Publications by authors named "Azhar Hussain"

155 Publications

Subtle aortic dissection in a patient with severe aortic regurgitation and undiagnosed bicuspid aortic valve: A case report with a literature review.

J Card Surg 2021 Jun 1. Epub 2021 Jun 1.

Department of Cardiology, Gloucester Royal Hospital, Gloucester, UK.

Background And Aim Of The Study: A subtle aortic dissection can be challenging to detect despite the availability of multiple diagnostic modalities. Whilst rare, the inability to detect this variant of aortic dissection can lead to a dismal prognosis. We present an extremely rare case of a subtle aortic dissection with supra-annular aortic root intimal tear and acute severe aortic regurgitation in a patient with a bicuspid aortic valve.

Methods: Case report and literature review conserning subtle aortic dissection is provided.

Results: Initial concerns were either aortic dissection or infective endocarditis. Despite advanced multimodality preoperative imaging, diagnosis was made intraoperatively and a Bentall procedure with a mechanical aortic valve was performed.

Conclusions: Our case along with the review of current literature emphasizes that current imaging techniques may be inadequate for diagnosis of this rare variant of aortic dissection.
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http://dx.doi.org/10.1111/jocs.15714DOI Listing
June 2021

Compositional profile of barley landlines grown in different regions of Gilgit-Baltistan.

Food Sci Nutr 2021 May 24;9(5):2605-2611. Epub 2021 Mar 24.

Mountain Agriculture Research Center (MARC) Juglote, Gilgit Pakistan.

The current investigation was performed to explore the nutritional and functional composition of four landlines of barley denoted as LB (Gilgit), LB (Nagar), LB (Skardu), and LB (Shigar) from different regions of Gilgit-Baltistan. The samples were examined for nutritional profile and antioxidant attributes. Total phenolic values and total flavonoid results were in the range of 1.2 to 3.1 mg/g and 0.41 to 0.55 mg/g, respectively. Nutritional profile as crude starch, fiber, protein, ash, and fat ranged from 56.3%-50.80%, 16.50%-11.73%, 16.20%-11.53%, 2.8%-2.1%, and 2.63%-1.63%, respectively. The mineral composition in terms of Mg (527-616 mg/kg) was higher in the landlines followed by Ca (312-368 mg/kg), Na (122.6-146.6 mg/kg), Fe (43.3-65.6 mg/kg), and Zn (22.5-26.6 mg/kg). It was concluded that the indigenous barley landlines had immense nutritional potential and functional attributes. Thus, it can be used for value-added food products and the development of cottage industry in the region.
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http://dx.doi.org/10.1002/fsn3.2215DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8116868PMC
May 2021

COVID-19 related mortality in post-operative cardiac surgical patients.

J Cardiothorac Surg 2021 Apr 26;16(1):112. Epub 2021 Apr 26.

Department of Cardiac Surgery, St Bartholomew's Hospital, West Smithfield, London, EC1A 7BE, UK.

Background: COVID-19 has caused a global pandemic of unprecedented proportions. Elective cardiac surgery has been universally postponed with only urgent and emergency cardiac operations being performed. The National Health Service in the United Kingdom introduced national measures to conserve intensive care beds and significantly limit elective activity shortly after lockdown.

Case Presentation: We report two cases of early post-operative mortality secondary to COVID-19 infection immediately prior to the implementation of these widespread measures.

Conclusion: The role of cardiac surgery in the presence of COVID-19 is still very unpredictable and further studies on both short term and long term outcomes are warranted.
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http://dx.doi.org/10.1186/s13019-021-01487-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8072080PMC
April 2021

An unusual case of clavicular prosthesis migration causing traumatic injury to the ascending aorta.

Perfusion 2021 Apr 23:2676591211012574. Epub 2021 Apr 23.

Department of Cardiothoracic Surgery, Kings College Hospital, London, UK.

Traumatic aortic injuries can be a lethal event. Almost 88% of patients with traumatic aortic injuries die within the first hour and only 2% survive long enough to develop a chronic aneurysm. Injury to the ascending aorta, whether acute or chronic, are typically managed with surgery, and those in the descending aorta, are managed conservatively or in some cases with stents. We present a rare case of a 53-year old gentleman with intra-aortic migration of a left clavicular prosthesis used for restoration of the left shoulder girdle.
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http://dx.doi.org/10.1177/02676591211012574DOI Listing
April 2021

Acute Diaphragmatic Injuries Associated with Traumatic Rib Fractures: Experiences of a Major Trauma Centre and the Importance of Intra-Pleural Assessment.

J Chest Surg 2021 Feb;54(1):59-64

Department of Cardiothoracic Surgery, St. George's Hospital, London, UK.

Background: Diaphragmatic injuries following blunt or penetrating thoraco-abdominal trauma are rare, but can be life-threatening. Rib fractures are the most common associated injury in patients with a traumatic diaphragmatic injury (TDI). We hypothesized that the pattern of rib fracture injuries could dictate the likelihood of acute TDIs.

Methods: A retrospective study was carried out between April 2014 and October 2018 to analyze patients with TDIs and rib fractures at a major trauma center in London, United Kingdom.

Results: Over the study period, 1,560 patients had rib fractures, of whom 14 had associated diaphragmatic injuries. Left-sided diaphragmatic injuries were found in 8 patients (57%) . A significant proportion of the rib fractures were located posterolaterally (44.9%). The highest frequency of fractures was found in ribs 5-10, which accounted for 74% of all the fractures. Ten patients underwent surgery, of whom 7 were diagnosed with a diaphragmatic injury intraoperatively after video-assisted thoracoscopic surgery assessment of the pleural cavity. Two patients died due to severe injuries of other organs and the remaining 2 patients were managed conservatively.

Conclusion: Our series of patients demonstrates a relationship between significant rib fractures and diaphragmatic injuries in trauma patients, and the diagnostic difficulties in identifying the condition. We found that the location of the rib fractures and the pattern of injury in patients with TDIs were much lower and posterolateral in the chest wall without a preference for laterality. We suggest using a thoracoscope in patients undergoing chest wall surgery post-trauma to aid in diagnosing this condition.
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http://dx.doi.org/10.5090/kjtcs.20.126DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7946519PMC
February 2021

Feasibility of structured light Plethysmography (SLP) in patients with coronavirus disease 2019 (COVID-19).

J Cardiothorac Surg 2021 Mar 3;16(1):20. Epub 2021 Mar 3.

Thoracic Surgery, Bart's Heart Centre, St Bartholomews Hospital, London, UK.

As a result of the COVID-19 pandemic, most institutions have changed the way patients are assessed or investigated. Using novel non-contact technology, it is possible to continuously monitor the lung function of peri-operative patients undergoing cardiothoracic procedures. Primarily, this results in increased patient surveillance, and therefore, safety. Many centres, globally, are starting to use structured light plethysmography (SLP) technology, providing a non-aerosol generating procedure in place of traditional spirometry. While more evidence is needed, our clinical usage; previous and on-going studies; demonstrate definite potential that SLP is a valuable tool.
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http://dx.doi.org/10.1186/s13019-021-01395-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7925808PMC
March 2021

Minimally invasive (mini-thoracotomy) versus median sternotomy in redo mitral valve surgery: A meta-analysis of observational studies.

Asian Cardiovasc Thorac Ann 2021 Feb 20:218492321997084. Epub 2021 Feb 20.

Department of Cardiothoracic Surgery, King's College Hospital, London, UK.

Objective: Redo mitral valve surgery has traditionally been performed via a median sternotomy. It is often challenging and is associated with increased perioperative mortality. Advances in cardiac surgical techniques over the last two decades have led to an increase in the use of a minimally invasive approach via a right anterolateral mini-thoracotomy as opposed to a repeat median sternotomy. However, despite these advances, there is no general consensus on the best form of entry, and as of yet, there are no randomized controlled trials. We performed a meta-analysis of observational studies to aid in determining the best approach for redo mitral valve surgery.

Method: The MEDLINE and EMBASE databases were conducted up until 1 June 2020. Data regarding mortality, stroke, reoperation for bleeding and length of hospital stay, wound infection and cardiopulmonary bypass time were extracted and submitted to a meta-analysis using random effects modelling and the I-test for heterogeneity. Seven retrospective observational studies were included, enrolling a total of 1070 patients.

Results: There were a total of 1070 patients. Of these 364 had non-sternotomy approach compared with 707 patients who had median sternotomy. Further subgroup analysis revealed that 327 of the 364 patients had a mini-thoracotomy approach while the remaining 37 patients had a full thoracotomy approach. In-hospital mortality and length of stay were less in non-sternotomy group compared to median sternotomy group. There were no differences in stroke, CPB time and wound infections between the two groups.

Conclusion: Redo mitral valve surgery can be performed safely with satisfactory outcomes via a mini-thoracotomy approach. This meta-analysis shows comparable results with reduced in-hospital mortality and hospital length of stay with a mini-thoracotomy approach.
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http://dx.doi.org/10.1177/0218492321997084DOI Listing
February 2021

Acute aortic dissection type A: Impact of aortic specialists on short and long term outcomes.

J Card Surg 2021 Mar 8;36(3):952-958. Epub 2021 Jan 8.

Department of Cardiothoracic Surgery, King's College Hospital, London, UK.

Objectives: Acute aortic dissection type-A (AADA) is a life threatening condition which requires emergency surgery. Surgery is usually performed by cardiac surgeons with various levels of aortic surgical experience. We compared the short-term perioperative outcome and long-term survival of patients operated by specialist aortic surgeons (SASs)and those who were operated by surgeons without specialist expertise.

Methods: A single center retrospective review of 232 patients who underwent acute surgery for AADA was conducted between 2005 and 2020. The cohort was divided into those operated on by SASs (Group A, n = 186) and those operated on by nonaortic surgeons (Group B, n = 46). Statistical comparison was done using regression modelling and groups were propensity matched. Kaplan-Meier comparison was undertaken using STATA14.

Results: Of 232 patients, 186 were operated on by an aortic specialist and 46 were operated by a nonaortic specialist. Overall 30-day mortality was 10% in Group A compared to 26.0% in Group B (unadjusted: p = .01, multivariate: p = .02, and propensity matched p = .05). Long-term mortality at 14 years was 26% in Group A compared to 52.0% in Group B (unadjusted: p = .001, multivariate: p = .001, and propensity matched: p = .01). Aortic surgeons performed a significantly higher number of aortic root procedures (43.0% vs. 17.3%, p = .001). The cross-clamp time and bypass time was significantly shorter in Group A patients (89 vs. 105 min, p < .01 and 153 vs. 185, p = < .001). Postoperative requirement for renal filtration was (19% vs. 37%, unadjusted p = .01, multivariate p = .03 and propensity matched p = .04). Although postoperative bleeding was less in Group A (4.0% vs. 11.0%, unadjusted p = .05) after propensity matching it was not statistically significant.

Conclusions: In patients with AADA, surgery performed by aortic specialist's results in improved outcomes. Aortic specialists replaced more of dissected aorta, resulting in an increased number of complex procedures, which may explain improved long-term survival after AADA in this cohort. This study adds further support in establishing a specialist aortic surgical service in cardiac centers.
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http://dx.doi.org/10.1111/jocs.15292DOI Listing
March 2021

Pericardial Effusion Secondary to Amoebic Liver Abscess: A Rare Complication.

Cureus 2020 Nov 28;12(11):e11759. Epub 2020 Nov 28.

Pediatrics, Dow Medical College, Dr. Ruth K. M. Pfau Civil Hospital, Karachi, PAK.

Amoebiasis is a common infection widely prevalent in tropical countries with low income and poor sanitation. The clinical picture is usually nonspecific; however, invasion of the liver by could lead to an amoebic liver abscess (ALA). It is relatively uncommon in women and children. Though rare, extension of ALA into the lungs, pleural cavity, and pericardium may prove fatal. Pericardial amoebiasis is a rare complication which, if not treated early, could result in cardiac tamponade and subsequent death. The standard management option is eradication with metronidazole along with the drainage of fluid from the liver abscess and pericardial effusion. Herein, we present a case of a seven-year-old male child with ALA, who developed signs and symptoms suggesting pericardial effusion within a few days of hospital admission. Early diagnosis of pericardial complication and successful management of abscess resolved the pericardial effusion.
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http://dx.doi.org/10.7759/cureus.11759DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7779140PMC
November 2020

Growth and socio-economic status, influence on the age at menarche in school going girls.

J Adolesc 2021 Jan 9;86:40-53. Epub 2020 Dec 9.

Department of Finance and Economics, College of Business Administration, University of Sharjah, Sharjah, United Arab Emirates; Department of Social Sciences and Business, Roskilde University, Roskilde, Denmark.

Introduction: Onset age at menarche has been considered an important indicator of reproductive maturity in females and reflects the health status of the population. The purpose of this study was to determine the mean menarcheal age and to examine whether anthropometric and socio-economic status (SES) influences age at menarche in the girls from Punjab province of Pakistan.

Methods: In this population-based cross-sectional study, 10,050 school-going girls aged 8-16 years from 35 schools across 12 districts of Punjab were recruited. Menarcheal data was obtained by using a questionnaire, while the anthropometric data were obtained by the measurements of standing height, body weight, waist, and hip circumference. The anthropometric indices of pre- and post-menarcheal girls were compared. Student's t-test, ANOVA, and post-hoc Tukey's test was applied for comparison between two and multiple groups respectively, P < 0.05 was considered statistically significant.

Results: There was a normal distribution of age at menarche and mean was 12.4 years in the study population. The girls who reached menarche were found to be taller and heavier with higher BMIs, having a greater waist and hip circumference as compared to their pre-menarcheal peers. Waist-hip-ratio was less, and the waist-to-height ratio was higher in post-menarcheal as compared to pre-menarcheal girls. The girls belonging to low SES had delayed onset of menarche as compared to those belonging to middle/high SES.

Conclusion: The age at menarche was associated with SES and changes in various anthropometric measurements reflecting the growth status of girls.
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http://dx.doi.org/10.1016/j.adolescence.2020.12.001DOI Listing
January 2021

Plant-growth-promoting Bacillus and Paenibacillus species improve the nutritional status of Triticum aestivum L.

PLoS One 2020 1;15(12):e0241130. Epub 2020 Dec 1.

Botany and Microbiology Department, College of Science, King Saud University, Riyadh, Saudi Arabia.

Wheat is one of the best-domesticated cereal crops and one of the vital sources of nutrition for humans. An investigation was undertaken to reveal the potential of novel bio-inoculants enriching micronutrients in shoot and grains of wheat crop to eliminate the hazards of malnutrition. Sole as well as consortia inoculation of bio-inoculants significantly enhanced mineral nutrients including zinc (Zn) and iron (Fe) concentrations in shoot and grains of wheat. Various treatments of bio-inoculants increase Zn and Fe content up to 1-15% and 3-13%, respectively. Sole inoculation of Bacillus aryabhattai (S10) impressively improves the nutritious of wheat. However, the maximum increase in minerals contents of wheat was recorded by consortia inoculation of Paenibacillus polymyxa ZM27, Bacillus subtilis ZM63 and Bacillus aryabhattai S10. This treatment also showed a maximum bacterial population (18 × 104 cfu mL-1) in the rhizosphere. The consortium application of these strains showed up to a 17% increase in yield. It is evident from the results that the consortium application was more effective than sole and co-inoculation. A healthy positive correlation was found between growth, yield, and the accessibility of micronutrients to wheat crops at the harvesting stage. The present investigations revealed the significance of novel bacterial strains in improving the nutritional status of wheat crops. These strains could be used as bio-inoculants for the biofortification of wheat to combat hidden hunger in developing countries.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0241130PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7707572PMC
January 2021

Sternal wound infections during the COVID-19 pandemic: an unexpected benefit.

Asian Cardiovasc Thorac Ann 2021 Jun 26;29(5):376-380. Epub 2020 Nov 26.

Department of Cardiac Surgery, St Bartholomew's Hospital, London, UK.

Background: The novel coronavirus, now termed SARS-CoV-2, has had a significant impact on cardiac surgical services globally. Although drastically reduced, our institution has maintained a significant level of cardiac surgical activity during the pandemic. Rigorous COVID-19 guidelines have been instituted to mitigate the risk of viral transmission. We observed a reduction in sternal wound infections since the institution of new perioperative surgical guidelines.

Methods: We performed a retrospective analysis of all patients who underwent cardiac surgery at our institution since a national lockdown was declared in March 2020. A retrospective analysis of all patients who underwent cardiac surgery in the 12 months preceding the national lockdown, as a baseline cohort group, was also performed.

Results: A total of 2600 patients (493 during the COVID-19 pandemic) were included in this study. Urgent/emergency procedures accounted for more than 60% of procedures performed during the lockdown compared to 39% previously. During the COVID-19 pandemic, there were 4 sternal wound infections with an overall incidence of 0.8%. In comparison, the incidence of sternal wound infections was significantly higher at 3.0% in the 12-month period prior to lockdown with 63 sternal wound infections ( = 0.006).

Conclusion: This report suggests a significant role of iatrogenic causes in sternal wound infections prior to the pandemic. The strict implementation of guidelines in the perioperative period suggests that sternal wound infections can be prevented. We propose that the now widespread COVID-19 guidelines to reduce transmission risk be adapted to help reduce the incidence of sternal wound infections.
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http://dx.doi.org/10.1177/0218492320977633DOI Listing
June 2021

A Comprehensive Review of Pharmaceutical and Surgical Interventions of Prostate Cancer.

Cureus 2020 Nov 22;12(11):e11617. Epub 2020 Nov 22.

Medicine, Windsor University School of Medicine, Cayon, KNA.

As the second most common cause of death amongst men in the United States, prostate cancer is a type of cancer that is known to develop and originate in the prostate gland. The main function of the prostate gland is to produce seminal fluid in which the sperm bathes. The seminal fluids are necessary for allowing the sperm to move easily through the urethra and also allows successful fertilization by providing an alkaline environment for the sperm in the acidic nature of the vagina. The seminal vesicles are two smaller glands that are attached to either side of the prostate gland and in radical prostatectomies, can get removed. In the event that the seminal vesicles are removed during a radical prostatectomy, the individual is unable to produce any seminal fluids and thus, becoming infertile. Prostate cancer is most commonly seen in patients over the age of 66 years, however, in the presence of predisposing risk factors, may occur as early as in the late 40s. Certain risk factors may speed the presentation of prostate cancer in individuals and thus, mandatory screening is recommended around the age of 45. If no risk factors are present, screening is recommended to begin after the age of 50 years. Screening for prostate cancer is focused on looking for prostate-specific antigen (PSA) in a blood test, though this may not be the most reliable method. The method of diagnosis stems from further testing done following an abnormal PSA test. A digital rectal examination and ultrasonography may also be used to assist with the diagnosis of prostate cancer. Though there are several different types of pharmaceutical interventions currently present in the eradication of prostate cancer, with androgen deprivation therapy being the most commonly used, surgical interventions may be utilized to completely resect cancer from an individual. Different radical prostatectomies are used; the appropriate approach utilized is dependent on the extensiveness of cancer and the type of cancer that is present.
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http://dx.doi.org/10.7759/cureus.11617DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7681941PMC
November 2020

COVID-19-Induced Hepatic Injury: A Systematic Review and Meta-Analysis.

Cureus 2020 Oct 13;12(10):e10923. Epub 2020 Oct 13.

Internal Medicine, St. Matthew's University School of Medicine, Grand Cayman, CYM.

Background The current pandemic of the novel coronavirus disease (COVID-19) is a global health challenge. Pulmonary dysfunction is the main outcome of COVID-19 infection. In critically ill patients, however, liver complications have also been reported. Thus, we conducted a systematic review and meta-analysis to draw generalized conclusions regarding impaired liver biochemistry and its potential relationship with COVID-19 disease severity. Materials and Methods We searched the PubMed, Scopus, and Web of Science databases for all the related literature published up to June 20, 2020. The data were analyzed using R statistical software. A random-effects model was employed for pooling the data. The risk of bias and quality of included studies was assessed using the modified Newcastle-Ottawa Scale (NOS) for cohort studies. Results The present meta-analysis comprises 10 retrospective and two prospective studies (6,976 COVID-19 patients). The serum analysis revealed significantly higher levels of alanine aminotransferases and aspartate aminotransferases and significantly lower albumin levels. Moreover, insignificant increases in serum levels of total bilirubin were observed. Upon subgroup analysis of six studies (severe cases, n=131; non-severe cases, n=334) stratified on the basis of disease severity, we found that these abnormalities were relatively higher in severe cases of COVID-19 (albumin [weighted mean difference (WMD), 34.03 g/L; 95% CI, 27.42 to 40.63; p<0.0001; I=96.83%); alanine transaminase (ALT) [WMD, 31.66 U/L; 95% CI, 25.07 to 38.25; p<0.0001; I=55.64%]; aspartate aminotransferase (AST) [WMD, 41.79 U/L; 95% CI, 32.85 to 50.72; p<0.0001; I=51.43%]; total bilirubin [WMD, 9.97 μmol/L; 95% CI, 8.46 to 11.48; p<0.0001; I=98%]) than in non-severe cases. Conclusion Deranged liver enzymes serve as prognostic factors to assess the severity of COVID-19. Liver markers should, therefore, be observed and monitored continuously.
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http://dx.doi.org/10.7759/cureus.10923DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7657443PMC
October 2020

Exopolysaccharides and indole-3-acetic acid producing Bacillus safensis strain FN13 potential candidate for phytostabilization of heavy metals.

Environ Monit Assess 2020 Oct 30;192(11):738. Epub 2020 Oct 30.

Department of Forestry, Range and Wildlife Management, The Islamia University of Bahawalpur, Bahawalpur, 63100, Pakistan.

Microbial population of soils irrigated with industrial wastewater may contain certain exopolysaccharides (EPS) and indole-3-acetic acid (IAA) producing bacterial strains having the ability to tolerate heavy metals along with plant growth-promoting (PGP) traits. As cadmium is one of the most toxic heavy metals for soils, plants, animals, and human beings, the present study was planned to isolate and characterize EPS- and IAA-producing, Cd-tolerant bacterial strains having tolerance against heavy metals along with plant growth-promoting traits. A total of 30 rhizobacterial strains (FN1-FN30) were isolated from rhizosphere soil collected from fields around industrial areas and roadsides irrigated with industrial wastewater. Out of these, eight isolates with the combined ability of IAA production and EPS production were characterized for PGP traits. On the basis of multifarious PGP traits and the results of root colonization assay, three most efficient EPS- and IAA-producing, Cd-tolerant plant growth-promoting strains, i.e., FN13, FN14, and FN16, were selected for multiple metal (Cd, Pb, Ni, and Cu) tolerance test along with quantification of growth, and IAA and EPS production abilities under Cd stress. Increasing levels of Cd stress negatively affected the tested characteristics of these strains, but FN13 showed more stability in growth, IAA production (18.24 μg mL), and EPS production (148.99 μg mL) compared to other strains under Cd stress. The morphological and biochemical analysis confirmed FN13 as Gram-positive, rod-shaped bacteria with smooth colonies of yellow appearance. The strain FN13 has strong root colonization (3.36 × 10 CFU g) ability for mustard seedlings and can solubilize Zn and phosphate along with the production of HCN, ammonia, and siderophores. The 16S rRNA sequencing confirmed it as the Bacillus safensis strain FN13. It can be explored as potential phytostabilizing biofertilizer for heavy metal-contaminated soils.
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http://dx.doi.org/10.1007/s10661-020-08715-2DOI Listing
October 2020

Integrated use of phosphate-solubilizing Bacillus subtilis strain IA6 and zinc-solubilizing Bacillus sp. strain IA16: a promising approach for improving cotton growth.

Folia Microbiol (Praha) 2021 Feb 24;66(1):115-125. Epub 2020 Oct 24.

Department of Soil Science, University College of Agriculture and Environmental Sciences, Islamia University of Bahawalpur, Bahawalpur, Pakistan.

Mineral nutrition of crop plants is one of the major challenges faced by modern agriculture, particularly in arid and semi-arid regions. In alkaline calcareous soils, the availability of phosphorus and zinc is critically less due to their fixation and precipitation as complexes. Farmers use fertilizers to fulfill crop requirements, but their efficacy is less, which increases production costs. Plant growth-promoting rhizobacteria (PGPR) can improve the availability of crop nutrients through solubilizing the insoluble compounds of phosphorus and zinc in soil. In the present study, a total of 40 rhizobacterial isolates were isolated from cotton rhizosphere and screened for improving cotton growth through the solubilization of phosphorus and zinc. Out of these 40 isolates, seven isolates (IA2, IA3, IA6, IA7, IA8, IA13, and IA14) efficiently solubilized insoluble rock phosphate while seven isolates (IA10, IA16, IA20, IA23, IA24, IA28, and IA30) were more efficient in solubilizing insoluble zinc oxide. In liquid media, strain IA7 (2.75 μg/mL) solubilized the highest amount of phosphate while the highest concentration of soluble zinc was observed in the broth inoculated with strain IA20 (3.94 μg/mL). Seven phosphate-solubilizing and seven zinc-solubilizing strains were evaluated using jar trial to improve the growth of cotton seedlings, and the results were quite promising. All the inoculated treatments showed improvement in growth parameters in comparison with control. Best results were shown by the combined application of IA6 and IA16, followed by the combination of strains IA7 and IA20. Based on the jar trial, the selected isolates were further characterized by plant growth-promoting characters such as siderophores production, HCN production, ammonia production, and exopolysaccharides production. These strains were identified through 16S rRNA sequencing as Bacillus subtilis IA6 (accession # MN005922), Paenibacillus polymyxa IA7 (accession # MN005923), Bacillus sp. IA16 (accession # MN005924), and Bacillus aryabhattai IA20 (accession # MN005925). It is hence concluded that the integrated use of phosphate-solubilizing and zinc-solubilizing strains as potential inoculants can be a promising approach for improving cotton growth under semi-arid conditions.
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http://dx.doi.org/10.1007/s12223-020-00831-3DOI Listing
February 2021

Concomitant cardiac surgery and liver transplantation: an alternative approach in patients with end stage liver failure?

Perfusion 2020 Oct 23:267659120966549. Epub 2020 Oct 23.

Department of Cardiothoracic Surgery, King's College Hospital, London, UK.

Background: The results of cardiac surgery in patients with end-stage-liver-disease (ESLD) are poor. Concomitant cardiac surgery and orthotopic liver transplantation (OLT) may be an alternative treatment strategy in these patients.

Methods: Between 2001 and 2018, eight patients underwent concomitant cardiac surgery and OLT (Conc_OLT) in our institution. We analyzed their preoperative, intraoperative and postoperative data and compared them to seven high risk patients with ESLD who underwent isolated cardiac surgery (Iso_Surg).

Results: The two groups were not significantly different in terms of gender and age (Conc_OLT: 5 males, 55 ± 15 years, Iso_Surg: 4 males, 60 ± 10 years). Causes for ESLD were primary biliary cirrhosis (Conc_OLT = 1, Iso_Surg = 1), alcoholism (Conc_OLT = 2, Iso_Surg = 2), viral hepatitis (Conc_OLT = 2, Iso_Surg = 2), cryptogenic (Conc_OLT = 2, Iso_Surg = 1), ischemic (Conc_OLT = 1) and hepatocellular carcinoma (Iso_Surg = 1). Model for End-stage-Liver-Disease (MELD) Score (Conc_OLT = 14, Iso_Surg = 13) and Child-Pugh Score (Conc_OLT = 9.5, Iso_Surg = 8) were not significantly different between the two groups. Median logistic European System for Cardiac Operative Risk Evaluation (EuroSCORE) was 9.5% (Conc_OLT) and 7.1% (Iso_Surg). Cardiac procedures undertaken were aortic valve replacement (Conc_OLT = 6, Iso_Surg = 3), coronary bypass grafting (Conc_OLT = 1,Iso_Surg = 2), tricuspid valve repair (Conc_OLT = 1), combined aortic and mitral valve replacement (Iso_Surg = 1) and excision of atrial myxoma (Iso_Surg = 1). Median length of in-hospital-stay was longer in the Conc_OLT group (73 vs. 42 days; p = 0.11). At 3 months, in-hospital mortality was 25% in the Conc_OLT group (n = 2) and lower compared to 71% observed in the Iso_Surg group (n = 5, p = 0.13).

Conclusion: Concomitant cardiac surgery and OLT is a promising alternative compared to isolated cardiac surgery in high risk patients with ESLD. Given the high operative mortality of cardiac surgery in patients with ESLD, the complex peri-operative management of these patients should be performed in an interdisciplinary team with an expert team of liver specialists involved.
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http://dx.doi.org/10.1177/0267659120966549DOI Listing
October 2020

Electrolyte Imbalance in Children With Severe Acute Malnutrition at a Tertiary Care Hospital in Pakistan: A Cross-Sectional Study.

Cureus 2020 Sep 19;12(9):e10541. Epub 2020 Sep 19.

Healthcare Administration, Franklin University, Columbus, USA.

Background Malnutrition is a significant public health concern and a leading contributor to the global burden of children's diseases, affecting 50 to 150 million children under the age of five years worldwide. Globally, undernutrition accounts for approximately 33% of the deaths among under-fives. South Asia alone contributes to 50% and 38.8% of the world's population of wasted and stunted children, respectively. In Pakistan, malnutrition is the leading cause of childhood mortality, accounting for nearly 35% of all deaths under five years of age. Severe acute malnutrition (SAM), the most severe form of malnutrition, is often associated with electrolyte imbalances. This study aimed to determine the frequency of electrolyte imbalance in children with SAM admitted at a tertiary care hospital. Methods This cross-sectional study includes 184 patients with SAM aged between 6 and 60 months, who were admitted at the inpatient Department of Pediatrics, Dr. Ruth K. M. Pfau, Civil Hospital, Karachi, Pakistan, from January 17, 2017 to July 16, 2017. Weight and length/height were measured, and weight-for-height was calculated. Children were labeled to have SAM when weight-for-height was below -3 standard deviation (SD). Blood samples for serum electrolytes were drawn and sent to the lab. Descriptive statistics were calculated, and stratification was performed using the chi-square test. A p-value of ≤0.05 was considered statistically significant. Results  The mean age of participants was 22.63 ± 12.71 months. Of the 184 patients with SAM, 172 (93.5%) patients had electrolyte imbalance. Hypokalemia was present in 79.9%, whereas hypocalcemia, hyponatremia, and hypomagnesemia were present in 71.7%, 48.9%, and 13.6%, respectively. Post-stratification results showed a significant association of electrolyte imbalance with gender (p = 0.005) and educational status of parents (p = 0.001). Conclusions Electrolyte disturbances are common in SAM. Serum electrolytes of every malnourished child admitted should be assessed and corrected to avoid fatal outcomes. We suggest that more research with better study designs should be conducted to develop policies and strategies for successfully combating malnutrition in Pakistan. In the meantime, we recommend adopting national guidelines for the management of acute malnutrition to reduce morbidity and mortality.
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http://dx.doi.org/10.7759/cureus.10541DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7574973PMC
September 2020

Impact of Coating of Urea with -Augmented Zinc Oxide on Wheat Grown under Salinity Stress.

Plants (Basel) 2020 Oct 15;9(10). Epub 2020 Oct 15.

Department of Botany and Microbiology, College of Science, King Saud University, Riyadh 11451, Saudi Arabia.

Zinc (Zn) availability is limited in salt-affected soils due to high soil pH and calcium concentrations causing Zn fixation. The application of synthetic Zn fertilizer is usually discouraged due to the high cost and low Zn use efficiency. However, salt-tolerant Zn-solubilizing bacteria (ZSB) are capable of solubilizing fixed fractions of Zn and improving fertilizer use efficiency. In the current study, a product was formulated by coating urea with bioaugmented zinc oxide (ZnO) to improve wheat productivity under a saline environment. The promising ZSB strain sp. AZ6 was used for bioaugmentation on ZnO powder and termed as sp. AZ6-augmented ZnO (BAZ). The experiment was conducted in pots by applying urea granules after coating with BAZ, to evaluate its effects on wheat physiology, antioxidant activity, and productivity under saline (100 mM NaCl) and non-saline (0 mM NaCl) conditions. The results revealed that the application of BAZ-coated urea alleviated salt stress through improving the seed germination, plant height, root length, photosynthetic rate, transpiration rate, stomatal conductance, soil plant analysis development (SPAD) value, number of tillers and grains, spike length, spike weight, 1000-grain weight, antioxidant activity (APX, GPX, GST, GR, CAT, and SOD), and NPK contents in the straw and grains of the wheat plants. Moreover, it also enhanced the Zn contents in the shoots and grains of wheat by up to 29.1 and 16.5%, respectively, over absolute control, under saline conditions. The relationships and variation among all the studied morpho-physio and biochemical attributes of wheat were also studied by principal component (PC) and correlation analysis. Hence, the application of such potential products may enhance nutrient availability and Zn uptake in wheat under salt stress. Therefore, the current study suggests the application of BAZ-coated urea for enhancing wheat's physiology, antioxidant system, nutrient efficiency, and productivity effectively and economically.
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http://dx.doi.org/10.3390/plants9101375DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7602814PMC
October 2020

Are non-radiation-based imaging modalities effective for objectively assessing and monitoring patients with pectus deformities?

Interact Cardiovasc Thorac Surg 2020 10;31(4):536-539

Department of Thoracic Surgery, St Georges Hospital, London, UK.

A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was 'What is the role of non-radiation-based imaging modalities in the management of pectus deformities?'. Altogether 29 papers were found using the reported search, of which 8 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. We conclude that non-radiation-based imaging modalities provide a safe and easily implemented alternative to traditional computed tomography scan assessment for pectus deformities. This is particularly true for deformities on the more severe end of the spectrum and as an aid in providing an on-going assessment tool particularly in treatment modalities requiring a high degree of compliance (external bracing or vacuum bell therapy).
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http://dx.doi.org/10.1093/icvts/ivaa134DOI Listing
October 2020

Management of pneumothorax in mechanically ventilated COVID-19 patients: early experience.

Interact Cardiovasc Thorac Surg 2020 10;31(4):540-543

Department of Cardiothoracic Surgery, King's College Hospital, London, UK.

A significant proportion of patients infected with the novel coronavirus, now termed severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), require intensive care admission and subsequent mechanical ventilation. Pneumothorax, a potential fatal complication of mechanical ventilation, can further complicate the management of COVID-19 patients, whilst chest drain insertion may increase the risk of transmission of attending staff. We present a case series and a suggested best-practice protocol for how to manage and treat pneumothoraces in COVID-19 patients in an intensive care unit setting.
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http://dx.doi.org/10.1093/icvts/ivaa129DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7499637PMC
October 2020

Existence of solution and stability for the fractional order novel coronavirus (nCoV-2019) model.

Adv Differ Equ 2020 25;2020(1):384. Epub 2020 Jul 25.

Department of Mathematics, University of Central Punjab, Lahore, Pakistan.

The aim of this work is to present a new fractional order model of novel coronavirus (nCoV-2019) under Caputo-Fabrizio derivative. We make use of fixed point theory and Picard-Lindelöf technique to explore the existence and uniqueness of solution for the proposed model. Moreover, we explore the generalized Hyers-Ulam stability of the model using Gronwall's inequality.
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http://dx.doi.org/10.1186/s13662-020-02845-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7382328PMC
July 2020

Response of Parathyroid Hormone to Vitamin D Deficiency in Otherwise Healthy Individuals.

Cureus 2020 Aug 15;12(8):e9764. Epub 2020 Aug 15.

Medicine, Xavier University School of Medicine, Oranjestad, ABW.

Background and objectives Vitamin D deficiency is a global public health issue, which affects people of all ages and ethnicities. However, severe deficiency seems to be more prevalent in the Middle East and South Asia. Evidence suggests that low serum 25-hydroxycholicalciferol [25(OH)D] levels are associated with an increase in parathyroid hormone (PTH). Yet, the 25-OHD levels leading to serum PTH increase are still a matter of debate. The objective of this study is to assess deficiency of vitamin D in otherwise healthy individuals, and to determine the response of the PTH to vitamin D deficiency. Methods This observational study was conducted from January 2018 to May 2018. A total of 43 individuals were selected from three separate clinics in Libya (Alrazy clinic, Alhaya clinic, and Alnukbah clinic). Blood drawn from these individuals was assessed for serum calcium, phosphorus, 25(OH)D, and PTH. These data were collected and analyzed using the Statistical Package for Social Sciences (SPSS) version 17.0 for Windows (SPSS Inc., Chicago, IL). Results The mean age and standard (SD) of the study participants was 47.4 ± 12.4. The age range was 19-67 years. The ratio of male to female was 1:2. The percentage of individuals with vitamin D deficiency in the study group was 95.3%, whereas the percentage of vitamin D insufficiency was 4.7%. These data suggest that individuals with severe deficiency show higher PTH values (75.66 ng/ml), whereas those with insufficiency showed lower PTH values (37.5 ng/ml). Conclusion The population in the present study was overall deficient in 25-OH vitamin D, which indicates a greater need for supplementation with vitamin D. However, not all the individuals with vitamin D deficiency have high levels of PTH, a finding that agrees with the need for new criteria in the management of vitamin D deficiency and the importance of PTH testing.
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http://dx.doi.org/10.7759/cureus.9764DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7430694PMC
August 2020

Sale of WHO AWaRe groups antibiotics without a prescription in Pakistan: a simulated client study.

J Pharm Policy Pract 2020 3;13:26. Epub 2020 Aug 3.

Hamdard Institute of Pharmaceutical Sciences, Hamdard University, Islamabad, Pakistan.

Introduction: Resistant strains of bacteria are rapidly emerging with increasing inappropriate use of antibiotics rendering them less efficacious. Self-purchasing of antibiotics particularly for viral infections is a key driver of inappropriate use, especially in lower- and middle-income countries. There is a particular issue in countries such as Pakistan. Consequently, there is a need to assess current rates of self-purchasing especially for reserve antibiotics to guide future policies.

Aims: Assess the extent of current antibiotic sales without a prescription in urban areas of Pakistan.

Methodology: A multicenter cross-sectional study was conducted in different areas of Punjab, Pakistan using Simulated Client technique. The investigators demanded different predefined antibiotics from WHO AWaRe groups without prescription. Three levels of demand were used to convince the pharmacy staff in order to dispense the antibiotic without a prescription. A data collection form was completed by simulated clients within 15 min of each visit.

Results: Overall 353 pharmacies and medical stores were visited out of which 96.9% pharmacies and medical stores dispensed antibiotics without demanding a prescription (82.7% at demand level 1 and 14.2% at demand level 2), with only 3.1% of pharmacies refusing to dispense antibiotics. The most frequently dispensed antibiotic was ciprofloxacin (22.1%). Surprisingly, even the reserve group antibiotics were also dispensed without a prescription. In only 25.2% visits, pharmacy staff guided patients about the use of antibiotics, and in only 11.0% pharmacists enquired about other medication history.

Conclusion: Currently, antibiotics are easily acquired without a legitimate prescription in Pakistan. There is a need for strict adherence to regulations combined with a multi-dimensional approach to enhance appropriate dispensing of antibiotics and limit any dispensing of WHO restricted antibiotics without a prescription.
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http://dx.doi.org/10.1186/s40545-020-00233-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7397594PMC
August 2020

Media on the frontline against mental health implications of COVID-19 in Pakistan.

Asian J Psychiatr 2020 Dec 29;54:102342. Epub 2020 Jul 29.

MBBS, Liaquat University of Medical & Health Sciences, Jamshoro, 76090, Pakistan.

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http://dx.doi.org/10.1016/j.ajp.2020.102342DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7387925PMC
December 2020

Cardiac surgery and COVID-19: Response to the letter to the editor.

Authors:
Azhar Hussain

J Card Surg 2020 08 11;35(8):2121. Epub 2020 Jul 11.

Department of Cardiac Surgery, St. Bartholomew's Hospital, London, UK.

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http://dx.doi.org/10.1111/jocs.14825DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7405474PMC
August 2020

Neurological Consequences of 2019-nCoV Infection: A Comprehensive Literature Review.

Cureus 2020 Jun 24;12(6):e8790. Epub 2020 Jun 24.

Medicine, Windsor University School of Medicine, Cayon, KNA.

First identified in November 2019 in Hubei Province, the coronavirus disease of 2019 (COVID-19) caused by SARS-CoV-2 soon spread worldwide to become a global health pandemic. The COVID-19 preferentially damages the respiratory system that produces symptoms such as fever, cough, and shortness of breath. However, the infection often tends to disseminate to involve various organ systems. Recent evidence indicates that SARS-CoV-2 can cause significant neurological damage and resultant neurological symptoms and complications. Here, we provide a comprehensive and thorough review of original articles, case reports, and case series to delineate the possible mechanisms of nervous system invasion and damage by SARS-CoV-2 and subsequent consequences. We divided the neurological manifestations into three categories: (1) Central Nervous System involvement, (2) Peripheral Nervous System manifestations, and (3) Skeletal Muscle Injury. Headache and dizziness were found to be the most prevalent symptoms followed by impaired consciousness. Among the symptoms indicating peripheral nervous system invasion, anosmia and dysgeusia were commonly reported. Skeletal muscle injury predominantly presents as myalgia. In addition, encephalitis, myelitis, cerebrovascular disease, Guillain-Barre syndrome, and Miller Fischer syndrome were among the commonly noted complications. We also emphasized the association of pre-existing comorbidities with neurological manifestations. The aim of this review is to provide a deeper understanding of the potential neurological implications to help neurologists have a high index of clinical suspicion allowing them to manage the patient appropriately.
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http://dx.doi.org/10.7759/cureus.8790DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7317136PMC
June 2020

The Pan London Emergency Cardiac Surgery service: Coordinating a response to the COVID-19 pandemic.

J Card Surg 2020 Jul 29;35(7):1563-1569. Epub 2020 Jun 29.

Department of Cardiac Surgery, St Bartholomew's Hospital, London, UK.

Over the last 4 months, the novel coronavirus, SARS-CoV-2, has caused a significant economic, political, and public health impact on a global scale. The natural history of the disease and surge in the need for invasive ventilation has required the provision of intensive care beds in London to be reallocated. NHS England have proposed the formation of a Pan-London Emergency Cardiac surgery (PLECS) service to provide urgent and emergency cardiac surgery for the whole of London. In this initial report, we outline our experience of setting up and delivering a pan-regional service for the delivery of urgent and emergency cardiac surgery with a focus on maintaining a COVID-free in-hospital environment. In doing so, we hope that other regions can use this as a starting point in developing their own region-specific pathways if the spread of coronavirus necessitates similar measures be put in place across the United Kingdom.
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http://dx.doi.org/10.1111/jocs.14747DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7361315PMC
July 2020

Emerging Pharmaceutical Treatments of Novel COVID-19: A Review.

Cureus 2020 May 24;12(5):e8260. Epub 2020 May 24.

Pharmacology, Xavier University School of Medicine, Oranjestad, ABW.

As a new decade began, COVID-19 quickly gained importance as it became the cause of the current global pandemic. Research has been focusing on studying the structure of SARS-CoV-2 and investigates possible pharmaceutical approaches. With the number of cases increasing every day, globally, multiple drugs are being researched as possible candidates. Although multiple drugs show promise in the treatment of COVID-19 via either inhibiting viral replication or preventing fusion of the virus to the ACE2 receptors, further investigation is still warranted and necessary before the admission of any type of pharmaceutical agent. Furthermore, several supplements have also been documented in being utilized as treatment of COVID-19. The exact mechanism and efficacy of current candidate drugs are still being explored through clinical trials. Despite the advancements in current research with emerging treatments, social distancing and engaging in preventative measures remains crucial to attempt to prevent the occurrence of more cases and deaths, worldwide. This review explores various drugs and their mechanism of action which are either currently being used in clinical trials or may be used in the future for the treatment of COVID-19.
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http://dx.doi.org/10.7759/cureus.8260DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7313429PMC
May 2020

Novel COVID-19: A Comprehensive Review of Transmission, Manifestation, and Pathogenesis.

Cureus 2020 May 18;12(5):e8184. Epub 2020 May 18.

Gastroenterologist and Hepatologist, University of Central Florida College of Medicine, Orlando, USA.

A global outbreak highlights the start of a new decade as a new strain of coronaviruses emerges. Coronavirus disease 2019 (COVID-19), also referred to as Wuhan-Hu-1-CoV - amongst many other names - emerged from the West District of Southern China Seafood Wholesale Market in late December 2019. With the emergence of the new decade, the causative agent of COVID-19 was identified: severe acute respiratory syndrome coronavirus 2 (SARS-CoV2). COVID-19 became declared a global pandemic by the World Health Organization (WHO). COVID-19, currently, is affecting 204 countries and territories and two international conveyances. Initial stages of COVID-19 present with symptoms that mimic the common cold and individuals may be asymptomatic carriers and thus, transmitting the virus to others. COVID-19, like other coronaviruses, presents with S glycoproteins on the membrane that plays an integral role in the virus binding with the angiotensin-converting enzyme 2 (ACE2) receptor. The ACE2 receptor is an intramembrane receptor on the type II pneumocytes, where the virus is able to replicate after getting endocytosed within the cytoplasm. As the viral load increases within the alveolar cell, the alveolar epithelial cell will burst, releasing the newly replicated viral RNA. Elderly individuals are at a greater risk of infection due to weakened immune systems and pre-existing medical conditions resulting in a compromised immune response, also increasing the susceptibility of infection. Infected individuals presenting with mild to moderate symptoms are recommended to self-isolate as the majority will recover without any intervention.
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http://dx.doi.org/10.7759/cureus.8184DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7301445PMC
May 2020