Publications by authors named "Asrar Ahmed"

35 Publications

Antimicrobial and self-crosslinking potential of experimentally developed dioctadecyldimethyl ammonium bromide and riboflavin dentin adhesive.

J Biomed Mater Res A 2021 Nov 21;109(11):2392-2406. Epub 2021 May 21.

Clinical Dentistry, Faculty of Dentistry, International Medical University Kuala Lumpur, Kuala Lumpur, Malaysia.

The aim of the study is to investigate a new formulation, based on dioctadecyldimethyl ammonium-bromide (QA) and riboflavin (RF), combining antimicrobial activities and protease inhibitory properties with collagen crosslinking without interference to bonding capabilities in a rabbit model. Quaternary ammonium riboflavin (QARF) experimental adhesives modified with dioctadecyldimethyl ammonium-bromide and riboflavin were bonded (0.5/1.0/2.0%) to rabbit dentin to investigate for pulpal-histology, interfacial-morphology, transmission electron microscopy, mechanical properties, collagen crosslinking, micro-Raman analysis, antimicrobial, and anti-protease activities. Collagen type-I molecules were generated using molecular-docking. Odontoblasts appeared with normal histology, were seen in controls with no inflammatory cells detected in 0.5% specimens at day 7 and mild inflammatory response at day 30. In QARF 2.0%, inflammatory cells were not detected at day 7 and 30 (p < .05). Dentinal tubules are seen with intact collagen surface in 1% specimens. Resin penetrated inside 1% adhesive specimens with few irregularly funnel-shaped tags. Transmission electron microscopy showed thinner collagen in all specimens except 1% QARF specimens. Biofilms were influenced by QARF adhesives. Elastic moduli were significantly higher in 1.0% and 2.0% QARF adhesive specimens with a significant increase in total crosslinks. Stable amide groups with anti-protease activity was observed in QARF groups. Charged residues were seen in the triple helix hCOL3A1, Gly489-Gly510 after stabilisation with formulation. The 1% QARF modified adhesives improved biochemical and biomechanical properties of rabbit dentin.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/jbm.a.37221DOI Listing
November 2021

COVID-19 pandemic and STEMI: pathway activation and outcomes from the pan-London heart attack group.

Open Heart 2020 10;7(2)

Department of Cardiology, Royal Free London NHS Foundation Trust, London, United Kingdom.

Objectives: To understand the impact of COVID-19 on delivery and outcomes of primary percutaneous coronary intervention (PPCI). Furthermore, to compare clinical presentation and outcomes of patients with ST-segment elevation myocardial infarction (STEMI) with active COVID-19 against those without COVID-19.

Methods: We systematically analysed 348 STEMI cases presenting to the PPCI programme in London during the peak of the pandemic (1 March to 30 April 2020) and compared with 440 cases from the same period in 2019. Outcomes of interest included ambulance response times, timeliness of revascularisation, angiographic and procedural characteristics, and in-hospital clinical outcomes RESULTS: There was a 21% reduction in STEMI admissions and longer ambulance response times (87 (62-118) min in 2020 vs 75 (57-95) min in 2019, p<0.001), but that this was not associated with a delays in achieving revascularisation once in hospital (48 (34-65) min in 2020 vs 48 (35-70) min in 2019, p=0.35) or increased mortality (10.9% (38) in 2020 vs 8.6% (38) in 2019, p=0.28). 46 patients with active COVID-19 were more thrombotic and more likely to have intensive care unit admissions (32.6% (15) vs 9.3% (28), OR 5.74 (95%CI 2.24 to 9.89), p<0.001). They also had increased length of stay (4 (3-9) days vs 3 (2-4) days, p<0.001) and a higher mortality (21.7% (10) vs 9.3% (28), OR 2.72 (95% CI 1.25 to 5.82), p=0.012) compared with patients having PPCI without COVID-19.

Conclusion: These findings suggest that PPCI pathways can be maintained during unprecedented healthcare emergencies but confirms the high mortality of STEMI in the context of concomitant COVID-19 infection characterised by a heightened state of thrombogenicity.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/openhrt-2020-001432DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7592245PMC
October 2020

Experience with Haemorrhoidal artery ligation under direct vision at a tertiary care hospital: A case series.

J Pak Med Assoc 2020 Jun;70(6):1089-1093

Department of General Surgery, Combined Military Hospital, Nowshera, Pakistan.

This study aims to share the results of haemorrhoidal artery ligation under direct vision in the management of symptomatic haemorrhoids. We conducted a case series of 70 patients at Combined Military Hospital Rawalpindi & Quetta, from January 2015 to October 2017. All patients underwent Haemorrhoidal Artery Ligation (HAL) and Recto Anal Repair (RAR). Ligation of superior haemorrhoidal artery was done under direct vision following manual palpation. Patients were followed up postoperatively at 1, 3 and 6 months. At 1 month follow up, all 70 (100%) patients were pain free. Post operative bleeding was observed in 7 (10%) patients but did not require surgical intervention. Sixty two (89%) patients were able to return to their daily activities 1 week after surgery and 57 (81%) resumed military duties or joined their work place at 2 weeks. 70 (100%) patients were asymptomatic and 45 (64%) highly satisfied with their surgery at 3 months. This increased to 53 (75%) at 6 months. 48 (69%) said that they would recommend this procedure to someone else. Prolapse recurrence was observed in 1(1.42%) patient 6 months post operatively which was dealt by band ligation. All patients completed follow-up at 1, 3 and 6 months. HAL is a simple yet safe technique with few complications, acceptable patient satisfaction and early return to work.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.5455/JPMA.300504DOI Listing
June 2020

Characteristics and Outcomes of Hospitalized Young Adults with Mild Covid -19.

J Assoc Physicians India 2020 Aug;68(8):62-65

Department of Research, RUHS College of Medical Sciences, Rajasthan.

Background: Stormy course has been reported among hospitalized adults with COVID-19 in high- and middle-income countries. To assess clinical outcomes in consecutively hospitalized patients with mild covid-19 in India we performed a study.

Methods: We developed a case registry of successive patients admitted with suspected covid-19 infection to our hospital (n=501). Covid-19 was diagnosed using reverse transcriptase polymerase chain reaction (RT-PCR). Demographic, clinical, investigations details and outcomes were recorded. Descriptive statistics are presented.

Results: Covid-19 was diagnosed in 234 (46.7%) and data compared with 267 (53.3%) negative controls. Mean age of covid-19 patients was 35.1±16.6y, 59.4% were <40y and 64% men. Symptoms were in less than 10% and comorbidities were in 4-8%. History of BCG vaccination was in 49% cases vs 10% controls. Cases compared to controls had significantly greater white cell (6.96+1.89 vs 6.12+1.69x109 cells/L) and lower lymphocyte count (1.98+0.79 vs 2.32+0.91x109 cells/L). No radiological and electrocardiographic abnormality was observed. All these were isolated or quarantined in the hospital and observed. Covid-19 patients received hydroxychloroquine and azithromycin according to prevalent guidelines. One patient needed oxygen support while hospital course was uncomplicated in the rest. All were discharged alive. Conversion to virus negative status was in 10.2±6.4 days and was significantly lower in age >40y (9.1±5.2) compared to 40-59y (11.3±6.1) and ≥60y (16.4±13.3) (p=0.001).

Conclusions: This hospital-based registry shows that mildly symptomatic or asymptomatic young covid-19 patients have excellent prognosis.
View Article and Find Full Text PDF

Download full-text PDF

Source
August 2020

Atrial fibrillation: a leading cause of heart failure-related hospitalizations; a dual epidemic.

Am J Cardiovasc Dis 2019 15;9(5):109-115. Epub 2019 Oct 15.

Internal Medicine, Abington-Jefferson Health Abington, USA.

Background: Atrial fibrillation (AF), and heart failure (HF) are a major cardiovascular epidemic over the last decade. The prevalence and rehospitalization of heart failure are on rising edge, and many factors are responsible for these re-exacerbations of heart failure. In this study, we sought to determine an association of a risk factor for frequent rehospitalization of heart failure at our institute. We aimed to find the re-admission rate, heart rate, and rhythm of heart failure exacerbation.

Methods: We performed a single-center retrospective study at the Abington Hospital - Jefferson health and 418 patients having a history of heart failure, and AF were selected. The heart failure readmission rate (days), heart rate, and rhythm were analyzed.

Results: The mean age of the included population was 82.8 years SD ± 9.2. About 53% had AF with a mean heart rate 90 SD ± 21 bpm, and 47% had normal sinus rhythm (NSR) with a mean heart rate of 78 ± 16 bpm on re-admission. This difference was statistically significant (p=0.02). The mean re-admission rate for atrial fibrillation was 27.49 days SD ± 18.97, compared to 32.68 SD ± 20.26 days for NSR, statistically significant (p=0.007) and the Pearson Chi-square was also significant P = 0.006.

Conclusion: There is a significantly increased rate of re-admission in heart failure patients with atrial fibrillation with a rapid ventricular rate. Efforts should be taken to keep the patient in NSR or controlled AF to minimize the rehospitalization rate, and this, in turn, reduces the financial burden on patients and institutes.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6872464PMC
October 2019

"Revised diagnostic criteria" for Vogt-Koyanagi-Harada disease fail to improve disease management.

J Curr Ophthalmol 2019 Mar 13;31(1):1-7. Epub 2018 Dec 13.

Retinal and Inflammatory Eye Diseases, Centre for Ophthalmic Specialized Care, Clinic Montchoisi Teaching Centre, Lausanne, Switzerland.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.joco.2018.10.011DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6407152PMC
March 2019

Gitelman Syndrome: A Rare Cause of Seizure Disorder and a Systematic Review.

Case Rep Med 2019 5;2019:4204907. Epub 2019 Feb 5.

Resident Physician, Abington Hospital-Jefferson Health, Abington, PA, USA.

Gitelman syndrome is one of the few inherited causes of metabolic alkalosis due to salt losing tubulopathy. It is caused by tubular defects at the level of distal convoluted tubules, mimicking a thiazide-like tumor. It usually presents in late childhood or in teenage as nonspecific weakness, fatigability, polyuria, and polydipsia but very rarely with seizures. It is classically associated with hypokalemia, hypomagnesemia, hypocalciuria, hyperreninemia, and hyperaldosteronism. However, less frequently, it can present with normal magnesium levels. It is even rarer to find normomagnesemic patients of GS who develop seizures as the main complication since hypomagnesemia is considered the principal etiology of abnormal foci of seizure-related brain activity in GS cases. Interestingly, patients with GS are oftentimes diagnosed during pregnancy when the classic electrolyte pattern consistent with GS is noticed. Our case presents GS with normal serum magnesium in a patient, with seizures being the main clinical presentation. We also did a comprehensive literature review of 122 reported cases to show the prevalence of normal magnesium in GS cases and an overview of clinical and biochemical variability in GS. We suggest that further studies and in-depth analysis are required to understand the pathophysiology of seizures in GS patients with both normal and low magnesium levels.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2019/4204907DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6379858PMC
February 2019

Differential CXC and CX3C Chemokine Expression Profiles in Aqueous Humor of Patients With Specific Endogenous Uveitic Entities.

Invest Ophthalmol Vis Sci 2018 05;59(6):2222-2228

Department of Microbiology and Immunology, Rega Institute for Medical Research, University of Leuven, KU Leuven, Leuven, Belgium.

Purpose: To determine the levels of the neutrophil chemoattractants CXCL1, CXCL2, CXCL5, CXCL6, and CXCL8, the T helper 1 chemoattractants CXCL9, CXCL10 and CXCL11, the lymphoid chemokines CXCL12 and CXCL13 and the soluble form of the transmembrane chemokines CXCL16 and CX3CL1, in aqueous humor samples from patients with specific uveitic entities.

Methods: Aqueous humor samples from patients with active uveitis associated with Behçet's disease (n = 13), sarcoidosis (n = 8), HLA-B27-related inflammation (n = 12), Vogt-Koyanagi-Harada (VKH) disease (n = 12), and healthy controls (n = 9) were assayed with the use of a multiplex assay.

Results: All chemoattractant levels were significantly higher in all patients than in the controls. The levels of all neutrophil chemoattractants and CXCL10, CXCL16, and CX3CL1 were significantly higher in nongranulomatous uveitis (Behçet's disease and HLA-B27-associated uveitis) than in granulomatous uveitis (sarcoidosis and VKH disease), whereas the levels of the B cell chemoattractant CXCL13 were significantly higher in granulomatous uveitis than in nongranulomatous uveitis. CXCL13 levels were highest in the patients with VKH disease. CXCL9, CXCL11, and CXCL12 levels did not differ significantly.

Conclusions: Inflammation in nongranulomatous uveitis appears to be driven by neutrophils and T helper 1 lymphocytes, whereas B lymphocytes may contribute to the inflammatory process in granulomatous uveitis, particularly in VKH disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1167/iovs.17-23225DOI Listing
May 2018

Cost-effectiveness of a management strategy based on exercise echocardiography versus exercise electrocardiography in patients presenting with suspected angina during long term follow up: A randomized study.

Int J Cardiol 2018 05;259:1-7

Department of Cardiology, Northwick park Hospital, Harrow, United Kingdom; Department of Cardiology, Royal Brompton Hospital, United Kingdom; Biomedical Research Unit, National Heart and Lung Institute, Imperial College, London, United Kingdom. Electronic address:

Introduction: Exercise ECG (Ex-ECG) is advocated by guidelines for patients with low - intermediate probability of coronary artery disease (CAD). However, there are no randomized studies comparing Ex-ECG with exercise stress echocardiography (ESE) evaluating long term cost-effectiveness of each management strategy.

Methods: Accordingly, 385 patients with no prior CAD and low-intermediate probability of CAD (mean pre-test probability 34%), were randomized to undergo either Ex-ECG (194 patients) or ESE (191 patients). The primary endpoint was clinical effectiveness defined as the positive predictive value (PPV) for the detection of CAD of each test. Cost-effectiveness was derived using the cumulative costs incurred by each diagnostic strategy during a mean of follow up of 3.0 years.

Results: The PPV of ESE and Ex-ECG were 100% and 64% (p = 0.04) respectively for the detection of CAD. There were fewer clinic (31 vs 59, p < 0.01) and emergency visits (14 vs 30, p = 0.01) and lower number of hospital bed days (8 vs 29, p < 0.01) in the ESE arm, with fewer patients undergoing coronary angiography (13.4% vs 6.3%, p = 0.02). The overall cumulative mean costs per patient were £796 for Ex-ECG and £631 for ESE respectively (p = 0.04) equating to a >20% reduction in cost with an ESE strategy with no difference in the combined end-point of death, myocardial infarction, unplanned revascularization and hospitalization for chest pain between ESE and Ex-ECG (3.2% vs 3.7%, p = 0.38).

Conclusion: In patients with low to intermediate pretest probability of CAD and suspected angina, an ESE management strategy is cost-effective when compared with Ex-ECG during long term follow up.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijcard.2018.01.112DOI Listing
May 2018

Diagnostic Concordance and Clinical Outcomes in Patients Undergoing Fractional Flow Reserve and Stress Echocardiography for the Assessment of Coronary Stenosis of Intermediate Severity.

J Am Soc Echocardiogr 2018 02 13;31(2):180-186. Epub 2017 Dec 13.

Department of Cardiology, Northwick Park Hospital, Harrow, United Kingdom; Department of Cardiology, Royal Brompton Hospital, London, United Kingdom; Biomedical Research Unit, National Heart and Lung Institute, Imperial College, London, United Kingdom. Electronic address:

Background: The ischemic consequences of coronary artery stenosis can be assessed by invasive fractional flow reserve (FFR) or by noninvasive imaging. We sought to determine (1) the concordance between wall thickening assessment during clinically indicated stress echocardiography (SE) and FFR measurements and (2) the factors associated with hard events in these patients.

Methods: Two hundred twenty-three consecutive patients who underwent SE and invasive FFR measurements in close succession were analyzed retrospectively for diagnostic concordance and clinical outcomes.

Results: At the vessel level, the sensitivity, specificity, positive predictive value, and negative predictive value of SE for identifying significant disease as assessed by FFR was 68%, 75%, 43%, and 89%, respectively. The greatest discordance was seen in patients with wall thickening abnormalities (WTAs) and negative FFR. During a follow-up of 3.6 ± 2.2 years, there were 23 cardiovascular (CV) events (death and nonfatal myocardial infarction). The number of wall segments with inducible WTAs emerged as the strongest factor associated with CV events (hazard ratio, 1.18 [1.05-1.34]; P = .008). FFR was not associated with outcome. There was a significant increase in event rate in patients with WTA/negative FFR versus no WTA/negative FFR (P = .01), but no significant difference versus WTA/positive FFR (P = .85).

Conclusions: In a patient population with significant CV risk factors, a normal SE had a high negative predictive value for excluding abnormal FFR. WTAs were associated with outcomes regardless of FFR value, suggesting that this is a superior marker of ischemia to FFR.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.echo.2017.10.012DOI Listing
February 2018

The Effect of Honey on Radiation-induced Oral Mucositis in Head and Neck Cancer Patients.

Indian J Palliat Care 2017 Jul-Sep;23(3):317-320

Children Hospital, Lahore, Pakistan.

Aim: The aim of this study is to evaluate the effect of honey on clinically scoring grades of oral mucositis.

Materials And Methods: This interventional study was carried out in Radiation Oncology Department of Mayo Hospital, Lahore. In this study, 82 patients of both genders, of head and neck cancer, planned for radiotherapy, were divided into two groups by random sampling numbers. Patients in both groups were treated with a total dose of 60-78 Grays in 4-6 weeks. In treatment group, patients were instructed to take 20 mL of honey. In control group, they were advised to rinse with 0.9% of saline. Patients were evaluated every week to assess the grades of oral mucositis up to 6 weeks. The assessment tool was Radiation Therapy Oncology Group Grading System. The statistical analysis was done by Chi-square test.

Results: In honey-treated group, the proportion of mucositis (Grades 3 and 4) was lower and statistically significant as compared to control group at the end of 6 weeks of radiation.

Conclusion: This study showed that oral intake of honey during radiotherapy is valuable in the reduction of severity of oral mucositis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/IJPC.IJPC_146_16DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5545960PMC
August 2017

Synthesis of novel 5-(aroylhydrazinocarbonyl)escitalopram as cholinesterase inhibitors.

Eur J Med Chem 2017 Sep 30;138:396-406. Epub 2017 Jun 30.

Institute of Chemistry, University of the Punjab, Lahore 54590, Pakistan; Department of Chemistry, The Islamia University of Bahawalpur, Bahawalpur 63100, Pakistan.

A novel series of 5-(aroylhydrazinocarbonyl)escitalopram (58-84) have been designed, synthesized and tested for their inhibitory potential against cholinesterases. 3-Chlorobenzoyl- (71) was found to be the most potent compound of this series having IC 1.80 ± 0.11 μM for acetylcholinesterase (AChE) inhibition. For the butyrylcholinesterase (BChE) inhibition, 2-bromobenzoyl- (76) was the most active compound of the series with IC 2.11 ± 0.31 μM. Structure-activity relationship illustrated that mild electron donating groups enhanced enzyme inhibition while electron withdrawing groups reduced the inhibition except o-NO. However, size and position of the substituents affected enzyme inhibitions. . In docking study of AChE, the ligands 71, 72 and 76 showed the scores of 5874, 5756 and 5666 and ACE of -64.92,-203.25 and -140.29 kcal/mol, respectively. In case of BChE, ligands 71, 76 and 81 depicted high scores 6016, 6150 and 5994 with ACE values -170.91, -256.84 and -235.97 kcal/mol, respectively.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ejmech.2017.06.036DOI Listing
September 2017

The clinical efficacy and long-term prognostic value of stress echocardiography in octogenarians.

Heart 2017 04 30;103(7):517-523. Epub 2016 Sep 30.

Department of Cardiology, Northwick Park Hospital, Harrow, UK.

Introduction: Although stress echocardiography (SE) is invaluable in younger populations, its prognostic value may be attenuated in the elderly due to shorter life expectancy and the frequent presence of severe comorbidities. This study sought to evaluate the clinical effectiveness of SE in octogenarians, particularly its prognostic value over clinical variables, in predicting hard events.

Methods: A total of 374 consecutive octogenarians who underwent SE for evaluation of coronary artery disease (CAD) were assessed for feasibility, diagnostic accuracy and safety of the test, and followed up for hard outcomes (all-cause mortality, cardiovascular (CV) deaths and non-fatal myocardial infarction (NFMI)). Cox regression analysis was performed to identify predictors of outcome.

Results: Of the 374 tests, 360 (96.3%) were diagnostic. Of the 50 patients with inducible ischaemia, 33 patients (66%) proceeded to angiography of which 27 (82%) patients had significant CAD. During long-term follow-up of 4.0±2.0 years, there were 127 deaths and 36 NFMIs. The annualised mortality, NFMI and combined mortality /NFMI rates were 8.1%, 1.8% and 9.4% for patients with a normal SE and 12.1%, 5.5% and 14.1% for those with an abnormal SE, respectively. Predictors of NFMI on multivariate analysis were prior CAD (HR 2.89, CI 1.03 to 8.15, p=0.045), peripheral vascular disease (HR 3.33, CI 1.18 to 9.45, p=0.02), and inducible ischaemia (HR 3.97, CI 1.49 to 10.55, p=0.006). In patients without prior history of CAD, inducible ischaemia was the only independent predictor of NFMI (HR 8.72, CI 1.46 to 52.2, p=0.018). The larger the extent of ischaemia, the greater the incidence of NFMI. The independent predictors of CV events (NFMI or CV mortality) were PAD (HR 2.81, CI 1.21 to 6.52, p=0.016) and peak wall motion score index (HR 5.71, CI 1.67 to 19.6, p=0.006). Although inducible ischaemia predicted all-cause mortality on unadjusted analysis, it did not on multivariate analysis.

Conclusions: In octogenarians, SE demonstrated excellent feasibility, safety and diagnostic accuracy. SE parameters were independent predictors of NFMI and CV events, and the presence of inducible ischaemia was associated with a 50% increase in all-cause mortality.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1136/heartjnl-2016-310026DOI Listing
April 2017

Relative clinical and economic impact of exercise echocardiography vs. exercise electrocardiography, as first line investigation in patients without known coronary artery disease and new stable angina: a randomized prospective study.

Eur Heart J Cardiovasc Imaging 2017 Feb 24;18(2):195-202. Epub 2016 Mar 24.

Department of Cardiovascular Medicine and Institute for Medical Research, Northwick Park Hospital, Harrow, UK

Aims: Exercise electrocardiography (ExECG) is widely used in suspected stable angina (SA) as the initial test for the evaluation of coronary artery disease (CAD). We hypothesized that exercise stress echo (ESE) would be efficacious with cost advantage over ExECG when utilized as the initial test.

Methods And Results: Consecutive patients with suspected SA, without known CAD were randomized into ExECG or ESE. Patients with positive tests were offered coronary angiography (CA) and with inconclusive tests were referred for further investigations. All patients were followed-up for cardiac events (death, myocardial infarction, and unplanned revascularization). Cost to diagnosis of CAD was calculated by adding the cost of all investigations, up to and including CA. In the 194 and 191 patients in the ExECG vs. ESE groups, respectively, pre-test probability of CAD was similar (34 ± 23 vs. 35 ± 25%, P = 0.6). Results of ExECG were: 108 (55.7%) negative, 14 (7.2%) positive, 72 (37.1%) inconclusive and of ESE were 181 (94.8%) negative, 9 (4.7%) positive, 1 (0.5%) inconclusive, respectively. Patients with obstructive CAD following positive ESE vs. Ex ECG were 9/9 vs. 9/14, respectively (P = 0.04). Cost to diagnosis of CAD was £266 for ESE vs. £327 for ExECG (P = 0.005). Over a mean follow-up period of 21 ± 5 months, event rates were similar between the two groups.

Conclusion: In this first randomized study, ESE was more efficacious and demonstrated superior cost-saving, compared with ExECG when used as the initial investigation for the evaluation of CAD in patients with new-onset suspected SA without known CAD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ehjci/jew049DOI Listing
February 2017

Giant lymphomatous cardiac mass: In vivo imaging and histological findings.

Int J Cardiol 2016 Jan 25;202:81-3. Epub 2015 Aug 25.

Department of Cardiology, Northwick Park Hospital, Harrow, United Kingdom; Department of Cardiology, Royal Brompton Hospital, National Heart and Lung Institute, Imperial College, London, United Kingdom.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijcard.2015.08.151DOI Listing
January 2016

Relative diagnostic, prognostic and economic value of stress echocardiography versus exercise electrocardiography as initial investigation for the detection of coronary artery disease in patients with new onset suspected angina.

Int J Cardiol Heart Vasc 2015 Jun 6;7:124-130. Epub 2015 Apr 6.

Department of Cardiovascular Medicine and Institute for Medical Research, Northwick Park Hospital, Harrow, UK.

Objectives: We hypothesised that stress echocardiography (SE), may be superior to exercise ECG (ExECG), for predicting CAD and outcome, and cost-beneficial, when performed as initial investigation in newly suspected angina.

Methods: All patients seen in 2011, with suspected angina, no history of CAD, pre-test likelihood of CAD of > 10% and who underwent SE or ExECG as first line were identified retrospectively. Cost to diagnosis was calculated by adding the cost of all tests, up to and including coronary angiography (CA), on an intention-to-treat basis. Follow-up data on cardiac death and myocardial infarction (MI) were collected, 26 months after the presentation of the last study patient.

Results: A total of 456 patients underwent ExECG (224 (49%) negative, 93 (20%) positive, 139 (31%) inconclusive) and 241 underwent SE (200 (83%) negative, 35 (15%) positive, 6 (2%) inconclusive) as first line. In patients subsequently undergoing CA, CAD was present in 46% (37/80) of patients with positive ExECG vs. 72% (23/32) patients with positive SE (p = 0.01). Mean cost to diagnosis was £456 for the ExECG vs. £360 for the SE group (p = 0.002). Over a mean follow-up period of 31 ± 5 months, cardiac events were 2% each in negative SE vs. negative ExECG (p = 0.9).

Conclusions: SE is superior to ExECG for prediction of CAD and is cost-beneficial when used as initial test in patients with no history of CAD presenting with suspected angina.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ijcha.2015.03.008DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5497249PMC
June 2015

The benefits of revascularization in chronic heart failure.

Curr Heart Fail Rep 2015 Apr;12(2):112-9

Department of Cardiology, Northwick Park Hospital, Harrow, UK.

Recent efforts have reduced the mortality from coronary artery disease (CAD), with the consequent increase in heart failure with reduced left ventricular function, referred to as ischaemic cardiomyopathy (ICM). As ischemic left ventricular (LV) dysfunction may be partially or completely reversible by revascularization in the presence of viable myocardium, the assessment of myocardial viability is central to the management of ICM. Decades of observational analyses have provided positive evidence for the role of revascularization in hibernating myocardium in improving survival. However, recently the Surgical Treatment for Ischaemic Heart Failure (STICH) trial has challenged this notion, highlighting the noninferiority of optimal medical therapy (OMT) over revascularization and OMT. In this review, we discuss noninvasive imaging modalities to assess myocardial viability and the impact of myocardial viability on revascularization. We critically appraise the STICH trial and suggest an algorithm for viability testing before revascularization in patients with ICM and significant LV dysfunction.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s11897-014-0245-1DOI Listing
April 2015

Inequity aversion and the evolution of cooperation.

Phys Rev E Stat Nonlin Soft Matter Phys 2014 Feb 7;89(2):022802. Epub 2014 Feb 7.

International Institute of Information Technology-Hyderabad, Centre for Data Engineering, Hyderabad, India.

Evolution of cooperation is a widely studied problem in biology, social science, economics, and artificial intelligence. Most of the existing approaches that explain cooperation rely on some notion of direct or indirect reciprocity. These reciprocity based models assume agents recognize their partner and know their previous interactions, which requires advanced cognitive abilities. In this paper we are interested in developing a model that produces cooperation without requiring any explicit memory of previous game plays. Our model is based on the notion of inequity aversion, a concept introduced within behavioral economics, whereby individuals care about payoff equality in outcomes. Here we explore the effect of using income inequality to guide partner selection and interaction. We study our model by considering both the well-mixed and the spatially structured population and present the conditions under which cooperation becomes dominant. Our results support the hypothesis that inequity aversion promotes cooperative relationship among nonkin.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1103/PhysRevE.89.022802DOI Listing
February 2014

Reduced levels of brain derived neurotrophic factor (BDNF) in the serum of diabetic retinopathy patients and in the retina of diabetic rats.

Cell Mol Neurobiol 2013 Apr 28;33(3):359-67. Epub 2012 Dec 28.

Department of Biochemistry, College of Science, King Saud University, Riyadh, 11415, Saudi Arabia.

Diabetic retinopathy (DR) is widely recognized as a neurovascular disease. Retina, being a neuronal tissue of the eye, produces neurotrophic factors for its maintenance. However, diabetes dysregulates their levels and thereby may damage the retina. Among neurotrophins, brain derived neurotrophic factor (BDNF) is the most abundant in the retina. In this study, we investigated the level of BDNF in the serum of patients with DR and also in the serum and retina of streptozotocin-induced diabetic rats. The level of BDNF was significantly decreased in the serum of proliferative diabetic retinopathy patients as compared to that of non-diabetic healthy controls (25.5 ± 8.5-10.0 ± 8.1 ng/ml, p < 0.001) as well as compared to that of diabetic patients with no retinopathy (21.8 ± 4.7-10.0 ± 8.1 ng/ml, p < 0.001), as measured by ELISA techniques. The levels of BDNF in the serum and retina of diabetic rats were also significantly reduced compared to that of non-diabetic controls (p < 0.05). In addition, the expression level of tropomyosin-related kinase B (TrkB) was significantly decreased in diabetic rat retina compared to that of non-diabetic controls as determined by Western blotting technique. Caspase-3 activity was increased in diabetic rat retina after 3 weeks of diabetes and remained elevated until 10 weeks, which negatively correlated with the level of BDNF (r = -0.544, p = 0.013). Our results indicate that reduced levels of BDNF in diabetes may cause apoptosis and neurodegeneration early in diabetic retina, which may lead to neuro-vascular damage later in DR.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s10571-012-9901-8DOI Listing
April 2013

An unusual case of urinary incontinence in a female child.

J Pediatr Urol 2013 Feb 24;9(1):e43-5. Epub 2012 Jul 24.

Department of Pediatric Surgery, Military Hospital (MH), The Mall, Rawalpindi, Pakistan.

We report a case of a 3-year-old female child presenting with continuous urinary incontinence since birth. After relevant investigations, a diagnosis of bilateral single-system ectopic ureters into a vaginalized urogenital sinus was made. We discuss the extreme rarity of the case, importance of an accurate history, along with various treatment options.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jpurol.2012.07.003DOI Listing
February 2013

Role of inflammation in the pathogenesis of diabetic retinopathy.

Middle East Afr J Ophthalmol 2012 Jan;19(1):70-4

Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

Diabetic retinopathy (DR) remains a major cause of worldwide preventable blindness. The microvasculature of the retina responds to hyperglycemia through a number of biochemical changes, including activation of protein kinase C, increased advanced glycation end products formation, polyol pathway, and oxidative stress, and activation of the renin angiotensin system (RAS). There is an accumulating body of evidence that inflammation plays a prominent role in the pathogenesis of DR.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/0974-9233.92118DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3277027PMC
January 2012

High-mobility group box-1 and biomarkers of inflammation in the vitreous from patients with proliferative diabetic retinopathy.

Mol Vis 2011 6;17:1829-38. Epub 2011 Jul 6.

Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

Purpose: To measure levels of high-mobility group box -1 (HMGB1) and soluble receptor for advanced glycation end products (sRAGE) in the vitreous fluid from patients with proliferative diabetic retinopathy (PDR) and to correlate their levels with clinical disease activity and the levels of the inflammatory biomarkers monocyte chemoattractant protein-1 (MCP-1), soluble intercellular adhesion molecule-1 (sICAM-1), interleukin-1β (IL-1β), and granulocyte macrophage colony-stimulating factor (GM-CSF). In addition, we examined the expression of HMGB1 in the retinas of diabetic mice.

Methods: Vitreous samples from 29 PDR and 17 nondiabetic patients were studied by enzyme-linked immunosorbent assay. Retinas of mice were examined by immunofluorescence analysis and western blotting.

Results: HMGB1 was detected in all vitreous samples and sRAGE was detected in 5 PDR samples. IL-1β was detected in 3PDR samples and GM-CSF was not detected. Mean HMGB1 levels in PDR with active neovascularization were twofold and threefold higher than that in inactive PDR and nondiabetic patients, respectively. Mean HMGB1 levels in PDR patients with hemorrhage were significantly higher than those in PDR patients without hemorrhage and nondiabetic patients (p=0.0111). There were significant correlations between levels of HMGB1 and levels of MCP-1 (r=0.333, p=0.025) and sICAM-1 (r=0.548, p<0.001). HMGB1 expression was also upregulated in the retinas of diabetic mice.

Conclusions: Subclinical chronic inflammation might contribute to the progression of PDR.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3137555PMC
December 2011

CXC chemokine expression profiles in aqueous humor of patients with different clinical entities of endogenous uveitis.

Immunobiology 2011 Sep 7;216(9):1004-9. Epub 2011 Apr 7.

Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

Aqueous humor (AH) samples from patients with Behçet's disease (BD) (n=29), Vogt-Koyanagi-Harada (VKH) disease (n=21), and HLA-B27-associated uveitis (n=8), and 42 control patients were assayed for the neutrophil chemoattractants CXCL1/GRO-α and CXCL8/IL-8 and the lymphocyte chemoattractants CXCL9/MIG, CXCL10/IP-10 and CXCL12/SDF-1 with the use of a multiplex chemokine assay. Chemokine levels except SDF-1 were significantly higher in the 3 disease groups than in normal controls. Considering all patients, mean GRO-α levels were 15-fold higher than IL-8 levels and mean IP-10 levels were 22-fold higher than MIG levels. In patients with the same disease activity, AH levels of GRO-α and IP-10 were significantly higher in patients with BD than in patients with VKH disease and HLA-B27-associated uveitis (p=0.0474; p<0.001, respectively). These data suggest that GRO-α and IP-10 are the predominant CXC chemokines involved in neutrophil and activated T lymphocyte chemoattraction in endogenous uveitis, particularly in BD.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.imbio.2011.03.007DOI Listing
September 2011

Visual outcome and complications of pars plana vitrectomy for dislocated intraocular lenses.

Saudi J Ophthalmol 2011 Apr 31;25(2):187-92. Epub 2011 Jan 31.

Vitreoretinal Division, King Khaled Eye Specialist Hospital, King Saud University, Riyadh, Saudi Arabia.

Objective: To report factors predicting the visual outcome and complications in eyes that underwent pars plana vitrectomy (PPV) to manage dislocated intraocular lenses (IOLs).

Patients And Methods: A retrospective chart review was performed. Clinical data recorded from the patient charts include, demographic, preoperative, intraoperative, and postoperative, with emphasis on visual acuity, interval between IOL dislocation and pars plana vitrectomy, surgical method and complications. Patients with follow-up of less than three months were excluded.

Results: Ninety-four patients were identified, 63 males and 31 females. Age ranged from 2 to 85 years (mean 52.6). The range of follow-up was 3 to 108 months (mean ± SD 19.4 ± 17.4 months). The final visual acuity was 20/50 or better in 52 (55.3%) eyes. Our analysis indicated that visual rehabilitation with IOL was significantly associated with better visual acuity as compared with eyes that were left aphakic (P = 0.0092). There was a trend toward a better visual outcome when PPV was performed within two weeks from the diagnosis of the dislocated IOL which was associated with good visual outcome (20/200 or better) in 85.7% of eyes compared with 78.8% of eyes. Management of IOL by interofixation was associated in (90.0%) of eyes with good vision (20/200 or better) compared to 76.1% eyes that had exchange of IOL through the limbus. Postoperative complications include cystoid macular edema in 9 (9.6%), glaucoma in 9 (9.6%), bullous keratopathy in 8 (8.5%), retinal detachments in 6 (6.4%) eyes, and relapsing uveitis in 2 (2%).

Conclusion: In this series, the final visual outcomes were improved and the rate of postoperative complications were low. Eyes that were pseudophakic had significantly good visual outcome compared with eyes that were left aphakic. To the best of our knowledge, this may be the largest study on dislocated IOL removal by PPV with good visual results compared to other studies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.sjopt.2011.01.013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3729642PMC
April 2011

Expression of high-mobility groups box-1/receptor for advanced glycation end products/osteopontin/early growth response-1 pathway in proliferative vitreoretinal epiretinal membranes.

Mol Vis 2011 Feb 17;17:508-18. Epub 2011 Feb 17.

Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

Purpose: The high-mobility group box -1 (HMGB1)/receptor for advanced glycation end products (RAGE)/osteopontin (OPN)/early growth response-1 (Egr-1) pathway is involved in inflammation, angiogenesis, and fibrosis. We investigated the expression of the components of this pathway in proliferative diabetic retinopathy (PDR) and proliferative vitreoretinopathy (PVR) epiretinal membranes.

Methods: Nine active and 13 inactive membranes from patients with PDR and 21 membranes from patients with PVR were studied by immunohistochemistry.

Results: In PDR membranes, vascular endothelial cells expressed HMGB1, RAGE, OPN, and Egr-1 in 21, 15, 20, and 16 membranes, respectively. Stromal cells expressed HMGB1, RAGE, OPN, and Egr-1 in 21, 20, 20, and 16 membranes, respectively. Significant correlations were detected between the number of blood vessels expressing the panendothelial cell marker CD34 and the number of blood vessels and stromal cells expressing HMGB1, RAGE, and OPN. The numbers of blood vessels and stromal cells expressing CD34, HMGB1, RAGE, and OPN and stromal cells expressing Egr-1 were significantly higher in active membranes than in inactive membranes. In PVR membranes, spindle-shaped myofibroblasts expressing α-smooth muscle actin coexpressed HMGB1, RAGE, OPN, and Egr-1.

Conclusions: The HMGB1/RAGE/OPN/Egr-1 pathway may be involved in inflammatory, angiogenic and fibrotic responses in proliferative vitreoretinal disorders.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3042358PMC
February 2011

Cytokine profiles in aqueous humor of patients with different clinical entities of endogenous uveitis.

Clin Immunol 2011 May 31;139(2):177-84. Epub 2011 Jan 31.

Department of Ophthalmology, King Abdulaziz University Hospital, College of Medicine, King Saud University, Old Airport Road, PO Box 245, Riyadh 11411, Saudi Arabia.

We assayed aqueous humor (AH) samples from patients with Behçet's disease (BD), Vogt-Koyanagi-Harada (VKH) disease, and HLA-B27-associated uveitis and control patients for the proinflammatory cytokines IL-15, IL-17, interferon-γ and tumor necrosis factor-α and the immunosuppressive cytokine IL-10. Cytokine levels were significantly higher in the three disease groups than in controls. In patients with similar disease activity, levels of IL-15 and IFN-γ were significantly higher in BD patients than in VKH and HLA-B27-associated uveitis groups. Logistic regression identified a significant negative correlation between BD and high levels of IL-10 and a significant positive correlation between VKH disease and high levels of IL-10. The proinflammatory cytokines versus IL-10 ratios were significantly higher in BD compared with other groups. These data suggest that both T helper (Th) 1 and Th17 cells are involved in endogenous uveitis immunopathogenesis. BD is characterized by extensive Th1 polarization, severe proinflammatory conditions and a low immunosuppressive status.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.clim.2011.01.014DOI Listing
May 2011

Pharmacologic vitreolysis in diabetic retinopathy.

Curr Pharm Biotechnol 2011 Mar;12(3):406-9

Department of Ophthalmology, College of Medicine, King Saud University, Riyadh, Saudi Arabia.

Diabetic retinopathy remains a major cause of worldwide preventable blindness. The vitreo-retinal interface plays a critical role in the pathogenesis of diabetic retinopathy. The term pharmacologic vitreolysis refers to the use of enzymes to liquefy the vitreous gel, and to induce posterior vitreous detachment (PVD). Intravitreal ovine hyaluronidase injection was effective in clearing vitreous hemorrhage. Several human case series demonstrated that intravitreal injection of autologous plasmin enzyme was a safe and effective adjunct to vitreous surgery for the treatment of diabetic macular edema and proliferative diabetic retinopathy. Recently, it was shown that intravitreal injection of plasmin enzyme without the performance of vitrectomy induced complete PVD and reduced macular thickening due to refractory diabetic macular edema.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2174/138920111794480543DOI Listing
March 2011

Expression of angiostatic platelet factor-4var/CXCL4L1 counterbalances angiogenic impulses of vascular endothelial growth factor, interleukin-8/CXCL8, and stromal cell-derived factor 1/CXCL12 in esophageal and colorectal cancer.

Hum Pathol 2010 Jul 23;41(7):990-1001. Epub 2010 Mar 23.

Rega Institute for Medical Research, Laboratory of Molecular Immunology, K. U. Leuven, 3000 Leuven, Belgium.

Chemokines influence tumor progression through regulation of leukocyte chemotaxis, angiogenesis, and metastasis. In this study, the regulated expression of angiogenic (stromal cell-derived factor [SDF]-1/CXCL12 and interleukin [IL]-8/CXCL8) and angiostatic (platelet factor [PF]-4var/CXCL4L1 and inducible protein [IP-10]/CXCL10) chemokines was examined in human colorectal and esophageal cancer. In HCT 116 and HCT-8 colorectal adenocarcinoma cells, the production of IL-8 immunoreactivity was up-regulated by IL-1beta, tumor necrosis factor (TNF)-alpha, the toll-like receptor (TLR) ligands double-stranded RNA and peptidoglycan and phorbol ester. Increased PF-4 and synergistic IL-8 and IP-10 induction in carcinoma cells after stimulation with IL-1beta plus TNF-alpha or interferon-gamma was demonstrated by enzyme-linked immunosorbent assay, quantitative reverse transcriptase polymerase chain reaction, or immunocytochemistry. In addition, IL-8 from HT-29 colorectal adenocarcinoma cells was molecularly identified as intact chemokine, as well as NH(2)-terminally truncated, more active IL-8(6-77). The presence of PF-4var, SDF-1, and vascular endothelial growth factor (VEGF) was evidenced by immunohistochemistry in surgical samples from 51 patients operated on for colon adenocarcinoma (AC), esophageal AC, or esophageal squamous cell carcinoma (SCC). PF-4var was strongly detected in colorectal cancer, whereas its expression in esophageal cancer was rather weak. Staining for SDF-1 was almost negative in esophageal SCC, whereas a more intense and frequent staining was observed in AC of the esophagus and colon. Staining for VEGF was moderately to strongly positive in all 3 types of cancer, although less prominent in esophageal AC. The heterogenous expression of angiogenic (IL-8, SDF-1) as well as angiostatic (IP-10, PF-4var) chemokines not only within the tumor and between the different cases but also between the different tumor cell types may indicate a distinct role of the various chemokines in the complex process of tumor development.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.humpath.2009.09.021DOI Listing
July 2010

Clinical, electrophysiological, and prognostic study of postinjection sciatic nerve injury: An avoidable cause of loss of limb in the peripheral medical service.

Ann Indian Acad Neurol 2009 Apr;12(2):116-9

Department of Neurology, S. K. Institute of Medical Sciences, Soura, J & K, India.

Background: Post injection sciatic nerve injury is a common cause of sciatic nerve mononeuropathy in the developing world largely due to inadequate health care facilites in the rural regions.

Objective: The study was conducted to analyse the pattern of this nerve lesion in clinical and electrophysiological parameters and also to study the outcome in a conservatively treated cohort.

Materials And Methods: One hundred and six patients who underwent evaluation at our laboratory from 2000 to 2006 for post injection sciatic neuropathy formed the study population. Twenty two of these were followed up (mean 6.6 months) for the outcome.

Results: In the cases with full data, common peroneal division of the sciatic nerve was affected alone or predominantly. On follow up, 72% cases showed little or partial recovery. Thirty two percent patients had residual trophic changes and causalgia at their last visit.

Conclusion: The majority of cases of postinjection sciatic nerve injury have poor prognosis on conservative treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.4103/0972-2327.53081DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2812736PMC
April 2009
-->