Publications by authors named "Mamoon Rashid"

100 Publications

Deep Learning Approach for Discovery of In Silico Drugs for Combating COVID-19.

J Healthc Eng 2021 20;2021:6668985. Epub 2021 Jul 20.

Department of Mechanical Engineering, Mount Zion College of Engineering and Technology, Pudukkottai, India.

Early diagnosis of pandemic diseases such as COVID-19 can prove beneficial in dealing with difficult situations and helping radiologists and other experts manage staffing more effectively. The application of deep learning techniques for genetics, microscopy, and drug discovery has created a global impact. It can enhance and speed up the process of medical research and development of vaccines, which is required for pandemics such as COVID-19. However, current drugs such as remdesivir and clinical trials of other chemical compounds have not shown many impressive results. Therefore, it can take more time to provide effective treatment or drugs. In this paper, a deep learning approach based on logistic regression, SVM, Random Forest, and QSAR modeling is suggested. QSAR modeling is done to find the drug targets with protein interaction along with the calculation of binding affinities. Then deep learning models were used for training the molecular descriptor dataset for the robust discovery of drugs and feature extraction for combating COVID-19. Results have shown more significant binding affinities (greater than -18) for many molecules that can be used to block the multiplication of SARS-CoV-2, responsible for COVID-19.
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http://dx.doi.org/10.1155/2021/6668985DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8302400PMC
July 2021

CP-BDHCA: Blockchain-based Confidentiality-Privacy preserving Big Data scheme for healthcare clouds and applications.

IEEE J Biomed Health Inform 2021 Jul 14;PP. Epub 2021 Jul 14.

Healthcare big data (HBD) allows medical stakeholders to analyze, access, retrieve personal and electronic health records (EHR) of patients. Mostly, the records are stored on healthcare cloud and application (HCA) servers, and thus, are subjected to end-user latency, extensive computations, single point failures, and security and privacy risks. A joint solution is required to address the issues of responsive analytics, coupled with high data ingestion in HBD and secure EHR access. Motivated from the research gaps, the paper proposes a scheme, that integrates blockchain (BC)-based confidentiality-privacy (CP) preserving scheme, CP-BDHCA, that operates in two phases. In the first phase, elliptic curve cryptographic (ECC)-based digital signature framework, HCA-ECC is proposed to establish a session key for secure communication among different healthcare entities. Then, in the second phase, a two-step authentication framework is proposed that integrates RivestShamirAdleman (RSA) and advanced encryption standard (AES), named as HCARSAE is proposed that safeguards the ecosystem against possible denial-of-service (DoS) and distributed DoS (DDoS) based attack vectors. CP-BDAHCA is compared against existing HCA cloud applications in terms of parameters like response time, average delay, transaction and signing costs, signing and verifying of mined blocks, and resistance to DoS and DDoS attacks. We consider 10 BC nodes and create a real-world customized dataset to be used with SEER dataset. The dataset has 30; 000 patient profiles, with 1000 clinical accounts. Based on the combined dataset the proposed scheme outperforms traditional schemes like AI4SAFE, TEE, Secret, and IIoTEED, with a lower response time. For example, the scheme has a very less response time of 300 ms in DDoS. The average signing cost of mined BC transactions is 3; 34 seconds, and for 205 transactions, has a signing delay of 1405 ms, with improved accuracy of 12% than conventional state-of-the-art approaches.
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http://dx.doi.org/10.1109/JBHI.2021.3097237DOI Listing
July 2021

A Simplified Method for Compounding Lidocaine Topical Gel: A Demonstration of Quality Assurance to Prevent Errors in 503A Pharmacies.

Int J Pharm Compd 2021 May-Jun;25(3):197-204

Appalachian College of Pharmacy, Oakwood, Virginia.

Quality assurance is a key element in the process of creating safe and effective preparations. Furthermore, the implementation of quality-assurance measures allows 503A pharmacies to ensure accurate, well-made preparations to their customers. When corrective and preventive measures are not implemented, the risk of errors is increased, like subtherapeutic or supratherapeutic compounded medications. The objective of this article was to demonstrate the importance of quality assurance through the development and validation of the compounding method, preparation characterization, training, implementation of a master formulation record, compounding protocol, and verification to prevent compounding errors. Two groups, comprising of 10 students, compounded lidocaine gel following the quality-assurance guidelines in accordance with United States Pharmacopeia Chapter <1163>. Following the trial, the preparations from both groups were tested to evaluate the content of lidocaine using high-performance liquid chromatography and an ultra-viscosity detector. The study results indicated that the newly developed, validated procedure produced a stable, uniform, highly reproducible (%Assay ± SD; 101.65% ± 1.04), and elegant (clear hydro-alcoholic gel) preparation with a high yield (~98.5%). There was no significant difference observed in the %Assay results obtained from the two groups (%Assay ±SD; P1: 98.76% ±1.01, and P2: 99.02% ±1.39, %Difference: 0.3). Overall, our findings suggest that the implementation of quality assurance could significantly reduce compounding errors and improve both preparation quality and patient safety.
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June 2021

Performance Analysis of IoT and Long-Range Radio-Based Sensor Node and Gateway Architecture for Solid Waste Management.

Sensors (Basel) 2021 Apr 14;21(8). Epub 2021 Apr 14.

School of Computer Science and Engineering, Lovely Professional University, Jalandhar 144411, India.

Long-range radio (LoRa) communication is a widespread communication protocol that offers long range transmission and low data rates with minimum power consumption. In the context of solid waste management, only a low amount of data needs to be sent to the remote server. With this advantage, we proposed architecture for designing and developing a customized sensor node and gateway based on LoRa technology for realizing the filling level of the bins with minimal energy consumption. We evaluated the energy consumption of the proposed architecture by simulating it on the Framework for LoRa (FLoRa) simulation by varying distinct fundamental parameters of LoRa communication. This paper also provides the distinct evaluation metrics of the the long-range data rate, time on-air (ToA), LoRa sensitivity, link budget, and battery life of sensor node. Finally, the paper concludes with a real-time experimental setup, where we can receive the sensor data on the cloud server with a customized sensor node and gateway.
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http://dx.doi.org/10.3390/s21082774DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8071010PMC
April 2021

Interferon-induced transmembrane protein-3 genetic variant rs12252 is associated with COVID-19 mortality.

Genomics 2021 07 7;113(4):1733-1741. Epub 2021 Apr 7.

Experimental Medicine Department, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard - Health Affairs, Riyadh, Saudi Arabia. Electronic address:

Interferon-induced membrane proteins (IFITM) 3 gene variants are known risk factor for severe viral diseases. We examined whether IFITM3 variant may underlie the heterogeneous clinical outcomes of SARS-CoV-2 infection-induced COVID-19 in large Arab population. We genotyped 880 Saudi patients; 93.8% were PCR-confirmed SARS-CoV-2 infection, encompassing most COVID-19 phenotypes. Mortality at 90 days was 9.1%. IFITM3-SNP, rs12252-G allele was associated with hospital admission (OR = 1.65 [95% CI; 1.01-2.70], P = 0.04]) and mortality (OR = 2.2 [95% CI; 1.16-4.20], P = 0.01). Patients less than 60 years old had a lower survival probability if they harbor this allele (log-rank test P = 0.002). Plasma levels of IFNγ were significantly lower in a subset of patients with AG/GG genotypes than patients with AA genotype (P = 0.00016). Early identification of these individuals at higher risk of death may inform precision public health response.
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http://dx.doi.org/10.1016/j.ygeno.2021.04.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8025598PMC
July 2021

Role of Ferromagnetic Monolayer WSe Flakes in the Pt/YFeO Bilayer Structure in the Longitudinal Spin Seebeck Effect.

ACS Appl Mater Interfaces 2021 Apr 26;13(13):15783-15790. Epub 2021 Mar 26.

Department of Physics, Chung-Ang University, Seoul 06974, Republic of Korea.

The spin Seebeck effect (SSE) has attracted renewed interest as a promising phenomenon for energy harvesting systems. A noteworthy effort has been devoted to improving the SSE voltage by inserting ultrathin magnetic layers including FeCu interlayers in Pt/YFeO (Pt/YIG) systems with increased spin-mixing conductance at the interfaces. Nevertheless, the responsible underlying physics associated with the role of the interlayer in Pt/YIG systems in the SSE is still unknown. In this paper, we demonstrate that with a monolayer tungsten diselenide (ML WSe) interlayer in the Pt/YIG bilayer system, the longitudinal SSE (LSSE) voltage is significantly increased by the increased spin accumulation in the Pt layer; the spin fluctuation in ML WSe amplifies the spin current transmission because the in-plane-aligned WSe spins are coupled to thermally pumped spins under nonequilibrium magnetization conditions in the LSSE configuration at room temperature. The thermopower (/ΔT) improves by 323% with respect to the value of the reference Pt/YIG bilayer sample in the LSSE at room temperature. In addition, the induced ferromagnetic properties of the ML WSe flakes on YIG increase the LSSE voltage () of the sample; the ferromagnetic properties are a result of the improved magnetic moment density in the ML WSe flakes and their two-dimensional (2D) ML nature in the LSSE under nonequilibrium magnetization conditions. The results can extend the application range of the materials in energy harvesting and provide important information on the physics of the LSSE with a transition metal dichalcogenide intermediate layer in spin transport.
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http://dx.doi.org/10.1021/acsami.0c22345DOI Listing
April 2021

Taking a step down on the reconstruction ladder for head and neck reconstruction during the COVID-19 pandemic.

BMC Surg 2021 Mar 8;21(1):120. Epub 2021 Mar 8.

Plastic Surgery Department, Shifa International Hospital, Pitras Bukhari Road H-8, Islamabad, Pakistan.

Background: Most of the head and neck cancers are time-critical and need urgent surgical treatment. Our unit is one of the departments in the region, at the forefront in treating head and neck cancers in Pakistan. We have continued treating these patients in the COVID-19 pandemic with certain modified protocols. The objective of this study is to share our experience and approach towards head and neck reconstruction during the COVID-19 pandemic.

Results: There were a total of 31 patients, 20 (64.5%) were males and 11 (35.4%) patients were females. The mean age of patients was 52 years. Patients presented with different pathologies, i.e. Squamous cell carcinoma n = 26 (83.8%), mucoepidermoid carcinoma n = 2 (6.4%), adenoid cystic carcinoma n = 2 (6.4%) and mucormycosis n = 1 (3%). The reconstruction was done with loco-regional flaps like temporalis muscle flap n = 12 (38.7%), Pectoralis major myocutaneous flap n = 8 (25.8%), supraclavicular artery flap n = 10 (32.2%) and combination of fore-head, temporalis major and cheek rotation flaps n = 1 (3%). Defects involved different regions like maxilla n = 11 (35.4%), buccal mucosa n = 6 (19.3%), tongue with floor of mouth n = 6 (19.3%), mandible n = 4 (12.9%), parotid gland, mastoid n = 3 (9.6%) and combination of defects n = 1 (3%). Metal reconstruction plate was used in 3 (9.6%) patients with mandibular defects. All flaps survived, with the maximum follow-up of 8 months and minimum follow-up of 6 months.

Conclusion: Pedicled flaps are proving as the workhorse for head and neck reconstruction in unique global health crisis. Vigilant use of proper PPE and adherence to the ethical principles proves to be the only shield that will benefit patients, HCW and health system.
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http://dx.doi.org/10.1186/s12893-021-01134-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7938274PMC
March 2021

Small Intestinal Bacterial Overgrowth: A Critical Review of an Underrecognized but Disrupting Entity.

Crit Rev Oncog 2020 ;25(4):365-379

Department of Gynecologic Oncology, AdventHealth Cancer Institute, Orlando, FL 32804.

Small intestinal bacterial overgrowth (SIBO) is a common gastrointestinal (GI) problem, but its diagnosis is often missed in the clinical setting. Because its diagnosis mostly requires invasive testing, often its true prevalence is unknown. Commonly presenting complaints include abdominal distension, diarrhea, and malabsorption. Multiple predisposing factors have been recognized in peer-reviewed literature, including achlorhydria, motility disorders, anatomical abnormalities of the gastrointestinal tract, and immunodeficiency disorders, including cancer. Multiple culture-dependent and independent methods are used to confirm diagnosis. Symptomatic relief can be achieved through multiple antibiotics regimens, but correction of underlying etiology, if possible, is necessary for long-lasting cure. Increased awareness and clinical vigilance can transform the landscape of SIBO via better management of patients with GI and related disorders.
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http://dx.doi.org/10.1615/CritRevOncog.2020036017DOI Listing
January 2020

Speed and accuracy of pharmacy students' response to calculation problems with or without formula prompts.

Curr Pharm Teach Learn 2021 01 30;13(1):49-56. Epub 2020 Aug 30.

American University of Health Sciences School of Pharmacy, Signal Hill, CA, United States. Electronic address:

Introduction: The purpose of this study was to evaluate the amount of time spent per problem and the level of accuracy per problem, based on the presence or absence of a stressor. The impact on accuracy created by stress due to the lack of the formula prompt during an assessment is a major focus of this study.

Methods: Sixty-nine first-year pharmacy students were tested with four calculation questions (Qs) divided between two quizzes. The first quiz contained three multiple-choice questions (MCQs), Q1 to Q3, and no formulas to assist students. The second quiz contained one MCQ, Q4, and provided a formula to assist students. The degree of difficulty of Q1, Q2, Q3 was set lower. Also, Q3 and Q4 were identical. The only difference was the inclusion of the formula to assist the student. The absence of the formula on the first quiz served as the stressor, which impacted the average response time and level of accuracy. Analysis was performed for determining the difference among the groups of students based on their rate of accuracy and the rapidness of response.

Results: The mean time to respond to the question with the formula was not significantly different from the mean time to respond to the question with no formula. While the rapidness of response increased due to confidence in the formula provided, accuracy in response selection decreased.

Conclusion: The absence of cognitive stressors contributed to boosting student confidence and rapidness of response but reduced the accuracy.
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http://dx.doi.org/10.1016/j.cptl.2020.08.007DOI Listing
January 2021

Negative Pressure Wound Therapy (NPWT): Our Experience in Pakistan With Locally Made Dressing.

Cureus 2020 Jul 29;12(7):e9464. Epub 2020 Jul 29.

Plastic and Reconstructive Surgery, Shifa International Hospital, Islamabad, PAK.

Introduction Worldwide numbers of patients suffering from complex wounds appear to increase annually. These patients present with acute, sub-acute and chronic wounds which can be difficult to manage. Management of these patients typically requires a multi-disciplinary approach by a plastic surgeon, orthopaedic surgeon and infectious disease control team. Despite the advent of numerous new techniques and technologies, negative pressure wound therapy (NPWT) remains a cornerstone to the management of complex wounds. We present our experience with NPWT in this study. Methods This is a retrospective study of 380 patients who were treated with NPWT in the last 10 years at a single center. We receive hundreds of infected wounds of limbs each year which are either post-traumatic or post-debridement. Frequency of dressing change, C-reactive protein levels, bacterial cultures, complication rate and cost of apparatus in each case were noted. All patients received systemic antibiotics during the treatment. Results We reviewed hospital data of 520 patients in which debridement was performed. Of the 520 patients derided, 380 patients were treated with NPWT, and included in study. Number of NPWT sessions was decided on the basis of wound status (adequate healthy granulation tissue, clinically improved circulation). A single session of NPWT dressing was applied in 84% (n = 320) patients, 8% (n = 31) patients needed two sessions of NPWT dressing, 6% (n = 24) patients had three sessions of NPWT dressing and only 1% (n = 5) patients did not respond to NPWT dressing. 78% (n = 297) patients had reduced levels of C-reactive protein levels and wound cultures were negative in 54% (n = 208) patients after application of NPWT dressing. Minor complications occurred in 0.7% (n = 3) patients due to occult osteomyelitis. In 0.5% (n = 2) patients, NPWT dressing was discontinued due to persistent leakage near a natural orifice. Sinus formation was seen in 6% (n = 23) patients who were treated with curettage and conventional dressings. The mean pain score on the verbal analogue scale was 3 out of 10. The mean cost of an NPWT dressing apparatus was 90 dollars. Conclusion We conclude from this study that NPWT dressing can be easily applied to any region of the body and it can be customized to the needs of patients from different socio-economic status.
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http://dx.doi.org/10.7759/cureus.9464DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7457887PMC
July 2020

Resection and Reconstructive Options in the Management of Dermatofibrosarcoma Protuberans of the Head and Neck.

Cureus 2020 Jul 27;12(7):e9423. Epub 2020 Jul 27.

Plastic Surgery, Shifa International Hospital, Islamabad, PAK.

Objective To discuss resection and various reconstructive options in patients with dermatofibrosarcoma protuberans (DFSP). Methods This study was conducted at Shifa International Hospital, Islamabad, Pakistan, from May 2018 to December 2019. All patients aged 20 years or above of either gender who were diagnosed to have DFSP over this period were included in the study. All the patients underwent wide local excision of the tumor under general anesthesia. A peroperative frozen section was conducted in all the cases to confirm complete excision. Immediate reconstruction was performed following the tumor excision. The choice of reconstruction, i.e. free, regional, or local flap was based on the size of the resultant defect. Results The mean age of the patients was 37.11 ±10.91 years. There were 12 (66.7%) males and six (33.3%) females. The mean duration of the disease was 11.22 ±2.94 months. The affected anatomical site showed that the face was involved in the majority, nine (50%) patients, followed by the scalp in four (22.2%), nape of the neck in three (16.7%), and supraclavicular region in two (11.1%) patients. In most of the cases, the free flap was observed, i.e. (n=9, 50%), followed by a regional flap in seven (38.9%), and the local flap in two (10.1%) patients. Conclusion Wide local excision of the disease, confirmed on frozen section, offers improved survival. Among DFSP of the head and neck, the face was found to be the affected anatomical site in half the cases. Also, reconstruction following tumor excision with a free flap is the most favorable option among patients with DFSP.
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http://dx.doi.org/10.7759/cureus.9423DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7450883PMC
July 2020

SARS-CoV-2 ORF8 and SARS-CoV ORF8ab: Genomic Divergence and Functional Convergence.

Pathogens 2020 Aug 20;9(9). Epub 2020 Aug 20.

Experimental Medicine Department, King Abdullah International Medical Research Center, King Saud bin Abdulaziz University for Health Sciences, MNGHA, Riyadh 11426, Saudi Arabia.

The COVID-19 pandemic, in the first seven months, has led to more than 15 million confirmed infected cases and 600,000 deaths. SARS-CoV-2, the causative agent for COVID-19, has proved to be a great challenge for its ability to spread in asymptomatic stages and the diverse disease spectrum it has generated. This has created a challenge of unimaginable magnitude, not only affecting human health and life but also potentially generating a long-lasting socioeconomic impact. Both medical sciences and biomedical research have also been challenged, consequently leading to a large number of clinical trials and vaccine initiatives. While known proteins of pathobiological importance are targets for these therapeutic approaches, it is imperative to explore other factors of viral significance. Accessory proteins are one such trait that have diverse roles in coronavirus pathobiology. Here, we analyze certain genomic characteristics of SARS-CoV-2 accessory protein ORF8 and predict its protein features. We have further reviewed current available literature regarding its function and comparatively evaluated these and other features of ORF8 and ORF8ab, its homolog from SARS-CoV. Because coronaviruses have been infecting humans repeatedly and might continue to do so, we therefore expect this study to aid in the development of holistic understanding of these proteins. Despite low nucleotide and protein identity and differentiating genome level characteristics, there appears to be significant structural integrity and functional proximity between these proteins pointing towards their high significance. There is further need for comprehensive genomics and structural-functional studies to lead towards definitive conclusions regarding their criticality and that can eventually define their relevance to therapeutics development.
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http://dx.doi.org/10.3390/pathogens9090677DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7558349PMC
August 2020

Risk Factors Associated With Postendoscopic Mucosal Resection Bleeding in Patients With Cirrhosis: A Retrospective Multicenter Cohort Study.

J Clin Gastroenterol 2021 04;55(4):355-360

Department of Gastroenterology, Cleveland Clinic Florida, Weston.

Background And Aim: There is limited data regarding the safety of endoscopic mucosal resection (EMR) in the cirrhotic population. Our study aimed to evaluate the safety of colonoscopic EMR in cirrhosis.

Materials And Methods: This was a retrospective review of cirrhotics who underwent colonic EMR at 8 Cleveland Clinic Centers between January 1, 2006, and December 31, 2018. Patient data including polyp details and complications occurring within 30 days of the procedure were noted. Univariable and multivariable logistic regression analyses were conducted to find risk factors for post-EMR bleeding.

Results: A total of 238 patients who underwent EMR were included. There were 145 males (60.9%) and the mean age was 61.9±8.6 years. Immediate and delayed bleeding, and postpolypectomy syndrome rates were 9.2%, 5.8%, and 1.3%, respectively. Significant risk factors for postpolypectomy bleeding were: increased age (P=0.001), procedure duration >37 minutes (P=0.001), antiplatelet use within 5 days (P=0.023), and lesion diameter >15 mm (P=0.004). Multivariable analysis revealed independent predictors of procedure-related bleeding: age above 65 years [odds ratio (OR) 2.14, P=0.044], antiplatelet use within 5 days (OR 2.42, P=0.047), right colon polyp (OR 3.51, P=0.001), and lesion diameter >15 mm (OR 3.22, P=0.003).

Conclusions: EMR in cirrhotics has an acceptable bleeding risk. Age above 65 years, right colon polyp, polyp size >15 mm, and use of antiplatelets within 5 days are independent risk factors for bleeding.
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http://dx.doi.org/10.1097/MCG.0000000000001407DOI Listing
April 2021

Multiloculated Liver Abscess Caused by Fusobacterium: Role of Karius Testing in Diagnosis.

Cureus 2020 Jun 25;12(6):e8823. Epub 2020 Jun 25.

Internal Medicine, AdventHealth Orlando, Orlando, USA.

Pyogenic liver abscess can be a major diagnostic and therapeutic challenge despite advances in cutting edge technologies. A patient presented with fever, right upper quadrant pain and diarrhea. CT revealed multiple hypodensities in both lobes of liver. The largest lesion was in the left lobe of liver and was multiloculated with thick septations. The causative organism was identified to be by Karius testing. The patient was discharged on six weeks of ertapenem therapy, which resulted in complete resolution. This is the first case of liver abscess where Karius testing was used to identify microorganism. It also highlights that multiloculated and difficult to drain liver abscesses caused by highly sensitive organisms can potentially be treated by intravenous antibiotics alone in immunocompetent patients.
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http://dx.doi.org/10.7759/cureus.8823DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7384737PMC
June 2020

Colon mucosal neoplasia referred for endoscopic mucosal resection: Recurrence of adenomas and prediction of submucosal invasion.

World J Gastrointest Endosc 2020 Jul;12(7):198-211

Center for Interventional Endoscopy, AdventHealth, Orlando, FL 32803, United States.

Background: Endoscopic mucosal resection (EMR) is an effective and minimally invasive alternative to surgery for large polyps and laterally spreading lesions. Gross morphology and surface characteristics may help predict submucosal invasion of the lesion (SMIL) during endoscopic evaluation. This is one of the largest single-center studies reporting endoscopic mucosal resection for larger (≥ 20 mm) colorectal lesions in the United States.

Aim: To determine the recurrence rate of adenomas and endoscopic features that may predict submucosal invasion of colonic mucosal neoplasia.

Methods: This is a retrospective cohort study of all the patients referred for endoscopic mucosal resection for lesions ≥ 20 mm, spanning a period from January 2013 to February 2017. The main outcome measure was identifying features that may predict submucosal invasion of mucosal lesions and predict recurrence of adenomas on follow-up surveillance colonoscopy performed at 4-6 mo.

Results: A total of 480 patients with 500 lesions were included in the study. The median age was 68 (Inter quantile range: 14) with 52% males. The most common lesion location was ascending colon (161; 32%). Paris classification 0-IIa (Flat elevation of mucosa - 316; 63.2%); Kudo Pit Pattern IIIs (192; 38%) and Granular surface morphology (260; 52%) were most prevalent. Submucosal invasion was present in 23 (4.6%) out of 500 lesions. The independent risk factors for SMIL were Kudo Pit Pattern IIIL + IV and V (Odds ratio: 4.5; value < 0.004) and Paris classification 0-IIc (Odds ratio: 18.2; value < 0.01). Out of 500, 354 post-endoscopic mucosal resection scars were examined at surveillance colonoscopy. Recurrence was noted in 21.8% (77 cases).

Conclusion: There was overall low prevalence of SMIL in our study. Kudo pit pattern (IIIL + IV and V) and Paris classification 0-IIc were the only factors identified as an independent risk factor for submucosal invasion. The independent risk factor for recurrence was adenoma size (> 40 mm). Almost all recurrences (98.8%) were treated endoscopically.
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http://dx.doi.org/10.4253/wjge.v12.i7.198DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7360516PMC
July 2020

What is the right sequencing approach? Solo VS extended family analysis in consanguineous populations.

BMC Med Genomics 2020 07 17;13(1):103. Epub 2020 Jul 17.

Division of Genetics, Department of Pediatrics, King Abdulaziz Medical City, Riyadh, Saudi Arabia.

Background: Testing strategies is crucial for genetics clinics and testing laboratories. In this study, we tried to compare the hit rate between solo and trio and trio plus testing and between trio and sibship testing. Finally, we studied the impact of extended family analysis, mainly in complex and unsolved cases.

Methods: Three cohorts were used for this analysis: one cohort to assess the hit rate between solo, trio and trio plus testing, another cohort to examine the impact of the testing strategy of sibship genome vs trio-based analysis, and a third cohort to test the impact of an extended family analysis of up to eight family members to lower the number of candidate variants.

Results: The hit rates in solo, trio and trio plus testing were 39, 40, and 41%, respectively. The total number of candidate variants in the sibship testing strategy was 117 variants compared to 59 variants in the trio-based analysis. We noticed that the average number of coding candidate variants in trio-based analysis was 1192 variants and 26,454 noncoding variants, and this number was lowered by 50-75% after adding additional family members, with up to two coding and 66 noncoding homozygous variants only, in families with eight family members.

Conclusion: There was no difference in the hit rate between solo and extended family members. Trio-based analysis was a better approach than sibship testing, even in a consanguineous population. Finally, each additional family member helped to narrow down the number of variants by 50-75%. Our findings could help clinicians, researchers and testing laboratories select the most cost-effective and appropriate sequencing approach for their patients. Furthermore, using extended family analysis is a very useful tool for complex cases with novel genes.
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http://dx.doi.org/10.1186/s12920-020-00743-8DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7368798PMC
July 2020

Hyperplastic Gastric Polyp Causing Upper Gastrointestinal Hemorrhage and Acute Blood Loss Anemia.

Cureus 2020 Jun 7;12(6):e8494. Epub 2020 Jun 7.

Internal Medicine, AdventHealth Orlando, Orlando, USA.

Hyperplastic polyps are the second most common type of gastric polyp in the United States with equal incidence in both genders, usually found incidentally during endoscopic examinations. It is a well-known fact that they are associated with iron-deficiency anemia due to chronic blood loss. We present a case of a 69-year-old man with a relatively small hyperplastic gastric polyp with acute upper gastrointestinal bleeding, presenting with melena and acute blood loss anemia requiring admission to intensive care unit and urgent endoscopic intervention with hot snare removal of the polyp and cautery of surrounding area with excellent hemostasis. The pathology revealed focal intestinal metaplasia and low-grade dysplasia with no evidence of malignancy. He was subsequently discharged with outpatient follow-up with gastroenterology.
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http://dx.doi.org/10.7759/cureus.8494DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7343302PMC
June 2020

Incorporating Quality Assurance in Pharmaceutical Compounding-related Courses in the PharmD Curricula.

Int J Pharm Compd 2020 Jul-Aug;24(4):322-326

Appalachian College of Pharmacy, Oakwood, Virginia.

The art and the skill set of compounding fulfill the important need of tailor-made pharmaceuticals for use by both institutions and individual  patients. Over the last 20 years, there have been more than 200 adverse events involving compounded products; infections, poisonings, contaminations, and dosing inaccuracies have been problematic. The probability of a correlation between the lack of institutional training and number of serious events could be significant. This survey was an endeavor at fundamental cause analysis and proactive management in relation to the PharmD Curricula as a means of error prevention. A questionnaire was sent to the pharmacy school faculty (department chairs, dean/assistant deans, and pharmaceutical science faculty) across the country. The survey responses were received from 78 participants. The questionnaire evaluated the respondent's overall knowledge and approach toward the subject in their curriculum. The survey results show 38.9% faculty agree that their college's curricula lacks sufficient training in microbiological testing, and 16.7% faculty agree their college does not provide sufficient training in nonsterile and sterile compounding (as per United States Pharmacopeia Chapters <795> and <797>). A majority of faculty agree on the implementation of quality assurance in compounding courses (as per United States Pharmacopeia Chapter  <1163>) as either an elective (62.5%) or mandatory class (43.3%), and most of the participants (85.1%) think there is a need to teach quality assurance as continuing education to practicing pharmacists. The survey data suggest a general desire for enhancement of compounding course curriculum, which could reduce the number of adverse events related to compounding. The data also suggests a necessity for the implementation of continuing education programs for practicing pharmacists and academic faculty across the country.
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July 2020

CYP1B1 gene: Implications in glaucoma and cancer.

J Cancer 2020 19;11(16):4652-4661. Epub 2020 May 19.

King Abdullah International Medical Research Center (KAIMRC)/ King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS), MNGHA, Saudi Arabia.

Glaucoma is a serious disease that can lead to irreversible loss of vision. Patients with primary congenital glaucoma may have elevated intraocular pressure. Hypertension causes damages to intraocular structures and affects the Schlemm's canal, collector channels, trabecular meshwork, and optic nerve's molecular structures. An important gene that is defective in patients with glaucoma is CYP1B1, a gene associated with optic nerve deterioration. CYP1B1is a key enzyme involved in the metabolism of exogenous and endogenous compounds. Also, it is critical in the detoxification of pre-carcinogens, such as polycyclic aromatic hydrocarbons and estrogen. It catalyzes their conversion into metabolites subsequently eliminated from the body. In malignant tumors, the CYP1B1 promoter is hypomethylated. CYP1B1 overexpression results in the conversion of estrogens to quinone forms, which bind with DNA and create a predisposition for cancer in several organs, such as the brain, breast, and ovary. Increased cytokine interleukin-6 and leptin lead to elevated CYP1B1 activity, which possibly causes cancer. In addition, the expression of aromatic hydrocarbon receptors is increased in tumor tissues, and it elevates oxidative stress and cell growth. TCGA database analysis showed increased survival at bladder and renal carcinoma when CYP1B1 expression is low. Therefore, alteration of CYP1B1 expression may suggest a therapeutic benefit for multiple diseases such as glaucoma and cancer.
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http://dx.doi.org/10.7150/jca.42669DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7330686PMC
May 2020

Focal Active Colitis Presented With Chronic Diarrhea.

Cureus 2020 May 15;12(5):e8140. Epub 2020 May 15.

Gastroenterology, AdventHealth, Orlando, USA.

There are various etiologies of colonic injury and inflammation. The most commonly described colitides in clinical practice are associated with infection, inflammatory bowel disease, ischemia, radiation and medications. The colonic wall has a limited set of responses to different types of injury; therefore, there is overlap between many of these disorders. Focal active colitis is characterized by isolated neutrophilic cryptitis with the background mucosa displaying normal crypt architecture. This inflammatory pattern can be easily unnoticed by pathologists because on low-power examination the mucosa may have almost normal appearance. General practitioners also may not be familiar with this term, underlying etiologies, associated risk factors, course, available therapies and follow up.  We present a case of an 82-year-old female with chronic diarrhea and weight loss. She had a negative infectious workup and normal radiology series. She subsequently underwent endoscopic evaluation in lieu of persistent and debilitating symptoms which revealed nonspecific macroscopic findings with pathology noting focal active colitis. She was empirically treated with a 14-day course of Xifaxan and responded well to management with almost complete resolution of her symptoms and no recurrence on six-month follow-up.
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http://dx.doi.org/10.7759/cureus.8140DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7294873PMC
May 2020

Comparing Transcatheter Aortic Valve Replacement (AVR) With Surgical AVR in Lower Risk Patients: A Comprehensive Meta-Analysis and Systematic Review.

Cardiol Res 2020 Jun 3;11(3):168-178. Epub 2020 May 3.

Department of Cardiology, Mercy Saint Vincent Medical Center, Toledo, OH 43608, USA.

Background: Transcutaneous aortic valve replacement (TAVR) is a novel percutaneous procedure for severe aortic stenosis and has been recently approved by Food and Drug Administration in lower risk patients. We performed the first ever meta-analysis and literature review of clinical trials comparing both 30-day and 1-year outcomes in lower risk patients undergoing TAVR vs. surgical aortic valve replacement (SAVR, having Society of Thoracic Surgeons score < 4% or equivalent).

Methods: Using predefined selection criteria as above, 68 articles were identified. Seven eligible articles were selected after extensive review. Primary effect outcomes were 30-day and 1-year all-cause mortality using risk ratio (RR) with significant P value of < 0.05.

Results: A total of 4,859 subjects were included. Risk of 30-day all-cause mortality was 40.1% less in TAVR group, RR 0.59 (95% confidence interval (CI): 0.38 - 0.92, P = 0.02) with no significant heterogeneity. Six studies except Schymik et al also reported 1-year risk. This was, however, not statistically significant with a 21% decrease in the TAVR group, RR 0.79 (95% CI: 0.57 - 1.09, P = 0.15). Six studies reported 30-day risk of secondary outcomes. The risk of 30-day stroke was 36% less in TAVR group, although this was not statistically significant, RR 0.64 (95% CI: 0.38 - 1.9, P = 0.10). The risk of acute kidney injury (AKI) stage 2 and above was 56% less in post-TAVR patients, RR 0.43 (95% CI: 0.35 - 0.54, P < 0.001) with no heterogeneity. For vascular complications, RR was high in TAVR group 4.62 (95% CI: 1.42-15.18, P = 0.01). Significant heterogeneity was demonstrated though (I = 81). The risks for permanent pacemaker (PPM) were also higher in the TAVR group, RR 3.30 (95% CI: 2.04 - 5.33, P < 0.001) and significant heterogeneity was observed. After removing Thyregod et al and Partner 3 trial from the analysis, heterogeneity was removed, but the RR was still high 3.21 (95% CI: 2.54 - 4.068, P < 0.001). Post-operative incidence of endocarditis among TAVR patients was low but not statistically significant. The 30-day risk for infective endocarditis was RR 0.67 (95% CI: 0.13 - 3.48, P = 0.63). The 1-year risk was similarly low but not significant, RR 0.73 (95% CI: 0.28 - 1.92, P = 0.53).

Conclusions: Among low risk patients, TAVR was found to be superior in short-term all-cause mortality and 1-year stroke, a result that was statistically significant for TAVR and close to significance for stroke. TAVR patients were also less likely to have post-operative bleeding and AKI stage 2 and beyond. Post-operative incidence of endocarditis among TAVR patients was low but not statistically significant. However, the rates of PPM and vascular complications are higher in TAVR patients. The results of TAVR in low risk population are thus extremely encouraging. However, the issue of long-term valve durability in this group needs further studies. Also, caution needs to be exercised while extending the indications to extremely young patients due to lack of enough studies.
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http://dx.doi.org/10.14740/cr1046DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7239597PMC
June 2020

Effect of Temperature on H NMR Spectra, Antitrypanosomal Activity, Conformational Analysis, and Molecular Docking of Curine Derivatives from .

J Nat Prod 2020 05 4;83(5):1383-1393. Epub 2020 May 4.

Department of Chemistry, University of Alabama in Huntsville, Huntsville, Alabama 35899, United States.

The ethanolic root extract of afforded a new bisbenzylisoquinoline alkaloid, 13-nitrochondrofoline (), and two known bisbenzylisoquinoline alkaloids, chondrofoline () and curine (). The acetylation of chondrofoline () gave -acetylchondrofoline (). The dimeric structures of and were studied through variable-temperature H NMR spectroscopy at 25, 40, 60, and 80 °C and conformational analysis, using density functional theory employing the M06-2X functional and the 6-31G* basis set. The in vitro antitrypanosomal activity of compounds , , , and against showed significant potential with MIC values of 2.6, 2.2, 2.3, and 3.8 μM, respectively. Molecular docking evaluation of alkaloids , , , and against known protein targets revealed phosphodiesterase B1 to be the preferred target. The docking energies of the alkaloids with Tb6PGL (PDB 3EB9) ranged from -88.8 to -106.0 kJ/mol and was comparable to the cocrystallized ligand, citrate ( = -78.3 kJ/mol). It seems reasonable that the curine alkaloids may compete with the natural substrates for these protein targets and serve as leads in designing and developing more potent and selective drugs against .
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http://dx.doi.org/10.1021/acs.jnatprod.9b00397DOI Listing
May 2020

A Rare Complication of Cardiac Ablation: Atrial-esophageal Fistula Presenting as Odynophagia.

Cureus 2020 Feb 4;12(2):e6871. Epub 2020 Feb 4.

Gastroenterology, AdventHealth, Orlando, USA.

Radiofrequency catheter ablation has been commonly used for the treatment of drug-refractory atrial fibrillation. The esophageal injury along with the development of atrial-esophageal fistula (AE fistula) is fairly rare but is a devastating complication of catheter ablation. Described in 2004 for the first time, it is the most lethal of all the complications of catheter ablation with a high mortality rate. The clinical presentation of an AE fistula is variable, however, early diagnosis and treatment can prevent a fatality. We have reported a case of an AE fistula post catheter ablation for drug-resistant atrial fibrillation, along with its treatment, diagnosis, and possible preventive measures.
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http://dx.doi.org/10.7759/cureus.6871DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7053677PMC
February 2020

Splenic injuries secondary to colonoscopy: Rare but serious complication.

World J Gastrointest Surg 2020 Feb;12(2):55-67

Department of Gastroenterology, Advent Health Hospital, Orlando, FL 32804, United States.

Background: Colonoscopy is a safe and routine diagnostic and therapeutic procedure for evaluation of large bowel diseases. Most common procedure related complications include bleeding and perforation but rarely a splenic Injury.

Aim: To investigate the reason for colonoscopy, presentation of patient with spleen injury, types of injury, diagnosis, management and outcomes of patients.

Methods: A structured search on four databases was done and 45 articles with 68 patients were selected. The reason for colonoscopy, presentation of patient with spleen injury, types of injury, diagnosis, management and outcomes of patients were identified and analyzed using SPSS.

Results: The mean age of the patients was 62.7 years with 64% females. Twenty two percent had a complete splenic rupture with colonoscopy while 63% had subcapsular hematoma, spleen laceration and spleen avulsion. The most common reason for colonoscopy was screening (46%) followed by diagnostic colonoscopy (28%). Eighty seven percent of patients presented with abdominal pain. Patients with spleen rupture mostly required splenectomy (47%), while minor spleen hematomas and lacerations were managed conservatively (38%). Six percent of the patients were managed with proximal splenic artery splenic embolization and 4% were managed with laparoscopic repair. The overall mortality was 10% while 77% had complete recovery. The reason of colonoscopy against presentation specifically, abdominal pain showed no statistical significance = 0.69. The indication of colonoscopy had no significant impact on incidence of splenic injury ( = 0.89). Majority of the patients (47%) were managed with splenectomy while the rest were managed conservatively ( = 0.04). This association was moderately strong at a cramer's V test (0.34). The Fisher exact test showed a higher mortality with spleen rupture ( = 0.028).

Conclusion: Spleen rupture due to colonoscopy is a significant concern and is associated with high mortality. The management of the patients can be individualized based on clinical presentation.
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http://dx.doi.org/10.4240/wjgs.v12.i2.55DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7044106PMC
February 2020

Carcinoid Tumor: Advances in Treatment Options.

Cureus 2020 Jan 13;12(1):e6641. Epub 2020 Jan 13.

Gastroenterology, AdventHealth, Orlando, USA.

Small bowel neoplasms are rare, accounting for only 3%-6% of all gastrointestinal neoplasms. Carcinoid tumors represent a large portion of these (20%-30%), making them the second most common small bowel malignancy after adenocarcinoma. Gastrointestinal carcinoids constitute 70% of all neuroendocrine tumors, and out of those, 42% originate in the small bowel. They are predominantly seen in older patients around the age of 65 years. From 1973 to 2004, there has been more than a fourfold increase in the incidence of carcinoid tumors. This can be probably due to increased diagnostic accuracy rather than an actual increase in the number of new cases. The workup of a suspicious case of gastrointestinal bleeding consists of esophagogastroduodenoscopy and/or colonoscopy, and other imaging tests including video capsule endoscopy and balloon-assisted endoscopy. Management of the tumors is dependent on the size and location of the lesion. Treatment options include surgery, endoscopic removal of tumors, and various immunotherapy and chemotherapeutic agents.
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http://dx.doi.org/10.7759/cureus.6641DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7011579PMC
January 2020

Postsurgical Refractory Gastroparesis: Response to Botulinum Toxin Therapy.

Cureus 2020 Jan 8;12(1):e6596. Epub 2020 Jan 8.

Gastroenterology, AdventHealth, Orlando, USA.

Gastroparesis is a complex dysmotility disorder characterized by chronic dyspepsia and delayed gastric emptying in the absence of mechanical obstruction. Postsurgical gastroparesis is the third most common cause and accounts for 13% of total cases. Studies have shown that catheter ablation procedures for atrial fibrillation can rarely result in gastroparesis, secondary to damage to the vagus nerve. Once the diagnosis is confirmed, treatment options include: dietary management, prokinetic drugs, and new invasive treatments. Botulinum toxin injection is an emerging pyloric intervention, increasingly used in the management of gastroparesis refractory to pharmacological therapy. It is given as an injection into the pyloric sphincter, with the help of an endoscope. Botulinum toxin acts by inhibiting smooth muscle contraction through a decreased response to acetylcholine. Here we report a case of postsurgical gastroparesis that responded well to botulinum toxin therapy.
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http://dx.doi.org/10.7759/cureus.6596DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7003725PMC
January 2020

Hydrogen Peroxide Enema-induced Proctitis in a Young Female: A Case Report.

Cureus 2019 Dec 26;11(12):e6468. Epub 2019 Dec 26.

Gastroenterology, AdventHealth, Orlando, USA.

Hydrogen peroxide is a disinfectant commonly used for cleansing superficial wounds due to its oxidizing capacity. In the past, it has also been used for the management of meconium ileus in children as the oxidizing action of hydrogen peroxide potentiates peristalsis that relieves ileus or fecal impaction. The potential dangers were unknown till Pumphrey, in 1951, described the harmful effects of its use as an enema. We present a case of a 32-year-old female who was admitted for complaints of perianal pain. She used an enema, consisting of water and hydrogen peroxide, for constipation. It improved her symptoms but subsequently, she developed a burning sensation in her rectum. The patient had a colonoscopy which revealed severe proctitis up to 15 cm from the anal verge manifested by superficial mucosal ulceration, marked erythema, and edema with friable mucosa and hemorrhage. The patient was subsequently given mesalamine, and the symptoms resolved.
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http://dx.doi.org/10.7759/cureus.6468DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6984182PMC
December 2019

Liposuction in Gynecomastia: An Assessment of the Suction-assisted Arthroscopic Shaver Versus Open Disc Excision Techniques.

Cureus 2019 Oct 12;11(10):e5897. Epub 2019 Oct 12.

Plastic Surgery, Shifa International Hospital, Islamabad, PAK.

Introduction Gynecomastia is a common problem of the male breasts, which imposes a great psychological burden on patients. It is mostly bilateral and frequently asymmetrical. Surgical management of gynecomastia has undergone significant changes over the past few decades. Currently, the predominant mode of treatment includes liposuction of the fibro-fatty tissue either alone or in combination with the removal of the glandular tissue by the open excision technique or arthroscopic shaver. This study aims to compare both techniques in terms of hematoma formation, nipple necrosis, reoperation, contour irregularities, acceptability of scarring, asymmetry, and patient satisfaction. Methods The study has been conducted at Shifa International Hospital, Islamabad, from May 2018 to September 2019. Sixty patients were included in the study. All the patients had bilateral gynecomastia and Simon's Grade II-A or II-B. The study sample was divided into two equal groups. Group A underwent liposuction combined with open disc excision while Group B underwent liposuction coupled with disc excision via suction-assisted arthroscopic shaver. Postoperatively, all the patients received follow-up for a minimum period of six months. Results In a cohort of 60 patients, the mean age was 25.76±5.38 years. There were minor differences noted in terms of hematoma formation, nipple necrosis, rates of re-operation, and contour irregularities between open disc excision and arthroscopic disc excision, respectively (p-value > 0.05). About eight patients reported asymmetry in open disc excision as compared to 10 in arthroscopic disc excision. The acceptability of scarring was reported as equal in both groups. Mean patient satisfaction was based on the visual analog scale (VAS) scale was 8.25 in both groups. No statistical difference regarding patient satisfaction was noted in both groups (p-value 0.126). Conclusion Our study concludes that arthroscopic shaver-assisted disc excision despite being a novel and minimally invasive technique does not hold superiority over conventional open disc excision for the management of gynecomastia. Furthermore, in a developing country like Pakistan, there is a lack of expertise with the procedure and a need for more training among plastic surgeons.
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http://dx.doi.org/10.7759/cureus.5897DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6839758PMC
October 2019

Correction to: Health seeking behaviour, delayed presentation and its impact among oral cancer patients in Pakistan: a retrospective qualitative study.

BMC Health Serv Res 2019 Nov 14;19(1):835. Epub 2019 Nov 14.

Shifa International Hospital, Islamabad, Pakistan.

In the original publication of this article [1], an author's name needs to be revised from Babar Tasneen Shaikh to Babar Tasneem Shaikh.
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http://dx.doi.org/10.1186/s12913-019-4716-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6854726PMC
November 2019

Idiopathic Thrombocytopenic Purpura: A Rare Syndrome with Alemtuzumab, Review of Monitoring Protocol.

Cureus 2019 Sep 20;11(9):e5715. Epub 2019 Sep 20.

Internal Medicine, Khyber Teaching Hospital, Peshawar, PAK.

Alemtuzumab, a humanized monoclonal antibody that targets surface molecule CD52, causes rapid and complete depletion of circulating T- and B-lymphocytes through antibody-dependent cell-mediated and complement-mediated cytotoxicity. Alemtuzumab has demonstrated superior efficacy compared to subcutaneous interferon beta-1a (SC IFNB-1a) in patients with multiple sclerosis (MS). Alemtuzumab treatment causes a rare and distinct form of secondary immune thrombocytopenic purpura (ITP), characterized by delayed onset, responsiveness to conventional therapies, and prolonged remission following treatment. In phase two and three clinical trials, the incidence of ITP was higher with alemtuzumab treatment compared to the patients receiving SC IFNB-1a. Here we report a case of ITP occurring two years after the first treatment with alemtuzumab. The patient recovered completely after a timely diagnosis and adequate treatment. Rigorous patient education and careful complete blood count (CBC) monitoring by the physician are critical for early identification and treatment of this potentially fatal disorder.
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http://dx.doi.org/10.7759/cureus.5715DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6823085PMC
September 2019
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