Furqaan Ahmed - Academia.edu (original) (raw)

Papers by Furqaan Ahmed

Clinical Gastroenterology and Hepatology, 2020

American Journal of Gastroenterology, 2013

Journal of Clinical Oncology, 2014

3545 Background: There has been a rapid rise in colorectal cancer (CRC) incidence in recent decad... more 3545 Background: There has been a rapid rise in colorectal cancer (CRC) incidence in recent decades in many Asian countries. Age, gender, smoking, and family history are the significant risk factors of CRC. This study would like to develop an Asia-Pacific Colorectal Screening (APCS) score to identify subjects with high-risk for colorectal advanced neoplasia (AN) in Asia. Methods: A multicentre study was in 11 Asian cities. A total of 7,463 asymptomatic subjects underwent screening colonoscopy. The first 2,000 subjects were used as a derivation cohort. AN was defined as advanced adenoma and CRC. A multiple logistic regression was applied to the derivation cohort identifying significant risk factors for AN; odds ratios of significant risk factors were then utilized to develop APCS score ranging from 0-6, including age (0=40-49, 1=50-59, 2=60+), gender (0=female, 1=male), family history (0=absent, 1=present), smoking (0=no, 1=current or past), and Body Mass Index (BMI) (0= 23kg/m2). Three tiers...

Clinical gastroenterology and hepatology : the official clinical practice journal of the American Gastroenterological Association, 2009

ional Polyp Study (NPS)2 for the adenoma-bearing subgroup. owever, the small sample size of the a... more ional Polyp Study (NPS)2 for the adenoma-bearing subgroup. owever, the small sample size of the adenoma subgroup (n 90, compared with 1418 in the NPS), and the rarity of incident ancers in the subgroup with no baseline adenomas (1 cancer) bviously precluded a robust analysis. The NPS shows how fficacious polypectomy can be, as opposed to how effective it is n the real world in which clearing exams may not be as astidiously performed, or follow-up not as intense or as comlete. Additionally, 13% of patients in the NPS underwent a econd clearing colonoscopy, which is not done in usual pracice, and patients with adenomas 3 cm were excluded. These onsiderations highlight major methodological differences beween the NPS and subsequent studies, including our own.

Journal of Clinical Gastroenterology, 2011

Seizures are reported as an uncommon side effect of interferon therapy. To determine the frequenc... more Seizures are reported as an uncommon side effect of interferon therapy. To determine the frequency and presentation of seizures occurring during pegylated interferon-α (PEG-IFNα) and ribavirin therapy for chronic hepatitis C. Patients were identified using data from the WIN-R trial database, a US multicenter study comparing fixed (800 mg) versus weight-based (800 to 1400 mg) daily dosing of ribavirin in combination with PEG-IFNα-2b (1.5 μg/kg/wk). Of the 4913 enrolled patients, 8 (0.16%) had a seizure. Three patients had a grand mal seizure and the seizure type was unknown in 5 patients. At the time of seizure, 6 patients were taking antidepressants (including 3 on bupropion), 1 was hyponatremic, and 1 had consumed a significant amount of alcohol. One patient had a history of seizures. Neuroimaging and electroencephalographic studies were negative. Antiepileptic medications were continued in the patient with a history of seizures and initiated in 1 patient. PEG-IFNα-2b plus ribavirin therapy was continued in 2 patients following seizure and neither experienced a recurrent seizure. Seizures occur infrequently in patients receiving PEG-IFNα-2b plus ribavirin, and appear to be associated with other risk factors including antidepressant use.

Gastrointestinal Endoscopy, 2007

Methods: Between October 2005 and October 2006, 90 stents were implanted in 87 patients having ei... more Methods: Between October 2005 and October 2006, 90 stents were implanted in 87 patients having either symptoms of dysphagia or having tracheo-esophageal fistulae. Implantation was performed by 8 investigators at 7 separate centers in the US and Europe. Stent placement ...

Endoscopy, 2009

Sphincter of Oddi manometry (SOM), performed at endoscopic retrograde cholangiopancreatography (E... more Sphincter of Oddi manometry (SOM), performed at endoscopic retrograde cholangiopancreatography (ERCP), is the gold standard for diagnosing sphincter of Oddi dysfunction (SOD). The question remains as to whether the short-term manometric recordings reflect the 24-hour pathophysiology of the sphincter. The aim of this study was to determine the frequency of SOD in persistently symptomatic patients with previously normal SOM studies. All patients who underwent ERCP for suspected SOD over a 13-year period (1994 - 2007) were considered for inclusion in the study. Patients with an intact papilla and a previously normal SOM who had a repeat ERCP for persistent symptoms formed the study group. SOM was performed in conventional retrograde fashion. In all, 5352 patients without prior papillary intervention underwent SOM during the study period. A total of 1037 patients had normal SOM, and of these, 30 patients (27 female, mean age 40.1 years) underwent repeat ERCP for persistent symptoms. The median duration between the two ERCPs was 493.5 days (range 52-3538 days). In these 30 patients, SOD classification prior to the initial ERCP was: type I in one patient (not treated in 1994), type II in 17 patients, and type III in 12 patients. Of the 30 patients, 12 (40%) had normal SOM at repeat ERCP; SOD was diagnosed in 18/30 (60%) patients. A single SOM study may not represent the day-to-day physiology of the sphincter of Oddi; sphincter pathology may progress over time. One normal exam may not rule out SOD. A repeat ERCP with manometry may be warranted in a subset of patients with persistent debilitating symptoms and a high index of suspicion for SOD. Outcome data are needed to determine whether this approach justifies the potential risks of ERCP.

Alimentary Pharmacology and Therapeutics, 2005

Alimentary Pharmacology and Therapeutics, 2006

Background There is yet no established treatment for chronic hepatitis C patients non-responder t... more Background There is yet no established treatment for chronic hepatitis C patients non-responder to standard interferon and ribavirin. Aim To evaluate efficacy and safety of pegylated-interferon-a2a plus ribavirin with or without amantadine in such patients. Methods 161 non-responders to standard interferon and ribavirin were randomized into two groups: 81 patients (Group 1) were given weekly Peg-IFN-a2a 180 lg plus ribavirin 1000-1200 mg/daily for 12 months, 80 patients (Group 2) received weekly Peg-IFN-a2a 180 lg plus ribavirin 1000-1200 mg/daily and amantadine 200 mg/daily for 12 months. Results At the end of follow-up, HCV-RNA was negative in 29.6% of Group 1 and in 21.2% of Group 2 patients (P ¼ 0.22). Patients with genotypes 1 and 4 responded better to bi-therapy (21.7%) than to triple therapy (17.3%, P ¼ 0.5) while among patients with genotypes 2 and 3 there was a trend towards a higher sustained virological response rate when retreated with triple treatment (80% vs. 75%, P ¼ 0.82). On multivariate analysis, genotype 1 or 4, high body mass index and >20% reduction of Peg-interferon were associated with the treatment failure. Conclusions The addition of amantadine does not improve the overall SVR rate in non-responder patients retreated with Peg-IFN and ribavirin; however, about 30% of non-responders may achieve a sustained response, in particular patients with genotypes 2 and 3 show a high SVR (75%).

The American Journal of Gastroenterology, 2004

Most studies establishing the role of antiviral therapy in patients with chronic hepatitis C (CHC... more Most studies establishing the role of antiviral therapy in patients with chronic hepatitis C (CHC) excluded the patients with normal ALT levels. Small trials with interferon monotherapy suggested a limited efficacy and/or de novo ALT elevations. We sought to evaluate the efficacy of two doses of interferon alpha-2b (IFN) with ribavirin (RBV) in patients with normal ALT. METHODS: Patients with biopsy-proven CHC with detectable HCV RNA and at least two normal ALT levels three or more months apart were randomized to receive either 3 or 5 million units of IFN thrice a week plus RBV 1,000-1,200 mg. Therapy was stopped at 24 wk if HCV RNA remained detectable and continued for an additional 24 wk if HCV RNA was undetectable. A final HCV RNA level was obtained 24 wk after discontinuation of therapy. RESULTS: Fifty-six patients were randomized and received at least one dose of treatment. The overall rate of sustained virologic response (SVR) was 32%. SVR rates were higher in genotype 2 and 3 patients (80%) than in genotype 1 patients (24%, p = 0.002). There was a tendency toward higher SVR in genotype 1 patients treated with the higher IFN dose (36% vs 10%, p = 0.07). Five patients had mild, transient ALT elevations. No sustained ALT elevations were noted. CONCLUSIONS: Patients with normal ALT had a rate of SVR comparable to that reported in patients with elevated ALT. Higher dose of interferon tended to be more effective in genotype 1 infected patients. De novo ALT elevations were transient and not clinically significant. Patients with CHC should not be excluded from treatment on the basis of ALT alone. Combination therapy with pegylated interferon and ribavirin should be evaluated in these patients.

Journal of Gastroenterology, Pancreatology & Liver Disorders, 2015

SM Journal of Hepatitis Research and Treatment

Introduction: Pakistan, with a population of 180 million, has a 5% prevalence of hepatitis C and ... more Introduction: Pakistan, with a population of 180 million, has a 5% prevalence of hepatitis C and a 2.5% prevalence of hepatitis B. Although several studies have looked at individual risk factors, in particular, the practice of unsafe injections, there are many unresolved questions regarding the epidemiology of chronic hepatitis B and C infections in Pakistan. Objective: To assess the potential risk factors for hepatitis B and C infections in Pakistani patients. Methods: Consecutive patients with chronic hepatitis B or C presenting to a private gastroenterology clinic in Karachi, Pakistan were interviewed regarding potential risk factors for acquiring their infections. Results: 389 patients were interviewed, 239 (61%) with chronic hepatitis C and 150 (39%) with chronic hepatitis B.308 (79%) had more than one potential risk factor for viral infection. 71 (18%) had one risk factor and 12 (3%) had no identifiable risk factors. The following risk factors were identified: blood transfusion (96, 25%), surgery (171, 44%), dental work (202, 52%), injections (310, 80%), body piercings (144, 37%), spousal transmission (15, 4%), IVDU (1, 0.2%), hemodialysis (4, 1%), tattoos (1, 0.2%), sexual (1, 0.2%), and vertical transmission (5, 1%). 74 (11%) patients had a first degree relative with hepatitis B or C. Of the 71 patients with a single risk factor, in 58 (82%) the risk factor was having received an injection. Conclusion: It is only by understanding the epidemiology of the acquisition of chronic hepatitis B and C infections in Pakistan that effective efforts can be made to control the spread of these infections. Most patients have multiple potential risk factors, highlighting the need for a multipronged approach to the control of these risk factors. Parenteral injections remain the single most common risk factor for infection.

Journal of Clinical and Experimental Hepatology

Gastroenterology, 2003

Batkground: PegyLated interkron (PEG IFN) has proven superior to standard interferon (IFN) as mon... more Batkground: PegyLated interkron (PEG IFN) has proven superior to standard interferon (IFN) as monotberapy for chronic hepatitis C and, more recently, in combination with ribavirin (RBV) in treatment naive patients. Aim: To compare the efficacy of two dose regimeus ot pegi~nterteron alLa-2b plus ribavinn in patients with prior nonresponse to 1FN monotherapy or corubination therapy, or with reLapse afier combination therapy. We present final data from this study Methods: Patients in the three categories were randomized to receive (1) i• alta-2b 1.0 I.t/kg plus RBV 1000-1200 mg/d (Group 1), or (2) peginterteron alfa-2b 1 5 w'kg plus RBV 800 mg/d (Group 2). Prior therapy must have been stopped at least three months prior to entry. Patients were treated for 48 weeks with cessation of therapy if }tCV RNA PCR (Roche Ampficor) was positive at 24 weeks. Results: Of 321 patients em"olled in the study, 161 were randomized to Group 1 and 160 were randomized to Group 2 Overall, the sustained response (SD rate was 15% acrnss the three categories. SR rates tot *be different treatment groups are given in the table Among the combination uonresponders, patients with genotype 1 had lower SR rates than genotype non-l patients (5-9% vs 13-25%). Patients with normal ALT responded as well as those with an elevated A1T at onset of therapy (21% vs 14%, p = 0 54). Patients with advanced fibrosis (Metavir stage 3-4) tended to respond better with *be higher dose of PEG IFN (25% vs. 5%, p = 0.44) Conclusions: (1) SR rates are higtrest in combination reLapsel~ (range 32-47%) and lowest in genotype l combination nouresponders (range 5-9%). (2) Breakthrough and relapse are more common lhan in naive patients; *be o:mcept of treatment for more than 12 months warrants turther study (3) Higher close of PEG IFN may be better in patients with fibrosis.

The American journal of gastroenterology, Jan 15, 2016

We tested the hypothesis that the risk of colorectal cancer (CRC), advanced colorectal neoplasia ... more We tested the hypothesis that the risk of colorectal cancer (CRC), advanced colorectal neoplasia (ACN), and colorectal adenoma among screening participants with different first-degree relatives (FDRs) affected by CRC was similar. A multi-center, prospective colonoscopy study involving 16 Asia-Pacific regions was performed from 2008 to 2015. Consecutive self-referred CRC screening participants aged 40-70 years were recruited, and each subject received one direct optical colonoscopy. The prevalence of CRC, ACN, and colorectal adenoma was compared among subjects with different FDRs affected using Pearson's χ(2) tests. Binary logistic regression analyses were performed to evaluate the risk of these lesions, controlling for recognized risk factors including age, gender, smoking habits, alcohol drinking, body mass index, and the presence of diabetes mellitus. Among 11,797 asymptomatic subjects, the prevalence of CRC was 0.6% (none: 0.6%; siblings: 1.1%; mother: 0.5%; father: 1.2%; ≥2 ...

Journal of Liver: Disease & Transplantation, 2015