PMCC PMCC

Search tips
Search criteria

Advanced
Results 1-25 (93)
 

Clipboard (0)
None

Select a Filter Below

Journals
more »
Year of Publication
more »
1.  Multicentre prospective cohort study of body mass index and postoperative complications following gastrointestinal surgery 
Drake, T. M. | Nepogodiev, D. | Chapman, S. J. | Glasbey, J. C. | Khatri, C. | Kong, C. Y. | Claireaux, H. A. | Bath, M. F. | Mohan, M. | McNamee, L. | Kelly, M. | Mitchell, H. | Fitzgerald, J. E. | Harrison, E. M. | Bhangu, A. | Claireaux, H. A. | Antoniou, I. | Dean, R. | Davies, N. | Trecarten, S. | Henderson, I. | Holmes, C. | Wylie, J. | Shuttleworth, R. H. | Jindal, A. | Hughes, F. | Gouda, P. | McNamee, L. | Fleck, R. | Hanrahan, M. | Karunakaran, P. | Chen, J. H. | Sykes, M. C. | Sethi, R. K. | Suresh, S. | Patel, P. | Patel, M. | Varma, R. K. | Mushtaq, J. | Gundogan, B. | Bolton, W. | Mohan, M. | Khan, T. | Burke, J. | Morley, R. | Favero, N. | Adams, R. | Thirumal, V. | Kennedy, E. D. | Ong, K. K. | Tan, Y. H. | Gabriel, J. | Bakhsh, A. | Low, J. Y. L. | Yener, A. | Paraoan, V. | Preece, R. | Tilston, T. W. | Cumber, E. | Dean, S. | Ross, T. | McCance, E. | Amin, H. | Satterthwaite, L. | Clement, K. D. | Gratton, R. | Mills, E. D. | Chiu, S. M. | Hung, G. | Rafiq, N. M. | Hayes, J. D. B. | Robertson, K. L. | Dynes, K. | Huang, H. C. | Assadullah, S. | Duncumb, J. W. | Moon, R. D. C. | Poo, S. X. | Mehta, J. K. | Joshi, K. R. | Callan, R. | Norris, J. M. | Chilvers, N. J. | Keevil, H. | Jull, P. | Mallick, S. | Elf, D. | Carr, L. | Player, C. | Barton, E. C. | Martin, A. L. | Ratu, S. G. | Roberts, E. J. | Phan, P. N. | Dyal, A. R. | Rogers, J. E. | Henson, A. D. | Reid, N. B. | Burke, D. | Culleton, G. | Lynne, S. | Burke, D. | Mansoor, S. | Brennan, C. | Blessed, R. | Holloway, C. | Hill, A. | Goldsmith, T. | Mackin, S. | Kim, S. | Woin, E. | Brent, G. | Coffin, J. | Ziff, O. | Momoh, Z. | Debenham, R. | Ahmed, M. | Yong, C. S. | Wan, J. C. | Copley, H. C. | Raut, P. | Chaudhry, F. I. | Shuttleworth, R. H. | Nixon, G. | Dorman, C. | Tan, R. | Kanabar, S. | Canning, N. | Dolaghan, M. | Bell, N. | McMenamin, M. | Chhabra, A. | Duke, K. | Turner, L. | Patel, T. | Chew, L. S. | Mirza, M. | Lunawat, S. | Oremule, B. | Ward, N. | Khan, M. | Tan, E. T. | Maclennan, D. | McGregor, R. J. | Chisholm, E. G. | Griffin, E. J. | Bell, L. | Hughes, B. A. | Davies, J. | Haq, H. | Ahmed, H. | Ungcharoen, N. | Whacha, C. | Thethi, R. | Markham, R. M. | Lee, A. H. Y. | Batt, E. | Bullock, N. P. | Francescon, C. T. | Davies, J. E. | Shafiq, N.M. | Zhao, J. | Vivekanantham, S. | Barai, I. | Allen, J. L. Y. | Marshall, D. C. | McIntyre, C. J. | Wilson, H. C. P. | Ashton, A. J. | Lek, C. | Behar, N. | Davis‐Hall, M. | Seneviratne, N. | Kim, S. | Esteve, L. | Sirakaya, M. | Ali, S. | Pope, S. | Ahn, J. S. | Craig‐McQuaide, A. | Gatfield, W. A. | Leong, S. | Demetri, A. M. | Kerr, A. L. | Rees, C. | Loveday, J. | Liu, S. | Wijesekera, M. | Maru, D. | Attalla, M. | Smith, N. | Brown, D. | Sritharan, P. | Shah, A. | Charavanamuttu, V. | Heppenstall‐Harris, G. | Ng, K. | Raghvani, T. | Rajan, N. | Hulley, K. | Moody, N. | Williams, M. | Cotton, A. | Sharifpour, M. | Lwin, K. N. | Bright, M. | Chitnis, A. R. | Abdelhadi, M. | Semana, A. D. | Morgan, F. | Reid, R. | Dickson, J. | Anderson, L. | McMullan, R. | Dickson, J. | Ahern, N. | Asmadi, A. | Anderson, L. B. | Lua Boon Xuan, J. | Crozier, L. | McAleer, S. | Lees, D. M. | Adebayo, A. A. | Das, M. | Amphlett, A. H. | Al‐Robeye, A. | Valli, A. | Khangura, J. | Winarski, A. | Ali, A. | Khangura, J. | Woodward, H. | Gouldthrope, C. | Turner, M. | Sasapu, K. | Tonkins, M. | Wild, J. R. L. | Robinson, M. | Hardie, J. | Heminway, R. | Narramore, R. | Ramjeeawon, N. | Hibberd, A. | Winslow, F. | Ho, W. | Chong, B. F. | Lim, K. | Ho, S. | Crewdson, J. A. | Singagireson, S. | Kalra, N. | Koumpa, F. | Jhala, H. | Soon, W. C. | Karia, M. | Rasiah, M. G. | Xylas, D. | Gilbert, H. | Sundar‐Singh, M. | Wills, J. | Mushtaq, J. | Akhtar, S. | Patel, S. | Hu, L. | Brathwaite‐Shirley, C. | Nayee, H. | Amin, O. | Rangan, T. | Turner, E. J. H. | McCrann, C. | Shepherd, R. | Patel, N. | Prest‐Smith, J. | Auyoung, E. | Murtaza, A. | Coates, A. | Prys‐Jones, O. | King, M. | Gaffney, S. | Dewdney, C. J. | Nehikhare, I. | Lavery, J. | Bassett, J. | Davies, K. | Ahmad, K. | Collins, A. | Acres, M. | Egerton, C. | Khan, T. | Cheng, K. | Chen, X. | Chan, N. | Sheldon, A. | Khan, S. | Empey, J. | Ingram, E. | Malik, A. | Johnstone, M. | Goodier, R. | Shah, J. P. | Giles, J. E. | Sanders, J. A. | McLure, S. W. | Pal, S. | Rangedara, A. | Baker, A. N. | Asbjoernsen, C. A. | Girling, C. | Gray, L. | Gauntlett, L. | Joyner, C. | Qureshi, S. | Dean, S. | Mogan, Y. P. | Ng, J. C. K. | Kumar, A. N. | Park, J. H. | Tan, D. | Choo, K. P. | Raman, K. P. | Buakuma, P. | Xiao, C. | Govinden, S. | Thompson, O. D. | Charalambos, M. A. | Brown, E. | Karsan, R. B. | Dogra, T. | Bullman, L. M. | Dawson, P. M. | Frank, A. L. | Abid, H. | Tung, L. | Qureshi, U. | Tahmina, A. | Matthews, B. W. | Harris, R. T. | O'Connor, A. | Mazan, K. | Iqbal, S. | Stanger, S. A. | Thompson, J. D. | Sullivan, J. A. L. | Uppal, E. | MacAskill, A. | Bamgbose, F. A. | Neophytou, C. | Carroll, A. F. | Rookes, C. W. | Datta, U. | Dhutia, A. J. | Rashid, S. | Ahmed, N. | Lo, T. | Bhanderi, S. | Blore, C. D. | Ahmed, S. | Shaheen, H. | Abburu, S. | Majid, S. | Abbas, Z. | Talukdar, S. S. | Ahmed, S. | Burney, L. J. | Patel, J. B. | Al‐Obaedi, O. | Roberts, A. W. | Al‐Obaedi, O. | Mahboob, S. | Singh, B. | Sheth, S. | Karia, P. | Prabhudesai, A. | Kow, K. | Koysombat, K. | Wang, S. | Morrison, P. | Maheswaran, Y. | Keane, P. | Copley, P. C. | Brewster, O. | Xu, G. X. | Harries, P. | Wall, C. | Al‐Mousawi, A. | Bonsu, S. | Cunha, P. | Ward, T. | Paul, J. | Nadanakumaran, K. | Tayeh, S. | Ward, T. | Holyoak, H. | Remedios, J. | Theodoropoulou, K. | Ward, T. | Luhishi, A. | Jacob, L. | Long, F. | Atayi, A. | Sarwar, S. | Parker, O. | Harvey, J. | Ross, H. | Rampal, R. | Thomas, G. | Vanmali, P. | McGowan, C. | Stein, J. | Robertson, V. | Carthew, L. | Teng, V. | Fong, J. | Street, A. N. | Thakker, C. E. | O'Reilly, D. | Bravo, M. | Pizzolato, A. | Khokhar, H. A. | Ryan, M. | Cheskes, L. | Carr, R. | Salih, A. E. | Bassiony, S. | Yuen, R. | Chrastek, D. | Rosen O'Sullivan, H. | Amajuoyi, A. | Wang, A. | Sitta, O. | Wye, J. | Qamar, M. A. | Major, C. | Kaushal, A. | Morgan, C. | Petrarca, M. | Allot, R. | Verma, K. | Dutt, S. | Allot, R. | Chilima, C. P. | Peroos, S. | Allot, R. | Kosasih, S. R. | Chin, H. | Ashken, L. | Pearse, R. J. | O'Loughlin, R. A. | Menon, A. | Singh, K. | Norton, J. | Sagar, R. | Jathanna, N. | Rothwell, L. | Watson, N. | Harding, F. | Dube, P. | Khalid, H. | Punjabi, N. | Sagmeister, M. | Gill, P. | Shahid, S. | Hudson‐Phillips, S. | George, D. | Ashwood, J. | Lewis, T. | Dhar, M. | Sangal, P. | Rhema, I. A. | Kotecha, D. | Dean, R. | Afzal, Z. | Syeed, J. A. | Prakash, E. | Jalota, P. | Dean, R. | Herron, J. | Kimani, L. | Delport, A. | Shukla, A. | Agarwal, V. | Parthiban, S. | Thakur, H. | Cymes, W. | Rinkoff, S. | Turnbull, J. A. | Hayat, M. | Darr, S. | Khan, U. | Lim, J. | Higgins, A. | Lakshmipathy, G. | Forte, B. | Canning, E. | Jaitley, A. | Lamont, J. | Toner, E. | Ghaffar, A. | McDowell, M. | Salmon, D. | Gouda, P. | O'Carroll, O. | Khan, A. | Kelly, M. E. | Clesham, K. | Palmer, C. | Lyons, R. | Kelly, M. E. | Bell, A. | Chin, R. | Waldron, R. M. | Kelly, M. E. | Trimble, A. | Cox, S. E. | Ashfaq, U. | Campbell, J. | Holliday, R. B. S. | McCabe, G. | Morris, F. | Priestland, R. | Dean, S. | Vernon, O. K. | Ledsam, A. | Vaughan, R. | Lim, D. | Bakewell, Z. R. | Hughes, R. K. | Koshy, R. M. | Jackson, H. R. | Narayan, P. | Cardwell, A. E. | Jubainville, C. L. | Arif, T. | Elliott, L. E. | Gupta, V. | Arif, T. | Bhaskaran, G. | Singh, K. | Odeleye, A. | Ahmed, F. | Shah, R. | Odeleye, A. | Pickard, J. | Suleman, Y. N. | Odeleye, A. | North, A. S. | McClymont, L. F. | Hussain, N. | Ibrahim, I. | Ng, G. S. | Wong, V. | Lim, A. E. | Harris, L. N. | Tharmachandirar, T. | Mittapalli, D. | Patel, V. | Lakhani, M. | Davies, N. | Bazeer, H. Z. | Narwani, V. | Sandhu, K. K. | Wingfield, L. R. | Gentry, S. | Adjei, H. | Bhatti, M. | Braganza, L. | Barnes, J. | Mistry, S. | Chillarge, G. | Stokes, S. | Cleere, J. | Wadanamby, S. | Bucko, A. M. | Meek, J. | Boxall, N. | Heywood, E. G. | Wiltshire, J. J. | Toh, C. | Ward, A. E. | Shurovi, B. N. | Drake, T. M. | Horth, D. | Patel, B. Y. | Ali, B. | Spencer, T. | Axelson, T. | Kretzmer, L. | Chhina, C. | Anandarajah, C. | Fautz, T. | Horst, C. | Thevathasan, A. A. | Ng, J. Q. | Hirst, F. | Brewer, C. F. | Logan, A. E. | Lockey, J. W. | Forrest, P. R. | Keelty, N. | Wood, A. D. | Springford, L. R. | Avery, P. | Schulz, T. M. | Bemand, T. P. | Howells, L. | Collier, H. | Khajuria, A. | Tharakan, R. G. | Parsons, S. | Buchan, A. M. | McGalliard, R. J. | Mason, J. D. | Cundy, O. J. | Li, N. | Redgrave, N. A. | Watson, R. P. | Pezas, T. P. | Dennis, Y. F. | Segall, E. | Hameed, M. | Lynch, A. S. | Chamberlain, M. | Peck, F. S. | Neo, Y. N. | Russell, G. | Elseedawy, M. | Lee, S. | Foster, N. L. | Soo, Y. H. | Puan, L. | Dennis, R. | Goradia, H. | Qureshi, A. | Osman, S. | Reeves, T. | Dinsmore, L. | Marsden, M. | Lu, Q. | Pitts‐Tucker, T. | Dunn, C. E. | Walford, R. A. | Heathcote, E. | Martin, R. | Pericleous, A. | Brzyska, K. | Reid, K. G. | Williams, M. R. | Wetherall, N. | McAleer, E. | Thomas, D. | Kiff, R. | Gouldthrope, C. | Milne, S. | Holmes, M. J. V. | Stokes, S. | Bartlett, J. | de Carvalho, J. Lucas | Bloomfield, T. | Tongo, F. | Bremner, R. H. | Yong, N. | Atraszkiewicz, B. A. | Mehdi, A. | Tahir, M. | Sherliker, G. X. J. | Tear, A. K. | Pandey, A. | Broyd, A. | Omer, H. M. | Raphael, M. | Chaudhry, W. W. | Shahidi, S. | Jawad, A. S. | Gill, C. K. | Hindle Fisher, I. | Adeleja, I. | Clark, I. J. | Aidoo‐Micah, G. E. | Stather, P. W. | Salam, G. J. | Glover, T. E. | Deas, G. | Sim, N. K. | Obute, R. D. | Wynell‐Mayow, W. M. | Sait, M. S. | Mitha, N. | de Bernier, G. L. | Siddiqui, M. | Shaunak, R. | Wali, A. | Cuthbert, G. | Bhudia, R. | Webb, E. | Shah, S. | Ansari, N. | Perera, M. | Kelly, N. | McAllister, R. | Stanley, G. H. | Keane, C. P. | Shatkar, V. | Maxwell‐Armstrong, C. | Henderson, L. A. | Maple, N. | Manson, R. | Adams, R. D. | Brown, E. | Semple, E. | Mills, M. | Daoub, A. | Marsh, A. | Ramnarine, A. | Hartley, J. | Malaj, M. | Jewell, P. D. | Whatling, E. A. | Hitchen, N. | Chen, M. | Goh, B. | Fern, J. | Rogers, S. | Derbyshire, L. | Robertson, D. T. | Abuhussein, N. | Deekonda, P. | Abid, A. | Bakhsh, A. | Harrison, P. L. M. | Aildasani, L. | Turley, H. | Sherif, M. A. | Pandey, G. | Filby, J. J. | Johnston, A. | Burke, E. | Mohamud, M. | Gohil, K. | Tsui, A. Y. | Singh, R. | Lim, S. J. | O'Sullivan, K. | McKelvey, L. L. | O'Neill, S. | Roberts, H. F. | Brown, F. S. | Cao, Y. | Buckle, R. T. | Liew, Y. | Sii, S. | Ventre, C. M. | Graham, C. J. | Filipescu, T. | Yousif, A. | Dawar, R. | Wright, A. | Peters, M. | Varley, R. | Owczarek, S. | Hartley, S. | Khattak, M. | Iqbal, A. | Ali, M. | Durrani, B. | Narang, Y. | Bethell, G. S. | Horne, L. | Pinto, R. | Nicholls, K. | Kisyov, I. | Torrance, H. D. | Patel, P. | Patel, M. | English, W. | Lakhani, S. M. | Ashraf, S. F. | Venn, M. | Elangovan, V. | Kazmi, Z. | Brecher, J. | Sukumar, S. | Mastan, A. | Mortimer, A. | Parker, J. | Boyle, J. | Elkawafi, M. | Beckett, J. | Mohite, A. | Narain, A. | Mazumdar, E. | Sreh, A. | Hague, A. | Weinberg, D. | Fletcher, L. | Steel, M. | Shufflebotham, H. | Masood, M. | Sinha, Y. | Amin, H. | Jenvey, C. | Kitt, H. | Slade, R. | Craig, A. R. | Deall, C. | Sinha, Y. | Gabriel, J. | Reakes, T. | Chervenkoff, J. | Strange, E. | O'Bryan, M. | Murkin, C. | Joshi, D. | Strange, E. | Bergara, T. | Naqib, S. | Wylam, D. | Strange, E. | Scotcher, S. E. | Hewitt, C. M. | Stoddart, M. T. | Kerai, A. | Trist, A. J. | Cole, S. J. | Knight, C. L. | Stevens, S. | Cooper, G. E. | Ingham, R. | Dobson, J. | Wylie, J. | O'Kane, A. | Moradzadeh, J. | Duffy, A. | Henderson, C. | Ashraf, S. | McLaughin, C. | Hoskins, T. C. | Reehal, R. S. | Bookless, L. R. | McLean, R. C. | Stone, E. J. | Wright, E. V. | Abdikadir, H. R. | Roberts, C. | Spence, O. | Srikantharajah, M. | Patel, M. | Ruiz, E. M. | Matthews, J. H. | Gardner, E. | Roberts, C. | Hester, E. | Naran, P. | Simpson, R. | Minhas, M. | Cornish, E. | Semnani, S. A. | Rojoa, D. | Radotra, A. | Eraifej, J. | Eparh, K. | Smith, D. N. E. | Mistry, B. D. | Hickling, S. L. | Bhangu, A. | Din, W. | Liu, C. | Mithrakumar, P. | Mirdavoudi, V. | Rashid, M. | Mcgenity, C. | Hussain, O. | Kadicheeni, M. | Gardner, H. | Anim‐Addo, N. | Pearce, J. | Aslanyan, A. | Ntala, C. | Sorah, T. | Parkin, J. | Alizadeh, M. | White, A. | Edozie, F. | Johnston, J. | Kahar, A. | Navayogaarajah, V. | Patel, B. | Carter, D. | Khonsari, P. | Burgess, A. | Patel, B. | Kong, C. | Ponweera, A. | Cody, A. | Tan, Y. | Ng, A. Y. L. | Croall, A. | Allan, C. | Ng, S. | Raghuvir, V. | Telfer, R. | Greenhalgh, A. D. | McKerr, C. N. | Edison, M. A. | Patel, B. A. | Dear, K. | Hardy, M. R. | Williams, P. | Hassan, S. | Sajjad, U. | O'Neill, E. M. | Lopes, S. | Healy, L. | Jamal, N. | Tan, S. | Lazenby, D. | Husnoo, S. B. | Beecroft, S. | Sarvanandan, T. | Weston, C. | Bassam, N. | Rabinthiran, S. | Hayat, U. | Ng, L. | Varma, D. | Sukkari, M. | Mian, A. | Coates, A. | Omar, A. | Kim, J.W. | Coates, A. | Sellathurai, J. | Mahmood, J. | O'Connell, C. | Bose, R. | Heneghan, H. | Lalor, P. | Matheson, J. | Doherty, C. | Cullen, C. | Cooper, D. | Angelov, S. | Drislane, C. | Smith, A. C. D. | Kreibich, A. | Palkhi, E. | Durr, A. | Lotfallah, A. | Gold, D. | Mckean, E. | Durr, A. | Dhanji, A. | Anilkumar, A. | Thacoor, A. | Durr, A. | Siddiqui, Z. H. | Lim, S. | Piquet, A. | Anderson, S. M. | Jindal, A. | McCormack, D. R. | Gulati, J. | Ibrahim, A. | Jindal, A. | Murray, S. E. | Walsh, S. L. | McGrath, A. | Ziprin, P. | Chua, E. Y. | Lou, C. N. | Bloomer, J. | Paine, H. R. | Osei‐Kuffour, D. | White, C. J. | Szczap, A. | Gokani, S. | Patel, K. | Malys, M. K. | Reed, A. | Torlot, G. E. | Cumber, E. M. | Charania, A. | Ahmad, S. | Varma, N. | Cheema, H. | Austreng, L. | Petra, H. | Chaudhary, M. | Zegeye, M. I. | Cheung, F. | Coffey, D. | Heer, R. S. | Singh, S. | Seager, E. | Cumming, S. | Suresh, R. S. | Verma, S. | Ptacek, I. B. | Gwozdz, A. M. | Yang, T. | Khetarpal, A. A.
The British Journal of Surgery  2016;103(9):1157-1172.
Background
There is currently conflicting evidence surrounding the effects of obesity on postoperative outcomes. Previous studies have found obesity to be associated with adverse events, but others have found no association. The aim of this study was to determine whether increasing body mass index (BMI) is an independent risk factor for development of major postoperative complications.
Methods
This was a multicentre prospective cohort study across the UK and Republic of Ireland. Consecutive patients undergoing elective or emergency gastrointestinal surgery over a 4‐month interval (October–December 2014) were eligible for inclusion. The primary outcome was the 30‐day major complication rate (Clavien–Dindo grade III–V). BMI was grouped according to the World Health Organization classification. Multilevel logistic regression models were used to adjust for patient, operative and hospital‐level effects, creating odds ratios (ORs) and 95 per cent confidence intervals (c.i.).
Results
Of 7965 patients, 2545 (32·0 per cent) were of normal weight, 2673 (33·6 per cent) were overweight and 2747 (34·5 per cent) were obese. Overall, 4925 (61·8 per cent) underwent elective and 3038 (38·1 per cent) emergency operations. The 30‐day major complication rate was 11·4 per cent (908 of 7965). In adjusted models, a significant interaction was found between BMI and diagnosis, with an association seen between BMI and major complications for patients with malignancy (overweight: OR 1·59, 95 per cent c.i. 1·12 to 2·29, P = 0·008; obese: OR 1·91, 1·31 to 2·83, P = 0·002; compared with normal weight) but not benign disease (overweight: OR 0·89, 0·71 to 1·12, P = 0·329; obese: OR 0·84, 0·66 to 1·06, P = 0·147).
Conclusion
Overweight and obese patients undergoing surgery for gastrointestinal malignancy are at increased risk of major postoperative complications compared with those of normal weight.
High BMI increases risk of complications
doi:10.1002/bjs.10203
PMCID: PMC4973675  PMID: 27321766
2.  Incidence and severity of postoperative sore throat: a randomized comparison of Glidescope with Macintosh laryngoscope 
BMC Anesthesiology  2017;17:127.
Background
Postoperative sore throat (POST) is a common problem following endotracheal (ET) intubation during general anesthesia. The objective was to compare the incidence and severity of POST during routine intubation with Glidescope (GL) and Macintosh laryngoscope (MCL).
Methods
One hundred forty adult patients ASA I and II with normal airway, scheduled to undergo elective surgery under GA requiring ET intubation were enrolled in this prospective randomized study and were randomly divided in two groups, GL and MCL. Incidence and severity of POST was evaluated at 0, 6, 12 and 24 h after surgery.
Results
At 0 h, the incidence of POST was more in MCL than GL (n = 41 v.s n = 22, P = 0.001), and also at 6 h after surgery (n = 37 v.s n = 23, P = 0.017). Severity of POST was more at 0, 6 and 12 h after surgery in MCL (P < 0.001, P = 0.001, P = 0.004 respectively).
Conclusions
Routine use of GL for ET tube placement results in reduction in the incidence and severity of POST compared to MCL.
Trial regisration
ClinicalTrials.gov NCT02848365. Retrospectively Registered (Date of registration: July, 2016).
doi:10.1186/s12871-017-0421-4
PMCID: PMC5596501  PMID: 28899338
Sore throat; Laryngoscope; Peroperative complications; Endotracheal intubation
3.  Refractory Case of Takayasu Arteritis in a Young Woman: A Clinical Challenge 
Cureus  null;8(11):e872.
Takayasu arteritis (TA) is an idiopathic chronic inflammatory vasculitis of the aorta and its main branches, which if not treated can lead to severe vascular damage and fatal vascular events. Glucocorticoids (GCs) are the mainstay of the therapy of TA but a significant proportion of patients tend to experience flare-ups when their GCs are tapered. We report a case of a 42-year-old female with TA, diagnosed according to the 1990 American College of Rheumatology Criteria for TA. Cardiovascular assessment showed normal carotid upstrokes with bilateral carotid bruits and soft right and left subclavian bruits with weak peripheral pulses. A computed tomography (CT) aortogram of the chest showed severe stenosis of bilateral subclavian arteries and mild stenosis of right and left common carotid arteries at the origin. A CT aortogram of the abdomen showed an occluded left renal artery, a very small left kidney, and mild narrowing of the abdominal aorta below the level of renal arteries. 
She was initially managed with GCs along with immunosuppressive therapy including methotrexate, azathioprine, and cyclophosphamide, but her disease remained active. She was then sequentially treated with inhibitor etanercept (ETN), inhibitor tocilizumab (TCZ) and monoclonal anti-CD20 antibody rituximab (RTX), and in spite of aggressive biologic therapy she continued to have active disease. To the best of our knowledge, this is the first case of refractory TA treated sequentially with three different biologic drugs.
doi:10.7759/cureus.872
PMCID: PMC5154399  PMID: 27994990
autoimmunity; immunosupressive; vasculitis
4.  Physiologically based pharmacokinetic modeling for predicting irinotecan exposure in human body 
Oncotarget  2017;8(29):48178-48185.
Colorectal cancer is the third leading cause of cancer-related deaths in the United States. Treatment of colorectal cancer remains a challenge to clinicians as well as drug developers. Irinotecan, a Camptothecin derivative, is successfully used for the treatment of this rapidly progressing malignancy and finds its place in the first line of therapeutic agents. Irinotecan is also effective in treating SCLC, malignant glioma and pancreatic adenocarcinoma. However, its adverse effects limit its clinical application. Mainly metabolized by hepatic route, and excreted through biliary tract, this dug has been found to possess high variation in patients in its pharmacokinetic (PK) profile. Physiologically based pharmacokinetic (PBPK) models using compartmental approach have attained their position to foresee the possible PK behavior of different drugs before their administration to patients and such models have been proposed for several anticancer agents. In this work, we used WB-PBPK technology to develop a model in a population of tumor patients who used IV irinotecan therapy. This model depicted the concentration of drug and its pharmacologically active metabolite in human body over a specific period of time. Knowledge about pharmacokinetic parameters is extracted from this profile and the model is evaluated by the observed results of clinical study presented in literature. The predicted behavior of the drug by this approach is in good agreement with the observed results and can aid in further exploration of PK of irinotecan in cancer patients, especially in those concomitantly suffer from other morbidity.
doi:10.18632/oncotarget.18380
PMCID: PMC5564636  PMID: 28636998
physiologically based pharmacokinetics (PBPK); irinotecan; colorectal cancer
5.  Role of Sex Hormone Levels and Psychological Stress in the Pathogenesis of Autoimmune Diseases 
Cureus  null;9(6):e1315.
The aim of this review article is to assess the connection between psychological stress and sex hormones and their effect on the development of autoimmune diseases. Psychological stress describes what people feel when they are under mental, physical, or emotional pressure. We searched for online articles using MEDLINE®, Embase, Cochrane Library and Google Scholar. Our research yielded a total of 165 articles out of which 30 articles were considered for further perusal. The articles were reviewed from February 2016 to February 2017. Case reports and patients suffering from hematolymphoid malignancies and active infections were excluded from the review. Estrogen and testosterone are potential physiological regulatory factors for the peripheral development of CD4+CD25+ T regulatory cells. Stress at any age leads to the depletion of estrogen and testosterone stores in the body, leading to the loss of expansion of T regulatory cells, making the immature B cells evade the negative selection at the germinal center, or in other words, leading to the loss of central tolerance, a triggering event in autoimmune diseases like systemic lupus erythematosus. Autoimmune diseases in women are most likely due to changes in estrogen levels during mental, physical, pre-menopausal, post-menopausal, and pregnancy-induced stress. We conclude that modulating estrogen in females (pre-menopausal and post-menopausal) and testosterone in males can be used to treat stress-related immune imbalance resulting in autoimmune diseases in both sexes.
doi:10.7759/cureus.1315
PMCID: PMC5498122  PMID: 28690949
central tolerance; autoimmunity; systemic lupus erythematosus; multiple sclerosis; peripheral tolerance
6.  Comparative study of extrapolative factors linked with oxidative injury and anti-inflammatory status in chronic kidney disease patients experiencing cardiovascular distress 
PLoS ONE  2017;12(2):e0171561.
Background
Chronic kidney disease (CKD) is a group of heterogeneous abnormalities affecting the function and structure of the kidney and mostly further proceeds to cardiovascular damage prior to end stage renal disease (ESRD). The oxidative insult and inflammatory mediators have some undefined role in CKD and cardiovascular complications. It is therefore, aimed at to pin point the predictive factors in the development of cardiovascular disorder in patients with chronic kidney disease.
Methods
Fifty patients of CKD experiencing cardiovascular distress and twenty normal individuals having same age and sex acted as control during these observations. Blood samples (Each 5 ml) were drawn and subjected to centrifugation for 10–15 minutes to separate the serum at 4000-5000rpm. The levels of MDA, GSH, SOD, CAT, VIT C, VIT E, IL-1, TNF-alpha, nitric oxide (NO) and advanced oxidation protein products (AOPPs) were estimated and analyzed.
Results
The nitric oxide levels in the CKD patients decreased significantly (13.26±1.25 ng/ml) compared to controls (42.15±5.26 ng/ml). The serum vitamin E and C levels in these patients recorded 2.15±0.25 μg/ml and 0.97±0.09 μg/ml respectively as against their assigned controls which read 6.35±1.22 μg/ml and 3.29±0.25 μg/ml. Furthermore, a significantly higher level of Malondialdehyde (MDA) as1.25±0.07 nmol/ml was observed in CKD patients viz-a-viz relevant control. However, the serum SOD, catalase (CAT) and GSH levels in the same patients registered a significant decline as evident from respective figures 0.07±0.002 μg/dl, 1.22±0.012 μmol/mol, and 3.25±1.05 μg/dl. The control for these was observed as0.99±0.06 μg/dl, 3.19±0.05 μmol/mol, and 8.64±0.03 μg/dL. On the other hand, the IL-1 levels in the CKD patients found quite higher (402.5±18.26 pg/ml). This clearly points to substantial increase in oxidative insult and reduced NO levels leading to the renal and cardiovascular damage.
Conclusion
Observations support the fact that the decrease in anti-oxidative capacity accompanied by higher inflammatory mediators in CKD is indicative of oxidative stress, consequently leading to CKD progression, in all probability to cardiovascular insult. The outcome reiterates that strategies be designed afresh to contain CKD progression to cardiovascular complications and ESRD. One way could be to focus on early detection of stress related to the disease. It requires analyzing the factors related to stress, such as the one reported here. Linking these factors with the symptoms could be a crucial step forward. And further, the disease could be monitored in a more disciplined manner.
doi:10.1371/journal.pone.0171561
PMCID: PMC5298283  PMID: 28178330
7.  Prevalence of Obesity in Carpal Tunnel Syndrome Patients: A Cross-Sectional Survey 
Cureus  null;9(7):e1519.
Carpal tunnel syndrome (CTS) is the most common compressive entrapment neuropathy caused by the compression of the median nerve at the wrist space known as the carpal tunnel. The epidemiologic factors related to CTS include genetic, medical, social, vocational, and demographic factors. The common symptoms experienced include pain, paresthesia, and numbness in the median nerve distribution. If left untreated, it can lead to irreversible median nerve damage, causing a loss of hand function. Body mass index (BMI) has been attributed as a risk factor for the development of CTS.
We planned to determine the frequency of obesity among CTS patients in the neurophysiology department of a tertiary care center in Islamabad, Pakistan. The survey was designed as a cross-sectional descriptive study from March 2016 to August 2016 using a consecutive nonprobability sampling technique. A total of 112 patients with a mean age of 54 ± 5 years were included in the study. In the study population, 39 patients (35 percent) were males and 73 were females (65 percent). Based on BMI, 74 patients (66 percent) had a normal weight and 38 (34 percent) were obese. The frequency of obesity in our study was 34 percent, excluding the other comorbid conditions, which is quite high. Targeted therapy in those with CTS should also include weight reduction measures because obesity poses a cause-and-effect relationship for both the severity and the pathogenesis of CTS.
doi:10.7759/cureus.1519
PMCID: PMC5613927
carpal tunnel syndrome; body mass index; obesity; pakistan
8.  Quality Evaluation of Biscuits Supplemented with Alfalfa Seed Flour 
Foods  2016;5(4):68.
The effect of alfalfa seed flour supplementation on the quality characteristics of refined wheat flour-based biscuits was studied. The proximate composition of refined wheat flour and alfalfa seed flour was determined. Refined wheat flour contained 12.43% moisture, 11.52% crude protein, 1.61% crude fat, 0.71% crude fiber, 1.43% ash and 70.83% nitrogen free extract, while alfalfa seed flour contained 5.79%, 29.49%, 12.71%, 5.53%, 4.80% and 41.73% moisture, crude protein, crude fat, crude fiber, ash and nitrogen free extract correspondingly. Alfalfa seed flour at 5%, 10%, 15% and 20% supplementation levels was incorporated in refined wheat flour to produce composite flour. The biscuits prepared were subjected to quality evaluation. Physical analysis of biscuits disclosed that supplementation of alfalfa seed flour decreased the width from 47.25 to 42 mm and the spread factor from 62.7 to 53.12, while it increased the thickness from 7.53 to 8.10 mm. Supplementation of refined wheat flour–based biscuits with alfalfa seed flour at different inclusion levels significantly (p < 0.05) increased the crude protein content from 10.19% to 15.30%, the crude fiber content from 0.73% to 1.62%, the crude fat content from 17.46% to 21.59% and the ash content from 1.37% to 1.92%, whereas it decreased the moisture content from 3.57% to 3.26% and the nitrogen free extract from 66.90% to 59.32%. The effect of supplementation on the mineral contents of biscuits was also significant (p < 0.05). Potassium, magnesium, calcium, iron and zinc contents increased from 105.30, 14.65, 43.91, 3.74 and 0.94 to 145.00, 26.64, 79.60, 7.93 and 1.60 mg/100 g, respectively. Sensory evaluation revealed that the quality score of biscuits in terms of color, taste, texture and overall acceptability decreased with increased supplementation. The present research work confirmed that a maximum of 10% alfalfa seed flour supplementation in refined wheat flour could produce acceptable biscuits with an appropriate nutritional profile.
doi:10.3390/foods5040068
PMCID: PMC5302434
alfalfa seed flour; supplemented biscuits; quality evaluation
9.  Study of PKRBD in HCV genotype 3a infected patients in response to interferon therapy in Pakistani population 
Virology Journal  2013;10:352.
Background
Hepatitis C virus (HCV) is a major cause of liver cirrhosis and hepatocellular carcinoma and infects about 3% world population. Response to interferon therapy depends upon the genotype of the virus and factors associated with the host. Despite a good response to interferon therapy, a considerable number of genotype 3a infected patients remains unalleviated.
Results
In total forty-nine patients including twenty-five non-responders (non-SVR) and twenty-four responders (SVR) were recruited. Patients were tested for viral status at different intervals and the isolated RNA was sequenced for the NS5A region in both groups. The comparison of PKRBD of HCV between the SVR and non-SVR patients did not confirm any significant difference in the number of mutations. However, when the sequence downstream to the PKRBD of NS5A was compared, two important statistically significant mutations were observed; at positions 2309 (Ala to Ser) and 2326 (Gly to Ala). These mutations were then analysed for tertiary protein structure and important structural changes were observed. Statistically significant difference was also observed when age groups of patients were compared; younger patients showed better response than the older ones.
Conclusions
The region between PKRBD and IRRDR may be important for prediction of response to IFN therapy for genotype 3a. ISDR and PKRBD have not shown any involvement in treatment response. Further functional analyses of these findings can help in understanding the involvement of the NS5A region in interferon treatment of HCV-3a infected patients.
doi:10.1186/1743-422X-10-352
PMCID: PMC4029318  PMID: 24321105
10.  Use of Recombinant Tobacco Mosaic Virus To Achieve RNA Interference in Plants against the Citrus Mealybug, Planococcus citri (Hemiptera: Pseudococcidae) 
PLoS ONE  2013;8(9):e73657.
The citrus mealybug, Planococcus citri, is an important plant pest with a very broad plant host range. P. citri is a phloem feeder and loss of plant vigor and stunting are characteristic symptoms induced on a range of host plants, but P. citri also reduces fruit quality and causes fruit drop leading to significant yield reductions. Better strategies for managing this pest are greatly needed. RNA interference (RNAi) is an emerging tool for functional genomics studies and is being investigated as a practical tool for highly targeted insect control. Here we investigated whether RNAi effects can be induced in P. citri and whether candidate mRNAs could be identified as possible targets for RNAi-based P. citri control. RNAi effects were induced in P. citri, as demonstrated by specific target reductions of P. citri actin, chitin synthase 1 and V-ATPase mRNAs after injection of the corresponding specific double-stranded RNA inducers. We also used recombinant Tobacco mosaic virus (TMV) to express these RNAi effectors in Nicotiana benthamiana plants. We found that P. citri showed lower fecundity and pronounced death of crawlers after feeding on recombinant TMV-infected plants. Taken together, our data show that actin, chitin synthase 1 and V-ATPase mRNAs are potential targets for RNAi against P. citri, and that recombinant TMV is an effective tool for evaluating candidate RNAi effectors in plants.
doi:10.1371/journal.pone.0073657
PMCID: PMC3767618  PMID: 24040013
11.  Plastic surgical trauma: A single-centre experience 
Objectives:
To analyse the demographics, mechanism, nature, anatomical distribution, management and complications in trauma patients presenting to the plastic surgery unit.
Study Design:
Descriptive cross-sectional study.
Setting:
This study was conducted in the Plastic and Reconstructive Surgery Unit, Hayatabad Medical Complex, Peshawar, from 1st January 2009 to 30th April 2012.
Materials and Methods:
All trauma patients referred from emergency department and other departments irrespective of age and gender were enrolled in the study, excluding acute burns and trauma sequelae patients. The details were obtained from the data sheets of the patients. All the data were analysed and projected in the form of tables and figures.
Results:
A total of 1034 patients including 855 (82.7%) males and 179 (17.3%) females presented with plastic surgical trauma, with age ranging from 1 to 86 years, with a mean age of 20.84 ± 15.469 SD. The upper limb was affected in 492 (47.6%) patients, followed by head and neck in 273 (26.4%) cases. Road traffic accidents (RTAs) were the main cause of trauma, affecting 340 (32.9%) patients. Wound excision and closure was performed in 473 (45.7%) patients, followed by skin grafting and flap coverage in 232 (22.4%) and 132 (13.2%) patients, respectively. Postoperative complications were observed in 45 (4.35%) patients.
Conclusion:
Males in their young age mainly presented with plastic surgical trauma with RTA as the main mechanism and laceration as the most common type of these injuries. The upper limb was the most commonly affected region. The frequency of different types of surgical procedures and postoperative complications observed are comparable with international literature except for the microvascular surgery which is not performed in our centre. Regular audit of the plastic surgical trauma should be conducted in all plastic surgical units to both improve trauma care and reaffirm the role of Plastic Surgery in the new age trauma.
doi:10.4103/0970-0358.105970
PMCID: PMC3580356  PMID: 23450198
Plastic surgery; skin grafting; trauma
12.  Physico-mechanical and Stability Evaluation of Carbamazepine Cocrystal with Nicotinamide 
AAPS PharmSciTech  2011;12(2):693-704.
The focus of this investigation was to prepare the cocrystal of carbamazepine (CBZ) using nicotinamide as a coformer and to compare its preformulation properties and stability profile with CBZ. The cocrystal was prepared by solution cooling crystallization, solvent evaporation, and melting and cryomilling methods. They were characterized for solubility, intrinsic dissolution rate, chemical identification by Fourier transform infrared spectroscopy, crystallinity by differential scanning calorimetry, powder X-ray diffraction, and morphology by scanning electron microscopy. Additionally, mechanical properties were evaluated by tensile strength and Heckel analysis of compacts. The cocrystal and CBZ were stored at 40°C/94% RH, 40°C/75% RH, 25°C/60% RH, and 60°C to determine their stability behavior. The cocrystals were fluffy, with a needle-shaped crystal, and were less dense than CBZ. The solubility profiles of the cocrystals were similar to CBZ, but its intrinsic dissolution rate was lower due to the high tensile strength of its compacts. Unlike CBZ, the cocrystals were resistant to hydrate transformation, as revealed by the stability studies. Plastic deformation started at a higher compression pressure in the cocrystals than CBZ, as indicated by the high yield pressure. In conclusion, the preformulation profile of the cocrystals was similar to CBZ, except that it had an advantageous resistance to hydrate transformation.
doi:10.1208/s12249-011-9603-4
PMCID: PMC3134642  PMID: 21598082
carbamazepine; cocrystal; mechanical property; nicotinamide; stability
13.  Post-traumatic stress disorder and its predictors in emergency medical service personnel: a cross-sectional study from Karachi, Pakistan 
Background
Emergency medical service (EMS) personnel who work to provide emergency medical care at the scene and during transportation are exposed to various kinds of stressors and are particularly susceptible to developing stress-reactions. This study assesses symptoms of post-traumatic stress disorder and its predictors among the personnel of a selected EMS in Karachi, Pakistan.
Methods
Data were gathered from 518 personnel working in an EMS setting from February to May 2014. Participants were screened for post-traumatic stress symptoms using the Impact of Event Scale-Revised (IES-R). Demographic and work-related characteristics, coping styles and the social support systems of the participants were assessed. Linear regression was used on the IES-R to identify predictors of post-traumatic stress symptoms.
Results
The mean score of the IES-R was 23.9 ± 12.1. EMS personnel with a dysfunctional coping style (β = 0.67 CI 0.39 – 0.95), anxiety, and depression (β = 0.64 CI 0.52 – 0.75) were more likely to have increased severity of post-traumatic stress symptoms. Age was found to have an inverse relationship with stress symptoms (β = −0.17 CI 0.33 – -0.023), indicating the susceptibility of younger EMS personnel to stress.
Conclusion
The EMS personnel in this setting were found to have a moderate level of post-traumatic stress symptoms. The significant predictors of post-traumatic stress symptoms in this EMS population were age, coping style, and levels of anxiety and depression. These predicting factors can be a potential avenue for interventions to improve the mental health of these frontline workers.
doi:10.1186/s12873-017-0140-7
PMCID: PMC5575882  PMID: 28851280
Emergency medical service; Low- and middle-income country; Karachi; Pakistan; Post-traumatic stress disorder
14.  History based forward and feedback mechanism in cooperative spectrum sensing including malicious users in cognitive radio network 
PLoS ONE  2017;12(8):e0183387.
In cognitive radio communication, spectrum sensing plays a vital role in sensing the existence of the primary user (PU). The sensing performance is badly affected by fading and shadowing in case of single secondary user(SU). To overcome this issue, cooperative spectrum sensing (CSS) is proposed. Although the reliability of the system is improved with cooperation but existence of malicious user (MU) in the CSS deteriorates the performance. In this work, we consider the Kullback-Leibler (KL) divergence method for minimizing spectrum sensing data falsification (SSDF) attack. In the proposed CSS scheme, each SU reports the fusion center(FC) about the availability of PU and also keeps the same evidence in its local database. Based on the KL divergence value, if the FC acknowledges the user as normal, then the user will send unified energy information to the FC based on its current and previous sensed results. This method keeps the probability of detection high and energy optimum, thus providing an improvement in performance of the system. Simulation results show that the proposed KL divergence method has performed better than the existing equal gain combination (EGC), maximum gain combination (MGC) and simple KL divergence schemes in the presence of MUs.
doi:10.1371/journal.pone.0183387
PMCID: PMC5562327  PMID: 28820890
15.  Association Between Coronary Artery Disease and MicroRNA: Literature Review and Clinical Perspective 
Cureus  null;9(4):e1188.
Background
Until recently, circulating micro-RNAs (miRNAs) have attracted major interest as novel biomarkers for the early diagnosis of coronary artery disease (CAD). This review article summarizes the available evidence on the correlation of micro-RNAs with both the clinical and subclinical coronary artery disease and highlights the necessity for exploring miRNAs as a potential diagnostic and prognostic biomarker of early CAD in an adult population.
Methods
A systematic literature analysis and retrieval online systems Public/Publisher MEDLINE/ Excerpta Medica Database /Medical Literature Analysis and Retrieval System Online,(PUBMED/EMBASE/MEDLINE) search were conducted for relevant information. Search was limited to the articles published in English language and conducted on humans, January 2000 onwards. We excluded studies of heart surgery, coronary artery bypass grafting (CABG), angioplasty and heart transplant. Eighteen studies met the inclusion criteria.
Results
Seven out of 18 studies were multivariate, i.e. adjusted for age, gender, body mass index (BMI), smoking, hypertension, diabetes, and blood lipid profiles, while the remaining twelve studies were univariate analysis. Different sources of miRNAs were used, i.e. plasma/serum, microparticles, whole blood, platelets, blood mononuclear intimal and endothelial progenitor cells were investigated. Fourteen out of 18 studies showed up-regulation of different miRNA in CAD patients and in vulnerable plaque disease. Four out of 18 studies showed both the up-regulation and down-regulation of miRNA in the population, while only three studies showed down-regulation of miRNA. Various sources and types of miRNA were used in each study.
Conclusion
This review gives an extensive overview of up-regulation and down-regulation of miRNA in CAD and non-CAD patients. The pattern of miRNA regulation with respect to CAD/non-CAD study subjects varies across individual studies and different parameters, which could be the possible reason for this aberrancy. We suggest further trials be conducted in future for highlighting the role of miRNA in CAD, which may improve both the diagnostic and therapeutic approaches to stratifying CAD burden in the general population.
doi:10.7759/cureus.1188
PMCID: PMC5441689
mirna; coronary artery disease; association
16.  Risk based In Vitro Performance Assessment of Extended Release Abuse Deterrent Formulations 
High strength extended release opioid products, which are indispensable tools in the management of pain, are associated with serious risks of unintentional and potentially fatal overdose, as well as of misuse and abuse that might lead to addiction. The issue of drug abuse becomes increasingly prominent when the dosage forms can be readily manipulated to release a high amount of opioid or to extract the drug in certain products or solvents. One approach to deter opioid drug abuse is by providing novel abuse deterrent formulations (ADF), with properties that may be viewed as barriers to abuse of the product. However, unlike regular extended release formulations, assessment of ADF technologies are challenging, in part due to the great variety of formulation designs available to achieve deterrence of abuse by oral, parenteral, nasal and respiratory routes. With limited prior history or literature information, and lack of compendial standards, evaluation and regulatory approval of these novel drug products become increasingly difficult. The present article describes a risk-based standardized in-vitro approach that can be utilized in general evaluation of abuse deterrent features for all ADF products.
doi:10.1016/j.ijpharm.2016.01.031
PMCID: PMC4755808  PMID: 26784976
Abuse deterrent formulation; opioid analgesics; evaluation matrix; drug abuse; manipulation; mode of abuse; syringeability; injectability
17.  Pharmaceutical characterization of novel tenofovir liposomal formulations for enhanced oral drug delivery: in vitro pharmaceutics and Caco-2 permeability investigations 
Tenofovir, currently marketed as the prodrug tenofovir disoproxil fumarate, is used clinically to treat patients with HIV/AIDS. The oral bioavailability of tenofovir is relatively low, limiting its clinical effectiveness. Encapsulation of tenofovir within modified long-circulating liposomes would deliver this hydrophilic anti-HIV drug to the reticuloendothelial system for better therapeutic efficacy. The objectives of the current study were to prepare and pharmaceutically characterize model liposomal tenofovir formulations in an attempt to improve their bioavailability. The entrapment process was performed using film hydration method, and the formulations were characterized in terms of encapsulation efficiency and Caco-2 permeability. An efficient reverse-phase high-performance liquid chromatography method was developed and validated for tenofovir quantitation in both in vitro liposomal formulations and Caco-2 permeability samples. Separation was achieved isocratically on a Waters Symmetry C8 column using 10 mM Na2PO4/acetonitrile pH 7.4 (95:5 v/v). The flow rate was 1 mL/min with a 12 min elution time. Injection volume was 10 µL with ultraviolet detection at 270 nm. The method was validated according to United States Pharmacopeial Convention category I requirements. The obtained result showed that tenofovir encapsulation within the prepared liposomes was dependent on the employed amount of the positive charge-imparting agent. The obtained results indicated that calibration curves were linear with r2 > 0.9995 over the analytical range of 1–10 µg/mL. Inter- and intraday accuracy and precision values ranged from 95% to 101% and 0.3% to 2.6%, respectively. The method was determined to be specific and robust. Regarding the potential of the prepared vectors to potentiate tenofovir permeability through the Caco-2 model, a 10-fold increase in tenofovir apparent permeability was observed compared to its oral solution. In conclusion, this novel and validated method was successfully applied to characterize both in vitro encapsulation efficiency and Caco-2 permeability transport for the pharmaceutical assessment of novel tenofovir formulations.
doi:10.2147/CPAA.S119875
PMCID: PMC5327912
liposomes; tenofovir; targeting; chromatography; entrapment; permeation
18.  The efficacy of varenicline in achieving abstinence among waterpipe tobacco smokers – study protocol for a randomized controlled trial 
Trials  2017;18:14.
Background
Waterpipe tobacco smoking has increased among youth across the globe including in the US, and it continues as a common and traditional form of smoking tobacco in Pakistan. A range of behavioral and pharmacological therapies are available to support people in quitting cigarette smoking; however, little evidence exists for the efficacy of these therapies in achieving abstinence among waterpipe tobacco smokers. The objective of this study is to assess the efficacy of varenicline when added to behavioral support for waterpipe tobacco smoking cessation, by measuring biochemically validated continuous abstinence in waterpipe tobacco smokers.
Methods/design
This is a two-arm, double-blind, placebo-controlled randomized trial conducted in four districts in Punjab, Pakistan. Study participants include adults using a waterpipe (with or without concomitant cigarette, bidi or other forms of tobacco smoking) on a daily basis for at least 6 months and who are willing to quit. We will individually randomize 510 participants to one of the two arms of the trial. Participants in the intervention arm will receive varenicline and behavioral support and those in the control arm will receive placebo and behavioral support. The primary outcome will be continuous abstinence for at least 6 months (week 25) which is biochemically verified by a carbon monoxide level of <10 ppm. Secondary outcomes will include biochemically verified 7-day point abstinence at 5, 12 and 25 weeks and any lapses and relapses between the different assessment points. Tertiary outcomes will include assessment of withdrawal symptoms using the Mood and Physical Symptoms Scale (MPSS), smoking dependency using the Lebanon Waterpipe Dependency Scale (LWDS-11) and monitoring adverse outcomes.
Discussion
This is an efficacy trial and would require a subsequent effectiveness trial for a definitive evaluation of the intervention.
Trial registration
ISRCTN, ISRCTN94103375. Registered on 1 December 2015.
Electronic supplementary material
The online version of this article (doi:10.1186/s13063-016-1761-y) contains supplementary material, which is available to authorized users.
doi:10.1186/s13063-016-1761-y
PMCID: PMC5225555  PMID: 28077163
Waterpipe; Tobacco; Smoking; Hookah; Shisha; Pharmacotherapy; Varenicline; Cessation; Abstinence; Behavioral support
19.  Novel derivative of aminobenzenesulfonamide (3c) induces apoptosis in colorectal cancer cells through ROS generation and inhibits cell migration 
BMC Cancer  2017;17:4.
Background
Colorectal cancer (CRC) is the 3rd most common type of cancer worldwide. New anti-cancer agents are needed for treating late stage colorectal cancer as most of the deaths occur due to cancer metastasis. A recently developed compound, 3c has shown to have potent antitumor effect; however the mechanism underlying the antitumor effect remains unknown.
Methods
3c-induced inhibition of proliferation was measured in the absence and presence NAC using MTT in HT-29 and SW620 cells and xCELLigence RTCA DP instrument. 3c-induced apoptotic studies were performed using flow cytometry. 3c-induced redox alterations were measured by ROS production using fluorescence plate reader and flow cytometry and mitochondrial membrane potential by flow cytometry; NADPH and GSH levels were determined by colorimetric assays. Bcl2 family protein expression and cytochrome c release and PARP activation was done by western blotting. Caspase activation was measured by ELISA. Cell migration assay was done using the real time xCELLigence RTCA DP system in SW620 cells and wound healing assay in HT-29.
Results
Many anticancer therapeutics exert their effects by inducing reactive oxygen species (ROS). In this study, we demonstrate that 3c-induced inhibition of cell proliferation is reversed by the antioxidant, N-acetylcysteine, suggesting that 3c acts via increased production of ROS in HT-29 cells. This was confirmed by the direct measurement of ROS in 3c-treated colorectal cancer cells. Additionally, treatment with 3c resulted in decreased NADPH and glutathione levels in HT-29 cells. Further, investigation of the apoptotic pathway showed increased release of cytochrome c resulting in the activation of caspase-9, which in turn activated caspase-3 and −6. 3c also (i) increased p53 and Bax expression, (ii) decreased Bcl2 and BclxL expression and (iii) induced PARP cleavage in human colorectal cancer cells. Confirming our observations, NAC significantly inhibited induction of apoptosis, ROS production, cytochrome c release and PARP cleavage. The results further demonstrate that 3c inhibits cell migration by modulating EMT markers and inhibiting TGFβ-induced phosphorylation of Smad2 and Samd3.
Conclusions
Our findings thus demonstrate that 3c disrupts redox balance in colorectal cancer cells and support the notion that this agent may be effective for the treatment of colorectal cancer.
Electronic supplementary material
The online version of this article (doi:10.1186/s12885-016-3005-7) contains supplementary material, which is available to authorized users.
doi:10.1186/s12885-016-3005-7
PMCID: PMC5210304  PMID: 28049506
Colorectal cancer; ROS; NAC; Apoptosis; Cell migration
20.  Significance Of Pirani Score at Bracing-Implications for Recognizing A Corrected Clubfoot 
The Iowa Orthopaedic Journal  2017;37:151-156.
Abstract
Background:
The aim of clubfoot treatment by Ponseti method is to achieve a corrected foot, with at least 15° dorsiflexion and 70° abduction, and fit comfortably into a brace at the recommended setting. This study aimed to acknowledge the validity and reliability of the Pirani scoring system, while investigating if a corrected clubfoot has a Pirani score of zero. The study hypothesized that a corrected clubfoot may or may not have a Pirani score of zero.
Methods:
706 patients with clubfoot were treated by Ponseti’s method of weekly manipulations and casting, from November 2011 to May 2016, at a tertiary care hospital, making a total of 1055 feet. All data was entered into the International Clubfoot Network Database, along with Pirani scoring. Tenotomy was performed in eligible patients.
Results:
The mean Pirani score at the end of treatment phase of casting and initiation of the maintenance phase of bracing for the right foot was 1.1 (SD=0.55) and left foot was 1.2 (SD=0.58). These feet not only fit the criteria of a corrected clubfoot, 70° abduction and 15° dorsiflexion, but also fit well in a foot abduction brace.
Of the 1055 diagnosed Clubfeet, 643 required tenotomy (60.9%).
Conclusion:
The study shows that the affected foot does not need to have a Pirani score of zero to be considered a corrected foot. Pirani score is an excellent tool used over the years to evaluate clubfoot. Pirani score does not assess adequately the transition from the treatment phase of casting to the maintenance phase of bracing. The use of the International Clubfoot Database-Treatment visit form, including all components of clubfoot and the Pirani score, provides a clear understanding of whether the patient has achieved foot correction or not.
Level of Evidence: Level IV
PMCID: PMC5508266
clubfoot; pirani score; ponseti method; dorsiflexion; abduction
21.  Bilateral Moyamoya Disease in a 2-Year-Old Pakistani Male Treated with Bilateral Encephaloduroarteriosynangiosis: A Positive Outcome 
Background. We present a rare case of bilateral moyamoya disease presenting as multiple strokes and neurological deficits, treated with the neurosurgical procedure, encephaloduroarteriosynangiosis (EDAS), in a 2-year-old male Pakistani minor. A positive outcome was achieved and the patient recovered fully. Case Summary. Our patient presented with a history of seizures and multiple episodes of hemiparesis (on and off weakness) at the age of 2 years. He had a delayed speech development and could not speak more than a few words. He had a slight slurring of speech too. He was diagnosed with bilateral moyamoya disease on Computed Tomography Angiography (CTA). Bilateral EDAS was done in the same year, after which his symptoms improved and patient had moderate functional recovery. Conclusion. A rare disease, moyamoya has been left unexplored in Pakistan; physicians and surgeons when dealing with cases in the pediatric population presenting with symptoms of stroke, signs of generalized weakness, and seizures should consider moyamoya disease as a possibility. Furthermore, this case demonstrates the effectiveness of EDAS procedure for the treatment of moyamoya disease.
doi:10.1155/2016/1467582
PMCID: PMC5215642  PMID: 28101388
22.  Spontaneous subcutaneous emphysema of the scalp following hair coloring/treatment 
Radiology Case Reports  2016;12(1):78-80.
Subcutaneous emphysema of the scalp is a process often attributed to secondary factors such as trauma, infection, or a myriad of iatrogenic etiologies. Here, we are presenting a case report of an adult patient with spontaneous subcutaneous emphysema of the scalp following a hair coloring/treatment. We performed an extensive review of literature on this topic, however, could not find a single case with similar presentation of subcutaneous emphysema. This case demonstrates an unreported etiology for this diagnosis and is thus being reported for its uniqueness and to raise clinical awareness.
doi:10.1016/j.radcr.2016.11.007
PMCID: PMC5310390
Subcutaneous emphysema; hair coloring; hair treatment
23.  Measurement of endotracheal tube cuff pressure: Instrumental versus conventional method 
Saudi Journal of Anaesthesia  2016;10(4):428-431.
Objective:
To evaluate the conventional practice of endotracheal tube (ETT) cuff inflation and pressure measurement as compared to the instrumental method.
Study Design:
Prospective observational study.
Place and Duration of Study:
Department of Anaesthesia, King Saud University Hospital, Riyadh, Saudi Arabia (June 2014–July 2014).
Methods:
A total of 100 adult patients were observed according to the syringe size used Group-1 (10 ml) and Group-2 (20 ml) for ETT cuff inflation in general anesthesia. Patients with anticipated difficult intubation, risk for aspiration, known anatomical laryngotracheal abnormalities, and emergency cases were excluded. Trachea was intubated with size 8 or 8.5 mm and 7.0 or 7.5 mm ETT in male and female patients respectively. The ETT cuff was inflated with air by one of the anesthesia technician. Cuff pressures were measured using aneroid manometer. ETT cuff pressure of 20–30 cm of water was considered as standard.
Results:
In 69% of the patients, the cuff pressure measurements were above the standard. Age (P = 0.806), weight (P = 0.527), height (P = 0.850), and gender (P = 1.00) were comparable in both groups. The mean cuff pressure in Group-1 and Group-2 was 32.52 ± 6.39 and 38.90 ± 6.60 cm of water (P = 0.001). The cuff inflation with 20 ml syringe resulted in higher cuff pressure as compared to 10cc syringe 37.73 ± 4.23 versus 40.74 ± 5.01 (86% vs. 52%, P = 0.013).
Conclusion:
The conventional method for ETT cuff inflation and pressure measuring is unreliable. As a routine instrumental cuff pressure, monitoring is suggested.
doi:10.4103/1658-354X.179113
PMCID: PMC5044728  PMID: 27833487
Cuff pressure; endotracheal tube; measurement
24.  Anesthetic management of patient with hemophilia a undergoing emergency ventriculoperitoneal shunting: A case report and review of literature 
Saudi Journal of Anaesthesia  2016;10(4):474-476.
Hemophilia A is a hemorrhagic trend almost exclusively affecting males (X-related recessive disease). In 85% of cases, it is caused by factor VIII deficiency, called hemophilia A or classic hemophilia. Successful anesthetic management depends on the special care and a multidisciplinary team of health professionals informed about the disease, including qualified hematologist, surgeon, and anesthesiologist.
doi:10.4103/1658-354X.179120
PMCID: PMC5044742  PMID: 27833501
Anesthesia; hemophilia; ventriculoperitoneal shunt
25.  Conjunctival Leiomyoma; a Rare Tumor of the Ocular Surface 
Purpose:
To report a case of conjuctival leiomyoma.
Case Report:
An 18-year-old female patient presented with a conjunctival growth in the left eye for a 2-year-period with no change in size. She merely presented for cosmetic reasons. Visual acuity was 20/20 in each eye. The lesion had prominent vessels and was not adherent to the sclera. The growth resembled a benign lesion of the conjunctiva. The tough and vascular tissue was excised and sent for histopathology. The defect was covered by an end to end conjunctival suturing. Histopathology showed the lesion to be conjunctival leiomyoma. Trichome was used to highlight the spindle shaped cells and immuno-histochemistry using anti-smooth muscle actin antibody and Vimentin was applied to confirm the diagnosis.
Conclusion:
This case adds to the total number of cases of conjuctival leiomyoma reported in the literature to date. An ophthalmologist needs to think beyond a common mass when encountering a conjunctival growth extending onto the cornea.
doi:10.4103/2008-322X.194142
PMCID: PMC5139556  PMID: 27994813
Benign; Conjuctival; Leiomyoma; Pterygium

Results 1-25 (93)