Publications by authors named "Naveed Ahmed"

170 Publications

Methotrexate versus expectant management in ectopic pregnancy: a meta-analysis.

Arch Gynecol Obstet 2021 Sep 15. Epub 2021 Sep 15.

Department of Nephrology, Dr. Ziauddin Hospital, Karachi, Pakistan.

Background: Ectopic pregnancy (EP) affects 1-2% of all pregnant females'(Barnhart et al., Expert Opin Pharmacother 2(3):409-417, 2001) that can require emergent surgical intervention. Noninvasive diagnostic tests like transvaginal ultrasound (TVUS), and serial β-hCG levels have enabled early diagnosis and allowed medical therapy to be tried. Methotrexate (MTX) versus expectant management, both have been considered safe but superiority of one over the other is lacking.

Methods: We searched for RCT that have shown efficacy of MTX versus expectant management in hemodynamically stable patients. Our primary outcome was whether one modality is superior to the other.

Results: Four RCT were included in the meta-analysis after review. Our pooled analysis when comparing MTX and expectant management showed us that the difference between the uneventful decline in β-hCG levels (treatment success) was statistically insignificant (RR = 1.06, 95% CI 0.93-1.21) with no significant heterogeneity between trials (I = 0.0%, P = 0.578). The difference between need for surgical intervention between methotrexate and expectant management was also statistically insignificant (RR = 0.77, 95% CI 0.43-1.40) with no significant heterogeneity between trials (I = 0.0%, P = 0.552).

Conclusion: We conclude that expectant management is not inferior to MTX in hemodynamically stable patients with ectopic pregnancy that have declining or low β-hCG levels.
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http://dx.doi.org/10.1007/s00404-021-06236-yDOI Listing
September 2021

Assessment of trends in climatic extremes from observational data in the Kashmir basin, NW Himalaya.

Environ Monit Assess 2021 Sep 14;193(10):649. Epub 2021 Sep 14.

Department of Geology, School Education Department, Government of Jammu and Kashmir, Srinagar, 190002, India.

The present study aims to assess the recent changes and trends in the extreme climate indices in the Kashmir basin using the observational records from 1980 to 2016. The extreme climate indices were computed using the ClimPACT2 software and a total of 39 indices were selected for the analysis having particular utility to various sectors like agriculture, water resources, energy consumption, and human health. Besides adopting the station scale analysis, regional averages were computed for each index. In terms of the mean climatology, an increase has been observed in the annual mean temperature with a magnitude of 0.024 °C/year. Further, differential warming patterns have been observed in the mean maximum and minimum temperatures with mean maximum temperature revealing higher increases than mean minimum temperature. On the other hand, the annual precipitation shows a decrease over most of the region, and the decreases are more pronouncing in the higher altitudes. The trend analysis of the extreme indices reveals that in consonance with the rising temperature there has been an increase in the warm temperatures and decrease in the cold temperatures across the Kashmir basin. Furthermore, our analysis suggests a decrease in the extreme precipitation events. The drought indices viz., Standardised Precipitation Index (SPI), and Standardised Precipitation Evapotranspiration Index (SPEI) manifest decreasing trends with the tendency towards drier regimes implying the need for better water resource management in the region under changing climate.
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http://dx.doi.org/10.1007/s10661-021-09439-7DOI Listing
September 2021

Relationship Of Prior Pulmonary Tuberculosis With The Occurrence Of Covid-19 Pneumonia: Review Of 500 Plus HRCT Chest Scans From Two Different Centres Of Sindh, Pakistan.

J Ayub Med Coll Abbottabad 2021 Jul-Sep;33(3):368-375

Department of Pulmonology, Liaquat University of Medical & Health Sciences, Hyderabad, Pakistan.

Background: COVID-19 pandemic has severely affected the entire world. However, its severity and mortality rate are lesser in developing countries, including Pakistan. This study aims to determine the association of prior pulmonary tuberculosis with COVID-19 pneumonia.

Methods: This cross-sectional study was conducted at two centres of Sindh, Pakistan. 521 HRCT chest performed from 1st May to 31st July 2020 were included and marked as "COVID-19 group". 761 HRCT chest performed during the first six months of 2019 were retrospectively evaluated to determine the prevalence of prior pulmonary tuberculosis and marked as the "pre-COVID-19 group". Previous pulmonary tuberculosis was documented as evidenced by clinical history, ATT intake and HRCT findings. Chi-square test was used to determine the association of prior pulmonary tuberculosis with COVID-19 pneumonia. A p-value of ≤0.01 was considered statistically significant.

Results: In the "COVID-19 group", 4.9% (n=26) patients had prior pulmonary tuberculosis. In the "pre-COVID-19 group", 9.8% (n=75) patients had prior pulmonary tuberculosis with a confirmed history of tuberculosis in 8.9% (n=68) and without documented history in 0.9% (n=7) cases. A significant p-value of 0.001 was obtained with a confidence interval of 99%.

Conclusions: Prior pulmonary tuberculosis might have a protective effect against COVID-19 pneumonia which could be due to developed antibodies secondary to exposure to prior tuberculosis or BCG vaccination. Our results warrant further consideration due to the potential public-health benefits that can be achieved in our fight against the novel pandemic.
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September 2021

A Review on the Degradation of Pollutants by Fenton-Like Systems Based on Zero-Valent Iron and Persulfate: Effects of Reduction Potentials, pH, and Anions Occurring in Waste Waters.

Molecules 2021 Jul 29;26(15). Epub 2021 Jul 29.

Department of Chemistry, University of Turin, Via Pietro Giuria 5, 10125 Turin, Italy.

Among the advanced oxidation processes (AOPs), the Fenton reaction has attracted much attention in recent years for the treatment of water and wastewater. This review provides insight into a particular variant of the process, where soluble Fe(II) salts are replaced by zero-valent iron (ZVI), and hydrogen peroxide (HO) is replaced by persulfate (SO). Heterogeneous Fenton with ZVI has the advantage of minimizing a major problem found with homogeneous Fenton. Indeed, the precipitation of Fe(III) at pH > 4 interferes with the recycling of Fe species and inhibits oxidation in homogeneous Fenton; in contrast, suspended ZVI as iron source is less sensitive to the increase of pH. Moreover, persulfate favors the production of sulfate radicals (SO) that are more selective towards pollutant degradation, compared to the hydroxyl radicals (OH) produced in classic, HO-based Fenton. Higher selectivity means that degradation of SO-reactive contaminants is less affected by interfering agents typically found in wastewater; however, the ability of SO to oxidize HO/OH to OH makes it difficult to obtain conditions where SO is the only reactive species. Research results have shown that ZVI-Fenton with persulfate works best at acidic pH, but it is often possible to get reasonable degradation at pH values that are not too far from neutrality. Moreover, inorganic ions that are very common in water and wastewater (Cl, HCO, CO, NO, NO) can sometimes inhibit degradation by scavenging SO and/or OH, but in other cases they even enhance the process. Therefore, ZVI-Fenton with persulfate might perform unexpectedly well in some saline waters, although the possible formation of harmful by-products upon oxidation of the anions cannot be ruled out.
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http://dx.doi.org/10.3390/molecules26154584DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8347750PMC
July 2021

Fabrication and characterization of electrospun zein/nylon-6 (ZN6) nanofiber membrane for hexavalent chromium removal.

Environ Sci Pollut Res Int 2021 Aug 2. Epub 2021 Aug 2.

Nano Fusion Technology Research Group, Division of Frontier Fibers, Institute for Fiber Engineering (IFES), Interdisciplinary Cluster for Cutting Edge Research (ICCER), Shinshu University, Tokida 3-15-1, Ueda, Nagano Prefecture, 386-8567, Japan.

Zein has drawn attention for its great potential for biodegradability and adsorption of hexavalent chromium Cr(VI) that is a carcinogenic industrial pollutant. Zein is a biopolymer extracted from corn and is used for many purposes, but because of its poor stability in aqueous solution, a novel composite of zein and nylon-6 was used to synthesize a nanofibrous membrane using electrospinning to improve its stability and tensile strength. The scanning electron microscope (SEM) image of the zein/nylon-6 (ZN6) nanofiber membrane showed a smooth, beadless, and continuous structure of the nanofibers, but the Fourier transform infrared (FTIR) spectrum of pristine and Cr(VI) saturated ZN6 showed that peaks of secondary amide, carbonyl, and hydroxyl functional groups were involved in adsorption. Optimized experimental parameters were obtained with pH 2.0, contact time 60 min, adsorbent dosage 25 mg, and adsorbate concentration 5.0 mg Cr-VI/mL. Experimental results show that the ZN6 nanofibers removed 87% Cr(VI) with an adsorption capacity of 4.73 mg/g at ambient temperature. Also, the Langmuir isotherm fits well, and the adsorption process followed a pseudo-2-order kinetics with r of 0.90 and 0.99 respectively.
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http://dx.doi.org/10.1007/s11356-021-15729-xDOI Listing
August 2021

Care-seeking and managing diabetes in rural Bangladesh: a mixed methods study.

BMC Public Health 2021 07 22;21(1):1445. Epub 2021 Jul 22.

Institute for Global Health, University College London, London, UK.

Background: Type 2 diabetes mellitus poses a major health challenge worldwide and in low-income countries such as Bangladesh, however little is known about the care-seeking of people with diabetes. We sought to understand the factors that affect care-seeking and diabetes management in rural Bangladesh in order to make recommendations as to how care could be better delivered.

Methods: Survey data from a community-based random sample of 12,047 adults aged 30 years and above identified 292 individuals with a self-reported prior diagnosis of diabetes. Data on health seeking practices regarding testing, medical advice, medication and use of non-allopathic medicine were gathered from these 292 individuals. Qualitative semi-structured interviews and focus group discussions with people with diabetes and semi-structured interviews with health workers explored care-seeking behaviour, management of diabetes and perceptions on quality of care. We explore quality of care using the WHO model with the following domains: safe, effective, patient-centred, timely, equitable and efficient.

Results: People with diabetes who are aware of their diabetic status do seek care but access, particularly to specialist diabetes services, is hindered by costs, time, crowded conditions and distance. Locally available services, while more accessible, lack infrastructure and expertise. Women are less likely to be diagnosed with diabetes and attend specialist services. Furthermore costs of care and dissatisfaction with health care providers affect medication adherence.

Conclusion: People with diabetes often make a trade-off between seeking locally available accessible care and specialised care which is more difficult to access. It is vital that health services respond to the needs of patients by building the capacity of local health providers and consider practical ways of supporting diabetes care.

Trial Registration: ISRCTN41083256 . Registered on 30/03/2016.
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http://dx.doi.org/10.1186/s12889-021-11395-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8299577PMC
July 2021

Development of novel biopolymer-based nanoparticles loaded cream for potential treatment of topical fungal infections.

Drug Dev Ind Pharm 2021 Aug 6:1-10. Epub 2021 Aug 6.

Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan.

Objective: Biodegradable polymers are extensively used due to their efficient safety profiles. The aim of the current study was to fabricate, evaluate, and characterize biodegradable, biocompatible fluconazole (FLZ) loaded chitosan (CHS) chondroitin sulfate (CS) nanoparticles (NPs) for topical delivery. Polymers utilized in the formulation not only served as a carrier system but also aided in fighting with complex etiology of the disease due to their innate antifungal activities.

Methods: NPs were prepared by the complex coacervation method, then were optimized for various parameters and subsequently loaded into a cream.

Results: Scanning electron microscopic (SEM) analysis showed spherical morphology of the NPs. Prepared NPs showed an average particle size in the range of 350-450 nm and an encapsulation efficiency (EE) of 86%. The polydispersity index (PDI) was found to be 0.148 that showed a uniform distribution of NPs. Fourier transform infrared (FTIR) spectroscopy confirmed the absence of any electrostatic interaction between ingredients. drug release analyses exhibited a sustained release of the drug and higher antifungal activity than free FLZ. permeability and drug distribution in different skin layers ensured a site-specific delivery of the FLZ-NPs. As compared with free FLZ and other control groups, the prepared NPs also exhibited significantly higher antifungal activity against ( < .01).

Conclusion: It was concluded from the results that the FLZ-NPs laden cream could be a potential candidate for topical and site-specific delivery of the drug cargo for the potential treatment of fungal infections.
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http://dx.doi.org/10.1080/03639045.2021.1957914DOI Listing
August 2021

Pedestrian attribute recognition using trainable Gabor wavelets.

Heliyon 2021 Jun 30;7(6):e07422. Epub 2021 Jun 30.

University of Sharjah, Sharjah, United Arab Emirates.

Surveillance cameras are everywhere keeping an eye on pedestrians or people as they navigate through the scene. Within this context, our paper addresses the problem of pedestrian attribute recognition (PAR). This problem entails the extraction of different attributes such as age-group, clothing style, accessories, footwear style etc. This is a multi-label problem with a host of challenges even for human observers. As such, the topic has rightly attracted attention recently. In this work, we integrate trainable Gabor wavelet (TGW) layers inside a convolution neural network (CNN). Whereas other researchers have used fixed Gabor filters with the CNN, the proposed layers are learnable and adapt to the dataset for a better recognition. We test our method on publicly available challenging datasets and demonstrate considerable improvements over state of the art approaches.
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http://dx.doi.org/10.1016/j.heliyon.2021.e07422DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8258859PMC
June 2021

Nickel in soil and water: Sources, biogeochemistry, and remediation using biochar.

J Hazard Mater 2021 Oct 16;419:126421. Epub 2021 Jun 16.

State Key Laboratory of Subtropical Silviculture, Zhejiang A&F University, Lin'an 311300, China; Department of Renewable Resources, University of Alberta, Edmonton, Alberta, T6G 2H1, Canada. Electronic address:

Nickel (Ni) is a potentially toxic element that contaminates soil and water, threatens food and water security, and hinders sustainable development globally. Biochar has emerged as a promising novel material for remediating Ni-contaminated environments. However, the potential for pristine and functionalized biochars to immobilize/adsorb Ni in soil and water, and the mechanisms involved have not been systematically reviewed. Here, we critically review the different dimensions of Ni contamination and remediation in soil and water, including its occurrence and biogeochemical behavior under different environmental conditions and ecotoxicological hazards, and its remediation using biochar. Biochar is effective in immobilizing Ni in soil and water via ion exchange, electrostatic attraction, surface complexation, (co)precipitation, physical adsorption, and reduction due to the biogeochemistry of Ni and the interaction of Ni with surface functional groups and organic/inorganic compounds contained in biochar. The efficiency for Ni removal is consistently greater with functionalized than pristine biochars. Physical (e.g., ball milling) and chemical (e.g., alkali/acidic treatment) activation achieve higher surface area, porosity, and active surface groups on biochar that enhance Ni immobilization. This review highlights possible risks and challenges of biochar application in Ni remediation, suggests future research directions, and discusses implications for environmental agencies and decision-makers.
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http://dx.doi.org/10.1016/j.jhazmat.2021.126421DOI Listing
October 2021

Huge Abdominal Mass in a Young Unmarried Lady - A Social and Psychotherapeutic Challenge.

Cureus 2021 Apr 25;13(4):e14672. Epub 2021 Apr 25.

General Medicine, Army Medical College, Rawalpindi, PAK.

Large ovarian tumours are rare. Various diagnostic modalities are used to help in confirming the size and type of ovarian tumours. Laparotomy in a lateral decubitus position under general anaesthesia is the most common treatment approach. Here we present a case of a 17-year-old unmarried girl from whom a 13 kg ovarian tumor was resected. We highlight in this case report the mental stress that a patient goes through when accused of having an extramarital pregnancy by the community in a conservative society like ours. Furthermore, the importance of psychological support and counselling is paramount.
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http://dx.doi.org/10.7759/cureus.14672DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8146157PMC
April 2021

Cyberknife Radiosurgery in Hepatocellular Carcinoma.

J Coll Physicians Surg Pak 2021 May;30(5):532-536

Department of Radiology and Cyberknife Robotic Radiosurgery, Jinnah Postgraduate Medical Centre, Karachi, Pakistan.

Objective: To determine the outcome of Stereotactic Body Radiation Therapy (SBRT) and its prognostic factors among hepatocellular carcinoma (HCC) patients.

Study Design: Descriptive study.

Place And Duration Of Study: Department of Radiology and Cyberknife Robotic Radiosurgery, Jinnah Postgraduate Medical Centre (JPMC), Karachi, Pakistan from 1st July 2019 to 31st August 2020.

Methodology: All patients of either gender age 18 years and above presenting with pathological confirmation of HCC, ECOG performance status of ≤2 and child Pugh A or B were consecutively enrolled. Progression of >20% was defined as progressive disease (PD). SBRT was performed using the Cyberknife. Clinical outcome was measured in terms of progression free survival. Moreover, radiation induced toxicity was also observed along with other predictor variables.            Results: Of 52 patients, the median age was 58 (53-59) years. There were 42 (80.8%) males and 10 (19.2%) females. All patients were alive at 3 months, i.e. 52 (100%). However, at 6 months, 49 (94.2%) were alive, at 9 months, 38 (73.1%) patients were alive while at 1 year, 24 (46.2%) patients were alive. A significant association was observed for survival at 6 months and ECOG performance status score (p-value 0.036), survival at 9 months and AFP (p= 0.003), survival at 1 year and age (p = 0.019), survival at 1 year and HBV (p = 0.001), and survival at 1 year and previous treatment (p = 0.010). Moreover, none of the patients reported complications / radiation induced liver toxicity.

Conclusion: A higher efficiency of SBRT was found among HCC patients attending Radiology Department. Key Words: Stereotactic body radiation therapy, Hepatocellular carcinoma, Toxicity, Survival.
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http://dx.doi.org/10.29271/jcpsp.2021.05.532DOI Listing
May 2021

Thermal transport investigation in AA7072 and AA7075 aluminum alloys nanomaterials based radiative nanofluids by considering the multiple physical flow conditions.

Sci Rep 2021 May 10;11(1):9837. Epub 2021 May 10.

Department of Mathematics, College of Arts and Sciences, Prince Sattam Bin Abdulaziz University, Wadi Aldawaser, 11991, Saudi Arabia.

Now a day's variety of nanomaterials is available, among these Aluminum Alloys AA7072 and AA705 are significant due to their thermal, physical and mechanical characteristics. These extensively used in manufacturing of spacecraft, aircraft parts and building testing. Keeping in view the significance of nanoliquids, the analysis of methanol suspended by AA7072 and AA7075 alloys under the multiple physical flow conditions is reported. The model is successfully treated by coupling of RK and shooting algorithm and examined the results for the flow regimes by altering the ingrained physical parameters. Then physical interpretation of the results discussed comprehensively. To validate the analysis, a comparison between the presented and existing is reported under certain assumptions on the flow parameters. It is found that the results are reliable inline with existing once.
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http://dx.doi.org/10.1038/s41598-021-87900-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8110842PMC
May 2021

Learning from a diabetes mHealth intervention in rural Bangladesh: what worked, what did not and what next?

Glob Public Health 2021 May 8:1-15. Epub 2021 May 8.

Institute for Global Health, University College London, London, UK.

There is an urgent need for population-based interventions to slow the growth of the diabetes epidemic in low-and middle-income countries. We tested the effectiveness of a population-based mHealth voice messaging intervention for T2DM prevention and control in rural Bangladesh through a cluster randomised controlled trial. mHealth improved knowledge and awareness about T2DM but there was no detectable effect on T2DM occurrence. We conducted mixed-methods research to understand this result. Exposure to messages was limited by technological faults, high frequency of mobile phone number changes, message fatigue and (mis)perceptions that messages were only for those who had T2DM. Persistent social norms, habits and desires made behaviour change challenging, and participants felt they would be more motivated by group discussions than mHealth messaging alone. Engagement with mHealth messages for T2DM prevention and control can be increased by (1) sending identifiable messages from a trusted source (2) using participatory design of mHealth messages to inform modelling of behaviours and increase relevance to the general population (3) enabling interactive messaging. mHealth messaging is likely to be most successful if implemented as part of a multi-sectoral, multi-component approach to address T2DM and non-communicable disease risk factors.
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http://dx.doi.org/10.1080/17441692.2021.1923776DOI Listing
May 2021

Investigating the material modelling of a polymeric bioresorbable scaffold via in-silico and in-vitro testing.

J Mech Behav Biomed Mater 2021 08 23;120:104557. Epub 2021 Apr 23.

Computational Engineering and Design Research Group, Faculty of Engineering and Physical Sciences, University of Southampton, Southampton, UK. Electronic address:

The accurate material modelling of poly-l-lactic acid (PLLA) is vital in conducting finite element analysis of polymeric bioresorbable scaffolds (BRS) to investigate their mechanical performance and seek improved scaffold designs. To date, a large variety of material models have been utilised, ranging from simple elasto-plastic models to high fidelity parallel network models. However, no clear consensus has been reached on the appropriateness of these different models and whether simple, less computationally expensive models can serve as acceptable approximations. Therefore, we present a study which explored the use of different isotropic and anisotropic elasto-plastic models in simulating the balloon expansion and radial crushing of the thin-strut (sub-100 μm) ArterioSorb BRS using the Abaqus/Explicit (DS SIMULIA) solution method. Stress-strain data was obtained via tensile tests at two different displacement rates. The use of isotropic and transversely isotropic elastic theories was explored, as well as the implementation of stress relaxation in the plastic regime of the material. The scaffold performance was quantified via its post-expansion diameter, percentage recoil and radial strength. The in-silico results were validated via comparison with in-vitro data of an analogous bench test. Accurately predicting both the post-expansion scaffold shape and radial strength was found to be challenging using the in-built Abaqus models. Therefore, a novel user-defined material model was developed via the VUMAT subroutine which improved functionality by facilitating a variable yield ratio, dependent upon the plastic strain as well as stress relaxation in overly strained elements. This achieved prediction of the radial strength within 1.1% of the in-vitro results and the scaffold's post-expansion diameter within 6.7%. A realistic multi-balloon simulation strategy was also used which confirmed that a mechanism exists in the PLLA which facilitates the extremely low percentage recoil behaviour observed in the ArterioSorb BRS. This could not be captured by the aforementioned material property models.
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http://dx.doi.org/10.1016/j.jmbbm.2021.104557DOI Listing
August 2021

Heat Emergencies: Perceptions and Practices of Community Members and Emergency Department Healthcare Providers in Karachi, Pakistan: A Qualitative Study.

Int J Environ Res Public Health 2021 04 29;18(9). Epub 2021 Apr 29.

Centre for Global Emergency Care, Department of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD 21218, USA.

Heat waves are the second leading cause of weather-related morbidity and mortality affecting millions of individuals globally, every year. The aim of this study was to understand the perceptions and practices of community residents and healthcare professionals with respect to identification and treatment of heat emergencies. A qualitative study was conducted using focus group discussions and in-depth interviews, with the residents of an urban squatter settlement, community health workers, and physicians and nurses working in the emergency departments of three local hospitals in Karachi. Data was analyzed using content analysis. The themes that emerged were (1) perceptions of the community on heat emergencies; (2) recognition and early treatment at home; (3) access and quality of care in the hospital; (4) recognition and treatment at the health facility; (5) facility level plan; (6) training. Community members were able to recognize dehydration as a heat emergency. Males, elderly, and school-going children were considered at high risk for heat emergencies. The timely treatment of heat emergencies was widely linked with availability of financial resources. Limited availability of water, electricity, and open public spaces were identified as risk factors for heat emergencies. Home based remedies were reported as the preferred practice for treatment by community members. Both community members and healthcare professionals were cognizant of recognizing heat related emergencies.
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http://dx.doi.org/10.3390/ijerph18094736DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8125281PMC
April 2021

Polysaccharide Chemistry in Drug Delivery, Endocrinology, and Vaccines.

Chemistry 2021 Jun 11;27(33):8437-8451. Epub 2021 May 11.

Univ Lyon, University Claude Bernard Lyon-1, CNRS, ISA-UMR 5280, 69622, Villeurbanne, France.

Polysaccharides, due to their outstanding properties, have attracted the attention of researchers, working in the biomedical field and especially of those working in drug delivery. Modified/functionalized polysaccharides further increase the importance for various applications. Delivery of therapeutics for diverse ailments in different endocrine glands and hormones safely, is a focal point of researchers working in the field. Among the routes followed, the transdermal route is preferred due to non-exposure of active moieties to the harsh gastric environment and first-pass metabolism. This review starts with the overview of polysaccharides used for the delivery of various therapeutic agents. Advantages of polysaccharides used in the transdermal route are addressed in detail. Types of polysaccharides will be elaborated through examples, and in this context, special emphasis will be on the polysaccharides being used for synthesis of the membranes/films. Techniques employed for their modification to design novel carriers for therapeutics delivery will also be discussed. The review will end with a brief discussion on recent developments and future perspectives for delivery of therapeutic agents, and vaccine development.
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http://dx.doi.org/10.1002/chem.202100204DOI Listing
June 2021

Community participatory learning and action cycle groups to reduce type 2 diabetes in Bangladesh (D:Clare trial): study protocol for a stepped-wedge cluster randomised controlled trial.

Trials 2021 Mar 29;22(1):235. Epub 2021 Mar 29.

Institute for Global Health, University College London, 30 Guildford Street, London, WC1N 1EH, UK.

Background: An estimated 463 million people globally have diabetes, with the prevalence growing in low-and middle-income settings, such as Bangladesh. Given the need for context-appropriate interventions to prevent type 2 diabetes mellitus (T2DM), the 'Diabetes: Community-led Awareness, Response and Evaluation' (D:Clare) trial will rigorously evaluate the replication and scale-up of a participatory learning and action (PLA) cycle intervention in Bangladesh, to inform policy on population-level T2DM prevention and control.

Methods: This is a stepped-wedge cluster randomised controlled trial, with integrated process and economic evaluations, conducted from March 2020 to September 2022. The trial will evaluate a community-based four-phase PLA cycle intervention focused on prevention and control of T2DM implemented over 18 months, against a control of usual care. Twelve clusters will be randomly allocated (1:1) to implement the intervention at project month 1 or 12. The intervention will be evaluated through three cross-sectional surveys at months 1, 12 and 24. The trial will be conducted in Alfadanga Upazila, Faridpur district, with an estimated population of 120,000. Clusters are defined as administrative geographical areas, with approximately equal populations. Each of the six unions in Alfadanga will be divided into two clusters, forming 12 clusters in total. Given the risk of inter-cluster contamination, evaluation surveys will exclude villages in border areas. Participants will be randomly sampled, independently for each survey, from a population census conducted in January 2020. The primary outcome is the combined prevalence of intermediate hyperglycaemia and T2DM, measured through fasting and 2-h post-glucose load blood tests. A total of 4680 participants provide 84% power to detect a 30% reduction in the primary outcome, assuming a baseline of 30% and an ICC of 0.07. The analysis will be by intention-to-treat, comparing intervention and control periods across all clusters, adjusting for geographical clustering.

Discussion: This study will provide further evidence of effectiveness for community-based PLA to prevent T2DM at scale in a rural Bangladesh setting. However, we encountered several challenges in applying the stepped-wedge design to our research context, with particular consideration given to balancing seasonality, timing and number of steps and estimation of partial versus full effect.

Trial Registration: ISRCTN: ISRCTN42219712 . Registered on 31 October 2019.
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http://dx.doi.org/10.1186/s13063-021-05167-yDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8006505PMC
March 2021

Development and Evaluation of a Physiologically Based Pharmacokinetic Drug-Disease Model of Propranolol for Suggesting Model Informed Dosing in Liver Cirrhosis Patients.

Drug Des Devel Ther 2021 17;15:1195-1211. Epub 2021 Mar 17.

Department of Pharmacy, Quaid-i-Azam University, Islamabad, 45320, Pakistan.

Aim: The study was aimed to understand the underlying causes for the differences in propranolol pharmacokinetics (PK) between healthy and cirrhosis populations by using a systematic whole-body physiologically based pharmacokinetic (PBPK) model-building approach for suggesting model informed propranolol dosing in liver cirrhosis patients with different stages of disease severity.

Methods: A whole-body PBPK model was developed by using population simulator PK-Sim by using reported physicochemical and clinical data for propranolol in healthy and liver cirrhosis populations. The model evaluation was done by visual verification and comparison of PK parameters using their observed/predicted ratios (R).

Results: The developed model has effectively described the disposition of propranolol after intravenous and oral application in healthy and liver cirrhosis populations. All the model predictions were comparable to the observed clinical data and the R for all the PK parameters were within a 2-fold range. A significant increase in plasma concentration of propranolol and decrease in drug clearance was observed in progressive stages of liver cirrhosis. The developed model after evaluation with the reported clinical PK data was used for suggesting model informed propranolol dosing in different stages of liver cirrhosis based on systemic unbound drug concentration.

Conclusion: The developed PBPK model has successfully described propranolol PK in healthy and cirrhosis populations after IV and oral administration. The evaluated PBPK propranolol-cirrhosis model can have many implications in predicting propranolol dosing in liver cirrhosis patients with different stages of disease severity.
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http://dx.doi.org/10.2147/DDDT.S297981DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7982780PMC
March 2021

An efficient approach for development and optimisation of curcumin-loaded solid lipid nanoparticles' patch for transdermal delivery.

J Microencapsul 2021 Jun 16;38(4):233-248. Epub 2021 Mar 16.

Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan.

This study aimed to develop and optimise a Curcumin-loaded SLNs (C-SLNs) patch through a new approach for transdermal delivery. C-SLNs were optimised through the response surface central composite design using the modified injection method. Optimised C-SLNs were loaded into a polyvinyl alcohol-based patch through the backing membrane method. Compatibility studies (FTIR, XRPD) release, skin permeation, accelerated stability, and evaluation studies of the patch were also performed. Prepared C-SLNs exhibited average particle diameter of 170± 2 nm with an encapsulation efficiency of 90 ± 3.5% (w/w) while SEM illustrated spherical shape of particles. release data ensured a sustained release for up to 72 hours. The enhancement ratio of C-SLNs based patch with permeation enhancer (PE) was high up to 6.5 folds as compared to patch without PE. It is concluded that the modified injection method is simple, economical, and less time consuming for the development of C-SLNs patch for the transdermal route.
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http://dx.doi.org/10.1080/02652048.2021.1899321DOI Listing
June 2021

A prospective evaluation of clinical and functional outcome of single bundle anatomic anterior cruciate ligament reconstruction with hamstrings autograft.

J Pak Med Assoc 2020 Dec;70(12(B)):2476-2480

Department of Orthopedics, Jinnah Post Graduate Medical Center, Karachi, Pakistan.

A case series was conducted at the Department of Orthopaedic surgery, Jinnah Postgraduate Medical Centre, Karachi, from July 2016 to June 2018, to evaluate the functional and clinical outcome of arthroscopic anatomic anterior cruciate ligament (ACL) reconstruction with hamstrings autograft. Patients aged 17 years and above with anterior cruciate ligament (ACL) injuries of duration three months or older, diagnosed on history and clinical examination and confirmed on Magnetic Resonance Imaging were prospectively recruited from outpatient department. Patients with multiligamentous injury were excluded. Information on patient's demographics such as age, duration of injury and mechanism of injury were recorded. In addition, graft length and diameter, associated injuries of lateral or medical menisci were noted peroperatively. Patients were followed for a minimum of 12 months. The functional outcomes were assessed through lysholm knee score, and Tegner activity scale. Clinical outcome was assessed with loss of motion in flexion and extension and residual laxity using Lachman test. Paired sample t-test was applied to compare mean scores pre and post-operatively. The study findings reveal that arthroscopic anatomic Anterior Cruciate Ligament reconstruction using quadruple strand hamstring tendon autograft was an effective method of treatment for the ACL-deficient knee with improved clinical and functional status.
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http://dx.doi.org/10.47391/JPMA.678DOI Listing
December 2020

Outcomes and Impact of a Universal COVID-19 Screening Protocol for Asymptomatic Oncology Patients.

Gulf J Oncolog 2020 Sep;1(34):7-12

Oncology Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, United Arab Emirates.

Introduction: COVID-19 has become a serious hazard worldwide in a relatively short time. Scientific evidence supports that cancer patients infected with COVID-19 had a higher risk of developing severe complications. COVID-19 patients can be asymptomatic during part or all of their disease course, therefore it is a compelling need to develop universal pre-interventional COVID-19 screening guidelines. The aim of this study is to is review COVID-19 positive rate among asymptomatic cancer patients since the implementation of universal policy at our institution, and assess the impact of diagnosing COVID-19 on delay of oncologic interventions.

Materials And Methods: The study population comprised of all cancer patients planned for high risk interventions between April 1, 2020 - May 14, 2020 at Cleveland Clinic Abu Dhabi [CCAD] after implementing universal COVID-19 screening policy.

Discussion: Nosocomial transmission of COVID-19 among cancer patients could result in poor outcomes. Universal screening for high-risk populations may facilitate earlier diagnosis of COVID-19 and implementation of control strategies. Our review demonstrated that [7.5%] of asymptomatic cancer patients tested positive for COVID-19 after implementation of universal prospective screening policy. The overall evidence supporting universal COVID-19 screening of cancer patients is limited, yet as tests become more widely available, it may be reasonable to screen all cancer patients for COVID-19 before anticancer therapies. While such policy may delay and affect the timing of anticancer therapy as shown in this report, it should improve the safety of care for oncology patients and help protect healthcare workers.

Conclusion: COVID-19 infection rate is higher in cancer patients than general population and can present without symptoms. Universal COVID-19 screening of cancer patients before high risk interventions is supported by the present findings.
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September 2020

High Aspect Ratio Thin-Walled Structures in D2 Steel through Wire Electric Discharge Machining (EDM).

Micromachines (Basel) 2020 Dec 22;12(1). Epub 2020 Dec 22.

Department of Industrial Engineering, College of Engineering, King Saud University, Riyadh 11421, Saudi Arabia.

Thin structures are often required for several engineering applications. Although thick sections are relatively easy to produce, the cutting of thin sections poses greater challenges, particularly in the case of thermal machining processes. The level of difficulty is increased if the thin sections are of larger lengths and heights. In this study, high-aspect-ratio thin structures of micrometer thickness (117-500 µm) were fabricated from D2 steel through wire electrical discharge machining. Machining conditions were kept constant, whereas the structure (fins) sizes were varied in terms of fin thickness (FT), fin height (FH), and fin length (FL). The effects of variation in FT, FH, and FL were assessed over the machining errors (FT and FL errors) and structure formation and its quality. Experiments were conducted in a phased manner (four phases) to determine the minimum possible FT and maximum possible FL that could be achieved without compromising the shape of the structure (straight and uniform cross-section). Thin structures of smaller lengths (1-2 mm long) can be fabricated easily, but, as the length exceeds 2 mm, the structure formation loses its shape integrity and the structure becomes broken, deflected, or deflected and merged at the apex point of the fins.
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http://dx.doi.org/10.3390/mi12010001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7821946PMC
December 2020

Time to Enhance Immunity via Functional Foods and Supplements: Hope for SARS-CoV-2 Outbreak.

Altern Ther Health Med 2021 Jun;27(S1):30-44

Coronavirus disease 2019 (COVID-19) is a recently emerged pandemic caused by a novel virus known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This disease is communicable and mainly affects the respiratory tract. The outbreak of this disease has greatly influenced human health and economic activities worldwide. The absence of any medication for this infection highlights the urgent need for the development of alternative methods for managing the spread of the disease. Our immune system operates based on a complex array of cells, processes, and chemicals that continuously protect our body from invading pathogens, including viruses, toxins, and bacteria. The present study was conducted to perform a comprehensive review of all dietary treatments for boosting immunity against viral infections. No study was found to explicitly support the use of any healthy foods or supplements to protect against COVID-19. However, this study offers details on well-researched functional foods and supplements that typically improve the immune response, which could be helpful against this newly emerged pandemic.
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June 2021

Benign uptake of F-fluorodeoxyglucose in the gallbladder on positron emission tomography-computed tomography.

World J Nucl Med 2020 Jul-Sep;19(3):288-290. Epub 2020 Jul 22.

Department of Radiology, PET-CT, Jinnah Postgraduate Medical Center, Karachi, Pakistan.

F-fluorodeoxyglucose (FDG) positron emission tomography (PET) has been established as the indisputable tool in the oncological arena to diagnose, stage/restage, and report treatment response for various tumor malignancies. FDG uptake mostly identifies pathological uptake in oncological scans with the tracer on PET studies; however, benign uptakes are also commonly seen. Reported here is a benign case of increased uptake of the FDG on a PET with computed tomography scan in the gallbladder (GB) of a patient being screened for a known carcinoma breast. The benign accumulation of the tracer is seen in the GB to various degrees and this phenomenon may occur as a result of FDG excretion into the bile. When interpreting clinical PET images, recognition of this phenomenon is important to avoid misdiagnosing physiological GB FDG uptake as pathological so as to avoid misinterpretations of the findings.
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http://dx.doi.org/10.4103/wjnm.WJNM_82_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7745864PMC
July 2020

Assessment of Vitamin D Levels in Patients Presenting With Chronic Low Back Pain at a Tertiary Care Hospital.

Cureus 2020 Dec 3;12(12):e11867. Epub 2020 Dec 3.

Trauma and Orthopedic Surgery, Dow University of Health Sciences, Karachi, PAK.

Objective To evaluate the association of chronic low back pain with levels of vitamin D in the affected population. Methodology This observational study was carried out from August 2016 to August 2019 at Khairpur Medical College and Shaheed Mohatarma Benazir Bhutto Medical College, Karachi, Pakistan. Patients aged 18 years and above suffering from chronic low back pain with pain persisting for more than 12 weeks were the study participants after written consent and prior approval from the ethical review committee was obtained for conducting the study. Data was recorded on predesigned performa and analyzed on SPSS Version 20 (IBM Corp.). Results There were 1,152 cases with chronic lower back pain, of whom 632 (54.9%) were females and 520 (45.1%) were males. The mean age of the patients was 41.76 ± 11.18 years. The mean visual analog scale (VAS) level was 5.36 ± 1.65; 707 cases (61.4%) had moderate pain according to VAS, 292 (25.3%) had severe pain, and 153 (13.3%) had mild pain. Concerning vitamin D levels, the mean levels were 22.74 ± 13.80, with 599 (52%) of the patients having deficient levels of vitamin D, 347 (30.1%) having insufficient levels, and only 204 (17.7%) of the cases having normal vitamin D levels. Conclusions Lower back pain is one of the common presenting problems in orthopedic clinics. We found no relationship between chronic lower back pain and vitamin D levels in our study.
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http://dx.doi.org/10.7759/cureus.11867DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7714737PMC
December 2020

Functional Outcome of Intraarticular Fracture of Distal Radius Managed by Volar Locking Plate.

Cureus 2020 Oct 31;12(10):e11271. Epub 2020 Oct 31.

Orthopedic Surgery, Sheikh Zayed Taluka Headquarter Hospital, Thatta, PAK.

Objective This study's main purpose is to determine the functional outcome of volar locking plates in the management of intraarticular fracture of the distal radius. Methodology This cross-sectional study was conducted from August 2016 to August 2019. Forty-nine patients with the intraarticular distal radius fractures managed by the volar locking plate were included in the study. Patients with open fractures, ipsilateral other limb injuries, polytrauma patients, pathological fractures, and patients having neurovascular injuries were excluded from the study. AO Classification was used to classify fractures. The fracture was approached through the volar approach and fixed by the volar locking plate. A modified mayo wrist score evaluated the functional outcome. All the data were recorded on predesigned performa, and Statistical Package for the Social Sciences (SPSS), version 20 (IBM Corp., Armonk, NY) was used to analyze the data. Results A total of 49 patients with intraarticular fractures of the distal radius were included in the study. The mean age of the patient was 37.20 ± 10.05 years. Out of 49 patients, 29 (59.2%) were males, and 20 (40.8%) were females. Union was achieved in almost all fractures except one case, which went into non-union despite the adequate initial reduction, and the mean time of union was 11.98 ± 1.64 weeks. With respect to the stratification of functional outcome very good and good functional outcome was achieved in 46 patients (93.8%) in both the groups, the satisfactory outcome was achieved in two (4.1%) cases and one patient had a bad outcome in which union was not achieved and went into non-union. Conclusion Open reduction and internal fixation of intraarticular fracture of the distal radius using a volar locking plate is a good option for managing these fractures as it provides stable fixation, and good to excellent outcomes can be achieved by using these plates.
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http://dx.doi.org/10.7759/cureus.11271DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7707882PMC
October 2020

Chloroform-Injection (CI) and Spontaneous-Phase-Transition (SPT) Are Novel Methods, Simplifying the Fabrication of Liposomes with Versatile Solution to Cholesterol Content and Size Distribution.

Pharmaceutics 2020 Nov 9;12(11). Epub 2020 Nov 9.

Department of Pharmacy, Quaid-i-Azam University, Islamabad 45320, Pakistan.

Intricate formulation methods and/or the use of sophisticated equipment limit the prevalence of liposomal dosage-forms. Simple techniques are developed to assemble amphiphiles into globular lamellae while transiting from the immiscible organic to the aqueous phase. Various parameters are optimized by injecting chloroform solution of amphiphiles into the aqueous phase and subsequent removal of the organic phase. Further simplification is achieved by reorienting amphiphiles through a spontaneous phase transition in a swirling biphasic system during evaporation of the organic phase under vacuum. Although the chloroform injection yields smaller Z-average and poly-dispersity-index the spontaneous phase transition method overrides simplicity and productivity. The increasing solid/solvent ratios results in higher Z-average and broader poly-dispersity-index of liposomes under a given set of experimental conditions, and vice versa. Surface charge dependent large unilamellar vesicles with a narrow distribution have poly-dispersity-index < 0.4 in 10 μM saline. As small and monodisperse liposomes are prerequisites in targeted drug delivery strategies, hence the desired Z-average < 200 d.nm and poly-dispersity-index < 0.15 is obtained through the serial membrane-filtration method. Phosphatidylcholine/water 4 μmol/mL is achieved at a temperature of 10°C below the phase-transition temperature of phospholipids, ensuring suitability for thermolabile entities and high entrapment efficiency. Both methods furnish the de-novo rearrangement of amphiphiles into globular lamellae, aiding in the larger entrapped volume. The immiscible organic phase benefits from its faster and complete removal from the final product. High cholesterol content (55.6 mol%) imparts stability in primary hydration medium at 5 ± 3 °C for 6 months in light-protected type-1 glass vials. Collectively, the reported methods are novel, scalable and time-efficient, yielding high productivity in simple equipment.
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http://dx.doi.org/10.3390/pharmaceutics12111065DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7695269PMC
November 2020

Aminodextran Coated CoFeO Nanoparticles for Combined Magnetic Resonance Imaging and Hyperthermia.

Nanomaterials (Basel) 2020 Nov 2;10(11). Epub 2020 Nov 2.

Univ Lyon, University Claude Bernard Lyon-1, CNRS, LAGEPP-UMR 5007, F-69622 Lyon, France.

Aminodextran (AMD) coated magnetic cobalt ferrite nanoparticles are synthesized via electrostatic adsorption of aminodextran onto magnetic nanoparticles and their potential theranostic application is evaluated. The uncoated and aminodextran-coated nanoparticles are characterized to determine their hydrodynamic size, morphology, chemical composition, zeta potential and magnetization. The aminodextran containing cobalt ferrite nanoparticles of nanometer size are positively charged in the pH range from 3 to 9 and exhibit saturation magnetization of 50 emu/g. The magnetic resonance imaging (MRI) indicates capability for diagnostics and a reduction in intensity with an increase in nanoparticle amount. The hyperthermia capability of the prepared particles shows their potential to generate suitable local heat for therapeutic purposes. There is a rise of 7 °C and 9 °C at 327 kHz and 981 kHz respectively and specific absorption rates (SAR) of aminodextran-coated nanoparticles are calculated to be 259 W/g and 518 W/g at the given frequencies larger than uncoated nanoparticles (0.02 W/g). The development of novel aminodextran coated magnetic cobalt ferrite nanoparticles has significant potential to enable and improve personalized therapy regimens, targeted cancer therapies and ultimately to overcome the prevalence of nonessential and overdosing of healthy tissues and organs.
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http://dx.doi.org/10.3390/nano10112182DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7692372PMC
November 2020

Achieving the Minimum Roughness of Laser Milled Micro-Impressions on Ti 6Al 4V, Inconel 718, and Duralumin.

Materials (Basel) 2020 Oct 12;13(20). Epub 2020 Oct 12.

Department of Industrial Engineering, College of Engineering, King Saud University, Riyadh 11421, Saudi Arabia.

Titanium-aluminium-vanadium (Ti 6Al 4V) alloys, nickel alloys (Inconel 718), and duraluminum alloys (AA 2000 series) are widely used materials in numerous engineering applications wherein machined features are required to having good surface finish. In this research, micro-impressions of 12 µm depth are milled on these materials though laser milling. Response surface methodology based design of experiment is followed resulting in 54 experiments per work material. Five laser parameters are considered naming lamp current intensity (), pulse frequency (), scanning speed (), layer thickness (), and track displacement (). Process performance is evaluated and compared in terms of surface roughness through several statistical and microscopic analysis. The significance, strength, and direction of each of the five laser parametric effects are deeply investigated for the said alloys. Optimized laser parameters are proposed to achieve minimum surface roughness. For the optimized combination of laser parameters to achieve minimum surface roughness (Ra) in the titanium alloy, the said alloy consists of = 85%, = 20 kHz, = 250 mm/s, = 11 µm, and = 3 µm. Similarly, optimized parameters for nickel alloy are as follows: = 85%, = 20 kHz, = 256 mm/s, = 8 µm, and = 1 µm. Minimum roughness (Ra) on the surface of aluminum alloys can be achieved under the following optimized parameters: = 75%, = 20 kHz, = 200 mm/s, = 12 µm, and = 3 µm. Micro-impressions produced under optimized parameters have surface roughness of 0.56 µm, 2.46 µm, and 0.54 µm on titanium alloy, nickel alloy, and duralumin, respectively. Some engineering applications need to have high surface roughness (e.g., in case of biomedical implants) or some desired level of roughness. Therefore, validated statistical models are presented to estimate the desired level of roughness against any laser parametric settings.
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http://dx.doi.org/10.3390/ma13204523DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7601468PMC
October 2020

Audit of antibiotic prophylaxis and adherence of surgeons to standard guidelines in common abdominal surgical procedures.

East Mediterr Health J 2020 Sep 24;26(9):1052-1061. Epub 2020 Sep 24.

Department of Microbiology, Faculty of Chemical and Life Sciences, Abdul Wali Khan University, Mardan, Pakistan.

Background: Prophylactic use of antibiotics before surgery is evidence-based practice for prevention of surgical site infections (SSIs).

Aims: To investigate adherence to and surgeons' perception of antibiotic prophylaxis guidelines.

Methods: A two-phase, cross-sectional prospective study conducted in two teaching hospitals. Phase 1: 6-month audit of prescriptions to investigate adherence rate to evidence-based guidelines. The important information was collected from medical charts through a predesigned proforma. Phase 2: self-administration questionnaire was used to investigate the surgeons' perception. Descriptive statistics, independent-sample Kruskal-Wallis test and multivariate linear regression analysis were performed using SPSS version 21.0.

Results: A total of 866 eligible surgical cases (acute appendectomy; n = 418; 48.2%), laparoscopic cholecystectomy (n = 278; 32.1%) and inguinal hernia (n = 170; 19.7%) were investigated. Surgical antibiotic prophylaxis was prescribed in 97.5% of procedures. Out of these, 9.5% adhered to guidelines with respect to correct choice, 40% for timing, and 100% for dose and route (optimal value 100%). Most patients received ceftriaxone (n = 503; 59.5%) as prophylactic antibiotic. The questionnaire (good internal consistency; α ≥ 0.7) was filled out by 200 surgeons. More than half (69%) of participants thought that antibiotics were overused. Most surgeons perceive that poor adherence to treatment guidelines is due to poor awareness, underestimation of infection, lack of consensus, and disagreement with guidelines recommendations.

Conclusions: Surgeons have positive perception that antibiotics should be used according to guidelines recommendations. However, we found poor treatment adherence to antibiotic prophylaxis guidelines.
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http://dx.doi.org/10.26719/emhj.20.025DOI Listing
September 2020
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