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Ullah A, Khan U, Asif S, Shafique HM, Sajid T, Kumar J, Akhtar W, Zaidi SMJ, Malik J, Mehmoodi A. Clinical outcomes of myocardial infarction with non-obstructive coronary arteries presenting with diabetic ketoacidosis: a propensity score-matched analysis. Eur J Med Res 2024; 29:36. [PMID: 38185694 PMCID: PMC10773043 DOI: 10.1186/s40001-023-01633-2] [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: 09/12/2023] [Accepted: 12/30/2023] [Indexed: 01/09/2024] Open
Abstract
INTRODUCTION AND OBJECTIVE There is a paucity of data on patients with myocardial infarction with nonobstructive coronary arteries (MINOCA) and a decompensated diabetic state, diabetic ketoacidosis (DKA). Therefore, we aimed to investigate the outcomes of patients with MINOCA presenting with or without DKA. METHODS We conducted this retrospective propensity score-matched analysis from January 1, 2015, to December 4, 2022. The patients with a principal admission diagnosis of ST-Elevation MI (STEMI) and discharge labeled as MINOCA (ICD-10-CM code 121.9) with DKA were analyzed. We performed a comparative analysis for MINOCA with and without DKA before and after propensity score matching for primary and secondary endpoints. RESULTS Three thousand five hundred sixty-three patients were analyzed, and 1150 (32.27%) presented with DKA, while 2413 (67.72%) presented as non-DKA. The DKA cohort had over two-fold mortality (5.56% vs. 1.19%; p = 0.024), reinfarction (5.82% vs. 1.45%; p = 0.021), stroke (4.43% vs. 1.36%; p = 0.035), heart failure (6.89% vs. 2.11%; p = 0.033), and cardiogenic shock (6.43% vs. 1.78%; p = 0.025) in a propensity score-matched analysis. There was an increased graded risk of MINOCA with DM (RR (95% CI): 0.50 (0.36-0.86; p = 0.023), DKA (RR (95% CI): 0.46 (0.24-0.67; p = 0.001), and other cardiovascular (CV) risk factors. CONCLUSION DKA complicates a portion of MINOCA and is associated with increased mortality and major adverse cardiovascular events (MACE).
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Affiliation(s)
- Asif Ullah
- Department of Cardiology, Khyber Medical Univerity Institute of Medical Sciences, Kohat, Pakistan
| | - Umar Khan
- Department of Pulmonology, University Hospital Kerry, Tralee, Ireland
| | - Shumaila Asif
- Department of Cardiology, Armed Forces Institute of Cardiology, Rawalpindi, Pakistan
| | | | - Talha Sajid
- Department of Medicine, Shifa International Hospital, Islamabad, Pakistan
| | - Jateesh Kumar
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | - Waheed Akhtar
- Department of Cardiology, Abbas Institute of Medical Sciences, Muzaffarabad, Pakistan
| | | | - Jahanzeb Malik
- Department of Cardiovascular Medicine, Cardiovascular Analytics Group, Canterbury, UK
| | - Amin Mehmoodi
- Department of Medicine, Ibn e Seena Hospital, Kabul, Afghanistan.
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Ahmad M, Nadeem S, Raza HA, Hashmi AW, Talat F, Kumar D, Zaidi SMJ, Mehmoodi A, Malik J. Outcomes of dual-chamber implantable cardioverter defibrillator for left bundle branch area pacing: A systematic review of literature. Ann Noninvasive Electrocardiol 2024; 29:e13098. [PMID: 37997513 PMCID: PMC10770818 DOI: 10.1111/anec.13098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 10/30/2023] [Accepted: 11/08/2023] [Indexed: 11/25/2023] Open
Abstract
OBJECTIVE This systematic review of literature aimed to evaluate the safety and efficacy of dual-chamber ICDs for LBBAP in patients with left bundle branch block (LBBB). METHODS Digital databases were searched systematically to identify studies reporting the left bundle branch area pacing (LBBAP) with implantable cardioverter defibrillator (ICD) placement in patients with LBBB. Detailed study and patient-level baseline characteristics including the type of study, sample size, follow-up, number of cases, age, gender, and baseline characteristics were abstracted. RESULTS In a total of three studies, 34 patients were included in this review. There was a significant improvement reported in QRS duration in all studies. The mean QRS duration at baseline was 170 ± 17.4 ms, whereas the follow-up QRS duration at follow-up was 121 ± 17.3 ms. Two studies reported a significant improvement of 50% in LVEF from baseline. No lead-related complications or arrhythmic events were recorded in any study. The findings of the systematic review suggest that dual-chamber ICD for LBBAP is a promising intervention for patients with heart conditions. CONCLUSION The procedure offers significant improvements in QRS duration and LVEF, and there were no lead-related complications or arrhythmic events recorded in any of the studies.
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Affiliation(s)
- Muhammad Ahmad
- Department of MedicineAl Saeed Medical ComplexRahim Yar KhanPakistan
| | - Saffa Nadeem
- Department of CardiologyMultan Institute of CardiologyMultanPakistan
| | - Hafiz Ahmed Raza
- Department of Emergency MedicineSocial Security HospitalSheikuphuraPakistan
| | | | - Fawad Talat
- Department of MedicineKing Edward Medical UniversityLahorePakistan
| | - Deepak Kumar
- Department of MedicineJinnah Sindh Medical UniversityKarachiPakistan
| | | | - Amin Mehmoodi
- Department of MedicineIbn e Seena HospitalKabulAfghanistan
| | - Jahanzeb Malik
- Department of Cardiovascular ResearchCardiovascular Analytics GroupIslamabadPakistan
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Zaidi SMJ, Ishaq U, Malik J, Nadir M, Almas T. Ticagrelor-Associated Urticaria. Am J Ther 2023; 30:e580-e583. [PMID: 35639409 DOI: 10.1097/mjt.0000000000001523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
| | - Uzma Ishaq
- Department of Hematology, Healthway's Laboratories, Rawalpindi, Pakistan
| | - Jahanzeb Malik
- Department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
| | - Maha Nadir
- Department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
| | - Talal Almas
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
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Shehram M, Khalid H, Shafique HM, Umer B, Zafar A, Ullah A, Zaidi SMJ, Basit J, Mehmoodi A, Malik J. Efficacy and safety of cardiac resynchronization therapy in chemotherapy-induced cardiomyopathy: A systematic review. Ann Noninvasive Electrocardiol 2023; 28:e13070. [PMID: 37435629 PMCID: PMC10475884 DOI: 10.1111/anec.13070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/12/2023] [Accepted: 06/27/2023] [Indexed: 07/13/2023] Open
Abstract
OBJECTIVE The aim of the study was to assess the efficacy of cardiac resynchronization therapy (CRT) in patients with chemotherapy-induced cardiomyopathy (CIC). METHODS With the increasing incidence of CIC, the association of CRT with improvement in clinical outcomes, echocardiographic parameters, and New York Heart Classification (NYHA) class was assessed through this qualitative systematic review. RESULTS The five studies included a total of 169 patients who underwent CRT after CIC, and of these, 61 (36.1%) patients were males. All studies showed an improvement in left ventricular ejection fraction (LVEF), among other echocardiographic parameters of LV volume. However, these findings are limited by short follow-up periods, small sample sizes, and the absence of a control group. CONCLUSION CRT was associated with improvement in all patient parameters with CIC.
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Affiliation(s)
- Muhammad Shehram
- Department of CardiologyMufti Mehmood Memorial Teaching HospitalDI KhanPakistan
| | - Hiba Khalid
- Department of DermatologyBenazir Bhutto HospitalRawalpindiPakistan
| | - Hafiz Muhammad Shafique
- Department of Interventional CardiologyArmed Forces Institute of CardiologyRawalpindiPakistan
| | - Bakht Umer
- Department of Interventional CardiologyArmed Forces Institute of CardiologyRawalpindiPakistan
| | - Awais Zafar
- Department of MedicineSahiwal Medical CollegeSahiwalPakistan
| | - Asif Ullah
- Department of CardiologyKhyber Medical University Institute of Medical SciencesKohatPakistan
| | | | - Jawad Basit
- Department of Cardiovascular MedicineCardiovascular Analytics GroupCanterburyUK
| | - Amin Mehmoodi
- Department of MedicineIbn e Seen HospitalKabulAfghanistan
| | - Jahanzeb Malik
- Department of Cardiovascular MedicineCardiovascular Analytics GroupCanterburyUK
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Ibne Ali Jaffari SM, Hashmi M, Hashmi AW, Nisar S, Ashraf H, Tariq G, Farooq A, Awan J, Zaidi SMJ, Kaneez M. Infection-Associated Mortality During Induction Chemotherapy in Group B Intermediate-Risk Pediatric Burkitt's Lymphoma. Cureus 2023; 15:e40365. [PMID: 37456486 PMCID: PMC10340133 DOI: 10.7759/cureus.40365] [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] [Accepted: 06/13/2023] [Indexed: 07/18/2023] Open
Abstract
Background Burkitt's lymphoma (BL) in the pediatric population has significant burden in developing countries. Infection-related complications during the induction chemotherapy phase pose a major challenge and contribute to high mortality rates due to a severely immunocompromised state. However, there is scarce data on the etiologies and optimal management strategies for infection-related mortality in pediatric BL patients, especially in developing countries like Pakistan. Methods This is a cross-sectional study that included a total of 116 pediatric patients with intermediate-risk BL. All patients were treated based on the Children's Cancer and Leukaemia Group (CCLG) 2020 guidelines. Data on patient demographics, presenting symptoms, diagnosis, infectious etiologies, and outcomes were collected. Infection-related complications and mortality were monitored during the induction chemotherapy period. The results of relevant culture reports were tabulated and data were analyzed. Results Among the 116 included patients, 61.1% were males with a mean age of 4.83 ± 2.12 years. Abdominal BL was the most common anatomical location. During the induction period, 66 patients (56.9%) had culture-proven infections, resulting in 33 deaths (28.4%). Fever was the predominant presenting symptom in all patients, followed by vomiting (57.6%), loose stools (42.4%), and cough (18.2%). Neutropenic colitis, sepsis, pneumonia, and meningitis were among the diagnosed infections. Hospital-acquired bacterial infections, including multi-drug resistant gram-negative and gram-positive organisms, were the main cause of mortality, with fungal infections and cytomegalovirus viremia also identified in a few patients. Conclusions This study highlights the urgent need for improved management strategies in pediatric BL patients in Pakistan to reduce infection-related complications and mortality rates, emphasizing the importance of context-specific approaches for infection prevention and management.
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Affiliation(s)
| | - Masooma Hashmi
- Internal Medicine, Walsall Manor Hospital, Royal Wolverhampton NHS Trust, Walsall, GBR
| | | | - Samaha Nisar
- Pediatrics, Shalamar Medical and Dental College, Lahore, PAK
| | - Hafsa Ashraf
- Pediatrics, Shalamar Medical and Dental College, Lahore, PAK
| | - Ghufran Tariq
- Pediatrics, Arif Memorial Teaching Hospital, Lahore, PAK
| | - Arslan Farooq
- Internal Medicine, Combined Military Hospital, Lahore, PAK
| | - Javeria Awan
- Pediatrics, Rawalpindi Medical University, Rawalpindi, PAK
| | - Syed Muhammad Jawad Zaidi
- Pediatrics, Holy Family Hospital, Rawalpindi, PAK
- Pediatric Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Mehwish Kaneez
- Pediatrics, Holy Family Hospital, Rawalpindi, PAK
- Pediatric Oncology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
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Almas T, Ehtesham M, Khan AA, Ramtohul RK, Nazir M, Zaidi SMJ, Alsubai AK, Al-Ansari H, Awais M, Alsufyani R, Alsufyani M, Almesri A, Ismail H, Hadeed S, Malik J. Effect of COVID-19 on cardiac electrophysiology practice: A systematic review of literature. Ann Med Surg (Lond) 2023; 85:884-891. [PMID: 37113877 PMCID: PMC10129206 DOI: 10.1097/ms9.0000000000000328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 02/12/2023] [Indexed: 03/31/2023] Open
Abstract
The authors conducted a systematic review on the effect of coronavirus disease 2019 on electrophysiology (EP) practice and procedure volume in various settings. This review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. PubMed/MEDLINE, Scopus, Web of Science, CINAHL, and Embase were examined with combinations of medical subject headings terms for identification of the relevant studies. After excluding duplicates, irrelevant, and ineligible studies, 23 studies were included for full qualitative analysis. The overall study-level volume reduction of EP procedures ranged from 8 to 96.7%. All studies reported an overall reduction in EP physiology procedures being carried out except one in Poland, which reported an overall increase in the total EP procedures carried out in 2020. This study still reported a decrease in EP procedure volume during the first lockdown phase. Procedural volume reduction was seen most commonly for cardiovascular implantable electronic device placement (20/23 studies, 86.9%), electrophysiology studies (11/23 studies, 47.8%), and ablations (9/23, 39.1% studies). The most common reason stated for the observed decline in EP procedures was the cancellation and postponement of nonurgent elective cases in the hospitals (15/23 studies, 65.2%). There has been an overall reduction in EP procedure volume across different centers. The impact of the decline in EP procedures will be seen only after the services resume to prepandemic levels, but an increase in-patient volume and procedure waiting time is expected. This review will provide insights into improving healthcare service delivery in times of unprecedented public health emergencies.
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Rashid S, Noor TA, Saeed H, Ali AS, Meheshwari G, Mehmood A, Fatima L, Zaidi SMJ, Malik J, Mehmoodi A, Hayat A. Association of gut microbiome dysbiosis with the progression of atrial fibrillation: A systematic review. Ann Noninvasive Electrocardiol 2023:e13059. [PMID: 36940225 DOI: 10.1111/anec.13059] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/09/2023] [Indexed: 03/21/2023] Open
Abstract
OBJECTIVE Many clinical and preclinical studies have implicated an association between atrial fibrillation (AF) and its progression to imbalances in the gut microbiome composition. The gut microbiome is a diverse and complex ecosystem containing billions of microorganisms that produce biologically active metabolites influencing the host disease development. METHODS For this review, a literature search was conducted using digital databases to systematically identify the studies reporting the association of gut microbiota with AF progression. RESULTS In a total of 14 studies, 2479 patients were recruited for the final analysis. More than half (n = 8) of the studies reported alterations in alpha diversity in atrial fibrillation. As for the beta diversity, 10 studies showed significant alterations. Almost all studies that assessed gut microbiota alterations reported major taxa associated with atrial fibrillation. Most studies focused on short-chain fatty acids (SCFAs), whereas three studies evaluated TMAO levels in the blood, which is the breakdown product of dietary l-carnitine, choline, and lecithin. Moreover, an independent cohort study assessed the relationship between phenylacetylglutamine (PAGIn) and AF. CONCLUSION Intestinal dysbiosis is a modifiable risk factor that might provide newer treatment strategies for AF prevention. Well-designed research and prospective randomized interventional studies are required to target the gut dysbiotic mechanisms and determine the gut dysbiotic-AF relationship.
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Affiliation(s)
- Sarim Rashid
- Department of General Surgery, Eash Lancashire NHS Hospital, Burnley, UK
| | | | - Hamayle Saeed
- Department of Medicine, Fatima Memorial Hospital, Lahore, Pakistan
| | - Asma Sabir Ali
- Department of Dermatology, KRL Hospital, Islamabad, Pakistan
| | - Govinda Meheshwari
- Department of Medicine, Jinnah Postgraduate Medical Center, Karachi, Pakistan
| | - Asad Mehmood
- Department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
| | - Laveeza Fatima
- Department of Medicine, Allama Iqbal Medical College, Lahore, Pakistan
| | - Syed Muhammad Jawad Zaidi
- Department of Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan.,Department of Cardiovascular Research, Cardiovascular Analytics Group, Canterbury, UK
| | - Jahanzeb Malik
- Department of Cardiovascular Research, Cardiovascular Analytics Group, Canterbury, UK.,Department of Electrophysiology, Armed Forces Institute of Cardiology, Rawalpindi, Pakistan
| | - Amin Mehmoodi
- Department of Medicine, Ibn e Seena Hospital, Kabul, Afghanistan
| | - Azmat Hayat
- Department of Electrophysiology, Armed Forces Institute of Cardiology, Rawalpindi, Pakistan
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Sami A, Mustafa B, Butt HA, Ashraf Z, Ullah A, Babar F, Asad M, Awais M, Zaidi SMJ, Fakhar T, Mehmoodi A, Adnan N, Malik J. Echocardiography- versus intracardiac electrocardiogram-based optimization of cardiac resynchronization therapy: A systematic review. Ann Noninvasive Electrocardiol 2023; 28:e13040. [PMID: 36606676 PMCID: PMC10023891 DOI: 10.1111/anec.13040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 12/19/2022] [Accepted: 12/22/2022] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE This systematic review aimed to evaluate the performance of echocardiography-based programming in comparison with the intracardiac electrocardiogram (IEGM)-based method for the optimization of cardiac resynchronization therapy (CRT). METHODS A literature review was conducted using digital databases to systematically identify the studies reporting CRT optimization through echocardiography compared with IEGM. Detailed patient-level study characteristics including the type of study, sample size, therapy, the New York Heart Classification (NYHA) status, lead placement, and other parameters were abstracted. Finally, postprogramming outcomes were extracted for each article. RESULTS In a total of 11 studies, 919 patients were recruited for the final analysis. Overall, 692 (75.29%) were males. The mean duration of the QRS complex in our study population ranged from 145.2 ± 21.8 ms to 183 ± 19.9 ms. There was an equal improvement in the NYHA class between the two methods while the left ventricular ejection fraction (LVEF) demonstrated an improvement by IEGM. Many studies supported IEGM to increase the 6-minute walk test and left ventricular outflow tract velocity time interval (LVOT VTI) when compared to echocardiography. The mean time for echocardiography-based optimization was 60.15 min while that of IEGM-based optimization was 6.65 min. CONCLUSION IEGM is an alternative method for CRT optimization in improving the NYHA class, LVEF, and LVOT VTI, and is less time-consuming when compared to the echocardiography-based methods.
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Affiliation(s)
- Abdul Sami
- Department of CardiologyDHQ Teaching HospitalKohatPakistan
| | - Bilal Mustafa
- Department of CardiologyAkbar Niazi Teaching HospitalIslamabadPakistan
| | | | - Zainab Ashraf
- Department of MedicineCMH Lahore Medical CollegeLahorePakistan
| | - Asif Ullah
- Department of CardiologyKhyber Medical University Institute of Medical SciencesKohatPakistan
| | | | - Muhammad Asad
- Department of CardiologyBenazir Bhutto HospitalRawalpindiPakistan
| | - Muhammad Awais
- Department of ElectrophysiologyArmed Forces Institute of CardiologyRawalpindiPakistan
| | | | - Tehniat Fakhar
- Department of MedicineShifa Tameer e Millat UniversityIslamabadPakistan
| | - Amin Mehmoodi
- Department of MedicineIbn e Seena HospitalKabulAfghanistan
| | - Nawal Adnan
- Department of MedicineJinnah Sindh Medical UniversityKarachiPakistan
| | - Jahanzeb Malik
- Department of ElectrophysiologyArmed Forces Institute of CardiologyRawalpindiPakistan
- Cardiovascular Analytics GroupHong KongChina
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Abstract
Dengue viral illness is endemic in many tropical countries with temperate climates. The haematological and cardiovascular sequelae of dengue are well known; however, respiratory manifestations are still an area of active medical research. We conducted a literature search on PubMed, Medline CINAHIL, EMBASE and found 64 articles on respiratory sequelae of dengue. All relevant original articles and case reports were included and the relevant information regarding the respiratory manifestations of dengue was retrieved from the relevant eligible articles. Respiratory manifestations of dengue range from mild pleural effusion to acute respiratory distress syndrome. The former was the most common complication, seen in 5.1% of patients, followed by acute respiratory distress syndrome (ARDS) in 1.7%, pneumonia in 0.5%, respiratory distress in 0.3%, pulmonary hemorrhage in 0.1%, and haemothorax in 0.01%. Involvement of the respiratory system indicates severe disease and is difficult to manage. Therefore its early detection is important.
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Affiliation(s)
- Asad Mehmood
- Department of Cardiology, 418648Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
| | | | - Muhammad Ahmad
- Department of Medicine, Bahawal Victoria Hospital, Bahawalpur, Pakistan
| | - Mahreen Mufti
- Department of Medicine, 66909Allama Iqbal Medical College, Lahore, Pakistan
| | - Jahanzeb Malik
- Department of Cardiac Electrophysiology, Armed Forces Institute of Cardiology, National Institute of Heart Diseases, Rawalpindi, Pakistan
| | - Syed Muhammad Jawad Zaidi
- Department of Medicine, 123683Rawalpindi Medical University and Allied Hospitals, Rawalpindi, Pakistan
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Rashid H, Haq ZU, Alam S, Nazir M, Nadir M, Fakhar T, Zaidi SMJ, Mustafa B, Malik J. Procedural complications associated with percutaneous mitral balloon valvotomy: A systematic review. Expert Rev Cardiovasc Ther 2022; 20:929-932. [PMID: 36421070 DOI: 10.1080/14779072.2022.2152328] [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] [Indexed: 11/25/2022]
Abstract
BACKGROUND As Percutaneous mitral balloon valvotomy (PMBV) remains the keystone in treating mitral stenosis, we conducted this review to elucidate the cumulative frequency and predictors of complications following PMBV and their occurrence in various patient populations. AREAS COVERED We searched digital databases for relevant studies covering complications of PMBV and retrieved articles using the Medical Subject Heading (MeSH) keywords. EXPERT OPINION A total of 37 articles (8 RCTs, 7 nonrandomized clinical trials, 22 observational studies) were selected for qualitative analysis. A total of 11,803 patients undergoing PMBV among 37 studies were included, with a mean success rate of 84.54%. The most common complication was mitral regurgitation (8.2%) followed by an atrial septal defect (2.4%). Other relevant complications like stroke, pericardial tamponade, rupture of mitral leaflets, and conduction abnormalities were present in <1% of the patients.
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Affiliation(s)
- Haroon Rashid
- Department of Critical Care, Wythenshawe Hospital, Manchester, England
| | - Zargham Ul Haq
- Medical Student, Lahore Medical and Dental College, Lahore, Pakistan
| | - Shafiq Alam
- Department of Cardiology, Mardan Medical Complex, Mardan, Pakistan
| | - Maheen Nazir
- Medical Student, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Maha Nadir
- Department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
| | - Tehniat Fakhar
- Medical Student, Shifa College of Medicine, Islamabad, Pakistan
| | | | - Bilal Mustafa
- Department of Cardiology, Akbar Niazi Teaching Hospital, Islamabad, Pakistan
| | - Jahanzeb Malik
- Department of Electrophysiology, Armed Forces Institute of Cardiology, Rawalpindi, Pakistan
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Almas T, Haider R, Malik J, Mehmood A, Alvi A, Naz H, Satti DI, Zaidi SMJ, AlSubai AK, AlNajdi S, Alsufyani R, Ramtohul RK, Almesri A, Alsufyani M, H. Al-Bunnia A, Alghamdi HAS, Sattar Y, Alraies MC, Raina S. Nanotechnology in interventional cardiology: A state-of-the-art review. IJC Heart & Vasculature 2022; 43:101149. [DOI: 10.1016/j.ijcha.2022.101149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Revised: 11/03/2022] [Accepted: 11/14/2022] [Indexed: 11/19/2022]
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Naz H, Haider R, Rashid H, Ul Haq Z, Malik J, Zaidi SMJ, Ishaq U, Trevisan R. Islamic fasting: cardiovascular disease perspective. Expert Rev Cardiovasc Ther 2022; 20:795-805. [PMID: 36260858 DOI: 10.1080/14779072.2022.2138344] [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] [Indexed: 10/31/2022]
Abstract
INTRODUCTION Ramadan is a month of obligatory fasting observed by the majority of 2 billion Muslims living around the globe. The guidelines for 'risk-free' fasting exist for chronic diseases, including diabetes mellitus, but recommendations for cardiovascular disease (CVD) patients are deficient due to the paucity of literature. AREAS COVERED Databases were screened to find relevant studies for an evidence-based consensus regarding the risk stratification and management of CVD. Using practical guidelines of the European Society of Cardiology (ESC), we categorized patients into low-, moderate-, and high-risk categories and proposed a pre-Ramadan checklist for the assessment of cardiac patients before fasting. Regular moderate-intensity exercise is recommended for most cardiac patients, which has been demonstrated to provide an anti-inflammatory and antioxidant effect that improves immune function. EXPERT OPINION In Ramadan, many physiological changes occur during fasting, which brings about a balanced metabolic homeostasis of the body. In addition, Ramadan fasting is a nonpharmacologic means of decreasing CV risk factors. As Islam exempts Muslims from fasting if they are unwell; therefore, patients with the acute coronary syndrome (ACS), advanced heart failure (HF), recent percutaneous coronary intervention (PCI), or cardiac surgery should avoid fasting.
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Affiliation(s)
- Hifza Naz
- Medical Student, School of Medicine and Surgery, University of Milan Bicocca, Bergamo, Italy
| | - Rakhshan Haider
- Department of Medicine, Shifa International Hospital, Islamabad, Pakistan
| | - Haroon Rashid
- Department of Intensive care, Wythenshawe Hospital, Manchester, UK
| | | | - Jahanzeb Malik
- Department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
| | | | - Uzma Ishaq
- Department of Hematology, Healthways Laboratories, Rawalpindi, Pakistan
| | - Roberto Trevisan
- Department of Endocrinology, Azienda Socio Sanitaria Territoriale Papa Giovanni XXIII, Bergamo, Italy
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Akhtar W, Awan S, Ishaq U, Malik A, Malik J, Zaidi SMJ. Pyrexia of unknown origin and its aetiology in Pakistan. Trop Doct 2022; 52:567-571. [PMID: 35833343 DOI: 10.1177/00494755221096902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Pyrexia of unknown origin (PUO) and its aetiology vary considerably according to geography. We conducted a retrospective study to update our knowledge of PUO in Pakistan. PUO was defined as a febrile illness of >3 weeks' duration, a temperature of >38.3°C, and >3 outpatient visits or 3 days' hospitalization. Infection was the cause in 47.1%, malignancy in 23.1%, noninfectious inflammatory disease in 21.8%, miscellaneous causes in 1.2%, and in 6.8%, the cause of the fever was not found.
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Affiliation(s)
- Waheed Akhtar
- Department of Cardiology, 172630Abbas Institute of Medical Sciences, Muzaffarabad, Pakistan
| | - Sobia Awan
- Department of Dermatology, 172630Abbas Institute of Medical Sciences, Muzaffarabad, Pakistan
| | - Uzma Ishaq
- Department of Hematology, Health ways Laboratories, Rawalpindi, Pakistan
| | - Asmara Malik
- Department of Community medicine, 445232National University of Medical Sciences, Rawalpindi, Pakistan
| | - Jahanzeb Malik
- Department of Cardiology, 418648Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
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14
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Zaidi SMJ, Sohail H, Satti DI, Sami A, Anwar M, Malik J, Mustafa B, Mustafa M, Mehmoodi A. Tricuspid regurgitation in His bundle pacing: A systematic review. Ann Noninvasive Electrocardiol 2022; 27:e12986. [PMID: 35763445 DOI: 10.1111/anec.12986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 05/31/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE This systematic review aimed to explore an association of new TR and its quantification in patients undergoing His bundle pacing (HBP). METHODS A literature review was conducted using Mesh terms (His bundle pacing, tricuspid regurgitation, tricuspid valve incompetence, etc.) in PubMed, EMBASE, Web of science CINAHL, and the Cochrane Library till October 2021. Relevant studies evaluating tricuspid regurgitation in HBP were included and information regarding TR and its related factors (ejection fraction (EF) and New York Heart Association (NYHA) class) were retrieved from the eligible studies. RESULTS Out of 196 articles, 10 studies met the inclusion criteria, which consisted of 546 patients with HBP. The mean age of the patients ranged between 61.2 ± 12.3 and 75.1 ± 7.9 years with 54.1% males. The overall implant success rate was 79.2%. Only one study reported a 5% incidence of TR, while 9 studies reported no new TR after HBP. Four studies reported overall decrease in TR by 1 grade and 3 studies demonstrated increased TR from baseline. Two studies showed no change from baseline TR. CONCLUSION HBP causes improvement in TR grade after HBP for cardiac resynchronization therapy (CRT) as well as atrioventricular block (AVB). Further studies in the form of randomized controlled trials are required to further evaluate the effect of HBP on tricuspid valve functioning.
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Affiliation(s)
| | - Hasan Sohail
- Department of Cardiology, Sialkot Medical Complex, Sialkot, Pakistan
| | | | - Abdul Sami
- Department of Electrophysiology, DHQ Teaching Hospital, Kohat, Pakistan
| | - Mateen Anwar
- Department of Cardiology, THQ Hospital, Pakistan
| | - Jahanzeb Malik
- Department of Interventional Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
| | - Bilal Mustafa
- Department of Cardiology, Akbar Niazi Teaching Hospital, Islamabad, Pakistan
| | - Mohammad Mustafa
- Department of Interventional Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
| | - Amin Mehmoodi
- Department of Medicine, Ibn e Seena Hospital, Kabul, Afghanistan
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15
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Abstract
BACKGROUND : Dengue is the most important viral diseases globally and a majority of symptomatic infections result in a benign course. However, a small number of patients develop severe manifestations, including myocardial impairment, arrhythmias, and fulminant myocarditis. AREAS COVERED This review outlines the incidence of cardiovascular (CV) manifestations of dengue. Electronic databases, including PubMed/MEDLINE, EMBASE, Scopus, and CINAHL were searched for articles incorporating cardiac manifestations of dengue fever (DF). EXPERT OPINION : Included studies involved 6,773 patients and 3,122 (46.1%) exhibited at least one cardiac manifestation with DF. Electrocardiogram (ECG) abnormalities (30.6%) included sinus bradycardia (8.8%), non-specific ST-T changes (8.6%), ST depression (7.9%), and T-wave inversion (2.3%). Mechanical sequelae were present in 10.4%, including left ventricular (LV) systolic dysfunction (5.7%), and myocarditis (2.9%). Pericardial involvement was noted as pericarditis (0.1%), pericardial effusion (1.3%), and pericardial tamponade (0.1%). Apart from that, the cardiac injury was depicted through a rise in cardiac enzymes (4.5%). The spectrum of CV manifestations in dengue is broad, ranging from subtle ST-T changes to fulminant myocarditis. This can be a cause of hemodynamic collapse during the critical phase of capillary leakage. Use of contemporary techniques in diagnosing cardiac involvement should be employed for rapid diagnosis and treatment in DF.
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Affiliation(s)
- Abdur Rahim
- Department of Cardiology, Saidu Teaching Hospital, Saidu Sharif, Swat, Pakistan
| | - Ali Hameed
- Department of Cardiology, Punjab Institute of Cardiology, Lahore, Pakistan
| | - Uzma Ishaq
- Department of Hematology, Foundation University Medical College Islamabad, Pakistan
| | - Jahanzeb Malik
- Department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
| | | | | | - Asmara Malik
- Department of Community Medicine, National University of Medical Sciences, Rawalpindi, Pakistan
| | - Danish Iltaf Satti
- Department of Medicine, Shifa Tameer e Millat University, Islamabad, Pakistan
| | - Hifza Naz
- Department of Medicine, Universita degli studi di Milano, Milan, Italy
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16
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Nazir A, Niazi K, Zaidi SMJ, Ali M, Maqsood S, Malik J, Kaneez M, Mehmoodi A. Success Rate and Complications of the Supraclavicular Approach for Central Venous Access: A Systematic Review. Cureus 2022; 14:e23781. [PMID: 35518538 PMCID: PMC9063609 DOI: 10.7759/cureus.23781] [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] [Accepted: 04/03/2022] [Indexed: 11/05/2022] Open
Abstract
Central venous catheterization plays a key role in patients that require immediate resuscitation, long-term fluid management, and invasive monitoring. The supraclavicular (SC) and infraclavicular (IC) approaches are utilized for central venous catheterization and both have their benefits and limitations. In this systematic review, we aim to explore the success rate and various complications of the SC technique. A literature review was conducted on the PubMed, EMBASE, Scopus, CINAHL, and Cochrane databases. All relevant original articles that evaluated success rates and complications of SC access were retrieved and included for qualitative synthesis. After screening 1040 articles, 28 studies were included for further analysis. The overall success rate of SC access ranged between 79% and 100%. The overall complication rate in SC access ranged between 0% and 24.24% (Mean: 4.27%). The most prevalent complication was arterial puncture (1.39%) followed by catheter malposition (0.42%). The SC approach can be used as an alternative to the IC technique because of its low access time and high success rate. The SC approach should be more commonly used in day-to-day central venous cannulation. Further studies on the role of ultrasound guidance are warranted for the SC approach.
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17
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Ghauri H, Iqbal R, Ahmed S, Ashraf A, Khan MSQ, Malik J, Zaidi SMJ, Almas T. Predictors of permanent pacemaker insertion after mitral valve replacement: a systematic review. Pacing Clin Electrophysiol 2022; 45:681-687. [PMID: 35304920 DOI: 10.1111/pace.14484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 12/30/2021] [Revised: 03/01/2022] [Accepted: 02/27/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE As the established surgical mitral valve replacement (MVR) expands towards various contemporary techniques and access routes, the predictors and burden of procedure-related complications including the need for permanent pacemaker (PPM) implantation need to be identified. METHODS Digital databases were searched systematically to identify studies reporting the incidence of PPM implantation after MVR. Detailed study and patient-level baseline characteristics including the type of study, sample size, follow-up, number of post-MVR PPM implantations, age, gender, and baseline ECG abnormalities were abstracted. RESULTS A total of 12 studies, recruiting 37,124 patients were included in the final analysis. Overall, 2,820 (7.6%) patients required a PPM with the net rate ranging from 1.7% to 10.96%. Post-MVR atrioventricular (AV) block was the most commonly observed indication for PPM, followed by sinoatrial (SA) node dysfunction, and bradycardia. Age, male gender, pre-existing comorbid conditions, prior CABG, history of arrhythmias or using anti-arrhythmic drugs, AF ablation, and double valve replacement were predictors of PPM implantation post-MVR. CONCLUSION Age, male gender, comorbid conditions like diabetes and renal impairment, prior CABG, double valve replacement, and anti-arrhythmic drugs served as positive predictors of PPM implantation in patients undergoing MVR. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Hamza Ghauri
- Department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
| | - Raafe Iqbal
- Department of Cardiology, Wah Medical College, Wah, Pakistan
| | - Sohail Ahmed
- Department of Cardiology, DHQ Hospital, Chakwal, Pakistan
| | - Amna Ashraf
- Department of Medicine, Military Hospital, Rawalpindi, Pakistan
| | | | - Jahanzeb Malik
- Department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
| | | | - Talal Almas
- Department of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
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18
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Ishaq U, Malik A, Malik J, Mehmood A, Qureshi A, Laique T, Zaidi SMJ, Javaid M, Rana AS. Association of ABO blood group with COVID-19 severity, acute phase reactants and mortality. PLoS One 2021; 16:e0261432. [PMID: 34905588 PMCID: PMC8670663 DOI: 10.1371/journal.pone.0261432] [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] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 12/01/2021] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Coronavirus disease 2019 (COVID-19) is the ongoing pandemic with multitude of manifestations and association of ABO blood group in South-East Asian population needs to be explored. METHODS It was a retrospective study of patients with COVID-19. Blood group A, B, O, and AB were identified in every participant, irrespective of their RH type and allotted groups 1, 2,3, and 4, respectively. Correlation between blood group and lab parameters was presented as histogram distributed among the four groups. Multivariate regression and logistic regression were used for inferential statistics. RESULTS The cohort included 1067 patients: 521 (48.8%) participants had blood group O as the prevalent blood type. Overall, 10.6% COVID-19-related mortality was observed at our center. Mortality was 13.9% in blood group A, 9.5% in group B, 10% in group C, and 10.2% in AB blood group (p = 0.412). IL-6 was elevated in blood group A (median [IQR]: 23.6 [17.5,43.8]), Procalcitonin in blood group B (median [IQR]: 0.54 [0.3,0.7]), D-dimers and CRP in group AB (median [IQR]: 21.5 [9,34]; 24 [9,49], respectively). Regarding severity of COVID-19 disease, no statistical difference was seen between the blood groups. Alteration of the acute phase reactants was not positively associated with any specific blood type. CONCLUSION In conclusion, this investigation did not show significant association of blood groups with severity and of COVID-19 disease and COVID-19-associated mortality.
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Affiliation(s)
- Uzma Ishaq
- Department of Hematology, Foundation University Medical College, Islamabad, Pakistan
| | - Asmara Malik
- Department of Community Medicine, National University of Medical Sciences, Rawalpindi, Pakistan
| | - Jahanzeb Malik
- Department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
- Department of Cardiology, Advanced Diagnostics and Liver Center, Rawalpindi, Pakistan
| | - Asad Mehmood
- Department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
| | - Azhar Qureshi
- Department of Cardiology, Armed Forces Institute of Cardiology, Rawalpindi, Pakistan
| | - Talha Laique
- Department of Pharmacology, Allama Iqbal Medical College, Lahore, Pakistan
| | | | - Muhammad Javaid
- Department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
| | - Abdul Sattar Rana
- Department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
- Department of Cardiology, Advanced Diagnostics and Liver Center, Rawalpindi, Pakistan
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Mughal HH, Zaidi SMJ, Bhatti HW, Maryum M, Khaliq M, Khan N, Kaneez M. Comparison of chest HRCT severity score in PCR positive and PCR negative clinically suspected COVID-19 Patients. Afr Health Sci 2021; 21:1558-1566. [PMID: 35283962 PMCID: PMC8889845 DOI: 10.4314/ahs.v21i4.9] [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] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background The limitations and false-negative results of Real-time Polymerase chain reaction (RT PCR) in diagnosing COVID-19 infection demand the need for imaging modalities such as chest HRCT to improve the diagnostic accuracy and assess the severity of the infection. Objectives The study aimed to compare the chest HRCT severity scores in RT-PCR positive and negative cases of COVID-19. Methods This cross-sectional study included 50 clinically suspected COVID-19 patients. Chest HRCT and PCR testing of all 50 patients were done and the chest HRCT severity scores for each lung and bronchopulmonary segments were compared in patients with positive and negative PCR results. Chi-square and Mann Whitney U test were used to assess differences among study variables Results Chest HRCT severity score was more in PCR negative patients than in those with PCR positive results. However, the difference was not significant (p=0.11). There was a significant association in severity scores of the anterior basal segment of the left lung (p=0.022) and posterior segment upper lobe of right lung (p=0.035) with PCR results. This association was insignificant for other bronchopulmonary segments (p>0.05). Conclusion CR negativity does not rule out infection in clinically suspected COVID-19 patients. The use of chest HRCT helps to determine the extent of lung damage in clinically suspected patients irrespective of PCR results. Guidelines that consider clinical symptoms, chest HRCT severity score and PCR results for a confirmed diagnosis of COVID-19 in suspected patients are needed.
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Affiliation(s)
| | | | | | | | | | - Nasir Khan
- Holy Family Hospital, Department of Radiology
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20
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Malik J, Zaidi SMJ, Rana AS, Haider A, Tahir S. Post-cardiac injury syndrome: An evidence-based approach to diagnosis and treatment. Am Heart J Plus 2021; 12:100068. [PMID: 38559602 PMCID: PMC10978175 DOI: 10.1016/j.ahjo.2021.100068] [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] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Revised: 10/12/2021] [Accepted: 10/22/2021] [Indexed: 04/04/2024]
Abstract
Post-cardiac injury syndrome (PCIS) is an umbrella term used for the post-pericardiotomy syndrome, post-myocardial infarction (MI) related pericarditis (Dressler syndrome), and post-traumatic pericarditis (percutaneous coronary intervention (PCI) or cardiac implantable electronic device (CIED) placement). All these conditions give rise to PCIS due to an inciting cardiac injury to pericardial or pleural mesothelial cells, leading to subsequent inflammation syndromes ranging from uncomplicated pericarditis to massive pleural effusion. We did a literature search on MEDLINE/PubMed for relevant studies using the terms "post-acute cardiac injury syndrome", "post-cardiac injury syndrome", "post-cardiotomy syndrome", "post-pericardiotomy syndrome", "post-MI pericarditis" and to summarize the body of evidence, all relevant full texts were selected and incorporated in a narrative fashion. Pathophysiology of PCIS is suggested as autoimmune-mediated in predisposed patients who develop anti-actin and anti-myosin antibodies following a cascade of cardiac injury in various forms. Colchicine and NSAIDs including ibuprofen are demonstrated as efficacious in preventing recurrent attacks of PCIS while corticosteroids show no benefit on prognosis and recurrence of the disease.
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Affiliation(s)
- Jahanzeb Malik
- Department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi 46000, Pakistan
| | | | - Abdul Sattar Rana
- Department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi 46000, Pakistan
| | - Ali Haider
- Department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi 46000, Pakistan
| | - Saleha Tahir
- Department of Respiratory Medicine, Shifa International Hospital, Islamabad 44000, Pakistan
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21
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Javed N, Iqbal R, Malik J, Rana G, Akhtar W, Zaidi SMJ. Tricuspid insufficiency after cardiac-implantable electronic device placement. J Community Hosp Intern Med Perspect 2021; 11:793-798. [PMID: 34804393 PMCID: PMC8604508 DOI: 10.1080/20009666.2021.1967569] [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] [Indexed: 11/29/2022] Open
Abstract
Objective Device-related estimates of incidence and significance of tricuspid regurgitation (TR) is mainly based on case reports and small observational studies. We sought to determine whether right-heart device implantation increased the risk of TR in this interventional study. Methods All patients who underwent permanent pacemaker (PPM) or other device implantation were assessed for degree of TR at one year. The data collected was analyzed on IBM SPSS version 26. Descriptive statistics were applied for qualitative variables. Mean and standard deviation were applied for quantitative variables. Regression analysis and paired t-tests were applied for the degree of change and predictors of TR. Results Out of 165 participants, 73.94% were male. The mean age of the participants was 59.86 ± 12.03 years. Dual-chamber pacemaker (DDDR) was the most common device implanted (78.18%) causing significant TR and drop in left ventricular ejection fraction as compared to other devices (p-value < 0.05). The paired t-test for changes in ejection fraction (LVEF) and TR were also significant (p-value < 0.05). A regression model predicted significant TR to depend on baseline LVEF (p-value < 0.05). Conclusion Device-related worsening of TR is related to mechanical mechanisms. It is significantly associated with DDDR pacemakers after a 1-year follow-up.
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Affiliation(s)
- Nismat Javed
- Department of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Raafe Iqbal
- Department of Cardiology, Pakistan Ordinances Factory Hospital, Wah Cantt, Pakistan
| | - Jahanzeb Malik
- Department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
| | - Ghazanfar Rana
- Department of Cardiology, St. Lukes General Hospital, Kilkenny, Ireland
| | - Waheed Akhtar
- Department of Cardiology, Abbas Institute of Medical Sciences, Muzaffarabad, Pakistan
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22
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Malik J, Zaidi SMJ, Waqar AU, Khawaja H, Malik A, Ishaq U, Rana AS, Awan AH. Association of hypothyroidism with acute COVID-19: a systematic review. Expert Rev Endocrinol Metab 2021; 16:251-257. [PMID: 34424110 DOI: 10.1080/17446651.2021.1968830] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 08/11/2021] [Indexed: 01/09/2023]
Abstract
OBJECTIVE There is an increasing body of literature on the impact of COVID-19 on the pituitary-thyroid axis. Therefore, we conducted a systematic review to assess the prevalence of hypothyroidism in patients with COVID-19. METHODS A literature review was conducted using LitCOVID for study selection in PubMed and MEDLINE till May 2021. All relevant original articles evaluating thyroid dysfunction were included and information regarding the prevalence of hypothyroid disease in COVID-19 was retrieved from the eligible articles. RESULTS Out of 32 articles, six articles qualified for the final analysis which included 1160 patients. There was significant heterogeneity among the included articles. Most of the patients had lower mean triiodothyronine (T3) and normal or low thyroid-stimulating hormone (TSH). Increased TSH ranged from 5.1% to 8% while low T3 was present in up to 28% of the patients. In these studies, the prevalence of altered thyroid hormones was significantly more in COVID-19 patients as compared to control groups. A positive correlation between low mean T3 and clinical severity of COVID-19 was reported. CONCLUSION This systematic review reveals a significant proportion of hypothyroidism associated with COVID-19. Therefore, routine assessment of thyroid function is warranted in hospitalized COVID-19 patients.
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Affiliation(s)
- Jahanzeb Malik
- Department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
| | | | - Ali Umer Waqar
- Department of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Hashir Khawaja
- Department of Medicine, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Asmara Malik
- Department of Community Medicine, National University of Medical Sciences, Rawalpindi, Pakistan
| | - Uzma Ishaq
- Department of Hematology, Foundation University Medical College, Islamabad, Pakistan
| | - Abdul Sattar Rana
- Department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
| | - Ali Haider Awan
- Department of Cardiology, Rawalpindi Institute of Cardiology, Rawalpindi, Pakistan
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Almas T, Niaz MA, Zaidi SMJ, Haroon M, Khedro T, Alsufyani R, Al-Awaid AH, Tran E, Khan AW, Alaeddin H, Rifai A, Manamperi KT, Khan A, Haadi A. The Spectrum of Clinical Characteristics and Complications of Tetanus: A Retrospective Cross-Sectional Study From a Developing Nation. Cureus 2021; 13:e15484. [PMID: 34268020 PMCID: PMC8261793 DOI: 10.7759/cureus.15484] [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] [Accepted: 06/06/2021] [Indexed: 11/21/2022] Open
Abstract
Introduction While tetanus has largely been eradicated with the advent of the tetanus vaccine, its prevalence in Pakistan remains alarmingly high due to insufficient uptake of the vaccination program. The clinical presentations that the disease elicits range from mere opisthotonos to more sinister complications, including respiratory failure and death, often posing an insurmountable challenge for hospitals. Methods A retrospective cross-sectional study was conducted and analyzed the medical charts of 43 patients with a confirmed diagnosis of tetanus infection. The charts were perused for the patients' demographics, clinical characteristics, and disease outcomes. The prevalence of various clinical symptoms and complications were reported in terms of frequencies and percentages. Results The mean age of the patients hovered at 29.53 ± 16.53 years, with a range of 12 to 65 years. Of those affected, 83.7% were males while 16.3% were females. Notably, none of the infected patients had a prior history of vaccination against tetanus. Trismus was noted to be the most prevalent clinical manifestation and was found in 90.70% of the patients while paraesthesia at the site of infection, found in 6.98%, was the least prevalent. The overall mortality was noted to hover at 46.5%. Conclusion While tetanus has largely been eradicated, its prevalence in Pakistan remains alarmingly high. The complications noted in the study have implications for the country's public health system and aims to better inform the current state of the national vaccination program.
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Affiliation(s)
- Talal Almas
- Internal Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
| | | | | | | | - Tarek Khedro
- Internal Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
| | - Reema Alsufyani
- Internal Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
| | | | - Estelle Tran
- Internal Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
| | - Abdul Wali Khan
- Internal Medicine, College of Physicians and Surgeons Pakistan, Peshawar, PAK
- Internal Medicine, Hayatabad Medical Complex, Peshawar, PAK
| | - Hasan Alaeddin
- Internal Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
| | - Ali Rifai
- Internal Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
| | | | - Abat Khan
- Cardiology, Khyber Teaching Hospital, Peshawar, PAK
| | - Abdul Haadi
- Internal Medicine, Royal College of Surgeons In Ireland, Dublin, IRL
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Kaneez M, Zaidi SMJ, Zubair AB, Rehan M, Hassan A, Sarwar Z, Bibi A, Azhar M, Kinza K, Sabir M. Sleep Quality and Compliance to Medical Therapy Among Hemodialysis Patients With Moderate-to-Severe Depression: A Cross-Sectional Study. Cureus 2021; 13:e13477. [PMID: 33777565 PMCID: PMC7989974 DOI: 10.7759/cureus.13477] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background Depression is a fairly common finding among end-stage renal disease (ESRD) patients and is an independent risk factor for morbidity and mortality. The psychiatric manifestations of the disease may affect their compliance to medications and alter sleep quality that is often overlooked. This translates into poor quality of life and poorer disease prognosis. Our study aims to assess the prevalence of depression and its association with compliance to medical therapy and sleep quality among ESRD patients on hemodialysis. Methodology In this cross-sectional study, a total of 288 hemodialysis patients with a confirmed diagnosis of ESRD were evaluated for depression using Patient Health Questionnaire-9 (PHQ-9) scale. Only patients with moderate-to-severe depressive symptoms on PHQ-9 were further evaluated for sleep quality and compliance to medications using Pittsburgh Sleep Quality Index (PSQI) and Drug Attitude Inventory-10 (DAI-10), respectively. The characteristics of ESRD patients with depression were also assessed. Median PHQ-9, DAI-10, and PSQI scores were calculated, and the correlation between study variables was assessed using Spearman’s correlation. Results Of the 288 included participants, 188 (65.27%) had depression as evaluated via PHQ-9. Of these 188 patients, 114 were males while 74 were females. A total of 113 (60.01%) of depressed patients had poor compliance to medication while 137 (72.87%) patients had poor sleep quality. Higher PHQ-9 scores were positively correlated with disease duration, dialysis years, and time between diagnosis and therapy (r = 0.41, 0.39, and 0.43, respectively) and negatively with marital and employment status (r = -0.32 and -0.49, respectively). Spearman’s correlation showed a significant negative correlation of PHQ-9 scores with DAI-10 scores but a significant positive correlation with PSQI scores. The correlation between DAI-10 and PSQI was a significant negative correlation. Conclusions This study indicated a high prevalence of moderate-to-severe depression among ESRD patients on hemodialysis. Poor sleep quality and non-adherence to medications are frequent among ESRD patients with depression. These psychiatric components must be considered to optimize medical treatment and improve the quality of life in this subset of patients. More studies should be conducted to assess the risk factors of depression in patients with ESRD.
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Affiliation(s)
- Mehwish Kaneez
- Internal Medicine, Rawalpindi Medical University, Rawalpindi, PAK
| | | | | | - Muhammad Rehan
- Internal Medicine, Arif Memorial Teaching Hospital, Lahore, PAK
| | - Ahtisham Hassan
- Internal Medicine, King Edward Medical University, Lahore, PAK
| | - Zoya Sarwar
- Internal Medicine, Rashid Latif Medical College, Lahore, PAK
| | - Aisha Bibi
- Psychiatry, Rashid Latif Medical College, Lahore, PAK
| | - Mahnoor Azhar
- Psychiatry, Rashid Latif Medical College, Lahore, PAK
| | - Kinza Kinza
- Psychiatry, Rashid Latif Medical College, Lahore, PAK
| | - Muzammil Sabir
- Internal Medicine, Rashid Latif Medical College, Lahore, PAK
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25
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Wattoo MA, Tabassum M, Bhutta KR, Kaneez M, Zaidi SMJ, Ijaz H, Awan J, Irshad U, Azhar MJ, Rafi Z. Correlation of Prolonged Corrected QT Interval With Ventricular Arrhythmias and In-Hospital Mortality Among ST-Elevation Myocardial Infarction Patients: A Mystique or Lucidity? Cureus 2020; 12:e12356. [PMID: 33520550 PMCID: PMC7839800 DOI: 10.7759/cureus.12356] [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] [Indexed: 11/05/2022] Open
Abstract
Background Ventricular arrhythmias (VAs) are a frequent cause of cardiovascular mortality, especially in developing countries. Prolongation of corrected QT (QTc) interval predisposes patients to life-threatening VAs. Our study aims to assess the correlation of prolonged QTc interval with VAs and in-hospital mortality among ST-elevation myocardial infarction (STEMI) patients. Methods This cross-sectional study analyzed the data from 40 patients with a confirmed diagnosis of STEMI and prolonged QTc interval. The patients were evaluated for several characteristics including their electrocardiography (ECG) findings. The frequency of in-hospital mortality and VAs developed after admission were recorded. Spearman correlation was used to assess the correlation of prolonged QTc interval with VAs and in-hospital mortality. Results Out of 40 cases, 30 patients were males and 10 were females with a mean age hovering at 52.95 ± 10.65 years. The mean QTc interval of our patients was 512.02 ± 49.74 milliseconds (ms). A total of 11 (27.5%) patients developed VAs while 14 (35%) of the patients succumbed to the disease complications. Spearman correlation showed a strong significant positive correlation of QTc interval with VAs (rho = 0.658, p < 0.001) and in-hospital mortality (rho = 0.314, p = 0.04). Conclusion Prolonged QTc interval is positively correlated with VAs and in-hospital mortality among STEMI patients. These patients should be regularly monitored and must be managed with caution as they have increased chances to develop VAs and in-hospital mortality. There is an utmost need for curation of guidelines that aid in risk stratification and appropriate management of such patients.
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Affiliation(s)
| | | | | | - Mehwish Kaneez
- Internal Medicine, Rawalpindi Medical University, Rawalpindi, PAK
| | | | - Hania Ijaz
- Internal Medicine, Rawalpindi Medical University, Rawalpindi, PAK
| | - Javeria Awan
- Internal Medicine, Rawalpindi Medical University, Rawalpindi, PAK
| | - Umer Irshad
- Internal Medicine, Rawalpindi Medical University, Rawalpindi, PAK
| | | | - Zainab Rafi
- Cardiology, Sialkot Medical College, Sialkot, PAK
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Almas T, Saleem H, Ehtesham M, Hussain S, Khedro T, Alsufyani R, Alahmed F, Almubarak D, Zaidi SMJ, Hameed A. The Spectrum of Non-ischemic Cardiac Magnetic Resonance Imaging Findings: A Retrospective Analysis. Cureus 2020; 12:e11354. [PMID: 33304689 PMCID: PMC7720915 DOI: 10.7759/cureus.11354] [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] [Indexed: 11/24/2022] Open
Abstract
Introduction Since cardiac pathologies remain ubiquitous, their prompt diagnosis through the means of innovative technologies, such as cardiac magnetic resonance imaging, remains pivotal. The spectrum of these pathologies varies widely, ranging from ischemic etiologies to rare cardiac malignancies. This study evaluates the prevalence of nonischemic cardiac pathologies, such as infiltrative heart diseases, that often warrant meticulous diagnostic evaluation through the means of cardiac magnetic resonance imaging. Methods We performed a retrospective study in order to analyse the cardiac magnetic resonance imaging records of 250 patients over a period of six months with previously remarkable cardiac histories. Patients with a prior history of ischemic cardiac disease, as determined from past medical and surgical records, were excluded from the study. The prevalence of various nonischemic findings was ascertained. The demographic characteristics and comorbidities of the patients were also tabulated. Results In the present study, 250 patients were included, of which 115 were females and 135 were males, with the mean age hovering at 48.21 ± 11.49 years. The top two most prevalent cardiac magnetic resonance imaging findings were concentric moderate-to-severe left ventricular hypertrophy and patchy subendocardial late gadolinium enhancement of the left ventricle; these were observed in 62.2% and 23.7% of the patients, respectively. Cardiac magnetic resonance imaging also divulged findings typical of rarer pathologies, including cardiac sarcoidosis and primary cardiac lymphoma. Conclusion Pathologies of the heart often mandate extensive diagnostic workup through the means of radiological modalities such as cardiac magnetic resonance imaging. In patients with indications of nonischemic cardiac pathologies, cardiac magnetic resonance imaging can be employed as part of the initial radiological armamentarium. Furthermore, cardiac magnetic resonance remains the imaging modality of choice for detecting infrequent cardiac pathologies, such as cardiac sarcoidosis.
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Affiliation(s)
- Talal Almas
- Internal Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
| | - Hassan Saleem
- Radiology, Islamabad Diagnostic Center, Islamabad, PAK
| | - Maryam Ehtesham
- Internal Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
| | - Salman Hussain
- Internal Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
| | - Tarek Khedro
- Internal Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
| | - Reema Alsufyani
- Internal Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
| | - Fatimah Alahmed
- Internal Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
| | - Dana Almubarak
- Internal Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
| | | | - Aamir Hameed
- Tissue Engineering Research Group, Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland University of Medicine and Health Sciences, Dublin, IRL
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27
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Syed MK, Al Faqeeh AA, Othman A, Hussein AA, Rajab H, Hussain S, Zaidi SMJ, Syed SK, Syed S, Almas T. Antimicrobial Prophylaxis in Clean Pediatric Surgical Procedures: A Necessity or Redundancy? Cureus 2020; 12:e10701. [PMID: 33133866 PMCID: PMC7594672 DOI: 10.7759/cureus.10701] [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] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background The clinical utility of antimicrobial prophylaxis in clean pediatric surgical cases remains enigmatic. The present study aims to evaluate the prevalence of surgical site infections in instances where antibiotic prophylaxis is not employed prior to clean pediatric surgical procedures. Methods A retrospective cross-sectional study that included data of all pediatric clean surgical procedures from January 2018 till January 2020 was conducted. All children undergoing clean surgical procedures who did not receive antibiotics at least two weeks prior to the procedure were included in the study. The exclusion criteria included patients with congenital heart disease, ventriculoperitoneal shunt, nephrotic syndrome, immunodeficiency, and prior administration of antimicrobial prophylaxis. All patients were followed for two to four weeks for any signs of surgical site infections. Results Of the 178 patients included, 119 were male and 59 were female, with the mean age hovering at 8.19 ± 2.87 years. Orchidopexy and herniotomy were the most commonly performed surgical procedures, and were performed in 56 (31.46%) and 54 (30.33%) patients, respectively. Only one case of postoperative surgical site wound infection was reported, accounting for a prevalence rate of 0.56%. Conclusion In clean pediatric surgical procedures, the risk of surgical site infections is exceedingly low. The unnecessary use of antibiotics in children can cause deleterious adverse effects and promote antimicrobial resistance. In a carefully selected pediatric population, administration of antibiotic prophylaxis might confer no added benefit.
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Affiliation(s)
| | | | - Alsayed Othman
- Pediatric Surgery, Al-Azhar University - Assuit Branch, Assuit, EGY
| | | | - Hala Rajab
- Pediatric Surgery, King Fahad Hospital, Al Baha, SAU
| | - Salman Hussain
- Internal Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
| | | | - Sabahat K Syed
- Internal Medicine, Jinnah Sindh Medical University, Karachi, PAK
| | - Saifullah Syed
- Internal Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
| | - Talal Almas
- Internal Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
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28
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Hashim L, Khan HR, Ullah I, Khalid M, Almas T, Zaidi SMJ, Ehtesham M, Niaz MA, Akbar A, Haadi A. Physician Preparedness in Response to the Coronavirus Disease 2019 Pandemic: A Cross-Sectional Study From a Developing Country. Cureus 2020; 12:e10383. [PMID: 33062504 PMCID: PMC7550013 DOI: 10.7759/cureus.10383] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Indexed: 12/19/2022] Open
Abstract
Background December 2019 marked the inception of a global pandemic, with cases being reported worldwide. In the developing nations with scarce healthcare resources, the reliance on healthcare workers who are amply prepared to withstand the prevailing scenario is indispensable. Our study aimed to assess the level of preparedness of doctors working in various hospitals across Pakistan to combat coronavirus disease 2019 (COVID-19). Methods We conducted an online questionnaire-based survey in May 2020 to estimate the level of preparedness of doctors working in various departments of various private and public hospitals across Pakistan. The survey comprised 36 questions, with items evaluating the provision of adequate protective equipment, training, mental health resources, and sound collaboration between healthcare workers and the hospital management during the COVID-19 crisis. Results A total of 346 doctors responded to the survey, among whom 56.4% were working in public sector hospitals and 46.5% were working more than five days per week. Of those included, 87.6% were being provided with disposable gloves, but 72.8% and 43.4% of respondents professed to having no access to eye protective equipment and gowns, respectively. Only 35.3% of respondents claimed to be trained regarding the use of personal protective equipment and 28.95% were being tested. Of the physicians, 43.4% claimed to have no proper triage system for the suspected patients and 98.3% were concerned about transmitting the disease to their family members. Of the doctors, 53.5% reported that there was sound collaboration between the hospital management and healthcare staff. Conclusion The survey provided evidence of inadequate delivery of personal protective equipment and training to doctors working in various hospitals across Pakistan. A sound collaboration between the hospital management and departments needs to be addressed.
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Affiliation(s)
- Laila Hashim
- Internal Medicine, Fatima Jinnah Medical University, Lahore, PAK
| | - Hamza R Khan
- Internal Medicine, Quaid-e-Azam Medical College, Bahawalpur, PAK
| | - Irfan Ullah
- Internal Medicine, Kabir Medical College, Peshawar, PAK.,Internal Medicine, Naseer Teaching Hospital, Peshawar, PAK
| | - Maida Khalid
- Internal Medicine, Foundation University Medical College, Islamabad, PAK
| | - Talal Almas
- Internal Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
| | | | - Maryam Ehtesham
- Internal Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
| | | | - Absam Akbar
- Internal Medicine, Aga Khan University, Karachi, PAK
| | - Abdul Haadi
- Internal Medicine, Royal College of Surgeons In Ireland, Dublin, IRL
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29
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Fatima M, Mehmood N, Zaidi SMJ, Hamza M, Kaneez M, Irshad U, Azhar MJ, Zubair AB, Rizwan R, Sabir M. MR Product as a Novel Diagnostic Indicator for Chronic Secondary Mitral Regurgitation. Cureus 2020; 12:e10052. [PMID: 32999775 PMCID: PMC7520408 DOI: 10.7759/cureus.10052] [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] [Indexed: 11/17/2022] Open
Abstract
Background Chronic secondary mitral regurgitation (SMR) is a common form of valvular heart disease. Its diagnosis through echocardiography is challenging and dependent on subjective interpretations. The subjective error to diagnose SMR can be reduced by developing accurate predictive quantitative parameters that support echocardiographic interpretations and clinical manifestations. The present study aims to develop a new diagnostic indicator for chronic SMR. The new indicator called MR product is the product of left atrial diameter (LAD) and left ventricular internal dimension at end-systole (LVIDs). Materials and Methods An analytical, case-control study was conducted from transthoracic echocardiography (TTE) reports of 720 patients performed according to the guidelines of the American Society of Echocardiography. The LAD and LVIDs were measured using the standard M Mode TTE. Out of the 720 patients who underwent TTE, 300 patients were diagnosed with chronic SMR by experienced clinicians. Only 115 of those 300 patients met the inclusion criteria for chronic SMR. Results The MR product was significantly associated with chronic SMR (rho = 0.83) and predicted it with an odds ratio of 1.014 (p < 0.001). The MR product was able to diagnose SMR with a sensitivity of 94.8% and a specificity of 92.2%, respectively, for a cut off value of 1,045 mm2. Conclusion A new parameter called MR product (LAD multiplied with LVIDs) has very high sensitivity and specificity for SMR. Therefore, it can aid in establishing its diagnosis, along with other diagnostic modalities. The new parameter may also potentially increase the diagnostic accuracy of the disease.
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Affiliation(s)
- Mishal Fatima
- Cardiology, Rawalpindi Medical University, Rawalpindi, PAK
| | - Nadir Mehmood
- General Surgery, Rawalpindi Medical University, Rawalpindi, PAK
| | | | - Muhammad Hamza
- Cardiology, Rawalpindi Medical University, Rawalpindi, PAK
| | - Mehwish Kaneez
- Cardiology, Rawalpindi Medical University, Rawalpindi, PAK
| | - Umer Irshad
- Cardiology, Rawalpindi Medical University, Rawalpindi, PAK
| | | | | | - Rafay Rizwan
- Cardiology, Rashid Latif Medical College, Lahore, PAK
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30
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Almas T, Khan MK, Murad MF, Ullah M, Shafi A, Ehtesham M, Zaidi SMJ, Hussain S, Kaneez M. Clinical and Pathological Characteristics of Soft Tissue Sarcomas: A Retrospective Study From a Developing Country. Cureus 2020; 12:e9913. [PMID: 32968575 PMCID: PMC7505639 DOI: 10.7759/cureus.9913] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Indexed: 11/05/2022] Open
Abstract
Introduction Soft tissue sarcomas remain an exceedingly rare malignancy. While soft tissue sarcomas boast a high mortality rate, their characteristics and behavior patterns are poorly understood. This study aims to evaluate the various aspects that pertain to soft tissue sarcomas, including their histology, tumor characteristics, survival rates, and therapeutic modalities. Methods A retrospective study analyzing the data from 19 patients presenting over four years with a histologically confirmed diagnosis of soft tissue sarcomas was conducted. The patients were studied for various parameters, including tumor site and the particular pathological subtypes. The data obtained were analyzed using the SPSS 23.0 statistical software (IBM Corporation, Armonk, NY), and the results were then tabulated. Results A total of 19 patients with a confirmed diagnosis of a soft tissue sarcoma were included in the study. The mean age of the patients included was 45.32 ± 16.88 years. Wide local excision was the most common surgical procedure employed for the resection of these tumors. Within the cohort, the mortality rate was noted to hover at 10.52%. Gastrointestinal stromal tumors were observed in 21% of the patients and were therefore the most common histological subtype. Of the patients included, 42.10% required blood transfusion during the perioperative time. Most of the tumors were noted to be intermediate grade, with high-grade tumors observed in 26.3% of the cases. Conclusion Soft tissue sarcomas remain a rare but potent cause of death in developing countries. The diversity of the tissues that they afflict renders their prompt detection a diagnostic challenge. A meticulous exploration of the various characteristics honed by soft tissue sarcomas, such as the particular histological subtype and the associated mortality rates, can better elucidate the prognosis and the eventual disease outcomes.
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Affiliation(s)
- Talal Almas
- Internal Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
| | - Muhammad Kashif Khan
- Surgical Oncology, Federal Government Poly Clinic (Post Graduate Medical Institute), Islamabad, PAK.,Surgical Oncology, Maroof International Hospital, Islamabad, PAK
| | | | - Muneeb Ullah
- General Surgery, Maroof International Hospital, Islamabad , PAK
| | - Adil Shafi
- General Surgery, Maroof International Hospital, Islamabad, PAK
| | - Maryam Ehtesham
- Internal Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
| | | | - Salman Hussain
- Internal Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
| | - Mehwish Kaneez
- Internal Medicine, Rawalpindi Medical University, Rawalpindi, PAK
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31
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Rizvi ZA, Jamal AM, Malik AH, Zaidi SMJ, Abdul Rahim NU, Arshad D. Exploring Antimicrobial Resistance in Agents Causing Urinary Tract Infections at a Tertiary Care Hospital in a Developing Country. Cureus 2020; 12:e9735. [PMID: 32944453 PMCID: PMC7489772 DOI: 10.7759/cureus.9735] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [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] [Indexed: 11/09/2022] Open
Abstract
Background and objective Urinary tract infections (UTIs) are usually treated with empirical therapy by physicians based on previous knowledge of the predictability of causative agents and their antimicrobial susceptibilities. The objective of this study was to determine the frequency of various pathogens causing UTIs and their antimicrobial resistance profile in patients presenting to the outpatient department (OPD) of a tertiary care hospital. Materials and methods This descriptive cross-sectional study was conducted in the urology OPD of a tertiary care hospital in Pakistan. The study was conducted over a period of six months, and it included 1,000 patients (of ages 12 years or above) who were clinically suspected for UTIs. Patients with comorbidities and immunocompromised patients were excluded from the study. Recipients of corticosteroid therapy or those with a history of intake of broad-spectrum antibiotics in the previous 15 days were also excluded. The modified Kirby-Bauer disc diffusion method was used for determining antimicrobial resistance against various antimicrobials. Results Out of 1,000 tested specimens, 530 (53%) isolates were found to be culture-positive. E.coli was the most common species isolated from the cultures with a prevalence of 77.4%, followed by Klebsiella (6.4%), Enterobacter (6.0%), Pseudomonas (3.8%), Staphylococcus saprophyticus (3.4%), Citrobacter (1.1%), and Morganella (0.4%). Antimicrobial resistance against commonly used antimicrobials was found to be alarmingly high. Conclusion E.coli was the most commonly isolated microorganism from the urine samples of UTI patients. Antimicrobial resistance against UTI-causing organisms is of great concern. The Surveillance of trends of antimicrobial susceptibility pattern for organisms causing UTIs is highly important. Antibiotics should be prescribed according to proper guidelines to prevent increasing antimicrobial resistance.
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32
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Almas T, Murad MF, Khan MK, Ullah M, Nadeem F, Ehtesham M, Zaidi SMJ. The Spectrum of Gallbladder Histopathology at a Tertiary Hospital in a Developing Country: A Retrospective Study. Cureus 2020; 12:e9627. [PMID: 32923228 PMCID: PMC7478930 DOI: 10.7759/cureus.9627] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [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] [Indexed: 12/17/2022] Open
Abstract
Background Affections of the gallbladder remain exceedingly ubiquitous and often warrant surgical intervention. The histopathological patterns represent a spectrum, ranging from cholecystitis to gallbladder carcinoma. The present study aims to delineate the occurrence of various gallbladder histopathologies in a tertiary care hospital in Pakistan. Methods A retrospective study was conducted at Maroof International Hospital, Islamabad, Pakistan. Histopathological records of 442 gallbladder specimens obtained from cholecystectomy were analysed. The prevalence of various histopathological outcomes was assessed. The data were eventually analysed using the SPSS 23.0 software (Armonk, NY: IBM Corp.). Thereafter, the distribution of various gallbladder histopathologies was tabulated across gender. Results Of the 442 patients included, 330 were females and 112 were males, with the mean age hovering at 45.77±14.65 years. The most common histopathological findings were chronic cholecystitis and cholesterolosis, observed in 78.6% and 32.8% of the patients, respectively. While only one case of gallbladder adenocarcinoma was observed, multiple specimens divulged premalignant lesions including reactive atypia and intestinal metaplasia. Conclusions Diseases of the gallbladder often mandate prompt surgical intervention. Of these, chronic cholecystitis, which is an established risk factor for gallbladder carcinoma, is exceedingly common. The employment of histopathological techniques remains imperative in the detection of premalignant and malignant lesions that might otherwise evade macroscopic detection and thus progress to adenocarcinoma.
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Affiliation(s)
- Talal Almas
- Internal Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
| | | | - Muhammad Kashif Khan
- Surgical Oncology, Federal Government Poly Clinic (Post Graduate Medical Institute), Islamabad, PAK.,Surgical Oncology, Maroof International Hospital, Islamabad, PAK
| | - Muneeb Ullah
- General Surgery, Maroof International Hospital, Islamabad, PAK
| | - Faisal Nadeem
- Laparoscopic Surgery, Maroof International Hospital, Islamabad, PAK
| | - Maryam Ehtesham
- Internal Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
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Almas T, Ullah M, Kaneez M, Zaidi SMJ, Khan MK. Gone but Not Forgotten: Ovarian Metastasis From a Colon Carcinoma in a 19-Year-Old Female. Cureus 2020; 12:e9466. [PMID: 32874796 PMCID: PMC7455375 DOI: 10.7759/cureus.9466] [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] [Indexed: 11/05/2022] Open
Abstract
Ovarian tumors occurring secondarily to metastatic colorectal carcinoma remain a rare occurrence. Since ovarian tumors remain predominantly asymptomatic in the initial stages, they are often diagnosed incidentally. The vague, non-specific symptoms elicited by a secondary ovarian carcinoma, coupled with a histopathology remarkably similar to that evoked by primary ovarian tumors, render its ascertainment a diagnostic challenge. We hereby delineate an interesting case of a metachronous ovarian adenocarcinoma in a 19-year-old patient with a prior medical history significant for colorectal carcinoma treated with hemicolectomy. Subsequent diagnostic workup divulged a mass in her left adnexal region, which was ultimately diagnosed as a metastatic colon adenocarcinoma to the ovary. Unfortunately, the patient succumbed to the aggressive malignancy and did not survive. We therefore aim to accentuate the diagnostic and therapeutic dilemmas fomented by ovarian adenocarcinomas that arise secondarily to primary colorectal cancers.
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Affiliation(s)
- Talal Almas
- Internal Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
| | - Muneeb Ullah
- General Surgery, Maroof International Hospital, Islamabad , PAK
| | - Mehwish Kaneez
- Internal Medicine, Rawalpindi Medical University, Rawalpindi, PAK
| | | | - Muhammad Kashif Khan
- Surgical Oncology, Federal Government Poly Clinic (Post Graduate Medical Institute), Islamabad, PAK.,Surgical Oncology, Maroof International Hospital, Islamabad, PAK
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Zaidi SMJ, Kaneez M, Almas T, Fatima L, Safian HA, Jamal AM, Satti MZ, Dhillon RA, Zubair AB, Bukhari SF. Gauging the Risk Factors for Asymptomatic Bacteriuria in Type-2 Diabetic Women: A Case-Control Study. Cureus 2020; 12:e9069. [PMID: 32782886 PMCID: PMC7413567 DOI: 10.7759/cureus.9069] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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] [Indexed: 01/11/2023] Open
Abstract
Background There is conflicting literature pertaining to the risk factors of asymptomatic bacteriuria (ASBU) in diabetic women. ASBU is a well-established risk factor for frequent urinary tract infections (UTIs), and the risk factors that predispose diabetic women to ASBU should, therefore, be evaluated. Objectives This study aims to discern these aforesaid risk factors in type-2 diabetic women, define a population subset at particularly high risk for ASBU, and gauge the efficacy inherent in adhering to an antibiotic regimen in combatting ASBU. Methods An analytical, case-control study was conducted at the Diabetic Clinic of the Holy Family Hospital (HFH), Rawalpindi, Pakistan. The participants included were type-2 diabetic women reporting to the clinic for routine follow-up. Six hundred and sixty-seven urine samples from these type-2 diabetic women were evaluated. Positive cases were those in which patients were diagnosed with ASBU according to the guidelines, while those with no ASBU constituted the control group. Common risk factors for UTI were excluded in both groups. Age, socioeconomic status, hygiene practices, and contraceptive use were matched between cases and controls. Results Nineteen percent of type-2 diabetic women presented with ASBU in our study. The significant risk factors for ASBU were a higher HbA1c level (OR 1.97), more years since the initial diagnosis of diabetes (OR 1.49), a prior UTI history (OR 2.49), excessive antibiotic use (OR 2.72), sodium-glucose cotransporter-2 (SGLT2) inhibitor use (OR 1.75), and proteinuria (OR 1.88) in the multivariate model. Body mass index (BMI), age of the patients, pyuria, and voiding dysfunction manifested no association with ASBU. Antibiotic use was significantly associated with the type of bacterial species precipitating the ASBU. Conclusion The clinicians must keep in mind the association between the various patient parameters and ASBU, especially in prescribing antibiotics to diabetic women. More studies are needed to further elaborate on these risk factors and revise the patient management in at-risk cases for ASBU and UTIs.
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Affiliation(s)
| | - Mehwish Kaneez
- Internal Medicine, Rawalpindi Medical University, Rawalpindi, PAK
| | - Talal Almas
- Internal Medicine, Royal College of Surgeons in Ireland, Dublin, IRL
| | - Laiba Fatima
- Cardiology, Rawalpindi Medical University, Rawalpindi, PAK
| | - Hafiz Abu Safian
- Internal Medicine, Rawalpindi Medical University, Rawalpindi, PAK
| | - Ali Murad Jamal
- Internal Medicine, Rawalpindi Medical University, Rawalpindi, PAK
| | | | - Rubaid A Dhillon
- Internal Medicine, Islamic International Medical College, Rawalpindi, PAK
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Satti MZ, Hamza M, Sajid Z, Asif O, Ahmed H, Zaidi SMJ, Irshad U. Compliance Rate of Surgical Antimicrobial Prophylaxis and its Association with Knowledge of Guidelines Among Surgical Residents in a Tertiary Care Public Hospital of a Developing Country. Cureus 2019; 11:e4776. [PMID: 31367494 PMCID: PMC6666917 DOI: 10.7759/cureus.4776] [Citation(s) in RCA: 10] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Surgical antimicrobial prophylaxis (SAP) means the administration of antibiotics in surgical practice, and it reduces the likelihood of surgical site infections (SSIs). Inappropriate SAP practice regarding the prescription, timing, and duration of antibiotic use prolongs the hospital stay of patients, increases patient morbidity (by exposing them to the adverse effects of antibiotics), promotes bacterial resistance, and puts an economic burden on health care. While developed countries regularly monitor and revise their SAP protocols, there are only a few such researches in developing countries, which is a major setback to proper surgical care. Objectives of the study This study aims to compare the practice of SAP in a tertiary health care hospital of a developing country Pakistan, with internationally recommended protocols and evaluate the impact of knowledge of international guidelines on SAP practice. The results of the study will highlight important shortcomings in prophylactic practice in the hospital and help develop recommendations to improve SAP practice and ensure better surgical care for patients. Materials and methods An observational, cross-sectional study was conducted in the general surgery unit of Holy Family Hospital (HFH), Rawalpindi, Pakistan, from March 2017 to November 2017 during which antimicrobial prophylaxis of 150 general surgery procedures was documented on the basis of six international SAP criteria, which were "indication for use of prophylaxis, timing of preoperative dose, choice of drug, route of administration, duration of postoperative prophylaxis, and the assessment of beta-lactam allergy." The compliance rate (number of procedures following all the six criteria) was calculated for each operating surgical resident. A questionnaire was formulated that assessed the knowledge of 33 surgical residents working at that time regarding the above- mentioned six variables of SAP by six close-ended questions. Their responses were then compared to their compliance rate by chi-square analysis and binary logistic regression in SPSS version 23 (IBM Corp, Armonk, NY, US). A p-value of less than or equal to 0.05 was considered significant. The required ethical approval was obtained from the departmental heads as well as institutional research forum. Results Seventy-four of 150 observed procedures followed all the six international criteria of SAP, giving a compliance rate of 49.33%. Seventeen out of 33 (51%) surgical residents were aware of the guidelines. A chi-square analysis revealed a highly significant association between the awareness of guidelines and the number of compliant procedures performed by a resident (p<0.000). Forty-five out of 74 compliant procedures were performed by residents who were aware of the guidelines (61% of compliant procedures). The odds ratio for awareness and correct prophylaxis was 4.064 (p<0.000). Conclusions The study indicates an overall low compliance rate of 49.33% regarding surgical antimicrobial prophylaxis (SAP) practice in a public health care hospital of a developing country. The most common cause of non-compliance was prolonged postoperative prophylaxis. This study also shows that the knowledge of international guidelines significantly improves the prophylaxis practice by about four times. Hence, proper SAP compliance rate can be increased by actively educating and monitoring surgical residents.
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Affiliation(s)
| | - Muhammad Hamza
- Psychiatry, Rawalpindi Medical University, Rawalpindi, PAK
| | - Zaina Sajid
- Surgery, Rawalpindi Medical University, Rawalpindi, PAK
| | - Omaima Asif
- Miscellaneous, Rawalpindi Medical University, Rawalpindi, PAK
| | - Hassaan Ahmed
- General Surgery, Rawalpindi Medical University, Rawalpindi, PAK
| | | | - Umer Irshad
- Psychiatry, Rawalpindi Medical University, Rawalpindi, PAK
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