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Ashfaq QUA, Ejaz T, Baloch MH, Imam KA. Perceptions and use of evidence-based revision methods among undergraduate medical students. J PAK MED ASSOC 2024; 74:499-503. [PMID: 38591286 DOI: 10.47391/jpma.9307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Objective To assess awareness, perceptions and use related to evidence-based revision methods by undergraduate medical students. METHODS The descriptive cross-sectional study was conducted in three medical colleges of Rawalpindi, Islamabad, Pakistan, from December 01, 2019, to January 31, 2020, after approval from the ethics review committee of Army Medical College, Rawalpindi. The sample comprised undergraduate medical students of either gender. Data was collected online using a 10-item standardised questionnaire. Students were asked about the revision methods they used routinely and their perceptions of conventional and evidence-based revision methods. Data was analysed using SPSS 23. RESULTS Of the total 136 respondents, 92(67%) were females and 44(32.3%) were male students. The response from preclinical and clinical years was 67 (50.7%) and 69(49.2%), respectively. Highlighting was the most widely used revision method among students (70 (51%) students), followed by re-reading important points (65 (47.7%) students). 126 (92%) students had the opinion that conventional revision methods were effective learning tools. Only 52 (38.2%) students were aware of the term 'evidence-based revision methods'. Digital tools based on principles of evidence-based revision were used by a minority of students which included use of online question banks by 21 (15.4%) students, osmosis by 40 (29.4%) students, sketchy pharma by 35 (25%)students, flashcards by 19 (14%) and picmonic by only 3 (2.2%). More than 114 (80%) students responded that they wanted evidence-based revision methods to be incorporated into curriculum, and 116 (85%) students said they would like to have a workshop on these techniques. Conclusion Most medical students were not aware of and were not using evidence-based revision methods, and relied on conventional revision tools. They were, however, eager to learn about newer revision strategies.
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Affiliation(s)
| | - Taymmia Ejaz
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Maria Hasan Baloch
- Department of Biochemistry, Shifa College of Medicine, Islamabad, Pakistan
| | - Kamil Asghar Imam
- Department of Physiology, Quetta Institute of Medical Sciences, Quetta, Pakistan
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Fatima S, Ismail M, Ejaz T, Shah Z, Fatima S, Shahzaib M, Jafri HM. Association between long COVID and vaccination: A 12-month follow-up study in a low- to middle-income country. PLoS One 2023; 18:e0294780. [PMID: 37992084 PMCID: PMC10664948 DOI: 10.1371/journal.pone.0294780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 11/08/2023] [Indexed: 11/24/2023] Open
Abstract
OBJECTIVE There is a lack of estimates regarding the at-risk population associated with long COVID in Pakistan due to the absence of prospective longitudinal studies. This study aimed to determine the prevalence of long COVID and its association with disease severity and vaccination status of the patient. DESIGN AND DATA SOURCES This prospective cohort study was conducted at the Aga Khan University Hospital and recruited patients aged > 18 years who were admitted between February 1 and June 7, 2021. During this time, 901 individuals were admitted, after excluding patients with missing data, a total of 481 confirmed cases were enrolled. RESULTS The mean age of the study population was 56.9±14.3 years. Among patients with known vaccination status (n = 474), 19%(n = 90) and 19.2%(n = 91) were fully and partially vaccinated, respectively. Severe/critical disease was present in 64%(n = 312). The mortality rate following discharge was 4.58%(n = 22). Around 18.9%(n = 91) of the population required readmission to the hospital, with respiratory failure (31.8%, n = 29) as the leading cause. Long COVID symptoms were present in 29.9%(n = 144), and these symptoms were more prevalent in the severe/critical (35.5%, n = 111) and unvaccinated (37.9%, n = 105) cohort. The most prominent symptoms were fatigue (26.2%, n = 126) and shortness of breath (24.1%, n = 116), followed by cough (15.2%, n = 73). Vaccinated as compared to unvaccinated patients had lower readmissions (13.8% vs. 21.51%) and post-COVID pulmonary complications (15.4% vs. 24.2%). On multivariable analysis, after adjusting for age, gender, co-morbidity, and disease severity, lack of vaccination was found to be an independent predictor of long COVID with an Odds ratio of 2.42(95% CI 1.52-3.84). Fully and partially vaccinated patients had 62% and 56% reduced risk of developing long COVID respectively. CONCLUSIONS This study reports that the patients continued to have debilitating symptoms related to long COVID, one year after discharge, and most of its effects were observed in patients with severe/critical disease and unvaccinated patients.
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Affiliation(s)
- Samar Fatima
- Section of Internal Medicine, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Madiha Ismail
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Taymmia Ejaz
- Section of Internal Medicine, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Zarnain Shah
- Section of Internal Medicine, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Summaya Fatima
- Section of Internal Medicine, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Mohammad Shahzaib
- Section of Internal Medicine, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Hassan Masood Jafri
- Department of Emergency Medicine, Aga Khan University Hospital, Karachi, Pakistan
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Fatima S, Shamim S, Ejaz T. Clinical Outcomes And Predictors Of Mortality In COVID-19 Patients Admitted To A High Dependency Unit In Pakistan-A Cross-Sectional Study. J PAK MED ASSOC 2023; 73:1628-1633. [PMID: 37697753 DOI: 10.47391/jpma.7288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
Objectives To determine the outcomes and predictors of in-hospital mortality of patients admitted to high dependency unit with coronavirus disease 2019 infection. METHODS The retrospective study was conducted at a tertiary care hospital in Karachi, and comprised data of adult coronavirus disease 2019 patients of either gender admitted to the high dependency unit from March 1 to June 30, 2020. Outcomes were categorised as patients 'recovered without deterioration', 'deteriorated but survived', and 'deteriorated but expired'. Data was analysed using SPSS 22. RESULTS Of the 525 patients with confirmed infection, 245(46.6%) were admitted to the high dependency unit. Leaving out 38(15.5%) cases with missing data, 207(84.5%) cases formed the study sample; 156(75.4%) males and 51(24.6%) females. The overall mean age was 56.9±14years (range: 24-86 years). The most common comorbid condition was hypertension 105(50.7%), and the most common reason for critical care was hypoxic respiratory failure 199(96.1%). Of the total, 153(74%) patients recovered, 31(15%) deteriorated, and mortality was the outcome in 23(11%). There was no significant effect of drug treatment on mortality (p>0.05). Age, multimorbidity and high D-Dimer level were significantly associated with disease progression and mortality (p<0.05). CONCLUSIONS Mortality was high among coronavirus disease 2019 patients who were older and had multimorbidity.
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Affiliation(s)
- Samar Fatima
- Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan
| | - Sara Shamim
- Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan
| | - Taymmia Ejaz
- Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan
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Fatima S, Zafar A, Afzal H, Ejaz T, Shamim S, Saleemi S, Subhan Butt A. COVID-19 infection among vaccinated and unvaccinated: Does it make any difference? PLoS One 2022; 17:e0270485. [PMID: 35839210 PMCID: PMC9286242 DOI: 10.1371/journal.pone.0270485] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [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: 03/07/2022] [Accepted: 06/12/2022] [Indexed: 11/19/2022] Open
Abstract
Objective There is a probability that vaccination may lead to reduction in the severity and complications associated with COVID-19 infection among hospitalized patients. This study aimed to determine the characteristics, clinical profiles, and outcomes of COVID-19 infection in vaccinated and non-vaccinated patients. Design and data sources This prospective observational cohort study was conducted at the Aga Khan University Hospital (AKUH) and recruited COVID-19 patients admitted between June 1st and September 30th, 2021. Patients’ demographics, date of admission and discharge, comorbid conditions, immunization status for COVID-19 infection, presenting complaints, lab workup and computed tomography (CT) scan findings were obtained from the medical records. The primary outcome of the study was patients’ condition at discharge and the secondary outcomes included level of care, length of stay (LOS), requirement of non-invasive ventilation (NIV) and inotropic support. Results Among a cohort of 434 patients, 37.7% (n = 164), 6.6% (n = 29) and 55.5% (n = 241) were fully vaccinated, partially vaccinated, and unvaccinated, respectively. Around 3% and 42.9% of the patient required inotropic and NIV support respectively; however, there was no discernible difference between them in terms of vaccination status. In case of unvaccinated patients there were significantly increased number of critical care admissions (p-value 0.043). Unvaccinated patients had significantly higher median serum procalcitonin, ferritin, LDH and D-dimer levels. Around 5.3% (n = 23) of the patient required invasive ventilation and it was more common in unvaccinated patients (p-value 0.04). Overall, mortality rate was 12.2% (n = 53) and this was higher (16.2%, n = 39) in unvaccinated patients as compared to fully vaccinated patients (6.1%, n = 10, p-value 0.006). Conclusions Through this preliminary data, we can conclude that patient can develop severe and critical COVID-19 infection despite being vaccinated but this proportion is low as compared to unvaccinated population. So, uninterrupted endeavors need to be done to vaccinate as many individuals as possible. Furthermore, more effective vaccinations need to be developed to lessen the high death toll of COVID-19 infection.
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Affiliation(s)
- Samar Fatima
- Department of Medicine, Section of Internal Medicine, Aga Khan University Hospital, Karachi, Pakistan
- * E-mail:
| | - Amara Zafar
- Department of Medicine, Section of Internal Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Haris Afzal
- Department of Medicine, Section of Internal Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Taymmia Ejaz
- Department of Medicine, Section of Internal Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Sara Shamim
- Department of Medicine, Section of Internal Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Shayan Saleemi
- Department of Medicine, Section of Internal Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Amna Subhan Butt
- Department of Medicine, Section of Gastroenterology, Aga Khan University Hospital, Karachi, Pakistan
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Siddiqui AF, Saadia S, Ejaz T, Mushtaq Z. COVID-19 encephalopathy: an unusual presentation with new-onset seizure causing convulsive status epilepticus. BMJ Case Rep 2022; 15:15/3/e245387. [PMID: 35260396 PMCID: PMC8905954 DOI: 10.1136/bcr-2021-245387] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Although neurological manifestations such as headache and myalgias have been observed with COVID-19, presentation with more serious neurological illness is uncommon and rare. We report a case of a middle-aged woman who presented to the emergency department of a tertiary care hospital. Her clinical presentation was primarily neurological rather than the more common presentation with respiratory manifestations. She presented with generalised tonic–clonic seizures, along with history of undocumented low-grade fever and generalised body aches. The positive SARS-CoV-2 RT-PCR nasal swab, the cerebrospinal fluid analysis (lymphocytic pleocytosis) and electroencephalogram were consistent with viral encephalitis; brain imaging was unremarkable. This case highlights the variable presenting features of COVID-19 infection as patients can primarily present with neurological manifestations in the absence of significant respiratory symptoms. We believe it is important to recognise neurological disease associated with SARS-CoV-2 in patients with asymptomatic respiratory infection.
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Affiliation(s)
- Aisha Fareed Siddiqui
- Section of Internal Medicine, Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan
| | - Sheema Saadia
- Section of Internal Medicine, Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan
| | - Taymmia Ejaz
- Section of Internal Medicine, Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan
| | - Zain Mushtaq
- Section of Internal Medicine, Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan
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Ejaz T, Saadia S, Akhlaq S, Aziz A, Ahmed MA, Siddiqui AF. Clinical Features and Outcomes of Acute Chlorine Gas Inhalation; a Brief Report. Arch Acad Emerg Med 2022; 10:e15. [PMID: 35402997 PMCID: PMC8986491 DOI: 10.22037/aaem.v10i1.1448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Introduction On March 6th,2020, chlorine gas leak was reported at Engro Polymer & Chemicals Plant in Karachi City, Pakistan. This study aimed to evaluate the clinical features and outcomes of patients who presented to emergency department (ED) following this event. Methods This retrospective cross-sectional study, evaluated the clinical features and outcomes (length of hospital stay, complications, and mechanical ventilation requirement) of patients presenting to ED of Aga Khan University Hospital, Karachi, Pakistan, with history of chlorine gas exposure at the Engro Plant from 6th March to 14th March 2020. Results 38 patients with mean age of 33.1 ± 8.1 years presented to ED with history of chlorine gas exposure (100% male). 4 (10.5%) cases had comorbid diseases. Most common presenting symptom was dyspnea, observed in 33 (86.8%) cases, followed by cough, seen in 27 (71.1%) subjects. 13.2% (5/38) patients had infiltration on chest x-ray and 33 (86.8 %) required hospitalization. 6 (15.8%) patients had repeat presentation requiring hospitalization or ED visit. 18 (47.4%) were managed with high flow oxygen therapy, 9 (23.7%) required non-invasive ventilation and one patient was intubated due to development of pneumo-mediastinum. Mean length of stay was 1.55 ± 1.58 days and no patients died. Presence of tachycardia was the only finding significantly associated with need for oxygen (p = 0.033) and non-invasive ventilation (p = 0.012). Conclusion The majority of patients presenting with acute chlorine gas exposure showed good clinical outcomes and rapid recovery, however, a high index of suspicion and vigilance should be maintained for complications such as pneumomediastinum and acute respiratory distress syndrome in these patients.
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Affiliation(s)
- Taymmia Ejaz
- Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan.,Corresponding author: Taymmia Ejaz; Department of Medicine, The Aga Khan University Hospital, Stadium Road, Karachi, 78600, Pakistan. / , Tel: +923225830686
| | - Sheema Saadia
- Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan
| | - Safia Akhlaq
- Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan
| | - Adil Aziz
- Department of Medicine, The Aga Khan University Hospital, Karachi, Pakistan
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Ejaz T, Malik MI, Ahmed J, Azam R, Jamal Y, Saadia S. Clinico-radiological and bronchoscopic predictors of microbiological yield in sputum negative tuberculosis in Pakistan. Monaldi Arch Chest Dis 2021; 92. [PMID: 34873901 DOI: 10.4081/monaldi.2021.1976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 10/05/2021] [Indexed: 11/23/2022] Open
Abstract
To determine association of clinico-radiological factors and radiological activity with diagnostic yield in sputum-smear negative tuberculosis (TB). Prospective observational study in Military Hospital Rawalpindi from July to December 2018. Adult patients having no contraindications to bronchoscopy were included. HIV positive patients and those on anti-tuberculosis therapy for more than one week were excluded. High-Resolution Computed tomography (HRCT) findings were classified based on active and inactive tuberculosis features. Washings were sent for Acid-Fast Bacillus (AFB) smear, GeneXpert assay and cultures. Out of 215 patients, 42.3% (91) were diagnosed with microbiological or histological evidence of TB. On univariate analysis, cavitation (p-value <0.001), soft-tissue nodules (p-value 0.04), and endobronchial mucosal changes (p-value 0.02) were associated with culture positivity. Presence of cavitation (OR= 4.10; CI= 2.18,7.73; p-value<0.001) was the only independent predictor of microbiological yield. Diagnostic yield was 70%, 50%, 12.5% and 8.6% in patients with definitely active, probably active, indeterminate and inactive tuberculosis HRCT features respectively. Sensitivity, specificity, positive predictive value and negative predictive value of HRCT active TB were 95.38% (95% CI 87.10 -99.04), 48.00 % (95% CI 39.78 -56.30), 44.29% (95% CI 40.31 -48.33), 96.00 % (95%CI 88.70 -98.66) respectively. There was no significant association between age groups, smoking status and gender with diagnosis of tuberculosis in our study. Radiological activity and certain visualized bronchoscopic changes were associated with good diagnostic performance and can be used as predictive factors in diagnosis of active smear negative tuberculosis.
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Affiliation(s)
- Taymmia Ejaz
- Department of Medicine, Aga Khan University Hospital, Karachi.
| | - Mahmood Iqbal Malik
- Department of Pulmonology, Pak Emirates Military Hospital, National University of Medical Sciences, Rawalpindi.
| | - Jamal Ahmed
- Department of Pulmonology, Pak Emirates Military Hospital, National University of Medical Sciences, Rawalpindi.
| | - Rizwan Azam
- Department of Pulmonology, Pak Emirates Military Hospital, National University of Medical Sciences, Rawalpindi.
| | - Yousaf Jamal
- Department of Pulmonology, Pak Emirates Military Hospital, National University of Medical Sciences, Rawalpindi.
| | - Sheema Saadia
- Department of Medicine, Aga Khan University Hospital, Karachi.
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Akhlaq S, Ejaz T, Aziz A, Ahmed A. Spontaneous pneumomediastinum in accidental chlorine gas inhalational injury: case report and review of literature. BMJ Case Rep 2021; 14:14/7/e236549. [PMID: 34330735 PMCID: PMC8327745 DOI: 10.1136/bcr-2020-236549] [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: 11/03/2022] Open
Abstract
A young man presented in emergency department with shortness of breath and cough after accidental inhalation of chlorine gas. Initial presentation was unremarkable; therefore, he was kept under observation for 8 hours and was later discharged. After 5 hours, the patient presented again in emergency department with sudden-onset shortness of breath and chest discomfort. On examination, subcutaneous crepitation around the neck and chest was found. Chest and neck X-ray revealed subcutaneous emphysema and pneumomediastinum. CT neck and chest was done, which revealed subcutaneous emphysema and pneumomediastinum and a linear air density in close approximation to right posterolateral wall of trachea at the level of superior margin of sternum was reported. These findings raised the possibility of tracheal injury which was later confirmed by fiberoptic laryngoscopy. The patient was intubated due to hypercapnic respiratory failure resulting from hypoventilation and respiratory distress. Bilateral chest tube insertion was done due to worsening subcutaneous emphysema, high ventilator parameters and prevention of progression to pneumothorax. He was extubated after 5 days; bilateral chest tubes were removed before discharge and underwent uneventful recovery.
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Affiliation(s)
- Safia Akhlaq
- Medicine, Aga Khan University, Karachi, Pakistan
| | - Taymmia Ejaz
- Medicine, Aga Khan University, Karachi, Pakistan
| | - Adil Aziz
- Medicine, Aga Khan University, Karachi, Pakistan
| | - Arslan Ahmed
- Medicine, Aga Khan University, Karachi, Pakistan
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Saadia S, Hassan M, Ejaz T, Shaikh A, Saeed Y, Ahsan S. QT interval in patients receiving HCQ in SARS-CoV-2- A study on risk factors and correlation of baseline QTc with delta QTc in Pakistani population. Europace 2021. [PMCID: PMC8194794 DOI: 10.1093/europace/euab116.017] [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] [Indexed: 11/13/2022] Open
Abstract
Funding Acknowledgements Type of funding sources: None. Introduction Hydroxychloroquine(HCQ) use alone or in combination with Azithromycin (AZM) in SARS-CoV-2 infection is associated with QTc prolongation and risk of arrhythmias. Objectives To determine changes in QTc interval and factors predictive of extreme QTc prolongation in patients receiving HCQ alone or in azithromycin combination in Pakistani patients. Methodology Retrospective review of records of hospitalized patients with SARS-Cov2 RT-PCR positive result who received HCQ or HCQ/Azithromycin in combination from March-May 2020. Baseline ECGs as well as post drug use ECGs data was recorded. Tisdale score was calculated for predicting risk of QTc prolongation,QTc interval was calculated using Bazett formula. Data entry and analysis was done in SPSS version 23. Results A total of 134 patients were included in the study. 82.1%(110) were males and 17.9%(24) were females, mean age was 54.9 ± 13.7 years. 61.2% (82) had severe disease and 38.8 %(52) had non-severe disease. 14.2%(19) had history of cardiac disease, 35.8%(48) had hypertension and 35.1%(47) had diabetes mellitus. 70.1% (94) patients had received HCQ, AZM, or HCQ/AZM in combination. 40(29.9%) patients had not received any drug. Median baseline QTc among controls and non-control group was 383.5 (IQR 342.25-413.75)msec and 379(IQR 358-402)msec respectively. HCQ alone was administered to 26.9%(36) and HCQ/AZM to 33.6%(45) patients. 55.6% (45/81) developed QTc prolongation(QTc> 480 msec) or delta QTc increase > 60 msec. 6.2%(5/81) had absolute QTc > 500 msec post-drug administration. 55.6%(25/45) and 30.6%(11/36) (p-value 0.024) developed QTc prolongation in combination and HCQ alone groups respectively. Delta QTc increased to >60msec in 42.0% (34/81); 53.3%(24/45) in combination group and in 27.8%(10/36) of those receiving HCQ alone( p-value 0.021). Median delta change was 63( IQR 25-81) and 48.5(IQR 26.25-66.75) msec; Median Day 2 QTc was 413.5 msec (IQR 377.5-436) and 413 msec (IQR361-447); and median maximum QTc was 447(IQR391-471) and 429.8(IQR401.5-45.75) msec in those receiving HCQ/AZM combination and HCQ alone respectively. 9%(12/134) had arrhythmias during hospital stay, in 8.9% (4) and 5.6%(2) patients of those receiving HCQ/AZM combination and HCQ alone respectively, no patient developed torsade de pointes, one patient had non-sustained VT. There was no statistically significant association of QTc prolongation with mortality, acute kidney injury, myocardial injury or severity of disease. Diuretic use was found to be statistically significant association with QTc prolongation(p-value 0.038). There was a weak correlation of baseline QTc with Δ QTc(r = 0.207 and p-value 0.017) Conclusion QTc prolongation was observed in a significant population of patients receiving HCQ and HCQ/AZM combination, however, no significant life threating arrhythmias occurred.
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Affiliation(s)
- S Saadia
- Aga Khan University Hospital, Karachi, Pakistan
| | - M Hassan
- Aga Khan University Hospital, Karachi, Pakistan
| | - T Ejaz
- Aga Khan University Hospital, Karachi, Pakistan
| | - A Shaikh
- Aga Khan University Hospital, Karachi, Pakistan
| | - Y Saeed
- Aga Khan University Hospital, Karachi, Pakistan
| | - S Ahsan
- Aga Khan University Hospital, Karachi, Pakistan
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Ejaz T, Butt B, Raja K, Abbass M. Outcomes and Predictors of In-hospital Mortality in Critically Ill Acute Kidney Injury Patients: A Tertiary Care Center Experience. Saudi J Kidney Dis Transpl 2021; 32:1736-1743. [DOI: 10.4103/1319-2442.352436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Vusqa UT, Liaqat H, Ejaz T, Safdar SA. The influence of operation theatre environment on patients' perceptions during awake procedures: a cross-sectional study. J PAK MED ASSOC 2019; 69:1521-1525. [PMID: 31622309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To determine the perceptions of patients regarding operation theatre conversation and environment during an awake procedure. METHODS The descriptive, cross-sectional study was conducted from February to August 2017 in postoperative wards of Military Hospital, Rawalpindi, Pakistan, and comprised women undergoing gynaecological or obstetric procedures under regional anaesthesia. Closedended questionnaires were distributed via nonprobability convenient sampling. Operation theatre data was collected from the anaesthesia notes, and data was analysed using SPSS 22. RESULTS There were 93 female subjects with a mean age of 28.23}5.42 years (range: 19-48 years). Overall, 90(96.8%) subjects regarded the conduct of operation theatre staff as cooperative and friendly with 64(68.8%) viewing the conversation among the staff as helpful in relieving anxiety. The thought of anaesthesia waning caused anxiety in 40(43%) subjects, but there was no difference in perceived anxiety between those counselled 61(65%) and not counselled by the anaesthetist. With regards to the environment, 41(44%) subjects said more measures were required to prevent patients from seeing the operating field. Besides, 30(32.2%) and 20(21%)subjects had reservations regarding the presence of male staff and medical students respectively. The opinion regarding medical professionals did not change for 60(64%) subjects after the procedure, and 37(39.8%) recommended that communication skills of medical professional needed improvement. CONCLUSIONS The environment in the theatre can have an influence on the patient's anxiety levels. Counselling by surgeons, casual conversations in the theatre can help alleviate apprehensions of the patients.
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Joyce DP, Craig R, Dakin A, Elsheik H, Ejaz T, Mansoor S, Toomey DP. Scope and Safety of Paediatric Surgery in a Model III Hospital. Ir Med J 2019; 112:896. [PMID: 31045335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Introduction Elective and emergency paediatric general surgery is performed in numerous hospitals but with differing exclusion and transfer thresholds. Recent national guidelines detail necessary surgical, anaesthetic and nursing resources for safe and efficient delivery of services. Methods A retrospective review of paediatric surgical admissions was performed from January 2015 to December 2016. Charts of prolonged admissions or readmissions were reviewed. Results There was a total of 2,079 surgical admissions. 575 (27.2%) were elective and 1504 (71.2%) were emergency admissions. Significantly more surgical procedures were performed in 2016 (n=546, 56% versus n=433, 44.2%). Laparoscopic appendicectomy was the most commonly performed procedure. Re-admission rates were lower in 2016 (n=9, 0.8% versus n=21, 2.2%). All complications were Clavien-Dindo Grade I or II. Discussion Paediatric general surgery can be safely and efficiently performed by staffed and resourced Model III hospitals.
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Affiliation(s)
- D P Joyce
- Department of Surgery, Regional Hospital Mullingar, Co. Westmeath
| | - R Craig
- Department of Surgery, Regional Hospital Mullingar, Co. Westmeath
| | - A Dakin
- Department of Surgery, Regional Hospital Mullingar, Co. Westmeath
| | - H Elsheik
- Department of Surgery, Regional Hospital Mullingar, Co. Westmeath
| | - T Ejaz
- Department of Surgery, Regional Hospital Mullingar, Co. Westmeath
| | - S Mansoor
- Department of Surgery, Regional Hospital Mullingar, Co. Westmeath
| | - D P Toomey
- Department of Surgery, Regional Hospital Mullingar, Co. Westmeath
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Vusqa U, Liaqat H, Ejaz T, Safdar S. The Influence of Operation Theater Environment on Patients' Perceptions During Awake Procedures: A Cross-sectional study. J PAK MED ASSOC 2019. [DOI: 10.5455/jpma.299192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Abstract
Changes in the subendo-subepi flow ratio were studied by using a simple electronic circuit model of the coronary vessel consisting of a resistor, capacitor and field effect transistor in order to provide a better understanding of the ischemic vulnerability of the subendocardium. The simulated subendo-subepi flow ratio was found to be approximately 1.2 under normal condition. Changes in the flow ratio were observed while varying the main arterial resistance, mean arterial pressure and intramyocardial pressure individually. The mean flow in the subendocardium was found to decrease at a rate faster than that in the subepicardium with the increase in the septal arterial resistance and the intramyocardial pressure. The same tendency was also observed while the arterial pressure was lowered. This decrease in the mean subendocardial flow is considered to be the effect of higher end-systolic resistance in the subendocardial venule compared to that in the subepicardial venule. These results would be helpful in understanding the vulnerability of the subendocardium to ischemia and in providing clinical treatment to patients with that disease.
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Affiliation(s)
- T Ejaz
- Graduate School of Electronic Science and Technology, Shijuoka University Faculty of Engineering, Hamamatsu, Japan.
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Abstract
Ectopic duplex ureter is a well recognized cause of urinary incontinence in female subjects but to our knowledge it has not been documented in a male subject. We report on a boy who presented with urinary incontinence secondary to an ectopic duplex ureter.
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Affiliation(s)
- T Ejaz
- Department of Paediatric Urology, Wessex Centre for Paediatric Surgery, Southampton General Hospital, England
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