Publications by authors named "Hassan Khan"

144 Publications

Pakistan Oral Cancer Collaborative: analyzing barriers and obstacles to oral cancer diagnosis, treatment, and prevention in Pakistan.

Oral Surg Oral Med Oral Pathol Oral Radiol 2021 May 13:4623. Epub 2021 May 13.

Senior Clinical Lecturer and Consultant Pathologist, School of Clinical Dentistry, University of Sheffield, Sheffield, UK. Electronic address:

Oral cancer is a global health problem with increasing case numbers worldwide and no significant improvement in prognosis over the last few decades. It is one of the most common cancers and a leading cause of death in Pakistan, although the number reported is significantly underreported owing to the lack of a national cancer repository, and the true magnitude of this challenge is not known. Bilateral discussions and workshops funded by the Global Challenges Research Fund brought together a number of like-minded researchers and clinicians from the United Kingdom and Pakistan to analyze the status quo and plan the future course. This article reviews some of these discussions as well as barriers to oral cancer diagnosis in Pakistan and makes recommendations to investigate the magnitude and develop measures that may help tackle this devastating disease.
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http://dx.doi.org/10.1016/j.oooo.2021.04.058DOI Listing
May 2021

Atrial Fibrillation in COVID-19: Therapeutic Target or Grave Omen?

Heart Lung Circ 2021 Aug;30(8):1114-1116

Leon H. Charney Division of Cardiology, New York University Langone Health, New York, NY, USA. Electronic address:

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http://dx.doi.org/10.1016/j.hlc.2021.06.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8240120PMC
August 2021

Percentage of Age-Predicted Cardiorespiratory Fitness Is Inversely Associated with Cardiovascular Disease Mortality: A Prospective Cohort Study.

Cardiology 2021 Jul 1:1-8. Epub 2021 Jul 1.

National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, United Kingdom.

Introduction: Percentage of age-predicted cardiorespiratory fitness (% age-predicted CRF) is a potentially useful cardiopulmonary exercise testing (CPX) parameter, but there are limited data on its prognostic relevance for adverse cardiovascular disease (CVD) outcomes. We aimed to assess the association of % age-predicted CRF with CVD mortality and the extent to which % age-predicted CRF measurements could improve the prediction of CVD mortality.

Methods: Peak oxygen uptake, used as the measure of CRF, was directly assessed in 2,276 men who underwent CPX. The age-predicted CRF estimated from a regression equation for age was transformed to % age-predicted CRF with the following formula: (achieved CRF/age-predicted CRF) × 100. Hazard ratios (HRs) (95% confidence intervals [CIs]) and measures of risk discrimination for CVD mortality were calculated.

Results: During a median follow-up of 28.5 years, 643 fatal CVDs were recorded. The relationship between % age-predicted CRF and CVD mortality was dose response in nature. In analysis adjusted for conventional risk factors, one standard deviation increase in % age-predicted CRF was associated with a reduced risk of CVD mortality (HR 0.61; 95% CI: 0.56-0.67), which was minimally attenuated on further adjustment for several other confounders (HR 0.71; 95% CI: 0.64-0.78). Addition of % age-predicted CRF to a CVD mortality risk prediction model containing established risk factors significantly improved risk discrimination and reclassification.

Conclusion: Percentage of age-predicted CRF is inversely and independently associated with CVD mortality in a graded fashion and significantly improves the prediction and classification of the long-term risk for CVD mortality beyond established risk factors.
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http://dx.doi.org/10.1159/000516123DOI Listing
July 2021

Early Chest Re-Exploration for Excessive Bleeding in Post Cardiac Surgery Patients: Does It Matter?

Cureus 2021 May 18;13(5):e15091. Epub 2021 May 18.

Anesthesiology, Rehman Medical Institute, Peshawar, PAK.

Introduction Re-explorations after open-heart surgery are often required if the patient is bleeding or shows features of cardiovascular instability and does not improve with conservative measures. Our study aims to determine whether timely re-exploration of patients who are bleeding has an impact on the morbidity and mortality of the patients. Methods A retrospective analysis of 75 patients that underwent open-heart surgery and subsequently underwent chest re-exploration for excessive bleeding betweenMarch 2018 and March 2020. Patients who were reopened post-op for indications other than excessive bleeding were excluded. Results A total number of cases were 700, out of which 75 (9.3%) patients were reopened, as compared to the literature, which shows worldwide 2-11% being reopened. Post-operative drain output was 1000ml to 1500ml in 47 (62.7%) and more than 1500ml in 28 (37.3%) patients before they were reopened. In 67 (89.3%) patients, three to five units of blood were transfused, and in eight (10.7%) patients, more than five units of blood were transfused. We believe our mortality in the reopened patients was low, because of timely intervention and early re-exploration, and is probably the reason why our figures land in a higher range (2-11%) of reopened cases (9.3%). Reopening time was less than five hours in 49 (65.3%) patients and less than 10 hours in 26 (34.7%) patients in our study. We tried to minimize the loss of blood and re-explored the patients before they lose excessive blood, the average time for reopening in our study was less than 10 hours. The average intensive care unit (ICU) stay was 4.2 days (range three to six days). Wound infections were reported in one of three patients. There was no mortality in these patients. Surgical site of bleeding was identified in 54 (72%) patients and no particular site was found in 21 (28%) patients. Suggesting that it is common to have a surgical bleeder than coagulopathy induced bleeding in post-cardiac surgery patients Conclusions We believe our low mortality (0%) is due to early reopening in patients who are bleeding excessively after cardiac surgery.
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http://dx.doi.org/10.7759/cureus.15091DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8212849PMC
May 2021

The Experience Of Intralesional Bleomycin For Orbital Vascular Anomalies.

J Ayub Med Coll Abbottabad 2021 Apr-Jun;33(2):240-243

LRBT Tertiary Teaching Eye Hospital, Korangi 21/2, Karachi, Pakistan.

Background: Orbital vascular anomalies are congenital and pose a challenge. They require various treatment modalities which are often unsuccessful. The use of intralesional Bleomycin has gained popularity in recent times as a scar less procedure when other treatment modalities are not effective.

Purpose: To share the experience of using intra lesional Bleomycin in orbital vascular anomalies in a Tertiary care hospital.

Methods: This quasi-experimental study was carried out at Layton Rahmatullah Benevolent Trust (LRBT) Teaching Tertiary care hospital, Karachi from 1st June to 31st December 2018. It included fifteen patients of various orbital vascular anomalies treated with injection of intra lesional sclerosing (Bleomycin) agent. Patients were given multiple injections and the effects of sclerosing agent on orbital vascular anomalies were observed.

Results: Results were excellent in terms of regression of vascular anomalies.

Conclusions: Intralesional sclerosing agent (Bleomycin) has an outstanding role in vascular tumour.
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July 2021

Outcome Of Recurrent Macular Hole Closure With Amniotic Membrane Plug.

J Ayub Med Coll Abbottabad 2021 Apr-Jun;33(2):179-182

Department of Ophthalmology, Layton Rehmatullah Benevolent Trust free tertiary Care Eye Hospital, Karachi, Pakistan.

Background: The surgery of macular hole is a complex and intricate micro-surgery and chances of recurrence of macular hole are always high. Therefore, in order to provide a medium to close this hole, we carried out this research on subjects using amniotic membrane, in light of the studies being conducted around the world. This in turn led to benefitting the patients by improving their vision over time.

Purpose: To assess the rate of recurrent macular hole closure with amniotic membrane plug. It was a Quasi-experimental study, conducted at Layton Rahmatullah Benevolent Trust (LRBT) Free Eye Hospital Karachi, from January 2019 to January 2020.

Methods: This study was conducted using 13 eyes of 13 patients with recurrent macular hole who underwent amniotic membrane plugging via pars plana approach. Outcomes measured were changes in best corrected visual acuity (BCVA) and change in hole size with the help of optical coherence tomography (OCT).

Results: Anatomic closure was attained in 100% of the cases whereas BCVA improved from 1.7±0.33 (6/300) to 0.9±0.15 (6/48).

Conclusions: The use of AM is a functional method for management of large RMH.
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July 2021

A Network Meta-Analysis Comparing Osteoporotic Fracture among Different Direct Oral Anticoagulants and Vitamin K Antagonists in Patients with Atrial Fibrillation.

J Bone Metab 2021 May 31;28(2):139-150. Epub 2021 May 31.

Department of Cardiology, Sri Jayadeva Institute of Cardiac Sciences and Research, Bengaluru, India.

Background: There are limited studies comparing the risk of osteoporosis and fractures between different direct oral anticoagulants (DOACs) and vitamin K antagonists (VKA) in non-valvular atrial fibrillation (AF). Using a network meta-analysis (NMA), we compared osteoporotic fractures among 5 different treatment arms, viz. dabigatran, rivaroxaban, apixaban, edoxaban, and VKA.

Methods: Ten studies, including 5 randomized control trials and 5 population-based studies, with a total of 321,844 patients (148,751 and 173,093 in the VKA and DOAC group, respectively) with a median follow-up of 2 years, were included. A Bayesian random-effects NMA model comparing fractures among the treatment arms was performed using MetInsight V3. Sensitivity analysis excluded studies with the highest residual deviances from the NMA model.

Results: The mean age of the patients was 70 years. The meta-analysis favored DOACs over VKA with significantly lower osteoporotic fracture (odds ratio [OR], 0.77; 95% credible interval [CrI], 0.70-0.86). The NMA demonstrated that fractures were significantly lower with apixaban compared with dabigatran (OR, 0.64; 95% CrI, 0.44-0.95); however, fractures were statistically similar between apixaban and rivaroxaban (OR, 0.84; 95% CrI, 0.58-1.24) and dabigatran and rivaroxaban (OR, 1.32; 95% CrI, 0.90-1.87). Based on the Bayesian model of NMA, the probability of osteoporotic fracture was highest with VKA and lowest with apixaban, followed by rivaroxaban, edoxaban, and dabigatran.

Conclusions: The decision to prescribe anticoagulants in elderly patients with AF should be made not only based on thrombotic and bleeding risks but also on the risk of osteoporotic fracture; these factors should be considered and incorporated in contemporary cardiology practice.
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http://dx.doi.org/10.11005/jbm.2021.28.2.139DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8206613PMC
May 2021

To assess the role of cataract extraction in glaucoma management by its intraocular pressure lowering effect.

J Pak Med Assoc 2021 Apr;71(4):1100-1102

Department of Ophthalmology, LRBT Free Eye Care Hospital, Shahpur, Pakistan.

Objective: To measure the mean change of intraocular pressure in glaucoma patients with cataract after uncomplicated phacoemulsification surgery with intraocular lens implanted in capsular bag.

Methods: The quasi-experimental study was conducted at the Ophthalmology Department of Pakistan Institute of Medical Sciences Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan, from June 11 to December 10, 2018, and comprised patients who had uncomplicated cataract extraction by phacoemulsification with intraocular lens implant in the capsular bag in glaucomatous eyes of age 30-80 years. Visual acuity, intraocular pressure, slit lamp examination, fundoscopy, visual fields, details about topical medication and relevant history were recorded not more than 5 days before cataract extraction. Intraocular pressure was recorded using Goldman's applanation tonometer one day before surgery, and post-surgery 1 month and 3 months. Data was analysed using SPSS 20.

Results: Of the 40 patients, 19(47.50%) were males and 21(52.50%) were females. The overall mean age was 52.23±9.44 years. Mean pre-operation intraocular pressure was 20.42±1.69mmHg, while at 1 month post-surgery it was 18.55±0.90mmHg and at 3 months it was 17.03±1.19mmHg (p=0.0001).

Conclusions: There was a significant change in intraocular pressure readings in glaucoma patients with cataract after uncomplicated phacoemulsification surgery with intraocular lens implanted in capsular bag.
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http://dx.doi.org/10.47391/JPMA.749DOI Listing
April 2021

Incidence and Causes of Reintubation Other Than Reopening of the Chest in Post-Cardiac Surgical Patients in a Tertiary Care Hospital.

Cureus 2021 May 10;13(5):e14939. Epub 2021 May 10.

Surgery, Hayatabad Medical Complex, Peshawar, PAK.

Objective To determine the incidence of endotracheal reintubation, excluding surgical reopening, in post-cardiac surgical patients in a tertiary care hospital. Material and methods A retrospective descriptive analysis of 408 patients who underwent different cardiac surgeries during this period. Post-operative extubation was performed when patients fulfilled the preset criteria for extubation, which include consciousness (awake and aware), stable vital signs, acceptable arterial blood gases, acceptable respiratory mechanics, a maximum inspiratory force greater than 20-25 cm HO, chest tube drainage less than 100 ml per hour, normal temperature and electrolytes. The total number of patients who were reintubated within 72 hours of extubation was noted. The criteria for reintubation included altered conscious level with Glasgow Coma Score (GCS) of less than 8, respiratory failure, unstable hemodynamics, and arrhythmias such as ventricular tachycardia (VT) and fibrillation. All of the information was collected retrospectively on a specifically prepared form. Data was entered and evaluated in Statistical Package for the Social Sciences. The research was piloted in the Cardiac Intensive Care Unit (CICU) of Northwest General Hospital and Research Center, Hayatabad, Peshawar from December 2018 to March 2020. Results Out of 408 patients who had cardiac surgeries, only nine (2.2%) were reintubated after initial extubation. The average time for which patients remained on the ventilator was 8 ± 2 hours. The reasons for reintubation were recorded. Among those reintubated, eight patients (88.88%) had undergone coronary artery bypass grafting (CABG) whereas one patient (11.11%) had undergone mitral valve replacement (MVR). In three (33.33%) patients, stroke (hemiplegia in two and global brain ischemia in one) with low GCS was the primary cause of reintubation. Arrhythmias - which included VT, ventricular fibrillation (VF), and supraventricular tachyarrhythmias (SVT) - were responsible for three (33.33%) cases of reintubation. Respiratory failure - with a partial pressure of oxygen in arterial blood less than 60 mmHg, along with tachypnea - was responsible for reintubation in two (22.22%) patients. In one (11.11%) patient who had MVR, cardiac arrest was the underlying reason; the cause of arrest could not be retrieved from the retrospective data. Notably, as a common variable, five (62.5%) out of the eight reintubated CABG patients had a poor left ventricular function.  Conclusion Causes of reintubation were primarily cardiac (arrhythmias) and neurological, followed by respiratory causes in our center. Patients with poor left ventricular function and diffuse coronary artery disease appear to have a higher incidence of reintubation which can lead to extended CICU and hospital stay, elevated mortality, and higher costs.
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http://dx.doi.org/10.7759/cureus.14939DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8189528PMC
May 2021

Refining the Approach to Risk Stratification in Patients With Dilated Cardiomyopathy.

J Am Coll Cardiol 2021 Jun;77(23):2906-2908

Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York, USA.

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http://dx.doi.org/10.1016/j.jacc.2021.04.031DOI Listing
June 2021

Inverse Association of Handgrip Strength With Risk of Heart Failure.

Mayo Clin Proc 2021 06 26;96(6):1490-1499. Epub 2021 Mar 26.

National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, United Kingdom; Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, United Kingdom.

Objective: To evaluate the nature, magnitude, and specificity of the association between handgrip strength (HGS) and heart failure (HF) risk.

Patients And Methods: Handgrip strength was assessed at baseline from March 1, 1998, to December 31, 2001, by use of a hand dynamometer in the Finnish Kuopio Ischemic Heart Disease prospective population-based cohort of 770 men and women aged 61 to 74 years without a history of HF. Relative HGS was obtained by dividing the absolute value by body weight. Hazard ratios (HRs) with 95% CIs were estimated with Cox regression models. We used multiple imputation to account for missing data.

Results: During a median (interquartile range) follow-up of 17.1 (11.3-18.3) years, 177 HF events were recorded. Handgrip strength was continually associated with risk of HF, consistent with a curvilinear shape. On adjustment for several established risk factors and other potential confounders, the HR (95% CI) for HF was 0.73 (0.59-0.91) per 1 SD increase in relative HGS. Comparing the top vs bottom tertiles of relative HGS, the corresponding adjusted HR was 0.55 (0.38-0.81). The association remained similar across several clinical subgroups. Imputed results were broadly similar to the observed results.

Conclusion: Relative HGS is inversely and continually associated with the future risk of HF in the general population. Studies are warranted to evaluate whether HGS may be a useful prognostic tool for HF in the general population and to determine whether resistance exercise training may lower the risk of HF.
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http://dx.doi.org/10.1016/j.mayocp.2020.09.040DOI Listing
June 2021

Spatiotemporal variation in urban overheating magnitude and its association with synoptic air-masses in a coastal city.

Sci Rep 2021 Mar 24;11(1):6762. Epub 2021 Mar 24.

Department of Physics, University of Ioannina, 45110, Ioannina, Greece.

Urban overheating (UO) may interact with synoptic-scale weather conditions. The association between meteorological parameters and UO has already been a subject of considerable research, however, the impact of synoptic-scale weather conditions on UO magnitude, particularly in a coastal city that is also near the desert landmass (Sydney) has never been investigated before. The present research examines the influence of synoptic-scale weather conditions on UO magnitude in Sydney by utilizing the newly developed gridded weather typing classification (GWTC). The diurnal, and seasonal variations in suburban-urban temperature contrast (ΔT) in association with synoptic-scale weather conditions, and ΔT response to synoptic air-masses during extreme heat events are investigated in three zones of Sydney. Generally, an exacerbation in UO magnitude was reported at daytime over the years, whereas the nocturnal UO magnitude was alleviated over time. The humid warm (HW), and warm (W) air-masses were found primarily responsible for exacerbated daytime UO during extreme heat events and in all other seasons, raising the mean daily maximum ΔT to 8-10.5 °C in Western Sydney, and 5-6.5 °C in inner Sydney. The dry warm (DW), and W conditions were mainly responsible for urban cooling (UC) at nighttime, bringing down the mean daily minimum ΔT to - 7.5 to - 10 °C in Western Sydney, and - 6 to - 7.5 °C in inner Sydney. The appropriate mitigation technologies can be planned based on this study to alleviate the higher daytime temperatures in the Sydney suburbs.
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http://dx.doi.org/10.1038/s41598-021-86089-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7991413PMC
March 2021

Percentage of age-predicted cardiorespiratory fitness and risk of sudden cardiac death: A prospective cohort study.

Heart Rhythm 2021 Jul 6;18(7):1171-1177. Epub 2021 Mar 6.

National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and the University of Bristol, Bristol, United Kingdom; Translational Health Sciences, Bristol Medical School, University of Bristol, Learning & Research, Southmead Hospital, Bristol, United Kingdom.

Background: The inverse associations between cardiorespiratory fitness (CRF) and vascular outcomes have been established. However, there has been no prospective evaluation of the relationship between percentage of age-predicted cardiorespiratory fitness (%age-predicted CRF) and risk of sudden cardiac death (SCD).

Objective: The purpose of this study was to assess the association of %age-predicted CRF with SCD risk in a long-term prospective cohort study.

Methods: CRF was assessed using the gold standard respiratory gas exchange analyzer in 2276 men who underwent cardiopulmonary exercise testing. The age-predicted CRF estimated from a regression equation for age was converted to %age-predicted CRF using (Achieved CRF/Age-predicted CRF) × 100. Hazard ratios (HRs) [95% confidence intervals (CIs)] were calculated for SCD.

Results: During median follow-up of 28.2 years, 260 SCDs occurred. There was a dose-response relationship between age-predicted CRF and SCD. A 1-SD increase in %age-predicted CRF was associated with a decreased risk of SCD in analysis adjusted for established risk factors (HR 0.60; 95% CI 0.53-0.70), which remained consistent on further adjustment for several potential confounders, including alcohol consumption, physical activity, socioeconomic status, and systemic inflammation (HR 0.73; 95% CI 0.62-0.85). The corresponding adjusted HRs were 0.34 (0.23-0.50) and 0.52 (0.34-0.79), respectively, when comparing extreme quartiles of %age-predicted CRF levels. HRs for the associations of absolute CRF levels with SCD risk in the same participants were similar.

Conclusion: Percentage of age-predicted CRF is continuously, strongly, and independently associated with risk of SCD and is comparable to absolute CRF as a risk indicator for SCD.
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http://dx.doi.org/10.1016/j.hrthm.2021.03.010DOI Listing
July 2021

Multifaceted strategies to improve blood pressure control in a primary care clinic: A quality improvement project.

Int J Cardiol Hypertens 2020 Dec 27;7:100060. Epub 2020 Oct 27.

Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA.

Background: Approximately 80% of patients with hypertension in the Internal Medicine Clinic were uncontrolled (BP > 130/80 mmHg), according to the 2017 American College of Cardiology (ACC)/American Heart Association (AHA) hypertension guidelines, leading to increased morbidity and mortality. The aim of this quality improvement (QI) was to improve BP control <130/80 from the baseline rates of 20%-30% and <140/90 from the baseline rates of 40%-60% between ages of 18-75 years, within 12 months.

Methods: We used the Plan-Do-Study-Act method. A multidisciplinary QI team identified barriers by fish bone diagram. Barriers included: 1) Physicians' knowledge gap and clinical inertia in optimization of medications, and 2) Patients' nonadherence to medication and appointments. The outcome measures were the percentage of patients with BP < 140/90 and < 130/80. Process measures included: 1) attendance rates of physician and nurses at educational sessions, 2) medication reconciliation completion rates and 3) care guide order rates. Key interventions were: 1) physicians and nurses' education regarding ACC/AHA guidelines, 2) patient education and engagement and 3) enhancement of health information technology. Data analysis was performed using monthly statistical process control charts.

Results: We achieved 62.6% (n = 885/1426) for BP < 140/90 and 24.47% (n = 349/1426) for BP < 130/80 within 12 months project period. We sustained and exceeded at 72.64% (n = 945/1301) for BP < 140/90 and 44.58% (n = 580/1301) for BP < 130/80 during the 10 months post-project period.

Conclusions: Overcoming physician clinical inertia, enhancing patient adherence to appointments and medications, and a high functioning multidisciplinary team were the key drivers for the success.
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http://dx.doi.org/10.1016/j.ijchy.2020.100060DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7803046PMC
December 2020

Haematological outcomes in progression of malaria: A cohort study from district Dera Ismail Khan, Pakistan.

J Pak Med Assoc 2020 Oct;70(10):1830-1833

Department of Medical Laboratory Technology, University of Haripur, KPK, Pakistan.

Malaria is the second highest reported disease from public health sector which affects about 4 million people each year in Pakistan. The study sought to evaluate the haematological changes in malarial patients in order to find any relation of these changes with malarial pathogenesis. This cross sectional descriptive study was designed at the pathology department of Gomal Medical College, Dera Ismail Khan during March 2015 to February 2017. Blood samples were collected from 400 malaria microscopy positive in EDTA tubes for the analysis of haematological parameters like Total leucocyte count, Haemoglobin, Platelets, Mean Cell Volume, Mean Cell Haemoglobin and Mean Cell Haemoglobin Concentration. Out of the 400 cases of malaria, 366 (91.5%) were Plasmodium vivax, 24 (6.0%) were Plasmodium falciparum and 10 (2.5%) were co-infection of Plasmodium vivax and Plasmodium falciparum infection. Anaemia was seen in 148 (37%) of cases; thrombocytopenia was 316(79%) and 60 (15%) cases had leucopenia. This study shows that malarial patients exhibited important changes in haematological parameters like thrombocytopenia; anaemia and leucopenia are significant predictors of malaria infection. When used in combination with other clinical and microscopy methods, these parameters could improve the diagnosis and treatment of malaria.
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http://dx.doi.org/10.5455/JPMA.15845DOI Listing
October 2020

Brain tumor classification in MRI image using convolutional neural network.

Math Biosci Eng 2020 09;17(5):6203-6216

School of Information Engineering, Southwest Unversity of Science and Techonlogy, Mianyang 621010, China.

Brain tumor is a severe cancer disease caused by uncontrollable and abnormal partitioning of cells. Recent progress in the field of deep learning has helped the health industry in Medical Imaging for Medical Diagnostic of many diseases. For Visual learning and Image Recognition, task CNN is the most prevalent and commonly used machine learning algorithm. Similarly, in our paper, we introduce the convolutional neural network (CNN) approach along with Data Augmentation and Image Processing to categorize brain MRI scan images into cancerous and non-cancerous. Using the transfer learning approach we compared the performance of our scratched CNN model with pre-trained VGG-16, ResNet-50, and Inception-v3 models. As the experiment is tested on a very small dataset but the experimental result shows that our model accuracy result is very effective and have very low complexity rate by achieving 100% accuracy, while VGG-16 achieved 96%, ResNet-50 achieved 89% and Inception-V3 achieved 75% accuracy. Our model requires very less computational power and has much better accuracy results as compared to other pre-trained models.
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http://dx.doi.org/10.3934/mbe.2020328DOI Listing
September 2020

Evidence of chitin in the ampullae of Lorenzini of chondrichthyan fishes.

Curr Biol 2020 10;30(20):R1254-R1255

Department of Biology, University of Washington, Seattle, WA 98195, USA; Department of Molecular and Cell Biology, University of California, Merced, Merced, CA 95343, USA. Electronic address:

We previously reported that the polysaccharide chitin, a key component of arthropod exoskeletons and fungal cell walls, is endogenously produced by fishes and amphibians in spite of the widely held view that it was not synthesized by vertebrates [1]. Genes encoding chitin synthase enzymes were found in the genomes of a number of fishes and amphibians and shown to be correspondingly expressed at the sites where chitin was localized [1,2]. In this report, we present evidence suggesting that chitin is prevalent within the specialized electrosensory organs of cartilaginous fishes (Chondrichthyes). These organs, the Ampullae of Lorenzini (AoL), are widely distributed and comprise a series of gel-filled canals emanating from pores in the skin (Figure 1A). The canals extend into bulbous structures called alveoli that contain sensory cells capable of detecting subtle changes in electric fields (Figure 1B) [3,4]. The findings described here extend the number of vertebrate taxa where endogenous chitin production has been detected and raise questions regarding chitin's potential function in chondrichthyan fishes and other aquatic vertebrates.
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http://dx.doi.org/10.1016/j.cub.2020.08.014DOI Listing
October 2020

Handgrip Strength and Risk of Atrial Fibrillation.

Am J Cardiol 2020 12 9;137:135-138. Epub 2020 Oct 9.

Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland; Institute of Clinical Medicine, Department of Medicine, University of Eastern Finland, Kuopio, Finland; Central Finland Health Care District Hospital District, Department of Medicine, Jyväskylä, Finland.

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http://dx.doi.org/10.1016/j.amjcard.2020.10.006DOI Listing
December 2020

Analyzing the local and climatic conditions affecting the urban overheating magnitude during the Heatwaves (HWs) in a coastal city: A case study of the greater Sydney region.

Sci Total Environ 2021 Feb 24;755(Pt 1):142515. Epub 2020 Sep 24.

Department of Physics, University of Ioannina, GR-45110 Ioannina, Greece.

Urban overheating coincides with Heatwaves (HWs) and the thermal stress might get amplified in cities. To predict the interactions between urban overheating and HWs, the surface energy balance response to HWs is crucial. HW is a regional phenomenon and the climatic conditions may influence the local conditions to alter the energy budget contrast between a city and its adjacent peripheral areas. The interactions between the urban overheating and HWs are explored in a coastal city (Sydney Australia), also in the proximity of dry landmass, while considering the site characteristics, distance from the coast, and the population density. A positive response between urban overheating and HWs is reported. Advective heat flux in the form of a dualistic circulation system is found responsible for exacerbating the urban overheating magnitude (ΔT) during the HWs and altering the available energy balance. Land-coastal distance is also found as an important contributor in magnifying the urban-suburban temperature contrast. Considering the future urbanization in western Sydney, surfaces capable of retaining higher moisture content are prescribed to reduce the occurrence of extreme HW events. Activation of the ventilation corridor for the coastal wind penetration in western Sydney is another recommendation of this study.
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http://dx.doi.org/10.1016/j.scitotenv.2020.142515DOI Listing
February 2021

Automated feature detection in dental periapical radiographs by using deep learning.

Oral Surg Oral Med Oral Pathol Oral Radiol 2021 Jun 27;131(6):711-720. Epub 2020 Aug 27.

Senior Clinical Lecturer, Consultant Oral Pathologist, University of Sheffield, Sheffield, UK.

Objective: The aim of this study was to investigate automated feature detection, segmentation, and quantification of common findings in periapical radiographs (PRs) by using deep learning (DL)-based computer vision techniques.

Study Design: Caries, alveolar bone recession, and interradicular radiolucencies were labeled on 206 digital PRs by 3 specialists (2 oral pathologists and 1 endodontist). The PRs were divided into "Training and Validation" and "Test" data sets consisting of 176 and 30 PRs, respectively. Multiple transformations of image data were used as input to deep neural networks during training. Outcomes of existing and purpose-built DL architectures were compared to identify the most suitable architecture for automated analysis.

Results: The U-Net architecture and its variant significantly outperformed Xnet and SegNet in all metrics. The overall best performing architecture on the validation data set was "U-Net+Densenet121" (mean intersection over union [mIoU] = 0.501; Dice coefficient = 0.569). Performance of all architectures degraded on the "Test" data set; "U-Net" delivered the best performance (mIoU = 0.402; Dice coefficient = 0.453). Interradicular radiolucencies were the most difficult to segment.

Conclusions: DL has potential for automated analysis of PRs but warrants further research. Among existing off-the-shelf architectures, U-Net and its variants delivered the best performance. Further performance gains can be obtained via purpose-built architectures and a larger multicentric cohort.
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http://dx.doi.org/10.1016/j.oooo.2020.08.024DOI Listing
June 2021

Handgrip strength-A risk indicator for type 2 diabetes: Systematic review and meta-analysis of observational cohort studies.

Diabetes Metab Res Rev 2021 Feb 18;37(2):e3365. Epub 2020 Jul 18.

Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.

Aims: Evolving debate suggests that handgrip strength (HGS), a measure of muscular strength, might be associated with the risk of type 2 diabetes (T2D); however, the evidence is conflicting. Using a systematic review and meta-analysis of published observational cohort studies in general populations, we aimed to assess the association of HGS with the future risk of T2D.

Methods: Relevant studies were sought from inception until April 2020 in MEDLINE, Embase, Web of Science, and manual search of relevant articles. Transformed or extracted relative risks (RRs) with 95% confidence intervals (CIs) comparing the top vs bottom thirds of HGS levels were pooled using random effects meta-analysis.

Results: A total of 10 unique observational cohort studies comprising of 177 826 participants and >5167 T2D cases were eligible. The pooled multivariable RR (95% CI) for T2D comparing the top vs bottom thirds of HGS levels was 0.73 (0.63-0.84). This association was consistent across several relevant subgroups except for evidence of effect modification by sample size (P value for meta-regression <.001): evidence of an association in smaller studies (<250 events) 0.50 (0.40-0.63), with no significant association in bigger studies (≥250 events) 0.87 (0.73-1.05). There was no evidence of small study effects using formal tests such as funnel plots and Egger's regression symmetry test.

Conclusion: Pooled analysis of observational cohort studies suggests that HGS may be a risk indicator for T2D in the general population. The role of utilizing HGS measurements in T2D prevention strategies warrants further investigation.
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http://dx.doi.org/10.1002/dmrr.3365DOI Listing
February 2021

Extensively Drug-Resistant (XDR) Typhoid: Evolution, Prevention, and Its Management.

Biomed Res Int 2020 2;2020:6432580. Epub 2020 May 2.

Faculty of Allied Health Sciences, The University of Lahore, Lahore, Pakistan.

Typhoid fever is the result of a human host-restricted serotype typhi infection that causes enteric fever. Around 21 million people contract typhoid annually, with Pakistan's inhabitants at most risk amongst Asian countries where typhoid remains prevalent. Decades of indiscriminate antibiotic usage has driven the evolution of multidrug-resistant strains and more recently, extensively drug-resistant (XDR) strains of serotype typhi. Current reports of extensively drug-resistant typhoid fever outbreak in Pakistan are not only a major concern for Pakistan but also for health authorities worldwide: intercontinental transmission, spread, and replacement of native strains in neighboring countries and a major impediment to Pakistani health care management. The WHO records that there are 5274 cases of extensively drug-resistant (XDR) typhoid fever out of a total of 8188 total cases of typhoid fever reported in Pakistan. The last remaining feasible oral antibiotic that XDR typhoid remains susceptible to is azithromycin; this is a cause of major concern. Additionally, several cases of XDR typhoid fever have also been reported in patients travelling from Pakistan to the USA, UK, and Canada. This review article attempts to raise the issue of XDR typhoid with respect to its epidemiology, prevention, management, and future outlook and stresses a better understanding of antimicrobial stewardship and general surveillance of the disease. Although progress is being made to combat XDR typhoid locally, efficient, unified efforts on a national and international scale are required to contain the XDR outbreak before it is no longer manageable and leads us back to the preantibiotic era.
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http://dx.doi.org/10.1155/2020/6432580DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7212280PMC
February 2021

Prognostic Relevance of Cardiorespiratory Fitness as Assessed by Submaximal Exercise Testing for All-Cause Mortality: A UK Biobank Prospective Study.

Mayo Clin Proc 2020 05;95(5):867-878

Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester, UK.

Objective: To investigate whether the inverse associations of cardiorespiratory fitness (CRF) with all-cause and cardiovascular mortality in the general population vary among individuals who are at different levels of pretest risk.

Patients And Methods: Cardiorespiratory fitness was assessed through submaximal bicycle tests in 58,892 participants aged 40 to 69 years who completed baseline questionnaires between January 1, 2006, and December 31, 2010, in the UK Biobank Prospective Study. Participants were categorized into risk categories, which determined allocation to an individualized bicycle protocol. The groups at minimal risk (category 1), small risk (category 2), and medium risk (category 3) were tested at 50%, 35% of the predicted maximal workload, and constant level, respectively. We investigated associations of CRF with mortality across different levels of pretest risk and determined whether CRF improves risk prediction.

Results: During a median follow-up of 5.8 years, 936 deaths occurred. Cardiorespiratory fitness was linearly associated with mortality risk. Comparing extreme fifths of CRF, the multivariable-adjusted hazard ratios (95% CIs) for mortality were 0.63 (0.52-0.77), 0.54 (0.36-0.82), 0.81 (0.46-1.43), and 0.58 (0.48-0.69) in categories 1, 2, and 3 and overall population, respectively. The addition of CRF to a 5-year mortality risk score containing established risk factors was associated with a C-index change (0.0012; P=.49), integrated discrimination improvement (0.0005; P<.001), net reclassification improvement (+0.0361; P=.005), and improved goodness of fit (likelihood ratio test, P<.001). Differences in 5-year survival were more pronounced across levels of age, smoking status, and sex.

Conclusion: Cardiorespiratory fitness, assessed by submaximal exercise testing, improves mortality risk prediction beyond conventional risk factors and its prognostic relevance varies across cardiovascular risk levels.
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http://dx.doi.org/10.1016/j.mayocp.2019.12.030DOI Listing
May 2020

Screening for atrial fibrillation in high-risk nursing home residents.

Heart Rhythm O2 2020 Apr 27;1(1):10-13. Epub 2020 Apr 27.

Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, New York.

Background: Various methods have been implemented for screening of patients for atrial fibrillation (AF), but the yield has generally been low. Targeting high-risk patients may improve detection of asymptomatic AF, which could be of value if appropriate treatment could be initiated before a potential thromboembolic event.

Objective: The purpose of this study was to test screening of high-risk nursing home residents having ≥2 risk factors for AF and no previous history of AF using a smartphone-based electrocardiographic (ECG) monitoring device to determine whether it is an accurate, easy-to-use method of screening for asymptomatic AF.

Methods: Study participants had ≥2 risk factors, consisting of age ≥75 years, female sex, obstructive sleep apnea, peripheral vascular disease, diabetes mellitus, obesity, hypertension, and congestive heart failure. Using the monitoring device, 30-second heart rhythm recordings were obtained on 4 different occasions. All tracings were reviewed by a cardiologist and, if uncertain, by an electrophysiologist. The nursing facility was notified of any diagnosis of AF, prompting further evaluation by the primary physician.

Results: Of the 245 residents screened, 18 (7.4%) had a diagnostic tracing for AF, 15 (83.3%) of whom had AF on the initial screen. There were no significant differences in demographics or individual risk factors between residents with and those without AF.

Conclusion: Intermittent ECG screening of high-risk nursing home residents using a simple, handheld device provided a diagnostic yield in our population comparable to that observed in past studies. Such screening of high-risk individuals can aid in the early diagnosis of AF and initiation of appropriate treatment.
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http://dx.doi.org/10.1016/j.hroo.2020.02.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8183881PMC
April 2020

Leisure-time cross-country skiing and risk of atrial fibrillation and stroke: A prospective cohort study.

Eur J Prev Cardiol 2020 12 3;27(19):2354-2357. Epub 2020 Feb 3.

Division of Cardiology, Emory University, Atlanta, USA.

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http://dx.doi.org/10.1177/2047487319901040DOI Listing
December 2020

Cancer Image Quantification With And Without, Expensive Whole Slide Imaging Scanners.

Annu Int Conf IEEE Eng Med Biol Soc 2019 Jul;2019:4462-4465

Automated analysis of digitized pathology images in tele-health applications can have a transformative impact on under-served communities in the developing world. However, the vast majority of existing image analysis algorithms are trained on slide images acquired via expensive Whole-Slide-Imaging (WSI) scanners. High scanner cost is a key bottleneck preventing large-scale adoption of digital pathology in developing countries. In this work, we investigate the viability of automated analysis of slide images captured from the eyepiece of a microscope via a smart phone. The mitosis detection application is considered as a use case.Results indicate performance degradation when using (lower-quality) smartphone images; as expected. However, the performance gap is not too wide (F1-score smartphone=0.65, F1-score WSI=0.70) demonstrating that smartphones could potentially be employed as image acquisition devices for digital pathology at locations where expensive scanners are not available.
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http://dx.doi.org/10.1109/EMBC.2019.8857765DOI Listing
July 2019

Generation of Lamprey Monoclonal Antibodies (Lampribodies) Using the Phage Display System.

Biomolecules 2019 12 12;9(12). Epub 2019 Dec 12.

Department of Molecular and Cell Biology, University of California-Merced, Merced, CA 95343, USA.

The variable lymphocyte receptors (VLRs) consist of leucine rich repeats (LRRs) and comprise the humoral antibodies produced by lampreys and hagfishes. The diversity of the molecules is generated by stepwise genomic rearrangements of LRR cassettes dispersed throughout the VLRB locus. Previously, target-specific monovalent VLRB antibodies were isolated from sea lamprey larvae after immunization with model antigens. Further, the cloned VLR cDNAs from activated lamprey leukocytes were transfected into human cell lines or yeast to select best binders. Here, we expand on the overall utility of the VLRB technology by introducing it into a filamentous phage display system. We first tested the efficacy of isolating phage into which known VLRB molecules were cloned after a series of dilutions. These experiments showed that targeted VLRB clones could easily be recovered even after extensive dilutions (1 to 10). We further utilized the system to isolate target-specific "lampribodies" from phage display libraries from immunized animals and observed an amplification of binders with relative high affinities by competitive binding. The lampribodies can be individually purified and ostensibly utilized for applications for which conventional monoclonal antibodies are employed.
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http://dx.doi.org/10.3390/biom9120868DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6995607PMC
December 2019

Finnish sauna bathing does not increase or decrease the risk of cancer in men: A prospective cohort study.

Eur J Cancer 2019 11 4;121:184-191. Epub 2019 Oct 4.

National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol NHS Foundation Trust and University of Bristol, Bristol, UK; Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Learning & Research Building (Level 1), Southmead Hospital, Bristol, BS10 5NB, UK. Electronic address:

Introduction: Evidence suggests that heat therapy can be used to prevent and treat cancer; anecdotal reports suggest passive heat therapies may increase cancer risk. Finnish sauna bathing has been linked to a reduced risk of chronic diseases, but its association with cancer risk is unknown. We aimed to assess the prospective association between frequency of sauna bathing and the risk of all-cause and site-specific cancers using the Kuopio Ischemic Heart Disease prospective cohort.

Methods: Baseline sauna bathing habits were assessed in 2173 men aged 42-61 years with no history of cancer. Hazard ratios (HRs) with 95% confidence intervals (CIs) for cancer were calculated using Cox proportional hazard models. We corrected for within-person variability in sauna bathing habits using data from repeat assessments taken 11 years apart.

Results: During a median follow-up of 24.3 years, 588 (27.1%) all-cause cancer cases were recorded. The age-adjusted regression dilution ratio of sauna bathing frequency was 0.69 (0.62-0.76). In multivariable-adjusted analyses, the HRs (95% CIs) of all-cause cancer were 0.92 (0.76-1.11) and 0.92 (0.66-1.27) for men who had 2-3 and ≥4 sauna sessions per week, respectively, compared with men who had ≤1 sauna session per week. The non-significant findings were consistent for prostate, gastrointestinal and lung cancers on multivariate adjustment.

Conclusion: Frequent Finnish sauna bathing is not associated with the risk of cancer in a middle-aged male Caucasian population. Further studies are required to confirm or refute these findings, particularly in women and other age groups.
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http://dx.doi.org/10.1016/j.ejca.2019.08.031DOI Listing
November 2019

Sauna bathing reduces the risk of venous thromboembolism: a prospective cohort study.

Eur J Epidemiol 2019 Oct 1;34(10):983-986. Epub 2019 Aug 1.

Institute of Public Health and Clinical Nutrition, University of Eastern Finland, Kuopio, Finland.

Emerging evidence suggests there is an inverse and independent association between sauna bathing and arterial thrombotic disease. However, the potential association between sauna bathing and venous thromboembolism (VTE) has not yet been investigated. We aimed to assess the prospective association between frequency of sauna bathing and the risk of VTE. Baseline sauna bathing habits were assessed in 2242 men aged 42-61 years without a history of VTE in the Kuopio Ischemic Heart Disease prospective cohort. Cox proportional hazards models were used to estimate hazard ratios (HRs) with 95% confidence intervals (CIs) for VTE. During a median follow-up of 24.9 years, 146 (6.5%) incident VTE events were recorded. In age-adjusted analyses, the HRs 95% (CIs) of VTE were 0.67 (0.47-0.96) and 0.95 (0.53-1.70) for participants who had 2-3 and ≥ 4 sauna sessions per week respectively compared with participants who had ≤ 1 sauna session per week. After further adjustment for several established risk factors including lifestyle factors, the corresponding HRs (95% CIs) were 0.67 (0.46-0.96) and 0.92 (0.51-1.68) respectively. Having sauna baths was associated with a reduced risk of VTE in a middle-aged male Caucasian population. Further studies in other populations and age groups are required to confirm these findings.
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http://dx.doi.org/10.1007/s10654-019-00544-zDOI Listing
October 2019
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