Publications by authors named "Abdul Haleem"

40 Publications

Spontaneous pneumomediastinum, pneumothorax and subcutaneous emphysema in COVID-19 pneumonia: a rare case and literature review.

BMJ Case Rep 2020 Dec 12;13(12). Epub 2020 Dec 12.

Department of Internal Medicine, Kendall Regional Medical Center, Miami, Florida, USA.

Spontaneous pneumomediastinum (SPM) and pneumothorax (PNX) unrelated to positive pressure ventilation has been recently reported as an unusual complication in cases of severe COVID-19 pneumonia. The presumed pathophysiological mechanism is diffuse alveolar injury leading to alveolar rupture and air leak. We present a case of COVID-19 pneumonia complicated on day 13 post admission by SPM, PNX and subcutaneous emphysema in a patient with no identifiable risk factors for such complication. The patient received medical treatment for his COVID-19 infection without the use of an invasive or non-invasive ventilator. Moreover, he is a non-smoker with no lung comorbidities and never reported a cough. He was eventually discharged home in stable condition. A comprehensive literature review revealed 15 cases of SPM developing in patients with COVID-19 pneumonia.
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http://dx.doi.org/10.1136/bcr-2020-239489DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7735137PMC
December 2020

Towards a novel peptide vaccine for Middle East respiratory syndrome coronavirus and its possible use against pandemic COVID-19.

J Mol Liq 2021 Feb 6;324:114706. Epub 2020 Nov 6.

Department of Biological Sciences, National University of Medical Sciences, the Mall, Rawalpindi 46000, Pakistan.

Middle East respiratory syndrome coronavirus (MERS-CoV) is an emerging health concern due to its high mortality rate of 35%. At present, no vaccine is available to protect against MERS-CoV infections. Therefore, an in silico search for potential antigenic epitopes in the non-redundant proteome of MERS-CoV was performed herein. First, a subtractive proteome-based approach was employed to look for the surface exposed and host non-homologous proteins. Following, immunoinformatics analysis was performed to predict antigenic B and T cell epitopes that were used in the design of a multi-epitopes peptide. Molecular docking study was carried out to predict vaccine construct affinity of binding to Toll-like receptor 3 (TLR3) and understand its binding conformation to extract ideas about its processing by the host immune system. We identified membrane protein, envelope small membrane protein, non-structural protein ORF3, non-structural protein ORF5, and spike glycoprotein as potential candidates for subunit vaccine designing. The designed multi-epitope peptide then linked to β-defensin adjuvant is showing high antigenicity. Further, the sequence of the designed vaccine construct is optimized for maximum expression in the expression system. A rich pattern of hydrogen and hydrophobic interactions of the construct was observed with the TLR3 allowing stable binding of the construct at the docked site as predicted by the molecular dynamics simulation and MM-PBSA binding energies. We expect that the panel of subunit vaccine candidates and the designed vaccine construct could be highly effective in immunizing populations from infections caused by MERS-CoV and could possible applied on the current pandemic COVID-19.
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http://dx.doi.org/10.1016/j.molliq.2020.114706DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7644433PMC
February 2021

Climate engineering: a strategic approach to combat environmental potential risks associated with Pak-China Economic corridor (CPEC) Development.

Rev Environ Health 2021 Mar 5;36(1):143-144. Epub 2020 Nov 5.

Department of Microbiology, Quaid-i-Azam University, 45320Islamabad, Pakistan.

China-Pak Economic Corridor (CPEC) has become a future economic potential for both countries. It will serve as a gateway to share trade and other industrial benefits with each other. On one hand it's a blessing for both countries, the other way it is offering a potential threat to the environment i.e. due to wide construction of roads the major effect is threatening biodiversity and environmental sustainability. It will cause deforestation, floods, glacier melting, climate change, and global warming. "Climate engineering" is the newly emerging concept to resolve the problems related to the environment and biodiversity. Under the umbrella of concept "Climate engineering" we proposed attractive and environmentally friendly solutions that are helpful to mitigate the impact of anthropogenic activities on the environment of both countries. These proposed strategies include installation of CO scrubbers, construction of Algal ponds, and development of research stations across the roads and by introducing the concept of carbon canopy. It will also help the legislators and policymakers of both countries to incorporate these solutions for sustainable development on each side.
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http://dx.doi.org/10.1515/reveh-2020-0111DOI Listing
March 2021

Temperature Driven Membrane Lipid Adaptation in Glacial Psychrophilic Bacteria.

Front Microbiol 2020 14;11:824. Epub 2020 May 14.

Applied Environmental and Geomicrobiology Laboratory, Department of Microbiology, Quaid-i-Azam University, Islamabad, Pakistan.

Bacteria inhabiting non-polar glaciers are exposed to large variations in temperature, which significantly affects the fluidity of bacterial cell membranes. In order to maintain normal functions of the cell membranes, psychrophilic bacteria adapt by changing the composition of cell membrane fatty acids. However, information on the exact pattern of cell membrane adaptability in non-polar low-temperature habitats is scarce. In the present study, 42 bacterial strains were isolated from the Ghulmet, Ghulkin, and Hopar glaciers of the Hunza Valley in the Karakoram Mountain Range, Pakistan and their cell membrane fatty acid distributions studied, using gas chromatography/mass spectrometry (GC-MS) for the analysis of fatty acid methyl esters (FAMEs) liberated by acid-catalyzed methanolysis. Furthermore, Gram-negative and Gram-positive groups were grown under different temperature settings (5, 15, 25, and 35°C) in order to determine the effect of temperature on cell membrane (CM) fatty acid distribution. The analyses identified the major groups of cell membrane fatty acids (FA) as straight-chain monounsaturated fatty acids (-MUFAs) and branched fatty acids (-FAs), accounting for more than 70% of the fatty acids analyzed. The distribution of br-FAs and -FAs in bacterial cell membranes was significantly affected by temperature, with the level of br-FAs decreasing relative to -FAs with increasing temperature. Notably, the production of polyunsaturated fatty acids (PUFAs) was only seen at lower temperatures. This study contributes to understanding, for the first time, the role of br-FAs in the maintenance of cell membrane fluidity of bacteria inhabiting non-polar habitats.
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http://dx.doi.org/10.3389/fmicb.2020.00824DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7240044PMC
May 2020

Rapid UV-radiation synthesis of polyacrylate cryogel oil-sorbents with adaptable structure and performance.

Environ Res 2020 08 30;187:109488. Epub 2020 Apr 30.

CAS Key Laboratory of Soft Matter Chemistry, Department of Polymer Science and Engineering, University of Science and Technology of China, Hefei, Anhui 230026, China. Electronic address:

Macro-porous poly(lauryl acrylate) cryogel sheets as oil-sorbents were prepared through UV-radiation cryo-polymerizations in 1, 4-dioxane at low temperatures (-5, -2 and 0 °C) within 30 min. The influences of total monomer concentration, crosslinking monomer amount and polymerization temperature on the formation of cryogels were studied. The chemical structure and porous morphology were characterized through the techniques of Fourier transform infrared spectroscopy, thermal gravimetric analysis, contact angle measurement and scanning electron microscopy, confirming the features of high hydrophobicity, macro-porosity and good thermal stability. As well, the comparison between conventional gels prepared at room temperature and cryogels at lower temperatures was made, showing the higher rate of cryo-polymerization than conventional polymerization under the same UV-radiation condition. The swelling investigation was carried out with several organic solvents and oils. Enhanced performance of oil absorption was observed for those cryogels considering the absorption capacity and absorption rate. Variation of initiator amount and acrylate monomers could also modulate the absorption capacity. Those cryogel oil-sorbents exhibited wide adaptability, good reusability and high-temperature tolerance. Thus, this rapid and low-cost fabrication opens out a novel pathway to prepare efficient oil-sorbents used in waste water treatment.
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http://dx.doi.org/10.1016/j.envres.2020.109488DOI Listing
August 2020

Hemorrhagic Stroke in a Young Adult with Undiagnosed Asymptomatic Dandy-Walker Malformation.

Case Rep Neurol Med 2019 17;2019:1450703. Epub 2019 Sep 17.

Kendall Regional Medical Center, Miami, FL 33175, USA.

The Dandy-Walker Malformation was first described in 1914 by Dandy and Blackfan and is characterized by hypoplasia of the vermis, pseudocystic fourth ventricle, upward displacement of the tentorium, torcular and lateral sinuses, and anteroposterior enlargement of the posterior fossa. This syndrome commonly manifests as hydrocephalus in children, though rare adult cases have been reported. The literature reveals adult symptomatology including brainstem infarction, psychosis, and neuromuscular disease. Stroke is an exceptionally rare presentation of this malformation, with only one ischemic event reported in the literature. This case offers a rare opportunity for diagnosis in an adult presenting with a hemorrhagic stroke of the basal ganglia in an otherwise asymptomatic young adult male. To the best of our knowledge, this is the first reported case of a hemorrhagic stroke in an adult patient with Dandy-Walker Malformation.
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http://dx.doi.org/10.1155/2019/1450703DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6766112PMC
September 2019

Macroporous Oil-Sorbents with a High Absorption Capacity and High-Temperature Tolerance Prepared through Cryo-Polymerization.

Polymers (Basel) 2019 Oct 7;11(10). Epub 2019 Oct 7.

CAS Key Laboratory of Soft Matter Chemistry, Department of Polymer Science and Engineering, University of Science and Technology of China, Hefei, Anhui 230026, China.

The facile preparation and admirable performance of macro-porous poly(lauryl acrylate)-based oil-sorbents for organic solvents and oils are reported in this manuscript. Cryo-polymerizations of lauryl acrylate (LA) with ethylene glycol dimethacrylate (EGDMA) as the cross-linker were carried out at temperatures below the freezing point of the polymerization mixture. The polymerization medium and pore-forming agent was 1,4-dioxane. The influences of the total monomer concentration, EGDMA content and cryo-polymerization temperature on the structure of the obtained P(LA--EGDMA) cryogels were investigated with the techniques of Fourier transform infrared spectroscopy, scanning electron microscopy, contact angle measurement and thermo-gravimetric analysis. Through the modulation of the crosslinking density and porosity of these cryogels, the P(LA--EGDMA) oil-sorbents demonstrated a high absorption capacity for organic solvents and oils, recyclability and high-temperature tolerance. The absorption capacity reached 20-21 and 16-17 g/g for toluene and gasoline oil, respectively. Those fabricated sorbents survived high temperatures up to 150 °C without any change in absorption capacity as well as porosity. Considering the convenient synthesis process and absorption performance, the present work offers a remarkable opportunity to bring polymer cryogels to practical application in waste oil clean-up.
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http://dx.doi.org/10.3390/polym11101620DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6835346PMC
October 2019

Gold Nanoparticles Grafted with PLL--PNIPAM: Interplay on Thermal/pH Dual-Response and Optical Properties.

Molecules 2018 04 16;23(4). Epub 2018 Apr 16.

CAS Key Laboratory of Soft Matter Chemistry, Department of Polymer Science and Engineering, University of Science and Technology of China, Hefei 230026, China.

Narrowly distributed poly(l-lysine---isopropylacrylamide) (PLL--PNIPAM) was prepared through ring-opening polymerization of ε-benzyloxycarbonyl-l-lysine -carboxy-α-amino anhydride and atom transfer radical polymerization of NIPAM, followed with the removal of ε-benzyloxycarbonyl group. Then gold nanoparticles (AuNPs) grafted with PLL--PNIPAM (PNIPAM-PLL-AuNPs) were obtained by the reduction of chloroauric acid with sodium citrate in the presence of PLL--PNIPAM. PNIPAM-PLL-AuNPs and its precursors were thoroughly characterized by proton magnetic resonance spectroscope, Fourier transform infrared spectroscope, UV-vis spectroscope, transmission electron microscopy, dynamic light scattering, thermogravimetric analysis, and circular dichroism. The obtained PNIPAM-PLL-AuNPs exhibited high colloid stability even at strong alkaline (pH = 12) and acidic (pH = 2) conditions. The thermal and pH dual-responsive behaviors of the grafting PLL--PNIPAM chains was observed to be affected by AuNPs, while not for the secondary structure of PLL chains. Correspondingly, the surface plasmon resonance (SPR) of AuNPs was found to be sensitive to both pH value and temperature. A blue shift in the SPR happened both with increasing pH value and increasing temperature. The stimuli-response was reversible in heating-cooling cycles. The gold nanoparticles with both pH and temperature response may have potential applications in biomedical areas and biosensors.
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http://dx.doi.org/10.3390/molecules23040921DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6017248PMC
April 2018

Food and Feeding Habits of Gaur (Bos gaurus) in Highlands of Central India: A Case Study at Pench Tiger Reserve, Madhya Pradesh (India).

Zoolog Sci 2018 Feb;35(1):57-67

Department of Wildlife Sciences, Aligarh Muslim University, Aligarh, UP. 202001 India.

Indian gaur (Bos gaurus) is one of nine species of wild oxen found in the world. They are largely confined to evergreen, semi-evergreen, and moist deciduous forests, but also occur in dry deciduous forest areas at the periphery of their range. According to the IUCN Red List ( 2017 ), the estimated population of gaur in India is between 15,000 and 35,000 individuals, and probably due to this, despite the gaur's vast range of distribution, they are listed as a vulnerable species by IUCN and listed as schedule-I of the Indian Wildlife Protection Act ( 1972 ) as well as in appendix-I in CITES ( 2003 ). Gaur is not a well studied species, and baseline data are thus needed to support conservation efforts. We studied the feeding habits of gaur in Pench Tiger Reserve. Pench Tiger Reserve is the 19th tiger reserve in India, situated in the Seoni and Chhindwara districts of MP, India (21°41'35″N 79°14'54″E). Diet composition of gaur was studied by micro-histological examination of 32 dung piles collected from different sampling plots in different seasons. For this purpose, 169 sampling plots were established at an interval of 200 m. To locate gaur faecal matter, a circular plot of 10 m radius was laid within each sampling plot. Eighty-eight permanent reference slides of available plants were prepared and used for plant fragment identification from the dung piles. A total of 29 plant species were identified from dung piles of gaur. On average, 44.51% of grass-fragments were detected in the diet of gaur, suggesting that gaurs are primarily grazers in the Pench Tiger Reserve.
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http://dx.doi.org/10.2108/zs170097DOI Listing
February 2018

An Alternative to the Transforaminal Cervical Epidural: A Selective Dorsal Epidural.

Pain Med 2018 02;19(2):406-408

Interventional Spine and Pain Medicine, Holy Cross Orthopedic Institute, Fort Lauderdale, Florida, USA.

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http://dx.doi.org/10.1093/pm/pnx128DOI Listing
February 2018

Cystoid macular oedema after phacoemulsification with and without type 2 diabetes mellitus; a hospital-based clinical prospective trial in Karachi.

J Pak Med Assoc 2017 Mar;67(3):395-399

Al-Ibrahim Eye Hospital, Isra Postgraduate Institute of Ophthalmology, Gaddap Town Malir, Karachi.

Objective: To know the outcomes of cystoid macular oedema after phacoemulsification in patients with and without type 2 diabetes mellitus using optical coherence tomography.

Methods: This non-concurrent, clinical, prospective study was carried out at Al-Ibrahim Eye Hospital, Karachi, from January to August 2015. After phacoemulsification with injectable posterior chamber intraocular lens implantation, eyes of patients were analysed. The patients were divided into diabetic and non-diabetic groups visual acuity, optical coherence tomography and dilated fundus examination were performed preoperatively (baseline) and post-operative 1st week and 6th week. SPSS 20 was used for data analysis.

Results: Of the 100 subjects, there were 50(50%) each in diabetic and non-diabetic group. Subsequently, 14(14%) patients were lost to follow-up, and 86 eyes of 86(86%) patients were analysed. Of them, 37(43%) were male and 49(57%) were female. The mean age of participants was 52.21±7.43 years (range: 38-62years). The non-diabetic group had 41(47.7%) patients and the diabetic group had 45(52.3%). There was no clinically significant cystoid macular oedema in either group. Central foveal thickness > 43.94 µm was observed in 1(2.5%) eye in the non-diabetic group and in none in the diabetic group at 1st post-operative week. At the 6th post-operative week, none of eyes in the non-diabetic group and 2(4.44%) eyes of the diabetic group showed macular oedema. There was no statistically significant difference in mean foveal volume between both groups at 1st week (p=0.896) and 6th week (p=0.230).

Conclusions: Cystoid macular oedema after phacoemulsification was equally present in both diabetics and non-diabetics without any retinopathy.
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March 2017

Intrathecal Bupivacaine Monotherapy with a Retrograde Catheter for the Management of Complex Regional Pain Syndrome of the Lower Extremity.

Pain Physician 2016 Sep-Oct;19(7):E1087-92

Holy Cross Hospital, Dept. of Pain Medicine, Fort Lauderdale, FL.

Unlabelled: Complex regional pain syndrome (CRPS) presents a therapeutic challenge due to its many presentations and multifaceted pathophysiology. There is no approved treatment algorithm and clinical interventions are often applied empirically. In cases of CRPS where symptoms are localized to an extremity, a targeted treatment is indicated. We describe the use of intrathecal bupivacaine monotherapy, delivered through a retrograde catheter, in the treatment of CRPS affecting the lower extremity. The patient, a 57-year-old woman with a history of failed foot surgery, was seen in our office after 2 years of ineffective treatments with local blocks and neurolytic procedures. We advanced therapy to moderately invasive procedures with an emphasis on neuromodulation. A combined central and peripheral stimulation technique that initially provided 75% pain relief, failed to provide lasting analgesia. We proceeded with an intrathecal pump implant. Based on the results of dorsal root ganglion (DRG) mapping, L5-S1 was identified as the optimal target for therapy and a retrograde catheter was placed at this level. Various intrathecal medications were tested individually. An intrathecal morphine trial was ineffective (visual analog scale [VAS] 7), while intrathecal clonidine provided excellent pain relief (VAS 0) that was limited by severe side effects. Bupivacaine provided 100% analgesia with tolerable side effects (lower extremity weakness and minor bladder incontinence) and was selected for intrathecal infusion. After 14 months, bupivacaine treatment continued to control pain exacerbations. We conclude that CRPS patients benefit from early identification of the predominant underlying symptoms and a targeted treatment with moderately invasive techniques when less invasive techniques fail.

Key Words: Intrathecal bupivacaine, bupivacaine monotherapy, retrograde catheter, complex regional pain syndrome (CRPS), dual stimulation, dosal root ganglion (DRG) testing.
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July 2017

The role of repetition and reinforcement in school-based oral health education-a cluster randomized controlled trial.

BMC Public Health 2016 Jan 4;16. Epub 2016 Jan 4.

Department of Oral Health Sciences, Federal Postgraduate Medical Institute, Shaikh Zayed Medical Complex, Lahore, 54600, Pakistan.

Background: Repetition and reinforcement have been shown to play a crucial role in the sustainability of the effect of Oral Health Education (OHE) programs. However, its relevance to school-based OHE imparted by different personnel is not depicted by the existing dental literature. The present study was undertaken to determine the effectiveness of the repeated and reinforced OHE (RR-OHE) compared to one-time OHE intervention and to assess its role in school-based OHE imparted by dentist, teachers and peers.

Methods: The study was a cluster randomized controlled trial that involved 935 adolescents aged 10-11 years. Twenty four boys' and girls' schools selected at random in two towns of Karachi, Pakistan were randomly assigned to three groups to receive OHE by dentist (DL), teachers (TL) and peer-leaders (PL). The groups received a single OHE session and were evaluated post-intervention and 6 months after. The three groups were then exposed to OHE for 6 months followed by 1 year of no OHE activity. Two further evaluations at 6-month and 12-month intervals were conducted. The data were collected by a self-administered questionnaire preceded by a structured interview and followed by oral examination of participants.

Results: The adolescents' oral health knowledge (OHK) in the DL and PL groups increased significantly by a single OHE session compared to their baseline knowledge (p < 0.05) and the increase was sustained over 6 months. Although one-time OHE resulted in a significant improvement in adolescents' oral health behavior (OHB) related to the prevention of gingivitis in the two groups (p < 0.05), no significant change was observed in their behavior towards prevention of oral cancer. One-time teacher-led OHE was ineffective in improving adolescents' OHK and OHB. The oral hygiene status (OHS) of the participants in all three groups did not change statistically after one-time OHE. The OHK, OHB and OHS indices increased significantly 6 months after RR-OHE than the initial scores (p < 0.001) irrespective of OHE strategy. Although the OHK scores of the DL and PL groups decreased significantly at 12-month evaluation of RR-OHE (p < 0.05), the said score of the TL group; and OHB and OHS scores of all three groups remained statistically unchanged during this period.

Conclusions: The repetition and reinforcement play a key role in school-based OHE irrespective of educators. The trained teachers and peers can play a complementary role in RR-OHE.
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http://dx.doi.org/10.1186/s12889-015-2676-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4700643PMC
January 2016

An unusual case of a patient who lost his native kidneys and renal allograft from cholesterol crystal emboli.

Saudi J Kidney Dis Transpl 2015 Sep;26(5):966-9

Department of Medicine, King Abdul Aziz Hospital, National Guard Health Affairs, King Abdullah International Medical Research Center/King Saud bin Abdulaziz University for Health Sciences, Al Ahsa, Saudi Arabia.

Cholesterol crystal emboli (CCE) syndrome involving native kidneys is an underdiagnosed condition. CCE is rare in renal allografts. It may present with acute kidney injury, but usually not acute graft loss. CCE should be considered in patients with a history of atherosclerosis and an invasive arterial procedure who present with acute or chronic renal allograft dysfunction. Therapy for CCE is mainly supportive and carries a high rate of mortality. To the best of our knowledge, this is the first reported case of a patient who lost his native kidneys and renal allograft due to CCE arising from his own vasculature.
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http://dx.doi.org/10.4103/1319-2442.164580DOI Listing
September 2015

Extrinsic stain removal with a toothpowder: A randomized controlled trial.

Int J Health Sci (Qassim) 2014 Jul;8(3):269-74

Liaquat College of Medicine & Dentistry, Karachi, Pakistan.

Objectives: The efficacy of a commercially available toothpowder was compared with toothpaste in removing extrinsic dental stains.

Methods: In this single-blind, randomized controlled trial, 77 volunteers were included from a residential professional college. All study subjects (control toothpaste users and test toothpowder users) plaque control measures. All study subjects were instructed to rinse with 5 ml 0.12% chlorhexidine mouthwash for 1 minute, twice and one cup of double tea bag solution three times daily for three weeks. Subjects were randomized into test (n=36) and control (n=36) groups. Toothpaste (control) and toothpowder (test) was used for two weeks to see the effects on removing stains on the labial surfaces of 12 anterior teeth. For measuring dental extrinsic stains Lobene Stain Index (SI) was used.

Results: The amount of stain following the use of toothpaste and toothpowder was more controlled with the experimental toothpowder. For all sites combined, there was evidence that the experimental toothpowder was significantly superior to toothpaste in reducing stain area (p<.001), stain intensity (p<.001) and composite/product (area × intensity) (p<.001).

Conclusion: Stain removing efficacy of toothpowder was significantly higher as compared with toothpaste. A toothpowder may be expected to be of benefit in controlling and removing extrinsic dental staining.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4257362PMC
http://dx.doi.org/10.12816/0023979DOI Listing
July 2014

Oral hygiene assessment by school teachers and peer leaders using simplified method.

Int J Health Sci (Qassim) 2012 Jun;6(2):174-84

Department of Community Dentistry, College of Dentistry, Qassim University, Buraidah-51452, Qassim, Saudi Arabia, P O Box: 6700, E.mail:

Background: A significant proportion of children in developing countries are having plaque-induced gingivitis. A public health strategy may involve teachers and peer leaders to motivate and train school children for regular and thorough removal of dental plaque. The monitoring and evaluation of such a strategy may require teachers and peer leaders to assess oral hygiene status of children at periodic intervals.

Objective: To validate the simplified dental examination performed by teachers and peer leaders to detect dental plaque and calculus.

Methodology: This longitudinal study involved 632 adolescents studying in sixteen schools of Karachi, Pakistan. Eight schools each were randomly allocated to the peer-led and teacher-led strategies of examination. One section of class six was selected at random in each school to be included in the study. In each selected section of class six the trained teacher-in-charge or a peer-leader undertook dental examinations at baseline, 6-month and 18-month intervals and their findings were compared with those of a dentist. The outcome measures included the Kappa values for examiner agreement as well as the sensitivity, specificity, positive and negative predictive values.

Results: All teachers and peer leaders showed a substantial degree of agreement (Kappa ≥ 0.8) with the dentist in detecting plaque and calculus at all three examinations. The values of validity measures for teachers' and peer leaders' examination were in the range of 87-90%.

Conclusions: The examinations performed by teachers and peer leaders were reasonably valid to detect plaque and calculus. However, booster training sessions are needed to maintain their performance as dental examiners.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3616946PMC
http://dx.doi.org/10.12816/0005992DOI Listing
June 2012

School-based strategies for oral health education of adolescents--a cluster randomized controlled trial.

BMC Oral Health 2012 Dec 18;12:54. Epub 2012 Dec 18.

Department of Oral Health Sciences, Federal Postgraduate Medical Institute, Shaikh Zayed Medical Complex, Lahore, Pakistan.

Background: Oral health education (OHE) in schools has largely been imparted by dental professionals. Considering the substantial cost of this expert-led approach, the strategies relying on teachers, peer-leaders and learners themselves have also been utilized. However the evidence for comparative effectiveness of these strategies is lacking in the dental literature. The present study was conducted to compare the effectiveness of dentist-led, teacher-led, peer-led and self-learning strategies of oral health education.

Methods: A two-year cluster randomized controlled trial following a parallel design was conducted. It involved five groups of adolescents aged 10-11 years at the start of the study. The trial involved process as well as four outcome evaluations. The present paper discusses the findings of the study pertaining to the baseline and final outcome evaluation, both comprising of a self-administered questionnaire, a structured interview and clinical oral examination. The data were analyzed using Generalized Estimating Equations.

Results: All the three educator-led strategies of OHE had statistically higher mean oral health knowledge (OHK), oral health behavior (OHB), oral hygiene status (OHS) and combined knowledge, behavior and oral hygiene status (KBS) scores than the self-learning and control groups (p<0.001). The mean OHK, OHS and KBS scores of the three educator-led strategies did not differ significantly. The peer-led strategy was, however, found to have a significantly better OHB score than the respective score of the teacher-led strategy (p<0.05). The self-learning group had significantly higher OHB score than the control group (p<0.05) but the OHK, OHS and KBS scores of the two groups were not significantly different.

Conclusions: The dentist-led, teacher-led and peer-led strategies of oral health education are equally effective in improving the oral health knowledge and oral hygiene status of adolescents. The peer-led strategy, however, is almost as effective as the dentist-led strategy and comparatively more effective than the teacher-led and self-learning strategies in improving their oral health behavior. SRCTN39391017
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http://dx.doi.org/10.1186/1472-6831-12-54DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3552898PMC
December 2012

In brief: Ficat classification: avascular necrosis of the femoral head.

Clin Orthop Relat Res 2012 Sep;470(9):2636-9

Department of Orthopedic Surgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.

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http://dx.doi.org/10.1007/s11999-012-2416-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3830078PMC
September 2012

Antibody-mediated rejection: importance of lactate dehydrogenase and neutrophilia in early diagnosis.

Saudi J Kidney Dis Transpl 2011 May;22(3):525-30

Department of Renal Transplant Surgery, Riyadh Military Hospital, Riyadh, Saudi Arabia.

We report the importance of elevated serum lactate dehydrogenase (LDH) and neutrophilia (NT) in two renal transplant recipients who developed renal impairment in the early post-operative period. One of our recipients developed oliguria and increased serum creatinine with unexplained elevation of LDH and NT. The biopsy was C4d positive with platelet and fibrin thrombi in the glomerular capillaries and arterioles and interpreted as acute vasculitis or thrombotic form of antibody-mediated rejection (VAMR) with positive donor-specific antibodies (DSA). Despite intensive treatment, this graft was lost. When another patient developed a similar picture, prompt immunoadsorption was started without waiting for a confirmatory biopsy or DSA, and both were later reported as positive. Improvement in renal function was associated with decreasing levels of LDH and NT. Neither of these was elevated in cases of acute cellular rejection (ACR) or antibody mediated rejection (AMR) with isolated tubular injury (TAMR). It may therefore be reasonable to assume that LDH and NT are potential diagnostic and prognostic markers of VAMR.
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May 2011

Malignant sarcoma of the pelvic bones: treatment outcomes and prognostic factors vary by histopathology.

Cancer 2011 Apr 8;117(7):1529-41. Epub 2010 Nov 8.

Department of Orthopedics, Stanford University Hospital and Clinics, Stanford, California 94301, USA.

Background: Treatment of malignant sarcomas of the pelvis poses a challenge for local disease control and oncologic outcome. Many reports have described the dismal outcomes. Most studies are retrospective series coming out of single centers, thus biased toward patient selection and are of limited statistical power.

Methods: The authors used the Surveillance, Epidemiology, and End Results database to analyze 1185 pelvic sarcoma cases from 1987 to 2006. Kaplan-Meier and Cox regression were used to analyze the significance of prognostic factors. The analysis was repeated for different histopathological subtypes to determine specific prognostic factors in each case.

Results: Incidence of pelvic sarcoma in 2006 was 89 per 100,000 persons; it has significantly increased since 1973 (P < .05). The overall 5-year survival for all the patients with pelvic sarcoma was 47%, with osteosarcoma having the worst 5-year survival at 19% and patients with chordoma having the best 5-year survival at 60%. Independent prognostic factors included age, stage, grade, size of primary lesion, histopathology, and treatment-related factors. Comparing the patients only with high-grade lesions, patients with Ewing sarcoma have the best prognosis.

Conclusions: This is an analysis of patients with pelvic sarcomas derived from a population-based registry. Survival and prognostics vary with histopathological diagnoses. Although surgical resection was associated with superior outcomes for osteosarcoma and chondrosarcoma, there was no significant difference in outcomes of patients with Ewing sarcoma treated with surgery and/or radiotherapy.
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http://dx.doi.org/10.1002/cncr.25684DOI Listing
April 2011

Bedside lung mechanics predict survival in hypoplastic lung disease.

Am J Perinatol 2011 Apr 29;28(4):305-14. Epub 2010 Nov 29.

Division of Newborn Medicine, Department of Pediatrics, Maria Fareri Children's Hospital, Westchester Medical Center, New York Medical College, Valhalla, USA.

Newer bedside pulmonary mechanics using conventional ventilators allow for CONTINUOUS serial determinations of tidal volume (V(T)). We sought to determine whether the degree of pulmonary hypoplasia could be measured using bedside pulmonary graphics and whether survival could be predicted in potential extracorporeal membrane oxygenation (ECMO) candidates. Data on all neonates considered for or treated with ECMO at our center between April 2000 and March 2005 were collected. The "maximal bedside V(T)" was measured daily at the peak pressure where "beaking" began with a peak end expiratory pressure of 4 cm H(2)O. Twenty-two patients were reviewed: eight ECMO plus fourteen similar patients in whom the threshold for ECMO intervention was not achieved. Independent of need for ECMO, any patient with V(T) of < 3 mL/kg or < 0.2 mL/cm length died ( N = 4). All other measures of lung capacity or blood gas assessments were less valuable than V(T) in predicting survival. We conclude that bedside V(T) can be easily measured and that values < 3 mL/kg or < 0.2 mL/cm length demarcate severe lung hypoplasia, which in our patient population was incompatible with survival. We speculate that bedside V(T) may assist in evaluating the utility of ECMO.
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http://dx.doi.org/10.1055/s-0030-1268715DOI Listing
April 2011

Giant aneurysm of the extracranial internal carotid artery.

J Coll Physicians Surg Pak 2010 May;20(5):345-6

Surgical Unit-II1 Combined Military Hospital/Army Medical College, Rawalpindi.

Aneurysm of the extracranial internal artery is a rare condition with incidence of 0.8-1% of all aneurysms. It can give rise to serious complications like; haemorrhage due to rupture, stroke and thrmboembolism. Its treatment is technically challenging. One such case of giant aneurysm of extracranial internal carotid artery was found in a 70 years old lady. The aneurysm was treated by proximal and distal ligation of the internal carotid artery and excision of the aneurysm with excellent postoperative recovery and early follow-up.
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http://dx.doi.org/05.2010/JCPSP.345346DOI Listing
May 2010

Attenuation of somatodendritic responses to 8-hydroxy-2-di-npropylamino tetralin following long-term dietary sugar consumption in rats.

J Coll Physicians Surg Pak 2009 Jul;19(7):401-5

Department of Biochemistry, University of Karachi, Karachi.

Objective: To determine changes in response to a selective serotonin-1A receptor agonist 8-hydroxy-2-(di-n-propylamino) tetralin (8-OH-DPAT) following long-term consumption of sugar as part of meal in rats.

Study Design: Experimental study.

Place And Duration Of Study: The Department of Biochemistry, University of Karachi, from June to August 2005.

Methodology: The study was conducted on 24 male albino Wistar rats. Sugar containing diet was prepared by mixing standard rodent diet and table sugar in the ratio of 3:1 (w/w) and rats were fed freely on this diet. Control rats were fed freely on standard rodent diet. After five weeks of treatment, control and sugar diet treated animals were injected with 8-OH-DPAT, at a dose of 0.5 mg/ml/kg, to monitor the effects of drug on food intake and brain serotonin (5-hydroxytryptamine, 5-HT) metabolism. Dissected neural tissue was analyzed electrochemically and findings were compared by Newman-Keuls test.

Results: Administration of 8-OH-DPAT elicited hyperphagia and decreased 5-HT metabolism in normal diet treated rats. The neurochemical and hyperphagic responses to 8-OH-DPAT were smaller in sugar than normal diet treated animals suggesting a downregulation of somatodendritic responses in sugar diet treated animals.

Conclusion: A decrease in serotonin metabolism but not an increase in the responsiveness of somatodendritic 5-HT-1A receptors is involved in sugar-rich diet induced hyperphagia.
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http://dx.doi.org/07.2009/JCPSP.401405DOI Listing
July 2009

A simplified dental examination for detection of cavitated carious lesions in school setting.

Community Dent Oral Epidemiol 2009 Jun 19;37(3):276-83. Epub 2009 Mar 19.

Community Dentistry Department, Dr. Ishrat-ul-Ebad Khan Institute of Oral Health Sciences, Dow University of Health Sciences, SMC Campus, Karachi, Pakistan.

Objective: The objective of the study was to compare a simplified dental examination involving the use of a wooden spatula and a toothpick (TS examination) with the conventional dental mirror and probe examination (MP examination) for detection of cavitated carious lesions in schoolchildren.

Methods: The study involved three groups of caries-positive schoolchildren aged 4-5, 9-10 and 13-14 years with 179, 188 and 202 children, respectively. All children were examined by a trained and calibrated examiner using a wooden spatula and a toothpick under natural light. After a week the same examiner examined the three groups of children by a dental mirror and a Community Periodontal Index (CPI) probe. 'Teeth' were considered as units of measurement for data analysis. The WHO recommended criteria (2) for decayed, missing and filled teeth were followed for recording dental caries on a specially designed recording form. The sensitivity, specificity, positive predictive value, negative predictive value, false-positive rate and false-negative rate of TS examination were calculated using MP examination as the standard method.

Results: The specificity of TS examination was well above 95% in three types of dentition. Although the sensitivity of this type of examination in deciduous and mixed dentitions was almost comparable with that of MP examination, it was the lowest for permanent dentition but still within the acceptable limits.

Conclusion: The TS examination can provide an alternative to traditional MP examination to undertake regular check-ups of schoolchildren for dental caries.
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http://dx.doi.org/10.1111/j.1600-0528.2009.00464.xDOI Listing
June 2009

Eosinophilic gastroenteritis causing stenosis of bulbo-duodenal junction: medical and endoscopic management.

BMJ Case Rep 2009 14;2009. Epub 2009 Jul 14.

Riyadh Military Hospital, Gastroenterology, B-87, PO Box 7897, Riyadh Military Hospital, Riyadh, 11159, Saudi Arabia.

Eosinophilic gastroenteritis is a rare disease characterised by tissue eosinophilia that can involve any layer or part of the gut from the oesophagus to the rectum. In Saudi Arabia, the disease has not been reported in the literature before. We report the disease entity as an unusual cause of gastric outlet obstruction. A 50-year-old man was admitted through the gastrointestinal clinic with complaints of epigastric pain associated with dyspepsia for 1 month, and weight loss of 4 kg in 2 months. Examination revealed only the epigastric tenderness on deep palpation. Laboratory investigations including full blood count, liver function tests and renal function tests were normal. Gastroscopy disclosed stenosis of the second and third part of the duodenum. Biopsies were taken and the patient underwent endoscopic dilatation of the pylorus and duodenal bulb. Histopathology showed chronic active eosinophilic inflammation. The patient was successfully treated with a tapering course of steroids and had a complete recovery post-endoscopic dilatation.
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http://dx.doi.org/10.1136/bcr.03.2009.1641DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3028128PMC
July 2011

Kimura disease of the epiglottis.

Head Neck Pathol 2008 Dec 22;2(4):328-32. Epub 2008 Aug 22.

Histopathology Department, Armed Forces hospital, Riyadh, Saudi Arabia.

Kimura disease is a distinct clinicopathological entity of a benign chronic inflammatory disorder of unknown etiology. It is endemic in Oriental Asians, but sporadic and relatively rare in the West, both in whites and blacks alike. It usually presents as a mass lesion, most commonly in the head and neck region. It had for a long time been confused as synonymous with angiolymphoid hyperplasia with esinophilia. It can impose a challenging diagnosis both clinically and pathologically, especially in non-endemic areas with unusual sites involvement. Even though it is a benign lesion, it can be life-threatening in the epiglottis with a risk of airways obstruction. So far, one case had been reported in the epiglottis with upper respiratory tract obstruction. We report a similar case with a brief review of the literature.
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http://dx.doi.org/10.1007/s12105-008-0078-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2807571PMC
December 2008

Extraction of urinary stone.

Saudi J Kidney Dis Transpl 1998 Apr-Jun;9(2):157-68

Department of Physiology, School of Medicine, King Saud University, Riyadh, Saudi Arabia.

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October 2012

Increase in the effectiveness of somatodendritic 5-HT-1A receptors in a rat model of tardive dyskinesia.

Acta Neurobiol Exp (Wars) 2007 ;67(4):389-97

Department of Biochemistry, Neurochemistry and Biochemical Neuropharmacology Research Laboratory, University of Karachi, Karachi-75270, Pakistan.

The present study concerns responsiveness of pre- and postsynaptic 5-hydroxytryptamine (5-HT)-1A receptors in a rat model of tardive dyskinesia (TD). Vacuous chewing movements (VCMs) in rats are widely accepted as an animal model of TD. Results show that haloperidol injected at a dose of 1 mg/kg twice a day for 5 weeks elicited VCMs, which increased in a time dependent manner following the drug administration for 3-5 weeks. Tolerance was produced in motor coordination during the potentiation of VCMs. Exploratory activity in an open field and in an activity box decreased in haloperidol treated animals. The effects of 8-hydroxy-2-(di-n-propylamino)tetraline (8-OH-DPAT; 0.5 mg/kg) were monitored 48-h after withdrawal from repeated administration of haloperidol. 8-OH-DPAT-induced locomotion was greater in haloperidol treated rats. 5-HT synthesis increased in haloperidol treated animals, while 8-OH-DPAT-induced decreases of 5-HT synthesis were greater in repeated haloperidol than repeated saline injected animals. The results suggest that an increase in the effectiveness of somatodendritic 5-HT-1A receptors may decrease the inhibitory influence of 5-HT on the activity of dopaminergic neurons to precipitate VCMs. The 5-HT-1A agonist may help to alleviate neuroleptic-induced TD.
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April 2008

Filariasis: a report of three cases.

Ann Saudi Med 2002 Jan-Mar;22(1-2):77-9

Department of Histopathology, Armed Forces Hospita, Riyadh, Saudi Arabia.

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http://dx.doi.org/10.5144/0256-4947.2002.77DOI Listing
June 2007

Reply to Filariasis: A report of three cases.

Authors:
Abdul Haleem

Ann Saudi Med 2003 Jan-Mar;23(1-2):93-4

Senior Consultant Hispathologist, Riyadh Armed Forces Hospital, Riyadh, Saudi Arabia.

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http://dx.doi.org/10.5144/0256-4947.2003.93aDOI Listing
October 2012