of 17% (± 15%) of patients were referred from the emergency department and a mean of 52% (± 24%) were referred from primary care. Most centres had access to specialized testing (adrenal vein sampling, level 1 sleep studies, autonomic testing) and advanced therapies for resistant hypertension (renal denervation). Considerable heterogeneity was present in the target blood pressure in young people with low cardiovascular risk and in the diagnostic algorithms for investigating secondary causes of hypertension. Conclusions These results summarize the current state of hypertension specialist care and highlight opportunities for further collaboration among hypertension specialists, including standardization of the approach to specialist care for patients with hypertension.
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Affiliation(s)
- Samantha Lui
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Lisa Dubrofsky
- Department of Medicine, Women’s College Hospital, Toronto, Ontario, Canada, Division of Nephrology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nadia A. Khan
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Sheldon W. Tobe
- Division of Nephrology Sunnybrook Health Sciences Centre, University of Toronto, Toronto and Northern Ontario School of Medicine, Sudbury, Ontario, Canada
| | - Jessica Huynh
- Department of General Internal Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Laura Kuyper
- Division of General Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anna Mathew
- Division of Nephrology, Department of Medicine, St. Joseph Healthcare Hamilton, Hamilton, Ontario, Canada
| | - Syed Amin
- Division of Nephrology, Saskatchewan Health Authority, Regina, Saskatchewan, Canada
| | - Ernesto L. Schiffrin
- Department of Medicine, Lady Davis Institute for Medical Research, Sir Mortimer B. Davis-Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Paula Harvey
- Division of Cardiology, Department of Medicine and Women’s College Research Institute, Women’s College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Alexander A. Leung
- Departments of Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Marcel Ruzicka
- Division of Nephrology, University of Ottawa, Ottawa, Ontario, Canada
| | - Birinder Mangat
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - David Reid
- Dvision of Nephrology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - John Floras
- University Health Network and Sinai Health Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Jesse Bittman
- Division of Community Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lauren Garbutt
- Division of Endocrinology, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Branko Braam
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - Rita Suri
- Division of Nephrology, Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Fady Hannah-Shmouni
- Division of Endocrinology, University of British Columbia, Vancouver, British Columba, Canada, Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), National Institutes of Health (NIH), Bethesda, Maryland, USA
| | - Ally Prebtani
- Division of Endocrinology & Metabolism, Department of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Sebastien Savard
- Department of Medicine, Universite Laval, Hotel-Dieu de Quebec, Quebec City, Quebec, Canada
| | - Thomas E. MacMillan
- Department of Medicine, Division of General Internal Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Terrence D. Ruddy
- Division of Cardiology, University of Ottawa Heart Institute, Ottawa, Ontario, Canada
| | - Michel Vallee
- Faculté de Médecine, Université de Montréal, Montreal, Quebec, Canada
| | - Apoorva Bollu
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Alexander Logan
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Raj Padwal
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer Ringrose
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Sorwer MS, Khan NA, Miah AH, Rahman MA, Khan DJ, Islam MA, Jahan UR, Roy HK, Islam MA. Assessment of Serum Homocysteine Level to Predict Early Prognosis of Ischaemic Stroke. Mymensingh Med J 2023; 32:975-982. [PMID: 37777889] [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: 10/02/2023]
Abstract
Cerebrovascular disease is the third most familiar cause of mortality worldwide and in Bangladesh. The reported prevalence of stroke in Bangladesh is 0.3%. Age, high serum glucose, elevated admission blood pressure, fever, large infarction size, and hyperhomocysteinemia has been reported to be risk factor for early post-stroke neurological deterioration. Early serum homocysteine level estimation can predict the early prognosis of ischemic stroke. In a developing country like Bangladesh, an earlier stroke outcome prediction for guiding therapeutic approach is essential. This study aimed to specify the role of estimating serum homocysteine during the early phase of acute ischemic stroke to assume an early prognosis that would guide- a management plan, the need to stay in the hospital and the need for intervention. This cross-sectional descriptive study was performed at the Department of Medicine, Mymensingh Medical College Hospital, Bangladesh from October 2021 to April 2022. Radiologically confirmed all ischemic stroke patients admitted at the Department of Medicine, Mymensingh Medical College Hospital, during the study period fulfilling the inclusion and exclusion criteria were included in this study. Non-probability purposive sampling technique was used. Data was collected using a pre-designed case record form. Quantitative data were represented as mean and standard deviation and qualitative data as frequency and percentage. The comparison was made by Chi-square test and independent samples t-test using SPSS (version 26.0). During the study period, among 716 stroke patients, 59 ischemic stroke patients were included in this study. The mean age of the patients was 64.0±11.72 years. After 72 hours of supportive treatment, early neurological outcomes were observed using NIHSS scoring. Out of 59 patients, the condition of 45(76.0%) patients improved or remained stable (END-) and the state of 14(24.0%) patients worsened (END+). Elderly age-raised temperature and elevated blood glucose level are known to increase infarction size, but only elevated temperature (p value 0.009) has statistical significance in this study. The mean homocysteine level ±SD was 20.22±6.95μmol/L, which is above the normal (<15μmol/L). The level was above average for both outcome groups. Serum homocysteine level was significantly higher in END(+) group (31.59±2.98μmol/L) than END(-) group (16.69±2.66μmol/L) and p value was <0.001.
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Affiliation(s)
- M S Sorwer
- Dr Md Sayem Sorwer, Indoor Medical Officer, Department of Respiratory Medicine, Mymensingh Medical College Hospital (MMCH), Mymensingh, Bangladesh; E-mail:
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Omboni S, Khan NA, Kunadian V, Olszanecka A, Schutte AE, Mihailidou AS. Sex Differences in Ambulatory Blood Pressure Levels and Subtypes in a Large Italian Community Cohort. Hypertension 2023; 80:1417-1426. [PMID: 37315119 DOI: 10.1161/hypertensionaha.122.20589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 04/11/2023] [Indexed: 06/16/2023]
Abstract
BACKGROUND Sex differences in blood pressure control are recognized. We systematically investigated sex differences in specific components of ambulatory blood pressure (ABP), including variability, day-night changes, morning surge, and hypertension types. METHODS We analyzed ABPs of 52 911 participants (45.6% male, 54.4% female, 37.0% treated for hypertension) visiting 860 Italian community pharmacies. Sex differences in ABP levels and patterns were evaluated in the whole group and 4 risk groups (antihypertensive-treated patients, patients with diabetes, dyslipidemia, or cardiovascular disease). RESULTS Average 24-hour, day-time, and night-time blood pressure values were consistently higher in males than females (P<0.001). Variability in ABP was higher in females, except during the night. Nondippers and an abnormal morning surge were more common among males (odds ratio and 95% CI, 1.282 [1.230-1.335] and 1.244 [1.159-1.335]; P<0.001). The prevalence of 24-hour and masked hypertension was higher in males (odds ratio and 95% CI, 2.093 [2.019-2.170] and 1.347 [1.283-1.415]; P<0.001) and that of white-coat hypertension in females (0.719 [0.684-0.755]; P<0.001). Ambulatory heart rate mean values were higher (P<0.001) in females. Day-time HR variability was higher and night-time heart rate variability lower in females (P<0.001). Sex differences in ABP levels and patterns detected in the whole population were replicated in all risk groups, except for the prevalence of abnormal morning surge (between sexes difference in antihypertensive-treated participants only). CONCLUSIONS Females show better ABP control than males, but with an increased blood pressure variability and a greater prevalence of white-coat hypertension. These findings support tailored management of hypertension. REGISTRATION URL: https://www. CLINICALTRIALS gov; Unique identifier: NCT03781401.
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Affiliation(s)
- Stefano Omboni
- Clinical Research Unit, Italian Institute of Telemedicine, Varese, Italy (S.O.)
- Department of Cardiology, Sechenov First Moscow State Medical University, Russian Federation (S.O.)
| | - Nadia A Khan
- Department of Medicine, University of British Columbia, Vancouver, Canada (N.A.K.)
| | - Vijay Kunadian
- Translational and Clinical Research Institute, Faculty of Medical Sciences, Newcastle University (V.K.), Newcastle upon Tyne, United Kingdom
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne Hospitals NHS Foundation Trust (V.K.), Newcastle upon Tyne, United Kingdom
| | - Agnieszka Olszanecka
- First Department of Cardiology, Interventional Electrocardiology and Arterial Hypertension, Jagiellonian University Medical College, Krakow, Poland (A.O.)
| | - Aletta E Schutte
- School of Population Health, University of New South Wales, The George Institute for Global Health, Sydney, Australia (A.E.S.)
- Hypertension in Africa Research Team, South African Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, South Africa (A.E.S.)
| | - Anastasia S Mihailidou
- Department of Cardiology and Kolling Institute, Royal North Shore Hospital (A.S.M.), Sydney, New South Wales, Australia
- Macquarie University (A.S.M.), Sydney, New South Wales, Australia
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Easwaran V, Khan NA, Iqbal MJ, Alshahrani SM, Orayj K, Almeleebia TM, Sadiq MMJ, Vijayaraghavalu S, Hussain ATM. The study of healthcare professionals' perspective towards the quality of diabetic care services in Abha. Eur Rev Med Pharmacol Sci 2023; 27:4328-4336. [PMID: 37259764 DOI: 10.26355/eurrev_202305_32437] [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: 06/02/2023]
Abstract
OBJECTIVE The aim of this study was to investigate the relationship between organizational characteristics and diabetes care from the perspective of health care professionals (HCPs) in Abha, Kingdom of Saudi Arabia. SUBJECTS AND METHODS A cross-sectional, self-reported survey of healthcare professionals was done. The study comprised a total of 106 HCPs from various departments involved with diabetes patient clinics or service providers. The electronic data collecting form was used to gather the data. RESULTS The study revealed a stronger association between the availability of bed facilities and better glycemic control. Moreover, the majority of HCPs believes that urbanization and sedentary lifestyles are the main contributors to the rise of diabetes mellitus in Saudi Arabia. Depending on organizational features, the regulations that are available for monitoring defaulter patients and running continuous medical education (CME) programs are vastly different. The main cause of the reported lack of medications for managing diabetic care was described as being a problem with the central medical supply store's drug supply, which was influenced by the type of health sector. CONCLUSIONS Facilitating change at all levels, including patient education, HCPs education, and organizational development, can improve the quality of treatment. The current study can provide insight into the focus of interventional strategies to deliver diabetes patients with high-quality patient care.
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Affiliation(s)
- V Easwaran
- Department of Clinical Pharmacy, King Khalid University, Abha, Kingdom of Saudi Arabia.
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8
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Schutte AE, Jafar TH, Poulter NR, Damasceno A, Khan NA, Nilsson PM, Alsaid J, Neupane D, Kario K, Beheiry H, Brouwers S, Burger D, Charchar FJ, Cho MC, Guzik TJ, Haji Al-Saedi GF, Ishaq M, Itoh H, Jones ESW, Khan T, Kokubo Y, Kotruchin P, Muxfeldt E, Odili A, Patil M, Ralapanawa U, Romero CA, Schlaich MP, Shehab A, Mooi CS, Steckelings UM, Stergiou G, Touyz RM, Unger T, Wainford RD, Wang JG, Williams B, Wynne BM, Tomaszewski M. Addressing global disparities in blood pressure control: perspectives of the International Society of Hypertension. Cardiovasc Res 2023; 119:381-409. [PMID: 36219457 PMCID: PMC9619669 DOI: 10.1093/cvr/cvac130] [Citation(s) in RCA: 20] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Revised: 05/13/2022] [Accepted: 05/31/2022] [Indexed: 11/14/2022] Open
Abstract
ABSTRACT Raised blood pressure (BP) is the leading cause of preventable death in the world. Yet, its global prevalence is increasing, and it remains poorly detected, treated, and controlled in both high- and low-resource settings. From the perspective of members of the International Society of Hypertension based in all regions, we reflect on the past, present, and future of hypertension care, highlighting key challenges and opportunities, which are often region-specific. We report that most countries failed to show sufficient improvements in BP control rates over the past three decades, with greater improvements mainly seen in some high-income countries, also reflected in substantial reductions in the burden of cardiovascular disease and deaths. Globally, there are significant inequities and disparities based on resources, sociodemographic environment, and race with subsequent disproportionate hypertension-related outcomes. Additional unique challenges in specific regions include conflict, wars, migration, unemployment, rapid urbanization, extremely limited funding, pollution, COVID-19-related restrictions and inequalities, obesity, and excessive salt and alcohol intake. Immediate action is needed to address suboptimal hypertension care and related disparities on a global scale. We propose a Global Hypertension Care Taskforce including multiple stakeholders and societies to identify and implement actions in reducing inequities, addressing social, commercial, and environmental determinants, and strengthening health systems implement a well-designed customized quality-of-care improvement framework.
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Affiliation(s)
- Aletta E Schutte
- School of Population Health, University of New South Wales, Kensington Campus, High Street, Sydney 2052 NSW, Australia; The George Institute for Global Health, King Street, Newton, Sydney NSW 2052, Australia
- Hypertension in Africa Research Team, SAMRC Unit for Hypertension and Cardiovascular Disease; North-West University, Hoffman Street, Potchefstroom 2520, South Africa
- SAMRC Development Pathways for Health Research Unit, School of Clinical Medicine, University of the Witwatersrand, 1 Jan Smuts Ave, Braamfontein, Johannesburg, 2000, South Africa
| | - Tazeen H Jafar
- Program in Health Services and Systems Research, Duke-NUS Medical School, Department of Renal Medicine, 8 College Rd., Singapore 169857, Singapore
- Duke Global Health Institute, Duke University, 310 Trent Dr, Durham, NC 27710, USA
| | - Neil R Poulter
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, London W12 7RH, UK
| | - Albertino Damasceno
- Faculty of Medicine, Eduardo Mondlane University, 3453 Avenida Julius Nyerere, Maputo, Mozambique
| | - Nadia A Khan
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Center for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada
| | - Peter M Nilsson
- Department of Clinical Sciences, Skane University Hospital, Lund University, Malmö, Sweden
| | - Jafar Alsaid
- Ochsner Health System, New Orleans, Louisiana, USA
- Queensland University, Brisbane, Queensland, Australia
| | - Dinesh Neupane
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, MD, USA
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University School of Medicine, Tochigi, Japan
| | - Hind Beheiry
- International University of Africa, Khartoum, Sudan
| | - Sofie Brouwers
- Department of Cardiology, Cardiovascular Center Aalst, OLV Clinic Aalst, Aalst, Belgium
- Department of Experimental Pharmacology, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Dylan Burger
- Kidney Research Centre, Ottawa Hospital Research Institute, Department of Cellular and Molecular Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Fadi J Charchar
- Health Innovation and Transformation Centre, Federation University, Ballarat, Victoria, Australia
- Department of Physiology and Anatomy, University of Melbourne, Melbourne, Victoria, Australia
| | - Myeong-Chan Cho
- Department of Internal Medicine, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Tomasz J Guzik
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | | | | | - Hiroshi Itoh
- Department of Endocrinology, Metabolism and Nephrology, School of Medicine, Keio University, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8585, Japan
| | - Erika S W Jones
- Division of Nephrology and Hypertension, Groote Schuur Hospital and Kidney and Hypertension Research Unit, University of Cape Town, Cape Town, South Africa
| | - Taskeen Khan
- Department of Public Health Medicine, University of Pretoria, Pretoria, South Africa
| | - Yoshihiro Kokubo
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Praew Kotruchin
- Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
| | - Elizabeth Muxfeldt
- University Hospital Clementino Fraga Filho, Hypertension Program, Universidade Federal do Rio de Janeiro, Brazil
| | - Augustine Odili
- Circulatory Health Research Laboratory, College of Health Sciences, University of Abuja, Abuja, Nigeria
| | - Mansi Patil
- Department of Nutrition and Dietetics, Asha Kiran JHC Hospital, Chinchwad, India
| | - Udaya Ralapanawa
- Faculty of Medicine, University of Peradeniya, Kandy, Central Province, Sri Lanka
| | - Cesar A Romero
- Renal Division, Department of Internal Medicine, Emory University School of Medicine, Atlanta, GA, USA
| | - Markus P Schlaich
- Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit and RPH Research Foundation, The University of Western Australia, Perth, Australia
- Department of Cardiology, Royal Perth Hospital, Perth, Western Australia, Australia
- Department of Nephrology, Royal Perth Hospital, Perth, Western Australia, Perth, Western Australia, Australia
| | - Abdulla Shehab
- College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Ching Siew Mooi
- Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Malaysia
| | - U Muscha Steckelings
- Department of Cardiovascular & Renal Research, Institute of Molecular Medicine. University of Southern Denmark, Odense, Denmark
| | - George Stergiou
- Hypertension Centre STRIDE-7, School of Medicine, Third Department of Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Rhian M Touyz
- Research Institute of the McGill University Health Centre, McGill University, Montreal, QC, Canada
| | - Thomas Unger
- CARIM - Cardiovascular Research Institute, Maastricht University, Maastricht, The Netherlands
| | - Richard D Wainford
- Department of Pharmacology & Experimental Therapeutics and the Whitaker, Cardiovascular Institute, Boston University School of Medicine, Boston, MA, USA
| | - Ji-Guang Wang
- Department of Hypertension, Centre for Epidemiological Studies and Clinical Trials, The Shanghai Institute of Hypertension, Shanghai Key Laboratory of Hypertension, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Bryan Williams
- Institute of Cardiovascular Science, University College London (UCL), National Institute for Health Research (NIHR), UCL Hospitals Biomedical Research Centre, London, UK
| | - Brandi M Wynne
- Department of Internal Medicine, Division of Nephrology & Hypertension, University of Utah, Salt Lake City, UT, USA
| | - Maciej Tomaszewski
- Division of Cardiovascular Sciences, Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK
- Manchester Heart Centre, Manchester University NHS Foundation Trust, Manchester, UK
- Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, UK
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9
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Easwaran V, Alshahrani SM, Sadiq MMJ, Khan NA, Alavudeen SS, Almeleebia TM, Alkhaldi BA, Alshuraymi MK, Asiri MY, Khulaif NW. Knowledge, beliefs, and attitudes among general population towards bipolar disorders: a cross-sectional report from the Southern region of Saudi Arabia. Eur Rev Med Pharmacol Sci 2023; 27:2288-2296. [PMID: 37013746 DOI: 10.26355/eurrev_202303_31762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
OBJECTIVE The aim of this study was to understand the impact of demographic characteristics and to describe the gender differences in knowledge, beliefs, and attitudes towards bipolar disorders among common residents in the Southern region of Saudi Arabia. SUBJECTS AND METHODS This cross-sectional survey was conducted between January 2021 and March 2021. The survey was conducted among the common residents in the southern region of the Kingdom of Saudi Arabia. The data were collected by using a structured, self-administered, validated questionnaire comprised of a dichotomous type of questions along with Likert scale. RESULTS There is a significant difference in the distribution of knowledge scores between male and female study participants (p=0.000). No significant gender differences have been identified in beliefs and attitudes toward bipolar disorder (p=0.229) and in overall score (p=0.159). The traumatic event was reported as the major cause of bipolar disorder. The age group and employment status were found to be the major predictor of knowledge, beliefs, and attitudes about bipolar disorder. CONCLUSIONS Although the knowledge awareness rate on bipolar disorder is high among public in the Southern region, there is a vast scope for improving it. Education should be disseminated to promote mental health awareness and improve attitudes and beliefs on bipolar disorders and reduce stigma and discrimination against patients with bipolar disorders.
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Affiliation(s)
- V Easwaran
- Department of Clinical Pharmacy, King Khalid University, Abha, Kingdom of Saudi Arabia.
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Poulter NR, Borghi C, Damasceno A, Jafar TH, Khan NA, Kokubo Y, Nilsson PM, Prabhakaran D, Schlaich MP, Schutte AE, Stergiou GS, Unger T, Wang W, Beaney T. May Measurement Month: results of 12 national blood pressure screening programmes between 2017 and 2019 . Eur Heart J Suppl 2022; 24:F1-F5. [PMID: 36381519 PMCID: PMC9647150 DOI: 10.1093/eurheartjsupp/suac045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Neil R Poulter
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, 68 Wood Lane, London W12 7RH, UK
| | - Claudio Borghi
- Department of Medical and Surgical Sciences, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Via Massarenti 9, Bologna, Italy
| | | | - Tazeen H Jafar
- Health Services and Systems Research, DUKE-NUS Medical School, Singapore, Singapore.,Duke Global Health Institute, Duke University, Durham, NC, USA
| | - Nadia A Khan
- Department of Medicine, Center for Health Evaluation and Outcomes Sciences, University of British Colombia, Vancouver, BC, Canada
| | - Yoshihiro Kokubo
- Department of Preventive Cardiology, National Cerebral and Cardiovascular Centre, Suita, Japan
| | - Peter M Nilsson
- Department of Clinical Sciences, Lund University, Skane University Hospital, Malmo, Sweden
| | | | - Markus P Schlaich
- Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit, University of Western Australia, Level 3, MRF Building, 50 Rear Street, Perth, WA 6000, Australia
| | - Aletta E Schutte
- School of Population Health, University of New South Wales, The George Institute for Global Health, Sydney, NSW 2052, Australia
| | - George S Stergiou
- Hypertension Center STRIDE-7, Third Department of Medicine, National and Kapodistrian University of Athens, School of Medicine, Sotiria Hospital, 152 Mesogion Avenue, Athens 11527, Greece
| | - Thomas Unger
- CARIM School for Cardiovascular Diseases, Maastricht University, P.O. Box 616,6200, Maastricht, The Netherlands
| | - Wei Wang
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, 68 Wood Lane, London W12 7RH, UK
| | - Thomas Beaney
- Imperial Clinical Trials Unit, School of Public Health, Imperial College London, 68 Wood Lane, London W12 7RH, UK.,Department of Primary Care and Public Health, Imperial College London, St Dunstan's Road, London W6 8RP, UK
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11
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Mdkhana B, Goel S, Saleh MA, Siddiqui R, Khan NA, Elmoselhi AB. Role of oxidative stress in angiogenesis and the therapeutic potential of antioxidants in breast cancer. Eur Rev Med Pharmacol Sci 2022; 26:4677-4692. [PMID: 35856359 DOI: 10.26355/eurrev_202207_29192] [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: 06/15/2023]
Abstract
The escalation of cancer cases globally, especially breast cancer, is of concern. Angiogenesis is hallmark of cancer pathogenesis and plays an important role in cancer progression and metastasis. Pro-angiogenic agents, secreted by tumor cells, form new blood vessels, and produce reactive oxygen species (ROS). ROS promote angiogenesis via two major pathways: namely Vascular Endothelial Growth Factor (VEGF) dependent and non-VEGF dependent pathways. As a consequence of unbalanced ROS overproduction and low antioxidants levels, oxidative stress occurs and promotes angiogenesis in breast cancer tissues. Thus, the potential use of antioxidants as a preventive therapy in breast cancer. Preclinical studies depict that vitamins A and E may counter oxidative stress resulting in reduction of metastasis and viability of breast cancer. Furthermore, clinical studies demonstrate a decline in breast cancer risk in postmenopausal women upon the consumption of antioxidants. Herein, we discuss various pro-angiogenic agents that may play an important role in breast cancer angiogenesis. Moreover, the contribution of oxidative stress in inducing the angiogenic process is extensively reviewed here. Furthermore, the findings of pre-clinical and clinical studies on the use of antioxidants, namely vitamins A and E, in breast cancer are deliberated upon, along with the role of angiogenesis in cancer therapy.
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Affiliation(s)
- B Mdkhana
- Sharjah Institute of Medical Research, Clinical Sciences Department, College of Medicine, University of Sharjah, Sharjah, UAE.
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12
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Aslam HMU, Khan NA, Hussain SI, Ali Y, Raheel M, Shahzad R, Jamil S, Yasin O, Ali S, Amrao L. First Report of Brown Leaf Spot of Rice ( Oryza sativa) Caused by Bipolaris sorokiniana in Pakistan. Plant Dis 2022; 106:PDIS05211097PDN. [PMID: 34798785 DOI: 10.1094/pdis-05-21-1097-pdn] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Affiliation(s)
- H M U Aslam
- Department of Plant Pathology, Institute of Plant Protection (IPP), MNS-University of Agriculture, Multan, Pakistan
- Department of Plant Pathology, University of Agriculture, Faisalabad, Pakistan
| | - N A Khan
- Department of Plant Pathology, University of Agriculture, Faisalabad, Pakistan
| | - S I Hussain
- Pest Warning and Quality Control of Pesticides, Punjab, Pakistan
| | - Y Ali
- College of Agriculture, BZU, Bahadur Sub-Campus Layyah, Pakistan
| | - M Raheel
- Department of Plant Pathology, Faculty of Agriculture and Environment, The Islamia University of Bahawalpur, Pakistan
| | - R Shahzad
- Agricultural Biotechnology Research Institute, Ayub Agricultural Research Institute, Faisalabad, Pakistan
| | - S Jamil
- Agricultural Biotechnology Research Institute, Ayub Agricultural Research Institute, Faisalabad, Pakistan
| | - O Yasin
- Department of Plant Pathology, University of Agriculture, Faisalabad, Pakistan
| | - S Ali
- Department of Plant Pathology, University of Agriculture, Faisalabad, Pakistan
| | - L Amrao
- Department of Plant Pathology, University of Agriculture, Faisalabad, Pakistan
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Omboni S, Padwal RS, Alessa T, Benczúr B, Green BB, Hubbard I, Kario K, Khan NA, Konradi A, Logan AG, Lu Y, Mars M, McManus RJ, Melville S, Neumann CL, Parati G, Renna NF, Ryvlin P, Saner H, Schutte AE, Wang J. The worldwide impact of telemedicine during COVID-19: current evidence and recommendations for the future. Connect Health 2022; 1:7-35. [PMID: 35233563 PMCID: PMC7612439 DOI: 10.20517/ch.2021.03] [Citation(s) in RCA: 63] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
During the COVID-19 pandemic, telemedicine has emerged worldwide as an indispensable resource to improve the surveillance of patients, curb the spread of disease, facilitate timely identification and management of ill people, but, most importantly, guarantee the continuity of care of frail patients with multiple chronic diseases. Although during COVID-19 telemedicine has thrived, and its adoption has moved forward in many countries, important gaps still remain. Major issues to be addressed to enable large scale implementation of telemedicine include: (1) establishing adequate policies to legislate telemedicine, license healthcare operators, protect patients' privacy, and implement reimbursement plans; (2) creating and disseminating practical guidelines for the routine clinical use of telemedicine in different contexts; (3) increasing in the level of integration of telemedicine with traditional healthcare services; (4) improving healthcare professionals' and patients' awareness of and willingness to use telemedicine; and (5) overcoming inequalities among countries and population subgroups due to technological, infrastructural, and economic barriers. If all these requirements are met in the near future, remote management of patients will become an indispensable resource for the healthcare systems worldwide and will ultimately improve the management of patients and the quality of care.
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Affiliation(s)
- Stefano Omboni
- Clinical Research Unit, Italian Institute of Telemedicine, Solbiate Arno, Varese 21048, Italy
- Department of Cardiology, Sechenov First Moscow State Medical University, Moscow 119991, Russia
| | - Raj S. Padwal
- Department of Medicine, University of Alberta, Edmonton, Alberta T6G 2R3, Canada
| | - Tourkiah Alessa
- Biomedical Technology Department, College of Applied Medical Science, King Saud University, Riyadh 11362, Saudi Arabia
| | - Béla Benczúr
- First Department of Internal Medicine (Cardiology-Nephrology), Balassa Janos County Hospital, Szekszard 7100, Hungary
| | - Beverly B. Green
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, WA 98101, USA
| | - Ilona Hubbard
- Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne 1011, Switzerland
| | - Kazuomi Kario
- Department of Cardiology, Jichi Medical University School of Medicine, Tochigi 329-0498, Japan
| | - Nadia A. Khan
- Department of Medicine, University of British Columbia, Vancouver, British Columbia V6T 1Z4, Canada
| | - Alexandra Konradi
- Almazov National Medical Research Centre, Saint Petersburg 197341, Russia
| | - Alexander G. Logan
- Department of Medicine, University of Toronto, Toronto, Ontario M5S 1A1, Canada
- Sinai Health System, Lunenfeld-Tanenbaum Research Institute, Toronto, Ontario M5G 1X5, Canada
| | - Yuan Lu
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, CT 06510, USA
| | - Maurice Mars
- Department of TeleHealth, School of Nursing and Public Health, College of Health Sciences, University of KwaZulu-Natal, Durban 4041, South Africa
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia 5042, Australia
| | - Richard J. McManus
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford OX1 2JD, UK
| | - Sarah Melville
- Division of Cardiology, Saint John Regional Hospital, Saint John, New Brunswick E2L 4L2, Canada
| | | | - Gianfranco Parati
- Department of Medicine and Surgery, University of Milano-Bicocca, Milano 20126, Italy
- Istituto Auxologico Italiano, IRCCS San Luca, Milano 20149, Italy
| | - Nicolas F. Renna
- Unit of Hypertension, Hospital Español de Mendoza, School of Medicine, National University of Cuyo, IMBECU-CONICET, Mendoza 5500, Argentina
| | - Philippe Ryvlin
- Department of Clinical Neurosciences, Centre Hospitalier Universitaire Vaudois (CHUV), Lausanne 1011, Switzerland
| | - Hugo Saner
- ARTORG Center for Biomedical Engineering Research and Institute for Social and Preventive Medicine, University of Bern, Bern 3012, Switzerland
| | - Aletta E. Schutte
- School of Population Health, University of New South Wales, The George Institute for Global Health, Sydney 2042, New South Wales, Australia
- Hypertension in Africa Research Team, South African Medical Research Council Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom 2520, South Africa
| | - Jiguang Wang
- The Shanghai Institute of Hypertension, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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14
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Alqahtani T, Alqahtani AM, Alshahrani SM, Orayj K, Almanasef M, Alamri AH, Easwaran V, Khan NA. Assessment of knowledge and practice of mammography and breast self-examination among the general female population in Asir region of KSA. Eur Rev Med Pharmacol Sci 2021; 25:7231-7237. [PMID: 34919222 DOI: 10.26355/eurrev_202112_27416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Breast cancer is the most common malignancy in Kingdom of Saudi Arabia (KSA) and an increasing burden in terms of incidence, morbidity and mortality. It accounts for about 28.7% of all new cancers in women. In 2015, the Saudi cancer registry shows that breast cancer was graded first among women and it accounts for 16.7% of all cancers reported among Saudi nationals. This study was designed to assess breast cancer screening knowledge and practices among women in the Asir region, Kingdom of Saudi Arabia. MATERIALS AND METHODS A cross-sectional study recruiting 1,021 female participants was performed. The variables included breast cancer knowledge, socio-demographic features, breast self-examination knowledge and practice. Descriptive statistics was used to compare and analyze the collected data while chi-square test was used to check the statistical significance among the selected variables. Saudi married women from Asir region were the participants of this cross-sectional study. RESULTS Our findings suggested that participants had a satisfactory level of knowledge about breast self-examination and mammograms at a rate of > 90% and 44.76% respectively. Over 90% of participants had good breast self-exam knowledge, however, only 6.37% was always performed breast self-examination. Similarly, nearly 40% of participants performed mammograms, while 40.5% were unaware. Leaflets and doctors were the primary sources of information for participants regarding the information of breast cancer screening. CONCLUSIONS Breast self-examination is a crucial approach to the timely detection of breast cancer and is subsequently critical for effective treatment. From the findings of this study we concluded that most women in the Asir region have a good awareness of breast cancer screening methods. However, either screening of self-examination or mammogram for breast cancer was not carried out thoroughly and regularly. This means that we must continue to emphasize the importance of primary health care in the earliest stages of breast cancer.
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Affiliation(s)
- T Alqahtani
- Department of Pharmacology, College of Pharmacy, King Khalid University, Abha, Saudi Arabia.
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15
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Hosseini Z, Safari A, Khan NA, Veenstra G, Conklin AI. Gender Differences in the Role of Social Support for Hypertension Prevention in Canada: A Population-Based Cross-Sectional Study of the Canadian Longitudinal Study on Aging Cohort. CJC Open 2021; 3:S62-S70. [PMID: 34993435 PMCID: PMC8712674 DOI: 10.1016/j.cjco.2021.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 09/12/2021] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND The relationship between social support and hypertension is poorly understood in women and men. We investigated whether multiple measures of social support are linked to blood pressure levels differentially by gender. METHODS Cross-sectional study of 28,779 middle-age and older-age adults (45-85 years) in the baseline Canadian Longitudinal Study on Aging comprehensive cohort. Stratified multivariable regression models estimated the role and relative contribution of 4 types of support to blood pressure in women and men. RESULTS The highest levels of perceived availability of informational, tangible, emotional, and belonging support were significantly associated with the lowest mean level of systolic blood pressure (SBP) but not diastolic blood pressure, independent of known confounders and other support types. However, associations were small, and their directions were more consistent in women. The lowest levels of informational support, relative to the highest, were associated with higher odds of hypertension in women (odds ratio [OR] = 1.20 [95% confidence interval {CI}: 1.06, 1.36]), more so than in men (OR = 1.16 [95% CI: 1.03, 1.32]). The lowest levels of emotional support were similarly associated with the odds of hypertension (OR = 1.08 [95% CI: 1.00, 1.17] in women and OR = 1.08 [95% CI: 1.00, 1.15] in men), relative to the highest. Larger differences in mean SBP in women, compared with men, were seen for informational support (2.43 and 1.18 mm Hg, respectively) and emotional support (1.60 and 0.74 mm Hg, respectively). Findings were unaltered by sensitivity analyses. CONCLUSIONS Informational and emotional support were inversely associated with SBP, more so in women than men. Further longitudinal investigation is warranted, as results suggest that specific supports may help prevent hypertension and lower cardiovascular risk, especially in women.
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Affiliation(s)
- Zeinab Hosseini
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
- College of Kinesiology, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Abdollah Safari
- Data, Analytics, Statistics and Informatics (DASI), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nadia A. Khan
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences (CHÉOS), St. Paul’s Hospital, Vancouver, British Columbia, Canada
| | - Gerry Veenstra
- Department of Sociology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Annalijn I. Conklin
- Collaboration for Outcomes Research and Evaluation (CORE), Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences (CHÉOS), St. Paul’s Hospital, Vancouver, British Columbia, Canada
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16
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Ul-Hassan H, Mahboob S, Masood Z, Riaz MN, Rizwan S, Al-Misned F, Abdel-Aziz MFA, Al-Ghanim KA, Gabol K, Chatta AM, Khan NA, Saeed, Waqar M. Biodiversity of commercially important finfish species caught by mid-water and bottom trawls from two different coasts of Arabian Sea: Threats and conservation strategies. BRAZ J BIOL 2021; 83:e249211. [PMID: 34730605 DOI: 10.1590/1519-6984.249211] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 04/04/2021] [Indexed: 11/22/2022] Open
Abstract
This study was conducted to estimate the diversity and the occurrence of commercially important finfish species collected by twenty fish sampling site of Sindh and Baluchistan coasts of the Arabian Sea in Pakistan from January to December 2019. Additionally, physicochemical characteristics of seawater were analyzed from these selected sites and found to be within suitable ranges required for fish growth and survive. A total of 81287 fish individuals were collected and identified as 49 species belonging to 26 families in our study. The most diversified family was Sparidae (13 species) followed by Carangidae and Lutjanidae (4 species), Mullidae, Serranidae, Ariidae (3 species), and Sciaenidae (2 species). The remaining 20 families were represented by only one species. The values of Shannon diversity index calculated for the four selected habitats revealed that high fish diversity was reported at Sonmiani Coast (H'=1.81), while less at Ormara Coast (H'=0.23). Likewise, Evenness index (E) was high at Sonmiani Coast (E=0.50) and less fish diversity was reported at Ormara Coast (E=0.06). Reducing risks to threatened marine species in coastal habitats also requires conservation actions at multiple scales. Thus, it was concluded that our study could be valuable in providing the more information's regarding to the diversity of finfish species and their occurrence along the Pakistan Coast. Further, to better understand the effects, regular monitoring and conservation measures should be taken to mitigate the influence of anthropogenic activities and protect finfish diversity from further decline.
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Affiliation(s)
- H Ul-Hassan
- University of Karachi, Department of Zoology, Karachi, Pakistan.,Ministry of National Food Security and Research, Fisheries Development Board, Karachi, Pakistan
| | - S Mahboob
- King Saud University, College of Science, Department of Zoology, Riyadh, Saudi Arabia
| | - Z Masood
- SBK Women University Quetta, Department of Zoology, Baluchistan, Pakistan
| | - M N Riaz
- Texas A&M University, College Station, Texas, USA
| | - S Rizwan
- Jinnah University for Women, Karachi, Pakistan
| | - F Al-Misned
- King Saud University, College of Science, Department of Zoology, Riyadh, Saudi Arabia
| | - M F A Abdel-Aziz
- National Institute of Oceanography and Fisheries - NIOF, Aquculture Division, Cairo, Egypt
| | - K A Al-Ghanim
- King Saud University, College of Science, Department of Zoology, Riyadh, Saudi Arabia
| | - K Gabol
- University of Karachi, Department of Zoology, Karachi, Pakistan
| | - A M Chatta
- Ministry of National Food Security and Research, Fisheries Development Board, Karachi, Pakistan
| | - N A Khan
- Sindh Madressa-tul-Islam University, Department of Environmental Sciences, Karachi Pakistan
| | - Saeed
- University of Karachi, Department of Zoology, Karachi, Pakistan
| | - M Waqar
- University of Karachi, Department of Zoology, Karachi, Pakistan
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17
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Haider R, Shamsi TS, Khan NA. Machine learning based decipherment of Cell Population Data: a promising hospital front-door screening tool for COVID-19. Am J Clin Pathol 2021. [PMCID: PMC8574509 DOI: 10.1093/ajcp/aqab191.216] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Introduction/Objective Key challenges against early diagnosis of COVID-19 are its symptoms sharing nature and prolong SARS-CoV-2 PCR turnaround time. Hither machine learning (ML) tools experienced by routinely generated clinical data; potentially grant early prediction. Methods/Case Report Routine and earlier diagnostic data along demographic information were extracted for total of 21,672 subsequent presentations. Along conventional statistics, multilayer perceptron (MLP) and radial basis function (RBF) were applied to predict COVID-19 from pre-pandemic control. Three feature sets were prepared, and performance evaluated through stratified 10-fold cross validation. With differing predominance of COVID-19, multiple test sets were created and predictive efficiency was evaluated to simulate real-fashion performance against fluctuating course of pandemic. Models validation was also inducted in prospective manner on independent dataset, equating framework forecasting to conclusions from PCR. Results (if a Case Study enter NA) RBF model attained superior cross entropy error 20.761(7.883) and 20.782(3.991) for Q-Flags and Routine Items respectively while MLP outperformed for cell population data (CPD) parameters with value of 6.968(1.259) for ‘training(testing)’. Our CPD driven MLP framework in challenge of lower (<5%) COVID-19 predominance affords greater negative predictive values (NPV >99%). Higher accuracy (%correct 92.5) was offered during prospective validation using independent dataset. Sensitivity analysis advances illusive accuracy (%correct 94.1) and NPV (96.9%). LY-WZ, Blasts/Abn Lympho?, ‘HGB Interf?’, and ‘RBC Agglutination?’ are among novel enlightening study attributes. Conclusion CPD driven ML tools offer efficient screening of COVID-19 patients at presentation to hospital to backing early expulsion and directing patients’ flow-from amid the initial presentation to hospital.
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Affiliation(s)
- R Haider
- Baqai Institute of Hematology, Baqai Medical University, Karachi, Select..., PAKISTAN
| | - T S Shamsi
- National Institute of Blood Disease, Karachi, PAKISTAN
| | - N A Khan
- NED University of Engineering and Technology, Karachi, PAKISTAN
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18
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Khan MIR, Khan NA, Jahan B, Goyal V, Hamid J, Khan S, Iqbal N, Alamri S, Siddiqui MH. Phosphorus supplementation modulates nitric oxide biosynthesis and stabilizes the defence system to improve arsenic stress tolerance in mustard. Plant Biol (Stuttg) 2021; 23 Suppl 1:152-161. [PMID: 33176068 DOI: 10.1111/plb.13211] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Accepted: 11/01/2020] [Indexed: 05/21/2023]
Abstract
The interaction of mineral nutrients with metals/metalloids and signalling molecules is well known. In the present study, we investigated the effect of phosphorus (P) in mitigation of arsenic (As) stress in mustard (Brassica juncea L.). The study was conducted to investigate potential of 30 mg P·kg-1 soil P supplement (diammonium phosphate) to cope up with the adverse effects of As stress (24 mg As·kg-1 soil) in mustard plants Supplementation of P influenced nitric oxide (NO) generation, which up-regulated proline metabolism, ascorbate-glutathione system and glyoxalase system and alleviated the effects of on photosynthesis and growth. Arsenic stress generated ROS and methylglyoxal content was scavenged through P-mediated NO, and reduced As translocation from roots to leaves. The involvement of NO under P-mediated alleviation of As stress was substantiated with the use of cPTIO (NO biosynthesis inhibitor) and SNP (NO inducer). The reversal of P effects on photosynthesis under As stress with the use of cPTIO emphasized the role of P-mediated NO in mitigation of As stress and protection of photosynthesis The results suggested that P reversed As-induced oxidative stress by modulation of NO formation, which regulated antioxidant machinery. Thus, P-induced regulatory interaction between NO and reversal of As-induced oxidative stress for the protection of photosynthesis may be suggested for sustainable crops.
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Affiliation(s)
- M I R Khan
- Department of Botany, Jamia Hamdard, New Delhi, India
| | - N A Khan
- Department of Botany, Aligarh Muslim University, Aligarh, India
| | - B Jahan
- Department of Botany, Aligarh Muslim University, Aligarh, India
| | - V Goyal
- Department of Botany, Jamia Hamdard, New Delhi, India
| | - J Hamid
- Department of Botany, Jamia Hamdard, New Delhi, India
| | - S Khan
- Department of Botany, Jamia Hamdard, New Delhi, India
| | - N Iqbal
- Department of Botany, Jamia Hamdard, New Delhi, India
| | - S Alamri
- Department of Botany and Microbiology, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - M H Siddiqui
- Department of Botany and Microbiology, College of Science, King Saud University, Riyadh, Saudi Arabia
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Soopramanien M, Khan NA, Siddiqui R. Gut microbiota of animals living in polluted environments are a potential resource of anticancer molecules. J Appl Microbiol 2021; 131:1039-1055. [PMID: 33368930 DOI: 10.1111/jam.14981] [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] [Received: 08/21/2020] [Revised: 12/09/2020] [Accepted: 12/21/2020] [Indexed: 12/17/2022]
Abstract
Cancer is a prominent cause of morbidity and mortality worldwide, in spite of advances in therapeutic interventions and supportive care. In 2018 alone, there were 18·1 million new cancer cases and 9·6 million deaths indicating the need for novel anticancer agents. Plant-based products have often been linked with protective effects against communicable and non-communicable diseases. Recently, we have shown that animals such as crocodiles thrive in polluted environments and are often exposed to carcinogenic agents, but still benefit from prolonged lifespan. The protective mechanisms shielding them from cancer could be attributed to the immune system, and/or it is possible that their gut microbiota produce anticancer molecules. In support, several lines of evidence suggest that gut microbiota plays a critical role in the physiology of its host. Here, we reviewed the available literature to assess whether the gut microbiota of animals thriving in polluted environment possess anticancer molecules.
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Affiliation(s)
- M Soopramanien
- Department of Biological Sciences, Sunway University, Bandar Sunway, Malaysia
| | - N A Khan
- Department of Basic Medical Sciences, College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - R Siddiqui
- College of Arts and Sciences, American University of Sharjah, University City, Sharjah, United Arab Emirates
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Siddiqui R, Akbar N, Khan NA. Gut microbiome and human health under the space environment. J Appl Microbiol 2020; 130:14-24. [PMID: 32692438 DOI: 10.1111/jam.14789] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/10/2020] [Accepted: 07/15/2020] [Indexed: 12/17/2022]
Abstract
The gut microbiome is well recognized to have a pivotal role in regulation of the health and behaviour of the host, affecting digestion, metabolism, immunity, and has been linked to changes in bones, muscles and the brain, to name a few. However, the impact of microgravity environment on gut bacteria is not well understood. In space environments, astronauts face several health issues including stress, high iron diet, radiation and being in a closed system during extended space missions. Herein, we discuss the role of gut bacteria in the space environment, in relation to factors such as microgravity, radiation and diet. Gut bacteria may exact their effects by synthesis of molecules, their absorption, and through physiological effects on the host. Moreover we deliberate the role of these challenges in the dysbiosis of the human microbiota and possible dysregulation of the immune system.
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Affiliation(s)
- R Siddiqui
- Department of Biology, Chemistry and Environmental Sciences, College of Arts and Sciences, American University of Sharjah, University City, Sharjah, United Arab Emirates
| | - N Akbar
- Department of Biology, Chemistry and Environmental Sciences, College of Arts and Sciences, American University of Sharjah, University City, Sharjah, United Arab Emirates
| | - N A Khan
- Department of Biology, Chemistry and Environmental Sciences, College of Arts and Sciences, American University of Sharjah, University City, Sharjah, United Arab Emirates
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21
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Hosseini Z, Veenstra G, Khan NA, Conklin AI. Associations between social connections, their interactions, and obesity differ by gender: A population-based, cross-sectional analysis of the Canadian Longitudinal Study on Aging. PLoS One 2020; 15:e0235977. [PMID: 32730260 PMCID: PMC7392536 DOI: 10.1371/journal.pone.0235977] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 06/26/2020] [Indexed: 11/18/2022] Open
Abstract
Objectives To quantify the link between four different types of social ties and objective measures of abdominal and general obesity, and to explore their inter-relationships in association with obesity using a gender-sensitive analysis. Methods A cross-sectional analysis of 28,238 adults (45–85 years) from the baseline Canadian Longitudinal Study on Aging Comprehensive cohort (2012–15). Social ties (marital status, living arrangement, social network size, and social participation) and measured anthropometry (body mass index, waist circumference) were analyzed using linear and logistic regression models with interaction terms conditioned on known confounders. Results We found that being single, widowed or divorced/separated was associated with worse anthropometric outcomes in women, including higher odds of both abdominal and general obesity, and that associations were enhanced when combined with limited social participation, lone-living and greater social network size. Few clear associations were observed in men. Limited social participation (no social activities at least once/month) among women was associated with larger waist circumference (+4.19 cm [95% CI: 1.86, 6.52]) and higher odds of both abdominal and general obesity. By contrast, associations appeared to be reversed in men: lone-living and smaller social networks were associated with lower odds of obesity, compared to co-living and larger social networks. We also found that more regular social participation can potentially mitigate the adverse associations between non-partnership (single, divorced) and obesity in women. Overall, the combined influence of two types of social tie deficits on excess weight measures was more pronounced in women than men. Conclusions Results highlight the importance of considering how the role of social ties for obesity prevention may differ for women and men. Frequent social participation and number of social contacts may matter for assessing whether divorced, single or lone-living older women are at risk of obesity while living arrangement and social contacts may matter for obesity in men.
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Affiliation(s)
- Zeinab Hosseini
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
- * E-mail:
| | - Gerry Veenstra
- Department of Sociology, University of British Columbia, Vancouver, Canada
| | - Nadia A. Khan
- Department of Medicine, University of British Columbia, Vancouver, Canada
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, Vancouver, Canada
| | - Annalijn I. Conklin
- Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
- Centre for Health Evaluation and Outcome Sciences, St. Paul’s Hospital, Vancouver, Canada
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Unger T, Borghi C, Charchar F, Khan NA, Poulter NR, Prabhakaran D, Ramirez A, Schlaich M, Stergiou GS, Tomaszewski M, Wainford RD, Williams B, Schutte AE. 2020 International Society of Hypertension Global Hypertension Practice Guidelines. Hypertension 2020; 75:1334-1357. [PMID: 32370572 DOI: 10.1161/hypertensionaha.120.15026] [Citation(s) in RCA: 1518] [Impact Index Per Article: 379.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Affiliation(s)
- Thomas Unger
- From the CARIM - School for Cardiovascular Diseases, Maastricht University, the Netherlands (T.U.)
| | - Claudio Borghi
- Department of Medical and Surgical Sciences, University of Bologna, Italy (C.B.)
| | - Fadi Charchar
- Federation University Australia, School of Health and Life Sciences, Ballarat, Australia (F.C.).,University of Melbourne, Department of Physiology, Melbourne, Australia (F.C.).,University of Leicester, Department of Cardiovascular Sciences, United Kingdom (F.C.)
| | - Nadia A Khan
- University of British Columbia, Vancouver, Canada (N.A.K.).,Center for Health Evaluation and Outcomes Sciences, Vancouver, Canada (N.A.K.)
| | - Neil R Poulter
- Imperial Clinical Trials Unit, Imperial College London, United Kingdom (N.R.P.)
| | - Dorairaj Prabhakaran
- Public Health Foundation of India, New Delhi, India (D.P.).,Centre for Chronic Disease Control, New Delhi, India (D.P.).,London School of Hygiene and Tropical Medicine, United Kingdom (D.P.)
| | - Agustin Ramirez
- Hypertension and Metabolic Unit, University Hospital, Favaloro Foundation, Buenos Aires, Argentina (A.R.)
| | - Markus Schlaich
- Dobney Hypertension Centre, School of Medicine, Royal Perth Hospital Unit, University of Western Australia, Perth (M.S.).,Neurovascular Hypertension & Kidney Disease Laboratory, Baker Heart and Diabetes Institute, Melbourne, Victoria, Australia (M.N.)
| | - George S Stergiou
- Hypertension Center STRIDE-7, School of Medicine, Third Department of Medicine, Sotiria Hospital, National and Kapodistrian University of Athens, Greece (G.S.S.)
| | - Maciej Tomaszewski
- Division of Cardiovascular Sciences, Faculty of Medicine, Biology and Health, University of Manchester, United Kingdom (M.T.).,Division of Medicine and Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust Manchester, United Kingdom (M.T.)
| | - Richard D Wainford
- Department of Pharmacology and Experimental Therapeutics, Boston University School of Medicine, MA (R.D.W.).,The Whitaker Cardiovascular Institute, Boston University, MA (R.D.W.).,Department of Health Sciences, Boston University Sargent College, MA (R.D.W.)
| | - Bryan Williams
- University College London, NIHR University College London, Hospitals Biomedical Research Centre, London, United Kingdom (B.W.)
| | - Aletta E Schutte
- Faculty of Medicine, University of New South Wales, Sydney, Australia (A.E.S.).,The George Institute for Global Health, Sydney, Australia (A.E.S.).,Hypertension in Africa Research Team (A.E.S.), North-West University, Potchefstroom, South Africa.,South African MRC Unit for Hypertension and Cardiovascular Disease (A.E.S.), North-West University, Potchefstroom, South Africa
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Abdellatif W, Ding J, Jalal S, Nguyen T, Khorshed D, Rybicki FJ, Ali IT, McInnes MDF, Khan NA, Shah S, Khosa F. Lack of Gender Disparity Among Administrative Leaders of Canadian Health Authorities. J Womens Health (Larchmt) 2020; 29:1469-1474. [PMID: 32091966 DOI: 10.1089/jwh.2019.7852] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Gender distribution within the managing bodies of the Canadian health authorities has not been studied despite their integral role in the health care system. The purpose of this study is to quantify gender differences and to craft a geographic gender analysis of such distribution. Methods: Retrospective data collection of all Canadian health authorities at the provincial, territorial, regional, and first nations levels was conducted. The dependent variable was gender, and other covariates, where applicable, included province/territory, region, leadership position, education (PhD or Master's), honorary degree, and primary occupation. Any member within the executive managing body or board of directors of a Canadian health authority was included, unless their gender could not be determined, in which case they were excluded. Results: Quantitative analysis of the 67 health authorities revealed 1346 individuals with identifiable gender (710 women; 636 men). Thematic distribution showed no significant difference in the gender distribution by provinces/territories (chi square = 14.248; p = 0.28), by leadership position (chi square = 1.88; p = 0.75), by education (chi square = 1.85; p = 0.17), or by primary occupation (chi square = 1.53; p = 0.46). Conclusion: The overall number of females exceeded that of males and there were no gender disparities. Critical analysis of probable causes was discussed. Further studies should be conducted to examine the policies and programs within the Canadian health authorities that successfully tackle the retention, recruitment, and promotion of females.
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Affiliation(s)
- Waleed Abdellatif
- Radiology Department, University of British Columbia/Vancouver General Hospital, Vancouver, Canada
| | - Jeffrey Ding
- Faculty of Science, University of British Columbia, Vancouver, Canada
| | - Sabeena Jalal
- Department of Radiology, Vancouver General Hospital, Vancouver, Canada
| | - Tribesty Nguyen
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | | | - Frank J Rybicki
- Department of Radiology, University of Ottawa and The Ottawa Hospital Research Institute, Ottawa, Canada
| | - Ismail Tawakol Ali
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Canada
| | | | - Nadia A Khan
- Department of Medicine, University of British Columbia Centre for Health Evaluation and Outcomes Sciences, Vancouver, Canada
| | - Samad Shah
- Department of Clinical Radiology, Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Faisal Khosa
- Radiology Department, University of British Columbia/Vancouver General Hospital, Vancouver, Canada
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Al Amin MM, Paul SK, Aung MS, Paul A, Aziz MA, Khan NA, Haque AKMF, Ahamed F, Melan A, Sarker SR, Hossain MA, Ahmed S, Nasreen SA, Haque N, Kobayashi N. Molecular characterization of Orientia tsutsugamushi causing scrub typhus among febrile patients in north-central Bangladesh. New Microbes New Infect 2019; 32:100595. [PMID: 31641512 PMCID: PMC6796758 DOI: 10.1016/j.nmni.2019.100595] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 08/19/2019] [Accepted: 08/21/2019] [Indexed: 01/30/2023] Open
Abstract
Scrub typhus is a mite-borne rickettsial disease caused by Orientia tsutsugamushi, which is endemic in Asia Pacific region. In this study, infection rate and molecular epidemiologic traits of O. tsutsugamushi was investigated in Mymensingh, located in north-central Bangladesh. Among the blood samples from 453 febrile patients who visited Mymensingh medical college hospital in 2018, the 47 kDa protein gene of O. tsutsugamushi was detected in 78 samples (17.2%) by nested PCR. Phylogenetic analysis of the O. tsutsugamushi 56 kDa protein gene (18 samples) revealed a predominance of Karp-related genotype (89%), while the remaining belonged to Gilliam genotype. Samples of the Karp-related genotype mostly clustered with those of China, Taiwan, Thailand and India, etc., in emergent subgroups clades 2 and 4, which were distinct from clade 1, including prototype Karp strains. Among the 18 samples, three variable domains (VD) of 56 kDa type-specific antigen had different types of sequence diversity; VDI contained two or three repeats of eight amino acid units, while VDII and VDIII had amino acid substitution, deletion or insertion. The present study documented a potentially high prevalence of genetically diverse O. tsutsugamushi in north-central Bangladesh.
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Affiliation(s)
- M M Al Amin
- Mymensingh Medical College, Mymensingh, Bangladesh
| | - S K Paul
- Mymensingh Medical College, Mymensingh, Bangladesh
| | - M S Aung
- Sapporo Medical University School of Medicine, Sapporo, Japan
| | - A Paul
- Mymensingh Medical College, Mymensingh, Bangladesh
| | - M A Aziz
- Mymensingh Medical College, Mymensingh, Bangladesh
| | - N A Khan
- Mymensingh Medical College, Mymensingh, Bangladesh
| | | | - F Ahamed
- Mymensingh Medical College, Mymensingh, Bangladesh
| | - A Melan
- Mymensingh Medical College, Mymensingh, Bangladesh
| | - S R Sarker
- Mymensingh Medical College, Mymensingh, Bangladesh
| | - M A Hossain
- National Institute of Preventive and Social Medicine (NIPSOM), Dhaka, Bangladesh
| | - S Ahmed
- Mymensingh Medical College, Mymensingh, Bangladesh
| | - S A Nasreen
- Sheikh Hasina Medical College, Jamalpur, Bangladesh
| | - N Haque
- Mymensingh Medical College, Mymensingh, Bangladesh
| | - N Kobayashi
- Sapporo Medical University School of Medicine, Sapporo, Japan
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Bacon SL, Campbell NRC, Raine KD, Tsuyuki RT, Khan NA, Arango M, Kaczorowski J. Canada's new Healthy Eating Strategy: Implications for health care professionals and a call to action. Can Fam Physician 2019; 65:393-398. [PMID: 31189626 PMCID: PMC6738387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Simon L Bacon
- Co-Director of the Montreal Behavioural Medicine Centre in Quebec, a researcher at the CIUSSS-NIM and Hôpital du Sacré-Coeur de Montréal, and Professor in the Department of Health, Kinesiology and Applied Physiology at Concordia University in Montreal.
| | - Norm R C Campbell
- Professor of Medicine, Physiology and Pharmacology, and Community Health Sciences at the University of Calgary in Alberta and a member of the O'Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta
| | - Kim D Raine
- Professor and Associate Dean (Research) in the School of Public Health at the University of Alberta in Edmonton
| | - Ross T Tsuyuki
- Professor in the Department of Medicine and the Division of Cardiology at the University of Alberta
| | - Nadia A Khan
- Associate Professor in the Department of Medicine and Division of General Internal Medicine at the University of British Columbia in Vancouver
| | - Manuel Arango
- Director, Health Policy & Advocacy for the Heart and Stroke Foundation of Canada in Ottawa, Ont
| | - Janusz Kaczorowski
- Professor and Research Director in the Department of Family and Emergency Medicine at the University of Montreal and the Centre de Recherche CHUM in Montreal
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Bacon SL, Campbell NRC, Raine KD, Tsuyuki RT, Khan NA, Arango M, Kaczorowski J. [Not Available]. Can Fam Physician 2019; 65:e244-e250. [PMID: 31189637 PMCID: PMC6738384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Simon L Bacon
- Codirecteur du Centre de médecine comportementale de Montréal (Québec), chercheur au CIUSSS-NIM et à l'Hôpital du Sacré-Cœur de Montréal, et professeur au Département de santé, kinésiologie et physiologie appliquée de l'Université Concordia à Montréal.
| | - Norm R C Campbell
- Professeur de médecine, physiologie et pharmacologie, et de sciences de la santé communautaire à l'Université de Calgary (Alberta), et membre de l'O'Brien Institute for Public Health et du Libin Cardiovascular Institute of Alberta
| | - Kim D Raine
- Professeure et vice-doyenne (Recherche) à l'École de santé publique de l'Université de l'Alberta à Edmonton
| | - Ross T Tsuyuki
- Professeur au Département de médecine et à la Division de cardiologie à l'Université de l'Alberta
| | - Nadia A Khan
- Professeure agrégée au Département de médecine et à la Division de médecine interne générale de l'Université de la Colombie-Britannique à Vancouver
| | - Manuel Arango
- Directeur, Politiques de la santé et Mobilisation à la Fondation des maladies du cœur et de l'AVC du Canada à Ottawa (Ontario)
| | - Janusz Kaczorowski
- Professeur et directeur de la recherche au Département de médecine de famille et de médecine d'urgence de l'Université de Montréal et au Centre de Recherche CHUM à Montréal
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Khan NA, Viana Parente Lopes JM, Santos Pires JP, Lopes Dos Santos JMB. Spectral functions of one-dimensional systems with correlated disorder. J Phys Condens Matter 2019; 31:175501. [PMID: 30703754 DOI: 10.1088/1361-648x/ab03ad] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We investigate the spectral function of Bloch states in a one-dimensional tight-binding non-interacting chain with two different models of static correlated disorder, at zero temperature. We report numerical calculations of the single-particle spectral function based on the Kernel polynomial method, which has an [Formula: see text] computational complexity. These results are then confirmed by analytical calculations, where precise conditions were obtained for the appearance of a classical limit in a single-band lattice system. Spatial correlations in the disordered potential give rise to non-perturbative spectral functions shaped as the probability distribution of the random on-site energies, even at low disorder strengths. In the case of disordered potentials with an algebraic power-spectrum, [Formula: see text] [Formula: see text], we show that the spectral function is not self-averaging for [Formula: see text].
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Affiliation(s)
- N A Khan
- Centro de Física das Universidades do Minho e Porto, Departamento de Física e Astronomia, Faculdade de Ciências, Universidade do Porto, 4169-007 Porto, Portugal
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Bacon SL, Campbell NR, Raine KD, Tsuyuki R, Khan NA, Arango M, Kaczorowski J. Canada's New Healthy Eating Strategy: Implications for Healthcare Professionals and a Call to Action. Can J Diabetes 2019; 43:155-160. [DOI: 10.1016/j.jcjd.2019.02.001] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bacon SL, Campbell NRC, Raine KD, Tsuyuki RT, Khan NA, Arango M, Kaczorowski J. Canada's new Healthy Eating Strategy: Implications for health care professionals and a call to action. Can Pharm J (Ott) 2019; 152:151-157. [PMID: 31156726 DOI: 10.1177/1715163519834891] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Simon L Bacon
- Montreal Behavioural Medicine Centre (Bacon), CIUSSS-NIM, Hôpital du Sacré-Coeur de Montréal.,Department of Health, Kinesiology and Applied Physiology (Bacon), Concordia University, Montreal, Quebec.,Department of Medicine, Physiology and Pharmacology and Community Health Sciences (Campbell), O'Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary.,School of Public Health (Raine), University of Alberta, Edmonton; the Department of Medicine (Tsuyuki), Division of Cardiology, University of Alberta, Edmonton, Alberta.,Department of Medicine (Khan), Division of General Internal Medicine, University of British Columbia, Vancouver, British Columbia.,The Heart and Stroke Foundation of Canada (Arango), Ottawa, Ontario.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal.,Centre de Recherche CHUM (Kaczorowski), Montreal, Quebec
| | - Norm R C Campbell
- Montreal Behavioural Medicine Centre (Bacon), CIUSSS-NIM, Hôpital du Sacré-Coeur de Montréal.,Department of Health, Kinesiology and Applied Physiology (Bacon), Concordia University, Montreal, Quebec.,Department of Medicine, Physiology and Pharmacology and Community Health Sciences (Campbell), O'Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary.,School of Public Health (Raine), University of Alberta, Edmonton; the Department of Medicine (Tsuyuki), Division of Cardiology, University of Alberta, Edmonton, Alberta.,Department of Medicine (Khan), Division of General Internal Medicine, University of British Columbia, Vancouver, British Columbia.,The Heart and Stroke Foundation of Canada (Arango), Ottawa, Ontario.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal.,Centre de Recherche CHUM (Kaczorowski), Montreal, Quebec
| | - Kim D Raine
- Montreal Behavioural Medicine Centre (Bacon), CIUSSS-NIM, Hôpital du Sacré-Coeur de Montréal.,Department of Health, Kinesiology and Applied Physiology (Bacon), Concordia University, Montreal, Quebec.,Department of Medicine, Physiology and Pharmacology and Community Health Sciences (Campbell), O'Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary.,School of Public Health (Raine), University of Alberta, Edmonton; the Department of Medicine (Tsuyuki), Division of Cardiology, University of Alberta, Edmonton, Alberta.,Department of Medicine (Khan), Division of General Internal Medicine, University of British Columbia, Vancouver, British Columbia.,The Heart and Stroke Foundation of Canada (Arango), Ottawa, Ontario.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal.,Centre de Recherche CHUM (Kaczorowski), Montreal, Quebec
| | - Ross T Tsuyuki
- Montreal Behavioural Medicine Centre (Bacon), CIUSSS-NIM, Hôpital du Sacré-Coeur de Montréal.,Department of Health, Kinesiology and Applied Physiology (Bacon), Concordia University, Montreal, Quebec.,Department of Medicine, Physiology and Pharmacology and Community Health Sciences (Campbell), O'Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary.,School of Public Health (Raine), University of Alberta, Edmonton; the Department of Medicine (Tsuyuki), Division of Cardiology, University of Alberta, Edmonton, Alberta.,Department of Medicine (Khan), Division of General Internal Medicine, University of British Columbia, Vancouver, British Columbia.,The Heart and Stroke Foundation of Canada (Arango), Ottawa, Ontario.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal.,Centre de Recherche CHUM (Kaczorowski), Montreal, Quebec
| | - Nadia A Khan
- Montreal Behavioural Medicine Centre (Bacon), CIUSSS-NIM, Hôpital du Sacré-Coeur de Montréal.,Department of Health, Kinesiology and Applied Physiology (Bacon), Concordia University, Montreal, Quebec.,Department of Medicine, Physiology and Pharmacology and Community Health Sciences (Campbell), O'Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary.,School of Public Health (Raine), University of Alberta, Edmonton; the Department of Medicine (Tsuyuki), Division of Cardiology, University of Alberta, Edmonton, Alberta.,Department of Medicine (Khan), Division of General Internal Medicine, University of British Columbia, Vancouver, British Columbia.,The Heart and Stroke Foundation of Canada (Arango), Ottawa, Ontario.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal.,Centre de Recherche CHUM (Kaczorowski), Montreal, Quebec
| | - Manuel Arango
- Montreal Behavioural Medicine Centre (Bacon), CIUSSS-NIM, Hôpital du Sacré-Coeur de Montréal.,Department of Health, Kinesiology and Applied Physiology (Bacon), Concordia University, Montreal, Quebec.,Department of Medicine, Physiology and Pharmacology and Community Health Sciences (Campbell), O'Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary.,School of Public Health (Raine), University of Alberta, Edmonton; the Department of Medicine (Tsuyuki), Division of Cardiology, University of Alberta, Edmonton, Alberta.,Department of Medicine (Khan), Division of General Internal Medicine, University of British Columbia, Vancouver, British Columbia.,The Heart and Stroke Foundation of Canada (Arango), Ottawa, Ontario.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal.,Centre de Recherche CHUM (Kaczorowski), Montreal, Quebec
| | - Janusz Kaczorowski
- Montreal Behavioural Medicine Centre (Bacon), CIUSSS-NIM, Hôpital du Sacré-Coeur de Montréal.,Department of Health, Kinesiology and Applied Physiology (Bacon), Concordia University, Montreal, Quebec.,Department of Medicine, Physiology and Pharmacology and Community Health Sciences (Campbell), O'Brien Institute for Public Health and Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary.,School of Public Health (Raine), University of Alberta, Edmonton; the Department of Medicine (Tsuyuki), Division of Cardiology, University of Alberta, Edmonton, Alberta.,Department of Medicine (Khan), Division of General Internal Medicine, University of British Columbia, Vancouver, British Columbia.,The Heart and Stroke Foundation of Canada (Arango), Ottawa, Ontario.,Department of Family and Emergency Medicine (Kaczorowski), University of Montreal.,Centre de Recherche CHUM (Kaczorowski), Montreal, Quebec
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Garies S, Hao S, McBrien K, Williamson T, Peng M, Khan NA, Padwal RS, Quan H, Leung AA. Prevalence of Hypertension, Treatment, and Blood Pressure Targets in Canada Associated With the 2017 American College of Cardiology and American Heart Association Blood Pressure Guidelines. JAMA Netw Open 2019; 2:e190406. [PMID: 30848811 PMCID: PMC6484648 DOI: 10.1001/jamanetworkopen.2019.0406] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [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: 12/19/2022] Open
Abstract
IMPORTANCE The 2017 American College of Cardiology and American Heart Association (ACC/AHA) blood pressure (BP) guidelines redefined hypertension using a BP threshold of 130/80 mm Hg or greater and applied a treatment target of less than 130/80 mm Hg. OBJECTIVE To evaluate the potential change in the diagnosis, treatment, and control of hypertension in a Canadian cohort of patients with hypertension attending primary care practices using the ACC/AHA guidelines. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used primary care practices across Canada electronic medical record data from the Canadian Primary Care Sentinel Surveillance Network, extracted as of June 30, 2015. Adults with at least 1 primary care encounter in the previous 2 years (July 1, 2013, to June 30, 2015) were included in the study. Those with current hypertension were identified using a validated definition consisting of diagnoses, billing codes, and/or antihypertensive medication from within the primary care electronic medical record. Data analysis was conducted from December 2017 to July 2018. MAIN OUTCOMES AND MEASURES Proportion of individuals with a diagnosis of hypertension, prescribed antihypertensive medication, and meeting treatment BP targets. RESULTS Of the 594 492 Canadian participants included in the study, 144 348 (24.2%) had hypertension (45.6% male; mean [SD] age, 65.5 [14.5] years). On applying the ACC/AHA guidelines, 252 279 individuals (42.4%) were considered hypertensive and half (51.0%; 95% CI, 50.8%-51.2%) were prescribed an antihypertensive medication. Individuals who were not previously considered to have hypertension but were reclassified as having elevated BP using the lower cutoff of 130/80 mm Hg or greater tended to be younger and were at lower cardiovascular risk. There was a shift toward more individuals requiring antihypertensive treatment, particularly in the lower-risk categories. The crude prevalence of hypertension increased from 13.3% to 32.0% in those aged 18 to 64 years, and of those aged 65 years and older, 16.6% more individuals were reclassified as having hypertension (from 55.2% to 71.8%). Only 12.3% of those who were considered at high risk were reclassified as hypertensive. CONCLUSIONS AND RELEVANCE Adoption of the ACC/AHA BP guidelines would result in a near doubling in the prevalence of hypertension in Canada. The changes would largely affect individuals who are younger and at low to moderate cardiovascular risk.
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Affiliation(s)
- Stephanie Garies
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sylvia Hao
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Kerry McBrien
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Family Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Tyler Williamson
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Mingkai Peng
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Nadia A. Khan
- Division of General Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - Raj S. Padwal
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Hude Quan
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta, Canada
| | - Alexander A. Leung
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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Tran KC, Potts J, Robertson J, Ly K, Dayan N, Khan NA, Chan W. Out-of-office blood pressure measurement for the diagnosis of hypertension in pregnancy: Survey of Canadian Obstetric Medicine and Maternal Fetal Medicine specialists. Obstet Med 2019; 13:20-24. [PMID: 32284728 DOI: 10.1177/1753495x18819338] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 11/23/2018] [Indexed: 11/15/2022] Open
Abstract
Background Multiple hypertension guidelines recommend out-of-office measurements for the diagnosis of hypertension in non-pregnant adults, whereas pregnancy guidelines recommend in-office blood pressure measurements. The objective of our study was to determine how Canadian Obstetric Medicine and Maternal Fetal Medicine specialists measure blood pressure in pregnancy. Methods An email survey was sent to 69 Canadian Obstetric Medicine and Maternal Fetal Medicine specialists in academic centers across Canada to explore the practice patterns of blood pressure measurement in pregnant women. Results The response rate was 48%. The majority of respondents (63.6%) preferred office blood pressure measurement for diagnosing hypertension, but relied on home blood pressure readings for ongoing monitoring and management of hypertension during pregnancy (59.4%). The preferred method of out-of-office blood pressure measurement was home monitoring; 24-hour ambulatory blood pressure monitoring was not used due to limited availability and cost. Conclusions There is wide practice variation in methods of measuring blood pressure among Canadian specialists managing hypertension in pregnancy.
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Affiliation(s)
- K C Tran
- Department of Medicine, Division of General Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - J Potts
- Department of Medicine, Division of General Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - J Robertson
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
| | - K Ly
- Department of Medicine, Division of General Internal Medicine Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | - N Dayan
- Department of Medicine, Division of General Internal Medicine Research Institute, McGill University Health Centre, Montreal, Quebec, Canada
| | - N A Khan
- Department of Medicine, Division of General Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Center for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - W Chan
- Department of Medicine, Division of General Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Amin MS, Islam MN, Khan NA. Adenoma Malignum of the Uterine Cervix: A Case Report. Mymensingh Med J 2018; 27:654-657. [PMID: 30141460] [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: 06/08/2023]
Abstract
Adenoma malignum (AM) of the uterine cervix, otherwise known as minimal deviation adenocarcinoma, is a rare variant of cervical adenocarcinoma, which represents a diagnostic challenge, due to its benign-resembling histological characteristics. We present a case of 54-year-old nullipara woman presented with menorrhagia for 2 years and that had worsened over the past few months. Transabdominal ultrasound fibroid uterus with cluster of nabothian cysts was in the cervix. Subsequently MRI was done for better characterization and showed intramural myomas in the uterine body. A large ovoid mass containing multiple cystic components in the left side of cervix communicating with a tract to the cervical canal, which was consistent with features of adenoma malignum of the cervix. Then the differential diagnosis was included tunnel cluster nabothian cysts. The patient underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy. The final histopathologic diagnosis revealed adenoma malignum of the cervix and intramural myomas. Subsequently, a review of literature was performed and the results demonstrated that early diagnosis, clinical stage and surgical protocols are the main factors affecting the prognosis of AM. Close follow-up of the cases may provide more information regarding this disease and the efficacy of the available therapeutic methods.
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Affiliation(s)
- M S Amin
- Dr Md Sadrul Amin, Associate Professor, Department of Radiology & Imaging, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh; E-mail:
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Brunham LR, Lynch K, English A, Sutherland R, Weng J, Cho R, Wong GC, Anis AH, Francis GA, Khan NA, McManus B, Wood D, Walley KR, Leipsic J, Humphries KH, Hoens A, Krahn AD, John Mancini GB, Pimstone S. The design and rationale of SAVE BC: The Study to Avoid CardioVascular Events in British Columbia. Clin Cardiol 2018; 41:888-895. [PMID: 29635745 DOI: 10.1002/clc.22959] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 01/10/2018] [Revised: 03/20/2018] [Accepted: 03/30/2018] [Indexed: 11/05/2022] Open
Abstract
Atherosclerotic cardiovascular disease (ASCVD) is highly heritable, particularly when it occurs at a young age. The screening of individuals with premature ASCVD, although often recommended, is not routinely performed. Strategies to address this gap in care are essential. We designed the Study to Avoid CardioVascular Events in British Columbia (SAVE BC) as a prospective, observational study of individuals with a new diagnosis of very premature ASCVD (defined as age ≤ 50 years in males and age ≤ 55 years in females) and their first-degree relatives (FDRs) and spouses. FDRs and spouses will undergo screening for cardiovascular (CV) risk factors and subclinical ASCVD using a structured screening algorithm. All subjects will be followed longitudinally for ≥10 years. The overall goal of SAVE BC is to evaluate the yield of a structured screening program for identifying individuals at risk of premature ASCVD. The primary objectives of SAVE BC are to identify and follow index cases with very premature ASCVD and their FDRs and to determine the diagnostic yield of a structured screening program for these individuals. We will collect data on CV risk factors, medication use, CV events, and healthcare costs in these individuals. SAVE BC will provide insight regarding approaches to identify individuals at risk for premature ASCVD with implications for prevention and treatment in this population.
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Affiliation(s)
- Liam R Brunham
- Department of Medicine, University of British Columbia, Vancouver, Canada.,Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
| | - Kelsey Lynch
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
| | - Amy English
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
| | - Rory Sutherland
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
| | - Jian Weng
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
| | - Raymond Cho
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
| | - Graham C Wong
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Aslam H Anis
- School of Population and Public Health, University of British Columbia, Vancouver, Canada.,Center for Health Evaluation and Outcomes Science, University of British Columbia, Vancouver, Canada
| | - Gordon A Francis
- Department of Medicine, University of British Columbia, Vancouver, Canada.,Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
| | - Nadia A Khan
- Department of Medicine, University of British Columbia, Vancouver, Canada.,Center for Health Evaluation and Outcomes Science, University of British Columbia, Vancouver, Canada
| | - Bruce McManus
- Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada.,Prevention of Organ Failure (PROOF) Centre of Excellence, Vancouver, Canada
| | - David Wood
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Keith R Walley
- Department of Medicine, University of British Columbia, Vancouver, Canada.,Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
| | - Jonathon Leipsic
- Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Karin H Humphries
- Center for Health Evaluation and Outcomes Science, University of British Columbia, Vancouver, Canada.,BC Centre for Improved Cardiovascular Health, Vancouver, Canada
| | - Alison Hoens
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
| | - Andrew D Krahn
- Department of Medicine, University of British Columbia, Vancouver, Canada.,Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
| | - G B John Mancini
- Department of Medicine, University of British Columbia, Vancouver, Canada
| | - Simon Pimstone
- Department of Medicine, University of British Columbia, Vancouver, Canada.,Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
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Daskalopoulou SS, Rabi DM, Schiffrin EL, Feldman RD, Padwal RS, Tremblay G, Khan NA. Hypertension Guidelines in the United States and Canada: Are We Getting Closer? Hypertension 2018; 71:976-978. [DOI: 10.1161/hypertensionaha.117.10772] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Doreen M. Rabi
- McGill University, Montreal, Quebec, Canada; O’Brien Institute of Public Health, University of Calgary, Alberta, Canada (D.M.R.)
| | | | - Ross D. Feldman
- Winnipeg Regional Health Authority and the University of Manitoba, Winnipeg, Canada (R.D.F.)
| | - Raj S. Padwal
- Department of Medicine, University of Alberta, Edmonton, Canada (R.S.P.)
| | - Guy Tremblay
- CHU-Québec-Hopital St. Sacrement, Quebec, Canada (G.T.)
| | - Nadia A. Khan
- and Division of General Internal Medicine, University of British Columbia and the Center for Health Evaluation and Outcomes Sciences, Vancouver, Canada (N.A.K.)
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Khan NA, Rabkin SW, Zhao Y, McAlister FA, Park JE, Guan M, Chan S, Humphries KH. Effect of Lowering Diastolic Pressure in Patients With and Without Cardiovascular Disease. Hypertension 2018; 71:840-847. [DOI: 10.1161/hypertensionaha.117.10177] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2017] [Revised: 08/29/2017] [Accepted: 02/05/2018] [Indexed: 12/26/2022]
Abstract
Systolic and diastolic blood pressure thresholds, below which cardiovascular events increase, are widely debated. Using data from the SPRINT (Systolic Blood Pressure Intervention Trial), we evaluated the relation between systolic and diastolic pressure and cardiovascular events among 1519 participants with or 7574 without prior cardiovascular disease. Using Cox regression, we examined the composite risk of myocardial infarction, other acute coronary syndrome, stroke, heart failure, or cardiovascular death, and follow-up systolic and diastolic pressure were analyzed as time-dependent covariates for a median of 3.1 years. Models were adjusted for age, sex, baseline systolic pressure, body mass index, 10-year Framingham risk score, and estimated glomerular filtration rate. A J-shaped relationship with diastolic pressure was observed in both treatment arms in patients with or without cardiovascular disease (
P
nonlinearity≤0.002). When diastolic pressure fell <55 mm Hg, the hazards were at least 25% higher relative to 70 mm Hg (
P
=0.29). The hazard ratios (95% CI) of diastolic pressure <55 mm Hg versus 55 to 90 mm Hg were 1.68 (1.16–2.43),
P
value 0.006 and 1.52 (0.99–2.34),
P
value 0.06 in patients without and with prior cardiovascular disease, respectively. After adjusting for follow-up diastolic pressure, follow-up systolic pressure was not associated with the outcome in those without prior cardiovascular disease (
P
=0.64). In those with cardiovascular disease, adjusting for diastolic pressure, follow-up systolic pressure was associated with the risk in the intensive arm (hazard ratio per 10 mm Hg decrease, 0.86; 95% CI, 0.75–0.99;
P
interaction=0.02). Although the observed J-shaped relationship may be because of reverse causality in the SPRINT population, we advise caution in aggressively lowering diastolic pressure.
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Affiliation(s)
- Nadia A. Khan
- From the Division of Internal Medicine, Department of Medicine, Center for Health Evaluation and Outcomes Science Canada (N.A.K.) and Division of Cardiology, Department of Medicine (S.W.R., S.C., K.H.H.), University of British Columbia, Vancouver, Canada; British Columbia Centre for Improved Cardiovascular Health, Vancouver, Canada (Y.Z., J.E.P., M.G., K.H.H.); and Division of Internal Medicine, Department of Medicine, University of Alberta, Edmonton, Canada (F.A.M.)
| | - Simon W. Rabkin
- From the Division of Internal Medicine, Department of Medicine, Center for Health Evaluation and Outcomes Science Canada (N.A.K.) and Division of Cardiology, Department of Medicine (S.W.R., S.C., K.H.H.), University of British Columbia, Vancouver, Canada; British Columbia Centre for Improved Cardiovascular Health, Vancouver, Canada (Y.Z., J.E.P., M.G., K.H.H.); and Division of Internal Medicine, Department of Medicine, University of Alberta, Edmonton, Canada (F.A.M.)
| | - Yinshan Zhao
- From the Division of Internal Medicine, Department of Medicine, Center for Health Evaluation and Outcomes Science Canada (N.A.K.) and Division of Cardiology, Department of Medicine (S.W.R., S.C., K.H.H.), University of British Columbia, Vancouver, Canada; British Columbia Centre for Improved Cardiovascular Health, Vancouver, Canada (Y.Z., J.E.P., M.G., K.H.H.); and Division of Internal Medicine, Department of Medicine, University of Alberta, Edmonton, Canada (F.A.M.)
| | - Finlay A. McAlister
- From the Division of Internal Medicine, Department of Medicine, Center for Health Evaluation and Outcomes Science Canada (N.A.K.) and Division of Cardiology, Department of Medicine (S.W.R., S.C., K.H.H.), University of British Columbia, Vancouver, Canada; British Columbia Centre for Improved Cardiovascular Health, Vancouver, Canada (Y.Z., J.E.P., M.G., K.H.H.); and Division of Internal Medicine, Department of Medicine, University of Alberta, Edmonton, Canada (F.A.M.)
| | - Julie E. Park
- From the Division of Internal Medicine, Department of Medicine, Center for Health Evaluation and Outcomes Science Canada (N.A.K.) and Division of Cardiology, Department of Medicine (S.W.R., S.C., K.H.H.), University of British Columbia, Vancouver, Canada; British Columbia Centre for Improved Cardiovascular Health, Vancouver, Canada (Y.Z., J.E.P., M.G., K.H.H.); and Division of Internal Medicine, Department of Medicine, University of Alberta, Edmonton, Canada (F.A.M.)
| | - Meijiao Guan
- From the Division of Internal Medicine, Department of Medicine, Center for Health Evaluation and Outcomes Science Canada (N.A.K.) and Division of Cardiology, Department of Medicine (S.W.R., S.C., K.H.H.), University of British Columbia, Vancouver, Canada; British Columbia Centre for Improved Cardiovascular Health, Vancouver, Canada (Y.Z., J.E.P., M.G., K.H.H.); and Division of Internal Medicine, Department of Medicine, University of Alberta, Edmonton, Canada (F.A.M.)
| | - Sammy Chan
- From the Division of Internal Medicine, Department of Medicine, Center for Health Evaluation and Outcomes Science Canada (N.A.K.) and Division of Cardiology, Department of Medicine (S.W.R., S.C., K.H.H.), University of British Columbia, Vancouver, Canada; British Columbia Centre for Improved Cardiovascular Health, Vancouver, Canada (Y.Z., J.E.P., M.G., K.H.H.); and Division of Internal Medicine, Department of Medicine, University of Alberta, Edmonton, Canada (F.A.M.)
| | - Karin H. Humphries
- From the Division of Internal Medicine, Department of Medicine, Center for Health Evaluation and Outcomes Science Canada (N.A.K.) and Division of Cardiology, Department of Medicine (S.W.R., S.C., K.H.H.), University of British Columbia, Vancouver, Canada; British Columbia Centre for Improved Cardiovascular Health, Vancouver, Canada (Y.Z., J.E.P., M.G., K.H.H.); and Division of Internal Medicine, Department of Medicine, University of Alberta, Edmonton, Canada (F.A.M.)
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Tam P, Nijjar AP, Fok M, Little C, Shingina A, Bittman J, Raghavan R, Khan NA. Structured patient handoff on an internal medicine ward: A cluster randomized control trial. PLoS One 2018; 13:e0195216. [PMID: 29672526 PMCID: PMC5908079 DOI: 10.1371/journal.pone.0195216] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2017] [Accepted: 03/08/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The effect of a multi-faceted handoff strategy in a high volume internal medicine inpatient setting on process and patient outcomes has not been clearly established. We set out to determine if a multi-faceted handoff intervention consisting of education, standardized handoff procedures, including fixed time and location for face-to-face handoff would result in improved rates of handoff compared with usual practice. We also evaluated resident satisfaction, health resource utilization and clinical outcomes. METHODS This was a cluster randomized controlled trial in a large academic tertiary care center with 18 inpatient internal medicine ward teams from January-April 2013. We randomized nine inpatient teams to an intervention where they received an education session standardizing who and how to handoff patients, with practice and feedback from facilitators. The control group of 9 teams continued usual non-standardized handoffs. The primary process outcome was the rate of patients handed over per 1000 patient nights. Other process outcomes included perceptions of inadequate handoff by overnight physicians, resource utilization overnight and hospital length of stay. Clinical outcomes included medical errors, frequency of patients requiring higher level of care overnight, and in-hospital mortality. RESULTS The intervention group demonstrated a significant increase in the rate of patients handed over to the overnight physician (62.90/1000 person-nights vs. 46.86/1000 person-nights, p = 0.002). There was no significant difference in other process outcomes except resource utilization was increased in the intervention group (26.35/1000 person-days vs. 17.57/1000 person-days, p-value = 0.01). There was no significant difference between groups in medical errors (4.8% vs. 4.1%), need for higher level of care or in hospital mortality. Limitations include a dependence of accurate record keeping by the overnight physician, the possibility of cross-contamination in the handoff process, analysis at the cluster level and an overall low number of clinical events. CONCLUSIONS Implementation of a multi-faceted resident handoff intervention did not result in a significant improvement in patient safety although did improve number of patients handed off. Novel methods to improve handoff need to be explored. TRIAL REGISTRATION Registered at ClinicalTrials.gov: NCT01796756.
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Affiliation(s)
- Penny Tam
- Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Aman P. Nijjar
- Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Mark Fok
- Division of Geriatric Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Chris Little
- Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Jesse Bittman
- Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rashmi Raghavan
- Division of Family Practice, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nadia A. Khan
- Division of General Internal Medicine, Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Center for Health Evaluation and Outcomes Sciences, University of British Columbia, Vancouver, British Columbia, Canada
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Akbar N, Siddiqui R, Iqbal M, Sagathevan K, Khan NA. Gut bacteria of cockroaches are a potential source of antibacterial compound(s). Lett Appl Microbiol 2018; 66:416-426. [PMID: 29457249 DOI: 10.1111/lam.12867] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2017] [Revised: 02/08/2018] [Accepted: 02/09/2018] [Indexed: 12/19/2022]
Abstract
Here, we hypothesized that the microbial gut flora of animals/pests living in polluted environments, produce substances to thwart bacterial infections. The overall aim of this study was to source microbes inhabiting unusual environmental niches for potential antimicrobial activity. Two cockroach species, Gromphadorhina portentosa (Madagascar) and Blaptica dubia (Dubia) were selected. The gut bacteria from these species were isolated and grown in RPMI 1640 and conditioned media were prepared. Conditioned media were tested against a panel of Gram-positive (Methicillin-resistant Staphylococcus aureus, Streptococcus pyogenes, Bacillus cereus) and Gram-negative (Escherichia coli K1, Salmonella enterica, Serratia marcescens, Pseudomonas aeruginosa, Klebsiella pneumoniae) bacteria, as well as the protist pathogen, Acanthamoeba castellanii. The results revealed that the gut bacteria of cockroaches produce active molecule(s) with potent antibacterial properties, as well as exhibit antiamoebic effects. However, heat-inactivation at 95°C for 10 min had no effect on conditioned media-mediated antibacterial and antiamoebic properties. These results suggest that bacteria from novel sources i.e. from the cockroach's gut produce molecules with bactericidal as well as amoebicidal properties that can ultimately lead to the development of therapeutic drugs. SIGNIFICANCE AND IMPACT OF THE STUDY The bacteria isolated from unusual dwellings such as the cockroaches' gut are a useful source of antibacterial and antiamoebal molecules. These are remarkable findings that will open several avenues in our search for novel antimicrobials from unique sources. Furthermore studies will lead to the identification of molecules to develop future antibacterials from insects.
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Affiliation(s)
- N Akbar
- Department of Biological Sciences, School of Science and Technology, Sunway University, Bandar Sunway, Malaysia
| | - R Siddiqui
- Department of Biological Sciences, School of Science and Technology, Sunway University, Bandar Sunway, Malaysia
| | - M Iqbal
- National Institute for Biotechnology and Genetic Engineering, Faisalabad, Pakistan
| | - K Sagathevan
- Department of Biological Sciences, School of Science and Technology, Sunway University, Bandar Sunway, Malaysia
| | - N A Khan
- Department of Biological Sciences, School of Science and Technology, Sunway University, Bandar Sunway, Malaysia
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Khan NA, McAlister FA, Pilote L, Palepu A, Quan H, Hill MD, Fang J, Kapral MK. Secondary prevention treatment after acute stroke in older South Asian, Chinese and other Canadians: a retrospective data analysis. CMAJ Open 2017; 5:E702-E709. [PMID: 28899946 PMCID: PMC5621941 DOI: 10.9778/cmajo.20160147] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Little is known about whether there are differences in medication use between older patients of Chinese descent, those of South Asian descent and other Canadian patients after acute ischemic or primary intracerebral hemorrhagic stroke. The aim of this population-based study was to evaluate potential ethnic differences in secondary prevention pharmacotherapy after acute stroke. METHODS Using health administrative data, we conducted a retrospective analysis of all patients aged 66 years or more admitted to hospital with acute stroke in Ontario (1997-2011) and British Columbia (1997-2009). We compared prescriptions filled for statins, warfarin, any antihypertensive agent, the recommended combination of angiotensin-converting-enzyme (ACE) inhibitor and diuretic, and the combination of ACE inhibitor, diuretic and statin within 1 year after ischemic or primary intracerebral hemorrhagic stroke. RESULTS There were 118 362 patients with acute stroke (3430 Chinese, 2075 South Asian and 112 857 other Canadians). Among those with ischemic stroke (n = 108 699), Chinese patients were less likely than other Canadian patients to fill prescriptions for the combination of ACE inhibitor, diuretic and statin (adjusted odds ratio [OR] 0.64 [95% confidence interval (CI) 0.55-0.74]) and, in those with atrial fibrillation, for warfarin (adjusted OR 0.75 [95% CI 0.59-0.95]). There were no differences in filling of prescriptions for antihypertensive therapy overall between the 3 groups. Among patients with intracerebral hemorrhagic stroke (n = 9663), Chinese patients were less likely than other Canadian patients to fill prescriptions for the combination of ACE inhibitor and diuretic (adjusted OR 0.51 [95% CI 0.38-0.69]), and South Asians were more likely than other Canadian patients to fill prescriptions for any antihypertensive agent (adjusted OR 1.73 [95% CI 1.21-2.49]). INTERPRETATION We identified ethnic differences in filling of prescriptions for several secondary prevention medications after acute stroke. The reasons underlying these differences need to be investigated.
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Affiliation(s)
- Nadia A Khan
- Affiliations: Division of General Internal Medicine (Khan, Palepu), University of British Columbia; Centre for Health Evaluation & Outcomes Sciences (Khan, Palepu), Vancouver, BC; Division of General Internal Medicine (McAlister) and Patient Health Outcomes Research and Clinical Effectiveness Unit (McAlister), University of Alberta, Edmonton, Alta; Divisions of Clinical Epidemiology (Pilote) and General Internal Medicine (Pilote), Department of Medicine, McGill University; The Research Institute of the McGill University Health Centre (Pilote), Montréal, Que.; Departments of Community Health Sciences (Quan, Hill) and Clinical Neurosciences (Hill), University of Calgary, Calgary, Alta.; Institute for Clinical Evaluative Sciences (Fang, Kapral); Division of General Internal Medicine (Kapral), Department of Medicine, University of Toronto, Toronto, Ont
| | - Finlay A McAlister
- Affiliations: Division of General Internal Medicine (Khan, Palepu), University of British Columbia; Centre for Health Evaluation & Outcomes Sciences (Khan, Palepu), Vancouver, BC; Division of General Internal Medicine (McAlister) and Patient Health Outcomes Research and Clinical Effectiveness Unit (McAlister), University of Alberta, Edmonton, Alta; Divisions of Clinical Epidemiology (Pilote) and General Internal Medicine (Pilote), Department of Medicine, McGill University; The Research Institute of the McGill University Health Centre (Pilote), Montréal, Que.; Departments of Community Health Sciences (Quan, Hill) and Clinical Neurosciences (Hill), University of Calgary, Calgary, Alta.; Institute for Clinical Evaluative Sciences (Fang, Kapral); Division of General Internal Medicine (Kapral), Department of Medicine, University of Toronto, Toronto, Ont
| | - Louise Pilote
- Affiliations: Division of General Internal Medicine (Khan, Palepu), University of British Columbia; Centre for Health Evaluation & Outcomes Sciences (Khan, Palepu), Vancouver, BC; Division of General Internal Medicine (McAlister) and Patient Health Outcomes Research and Clinical Effectiveness Unit (McAlister), University of Alberta, Edmonton, Alta; Divisions of Clinical Epidemiology (Pilote) and General Internal Medicine (Pilote), Department of Medicine, McGill University; The Research Institute of the McGill University Health Centre (Pilote), Montréal, Que.; Departments of Community Health Sciences (Quan, Hill) and Clinical Neurosciences (Hill), University of Calgary, Calgary, Alta.; Institute for Clinical Evaluative Sciences (Fang, Kapral); Division of General Internal Medicine (Kapral), Department of Medicine, University of Toronto, Toronto, Ont
| | - Anita Palepu
- Affiliations: Division of General Internal Medicine (Khan, Palepu), University of British Columbia; Centre for Health Evaluation & Outcomes Sciences (Khan, Palepu), Vancouver, BC; Division of General Internal Medicine (McAlister) and Patient Health Outcomes Research and Clinical Effectiveness Unit (McAlister), University of Alberta, Edmonton, Alta; Divisions of Clinical Epidemiology (Pilote) and General Internal Medicine (Pilote), Department of Medicine, McGill University; The Research Institute of the McGill University Health Centre (Pilote), Montréal, Que.; Departments of Community Health Sciences (Quan, Hill) and Clinical Neurosciences (Hill), University of Calgary, Calgary, Alta.; Institute for Clinical Evaluative Sciences (Fang, Kapral); Division of General Internal Medicine (Kapral), Department of Medicine, University of Toronto, Toronto, Ont
| | - Hude Quan
- Affiliations: Division of General Internal Medicine (Khan, Palepu), University of British Columbia; Centre for Health Evaluation & Outcomes Sciences (Khan, Palepu), Vancouver, BC; Division of General Internal Medicine (McAlister) and Patient Health Outcomes Research and Clinical Effectiveness Unit (McAlister), University of Alberta, Edmonton, Alta; Divisions of Clinical Epidemiology (Pilote) and General Internal Medicine (Pilote), Department of Medicine, McGill University; The Research Institute of the McGill University Health Centre (Pilote), Montréal, Que.; Departments of Community Health Sciences (Quan, Hill) and Clinical Neurosciences (Hill), University of Calgary, Calgary, Alta.; Institute for Clinical Evaluative Sciences (Fang, Kapral); Division of General Internal Medicine (Kapral), Department of Medicine, University of Toronto, Toronto, Ont
| | - Michael D Hill
- Affiliations: Division of General Internal Medicine (Khan, Palepu), University of British Columbia; Centre for Health Evaluation & Outcomes Sciences (Khan, Palepu), Vancouver, BC; Division of General Internal Medicine (McAlister) and Patient Health Outcomes Research and Clinical Effectiveness Unit (McAlister), University of Alberta, Edmonton, Alta; Divisions of Clinical Epidemiology (Pilote) and General Internal Medicine (Pilote), Department of Medicine, McGill University; The Research Institute of the McGill University Health Centre (Pilote), Montréal, Que.; Departments of Community Health Sciences (Quan, Hill) and Clinical Neurosciences (Hill), University of Calgary, Calgary, Alta.; Institute for Clinical Evaluative Sciences (Fang, Kapral); Division of General Internal Medicine (Kapral), Department of Medicine, University of Toronto, Toronto, Ont
| | - Jiming Fang
- Affiliations: Division of General Internal Medicine (Khan, Palepu), University of British Columbia; Centre for Health Evaluation & Outcomes Sciences (Khan, Palepu), Vancouver, BC; Division of General Internal Medicine (McAlister) and Patient Health Outcomes Research and Clinical Effectiveness Unit (McAlister), University of Alberta, Edmonton, Alta; Divisions of Clinical Epidemiology (Pilote) and General Internal Medicine (Pilote), Department of Medicine, McGill University; The Research Institute of the McGill University Health Centre (Pilote), Montréal, Que.; Departments of Community Health Sciences (Quan, Hill) and Clinical Neurosciences (Hill), University of Calgary, Calgary, Alta.; Institute for Clinical Evaluative Sciences (Fang, Kapral); Division of General Internal Medicine (Kapral), Department of Medicine, University of Toronto, Toronto, Ont
| | - Moira K Kapral
- Affiliations: Division of General Internal Medicine (Khan, Palepu), University of British Columbia; Centre for Health Evaluation & Outcomes Sciences (Khan, Palepu), Vancouver, BC; Division of General Internal Medicine (McAlister) and Patient Health Outcomes Research and Clinical Effectiveness Unit (McAlister), University of Alberta, Edmonton, Alta; Divisions of Clinical Epidemiology (Pilote) and General Internal Medicine (Pilote), Department of Medicine, McGill University; The Research Institute of the McGill University Health Centre (Pilote), Montréal, Que.; Departments of Community Health Sciences (Quan, Hill) and Clinical Neurosciences (Hill), University of Calgary, Calgary, Alta.; Institute for Clinical Evaluative Sciences (Fang, Kapral); Division of General Internal Medicine (Kapral), Department of Medicine, University of Toronto, Toronto, Ont
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Ke CH, Morgan S, Smolina K, Gasevic D, Qian H, Khan NA. Is cardiovascular risk reduction therapy effective in South Asian, Chinese and other patients with diabetes? A population-based cohort study from Canada. BMJ Open 2017; 7:e013808. [PMID: 28860225 PMCID: PMC5588972 DOI: 10.1136/bmjopen-2016-013808] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES Guidelines recommend ACE inhibitors (ACEi), angiotensin receptor blockers (ARBs), calcium channel blockers (CCBs) and diuretics in all patients with diabetes mellitus. However, the effectiveness of these agents in South Asian and Chinese populations is unknown. We sought to determine whether ACEi, ARB, CCB and diuretics are associated with reduced mortality in South Asian, Chinese and other patients with diabetes. DESIGN Population-based cohort study using administrative health databases. SETTING Province of British Columbia, Canada (2006-2013). PARTICIPANTS Patients aged ≥35 years with incident diabetes. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcome was all-cause mortality for each medication class compared with untreated patients within each ethnicity. Treatment effect was assessed using inverse probability of treatment weighted Cox proportional hazards models. Medication adherence effect on mortality was also evaluated. RESULTS 208 870 patients (13 755 South Asian, 22 871 Chinese, 172 244 other Canadian) were included. ACEi reduced mortality in other patients (HR=0.88, 0.84-0.91), but power was insufficient to evaluate for benefit in Chinese and South Asian patients. ARB and diuretics reduced mortality in Chinese (ARB HR=0.64, 0.50-0.82; diuretics HR=0.77, 0.62-0.96) and other patients (ARB HR=0.69, 0.64-0.74; diuretics HR=0.66, 0.63-0.69) compared with untreated patients. No mortality benefit was observed among South Asians for any drug class or for CCB among all ethnicities. Higher medication adherence was associated with lower mortality for other patients only (HR=0.79, 0.72-0.86). CONCLUSIONS Effectiveness of cardiovascular risk reduction therapy on mortality varies considerably by ethnicity. Further study is needed to evaluate the mortality benefit of antihypertensive agents in South Asians. Inclusion of these ethnic groups in future clinical trials is essential to examine for differential responses.
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Affiliation(s)
- Calvin H Ke
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Steve Morgan
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kate Smolina
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Danijela Gasevic
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
| | - Hong Qian
- Centre for Health Evaluation and Outcomes Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nadia A Khan
- Centre for Health Evaluation and Outcomes Sciences, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Peng QH, Khan NA, Xue B, Yan TH, Wang ZS. Effect of different levels of protein concentrates supplementation on the growth performance, plasma amino acids profile and mTOR cascade genes expression in early-weaned yak calves. Asian-Australas J Anim Sci 2017; 31:218-224. [PMID: 28728363 PMCID: PMC5767503 DOI: 10.5713/ajas.16.0999] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/10/2016] [Revised: 03/26/2017] [Accepted: 06/13/2017] [Indexed: 11/27/2022]
Abstract
Objective This study evaluated the effects of different levels of protein concentrate supplementation on the growth performance of yak calves, and correlated the growth rate to changes occurring in the plasma- amino acids, -insulin profile, and signaling activity of mammalian target of rapamycin (mTOR) cascade to characterize the mechanism through which the protein synthesis can be improved in early weaned yaks. Methods For this study, 48 early (3 months old) weaned yak calves were selected, and assigned into four dietary treatments according to randomized complete block design. The four blocks were balanced for body weight and sex. The yaks were either grazed on natural pasture (control diet) in a single herd or the grazing yaks was supplemented with one of the three protein rich supplements containing low (17%; LP), medium (19%; MP), or high (21%; HP) levels of crude proteins for a period of 30 days. Results Results showed that the average daily gain of calves increased (0.14 vs 0.23–0.26 kg; p<0.05) with protein concentrates supplementation. The concentration of plasma methionine increased (p<0.05; 8.6 vs 10.1–12.4 μmol/L), while those of serine and tyrosine did not change (p>0.05) when the grazing calves were supplemented with protein concentrates. Compared to control diet, the insulin level of calves increased (p<0.05; 1.86 vs 2.16–2.54 μIU/mL) with supplementation of protein concentrates. Addition of protein concentrates up-regulated (p<0.05) expression of mTOR-raptor, mammalian vacuolar protein sorting 34 homolog, the translational regulators eukaryotic translation initiation factor 4E binding protein 1, and S6 kinase 1 genes in both Longissimus dorsi and semitendinosus. In contrast, the expression of sequestosome 1 was down-regulated in the concentrate supplemented calves. Conclusion Our results show that protein supplementation improves the growth performance of early weaned yak calves, and that plasma methionine and insulin concentrations were the key mediator for gene expression and protein deposition in the muscles.
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Affiliation(s)
- Q H Peng
- Animal Nutrition Institute of Sichuan Agricultural University, Key Laboratory of Bovine Low-Carbon Farming and Safe Production, Ya'an 625014, China
| | - N A Khan
- Department of Animal Nutrition, The University of Agriculture Peshawar, KP 25120, Pakistan
| | - B Xue
- Animal Nutrition Institute of Sichuan Agricultural University, Key Laboratory of Bovine Low-Carbon Farming and Safe Production, Ya'an 625014, China
| | - T H Yan
- Animal Nutrition Institute of Sichuan Agricultural University, Key Laboratory of Bovine Low-Carbon Farming and Safe Production, Ya'an 625014, China.,Agri-Food and Biosciences Institute, Hillsborough, Co Down BT26 6DR, UK
| | - Z S Wang
- Animal Nutrition Institute of Sichuan Agricultural University, Key Laboratory of Bovine Low-Carbon Farming and Safe Production, Ya'an 625014, China
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Attakpa ES, Bertin GA, Chabi NW, Ategbo JM, Seri B, Khan NA. Moringa oleifera-rich diet and T cell calcium signaling in spontaneously hypertensive rats. Physiol Res 2017; 66:753-767. [PMID: 28406707 DOI: 10.33549/physiolres.933397] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Moringa oleifera is a plant whose fruits, roots and leaves have been advocated for traditional medicinal uses. The physicochemical analysis shows that Moringa oleifera contains more dietary polyunsaturated fatty acids (PUFA) than saturated fatty acids (SFA). The consumption of an experimental diet enriched with Moringa oleifera extracts lowered blood pressure in spontaneously hypertensive rats (SHR), but not in normotensive Wistar-Kyoto (WKY) rats as compared to rats fed an unsupplemented control diet. Anti-CD3-stimulated T cell proliferation was diminished in both strains of rats fed the Moringa oleifera. The experimental diet lowered secretion of interleukin-2 in SHR, but not in WKY rats compared with rats fed the control diet. Studies of platelets from patients with primary hypertension and from SHR support the notion that the concentration of intracellular free calcium [Ca(2+)](i) is modified in both clinical and experimental hypertension. We observed that the basal, [Ca(2+)](i) was lower in T cells of SHR than in those of WKY rats fed the control diet. Feeding the diet with Moringa oleifera extracts to WKY rats did not alter basal [Ca(2+)](i) in T cells but increased basal [Ca(2+)](i) in SHR. Our study clearly demonstrated that Moringa oleifera exerts antihypertensive effects by inhibiting the secretion of IL-2 and modulates T cell calcium signaling in hypertensive rats.
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Affiliation(s)
- E S Attakpa
- Laboratoire de Physiopathologie Moléculaire et Toxicologie, Département de Physiologie Animale, Faculté des Sciences et Techniques, Université d'Abomey Calavi, Cotonou, Republic of Benin.
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Ahmad HR, Khan NA. Dialectics of Imagination and Experimentation: Basic Science Research in Developing Countries. Pak J Med Sci 2017; 33:248. [PMID: 28367210 PMCID: PMC5368320 DOI: 10.12669/pjms.331.12591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- H R Ahmad
- HR Ahmad, Department of Biological and Biomedical Sciences Aga Khan University, Karachi Pakistan. E-mail:
| | - N A Khan
- NA Khan. Department of Biological Sciences, Sunway University Malaysia
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Imam S, Islam MN, Khan NA, Mostafa SN, Amin MS, Rahman S, Akhter P. Magnetic Resonance Cholangiopancreatography (MRCP) Evaluation of Obstructive Jaundice in Comparison with Endoscopic Retrograde Cholangiopancreatography (ERCP). Mymensingh Med J 2017; 26:420-425. [PMID: 28588181] [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: 06/07/2023]
Abstract
This cross sectional study was carried out in the department of Radiology and Imaging in collaboration with Department of Gastroenterology of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from July 2013 to June 2014 to evaluate the efficacy of Magnetic resonance cholangiopancreatography (MRCP) and ERCP in the management of obstructive jaundice and also to determine diagnostic validity accuracy, sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of MRCP in evaluation of obstructive jaundice. For this purpose, a total of 60 patients with obstructive jaundice who underwent MRCP and Endoscopic retrograde cholangiopancreatography (ERCP) in the above mentioned hospital were enrolled. More than one third (35.0%) patients were in 5th decade and the mean age was 46.2±12.9 years. Male female ratio was 1.1:1. Most (45.0%) of the patients had filling defect, 28.3% had concentric stenosis and 26.7% eccentric stenosis. In MRCP findings more than one third (35.0%) patients had choledocholithiasis followed by 26.7% had cholangiocarcinoma, 10.0% benign CBD stricture and 8.3% had ascariasis. In ERCP findings 31.7% patients had choledocholithiasis followed by 16.7% had cholangiocarcinoma, 13.3% benign CBD stricture and 10.0% ascariasis. All patients had increased serum bilirubin.
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Affiliation(s)
- S Imam
- Dr Sadia Imam, Consultant, Department of Radiology & Imaging, Ibn Sina Hospital, Dhanmondi, Dhaka, Bangladesh
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Tran KC, Leung AA, Tang KL, Quan H, Khan NA. Efficacy of Calcium Channel Blockers on Major Cardiovascular Outcomes for the Treatment of Hypertension in Asian Populations: A Meta-analysis. Can J Cardiol 2017; 33:635-643. [PMID: 28377067 DOI: 10.1016/j.cjca.2017.01.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2016] [Revised: 01/12/2017] [Accepted: 01/12/2017] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Whether calcium channel blockers exert a greater effect on cardiovascular risk reduction in Asian populations than other antihypertensive agents is unclear. We conducted a meta-analysis of hypertension trials of dihydropyridine calcium channel blockers in Asian populations to clarify this association. METHODS EMBASE, MEDLINE, and Cochrane databases were searched (from inception to August 2016) for randomized controlled trials on cardiovascular death, major adverse cardiovascular events, stroke, congestive heart failure, and coronary revascularization in Asian persons with hypertension. We identified 9 trials that reported data specific to Asian populations (N = 29,643). These trials included 1 placebo-controlled trial and 8 active comparator trials; of these, 5 had angiotensin receptor blockers as the active comparator. RESULTS One placebo-controlled trial (n = 9711) showed significantly reduced cardiovascular mortality, major adverse cardiovascular events, and stroke with calcium channel blockers. Among 8 active comparator trials (n = 19,932), there were no significant differences in mortality (relative risk [RR], 1.10; 95% confidence interval [CI], 0.72-1.67; I2 = 0.0%), major adverse cardiovascular events (RR, 1.02; 95% CI, 0.90-1.15; I2 = 0.0%), stroke (RR, 0.97; 95% CI, 0.80-1.17; I2 = 0.0%), congestive heart failure (RR, 1.01; 95% CI, 0.51-2.00; I2 = 53.7), or coronary revascularization rates (RR, 0.98; 95% CI, 0.76-1.25; I2 = 0.0%) in the calcium channel blocker group compared with other antihypertensive agents. When restricting the meta-analysis to angiotensin receptor blocker comparators (n = 10,384), there were no significant differences in cardiovascular outcomes. CONCLUSIONS There is no evidence that dihydropyridine calcium channel blockers are superior to other antihypertensive agents in Asian populations for the treatment of hypertension.
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Affiliation(s)
- Karen C Tran
- Division of General Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
| | - Alexander A Leung
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Karen L Tang
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Hude Quan
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | - Nadia A Khan
- Division of General Internal Medicine, University of British Columbia, Vancouver, British Columbia, Canada; Center for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
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Attakpa ES, Sangaré MM, Béhanzin GJ, Ategbo JM, Seri B, Khan NA. Moringa olifeira Lam. Stimulates Activation of the Insulin-Dependent Akt Pathway. Antidiabetic Effect in a Diet-Induced Obesity (DIO) Mouse Model. Folia Biol (Praha) 2017; 63:42-51. [PMID: 28557705] [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: 06/07/2023]
Abstract
We investigated the antidiabetic effect of Moringa olifeira Lam. in a diet-induced obesity (DIO) mouse model. Six mice were randomly selected as normal controls. Moringa olifeira Lam. leaf extract at a dose of 200, 400 or 600 mg/kg body weight, glibenclamide (Glib) at the dose of 10 mg/kg (positive control) and distilled water at 10 ml/kg (control group) were administered orally by gastric intubation, and each group consisted of six mice. Insulinsensitive tissues (liver, skeletal muscle) were collected to investigate antidiabetic effects and examine the plant's molecular mechanisms. Moringa olifeira Lam. leaf extract prevented weight gain. It also reduced blood glucose in DIO mice. Glib and Moringa olifeira Lam. leaf extract, 400 mg/kg, treatments restored insulin levels towards normal values (P < 0.05 versus diabetic control group). Western immunoblot analysis of different tissues, collected at the end of the study, demonstrated that Moringa olifeira Lam. stimulated activation of the insulin-dependent Akt pathway and increased the protein content of Glut 4 in skeletal muscle. The improvement of hepatic steatosis observed in DIO-treated mice was associated with a decrease in the hepatic content of SREBP-1, a transcription factor involved in de novo lipogenesis. The hepatic PPARα protein content in the plant extract- treated mice remained significantly higher than those of the control group (P < 0.05). In conclusion, this study provides the first evidence for direct action of Moringa olifeira Lam. on pancreatic β-cells, enhancing glucose-stimulated insulin secretion. This correlated with hypoglycaemic effects in diabetic mice associated with restored levels of plasma insulin.
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Affiliation(s)
- E S Attakpa
- Laboratoire de Physiopathologie Moléculaire et Toxicologie, Département de Physiologie Animale, Faculté des Sciences et Techniques, Université d'Abomey Calavi Cotonou, France
| | - M M Sangaré
- Laboratoire de Physiopathologie Moléculaire et Toxicologie, Département de Physiologie Animale, Faculté des Sciences et Techniques, Université d'Abomey Calavi Cotonou, Rép. du Bénin, Université de Bourgogne, Dijon, France
| | - G J Béhanzin
- Laboratoire de Physiopathologie Moléculaire et Toxicologie, Département de Physiologie Animale, Faculté des Sciences et Techniques, Université d'Abomey Calavi Cotonou, Rép. du Bénin, Université de Bourgogne, Dijon, France
| | - J-M Ategbo
- Laboratoire de Physiopathologie Moléculaire et Toxicologie, Département de Physiologie Animale, Faculté des Sciences et Techniques, Université d'Abomey Calavi Cotonou, Rép. du Bénin, Université de Bourgogne, Dijon, France
| | - B Seri
- Laboratoire de Neurosciences, Unité de Formation Biosciences 22 BP 582 Abidjan 22, Université de Cocody-Abidjan, Rép. de Côte-d'Ivoire, Université de Bourgogne, Dijon, France
| | - N A Khan
- INSERM U866, Physiologie de la Nutrition & Toxicologie. Université de Bourgogne, Dijon, France
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Khan NA, Daskalopoulou SS, Karp I, Eisenberg MJ, Pelletier R, Tsadok MA, Dasgupta K, Norris CM, Pilote L. Sex differences in prodromal symptoms in acute coronary syndrome in patients aged 55 years or younger. Heart 2016; 103:863-869. [PMID: 27965279 DOI: 10.1136/heartjnl-2016-309945] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 11/04/2016] [Accepted: 11/17/2016] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Studies suggest that young women are at highest risk for failing to recognise early symptoms of acute coronary syndrome (ACS). OBJECTIVES To examine sex differences in prodromal symptoms occurring days and weeks prior to the acute presentation of ACS. We also examined health-seeking behaviours and prehospital management in young patients. METHODS Prospective cross-sectional analysis of 1145 patients (368 women) hospitalised for ACS, aged ≤55 years, from the GENdEr and Sex DetermInantS of Cardiovascular Disease: From Bench to Beyond Premature Acute Coronary SYndrome cohort study (January 2009-April 2013). Prodromal symptoms were determined using the McSweeney Acute and Prodromal Myocardial Infarction Symptom questionnaire. Health-seeking behaviour and prehospital care were determined by questionnaires. RESULTS The median age was 49 years. The prevalence of prodromal symptoms was high and more women reported symptoms than men (85% vs 72%, p<0.0001). Symptoms were similar between sexes and included unusual fatigue, sleep disturbances, anxiety and arm weakness/discomfort. Chest pain was less common in both sexes (24%). Women were more likely to seek care (49% vs 42%, p=0.04). Among those who sought care, women were more likely to use an ambulance for their ACS compared with men (52% vs 39%). Cardiovascular risk-reduction therapy use was low (≤40%) in all patients and less than half perceived their care provider suspected a cardiac source. CONCLUSIONS Prior to ACS, women were more likely to experience prodromal symptoms and seek medical attention than men. Prehospital care was generally similar between sexes but demonstrated underutilisation of risk-reduction therapies in at-risk young adults.
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Affiliation(s)
- Nadia A Khan
- Department of Medicine, Center for Health Evaluation and Outcomes Science, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stella S Daskalopoulou
- Research Institute of the McGill University Health Center, Montreal, Quebec, Canada.,Division of General Internal Medicine, McGill University Health Center, Montréal, Québec, Canada
| | - Igor Karp
- Department of Social and Preventive Medicine, University of Montréal Hospital Research Center (CRCHUM), University of Montréal, Montréal, Québec, Canada
| | - Mark J Eisenberg
- Divisions of Cardiology and Clinical Epidemiology, Jewish General Hospital, McGill University, Montréal, Québec, Canada
| | - Roxanne Pelletier
- Research Institute of the McGill University Health Center, Montreal, Quebec, Canada.,Division of Clinical Epidemiology, McGill University Health Center, Montréal, Québec, Canada
| | - Meytal Avgil Tsadok
- Research Institute of the McGill University Health Center, Montreal, Quebec, Canada.,Division of Clinical Epidemiology, McGill University Health Center, Montréal, Québec, Canada
| | - Kaberi Dasgupta
- Research Institute of the McGill University Health Center, Montreal, Quebec, Canada.,Division of General Internal Medicine, McGill University Health Center, Montréal, Québec, Canada.,Division of Clinical Epidemiology, McGill University Health Center, Montréal, Québec, Canada
| | - Colleen M Norris
- Faculties of Nursing, Medicine and School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Louise Pilote
- Research Institute of the McGill University Health Center, Montreal, Quebec, Canada.,Division of General Internal Medicine, McGill University Health Center, Montréal, Québec, Canada.,Division of Clinical Epidemiology, McGill University Health Center, Montréal, Québec, Canada
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Ahmad HR, Arain FM, Khan NA. A New Model of Master of Philosophy in Physiological Sciences. Pak J Med Sci 2016; 32:1296-1301. [PMID: 27882040 PMCID: PMC5103152 DOI: 10.12669/pjms.325.11481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The objectives of Master of Philosophy (MPhil) in Physiological Sciences are: 1) to describe the new ways in which anatomy, biochemistry and physiology on one hand, and microbiology, pathology and pharmacology on other hand meet their functional requirements through multidisciplinary integrated concepts; 2) to elucidate relationships between cell biology, molecular biology and molecular genetics by connecting dots of how cell functions are driven by molecules and being controlled by genes. This forms the basis of cell, molecular and genetics [CMG] module upon which 7 multidisciplinary modules of Physiological Sciences follow; 3) these 24 credit hours provide the physiological basis for PhD studies as well as faculty development to enhance learning abilities of medical student; 4) the modules constitute Cardio- Respiratory Physiological Sciences, GI and Renal Physiological Sciences, Neurosciences, Endo-Reproductive Physiological Sciences.; 5) it has integrated microbiology, pathology and pharmacology in a unique way through CMG of microbes leading to associated pathology and mechanisms of prescribed drugs; 6) it has additional synopsis and thesis friendly course work leading to comprehensive examinations; 7) the year two deals with research work of 6 credit hours leading to defense of thesis; 8) The MPhil in Physiological Sciences is fundamentally different from what is being offered elsewhere. It prepares and offers a good spring board to dovetail PhD studies as well as faculty and institutional development. This is the first study that deals with innovative programmes in research, learning and education in the field of physiological sciences. This broad-based MPhil would make its recipients competent, critical, confident and productive learner. This is a completely unique design of a curriculum that has no comparable examples elsewhere. Our mission is to educate graduate students in the field of Physiological Sciences such that they have a complete grasp over the broad-based integrated concepts of basic health sciences. Upon completion of their education, the students will be able to use the duality of imagination and skepticism. Hence, the students will contribute to their fields by unfolding their creative energy.
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Affiliation(s)
- H R Ahmad
- HR Ahmad, Department of Biological and Biomedical Sciences, The Aga Khan University, Karachi, Pakistan
| | - F M Arain
- FM Arain, Department of Biological and Biomedical Sciences, The Aga Khan University, Karachi, Pakistan
| | - N A Khan
- NA Khan, Department of Biological Sciences, Sunway University, Malaysia
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Khan NA. Getting to Lower Systolic Blood Pressure: Beyond Antihypertensive Therapy. Ann Intern Med 2016; 165:661-662. [PMID: 27537098 DOI: 10.7326/m16-1421] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Nadia A Khan
- From University of British Columbia, Vancouver, British Columbia, Canada
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Poureslami I, Kwan S, Lam S, Khan NA, FitzGerald JM. Assessing the effect of culturally specific audiovisual educational interventions on attaining self-management skills for chronic obstructive pulmonary disease in Mandarin- and Cantonese-speaking patients: a randomized controlled trial. Int J Chron Obstruct Pulmon Dis 2016; 11:1811-22. [PMID: 27536093 PMCID: PMC4976815 DOI: 10.2147/copd.s105408] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [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] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patient education is a key component in the management of chronic obstructive pulmonary disease (COPD). Delivering effective education to ethnic groups with COPD is a challenge. The objective of this study was to develop and assess the effectiveness of culturally and linguistically specific audiovisual educational materials in supporting self-management practices in Mandarin- and Cantonese-speaking patients. METHODS Educational materials were developed using participatory approach (patients involved in the development and pilot test of educational materials), followed by a randomized controlled trial that assigned 91 patients to three intervention groups with audiovisual educational interventions and one control group (pamphlet). The patients were recruited from outpatient clinics. The primary outcomes were improved inhaler technique and perceived self-efficacy to manage COPD. The secondary outcome was improved patient understanding of pulmonary rehabilitation procedures. RESULTS Subjects in all three intervention groups, compared with control subjects, demonstrated postintervention improvements in inhaler technique (P<0.001), preparedness to manage a COPD exacerbation (P<0.01), ability to achieve goals in managing COPD (P<0.01), and understanding pulmonary rehabilitation procedures (P<0.05). CONCLUSION Culturally appropriate educational interventions designed specifically to meet the needs of Mandarin and Cantonese COPD patients are associated with significantly better understanding of self-management practices. Self-management education led to improved proper use of medications, ability to manage COPD exacerbations, and ability to achieve goals in managing COPD. CLINICAL IMPLICATION A relatively simple culturally appropriate disease management education intervention improved inhaler techniques and self-management practices. Further research is needed to assess the effectiveness of self-management education on behavioral change and patient empowerment strategies.
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Affiliation(s)
- Iraj Poureslami
- Respiratory Division, Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada; Department of Graduate Studies, Centre for Clinical Epidemiology and Evaluation, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Susan Kwan
- Respiratory Department, Burnaby Hospital, University of British Columbia, Burnaby, Canada
| | - Stephen Lam
- Respiratory Division, University of British Columbia, Vancouver, Canada; Department of Integrative Oncology, BC Cancer Research Centre, Vancouver, Canada
| | - Nadia A Khan
- Department of Internal Medicine, Faculty of Medicine, University of British Columbia, Vancouver, Canada; Department of Internal Medicine, Providence Health Care Authority, Vancouver, Canada
| | - John Mark FitzGerald
- VGH Divisions of Respiratory Medicine, University of British Columbia, Vancouver, Canada; Respiratory Medicine, Vancouver Coastal Health Authority, Vancouver Coastal Health Research Institute, Institute for Heart and Lung Health, The Lung Centre, Gordon and Leslie Diamond Health Care Centre, Vancouver, Canada
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