Publications by authors named "Asad Ullah"

103 Publications

Genotyping of Brucella strains isolated from humans and cattle of different geographical regions of Pakistan using MLVA-15.

Vet Med Sci 2021 Jul 10. Epub 2021 Jul 10.

Planning and Development Division, Pakistan Agriculture Research Council, Islamabad, Pakistan.

Background: Prevalence of brucellosis and MLVA genotyping in animals and humans, isolated from different regions of Pakistan was performed. Animals having history of brucellosis from the field and local farms of Bannu, Mardan, Peshawar, Swat, Lahore and Islamabad were selected for blood collection. Humans that work with them were also selected for sampling in this study. Total of 600 samples were taken from cattle and humans and subjected to Rose Bengal plate Test (RBPT) for the initial screening of positive samples. Designed primers of B.abortus for cattle and B.melitensis for humans were utilised to perform PCR. Culturing and isolation was carried to further to perform MLVA genotyping assay through the selection of two panels of primer markers.

Results: RBPT showed more number of cases of brucellosis in animals and humans compared to the PCR findings. Genotyping findings based upon MLVA-15 set of markers demonstrated that the isolated strains of B.abortus fall in the same clade with strain A1, P8 and A2 from Pakistan and also similar with BCCN#02-45 strain from India. On the other hand, B.melitensis isolated from different districts of Pakistan shared the same clade with BwIM-AFG 63, BwIM-AFG 44 strains from Afghanistan and BwIM IRN 37 strain from Iran. Selected VNTR alleles were sequenced for calibration purposes.

Conclusion: It is concluded that Brucella is prevalent in animals and humans in studied districts of Pakistan. Moreover, A1, P8, BwIM-AFG 63, BwIM-AFG 44 and A2 were found the common genotypes in Pakistan.
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http://dx.doi.org/10.1002/vms3.550DOI Listing
July 2021

Genome Sequences of Two Novel Coronavirus (SARS-CoV-2) Isolates from Dhaka, Bangladesh.

Microbiol Resour Announc 2021 Jul 8;10(27):e0051121. Epub 2021 Jul 8.

Department of Biotechnology and Genetic Engineering, Faculty of Biological Sciences, Jahangirnagar University, Savar, Dhaka, Bangladesh.

This study reports the genome sequences of two severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strains detected in the nasopharyngeal swab specimens of two coronavirus disease 2019 (COVID-19) patients from Dhaka, Bangladesh.
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http://dx.doi.org/10.1128/MRA.00511-21DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8265230PMC
July 2021

Primary Neurosarcoidosis Mimicking Gallbladder Pathology.

Curr Health Sci J 2021 Jan-Mar;47(1):114-116. Epub 2021 Mar 31.

Medical College of Georgia, Department of Radiology, AU Medical Center, Augusta, GA, USA.

A 40-year-old African American male with long standing headaches and unintentional weight loss presented with nausea, vomiting, and blurry vision. Laboratory findings include hyponatremia and mildly raised liver enzymes. He underwent cholecystectomy six months prior for unexplained nausea and vomiting, which in hindsight was likely neurologic-induced vomiting from neurosarcoidosis. Brain imaging revealed diffuse, leptomeningeal, nodular enhancement involving the brain, brainstem, and upper cervical spinal cord. Further work up showed extensive lymphadenopathy above and below the diaphragm, solitary liver lesion, and multiple lytic lesions involving bones. Iliac spine biopsy revealed ill-defined, non-caseating granulomas with giant cell reaction infiltrating bone fragments. Acid-fast bacilli and fungal stains were negative. Patient was treated with steroids. Diagnosis of neurosarcoidosis is challenging in the absence of physical signs and symptoms. However, radiological and pathological correlation in clinical suspicion of sarcoidosis is helpful in more accurate diagnosis and timely management of the patient.
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http://dx.doi.org/10.12865/CHSJ.47.01.18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8200603PMC
March 2021

Double-Negative T-Cell Reaction in a Case of Meningitis.

Int J Environ Res Public Health 2021 06 16;18(12). Epub 2021 Jun 16.

Department of Pathology, Medical College of Georgia, Augusta University, Augusta, GA 30912, USA.

Gamma delta T-cells are commonly found in response to infection in mice, whereas this same immunological response has only been reported a few times in vivo in humans. Moreover, gamma delta T-cell response in cerebral spinal fluid samples in conjunction with meningitis has never been described in medical literature to date. Thus, we describe a 64-year-old male who presented with altered mental status, fever, and neck stiffness. After lumbar puncture revealed elevated glucose, protein, lactate dehydrogenase, and white blood cell count, further cytologic analysis was indicated. The CSF showed a markedly hypercellular sample with a lymphocytic pleocytosis, including some enlarged forms with irregular nuclear contours, and rare macrophage containing intracytoplasmic bacteria. Lymphocyte immunophenotyping was performed via flow cytometric analysis, which ultimately revealed a prominent CD4/CD8 negative T-cell population, suggestive of a gamma delta T-cell population. Thus, an initial suspicion of malignancy was considered but was ruled out due to the absence of mass lesion on imaging and overall features including heterogenous lymphocyte morphology. Shortly after, gram stain and cultures were obtained revealing . Unfortunately, the patient rapidly succumbed to disease following the diagnosis of meningitis. Studies suggest that gamma delta T-cells are activated by the protein components of and thus have been found to be an important mediator of resistance to infection. Studies have also discovered that the level of activation for these T-cells appears to be tissue specific and dose dependent, with most cases occurring within visceral organs. Hence, we herein present the first case of gamma delta T-cell activation due to within the cerebral spinal fluid of a human patient.
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http://dx.doi.org/10.3390/ijerph18126486DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8296375PMC
June 2021

Standard induction with basiliximab versus no induction in low immunological risk kidney transplant recipients: study protocol for a randomized controlled trial.

Trials 2021 Jun 24;22(1):414. Epub 2021 Jun 24.

King Faisal Specialist Hospital and Research Centre (KFSHRC), Pharmaceutical Care Division MBC 11, Riyadh, Saudi Arabia.

Background: Induction therapy with IL-2 receptor antagonist (IL2-RA) is recommended as a first-line agent in low immunological risk kidney transplant recipients. However, the role of IL2-RA in the setting of tacrolimus-based immunosuppression has not been fully investigated.

Aims: To compare different induction therapeutic strategies with 2 doses of basiliximab vs. no induction in low immunologic risk kidney transplant recipients as per KFSHRC protocol.

Methods: Prospective, randomized, double blind, non-inferiority, controlled clinical trial EXPECTED OUTCOMES: 1. Primary outcomes: Biopsy-proven acute rejection within first year following transplant 2.

Secondary Outcomes: a. Patient and graft survival at 1 year b. eGFR at 6 months and at 12 months c. Emergence of de novo donor-specific antibodies (DSAs) TRIAL REGISTRATION: The study has been prospectively registered at clinicaltrials.gov (NTC: 04404127). Registered on 27 May 2020.
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http://dx.doi.org/10.1186/s13063-021-05253-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8223264PMC
June 2021

A threshold approach to sustainable development: Nonlinear relationship between renewable energy consumption, natural resource rent, and ecological footprint.

J Environ Manage 2021 Jun 23;295:113073. Epub 2021 Jun 23.

Department of Business Administration, IQRA University, Karachi, 75300, Pakistan. Electronic address:

All over the world, humankind and nature are paying off economic development's opportunity cost through accelerated environmental degradation. Renewable energy is the best option to control and minimize environmental degradation for sustainable development. This study's primary motive is to examine the nonlinear relationship between renewable energy consumption, natural resource rent, and ecological footprint in the context of the world's top 15 renewable energy consumption economies to achieve sustainable development. Panel time-series data from 1996 to 2018 is focused on concluding the study. Panel Smooth Transition Model is used to explore the nonlinear relationship and transition between the low and high regimes because of the nonlinear behavior. The study's results suggest a negative association between renewable energy consumption and ecological footprint and a positive relationship between natural resource rent and ecological footprint in both low and high regimes in the case of these 15 economies. It is highly recommended that the nations must shift their energy consumption policies towards renewable energy sources by investing in renewable energy technology and research for a more sustainable development.
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http://dx.doi.org/10.1016/j.jenvman.2021.113073DOI Listing
June 2021

Immune subtraction for improved resolution in serum protein immunofixation electrophoresis and antibody isotype determination in a patient with autoantibody.

Pract Lab Med 2021 Aug 30;26:e00240. Epub 2021 May 30.

Department of Pathology, Medical College of Georgia at Augusta University, Augusta, GA, 30912, USA.

Heavy chain isotypes of low level monoclonal immunoglobulins are sometimes obscured in serum immunofixation electrophoresis (SIFE) by a heavy background of polyclonal immunoglobulins. However, accurate determination of the heavy chain isotype is essential for a complete diagnosis, as isotype determination of autoantibodies may have relevance in determining therapeutic procedures. Immune subtraction (IS) was employed in a patient with neuropathy and GD1a autoantibody. IS allowed identification of the cognate heavy chain related to a lambda light chain restriction noted on initial SIFE as well as isotype determination of the autoantibody. Antisera specific to individual heavy and light chains were used for depletion of specific immunoglobulin types. Depletion of kappa light chain associated immunoglobulins allowed unequivocal determination of the isotype of lambda light chain-associated low level monoclonal band to be IgG Lambda. Selective depletion of kappa, lambda, gamma and mu heavy chain immunoglobulins was employed to determine IgG Kappa isotype of the auto-antibody.
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http://dx.doi.org/10.1016/j.plabm.2021.e00240DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8173025PMC
August 2021

Factors Responsible for Non-Diagnostic Cytology on Ultrasound-Guided Fine-Needle Aspiration of Thyroid Nodules.

Cureus 2021 May 11;13(5):e14955. Epub 2021 May 11.

Radiology, Dr. Ziauddin Hospital, Karachi, PAK.

Introduction Fine-needle aspiration (FNA) is a well-recognized procedure for the diagnosis of thyroid nodules, with the advantage of being safe and inexpensive. Fine-needle aspiration cytology (FNAC) is mainly performed for nodules showing suspicious sonographic features that may require thyroidectomy. Even when FNAC is performed under sonographic guidance, the cytological specimen obtained may be inadequate, leading to a non-diagnostic outcome. The aim of this study is to determine the sonographic and technical factors influencing the outcome of FNAC. Material and methods This cross-sectional study was conducted prospectively at the radiology department, Dr. Ziauddin Hospital, Karachi, from January 1, 2019, to December 31, 2020. This study was approved by the Ethical Review Committee (ERC) of Ziauddin University. All the patients undergoing ultrasound (US)-guided FNAC of thyroid nodules were included. Patients with a history of previous thyroid surgery, very large thyroid lesions (>5 cm), and those with adjacent soft tissue pathology obscuring the assessment of thyroid nodules were excluded from this study. Result Out of 176 nodules studied, 14 were non-diagnostic and 162 were diagnostic. A 22G needle was used in most of the patients, i.e. 102 (57.3%), which demonstrated no relationship with the non-diagnostic results. According to Bethesda, 136 (77.3%) patients were benign, 22 (12.5%) had lesions with atypia/follicular lesions of undetermined significance, 14 (8%) were non-diagnostic and four (2.3%) were suspicious for malignancy. A subset, including 76 nodules, was categorized according to Thyroid Imaging Reporting and Data System (TIRADS) as follows: 28 (36.8%) nodules were moderately suspicious, 24 (31.6%) were mildly suspicious, 20 (26.3%) were not suspicious, and four (5.3%) nodules were benign. It was also observed that none of the hypoechoic nodules yielded non-diagnostic cytology. Conclusion This study concludes that radiologists must be aware of the technical details, cytologic preparation, and procedure-related complications associated with US-guided FNA to optimize patient care and the diagnostic outcome.
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http://dx.doi.org/10.7759/cureus.14955DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8191422PMC
May 2021

Therapeutic effects of chitosan-embedded vitamin C, E nanoparticles against cisplatin-induced gametogenic and androgenic toxicity in adult male rats.

Environ Sci Pollut Res Int 2021 May 29. Epub 2021 May 29.

Division of Endocrinology, Children's Hospital, Zhejiang University School of Medicine, Hangzhou, 310051, China.

Cisplatin, an anticancer drug used in treating various types of cancers, can cause reproductive toxicities during chemotherapy. Keeping this in view, the present study was designed to investigate the possible protective effects of normal vitamin C and E and vitamin C and E nanoparticles (embedded in chitosan) against cisplatin-induced reproductive toxicities. Vitamins C, E, and their nanoparticles in this regard proved to be an effective therapy. The work aimed to treat cisplatin-induced reproductive toxicities through vitamin C and E and their nanoparticles. Cisplatin exposure caused significant reduction in the weight, testosterone level, and changed lipid profile. Similarly, cisplatin induced significant widespread testicular atrophy and testicular lesions as evidenced by the gaps in the epithelium and loss of differentiating germ cells. Vitamin C and E and their nanoparticles rescued the weight, testosterone level, and testicular disturbances, which is associated with improved histological view of testicular tissues. The current study highlights evidence that designing a medication of vitamin C and E nanoparticles is useful in mitigating cisplatin-induced reproductive toxicity in cancerous male patients underlying chemotherapy.
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http://dx.doi.org/10.1007/s11356-021-14516-yDOI Listing
May 2021

Small cell carcinoma of the lung in a patient with previously treated synchronous adenocarcinoma and squamous cell carcinoma.

Lung India 2021 May-Jun;38(3):263-265

Department of Pathology, Medical College of Georgia, Augusta, GA, USA.

A 66-year-old Caucasian female with a 40-pack-year history of smoking and chronic obstructive pulmonary disease presented for follow-up of synchronous multiple primary lung cancers: Stage IB left upper lobe adenocarcinoma and Stage IA right middle lobe (RML) squamous cell carcinoma. The patient was treated with left upper lobectomy and RML pulmonary wedge resection 5 years prior. Surveillance chest computed tomography showed an increase in the size of the subcarinal lymph node and right lymph node conglomerate encasing the right upper lobe pulmonary artery, consistent with metastasis. Fine-needle aspiration of level 4R lymph nodes was performed. Histology and immunohistochemical staining confirmed the diagnosis of small cell carcinoma. Consequently, the patient was placed on cisplatin/etoposide combination chemotherapy.
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http://dx.doi.org/10.4103/lungindia.lungindia_739_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8194443PMC
May 2021

Metastatic Neuroblastoma Presenting as a Submandibular Mass with Mandibular Bone Involvement in a Three-Year-Old Child.

Int J Environ Res Public Health 2021 04 14;18(8). Epub 2021 Apr 14.

Department of Pediatric Surgery, Medical College of Georgia at Augusta University, Augusta, GA 30912, USA.

Although neuroblastoma is one of the most common extra-cranial tumors in the pediatric population, it is rarely seen as a metastasis to the mandibular bone. The following is a case report of a 3-year-old male who initially presented with a submandibular mass that was proven to be a poorly differentiated metastatic neuroblastoma through excisional biopsy. This report is one of the few case reports that demonstrates metastatic submandibular neuroblastoma with mandibular bone involvement in the pediatric population.
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http://dx.doi.org/10.3390/ijerph18084157DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8071055PMC
April 2021

Exploring the utility of extracellular vesicles in ameliorating viral infection-associated inflammation, cytokine storm and tissue damage.

Transl Oncol 2021 Jul 19;14(7):101095. Epub 2021 Apr 19.

Institute for Immunity and Transplantation, Stem Cell Biology and Regenerative Medicine, School of Medicine, Stanford University, Palo Alto, CA 94304, United States; Molecular Medicine Department of Medicine, Stanford University, CA, United States. Electronic address:

Extracellular vesicles (EVs) have emerged as potential mediators of intercellular communication. EVs are nano-sized, lipid membrane-bound vesicles that contains biological information in the form of proteins, metabolites and/or nucleic acids. EVs are key regulators of tissue repair mechanisms, such as in the context of lung injuries. Recent studies suggest that EVs have the ability to repair COVID19-associated acute lung damage. EVs hold great promise for therapeutic treatments, particularly in treating a potentially fatal autoimmune response and attenuate inflammation. They are known to boost lung immunity and are involved in the pathogenesis of various lung diseases, including viral infection. EV-based immunization technology has been proven to elicit robust immune responses in many models of infectious disease, including COVID-19. The field of EV research has tremendous potential in advancing our understanding about viral infection pathogenesis, and can be translated into anti-viral therapeutic strategies.
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http://dx.doi.org/10.1016/j.tranon.2021.101095DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8053440PMC
July 2021

Prevalence of Different Hepatobiliary Tree Variants on Magnetic Resonance Cholangiopancreatography in Patients Visiting a Tertiary Care Teaching Hospital in Karachi.

Cureus 2020 Dec 27;12(12):e12329. Epub 2020 Dec 27.

Diagnostic Radiology, Dr. Ziauddin Hospital, Karachi, PAK.

Introduction Hepatobiliary tree variant anatomy is crucial to understand the preoperative planning of hepatobiliary surgeries. Although the presence of variant anatomy is not an absolute contraindication for liver transplantation, inadvertent mapping can lead to postoperative biliary complications. These variants are also important to be recognized in various hepatobiliary surgeries and interventional procedures. Magnetic resonance cholangiopancreatography (MRCP) is an excellent non-invasive imaging tool that can identify biliary anatomy. The purpose of the current study is focused on determining anatomical variants of the biliary tree on MRCP in our population visiting a teaching hospital in Karachi. Methods This cross-sectional study was conducted on patients referred to Dr. Ziauddin Hospital for MRCP. MRCP was performed on MAGNETOM Avanto, SIEMENS, Belgium, Germany. Images were analyzed on a workstation by two radiologists and a postgraduate trainee. A senior radiologist reviewed equivocal cases. SPSS 22.0 (SPSS Inc., Chicago, IL) was used for statistical analysis. Chi-square test was used to see the link between anatomical variants of biliary tree and gender. P-value of ≤0.05 was considered as statistically significant. Results We recruited 369 patients undergoing MRCP consecutively for our study. Out of 369, 342 patients were eligible for analysis (139 males and 203 females). Standard anatomy was found to be prevalent in 65.8%. Type 3 was the leading variant. A statistically significant difference was recorded for the type 2 anatomic variant which was more frequent in males than females (p-value <0.001), while types 1, 3, and 4 anatomic variants were found to be more in females than males but this difference was not statistically significant. Few other variants were also recorded. Conclusion This study is robust evidence regarding biliary variants in Pakistan. It is important to consider these variants in our region, owing to an increased trend of liver transplants and other hepatobiliary procedures.
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http://dx.doi.org/10.7759/cureus.12329DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7837639PMC
December 2020

Renal Cell Carcinoma Presenting as an Isolated Eyelid Metastasis.

J Endourol Case Rep 2020 29;6(4):322-324. Epub 2020 Dec 29.

Department of Surgery, Section of Urology, Medical College of Georgia, Augusta University Health, Augusta, Georgia, USA.

Renal cell carcinoma (RCC) has a propensity to metastasize with the most common sites of metastasis being the lungs and bones. Cutaneous metastasis of RCC to the eyelid is exceedingly rare, with only six cases reported in the past decade. We are reporting a case of metastatic renal cell carcinoma (mRCC) that presented with a painless eyelid mass. We describe a case of a 66-year-old man with a history of chronic kidney disease stage III presenting with a rapidly growing left lower eyelid lesion thought to be a capillary hemangioma. Biopsy revealed polygonal clear cells with small central nuclei with thin-walled vasculature and strong immunostaining with PAX8 consistent with mRCC, clear cell type. Subsequent abdominal CT scan revealed a 5.1 × 4.7 × 4.3 cm heterogeneously enhancing mass with central necrosis in the upper pole of the left kidney. The patient was treated with excision of the eyelid lesion followed by robotic partial nephrectomy of the primary tumor. Follow-up CT scan at 3 and 6 months showed no evidence of recurrence. Isolated eyelid metastasis is an extremely rare form of presentation of mRCC. Interestingly, that patient did not have any other site of metastasis. Cytoreductive partial nephrectomy has been previously reported to be oncologically safe in selected patients.
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http://dx.doi.org/10.1089/cren.2020.0107DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7803249PMC
December 2020

Continuous Determination of Glucose Using a Membraneless, Microfluidic Enzymatic Biofuel Cell.

Micromachines (Basel) 2020 Dec 20;11(12). Epub 2020 Dec 20.

School of Mechanical Engineering, Kyungpook National University, Daegu 41566, Korea.

In this article, we describe an enzyme-based, membraneless, microfluidic biofuel cell for the continuous determination of glucose using electrochemical power generation as a transducing signal. Enzymes were immobilized on multi-walled carbon nanotube (MWCNT) electrodes placed parallel to the co-laminar flow in a Y-shaped microchannel. The microchannel was produced with polydimethylsiloxane (PDMS) using soft lithography, while the MWCNT electrodes were replicated via a PDMS stencil on indium tin oxide (ITO) glass. Moreover, the electrodes were modified with glucose oxidase and laccase by direct covalent bonding. The device was studied at different MWCNT deposition amounts and electrolyte flow rates to achieve optimum settings. The experimental results demonstrated that glucose could be determined linearly up to a concentration of 4 mM at a sensitivity of 31 mV∙mMcm.
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http://dx.doi.org/10.3390/mi11121129DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7765875PMC
December 2020

Role of CT Imaging With Three-Dimensional Maximum Intensity Projection Reconstruction in the Evaluation of Portal Vein Variants at a Tertiary Care Hospital.

Cureus 2020 Nov 28;12(11):e11733. Epub 2020 Nov 28.

Diagnostic Radiology, Dr. Ziauddin Hospital, Karachi, PAK.

Introduction: Portal vein (PV) is the principal blood vessel transporting blood from the alimentary tract and spleen to the liver. The aim of this study is to determine the prevalence of PV anatomical variations in our population using multidetector CT with maximum intensity projection (MIP) technique at a tertiary care hospital.

Methods: This cross-sectional study was prospectively conducted from November 2018 to June 2019 in the Department of Radiology at a tertiary care hospital in Karachi. After informed consent, all the patients with no known hepatic pathology undergoing routine abdomen CT were included in this study. Patients with previous hepatic resection surgeries, undiagnosed large hepatic tumors/metastasis, and those with PV thrombosis were excluded.

Results: A total of 500 patients (256 males and 244 females) were included in the study; the mean age of female patients was relatively higher as compared to the male patients (53.80 ± 18.44 vs. 44.15 ± 19.94 years; p = 0.000). Standard PV anatomy (type 1) was found in 438 patients (87.6%). Trifurcation (type 2) occurred in 18 patients (3.6%). Right posterior portal vein as the first branch of main PV (type 3) was found in 22 patients (4.4%). A separate branch of the right portal vein (RPV) to segment VII (type 4) and separate branch of the RPV to segment VI (type 5) were found in 6 (1.2%) and 16 (3.2%) patients, respectively.

Conclusion: Our study displayed a relatively higher frequency of standard PV anatomy (type 1) compared to previous studies. We highlight the role of MIP in the analysis of hepatic venous anatomy with its utility demonstrating improved detection of variations.
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http://dx.doi.org/10.7759/cureus.11733DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7773306PMC
November 2020

Endoscopic full-thickness resection of polyps involving the appendiceal orifice: a multicenter international experience.

Endoscopy 2021 Jan 4. Epub 2021 Jan 4.

Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA.

Background:  Endoscopic resection of lesions involving the appendiceal orifice remains a challenge. We aimed to report outcomes with the full-thickness resection device (FTRD) for the resection of appendiceal lesions and identify factors associated with the occurrence of appendicitis.

Methods:  This was a retrospective study at 18 tertiary-care centers (USA 12, Canada 1, Europe 5) between November 2016 and August 2020. Consecutive patients who underwent resection of an appendiceal orifice lesion using the FTRD were included. The primary outcome was the rate of R0 resection in neoplastic lesions, defined as negative lateral and deep margins on post-resection histologic evaluation. Secondary outcomes included the rates of: technical success (en bloc resection), clinical success (technical success without need for further surgical intervention), post-resection appendicitis, and polyp recurrence.

Results:  66 patients (32 women; mean age 64) underwent resection of colonic lesions involving the appendiceal orifice (mean [standard deviation] size, 14.5 (6.2) mm), with 40 (61 %) being deep, extending into the appendiceal lumen. Technical success was achieved in 59/66 patients (89 %), of which, 56 were found to be neoplastic lesions on post-resection pathology. Clinical success was achieved in 53/66 (80 %). R0 resection was achieved in 52/56 (93 %). Of the 58 patients in whom EFTR was completed who had no prior history of appendectomy, appendicitis was reported in 10 (17 %), with six (60 %) requiring surgical appendectomy. Follow-up colonoscopy was completed in 41 patients, with evidence of recurrence in five (12 %).

Conclusions:  The FTRD is a promising non-surgical alternative for resecting appendiceal lesions, but appendicitis occurs in 1/6 cases.
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http://dx.doi.org/10.1055/a-1345-0044DOI Listing
January 2021

COVID-19 pandemic: Mechanistic approaches and gender vulnerabilities.

Saudi Pharm J 2020 Dec 25;28(12):1874-1876. Epub 2020 Nov 25.

Department of Immunology and Transplantation, School of Medicine, Stanford University, CA, USA.

Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) is a highly pathogenic virus that causes coronavirus-19 disease (COVID-19), a severe respiratory damaging syndrome with serious health complications worldwide. SARS-CoV-2 was unfamilar before the epidemic started in Wuhan, China, in December 2019. COVID-19 is currently a pandemic influencing several countries worldwide. One of the mysteries of the new coronavirus is that it is deadlier for men than women with the male mortality rate is twice as high as that of females.
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http://dx.doi.org/10.1016/j.jsps.2020.11.014DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7685944PMC
December 2020

Obesity Paradox: Laboratory Findings in Uncomplicated Obesity. Is Bias a Plausible Explanation?

J Appl Lab Med 2021 Jan;6(1):113-118

Medical College of Georgia, Augusta University, Augusta, GA.

Objectives: Obesity predisposes to multiple diseases, such as heart disease, diabetes, stroke, arthritis, and malignancy. However, obese patients have better outcomes than normal-weight patients with some of these disorders, including those admitted to critical care units. We compared the results for common laboratory tests in patients with uncomplicated obesity against the findings in normal-weight patients.

Methods: Patients who had a comprehensive metabolic profile test were identified. Patients with acute and/or chronic debilitating disorders were excluded, and the laboratory parameters were compared among 4 groups based on body mass index.

Results: With the exception of elevated triglycerides and lower high-density lipoprotein in obese and morbidly obese patients, laboratory findings were not meaningfully different from those in normal-weight patients.

Conclusions: The obesity paradox of better outcomes in obese patients admitted to critical care units could not be explained on the basis of lower additional disease burden necessitating critical care admission due to abnormal laboratory values at the baseline. It is conceivable that unconscious bias against obese patients, with lower disease burden than normal-weight patients, triggers their admission to critical care, thus creating the appearance of better outcomes.
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http://dx.doi.org/10.1093/jalm/jfaa049DOI Listing
January 2021

School role in improving parenting skills and academic performance of secondary schools students in Pakistan.

Heliyon 2020 Nov 9;6(11):e05443. Epub 2020 Nov 9.

Department of Rural Sociology, Agriculture University Peshawar, Pakistan.

Background: This research investigated the association between school role in improving parenting skills and the academic performance of secondary school students. And to examine the role of student gender, literacy status of the parents and parental importance to children education in the association between school role in improving parenting skills and students' academic performance.

Methods: A multistage stratified random sampling technique was adopted to portray information from 448 students on a Likert scale. Chi-square, Kendall's Tau-c tests were used to determine the direction and strength of association among variables.

Results: The results depicted that the association of children's academic performance was found significant (P = 0.000) and positive (Tau-c = 0.215) with school capacitating parents how to monitor and discuss schoolwork at home with children, assisting parents in setting academic goals for children (P = 0.000, Tau-c = 0.225). Moreover, the respondent's gender, parent literacy status and parental importance to children's education explained variation in the association between school role in improving parenting skills and children's academic performance.

Conclusions: The school role in improving parenting skills significantly and positively contributed to children's academic performance. Moreover, boys, children of literate parents and children whose parents give more importance to their education with school active role in improving parenting skills were more liable to score higher grades.
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http://dx.doi.org/10.1016/j.heliyon.2020.e05443DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7662842PMC
November 2020

Important Flavonoids and Their Role as a Therapeutic Agent.

Molecules 2020 Nov 11;25(22). Epub 2020 Nov 11.

Division of Biological and Environmental Sciences and Engineering (BESE), King Abdullah University of Science and Technology (KAUST), Thuwal 23955-6900, Saudi Arabia.

Flavonoids are phytochemical compounds present in many plants, fruits, vegetables, and leaves, with potential applications in medicinal chemistry. Flavonoids possess a number of medicinal benefits, including anticancer, antioxidant, anti-inflammatory, and antiviral properties. They also have neuroprotective and cardio-protective effects. These biological activities depend upon the type of flavonoid, its (possible) mode of action, and its bioavailability. These cost-effective medicinal components have significant biological activities, and their effectiveness has been proved for a variety of diseases. The most recent work is focused on their isolation, synthesis of their analogs, and their effects on human health using a variety of techniques and animal models. Thousands of flavonoids have been successfully isolated, and this number increases steadily. We have therefore made an effort to summarize the isolated flavonoids with useful activities in order to gain a better understanding of their effects on human health.
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http://dx.doi.org/10.3390/molecules25225243DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7697716PMC
November 2020

Treatment of Bouveret Syndrome Using an Ultrathin Gastroscope: Making the Best out of a Tight Situation!

Am J Gastroenterol 2020 11;115(11):1748

Division of Gastroenterology and Hepatology, University of Rochester Medical Center, Rochester, New York, USA.

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http://dx.doi.org/10.14309/ajg.0000000000000841DOI Listing
November 2020

Intrapulmonary Pharmacokinetics of Cefepime and Enmetazobactam in Healthy Volunteers: Towards New Treatments for Nosocomial Pneumonia.

Antimicrob Agents Chemother 2020 12 16;65(1). Epub 2020 Dec 16.

Antimicrobial Pharmacodynamics and Therapeutics, University of Liverpool, Liverpool Health Partners, Liverpool, United Kingdom

Cefepime-enmetazobactam is a novel β-lactam-β-lactamase inhibitor combination with broad-spectrum antimicrobial activity against a range of multidrug-resistant This agent is being developed for a range of serious hospital infections. An understanding of the extent of partitioning of β-lactam-β-lactamase inhibitor combinations into the human lung is required to better understand the potential role of cefepime-enmetazobactam for the treatment of nosocomial pneumonia. A total of 20 healthy volunteers were used to study the intrapulmonary pharmacokinetics of a regimen of 2 g cefepime-1 g enmetazobactam every 8 h intravenously (2 g/1 g q8h i.v.). Each volunteer contributed multiple plasma samples and a single epithelial lining fluid (ELF) sample, obtained by bronchoalveolar lavage. Concentrations of cefepime and enmetazobactam were quantified using liquid chromatography-tandem mass spectrometry. The pharmacokinetic data were modeled using a population methodology, and Monte Carlo simulations were performed to assess the attainment of pharmacodynamic targets defined in preclinical models. The concentration-time profiles of both agents in plasma and ELF were similar. The mean ± standard deviation percentage of partitioning of total drug concentrations of cefepime and enmetazobactam between plasma and ELF was 60.59% ± 28.62% and 53.03% ± 21.05%, respectively. Using pharmacodynamic targets for cefepime of greater than the MIC and free enmetazobactam concentrations of >2 mg/liter in ELF of 20% of the dosing interval, a regimen of cefepime-enmetazobactam of 2 g/0.5 g q8h i.v. infused over 2 h resulted in a probability of target attainment of ≥90% for with cefepime-enmetazobactam MICs of ≤8 mg/liter. This result provides a rationale to further consider cefepime-enmetazobactam for the treatment of nosocomial pneumonia caused by multidrug-resistant .
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http://dx.doi.org/10.1128/AAC.01468-20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7927813PMC
December 2020

Carcinosarcoma of the Uterus: A Study From the Surveillance Epidemiology and End Result (SEER) Database.

Cureus 2020 Sep 6;12(9):e10283. Epub 2020 Sep 6.

Surgery, Sandeman Provincial Hospital, Quetta, PAK.

Background: Uterine cancer (UC) is one of the leading gynecologic neoplastic disorders in the United States (US), of which over 80% are endometrioid adenocarcinomas (EA). In contrast to EA, carcinosarcoma (CS) of the uterus is a sporadic and highly malignant tumor, phylogenetically containing both epithelial and mesenchymal histologic elements. This study sought to analyze demographic, pathological retrospectively, and survival characteristics of a large cohort of CS patients compared to EA patients to identify prognostic factors and treatment approaches that may improve the current clinical management of CS patients.

Methods: Demographic and clinical data were abstracted from 88,530 patients diagnosed with uterine malignancy from the Surveillance, Epidemiology, and End Results (SEER) database for 38 years (1973-2010). Extracted variables were analyzed using the Chi-square test, paired t-test, and multivariate analysis, while Kaplan-Meier functions were used to compare survival between groups. Statistical analyses were performed with IBM Statistical Product and Service Solutions (SPSS), version 20.2 (IBM Corp., Armonk, NY).

Results: A total of 3,706 cases of CS comprised 38.2% of uterine sarcomas (n=9,702), and 4.1% of uterine cancers overall (n=88,530). EA made up 88.6% (n=78,481) of all uterine cancers. CS patients presented later in life (68.3±11.5 years) than EA (61.9±12.5 years). 65.2% of CS and 77.8% of EA occurred in Caucasians. The incidence (per million) of EA was higher in Caucasians compared to African-Americans (AA) (41% vs. 26.8%), while the incidence of CS was higher among AA than Caucasians (4% vs. 1.9%, p<0.001). 33.4% of CS was poorly differentiated at presentation, compared to 13.1% of EA. 27.8% of CS patients presented with a distant disease compared to only 4.7% of EA patients. 29.9% of AA patients with CS presented with metastatic disease, compared to 28.2% of Caucasian patients (p<0.001). Mean survival for CS patients (6.6±0.2 years) was significantly lower than that of EA patients (17.7±0.7 years, p<0.001), and AA CS patients had significantly lower survival than Caucasians CS patients (4.5±0.4 years vs. 7.1±0.3 years, p<0.001). CS patients treated with combined surgery and radiotherapy had the highest survival (9.4±0.5 years, p<0.001), while EA patients treated with surgery alone had the highest survival (20.4±1.2 years, p<0.001). Survival among AA CS patients treated with combination therapy was significantly inferior compared to Caucasians (6.5±0.6 years vs. 9.8±0.5 years, p<0.001). Multivariate analysis identified CS histology (odds ratio [OR] 1.9, CI=1.7-2.1), AA race (OR 1.3, CI=1.2-1.4), age over 40 (OR 3.4, CI=2.9-4.1), undifferentiated grade (OR 3.0, CI=2.6-3.4), and distant metastases (OR 6.2, CI=5.8-6.8) as independently associated with increased mortality (p<0.005). The use of radiotherapy in CS patients was independently associated with decreased mortality (OR 0.1, CI=0.02-0.6, p<0.005).

Conclusions: Uterine CS is a highly malignant tumor with a significantly worse prognosis than EA. AA has a considerably higher CS incidence compared to EA. Moreover, AA CS had higher tumor grades, higher rates of metastatic disease, and experienced significantly lower overall survival compared to Caucasians despite receiving similar therapy. Primary radiotherapy or combination radiotherapy confers a survival advantage to AA uterine CS patients.
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http://dx.doi.org/10.7759/cureus.10283DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7538206PMC
September 2020

Paraneoplastic Limbic Encephalitis in a Patient with Primary Well-differentiated Teratoma and Metastatic Poorly Differentiated Embryonal Carcinoma.

Yale J Biol Med 2020 09 30;93(4):495-500. Epub 2020 Sep 30.

Department of Pathology, Medical College of Georgia, Augusta, GA.

Testicular tumors account for 1-2% of all tumors in men, with 95% of these being germ cell tumors. Paraneoplastic limbic encephalitis is a rare sequela of testicular tumors associated with anti-Ma2 and KLH11 antibodies. The most effective treatment for paraneoplastic limbic encephalitis is treatment of the primary malignancy. We report a 41-year-old male that presented to the emergency department with episodic alteration of consciousness and memory disturbances. Negative neurologic evaluation and imaging led to concern for a paraneoplastic process from a distant malignancy. CT imaging revealed an enlarged, necrotic para-aortic lymph node and subsequent ultrasound demonstrated a right-sided testicular mass. Right radical orchiectomy was performed. Microscopically, the mass consisted of mixed respiratory epithelium, gastrointestinal glands, and squamous epithelium with keratinization consistent with a post-pubertal testicular teratoma with associated germ cell neoplasia. Resection of the para-aortic mass revealed large anaplastic cells with epithelioid features, nuclear pleomorphism and frequent mitoses. Immunostaining was positive for Pan-Keratin and OCT4, consistent with poorly differentiated embryonal carcinoma. Resection of the primary and metastatic disease, as well as treatment with corticosteroids, resulted in resolution of the encephalitis. This presentation of severe neurological disturbances in the setting of a metastatic mixed non-seminomatous germ cell tumor represents a rare presentation of paraneoplastic limbic encephalitis.
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http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7513443PMC
September 2020

Primary Pleural Epithelioid Angiosarcoma With Extensive and Rapid Metastasis to Brain and Bilateral Adrenal Glands.

Cureus 2020 Aug 24;12(8):e9982. Epub 2020 Aug 24.

Pathology, Medical College of Georgia - Augusta University, Augusta, USA.

A 64-year-old male presents with shoulder pain, arm pain, and a chronic cough. CT imaging of the thorax shows a large 8.0 x 6.7 cm mass with central necrosis in the left upper lung lobe with invasion into the chest wall with partial destruction of the second and third ribs, and left axillary adenopathy. Bilateral adrenal nodules are identified via CT imaging and subsequently biopsied. Histologically, the mass reveals sheets of atypical epithelioid cells with round nuclei and abundant eosinophilic cytoplasm. Immunostaining is positive for CD31, CD34, FLI-1, AE1/AE3, and CK7, diagnostic of primary epithelioid angiosarcoma. The patient developed symptoms of confusion, dizziness, and ataxia. An MRI showed metastatic brain lesions. One month later, the patient had worsening symptoms. Repeat imaging demonstrates enlargement of the bilateral adrenal masses, a new lesion posterior to the left kidney, and doubling of the size of the brain lesions.  This case illustrates the metastatic potential and pattern of the spread of an aggressive primary pleural angiosarcoma that is not described elsewhere in current literature. It also highlights the importance of timely intervention based on the rapid metastatic progression of this neoplasm.
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http://dx.doi.org/10.7759/cureus.9982DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7511080PMC
August 2020

EVALUATION OF INDOOR/OUTDOOR GAMMA EXPOSURE RATES AND EXCESS LIFE TIME CANCER RISK IN DIFFERENT CITIES OF PAKISTAN.

Radiat Prot Dosimetry 2020 Oct;190(4):355-363

Pakistan Institute of Nuclear Science and Technology, P.O. Nilore, Islamabad, Pakistan.

This study presents a detailed measurement of indoor and outdoor terrestrial gamma radiation levels in different cities of Pakistan. The measurements covered dwellings in 27 cities, covering all provinces and region of Azad Kashmir. Most of the houses were of attached type, made of brick walls and concrete roofs. The measurements were made by a handheld radiation survey meter containing Geiger-Muller tube. The average absorbed dose rate in air was 100 ± 32 nGy h-1 for indoor and 74 ± 30 nGy h-1 for outdoor. The population-weighted mean terrestrial dose rates were 90 nGy h-1 for indoor and 78 nGyh-1 for outdoor. The ratio of indoor to outdoor absorbed dose rate was 1.5 as compared to 1.3 for the world average. The estimated average annual effective dose rate was 0.58 ± 0.18 mSv a-1 and the mean excess life time cancer risk was 2.0 × 10-3.
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http://dx.doi.org/10.1093/rpd/ncaa115DOI Listing
October 2020

Coronavirus Disease-19: Disease Severity and Outcomes of Solid Organ Transplant Recipients: Different Spectrums of Disease in Different Populations?

Transplantation 2021 01;105(1):121-127

Organ Transplant Center, King Faisal Specialist Hospital & Research Center, Riyadh, Saudi Arabia.

Background: Coronavirus disease-19 (COVID-19) is associated with significant mortality. The elderly, patients with comorbidities, and solid organ transplant (SOT) recipients are particularly at risk. We observed a low incidence of severe disease in our population and aimed to determine the outcomes of COVID-19 (disease severity/intensive care unit [ICU] admissions/mortality) in SOT recipients.

Methods: All SOT recipients diagnosed with COVID-19 were included. Their demographic and clinical data were recorded from the hospital electronic system. Patients were assigned to 1 of 4 stages of disease severity: stage A = asymptomatic, stage B = mild, stage C = moderate, and stage D = severe.

Results: Of the 3052 SOT recipients, 67 were diagnosed with COVID-19. The mean age was 52 years, and 69% were male. There were approximately 25% patients in stage A, 28% in stage B, 34% in stage C, and 12% in stage D. Patients in stages C and D were older than those in stage A (P = 0.04) or stage B (P = 0.03). Lactic dehydrogenase (P < 0.01) and D-dimer (P < 0.01) levels were higher across the stages. Approximately 70% of patients were admitted for a median duration of 9 days and the median follow-up was 35 days. Acute kidney injury occurred in 19% of patients, and 45% required supplementary oxygen. The symptomatic patients were treated with Hydroxychloroquine (83%), Azithromycin (89%), and Tocilizumab (23%). Around 15% of patients were admitted to ICU and 2 patients have died.

Conclusions: Most SOT recipients developed mild to moderate COVID-19 infection; few required ICU admission and 2 patients have died. Remaining patients have recovered and have been discharged from the hospital.
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http://dx.doi.org/10.1097/TP.0000000000003433DOI Listing
January 2021

Spread of coronavirus disease-19 among devotees during religious congregations.

Ann Thorac Med 2020 Jul-Sep;15(3):105-106. Epub 2020 Jun 18.

Department of Chemistry and Biochemistry, Islamia College University, Peshawar, Pakistan.

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http://dx.doi.org/10.4103/atm.ATM_162_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7423201PMC
June 2020

Thrombolysis in Myocardial Infarction (TIMI) Risk Score Assessment for Complications in Acute Anterior Wall ST Elevation Myocardial Infarction.

Cureus 2020 Jun 15;12(6):e8646. Epub 2020 Jun 15.

Internal Medicine, Bolan Medical College, Quetta, PAK.

Introduction and objective Effective risk stratification is integral to the management of acute coronary syndromes. The Thrombolysis in Myocardial Infarction (TIMI) risk score for ST-segment elevation myocardial infarction (STEMI) is based on eight high-risk parameters that can be used at the bedside for risk stratification of patients presenting with STEMI. This study was designed to determine the frequency of cardiac complications of anterior wall STEMI assessed on TIMI risk score and to compare the rate of cardiac complications according to the TIMI score. Materials and methods An observational case series study was conducted in the Department of Cardiology at Sandeman Provincial Hospital in Quetta, Pakistan. The study duration was six months, from September 22, 2016 to March 23, 2017. A total of 369 patients were selected who had anterior wall myocardial infarction and received thrombolytic therapy, according to the inclusion and exclusion criteria. The TIMI score was calculated by proforma at the time of admission. Patients were divided into three groups: low-risk, moderate-risk, and high-risk TIMI groups. The frequency of complications of anterior wall myocardial infarction at the time of discharge was compared among these groups. Results The study included 285 male patients (77.2%) and 84 (22.8%) female patients. A total of 174 (47.2%) patients were smokers, 79 (21.4%) were obese, and 93 (25.2%) had hyperlipidemia. Of the 369 patients, 205 (55.6%) were included in the low-risk group, 150 (40.7%) in the moderate-risk group, and 14 (3.8%) in the high-risk group. Post-myocardial infarction arrhythmias were noted in 33 (16.09%) patients in the low-risk group and six (4%) patients in the moderate-risk group. Left ventricular dysfunction was noted in 158 (77.07%) patients in the low-risk group, 78 (52%) patients in the moderate-risk group, and seven (50%) patients in the high-risk group. Cardiogenic shock occurred in seven (3.41%) patients in the low-risk group, 47 (31.33%) patients in the moderate-risk group, and 0 (0%) patient in the high-risk group. Death occurred in seven (3.41%) patients in the low-risk group, 19 (12.66%) patients in the moderate-risk group, and seven (50%) patients in the high-risk group. Conclusion TIMI scoring provides a better assessment in terms of complications caused by STEMI. The complications include the mechanical and electrophysiology of the heart.
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http://dx.doi.org/10.7759/cureus.8646DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7366066PMC
June 2020