Author: "Ambreen A" / Topic: humans - Searchworks@Jio Institute Digital Library Search Results

568 results on '"Ambreen A"'

1. Biallelic NAA60 variants with impaired n-terminal acetylation capacity cause autosomal recessive primary familial brain calcifications.

Author: Chelban, Viorica, Aksnes, Henriette, Maroofian, Reza, LaMonica, Lauren, Seabra, Luis, Siggervåg, Anette, Devic, Perrine, Shamseldin, Hanan, Vandrovcova, Jana, Murphy, David, Richard, Anne-Claire, Quenez, Olivier, Bonnevalle, Antoine, Zanetti, M, Kaiyrzhanov, Rauan, Salpietro, Vincenzo, Efthymiou, Stephanie, Schottlaender, Lucia, Morsy, Heba, Scardamaglia, Annarita, Tariq, Ambreen, Pagnamenta, Alistair, Pennavaria, Ajia, Krogstad, Liv, Bekkelund, Åse, Caiella, Alessia, Glomnes, Nina, Brønstad, Kirsten, Tury, Sandrine, Moreno De Luca, Andrés, Boland-Auge, Anne, Olaso, Robert, Deleuze, Jean-François, Anheim, Mathieu, Cretin, Benjamin, Vona, Barbara, Alajlan, Fahad, Abdulwahab, Firdous, Battini, Jean-Luc, İpek, Rojan, Bauer, Peter, Zifarelli, Giovanni, Gungor, Serdal, Kurul, Semra, Lochmuller, Hanns, Daas, Sahar, Fakhro, Khalid, Gómez-Pascual, Alicia, Botía, Juan, Wood, Nicholas, Horvath, Rita, Ernst, Andreas, Rothman, James, McEntagart, Meriel, Crow, Yanick, Alkuraya, Fowzan, Nicolas, Gaël, Arnesen, Thomas, and Houlden, Henry
Subjects: Humans, Acetylation, Brain, Brain Diseases, Inheritance Patterns, Mutation, Phosphates, Sodium-Phosphate Cotransporter Proteins, Type III
Abstract: Primary familial brain calcification (PFBC) is characterized by calcium deposition in the brain, causing progressive movement disorders, psychiatric symptoms, and cognitive decline. PFBC is a heterogeneous disorder currently linked to variants in six different genes, but most patients remain genetically undiagnosed. Here, we identify biallelic NAA60 variants in ten individuals from seven families with autosomal recessive PFBC. The NAA60 variants lead to loss-of-function with lack of protein N-terminal (Nt)-acetylation activity. We show that the phosphate importer SLC20A2 is a substrate of NAA60 in vitro. In cells, loss of NAA60 caused reduced surface levels of SLC20A2 and a reduction in extracellular phosphate uptake. This study establishes NAA60 as a causal gene for PFBC, provides a possible biochemical explanation of its disease-causing mechanisms and underscores NAA60-mediated Nt-acetylation of transmembrane proteins as a fundamental process for healthy neurobiological functioning.
Published: 2024

2. Association of maternal prenatal copper concentration with gestational duration and preterm birth: a multicountry meta-analysis.

Author: Monangi, Nagendra, Xu, Huan, Fan, Yue-Mei, Khanam, Rasheeda, Khan, Waqasuddin, Deb, Saikat, Pervin, Jesmin, Price, Joan, Kaur, Lovejeet, Al Mahmud, Abdullah, Thanh, Le, Care, Angharad, Landero, Julio, Combs, Gerald, Belling, Elizabeth, Chappell, Joanne, Chen, Jing, Kong, Fansheng, Lacher, Craig, Ahmed, Salahuddin, Chowdhury, Nabidul, Rahman, Sayedur, Kabir, Furqan, Nisar, Imran, Hotwani, Aneeta, Mehmood, Usma, Nizar, Ambreen, Khalid, Javairia, Dhingra, Usha, Dutta, Arup, Ali, Said, Aftab, Fahad, Juma, Mohammed, Rahman, Monjur, Ahmed, Tahmeed, Islam, M, Vwalika, Bellington, Musonda, Patrick, Ashorn, Ulla, Maleta, Kenneth, Hallman, Mikko, Goodfellow, Laura, Gupta, Juhi, Alfirevic, Ana, Murphy, Susan, Ryckman, Kelli, Murray, Jeffrey, Bahl, Rajiv, Litch, James, Baruch-Gravett, Courtney, Sopory, Shailaja, Chandra Mouli Natchu, Uma, Kumar, Pavitra, Kumari, Neha, Thiruvengadam, Ramachandran, Singh, Atul, Kumar, Pankaj, Alfirevic, Zarko, Baqui, Abdullah, Bhatnagar, Shinjini, Hirst, Jane, Hoyo, Cathrine, Jehan, Fyezah, Jelliffe-Pawlowski, Laura, Rahman, Anisur, Roth, Daniel, Sazawal, Sunil, Stringer, Jeffrey, Ashorn, Per, Zhang, Ge, Muglia, Louis, and Rand, Larry
Subjects: acute-phase reactants, copper, gestational duration, inflammation, low- and middle-income countries, nutrition, pregnancy, preterm birth, Pregnancy, Female, Humans, Infant, Newborn, Premature Birth, Copper, Gestational Age, Live Birth, Inflammation, Risk Factors
Abstract: BACKGROUND: Copper (Cu), an essential trace mineral regulating multiple actions of inflammation and oxidative stress, has been implicated in risk for preterm birth (PTB). OBJECTIVES: This study aimed to determine the association of maternal Cu concentration during pregnancy with PTB risk and gestational duration in a large multicohort study including diverse populations. METHODS: Maternal plasma or serum samples of 10,449 singleton live births were obtained from 18 geographically diverse study cohorts. Maternal Cu concentrations were determined using inductively coupled plasma mass spectrometry. The associations of maternal Cu with PTB and gestational duration were analyzed using logistic and linear regressions for each cohort. The estimates were then combined using meta-analysis. Associations between maternal Cu and acute-phase reactants (APRs) and infection status were analyzed in 1239 samples from the Malawi cohort. RESULTS: The maternal prenatal Cu concentration in our study samples followed normal distribution with mean of 1.92 μg/mL and standard deviation of 0.43 μg/mL, and Cu concentrations increased with gestational age up to 20 wk. The random-effect meta-analysis across 18 cohorts revealed that 1 μg/mL increase in maternal Cu concentration was associated with higher risk of PTB with odds ratio of 1.30 (95% confidence interval [CI]: 1.08, 1.57) and shorter gestational duration of 1.64 d (95% CI: 0.56, 2.73). In the Malawi cohort, higher maternal Cu concentration, concentrations of multiple APRs, and infections (malaria and HIV) were correlated and associated with greater risk of PTB and shorter gestational duration. CONCLUSIONS: Our study supports robust negative association between maternal Cu and gestational duration and positive association with risk for PTB. Cu concentration was strongly correlated with APRs and infection status suggesting its potential role in inflammation, a pathway implicated in the mechanisms of PTB. Therefore, maternal Cu could be used as potential marker of integrated inflammatory pathways during pregnancy and risk for PTB.
Published: 2024

3. Serine, N-acetylaspartate differentiate adolescents with juvenile idiopathic arthritis compared with healthy controls: a metabolomics cross-sectional study

Author: Lewis, Kimberly A, Osier, Nico, Carrasco, Ruy, Chiou, Jennifer, Carter, Patricia, Garcia, Alexandra, Flowers, Elena, Gennatas, Efstathios D, Nguyen, Christina, Rana, Ambreen, Brown, Sharon A, and Tiziani, Stefano
Subjects: Medical Biochemistry and Metabolomics, Biomedical and Clinical Sciences, Prevention, Rheumatoid Arthritis, Rare Diseases, Pediatric, Clinical Research, Arthritis, Autoimmune Disease, Good Health and Well Being, Adolescent, Arthritis, Juvenile, Aspartic Acid, Cross-Sectional Studies, Female, Humans, Male, Metabolomics, Serine, Juvenile idiopathic arthritis, Adolescents, N-acetylaspartate, Biomarkers, Precision medicine, Systems biology, Clinical Sciences, Paediatrics and Reproductive Medicine, Arthritis & Rheumatology, Clinical sciences, Paediatrics
Abstract: BackgroundIn comparison with the general population, adolescents with juvenile idiopathic arthritis (JIA) are at higher risk for morbidity and mortality. However, limited evidence is available about this condition's underlying metabolic profile in adolescents with JIA relative to healthy controls. In this untargeted, cross-sectional metabolomics study, we explore the plasma metabolites in this population.MethodsA sample of 20 adolescents with JIA and 20 controls aged 13-17 years were recruited to complete surveys, provide medical histories and biospecimens, and undergo assessments. Fasting morning plasma samples were processed with liquid chromatography-mass spectrometry. Data were centered, scaled, and analyzed using generalized linear models accounting for age, sex, and medications (p-values adjusted for multiple comparisons using the Holm method). Spearman's correlations were used to evaluate relationships among metabolites, time since diagnosis, and disease severity.ResultsOf 72 metabolites identified in the samples, 55 were common to both groups. After adjustments, 6 metabolites remained significantly different between groups. Alpha-glucose, alpha-ketoglutarate, serine, and N-acetylaspartate were significantly lower in the JIA group than in controls; glycine and cystine were higher. Seven additional metabolites were detected only in the JIA group; 10 additional metabolites were detected only in the control group. Metabolites were unrelated to disease severity or time since diagnosis.ConclusionsThe metabolic signature of adolescents with JIA relative to controls reflects a disruption in oxidative stress; neurological health; and amino acid, caffeine, and energy metabolism pathways. Serine and N-acetylaspartate were promising potential biomarkers, and their metabolic pathways are linked to both JIA and cardiovascular disease risk. The pathways may be a source of new diagnostic, treatment, or prevention options. This study's findings contribute new knowledge for systems biology and precision health approaches to JIA research. Further research is warranted to confirm these findings in a larger sample.
Published: 2022

4. Best practices for recruitment of adolescents for biobanking and precision health research: a retrospective analysis comparing juvenile idiopathic arthritis cases with healthy controls

Author: Lewis, Kimberly A, Brooks, Shelby, Carrasco, Ruy, Carter, Patricia, Garcia, Alexandra, Chiou, Jennifer, Nguyen, Christina, Rana, Ambreen, Brown, Sharon A, Tiziani, Stefano, and Osier, Nico
Subjects: Paediatrics, Biomedical and Clinical Sciences, Clinical Sciences, Clinical Trials and Supportive Activities, Rare Diseases, Pediatric, Pediatric Research Initiative, Mental Health, Autoimmune Disease, Arthritis, Clinical Research, Good Health and Well Being, Adolescent, Arthritis, Juvenile, Biological Specimen Banks, Biomedical Research, Female, Healthy Volunteers, Humans, Male, Precision Medicine, Retrospective Studies, Social Media, Healthy controls, Adolescents, Biobehavioral study, Precision health, Juvenile idiopathic arthritis, Metabolomics, Recruitment, Biobanking, Paediatrics and Reproductive Medicine, Arthritis & Rheumatology, Clinical sciences
Abstract: BackgroundPrecision health in adolescents relies on the successful collection of data and biospecimens from an adequately sized sample of cases and comparison group(s), often healthy controls, to answer the research question. This research report describes the recruitment strategy, enrollment rates, and approach utilized in a successful biobehavioral research study. The study was designed to examine key health indicators in adolescents (13-17 years of age) with juvenile idiopathic arthritis (JIA) compared to a control group of healthy adolescents. The purpose of this analysis is to establish best practices and identify strategies to overcome barriers to recruitment of older adolescents, an age group that tends to be underrepresented in research studies.MethodsA retrospective secondary analysis of data from a parent study about JIA with high consent rates was employed to explore factors affecting enrollment into the biobehavioral study.ResultsOf the 113 subjects who were recruited to the study, 74 met the eligibility criteria and reviewed the consent form. The consented group (n=40) represents 54% of those who were eligible upon initial screening. The rate of project enrollment was 2.7 participants per month. The pediatric rheumatologists referred 85% of the JIA group, and the study's principal investigator, a nurse scientist, referred 95% of the control group. Typical recruitment strategies, such as posting on social media, distributing flyers, and cold-calling potential participants from the clinic schedule were ineffective for both cases and controls. Barriers to enrollment included scheduling and fear of venipuncture. There were no demographic characteristics that significantly explained enrollment, differentiating between those who agreed to participate compared to those who refused. Successful strategies for enrollment of adolescents into this biobehavioral research study included scheduling study visits on weekends and school holidays; an informed consent and assent process that addressed adolescent fears of venipuncture; including a JIA patient on the study team; and utilizing existing relationships to maximize enrollment efforts.ConclusionsEffective recruitment and enrollment practices were relationship-specific and patient-centered. Researchers should utilize best practices to ensure that precision health for adolescents is advanced.
Published: 2021

5. Association of maternal prenatal selenium concentration and preterm birth: a multicountry meta-analysis

Author: Monangi, Nagendra, Xu, Huan, Khanam, Rasheda, Khan, Waqasuddin, Deb, Saikat, Pervin, Jesmin, Price, Joan T, Consortium, INTERBIO-21st Study, Kennedy, Stephen H, Mahmud, Abdullah Al, Fan, Yuemei, Le, Thanh Q, Care, Angharad, Landero, Julio A, Combs, Gerald F, Belling, Elizabeth, Chappell, Joanne, Kong, Fansheng, Lacher, Criag, Ahmed, Salahuddin, Chowdhury, Nabidul Haque, Rahman, Sayedur, Kabir, Furqan, Nisar, Imran, Hotwani, Aneeta, Mehmood, Usma, Nizar, Ambreen, Khalid, Javairia, Dhingra, Usha, Dutta, Arup, Ali, Said, Aftab, Fahad, Juma, Mohammed Hamad, Rahman, Monjur, Vwalika, Bellington, Musonda, Patrick, Ahmed, Tahmeed, Islam, Munirul, Ashorn, Ulla, Maleta, Kenneth, Hallman, Mikko, Goodfellow, Laura, Gupta, Juhi K, Alfirevic, Ana, Murphy, Susan, Rand, Larry, Ryckman, Kelli K, Murray, Jeffrey C, Bahl, Rajiv, Litch, James A, Baruch-Gravett, Courtney, Alfirevic, Zarko, Ashorn, Per, Baqui, Abdullah, Hirst, Jane, Hoyo, Cathrine, Jehan, Fyezah, Jelliffe-Pawlowski, Laura L, Rahman, Anisur, Roth, Daniel E, Sazawal, Sunil, Stringer, Jeffrey, Zhang, Ge, and Muglia, Louis
Subjects: Health Services and Systems, Public Health, Health Sciences, Prevention, Perinatal Period - Conditions Originating in Perinatal Period, Pediatric, Complementary and Integrative Health, 2.2 Factors relating to the physical environment, Aetiology, Reproductive health and childbirth, Female, Gestational Age, Humans, Infant, Newborn, Pregnancy, Premature Birth, Selenium, child health, environmental health, epidemiology, maternal health, nutrition, INTERBIO-21st Study Consortium, preterm birth, gestational duration, Health services and systems, Public health
Abstract: BackgroundSelenium (Se), an essential trace mineral, has been implicated in preterm birth (PTB). We aimed to determine the association of maternal Se concentrations during pregnancy with PTB risk and gestational duration in a large number of samples collected from diverse populations.MethodsGestational duration data and maternal plasma or serum samples of 9946 singleton live births were obtained from 17 geographically diverse study cohorts. Maternal Se concentrations were determined by inductively coupled plasma mass spectrometry analysis. The associations between maternal Se with PTB and gestational duration were analysed using logistic and linear regressions. The results were then combined using fixed-effect and random-effect meta-analysis.FindingsIn all study samples, the Se concentrations followed a normal distribution with a mean of 93.8 ng/mL (SD: 28.5 ng/mL) but varied substantially across different sites. The fixed-effect meta-analysis across the 17 cohorts showed that Se was significantly associated with PTB and gestational duration with effect size estimates of an OR=0.95 (95% CI: 0.9 to 1.00) for PTB and 0.66 days (95% CI: 0.38 to 0.94) longer gestation per 15 ng/mL increase in Se concentration. However, there was a substantial heterogeneity among study cohorts and the random-effect meta-analysis did not achieve statistical significance. The largest effect sizes were observed in UK (Liverpool) cohort, and most significant associations were observed in samples from Malawi.InterpretationWhile our study observed statistically significant associations between maternal Se concentration and PTB at some sites, this did not generalise across the entire cohort. Whether population-specific factors explain the heterogeneity of our findings warrants further investigation. Further evidence is needed to understand the biologic pathways, clinical efficacy and safety, before changes to antenatal nutritional recommendations for Se supplementation are considered.
Published: 2021

6. Digestive Manifestations in Patients Hospitalized With Coronavirus Disease 2019.

Author: Elmunzer, B, Spitzer, Rebecca, Foster, Lydia, Merchant, Ambreen, Howard, Eric, Patel, Vaishali, West, Mary, Qayed, Emad, Nustas, Rosemary, Zakaria, Ali, Piper, Marc, Taylor, Jason, Jaza, Lujain, Forbes, Nauzer, Chau, Millie, Lara, Luis, Papachristou, Georgios, Volk, Michael, Hilson, Liam, Zhou, Selena, Kushnir, Vladimir, Lenyo, Alexandria, McLeod, Caroline, Amin, Sunil, Kuftinec, Gabriela, Yadav, Dhiraj, Fox, Charlie, Kolb, Jennifer, Pawa, Swati, Pawa, Rishi, Canakis, Andrew, Huang, Christopher, Jamil, Laith, Aneese, Andrew, Glamour, Benita, Smith, Zachary, Hanley, Katherine, Wood, Jordan, Patel, Harsh, Shah, Janak, Agarunov, Emil, Sethi, Amrita, Fogel, Evan, McNulty, Gail, Haseeb, Abdul, Trieu, Judy, Dixon, Rebekah, Yang, Jeong, Mendelsohn, Robin, Calo, Delia, Aroniadis, Olga, LaComb, Joseph, Scheiman, James, Sauer, Bryan, Dang, Duyen, Piraka, Cyrus, Shah, Eric, Pohl, Heiko, Tierney, William, Mitchell, Stephanie, Condon, Ashwinee, Lenhart, Adrienne, Dua, Kulwinder, Kanagala, Vikram, Kamal, Ayesha, Singh, Vikesh, Pinto-Sanchez, Maria, Hutchinson, Joy, Kwon, Richard, Korsnes, Sheryl, Singh, Harminder, Solati, Zahra, Willingham, Field, Yachimski, Patrick, Conwell, Darwin, Mosier, Evan, Azab, Mohamed, Patel, Anish, Buxbaum, James, Wani, Sachin, Chak, Amitabh, Hosmer, Amy, Keswani, Rajesh, DiMaio, Christopher, Bronze, Michael, Muthusamy, Raman, Canto, Marcia, Gjeorgjievski, V, Imam, Zaid, Odish, Fadi, Edhi, Ahmed, Orosey, Molly, Tiwari, Abhinav, Patwardhan, Soumil, Brown, Nicholas, Ordiah, Collins, Sloan, Ian, Cruz, Lilian, and Koza, Casey
Subjects: COVID-19, Digestive Manifestations, Gastrointestinal Symptoms, Hepatic Manifestations, SARS-CoV-2, Adolescent, Adult, Aged, Aged, 80 and over, COVID-19, Female, Gastrointestinal Diseases, Humans, Male, Middle Aged, North America, Young Adult
Abstract: BACKGROUND & AIMS: The prevalence and significance of digestive manifestations in coronavirus disease 2019 (COVID-19) remain uncertain. We aimed to assess the prevalence, spectrum, severity, and significance of digestive manifestations in patients hospitalized with COVID-19. METHODS: Consecutive patients hospitalized with COVID-19 were identified across a geographically diverse alliance of medical centers in North America. Data pertaining to baseline characteristics, symptomatology, laboratory assessment, imaging, and endoscopic findings from the time of symptom onset until discharge or death were abstracted manually from electronic health records to characterize the prevalence, spectrum, and severity of digestive manifestations. Regression analyses were performed to evaluate the association between digestive manifestations and severe outcomes related to COVID-19. RESULTS: A total of 1992 patients across 36 centers met eligibility criteria and were included. Overall, 53% of patients experienced at least 1 gastrointestinal symptom at any time during their illness, most commonly diarrhea (34%), nausea (27%), vomiting (16%), and abdominal pain (11%). In 74% of cases, gastrointestinal symptoms were judged to be mild. In total, 35% of patients developed an abnormal alanine aminotransferase or total bilirubin level; these were increased to less than 5 times the upper limit of normal in 77% of cases. After adjusting for potential confounders, the presence of gastrointestinal symptoms at any time (odds ratio, 0.93; 95% CI, 0.76-1.15) or liver test abnormalities on admission (odds ratio, 1.31; 95% CI, 0.80-2.12) were not associated independently with mechanical ventilation or death. CONCLUSIONS: Among patients hospitalized with COVID-19, gastrointestinal symptoms and liver test abnormalities were common, but the majority were mild and their presence was not associated with a more severe clinical course.
Published: 2021

7. Enhanced serodiagnostic potential of a fusion molecule consisting of Rv1793, Rv2628 and a truncated Rv2608 of Mycobacterium tuberculosis

Author: Sulman, Sadaf, Shahid, Saher, Khaliq, Aasia, Ambreen, Atiqa, Khan, Imran H, Cooper, Andrea M, and Akhtar, Muhammad Waheed
Subjects: Biochemistry and Cell Biology, Biomedical and Clinical Sciences, Biological Sciences, Biodefense, Infectious Diseases, Lung, Prevention, Emerging Infectious Diseases, Vaccine Related, Rare Diseases, Tuberculosis, Biotechnology, Infection, Good Health and Well Being, Adolescent, Adult, Aged, Aged, 80 and over, Antibodies, Bacterial, Antigens, Bacterial, Bacterial Proteins, Epitopes, Escherichia coli, Female, Follow-Up Studies, Humans, Male, Middle Aged, Mycobacterium tuberculosis, Pakistan, Recombinant Fusion Proteins, Sensitivity and Specificity, Serologic Tests, Sputum, Tuberculosis, Pulmonary, Young Adult, General Science & Technology
Abstract: Serodiagnosis of tuberculosis (TB) can be rapid, reliable and cost-effective if the issue of variable antibody responses of TB patients against different Mycobacterium tuberculosis (Mtb) antigens can be overcome by developing fusion proteins containing epitopes from multiple antigens of Mtb. In this study, Mtb antigens Rv1793, Rv2628, Rv2608 and a truncated variant produced by removing non-epitopic region from N-terminal of Rv2608 (tnRv2608), and the fusion protein Rv1793-Rv2628-tnRv2608 (TriFu64), were expressed in E. coli and purified. Plasma samples from TB patients characterized by sex, age and sputum/culture positivity, were used to compare the sensitivity of the single antigens with the fusion protein. Sensitivity of Rv1793, Rv2628 and Rv2608, was 27.8%, 39% and 36.3%, respectively. Truncation of Rv2608 increased sensitivity by approximately 35% in confirmed TB cases. Sensitivity of the fusion construct, TriFu64 increased to 66% with a specificity of 100%. Importantly, tnRv2608 was better able to detect sputum and culture negative patients, and this carried through to the fusion protein. We demonstrate that fusion of Mtb proteins ensures broad sensitivity across disease types, sex and age groups in a Pakistani population.
Published: 2021

8. Gut microbiome dysbiosis and correlation with blood biomarkers in active-tuberculosis in endemic setting

Author: Khaliq, Aasia, Ravindran, Resmi, Afzal, Samia, Jena, Prasant Kumar, Akhtar, Muhammad Waheed, Ambreen, Atiqa, Wan, Yu-Jui Yvonne, Malik, Kauser Abdulla, Irfan, Muhammad, and Khan, Imran H
Subjects: Rare Diseases, Infectious Diseases, Lung, Emerging Infectious Diseases, Clinical Research, Biodefense, Prevention, Vaccine Related, Biotechnology, Tuberculosis, Detection, screening and diagnosis, 2.1 Biological and endogenous factors, Aetiology, 4.1 Discovery and preclinical testing of markers and technologies, Infection, Inflammatory and immune system, Good Health and Well Being, Acyl Coenzyme A, Adult, Biomarkers, Dysbiosis, Endemic Diseases, Female, Gastrointestinal Microbiome, Gene Dosage, Humans, Male, General Science & Technology
Abstract: Tuberculosis (TB) is the largest infectious disease with 10 million new active-TB patients and1.7 million deaths per year. Active-TB is an inflammatory disease and is increasingly viewed as an imbalance of immune responses to M. tb. infection. The mechanisms of a switch from latent infection to active disease is not well worked out but a shift in the immune responses is thought to be responsible. Increasingly, the role of gut microbiota has been described as a major influencer of the immune system. And because the gut is the largest immune organ, we aimed to analyze the gut microbiome in active-TB patients in a TB-endemic country, Pakistan. The study revealed that Ruminococcacea, Enetrobactericeae, Erysipelotrichaceae, Bifidobacterium, etc. were the major genera associated with active-TB, also associated with chronic inflammatory disease. Plasma antibody profiles against several M. tb. antigens, as specific biomarkers for active-TB, correlated closely with the patient gut microbial profiles. Besides, bcoA gene copy number, indicative of the level of butyrate production by the gut microbiome was five-fold lower in TB patients compared to healthy individuals. These findings suggest that gut health in TB patients is compromised, with implications for disease morbidity (e.g., severe weight loss) as well as immune impairment.
Published: 2021

9. Duplication events downstream of IRX1 cause North Carolina macular dystrophy at the MCDR3 locus.

Author: Cipriani, Valentina, Silva, Raquel S, Arno, Gavin, Pontikos, Nikolas, Kalhoro, Ambreen, Valeina, Sandra, Inashkina, Inna, Audere, Mareta, Rutka, Katrina, Puech, Bernard, Michaelides, Michel, van Heyningen, Veronica, Lace, Baiba, Webster, Andrew R, and Moore, Anthony T
Subjects: Retina, Chromosomes, Human, Pair 5, Chromosomes, Human, Pair 6, Fetus, Humans, Corneal Dystrophies, Hereditary, Homeodomain Proteins, Eye Proteins, Transcription Factors, Tomography, Optical Coherence, Sequence Analysis, DNA, Family, Gene Expression, Base Sequence, Haplotypes, Adult, Female, Male, Genetic Loci, Chromosome Duplication, ADAMTS Proteins, Chromosomes, Human, Pair 5, Pair 6, Corneal Dystrophies, Hereditary, Sequence Analysis, DNA, Tomography, Optical Coherence
Abstract: Autosomal dominant North Carolina macular dystrophy (NCMD) is believed to represent a failure of macular development. The disorder has been linked to two loci, MCDR1 (chromosome 6q16) and MCDR3 (chromosome 5p15-p13). Recently, non-coding variants upstream of PRDM13 (MCDR1) and a duplication including IRX1 (MCDR3) have been identified. However, the underlying disease-causing mechanism remains uncertain. Through a combination of sequencing studies on eighteen NCMD families, we report two novel overlapping duplications at the MCDR3 locus, in a gene desert downstream of IRX1 and upstream of ADAMTS16. One duplication of 43 kb was identified in nine families (with evidence for a shared ancestral haplotype), and another one of 45 kb was found in a single family. Three families carry the previously reported V2 variant (MCDR1), while five remain unsolved. The MCDR3 locus is thus refined to a shared region of 39 kb that contains DNAse hypersensitive sites active at a restricted time window during retinal development. Publicly available data confirmed expression of IRX1 and ADAMTS16 in human fetal retina, with IRX1 preferentially expressed in fetal macula. These findings represent a major advance in our understanding of the molecular genetics of NCMD and provide insights into the genetic pathways involved in human macular development.
Published: 2017

10. Field evaluation of a blood based test for active tuberculosis in endemic settings.

Author: Khaliq, Aasia, Ravindran, Resmi, Hussainy, Syed Fahadulla, Krishnan, Viwanathan V, Ambreen, Atiqa, Yusuf, Noshin Wasim, Irum, Shagufta, Rashid, Abdul, Jamil, Muhammad, Zaffar, Fareed, Chaudhry, Muhammad Nawaz, Gupta, Puneet K, Akhtar, Muhammad Waheed, and Khan, Imran H
Subjects: Sputum, Plasma, Humans, Mycobacterium tuberculosis, Tuberculosis, Pulmonary, Hematologic Tests, Serologic Tests, Sensitivity and Specificity, Adult, Female, Male, Young Adult, Clinical Research, HIV/AIDS, Prevention, Tuberculosis, Biodefense, Emerging Infectious Diseases, Rare Diseases, Infectious Diseases, Lung, Vaccine Related, Detection, screening and diagnosis, 4.1 Discovery and preclinical testing of markers and technologies, 4.2 Evaluation of markers and technologies, Infection, Good Health and Well Being, General Science & Technology
Abstract: Over 9 million new active tuberculosis (TB) cases emerge each year from an enormous pool of 2 billion individuals latently infected with Mycobacterium tuberculosis (M. tb.) worldwide. About 3 million new TB cases per year are unaccounted for, and 1.5 million die. TB, however, is generally curable if diagnosed correctly and in a timely manner. The current diagnostic methods for TB, including state-of-the-art molecular tests, have failed in delivering the capacity needed in endemic countries to curtail this ongoing pandemic. Efficient, cost effective and scalable diagnostic approaches are critically needed. We report a multiplex TB serology panel using microbead suspension array containing a combination of 11 M.tb. antigens that demonstrated overall sensitivity of 91% in serum/plasma samples from TB patients confirmed by culture. Group wise sensitivities for sputum smear positive and negative patients were 95%, and 88%, respectively. Specificity of the test was 96% in untreated COPD patients and 91% in general healthy population. The sensitivity of this test is superior to that of the frontline sputum smear test with a comparable specificity (30-70%, and 93-99%, respectively). The multiplex serology test can be performed with scalability from 1 to 360 patients per day, and is amenable to automation for higher (1000s per day) throughput, thus enabling a scalable clinical work flow model for TB endemic countries. Taken together, the above results suggest that well defined antibody profiles in blood, analyzed by an appropriate technology platform, offer a valuable approach to TB diagnostics in endemic countries.
Published: 2017

11. Effects of hospital facilities on patient outcomes after cancer surgery

Author: Knight, Sr, Chu, K, Lapitan, Mc, Dare, Aj, Pius, R, Shaw, Ca, Drake, Tm, Norman, L, Ademuyiwa, Ao, Adisa, Ao, Aguilera, Ml, Al-Saqqa, Sw, Al-Slaibi, I, Bhangu, A, Biccard, Bm, Brocklehurst, P, Costas-Chavarri, A, Elhadi, M, Fairfield, Cj, Fitzgerald, Je, Ghosh, D, Glasbey, J, Henegouwen, Miv, Ingabire, Jca, Kingham, Tp, Lawani, I, Lieske, B, Lilford, R, Martin, J, Mclean, Ka, Moore, R, Morton, D, Nepogodiev, D, Ntirenganya, F, Pata, F, Pinkney, T, Stephen, R Knight, Catherine, A Shaw, Riinu, Pius, Thomas, M Drake, Lisa, Norman, Adesoji, O Ademuyiwa, Adewale, O Adisa, Maria Lorena Aguilera, Sara, W Al-Saqqa, Ibrahim, Al-Slaibi, Aneel, Bhangu, Bruce, M Biccard, Peter, Brocklehurst, Ainhoa, Costas-Chavarri, Kathryn, Chu, Anna, Dare, Muhammed, Elhadi, Cameron, J Fairfield, J Edward Fitzgerald, Dhruv, Ghosh, James, Glasbey, Mark, I van Berge Henegouwen, C Allen Ingabire, J, T Peter Kingham, Marie Carmela Lapitan, Ismaïl, Lawani, Bettina, Lieske, Richard, Lilford, Janet, Martin, Kenneth, A McLean, Rachel, Moore, Dion, Morton, Dmitri, Nepogodiev, Faustin, Ntirenganya, Francesco, Pata, Thomas, Pinkney, Ahmad Uzair Qureshi, Antonio Ramos-De la Medina, Aya, Riad, Hosni Khairy Salem, Joana, Simões, Richard, Spence, Neil, Smart, Stephen, Tabiri, Hannah, Thomas, Thomas, G Weiser, Malcolm, West, John, Whitaker, Ewen, M Harrison, Arben, Gjata, Maria Marta Modolo, Sebastian, King, Erick, Chan, Sayeda Nazmun Nahar, Ade, Waterman, Dominique, Vervoort, Alemayehu Ginbo Bedada, Bernardo De Azevedo, Ana Gabriela Figueiredo, Manol, Sokolov, Venerand, Barendegere, Gerald, Ekwen, Arnav, Agarwal, Qinyang, Liu, Juan Camilo Correa, Kalisya Luc Malemo, Jacques, Bake, Jakov, Mihanovic, Kamila, Kunčarová, Julius, Orhalmi, Hosni, Salem, Jyri, Teras, Aristotelis, Kechagias, Alexis, P Arnaud, Judith, Lindert, Vasileios, Kalles, Maria-Lorena, Aguilera-Arevalo, Gustavo, Recinos, Zsolt, Baranyai, Basant, Kumar, Harish Neelamraju Lakshmi, Sanoop Koshy Zachariah, Philip, Alexander, Sunil Kumar Venkatappa, Pramesh, C, Radhian, Amandito, Christina, Fleming, Luca, Ansaloni, Gianluca, Pellino, Ahmed, M Altibi, Ibrahim, Nour, Intisar, Hamdun, Ali, M Ghellai, Donatas, Venskutonis, Tomas, Poskus, Justas, Zilinskas, Precious, Malemia, Yong Yong Tew, Elaine, Borg, Sarah, Ellul, Fatima Zahraa Wafqui, David, W Borowski, Anne Sophie van Dalen, Cameron, Wells, Harissou, Adamou, Adesoji, Ademuyiwa, Adewale, Adisa, Kjetil, Søreide, Sara Al Saqqa, Osaid, Alser, Haya, Tahboub, Helmut Alfredo Segovia Lohse, Sebastian Shu Yip, Piotr, Major, António Sampaio Soares, Matei Razvan Bratu, Andrey, Litvin, Armen, Vardanyan, Ahmad, Gudal, Naif, Albati, Jovan, Juloski, Miran, Rems, Sarah, Rayne, Stephanie Van Straten, Yoshan, Moodley, Irene Ortega Vázquez, Jaime, Ruiz-Tovar, Kithsiri Janakantha Senanayake, Sujeewa Priyantha Bandara Thalgaspitiya, Omer Abdelbagi Omer, Anmar, Homeida, Yucel, Cengiz, Daniel, Clerc, Muhammad, Alshaar, Hanen, Bouaziz, Yuksel, Altinel, Matthew, Doe, Maryna, Freigofer, Ella, Teasdale, Rakan, Kabariti, Joshua Michael Clements, Stephen Richard Knight, Ahsan, Ashfaq, Ijeoma, Azodo, Gabriela, Wagner, Ivan, Trostchansky, Mayaba, Maimbo, David, Linyama, Helidon, Nina, Amanda, Zeko, Claudio Gabriel Fermani, Santiago, Villalobos, Federico, Carballo, Pablo, Farina, Sebastian, Guckenheimer, Marilla, Dickfos, Ankit, Ajmera, Chester, Chong, Ralph, Gourlay, Sikandar, Hussaini, Yi Jia Lee, Adeeb, Majid, Peter, Martin, Rebecca, Miles, Owen James Morris, Jamie, Phua, William, Ridley, Tarunpreet, Saluja, Ryan Renxin Tan, Jen, Teh, Anna, Wells, Bharti, Arora, Qaasim, Dollie, Debbie, Ho, Yanru, Ma, Omattage Mahasha Perera, Anthony, Truong, Amanda Caroline Dawson, Bryan, Lim, Upuli, Pahalawatta, Jacqueline, Phan, Xiao-Ming Sarah Woon-Shoo-Tong, Andrea, Yeoh, Lillian, Charman, Andrew, Drane, Sharon, Laura, Charmaine Chu Wen Lo, Amy, Mozes, Rita, Poon, Hao Han Tan, Ellen, Wall, Prakshi, Chopra, Jasmine De Giovanni, Bal, Dhital, Brian, Draganic, Alexander, Duller, Jonathan, Gani, Yao Kuan Goh, Jun Young Jeong, Brendan, Mcmanus, Prakash, Nagappan, Peter, Pockney, Anya, Rugendyke, Mahsa, Sarrami, Stephen, Smith, Vanessa, Wills, Hsu Ven Wong, Geoffrey, Ye, Geoffrey, Zhang, Ethan, Brooker, Daniel, Feng, Bonnie, Lau, Carlin, Ngai, Sarah, Birks, David, Gyorki, Jaime Otero de Pablos, Ali, Abbosh, Chris, Gillespie, Ahmed, Mahmoud, Bianca, Kwan, Joshua, Lawson, Andrea, Warwick, Janne, Bingham, Andrew, J Cockbain, Nagendra Naidu Dudi-Venkata, Jordan, Ellaby-Hall, Ben, Finlay, Emily, Humphries, Jade, Pisaniello, Monique, Pisaniello, Salma, Salih, Tarik, Sammour, Haidar Hadri Abd Wahab, April De Silva, Nicola, Hayward, Kartik, Iyer, Guy, Maddern, Gian Andrea Prevost, Naga, Annapureddy, Krishna Pranathi Settipalli, Jeremy, Yeo, Lucy, Hempenstall, Lily, Pham, Shaun, Purcell, Cherry, Talavera, Ashish, I Vaska, Gurpreet, Chaggar, Phillip, Chrapko, Annelise, Cocco, Sarah Michelle Crystal Jade Coulter-Nile, Grahame, Ctercteko, James, French, Houchen, Gong, Martijn, Gosselink, Thuvarahan, Jegathees, Ivan, Jin, Michelle, Kalachov, Kathryn, Kiefhaber, Katherine, Lee, Jason, Luong, Steven, Phan, Henry, Pleass, Kelly, Veale, Zhi, Zeng, Angela, Au, Ashe, Debiasio, Idy, Deng, Jananee, Myooran, Amrita, Nair, Peter, Stewart, Anton, Stift, Lukas Walter Unger, Kerstin, Wimmer, Nabila, Ahmed, Syed, Hasan, Saber, Rahman, Margaret, O'Shea, Greg, Padmore, Adrian, Peters, Pietro, Perduca, Guenda, Pulcina, Nicolas, Tinton, Frederic, Buxant, Elsa, Dabin, Giulia, Garofalo, Francis, Dossou, Freddy Houehanou Rodrigue Gnangnon, Yacoubou Imorou Souaibou, Pako, Motlaleselelo, Omphile, Tlhomelang, Igor Lima Buarque, Gustavo Mendonça Ataíde Gomes, Aldo Vieira Barros, Ilia, Batashki, Nikolai, Damianov, Vladislav, Stoyanov, Dragomir, Dardanov, Svilen, Maslyankov, Plamen, Petkov, George, Todorov, Evgeni, Zhivkov, Aygulya, Akisheva, Miguel Angel Castilla Moreno, Geno, Genov, Ivelina, Ilieva, Tsvetomir, Ivanov, Martin, Karamanliev, Azhar, Khan, Emil, Mitkov, Tsanko, Yotsov, Boyko, Atanasov, Nikolay, Belev, Mihail, Slavchev, Carlos, Nsengiyumva, Elgan, Jones, Simon, Stock, Steve, Kyota, James, Brown, Tresor Mabanza, K, Lemery Nigo Samuel, Chidi, Otuneme, Ngwang, Prosper, Franklin, Umenze, Marylise, Boutros, Natasha, Caminsky, Sinziana, Dumitra, Richard, Garfinkle, Dominique, Morency, Ebram, Salama, Alexander, Banks, Lorenzo, Ferri, Haitian, He, Amit, Katz, Alexander Sender Liberman, Sarkis, Meterissian, Allison, Pang, Elena, Parvez, Usmaan, Hameed, Fahima, Osman, Sangita, Sequeira, Natalie, Coburn, Alisha, Jaffer, Paul, Karanicolas, Matthew, Mosseler, Reilly, Musselman, Xinyuan, Liu, Ching Wan Yip, Juan Sebastian Garces-Otero, Carolina, Guzman, Sebastian, Sierra, Andres Uribe Valencia, Paulo Andrés Cabrera Rivera, Saul, Camelo, Andrea, Gonzalez, Alejandro, González-Orozco, Manuel Santiago Mosquera Paz, Carlos J- Perez Rivera, Felipe, Gonzalez, Andres, Isaza-Restrepo, Laura, Nino-Torres, Natalia Arias Madrid, Maria Clara Mendoza Arango, Justin, Tsandiraki, Damir, Jemendžić, Branislav, Kocman, Oliver, Šuman, Renata, Canic, Darko, Jurišić, Ivana, Karakas, Ana Krizanovic Rupcic, Vlatka, Pitlovic, Josip, Samardžić, Mario, Kopljar, Ivan, Bacic, Edgar, Domini, Robert, Karlo, Danijela, Miljanić, Andrea, Simic, Mariam, Ahmed, Majdi Al Nassrallah, Rabiya, Altaf, Talal, Amjad, Ruba, Eltoum, Heba, Haidar, Alhassan, Hassan, Omar, Khalil, Marwan, Qasem, Rommel, Ramesh, Gautham, Sajith, Maham, Wisal, Jan, Žatecký, Michele, Bujda, Katerina, Jirankova, Ales, Paclik, Aya, Abdallah, Mariam Abdulgawad Almogy, Esraa Ayman El-Sawy, Ahmed Moustafa ElFayoumy, Nourhan, Elghareeb, Nourhan Ahmed Esmat, Ahmed, Fadel, Abdullah, Habater, Heba, Hamdy, Amr, Hefni, Marwa, Kamal, Norhan Mohamed Abobakr, Ahmed, Sayed, Nancy, Shaker, Ehab, Taha, Hoda, Tharwat, Omar, Zakaria, Ibrahem, Abdelmotaleb, Ali, Al-Dhufri, Hamza, S Al-Himyari, Enas El Sheikh, Asmaa, Eldmaty, Aya, Elkhalawy, Ahmed, M Elkhashen, Kithara, Magdy, Safa, Mostafa, Habib Doutoum Sadia, Mohamed Mahmoud Saleh, Dina, Samir, Mohamed Yahia Mohamed Ali, Mahmoud, A Nassar, Samar, Abdelhady, Aly, Abdelrazek, Israa, Abdelsalam, Aya, El-Sawy, Eman, Essam, Mohamed, Gadelkarim, Khaled, Ghaly, Mohamed, Hassabalnaby, Rana, Masarani, Nourhan Mohamed Shaaban, Ahmed, Sabry, Menatalla, Salem, Nourhan Akram Soliman, Diaaaldin, Zahran, Moustafa Ramadan Abou El Soud, Esraa Tarek Badr, Hala, Borham, Nehal, Elmeslemany, Mohammad, Elsayed, Fawzia, Elsherif, Sara, Eslam, Gehad, Gaber, Sondos, Ibrahim, Yara, Kamh, Abdelrahman, Mahmoud, Shimaa Gamal Mohamed, Eman, Morshedy, Cinderella, Omar, Fatima Salem Soliman, Shaza, Abdelkawy, Naglaa, Abdelmohsen, Mahmoud, Abdelshakour, Ahmed, Dahy, Norhan, Gamal, Mohammed, Gamal, Ahmad, Hasan, Helal, Hetta, Nehad, Mousa, Mohamed, Omar, Somia, Rabie, Mahmoud, Saad, Bakeer, Saleh, Marwa Sayed Mohamed, Muhammad, Shawqi, Heba Abdelhady Mousa, Mostafa, Alnoury, Mohamed, Elbealawy, Ahmed, Elshafey, Muhammad Essam Ibrahim El Desouki Muhammad Ahmed, Mennatullah, Ghonaim, Fawzy, Hgag, Mohamed, Ibrahim, Mahmoud, Morsy, Mohamed Reda Loaloa, Ahmed, Refaat, Hadeer, Samir, Fatma, Shahien, Mohamed, Sobhy, Fathy, Sroor, Esraa, Abdellatif, Marina, Adel, Amr Abdelghani Afifi, Eman, Afifi, Marco, Antaky, Amr, Dawoud, Naira El Zoghby, Amira, El-Remaily, Ali Abdelazez Elzanfaly, Ahmed, Gadallah, Fatma Alzahraa Gamal, Omar, Hashem, Shrouk Medhat Youssef, Aliaa Muhammad Attyah, Malak, Munir, Omar, Shazly, Esraa, Taha, Karim, Wilson, Sawsan, Adel, Asmaa, Ali, Esraa, Eid, Esraa, Elhelow, Marwa, Elmahdy, Bassant, Elshatby, Amany Hossam El-Din Zakaria, Ahmad, Hossny, Eman, Ibrahim, Ahmed, M Yonis, Maram, Metwalli, Basant, Yousry, Esraa, Zid, Mina, A Yacoub, Ahmed, Abdelhakim, Nervana, Abouelsoad, Mo'Min, Alkhatib, Ahmed, Ashraf, Alaa, Ashraf, Yasmin, Elazab, Mahmoud, Elfanty, Osama, Elkabir, Mai, Elsayed, Ahmed, Elshimy, Hager, Elsobky, John, Eskander, Ahmed, Gad, Ward, Hamsho, Noura Khaled Abdelwahed, Menna, Magdy, Dalia, Moharam, Abeer, Osama, Shereen, Ramadan, Radwa, Roum, Taqwa, Sayed, Tarneem, Shehada, Ahmed Mohy Zidan, Khalid, Abbas, Amr, Ali, Mohamed, Attia, Mohamed, Balata, Ayman El Nakeeb, Mohamed Ibrahim Elsayed Elewaily, Ahmed, Elfallal, Hossam, Elfeki, Ahmed, Elkhadragy, Sameh, Emile, Helmy, Ezzat, Hasnaa, Hosni, Islam, Mansour, Waleed, Omar, Gehad, Othman, Kareem, Sadek, Mostafa, Shalaby, Noura, Shehab-Eldeen, Rawda Anas Khalifa, Helmy, Badr, Mostafa, Eldeep, Ahmed, Eldeep, Amany Eldoseuky Mohammed, Salwa, Khallaf, Eman Magdy Hegazy, Rokia, Mahmoud, Pola, Mikhail, Mahmoud, Morsi, Sara, Mowafy, Dina, Raafat, Amina, Safy, Marwa, Sera, Ahmed Shible Sera, Mostafa Salim Mohamed AbdAllah, Muhammad, Abdelkader, Abdulrahman Osama Abdou, Ahmedgaber, Ahmed, Shireen, Gaafar, Fatma Ibrahim Negm, Mina, Lapic, Ahmed, Maher, Hagar, Mahmoud, Ahmed, Mostafa, Mohamed, Samir, Fatma, Samy, Nourhan, Semeda, Hind, I Shalaby, Alaa, El-Taweel, Ahmed Galal Elnagar, Ahmed Gamal Hemidan, Mohamed, Hussein, Ahmed, A Kandil, Moawad, Mf, Ayat Allah Nasser Hamamah, Mostafa, Soliman, Mohamed, Abdelkhalek, Noura Abdelmaksoud Tawakel, Ahmed Mohamed Abdelwahed, Alrawy, Abdou, Khalid, Atallah, Mohammed Yasser Elsherbeny, Eman, Emara, Mohamed, Hamdy, Omar, Hamdy, Amira, Haron, Salma, Ismail, Islam Hany Metwally, Nihal Mohamed Hamed Elgaml, Ahmed, Nassar, Basel, Refky, Mirna, Sadek, Mahmoud, Saleh, Asmaa, Yunes, Mai, Zakaria, Mohammed, Zuhdy, Notila, Fayed, Mohammed Mustafa Hassan Mohammed, Sander, Kütner, Priit, Melnik, Indrek, Seire, Toomas, Ümarik, Eppu, Ainoa, Verner, Eerola, Hanna, Koppatz, Laura, Koskenvuo, Ville, Sallinen, Sini, Takala, Jevgeni, Katunin, Arto, Turunen, Niki, Christou, Muriel, Mathonnet, Vincent, Lavoue, Krystel Nyangoh Timoh, Lucie, Soulabaille, Romain, Lesourd, Aude, Merdrignac, Laurent, Sulpice, Benoît, André, Elodie, Chantalat, Charlotte, Vaysse, Bertrand, Dousset, Sebastien, Gaujoux, Gregory, Martin, Octavian, Clonda, Domantas, Juodis, Klaus, Kienle, Andras, Mravik, Samuel, Palmer, Gabor, Szabadhegyi, Anita Eseenam Agbeko, Solomon, Gyabaah, Frank Enoch Gyamfi, Nuhu, Naabo, Atta Owusu Senior, Joseph, Yorke, Frank, Owusu, Francis, Abantanga, Theophilus Teddy Kojo Anyomih, Abdul-Jalilu Mohammed Muntaka, Emmanuel Owusu Abem, Mohammed, Sheriff, Paul, M Wondoh, Dimitrios, Balalis, Dimitrios, Korkolis, Georgios, Gkiokas, Eirini, Pantiora, Theodosios, Theodosopoulos, Argyrios, Ioannidis, Konstantinos, Konstantinidis, Sofia, Konstantinidou, Nikolaos, Machairas, Anna, Paspala, Anastasia, Prodromidou, Christos, Chouliaras, Konstantinos, Papadopoulos, Ioannis, Baloyiannis, Ioannis, Mamaloudis, George, Tzovaras, Ioanna, Akrida, Maria-Ioanna, Argentou, Stylianos, Germanos, Evangelos, Iliopoulos, Ioannis, Maroulis, George, Skroubis, George, Theofanis, Christos, Chatzakis, Orestis, Ioannidis, Lydia, Loutzidou, Panagiotis, Karathanasis, Nikolaos, Michalopoulos, Charalampos, Theodoropoulos, Dimitrios, Theodorou, Tania, Triantafyllou, Zoe, Garoufalia, Natasha, Hasemaki, Michalis, Kontos, Gregory, Kouraklis, Stylianos, Kykalos, Theodore, Liakakos, Eustratia, Mpaili, Alexandros, Papalampros, Dimitrios, Schizas, Athanasios, Syllaios, Ekaterini Christina Tampaki, Antonios, Tsimpoukelis, Maria Ioanna Antonopoulou, Eirini, Deskou, Dimitrios, K Manatakis, Dimitrios, Papageorgiou, Menelaos, Zoulamoglou, Christos, Anthoulakis, Michalis, Margaritis, Nikolaos, Nikoloudis, Veronica, Campo, André, Ceballos, Mario-Andrés, Flores, Waleska, Giron, Donghyun, Ko, Gabriel, Martinez, Verónica Rivera Lara, Nataly, Rueda, Andres, Sanchez, Jorge Carlos Guillermo Tejeda Garrido, Alvaro Eduardo Alvarez Rivera, Elvis Benjamin Bamaca Ixcajoc, Lilian Elizabeth Barreda Zelaya, Patricia, Chacòn-Herrera, Ligia Margarita Corea Ruiz, Guillermo, Echeverria-Davila, Mario, Garcia, Danilo, García, Edgar Fernando Gutiérrez Mayen, Noriega, José, Nery, Mazariegos, Diego, Méndez, Michael Paniagua Espinoza, David, Bardos, Marton, Benke, Kristof, Illes, Balint András Kokas, Réka, Szabó, Akhila, Appukuttan, Anjitha, Asok, D K, Vijaykumar, Kapil, Malik, Praveen, Ravishankaran, Ritesh, Tapkire, Guru, Moorthy, Joyner, Abraham, Ramesh, Muthuvel, John, Alapatt, Abhay, Kattepur, Nizamudheen, Pareekutty, Mebanshanbor, Garod, Caleb, Harris, Cliff, Wanniang, Ashish, Gupta, Deepak, Nehra, Sanjeev, Parshad, Rajgopal, Acharya, Rajendra, Badwe, Manish, Bhandare, Urvashi, Jain, Karishma, Kirti, Nita, Nair, Shailesh, Shrikhande, Purvi, Thakkar, Premkumar, Anandan, C S, Archana, Arun Holenarasipur Narasannaiah, Tejaswi, Jagarlamudi, M R, Rashmi, Mallikarjuna, Manangi, Abhishek, Raghavendra, K Seshagiri Rao, Vinay, S, Vinay, Sajjan, Aneesh, Shenoy, Santhosh Shivashankar Chikkanayakanahalli, Kavya, Tharanath, Sushmita, V, Peter, Adidharma, Raksheeth, Agarwal, Phebe Anggita Gultom, Ghafur Rasyid Arifin, Matthew, Billy, Zatira, Elfizri, Alessa, Fahira, Devi, Felicia, Triana Hardianti Gunardi, Nadya, Johanna, Nadia Rahmadiani Nugrahadi, Sonar Soni Panigoro, Siti, Rahmayanti, Retta Catherina Sihotang, Santi Yuanita Brata, Hadi, Winoto, Nastaran, Barati, Manoochehr, Karami, Hamidreza, Khorshidi, Homa, Naderifar, Mazin, A Abdulla, Maggie, Coleman, Ronan, J Doherty, Rob, Hannon, Brenda, Murphy, Aine, Stakelum, Des, Winter, Lylas, Aljohmani, Richard, Farnan, Yeshey, Seldon, Tanna, Tan, Shriya, Varghese, Mohammad, Alherz, Muaaz, Ather, Mohammad, Bajilan, Vivien, Graziadei, Isobel, Pilkington, Omar, Quidwai, Paul, Ridgway, Haaris, Shiwani, Abd Al-Rahman Tahir, Eimear, Blunnie, Daniel, Burke, Niall, Kennedy, Kate, Macdonagh, Maeve, O'Neill, Siobhan, Rooney, Giuseppe, Falco, Guglielmo, Ferrari, Simone, Mele, Gabriela Elisa Nita, Lara, Ugoletti, Maurizio, Zizzo, Gianmaria, Confalonieri, Giovanni, Pesenti, Fulvio, Tagliabue, Gianluca, Baronio, Deborah, Ongaro, Giacomo, Pata, Bruno, Compagnoni, Renato, Salvadori, Lucio, Taglietti, Nicola, D'Alessandro, Pierpaolo Di Lascio, Giovanni, Pascale, Luca, Bortolasi, Tommaso, Campagnaro, Massimo, Carlini, Giorgio, Lisi, Davide, Lombardi, Corrado, Pedrazzani, Domenico, Spoletini, Giulia, Turri, Paola, Violi, Donato Francesco Altomare, Fabrizio, Aquilino, Nicola, Musa, Vincenzo, Papagni, Arcangelo, Picciariello, Leonardo, Vincenti, Dario, Andreotti, Savino, Occhionorelli, Matteo, Tondo, Stefano Maria Massimiliano Basso, Paolo, Ubiali, Riccardo, Cirelli, Marco Enrico Mario Maino, Guglielmo Niccolò Piozzi, Emanuele, Picone, Rosa, Scaramuzzo, Giovanni, Sinibaldi, Alfonso, Amendola, Lorenzo, Anastasio, Luigi, Bucci, Emanuele, Caruso, Antonio, Castaldi, Sara Di Maso, Vincenza Paola Dinuzzi, Giovanni, Esposito, Maria, Gaudiello, Mariano Cesare Giglio, Paola Antonella Greco, Gaetano, Luglio, Andrea, Manfreda, Ester, Marra, Federica, Mastella, Gianluca, Pagano, Roberto, Peltrini, Vincenzo, Pepe, Michele, Sacco, Viviana, Sollazzo, Giovanni, Spiezio, Ettore, Cianchetti, Nunzia, Menduni, Michele Maria Carvello, Francesca Di Candido, Antonino, Spinelli, Fabio, Corsi, Luca, Sorrentino, Fabio, Marino, Emanuele Luigi Giuseppe Asti, Luigi, Bonavina, Emanuele, Rausa, Martina, Asta, Andrea, Belli, Francesco, Bianco, Carmela, Cervone, Paolo, Delrio, Armando, Falato, Andrea Fares Bucci, Rita, Guarino, Ugo, Pace, Daniela, Rega, Emilia De Luca, Gaetano, Gallo, Giuseppe, Sammarco, Giuseppe, Sena, Giuseppina, Vescio, Letizia, Santandrea, Giampaolo, Ugolini, Davide, Zattoni, Nicola, Chetta, Gaetano, Logrieco, Serafino, Vanella, Gianluca, Garulli, Nicola, Zanini, Andrea, Bondurri, Francesco, Cammarata, Francesco, Colombo, Diego, Foschi, Giulia Maria Beatrice Lamperti, Anna, Maffioli, Gianluca Matteo Sampietro, Al'Ona, Yakushkina, Gloria, Zaffaroni, Enrico, Cicuttin, Maria Grazia Sibilla, Harmony, Impellizzeri, Marco, Inama, Gianluigi, Moretto, Sylvie, Mochet, Elisa, Ponte, Antonella, Usai, Stefano, Mancini, Andrea, Sagnotta, Luigi, Solinas, Elisa, Bolzonaro, Nicolò, Tamini, Gianluca, Curletti, Raffaele, Galleano, Michele, Malerba, Sofia, Campanella, Gianfranco, Cocorullo, Francesco, Colli, Paolino De Marco, Nicolò, Falco, Tommaso, Fontana, Leonel Jospin Kamdem Mambou, Antonella La Brocca, Leo, Licari, Brenda, Randisi, Giovanna, Rizzo, Giulia, Rotolo, Giuseppe, Salamone, Roberta, Tutino, Paolina, Venturelli, Stefano, Malabarba, Alessandro, Sgrò, Ivan, Vella, Bruno, Cirillo, Daniele, Crocetti, Giorgio De Toma, Pierfrancesco, Lapolla, Andrea, Mingoli, Paolo, Sapienza, Angela, Belvedere, Stefania, Bianchini, Margherita, Binetti, Arianna, Birindelli, Valeria, Tonini, Mauro, Podda, Fabio, Pulighe, Michele De Rosa, Lorenzo, Bono, Felice, Borghi, Paolo, Geretto, Maria Carmela Giuffrida, Corrado, Lauro, Alessandra, Marano, Luca, Pellegrino, Paola, Salusso, Diego, Sasia, Michela, Campanelli, Alberto Realis Luc, Mario, Trompetto, Roberto, Cardia, Nicola, Cillara, Antonio Nicola Giordano, Antonio, Costanzo, Mario Alessandro Giovilli, Luca, Turati, Silvestro, Canonico, Sciaudone, Guido, Francesco, Selvaggi, Lucio, Selvaggi, Nader, Albsoul, Ahmad, Albsoul, Ala'a Aldeen Alkhatib, Osama, Alsallaq, Justin, Z Amarin, Rami, Ayoub, Isam, Bsisu, S El Muhtaseb, M, Mohammad, Jabaiti, Jamal, Melhem, Yasmeen, Z Qwaider, Mohammad Hasan Salameh, Ahmad, Suleihat, Haya, H Suradi, Mohammad, Alammarin, Almoutuz, Aljaafreh, Mohammad Bani Hani, Zeina Bani Hani, Farah Bani Hani, Toqa, Fahmawee, Shadi, Hamouri, Cyrine, Katanani, Ra'Fat, Tawalbeh, Tamara, Tawalbeh, Hassan, Zawahrah, Mohamad, K Abou Chaar, Lana, Abusalem, Mahmoud, Al-Masri, Hani, Al-Najjar, Lutfi, Barghuthi, Zahra, Ahmed, Adnan, Maulana, Omar, Ngotho, Charbel, Kamau, Aruyaru Stanley Mwenda, Fridah, Bosire, Elizabeth, Mwachiro, Robert, Parker, Ian, Simel, Kimutai, Sylvester, Abdulmunem Ahmed Mustafa Althini, Sofian, Elbarouni, Aya Elseed Elbeshina, Ahmed, Gwea, Ans, Malek, Wedad Albashir Masoud Farag, Abdulwahab, Abdalei, Abu Baker Abdel Malik, Areej, Abo-Khammash, Ma'Aly, Abuhlaiga, Nour, Adnan, Marwa, Albaggar, Asma, Alfitory, Asma, Aljanfi, Fakhruddin, Almuzghi, Zohoor, Altumei, Fatima, Alzabti, Hana, Ashoushan, Mohamed, Assalhi, Joma, Azzubia, Sondos, Bnhameida, Malik, Delhen, Houssein, 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Alcides Ylatoma Díaz, Mark Anthony Fontanilla, Joseph Roy Fuentes, Anna Leah Salazar, Genieve, Dominguez, Marc Paul Lopez, Shiela, Macalindong, Mark Augustine Onglao, Arjel, Ramirez, Marie Dione Sacdalan, Mayou Martin Tampo, Gemma Leonora Uy, Jeremiah, Mangahas, Kenneth, Yabut, Joannes Paul Cañete, Bernalynn Eris Cansana, Ernes John Castro, Maria Kaiserin Lipana, Manuel Francisco Roxas, Vlu Jean Zara, Maciej, Chroł, Paula, Franczak, Michał, Orłowski, Piotr, Budzyński, Andrzej, Budzyński, Pawel, Bury, Agata, Czerwińska, Jadwiga, Dworak, Jacek, Dziedzic, Michał, Kisielewski, Jan, Kulawik, Anna, Lasek, Piotr, Małczak, Marcin, Migaczewski, Michał, Pędziwiatr, Magdalena, Pisarska, Dorota, Radkowiak, Mateusz, Rubinkiewicz, Anna, Rzepa, Tomasz, Skoczylas, Maciej, Stanek, Katarzyna, Truszkiewicz, Mateusz, Wierdak, Marek, Winiarski, Piotr, Zarzycki, Anna, Zub-Pokrowiecka, Piotr, Kowalewski, Rafał, Roszkowski, Maciej, Walędziak, Miguel, Tomé, Sara, Patrocinio, Ines, Guerreiro, Filipe, Almeida, 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García, Pastora Rodriguez Fraga, Gonzalo De Castro Parga, Maria Pilar Fernández Veiga, Lucía Garrido López, Hugo Infante Pino, Irene Lages Cal, Marta López Otero, Manuel Nogueira Sixto, Marta Paniagua García Señorans, Laura Rodríguez Fernández, Alejandro Ruano Poblador, Erika Rufo Crespo, Raquel, Sanchez-Santos, Vincenzo, Vigorita, Ester Alonso Batanero, Dorisme, Asnel, Isabel Cifrian Canales, Elisa Contreras Saiz, Irene De Santiago Alvarez, Tamara Díaz Vico, Sebastian Fernandez Arias, Daniel Fernández Martínez, Carmen García Bernardo, Luis Joaquín García Flórez, Carmen Garcia Gutierrez, Manuel García Munar, Carlos Alberto Márquez Zorrilla Molina, Marta, Merayo, José Luis Michi Campos, Maria Moreno Gijon, Jorge, L Otero-Diez, Jose Luis Rodicio Miravalles, Lorena, Solar-Garcia, Aida Suárez Sánchez, Nuria, Truan, Cristina Alejandre Villalobos, Yurena Caballero Díaz, Marta, Jimenez, Dacil, Montesdeoca, Antonio, Navarro-Sánchez, Victor, Vega, Juan Beltrán de Heredia, Zahira, Gómez, Carlos, 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M., Martin-Borregon, P., Martinez Caballero, J., Nevado Garcia, C., Rodriguez Fraga, P., De Castro Parga, G., Fernandez Veiga, M. P., Garrido Lopez, L., Infante Pino, H., Lages Cal, I., Lopez Otero, M., Nogueira Sixto, M., Paniagua Garcia Senorans, M., Rodriguez Fernandez, L., Ruano Poblador, A., Rufo Crespo, E., Sanchez-Santos, R., Vigorita, V., Alonso Batanero, E., Asnel, D., Cifrian Canales, I., Contreras Saiz, E., De Santiago Alvarez, I., Diaz Vico, T., Fernandez Arias, S., Fernandez Martinez, D., Garcia Bernardo, C., Garcia Florez, L. J., Garcia Gutierrez, C., Garcia Munar, M., Marquez Zorrilla Molina, C. A., Merayo, M., Michi Campos, J. L., Moreno Gijon, M., Otero-Diez, J. L., Rodicio Miravalles, J. L., Solar-Garcia, L., Suarez Sanchez, A., Truan, N., Alejandre Villalobos, C., Caballero Diaz, Y., Jimenez, M., Montesdeoca, D., Navarro-Sanchez, A., Vega, V., Beltran de Heredia, J., Gomez, Z., Jezieniecki, C., Legido Moran, A. P., Montes-Manrique, M., Rodriguez-Lopez, M., Ruiz Soriano, M., Trujillo Diaz, J., Vazquez Fernandez, A., Argudo, N., Pera, M., Torrent Jansa, L., Garcia Dominguez, M., Goded, I., Roldon Golet, M., Talal El-Abur, I., Utrilla Fornals, A., Zambrana Campos, V., Aguilar Martinez, M. D. M., Bosch, M., Garcia-Catala, L., Sanchez-Guillen, L., Artigau, E., Gomez Romeu, N., Julia Bergkvist, D., Espina Perez, B., Morato, O., Olona, C., Dieguez, B., Forero-Torres, A., Losada, M., Gomez-Abril, S., Gonzalvez, P., Martinez, R., Navarro Martinez, S., Paya-Llorente, C., Perez Rubio, A., Santarrufina Martinez, S., Sebastian Tomas, J. C., Trullenque Juan, R., Gegundez Simon, A., Mate, P., Prieto-Nieto, M. I., Rubio-Perez, I., Urbieta, A., Vicario Bravo, M., Abello, D., Frasson, M., Garcia-Granero, A., Abad Gurumeta, A., Abad-Motos, A., Lucena-de Pablo, E., Nozal, B., Ripolles-Melchor, J., Salvachua, R., Ferrero, E., Garcia-Sancho Tellez, L., Picardo, A. L., Rojo Lopez, J. A., Zorrilla Matilla, L. P., Cagigas Fernandez, C., Castanedo Bezanilla, S., Estevez Tesouro, J., Fernandez-Diaz, M. J., Garcia Cardo, J., Gomez Ruiz, M., Gonzalez-Tolaretxipi, E., Jimeno Fraile, J., Poch, C., Rodriguez-Aguirre, M., Troche Pesqueira, N., Trugeda-Carrera, M. S., de la Torre, J., Blanco-Colino, R., Espin-Basany, E., Espinosa-Bravo, M., Morales Comas, C., Reyes Afonso, E., Rivero Deniz, J., Siso Raber, C., Verdaguer Tremolosa, M., Chandrasinghe, P., Kumarage, S., Wijekoon Arachchilage, N., Abdalla Ahmed Elkamel, A., A. Adam, M., Blomme, N., Thorell, A., Wogensen, F., Alga, A., Ansarei, D., Celebioglu, F., Heinius, G., Nigard, L., Pieniowski, E., Ahlqvist, S., Bjorklund, I., Franberg, A., Hakansson, M., Adamo, K., Franklin, O., Sund, M., Wiberg, R., Andersson, Y., Chabok, A., Nikberg, M., Kugelberg, A., Canonica, C., Christoforidis, D., Fasolini, F., Gaffuri, P., Giuliani, M., Meani, F., Popeskou, S. G., Pozza, S., Wandschneider, W., Peterer, L., Widmer, L. W., Zimmermann, B., Bakoleas, P., Chanousi, I., Charalampidou, L., Grochola, L. F., Heid, F., Ntaoulas, S., Outos, M., Peros, G., Podolska-Skoczek, H., Reinisch, K. B., Zielasek, C., Demartines, N., Gilgien, J., Kefleyesus, A., St-Amour, P., Toussaint, A., Alhimyar, M., Alsaid, B., Alyafi, A., Alkhaledi, A., Kouz, B., Omarain, A., Al-Sabbagh, Y., Alkhatib, H., Sara, S., Alhaj, A., Danial, A., Kadoura, L., Maa Albared, S., Monawar, Y., Nahas, L., Abd, B., Saad, A., Wakkaf, H., Bouzaiene, H., Ghalleb, M., Akaydin, E., Akbaba, A. C., Atakul, O., Baltaci, E., Besli, S., Burgu, G., Cenal, U., de Muijnck, C., Demirkaya, H. C., Dogruoz, A., Gezer, Z. I., Gundogdu, Y., Kara, M., Korkmaz, H. K., Kurtoglu, G. K., Ozben, V., Ozmen, B. B., Pektas, A. M., Sel, E. K., Yenidunya, N., Bengur, F. B., Oral, B. M., Yozgatli, T. K., Abdullayev, S., Gunes, M. E., Sahbaz, N. A., Banaz, T., Kargici, K., Kuyumcu, O. F., Yanikoglu, E., Yesilsancak, M., Yilmaz, D., Aktas, M. K., Rencuzogullari, A., Isik, A., Leventoglu, S., Yalcinkaya, A., Yuksel, O., Kalayci, M. U., Kara, Y., Sarici, I. S., Akin, A., Alemdag, G. N., Arslan, E., Baki, B. E., Bodur, M. S., Calik, A., Candas Altinbas, B., Cihanyurdu, I., Erkul, O., Gul, B., Guner, A., Kose, B., Semiz, A., Sevim, Tayar, S., Tomas, K., Tufek, O. Y., Turkyilmaz, S., Ulusahin, M., Usta, A., Yildirim, R., Guler, S. A., Tatar, O. C., Varol, E., Kirimtay, B., Uysal, M., Yildiz, A., Kose, E., Ciftci, A. B., Colak, E., Eraslan, H., Kucuk, G. O., Yemez, K., Lule, H., Bienfait, M., Bua, E., Okalany, N., Basarab, M., Bielosludtsev, O., Kolhanova, K., Perepelytsia, K., Romanukha, K., Savenkov, D., Siryi, S., Tereshchenko, M., Viacheslav, N., Volovetskyi, A., Kebkalo, A., Tryliskyy, Y., Tyselskiy, V., Bruce, E., Chow, B. L., Iddles, E., Mcguckin, S., Newall, N., Ramsay, G., Sharma, P., Stewart, C., Wong, J., Badran, A., Bath, M., Belais, F., Butt, E., Joshi, K., Kapur, M., Shaw, M., Townson, A., Williams, C. Y. K., Gray, T., Greig, R., Husain, M., Murray, E., Mustafa, A., Asif, A., Gokul, A., Shah, M., Akitikori, M. T., Charalabopoulos, A., Davidson, S., Mcnally, S., Rupani, S., Juma, F., Mills, S. C., Muirhead, L., Sellars, K., Walsh, U., Warren, O., Chambers, A., Hunt, R., Boyce, S., Cornwall, H., Tol, I., Argyriou, E. O., Eardley, N., Povey, M., Aithie, J. M. S., Irfan, A., Mcguigan, M. -C., Starr, R., Warren, C. R., Archibald, J., Kirby, G., Kisyov, I., Khoo, C. K., Lee, R., Photiou, D., Davis, R., Prasad, U., Yang, P. Z., Bird, J., Leung, E., Summerour, V., Currow, C., Kiam, J., Tan, G. J. S., Muthusami, A., Pegba-Otemolu, I., Urbonas, T., Nunoo-Mensah, J., Smolskas, E., Boddy, A., Gravante, G., Hunter, D., Andrew, D., Koh, A., Thompson, A., Adams, L., Clements, H. A., De Silva, K., Ekpete, O., Haque, S., Henderson, S., Ibrahim, B., Jayasinghe, T., Livie, J., Mailley, K., Nair, G., Tan, D., Baggaley, C., Dawidziuk, A., Szyszka, B., Barter, C., Gandhi, N., Hassell, K., Hitchin, S., Kelsall, J., Nagy, E., Nessa, A., Whisker, L., Yanni, F., Ali, M., Arora, D., Hediwattege, S., Kumarasinghe, N., Rathore, M., Tennakoon, A., Ali Ahmad, S. M., Bajomo, O., Nadira, F., Celentano, V., Griffiths, E., Karri, R. S., Mak, J. K. C., Pipe, M., Bhatti, M. I., Rabie, M., Boyle, C., Hamilton, D., Mihuna, A., Ng, J. C. K., Nicholson, G., Oliwa, A., Pearson, R., Rose, A., Yong, S. Q., Boereboom, C., Hanna, M., Walter, C., Greensmith, T. S., Mitchell, R., Monaghan, E., Crawford, J., Moug, S., Blackwell, J., Boyd-Carson, H., Herrod, P., Al-Allaf, O., Beattie, M., Bullock, C., Burman, S., Clark, G., Flamey, N., Flannery, O., Harding, A., Kodiatt, B., Lawday, S., Mahapatra, S., Mukundu Nagesh, N., Ng, M., Rye, D., Yoong, A., Clark, L., Deans, C., Edirisooriya, M., Carrington, E. V., Wong, T. L. E., Yusuf, B., Chamberlain, C., Duke, K., Kmiotek, E., Botes, A., Condie, N., Schrire, T., Shah, R., Thomas-Jones, I., Yates, C., Anthony, N., Matthews, E., Sahnan, K., Tankel, J., Tucker, S., Winter Beatty, J., Ziprin, P., Duggan, W., Kantartzi, A., Sridhar, S., Khaw, R. A., Srivastava, P., Underwood, C., Alves do Canto Brum, H., Chopra, S., Davis, L., Hughes, R., Tulley, J., Alberts, J., Athisayaraj, T., Olugbemi, M., Ahmad, K., Chan, C., Chapman, G., Fleming, H., Fox, B., Grewar, J., Hulse, K., Rutherford, D., Sinead, M., Speake, D., Vaughan-Shaw, P. G., Christodoulides, N., Kudhail, S., Welch, M., Husaini, S. M., Lambracos, S., Anyanwu, C., Suresh, R., Thomas, J. S., Gleeson, E., Platoff, R., Saif, A., Enumah, Z., Etchill, E., Gabre-Kidan, A., Bernstein, M., Carrano, F. M., Connors, J., Lynn, P., Melis, M., Newman, E., Foster, D. S., Perrone, K., Titan, A., Ahmad, S., Bafford, A. C. M. D., Dal Molin, M., Hanna, N., Zafar, S. N., Hemmila, M., Napolitano, L., Wong, J. J., Chandler, J., Wood, L., Wren, S., Ottesen, T., You, L., Yu, K., Arcienega Yanez, M. D. P., Ferreira Fernandes, M., Gonzalez, D., Cubas, S., Gonzalez, M. C., Zubiaurre, V., Demolin, R., Giroff, N., Sciuto, P., Campos, M., Rodriguez Cantera, G., Deepika, G., Simuchimba, E., Bulaya, A., Chibuye, C., Chirengendure, B., Kabale, M. -R., Kabongo, K., Munthali, J., Mweso, O., Pikiti, F., Otieno, J., Lai, L. T., Blackman, B., Subramaniam, S., Karim, R., Kok, N., Lee, Y. D., Ali, S., Sinha, A., Corrigan, R., Barnes, N., Wong, F., Dennis, G., Jedamzik, J., Phillips, E., Piette, W., Van hentenryck, M., Koco, H., Lawani, S., Kassa, M. W., Santos Bezerra, T., Gribnev, P., Dimitrov, D., Krastev, P., Oum, S., Bonghaseh, D. T., Al Farsi, M., Alsharqawi, N., Acevedo, V., Castillo Barbosa, A. C., Giron, F., Leon Rodriguez, J. P., Kucan, D., Rosko, D., Barsic, N., Zupan, D., Hegazi, A., Truncikova, V., Fryba, V., Mohamed, M., Nagi, A., Rashad Temerik, A., Elshawy, M. E., Mahmoud, M. I., Anwar, M., Rageh, T., Elmokadem, A., Gaballa, K., Teppo, S., Pengerma, P., Ballouhey, Q., Bergeat, D., Weyl, A., Hain, E., Gyedu, A., Yenli, E., Osei-Poku, D., Rompou, V. -A., Zoikas, A., Gaitanidis, A., Koukis, G., Perivoliotis, K., Tavlas, P., Galanos-Demiris, K., Zografos, G., Karavokyros, I., Xanthopoulou, G., Iordanidou, E., Ayau, F., Garcia, A., Damjan, P., Wason, D., B L, A., Rangganata, E., Kamath, P., O'Connor, D. B., Pinto, M., Perrone, F., Tropeano, F. P., Troilo, F., Bossi, D., Scala, D., Pulitano, L., Carella, M., Pietrabissa, A., Gori, A., Giraudo, G., De Simone, V., Russo, A. A., Braccio, B., Al-Taher, R., Athamneh, S., Parker, A., Sawiee, A., Kattia, A., Tababa, O., Shaeeb, Z., Syminas, V., Jurgaitis, J., Damuleviciene, G., Svagzdys, S., Razafimanjato, N. N. M., Chieng Loo, L., Tiong, I. C., Wan Muhmad, W. F., Vijeyan, H., Li Ying, T., Grech, G., Arrangoiz, R., Jimenez Ley, V. B., Arizpe, D., Lagunes Lara, E., Castro Lopez, E. V., Eaazim, J., Gordinou de Gouberville, M., Bastiaenen, V., Rottier, S., Nahab, F., Ji, M. Y., Seyoji, M., Nwachukwu, C., Emeghara, O., Muhammed, S. E., Idowu, A., Sowemimo, O., Ogundoyin, O., Akande, O., Lott, A., Nadeem, M., Laghari, A. A., Loya, A., Mushtaq, H., Abdullah, M. T., Abuhilal, B., Atawneh, M., Hamdan, H., Alhabil, B., Srour, A., Mousa, I., Da Silva Medina, L., Bartosiak, K., Ferreira, P., Francisco, V., Lemos, R., Frutuoso, L., Fernandes, S., Fonseca, T., Pereira, J., Rachadell, J., Torre, A., Madeira Martins, F., Carvalho, A. C., Rodrigues Ferreira, J., Ribeiro da Silva, B., Devesa, H., Vieira, A., Monica, I., Amaro, M., Sousa, D., Reia, M., Louro, J., Martins, A., Dominguez, J., Santos, I., Freitas Oliveira, N. M., Pereira, J. C., Silva-Vaz, P., Freire, L., Escrevente, R., Negoita, V. M., Shakhmatov, D., Nezerwa, Y., Radulovic, R., Obery, G., Viljoen, F., Mendes, T., Suarez, A., Moncada, E., Fernandez-Hevia, M., Curtis Martinez, C., Gil Garcia, J. M., Gonzalez Zunzarren, M., Idris, T., Eklov, K., Grahn, O., Amin, L., Blomqvist, M., Ajani, C., Kraus, R., Seeger, N., Willemin, M., Rayya, F., Ayash, M., Msouti, R., Kannas, I., Abazid, E., Esper, A., Slim, S., Kavcar, A. S., Aytac, E., Dural, A. C., Ilker, A., Eray, I. C., Kurnaz, E., Altiner, S., Tepe, M. D., Sahin, C., Savli, E., Innocent, A., Babirye, L., Diachenko, A., Hordoskiy, V., Curry, H., Chau, C. Y. C., Robertson, H., Lennon, H., Loi, L., Kirkham, E., Mccann, C., Watts, D., Gurung, B., Wilson, M., Tribedi, T., Garofalo, E., Zahra, B., Macdonald, S., Daniels, I., Ng, N., Khosla, S., Olivier, J., Yue, S. Y. P., Suresh, G., Wellington, J., Lorejo, E., Mossaad, M., Crutcher, M., Alimi, M., Baiu, I., Abdou, H., Conway, A., Peck, C., Perdomo Perez, M. A., Zulu, S., Nakazwe, M., Burger, S., Davies, J., Donaldson, R., Ede, C., Garden, O. J., Lesetedi, C., Mabedi, C., Magill, L., Makinde Alakaloko, F., Makupe, A., Monahan, M., Mulira, S., Muller, E., Musowoyo, J., Olory-Togbe, J. L., Roberts, T., Smith, M., Tayler, V., Windsor, J., Yepez, R., Sundar, S., Runigamugabo, E., Verjee, A., Chen, J., Daya, L., El Aroussi, N., Farina, V., Gnintedeme Olivier, T., Gonzales Nacarino, M., Hammani, A., Honjo, S., Jacobs, R., Kimura, H., Nkoronko, M., Oscullo Yepez, J. J., Pin Hung, W., Raj, A., Romani Pozo, A., Rommaneh, M., Sassamela Fabiano, S. C., Shiroma Gago, C. M., Srinivas, A., Sung, C. -Y., Tai, A., Valle Aranda, Y. C., Venturini, S., Wilguens Lartigue, J., Public and occupational health, AMS - Sports, APH - Health Behaviors & Chronic Diseases, CCA - Cancer Treatment and quality of life, Amsterdam Gastroenterology Endocrinology Metabolism, Cancer Center Amsterdam, and Albarella, Sara
Subjects: global surgery, hospitals, humans, income, neoplasms, postoperative period, poverty, prospective studies, no keywords listed, General Medicine, Prospective Studie, Hospital, Settore MED/18 - Chirurgia Generale, outcome, Hospitals, Humans, Income, Neoplasms, surgery, Postoperative Period, Poverty, Prospective Studies, cancer surgery, Human, hospital facilities
Abstract: © 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 licenseBackground: Early death after cancer surgery is higher in low-income and middle-income countries (LMICs) compared with in high-income countries, yet the impact of facility characteristics on early postoperative outcomes is unknown. The aim of this study was to examine the association between hospital infrastructure, resource availability, and processes on early outcomes after cancer surgery worldwide. Methods: A multimethods analysis was performed as part of the GlobalSurg 3 study—a multicentre, international, prospective cohort study of patients who had surgery for breast, colorectal, or gastric cancer. The primary outcomes were 30-day mortality and 30-day major complication rates. Potentially beneficial hospital facilities were identified by variable selection to select those associated with 30-day mortality. Adjusted outcomes were determined using generalised estimating equations to account for patient characteristics and country-income group, with population stratification by hospital. Findings: Between April 1, 2018, and April 23, 2019, facility-level data were collected for 9685 patients across 238 hospitals in 66 countries (91 hospitals in 20 high-income countries; 57 hospitals in 19 upper-middle-income countries; and 90 hospitals in 27 low-income to lower-middle-income countries). The availability of five hospital facilities was inversely associated with mortality: ultrasound, CT scanner, critical care unit, opioid analgesia, and oncologist. After adjustment for case-mix and country income group, hospitals with three or fewer of these facilities (62 hospitals, 1294 patients) had higher mortality compared with those with four or five (adjusted odds ratio [OR] 3·85 [95% CI 2·58–5·75]; p
Published: 2022

12. Indoor Urban Environment and Conventional Risk Factors for Pediatric Tuberculosis Among 1–12 Years Old Children in a Megacity in Pakistan: A Matched Case–Control Study

Author: Ambreen Sahito, Zafar Fatmi, Muhammad Masood Kadir, and Fehmina Arif
Subjects: Male, Pulmonary and Respiratory Medicine, Adolescent, Infant, Risk Factors, Child, Preschool, Case-Control Studies, Air Pollution, Indoor, Pediatrics, Perinatology and Child Health, Humans, Tuberculosis, Immunology and Allergy, Female, Pakistan, Child, Tuberculosis, Pulmonary
Published: 2022

13. Microbe-based therapies for colorectal cancer: Advantages and limitations

Author: Ahmad Almatroudi, Ramesh C. Gupta, Shamama Javed, Ambreen Shoaib, Mohd Saeed, Raghuram Kandimalla, and Farrukh Aqil
Subjects: Male, 0301 basic medicine, Cancer Research, Colorectal cancer, Gut flora, Bioinformatics, 03 medical and health sciences, Dietary interventions, 0302 clinical medicine, Human gut, medicine, Humans, biology, business.industry, Probiotics, Microbiota, Cancer, Fecal bacteriotherapy, medicine.disease, biology.organism_classification, Gastrointestinal Microbiome, Prebiotics, 030104 developmental biology, 030220 oncology & carcinogenesis, Cancer cell, Female, Lifetime risk, Colorectal Neoplasms, business
Abstract: Cancer is one of the leading global causes of death in both men and women. Colorectal cancer (CRC) alone accounts for ∼10 % of total new global cases and poses an over 4% lifetime risk of developing cancer. Recent advancements in the field of biotechnology and microbiology concocted novel microbe-based therapies to treat various cancers, including CRC. Microbes have been explored for human use since centuries, especially for the treatment of various ailments. The utility of microbes in cancer therapeutics is widely explored, and various bacteria, fungi, and viruses are currently in use for the development of cancer therapeutics. The human gut hosts about 100 trillion microbes that release their metabolites in active, inactive, or dead conditions. Microbial secondary metabolites, proteins, immunotoxins, and enzymes are used to target cancer cells to induce cell cycle arrest, apoptosis, and death. Various approaches, such as dietary interventions, the use of prebiotics and probiotics, and fecal microbiota transplantation have been used to modulate the gut microbiota in order to prevent or treat CRC pathogenesis. The present review highlights the role of the gut microbiota in CRC precipitation, the potential mechanisms and use of microorganisms as CRC biomarkers, and strategies to modulate microbiota for the prevention and treatment of CRC.
Published: 2022

14. SLGT2 Inhibitor Rescues Myelopoiesis in G6PC3 Deficiency

Author: Prashant Hiwarkar, Umair Bargir, Ambreen Pandrowala, Minnie Bodhanwala, Naresh Thakker, Prasad Taur, Manisha Madkaikar, and Mukesh Desai
Subjects: Myelopoiesis, Adult, Neutropenia, Monosaccharide Transport Proteins, Immunology, Glycogen Storage Disease Type I, Antiporters, Phosphoric Monoester Hydrolases, Mice, Glucose-6-Phosphatase, Quality of Life, Animals, Humans, Immunology and Allergy, Female, Sodium-Glucose Transporter 2 Inhibitors
Abstract: The energy metabolism of myeloid cells depends primarily on glycolysis. 1,5-anhydroglucitol (1,5AG), a natural monosaccharide is erroneously phosphorylated by glucose-phosphorylating enzymes to produce 1,5-anhydroglucitol-6-phosphate (1,5AG6P), a powerful inhibitor of hexokinases. The endoplasmic reticulum transporter (SLC37A4/G6PT) and the phosphatase G6PC3 co-operate to dephosphorylate 1,5AG6P. Failure to eliminate 1,5AG6P is the mechanism of neutrophil dysfunction and death in G6PC3-deficient mice. SLGT2-inhibitor reduces 1,5AG level in the blood and restores the neutrophil count in G6PC3-deficient mice. In the investigator-initiated study, a 30 year-old G6PC3-deficient woman with recurrent infections, distressing gastrointestinal symptoms and multi-lineage cytopenia was treated with an SLGT2-inhibitor. A significant increase in all the hematopoietic cell lineages and substantial improvement in the quality of life was observed.
Published: 2022

15. COMPARISON OF HEPATITIS C ANTIBODY ASSAYS AND EVALUATION OF AGREEMENT BETWEEN HEPATITIS C ANTIGEN AND PCR RESULTS

Author: Sahar, Iqbal, Samina, Baig, Saima, Naseem, Syed Talha, Naeem, Ambreen, Fatima, and Saeed, Khan
Subjects: Cross-Sectional Studies, Humans, RNA, Viral, Hepacivirus, General Medicine, Hepatitis C Antigens, Hepatitis C Antibodies, Hepatitis C, Polymerase Chain Reaction, Sensitivity and Specificity
Abstract: Background: Hepatitis C is associated with a wide range of health repercussions. Pakistan is one of the highly prevalent countries of Hepatitis C Virus (HCV) infection. The availability of cost-effective, robust, and reliable screening and diagnostic tests for hepatitis C is important to address the disease burden. Standardization of screening and diagnostic assays in clinical laboratories is crucial for achieving big goals. Objectives of this study are to correlate the results of two different HCV antibody (HCV Ab) assays and to examine the correlation of HCV core antigen (HCV c Ag) results with HCV PCR for HCV infection diagnosis. Methods: This descriptive cross-sectional study was carried out from November to December 2020 at Dow University of Health Sciences. Total number of 40 HCV Ab samples were analysed by both chemiluminescence (CMIA) and electrochemiluminescence (ECLIA) immunoassays. Tests for HCV RNA PCR and HCV c Ag were performed on all samples. Results of screening and diagnostic assays were correlated and agreements were examined. Statistical analysis for agreement was carried out by using R software version 3.6.3 through AC1 Gwetz Statistic. The study was approved by the institutional ethical review committee. Results: An agreement of 0.73 and 0.95 was found between two different HCV Ab immunoassays and HCV c Ag and HCV PCR, respectively. Conclusion: We found a good correlation between CMIA and ECLIA for HCV Ab. An excellent correlation was found between HCV c Ag and HCV PCR. Based on our study findings, HCV c Ag is a candidate test for the diagnosis of active HCV infection.
Published: 2022

16. PATTERN OF THE ORO-FACIAL INFECTIONS IN PATIENTS PRESENTING TO AYUB MEDICAL INSTITUTE, ABBOTTABAD

Author: Alamgir Alamgir, Abdur Rehman, Ambreen Khurshid Haider, Haris Hameed, Wajahat Hameed, and Babar Saeed
Subjects: Male, Focal Infection, Dental, Incidence, Face, Humans, Female, General Medicine, Molar
Abstract: Background: Orofacial space infections are commonly odontogenic in origin and the anatomical locations along with mode of spread to critical areas (e.g., orbit, brain, mediastinum) can result in morbidly and mortality if not diagnosed and treated well in time. This study was aimed to analyzing the incidence and pattern of oro-facial infections. Methods: This Descriptive case series was carried out at Oral Surgery unit (Ayub Medical College) Abbottabad from January 2016 - May 2017. The sample was collected using purposive, consecutive non-probability sampling. The demographic data, infection site and clinical features were recorded. The data was analyzed by using SPSS version 21. All the descriptive variables were analyzed for percentages & frequencies. Results: Thirty-six patients were included in the study. The male (23) to female (13) ratio was (1.7:1). Right Submandibular space was most common site. In one case each, there was involvement of retropharyngeal and retromandibular space. Majority of the patients presented with swelling (88.89%). Diabetes mellitus was the most commonly found systemic disorder in the patients affecting aggressiveness of infection. Conclusion: The most common source of odontogenic facial space infections is mandibular molars resulting spread to submandibular space. Diabetes Mellitus was the most common systemic disorder affecting host immunity. The proximity of oro-facial spaces with the critical areas makes it crucial for clinicians to identify the condition promptly and provide pertinent treatment in order to avoid the fatal complications as the rate of spread of facial space infection is very rapid.
Published: 2022

17. Haploidentical hematopoietic cell transplant for severe aplastic anemia in children with carbapenem-resistant enterocolitis

Author: Ambreen, Pandrowala, Ajay Narayan, Sharma, Sangeeta, Mudaliar, Saroj, Chavan, Parag, Karkera, Pradnya, Bendre, Parth, Ganatra, Minnie, Bodhanwala, Bharat, Agarwal, and Prashant, Hiwarkar
Subjects: Transplantation Conditioning, Carbapenems, Oncology, Enterocolitis, Pediatrics, Perinatology and Child Health, Hematopoietic Stem Cell Transplantation, Anemia, Aplastic, Graft vs Host Disease, Humans, Hematology, Child
Published: 2022

18. Ring-shaped cataract and urinary metabolites among 2,4,6-trinitrotoluene exposed population of Pakistan

Author: Sidra Sarwat, Ambreen Akhtar, Syeda Fizza Abdud Dayan, Najma Shaheen, Humna Shahid Durrani, Tariq Usman, and Tayyab Afghani
Subjects: Adult, Male, Ophthalmology, Slit Lamp, Case-Control Studies, Humans, Female, Pakistan, Middle Aged, Cataract, Aged, Trinitrotoluene
Abstract: Safety protocols are usually neglected among most of the trinitrotoluene (TNT)-exposed population, therefore, rendering the community prone to various occupational hazards. The current study highlights ring-shaped cataract and urinary metabolites of TNT among TNT-exposed population (n = 26) against a control group (n = 20).An observational case-control study was carried out in two groups: subjects exposed to TNT in Dir and Bajour Agency, Pakistan, and a control group from the base hospital. We determined the presence of ring-shaped cataract and urine metabolites of TNT using slit-lamp biomicroscope and gas chromatography-mass spectrometric analysis, respectively.Results substantiate a high level of urine metabolites for exposed subjects compared to the control group (p 0.001). Age had no significant effect (p 0.05) on the presence of ring-shaped cataract and the level of urinary metabolites of TNT, while duration of exposure showed significant effect (p 0.001). Females showed high incidence of ring-shaped cataract and urinary metabolites of TNT than men ( p 0.001). The mean age of the exposed subjects was 51 ± 14.38 (Mean ± SD) years. The mean year of exposure was 49 ± 5 (Mean ± SD) years.This study showed TNT as a risk factor for the presence of ring-shaped cataract among TNT-exposed group in Pakistan. It is important to screen exposed community for the presence of ring-shaped cataract, and pre-clinical identification of TNT adducts to prevent systemic complications.
Published: 2022

19. Predictive biomarkers of response to immune checkpoint inhibitors in hepatocellular carcinoma

Author: Ambreen Muhammed, Antonio D’Alessio, Andrei Enica, Thomas Talbot, Claudia Angela Maria Fulgenzi, Georgios Nteliopoulos, Robert D. Goldin, Alessio Cortellini, and David J. Pinato
Subjects: Carcinoma, Hepatocellular, Liver Neoplasms, Biomarkers, Tumor, Genetics, Humans, Molecular Medicine, Immune Checkpoint Inhibitors, Molecular Biology, B7-H1 Antigen, Pathology and Forensic Medicine
Abstract: Hepatocellular carcinoma (HCC) is the most common primary liver cancer and fourth-leading cause of cancer death. While drug discovery to improve disease survival was historically poor, there is now evidence of significant potential for immune checkpoint inhibitors (ICPIs) in treatment of the disease, and indeed such drug approvals are beginning to emerge.HCC typically arises in the context of cirrhosis and chronic liver disease (CLD), and HCC exhibits significant biological heterogeneity, in part reflecting the broad range of etiologies of CLD. Different classes and combinations of ICPI-based therapy exist, but not all patients will respond and predictive biomarkers are not yet available to guide clinician decision-making, unlike some other cancer types. In this review, we discuss the emerging biomarkers for ICPI sensitivity in HCC, including tumor genomic features, perturbation of the gut microbiome, and systemic inflammatory markers.Additional profiling studies are required to appreciate existing trends with clinical outcome and to further drive clinical studies in disease stratification by response. This will only be possible within collaborative and international efforts, especially regarding biopsy collection. A close collaboration between basic scientists and clinicians will be the key to shape the next future of HCC biomarker research.
Published: 2022

20. Association of donor hepatitis C virus infection status and risk of BK polyomavirus viremia after kidney transplantation

Author: Ambreen Azhar, Anshul Bhalla, Rachel C. Forbes, Beatrice P. Concepcion, Roy D. Bloom, Deirdre Sawinski, Miklos Z Molnar, Jennifer Trofe-Clark, Raymond T. Chung, Peter P. Reese, Vasanthi Balaraman, David Shaffer, Ian A. Strohbehn, Behdad Besharatian, Douglas E. Schaubel, Emily A. Blumberg, Mital Shah, David S. Goldberg, Manish Talwar, Laura A Binari, Nahel Elias, James D. Eason, Vishnu S. Potluri, and Meghan E. Sise
Subjects: Nephrology, medicine.medical_specialty, Hepatitis C virus, Viremia, Hepacivirus, medicine.disease_cause, Gastroenterology, Article, Nephropathy, Internal medicine, medicine, Humans, Immunology and Allergy, Pharmacology (medical), Kidney transplantation, Retrospective Studies, Polyomavirus Infections, Transplantation, Kidney, business.industry, Proportional hazards model, virus diseases, Retrospective cohort study, medicine.disease, Kidney Transplantation, Tumor Virus Infections, medicine.anatomical_structure, BK Virus, business
Abstract: Kidney transplantation (KT) from deceased donors with hepatitis C virus (HCV) into HCV-negative recipients has become more common. However, the risk of complications such as BK polyomavirus (BKPyV) remains unknown. We assembled a retrospective cohort at four centers. We matched recipients of HCV-viremic kidneys to highly similar recipients of HCV-aviremic kidneys on established risk factors for BKPyV. To limit bias, matches were within the same center. The primary outcome was BKPyV viremia ≥1000 copies/ml or biopsy-proven BKPyV nephropathy; a secondary outcome was BKPyV viremia ≥10 000 copies/ml or nephropathy. Outcomes were analyzed using weighted and stratified Cox regression. The median days to peak BKPyV viremia level was 119 (IQR 87-182). HCV-viremic KT was not associated with increased risk of the primary BKPyV outcome (HR 1.26, p = .22), but was significantly associated with the secondary outcome of BKPyV ≥10 000 copies/ml (HR 1.69, p = .03). One-year eGFR was similar between the matched groups. Only one HCV-viremic kidney recipient had primary graft loss. In summary, HCV-viremic KT was not significantly associated with the primary outcome of BKPyV viremia, but the data suggested that donor HCV might elevate the risk of more severe BKPyV viremia ≥10 000 copies/ml. Nonetheless, one-year graft function for HCV-viremic recipients was reassuring.
Published: 2022

21. The Transitions to Long-term In Home Ventilator Engagement Study (Transitions to LIVE): study protocol for a pragmatic randomized controlled trial

Author: Reshma Amin, Andrea Gershon, Francine Buchanan, Regina Pizzuti, Adam Qazi, Nishali Patel, Ruxandra Pinto, Myla E. Moretti, Munazzah Ambreen, TtLIVE Group, and Louise Rose
Subjects: Adult, medicine.medical_specialty, Medicine (General), Medicine (miscellaneous), Virtual care, law.invention, Mechanical ventilation, R5-920, Randomized controlled trial, law, Pragmatic Clinical Trials as Topic, Medicine, Humans, Multicenter Studies as Topic, Pharmacology (medical), Single-Blind Method, Child, Randomized Controlled Trials as Topic, Protocol (science), Ontario, Ventilators, Mechanical, business.industry, Continuity of patient care, Home care services, Term (time), Telehealth, Physical therapy, Quality of Life, eHealth, business
Abstract: Background overview and rationale We co-developed a multi-component virtual care solution (TtLIVE) for the home mechanical ventilation (HMV) population using the aTouchAway™ platform (Aetonix). The TtLIVE intervention includes (1) virtual home visits; (2) customizable care plans; (3) clinical workflows that incorporate reminders, completion of symptom profiles, and tele-monitoring; and (4) digitally secure communication via messaging, audio, and video calls; (5) Resource library including print and audiovisual material. Objectives and brief methods Our primary objective is to evaluate the TtLIVE intervention compared to a usual care control group using an eight-center, pragmatic, parallel-group single-blind (outcome assessors) randomized controlled trial. Eligible patients are children and adults newly transitioning to HMV in Ontario, Canada. Our target sample size is 440 participants (220 each arm). Our co-primary outcomes are a number of emergency department (ED) visits in the 12 months after randomization and change in family caregiver (FC) reported Pearlin Mastery Scale score from baseline to 12 months. Secondary outcomes also measured in the 12 months post randomization include healthcare utilization measured using a hybrid Ambulatory Home Care Record (AHCR-hybrid), FC burden using the Zarit Burden Interview, and health-related quality of life using the EQ-5D. In addition, we will conduct a cost-utility analysis over a 1-year time horizon and measure process outcomes including healthcare provider time using the Care Coordination Measurement Tool. We will use qualitative interviews in a subset of study participants to understand acceptability, barriers, and facilitators to the TtLIVE intervention. We will administer the Family Experiences with Care Coordination (FECC) to interview participants. We will use Poisson regression for a number of ED visits at 12 months. We will use linear regression for the Pearlin Mastery scale score at 12 months. We will adjust for the baseline score to estimate the effect of the intervention on the primary outcomes. Analysis of secondary outcomes will employ regression, causal, and linear mixed modeling. Primary analysis will follow intention-to-treat principles. We have Research Ethics Board approval from SickKids, Children’s Hospital Eastern Ontario, McMaster Children’s Hospital, Children’s Hospital-London Health Sciences, Sunnybrook Hospital, London Health Sciences, West Park Healthcare Centre, and Ottawa Hospital. Discussion This pragmatic randomized controlled single-blind trial will determine the effectiveness and cost-effectiveness of the TtLIVE virtual care solution compared to usual care while providing important data on patient and family experience, as well as process measures such as healthcare provider time to deliver the intervention. Trial registration ClinicalTrials.gov NCT04180722. Registered on November 27, 2019.
Published: 2022

22. Serine, N-acetylaspartate differentiate adolescents with juvenile idiopathic arthritis compared with healthy controls: a metabolomics cross-sectional study

Author: Kimberly A. Lewis, Nico Osier, Ruy Carrasco, Jennifer Chiou, Patricia Carter, Alexandra Garcia, Elena Flowers, Efstathios D. Gennatas, Christina Nguyen, Ambreen Rana, Sharon A. Brown, and Stefano Tiziani
Subjects: Male, Aspartic Acid, Adolescent, Diseases of the musculoskeletal system, Juvenile idiopathic arthritis, Adolescents, Pediatrics, Arthritis, Juvenile, RJ1-570, Cross-Sectional Studies, N-acetylaspartate, Rheumatology, RC925-935, Pediatrics, Perinatology and Child Health, Serine, Immunology and Allergy, Humans, Metabolomics, Female, Biomarkers
Abstract: Background In comparison with the general population, adolescents with juvenile idiopathic arthritis (JIA) are at higher risk for morbidity and mortality. However, limited evidence is available about this condition’s underlying metabolic profile in adolescents with JIA relative to healthy controls. In this untargeted, cross-sectional metabolomics study, we explore the plasma metabolites in this population. Methods A sample of 20 adolescents with JIA and 20 controls aged 13–17 years were recruited to complete surveys, provide medical histories and biospecimens, and undergo assessments. Fasting morning plasma samples were processed with liquid chromatography–mass spectrometry. Data were centered, scaled, and analyzed using generalized linear models accounting for age, sex, and medications (p-values adjusted for multiple comparisons using the Holm method). Spearman’s correlations were used to evaluate relationships among metabolites, time since diagnosis, and disease severity. Results Of 72 metabolites identified in the samples, 55 were common to both groups. After adjustments, 6 metabolites remained significantly different between groups. Alpha-glucose, alpha-ketoglutarate, serine, and N-acetylaspartate were significantly lower in the JIA group than in controls; glycine and cystine were higher. Seven additional metabolites were detected only in the JIA group; 10 additional metabolites were detected only in the control group. Metabolites were unrelated to disease severity or time since diagnosis. Conclusions The metabolic signature of adolescents with JIA relative to controls reflects a disruption in oxidative stress; neurological health; and amino acid, caffeine, and energy metabolism pathways. Serine and N-acetylaspartate were promising potential biomarkers, and their metabolic pathways are linked to both JIA and cardiovascular disease risk. The pathways may be a source of new diagnostic, treatment, or prevention options. This study’s findings contribute new knowledge for systems biology and precision health approaches to JIA research. Further research is warranted to confirm these findings in a larger sample.
Published: 2022

23. Dietary Phytochemicals in Cancer Signalling Pathways: Role of miRNA Targeting

Author: Summya Rashid, Ambreen Shoaib, Azher Arafah, Shafat Ali, Mohammad Tabish, Muneeb U. Rehman, Shadma Wahab, and Feras M Al-Marshadh
Subjects: Curcumin, Phytochemicals, Notch signaling pathway, Resveratrol, Biology, Biochemistry, chemistry.chemical_compound, Neoplasms, Drug Discovery, microRNA, medicine, Humans, Pharmacology, Cell growth, Organic Chemistry, Wnt signaling pathway, Cancer, medicine.disease, Hedgehog signaling pathway, Diet, MicroRNAs, chemistry, Cancer research, Molecular Medicine, Female, Neoplasm Recurrence, Local, Signal Transduction
Abstract: Cancer is a multi-factorial health condition involving uncontrolled cell divisions. The disease has its roots in genetic mutation. This disease affects men, women, and even children. Chemotherapy, photodynamic, photothermal, and hormonal therapies have been used to treat this deadliest disease, but a huge percentage of patients have chances of disease recurrence or resistance. Nowadays, dysregulation in miRNAs is considered one of the key factors for the development and progression of different types of cancers as they control the expression of genes responsible for cell proliferation, growth, differentiation, and apoptosis. Dietary phytochemicals with anticancer properties have been gaining focus for cancer treatment since they have been found more effective in targeting cancer via regulating miRNAs expression. These phytochemicals have no side effects and are readily available at a low cost. Several dietary phytochemicals with regulatory effects on the expression of miRNAs have been reported, including curcumin, diallyl disulfide, 3, 30-diindolylmethane, ellagic acid, genistein, indole-3-carbinol, quercetin, resveratrol, and sulforaphane. They exert their regulatory effects against different cancers either by upregulating or downregulating different cancer signalling pathways and inhibiting their progression. Curcumin down-regulates SHH pathways, epigallocatechin-3-gallate regulates the Notch pathway and inhibits TGFβ1/SMAD signalling, and resveratrol regulates the Wnt/β-catenin pathway and carnosic acid-induced apoptosis in colon cancer cell via JAK2/STAT3 signalling pathway. The miRNAs are used for the treatment of cancer as essential modulators in cellular pathways. Therefore, identifying the miRNAs and their targets and countering them with specific phytochemicals provide a safe and effective mechanism for the treatment of cancer.
Published: 2021

24. CHOP-ASO Ameliorates Glomerular and Tubular Damage on Top of ACE Inhibition in Diabetic Kidney Disease

Author: Richard Klar, Nora Klöting, Peter R. Mertens, Matthias Blüher, Sven Michel, Frank Jaschinski, Ahmed Elwakiel, Sameen Fatima, Peter P. Nawroth, Hamzah Khawaja, Saira Ambreen, Moh'd Mohanad Al-Dabet, Khurrum Shahzad, Berend Isermann, and Ihsan Gadi
Subjects: Oncology, medicine.medical_specialty, Programmed cell death, Chronic Kidney Disease, Chronic Nephropathy, Diabetic Nephropathy, Cell, CHOP, Pharmacology, Diabetic nephropathy, In vivo, Internal medicine, medicine, Humans, biology, business.industry, Stress induced, General Medicine, Endoplasmic Reticulum Stress, medicine.disease, Gene expression profiling, Basic Research, medicine.anatomical_structure, Nephrology, Enzyme inhibitor, Unfolded protein response, biology.protein, business, Signal Transduction
Abstract: Background: Maladaptive ER stress signaling in diabetic kidney disease (DKD) is linked to increased glomerular and tubular expression of the cell death-promoting transcription factor C/EBP homologous protein (CHOP). We determined whether therapy with locked nucleic acid (LNA)-modified antisense oligonucleotides (ASOs) targeting CHOP ameliorates experimental DKD. Methods: Following an in vivo dose-escalation study, we determined the efficacy of CHOPASO in the early and later stages of experimental DKD (8- or 16-week-old db/db mice, respectively) alone or in combination with an angiotensin-converting enzyme inhibitor (ACEi). Renal functional parameters and morphological analyses were used to determine the effects. Renal gene expression profiling was conducted to determine differentially regulated genes and pathways. Several human CHOP-ASOs were tested in hyperglycemia-exposed human kidney cells. Results: CHOP-ASOs efficiently reduced renal CHOP expression in diabetic mice and reduced markers of DKD at early and late stages. Early combined intervention (CHOP-ASO and ACEi) efficiently prevented interstitial damage. At the later timepoint, the combined treatment reduced indices of both glomerular and tubular damage more efficiently than either intervention alone. A significantly larger number of genes and disease pathways were affected by CHOP-ASO, including reduced Slc5a2 (sodium-glucose transport protein 2) and PROM1 (CD133). Human CHOP-ASOs efficiently reduced glucose-induced CHOP and prevented cell death of human kidney cells in vitro Conclusions: The ASO-based approach efficiently reduced renal CHOP expression in a diabetic mouse model, providing an additional benefit to an ACEi in particular at later timepoints. These studies demonstrate that ASO-based therapies efficiently reduce maladaptive CHOP expression and ameliorate experimental DKD.
Published: 2021

25. The use of loop diuretics in the context of hypertensive disorders of pregnancy: a systematic review and meta-analysis

Author: Isabelle Malhamé, Susan Dong, Ambreen Syeda, Rizwana Ashraf, Jonathan Zipursky, Daphne Horn, Stella S. Daskalopoulou, and Rohan D'Souza
Subjects: Cohort Studies, Sodium Potassium Chloride Symporter Inhibitors, Physiology, Pregnancy, Internal Medicine, Humans, Female, Vascular Resistance, Hypertension, Pregnancy-Induced, Cardiology and Cardiovascular Medicine, Antihypertensive Agents
Abstract: Addressing volume expansion may improve the management of hypertension across the pregnancy continuum. We conducted a systematic review to summarize the evidence on the use of loop diuretics in the context of hypertensive disorders during pregnancy and the postpartum period.Medline, Embase, Cochrane library, ClinicalTrials.gov, and Google Scholar were searched for original research articles published up to 29 June 2021. Of the 2801 results screened, 15 studies were included: eight randomized controlled trials, six before-after studies, and one cohort study. Based on random effects meta-analysis of before-after studies, antepartum use of loop diuretics was associated with lower DBP [mean difference -17.73 mmHg, (95% confidence intervals -34.50 to -0.96); I2 = 94%] and lower cardiac output [mean difference -0.75 l/min, (-1.11 to -0.39); I2 = 0%], with no difference in SBP, mean arterial pressure, heart rate, or total peripheral resistance. Meta-analysis of randomized controlled trials revealed that postpartum use of loop diuretics was associated with decreased need for additional antihypertensive patients [relative risk 0.69, (0.50-0.97); I2 = 14%], and an increased duration of hospitalization [mean difference 8.80 h, (4.46-13.14); I2 = 83%], with no difference in the need for antihypertensive therapy at hospital discharge, or persistent postpartum hypertension.Antepartum use of loop diuretics lowered DBP and cardiac output, while their postpartum use reduced the need for additional antihypertensive medications. There was insufficient evidence to suggest a clear benefit. Future studies focusing on women with hypertensive pregnancy disorders who may most likely benefit from loop diuretics are required.
Published: 2022

26. ANALYSIS OF CAESAREAN SECTIONS RATES USING ROBSON’S TEN GROUP CLASSIFICATION SYSTEM, UNIT B MCHC, ATH ABBOTTABAD

Author: Sundus Ambreen, Afridi, Khalid, Ahmad, and Ruqqiya, Sultana
Subjects: Erythrocyte Indices, Cross-Sectional Studies, Pregnancy, Cesarean Section, Infant Mortality, Humans, Female, General Medicine
Abstract: Background: There is growing international concern about the increased rate of caesarean sections (CS), Caesarean procedures performed in the absence of a clinical justification do not reduce maternal or infant death rates if carried out at a rate higher than 10%–15% Achieving reductions in maternal and infant morbidity and mortality are, among others, the objectives promoted by the World Health Organization (WHO) for 2030. The analysis of unjustified C/S rate is done by Using Robson’s Ten Group Classification system. Methods: Cross-sectional study by using Robson’s Ten Group classification, in Unit B MCHC, ATH Abbottabad during 6 months, from 1st August 2021–31st January 2022. Results: Total Patients Delivered during this duration of study were 777, among which 352 were delivered by C/S were 352. Analysis by Robson ten-group classification system showed C/S Rate as: Group 1:16.81%, Group 2: 78.95%, group 3:1.56%, group 4:77.14%, group 5:89.22%, group 6: 83.33, Group 7:67.86, Group 8:40, group 9:100%, Group 10:46.97. The total Caesarean section rate was 45.3%. Conclusion: By RTGCS analysis, C/S rates Group 5, 4 and 2 are major contributions in overall C/S rates in studied clinical setup. Group 1 and 10 are also contributing. Overall C/S rates can be decreased by working on them.
Published: 2022

27. Brain exosomes as minuscule information hub for Autism Spectrum Disorder

Author: Srinivasan Muthuswamy, Sarita Agarwal, Ambreen Asim, and Deepika Delsa Dean
Subjects: Autism Spectrum Disorder, business.industry, Brain, Exosomes, medicine.disease, behavioral disciplines and activities, Exosome, Microvesicles, Pathology and Forensic Medicine, Quality of life (healthcare), Neurodevelopmental disorder, Autism spectrum disorder, mental disorders, Quality of Life, Genetics, Humans, Molecular Medicine, Biomarker (medicine), Medicine, Autism, Biomarker discovery, business, Molecular Biology, Neuroscience, Biomarkers
Abstract: Introduction Autism spectrum disorder (ASD) is a neurodevelopmental disorder initiating in the first three years of life. Early initiation of management therapies can significantly improve the health and quality of life of ASD subjects. Thus, indicating the need for suitable biomarkers for the early identification of ASD. Various biological domains were investigated in the quest for reliable biomarkers. However, most biomarkers are in the preliminary stage, and clinical validation is yet to be defined. Exosome based research gained momentum in various Central Nervous System disorders for biomarker identification. However, the utility and prospect of exosomes in ASD is still underexplored. Areas covered In the present review, we summarised the biomarker discovery current status and the future of brain-specific exosomes in understanding pathophysiology and its potential as a biomarker. The studies reviewed herein were identified via systematic search (dated: June 2021) of PubMed using variations related to autism (ASD OR autism OR Autism spectrum disorder) AND exosomes AND/OR biomarkers. Expert opinion As exosomess are highly relevant in brain disorders like ASD, direct access to brain tissue for molecular assessment is ethically impossible. Thus investigating the brain-derived exosomes would undoubtedly answer many unsolved aspects of the pathogenesis and provide reliable biomarkers.
Published: 2021

28. Placenta accreta risk—antepartum score in predicting clinical outcomes of placenta accreta spectrum: A multicenter validation study

Author: Pedro Viana Pinto, Mohamed S. Fahmy, Arpine M. Amirkhanyan, Hironori Takahashi, Farhat ul Ain Ahmed, Aliaa E. Said, Ercan Yilmaz, Rauf Melekoglu, Afshan Ambreen, Amr S. Abdelbadie, Gregory A. Penzhoyan, Nermeen B. Ahmed, Tatiana B. Makukhina, Hijab Aziz, Sherif A. Shazly, Tayyaba Akhter, Mohamed A Anan, Gena M. Elassall, Esraa G. Sayed, Nesibe Z. Celik, and Diaa M. Dawyee
Subjects: medicine.medical_specialty, Placenta accreta, Placenta, Placenta Previa, Placenta Accreta, law.invention, Cohort Studies, Pregnancy, Risk Factors, Interquartile range, law, medicine, Humans, Prospective Studies, Prospective cohort study, Retrospective Studies, Receiver operating characteristic, business.industry, Obstetrics, Obstetrics and Gynecology, General Medicine, Perioperative, medicine.disease, Intensive care unit, Placenta previa, Cohort, Female, business
Abstract: Objective To validate the use of placenta accreta risk-antepartum (PAR-A) score as a predictive tool of clinical outcomes of placenta accreta spectrum (PAS). Methods This is a prospective study, conducted in six PAS specialized centers in six different countries. The study was conducted between October 1, 2020 and March 31, 2021. Women who were provisionally diagnosed with PAS during pregnancy were considered eligible. A machine-learning-based PAR-A score was calculated. Diagnostic performance of the PAR-A score was evaluated using a receiver operating characteristic curve, for perioperative massive blood loss and admission to intensive care unit (ClinicalTrials.gov identifier NCT04525001). Results Of 97 eligible women, 86 were included. PAS-associated massive blood loss occurred in 10 patients (11.63%). Median PAR-A scores of massive blood loss in the current cohort were 8.9 (interquartile range 6.9-14.1). In predicting massive blood loss, the area under the curve of PAR-A scores was 0.85 (95% confidence interval [CI] 0.74-0.95), which was not significantly different from the original cohort (P = 0.2). PAR-A score prediction of intensive care unit admission was slightly higher compared with the original cohort (0.88, 95% CI 0.81-0.95; P = 0.06). Conclusion PAR-A score is a novel scoring system of PAS outcomes, which showed external validity based on current data.
Published: 2021

29. Opuntiol Inhibits Growth and Induces Apoptosis in Human Glioblastoma Cells by Upregulating Active Caspase 3 Expression

Author: Sumreen Begum, Sumbul Zehra, Muhammad Furqan Bari, Farina Hanif, Shaheen Faizi, Talat Mirza, Shabana Usman Simjee, Ambreen Ashfaque, and Lubna Khan
Subjects: Coumaric Acids, Cell Survival, Antineoplastic Agents, Apoptosis, Cell Growth Processes, Central Nervous System Neoplasms, chemistry.chemical_compound, Cell Line, Tumor, Temozolomide, medicine, Humans, MTT assay, Viability assay, DAPI, TUNEL assay, Caspase 3, General Medicine, Up-Regulation, chemistry, Cancer research, DNA fragmentation, Growth inhibition, Glioblastoma, medicine.drug
Abstract: Background: Glioblastoma Multiforme (GBM) is a deadly tumor with poor prognosis. Resistance to apoptosis considered as an important factor in treatment failure. Therefore, identification of new compounds that facilitates apoptosis is crucial. Natural Anti-inflammatory compounds have emerged as potential anti-cancer agents and should be explored for their apoptotic activity against GBM. Therefore, the present study aims to evaluate growth inhibitory and apoptotic activity of a natural anti-inflammatory compound “Opuntiol” against GBM cell line U87. Methods: MTT assay was performed to determine the effect of Temozolomide and Opuntiol on growth inhibition of U87 cell. While, TUNEL assay was used to assess their apoptotic activity. To further assess apoptosis, nuclear condensation and nuclear area factor (NAF) was evaluated through DAPI staining. Whereas, active caspase-3 protein expression determined using immunocytochemistry. Results: Significant growth inhibition was observed in U87 cells treated with Temozolomide (IC50 380 µM) and Opuntiol (IC50 357 µM). Temozolomide (p
Published: 2021

30. Will I speak up or remain silent? Workplace ostracism and employee performance based on self-control perspective

Author: Tehreem Fatima, Ambreen Sarwar, Muhammad Kashif Imran, and Syed Muhammad Javed Iqbal
Subjects: Social Psychology, business.industry, media_common.quotation_subject, Emotions, Perspective (graphical), Ostracism, Employee silence, Self-control, Self Concept, Self-Control, Moderated mediation, Social exchange theory, Humans, Employee voice, Workplace, business, Psychology, Social psychology, Financial services, media_common
Abstract: Drawing on the self-control perspective, this study investigated the buffering effect of emotional suppression in reducing the harmful influence of workplace ostracism on employee performance. The research also studied the mediating role of employee silence and voice behaviors based on social exchange theory. We performed moderated mediation analysis on responses received from 159 employees working in the financial industry of the Southern Punjab region of Pakistan. The results showed that workplace ostracism harms employee performance via employee silence and voice behaviors. Furthermore, emotional suppression moderated the mediated relationship between workplace ostracism and employee performance. The results indicated that if ostracized employees adopt voice behavior, emotional suppression cannot aid them in performing better as compared to those who remain silent and regain their self-esteem. Our findings highlight the importance of emotional suppression capability in reducing the damaging outcomes of ostracism in organizational settings.
Published: 2021

31. Postpartum Insertion Of Intrauterine Contraceptive Device: A Safe And Effective Contraception

Author: Saher Fatima, Anjum Rehman, Zeeshan Ahmed, Muhammad Maaz Sajid, Umme Habiba, and Ambreen Rehman
Subjects: Contraception, Contraceptive Agents, Pregnancy, Health Personnel, Postpartum Period, Humans, Female, General Medicine, Intrauterine Devices
Abstract: Background: The incidence of maternal mortality and morbidity related to the termination of unwanted pregnancy in Pakistan is rising at an alarming rate. Instant Postpartum insertion of intra- uterine contraceptive device (PPIUCD) is an effective contraceptive measure to reduce unexpected pregnancy and its associated complications in developing countries like Pakistan. Methods: The current study was conducted in a public sector hospital in Karachi with a total of 7314 pregnant women counselled for insertion of PPIUCD antenatally. Out of which 5682 women agreed to the insertion and 1632 refused the procedure, mostly due to unfamiliarity with PPIUCD insertion. PPIUCD was inserted within 48 hours of delivery in 1441 patients and they were followed for 6 months onwards. Results: Total postpartum insertions were 1441 which was found to be an effective measure with the continuation rate of 91% among 785 followed up cases. Postpartum IUCD insertion was found as an effective, satisfactory and convenient practice for the women of developing countries like Pakistan, to get an on-time appropriate contraceptive measure. Conclusion: PPIUCD was found to have high retention and low expulsion rate and its efficacy can be improved further by proper training and skills of healthcare professionals. In this regard, appropriate strategies should be formulated and implemented at the statutory level by increasing social awareness and practice of using PPIUCD by health care providers to reduce undesired pregnancies.
Published: 2022

32. Preliminary studies on apparent mendelian psychotic disorders in consanguineous families

Author: Ambreen Kanwal, Sohail A. Sheikh, Amina Iftikhar, Sadaf Naz, and José V. Pardo
Subjects: Consanguinity, Psychiatry and Mental health, Psychotic Disorders, Mental Disorders, Schizophrenia, Humans, Genome-Wide Association Study
Abstract: Background Psychiatric disorders are characterized by alteration in emotions, mood and behavior. Genetics is known to play a significant role in the development of psychiatric disorders. Genome-wide association studies have identified several loci associated with psychiatric illnesses. We hypothesize the existence of rare variants following Mendelian recessive mode of inheritance. These variants can be identified in families with multiple affected individuals born to unaffected consanguineous parents. Methods We visited psychiatric outpatient departments of multiple hospitals in Lahore, Pakistan. We focused on psychosis, as it can occur in several DSM disorders such as schizophrenia, dementia and bipolar disorder. After clinical diagnosis by an American trained psychiatrist, detailed clinical assessments using Diagnostic Interview for Genetic Studies (DIGS), Diagnostic Interview for Psychosis and Affective Disorders (DI-PAD), Positive and Negative Syndrome Scale (PANSS), Hamilton Depression and Anxiety Rating Scale (HAM-D; HAM-A) were administered to all willing affected and unaffected participants. Results We identified eight pedigrees with two or more psychotic individuals in each family. Clinical diagnoses determined by their psychiatrists included ten individuals with schizophrenia; four individuals with psychosis and bipolar disorder; and two patients with “unspecified psychosis.” The rating instruments rigorously confirmed the diagnosis of psychosis in the affected patients from the six families as well as the absence of psychotic disorders in unaffected individuals from the six families. We obtained DNA samples from willing members of all eight families for future genetic analyses. Conclusion Our research highlights an alternative approach to discovery of rare recessively inherited genetic variants causing psychiatric disorders that have remained unidentified to date. These findings could illuminate underlying biological mechanisms leading toward development of targeted therapies in future.
Published: 2022

33. Lesson of the month: Cerebral amyloid angiopathy masquerading as recurrent transient ischaemia attacks in an older adult

Author: Lau, Keng Ming and Sheikh, Ambreen Ali
Subjects: Cerebral Amyloid Angiopathy, Ischemic Attack, Transient, Ischemia, Acute Disease, Humans, Lesson of the Month, Aged, Cerebral Hemorrhage
Abstract: Cerebral amyloid angiopathy (CAA) is a common cause of lobar cerebral haemorrhage in elderly populations, which can present as transient focal neurological episodes (TFNEs) or sometimes known as 'amyloid spells'. CAA-TFNE poses a common diagnostic challenge to physicians as it can be difficult to distinguish from transient ischaemic attacks or other transient neurologic syndromes. Prompt recognition of CAA is crucial as it heralds a high risk of intracerebral haemorrhage and to avoid unnecessary investigation with inappropriate long-term prevention treatment.
Published: 2022

34. Exploring the psychological and religious perspectives of cancer patients and their future financial planning: a Q-methodological approach

Author: Kanwal Iqbal, Khan, Qurat Ul An, Sabir, Ambreen, Shafqat, and Muhammad, Aslam
Subjects: Religion, Mental Health, Neoplasms, Adaptation, Psychological, Humans, Fear, General Medicine
Abstract: Background Cancer patients are often hesitant to talk about their mental health, religious beliefs regarding the disease, and financial issues that drain them physically and psychologically. But there is a need to break this taboo to understand the perceptions and behaviours of the patients. Previous studies identified many psychological factors that are bothering cancer patients. However, it still requires exploring new elements affecting their mental and physical health and introducing new coping strategies to address patients’ concerns. Methods The current study aims to identify cancer patients’ perceived attitudes towards the severity of illness, understand their fears, tend towards religion to overcome the disease, and future financial planning by using a Q-methodological approach. Data were collected in three steps from January-June 2020, and 51 cancer patients participated in the final stage of Q-sorting. Results The findings of the study are based on the principal component factor analysis that highlighted three essential factors: (1) feelings, (2) religious beliefs about the acceptance of death, and (3) their future personal and financial planning. Further, the analysis shows that the patients differ in their beliefs, causes and support that they received as a coping mechanism. Conclusion This study explains cancer patients’ psychological discomfort and physical pain but cannot relate it to co-morbidities. Q methodology allows the contextualization of their thoughts and future planning in different sets, like acceptance of death, combating religion’s help, and sharing experiences through various platforms. This study will help health professionals derive new coping strategies for treating patients and financial managers to design insurance policies that help them to share their financial burdens.
Published: 2022

35. Smoking by altering the peri-implant microbial community structure compromises the responsiveness to treatment

Author: Yuchen Zhang, Sadia Ambreen Niazi, Yuguang Yang, Yiqing Wang, Xiao Cao, Yibing Liu, Yinhu Li, and Qin Zhou
Subjects: Microbiology (medical), Infectious Diseases, Smokers, Microbiota, Immunology, Smoking, Humans, Prostheses and Implants, Microbiology, Peri-Implantitis
Abstract: Smoking is an essential risk factor for peri-implant diseases. It also hampers the clinical outcomes of peri-implant therapies. Nonetheless, the effect of smoking can go undetected until the emergence of clinical signs. Bacterial-induced inflammation is responsible for the initiation and progression of peri-implant diseases. We hypothesize that smoking impacts the peri-implant microbiome even in status of clinical health, putting it into a sub-healthy condition that responds poorly to peri-implant treatments. To validate this, peri-implant plaque samples from 18 participants including 10 smokers (S) and 8 non-smokers (NS), who had received implant prostheses were analyzed using metagenomic shotgun sequencing. The results showed that in addition to taxonomical and functional differences, the local stability in the S group was also shown to be much higher than that in the NS group, indicating greater stubbornness of the peri-implant microbiome associated with smoking. Besides, the topological structures were also distinct between the two groups. The highly connected species interacted more preferentially with each other in the S group (eigenvector centralization, 0.0273 in S and 0.0183 in NS), resulting in a greater tendency of forming small-world modules (modularity, 0.714 in S and 0.582 in NS). While in the NS group, inter-species correlations were more evenly distributed (clustering coefficient, 0.532 in S and 0.666 in NS). These alterations overall explained the greater stubbornness of the peri-implant microbiome associated with smoking, which may cause poor responsiveness to peri-implant therapies. From a microbial perspective, this may be a potential reason why smoking impacts negatively on the outcome of peri-implant treatments.
Published: 2022

36. Identifying monkeypox: do dental professionals have adequate knowledge and awareness?

Author: Ambreen, Kaur, Richa, Goel, Ravinder, Singh, Arvind, Bhardwaj, Raj, Kumari, and Ramandeep Singh, Gambhir
Subjects: Health Knowledge, Attitudes, Practice, Cross-Sectional Studies, Surveys and Questionnaires, Dentists, Humans, Monkeypox
Abstract: The emergence of monkeypox has presented a new challenge for health agencies around the globe. There is significant increase in the number of cases that too in non-endemic countries with more than 18000 cases reported worldwide.The present study was conducted to assess knowledge and awareness regarding monkeypox among dental professionals.The present cross-sectional study among 410 subjects who were residing in a northern state of the country. Informed consent was obtained from all the subjects. Study sample was selected on the basis of Systematic random sampling methodology. A self-designed close-ended questionnaire written in English and verified by experts was utilized for the study. The questionnaire was delivered personally to study subjects to collect the required information. Chi-square test and ANOVA were used for statistical analysis.One-fourth (24.8%) of the subjects never heard about monkeypox disease. Negative response was given by 44.8% of subjects regarding resemblance of monkeypox with small pox. Only 31.2% of subjects had knowledge regarding oral manifestations of the disease. High knowledge scores were reported by only 28% of subjects. Higher knowledge levels were significantly related to education level and working profile of study subjects. Online media (Internet) was preferred as the main source to obtain more information by 42.2 of subjects.There was low level of knowledge regarding monkeypox among study subjects. There is an urgent need for dental professionals to keep themselves updated with recent knowledge on new emerging infectious diseases.
Published: 2022

37. Optimizing imaging in the pediatric trauma patient, part 2: thoracic and abdominal trauma

Author: Jinel, Scott, Tarundeep, Grewal, Selwena, Brewster, and Ambreen, Khan
Subjects: Diagnostic Imaging, Thoracic Injuries, Humans, Abdominal Injuries, Child, Wounds, Nonpenetrating, Physical Examination, Retrospective Studies
Abstract: Imaging is a critical tool for the diagnosis and management of thoracic and abdominal injuries in pediatric patients. The location and mechanism of injury, the physical examination, and other clinical findings should guide emergency clinicians in the selection of the most appropriate imaging modality for the pediatric trauma patient. This supplement reviews the evidence for imaging decisions in the setting of pleural space, lung parenchyma, chest wall, cardiac, diaphragm, solid-organ, and hollow-viscus injuries in pediatric patients. Examples demonstrating imaging modalities, interpretations, and specific findings are provided. Considerations for imaging in suspected nonaccidental abdominal trauma are also discussed.
Published: 2022

38. Obstructive sleep apnoea: Potential role of tumour necrosis factor alpha as a circulating biomarker

Author: Ambreen Qamar, Zeba Haque, Sitwat Zehra, and Mirza Saifullah Baig
Subjects: Adult, Male, Sleep Apnea, Obstructive, Cross-Sectional Studies, Tumor Necrosis Factor-alpha, Snoring, Humans, Female, General Medicine, Middle Aged, Biomarkers, respiratory tract diseases
Abstract: Objective: To assess the relationship of tumour necrosis factor-alpha with obstructive sleep apnoea and its severity in Pakistani population. Method: The cross-sectional study was conducted at the Sleep Laboratory of Dow University Hospital, Karachi, from December, 2018, to March, 2020, and comprised patients of either gender having symptoms of snoring, witnessed apnoea or daytime sleepiness. They were divided into four groups on the basis of obstructive sleep apnoea status. Those without obstructive sleep apnoea were in Group A, mild status in Group B, moderate in Group C and severe obstructive sleep apnoea in Group D. Polysomnography was done to confirm obstructive sleep apnoea status and to categorise the subjects using apnoea-hypopnea index, while enzyme-linked immunosorbent assay was used to assess their tumour necrosis factor alpha levels.. Data was analysed using SPSS 20. Results: Of the 150 subjects, 94(63%) were males. The overall mean age was 49.68±12.14 years. There were 50(33.33%) subjects in Group A, 19(12.66%) Group B, 23(15.33%) Group C and 58(38.66%) in Group D. Mean tumour necrosis factor-alpha level was 3.88±1.65pg/mL in Group A, 9.97±4.33pg/mL in Group B, 12.65±4.46pg/mL in Group C and 12.83±4.33pg/mL in Group D. Mean tumour necrosis factor-alpha levels had significant association with the severity of obstructive sleep apnoea (p
Published: 2022

39. Intravenous vs intravenous plus aerosolized colistin for treatment of ventilator-associated pneumonia – a matched case–control study in neonates

Author: Ambreen Mughal, Sidra Idrees, Muhammad Sohail Salat, Javaid Iqbal, Kashif Hussain, Gul Ambreen, and Mehreen Sohail
Subjects: Male, medicine.medical_specialty, 030204 cardiovascular system & hematology, Severity of Illness Index, Hospitals, University, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Drug Resistance, Multiple, Bacterial, Internal medicine, Administration, Inhalation, polycyclic compounds, Humans, Medicine, Pharmacology (medical), Multidrug-resistant gram-negative bacteria, Infusions, Intravenous, Aerosolization, Retrospective Studies, Aerosols, biology, Colistin, business.industry, Infant, Newborn, Case-control study, Ventilator-associated pneumonia, Pneumonia, Ventilator-Associated, General Medicine, biochemical phenomena, metabolism, and nutrition, bacterial infections and mycoses, medicine.disease, biology.organism_classification, Respiration, Artificial, Anti-Bacterial Agents, respiratory tract diseases, Pneumonia, Treatment Outcome, Case-Control Studies, 030220 oncology & carcinogenesis, Female, lipids (amino acids, peptides, and proteins), business, Bacteria, medicine.drug
Abstract: Recently intravenous (IV) and aerosolized (ASZ) colistin have been used for treating ventilator-associated pneumonia (VAP) due to colistin susceptible multidrug-resistant Gram-negative bacteria (MDR-GNB). Colistin has limited lung penetration. We compared the efficacy and safety of IV-alone versus IV+ASZ-colistin for treating VAP in neonates.This retrospective matched case-control study was performed at NICU of the Aga Khan University Hospital, Pakistan between January 2015 and December 2018. Sixteen neonates with MDR-GNB associated VAP received IV-ASZ-colistin and were matched for date of birth, gestational age, birth weight, Apgar score, antenatal steroid history, disease severity, and duration of mechanical ventilation with 16 control neonates who received IV-colistin alone.Both groups had similar MDR-GNB isolates andWith better lung penetration, ASZ-colistin offers effective and safe microbiological and clinical benefits as adjunctive or alternate treatment of VAP due to colistin susceptible MDR-GNB in neonates.
Published: 2020

40. Integrative analysis reveals methylenetetrahydrofolate dehydrogenase 1-like as an independent shared diagnostic and prognostic biomarker in five different human cancers

Author: Nuzhat Sial, Jalil Ur Rehman, Saba Saeed, Mukhtiar Ahmad, Yasir Hameed, Muhammad Atif, Abdul Rehman, Rizwan Asif, Hamad Ahmed, Muhammad Safdar Hussain, Muhammad Rashid Khan, Atifa Ambreen, and Ayesha Ambreen
Subjects: Adult, Male, Bioinformatics, Biophysics, Biochemistry, Formate-Tetrahydrofolate Ligase, Young Adult, MTHFD1L, Aminohydrolases, Multienzyme Complexes, Predictive Value of Tests, Neoplasms, Databases, Genetic, Biomarkers, Tumor, Humans, Gene Regulatory Networks, Protein Interaction Maps, Expression variations, Molecular Biology, Diagnostics & Biomarkers, Research Articles, Aged, Cancer, Aged, 80 and over, Methylenetetrahydrofolate Dehydrogenase (NADP), Biomarker, Cell Biology, Middle Aged, Prognosis, Up-Regulation, Gene Expression Regulation, Neoplastic, Female, Signal Transduction
Abstract: Background: Defects in methylenetetrahydrofolate dehydrogenase 1-like (MTHFD1L) expression have earlier been examined in only a few human cancers. Objectives: Multi-omics profiling of MTHFD1L as a shared biomarker in distinct subtypes of human cancers. Methods: In the current study, for the multi-omics analysis of MTHFD1L in 24 major subtypes of human cancers, a comprehensive in silico approach was adopted to mine different open access online databases including UALCAN, Kaplan–Meier (KM) plotter, LOGpc, GEPIA, Human Protein Atlas (HPA), Gene Expression across Normal and Tumor tissue (GENT2), MEXPRESS, cBioportal, STRING, DAVID, TIMER, and Comparative Toxicogenomics Database (CTD). Results: We noticed that the expression of MTHFD1L was significantly higher in all the analyzed 24 subtypes of human cancers as compared with the normal controls. Moreover, MTHDF1L overexpression was also found to be significantly associated with the reduced overall survival (OS) duration of Bladder urothelial cancer (BLCA), Head and neck cancer (HNSC), Kidney renal papillary cell carcinoma (KIRP), Lung adenocarcinoma (LUAD), and Uterine corpus endometrial carcinoma (UCEC). This implies that MTHFD1L plays a significant role in the development and progression of these cancers. We further noticed that MTHFD1L was also overexpressed in BLCA, HNSC, KIRP, LUAD, and UCEC patients of different clinicopathological features. Pathways enrichment analysis revealed the involvement of MTHFD1L-associated genes in five diverse pathways. We also explored few interesting correlations between MTHFD1L expression and its promoter methylation, genetic alterations, CNVs, and between CD8+ T immune cells level. Conclusion: In conclusion, our results elucidated that MTHFD1L can serve as a shared diagnostic and prognostic biomarker in BLCA, HNSC, KIRP, LUAD, and UCEC patients of different clinicopathological features.
Published: 2022

41. Strategies for improving faculty retention: a mixed-methods study in a private medical university in Karachi, Pakistan

Author: Fatima Zehra, Nighat Rukhsana, and Ambreen Usmani
Subjects: Adult, Male, Medical education, Faculty, Medical, Universities, business.industry, General Medicine, Faculty, Surveys and Questionnaires, Humans, Medicine, Female, Pakistan, Factor Analysis, Statistical, business
Abstract: Introduction: To determine the strategies that improve faculty retention at a medical university. Methods: The mixed-method study was conducted at Bahria University Medical and Dental College, Karachi, from August to September 2020, and comprised faculty members of either gender associated either with the university or with Pakistan Navy Station Shifa Hospital. Qualitative component comprised of semi-structured interviews. Quantitative data was collected using the 35-item Faculty Retention Strategies Questionnaire (FRSQ). Data was analysed using SPSS 23. Exploratory factor analysis (EFA) was done to extract the common factors influencing faculty retention. Results: Of the 182 faculty members approached, 101(56%) responded. Of them, 66(65.3%) subjects were females, 35(34.7%) were males, 46(45.5%) were aged
Published: 2021

42. Building Equitable Patient Partnerships during the COVID-19 Pandemic: Challenges and Key Considerations for Research and Policy

Author: Janet A. Parsons, Aisha Lofters, Gary Bloch, Ambreen Sayani, Alies Maybee, Stephen W. Hwang, Jackie Manthorne, and Erika Nicholson
Subjects: Adult, Male, Canada, Affirmative action, Biomedical Research, Public policy, Guidelines as Topic, Political science, Humans, Social inequality, Pandemics, Health policy, Aged, Aged, 80 and over, Discussion and Debate, Equity (economics), Health Equity, SARS-CoV-2, business.industry, Health Policy, Patient Selection, COVID-19, Middle Aged, Public relations, Health equity, Research Design, Public participation, Female, business, Delivery of Health Care, Diversity (business)
Abstract: The unequal social and economic burden of the COVID-19 pandemic is evident in racialized and low-income communities across Canada. Importantly, social inequities have not been adequately addressed and current public policies are not reflective of the needs of diverse populations. Public participation in decision-making is crucial and there is, therefore, a pressing need to increase diversity of representation in patient partnerships in order to prevent the further exclusion of socially marginalized groups from research and policy making. Deliberate effort and affirmative action are needed to meaningfully engage and nurture diverse patient partnerships by broadening the scope of the patient community to include excluded or underrepresented individuals or groups. This will help us co-develop ways to enhance access and equity in healthcare and prevent the systematic reproduction of structural inequalities that have already been heightened by the COVID-19 pandemic.
Published: 2021

43. Leveraging technology and supply chain to improve family planning logistics in Pakistan

Author: Ambreen Khan, Kayhan Motla, and Muhammad Tariq
Subjects: Finance, Technology, Public Sector, Warning system, business.industry, Supply chain, Public sector, Commodity, General Medicine, Family planning, Family Planning Services, Business intelligence, Accountability, Information system, Humans, Pakistan, business
Abstract: Pakistan and USAID have invested in improving the contraceptive supply chain data and commodity security. In 2011, the first digital contraceptive logistics management information system (cLMIS) was launched, enabling supply chain data visibility from the federal level to health facilities. The system has built-in modules on forecasting and supply planning, inventory management, consumption reporting, business intelligence tools, automatic email and SMS alerts. Using these features, policy-makers and health managers annually forecast needs, and procure contraceptives accordingly.The objective of this research was to understand the existing technological platforms for family planning (FP) supply chain data visibility and the potential impact on contraceptive commodity security.The authors reviewed available published and grey literature papers on contraceptives and supplies in Pakistan. We extracted data from the cLMIS, evaluated indicators including reporting compliance, reported stock-out rates, and contraceptive performance. The analysis was validated by reviewing supply chain and FP indicators, such as average monthly consumption, months of stock, and couple years of protection.The cLMIS has resulted in improved distribution, early warning and accountability at the lowest tiers in the FP supply chain in the public sector. At the facility level, FP commodity availability increased from 40% in 2009 to 84% in 2018.Contraceptive supply chain has seen significant growth over the past decade to meet expanding reproductive health evidence to inform strategic decisions; cLMIS is a prime contributor to improvements registered in FP stock availability at public sector facilities.الاستفادة من التكنولوجيا وسلسلة الإمداد في تحسين لوجستيات تنظيم الأسرة في باكستان.محمد طارق، أمبرين خان، كيهان موتلا.استثمرت باكستان والوكالة الأمريكية للتنمية الدولية في تحسين بيانات سلسلة الإمداد بوسائل منع الحمل وتأمين السلع الخاصة بها. وفي عام 2011، أُطلق أول نظام معلومات رقمي لإدارة لوجستيات وسائل منع الحمل، مما سهَّل وضوح بيانات سلسلة الإمداد على المستوى الاتحادي للمرافق الصحية. ويتضمن النظام وحدات مدمجة بشأن التنبؤ وتخطيط الإمدادات، وإدارة المخزون، والإبلاغ عن الاستهلاك، وأدوات تحليل المعلومات التجارية، والرسائل الإلكترونية الآلية، والتنبيهات باستخدام الرسائل النصية القصيرة. وباستخدام هذه الخصائص، يمكن لراسمي السياسات والمديرين الصحيين التنبؤ بالاحتياجات سنويًا، وشراء وسائل منع الحمل وفقًا لذلك.هدفت هذه الدراسة إلى فهم المنصات التكنولوجية الحالية لوضوح بيانات سلسلة الإمداد المتعلقة بتنظيم الأسرة والتأثير المحتمل على تأمين السلع الخاصة بوسائل منع الحمل.استعرض المؤلفون المؤلفات غير الرسمية والمنشورة المتاحة عن وسائل منع الحمل والإمدادات في باكستان. واستخلصنا بيانات من نظام المعلومات الرقمي لإدارة لوجستيات وسائل منع الحمل، وقيَّمنا المؤشرات، بما يشمل الإبلاغ عن الامتثال، ومعدلات نفاد المخزون المُبلَّغ عنها، وأداء وسائل منع الحمل. وتم التحقق من صحة التحليل من خلال استعراض مؤشرات سلسلة الإمداد وتنظيم الأسرة، مثل متوسط الاستهلاك الشهري، وشهور المخزون، وفترة الحماية من الإنجاب.أسفر نظام المعلومات الرقمي لإدارة لوجستيات وسائل منع الحمل عن تحسن التوزيع والإنذار المبكر والمساءلة في أدنى مستويات سلسلة الإمداد المتعلقة بتنظيم الأسرة في القطاع العام. وعلى مستوى المرافق، ازداد توافر سلع تنظيم الأسرة من 40٪ في عام 2009 إلى 84٪ في عام 2018.شهدت سلسلة الإمداد بوسائل منع الحمل نموًا كبيرًا على مدى العقد الماضي لتلبية الدلائل المتزايدة في مجال الصحة الإنجابية لتوجيه القرارات الاستراتيجية؛ ويُعدّ نظام المعلومات الرقمي لإدارة لوجستيات وسائل منع الحمل عاملاً مساهمًا رئيسيًا في التحسينات المسجلة في توافر مخزونات تنظيم الأسرة في مرافق القطاع العام.Mettre à profit la technologie et la chaîne d'approvisionnement pour améliorer la logistique de la planification familiale au Pakistan.Le Pakistan et l'USAID ont investi dans l'amélioration des données de la chaîne d'approvisionnement en contraceptifs et de la sécurité des produits. En 2011, le premier système numérique d'information pour la gestion de la logistique des contraceptifs a été lancé, permettant la visibilité des données de la chaîne d'approvisionnement depuis le niveau fédéral jusqu'aux établissements de santé. Le système comprend des modules intégrés de prévision et de planification de l'approvisionnement, de gestion des stocks, de rapports de consommation, d'outils de veille stratégique, d'alertes automatiques par courriel et par SMS. En utilisant ces options, les responsables de l'élaboration des politiques et les responsables de la santé peuvent prévoir les besoins chaque année et en conséquence se procurer des contraceptifs.L'objectif de la présente recherche était de comprendre les plateformes technologiques existantes pour la visibilité des données de la chaîne d'approvisionnement pour la planification familiale et l'impact potentiel sur la sécurité des produits contraceptifs.Nous avons passé en revue les articles disponibles publiés et la littérature grise sur les contraceptifs et les fournitures au Pakistan. Nous avons extrait les données du système numérique d'information pour la gestion de la logistique des contraceptifs, évalué les indicateurs, notamment la conformité des rapports, les taux de rupture de stock rapportés et la performance des contraceptifs. L'analyse a été validée par l'examen de la chaîne d'approvisionnement et des indicateurs de planification familiale, tels que la consommation mensuelle moyenne, les mois de stock et le couple-années de protection.Le système numérique d'information pour la gestion de la logistique contraceptive a amélioré la distribution, l'alerte précoce et la responsabilisation aux niveaux les plus bas de la chaîne d'approvisionnement en planification familiale dans le secteur public. Au niveau des établissements, la disponibilité des produits de planification familiale est passée de 40 % en 2009 à 84 % en 2018.La chaîne d'approvisionnement en contraceptifs a connu une croissance significative au cours de la dernière décennie pour répondre à l'augmentation des bases factuelles en matière de santé reproductive afin d'informer les décisions stratégiques. Le système numérique d'information pour la gestion de la logistique des contraceptifs joue un rôle important dans les améliorations de la disponibilité des stocks de planification familiale dans les établissements du secteur public.
Published: 2021

44. Impact of a standardised parenteral nutrition protocol: a quality improvement experience from a NICU of a developing country

Author: Khalil Ahmad, Uzair Ansari, Vikram Kumar, Arjumand Rizvi, Simon Demas, Kashif Hussain, Shabina Ariff, Syed Rehan Ali, Ali Shabbir Hussain, Syed Shamim Raza, Waqar Khowaja, Uswa Jiwani, and Gul Ambreen
Subjects: Parenteral Nutrition, medicine.medical_specialty, Pediatrics, Neonatal intensive care unit, 030309 nutrition & dietetics, Weight Gain, Sepsis, 03 medical and health sciences, 0302 clinical medicine, Intensive Care Units, Neonatal, medicine, Humans, 030212 general & internal medicine, Neonatology, Developing Countries, Retrospective Studies, 0303 health sciences, business.industry, Infant, Newborn, Outcome measures, medicine.disease, Quality Improvement, Parenteral nutrition, Pediatrics, Perinatology and Child Health, medicine.symptom, business, Weight gain, Hospital stay
Abstract: ObjectiveNutrition societies recommend using standardised parenteral nutrition (SPN) solutions. We designed evidence-based SPN formulations for neonates admitted to our neonatal intensive care unit (NICU) and evaluated their outcomes.DesignThis was a quality improvement initiative. Data were collected retrospectively before and after the intervention.SettingA tertiary-care level 3 NICU at the Aga Khan University in Karachi, Pakistan.PatientsAll NICU patients who received individualised PN (IPN) from December 2016 to August 2017 and SPN from October 2017 to June 2018.InterventionsA team of neonatologists and nutrition pharmacists collaborated to design two evidence-based SPN solutions for preterm neonates admitted to the NICU.Main outcome measuresWe recorded mean weight gain velocity from days 7 to 14 of life. The other outcomes were change in weight expressed as z-scores, metabolic abnormalities, PN-associated liver disease (PNALD), length of NICU stay and episodes of sepsis during hospital stay.ResultsNeonates on SPN had greater rate of change in weight compared with IPN (β=13.40, 95% CI: 12.02 to 14.79) and a smaller decrease in z-scores (pConclusionsWe found that SPN was associated with shorter NICU stay and greater weight gain. In-house preparation of SPN can be used to address the nutritional needs in resource-limited settings where commercially prepared SPN is not available.
Published: 2021

45. A road map for identifying autism spectrum disorder: Recognizing and evaluating characteristics that should raise red or 'pink' flags to guide accurate differential diagnosis

Author: Caroline Grantz, Deborah Fein, Kira Armstrong, Catherine Lord, Susanne W. Duvall, and Ambreen Shahabuddin
Subjects: 050103 clinical psychology, Referral, Autism Spectrum Disorder, media_common.quotation_subject, Psychological intervention, Neuropsychological Tests, Diagnosis, Differential, Presentation, Arts and Humanities (miscellaneous), mental disorders, Common Rule, Prevalence, Developmental and Educational Psychology, medicine, Humans, 0501 psychology and cognitive sciences, Road map, media_common, 05 social sciences, medicine.disease, Psychiatry and Mental health, Clinical Psychology, Neuropsychology and Physiological Psychology, Autism spectrum disorder, Autism, Differential diagnosis, Emblems and Insignia, Psychology, Clinical psychology
Abstract: Objective: Given the high population prevalence of Autism Spectrum Disorder (ASD) and overlapping symptoms with medically complex groups, ASD is a common rule out diagnosis for neuropsychologists even when not identified in the referral or initial presenting concerns. This paper presents practical guidance to support neuropsychologists in their ability to accurately assess, diagnose, and/or rule out ASD, especially in patients with more subtle presentations. Method: This paper combines clinical experience and empirical literature to highlight important assessment measures and related considerations, differential diagnostic considerations, common misconceptions about ASD and person/family characteristics, as well as variability in presentation and comorbidities that can obscure the diagnosis. Characteristics that may be considered "red flags" (clearly diagnostic, classic symptoms) and "pink flags" (associated features and symptoms that are suggestive of ASD but not quite definitive and that may overlap with symptoms seen in other neurodevelopmental or psychiatric diagnoses) will be discussed. Conclusions: Neuropsychologists in all clinical settings should be able to effectively screen for and/or diagnose ASD, even when its presentation is more subtle and/or when symptoms are masked by patient strengths in a way that makes their clinical presentation less obvious. Practical strategies for communicating the diagnosis and next steps/recommendations for interventions are reviewed.
Published: 2021

46. Psychological Impact of Cadaveric Dissection on First-Year Medical Students

Author: Satia Waheed, Faryal Shuja, and Ambreen Zubair
Subjects: Students, Medical, business.industry, Dissection, General Medicine, Anxiety, medicine.disease, Acute Stress Disorder, Education, Test (assessment), Death anxiety, Cross-Sectional Studies, Cadaver, medicine, Cadaveric dissection, Humans, Cadaver dissection, Pakistan, medicine.symptom, business, Stress, Psychological, Clinical psychology
Abstract: Background This cross-sectional study was carried out to ascertain if first-time cadaver dissections can cause acute stress disorder (ASD) in medical students, and if death anxiety and gender play a role in the development of these symptoms. Methods A total of 135 first-year medical students at the Services Institute of Medical Sciences and King Edward Medical University, Lahore, Pakistan, who had recently conducted their first ever cadaver dissection filled out three scales: the Impact of Event Scale-Revised (IES-R), the Appraisal of Life Scale (Revised) (ALS-R) and Death Anxiety Inventory. The results were then calculated via SPSS v.23. Any students with a history of psychiatric treatment or disorder were not included in the study. Results Scores on the IES-R showed that the sample suffered from symptoms of ASD (mean = 36.15, standard deviation = 15.99). Multilinear regression showed that death anxiety did not predict any variance on the scores for IES-R, whereas higher scores on the ALS-R threat domain scale predicted higher scores on the IES-R. Death anxiety had little to no impact on the scores for IES-R. Conclusion Results showed that students who perceived the dissection situation as threatening and anxiety inducing were more likely to test positively for ASD symptoms. A major limitation of the study was that it did not measure whether these symptoms reduced with repeated exposure to cadaver dissection or how symptoms changed over time.
Published: 2021

47. Formulation and characterization of orodispersible film containing diltiazem hydrochloride with taste masked effects

Author: Sumera, Latif, Ambreen, Kokab, Hafsa, Afzal, Qurat-Ul Ain, Shoaib, Misbah, Hameed, Mobina, Manzoor, Nighat, Batool, and Qazi Amir, Ijaz
Subjects: Diltiazem, Solubility, Plasticizers, Polymers, Chemistry, Pharmaceutical, Taste, Administration, Oral, Humans, Tablets
Abstract: Orodispersible film (ODF) is a better alternate to oral disintegrating tablets owing to its ease in application and subsequent patient compliance. This study investigates an improvement in physico-mechanical properties and palatability of Diltiazem Hydrochloride (DTZ) by formulating ODF employing solvent casting method. DTZ, used in the treatment of angina and hypertension, undergoes extensive presystemic metabolism and gives an incomplete bioavailability of 35-40%. DTZ also manifests a very bitter taste and after taste. DTZ was formulated into films using different polymer concentrations of Hydroxypropyl methylcellulose ethocel5 and Carboxymethyl cellulose and plasticizer levels of Propylene glycol and Glycerin to screen appropriate polymer-plasticizer combination. Optimized film disintegrated in 10.0±1.53 sec and appeared to be clear and smooth and almost 100% of the drug release was achieved within 4min from the ODF. Film revealed a good mechanical strength with folding endurance of260, tensile strength of 1.36±0.11 N/mm2 and % elongation of 15.47±0.47%. FTIR and DSC showed compatibility between the drug and polymer. Film demonstrated a slightly sweet taste and after taste as well as an acceptability by the human volunteers. In conclusion DTZ was successfully formulated into film with improved physical properties and taste and could be beneficial to patients with cardiovascular disorders.
Published: 2022

48. Relationship of caffeine regimen with osteopenia of prematurity in preterm neonates: a cohort retrospective study

Author: Manoj Kumar, Amin Ali, Muhammad Azeem Khan, Sadia Sohail, Syed Muzafar Saleem, Midhat Khan, Fizzah Naz, Wasif Ahmed Khan, Muhammad Sohail Salat, Kashif Hussain, and Gul Ambreen
Subjects: Male, Infant, Newborn, Vitamins, Cohort Studies, Bone Diseases, Metabolic, Sleep Apnea Syndromes, Caffeine, Pediatrics, Perinatology and Child Health, Humans, Infant, Very Low Birth Weight, Female, Infant, Premature, Retrospective Studies, Rickets
Abstract: Background Caffeine is a routinely prescribed pharmacological active compound in neonatal intensive care units (NICU) for treating apnea of prematurity (AOP), which also decreases the risk of bronchopulmonary dysplasia and cerebral palsy in neonates. Caffeine-induced excessive calcium loss can promote the development of metabolic bone disease (MBD) in preterm neonates. This study aimed to evaluate the effect of the caffeine regimen on the development of osteopenia of prematurity (OOP), using serum alkaline phosphatase (serum-ALP) concentrations as a surrogate marker at the 4th week of life. Methods This retrospective cohort study was conducted including neonates of Results From the total of 268 participants, 52 (19%) developed OOP, mostly female (61.5%). In the high ALP group, the serum-ALP levels were significantly higher than in the low-ALP group (725.0 ± 143.8 vs 273.6 ± 55.0 units/L, p p Conclusion The daily and cumulative doses of caffeine and smaller GA are associated with the development of OOP in this study cohort. Clinical randomized control studies are needed to validate the outcomes and determine the range of safest and most effective caffeine doses for treating AOP in preterm neonates.
Published: 2022

49. Developing consensus on content and format of e-portfolio for MHPE students: A Delphi study

Author: null Ambreen Ansar, Rahila Yasmeen, and Robina Mushtaq Rizvi
Subjects: 3-Methoxy-4-hydroxyphenylethanol, Consensus, Delphi Technique, Humans, Pilot Projects, General Medicine, Students
Abstract: To build a consensus on portfolio framework for master's in health professional education students and document programme learning outcomes, tasks for students related to each outcome, and the pieces of evidence regarding the completion of each task.The modified Delphi study was conducted from February to July 2020 at Riphah International University, Islamabad, Pakistan, and comprised a three-round electronic-based survey of faculty members associated with the master's in health professional education programme, alumni, and current students as well as portfolio experts. The panellists had to choose from 10 programme learning outcomes, 75 tasks for students to achieve those outcomes, and 510 pieces of evidence to confirm that the tasks had been done to achieve the outcomes. A consensus cut-off of ≥80% was decided to select the item.Of the 45 stakeholders approached, 41(91.5%) responded in round 1. Of them, 31(75.6%) responded in round 2, while round 3 comprised responses from 31(96.7%) subjects. The draft template was originally derived from the master's in health professional education programme guide, expert opinions, and systematic literature review available for portfolios of other higher education degrees. The list of items was refined through a pilot study. The final template was approved by the expert panel after 3 iterations. The final list of items included 59 (78.6%) tasks and 105(21%) pieces of evidence related to all the 10 programme learning outcomes.The important programme learning outcomes, their related tasks, and the required pieces of evidence to be added in the e-portfolio of master's in health professional education programme students were identified, and recommendations for the format of implementation and assessment were given.
Published: 2022

50. Case study: night compression use in a patient with Milroy's disease

Author: Chohan, Ambreen, Sumner, Simon, Olivier, Mairi, and Whitaker, Justine Claire
Subjects: Adult, Leg, Adolescent, H168, A300, B700, Clothing, B800, Compression Bandages, Pressure, Humans, Female, Lymphedema, General Nursing, Stockings, Compression
Abstract: Aim: Lymphoedema is associated with dysfunctional lymphatics, tissue fibrosis and inflammatory changes in the skin and local tissue. Ensuring compression supports tissue health is crucial to managing lymphoedema. Providing patients with safe compression which enhances their tissue health is paramount when supporting their 24-hour self-management regimens. This case study explores the use of a new compression garment in two sitting positions in an adult with primary lymphoedema. Method: An 18-year-old female (body mass index 25.2 kg/m2) with Milroy's disease was recruited. She attended two separate 1-hour sessions to evaluate tissue oxygenation (StO2) in chair-sitting and long-sitting (sitting up with a supported back and legs horizontal) positions. Following removal of her usual class 2 (20–30 mmHg) flat-knit compression hosiery, StO2 was recorded for 20 minutes: pre-, during and post the application of an adjustable compression garment (Lohmann & Rauscher) to the right leg. Results: In the long-sitting position, StO2 levels started high at baseline (94.5%), and were relatively maintained both during and post-a short 20-minute intervention (94.1%). In the chair-sitting position, StO2 levels were significantly lower at baseline (52%), showing a 77% increase during the intervention (92%), followed by a small 9% decrease post-intervention (83.7%). Conclusion: This compression garment significantly increased StO2 levels in the chair-sitting position, while maintaining the effects of the patient's compression stockings, in the long-sitting position. Similar to non-lymphoedematous limbs, the patient's normal prescription hosiery maintains StO2. Through implementation of the short intervention sessions, night compression garments may have the potential to improve tissue health in individuals with primary lymphoedema, encouraging self-management and offering a potential night compression solution where the need arises in a 24-hour management plan.
Published: 2022

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