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Fulltext Numerical investigation of the effect of stenosis geometry on the coronary diagnostic parameters

Kamangar S, Kalimuthu G, Badruddin IA, Badarudin A, Ahmed NJ, Khan TM

ScientificWorldJournal, 2014;2014:354946.
PMID: 25258722 DOI: 10.1155/2014/354946

The present study deals with the functional severity of a coronary artery stenosis assessed by the fractional flow reserve (FFR). The effects of different geometrical shapes of lesion on the diagnostic parameters are unknown. In this study, 3D computational simulation of blood flow in three different geometrical shapes of stenosis (triangular, elliptical, and trapezium) is considered in steady and transient conditions for 70% (moderate), 80% (intermediate), and 90% (severe) area stenosis (AS). For a given percentage AS, the variation of diagnostic parameters which are derived from pressure drop across the stenosis was found in three different geometrical shapes of stenosis and it was observed that FFR is higher in triangular shape and lower in trapezium shape. The pressure drop coefficient (CDP) was higher in trapezium shape and lower in triangular model whereas the LFC shows opposite trend. From the clinical perspective, the relationship between percentage AS and FFR is linear and inversely related in all the three models. A cut-off value of 0.75 for FFR was observed at 76.5% AS in trapezium model, 79.5% in elliptical model, and 82.7% AS for the triangular shaped model. The misinterpretation of the functional severity of the stenosis is in the region of 76.5%-82.7 % AS from different shapes of stenosis models.
Effect of porous media of the stenosed artery wall to the coronary physiological diagnostic parameter: a computational fluid dynamic analysis

Govindaraju K, Kamangar S, Badruddin IA, Viswanathan GN, Badarudin A, Salman Ahmed NJ

Atherosclerosis, 2014 Apr;233(2):630-635.
PMID: 24549189 DOI: 10.1016/j.atherosclerosis.2014.01.043

Functional assessment of a coronary artery stenosis severity is generally assessed by fractional flow reserve (FFR), which is calculated from pressure measurements across the stenosis. The purpose of this study is to investigate the effect of porous media of the stenosed arterial wall on this diagnostic parameter. To understand the role of porous media on the diagnostic parameter FFR, a 3D computational simulations of the blood flow in rigid and porous stenotic artery wall models are carried out under steady state and transient conditions for three different percentage area stenoses (AS) corresponding to 70% (moderate), 80% (intermediate), and 90% (severe). Blood was modeled as a non Newtonian fluid. The variations of pressure drop across the stenosis and diagnostic parameter were studied in both models. The FFR decreased in proportion to the increase in the severity of the stenosis. The relationship between the percentage AS and the FFR was non linear and inversely related in both the models. The cut-off value of 0.75 for FFR was observed at 81.89% AS for the rigid artery model whereas 83.61% AS for the porous artery wall model. This study demonstrates that the porous media consideration on the stenotic arterial wall plays a substantial role in defining the cut-off value of FFR. We conclude that the effect of porous media on FFR, could lead to misinterpretation of the functional severity of the stenosis in the region of 81.89 %-83.61% AS.
The influence of artery wall curvature on the anatomical assessment of stenosis severity derived from fractional flow reserve: a computational fluid dynamics study

Govindaraju K, Viswanathan GN, Badruddin IA, Kamangar S, Salman Ahmed NJ, Al-Rashed AA

Comput Methods Biomech Biomed Engin, 2016 Nov;19(14):1541-9.
PMID: 27052093 DOI: 10.1080/10255842.2016.1170119

This study aims to investigate the influence of artery wall curvature on the anatomical assessment of stenosis severity and to identify a region of misinterpretation in the assessment of per cent area stenosis (AS) for functionally significant stenosis using fractional flow reserve (FFR) as standard. Five artery models of different per cent AS severity (70, 75, 80, 85 and 90%) were considered. For each per cent AS severity, the angle of curvature of the arterial wall varied from straight to an increasingly curved model (0°, 30°, 60°, 90° and 120°). Computational fluid dynamics was performed under transient physiologic hyperemic flow conditions to investigate the influence of artery wall curvature on the pressure drop and the FFR. The findings in this study may be useful in in vitro anatomical assessment of functionally significant stenosis. The FFR decreased with increasing stenosis severity for a given curvature of the artery wall. Moreover, a significant decrease in FFR was found between straight and curved models discussed for a given severity condition. These findings indicate that the curvature effect was included in the FFR assessment in contrast to minimum lumen area (MLA) or per cent AS assessment. The MLA or per cent AS assessment may lead to underestimation of stenosis severity. From this numerical study, an uncertainty region could be evaluated using the clinical FFR cutoff value of 0.8. This value was observed at 81.98 and 79.10% AS for arteries with curvature angles of 0° and 120° respectively. In conclusion, the curvature of the artery should not be neglected in in vitro anatomical assessment.
Fulltext Noise characteristics of grass-trimming machine engines and their effect on operators

Mallick Z, Badruddin IA, Khaleed Hussain MT, Salman Ahmed NJ, Kanesan J

Noise Health, 2009 Apr-Jun;11(43):98-102.
PMID: 19414929 DOI: 10.4103/1463-1741.50694

Over the last few years, interaction of humans with noisy power-driven agricultural tools and its possible adverse after effects have been realized. Grass-trimmer engine is the primary source of noise and the use of motorized cutter, spinning at high speed, is the secondary source of noise to which operators are exposed. In the present study, investigation was carried out to determine the effect of two types of grass-trimming machine engines (SUM 328 SE and BG 328) noise on the operators in real working environment. It was found that BG-328 and SUM-328 SE produced high levels of noise, of the order of 100 and 105 dB(A), respectively, to which operators are exposed while working. It was also observed that situation aggravates when a number of operators simultaneously operate resulting in still higher levels of noise. Operators should be separated 15 meters from each other in order to avoid the combined level of noise exposure while working with these machines. It was found that SPL, of the grass-trimmer machine engines (BG-328 and SUM-328 SE), were higher than the limit of noise recommended by ISO, NIOSH, and OSHA for an 8-hour workday. Such a high level of noise exposure may cause physiological and psychological problems to the operators in long run.
Fulltext Incidence of Healthcare-Associated Infections (HAIs) and the adherence to the HAIs' prevention strategies in a military hospital in Alkharj

Ahmed NJ, Haseeb A, Elazab EM, Kheir HM, Hassali AA, Khan AH

Saudi Pharm J, 2021 Oct;29(10):1112-1119.
PMID: 34703364 DOI: 10.1016/j.jsps.2021.08.012

Background: Healthcare-associated infections (HAI) are considered one of the most common adverse events in health care service provision. In order to prevent the occurrence of HAIs, it is important to implement several prevention strategies.
Objectives: This study aims to determine the incidence of healthcare-associated infections in a military hospital in Alkharj and the adherence to the HAIs' prevention strategies.
Methods: This study included exporting data for all infected cases confirmed by the infection disease specialists in 2019. The data were collected from the reports that were written by infection control unit and infectious disease department.
Results: The rate of healthcare associated infections (HAIs) in 2019 was 0.43% of total patient admissions. The rate of central line associated bloodstream infections in 2019 was 1.15 per 1000 central line days. The rate of catheter associated urinary tract infections in 2019 was 1.00 per 1000 catheter days. The rate of ventilator associated pneumonia in 2019 was 2.11 per 1000 ventilator days and the rate of surgical site infections in 2019 was 0.41 %.
Conclusion: The rate of overall healthcare-associated infections (HAI) was low. The compliance rate of health care workers to preventive measures that control HAIs was generally high but there was a need for more awareness particularly regarding personal protective equipment and hand hygiene. So it is important to attend more awareness activities and workshops particularly regarding personal protective equipment and hand hygiene. Furthermore, infection control unit and infectious disease department in the hospital should support the robust HAI prevention programs.
Fulltext Meta-Analysis of Clinical Trials Comparing Cefazolin to Cefuroxime, Ceftriaxone, and Cefamandole for Surgical Site Infection Prevention

Ahmed NJ, Haseeb A, Alamer A, Almalki ZS, Alahmari AK, Khan AH

Antibiotics (Basel), 2022 Nov 03;11(11).
PMID: 36358198 DOI: 10.3390/antibiotics11111543

Surgical site infections are among the most prevalent and costly healthcare-associated infections, resulting in poor patient outcomes and even death. Cefazolin is a first-generation cephalosporin antibiotic that is widely used for surgical prophylaxis in a variety of surgical disciplines. Although previous studies showed that cefazolin is effective in preventing surgical site infections, other agents, such as cefuroxime and ceftriaxone, were used excessively for surgical patients. The present analysis included only clinical trials comparing the efficacy of cefazolin to cefuroxime, ceftriaxone, and cefamandole in lowering SSIs using PubMed, Google Scholar, and ClinicalTrials.gov. Review Manager software (RevMan version 5.4) was used to conduct the meta-analyses. A total of 12,446 patients were included in the study. Among these patients, 6327 patients received cefazolin and 6119 patients received cefamandole, cefuroxime, or ceftriaxone. Our analysis showed that cefazolin is as effective as cefuroxime, cefamandole, and ceftriaxone in preventing surgical site infections. Hence, our findings have provided evidence for the use of cefazolin before surgeries because of its efficacy, as previous studies showed that it is inexpensive and safer than other agents.
Influence of stenosis on hemodynamic parameters in the realistic left coronary artery under hyperemic conditions

Kamangar S, Badruddin IA, Badarudin A, Nik-Ghazali N, Govindaraju K, Salman Ahmed NJ, et al.

Comput Methods Biomech Biomed Engin, 2017 Mar;20(4):365-372.
PMID: 27612619 DOI: 10.1080/10255842.2016.1233402

The current study investigates the hyperemic flow effects on heamodynamics parameters such as velocity, wall shear stress in 3D coronary artery models with and without stenosis. The hyperemic flow is used to evaluate the functional significance of stenosis in the current era. Patients CT scan data of having healthy and coronary artery disease was chosen for the reconstruction of 3D coronary artery models. The diseased 3D models of coronary artery shows a narrowing of >50% lumen area. Computational fluid dynamics was performed to simulate the hyperemic flow condition. The results showed that the recirculation zone was observed immediate to the stenosis and highest wall shear stress was observed across the stenosis. The decrease in pressure was found downstream to the stenosis as compared to the coronary artery without stenosis. Our analysis provides an insight into the distribution of wall shear stress and pressure drop, thus improving our understanding of hyperemic flow effect under both conditions.
Fulltext Coping With Diabetes During the COVID-19 Lockdown in Saudi Arabia: Lessons Learned in the Post-pandemic Era

Alharbi A, Alduribi A, Alghthami A, Elnaem M, Alsenani FS, Haseeb A, et al.

Cureus, 2022 Nov;14(11):e31522.
PMID: 36532936 DOI: 10.7759/cureus.31522

BACKGROUND: Uncontrolled diabetes has appeared as one of the major risk factors for morbidity and mortality in diabetic patients with coronavirus disease 2019 (COVID-19). Alterations in dietary habits, physical inactivity, and inability to take advice from the physician are some of the contributing factors. This study aimed to assess the impact of the COVID-19 lockdown in Saudi Arabia on medication accessibility, medication adherence, lifestyle, and quality of life of diabetes patients.
METHODS: A cross-sectional observational study was conducted among diabetic patients using a self-reported questionnaire developed on an online platform (SurveyMonkey®). The survey was distributed through social media platforms (WhatsApp, Telegram). For those who were digitally illiterate, responses were collected by family members. The targeted population was type 1, type 2 and gestational diabetes patients. The analysis of the data was done using IBM SPSS Statistics, version 26.
RESULTS: Four hundred forty-nine participants completed the survey. Most of the participants had type 2 diabetes (n=359; 79.8%) and were well educated (83.2%) with a high school degree and above. Complications from COVID-19 infection were reported in 12% (n=54) patients. During quarantine, 78.8% (n=354) of participants measured their blood glucose regularly. Results showed that during quarantine, 68.3% (n=311) participants skipped their scheduled follow-up whereas only 5.1% (n=23) of them took their medication inappropriately.
CONCLUSION: This study reported good levels of self-monitoring of blood glucose levels, whereas patients' accessibility to seek healthcare services seemed to be interrupted. Further efforts are needed in the post-pandemic era to empower patients' self-care behaviors and utilize telehealth models to facilitate timely access to medical care.
Visualization of multiphase pulsatile blood over single phase blood flow in a patient specific stenosed left coronary artery using image processing technique

Athani A, Ghazali NNN, Anjum Badruddin I, Kamangar S, Salman Ahmed NJ, Honnutagi A

Biomed Mater Eng, 2023;34(1):13-35.
PMID: 36278331 DOI: 10.3233/BME-211333

BACKGROUND: Coronary arteries disease has been reported as one of the principal roots of deaths worldwide.
OBJECTIVE: The aim of this study is to analyze the multiphase pulsatile blood flow in the left coronary artery tree with stenosis.
METHODS: The 3D left coronary artery model was reconstructed using 2D computerized tomography (CT) scan images. The Red Blood Cell (RBC) and varying hemodynamic parameters for single and multiphase blood flow conditions were analyzed.
RESULTS: Results asserted that the multiphase blood flow modeling has a maximum velocity of 1.017 m/s and1.339 m/s at the stenosed region during the systolic and diastolic phases respectively. The increase in Wall Shear Stress (WSS) observed at the stenosed region during the diastole phase as compared during the systolic phase. It was also observed that the highest Oscillatory Shear Index (OSI) regions are found in the downstream area of stenosis and across the bifurcations. The increase in RBCs velocity from 0.45 m/s to 0.6 m/s across the stenosis was also noticed.
CONCLUSION: The computational multiphase blood flow analysis improves the understanding and accuracy of the complex flow conditions of blood elements (RBC and Plasma) and provides the progression of the disease development in the coronary arteries. This study helps to enhance the diagnosis of the blocked (stenosed) arteries more precisely compared to the single-phase blood flow modeling.
Patient specific 3-d modeling of blood flow in a multi-stenosed left coronary artery

Kamangar S, Badruddin IA, Ameer Ahamad N, Soudagar MEM, Govindaraju K, Nik-Ghazali N, et al.

Biomed Mater Eng, 2017;28(3):257-266.
PMID: 28527189 DOI: 10.3233/BME-171672

The current study investigates the effect of multi stenosis on the hemodynamic parameters such as wall pressure, velocity and wall shear stress in the realistic left coronary artery. Patients CT scan image data of normal and diseased left coronary artery was chosen for the reconstruction of 3D coronary artery models. The diseased 3D model of left coronary artery shows a narrowing of more than 70% and 80% of area stenosis (AS) at the left main stem (LMS) and left circumflex (LCX) respectively. The results show that the decrease in pressure was found downstream to the stenosis as compared to the coronary artery without stenosis. The maximum pressure drop was noted across the 80% AS at the left circumflex branch. The recirculation zone was also observed immediate to the stenosis and highest wall shear stress was found across the 80% area stenosis. Our analysis provides an insight into the distribution of wall shear stress and pressure drop, thus improving our understanding on the hemodynamics in realistic coronary artery.
Fulltext Treatment Outcomes of Childhood TB Patients in Four TB High Burden States of Malaysia: Results from a Multicenter Retrospective Cohort Study

Ahmad R, Syed Sulaiman SA, Muttalif AR, Ahmad N, Yaghi ARA, Goh KW, et al.

Antibiotics (Basel), 2022 Nov 16;11(11).
PMID: 36421282 DOI: 10.3390/antibiotics11111639

Data regarding treatment outcomes among childhood TB patients are lacking in Malaysia. The present study aimed to evaluate the treatment outcomes and predictors of unsuccessful treatment outcomes among childhood TB patients in four TB high-burden states of Malaysia. This was a retrospective cohort study conducted at 13 healthcare centers in four states of Malaysia, namely, Sabah, Sarawak, Selangor, and Penang. During the study period, a total of 8932 TB patients were enrolled for treatment at the study sites, of whom 206 (2.31%) were children. The majority of the childhood TB patients were female (52.9%) and belonged to the age group of 6-10 years (42.7%). Pulmonary TB accounted for 70.9% of childhood TB. Among childhood PTB patients, 50% were sputum smear negative. One hundred and seventy-eight patients (86.4%) were successfully treated (87 were cured and 91 completed treatment). Among 28 (13.6%) patients with unsuccessful treatment outcomes, 13 (6.3%) died, 3 (1.5%) failed treatment, 9 (4.4%) defaulted, and 3 (1.5%) were transferred out. Multivariate analysis revealed that patients' age (5-14 years) (OR = 0.279, p-value = 0.006) and male gender (OR = 0.390, p-value = 0.046) had a statistically significant negative association with unsuccessful treatment outcomes. The prevalence of childhood TB in the current study was comparable to the recently published national estimates. The study sites reached the WHO target of treatment success. Special attention to patients with identified risk factors can improve treatment outcomes.
Fulltext Antibiotics for preventing infection at the surgical site: Single dose vs. multiple doses

Ahmed NJ, Haseeb A, AlQarni A, AlGethamy M, Mahrous AJ, Alshehri AM, et al.

Saudi Pharm J, 2023 Dec;31(12):101800.
PMID: 38028220 DOI: 10.1016/j.jsps.2023.101800

BACKGROUND: Surgical site infections are common and expensive infections that can cause fatalities or poor patient outcomes. To prevent these infections, antibiotic prophylaxis is used. However, excessive antibiotic use is related to higher costs and the emergence of antimicrobial resistance.
OBJECTIVES: The present meta-analysis aimed to compare the effectiveness of a single dosage versus several doses of antibiotics in preventing the development of surgical site infections.
METHODS: PubMed was used to find clinical trials evaluating the effectiveness of a single dosage versus several doses of antibiotics in avoiding the development of surgical site infections. The study included trials that were published between 1984 and 2022. Seventy-four clinical trials were included in the analysis. Odds ratios were used to compare groups with 95% confidence intervals. The data were displayed using OR to generate a forest plot. Review Manager (RevMan version 5.4) was used to do the meta-analysis.
RESULTS: Regarding clean operations, there were 389 surgical site infections out of 5,634 patients in a single dose group (6.90%) and 349 surgical site infections out of 5,621 patients in multiple doses group (6.21%) (OR = 1.11, lower CI = 0.95, upper CI = 1.30). Regarding clean-contaminated operations, there were 137 surgical site infections out of 2,715 patients in a single dose group (5.05%) and 137 surgical site infections out of 2,355 patients in multiple doses group (5.82%) (OR = 0.87, lower CI = 0.68, upper CI = 1.11). Regarding contaminated operations, there were 302 surgical site infections out of 3,262 patients in a single dose group (9.26%) and 276 surgical site infections out of 3,212 patients in multiple doses group (8.59%) (OR = 1.11, lower CI = 0.84, upper CI = 1.47). In general, there were 828 surgical site infections out of 11,611 patients in a single dose group (7.13%) and 762 surgical site infections out of 11,188 patients in multiple doses group (6.81%) (OR = 1.05, lower CI = 0.93, upper CI = 1.20). The difference between groups was not significant.
CONCLUSION: The present study showed that using a single-dose antimicrobial prophylaxis was equally effective as using multiple doses of antibiotics in decreasing surgical site infections.

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