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Shaikh TG, Hasan SFS, Ahmed H, Kazi AI, Mansoor R. The role of angiotensin receptor blockers in treating epilepsy: a review. Neurol Sci 2024; 45:1437-1445. [PMID: 38079018 DOI: 10.1007/s10072-023-07249-y] [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: 09/23/2023] [Accepted: 12/01/2023] [Indexed: 03/16/2024]
Abstract
Epilepsy is a chronic brain disease with a global prevalence of 70 million people. According to the World Health Organization, roughly 5 million new cases are diagnosed every year. Anti-seizure drugs are the treatment of choice. However, in roughly one third of the patients, these drugs fail to produce the desired effect. As a result, finding novel treatments for epilepsy becomes inevitable. Recently, angiotensin receptor blockers have been proposed as a treatment to reduce the over-excitation of neurons in epilepsy. For this purpose, we conducted a review using Medline/PubMed and Google Scholar using the relevant search terms and extracted the relevant data in a table. Our review suggests that this novel approach has a very high potential to treat epilepsy, especially in those patients who fail to respond to conventional treatment options. However, more extensive and human-based trials should be conducted to reach a decisive conclusion. Nevertheless, the use of ARBs in patients with epilepsy should be carefully monitored keeping the adverse effects in mind.
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Affiliation(s)
- Taha Gul Shaikh
- Dow Medical College, Dow University of Health Sciences, Karachi, Sindh, Pakistan.
| | | | - Hiba Ahmed
- Dow Medical College, Dow University of Health Sciences, Karachi, Sindh, Pakistan
| | - Amal Iqbal Kazi
- Dow Medical College, Dow University of Health Sciences, Karachi, Sindh, Pakistan
| | - Ruhma Mansoor
- Dow Medical College, Dow University of Health Sciences, Karachi, Sindh, Pakistan
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2
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Tariq S, Niaz F, Waseem S, Shaikh TG, Ahmed SH, Irfan M, Nashwan AJ, Ullah I. Managing and treating Sydenham chorea: A systematic review. Brain Behav 2023; 13:e3035. [PMID: 37150977 PMCID: PMC10275551 DOI: 10.1002/brb3.3035] [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: 11/24/2022] [Revised: 04/12/2023] [Accepted: 04/17/2023] [Indexed: 05/09/2023] Open
Abstract
INTRODUCTION Sydenham's chorea (SC), prevalent in developing countries and occasionally affecting developed ones, poses a clinical challenge due to the lack of systematic guidelines for diagnosis and treatment. Resulting from Group A Beta-Hemolytic Streptococcus infection, SC presents various symptoms. This review aims to collect and evaluate available data on SC management to propose a cohesive treatment plan. METHODS We searched PubMed, the Cochrane Library, Google Scholar, and ClinicalTrials.gov for literature on SC management from inception until 24th July 2022. Studies were screened by titles and abstracts. Cochrane Collaboration's Risk of Bias tool (RoB-1) assessed Randomized Controlled Trials, while the Risk of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool evaluated nonrandomized studies. RESULTS The review includes 11 articles assessing 579 patients. Excluding one study with 229 patients, of the remaining 550 patients, 338 (61.5%) were females. Treatments used were dopamine antagonists in 118 patients, antiepileptics in 198, corticosteroids in 134, IVIG in 7, and PE in 8 patients. Dopamine antagonists, particularly haloperidol, were the primary treatment choice, while valproic acid (VPA) was favored among antiepileptics. Prednisolone, a corticosteroid, showed promising results with weight gain as the only side-effect. Our review emphasizes the importance of immunomodulators in SC, contrasting previous literature. CONCLUSION Despite limitations, dopamine antagonists can serve as first-line agents in SC management, followed by antiepileptics. The role of immunomodulators warrants further investigation for conclusive recommendations.
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Affiliation(s)
- Samiuddin Tariq
- Dow Medical CollegeDow University of Health SciencesKarachiPakistan
| | - Faizan Niaz
- Dow Medical CollegeDow University of Health SciencesKarachiPakistan
| | - Summaiyya Waseem
- Dow Medical CollegeDow University of Health SciencesKarachiPakistan
| | - Taha Gul Shaikh
- Dow Medical CollegeDow University of Health SciencesKarachiPakistan
| | | | - Muhammad Irfan
- Department of Internal MedicineWellstar Health System Spalding Hospital GriffinGeorgiaUSA
| | | | - Irfan Ullah
- Kabir Medical CollegeGandhara UniversityPeshawar Khyber PakhtunkhkwaPakistan
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Jadoon SK, Soomro R, Ahsan MN, Ijaz Khan RM, Iqbal S, Yasmin F, Najeeb H, Saleem N, Cho N, Shaikh TG, Saba Hasan SF, Khalid MZ, Alvi S, Rizvi AM, Asghar MS. Association of neutrophil-to-lymphocyte ratio with clinical, pathological, radiological, laboratory features and disease outcomes of invasive breast cancer patients: A retrospective observational cohort study. Medicine (Baltimore) 2023; 102:e33811. [PMID: 37335707 DOI: 10.1097/md.0000000000033811] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
Inflammatory conditions play part in the progression of malignancies, and markers signifying growth of these factors can indicate prognosis. Neutrophil-to-lymphocyte (NLR) is used as a marker of subclinical inflammation that may become an integral part of workup to indicate prognosis and associated pathology. This study aims to explore the association of NLR ratio with clinical characteristics, radiological assessment and staging, histopathology, and disease outcomes of breast cancer. A retrospective cohort study was conducted in a tertiary care center to include breast cancer patients that were diagnosed between January 2001 and December 2020. Data including tumor size, lymph nodes, metastasis, histological grading, ER/PR/HER2-neu status, molecular subtypes, clinical staging); nodal findings (sentinel and axillary); pathology from frozen section; and disease outcomes were assessed. Multivariable regression and Kaplan-Meier survival curves were employed to indicate the association of NLR with breast cancer features and disease-free survival. A total of 2050 patients had a median age of 50 years, median NLR levels of 2.14, most common pathology ductal followed by lobular, and most common site of metastasis being lungs followed by bones. Disease-free rate was 7.6%, and a recurrence rate of 1.8%, while 1.6% deaths were reported. NLR was found associated with age, treatment outcomes, tumor size, lymph nodes, metastasis and clinical staging. Other positive correlations were with Ki67 proliferation index, molecular subtypes, and tumor size on frozen section (at transverse and craniocaudal dimensions). Negative correlations were seen with estrogen and progesterone receptors. However, NLR was not found predictable of disease-free survival (P = .160). Significant predictors of disease-free survival were histological grading, ER, PR status, molecular subtype, and Ki67 proliferation index. NLR being a readily available marker has shown novel findings in its association with tumor staging, disease outcomes and characteristics of breast malignancy.
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Affiliation(s)
| | - Rufina Soomro
- Department of General Surgery, Liaquat National Hospital and Medical College, Karachi, Pakistan
| | | | | | - Sadia Iqbal
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Farah Yasmin
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Hala Najeeb
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Nida Saleem
- Department of Nephrology, Dow University of Health Sciences, Karachi, Pakistan
| | - Namiya Cho
- Department of Nephrology, Dow University of Health Sciences, Karachi, Pakistan
| | - Taha Gul Shaikh
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Muhammad Zain Khalid
- Department of General Surgery, Liaquat National Hospital and Medical College, Karachi, Pakistan
| | - Sarosh Alvi
- Teaching Assistant, Faculty of Medicine, University of Bakht Al-Ruda, Khartoum, Sudan
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Ahmed SH, Waseem S, Shaikh TG, Hasan MM. Advancing haemophilia care in Pakistan: Progress and future directions. Haemophilia 2023; 29:939-941. [PMID: 37040340 DOI: 10.1111/hae.14789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/31/2023] [Accepted: 04/02/2023] [Indexed: 04/12/2023]
Affiliation(s)
| | | | | | - Mohammad Mehedi Hasan
- Department of Biochemistry and Molecular Biology, Faculty of Life Science, Mawlana Bhashani Science and Technology University, Tangail, Bangladesh
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Shaikh TG, Jawed S, Rahmat ZS, Ahmed SH, Waseem S, Ullah I, Irfan M, Asghar MS. Efficacy and Safety of Vericiguat for Treatment of Heart Failure: A Systematic Review. Curr Probl Cardiol 2023; 48:101586. [PMID: 36623755 DOI: 10.1016/j.cpcardiol.2023.101586] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Accepted: 01/03/2023] [Indexed: 01/08/2023]
Abstract
Heart failure is a growing global health concern with high mortality and morbidity. Beta-blockers, mineralocorticoid receptor antagonists, and angiotensin-converting-enzyme inhibitors are the treatments of choice for worsening clinical symptoms. In early 2021, the FDA approved a new oral soluble guanylate cyclase stimulator, Vericiguat, for the treatment of chronic heart failure. To evaluate the efficacy and safety of this approved drug, we conducted a systematic review of the available randomized controlled trials (RCTs). A literature search was conducted using PubMed, The Cochrane Library, and Clinicaltrials.gov from inception to June 6, 2022, without any language restriction. The systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. The quality of the included studies was checked using the Cochrane Risk-of-Bias tool. After a thorough literature search, 7 studies met our pre-defined criteria and were therefore included in this review. Our review suggests that vericiguat was better in preventing all causes of death, cardiovascular death, and hospitalizations due to heart failure irrespective of the atrial fibrillation status of the patients and was even beneficial for patients with NT-proBNP levels up to 8000 pg/ml. The safety of the vericiguat, according to our review, is not up to the standards, especially with a higher dosage of vericiguat. Despite all of this, vericiguat can be a breakthrough in the treatment of heart failure as it has great potential to improve the disease severity.
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Affiliation(s)
| | - Shizra Jawed
- Dow University of Health Sciences, Karachi, Sindh, Pakistan
| | | | | | | | - Irfan Ullah
- Kabir Medical College, Gandhara University, Peshawar, KPK, Pakistan
| | - Muhammad Irfan
- Department of Internal Medicine, Wellstar Health system Spalding Hospital, Atalanta, GA
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Ahmed SH, Waseem S, Shaikh TG, Mehedi Hasan M. Baffling dilemma of workplace violence in healthcare: will there be an end? Med Confl Surviv 2022; 38:289-294. [PMID: 35538883 DOI: 10.1080/13623699.2022.2073648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Syed Hassan Ahmed
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Summaiyya Waseem
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Taha Gul Shaikh
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Mohammad Mehedi Hasan
- Department of Biochemistry and Molecular Biology, Faculty of Life Science, Mawlana Bhashani Science and Technology University, Tangail, Bangladesh
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Shaikh TG, Waseem S, Ahmed SH, Asghar MS, Tahir MJ. Disproportionate distribution of coronavirus disease 2019 (COVID-19) antiviral pills: Vaccine inequity replay? Infect Control Hosp Epidemiol 2022; 43:1989-1990. [PMID: 34955110 PMCID: PMC8770834 DOI: 10.1017/ice.2021.532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 12/03/2021] [Accepted: 12/14/2021] [Indexed: 01/14/2023]
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Ahmed SH, Pervez N, Rehan ST, Shaikh TG, Waseem S. Postoperative cardiac troponin I as an indicator of surgical outcomes: A systematic review. J Card Surg 2022; 37:5351-5361. [PMID: 36403270 DOI: 10.1111/jocs.17197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 10/27/2022] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Cardiac surgeries are generally associated with high morbidity and mortality. To prevent any adverse outcomes, it is crucial to identify patients at risk of developing postoperative complications and initiate relevant therapeutic interventions. Several biomarkers are used to determine postoperative myocardial injury but they either lack sensitivity and specificity or are elevated for a short time. In this systematic review, we evaluate postoperative troponin I as a predictor of postoperative myocardial infarction, mortality, and hospital and Intensive Care Unit stay. METHODS This systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-Analysis guidelines. A thorough literature search was conducted over PubMed, clinicaltrials. gov, and the Cochrane library from inception till May 24, 2022 using relevant keywords, and only articles that met the pre-defined criteria were recruited. RESULTS Following a comprehensive literature search, a total of 359 articles were obtained. Following a rigid screening and full-length review, only 13 studies met our inclusion criteria and were included. The recruited studies evaluated data from a total of 12,483 individuals and assessed troponin I as a predictor of at least one outcome. CONCLUSION Troponin I has the potential to be used as a stand-alone predictor of surgical outcomes following coronary artery bypass grafting and valvular surgeries. However, supplementing it with other markers and scores offers the best chance at timely diagnosing any complications.
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Affiliation(s)
| | - Neha Pervez
- Dow University of Health Sciences, Karachi, Pakistan
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Shaikh TG, Waseem S, Ahmed SH, Qadir NA, Piccolo V. SARS-CoV-2 Vaccination and Chilblain-like Lesions: What Do We Know so Far? Dermatol Pract Concept 2022; 12:e2022170. [PMID: 36534559 PMCID: PMC9681186 DOI: 10.5826/dpc.1204a170] [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: 02/14/2022] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION The coronavirus pandemic has caused massive damage to global health care and the economy. The vaccination program has been paced around the globe to return as soon as possible to pre-COVID time. Although all the vaccines have been approved after the rigorous clinical and safety trials, some adverse effects have surfaced and are being reported from different parts of the world. One such side effect is chilblain-like lesions following the COVID vaccination. Chilblain lesions, also known as pernio, are an inflammatory condition usually affecting the acral regions of the body. It is mostly reported from cold and damp areas and has multiple causes associated with it. OBJECTIVE This study aims to review the publicly available data and to provide concise and comprehensive information as well as evaluate the potential pathology, clinical approach, and management of CLL post-vaccination. METHODS An extensive literature search over PubMed, Cochrane library, Google Scholar, and Clinicaltrails. gov from inception till 5th October 2021, without any restriction of language was carried out. All the recruited articles were reviewed, and their bibliographies were also screened for any relevant information. RESULTS 12 studies (10 case reports and 2 case series) were retrieved reporting the incidence of CLL post-vaccination. 8 studies reported incidence in female patients while 5 reported in males, with one study mentioning no gender. Moreover, most of them were either from Europe or the United States of America, except for two cases, reported from Turkey. CONCLUSIONS Although the overall incidence of Chilblains following COVID-19 vaccination is low, there is still a strong need to find out the exact mechanism behind this to redefine the safety and administration criteria of the vaccines and to formulate a proper management protocol.
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Affiliation(s)
| | | | | | | | - Vincenzo Piccolo
- Dermatology Unit, University of Campania Luigi Vanvitelli, Naples, Italy
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10
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Ahmed SH, Shaikh TG, Waseem S, Hasan MM, Bardhan M, Mukerjee N. Rise in cholera amid COVID-19: Spotlight on Pakistan and Bangladesh. The Lancet Regional Health - Southeast Asia 2022; 4:100041. [PMID: 35822107 PMCID: PMC9263689 DOI: 10.1016/j.lansea.2022.100041] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
| | | | | | - Mohammad Mehedi Hasan
- Department of Biochemistry and Molecular Biology, Faculty of Life Science, Mawlana Bhashani Science and Technology University, Tangail, Bangladesh
| | - Mainak Bardhan
- Division of Bacteriology, ICMR-National Institute of Cholera and Enteric Diseases, Kolkata, India
| | - Nobendu Mukerjee
- Department of Microbiology, Ramakrishna Mission Vivekananda Centenary College, Kolkata, India
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11
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Waseem S, Ahmed SH, Fatima S, Shaikh TG, Ahmed J. SARS-CoV-2 vaccination and uveitis: Are they linked? Ann Med Surg (Lond) 2022; 81:104472. [PMID: 36060437 PMCID: PMC9420081 DOI: 10.1016/j.amsu.2022.104472] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 08/18/2022] [Accepted: 08/19/2022] [Indexed: 11/27/2022] Open
Abstract
In 2019, the discovery of a new strain of Coronavirus, later referred to as SARS-CoV2 took the world by storm, leading to a pandemic and shutting down all global activities. Several measures were taken adequately to combat the viral havoc, including developing numerous vaccines. All the vaccines currently available for the general population went through rigorous screenings and trials to ensure maximum safety and were only approved after that. However, once they were rolled out in the markets and administered to the population, some adverse reactions were reported, one of which included uveitis. It is an ocular inflammatory condition of the uveal tract, choroid, or iris. If untreated, it can lead to severe consequences, including blindness. It is further divided into four categories based on its anatomical location. Despite the rare incidence of uveitis following COVID-19 vaccination, it may contribute to vaccine hesitancy; hence addressing and digging into the pathophysiological cause is crucial. This study evaluates all the pathophysiological and demographical links between COVID-19 vaccination and uveitis, suggesting appropriate management plans. The phenomenon of vaccine associated uveitis has been previously reported with several vaccines. The reporting of uveitis following COVID-19 vaccinations might contribute to vaccine hesitancy. Past medical history and certain demographic conditions might dispose some people to developing uveitis. Corticosteroids were the initial drug of choice for many cases. Large scale studies are needed to reach a decisive conclusion.
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Shaikh TG, Waseem S, Ahmed SH, Swed S, Hasan MM. Infectious disease surveillance system in Pakistan: challenges and way forward. Trop Med Health 2022; 50:46. [PMID: 35850780 PMCID: PMC9295525 DOI: 10.1186/s41182-022-00439-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 07/12/2022] [Indexed: 11/10/2022] Open
Abstract
Infectious Disease Surveillance (IDS) in the community is essential to prevent, control, and detect outbreaks. A strong surveillance system is a need of time for low to middle-income countries like Pakistan where around half of the reported deaths are due to infections that can be easily prevented in the presence of a surveillance system. Although Pakistan has IDS which monitors and collects the data on several infectious diseases, the system is unreliable, inadequate, and substandard. As a result, dengue, tuberculosis, malaria, hepatitis B and C, and many other infectious diseases are still prevalent in Pakistan and unfortunately, the numbers are still rising. In this commentary, we have tried to highlight the problems the country is facing to establish a proper and self-sustainable surveillance system and have recommended some steps the relevant stakeholders should consider taking to make healthcare better in Pakistan.
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Affiliation(s)
| | | | | | - Sarya Swed
- Faculty of Medicine, Aleppo University, Aleppo, Syria.
| | - Mohammad Mehedi Hasan
- Department of Biochemistry and Molecular Biology, Faculty of Life Science, Mawlana Bhashani Science and Technology University, Tangail, 1902, Bangladesh.
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Naeem FN, Hasan SFS, Ram MD, Waseem S, Ahmed SH, Shaikh TG. The association between SARS-CoV-2 vaccines and transverse myelitis: A review. Ann Med Surg (Lond) 2022; 79:103870. [PMID: 35702684 PMCID: PMC9181565 DOI: 10.1016/j.amsu.2022.103870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 05/19/2022] [Accepted: 05/22/2022] [Indexed: 12/02/2022] Open
Abstract
In late 2019, the emergence of a new viral strain, later referred to as Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) took the shape of a global pandemic, affecting millions of lives and deteriorating economies around the globe. Vaccines were developed at an exceptional rate to combat the viral desolation, all of them being rolled out once they displayed sufficient safety and efficacy. However, assorted adverse events came into attention, one of them being Transverse Myelitis (TM), an infrequent, immune-mediated, focal disease of the spinal cord. This disorder can lead to severe neurological complications including autonomic, sensory, and motor deficits. The literature aims to shed light on TM and its various etiologies, specifically in line with the vaccine, and a comprehensive treatment plan. Discussing and reducing the number of vaccines related adverse events can help succor in bringing down the vaccine hesitancy and ultimately combatting the pandemic.
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Waseem S, Ahmed SH, Shaikh TG, Qadar LT, Khalid S, Nimavat N, Hasan MM. Mysterious
dengue‐like
virus: A case report from Pakistan. Clin Case Rep 2022; 10:e6107. [PMID: 35865785 PMCID: PMC9291263 DOI: 10.1002/ccr3.6107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 06/09/2022] [Accepted: 06/11/2022] [Indexed: 11/25/2022] Open
Abstract
Recently, in Pakistan, several cases of mysterious dengue‐like illness are being reported, which has concerned the authorities and requires prompt action. We present a case of a 52‐year‐old female patient presenting with a history of continuous fever, documented up to 104 F, for 5 days. The symptoms were associated with headache, nausea, retro‐orbital headache, arthralgia, and myalgia. Currently, to the best of our knowledge, this is the first reported case in the literature for the endemic mysterious virus and may serve as the groundwork for future studies. The mysterious virus, presenting with symptoms similar to dengue, is currently presumed to be endemic in Pakistan. The classical presentation of the viral fever is headache, nausea, retro‐orbital headache, arthralgia, myalgia, and fatigue. Till now, no known mortality has been reported under the pounce of this virus.
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Affiliation(s)
- Summaiyya Waseem
- Department of Internal Medicine Dow University of Health Sciences Karachi Pakistan
| | - Syed Hassan Ahmed
- Department of Internal Medicine Dow University of Health Sciences Karachi Pakistan
| | - Taha Gul Shaikh
- Department of Internal Medicine Dow University of Health Sciences Karachi Pakistan
| | - Laila Tul Qadar
- Department of Internal Medicine Dow University of Health Sciences Karachi Pakistan
| | - Saad Khalid
- Department of Internal Medicine Dow University of Health Sciences Karachi Pakistan
| | - Nirav Nimavat
- Department of Community Medicine Dr. Kiran C Patel Medical College and Institute Bharuch India
| | - Mohammad Mehedi Hasan
- Department of Biochemistry and Molecular Biology, Faculty of Life Science Mawlana Bhashani Science and Technology University Tangail Bangladesh
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Waseem S, Shaikh TG, Ahmed SH, Usama RM, Asghar MS, Tahir MJ. West Nile virus outbreak in Pakistan: Another potential public health threat in the pipeline? Ann Med Surg (Lond) 2022; 77:103663. [PMID: 35638065 PMCID: PMC9142610 DOI: 10.1016/j.amsu.2022.103663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 04/18/2022] [Indexed: 11/16/2022] Open
Abstract
West Nile virus (WNV), a single-stranded RNA virus belonging to the family of Flaviviridae, is an arbovirus transmitted to humans predominantly by mosquito bites. It exhibits a wide range of clinical findings ranging from asymptomatic presentation to severe several neurological disorders. WNV has afflicted several countries around the globe including Pakistan. News of yet another outbreak in the country by WNV is circulating again. Concerned authorities should act vigilantly before the endemic takes over completely and bring down the already bereaving healthcare of Pakistan.
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Affiliation(s)
| | | | | | | | - Muhammad Sohaib Asghar
- Dow University of Health Sciences–Ojha Campus, 75300, Karachi, Pakistan
- Corresponding author. Resident Physician at Dow University of Health Sciences–Ojha Campus, Karachi, Pakistan.
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Ul-Haque I, Shaikh TG, Ahmed SH, Waseem S, Qadir NA, Bin Arif T, Haque SU. Efficacy of Remimazolam for Procedural Sedation in American Society of Anesthesiologists (ASA) I to IV Patients Undergoing Colonoscopy: A Systematic Review and Meta-Analysis. Cureus 2022; 14:e22881. [PMID: 35399486 PMCID: PMC8982285 DOI: 10.7759/cureus.22881] [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: 03/06/2022] [Indexed: 11/11/2022] Open
Abstract
Remimazolam is made by combining midazolam and remifentanil as an alternative to conventional sedatives. To evaluate the efficacy of remimazolam for sedation in patients undergoing colonoscopy, we conducted a systematic review and meta-analysis of the available randomized controlled trials (RCTs) comparing remimazolam and midazolam. A search was conducted using PubMed, Cochrane Library, and clinicaltrial.gov from inception till December 26, 2021, for RCTs that investigated the efficacy of remimazolam during the above-mentioned procedure. There was no restriction of language. A quality assessment was performed using the Cochrane Risk-of-Bias tool. The data were pooled, and a meta-analysis was completed. The systemic review was conducted in accordance with the Preferred Reporting Items for Systemic Reviews and Meta-Analysis (PRISMA) guideline statement. Three randomized controlled trials involving 539 patients were included in the meta-analysis. Compared with midazolam during colonoscopy, remimazolam results in reduced need for top-up doses (RR= 3.45, 95% CI=1.07 to 11.14; P=0.04, I2=84%). The need for rescue medication was reduced with remimazolam as compared to midazolam (RR=2.42, 95%CI=1.04 to 5.61; P=0.04, I2=96%). There was no significant difference observed between the two drugs on completion of colonoscopy and the overall procedural sedation, but the sensitivity analysis favored remimazolam over midazolam for procedural sedation (RR=4.08, 95%CI=2.35 to 7.09; P<0.00001, I2=39%). This analysis demonstrates the advantages of remimazolam over other agents and sets a platform for relevant future studies.
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Ahmed SH, Waseem S, Shaikh TG, Qadir NA, Siddiqui SA, Ullah I, Waris A, Yousaf Z. SARS-CoV-2 vaccine-associated-tinnitus: A review. Ann Med Surg (Lond) 2022; 75:103293. [PMID: 35096388 PMCID: PMC8788157 DOI: 10.1016/j.amsu.2022.103293] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/12/2022] [Accepted: 01/23/2022] [Indexed: 12/23/2022] Open
Abstract
The global vaccination drive against severe acute respiratory syndrome coronavirus-2 is being pursued at a historic pace. Unexpected adverse effects have been reported following vaccination, including thrombotic thrombocytopenia, myocarditis, amongst others. More recently, some cases of tinnitus are reported post-vaccination. According to the Vaccine Adverse Events Reporting System (VAERS), 12,247 cases of coronavirus post-vaccination tinnitus have been reported till September 14, 2021. To the best of our knowledge, this is the first review evaluating any otologic manifestation following vaccine administration and aims to evaluate the potential pathophysiology, clinical approach, and treatment. Although the incidence is infrequent, there is a need to understand the precise mechanisms and treatment for vaccine-associated-tinnitus.
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Affiliation(s)
| | | | | | | | | | - Irfan Ullah
- Kabir Medical College, Gandhara University, Peshawar, Pakistan
| | - Abdul Waris
- Kabir Medical College, Gandhara University, Peshawar, Pakistan
| | - Zohaib Yousaf
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
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Shaikh TG, Ahmed SH, Waseem S. Is liraglutide the solution for weight loss in women with polycystic ovarian syndrome? J PAK MED ASSOC 2022; 72:203-204. [PMID: 35099475 DOI: 10.47391/jpma.11-4370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Madam, Liraglutide is an acylated glucagon-like peptide-1 (GLP-1) receptor agonist that helps patients suffering from diabetes mellitus type 2 in control their blood glucose level day through its meal induced insulin secretion, so-called incretin effect. The pharmacokinetic properties of liraglutide enable it to control 24-hour glycaemia(1). It is also found to decrease the risk of stroke and cardiovascular events among patients with type 2 diabetes. It has gained a lot of popularity as it is potent and can be taken in combination with almost any other diabetic medication.
However, the use of this drug is not just limited to the treatment of diabetes mellitus. Several recent studies have shown that this drug could treat obese women suffering from polycystic ovarian syndrome (PCOS). A randomized controlled trial published in 2015 in Hormones (Athens) compared the effect of liraglutide and metformin on weight loss in women with PCOS(2). Twenty-eight individuals participated in this study and were randomly categorized into patients receiving liraglutide (n=14) or patients receiving metformin (n=14). The study highlighted that the short-term use of liraglutide significantly reduced the weight in newly diagnosed PCOS womenThe aforementioned is not the only study that supports this result. A 2018 meta-analysis published in Obesity Reviews compared liraglutide, metformin and orlistat in reducing the weight in obese women suffering from PCOS(3). Data from 23 randomized controlled trials, consisting of 941 women, were evaluated, and the results showed that liraglutide whether used alone or in combination with metformin, helped reduce weight.
PCOS is one of the most prevalent endocrinology disorders in South Asia, including Pakistan. It leads to several health risks and is found to affect the quality of life. Most women with PCOS show signs of metabolic syndrome, including obesity, hypertension, dyslipidaemia, and insulin resistance(4). Obesity along with insulin resistance is found to increase risk of hyperandrogenism. This leads to a chain of circumstances that promotes development of PCOS(5). Lifestyle changes and dietary modifications should be the first- line treatment for women with PCOS. But if lifestyle intervention is not effective in reducing weight, then the more aggressive treatment, use of liraglutide, should be considered after consultation with the health care professional.
Continuous...
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Affiliation(s)
- Taha Gul Shaikh
- 3rd Year MBBS Student, Dow University of Health Sciences, Karachi, Pakistan
| | - Syed Hassan Ahmed
- 3rd Year MBBS Student, Dow University of Health Sciences, Karachi, Pakistan
| | - Summaiyya Waseem
- 3rd Year MBBS Student, Dow University of Health Sciences, Karachi, Pakistan
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Ahmed SH, Shaikh TG, Waseem S, Qadir NA, Yousaf Z, Ullah I. Vaccine-induced thrombotic thrombocytopenia following coronavirus vaccine: A narrative review. Ann Med Surg (Lond) 2022; 73:102988. [PMID: 34745596 PMCID: PMC8556865 DOI: 10.1016/j.amsu.2021.102988] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2021] [Revised: 10/27/2021] [Accepted: 10/28/2021] [Indexed: 12/26/2022] Open
Abstract
The novel coronavirus pandemic has taken a toll on the global healthcare systems and economy. Safety precautions, along with vaccination, are the most effective preventive measures. The global vaccination program against COVID-19 has dramatically reduced the number of deaths and cases. However, the incidence of thrombotic events and thrombocytopenia post-COVID-19 vaccination known as vaccine-induced thrombotic thrombocytopenia has raised safety concerns. This has led to an element of vaccine hesitancy. The exact mechanism for vaccine-induced thrombotic thrombocytopenia is unknown. Although the incidence of thrombosis associated with COVID-19 vaccination is low, it still requires attention, especially in older people, smokers, and people with preexisting comorbidities. This study aims to review the pathophysiology, diagnosis, and management of vaccine-induced thrombotic thrombocytopenia, to provide a concise and comprehensive update.
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Affiliation(s)
| | | | | | | | - Zohaib Yousaf
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Irfan Ullah
- Kabir Medical College, Gandhara University, Peshawar, Pakistan
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