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Quantitative assessment of the impact of a triage physician on the Accreditation Council for Graduate Medical Education resident milestones in the emergency department

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World Journal of Emergency Medicine 2024年第3期15卷 220-222页

作者： Julie Cueva Duncan Grossman Vishnu Muppala Arlene Chung Mahlaqa butt Jefferson Drapkin Antonios Likourezos Errel Khordipour Department of Emergency Medicine Maimonides Medical CenterNew York 11219USA

The “door-to-doctor” time for patients to be seen by a physician is an increasingly studied metric.Hospitals may shorten this time by implementing a triage physician (TP).The exact role of a TP may vary across departments.TPs put in preliminary orders for lab work,imaging,and treatment,and decide treatment location for further evaluation.As the prevalence of TPs grows,its effect on resident education in academic emergency departments (EDs) remains unclear.We implemented a TP in the spring of 2016 and assessed resident physicians before and after implementation.

关键词： physician doctor treatment

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超表面:塑造光子学的未来

Science Bulletin 2024年第11期69卷 1607-1611页

作者： Nikolay L.Kazanskiy Svetlana N.Khonina Muhammad A.butt Samara National Research University Samara 443086Russia

A metasurface, often abbreviated as MS, represents a thin, artificially crafted surface consisting of an assembly of subwavelength structures that interact with light in distinct manners. Typically,smaller than the wavelength of the light they engage with, these structures empower precise management of light properties such as polarization, phase, and amplitude.

关键词： precise abbreviated 光子学

Lipid dysregulation in hepatitis C virus, and impact of statin therapy upon clinical outcomes

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World Journal of Gastroenterology 2015年第27期21卷 8293-8303页

作者： Tracey G Simon adeel a butt Department of Medicine Brigham and Women’s Hospital Harvard Medical School Boston VA Pittsburgh Healthcare System Pittsburgh University of Pittsburgh School of Medicine Hamad Healthcare Quality Institute Hamad Medical Corporation

The hepatitis C virus(HCV) is one of the most common causes of chronic liver disease and the leading indication for liver transplantation worldwide. Every aspect of the HCV life cycle is closely tied to human lipid metabolism. The virus circulates as a lipid-rich particle, utilizing lipoprotein cell receptors to gain entry into the hepatocyte. It has also been shown to upregulate lipid biosynthesis and impair lipid degradation, resulting in significant intracellular lipid accumulation and circulating hypocholesterolemia. Patients with chronic hepatitis C(CHC) are at increased risk of hepatic steatosis, fibrosis, and cardiovascular disease including accelerated atherosclerosis. HMG Co A Reductase inhibitors, or statins, have been shown to play an important role in the modulation of hepatic steatosis and fibrosis, and recent attention has focused upon their potential therapeutic role in CHC. This article reviews the hepatitis C viral life cycle as it impacts host lipoproteins and lipid metabolism. It then describes the pathogenesis of HCV-related hepatic steatosis, hypocholesterolemia and atherosclerosis, and finally describes the promising anti-viral and anti-fibrotic effects of statins, for the treatment of CHC.

关键词： Hepatitis C virus Lipid profiles Cholesterol Statin Fibrosis Cirrhosis

Structural regulation of coal-derived hard carbon anode for sodium-ion batteries via pre-oxidation

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Rare Metals 2024年第6期43卷 2585-2596页

作者： Meng-Yuan Su Kai-Yang Zhang Edison Huixiang Ang Xue-Li Zhang Yan-Ning Liu Jia-Lin Yang Zhen-Yi Gu Faaz A.butt Xing-Long Wu Faculty of Chemistry Northeast Normal University MOE Key Laboratory for UV Light-Emitting Materials and Technology Northeast Normal UniversityMinistry of Education Natural Sciences and Science Education National Institute of EducationNanyang Technological University Materials Engineering Department NED University of Engineering and Technology

Hard carbon（HC） is broadly recognized as an exceptionally prospective candidate for the anodes of sodium-ion batteries（SIBs）,but their practical implementation faces substantial limitations linked to precursor factors,such as reduced carbon yield and increased cost.Herein,a cost-effective approach is proposed to prepare a coal-derived HC anode with simple pre-oxidation followed by a post-carbonization process which effectively expands the d002layer spacing,generates closed pores and increases defect sites.Through these modifications,the resulting HC anode attains a delicate equilibrium between plateau capacity and sloping capacity,showcasing a remarkable reversible capacity of 306.3 mAh·g-1at 0.03 A·g-1.Furthermore,the produ ced HC exhibits fast reaction kinetics and exceptional rate performance,achieving a capacity of 289 mAh·g-1at 0.1 A·g-1,equivalent to ～94.5% of that at 0.03 A·g-1.When implemented in a full cell configuration,the impressive electrochemical performance is evident,with a notable energy density of 410.6 Wh·kg-1（based on cathode mass）.In short,we provide a straightforward yet efficient method for regulating coal-derived HC,which is crucial for the widespread use of SIBs anodes.

关键词： Sodium-ion batteries Hard carbon Anode Coal Pre-oxidation

Phase 3 trial of first generation protease inhibitor therapy for hepatitis C virus/human immunodeficiency virus coinfection

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World Journal of Hepatology 2017年第4期9卷 217-223页

作者： Kenneth E Sherman Minhee Kang Richard Sterling Triin Umbleja Kristen Marks Jennifer J Kiser Beverly Alston-Smith Wayne Greaves adeel a butt 无 Division of Digestive Diseases University of Cincinnati College of Medicine harvard T.h. Chan School of Public health Department of Gastroenterology Virginia Commonwealth University Division of Infectious Disease Weill Cornell Medical School University of Colorado School of Pharmacy NIAID-Division of AIDS Merck and Co Inc. University of Pittsburgh School of Medicine hamad healthcare Quality Institute the ACTG 5294 BIRTH Study Team

AIM To evaluate efficacy/safety of hepatitis C virus(HCV) protease inhibitor boceprevir with pegylated interferon(PEG-IFN) alfa and weight-based ribavirin(RBV) in a phase 3 trial. METHODS A prospective, multicenter, phase 3, open-label, singlearm study of PEG-IFN alfa, weight-based RBV, and boceprevir, with a PEG-IFN/RBV lead-in phase was performed. The HCV/human immunodeficiency virus coinfected study population included treatment na?ve(TN) and treatment experienced(TE) patients. Treatment duration ranged from 28 to 48 wk dependent upon response-guided criteria. All patients had HCV Genotype 1 with a viral load > 10000 IU/ml. Compensated cirrhosis was allowed. Sample size was determined to establish superiority to historical(PEG-IFN plus RBV) rates in sustained viral response(SVR). RESULTS A total of 257 enrolled participants were analyzed(135 TN and 122 TE). In the TN group, 81.5% were male and 54.1% were black. In the TE group, 76.2% were male and 47.5% were white. Overall SVR12 rates(HCV RNA < lower limit of quantification, target not detected, target not detected) were 35.6% in TN and 30.3% in TE. Response rates at SVR24 were 28% in TN and 10% in TE, and exceeded those in historical controls. The highest rate was observed in TN non-cirrhotic participants(36.8% and the lowest in TE cirrhotics(26.3%). Cirrhotic TN participants had a 27.8% SVR12 rate and 32.1% of TE non-cirrhotics achieved SVR12. Significantly lower response rates were observed among black participants; in the TE, SVR12 was 39.7% in white participants but only 13.2% of black subjects(P = 0.002). Among the TN, SVR12 was 42.1% among whites and 27.4% among blacks(P = 0.09). CONCLUSION The trial met its hypothesis of improved SVR compared to historical controls but overall SVR rates were low. All-oral HCV treatments will mitigate these difficulties.

关键词：人的免疫不全病毒丙肝病毒 Boceprevir Pegylated 干扰素 A Ribavirin

Bullous Pemphigoid Induced by Doxycycline: Case Report and Literature Review

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Case Reports in Clinical Medicine 2024年第5期13卷 187-192页

作者： Mishal Al Mebayadh Rahaf Aldawish Sohail A. butt Abdulrahman Saad Aljahhan Dermatology Department Imam Abdulrahman Bin Faisal University-National Guard Hospital Dammam Saudi Arabia Dermatology Department Al Rass General Hospital Al-Qassim Saudi Arabia Pathology Department Dammam Regional Laboratory & Blood Bank MOH Dammam Saudi Arabia Clinical Documentation Improvement (CDI) Dammam Health Network Dammam Saudi Arabia

Bullous pemphigoid (BP) is the most prevalent autoimmune sub-epidermal blistering disease that affects mainly the elderly and could lead to serious morbidity. It has numerous risk factors and triggers, including an aging population with several comorbidities and drug exposure. In the published paper, we reported a case about a 32 years old male patient with unknown medical conditions who presented with erythematous patches and plaques on the scalp, face, and trunk with scattered blisters two weeks after initiating doxycycline treatment for folliculitis. The exact pathogenesis of the drug-reaction in drug- associated bullous pemphigoid (DABP) remains controversial. In conclusion, it is crucial for clinicians to be aware of DABP when prescribing doxycycline. The purpose of this case report is to raise awareness of the possible association between bullous pemphigoid and doxycycline.

关键词： Bullous Pemphigoid Doxycycline Drug-Associated Bullous Pemphigoid

Web GIS-Based Temporal Analysis of Climatic Factors Impacting Heat Stroke in Karachi

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Journal of Geographic Information System 2024年第1期16卷 61-69页

作者： Ali Atif Mahnoor Rehman Muhammad butt Syed Mahmood Shahid Ghazi Rashid Mehmood Department of Management Victoria University Sydney Australia Department of Geography Government College University Lahore Pakistan Department of Space Science University of the Punjab Lahore Pakistan Centre of Geographic Information System University of The Punjab Lahore Pakistan

This study focuses on the impact of climate change, specifically the increasing threat of heatwaves, in Pakistan, with a particular emphasis on the city of Karachi. The Pakistan Meteorological Department (PMD) analysed a century of climatic data to reveal warming trends, attributing them to human-induced factors. The vulnerability of Pakistan to climate change is highlighted, given its warm climate and location in a region where temperature increases are expected to surpass global averages. The study examines the past three decades, noting a significant rise in the frequency of hot days, especially in Karachi, where heatwaves have become more prevalent. The aims and objectives of the study involve identifying temporal changes in temperature, rainfall, humidity, and wind speed from 1984 to 2014 in Karachi. The literature review emphasizes the health implications of heatwaves, citing increased mortality during such events globally. The study incorporates a comprehensive temporal analysis, addressing gaps in previous research by considering multiple climate indicators responsible for heatwaves. The methodology involves statistical analyses, including linear regression and Pearson correlation, applied to temperature data and urbanization parameters. Results indicate an increasing trend in heat index temperature, with heatwave vulnerability peaking in the last three decades. Heat Index Temperature Anomalies show a clear surge, emphasizing the need for new indices to control critical heat stress conditions. The study concludes that tropical climate variability, particularly heat index, is linked to extreme hot days, urging measures to reduce population vulnerability. The findings underscore the importance of policy strategies, such as integrated coastal zone management, to mitigate the adverse health effects of heatwaves in Karachi’s vulnerable population.

关键词： IPCC Heat Wave Heat Index PMD

Risk factors and outcomes of peptic ulcer bleed in a Pakistani population:A single-center observational study

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World Journal of Gastrointestinal Pharmacology and Therapeutics 2024年第3期15卷 1-9页

作者： Nazish butt Muhammad Tayyab Usmani Nimrah Mehak Saba Mughal Fakhar Ali Qazi-Arisar Ghulam Mohiuddin Gulzar Khan Department of Gastroenterology Jinnah Postgraduate Medical CentreKarachi 75505SindhPakistan National Institute of Liver&GI Diseases Dow University of Health SciencesKarachi 75330SindhPakistan School of Public Health Dow University of Health SciencesKarachi 75330SindhPakistan

BACKGROUND Peptic ulcer disease(PUD)remains a significant healthcare burden,contributing to morbidity and mortality worldwide.Despite advancements in therapies,its prevalence persists,particularly in regions with widespread nonsteroidal antiinflammatory drugs(NSAIDs)use and Helicobacter pylori infection.AIM To comprehensively analyse the risk factors and outcomes of PUD-related upper gastrointestinal(GI)bleeding in Pakistani population.METHODS This retrospective cohort study included 142 patients with peptic ulcer bleeding who underwent upper GI endoscopy from January to December 2022.Data on demographics,symptoms,length of stay,mortality,re-bleed,and Forrest classification was collected.RESULTS The mean age of patients was 53 years,and the majority was men(68.3%).Hematemesis(82.4%)and epigastric pain(75.4%)were the most common presenting symptoms.Most patients(73.2%)were discharged within five days.The mortality rates at one week and one month were 10.6%and 14.8%,respectively.Re-bleed within 24 h and seven days occurred in 14.1%and 18.3%of patients,respectively.Most ulcers were Forrest class(FC)Ⅲ(72.5%).Antiplatelet use was associated with higher mortality at 7 and 30 d,while alternative medications were linked to higher 24-hour re-bleed rates.NSAID use was associated with more FCⅢulcers.Re-bleed at 24 h and 7 d was strongly associated with one-week or one-month mortality.CONCLUSION Antiplatelet use and rebleeding increase the risk of early mortality in PUD-related upper GI bleeding,while alternative medicines are associated with early rebleeding.

关键词： Non variceal bleed Mortality Re-bleed Forrest classification Antiplatelets Alternative medicines

National guidelines for the diagnosis and treatment of hilar cholangiocarcinoma

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World Journal of Gastroenterology 2024年第9期30卷 1018-1042页

作者： Faisal Saud Dar Zaigham Abbas Irfan Ahmed Muhammad Atique Usman Iqbal Aujla Muhammad Azeemuddin Zeba Aziz Abu Bakar Hafeez Bhatti Tariq Ali Bangash Amna Subhan butt Osama Tariq butt Abdul Wahab Dogar Javed Iqbal Farooqi Faisal Hanif Jahanzaib Haider Siraj Haider Syed Mujahid Hassan Adnan Abdul Jabbar Aman Nawaz Khan Muhammad Shoaib Khan Muhammad Yasir Khan Amer Latif Nasir Hassan Luck Ahmad Karim Malik Kamran Rashid Sohail Rashid Mohammad Salih Abdullah Saeed Amjad Salamat Ghias-un-Nabi Tayyab Aasim Yusuf Haseeb Haider Zia Ammara Naveed Department of Hepatopancreatic Biliary Surgery&Liver Transplant Pakistan Kidney and Liver Institute&Research CentreLahore 54000Pakistan Department of Hepatogastroenterology and Liver Transplantation Dr.Ziauddin University HospitalKarachi 75600SindhPakistan University of Aberdeen Aberdeen B243FXUnited Kingdom Department of Pathology Pakistan Kidney and Liver Institute&Research CentreLahore 54000Pakistan Department of Gastroenterology&Hepatology Pakistan Kidney and Liver Institute&Research CentreLahore 54000Pakistan Department of Radiology Aga Khan UniversityKarachi 74800Pakistan Department of Oncology Hameed Latif HospitalLahore 54000Pakistan Division of Hepatopancreatic Biliary Surgery&Liver Transplantation Shifa International HospitalIslamabad 44000Pakistan Department of Hepatopancreatic Biliary Surgery&Liver Transplant Shaikh Zayed Hospital and Post Graduate Medical InstituteLahore 54000Pakistan Department of Medicine Aga Khan University HospitalKarachi 74800Pakistan Department of Liver Transplant Pir Abdul Qadir Shah Jeelani Institute of Medical SciencesGambat 66020Pakistan Department of Medicine&Gastroenterology Lifecare Hospital and Research CentrePeshawar 25000Khyber PakhtunkhwaPakistan Department of Hepatopancreatobiliary&Liver Transplant Bahria International HospitalLahore 54000Pakistan Department of Surgery Hepatopancreatobiliary&Liver TransplantDow University of Health SciencesKarachi 74800Pakistan Department of Gastroenterology Hepatology&NutritionPir Abdul Qadir Shah Jeelani Institute of Medical SciencesGambat 66020Pakistan Department of Oncology Dr.Ziauddin HospitalKarachi 74800Pakistan Department of Radiology Rehman Medical InstitutePeshawar 25000Pakistan Army Liver Transplant Unit Pak Emirates Military HospitalRawalpindi 46000Pakistan Department of Gastroenterology Sindh Institute of Urology and TransplantationKarachi 75500Pakistan Rashid Nursing Home and Cancer Clinic Rashid Nursing Home and Cancer ClinicRawalpindi 46000Pakistan Department of Gastroentero

A consensus meeting of national experts from all major national hepatobiliary centres in the country was held on May 26,2023,at the Pakistan Kidney and Liver Institute&Research Centre(PKLI&RC)after initial consultations with the experts.The Pakistan Society for the Study of Liver Diseases(PSSLD)and PKLI&RC jointly organised this meeting.This effort was based on a comprehensive literature review to establish national practice guidelines for hilar cholangiocarcinoma(hCCA).The consensus was that hCCA is a complex disease and requires a multidisciplinary team approach to best manage these patients.This coordinated effort can minimise delays and give patients a chance for curative treatment and effective palliation.The diagnostic and staging workup includes high-quality computed tomography,magnetic resonance imaging,and magnetic resonance cholangiopancreato-graphy.Brush cytology or biopsy utilizing endoscopic retrograde cholangiopancreatography is a mainstay for diagnosis.However,histopathologic confirmation is not always required before resection.Endoscopic ultrasound with fine needle aspiration of regional lymph nodes and positron emission tomography scan are valuable adjuncts for staging.The only curative treatment is the surgical resection of the biliary tree based on the Bismuth-Corlette classification.Selected patients with unresectable hCCA can be considered for liver transplantation.Adjuvant chemotherapy should be offered to patients with a high risk of recurrence.The use of preoperative biliary drainage and the need for portal vein embolisation should be based on local multidisciplinary discussions.Patients with acute cholangitis can be drained with endoscopic or percutaneous biliary drainage.Palliative chemotherapy with cisplatin and gemcitabine has shown improved survival in patients with irresectable and recurrent hCCA.

关键词： Hilar cholangiocarcinoma Bismuth-Corlette classification Memorial Sloan Kettering Cancer Centre Staging Preoperative biliary drainage Portal vein embolisation Surgical resection Hepatectomy