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Muzaffar T, Danial A, Ahmed MK. Correspondence on 'Acute ischemic stroke outcomes in patients with COVID-19: a systematic review and meta-analysis' by Ferrone et al. J Neurointerv Surg 2024; 16:431-432. [PMID: 37586817 DOI: 10.1136/jnis-2023-020868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/18/2023]
Affiliation(s)
- Tayyab Muzaffar
- Department of Neurology, Quaid-e-Azam Medical College, Islamabad, Pakistan
- Quaid-e-Azam Medical College, Bahawalpur, Pakistan
| | - Ahmad Danial
- Quaid-e-Azam Medical College, Bahawalpur, Pakistan
| | - Muhammad Khaleeq Ahmed
- Department of Neurology, Augusta University, Rome, Georgia, USA
- Department of Neurology, Medical College of Georgia, Augusta, Georgia, USA
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Fatima L, Danial A, Ali MZ. Is A Therapeutic Approach Required To Treat Insomnia In Pakistan? J PAK MED ASSOC 2023; 73:2311. [PMID: 38013567 DOI: 10.47391/jpma.8622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2023]
Abstract
Insomnia, defined as difficulty falling or staying asleep, is prevalent among one-third of the general population. (1) It can give rise to various physical and mental problems, such as obesity, diabetes, anxiety, and depression. (2) While there are many effective medications for insomnia, a therapeutic approach for treating it is more likely to be dependable over time. A meta-analysis exploring the benefits of cognitive behavioural therapy (CBT) for chronic insomnia revealed an improvement of sleep onset latency by 19.03 minutes, a gain of total sleep time by 7.61 minutes, and improved sleep efficiency by 9.91%. (3)CBT has been recognized as a first-line treatment for insomnia by NIH Consensus and State of the Science Statements (4)as it is equally effective as medication for a brief treatment and is more reliable over time.
One in every three persons in Pakistan is reported to have sleep problems and, a third of those take sleeping pills. (5)In developing countries like Pakistan, where people don't have resources, a therapeutic approach is likely to reduce the cost and risk of adverse effects of medications. Pakistan is a pill-oriented society, and people prefer pills over therapy. The awareness among the population to adopt treatments or shift to therapeutic interventions is close to none. The cultural stigma associated with therapy is a significant hurdle as well. Unlike medicines, therapy reduces the risk of relapse after its discontinuation. Introducing therapy in the public sector can result in more jobs for therapists and counsellors and provide a cheaper alternative to pills. The best way to introduce CBT among the population is through awareness campaigns, media, and discussions on public platforms. In addition, counsellors can provide outreach in places where additional resources are required to combat the stigma associated with psychotherapy and inform people regarding its benefits. Counsellors collaborating with other health care professionals and gaining a valuable referral source from primary care physicians can also be a meaningful strategy. It would be worth mentioning here that more studies comparing the pills to CBT should be conducted to address the issue.
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Affiliation(s)
- Laveeza Fatima
- 3rd Year MBBS Student, Allama Iqbal Medical College, Lahore, Pakistan
| | - Ahmad Danial
- Quaid-e-Azam Medical College, Bahawalpur, Pakistan
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Mumtaz M, Jabeen S, Danial A, Chaychi MTM, Zaheer MK, Mumtaz A, Mumtaz T, Herweg B. Adjunct posterior wall isolation reduces the recurrence of atrial fibrillation in patients undergoing cryoballoon ablation: A systematic review and meta-analysis. J Cardiovasc Electrophysiol 2023; 34:2043-2052. [PMID: 37526224 DOI: 10.1111/jce.16028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 07/03/2023] [Accepted: 07/22/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Recurrence rates of atrial fibrillation (AF) remain high even after complete wide area circumferential pulmonary vein isolation (PVI). In recent years adjunct posterior wall isolation (PWI) has been performed in patients with more persistent forms of AF but the benefits remain unclear. AIM The objective of this meta-analysis was to evaluate the efficacy of adjunct posterior wall isolation in reducing recurrence rates of AF using cryoballoon ablation (CBA). METHODS We searched PubMed, Google Scholar, Clinicaltrials.gov and Cochrane CENTRAL. We included studies comparing PVI to PVI + PWI in patients with either persistent or paroxysmal AF (PAF) undergoing CBA. After data extraction and quality assessment of the studies, we assessed recurrence rates of atrial tachy-arrhythmias (AF, atrial flutter, and atrial tachycardia) as well as total ablation time and procedural adverse events. Risk ratio (RR), mean difference (MD), and 95% confidence interval (CI) were calculated using Review Manager. RESULTS Concomitant PWI exhibited a substantial reduction in the risk of AF recurrence (RR: 0.51; 95% CI: 0.42-0.63, p < .00001), as well as all atrial arrhythmias (RR: 0.58; 95% CI: 0.49-0.68, p < .00001). On subgroup analysis, in patients with only PAF, adjunct PWI resulted in significant reduction in recurrence risk of AF (RR: 0.56; 95% CI: 0.41-0.76, p = .0002) as well. There was no significant difference in adverse events between both groups (RR: 0.90; 95% CI: 0.44-1.86; p = .78), whereas total ablation time was significantly increased in PVI + PWI group (MD: 21.75; 95% CI: 11.13-32.37, p < .0001). CONCLUSION Adjunct PWI when compared to PVI alone decreases recurrence rates of atrial fibrillation after CBA of patients with persistent as well as paroxysmal atrial fibrillation.
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Affiliation(s)
- Mishal Mumtaz
- Department of medicine, Quaid-e-Azam Medical College Bahawalpur, Affiliated with University of Health Sciences Lahore, Lahore, Pakistan
| | - Sidra Jabeen
- Department of medicine, Liaquat National Hospital and Medical College, Affiliated with Jinnah Sindh Medical University Karachi, Karachi, Pakistan
| | - Ahmad Danial
- Department of medicine, Quaid-e-Azam Medical College Bahawalpur, Affiliated with University of Health Sciences Lahore, Lahore, Pakistan
| | - Muhammad Tayyab Muzaffar Chaychi
- Department of medicine, Quaid-e-Azam Medical College Bahawalpur, Affiliated with University of Health Sciences Lahore, Lahore, Pakistan
| | - Muhammad Kashan Zaheer
- Department of medicine, Liaquat National Hospital and Medical College, Affiliated with Jinnah Sindh Medical University Karachi, Karachi, Pakistan
| | - Aymen Mumtaz
- Department of medicine, CMH Lahore Medical and Dental College, Affiliated with National University of Medical Sciences, Pakistan
| | - Tayebah Mumtaz
- Department of Cardiovascular, St. Elizabeth's Medical Centre, Boston, Massachusetts, USA
| | - Bengt Herweg
- Division of Cardiovascular Sciences, University of South Florida Morsani College of Medicine, Heart & Vascular Institute, Tampa General Hospital, Tampa, Florida, USA
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Fatima K, Ur Rehman MA, Asmar A, Farooq H, Ahmad NUS, Danial A, Ur Rehman ME, Khan AA, Tahir S, Ahmed U, Zubair S, Khawaja A. The efficacy of antifibrinolytic therapy in aneurysmal subarachnoid hemorrhage: a systematic review and meta-analysis. Future Sci OA 2023; 9:FSO866. [PMID: 37228855 PMCID: PMC10203907 DOI: 10.2144/fsoa-2023-0014] [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: 02/06/2023] [Accepted: 05/03/2023] [Indexed: 05/27/2023] Open
Abstract
Aim The efficacy of antifibrinolytics in subarachnoid hemorrhage remains unclear due to conflicting evidence from studies. Materials & methods Online databases were queried to include randomized controlled trials and propensity matched observational studies. We used Review Manager for the statistical analysis, presenting results as odds ratios with 95% CI. Results The 12 shortlisted studies included 3359 patients, of which 1550 (46%) were in the intervention (tranexamic acid) group and 1809 (54%) in the control group. Antifibrinolytic therapy significantly reduced the risk of rebleeding (OR: 0.55; 95% CI: 0.40-0.75; p = 0.0002) with no significant decrease in poor clinical outcome (OR: 1.02; 95% CI: 0.86-1.20; p = 0.85) and all-cause mortality (OR: 0.92; CI: 0.72-1.17; p = 0.50). Conclusion In patients with subarachnoid hemorrhage, antifibrinolytics reduce the risk of rebleeding without significantly affecting mortality or clinical outcomes.
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Affiliation(s)
- Kaneez Fatima
- Dow University of Health Sciences, Mission Rd, New Labour Colony Nanakwara, Karachi, Sindh, 74200, Pakistan
| | | | - Abyaz Asmar
- Mayo Hospital, King Edward Medical University, Neela Gumbad Chowk Anarkali, Lahore, 54000, Pakistan
| | - Hareem Farooq
- Mayo Hospital, King Edward Medical University, Neela Gumbad Chowk Anarkali, Lahore, 54000, Pakistan
| | - Noor-Us-Sabah Ahmad
- Mayo Hospital, King Edward Medical University, Neela Gumbad Chowk Anarkali, Lahore, 54000, Pakistan
| | - Ahmad Danial
- Quaid-e-Azam Medical College, Bahawalpur, 63100, Pakistan
| | | | - Abdullah Ali Khan
- Mayo Hospital, King Edward Medical University, Neela Gumbad Chowk Anarkali, Lahore, 54000, Pakistan
| | - Sidra Tahir
- Mayo Hospital, King Edward Medical University, Neela Gumbad Chowk Anarkali, Lahore, 54000, Pakistan
| | - Umair Ahmed
- Mayo Hospital, King Edward Medical University, Neela Gumbad Chowk Anarkali, Lahore, 54000, Pakistan
| | - Salman Zubair
- St Anthony Hospital, 1000 N Lee Ave, Oklahoma City, OK 73102, USA
| | - Ayaz Khawaja
- Wayne State University, 540 E Canfield St, Detroit, MI 48201, USA
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Danial A, Fatima L, Bosan MF. The impact of cognitive impairment resulting from traumatic brain injury on health-related quality of life (HRQOL) in Pakistan. J PAK MED ASSOC 2023; 73:1559. [PMID: 37469087 DOI: 10.47391/jpma.8621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Madam,
Millions of people are affected by traumatic brain injury (TB) across the world each year. Road traffic accidents (RTAs) are among the top contributors of mild to severe TBI cases, and in developing countries like Pakistan, low literacy rates and lack of awareness regarding traffic rules have further aggravated the situation.(1) Many survivors of RTAs never return to their normal life and are made to live with persistent disabilities. The limitation of knowledge regarding post-TBI cognitive impairment has been noted, and it further adds a barrier to necessary actions. It's evident that following mild to moderate TBI, the patients are prone to cognitive impairment and its associated adverse effects.(2)
A recent 2019 study by Gorgoraptis et al. reported that cognitive impairment adversely effects health-related quality of life (HRQOL) following TBI.(3) In Pakistan’s already struggling healthcare system, there are a few emergency trauma centres with neurocritical care units in it. Another study indicates that TBI patients are not assessed by an experienced doctor most of the time, with poor reporting of the clinical findings and hence missing out on an important finding in such patients. (4) Computed Tomography (CT) scans for critical patients are available only in large centres and patient load, and cost of investigation can hinder to its timely availability for most TBI patients. Post TBI cognitive impairment can cause a significant burden on the healthcare system leading to other social implications as well. The patients are discharged once they get stabilized with no proper follow-up plans which can lead to other avoidable cognitive impairments like dementia, psychiatric problems, and behavioural changes.
In TBI cases, risk assessment and more advanced investigations like MRI can be provided to the patients who suspected of any finding missed on a CT scan. Furthermore, TBI guidelines need to be reviewed and planned accordingly. A psychiatric team must assess patient’s mental status changes during the stay and if needed proper therapy must be initiated. Neuropsychological rehabilitation plays a pivotal role in cognitive impairments and can help decrease the burden of neurological diseases (5) and improves HRQOL of patients. Hence, a unified and interdisciplinary approach towards patients with traumatic brain injury is required so that not only can mortality be reduced but also to better the quality of life in survivors.
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Affiliation(s)
- Ahmad Danial
- Quaid-e-Azam Medical College, Bahawalpur, Pakistan
| | - Laveeza Fatima
- 3rd Year MBBS Student, Allama Iqbal Medical College, Lahore, Pakistan
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Abstract
Cryptococcosis is the most common fungal disease in HIV-infected persons. It is known as the AIDS-defining illness for 60-70% of HIV-infected patients. Before antiretroviral therapy (ARV) was discovered, fungal and other opportunistic infections were a major problem for people with advanced HIV/AIDS. Presented here is a case of a 43-year-old man who was newly diagnosed HIV, in which he was admitted due to shortness of breath and decreased consciousness. His clinical symptoms, physical examination, laboratory and radiologic findings indicated a Cryptococcus neoformans infection. The patient had received treatment using anti-fungal and ARV that showed a clinical improvement during observation.
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Affiliation(s)
- Bramantono Bramantono
- Tropical and Infectious Disease Division, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Teaching Hospital, Surabaya, East Java, Indonesia
| | - Ahmad Danial
- Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Teaching Hospital, Surabaya, East Java, Indonesia
| | - Usman Hadi
- Tropical and Infectious Disease Division, Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Teaching Hospital, Surabaya, East Java, Indonesia.,Department of Internal Medicine, Faculty of Medicine, Universitas Airlangga, Dr. Soetomo Teaching Hospital, Surabaya, East Java, Indonesia
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Elsamadony M, Tawfik A, Danial A, Suzuki M. Use of Carica Papaya Enzymes for Enhancement of H2 Production and Degradation of Glucose, Protein, and Lipids. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.egypro.2015.07.308] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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