Publications by authors named "Hamza Muhammad"

70 Publications

Clinical management of snakebite envenoming: Future perspectives.

Toxicon X 2021 Sep 8;11:100079. Epub 2021 Aug 8.

Infectious and Tropical Diseases Unit, Bayero University Kano, Nigeria.

Snakebite envenoming is a major cause of morbidity and mortality in rural communities throughout the tropics. Generally, the main clinical features of snakebites are local swelling, tissue necrosis, shock, spontaneous systemic hemorrhage, incoagulable blood, paralysis, rhabdomyolysis, and acute kidney injury. These clinical manifestations result from complex biochemical venom constituents comprising of cytotoxins, hemotoxins, neurotoxins, myotoxins, and other substances. Timely diagnosis of envenoming and identification of the responsible snake species is clinically challenging in many parts of the world and necessitates prompt and thorough clinical assessment, which could be supported by the development of reliable, affordable, widely-accessible, point-of-care tests. Conventional antivenoms based on polyclonal antibodies derived from animals remain the mainstay of therapy along with supportive medical and surgical care. However, while antivenoms save countless lives, they are associated with adverse reactions, limited potency, and are relatively inefficacious against presynaptic neurotoxicity and in preventing necrosis. Nevertheless, major scientific and technological advances are facilitating the development of new molecular and immunologic diagnostic tests, as well as a new generation of antivenoms comprising human monoclonal antibodies with broader and more potent neutralization capacity and less immunogenicity. Repurposed pharmaceuticals based on small molecule inhibitors (e.g., marimastat and varespladib) used alone and in combination against enzymatic toxins, such as metalloproteases and phospholipase As, have shown promise in animal studies. These orally bioavailable molecules could serve as early interventions in the out-of-hospital setting if confirmed to be safe and efficacious in clinical studies. Antivenom access can be improved by the usage of drones and ensuring constant antivenom supply in remote endemic rural areas. Overall, the improvement of clinical management of snakebite envenoming requires sustained, coordinated, and multifaceted efforts involving basic and applied sciences, new technology, product development, effective clinical training, implementation of existing guidelines and therapeutic approaches, supported by improved supply of existing antivenoms.
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http://dx.doi.org/10.1016/j.toxcx.2021.100079DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8374517PMC
September 2021

Relationship of left ventricular and atrial dimensions with moderate to severe left ventricular diastolic dysfunction (grade II and above).

Afr Health Sci 2020 Dec;20(4):1749-1753

Rawalpindi Medical College, Cardiology.

Introduction: Left ventricular diastolic dysfunction (DD) is an entity in which the ventricle fails to fill up properly due to impaired ventricular relaxation and/or decreased compliance. The diagnosis of diastolic dysfunction is based on a variety of parameters in doppler echocardiograpy. However, some parameters like interventricular septal thickness in diastole (IVSd), posterior wall thickness in diastole (PWd), left ventricular internal end diastolic and systolic diameters (LVIDD and LVISD) along with left atrial diameters (LAD) have yet to be evaluated for the diagnostic workup of DD.

Methods: A case control study was done in the cardiology department from patient records from 2016 to 2018. Patients were diagnosed as diastolic dysfunction grade II and above by doppler echocardiography. IVSd, PWd, LVIDD, LAD, LVISD were obtained through 2-D echocardiography.

Results: Patients with DD had greater LAD, IVSd and PWd and decreased LVIDD and LVISD as compared to control group. Overall, IVSD was the most significant predictor (OR 1.52 95%CI 1.35-1.71) of DD followed by PWd and LAD. Similarly, LAD, IVSd and PWd had higher sensitivity and specificity than LVIDD and LVIDS.

Conclusion: IVSd, LAD and PWd showed significant performance in the diagnosis of diastolic dysfunction and hence can be used as a screening and diagnostic tool in diastolic dysfunction of grade ll and above.
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http://dx.doi.org/10.4314/ahs.v20i4.27DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8351830PMC
December 2020

Cisatracurium-Associated Malignant Hyperthermia During Severe Sars-CoV-2 Infection.

Am J Ther 2021 08 10;28(5):e590-e591. Epub 2021 Aug 10.

Division of Pulmonary/Critical Care, University of South Dakota Sanford School of Medicine, Sioux Falls, SD.

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http://dx.doi.org/10.1097/MJT.0000000000001437DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8415506PMC
August 2021

Catalytic Oxidation of Toluene into Benzaldehyde and Benzyl Alcohol Using Molybdenum-Incorporated Manganese Oxide Nanomaterials.

ACS Omega 2021 Aug 20;6(30):19606-19615. Epub 2021 Jul 20.

Department of Chemistry, Faculty of Science, King Khalid University, P.O. Box 9004, Abha 61413, Saudi Arabia.

Oxidation of toluene (an organic pollutant), into useful chemical products, is of great interest nowadays. However, efficient conversion of toluene under mild and sustainable conditions is a thought-provoking task. Here, we report MnMoO nanomaterials , synthesized through a very facile solvothermal approach. Catalytic efficiencies of MnMoO nanomaterials were evaluated by direct oxidation of toluene via C-H activation. Toluene was converted into benzaldehyde and benzyl alcohol in the presence of HO as an oxidant at 80 °C. The reaction parameters, that is, catalyst dose, time, and toluene concentration, were varied to obtain the optimal conditions for the oxidation process. The 40.62% maximum toluene conversion rate was obtained after 18 h of oxidation activity with 0.06 g of catalyst . A maximum of 78% benzaldehyde selectivity was obtained with 0.06 g of catalyst after 18 h of toluene oxidation activity. Also, 62.33% benzyl alcohol selectivity was achieved using 0.1 g of catalyst after 1 h of activity. Several catalytic cycles were run with to evaluate catalyst reusability. Potential % toluene conversion was obtained for up to six cycles and their turnover frequencies were found to be 1.94-1.01 s. FTIR spectra of catalyst before and after recovery indicate no significant change. The good conversion rate of toluene and efficient selectivity toward benzaldehyde and benzyl alcohol indicates the robustness and high potential of these catalysts to oxidize toluene under a milder, greener, and hazardous chlorine-free environment.
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http://dx.doi.org/10.1021/acsomega.1c02163DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8340403PMC
August 2021

Pleural and Pulmonary Tuberculosis in a Patient Presenting with a Massive Exudative Pleural Effusion: A Diagnostic Challenge.

S D Med 2021 02;74(2):61-64

Avera McKennan University Hospital, Sioux Falls, South Dakota.

Worldwide, Mycobacterium tuberculosis (MTB) is the leading cause of death due to a single infectious agent. According to the CDC, there were 9,025 reported new cases of active TB in the U.S. in 2018. There are various diagnostic modalities available to diagnose infection with MTB, whether it is latent or active. We present a diagnostically challenging case of pulmonary and pleural TB in a patient with known risk factors. It serves as a reminder of the high false negative rate of many of the tests for TB.
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February 2021

Strategies for Successful Clinical Trial Recruitment of People Living with HIV in Low- and Middle-Income Countries: Lessons Learned and Implementation Implications from the Nigeria Renal Risk Reduction (R3) Trial.

Curr HIV/AIDS Rep 2021 08 4;18(4):289-298. Epub 2021 Jun 4.

Vanderbilt Institute for Global Health (VIGH), Vanderbilt University Medical Center (VUMC), 2525 West End Ave, Suite, Nashville, TN, 750, USA.

Purpose Of Review: Clinical trials represent a bedrock for measuring efficacy of interventions in biomedical research, but recruitment into clinical trials remains a challenge. Few data have focused on recruitment strategies from the perspective of clinical trial teams, especially in low- and middle-income countries (LMIC), where HIV is most prevalent.

Recent Findings: We summarized data from the literature and our experience with recruitment for the Renal Risk Reduction trial, aimed at reducing risk of kidney complications among people living with HIV in Nigeria. Using an implementation science framework, we identified strategies that contributed to successful clinical trial recruitment. For strategies that could not be categorized by this framework, we summarized key features according to selected action, actor, target, context, and time. We identified how these identified strategies could map to subsequent implementation outcomes at the patient and provider/health system level, as well as capacity-building efforts to meet needs identified by LMIC partners, which is a priority for success. Our experience highlights the importance of considering implementation outcomes, and the strategies necessary to achieve those outcomes early, in the planning and execution of clinical trials. Clinical trial recruitment can be optimized via methodologies grounded in implementation science.
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http://dx.doi.org/10.1007/s11904-021-00566-xDOI Listing
August 2021

Apolipoprotein-1 risk variants and associated kidney phenotypes in an adult HIV cohort in Nigeria.

Kidney Int 2021 07 24;100(1):146-154. Epub 2021 Apr 24.

Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA; Department of Medicine, Division of Infectious Diseases, Vanderbilt University Medical Center, Nashville, Tennessee, USA. Electronic address:

HIV-positive adults are at risk for various kidney diseases, and apolipoprotein 1 (APOL1) high-risk genotypes increase this risk. This study aimed to determine the prevalence and ethnic distribution of APOL1 risk genotypes among a cohort of HIV-positive Nigerian adults and explore the relationship between APOL1 risk variant status with albuminuria and estimated glomerular filtration rate (eGFR). We conducted a cross-sectional study among 2 458 persons living with HIV who attended an HIV clinic in northern Nigeria and had received antiretroviral therapy for a minimum of six months. We collected two urine samples four-eight weeks apart to measure albumin excretion, and blood samples to measure eGFR and determine APOL1 genotype. The frequency of APOL1 high-risk genotype was 6.2%, which varied by ethnic group: Hausa/Fulani (2.1%), Igbo (49.1%), and Yoruba (14.5%). The prevalence of microalbuminuria (urine/albumin creatinine ratio 30- 300 mg/g) was 37%, and prevalence of macroalbuminuria (urine/albumin creatinine ratio over 300 mg/g) was 3%. The odds of microalbuminuria and macroalbuminuria were higher for participants with the APOL1 high-risk genotype compared to those carrying the low-risk genotype ([adjusted odds ratio 1.97, 95% confidence interval 1.37-2.82] and [3.96, 1.95-8.02] respectively). APOL1 high-risk genotype participants were at higher risk of having both an eGFR under 60 ml/min/1.73m and urine/albumin creatinine ratio over 300 mg/g (5.56, 1.57-19.69). Thus, we found a high proportion of HIV-positive, antiretroviral therapy-experienced, and largely virologically suppressed adults had microalbuminuria. Hence, although the high-risk APOL1 genotype was less prevalent than expected, it was strongly associated with some level of albuminuria.
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http://dx.doi.org/10.1016/j.kint.2021.03.038DOI Listing
July 2021

Can vital signs recorded in patients' homes aid decision making in emergency care? A Scoping Review.

Resusc Plus 2021 Jun 10;6:100116. Epub 2021 Apr 10.

School of Medical Sciences, Bangor University, Bangor, United Kingdom.

Aim: Use of tele-health programs and wearable sensors that allow patients to monitor their own vital signs have been expanded in response to COVID-19. We aimed to explore the utility of patient-held data during presentation as medical emergencies.

Methods: We undertook a systematic scoping review of two groups of studies: studies using non-invasive vital sign monitoring in patients with chronic diseases aimed at preventing unscheduled reviews in primary care, hospitalization or emergency department visits and studies using vital sign measurements from wearable sensors for decision making by clinicians on presentation of these patients as emergencies. Only studies that described a comparator or control group were included. Studies limited to inpatient use of devices were excluded.

Results: The initial search resulted in 896 references for screening, nine more studies were identified through searches of references. 26 studies fulfilled inclusion and exclusion criteria and were further analyzed. The majority of studies were from telehealth programs of patients with congestive heart failure or Chronic Obstructive Pulmonary Disease. There was limited evidence that patient held data is currently used to risk-stratify the admission or discharge process for medical emergencies. Studies that showed impact on mortality or hospital admission rates measured vital signs at least daily. We identified no interventional study using commercially available sensors in watches or smart phones.

Conclusions: Further research is needed to determine utility of patient held monitoring devices to guide management of acute medical emergencies at the patients' home, on presentation to hospital and after discharge back to the community.
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http://dx.doi.org/10.1016/j.resplu.2021.100116DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8035051PMC
June 2021

Conformal Radiation Therapy in Patients With Cardiovascular Implantable Electronic Devices: Proposed Practical Implementation of the 2019 American Association of Physicists in Medicine Task Group No. 203 Risk-Stratified Interrogation Schedule.

Pract Radiat Oncol 2021 Jul-Aug;11(4):e402-e414. Epub 2021 Apr 3.

Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, Maryland. Electronic address:

Purpose: Radiation therapy (RT) in patients with cardiac implantable electronic devices (CIED) carries a risk of device malfunction from radiation exposure. We sought to evaluate the incidence of CIED malfunction in a cohort of patients treated with modern RT techniques.

Methods And Materials: A retrospective analysis of 193 CIED patients treated with RT between 2000 and 2018 was conducted. All patients underwent pre-, intra-, and post-RT CIED interrogations. Patient demographics, CIED details, RT details, including total dose, modality, treatment site, CIED distance from RT field, treatment planning system maximum dose and in vivo dose estimates, and CIED malfunction data were analyzed.

Results: CIEDs in use were mainly pacemakers (single-chamber 10%, dual-chamber 49%) and defibrillators (35%). Patients received a median RT dose of 50 Gy (range, 7-80 Gy), treated with 3-dimensional CRT (47%), intensity modulated RT/volumetric modulated arc therapy (38%), and stereotactic body radiation therapy (10%). Neutron producing energies were used in 13% of the treatments. A strong correlation was noted between treatment planning system estimated maximum dose and in vivo estimated CIED dose when the CIED distance from the treatment field was >3 cm. However, in vivo measurements provide a lower estimated absorbed dose for CIED devices <3 cm from the RT field. During a median follow-up of 24 months (range, 7-64 months), 2 adverse CIED-related events were recorded: a spontaneous defibrillator discharge and a pacemaker malfunction subsequently causing ventricular tachycardia. Both patients received stereotactic body radiation therapy to the thorax, with CIED dose of 5 and 19.2 cGy, respectively. Both events occurred 2 years posttreatment without any intra- or post-RT CIED interrogations changes noted.

Conclusions: In this series of patients treated with modern RT techniques, we observed a CIED malfunction rate of 1.04%. These low event rates establish the safety of delivering modern RT in CIED patients with the possibility of reducing the burden of intra- and posttreatment CIED monitoring.
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http://dx.doi.org/10.1016/j.prro.2021.03.004DOI Listing
September 2021

Incidence of Acute Endophthalmitis After Intravitreal Bevacizumab Injection at a Tertiary Care Hospital in Lahore.

Cureus 2021 Feb 6;13(2):e13185. Epub 2021 Feb 6.

Department of Ophthalmology, King Edward Medical University, Mayo Hospital, Lahore, PAK.

Objective: We aimed to assess the incidence, management, and visual outcome of acute endophthalmitis in patients following intravitreal bevacizumab injection in a tertiary care setup. It was a prospective and single-center database study.

Patients And Methods: Patients receiving intravitreal bevacizumab injections for various retinal vascular diseases from January 2019 to September 2020. The study was carried out at the Institute of Ophthalmology, Mayo Hospital, Lahore over a period of 21 months. Preformed bevacizumab injections were administered intravitreally on patients of various retinal vascular diseases under strict aseptic measures and by following the standard guidelines. The patients were put on follow-ups for a duration of four weeks to see any signs of acute endophthalmitis.

Results: A total of 3051 injections were administered in 1104 eyes of 743 patients during the above-mentioned study period. The incidence of endophthalmitis was found to be 0.0328% (1/3051). The patient, who developed endophthalmitis, was treated with topical and intravitreal antibiotics followed by vitrectomy that resulted in clinically significant improvement in vision.

Conclusion: Incidence of acute endophthalmitis following intravitreal bevacizumab injection was low and could be prevented by taking strict aseptic measures during administration.
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http://dx.doi.org/10.7759/cureus.13185DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7943056PMC
February 2021

In silico analysis of quranic and prophetic medicinals plants for the treatment of infectious viral diseases including corona virus.

Saudi J Biol Sci 2021 May 23;28(5):3137-3151. Epub 2021 Feb 23.

The Second Affiliated Hospital of Zhengzhou University, Zhengzhou, China.

Coronavirus disease (COVID-19) is an infection of the respiratory system caused by single standard RNA viruses named as Severe Acute Respiratory Syndrome 2 (SARS-CoV-2). The disease appeared as a serious problem and the leading cause of death in human beings throughout the world. The main source of different phytochemicals are plants, which helps in the development of new drugs against various ailments. Islam is comprehensive religion and a complete code of life for Muslims. The teaching of Islam, according to the Holy Quran and Hadith are universal for the benefit of humanity. Islam believes that every ailment is from God and who made the disease definitely made its medication. There is a complete guideline with regard to taking measures against infectious diseases such as quarantine and seeking medicinal treatment. The research objective is to gather the knowledge of medicinal plants described in the Holy Quran or utilized by the Prophet (SAW) for the treatment of different ailments or advised to use them to boost immunity and strengthen the body. Scientists across the globe have found these plants beneficial for many diseases and have antiviral potential. In present study, the six plant species including and were selected which contain phytochemicals like Calcium Elenolate, Thymoquinone, S-Allylcysteine, Dipropyl Disulfide, Sesquiterpene, Monoterpene, Pelargonidin 3-Galactoside ion and Kaempferol. The phytochemicals monoterpene (from ) shows best interaction with target proteins RdRP, 3CLPro, ACE2. Calcium Elonate (from olive) bonds with 3CLPro, ACE2 and Kemoferol and Pelargomidine (from Senna Makki) bonds with RdRP, ACE2. The ligands show a unique set of intersections i.e. hydrogen bonding, and alkyl interaction. These medicinal plants can be utilized immediately for the treatment of COVID-19 as their safety is already established. This treatment can enhance recovery when combined with other treatments. Furthermore, the screening of bioactive compounds or phytochemicals found in these plants can be utilized to design new therapeutic drug to treat COVID-19 pandemic.
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http://dx.doi.org/10.1016/j.sjbs.2021.02.058DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7899931PMC
May 2021

network-based analysis of drugs used against COVID-19: Human well-being study.

Saudi J Biol Sci 2021 Mar 21;28(3):2029-2039. Epub 2021 Jan 21.

Department of Zoology, College of Science, King Saud University, Riyadh, 11451, Saudi Arabia.

Introduction: Researchers worldwide with great endeavor searching and repurpose drugs might be potentially useful in fighting newly emerged coronavirus. These drugs show inhibition but also show side effects and complications too. On December 27, 2020, 80,926,235 cases have been reported worldwide. Specifically, in Pakistan, 471,335 has been reported with inconsiderable deaths.

Problem Statement: Identification of COVID-19 drugs pathway through drug-gene and gene-gene interaction to find out the most important genes involved in the pathway to deal with the actual cause of side effects beyond the beneficent effects of the drugs.

Methodology: The medicines used to treat COVID-19 are retrieved from the Drug Bank. The drug-gene interaction was performed using the Drug Gene Interaction Database to check the relation between the genes and the drugs. The networks of genes are developed by Gene MANIA, while Cytoscape is used to check the active functional association of the targeted gene. The developed systems cross-validated using the EnrichNet tool and identify drug genes' concerned pathways using Reactome and STRING.

Results: Five drugs Azithromycin, Bevacizumab, CQ, HCQ, and Lopinavir, are retrieved. The drug-gene interaction shows several genes that are targeted by the drug. Gene MANIA interaction network shows the functional association of the genes like co-expression, physical interaction, predicted, genetic interaction, co-localization, and shared protein domains.

Conclusion: Our study suggests the pathways for each drug in which targeted genes and medicines play a crucial role, which will help experts o overcome and deal with the side effects of these drugs, as we find out the gene analysis for the COVID-19 drugs.
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http://dx.doi.org/10.1016/j.sjbs.2021.01.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7825994PMC
March 2021

Metered Dose Inhaler Technique: A Priority Catch for Physicians.

Cureus 2020 Oct 8;12(10):e10857. Epub 2020 Oct 8.

Department of General Surgery, Benazir Bhutto Hospital, Rawalpindi, PAK.

Background: Asthma is a non-curable but preventable disease that can be controlled by a proper approach. Inhalational route is considered to be one of the fastest, non-invasive course for the management of asthma. Despite its importance, compliance towards proper inhalational technique remains quite low. Thus, United Kingdom guidelines and Global Strategy for Asthma Management and Prevention (GINA) recommend regular assessment of inhaler techniques in all asthma patients.

Objective: To evaluate the inhalational technique of asthma patients visiting out-patient departments of public sector tertiary care hospitals of Rawalpindi and correlate with various demographic factors.

Methods: A cross-sectional study was conducted on a total of 209 respondents visiting the outpatient department of public sector hospitals in Rawalpindi. Asthmatic patients were included via a non-probability consecutive sampling technique and were assessed for inhaler techniques via a structured checklist. Statistical data were analyzed using IBM Statistical Package for Social Sciences (SPSS®), version 25.0 (IBM Corp., Armonk, NY, USA).

Results: Two hundred and nine asthma patients were included. Only 10% of patients demonstrated the correct inhaler technique. Continuing inhaling till lungs are full, holding breath for five to 10 seconds, and breathing out slowly after using the inhaler were most poorly followed.

Conclusion: Most asthma patients are using poor inhalation technique, risking sub-optimal drug delivery and inadequate effects. Hence, it is the need of the hour to focus on patient training and education.
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http://dx.doi.org/10.7759/cureus.10857DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7652015PMC
October 2020

MR Product as a Novel Diagnostic Indicator for Chronic Secondary Mitral Regurgitation.

Cureus 2020 Aug 26;12(8):e10052. Epub 2020 Aug 26.

Cardiology, Rashid Latif Medical College, Lahore, PAK.

Background Chronic secondary mitral regurgitation (SMR) is a common form of valvular heart disease. Its diagnosis through echocardiography is challenging and dependent on subjective interpretations. The subjective error to diagnose SMR can be reduced by developing accurate predictive quantitative parameters that support echocardiographic interpretations and clinical manifestations. The present study aims to develop a new diagnostic indicator for chronic SMR. The new indicator called MR product is the product of left atrial diameter (LAD) and left ventricular internal dimension at end-systole (LVIDs). Materials and Methods An analytical, case-control study was conducted from transthoracic echocardiography (TTE) reports of 720 patients performed according to the guidelines of the American Society of Echocardiography. The LAD and LVIDs were measured using the standard M Mode TTE. Out of the 720 patients who underwent TTE, 300 patients were diagnosed with chronic SMR by experienced clinicians. Only 115 of those 300 patients met the inclusion criteria for chronic SMR.  Results The MR product was significantly associated with chronic SMR (rho = 0.83) and predicted it with an odds ratio of 1.014 (p < 0.001). The MR product was able to diagnose SMR with a sensitivity of 94.8% and a specificity of 92.2%, respectively, for a cut off value of 1,045 mm. Conclusion A new parameter called MR product (LAD multiplied with LVIDs) has very high sensitivity and specificity for SMR. Therefore, it can aid in establishing its diagnosis, along with other diagnostic modalities. The new parameter may also potentially increase the diagnostic accuracy of the disease.
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http://dx.doi.org/10.7759/cureus.10052DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7520408PMC
August 2020

Patterns of Failure in Triple Negative Breast Cancer Patients in an Urban, Predominately Black Population.

J Racial Ethn Health Disparities 2021 Aug 4;8(4):1035-1046. Epub 2020 Sep 4.

Department of Radiation Oncology, University of Maryland School of Medicine, Baltimore, MD, USA.

Triple negative breast cancers (TNBC) behave more aggressively than hormone-receptor positive breast cancers. They are also known preferentially to affect young black women, often leading to poorer outcomes compared with those for white women. We sought to evaluate the comprehensive patterns of failure associated with treatment for TNBC at an urban institution with a predominantly black population and to assess the impact of social determinants of health on treatment failure. A retrospective review of TNBC patients treated from 2005 to 2015 was conducted. Detailed patient, tumor, and treatment characteristics and information on patterns of failure were included. With a median follow-up of 46 months, 32 (16%) documented failures occurred. Locoregional failures comprised 84% of failure patterns whether isolated or in combination with distant failure. Treatment failure was associated with insurance type and smoking status, as well as several tumor characteristics. On multivariate analysis, pathologic nodal staging was the most significant predictor of treatment failure. In contrast to previous studies, we found that black women had higher overall survival than white women, but race was not associated with differences in recurrence patterns or with likelihood of treatment failure. Regardless of race, of the patients who recurred, 53% failed in distant and locoregional sites simultaneously, with an additional 34% failing locally only. These results highlight the need for aggressive local therapies in high-risk patients and suggest a need for improved follow-up focusing on detecting locoregional failures. Multidisciplinary care is essential in the management of these patients at time of failure.
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http://dx.doi.org/10.1007/s40615-020-00860-1DOI Listing
August 2021

Major Depressive Disorder: An Alarming Stigma Of Pregnant Women.

J Ayub Med Coll Abbottabad 2020 Apr- Jun;32(2):244-249

Department of Community Medicine, Ayub Medical College, Abbottabad, Pakistan.

Background: Major depressive disorder is the most common psychiatric disease affecting women. Pregnancy significantly increases its prevalence, especially in developing countries. Antenatal major depression is an alarming condition for the mother and the growing foetus. This study aimed to find the frequency of antenatal depression and its relation with obstetric predictors.

Methods: This crosssectional study was conducted during Jan-March of 2014, in Benazir Bhutto women and children, Hospital, Abbottabad. By non- probability consecutive sampling techniques, total 96 pregnant women in third trimester were included during outpatient visiting hours. After inclusion and exclusion criteria, they were diagnosed for low back pain and major depressive disorder. All the data and questions were recorded in a pre-tested questionnaire. Verbal informed consents were obtained. SPSS software (version 21) was used for statistical analysis.

Results: The sample included 96 participants with a mean age of 24.56±4.24 years, and mean duration of pregnancy 35.06±3.80 weeks. Forty-one women (42.7%) had high school education level, women from urban areas were 50 (52.1), 54 (56.3%) were from age group, 21-25 years, and 54 (56.3%) had first pregnancy. Among the total, 68 (70.8%) were depressed and 42 (43.8%) were of mild severity. Two third, i.e., 66 (68.8%) had low back pain. None of the results were statistically significant.

Conclusions: Major depressive disorder (of mild severity) is quite high in 3rd-trimester pregnant population of Abbottabad. Frequency was more in uneducated younger age group women, resident of remote areas with first conception were more depressed.
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November 2020

Utility of Endoscopic Ultrasound in the Work Up for Solitary Hepatobiliary Neuroendocrine Lesions.

S D Med 2020 Jun;73(6):270-274

Department of Internal Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota.

A 43-year-old woman, with an unremarkable past medical history, presented with a three-week history of generalized itching, jaundice, and abdominal pain. Initial workup showed amorphous, regionally invasive, and obstructing soft tissue mass in the region of the hepatic hilum. The middle third of the main bile duct was subsequently found to harbor a polypoid mass on endoscopic retrograde cholangiopancreatograph. Biopsy revealed nests of neoplastic cells that was subsequently identified as well-differentiated neuroendocrine tumor. A search for a possible primary neuroendocrine tumor was performed and included imaging of the chest, abdomen, and pelvis, a colonoscopy, capsule endoscopy, and an octreotide scan; however, no primary tumor outside of the liver was identified. Surgical debulking was performed, during which intraoperative exploration and ultrasound failed to reveal any extra-hepatic tumor sanctuaries. A few months later, patient underwent endoscopic ultrasound (EUS) for evaluation of recurrent abdominal pain which revealed a small lesion in the pancreas. It was unclear, however, whether it was primary or a metastatic lesion. This case represents a diagnostic challenge and emphasizes the potential utility of EUS in the preoperative work up for any presumable primary hepatobiliary neuroendocrine tumor.
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June 2020

nCOV-19 peptides mass fingerprinting identification, binding, and blocking of inhibitors flavonoids and anthraquinone of and hydroxychloroquine.

J Biomol Struct Dyn 2021 07 22;39(11):4089-4099. Epub 2020 Jun 22.

Department of Bioinformatics, Govt. Postgraduate College Mandian Abbottabad, Abbottabad, KPK, Pakistan.

An rare pandemic of viral pneumonia occurs in December 2019 in Wuhan, China, which is now recognized internationally as Corona Virus Disease 2019 (COVID-19), the etiological agent classified as Severe Acute Respiratory Syndrome Corona Virus 2 (SARS-CoV-2). According to the World Health Organization (WHO), it has so far expanded to more than 213 countries/territories worldwide. Our study aims to find the viral peptides of SARS-COV-2 by peptide mass fingerprinting (PMF) in order to predict its novel structure and find an inhibitor for each viral peptide. For this reason, we calculated the mass of amino acid sequences translated from the SARS-CoV2 whole genome and identify the peptides that may be a target for inhibition. Molecular peptide docking with phytochemicals (aqueous and ethanolic) leaf extracts of flavonoids (3.56 ± 0.03), (3.83 ± 0.02), anthraquinone (11.68 ± 0.04), (10.86 ± 0.06) and hydroxychloroquine present therapy of COVID-19 in Pakistan for comparative study. Results indicate that 15 peptides of SARS-CoV2 have been identified from PMF, which is then used as a selective inhibitor. The maximum energy obtained from AutoDock Vina for hydroxychloroquine is -5.1 kcal/mol, kaempferol (flavonoid) is -6.2 kcal/mol, and for anthraquinone -6 kcal/mol. Visualization of docking complex, important effects are observed regarding the binding of peptides to drug compounds. In conclusion, it is proposed that these compounds are effective antiviral agents against COVID-19 and can be used in clinical trials.Communicated by Ramaswamy H. Sarma.
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http://dx.doi.org/10.1080/07391102.2020.1778534DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7332867PMC
July 2021

WhatsApp groups: an effective way of intradepartmental and interdepartmental communication regarding patient consultations.

J R Coll Physicians Edinb 2020 03;50(1):92-95

Department of Surgery Unit II, Benazir Bhutto Hospital, Rawalpindi, Pakistan.

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http://dx.doi.org/10.4997/JRCPE.2020.125DOI Listing
March 2020

Brucellosis As a Cause of Intestinal Perforation.

Cureus 2020 Feb 22;12(2):e7075. Epub 2020 Feb 22.

Surgical Unit II, Benazir Bhutto Hospital, Rawalpindi Medical Uninversity, Rawalpindi, PAK.

Brucellosis is a multisystem zoonotic infection. Patients usually presents with fever and nonspecific systemic symptoms but may rarely present with clinical presentation of an acute abdomen. In this case report, we present a 32-year-old male who presented to the emergency department with symptoms of acute abdomen. Exploration revealed ileal perforation secondary to brucellosis, for which loop ileostomy was fashioned.
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http://dx.doi.org/10.7759/cureus.7075DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7093939PMC
February 2020

Posttraumatic stress disorder and psycho-social impairment following snakebite in Northeastern Nigeria.

Int J Psychiatry Med 2021 Mar 26;56(2):97-115. Epub 2020 Mar 26.

Infectious and Tropical Diseases Unit, Bayero University Kano/Aminu Kano Teaching Hospital, Kano, Nigeria.

Background: Snakebite is a major public health problem among impoverished rural populations causing considerable morbidity and mortality in West Africa. Despite the huge burden of snakebite in this region, psycho-social impairment following snakebite has not been evaluated. In this study, we assessed for features of posttraumatic stress disorder and psycho-social impairment among rural snakebite victims in Northeastern Nigeria.

Methods: Individuals with previous snakebite managed in our facility, defined as exposed to snakebite, and their matched relatives not exposed to snakebite were invited to participate in the study following community mobilization. A retrospective cohort study was conducted evaluating the presence of psycho-social functioning, posttraumatic stress disorder, quality of life, social disability, cognitive impairment, and psychological morbidity using standard tools administered by the investigators, trained nurses, and community health workers.

Results: The prevalence of features of posttraumatic stress disorder among those exposed to snakebite compared to those not exposed to snakebite was 43% and 28%, respectively (risk ratio = 1.53; 95% confidence interval: 1.04-2.24; p = 0.024). Subjects exposed to snakebite had significantly poorer quality of life score in the psychological and social domains (p < 0.05). Other psycho-social complications associated with snakebite were impaired family/school functioning and psychological morbidity. No difference in cognitive functioning was observed between the two groups.

Conclusions: Snakebite is complicated by features of posttraumatic stress disorder, poor quality of life, and psycho-social impairments in northeastern Nigeria. Detection, monitoring, and appropriate management interventions should be provided and made more accessible to snakebite victims to ameliorate mental and psychological impairment.
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http://dx.doi.org/10.1177/0091217420913400DOI Listing
March 2021

Ovarian dermoid cyst presenting with unusual complaint of hair coming out of the anal orifice - A case report.

J Pak Med Assoc 2020 Mar;70(3):534-536

3rd Year MBBS Student, Rawalpindi Medical University, Rawalpindi, Pakistan.

Dermoid cyst of the ovary is a common benign condition. It is usually asymptomatic but can present with pain, mass, hormone related symptoms or paraneoplastic syndrome. Hair is a common morphological component of the dermoid cyst; however, it rarely manifests as a presenting complain. We report a case, who presented with the complaints of hair coming out through her anal orifice for a year. Ultrasound and computed tomography scan revealed a dermoid cyst of the right ovary adherent to the rectum. Surgical removal showed hair coming out of the cyst. Primary repair of the defect in rectal wall was performed which resulted in resolution of the symptoms.
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http://dx.doi.org/10.5455/JPMA.13778DOI Listing
March 2020

Images in Medicine: Right Atrial Tumor Thrombosis Causing Lower Extremity Edema.

S D Med 2020 03;73(3):122-123

Avera Mckennan Hospital and University Center, Sioux Falls, South Dakota.

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March 2020

Mesenteric Ischemia due to Thrombosis Involving the Aorta, Celiac Artery, and Superior Mesenteric Artery in a Young Female with Protein C Deficiency.

Cureus 2019 Nov 14;11(11):e6151. Epub 2019 Nov 14.

Surgical Unit II, Benazir Bhutto Hospital, Rawalpindi Medical University, Rawalpindi, PAK.

An arterial thrombus affecting the descending aorta, celiac artery, and superior mesenteric artery at the same time, resulting in mesenteric ischemia and splenic infarction, is a very rare phenomenon. We report a case of a 35-year-old, unmarried female, gravida 0 para 0, who presented with abdominal pain, vomiting, and constipation for two days. Computed tomography (CT) scan showed thrombi in the descending aorta to the celiac axis and superior mesenteric artery with splenic infarction, bowel ischemia, hepatic portal venous air, and uterine fibroid. The diagnosis of arterial thrombotic mesenteric ischemia was made. An exploratory laparotomy was performed. Gangrenous intestine resection was done with ileojejunostomy and feeding ileostomy.
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http://dx.doi.org/10.7759/cureus.6151DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6913912PMC
November 2019

βC1, pathogenicity determinant encoded by Cotton leaf curl Multan betasatellite, interacts with calmodulin-like protein 11 (Gh-CML11) in Gossypium hirsutum.

PLoS One 2019 3;14(12):e0225876. Epub 2019 Dec 3.

National Institute for Biotechnology and Genetic Engineering, Faisalabad, Pakistan.

Begomoviruses interfere with host plant machinery to evade host defense mechanism by interacting with plant proteins. In the old world, this group of viruses are usually associated with betasatellite that induces severe disease symptoms by encoding a protein, βC1, which is a pathogenicity determinant. Here, we show that βC1 encoded by Cotton leaf curl Multan betasatellite (CLCuMB) requires Gossypium hirsutum calmodulin-like protein 11 (Gh-CML11) to infect cotton. First, we used the in silico approach to predict the interaction of CLCuMB-βC1 with Gh-CML11. A number of sequence- and structure-based in-silico interaction prediction techniques suggested a strong putative binding of CLCuMB-βC1 with Gh-CML11 in a Ca+2-dependent manner. In-silico interaction prediction was then confirmed by three different experimental approaches: The Gh-CML11 interaction was confirmed using CLCuMB-βC1 in a yeast two hybrid system and pull down assay. These results were further validated using bimolecular fluorescence complementation system showing the interaction in cytoplasmic veins of Nicotiana benthamiana. Bioinformatics and molecular studies suggested that CLCuMB-βC1 induces the overexpression of Gh-CML11 protein and ultimately provides calcium as a nutrient source for virus movement and transmission. This is the first comprehensive study on the interaction between CLCuMB-βC1 and Gh-CML11 proteins which provided insights into our understating of the role of βC1 in cotton leaf curl disease.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0225876PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6890265PMC
March 2020

The prevalence and clinical profile of adrenocortical deficiency among HIV infected persons in Northern Nigeria.

Afr Health Sci 2019 Jun;19(2):1947-1952

Endocrinology Unit, Aminu Kano Teaching Hospital, Kano.

Background: Infection with the human immune deficiency virus (HIV) is still a prevalent problem in Africa.

Objectives: The aim of this study was to determine the prevalence of hypocortisolism among patients with HIV and their clinical profile at Aminu Kano Teaching Hospital (AKTH), Kano, Nigeria.

Method: Three hundred and fifty adult patients with HIV infection were recruited from the HIV clinic of AKTH, Kano. Blood samples for serum electrolytes, and cortisol both before and after the short Synacthen test were taken for estimation. Data were analyzed using the SPSS version 20.0 software.

Results: One hundred and eight (30.9%) of participants had low baseline serum cortisol levels, while 57 (16.3%) had a low serum cortisol after short synacthen test. There was no significant relationship between the cortisol levels and clinical features of hypocortisolism, WHO clinical stage of HIV, hypernatremia or HAART regimen. There was a negative correlation between the stimulated serum cortisol and duration of diagnosis of HIV, participants BMI and CD4 counts.

Conclusion: The biochemical evidence of hypocortisolism was common among patients infected with HIV, associated with a longer duration of HIV infection. However, none of CD4 counts, clinical features or HAART regimen were associated with hypocortisolism.
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http://dx.doi.org/10.4314/ahs.v19i2.18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6794548PMC
June 2019

Quantifying Pore Width Effects on Diffusivity via a Novel 3D Stochastic Approach with Input from Atomistic Molecular Dynamics Simulations.

J Chem Theory Comput 2019 Dec 6;15(12):6907-6922. Epub 2019 Nov 6.

Department of Chemical Engineering , University College London , Torrington Place , London WC1E 7JE , United Kingdom.

The increased production of unconventional hydrocarbons emphasizes the need to understand the transport of fluids through narrow pores. Although it is well-known that confinement affects fluids structure and transport, it is not yet possible to quantitatively predict properties such as diffusivity as a function of pore width in the range of 1-50 nm. Such pores are commonly found not only in shale rocks but also in a wide range of engineering materials, including catalysts. We propose here a novel and computationally efficient methodology to obtain accurate diffusion coefficient predictions as a function of pore width for pores carved out of common materials, such as silica, alumina, magnesium oxide, calcite, and muscovite. We implement atomistic molecular dynamics (MD) simulations to quantify fluid structure and transport within 5 nm-wide pores, with particular focus on the diffusion coefficient within different pore regions. We then use these data as input to a bespoke stochastic kinetic Monte Carlo (KMC) model, developed to predict fluid transport in mesopores. The KMC model is used to extrapolate the fluid diffusivity for pores of increasing width. We validate the approach against atomistic MD simulation results obtained for wider pores. When applied to supercritical methane in slit-shaped pores, our methodology yields data within 10% of the atomistic simulation results, with significant savings in computational time. The proposed methodology, which combines the advantages of MD and KMC simulations, is used to generate a digital library for the diffusivity of gases as a function of pore chemistry and pore width and could be relevant for a number of applications, from the prediction of hydrocarbon transport in shale rocks to the optimization of catalysts, when surface-fluid interactions impact transport.
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http://dx.doi.org/10.1021/acs.jctc.9b00776DOI Listing
December 2019

Megacolon Secondary to Ogilvie's Syndrome.

S D Med 2019 09;72(9):394

University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota.

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September 2019

Association of Physical Activity and Sleep Quality with Academic Performance Among Fourth-year MBBS Students of Rawalpindi Medical University.

Cureus 2019 Jul 6;11(7):e5086. Epub 2019 Jul 6.

Psychiatry, Rawalpindi Medical University, Rawalpindi, PAK.

Background Medical students face greater academic stress and devote more time to their studies due to the tough nature of medical education, at the cost of sleep and physical activity. Good sleep quality and physical activity improve the mental ability and academic performance of the students. Objectives and rationale The study aims to assess sleep quality and physical activity levels among fourth-year MBBS students of Rawalpindi Medical University. We compare these levels with gender and boarding status and correlate them with the academic performance of the students. This may provide new target areas to improve the academics of students performing below average. Materials and methods It was a descriptive, cross-sectional study conducted in March 2019 on 344 medical students enrolled in the fourth-year MBBS class of Rawalpindi Medical University. Sleep quality was assessed by the Pittsburgh Sleep Quality Index (PSQI), physical activity levels by the Global Physical Activity Questionnaire (GPAQ), and academic performance by the marks attained in the most recent pathology class test. The students who could not prepare for the test in the usual manner were excluded from the study. Two-hundred nineteen (219) students were part of the final study sample. Data analysis was performed using SPSS v.22.0 (IBM Corp, Armonk, NY, US). A chi-squared test, independent samples t-test, Pearson's correlation, and a multiple linear regression model were used to assess the variables. Results Sleep quality and physical activity were significantly correlated with academic performance (p-values of the chi-square and t-test were <0.000). Pearson's correlation coefficient was -0.69 for PSQI (p<0.000) and 0.62 for GPAQ (p 0.003) with test scores. Gender showed significant association with sleep and physical activity levels (male students had better physical activity level and poorer sleep quality than female students) but no association with test scores. Boarding status was significantly associated with all three variables. Boarders had lower mean test scores and poorer sleep and physical activity indices as compared to non-boarders. The multiple linear regression model was valid (p-value of the F test was <0.000), with beta coefficients of -2.53 ( p=0.002) for sleep quality and 1.37 (p=0.01) for physical activity. The R value was 0.84 (84%). Conclusions Our study indicates an overall poor sleep quality and physical activity level among fourth-year medical students, particularly boarding students, who have lower test scores and worse sleep and physical activity levels. In general, male students have better GPAQ scores and female students have better PSQI scores. Both the PSQI and GPAQ scores are significantly correlated with test scores and provide potential target areas to improve the exam performance of the students.
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http://dx.doi.org/10.7759/cureus.5086DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6721912PMC
July 2019
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