Publications by authors named "Muhammad N Khan"

28 Publications

  • Page 1 of 1

Enhancing Value-Based Care With a Walk-in Clinic: A Primary Care Provider Intervention to Decrease Low Acuity Emergency Department Overutilization.

Cureus 2021 Feb 11;13(2):e13284. Epub 2021 Feb 11.

Family Medicine, WellSpan Good Samaritan Hospital, Lebanon, USA.

Background Emergency department overutilization is a known contributor to the high per-capita healthcare cost in the United States. There is a knowledge gap regarding the substitution effect of walk-in clinic availability in primary care provider (PCP) offices and emergency department utilization (EDU). This study evaluates associations between PCP availability and EDU and analyzes the potential cost savings for health systems. Methods A retrospective cohort analysis compared low acuity EDU rates in established patients at a family medicine residency's PCP office before and after walk-in clinic implementation. The practice had 12 providers, 12 residents, and a patient panel of approximately 7,000-8,000. Inclusion criteria were met if patients were: (1) established with the PCP office, (2) had a low acuity emergency department (ED) visit (emergency index score level 4 or 5) had a walk-in clinic visit at the family practice. ED visits were tracked from January 2018 to January 2020 and encounters were compared numbers to pre and post-implementation of a walk-in clinic. Cost savings for comparable management was estimated with average price differences for low acuity encounters in the ED versus clinic. Results Over the two-year timeframe, there were 10,962 total visits to the ED by family practice patients, 4,250 of these visits were low acuity. Despite gross monthly increases of EDU from 2018-2020, after implementation of a walk-in clinic in 2019, rates of total EDU decreased by 1.5% and low acuity utilization rates also decreased. The average annual patient census nearly doubled from 5,763 to 8,042. T-tests confirmed statistical significance with p-values <0.05. Average low acuity ED visits ($437) cost 4.9 times more than comparable PCP office visits ($91). Managing 2,387 patients in the walk-in clinic resulted in an estimated annual cost savings of $825,902. Conclusion Extended walk-in availability in primary care offices provides non-ED capacity for low acuity management and might mitigate low acuity ED utilization while providing more cost-effective care. This study supports similarly described pre-hospital diversions in reducing ED over-utilization by increasing access to care. Higher levels of evidence are needed to establish causality.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7759/cureus.13284DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7955766PMC
February 2021

Application of spore morphology to solve identification problems in certain species of family Dryopteridaceae from Malakand Division, Pakistan.

Microsc Res Tech 2021 Mar 3. Epub 2021 Mar 3.

Plant Eco-Physiology and Evolution Group, State Key Laboratory of Conservation and Utilization of Subtropical Agro-bio-resources, College of Forestry, Guangxi University Daxuedonglu 100, Nanning, Guangxi, China.

Here we investigate the morphology of the spores of 12 native taxa of Dryopteridaceae that grow in Malakand division, Pakistan; most of these species not fully described before. This study intends to survey the taxonomic significance of spore morphological features and their variation useful for species identification in 7 species of Polystichum and 5 taxa of Dryopteris. The spores examinations were accomplished utilizing a light microscope (LM), and scanning electron microscope (SEM). The spores are monolete, medium-sized, with variable shapes in both equatorial and polar views. The mean estimation of equatorial diameter ranging from 28.3 to 58.3 μm and the polar diameter varied from 27.6 to 45.8 μm. The exospore thickness ranges between 1.6 to 3.8 μm, and the thickness of perispore is 0.8-6.7 μm. The perispore is perforated, ornamentation elements occur in different ways in the studied taxa of Polystichum. In investigated Dryopteris taxa, rugate perispore type is found. Results of multivariate statistical analysis (UPGMA, and PCA) established on quantitative and qualitative morphological traits of spores demonstrate that the species form distinct groups, not reflecting any phylogenetic relationships. A key to the spores types is provided for species identification, which dependent on the diagnostic characters of spores. The results of this study indicate that variation of spore morphological traits; in particular, the ornamentation and perispore characteristics, which is surface texture, have diagnostic value at the species level. Our data will help in the identification of spores of the family Dryopteridaceae in palynological and taxonomic studies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/jemt.23746DOI Listing
March 2021

Formation of 3-Aminophenols from Cyclohexane-1,3-diones.

J Org Chem 2021 01 4;86(1):619-631. Epub 2020 Dec 4.

Chemistry Department, University of Alberta, Edmonton, Alberta T6G 2G2, Canada.

-Aminophenols are formed by the action of DBU on 3-amino-2-chlorocyclohex-2-en-1-ones at room temperature in MeCN. The chloro compounds are generated by treating 3-aminocyclohex-2-en-1-ones with the easily prepared halogenating agent BnNMe·ICl in MeOH-CHCl. The amino group must carry two substituents, either two aryl, one aryl and one alkyl, or two alkyl groups; 3-aminocyclohex-2-en-1-ones of this type are readily made from cyclohex-2-en-1-one and a primary or secondary amine.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1021/acs.joc.0c02284DOI Listing
January 2021

Coronary Artery Anomalies in Tetralogy of Fallot Patients Undergoing CT Angiography at a Tertiary Care Hospital.

Cureus 2020 Sep 29;12(9):e10723. Epub 2020 Sep 29.

Statistics, National Institute of Cardiovascular Diseases, Karachi, PAK.

Background The aim of this study was to determine the frequency of coronary artery anomalies (CAAs) in Tetralogy of Fallot (TOF) patients undergoing computed tomography (CT)-angiography in a tertiary care hospital. Methodology In this observational study, we included consecutive TOF patients undergoing CT-angiography without prior history of cardiac surgery or congenital heart disease. CAAs were defined based on either origin or course of the artery. Results Out of 441 TOF patients, the prevalence of CCAs was 3.6% (16), of which 13 were below 18 years of age. Anomalous left main artery was observed in six (1.4%) patients, followed by left anterior descending artery and right coronary artery, observed in four (0.9%) patients each, and two (0.5%) patients had a single coronary artery originating from the left coronary cusp with an interarterial course. Conclusions CAAs were observed in a significant number (3.6%) of TOF patients. A CT-angiographic assessment before surgical correction would help identify the exact anatomy for better surgical planning to minimize complications.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7759/cureus.10723DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7599042PMC
September 2020

Determination of cefixime in pure form, in pharmaceutical products and biological samples through fluorescence quenching of eosin Y.

Luminescence 2021 Mar 18;36(2):515-524. Epub 2020 Nov 18.

Department of Chemistry, Bacha Khan University Charsadda, Pakistan.

A simple, economic and validated spectrofluorimetric method was developed to assay cefixime (CFX). The technique relies on the quenching effect of CFX on the fluorescence intensity of eosin Y in the presence of acetate buffer pH 3.4 to produce an ion-pair complex that is measured at 549 nm using an excitation wavelength of 300 nm. Reaction-influencing factors were carefully investigated and optimized. The fluorescence quenching value was linear to the CFX concentration in the range 0.2-40 μg/ml with a correlation coefficient of 0.992. The calculated limit of detection and limit of quantification were found to be 0.00242 and 0.0080 μg ml , respectively. The selectivity of the method was confirmed by studying the effects of excipients and no interference was distinguished. The developed method was used to determine CFX in marketable products and in biological samples. To validate the method, directives of the International Conference on Harmonization were applied and per cent recoveries obtained ranged from 95.30 to 102.50% for pharmaceutical products and from 97.00 to 103.00% for biological fluids.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/bio.3971DOI Listing
March 2021

Multivessel Coronary Artery Disease and Subsequent Thrombolysis in Myocardial Infarction Flow Grade After Primary Percutaneous Coronary Intervention.

Cureus 2020 Jun 21;12(6):e8752. Epub 2020 Jun 21.

Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK.

Background In underdeveloped countries, coronary artery disease (CAD) has developed into a serious health issue due to the high rates of risk factors such as obesity and smoking amongst the population. This study has been performed to find the rate of multivessel CAD (MVD) and subsequent thrombolysis in myocardial infarction (TIMI) flow grade III in patients undergoing primary percutaneous coronary intervention (PCI). Methods This transverse study was carried out involving 110 patients from the emergency department of the National Institute of Cardiovascular Diseases, Karachi, Pakistan, from August 2015 to March 2016. All patients were diagnosed as ST-segment elevation myocardial infarction (STEMI) and had gone through primary PCI. Pre-procedure angiographic findings regarding the number of vessels involved and post-procedure TIMI flow grade were assessed and analysed. Results The average age of the study sample was 56.3 ± 11.4 years. The proportion of male patients was 81.8% (n=90), and hypertension was the most prevalent risk factor followed by type II diabetes with a frequency of 67.3% (n=74) and 40.0% (n=44), respectively. Coronary angiography showed MVD in 50.0% (n=55) of the patients, of whom 34 patients had two-vessel disease, and the remaining 21 had three-vessel disease. Ninety percent (n=99) of the patients exhibited TIMI flow grade III after the procedure with no significant difference between patients with MVD and those with single-vessel disease with a rate of 87.3% (n=48/55) versus 92.7% (n=51/55, P=0.527), respectively. Conclusion Post-procedure TIMI flow grade III was accomplished in almost 90% of the subjects with or without MVD. It can be concluded that primary PCI has a significant role in the early restoration of myocardial blood flow following STEMI regardless of the vessels involved.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7759/cureus.8752DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7377666PMC
June 2020

Partial Annuloplasty Rings in the Repair of Functional Ischemic Mitral Regurgitation.

Cureus 2020 Jun 3;12(6):e8419. Epub 2020 Jun 3.

Research and Statistics, Tabba Institute of Heart Disease, Karachi, PAK.

Background Acute myocardial infarction (MI) is the leading cause of worldwide cardiac morbidities and mortalities. Mitral regurgitation (MR) is a common complication of MI. The severity of ischemic MR (IMR) can range widely, both clinically and hemodynamically. Mitral valve (MV) repair by lifting annuloplasty is a surgical procedure used to correct the pathology of IMR. The immediate outcomes of this technique have not yet been determined. The present study, therefore, evaluated the immediate results of MV annuloplasty performed to complement MV repair in patients with IMR. Methodology All adult patients with IMR who underwent lifting posterior mitral annuloplasty (LPMA) plus concomitant coronary artery bypass grafting (CABG) were included. Immediate outcomes were evaluated by transesophageal color Doppler echocardiography. The frequency of successful outcomes was compared in patients with different baseline characteristics. Results Posterior mitral annuloplasty was successful in 93.1% of patients, including in 92.8% of men and 94.1% of women. The percentages of successful immediate outcomes differed significantly in patients with and without diabetes and hypertension, and in patients with two- and three-vessel disease. Conclusion LPMA resulted in a high percentage of successful immediate outcomes in patients with IMR. Further studies should compare rates of immediate, intermediate, and late outcomes of this technique.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7759/cureus.8419DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7336716PMC
June 2020

Outcome at Six Months After Primary Percutaneous Coronary Interventions Performed at a Rural Satellite Center of Sindh Province of Pakistan.

Cureus 2020 May 28;12(5):e8345. Epub 2020 May 28.

Cardiology, National Institute of Cardiovascular Diseases, Karachi, PAK.

Introduction Primary percutaneous coronary intervention (PPCI) is now a well-established treatment of acute ST-elevation myocardial infarction (STEMI). For the first time in Pakistan, various off-site satellite centers are established to perform PPCI 24-hours. Our population mainly resides in the rural area with low literacy rate and poor socioeconomic conditions. The majority of the patients who are presented in the satellite center had either never received any long-term treatment plan or were non-compliant to their medication. The objective of this study was to determine the outcome of patients at six months who underwent primary PCI at a rural satellite center of Sindh, Pakistan. Methods This study was conducted at Larkana satellite center of National Institute of Cardiovascular Diseases, Karachi. Patients who underwent PPCI for STEMI from October 2017 to March 2018 were enrolled in the study. In case of death of the patient, data were obtained from the attendant of the deceased. Patients, on follow-up visits, were interrogated for post-procedure symptoms. Results A total of 271 patients were enrolled in the study. The mean age ± standard deviation of patients was 54.84 ± 10.64 years. The most common culprit artery was left anterior descending (LAD) artery with 161 (59.4%) patients, followed by right coronary artery (RCA) with 98 (36.2%) patients. Only 41 (15%) patients had a three-vessel disease, while 141 (52%) patients had single-vessel disease. On follow-up, 70 (25.8%) patients complained of chest pain grade II, 20 (7.4%) complained of shortness of breath (SOB) grade II, 44 (16.2%) complained of vertigo, and 16 (5.9%) complained of nonspecific weakness. The mortality rate of 6.3% (17) was observed after six months of PPCI. The mortality rate was found to be lower for patients with LAD disease (p = 0.036) and higher among patients with RCA as the culprit artery (p = 0.045). The mortality rate was significantly associated with the number of diseased vessels and the type of stent deployed. Conclusion Primary PCI, at a rural satellite center, has an overall positive outcome. Steps should be taken to provide free medication along with encouragement towards compliance of dual antiplatelet medication. Furthermore, the facility for subsequent procedures should be provided at the same set-up.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7759/cureus.8345DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7325348PMC
May 2020

Outcomes of Primary Percutaneous Coronary Intervention through a Transradial Approach in a Tertiary Care Cardiac Center.

Cureus 2019 Dec 27;11(12):e6484. Epub 2019 Dec 27.

Statistician, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK.

Background Transradial approach for percutaneous coronary intervention (PCI) is gaining popularity due to lesser bleeding and other access site related complications. This study aims to determine the in-hospital outcomes of primary PCI through a transradial approach in a tertiary care cardiac center. Methods Consecutive patients with ST-segment elevation myocardial infarction presenting within 12 hours with symptoms without a previous history of thrombolytic therapy, coronary angioplasty, or cardiac surgery were included in the study. All patients underwent a diagnostic angiogram followed by primary PCI of the infarct-related artery through a radial route and were kept under observation during the hospital stay for forearm hematoma or mortality. Results A total of 180 patients were included in this study, with a mean age of 52.04±7.31 years. Majority (87.2%) of the patients were male, and diabetes (72.8%) was the most commonly observed co-morbid condition followed by hypertension (67.2%). Hospital mortality rate was 3.9% (7 patients), and post-procedure forearm hematoma was noted in 5.6% (10 patients). An increased mortality rate was found to be associated with age above 50 years (7.1% vs. 0.0%; p=0.012) and non-hypertension (8.5% vs. 1.7%; p=0.026). An increased incidence of forearm hematoma was found to be associated with age above 50 years (10.2% vs. 0.0%; p=0.002), diabetic mellitus (7.6% vs. 0.0%; p=0.047), hyperlipidemia (11% vs. 0.0%; p=0.001), and non-smoking (10.2% vs. 0.0%; p=0.003). Conclusion Our study showed that primary PCI through a transradial approach is a safe option with excellent success rates in terms of both mortality rates and morbidity such as forearm hematoma.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7759/cureus.6484DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6984168PMC
December 2019

Perceptions and Practices towards Medication Non-Adherence among Hypertensive Patients: An Observational Study.

Cureus 2019 Oct 15;11(10):e5917. Epub 2019 Oct 15.

Department of Biostatistics, National Institute of Cardiovascular Diseases (NICVD), Karachi, PAK.

Background The present study broadly evaluates the adherence to pharmacotherapy, perceptions, and practices among ambulatory hypertensive patients attending a cardiac institution in Karachi, Pakistan. Methods A cross-sectional, single-center study was conducted at the National Institute of Cardiovascular Diseases Karachi, Pakistan. The study continued from 4 July 2019 to 3 September 2019. A total of 200 patients with a primary diagnosis of hypertension (HTN) were recruited for the study. The data was collected through a questionnaire based on a nine-item modified adherence predictor scale to assess medication adherence. Along with the demographic details patients smoking status, history of comorbidities and past complications were noted. Results It was found that the mean age of the study population was 56.45±12.36 years. A total of 62.5% of patients were taking medication daily while 15.5% were consuming medications intermittently and only 6.5% patients were not adherent at all. Around 35% patients preferred follow-up visits once in a month. Besides this, 35.5% patients never monitored their blood pressure while more than half of the studied population believed that their BP has mostly been controlled and skipped the prescribed medication. Conclusion The study indicated that the perception and awareness among the hypertensive patients regarding their medical condition are suboptimal. Concerted strategies like health education program and campaigns must be launched in order to help the sufferers.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.7759/cureus.5917DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6886734PMC
October 2019

Fluorescence Quenching of the Probes L-Tryptophan and Indole by Anions in Aqueous System.

Anal Sci 2020 Feb 27;36(2):183-185. Epub 2019 Sep 27.

Department of Chemistry, Bacha Khan University.

A fluorescence quenching study of the fluorescent probes L-tryptophan and indole by anions (NO, Cl, SO) was carried out in an aqueous system. The ions NO, Cl and SO showed very good quenching of both the probes. Quenching of L-tryptophan by all the anions studied was higher as compare to the quenching of indole. The data was fitted with the Stern-Volmer equation. Stern-Volmer constants were observed in the order NO > Cl > SO. Stern-Volmer constants reflect the sensitivity of the method for the studied anions. Limit of detection (LOD) was calculated as three times the standard deviation of the blank for n = 10 (3 × SD) while the limit of quantification (LOQ) was calculated as ten times the standard deviation of the blank for n = 10 (10 × SD). In the case of L-tryptophan LOD and LOQ varied from 4.08 × 10 - 4.56 × 10 mol L, while in the case of indole the values ranged from 3.87 × 10 - 6.59 × 10 respectively. Fluorescence quenching of L-tryptophan and indole by the studied anions showed good reproducibility and the method could be very effective for the determination of anions.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.2116/analsci.19P264DOI Listing
February 2020

Draft Genome Sequence of Bacillus pumilus SCAL1, an Endophytic Heat-Tolerant Plant Growth-Promoting Bacterium.

Genome Announc 2018 May 3;6(18). Epub 2018 May 3.

Department of Plant Sciences, Quaid-i-Azam University, Islamabad, Pakistan

strain SCAL1 is an endophytic, thermophilic plant that was isolated from the leaf of a plant, L., in Sindh, Pakistan. strain SCAL1 has usually exhibited high resistance to environmental stresses, with a growth temperature ranging from 30 to 60°C. An approximately 3.75-Mb draft genome was assembled into 68 contigs.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1128/genomeA.00306-18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5940947PMC
May 2018

Identification of a novel homozygous TRAPPC9 gene mutation causing non-syndromic intellectual disability, speech disorder, and secondary microcephaly.

Am J Med Genet B Neuropsychiatr Genet 2017 Dec 14;174(8):839-845. Epub 2017 Oct 14.

Charité - Universitätsmedizin Berlin, Institute of Neuroanatomy and Cell Biology, Berlin, Germany.

TRAPPC9 gene mutations have been linked recently to autosomal recessive mental retardation 13 (MRT13; MIM#613192) with only eight families reported world-wide. We assessed patients from two consanguineous pedigrees of Pakistani descent with non-syndromic intellectual disability and postnatal microcephaly through whole exome sequencing (WES) and cosegregation analysis. Here we report six further patients from two pedigrees with homozygous TRAPPC9 gene mutations, the novel nonsense mutation c.2065G>T (p.E689*) and the previously identified nonsense mutation c.1423C>T (p.R475*). We provide an overview of previously reported clinical features and highlight common symptoms and variability of MRT13. Common findings are intellectual disability and absent speech, and frequently microcephaly, motor delay and pathological findings on MRI including diminished cerebral white matter volume are present. Mutations in TRAPPC9 should be considered in non-syndromic autosomal recessive intellectual disability with severe speech disorder.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1002/ajmg.b.32602DOI Listing
December 2017

Outcomes of Cardiopulmonary Resuscitation and Estimation of Healthcare Costs in Potential 'Do Not Resuscitate' Cases.

Sultan Qaboos Univ Med J 2016 Feb 2;16(1):e27-34. Epub 2016 Feb 2.

Department of Medicine, Sultan Qaboos Hospital, Salalah, Oman.

Objectives: Cardiopulmonary resuscitation (CPR) is a life-saving procedure which may fail if applied unselectively. 'Do not resuscitate' (DNR) policies can help avoid futile life-saving attempts among terminally-ill patients. This study aimed to assess CPR outcomes and estimate healthcare costs in potential DNR cases.

Methods: This retrospective study was carried out between March and June 2014 and included 50 adult cardiac arrest patients who had undergone CPR at Sultan Qaboos Hospital in Salalah, Oman. Medical records were reviewed and treating teams were consulted to determine DNR eligibility. The outcomes, clinical risk categories and associated healthcare costs of the DNR candidates were assessed.

Results: Two-thirds of the potential DNR candidates were ≥60 years old. Eight patients (16%) were in a vegetative state, 39 (78%) had an irreversible terminal illness and 43 (86%) had a low likelihood of successful CPR. Most patients (72%) met multiple criteria for DNR eligibility. According to clinical risk categories, these patients had terminal malignancies (30%), recent massive strokes (16%), end-stage organ failure (30%) or were bed-bound (50%). Initial CPR was unsuccessful in 30 patients (60%); the remaining 20 patients (40%) were initially resuscitated but subsequently died, with 70% dying within 24 hours. These patients were ventilated for an average of 5.6 days, with four patients (20%) requiring >15 days of ventilation. The average healthcare cost per patient was USD $1,958.9.

Conclusion: With careful assessment, potential DNR patients can be identified and futile CPR efforts avoided. Institutional DNR policies may help to reduce healthcare costs and improve services.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.18295/squmj.2016.16.01.006DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4746039PMC
February 2016

Genetic causes of MCPH in consanguineous Pakistani families.

Clin Genet 2016 06 8;89(6):744-5. Epub 2015 Nov 8.

Institute of Cell Biology and Neurobiology, University of Azad Jammu and Kashmir, Muzaffarabad, Pakistan.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/cge.12685DOI Listing
June 2016

Identification of novel mutation in the HR gene responsible for atrichia with papular lesions in a Pakistani family.

J Dermatol 2013 Nov 20;40(11):927-8. Epub 2013 Sep 20.

Department of Bioinformatics and Biotechnology, International Islamic University, Islamabad, Pakistan.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/1346-8138.12266DOI Listing
November 2013

Anticoccidial activity of herbal complex in broiler chickens challenged with Eimeria tenella.

Parasitology 2012 Feb 24;139(2):237-43. Epub 2011 Oct 24.

Department of Parasitology, University of Agriculture, Faisalabad-38040-Pakistan.

The objective of the present study was to evaluate the anticoccidial effect of different concentrations of the herbal complex of 4 plants (leaves of Azadirachta indica and Nicotiana tabacum, flowers of Calotropis procera and seeds of Trachyspermum ammi) in broiler chickens in comparison with amprolium anticoccidial. Three concentrations (2 g, 4 g and 6 g) of herbal complex were given to the experimental groups once a day and amprolium (at the dose rate of 125 ppm) was given orally in drinking water from the 14th to the 21st days of age. One group was kept as infected, non-medicated control and one as non-infected, non-medicated control. All groups were inoculated orally with 75,000 sporulated oocysts on the 14th day of age except the non-infected, non-medicated control. Among herbal complex medicated groups, the maximum anticoccidial effect was seen in the group medicated with 6 g herbal complex followed by 4 g and 2 g herbal complex medicated groups. Treatment with 6 g of the herbal complex significantly reduced the negative performance and pathogenic effects associated with Eimeria tenella challenge at a level that was comparable with amprolium when using a largely susceptible recent field isolate. In summary, concentration-dependent anticoccidial activity of the studied herbal complex suggests its use as an alternative anticoccidial agent to chemotherapeutic drugs for Eimeria tenella control.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/S003118201100182XDOI Listing
February 2012

Early complications after biliary enteric anastomosis for benign diseases: a retrospective analysis.

BMC Surg 2011 Aug 25;11:19. Epub 2011 Aug 25.

Dertment of Surgery, Aga Khan University, Stadium Road, Karachi-74800, Pakistan.

Background: Biliary-enteric anastomosis (BEA) is a common surgical procedure performed for the management of biliary obstruction or leakage that results from a variety of benign and malignant diseases. Complications following BEA are not rare. We aimed to determine the incidence and the factors associated with early complications occurring after BEA for benign diseases.

Methods: We reviewed the medical records of all patients who underwent BEA for benign diseases at our institution between January 1988 and December 2009. The primary outcome was early post operative complication. Logistic regression analysis was done to identify factors predicting the occurrence of complications.

Results: Records of 79 patients were reviewed. There were 34 (43%) males and 45 (57% females). Majority (53%) had choledocholithiasis with impacted stone or distal stricture, followed by traumatic injury to the biliary system (33%). Thirty-four patients (43%) underwent a hepaticojejunostomy, 19 patients (24%) underwent a choledochojejunostomy, and choledochoduodenostomy was performed in 26 patients (33%). Early complications occurred in 39 (49%) patients - 41% had local complications and 25% had systemic complications. Most frequent complications were wound infection (23%) and bile leak (10%). Four (5%) patients died. On multivariate analysis, low serum albumin level (odds ratio = 16, 95% CI = 1.14-234.6) and higher ASA levels (odds ratio = 7, 95% CI: 1.22-33.34) were the independent factors predicting the early complications following BEA.

Conclusions: Half of the patients who underwent BEA for benign diseases had complications in our population. This high incidence may be explained by the high incidence of hypoalbuminemia and the high-risk group who underwent operation.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/1471-2482-11-19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3176468PMC
August 2011

Educating the power: HIV/AIDS and parliamentarians of Pakistan.

Health Res Policy Syst 2009 Sep 16;7:20. Epub 2009 Sep 16.

Aga Khan University, Karachi, Pakistan.

Increasing rates of HIV have been recorded amongst the Injection Drug User community from all parts of Pakistan. This has mobilized the health authorities into definitive action before there is a general spread of the epidemic into the Pakistani populace. Lacking any formal research as pertains to HIV policy development in Pakistan, international collaborating agencies, including the United Nations, are aiding in the formulation of a national policy to tackle HIV/AIDS. This article discusses the progress and importance of interventions being conducted amongst the Parliamentarians of Pakistan, relatively unchartered waters. The series of Seminars help to appraise the Parliamentarians of the ground situation as pertains to HIV in their constituencies, aiming to ultimately generate federal and provincial governmental policies, and a solid strategy to combat the spread of HIV/AIDS in Pakistan.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/1478-4505-7-20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2753331PMC
September 2009

In vitro and in vivo efficacies of ivermectin and cypermethrin against the cattle tick Hyalomma anatolicum anatolicum (Acari: Ixodidae).

Parasitol Res 2009 Oct 27;105(4):1133-8. Epub 2009 Jun 27.

Department of Parasitology, University of Agriculture, Faisalabad 38040, Pakistan.

This study investigated the comparative efficacy of ivermectin and cypermethrin pour-on, for the treatment of Hyalomma anatolicum (a.) anatolicum infestations in bovines. For examining acaricidal efficacy, 480 ticks were exposed in vitro to graded doses of both the acaricides and in vivo efficacy was examined in 360 tick-infested bovines treated at the recommended doses of ivermectin (IVM) and cypermethrin (CYM) pour-on. The comparative quantitative assessment of tick burden was done on days 0, 5, 10, 15, and 20 after treatment using "finger counting." The results of the tick survival assay indicated both compounds were effective in vitro against H. a. anatolicum. The arc transformed mean surviving ticks, 24 h post immersion, was 2.66 and zero in groups treated with the highest dilutions of IVM and CYM, respectively. At 15 days post-treatment, the CYM pour-on showed a higher in vivo efficacy (no surviving ticks) compared to IVM (mean of 20 surviving ticks). A single dose of CYM and IVM was found effective for 20 and 15 days post-treatment, respectively. Additionally, a questionnaire was used to gather information from 30 small holder dairy farms on the farmer's approach toward the control of ticks. The majority (90%) of respondents were using acaricides incorrectly along with poor husbandry practices on their farms. Overuse of IVM in the tested area of Pakistan may be the reason the IVM is not as effective as expected. These results provide useful tools for the decision making in tick control, as well as providing the basis for testing the findings on provincial and national levels in future studies.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1007/s00436-009-1538-2DOI Listing
October 2009

Antiseptics, iodine, povidone iodine and traumatic wound cleansing.

J Tissue Viability 2006 Nov;16(4):6-10

General Surgery, North Hampshire Hospital NHS Trust, Basingstoke.

Wound cleansing is an integral part of the management of acute traumatic wounds. There is consensus that it reduces infection rates. However, the choice of cleansing agent remains controversial, especially the use of antiseptics has been questioned. This article reviews the current literature on the use of antiseptics particularly povidine iodine in traumatic wound cleansing and discusses the beneficial and harmful effects of such practice.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/s0965-206x(06)64002-3DOI Listing
November 2006

HIV-1 subtype A infection in a community of intravenous drug users in Pakistan.

BMC Infect Dis 2006 Nov 14;6:164. Epub 2006 Nov 14.

Department of Biological and Biomedical Sciences, Aga Khan University, Karachi, Pakistan.

Background: Data on the subtypes of HIV in a population help in predicting the potential foci of epidemic, tracking the routes of infection and following the patterns of the virus' genetic divergence. Globally, the most prevalent HIV infection is the HIV-1 subtype C. In Asia, predominant subtypes of HIV-1 are B, C, and CRF-01AE. During the last few years, HIV prevalence in Pakistan has taken the form of a concentrated epidemic in at least two high risk groups, namely, Intravenous Drug Users (IDUs) and Male Sex Workers (MSWs). Factors that have facilitated the proliferation of HIV infection include transmission through a large number of repatriates and needle-sharing intravenous drug users, unscreened blood transfusions, and sexual illiteracy. The HIV subtypes infecting Pakistani populations have not been explored to date. In this study, we analyzed HIV-1 subtypes from in a high-risk community of IDUs in Karachi, the largest city of Pakistan.

Methods: Samples were collected from 34 IDUs after their informed consent. In addition, the study subjects were administered a questionnaire regarding their sexual behavior and travel history. For HIV analysis, DNA was extracted from the samples and analyzed for HIV types and subtypes using subtype-specific primers in a nested polymerase chain reaction (PCR). The results from this PCR were further confirmed using the Heteroduplex Mobility Assay (HMA).

Results: We found HIV-1 subtype A in all the 34 samples analyzed. A few of the study subjects were found to have a history of travel and stay in the United Arab Emirates. The same subjects also admitted to having contact with commercial sex workers during their stay abroad.

Conclusion: Our study therefore shows clade A HIV-1 to be prevalent among the IDUs in Karachi. As the prevalence of HIV in Pakistan continues to rise, more work needs to be done to track the infection, and to analyze the strains of HIV spreading through the country.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/1471-2334-6-164DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1654165PMC
November 2006

Advances in the management of leg ulcers--the potential role of growth factors.

Int Wound J 2006 Jun;3(2):113-20

Salisbury District Hospital Salisbury, UK.

Venous ulcers are a major health problem because of the increased costs of the treatment and the refractory nature of the ulcers. The treatment cost is estimated to be around 1 billion dollars per year in the United States (US), and the average cost for one patient over a lifetime exceeds dollars 400,000. There has been an increasing trend in the use of growth factors in their management. Genetic engineering has revolutionised the research of wound healing, as the majority of recombinant growth factors are now available for in vitro and in vivo studies. Online searches of Medline, Pub Medical and Embase were carried out using the terms venous ulcers, leg ulcers, growth factors and growth hormone. The literature regarding the potential role of growth factors in the management of leg ulcers is reviewed. The important clinical studies are critically analysed with a view to appreciate the emerging therapies and the further research possibilities in the management of venous leg ulcers. Clinical results with the use of growth factors in non-healing wounds are encouraging. However, small sample sizes and inconsistent end points in different clinical studies have been the main hurdle in reaching a definite conclusion. Further research is needed to provide the definite evidence. Future developments may include different delivery methods for the growth factors, use of different combinations of growth factors administered simultaneously or, sequentially, bioengineered skin grafts and chemical induction of angiogenesis with the use of gene transfer techniques.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1111/j.1742-4801.2006.00211.xDOI Listing
June 2006

Anthelmintic resistance: the state of play revisited.

Life Sci 2006 Nov 17;79(26):2413-31. Epub 2006 Aug 17.

Chemotherapy Laboratory, Department of Veterinary Parasitology, University of Agriculture, Faisalabad-38040, Pakistan.

Helminthosis is one of the major constraints in the successful wool and mutton industry throughout the world. Anthelmintic Resistance (AR) is said to have been established when previously effective drug ceases to kill exposed parasitic population at the therapeutically recommended dosages. Anthelmintic resistance is almost cosmopolitan in distribution and it has been reported in almost all species of domestic animals and even in some parasites of human beings. Some of the most important species of parasites of small ruminants in which AR has been reported include: Haemonchus spp., Trichostrongylus spp. Teladorsagia spp., Cooperia spp. Nematodirus spp., and Oesophagostomum spp. All the major groups of anthelmintics have been reported for development of variable degrees of resistance in different species of gastrointestinal nematodes. This paper describes the global scenario of prevalence and methods used for detection of AR in small ruminants. Different mechanisms and contributory factors for the development of AR are discussed. Various options and alternate strategies for the control and/or delay in the onset of AR are suggested in the light of available information.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.lfs.2006.08.010DOI Listing
November 2006

The limited role of microbiological culture and sensitivity in the management of superficial soft tissue abscesses.

ScientificWorldJournal 2006 Sep 6;6:1118-23. Epub 2006 Sep 6.

Salisbury District Hospital, Salisbury, UK.

The aim of this study was to assess the role of the routine practice of microbial culture and sensitivity at incision and drainage of superficial soft tissue abscesses. The case notes of 162 consecutive patients, selected from the microbiology database over a period of 1 year, were reviewed. All had incision and drainage of superficial soft tissue abscesses and included perianal, pilonidal, axillary, and breast abscesses. Patients with chronic wounds, recurrent abscesses, diabetes, pregnancy, and immunosuppression were excluded. The impact of pus culture and sensitivity (C/S) on management and clinical outcome was documented. Out of 162 patients, 97 were male (59.8%) and 65 were female (40.1%). Only 115 (70.9%) yielded positive cultures and 47 (29.1%) were sterile. The cultured microbial flora was predictable and sensitive to empirical antibiotics. In four patients, the results of microbial culture sensitivity showed microbial resistance to empirical antibiotics; however, it did not affect the management or the outcome for these patients. The routine practice of sending swabs for C/S after incision and drainage of superficial soft tissue abscesses does not contribute significantly towards patient management. Most patients are already on antibiotics prior to the referral and in the remainder, surgeons start antibiotics empirically. These broad-spectrum antibiotics cover the common pathogens involved, and there is no significant change in the antibiotic treatment after reviewing the culture reports following incision and drainage of uncomplicated superficial skin abscesses.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1100/tsw.2006.215DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5917195PMC
September 2006

Carcinoma of sigmoid colon following urinary diversion: a case report and review of literature.

World J Surg Oncol 2004 Jun 8;2:20. Epub 2004 Jun 8.

General Surgery, L & D Hospital, Lewsey Road, Luton, UK.

Background: The association of ureterosigmoidostomy with colonic cancer is well established. A 100-fold increased risk of malignancy has been proposed in association with ureterosigmoidostomy. Characteristically there is a latent period of around 20-30 years before the occurrence of cancer.

Case Presentation: An unusual case of adenocarcinoma of the colon in a 36-year-old patient is presented. The patient underwent three operations in his infancy for exstrophy but after failure to close bladder, ureterosigmoidostomy was attempted at the age of 5 years and was converted to an ileal conduit after 8 months. At the age of 36 years, 30 years following ileal conduit urinary diversion for exstrophy, he presented in emergency with large bowel obstruction due to adenocarcinoma of the sigmoid colon.

Conclusion: Patients who undergo urinary diversion for exstrophy may be kept on a regular follow-up surveillance colonoscopy as most of these young adults may later present with vague abdominal symptoms which may not be taken seriously until they increase to an extent as to present with intestinal obstruction as in the present case.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1186/1477-7819-2-20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC425598PMC
June 2004