Publications by authors named "Arsalan Khan"

11 Publications

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Comparative Overview of the Performance of Cementitious and Non-Cementitious Nanomaterials in Mortar at Normal and Elevated Temperatures.

Nanomaterials (Basel) 2021 Apr 2;11(4). Epub 2021 Apr 2.

Civil Engineering Department, College of Engineering, King Khalid University, Abha 61421, Saudi Arabia.

Nanotechnology has emerged as a field with promising applications in building materials. Nanotechnology-based mortars are examples of such building materials that have widespread applications in the construction industry. The main nanomaterials used in mortars include nano-silica, nano-magnesium oxide, nano-alumina, nano-titanium oxide, nano-zinc oxide, nano-clay, and nano-carbon. This review paper presents a summary of the properties and effects of these nanomaterials on cement mortar in terms of its fresh-state and hard-state properties. The fresh-state properties include the setting time, consistency, and workability, while the hard-state properties include mechanical properties such as compressive, flexural, tensile strengths, as well as the elasticity modulus, in addition to durability properties such as water absorption, shrinkage strain, strength loss due to freeze-thaw cycles, and chloride penetration, among others. Different nanomaterials cause different physical and chemical alterations within the microstructures of cement mortar. Therefore, the microstructural characterization and densification of mortar are discussed in detail at varying temperatures. In general, the involvement of nanomaterials in cement mortar influences the fresh-state properties, enhances the mechanical properties, and impacts the durability properties, while reducing the porosity present in the mortar matrix. Cementitious nanomaterials can create a pathway for the easy injection of binding materials into the internal microstructures of a hydration gel to impact the hydration process at different rates, whereas their non-cementitious counterparts can act as fillers. Furthermore, the research gaps and future outlook regarding the application of nanomaterials in mortar are discussed.
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http://dx.doi.org/10.3390/nano11040911DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8067273PMC
April 2021

Gastrointestinal pathophysiology of SARS-CoV2 - a literature review.

J Community Hosp Intern Med Perspect 2020 Oct 29;10(6):523-528. Epub 2020 Oct 29.

Internal Medicine, University of Illinois College of Medicine Peoria, Peoria, IL, USA.

SARS-CoV2 is a novel coronavirus responsible for causing COVID-19, first identified in the city of Wuhan, China and officially declared a pandemic by the World Health Organization. SARS-CoV2 expresses high affinity to human ACE2 receptors, including within the gastrointestinal tract. Patients with COVID-19 exhibit a wide spectrum of GI symptoms including anorexia, nausea, vomiting, abdominal pain, and abnormal liver function tests. Pathogenesis behind gastrointestinal symptoms caused by SARS-CoV2 has been postulated to be multifactorial including disruption of the intestinal mechanical barrier integrity, alteration of the gut microbiome and systemic inflammatory response to the virus. SARS-CoV-2 RNA has also been found in stool samples of infected patients for a significantly longer period than in nasopharyngeal samples, though the implication of this finding is unclear at this time. Liver injury in patients with COVID-19 is usually mild, stemming from immune-mediated damage, drug induced hepatotoxicity, or ischemia from sepsis. Patients with pre-existing liver disease may be at a higher risk for hospitalization and mortality. Given the high degree of infectivity of this disease, healthcare providers will need to remain watchful for resurgence of this virus. Strict protocols should be implemented regarding hand hygiene, isolation, personal protective equipment, and appropriate disposal of waste. It is also imperative to identify patients with gastrointestinal symptoms at an early stage as these patients may have a prolonged course between symptom onset and viral clearance.
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http://dx.doi.org/10.1080/20009666.2020.1811556DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7599006PMC
October 2020

Not so Element-ary: A Copper Conundrum.

Cureus 2020 Aug 23;12(8):e9950. Epub 2020 Aug 23.

Clinical Nutrition, OSF Healthcare, Peoria, USA.

Copper is an essential micronutrient required for a number of enzymatic activities. Deficiency is relatively rare as only trace amounts are needed to maintain homeostasis. Deficiencies however do occur and are most commonly seen in malabsorptive states such as after bariatric surgeries. Herein, we present an interesting case of copper deficiency diagnosed in a 70-year-old male patient post duodenal switch procedure which persisted despite aggressive oral and intravenous copper supplementation. This lack of response to supplementation prompted further evaluation, leading to a diagnosis of underlying heterozygous Wilson's disease.
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http://dx.doi.org/10.7759/cureus.9950DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7510182PMC
August 2020

Jejunal-Ileal Bypass and its Complications: Case Report and Review of the Literature.

Cureus 2020 Jul 19;12(7):e9276. Epub 2020 Jul 19.

Gastroenterology and Hepatology, OSF HealthCare, Peoria, USA.

Herein, we describe an interesting case of a patient who underwent a jejunal-ileal bypass (JIB). She presented to the hospital with gastrointestinal bleeding after which her hospital course was complicated by electrolyte abnormalities. She was a 76-year-old Caucasian female with a past medical history of hypertension, type II diabetes, atrial fibrillation on warfarin, chronic obstructive pulmonary disease (COPD) treated with 3 liters of oxygen at home, obstructive sleep apnea, and morbid obesity, with history of an unknown type of bariatric procedure done in the 1970s. Her upper endoscopy showed a normal esophagus, stomach, and duodenum despite her history of bariatric surgery. Her colonoscopy revealed stenotic terminal ileum and an incidental colonic anastomosis at 35 cm from the anal verge with spot tattoo ink of unknown significance. Also noted were moderate internal hemorrhoids and large external hemorrhoids which were likely the source of her bleeding. Post endoscopy she had marked derangement in electrolytes, specifically hypocalcemia, hypomagnesemia, and hypo-phosphatemia.  JIB was first popularized in the 1960s for the treatment of obesity. There are two variations of the procedure, colloquially known as the Scott bypass and the Payne bypass. Our patient underwent the Scott JIB. The relatively longer intestinal tract combined with her ileal stenosis may explain her 50 years of relatively stable adaptation. It is imperative that treating physicians have a keen understanding of anatomy and physiology to adequately care for the long-term needs of these patients.
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http://dx.doi.org/10.7759/cureus.9276DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7372220PMC
July 2020

Extensively Drug-Resistant (XDR) Typhoid: Evolution, Prevention, and Its Management.

Biomed Res Int 2020 2;2020:6432580. Epub 2020 May 2.

Faculty of Allied Health Sciences, The University of Lahore, Lahore, Pakistan.

Typhoid fever is the result of a human host-restricted serotype typhi infection that causes enteric fever. Around 21 million people contract typhoid annually, with Pakistan's inhabitants at most risk amongst Asian countries where typhoid remains prevalent. Decades of indiscriminate antibiotic usage has driven the evolution of multidrug-resistant strains and more recently, extensively drug-resistant (XDR) strains of serotype typhi. Current reports of extensively drug-resistant typhoid fever outbreak in Pakistan are not only a major concern for Pakistan but also for health authorities worldwide: intercontinental transmission, spread, and replacement of native strains in neighboring countries and a major impediment to Pakistani health care management. The WHO records that there are 5274 cases of extensively drug-resistant (XDR) typhoid fever out of a total of 8188 total cases of typhoid fever reported in Pakistan. The last remaining feasible oral antibiotic that XDR typhoid remains susceptible to is azithromycin; this is a cause of major concern. Additionally, several cases of XDR typhoid fever have also been reported in patients travelling from Pakistan to the USA, UK, and Canada. This review article attempts to raise the issue of XDR typhoid with respect to its epidemiology, prevention, management, and future outlook and stresses a better understanding of antimicrobial stewardship and general surveillance of the disease. Although progress is being made to combat XDR typhoid locally, efficient, unified efforts on a national and international scale are required to contain the XDR outbreak before it is no longer manageable and leads us back to the preantibiotic era.
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http://dx.doi.org/10.1155/2020/6432580DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7212280PMC
February 2021

Knowledge and Beliefs Regarding Thalassemia in an Urban Population.

Cureus 2019 Jul 29;11(7):e5268. Epub 2019 Jul 29.

Internal Medicine, Dow Medical College and Civil Hospital, Karachi, PAK.

Background:  Thalassemia is one of the most common genetic blood disorders in Asia. Consanguineous marriages and avoiding pre-marital and antenatal screening are common in Pakistan due to psychosocial, cultural, and religious factors. Few studies have investigated the beliefs regarding thalassemia, especially in a developing country. The aim of this study was to assess the knowledge, beliefs, and practices regarding thalassemia in an urban population.

Method:  A cross-sectional descriptive study was conducted in the urban areas of Karachi, Pakistan over a period of six months during March 2016 through August 2016. Participants selected by representative sampling were interviewed face-to-face using a pre-designed, pre-tested questionnaire. The questionnaire was divided into four parts. The first part inquired about general demographic variables, while the second part assessed knowledge of the participant regarding thalassemia. The third and fourth parts were concerning the beliefs and practices regarding thalassemia. Data were entered and analyzed using the Statistical Package for Social Sciences (SPSS) Statistics, v. 24.0 (IBM SPSS Statistics, Armonk, NY).

Results:  Only 53% (n = 720) of the respondents had heard about thalassemia. The mean knowledge score was 5.8. The total possible score ranged between 0 - 12 with the higher scores indicating better knowledge. About three-quarters (70%) of the sample did not know that an individual can be a carrier of thalassemia. Less than half (38%) of the participants viewed premarital screening for thalassemia as necessary, with only 10% agreeing that thalassemia carriers should not marry. There was no pre-marriage counseling done in 98% of the families.  Conclusion: Our study highlights the prevalence of numerous myths and a low level of knowledge regarding thalassemia in an urban population of Pakistan.
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http://dx.doi.org/10.7759/cureus.5268DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6764615PMC
July 2019

A Retrospective Cohort Study on Coronary Endarterectomy Outcomes in Coronary Artery Bypass Graft Patients.

Cureus 2019 Mar 19;11(3):e4279. Epub 2019 Mar 19.

Internal Medicine, Khyber Teaching Hospital, Peshawar, PAK.

Introduction: The aim of this study is to determine the outcomes following coronary endarterectomy (CE) in patients who underwent coronary artery bypass grafting (CABG) for revascularization in our hospital.

Methods: We retrospectively reviewed patients who underwent CABG over a six-month period, from November 1, 2016 to May 31, 2017 and examined their outcomes in regards to CE.

Results: A total of (n=361) CABG procedures were performed in our study period, though complete records were available for only (n=254) patients. Amongst these, (n=37) patients (14.5%) required CE. Ages ranged from 43 to 75 years for these patients, (n=7) were females and (n=30) males. Comorbidities included hypertension in (n=19) patients, diabetes in (n=12) patients and hepatitis B in (n=11) patients. The right coronary artery (RCA) was the most common artery endarterectomized (n= 15), followed by the left anterior descending (LAD) (n= 10), obtuse marginal (n= 6 patients), diagonals (n=5) and ramus (n=2). Two vessels were endarterectomized in (n=4) patients. A total of (n=9) patients had two-vessel CABG, (n=16) had three-vessel CABG and (n=8) had four-vessel CABG. The left internal mammary artery (LIMA) was used in (n=25) patients. Two patients required intra-aortic balloon pump post-operatively. All the patients had received inotropic support postoperatively in the intensive care unit (ICU). There were no reports of postoperative mortality. One patient remained in the ICU for four days postoperatively, the rest of the patients were stepped down to the ward in less than four days.

Conclusions: CE is a safe and viable option as an adjunct to CABG in long segment totally occluded vessels needing revascularization and reconstruction.
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http://dx.doi.org/10.7759/cureus.4279DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6529046PMC
March 2019

Frequency and Determinants of Inappropriate Use of Treadmill Stress Test for Coronary Artery Disease.

Cureus 2018 Jan 23;10(1):e2101. Epub 2018 Jan 23.

Science, Karachi Grammar School.

Background In developing countries like Pakistan, treatment is mediated by private and public healthcare setups with a limited budget for health facilities. Moreover, the inappropriate use of treadmill tests imposes a burden on healthcare resources and leads to unwarranted interventions. Our aim is to assess the prevalence and predictors of inappropriate referrals for the exercise tolerance test (ETT) to diagnose coronary artery disease (CAD) while taking public and private healthcare settings into consideration. Methods A cross-sectional study was conducted to find the prevalence of the inappropriate use of ETT to diagnose obstructive CAD and to determine the factors responsible for it. A total of 264 patients were enrolled from outpatient departments in Karachi. The inclusion criterion was the referral of treadmill testing for the diagnosis of CAT. The analysis was performed by logistic regression models to ascertain independent predictors of inappropriate use. Results Exercise stress tests were found to be inappropriate in 209 (79%) patients. The study indicated that the majority of patients had a low or very low pre-test probability of CAD. Diabetes, hypertension, and dyslipidemia were less frequent in the inappropriate as compared to the appropriate referrals (10%, 45%, and 16% versus 20%, 69%, and 32%). Both public and private sectors showed a high prevalence of inappropriate testing, but it was much higher in the latter (27% versus 73%, P < 0.001). In all regression models, the private healthcare system was the major independent predictor for inappropriate indications of ETT with an average odds ratio of 4.9 (P < 0.001). Conclusion The high prevalence of ETT referrals was found for the diagnosis of CAD. This result was consistent with both public and private healthcare systems, but it was considerably higher in private setups. Comorbidities, number of risk factors, and cardiovascular risk were not associated with the inappropriate use of ETT.
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http://dx.doi.org/10.7759/cureus.2101DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5898845PMC
January 2018

Comparison of in-vivo failure of single-thread and dual-thread temporary anchorage devices over 18 months: A split-mouth randomized controlled trial.

Am J Orthod Dentofacial Orthop 2017 Oct;152(4):451-457

Department of Orthodontics, Riphah International University, Islamabad, Pakistan.

Introduction: The purpose of this study was to compare the in-vivo failure rates of single-thread and dual-thread temporary anchorage device (TAD) designs over 18 months.

Methods: Thirty patients with skeletal Class II Division 1 malocclusion requiring anchorage from TADs for retraction of maxillary incisors into the extracted premolar space were recruited in this parallel group, split-mouth, randomized controlled trial. A block randomization sequence was generated with Random Allocation Software (version 2.0; Isfahan, Iran) with the allocations concealed in sequentially numbered, opaque, sealed envelopes. A total of 60 TADs (diameter, 2 mm; length, 10 mm) were placed in the maxillary arches of these patients with random allocation of the 2 types to the left and the right sides in a 1:1 ratio. All TADs were placed between the roots of the second premolar and the first molar and were immediately loaded. Patients were followed for a minimum of 12 months and a maximum of 18 months for the failure of the TADs. Data were analyzed blindly on an intention-to-treat basis.

Results: Four TADs (13.3%) failed in the single-thread group, and 6 TADs (20%) failed in the dual-thread group. The McNemar test showed an insignificant difference (P = 0.72) between the 2 groups. An odds ratio of 1.6 (95% confidence interval, 0.39-6.97) showed no significant associations among the variables. Most TADs failed in the first month after insertion (50%).

Conclusions: The failure rate of dual-thread TADs compared with single-thread TADs is statistically insignificant when placed in the maxilla for retraction of the anterior segment. Registration: The trial was not registered before commencement.

Protocol: The protocol was not published before the trial.
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http://dx.doi.org/10.1016/j.ajodo.2017.05.019DOI Listing
October 2017

Antihistamine-Induced Hepatitis: 2 Cases Involving Loratidine.

Case Reports Hepatol 2016 15;2016:6890313. Epub 2016 May 15.

University of Illinois, Oak Lawn, IL 60453, USA.

Antihistamine-induced hepatitis is rare. We present 2 cases of antihistamine-induced hepatitis with autoimmune features, caused by loratidine. One case was confirmed by rechallenge. Identifying and discontinuing the offending agent are essential for treatment.
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http://dx.doi.org/10.1155/2016/6890313DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4884577PMC
June 2016

Non-alcoholic fatty liver disease among visitors to a hepatitis awareness programme.

Trop Gastroenterol 2013 Jul-Sep;34(3):153-8

Background And Aims: Non-alcoholic fatty liver disease (NAFLD) is rapidly becoming the most common liver disease worldwide. The present study aimed to evaluate the prevalence of NAFLD among the visitors screened on World Hepatitis Day 2010 and 2011.

Methods: Attendees of the hepatitis awareness programme (n = 928) were offered screening to rule out liver ailments. The participants were evaluated on history, body mass index (BMI) measurement, blood tests for hepatitis B surface antigen (HBsAg), anti-hepatitis C virus (anti-HCV), alanine aminotransferase (ALT) levels and abdominal ultrasound (US).

Results: On ultrasonography, fatty liver was present in 142 of 806 subjects who were found negative for viral serology and had no history of regular alcohol intake. This accounted for 15.3% of all the visitors. Comparing them with the rest of the serology-negative alcohol-negative subjects, there were more housewives (p = 0.005) with fatty liver. They were older with mean age 43.3 +/- 12.1 years compared to 33.1 +/- 16.1 years (p = 0.000) in patients without fatty liver and had a higher BMI 28.6 +/- 6.0 kg/m2 vs. 22.2 +/- 5.3 kg/m2 (p = 0.000). Regression analysis suggested BMI as the only significant independent risk factor (p = 0.000). However, 32 subjects with fatty liver had BMI < 25 kg/m2 and 6 of them had diabetes mellitus. Thirty-one subjects (21.8%) with fatty liver had raised ALT level (p = 0.000) and possible non-alcoholic steatohepatitis (NASH) which accounts for 3.34% (31/928) of the total visitors.

Conclusions: This analysis reveals that our general population is at risk of having NAFLD and NASH and these should be looked into even in non-obese persons.
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http://dx.doi.org/10.7869/tg.119DOI Listing
June 2014
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