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Amin A, Cardoso SA, Suyambu J, Abdus Saboor H, Cardoso RP, Husnain A, Isaac NV, Backing H, Mehmood D, Mehmood M, Maslamani ANJ. Future of Artificial Intelligence in Surgery: A Narrative Review. Cureus 2024; 16:e51631. [PMID: 38318552 PMCID: PMC10839429 DOI: 10.7759/cureus.51631] [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] [Accepted: 01/03/2024] [Indexed: 02/07/2024] Open
Abstract
Artificial intelligence (AI) is the capability of a machine to execute cognitive processes that are typically considered to be functions of the human brain. It is the study of algorithms that enable machines to reason and perform mental tasks, including problem-solving, object and word recognition, and decision-making. Once considered science fiction, AI today is a fact and an increasingly prevalent subject in both academic and popular literature. It is expected to reshape medicine, benefiting both healthcare professionals and patients. Machine learning (ML) is a subset of AI that allows machines to learn and make predictions by recognizing patterns, thus empowering the medical team to deliver better care to patients through accurate diagnosis and treatment. ML is expanding its footprint in a variety of surgical specialties, including general surgery, ophthalmology, cardiothoracic surgery, and vascular surgery, to name a few. In recent years, we have seen AI make its way into the operating theatres. Though it has not yet been able to replace the surgeon, it has the potential to become a highly valuable surgical tool. Rest assured that the day is not far off when AI shall play a significant intraoperative role, a projection that is currently marred by safety concerns. This review aims to explore the present application of AI in various surgical disciplines and how it benefits both patients and physicians, as well as the current obstacles and limitations facing its seemingly unstoppable rise.
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Affiliation(s)
- Aamir Amin
- Cardiothoracic Surgery, Harefield Hospital, Guy's and St Thomas' NHS Foundation Trust, London, GBR
| | - Swizel Ann Cardoso
- Major Trauma Services, University Hospital Birmingham NHS Foundation Trust DC, Birmingham, GBR
| | - Jenisha Suyambu
- Medicine, University of Perpetual Help System Data - Jonelta Foundation School of Medicine, Las Piñas, PHL
| | | | - Rayner P Cardoso
- Medicine and Surgery, All India Institute of Medical Sciences, Jodhpur, Jodhpur, IND
| | - Ali Husnain
- Radiology, Northwestern University, Lahore, PAK
| | - Natasha Varghese Isaac
- Medicine and Surgery, St John's Medical College Hospital, Rajiv Gandhi University of Health Sciences, Bengaluru, IND
| | - Haydee Backing
- Medicine, Universidad de San Martin de Porres, Lima, PER
| | - Dalia Mehmood
- Community Medicine, Fatima Jinnah Medical University, Lahore, PAK
| | - Maria Mehmood
- Internal Medicine, Shalamar Medical and Dental College, Lahore, PAK
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Iqbal J, Mansour MNM, Saboor HA, Suyambu J, Lak MA, Zeeshan MH, Hafeez MH, Arain M, Mehmood M, Mehmood D, Ashraf M. Role of deep brain stimulation (DBS) in addiction disorders. Surg Neurol Int 2023; 14:434. [PMID: 38213452 PMCID: PMC10783698 DOI: 10.25259/sni_662_2023] [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: 08/06/2023] [Accepted: 11/19/2023] [Indexed: 01/13/2024] Open
Abstract
Background Addiction disorders pose significant challenges to public health, necessitating innovative treatments. This assesses deep brain stimulation (DBS) as a potential intervention for addiction disorders. Methods A literature review was carried out with a focus on the role of DBS in addiction disorders and its future implications in neurosurgical research. Results The online literature shows that DBS precisely modulates certain brain regions to restore addiction-related neural circuits and promote behavioral control. Conclusion Preclinical evidence demonstrates DBS's potential to rebalance neural circuits associated with addiction, and early clinical trials provide encouraging outcomes in enhancing addiction-related outcomes. Ethical considerations, long-term safety, and personalized patient selection require further investigation.
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Affiliation(s)
- Javed Iqbal
- School of Medicine, King Edward Medical University, Lahore, Pakistan
| | | | | | - Jenisha Suyambu
- Department of Neurosurgery, Jonelta Foundation School of Medicine, University of Perpetual Help System Dalta, Las Pinas City, Philippines
| | - Muhammad Ali Lak
- School of Medicine, Combined Military Hospitals (CMH) Lahore Medical College and Institute of Dentistry, Lahore, Pakistan
| | | | | | - Mustafa Arain
- School of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Maria Mehmood
- School of Medicine, Shalamar Medical and Dental College, Lahore, Pakistan
| | - Dalia Mehmood
- School of Medicine, Fatima Jinnah Medical University, Sir Ganga Ram Hospital, Lahore, Pakistan
| | - Mohammad Ashraf
- Wolfson School of Medicine, University of Glasgow, Scotland, United Kingdom
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Iqbal J, Naeem A, Jahangir K, Ali Y, Mashkoor Y, Ashraf A, Mehmood D, Mehmood M, Brandon LW. Hyperbaric Oxygen and Outcomes Following the Brain Injury: A Systematic Review. J Neurol Res Rev Rep 2023; 5:178. [PMID: 37576437 PMCID: PMC10421647 DOI: 10.47363/jnrrr/2023(5)178] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/15/2023]
Abstract
Introduction Hyperbaric oxygen therapy (HBO2) aims to address ischemia resulting from brain injury by subjecting patients to an atmosphere that dramatically raises the concentration of inspired oxygen (100% O2 at greater than 1 ATA). This results in elevated levels of oxygen in the plasma, which in turn boosts the delivery of oxygen for diffusion to the brain tissue. Objective To study the efficacy of hyperbaric oxygen (HBO)-based modalities in brain injury. Method Preferred reporting items for systematic reviews protocol was applied to perform literature search regarding this analytical review. Results In our study, fifteen studies are included in this review, involving 1067 people. The mean age group of patients enrolled was 57.0±11.6 and the mean NIHSS score was 10.5±8.7, of which 21 participants had moderate to severe neurological impairment. The total number of HBO treatments was 8 to 70 times (28.3±17.9), at the end of the 6-month follow-up period. mRS (modified Rankin scale) ≤3 was found in 25 cases, of which 12 patients with high-grade aSAH recovered. Poor prognosis was prevalent in patients who experienced delayed cerebral ischemia, this was true for 22.7% of patients in this study. In 3 studies conducted by Rockswold, ICP (mm Hg) was significantly lower in the HBO2 group after the treatment than pretreatment. (p<0.05). 4 studies showed an improvement in GCS score after HBO2 therapy.One trial (Imai 2006) reported that three patients in the HBO group died due to pneumonia (two) and heart failure (one) and one patient died in the control group due to heart failure. Overall, it is relatively safe to use HBO in the treatment of brain-related haemorrhage, strokes, and injury as there were no major complications reported. Conclusion This systematic review demonstrates that HBO2 has significant clinical potential in treatment of brain related haemorrhages, stroke and injury.
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Affiliation(s)
- Javed Iqbal
- King Edward Medical University Lahore Pakistan
| | - Abdullah Naeem
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Kainat Jahangir
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Yumna Ali
- Faculty of Medicine, Dow Medical College, Dow University of Health Sciences
| | - Yusra Mashkoor
- Department of Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | | | | | - Maria Mehmood
- Graduate of Shalamar Medical and Dental College Lahore year 2021
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Dar SF, Mehmood M, Zafar A, Shah SR, Ateeq M. Two cases of complicated jejunal diverticulosis in a low-resource peripheral teaching hospital. J PAK MED ASSOC 2023; 73:184-186. [PMID: 36842037 DOI: 10.47391/jpma.5337] [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: 01/20/2023]
Abstract
Jejunal diverticula, like other intestinal diverticula, can become complicated and present as acute abdomen. Diagnosis is difficult and management in complicated cases can be surgical as well as conservative. We present two cases of complicated jejunal diverticulosis that presented with acute abdomen and were managed surgically. Post-operative recovery was satisfactory. Jejunal diverticula is a diagnostic challenge in a low-resource peripheral hospital.
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Affiliation(s)
- Salman Farooq Dar
- Department of Surgery, Aziz Bhatti Shaheed Teaching Hospital, Nawaz Sharif Medical College, Gujrat, Pakistan
| | - Maria Mehmood
- Department of Surgery, Aziz Bhatti Shaheed Teaching Hospital, Nawaz Sharif Medical College, Gujrat, Pakistan
| | - Adnan Zafar
- Department of Surgery, Aziz Bhatti Shaheed Teaching Hospital, Nawaz Sharif Medical College, Gujrat, Pakistan
| | - Saleem Raza Shah
- Department of Surgery, Aziz Bhatti Shaheed Teaching Hospital, Nawaz Sharif Medical College, Gujrat, Pakistan
| | - Muhammad Ateeq
- Department of Surgery, Aziz Bhatti Shaheed Teaching Hospital, Nawaz Sharif Medical College, Gujrat, Pakistan
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Jabeen K, Saleem S, Jahan S, Nizamudin S, Arshad F, Huma ZE, Raza SM, Mehmood M, Roman M, Haq FU. Molecular Characterization of Extensively Drug Resistant Salmonella Enterica Serovar Typhi Clinical Isolates from Lahore, Pakistan. Infect Drug Resist 2023; 16:2987-3001. [PMID: 37201126 PMCID: PMC10187657 DOI: 10.2147/idr.s406253] [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: 02/10/2023] [Accepted: 04/11/2023] [Indexed: 05/20/2023] Open
Abstract
Background The emergence of extensively drug-resistant (XDR) typhoid in Pakistan has endangered the treatment options available to manage this infection. Third generation cephalosporin were the empiric choice to treat typhoid fever in Pakistan, but acquisition of ESBLs have knocked them out of the arsenal. The current empiric choice is azithromycin which is vulnerable to resistance too. This study aimed to assess the burden of XDR typhoid and the frequency of resistance determinants in blood culture samples collected from different hospitals in Lahore, Pakistan. Methods A total of 835 blood cultures were collected from different tertiary care hospitals in Lahore during January 2019 to December 2021. Among 835 blood cultures, 389 Salmonella Typhi were identified, and 150 were XDR S. Typhi (resistant to all recommended antibiotics). Antibiotics resistance genes of the first-line drugs (blaTEM-1, catA1, sul1, and dhfR7) and second line drugs (gyrB, gyrA, qnrS, ParC and ParE) were investigated among XDR S. Typhi. There were different CTX-M genes isolated using the specific primers, blaCTX-M-U, blaCTX-M-1, blaCTX-M-15, blaCTX-M-2, blaCTX-M-8 and blaCTX-M-9. Results Antibiotic resistant genes of the first-line drugs were isolated with different frequency, blaTEM-1 (72.6%), catA1 (86.6%), sul1 (70%), and dhfR7 (56%). Antibiotics resistance genes of second-line drugs were isolated as: gyrB (60%), gyrA (49.3%), qnrS (32.6%), parC (44%) and parE (28%). Among CTX-M genes, blaCTX-M-U (63.3%) was the most frequent followed by blaCTX-M-15 (39.3%) and blaCTX-M-1 (26%). Conclusion Our study concluded that XDR isolates circulating in Pakistan have acquired first-line and second-line antibiotic resistant genes quite successfully along with CTX-M genes (ESBLs) rendering them resistant to the third generation cephalosporins as well. Emergence of azithromycin resistance in XDR S. Typhi which is currently used as an empiric treatment option is worrisome and needs to be monitored carefully in endemic countries like Pakistan.
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Affiliation(s)
- Kokab Jabeen
- Department of Microbiology, University of Health Sciences, Lahore, Pakistan
- Correspondence: Kokab Jabeen, Tel +92 3128878893, Email
| | - Sidrah Saleem
- Department of Microbiology, University of Health Sciences, Lahore, Pakistan
| | - Shah Jahan
- Department of Microbiology, University of Health Sciences, Lahore, Pakistan
| | - Summiya Nizamudin
- Department of Microbiology, Shaukat Khanum Memorial Cancer Hospital & Research Centre, Lahore, Pakistan
| | - Faiqa Arshad
- Department of Microbiology, University of Health Sciences, Lahore, Pakistan
| | - Zill-e Huma
- Department of Microbiology, University of Health Sciences, Lahore, Pakistan
| | - Syed Mohsin Raza
- Department of Allied Health Sciences, University of Health Sciences, Lahore, Pakistan
| | - Maria Mehmood
- Department of Microbiology, University of Health Sciences, Lahore, Pakistan
| | - Muhammad Roman
- Department of Microbiology, University of Health Sciences, Lahore, Pakistan
| | - Faiz Ul Haq
- Department of Microbiology, University of Health Sciences, Lahore, Pakistan
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Khan A, Faisal M, Aslam B, Anwar H, Mehmood M, Aslam N, Roobi A, Aslam J, Muzaffar H, Mehmood A, Majeed L, Ahmad N, Haider U. Studying the wnt/beta- catenin and microrna signaling crosstalk in CTNNB1and ABCG2 genes expression in prostate cancer. EUR UROL SUPPL 2022. [DOI: 10.1016/s2666-1683(22)02357-6] [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] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
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Gallagher E, Mehmood M, Lavan A, Kenny RA, Briggs R. 179 WHAT IS THE RISK OF FALLS DUE TO PSYCHOTROPIC MEDICATIONS IN A LARGE POPULATION-REPRESENTATIVE COHORT OF COMMUNITY-DWELLING OLDER PEOPLE? Age Ageing 2022. [DOI: 10.1093/ageing/afac218.153] [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: 11/13/2022] Open
Abstract
Abstract
Background
Psychotropic medications including antidepressants, anticholinergics, benzodiazepines, ‘Z’ drugs and antipsychotics, are frequently identified as Falls Risk Increasing Drugs (FRIDS), yet there is a relative lack of robust data detailing the prospective risk of falls associated with these drug classes.
Methods
Participants aged ≥65 years from the Irish Longitudinal Study on Ageing (TILDA) were included and followed from Waves 1 to 5 (Mean 7.6 years follow-up). Incidence of falls was ascertained by self-report and unexplained falls were defined as falls not caused by a slip or trip with no apparent cause. Medication lists were examined for medications of interest. Logistic Regression models, reporting odds ratio with 95% confidence intervals, were used to assess the association between medication classes and incident fall types and were adjusted for relevant covariates.
Results
2,090 participants were included (mean age at baseline 72 years, 53% female). During follow-up, over half of participants (52%, n=1,089) had a fall, with one quarter (25%, n=526) reporting an unexplained fall and almost one fifth (19%, n=394) reporting a fall causing injury. Anti-depressants were associated with an increased risk of falling (OR=3.01, 1.98-4.58, p<0.001), injurious falls (OR=1.96, 1.37-2.81, p<0.001) and unexplained falls (OR=2.71, 1.88-3.91, p<0.001) in fully adjusted models. Anti-cholinergic medications were associated with an increased risk of falling (OR=1.79, 1.11-2.88, p=0.017) and of unexplained falls (OR=1.89, 1.19-3.01, p=0.007). ‘Z’ drugs were associated with an increased risk of falling (OR=2.96, 1.64-5.32, p<0.001) and of injurious falls (OR=2.05, 1.26-3.34, p=0.004). Benzodiazepines and Anti-psychotics were not associated with incident falls in fully adjusted models.
Conclusion
Anti-depressants, anti-cholinergic medications and ‘Z’ drugs are independently associated with an increased falls risk. Given the profound impact falls can have on functional trajectory and quality of life, regular review of ongoing need for these medications should be central to the comprehensive geriatric assessment.
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Affiliation(s)
- E Gallagher
- St. James’s Hospital Mercer’s Institute of Successful Ageing, , Dublin, Ireland
| | - M Mehmood
- St. James’s Hospital Department of Emergency Medicine, , Dublin, Ireland
| | - A Lavan
- St. James’s Hospital Mercer’s Institute of Successful Ageing, , Dublin, Ireland
- Trinity College Dublin Discipline of Medical Gerontology, , Dublin, Ireland
- Trinity College Dublin The Irish Longitudinal Study on Ageing, , Dublin, Ireland
| | - RA Kenny
- St. James’s Hospital Mercer’s Institute of Successful Ageing, , Dublin, Ireland
- Trinity College Dublin Discipline of Medical Gerontology, , Dublin, Ireland
- Trinity College Dublin The Irish Longitudinal Study on Ageing, , Dublin, Ireland
| | - R Briggs
- St. James’s Hospital Mercer’s Institute of Successful Ageing, , Dublin, Ireland
- Trinity College Dublin Discipline of Medical Gerontology, , Dublin, Ireland
- Trinity College Dublin The Irish Longitudinal Study on Ageing, , Dublin, Ireland
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Khan A, Faisal M, Aslam B, Anwar H, Muzaffar H, Roobi A, Aslam N, Majeed L, Ali S, Aslam J, Mehmood M, Tanveer Q, Mahmood A. 39P Understanding the crosstalk between micro-RNA and Wnt signaling cascade associated with the expression level of HOXB13 and SRC genes in female breast cancer. Ann Oncol 2022. [DOI: 10.1016/j.annonc.2022.03.054] [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] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Mehmood M, Usman Khan H, Khan MI, Khan I, Al-Raddadi RM, Harakeh S, Yousafzai YM. Trajectory of anti-SARS-COV-2 IgG antibodies from onset of symptoms to 6 months in a cohort of Pakistani patients. Infect Dis (Lond) 2022; 54:460-463. [PMID: 35147051 DOI: 10.1080/23744235.2022.2033312] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Maria Mehmood
- Department of Pathology, Khyber Medical College, Peshawar, Pakistan
| | - Haleema Usman Khan
- Institute of Pathology and Diagnostic Medicine, Khyber Medical University, Peshawar, Pakistan
| | | | - Ishaq Khan
- Institute of Basic Medical Sciences, Khyber Medical University, Peshawar, Pakistan
| | | | - Steve Harakeh
- Special Infectious Agents Unit, King Fahd Medical Research Center, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Yasar Mehmood Yousafzai
- Institute of Pathology and Diagnostic Medicine, Khyber Medical University, Peshawar, Pakistan.,Institute of Infection, Immunity and Inflammation, University of Glasgow, Glasgow, UK
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Abbas S, Imtiaz-ud-Din, Mehmood M, Raheel A, Ayub R, Zahid M, Tahir MN. Synthesis and Structural Characterization of Bioactive Ferrocenyl Substituted Hydrazones. RUSS J COORD CHEM+ 2021. [DOI: 10.1134/s107032842112006x] [Citation(s) in RCA: 1] [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: 12/16/2022]
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Howley F, Lavan A, McMahon G, Mehmood M, Briggs R. 162 TRENDS IN EMERGENCY DEPARTMENT USE BY OLDER PEOPLE DURING THE COVID-19 PANDEMIC. Age Ageing 2021. [PMCID: PMC8690002 DOI: 10.1093/ageing/afab216.162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background Older people have been disproportionately affected by the COVID-19 pandemic with reports suggesting that many older people deferred seeking healthcare during the pandemic due to fear of contracting COVID-19. The aim of this study was to examine trends of emergency department (ED) use by older people during the first wave of the COVID-19 pandemic compared to previous years. Methods The study site is a 1,000-bed university teaching hospital with annual ED new-patient attendance of >50,000. All ED presentations of patients aged ≥70 years from March–August 2020, 2019 and 2018 inclusive (n = 13,989) were reviewed and compared for presenting complaint, Manchester Triage Score, and admission/discharge decision. Results There was a 16% reduction in presentations across the 6 months in 2020 compared to the average of 2018/2019. On average 4 fewer people aged ≥70 years presented to the ED per day in 2020. Much of this was concentrated in March (33% fewer presentations) and April (31% fewer presentations), when the country was in ‘lockdown’, i.e. non-essential journeys were banned. There was a 20% reduction in patients presenting with stroke and cardiac complaints. In the three months following easing of restrictions, there was a 25% increase in falls and orthopaedic injuries when compared to 2018/2019. Conclusion This study demonstrates a significant decline in the number of older people presenting to the ED for unscheduled care, including for potentially time-dependent illnesses such as stroke or cardiac complaints. Presenting to the ED remains the most frequent route by which unwell older people access acute hospital care and it is vitally important that they continue to do so in a timely manner when necessary. Given the possibility of further lockdowns and restrictions, this message needs to be communicated to older people clearly by healthcare professionals and governmental bodies to mitigate against adverse outcomes related to delayed or deferred care.
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Affiliation(s)
- F Howley
- Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland,Department of Emergency Medicine, St James's Hospital, Dublin, Ireland
| | - A Lavan
- Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
| | - G McMahon
- Department of Emergency Medicine, St James's Hospital, Dublin, Ireland
| | - M Mehmood
- Department of Emergency Medicine, St James's Hospital, Dublin, Ireland
| | - R Briggs
- Mercer's Institute for Successful Ageing, St James's Hospital, Dublin, Ireland
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Bengali R, Siddiqi DA, Mehmood M, Khan AA, Baig Q, Khan AJ, Chandir S. Feasibility of youth empowerment initiative for identifying never- and under-immunized children. Eur J Public Health 2021. [DOI: 10.1093/eurpub/ckab165.555] [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: 11/15/2022] Open
Abstract
Abstract
Background
One-in-every 5 children globally remains deprived of life-saving vaccines. We developed and implemented the Adolescent Health and Leadership Program (AHLP) among school girls from grades 8-10 (Kiran Sitaras (KSs); Shining Stars) to provide them with soft skills and community mobilization skills and equipping them to become community advocates for immunization. We evaluated the feasibility of KS community mobilization through validating KSs' ability to accurately identify and link never- and under-immunized children with immunization services.
Methods
We implemented a mixed-methods study in six public schools located in peri-urban areas of Karachi, Pakistan. After the development and roll-out of AHLP in schools, KSs conducted door-to-door visits in their neighborhoods to identify never-and under-immunized children. This was followed by verification visits by field staff to establish accuracy and immunization camps to vaccinate never- and under-immunized children identified by KSs.
Results
From January 28 to February 22, 2020, 591 KSs visited 10,330 households, screened 3,295 under-2 children and identified 7.5% (247/3,295) never- and 27.0% (889/3,295) under-immunized children, with an accuracy of 90.4% and 49.6%, respectively. In January 2021, 291 never- and under-immunized children were invited to immunization camps, of which 28.9% (84/291) received vaccinations, while 57.0% (166/291) did not respond to the invite and 14.1% (41/291) were deemed ineligible (illness, overage, etc.).
Conclusions
We demonstrated the feasibility of empowering adolescent girls to boost immunization uptake in LMIC settings. Engaging young women from within the community provides an organic and sustainable solution for promoting immunization coverage and equity today and ensuring they will continue to champion the cause in their capacity as tomorrow's mothers. We are actively scaling-up our solution across the country to create a force of 100,000+ KSs to magnify our efforts.
Key messages
The Kiran Sitara initiative, via its community-centered approach, leverages the force of adolescent school girls to boost demand and referrals for immunization in unreached geographical pockets. The Kiran Sitara initiative utilizes the power of youth engagement to identify never- and under-immunized children, and subsequently increase vaccine-uptake.
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Affiliation(s)
- R Bengali
- MCH, IRD Pakistan, Karachi, Pakistan
| | | | - M Mehmood
- MCH, IRD Pakistan, Karachi, Pakistan
| | - AA Khan
- MCH, IRD Pakistan, Karachi, Pakistan
| | - Q Baig
- MCH, IRD Pakistan, Karachi, Pakistan
| | - AJ Khan
- MCH, IRD Global, Singapore, Singapore
| | - S Chandir
- MCH, IRD Global, Singapore, Singapore
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA
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Chandir S, Siddiqi DA, Mehmood M, Iftikhar S, Siddique M, Jai S, Dharma VK, Khan AA, Akhter MA, Khan AJ. 1-year impact of COVID-19 on childhood immunizations in Pakistan: analysis of > 3.7 million children. Eur J Public Health 2021. [PMCID: PMC8574899 DOI: 10.1093/eurpub/ckab164.538] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Covid-19 has universally disrupted primary health care, but routine childhood immunizations are one the most affected services. We analyzed big data in vaccines for measuring the 1-year impact of Covid-19 on outline childhood immunizations for the 48 million population in the Sindh province of Pakistan. We extracted and analyzed >3.7m real-time immunization records of 0-23 months old children from the Sindh Government's Electronic Immunization Registry (EIR). Using a 6-month baseline preceding the COVID-19 lockdown, we quantified the lockdown's (March 23-May 9, 2020) impact on daily immunization rates by geographical area and the change in coverage rates at the one-year mark since the lockdown. The lockdown resulted in 53% drop in the number of immunizations. The impact in rural areas as more than in urban areas (54.9% decline vs 47.5% decline from baseline), and slums had a slightly larger decrease in immunization coverage than non-slum areas (53.8% vs. 51.3%). Of 1,246,321 children who missed immunizations during first year of the pandemic, 76% of these children were eventually vaccinated by the end of March 2021. Similarly, of the 417,553 children who had dropped out during the initial 7-week national lockdown (March 23-May 10, 2020), 79% were immunized by March 2021. Our analysis of EIR data shows that the catch-up and recovery of coverage rates have primarily been driven through intensive outreach vaccination efforts instead of an increase in demand. One year since the onset of the pandemic, the average daily immunization doses administered through outreach increased by 121 percent above baseline estimates. In contrast, vaccines administered at immunization clinics were still 22 percent below baseline. The example of Pakistan shows LMICs can successfully deploy mitigation strategies to catch up with missed children during Covid-19 and sustain routine childhood immunizations to close immunity gaps. Key messages Although the lockdown resulted in a 53% drop in immunizations, at the 1-year mark since the pandemic started, 76% of children who missed immunizations are vaccinated. Pakistan data shows LMICs can rectify routine immunization coverage and immunity gaps and rebound successfully to their pre-COVID-19 coverage rates.
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Affiliation(s)
- S Chandir
- Maternal & Child Health, IRD Pakistan, Karachi, Pakistan
- IRD Global, Singapore, Singapore
| | | | - M Mehmood
- Maternal & Child Health, IRD Pakistan, Karachi, Pakistan
| | - S Iftikhar
- Maternal & Child Health, IRD Pakistan, Karachi, Pakistan
| | - M Siddique
- Maternal & Child Health, IRD Pakistan, Karachi, Pakistan
| | - S Jai
- Maternal & Child Health, IRD Pakistan, Karachi, Pakistan
| | - VK Dharma
- Maternal & Child Health, IRD Pakistan, Karachi, Pakistan
| | - AA Khan
- Maternal & Child Health, IRD Pakistan, Karachi, Pakistan
| | - MA Akhter
- Maternal & Child Health, IRD Pakistan, Karachi, Pakistan
| | - AJ Khan
- IRD Global, Singapore, Singapore
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Mehmood M, Siddiqi DA, Abdullah S, Baig Q, Khan AJ, Chandir S. Empowering adolescent girls and creating lifelong champions to improve immunization coverage. Eur J Public Health 2020. [DOI: 10.1093/eurpub/ckaa166.918] [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: 11/12/2022] Open
Abstract
Abstract
Background
Despite the global imperative to 'leave no child behind', one in every 5 children remain deprived of life-saving vaccines. Low immunization coverage is in part due to the weak linkages between community and health system, inaccessibility of outsiders to closely-knit societies and low parental awareness regarding immunizations. The Kiran Sitara (Shining Stars; KS) Adolescent Health and Leadership Program (AHLP), was implemented using adolescent girls (Kiran Sitaras-KSs) as the agents of change, who by virtue of belonging to the community were able to cause a ripple effect in boosting uptake for WHO-recommended immunizations for children under 2 years of age. Our research evaluated the feasibility of the KS community mobilization and validated KS's ability to accurately identify under-immunized and zero-dose (never-vaccinated) children.
Methods
AHLP was implemented in grades 8-10 of two public secondary schools in Shikarpur and Lakhi Town, Pakistan. From April-May, 2017, a door-to-door survey was conducted by KSs followed by visits of trained staff to verify the immunization statuses identified by KSs.
Results
KSs (N = 45) screened 207 children and identified under-immunized and zero-dose children with an accuracy of 74% and 94% respectively.
Conclusions
Our strategy of mobilizing girls from within the communities provides a promising avenue to provide immunization services in high-risk areas that cannot be penetrated through conventional mechanisms. We are actively scaling-up our sustainable solution by implementing AHLP in 250+ schools and creating a force of 100,000+ KSs who can promote health equity today and champion the cause in their capacity as tomorrow's mothers.
Key messages
The Kiran Sitara initiative via its community-centered approach leverages the force of adolescent school girls to boost demand and provide referrals for immunization in unreached geographical pockets. The Kiran Sitara initiative utilizes the power of youth engagement to identify zero-dose and under-immunized children, link them to immunization services and improve knowledge among caregivers.
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Affiliation(s)
| | | | | | - Q Baig
- IRD Pakistan, Karachi, Pakistan
| | - A J Khan
- IRD Global, Singapore, Singapore
- Harvard Medical School, Boston, USA
| | - S Chandir
- IRD Global, Perry Hall, USA
- Harvard Medical School, Boston, USA
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Ahsan Baig MM, Anwaar O, Hussain M, Zahid S, Mehmood M, Saleem S. Efficacy of Prednisolone in bronchiolitis with and without family history of atopy. J PAK MED ASSOC 2019; 69:1448-1452. [PMID: 31622295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To determine decrease in respiratory distress and hospital stay in bronchiolitis patients with and without family history of atopy when treated with prednisolone. METHODS The multi-centre quasi-experimental study was conducted in three hospitals of Sialkot, Pakistan, from October 2017 to March 2018, and comprised patients of bronchiolitis who were divided into 2 groups on the basis of presence or absence of family history of atopy. Half of the patients in each group received oral prednisolone 2mg/kg/day for three consecutive days along with supportive care, and the remaining half received only supportive care. Patients were monitored at 12 and 24 hours for clinical response using Modified Respiratory distress Assessment Instrument score. Length of hospital stay was monitored upto 72 hours. SPSS 20 was used for data analysis. RESULTS Of the 212 patients, 72(34%) were in the atopic group and 140(66%) in the non-atopic group. In atopic group, there was a significant respiratory distress difference observed between steroid and non-steroid subgroups at 24 hours (p=0.001) and all (100%) patients in the steroid subgroup got discharged at 24 hours, while only 8(22%) were discharged in the non-steroid subgroup. In non-atopic group, no significant improvement in corresponding terms was observed (p>0.05). CONCLUSIONS Oral prednisolone in bronchiolitis was found to be only effective in patients with family history of atopy.
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Affiliation(s)
| | - Osama Anwaar
- Allama Iqbal Memorial Teaching hospital, Sialkot
| | | | - Saman Zahid
- Khawaja Muhammad Safdar Medical College, Sialkot
| | | | - Saba Saleem
- Allama Iqbal Memorial Teaching hospital, Sialkot
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Agarwala S, Vijayvargiya M, Mehmood M. Protection of trunnion during revision total hip arthroplasty. Ann R Coll Surg Engl 2019; 101:532-533. [PMID: 31155925 DOI: 10.1308/rcsann.2019.0084] [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: 11/22/2022] Open
Affiliation(s)
- S Agarwala
- Department of Surgery, PD Hinduja Hospital Medical Research Centre, Mumbai, India
| | - M Vijayvargiya
- Department of Orthopedics, PD Hinduja Hospital and Medical Research Centre, Mumbai, India
| | - M Mehmood
- Department of Orthopedics, PD Hinduja Hospital and Medical Research Centre, Mumbai, India
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Baig M, Anwaar O, Hussain M, Zahid S, Mehmood M, Saleem S. Efficacy of Prednisolone in bronchiolitis with and without family history of atopy. J PAK MED ASSOC 2019. [DOI: 10.5455/jpma.296296] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Mehmood M, Hor K, Al-Khalidi H, Benson D, Jefferies J, Taylor M, Egnaczyk G, Raman S, Basu S, Cripe L, Mazur W. Comparison of Right and Left Ventricular Systolic Function Indices in Duchenne Muscular Dystrophy: A Longitudinal Cardiac Magnetic Resonance Study. J Heart Lung Transplant 2015. [DOI: 10.1016/j.healun.2015.01.931] [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] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Khasawneh FA, Karim A, Mahmood T, Ahmed S, Jaffri SF, Tate ME, Mehmood M. Antibiotic de-escalation in bacteremic urinary tract infections: potential opportunities and effect on outcome. Infection 2014; 42:829-34. [DOI: 10.1007/s15010-014-0639-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2014] [Accepted: 05/19/2014] [Indexed: 12/13/2022]
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