Journal of Bronchology & Interventional Pulmonology, 2022
Background: During diagnostic bronchoscopies, conscious sedation improves patient tolerance, but ... more Background: During diagnostic bronchoscopies, conscious sedation improves patient tolerance, but it can contribute to hypercapnia and hypoxia by various mechanisms including depression of ventilatory drive. This prospective study was undertaken to determine the frequency of respiratory events and associated oxygen desaturations during bronchoscopy with conscious sedation. Patients and Methods: The Nox-T3 monitoring system was placed before starting the bronchoscopy and remained in place for 30 minutes following the procedure. The primary endpoint was the occurrence of obstructive and central apneic events during bronchoscopy under conscious sedation. Results: Obstructive events (apnea and hypopnea) occurred in 100% of patients (n=31), and central apneas occurred in 58% of patients (n=18) during the procedure with a median of 9 and 2 events per patient, respectively. During recovery, a significant proportion of patients had detectable obstructive (86%) and central (36%) events. Highe...
In this study we used dried leaf powders of five plants i.e., Syzygium cumini, Citrus limon, Momo... more In this study we used dried leaf powders of five plants i.e., Syzygium cumini, Citrus limon, Momordica charantia, Eucalyptus globulus and Piper nigrum against Callosobruchus chinensis infesting chickpea seeds during storage. Free choice and no choice tests were conducted. Plant powders were applied at dose of 2% (w/w). Efficacy of all plant powders were compared by orientation, oviposition, adult mortality and adult emergence of the pulse beetle. Effect of plant powder on germination of seed was also observed by germination test. Leaf powder of M. charantia was found to be more effective while leaf powder of S. cumini was found to be least effective in adult mortality and oviposition deterrence. Furthermore, the results showed that leaf powders of all plants had no effects on germination of seeds.
Background and objectives In surgical patients, coronary disease is the main cause of perioperati... more Background and objectives In surgical patients, coronary disease is the main cause of perioperative mortality. The incidence of serious cardiovascular complications is reported as 5% with a probability of 1-2% of death from the cardiac cause in major non-cardiac surgery. B-type natriuretic peptide (BNP) is a sensitive and specific predictor of left ventricular systolic dysfunction and predicts first cardiovascular event and death in the general population. The recent guidelines recommended the use of pro-BNP for independent perioperative prognosis in cardiac patients undergoing non-cardiac surgery. The aim of this study is to assess the predictive value of raised pro-BNP levels in patients who underwent major abdominal surgery and evaluate its relationship with cardiovascular complications and mortality occurring up to 30 days after surgery.
Background and objectives The frequency of COVID-19-positive or suspicious patients grew steadily... more Background and objectives The frequency of COVID-19-positive or suspicious patients grew steadily, and these patients were received in emergency and outpatient departments at an unprecedented pace for the need of an elective or emergent surgical assessment. We conducted this survey to document the number of surgeries performed on COVID-19-positive patients during the ongoing pandemic at a tertiary care center in Pakistan. Materials and methods A retrospective clinical audit was conducted in a tertiary care hospital that receives surgical cases from almost all over the country. Ethical approval was granted prior to the execution of this intra-departmental audit. Both patients who were admitted to general surgery and visited on a consultative basis in other departments during the year 2020 were evaluated, and only those having COVID-19 polymerase chain reaction (PCR)-positive were included. Those with PCR-negative were omitted from the analysis. All the surgical procedures performed i...
Rationale & Objective Acute kidney injury treated with kidney replacement therapy (AKI-KRT) o... more Rationale & Objective Acute kidney injury treated with kidney replacement therapy (AKI-KRT) occurs frequently in critically ill patients with COVID-19. We examined the clinical factors that determine kidney recovery in this population. Study Design Multicenter cohort study. Setting & Participants 4221 adults with COVID-19 not receiving kidney replacement therapy who were admitted to intensive care units at 68 US hospitals with COVID-19 from March 1 to June 22, 2020 (the “ICU cohort”). Among these, 876 developed AKI-KRT after admission to the ICU (the “AKI-KRT subcohort”). Exposure(s) The ICU cohort was analyzed using AKI severity as the exposure. For the AKI-KRT subcohort, exposures included demographics, comorbidities, initial mode of KRT, and markers of illness severity at the time of dialysis initiation. Outcome(s) The outcome for the ICU cohort was estimated glomerular filtration rate (GFR) at hospital discharge. A three-level outcome including death, kidney nonrecovery, and kidney recovery at discharge, was analyzed for the AKI-KRT subcohort. Analytical approach The ICU cohort was characterized using descriptive analyses. The AKI-KRT subcohort was characterized with both descriptive analyses and multinomial logistic regression to assess factors associated with kidney nonrecovery while accounting for death. Results Among a total of 4221 patients in the ICU cohort, 2361 (56%) developed AKI, including 876 (21%) who received KRT. More severe AKI was associated with higher mortality. Among survivors, more severe AKI was associated with an increased rate of kidney nonrecovery and lower kidney function at discharge. Among the 876 patients with AKI-KRT, 588 (67%) died, 95 (11%) had kidney nonrecovery, and 193 (22%) had kidney recovery by the time of discharge. The odds of kidney nonrecovery was greater for lower estimated GFR with odds ratios (ORs) of 2.09 (95% CI, 1.09-4.04), 4.27 (95% CI, 1.99-9.17), and 8.69 (95% CI, 3.07-24.55) for CKD GFR categories 3, 4, and 5, respectively, compared to estimated GFR > 60 mL/min/1.73 m2. Oliguria at the time of KRT initiation was also associated with nonrecovery (OR 2.10 [95% CI, 1.14-3.88] and 4.02 [95% CI, 1.72-9.39] for patients with 50-499 and <50 mL urine/day respectively, compared to ≥500 mL urine/day). Limitations Later recovery events may not have been captured due to lack of post-discharge follow-up. Conclusions Lower baseline eGFR and reduced urine output at the time of KRT initiation are each strongly and independently associated with kidney nonrecovery among critically ill patients with COVID-19.
Objective: To determine if granulocyte colony-stimulating factor (G-CSF) withempirical antibiotic... more Objective: To determine if granulocyte colony-stimulating factor (G-CSF) withempirical antibiotics therapy accelerates febrile neutropenia resolution compared with antibioticswithout it. Study design: Experimental study. Place and Duration of Study: Study wasconducted for a period of one year from march 2012 to february 2013 in oncology/haematologydepartment Children Hospital Lahore (PAKISTAN). Subject and Methods: A total of 56 childrenwith febrile neutropenia due to chemotherapy were included in the study. Two groups were madeA and B. Twenty eight patients were included in each group. Patients included in the group Awere given granulocyte colony stimulating factor with the dose of 5 microg/kg/day for five daysand the patients included in group B were not given granulocyte colony stimulating factor.Subcutaneous administration was recommended. Patients remained on study until absoluteneutrophil count (ANC) >500/microl and > or =48 hr without fever. Every child in both groupswa...
Pakistan Journal of Medical and Health Sciences, 2021
Aim: To detect the clinical presentation, biopsy and surgery of breast cancer in women at tertiar... more Aim: To detect the clinical presentation, biopsy and surgery of breast cancer in women at tertiary care hospital in Gujrat, Pakistan. Study design: Cross sectional descriptive study. Place and duration of study: This study was conducted in 06 years April 2014 to March 2020 at Aziz Bhatti Shaheed Teaching Hospital Gujrat, Pakistan. Methods: Total 138 women were selected for study that was having breast lump, breast ulcer or abnormal breast (nipple) discharge. Women were admitted for investigations and further plan for treatment. Breast cancer was diagnosed on history, examination and investigations. Complete blood count, serum studies, ultra-sonography of breast, mammography and breast biopsy was planned. Results: Total 138 women were enrolled in the study. Women 25-85 years of age were included in the study. Youngest woman was 27 years of age and the oldest was 85 years of age. Thirty two (23.18%) women were less than 50 years of age and 106(76.81%) women were more than 50 years of ...
BACKGROUND: Long-term oxygen therapy (LTOT) delivered continuously is known to decrease mortality... more BACKGROUND: Long-term oxygen therapy (LTOT) delivered continuously is known to decrease mortality in patients with COPD and who are hypoxemic; however, supportive data for LTOT use in patients without COPD is lacking. In addition, many patients may be prescribed LTOT without a definitive etiology for hypoxemia. First, we investigated the diagnoses for which oxygen was prescribed to a sample of veterans and whether each diagnosis was supported by confirmatory testing. Second, we looked at the proportion of subjects who were prescribed non-continuous therapy. METHODS: We retrospectively studied subjects prescribed domiciliary oxygen at the Veterans Administration Western New York Healthcare System. The subjects who met inclusion criteria were identified by using a computerized patient record system; data were collected on subject characteristics, oxygen prescription information, diagnosis for hypoxia, and diagnostic workup. Descriptive data were presented as mean 6 SD and median (range). Statistical analysis was performed by using the chi-square test and an unpaired t test. RESULTS: A total of 494 patients were included: 96.8% men, mean 6 SD ages 74.2 6 10.8 y. Most of the subjects were prescribed oxygen as outpatients (68.5%). A total of 335 (67.8%) were prescribed oxygen for continuous therapy, 72 (14.1%) for nocturnal therapy, 50 (10.1%) for exertion, and 30 (6.1%) for both exertion and nocturnal use. At 3 months, 19.6% of the initial cohort had oxygen discontinued. In those subjects with oxygen continued at 3 months, COPD was the most common diagnosis (63.6%), of which 76.1% had pulmonary function tests (PFTs), with 85.7% showing obstruction on spirometry. CONCLUSIONS: Results of our study showed a 99.4% adherence to Medicare criteria for domiciliary oxygen prescription. Also, 30.3% of the subjects were prescribed LTOT for exertional or nocturnal desaturation or both. Repeated testing at 3 months identified subjects who no longer required oxygen. COPD was the most common etiology for domiciliary oxygen. A small proportion of the subjects (6.9%) were prescribed oxygen without underlying etiology for hypoxia. Exertional and/or nocturnal oxygen prescription was common, and further research to elucidate its utility is clearly warranted.
Many shreds of evidence found on the crime scenes contain a trace amount of DNA which results in ... more Many shreds of evidence found on the crime scenes contain a trace amount of DNA which results in insignificant profiling results for subsequent comparison. This can nullify the potential evidence material and hamper investigation process. Over the years, different strategies have been employed by various DNA testing laboratories to create interpretable DNA profiles generated from low template of DNA. This review highlights different strategies used by forensic laboratories worldwide for creating complete DNA profiles from low copy number template for comparison purposes along with its associated risks for forensic purposes
Mixed matrix membranes (MMMs) fabricated with porous metal organic frame works have enhanced the ... more Mixed matrix membranes (MMMs) fabricated with porous metal organic frame works have enhanced the separation performance of polymer membranes. In this context microporous 3D Tb(BTC)(H 2 O).(DMF) 1.1 MOF was incorporated into pristine MatrimidÒ with loadings of 10, 20 and 30 weight percentages. SEM micrographs indicated proper distribution of filler in the Matrimid and no interfacial voids were observed. Gas permeation studies evidenced the CO 2 permeability to be 13.2 (82.32%) and 18.34 (153.31%) and 25.86 Barrer for 10, 20 and 30 wt% MMMs respectively. The 257.18% increase in CO 2 permeability of 30 wt% MMM than methane was attributed to polar nature of CO 2 , its smaller kinetic diameter, condensability, and larger solubility within the Matrimid matrix than non-polar and larger CH 4 molecules. Addition of filler influenced the pure gas selectivity of all MMMs positively. So, 30 wt% MMM exhibited the highest 58.04% increase in selectivity that was attributed to the molecular sieving property of the filler and the size exclusion phenomena as followed by CH 4 and CO 2. The high values of mixed and pure gas selectivity were obtained upon increasing filler concentration. The commercial applicability of these MMMs was tested by checking their selectivity under increased feed concentrations of CO 2 and checking permeability and selectivities at high temperatures. The study depicted that, competitive sorption of gases, prevalence of size exclusion phenomena and polymer
With the increasing number of people suffering from coronavirus disease 2019 (COVID-19), caused b... more With the increasing number of people suffering from coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), there is a dire need to look for effective remedies against this pandemic. Drug repurposing seems to be the solution for the current situation. Methods: In a quest to find a potential drug against this virus, 15 antimalarial drugs (including chloroquine) and 2413 US Food and Drug Administration-approved drugs were investigated for activity against both the protease and spike proteins of SARS-CoV-2 using an in silico approach. Molecular docking analysis followed by molecular dynamics simulation was performed to estimate the binding and stability of the complexes. Results: This study identified a single drugparomomycinwith activity against two targets of SARS-CoV-2, i.e., spike protein (S1) and protease domain. Paromomycin was found to have strong binding affinity for both targets of coronavirus. The results also showed that no antimalarial drug exhibited effective binding for either S1 or protease. Conclusions: This study found that paromomycin may be an effective dual targeting drug against coronavirus, as it binds not only to the protease domain of the virion, but also to the spike domain, with high stability. Furthermore, none of the antimalarial drugs showed strong binding affinity for either protease or the receptor binding domain (RBD).
American Journal of Respiratory and Critical Care Medicine, 2020
A 34-year-old man was referred to an interventional pulmonary clinic for evaluation of incidental... more A 34-year-old man was referred to an interventional pulmonary clinic for evaluation of incidentally found pleural opacities on a screening full-body computed tomographic scan performed at an international facility. He was asymptomatic and denied tobacco use, and his lungs were clear on examination. The computed tomographic scan showed lesions at or near the pleura at the level of the thoracic spine, and they were described as possible loculated pleural effusions (Figure 1A). After discussing the case at a multidisciplinary radiology conference, we obtained a magnetic resonance imaging scan, which showed perineural sleeve cysts at the level of the seventh and eighth thoracic vertebrae (Figure 1B). Perineural or Tarlov cysts are type II meningeal cysts, which were first described in 1938 by Dr. Tarlov (1). They are a cerebrospinal fluid-filled abnormal expansion of spinal nerve roots. They are most commonly found in the lumbosacral spine with a prevalence of 1.5-4.6%, with 20% of them being symptomatic (2, 3). It is unclear why they form or persist; however, various mechanisms have been described. These mechanisms include deposition of hemosiderin after trauma leading to blockage of venous drainage of perineurium and epineurium with subsequent cyst formation, persistence of embryonic fissures forming congenital diverticula, or proliferation of the arachnoid membrane along the exiting nerve roots causing formation of perineural cysts (4, 5). In addition, it is also suggested that a ball-valve mechanism allows cerebrospinal fluid to enter the cyst but prevents it from exiting (6). Thoracic Tarlov cysts are very uncommon and can be mistaken for nerve root sheath tumors on imaging. A majority of them are clinically insignificant because they are asymptomatic. However, they can compress nerve roots, causing thoracic radiculopathy, including extremity pain, decreased sensation, or weakness. When symptomatic, surgical intervention, including cyst drainage, clipping, or resection, can be curative; however, recurrence is possible (7). Furthermore, invasive spinal or pleural procedures in the presence of Tarlov cysts should be performed with extreme caution to avoid dural puncture and subsequent complications (8). To date, this patient remains asymptomatic and does not need any additional treatment. n Author disclosures are available with the text of this article at www.atsjournals.org.
Crime scene investigation is an important tool in criminal investigation process. Proper processi... more Crime scene investigation is an important tool in criminal investigation process. Proper processing of crime scene is a prerequisite for successfully solving a criminal case. In Pakistan, local policemen are not properly trained and equipped with the necessary items required for systematic processing of crime scene including proper identification and collection of evidence. Certain capacity building measures and improvements must be needed for proper processing of crime scene in Pakistan. This article focuses the current situation and strategies being practiced in Pakistan followed by suggestions for capacity building measures in this field.
Clinical practice and cases in emergency medicine, 2018
We describe an unusual ruptured ectopic pregnancy. The unique features of the case include abdomi... more We describe an unusual ruptured ectopic pregnancy. The unique features of the case include abdominal pain without vaginal bleeding; cervical implantation and a placenta accreta; and the late presentation at 16 weeks of gestation without prior symptoms. Both the initial point-of-care ultrasound and the formal ultrasound were interpreted as showing an intrauterine pregnancy. The clinical presentation was misleading; the correct diagnosis was made by magnetic resonance imaging. We show the ultrasonic images. We discuss cervical ectopic pregnancies, their diagnosis and management. The woman survived but required emergency hysterectomy and many units of blood.
Journal of Bronchology & Interventional Pulmonology, 2022
Background: During diagnostic bronchoscopies, conscious sedation improves patient tolerance, but ... more Background: During diagnostic bronchoscopies, conscious sedation improves patient tolerance, but it can contribute to hypercapnia and hypoxia by various mechanisms including depression of ventilatory drive. This prospective study was undertaken to determine the frequency of respiratory events and associated oxygen desaturations during bronchoscopy with conscious sedation. Patients and Methods: The Nox-T3 monitoring system was placed before starting the bronchoscopy and remained in place for 30 minutes following the procedure. The primary endpoint was the occurrence of obstructive and central apneic events during bronchoscopy under conscious sedation. Results: Obstructive events (apnea and hypopnea) occurred in 100% of patients (n=31), and central apneas occurred in 58% of patients (n=18) during the procedure with a median of 9 and 2 events per patient, respectively. During recovery, a significant proportion of patients had detectable obstructive (86%) and central (36%) events. Highe...
In this study we used dried leaf powders of five plants i.e., Syzygium cumini, Citrus limon, Momo... more In this study we used dried leaf powders of five plants i.e., Syzygium cumini, Citrus limon, Momordica charantia, Eucalyptus globulus and Piper nigrum against Callosobruchus chinensis infesting chickpea seeds during storage. Free choice and no choice tests were conducted. Plant powders were applied at dose of 2% (w/w). Efficacy of all plant powders were compared by orientation, oviposition, adult mortality and adult emergence of the pulse beetle. Effect of plant powder on germination of seed was also observed by germination test. Leaf powder of M. charantia was found to be more effective while leaf powder of S. cumini was found to be least effective in adult mortality and oviposition deterrence. Furthermore, the results showed that leaf powders of all plants had no effects on germination of seeds.
Background and objectives In surgical patients, coronary disease is the main cause of perioperati... more Background and objectives In surgical patients, coronary disease is the main cause of perioperative mortality. The incidence of serious cardiovascular complications is reported as 5% with a probability of 1-2% of death from the cardiac cause in major non-cardiac surgery. B-type natriuretic peptide (BNP) is a sensitive and specific predictor of left ventricular systolic dysfunction and predicts first cardiovascular event and death in the general population. The recent guidelines recommended the use of pro-BNP for independent perioperative prognosis in cardiac patients undergoing non-cardiac surgery. The aim of this study is to assess the predictive value of raised pro-BNP levels in patients who underwent major abdominal surgery and evaluate its relationship with cardiovascular complications and mortality occurring up to 30 days after surgery.
Background and objectives The frequency of COVID-19-positive or suspicious patients grew steadily... more Background and objectives The frequency of COVID-19-positive or suspicious patients grew steadily, and these patients were received in emergency and outpatient departments at an unprecedented pace for the need of an elective or emergent surgical assessment. We conducted this survey to document the number of surgeries performed on COVID-19-positive patients during the ongoing pandemic at a tertiary care center in Pakistan. Materials and methods A retrospective clinical audit was conducted in a tertiary care hospital that receives surgical cases from almost all over the country. Ethical approval was granted prior to the execution of this intra-departmental audit. Both patients who were admitted to general surgery and visited on a consultative basis in other departments during the year 2020 were evaluated, and only those having COVID-19 polymerase chain reaction (PCR)-positive were included. Those with PCR-negative were omitted from the analysis. All the surgical procedures performed i...
Rationale & Objective Acute kidney injury treated with kidney replacement therapy (AKI-KRT) o... more Rationale & Objective Acute kidney injury treated with kidney replacement therapy (AKI-KRT) occurs frequently in critically ill patients with COVID-19. We examined the clinical factors that determine kidney recovery in this population. Study Design Multicenter cohort study. Setting & Participants 4221 adults with COVID-19 not receiving kidney replacement therapy who were admitted to intensive care units at 68 US hospitals with COVID-19 from March 1 to June 22, 2020 (the “ICU cohort”). Among these, 876 developed AKI-KRT after admission to the ICU (the “AKI-KRT subcohort”). Exposure(s) The ICU cohort was analyzed using AKI severity as the exposure. For the AKI-KRT subcohort, exposures included demographics, comorbidities, initial mode of KRT, and markers of illness severity at the time of dialysis initiation. Outcome(s) The outcome for the ICU cohort was estimated glomerular filtration rate (GFR) at hospital discharge. A three-level outcome including death, kidney nonrecovery, and kidney recovery at discharge, was analyzed for the AKI-KRT subcohort. Analytical approach The ICU cohort was characterized using descriptive analyses. The AKI-KRT subcohort was characterized with both descriptive analyses and multinomial logistic regression to assess factors associated with kidney nonrecovery while accounting for death. Results Among a total of 4221 patients in the ICU cohort, 2361 (56%) developed AKI, including 876 (21%) who received KRT. More severe AKI was associated with higher mortality. Among survivors, more severe AKI was associated with an increased rate of kidney nonrecovery and lower kidney function at discharge. Among the 876 patients with AKI-KRT, 588 (67%) died, 95 (11%) had kidney nonrecovery, and 193 (22%) had kidney recovery by the time of discharge. The odds of kidney nonrecovery was greater for lower estimated GFR with odds ratios (ORs) of 2.09 (95% CI, 1.09-4.04), 4.27 (95% CI, 1.99-9.17), and 8.69 (95% CI, 3.07-24.55) for CKD GFR categories 3, 4, and 5, respectively, compared to estimated GFR > 60 mL/min/1.73 m2. Oliguria at the time of KRT initiation was also associated with nonrecovery (OR 2.10 [95% CI, 1.14-3.88] and 4.02 [95% CI, 1.72-9.39] for patients with 50-499 and <50 mL urine/day respectively, compared to ≥500 mL urine/day). Limitations Later recovery events may not have been captured due to lack of post-discharge follow-up. Conclusions Lower baseline eGFR and reduced urine output at the time of KRT initiation are each strongly and independently associated with kidney nonrecovery among critically ill patients with COVID-19.
Objective: To determine if granulocyte colony-stimulating factor (G-CSF) withempirical antibiotic... more Objective: To determine if granulocyte colony-stimulating factor (G-CSF) withempirical antibiotics therapy accelerates febrile neutropenia resolution compared with antibioticswithout it. Study design: Experimental study. Place and Duration of Study: Study wasconducted for a period of one year from march 2012 to february 2013 in oncology/haematologydepartment Children Hospital Lahore (PAKISTAN). Subject and Methods: A total of 56 childrenwith febrile neutropenia due to chemotherapy were included in the study. Two groups were madeA and B. Twenty eight patients were included in each group. Patients included in the group Awere given granulocyte colony stimulating factor with the dose of 5 microg/kg/day for five daysand the patients included in group B were not given granulocyte colony stimulating factor.Subcutaneous administration was recommended. Patients remained on study until absoluteneutrophil count (ANC) >500/microl and > or =48 hr without fever. Every child in both groupswa...
Pakistan Journal of Medical and Health Sciences, 2021
Aim: To detect the clinical presentation, biopsy and surgery of breast cancer in women at tertiar... more Aim: To detect the clinical presentation, biopsy and surgery of breast cancer in women at tertiary care hospital in Gujrat, Pakistan. Study design: Cross sectional descriptive study. Place and duration of study: This study was conducted in 06 years April 2014 to March 2020 at Aziz Bhatti Shaheed Teaching Hospital Gujrat, Pakistan. Methods: Total 138 women were selected for study that was having breast lump, breast ulcer or abnormal breast (nipple) discharge. Women were admitted for investigations and further plan for treatment. Breast cancer was diagnosed on history, examination and investigations. Complete blood count, serum studies, ultra-sonography of breast, mammography and breast biopsy was planned. Results: Total 138 women were enrolled in the study. Women 25-85 years of age were included in the study. Youngest woman was 27 years of age and the oldest was 85 years of age. Thirty two (23.18%) women were less than 50 years of age and 106(76.81%) women were more than 50 years of ...
BACKGROUND: Long-term oxygen therapy (LTOT) delivered continuously is known to decrease mortality... more BACKGROUND: Long-term oxygen therapy (LTOT) delivered continuously is known to decrease mortality in patients with COPD and who are hypoxemic; however, supportive data for LTOT use in patients without COPD is lacking. In addition, many patients may be prescribed LTOT without a definitive etiology for hypoxemia. First, we investigated the diagnoses for which oxygen was prescribed to a sample of veterans and whether each diagnosis was supported by confirmatory testing. Second, we looked at the proportion of subjects who were prescribed non-continuous therapy. METHODS: We retrospectively studied subjects prescribed domiciliary oxygen at the Veterans Administration Western New York Healthcare System. The subjects who met inclusion criteria were identified by using a computerized patient record system; data were collected on subject characteristics, oxygen prescription information, diagnosis for hypoxia, and diagnostic workup. Descriptive data were presented as mean 6 SD and median (range). Statistical analysis was performed by using the chi-square test and an unpaired t test. RESULTS: A total of 494 patients were included: 96.8% men, mean 6 SD ages 74.2 6 10.8 y. Most of the subjects were prescribed oxygen as outpatients (68.5%). A total of 335 (67.8%) were prescribed oxygen for continuous therapy, 72 (14.1%) for nocturnal therapy, 50 (10.1%) for exertion, and 30 (6.1%) for both exertion and nocturnal use. At 3 months, 19.6% of the initial cohort had oxygen discontinued. In those subjects with oxygen continued at 3 months, COPD was the most common diagnosis (63.6%), of which 76.1% had pulmonary function tests (PFTs), with 85.7% showing obstruction on spirometry. CONCLUSIONS: Results of our study showed a 99.4% adherence to Medicare criteria for domiciliary oxygen prescription. Also, 30.3% of the subjects were prescribed LTOT for exertional or nocturnal desaturation or both. Repeated testing at 3 months identified subjects who no longer required oxygen. COPD was the most common etiology for domiciliary oxygen. A small proportion of the subjects (6.9%) were prescribed oxygen without underlying etiology for hypoxia. Exertional and/or nocturnal oxygen prescription was common, and further research to elucidate its utility is clearly warranted.
Many shreds of evidence found on the crime scenes contain a trace amount of DNA which results in ... more Many shreds of evidence found on the crime scenes contain a trace amount of DNA which results in insignificant profiling results for subsequent comparison. This can nullify the potential evidence material and hamper investigation process. Over the years, different strategies have been employed by various DNA testing laboratories to create interpretable DNA profiles generated from low template of DNA. This review highlights different strategies used by forensic laboratories worldwide for creating complete DNA profiles from low copy number template for comparison purposes along with its associated risks for forensic purposes
Mixed matrix membranes (MMMs) fabricated with porous metal organic frame works have enhanced the ... more Mixed matrix membranes (MMMs) fabricated with porous metal organic frame works have enhanced the separation performance of polymer membranes. In this context microporous 3D Tb(BTC)(H 2 O).(DMF) 1.1 MOF was incorporated into pristine MatrimidÒ with loadings of 10, 20 and 30 weight percentages. SEM micrographs indicated proper distribution of filler in the Matrimid and no interfacial voids were observed. Gas permeation studies evidenced the CO 2 permeability to be 13.2 (82.32%) and 18.34 (153.31%) and 25.86 Barrer for 10, 20 and 30 wt% MMMs respectively. The 257.18% increase in CO 2 permeability of 30 wt% MMM than methane was attributed to polar nature of CO 2 , its smaller kinetic diameter, condensability, and larger solubility within the Matrimid matrix than non-polar and larger CH 4 molecules. Addition of filler influenced the pure gas selectivity of all MMMs positively. So, 30 wt% MMM exhibited the highest 58.04% increase in selectivity that was attributed to the molecular sieving property of the filler and the size exclusion phenomena as followed by CH 4 and CO 2. The high values of mixed and pure gas selectivity were obtained upon increasing filler concentration. The commercial applicability of these MMMs was tested by checking their selectivity under increased feed concentrations of CO 2 and checking permeability and selectivities at high temperatures. The study depicted that, competitive sorption of gases, prevalence of size exclusion phenomena and polymer
With the increasing number of people suffering from coronavirus disease 2019 (COVID-19), caused b... more With the increasing number of people suffering from coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), there is a dire need to look for effective remedies against this pandemic. Drug repurposing seems to be the solution for the current situation. Methods: In a quest to find a potential drug against this virus, 15 antimalarial drugs (including chloroquine) and 2413 US Food and Drug Administration-approved drugs were investigated for activity against both the protease and spike proteins of SARS-CoV-2 using an in silico approach. Molecular docking analysis followed by molecular dynamics simulation was performed to estimate the binding and stability of the complexes. Results: This study identified a single drugparomomycinwith activity against two targets of SARS-CoV-2, i.e., spike protein (S1) and protease domain. Paromomycin was found to have strong binding affinity for both targets of coronavirus. The results also showed that no antimalarial drug exhibited effective binding for either S1 or protease. Conclusions: This study found that paromomycin may be an effective dual targeting drug against coronavirus, as it binds not only to the protease domain of the virion, but also to the spike domain, with high stability. Furthermore, none of the antimalarial drugs showed strong binding affinity for either protease or the receptor binding domain (RBD).
American Journal of Respiratory and Critical Care Medicine, 2020
A 34-year-old man was referred to an interventional pulmonary clinic for evaluation of incidental... more A 34-year-old man was referred to an interventional pulmonary clinic for evaluation of incidentally found pleural opacities on a screening full-body computed tomographic scan performed at an international facility. He was asymptomatic and denied tobacco use, and his lungs were clear on examination. The computed tomographic scan showed lesions at or near the pleura at the level of the thoracic spine, and they were described as possible loculated pleural effusions (Figure 1A). After discussing the case at a multidisciplinary radiology conference, we obtained a magnetic resonance imaging scan, which showed perineural sleeve cysts at the level of the seventh and eighth thoracic vertebrae (Figure 1B). Perineural or Tarlov cysts are type II meningeal cysts, which were first described in 1938 by Dr. Tarlov (1). They are a cerebrospinal fluid-filled abnormal expansion of spinal nerve roots. They are most commonly found in the lumbosacral spine with a prevalence of 1.5-4.6%, with 20% of them being symptomatic (2, 3). It is unclear why they form or persist; however, various mechanisms have been described. These mechanisms include deposition of hemosiderin after trauma leading to blockage of venous drainage of perineurium and epineurium with subsequent cyst formation, persistence of embryonic fissures forming congenital diverticula, or proliferation of the arachnoid membrane along the exiting nerve roots causing formation of perineural cysts (4, 5). In addition, it is also suggested that a ball-valve mechanism allows cerebrospinal fluid to enter the cyst but prevents it from exiting (6). Thoracic Tarlov cysts are very uncommon and can be mistaken for nerve root sheath tumors on imaging. A majority of them are clinically insignificant because they are asymptomatic. However, they can compress nerve roots, causing thoracic radiculopathy, including extremity pain, decreased sensation, or weakness. When symptomatic, surgical intervention, including cyst drainage, clipping, or resection, can be curative; however, recurrence is possible (7). Furthermore, invasive spinal or pleural procedures in the presence of Tarlov cysts should be performed with extreme caution to avoid dural puncture and subsequent complications (8). To date, this patient remains asymptomatic and does not need any additional treatment. n Author disclosures are available with the text of this article at www.atsjournals.org.
Crime scene investigation is an important tool in criminal investigation process. Proper processi... more Crime scene investigation is an important tool in criminal investigation process. Proper processing of crime scene is a prerequisite for successfully solving a criminal case. In Pakistan, local policemen are not properly trained and equipped with the necessary items required for systematic processing of crime scene including proper identification and collection of evidence. Certain capacity building measures and improvements must be needed for proper processing of crime scene in Pakistan. This article focuses the current situation and strategies being practiced in Pakistan followed by suggestions for capacity building measures in this field.
Clinical practice and cases in emergency medicine, 2018
We describe an unusual ruptured ectopic pregnancy. The unique features of the case include abdomi... more We describe an unusual ruptured ectopic pregnancy. The unique features of the case include abdominal pain without vaginal bleeding; cervical implantation and a placenta accreta; and the late presentation at 16 weeks of gestation without prior symptoms. Both the initial point-of-care ultrasound and the formal ultrasound were interpreted as showing an intrauterine pregnancy. The clinical presentation was misleading; the correct diagnosis was made by magnetic resonance imaging. We show the ultrasonic images. We discuss cervical ectopic pregnancies, their diagnosis and management. The woman survived but required emergency hysterectomy and many units of blood.
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