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Mohammad A, Gulab A, Swamy P, Tran DD, Parwani P. SYSTOLIC HEART FAILURE AND MINOCA IN PATIENTS WITH SYSTEMIC SCLEROSIS: A DIAGNOSTIC DILEMMA. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)03385-5] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Shahzad A, Patil S, Bakhshi A, Sandhu K, Gulab A, Khraisha O, Amanullah AM. A STARVED SINUS NODE. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)03688-4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Lo KB, Essa H, Wattoo A, Gulab A, Akhtar H, Sudani HA, Angelim L, Helfman B, Peterson E, Brousas S, Whybrow-Huppatz I, Yazdanyar A, Sankaranarayanan R, Rangaswami J. Representation of Chronic Kidney Disease in Randomized Controlled Trials Among Patients With Heart failure With Reduced Ejection Fraction: A Systematic Review. Curr Probl Cardiol 2023; 48:101047. [PMID: 34785259 DOI: 10.1016/j.cpcardiol.2021.101047] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 11/05/2021] [Indexed: 02/01/2023]
Abstract
Patients with advanced chronic kidney disease (CKD) have largely been excluded from randomized control trials (RCTs) in heart failure (HF). This creates a paucity of high quality evidence for guideline directed medical therapy (GDMT), particularly in patients with heart failure with reduced ejection fraction (HFrEF) and CKD. This is a systematic review looking at the patterns and rates of inclusion of CKD in RCTs among patients with HFrEF. The search included RCTs from January 2010 to December 2020. A heat map was constructed to reflect the stages of CKD stages. The percentage of studies that included advanced CKD (stages IV-V) was recorded and log transformed, and then fitted into a time regression model. A P value of <0.05 was considered statistically significant. Out of the 3052 screened, 706 studies were included in the analysis. Only 61% of the RCTs reported at least some information on kidney function. There was a trend of increase in percentage of studies that included CKD stages IV-V from years 2010 to 2020. This was confirmed with a statistically significant linear trend P = 0.02 while the percentage of studies that included dialysis and kidney transplant recipients remained consistently low. There is a paucity of high-quality evidence for GDMT in the HFrEF population with CKD, particularly in those with advanced non-dialytic CKD, those on maintenance dialysis and kidney transplant recipients. There is a pressing need for wider inclusion of patients with advanced CKD in RCTs of GDMT in HFrEF.
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Affiliation(s)
- Kevin Bryan Lo
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA.
| | - Hani Essa
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK; Liverpool Centre for Cardiovascular Science, Liverpool Heart & Chest Hospital, Liverpool, UK; University of Liverpool, Liverpool, UK
| | - Ammaar Wattoo
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA
| | - Asma Gulab
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA
| | - Hamza Akhtar
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA
| | - Hussein Al Sudani
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA
| | - Lucas Angelim
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA
| | - Beth Helfman
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA
| | - Eric Peterson
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA
| | - Sophia Brousas
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | | | - Ali Yazdanyar
- Morsani College of Medicine, University of South Florida, Tampa, FL; Department of Medicine, Lincoln Medical Center, New York, NY
| | - Rajiv Sankaranarayanan
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK; Liverpool Centre for Cardiovascular Science, Liverpool Heart & Chest Hospital, Liverpool, UK; University of Liverpool, Liverpool, UK
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Gulab A, Mohammad A, Basharat SA, Contractor T, Parwani P. LOOK BEYOND LUPUS: ARRHYTHMOGENIC CARDIOMYOPATHY IN A CASE OF SLE. J Am Coll Cardiol 2023. [DOI: 10.1016/s0735-1097(23)04056-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/06/2023]
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Butt N, Gulab A, Yook JH, Alsaray IAF, Chhabra L. Ascending Aortic Wall Fibroelastoma in an Elderly Woman with Dyspnea. Methodist Debakey Cardiovasc J 2022; 18:23-28. [PMID: 35855402 PMCID: PMC9248980 DOI: 10.14797/mdcvj.1081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/30/2022] [Indexed: 11/08/2022] Open
Abstract
Aortic fibroelastoma is an uncommon pathology that is often found incidentally on routine cardiac imaging. The use of multimodality imaging including computerized tomography and magnetic resonance imaging has led to discovery of further distinguishing features of these lesions that may allow improved differentiation from aortic thrombi. Although most are located on cardiac valves, nonvalvular fibroelastomas have been seen on occasion. Optimal diagnosis and management of incidental aortic fibroelastomas remains debated. We describe a case of nonvalvular aortic fibroelastoma and review current diagnostic and management approaches.
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Affiliation(s)
| | - Asma Gulab
- Einstein Medical Center, Philadelphia, Pennsylvania, US
| | - Ji Hyun Yook
- Shanghai Medical College of Fudan University, Shanghai, CN
| | | | - Lovely Chhabra
- Mid-Hudson Regional Hospital, Poughkeepsie, New York, US
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Al Sudani H, Lo KB, Essa H, Wattoo A, Gulab A, Akhtar H, Angelim L, Helfman B, Peterson E, Brousas S, Whybrow-Huppatz I, Yazdanyar A, Soman S, Sankaranarayanan R, Rangaswami J. Differences in ejection fraction as inclusion criterion in randomized controlled trials among patients with heart failure with reduced ejection fraction: a systematic review. Expert Rev Cardiovasc Ther 2022; 20:481-484. [PMID: 35654018 DOI: 10.1080/14779072.2022.2085687] [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: 10/18/2022]
Abstract
INTRODUCTION Heart failure (HF) with reduced ejection fraction (HFrEF) has been defined by varying ejection fraction (EF) criteria in clinical trials, leading to differences in quantifying treatment effects. AREAS COVERED The definitions of HFrEF in randomized controlled trials from 2010 until 2020 were collected. The EF ranges were clustered into very low (<30%), low (30-39%) and mildly reduced (40-49%) stratified by intervention. Time series regression analysis was performed.A total of 3052 articles were screened and 706 were included. Interventions included were pharmacologic (37%), device therapy (10%) and 53% a combination of programs, procedural, and laboratory testing. By EF cutoffs, 41% of the studies utilized <40% while 26% used <35%. About 31% did not have a clearly defined EF. Between 2010-2020, studies with HFrEF ranges 30-39% have significantly decreased (p value<0.001 for trend) but those which included very low EF (<30%) and mildly reduced EF (40-49%) have remained the same. Expert opinion:EF definitions across clinical trials in HFrEF varied widely. Defining the specific target HF population phenotype when designing trials or in patient treatment is important as various beneficial effects of different heart failure treatment modalities can be modified or even attenuated across the spectrum of EF.
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Affiliation(s)
- Hussein Al Sudani
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Kevin Bryan Lo
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Hani Essa
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.,Liverpool Centre for Cardiovascular Science, Liverpool Heart & Chest Hospital, Liverpool, UK.,University of Liverpool, Liverpool, UK
| | - Ammaar Wattoo
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Asma Gulab
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Hamza Akhtar
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Lucas Angelim
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Beth Helfman
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Eric Peterson
- Department of Internal Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Sophia Brousas
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | | | | | - Sandeep Soman
- Department of Nephrology, Henry Ford Hospital, Detroit, MI 48202 USA
| | - Rajiv Sankaranarayanan
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK.,Liverpool Centre for Cardiovascular Science, Liverpool Heart & Chest Hospital, Liverpool, UK.,University of Liverpool, Liverpool, UK
| | - Janani Rangaswami
- George Washington University School of Medicine, Washington, DC, USA
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Abstract
Introduction: The role of serum uric acid as a connector in cardiorenal interactions has been long debated and studied extensively in the past decade. Epidemiological, and clinical data suggest that hyperuricemia may be an independent risk factor as well as a strong predictor of morbidity and mortality in cardiovascular diseases (CVD) and renal diseases. New data suggesting that urate lowering therapies may improve outcomes in cardiovascular diseases have generated interest.Areas Covered: This review attempts to summarize the pathophysiological mechanisms by which hyperuricemia causes cardiorenal dysfunction. It also provides a summary of the recent evidence for urate lowering therapies and the possible underlying mechanisms which lead to cardiovascular benefits. This was a narrative review with essential references or cross references obtained via expert opinion.Expert Opinion: Emphasis on newer drugs that address the cardio-renal metabolic axis and the relation to their effects on uric acid may help further elucidate underlying mechanisms responsible for their cardiovascular and renal benefits. Once these benefits are well established, we will be able to come up with guidelines for targeting hyperuricemia. This can potentially lead to a change in clinical practice and can possibly lead to improved cardiovascular and renal outcomes.
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Affiliation(s)
- Asma Gulab
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Ricardo Torres
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Jerald Pelayo
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Kevin Bryan Lo
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Anum Shahzad
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Supriya Pradhan
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA
| | - Janani Rangaswami
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, USA.,Department of Internal Medicine, Sidney Kimmel College of Thomas Jefferson University, Philadelphia, PA, USA
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Babapoor-Farrokhran S, Kalla A, Gill D, Gulab A, Banka S, Kalra S. Peripheral Administration of Nitroglycerin in Pulseless Ventricular Tachycardia due to Cocaine-Induced Coronary Vasospasm. Cardiovasc Toxicol 2021; 21:490-493. [PMID: 33534027 DOI: 10.1007/s12012-021-09635-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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: 11/03/2020] [Accepted: 01/22/2021] [Indexed: 10/22/2022]
Abstract
Cocaine use accounts for 40% of the annual drug use related emergency department visits in the United States. Cocaine use is hence recognized as a major health problem. Cocaine blocks the presynaptic reuptake of norepinephrine and dopamine. The resulting increased adrenergic activity leads to vasoconstriction. Additionally, via various mechanisms, cocaine leads to a prothrombotic state and increases myocardial demand. Cocaine can cause coronary vasospasm and is therefore, associated with acute myocardial injury even in the absence of pre-existing atherosclerotic coronary artery disease. Nitroglycerin has a class 1C indication by the ACCF/AHA guidelines for patients with ST-segment elevation or depression that accompanies ischemic chest discomfort in the setting of cocaine use. It has been shown to reverse cocaine-induced coronary vasospasm and chest pain. In this case report, for the first time, we discuss how intravenous administration of high dose nitroglycerin to a patient in pulseless ventricular tachycardia with angiographically confirmed vasospasm induced by cocaine resulted in return of spontaneous circulation.
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Affiliation(s)
- Savalan Babapoor-Farrokhran
- Division of Cardiology, Department of Medicine, Einstein Medical Center, 5501 Old York Road, Philadelphia, PA, 19141, USA.
| | - Aditi Kalla
- Division of Cardiology, Department of Medicine, Einstein Medical Center, 5501 Old York Road, Philadelphia, PA, 19141, USA
| | - Deanna Gill
- Department of Medicine, Emory University School of Medicine, Atlanta, GA, 30322, USA
| | - Asma Gulab
- Department of Medicine, Einstein Medical Center, Philadelphia, PA, 19141, USA
| | - Sahil Banka
- Division of Cardiology, Department of Medicine, Einstein Medical Center, 5501 Old York Road, Philadelphia, PA, 19141, USA
| | - Sanjog Kalra
- Division of Cardiology, Department of Medicine, Einstein Medical Center, 5501 Old York Road, Philadelphia, PA, 19141, USA
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Jeon HD, Lo KB, Quintero EE, Lee B, Gulab A, Bhargav R, Pressman GS. Dialysis access as a source of infective endocarditis in dialysis patients. Monaldi Arch Chest Dis 2020; 90. [PMID: 33099991 DOI: 10.4081/monaldi.2020.1505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 08/28/2020] [Indexed: 11/23/2022] Open
Abstract
The incidence of Infective Endocarditis (IE) is higher in dialysis patients compared to the general population. A major risk factor for IE in this group stems from bacterial invasion during repeated vascular access. Previous studies have shown increased risk of bacteremia in patients with indwelling dialysis catheters compared to permanent vascular access. However, association between the development of IE and the type of dialysis access is unclear. We aimed to examine the associated types of intravascular access and route of infection in dialysis patients who were admitted with infective endocarditis at our center. All patients admitted to Albert Einstein Medical Center in Philadelphia with a diagnosis of infective endocarditis who were on chronic hemodialysis were identified from the hospital database for the period of 1/1/07 to 12/31/18. Modified Duke criteria was used to confirm the diagnosis of infective endocarditis. A total of 96 cases were identified. Of those, 57 patients had an indwelling dialysis catheter while the other 39 had permanent dialysis access. In 82% of patients with dialysis catheters, their dialysis access site was identified as the primary source of infection compared to 30% in those with permanent dialysis access (p<0.001). The number of dialysis catheters placed in the preceding 6 months was strongly associated with endocarditis resulting from the dialysis access site (OR = 3.202, p=0.025). Dialysis catheters are more likely to serve as the source of infection in dialysis patients developing IE compared to permanent dialysis access. Increased awareness of risk of IE associated with dialysis catheters is warranted.
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Affiliation(s)
- Hee D Jeon
- Department of Cardiology, Loma Linda University Medical Center, Loma Linda, CA.
| | - Kevin B Lo
- Department of Internal Medicine, Albert Einstein Medical Center, Philadelphia, PA.
| | - Eduardo E Quintero
- Department of Internal Medicine, Albert Einstein Medical Center, Philadelphia, PA.
| | - Byeori Lee
- Department of Internal Medicine, Albert Einstein Medical Center, Philadelphia, PA.
| | - Asma Gulab
- Department of Internal Medicine, Albert Einstein Medical Center, Philadelphia, PA.
| | - Ruchika Bhargav
- Department of Internal Medicine, Albert Einstein Medical Center, Philadelphia, PA.
| | - Gregg S Pressman
- Department of Cardiology, Albert Einstein Medical Center, Philadelphia, PA.
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Pinto WAH, Gulab A, Lo K, Brito D, Alhamshari Y, Pressman GS. ARRHYTHMOGENIC RIGHT VENTRICULAR CARDIOMYOPATHY: AN UNDERRECOGNIZED TIME BOMB. J Am Coll Cardiol 2020. [DOI: 10.1016/s0735-1097(20)33095-3] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Malik S, Kiran Z, Rashid MO, Mawani M, Gulab A, Masood MQ, Islam N. Hypopituitarism other than sellar and parasellar tumors or traumatic brain injury assessed in a tertiary hospital. Pak J Med Sci 2019; 35:1149-1154. [PMID: 31372159 PMCID: PMC6659092 DOI: 10.12669/pjms.35.4.174] [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: 11/30/2022] Open
Abstract
Objective: Data regarding the etiology, clinical and biochemical patterns in hypopituitarism is scant for Pakistan. We describe the characteristics of patients with hypopituitarism other than sellar and parasellar tumors or traumatic brain injury from a tertiary care center in Pakistan. Methods: We conducted a retrospective descriptive study in the Aga Khan University Hospital, Karachi, Pakistan. We studied all patients presenting with hypopituitarism, between January 2004 and December 2013. Clinical, hormonal and imaging data pertinent to the study was collected according to inclusion criteria. Results: Forty-two patients presented to the endocrinology clinics at the Aga Khan University Hospital during the study period. Thirty-seven patients (88.1%) were females. Mean age ± standard deviation of the participants was 53.8 ± 14.7 years. Sixteen patients had secondary infertility and all were females; a majority of patients in this group had Sheehan’s syndrome (n=8) followed by empty sella syndrome (n=3), partial empty sella syndrome (n=2), idiopathic cause (n=2) and tuberculoma (n=1). Eighteen females (48.6%) reported inability to lactate. Conclusions: Non-traumatic hypopituitarism was more common in women, with Sheehan syndrome being the most common cause of hypopituitarism in our study (35.7%). Secondary hypothyroidism was the most common hormonal deficiency. The most commonly reported symptom was weakness.
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Affiliation(s)
- Sarwar Malik
- Dr. Sarwar Malik, FCPS (Medicine), FCPS (Endocrinology). Department of Medicine, Federal Govt. Polyclinic Hospital, Islamabad, Pakistan
| | - Zareen Kiran
- Dr. Zareen Kiran, FCPS (Medicine), MRCP (UK), FCPS (Endocrinology). Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Owais Rashid
- Dr. Muhammad Owais Rashid, FCPS (Medicine). Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Minaz Mawani
- Ms. Minaz Mawani, MSc (Epidemiology and Biostatistics). Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Asma Gulab
- Dr. Asma Gulab, MBBS. Aga Khan Medical College, Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Qamar Masood
- Dr. Muhammad Qamar Masood, Diplomate American Board of Endocrinology, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
| | - Najmul Islam
- Dr. Najmul Islam, FRCP. Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
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Raza VF, Iftikhar M, Gulab A, Anwar J, Tetlay M, Atif S, Butt Z, Khan MH, Moiz A, Nadeem M, Saleem S. Impressions and attitudes of adult residents of Karachi towards a possible public health insurance scheme. J PAK MED ASSOC 2017; 67:1460-1465. [PMID: 28924298] [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: 06/07/2023]
Abstract
OBJECTIVE To gauge the general population's knowledge and attitude towards a possible public health insurance scheme. METHODS This descriptive, cross-sectional study was conducted at the Aga Khan University Hospital, Karachi, from April to May 2015, and comprised permanent residents of the city. Convenience sampling was used. Data was collected via questionnaires. SPSS 22 was used for data analysis. RESULTS There were 340 participants in the study with an overall mean age of 32.9±12.4 years. Besides, 159(46.8%) participants were aware of the concept of medical insurance while the correct definition was identified by 160(50.5%) respondents. Overall, 256(75.3%) participants were willing to join a theoretical public health insurance scheme. Of all the respondents, 107(31.5%) had faced a catastrophic event in the past and consequently were more willing to join. Of those unsure or not willing to join, 33(37.9%) respondents identified lack of trust in government programmes as the main reason for their choice. CONCLUSIONS A large majority of adults had a favourable attitude towards the implementation of a possible public health insurance scheme.
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Affiliation(s)
| | - Mustafa Iftikhar
- Medical College, Aga Khan University Hospital, Karachi, Pakistan
| | - Asma Gulab
- Medical College, Aga Khan University Hospital, Karachi, Pakistan
| | - Javeria Anwar
- Medical College, Aga Khan University Hospital, Karachi, Pakistan
| | - Maryam Tetlay
- Medical College, Aga Khan University Hospital, Karachi, Pakistan
| | - Sara Atif
- Medical College, Aga Khan University Hospital, Karachi, Pakistan
| | - Zoya Butt
- Medical College, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Asad Moiz
- Medical College, Aga Khan University Hospital, Karachi, Pakistan
| | - Marium Nadeem
- Medical College, Aga Khan University Hospital, Karachi, Pakistan
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University Hospital, Karachi, Pakistan
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Abstract
Five hundred and thirty cases of spring catarrh were studied at the Department of Ophthalmology, Khyber Hospital Peshawar, Pakistan. Corneal complications occurred in 259 patients, of which 48 cases were of keratoconus, consisting of 41 male and seven female patients. Most of the patients affected (37) were between the ages of 10 and 30 years. Six patients developed acute hydrops, which in one case affected both eyes, though after an interval of a few months. Keratoconus was progressive in many patients, resulting in gross visual loss, often not correctable with glasses or contact lenses and thus requiring keratoplasty. The importance of association of keratoconus with atopic disorders is discussed and its association with spring catarrh is stressed.
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Affiliation(s)
- M D Khan
- Lady Reading Hospital, Peshawar, Pakistan
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