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Akhtar SMM, Fareed A, Ali M, Khan MS, Ali A, Mumtaz M, Kirchoff R, Asghar MS. Efficacy and safety of Ciprofol compared with Propofol during general anesthesia induction: A systematic review and meta-analysis of randomized controlled trials (RCT). J Clin Anesth 2024; 94:111425. [PMID: 38412619 DOI: 10.1016/j.jclinane.2024.111425] [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] [Received: 10/12/2023] [Revised: 02/04/2024] [Accepted: 02/23/2024] [Indexed: 02/29/2024]
Abstract
BACKGROUND Ciprofol, a newer entrant with similarities to propofol, has shown promise with a potentially improved safety profile, making it an attractive alternative for induction of general anesthesia. This meta-analysis aimed to assess the safety and efficacy of ciprofol compared with propofol during general anesthesia induction. METHODS A comprehensive literature search was conducted using PubMed, Clinical Trial.gov, and Cochrane Library databases from inception to July 2023 to identify relevant studies. All statistical analyses were conducted using R statistical software version 4.1.2. RESULTS Thirteen Randomized Controlled Trials (RCTs) encompassing a total of 1998 participants, were included in our analysis. The pooled analysis indicated that Ciprofol was associated with a notably lower incidence of pain upon injection [RR: 0.15; 95% CI: 0.10 to 0.23; I^2 = 43%, p < 0.0000001] and was non-inferior to propofol in terms of anesthesia success rate [RR: 1.00; 95% CI: 0.99 to 1.01; I^2 = 0%; p = 0.43]. In terms of safety, the incidence of hypotension was significantly lower in the ciprofol group [RR:0.82; 95% CI:0.68 to 0.98; I^2 = 48%; p = 0.03]. However, no statistically significant differences were found for postoperative hypertension, bradycardia, or tachycardia. CONCLUSION In conclusion, Ciprofol is not inferior to Propofol in terms of its effectiveness in general anesthesia. Ciprofol emerges as a valuable alternative sedative with fewer side effects, especially reduced injection pain, when compared to Propofol. SUMMARY Propofol, frequently utilized as an anesthetic, provides swift onset and quick recovery. However, it has drawbacks such as a narrow effective dosage range and a high occurrence of adverse effects, particularly pain upon injection. Ciprofol, a more recent drug with propofol-like properties, has demonstrated promise and may have an improved safety profile, making it a compelling alternative for inducing general anesthesia. This meta-analysis compared the safety and effectiveness of Ciprofol with Propofol for general anesthesia induction in a range of medical procedures, encompassing thirteen Randomized Controlled Trials (RCTs) and 1998 individuals. The pooled analysis indicated that Ciprofol was associated with a notably lower incidence of pain upon injection [RR: 0.15; 95% CI: 0.10 to 0.23; I^2 = 43%, p < 0.0000001] and was non-inferior to propofol in terms of anesthesia success rate [RR: 1.00; 95% CI: 0.99 to 1.01; I^2 = 0%; p = 0.43]. In terms of safety, the incidence of hypotension was significantly lower in the ciprofol group [RR:0.82; 95% CI:0.68 to 0.98; I^2 = 48%; p = 0.03]. However, no statistically significant differences were found for hypertension, bradycardia, or tachycardia. In conclusion, ciprofol is equally effective at inducing and maintaining general anesthesia as propofol. When compared to propofol, ciprofol is a better alternative sedative for operations including fiberoptic bronchoscopy, gynecological procedures, gastrointestinal endoscopic procedures, and elective surgeries because it has less adverse effects, most notably less painful injections.
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Affiliation(s)
| | - Areeba Fareed
- Department of Medicine, Karachi Medical and Dental College, Karachi, Pakistan
| | - Mirha Ali
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | | | - Abraish Ali
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Munazza Mumtaz
- Department of Obstetrics and Gynecology, Civil Hospital, Karachi, Pakistan
| | - Robert Kirchoff
- Department of Medicine, Mayo Clinic Alix School of Medicine, Phoenix, AZ, USA.
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Akhtar SMM, Ali A, Khan MS, Khan V, Fareed A, Saleem SZ, Mumtaz M, Ahsan MN, Iqbal S, Asghar MS. Efficacy and safety of fezolinetant for vasomotor symptoms in postmenopausal women: A systematic review and meta-analysis of randomized controlled trials. Int J Gynaecol Obstet 2024. [PMID: 38563867 DOI: 10.1002/ijgo.15467] [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: 08/03/2023] [Revised: 02/10/2024] [Accepted: 02/26/2024] [Indexed: 04/04/2024]
Abstract
BACKGROUND Vasomotor symptoms (VMS), such as hot flashes and night sweats, are highly prevalent and burdensome for women experiencing menopausal transition. Fezolinetant, a selective neurokinin 3 receptor (NK3R) antagonist, is a potential therapeutic option for mitigating VMS. OBJECTIVES Our aim is to assess the efficacy and evaluate the safety profile of fezolinetant compared with placebo in post-menopausal women suffering from VMS, by pooling all the relevant data and reflecting the most current evidence. SEARCH STRATEGY/SELECTION CRITERIA An extensive literature search was performed in the PubMed, Medline and Cochrane Library databases from inception until June 2023 to identify relevant trials. DATA COLLECTION AND ANALYSIS Mean differences (MDs) and 95% confidence intervals (CIs) were calculated for continuous outcomes. Risk ratios (RRs) were calculated for dichotomous outcomes. All statistical analyses were performed using R Statistical Software. MAIN RESULTS A total of six randomized controlled trials were added. For the frequency of daily VMS, the combined pooled result favored the fezolinetant group over placebo (MD -2.38, 95% CI -2.64 to -2.12; P < 0.001, I2 = 0%). For the severity of daily VMS, fezolinetant was again found to be superior to the placebo group (MD -0.40, 95% CI -0.51 to -0.29; P < 0.001, I2 = 70%). Fezolinetant (120 mg) consistently demonstrated a significant reduction in the severity of daily moderate/severe VMS compared with other doses at both 4 and 12 weeks. Patient-reported outcomes (PROs) of Greene Climacteric Scale (GCS), PROMIS the Sleep Disturbance Short Form 8b and Menopause-Specific Quality of Life (MENQoL) scores indicated significant improvement with fezolinetant. No significant difference in efficacy of fezolinetant at 4 and 12 weeks were observed in any outcome. As for safety, no significant differences in the treatment emergent adverse events at 12 weeks were found between fezolinetant and placebo. CONCLUSIONS Our study significantly favors fezolinetant over placebo regarding the primary efficacy outcomes of daily moderate to severe VMS frequency and severity, including PROs, while both the groups are comparable in terms of treatment emergent adverse events. Further studies are needed to confirm these findings.
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Affiliation(s)
| | - Abraish Ali
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Vareesha Khan
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Areeba Fareed
- Department of Medicine, Karachi Medical and Dental College, Karachi, Pakistan
| | - Syed Zia Saleem
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Munazza Mumtaz
- Department of Obstetrics and Gynecology, Civil Hospital, Karachi, Pakistan
| | | | - Sadia Iqbal
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
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Junaid Tahir M, Aymen U, Mehmood Q, Sohaib Asghar M, Kumari U, Hassan Z, Naz N, Rafiq N, Tayyeb M, Ullah I, Abbasher Hussien Mohamed Ahmed K, Alwalid O. Digital eye strain and its associated factors among radiology physicians in Pakistan: a cross-sectional survey using logistic regression analysis. Ann Med Surg (Lond) 2024; 86:1933-1941. [PMID: 38576948 PMCID: PMC10990352 DOI: 10.1097/ms9.0000000000001882] [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] [Received: 01/10/2024] [Accepted: 02/20/2024] [Indexed: 04/06/2024] Open
Abstract
Background and aims Increased use of digital devices in the modern era has led to the development of digital eye strain (DES) or computer vision syndrome in their users. This can result in the development of various ocular and visual symptoms among them. In this study, the authors aimed to view the prevalence of digital eye strain among radiology physicians in Pakistan and their associated risk factors. Materials and methods A cross-sectional study was conducted to evaluate occupational DES among radiology physicians in Pakistan. The data collection was done using the convenience sampling technique, and the data were analyzed using IBM SPSS for Windows, Version 25.0. Results Out of the 247 respondents, 33.6% were males and 66.4% were females. 41.7% of them were between 30 and 40 years of age and 51.8% of them were radiology residents. 52.2% of the participants had a refractive error and were using a corrective lens. The majority of the radiologists in our study (84.2%) preferred picture archiving and communication system (PACS) over films and 82.2% of them reported having breaks of less than 15 min. Major symptoms reported by the participants were tired or heavy eyes (69.6%) and headache (69.3%). The proportion of developing DES was higher in females [P=0.001, adjusted odds ratio (aOR)=2.94], radiology residents (P=0.031, aOR=3.29), and working hours of more than 4 h per day (P<0.001, aOR=0.04). Conclusion With recent advances in the field of radiology in Pakistan, the frequency of developing DES among radiologists is increasing. Being a female, having long working hours, and having noticeable flickers on the digital screens were among the significant factors in developing DES among radiologists.
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Affiliation(s)
| | | | | | | | | | | | | | - Nida Rafiq
- Dow University of Health Sciences, Karachi
| | | | - Irfan Ullah
- Kabir Medical College, Gandhara University, Peshawar
| | | | - Osamah Alwalid
- Department of Diagnostic Imaging, Sidra Medicine, Doha, Qatar
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Yasmin F, Jawed S, Najeeb H, Moeed A, Atif AR, Umar M, Asghar MS, Alraies MC. Comparative efficacy and safety of mitral valve repair versus mitral valve replacement in Rheumatic heart disease: A high-value care systematic review and meta-analysis. Curr Probl Cardiol 2024; 49:102530. [PMID: 38518844 DOI: 10.1016/j.cpcardiol.2024.102530] [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: 03/13/2024] [Accepted: 03/15/2024] [Indexed: 03/24/2024]
Abstract
Rheumatic Heart Disease (RHD) remains a leading cause of cardiovascular death (CVD) globally. Mitral Valve repair (MVP) and mitral valve replacement (MVR) are the two most commonly and successfully used techniques to treat the disease. MVP is associated with reduced post-operative complications compared to MVR; however, it carries the risk of valvular fibrosis and scarring. Given the lack of recommendations, inconsistent findings, and paucity of pathophysiological evidence at present, we aimed to conduct a meta-analysis and systematically review the available literature to determine the efficacy and safety of MVP compared to MVR in improving clinical outcomes among patients with RHD. A comprehensive literature search was conducted on MEDLINE (PubMed), Cochrane Central and Scopus from inception till September 2023. The primary objective was early mortality defined as any cause-related death occurring 30 days following surgery. Secondary outcomes included long-term survival defined as the time duration between hospital discharge and all-cause death. Infectious endocarditis, thromboembolic events (including stroke, brain infarction, peripheral embolism, valve thrombosis, and transient ischemic attack), and haemorrhagic events (any serious bleeding event that required hospitalisation, resulted in death, resulted in permanent injury, or required blood transfusion) were all considered as post- operative complications. Additionally aggregated Kaplan-Meier curves were reconstructed for long term survival, freedom from reoperation, and freedom from valve-related adverse events by merging the reconstructed individual patient data (IPD) from each individual study. A significant decrease in early mortality with MV repair strategy versus MV replacement [RR 0.63; P = 0.003) irrespective of mechanical or bioprosthetic valves was noted. The results reported significantly higher long-term survival in patients undergoing MVP versus MVR (HR 0.53; P = 0.0009). Reconstructed Kaplan-Meier curves showed that the long term survival rates at 4, 8, and 12 years were 88.6, 82.0, 74.6 %, in the MVR group and 91.7, 86.8, 81.0 %, in the MVP group, respectively. MVP showed statistically significant reduction in early mortality, adverse vascular events, and better long-term survival outcomes compared to the MVR strategy in this analysis.
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Affiliation(s)
- Farah Yasmin
- Yale University School of Medicine, New Haven, CT 06511, USA
| | | | - Hala Najeeb
- Dow Medical College, Karachi 74200, Pakistan
| | - Abdul Moeed
- Dow Medical College, Karachi 74200, Pakistan
| | | | - Muhammad Umar
- IU Health Ball Memorial Hospital, Muncie, IN 47303, USA
| | | | - M Chadi Alraies
- Cardiovascular Institute, Detroit Medical Center, DMC Heart Hospital, Detroit, MI 48201, USA.
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Muhammad Muneeb Akhtar S, Fareed A, Sohaib Asghar M, Mumtaz M, Kaur S. Efficacy and Safety of Lotilaner Ophthalmic Solution 0.25% for the Treatment of Demodex Blepharitis: A Meta-Analysis of Randomized Controlled Trials. Cont Lens Anterior Eye 2024:102148. [PMID: 38514290 DOI: 10.1016/j.clae.2024.102148] [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: 11/13/2023] [Revised: 03/07/2024] [Accepted: 03/14/2024] [Indexed: 03/23/2024]
Abstract
PURPOSE Demodex blepharitis, often overlooked in ocular surface disease, involves Demodex mites, prevalent ectoparasites on human skin. Current treatments may not effectively eliminate these mites, prompting a need for targeted therapies. Lotilaner, an antiparasitic agent, shows promise. This systematic review and meta-analysis assesses 0.25% lotilaner ophthalmic solution's efficacy in reducing Demodex mite populations and its impact on ocular surface inflammation in Demodex blepharitis patients. METHODS A comprehensive literature search was performed in the PubMed and Cochrane Library databases from inception until February 2024 to identify relevant trials investigating the use of lotilaner in patients with Demodex blepharitis. The included studies were assessed for quality, and a meta-analysis was conducted to determine the overall treatment effects of lotilaner. Odds ratios (OR) and 95% confidence intervals (CIs) were calculated for binary variables. All statistical analyses were performed using the R Statistical Software. RESULTS Five studies met the inclusion criteria and were included in this systematic review and meta-analysis. Lotilaner demonstrated significant efficacy in Collarette Cure [OR = 6.64; 95 % CI 3.78 to 11.04; p < 0.00001, I2 = 62 %] %], clinically meaningful collarette reduction [OR = 6.21; 95 % CI 3.67 to 10.49; p < 0.00001, I2 = 90 %], and achieving at least 1-grade collarette improvement [OR = 5.12; 95 % CI (2.96 to 8.88); p < 0.00001, I2 = 90 %] compared to the placebo group. The treatment also resulted in mite eradication [OR = 6.18; 95 % CI 4.67 to 6.18; p < 0.00001, I2 = 34 %], reduction in mite density [OR = 9.37; 95 % CI 5.36 to 16.36; p < 0.00001, I2 = 84 %], and erythema cure [OR = 2.29; 95 % CI 2.24 to 3.39; p < 0.00001, I2 = 5 %] and composite cure [OR = 7.05; 95 % CI 3.66 13. 61; p < 0.00001, I2 = 11 %]. The study suggests that lotilaner is a promising therapeutic option for collarette and associated symptoms, but the high heterogeneity in some outcomes and limited long-term data warrant further research to confirm its effectiveness and safety. CONCLUSION This systematic review and meta-analysis provides robust evidence supporting the efficacy of 0.25% lotilaner ophthalmic solution in treating Demodex blepharitis. Approval of this targeted therapy represents a significant milestone in ophthalmology and offers a promising treatment option for patients with Demodex blepharitis. Eye care professionals should consider the potential benefits of lotilaner in managing and alleviating the symptoms associated with Demodex infestations on the eyelids. Further research and long-term follow-up studies are warranted to assess the safety and effectiveness of lotilaner in treating Demodex blepharitis.
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Affiliation(s)
| | | | | | - Munazza Mumtaz
- Department of Obstetrics and Gynecology, Civil Hospital, Karachi, Pakistan
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Rehan ST, Ali A, Imran L, Ahmed J, Ullah I, Abdalla AS, Majid M, Asghar MS. Effects of Mavacamten Concomitant With Beta-Blockers on Patients With Hypertrophic Cardiomyopathy: A Meta-Analysis of Randomized Controlled Trials. Am J Ther 2024:00045391-990000000-00185. [PMID: 38563758 DOI: 10.1097/mjt.0000000000001698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024]
Affiliation(s)
| | - Abraish Ali
- Dow University of Health Sciences, Karachi, Pakistan
| | - Laiba Imran
- Dow University of Health Sciences, Karachi, Pakistan
| | - Jawad Ahmed
- Dow University of Health Sciences, Karachi, Pakistan
| | - Irfan Ullah
- Kabir Medical College, Gandhara University, Peshawar, Pakistan
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Muneeb Akhtar SM, Fareed A, Afzal U, Asghar MS, Mumtaz M, Faraz F, Naeem H, Vaid R. Effectiveness of erector spinae plane block in reducing opioid consumption after colorectal surgery: A comprehensive meta-analysis. Am J Surg 2024:S0002-9610(24)00034-5. [PMID: 38336575 DOI: 10.1016/j.amjsurg.2024.01.032] [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: 12/29/2023] [Revised: 01/24/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024]
Abstract
Despite the life-saving nature of colorectal surgeries, patients often experience intra and post-operative problems, especially pain and discomfort. This meta-analysis aimed to evaluate the effectiveness of erector spinae plane block (ESP block) in postoperative pain management for patients undergoing colorectal surgeries. A comprehensive systematic literature search was conducted in PubMed and Cochrane Library databases from inception until December 2023. Eight studies were deemed appropriate for inclusion. The pooled analysis demonstrated a significant decrease with the ESP block compared to the control group in postoperative opioid consumption [MD = -15.96 mg; 95 % CI (-28.74 to -3.18); p = 0.014, I2 = 87 %], intraoperative opioid consumption [MD = -35.51 mg; 95 % CI (-62.63 to -8.40); p = 0.010, I2 = 87 %], pain scores [MD = -0.94; 95 % CI (-1.27 to -0.60); p < 0.000001, I2 = 86 %], with a significantly shorter duration of hospital stay [MD = -1.25 days; 95 % CI (-2.02 to -0.48); p = 0.002, I2 = 23 %]. This meta-analysis support the use of erector spinae plane block (ESP) for postoperative pain management in colorectal surgeries. ESP shows significant reductions in opioid consumption, pain scores and hospital stay.
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Affiliation(s)
| | - Areeba Fareed
- Department of Medicine, Karachi Medical and Dental College, Karachi, Pakistan.
| | - Urwah Afzal
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan.
| | | | - Munazza Mumtaz
- Department of Obstetrics and Gynecology, Civil Hospital, Karachi, Pakistan.
| | - Fatima Faraz
- Department of Medicine, Rawalpindi Medical University, Pakistan.
| | - Huda Naeem
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan.
| | - Rayyan Vaid
- Department of Medicine, Karachi Medical and Dental College, Karachi, Pakistan.
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Raja A, Raja S, Amin SB, Ahmed M, Rizvi SHA, Abdalla AS, Majid M, Asghar MS. Trends in substance-induced cardiomyopathy-related mortality among older adults in the United States from 1999 to 2020. Curr Probl Cardiol 2024; 49:102355. [PMID: 38128635 DOI: 10.1016/j.cpcardiol.2023.102355] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Received: 12/16/2023] [Accepted: 12/18/2023] [Indexed: 12/23/2023]
Abstract
In this retrospective study, spanning from 1999 to 2020, we examined mortality trends related to SICM (substance-induced cardiomyopathy) among individuals aged 75 and older. A total of 473,408 SICM-related deaths were identified, with detailed data on the place of death available for 454,632 cases, revealing that a significant proportion occurred in medical facilities (45.43 %), nursing homes (24.67 %), hospices (4.21 %), and at home (25.69 %). Our analysis of age-adjusted mortality rates (AAMR) showed an overall decline from 1999 to 2020, decreasing from 14.5 to 7.7 per 10,000 population, with an initial increase from 1999 to 2001 followed by a subsequent decline. Gender-based analysis indicated consistently higher AAMRs for elderly men compared to elderly women. Moreover, we observed variations in AAMRs based on race and ethnicity, with NH Black or African American individuals having the highest AAMRs. Geographic disparities were notable, with states like Delaware having AAMRs twice as high as Utah. The Southern region consistently exhibited the highest AAMR, followed by the Midwestern, Northeastern, and Western regions. Furthermore, metropolitan areas consistently had higher AAMRs than nonmetropolitan areas, although both showed declining trends over the study period. These findings provide valuable insights into SICM-related mortality patterns among the elderly population, emphasizing the importance of considering demographic and geographic factors in public health planning and interventions.
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Affiliation(s)
- Adarsh Raja
- Department of Cardiology, Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan.
| | - Sandesh Raja
- Department of Cardiology, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
| | - Shafin Bin Amin
- Department of Cardiology, Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan
| | - Muhammad Ahmed
- Department of Cardiology, Shaheed Mohtarma Benazir Bhutto Medical College Lyari, Karachi, Pakistan
| | - Syed Hassan Ahmed Rizvi
- Department of Cardiology, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Muhammad Majid
- Department of Internal Medicine, AdventHealth Sebring, FL, United States; Section of Cardiovascular Imaging, Cleveland Clinic, OH, United States
| | - Muhammad Sohaib Asghar
- Department of Internal Medicine, AdventHealth Sebring, FL, United States; Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, United States.
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Rehan ST, Ali A, Shuja SH, Eqbal F, Ahmed J, Ullah W, Asghar MS. Effects of Anticoagulation on Patients With Intra-Aortic Balloon Pump-A Meta-Analysis of 19,427 Patients. Am J Ther 2024:00045391-990000000-00168. [PMID: 38227903 DOI: 10.1097/mjt.0000000000001684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2024]
Affiliation(s)
- Syeda Tayyaba Rehan
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Abraish Ali
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Syed Hasan Shuja
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Farea Eqbal
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Jawad Ahmed
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Waqas Ullah
- Department of Cardiology, Thomas Jefferson University Hospitals, Philadelphia, PA
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Rehan ST, Ali E, Eqbal F, Ahsan MN, Asghar MS. Meta-analysis on the efficacy and safety of rituximab versus tacrolimus for nephrotic syndrome in the paediatric age group. Clin Kidney J 2024; 17:sfad263. [PMID: 38186898 PMCID: PMC10768748 DOI: 10.1093/ckj/sfad263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2023] [Indexed: 01/09/2024] Open
Affiliation(s)
| | - Eman Ali
- Dow University of Health Sciences, Karachi, Pakistan
| | - Farea Eqbal
- Dow University of Health Sciences, Karachi, Pakistan
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Rehan ST, Eqbal F, Ul Hussain H, Ali E, Ali A, Ullah I, Ullah W, Ahmed J, Brailovsky Y, Rajapreyar IN, Asghar MS. Transcatheter Edge-to-Edge Repair for Tricuspid Regurgitation-A Systematic Review and Meta-Analysis. Curr Probl Cardiol 2024; 49:102055. [PMID: 37652111 DOI: 10.1016/j.cpcardiol.2023.102055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 08/23/2023] [Indexed: 09/02/2023]
Abstract
Transcatheter edge-to-edge repair (TEER) has emerged as a widely accepted procedure for tricuspid regurgitation (TR) as gauged by echocardiographic parameters and clinical outcomes. Our study aims to assess TR severity and other echocardiographic outcomes in patients undergoing TEER with TriClip, MitraClip, and PASCAL devices. A literature search of 5 databases was performed until 1st June 2023. Randomized controlled trials (RCTs) or observational studies with moderate to severe (grade III-V) TR patients undergoing isolated TEER were considered eligible. Echocardiographic, and quality of life determining outcomes such as improvement in TR severity grade ≥3, New York Heart Association (NYHA) class ≥3, procedural success, 6-minute walking distance (6MWD), and adverse outcomes were analyzed. Grade assessment was performed and studies were assessed for risk of bias and publication bias. We included 15 studies (14 observational and 1 RCT) in our paper. Analysis revealed a substantial reduction in TR volume (P < 0.00001), TR grading (P < 0.00001), tricuspid annular diameter (P < 0.00001), proximal isovelocity surface area radius (P < 0.00001), effective regurgitant orifice area (P < 0.00001), and improvement in NYHA class (P < 0.00001) at 30 days from baseline, postprocedurally. A significant increase in 6MWD at 1 year (P = 0.001) was also recorded. No significant differences in left ventricular ejection fraction (P = 0.87), fractional area change (P = 0.37), or tricuspid annular plane systolic excursion (P = 0.76) were observed. TEER procedural success was 97%. TEER produced a significant reduction in TR grade and volume, NYHA class, 6MWD, and showed prominent procedural success. Large scale RCTs comparing the TEER devices are needed to strengthen the present findings.
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Affiliation(s)
| | - Farea Eqbal
- Dow University of Health Sciences, Karachi, Pakistan
| | | | - Eman Ali
- Dow University of Health Sciences, Karachi, Pakistan
| | - Abraish Ali
- Dow University of Health Sciences, Karachi, Pakistan
| | - Irfan Ullah
- Kabir Medical College, Gandhara University, Peshawar, Pakistan
| | - Waqas Ullah
- Thomas Jefferson University Hospitals, Philadelphia, PA
| | - Jawad Ahmed
- Dow University of Health Sciences, Karachi, Pakistan
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Eljack MMF, Elhadi YAM, Mahgoub EAA, Ahmed KAHM, Mohamed MTAA, Elnaiem W, Mohamedsharif A, Nour AB, Muhammed AEM, Gebril MSM, Asghar MS, El-Osta A. Physician experiences with teleconsultations amidst conflict in Sudan. Sci Rep 2023; 13:22688. [PMID: 38114741 PMCID: PMC10730898 DOI: 10.1038/s41598-023-49967-5] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/14/2023] [Indexed: 12/21/2023] Open
Abstract
The current conflict in Sudan severely hinders the accessibility of health services across the country. To address this, several initiatives were proposed including offering services using teleconsultations. This study aimed to assess Sudanese doctors' teleconsultation experience, perception, and concerns during the recent conflict. This cross-sectional survey focused on Sudanese medical officers, residents, specialists, and consultants living inside or outside the country having a practice license from the Sudan Medical Council and conducting teleconsultations with Sudanese patients during the conflict period. The questionnaire was distributed to personal and professional contacts and via social media platforms in the English language among doctors who provided teleconsultation during the conflict. Data analysis was performed using the Statistical Package for Social Sciences software version 26. The study enrolled 2463 clinicians from 17 different specialties, and females represented more than half the sample (56.8%). Internal medicine was the most frequent specialty (36.1%) and the majority (68.7%) of clinicians had less than 5 years of work experience. Voice call was the most frequent platform (50.1%) used for teleconsultation during the conflict and had the highest convenience score (p < 0.01), whereas messaging platforms had the lowest score. Most clinicians (73.3%) agreed that teleconsultations created a trusted patient-physician relationship and provided good-quality care (61.8%). However, 85.1% highlighted the importance of physical touch in medical practice. Clinicians were concerned that incomplete information (81.4%), missed diagnosis (76.8%), medicolegal problems (71.0%), and prescription errors (68.4%) could arise with teleconsultations. Most respondents (70.7%) emphasized the importance of continuing to offer teleconsultation even after the war abated. In conclusion, physicians who participated in the current study agreed that teleconsultation provided quality care even in this dire crisis in Sudan. Based on our study findings, we recommend upscaling telemedicine interventions including teleconsultations at the national level. This would require unified coordination efforts of a wide mix of stakeholders to address concerns identified in the current study.
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Affiliation(s)
| | | | | | | | | | - Walaa Elnaiem
- Community Department, Faculty of Medicine, University of Alneelain, Khartoum, Sudan
| | - Asma Mohamedsharif
- Faculty of Health Sciences and Medicine, University of Lucerne, Lucerne, Switzerland
| | - Alshareef B Nour
- Wad Medani College of Medical Sciences and Technology, Wad Medani, Sudan
| | | | | | | | - Austen El-Osta
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK
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13
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Asghar MS, Ismail Shah SM, Rani A, Kazmi S, Savul IS, Ukrani J, Khan F, Hasan CA, Rathore N, Syed M, Keswani S, Surkasha FNU, Mal D, Kumar D. Toxicities of CAR T-cell therapy: a review of current literature. Ann Med Surg (Lond) 2023; 85:6013-6020. [PMID: 38098580 PMCID: PMC10718333 DOI: 10.1097/ms9.0000000000001375] [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] [Received: 08/02/2022] [Accepted: 09/24/2023] [Indexed: 12/17/2023] Open
Abstract
The chimeric antigen receptor (CAR) design, first invented by Zelig Eshhar, paved the way for the use of genetically modified T-cells in targeted therapy against cancer cells. Since then, it has gone through many generations, especially with the integration of co-stimulation in the second and third-generation CARs. However, it also mounts a hyperactive immune response named as cytokine release syndrome with the release of several cytokines eventually resulting in multiple end-organ toxicities. The severity of cytokine release syndrome depends upon certain factors such as the tumor burden, choice of co-stimulation, and degree of lymphodepletion, and can manifest as pulmonary edema, vascular leak, renal dysfunction, cardiac problems, hepatic failure, and coagulopathy. Many grading criteria have been used to define these clinical manifestations but they lack harmonization. Neurotoxicity has also been significantly associated with CAR T-cell therapy but it has not been studied much in previous literature. This review aims to provide a comprehensive account of the clinical manifestations, diagnosis, management, and treatment of CAR T-cell associated neurotoxicity.
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Affiliation(s)
| | | | - Anooja Rani
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences
| | - Sana Kazmi
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences
| | - Ilma S. Savul
- Department of Internal Medicine, St. Joseph Medical Center, Houston
| | - Janta Ukrani
- Department of Internal Medicine, Mather Hospital-Northwell Health, New York
| | - Farmanullah Khan
- Department of Medicine, Liaquat National Hospital and Medical College
| | - Chaudhary A. Hasan
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences
| | - Navin Rathore
- Department of Medicine, Liaquat National Hospital and Medical College
| | - Maria Syed
- Department of Surgery, Aga Khan University Hospital, Karachi, Pakistan
| | - Shiwani Keswani
- Department of Medicine, Ghulam Muhammad Mahar Medical College, Sukkur
| | - FNU Surkasha
- Department of Medicine, Ghulam Muhammad Mahar Medical College, Sukkur
| | - Doongro Mal
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences
| | - Dileep Kumar
- Department of Medicine, Liaquat University of Medical and Health Sciences
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14
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Rehan ST, Hussain HU, Ali E, Kumar KA, Tabassum S, Hasanain M, Shaikh A, Ali G, Yousaf Z, Asghar MS. Role of soluble urokinase type plasminogen activator receptor (suPAR) in predicting mortality, readmission, length of stay and discharge in emergency patients: A systematic review and meta analysis. Medicine (Baltimore) 2023; 102:e35718. [PMID: 37960735 PMCID: PMC10637562 DOI: 10.1097/md.0000000000035718] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 09/28/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Soluble urokinase plasminogen activator receptor (suPAR) is an inflammatory biomarker that is used to predict mortality, readmission, early discharge, and LOS, thus, serves as a useful tool for ED physicians. Our study aims to analyze the efficacy of suPAR in predicting these prognostic markers in ED. METHODS We performed a comprehensive search on 6 databases from the inception to 30th November 2022, to select the following eligibility criteria; a) observation or triage trial studies investigating the role of suPAR levels in predicting: 30 day and 90-day mortality, 30-day readmission, early discharge (within 24hr), and LOS in patients coming to AMU. RESULTS A total of 13 studies were included, with a population size of 35,178, of which 52.9% were female with a mean age of 62.93 years. Increased risk of 30-day mortality (RR = 10.52; 95% CI = 4.82-22.95; I2 = 38%; P < .00001), and risk of 90-day mortality (RR = 5.76; 95% CI = 3.35-9.91; I2 = 36%; P < .00001) was observed in high suPAR patients. However, a slightly increased risk was observed for 30-day readmission (RR = 1.50; 95% CI = 1.16-1.94; I2 = 54%; P = .002). More people were discharged within 24hr in the low suPAR level group compared to high suPAR group (RR = 0.46; 95% CI = 0.40-0.53; I2 = 41%; P < .00001). LOS was thrice as long in high suPAR level patients than in patients with low suPAR (WMD = 3.20; 95% CI = 1.84-4.56; I2 = 99%; P < .00001). CONCLUSION suPAR is proven to be a significant marker in predicting 30-day and 90-day mortality in ED patients.
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Affiliation(s)
| | | | - Eman Ali
- Dow University of Health Sciences, Karachi, Pakistan
| | | | | | | | - Asim Shaikh
- Department of Medicine, The Aga Khan University, Karachi, Pakistan
| | - Gibran Ali
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic - Rochester, NY, USA
| | - Zohaib Yousaf
- Department of Internal Medicine, Tower Health - Reading Hospital, PA, USA
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15
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Rehman FU, Rehan ST, Rind BJ, Valliani K, Asghar MS, Omair F. Hyponatremia causing factors and its association with disease severity and length of stay in COVID-19 patients: A retrospective study from tertiary care hospital. Medicine (Baltimore) 2023; 102:e35920. [PMID: 37960743 PMCID: PMC10637499 DOI: 10.1097/md.0000000000035920] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 10/12/2023] [Indexed: 11/15/2023] Open
Abstract
The coronavirus disease-2019 (COVID-19) infection has taken the world by storm within a few months. Evidence has suggested that patients with electrolyte imbalances at baseline may have a longer duration of hospital stay. We aimed to determine the factors associated with hyponatremia on admission in COVID-19 patients and its impact on the length of stay. We conducted a retrospective study including 521 patients who tested positive for COVID-19 and had their electrolytes checked on admission from June 2020 to October 2020. Patients with sodium <135 mmol/l were included in the hyponatremic group and were compared against normonatremic patients. The severity of COVID-19 was found to be more prevalent in the case group as compared to control (38.3% vs 29.2%; 21.1% vs 17.7%). Hyponatremic patients stayed more than 5 days in hospital (56.3% vs 46.5%), and stayed longer in special care (23.4% vs 20.0%) as compared to controls. Hyponatremic patients as compared to control were more likely to have diabetes (47.9% vs 30.0%), hypertension (49.0% vs 38.5%), ischemic heart disease (20.7% vs 15.4%), chronic liver disease (2.7% vs 1.2%), and chronic kidney disease (9.6% vs 3.8%). Upon matching on the age, the adjusted odds of hyponatremia in COVID-19-positive patients were 1.9 times among diabetic patients. Moreover, COVID-19-positive patients suffering from CKD had a higher risk of developing hyponatremia (OR = 2.3, 95% CI: 1.1-5.6). The risk of hyponatremia among COVID-19-positive patients is statistically higher in patients with 1 comorbidity (OR = 1.9, 95%CI: 1.3-3.4). Hyponatremia on admission can be used to forecast the length of hospital stay and the severity of illness in COVID-19 patients.
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Affiliation(s)
- Fazal ur Rehman
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | | | | | - Komal Valliani
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Farrukh Omair
- Consultant Nephrologist- Transplant, King Fahad Armed Forces Hospital, Jeddah, KSA
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16
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Ashraf MT, Ahmed Rizvi SH, Kashif MAB, Shakeel Khan MK, Ahmed SH, Asghar MS. Efficacy of anti-CD3 monoclonal antibodies in delaying the progression of recent-onset type 1 diabetes mellitus: A systematic review, meta-analyses and meta-regression. Diabetes Obes Metab 2023; 25:3377-3389. [PMID: 37580969 DOI: 10.1111/dom.15237] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 07/11/2023] [Accepted: 07/22/2023] [Indexed: 08/16/2023]
Abstract
AIM Type 1 diabetes mellitus is widely recognized as a chronic autoimmune disease characterized by the pathogenic destruction of beta cells, resulting in the loss of endogenous insulin production. Insulin administration remains the primary therapy for symptomatic treatment. Recent studies showed that disease-modifying agents, such as anti-CD3 monoclonal antibodies, have shown promising outcomes in improving the management of the disease. In late 2022, teplizumab received approval from the US Food and Drug Administration (FDA) as the first disease-modifying agent for the treatment of type 1 diabetes. This review aims to evaluate the clinical evidence regarding the efficacy of anti-CD3 monoclonal antibodies in the prevention and treatment of type 1 diabetes. METHODS A comprehensive search of PubMed, Google Scholar, Scopus and Cochrane Central Register of Controlled Trials (CENTRAL) was conducted up to December 2022 to identify relevant randomized controlled trials. Meta-analysis was performed using a random-effects model, and odds ratios with 95% confidence intervals (CIs) were calculated to quantify the effects. The Cochrane risk of bias tool was employed for quality assessment. RESULTS In total, 11 randomized controlled trials involving 1397 participants (908 participants in the intervention arm, 489 participants in the control arm) were included in this review. The mean age of participants was 15 years, and the mean follow-up time was 2.04 years. Teplizumab was the most commonly studied intervention. Compared with placebo, anti-CD3 monoclonal antibody treatment significantly increased the C-peptide concentration in the area under the curve at shorter timeframes (mean difference = 0.114, 95% CI: 0.069 to 0.159, p = .000). Furthermore, anti-CD3 monoclonal antibodies significantly reduced the patients' insulin intake across all timeframes (mean difference = -0.123, 95% CI: -0.151 to -0.094, p < .001). However, no significant effect on glycated haemoglobin concentration was observed. CONCLUSION The findings of this review suggest that anti-CD3 monoclonal antibody treatment increases endogenous insulin production and improves the lifestyle of patients by reducing insulin dosage. Future studies should consider the limitations, including sample size, heterogeneity and duration of follow-up, to validate the generalizability of these findings further.
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Affiliation(s)
- Muhammad Talal Ashraf
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | | | | | - Syed Hassan Ahmed
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
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17
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Rehman FU, Rehan ST, Yousaf F, Rathore N, Rind BJ, Mahmmoud Fadelallah Eljack M, Asghar MS, Omair F. Renal cortical necrosis - a rare manifestation of dengue fever: A case report. Medicine (Baltimore) 2023; 102:e35719. [PMID: 37904359 PMCID: PMC10615500 DOI: 10.1097/md.0000000000035719] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 09/29/2023] [Indexed: 11/01/2023] Open
Abstract
RATIONALE Dengue fever is a widespread mosquito-borne viral disease, most prevalent in the tropical and subtropical areas of the world. There has been a significant rise in the incidence and number of outbreaks of dengue in recent years, which has made it a matter of global concern. It may be associated with a number of renal complications, ranging from hematuria, proteinuria, glomerulonephritis, and acute tubular necrosis. However, renal cortical necrosis (RCN) is a rare renal complication of this disease. PATIENTS CONCERNS We report the case of a young gentleman who presented with fever, vomiting, and anuria. On workup, he was found to be having complicated Dengue fever with RCN resulting in acute renal failure. DIAGNOSIS To the best of our knowledge, RCN is not a reported renal complication of dengue fever. INTERVENTIONS AND OUTCOMES Our report highlights the importance of early consideration of renal cortical necrosis in patients with dengue fever and persistent anuria. LESSON This would allow for better disease prognostication while enabling physicians to develop more effective treatment strategies.
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Affiliation(s)
- Fazal ur Rehman
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Fatima Yousaf
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Navin Rathore
- Liaquat National Hospital and Medical College, Karachi, Pakistan
| | | | | | - Muhammad Sohaib Asghar
- Department of Internal Medicine at Sun ’N Lake, AdventHealth, Sebring, FL
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Farruk Omair
- King Fahad Armed Forces Hospital, Jeddah, Kingdom of Saudi Arabia
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18
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Akhtar SMM, Saleem SZ, Rizvi SHA, Raja S, Asghar MS. Beyond the surface: analyzing etomidate and propofol as anesthetic agents in electroconvulsive therapy-A systematic review and meta-analysis of seizure duration outcomes. Front Neurol 2023; 14:1251882. [PMID: 37915381 PMCID: PMC10616260 DOI: 10.3389/fneur.2023.1251882] [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] [Received: 07/02/2023] [Accepted: 09/13/2023] [Indexed: 11/03/2023] Open
Abstract
Background Electroconvulsive therapy (ECT) is a widely used treatment for severe psychiatric disorders such as schizophrenia, depression, and mania. The procedure involves applying brief electrical stimulation to induce a seizure, and anesthesia is used to ensure sedation and muscle relaxation. Finding the right anesthetic agent with minimal side effects, especially on seizure duration, is crucial for optimal outcomes because seizure duration is an important factor in the effectiveness of ECT, but the anesthetic agents used can affect it. Objective This systematic review and meta-analysis aimed to pool the results of all relevant studies comparing the two induction agents, etomidate and propofol, for motor and electroencephalogram (EEG) seizure duration outcomes. Methods A comprehensive literature search was conducted in the PubMed, Medline, and Cochrane Library databases to identify the relevant articles. The primary outcome measures were motor and EEG seizure durations. Statistical power was ensured by performing heterogeneity, publication bias, sensitivity analysis, and subgroup analysis. Standard mean difference and 95% confidence intervals were calculated for continuous outcomes, and a random-effects model was used. Results A total of 16 studies were included in this meta-analysis, comprising 7 randomized control trials (RCTs), 7 crossover trials, and 2 cohorts. The overall motor seizure duration was statistically significantly longer with etomidate than with propofol. The overall result for EEG seizure duration was also longer with the use of etomidate over propofol and was statistically significant. In addition, subgrouping was performed based on the study design for both outcomes, which showed insignificant results in the cohort's subgroup for both outcomes, while the RCTs and crossover subgroups supported the overall results. Heterogeneity was assessed through subgrouping and sensitivity analysis. Conclusion Our meta-analysis found that etomidate is superior to propofol in terms of motor and EEG seizure duration in ECT, implying potentially better efficacy. Hence, etomidate should be considered the preferred induction agent in ECT, but larger studies are needed to further validate our findings.
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Affiliation(s)
- Syed M. M. Akhtar
- Department of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Syed Z. Saleem
- Department of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Syed H. A. Rizvi
- Department of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Sandesh Raja
- Department of Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
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19
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Chattha M, Tahir MJ, Zia A, Chattha M, Tariq W, Masood MF, Sani S, Yousaf Z, Eljack MMF, Asghar MS. Exposure to, understanding of and interest in interventional radiology among Pakistani medical students: a cross-sectional study. Front Med (Lausanne) 2023; 10:1226294. [PMID: 37908856 PMCID: PMC10615072 DOI: 10.3389/fmed.2023.1226294] [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] [Received: 05/22/2023] [Accepted: 09/27/2023] [Indexed: 11/02/2023] Open
Abstract
Background Medical students need more awareness regarding minimally invasive image-guided procedures carried out by interventional radiological approach. This study analyzed the knowledge and attitudes of medical students regarding interventional radiology (IR) and the factors influencing their decision to choose IR as a specialty in the future. Methods A cross-sectional, web-based study was conducted among medical students across Pakistan. The data were collected from October 14, 2021, to November 14, 2021. The questionnaire included demographic variables, exposure, interest, and self-reported knowledge of IR, interventions, instruments utilized in IR, and the responsibilities of the interventional radiologist. Variables affecting the possible choice of IR as a future career were analyzed using logistic regression analysis. Results The median age was 22 years, with a male predominance. 65.5% exhibited an interest in radiology, and 20.2% in IR. The majority, 83.5%, perceived IR. As having good to adequate prospects. Male participants preferred IR more as compared to females. Participants willing to attend IR rotation and had an excellent view of IR as a specialty had higher propensity towards IR as a future career than their counterparts. The majority opted for IR as a better-paying job with lots of intellectual stimulation and career flexibility. Conclusion IR is a demanding specialty with rigorous routines but reasonable monetary compensation. Lack of infrastructure and low numbers of trained specialists limit medical students' exposure to IR in developing health economies like Pakistan. Clinical rotations in IR departments would help raise awareness about the field and bridging this gap.
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Affiliation(s)
- Muneeb Chattha
- Department of Medicine, Foundation University Medical College, Rawalpindi, Pakistan
| | - Muhammad Junaid Tahir
- Department of Radiology, Pakistan Kidney and Liver Institute and Research Center (PKLI & RC), Lahore, Pakistan
| | - Ahmad Zia
- Department of Radiology, Pakistan Kidney and Liver Institute and Research Center (PKLI & RC), Lahore, Pakistan
| | - Maha Chattha
- Department of Radiology, Army Medical College, Rawalpindi, Pakistan
| | - Waleed Tariq
- Department of Medicine, Mayo Hospital, Lahore, Pakistan
| | | | - Salman Sani
- Department of Medicine, Jinnah Hospital, Lahore, Pakistan
| | - Zohaib Yousaf
- Department of Medicine, Tower Health, Reading, PA, United States
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20
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Yasmin F, Aamir M, Najeeb H, Atif AR, Siddiqui AH, Ahsan MN, Moeed A, Ali SH, Tahir HM, Asghar MS. Efficacy and safety of finerenone in chronic kidney disease and type 2 diabetes patients: a systematic review and meta-analysis. Ann Med Surg (Lond) 2023; 85:4973-4980. [PMID: 37811017 PMCID: PMC10553111 DOI: 10.1097/ms9.0000000000001180] [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] [Received: 04/15/2023] [Accepted: 08/05/2023] [Indexed: 10/10/2023] Open
Abstract
Background and objectives The incidence of morbidity and mortality in patients with type 2 diabetes mellitus is substantially correlated with cardiovascular disease and chronic kidney disease. The current guidelines recommend the use of renin-angiotensin system blockers, but recent studies probed into the effects of finerenone to mitigate the risk of cardiorenal events. This meta-analysis was performed to demonstrate the effects of finerenone on cardiorenal events, comprising cardiovascular mortality, heart failure, change in estimated glomerular filtration rate, and serum potassium levels. Methods After screening with our eligibility criteria, 350 articles were identified with an initial literature search on multiple databases, including PubMed, Science Direct, and Cochrane Central. Seven randomized controlled trials with a total of 15 462 patients (n=8487 in the finerenone group; n=6975 in the control group) were included. Results Patients receiving finerenone were at a reduced risk for cardiovascular mortality [HR: 0.84 (0.74, 0.95)], heart failure [OR: 0.79 (0.68, 0.92)], decrease in estimated glomerular filtration rate by 40% [OR: 0.82 (0.74, 0.91)] and by 57% [OR: 0.70 (0.59, 0.82)]; and a higher incidence of moderate hyperkalemia [OR: 2.25 (1.78, 2.84)]. Conclusion Finerenone, owing to its better mineralocorticoid affinity, and a much lower risk of adverse effects, promises to be a much better alternative than other renin-angiotensin system blockers available for the treatment of chronic kidney disease patients with type 2 diabetes. Further trials should be conducted to provide more definitive evidence to assess the safety and efficacy of finerenone compared to spironolactone and eplerenone.
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Affiliation(s)
- Farah Yasmin
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences
| | - Muhammad Aamir
- Department of Cardiovascular Medicine, Lehigh Valley Health Network, Allentown, Pennsylvania
| | - Hala Najeeb
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences
| | - Abdul Raafe Atif
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences
| | - Abdul Hannan Siddiqui
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences
| | - Muhammad Nadeem Ahsan
- Department of Nephrology and Dialysis Unit, Dow University of Health Sciences-Ojha Campus, Karachi, Pakistan
| | - Abdul Moeed
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences
| | - Syed Hasan Ali
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences
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21
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Yasmin F, Kumari K, Saleem K, Lareeb I, Shaikh A, Ashfaq R, Ahmed B, Bashar N, Najeeb H, Asghar MS. Caregiver's perceptions of COVID-19 vaccination, and intention to vaccinate their children against the disease: a questionnaire based qualitative study. Ann Med Surg (Lond) 2023; 85:4757-4763. [PMID: 37811020 PMCID: PMC10553153 DOI: 10.1097/ms9.0000000000001165] [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] [Received: 04/15/2023] [Accepted: 08/02/2023] [Indexed: 10/10/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) vaccine side effects have an important role in the hesitancy of the general population toward vaccine administration. Another reason for vaccine hesitancy might be that healthcare professionals may not address their concerns regarding vaccines appropriately. Regardless, hesitancy in the form of delay, refusal, or acceptance with doubts about its usefulness can limit the downward trajectory of the COVID-19 pandemic. Therefore, the authors conducted a national cross-sectional study (n=306) to assess causes and concerns for vaccine hesitancy in caregivers in Pakistan toward getting their children vaccinated. The questions identified caregivers by socioeconomic demographics, perceived COVID-19 pandemic severity, and concerns toward the COVID-19 vaccine. The majority of the participants were 45-59 years of age (42.8%) with a mean age of 36.11 years (SD: 7.81). A total of 80% of these participants were willing to vaccinate their child with any COVID-19 vaccine. Present comorbidities had a frequency of 28.4% (n=87/306) and only 26.9% (n=66/245) participants were willing to vaccinate their child. Participants with high social standing were 15.4% (n=47/306) with the majority of them being willing to vaccinate their children (45/47). Socioeconomic status (OR:2.911 [0.999-8.483]), and the child's vaccinations being up to date (OR:1.904 [1.078-3.365]) were found to be independent factors for caregivers to be willing to vaccinate their child. Around 62% (n=191/306) were not willing to vaccinate due to the concern for side effects, 67.6% (n=207/306) were not willing because they did not have ample information available, and 51% (n=156/306) were not willing as they were concerned about vaccine effectiveness. Further studies on vaccine safety in the pediatric population are required to improve caregivers' perceptions.
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Affiliation(s)
| | | | | | - Iqra Lareeb
- Liaquat National Hospital and Medical College
| | - Asim Shaikh
- Civil Hospital, Dow University of Health Sciences
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22
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Rehan ST, Hussain HU, Imran L, Eqbal F, Asghar MS. Perioperative selenium administration in cardiac surgery patients, a way out to reduce post surgical adversities? A meta analysis. Front Cardiovasc Med 2023; 10:1235247. [PMID: 37711553 PMCID: PMC10497979 DOI: 10.3389/fcvm.2023.1235247] [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] [Received: 06/06/2023] [Accepted: 08/15/2023] [Indexed: 09/16/2023] Open
Abstract
Introduction The oxidative damage suffered in cardiac surgery is associated with declining trace elements which lead to the development of multi organ dysfunction (MOD), acute kidney injury (AKI), or increased length of hospital stay (LOS). Recent evidence shows the cardioprotective role of the trace element selenium as it mitigates worsening outcomes post cardiac surgery. Hence, this meta analysis aims to investigate the role of selenium in lowering cardiac surgery related adverse outcomes. Methods Literature search of five electronic databases was performed from the inception of the paper till 29th July, 2023. Eligibility criteria included; (a) randomized clinical trials with Adult patients (≥18 years) undergoing cardiac surgery (b) intervention with selenium pre or/and postoperatively; (c) a control group of a placebo, normal saline, or no selenium. Outcomes of interest include postoperative mortality, LOS in the hospital and Intensive Care Unit (ICU), AKI, troponin I, and Creatinine Kinase-MB (CK-MB). The Cochrane bias assessment tool was used to evaluate the risk of bias. Outcomes were pooled with the Mantel-Haenszel Random-effects model using Review Manager. Results Seven RCTs with 2,521 patients and 65% of males were included in this paper. No noticable differences were observed between selenium and control groups in terms of postoperative AKI, mortality, LOS in hospital and ICU, troponin I, and CK-MB levels. All studies had a low risk of bias on quality assessment. Discussion Our meta analysis demonstrated no discernible effects of selenium infusion on post operative complications among patients undergoing cardiac surgery. Further large scale multi centered studies comparing the protective role of selenium with combined therapy of other bioactive agents are needed to provide convincing explanations. Systematic Review Registration PROSPERO Identifier: 424920.
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Affiliation(s)
- Syeda Tayyaba Rehan
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Hassan Ul Hussain
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Laiba Imran
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Farea Eqbal
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
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23
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Jamil H, Idrees M, Idrees K, Tariq W, Sayyeda Q, Asghar MS, Tahir MJ, Akram S, Ullah K, Ahmed A, Mohanty A, Padhi BK, Sah R. Socio-demographic determinants of Monkeypox virus preventive behavior: A cross-sectional study in Pakistan. PLoS One 2023; 18:e0279952. [PMID: 37561764 PMCID: PMC10414588 DOI: 10.1371/journal.pone.0279952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Accepted: 03/29/2023] [Indexed: 08/12/2023] Open
Abstract
BACKGROUND Monkeypox (mpox), re-emerging zoonotic infectious disease, is striking the world with serious public health concerns, especially in non-endemic countries. The public's knowledge and attitude towards the monkeypox virus (MPXV) influence their adherence to preventive strategies. Therefore, we aimed to assess the public's knowledge, attitudes, and perceptions (KAP) of MPXV in Pakistan. METHODS We collected data for this cross-sectional study from 1040 participants via online self-reported questionnaire from July 5th, 2022, to August 1st, 2022. The questionnaire consisted of a total of 29 items in four sections, assessing socio-demographics, knowledge, attitudes, and practices regarding MPXV. The data were analyzed using IBM SPSS V.25, and factors associated with MPXV knowledge, attitude, and practices were identified by using logistic regression analyses. RESULTS A total of 1040 participants were included. 61.4% were male, and 57.2% had graduation level education. Only 34.4% had good knowledge about MPXV, and 30% knew the effectiveness of the smallpox vaccine against MPXV. 41.7% had a positive attitude, 48.6% agreed that it is a fatal disease, and 44.6% were in favour of banning travel from endemic to non-endemic regions. 57.7% had good practices, and 69.9% would use protective measures if MPXV became an epidemic. Binary logistic regression analysis revealed that gender and education significantly impacted knowledge (p<0.05). While monthly income status had a significant impact on attitudes (p<0.05). The practices were positively correlated with gender and education (p<0.05). CONCLUSION The majority of study participants had inadequate levels of knowledge, and attitudes regarding MPXV. To prevent the emergence and spread of MPXV in Pakistan, a comprehensive strategic framework for public health education must be established and implemented.
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Affiliation(s)
| | | | | | | | - Qudsia Sayyeda
- Red Crescent of Tampa Bay, Tampa, FL, United States of America
| | | | | | | | - Kaleem Ullah
- Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences, Gambat, Pakistan
| | - Ali Ahmed
- School of Pharmacy, Monash University, Subang Jaya, Selangor, Malaysia
| | - Aroop Mohanty
- Department of Microbiology, All India Institute of Medical Sciences, Gorakhpur, India
| | - Bijaya Kumar Padhi
- Department of Community Medicine and School of Public Health, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Ranjit Sah
- Tribhuvan University Teaching Hospital, Institute of Medicine, Kathmandu, Nepal
- Department of Microbiology, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Dr. D. Y. Patil Vidyapeeth, Pune, Maharashtra, India
- Harvard Medical School, Boston, MA, United States of America
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24
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Tahir MJ, Ashraf S, Tariq W, Cheema MS, Asghar MS, Yousaf Z. The future role of forensic radiology - scope and challenges. Radiologia (Engl Ed) 2023; 65:385-386. [PMID: 37516491 DOI: 10.1016/j.rxeng.2023.02.003] [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] [Received: 01/26/2023] [Accepted: 02/01/2023] [Indexed: 07/31/2023]
Affiliation(s)
- M J Tahir
- Pakistan Kidney and Liver Institute and Research Center (PKLI & RC), Lahor, Pakistan.
| | - S Ashraf
- Dow University of Health Sciences, Karachi, Pakistan
| | - W Tariq
- Hospital General de Lahore, Lahore, Pakistan
| | - M S Cheema
- CMH Lahore Medical College, Lahore, Pakistan
| | - M S Asghar
- Mayo Clinic, Rochester, MN, United States
| | - Z Yousaf
- Tower Health, Reading, PA, United States
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Rehan ST, Imran L, Salim A, Javed SO, Sohail A, Hussain HU, Ahmed J, Yasmin F, Islam MS, Asghar MS. Therapeutic and safety outcomes of intracoronary nicardipine in coronary artery disease patients: a systematic review. Future Cardiol 2023. [PMID: 37264944 DOI: 10.2217/fca-2022-0085] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023] Open
Abstract
Aim: This systematic review aimed to shed light on the efficacy of intracoronary (IC) nicardipine in treating no reflow with CAD undergoing revascularization. Methods: Literature search was performed on databases with following eligibility criteria: adult patients with CAD; clinical trials or observational studies; IC nicardipine as intervention; therapeutic and safety outcome reported. Results: A total of 1249 papers were yielded during the literature search. Of these, 11 studies were finalized for this systematic review. Complete restoration of TIMI 3 flow was observed in 98.6% of the patients receiving IC nicardipine. A significant increase in the CBF after infusion of IC nicardipine (p < 0.05) was also observed. Conclusion: IC nicardipine significantly increases CBF and decreases coronary vascular resistance.
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Affiliation(s)
- Syeda Tayyaba Rehan
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, 74200, Pakistan
| | - Laiba Imran
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, 74200, Pakistan
| | - Aqsa Salim
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, 74200, Pakistan
| | - Syed Owais Javed
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, 74200, Pakistan
| | - Aruba Sohail
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, 74200, Pakistan
| | - Hassan Ul Hussain
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, 74200, Pakistan
| | - Jawad Ahmed
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, 74200, Pakistan
| | - Farah Yasmin
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, 74200, Pakistan
| | - Md Saiful Islam
- Department of Public Health & Informatics, Jahangirnagar University, Savar, Dhaka, 1342, Bangladesh
- Centre for Advanced Research Excellence in Public Health, Savar, Dhaka, 1342, Bangladesh
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26
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Tahir MJ, Zaman M, Saffi J, Asghar MS, Tariq W, Ahmed F, Islam R, Farooqui US, Ullah I, Saqlain M, Ullah K, Ahmed A. Knowledge, attitudes, and practices of the general population of Pakistan regarding typhoid conjugate vaccine: findings of a cross-sectional study. Front Public Health 2023; 11:1151936. [PMID: 37333546 PMCID: PMC10272827 DOI: 10.3389/fpubh.2023.1151936] [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] [Received: 01/27/2023] [Accepted: 04/28/2023] [Indexed: 06/20/2023] Open
Abstract
Typhoid fever, a common enteric disease in Pakistan, caused by Salmonella typhi, is becoming an extended drug-resistant organism and is preventable through the typhoid conjugate vaccine (TCV). Public adherence to preventive measures is influenced by knowledge and attitude toward the vaccine. This study investigates the knowledge, attitudes, and practices of the general population of Pakistan toward TCV. The differences in mean scores and factors associated with typhoid conjugate vaccine knowledge, attitudes, and practices were investigated. A total of 918 responses were received with a mean age of 25.9 ± 9.6, 51% were women, and 59.6% had graduation-level education. The majority of them responded that vaccines prevent illness (85.3%) and decrease mortality and disability (92.6%), and typhoid could be prevented by vaccination (86.7%). In total, 77.7 and 80.8% considered TCV safe and effective, respectively. Of 389 participants with children, 53.47% had vaccinated children, according to the extended program on immunization (EPI). Higher family income has a higher odds ratio (OR) for willingness toward booster dose of TCV [crude odds ratio (COR) = 4.920, p-value <0.01; adjusted odds ratio (aOR) = 2.853, value of p <0.001], and negative attitude regarding the protective effect of TCV has less willingness toward the booster dose with statistical significance (COR = 0.388, value of p = 0.017; aOR = 0.198, value of p = 0.011). The general population of Pakistan had a good level of knowledge about the benefits of TCV, and attitude and practices are in favor of the usage of TCV. However, a few religious misconceptions are prevalent in public requiring the efforts to overcome them to promote the usage of vaccines to prevent the disease and antibiotic resistance.
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Affiliation(s)
| | - Musharaf Zaman
- Department of Anesthesia, Pakistan Red Crescent Teaching Hospital, Lahore, Pakistan
| | - Junaid Saffi
- Department of Medicine, Lahore General Hospital, Lahore, Pakistan
| | - Muhammad Sohaib Asghar
- Department of Internal Medicine, Dow University of Health Sciences-Ojha Campus, Karachi, Pakistan
| | - Waleed Tariq
- Department of Medicine, Lahore General Hospital, Lahore, Pakistan
| | - Faizan Ahmed
- Department of Medicine, Lahore General Hospital, Lahore, Pakistan
| | - Rabia Islam
- Department of Medicine, Punjab Medical College, Faisalabad, Pakistan
| | | | - Irfan Ullah
- Department of Medicine, Kabir Medical College, Gandhara University, Peshawar, Pakistan
| | - Muhammad Saqlain
- Department of Pharmacy, Quaid-I-Azam University, Islamabad, Pakistan
| | - Kaleem Ullah
- Department of Hepatobiliary Surgery and Transplant, Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences, Gambat, Pakistan
| | - Ali Ahmed
- Department of Pharmacy, School of Pharmacy, Monash University, Subang Jaya, Selangor, Malaysia
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Jadoon SK, Soomro R, Ahsan MN, Ijaz Khan RM, Iqbal S, Yasmin F, Najeeb H, Saleem N, Cho N, Shaikh TG, Saba Hasan SF, Khalid MZ, Alvi S, Rizvi AM, Asghar MS. Association of neutrophil-to-lymphocyte ratio with clinical, pathological, radiological, laboratory features and disease outcomes of invasive breast cancer patients: A retrospective observational cohort study. Medicine (Baltimore) 2023; 102:e33811. [PMID: 37335707 DOI: 10.1097/md.0000000000033811] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
Inflammatory conditions play part in the progression of malignancies, and markers signifying growth of these factors can indicate prognosis. Neutrophil-to-lymphocyte (NLR) is used as a marker of subclinical inflammation that may become an integral part of workup to indicate prognosis and associated pathology. This study aims to explore the association of NLR ratio with clinical characteristics, radiological assessment and staging, histopathology, and disease outcomes of breast cancer. A retrospective cohort study was conducted in a tertiary care center to include breast cancer patients that were diagnosed between January 2001 and December 2020. Data including tumor size, lymph nodes, metastasis, histological grading, ER/PR/HER2-neu status, molecular subtypes, clinical staging); nodal findings (sentinel and axillary); pathology from frozen section; and disease outcomes were assessed. Multivariable regression and Kaplan-Meier survival curves were employed to indicate the association of NLR with breast cancer features and disease-free survival. A total of 2050 patients had a median age of 50 years, median NLR levels of 2.14, most common pathology ductal followed by lobular, and most common site of metastasis being lungs followed by bones. Disease-free rate was 7.6%, and a recurrence rate of 1.8%, while 1.6% deaths were reported. NLR was found associated with age, treatment outcomes, tumor size, lymph nodes, metastasis and clinical staging. Other positive correlations were with Ki67 proliferation index, molecular subtypes, and tumor size on frozen section (at transverse and craniocaudal dimensions). Negative correlations were seen with estrogen and progesterone receptors. However, NLR was not found predictable of disease-free survival (P = .160). Significant predictors of disease-free survival were histological grading, ER, PR status, molecular subtype, and Ki67 proliferation index. NLR being a readily available marker has shown novel findings in its association with tumor staging, disease outcomes and characteristics of breast malignancy.
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Affiliation(s)
| | - Rufina Soomro
- Department of General Surgery, Liaquat National Hospital and Medical College, Karachi, Pakistan
| | | | | | - Sadia Iqbal
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Farah Yasmin
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Hala Najeeb
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Nida Saleem
- Department of Nephrology, Dow University of Health Sciences, Karachi, Pakistan
| | - Namiya Cho
- Department of Nephrology, Dow University of Health Sciences, Karachi, Pakistan
| | - Taha Gul Shaikh
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Muhammad Zain Khalid
- Department of General Surgery, Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Sarosh Alvi
- Teaching Assistant, Faculty of Medicine, University of Bakht Al-Ruda, Khartoum, Sudan
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Mustafa G, Asad A, Hashim I, Farooq N, Fatir CA, Asghar MS. Evisceration of appendix via drain site - a rare complication in a child. Int J Surg Case Rep 2023; 106:108111. [PMID: 37060768 PMCID: PMC10130592 DOI: 10.1016/j.ijscr.2023.108111] [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: 01/05/2023] [Revised: 03/03/2023] [Accepted: 03/16/2023] [Indexed: 04/07/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Abdominal drains prevent fluid accumulation and help drain fluid (blood, pus). In recent years, abdominal drains have been used less frequently due to drain-associated complications, like infections, anastomotic leakage, and the potential for the evisceration of intra-abdominal organs on drain removal. CASE PRESENTATION We present a young female with evisceration of the appendix via the drain site, successfully managed by abdominal exploration and appendectomy. CASE DISCUSSION The use of prophylactic abdominal drain is controversial and is of limited use even in complicated appendicitis in the modern era of antibiotics. If a drain is inserted, it should be removed at the earliest to avoid associated complications. CONCLUSION Abdominal drain usage should be minimized in children to avoid post-operative complications.
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Affiliation(s)
| | - Ali Asad
- Services Hospital, Lahore, Pakistan
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29
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Khan MQA, Kazmi SJH, Tabassum S, Ali G, Ali N, Asghar MS. An unusual foreign body ricocheting into the pericardium after a penetrating thoracic injury: A case report. Int J Surg Case Rep 2023; 105:108032. [PMID: 37004452 PMCID: PMC10090980 DOI: 10.1016/j.ijscr.2023.108032] [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: 10/09/2022] [Revised: 02/23/2023] [Accepted: 03/22/2023] [Indexed: 04/03/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Injuries to the thorax are common in trauma patients, among whom cardiac injuries are most lethal, particularly in the setting of penetrating trauma. CASE PRESENTATION In this case report, the foreign body was visualized to be lodged in between the left atrium and ventricle. After that, an emergency open heart surgery was performed. Post-intervention, the patient was shifted to the intensive care unit without ionotropic support and with stable haemodynamics. CLINICAL DISCUSSION Cardiac foreign bodies are rarely seen because most patients with penetrating cardiac injuries die from hemorrhagic shock or cardiac tamponade. CONCLUSION We report a case of a penetrating injury into the thorax with the foreign body being lodged into the pericardium and then managed surgically. The patient was discharged subsequently and followed up after a few days with progressive recovery.
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Affiliation(s)
| | - Syed Jawad Haider Kazmi
- Emergency Medicine Department, Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Shaesta Tabassum
- Emergency Medicine Department, Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Gibran Ali
- Department of Pulmonology and Critical Care, Mayo Clinic, Rochester, MN, USA
| | - Navaira Ali
- Department of Cardiothoracic Surgery, Liaquat National Hospital and Medical College, Karachi, Pakistan
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Shaikh OA, Amin S, Shaikh G, Kumari K, Ullah I, Asghar MS. Farcimab: a flicker of light in the darkness of neovascular age-related macular degeneration and Diabetes Mellitus - correspondence. Int J Surg 2023; 109:1056-1057. [PMID: 36917115 PMCID: PMC10389444 DOI: 10.1097/js9.0000000000000281] [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] [Received: 01/18/2023] [Accepted: 01/25/2023] [Indexed: 03/16/2023]
Affiliation(s)
| | - Shifa Amin
- Department of Medicine, Ziauddin University
| | - Gulrukh Shaikh
- Department of Medicine, Liaquat National Hospital and Medical College
| | | | - Irfan Ullah
- Kabir Medical College, Gandhara University, Peshawar, Pakistan
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Manan S, Shaikh OA, Shaikh G, Saleem K, Ullah I, Asghar MS. Fostering diagnostics of CVD in diabetics using ABI and baPWV - Correspondence. Ann Med Surg (Lond) 2023; 85:1316. [PMID: 37113832 PMCID: PMC10129086 DOI: 10.1097/ms9.0000000000000370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 02/25/2023] [Indexed: 03/31/2023] Open
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Shaikh OA, Shaikh G, Aftab RM, Baktashi H, Ullah I, Asghar MS. Unconventional but effective: breaking through IBS-D clinical practice guidelines – correspondence. Ann Med Surg (Lond) 2023; 85:1312-1313. [PMID: 37113818 PMCID: PMC10129270 DOI: 10.1097/ms9.0000000000000338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 02/25/2023] [Indexed: 03/31/2023] Open
Abstract
Irritable Bowel Syndrome (IBS) is a chronic, one of the commonest and persistent gastrointestinal (GI) disorder. Previously, the management plan for IBS-D included enhancing awareness; first line treatment included an increased dietary fiber intake, opioids for diarrhea and antispasmodics for pain management. A recent treatment guideline by the American Gastroenterology Association (AGA) suggests a modified approach to treating patients with IBS-D. Eight drug recommendations were made, and a set of instructions on when to employ which medication was devised. With the incorporation of these structured guidelines, a more tailored and focused approach to IBS management may become plausible.
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Anayat S, Majid K, Nazir HS, Nizami AA, Mustafa W, Abbasi MSR, Ahsan MN, Jadoon SK, Ullah I, Asghar MS. Meta-Analysis on the Efficacy of High-Dose Statin Loading Before Percutaneous Coronary Intervention in Reducing No-Reflow Phenomenon in Acute Coronary Syndrome. Am J Cardiol 2023; 195:9-16. [PMID: 36989606 DOI: 10.1016/j.amjcard.2023.02.024] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Revised: 02/15/2023] [Accepted: 02/27/2023] [Indexed: 03/31/2023]
Abstract
Currently, guidelines recommend the uptake of high-dose statins before and after percutaneous coronary intervention (PCI) in patients with acute coronary syndrome. However, the association of high-dose statins with the incidence of the no-reflow phenomenon remains unclear. This study aimed to review the evidence of preprocedural high-dose statin therapy to reduce no-reflow incidence after PCI. PubMed, Embase, and Google Scholar were searched from inception until May 2022 for studies comparing high-dose statins with low-dose or no statin therapy before PCI. Studies reporting the no-reflow phenomenon were shortlisted. The National Institutes of Health tool for randomized and cohort studies was used to assess the quality of included studies. A random-effects model was used to derive odds ratios (ORs) and their corresponding 95% confidence intervals (CIs). A total of 11 studies were included, with a population of 4,294 patients. The use of high-dose statins before PCI significantly reduced postprocedural no-reflow (OR 0.51, 95% CI 0.35 to 0.74, p = 0.0005, I2 = 32%). A total of 7 studies included patients who underwent PCI without previous use of statins. A significant decrease in overall no-reflow events was observed with high-intensity statin treatment versus low-intensity statin/placebo (OR 0.55, 95% CI 0.34 to 0.88, p = 0.01, I2 = 25%) among patients who were statin naive. Acute high-dose statin therapy before PCI significantly reduces the hazard of post-PCI no-reflow events in patients with acute coronary syndrome. Our results encourage the routine use of statins before PCI.
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Affiliation(s)
| | | | | | - Awais Ahmad Nizami
- Shahida Islam Institute of Cardiology/Shahida Islam Medical College, Lodhran Bahawalpur, Pakistan
| | - Waqar Mustafa
- Abbas Institute of Medical Sciences, Azad Jammu Kashmir Medical College, Muzaffarabad, Pakistan
| | | | - Muhammad Nadeem Ahsan
- Department of Nephrology and Hypertension, Dow University of Health Sciences, Karachi, Pakistan
| | - Sarosh Khan Jadoon
- Sheikh Khalifa Bin Zayed Al Nahyan Hospital/Combined Miltiary Hospital, Muzaffarabad, Pakistan
| | - Irfan Ullah
- Gandhara University Kabir Medical College, Peshawar, Pakistan
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Khan NA, Siraj MI, Rajput IA, Memon ZA, Ali RR, Ursani A, Anees MM, Kumar K, Naina, Kumar RR, Kumar R, Shahab R, Asghar MS. Normal preoperative levels of gamma glutamyltransferase predict absence of common bile duct stones in patients scheduled for laparoscopic cholecystectomy. a retrospective cohort study. Ann Med Surg (Lond) 2023; 85:701-705. [PMID: 37113898 PMCID: PMC10129176 DOI: 10.1097/ms9.0000000000000281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 01/24/2023] [Indexed: 04/05/2023] Open
Abstract
Laparoscopic cholecystectomy, nowadays, is considered the gold standard option for management in patients diagnosed with symptomatic cholelithiasis. Nevertheless, some patients may have coexisting choledocholithiasis, which manifests later in life with grave complications such as cholangitis and pancreatitis. The objective of this study is to evaluate the role of preoperative gamma-glutamyltransferase (GGT) in predicting choledocholithiasis in patients undergoing laparoscopic cholecystectomy. Method A total of 360 patients with symptomatic cholelithiasis based on diagnosis aided with abdominal ultrasound were included in the study. The study design was a retrospective cohort. Patients were evaluated based on a comparison between findings of per-operative cholangiogram and laboratory measure of GGT. Result The mean age of study participants was 47.22 (±28.41) years. Mean GGT levels were 121.54 (±87.91) U/l. One hundred (27.7%) participants had raised GGT. But only 19.4% had been diagnosed with filling defect positive on cholangiogram. The predictability of GGT for positive cholangiogram is statistically significant at less than 0.001 with an area under the curve of 0.922 (0.887-0.957), sensitivity of 95.7%, specificity of 88.6%, and accuracy of 90%. The standard error reported (0.018) was found to be relatively low. Conclusion Based on the provided information, it is concluded that GGT plays an important role in predicting the coexistence of choledocholithiasis in symptomatic cholelithiasis and can be used in the setting where the facility of per-operative cholangiogram is not available.
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Jabeen K, Saleem S, Nizamuddin S, Arshad F, Jahan S, Hasnain F, Tariq W, Tahir MJ, Yousaf Z, Asghar MS. Reporting of Azithromycin Activity against Clinical Isolates of Extensively Drug-Resistant Salmonella enterica Serovar Typhi. Am J Trop Med Hyg 2023; 108:942-947. [PMID: 36940665 PMCID: PMC10160884 DOI: 10.4269/ajtmh.22-0557] [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: 08/30/2022] [Accepted: 12/19/2022] [Indexed: 03/22/2023] Open
Abstract
This study aimed to evaluate the minimum inhibitory concentration (MIC) of azithromycin (AZM) in clinical isolates of extensively drug-resistant (XDR) Salmonella Typhi (i.e., resistant to chloramphenicol, ampicillin, trimethoprim-sulfamethoxazole, fluoroquinolones, and third-generation cephalosporin) using the E-test versus the broth microdilution method (BMD). From January to June 2021, a retrospective cross-sectional study was carried out in Lahore, Pakistan. Antimicrobial susceptibility was performed initially by the Kirby-Bauer disk diffusion method for 150 XDR Salmonella enterica serovar Typhi isolates, and MICs of all the recommended antibiotics were determined by the VITEK 2 (BioMérieux) fully automated system using Clinical Laboratory Standard Institute (CLSI) 2021 guidelines. The E-test method was used to determine AZM MICs. These MICs were compared with the BMD, which is the method recommended by the CLSI but not adopted in routine laboratory reporting. Of 150 isolates, 10 (6.6%) were resistant by disk diffusion. Eight (5.3%) of these had high MICs against AZM by the E-test. Only three isolates (2%) were resistant by E-test, having an MIC of 32 μg/mL. All eight isolates had a high MIC by BMD with different MIC distributions, but only one was resistant, having an MIC of 32 μg/mL by BMD. The sensitivity, specificity, negative predictive value, positive predictive value, and diagnostic accuracy of the E-test method versus BMD were 98.65%,100%, 99.3%, 33.3%, and 98.6%, respectively. Similarly, the concordance rate was 98.6%, negative percent agreement was 100%, and positive percent agreement was 33%. The BMD is the most reliable approach for reporting AZM sensitivity in XDR S. Typhi compared with the E-test and disk diffusion methods. Potentially, AZM resistance in XDR S. Typhi is around the corner. Sensitivity patterns should be reported with MIC values, and if possible, higher values should be screened for the presence of any potential resistance genes. Antibiotic stewardship should be strictly implemented.
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Affiliation(s)
| | | | | | | | - Shah Jahan
- University of Health Sciences, Lahore, Pakistan
| | | | | | - Muhammad Junaid Tahir
- Pakistan Kidney and Liver Institute and Research Center (PKLI & RC), Lahore, Pakistan
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Yasmin F, Najeeb H, Naeem U, Moeed A, Atif AR, Asghar MS, Nimri N, Saleem M, Bandyopadhyay D, Krittanawong C, Fadelallah Eljack MM, Tahir MJ, Waqar F. Adverse events following COVID‐19 mRNA vaccines: A systematic review of cardiovascular complication, thrombosis, and thrombocytopenia. Immun Inflamm Dis 2023; 11:e807. [PMID: 36988252 PMCID: PMC10022421 DOI: 10.1002/iid3.807] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [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: 07/14/2022] [Revised: 12/26/2022] [Accepted: 02/24/2023] [Indexed: 03/19/2023] Open
Abstract
Background and Objectives Since publishing successful clinical trial results of mRNA coronavirus disease 2019 (COVID‐19) vaccines in December 2020, multiple reports have arisen about cardiovascular complications following the mRNA vaccination. This study provides an in‐depth account of various cardiovascular adverse events reported after the mRNA vaccines' first or second dose including pericarditis/myopericarditis, myocarditis, hypotension, hypertension, arrhythmia, cardiogenic shock, stroke, myocardial infarction/STEMI, intracranial hemorrhage, thrombosis (deep vein thrombosis, cerebral venous thrombosis, arterial or venous thrombotic events, portal vein thrombosis, coronary thrombosis, microvascular small bowel thrombosis), and pulmonary embolism. Methods A systematic review of original studies reporting confirmed cardiovascular manifestations post‐mRNA COVID‐19 vaccination was performed. Following the PRISMA guidelines, electronic databases (PubMed, PMC NCBI, and Cochrane Library) were searched until January 2022. Baseline characteristics of patients and disease outcomes were extracted from relevant studies. Results A total of 81 articles analyzed confirmed cardiovascular complications post‐COVID‐19 mRNA vaccines in 17,636 individuals and reported 284 deaths with any mRNA vaccine. Of 17,636 cardiovascular events with any mRNA vaccine, 17,192 were observed with the BNT162b2 (Pfizer−BioNTech) vaccine, 444 events with mRNA‐1273 (Moderna). Thrombosis was frequently reported with any mRNA vaccine (n = 13,936), followed by stroke (n = 758), myocarditis (n = 511), myocardial infarction (n = 377), pulmonary embolism (n = 301), and arrhythmia (n = 254). Stratifying the results by vaccine type showed that thrombosis (80.8%) was common in the BNT162b2 cohort, while stroke (39.9%) was common with mRNA‐1273 for any dose. The time between the vaccination dosage and the first symptom onset averaged 5.6 and 4.8 days with the mRNA‐1273 vaccine and BNT162b2, respectively. The mRNA‐1273 cohort reported 56 deaths compared to the 228 with BNT162b2, while the rest were discharged or transferred to the ICU. Conclusion Available literature includes more studies with the BNT162b2 vaccine than mRNA‐1273. Future studies must report mortality and adverse cardiovascular events by vaccine types.
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Affiliation(s)
- Farah Yasmin
- Department of Internal MedicineDow University of Health SciencesKarachiPakistan
| | - Hala Najeeb
- Department of Internal MedicineDow University of Health SciencesKarachiPakistan
| | - Unaiza Naeem
- Department of Internal MedicineDow University of Health SciencesKarachiPakistan
| | - Abdul Moeed
- Department of Internal MedicineDow University of Health SciencesKarachiPakistan
| | - Abdul Raafe Atif
- Department of Internal MedicineDow University of Health SciencesKarachiPakistan
| | | | - Nayef Nimri
- Department of Cardiovascular MedicineUniversity of CincinnatiCincinnatiOhioUSA
| | - Maryam Saleem
- Department of Cardiovascular MedicineUniversity of CincinnatiCincinnatiOhioUSA
| | | | | | | | - Muhammad Junaid Tahir
- Department of RadiologyPakistan Kidney and Liver Institute and Research CenterLahorePakistan
| | - Fahad Waqar
- Department of Cardiovascular MedicineUniversity of CincinnatiCincinnatiOhioUSA
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Zafar MT, Zia BF, Khalid SR, Bai J, Memon ZA, Jan ZU, Jadoon SK, Khan NA, Kajal D, Ali F, Kirmani TA, Asghar MS. Clinicopathological correlation of aspartate aminotransferase-to-platelet ratio (apri) and aspartate aminotransferase-to-alanine aminotransferase ratio (aar) with survival in esophageal carcinoma patients: a retrospective cohort analysis of 951 patients. Ann Med Surg (Lond) 2023; 85:706-711. [PMID: 37113975 PMCID: PMC10129076 DOI: 10.1097/ms9.0000000000000311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 02/12/2023] [Indexed: 03/31/2023] Open
Abstract
Esophageal cancer is the eighth most prevalent cancer globally. Previously, several biomarkers have been used to predict the prognosis, although with variable reliability. Interestingly, it is noted that changes in liver function tests levels before and after neoadjuvant treatment are predictive in terms of cancer recurrence. Objectives The objectives of the current study were to associate novel markers, including aspartate aminotransferase-to-platelet ratio (APRI) and aspartate aminotransferase-to-alanine aminotransferase ratio (AAR) with survival in esophageal malignancy. Materials and Methods A retrospective study in a tertiary care hospital (single-center) included 951 patients having diagnosed esophageal carcinoma of any age group. Results The median (interquartile range) age of study participants were 50 (38-60) years, including 43% males and 57% female patients, while the median (interquartile range) levels of AAR and APRI were 0.97 (0.81-1.25) and 0.19 (0.13-0.29), respectively. AAR was found to be higher in dysphagia for solids only and dysphagia for both liquids and solids rather than liquids only (P=0.002), while other associations included well-differentiated tumor grade (P=0.011), finding of esophageal stricture on esophagogastroduodenoscopy (P=0.015), and characteristic of mass on computerized tomography scan being both circumferential and mural (P=0.005). APRI was found to be higher in adenocarcinoma (P=0.038), and finding of circumferential±ulcerated mass on esophagogastroduodenoscopy (P<0.001). On survival analysis, adenocarcinoma (P<0.001), luminal narrowing (P=0.002), AAR greater than 1.0 (P=0.006), and APRI greater than 0.2 (P=0.007) were found to be poor survival predictors. On Cox proportional hazards regression, APRI was found to be more associated with poor survival than AAR (Hazard ratio: 1.682, 1.208-2.340, P=0.002). Conclusion This study correlated clinical and pathological features of esophageal malignancy with noninvasive markers of hepatic function.
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Yasmin F, Shaikh A, Asghar MS, Moeed A, Najeeb H, Waqar E, Ram MD, Nankani A, Ochani RK, Aamir M, Ullah W, Waqar F, Johnson DM, Johnson DM. Early Transcatheter or Surgical Aortic Valve Replacement Versus Conservative Management in Asymptomatic Patients With Severe Aortic Stenosis: A Systematic Review and Meta-analysis. Curr Probl Cardiol 2023; 48:101477. [PMID: 36328337 DOI: 10.1016/j.cpcardiol.2022.101477] [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: 10/16/2022] [Accepted: 10/26/2022] [Indexed: 02/01/2023]
Abstract
The merits of conservative management vs early intervention in patients with asymptomatic severe aortic stenosis remains unknown. Digital databases (MEDLINE, Google Scholar, and Embase) were searched for all relevant studies from inception through September 2022. Studies comparing conservative management with early intervention were compared using a random-effects model to calculate risk ratios (RRs) with 95% confidence interval (CI). A total of 12 studies comprising 3624 asymptomatic aortic stenosis patients (1747 receiving surgery, and 1877 receiving conservative treatment) were included in the analysis. The average follow-up time was 4.45 (IQR 3.5-5) years. Early intervention was associated with a significantly reduced risk of cardiac (RR 0.42, 95% CI 0.25-0.72; P = 0.001; I2 = 54%), non-cardiac (RR 0.46, 95% CI 0.32-0.68; P < 0.0001; I2 = 0%), all-cause mortality (RR 0.40, 95% CI 0.32-0.51; P < 0.00001; I2 = 58%), heart failure hospitalization (RR 0.21, 95% CI 0.13-0.36; P < 0.00001; I2 = 0%), sudden cardiac death (RR 0.29, 95% CI 0.12-0.66; P = 0.004, I2 = 24%), and MACE (RR 0.46, 95% CI; 0.28-0.75; P = 0.002; I2 = 68%), compared with conservative management. There was no significant difference in the 30-day mortality (RR 0.63, 95% CI 0.19-2.04; P = 0.44; I2 = 28%), myocardial infarction (RR 0.44, 95% CI 0.19-1.06; P = 0.07, I2=0%), and 90-day mortality (RR 0.68, 95% CI 0.20-2.37; P = 0.55; I2 = 61%) between the 2 groups. This meta-analysis shows statistically significant reductions in the risk for all-cause mortality, cardiac specific mortality, non-cardiac mortality, heart failure hospitalization, MACE, and sudden cardiac death among asymptomatic aortic stenosis patients who underwent early intervention as opposed to conservative management.
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Affiliation(s)
- Farah Yasmin
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Asim Shaikh
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Abdul Moeed
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Hala Najeeb
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Eisha Waqar
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Muskaan Doulat Ram
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Avinash Nankani
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Rohan Kumar Ochani
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad Aamir
- Lehigh Valley Heart Specialists, Lehigh Valley Health Network, Allentown PA
| | - Waqas Ullah
- Division of Cardiology, Sidney Kimmel Medical College, Thomas Jefferson University Hospitals, Philadelphia PA
| | - Fahad Waqar
- Division of Cardiovascular Health and Disease, University of Cincinnati College of Medicine, Cincinnati, OH
| | - Drew M Johnson
- Division of Cardiology, Sidney Kimmel Medical College, Thomas Jefferson University Hospitals, Philadelphia PA.
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Faraz F, Rehman MEU, Sabir B, Ghaffar A, Iftikhar A, Maqsood A, Ahmad Cheema H, Yasmin F, Aamir M, Ahmed MU, Asghar MS. Efficacy of Catheter Ablation for Atrial Fibrillation in Hypertrophic Cardiomyopathy: A Systematic Review and Meta-Analysis. Curr Probl Cardiol 2023; 48:101524. [PMID: 36455792 DOI: 10.1016/j.cpcardiol.2022.101524] [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: 11/20/2022] [Accepted: 11/25/2022] [Indexed: 11/29/2022]
Abstract
Atrial fibrillation (AF) is the most common arrhythmia in patients with hypertrophic cardiomyopathy (HCM). Catheter ablation (CA) has emerged as an effective therapy for AF. We conducted a meta-analysis to update the current clinical evidence on the efficacy of CA for AF in patients with HCM. We searched PubMed, Embase, Cochrane and Clinicaltrials.gov for interventional and observational studies assessing single and multiple procedure success rate of CA in HCM patients. Our meta-analysis included 25 studies involving 1817 patients. Success rate following single procedure was 40.4% (95% CI 33.1 to 48.0%) at latest follow-up. The pooled success rate following multiple procedures was 51.4% (95% CI 42.9% to 60.0%) at latest follow-up. In the subgroup analysis for AF subtype, TCA was more successful for paroxysmal AF compared to non-paroxysmal AF. For the subset of studies reporting drug-free success rate, single and multiple procedures had a success rate of 33.4% (95% CI 19.3 to 49.1%) and 51.8% (95% CI 41.3 to 62.2%) at latest follow-up, respectively. CA is a suitable option for AF in patients with HCM. Success rate is greater in paroxysmal AF, after multiple procedures and with antiarrhythmic drugs.
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Affiliation(s)
- Fatima Faraz
- Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan
| | | | - Beenish Sabir
- Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Areeba Ghaffar
- Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Ahmad Iftikhar
- Department of Medicine, The University of Arizona, Tucson, AZ
| | - Aimen Maqsood
- Department of Medicine, Mohtarma Benazir Bhutto Shaheed Medical College, Mirpur, Azad and Jammu Kashmir
| | | | - Farah Yasmin
- Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad Aamir
- Lehigh Valley Heart Specialists, Lehigh Valley Health Network, Allentown, PA
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Ahsan MN, Asghar MS, Iqbal S, Alvi H, Akram M, Fayyaz B, Irshad SG, Ullah I, Alvi S, Yousaf Z. Outcomes of COVID-19 patients with acute kidney injury and longitudinal analysis of laboratory markers during the hospital stay: A multi-center retrospective cohort experience from Pakistan. Medicine (Baltimore) 2023; 102:e32919. [PMID: 36820547 PMCID: PMC9907899 DOI: 10.1097/md.0000000000032919] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023] Open
Abstract
The frequency of acute kidney injury (AKI) in COVID-19 patients can be varied and related to worse outcomes in the disease population. AKI is common among hospitalized patients with COVID-19, particularly the ones needing critical care. This study was conducted in order to determine the outcomes of hospitalized patients with prolonged hospital stays who suffered from COVID-19 associated AKI. It was conducted as a multi-centered, retrospective, cohort study, and including all patients who were diagnosed on COVID-19 PCR. End-stage renal disease patients on hemodialysis were excluded. The cohort included 1069 patients, with 68% males, mean age of 56.21 years, and majority within 50 to 75 years age group (60%). Mean disease onset was 14.43 ± 7.44 days and hospital stay was 7.01 ± 5.78 days. About 62% of patients stayed in intensive care and 18% of them were on invasive ventilation. The mortality rate was 27%. Frequency of AKI was 42%, around 14% of them were resolving during hospital stay and other 28% worsened. The mortality rate was significantly higher with AKI (OR: 4.7, P < .001). Alongside AKI, concomitant liver dysfunction was also significantly contributing to mortality (OR: 2.5), apart from ICU stay (OR: 2.9), invasive ventilation (OR: 9.2), and renal replacement therapy (OR: 2.4). Certain laboratory markers were associated with AKI throughout in-hospital stay.
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Affiliation(s)
- Muhammad Nadeem Ahsan
- Department of Nephrology, Dow University of Health Sciences-Ojha Campus, Karachi, Pakistan
| | - Muhammad Sohaib Asghar
- Department of Internal Medicine, Dow University of Health Sciences-Ojha Campus, Karachi, Pakistan
| | - Sadia Iqbal
- Department of Internal Medicine, Dow University of Health Sciences-Ojha Campus, Karachi, Pakistan
| | - Haris Alvi
- Department of Internal Medicine, Dow University of Health Sciences-Ojha Campus, Karachi, Pakistan
| | - Mohammed Akram
- Department of Internal Medicine, Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Basmah Fayyaz
- Department of Internal Medicine, Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Syeda Ghazala Irshad
- Department of Nephrology, Dow University of Health Sciences-Ojha Campus, Karachi, Pakistan
| | - Irfan Ullah
- Department of Internal Medicine, Kabir Medical College Gandhara University, Peshawar, Pakistan
| | - Sarosh Alvi
- Teaching Faculty, University of Khartoum, Khartoum, Sudan
- * Correspondence: Sarosh Alvi, Teaching Faculty, University of Khartoum, Khartoum 13314, Sudan (e-mail: )
| | - Zohaib Yousaf
- Department of Internal Medicine, Reading Hospital – Tower Health, Reading, PA
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Jawed S, Islam MB, Awan HA, Ullah I, Asghar MS. Cholera outbreak in Balochistan amidst flash floods: an impending public health crisis. Int J Surg 2023; 109:107-108. [PMID: 36799817 PMCID: PMC10389440 DOI: 10.1097/js9.0000000000000150] [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: 02/18/2023]
Abstract
Despite being the largest province in Pakistan due to inadequate and underdeveloped infrastructure, Balochistan has been the worst-inflicted region with biblical floods. Following these disastrous flash floods, a sudden rise in cholera cases was seen in the affected province. To overcome this public health crisis, the authorities must put in place a system to ensure food safety, an adequate supply of clean drinking water, and the provision of proper sanitation facilities for the locals.
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Affiliation(s)
- Shizra Jawed
- Department of Internal Medicine, Dow Medical College, Karachi, Pakistan
| | | | - Hashir Ali Awan
- Department of Internal Medicine, Dow Medical College, Karachi, Pakistan
| | - Irfan Ullah
- Kabir Medical College, Gandhara University, Peshawar, Pakistan
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Yasmin F, Najeeb H, Siddiqui HF, Asghar MS, Awan HA, Usama RM, Allahuddin Z, Tahir MJ, Ullah K, Mahmmoud Fadelallah Eljack M. Frequency of COVID-19 vaccine side effects and its associated factors among the vaccinated population of Pakistan: A cross-sectional study. Health Sci Rep 2023; 6:e1071. [PMID: 36698706 PMCID: PMC9847396 DOI: 10.1002/hsr2.1071] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [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] [Received: 10/01/2022] [Revised: 11/18/2022] [Accepted: 12/12/2022] [Indexed: 01/19/2023] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) vaccine side effects have an important role in the hesitancy of the general population toward vaccine administration. Therefore, this study was conducted to document the COVID-19 vaccine side effects in our population. Materials and Methods An online survey-based, cross-sectional study was carried out from September 1, 2021, to October 1, 2021, to document the side effects of the COVID-19 vaccine among the general public. The questionnaire included participants' sociodemographic data, type of vaccine, comorbidities, previous COVID-19 infection, and assessment of side effects reported by them. Results The majority of the participants were <20 years of age (62.2%), females (74.9%), belonged to the educational sector (58.1%), residents of Sindh (65.7%), and were previously unaffected by COVID-19 infection (73.3%). Sinovac (38.7%) followed by Sinopharm (30.4%) and Moderna (18.4%) were administered more frequently. Commonly reported side effects were injection site pain (82%), myalgia (55%), headache (46%), fatigue/malaise (45%), and fever (41%). Vaccine side effects were more likely to be reported with the first dose as compared to the second dose. On regression analysis, factors associated with occurrence of side effects included younger age (odds ratio [OR]: 6.000 [2.065-17.431], p < 0.001), female gender (OR: 2.373 [1.146-4.914], p = 0.020), marital status (OR: 0.217 [0.085-0.556], p < 0.001), graduate level of education (OR: 0.353 [0.153-0.816], p = 0.015), and occupation being either retired, freelancers, or social workers (OR: 0.310 [0.106-0.909]), p = 0.033). Previous infection with COVID-19 (p = 0.458) and comorbidities were found unrelated (p = 0.707) to the occurrence of side effects. Conclusion The overall prevalence of local side effects was quite higher than the systemic ones. Further large-scale studies on vaccine safety are required to strengthen public confidence in the vaccination drive.
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Affiliation(s)
- Farah Yasmin
- Department of Medicine, Dow Medical CollegeDow University of Health SciencesKarachiPakistan
| | - Hala Najeeb
- Department of Medicine, Dow Medical CollegeDow University of Health SciencesKarachiPakistan
| | - Hasan Fareed Siddiqui
- Department of Medicine, Dow Medical CollegeDow University of Health SciencesKarachiPakistan
| | - Muhammad Sohaib Asghar
- Department of Medicine, Dow University Hospital‐Ojha CampusDow University of Health SciencesKarachiPakistan
| | - Hashir Ali Awan
- Department of Medicine, Dow Medical CollegeDow University of Health SciencesKarachiPakistan
| | | | - Zoha Allahuddin
- Department of Medicine, Dow Medical CollegeDow University of Health SciencesKarachiPakistan
| | - Muhammad Junaid Tahir
- Department of RadiologyPakistan Kidney and Liver Institute and Research Center (PKLI & RC)LahorePakistan
| | - Kaleem Ullah
- Department of Surgery, Liver Transplant and Hepatobiliary UnitPir Abdul Qadir Shah Jelani Institute of Medical SciencesGambatPakistan
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Shaikh TG, Jawed S, Rahmat ZS, Ahmed SH, Waseem S, Ullah I, Irfan M, Asghar MS. Efficacy and Safety of Vericiguat for Treatment of Heart Failure: A Systematic Review. Curr Probl Cardiol 2023; 48:101586. [PMID: 36623755 DOI: 10.1016/j.cpcardiol.2023.101586] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 01/03/2023] [Indexed: 01/08/2023]
Abstract
Heart failure is a growing global health concern with high mortality and morbidity. Beta-blockers, mineralocorticoid receptor antagonists, and angiotensin-converting-enzyme inhibitors are the treatments of choice for worsening clinical symptoms. In early 2021, the FDA approved a new oral soluble guanylate cyclase stimulator, Vericiguat, for the treatment of chronic heart failure. To evaluate the efficacy and safety of this approved drug, we conducted a systematic review of the available randomized controlled trials (RCTs). A literature search was conducted using PubMed, The Cochrane Library, and Clinicaltrials.gov from inception to June 6, 2022, without any language restriction. The systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The quality of the included studies was checked using the Cochrane Risk-of-Bias tool. After a thorough literature search, 7 studies met our pre-defined criteria and were therefore included in this review. Our review suggests that vericiguat was better in preventing all causes of death, cardiovascular death, and hospitalizations due to heart failure irrespective of the atrial fibrillation status of the patients and was even beneficial for patients with NT-proBNP levels up to 8000 pg/ml. The safety of the vericiguat, according to our review, is not up to the standards, especially with a higher dosage of vericiguat. Despite all of this, vericiguat can be a breakthrough in the treatment of heart failure as it has great potential to improve the disease severity.
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Affiliation(s)
| | - Shizra Jawed
- Dow University of Health Sciences, Karachi, Sindh, Pakistan
| | | | | | | | - Irfan Ullah
- Kabir Medical College, Gandhara University, Peshawar, KPK, Pakistan
| | - Muhammad Irfan
- Department of Internal Medicine, Wellstar Health system Spalding Hospital, Atalanta, GA
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Tariq W, Asar MAT, Tahir MJ, Ullah I, Ahmad Q, Raza A, Qureshi MK, Ahmed A, Sarwar MZ, Ameer MA, Ullah K, Siddiqi H, Asghar MS. Impact of the COVID-19 pandemic on knowledge, perceptions, and effects of telemedicine among the general population of Pakistan: A national survey. Front Public Health 2023; 10:1036800. [PMID: 36684982 PMCID: PMC9849806 DOI: 10.3389/fpubh.2022.1036800] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [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] [Received: 09/05/2022] [Accepted: 12/05/2022] [Indexed: 01/07/2023] Open
Abstract
Background Telemedicine is the provision of healthcare services through information and communication technology with the potential to mobilize all facets of the health sector to prevent the spread of COVID-19, provide quality healthcare, protect patients, doctors, and the public from exposure to disease, and reduce the burden on the healthcare system. This study aims to identify knowledge, perceptions, willingness to use, and the impact of the COVID-19 pandemic on telemedicine awareness. Methods A cross-sectional study was conducted from 27 May 2020 to 17 June 2020 using the convenient sampling technique in the general population of Pakistan. Data were collected by designing an online questionnaire consisting of demographic information, knowledge, attitude perceptions, barriers, utilization, and the impact of the COVID-19 pandemic on telemedicine. Results Of the 602 participants included in the study, 70.1% had heard about telemedicine, 54.3% had a good understanding of the definition of "telemedicine," 81.4% had not used telemedicine in the past, 29.9% did not know that telemedicine was available before the COVID-19 pandemic, and 70.4% responded that the COVID-19 pandemic had changed their attitudes toward telemedicine. Gender (p = 0.017) and family income (p = 0.027) had a significant association with the perception of the benefits of telemedicine. Conclusion The knowledge and usage of telemedicine are lacking due to inadequate awareness and technology. The need of the hour is to maximize the application of telemedicine to overcome the deficiencies of the healthcare system. Hence, it is essential to increase awareness through various means and develop an appropriate infrastructure to attain maximum benefits from telehealth services.
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Affiliation(s)
- Waleed Tariq
- Department of Medicine, Lahore General Hospital, Lahore, Pakistan
| | | | | | - Irfan Ullah
- Department of Medicine, Kabir Medical College, Gandhara University, Peshawar, Pakistan
| | - Qasid Ahmad
- Department of Medicine, Lahore General Hospital, Lahore, Pakistan
| | - Ahmad Raza
- Department of Medicine, Mayo Hospital, Lahore, Pakistan
| | - Mohsin Khalid Qureshi
- Department of Medicine, Hazrat Bari Imam Sarkar Medical and Dental College, Islamabad, Pakistan
| | - Ali Ahmed
- Department of Medicine, School of Pharmacy, Monash University, Bandar Sunway, Malaysia
| | | | - Muhammad Atif Ameer
- Department of Medicine, Suburban Community Hospital, East Norriton, PA, United States
| | - Kaleem Ullah
- Department of Medicine, Pir Abdul Qadir Shah Jeelani Institute of Medical Sciences, Gambat, Pakistan
| | - Haziq Siddiqi
- Department of Medicine, University of California, San Francisco, San Francisco, CA, United States
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Taseen S, Abbas M, Nasir F, Wania Amjad S, Asghar MS. Tip of the iceberg: Emergence of Langya virus in the postpandemic world. J Med Virol 2023; 95:e28173. [PMID: 36156803 DOI: 10.1002/jmv.28173] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Accepted: 09/22/2022] [Indexed: 01/11/2023]
Affiliation(s)
- Shafaq Taseen
- Karachi Medical and Dental College, Karachi, Pakistan
| | - Munib Abbas
- Karachi Medical and Dental College, Karachi, Pakistan
| | - Filza Nasir
- Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, Pakistan
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Taseen S, Nasir F, Abbas M, Altaf M, Asghar MS, Tahir MJ. Post-pandemic world at the mercy of monkeypox virus outbreak: Time to worry or not? J Med Virol 2023; 95:e27948. [PMID: 35730397 DOI: 10.1002/jmv.27948] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Revised: 06/18/2022] [Accepted: 06/20/2022] [Indexed: 01/11/2023]
Affiliation(s)
- Shafaq Taseen
- Department of medicine, Karachi Medical and Dental College, Karachi, Pakistan
| | - Filza Nasir
- Department of medicine, Shaheed Mohtarma Benazir Bhutto Medical College, Karachi, Pakistan
| | - Munib Abbas
- Department of medicine, Karachi Medical and Dental College, Karachi, Pakistan
| | - Mahran Altaf
- Department of medicine, Lahore General Hospital, Lahore, Pakistan
| | - Muhammad Sohaib Asghar
- Department of medicine, Dow University of Health Sciences-Ojha Campus, Karachi, Pakistan
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Shah SMI, Yasmin F, Memon RS, Jatoi NN, Savul IS, Kazmi S, Monawwer SA, Zafar MDB, Asghar MS, Tahir MJ, Lee KY. COVID-19 and myasthenia gravis: A review of neurological implications of the SARS-COV-2. Brain Behav 2022; 12:e2789. [PMID: 36306401 PMCID: PMC9759145 DOI: 10.1002/brb3.2789] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 09/10/2022] [Accepted: 09/24/2022] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION This review highlights the potential mechanisms of neuromuscular manifestation of COVID-19, especially myasthenia gravis (MG). METHODS An extensive literature search was conducted by two independent investigators using PubMed/MEDLINE and Google Scholar from its inception to December 2020. RESULTS Exacerbations of clinical symptoms in patients of MG who were treated with some commonly used COVID-19 drugs has been reported, with updated recommendations of management of symptoms of neuromuscular disorders. Severe acute respiratory syndrome coronavirus 2 can induce the immune response to trigger autoimmune neurological disorders. CONCLUSIONS Further clinical studies are warranted to indicate and rather confirm if MG in the setting of COVID-19 can pre-existent subclinically or develop as a new-onset disease.
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Affiliation(s)
| | - Farah Yasmin
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Roha Saeed Memon
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Nadia Nazir Jatoi
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Ilma Saleh Savul
- Department of Internal Medicine, St. Joseph Medical Center, Houston, Texas, USA
| | - Sana Kazmi
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Muhammad Daim Bin Zafar
- Department of Internal Medicine, Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | | | | | - Ka Yiu Lee
- Swedish Winter Sports Research Centre, Department of Health Sciences, Mid Sweden University, Östersund, Sweden
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Shaikh TG, Waseem S, Ahmed SH, Asghar MS, Tahir MJ. Disproportionate distribution of coronavirus disease 2019 (COVID-19) antiviral pills: Vaccine inequity replay? Infect Control Hosp Epidemiol 2022; 43:1989-1990. [PMID: 34955110 PMCID: PMC8770834 DOI: 10.1017/ice.2021.532] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/03/2021] [Accepted: 12/14/2021] [Indexed: 01/14/2023]
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49
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Yasmin F, Ali SH, Naeem A, Savul S, Afridi MSI, Kamran N, Fazal F, Khawer S, Savul IS, Najeeb H, Asim HS, Nausherwan M, Asghar MS. Current Evidence and Future Perspectives of the Best Supplements for Cardioprotection: Have We Reached the Final Chapter for Vitamins? Rev Cardiovasc Med 2022. [DOI: 10.31083/j.rcm2311381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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50
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Khan MH, Salman A, Yasmin F, Sehar A, Abbasi M, Memon SF, Asghar MS, Fadelallah Eljack MM, Ullah K, Tahir MJ. Structure and evaluation of preventive medicine residency programs’ websites: A cross sectional analysis. Ann Med Surg (Lond) 2022; 84:104871. [DOI: 10.1016/j.amsu.2022.104871] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 10/16/2022] [Accepted: 11/07/2022] [Indexed: 11/27/2022] Open
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