Publications by authors named "M M Aarif Syed"

851 Publications

Urinary neutrophil gelatinase-associated lipocalin (NGAL) can potentially predict vascular complications and reliably risk stratify patients with peripheral arterial disease.

Sci Rep 2022 May 18;12(1):8312. Epub 2022 May 18.

Division of Vascular Surgery, St. Michael's Hospital, Toronto, ON, M5B 1W8, Canada.

Neutrophil gelatinase-associated lipocalin (NGAL) is expressed in atherosclerotic plaques and implicated in the development of cardiovascular diseases. Peripheral arterial disease (PAD) is an atherosclerotic disease that often results in major cardiovascular events. This study aimed to prospectively examine the potential of urine NGAL (uNGAL) in predicting worsening PAD status and major adverse limb events (MALE). Baseline urine NGAL (uNGAL) and urine creatinine (uCr) concentrations were measured in PAD (n = 121) and non-PAD (n = 77) patients. Levels of uNGAL were normalized for urine creatinine (uNGAL/uCr). Outcomes included worsening PAD status, which was defined as a drop in ankle brachial index (ABI) > 0.15, and major adverse limb events (MALE), which was defined as a need for surgical revascularization or amputations. PAD patients had 2.30-fold higher levels of uNGAL/uCr [median (IQR) 31.8 (17.0-62.5) μg/g] in comparison to non-PAD patients [median (IQR) 73.3 (37.5-154.7) μg/g] (P = 0.011). Multivariate cox analysis showed that uNGAL/uCr levels were independently associated with predicting worsening PAD status and MALE outcomes. Cumulative survival analysis, over follow up period, demonstrated a direct correlation between elevated uNGAL/uCr levels and PAD disease progression and MALE outcomes. These data demonstrate an association between elevated uNGAL/uCr levels and worsening PAD disease status and MALE outcomes, indicating its potential for risk-stratification of PAD patients.
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http://dx.doi.org/10.1038/s41598-022-12286-2DOI Listing
May 2022

High-intensity Hospital Utilization Among Adults With Diabetic Foot Ulcers: A Population-based Study.

Can J Diabetes 2021 Oct 22. Epub 2021 Oct 22.

Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Division of Vascular Surgery, Department of Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Diabetes Action Canada, Toronto, Ontario, Canada. Electronic address:

Background: Diabetic foot ulcers (DFUs) are common and disabling, necessitating lengthy hospitalizations. In this study we sought to identify potentially modifiable determinants of high-intensity hospital care use among adults with DFUs.

Methods: Three related case-control studies were conducted using Canada-wide cohorts of adults hospitalized with a DFU from 2011 to 2015. In study 1, cases comprised the top 10% with the highest cumulative 1-year acute care hospital costs; controls were randomly selected from those below the top 10%. Study 2 comprised cases/controls within/below the top 10% for cumulative acute care hospital length of stay (LOS). Study 3 included cases/controls within/below the top 10% for cumulative number of acute care hospitalizations. Using generalized linear models, predictor variables were tested between cases and controls, while adjusting for age and sex.

Results: In study 1, mean acute care costs among 8,971 cases and 3,174 controls were $71,757 and $13,687, respectively. Sepsis conferred the greatest excess cost (mean, $38,790; 95% confidence interval [CI], $34,597 to $43,508), followed by chronic kidney disease (mean, $30,607; 95% CI, $28,389 to $32,825) and major lower limb amputation (mean, $30,884; 95% CI, $28,613 to $33,155). In study 2, mean LOS was higher among 8,477 cases (69 days) than 3,467 controls (12 days). Lower limb amputation conferred the greatest adjusted excess in mean LOS (mean, 28 days; 95% CI, 27 to 28 days). In study 3, there was a mean of 3 hospitalizations among 10,341 cases and 1 among 5,509 controls. Peripheral artery disease conferred the greatest excess number of hospitalizations (1.3 more hospitalizations; 1.2 to 1.4).

Conclusions: Early aggressive treatment of chronic kidney disease and peripheral artery disease, alongside guideline-based amputation prevention strategies, may reduce high-intensity hospital care use among adults with DFU.
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http://dx.doi.org/10.1016/j.jcjd.2021.10.005DOI Listing
October 2021

Epidemiology and molecular characterization of Staphylococcus aureus causing bovine mastitis in water buffaloes from the Hazara division of Khyber Pakhtunkhwa, Pakistan.

PLoS One 2022 5;17(5):e0268152. Epub 2022 May 5.

Centre for Antimicrobial Resistance, Alberta Health Services/Alberta Precision Laboratories/University of Calgary, Calgary, Alberta, Canada.

Buffalo represent a major source of milk in Pakistan. However, production is impacted by the disease bovine mastitis. Mastitis causes significant economic losses, with Staphylococcus aureus (S. aureus) being one of its major causative agents. While much work has been done understanding the epidemiology of bovine mastitis in Pakistan, detailed molecular characterization of the associated S. aureus is unavailable. In the current study both the epidemiological and molecular characterization of S. aureus from bovine mastitis in the Hazara division of Pakistan are examined. S. aureus was isolated from 18.41% of the animals, and left quarters more prone to infection (69.6%) than right quarters (30.4%). Sub-clinical mastitis (75.31%) was more prevalent than clinical mastitis (24.69%), with infections evenly distributed amongst the eight districts. Molecular characterization revealed that only 19.6% of the isolates were methicillin-resistant, and four strains types identified, including ST9-t7867-MSSA, ST9-MSSA, ST101-t2078-MSSA, and ST22-t8934-MRSA-IVa. Antiseptic resistance genes were not detected in the isolates, and low levels of antibiotic resistance were also noted, however the methicillin-resistant strains had higher overall antibiotic resistance. This study represents the most complete molecular typing data for S. aureus causing bovine mastitis in the Hazara district of Pakistan, and the country as a whole.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0268152PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC9071125PMC
May 2022

Is Routine Imaging Necessary for the Management of Pediatric Hand Fractures Postoperatively?

Ann Plast Surg 2022 Apr 2. Epub 2022 Apr 2.

From the Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom.

Background: Pediatric hand fractures heal remarkedly well, and clinically significant displacement after operative fixation is rare. Radiation exposure in medical practice is regulated by the Ionizing Radiation Medical Exposure Regulations 2017, and unnecessary radiation should be avoided. In the literature, there is paucity of information regarding the number of radiographs required in the postoperative period and guidelines are lacking.

Methods: This study aims to examine whether routine imaging or the lack of it influences functional outcome and time to discharge from the clinic. A retrospective data of pediatric hand fractures requiring intervention between 2014 and 2018 at our institution were conducted before and after elimination of routine postoperative imaging. A total of 230 patients were included in the study.

Results: Two cohorts of patients were identified. The first had routine postoperative radiographs, whereas the second did not have routine radiographs. There was no change in management and difference in the range of motion at discharge between the 2 groups (P = 0.74). Patients without routine imaging were discharged earlier from clinic (74.4 vs 108.2 days, P = 0.012).

Conclusions: This study shows that clinically significant fracture displacement is rare after operative reduction and fixation in pediatric age group. It demonstrates our experience in refraining from routine postoperative radiographs. The overall benefit is to avoid unnecessary radiation and subsequent costs implicated.
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http://dx.doi.org/10.1097/SAP.0000000000003151DOI Listing
April 2022

In Pursuit of Better Care Transitions: Lessons Learned from a Co-Designed Project.

Healthc Q 2022 Apr;24(SP):49-54

A caregiver partner on the ALC Patient and Caregiver Advisory Council in Mississauga, ON.

In this commentary, we reflect on our experience of co-designing an intervention to address challenges due to delayed hospital discharge (known as alternate level of care in Canada). Through a series of focus groups and co-design sessions, we identified common challenges with delayed discharge (including a lack of services while waiting for discharge and poor communication with the care team). In co-designing service improvements, we (1) amplified the voices of patients and caregivers, which helped them feel unified in their experience and (2) developed tools that aim to improve patient, caregiver and provider experiences. In this commentary, we reflect on these impacts along with the key lessons learned.
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http://dx.doi.org/10.12927/hcq.2022.26774DOI Listing
April 2022
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