Publications by authors named "Sarah Khan"

141 Publications

A 3D In Vitro Model for Burn Wounds: Monitoring of Regeneration on the Epidermal Level.

Biomedicines 2021 Sep 3;9(9). Epub 2021 Sep 3.

Department Tissue Engineering & Regenerative Medicine (TERM), University Hospital Würzburg, 97070 Würzburg, Germany.

Burns affect millions every year and a model to mimic the pathophysiology of such injuries in detail is required to better understand regeneration. The current gold standard for studying burn wounds are animal models, which are under criticism due to ethical considerations and a limited predictiveness. Here, we present a three-dimensional burn model, based on an open-source model, to monitor wound healing on the epidermal level. Skin equivalents were burned, using a preheated metal cylinder. The healing process was monitored regarding histomorphology, metabolic changes, inflammatory response and reepithelialization for 14 days. During this time, the wound size decreased from 25% to 5% of the model area and the inflammatory response (IL-1β, IL-6 and IL-8) showed a comparable course to wounding and healing in vivo. Additionally, the topical application of 5% dexpanthenol enhanced tissue morphology and the number of proliferative keratinocytes in the newly formed epidermis, but did not influence the overall reepithelialization rate. In summary, the model showed a comparable healing process to in vivo, and thus, offers the opportunity to better understand the physiology of thermal burn wound healing on the keratinocyte level.
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http://dx.doi.org/10.3390/biomedicines9091153DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8466997PMC
September 2021

Single-centre, open-label, randomised, trial to compare rapid molecular point-of-care streptococcal testing to standard laboratory-based testing for the management of streptococcal pharyngitis in children: study protocol.

BMJ Open 2021 08 11;11(8):e047271. Epub 2021 Aug 11.

Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada.

Introduction: Streptococcal pharyngitis, which commonly occurs in children, should be treated with antibiotics. Clinical prediction rules to differentiate streptococcal pharyngitis from viral infection are not recommended in children. Rapid point-of-care (POC) antigen tests have limited sensitivity and so are not often used in Canadian paediatric emergency departments (EDs). Standard paediatric practice is to rely on laboratory-based testing, which often results in a delay before the results can be communicated to the patient; this may impede appropriate prescribing, decrease caregiver satisfaction and delay recovery. The objective of this study is to determine whether a novel rapid molecular POC assay for streptococcal pharyngitis leads to more appropriate antibiotic use in children seeking care in a paediatric ED than standard laboratory-based testing.

Methods And Analysis: A randomised, superiority, open-label, trial with two parallel groups. Children presenting to a tertiary paediatric ED at least 3 years of age who have a throat swab ordered for diagnosis of streptococcal pharyngitis will be eligible; those who have taken antibiotics within 72 hours prior to presentation and those with additional active infections will be excluded. The primary study outcome will be appropriate antibiotic treatment at 3-5 days postenrolment. Secondary outcomes include time to symptom resolution, caregiver satisfaction, caregiver/child absenteeism, number of subsequent healthcare visits, clinician satisfaction and incremental cost-effectiveness of POC testing. A total of 352 participants will be needed.

Ethics And Dissemination: All study documentation has been approved by the Hamilton Integrated Research Ethics board and informed consent will be obtained from all participants. Data from this trial will be presented at major conferences and published in peer-reviewed publications to facilitate collaborations with networks of clinicians experienced in the dissemination of clinical guidelines.

Trial Registration Number: NCT04247243.
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http://dx.doi.org/10.1136/bmjopen-2020-047271DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8359528PMC
August 2021

Autism Characteristics and Self-Reported Health in Older Adulthood.

J Gerontol B Psychol Sci Soc Sci 2021 Jul 19. Epub 2021 Jul 19.

Canisius College.

Objectives: The present research used a continuous measurement approach to extend evidence that autism is associated with significant struggles in physical health as well as mental health and psychological well-being.

Method: The relationship of autism characteristics to physical health and psychological well-being was examined in 294 individuals (M age = 70.51, SD age = 8.17, age range = 53 - 96). The sample is 57.4% female (n = 166) and primarily White (n = 270, 96.8%). The majority of the participants did not identify as having an autism diagnosis (n = 284, 96.6%). Participants completed the Autism Quotient Scale (AQ, Baron-Cohen et al., 2001) alongside self-report measures of physical health, mental health, and psychological well-being.

Results: Autism characteristics correlated strongly with challenges in social engagement due to poor health (r = .46), depression (r = .39) and anxiety (r = .47), limitations due to poor mental health (r =.41), satisfaction with life (r = -.47), and psychological well-being (r = -.62).

Discussion: These findings help shed light on the challenges experienced by individuals aging with elevated autism characteristics. The limitations of this study and prior work on this topic help identify important avenues for future research in this area.
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http://dx.doi.org/10.1093/geronb/gbab136DOI Listing
July 2021

Vagal nerve stimulation as a possible non-invasive treatment for chronic widespread pain in Gulf Veterans with Gulf War Illness.

Life Sci 2021 Oct 5;282:119805. Epub 2021 Jul 5.

Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston TX, USA.

Aims: Widespread pain and headache are common in Gulf War Illness with suboptimal treatments available. We tested the efficacy of non-invasive, transcutaneous vagal nerve stimulation (nVNS) for relief of widespread pain and migraine in Gulf War Veterans with GWI.

Main Methods: A 10-week double-blind, randomized controlled trial of nVNS used the gammaCore (ElectroCore, Inc.) compared to sham stimulation with the same device followed by a 10-week open-label follow up with active nVNS. The primary outcome was a numerical pain rating at the end of the blinded period. Secondary outcomes included physical function, migraine frequency and severity, and impression of change during the blinded and open-label periods. Two-factor MANOVA models tested for significant differences between groups from baseline to end of the blinded period and during the open-label period.

Key Findings: Among 27 participants enrolled and issued a nVNS device, there was a slight improvement in pain ratings from baseline to the end of the blinded phase [6.18 (±0.82) vs. 5.05 (±2.3); p = 0.040] which did not differ between active and sham nVNS. Physical function was also slightly improved overall without group differences. There were no significant changes in migraine frequency or severity during the blinded period. Twenty participants started in the open-label phase; no statistically significant changes in pain, physical function, migraine measures, or impression of change were noted during this phase.

Significance: Veterans with GWI actively treated with nVNS reported no improvement in either widespread pain or migraine frequency or severity relative to Veterans with GWI who received sham nVNS.
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http://dx.doi.org/10.1016/j.lfs.2021.119805DOI Listing
October 2021

The Relationship of Age with the Autism-Spectrum Quotient Scale in a Large Sample of Adults.

Autism Adulthood 2021 Jun 7;3(2):147-156. Epub 2021 Jun 7.

Department of Teacher Education, Institute for Autism Research, Canisius College, Buffalo, New York, USA.

The historical focus on autism as a childhood disorder means that evidence regarding autism in adulthood lags significantly behind research in other age groups. Emerging studies on the relationship of age with autism characteristics do not target older adult samples, which presents a barrier to studying the important variability that exists in life span developmental research. This study aims to further our understanding of the relationship between the Autism-Spectrum Quotient Scale and age in a large adult sample. The present study examines the relationship of Autism-Spectrum Quotient Scale (AQ) scores with age in 1139 adults, ages 18-97 years. Participants came from three distinct samples-a sample of primarily students, a sample of MTurk participants, and a sample of primarily community dwelling older adults. The majority of the participants did not self-report an autism diagnosis (91%), were female (67%), and identified as White (81%). Participants completed the AQ primarily via online surveys. Researchers scored the AQ following six common scoring practices. Results of preregistered analyses indicate that autism characteristics measured by the AQ are not strongly associated with age ( values from -0.01 to -0.11). Further findings indicate that the measurement of autism characteristics is consistent across age into late life using both multiple groups and local structural equation modeling approaches to measurement invariance (comparative fit indices = 0.82-0.83, root mean square error = 0.06) as well as reliability analysis. Finally, demographic and autism-related variables (sex, race, self-identified autism spectrum disorder diagnosis, and degree of autism characteristics) did not moderate the relationship between age and autism characteristics. These results suggest that self-reports of autism characteristics using the AQ do not vary strongly by age in this large age-representative sample. Findings suggest that the AQ can potentially serve as a useful tool for future research on autism across the life span. Important limitations on what we can learn from these findings point toward critical avenues for future research in this area.

Lay Summary: Self-report questionnaires of autism characteristics are a potentially important resource for studying autism in adulthood. This study sought to provide additional information about one of the most commonly used self-report questionnaires, the Autism-Spectrum Quotient Scale (AQ), across adulthood. This study intended to determine if there is a relationship between scores on the AQ and age. Researchers also worked to identify which of the multiple different ways of scoring the AQ worked best across adulthood. Researchers collected data from over a thousand participants aged 18-97 years. Participants from three different age groups completed online surveys to self-report their levels of autism characteristics on the AQ. Researchers tested the relationship between AQ scores and age with six different commonly used ways to calculate AQ scores. Researchers used multiple statistical techniques to evaluate various measurement properties of the AQ. The results indicate that autism characteristics measured by the AQ are not strongly associated with age. Along with that, there is evidence that certain approaches to measuring of autism characteristics are consistent across age into late life and do not vary with demographic and autism-related factors. These results add to the growing evidence that self-reports of autism characteristics using the AQ in general samples are not strongly associated with age across adulthood. These findings also provide guidance about ways of scoring the AQ that work well through late life. While the AQ has a degree of relationship with autism diagnoses, this is far from perfect and has not been evaluated in the context of aging research. Therefore, findings from the present research must be carefully interpreted to be about autism characteristics not diagnoses. The sample was also limited in a number of other ways. As in any studies including a broad age range of individuals, the oldest participants are likely quite healthy, engaged individuals. This may particularly be the case given the higher mortality rates and health challenges seen with autism. Similarly, as with any self-report research, this research is limited to those individuals who could answer questions about their autism characteristics. The sample was also predominantly White and nonautistic. Finally, the research was limited to one point in time and so cannot tell us about how autism characteristics may change across adulthood. These findings support the potential for the AQ to be a useful tool for future research on autism in adulthood. For example, researchers can use measures such as the AQ to study how autism characteristics change over time or are associated with aging-related issues such as changes in physical health and memory. Such research may be able to provide a better understanding of how to support autistic individuals across adulthood.
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http://dx.doi.org/10.1089/aut.2020.0010DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8216140PMC
June 2021

Endoluminal flow diverters in the treatment of sidewall and bifurcation aneurysm: A systematic review and meta-analysis of complications and angiographic outcomes.

Interv Neuroradiol 2021 Jun 22:15910199211026713. Epub 2021 Jun 22.

Department of Radiology, Mayo Clinic, Rochester, MN, USA.

Background And Aim: The use of endoluminal flow diversion in bifurcation aneurysms has been questioned due to the potential for complications and lower occlusion rates. In this study we assessed outcomes of endovascular treatment of intracranial sidewall and bifurcation aneurysms with flow diverters.

Methods: In July 2020, a literature search for all studies utilizing endoluminal flow diverter treatment for sidewall or bifurcation aneurysms was performed. Data were collected from studies that met our inclusion/exclusion criteria by two independent reviewers and confirmed by a third reviewer. Using random-effects meta-analysis the target outcomes including overall complications (hematoma, ischemic events, minor ischemic stroke, aneurysm rupture, side vessel occlusion, stenosis, thrombosis, transient ischemic stroke, and other complications), perioperative complications, and follow-up (long-term) aneurysm occlusion were intestigated.

Results: Overall, we included 35 studies with 1084 patients with 1208 aneurysms. Of these aneurysms, 654 (54.14%) and 554 (45.86%) were classified as sidewall and bifurcation aneurysm, respectively, based on aneurysm location. Sidewall aneurysms had a similar total complication rate (R) of 27.12% (95% CI, 16.56%-41.09%), compared with bifurcation aneurysms (R, 20.40%, 95% CI, 13.24%-30.08%) (p = 0.3527). Follow-up angiographic outcome showed comparable complete occlusion rates for sidewall aneurysms (R 69.49%; 95%CI, 62.41%-75.75%) and bifurcation aneurysms (R 73.99%; 95% CI, 65.05%-81.31%; p = 0.4328).

Conclusions: This meta-analysis of sidewall and bifurcation aneurysms treated with endoluminal flow diverters demonstrated no significant differences in complications or occlusion rates. These data provide new information that can be used as a benchmark for comparison with emerging devices for the treatment of bifurcation aneurysms.
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http://dx.doi.org/10.1177/15910199211026713DOI Listing
June 2021

Retrospective analysis of real-world treatment patterns and clinical outcomes in patients with advanced non-small cell lung cancer starting first-line systemic therapy in the United Kingdom.

BMC Cancer 2021 May 7;21(1):515. Epub 2021 May 7.

EMD Serono Research & Development Institute, Inc, Billerica, MA, USA, an affiliate of Merck KGaA, Darmstad, Germany.

Background: The treatment landscape for advanced non-small cell lung cancer (aNSCLC) has evolved rapidly since immuno-oncology (IO) therapies were introduced. This study used recent data to assess real-world treatment patterns and clinical outcomes in aNSCLC in the United Kingdom.

Methods: Electronic prescribing records of treatment-naive patients starting first-line (1 L) treatment for aNSCLC between June 2016 and March 2018 (follow-up until December 2018) in the United Kingdom were assessed retrospectively. Patient characteristics and treatment patterns were analyzed descriptively. Outcomes assessed included overall survival (OS), time to treatment discontinuation, time to next treatment, and real-world tumor response.

Results: In all, 1003 patients were evaluated (median age, 68 years [range, 28-93 years]; 53.9% male). Use of 1 L IO monotherapy (0-25.9%) and targeted therapy (11.8-15.9%) increased during the study period, but chemotherapy remained the most common 1 L treatment at all time points (88.2-58.2%). Median OS was 9.5 months (95% CI, 8.8-10.7 months) for all patients, 8.1 months (95% CI, 7.4-8.9 months) with chemotherapy, 14.0 months (95% CI, 10.7-20.6 months) with IO monotherapy, and 20.2 months (95% CI, 16.0-30.5 months) with targeted therapy. In the 28.6% of patients who received second-line treatment, IO monotherapy was the most common drug class (used in 51.6%).

Conclusions: Although use of 1 L IO monotherapy for aNSCLC increased in the United Kingdom during the study period, most patients received 1 L chemotherapy. An OS benefit for first-line IO monotherapy vs chemotherapy was observed but was numerically smaller than that reported in clinical trials. Targeted therapy was associated with the longest OS, highlighting the need for improved treatment options for tumors lacking targetable mutations.
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http://dx.doi.org/10.1186/s12885-021-08096-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8106229PMC
May 2021

Utility of gastric ultrasound in evaluating status in a child.

Saudi J Anaesth 2021 Jan-Mar;15(1):46-49. Epub 2021 Jan 5.

Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.

Although rare, the aspiration of gastric contents can lead to significant morbidity or even mortality in pediatric patients receiving anesthetic care. For elective cases, routine preoperative practices include the use of standard times to decrease the risk of aspiration. However, patients may fail to adhere to provided NPO guidelines or other patient factors may impact the efficacy of standard NPO times. Gastric point-of-care ultrasound provides information on the volume and quality of gastric contents and may allow improved patient management strategies. We present a 4-year-old patient who presented for bilateral myringotomy with tympanostomy tube insertion, who was found to have evidence of a full stomach during preoperative gastric ultrasound examination. The use of preoperative gastric point-of-care ultrasound in evaluating stomach contents and confirming NPO times is reviewed and its application to perioperative practice discussed.
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http://dx.doi.org/10.4103/sja.SJA_702_20DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8016049PMC
January 2021

Comparison of Ferumoxytol-enhanced MR Angiography and CT Angiography for the Detection of Pulmonary Arteriovenous Malformations in Hereditary Hemorrhagic Telangiectasia: Initial Results.

Radiol Cardiothorac Imaging 2020 Apr 30;2(2):e190077. Epub 2020 Apr 30.

Department of Radiological Sciences, University of California at Los Angeles, Peter V. Ueberroth Building Suite 3371, 10945 Le Conte Ave, Los Angeles, CA 90095-7206.

Purpose: To perform a preliminary comparison of the sensitivity and positive predictive value of ferumoxytol-enhanced MR angiography with those of CT angiography for detection of pulmonary arteriovenous malformations (AVMs) in hereditary hemorrhagic telangiectasia (HHT).

Materials And Methods: Institutional review board approval and informed patient consent were obtained. Ten patients with pulmonary AVMs who had undergone CT of the chest within 12 months underwent MRI of the chest and abdomen with ferumoxytol at 3.0 T at a dose of 4 mg per kilogram of body weight. Consensus review of MR and CT images assessed the presence and characteristics of pulmonary AVMs, image quality, vessel visibility, and artifact grade.

Results: Forty-three AVMs were detected, 13 native and 30 recanalized. Twenty-one AVMs had a feeding artery diameter of greater than 2 mm, of which detection occurred in 19 (at MRI and CT), in two (at MRI only), and zero (at CT only). Twenty-two AVMs had a feeding artery diameter of less than or equal to 2 mm, of which detection occurred in 16 (at MRI and CT), six (at CT only), and zero (at MRI only). For the entire cohort, the sensitivity of ferumoxytol-enhanced MRI using CT as the reference standard was 85.4% (35 of 41), and the positive predictive value was 100% (35 of 35). No significant difference was found between CT and MRI in AVM size, feeding artery and draining vein diameter, and artifact score ( >.05 for all).

Conclusion: Initial results suggest that ferumoxytol-enhanced MRI is a feasible alternative to CT for detection of pulmonary AVM in HHT, while avoiding repeated exposure to radiation, nephrotoxic contrast material, or gadolinium-based contrast agent.© RSNA, 2020.
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http://dx.doi.org/10.1148/ryct.2020190077DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7978029PMC
April 2020

Mitigative Effects Of Nigella Sativa On The Histology Of Kidneys Against Aspirin-Induced Toxicity.

J Ayub Med Coll Abbottabad 2021 Jan-Mar;33(1):39-43

1Department of Anatomy, King Edward Medical University, Lahore, Pakistan.

Background: Aspirin is one of the popular, economical, easily accessible and commonly used drugs all over the world. Injudicious use of this over-the-counter available drug is a common cause of nephrotoxicity. The aim of the present study is to assess the protective effects of Nigella Sativa (NS) on the histology of kidneys against aspirin-induced toxicity. It was an experimental study that included comparative analysis of control and experimental groups, conducted in the department of Anatomy, University of Health Sciences, Lahore, from October 2016 to December 2016.

Methods: The study included thirty-two female albino rats which were equally distributed into 4 groups. Group A was run as control and given single oral dose of 1% methyl-cellulose (10mg/100gm body weight of rat). Group B and C were treated with a single oral dose of aspirin (1000mg/kg body weight) dissolved in 1% methyl-cellulose (10mg/100gm body weight). Group C animals were left untreated for 7 days. Group D was pre-treated on day 1 with oral dose of Nigella Sativa (NS) extract (250mg/kg body weight) followed one hour later by a single oral dose of aspirin (1000mg/kg body weight), subsequently NS extract was administered till day 7. Rats of group B were euthanized and dissected on 2nd day of experiment while those of groups A, C and D on 8th day. Kidneys were dissected out, weighed and fixed in 10% formalin. 5μm thick sections were yielded after tissue processing and stained with haematoxylin, eosin (H&E staining) and periodic acid Schiff's reagent (PAS staining). Histological parameters of distal convoluted tubules (DCT) were observed.

Results: All histological parameters were normal in group A. Group B showed marked increase in epithelial necrosis, intraluminal protein casts and broken basement membranes of distal convoluted tubules. Group C showed no self-recovery. Statistically significant improvement was observed in the histology of distal convoluted tubules with treatment of Nigella Sativa extract in aspirin-ingested rats in group D.

Conclusions: Nigella Sativa extract has shown protective effects on kidneys against aspirin-induced damage as shown by improvement in the histological parameters of distal convoluted tubules.
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June 2021

Short-Course Antimicrobial Therapy for Pediatric Community-Acquired Pneumonia: The SAFER Randomized Clinical Trial.

JAMA Pediatr 2021 May;175(5):475-482

Department of Pathology and Molecular Medicine, McMaster University, Hamilton, Ontario, Canada.

Importance: Community-acquired pneumonia (CAP) is a common occurrence in childhood; consequently, evidence-based recommendations for its treatment are required.

Objective: To determine whether 5 days of high-dose amoxicillin for CAP was associated with noninferior rates of clinical cure compared with 10 days of high-dose amoxicillin.

Design, Setting, And Participants: The SAFER (Short-Course Antimicrobial Therapy for Pediatric Respiratory Infections) study was a 2-center, parallel-group, noninferiority randomized clinical trial consisting of a single-center pilot study from December 1, 2012, to March 31, 2014, and the follow-up main study from August 1, 2016, to December 31, 2019 at the emergency departments of McMaster Children's Hospital and the Children's Hospital of Eastern Ontario. Research staff, participants, and outcome assessors were blinded to treatment allocation. Eligible children were aged 6 months to 10 years and had fever within 48 hours, respiratory symptoms, chest radiography findings consistent with pneumonia as per the emergency department physician, and a primary diagnosis of pneumonia. Children were excluded if they required hospitalization, had comorbidities that would predispose them to severe disease and/or pneumonia of unusual origin, or had previous β-lactam antibiotic therapy. Data were analyzed from March 1 to July 8, 2020.

Interventions: Five days of high-dose amoxicillin therapy followed by 5 days of placebo (intervention group) vs 5 days of high-dose amoxicillin followed by a different formulation of 5 days of high-dose amoxicillin (control group).

Main Outcomes And Measures: Clinical cure at 14 to 21 days.

Results: Among the 281 participants, the median age was 2.6 (interquartile range, 1.6-4.9) years (160 boys [57.7%] of 279 with sex listed). Clinical cure was observed in 101 of 114 children (88.6%) in the intervention group and in 99 of 109 (90.8%) in the control group in per-protocol analysis (risk difference, -0.016; 97.5% confidence limit, -0.087). Clinical cure at 14 to 21 days was observed in 108 of 126 (85.7%) in the intervention group and in 106 of 126 (84.1%) in the control group in the intention-to-treat analysis (risk difference, 0.023; 97.5% confidence limit, -0.061).

Conclusions And Relevance: Short-course antibiotic therapy appeared to be comparable to standard care for the treatment of previously healthy children with CAP not requiring hospitalization. Clinical practice guidelines should consider recommending 5 days of amoxicillin for pediatric pneumonia management in accordance with antimicrobial stewardship principles.

Trial Registration: ClinicalTrials.gov Identifier: NCT02380352.
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http://dx.doi.org/10.1001/jamapediatrics.2020.6735DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7941245PMC
May 2021

Spectrum of external genital anomalies in disorders of Sex Development at Children Hospital & Institute of Child Health, Lahore, Pakistan.

Pak J Med Sci 2021 Jan-Feb;37(1):244-249

Dr. Muhammad Yaqoob, MBBS, MCPS, PhD. Associate Professor of Genetics, Department of Genetics, The Children's Hospital & Institute of Child Health, Lahore, Pakistan.

Objective: To describe the mode of presentation and frequency of external genital anomalies in disorder of sex development (DSD).

Methods: This cross-sectional study was conducted at Children Hospital & Institute of Child Health, Lahore from January to December, 2016 on Children with DSD above 10 years of age. A detailed history and physical examination were done. Positive findings were recorded on a predesigned proforma and analyzed by SPSS 21. Karyotyping on blood samples was done to determine their genetic sex.

Results: Out of 83 DSD children, 67% (n=56) were assigned a female sex at birth of which 9% (n=5) had ambiguous genitalia. Male sex at birth was given to 33% (n=27) of which 96% (n=26) had genital ambiguity. Mode of presentation other than ambiguous genitalia were delayed puberty, amenorrhea, hirsuitism, gynaecomastia, cyclic hematuria etc. Clitoromegaly was the main finding in 62.5% (n=5) and micropenis in 45% (n=9). Karyotypic sex of 56 female sex of rearing was 46XX 80% (n=45), 45X0 13% (n=7), XXX 2% (n=1) and 46 XY in 5% (n=3). Karyotypic sex of 27 male sex of rearing was 46XY in 78% (n=21), 46XX in 15% (n=4) and 47XXY in 7% (n=2).

Conclusion: Disorders of sex development presented with a wide spectrum of external genital anomalies ranging from clitoromegaly in females to micropenis and hypospadias in males. There was also an extreme diversity in mode of presentation of these cases including pubertal delay, amenorrhea in females and gender confusion disorders.
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http://dx.doi.org/10.12669/pjms.37.1.2991DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7794156PMC
January 2021

Is diversion free ileal pouch-anal anastomosis a safe procedure? A meta-analysis of 4973 cases.

Int J Colorectal Dis 2021 Apr 4;36(4):657-669. Epub 2021 Jan 4.

Department of Colorectal Surgery, Castle Hill Hospital, Hull University Teaching Hospitals NHS Trust, East Yorkshire, HU16 5JQ, UK.

Purpose: Ileal pouch-anal anastomosis (IPAA) has been established as the procedure of choice for patients who require excision of the colon and rectum for familial adenomatous polyposis and ulcerative colitis. The requirement for proximal stomal diversion in IPAA is controversial.

Objectives: To compare post-operative outcomes following IPAA with and without proximal diversion.

Methods: Computerised literature search, of Ovid MEDLINE and EMBASE. Full-text comparative studies published between 1992 and 2019, in English language and on adult patients. Ileal pouch-anal anastomosis with or without proximal stomal diversion following proctocolectomy. Outcome measures were anastomotic leak, anastomosis strictures, re-operations, pouch failure, intra-abdominal sepsis, small bowel obstruction/ileus and mortality.

Results: Five hundred and forty-six studies were screened. Fourteen relevant studies included 4973 cases (1832 patients with no stomas vs 3141 with stomas). Anastomotic strictures (p ≤ 0.0001 OR 0.40; 95% CI (0.26-0.62)) and pouch failures (p = 0.003 OR 0.54; 95% CI (0.36-0.82)) were higher in diverted than non-diverted patients. Re-operation was more frequently required in non-diverted patients (p = 0.02 OR 2.51; 95% CI (1.12-5.59)). Heterogeneity was low in 5 out of 7 variables.

Conclusion: In selected patients, diversion-free IPAA is a safe procedure associated with lower anastomotic stricture and pouch failure rates than diverted IPAA. This appears to occur at the expense of a higher re-operation rate. An RCT is required to help define the selection criteria.
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http://dx.doi.org/10.1007/s00384-020-03814-5DOI Listing
April 2021

COVID-19-positive cancer patients undergoing active anticancer treatment: An analysis of clinical features and outcomes.

Hematol Oncol Stem Cell Ther 2020 Dec 24. Epub 2020 Dec 24.

Department of Medical Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre (SKMCH&RC), Peshawar, Pakistan.

Background: Cancer patients, particularly those on active anticancer treatment, are reportedly at a high risk of severe coronavirus disease 2019 (COVID-19) infection and death. This study aimed to describe the clinical characteristics and outcomes of patients diagnosed with COVID-19 whilst on anticancer treatment in a developing country.

Methods: This is a retrospective observational study of all adult cancer patients at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Pakistan, from March 15, 2020 to July 10, 2020, diagnosed with COVID-19 within 4 weeks of receiving anticancer treatment, where a purposive sampling was performed. Cancer patients who did not receive anticancer treatment and clinical or radiological diagnosis of COVID-19 without a positive reverse transcription-polymerase chain reaction (RT-PCR) test were excluded. The primary endpoint was all-cause mortality after 30 days of COVID-19 test. Data was analyzed with SPSS version 23 (SPSS Inc., Chicago, IL, USA). Categorical parameters were computed using chi-square test, keeping p value < 0.05 as significant.

Results: A total of 201 cancer patients with COVID-19 were analyzed. The median age of patients was 45 (18-78) years. Mild symptoms were present in 162 (80.6%) patients, whereas severe symptoms were present in 39 (19.4%) patients. The risk of death was statistically significant (p < .05) amongst patients with age greater than 50 years, metastatic disease, and ongoing palliative anticancer treatment. Anticancer treatment (chemotherapy, radiotherapy, hormonal therapy, targeted therapy, and surgery) received within preceding 4 weeks had no statistically significant (p > .05) impact on mortality.

Conclusions: In cancer patients with COVID-19, mortality appears to be principally driven by age, advanced stage of the disease, and palliative intent of cancer treatment. We did not identify evidence that cancer patients on chemotherapy are at significant risk of mortality from COVID-19 correlating to those not on chemotherapy.
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http://dx.doi.org/10.1016/j.hemonc.2020.12.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7759333PMC
December 2020

Meta-Analysis Comparing Ticagrelor or Prasugrel Versus Clopidogrel in Patients Undergoing Elective Percutaneous Coronary Intervention.

Am J Cardiol 2021 03 28;143:160-162. Epub 2020 Dec 28.

Division of Cardiovascular Health and Disease, University of Cincinnati College of Medicine, Cincinnati, Ohio. Electronic address:

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http://dx.doi.org/10.1016/j.amjcard.2020.12.054DOI Listing
March 2021

Paediatric Investigators Collaborative Network on Infections in Canada (PICNIC) study of the current landscape of invasive meningococcal disease in children.

Can Commun Dis Rep 2020 Oct 1;46(10):339-343. Epub 2020 Oct 1.

Department of Paediatrics, Western University, London, ON.

Background: Immunizations have led to a decrease in the incidence of invasive meningococcal disease (IMD) in Canada, but this infection still leads to significant morbidity and mortality.

Objectives: The purpose of this study was to determine the burden of illness and management of IMD in paediatric hospitals.

Methods: Data were collected on all cases of IMD in eight paediatric hospitals from 2013 to 2017.

Results: There were 17 cases of IMD. Three of eight hospitals had no cases. Just over half of the cases were serogroup B (n=9); a quarter (n=4) were serogroup W; less than a quarter (n=3) were serogroup Y; and one was unknown. Two infected children were not started on antibiotics until day one and day five after the initial blood culture was collected, but had uneventful recoveries. Six cases required admission to intensive care units; two died. Six cases had probable or proven meningitis. Thrombocytopenia was documented in seven cases. All cases had elevated C-reactive protein levels. Seven children received more than seven days of antibiotics; of these seven, only two had complications that justified prolonged therapy (subdural empyema and septic knee). Six cases had a central line placed.

Conclusion: IMD is now rare in Canadian children, but about one-third of the cases in our study required treatment in the intensive care unit and two died. Clinicians appear to not always be aware that a five to seven-day course is adequate for uncomplicated cases of bacteremia or meningitis.
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http://dx.doi.org/10.14745/ccdr.v46i10a05DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7723307PMC
October 2020

Role of Peroral Endoscopic Myotomy (POEM) in the Management of Esophageal Diverticula.

Clin Endosc 2020 Nov 26;53(6):646-651. Epub 2020 Nov 26.

Department of Gastroenterology and Hepatology, Johns Hopkins Hospital, Baltimore, MD, USA.

Esophageal diverticula are uncommon; however, when present, they can cause symptoms of dysphagia, regurgitation, and chest pain. Based on location and pathophysiological characteristics, they are classified as pulsion- and traction-type diverticula. In the past, the open surgical approach was the only treatment available; however, in the past few decades, transoral incisionless approaches in the form of rigid and flexible endoscopy have gained popularity. Diverticular peroral endoscopic myotomy has emerged as an alternative treatment option. In this paper, we reviewed the role of peroral endoscopic myotomy as a treatment option for different types of esophageal diverticula. Although a safe and effective procedure, this novel submucosal tunneling technique for the treatment of esophageal diverticula requires further validation, and head-to-head comparisons between the different approaches for the treatment of esophageal diverticula are warranted.
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http://dx.doi.org/10.5946/ce.2020.262DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7719426PMC
November 2020

Management of patients after failed peroral endoscopic myotomy: a multicenter study.

Endoscopy 2021 10 16;53(10):1003-1010. Epub 2020 Nov 16.

Division of Gastroenterology and Hepatology, Johns Hopkins Medical Institution, Baltimore, Maryland, USA.

Background: Although peroral endoscopic myotomy (POEM) is highly effective for the management of achalasia, clinical failures may occur. The optimal management of patients who fail POEM is not well known. This study aimed to compare the outcomes of different management strategies in patients who had failed POEM.

Methods: This was an international multicenter retrospective study at 16 tertiary centers between January 2012 and November 2019. All patients who underwent POEM and experienced persistent or recurrent symptoms (Eckardt score > 3) were included. The primary outcome was to compare the rates of clinical success (Eckardt score ≤ 3) between different management strategies. RESULTS : 99 patients (50 men [50.5 %]; mean age 51.4 [standard deviation (SD) 16.2]) experienced clinical failure during the study period, with a mean (SD) Eckardt score of 5.4 (0.3). A total of 29 patients (32.2 %) were managed conservatively and 70 (71 %) underwent retreatment (repeat POEM 33 [33 %], pneumatic dilation 30 [30 %], and laparoscopic Heller myotomy (LHM) 7 [7.1 %]). During a median follow-up of 10 (interquartile range 3 - 20) months, clinical success was highest in patients who underwent repeat POEM (25 /33 [76 %]; mean [SD] Eckardt score 2.1 [2.1]), followed by pneumatic dilation (18/30 [60 %]; Eckardt score 2.8 [2.3]), and LHM (2/7 [29 %]; Eckardt score 4 [1.8];  = 0.12). A total of 11 patients in the conservative group (37.9 %; mean Eckardt score 4 [1.8]) achieved clinical success. CONCLUSION : This study comprehensively assessed an international cohort of patients who underwent management of failed POEM. Repeat POEM and pneumatic dilation achieved acceptable clinical success, with excellent safety profiles.
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http://dx.doi.org/10.1055/a-1312-0496DOI Listing
October 2021

"It's Not Easy": Infant Feeding in the Context of HIV in a Resource-Rich Setting: Strengths, Challenges and Choices, a Qualitative Study.

J Assoc Nurses AIDS Care 2021 Jan-Feb 01;32(1):105-114

Sarah Khan, MD, MSc, is an Assistant Professor, Department of Pediatrics, McMaster University, Hamilton, Canada. V. Logan Kennedy, RN, MD, is a Research Associate and Clinical Nursing Specialist, Women's College Research Institute, Women's College Hospital and Maple Leaf Medical Clinic, Toronto, Canada. Mona Loutfy, MD, MPH, is a Senior Scientist and Director, Women HIV Research Program, Women's College Research Institute, Women's College Hospital, and Professor, Department of Medicine, University of Toronto, Toronto, Canada. Jay MacGillivray, RM, is a Registered Midwife and Adjunct Professor, Ryerson University, Co-Director Positive Pregnancy Program, St. Michael's Hospital, Toronto, Canada. Mark Yudin, MD, MSc, is an Associate Scientist and Staff Physician, Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Associate Professor, Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada. Stanley Read, MD, MSc, PhD, is the Chair of CANFAR's Scientific Advisory Committee and Professor Emeritus, Department of Pediatrics and Pathobiology, University of Toronto, Toronto, Canada. Ari Bitnun, MD, MSc, is an Academic Clinician, The Hospital for Sick Children, and Professor, Department of Paediatrics, University of Toronto, Toronto, Canada.

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http://dx.doi.org/10.1097/JNC.0000000000000216DOI Listing
June 2021

Treatment of Post-Ablation Bronchopleural Fistula Using Percutaneous Synthetic Hydrogel Surgical Sealant: Initial Experience of Safety and Efficacy.

Cardiovasc Intervent Radiol 2021 Feb 10;44(2):325-332. Epub 2020 Nov 10.

Department of Radiological Sciences, David Geffen School of Medicine At UCLA, Los Angeles, CA, USA.

Purpose Bronchopleural fistula is a rare but serious complication of lung ablation, as it is difficult to treat and is associated with a high mortality rate. Standard therapy often relies on surgical pleurodesis, which can be particularly problematic in patients with poor baseline lung function. A minimally invasive treatment option for bronchopleural fistula may offer an alternative to surgery for appropriate patients. This case series describes the technique, safety and efficacy of percutaneously administered synthetic hydrogel surgical sealant in the treatment of post-ablation bronchopleural fistula in five patients. Materials and methods Retrospective chart review was carried out in five consecutive patients identified to have had BPF after lung ablation between 2009 and 2017 who were treated with percutaneous administration of synthetic hydrogel surgical sealant using CT guidance. Results The procedure was successfully carried out in all patients without immediate complications, and complete resolution of air leak was achieved in four of five patients (80%). Up to the most recent follow-up, no evidence of delayed complications or recurrent air leak was present (follow-up range 1 week-8 years). Conclusion The authors' initial experience shows that targeted surgical sealant is a potentially safe and effective alternative treatment of post-ablation persistent air leak.
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http://dx.doi.org/10.1007/s00270-020-02691-3DOI Listing
February 2021

Silver linings of the coronavirus disease 2019 (COVID-19) pandemic from an infection prevention and control perspective.

Infect Control Hosp Epidemiol 2020 Nov 4:1-2. Epub 2020 Nov 4.

Department of Pediatrics, Infection Prevention and Control, McMaster University, Hamilton Health Sciences, Hamilton, Ontario, Canada.

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http://dx.doi.org/10.1017/ice.2020.1310DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7684029PMC
November 2020

Predictive value of repeated cerebrospinal fluid parameters in the outcomes of bacterial meningitis in infants <90 days of age.

PLoS One 2020 28;15(8):e0238056. Epub 2020 Aug 28.

Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada.

Background: There are variations in recommendations from different guidelines regarding the indications for repeat lumbar puncture (LP) in young infants with the diagnosis of bacterial meningitis.

Objective: To evaluate the frequency of repeat LPs and the characteristics of cerebrospinal fluid (CSF) parameters in repeated sampling and their predictive values for adverse outcomes in a national cohort.

Methods: This cohort study included infants born January 1, 2013 through December 31, 2014, who had proven or suspected bacterial meningitis within the first 90 days of life at seven paediatric tertiary care hospitals across Canada, and who underwent a repeat LP at the discretion of the treating physicians.

Results: Forty-nine of 111 infants (44%) underwent repeat LP at a median of 5 (IQR: 3, 13) days after the LP that led to the diagnosis of bacterial meningitis. Those who had meningitis caused by gram negative bacilli were more likely to have repeat LP than those with gram positive bacteria (77% versus 57%; p = 0.012). White blood cell (WBC) count on the second spinal tap yielded an area under the curve of 0.88 for predicting sequelae of meningitis at discharge from the hospital, with a cut-off value of 366 × 106/L, providing a sensitivity of 91% and specificity of 88%.

Conclusion: In this multi-centre retrospective cohort study, infants with gram negative meningitis were more likely to have repeated LP. A high WBC on the second CSF sample was predictive of adverse outcome at the time of discharge from the hospital.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0238056PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7454955PMC
October 2020

Epidemiology of brain tumors in the United Arab Emirates: a National Registry Cross-sectional Study.

BMC Neurol 2020 Aug 14;20(1):301. Epub 2020 Aug 14.

Tawam Hospital, Abu Dhabi, United Arab Emirates.

Background: Cancer is the third leading cause of death in the United Arab Emirates (UAE); brain cancer ranks 10th among the cancers, with 2.9% of the primary cancers originating from the nervous system. The epidemiology of brain cancers has not been explored. The unique population dynamics of UAE make it a fertile ground for analyzing the epidemiology of brain cancer. In this study, we aim to look at the frequency patterns and distribution of malignant primary brain tumors in the UAE.

Methods: A cross sectional study was carried out using data obtained from the Tawam Hospital Cancer Registry for the years 1984-2017. The sample size included 756 diagnosed cases of malignant primary brain tumors in the UAE. Using SPSS and Excel software, frequencies, mean ages, histological type frequencies, average annual crude incidence rates and average annual age adjusted incidence rates were analyzed.

Results: The expatriate population had higher percentage of brain tumors (72%) than the locals. The mean age at diagnosis was 33.48 years (± 21.14 years) with a male to female ratio of 1.69. Diffuse astrocytic and oligodendroglial tumors were the most commonly diagnosed tumors overall. Older adults had more cases of lymphoma while embryonal and ependymal tumors were most commonly seen in younger age groups. The overall average annual crude incidence rate for 2013-2016 for all primary brain tumors was 0.56 per 100,000 population.

Conclusion: This is the first cancer registry study in the UAE that describes histological types of primary brain tumors based on the WHO 2016 classification of brain tumors and highlights their incidence rates. Through this study, several patterns of incidence trends for brain tumors in the UAE, according to histological types, sex and age groups have been recognized. Comparative studies would help identify the influence of potential changes in lifestyle, environmental or occupational risk factors on primary brain tumors.
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http://dx.doi.org/10.1186/s12883-020-01869-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7427280PMC
August 2020

Utility of asymptomatic inpatient testing for COVID-19 in a low-prevalence setting: A multicenter point-prevalence study.

Infect Control Hosp Epidemiol 2020 Oct 22;41(10):1233-1235. Epub 2020 Jul 22.

Infection Control, St. Joseph's Healthcare Hamilton, Hamilton, Ontario, Canada.

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http://dx.doi.org/10.1017/ice.2020.349DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7390710PMC
October 2020

Acitretin induced lung injury by differentiation syndrome.

Respir Med Case Rep 2020 23;31:101138. Epub 2020 Jun 23.

Department of Rural Medicine - Pulmonary and Critical Care, Oklahoma State University College of Osteopathic Medicine, Tahlequah, OK, USA.

Differentiation syndrome is a life-threatening complication observed when retinoic acid is given to patients with acute promyelocytic leukemia. Retinoid compounds are also used in non-malignant conditions like psoriasis and it is rare to see differentiation syndrome in such settings. This reports details the clinical presentation and successful management of a patient with psoriasis who developed differentiation syndrome while on treatment with acitretin. The patient was managed with steroids and the differentiation syndrome abated with eventual complete resolution. This report exemplifies the need to consider differentiation syndrome in patients who have non-malignant conditions and are being managed with retoinds.
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http://dx.doi.org/10.1016/j.rmcr.2020.101138DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7348481PMC
June 2020
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