Publications by authors named "Muhammad Arif Khan"

32 Publications

Advanced Nanoscale Surface Characterization of CuO Nanoflowers for Significant Enhancement of Catalytic Properties.

Molecules 2021 May 4;26(9). Epub 2021 May 4.

School of Electrical Engineering, Faculty of Engineering, Universiti Teknologi Malaysia (UTM), Skudai, Johor Bharu 81310, Malaysia.

In this work, advanced nanoscale surface characterization of CuO Nanoflowers synthesized by controlled hydrothermal approach for significant enhancement of catalytic properties has been investigated. The CuO nanoflower samples were characterized by field-emission scanning electron microscopy (FE-SEM), X-ray powder diffraction (XRD), X-ray photoelectron spectroscopy (XPS), Raman spectroscopy, high-resolution transmission electron microscopy (HR-TEM), selected-area electron diffraction (SAED), high-angular annular dark field scanning transmission electron microscopy (HAADF-STEM) with elemental mapping, energy dispersive spectroscopy (STEM-EDS) and UV-Vis spectroscopy techniques. The nanoscale analysis of the surface study of monodispersed individual CuO nanoflower confirmed the fine crystalline shaped morphology composed of ultrathin leaves, monoclinic structure and purified phase. The result of HR-TEM shows that the length of one ultrathin leaf of copper oxide nanoflower is about ~650-700 nm, base is about ~300.77 ± 30 nm and the average thickness of the tip of individual ultrathin leaf of copper oxide nanoflower is about ~10 ± 2 nm. Enhanced absorption of visible light ~850 nm and larger value of band gap energy (1.68 eV) have further supported that the as-grown material (CuO nanoflowers) is an active and well-designed surface morphology at the nanoscale level. Furthermore, significant enhancement of catalytic properties of copper oxide nanoflowers in the presence of H2O2 for the degradation of methylene blue (MB) with efficiency ~96.7% after 170 min was obtained. The results showed that the superb catalytic performance of well-fabricated CuO nanoflowers can open a new way for substantial applications of dye removal from wastewater and environment fields.
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http://dx.doi.org/10.3390/molecules26092700DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8124738PMC
May 2021

Reconstruction of pH-universal atomic FeNC catalysts towards oxygen reduction reaction.

J Colloid Interface Sci 2021 Jan 29;582(Pt B):1033-1040. Epub 2020 Aug 29.

College of Sciences & Institute for Sustainable Energy, Shanghai University, Shanghai 200444, PR China.

Constructing of single atom catalysts that can stably exist in various energy conversion and storage devices is still in its infancy. Herein, a geometrically optimized three-dimensional hierarchically architectural single atomic FeNC catalyst with fast mass transport and electron transfer is rationally developed by post-molecule pyrolysis assisted with silicon template and reconstructs by ammonia treating. The ammonia-assisted secondary pyrolysis not only compensates for the volatilization of nitrogen species contained in organic precursors but also optimizes the surface structure of FeNC catalyst, thus increasing the content of pyridinic nitrogen and boosting the density of active sites (FeN) in FeNC samples. In addition, the pyridinic nitrogen adjusts the electronic distribution in Fe 3d active center and promotes the catalytic performances. Therefore, this hollow spherical atomically dispersed FeNC catalyst delivers outstanding oxygen reduction reaction (ORR) activity in pH-universal electrolyte and surpasses the most reported values.
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http://dx.doi.org/10.1016/j.jcis.2020.08.103DOI Listing
January 2021

Synthesis of an un-modified gum arabic and acrylic acid based physically cross-linked hydrogels with high mechanical, self-sustainable and self-healable performance.

Mater Sci Eng C Mater Biol Appl 2020 Nov 7;116:111278. Epub 2020 Jul 7.

College of Sciences & Institute for Sustainable Energy, Shanghai University, Shanghai 200444, China.

A novel and simple strategy was designed for the synthesis of an unmodified gum arabic (GA) and acrylic acid (AA) based polymer hydrogels using Fe as a physical cross-linking agent. The hydrogels showed a high mechanical strength, self-sustainability and self-healing ability, which depends on the content of GA and Fe in the composition. The fracture stress increased from 0.23 to 0.841 MPa and a decrease in self-healing from 53 to 34% was observed by increasing the GA amount from 12 to 50% respectively. The self-healing performance of the hydrogels enhanced with the existence of the Fe amount on the interface. Therefore, the 3% addition of Fe, increased the self-healing ability of up to 70%. Furthermore, the hydrogels also showed an excellent fatigue resistance up to 20 cycles without any rapture and can beard a load of 2.5 kg for a very long time. After 4 min of resting time, the percent recovery in dissipated energy reaching a high value of 95%, indicating the excellent fatigue resistance performance of the hydrogels. The hydrogels contain 3-5% of water at normal conditions and confirm its environmental stability. This work provides a new direction for the synthesis of unmodified GA based physically cross-linked polymer hydrogels systems and can be applied in bioengineering and robotic science in the future.
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http://dx.doi.org/10.1016/j.msec.2020.111278DOI Listing
November 2020

Surface Study of CuO Nanopetals by Advanced Nanocharacterization Techniques with Enhanced Optical and Catalytic Properties.

Nanomaterials (Basel) 2020 Jul 2;10(7). Epub 2020 Jul 2.

Microelectronics and Nanotechnology-Shamsuddin Research Centre (MiNT-SRC), Institute for Integrated Engineering, Universiti Tun Hussein Onn Malaysia (UTHM), Parit Raja, Batu Pahat Johor 86400, Malaysia.

In the present work, a facile one-step hydrothermal synthesis of well-defined stabilized CuO nanopetals and its surface study by advanced nanocharacterization techniques for enhanced optical and catalytic properties has been investigated. Characterization by Transmission electron microscopy (TEM) analysis confirmed existence of high crystalline CuO nanopetals with average length and diameter of 1611.96 nm and 650.50 nm, respectively. The nanopetals are monodispersed with a large surface area, controlled morphology, and demonstrate the nanocrystalline nature with a monoclinic structure. The phase purity of the as-synthesized sample was confirmed by Raman spectroscopy and X-ray diffraction (XRD) patterns. A significantly wide absorption up to 800 nm and increased band gap were observed in CuO nanopetals. The valance band (VB) and conduction band (CB) positions at CuO surface are measured to be of +0.7 and -1.03 eV, respectively, using X-ray photoelectron spectroscopy (XPS), which would be very promising for efficient catalytic properties. Furthermore, the obtained CuO nanopetals in the presence of hydrogen peroxide ( H 2 O 2 ) achieved excellent catalytic activities for degradation of methylene blue (MB) under dark, with degradation rate > 99% after 90 min, which is significantly higher than reported in the literature. The enhanced catalytic activity was referred to the controlled morphology of monodispersed CuO nanopetals, co-operative role of H 2 O 2 and energy band structure. This work contributes to a new approach for extensive application opportunities in environmental improvement.
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http://dx.doi.org/10.3390/nano10071298DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7408456PMC
July 2020

Recent trends in molecular epidemiology of Hepatitis C virus in Mardan, KPK Pakistan.

Infect Genet Evol 2018 12 8;66:66-71. Epub 2018 Sep 8.

Hazara University Mansehra, Pakistan.

To determine the genotypic distribution of HCV, frequency of risk factors involved in its transmission, and correlation of genotype with viral load in Mardan population which is the second largest city of Khyber Pakhtunkhwa (KPK), Pakistan. Blood samples of 1140 were collected from different regions of Mardan and major proportion of recruited patients were internally displaced people (IDPs), refugees, and slum dwellers. Complete patient's history was analyzed to assess the possible risks involved in HCV transmission. Viral genotype was determined by PCR (polymerase chain reaction) whereas, HCV RNA was measured by qRT-PCR. Data was analyzed using SPSS statistical software. Our results indicate 3a as the most abundant subtype in Mardan population followed by 3b, 2a, 2b, 4a, untypeable, mixed, 1a, and 1b. In contrast to previous findings, genotype 1 was the least prevalent genotype and the overall prevalence of HCV in Mardan population was significantly higher in females (n = 687, 60.2%) than males (n = 453, 39.7%). Significant difference between-genotypes and gender was observed in genotype 1 (p < .034) and genotype 3 (p < .004). The mean age was 44 (SD ± 9.51). The most frequently found mixed genotype was 3a + 1b and mixed genotype was more prevalent in males. The proportion of middle-aged people (41-49 years) was higher whereas, older and younger people were least infected with HCV. This is the first study that showed substantial correlation of genotype 3 with low and intermediate viral load in Mardan population. Moreover, high and extremely high viral load was associated with other genotypes. Our findings showed that most of the patients who experienced high and extremely high viremia in their blood were males and belonged to Takhat Bhai and Mardaan regions. There were significant difference in the prevalence of HCV genotype 3a (p = .001) and genotype 3b (p = .005) in different regions of Mardan. Pre-treatment viral load is significantly high (p 0.001) in tehsil Mardan patients infected with HCV genotype 3 as compared to other genotypes. Unsafe medical practices such as medical and dental surgeries, intravenous drug use, and blood transfusions were the main risk factors for HCV transmission in Mardan, KPK Pakistan. This study gives clear insights into the epidemiological status of HCV in Mardan population. Genotype 3 is correlated with low and intermediate viral load whereas high viral loads were revealed among patients infected with genotypes other than genotype 3. In the absence of better data and robust epidemiological information, this detailed analysis of HCV genotypes with special reference to risk factors, pretreatment viral load, gender, and age will provide the baseline data for development of optimal HCV eradication and preventive strategies.
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http://dx.doi.org/10.1016/j.meegid.2018.09.003DOI Listing
December 2018

Histopathological changes induced in liver, kidney, heart and pancreas of rabbits by prolonged oral cyanide exposure.

Pak J Pharm Sci 2018 Sep;31(5):1797-1803

Department of Clinical Medicine and Surgery, Faculty of Veterinary Science, University of Veterinary and Animal Sciences, Lahore, Pakistan.

The aim of the present study was to determine the deleterious effects of prolonged oral cyanide insult on various organs and tissues in rabbits. For this purpose, 12 locally bred adult male rabbits were allocated into two groups of 6 viz. control and experimental. Rabbits in control group were offered feed only while the rabbits in experimental group received feed plus potassium cyanide (KCN) at 3 mg/kg body weight orally for a period of 40 days. None of the rabbit in both the groups demonstrated any of the gross changes in any organ on postmortem examination. Liver was normal in size, shape, texture and color. Kidneys were also normal in size and color. Histopathological examination revealed severe hepatocyte vacuolation and degeneration in liver of rabbits in experimental group. There was also excessive congestion in liver and bile duct of rabbits in experimental group. Kidneys of rabbits in experimental group demonstrated severe glomerular and tubular necrosis and congestion. In the tubular epithelial cells, pyknotic nuclei were also present. On the other hand, heart and pancreas of rabbits in both control and experimental group did not show any histopathological change in microscopic structures. In conclusion, prolonged oral cyanide administration could have harmful effects on liver and kidney functions.
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September 2018

Congenital prepubic sinus-An aborted dorsal urethral duplication or a cloacal remnant?

J Pediatr Surg 2019 Jul 25;54(7):1467-1470. Epub 2018 Jul 25.

Section of Pediatric Surgery, Department of Surgery, The Aga Khan University Hospital(AKUH), Karachi 74800, Pakistan.

Background: Congenital Prepubic Sinus (CPS) is an uncommon urogenital anomaly characterized by a blind tract between the skin over the pubis to anterior of the urinary bladder, Urethra or umbilicus. We report four such cases to emphasize varied clinical presentation and embryological conundrum.

Methods: Following Ethical Review Committee (ERC) approval, medical records of pediatric patients (<16 years) presenting with CPS (identified through operating room records and Hospital Information Management System (HIMS) between 1994 and 2018 were reviewed for demographics, clinical presentation, investigations including histopathology, management and outcome.

Results: Four cases of CPS, 3 females and 1 male, age range 9 months to 13 years were managed over 25-years. Clinical presentation includes a discharging sinus and recurrent episodes of cellulitis and abscess formation in pubic area and labia majora. Urological investigations were mostly normal. Insertion of lacrimal probe or plastic sheath of intravenous cannula through the sinus opening was useful to determine the course of sinus and aid its excision. Histology of excised sinus highlights the possible embryological origin.

Conclusions: CPS is a rare anomaly with varied clinical presentation. It seems CPS is an aborted urethral duplication (Stephen Type 3) or a Cloacal remnant. Complete excision of the tract in the reported cases was curative.

Type Of Study: Case series.

Level Of Evidence: IV.
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http://dx.doi.org/10.1016/j.jpedsurg.2018.07.014DOI Listing
July 2019

Assessing the efficacy of aqueous garlic extract, sodium nitrite and sodium thiosulfate against prolonged oral cyanide exposure in rabbits.

Pak J Pharm Sci 2018 Mar;31(2):411-419

Department of Parasitology, University of Veterinary and Animal Sciences, Lahore, Pakistan.

This study was aimed to compare the efficacy of aqueous garlic extract, sodium nitrite (SNT), sodium thiosulfate (STS) and hydroxocobalamin against oral cyanide exposure in rabbits. For this purpose, forty two adult male rabbits were divided randomly into 7 groups of 6 animals (A-G) each. Rabbits in group A were offered feed only and served as negative control, while the rabbits in group B received feed plus potassium cyanide (KCN) at 3mg/kg orally and were kept as positive control. Animals in group C received feed, KCN and intraperitoneal injection (IP) of aqueous garlic extract at 500mg/kg. Rabbits in group D were given feed, KCN and IP injection of STS at 600mg/kg. Members in group E received feed, KCN and IP injection of both aqueous garlic extract at 500mg/kg and SNT at 20mg/kg. Animals in group F were given feed, KCN and IP injection of both STS at 600mg/kg and SNT at 20mg/kg, while the rabbits in group G received feed, KCN and IP injection of hydroxocobalamin at 300mg/kg. The treatments were given to respective groups for 40 days. The efficacy of the antidotes was measured on the basis of changes in biochemical profile of rabbits in each group. In this study, hydroxocobalamin was found to be significantly more effective cyanide (CNI) antidote than garlic, STS, SNT plus garlic extract, or SNT and STS, either alone or in combination. A combination of SNT and garlic extract was the second most effective CNI antidote. The efficacy of garlic alone was significantly higher than STS alone or in combination with SNT. The efficacy of combined SNT and STS was superior to STS alone in treating rabbits with CNI toxicity. In conclusion, aqueous garlic extract alone or in combination with STS can effectively be used against cyanide toxicity.
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March 2018

Neurological Recovery In Traumatic Spinal Cord Injuries After Surgical Intervention.

J Ayub Med Coll Abbottabad 2018 Jan-Mar;30(1):58-63

Department of Orthopaedic & Spine Surgery, Hayatabad Medical Complex, Peshawar, Pakistan.

Background: Spinal injuries are the most devastating injuries and affect every aspect of patients' lives. This may cause lifelong disability due to spinal cord injury. Recovery of neurological functions is highly desirable. Early or late surgical intervention is still debatable, but majority recommend early intervention. The result of late surgical intervention in term of neurological recovery is not clear. This study focuses on neurological recovery after late surgical intervention. The objective of this study was to assess neurological recovery in term of ASIA grading in patients with traumatic spinal cord injury.

Methods: This descriptive cross-sectional study was performed from June 2013 to June 2016. All patients treated for spinal trauma with spinal cord injury, operated after 24 hrs of injury were included in the study. Neurology was assessed according to ASIA scale preoperative and at 6 months. Data was analysed with the help of SPSS.

Results: Total of 149 patients, 32 (21.5%) were female and 117 (78.5%) male were included. mean age was 32±13.11 years. Ninety-six (64.4%) patients presented with fall while 53 (35.6%) presented with motor vehicular accidents (MVA). according to AO comprehensive classification 76 (51.1%) patients were type C, 47 (31.5) were type B and 26 (17.4%) were type A. preoperative neurology was ASIA A 65 (43.6%), B12 (8.1%), C 59 (39.6%) and D 13 (8.7%). Mean delay in surgery was 3.6±1.8 days with minimum of 1 and maximum 14 days. ASIA grading on 6 months was ASIA "A" 61 (40.9%), B4 (2.7%), C 26 (17.4%), D 33 (22.1%) and E 25 (16.8%). the overall improvement in neurology was in 67 (45%) of patients. improvement by one grade was documented in 49 (32.9%) patients, by two grades in 17 (11.4%) and by three grades in one patient (.7%).

Conclusions: fall from height is a major cause of spine injuries in our set up followed by RTA. Preventive measures need to be instituted to lessen the devastating outcome.
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August 2018

Association between bacterial strain type and host biomarkers in Clostridium perfringens infected goats.

Microb Pathog 2017 Nov 28;112:254-258. Epub 2017 Sep 28.

The University of Agriculture, Peshawar, Pakistan.

The study project was designed to determine the effects of Clostridium perfringens type D infection on hematological and biochemical parameters in goats. Purposive blood samples were collected from 6 healthy and 12 diseased goats positive for C. perfringens infection. Neither the animals nor their mother were vaccinated against Clostridium perfringens from whom samples were obtained. Study was carried out in two different topographic areas; hilly (district Swat) and plain (district Mardan) of Khyber Pakhtunkhwa, Pakistan but nonsignificant (P > 0.05) statistical difference was recorded between the prevalence of Clostridium perfringens infected goats. Mean erythrocytes count (RBC) and hemoglobin level decreased significantly (P < 0.05) while the white blood cells (WBC) increased significantly (P < 0.05) in diseased animals compared to the healthy animals. However non-significant differences (P > 0.05) were observed in packet cell volume (PCV) and platelets count in healthy and diseased animals. According to biochemical analysis, a significant increase (P < 0.05) in liver enzymes, total bilirubin, serum creatinine, blood urea and glucose was recorded in diseased goats. . The results demonstrated that fluctuation in most of the mean hematological values remained within the normal range however the mean liver enzymes, total bilirubin, serum creatinine, blood urea and glucose levels gone beyond the normal levels which demonstrated severe damages to liver and kidneys.
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http://dx.doi.org/10.1016/j.micpath.2017.09.059DOI Listing
November 2017

Recurrent and acquired tracheoesophageal fistulae (TEF)-Minimally invasive management.

J Pediatr Surg 2017 Oct 23;52(10):1688-1690. Epub 2017 Mar 23.

Section of Pediatric Surgery, Department of surgery, The Aga Khan University Hospital, Karachi 74800 (AKUH.K), Pakistan.

Objective: Recurrent and acquired fistulae are a serious complication of congenital esophageal atresia and tracheoesophageal fistula (TEF) repair and foreign body ingestion (FBI) (e.g., button battery). We report our experience with a minimally invasive approach to recurrent and acquired TEF.

Methods: Medical records of patients referred for management of recurrent and acquired TEF between 2003 and 2015 were reviewed retrospectively. Patients underwent endoscopic procedures (de-epithelization of fistulous tract and fibrin tissue adhesive-Tisseel) under general anesthesia.

Results: Nine children (7 male, 2 female) with age range 3months to 3years (mean 1.5year) were managed. TEF closed spontaneously in four patients, whereas in 5 patients the TEF closed after combined endoscopic procedure. Three patients required repeat endoscopic procedures. Follow-up ranged between 7months to 10years (mean 4.2years).

Conclusions: Active observation and repeat combined endoscopic procedures are safe alternatives to open surgical repair of acquired and recurrent TEF.

Level Of Evidence: Level IV study.
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http://dx.doi.org/10.1016/j.jpedsurg.2017.03.048DOI Listing
October 2017

Protean and intangible manifestation of renal stones in children.

Int J Surg 2016 Dec 12;36(Pt D):647-648. Epub 2016 Nov 12.

Section of Pediatric Surgery, Department of Surgery, The Aga Khan University, Karachi, 74800, Pakistan. Electronic address:

In the last decade, renal stones are being diagnosed more frequently in children across the globe. Children with renal stone often present with non-specific and subtle symptoms. Diagnosis of urolithiasis in children therefore requires a high index of suspicion especially for those living in endemic regions and with a positive family history. Additionally, management requires judicious use of radiological imaging by treating physicians.
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http://dx.doi.org/10.1016/j.ijsu.2016.11.022DOI Listing
December 2016

Percutaneous Closure of Patent Ductus Arteriosus Under Echocardiographic Guidance.

J Coll Physicians Surg Pak 2016 Jun;26(6):533-5

Department of Pediatric Cardiology, King Salman Heart Center, King Fahad Medical City, Riyadh, Saudi Arabia.

Percutaneous closure of patent ductus arteriosus (PDA) is done in the cardiac catheterization laboratory, usually under fluoroscopic and angiographic guidance. The aortogram is used for assessing PDAsize and shape the pre-device implantation. Additionally, post-device aortograms are applied for the assessment of device position, profile and residual shunt. Angiograms expose patient to radiation and possible untoward effects of contrast media. Recently, transthoracic echocardiography has been utilized to guide in PDAclosure to avoid radiation exposure as well as contrast material. On two occasions, we were obligated by special circumstances to close the PDAunder echocardiography guidance. First case was a 6-month baby girl with mild signs of heart failure having moderate size PDA. She underwent device closure under transthoracic echocardiogram as the angiographic system had stopped working during the procedure. Second case was a 6-year girl, weighting 16-kg with chronic renal failure. She had moderate size PDAclosed by device under transthoracic echocardiographic, guidance avoiding the use of contrast agent due to chronic renal failure.
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http://dx.doi.org/2358DOI Listing
June 2016

Evaluation of furazolidone, sulfadimidine and amprolium to treat coccidiosis in Beetal goats under field conditions.

Pak J Pharm Sci 2016 Mar;29(2):485-7

School of Animal and Veterinary Sciences, University of Adelaide, Roseworthy Campus, Roseworthy, Australia.

Coccidiosis is a protozoal and occasionally fatal diarrheic disease of goats imposing heavy economic losses to farming community. This study aimed to evaluate the efficacies of Furazolidone, Sulfadimidine and Amprolium against coccidiosis in Beetal goats. Twenty-four (24) Beetal goats naturally infected with coccidiosis were randomly divided into four groups of 6 (A-D). Goats in groups A, B and C were treated orally with Furazolidone (10 mg/Kg), Sulfadimidine (100 mg/Kg) and Amprolium (55 mg/Kg), respectively for 7 days. Goats in-group D served as positive control. Oocysts per gram (OPG) of feces counts of individual goats in each group were performed on Days; 0 (pre-treatment) 7, 14 and 21 (post-treatment). OPG counts amongst goats in all groups at day 0 were not significant (P>0.05). On days 7, 14 and 21, OPG values decreased significantly (P<0.05) in groups A, B and C compared to group D. The efficacy of Furazolidone, Sulfadimidine and Amprolium was 98.6, 98.0 and 99.6 percent, respectively on Day 21 (end of trial). Statistically, the efficacies of three drugs were not significantly different (P>0.05). In conclusion, Furazolidone, Sulfadimidine and Amprolium are well-tolerated and any one of these may be recommended to effectively treat coccidiosis in Beetal goats.
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March 2016

Chemotherapy Induced Acute Pericarditis in a Child.

J Coll Physicians Surg Pak 2015 Oct;25 Suppl 2:S81-3

Department of Pediatric Cardiology, King Salman Heart Centre, King Fahad Medical City, Riyadh, KSA.

A9 years boy diagnosed with nasopharyngeal carcinoma was started on chemotherapy protocol including 5-fluorouracil. After 90 hours of 5-fluorouracil infusion, he developed severe retrosternal chest pain. Electrocardiography showed signs of acute pericarditis and was managed with ibuprofen and 5-fluorouracil was discontinued. The 5-fluorouracil rarely causes cardiac complications such as angina pectoris and pericarditis in adult patients. We report acute myopericarditis in a child caused by 5-fluorouracil, which is a very rare complication of 5-fluorouracil in pediatric age group.
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http://dx.doi.org/10.2015/JCPSP.S81S83DOI Listing
October 2015

Psychosocial risk factors of myocardial infarction and adverse effects of streptokinase in public sector hospitals.

Pak J Med Sci 2015 Jul-Aug;31(4):821-6

Maria Afzal, M.SC Department of Psychology, Government College University, Lahore, Pakistan.

Objectives: This study investigated the psychosocial risk factors of myocardial infarction and time related adverse effects of administration of streptokinase on short-term morbidity and mortality in patients with ST-segment-elevation myocardial infarction (STEMI).

Methods: One hundred patients with STEMI treated with streptokinase in the hospital setting were prospectively enrolled in the study. The primary outcome parameter was the incidence of major adverse cardiac events. During hospital stay the psychosocial and demographic risk factors were also investigated.

Results: The overall mortality rate was similar in both groups and it was not significant. (5.7% vs 14.5%; P = 0.18). The number of recurrent chest pain was significantly higher in the group 2 compared to the group 1 (25% vs 62.5%; P = .01). The number of hypotesion was significantly higher in the group 1 as compared to the group 2 (30.7% vs 6.2%; P = .009). The demographic and psychosocial risk factors were recorded.

Conclusions: The early intravenous administration of streptokinase in the hospital setting leads to a reduced rate of major cardiovascular events compared to delayed administration beyond 2 hours. However, mortality rates were not significantly affected. Secondary prevention should be targeted on modifiable demographic, dietary, and psychosocial risk factors of STEMI.
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http://dx.doi.org/10.12669/pjms.314.6803DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4590367PMC
October 2015

Images of Percutaneous Closure of Ruptured Sinus of Valsalva.

Pediatr Cardiol 2015 Aug 22;36(6):1308-9. Epub 2015 Mar 22.

King Salman Heart Centre, King Fahad Medical City Riyadh, PO Box 59046, Riyadh, 11525, Kingdom of Saudi Arabia.

The images of transcatheter closure of ruptured sinus of valsalva are presented.
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http://dx.doi.org/10.1007/s00246-015-1149-xDOI Listing
August 2015

Empyema thoracis in children: clinical presentation, management and complications.

J Coll Physicians Surg Pak 2014 Aug;24(8):573-6

Department of Surgery, The Aga Khan University Hospital, Karachi.

Objective: To determine the etiology, clinical manifestation, management (medical and surgical) and complications of children with empyema thoracis in a tertiary care hospital from Karachi, Pakistan.

Study Design: Descriptive, analytical study.

Place And Duration Of Study: Department of Surgery, The Aga Khan University Hospital, Karachi, from January 1996 to December 2010.

Methodology: Medical records of admitted children aged > a month to 15 years with discharge diagnosis of empyema thoracis and data was collected on demographic features, clinical manifestation, management and complications. Children managed medically were compared with those managed surgically by using interquartile range and median comparison. Mann-Whitney U test was used to compare age in months, weight (kg) and length of stay in days and presenting complaint, duration of illness; chi-square test was used to compare thrombocytosis in between groups and p-value was calculated.

Results: Among the 112 patients, 59 (53%) were younger than 5 years of age. Males (n=83, 74%) were predominant. Fifty (45%) children were admitted in winter. Thirty (27%) children found unvaccinated and one fourth (n=27; 24%) were severely malnourished. Fever, cough, and dyspnea were the major presenting symptoms. Sixty-six (59%) were on some antibiotics prior to admission. Staphylococcus aureus (n=13) and Streptococcus pneumoniae (n=5) were the commonest organism isolated from blood and pleural fluid cultures. Majority of the children required some surgical intervention (n=86). Surgically managed children were younger (p=0.01); had less weight (p=0.01) and prolonged fever (p=0.02); and stayed longer in hospital (p < 0.001) as compared to medically managed children. Requiring readmission (n=8), subcutaneous emphysema (n=5) and recollection of pus (n=5) were the major complications.

Conclusion: Staphylococcus aureus was the major organism associated with paediatric empyema thoracis. Early identification and empiric antibiotic as per local data is essential to prevent short and long-term complications. Younger, lower weight children with prolonged fever required surgical management.
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http://dx.doi.org/08.2014/JCPSP.573576DOI Listing
August 2014

Prolonged oral cyanide effects on feed intake, growth rate and blood parameters in rabbits.

Pak J Pharm Sci 2014 Jul;27(4):773-7

University College of Veterinary and Animal Sciences, The Islamia University of Bahawalpur, Bahawalpur, Pakistan.

Twelve adult rabbits bred locally were divided into two equal groups of 6; experimental and control groups. Rabbits in the experimental group were orally dosed with KCN at 3mg/kg body weight for 40 consecutive days. Members in control group were given placebo (distilled water) for the same period. Animals in both groups were offered feed at 90gm/kg/day while ample drinking water was available ad lib. Feed consumption and body weight of rabbits in both the groups were recorded. Blood samples were also drawn to determine various hematological parameters. Statistical analysis revealed a non-significant difference of total and daily feed intakes in rabbits of experimental and control groups. Whereas the feed efficiency of rabbits in the experimental group were significantly reduced (P<0.05) compared to controls. Likewise a significant decrease in body weight gain of rabbits in experimental group (P<0.05) was observed. A non-significant difference (P>0.05) was observed in leukocyte count, differential leukocyte count and platelets of rabbits in both the groups. Erythrocyte count, hemoglobin concentration, packed cell volume and mean corpuscular hemoglobin were significantly decreased in treated rabbits. It was concluded that chronic cyanide intake had a deleterious effect on feed efficiency, growth rate and blood components of rabbits.
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July 2014

Percutaneous closure of atrial septal defect with situs solitus and dextrocardia.

Asian Cardiovasc Thorac Ann 2015 Feb 29;23(2):202-5. Epub 2013 Oct 29.

Prince Salman Heart Center, King Fahad Medical City, Riyadh, Saudi Arabia Skane University Hospital, Lund, Sweden.

Percutaneous closure of secundum atrial septal defect associated with situs solitus and dextrocardia has not been reported previously. We describe the technical difficulties encountered during transcatheter closure of a secundum atrial septal defect in a 19-month-old girl with situs solitus and dextrocardia.
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http://dx.doi.org/10.1177/0218492313500498DOI Listing
February 2015

Giant left ventricular fibroma presenting as ventricular tachycardia in a child.

Asian Cardiovasc Thorac Ann 2014 Jun 19;22(5):588-91. Epub 2013 Nov 19.

Prince Salman Heart Center, King Fahad Medical City Riyadh, Saudi Arabia.

We present a rare case of giant left ventricular apical fibroma presenting as recurrent ventricular tachycardia in a 14-month-old girl. The diagnosis was made by echocardiography and chest computed tomography, and confirmed by histopathology. The fibroma was resected surgically, and the patient followed up for 4 years.
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http://dx.doi.org/10.1177/0218492313478216DOI Listing
June 2014

Implantable port devices in paediatric oncology patients: a clinical experience from a tertiary care hospital.

J Pak Med Assoc 2013 Oct;63(10):1248-51

Section of Paediatric Surgery, Department of Surgery, Aga Khan University Hospital, Karachi.

Objective: To assess the frequency of infection of portacath in children having malignant tumours and undergoing chemotherapy, and to assess the association of the infection with already known risk factors.

Methods: The retrospective review was conducted at Aga Khan University Hospital, Karachi, and involved patient data related to the period between January 2005 to December 2010. A questionnaire was designed to collect the required data. A total of 67 children were included having portacath inserted for chemotherapy. Children in which portacath was inserted under local anaesthesia in Radiology department, reinserted or inserted because of a reason other than childhood malignancy were excluded. SPSS 19 was used for statistical analysis.

Results: Of the total, 46 (67%) patients were males and a majority of the total (n = 31; 46%) was between 6-10 years of age. Besides, 42 (63%) patients had leukaemia, 7 (11%) had lymphoma and 18 (26%) had various solid tumours. Six (8.95%) ports were removed due to infection. There was significant difference between infection and non-infection groups with respect to absolute neutrophilic count levels (p < 0.001). Positive association was found between low absoulute neutrophilic count level (< or = 500) and the occurrence of port infection.

Conclusions: Port infection rate is higher in children with low absoulute neutrophilic count. The issue needs to be addressed and one may have to alter the timings of port insertion. It is recommended to insert port when absolute neutrophilic count is normal. To further evaluate the subject, a multicentre trial must be conducted.
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October 2013

Focused abdominal sonography for trauma (FAST) in blunt paediatric abdominal trauma.

J Pak Med Assoc 2013 Mar;63(3):361-4

Section of Paediatric Surgery, Department of Surgery, The Aga Khan University Hospital, Karachi.

Objective: To evaluate the role of focussed abdominal sonography for trauma in blunt paediatric abdominal trauma patients, and to see if the role of computed tomography scan could be limited to only those cases in which sonography was positive.

Methods: The retrospective study covered 10 years, from January 1,2000 to December 31,2009, and was conducted at the Department of Radiology and Department of Emergency Medicine, Aga Khan University Hospital, Karachi. It comprised cases of 174 children from birth to 14 years who had presented with blunt abdominal trauma and had focussed abdominal sonography for trauma done at the hospital. The findings were correlated with computed tomography scan of the abdomen and clinical follow-up. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy of focussed abdominal sonography for trauma were calculated for blunt abdominal trauma. SPSS 17 was used for statistical analysis.

Results: Of the total 174 cases, 31 (17.81%) were later confirmed by abdominal scan. Of these 31 children, sonography had been positive in 29 (93.54%) children. In 21 (67.74%) of the 31 children, sonograpy had been true positive; 8 (25%) (8/31) were false positive; and 2 (6%) (2/31) were false negative. There were 6 (19.3%) children in which sonography was positive and converted to laparotomy. There was no significant difference on account of gender (p>0.356). Focussed abdominal sonography for trauma in the study had sensitivity of 91%, specificity of 95%, positive predictive value of 73%, and negative predictive value of 73% with accuracy of 94%. All patients who had negative sonography were discharged later, and had no complication on clinical follow-up.

Conclusions: Focussed abdominal sonography for trauma is a fairly reliable mode to assess blunt abdominal trauma in children. It is a useful tool to pick high-grade solid and hollow viscous injury. The results suggest that the role of computed tomography scan can be limited to those cases in which focussed sonography is positive.
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March 2013

Posterior spinal fixation with pedicle screws and rods system in thoracolumbar spinal fractures.

J Coll Physicians Surg Pak 2012 Dec;22(12):778-82

Department of Orthopaedics and Trauma Surgery, Jinnah Postgraduate Medical Centre, Karachi.

Objective: To determine the effectiveness of posterior spinal fixation in maintaining the stability of spine and to determine mortality in 6 months after posterior spinal fixation.

Study Design: Quasi experimental study.

Place And Duration Of Study: Department of Orthopaedics, Jinnah Postgraduate Medical Centre, Karachi and Department of Orthopaedics, Postgraduate Medical Institute, Hayatabad Medical Complex, Peshawar, from April 2006 to April 2009.

Methodology: Fifty patients with unstable thoracolumbar spinal fractures from T7 - L4 were included. All the patients were operated by posterior approach using pedicle screws and rods. Effectiveness of the fixation was measured at 6 months postoperatively in terms of relief of pain and improvement in mobility using Oswestry disability index, range of motion of spine using Schobar Test/sign, reduction in deformity by measuring Cobb angle, local kyphosis angle (LKA), thoracolumbar angle, anterior and posterior vertebral heights (AVH and PVH respectively), evidence of union was made using plain radiographs and by computer assisted measurement using " OSIRIS " software. The data was then analyzed using SPSS software version 13 and presented in the form of tables and charts.

Results: Twenty-eight patients were operated within first week. In 38 patients, 4 screws were used and in 12 patients, 8 screws were used with 2 rods. Pain and disability showed improvement, with mean 71.98% score pre-operatively to 44.96% mean at last visit (p = 0.001). Mean range of motion increased 0.5 - 2 cms postoperatively in all directions (p = 0.001). Mean kyphosis angle, Cobb angle and thoracolumbar angle improved postoperatively. Anterior and posterior vertebral body heights increased postoperatively with resultant decrease in anterior vertebral body compression. Ninety six percent patients showed signs of postoperative union on last visit and only 3 people died of unrelated causes till last visit.

Conclusion: Posterior spinal fixation with pedicle screws and rods is an effective surgical technique in maintaining stability of spine by improvement in pain and mobility, range of motion of spine, correction of deformity and bone union.
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http://dx.doi.org/12.2012/JCPSP.778782DOI Listing
December 2012

Hypoplastic left heart syndrome, cor triatriatum and partial anomalous pulmonary venous connection: Imaging of a very rare association.

J Saudi Heart Assoc 2012 Apr 20;24(2):137-40. Epub 2011 Oct 20.

Prince Salman Heart Centre, King Fahad Medical City, Riyadh.

A newborn is presented with an association of hypoplastic left heart syndrome, cor triatriatum and partial anomalous pulmonary venous connection. The diagnosis was established with echocardiography and further confirmed with computed tomography. To our knowledge the images of such an association have never been reported before.
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http://dx.doi.org/10.1016/j.jsha.2011.10.003DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3727436PMC
April 2012

Pulmonary atresia with hypoplastic right ventricle and large subaortic ventricular septal defect.

J Saudi Heart Assoc 2011 Jul 13;23(3):151-3. Epub 2011 Jan 13.

Prince Salman Heart Center, King Fahad Medical City, Riyadh, Saudi Arabia.

A neonate is presented with a very rare association consisting of pulmonary atresia with large ventricular septal defect but additionally, combined with a hypoplastic right ventricle and well developed pulmonary arteries. The management strategy is described.
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http://dx.doi.org/10.1016/j.jsha.2011.01.010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3801140PMC
July 2011

Modified picrate method for determination of cyanide in blood.

Pak J Pharm Sci 2011 Apr;24(2):149-53

Department of Clinical Medicine and Surgery, University of Veterinary and Animal Sciences, Lahore, Pakistan.

Cyanide (CN-) is widely distributed in the ecosystem and has been associated with toxic effects in humans and animals. Most outbreaks of CNֿ poisoning in animals result from ingestion of plants containing cyanogenic glycosides. Various analytical techniques for estimating cyanide in blood are available. A simple picrate method was developed to determine blood CN- in goats. This assay is a modification of commonly available methods using picrate paper and those using Conway diffusion cells. Cyanide in blood was measured during and after IV administration of KCN at 0.6 mg/min for 1 h. Blood CN- levels in rabbits were determined after oral administration of KCN for 10, 20, 30 and 40 days. The CN- concentration in blood of goats was time-dependent and continued rising during infusion followed by gradual decline after infusion stopped. A calibration curve set by dissolving various concentrations of KCN in distilled water showed a linear relationship between CN- concentration and absorbance (R=0.995) ranging from 0.3-120 mg CN-/L. Blood CN- levels in rabbits showed time-dependent increase with maximum concentration (1.34 mg/L) at 40 days. This is a simple and inexpensive tool for the determination of blood CN- in the laboratory and under field conditions as well.
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April 2011

Comparative efficacy of diminazene diaceturate and diminazene aceturate for the treatment of babesiosis in horses.

Trop Anim Health Prod 2008 Aug 15;40(6):463-7. Epub 2007 Dec 15.

Faculty of Veterinary Science, University of Veterinary and Animal Sciences, Lahore, Pakistan.

The present work was conducted to study the comparative efficacy of two anti-protozoan (babesicidal) drugs on the recovery and health of horses. A total of 80 horses, showing typical clinical symptoms of the disease, were selected for this study; the presence of babesiosis was confirmed through blood smear examination. These animals were divided into two groups i.e. A and B. Horses of Group A, were treated with diminazene diaceturate, while horses of Group B were treated with diminazene aceturate. Efficacy of the drugs was determined by the reversal of clinical signs and a negative blood smear examination. The efficacy of diminazene diaceturate was demonstrated to be 80% while diminazene aceturate was found to have 90% efficacy against babesiosis.
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http://dx.doi.org/10.1007/s11250-007-9121-2DOI Listing
August 2008

Gastrograffin use in distal intestinal obstruction syndrome of cystic fibrosis.

J Ayub Med Coll Abbottabad 2007 Jan-Mar;19(1):58-60

Department of Pediatrics, The Aga Khan University Hospital, Karachi, Pakistan.

Background: Meconium ileus equivalent or the Distal Intestinal Obstruction Syndrome (DIOS) is an entity that is frequently seen in patients with cystic fibrosis (CF). In the gastrointestinal tract cystic fibrosis may produces symptoms of malabsorption and constipation. The latter may be associated with complications such as impaction and intestinal perforation. Meconium ileus and DIOS are an emergency and requires to be treated aggressively to ensure that consequences such as perforation do not occur.

Method: Traditional modes of management of DIOS have included the use of laxatives, Acetylcysteine and Gastrograffin enemas. We are describing the use of oral gastrograffin in our patient seen at the Aga Khan University Hospital where small bowel obstruction was refractory to treatment. Oral gastrograffin was used once diluted in 4 times the volume of water or fruit juice with half doses given on day 2 and 3.

Results: Oral gastrograffin use was followed by relief of obstruction in this patient.

Conclusion: Gastrograffin use orally or rectally may be helpful in the treatment of refractions distal intestinal obstruction syndrome in cystic fibrosis.
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November 2007
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