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Vengurlekar D, Walker C, Mahajan R, Dalal A, Chavan V, Galindo MA, Iyer A, Mansoor H, Silsarma A, Isaakidis P, Spencer H. Linezolid resistance in patients with drug-resistant TB. Int J Tuberc Lung Dis 2023; 27:567-569. [PMID: 37353865 DOI: 10.5588/ijtld.22.0632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023] Open
Affiliation(s)
- D Vengurlekar
- Médecins Sans Frontières (MSF) Operational Centre Brussels, Mumbai, India
| | - C Walker
- MSF Operational Centre Brussels, Southern Africa Medical Unit, Cape Town, South Africa, MSF Luxembourg Operational Research Unit (LuxOR), Luxembourg, Luxembourg
| | - R Mahajan
- MSF Operational Centre Barcelona-Athens, New Delhi, India
| | - A Dalal
- Jupiter Hospital, Mumbai, India
| | - V Chavan
- Médecins Sans Frontières (MSF) Operational Centre Brussels, Mumbai, India
| | - M A Galindo
- Médecins Sans Frontières (MSF) Operational Centre Brussels, Mumbai, India
| | - A Iyer
- Médecins Sans Frontières (MSF) Operational Centre Brussels, Mumbai, India
| | - H Mansoor
- Médecins Sans Frontières (MSF) Operational Centre Brussels, Mumbai, India
| | - A Silsarma
- Médecins Sans Frontières (MSF) Operational Centre Brussels, Mumbai, India
| | - P Isaakidis
- MSF Operational Centre Brussels, Southern Africa Medical Unit, Cape Town, South Africa, Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - H Spencer
- MSF Operational Centre Brussels, Southern Africa Medical Unit, Cape Town, South Africa
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Iyer A, Ndlovu Z, Sharma J, Mansoor H, Bharati M, Kolan S, Morales M, Das M, Issakidis P, Ferlazzo G, Hirani N, Joshi A, Tipre P, Sutar N, England K. Operationalising targeted next-generation sequencing for routine diagnosis of drug-resistant TB. Public Health Action 2023; 13:43-49. [PMID: 37359066 PMCID: PMC10290261 DOI: 10.5588/pha.22.0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Accepted: 02/24/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Phenotypic drug susceptibility testing (pDST) for Mycobacterium tuberculosis can take up to 8 weeks, while conventional molecular tests identify a limited set of resistance mutations. Targeted next-generation sequencing (tNGS) offers rapid results for predicting comprehensive drug resistance, and this study sought to explore its operational feasibility within a public health laboratory in Mumbai, India. METHODS Pulmonary samples from consenting patients testing Xpert MTB-positive were tested for drug resistance by conventional methods and using tNGS. Laboratory operational and logistical implementation experiences from study team members are shared below. RESULTS Of the total number of patients tested, 70% (113/161) had no history of previous TB or treatment; however, 88.2% (n = 142) had rifampicin-resistant/multidrug-resistant TB (RR/MDR-TB). There was a high concordance between resistance predictions of tNGS and pDST for most drugs, with tNGS more accurately identifying resistance overall. tNGS was integrated and adapted into the laboratory workflow; however, batching samples caused significantly longer result turnaround time, fastest at 24 days. Manual DNA extraction caused inefficiencies; thus protocol optimisations were performed. Technical expertise was required for analysis of uncharacterised mutations and interpretation of report templates. tNGS cost per sample was US$230, while for pDST this was US$119. CONCLUSIONS Implementation of tNGS is feasible in reference laboratories. It can rapidly identify drug resistance and should be considered as a potential alternative to pDST.
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Affiliation(s)
- A Iyer
- Médecins Sans Frontières (MSF), Mumbai, India
| | - Z Ndlovu
- MSF, Southern African Medical Unit, Cape Town, South Africa
- Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - J Sharma
- Médecins Sans Frontières (MSF), Mumbai, India
| | - H Mansoor
- Médecins Sans Frontières (MSF), Mumbai, India
| | - M Bharati
- Médecins Sans Frontières (MSF), Mumbai, India
| | - S Kolan
- Médecins Sans Frontières (MSF), Mumbai, India
| | - M Morales
- Médecins Sans Frontières (MSF), Mumbai, India
| | - M Das
- Médecins Sans Frontières (MSF), Mumbai, India
| | - P Issakidis
- MSF, Southern African Medical Unit, Cape Town, South Africa
| | - G Ferlazzo
- MSF, Southern African Medical Unit, Cape Town, South Africa
| | - N Hirani
- Department of Mycobacteriology, Sir JJ Group of Hospitals, Mumbai, India
| | - A Joshi
- Department of Mycobacteriology, Sir JJ Group of Hospitals, Mumbai, India
| | - P Tipre
- National Tuberculosis Elimination Programme, Mumbai, India
| | - N Sutar
- National Tuberculosis Elimination Programme, Mumbai, India
| | - K England
- Independent Consultant, Honolulu, HI, USA
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Mansoor H, Hirani N, Chavan V, Das M, Sharma J, Bharati M, Oswal V, Iyer A, Morales M, Joshi A, Ferlazzo G, Isaakidis P, Ndlovu Z, England K. Clinical utility of target-based next-generation sequencing for drug-resistant TB. Int J Tuberc Lung Dis 2023; 27:41-48. [PMID: 36853141 PMCID: PMC9879084 DOI: 10.5588/ijtld.22.0138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND: In high TB burden countries, access to drug susceptibility testing is a major bottleneck. Targeted next-generation sequencing (tNGS) is a promising technology for rapid resistance detection. This study assessed the role of tNGS for the diagnosis of drug-resistant TB (DR-TB).METHODS: A total of 161 samples from bacteriologically confirmed TB cases were subjected to tNGS using the Deeplex® Myc-TB kit and sequenced using the MiSeq platform. These samples were also processed for conventional phenotypic DST (pDST) using 13 drugs on Mycobacteria Growth Indicator Tube and line-probe assays (MTBDRplus and MTBDRsl).RESULTS: There were 146 DR-TB and 15 drug-susceptible TB (DS-TB) samples. About 70% of patients with DR-TB had no previous TB treatment history. Overall, 88.2% had rifampicin-resistant/multidrug-resistant TB (RR/MDR-TB), 58.5% pre-extensively drug-resistant TB (pre-XDR-TB) and 9.2% had XDR-TB as defined by the WHO (2020). Around 8% (n = 13) of samples were non-culturable; however, identified 8 were resistant to first and second-line drugs using tNGS. Resistance frequency was similar across methods, with discordance in drugs less reliable using pDST or with limited mutational representation within databases. Sensitivities were aligned with literature reports for most drugs. We observed 10% heteroresistance, while 75% of strains were of Lineages 2 and 3.CONCLUSIONS: Programme data supported tNGS in the diagnosis of DR-TB for early treatment using individualised regimens.
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Affiliation(s)
| | - N. Hirani
- Grant Medical College, Sir Jamshedjee Jeejebhoy Group of Hospitals, Mumbai, India
| | - V. Chavan
- Médecins Sans Frontières, Mumbai, India
| | - M. Das
- Médecins Sans Frontières, Mumbai, India
| | - J. Sharma
- Médecins Sans Frontières, Mumbai, India
| | | | - V. Oswal
- National TB Elimination Programme, Mumbai, India
| | - A. Iyer
- Médecins Sans Frontières, Mumbai, India
| | | | - A. Joshi
- Grant Medical College, Sir Jamshedjee Jeejebhoy Group of Hospitals, Mumbai, India
| | - G. Ferlazzo
- Southern Africa Medical Unit, Médecins Sans Frontières, Cape Town, South Africa
| | - P. Isaakidis
- Southern Africa Medical Unit, Médecins Sans Frontières, Cape Town, South Africa
,Clinical and Molecular Epidemiology Unit, Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
| | - Z. Ndlovu
- Southern Africa Medical Unit, Médecins Sans Frontières, Cape Town, South Africa
,Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - K. England
- Independent Consultant, Infectious Disease Microbiologist, Honolulu, Hawaii, USA
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Moqeet MA, Ali W, Khan SA, Zafar A, Mansoor H. One-year Visual and Refractive Outcomes of Deep Anterior Lamellar Keratoplasty (DALK) in Patients with Advanced Keratoconus. J Coll Physicians Surg Pak 2022; 32:1160-1164. [PMID: 36089713 DOI: 10.29271/jcpsp.2022.09.1160] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 08/24/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To determine the one-year visual and refractive outcomes of deep anterior lamellar keratoplasty (DALK) in patients with advanced keratoconus (KC) using inexpensive readily available instruments. STUDY DESIGN An observational study. PLACE AND DURATION OF STUDY Department of Cornea and Refractive Surgery, Al-Shifa Trust Eye Hospital, from November 2016 to March 2021. METHODOLOGY The authors evaluated different types of big bubble (BB) formation and the conversion rate of intended DALK (n=120) to the penetrating keratoplasty (PK) in patients with grade 4 KC. For analysis, only those patients were included in whom DALK was completed. Main outcome measures at 1-year follow-up were best-corrected visual acuity (BCVA), maximum keratometry (Kmax) reading, spherical equivalent (SE), and topographic astigmatism (TA). All the postoperative complications were recorded. RESULTS Type 1 BB was formed in 68% (n=82) of the patients. An incomplete type 1 BB and type 2 BB were observed in twenty and eighteen patients, respectively. DALK was completed successfully in 102 patients. Whereas, the conversion rate to PK was 15% (n=18). The mean preoperative BCVA improved from 1.11±0.23 logMAR to 0.46±0.20 logMAR, at 1-year follow-up. The mean Kmax, SE, and TA readings reduced from a preoperative value of 62.1±4.60 D, -11.6±2.62 D, and 4.63±1.82 D, respectively, to 49.1±3.10 D, -5.65±0.84 D, and 2.78±1.35 D, respectively, at 1-year follow-up. Stromal rejection was recorded in two patients, but it responded well to topical therapy. CONCLUSION Inexpensive readily available instruments can be used to perform DALK in patients with advanced KC with favourable visual and refractive outcomes. KEY WORDS Big bubble, Deep anterior lamellar keratoplasty, Keratoconus, Perforation, Penetrating keratoplasty.
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Affiliation(s)
- Muhammad Abdul Moqeet
- Department of Cornea and Refractive Surgery, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
| | - Warda Ali
- Department of Cornea and Refractive Surgery, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
| | - Saad Alam Khan
- Department of Cornea and Refractive Surgery, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
| | - Aruba Zafar
- Department of Cornea and Refractive Surgery, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
| | - Hassan Mansoor
- Department of Cornea and Refractive Surgery, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
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Teo AWJ, Mansoor H, Sim N, Lin MTY, Liu YC. In Vivo Confocal Microscopy Evaluation in Patients with Keratoconus. J Clin Med 2022; 11:393. [PMID: 35054085 PMCID: PMC8778820 DOI: 10.3390/jcm11020393] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 01/07/2022] [Accepted: 01/11/2022] [Indexed: 02/05/2023] Open
Abstract
Keratoconus is the most common primary corneal ectasia characterized by progressive focal thinning. Patients experience increased irregular astigmatism, decreased visual acuity and corneal sensitivity. Corneal collagen crosslinking (CXL), a minimally invasive procedure, is effective in halting disease progression. Historically, keratoconus research was confined to ex vivo settings. In vivo confocal microscopy (IVCM) has been used to examine the corneal microstructure clinically. In this review, we discuss keratoconus cellular changes evaluated by IVCM before and after CXL. Cellular changes before CXL include decreased keratocyte and nerve densities, disorganized subbasal nerves with thickening, increased nerve tortuosity and shortened nerve fibre length. Repopulation of keratocytes occurs up to 1 year post procedure. IVCM also correlates corneal nerve status to functional corneal sensitivity. Immediately after CXL, there is reduced nerve density and keratocyte absence due to mechanical removal of the epithelium and CXL effect. Nerve regeneration begins after 1 month, with nerve fibre densities recovering to pre-operative levels between 6 months to 1 year and remains stable up to 5 years. Nerves remain tortuous and nerve densities are reduced. Corneal sensitivity is reduced immediately postoperatively but recovers with nerve regeneration. Our article provides comprehensive review on the use of IVCM imaging in keratoconus patients.
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Affiliation(s)
- Alvin Wei Jun Teo
- Department of Cornea and External Eye Disease, Singapore National Eye Centre, Singapore 168751, Singapore;
| | - Hassan Mansoor
- Al Shifa Trust Eye Hospital, Jhelum Road, Rawalpindi 46000, Pakistan;
| | - Nigel Sim
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore 168751, Singapore;
| | - Molly Tzu-Yu Lin
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore 169856, Singapore;
| | - Yu-Chi Liu
- Department of Cornea and External Eye Disease, Singapore National Eye Centre, Singapore 168751, Singapore;
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore 169856, Singapore;
- Cornea and Refractive Surgery Group, Singapore Eye Research Institute, Singapore 169856, Singapore
- Ophthalmology and Visual Sciences Academic Clinical Program, Duke-NUS Medical School, Singapore 169857, Singapore
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Akbari HA, Pourabbas M, Yoosefi M, Briki W, Attaran S, Mansoor H, Moalla W, Damak M, Dergaa I, Teixeira AL, Nauman J, Behm DG, Bragazzi NL, Ben Saad H, Lavie CJ, Ghram A. How physical activity behavior affected well-being, anxiety and sleep quality during COVID-19 restrictions in Iran. Eur Rev Med Pharmacol Sci 2021; 25:7847-7857. [PMID: 34982447 DOI: 10.26355/eurrev_202112_27632] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The Islamic Republic of Iran has displayed one of the highest rates of COVID-19 infection in the world and the highest rate of mortality in the Middle East. Iran has used a stringent package of preventive health measures to mitigate the spread of infection, which however has negatively affected individuals' physical and psychological health. This study aimed at examining whether physical-activity (PA) behavior, anxiety, well-being, and sleep-quality changed in response to the COVID-19-related public health restrictions enforced in Iran. PATIENTS AND METHODS An online questionnaire was disseminated to adults residing in Iran from November 17, 2020, to February 13, 2021 (~88 days), during Iran's strictest public health restrictions. Main outcome measures included Godin-Shephard Leisure-Time Exercise Questionnaire, General Anxiety Disorder-7, Mental Health Continuum-Short Form, and Pittsburgh Sleep Quality Index. RESULTS A total of 3,323 adults (mean age 30±11 years, 54.3% female) participated in the survey. Firstly, the restrictions generally reduced PA behavior: (a) among inactive participants (IPs), 60.6% became less active vs. 5.1% who became more active; and (b) among active participants (APs), 49.9% became less active vs. 22.8% who became more active. Secondly, PA behavior was associated with higher well-being and sleep quality during the restrictions: (a) APs reported higher (or lower) levels of well-being and sleep quality (or anxiety) than did IPs; and (b) among IPs as well as among APs, the more active the participants, the greater (or lower) the levels of well-being and sleep quality (or anxiety). CONCLUSIONS This study showed the beneficial role of PA behavior for well-being, anxiety, and sleep quality during the COVID-19 restrictions, whereas such restrictions appeared to decrease PA participation. Active lifestyle should be then encouraged during the COVID-19 outbreak while taking precautions.
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Affiliation(s)
- H A Akbari
- Department of Exercise Physiology, Faculty of Physical Education and Sport Sciences, University of Tehran, Tehran, Iran.
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Das M, Mamnoon F, Mansoor H, Meneguim AC, Singh P, Shah I, Ravi S, Kalon S, Hossain FN, Ferlazzo G, Isaakidis P, Furin J, Acharya S, Thakur HP. New TB drugs for the treatment of children and adolescents with rifampicin-resistant TB in Mumbai, India. Int J Tuberc Lung Dis 2021; 24:1265-1271. [PMID: 33317670 DOI: 10.5588/ijtld.20.0165] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
SETTING: Médecins Sans Frontières (MSF) clinic in Mumbai, India.OBJECTIVE: To determine the final treatment outcomes, culture conversion and adverse events (AEs) during treatment among children and adolescents (0-19 years) with rifampicin-resistant tuberculosis (RR-TB) who received ambulatory injectable-free treatment, including bedaquiline (BDQ) and/or delamanid (DLM) during September 2014-January 2020.DESIGN: This was a retrospective cohort study based on review of routinely collected programme data.RESULTS: Twenty-four patients were included; the median age was 15.5 years (min-max 3-19) and 15 (63%) were females. None were HIV-coinfected. All had fluoroquinolone resistance. Twelve received treatment, including BDQ and DLM, 11 received DLM and one BDQ. The median exposure to BDQ (n = 13) and DLM (n = 23) was 82 (IQR 80-93) and 82 (IQR 77-96) weeks, respectively. Seventeen (94%) patients with positive culture at baseline (n = 18) had negative culture during treatment; median time for culture-conversion was 7 weeks (IQR 5-11). Twenty-three (96%) had successful treatment outcomes: cured (n = 16) or completed treatment (n = 7); one died. Eleven (46%) had 17 episodes of AEs. Two of 12 serious AEs were associated with new drugs (QTcF >500 ms).CONCLUSION: Based on one of the largest global cohorts of children and adolescents to receive new TB drugs, this study has shown that injectable-free regimens containing BDQ and/or DLM on ambulatory basis were effective and well-tolerated among children and adolescents and should be made routinely accessible to these vulnerable groups.
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Affiliation(s)
- M Das
- Médecins Sans Frontières, Mumbai, Tata Institute of Social Sciences, Mumbai
| | | | | | | | - P Singh
- Médecins Sans Frontières, Mumbai
| | - I Shah
- Bai Jerbai Wadia Hospital for Children, Mumbai, India
| | - S Ravi
- Médecins Sans Frontières, Mumbai
| | - S Kalon
- Médecins Sans Frontières, Mumbai
| | | | - G Ferlazzo
- Southern Africa Medical Unit, Médecins Sans Frontières, Cape Town, South Africa
| | - P Isaakidis
- Southern Africa Medical Unit, Médecins Sans Frontières, Cape Town, South Africa
| | - J Furin
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
| | - S Acharya
- Mumbai Districts AIDS Control Society, Mumbai
| | - H P Thakur
- Tata Institute of Social Sciences, Mumbai, National Institute of Health and Family Welfare, New Delhi, India
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Sughra U, Siddiqui M, Noorani S, Mansoor H, Kausar S. Patient Satisfaction: A Tool towards Quality Improvement. pak J Ophthalmol 2021. [DOI: 10.36351/pjo.v37i2.1150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Purpose: To determine the importance of patient satisfaction as a tool for quality improvement.
Study Design: Cross sectional survey.
Place and Duration of Study: Pediatric Ophthalmology Department of Al-Shifa Trust Eye Hospital, Rawalpindi, from May 2017 to September 2017.
Methods: This study included 500 individuals, who were caregivers of children visiting the hospital at the time of data collection. Individuals who visited departments other than pediatric department were excluded. Two groups were made. Group 1 included 300 individuals who were interviewed for to assess the patient satisfaction. On the basis of response, play area was made spacious, additional registration counters were placed and more reception staff members were hired to shorten the waiting and registration time, additional fans were installed in the waiting area and patient information was displayed on TV screens to aid uneducated patients and their attendants. Second group with 200 individuals were interviewed after these improvements. Pretested structured questionnaire was used to collect data regarding socio-demographic characteristics and experience of visit to the hospital. SPSS version 20 was used for descriptive and inferential data analysis.
Results: Participants in this survey showed high level of satisfaction after interventions 45 to 65%.There was statistically significant association between satisfaction level and improvement in services was found (p < 0.001).
Conclusion: Satisfaction level of patients depends upon the quality of services and medical care provided and it can be used as a good tool for improving the services in the hospitals.
Key Words: Satisfaction, Outpatient department, Hospital.
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Mansoor H, Khan SA, Afghani T, Assir MZ, Ali M, Khan WA. Utility of teleconsultation in accessing eye care in a developing country during COVID-19 pandemic. PLoS One 2021; 16:e0245343. [PMID: 33444381 PMCID: PMC7808582 DOI: 10.1371/journal.pone.0245343] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 05/06/2020] [Accepted: 12/29/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate the utility of teleconsultation in the provision of eye care services during the COVID-19 lockdown. Disparities in the consultation burden of sub-specialities and socio-demographic differences in teleconsultation utilization were also assessed. METHODS Al-Shifa Trust Eye Hospital Rawalpindi began audio and video teleconsultation using broadband telecommunication services during the lockdown. Patients' and consultations' data gathered during the first three weeks after the commencement of this programme were compared with data from the four weeks prior to lockdown. The weekly consultation ratio and overall consultation burden of sub-specialities were measured. Chi-Square tests of association determined the relationship between different variables (socioeconomic status and consultation characteristics) and consultation modality (on-site vs online). RESULTS In total, 17507 on-site consultations (4377/week) were conducted compared to 1431 teleconsultations (477/week), which maintained 10.89% of the weekly pre-lockdown eye care services. The post-lockdown teleconsultation programme saw a relatively higher percentage of service utility among female (47.09% vs 44.71%), younger-age (31.33±19.45 vs 41.25±23.32 years) and higher-socioeconomic-status (32.21% vs 0.30%) patients compared to pre-lockdown on-site consultations. The most common indication for teleconsultation was red-eye (16.70%). While cornea and glaucoma clinics maintained most of the pre-lockdown services (30.42% and 29% respectively), the highest dropout was seen in optometric and vitreoretinal services supporting only 5.54% and 8.28% of pre-lockdown services, respectively. CONCLUSION Digital initiatives could partially maintain eye care services during the lockdown. Focused strategies to improve teleconsultation utilization are required during the pandemic and beyond.
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Affiliation(s)
- Hassan Mansoor
- Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
- * E-mail: (WAK); (HM)
| | | | | | - Muhammad Zaman Assir
- Department of Medicine, Allama Iqbal Medical College, University of Health Sciences, Lahore, Pakistan
| | - Mahmood Ali
- Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
| | - Wajid Ali Khan
- Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
- * E-mail: (WAK); (HM)
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Abstract
Diabetic keratopathy (DK) is a common, but underdiagnosed, ocular complication of diabetes mellitus (DM) that has a significant economic burden. It is characterised by progressive damage of corneal nerves, due to DM-induced chronic hyperglycaemia and its associated metabolic changes. With advances in corneal nerve imaging and quantitative analytic tools, studies have shown that the severity of diabetic corneal neuropathy correlates with the status of diabetic peripheral neuropathy. The corneal nerve plexus is, therefore, considered as an important surrogate marker of diabetic peripheral neuropathy and helps in the evaluation of interventional efficacy in the management of DM. The clinical manifestations of DK depend on the disease severity and vary from decreased corneal sensitivity to sight-threatening corneal infections and neurotrophic ulcers. The severity of diabetic corneal neuropathy and resultant DK determines its management plan, and a step-wise approach is generally suggested. Future work would focus on the exploration of biomarkers for diabetic corneal neuropathy, the development of new treatment for corneal nerve protection, and the improvement in the clinical assessment, as well as current imaging technique and analysis, to help clinicians detect diabetic corneal neuropathy earlier and monitor the sub-clinical progression more reliably.
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Affiliation(s)
- Hassan Mansoor
- Al Shifa Trust Eye Hospital, Rawalpindi 44000, Pakistan;
| | - Hong Chang Tan
- Department of Endocrinology, Singapore General Hospital, Singapore 169608, Singapore;
| | - Molly Tzu-Yu Lin
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore 169856, Singapore; (M.T.-Y.L.); (J.S.M.)
| | - Jodhbir S. Mehta
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore 169856, Singapore; (M.T.-Y.L.); (J.S.M.)
- Cornea and External Eye Diseases, Singapore National Eye Centre, Singapore 168751, Singapore
- Eye-Academic Clinical Program, Duke-National University Singapore Graduate Medical School, Singapore 169857, Singapore
| | - Yu-Chi Liu
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore 169856, Singapore; (M.T.-Y.L.); (J.S.M.)
- Cornea and External Eye Diseases, Singapore National Eye Centre, Singapore 168751, Singapore
- Eye-Academic Clinical Program, Duke-National University Singapore Graduate Medical School, Singapore 169857, Singapore
- Correspondence: ; Tel.: +65-65-767-246; Fax: +65-62-277-290
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Meneguim AC, Rebello L, Das M, Ravi S, Mathur T, Mankar S, Kharate S, Tipre P, Oswal V, Iyer A, Mansoor H, Kalon S, Garone D, Ferlazzo G, Isaakidis P. Adapting TB services during the COVID-19 pandemic in Mumbai, India. Int J Tuberc Lung Dis 2020; 24:1119-1121. [PMID: 33126951 DOI: 10.5588/ijtld.20.0537] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
| | | | - M Das
- Médecins Sans Frontières, Mumbai
| | - S Ravi
- Médecins Sans Frontières, Mumbai
| | - T Mathur
- Médecins Sans Frontières, Mumbai
| | - S Mankar
- National Tuberculosis Elimination Programme, Mumbai, India
| | - S Kharate
- National Tuberculosis Elimination Programme, Mumbai, India
| | - P Tipre
- National Tuberculosis Elimination Programme, Mumbai, India
| | - V Oswal
- National Tuberculosis Elimination Programme, Mumbai, India
| | - A Iyer
- Médecins Sans Frontières, Mumbai
| | | | - S Kalon
- Médecins Sans Frontières, Mumbai
| | - D Garone
- Médecins Sans Frontières, Brussels, Belgium
| | - G Ferlazzo
- Southern Africa Medical Unit, Médecins Sans Frontières, Cape Town, South Africa, ,
| | - P Isaakidis
- Southern Africa Medical Unit, Médecins Sans Frontières, Cape Town, South Africa, ,
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Afghani T, Khan SB, Mansoor H, Nisar S, Waseem S. Assessment of diabetic retinopathy and diabetes management systems in Pakistan using a WHO tool. J PAK MED ASSOC 2020; 70:1619-1624. [PMID: 33040121 DOI: 10.5455/jpma.12450] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Using WHO questionnaire known as TADDS(Tool for Assessment of Diabetic Retinopathy and Diabetes Management System), a country wide survey was conducted to assess the health care system for diabetes mellitus (DM) and diabetic retinopathy (DR). This would also provide any evidence of the presence and usefulness of links between the two. A total of 190 key informants for DR and DM services from 47 districts were interviewed. The answers were reviewed and any disagreement was resolved through discussion with stakeholders'. The final results were disseminated. The results showed that diabetes is listed as a priority; national plan exists but programme has not been implemented. Health professionals are unaware about Ministry of Health guidelines. There is infrequent networking between DM and DR care providers. Transport and cost are the main barriers for accessing these services. Out of pocket expenses provide 55% of health care financing.
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Affiliation(s)
- Tayyab Afghani
- Department of Orbit and Oculoplastics, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
| | | | - Hassan Mansoor
- Department of Eye Disease and Retractive Surgery, Singapore Eye Research Institute, Singapore
| | - Sana Nisar
- Department of Ophthalmology, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
| | - Shehzad Waseem
- Department of Ophthalmology, Fauji Foundation Hospital, Rawalpindi, Pakistan
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Mansoor H, Liu YC, Ang M, Mehta JS. Conjunctival sparing femtosecond laser-assisted conjunctival autografts for double-headed pterygium surgery. Clin Exp Ophthalmol 2020; 48:1115-1118. [PMID: 32918377 DOI: 10.1111/ceo.13860] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 08/28/2020] [Accepted: 09/06/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Hassan Mansoor
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore.,Cornea and External Disease Service, Singapore National Eye Centre, Singapore.,Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
| | - Yu-Chi Liu
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore.,Cornea and External Disease Service, Singapore National Eye Centre, Singapore.,Ophthalmology Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore
| | - Marcus Ang
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore.,Cornea and External Disease Service, Singapore National Eye Centre, Singapore.,Ophthalmology Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore
| | - Jodhbir S Mehta
- Tissue Engineering and Cell Therapy Group, Singapore Eye Research Institute, Singapore.,Cornea and External Disease Service, Singapore National Eye Centre, Singapore.,Ophthalmology Academic Clinical Program, Duke-NUS Graduate Medical School, Singapore.,School of Material Science and Engineering, Nanyang Technological University, Singapore
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Afghani T, Mansoor H, Mughal AM, Asif M, Asif M, Hamdani NR. Spectrum of Biopsy Proven Extraocular Muscle Tumours of Non-Thyroid Origin. J Coll Physicians Surg Pak 2019; 29:553-557. [PMID: 31133156 DOI: 10.29271/jcpsp.2019.06.553] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Accepted: 01/08/2019] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To describe different types of primary extraocular muscle (EOM) tumours based on the results of imaging studies, peroperative clinical picture and their histopathological diagnosis. STUDY DESIGN Case series. PLACE AND DURATION OF STUDY Al-Shifa Trust Eye Hospital, Rawalpindi, from July 2001 to January 2017. METHODOLOGY A retrospective analysis of 640 diagnosed orbital tumours was carried out using non-randomised sampling technique, and the prevalence of primary EOM tumours was determined. Based on the results of imaging studies, the clinical picture observed during surgery (orbitotomy) and the histopathological diagnosis, primary EOM tumours were divided into different types, accordingly. RESULTS Nineteen (n=19) primary EOM tumours (frequency of 2.96%) had 12 types of histopathological diagnoses, and were categorised into inflammatory tumours (n=8, 42%), vascular tumours (n=4, 21%), lymphoproliferative tumours (n=3, 16%), neurogenic tumours (n=2, 10.5%) and myogenic tumours (n=2, 10.5%). The recti were involved more frequently than obliques (n=15, 78.94% and n=4, 21.06%, respectively). All the patients presented with proptosis of varying degree with some degree of globe rotation and had surgical excision/appropriate management. Visual acuity was not affected in any of the patients. Four (n=4, 21.05%) tumours were malignant (NHL, ASPS, myeloid sarcoma and rhabdomyosarcoma) and these patients underwent chemotherapy and/or radiotherapy. CONCLUSION Biopsy-proven primary EOM tumours were devisable into five broad categories. Patients with primary EOM tumours presented with proptosis and impaired ocular motiliy. The primary EOM tumours involved both the recti and the obliques and were excised surgically with favourable outcomes in most cases.
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Affiliation(s)
- Tayyab Afghani
- Department of Orbit and Oculoplastics, Al-Shifa Trust Eye Hospital, Jhelum Road, Rawalpindi, Pakistan
| | - Hassan Mansoor
- Department of Orbit and Oculoplastics, Al-Shifa Trust Eye Hospital, Jhelum Road, Rawalpindi, Pakistan
| | - Amna Manzoor Mughal
- Department of Orbit and Oculoplastics, Al-Shifa Trust Eye Hospital, Jhelum Road, Rawalpindi, Pakistan
| | - Mohammad Asif
- Department of Orbit and Oculoplastics, Al-Shifa Trust Eye Hospital, Jhelum Road, Rawalpindi, Pakistan
| | - Muhammad Asif
- Department of Histopathology, Armed Forces Institute of Pathology (AFIP), Rawalpindi, Pakistan
| | - Naeem Raza Hamdani
- Department of Histopathology, Armed Forces Institute of Pathology (AFIP), Rawalpindi, Pakistan
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Siddiqui SN, Hannan A, Mansoor H, Asif M, Wakeel U. Anisometropia and Refractive Status in Children with Bilateral Congenital Nasolacrimal Duct Obstruction. J Coll Physicians Surg Pak 2018; 28:210-213. [PMID: 29544578 DOI: 10.29271/jcpsp.2018.03.210] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 12/23/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To evaluate the state of refraction in children with bilateral congenital nasolacrimal duct obstruction (CNLDO). STUDY DESIGN Descriptive study. PLACE AND DURATION OF STUDY Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan, from April 2014 to April 2016. METHODOLOGY Children with bilateral CNLDO were studied. Patients' refractive status were evaluated by performing cycloplegic refraction, followed by appropriate management plan. The refractive errors of both eyes were noted and compared for any significant anisometropia. RESULTS One hundred and seventeen (n=117) children with median age (IQR) of 32 (12) months having bilateral CNLDO were enrolled. Children with bilateral CNLDO had insignificant interocular difference in terms of spherical equivalent (SE) and cylindrical refractive errors (p>0.05). The rate of the anisometropia (>1 D difference between the two eyes) was 5.98% (n=7) in children with bilateral CNLDO. CONCLUSION Performing cycloplegic refraction routinely in patients with bilateral CNLDO is not as urgent as compared to ones with unilateral CNLDO. Further, avoidance of early surgical intervention in children with bilateral CNLDO will spare the parents from the emotional trauma and positively influence the health economics worldwide.
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Affiliation(s)
| | - Abdul Hannan
- Department of Pediatric Ophthalmology, Al-Shifa Trust Eye Hospital, Rawalpindi
| | - Hassan Mansoor
- Department of Pediatric Ophthalmology, Al-Shifa Trust Eye Hospital, Rawalpindi
| | - Muhammad Asif
- Department of Public Health, Government College University, Faisalabad
| | - Umair Wakeel
- Department of Pediatric Ophthalmology, Al-Shifa Trust Eye Hospital, Rawalpindi
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Afghani T, Mansoor H, Raza Hamdani SN. Pediatric Orbital Primitive Neuroectodermal Tumors. J Pediatr Ophthalmol Strabismus 2018; 55:128-134. [PMID: 29131914 DOI: 10.3928/01913913-20170703-03] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 06/28/2017] [Indexed: 12/31/2022]
Abstract
PURPOSE To present the clinical, radiological, histopathological, immunohistochemical features and the follow-up of orbital primitive neuroectodermal tumors (PNETs) in pediatric patients along with a review of the literature. METHODS A retrospective analysis of all diagnosed cases of orbital PNET was done. Patients' ophthalmic findings, imaging, immunohistochemistry, metastatic work-up, treatment, globe salvation, and survival were documented and a mini literature review of orbital PNET was performed. RESULTS Four diagnosed cases of orbital PNET presented with proptosis and visual impairment were treated during the study period. The radiological imaging showed primary orbital involvement. There were three males and one female with a mean age of 63.75 months (range: 3 to 244 months). Histopathology of all studied patients showed round malignant cells with hyperchromatic nuclei, increased nuclear cytoplasmic ratio, and positive test results for CD99 and FLI-1. The studied patients underwent orbital surgery for excision of tumors followed by chemotherapy. One of the patients also had external radiation in addition to chemotherapy after a second recurrence. The follow-up period of these patients varied from 1 to 5 years. Only one child who had recurrence twice was followed up to 5 years, but was lost to follow-up after that. CONCLUSIONS The authors believe that most orbital peripheral PNET tumors present as well-defined masses on both imaging and perioperatively and are easily removed surgically. The apparently disguised "benign profile" of orbital PNET may prove deceptive and the shorter duration of symptoms remains a strong reminder of the malignant nature of the lesion. [J Pediatr Ophthalmol Strabismus. 2018;55(2):93-99.].
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Abstract
AIMS This study describes different types of orbital osteoma based on clinical per-operative morphology and radiological findings to facilitate communication between ophthalmologists and surgical management for a better patient outcome. MATERIALS AND METHODS The study was conducted in the Orbit and Oculoplastics Department of Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan, from July 1, 2001 to June 30, 2014. A retrospective analysis of 520 diagnosed orbital tumours who presented to us was carried out and the prevalence of orbital osteoma was determined. The sampling technique was non-randomized sampling. Based on the clinical morphology observed during surgical intervention as well as the radiological findings of the orbital osteoma, a simple yet useful description of orbital osteoma was introduced. RESULTS The retrospective analysis of 520 diagnosed orbital tumours revealed a prevalence of 2.3% (n = 12) of orbital osteoma. Based on our observation of the 12 (n = 12) cases of orbital osteoma, we have classified orbital osteoma into a combination of seven types: "sessile" or broad-based osteoma; "pedunculated" or mushroom osteoma with a thin cylindrical stalk of origin; "dumb-bell"-shaped osteoma with the simultaneous presence in orbital and adjoining sinus/nasal cavity; "wrapped" osteoma, covered by a thin cartilaginous layer; "naked" osteoma, without any such covering; "homogenous" or uniformly dense osteoma; and "heterogeneous", soft-dense osteoma with varying areas of density. CONCLUSION This study attempts to introduce a simple description of different types of orbital osteoma based on clinical per-operative morphology and radiological findings for the first time to facilitate the surgical removal of orbital osteoma.
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Afghani T, Mansoor H, Nadeem M. Preventing Long-Term Ocular Complications of Trachoma With Topical Azithromycin: A 3-Year Follow-up Study. Asia Pac J Ophthalmol (Phila) 2017; 6:8-12. [PMID: 28161923 DOI: 10.22608/apo.2015156] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 04/06/2016] [Indexed: 11/08/2022] Open
Abstract
PURPOSE To determine the role of a single cycle of topical azithromycin in preventing long-term trachoma complications in children from an area with endemic trachoma. DESIGN A longitudinal cohort study. METHODS Two hundred thirty-eight (n = 238) children with active trachoma were enrolled in the current study. They were aged 1 to 10 years, with trachomatous inflammation based on the simplified World Health Organization grading system. These children were identified out of a survey of 8600 children from 7 villages in Punjab, Pakistan, where trachoma was endemic. The studied patients with active trachoma were treated with a single regimen of azithromycin 1.5% eye drops, given twice daily for 3 days, and were followed up for 3 years. The long-term effects of this therapy were documented for the first time in an endemic area. RESULTS Two hundred fourteen children (90%) were present at 1-year follow-up with 10% dropout, and 178 (75%) were present at 3-year follow-up with 25% dropout. Of these, 23% and 11% had active trachoma at 1 and 3 years, respectively. Active trachoma was minimized from 100% at baseline to 11% at the end of 3 years. The reinfection rate was 4%. None of the patients developed trachoma-related ocular complications during the study period. CONCLUSIONS A single cycle of topical azithromycin can be used as an effective and safe option for treating active trachoma in children in endemic areas. This study also documented that a single cycle of topical azithromycin prevents trachoma-related ocular complications in an endemic area.
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Affiliation(s)
- Tayyab Afghani
- Department of Orbit and Oculoplastics, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
| | - Hassan Mansoor
- Department of Community Ophthalmology, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
| | - Mohammad Nadeem
- Department of Community Ophthalmology, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
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Abstract
PURPOSE To report a case of conjuctival leiomyoma. CASE REPORT An 18-year-old female patient presented with a conjunctival growth in the left eye for a 2-year-period with no change in size. She merely presented for cosmetic reasons. Visual acuity was 20/20 in each eye. The lesion had prominent vessels and was not adherent to the sclera. The growth resembled a benign lesion of the conjunctiva. The tough and vascular tissue was excised and sent for histopathology. The defect was covered by an end to end conjunctival suturing. Histopathology showed the lesion to be conjunctival leiomyoma. Trichome was used to highlight the spindle shaped cells and immuno-histochemistry using anti-smooth muscle actin antibody and Vimentin was applied to confirm the diagnosis. CONCLUSION This case adds to the total number of cases of conjuctival leiomyoma reported in the literature to date. An ophthalmologist needs to think beyond a common mass when encountering a conjunctival growth extending onto the cornea.
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Affiliation(s)
- Tayyab Afghani
- Department of Orbit and Oculoplastics, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
| | - Furqan Ahmed Khan
- Department of Orbit and Oculoplastics, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
| | - Hassan Mansoor
- Department of Orbit and Oculoplastics, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
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Afghani T, Mansoor H. Can a dermoid cyst lead to an abnormal origin of an extraocular muscle? Indian J Ophthalmol 2016; 64:676-678. [PMID: 27853019 PMCID: PMC5151161 DOI: 10.4103/0301-4738.194327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 5-year-old boy presented with a large 5 cm × 5 cm cyst covering the left eye completely since birth. The cyst was excised in toto and was sent for histopathological examination. During the surgery, the inferior oblique (IO) muscle was seen originating from medial orbital wall, 10-12 mm behind the medial orbital margin, just posterior to the lacrimal bone and moving laterally, downward, and posteriorly from its origin making a more acute angle - around 20° to its site of origin. The insertion of the IO to sclera was at its normal site. The abnormal origin of IO was confirmed later by magnetic resonance imaging. The ocular movements of the left eye were tested 2 weeks after the surgery and were found to be normal in all directions. However, the child was hypertrophic and amblyopic. The histopathological findings showed the orbital cyst to contain dermal elements, respiratory, and intestinal epithelium.
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Affiliation(s)
- Tayyab Afghani
- Department of Orbit and Oculoplastics, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
| | - Hassan Mansoor
- Department of Orbit and Oculoplastics, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
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Shirodkar S, Anande L, Dalal A, Desai C, Corrêa G, Das M, Laxmeshwar C, Mansoor H, Remartinez D, Trelles M, Isaakidis P. Surgical interventions for pulmonary tuberculosis in Mumbai, India: surgical outcomes and programmatic challenges. Public Health Action 2016; 6:193-198. [PMID: 27695683 DOI: 10.5588/pha.16.0043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 08/03/2016] [Indexed: 11/10/2022] Open
Abstract
Setting: While surgery for pulmonary tuberculosis (PTB) is considered an important adjunct for specific cases, including drug-resistant tuberculosis, operational evidence on its feasibility and effectiveness is limited. Objective: To describe surgical outcomes and programmatic challenges of providing surgery for PTB in Mumbai, India. Design: A descriptive study of routinely collected data of surgical interventions for PTB from 2010 to 2014 in two Mumbai hospitals, one public, one private. Results: Of 85 patients, 5 (6%) died and 17 (20%) had complications, with wound infection being the most frequent. Repeat operation was required in 12 (14%) patients. Most procedures were performed on an emergency basis, and eligibility was established late in the course of treatment. Median time from admission to surgery was 51 days. Drug susceptibility test (DST) patterns and final treatment outcomes were not systematically collected. Conclusion: In a high-burden setting such as Mumbai, important data on surgery for PTB were surprisingly limited in both the private and public sectors. Eligibility for surgery was established late, culture and DST were not systematically offered, the interval between admission and surgery was long and TB outcomes were not known. Systematic data collection would allow for proper evaluation of surgery as adjunctive therapy for all forms of TB under programmatic conditions.
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Affiliation(s)
- S Shirodkar
- Chest Department, GTB Hospital, Sewri, Mumbai, India
| | - L Anande
- Chest Department, GTB Hospital, Sewri, Mumbai, India
| | - A Dalal
- Chest Department, Jupiter Hospital, Thane, India
| | - C Desai
- Chest Department, GTB Hospital, Sewri, Mumbai, India
| | - G Corrêa
- Médecins Sans Frontières (MSF), Operational Research, Mumbai, India
| | - M Das
- Médecins Sans Frontières (MSF), Operational Research, Mumbai, India
| | - C Laxmeshwar
- Médecins Sans Frontières (MSF), Operational Research, Mumbai, India
| | - H Mansoor
- Médecins Sans Frontières (MSF), Operational Research, Mumbai, India
| | - D Remartinez
- Médecins Sans Frontières (MSF), Operational Research, Mumbai, India
| | - M Trelles
- Medical Department, MSF, Brussels, Belgium
| | - P Isaakidis
- Médecins Sans Frontières (MSF), Operational Research, Mumbai, India
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Das M, Isaakidis P, Van den Bergh R, Kumar AMV, Sharath BN, Mansoor H, Saranchuk P. Treating all multidrug-resistant tuberculosis patients, not just bacteriologically confirmed cases. Public Health Action 2016; 6:157. [DOI: 10.5588/pha.16.0023] [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: 11/10/2022] Open
Affiliation(s)
- M. Das
- Médecins Sans Frontières (MSF) Operations Centre Brussels (OCB), New Delhi, India
| | - P. Isaakidis
- Médecins Sans Frontières (MSF) Operations Centre Brussels (OCB), New Delhi, India
| | | | - A. M. V. Kumar
- International Union Against Tuberculosis and Lung Disease, South-East Asia Regional Office, New Delhi, India
| | | | - H. Mansoor
- Médecins Sans Frontières (MSF) Operations Centre Brussels (OCB), New Delhi, India
| | - P. Saranchuk
- Southern Africa Medical Unit, MSF, Cape Town, South Africa
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Siddiqui SN, Mansoor H, Asif M, Wakeel U, Saleem AA. Comparison of Anisometropia and Refractive Status in Children With Unilateral and Bilateral Congenital Nasolacrimal Duct Obstruction. J Pediatr Ophthalmol Strabismus 2016; 53:168-72. [PMID: 27224951 DOI: 10.3928/01913913-20160405-06] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 02/04/2016] [Indexed: 11/20/2022]
Abstract
PURPOSE To evaluate and compare the refractive state in children diagnosed as having unilateral or bilateral congenital nasolacrimal duct obstruction (CNLDO). This study also compares how the laterality of CNLDO affects the refractive state of the patients. METHODS This descriptive cross-sectional study includes consecutive children with unilateral and bilateral CNLDO over a period of 1 year. Cycloplegic refraction was performed on each child who presented with CNLDO followed by appropriate plans for treatment. The refractive errors of patients with unilateral and bilateral CNLDO were compared. RESULTS One hundred sixty-one patients with unilateral CNLDO (mean age: 29 ± 19.93 months) and 46 with bilateral CNLDO (mean age: 30 ± 16.21 months) were enrolled from August 2013 to July 2014. The rate of the anisometropia (≥ 1 diopters [D] difference between the two eyes) was 13.7% (n = 22) and 8.6% (n = 4) in patients with unilateral and bilateral CNLDO, respectively. Interocular difference was significant in terms of spherical equivalent (P < .01) but not cylindrical refractive error in patients with unilateral CNLDO. Patients with bilateral CNLDO had insignificant interocular differences in terms of spherical equivalent and cylindrical refractive errors (P > .05). CONCLUSIONS Unilateral CNLDO is associated with statistically significant anisometropia compared to bilateral CNLDO, which predisposes children with unilateral CNLDO to amblyopia. It is vital to perform cycloplegic refraction routinely and counsel parents regarding regular follow-ups. [J Pediatr Ophthalmol Strabismus. 2016;53(3):168-172.].
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Qureshi NA, Mansoor H, Ahmad S, Zafar S, Asif M. Reducing intraocular-pressure spike after intravitreal-bevacizumab injection with ocular decompression using a sterile cotton swab soaked in proparacaine 0.5%: A quasi-experimental study. Taiwan J Ophthalmol 2016; 6:75-78. [PMID: 29018715 PMCID: PMC5602693 DOI: 10.1016/j.tjo.2015.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 12/13/2015] [Accepted: 12/29/2015] [Indexed: 11/24/2022] Open
Abstract
Background/Purpose: The study was conducted to determine the effect of preinjection ocular decompression by a cotton swab soaked in local anesthetic on the immediate postinjection rise in intraocular pressure (IOP) after intravitreal bevacizumab (IVB). Methods: A nonrandomized, quasi-experimental interventional study was conducted at Al-Shifa Trust Eye Hospital, Pakistan, from August 1, 2013 to July 31, 2014. One hundred (n = 100) patients receiving 0.05-mL IVB injection for the first time were assigned to two preinjection anesthetic methods: one with ocular decompression using a sterile cotton swab soaked in proparacaine 0.5%, and the other without ocular decompression using proparacaine 0.5% eyedrops. The IOP was recorded in the eye receiving IVB at three time intervals: Time 1 (preinjection), Time 2 (immediately after injection), and Time 3 (30 minutes after injection). Results: There was a significant difference in the mean IOP change (between Time 1 and Time 2) for the group injected with ocular decompression [M = 1.00, standard deviation (SD) = 1.47] and the group injected without ocular decompression (M = 5.00, SD = 2.38; t (68) = 9.761, p < 0.001). There was also a significant difference in the mean IOP change (between Time 1 and Time 3) for the group injected with ocular decompression (M = 0.428, SD = 1.58) and the group injected without ocular decompression (M = 4.318, SD = 3.34; t (58) = 7.111, p < 0.001). Conclusion: Patients receiving IVB injections with ocular-decompression soaking in proparacaine 0.5% experience significantly lower postinjection IOP spike, and that too for a considerably shorter duration as compared to those receiving IVB without ocular decompression.
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Affiliation(s)
- Naveed A. Qureshi
- Department of Vireo-Retina, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
| | - Hassan Mansoor
- Department of Vireo-Retina, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
- Corresponding author. Department of Vitreo-Retina, Al-Shifa Trust Eye Hospital, Jhelum Road, Rawalpindi, Pakistan. E-mail address: (H. Mansoor)
| | - Sabihuddin Ahmad
- Department of Vireo-Retina, Combined Military Hospital, Rawalpindi, Pakistan
| | - Sarah Zafar
- Department of Vireo-Retina, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
| | - Muhammad Asif
- Department of Vireo-Retina, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
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Shenoy R, Das M, Mansoor H, Anicete R, Wangshu L, Meren S, Ao I, Saranchuk P, Reid AJ, Isaakidis P. Double trouble: tuberculosis and substance abuse in Nagaland, India. Public Health Action 2015; 5:180-2. [PMID: 26399288 DOI: 10.5588/pha.15.0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 06/12/2015] [Indexed: 11/10/2022] Open
Abstract
The diagnosis and treatment of tuberculosis (TB) in people who use and/or inject illicit drugs (PWUIDs) remains a barrier to achieving universal coverage for TB in India and globally. This report describes treatment outcomes in PWUIDs who received treatment for drug-susceptible TB at the Mon District Hospital in Nagaland, India, during 2012-2013. The median age of the patients was 39 years, and most (92%) were male. Two thirds (33/49) of the patients had a successful TB treatment outcome. A previous TB episode and residence in a semi-urban area were associated with unsuccessful treatment outcomes. Separate diagnostic and treatment algorithms, including regular adherence counselling and opioid substitution therapies, should be considered for PWUIDs.
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Affiliation(s)
- R Shenoy
- Médecins Sans Frontières, Mon, Nagaland, India
| | - M Das
- Médecins Sans Frontières, Mon, Nagaland, India
| | - H Mansoor
- Médecins Sans Frontières, Mon, Nagaland, India
| | - R Anicete
- Médecins Sans Frontières, Mon, Nagaland, India
| | - L Wangshu
- Médecins Sans Frontières, Mon, Nagaland, India
| | - S Meren
- Evergreen Welfare Society, Mon, Nagaland, India
| | - I Ao
- District TB Control Office, Revised National TB Control Programme, Mon, Nagaland, India
| | - P Saranchuk
- Southern Africa Medical Unit, Médecins Sans Frontières, Cape Town, South Africa
| | - A J Reid
- Médecins Sans Frontières, Operational Research Unit, Luxembourg city, Luxembourg
| | - P Isaakidis
- Médecins Sans Frontières, Mon, Nagaland, India ; Médecins Sans Frontières, Operational Research Unit, Luxembourg city, Luxembourg
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Mansoor H, Afghani T, Shehzad W. Microphthalmos, orbital cyst, and missing thumbs: A rare case report. Oman J Ophthalmol 2015; 8:194-7. [PMID: 26903731 PMCID: PMC4738670 DOI: 10.4103/0974-620x.169901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
A 5-month-old girl was presented to us with a right orbital cyst covering a microphthalmic eye, absent digits (thumbs) in both hands, and absence of right radius and left kidney. The hematological profile of the patient was within normal limits. The patient had a family history of leukemia and the chromosomal analysis was suggestive of Fanconi's anemia (FA). The cyst was excised in toto and sent for histopathology. To the best of our knowledge, this is the first case report of an orbital cyst covering a microphthalmic eye in a patient with FA. This case report also stresses the fact that FA can be missed by ophthalmologists in the patients with congenital microphthalmos and missing thumbs and efforts should be made to avoid doing so.
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Afghani T, Mansoor H, Kiani SA, Mirza MA. Prevalence of eyelid lesions in cutaneous leishmaniasis in Pakistan. Community Eye Health 2015; 28:S01-3. [PMID: 26989327 PMCID: PMC4790178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Affiliation(s)
- Tayyab Afghani
- Professor and Head: Department of Orbit and Oculoplastics, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
| | - Hassan Mansoor
- Registrar: Department of Orbit and Oculoplastics, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan,
| | - Sultan A Kiani
- Associate professor: Department of Orbit and Oculoplastics, Al-Shifa Trust Eye Hospital, Rawalpindi, Pakistan
| | - Mukhtar A Mirza
- Medical superintendent: Mines Labor Welfare Hospital, Chakwal, Pakistan
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Khan Assir MZ, Kamran U, Ahmad HI, Bashir S, Mansoor H, Anees SB, Akram J. Effectiveness of platelet transfusion in dengue Fever: a randomized controlled trial. ACTA ACUST UNITED AC 2013; 40:362-8. [PMID: 24273491 DOI: 10.1159/000354837] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [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: 05/31/2012] [Accepted: 12/13/2012] [Indexed: 11/19/2022]
Abstract
BACKGROUND Scientific data regarding effects of platelet transfusion on platelet count in dengue-related thrombocytopenia is scanty. METHODS A single center, randomized non-blinded trial was conducted on adult patients with dengue fever and platelet counts less than 30,000/μl. Patients were randomized to treatment and control group. Treatment group received single donor platelets. Patients with post-transfusion platelet increment (PPI) ≥10,000/μl and/or corrected count increment (CCI) ≥5,000/μl 1 h post-transfusion were considered responders. Primary outcome was platelet count increments at 24 and 72 h. RESULTS 87 patients were enrolled, and 43 (48.2%) received platelet transfusion. Mean PPI and CCI at 1 h post-transfusion in the treatment group were 18,800/μl and 7,000/μl respectively. 22 (53.6%) patients in the treatment group were non-responders. Mean platelet increments at 24 and 72 h were higher in the treatment group as compared to the control group. Responders showed significantly higher increments when compared to non-responders and the control group at 24 h (p = 0.004 and p ≤ 0.001, respectively) and 72 h (p = 0.001 and p ≤ 0.001, respectively). Significant differences were found between non-responders and the control group at 24 h (p ≤ 0.001), but not at 72 h (p = 0.104). Patients with lower baseline platelet count were more likely to be non-responders. Platelet transfusion neither prevented development of severe bleeding nor shortened time to cessation of bleeding. Three severe transfusion reactions and two deaths occurred in treatment group. CONCLUSION In this trial, almost half the patients showed no response to a high-dose platelet transfusion. Platelet transfusion did not prevent development of severe bleeding or shorten time to cessation of bleeding and was associated with significant side effects. Therefore, platelet transfusion should not be routinely done in the management of dengue fever.
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Assir M, Mansoor H, Waseem T, Ahmed H, Bukhari S, Akram J. Effect of papaya leaf extract on platelet count in dengue fever: a randomized controlled trial (PLEAD Trial). Int J Infect Dis 2012. [DOI: 10.1016/j.ijid.2012.05.686] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Ndakidemi PA, Dakora FD, Nkonya EM, Ringo D, Mansoor H. Yield and economic benefits of common bean (Phaseolus vulgaris) and soybean (Glycine max) inoculation in northern Tanzania. ACTA ACUST UNITED AC 2006. [DOI: 10.1071/ea03157] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
On-farm experiments were conducted in farmers’ fields at 12 different sites in the 2 districts of Moshi and Rombo in northern Tanzania during the 2000–01 cropping season to study the effects of (brady)rhizobial inoculation in combination with P supply on growth and grain yields of soybean and common bean, and to assess the economic returns of these different technologies to farmers. A low level of N was included as an indicator of endogenous soil N status. The treatments included (brady)rhizobial inoculation, N fertilisation (30 kg N/ha as urea), P application [26 kg P/ha as triple super phosphate (TSP)], (brady)rhizobial inoculation + P fertilisation (26 kg/ha as TSP) and unfertilised uninoculated control. The study was conducted as a randomised complete block design with each of the 12 farmers’ fields as a replicate. At harvest, plant growth of soybean and common bean was significantly (P≤0.05) greater with (brady)rhizobial inoculation compared with N and P supply or uninoculated control in the 2 districts. Relative to uninoculated unfertilised plots, grain yields of common bean were markedly (P≤0.05) increased by 60–78% from inoculation alone, and 82–95% from inoculation + 26 kg P/ha; with soybean there was 127–139% increase in grain yield from inoculation alone, and 207–231% from inoculation + P. Thus, the combined application of bacterial inoculants and P fertiliser to field plants of soybean and common bean significantly (P≤0.05) increased biomass production and grain yield compared with the single use of N and P or (brady)rhizobial strains. From economic analysis, the increase in grain yield with inoculation translated into a significantly (P≤0.05) higher marginal rate of return and dollar profit for soybean and common bean farmers in northern Tanzania. With common bean, there was a 66 and 92% increase, respectively, in dollar profit with inoculation at Moshi and Rombo districts respectively relative to control; these profit margins rose to 84 and 102% with provision of supplemental P (26 kg P/ha). With soybean, however, the increase in profit with inoculation was much larger, about 140 and 153% at Rombo and Moshi, respectively, and these rose to 224 and 250% with P supply.
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