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Raheem A, Soomar SM, Issani A, Rahim KA, Dhalla Z, Soomar SM, Mian AI, Khan NU. Thirty-year trends of triple burden of disease in the adult population of Pakistan. J Public Health (Oxf) 2024:fdae054. [PMID: 38654655 DOI: 10.1093/pubmed/fdae054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 02/10/2024] [Accepted: 04/06/2024] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND The triple burden of disease, i.e. communicable diseases, non-communicable diseases and injuries, has significantly affected the healthcare system of Pakistan during the last three decades. Therefore, this study aims to determine and analyse the 30-year disease burden trends through prevalence, death rates and percentages. METHODS The data for the last three decades, i.e. 1990 to 2019, was extracted from the Global Burden of Disease for Pakistan. Percentage change in prevalence and deaths over 30 years was calculated. Poisson regression analysis was performed to evaluate the triple disease burden trends and the incidence rate ratio. RESULTS A relative decrease of 23.4% was noted in the prevalence rate of communicable diseases except for human immunodeficiency virus and dengue fever. A relative increase of 1.4% was noted in the prevalence rate of non-communicable diseases. A relative increase of 56.1% was recorded in the prevalence rate of injuries. The prevalence rate ratios of communicable diseases significantly decreased to 0.9796 [95% CI: 0.9887-0.9905], but the prevalence rate of injury increased to 1.0094 [95% CI: 1.0073-1.01145], respectively. CONCLUSION Pakistan must take the next steps and develop strategies to decrease this burden and mortality rates in the population to create better outcomes and therefore help the healthcare system overall.
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Affiliation(s)
- Ahmed Raheem
- Department of Emergency Medicine, Aga Khan University, Karachi 74800, Pakistan
| | | | - Ali Issani
- Department of Emergency Medicine, Aga Khan University, Karachi 74800, Pakistan
| | - Komal Abdul Rahim
- Department of Community Health Sciences, Aga Khan University, Karachi 74800, Pakistan
| | - Zeyanna Dhalla
- Department of Emergency Medicine, Aga Khan University, Karachi 74800, Pakistan
- University of Michigan, School of Public Health, Ann Arbor, Michigan 48109, USA
| | | | - Asad Iqbal Mian
- Department of Emergency Medicine, Aga Khan University, Karachi 74800, Pakistan
| | - Nadeem Ullah Khan
- Department of Emergency Medicine, Aga Khan University, Karachi 74800, Pakistan
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Khan NU, Ali A, Khudadad U, Khan UR, Ali N, Soomar SM, Abid S, Jilani M, Jamali S, Razzak JA. Challenges and health outcomes of the exposure to soybean dust in the harbor neighborhood of Karachi, Pakistan: a wake-up call. J Health Popul Nutr 2023; 42:136. [PMID: 38037137 PMCID: PMC10688105 DOI: 10.1186/s41043-023-00473-4] [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] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/11/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Chemical disasters are common worldwide and result from technological failure, war, and terrorism activities. Pakistan imports huge quantities of hazardous chemicals to meet its industrial and energy needs. Hence there is a risk of chemical disaster at the ports, during transportation of such material and processing in the chemical industry. This study aimed to review the challenges and health outcomes of cases of soybean dust exposure in Kemari district (harbor neighborhood) of Karachi, Pakistan. METHODS A cross-sectional survey was conducted with all the affected people from a chemical incident of soybean dust which was reported in the Keamari district of Karachi, Pakistan. Included patients ≥ 18 years who visited the two major tertiary care hospitals of Karachi, Pakistan after the incident between February 17 to 23, 2020. A total of 574 patients were brought to these two major tertiary care hospitals. We collected data on basic demographics, event details, and major signs and symptoms of the affected individuals. Calculated frequencies and percentages for categorical variables. Mean ± standard deviation (SD) was calculated for continuous variables. RESULTS The mean ± (SD) age of the victims were 32 (13.5) years. Of the 574 patients, majority of the patients (n = 319, 56%) were males. In 28 cases (41%), the onset of symptoms occurred at home, in 27 cases (39%) the onset of symptoms started in the workplace and the remaining cases (n = 14, 20%) experienced the first symptoms while roaming around the roadside. The most common reported co-morbidity was a history of asthma (56%), followed by diabetes mellitus (22%). The most common clinical manifestation was shortness of breath, reported in 94% of the cases, followed by neurological symptoms such as drowsiness, unconsciousness, or seizures experienced by 10% of the victims. A total of 9 deaths (1.5%) were recorded. CONCLUSION A multi-sectoral systematic approach is also required to address these incidents comprehensively including the trained and equipped pre-hospital system, integrated emergency medical response, and community-wide emergency response system.
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Affiliation(s)
- Nadeem Ullah Khan
- Department of Emergency Medicine, Aga Khan University, Karachi, 74800, Pakistan.
| | - Asrar Ali
- Department of Emergency Medicine, Aga Khan University, Karachi, 74800, Pakistan
| | - Umerdad Khudadad
- Department of Emergency Medicine, Aga Khan University, Karachi, 74800, Pakistan
| | - Uzma Rahim Khan
- Department of Emergency Medicine, Aga Khan University, Karachi, 74800, Pakistan
| | - Noman Ali
- Department of Emergency Medicine, Aga Khan University, Karachi, 74800, Pakistan
| | | | | | | | - Seemin Jamali
- Jinnah Postgraduate Medical Center, Karachi, Pakistan
| | - Junaid A Razzak
- Department of Emergency Medicine, Aga Khan University, Karachi, 74800, Pakistan
- Weil Cornell Medicine, New York, USA
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Habibullah N, Dayo J, Soomar SM, Ali N. Use of point-of-care ultrasound in a low-resource setting to diagnose Achilles tendon rupture and avulsion fracture of the calcaneal bone. Int J Emerg Med 2023; 16:66. [PMID: 37789250 PMCID: PMC10546640 DOI: 10.1186/s12245-023-00544-7] [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: 03/17/2023] [Accepted: 09/25/2023] [Indexed: 10/05/2023] Open
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) is becoming more prevalent in recent years for evaluating patients presenting with musculoskeletal injuries in the emergency department (ED). This imaging modality has been utilized to diagnose soft tissue and bony injuries accurately, obtain appropriate consultation, and perform timely interventional procedures in the ED. CASE PRESENTATION We present the case of a 55-year-old man who presented to the ED with significant left ankle pain following a ground-level fall. His physical examination showed swelling and tenderness around the ankle. POCUS examination aided the rapid and accurate detection of acute Achilles tendon rupture. CONCLUSION This case demonstrates that POCUS is a valuable diagnostic tool in evaluating patients with a suspected Achilles tendon rupture, especially in a resource-limited setting.
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Affiliation(s)
- Naheed Habibullah
- Department of Emergency Medicine, Aga Khan University, Karachi, 74800, Pakistan
| | - Jamil Dayo
- Department of Emergency Medicine, Aga Khan University, Karachi, 74800, Pakistan
| | | | - Noman Ali
- Department of Emergency Medicine, Aga Khan University, Karachi, 74800, Pakistan.
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Ali N, Aftab U, Soomar SM, Tareen H, Khan UR, Khan BA, Razzak JA. Clinical utility of routine investigations and risk factors of end-organ damage in asymptomatic severe hypertension. Intern Emerg Med 2023; 18:2037-2043. [PMID: 37668749 DOI: 10.1007/s11739-023-03403-8] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/18/2023] [Indexed: 09/06/2023]
Abstract
Asymptomatic severe hypertension is defined as systolic blood pressure of ≥ 180 mmHg or diastolic blood pressure of ≥ 120 mmHg without signs and symptoms of end-organ damage or dysfunction. Literature shows that around 5% of the patients with severe asymptomatic hypertension had acute hypertension-related end-organ damage. This study aimed to determine the clinical utility of routine investigations and risk factors of end-organ damage in patients presented to the emergency department with asymptomatic severe hypertension. This single-center, cross-sectional study was conducted at the emergency department of the Aga Khan University Hospital, Karachi, Pakistan, from January 2018 to December 2020. All adult patients (age ≥ 18 years) presented to the emergency department with a systolic blood pressure of ≥ 180 or diastolic blood pressure of ≥ 120 mmHg without any signs and symptoms of end-organ damage (e.g., chest pain, unilateral limb or facial weakness, or hemiplegia, altered mental status, shortness of breath, decreased urine output, and sudden-onset of severe headache) were included. Routine investigations were analyzed to detect end-organ damage, including complete blood count, basic metabolic panel, urine detailed report, electrocardiogram, and troponin-I. Multivariable binary logistic regression was applied to identify the risk factors of end-organ damage considering the significant p value of ≤ 0.05. A total of 180 patients were presented to the emergency department with asymptomatic severe hypertension during the study period. Among the total patients, 60 patients (33.3%) had abnormal investigation findings; out of them, new-onset end-organ damage was diagnosed in 15 patients (8.3%). The most common end-organ damage was the kidney (73.3%) followed by the heart (26.6%). The multivariable binary logistic regression showed that age of more than 60 years, past medical history of diabetes, ischemic heart disease, and cerebrovascular accident were significantly associated with a higher risk of end-organ damage (p < 0.05). The study identified a higher prevalence of abnormal routine investigations and acute end-organ damage in emergency department patients with asymptomatic severe hypertension compared to high-income countries and suggested a lower threshold for end-organ damage screening in these patients. The current recommendations of foregoing further workup in patients with asymptomatic severe hypertension may need modification for emergency departments in low-middle-income countries if similar associations are replicated in other settings.
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Affiliation(s)
- Noman Ali
- Department of Emergency Medicine, Aga Khan University Stadium Road, Karachi, 74800, Pakistan.
| | - Umaira Aftab
- Department of Emergency Medicine, Aga Khan University Stadium Road, Karachi, 74800, Pakistan
| | - Salman Muhammad Soomar
- Department of Emergency Medicine, Aga Khan University Stadium Road, Karachi, 74800, Pakistan
| | - Hafsa Tareen
- Department of Emergency Medicine, Aga Khan University Stadium Road, Karachi, 74800, Pakistan
| | - Uzma Rahim Khan
- Department of Emergency Medicine, Aga Khan University Stadium Road, Karachi, 74800, Pakistan
| | - Badar Afzal Khan
- Department of Emergency Medicine, Aga Khan University Stadium Road, Karachi, 74800, Pakistan
| | - Junaid Abdul Razzak
- Department of Emergency Medicine, Aga Khan University Stadium Road, Karachi, 74800, Pakistan
- Weill Cornell Medicine,, New York, USA
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Kumar P, Khan UR, Soomar SM, Jetha Z, Ali TS. Workplace Violence and Bullying Faced by Health Care Personnel at the Emergency Department of a Tertiary Care Hospital of Karachi, Pakistan: A Cross-Sectional Study. J Emerg Nurs 2023; 49:785-795. [PMID: 37178090 DOI: 10.1016/j.jen.2023.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 02/15/2023] [Accepted: 02/15/2023] [Indexed: 05/15/2023]
Abstract
INTRODUCTION The emergency department is the most affected by physical and verbal abuse and bullying in health care. Violence against health care workers not only affects their safety, but also their performance and motivation. This study aimed to determine the prevalence and associated determinants of violence against health care personnel. METHODS A cross-sectional study design was used with 182 health care personnel at the emergency department tertiary care hospital of Karachi, Pakistan. Data were collected through a questionnaire comprised of 2 sections: (1) demographic questions and (2) statements to identify the prevalence of workplace violence and bullying among health care personnel. Nonprobability purposive sampling was used for recruitment. Binary logistic regression was used to identify the prevalence and determinants of violence and bullying. RESULTS Most participants were younger than 40 years of age (n = 106, 58.2%). Participants were mainly nurses (n = 105, 57.7%) and physicians (n = 31, 17.0%). Participants reported experiencing sexual abuse (n = 5, 2.7%), physical violence (n = 30, 16.50%), verbal abuse (n = 107, 58.8%), and bullying (n = 49, 26.9%). The odds of experiencing physical violence were 3.7 times greater (confidence interval = 1.6-9.2) when there was not a procedure for reporting workplace violence compared to when there was a procedure. DISCUSSION Attention is required to identify the prevalence of workplace violence. Creating effective policies and procedures for a reporting system would potentially lead to lowering violence rates and positively impacting health care workers' well-being.
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Devi K, Soomar SM, Shaikh MU, Ali N. Response to ifosfamide, carboplatin, etoposide (ICE) vs. dexamethasone, cytarabine cisplatin (DHAP) as salvage chemotherapy in patients with relapsed/refractory lymphoma. Ann Med Surg (Lond) 2023; 85:4256-4261. [PMID: 37663724 PMCID: PMC10473291 DOI: 10.1097/ms9.0000000000000956] [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] [Received: 04/26/2023] [Accepted: 06/05/2023] [Indexed: 09/05/2023] Open
Abstract
Background Non-Hodgkin's lymphomas are the eighth-most prevalent malignancy in females and the eleventh in males. No research has been conducted comparing dexamethasone, cytarabine cisplatin (DHAP) vs. ifosfamide, carboplatin, etoposide (ICE) as salvage chemotherapy regimens for relapsed or refractory lymphomas in Pakistan. This study aims to compare the response of ICE vs. DHAP as salvage chemotherapy in patients with relapsed/refractory lymphomas. Methods A prospective follow-up study was conducted at the tertiary care hospital in Karachi, Pakistan, from 2019 to 2020. A total of 58 lymphoma patients after first-line chemotherapy were included in the study. The treatment response was evaluated after two cycles of salvage chemotherapy using WHO assessment criteria, and Cox regression was used to determine the hazard ratios considering the P value ≤0.05 significant. Results Of 58 patients, 19 (32.8%) patients achieved complete response (CR), and 8 (13.8%) patients achieved partial response (PR), with an overall response rate of overall response rate of 46.6%. In the ICE group, the response was assessed in 19 patients. Overall response was 42.1%, CR was 31.6% and PR was 10.5%. In the DHAP group, response was evaluated in 39 patients, the overall response rate was 48.7%, CR was 33.3% and PR was 15.4%. The hazard ratio for survival in patients with relapsed/refractory lymphomas who received DHAP was 1.40 times (95% CI: 1.27-3.63, P=0.001) compared to patients who received ICE as salvage chemotherapy. Conclusion DHAP seems to have a marginally better overall response rate than the ICE regimen in patients with refractory or relapsed lymphoma. However, the toxicity profile of patients in both groups was similar.
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Affiliation(s)
| | | | | | - Natasha Ali
- Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
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Soomar SM, Dhalla Z. Retraction Note: Injuries and outcomes resulting due to falls in elderly patients presenting to the emergency department of a tertiary care hospital - a cohort study. BMC Emerg Med 2023; 23:88. [PMID: 37563559 PMCID: PMC10413583 DOI: 10.1186/s12873-023-00867-x] [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: 08/12/2023] Open
Affiliation(s)
| | - Zeyanna Dhalla
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
- University of Michigan, Ann Arbor, MI, USA
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Ali N, Chhotani AA, Iqbal SP, Soomar SM, Raheem A, Waheed S. Point of Care Ultrasonographic Life Support in Emergency (PULSE)-a quasi-experimental study. Int J Emerg Med 2023; 16:49. [PMID: 37559012 PMCID: PMC10410962 DOI: 10.1186/s12245-023-00525-w] [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: 03/08/2023] [Accepted: 07/24/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Many physicians use point-of-care ultrasound (PoCUS) in their clinical practice to improve their diagnostic capabilities, accuracy, and timeliness. Over the last two decades, the use of PoCUS in the emergency room has dramatically increased. This study aimed to determine emergency physicians' retention of knowledge and skills after a brief training workshop on a focused ultrasound-guided approach to a patient presenting with undifferentiated shock, shortness of breath, and cardiac arrest in the emergency department of a tertiary care hospital. The secondary aim was to deliver the PoCUS-guided algorithmic approach to manage a patient presenting with undifferentiated shock, respiratory distress, and cardiac arrest in the emergency department. METHODS A quasi-experimental study was conducted with a single-day Point of Care Ultrasonographic Life Support in Emergency (PULSE) training workshop in October 2021 at the Aga Khan University Hospital, Karachi, Pakistan. A total of 32 participants attended the course, including twenty-one junior residents (PGY 1 and 2) and medical officers with experience of fewer than two years working in different emergency departments of urban tertiary care hospitals across Karachi, Pakistan. Pre- and post-assessment tools comprised a written examination, evaluating participants' knowledge and skills in ultrasound image acquisition and interpretation. Cronbach's alpha was used to calculate the validity of the tool. Results obtained before and after the training session were compared by the McNemar's test. A p value of ≤ 0.05 was considered significant. RESULTS There was a significant improvement in response to each question pre to post-test after completion of the course (Table 1). The significant change can be seen in questions 7, 8, 13, and 15, with a percentage change of 33.3, 80.9, 42.9, and 47.7. There was a significant improvement in the understanding and knowledge of participants after the training. The scores in the post-test were high compared to the pre-test in each category, i.e., respiratory distress (p < 0.017), cardiac arrest (p < 0.041), basic ultrasound knowledge (p < 0.001), and undifferentiated shock (p < 0.001). CONCLUSION All participants showed improvement in their knowledge and confidence regarding using PoCUS in life-threatening conditions. Through this study, we have also developed an algorithmic approach to managing undifferentiated shock, respiratory failure, and cardiac arrest. Future studies must assess the effectiveness and feasibility of incorporating these algorithms into clinical practice.
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Affiliation(s)
- Noman Ali
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan.
| | | | - Sannia Perwaiz Iqbal
- Department of Family Medicine, Bahria University of Health Sciences, Karachi, Pakistan
| | | | - Ahmed Raheem
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
| | - Shahan Waheed
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
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Khan UR, Soomar SM, Ghazi SM, Naeem R, Kerai S, Jamali S. Epidemiological pattern and management of dog bite injuries in Karachi, Pakistan: A cross-sectional study. Injury 2023; 54 Suppl 4:110473. [PMID: 37573070 DOI: 10.1016/j.injury.2022.11.016] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 10/19/2022] [Accepted: 11/07/2022] [Indexed: 08/14/2023]
Abstract
BACKGROUND Dog bite injuries are a common problem globally; however, little is known about the epidemiology of dog bite injury from a low-and-middle-income country like Pakistan. This study aims to determine the epidemiology of dog bite injuries among children and adults from a tertiary care hospital in Karachi, Pakistan. METHODS We conducted a cross-sectional study on dog bite patients visiting the emergency department from November 2015 to August 2016 of a major public tertiary care hospital. Data was collected using a structured questionnaire on demographic details, bite history, and management of dog bite victims. Descriptive analysis was reported. Chi-square test was applied to check the associations between age-specific dog bite cases and independent variables. RESULTS 2178 participants were included in the analysis. 715 (38.8%) were children less than 18 years old, and 1463 (61.2%) were adults over 18 years. A majority of the patients were males (1909, 87.7%). Results show that most dog bite injuries (2052, 94.2%) tend to occur outside the house by stray dogs biting without provocation. People aged 18 years and above (61.2%) and males (children: 84.6%, adults: 89.1%) tend to be bitten more often. Lower limbs are most frequently bitten (children: 69.5%, adults: 85.8%). Free-roaming stray dogs (children: 73.4%, adults: 74.9%) were involved in reported biting cases. Many of the patients did not receive appropriate first aid and instead just washed the wound with soap and water (children: 45.1%, adults: 43.7%). 99% of the victims received Tetanus toxoid, Rabies vaccine, and immunoglobulins while in the emergency department. CONCLUSION There is a high burden of dog bite injuries from stray dogs in Karachi, Pakistan. Efforts should be made to create awareness among the general public on the risks of dog bites and on seeking appropriate first aid and medical attention for a dog bite injury.
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Affiliation(s)
- Uzma Rahim Khan
- Instructor (Research), Department of Emergency Medicine, Aga Khan University Hospital, Main Stadium Road, Karachi 75300, Pakistan
| | - Salman Muhammad Soomar
- Instructor (Research), Department of Emergency Medicine, Aga Khan University Hospital, Main Stadium Road, Karachi 75300, Pakistan.
| | - Sanam Mir Ghazi
- Instructor (Research), Department of Emergency Medicine, Aga Khan University Hospital, Main Stadium Road, Karachi 75300, Pakistan
| | - Rubaba Naeem
- Instructor (Research), Department of Emergency Medicine, Aga Khan University Hospital, Main Stadium Road, Karachi 75300, Pakistan
| | - Salima Kerai
- Instructor (Research), Department of Emergency Medicine, Aga Khan University Hospital, Main Stadium Road, Karachi 75300, Pakistan
| | - Seemin Jamali
- Jinnah Postgraduate Medical Centre, Karachi, Pakistan
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Ali N, Shakeel E, Soomar SM. Need of Point of Care Ultrasound Training in Pediatric Emergency Medicine Practice: A Wake-Up Call for the Low-Income Countries. Glob Pediatr Health 2023; 10:2333794X231187485. [PMID: 37484605 PMCID: PMC10357049 DOI: 10.1177/2333794x231187485] [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: 02/21/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 07/25/2023] Open
Abstract
POCUS is the acquisition, interpretation, and rapid clinical integration of ultrasonographic imaging performed by the treating physician at the patient's bedside. It is used in the field Emergency Medicine to assist in diagnosing and managing various clinical conditions ranging from undifferentiated shock, respiratory failure, and cardiac arrest, which have shown a positive impact on clinical decision-making, resulting in a decreased emergency department and hospital length of stay. POCUS is also a valuable diagnostic tool in managing pediatric patients for whom radiation exposure is a significant concern. It is used to aid in diagnosing and managing various pediatric medical and surgical emergencies. Despite the evident literature regarding the utility of POCUS in Pediatric Emergency Medicine (PEM) practice, there is a lack of specialized training for pediatric emergency physicians, especially in low-income countries. Therefore, this comment emphasizes the need for POCUS training in PEM.
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Affiliation(s)
- Noman Ali
- Aga Khan University, Karachi, Pakistan
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Khan SR, Soomar SM, Asghari T, Ahmed A, Moosajee MS. Prognostic factors, oncological treatment and outcomes of uterine sarcoma: 10 years' clinical experience from a tertiary care center in Pakistan. BMC Cancer 2023; 23:510. [PMID: 37277708 DOI: 10.1186/s12885-023-11000-3] [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: 02/01/2023] [Accepted: 05/23/2023] [Indexed: 06/07/2023] Open
Abstract
BACKGROUND Uterine sarcoma is an uncommon aggressive malignancy. Optimal management and prognostic factors have yet to be well recognized due to their rarity and various histological subtypes. This study aims to investigate these patients' prognostic factors, treatment modalities, and oncological outcomes. METHODS A single-center retrospective cohort study was conducted on all patients diagnosed with uterine sarcoma and treated from January 2010 to December 2019 in a tertiary-care hospital in Pakistan. The data were analyzed using STATA software and stratified on the histological subtype. Survival rates were estimated using the Kaplan-Meier method. Crude and adjusted hazard ratios with 95% CI were estimated using univariate and multivariate analysis. RESULTS Of the 40 patients, 16(40%) had uterine leiomyosarcoma (u-LMS), 10(25%) had high-grade endometrial stromal sarcoma (HGESS), 8(20%) had low-grade endometrial stromal sarcoma (LGESS) and 6(15%) had other histological subtypes. The median age of all patients was 49 (40-55.5). Thirty-seven (92.5%) patients underwent primary surgical resection, and 24 (60%) patients received adjuvant systemic chemotherapy. The survival plots showed the overall population's DFS of 64 months and the OS of 88 months (p-value = 0.001). The median DFS in all patients was 12 months, and the median OS was 14 months (p-value = 0.001). A small but significant DFS benefit was found in patients who received adjuvant systemic chemotherapy, 13.5 versus 11 months (p-value = 0.001). Multivariate Cox-regression analysis revealed that large tumor size and advanced FIGO stage were substantial factors associated with decreased survival. CONCLUSION Uterine sarcomas are rare malignancies with poor prognosis. Multiple factors, including tumor size, mitotic count, stage of the disease, and myometrial invasion, impact survival outcomes. Adjuvant treatment may decrease the recurrence rate and improve DFS but do not affect OS.
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Affiliation(s)
- Saqib Raza Khan
- Department of Oncology, Aga Khan University Hospital, Karachi, Pakistan.
| | | | - Tamana Asghari
- Department of Histopathology, Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Arsalan Ahmed
- Department of Histopathology, Department of Pathology and Laboratory Medicine, Aga Khan University Hospital, Karachi, Pakistan
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Khan SR, Scheffler M, Soomar SM, Rashid YA, Moosajee M, Ahmad A, Raza A, Uddin S. Role of circulating-tumor DNA in the early-stage non-small cell lung carcinoma as a predictive biomarker. Pathol Res Pract 2023; 245:154455. [PMID: 37054576 DOI: 10.1016/j.prp.2023.154455] [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: 03/15/2023] [Revised: 04/07/2023] [Accepted: 04/07/2023] [Indexed: 04/15/2023]
Abstract
Lung cancer is one of the most common solid malignancies. Tissue biopsy is the standard method for accurately diagnosing lung and many other malignancies over decades. However, molecular profiling of tumors leads to establishing a new horizon in the field of precision medicine, which has now entered the mainstream in clinical practice. In this context, a minimally invasive complementary method has been proposed as a liquid biopsy (LB) which is a blood-based test that is gaining popularity as it provides the opportunity to test genotypes in a unique, less invasive manner. Circulating tumor cells (CTC) captivating the Circulating-tumor DNA (Ct-DNA) are often present in the blood of lung cancer patients and are the fundamental concept behind LB. There are multiple clinical uses of Ct-DNA, including its role in prognostic and therapeutic purposes. The treatment of lung cancer has drastically evolved over time. Therefore, this review article mainly focuses on the current literature on circulating tumor DNA and its clinical implications and future goals in non-small cell lung cancer.
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Affiliation(s)
- Saqib Raza Khan
- Medical Oncology Department, Aga Khan University Hospital, Karachi, Pakistan.
| | - Matthias Scheffler
- Internal Medicine Department, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | | | - Yasmin Abdul Rashid
- Medical Oncology Department, Aga Khan University Hospital, Karachi, Pakistan
| | - Munira Moosajee
- Medical Oncology Department, Aga Khan University Hospital, Karachi, Pakistan
| | - Aamir Ahmad
- Translational Research Institute & Dermatology Institute, Hamad Medical Corporation, Doha, Qatar
| | - Afsheen Raza
- College of Health Sciences, Abu Dhabi University, Abu Dhabi, United Arab Emirates
| | - Shahab Uddin
- Translational Research Institute & Dermatology Institute, Hamad Medical Corporation, Doha, Qatar.
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Soomar SM, Dhalla Z. Injuries and outcomes resulting due to falls in elderly patients presenting to the Emergency Department of a tertiary care hospital - a cohort study. BMC Emerg Med 2023; 23:14. [PMID: 36759778 PMCID: PMC9912659 DOI: 10.1186/s12873-023-00784-z] [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: 11/14/2022] [Accepted: 02/01/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND Fall injuries and trauma-related hospitalizations are the most common causes of injury and in-hospital stay amongst the elderly population. After the age of 65, the severity and frequency of fall-related problems increases; the repercussions are challenging for senior citizens, caregivers, and healthcare professionals. This study aims to determine the injuries and outcomes resulting from falls in elderly patients presenting to Emergency Department of a tertiary care hospital. METHODS A cohort study design was used. All elderly patients aged ≥ 60 years who visit the Emergency Department with a history of a fall as a primary complaint presenting to the ED of a tertiary care hospital in Karachi, Pakistan were included. A purposive sampling strategy was used to enroll 318 patients from August 2021 to February 2022. The outcome was risk of mortality. Each individual was followed for 90 days to study the outcome. A multivariable logistic regression was applied to check the association between the outcome and covariates. Crude and adjusted risk ratios were reported. A p-value ≤ 0.05 was considered significant. RESULTS Of the 318 participants, 265 (83.3%) were fall injury patients with comorbidities. More than half of the patients in both groups were female [32 (60.4%) & 146 (55.1%)]. Eyeglasses were used by most of the fall patients both without and with comorbidities [21 (39.6%) & 152 (57.4%) p 0.018]. There were multiple reasons for a fall including imbalance/dizziness, which was reported by one third of participants in both groups [15 (28.3%) & 77 (29.1%)] followed by a fall from stairs/steps/escalator [15 (28.3%) & 44 (16.6%) p 0.005]. At the end of one month, of those who had a comorbidity 20 (7.5%) expired. The risk of mortality among fall related injuries in elderly patients who were more than 80 years was 1.48 times (95% CI: 1.20-2.10) more likely when compared to those patients who were younger than 80 years. CONCLUSION Efforts should be made to improve management of the underlying etiology of falls to prevent them in future. The factors that contribute to falls should be identified. Strategies and interventions should be planned to mitigate this risk of fall in elderly to improve their quality of life.
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Affiliation(s)
| | - Zeyanna Dhalla
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
- University of Michigan, Ann Arbor, Michigan, USA
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Khan NU, Khan UR, Ahmed N, Ali A, Raheem A, Soomar SM, Waheed S, Kerai SM, Baig MA, Salman S, Saleem SG, Jamali S, Razzak JA. Improvement in the diagnosis and practices of emergency healthcare providers for heat emergencies after HEAT (heat emergency awareness & treatment) an educational intervention: a multicenter quasi-experimental study. BMC Emerg Med 2023; 23:12. [PMID: 36721088 PMCID: PMC9890699 DOI: 10.1186/s12873-022-00768-5] [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: 07/26/2022] [Accepted: 12/26/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The incidence of heat emergencies, including heat stroke and heat exhaustion, have increased recently due to climate change. This has affected global health and has become an issue of consideration for human health and well-being. Due to overlapping clinical manifestations with other diseases, and most of these emergencies occurring in an elderly patient, patients with a comorbid condition, or patients on poly medicine, diagnosing and managing them in the emergency department can be challenging. This study assessed whether an educational training on heat emergencies, defined as heat intervention in our study, could improve the diagnosis and management practices of ED healthcare providers in the ED setting. METHODS A quasi-experimental study was conducted in the EDs of four hospitals in Karachi, Pakistan. Eight thousand two hundred three (8203) patients were enrolled at the ED triage based on symptoms of heat emergencies. The pre-intervention data were collected from May to July 2017, while the post-intervention data were collected from May to July 2018. The HEAT intervention, consisting of educational activities targeted toward ED healthcare providers, was implemented in April 2018. The outcomes assessed were improved recognition-measured by increased frequency of diagnosing heat emergencies and improved management-measured by increased temperature monitoring, external cooling measures, and intravenous fluids in the post-intervention period compared to pre-intervention. RESULTS Four thousand one hundred eighty-two patients were enrolled in the pre-intervention period and 4022 in the post-intervention period, with at least one symptom falling under the criteria for diagnosis of a heat emergency. The diagnosis rate improved from 3% (n = 125/4181) to 7.5% (n = 7.5/4022) (p-value < 0.001), temperature monitoring improved from 0.9% (n = 41/4181) to 13% (n = 496/4022) (p-value < 0.001) and external cooling measure (water sponging) improved from 1.3% (n = 89/4181) to 3.4% (n = 210/4022) (p-value < 0.001) after the administration of the HEAT intervention. CONCLUSION The HEAT intervention in our study improved ED healthcare providers' approach towards diagnosis and management practices of patients presenting with health emergencies (heat stroke or heat exhaustion) in the ED setting. The findings support the case of training ED healthcare providers to address emerging health issues due to rising temperatures/ climate change using standardized treatment algorithms.
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Affiliation(s)
- Nadeem Ullah Khan
- grid.7147.50000 0001 0633 6224Department of Emergency Medicine, Aga Khan University, Karachi, 74800 Pakistan
| | - Uzma Rahim Khan
- grid.7147.50000 0001 0633 6224Department of Emergency Medicine, Aga Khan University, Karachi, 74800 Pakistan
| | - Naveed Ahmed
- grid.7147.50000 0001 0633 6224Department of Emergency Medicine, Aga Khan University, Karachi, 74800 Pakistan
| | - Asrar Ali
- grid.7147.50000 0001 0633 6224Department of Emergency Medicine, Aga Khan University, Karachi, 74800 Pakistan
| | - Ahmed Raheem
- grid.7147.50000 0001 0633 6224Department of Emergency Medicine, Aga Khan University, Karachi, 74800 Pakistan
| | - Salman Muhammad Soomar
- grid.7147.50000 0001 0633 6224Department of Emergency Medicine, Aga Khan University, Karachi, 74800 Pakistan
| | - Shahan Waheed
- grid.7147.50000 0001 0633 6224Department of Emergency Medicine, Aga Khan University, Karachi, 74800 Pakistan
| | - Salima Mansoor Kerai
- grid.17091.3e0000 0001 2288 9830School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Muhammad Akbar Baig
- grid.7147.50000 0001 0633 6224Department of Emergency Medicine, Aga Khan University, Karachi, 74800 Pakistan
| | - Saima Salman
- grid.464569.c0000 0004 1755 0228Indus Hospital and Health Network (IHHN), Karachi, Pakistan
| | - Syed Ghazanfar Saleem
- grid.464569.c0000 0004 1755 0228Indus Hospital and Health Network (IHHN), Karachi, Pakistan
| | - Seemin Jamali
- grid.414696.80000 0004 0459 9276Accident & Emergency Department, Jinnah Postgraduate Medical Center (JPMC), Karachi, Pakistan
| | - Junaid A. Razzak
- grid.5386.8000000041936877XDepartment of Emergency Medicine, Weill Cornell Medicine, New York, NY 10065 USA ,grid.7147.50000 0001 0633 6224Centre of Excellence for Trauma and Emergencies, Aga Khan University, Karachi, 74800 Pakistan
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Soomar SM, Soomar SM. Identifying factors to develop and validate a heat vulnerability tool for Pakistan – A review. Clinical Epidemiology and Global Health 2023. [DOI: 10.1016/j.cegh.2023.101214] [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: 01/09/2023] Open
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Khan SR, Muhammad A, Soomar SM, Shoaib D, Arshad Ali A, Muhammad T, Zahir MN, Abdul Jabbar A, Abdul Rashid Y, Heger M, Moosajee MS. No difference in treatment outcome between patients with nodal versus extranodal diffuse large B-cell lymphoma. J Clin Transl Res 2022; 9:37-49. [PMID: 36687299 PMCID: PMC9844226] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 07/24/2022] [Accepted: 11/23/2022] [Indexed: 01/24/2023] Open
Abstract
Background and Aim Diffuse large B-cell lymphoma (DLBCL) has been classified using various parameters, including the site of origin. Studies have reported conflicting outcomes when DLBLC patients were stratified according to the site of origin. This study aimed to investigate the response rate and survival outcomes in nodal versus extranodal DLBCL and compare the results to a region-matched study covering the 1988 - 2005 period. Methods A single-center retrospective cohort study was conducted on all patients diagnosed with DLBCL and treated in a tertiary care hospital in Pakistan during 2014 - 2019. We calculated the mean and median for continuous variables and frequency and percentages for all categorical variables. Progression-free survival (PFS) and overall survival (OS) were calculated using Kaplan-Meier survival curves. A Cox proportional hazards model was used to determine the hazard ratio (HR) for OS. Results Of the 118 patients, 49 patients (41.5%) had nodal disease and 69 patients (58.5%) were diagnosed with extranodal DLBCL. The majority of patients in the nodal and extranodal cohorts presented with Stages III and IV disease (73.4% and 62.3%, respectively). A complete response to (immuno) chemotherapy was achieved in 71.4% of nodal DLBCL patients and 65.2% of extranodal DLBCL patients. The 5-year PFS and median PFS in the entire cohort were 0.8% and 17 m, respectively. The PFS and median PFS in the nodal and extranodal DLBCL cohort were 0% and 1.4%, respectively, and 15 m and 19 m, respectively. The 5-year OS and median OS in the entire cohort were 16.1% and 19 m, respectively. The OS and median OS in the nodal and extranodal DLBCL cohort were 8.2% and 21.7%, respectively, and 19 m and 21 m, respectively. Multivariable linear regression revealed that the ABC phenotype (nodal, HR = 1.37, 95% CI = 1.37 - 3.20; extranodal, HR = 1.65, 95% CI = 1.46 - 3.17; GBC as reference) and double and triple hit DLBCL (nodal, HR = 1.29, 95% CI = 1.19 - 2.81; extranodal, HR = 1.87, 95% CI = 1.28 - 2.43; and non-expressors as reference) are independent negative predictors of OS. Conclusions DLBCL incidence in the Karachi region has remained comparable but patient composition in the extranodal DLBCL cohort has shifted to predominantly advanced stage. Nodal and extranodal DLBCL were associated with similar PFS and OS profiles and first- and second-line treatment responses. Cell of origin and antigen expression status was independent negative predictors of OS, disfavoring the ABC phenotype and lesions with c-MYC and BCL2 and/or BCL6 overexpression. Relevance for Patients DLBCL is an aggressive type of non-Hodgkin's lymphoma, however; patients respond well to standard systemic chemotherapy. Extranodal type of DLBCL patients tend to have more residual disease after first-line systemic chemotherapy, but physicians should keep in mind that the subsequent line treatment mitigates its negative impact on survival.
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Affiliation(s)
- Saqib Raza Khan
- 1Department of Oncology, Aga Khan University Hospital, Karachi, Pakistan,Corresponding author: Saqib Raza Khan Department of Oncology, Aga Khan University Hospital, Karachi, Pakistan.
| | - Afzal Muhammad
- 1Department of Oncology, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Daania Shoaib
- 1Department of Oncology, Aga Khan University Hospital, Karachi, Pakistan
| | | | | | | | - Adnan Abdul Jabbar
- 1Department of Oncology, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Michal Heger
- 4Department of Pharmaceutics, Jiaxing Key Laboratory for Photonanomedicine and Experimental Therapeutics, College of Medicine, Jiaxing University, Jiaxing, Zhejiang, P. R. China,5Laboratory Experimental Oncology, Department of Pathology, Erasmus MC, Rotterdam, the Netherlands,6Membrane Biochemistry and Biophysics, Department of Chemistry, Faculty of Science, Utrecht University, Utrecht, the Netherlands
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Soomar SM, Issani A, Moin G, Dhalla Z, Adnan A, Soomar SM. The Serological Confirmation and Outcome of the Pediatric Dengue Patients Presenting to Emergency Department: A Cross-Sectional Study. Glob Pediatr Health 2022; 9:2333794X221138434. [PMID: 36601355 PMCID: PMC9806414 DOI: 10.1177/2333794x221138434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 10/24/2022] [Indexed: 12/28/2022] Open
Abstract
Background In the emergency department, it is very uncommon perform a differential diagnosis to serologically differentiate between dengue, dengue hemorrhagic fever, and dengue shock syndrome. Prompt differential diagnosis and treatment is essential with the presentation of dengue. This study aims to determine the serological confirmation and outcome of the dengue epidemic in the pediatric population presenting to the ED in a tertiary care hospital. Methods A single-center cross-sectional study was conducted. All pediatric patients aged less than 18 years presented to ED with clinical features suggestive of DF, DFF, and DSS while also doing the serological confirmation for the dengue were enrolled in the study. Data was collected on demographics, clinical characteristics, diagnosis, and outcomes of 324 pediatric patients. Multivariable binary logistic regression was applied for the analysis. Results Out of 324 patients, 191 (59.13%) underwent NS1 testing and 132 (40.87%) did the IgM test. Most participants were in the age range of 13 to 18 years in both groups. Fever was the most common complaint in both groups 191 (100%) and 132 (100%). In each group, around one-third of the participants complained about body aches 69 (36.13%) and 44 (33.33%). The patient having a history of traveling within the past 14 days created a 1.51 (95% CI: 1.27-2.25) times higher odds of contracting dengue fever as compared to no history of travel. Conclusion The serologic confirmation of dengue in the ED helps in both the adequate and timely treatment as well as patient disposition and ultimately saves lives.
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Affiliation(s)
| | | | | | - Zeyanna Dhalla
- Aga Khan University, Karachi,
Pakistan
- The College of William and Mary,
Williamsburg, VA, United States
| | - Ahmer Adnan
- Aga Khan University, Karachi,
Pakistan
- Life Care Hospital, Karachi,
Pakistan
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Ali N, Haider S, Mustahsan S, Shaikh M, Raheem A, Soomar SM, Waheed S. Predictors of abnormal electroencephalogram and neuroimaging in children presenting to the emergency department with new-onset afebrile seizures. BMC Pediatr 2022; 22:619. [PMID: 36303125 PMCID: PMC9609244 DOI: 10.1186/s12887-022-03668-6] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 09/09/2022] [Accepted: 10/07/2022] [Indexed: 11/26/2022] Open
Abstract
Background Electroencephalogram and neuroimaging in pediatric patients with new-onset afebrile seizures are performed to detect any underlying pathological severe condition that may require emergent neuro-intervention and guide prognosis. This study aims to determine the predictors of abnormal EEG and neuroimaging in children presenting to the emergency department with new-onset afebrile seizures. Methods This single-center cross-sectional study was conducted at a tertiary care hospital in Karachi, Pakistan, from July 01, 2019, to June 30, 2021. All patients aged one month to 18 years who presented with new-onset afebrile seizures were included. Demographic and clinical data were recorded, including age, gender, seizure type, duration of seizure, associated signs and symptoms, and disposition. Multivariable regression analysis was applied to determine the predictors of abnormal EEG and CT scan or MRI findings. Results Out of 201 participants, most patients were in the infantile age group (41.3%), with an equal gender distribution. The most common type of seizure was generalized onset 152 (75.6%). EEG was performed on a total of 126 patients (62.7%) and out of these patients, 67 patients (53.1%) had abnormal findings. In a multivariable analysis, the age group of 5 to 10 years and seizure duration of more than 5 min were significantly associated with higher odds of abnormal EEG findings. In contrast, only the focal onset of seizure was significantly associated with higher odds of abnormal neuroimaging findings. Conclusion The study emphasizes the need for a protocol regarding the performance of EEG and neuroimaging in children presenting to the ED with new-onset afebrile seizures that would aid emergency physicians in the direction of appropriate management, thus ensuring a better quality of patient care and outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12887-022-03668-6.
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Affiliation(s)
- Noman Ali
- grid.7147.50000 0001 0633 6224Department of Emergency Medicine, Aga Khan University, 74800 Karachi, Pakistan
| | - Sohaib Haider
- grid.7147.50000 0001 0633 6224Department of Emergency Medicine, Aga Khan University, 74800 Karachi, Pakistan
| | - Syed Mustahsan
- grid.7147.50000 0001 0633 6224Department of Emergency Medicine, Aga Khan University, 74800 Karachi, Pakistan
| | - Murk Shaikh
- grid.7147.50000 0001 0633 6224Department of Pediatrics & Child Health, Aga Khan University, 74800 Karachi, Pakistan
| | - Ahmed Raheem
- grid.7147.50000 0001 0633 6224Department of Emergency Medicine, Aga Khan University, 74800 Karachi, Pakistan
| | - Salman Muhammad Soomar
- grid.7147.50000 0001 0633 6224Department of Emergency Medicine, Aga Khan University, 74800 Karachi, Pakistan
| | - Shahan Waheed
- grid.7147.50000 0001 0633 6224Department of Emergency Medicine, Aga Khan University, 74800 Karachi, Pakistan
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Habibullah N, Soomar SM, Ali N. Pneumoperitoneum following cardiopulmonary resuscitation: An unusual case. Int J Surg Case Rep 2022; 99:107649. [PMID: 36116305 PMCID: PMC9568792 DOI: 10.1016/j.ijscr.2022.107649] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/09/2022] [Accepted: 09/09/2022] [Indexed: 11/12/2022] Open
Abstract
Introduction and importance High-quality cardiopulmonary resuscitation (CPR) is the foundation of cardiac arrest resuscitation. Pneumoperitoneum due to gastric perforation is a rare surgical complication of CPR that, if left untreated, can result in significant morbidity and mortality. Case presentation We present a 51-year-old male patient with sealed perforation who received an urgent but non-diagnostic exploratory laparotomy after initial esophageal intubation and resuscitation in cardiac arrest, despite significant evidence of surgical pneumoperitoneum. Clinical discussion It is unusual to experience spontaneous pneumoperitoneum after cardiopulmonary resuscitation. We should promote cardiopulmonary resuscitation training for both medical and non-medical personnel. Conclusion Early endotracheal intubation, avoidance of esophageal intubation, and quick insertion of an orogastric tube may reduce the risk of gastric perforation. Pneumoperitoneum due to gastric perforation is a rare surgical complication if left untreated, can result in morbidity and mortality. It is unusual to experience spontaneous pneumoperitoneum after cardiopulmonary resuscitation. We should promote cardiopulmonary resuscitation training for both medical and non-medical personnel.
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Soomar SM, Soomar SM, Khan M, Moin G, Azam I. COVID-19 vaccine acceptance and hesitancy among the general population of Pakistan: a population-based survey. BMJ Open 2022; 12:e064096. [PMID: 36115670 PMCID: PMC9485645 DOI: 10.1136/bmjopen-2022-064096] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 08/28/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES This study aims to determine the COVID-19 vaccination coverage and the factors associated with vaccine acceptance and hesitancy in the general population of Pakistan. SETTING This population-based study covers all major areas of Pakistan, including Sindh, Punjab, Khyber Pakhtunkhwa and Baluchistan provinces and the capital Islamabad. PARTICIPANTS A total of 541 male and female Pakistani adults above 18 years were interviewed to determine the COVID-19 vaccination coverage and understand the factors associated with vaccine acceptance and hesitancy. OUTCOME The outcome was COVID-19 vaccination status (not vaccinated or vaccinated). RESULTS Of 541 participants, 227 (41.96%) were non-vaccinated and 314 (58.04%) were vaccinated. Two-thirds of the participants from both the non-vaccinated and vaccinated groups (185 (81.50%) vs 236 (75.16%), p=0.008) reside in Sindh. Nearly one-third of participants from both groups were ever infected with COVID-19 (77 (33.92%) and 90 (28.66%)). The odds of COVID-19 vaccination among the age group 34-42 years were 1.75 times higher (95% CI 1.35 to 2.09, p=0.008) than the other age groups. The odds of COVID-19 vaccination among those with COVID-19 ever-infected family members were 1.87 times higher (95% CI 1.56 to 2.34, p=0.032) than those with uninfected family members. CONCLUSIONS Targeted interventions for subsets of populations reluctant to vaccination can improve vaccine coverage. Moreover, advocacy and explaining the public health benefits of vaccination can enhance the coverage in Pakistan.
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Affiliation(s)
| | | | - Maria Khan
- Medical College, The Aga Khan University, Karachi, Pakistan
| | | | - Iqbal Azam
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
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Ahmed F, Khan UR, Soomar SM, Raheem A, Naeem R, Naveed A, Razzak JA, Khan NU. Acceptability of telephone-cardiopulmonary resuscitation (T-CPR) practice in a resource-limited country- a cross-sectional study. BMC Emerg Med 2022; 22:139. [PMID: 35918647 PMCID: PMC9347158 DOI: 10.1186/s12873-022-00690-w] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND T-CPR has been shown to increase bystander CPR rates dramatically and is associated with improved patient survival. OBJECTIVE To evaluate the acceptability of T-CPR by the bystanders and identify baseline quality measures of T-CPR in Karachi, Pakistan. METHODS A cross-sectional study was conducted from January to December 2018 at the Aman foundation command and control center. Data was collected from audiotaped phone calls of patients who required assistance from the Aman ambulance and on whom the EMS telecommunicator recognized the need for CPR and provided instructions. Information was recorded using a structured questionnaire on demographics, the status of the patient, and different time variables involved in CPR performance. A One-way ANOVA was used to compare different time variables with recommended AHA guidelines. P-value ≤ 0.05 was considered significant. RESULTS There were 481 audiotaped calls in which CPR instruction was given, listened to, and recorded data. Out of which in 459(95.4%) of cases CPR was attempted Majority of the patients were males (n = 278; 57.8%) and most had witnessed cardiac arrest (n = 470; 97.7%) at home (n = 430; 89.3%). The mean time to recognize the need for CPR by an EMS telecommunicator was 4:59 ± 1:59(min), while the mean time to start CPR instruction by a bystander was 5:28 ± 2:24(min). The mean time to start chest compression was 6:04 ± 1:52(min.). CONCLUSION Our results show the high acceptability of T-CPR by bystanders. We also found considerable delays in recognizing cardiac arrest and initiation of CPR by telecommunicators. Further training of telecommunicators could reduce these delays.
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Affiliation(s)
- Fareed Ahmed
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan.
| | - Uzma Rahim Khan
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
| | | | - Ahmed Raheem
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
| | - Rubaba Naeem
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
| | - Abid Naveed
- Sindh Rescue & Medical Services, Karachi, Pakistan
| | - Junaid Abdul Razzak
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan.,Emergency Medicine, Weill Cornell Medicine, New York City, USA
| | - Nadeem Ullah Khan
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
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Ahmed F, Asad S, Salim S, Soomar SM. Appendicitis after Appendectomy: A Rare Presentation of Acute Appendicitis as Stump Appendicitis. Case Rep Gastroenterol 2022; 16:441-445. [PMID: 35949230 PMCID: PMC9294939 DOI: 10.1159/000524118] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 03/02/2022] [Indexed: 11/19/2022] Open
Abstract
Appendicitis is one of the frequent complaints for which patients visit the Emergency Department. Appendectomy is one of the most commonly performed procedures. Stump appendicitis is a rare but severe complication of appendectomy due to the inflammation of the remaining part of the appendix. Because it is rare and partly due to physicians' lack of understanding of this entity, the diagnosis is highly delayed, leading to severe complications including perforation or peritonitis. This article aims to raise the importance and awareness and shed light on how possibly it could be avoided.
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Affiliation(s)
- Fareed Ahmed
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
- *Fareed Ahmed,
| | - Sadia Asad
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Shaharyar Salim
- Department of Emergency Medicine, Aga Khan University, Karachi, Pakistan
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Soomar SM, Soomar SM. Determinants of domestic violence among women of reproductive age (15-49 years) in Quetta, Balochistan-a mixed-method protocol. BMJ Open 2022; 12:e057299. [PMID: 35577475 PMCID: PMC9114969 DOI: 10.1136/bmjopen-2021-057299] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Worldwide, domestic violence (DV) is a cause of death and disability among women aged 15-49 years. In Pakistan, DV appears in different forms, and only 3.2% of women report any DV. There are various factors associated with DV against women. The data are sparse for the Balochistan province due to the under-reporting and scattered population. This research study aims to determine the factors associated with DV and the types of violence among women of reproductive age. Also, to understand the perspective of community leaders and healthcare workers (HCWs) for developing interventions for DV prevention against women of reproductive age in Quetta Balochistan. METHODS AND ANALYSIS A sequential explanatory mixed-method (quantitative study followed by qualitative) study design will be used to fulfil the study's objectives. Women of reproductive age (15-49 years), both married and unmarried, local residents, community leaders and community HCWs of Quetta Balochistan, will be made part of the study. A structured questionnaire will be used as the quantitative tool. Focus group discussions will be conducted using a semistructured guide for the qualitative data collection. The multivariable logistic regression analysis will be performed for the quantitative part. P value ≤0.05 will be considered significant. In the qualitative part, data will be transcribed, and recurrent themes/subthemes will be developed to understand the perspective and opinion regarding DV prevention. ETHICS AND DISSEMINATION Ethical Approval was taken from Aga Khan University, Karachi, Pakistan. Informed written consent will be obtained from all participants. The article will be published after data collection and analysis in the journal to disseminate the results.
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Zaki A, Soomar SM, Khan DH, Shaharyar Sheikh H, Iftikhar R, Mir A, Aziz Z, Bano K, Naseer H, Chaudhry QU, Bokhari SWI, Shabbir-Moosajee M. “Outcomes of COVID-19 infection in patients with hematological malignancies- A multicenter analysis from Pakistan”. PLoS One 2022; 17:e0267139. [PMID: 35446898 PMCID: PMC9022796 DOI: 10.1371/journal.pone.0267139] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 04/01/2022] [Indexed: 12/03/2022] Open
Abstract
Purpose COVID-19 infection resulting from severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) began to spread across the globe in early 2020. Patients with hematologic malignancies are supposed to have an increased risk of mortality from coronavirus disease of 2019 (COVID-19) infection. From Pakistan, we report the analysis of the outcome and interaction between patient demographics and tumor subtype and COVID-19 infection and hematological malignancy. Patients and methods This multicenter, retrospective study included adult patients with a history of histologically proven hematological malignancies who were tested positive for COVID-19 via PCR presented at the oncology department of 5 tertiary care hospitals in Pakistan from February to August 2020. A patient with any known hematological malignancy who was positive for COVID-19 on RT-PCR, was included in the study. Chi-square test and Cox-regression hazard regression model was applied considering p ≤ 0.05 significant. Results A total of 107 patients with hematological malignancies were diagnosed with COVID-19, out of which 82 (76.64%) were alive, and 25 (23.36%) were dead. The significant hematological malignancy was B-cell Lymphoma in dead 4 (16.00%) and alive group 21 (25.61%), respectively. The majority of the patients in both the dead and alive group were on active treatment for hematological malignancy while they came positive for COVID-19 [21 (84.00%) & 48 (58.54%) p 0.020]. All patients in the dead group were admitted to the hospital 25 (100.00%), and among these, 14 (56.00%) were admitted in ICU with a median 11 (6–16.5) number of days. Among those who had contact exposure, the hazard of survival or death in patients with hematological malignancies and COVID-19 positive was 2.18 (CI: 1.90–4.44) times and 3.10 (CI: 2.73–4.60) times in patients with travel history compared to no exposure history (p 0.001). Conclusion Taken together, this data supports the emerging consensus that patients with hematologic malignancies experience significant morbidity and mortality resulting from COVID-19 infection.
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Affiliation(s)
- Adeeba Zaki
- Aga Khan University Hospital, Karachi, Pakistan
- Department of Oncology, The Aga Khan University Hospital, Karachi, Pakistan
- * E-mail:
| | - Salman Muhammad Soomar
- Aga Khan University Hospital, Karachi, Pakistan
- Department of Oncology, The Aga Khan University Hospital, Karachi, Pakistan
| | - Danish Hasan Khan
- Hangzhou Tigermed, Karachi, Pakistan
- Clinical Project Manager (CPM Pakistan), Hangzhou Tigermed, Karachi, Pakistan
| | - Hasan Shaharyar Sheikh
- Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
- Consultant Medical Oncologist, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Raheel Iftikhar
- Armed Forces Bone Marrow Transplant Centre, Rawalpindi, Pakistan
| | - Ayaz Mir
- Shifa International Hospital, Islamabad, Pakistan
- Bone Marrow & Stem Cell Transplant, Shifa International Hospital, Karachi, Pakistan
| | - Zeba Aziz
- Hameed Latif Hospital, Lahore, Pakistan
- Medical Oncologist, Hammed Latif Hospital, Lahore, Pakistan
| | - Khadija Bano
- Shifa International Hospital, Islamabad, Pakistan
- Fellow Clinical Hematology Shifa International Hospital, Islamabad, Pakistan
| | - Hafsa Naseer
- Hameed Latif Hospital, Lahore, Pakistan
- Postgraduate Resident, Hameed Latif Hospital, Lahore, Pakistan
| | | | - Syed Waqas Imam Bokhari
- Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
- Medical Oncologist, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, Pakistan
| | - Munira Shabbir-Moosajee
- Aga Khan University Hospital, Karachi, Pakistan
- Department of Oncology, The Aga Khan University Hospital, Karachi, Pakistan
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Samar MR, Khan SR, Tariq M, Soomar SM, Shahzadi M. Bilateral congenital cryptorchidism and unilateral Leydig cell tumor in an adult presenting with gynecomastia and primary infertility: A case report. Int J Surg Case Rep 2022; 93:106923. [PMID: 35303605 PMCID: PMC8927705 DOI: 10.1016/j.ijscr.2022.106923] [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: 01/06/2022] [Revised: 02/10/2022] [Accepted: 03/05/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction and importance The neoplasms of the testis are sporadic tumors among men. Furthermore, the rarest subset of these is neoplasms belonging to the stromal tumors of the sex cord. Leydig cell tumors are the most common form among the testicular stromal tumors. In our case, the underlying risk factor associated with the development of Leydig cell tumors was cryptorchidism. While mostly unilateral, cases of bilateral cryptorchidism may be present and have been rarely reported. Case presentation We report a 36-year-old gentleman who presented to us with the inability to carry off intercourse without difficulty attaining erection on stimulation for the past two years. He had a history of left undescended testis since birth, for which he underwent left orchidopexy 20 years ago. An ultrasound of the pelvis showed an oval hypoechoic-shaped heterogeneous mass in the right mid-inguinal canal. Relevant blood investigations showed a deranged hormonal profile. He then underwent an uneventful right radical orchiectomy, histopathology of which was consistent with Leydig cell tumor. Clinical discussion LCT with a history of bilateral cryptorchidism has rarely been reported. This case highlights its clinical presentation, management, and further follow-up in such patients. Conclusion Bilateral congenital cryptorchidism may be associated with Leydig cell tumor years later in life hence long-term follow-up is required for these patients. The clinical presentation of these tumors may vary among individuals. Any change in physical appearance, hormonal assay, and imaging studies should promptly be followed for possible surgical resection and close monitoring. Bilateral congenital cryptorchidism may be associated with LCT, years later in life. The clinical presentation of these tumors may vary among individuals. Such patients need periodic monitoring of hormonal profiles and imaging studies.
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Affiliation(s)
| | - Saqib Raza Khan
- Department of Oncology, Aga Khan University, Karachi, Pakistan.
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Abbasi AM, Shaikh MU, Ali N, Khan M, Soomar SM. Response of Eltrombopag in immune thrombocytopenia and acquired idiopathic aplastic anemia: a single-center experience. Leuk Res Rep 2022; 17:100295. [PMID: 35242527 PMCID: PMC8886031 DOI: 10.1016/j.lrr.2022.100295] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Revised: 02/07/2022] [Accepted: 02/14/2022] [Indexed: 11/29/2022] Open
Abstract
Eltrombopag has been used in ITP and found its use in AA armamentarium recently. We retrospectively analyzed 61 patients at a tertiary care center in Pakistan from January 2015 to January 2021. They included patients with severe AA who were refractory to at least one course of immunosuppressive therapy and persistent/chronic ITP who have received at least one previous treatment for ITP. Responses to Eltrombopag in our population were comparable to real-world experiences while tolerable hepatotoxicity and GI issues were notable. We found Eltrombopag to be a safe and efficacious agent for treating patients with ITP and AA.
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Affiliation(s)
- Abdul Muqtadir Abbasi
- Department of Oncology, Aga Khan University Karachi Pakistan
- Corresponding author at: Department of Oncology Aga Khan University Hospital, Karachi Pakistan.
| | | | - Natasha Ali
- Department of Pathology & Laboratory Medicine, Aga Khan University Karachi Pakistan
| | - Maria Khan
- MBBS Class of 2022, Aga Khan University Karachi Pakistan
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Khan DSR, Tariq DM, Fayyaz DSM, Soomar SM, Moosajee DM. Lenalidomide induced secondary Acute Lymphoblastic Leukemia in a Multiple Myeloma patient: A case-report. Leuk Res Rep 2022; 17:100315. [PMID: 35462726 PMCID: PMC9026623 DOI: 10.1016/j.lrr.2022.100315] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/09/2022] [Accepted: 04/11/2022] [Indexed: 11/18/2022] Open
Abstract
This case highlights the importance of close follow-up of patients on long-term lenalidomide therapy, particularly for the development of secondary malignancies. Any change in blood counts that cannot be attributed to the progression of the underlying disease should be worked up for therapy-related hematological malignancies. The benefits and risk of maintenance therapy with lenalidomide verse risk of developing Secondary malignancies should be discussed with patients.
Lenalidomide mechanism of action has been shown to modulate the different components of the immune system. A 68-year-old lady presented to us with severe backache and was then diagnosed with MM. Lenalidomide started as per protocol along with dexamethasone. Later, she presented with complaints of generalized weakness and her workup showed significant blast cells with Pan-B-cell markers consistent with secondary B-ALL. The reported incidence of secondary Acute Lymphocytic Leukemia is 2.3%. The development of more aggressive neoplasm in a patient with prior malignancy dictates a poor outcome and hence such patients should be enrolled in a clinical trial whenever available.
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Affiliation(s)
- Dr. Saqib Raza Khan
- Department of Oncology, Aga Khan University Hospital, Karachi, Pakistan
- Corresponding author.
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Soomar SM, Siddiqui AR, Azam SI, Shah M. Determinants of hepatitis B vaccination status in health care workers of two secondary care hospitals of Sindh, Pakistan: a cross-sectional study. Hum Vaccin Immunother 2021; 17:5579-5584. [PMID: 34757865 DOI: 10.1080/21645515.2021.1986332] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Health care workers (HCWs) are at high risk of Hepatitis B virus (HBV) transmission. Hepatitis B vaccination is effective in protecting against HBV infection. Different factors influence HCW vaccination status such as lack of knowledge & awareness, cost, availability, and hesitancy. This study aimed to determine Hepatitis B vaccination status and factors influencing vaccination status in HCWs of two secondary care hospitals at Sindh, Pakistan. METHODS A cross-sectional study was conducted in two secondary care hospitals of Sindh, Pakistan. A total of 252 doctors, nurses, laboratory, and other HCWs were asked about the HBV vaccination coverage using a structured tool. Multivariable ordinal logistic regression was used to determine the association of participant's characteristics, vaccination knowledge with HBV vaccination coverage considering p-value ≤0.05 significant. Odds ratios with 95% confidence interval (CI) were reported. RESULTS Our study found that 64.9% doctors, 75.18% nurses, 58.3% allied HCWs, 40.0% laboratory staff, and 70.8% housekeeping staff were completely vaccinated. HCWs stated job entry requirement as the primary reason for complete vaccination (AOR 4.6, 95% CI 1.5-5.3) from the disease. HCWs working in Aga Khan hospital Karachi and who have received vaccination before working in that hospital had four-time higher odds for hepatitis B vaccination (AOR 4.3, 95% CI 1.7-4.9). CONCLUSION Two-third of the HCWs were completely vaccinated in secondary care hospitals in Sindh, Pakistan. Hepatitis B vaccination should be made a job entry requirement to achieve more complete vaccination numbers. Vaccination policies require to implement for all part-timers and full-timer health care workers.
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Affiliation(s)
| | | | - Syed Iqbal Azam
- Department of Community Health Sciences Aga, Khan University, Karachi, Pakistan
| | - Mairaj Shah
- Aga Khan University Hospital, Karachi, Pakistan
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Lakhdir MPA, Peerwani G, Soomar SM, Nathwani AA, Farooq S, Ali NA, Khaliq A, Kadir MM, Azam SI. Longitudinal association between parental-to-child-Maltreatment and self-reported Generalized Anxiety Disorder symptoms in Pakistani Adolescents. Child Adolesc Psychiatry Ment Health 2021; 15:36. [PMID: 34261505 PMCID: PMC8281488 DOI: 10.1186/s13034-021-00387-1] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 07/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Parent-to-child maltreatment is considered one of the risk factors for Generalized Anxiety Disorder (GAD) symptoms, but this hypothesis has not been adequately tested in Pakistani settings. AIM This study aimed to examine the association between parent-to-child maltreatment and the risk of developing GAD symptoms among adolescents. METHODS The association of none to rare, occasionally, and frequently parent-to-child maltreatment with the incidence of GAD symptoms was investigated in a sample of 800 adolescents aged 11-17 years who were followed for two years. Parent-to-child maltreatment was assessed using ICAST-C (International child abuse screening tool). GAD Symptoms were determined by SCARED (Screen for children anxiety-related disorders). Cox Proportional Algorithm was used to estimate risk ratios. RESULTS Among children with both uneducated parents, frequently maltreatment was associated with 7.31 (2.20-24.04) times the risk of GAD symptoms compared to none to rare maltreatment. In contrast, the risk of GAD symptoms in frequently maltreated children was 5.58 times (1.40-21.97) than negligibly maltreated children with either educated parent. CONCLUSION The frequency of parent-to-child maltreatment is significantly associated with an increased risk of developing GAD symptoms in which parental education plays a crucial role. Parents should be imparted with the awareness of the consequences of child maltreatment. In Pakistani settings the need to have this awareness is even more necessary due to the culturally acceptable disciplinary measures used by parents.
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Affiliation(s)
- Maryam Pyar Ali Lakhdir
- Department of Community Health Sciences, Aga Khan University, First Floor, Stadium Road, P.O Box 3500, Karachi, Pakistan.
| | - Ghazal Peerwani
- grid.7147.50000 0001 0633 6224Department of Community Health Sciences, Aga Khan University, First Floor, Stadium Road, P.O Box 3500, Karachi, Pakistan
| | - Salman Muhammad Soomar
- grid.7147.50000 0001 0633 6224Department of Community Health Sciences, Aga Khan University, First Floor, Stadium Road, P.O Box 3500, Karachi, Pakistan
| | - Apsara Ali Nathwani
- grid.7147.50000 0001 0633 6224Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Salima Farooq
- grid.7147.50000 0001 0633 6224Department of School of Nursing and Midwifery, Aga Khan University, Karachi, Pakistan
| | - Naureen Akber Ali
- grid.7147.50000 0001 0633 6224Department of School of Nursing and Midwifery, Aga Khan University, Karachi, Pakistan
| | - Asif Khaliq
- grid.1024.70000000089150953School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | - Muhammad Masood Kadir
- grid.7147.50000 0001 0633 6224Department of Community Health Sciences, Aga Khan University, First Floor, Stadium Road, P.O Box 3500, Karachi, Pakistan
| | - Syed Iqbal Azam
- grid.7147.50000 0001 0633 6224Department of Community Health Sciences, Aga Khan University, First Floor, Stadium Road, P.O Box 3500, Karachi, Pakistan
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Devi K, Shaikh MU, Ali NB, Adil SN, Khan M, Soomar SM. Outcomes of patients with double/triple expressor diffuse large B-cell lymphoma (DLBCL) treated with R-DA-EPOCH/R-CHOP: A single-center experience. Leuk Res Rep 2021; 16:100284. [PMID: 34926144 PMCID: PMC8648798 DOI: 10.1016/j.lrr.2021.100284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2021] [Revised: 11/03/2021] [Accepted: 11/27/2021] [Indexed: 11/29/2022] Open
Abstract
In Pakistan 76.4% of all NHLs to be diagnosed as DLBCLs. The survival of R-CHOP is better compared to the DA-REPOCH treatment regimen. A prospective follow-up study was conducted with 113 patients to study the outcomes of treatment. Multivariable cox-proportional hazard model was used to estimate the hazard ratios in patients receiving these treatment regimens considering p-value ≤0.05 significant. The survival rate among double/triple expressor lymphoma patients received R-DA-EPOCH was 82.8%, and 83.3% received R-CHOP. For double/triple expressor lymphoma patients received R-DA-EPOCH. The findings of our study demonstrated that the survival rate in both R-CHOP and R-DA-EPOCH is mostly similar.
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Affiliation(s)
- Kanta Devi
- Department of Oncology, Aga Khan University Hospital Karachi, Pakistan
- Corresponding author.
| | - Muhammad Usman Shaikh
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital Karachi, Pakistan
| | - Natasha Bahadur Ali
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital Karachi, Pakistan
| | - Salman Naseem Adil
- Department of Pathology and Laboratory Medicine, Aga Khan University Hospital Karachi, Pakistan
| | - Maria Khan
- Medical College, Aga Khan University Karachi, Pakistan
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