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Sajjad A, Khan AF, Jafri L, Kamal AK. Successful endovascular mechanical thrombectomy in anticoagulation-resistant COVID-19 associated cerebral venous sinus thrombosis. BMJ Case Rep 2021; 14:14/12/e245405. [PMID: 34972772 PMCID: PMC8720961 DOI: 10.1136/bcr-2021-245405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Affiliation(s)
- Ali Sajjad
- Neurology, The Aga Khan University, Karachi, Pakistan
| | | | - Lubna Jafri
- Neurology, The Aga Khan University, Karachi, Pakistan
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Kamal AK, Khalid W, Zulfiqar M, Muqeet A, Zaidi F, Gowani A, Virani SS. The potential of m-Health-based interventions to improve medication literacy and adherence in non-communicable diseases in Pakistan. Int J Stroke 2019; 14:NP8-NP10. [PMID: 30681041 DOI: 10.1177/1747493019827762] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
| | - Wardah Khalid
- 2 Department of Medicine, Aga Khan University, Karachi, Pakistan
| | | | - Abdul Muqeet
- 4 eHealth Resource Centre, Aga Khan Development Network, Karachi, Pakistan
| | - Fabiha Zaidi
- 4 eHealth Resource Centre, Aga Khan Development Network, Karachi, Pakistan
| | - Ambreen Gowani
- 5 School of Nursing and Midwifery, Aga Khan University, Karachi, Pakistan
| | - Salim S Virani
- 6 Michael E. DeBakey Veterans Affairs Medical Center, Houston, USA
- 7 Department of Medicine, Baylor College of Medicine, Houston, USA
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Kamal AK, Khalid W, Muqeet A, Jamil A, Farhat K, Gillani SRA, Zulfiqar M, Saif M, Muhammad AA, Zaidi F, Mustafa M, Gowani A, Sharif S, Bokhari SS, Tai J, Rahman N, Sultan FAT, Sayani S, Virani SS. Making prescriptions "talk" to stroke and heart attack survivors to improve adherence: Results of a randomized clinical trial (The Talking Rx Study). PLoS One 2018; 13:e0197671. [PMID: 30571697 PMCID: PMC6301764 DOI: 10.1371/journal.pone.0197671] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 03/11/2018] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND We developed and tested the effectiveness of a tailored health information technology driven intervention: "Talking Prescriptions" (Talking Rx) to improve medication adherence in a resource challenged environment. METHODS We conducted a parallel, randomized, controlled, assessor-blinded trial at the Aga Khan University (AKU), Karachi, Pakistan. Adults with diagnosis of cerebrovascular accident (CVA) or coronary artery disease (CAD) diagnosed least one month before enrollment, on anti-platelets and statins, with access to a mobile phone were enrolled. The intervention group received a) Daily Interactive Voice Response (IVR) call services regarding specific statin and antiplatelet b) Daily tailored medication reminders for statin and antiplatelet and c) Weekly lifestyle modification messages for a period of 3 months. We assessed Medication adherence to statin and antiplatelets by a validated version of the 8-item Morisky Medication Adherence scale 8 (MMAS-8) at 3 months by a blinded assessment officer. Analysis was conducted by intention-to-treat principle (ITT). RESULTS Between April 2015 and December 2015, 197 participants (99 in intervention and 98 in the usual care group) enrolled in the Talking Rx Study. The dropout rate was 9.6%. Baseline group characteristics were similar. At baseline, the mean MMAS-8 was 6.68 (SD = 1.28) in the intervention group and 6.77 (SD = 1.36) in usual care group. At end of follow-up, the mean MMAS-8 increased to 7.41(0.78) in the intervention group compared with 7.38 (0.99) in usual care group with mean difference of 0.03 (S.D 0.13) (95% C.I [-0.23, 0.29]), which was not statistically significant. (P-Value = 0.40) CVA patients showed a relatively greater magnitude of adherence via the MMAS-8 at the end of follow up where the mean MMAS-8 increased to 7.29 (S.D 0.82) in the intervention group as compared to 7.07(S.D 1.24) in usual care group with mean difference of 0.22 (SD = 0.22) 95% C.I (-0.20, 0.65) with (P-value = 0.15). Around 84% of those on intervention arm used the service, calling at least 3 times and listening to their prescriptions for an average of 8 minutes. No user was excluded due to technologic reasons. CONCLUSION The use of a phone based medication adherence program was feasible in LMIC settings with high volume clinics and low patient literacy. In this early study, with limited follow up, the program did not achieve any statistically significant differences in adherence behavior as self-reported by the MMAS-8 Scale. TRIAL REGISTRATION Clinical Trials.gov NCT02354040.
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Affiliation(s)
- Ayeesha Kamran Kamal
- Section of Neurology, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Wardah Khalid
- Stroke Service, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Abdul Muqeet
- Aga Khan Development Network e-Health Resource Centre, Karachi, Pakistan
| | - Anum Jamil
- Stroke Services, Aga Khan University, Karachi, Pakistan
| | - Kashfa Farhat
- Stroke Service, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Maryam Zulfiqar
- Stroke Service, Aga Khan University Hospital, Karachi, Pakistan
| | - Mehreen Saif
- Stroke Service, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Fabiha Zaidi
- Aga Khan Development Network Health Resource Centre, Karachi, Pakistan
| | | | - Ambreen Gowani
- School of Nursing & Midwifery, Aga Khan University, Karachi, Pakistan
| | - Shahrukh Sharif
- Aga Khan Development Network Health Resource Centre, Karachi, Pakistan
| | | | - Javed Tai
- Section of Cardiology, Aga Khan University, Karachi, Pakistan
| | - Nasir Rahman
- Section of Cardiology, Aga Khan University, Karachi, Pakistan
| | | | - Saleem Sayani
- Aga Khan Development Network e-Health Resource Centre, Karachi, Pakistan
| | - Salim S Virani
- Michael E. DeBakey Veterans Affairs Medical Center & Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, Houston, Texas, United States of America
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Awan S, Shafqat S, Kamal AK, Sonawalla A, Siddiqui S, Siddiqui F, Wasay M. Pattern of neurological diseases in adult outpatient neurology clinics in tertiary care hospital. BMC Res Notes 2017; 10:545. [PMID: 29096694 PMCID: PMC5667470 DOI: 10.1186/s13104-017-2873-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2017] [Accepted: 10/24/2017] [Indexed: 01/14/2023] Open
Abstract
OBJECTIVES The burden of neurological diseases in developing countries is rising although little is known about the epidemiology and clinical pattern of neurological disorders. The objective of this study was to understand the burden of disease faced by neurologists a in tertiary care setting. RESULTS A prospective observational study was conducted of all presentations to neurology clinics at Aga Khan University Hospital Karachi over a period of 2 years. A total of 16,371 out-patients with neurological diseases were seen during the study period. The mean age of the study participants were 46.2 ± 18.3 years and 8508 (52%) were male. Headache disorders were present in 3058 (18.6%) of patients followed by vascular diseases 2842 (17.4%), nerve and root lesions 2311 (14.1%) and epilepsies 2055 (12.5%). Parkinson's disease was more prevalent in male participants 564 (70.8%) as compared to female 257 (62.1%) (p = 0.002). Migraines and vertigo disease were more diagnosed in females as compared to males. Epilepsies were seen more in younger age groups. Parkinson's disease was seen in 50.9% of participants between the ages of 45 and 65 years, and the frequency increased with age.
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Affiliation(s)
- Safia Awan
- Section of Neurology, Department of Medicine, Aga Khan University Hospital Karachi, Karachi, Pakistan
| | - Saad Shafqat
- Section of Neurology, Department of Medicine, Aga Khan University Hospital Karachi, Karachi, Pakistan
| | - Ayeesha Kamran Kamal
- Section of Neurology, Department of Medicine, Aga Khan University Hospital Karachi, Karachi, Pakistan
| | - Aziz Sonawalla
- Section of Neurology, Department of Medicine, Aga Khan University Hospital Karachi, Karachi, Pakistan
| | - Sarwar Siddiqui
- Section of Neurology, Department of Medicine, Aga Khan University Hospital Karachi, Karachi, Pakistan
| | - Fowzia Siddiqui
- Section of Neurology, Department of Medicine, Aga Khan University Hospital Karachi, Karachi, Pakistan
| | - Mohammad Wasay
- Section of Neurology, Department of Medicine, Aga Khan University Hospital Karachi, Karachi, Pakistan
- Department of Neurology, Aga Khan University, Stadium Road, Karachi, 74800 Pakistan
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Khalid W, Rozi S, Ali TS, Azam I, Mullen MT, Illyas S, Un-Nisa Q, Soomro N, Kamal AK. Quality of life after stroke in Pakistan. BMC Neurol 2016; 16:250. [PMID: 27912744 PMCID: PMC5135839 DOI: 10.1186/s12883-016-0774-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [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: 10/02/2015] [Accepted: 11/28/2016] [Indexed: 12/20/2022] Open
Abstract
Background There is very little information about the quality of life (QOL) of stroke survivors in LMIC countries with underdeveloped non communicable health infrastructures, who bear two thirds of the global stroke burden. Methodology We used a sequential mix methods approach. First, a quantitative analytical cross-sectional study was conducted on 700 participants, who constituted 350 stroke survivor and their caregiver dyads. QOL of stroke survivor was assessed via Stroke Specific Quality of Life Scale (SSQOLS) whereas QOL of caregivers was assessed through RAND-36. In addition; we assessed complications, psychosocial and functional disability of stroke survivors. Following this quantitative survey, caregivers were qualitatively interviewed to uncover contextually relevant themes that would evade quantitative surveys. Multiple linear regression technique was applied to report adjusted β-coefficients with 95% C.I. Results The QOL study was conducted from January 2014 till June 2014, in two large private and public centers. At each center, 175 dyads were interviewed to ensure representativeness. Median age of stroke survivors was 59(17) years, 68% were male, 60% reported depression and 70% suffered post-stroke complications. The mean SSQOLS score was 164.18 ± 32.30. In the final model severe functional disability [adjβ -33.77(-52.44, -15.22)], depression [adjβ-23.74(-30.61,-16.82)], hospital admissions [adjβ-5.51(-9.23,-1.92)] and severe neurologic pain [adjβ -12.41(-20.10,-4.77)] negatively impacted QOL of stroke survivors (P < 0.01). For caregivers, mean age was 39.18 ± 13.44 years, 51% were female and 34% reported high stress levels. Complementary qualitative study revealed that primary caregivers were depressed, frustrated, isolated and also disappointed by health services. Conclusion The QOL of Stroke survivors as reported by SSQOLS score was better than compared to those reported from other LMIC settings. However, Qualitative triangulation revealed that younger caregivers felt isolated, depressed, overwhelmed and were providing care at great personal cost. There is a need to develop cost effective holistic home support interventions to improve lives of the survivor dyad as a unit. Trial registration NCT02351778 (Registered as Observational Study). Electronic supplementary material The online version of this article (doi:10.1186/s12883-016-0774-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Wardah Khalid
- Fogarty Cerebrovascular Research Fellow, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Karachi, Pakistan
| | - Shafquat Rozi
- Department of Community Health Sciences, Epidemiology & Biostatistics, Director Clinical Research Track (CRT), Aga Khan University, Karachi, Pakistan
| | - Tazeen Saeed Ali
- School of Nursing and Midwifery (SONAM), Karachi, Pakistan.,Department of Community Health Sciences, Aga Khan University Hospital, Karachi, Pakistan
| | - Iqbal Azam
- Department of Community Health Sciences, Aga Khan University Hospital, Karachi, Pakistan
| | - Michael T Mullen
- Department of Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA
| | - Saleem Illyas
- Development Centre DOW University of Health Sciences, Karachi, Pakistan
| | - Qamar Un-Nisa
- Department of Neurology, DOW University of Health Sciences, Karachi, Pakistan.,Department of Medicine, Lecturer, Section of Neurology, Aga Khan University, Karachi, Pakistan
| | - Nabila Soomro
- Institute of Physical Medicine and Rehabilitation, DOW University of Health Sciences, Karachi, Pakistan
| | - Ayeesha Kamran Kamal
- The International Cerebrovascular Translational Clinical Research Training Program, Fogarty International Center and the National Institute of Neurologic Disorders and Stroke, Aga Khan University, Stadium Road, 74800, Karachi, Pakistan. .,Department of Medicine, Aga Khan University, Karachi, Pakistan.
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Gowani A, Ahmed HI, Khalid W, Muqeet A, Abdullah S, Khoja S, Kamal AK. Facilitators and barriers to NCD prevention in Pakistanis-invincibility or inevitability: a qualitative research study. BMC Res Notes 2016; 9:282. [PMID: 27215828 PMCID: PMC4877737 DOI: 10.1186/s13104-016-2087-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 05/13/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Non-communicable diseases (NCD) are the leading causes of death globally. In Pakistan, they are among the top ten causes of mortality, especially in the productive age group (30-69 years). Evidence suggests that health perceptions and beliefs strongly influence the health behavior of an individual. We performed focus group interviews to delineate the same so as to design the user interface of a non-invasive stroke risk monitoring device. METHODS It was a qualitative study, designed to explore how health perceptions and beliefs influence behavior for NCD prevention. Four focus group discussions (FGD) were conducted with 30 stable participants who had diabetes mellitus, ischemic heart disease, blood pressure, and stroke. The data was collected using a semi-structured interview guide designed to explore participants' perceptions of their illnesses, self-management behaviors and factors affecting them. The interviews were transcribed and content analysis was done using steps of content analysis by Morse and Niehaus [10]. RESULTS Medication adherence, self-monitoring of blood sugars and blood pressures, and medical help seeking were the commonly performed self-management behaviors by the participants. Personal experience of illness, familial inheritance of disease, education and fear of premature death when life responsibilities were unfulfilled, emerged as strong facilitators of self-management behaviors. A sense of personal invincibility, Fatalism or inevitability, lack of personal threat realization, limited knowledge, inadequate health education, health care and financial constraints appeared as key barriers to the self-management of chronic disease in participants. CONCLUSIONS Behavioural interventional messaging will have to engender a sense of personal vulnerability and yet empower self-efficacy solutions at the individual level to deal with both invincibility and inevitability barriers to adoption of healthy behavior.
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Affiliation(s)
- Ambreen Gowani
- Stroke Service Research Nurse, Aga Khan University, Karachi, Pakistan
| | - Hafiz Imtiaz Ahmed
- Technology Development, Aga Khan Development Network, eHealth Resource Center, Karachi, Pakistan
| | - Wardah Khalid
- Fogarty Cerebrovascular Research Fellow, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health), Aga Khan University, Karachi, Pakistan
| | - Abdul Muqeet
- eHealth Innovation, Global, Aga Khan Development Network, eHealth Resource Center, Karachi, Pakistan
| | | | - Shariq Khoja
- Tech4Life Enterprises, Canada, and Technical Advisor-Evidence, Capacity and Policy mHealth Alliance, United Nations Foundation, Washington, USA
| | - Ayeesha Kamran Kamal
- Section of Neurology, Department of Medicine, Stroke Fellowship Program, International Cerebrovascular Translational Clinical Research Training Program, Fogarty International Center and the National Institute of Neurologic Disorders and Stroke, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan.
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Kamal AK, Muqeet A, Farhat K, Khalid W, Jamil A, Gowani A, Muhammad AA, Zaidi F, Khan D, Elahi T, Sharif S, Raz S, Zafar T, Bokhari SS, Rahman N, Sultan FAT, Sayani S, Virani SS. Using a tailored health information technology- driven intervention to improve health literacy and medication adherence in a Pakistani population with vascular disease (Talking Rx) - study protocol for a randomized controlled trial. Trials 2016; 17:121. [PMID: 26944938 PMCID: PMC4779210 DOI: 10.1186/s13063-016-1244-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Accepted: 02/19/2016] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Vascular disease, manifesting as myocardial infarction and stroke, is a major cause of morbidity and mortality, especially in low- and middle-income countries. Current estimates are that only one in six patients have good adherence to medications and very few have sufficient health literacy. Our aim is to explore the effectiveness and acceptability of Prescription Interactive Voice Response (IVR) Talking Prescriptions (Talking Rx) and SMS reminders in increasing medication adherence and health literacy in Pakistani patients with vascular disease. METHODS This is a randomized, controlled, single center trial. Adult participants, with access to a cell phone and a history of vascular disease, taking multiple risk-modifying medications (inclusive of anti-platelets and statins) will be selected from cerebrovascular and cardiovascular clinics. They will be randomized in a 1:1 ratio via a block design to the intervention or the control arm with both groups having access to a helpline number to address their queries in addition to standard of care as per institutional guidelines. Participants in the intervention group will also have access to Interactive Voice Response (IVR) technology tailored to their respective prescriptions in the native language (Urdu) and will have the ability to hear information about their medication dosage, correct use, side effects, mechanism of action and how and why they should use their medication, as many times as they like. Participants in the intervention arm will also receive scheduled SMS messages reminding them to take their medications. The primary outcome measure will be the comparison of the difference in adherence to anti-platelet and statin medication between baseline and at 3-month follow-up in each group measured by the Morisky Medication Adherence Scale. To ascertain the impact of our intervention on health literacy, we will also compare a local content-validated and modified version of Test of Health Literacy in Adults (TOFHLA) between the intervention and the control arm. We estimate that a sample size of 86 participants in each arm will be able to detect a difference of 1 point on the MMAS with a power of 90 % and significance level of 5 %. Accounting for an attrition rate of 15 %, we plan to enroll 100 participants in each arm (total study population = 200). We hypothesize that a linguistically tailored health IT intervention based on IVR and SMS will be associated with an improvement in adherence (to anti-platelet and lipid-lowering medications) and an improvement in health literacy in Pakistani patients with vascular disease. DISCUSSION This innovative study will provide early data for the feasibility of the use of IT based prescriptions in an lower middle incorme country setting with limited numeracy and literacy skills. TRIAL REGISTRATION Clinical Trials.gov: NCT02354040 - 2 February 2015.
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Affiliation(s)
- Ayeesha Kamran Kamal
- The International Cerebrovascular Translational Clinical Research Training Program, Aga Khan University, Stadium Road, 74800, Karachi, Pakistan.
| | - Abdul Muqeet
- eHealth Innovation, Aga Khan Development Network eHealth Resource Centre, Karachi, Pakistan.
| | - Kashfa Farhat
- Talking Rx Study, Stroke Service, Aga Khan University Hospital, Karachi, Pakistan.
| | - Wardah Khalid
- Stroke Service, The International Cerebrovascular Translational Clinical Research Training Program, Aga Khan University, Karachi, Pakistan.
| | - Anum Jamil
- Talking Rx Study, Stroke Service, Aga Khan University Hospital, Karachi, Pakistan.
| | - Ambreen Gowani
- Stroke Service, Department of Medicine, The International Cerebrovascular Translational Clinical Research Training Program, Aga Khan University, Karachi, Pakistan.
| | - Aliya Amin Muhammad
- Program Software Development and Integration, Aga Khan Development Network eHealth Resource Centre, Karachi, Pakistan.
| | - Fabiha Zaidi
- Program Software Development and Integration, Aga Khan Development Network eHealth Resource Centre, Karachi, Pakistan.
| | - Danyal Khan
- Aga Khan Development Network eHealth Resource Centre, Pakistan and Stroke Service, Aga Khan University Hospital, Karachi, Pakistan.
| | - Touseef Elahi
- Aga Khan Development Network eHealth Resource Centre, Pakistan and Stroke Service, Aga Khan University Hospital, Karachi, Pakistan.
| | - Shahrukh Sharif
- Aga Khan Development Network, eHealth Resource Centre, Karachi, Pakistan.
| | - Sibtain Raz
- eOcean, For Talking Rx Interactive Voice Response Systems Solutions, Karachi, Pakistan.
| | - Taha Zafar
- eOcean, For Talking Rx Interactive Voice Response Systems Solutions, Karachi, Pakistan.
| | | | - Nasir Rahman
- Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.
| | | | - Saleem Sayani
- Aga Khan Development Network, eHealth Resource Centre, Karachi, Pakistan.
| | - Salim S Virani
- Section of Cardiovascular Research, Department of Medicine, Baylor College of Medicine, and Staff Cardiologist, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA.
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Kamal AK, Khoja A, Usmani B, Muqeet A, Zaidi F, Ahmed M, Shakeel S, Soomro N, Gowani A, Asad N, Ahmed A, Sayani S, Azam I, Saleem S. Translating knowledge for action against stroke--using 5-minute videos for stroke survivors and caregivers to improve post-stroke outcomes: study protocol for a randomized controlled trial (Movies4Stroke). Trials 2016; 17:52. [PMID: 26818913 PMCID: PMC4728820 DOI: 10.1186/s13063-016-1175-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 01/13/2016] [Indexed: 12/19/2022] Open
Abstract
Background Two thirds of the global mortality of stroke is borne by low and middle income countries (LMICs). Pakistan is the world’s sixth most populous country with a stroke-vulnerable population and is without a single dedicated chronic care center. In order to provide evidence for a viable solution responsive to this health care gap, and leveraging the existing >70 % mobile phone density, we thought it rational to test the effectiveness of a mobile phone-based video intervention of short 5-minute movies to educate and support stroke survivors and their primary caregivers. Methods Movies4Stroke will be a randomized control, outcome assessor blinded, parallel group, single center superiority trial. Participants with an acute stroke, medically stable, with mild to moderate disability and having a stable primary caregiver will be included. After obtaining informed consent the stroke survivor-caregiver dyad will be randomized. Intervention participants will have the movie program software installed in their phone, desktop, or Android device which will allow them to receive, view and repeat 5-minute videos on stroke-related topics at admission, discharge and first and third months after enrollment. The control arm will receive standard of care at an internationally accredited center with defined protocols. The primary outcome measure is medication adherence as ascertained by a locally validated Morisky Medication Adherence Scale and control of major risk factors such as blood pressure, blood sugar and blood cholesterol at 12 months post discharge. Secondary outcome measures are post-stroke complications and mortality, caregiver knowledge and change in functional outcomes after acute stroke at 1, 3, 6, 9 and 12 months. Movies4Stroke is designed to enroll 300 participant dyads after inflating 10 % to incorporate attrition and non-compliance and has been powered at 95 % to detect a 15 % difference between intervention and usual care arm. Analysis will be done by the intention-to-treat principle. Discussion Movies4Stroke is a randomized trial testing an application aimed at supporting caregivers and stroke survivors in a LMIC with no rehabilitation or chronic support systems. Trial registration NCT02202330 (28 January 2015) Electronic supplementary material The online version of this article (doi:10.1186/s13063-016-1175-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ayeesha Kamran Kamal
- Section of Neurology, Department of Medicine, Aga Khan University, Stadium Road, 74800, Karachi, Pakistan.
| | - Adeel Khoja
- Stroke Service, the International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health), Aga Khan University, Karachi, Pakistan.
| | | | - Abdul Muqeet
- Aga Khan Development Network, eHealth Resource Center, Karachi, Pakistan.
| | - Fabiha Zaidi
- Aga Khan Development Network, eHealth Resource Center, Karachi, Pakistan.
| | - Masood Ahmed
- Movies for Stroke Study, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Karachi, Pakistan.
| | - Saadia Shakeel
- Movies for Stroke Study, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Karachi, Pakistan.
| | - Nabila Soomro
- Section of Neurology, Department of Medicine, Aga Khan University and Director, Institute of Physical Medicine and Rehabilitation, Dow University of Health Sciences, Karachi, Pakistan.
| | - Ambreen Gowani
- Stroke Service, Department of Medicine, Aga Khan University, Karachi, Pakistan.
| | - Nargis Asad
- Department of Psychiatry, Aga Khan University, Karachi, Pakistan.
| | - Asma Ahmed
- Section of Diabetes, Endocrinology and Metabolism, Department of Medicine, Aga Khan University, Karachi, Pakistan.
| | - Saleem Sayani
- eHealth Resource Centre, Aga Khan Development Network, Karachi, Pakistan.
| | - Iqbal Azam
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
| | - Sarah Saleem
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
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Abstract
The global burden of neurological, neuropsychiatric, substance-use and neurodevelopmental disorders in low- and middle-income countries is worsened, not only by the lack of targeted research funding, but also by the lack of relevant in-country research capacity. Such capacity, from the individual to the national level, is necessary to address the problems within a local context. As for many health issues in these countries, the ability to address this burden requires development of research infrastructure and a trained cadre of clinicians and scientists who can ask the right questions, and conduct, manage, apply and disseminate research for practice and policy. This Review describes some of the evolving issues, knowledge and programmes focused on building research capacity in low- and middle-income countries in general and for brain and nervous system disorders in particular.
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Affiliation(s)
- Linda B Cottler
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, USA
| | - Joseph Zunt
- Department of Neurology, University of Washington, Seattle, Washington, USA
| | - Bahr Weiss
- Department of Psychology and Human Development, Vanderbilt University, Nashville, Tennnesse, USA
| | - Ayeesha Kamran Kamal
- Stroke Service, Section of Neurology, Department of Medicine, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, NIH) Aga Khan University, Karachi, Pakistan
| | - Krishna Vaddiparti
- Department of Epidemiology, College of Public Health and Health Professions and College of Medicine, University of Florida, Gainesville, Florida, USA
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Kamal AK, Shaikh Q, Pasha O, Azam I, Islam M, Memon AA, Rehman H, Akram MA, Affan M, Nazir S, Aziz S, Jan M, Andani A, Muqeet A, Ahmed B, Khoja S. A randomized controlled behavioral intervention trial to improve medication adherence in adult stroke patients with prescription tailored Short Messaging Service (SMS)-SMS4Stroke study. BMC Neurol 2015; 15:212. [PMID: 26486857 PMCID: PMC4618367 DOI: 10.1186/s12883-015-0471-5] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 10/08/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The effectiveness of mobile technology to improve medication adherence via customized Short Messaging Service (SMS) reminders for stroke has not been tested in resource poor areas. We designed a randomized controlled trial to test the effectiveness of SMS on improving medication adherence in stroke survivors in Pakistan. METHODS This was a parallel group, assessor-blinded, randomized, controlled, superiority trial. Participants were centrally randomized in fixed block sizes. Adult participants on multiple medications with access to a cell phone and stroke at least 4 weeks from onset (Onset as defined by last seen normal) were eligible. The intervention group, in addition to usual care, received reminder SMS for 2 months that contained a) Personalized, prescription tailored daily medication reminder(s) b) Twice weekly health information SMS. The Health Belief Model and Social Cognitive theory were used to design the language and content of messages. Frontline SMS software was used for SMS delivery. Medication adherence was self-reported and measured on the validated Urdu version of Morisky Medication Adherence Questionnaire. Multiple linear regression was used to model the outcome against intervention and other covariates. Analysis was conducted by intention-to-treat principle. RESULTS Two hundred participants were enrolled. 38 participants were lost to follow-up. After 2 months, the mean medication score was 7.4 (95 % CI: 7.2-7.6) in the intervention group while 6.7 (95 % CI: 6.4-7.02) in the control group. The adjusted mean difference (Δ) was 0.54 (95 % CI: 0.22-0.85). The mean diastolic blood pressure in the intervention group was 2.6 mmHg (95 % CI; -5.5 to 0.15) lower compared to the usual care group. CONCLUSION A short intervention of customized SMS can improve medication adherence and effect stroke risk factors like diastolic blood pressure in stroke survivors with complex medication regimens living in resource poor areas. TRIAL REGISTRATION Clinicaltrials.gov NCT01986023 last accessed at https://clinicaltrials.gov/ct2/show/NCT01986023.
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Affiliation(s)
- Ayeesha Kamran Kamal
- Stroke Services, Section of Neurology, Department of Medicine, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Stadium Road, 74800, Karachi, Pakistan.
| | - Quratulain Shaikh
- Fogarty Cerebrovascular Research Fellow, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Karachi, Pakistan.
| | - Omrana Pasha
- Epidemiology and Biostatistics Program, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
| | - Iqbal Azam
- Department of Community Health Sciences, Biostatistics, Aga Khan University, Karachi, Pakistan.
| | - Muhammad Islam
- Department of Community Health Sciences, Biostatistics, Aga Khan University, Karachi, Pakistan.
| | - Adeel Ali Memon
- SMS4Stroke Study, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Karachi, Pakistan.
| | - Hasan Rehman
- Stroke Service, Aga Khan University, Karachi, Pakistan.
| | | | - Muhammad Affan
- SMS4Stroke Study, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Karachi, Pakistan.
| | - Sumaira Nazir
- SMS4Stroke Study, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Karachi, Pakistan.
| | - Salman Aziz
- SMS4Stroke Study, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Karachi, Pakistan.
| | - Muhammad Jan
- Stroke Services, Section of Neurology, Department of Medicine, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Stadium Road, 74800, Karachi, Pakistan.
| | - Anita Andani
- Stroke Services, Section of Neurology, Department of Medicine, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Stadium Road, 74800, Karachi, Pakistan.
| | - Abdul Muqeet
- eHealth Innovation, Global, eHealth Resource Center, Aga Khan Development Network, Karachi, Pakistan.
| | - Bilal Ahmed
- Epidemiology and Biostatistics, Department of Medicine, Aga Khan University, Karachi, Pakistan.
| | - Shariq Khoja
- Tech4Life Enterprises, and Technical Advisor-Evidence, Capacity & Policy mHealth Alliance, United Nations Foundation, Washington, USA.
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Kamal AK, Shaikh QN, Pasha O, Azam I, Islam M, Memon AA, Rehman H, Affan M, Nazir S, Aziz S, Jan M, Andani A, Muqeet A, Ahmed B, Khoja S. Improving medication adherence in stroke patients through Short Text Messages (SMS4Stroke)-study protocol for a randomized, controlled trial. BMC Neurol 2015; 15:157. [PMID: 26311325 PMCID: PMC4551769 DOI: 10.1186/s12883-015-0413-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Accepted: 08/20/2015] [Indexed: 11/10/2022] Open
Abstract
Background Stroke is a major cause of morbidity and mortality, especially in low and middle income countries. Medical management is the mainstay of therapy to prevent recurrence of stroke. Current estimates are that only 1 in 6 patients have perfect adherence to medication schedules. Using SMS (Short Messaging Service) as reminders to take medicines have been used previously for diseases such as diabetes and HIV with moderate success. We aim to explore the effectiveness and acceptability of SMS in increasing adherence to medications in patients with stroke. Methods This will be a randomized, controlled, assessor blinded single center superiority trial. Adult participants with access to a cell phone and a history of stroke longer than 1 month on multiple risk modifying medications will be selected from Neurology and Stroke Clinic. They will be randomized into two parallel groups in a 1:1 ratio via block technique with one group receiving the standard of care as per institutional guidelines while the parallel group receiving SMS reminders for each dose of medicine in addition to the standard of care. In addition intervention group will receive messages for lifestyle changes, medication information, risk factors and motivation for medication adherence. These will bemodeled on Social Cognitive Theory and Health Belief Model and will be categorized by Michies Taxonomy of Behavioral Change Communication. Patient compliance to medicines will be measured at baseline and then after 2 months in each group by using the Morisky Medication Adherence Scale. The change in compliance to medication regimen after the intervention and the difference between the two groups will be used to determine the effectiveness of SMS reminders as a tool to increase medication compliance. The acceptability of the SMS will be determined by a tool designed for this study whose attributes are based Rogers Diffusion of innovation theory. A sample size of 86 participants in each arm will be sufficient to detect a difference of 1 point on the MMAS with a power of 90 % and significance level of 5 % between the two groups; using an attrition rate of 15 %, 200 participants in all will be randomized. Discussion The SMS for Stroke Study will provide evidence for feasibility and effectiveness of SMS in improving post stroke medication adherence in an LMIC setting. Trial registration https://clinicaltrials.gov/ct2/show/NCT01986023 11 /11/2013 Electronic supplementary material The online version of this article (doi:10.1186/s12883-015-0413-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ayeesha Kamran Kamal
- Neurology, Stroke Service, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Department of Medicine, Aga Khan University, Karachi, Pakistan.
| | - Quratulain Nauman Shaikh
- The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Karachi, Pakistan.
| | - Omrana Pasha
- Director Masters in Epidemiology and Biostatistics Program, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
| | - Iqbal Azam
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
| | - Muhammad Islam
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
| | - Adeel Ali Memon
- SMS4Stroke Study, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Karachi, Pakistan.
| | - Hasan Rehman
- Department of Medicine, Aga Khan University, Karachi, Pakistan.
| | - Muhammad Affan
- SMS4Stroke Study, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Karachi, Pakistan.
| | - Sumaira Nazir
- SMS4Stroke Study, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Karachi, Pakistan.
| | - Salman Aziz
- SMS4Stroke Study, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Karachi, Pakistan.
| | - Muhammad Jan
- Stroke Service, Section of Neurology, Department of Medicine The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Karachi, Pakistan.
| | - Anita Andani
- Stroke Service, Section of Neurology, Department of Medicine The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Karachi, Pakistan.
| | - Abdul Muqeet
- eHealth Innovation, Global, Aga Khan Development Network, Karachi, Pakistan.
| | - Bilal Ahmed
- Epidemiology and Biostatistics, Department of Medicine, Aga Khan University, Karachi, Pakistan.
| | - Shariq Khoja
- Evidence, Capacity & Policy mHealth Alliance, United Nations Foundation Geneva Associate Professor COMSATS Institute of Information Technology, Islamabad Visiting faculty-University of Calgary, Calgary, AB, Canada.
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Kamal AK, Rehman H, Mustafa N, Ahmed B, Jan M, Wadivalla F, Kamran S. Diagnostic TCD for intracranial stenosis in acute stroke patients: experience from a tertiary care stroke center in Karachi, Pakistan. BMC Res Notes 2015; 8:341. [PMID: 26259954 PMCID: PMC4531487 DOI: 10.1186/s13104-015-1289-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Accepted: 07/22/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Stroke is a common cause of morbidity and mortality around the world. Intracranial large artery atherosclerosis (ICAD) is a frequent etiology of stroke in the South Asian population. There is a need for widely available screening tools to identify patients that are at high risk of stroke due to ICAD for aggressive risk management. This study describes the experience of using the transcranial Doppler (TCD) as a screening tool for this purpose at a tertiary care hospital in a developing country. METHODS 86 Patients admitted with stroke due to ICAD underwent TCD for six arteries (Right and left middle cerebral arteries, right and left anterior cerebral arteries, right and left posterior cerebral arteries) in addition to the magnetic resonance angiography (MRA) that is done routinely at the stroke center. Arteries were labeled with either <50 or >50% stenosis by TCD using two separate criteria. These findings were compared with those from the MRA which was used as the gold standard. The proportion of patients that had complete exams (all six arteries insonated by TCD) was reported. The success rate of each TCD criteria in detecting arteries with >50% stenosis was also calculated. RESULTS There was an attempt to visualize 516 arteries (86 patients with 6 arteries each) of which 375 (72.7%) were successfully insonated. 38 of the 86 (55.8%) patients had complete examinations. MRA reported 43 (8.3%) arteries as stenosed >50%. The TCD did not categorize any artery as stenosed using either criterion and hence failed to classify any stenosed artery correctly. The positive predictive and sensitivity was 0 for this study and the negative predictive value was 93.3%. CONCLUSIONS This study indicates the poor sensitivity of TCD to be a reliable screening tool for the presence of ICAD in the South Asian population in a real life clinical setting.
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Affiliation(s)
- Ayeesha Kamran Kamal
- Stroke Service, Stroke Fellowship Program, International Cerebrovascular Translational Clinical Research Training Program, Fogarty International Center and The National Institute of Neurologic Disorders and Stroke, Section of Neurology, Department of Medicine, Aga Khan University, Stadium Road, Karachi, 74800, Pakistan.
| | - Hasan Rehman
- Stroke Service, Section of Neurology, Department of Medicine, Aga Khan University, Karachi, Pakistan.
| | - Nasir Mustafa
- Stroke Service, Section of Neurology, Department of Medicine, Aga Khan University, Karachi, Pakistan.
| | - Bilal Ahmed
- Epidemiology and Biostatistics, Section of Neurology, Department of Medicine, Aga Khan University, Karachi, Pakistan.
| | - Mohammad Jan
- Data Management Stroke Service, Section of Neurology, Department of Medicine, Aga Khan University, Karachi, Pakistan.
| | - Faisal Wadivalla
- Stroke Service, Section of Neurology, Department of Medicine, Aga Khan University, Karachi, Pakistan.
| | - Syed Kamran
- Stroke Service, Section of Neurology, Department of Medicine, Aga Khan University, Karachi, Pakistan.
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Khan M, Rehman H, Kamal AK. Stroke knowledge and screening in a high prevalence, low-income community. Int J Stroke 2015; 10:E26. [PMID: 25777834 DOI: 10.1111/ijs.12444] [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: 11/30/2022]
Affiliation(s)
- Maria Khan
- Stroke Service, Section of Neurology, Department of Medicine, Aga Khan University, Karachi, Pakistan
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Kamal AK, Majeed F, Pasha O, Islam M, Azam I, Ilyas MS, Hussain M, Masood K, Ahmed B, Nazir S, Sajjad Z, Kasner SE. Study protocol: asymptomatic intracranial atherosclerotic disease in pakistanis. J Vasc Interv Neurol 2015; 8:27-35. [PMID: 25825629 PMCID: PMC4367804] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Intracranial atherosclerotic disease (ICAD) is the most frequent subtype of ischemic stroke globally. It is important to describe the determinants of early ICAD as a strategy to prevent strokes from clinically evident and progressive ICAD. Our objective is to report the determinants of asymptomatic ICAD by linking the presence or absence of ICAD on magnetic resonance angiogram (MRA) with detailed risk assessment in asymptomatic adults. METHODS This is an observational cross-sectional analytical study. We plan to recruit 200 adult participants from the radiology departments of two tertiary care centers of Karachi, Pakistan. The participants will first be screened for the absence of stroke symptoms via the Questionnaire for Verifying Stroke Free Status (QVSFS). QVSFS negative will be participants will be eligible. After written informed consent, participants will undergo detailed medical, sociodemographic, lifestyle, and anthropometric evaluation by a detailed interview. They will, in addition, undergo MRA to study the presence, degree, and distribution of asymptomatic ICAD. All MRA scans will be reviewed centrally by vascular neurologists blinded to clinical information. These images would be reviewed on DICOM Viewer 3.0 used for calculating the degree of stenosis using Warfarin-Aspirin Symptomatic Intracranial Disease (WASID) study defined criteria employing electronic calipers. A sample size of 200 will achieve 80% power for detecting a minimum difference of 20% in the prevalence of exposure factors (medical and lifestyle) between asymptomatic ICAD positive and ICAD negative persons. This study will generate regional data on risks for ICAD development and prevention in a high-risk susceptible population. Study ID: NCT02072876.
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Affiliation(s)
- Ayeesha Kamran Kamal
- Associate Professor Neurology, Stroke Service, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Karachi, Pakistan ; Joint First Authors ; Corresponding Author
| | - Farzin Majeed
- Fogarty Cerebrovascular Research Fellow, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Karachi, Pakistan ; Joint First Authors
| | - Omrana Pasha
- Associate Professor, Director Masters in Epidemiology and Biostatistics Program, Community Health Sciences, Aga Khan University Karachi, Pakistan
| | - Muhammad Islam
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Iqbal Azam
- Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | | | - Munawar Hussain
- Associate Professor and Head, Dow Institute of Radiology, Dow University of Health Sciences, Karachi, Pakistan
| | - Kamran Masood
- Radiology Resident, Dow Institute of Radiology, Dow University of Health Sciences, Karachi, Pakistan
| | - Bilal Ahmed
- Epidemiology and Biostatistics, Dept. of Medicine, Aga Khan University, Karachi, Pakistan
| | - Sumaira Nazir
- Research Associate, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Aga Khan University, Karachi, Pakistan
| | - Zafar Sajjad
- Associate Professor and Head, Radiology, Aga Khan University, Karachi, Pakistan
| | - Scott E Kasner
- Professor of Neurology, Chief of the Division of Stroke and Neurointensive Care, and Director of the Comprehensive Stroke Center University of Pennsylvania, USA
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Khan M, Kamal AK, Pasha O, Islam M, Azam I, Virk A, Nasir A, Andani A, Jan M, Akhtar A, Razzak JA. Study Protocol: Validation and Adaptation of community-worker-administered stroke symptom questionnaire in a periurban Pakistani community to determine disease burden. J Vasc Interv Neurol 2015; 8:1-10. [PMID: 25825625 PMCID: PMC4367800] [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] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND Stroke is the second leading cause of mortality and the leading cause of disability in the world today. The disease burden is on the rise in developing nations, but there is scarcity of data from these regions to inform policy decisions. Stroke burden can be determined by clinical diagnosis alone in the public health context and is a far more feasible way to assess disease status in low- to middle-income countries like Pakistan. We aim to translate and adapt a validated stroke symptom questionnaire, train community health workers in its administration, and verify it against assessment by two trained neurologists. METHODS/DESIGN This is a prospective study, which we aim to carry out in Ibrahim Hyderi, a periurban slum of Karachi. We translated into Urdu the questionnaire for verifying stroke free status (QVSFS), which is an internationally validated tool to assess the same. Two community health workers (CHW) will be identified and will receive training by neurologists, which will include teaching regarding stroke pathophysiology, symptomatology, and detection. They will be familiarized with the QVSFS, and their questionnaire administration will be assessed through roleplay. We intend to recruit 322 subjects from the same community and the CHWs will gather data on them. The same subjects will later be assessed by two trained neurologists, and the findings collaborated to validate those obtained by the CHWs. Sensitivity, specificity, positive and negative predictive values, and Cohen's kappa will be determined for the CHW-administered questionnaire tested against assessment by two neurologists together and separately for the two CHWs. Data analysis will be done using SPSS version 19.0. DISCUSSION The results of this study will determine if and how well CHW-administered questionnaires are at assessing stroke status in a community. This will facilitate use of the same as a practical alternative for stroke surveillance in the country. TRIAL REGISTRATION NCT02073955.
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Affiliation(s)
- Maria Khan
- Joint First Authors
- Fogarty Cerebrovascular Research Fellow, The International Cerebrovascular Translational Clinical Research Training Program ( Fogarty International Center, National Institutes of Health) and Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Ayeesha Kamran Kamal
- Joint First Authors
- Associate Professor Neurology, Stroke Service, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) and Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Omrana Pasha
- Associate Professor, Director Masters in Epidemiology and Biostatistics program, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Muhammad Islam
- Senior Instructor, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Iqbal Azam
- Assistant Professor, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Azam Virk
- Field Coordinator, AMAN Foundation, Karachi, Pakistan
| | - Alia Nasir
- Senior Community Work, AMAN Foundation, Karachi, Pakistan
| | - Anita Andani
- Research Coordination and Data Management Stroke Service, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) , Section of Neurology, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Muhammad Jan
- Research Coordination and Data Management Stroke Service, The International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center, National Institutes of Health) , Section of Neurology, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Anjum Akhtar
- Post Graduate Medical Education Stroke Fellow, Aga Khan University, Karachi, Pakistan
| | - Junaid Abdul Razzak
- Chairman and Associate Professor, Department of Emergency Medicine, Aga Khan University and Chief Executive Officer- AMAN Health, AMAN Foundation Karachi, Pakistan
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Rehman H, Kamal AK. My patient has had an intracerebral haemorrhage--how do I best control his blood pressure? J PAK MED ASSOC 2014; 64:1431-1432. [PMID: 25842595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Shaikh QN, Memon AA, Kamal AK. Association of hypertension with stroke recurrence may depend on ischaemic stroke subtype. J PAK MED ASSOC 2014; 64:1327-1328. [PMID: 25831660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Khan M, Kamal AK, Islam M, Azam I, Virk A, Nasir A, Rehman H, Arif A, Jan M, Akhtar A, Mawani M, Razzak JA, Pasha O. Can trained field community workers identify stroke using a stroke symptom questionnaire as well as neurologists? Adaptation and validation of a community worker administered stroke symptom questionnaire in a peri-urban Pakistani community. J Stroke Cerebrovasc Dis 2014; 24:91-9. [PMID: 25440346 DOI: 10.1016/j.jstrokecerebrovasdis.2014.07.030] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [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: 07/10/2014] [Revised: 07/22/2014] [Accepted: 07/30/2014] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Stroke is a leading cause of morbidity and mortality worldwide. There is a paucity of data from South Asia where stroke is highly prevalent. Validated tools administrable by community health workers (CHWs) are required to identify stroke in the community in a resource-strapped region such as this. METHODS The study was conducted in a transitional slum in Karachi, Pakistan. Questionnaire to Verify Stroke-Free Status (QVSFS) was adapted and translated into Urdu. Two CHWs, trained by a neurologist, selected 322 community-dwelling subjects using purposive sampling. Each CHW collected data independently, which was validated by a vascular neurologist who directly examined each participant. To assess the effect of audit and feedback, data from the final 10% of the subjects were collected after a second training session for the CHWs. Sensitivity, specificity, and Cohen kappa were determined for the CHW-administered questionnaire against neurovascular assessment. RESULTS Mean age of participants was 56.5 years with 71% of participants being women. The sensitivity and specificity of the questionnaire of detecting stroke was 77.1% (confidence interval [CI], 64.1-86.9) and 85.8% (CI, 83.5-87.5), respectively. The chance-corrected agreement using the Cohen kappa statistic was .51 (CI, .38-.60). Kappa ranged from .37 to .58 for each of the 7 stroke symptoms. Hemianesthesia (72.9%) and hemiplegia (64.6%) were the most sensitive symptoms. The performance and agreement improved from moderate to substantial after audit and feedback. CONCLUSIONS We found a reasonable sensitivity and specificity and moderate agreement between CHW-administered QVSFS and assessment by a vascular neurologist.
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Affiliation(s)
- Maria Khan
- Stroke Service, Department of Medicine, The International Cerebrovascular Translational Clinical Research Training Program, Fogarty International Center, National Institutes of Health, Aga Khan University
| | - Ayeesha Kamran Kamal
- Stroke Service, Department of Medicine, The International Cerebrovascular Translational Clinical Research Training Program, Fogarty International Center, National Institutes of Health, Aga Khan University.
| | - Muhammad Islam
- Department of Community Health Sciences, Aga Khan University
| | - Iqbal Azam
- Department of Community Health Sciences, Aga Khan University
| | | | | | - Hasan Rehman
- Stroke Service, Department of Medicine, The International Cerebrovascular Translational Clinical Research Training Program, Fogarty International Center, National Institutes of Health, Aga Khan University
| | - Anita Arif
- Stroke Service, Department of Medicine, The International Cerebrovascular Translational Clinical Research Training Program, Fogarty International Center, National Institutes of Health, Aga Khan University
| | - Muhammad Jan
- Stroke Service, Department of Medicine, The International Cerebrovascular Translational Clinical Research Training Program, Fogarty International Center, National Institutes of Health, Aga Khan University
| | - Anjum Akhtar
- Stroke Service, Department of Medicine, The International Cerebrovascular Translational Clinical Research Training Program, Fogarty International Center, National Institutes of Health, Aga Khan University
| | - Minaz Mawani
- Department of Medicine, Epidemiology and Biostatistics, Aga Khan University
| | - Junaid Abdul Razzak
- Department of Emergency Medicine, Aga Khan University and AMAN Health, AMAN Foundation Karachi, Pakistan
| | - Omrana Pasha
- Department of Community Health Sciences, Aga Khan University
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Shaikh QN, Memon AA, Kamal AK. Early magnetic resonance imaging in transient ischaemic attack and minor stroke. J PAK MED ASSOC 2014; 64:1207. [PMID: 25823169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Shaikh QN, Memon AA, Kamal AK. The impact of green tea and coffee consumption on risk of stroke in Japanese population. J PAK MED ASSOC 2014; 64:1094. [PMID: 25823197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
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Kamal AK, Majeed F, Pasha O, Rehman H, Islam M, Azam I, Ilyas MS, Hussain M, Masood K, Ahmed B, Nazir S, Sajjad Z, Kasner SE. Clinical, lifestyle, socioeconomic determinants and rate of asymptomatic intracranial atherosclerosis in stroke free Pakistanis. BMC Neurol 2014; 14:155. [PMID: 25124284 PMCID: PMC4236665 DOI: 10.1186/s12883-014-0155-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 07/21/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Intracranial Atherosclerotic Disease (ICAD) is the most frequent etiology of stroke with high prevalence among Asians. Despite this, early determinants of ICAD have not been described from this region. METHODS The study is an analytical prospective cross-sectional study of 200 adults from Radiology Departments of two diagnostic centers in Karachi. Eligible participants confirmed the absence of stroke symptoms via the Questionnaire for Verifying Stroke Free Status (QVSFS) and underwent an interview covering medical, socio demographic, lifestyle and anthropometric evaluation using locally validated and standardized definitions. Magnetic Resonance Images (MRI) were centrally reviewed to detect ICAD using the criterion used in the Warfarin-Aspirin Symptomatic Intracranial Disease study. The risk factors associated with asymptomatic ICAD are reported along with prevalence ratios. RESULTS Of the 200 participants, ICAD was found in 34.5% (n = 69) of the participants. Mean age was 37.1 (S.D 15.1) years with 62% younger than 45 years. Self-reported hypertension was found in 26.5% subjects, diabetes in 9%, dyslipidemia in 5% and depression in 60%. Smokeless tobacco (Adjusted PR 3.27 (1.07-6.05)), Western diet, high socioeconomic status (Adjusted PR 2.26 (1.99-5.62)) and dyslipidemia (Adjusted PR 1.88 (1.25-2.21)) had significant associations with ICAD after multivariable analysis. Age, gender, diabetes, hypertension, depression and physical activity did not have a significant association. CONCLUSION ICAD was found on MRI in one in three asymptomatic Pakistanis and was associated with modifiable risks. Initiatives targeting primary prevention may be able to decrease the burden of disease caused by stroke due to ICAD. STUDY REGISTRATION NUMBER NCT02072876 2/25/2014.
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Memon AA, Shaikh QN, Kamal AK. Depression and risk of stroke in middle aged women. J PAK MED ASSOC 2014; 64:969. [PMID: 25252532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Aftab K, Kamal AK. Will statin therapy improve the outcome after ischaemic stroke through neuroprotective effects? J PAK MED ASSOC 2014; 64:851. [PMID: 25255603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Aftab K, Kamal AK. Is Vorapaxar a safe and effective antiplatelet agent for patients with prior ischaemic stroke receiving standard antiplatelet therapy? J PAK MED ASSOC 2014; 64:719. [PMID: 25252501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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25
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Affan M, Shaikh Q, Kamal AK. Should I prevent my patient from developing depression after stroke? What is the best available option? J PAK MED ASSOC 2014; 64:603. [PMID: 25272558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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26
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Malik R, Kamal AK. State of endovascular therapy for acute ischaemic stroke. J PAK MED ASSOC 2014; 64:477-478. [PMID: 24864651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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27
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Ahmad N, Kamal AK. Asymptomatic atrial fibrillation and stroke risk. J PAK MED ASSOC 2014; 64:362. [PMID: 24864620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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28
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Affan M, Shaikh Q, Kamal AK. Should I prevent my patient from developing depression after stroke? What is the best available option? J PAK MED ASSOC 2014; 64:224. [PMID: 24640821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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29
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Shaikh Q, Kamal AK. Can prophylactic antibiotics for aspiration improve stroke outcomes? The PANTHERIS trial. J PAK MED ASSOC 2014; 64:98. [PMID: 24605726 PMCID: PMC4185077] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Quratulain Shaikh
- Stroke Service and Vascular Fellowship Program, International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center and National Institute of Neurologic Disorders and Stroke), Aga Khan University Hospital, Karachi, Pakistan
| | - Ayeesha Kamran Kamal
- Stroke Service and Vascular Fellowship Program, International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center and National Institute of Neurologic Disorders and Stroke), Aga Khan University Hospital, Karachi, Pakistan
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Nomani F, Kamal AK. Granulocyte-colony stimulating factor for mobilizing bone marrow stem cells in the sub acute stroke. How safe is the use of granulocyte-colony stimulating factor in sub-acute stroke? Is this stem cell trial of recovery enhancement beneficial? J PAK MED ASSOC 2013; 63:1558-1559. [PMID: 24397109 PMCID: PMC4185083] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Efforts are being made to develop neuroprotective agents for recovery and prevention of further deterioration of brain tissues in patient with stroke.Granulocyte-colony stimulating factor (GCSF) is a glycoprotein hormone encoded by a single gene located on chromosome 17q 11-22. It functions in the regulation of granulopoiesis& terminal maturation of neutrophills. It is being used for the treatment of neutropenia for the production of CD34+ haematopoietic stem cell (HSC) for bone marrow transplant patients. Neuroprotective effect of GCSF is being studied in various experimental studies but its mechanism of action is not well understood and appears to be multimodal.
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Affiliation(s)
- Fauzia Nomani
- Stroke Service and Vascular Fellowship Program, International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center and National Institute of Neurologic Disorders and Stroke), Aga Khan University Hospital, Karachi, Pakistan
| | - Ayeesha Kamran Kamal
- Stroke Service and Vascular Fellowship Program, International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center and National Institute of Neurologic Disorders and Stroke), Aga Khan University Hospital, Karachi, Pakistan
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Nomani F, Kamal AK. Citicoline in the treatment of acute ischaemic stroke: an international, randomized, multicentre, placebo-controlled study (ICTUS trial) is the use of Citicoline is beneficial for acute ischaemic stroke? J PAK MED ASSOC 2013; 63:1445. [PMID: 24392540] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Fauzia Nomani
- Stroke Service and Vascular Fellowship Program, International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center and National Institute of Neurologic Disorders and Stroke), Aga Khan University Hospital, Karachi, Pakistan
| | - Ayeesha Kamran Kamal
- Stroke Service and Vascular Fellowship Program, International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center and National Institute of Neurologic Disorders and Stroke), Aga Khan University Hospital, Karachi, Pakistan
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Shaikh Q, Ahmed B, Ahmed M, Mahar JH, Ahmad M, Ahmed A, Majeed F, Ali FS, Khan M, Kamal AK. Left atrial volumes and associated stroke subtypes. BMC Neurol 2013; 13:149. [PMID: 24139054 PMCID: PMC4015833 DOI: 10.1186/1471-2377-13-149] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 10/15/2013] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Cardio embolism and cerebrovascular atherosclerosis are two major mechanisms of stroke. Studies investigating associations between advanced echocardiographic parameters and stroke mechanisms are limited. METHODS This study is a standardized review of 633 patients admitted to the stroke service of a tertiary care hospital following a standardized stroke investigation and management pathway. Stroke subtypes were characterized using the Causative Classification System, using the hospitals online radiologic archival system with CCS certified stroke investigators. Patients with two mechanisms were excluded. RESULTS Patients with cardioembolic stroke had a higher proportion of atrial fibrillation (p < 0.001), acute myocardial infarction (p < 0.001) and ischemic heart disease (p < 0.001). On electrocardiogram (ECG) and transthoracic Echo (TTE), patients with cardioembolic stroke had a greater atrial fibrillation (p < .00), left ventricular thrombus (p < .00), left ventricular ejection fraction <30% (p < .00) and global hypokinesia (p < .00) Patients with cardioembolic stroke had higher mean left atrial volume indices (LAVi) (p < 0.001), mean left ventricular mass indices (LVMi) (p < 0.05) and mean left atrial diameters (LAD) (p < 0.05). At LAVi of 29-33 ml/m2, the risk of atherothrombotic stroke increased. The risk of cardioembolic stroke increased with LAVi of 34 ml/m2 and above. CONCLUSION Left atrial volume indices may be linked to specific stroke phenotype. At mild increases in left atrial dimensions, the risks of atherosclerotic stroke are high, and probably reflect hypertension as the unifying mechanism. Further increases in left atrial dimensions shifts the risk towards cardioembolic stroke.
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Affiliation(s)
- Quratulain Shaikh
- Neurovascular Clinical Research Fellow, The International Cerebrovascular Translational Clinical Research Training Program, Stroke Services, Aga Khan University, Karachi, Pakistan
| | - Bilal Ahmed
- Department of Medicine, Aga Khan University, M Sc. Epidemiology and Biostatistics, Karachi, Pakistan
| | - Maryam Ahmed
- Stroke Service, Aga Khan University, Karachi, Pakistan
| | - Jamal Hussain Mahar
- Stroke Research Electives, Medical College, Aga Khan University, Karachi, Pakistan
| | - Masood Ahmad
- Stroke Research Electives, Medical College, Aga Khan University, Karachi, Pakistan
| | - Ayesha Ahmed
- Stroke Research Electives, Medical College, Aga Khan University, Karachi, Pakistan
| | - Farzin Majeed
- Neurovascular Clinical Research Fellow, The International Cerebrovascular Translational Clinical Research Training Program, Stroke Services, Aga Khan University, Karachi, Pakistan
| | - Fariha Sadiq Ali
- Section of Cardiology, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Maria Khan
- Neurovascular Clinical Research Fellow, The International Cerebrovascular Translational Clinical Research Training Program, Stroke Services, Aga Khan University, Karachi, Pakistan
| | - Ayeesha Kamran Kamal
- The International Cerebrovascular Translational Clinical Research Training Program, Stroke Services, Aga Khan University, Karachi, Pakistan
- Stroke Services, Section of Neurology, Department of Medicine, Stroke Fellowship Program, International Cerebrovascular Translational Clinical Research Training Program, Aga Khan University Hospital, Stadium Road, 74800, Karachi, Pakistan
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Nomani F, Kamal AK. LOAD: a pilot study of the safety of loading of aspirin & clopidogrel in acute ischaemic stroke and transient ischaemic attack. Is the loading dose of aspirin and clopidogrel a good alternative for patients with acute ischaemic stroke and TIA? How this will impact our clinical practice? J PAK MED ASSOC 2013; 63:1316. [PMID: 24392571 PMCID: PMC4185080] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Fauzia Nomani
- Fogarty International Center and National Institute of Neurologic Disorders and Stroke, Aga Khan University Hospital, Karachi, Pakistan
| | - Ayeesha Kamran Kamal
- Fogarty International Center and National Institute of Neurologic Disorders and Stroke, Aga Khan University Hospital, Karachi, Pakistan
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Shaikh Q, Kamal AK. My patient has carotid stenosis. should he get stenting or endarterectomy? J PAK MED ASSOC 2013; 63:1201. [PMID: 24601208 PMCID: PMC4185067] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Affiliation(s)
- Quratulain Shaikh
- Stroke Service and Vascular Fellowship Program, International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center and National Institute of Neurologic Disorders and Stroke), Aga Khan University Hospital, Karachi, Pakistan
| | - Ayeesha Kamran Kamal
- Stroke Service and Vascular Fellowship Program, International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center and National Institute of Neurologic Disorders and Stroke), Aga Khan University Hospital, Karachi, Pakistan
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35
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Akhtar A, Kamal AK. CLEAR: the intraventricular haemorrhage thrombolysis trial. J PAK MED ASSOC 2013; 63:928. [PMID: 23901725 PMCID: PMC4185073] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Anjum Akhtar
- Stroke Service and Vascular Fellowship Program, International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center and National Institute of Neurologic Disorders and Stroke), Aga Khan University Hospital, Karachi, Pakistan
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Akhtar A, Kamal AK. Benefit of neuroprotection in acute ischaemic stroke, shall we dare to hope? J PAK MED ASSOC 2013; 63:792. [PMID: 23901691 PMCID: PMC4185065] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Anjum Akhtar
- Stroke Service and Vascular Fellowship Program, International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center and National Institute of Neurologic Disorders and Stroke), Aga Khan University Hospital, Karachi, Pakistan
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Kamal AK, Wadiwala MF, Ahmed B, Khan M, Majeed F, Rasheed A. Population Attributable Risks of Stroke from Intracranial Atherosclerotic Disease (ICAD) in South Asian Pakistanis. Int J Stroke 2013; 8:E17. [DOI: 10.1111/ijs.12094] [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: 11/28/2022]
Affiliation(s)
- Ayeesha Kamran Kamal
- Program Director Neurovascular Fellowship, The International Cerebrovascular Translational Clinical Research Training Program, Stroke Services, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Muhammad Faisal Wadiwala
- Neurovascular Clinical Research Fellow, The International Cerebrovascular Translational Clinical Research Training Program, Stroke Services, Aga Khan University, Karachi, Pakistan
| | - Bilal Ahmed
- Epidemiology and Biostatistics, Department of Medicine, Aga Khan University, Karachi, Pakistan
| | - Maria Khan
- Neurovascular Clinical Research Fellow, The International Cerebrovascular Translational Clinical Research Training Program, Stroke Services, Aga Khan University, Karachi, Pakistan
| | - Farzin Majeed
- Neurovascular Clinical Research Fellow, The International Cerebrovascular Translational Clinical Research Training Program, Stroke Services, Aga Khan University, Karachi, Pakistan
| | - Asif Rasheed
- Center for Non Communicable Diseases, Karachi, Pakistan
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Wadiwala MF, Kamal AK. My patient has intracranial stenosis, does he need an intracerebral stent? Results of the SAMMPRIS study. J PAK MED ASSOC 2013; 63:654-655. [PMID: 23758002 PMCID: PMC4185064] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Muhammad Faisal Wadiwala
- Stroke Service and Vascular Fellowship Program, International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center and National Institute of Neurologic Disorders and Stroke), Aga Khan University Hospital, Karachi, Pakistan
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Wadiwala MF, Kamal AK. My patient had a small vessel stroke, are two antiplatelet agents better than one? J PAK MED ASSOC 2013; 63:535-536. [PMID: 23905460 PMCID: PMC4185075] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Muhammad Faisal Wadiwala
- Stroke Service and Vascular Fellowship Programme, International Cerebrovascular Translational Clinical Research Training Program Fogarty International Center and National Institute of Neurological Disorders and Stroke), Aga Khan University Hospital, Karachi, Pakistan
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Kamran S, Muzammil SM, Kamal AK. Tenecteplase for stroke salvage therapy--extending the therapeutic window via CT based selection. J PAK MED ASSOC 2013; 63:406-407. [PMID: 23914652] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Syed Kamran
- Stroke Program, Neurology Section, Department of Medicine, Aga Khan University, Karachi, Pakistan
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Kamran SH, Muzammil SM, Kamal AK. Is HAS-BLED score better than CHADS2 and HEMOR2RHAGES schemes in assessing 1 year risk of major bleed in atrial fibrillation patients? J PAK MED ASSOC 2013; 63:281-282. [PMID: 23894915] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Syed Habibullah Kamran
- Stroke Program, Neurology Section, Department of Medicine, Aga Khan University, Karachi, Pakistan
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Kamran SH, Muzammil SM, Kamal AK. What are the new therapeutic alternatives to warfarin in atrial fibrillation? J PAK MED ASSOC 2013; 63:129-130. [PMID: 23865151] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Syed Habibullah Kamran
- Stroke Program, Neurology Section, Department of Medicine, Aga Khan University, Karachi, Pakistan
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Shaikh Q, Kamal AK. Can telemedicine improve stroke outcomes? J PAK MED ASSOC 2012; 62:1352-3. [PMID: 23866493 PMCID: PMC4185063] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Quratulain Shaikh
- Stroke Service and Vascular Fellowship Program, International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center and National Institute of Neurologic Disorders and Stroke), Aga Khan University Hospital, Karachi, Pakistan
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Shaikh Q, Kamal AK. Sarpogrelate- another new antiplatelet agent? J PAK MED ASSOC 2012; 62:1253. [PMID: 23866425 PMCID: PMC4185068] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Quratulain Shaikh
- Stroke Service and Vascular Fellowship Programme, International Cerebrovascular Translational Clinical Research Training Programme, Fogarty International Center and National Institute of Neurologic Disorders and Stroke
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Raza E, Kamal AK. Recurrent non-aneurysmal, metastatic intraparenchymal haemorrhages following resection of atrial myxoma - case report and literature review. BMJ Case Rep 2012; 2012:bcr.02.2012.5772. [PMID: 23104629 DOI: 10.1136/bcr.02.2012.5772] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Atrial myxomas are the commonest cardiac neoplasms. The most common extra-cardiac manifestations are embolic infarcts from tumour embolisation. Infrequently, aneurysm formation and intracranial haemorrhages also occur. Incredibly rare are space-occupying lesions and malignant transformation. The authors report a case of a previously healthy middle-aged lady who developed recurrent and expanding intraparenchymal haemorrhages following resection of a left atrial myxoma without any primary disease recurrence. The case described is completely different from the described literature in that her intracranial vasculature was free of aneurysms on angiography despite central nervous system haemorrhage and no myxomatous or malignant features were seen on histology of the resected symptomatic occipital lesion. The authors compare this case to the available literature and also provide a literature review.
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Affiliation(s)
- Emmon Raza
- Neurology Department, Stroke Service, Aga Khan University, Karachi, Pakistan
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Wadiwala MF, Kamal AK. Are robots any better in stroke rehabilitation? J PAK MED ASSOC 2012; 62:1104-1105. [PMID: 23866460 PMCID: PMC4185066] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Muhammad Faisal Wadiwala
- Stroke Service and Vascular Fellowship Program, Fogarty International Center and National Institute of Neurologic Disorders and Stroke, Aga Khan University Hospital, Karachi, Pakistan
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Khan M, Rasheed A, Hashmi S, Zaidi M, Murtaza M, Akhtar S, Bansari L, Shah N, Samuel M, Raza S, Khan UR, Ahmed B, Ahmed B, Ahmed N, Ara J, Ahsan T, Munir SM, Ali S, Mehmood K, Makki KU, Ahmed MM, Sheikh N, Memon AR, Frossard PM, Kamal AK. Stroke radiology and distinguishing characteristics of intracranial atherosclerotic disease in native South Asian Pakistanis. Int J Stroke 2012; 8 Suppl A100:14-20. [PMID: 23013556 DOI: 10.1111/j.1747-4949.2012.00878.x] [Citation(s) in RCA: 8] [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] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND There are no descriptions of stroke mechanisms from intracranial atherosclerotic disease in native South Asian Pakistanis. METHODS Men and women aged ≥ 18 years with acute stroke presenting to four tertiary care hospitals in Karachi, Pakistan were screened using magnetic resonance angiography/transcranial Doppler scans. Trial of ORG 10172 in Acute Stroke Treatment criteria were applied to identify strokes from intracranial atherosclerotic disease. RESULTS We studied 245 patients with acute stroke due to intracranial atherosclerotic disease. Two hundred thirty scans were reviewed. Also, 206/230 (89.0%) showed acute ischaemia. The most frequent presentation was with cortically based strokes in 42.2% (87/206) followed by border-zone infarcts (52/206, 25.2%). Increasing degrees of stenosis correlated with the development of both cortical and border-zone strokes (P = 0.002). Important associated findings were frequent atrophy (166/230, 72.2%), silent brain infarcts (66/230, 28%) and a marked lack of severe leukoaraiosis identified in only 68/230 (29.6%). A total of 1870 arteries were studied individually. Middle cerebral artery was the symptomatic stroke vessel in half, presenting with complete occlusion in 66%. Evidence of biological disease, symptomatic or asymptomatic was identified in 753 (40.2%) vessels of which 543 (72%) were significantly (>50%) stenosed at presentation. CONCLUSION Intracranial atherosclerotic disease is a diffuse process in Pakistani south Asians, with involvement of multiple vessels in addition to the symptomatic vessel. The middle cerebral artery is the most frequent symptomatic vessel presenting with cortical embolic infarcts. There is a relative lack of leukoaraiosis. Concomitant atrophy, silent brain infarcts and recent ischaemia in the symptomatic territory are all frequently associated findings.
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Affiliation(s)
- Maria Khan
- Stroke Service and the International Cerebrovascular Translational Clinical Research Training Program, Section of Neurology, Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
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Wadiwala MF, Kamal AK. What is better antiplatelet agent to prevent recurrent stroke? J PAK MED ASSOC 2012; 62:976-977. [PMID: 23139991 PMCID: PMC4185079] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Aspirin and Extended-Release Dipyridamole versus Clopidogrel for Recurrent StrokePrevention Regimen for Effectively Avoiding Second Strokes(PRoFESS) Study Group.
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Affiliation(s)
- Muhammad Faisal Wadiwala
- Stroke Service and Vascular Fellowship Program, International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center and National Institute of Neurologic Disorders and Stroke), Aga Khan University Hospital, Karachi, Pakistan
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Wadiwala MF, Kamal AK. Extending the window for thrombolysis in acute stroke. J PAK MED ASSOC 2012; 62:858-859. [PMID: 23862270 PMCID: PMC4185082] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Muhammad Faisal Wadiwala
- Stroke Service and Vascular Fellowship Program, International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center and National Institute of Neurologic Disorders and Stroke), Aga Khan University Hospital, Karachi, Pakistan
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Wadiwala MF, Kamal AK. Long-term effect of carotid surgery in asymptomatic stenosis. J PAK MED ASSOC 2012; 62:739-740. [PMID: 23866531 PMCID: PMC4185084] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Affiliation(s)
- Muhammad Faisal Wadiwala
- Stroke Service and Vascular Fellowship Program, International Cerebrovascular Translational Clinical Research Training Program (Fogarty International Center and National Institute of Neurologic Disorders and Stroke), Aga Khan University Hospital, Karachi, Pakistan
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