Publications by authors named "Erum Khan"

83 Publications

Acute transverse myelitis following SARS-CoV-2 vaccination: a case report and review of literature.

J Neurol 2021 Sep 5. Epub 2021 Sep 5.

Department of Neurology, Rockefeller Neuroscience Institute, West Virginia University School of Medicine, Morgantown, WV, USA.

Objective: To report a unique case and literature review of post COVID-19 vaccination associated transverse myelitis and with abnormal MRI findings.

Background: Coronavirus disease have been reported to be associated with several neurological manifestations such as stroke, Guillain-Barré syndrome, meningoencephalitis amongst others. There are only a few reported cases of transverse myelitis with the novel coronavirus (n-CoV-2). Here, we identify a post COVID-19 vaccination patient diagnosed with acute transverse myelitis.

Method: A retrospective chart review of a patient diagnosed with post SARS-CoV-2 vaccination acute transverse myelitis, and a review of literature of all the reported cases of other post vaccination and transverse myelitis, from December 1st, 2010 till July 15th, 2021, was performed.

Conclusion: To our knowledge, this is the one of early reported case of transverse myelitis and with post SARS-CoV-2 vaccination, who responded well to plasmapheresis. Further studies would be recommended to identify the underlying correlation between COVID-19 vaccination and transverse myelitis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00415-021-10785-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8418691PMC
September 2021

Comparative analysis of N95 respirators fit testing with commercially available and in house reagent.

Infect Prev Pract 2021 Sep 15;3(3):100116. Epub 2021 Jan 15.

Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Stadium Road, Karachi, Pakistan.

Background: Due to COVID-19, thousands of healthcare workers have been affected and have lost their lives in the line of duty. For the protection of healthcare workers, WHO and CDC have made standard guidelines and requirements for PPE use. N95 masks are amongst the most readily used PPE by healthcare professionals and it is highly recommended by OSHA that every make and model of N95 should go through a fit test at least once in a year.

Method: A total of 30 randomly selected healthcare professionals (who were a regular user of N95 respiratory masks) were subjected to assess in-house (saccharin sodium benzoate) reagent for use for standard qualitative fit testing in our hospital. Threshold testing with the in-house reagent at three different concentrations was performed prior to establish participants' sensitivity to the reagent. After successful completion of threshold testing, fit test was performed on participants wearing an N95 mask.

Results: All the participants included in the study passed the sensitivity testing with three concentrations of the reagents, while it was concluded that the concentration of the in-house reagent that was well suited for the sensitivity testing was a concentration of 1g/dl saccharin with 10g/dl sodium benzoate. For fit testing 12g/dl was found to be more appropriate.

Discussion: Our study provided a low cost solution to ensure safety of healthcare workers who are regular users of N95 masks following guidelines implemented by OSHA and CDC.

Conclusion: The in-house test solution prepared was found to be equally sensitive to its commercially available counterpart.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.infpip.2021.100116DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7837038PMC
September 2021

Evolution of our understanding of MS-COVID-19 interactions and concerns for vaccination.

J Clin Neurosci 2021 Aug 1;90:132-134. Epub 2021 Jun 1.

Department of Neurology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV, United States; West Virginia Clinical and Translational Science Institute, West Virginia University, Morgantown, WV, United States. Electronic address:

As the news of approval of COVID-19 vaccination emerge, neurologists across the globe ponder upon whether to use immunotherapies in patients with Multiple Sclerosis (MS). This paper highlights the mechanism of various disease modifying therapies (DMTs) as well as the recently approved Pfizer and Moderna vaccines for COVID-19 as well as guidelines as introduced by National Multiple Sclerosis Society. As their mechanisms counteract each other at the molecular level, we believe further evidence and data might lay the foundation to formulate much needed recommendations for the usage of these medications while vaccinating MS patients on DMTs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jocn.2021.05.063DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8166521PMC
August 2021

Mucormycosis and COVID-19: An epidemic within a pandemic in India.

Mycoses 2021 Oct 24;64(10):1253-1260. Epub 2021 Jul 24.

Division of Neurology, Department of Medicine, National University Hospital and Yong Loo Lin School of Medicine, National University of Singapore, Singapore.

Importance: Coronavirus disease (COVID-19) causes an immunosuppressed state and increases risk of secondary infections like mucormycosis. We evaluated clinical features, predisposing factors, diagnosis and outcomes for mucormycosis among patients with COVID-19 infection.

Methods: This prospective, observational, multi-centre study included 47 consecutive patients with mucormycosis, diagnosed during their course of COVID-19 illness, between January 3 and March 27, 2021. Data regarding demography, underlying medical conditions, COVID-19 illness and treatment were collected. Clinical presentations of mucormycosis, imaging and biochemical characteristics and outcome were recorded.

Results: Of the 2567 COVID-19 patients admitted to 3 tertiary centres, 47 (1.8%) were diagnosed with mucormycosis. Mean age was 55 ± 12.8years, and majority suffered from diabetes mellitus (n = 36, 76.6%). Most were not COVID-19 vaccinated (n = 31, 66.0%) and majority (n = 43, 91.5%) had developed moderate-to-severe pneumonia, while 20 (42.6%) required invasive ventilation. All patients had received corticosteroids and broad-spectrum antibiotics while most (n = 37, 78.7%) received at least one anti-viral medication. Mean time elapsed from COVID-19 diagnosis to mucormycosis was 12.1 ± 4.6days. Eleven (23.4%) subjects succumbed to their disease, mostly (n = 8, 72.7%) within 7 days of diagnosis. Among the patients who died, 10 (90.9%) had pre-existing diabetes mellitus, only 2 (18.2%) had received just one vaccine dose and all developed moderate-to-severe pneumonia, requiring oxygen supplementation and mechanical ventilation.

Conclusions: Mucormycosis can occur among COVID-19 patients, especially with poor glycaemic control, widespread and injudicious use of corticosteroids and broad-spectrum antibiotics, and invasive ventilation. Owing to the high mortality, high index of suspicion is required to ensure timely diagnosis and appropriate treatment in high-risk populations.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/myc.13353DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8446956PMC
October 2021

Chikungunya outbreak in Karachi Pakistan 2016-2017: An analysis of viral isolates.

J Pak Med Assoc 2021 May;71(5):1467-1471

Department of Comparative, Diagnostic, and Population Medicine, College of Veterinary Medicine, University of Florida, Florida, USA.

In December 2016 physicians in Karachi, Pakistan,witnessed an increase in patients presenting with febrile illness and severe polyarthralgia. Subsequently, chikungunya virus (CHIKV)) was isolated from three patients. This virus was sequenced and compared with other isolates of CHIKV obtained in India and Pakistan during recent outbreaks. Phylogenetic analysis indicated that the Karachi isolates were most similar to the East Central South African CHIKV lineage and showed sequence homology to isolates obtained in other parts of Pakistan and India. More importantly, two of the CHIKV isolates had a nucleotide substitution in the E1 gene corresponding to an amino acid change at chain F portion of the E1 protein.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.47391/JPMA.1287DOI Listing
May 2021

Clinical Characteristics and Outcomes of COVID-19 in West Virginia.

Viruses 2021 05 5;13(5). Epub 2021 May 5.

West Virginia Clinical and Translational Science Institute, Morgantown, WV 26505, USA.

This study examines the clinical characteristics, outcomes and types of management in SARS-CoV-2 infected patients, in the hospitals affiliated with West Virginia University. We included patients from West Virginia with SARS-CoV-2 infection between 15 April to 30 December 2020. Descriptive analysis was performed to summarize the characteristics of patients. Regression analyses were performed to assess the association between baseline characteristics and outcomes. Of 1742 patients, the mean age was 47.5 years (±22.7) and 54% of patients were female. Only 459 patients (26.3%) reported at least one baseline symptom, of which shortness of breath was most common. More than half had at least one comorbidity, with hypertension being the most common. There were 131 severe cases (7.5%), and 84 patients (4.8%) died despite treatment. The mean overall length of hospital stay was 2.6 days (±6.9). Age, male sex, and comorbidities were independent predictors of outcomes. In this study of patients with SARS-CoV-2 infection from West Virginia, older patients with underlying co-morbidities had poor outcomes, and the in-hospital mortality was similar to the national average.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/v13050835DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8148202PMC
May 2021

Overcoming the Elusiveness of Neurosarcoidosis: Learning from Five Complex Cases.

Neurol Int 2021 Mar 25;13(2):130-142. Epub 2021 Mar 25.

Department of Neurology, Rockefeller Neuroscience Institute, West Virginia University, Morgantown, WV 26505, USA.

The involvement of the central nervous system in sarcoidosis can manifest with a variety of neurological symptoms, and most of them can be nonspecific. The diagnosis of neurosarcoidosis (NS) can therefore be very challenging without a tissue biopsy. Both computed tomography (CT) and magnetic resonance imaging (MRI) are important imaging modalities in the diagnosis of NS, and MRI is the modality of choice due to its superior soft-tissue contrast resolution. We present a case series of NS with interesting neuroimaging features, complex neurological presentations, and clinical courses. We identify five cases presenting with clinically isolated neurosarcoidosis (CINS) without any other signs or symptoms of systemic disease which were diagnosed as NS on biopsy. In the first case, we describe a patient with an intramedullary cervical spinal cord lesion. In the second case we describe a patient presenting with inflammatory changes and enhancement in the orbit. The third case demonstrates a lesion with calcification around the region of the foramen of Monro. The fourth case shows multiple ring-enhancing lesions. Lastly, the fifth case exhibits unusual findings with both optic neuritis and a cerebellar nodule. We aim to describe the complicated clinical course with neurological workup, neuro-imaging, and eventual diagnosis and treatment of these challenging cases to highlight the variable presentations of NS. This case series will remind clinicians that NS should always be in the differential diagnosis when a patient presents with nonspecific neurological symptoms with unusual neuroimaging findings.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/neurolint13020013DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8103283PMC
March 2021

Acute transverse myelitis with Dysautonomia following SARS-CoV-2 infection: A case report and review of literature.

J Neuroimmunol 2021 04 20;353:577523. Epub 2021 Feb 20.

Department of Neurology, West Virginia University School of Medicine, Morgantown, WV, USA; West Virginia Clinical Transitional Science, Morgantown, WV, USA. Electronic address:

Objective: To report a unique case and literature review of post COVID-19 associated transverse myelitis and dysautonomia with abnormal MRI and CSF findings.

Background: Coronavirus disease have been reported to be associated with several neurological manifestations such as stroke, Guillain-Barré syndrome, meningoencephalitis amongst others. There are only few reported cases of transverse myelitis with the novel coronavirus (n-CoV-2) and only one reported case identifying dysautonomia in COVID-19 patient. Here, we identify a COVID-19 patient diagnosed with acute transverse myelitis in addition to dysautonomia following with complete resolution of symptoms.

Method: A retrospective chart review of a patient diagnosed with post SARS-CoV-2 infection acute transverse myelitis and dysautonomia, and a review of literature of all the reported cases of transverse myelitis and COVID-19, from December 1st, 2019 till December 25th, 2020, was performed.

Conclusion: To our knowledge, this is the first reported case of transverse myelitis and dysautonomia in a patient with SARS-CoV-2 infection, who responded to intravenous methyl prednisone and bromocriptine. Follow-up imaging of the spine showed complete resolution of the lesion. Further studies would be recommended to identify the underlying correlation between COVID-19 and transverse myelitis.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jneuroim.2021.577523DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7895682PMC
April 2021

Predictors of Arterial Stiffness Amongst the 24-Hour Ambulatory Blood Pressure Variables in Hypertensive Patients.

Cureus 2020 Dec 21;12(12):e12207. Epub 2020 Dec 21.

Cardiology, Medanta Hospital, Gurgaon, IND.

Objective The objective of the study is to identify the predominant determinants of arterial stiffness as assessed by pulse-wave-velocity (PVW) amongst various 24-hour ambulatory blood pressure monitoring (ABPM) parameters in Indian hypertensive subjects. Method Subjects of both genders between 18-60 years with hypertension and who were either drug naïve or on stable anti-hypertensive treatment for at least three months were included in the study. All subjects underwent clinical evaluation with a medical history, biochemical investigations, and assessment of arterial stiffness by PWV along with 24-hour ABPM. Results We found the males were younger than females amongst hypertensive cohort (41.53 ± 10.89 years vs. 52.2 ± 5.17 years, respectively; p=0.001) and had shorter duration of hypertension (41.42 ± 49.14 months vs. 87.8 ± 74.55 months, respectively; p=0.012) and had lower 24-hour average pulse pressure (aPP; 49.1 ± 7.8 mm Hg vs. 57.83 ± 8.92 mm Hg, respectively; p=0.001) at baseline. Younger people (<40-years) as compared to those >40-years of age had the lower carotid-femoral (cf) PWV (972.8 ± 125.0 cm/sec vs. 1165.0 ± 208.4 cm/sec, respectively; p=0.001) and average brachial-ankle (ba) PWV (1413.7 ± 160.4 cm/sec and 1640.0 ± 227.1 cm/sec, respectively; p=0.001). Bivariate analysis revealed that amongst all the 24-hour ABPM parameters, 24-hour aPP had the strongest correlation (r=0.414, p=0.003) with arterial stiffness as assessed by PWV. Also, statistically significant correlation was found in age group <40 years between cf-PWV and both 24-hour aPP (r=0.54, p=0.025) as well as night-time aPP (r=0.59, p=0.013) Conclusion We conclude that 24-hour aPP showed the strongest correlation with arterial stiffness parameters and best correlated with arterial stiffness variables amongst 24-hour ABPM parameters, especially amongst subjects <40 years of age. The pulsatile blood pressure (BP) was a better predictor of aortic PWV than the continuous part of BP.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7759/cureus.12207DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7818675PMC
December 2020

Prevalence and Patterns of Obstructive Sleep Apnea in Asian Indians With Congestive Heart Failure.

Cureus 2020 Nov 11;12(11):e11438. Epub 2020 Nov 11.

Interventional Cardiology, Tagore Hospital & Heart Care Centre Private Limited, Jalandhar, IND.

Background Sleep-disordered breathing (SDB) has a potential association with the pathogenesis of congestive heart failure (CHF). We assessed the prevalence and patterns of obstructive sleep apnea (OSA) in patients presenting with CHF. Method This was a prospective, observational, all-comers study of consecutive 77 confirmed cases of CHF. All these patients were clinically assessed and evaluated for OSA with sleep study after routine blood testing, electrocardiogram (ECG), chest X-ray, and echocardiography. Results Of 77 patients with CHF 38 (49.4%) had apnea-hypopnea index (AHI) <5 while 39 (50.6%) had AHI >5. Of these 39, 37 (94.8%) patients showed the clinical features of OSA. The majority (64.9%) of them were males. The majority of OSA (64.9%) had coronary artery disease (CAD) (p<0.05) as the etiology of CHF, followed by dilated cardiomyopathy (32.4%) and valvular heart disease (2.7%). The prevalence of OSA was higher amongst New York Heart Association (NYHA) class 2 (51.4%) as compared to NYHA class 3 (37.8%) and NYHA class 4 (10.8%). There were 12 (32.8%) patients, each having OSA with a heart rate between 71 and 80 bpm and 81 and 90 bpm. Twenty-two (59.5%) had systolic blood pressure (BP) more than 120 mmHg and 20 (54.1%) had diastolic BP more than 80 mmHg. The majority (64.9%) patients had the lowest O saturation between 80% and 90%. A significantly large number of patients (62.2%) had ejection fraction 21%-30% (p<0.05). The majority (62.16%) of patients with OSA had AHI between 5 and 15. With 5-15 AHI, 20 (87%) patients with OSA had a snoring, tiredness, observed apnea, high BP, BMI, age, neck circumference, and male gender (STOP-Bang) score between 3 and 7 with AHI 5-15 (p<0.05). Conclusions In our cohort, the prevalence of OSA in CHF was 50.6%. Predictors of OSA in CHF were left ventricular ejection fraction (LVEF) 20%-30% and NYHA class 2. The majority had AHI between 5 and 15. Sleep apnea screening should be routinely implemented in the evaluation and follow-up of heart failure patients.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7759/cureus.11438DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7732783PMC
November 2020

A qualitative study of trainer and trainee perceptions and experiences of clinical assessment in post-graduate dental training.

Eur J Dent Educ 2021 May 15;25(2):215-224. Epub 2020 Sep 15.

Centre for Outcomes and Research in Education, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, United Arab Emirates.

Background: The implementation of workplace-based assessment (WBA) needs to ensure the achievement of pre-set competences but may look different across varying contexts, such as in post-graduate dental education. The purpose of this study is to explore the perception of residents, faculty members and alumni concerning their experience with clinical assessment, and what configurations they consider as optimal to maximise the entailed learning experience.

Methods: This study relied on a qualitative descriptive design using two data collection tools: focus group sessions, and semi-structured, one-to-one interviews. Data were triangulated from three sources: residents, faculty members and alumni. The data were inductively analysed based on constructivist epistemology. This was done using the Thematic Analysis approach, facilitated by NVivo software.

Results: The analysis revealed two mutually exclusive themes: process and people. Within process, variables related to quality, workflow and feedback surfaced. As for the people theme, the main two group of stakeholders referred to in the related analysis were the trainees and the trainers.

Discussion: There are many variables that need to be considered when developing an evidence-driven WBA. In addition, factoring into the design of the WBA the perception of the main stakeholders will enable contextualisation which is expected to raise the reliability of the adapted tools.

Conclusion: This study introduced a framework that could support post-graduate universities in their journey towards developing context-specific WBA.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/eje.12593DOI Listing
May 2021

The Clinical Features of Co-circulating Dengue Viruses and the Absence of Dengue Hemorrhagic Fever in Pakistan.

Front Public Health 2020 17;8:287. Epub 2020 Jun 17.

Department of Biology, Baylor University, Waco, TX, United States.

Dengue virus (DENV) is the most common and widespread arboviral infection worldwide. Though all four DENV serotypes cocirculate in nature, the clinicopathological framework of these serotypes is undefined in Pakistan. A cross-sectional, observational study was performed to document the circulation of various arboviruses in the Sindh region of Pakistan. Here we describe a population of patients diagnosed with DENV spanning a 2-year period. This study used an orthogonal system of NS1 antigen ELISA followed by RT-PCR for DENV detection and subtyping. A total of 168 NS1 positive patients were evaluated of which 91 patients were serotyped via RT-PCR. There was no significant difference between sex or age for infection risk and peak transmission occurred during the Autumn months. DENV2 was the most common serotype followed by DENV1 then DENV3, then DENV4. The data show that DENV1 patients were more likely to have abnormal liver function tests; DENV2 infected patients were more likely to exhibit arthralgia and neurological symptoms; DENV3 patients were more likely to complain of burning micturition and have elevated lymphocyte counts and low hematocrit; and DENV4 patients were more likely to report headaches and rash. Notably, no dengue hemorrhagic fever or other manifestations of severe dengue fever were present in patients with primary or secondary infections. We were able to identify significantly more NS1 antigen positive patients than RT-PCR. This study demonstrates that all four DENV serotypes are co-circulating and co-infecting in Pakistan.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fpubh.2020.00287DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7311566PMC
May 2021

Investigation of Japanese encephalitis virus as a cause of acute encephalitis in southern Pakistan, April 2015-January 2018.

PLoS One 2020 12;15(6):e0234584. Epub 2020 Jun 12.

Departments of Pathology, Pediatrics, and Medicine, Aga Khan University, Karachi, Pakistan.

Background: Japanese encephalitis (JE) occurs in fewer than 1% of JE virus (JEV) infections, often with catastrophic sequelae including death and neuropsychiatric disability. JEV transmission in Pakistan was documented in 1980s and 1990s, but recent evidence is lacking. Our objective was to investigate JEV as a cause of acute encephalitis in Pakistan.

Methods: Persons aged ≥1 month with possible JE admitted to two acute care hospitals in Karachi, Pakistan from April 2015 to January 2018 were enrolled. Cerebrospinal fluid (CSF) or serum samples were tested for JEV immunoglobulin M (IgM) using the InBios JE DetectTM assay. Positive or equivocal samples had confirmatory testing using plaque reduction neutralization tests.

Results: Among 227 patients, testing was performed on CSF in 174 (77%) and on serum in 53 (23%) patients. Six of eight patient samples positive or equivocal for JEV IgM had sufficient volume for confirmatory testing. One patient had evidence of recent West Nile virus (WNV) neurologic infection based on CSF testing. One patient each had recent dengue virus (DENV) infection and WNV infection based on serum results. Recent flavivirus infections were identified in two persons, one each based on CSF and serum results. Specific flaviviruses could not be identified due to serologic cross-reactivity. For the sixth person, JEV neutralizing antibodies were confirmed in CSF but there was insufficient volume for further testing.

Conclusions: Hospital-based JE surveillance in Karachi, Pakistan could not confirm or exclude local JEV transmission. Nonetheless, Pakistan remains at risk for JE due to presence of the mosquito vector, amplifying hosts, and rice irrigation. Laboratory surveillance for JE should continue among persons with acute encephalitis. However, in view of serological cross-reactivity, confirmatory testing of JE IgM positive samples at a reference laboratory is essential.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0234584PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7292402PMC
August 2020

Draft Genome Sequences of Two Extensively Drug-Resistant Strains of Acinetobacter baumannii Isolated from Clinical Samples in Pakistan.

Microbiol Resour Announc 2020 May 14;9(20). Epub 2020 May 14.

Division of Microbiology, Office of Regulatory Science, Center for Food Safety and Applied Nutrition, U.S. Food and Drug Administration, College Park, Maryland, USA.

Infections in immunocompromised patients that are caused by extensively drug-resistant (XDR) strains have been increasingly reported worldwide. In particular, carbapenem-resistant strains are a prominent cause of health care-associated infections. Here, we report draft genome assemblies for two clinical XDR isolates obtained from hospitalized patients in Pakistan.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1128/MRA.00026-20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7225525PMC
May 2020

Salivary gland tissue engineering to attain clinical benefits: a special report.

Regen Med 2020 03 7;15(3):1455-1461. Epub 2020 Apr 7.

Department of Prosthodontics and Dental Implantology, College of Dentistry, King Faisal University, Al-Ahsa, Saudi Arabia.

The salivary glands produce saliva, which helps in mediating the oral colonization of microbes, the repair of mucosa, the remineralization of teeth, lubrication and gustation. However, certain medications, therapeutic radiation and certain autoimmune diseases can cause a reduction in the salivary flow. The aim of this report was to review and highlight the indications and techniques of salivary gland engineering to counter hyposalivation. This report concludes that in the literature, numerous strategies have been suggested and discussed pertaining to the engineering of salivary gland, however, challenges remain in terms of its production and accurate function. Dedicated efforts are required from researchers all over the world to obtain the maximum benefits from salivary gland engineering techniques.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2217/rme-2019-0079DOI Listing
March 2020

Comparison of clinical presentation and out-comes of Chikungunya and Dengue virus infections in patients with acute undifferentiated febrile illness from the Sindh region of Pakistan.

PLoS Negl Trop Dis 2020 03 23;14(3):e0008086. Epub 2020 Mar 23.

Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan.

Background: Arboviruses are a cause of acute febrile illness and outbreaks worldwide. Recent outbreaks of Chikungunya virus (CHIKV) in dengue endemic areas have alarmed clinicians as unique clinical features differentiating CHIKV from Dengue virus (DENV) are limited. This has complicated diagnostic efforts especially in resource limited countries where lab testing is not easily available. Therefore, it is essential to analyse and compare clinical features of laboratory confirmed cases to assist clinicians in suspecting possible CHIKV infection at time of clinical presentation.

Methodology: A prospective point prevalence study was conducted, with the hypothesis that not all patients presenting with clinical suspicion of dengue infections at local hospitals are suffering from dengue and that other arboviruses such as Chikungunya, West Nile viruses, Japanese Encephalitis virus and Zika virus are co-circulating in the Sindh region of Pakistan. Out-patients and hospitalized (in-patients) of selected district hospitals in different parts of Sindh province of Pakistan were recruited. Patients with presumptive dengue like illness (Syndromic diagnosis) by the treating physicians were enrolled between 2015 and 2017. Current study is a subset of larger study mentioned above. Here-in we compared laboratory confirmed cases of CHIKV and DENV to assess clinical features and laboratory findings that may help differentiate CHIKV from DENV infection at the time of clinical presentation.

Results: Ninety-eight (n = 98) cases tested positive for CHIKV, by IgM and PCR and these were selected for comparative analysis with DENV confirmed cases (n = 171). On multivariable analysis, presence of musculoskeletal [OR = 2.5 (95% CI:1.6-4.0)] and neurological symptoms [OR = 4.4 (95% CI:1.9-10.2)], and thrombocytosis [OR = 2.2 (95% CI:1.1-4.0)] were associated with CHIKV infection, while atypical lymphocytes [OR = 8.3 (95% CI:4.2-16.7)] and thrombocytopenia [OR = 8.1 (95% CI:1.7-38.8)] were associated with DENV cases at time of presentation. These findings may help clinicians in differentiating CHIKV from DENV infection.

Conclusion: CHIKV is an important cause of illness amongst patients presenting with acute febrile illness in Sindh region of Pakistan. Arthralgia and encephalitis at time of presentation among patients with dengue-like illness should prompt suspicion of CHIKV infection, and laboratory confirmation must be sought.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1371/journal.pntd.0008086DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7141694PMC
March 2020

Strain-Dependent Activity of Zika Virus and Exposure History in Serological Diagnostics.

Trop Med Infect Dis 2020 Mar 3;5(1). Epub 2020 Mar 3.

Department of Comparative Diagnostic and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL 32608, USA.

Zika virus (ZIKV) circulates as two separate lineages, with significant genetic variability between strains. Strain-dependent activity has been reported for dengue virus, herpes simplex virus and influenza. Strain-dependent activity of subject specimens to a virus could be an impediment to serological diagnosis and vaccine development. In order to determine whether ZIKV exhibits strain-dependent activity when exposed to antibodies, we measured the neutralizing properties of polyclonal serum and three monoclonal antibodies (ZKA185, 753(3)C10, and 4G2) against three strains of ZIKV (MR-766, PRVABC59, and R103454). Here, MR-766 was inhibited almost 60% less by ZKA185 than PRVABC59 and R103454 ( = 0.008). ZKA185 enhanced dengue 4 infection up to 50% ( = 0.0058). PRVABC59 was not inhibited by mAb 753(3)C10 while MR-766 and R103453 were inhibited up to 90% ( = 0.04 and 0.036, respectively). Patient serum, regardless of exposure history, neutralized MR-766 ~30%-40% better than PRVABC56 or R103454 ( = 0.005-0.00007). The most troubling finding was the significant neutralization of MR-766 by patients with no ZIKV exposure. We also evaluated ZIKV antibody cross reactivity with various flaviviruses and found that more patients developed cross-reactive antibodies to Japanese encephalitis virus than the dengue viruses. The data here show that serological diagnosis of ZIKV is complicated and that qualitative neutralization assays cannot discriminate between flaviviruses.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3390/tropicalmed5010038DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7157670PMC
March 2020

Microsatellite Instability in Endometrial Carcinoma by Immunohistochemistry, Association with Clinical and Histopathologic Parameters.

Asian Pac J Cancer Prev 2019 09 1;20(9):2601-2606. Epub 2019 Sep 1.

Department of Histopathology, Liaquat National Hospital and Medical College, Karachi, Pakistan.

Objective: We aimed to investigate the frequency of microsatellite instability (MSI) in endometrial carcinoma in our population and its association with clinico-pathologic features. Methods: A total of 126 cases of primary endometrial carcinoma were included in the study that underwent surgical resections. All slides of these cases were reviewed and representative paraffin fixed tissue blocks were selected for MLH1, MSH2, MSH6 and PMS2 IHC staining. IHC expression was categorized into five groups: no loss of expression; loss of expression of all four antibodies; combined loss of MLH1/PMS2; combined loss of MSH2/MSH6; and isolated loss of MLH1. Pathological records of all cases were retrieved from patient files. Result: Abnormal expression of MSI was noted in 56 cases (44.4%) among which 16 cases showed loss of nuclear expression of all markers, 34 cases showed loss of MLH1/PMS2 expression, 4 cases showed loss of MSH2/MSH6 while only 2 cases revealed isolated loss of MLH. Personal and family history suggestive of inherited cancer susceptibility was revealed in 11 cases most of which were associated with MSH2/MSH6 loss. Significant association of MSI expression was found with tumor stage and personal/family history of endometrial/ colon cancer. Conclusion: A high frequency of endometrioid cancers in our study showed abnormal expression of MSI markers, most of which depicted MLH1/PMS2 loss and were not associated with inherited cancer susceptibility. On the other hand, a minority of cases showed loss of all MSI markers or MSH2/MSH6 loss and were significantly associated with family/personal history of cancer. Therefore, we suggest that epigenetic changes in MLH1 locus may be a predominant pathway of tumorigenesis in our population rather than inherited mutation of MSI genes; however more large scale studies with genetic testing are required to validate this observation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.31557/APJCP.2019.20.9.2601DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6976824PMC
September 2019

Draft Genome Sequences of Antimicrobial-Resistant Clinical Isolates from Pakistan.

Microbiol Resour Announc 2019 Jul 25;8(30). Epub 2019 Jul 25.

Division of Microbiology, Office of Regulatory Science, Center for Food Safety and Applied Nutrition, U.S. Food and Drug Administration, College Park, Maryland, USA.

spp. are the most common cause of dysentery in developing countries and the second leading cause of diarrheal deaths worldwide. Multidrug-resistant (MDR) spp. are a serious threat to global health. Herein, we report draft genome sequences for three MDR isolates from Pakistan, two isolates and one isolate.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1128/MRA.00500-19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6658682PMC
July 2019

Assessment of Cytokine Release against Oral Mucosal Cell Line Culture (TR146) Stimulated by Neutrophil Elastase Associated with Behcet's Disease.

Int J Dent 2019 26;2019:6095628. Epub 2019 May 26.

Department of Oral Pathology, Liaquat University of Medical and Health Sciences, Jamshoro, Sindh, Pakistan.

Aim: Cytokines and chemokines may be involved in the onset of oral ulcer in Behcet's disease. The aim of our study is to assess the cytotoxic effects of proinflammatory cytokines and chemokines on reconstructed oral mucosal cell line (TR146) when treated with different concentrations of neutrophil elastase (NE).

Objective: For this purpose, a culture of the oral mucosal model (OMM) prepared from a cell line derived from an oral squamous cell carcinoma of buccal mucosa (TR146) is treated with different concentrations of neutrophil elastase. The cultures were incubated for 4- and 24-hour intervals and designed as follows: culture + artificial saliva served as the negative control; culture + 0.01% SLS (sodium lauryl sulphate) served as the positive control; and culture + NE (10, 50, 100, and 200 nM) served as the treated group.

Materials And Methods: We used sandwich ELISA technique to isolate IL-1 (interleukin 1), IL-8, and TNF- (tumor necrosis factor).

Results: We found no significant level of IL-8 and TNF- when treated with different concentrations of neutrophil elastase after 4- and 24-hour incubation. The IL-1 level was slightly higher when treated with 100 and 200 nM NE after 24 hours of incubation although a significantly high level was observed at 100 nM NE after 4 hours of incubation. Hence, we found an increase in the level of IL-1 when stimulating the reconstructed oral mucosal model (OMM) with different concentrations of NE. This is a preliminary study; however, further research is required to evaluate the cytotoxic effects of cytokines and chemokines released when treated with NE. Moreover, high concentrations of NE are recommended to stimulate the release of cytokines and chemokines against the OMM.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1155/2019/6095628DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6556314PMC
May 2019

Human saliva can be a diagnostic tool for Zika virus detection.

J Infect Public Health 2019 Sep - Oct;12(5):601-604. Epub 2019 May 23.

Centre for Genetics and Inherited Diseases (CGID), Taibah University, Medina Munawwarah, Saudi Arabia. Electronic address:

Zika virus (ZIKV), an Aedes mosquito-borne flavivirus, has captured public health attention worldwide. Initially, the virus was reported in Africa and Asia. However, the outbreak of ZIKV in Brazil and the United States of America demonstrated the global health risk. Symptoms of ZIKV infection vary from mild fever, rash, and joint pain to an apparent increase in microcephaly in infants and severe manifestations including Guillain-Barré syndrome in adults. Such consequences led to enormous health challenges, and consequently the World Health Organization declared a global health emergency. This review incorporates all aspects of ZIKV that could significantly impact human health, including epidemiology, clinical presentation, possible complications, cutting-edge therapeutic management of ZIKV infection, and latest developments in ZIKV diagnosis, particularly the value of human saliva as a diagnostic fluid.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.jiph.2019.05.004DOI Listing
January 2020

Corrigendum: Human West Nile Virus Disease Outbreak in Pakistan, 2015-2016.

Front Public Health 2018 29;6:384. Epub 2019 Jan 29.

Department of Comparative Diagnostic and Population Medicine, College of Veterinary Medicine, University of Florida, Gainesville, FL, United States.

[This corrects the article DOI: 10.3389/fpubh.2018.00020.].
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fpubh.2018.00384DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6362614PMC
January 2019

ERG oncoprotein expression in prostatic acinar adenocarcinoma; clinicopathologic significance.

BMC Res Notes 2019 Jan 18;12(1):35. Epub 2019 Jan 18.

Brown University, Providence, RI, USA.

Objectives: T/E fusion results in constitutive expression of ERG oncoprotein resulting in enhanced proliferation and invasive potential of prostatic cancer cells. In the present study we aimed to evaluate the ERG overexpression in 78 cases prostate acinar adenocarcinoma and its association with other prognostic parameters.

Results: ERG protein expression was noted in 39.7% (31 cases), out of which 3 cases (3.8%) showed low ERG expression, 10 cases (12.8%) showed intermediate expression and 18 cases (23.1%) revealed high ERG expression. Significant association of ERG expression was noted with gleason score (p = 0.009), WHO grade group (p = 0.008) and perineural invasion (p = 0.043). We found a significant proportion of our patients of prostatic acinar adenocarcinoma to over-express ERG protein which can help in devising therapeutic protocols. Significant association of ERG protein expression with gleason score and perineural invasion signifies its prognostic significance in prostatic carcinoma. Moreover, we also suggest that molecular studies should be performed in patients with prostatic carcinoma to look for T/E fusion gene and its correlation with ERG protein expression.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13104-019-4090-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6339396PMC
January 2019

Influence of phototherapy on adhesive strength and microleakage of bleached enamel bonded to orthodontic brackets: An in-vitro study.

Photodiagnosis Photodyn Ther 2019 Mar 14;25:344-348. Epub 2019 Jan 14.

Department of Orthodontics, Karachi Medical and Dental College FCPS II resident, Karachi, Pakistan. Electronic address:

Aim: The aim of the present in-vitro study was to explore bleached enamel reversal with phototherapy (Er,Cr:YSGG) when using two dissimilar bonding system to bond brackets on microleakage and shear bond strength.

Material And Methods: Amongst one twenty samples, ninety samples were bleached using 35% hydrogen peroxide. After the bleaching procedure, the teeth were randomly divided into three groups according to surface conditioning treatment (n = 30 each). Group 1: treated with Er,Cr:YSGG (ECL) Group 2: 10% sodium ascorbate (SA) and Group 3: Bleached only (BO). Based on the type of adhesive, specimens were further classified into eight subgroups. In subgroup 1,2,3 and no treatment (NT) (n = 15) adhesive Transbond XT was applied on already etched surface and these subgroups were named as NT-TEP, BO-TEP, ECL-TEP and SA-TEP. Similarly, in subgroup 5,6,7 and NT specimens (n = 15) were conditioned with Transbond Plus self-etching primer and these subgroups were named as NT-SEP, BO-SEP, ECL-SEP and SA-SEP. Samples from each subgroup were exposed to increasing load for evaluation of shear bond strength. Microleakage among subgroups were tested by immersing samples in Methylene blue prior one day. Analysis of variance and Tukey multiple comparisons test was used to assess data.

Results: The maximum and minimum bond strength was observed in group NT-TEP [17.14(2.54)] and BO-SEP [6.14(0.215)] respectively. Samples conditioned with phototherapy ECL-TEP [16.14(1.231)] exhibited comparable bond strength to specimens conditioned with sodium ascorbate (SA-TEP) [16.72(1.298)]. Similarly, bond strength values of ECL-SEP [13.43(0.921)] and SA-SEP were comparable. The highest microleakage score was demonstrated in BO-SEP [83.21(38.21)] whereas, the lowest microleakage scores were displayed in NT-TEP [23.73(13.45)].

Conclusion: Er,Cr:YSGG phototherapy reversal on bleached enamel with etch and rinse adhesives has a potential to be used in clinical settings alternate to conventional sodium ascorbate when bonding orthodontic brackets.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.pdpdt.2019.01.013DOI Listing
March 2019

Prognostic significance of p16 & p53 immunohistochemical expression in triple negative breast cancer.

BMC Clin Pathol 2018 3;18. Epub 2018 Oct 3.

4Brown University, Providence, RI USA.

Background: p16 and p53 genes are frequently mutated in triple negative breast cancer & prognostic value of these mutations have been shown; however, their role as immunohistochemical overexpression has not been fully validated. Therefore we aimed to evaluate the association of p16 and p53 overexpression in triple negative breast cancer with various prognostic parameters.

Methods: Total 150 cases of triple negative breast cancers were selected from records of pathology department archives that underwent surgeries at Liaquat National hospital, Karachi from January 2008 till December 2013. ER, PR and Her2neu immunohistochemistry were re-performed to confirm triple negative status. p16 & p53 immunohistochemistry was performed on all cases and association with various clinicopathologic parameters was determined.

Results: Mean age of the patients involved in the study was 48.9 years. Most of the patients presented at stage T2 with a high mean ki67 index i.e. 46.9%. 42.7% of cases had nodal metastasis. Although 84% cases were of invasive ductal carcinoma; however a significant proportion of cases were of metaplastic histology (9.3%). Fifty-one percent (76 cases) of cases showed positive p53 expression while 49% (74 cases) were negative. Higher percentage of p53 expression was found to correlate with higher T stage, high ki67 index and higher nodal stage. On the other hand, strong intensity of p53 expression was positively correlated with higher tumor grade and ki67 index. Seventy-one percent (98 cases) of cases showed positive p16 expression, whereas 24.8% (34 cases) were negative and 3.6% (5 cases) showed focal positive p16 expression. However, no significant association was found between p16 expression and various clinical and pathologic parameters. Similarly, no significant association of either p16 or p53 over-expression was noted with recurrence status of patients.

Conclusion: On the basis of significant association of p53 over-expression with worse prognostic factors in triple negative breast cancer, therefore we suggest that more large scale studies are needed to validate this finding in loco-regional population. Moreover, high expression of p16 in triple negative breast cancer suggests a potential role of this biomarker in triple negative breast cancer pathogenesis which should be investigated with molecular based research in our population.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12907-018-0077-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6171321PMC
October 2018

Microbiological and clinical profile of infective endocarditis patients: an observational study experience from tertiary care center Karachi Pakistan.

J Cardiothorac Surg 2018 Sep 15;13(1):94. Epub 2018 Sep 15.

Section of Microbiology, Department of Pathology and Laboratory Medicine, Aga Khan University, Karachi, Pakistan.

Background: The study analyzed microbiological and antimicrobial susceptibility profile of organisms isolated from patients with infective endocarditis (2015-17) and compared disease outcomes in cohorts of endocarditis patient with history of prior invasive vascular intervention (high risk group) vs those without (native valve group). We hypothesized that high risk group would be more likely to have severe disease outcomes.

Methods: This was a prospective cohort study (2015-17). All blood and cardiac tissue samples of enrolled patients suspected of endocarditis according to modified Duke's criteria were followed for microbiological and antimicrobial susceptibility profile. The high risk group was compared with the native valve group with 90 day follow up to determine difference in clinical course and outcome in terms of disease severity (defined as any patient with endocarditis undergoing surgical management, readmission or dying). The data was analyzed using SPSS 21.0 software and chi-square test. 90 day mortality was calculated using Kaplan Meier survival curves.

Results: Total 104 patients with endocarditis were enrolled. Overall culture positivity rate was 71.2%. Streptococcus species were the most common isolate (36.7%), followed by S. aureus (17.3%) cases. In Streptococcus species, 14.2% showed intermediate susceptibility to penicillin. Thirty six patients were included in the cohort analysis. A poor outcome was seen in 85.7% high risk group as compared to 50% of native valve group. The overall mortality rate was 19.4%.

Conclusions: We found Streptococcus species to be the predominant pathogen for endocarditis overall. However Staphylococcus aureus predominated native valve group. High risk group showed more complicated clinical course.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13019-018-0781-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6139130PMC
September 2018

Evidence of Chikungunya Virus Disease in Pakistan Since 2015 With Patients Demonstrating Involvement of the Central Nervous System.

Front Public Health 2018 10;6:186. Epub 2018 Jul 10.

Department of Comparative, Diagnostic, and Population Medicine, University of Florida, Gainesville, FL, United States.

Several arboviruses are endemic to and co-circulate in Pakistan. In recent years, Pakistan has observed a rise in arboviral infections. A cross-sectional study for arboviral diseases, which included screening for Chikungunya virus (CHIKV), was initiated in 2015 to determine which pathogens were causing disease in patients presenting to health care services. Exposure to CHIKV was verified via detection of viral nucleic acids or virus-specific IgM with virus-specific neutralizing antibodies. Out of 997 enrolled patients presenting with clinical features suggestive of arboviral disease, 102 patients were positive for CHIKV IgM antibodies and 60 patients were positive for CHIKV nucleic acids or neutralizing antibodies. The data presented here show that CHIKV has been circulating in Pakistan since April of 2015. CHIKV infections were detected in study subjects up to the conclusion of our enrollment period in July 2017. Syndromic and clinical data show that arthralgia was associated with CHIKV as was rash, fever greater than 38°C, and lymphopenia. Neurological symptoms were reported in 49% of CHIKV suspect patients and in 46.6% of confirmed infections. Acute disseminated encephalomyelitis was diagnosed in 5% of confirmed infection and various manifestation of encephalitis diagnosed in an additional 16.6% of patients with confirmed CHIKV infections. CHIKV-exposed patients were just as likely to present with neurological symptoms and encephalitis as patients with West Nile Virus infections but were 4.57 times more likely to have lymphopenia. This proportion of neurological symptoms may be a complicating factor in countries where WNV and/or JEV co-circulate with CHIKV.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3389/fpubh.2018.00186DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6048291PMC
July 2018

Immunohistochemical over expression of p53 in head and neck Squamous cell carcinoma: clinical and prognostic significance.

BMC Res Notes 2018 Jul 3;11(1):433. Epub 2018 Jul 3.

Brown University, Providence, RI, USA.

Objective: Immunohistochemical over expression of p53 is considered as a marker of poor prognosis in many cancers. Therefore, we aimed to evaluate immunohistochemical overexpression of p53 in 121 cases of head and neck Squamous cell carcinoma and its association with various clinicopathologic features and survival.

Results: Total 66.1% (80 cases) expressed positive p53 expression, 34% (29 cases) revealed no p53 expression, while focal positive p53 expression was noted in 9.9% (12 Cases). Moreover, high p53 expression (> 70%) was noted in 26.4% (32 cases), while 19% (23 cases) showed 51-70% p53 expression. On the basis of intensity of p53 staining; strong p53 expression was noted in 39.7% (48 cases), while 24.8% (30 cases) and 10.7% (13 cases) revealed intermediate and weak p53 expression respectively. Significant association of p53 intensity of expression with extranodal extension and higher tumor grade (grades II and III) was noted. p53 is useful prognostic biomarker in head and neck Squamous cell carcinoma and therefore we suggest that more large scale studies are needed to evaluate its prognostic significance in our population.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s13104-018-3547-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6029369PMC
July 2018

Immunohistochemical expression of epidermal growth factor receptor (EGFR) in South Asian head and neck squamous cell carcinoma: association with various risk factors and clinico-pathologic and prognostic parameters.

World J Surg Oncol 2018 Jun 28;16(1):118. Epub 2018 Jun 28.

Brown University, Providence, RI, USA.

Background: In this study, we intend to determine the immunohistochemical expression of EGFR in cases of head and neck squamous cell carcinoma and its association with prognostic clinico-pathologic features.

Methods: A total of 115 cases of head and neck squamous cell carcinoma treated at Liaquat National Hospital, Karachi, Pakistan, were included in the study. Clinico-pathologic features, risk factors, and recurrence status of cases were evaluated, and EGFR immunohistochemistry was performed.

Results: In our study, 52 cases (45.2%) of head and neck SCC were positive and 10 cases (8.7%) were focal positive for EGFR expression, while 53 cases (46.1%) were negative for EGFR expression. High EGFR expression (> 70%) was noted in 6.1% (7 cases), while 12.2% (14 cases) and 26.1% (30 cases) revealed 51-70% and 11-50% EGFR expression respectively. On the basis of intensity, strong EGFR expression was noted in 13.9% (16 cases) while 16.5% (19 cases) and 23.5% (27 cases) revealed intermediate and weak EGFR expression respectively. Significant association of EGFR expression was noted with tumor stage and disease-free survival.

Conclusion: We found a significant association of EGFR expression with tumor stage and disease-free survivals, which are the most important prognostic factors in head and neck squamous cell carcinoma; therefore, EGFR expression can help as a prognostic biomarker in head and neck squamous cell carcinoma. On the other hand, we suggest that molecular studies should be performed in squamous cell carcinoma of head and neck in our setup to identify patients that can avail response from anti-EGFR therapy.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/s12957-018-1425-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6022491PMC
June 2018

Resistome of carbapenem- and colistin-resistant Klebsiella pneumoniae clinical isolates.

PLoS One 2018 8;13(6):e0198526. Epub 2018 Jun 8.

Center for Food Safety and Applied Nutrition, U.S. Food & Drug Administration, College Park, Maryland, United States of America.

The emergence and dissemination of carbapenemases, bacterial enzymes able to inactivate most β-lactam antibiotics, in Enterobacteriaceae is of increasing concern. The concurrent spread of resistance against colistin, an antibiotic of last resort, further compounds this challenge further. Whole-genome sequencing (WGS) can play a significant role in the rapid and accurate detection/characterization of existing and emergent resistance determinants, an essential aspect of public health surveillance and response activities to combat the spread of antimicrobial resistant bacteria. In the current study, WGS data was used to characterize the genomic content of antimicrobial resistance genes, including those encoding carbapenemases, in 10 multidrug-resistant Klebsiella pneumoniae isolates from Pakistan. These clinical isolates represented five sequence types: ST11 (n = 3 isolates), ST14 (n = 3), ST15 (n = 1), ST101 (n = 2), and ST307 (n = 1). Resistance profiles against 25 clinically-relevant antimicrobials were determined by broth microdilution; resistant phenotypes were observed for at least 15 of the 25 antibiotics tested in all isolates except one. Specifically, 8/10 isolates were carbapenem-resistant and 7/10 isolates were colistin-resistant. The blaNDM-1 and blaOXA-48 carbapenemase genes were present in 7/10 and 5/10 isolates, respectively; including 2 isolates carrying both genes. No plasmid-mediated determinants for colistin resistance (e.g. mcr) were detected, but disruptions and mutations in chromosomal loci (i.e. mgrB and pmrB) previously reported to confer colistin resistance were observed. A blaOXA-48-carrying IncL/M-type plasmid was found in all blaOXA-48-positive isolates. The application of WGS to molecular epidemiology and surveillance studies, as exemplified here, will provide both a more complete understanding of the global distribution of MDR isolates and a robust surveillance tool useful for detecting emerging threats to public health.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0198526PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5993281PMC
December 2018
-->