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Raheem A, Soomar SM, Issani A, Rahim KA, Dhalla Z, Soomar SM, Mian AI, Khan NU. Thirty-year trends of triple burden of disease in the adult population of Pakistan. J Public Health (Oxf) 2024:fdae054. [PMID: 38654655 DOI: 10.1093/pubmed/fdae054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 02/10/2024] [Accepted: 04/06/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND The triple burden of disease, i.e. communicable diseases, non-communicable diseases and injuries, has significantly affected the healthcare system of Pakistan during the last three decades. Therefore, this study aims to determine and analyse the 30-year disease burden trends through prevalence, death rates and percentages. METHODS The data for the last three decades, i.e. 1990 to 2019, was extracted from the Global Burden of Disease for Pakistan. Percentage change in prevalence and deaths over 30 years was calculated. Poisson regression analysis was performed to evaluate the triple disease burden trends and the incidence rate ratio. RESULTS A relative decrease of 23.4% was noted in the prevalence rate of communicable diseases except for human immunodeficiency virus and dengue fever. A relative increase of 1.4% was noted in the prevalence rate of non-communicable diseases. A relative increase of 56.1% was recorded in the prevalence rate of injuries. The prevalence rate ratios of communicable diseases significantly decreased to 0.9796 [95% CI: 0.9887-0.9905], but the prevalence rate of injury increased to 1.0094 [95% CI: 1.0073-1.01145], respectively. CONCLUSION Pakistan must take the next steps and develop strategies to decrease this burden and mortality rates in the population to create better outcomes and therefore help the healthcare system overall.
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Affiliation(s)
- Ahmed Raheem
- Department of Emergency Medicine, Aga Khan University, Karachi 74800, Pakistan
| | | | - Ali Issani
- Department of Emergency Medicine, Aga Khan University, Karachi 74800, Pakistan
| | - Komal Abdul Rahim
- Department of Community Health Sciences, Aga Khan University, Karachi 74800, Pakistan
| | - Zeyanna Dhalla
- Department of Emergency Medicine, Aga Khan University, Karachi 74800, Pakistan
- University of Michigan, School of Public Health, Ann Arbor, Michigan 48109, USA
| | | | - Asad Iqbal Mian
- Department of Emergency Medicine, Aga Khan University, Karachi 74800, Pakistan
| | - Nadeem Ullah Khan
- Department of Emergency Medicine, Aga Khan University, Karachi 74800, Pakistan
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Hirani R, Khuram H, Elahi A, Maddox PA, Pandit M, Issani A, Etienne M. The Need for Improved End-of-Life Care Medical Education: Causes, Consequences, and Strategies for Enhancement and Integration. Am J Hosp Palliat Care 2024; 41:5-7. [PMID: 36854581 DOI: 10.1177/10499091231161605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
End-of-life (EOL) care is a unique area of medicine that emphasizes holistic patient-centered care. It requires clinicians to consider a patients' mental, emotional, spiritual, social and physical comforts and engage patients and their families in complex discussions and decisions. It is an area of medicine that requires sensitivity in communication in order to respond to a wide range of emotions from patients and their families. Given these intricacies, it is essential that healthcare professional trainees are exposed early in their careers so they can be better equipped to address EOL situations effectively. While many medical schools have integrated this important element in pre-clinical education, a formalized and standardized curriculum could allow for students to better engage in EOLcare scenarios that they will face as future physicians. In this editorial, we discuss potential strategies to incorporate EOL care didactics and experiential learning earlier in medical education as well as the consequences of inadequate EOL care education, particularly in medical schools, in its current state.
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Affiliation(s)
- Rahim Hirani
- New York Medical College School of Medicine, Valhalla, NY, United States
| | - Hassan Khuram
- Drexel University College of Medicine, Philadelphia, PA, United States
| | - Aria Elahi
- The Robert Larner, MD College of Medicine at The University of Vermont, Burlington, VT, United States
| | - Parker Alan Maddox
- Sidney Kimmel Medical College at Thomas Jefferson University, Philadelphia, PA, United States
| | - Maya Pandit
- New York Medical College School of Medicine, Valhalla, NY, United States
| | - Ali Issani
- Department of Emergency Medicine, The Aga Khan University, Karachi, Pakistan
| | - Mill Etienne
- New York Medical College School of Medicine, Valhalla, NY, United States
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Saha T, Arisoyin AE, Bollu B, Ashok T, Babu A, Issani A, Jhaveri S, Avanthika C. Enteric Fever: Diagnostic Challenges and the Importance of Early Intervention. Cureus 2023; 15:e41831. [PMID: 37575696 PMCID: PMC10423039 DOI: 10.7759/cureus.41831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 08/15/2023] Open
Abstract
Enteric fever is a systemic infection caused by highly virulent Salmonella enterica serovars: Typhi and Paratyphi. Diagnosis of enteric fever is challenging due to a wide variety of clinical features which overlap with other febrile illnesses. The current diagnostic methods are limited because of the suboptimal sensitivity of conventional tests like blood culture in detecting organisms and the invasive nature of bone marrow culture. It emphasizes the need to develop improved and more reliable diagnostic modalities. The rising rates of multidrug-resistant Salmonella strains call for an accurate understanding of the current management of the disease. Proper public health measures and large-scale immunization programs will help reduce the burden of the disease. A comprehensive surveillance system can help detect the chronic carrier state and is crucial in understanding antibiotic susceptibility patterns. We conducted an all-language literature search on Medline, Cochrane, Embase, and Google Scholar till May 2022. The following search words and medical subject headings (MeSH) were used: "enteric fever," "Salmonella Typhi," "multidrug-resistant Salmonella," chronic carrier state," "Salmonella detection, "and "typhoid vaccine." We reviewed the literature on clinical features, pathophysiology, new diagnostic tests, and interventions to prevent the disease. This article explores enteric fever and its various clinical features and addresses the emerging threat of multidrug resistance. It focuses on novel methods for diagnosis and prevention strategies, including vaccines and the use of surveillance systems employed across different parts of the world.
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Affiliation(s)
- Tias Saha
- Internal Medicine, Samorita General Hospital, Faridpur, BGD
- Internal Medicine, Diabetic Association Medical College, Faridpur, BGD
| | | | - Bhaswanth Bollu
- Emergency Medicine, All India Institute of Medical Sciences, New Delhi, IND
| | - Tejaswini Ashok
- Internal Medicine, Jagadguru Sri Shivarathreeshwara Medical College, Mysore, IND
| | - Athira Babu
- Pediatrics, Saudi German Hospital, Dubai, ARE
| | - Ali Issani
- Emergency Medicine, Aga Khan University, Karachi, PAK
| | - Sharan Jhaveri
- Internal Medicine, Nathiba Hargovandas Lakhmichand Municipal Medical College, Ahmedabad, IND
| | - Chaithanya Avanthika
- Pediatrics, Icahn School of Medicine at Mount Sinai, Elmhurst Hospital Center, New York, USA
- Medicine and Surgery, Karnataka Institute of Medical Sciences, Hubli, IND
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Maddox PA, Elahi A, Khuram H, Issani A, Hirani R. Sleep quality and physical activity in the management of depression and anxiety. Prev Med 2023; 171:107514. [PMID: 37060955 DOI: 10.1016/j.ypmed.2023.107514] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 02/17/2023] [Accepted: 04/11/2023] [Indexed: 04/17/2023]
Affiliation(s)
- Parker Alan Maddox
- Sidney Kimmel Medical College at Thomas Jefferson University, PA, United States
| | - Aria Elahi
- The Robert Larner, MD college of Medicine at The University of Vermont, United States
| | - Hassan Khuram
- Drexel University College of Medicine, PA, United States
| | - Ali Issani
- Department of Emergency Medicine, The Aga Khan University, Karachi, Pakistan
| | - Rahim Hirani
- New York Medical College School of Medicine, Valhalla, NY, United States.
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Khuram H, Maddox PA, Hirani R, Issani A. The COVID-19 pandemic and depression among medical students: Barriers and solutions. Prev Med 2023; 171:107365. [PMID: 37037317 PMCID: PMC10082642 DOI: 10.1016/j.ypmed.2022.107365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 11/20/2022] [Indexed: 04/12/2023]
Affiliation(s)
- Hassan Khuram
- Drexel University College of Medicine, PA, United States
| | - Parker Alan Maddox
- Sidney Kimmel Medical College at Thomas Jefferson University, PA, United States
| | - Rahim Hirani
- New York Medical College School of Medicine, Valhalla, NY, United States.
| | - Ali Issani
- Department of Emergency Medicine, The Aga Khan University, Karachi, Pakistan
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Khuram H, Maddox P, Elahi A, Hirani R, Issani A. Human Cerebral Organoids: Implications of Ontological considerations. AJOB Neurosci 2023; 14:213-214. [PMID: 37097849 DOI: 10.1080/21507740.2023.2188310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2023]
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Issani A. An updated narrative review on the management of the most common oncological and hematological emergencies. Dis Mon 2023; 69:101355. [PMID: 35379468 DOI: 10.1016/j.disamonth.2022.101355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Oncological emergencies are defined as an acute life-threatening event in a patient with a tumor occurring as part of their complex treatment regimen or secondarily to their underlying malignancy. These events can occur at any time from the initial diagnosis of their cancer to end-stage disease. These oncological emergencies are broadly classified into four major categories; metabolic, structural, hematological and treatment-related causes; and can be encountered in any clinical setting, ranging from primary care physician and emergency department visits to a variety of subspecialty environments. This study aims to cover an in-depth review of the underlying pathogenesis, clinical presentation, and updated management protocol of most common emergencies belonging to the above-mentioned categories. An all-language literature search was conducted on 15th October 2021 and 10th March 2022, limited to 5 years on PubMed database using the following search strings: oncological emergencies, malignant spinal cord compression, febrile neutropenia, hyperviscosity syndrome, superior vena cava syndrome, immune related adverse events, tumor lysis syndrome, hypercalcemia of malignancy, corrected calcium, malignant pericardial effusion and chemotherapy extravasation.
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Affiliation(s)
- Ali Issani
- Baqai Medical University, Karachi, Pakistan.
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Hirani R, Issani A. Healthcare Benefits of Preoperative Tamsulosin in Patients Before Ureteroscopy. J Coll Physicians Surg Pak 2023; 33:121-122. [PMID: 36597252 DOI: 10.29271/jcpsp.2023.01.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 06/05/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Rahim Hirani
- Department of Medicine, New York Medical College and Westchester Medical Center, Valhalla, United States
| | - Ali Issani
- Department of Emergency Medicine, The Aga Khan University, Karachi, Pakistan
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Hirani R, Khuram H, Sandoval OG, Issani A. Epidemiological effects of the COVID-19 pandemic on modifiable risk factors for dementia. Int J Geriatr Psychiatry 2023; 38:e5881. [PMID: 36703292 DOI: 10.1002/gps.5881] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Rahim Hirani
- New York Medical College School of Medicine, Valhalla, New York, USA
| | - Hassan Khuram
- Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | | | - Ali Issani
- Department of Emergency Medicine, The Aga Khan University Hospital, Karachi, Pakistan
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Soomar SM, Issani A, Moin G, Dhalla Z, Adnan A, Soomar SM. The Serological Confirmation and Outcome of the Pediatric Dengue Patients Presenting to Emergency Department: A Cross-Sectional Study. Glob Pediatr Health 2022; 9:2333794X221138434. [PMID: 36601355 PMCID: PMC9806414 DOI: 10.1177/2333794x221138434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/24/2022] [Indexed: 12/28/2022] Open
Abstract
Background In the emergency department, it is very uncommon perform a differential diagnosis to serologically differentiate between dengue, dengue hemorrhagic fever, and dengue shock syndrome. Prompt differential diagnosis and treatment is essential with the presentation of dengue. This study aims to determine the serological confirmation and outcome of the dengue epidemic in the pediatric population presenting to the ED in a tertiary care hospital. Methods A single-center cross-sectional study was conducted. All pediatric patients aged less than 18 years presented to ED with clinical features suggestive of DF, DFF, and DSS while also doing the serological confirmation for the dengue were enrolled in the study. Data was collected on demographics, clinical characteristics, diagnosis, and outcomes of 324 pediatric patients. Multivariable binary logistic regression was applied for the analysis. Results Out of 324 patients, 191 (59.13%) underwent NS1 testing and 132 (40.87%) did the IgM test. Most participants were in the age range of 13 to 18 years in both groups. Fever was the most common complaint in both groups 191 (100%) and 132 (100%). In each group, around one-third of the participants complained about body aches 69 (36.13%) and 44 (33.33%). The patient having a history of traveling within the past 14 days created a 1.51 (95% CI: 1.27-2.25) times higher odds of contracting dengue fever as compared to no history of travel. Conclusion The serologic confirmation of dengue in the ED helps in both the adequate and timely treatment as well as patient disposition and ultimately saves lives.
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Affiliation(s)
| | | | | | - Zeyanna Dhalla
- Aga Khan University, Karachi,
Pakistan
- The College of William and Mary,
Williamsburg, VA, United States
| | - Ahmer Adnan
- Aga Khan University, Karachi,
Pakistan
- Life Care Hospital, Karachi,
Pakistan
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Hirani R, Khuram H, Issani A. Healthcare Implications of Using Simulation-Based Models in Jugular Central Venous Catheter Placement. J Patient Saf 2022; 18:e1237. [PMID: 35819908 DOI: 10.1097/pts.0000000000001063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Hirani R, Rashid D, Lewis J, Hosein-Woodley R, Issani A. Monkeypox outbreak in the age of COVID-19: a new global health emergency. Mil Med Res 2022; 9:55. [PMID: 36184608 PMCID: PMC9527069 DOI: 10.1186/s40779-022-00419-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 09/21/2022] [Indexed: 12/03/2022] Open
Affiliation(s)
- Rahim Hirani
- New York Medical College School of Medicine, 1501 Old Farm Road, Valhalla, NY, 10595, USA.
| | - Dawood Rashid
- New York Medical College School of Medicine, 1501 Old Farm Road, Valhalla, NY, 10595, USA
| | - Joshua Lewis
- New York Medical College School of Medicine, 1501 Old Farm Road, Valhalla, NY, 10595, USA
| | - Rasheed Hosein-Woodley
- New York Medical College School of Medicine, 1501 Old Farm Road, Valhalla, NY, 10595, USA
| | - Ali Issani
- Department of Emergency Medicine, Aga Khan University, Karachi, 74800, Pakistan
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Prasad S, Mehadi A, Kaka N, Jhaveri S, Avanthika C, Patel N, Augustine I, Issani A. Diagnostic protocols and newer treatment modalities for cluster headache. Dis Mon 2022; 68:101316. [PMID: 35000758 DOI: 10.1016/j.disamonth.2021.101316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Cluster Headaches are one of the most arguably severe forms of primary headache syndrome that affects humans. Although it is relatively uncommon, it has a significant impact on the quality of life. It is a multifactorial disease that has risk factors ranging from seasonal changes, lifestyle habits to genetics. It occurs in 2 forms- Episodic and Chronic, each having its well-defined Diagnostic Criteria. Moreover, Cluster Headache has an exhaustive list of options for both Preventive and Abortive treatment. This article focuses on Cluster Headache, its pathophysiology, risk factors, differentials, and its diverse treatment modalities. In this study, an all-language literature search was conducted on Medline, Cochrane, Embase, and Google Scholar till October 2021. The following search strings and Medical Subject Headings (MeSH) terms were used: "Cluster Headache," "Triptans," "Neuromodulation," and "Migraine." We explored the literature on Cluster Headache for its epidemiology, pathophysiology, the role of various genes and how they bring about the disease as well as its episodic and chronic variants, and treatment options. Although we have a wide variety of options for Preventive and Abortive therapy, newer more effective pharmacological and non-pharmacological interventions are being developed, and must be integrated into new treatment protocols.
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Affiliation(s)
- Sakshi Prasad
- Faculty of Medicine, National Pirogov, Memorial Medical University, 21018, Vinnytsya, Ukraine.
| | | | - Nirja Kaka
- GMERS Medical College, Himmatnagar 383001, Gujarat, India.
| | - Sharan Jhaveri
- Smt. NHL Municipal Medical college, Ahmedabad 380006, India.
| | - Chaithanya Avanthika
- Karnataka Institute of Medical Sciences,PB Road, Hubli 580022, Karnataka, India.
| | - Neil Patel
- GMERS Medical College, Himmatnagar 383001, Gujarat, India.
| | - Ivan Augustine
- Government Medical college Thrissur 680596, Kerala,India.
| | - Ali Issani
- Baqai Medical University, Karachi, Pakistan.
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