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Ashraf S, Shahbaz A, Ashraf M, Ibrahim W, Saboor QA. Previously undiagnosed asymptomatic peripheral arterial disease in patients undergoing coronary angiography. Eur J Intern Med 2024; 122:146-147. [PMID: 38267296 DOI: 10.1016/j.ejim.2024.01.016] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Revised: 12/19/2023] [Accepted: 01/16/2024] [Indexed: 01/26/2024]
Affiliation(s)
- Sohaib Ashraf
- Department of Cardiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan.
| | - Amir Shahbaz
- Department of Cardiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | - Maryam Ashraf
- Department of Cardiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | - Wasim Ibrahim
- Department of Cardiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | - Qazi Abdul Saboor
- Department of Cardiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
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Ashraf S, Farooq U, Shahbaz A, Khalique F, Ashraf M, Akmal R, Siddal MT, Ashraf M, Ashraf S, Ashraf S, Ghufran M, Akram MK, Saboor QA. Factors Responsible for Worse Outcomes in STEMI Patients With Early vs Delayed Treatment Presenting in a Tertiary Care Center in a Third World Country. Curr Probl Cardiol 2024; 49:102049. [PMID: 37666350 DOI: 10.1016/j.cpcardiol.2023.102049] [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: 08/19/2023] [Accepted: 08/23/2023] [Indexed: 09/06/2023]
Abstract
The aim of the study is to compare the outcomes among ST-segment elevation myocardial infarction (STEMI) cases with early treatment vs delayed treatment. It was a prospective comparative study on 186 patients with consecutive (nonprobability) sampling. Two groups of cases were made as per their time to get admitted to the hospital (ie, within 2 hours of symptom onset = Group A; after 2 hours of symptom onset = Group B). Patients were asked for factors causing a delay in treatment after the onset of symptoms and were monitored for STEMI outcomes. The mean age of all patients was 46.62 ± 9.76 years and there were 140 (75.27%) male and 46 (24.73%) female, and male to female ratio 3:1.Factors significant for delayed treatment vs nondelayed treatment were poor social economic status (65.6% vs 20.4%), history of chronic stable angina (33.3% vs 11.8%), delayed response in the emergency room (20.4% vs 8.6%), delayed ECG acquisition (26.9% vs 8.6%), delayed ECG interpretation (25.8% vs 4.3%), pain at night 12:00-6:00 AM (21.5% vs 9.7%) and belief that the chest pain is noncardiac (26.9% vs 3.2%). Acute heart failure was significantly greater in group B (9.7%) in comparison with group A (2.2%), re-infarction was 18.3% in group B in comparison with 7.5% group A. Similarly sustained ventricular tachycardia and ventricular fibrillation and in-hospital mortality were higher in group B (12.9%, 14%, and 12.9% respectively). Due to delayed treatment patients had higher hospital stays, and complications, like acute heart failure, re-infarction, ventricular fibrillation, and in-hospital mortality.
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Affiliation(s)
- Sohaib Ashraf
- Department of Cardiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | - Usama Farooq
- Department of Cardiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | - Amir Shahbaz
- Department of Cardiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan.
| | - Faisal Khalique
- Department of Medicine, Lahore Medical and Dental College, Lahore, Pakistan
| | - Maryam Ashraf
- Department of Cardiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | - Rutaba Akmal
- Department of Medicine, Lahore Medical and Dental College, Lahore, Pakistan
| | - Muhammad Talha Siddal
- Department of Cardiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | - Moneeb Ashraf
- Department of Pharmacology, King Edward Medical University, Mayo Hospital, Lahore, Pakistan
| | - Shoaib Ashraf
- Department of Pharmacology, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Sidra Ashraf
- Department of Pharmacology, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Muhammad Ghufran
- Department of Pharmacology, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Muhammad Kiwan Akram
- Department of Pharmacology, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Qazi Abdul Saboor
- Department of Cardiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
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Ashraf S, Ashraf S, Ashraf M, Imran MA, Kalsoom L, Siddiqui UN, Farooq I, Akmal R, Akram MK, Ashraf S, Ghufran M, Majeed N, Habib Z, Rafique S, -Abdin ZU, Arshad S, Shahab MS, Ahmad S, Zheng H, Mirza AR, Zulfiqar S, Anwar MI, Humayun A, Mahmud T, Saboor QA, Ahmad A, Ashraf M, Izhar M. Honey and Nigella sativa against COVID-19 in Pakistan (HNS-COVID-PK): A multicenter placebo-controlled randomized clinical trial. Phytother Res 2023; 37:627-644. [PMID: 36420866 DOI: 10.1002/ptr.7640] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 07/07/2022] [Accepted: 09/18/2022] [Indexed: 11/25/2022]
Abstract
Until now, no specific and effective treatment exists for coronavirus disease 2019 (COVID-19). Since honey and Nigella sativa (HNS) have established antiviral, antibacterial, antiinflammatory, antioxidant, and immunomodulatory properties, we tested their efficacy for this disease in a multicenter, placebo-controlled, and randomized clinical trial at four medical care facilities in Pakistan. RT-PCR confirmed COVID-19 adults showing moderate or severe disease were enrolled in the trial. Patients were randomly assigned in a 1:1 ratio to receive either honey (1 g kg-1 day-1 ) and Nigella sativa seeds (80 mg kg-1 day-1 ) or a placebo for up to 13 days along with standard care. The outcomes included symptoms' alleviation, viral clearance, and 30-day mortality in the intention-to-treat population. Three hundred and thirteen patients, 210 with moderate and 103 with severe disease, underwent randomization from April 30 to July 29, 2020. Among the moderate cases, 107 were assigned to HNS, whereas 103 were assigned to the placebo group. Among the severe cases, 50 were given HNS, and 53 were given the placebo. HNS resulted in ~50% reduction in time taken to alleviate symptoms as compared to placebo (moderate cases: 4 vs. 7 days, Hazard Ratio [HR]: 6.11; 95% Confidence Interval [CI]: 4.23-8.84, p < 0.0001 and for severe cases: 6 vs. 13 days, HR: 4.04; 95% CI: 2.46-6.64; p < 0.0001). HNS also cleared the virus earlier than placebo in both moderate cases (6 vs. 10 days, HR: 5.53; 95% CI: 3.76-8.14, p < 0.0001) and severe cases (8.5 vs. 12 days, HR: 4.32; 95% CI: 2.62-7.13, p < 0.0001). HNS further led to a better clinical score on day 6 with normal activity resumption in 63.6% vs. 10.9% among moderate cases (OR: 0.07; 95% CI: 0.03-0.13, p < 0.0001) and hospital discharge in 50% versus 2.8% in severe cases (OR: 0.03; 95% CI: 0.01-0.09, p < 0.0001). In severe cases, the mortality rate was less than 1/4th in the HNS group than in placebo (4% vs. 18.87%, OR: 0.18; 95% CI: 0.02-0.92, p = 0.029). No HNS-related adverse effects were observed. HNS, compared with placebo, significantly improved symptoms, expedited viral load clearance, and reduced mortality in COVID-19 patients. This trial was registered on April 15, 2020 with ClinicalTrials.gov Identifier: NCT04347382.
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Affiliation(s)
- Sohaib Ashraf
- Department of Cardiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | - Shoaib Ashraf
- Department of Pathobiology, Riphah University, Lahore, Pakistan
| | - Moneeb Ashraf
- Department of Pharmacology, King Edward Medical University, Mayo Hospital, Lahore, Pakistan
| | - Muhammad Ahmad Imran
- Department of Microbiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | - Larab Kalsoom
- Department of Internal Medicine, Services Institute of Medical Sciences, Lahore, Pakistan
| | - Uzma N Siddiqui
- Department of Medicine, Port Macquarie Base Hospital, Port Macquarie, New South Wales, Australia.,Department of Internal Medicine, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | - Iqra Farooq
- Department of Pediatrics Surgery, Children Hospital, Lahore, Pakistan
| | - Rutaba Akmal
- Department of Medicine, Sahara Medical College, Narowal, Pakistan
| | - Muhammad Kiwan Akram
- Department of Nutrition, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Sidra Ashraf
- Department of Biochemistry, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Muhammad Ghufran
- Medico Cirujano, ESACHS (Empresa de Servico Externo de la Asociacion Chilena de Seguridad), Santiago, Chile
| | - Nighat Majeed
- Department of Internal Medicine, Services Institute of Medical Sciences, Lahore, Pakistan
| | - Zaighum Habib
- Department of Orthopedics, Shaikh Zayed Post-Graduate Medical Complex, Lahore, Pakistan
| | - Sundas Rafique
- Department of Oncology, Mayo Hospital, King Edward Medical University, Lahore, Pakistan
| | - Zain-Ul -Abdin
- Department of Cardiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | - Shahroze Arshad
- Department of Internal Medicine, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | - Muhammad Sarmad Shahab
- Department of Internal Medicine, Allied Hospital, Faisalabad Medical University, Faisalabad, Pakistan
| | - Sohail Ahmad
- Department of Poultry Production, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Hui Zheng
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Ali Rafique Mirza
- Department of Plastic Surgery, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | - Sibgha Zulfiqar
- Department of Physiology, Shaikh Khalifa Bin Zayed Al-Nahyan Medical and Dental College, Lahore, Pakistan
| | - Muhamad Imran Anwar
- Department of General Surgery, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | - Ayesha Humayun
- Department of Public Health and Community Medicine, Shaikh Zayed Postgraduate Medical Institute Lahore, Pakistan
| | - Talha Mahmud
- Department of Pulmonology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | - Qazi Abdul Saboor
- Department of Cardiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | - Ali Ahmad
- Department of Microbiology, Infectious Diseases & Immunology, Centre Hospitalier Universitaire (CHU) Sainte Justine/University of Montreal, Montreal, Quebec, Canada
| | - Muhammad Ashraf
- Department of Pharmacology and Toxicology, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Mateen Izhar
- Department of Microbiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
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Ashraf S, Ashraf S, Ashraf M, Imran MA, Choudhary ZA, Hafsa HT, Awais AB, Kalsoom L, Farooq I, Habib Z, Ashraf S, Iqbal QUA, Ghufran M, Sherazi SSH, Akram MK, Akmal R, Rafique S, Nawaz K, Safdar Z, Siddique UN, Hassan M, Arshad S, Virk AR, Ashraf M, Saboor QA, Humayun A, Izhar M. Knowledge, attitude, and practice of clinicians about antimicrobial stewardship and resistance among hospitals of Pakistan: a multicenter cross-sectional study. Environ Sci Pollut Res Int 2022; 29:8382-8392. [PMID: 34490566 PMCID: PMC8421064 DOI: 10.1007/s11356-021-16178-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 08/23/2021] [Indexed: 06/13/2023]
Abstract
Considering that antimicrobial resistance (AMR) is a global challenge, there is a dire need to assess the knowledge, attitude, and practice (KAP) of clinicians in AMR endemic countries. The current multicenter, cross-sectional study aimed at highlighting gaps in antimicrobial (AM) stewardship and AMR among practicing doctors working in public tertiary care teaching hospitals of Lahore, Pakistan. A KAP survey, based on a self-administered questionnaire containing 45 questions, was distributed among 336 clinicians in 6 randomly selected hospitals. Overall, 92% of the clinicians considered AMR as a worldwide problem but only 66% disagreed that cold and flu symptoms require antibiotics. Moreover, around 68% of the doctors felt confident about their practice in AM but still, 96% felt the need to get more knowledge about AM drugs. The need for refresher courses on rational antibiotic use was expressed by 84% of the participants. The main contributing factors considered for AMR by the doctors included excessive AM usage in the medical profession (87.1%) and multiple antibiotics per prescription (76.4%). Pharmacologically, AM spectrum was accurately chosen by 1.4% for Ampicillin, 0.003% for Erythromycin and 0% for Levofloxacin. Clinically, more than 50% of the clinicians used miscellaneous AM for empirical therapy of respiratory tract infection and cholecystitis. The data was analyzed using Statistical Package for Social Sciences (SPSS) version 25. It is concluded that the knowledge of clinicians is relatively poor for AM spectrum and drugs of choice for certain infections. However, the clinicians are aware of their shortcomings and desire for improvement.
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Affiliation(s)
- Sohaib Ashraf
- Department of Cardiology, Shaikh Zayed Post-Graduate Medical Complex, Lahore, Pakistan.
| | - Shoaib Ashraf
- Department of Pathobiology, Riphah International University, Lahore, Pakistan.
| | - Moneeb Ashraf
- Department of Pharmacology, King Edward Medical University, Mayo Hospital, Lahore, Pakistan.
| | - Muhammad Ahmad Imran
- Department of Microbiology, Shaikh Zayed Post-Graduate Medical Complex, Lahore, Pakistan.
| | - Zawar Ahmad Choudhary
- Department of Internal Medicine, Shaikh Zayed Post-Graduate Medical Complex, Lahore, Pakistan
| | - Hadiqa Tul Hafsa
- Department of Microbiology, Shaikh Zayed Post-Graduate Medical Complex, Lahore, Pakistan
| | - Abeer Bin Awais
- Department of Internal Medicine, Shaikh Zayed Post-Graduate Medical Complex, Lahore, Pakistan
| | - Larab Kalsoom
- Department of Internal Medicine, Services Institute of Medical Sciences, Lahore, Pakistan
| | - Iqra Farooq
- Department of Pediatrics Surgery, Children Hospital and Institute of Child Health, Lahore, Pakistan
| | - Zaighum Habib
- Department of Orthopedics, Tehsil Head Quarter, Ferozwala, Shaikhupura, Pakistan
| | - Sidra Ashraf
- Department of Biochemistry, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Qurrat Ul Ain Iqbal
- Department of Internal Medicine, Shaikh Zayed Post-Graduate Medical Complex, Lahore, Pakistan
| | - Muhammad Ghufran
- Medico Cirujano, ESACHS (Empresa de Servico Externo de la Asociacion Chilena de Seguridad), Punta Arenas, Chile
| | - Syed Sami Hussain Sherazi
- Department of Pharmacology and Toxicology, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Muhammad Kiwan Akram
- Department of Nutrition, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Rutaba Akmal
- Department of Community Medicine, Sahara Medical College, Narowal, Pakistan
| | - Sundas Rafique
- Department of Internal Medicine, Mayo Hospital, Lahore, Pakistan
| | - Khawar Nawaz
- Department of Pediatrics, Sunny Downstate/Kings Country Medical Center, New York, NY, USA
| | - Zartasha Safdar
- Department of Pharmacology and Toxicology, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Uzma Nasim Siddique
- Department of Internal Medicine, Shaikh Zayed Post-Graduate Medical Complex, Lahore, Pakistan
| | - Muhammad Hassan
- Department of Internal Medicine, Shaikh Zayed Post-Graduate Medical Complex, Lahore, Pakistan
| | - Shahroze Arshad
- Department of Internal Medicine, Shaikh Zayed Post-Graduate Medical Complex, Lahore, Pakistan
| | - Abdul Rehman Virk
- Department of Internal Medicine, Shaikh Zayed Post-Graduate Medical Complex, Lahore, Pakistan
| | - Muhammad Ashraf
- Department of Pharmacology and Toxicology, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Qazi Abdul Saboor
- Department of Cardiology, Shaikh Zayed Post-Graduate Medical Complex, Lahore, Pakistan
| | - Ayesha Humayun
- Department of Community Medicine, Shaikh Khalifa Bin Zayed Al-Nahyan Medical and Dental College, Lahore, Pakistan
| | - Mateen Izhar
- Department of Microbiology, Shaikh Zayed Post-Graduate Medical Complex, Lahore, Pakistan
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Ashraf S, Ashraf S, Ashraf M, Farooq I, Akmal R, Imran MA, Kalsoom L, Ashraf S, Rafique S, Ghufran M, Akram MK, Sohaib-Ur-Rehman, Nadeem MF, Matti N, Siddiqui UN, Humayun A, Saboor QA, Ahmad A, Ashraf M, Izhar M. Clinical efficacy of iodine complex in SARS-CoV-2-infected patients with mild to moderate symptoms: study protocol for a randomized controlled trial. Trials 2022; 23:58. [PMID: 35045888 PMCID: PMC8767036 DOI: 10.1186/s13063-021-05848-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 11/20/2021] [Indexed: 11/10/2022] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) caused by the novel coronavirus-infected millions globally. Despite a wide range of advised options for the treatment of COVID-19, a single strategy to tackle this pandemic remains elusive, thus far. That is why we are conducting a clinical trial to find out the efficacy of iodine complex to clear a viral load of severe respiratory syndrome coronavirus-2 (SARS-CoV-2) along with a reduction in time taken to alleviate symptoms. Method The proposed study is a placebo-controlled, add-on, randomized trial using parallel group designs. This is a closed-label and adaptive with sample size reassessment, multi-centered design with a 1:1:1:1 allocation ratio and superiority framework. It will be conducted in Shaikh Zayed Post-Graduate Medical Complex, Ali Clinic, and Doctors Lounge, Lahore, Pakistan. This study will have three arms of mild to moderately symptomatic COVID-19 patients (50 patients in each) which will receive ionic-iodine polymer complex with 200 mg of elemental iodine: interventional arm A will have encapsulated, arm B will receive suspension syrup form, arm C will get throat spray, while arm X will be standard care with placebo. Data will be collected on self-constructed, close-ended questionnaires after obtaining written consent. Data will be analyzed using SAS version 9.4. COVID-19 patients will be monitored by RT-PCR and HRCT (high-resolution computed tomography) chest. In addition to these, the duration of the symptomatic phase and mortality benefits will be analyzed in both groups. Discussion The study is designed to measure the superior efficacy of the iodine complex as an add-on in treating COVID-19-positive patients with mild to moderate symptoms. This combination is hypothesized to improve various parameters like rapid viral load reduction, clinical and radiological improvement, lower mortality, and reduction in hospitalization. The trial will aid in devising a better strategy to cope with COVID-19 in a relatively inexpensive and accessible way. The implications are global, and this could prove itself to be the most manageable intervention against COVID-19 especially for patients from limited-resource countries with deprived socioeconomic status. Trial registration ClinicalTrials.govNCT04473261. Registered on July 16, 2020.
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Affiliation(s)
- Sohaib Ashraf
- Department of Cardiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan.
| | - Shoaib Ashraf
- Department of Pathophysiology, Riphah International, Lahore, Pakistan.
| | - Moneeb Ashraf
- Department of Pharmacology, Mayo Hospital, Kingedward Medical University, Lahore, Pakistan.
| | - Iqra Farooq
- Department of Paediatric Surgery, Children Hospital, Lahore, Pakistan
| | - Rutaba Akmal
- Department of Medicine, Sahara Medical College, Narowal, Pakistan
| | - Muhammad Ahmad Imran
- Department of Microbiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | - Larab Kalsoom
- Department of Medicine, Services Institute of Medical Sciences, Lahore, Pakistan
| | - Sidra Ashraf
- Department of Biochemistry, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Sundas Rafique
- Department of Oncology, Mayo Hospital, Kingedward Medical University, Lahore, Pakistan
| | - Muhammad Ghufran
- ESACHS (Empresa de Servicio Externo de la Asociación Chilena de Seguridad), Santiago, Chile
| | - Muhammad Kiwan Akram
- Department of Animal Nutrition, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Sohaib-Ur-Rehman
- Department of Community Medicine, Shaikh Khalifa Bin Zayed Al-Nahyan Medical and Dental College, Lahore, Pakistan
| | - Muhammad Faisal Nadeem
- The University of Strasbourg, Alsace, France.,University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Nazish Matti
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Uzma Nasim Siddiqui
- Department of Medicine, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | - Ayesha Humayun
- Department of Community Medicine, Shaikh Khalifa Bin Zayed Al-Nahyan Medical and Dental College, Lahore, Pakistan
| | - Qazi Abdul Saboor
- Department of Cardiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | - Ali Ahmad
- Department of Microbiology, Infectiology and Immunology, Centre Hospitalier Universitaire (CHU) Sainte Justin/University of Montreal, Montreal, Canada.
| | - Muhammad Ashraf
- Department of Pharmacology and Toxicology, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Mateen Izhar
- Department of Microbiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
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Ashraf S, Ashraf S, Akmal R, Ashraf M, Kalsoom L, Maqsood A, Imran MA, Farooq I, Ashraf S, Siddiqui UN, Ghufran M, Akram MK, Majeed N, Rafique S, Habib Z, Shahab MS, Akmal A, Shaukat Z, Abdin ZU, Khaqan A, Arshad S, Rehman Virk MA, Gul M, Awais AB, Hassan M, Khalid N, Iqbal QUA, Ahmad T, Akram M, Muhammad A, Khalil M, Aslam A, Umer M, Sherazi SSH, Safdar Z, Ahmad S, Bilal M, Zahid MN, Koshak AE, Hilal A, Malik AA, Iqbal U, Baig AA, Alahmadi YM, Humayun A, Malik A, Ahmad A, Ashraf M, Saboor QA, Izhar M. Prophylactic potential of honey and Nigella sativa L. against hospital and community-based SARS-CoV-2 spread: a structured summary of a study protocol for a randomised controlled trial. Trials 2021; 22:618. [PMID: 34526081 PMCID: PMC8441040 DOI: 10.1186/s13063-021-05510-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 08/04/2021] [Indexed: 11/10/2022] Open
Abstract
Objectives Considering the therapeutic potential of honey and Nigella sativa (HNS) in coronavirus disease 2019 (COVID-19) patients, the objective of the study is defined to evaluate the prophylactic role of HNS. Trial design The study is a randomized, placebo-controlled, adaptive clinical trial with parallel group design, superiority framework with an allocation ratio of 1:1 among experimental (HNS) and placebo group. An interim analysis will be done when half of the patients have been recruited to evaluate the need to adapt sample size, efficacy, and futility of the trial. Participants All asymptomatic patients with hospital or community based COVID-19 exposure will be screened if they have had 4 days exposure to a confirmed case. Non-pregnant adults with significant exposure level will be enrolled in the study
High-risk exposure (<6 feet distance for >10min without face protection) Moderate exposure (<6 feet distance for >10min with face protection)
Subjects with acute or chronic infection, COVID-19 vaccinated, and allergy to HNS will be excluded from the study. Recruitment will be done at Shaikh Zayed Post-Graduate Medical Institute, Ali Clinic and Doctors Lounge in Lahore (Pakistan). Intervention and comparator In this clinical study, patients will receive either raw natural honey (0.5 g) and encapsulated organic Nigella sativa seeds (40 mg) per kg body weight per day or empty capsule with and 30 ml of 5% dextrose water as a placebo for 14 days. Both the natural products will be certified for standardization by Government College University (Botany department). Furthermore, each patient will be given standard care therapy according to version 3.0 of the COVID-19 clinical management guidelines by the Ministry of National Health Services of Pakistan. Main outcomes Primary outcome will be Incidence of COVID-19 cases within 14 days of randomisation. Secondary endpoints include incidence of COVID-19-related symptoms, hospitalizations, and deaths along with the severity of COVID-19-related symptoms till 14th day of randomization. Randomisation Participants will be randomized into experimental and control groups (1:1 allocation ratio) via the lottery method. There will be stratification based on high risk and moderate risk exposure. Blinding (masking) Quadruple blinding will be ensured for the participants, care providers and outcome accessors. Data analysts will also be blinded to avoid conflict of interest. Site principal investigator will be responsible for ensuring masking. Numbers to be randomised (sample size) 1000 participants will be enrolled in the study with 1:1 allocation. Trial Status The final protocol version 1.4 was approved by institutional review board of Shaikh Zayed Post-Graduate Medical Complex on February 15, 2021. The trial recruitment was started on March 05, 2021, with a trial completion date of February 15, 2022. Trial registration Clinical trial was registered on February 23, 2021, www.clinicaltrials.gov with registration ID NCT04767087. Full protocol The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). With the intention of expediting dissemination of this trial, the conventional formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-021-05510-3.
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Affiliation(s)
- Sohaib Ashraf
- Department of Cardiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan. .,Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA.
| | - Shoaib Ashraf
- Wellman Center for Photomedicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA. .,Department of Pathobiology, Riphah International, Lahore, Pakistan.
| | - Rutaba Akmal
- Department of Internal Medicine, Sahara Medical College, Narowal, Pakistan.
| | - Moneeb Ashraf
- Department of Pharmacology, Mayo Hospital, Kingedward Medical University, Lahore, Pakistan.
| | - Larab Kalsoom
- Department of Medicine, Services Institute of Medical Sciences, Lahore, Pakistan.
| | - Aadil Maqsood
- Department of Pulmonary & Critical Care Medicine, University of Toledo Medical Center, Toledo, Ohio, USA.
| | - Muhammad Ahmad Imran
- Department of Microbiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan.
| | - Iqra Farooq
- Department of Paediatric Surgery, Children Hospital, Lahore, Pakistan.
| | - Sidra Ashraf
- Institute of Biochemistry and Biotechnology, University of Veterinary and Animal Sciences, Lahore, Pakistan.
| | - Uzma Nasim Siddiqui
- Department of Medicine, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan.
| | - Muhammad Ghufran
- ESACHS (Empresa de Servicio Externo de la Asociación Chilena de Seguridad), Punta Arenas, Chile
| | - Muhammad Kiwan Akram
- Department of Animal Nutrition, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Nighat Majeed
- Department of Internal Medicine, Services Institute of Medical Sciences, Lahore, Pakistan
| | - Sundas Rafique
- Department of Radiotherapy, Mayo Hospital, King Edward Medical University, Lahore, Pakistan
| | - Zaigham Habib
- Department of Orthopedics, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | - Muhammad Sarmad Shahab
- Department of Internal Medicine, Allied Hospital, Faisalabad Medical University, Faisalabad, Pakistan
| | - Adeen Akmal
- Department of Surgery, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Zeeshan Shaukat
- Department of Cardiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | - Zain Ul Abdin
- Department of Cardiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | - Ayesha Khaqan
- Department of Cardiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | - Shahroze Arshad
- Department of Microbiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | | | - Mehak Gul
- Department of Medicine, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | - Abeer Bin Awais
- Department of Medicine, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | - Muhammad Hassan
- Department of Medicine, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | - Noman Khalid
- Department of Medicine, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | - Qurrat Ul Ain Iqbal
- Department of Medicine, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | - Tausif Ahmad
- Department of Medicine, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | - Muaaz Akram
- Department of Medicine, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | - Ameer Muhammad
- Department of Medicine, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | - Musa Khalil
- Department of Medicine, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | - Aneeq Aslam
- Department of Medicine, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | - Muhammad Umer
- Department of Gastroenterology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | - Syed Sami Hussain Sherazi
- Department of Pharmacology and Toxicology, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Zartasha Safdar
- Department of Pharmacology and Toxicology, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Sohail Ahmad
- Department of Department of Poultry Production, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Muhammad Bilal
- Department of Animal Science, McGill University, Sainte-Anne-de-Bellevue, Quebec, Canada
| | - Muhammad Nauman Zahid
- Department of Biology, college of Science, University of Bahrain, Sakhir, Kingdom of Bahrain
| | - Abdulrahman E Koshak
- Department of Natural Products and Alternative Medicine, Faculty of Pharmacy, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abubakar Hilal
- Department of Cardiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | - Ahmad Azam Malik
- Department of Family and Community Medicine, Rabigh Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Usman Iqbal
- Global Health and Development Department, College of Public Health, Taipei Medical University, Taipei, Taiwan
| | - Atif Amin Baig
- Unit of Biochemistry, Faculty of Medicine, University Sultan Zainal Abidin, Terengganu, Malaysia
| | - Yaser Masuod Alahmadi
- Clinical and Hospital Pharmacy Department, College of Pharmacy, Taibah University Medina, Medina, Kingdom of Saudi Arabia
| | - Ayesha Humayun
- Department of Community Medicine and Public Health
- , Shaikh Zayed Post-Graduate Medical Complex, Lahore, Pakistan
| | - Amber Malik
- Department of Cardiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | - Ali Ahmad
- Department of Microbiology, Infectiology and Immunology, Centre Hospitalier Universitaire (CHU) Sainte Justin/University of Montreal, Montreal, Canada
| | - Muhammad Ashraf
- Department of Department of Poultry Production, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Qazi Abdul Saboor
- Department of Cardiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | - Mateen Izhar
- Department of Microbiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan.
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7
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Ashraf S, Ashraf S, Ashraf M, Imran MA, Kalsoom L, Siddiqui UN, Farooq I, Ghufran M, Khokhar RA, Akram MK, Shahid I, Sohaib Ur Rehman M, Akmal R, Tahir A, Zahid A, Ashraf S, Rafique S, Matti N, Nadeem MF, Humayun A, Malik A, Saboor QA, Ahmad A, Ashraf M, Izhar M. A quadruple blinded placebo controlled randomised trial to evaluate the effectiveness of an Iodine complex for patients with mild to moderate COVID-19 in Pakistan (I-COVID-PK): A structured summary of a study protocol for a randomised controlled trial. Trials 2021; 22:127. [PMID: 33568226 PMCID: PMC7873514 DOI: 10.1186/s13063-021-05081-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 01/29/2021] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES The objective of the study is to measure the efficacy of ionic-iodine polymer complex [1] for clinical and radiological improvement in coronavirus disease 2019 (COVID-19) patients. TRIAL DESIGN The trial will be closed label, randomized and placebo-controlled with a 1:1:1:1 allocation ratio and superiority framework. PARTICIPANTS All PCR confirmed COVID-19 adult patients including non-pregnant females, with mild to moderate disease, will be enrolled from Shaikh Zayed Post-Graduate Medical Complex, Ali Clinic and Doctors Lounge in Lahore (Pakistan). Patients with any pre-existing chronic illness will be excluded from the study. INTERVENTION AND COMPARATOR In this multi-armed study ionic-iodine polymer complex with 200 mg of elemental iodine will be given using three formulations to evaluate efficacy. Patients will be receiving either encapsulated iodine complex of 200 mg (arm A), iodine complex syrup form 40 ml (arm B), iodine complex throat spray of 2 puffs (arm C) or empty capsule (arm D) as placebo; all three times a day. All the 4 arms will be receiving standard care as per version 3.0 of the clinical management guidelines for COVID-19 established by the Ministry of National Health Services of Pakistan. MAIN OUTCOMES Primary outcomes will be viral clearance with radiological and clinical improvement. SARS-CoV-2 RT-PCR and HRCT chest scans will be done on the admission day and then after every fourth day for 12 days or till the symptoms are resolved. RT-PCR will only be shown as positive or negative while HRCT chest scoring will be done depending on the area and severity of lung involvement [2]. Time taken for the alleviation of symptoms will be calculated by the number of days the patient remained symptomatic. 30-day mortality will be considered as a secondary outcome. RANDOMISATION Stratification for initial COVID-19 status (or days from initial symptoms as a proxy), age groups, gender, baseline severity of symptoms and co-morbidities will be used to ensure that the study arms remain balanced in size for the 1:1:1:1 allocation ratio. Randomization will be done using the lottery method. As patients are being admitted at different times, they will be recruited after obtaining their voluntary written informed consent following all standard protocols of the infection, control and disinfection. BLINDING (MASKING) This is a quadruple (participants, care providers, investigators and outcomes assessors) blinded study where only the study's Primary Investigator will have information about the arms and their interventions. NUMBERS TO BE RANDOMISED (SAMPLE SIZE) 200 patients will be randomized into four groups with three experimental and one placebo arm. TRIAL STATUS Protocol Version Number is 2.3 and it is approved from IRB Shaikh Zayed Hospital with ID SZMC/IRB/Internal0056/2020 on July 14th, 2020. The recruitment is in progress. It was started on July 30, 2020, and the estimated end date for the trial is August 15, 2021. TRIAL REGISTRATION Clinical Trial has been retrospectively registered on www.clinicaltrials.gov with registration ID NCT04473261 dated July 16, 2020. FULL PROTOCOL The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). With the intention of expediting dissemination of this trial, the conventional formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol. The study protocol has been reported in accordance with the Standard Protocol Items: Recommendations for Clinical Interventional Trials (SPIRIT) guidelines.
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Affiliation(s)
- Sohaib Ashraf
- Department of Cardiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan.
| | - Shoaib Ashraf
- Department of Pathobiology, Riphah International, Lahore, Pakistan.
| | - Moneeb Ashraf
- Department of Pharmacology, Mayo Hospital, King Edward Medical University, Lahore, Pakistan
| | - Muhammad Ahmad Imran
- Department of Microbiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan
| | - Larab Kalsoom
- Department of Medicine, Services Institute of Medical Sciences, Lahore, Pakistan
| | - Uzma Nasim Siddiqui
- Department of Medicine, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan.,Department of Medicine, Port Macquarie Base Hospital, New south Wales, Australia
| | - Iqra Farooq
- Department of Paediatric Surgery, Children Hospital, Lahore, Pakistan
| | - Muhammad Ghufran
- ESACHS (Empresa de Servicios Externos de la Asociación Chilena de Seguridad), Santiago, Chile
| | - Romaisa Arshad Khokhar
- Department of Oral Pathology, Shifa College of dentistry, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Muhammad Kiwan Akram
- Department of animal nutrition, University of veterinary and animal sciences, Lahore, Pakistan
| | - Iqra Shahid
- Department of gynaecology and obstetrics, Benazir Bhutto Hospital, Rawalpindi, Pakistan
| | | | - Rutaba Akmal
- Department of Community Medicine, Sahara Medical College, Narowal, Pakistan
| | - Arbaz Tahir
- Department of Community Medicine, Faisalabad Medical University, Faisalabad, Pakistan
| | - Ayesha Zahid
- Department of Medicine, Services Institute of Medical Sciences, Lahore, Pakistan
| | - Sidra Ashraf
- Department of biochemistry, University of veterinary and animal sciences, Lahore, Pakistan
| | - Sundas Rafique
- Department of West Medicine, Mayo Hospital, King Edward Medical University, Lahore, Pakistan
| | - Nazish Matti
- Department of Pharmacy, Quaid-i-Azam University, Islamabad, Pakistan
| | - Muhammad Faisal Nadeem
- Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Ayesha Humayun
- Department of Public Health and Community Medicine, Shaikh Zayed Medical complex, Lahore, Pakistan
| | - Amber Malik
- Department of Cardiology, Evercare Hospital, Lahore, Pakistan
| | - Qazi Abdul Saboor
- Department of Cardiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan.
| | - Ali Ahmad
- Department of Microbiology, Infectiology and Immunology, Centre Hospitalier Universitaire (CHU) Sainte Justin/University of Montreal, Montreal, Canada.
| | - Muhammad Ashraf
- Department of Pharmacology and Toxicology, University of veterinary and animal sciences, Lahore, Pakistan.
| | - Mateen Izhar
- Department of Microbiology, Shaikh Zayed Post-Graduate Medical Institute, Lahore, Pakistan.
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Mahmud T, Saboor QA, Aamir S, Aasim M, Bokhari SNH. General perceptions and practices of smokers regarding tobacco-related issues and hazards. J PAK MED ASSOC 2012; 62:590-595. [PMID: 22755346] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To assess the perceptions and practices related to tobacco consumption and its hazards among cigarette smokers seeking medical attention. METHODS The cross-sectional study included 180 active smokers who were either hospitalised in medical or chest ward or attending pulmonary OPD at Shaikh Zayed Hospital, Lahore, between January and July 2010. Patients having altered sensorium were excluded from the study. A questionnaire was filled by the consulting participants. SPSS version 15 and chi-square tests were used for statistical analyses. RESULTS A total of 180 questionnaires were distributed among 118 (65.6%) in-house and 62 (34.4%) active smokers in the out-patients department. These included 154 (85.6%) males and 26 (14.4%) females, with a mean age of 53.84 +/- 17.35 years, and with varying pack years (mean 26.44 +/- 19.89). Apart from cigarettes, 42 (74%) were also smoking other types of tobacco. Attempt to quit smoking was made by 92 (51.1%) and 151 (83.9%) were willing to give up. Majority of them 130 (72%) had at least two more smokers in the family. Most of the patients 169 (93.9%) presented with illnesses directly related to smoking. Besides, 127 (70.6%) patients had visited their general practitioners within the preceding year and a positive history of hospitalisation was found in 101 (56.1%). Regarding the knowledge of smoking hazards, only 5 (2.8%) could name three organs that may dysfunction due to smoking. While 162 (90%) had poor perception regarding the estimated number of chemicals in a cigarette, 120 (66.7%) knew the smoking's association with cancer. CONCLUSION A high proportion of urban population consumes tobacco and most are poorly informed about the traumatic effects of its consumption. The continuing habits of patients with a history of seeking medical attention suggest that healthcare providers are missing opportunities for quit-smoking counselling.
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Affiliation(s)
- Talha Mahmud
- Department of Pulmonology, Shaikh Zayed Hospital & Federal Postgraduate Medical Institute, Lahore.
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Hussain S, Siddique S, Saboor QA. Heart rate variability in early phase of acute myocardial infarction and convalescence. J Coll Physicians Surg Pak 2003; 13:67-9. [PMID: 12685944 DOI: 02.2003/jcpsp.6769] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2002] [Accepted: 01/18/2003] [Indexed: 12/01/2022]
Abstract
OBJECTIVE This study was done to evaluate the degree of change in autonomic activity, manifested as heart rate variability (HRV), from acute phase of MI to convalescent period of AMI. DESIGN Single center, observational prospective study. PLACE AND DURATION OF STUDY Department of Cardiology, Shaikh Zayed Hospital, Lahore. The study was completed in one year from June 2000 to July 2001. SUBJECTS AND METHODS Thirty consecutive patients presenting within 24 hours of an ST segment elevation AMI with or without thrombolysis were included. First 24 hour Holter recording was done within 24-36 hours after AMI and the second was done before discharge. RESULTS The mean hospital stay was 7.07 +/- 2.56 days. Mean duration between the two recordings was 5.47 +/- 2.36 days. The mean standard deviation of normal sinus interval (SDNN) was 65.07 +/- 25.11msec & 63-97 +/- 23.38msec; mean standard deviation of averaged sinus beats for 5 minutes segments of entire recording (SDANN) was 51.27 +/- 18.57msec and 55.83 +/- 19.65msec and mean SDDN index was 34.57 +/- 17.15msec and 30.57 +/- 14.89msec during early phase of acute MI & pre-discharge recordings respectively. There was no statistically significant difference in HRV between early phase of acute myocardial infarction and of pre-discharge recordings. CONCLUSION HRV may be monitored for risk stratification at any time post AMI prior to discharge.
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