1
|
Carugati M, Arif S, Yarrington ME, King LY, Harris M, Evans K, Barbas AS, Sudan DL, Perfect JR, Miller RA, Alexander BD. Limitations of antifungal prophylaxis in preventing invasive Candida surgical site infections after liver transplant surgery. Antimicrob Agents Chemother 2024; 68:e0127923. [PMID: 38299818 PMCID: PMC10916370 DOI: 10.1128/aac.01279-23] [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] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/06/2024] [Indexed: 02/02/2024] Open
Abstract
Invasive primary Candida surgical site infections (IP-SSIs) are a common complication of liver transplantation, and targeted antifungal prophylaxis is an efficient strategy to limit their occurrence. We performed a retrospective single-center cohort study among adult single liver transplant recipients at Duke University Hospital in the period between 1 January 2015 and 31 December 2020. The study aimed to determine the rate of Candida IP-SSI according to the peri-transplant antifungal prophylaxis received. Of 470 adult single liver transplant recipients, 53 (11.3%) received micafungin prophylaxis, 100 (21.3%) received fluconazole prophylaxis, and 317 (67.4%) did not receive systemic antifungal prophylaxis in the peri-transplant period. Ten Candida IP-SSIs occurred among 5 of 53 (9.4%) micafungin recipients, 1 of 100 (1.0%) fluconazole recipients, and 4 of 317 (1.3%) recipients who did not receive antifungal prophylaxis. Our study highlights the limitations of antifungal prophylaxis in preventing invasive Candida IP-SSI after liver transplant surgery. We hypothesize that pathogen, host, and pharmacokinetic-related factors contributed to the occurrence of Candida IP-SSI despite antifungal prophylaxis. Our study reinforces the need for a risk-based, multi-pronged approach to fungal prevention, including targeted antifungal administration in patients with risks for invasive candidiasis and close monitoring, especially among patients with surgically complex procedures, with timely control of surgical leaks.
Collapse
Affiliation(s)
- M. Carugati
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
| | - S. Arif
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
| | - M. E. Yarrington
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
| | - L. Y. King
- Department of Medicine, Division of Gastroenterology, Duke University, Durham, North Carolina, USA
| | - M. Harris
- Department of Pharmacy, Duke University, Durham, North Carolina, USA
| | - K. Evans
- Department of Pharmacy, Duke University, Durham, North Carolina, USA
| | - A. S. Barbas
- Department of Surgery, Division of Abdominal Transplant Surgery, Duke University, Durham, North Carolina, USA
| | - D. L. Sudan
- Department of Surgery, Division of Abdominal Transplant Surgery, Duke University, Durham, North Carolina, USA
| | - J. R. Perfect
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
| | - R. A. Miller
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
| | - B. D. Alexander
- Department of Medicine, Division of Infectious Diseases, Duke University, Durham, North Carolina, USA
| |
Collapse
|
2
|
Sain A, Metry A, Manzoor N, Wattage K, Elkilany A, Halasa M, Chia J, Arif S, Hussain F, Aisabokhale O, Sohail Z. THE ROLE OF DISTAL LOCKING IN INTRAMEDULLARY NAILS FOR HIP FRACTURE FIXATION: A REVIEW OF CURRENT LITERATURE. Georgian Med News 2024:149-150. [PMID: 38609132] [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: 04/14/2024]
Abstract
Traditionally, it was believed that both proximal and distal locking are essential for achieving stability during intra-medullary fixation for extra-capsular hip fractures. However, recent literature has presented varying perspectives on the necessity of distal locking. Distal locking plays a significant role in managing hip fractures with uncertainties regarding longitudinal and rotational stability. This includes cases of comminuted intertrochanteric fractures with subtrochanteric extension, reverse oblique and high oblique fractures, broad medullary canals, comminution of the lateral wall, diaphyseal fractures, and large posteromedial fragments extending below the level of the lesser trochanter. In stable pertrochanteric fractures, with the lag screw passing through the lateral cortex of the distal fragment, may not require a distal locking screw. Distal locking has been associated with potential complications, including irritation of the fascia lata, prolonged operation time, increased radiation exposure, greater blood loss, implant loosening, secondary femoral stress fractures, and damage to the femoral artery. Thus, although distal locking is of doubtful significance in stable pertrochanteric fractures it is essential in unstable fracture patterns.
Collapse
Affiliation(s)
- A Sain
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - A Metry
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - N Manzoor
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - K Wattage
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - A Elkilany
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - M Halasa
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - J Chia
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - S Arif
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - F Hussain
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - O Aisabokhale
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - Z Sohail
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| |
Collapse
|
3
|
Sain A, Arif S, Manyar H, Manzoor N, Wattage K, Halasa M, Metry A, Chia J, Prendergast E, Elkilany A, Aisabokhale O, Hussain F, Sohail Z. CURRENT CONCEPTS IN THE MANAGEMENT OF BOXER'S FRACTURE. Georgian Med News 2024:122-124. [PMID: 38609127] [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: 04/14/2024]
Abstract
Fractures of the metacarpal particularly the 5th metacarpal is quite common among all hand fractures and has a high incidence in male adult population. Proper management of these fractures plays a key role in rehabilitation and early return to work thus reducing the economic burden. Treatment of these injuries depends on the type of injury: whether it is a closed/open fracture, degree of angulation at the fracture site and also mal-rotation and shortening of the finger. Non-operative management is suitable for fractures which are closed, non-displaced and without angulation or rotation. Open fractures, fractures with angulation and/or mal-rotation and fractures with neuro-vascular injury are more suitable for operative management. The acceptable angulation for conservative management for most studies is 70 degrees. Buddy strapping with a Futura splint provides good functional results. In fractures requiring operative intervention, K-wire fixation is a minimally invasive method of fixation, which in most cases has good functional results. Plate and screw fixation, however, is preferred for cases with significant comminution or multiple metacarpal fractures.
Collapse
Affiliation(s)
- A Sain
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - S Arif
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - H Manyar
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - N Manzoor
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - K Wattage
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - M Halasa
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - A Metry
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - J Chia
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - E Prendergast
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - A Elkilany
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - O Aisabokhale
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - F Hussain
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| | - Z Sohail
- Worthing Hospital, University Hospitals Sussex NHS Foundation Trust, United Kingdom
| |
Collapse
|
4
|
Chambault AL, Drury NE, Poole E, Jones T, Khan N, Hudsmith L, Bowater S, Arif S, Botha P, Clift P. Adult outcomes of complex pulmonary atresia, ventricular septal defect and major aortopulmonary collaterals following repair during childhood, a single centre experience. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1847] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Complex pulmonary atresia with a ventricular septal defect and major aortopulmonary collateral arteries (PA VSD MAPCA) is a rare and complex form of congenital heart disease. Staged surgical palliation is carried out in childhood, and in expert centres, is associated with good medium term survival. Adult outcomes following transition to adult care are not known.
Purpose
To establish adult outcomes of PA VSD MAPCA following repair during childhood in our institution
Methods
Review of clinical records for outcome data including life status, NYHA class, employment status, re-intervention in adult life, arrhythmia, pregnancy, exercise capacity and mode of death, where known. We predefined our population into two groups based on their status at transition to adult care, A) complete repair with RV-PA conduit and VSD closed and B) repaired but VSD left open.
Results
188 patients from our series have transitioned to adult services. As many were tertiary referrals (nationally and internationally) the local follow up population was 53 adults (54.7% male), mean age of those alive under follow up is 27.2±6.5 years, with a mean follow up of 25.3±6.1 years. There were 43 in group A and 10 in group B. Mortality in the total population was 18.9% (10/53), group A (16.3%), group B (30.0%), mean age at death 37.5±10.3 years and 29.9±8.4 years, 6/10 deaths were sudden. 22.6% of the whole group had DiGeorge/22q11 microdeletion, with a learning deficit in 32.7% of the cohort, where this could be assessed. Reinterventions included RV-PA conduit change, coil occlusion, pacemaker implantation, ICD implantation and ablation procedures, overall 39.6% underwent reintervention in adult life. Pregnancy occurred in 33.3% of 24 female patients. 50% of individuals were found to have undertaken some form of paid work and of these 11.5% had DiGeorge.
Conclusions
Complex PA VSD MAPCA is associated with good late survival with late attrition including sudden death and heart failure. 22q11 is associated with learning deficit and consequent lack of employment. Non 22q11 have good educational outcomes and there is less observed deficit regarding employment. Successful pregnancy is possible within this population.
Funding Acknowledgement
Type of funding sources: None.
Collapse
Affiliation(s)
- A L Chambault
- University of Birmingham, Medical School, College of Medical and Dental Sciences , Birmingham , United Kingdom
| | - N E Drury
- University of Birmingham, Medical School, College of Medical and Dental Sciences , Birmingham , United Kingdom
| | - E Poole
- Birmingham Children's Hospital, Department of Cardiology , Birmingham , United Kingdom
| | - T Jones
- Birmingham Children's Hospital, Department of Cardiology , Birmingham , United Kingdom
| | - N Khan
- Birmingham Children's Hospital, Department of Cardiology , Birmingham , United Kingdom
| | - L Hudsmith
- Queen Elizabeth Hospital , Birmingham , United Kingdom
| | - S Bowater
- Queen Elizabeth Hospital , Birmingham , United Kingdom
| | - S Arif
- Queen Elizabeth Hospital , Birmingham , United Kingdom
| | - P Botha
- Birmingham Children's Hospital, Department of Cardiology , Birmingham , United Kingdom
| | - P Clift
- Queen Elizabeth Hospital , Birmingham , United Kingdom
| |
Collapse
|
5
|
Moore P, Wiggen T, Kent L, Arif S, Lucas S, O’Grady S, Hunter R. 414: Anaerobic microbiota facilitate Pseudomonas aeruginosa access to the airway epithelium in a novel co-culture model of colonization. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01838-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
6
|
Kent L, Arif S, Cleaver A, O’Connor J, Wagner B, Harris J, Laguna T, Hunter R. 518: Relationships between mucin integrity and microbiota in the pediatric CF airway. J Cyst Fibros 2021. [DOI: 10.1016/s1569-1993(21)01942-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
7
|
Okafor O, Zegard A, Stegemann B, Arif S, De Bono J, Marshall H, Leyva F. Endocardial pacing is not haemodynamically superior to trans-coronary sinus epicardial pacing in cardiac resynchronization therapy: the Endo-Epi CRT study. Europace 2021. [DOI: 10.1093/europace/euab116.444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): Medtronic
Background
Cardiac resynchronization therapy (CRT) conventionally involves trans-coronary sinus, epicardial left ventricular (LV) pacing. Some studies have suggested that endocardial LV pacing may be superior to epicardial LV pacing.
Objectives
To compare the acute haemodynamic effects of CRT when delivered from endocardial (Endo-CRT) and epicardial LV stimulation sites (Epi-CRT).
Methods and results
Sixteen CRT recipients (aged 70.4 ± 10.1 years [mean ± SD], 62.5% male, QRS: 156.5 ± 16.1 ms, LBBB in 13 [81.3%]) in sinus rhythm underwent intra-procedural measurements of the rate of rise of LV pressure (dP/dtmax) during Endo- and Epi-CRT (RADI pressure wire). Epi-CRT was delivered in basal, mid and apical positions. The Endo-CRT pacing site was chosen using iterative, biplane fluoroscopic views, to target the same position as the Epi-CRT site on the endocardium (see Figure A). Compared to AAI pacing (10 beats per minute above intrinsic rate), both Endo-CRT and Epi-CRT led to an increase in LV dP/dtmax (6.52 ± 8.90% and 6.15 ± 7.97% respectively, both p < 0.001). There were no significant differences in the change in LV dP/dtmax (ΔLV dP/dtmax) between Endo-CRT and Epi-CRT at basal (p = 0.54), mid (p = 0.78) or apical LV stimulation sites (p = 0.12) [Figure B].
Conclusions
Endo-CRT is not haemodynamically superior to Epi-CRT. Abstract Figure.
Collapse
Affiliation(s)
- O Okafor
- Aston University, Aston Medical Research Institute, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - A Zegard
- Aston University, Aston Medical Research Institute, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - B Stegemann
- Aston University, Aston Medical Research Institute, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - S Arif
- Queen Elizabeth Hospital Birmingham, Department of Cardiology, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - J De Bono
- Queen Elizabeth Hospital Birmingham, Department of Cardiology, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - H Marshall
- Queen Elizabeth Hospital Birmingham, Department of Cardiology, Birmingham, United Kingdom of Great Britain & Northern Ireland
| | - F Leyva
- Aston University, Aston Medical Research Institute, Birmingham, United Kingdom of Great Britain & Northern Ireland
| |
Collapse
|
8
|
Fung AS, Graham DM, Chen EX, Stockley TL, Zhang T, Le LW, Albaba H, Pisters KM, Bradbury PA, Trinkaus M, Chan M, Arif S, Zurawska U, Rothenstein J, Zawisza D, Effendi S, Gill S, Sawczak M, Law JH, Leighl NB. A phase I study of binimetinib (MEK 162), a MEK inhibitor, plus carboplatin and pemetrexed chemotherapy in non-squamous non-small cell lung cancer. Lung Cancer 2021; 157:21-29. [PMID: 34052705 DOI: 10.1016/j.lungcan.2021.05.021] [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] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 05/06/2021] [Accepted: 05/11/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION MEK inhibition is a potential therapeutic strategy in non-small cell lung cancer (NSCLC). This phase I study evaluates the MEK inhibitor binimetinib plus carboplatin and pemetrexed in stage IV non-squamous NSCLC patients (NCT02185690). METHODS A standard 3 + 3 dose-escalation design was used. Binimetinib 30 mg BID (dose level 1 [DL1]) or 45 mg BID (dose level 2 [DL2]) was given with standard doses of carboplatin and pemetrexed using an intermittent dosing schedule. The primary outcome was determination of the recommended phase II dose (RP2D) and safety of binimetinib. Secondary outcomes included efficacy, pharmacokinetics, and an exploratory analysis of response based on mutation subtype. RESULTS Thirteen patients (6 DL1, 7 DL2) were enrolled: 7 KRAS, 5 EGFR, and 1 NRAS mutation. The RP2D was binimetinib 30 mg BID. Eight patients (61.5%) had grade 3/4 adverse events, with dose limiting toxicities in 2 patients at DL2. Twelve patients were evaluated for response, with an investigator-assessed objective response rate (ORR) of 50% (95% CI 21.1%-78.9%; ORR 33.3% by independent-review, IR), and disease control rate 83.3% (95% CI 51.6%-97.9%). Median progression free survival (PFS) was 4.5 months (95% CI 2.6 months-NA), with a 6-month and 12-month PFS rate of 38.5% (95% CI 19.3%-76.5%) and 25.6% (95% CI 8.9%-73.6%), respectively. In an exploratory analysis, KRAS/NRAS-mutated patients had an ORR of 62.5% (ORR 37.5% by IR) vs. 25% in KRAS/NRAS wild-type patients. In MAP2K1-mutated patients, the ORR was 42.8%. CONCLUSION The addition of binimetinib to carboplatin and pemetrexed appears to have manageable toxicity with evidence of activity in advanced non-squamous NSCLC.
Collapse
Affiliation(s)
- A S Fung
- Department of Oncology, Queen's University, Canada; Princess Margaret Cancer Centre, University Health Network, Canada
| | - D M Graham
- Princess Margaret Cancer Centre, University Health Network, Canada; Division of Medical Oncology, University of Toronto, Canada; The Christie NHSFoundation Trust, Manchester, UK
| | - E X Chen
- Princess Margaret Cancer Centre, University Health Network, Canada; Division of Medical Oncology, University of Toronto, Canada
| | - T L Stockley
- Division of Clinical Laboratory Genetics, University Health Network, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Canada; Advanced Molecular Diagnostics Laboratory, University Health Network, Canada
| | - T Zhang
- Division of Clinical Laboratory Genetics, University Health Network, Canada; Advanced Molecular Diagnostics Laboratory, University Health Network, Canada
| | - L W Le
- Princess Margaret Cancer Centre, University Health Network, Canada
| | - H Albaba
- Princess Margaret Cancer Centre, University Health Network, Canada
| | - K M Pisters
- Princess Margaret Cancer Centre, University Health Network, Canada; MD Anderson Cancer Centre, Houston, TX, United States
| | - P A Bradbury
- Princess Margaret Cancer Centre, University Health Network, Canada; Division of Medical Oncology, University of Toronto, Canada
| | - M Trinkaus
- Division of Medical Oncology, University of Toronto, Canada; Markham Stouffville Hospital, Markham, Canada
| | - M Chan
- Division of Medical Oncology, University of Toronto, Canada; Trillium Health Partners, Mississauga, Canada
| | - S Arif
- Division of Medical Oncology, University of Toronto, Canada; Trillium Health Partners, Mississauga, Canada
| | - U Zurawska
- Division of Medical Oncology, University of Toronto, Canada; St. Joseph's Health Centre, Toronto, Canada
| | - J Rothenstein
- Division of Medical Oncology, University of Toronto, Canada; RS McLaughlin Durham Cancer Centre, Oshawa, Canada
| | - D Zawisza
- Princess Margaret Cancer Centre, University Health Network, Canada
| | - S Effendi
- Princess Margaret Cancer Centre, University Health Network, Canada
| | - S Gill
- Princess Margaret Cancer Centre, University Health Network, Canada
| | - M Sawczak
- Princess Margaret Cancer Centre, University Health Network, Canada
| | - J H Law
- Princess Margaret Cancer Centre, University Health Network, Canada
| | - N B Leighl
- Princess Margaret Cancer Centre, University Health Network, Canada; Division of Medical Oncology, University of Toronto, Canada.
| |
Collapse
|
9
|
Corrie PG, Qian W, Basu B, Valle JW, Falk S, Lwuji C, Wasan H, Palmer D, Scott-Brown M, Wadsley J, Arif S, Bridgewater J, Propper D, Gillmore R, Gopinathan A, Skells R, Bundi P, Brais R, Dalchau K, Bax L, Chhabra A, Machin A, Dayim A, McAdam K, Cummins S, Wall L, Ellis R, Anthoney A, Evans J, Ma YT, Isherwood C, Neesse A, Tuveson D, Jodrell DI. Scheduling nab-paclitaxel combined with gemcitabine as first-line treatment for metastatic pancreatic adenocarcinoma. Br J Cancer 2020; 122:1760-1768. [PMID: 32350413 PMCID: PMC7283477 DOI: 10.1038/s41416-020-0846-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 03/19/2020] [Accepted: 04/01/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Nab-paclitaxel plus gemcitabine (nabP+gemcitabine) offers modest survival gains for patients with metastatic pancreatic ductal adenocarcinoma (PDAC). Sequential scheduling of nabP+gemcitabine in a PDAC mouse model improved efficacy; this hypothesis was tested in a clinical trial. METHODS Patients with previously untreated metastatic PDAC were randomised to receive nabP+gemcitabine administered either concomitantly on the same day, or sequentially, with gemcitabine administered 24 h after nabP. The primary outcome measure was progression-free survival (PFS). Secondary outcome measures were objective response rate (ORR), overall survival (OS), safety, quality of life (QoL) and predictive biomarkers. RESULTS In total, 71 patients received sequential (SEQ) and 75 concomitant (CON) treatment. Six-month PFS was 46% with SEQ and 32% with CON scheduling. Median PFS (5.6 versus 4.0 months, hazard ratio [HR] 0.67, 95% confidence interval [95% CI] 0.47-0.95, p = 0.022) and ORR (52% versus 31%, p = 0.023) favoured the SEQ arm; median OS was 10.2 versus 8.2 months (HR 0.93, 95% CI 0.65-1.33, p = 0.70). CTCAE Grade ≥3 neutropaenia incidence doubled with SEQ therapy but was not detrimental to QoL. Strongly positive tumour epithelial cytidine deaminase (CDA) expression favoured benefit from SEQ therapy (PFS HR 0.31, 95% CI 0.13-0.70). CONCLUSIONS SEQ delivery of nabP+gemcitabine improved PFS and ORR, with manageable toxicity, but did not significantly improve OS. CLINICAL TRIAL REGISTRATION ISRCTN71070888; ClinialTrials.gov (NCT03529175).
Collapse
Affiliation(s)
- P G Corrie
- Cambridge University Hospitals NHS Foundation Trust (Addenbrooke's Hospital), Cambridge, UK.
| | - W Qian
- Cambridge University Hospitals NHS Foundation Trust (Addenbrooke's Hospital), Cambridge, UK
| | - B Basu
- Cambridge University Hospitals NHS Foundation Trust (Addenbrooke's Hospital), Cambridge, UK
- Cancer Research UK-Cambridge Institute, University of Cambridge, Cambridge, UK
| | - J W Valle
- University of Manchester and The Christie NHS Foundation Trust, Manchester, UK
| | - S Falk
- Bristol Haematology and Oncology Centre, Bristol, UK
| | - C Lwuji
- Leicester Royal Infirmary, Leicester, UK
| | - H Wasan
- Hammersmith Hospital, Imperial College, London, UK
| | - D Palmer
- Clatterbridge Cancer Centre, Liverpool, UK
| | - M Scott-Brown
- University Hospital Coventry and Warwickshire, Coventry, UK
| | | | - S Arif
- Velindre Cancer Centre, Cardiff, UK
| | | | | | | | - A Gopinathan
- Cancer Research UK-Cambridge Institute, University of Cambridge, Cambridge, UK
| | - R Skells
- Cambridge University Hospitals NHS Foundation Trust (Addenbrooke's Hospital), Cambridge, UK
| | - P Bundi
- Cambridge University Hospitals NHS Foundation Trust (Addenbrooke's Hospital), Cambridge, UK
| | - R Brais
- Cambridge University Hospitals NHS Foundation Trust (Addenbrooke's Hospital), Cambridge, UK
| | - K Dalchau
- Cambridge University Hospitals NHS Foundation Trust (Addenbrooke's Hospital), Cambridge, UK
| | - L Bax
- Cambridge University Hospitals NHS Foundation Trust (Addenbrooke's Hospital), Cambridge, UK
| | - A Chhabra
- Cambridge University Hospitals NHS Foundation Trust (Addenbrooke's Hospital), Cambridge, UK
| | - A Machin
- Cambridge University Hospitals NHS Foundation Trust (Addenbrooke's Hospital), Cambridge, UK
| | - A Dayim
- Cambridge University Hospitals NHS Foundation Trust (Addenbrooke's Hospital), Cambridge, UK
| | - K McAdam
- Peterborough City Hospital, Peterborough, UK
| | - S Cummins
- Royal Surrey County Hospital, Guildford, UK
| | - L Wall
- Western General Hospital, Edinburgh, UK
| | - R Ellis
- Royal Cornwall Hospitals, Truro, UK
| | - A Anthoney
- St. James's University Hospitals, Leeds, UK
| | - J Evans
- Beatson West of Scotland Cancer Centre, University of Glasgow, Glasgow, UK
| | - Y T Ma
- Queen Elizabeth Hospital, Birmingham, UK
| | - C Isherwood
- Cancer Research UK-Cambridge Institute, University of Cambridge, Cambridge, UK
| | - A Neesse
- Gastroenterology and Gastrointestinal Cancer Clinic, University of Göttingen, Göttingen, Germany
| | - D Tuveson
- Cold Spring Harbor Laboratory, Cold Spring Harbor, New York, USA
| | - D I Jodrell
- Cambridge University Hospitals NHS Foundation Trust (Addenbrooke's Hospital), Cambridge, UK
- Cancer Research UK-Cambridge Institute, University of Cambridge, Cambridge, UK
| |
Collapse
|
10
|
Kleczynski P, Dziewierz A, Socha S, Rakowski T, Daniec M, Zawislak B, Arif S, Wojtasik-Bakalarz J, Dudek D, Rzeszutko L. Direct Rapid Left Ventricular Wire Pacing during Balloon Aortic Valvuloplasty. J Clin Med 2020; 9:jcm9041017. [PMID: 32260289 PMCID: PMC7230545 DOI: 10.3390/jcm9041017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [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: 02/12/2020] [Revised: 03/27/2020] [Accepted: 03/31/2020] [Indexed: 11/16/2022] Open
Abstract
Background: Rapid ventricular pacing is mandatory for optimal balloon positioning during aortic valvuloplasty (BAV) in patients with severe aortic stenosis. We aimed to assess the safety and efficacy of direct left ventricular (LV) guidewire pacing in comparison with regular pacing induced by temporary pacemaker (PM) placement in the right ventricle. Methods: Direct rapid LV pacing was provided with a 0.035″ guidewire. Baseline clinical characteristics, echocardiographic and procedural data, as well as complication rates, were compared between the two groups. Results: A total of 202 patients undergoing BAV were enrolled (49.5% with direct LV guidewire pacing). The pacing success rate was 100%. In the direct LV guidewire pacing group, we found a lower radiation dose, shorter fluoroscopy and overall procedural time (0.16 vs. 0.28 Gy, p = 0.02; 5.4 vs. 10.3 min, p = 0.01; 17 vs. 25 min, p = 0.01; respectively). In addition, the complication rate was lower in that group (cardiac tamponades, vascular access site complications, blood transfusions rate, and in-hospital mortality: 0% vs. 3.9%; 4.0% vs. 15.7%; 2.0% vs. 12.7%; 2.0% vs. 9.8%, p = 0.01 for all, respectively). Conclusions: Direct rapid LV guidewire pacing is a simple, safe and effective option for BAV with a reduced complication rate compared to a temporary PM placed in the right ventricle.
Collapse
Affiliation(s)
- Pawel Kleczynski
- Department of Interventional Cardiology, Jagiellonian University Medical College, John Paul II Hospital, Pradnicka 80 Street, 31-202 Krakow, Poland
- 2nd Department of Cardiology, Jagiellonian University Medical College, University Hospital, Jakubowskiego 2 Street, 30-688 Krakow, Poland; (A.D.); (T.R.); (B.Z.); (D.D.)
- Correspondence:
| | - Artur Dziewierz
- 2nd Department of Cardiology, Jagiellonian University Medical College, University Hospital, Jakubowskiego 2 Street, 30-688 Krakow, Poland; (A.D.); (T.R.); (B.Z.); (D.D.)
| | - Sylwia Socha
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Jakubowskiego 2 Street, 30-688 Krakow, Poland; (S.S.); (M.D.); (S.A.); (J.W.-B.); (L.R.)
| | - Tomasz Rakowski
- 2nd Department of Cardiology, Jagiellonian University Medical College, University Hospital, Jakubowskiego 2 Street, 30-688 Krakow, Poland; (A.D.); (T.R.); (B.Z.); (D.D.)
| | - Marzena Daniec
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Jakubowskiego 2 Street, 30-688 Krakow, Poland; (S.S.); (M.D.); (S.A.); (J.W.-B.); (L.R.)
| | - Barbara Zawislak
- 2nd Department of Cardiology, Jagiellonian University Medical College, University Hospital, Jakubowskiego 2 Street, 30-688 Krakow, Poland; (A.D.); (T.R.); (B.Z.); (D.D.)
- Intensive Cardiac Care Unit, University Hospital, Jakubowskiego 2 Street, 30-688 Krakow, Poland
| | - Saleh Arif
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Jakubowskiego 2 Street, 30-688 Krakow, Poland; (S.S.); (M.D.); (S.A.); (J.W.-B.); (L.R.)
| | - Joanna Wojtasik-Bakalarz
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Jakubowskiego 2 Street, 30-688 Krakow, Poland; (S.S.); (M.D.); (S.A.); (J.W.-B.); (L.R.)
| | - Dariusz Dudek
- 2nd Department of Cardiology, Jagiellonian University Medical College, University Hospital, Jakubowskiego 2 Street, 30-688 Krakow, Poland; (A.D.); (T.R.); (B.Z.); (D.D.)
| | - Lukasz Rzeszutko
- Department of Cardiology and Cardiovascular Interventions, University Hospital, Jakubowskiego 2 Street, 30-688 Krakow, Poland; (S.S.); (M.D.); (S.A.); (J.W.-B.); (L.R.)
| |
Collapse
|
11
|
Pawlik A, Januszek R, Ruzsa Z, Óriás V, Kleczyński P, Wojtasik-Bakalarz J, Arif S, Nyerges A, Chyrchel M, Stanek A, Dudek D, Bartuś S. Gender differences and long-term clinical outcomes in patients with chronic total occlusions of infrainguinal lower limb arteries treated from retrograde access with peripheral vascular interventions. Adv Med Sci 2020; 65:197-201. [PMID: 32014808 DOI: 10.1016/j.advms.2020.01.004] [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] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 09/10/2019] [Accepted: 01/21/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE We sought to investigate gender-related differences in clinical outcomes after peripheral vascular interventions (PVIs) from retrograde access in patients with chronic total occlusions (CTOs) of the infrainguinal arteries. PATIENTS AND METHODS A total of 939 consecutive patients undergoing PVI were enrolled in the study. Patients with peripheral artery diseases (PAD) and CTOs were treated with PVI from retrograde access according to the local protocol. The participants were divided according to gender. Retrograde access included distal puncturing to reach the CTO. The mean follow-up lasted 1,144.9 ± 664.3 days. Baseline characteristics, procedural and long-term outcomes were compared according to gender. RESULTS Women represented 37.4% of the study population, and more frequently suffered from hypertension (92% vs. 86%, p = 0.001) and diabetes (54% vs. 46%, p = 0.02). Males more often presented with chronic obstructive pulmonary disease (14.8% vs. 6.8%, p = 0.0003), coronary artery disease (45.4% vs. 32.7%, p = 0.0001), smoking (60.4% vs. 45%, p = 0.007) and prior PVI (25% vs. 17%, p = 0.005). The Kaplan-Meier survival curves at 5 years did not reveal gender-related differences in mortality (p = 0.8), whereas men were at a significantly higher risk of re-PVI during the follow-up period (p = 0.047). Male gender was an independent predictor of re-PVI (Hazard ratio: 1.276; 95% confidence interval: 1.015-1.614, p = 0.03). CONCLUSION Males are at increased risk of re-PVI compared to females with PAD and CTOs of infrainguinal arteries treated with PVI from retrograde access.
Collapse
Affiliation(s)
- Artur Pawlik
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Rafał Januszek
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland; University of Physical Education, Department of Clinical Rehabilitation, Krakow, Poland.
| | - Zoltan Ruzsa
- Semmelweis University of Budapest, Cardiac and Vascular Center, Budapest, Hungary; Bács-Kiskun County Hospital, Invasive Cardiology Department, Teaching Hospital of the Szent-Györgyi Albert Medical University, Kecskemét, Hungary
| | - Viktor Óriás
- Semmelweis University of Budapest, Cardiac and Vascular Center, Budapest, Hungary
| | - Paweł Kleczyński
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Joanna Wojtasik-Bakalarz
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Saleh Arif
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Andras Nyerges
- Bács-Kiskun County Hospital, Invasive Cardiology Department, Teaching Hospital of the Szent-Györgyi Albert Medical University, Kecskemét, Hungary
| | - Michał Chyrchel
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Agata Stanek
- School of Medicine with the Division of Dentistry in Zabrze, Department of Internal Medicine, Angiology and Physical Medicine, Medical University of Silesia, Bytom, Poland
| | - Dariusz Dudek
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland; 2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Stanisław Bartuś
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland; 2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| |
Collapse
|
12
|
Ruzsa Z, Januszek R, Óriás V, Chyrchel M, Wojtasik-Bakalarz J, Bartuś J, Arif S, Kleczyński P, Tokarek T, Nyerges A, Stanek A, Dudek D, Bartuś S. Mortality and chronic obstructive pulmonary disease in patients treated with endovascular revascularization of the infra-inguinal lower limb arteries from retrograde access. Ann Transl Med 2020; 8:206. [PMID: 32309353 PMCID: PMC7154487 DOI: 10.21037/atm.2020.01.57] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Background In this trial, our objective was to evaluate the relationship between long-term clinical outcomes in patients with peripheral arterial disease (PAD) treated with retrograde endovascular recanalization (ER) of chronic total occlusions (CTOs) regarding the infra-inguinal lower limb arteries and chronic obstructive pulmonary disease (COPD). Methods A total of 834 consecutive subjects were enrolled in the study. The mean age was 67.8±10.6 years (62.6% males). COPD was diagnosed in 98 patients (11.7%). The infra-inguinal location included the deep, superficial and common femoral artery, popliteal artery or below the knee arteries. During follow-up, we evaluated major adverse cardiac and cerebrovascular events (MACCE) and major adverse limb events (MALE). MACCE was considered as death, stroke/transient ischemic attack, myocardial infarction, percutaneous coronary intervention or coronary artery bypass grafting operation, while MALE regarded amputation, target lesion re-intervention, target vessel re-intervention and surgical action. Results The mean follow-up was 1,144.9±664.3 days and the interquartile range was 1,110.5 (504.5–1,734.7). Data were collected between 2006 and 2016. We noticed significant differences in death rates among the COPD and non-COPD groups. The cumulative number of events (deaths) was 12.2%, 17.3%, 18.4%, 22.4%, 23.5%, 23.5% and 23.5% in the COPD group and 6.1%, 7.5%, 10.5%, 11.3%, 11.4% 11.5% and 11.5% in the non-COPD group after 1, 2, 3, 4, 5, 6 and 7 years of follow-up, and was notably greater for COPD (P=0.0007). Conclusions Patients with COPD and PAD treated with the ER and retrograde approach due to CTOs are related to higher mortality than non-COPD patients.
Collapse
Affiliation(s)
- Zoltan Ruzsa
- Semmelweis University of Budapest, Cardiac and Vascular Center, Budapest, Hungary.,Bács-Kiskun County Hospital, Invasive Cardiology Department, Teaching Hospital of the Szent-Györgyi Albert Medical University, Kecskemét, Hungary
| | - Rafał Januszek
- University of Physical Education, Department of Clinical Rehabilitation, Kraków, Poland.,2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Viktor Óriás
- Semmelweis University of Budapest, Cardiac and Vascular Center, Budapest, Hungary
| | - Michał Chyrchel
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Joanna Wojtasik-Bakalarz
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Jerzy Bartuś
- Jagiellonian University Medical College, Krakow, Poland
| | - Saleh Arif
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Paweł Kleczyński
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Tomasz Tokarek
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - Andras Nyerges
- Bács-Kiskun County Hospital, Invasive Cardiology Department, Teaching Hospital of the Szent-Györgyi Albert Medical University, Kecskemét, Hungary
| | - Agata Stanek
- School of Medicine with the Division of Dentistry in Zabrze, Department of Internal Medicine, Angiology and Physical Medicine, Medical University of Silesia, Bytom, Poland
| | - Dariusz Dudek
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland.,2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| | - Stanisław Bartuś
- 2nd Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland.,2nd Department of Cardiology, Jagiellonian University Medical College, Krakow, Poland
| |
Collapse
|
13
|
Case A, Arif S. The Velindre cancer centre experience of panitumumab versus cetuximab in combination with chemotherapy for metastatic colorectal cancer: a comparison of toxicity and economic evaluation. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz155.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
14
|
Permpalung N, Thaniyavarn T, Saullo J, Arif S, Miller R, Reynolds J, Alexander B. Impact of Respiratory Syncytial Virus Infection on Bronchiolitis Obliterans Syndrome in Lung Transplant Recipients. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
15
|
Al-Tameemi M, Arif S, Campiglia AD, Wilson WB, Wise SA. Photoluminescence spectroscopy of anthrathiophenes and benzonaphthothiophenes in Shpol'skii matrixes. Talanta 2019; 194:930-940. [PMID: 30609627 DOI: 10.1016/j.talanta.2018.10.044] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Revised: 10/04/2018] [Accepted: 10/05/2018] [Indexed: 10/28/2022]
Abstract
The dispersion of harmful oil components into the ocean waters could pose long-term risks to flora and fauna. Due to the complexity of oil-contaminated sites, the unambiguous identification and quantitation of environmental pollutants often requires the sequence of high-performance liquid chromatography and gas chromatography-mass spectrometry. A classic example is the analysis of polycyclic aromatic hydrocarbons. This article tackles a different aspect of environmental analysis as it focuses on the Shpol'skii spectroscopy of polycyclic aromatic sulfur heterocycles, specifically those belonging to the subgroups often known as anthrathiophenes and benzonaphthothiophenes. Photoluminescence measurements were made with a commercial spectrofluorimeter equipped with a continuous wave excitation source for steady state measurements and a pulsed excitation source for time-resolved measurements in the phosphorescence time domain. To the extent of our literature search, this is the first report on the 4.2 K fluorescence and phosphorescence spectra of anthrathiophenes and benzonaphthothiophenes, and the 77 K and 4.2 K phosphorescence lifetimes of benzonaphthothiophenes. 77 K and 4.2 K analytical figures of merit revealed the possibility to detect the studied compounds at the parts-per-billion (ng mL-1) concentration levels. The spectral and lifetime data gathered in this article provides the required information to choose an appropriate photoluminescence technique for the analysis of four-ring polycyclic aromatic sulfur heterocycles in complex environmental extracts.
Collapse
Affiliation(s)
- M Al-Tameemi
- Department of Chemistry, College of Sciences for Women, University of Baghdad, Baghdad, Iraq
| | - S Arif
- Department of Chemistry, University of Central Florida, Physical Sciences Bld. 4111, Orlando, FL 32816, USA
| | - A D Campiglia
- Department of Chemistry, University of Central Florida, Physical Sciences Bld. 4111, Orlando, FL 32816, USA.
| | - W B Wilson
- Chemical Sciences Division, Material Measurement Laboratory, National Institute of Standards and Technology, 100 Bureau Drive, Mail Stop 8390, Gaithersburg, MD 20899, USA
| | - S A Wise
- Chemical Sciences Division, Material Measurement Laboratory, National Institute of Standards and Technology, 100 Bureau Drive, Mail Stop 8390, Gaithersburg, MD 20899, USA
| |
Collapse
|
16
|
Abstract
ObjectivesType 2 peg fractures are known to have low fusion rates but most are elderly with comorbidities and not fit for surgery. Increasingly, clinicians want to stop using hard collars due to its complications, but with little supporting evidence. We aim to provide data to add to this debate.DesignSingle centre cohort study.Subjects145 consecutive patients referred to a Major Trauma Centre as type 2 peg fracture.MethodsAll patients referred with a suspected peg fracture between March 2015 and December 2017 were included. All imaging were assessed and case notes reviewed for patient demographics, fracture management, complications and outcomes.Results102 cases were peg fractures (mean age=80 years). 92 (90.2%) were managed conservatively with a hard collar (mean of 87 days). 37% developed symptoms from the collar, namely pain, stiffness and non-tolerance. Bony union was achieved in only 39.1% of patients with increasing age being an independent risk factor (p<0.001). Of the 56 patients who did not have bony union, there were no reported symptoms and 90% were discharged without a collar. 2 patients were offered but declined fixation and neither reported any on-going symptoms.ConclusionsThis study adds to the body of evidence that fusion rates are low, and collar complications are not insignificant when type 2 peg fractures are treated in a hard collar. However, outcomes are good regardless of union, potentially rendering the collar unnecessary. We aim to conduct a randomised prospective study to further investigate.
Collapse
|
17
|
Warriach HM, Wynn PC, Ishaq M, Arif S, Bhatti A, Latif S, Kumbher A, Batool Z, Majeed S, Bush RD, Pasha TN, McGill DM. Impacts of improved extension services on awareness, knowledge, adoption rates and perceived benefits of smallholder dairy farmers in Pakistan. Anim Prod Sci 2019. [DOI: 10.1071/an17849] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The provision of effective extension services to smallholder farmers across both developing and developed countries remains a challenge worldwide. The objective of the study is to demonstrate the impacts of improved extension services on awareness, knowledge, adoption rates and perceived benefits of smallholder dairy farmers in Pakistan. An extension program was developed and implemented in five districts of Punjab (Okara, Pakpattan, Jhelum, Kasur and Bhakkar) and two districts of Sindh (Thatta and Badin) provinces. The extension program involved the provision of research-based information on a monthly basis to smallholder farming families (FF = 523) over a 4-year period. The extension program was primarily a knowledge transfer-based system, but also relied on farmer engagement and feedback to help drive research and topics for discussion. No financial incentives were provided to the farmers for their participation. A ‘whole-family approach’ was used in the extension program, where comprehensive interdisciplinary training on the whole dairy-farming system was provided to the males, females and children of the farming household. To encourage greater participation and support different learning strategies, several information transfer media were used (including group discussions, one-on-one visits, practical demonstrations, problem-based learning techniques and videos). To assess the impact of this extension program on farms involved, data on farmer awareness, knowledge, adoption and their perceived benefits were collected using a mixed-method approach from three different groups of farmers; registered (IMPreg = 179) farmers directly involved in the extension program, non-registered (IMPnon-reg = 116) farmers indirectly benefiting from the program and traditional (IMPtrad = 104) farmers not associated with any project activities. Overall awareness, knowledge and adoption rates relating to seven different recommendations in the extension program were significantly (P < 0.05) higher in the registered farmers than in the non-registered and traditional farmers. The perceived benefits of the adopted recommendations varied between the different extension messages, but farmers described that they observed increases in milk production, improvements in animal health (body condition and morbidity) and labour efficiency (time savings). These results suggest that adopting improved extension services using a whole-family approach we can significantly achieve higher adoption rates, leading to on-farm benefits to smallholder dairy farmers and their families.
Collapse
|
18
|
Graham D, Chen E, Pisters K, Bradbury P, Trinkaus M, Chan M, Arif S, Zurawska U, Rothenstein J, Zawisza D, Effendie S, Sawczak M, Leighl N. P1.01-54 A Phase I/Ib Study of Binimetinib (MEK162), a MEK Inhibitor Plus Carboplatin/Pemetrexed in Non-Squamous NSCLC. J Thorac Oncol 2018. [DOI: 10.1016/j.jtho.2018.08.610] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
19
|
Isa M, Risby M, Norazman M, Khalis S, Hafizi M, Arif S. Simulation on the shock attenuation behavior of coupled RHA and sandwich composite panel under blast loading. J Fundam and Appl Sci 2018. [DOI: 10.4314/jfas.v9i3s.43] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
|
20
|
Corrie P, Qian W, Gopinathan A, Williams M, Brais R, Valle J, Basu B, Falk S, Iwuji C, Wasan H, Palmer D, Scott-Brown M, Wadsley J, Arif S, Bax L, Bundi P, Skells R, Neesse A, Tuveson D, Jodrell D. Strong tumour cytidine deaminase (CDA) staining predicts for improved survival associated with sequential nab-Paclitaxel (nabP) and gemcitabine (GEM) chemotherapy as first line treatment of patients (pts) with metastatic pancreatic adenocarcinoma (mPDAC). Ann Oncol 2017. [DOI: 10.1093/annonc/mdx369.121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
21
|
Bishawi M, Bell S, Cai L, Landford W, Arif S, McLarty A, Blue L, Phillips B, Nicoara A, Patel C, Milano C. Antibiotic Prophylaxis Strategies in LVAD Implantation and LVAD Infections: A Systematic Review of the Literature. J Heart Lung Transplant 2017. [DOI: 10.1016/j.healun.2017.01.640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
|
22
|
Arif S, Gibson VB, Nguyen V, Bingley PJ, Todd JA, Guy C, Dunger DB, Dayan CM, Powrie J, Lorenc A, Peakman M. β-cell specific T-lymphocyte response has a distinct inflammatory phenotype in children with Type 1 diabetes compared with adults. Diabet Med 2017; 34:419-425. [PMID: 27151105 DOI: 10.1111/dme.13153] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/03/2016] [Indexed: 12/31/2022]
Abstract
AIM To examine the hypothesis that the quality, magnitude and breadth of helper T-lymphocyte responses to β cells differ in Type 1 diabetes according to diagnosis in childhood or adulthood. METHODS We studied helper T-lymphocyte reactivity against β-cell autoantigens by measuring production of the pro-inflammatory cytokine interferon-γ and the anti-inflammatory cytokine interleukin-10, using enzyme-linked immunospot assays in 61 people with Type 1 diabetes (within 3 months of diagnosis, positive for HLA DRB1*0301 and/or *0401), of whom 33 were children/adolescents, and a further 91 were unaffected siblings. RESULTS Interferon-γ responses were significantly more frequent in children with Type 1 diabetes compared with adults (85 vs 61%; P = 0.04). Insulin and proinsulin peptides were preferentially targeted in children (P = 0.0001 and P = 0.04, respectively) and the breadth of the interferon-γ response was also greater, with 70% of children having an interferon-γ response to three or more peptides compared with 14% of adults (P < 0.0001). Islet β-cell antigen-specific interleukin-10 responses were similar in children and adults in terms of frequency, breadth and magnitude, with the exception of responses to glutamic acid decarboxylase 65, which were significantly less frequent in adults. CONCLUSIONS At diagnosis of Type 1 diabetes, pro-inflammatory autoreactivity is significantly more prevalent, focuses on a wider range of targets, and is more focused on insulin/proinsulin in children than adults. We interpret this as indicating a more aggressive immunological response in the younger age group that is especially characterized by loss of tolerance to proinsulin. These findings highlight the existence of age-related heterogeneity in Type 1 diabetes pathogenesis that could have relevance to the development of immune-based therapies.
Collapse
Affiliation(s)
- S Arif
- Department of Immunobiology, King's College London, London
- JDRF Centre for Diabetes Genes, Autoimmunity and Prevention, University of Cambridge, Cambridge, UK
| | - V B Gibson
- Department of Immunobiology, King's College London, London
| | - V Nguyen
- Department of Immunobiology, King's College London, London
| | - P J Bingley
- School of Clinical Sciences, University of Bristol, Bristol, UK
- JDRF Centre for Diabetes Genes, Autoimmunity and Prevention, University of Cambridge, Cambridge, UK
| | - J A Todd
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
- JDRF Centre for Diabetes Genes, Autoimmunity and Prevention, University of Cambridge, Cambridge, UK
| | - C Guy
- University Department of Paediatrics, Addenbrooke's Hospital, Cambridge, UK
- JDRF Centre for Diabetes Genes, Autoimmunity and Prevention, University of Cambridge, Cambridge, UK
| | - D B Dunger
- University Department of Paediatrics, Addenbrooke's Hospital, Cambridge, UK
- JDRF Centre for Diabetes Genes, Autoimmunity and Prevention, University of Cambridge, Cambridge, UK
| | - C M Dayan
- Institute of Molecular and Experimental Medicine, Cardiff University School of Medicine, Cardiff, UK
| | - J Powrie
- Department of Diabetes and Endocrinology, Guy's & St Thomas' National Health Service (NHS) Foundation Trust, London, UK
| | - A Lorenc
- National Institute for Health Research, Biomedical Research Centre at Guy's and St Thomas' NHS Foundation Trust and King's College London, UK
| | - M Peakman
- Department of Immunobiology, King's College London, London
- JDRF Centre for Diabetes Genes, Autoimmunity and Prevention, University of Cambridge, Cambridge, UK
| |
Collapse
|
23
|
Lin X, Qureshi MZ, Romero MA, Yaylim I, Arif S, Ucak I, Fayyaz S, Farooqi AA, Mansoor Q, Ismail M. Signaling networks in TMPRSS2-ERG positive prostate cancers: Do we need a Pied Piper or sharpshooter to deal with “at large” fused oncoprotein. Cell Mol Biol (Noisy-le-grand) 2017; 63:1-8. [DOI: 10.14715/cmb/2017.63.2.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Accepted: 03/23/2017] [Indexed: 11/18/2022]
|
24
|
Arif S, Wojtasik J, Dziewierz A, Bartuś K, Dudek D, Bartuś S. Long-term mortality and follow-up after carotid artery stenting. Hippokratia 2016; 20:204-208. [PMID: 29097886 PMCID: PMC5654437] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Carotid artery stenting (CAS) is an alternative to carotid endarterectomy for the prevention of stroke and transient ischemic attack (TIA). The high long-term mortality among patients who underwent CAS seems to be related to the high comorbidity burden, including coronary and peripheral artery disease. However, limited data on very long-term mortality (over four years) and predictors of death are available. AIM We sought to investigate the very long-term survival after CAS and the impact of comorbidities on mortality at follow-up. METHODS Data of 194 symptomatic and asymptomatic patients who underwent CAS with cerebral protection systems from December 2002 to March 2014 were analyzed. All cause mortality during long-term follow-up was assessed. Univariate and multivariate Cox regression analysis was used to find independent predictors of death. RESULTS The median age of patients was 66 [interquartile range (IQR): 60-73] years and 78.9 % of patients were male. The median follow-up was 7.6 (IQR: 4.4-10.2) years. The all-cause mortality rate after 30 days, one year, four years, and at maximum follow-up was 0 %, 5.1 %, 17.5 % and 31.4 %, respectively. Out of 61 deaths, 37 (60 %) were cardio-cerebral vascular related deaths, 15 (25 %) non-cardiovascular deaths, and 9 (15 %) due to unknown reasons. Among cardio-cerebral vascular deaths, there were 12 fatal strokes, 18 fatal myocardial infarctions and seven other cardiac related deaths. Non-cardiac deaths were due mainly to cancer (9/15). Age and diabetes mellitus were independent predictors of all-cause death during long-term follow-up. CONCLUSIONS The mortality rate during short and long-term follow-up after CAS was lower than reported in the literature. Age and diabetes mellitus were independent predictors of all-cause death. Further research is needed to confirm the potential association between those risk factors and decreased survival. Hippokratia 2016, 20(3): 204-208.
Collapse
Affiliation(s)
- S Arif
- 2 Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - J Wojtasik
- 2 Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - A Dziewierz
- 2 Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - K Bartuś
- 2 Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - D Dudek
- 2 Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| | - S Bartuś
- 2 Department of Cardiology and Cardiovascular Interventions, University Hospital, Krakow, Poland
| |
Collapse
|
25
|
Ooues G, Arif S, Bowater S, Thorne S, Hudsmith L, Clift P. P30 Early outcomes in adults with palliated hypoplastic left heart syndrome. Heart 2016. [DOI: 10.1136/heartjnl-2016-309377.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
26
|
Bartlett LA, LeFevre AE, Mir F, Soofi S, Arif S, Mitra DK, Quaiyum MA, Shakoor S, Islam MS, Connor NE, Winch PJ, Reller ME, Shah R, El Arifeen S, Baqui AH, Bhutta ZA, Zaidi A, Saha S, Ahmed SA. The development and evaluation of a community-based clinical diagnosis tool and treatment regimen for postpartum sepsis in Bangladesh and Pakistan. Reprod Health 2016; 13:16. [PMID: 26916141 PMCID: PMC4766721 DOI: 10.1186/s12978-016-0124-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 01/25/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Postpartum sepsis accounts for most maternal deaths between three and seven days postpartum, when most mothers, even those who deliver in facilities, are at home. Case fatality rates for untreated women are very high. Newborns of ill women have substantially higher infection risk. METHODS/DESIGN The objectives of this study are to: (1) create, field-test and validate a tool for community health workers to improve diagnostic accuracy of suspected puerperal sepsis; (2) measure incidence and identify associated risk factors and; (3) describe etiologic agents responsible and antibacterial susceptibility patterns. This prospective cohort study builds on the Aetiology of Neonatal Infection in South Asia study in three sites: Sylhet, Bangladesh and Karachi and Matiari, Pakistan. Formative research determined local knowledge of symptoms and signs of postpartum sepsis, and a systematic literature review was conducted to design a diagnostic tool for community health workers to use during ten postpartum home visits. Suspected postpartum sepsis cases were referred to study physicians for independent assessment, which permitted validation of the tool. Clinical specimens, including urine, blood, and endometrial material, were collected for etiologic assessment and antibiotic sensitivity. All women with puerperal sepsis were given appropriate antibiotics. DISCUSSION This is the first large population-based study to expand community-based surveillance for diagnoses, referral and treatment of newborn sepsis to include maternal postpartum sepsis. Study activities will lead to development and validation of a diagnostic tool for use by community health workers in resource-poor countries. Understanding the epidemiology and microbiology of postpartum sepsis will inform prevention and treatment strategies and improve understanding of linkages between maternal and neonatal infections.
Collapse
Affiliation(s)
- L A Bartlett
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
| | - A E LeFevre
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
| | - F Mir
- Department of Paediatrics and Child Health, Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan.
| | - S Soofi
- Department of Paediatrics and Child Health, Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan.
| | - S Arif
- Department of Paediatrics and Child Health, Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan.
| | - D K Mitra
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
| | - M A Quaiyum
- Centre for Reproductive Health, icddr,b, Dhaka, Bangladesh.
| | - S Shakoor
- Department of Paediatrics and Child Health, Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan.
| | - M S Islam
- Department of Microbiology, The Child Health Research Foundation, Dhaka Shishu Hospital, Dhaka, Bangladesh.
| | - N E Connor
- Department of Microbiology, The Child Health Research Foundation, Dhaka Shishu Hospital, Dhaka, Bangladesh.
| | - P J Winch
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
| | - M E Reller
- Division of Medical Microbiology, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| | - R Shah
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
| | - S El Arifeen
- Centre for Child and Adolescent Health, icddr,b, Dhaka, Bangladesh.
| | - A H Baqui
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
| | - Z A Bhutta
- Department of Paediatrics and Child Health, Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan.
| | - A Zaidi
- Department of Paediatrics and Child Health, Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan.
| | - S Saha
- Department of Microbiology, The Child Health Research Foundation, Dhaka Shishu Hospital, Dhaka, Bangladesh.
| | - S A Ahmed
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
| |
Collapse
|
27
|
Gómez-Touriño I, Simón-Vázquez R, Alonso-Lorenzo J, Arif S, Calviño-Sampedro C, González-Fernández Á, Pena-González E, Rodríguez J, Viñuela-Roldán J, Verdaguer J, Cordero OJ, Peakman M, Varela-Calvino R. Characterization of the autoimmune response against the nerve tissue S100β in patients with type 1 diabetes. Clin Exp Immunol 2015; 180:207-17. [PMID: 25516468 DOI: 10.1111/cei.12572] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2014] [Indexed: 01/08/2023] Open
Abstract
Type 1 diabetes results from destruction of insulin-producing beta cells in pancreatic islets and is characterized by islet cell autoimmunity. Autoreactivity against non-beta cell-specific antigens has also been reported, including targeting of the calcium-binding protein S100β. In preclinical models, reactivity of this type is a key component of the early development of insulitis. To examine the nature of this response in type 1 diabetes, we identified naturally processed and presented peptide epitopes derived from S100β, determined their affinity for the human leucocyte antigen (HLA)-DRB1*04:01 molecule and studied T cell responses in patients, together with healthy donors. We found that S100β reactivity, characterized by interferon (IFN)-γ secretion, is a characteristic of type 1 diabetes of varying duration. Our results confirm S100β as a target of the cellular autoimmune response in type 1 diabetes with the identification of new peptide epitopes targeted during the development of the disease, and support the preclinical findings that autoreactivity against non-beta cell-specific autoantigens may have a role in type 1 diabetes pathogenesis.
Collapse
Affiliation(s)
- I Gómez-Touriño
- Department of Biochemistry and Molecular Biology, University of Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
28
|
Thompson WS, Pekalski ML, Simons HZ, Smyth DJ, Castro-Dopico X, Guo H, Guy C, Dunger DB, Arif S, Peakman M, Wallace C, Wicker LS, Todd JA, Ferreira RC. Multi-parametric flow cytometric and genetic investigation of the peripheral B cell compartment in human type 1 diabetes. Clin Exp Immunol 2014; 177:571-85. [PMID: 24773525 PMCID: PMC4137841 DOI: 10.1111/cei.12362] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2014] [Indexed: 12/13/2022] Open
Abstract
The appearance of circulating islet-specific autoantibodies before disease diagnosis is a hallmark of human type 1 diabetes (T1D), and suggests a role for B cells in the pathogenesis of the disease. Alterations in the peripheral B cell compartment have been reported in T1D patients; however, to date, such studies have produced conflicting results and have been limited by sample size. In this study, we have performed a detailed characterization of the B cell compartment in T1D patients (n = 45) and healthy controls (n = 46), and assessed the secretion of the anti-inflammatory cytokine interleukin (IL)-10 in purified B cells from the same donors. Overall, we found no evidence for a profound alteration of the B cell compartment or in the production of IL-10 in peripheral blood of T1D patients. We also investigated age-related changes in peripheral B cell subsets and confirmed the sharp decrease with age of transitional CD19(+) CD27(-) CD24(hi) CD38(hi) B cells, a subset that has recently been ascribed a putative regulatory function. Genetic analysis of the B cell compartment revealed evidence for association of the IL2-IL21 T1D locus with IL-10 production by both memory B cells (P = 6·4 × 10(-4) ) and islet-specific CD4(+) T cells (P = 2·9 × 10(-3) ). In contrast to previous reports, we found no evidence for an alteration of the B cell compartment in healthy individuals homozygous for the non-synonymous PTPN22 Trp(620) T1D risk allele (rs2476601; Arg(620) Trp). The IL2-IL21 association we have identified, if confirmed, suggests a novel role for B cells in T1D pathogenesis through the production of IL-10, and reinforces the importance of IL-10 production by autoreactive CD4(+) T cells.
Collapse
Affiliation(s)
- W S Thompson
- JDRF/Wellcome Trust Diabetes and Inflammation Laboratory, Department of Medical Genetics, NIHR Cambridge Biomedical Research Centre, Cambridge Institute for Medical Research, University of Cambridge, Cambridge, UK
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Alvi Z, Mahmood A, Ali U, Rasul S, Arif S, Maqsood T, Ahmed S, Ishtiaq S. EP-1011: Therapeutic effects of whole brain radiotherapy with carboplatin in management of brain metastasis. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)33317-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
|
30
|
Alvi Z, Mahmood A, Rasool S, Ali U, Arif S, Ishtiaq S, Maqsood T. PO-107: Role of Honey in Prevention of Radiation Induced Mucositis in Head and Neck Cancer. Radiother Oncol 2013. [DOI: 10.1016/s0167-8140(15)34726-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
31
|
Bobrowska B, Zasada W, Surdacki A, Rakowski T, Kleczyński P, Świerszcz J, Kruszelnicka O, Rajtar-Salwa R, Arif S, Sorysz D, Dudek D, Dubiel JS. Predictors of coronary and carotid atherosclerosis in patients with severe degenerative aortic stenosis. Int J Med Sci 2013; 10:1361-6. [PMID: 23983597 PMCID: PMC3752723 DOI: 10.7150/ijms.6389] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Accepted: 06/21/2013] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Patients with degenerative aortic stenosis (AS) exhibit elevated prevalence of coronary artery disease (CAD) and internal carotid artery stenosis (ICAS). Our aim was to investigate prevalence of significant CAD and ICAS in relation to demographic and cardiovascular risk profile among patients with severe degenerative AS. METHODS We studied 145 consecutive patients (77 men and 68 women) aged 49-91 years (median, 76) with severe degenerative AS who underwent coronary angiography and carotid ultrasonography in our tertiary care center. The patients were divided into two groups according to the presence of either significant CAD (n=86) or ICAS (n=22). RESULTS The prevalence of significant CAD or ICAS was higher with increasing number of traditional risk factors (hypertension, hypercholesterolemia, diabetes, smoking habit) and decreasing renal function. We found interactions between age and gender in terms of CAD (p=0.01) and ICAS (p=0.06), which was confirmed by multivariate approach. With the reference to men with a below-median age, the prevalence of CAD or ICAS increased in men aged >76 years (89% vs. 55% and 28% vs. 14%, respectively), whereas the respective percentages were lower in older vs. younger women (48% vs. 54% and 7% vs. 17%). CONCLUSIONS In severe degenerative AS gender modulates the association of age with coronary and carotid atherosclerosis with its lower prevalence in women aged >76 years compared to their younger counterparts. This may result from a hypothetical "survival bias", i.e., an excessive risk of death in very elderly women with severe AS and coexisting relevant coronary or carotid atherosclerosis.
Collapse
Affiliation(s)
- Beata Bobrowska
- 2nd Department of Cardiology, Faculty of Medicine, Jagiellonian University Medical College and University Hospital, Cracow, Poland.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
32
|
Di Valentin T, Alam Y, Ali Alsharm A, Arif S, Aubin F, Biagi J, Booth CM, Bourque S, Burkes R, Champion P, Colwell B, Cripps C, Dallaire M, Dorreen M, Finn N, Frechette D, Gallinger S, Gapski J, Giacomantonio C, Gill S, Goel R, Goodwin R, Grimard L, Grothey A, Hammad N, Hedley D, Jhaveri K, Jonker D, Ko Y, L'espérance M, Maroun J, Ostic H, Perrin N, Rother M, St-Hilaire E, Tehfe M, Thirlwell M, Welch S, Yarom N, Asmis T. Eastern Canadian colorectal cancer consensus conference: application of new modalities of staging and treatment of gastrointestinal cancers. Curr Oncol 2012; 19:169-74. [PMID: 22670096 PMCID: PMC3364767 DOI: 10.3747/co.19.931] [Citation(s) in RCA: 2] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
The annual Eastern Canadian Colorectal Cancer Consensus Conference was held in Ottawa, Ontario, October 22-23, 2010. Health care professionals involved in the care of patients with colorectal cancer participated in presentation and discussion sessions for the purpose of developing the recommendations presented here. This consensus statement addresses current issues in the management of colorectal cancer, such as the use of epidermal growth factor inhibitors in metastatic colon cancer, the benefit of calcium and magnesium with oxaliplatin chemotherapy, the role of microsatellites in treatment decisions for stage II colon cancer, the staging and treatment of rectal cancer, and the management of colorectal and metastatic pancreatic cancers.
Collapse
|
33
|
Arif S, Mohammedi RD, Hellal A, Choucha A. A Memory Simulated Annealing Method to the Unit Commitment Problem with Ramp Constraints. Arab J Sci Eng 2012. [DOI: 10.1007/s13369-012-0217-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
34
|
Kleczyński P, Sorysz D, Zawiślak B, Arif S, Bartuś S, Legutko J, Dubiel J, Dudek D. [Percutaneous left atrial appendage closure with Watchman® LAA occluder device in a patient with persistent atrial fibrillation]. Kardiol Pol 2012; 70:965-967. [PMID: 22993014] [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: 06/01/2023]
Abstract
We present a case of a 74-year-old male with persistent atrial fibrillation and ischaemic stroke despite vitamin-K antagonist treatment who underwent successful left atrial appendage closure with Watchman device.
Collapse
Affiliation(s)
- Paweł Kleczyński
- II Klinika Kardiologii, Instytut Kardiologii, Collegium Medicum Uniwersytetu Jagiellońskiego, Kraków.
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Waldron J, Huang S, Houghton F, Arif S, Kim J, Bayley A, Dawson L, Hope A, Cho J, O'Sullivan B. 8557 POSTER The Characteristics of Tumour and Involved Lymph Nodes in Human Papilloma Virus (HPV) Related Oropharyngeal Carcinoma Determined by Gross Tumour Volumes (GTV) Defined for Radiotherapy Planning. Eur J Cancer 2011. [DOI: 10.1016/s0959-8049(11)72199-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
|
36
|
Arif S, Maher AR, Ormerod JOM, Mohan S, Madhani M, Frenneaux MP. 060 The acute haemodynamic effects of intravenous sodium nitrite in healthy volunteers during normoxia and hypoxia. Heart 2010. [DOI: 10.1136/hrt.2010.195966.8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
37
|
Thrower SL, James L, Hall W, Green KM, Arif S, Allen JS, Van-Krinks C, Lozanoska-Ochser B, Marquesini L, Brown S, Wong FS, Dayan CM, Peakman M. Proinsulin peptide immunotherapy in type 1 diabetes: report of a first-in-man Phase I safety study. Clin Exp Immunol 2008; 155:156-65. [PMID: 19040615 DOI: 10.1111/j.1365-2249.2008.03814.x] [Citation(s) in RCA: 127] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Immunotherapeutic strategies under consideration for type 1 diabetes include modification of the autoimmune response through antigen-specific routes. Administration of short peptides representing T cell epitopes targeted by patients with the disease represents one approach. This study evaluated safety and mechanistic outcomes during first-in-man intradermal administration of a human leucocyte antigen-DR4 (HLA-DR4)-restricted peptide epitope of proinsulin (C19-A3). This randomized, open-label study assessed two major theoretical risks of peptide immunotherapy, namely induction of allergic hypersensitivity and exacerbation of the proinflammatory autoimmune response, using clinical assessment and mechanistic assays in vitro. Patients with long-standing type 1 diabetes and HLA-DRB1*0401 genotype received 30 microg (n = 18) or 300 microg (n = 18) of peptide in three equal doses at 0, 1 and 2 months or no intervention (n = 12). Proinsulin peptide immunotherapy in the dosing regimen used is well tolerated and free from risk of systemic hypersensitivity and induction/reactivation of proinsulin-specific, proinflammatory T cells. Peptide-specific T cells secreting the immune suppressive cytokine interleukin (IL)-10 were observed at month 3 in four of 18 patients in the low-dose group (versus one of 12 in the control group; P = not significant). Mean IL-10 response to peptide in the low-dose group increased between 0 and 3 months (P = 0.05 after stimulation with 5 microM peptide in vitro) and then declined to baseline levels between 3 and 6 months (P = 0.01 at 10 microM peptide in vitro). These studies pave the way for future investigations in new-onset patients designed to examine whether proinsulin peptide immunotherapy has beneficial effects on markers of T cell autoimmunity and preservation of beta cell mass.
Collapse
Affiliation(s)
- S L Thrower
- Henry Wellcome Laboratories for Integrative Neuroscience and Endocrinology, University of Bristol, Bristol, UK
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Wilkie S, Picco G, Foster J, Davies D, Julien S, Cooper L, Arif S, Mather S, Taylor-Papadimitriou J, Burchell J, Maher J. Development of breast cancer immunotherapy using MUC1-retargeted T lymphocytes. Breast Cancer Res 2008. [PMCID: PMC3300700 DOI: 10.1186/bcr1881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
39
|
Abstract
AIMS The diagnosis of follicular thyroid carcinomas is mainly based on capsular and vascular invasion. The aim of this study was to determine the diagnostic relevance of nuclear features, inflammation and stromal changes. METHODS AND RESULTS Anisokaryosis, chromatin pattern, nucleolus, nuclear pleomorphism, nuclear/cytoplasmic ratio, necrosis, stromal changes and tumour interstitial lymphocytes (TIL) were analysed in adenomatous hyperplastic nodules (39), adenomas (43) and carcinomas (28 minimally invasive, 48 widely invasive and 27 anaplastic). Ki67 immunostaining, in situ end labelling (ISEL) for apoptosis and the Ki67/ISEL index were analysed by topographical compartments. Variables were compared by histological diagnosis using Fisher's exact test, analysis of variance and Student's t-tests and considered significant if P < 0.05. TIL were absent in 96% of neoplasms and 54% of adenomatous hyperplastic nodules. Conspicuous nucleoli, increased nuclear-cytoplasmic ratio and coexistent apoptosis-myxoid changes distinguished minimally invasive carcinomas from adenomas. The most specific variables of high-grade carcinoma were vasculonecrotic patterns, nuclear hyperchromatism and pleomorphism. A kinetic advantage predominated in the internal compartments of benign lesions and in the peripheral compartments of malignant lesions. CONCLUSIONS Follicular carcinomas show up-regulation of proliferation markers and the distinctive topographical kinetic profiles provide a basis for the distinction between benign and malignant and an explanation for the circumscription and encapsulation of benign lesions.
Collapse
Affiliation(s)
- S Arif
- Department of Pathology, Barts and the London Hospital, London, UK
| | | | | | | |
Collapse
|
40
|
Abstract
Benign metastasizing leiomyoma (BML) and intravascular leiomyomatosis (IVL) are rare variants of uterine leiomyomas. In our search of available literature, there have been only two reports of these conditions occurring in the same patient. We report a case of a 42-year-old female presenting with a left L4 nerve root lesion, left paravesical lesion, left ovarian cyst, multiple pulmonary metastases, and an intracaval lesion. Histology confirmed these to be leiomyomata strongly positive for estrogen receptors. Treatment included surgery, in two stages, to remove the L4 nerve root, left paravesical lesion, intracaval lesion, and a single pulmonary nodule. The remaining tumor was treated with a gonadotrophin-releasing hormone agonist, resulting in significant reductions in tumor size. It was concluded that the lesions in the lungs were an example of BML arising from the initial diagnosis of uterine leiomyoma, and the caval lesion was an IVL. Long-term follow-up is recommended, and familiarity with rare forms of benign smooth muscle uterine tumors is essential in avoiding misdiagnosis and overtreatment.
Collapse
Affiliation(s)
- S Arif
- Department of Oncology, Queen Elizabeth Hospital, Metchley Lane, Edgbaston, Birmingham B15 2TH, UK.
| | | | | |
Collapse
|
41
|
Arif S, Barrett-Lee PJ, Jordan C. The Incidence and Treatment Outcome after Radiotherapy for Brain Metastases in HER-2-positive Metastatic Breast Cancer Patients Treated with Trastuzumab. Clin Oncol (R Coll Radiol) 2006; 18:719-20. [PMID: 17100160 DOI: 10.1016/j.clon.2006.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
|
42
|
Arif S, Townend JN. Heart failure: be aware of reversible causes. QJM 2006; 99:717-8. [PMID: 16956925 DOI: 10.1093/qjmed/hcl099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
|
43
|
Abstract
Benign metastasizing leiomyoma (BML) and intravascular leiomyomatosis (IVL) are rare variants of uterine leiomyomas. In our search of available literature, there have been only two reports of these conditions occurring in the same patient. We report a case of a 42-year-old female presenting with a left L4 nerve root lesion, left paravesical lesion, left ovarian cyst, multiple pulmonary metastases, and an intracaval lesion. Histology confirmed these to be leiomyomata strongly positive for estrogen receptors. Treatment included surgery, in two stages, to remove the L4 nerve root, left paravesical lesion, intracaval lesion, and a single pulmonary nodule. The remaining tumor was treated with a gonadotrophin-releasing hormone agonist, resulting in significant reductions in tumor size. It was concluded that the lesions in the lungs were an example of BML arising from the initial diagnosis of uterine leiomyoma, and the caval lesion was an IVL. Long-term follow-up is recommended, and familiarity with rare forms of benign smooth muscle uterine tumors is essential in avoiding misdiagnosis and overtreatment.
Collapse
|
44
|
Abstract
Apart from clinical stage and lymph node status, acknowledged to be among the most powerful predictors of outcome in cervical cancer, the determination of prognosis and thereby the need for adjuvant therapy in surgically treated patients currently relies on a variety of histopathologic factors. The role of many of these is controversial. This may be because histopathology is genuinely lacking in sensitivity for predicting tumor behavior in vivo. There is, however, wide variation in histopathologic definitions and criteria. This is probably the major reason for both the lack of reproducibility in the reporting of certain factors and in their diminished value in predicting behavior. Tumor type, grade, vascular invasion, pattern of invasion, and depth are all extremely important prognostic indicators when used individually or as a part of a scoring system.
Collapse
Affiliation(s)
- N Singh
- Department of Histopathology, St Bartholomew's Hospital, London EC1A 7BE, UK.
| | | |
Collapse
|
45
|
Soo J, Arif S, Kidd BL, Jawad ASM. Pyrexia, pelvic pain and thrombocytopenia in an Asian man with Paget's disease of bone. Rheumatology (Oxford) 2004; 43:110-1. [PMID: 14681565 DOI: 10.1093/rheumatology/keg431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
|
46
|
|
47
|
Abstract
Apart from clinical stage and lymph node status, acknowledged to be among the most powerful predictors of outcome in cervical cancer, the determination of prognosis and thereby the need for adjuvant therapy in surgically treated patients currently relies on a variety of histopathologic factors. The role of many of these is controversial. This may be because histopathology is genuinely lacking in sensitivity for predicting tumor behavior in vivo. There is, however, wide variation in histopathologic definitions and criteria. This is probably the major reason for both the lack of reproducibility in the reporting of certain factors and in their diminished value in predicting behavior. Tumor type, grade, vascular invasion, pattern of invasion, and depth are all extremely important prognostic indicators when used individually or as a part of a scoring system.
Collapse
|
48
|
Abstract
PURPOSE Microscopic mesorectal soft tissue extranodal deposits discontinuous with the primary tumor are identified in many rectal adenocarcinomas. Current guidelines consider them to be involved lymph nodes. We studied the impact of these deposits on the outcome of patients with rectal cancer. METHODS This was a retrospective study, in which histology slides were reviewed from 55 patients whose resection specimens for rectal cancer were staged as Dukes C or Dukes B with extranodal deposits. Twenty-nine patients had extranodal deposits (19 males), and 26 control patients had lymph node involvement only (14 males). Patient outcome was analyzed in terms of local and systemic control and survival. RESULTS Distant metastases were diagnosed earlier in patients with extranodal deposits (mean, 14 months) compared with controls (mean, 37 months; P = 0.001). On follow-up, 31.03 percent (9/29) from the extranodal deposit group developed liver metastases compared with 11.5 percent (3/26) of the control group (P = 0.08). Local recurrence was seen in 17.2 percent of patients from the extranodal deposit group and 3.8 percent of the control group (P = not significant). Cancer-related mortality was higher in the extranodal deposit group (16 vs. 7 patients; P = 0.09). The three-year actuarial survival was 48.27 percent in patients with extranodal deposits and 65.38 percent in those without. A significant association was noted between the number of extranodal deposits and intramural vascular invasion (P = 0.017), extramural vascular invasion (P = 0.039), perineural invasion (P = 0.039), and lymph node involvement (P = 0.008). CONCLUSION These data suggest that extranodal deposit is a distinct form of metastatic disease in patients with rectal cancer. The association with vascular invasion and earlier development of metastases probably infers that a significant proportion of extranodal deposits may represent blood-borne spread. These tumor foci should be considered as indicators of poor prognosis.
Collapse
Affiliation(s)
- Ashish Prabhudesai
- Department of Colorectal Surgery, St. George's Hospital, London, United Kingdom
| | | | | | | |
Collapse
|
49
|
Astill TP, Ellis RJ, Arif S, Tree TIM, Peakman M. Promiscuous binding of proinsulin peptides to Type 1 diabetes-permissive and -protective HLA class II molecules. Diabetologia 2003; 46:496-503. [PMID: 12684749 DOI: 10.1007/s00125-003-1070-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [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] [Received: 07/26/2002] [Revised: 12/06/2002] [Indexed: 10/20/2022]
Abstract
AIMS/HYPOTHESIS Presentation of peptide epitopes derived from beta-cell autoantigens, such as insulin and its precursor molecules, by MHC class II molecules to autoreactive T-cells is believed to play a role in the development of Type 1 diabetes. However, little is known about the interaction between peptides of (prepro)insulin and MHC class II molecules permissive and protective for Type 1 diabetes. In this study therefore, peptides spanning the human preproinsulin sequence were assessed for their binding characteristics to Type 1 diabetes-protective and -permissive HLA molecules. METHODS HLA-DR2, -DQ6.2 (Type 1 diabetes-protective) and HLA-DR4, -DQ8 (Type 1 diabetes permissive) molecule binding affinity for overlapping synthetic 20mer peptides spanning human preproinsulin was measured in a direct competition binding assay against a biotinylated indicator peptide. RESULTS All HLA molecules tested showed similarity in their binding characteristics across the preproinsulin molecule, with regions of the insulin A-chain showing the highest affinity and C-peptide regions the lowest affinity for all HLA molecules tested. Furthermore, an insulin peptide implicated as a major CD4+ T-cell target in disease pathogenesis (B9-23) had high affinity binding to both protective and permissive HLA molecules but did not represent the highest affinity region of (prepro)insulin identified in either case. CONCLUSION/INTERPRETATION The results suggest that peptide binding affinity alone is unlikely to be the major determinant of disease susceptibility in relation to interactions between (prepro)insulin epitopes and HLA molecules. The identification of epitopes derived from beta-cell autoantigens that bind promiscuously to diabetes-permissive HLA molecules could be important in the design of peptide-based immunotherapeutic strategies for the prevention of Type 1 diabetes.
Collapse
Affiliation(s)
- T P Astill
- Department of Immunology, Guy's, King's and St. Thomas' School of Medicine, 123 Coldharbour Lane, SE5 9NU, London, United Kingdom
| | | | | | | | | |
Collapse
|
50
|
Abstract
Neoplastic transformation is a multistep process that results in a continuous spectrum from the normal (physiological) state to a fully established neoplasm. The gold standard for diagnosis of papillary thyroid carcinoma is conventional histology, the essential element being the characteristic nuclear features, regardless of whether papillary structures are present or not. However, other criteria are being used increasingly in the diagnosis of neoplasms, including immunohistochemical staining and molecular profile. The RET/PTC gene rearrangement is highly specific for papillary thyroid carcinoma and is associated with the characteristic nuclear features seen in papillary thyroid carcinoma. There is an overlap in the morphological features, immunohistochemical staining pattern, and most importantly, molecular profile between papillary thyroid carcinoma and Hashimoto's thyroiditis. Although considered a 'benign' condition, Hashimoto's thyroiditis almost always harbours a genetic rearrangement that is strongly associated with and is highly specific for papillary thyroid carcinoma. Submicroscopic foci of papillary thyroid carcinoma must be present in Hashimoto's thyroiditis, although the clinical behaviour is still benign. Further studies are required to predict which foci will progress to papillary thyroid carcinoma.
Collapse
Affiliation(s)
- S Arif
- Department of Histopathology, Barts and The London NHS Trust, The Royal London Hospital, Whitechapel, London, UK
| | | | | |
Collapse
|