1
|
Akharume O, Ojeniyi S, Naqvi HA. Systemic Amyloid A Protein Amyloidosis With Gastrointestinal Involvement. ACG Case Rep J 2024; 11:e01311. [PMID: 38560020 PMCID: PMC10980407 DOI: 10.14309/crj.0000000000001311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2023] [Accepted: 02/23/2024] [Indexed: 04/04/2024] Open
Abstract
Systemic amyloidosis is a multiorgan deposition of misfolded amyloid protein fibrils. The systemic amyloid A protein (AA) amyloidosis type predominantly involves the kidney and is mostly an under-recognized complication among persons who inject drugs. Gastrointestinal involvement in systemic AA amyloidosis that is associated with illicit drug use is uncommon. In this report, we present a case of a 40-year-old man with history of injection drug use, recurrent skin and soft-tissue infection, and renal AA amyloidosis that presented with painless bloody bowel movement, which initially resolved with conservative management. Upon further evaluation, the patient was found to have empyema that required antibiotic therapy and bilateral pleural drain. His hospital course was further complicated by multiple episodes of hematochezia requiring gastrointestinal consultation. Subsequent gastrointestinal biopsy revealed amyloid deposit.
Collapse
Affiliation(s)
- Olubunmi Akharume
- Department of Medicine, Medstar Union Memorial Hospital and Medstar Franklin Square Medical Center, Baltimore, MD
| | - Solabomi Ojeniyi
- Department of Medicine, Medstar Union Memorial Hospital and Medstar Franklin Square Medical Center, Baltimore, MD
| | - Haider A. Naqvi
- Department of Medicine, Medstar Union Memorial Hospital and Medstar Franklin Square Medical Center, Baltimore, MD
| |
Collapse
|
2
|
Qurashi I, Chaudhry IB, Khoso AB, Omair Husain M, Hafeez D, Kiran T, Lane S, Naqvi HA, Minhas FA, Tamizuddin Nizami A, Razzaque B, Qambar Bokhari S, Yung AR, Deakin B, Husain N. A randomised double-blind placebo-controlled trial of minocycline and/or omega-3 fatty acids added to treatment as usual for at risk Mental States: The NAYAB study. Brain Behav Immun 2024; 115:609-616. [PMID: 37924960 DOI: 10.1016/j.bbi.2023.10.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Revised: 10/03/2023] [Accepted: 10/28/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Inflammatory mechanisms are thought to contribute to the onset of psychosis in persons with an at-risk mental state (ARMS). We investigated whether the anti-inflammatory properties of minocycline and omega-3 polyunsaturated fatty acids (omega-3), alone or synergistically, would prevent transition to psychosis in ARMS in a randomised, double-blind, placebo-controlled trial in Pakistan. METHODS 10,173 help-seeking individuals aged 16-35 years were screened using the Prodromal Questionaire-16. Individuals scoring 6 and over were interviewed using the Comprehensive Assessment of At-Risk Mental States (CAARMS) to confirm ARMS. Participants (n = 326) were randomised to minocycline, omega-3, combined minocycline and omega-3 or to double placebo for 6 months. The primary outcome was transition to psychosis at 12 months. FINDINGS Forty-five (13.8 %) participants transitioned to psychosis. The risk of transition was greater in those randomised to omega-3 alone or in combination with minocycline (17.3.%), compared to 10.4 % in those not exposed to omega-3; a risk-ratio (RR) of 1.67, 95 % CI [0.95, 2.92] p = 0.07. The RR for transitions on minocycline vs. no minocycline was 0.86, 95 % CI [0.50, 1.49] p > 0.10. In participants who did not become psychotic, CAARMS and depression symptom scores were reduced at six and twelve months (mean CAARMS difference = 1.43; 95 % CI [0.33, 1.76] p < 0.01 in those exposed to omega-3. Minocycline did not affect CAARMS or depression scores. INTERPRETATION In keeping with other studies, omega-3 appears to have beneficial effects on ARMS and mood symptom severity but it increased transition to psychosis, which may reflect metabolic or developmental consequences of chronic poor nutrition in the population. Transition to psychosis was too rare to reveal a preventative effect of minocycline but minocycline did not improve symptom severity. ARMS symptom severity and transition to psychosis appear to have distinct pathogeneses which are differentially modulated by omega-3 supplementation. FUNDING The study was funded by the Stanley Research Medical Institute.
Collapse
Affiliation(s)
- Inti Qurashi
- Institute of Population Health, University of Liverpool, Liverpool, UK; Mersey Care NHS Foundation Trust, Prescott, UK
| | - Imran B Chaudhry
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK; Department of Psychiatry, Ziauddin University, Karachi, Pakistan; Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Ameer B Khoso
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Muhammad Omair Husain
- Centre for Addiction and Mental Health, Toronto, Canada; Department of Psychiatry, University of Toronto, Toronto, Canada
| | | | - Tayyeba Kiran
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Steven Lane
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | - Haider A Naqvi
- Department of Psychiatry, Dow University of Health Sciences, Karachi, Pakistan
| | - Fareed A Minhas
- Institute of Psychiatry, Rawalpindi Medical University, Rawalpindi, Pakistan
| | | | - Bushra Razzaque
- Institute of Psychiatry, Rawalpindi Medical University, Rawalpindi, Pakistan
| | - Sumira Qambar Bokhari
- Department of Psychiatry & Behavioural Sciences, Services Institute of Medical Sciences, Lahore, Pakistan
| | - Alison R Yung
- Centre for Youth Mental Health, The University of Melbourne, Parkville, Victoria, Australia; Orygen, Parkville, Victoria, Australia
| | - Bill Deakin
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, University of Manchester, Manchester, UK.
| | - Nusrat Husain
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK; Mersey Care NHS Foundation Trust, Prescott, UK
| |
Collapse
|
3
|
Husain MO, Khoso AB, Kiran T, Chaudhry N, Husain MI, Asif M, Ansari M, Rajput AH, Dawood S, Naqvi HA, Nizami AT, Tareen Z, Rumi J, Sherzad S, Khan HA, Bhatia MR, Siddiqui KMS, Zadeh Z, Mehmood N, Talib U, de Oliveira C, Naeem F, Wang W, Voineskos A, Husain N, Foussias G, Chaudhry IB. Culturally adapted psychosocial interventions (CaPSI) for early psychosis in a low-resource setting: study protocol for a large multi-center RCT. BMC Psychiatry 2023; 23:444. [PMID: 37328751 PMCID: PMC10276384 DOI: 10.1186/s12888-023-04904-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 05/26/2023] [Indexed: 06/18/2023] Open
Abstract
BACKGROUND Psychosis treatment guidelines recommend cognitive behaviour therapy (CBT) and family intervention (FI), for all patients with first episode psychosis (FEP), though guidance borrows heavily from literature in adults from high income countries. To our knowledge, there are few randomized controlled trials (RCTs) examining the comparative effect of these commonly endorsed psychosocial interventions in individuals with early psychosis from high-income countries and no such trials from low and middle-income countries (LMICs). The present study aims to confirm the clinical-efficacy and cost-effectiveness of delivering culturally adapted CBT (CaCBT) and culturally adapted FI (CulFI) to individuals with FEP in Pakistan. METHOD A multi-centre, three-arm RCT of CaCBT, CulFI, and treatment as usual (TAU) for individuals with FEP (n = 390), recruited from major centres across Pakistan. Reducing overall symptoms of FEP will be the primary outcome. Additional aims will include improving patient and carer outcomes and estimating the economic impact of delivering culturally appropriate psychosocial interventions in low-resource settings. This trial will assess the clinical-efficacy and cost-effectiveness of CaCBT and CulFI compared with TAU in improving patient (positive and negative symptoms of psychosis, general psychopathology, depressive symptoms, quality of life, cognition, general functioning, and insight) and carer related outcomes (carer experience, wellbeing, illness attitudes and symptoms of depression and anxiety). CONCLUSIONS A successful trial may inform the rapid scale up of these interventions not only in Pakistan but other low-resource settings, to improve clinical outcomes, social and occupational functioning, and quality of life in South Asian and other minority groups with FEP. TRIAL REGISTRATION NCT05814913.
Collapse
Affiliation(s)
- M O Husain
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 1025 Queen St West, Toronto, ON, Canada.
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.
| | - A B Khoso
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - T Kiran
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - N Chaudhry
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - M I Husain
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 1025 Queen St West, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - M Asif
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - M Ansari
- Department of Psychiatry, Liaquat University of Medical and Health Sciences, Hyderabad, Pakistan
| | - A H Rajput
- Department of Psychiatry, Liaquat University of Medical and Health Sciences, Hyderabad, Pakistan
| | - S Dawood
- Centre for Clinical Psychology, University of the Punjab, Lahore, Pakistan
| | - H A Naqvi
- Department of Psychiatry, Dow University Health Sciences, Karachi, Pakistan
| | - A T Nizami
- Institute of Psychiatry, Benazir Bhutto Hospital, Rawalpindi, Pakistan
| | - Z Tareen
- Department of Psychiatry, Balochistan Institute of Psychiatry & Behavioural Sciences, Quetta, Pakistan
| | - J Rumi
- Department of Psychiatry, Balochistan Institute of Psychiatry & Behavioural Sciences, Quetta, Pakistan
| | - S Sherzad
- Department of Psychiatry, Balochistan Institute of Psychiatry & Behavioural Sciences, Quetta, Pakistan
| | - H A Khan
- Department of Psychiatry, Balochistan Institute of Psychiatry & Behavioural Sciences, Quetta, Pakistan
| | - M R Bhatia
- Department of Psychiatry, Peoples University of Medical and Health Sciences, Shaheed Benazirabad, Pakistan
| | | | - Z Zadeh
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - N Mehmood
- Institute for Mental Health, Karwan-E-Hayat, Karachi, Pakistan
| | - U Talib
- Institute for Mental Health, Karwan-E-Hayat, Karachi, Pakistan
| | - C de Oliveira
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 1025 Queen St West, Toronto, ON, Canada
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
| | - F Naeem
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 1025 Queen St West, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - W Wang
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 1025 Queen St West, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - A Voineskos
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 1025 Queen St West, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - N Husain
- Mersey Care NHS Foundation Trust, Prescott, UK
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - G Foussias
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, 1025 Queen St West, Toronto, ON, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - I B Chaudhry
- Pakistan Institute of Living and Learning, Karachi, Pakistan
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Psychiatry, Ziauddin University, Karachi, Pakistan
| |
Collapse
|
4
|
Yousaf MN, Naqvi HA, Kane S, Chaudhary FS, Hawksworth J, Nayar VV, Faust TW. Cerebrospinal fluid liver pseudocyst: A bizarre long-term complication of ventriculoperitoneal shunt: A case report. World J Hepatol 2023; 15:715-724. [PMID: 37305372 PMCID: PMC10251282 DOI: 10.4254/wjh.v15.i5.715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 03/02/2023] [Accepted: 04/10/2023] [Indexed: 05/24/2023] Open
Abstract
BACKGROUND Ventriculoperitoneal (VP) shunt placement has become a standard of care procedure in managing hydrocephalus for drainage and absorption of cerebrospinal fluid (CSF) into the peritoneum. Abdominal pseudocysts containing CSF are the common long-term complication of this frequently performed procedure, mainly because VP shunts have significantly prolonged survival. Of these, liver CSF pseudocysts are rare entities that may cause shunt dysfunction, affect normal organ function, and therefore pose therapeutic challenges.
CASE SUMMARY A 49-year-old man with history of congenital hydrocephalus status post bilateral VP shunt placement presented with progressively worsening dyspnea on exertion, abdominal discomfort/distention. Abdominal computed tomography (CT) scan revealed a large CSF pseudocyst in the right hepatic lobe with the tip of VP shunt catheter into the hepatic cyst cavity. Patient underwent robotic laparoscopic cyst fenestration with a partial hepatectomy, and repositioning of VP shunt catheter to the right lower quadrant of the abdomen. Follow-up CT demonstrated a significant reduction in hepatic CSF pseudocyst.
CONCLUSION A high index of clinical suspicion is required for early detection of liver CSF pseudocysts since their presentation is often asymptomatic and cunning early in the course. Late-stage liver CSF pseudocysts could have adverse outcomes on the treatment course of hydrocephalus as well as on hepatobiliary dysfunction. There is paucity of data to define the management of liver CSF pseudocyst in current guidelines due to rare nature of this entity. The reported occurrences have been managed by laparotomy with debridement, paracentesis, radiological imaging guided fluid aspiration and laparoscopic-associated cyst fenestration. Robotic surgery is an additional minimally invasive option in the management of hepatic CSF pseudocyst; however, its use is limited by lack of widespread availability and cost of surgery.
Collapse
Affiliation(s)
- Muhammad Nadeem Yousaf
- Division of Gastroenterology and Hepatology, Department of Medicine, University of Missouri, Columbia, MO 65212, United States
| | - Haider A Naqvi
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, MD 21218, United States
| | - Shriya Kane
- Department of Surgery, University Iowa School of Medicine, Iowa City, IA 52242, United States
| | - Fizah S Chaudhary
- Department of Medicine, University of Missouri, Columbia, MO 65212, United States
| | - Jason Hawksworth
- Department of Surgery, Transplant Hepatology, MedStar Georgetown University Hospital, Washington, DC 20007, United States
| | - Vikram V Nayar
- Department of Neurosurgery, MedStar Georgetown University Hospital, Washington, DC 20007, United States
| | - Thomas W Faust
- Department of Medicine, Transplant Hepatology, James D. Eason Transplant Institute, Methodist Le Bonheur Healthcare, Memphis, TN 38104, United States
| |
Collapse
|
5
|
Pokharel A, Tu X, Naqvi HA, Raza R, Haas CJ. Acute Pancreatitis Following Percutaneous Mechanical Thrombectomy of Left Common Iliac Vein. J Community Hosp Intern Med Perspect 2023; 13:91-95. [PMID: 37877051 PMCID: PMC10593173 DOI: 10.55729/2000-9666.1186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 03/02/2023] [Accepted: 03/09/2023] [Indexed: 10/26/2023] Open
Abstract
While parental or oral anticoagulation remains a mainstay of therapy for thrombosis, in sporadic clinical situations, percutaneous mechanical thrombectomy is favored. Percutaneous mechanical thrombectomy is a well-tolerated subtype of catheter-directed intervention resulting in thrombus breakdown and removal. This procedure combines endovascular mechanical thrombectomy in combination with pharmacologic thrombolysis allowing for a significant reduction in procedure time. Similar to other catheter-based procedures, common complications include hemorrhage, dissection, pseudoaneurysm, and perforations. Acute pancreatitis, in contrast, is a rare complication of percutaneous mechanical thrombectomy with only limited cases reported and is hypothesized to occur secondary to release of heme byproducts. Here, we present a case of acute pancreatitis following outpatient percutaneous mechanical thrombectomy of the left common iliac vein that ultimately required hospitalization, intensive care unit (ICU) admission, and standard medical management for pancreatitis.
Collapse
Affiliation(s)
- Ashik Pokharel
- Department of Medicine,
United States
- Medstar Union Memorial Hospital, Baltimore, MD, 21218,
United States
- MedStar Good Samaritan Hospital, Baltimore, MD, 21239,
United States
- Medstar Franklin Square Medical Center, Baltimore, MD, 21237,
United States
- MedStar Harbor Hospital, Baltimore, MD, 21225,
United States
| | - Xinhang Tu
- Department of Medicine,
United States
- Medstar Union Memorial Hospital, Baltimore, MD, 21218,
United States
- MedStar Good Samaritan Hospital, Baltimore, MD, 21239,
United States
- Medstar Franklin Square Medical Center, Baltimore, MD, 21237,
United States
- MedStar Harbor Hospital, Baltimore, MD, 21225,
United States
| | - Haider A. Naqvi
- Department of Medicine,
United States
- Medstar Union Memorial Hospital, Baltimore, MD, 21218,
United States
- MedStar Good Samaritan Hospital, Baltimore, MD, 21239,
United States
- Medstar Franklin Square Medical Center, Baltimore, MD, 21237,
United States
- MedStar Harbor Hospital, Baltimore, MD, 21225,
United States
| | - Rafi Raza
- Medstar Franklin Square Medical Center, Baltimore, MD, 21237,
United States
- Department of Radiology,
United States
| | - Christopher J. Haas
- Department of Medicine,
United States
- Medstar Union Memorial Hospital, Baltimore, MD, 21218,
United States
- MedStar Good Samaritan Hospital, Baltimore, MD, 21239,
United States
- Medstar Franklin Square Medical Center, Baltimore, MD, 21237,
United States
- MedStar Harbor Hospital, Baltimore, MD, 21225,
United States
- Georgetown University Medical Center,
United States
| |
Collapse
|
6
|
Husain MI, Umer M, Asif M, Khoso AB, Kiran T, Ansari M, Aslam H, Bhatia MR, Dogar FA, Husain MO, Khan HA, Mufti AA, Mulsant BH, Naeem F, Naqvi HA, de Oliveira C, Siddiqui MS, Tamizuddin A, Wang W, Zaheer J, Husain N, Chaudhry N, Chaudhry IB. Culturally adapted psychoeducation for bipolar disorder in a low-resource setting: protocol for a multicentre randomised controlled trial - ERRATUM. BJPsych Open 2023; 9:e11. [PMID: 36810130 PMCID: PMC9970177 DOI: 10.1192/bjo.2023.16] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
|
7
|
Husain MI, Chaudhry IB, Khoso AB, Kiran T, Khan N, Ahmad F, Hodsoll J, Husain MO, Naqvi HA, Nizami AT, Chaudhry N, Khan HA, Minhas F, Meyer JH, Ansari MA, Mulsant BH, Husain N, Young AH. Effect of Adjunctive Simvastatin on Depressive Symptoms Among Adults With Treatment-Resistant Depression: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e230147. [PMID: 36808239 PMCID: PMC9941891 DOI: 10.1001/jamanetworkopen.2023.0147] [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] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
IMPORTANCE Immune-metabolic disturbances have been implicated in the pathophysiology of major depressive disorder and may be more prominent in individuals with treatment-resistant depression (TRD). Preliminary trials suggest that lipid-lowering agents, including statins, may be useful adjunctive treatments for major depressive disorder. However, no adequately powered clinical trials have assessed the antidepressant efficacy of these agents in TRD. OBJECTIVE To assess the efficacy and tolerability of adjunctive simvastatin compared with placebo for reduction of depressive symptoms in TRD. DESIGN, SETTING, AND PARTICIPANTS This 12-week, double-blind, placebo-controlled randomized clinical trial was conducted in 5 centers in Pakistan. The study involved adults (aged 18-75 years) with a Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) major depressive episode that had failed to respond to at least 2 adequate trials of antidepressants. Participants were enrolled between March 1, 2019, and February 28, 2021; statistical analysis was performed from February 1 to June 15, 2022, using mixed models. INTERVENTION Participants were randomized to receive standard care plus 20 mg/d of simvastatin or placebo. MAIN OUTCOMES AND MEASURES The primary outcome was the difference between the 2 groups in change in Montgomery-Åsberg Depression Rating Scale total scores at week 12. Secondary outcomes included changes in scores on the 24-item Hamilton Rating Scale for Depression, the Clinical Global Impression scale, and the 7-item Generalized Anxiety Disorder scale and change in body mass index from baseline to week 12. C-reactive protein and plasma lipids were measured at baseline and week 12. RESULTS A total of 150 participants were randomized to simvastatin (n = 77; median [IQR] age, 40 [30-45] years; 43 [56%] female) or placebo (n = 73; median [IQR] age, 35 [31-41] years; 40 [55%] female). A significant baseline to end point reduction in Montgomery-Åsberg Depression Rating Scale total score was observed in both groups and did not differ significantly between groups (estimated mean difference for simvastatin vs placebo, -0.61; 95% CI, -3.69 to 2.46; P = .70). Similarly, there were no significant group differences in any of the secondary outcomes or evidence for differences in adverse effects between groups. A planned secondary analysis indicated that changes in plasma C-reactive protein and lipids from baseline to end point did not mediate response to simvastatin. CONCLUSIONS AND RELEVANCE In this randomized clinical trial, simvastatin provided no additional therapeutic benefit for depressive symptoms in TRD compared with standard care. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03435744.
Collapse
Affiliation(s)
- M. Ishrat Husain
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Imran B. Chaudhry
- Department of Psychiatry, Ziauddin University, Karachi, Sindh, Pakistan
- Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom
- Pakistan Institute of Living and Learning, Karachi, Sindh, Pakistan
| | - Ameer B. Khoso
- Pakistan Institute of Living and Learning, Karachi, Sindh, Pakistan
| | - Tayyeba Kiran
- Pakistan Institute of Living and Learning, Karachi, Sindh, Pakistan
| | - Nawaz Khan
- Pakistan Institute of Living and Learning, Karachi, Sindh, Pakistan
| | - Farooq Ahmad
- Pakistan Institute of Living and Learning, Karachi, Sindh, Pakistan
| | - John Hodsoll
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| | - M. Omair Husain
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Haider A. Naqvi
- Department of Psychiatry, Dow University of Health Sciences, Karachi, Pakistan
| | - Asad T. Nizami
- Institute of Psychiatry, Rawalpindi Medical College, Rawalpindi, Pakistan
| | - Nasim Chaudhry
- Pakistan Institute of Living and Learning, Karachi, Sindh, Pakistan
| | | | - Fareed Minhas
- Institute of Psychiatry, Rawalpindi Medical College, Rawalpindi, Pakistan
| | - Jeffrey H. Meyer
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Moin A. Ansari
- Department of Psychiatry, Liaquat University of Medical and Health Sciences, Hyderabad, Pakistan
| | - Benoit H. Mulsant
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nusrat Husain
- Division of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom
| | - Allan H. Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, United Kingdom
| |
Collapse
|
8
|
Husain MI, Umer M, Asif M, Khoso AB, Kiran T, Ansari M, Aslam H, Bhatia MR, Dogar FA, Husain MO, Khan HA, Mufti AA, Mulsant BH, Naeem F, Naqvi HA, de Oliviera C, Siddiqui MS, Tamizuddin A, Wang W, Zaheer J, Husain N, Chaudhry N, Chaudhry IB. Culturally adapted psychoeducation for bipolar disorder in a low-resource setting: protocol for a multicentre randomised controlled trial. BJPsych Open 2022; 8:e206. [PMID: 36426568 PMCID: PMC9707505 DOI: 10.1192/bjo.2022.598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Bipolar disorder is a source of marked disability, morbidity and premature death. There is a paucity of research on personalised psychosocial interventions for bipolar disorder, especially in low-resource settings. A pilot randomised controlled trial (RCT) of a culturally adapted psychoeducation intervention for bipolar disorder (CaPE) in Pakistan reported higher patient satisfaction, enhanced medication adherence, knowledge and attitudes regarding bipolar disorder, and improvement in mood symptom scores and health-related quality of life measures compared with treatment as usual (TAU). AIMS The current protocol describes a larger multicentre RCT to confirm the clinical and cost-effectiveness of CaPE in Pakistan. Trial registration: NCT05223959. METHOD A multicentre individual, parallel-arm RCT of CaPE in 300 Pakistani adults with bipolar disorder. Participants over the age of 18, with a diagnosis of bipolar I or II disorder who are currently euthymic, will be recruited from seven sites: Karachi, Lahore, Multan, Rawalpindi, Peshawar, Hyderabad and Quetta. Time to recurrence will be the primary outcome assessed using the Longitudinal Interval Follow-up Evaluation (LIFE). Secondary measures will include mood symptoms, quality of life and functioning, adherence to psychotropic medications, and knowledge and attitudes regarding bipolar disorder. RESULTS This trial will assess the effectiveness of the CaPE intervention compared with TAU in reducing the time to recurrence for people with bipolar disorder currently in remission in Pakistan and determine the effect on clinical outcomes, quality of life and functioning. CONCLUSIONS A successful trial might lead to rapid implementation of CaPE in clinical practice, not only in Pakistan, but also in other low-resource settings, including those in high-income countries, to improve clinical outcomes, social and occupational functioning, and quality of life in South Asian and other minority group patients with bipolar disorder.
Collapse
Affiliation(s)
- M Ishrat Husain
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Madeha Umer
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; and Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Muqaddas Asif
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Ameer B Khoso
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Tayyeba Kiran
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Moin Ansari
- Department of Psychiatry, Liaquat University of Medical and Health Sciences, Hyderabad, Pakistan
| | - Huma Aslam
- Department of Psychiatry and Behavioral Sciences, Allama Iqbal Medical College/Jinnah Hospital, Lahore, Pakistan
| | - Moti Ram Bhatia
- Department of Psychiatry, Peoples University of Medical and Health Sciences for Women, Nawabshah-Shaheed Benazirabad, Pakistan
| | | | - M Omair Husain
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Hazrat A Khan
- Balochistan Institute of Psychiatry and Behavioral Sciences, Quetta, Pakistan
| | | | - Benoit H Mulsant
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Farooq Naeem
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Haider A Naqvi
- Department of Psychiatry, DOW University of Health Sciences, Karachi, Pakistan
| | - Claire de Oliviera
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | | | - Asad Tamizuddin
- Institute of Psychiatry, WHO Collaborating Centre for Mental Health Research and Training, Rawalpindi, Pakistan
| | - Wei Wang
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Juveria Zaheer
- Campbell Family Mental Health Research Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; and Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Nusrat Husain
- Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK; and Mersey Care NHS Foundation Trust, Liverpool, UK
| | - Nasim Chaudhry
- Pakistan Institute of Living and Learning, Karachi, Pakistan
| | - Imran B Chaudhry
- Pakistan Institute of Living and Learning, Karachi, Pakistan; Division of Psychology and Mental Health, School of Health Sciences, University of Manchester, Manchester, UK; and Department of Psychiatry, Ziauddin University, Karachi, Pakistan
| |
Collapse
|
9
|
Abstract
Patients with chronic liver disease (CLD) with or without cirrhosis remain at risk of developing hepatic decompensation when infected with viral or bacterial pathogens. The Advisory Committee on Immunization Practices (ACIP) currently recommends vaccination in CLD against hepatitis A virus (HAV), hepatitis B virus (HBV), influenza, pneumococcus, herpes zoster, tetanus, diphtheria, pertussis, and SARS-CoV-2. Inactivated vaccines are preferred over live attenuated ones, especially in transplant recipients where live vaccines are contraindicated. As the severity of the liver disease progresses, vaccine efficacy declines, and therefore, vaccines should be ideally administered early in the disease course for optimal immune response. Despite the strong recommendations, overall vaccination coverage in CLD remains poor; however, it is encouraging to note that in recent years coverage against influenza and pneumococcus has shown some improvement. Inadequate access to healthcare, lack of information on vaccine safety, poor financial reimbursement for healthcare providers, and vaccine misinformation are often responsible for low immunization rates. This review summarizes the impact of vaccine-preventable illness in those with CLD, updated vaccine guidelines, seroconversion rates in the vaccinated, and barriers faced by healthcare professionals in immunizing those with liver disease.
Collapse
Key Words
- ACIP, Advisory Committee on Immunization Practices
- ACLF, acute on chronic liver failure
- ALD, alcohol-related liver disease
- CLD, Chronic liver disease
- CLIF-C, Chronic Liver Failure Consortium
- DAA, direct-acting antiviral drugs
- HAV, hepatitis A virus
- HBV, hepatitis B virus
- HCV, hepatitis C virus
- LT, liver transplant
- NAFLD, nonalcoholic fatty liver disease
- SARS-CoV-2
- SOFA, sequential organ failure assessment
- chronic liver disease
- immunization
- vaccines
Collapse
Affiliation(s)
- Joseph J. Alukal
- Institute of Digestive Health & Liver Diseases, Mercy Medical Center, Baltimore MD, USA
| | | | - Paul J. Thuluvath
- Institute of Digestive Health & Liver Diseases, Mercy Medical Center, Baltimore MD, USA
- Department of Medicine, University of Maryland School of Medicine, Baltimore MD, USA
- Address for correspondence: Paul J. Thuluvath, MD., FRCP, Institute of Digestive Health & Liver Diseases, Mercy Medical Center, Baltimore MD, USA.
| |
Collapse
|
10
|
Siddiqi A, Chaudhary FS, Naqvi HA, Saleh N, Farooqi R, Yousaf MN. Black esophagus: a syndrome of acute esophageal necrosis associated with active alcohol drinking. BMJ Open Gastroenterol 2021; 7:bmjgast-2020-000466. [PMID: 32788199 PMCID: PMC7422689 DOI: 10.1136/bmjgast-2020-000466] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 07/15/2020] [Accepted: 07/16/2020] [Indexed: 11/09/2022] Open
Abstract
Black esophagus, also known as acute esophageal necrosis (AEN) syndrome, is a rare entity characterized by patchy or diffuse circumferential black pigmentation of the esophageal mucosa from ischemic necrosis. It may present with life-threatening upper gastrointestinal hemorrhage resulting in high mortality in immunocompromised patients. Advanced age with multiple comorbidities compounded with compromised hemodynamic states are poor prognostic factors. Findings on laboratory work-up and radiological imaging are non-specific. After initial resuscitation, endoscopic evaluation and histological examination of esophageal biopsy are diagnostic. Early recognition and aggressive resuscitation are the fundamental principles for the management of AEN and better outcome of the disease. We report a case of a 56-year-old woman with diabetes mellitus, gastro-esophageal reflux disease, and active alcohol binging who presented with hematemesis and acute epigastric pain due to AEN. This case illustrates a rare etiology of AEN due to active alcohol drinking, which may be overlooked. Physician awareness about this etiology is important as early recognition and timely management may improve survival.
Collapse
Affiliation(s)
- Anees Siddiqi
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, Maryland, USA.,Department of Medicine, MedStar Franklin Square Medical Center, Baltimore, Maryland, USA.,Department of Medicine, MedStar Good Samaritan Hospital, Baltomore, Maryland, USA.,Department of Medicine, MedStar Harbor Hospital, Baltimore, Maryland, USA
| | - Fizah S Chaudhary
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, Maryland, USA.,Department of Medicine, MedStar Franklin Square Medical Center, Baltimore, Maryland, USA.,Department of Medicine, MedStar Good Samaritan Hospital, Baltomore, Maryland, USA.,Department of Medicine, MedStar Harbor Hospital, Baltimore, Maryland, USA
| | - Haider A Naqvi
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, Maryland, USA.,Department of Medicine, MedStar Franklin Square Medical Center, Baltimore, Maryland, USA.,Department of Medicine, MedStar Good Samaritan Hospital, Baltomore, Maryland, USA.,Department of Medicine, MedStar Harbor Hospital, Baltimore, Maryland, USA
| | - Nahar Saleh
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, Maryland, USA.,Department of Medicine, MedStar Franklin Square Medical Center, Baltimore, Maryland, USA.,Department of Medicine, MedStar Good Samaritan Hospital, Baltomore, Maryland, USA.,Department of Medicine, MedStar Harbor Hospital, Baltimore, Maryland, USA
| | - Rehan Farooqi
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, Maryland, USA.,Department of Medicine, MedStar Franklin Square Medical Center, Baltimore, Maryland, USA.,Department of Medicine, MedStar Good Samaritan Hospital, Baltomore, Maryland, USA.,Department of Medicine, MedStar Harbor Hospital, Baltimore, Maryland, USA
| | - Muhammad Nadeem Yousaf
- Department of Medicine, MedStar Union Memorial Hospital, Baltimore, Maryland, USA .,Department of Medicine, MedStar Franklin Square Medical Center, Baltimore, Maryland, USA.,Department of Medicine, MedStar Good Samaritan Hospital, Baltomore, Maryland, USA.,Department of Medicine, MedStar Harbor Hospital, Baltimore, Maryland, USA
| |
Collapse
|
11
|
Yousaf MN, Naqvi HA, Chaudhary F, Raddawi K, Haas CJ. The Pathophysiology of Gastrointestinal and Hepatic Manifestations of COVID-19. Cureus 2020; 12:e11698. [PMID: 33391931 PMCID: PMC7769789 DOI: 10.7759/cureus.11698] [Citation(s) in RCA: 2] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/25/2020] [Indexed: 12/24/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19), also known as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is the sixth international public health emergency. While COVID-19 classically manifests as a respiratory illness, SARS-CoV-2 may infect multiple organ systems and cause a wide array of presentations. The gastrointestinal tract has become increasingly recognized as a site of SARS-CoV-2 infection with reports of diarrhea, nausea, and liver failure, with or without concomitant respiratory involvement. In this case series and literature review, we report three cases of SARS-CoV-2 infected patients that presented with predominantly gastrointestinal symptoms or laboratory abnormalities such as diarrhea, anorexia, and transaminitis. The receptor for SARS-CoV-2, angiotensin-converting enzyme 2 (ACE2), as well as the necessary protease to facilitate viral entry, transmembrane protease serine-2 (TMPRSS2), and to a lesser extent, cathepsins, have been demonstrated to be present throughout the gastrointestinal tract, thus facilitating viral entry and pathogenesis. Furthermore, multiple reports have demonstrated evidence of viral shedding outside the nasopharynx, including the stool, for prolonged time periods even in the absence of detection of viral RNA in the nasopharynx. As such, testing for SARS-CoV-2 in stool samples with reverse transcription polymerase chain reaction (RT-PCR) assays for detection of viral RNA could aid in identifying patients that lack classic respiratory symptoms, present with atypical symptoms, or in those with a high index of suspicion (e.g. elevated inflammatory markers), but test negative on the classic nasopharyngeal swab. Furthermore, this underscores the potential for atypical transmission, with a focus on fecal-oral transmission and the need for strict hand hygiene.
Collapse
Affiliation(s)
- Muhammad N Yousaf
- Medicine, MedStar Union Memorial Hospital, Baltimore, USA
- Medicine, MedStar Franklin Square Medical Center, Baltimore, USA
- Medicine, MedStar Good Samaritan Hospital, Baltimore, USA
- Medicine, MedStar Harbor Hospital, Baltimore, USA
| | - Haider A Naqvi
- Medicine, MedStar Union Memorial Hospital, Baltimore, USA
- Medicine, MedStar Franklin Square Medical Center, Baltimore, USA
- Medicine, MedStar Good Samaritan Hospital, Baltimore, USA
- Medicine, MedStar Harbor Hospital, Baltimore, USA
| | - Fizah Chaudhary
- Medicine, MedStar Union Memorial Hospital, Baltimore, USA
- Medicine, MedStar Franklin Square Medical Center, Baltimore, USA
- Medicine, MedStar Good Samaritan Hospital, Baltimore, USA
- Medicine, MedStar Harbor Hospital, Baltimore, USA
| | - Kenan Raddawi
- Medicine, MedStar Union Memorial Hospital, Baltimore, USA
- Medicine, MedStar Franklin Square Medical Center, Baltimore, USA
- Medicine, MedStar Good Samaritan, Baltimore, USA
- Medicine, MedStar Harbor Hospital, Baltimore, USA
| | - Christopher J Haas
- Medicine, MedStar Union Memorial Hospital, Baltimore, USA
- Medicine, MedStar Franklin Square Medical Center, Baltimore, USA
- Medicine, MedStar Good Samaritan Hospital, Baltimore, USA
- Medicine, MedStar Harbor Hospital, Baltimore, USA
- Medicine, MedStar Georgetown University School of Medicine, Washington, USA
| |
Collapse
|
12
|
Abstract
The COVID-19 pandemic with its subsequent mental health consequences has challenged the word view of most people. A genome typically of 26,000-32,000 bases long RNA has shut down the wheel of man made progress. The social isolation after the lock-down has not only led to economic difficulties but also adverse psychological reactions. The most common reaction is stress, anxiety and depression when faced with life-threatening circumstances. People have to deal with the imminent issue of death which is anxiety provoking in itself. This calls for dealing with the immediate mental health consequences with the aide of technological advancements as discussed in this write-up. A new inter-personal ethics need to emerge which is scientifically correct and in-line with age old values.
Collapse
Affiliation(s)
- Haider A Naqvi
- Department of Psyhciatry, Dow University of Health Sciences, Karachi
| |
Collapse
|
13
|
Husain MI, Chaudhry IB, Khoso AB, Husain MO, Hodsoll J, Ansari MA, Naqvi HA, Minhas FA, Carvalho AF, Meyer JH, Deakin B, Mulsant BH, Husain N, Young AH. Minocycline and celecoxib as adjunctive treatments for bipolar depression: a multicentre, factorial design randomised controlled trial. Lancet Psychiatry 2020; 7:515-527. [PMID: 32445690 DOI: 10.1016/s2215-0366(20)30138-3] [Citation(s) in RCA: 95] [Impact Index Per Article: 23.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/20/2020] [Accepted: 03/23/2020] [Indexed: 12/15/2022]
Abstract
BACKGROUND Several small studies suggest that the adjunctive use of anti-inflammatory agents might improve depressive symptoms in bipolar disorder. However, there are few well designed, appropriately powered clinical trials assessing the efficacy of these novel treatment strategies. We aimed to assess the efficacy of adjunctive minocycline or celecoxib in this setting. METHODS This double-blind, 12-week, randomised, placebo-controlled trial was done in four outpatient psychiatric clinics in Pakistan. Eligible participants were adults (aged 18-65 years) with DSM-5 bipolar disorder (type I or II) and a major depressive episode. In a 2 × 2 factorial design, participants were randomly assigned (1:1:1:1) to receive either active minocycline plus active celecoxib, active minocycline plus placebo celecoxib, placebo minocycline plus active celecoxib, or placebo minocycline plus placebo celecoxib. The primary outcome was the mean change from baseline to week 12 in score on the 17-item Hamilton Depression Rating Scale (HAMD-17), assessed in all randomised participants (missing data were imputed and assumed to be missing at random). The trial was registered with ClinicalTrials.gov, NCT02703363. FINDINGS 266 (17%) of 1542 patients assessed between May 1, 2016, and March 31, 2019, were randomly assigned to receive minocycline plus celecoxib (n=68), minocycline plus placebo (n=66), celecoxib plus placebo (n=66), or placebo plus placebo (n=66). From baseline to week 12, depressive symptoms as per HAMD-17 reduced in all four groups (from 24·5-25·2 to 11·3-12·8), but these reductions did not differ significantly between the groups. In terms of main effects, reductions in HAMD-17 did not differ for patients treated with minocycline (mean adjusted difference vs non-minocycline 1·48 [95% CI -0·41 to 3·36]; p=0·123) or for celecoxib (mean adjusted difference vs non-celecoxib -0·74 [-2·61 to 1·14]; p=0·443). Rates of serious adverse effects did not differ between groups (31 participants had a manic switch, two self-harmed, and one died in a motor vehicle accident). INTERPRETATION We found no evidence that minocycline or celecoxib was superior to placebo for the treatment of bipolar depression. This large trial casts doubt on the potential therapeutic benefits of adjunctive anti-inflammatory drugs for the acute management of bipolar depression. FUNDING Stanley Medical Research Institute.
Collapse
Affiliation(s)
| | - Imran B Chaudhry
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; Pakistan Institute of Learning and Living, Karachi, Pakistan; Department of Pyschiatry, Dow University of Health Sciences, Karachi, Pakistan; Ziauddin University Hospital, Karachi, Pakistan
| | - Ameer B Khoso
- Pakistan Institute of Learning and Living, Karachi, Pakistan
| | | | - John Hodsoll
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Moin A Ansari
- Department of Psychiatry, Liaquat University of Medical and Health Sciences, Hyderabad, Pakistan
| | - Haider A Naqvi
- Department of Pyschiatry, Dow University of Health Sciences, Karachi, Pakistan
| | - Fareed A Minhas
- Institute of Psychiatry, Rawalpindi Medical College, Rawalpindi, Pakistan
| | | | | | - Bill Deakin
- Division of Neuroscience and Experimental Psychology, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Benoit H Mulsant
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Nusrat Husain
- Division of Psychology and Mental Health, University of Manchester, Manchester, UK
| | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| |
Collapse
|
14
|
Abstract
Buerger's disease is a type of vasculitis that predominantly affects small to medium arteries and the veins of the upper and lower extremities. Intestinal vessels are rarely involved. This is a case report of a 38-year-old male, smoker, with known Buerger's disease who was found to have ischemic colitis of the sigmoid colon on biopsy and inferior mesenteric artery occlusion on computed tomography (CT) angiography. Intestinal ischemia is a rare complication in Buerger's disease. Patients may present with vague abdominal symptoms. Given the very low incidence of intestinal involvement, social history and clinical correlation are of chief importance for early detection. Smoking cessation is paramount, as it is the mainstay treatment of the underlying disease.
Collapse
Affiliation(s)
- Haider A Naqvi
- Internal Medicine, Medstar Union Memorial Hospital, Baltimore, USA
| | - Muhammed Bilal
- Medicine: Surgery, William Carey University College of Osteopathic Medicine, Hattiesburg, USA
| | - Shuja Yousuf
- Clinical Gastroenterology & Internal Medicine, Merit Health Rankin & William Carey University College of Osteopathic Medicine, Brandon, USA
| |
Collapse
|
15
|
Qurashi I, Chaudhry IB, Khoso AB, Farooque S, Lane S, Husain MO, Chu S, Sarginson J, Hamarani M, Naqvi HA, Razzaque B, Minhas FA, Yung AR, Deakin JFW, Husain N. A randomised, double-blind, placebo-controlled trial of minocycline and/or omega-3 fatty acids added to treatment as usual for at-risk mental states (NAYAB): study protocol. Trials 2017; 18:524. [PMID: 29121974 PMCID: PMC5679379 DOI: 10.1186/s13063-017-2275-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [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: 05/26/2017] [Accepted: 09/27/2017] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND The at-risk mental state (ARMS) describes individuals at high risk of developing schizophrenia or psychosis. The use of antipsychotics in this population is not supported, because most individuals with ARMS are unlikely to develop psychosis. Anti-inflammatory treatments and polyunsaturated fatty acids (PUFAs) may have some beneficial effects in the treatment of ARMS. There have been no controlled clinical trials in which researchers have investigated the use of minocycline for ARMS and no trials involving PUFAs in combination with other proposed treatments. There is a need to find effective, tolerable and inexpensive interventions for individuals with ARMS that are available in high-, low- and middle-income countries. METHODS/DESIGN A 6-month intervention study of minocycline and/or omega-3 fatty acids added to treatment as usual (TAU) in patients with ARMS will be conducted in Pakistan using a randomised, placebo-controlled, double-blind factorial design. A total of 320 consenting patients with capacity will be recruited from the community, general practitioner clinics and psychiatric units. Allowing for a 25% dropout rate, we will recruit 59 completing participants into each study arm, and in total 236 will complete the study. We will determine whether the addition of minocycline and/or omega-3 fatty acids to TAU attenuates the rate of transition from ARMS to first-episode psychosis and improves symptoms and/or level of functioning in ARMS. We will also investigate whether any candidate risk factors, such as negative symptoms, influence treatment response in the ARMS group. The primary efficacy endpoint is conversion to psychotic disorder at 12 months after study entry. Analysis will be done according to the intention to treat principle using analysis of variance, chi-square tests and adjusted ORs to assess between-group differences. Cox regression analysis will be used to evaluate potential between-group differences in time to onset of psychosis. DISCUSSION The outcomes of this trial will provide evidence of the potential benefits of minocycline and PUFAs in the treatment of ARMS. Both minocycline and PUFAs are inexpensive, are readily available in low-/middle-income countries such as Pakistan, and if proven, may be safe and effective for treating individuals with ARMS. TRIAL REGISTRATION ClinicalTrials.gov, NCT02569307 . Registered on 3 October 2015.
Collapse
Affiliation(s)
- Inti Qurashi
- Ashworth Research Centre, Mersey Care NHS Foundation Trust, Maghull, UK.,Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK
| | - Imran B Chaudhry
- Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK
| | - Ameer B Khoso
- Pakistan Institute of Living & Learning, Karachi, Pakistan
| | - Sana Farooque
- Pakistan Institute of Living & Learning, Karachi, Pakistan
| | - Steve Lane
- Institute of Translational Medicine, University of Liverpool, Liverpool, UK
| | | | - Simon Chu
- Ashworth Research Centre, Mersey Care NHS Foundation Trust, Maghull, UK. .,School of Psychology, University of Central Lancashire, Preston, UK.
| | - Jane Sarginson
- Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK
| | | | | | - Bushra Razzaque
- Institute of Psychiatry & WHO Collaborating Centre, Rawalpindi, Pakistan
| | - Fareed A Minhas
- Institute of Psychiatry & WHO Collaborating Centre, Rawalpindi, Pakistan
| | - Alison R Yung
- Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK
| | - J F W Deakin
- Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK
| | - Nusrat Husain
- Faculty of Medicine, Biology and Health, University of Manchester, Manchester, UK
| |
Collapse
|
16
|
Naqvi HA. Risks in Randomized Controlled Trials: Role of Interim Analysis and Data Monitoring Committee. J Coll Physicians Surg Pak 2015; 25:557-9. [PMID: 26305298 DOI: 08.2015/jcpsp.557559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 07/04/2015] [Indexed: 11/06/2022]
Affiliation(s)
- Haider A Naqvi
- Department of Psychiatry, The Ziauddin University, Karachi
| |
Collapse
|
17
|
Naqvi HA. The clinical trial design. J Coll Physicians Surg Pak 2014; 24:221-3. [PMID: 24709230 DOI: 04.2014/jcpsp.221223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 02/25/2014] [Indexed: 11/20/2022]
Affiliation(s)
- Haider A Naqvi
- Department of Psychiatry, The Aga Khan University, Karachi
| |
Collapse
|
18
|
Naqvi HA, Hussain S, Islam M, Huma S. Early psychosis symptoms. J Coll Physicians Surg Pak 2014; 24:198-202. [PMID: 24613118 DOI: 03.2014/jcpsp.198202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 04/14/2012] [Accepted: 09/24/2013] [Indexed: 11/18/2022]
Abstract
OBJECTIVE To determine the prodromal symptoms of schizophrenia in the pathways to help-seeking. STUDY DESIGN A cross-sectional study. PLACE AND DURATION OF STUDY The Department of Psychiatry, the Aga Khan University, Karachi, from 2008 to 2009. METHODOLOGY A total of 93 patients were interviewed in the pathways to care of schizophrenia. The diagnosis was based on ICD-10 criteria. The pathways to care were assessed through a semi-structured questionnaire. The onset, course and symptoms of psychosis were assessed through Interview for Retrospective Assessment at Age at Onset of Psychosis (IROAS). RESULTS Fifty five (59%) participants were male while 41% (n=38%) were female. Using IROAS, 108 symptoms were identified as concerning behaviour. Alternatively, 60 (55%) concerning behaviours were reported in the open-ended inquiry of the reasons for help seeking as assessed by the pathways to care questionnaire with a statistically significant difference between most symptoms category. The difference was most pronounced (p < 0.001) for depressed mood (66%), worries (65%), tension (63%), withdrawal/mistrust (54%) and loss of self-confidence (53%). Thought withdrawal (22%) and passivity (15%) were elicited only through structured interview (IROAS). When symptoms were categorized together, about 83% of the subjects presented with affective and non-specific prodromal symptoms. Roughly, 10% of the subjects presented with positive symptoms and 3% presented with the negative symptoms of psychosis. The non-specific, affective symptoms appear to predominate the prodromal phase of the illness. CONCLUSION Prodromal symptoms of schizophrenia include non-specific, affective symptoms. Attention needs to be paid on identifying the prodromal symptoms and change in social functioning in order to identify those who are at risk of longterm psychosis.
Collapse
Affiliation(s)
- Haider A Naqvi
- Department of Psychiatry, The Aga Khan University Hospital, Karachi
| | - Sajjad Hussain
- Department of Psychiatry, The Aga Khan University Hospital, Karachi
| | - Muhammad Islam
- Department of Community Health Sciences, The Aga Khan University Hospital, Karachi
| | - Shafqat Huma
- Department of Psychiatry, The Aga Khan University Hospital, Karachi
| |
Collapse
|
19
|
Naqvi HA. Medical educational: the development of intellect. J PAK MED ASSOC 2012; 62:1102-1103. [PMID: 23866459] [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)
- Haider A Naqvi
- Department of Psychiatry, Aga Khan University, Karachi, Pakistan.
| |
Collapse
|
20
|
Naqvi HA, Hussain A. Medical education: value based teaching. J PAK MED ASSOC 2011; 61:1027-1028. [PMID: 22356045] [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: 05/31/2023]
Affiliation(s)
- Haider A Naqvi
- Department of Psychiatry, The Aga Khan University, Karachi, Pakistan
| | | |
Collapse
|
21
|
Naqvi HA. Research culture. J Coll Physicians Surg Pak 2011; 21:515-516. [PMID: 21914404] [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] [Received: 05/06/2011] [Accepted: 06/25/2011] [Indexed: 05/31/2023]
|
22
|
Khan F, Naqvi HA. Evidence based treatment of schizophrenia: do we know enough? J PAK MED ASSOC 2011; 61:507-509. [PMID: 22204194] [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: 05/31/2023]
Affiliation(s)
- Faheem Khan
- Department of Psychiatry, Aga Khan University, Karachi, Pakistan
| | | |
Collapse
|
23
|
Naqvi HA. JCPSP Impact factor. J Coll Physicians Surg Pak 2011; 21:193. [PMID: 21419036] [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] [Received: 03/01/2011] [Accepted: 03/01/2011] [Indexed: 05/30/2023]
|
24
|
Naqvi HA. Students' research: tradition ahead of its time. J Coll Physicians Surg Pak 2010; 20:701-2. [PMID: 20943120 DOI: 10.2010/jcpsp.701702] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 10/15/2009] [Accepted: 08/12/2010] [Indexed: 11/20/2022]
Abstract
This view point describes the experience of introducing research at an undergraduate level during clinical rotation in psychiatry. Objective of this initiative was to encourage critical thinking, self directed learning and sensitization to mental health issues. This contributed to student learning besides galvanizing their interest in the subject. The opinion piece aims to expose various issues to students' research in the context of medical education in Pakistan.
Collapse
Affiliation(s)
- Haider A Naqvi
- Department of Psychiatry, The Aga Khan University, Karachi.
| |
Collapse
|
25
|
Akhtar W, Naqvi HA, Hussain S, Ali A, Ahmad N. Magnetic resonance imaging findings in patients with schizophrenia. J Coll Physicians Surg Pak 2010; 20:167-70. [PMID: 20392378 DOI: 03.2010/jcpsp.167170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Accepted: 10/20/2009] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To determine structural abnormalities in the brain of patients with schizophrenia by Magnetic Resonance Imaging (MRI). STUDY DESIGN Comparative study. PLACE AND DURATION OF STUDY The Departments of Radiology and Psychiatry, the Aga Khan University Hospital, Karachi, from January 2007 to June 2008. METHODOLOGY Thirty-three cases of schizophrenia (n=33) and thirty-three age-matched controls, (n=33) were enrolled for this study. Screening Magnetic Resonance Imaging (MRI) of brain was done in order to see structural changes in brain matter. Findings were compared among groups using chi-square and Fisher's exact test with significance at p < 0.05. RESULTS Among the total of 66 (n=66) MRI films studied for brain abnormalities, brain atrophy, presence of septum pellucidum and enlarged Virchow-Robins spaces were significantly associated with schizophrenia (p < 0.001). There was no significant difference between cases and controls for ventricular dilatation (p=0.5). Sinusitis was mostly associated with controls and well correlated with their symptoms (p < 0.001). CONCLUSION Brain atrophy was the most commonly seen brain change in the studied sample of patients with schizophrenia. MRI brain can be used to identify structural abnormalities in patients with schizophrenia.
Collapse
Affiliation(s)
- Waseem Akhtar
- Department of Radiology, The Aga Khan University Hospital, Karachi.
| | | | | | | | | |
Collapse
|
26
|
Naqvi HA, Kazim SF, Huma S. Terrorism and health: the responsibility of intellectuals? J PAK MED ASSOC 2010; 60:403-405. [PMID: 20527621] [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: 05/29/2023]
Affiliation(s)
- Haider A Naqvi
- Department of Psychiatry, Aga Khan University Hospital, Karachi
| | | | | |
Collapse
|
27
|
Abstract
Background Substantial amount of time is lost before initiation of treatment in Schizophrenia. The delay in treatment is labelled as Duration of Untreated Psychosis (DUP). Most of these estimates come from western countries, where health systems are relatively better developed. There is dearth of information on pathway to care from developing countries. Methods and Results Patients with ICD-10 based diagnosis of Schizophrenia were enrolled by convenient method of sampling. The pathway to care was explored through a semi-structured questionnaire. Onset, course and symptoms of psychosis were assessed using Interview for the Retrospective Assessment of the Onset of Schizophrenia (IRAOS). Ethical approval of the project was taken from The Aga Khan University, Ethics Review Committee. Of the enrolled 93 subjects, 55 (59%) were males and 38 (41%) were females. In our sample, 1.56 mean (median, 2) attempts were made prior to successful help seeking. The duration of untreated psychosis was 14.8 months (St. Deviation; 29.4). DUP was 16.8 months (St. Deviation; 34.9) for males and 11.8 months (St. Deviation; 18.9) for females. In the pathway to care, psychiatrists featured prominently as initial care providers. In the first attempt at help-seeking, 43% patients were initially taken to psychiatrists. After the initial consultation, 45% were prescribed psychotropic medication while 7% were hospitalized. Only 9% subjects were given the diagnosis of schizophrenia initially. When participants were inquired about the reasons for delay, 29% reported financial difficulties as the barrier to care. Positive symptoms of psychosis were present in 57% subjects while negative symptoms were present in 30% subjects. There was a statistically significant difference (Chi-square; 7.928, df: 1, Sig 0.005) between DUP and the positive and negative symptoms category. Conclusion In the absence of well developed primary care health system in Pakistan, majority of patients present to psychiatrists as a first contact. DUP, as a measurement of help seeking behaviour, tends to be shorter with positive symptoms of Schizophrenia. Substantial amount of time is lost due to non recognition of disease and subsequently, inadequate treatment. Secondary prevention strategies should focus on families, which play an important role in the treatment-seeking process of psychotic patients.
Collapse
Affiliation(s)
- Haider A Naqvi
- Department of Psychiatry, Aga Khan University, Karachi, Pakistan.
| | | | | | | |
Collapse
|
28
|
Naqvi HA. Research retreat. J Coll Physicians Surg Pak 2009; 19:603-604. [PMID: 19811707 DOI: 10.2009/jcpsp.603604] [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] [Received: 08/05/2009] [Accepted: 08/30/2009] [Indexed: 05/28/2023]
|
29
|
Naqvi HA. Data cooking: a recipe for disaster. J PAK MED ASSOC 2009; 59:61. [PMID: 19213387] [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: 05/27/2023]
|
30
|
Naqvi HA. Research question or questionable research? J Coll Physicians Surg Pak 2008; 18:531-532. [PMID: 18803887] [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] [Received: 07/07/2008] [Accepted: 07/19/2008] [Indexed: 05/26/2023]
|
31
|
Naqvi HA. Schizophrenia: a concept. J PAK MED ASSOC 2008; 58:133-137. [PMID: 18517118] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Much of the current research-work into biological basis of mental disorders is predicted on implicit concept of disease that is less critical and sophisticated as it should be. It is remarkable, how the fundamental conceptual frame work of schizophrenia, as proposed by Professor Emil Kraepelin has stayed the same, since its inception almost 100-years ago. This review explores these issues besides highlighting alternative disease classification that suits behavioural neuroscience research.
Collapse
|
32
|
Naqvi HA. Enigma of mental health research in pakistan. J Coll Physicians Surg Pak 2007; 17:450-1. [PMID: 17686369 DOI: 07.2007/jcpsp.450451] [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: 05/16/2023]
Affiliation(s)
- Haider A Naqvi
- Department of Psychiatry The Aga Khan University, Stadium Road Karachi
| |
Collapse
|
33
|
Naqvi HA, Khan MM. Mapping exercise of mental health research and researchers in Pakistan. J PAK MED ASSOC 2007; 57:294-8. [PMID: 17629230] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVE To systematically identify mental health research and researchers in Pakistan. Subsidiary objectives were to identify methodologies of studies published in the indexed journals along with their country wide mean impact factor. METHODS A systematic search strategy using key words related to neuropsychiatry was carried out to identify various studies published in Indexed and Non-indexed databases. RESULTS We identified 108 studies from Indexed data bases (77.8% Medline; 22.2% PsychInfo). Beside these, 51 studies were also identified from non-indexed databases. Among the indexed articles, 97 (89.8%) were Journal articles while 10 were other type of documents--there were 3 clinical trials of which only one was a randomized controlled trial. The mean Impact Factor (IF) of these studies was 2.75 (Range; 2.21-3.29). The median IF was 2.90. The most preferred journal for publication was the Journal of Pakistan Medical Association (JPMA; N = 33) followed by British Journal of Psychiatry (B J Psych; N = 11) and Journal of College of Physicians and Surgeons, Pakistan (JCPSP; N = 9). From the indexed and non-indexed publications we identified 43 researchers. Among these 34 (80%) were psychiatrists. CONCLUSION The key finding of this mental health research mapping exercise is that mental health research output from Pakistan is low both in numbers and quality, with very few studies making it to high impact international journals. There is an urgent need to strengthen research capacity in areas of mental health at individual, organizational and macro-system levels.
Collapse
Affiliation(s)
- Haider A Naqvi
- Department of Psychiatry, The Aga Khan University, Karachi
| | | |
Collapse
|
34
|
Naqvi HA, Khan MM. Pathway to psychiatric care in Karachi. J Coll Physicians Surg Pak 2006; 16:438-9. [PMID: 16787629 DOI: 6.2006/jcpsp.438439] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/13/2005] [Accepted: 05/16/2006] [Indexed: 11/04/2022]
Affiliation(s)
- Haider A Naqvi
- Department of Psychiatry, The Aga Khan University Hospital, Karachi, Pakistan.
| | | |
Collapse
|