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Sharieff S, Rafai W, Manzoor A, Idrees A, Ahmad B, Ghulam M, Shabbir MU. Experience of Sustained Low-Efficiency Dialysis (SLED) in an Intensive Care Unit of a Quaternary Care Hospital. Cureus 2024; 16:e54376. [PMID: 38505436 PMCID: PMC10950314 DOI: 10.7759/cureus.54376] [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: 02/16/2024] [Indexed: 03/21/2024] Open
Abstract
BACKGROUND In critically ill patients, sustained low-efficiency dialysis (SLED) has become a viable option for treating acute kidney injury (AKI) instead of continuous renal replacement therapy (CRRT). This study aimed to evaluate clinical outcomes in critically ill patients receiving SLED. MATERIAL AND METHODS In our ICU, we performed a retrospective cohort study on hemodynamically unstable patients requiring dialysis in the form of SLED. Demographics, clinical, and biochemical variables were analyzed. RESULTS A total of 58 patients were enrolled in the study. The mean age was 48.58 ± 15 with a male-to-female ratio of 3:1. Higher APACHE II score, high international normalized ratio, thrombocytopenia, and septic shock were found to be poor prognostic markers, with an overall observed mortality of 56.9%. CONCLUSION SLED can be considered as an alternative to CCRT for selected hemodynamically unstable patients requiring renal replacement therapy.
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Affiliation(s)
- Saleem Sharieff
- Critical Care Medicine, Pakistan Kidney and Liver Institute and Research Centre, Lahore, PAK
- Critical Care Medicine, Grand River Hospital, Kitchener, CAN
| | - Wajid Rafai
- Critical Care Medicine, Pakistan Kidney and Liver Institute and Research Centre, Lahore, PAK
| | - Adil Manzoor
- Nephrology, Pakistan Kidney and Liver Institute and Research Centre, Lahore, PAK
| | - Asim Idrees
- Critical Care Medicine, Pakistan Kidney and Liver Institute and Research Centre, Lahore, PAK
| | - Burhan Ahmad
- Critical Care Medicine, Pakistan Kidney and Liver Institute and Research Centre, Lahore, PAK
| | - Madiha Ghulam
- Critical Care Medicine, Pakistan Kidney and Liver Institute and Research Centre, Lahore, PAK
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Iqbal R, Khan Niazi MA, Shabbir MU, Raza U, Saleem A, Bhatti T. Association Of Biochemical Markers With COVID-19 Severity In Pakistan. J PAK MED ASSOC 2023; 73:1403-1407. [PMID: 37469051 DOI: 10.47391/jpma.6843] [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: 07/21/2023]
Abstract
Objective To evaluate demographics, biochemical markers and clinical features of patients suffering from coronavirus disease-2019. METHODS The cross-sectional study was conducted retrospectively at the Capital Hospital, Islamabad, and the Fauji Foundation Hospital, Rawalpindi, Pakistan, from October 08, 2021 to March 01, 2022 and comprised patients of either gender with coronavirus disease-2019 diagnosed on the basis of reverse transcriptase polymerase chain reaction. Patients' demographic, clinical and laboratory findings were obtained using patient charge sheets. Coronavirus disease-2019 was categorised as non-severe, severe and critical, according to the World Health Organisation criteria. Data was analysed using SPSS 26. RESULTS Of the 431 patients, 91(21.1%) were men and 340(78.9%) were women. The overall mean age was 60.75±14.45 years. Of the total, 148(34.3%) had non-severe, 190(44.1%) severe and 93(21.6%) had critical condition at the time of admission. Hypertension 307(71.2%) and diabetes mellitus 249(57.8%) were the most common comorbidities, while fever 353(81.9%), shortness of breath 339(78.7%) and cough 302(70.1%) were the most common symptoms reported. Higher age was significantly associated with coronavirus disease-2019 severity (p<0.001). Among comorbidities, chronic kidney disease (p<0.001) and cancer (p=0.046), and, among signs and symptoms, shortness of breath (p=0.002) and chest pain (p=0.021), were significantly associated with coronavirus disease-2019 severity. Serum total bilirubin, alanine aminotransferase, urea and creatinine levels had significant association with disease severity (p<0.001). Total leukocyte count, neutrophil-to-lymphocyte ratio, prothrombin time, and plasma D-Dimer levels had significant association with disease severity (p<0.001). Serum ferritin, lactate dehydrogenase and interleukin-6 levels were also significantly associated with disease severity (p<0.05). Conclusion Assessment of biochemical markers was an excellent way to monitor disease progression in coronavirus disease-2019 patients.
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Affiliation(s)
- Rashid Iqbal
- Department of Medical Technology, Shifa College of Medical Technology, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Muhammad Aamir Khan Niazi
- Department of Medical Technology, Shifa College of Medical Technology, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Muhammad Usman Shabbir
- Department of Medical Technology, Shifa College of Medical Technology, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Umama Raza
- Department of Medical Technology, Shifa College of Medical Technology, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Alina Saleem
- Department of Medical Technology, Shifa College of Medical Technology, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | - Theophilus Bhatti
- Department of Medical Technology, Shifa College of Medical Technology, Shifa Tameer-e-Millat University, Islamabad, Pakistan
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Malik S, Zaki A, Shabbir MU, Hussain T. Plasmablastic Lymphoma Mimicking Osteomyelitis of Femur in an Immunocompetent Individual: A Case Report. Cureus 2022; 14:e21183. [PMID: 35165629 PMCID: PMC8837809 DOI: 10.7759/cureus.21183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2022] [Indexed: 11/05/2022] Open
Abstract
Plasmablastic lymphoma (PBL) is an aggressive type of diffuse large B-cell lymphoma. It is most commonly seen in patients with human immunodeficiency virus (HIV) infection and other immunodeficiencies manifesting commonly in the form of oral lesions. Here, we report a case of an HIV-negative, immunocompetent elderly male who presented with a painful solitary tender lesion on the right anterior lateral thigh. A preliminary diagnosis of osteomyelitis (right femur) from a possibly infected dynamic compression plate was made following initial ultrasound and MRI of the right lower extremity. An attempt was made to incise and drain the lesion, which was abruptly stopped as it resulted in drainage of copious blood, leading to hemodynamic instability. Histopathology of the specimen revealed findings consistent with PBL. The diagnosis of PBL was further confirmed by immunohistochemical staining, which was positive for CD138, MUMI, and CD56 and negative for CD20 and ALK. Due to its rarity and heterogeneous presentations, PBL could be easily overlooked clinically in immunocompetent patients. Therefore, our case highlights the importance of considering the diagnosis of PBL even in lesions whose course is consistent with other infectious bone pathologies.
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Nawaz Z, Rasool MH, Siddique AB, Zahoor MA, Muzammil S, Shabbir MU, Javaid A, Chaudhry M. Prevalence and risk factors of Syphilis among blood donors of Punjab, Pakistan. Trop Biomed 2021; 38:106-110. [PMID: 33797532 DOI: 10.47665/tb.38.1.019] [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: 11/21/2022]
Abstract
Syphilis is a sexually transmitted disease and its actual prevalence among Pakistani blood donors is currently unknown. A cross sectional study was conducted at different district healthcare hospitals of Punjab, Pakistan with an aim to evaluate the prevalence and risk factors associated with syphilis in blood donors using immunochromatographic test (ICT) and enzyme linked immunosorbent assay (ELISA). A total (n=1200) blood samples were collected from donors aged 18-65 years. All the information regarding personal data, demographic data and risk factors was collected via structured questionnaire. On the basis of ICT and ELISA, the overall prevalence of syphilis was 3.91% among blood donors. The demographic factors positively linked with syphilis were age (P= 0.000; Odds ratio, OR= 7.18; 95% confidence interval CI= 2.816-18.295) and education status (P= 0.000; Odds ratio, OR= 12.33; 95% confidence interval CI= 3.469-43.849) of donors. Similarly among the risk factors analyzed, marital status (P= 0.012; Odds ratio OR= 2.251; 95% confidence interval CI= 1.206- 4.202) and blood transfusion history (P= 0.030; Odds ratio OR= 1.981; 95% confidence interval CI= 1.083-3.623) were also strongly associated with syphilis. We emphasized the importance of promoting preventive measures for syphilis. The syphilis diagnosis should not be based on a single test. The present study indicates that higher prevalence is alarming for blood donors in Pakistan. Stringent donor screening is highly recommended to ensure maximum safe blood transfusion.
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Affiliation(s)
- Z Nawaz
- Department of Microbiology, Government College University Faisalabad, Punjab, Pakistan
| | - M H Rasool
- Department of Microbiology, Government College University Faisalabad, Punjab, Pakistan
| | - A B Siddique
- Department of Microbiology, Government College University Faisalabad, Punjab, Pakistan
| | - M A Zahoor
- Department of Microbiology, Government College University Faisalabad, Punjab, Pakistan
| | - S Muzammil
- Department of Microbiology, Government College University Faisalabad, Punjab, Pakistan
| | - M U Shabbir
- Medical Laboratory Technician, DHQ Hospital, Mandi Bahauddin, Punjab, Pakistan
| | - A Javaid
- Department of Microbiology, Government College University Faisalabad, Punjab, Pakistan
| | - M Chaudhry
- Medical Laboratory Technician, DHQ Hospital, Okara, Punjab, Pakistan
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Shabbir MU, Ahmed A, Shaukat F, Zaki A, Askar G, Ansar I, Sohail MI, Khan H. Disseminated Hydatid Disease in a Child Involving Multiple Organ Systems: A Case Report. Cureus 2020; 12:e6564. [PMID: 32042534 PMCID: PMC6996532 DOI: 10.7759/cureus.6564] [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] [Indexed: 12/01/2022] Open
Abstract
Hydatid disease is a parasitic infestation by Echinococcus granulosus, which involves the liver and lungs primarily. The authors report a case of disseminated hydatid disease involving multiple organs simultaneously in a 7-year-old child from Kabul, Afghanistan. The patient under examination had been having a complaint of cough and low-grade fever for the last one year. Computed tomography (CT) and ultrasonography (USG) demonstrated cystic lesions in his liver, lungs, spleen, and suprarenal region. The literature review showed that it was very rare for hydatid disease to involve multiple organs simultaneously, even in endemic areas, and the management of disseminated disease was very challenging, especially in the pediatric population.
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Affiliation(s)
| | - Awaiz Ahmed
- Medicine, Shifa International Hospital, Islamabad, PAK
| | | | - Abdullah Zaki
- Internal Medicine, Shifa International Hospital, Islamabad, PAK
| | - Ghazan Askar
- Medicine, Shifa International Hospital, Islamabad, PAK
| | - Iqraa Ansar
- Pediatrics, Shifa International Hospital, Islamabad, PAK
| | | | - Hamza Khan
- Surgery, Shifa College of Medicine, Islamabad, PAK
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Hina S, Hasan A, Iqbal N, Shabbir MU, Sheikh AAE. Malakoplakia of the Urinary Bladder and Unilateral Ureter. J Coll Physicians Surg Pak 2019; 29:582-584. [PMID: 31133162 DOI: 10.29271/jcpsp.2019.06.582] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 11/12/2018] [Indexed: 11/11/2022]
Abstract
Malakoplakia is an unusual acquired granulomatous disease that can affect many systems including urogenital tract. It presents a huge diagnostic challenge as it can mimic malignancy. We report a 55-year diabetic woman who presented with history of macroscopic hematuria and right flank pain. On investigations, ultrasound of kidney, ureter and bladder (KUB) showed right hydronephroureter, and CT KUB showed right moderate hydronephroureter and right ureteric stone. Endoscopic examination revealed multiple white plaques involving urinary bladder and right ureter. The diagnosis of malakoplakia was based on microscopic findings that are specific for its diagnosis.
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Affiliation(s)
- Saddaf Hina
- Department of Urology, PIMS, Islamabad, Pakistan
| | - Aisha Hasan
- Department of Urology, Shifa College of Medicine, Shifa International Hospital, Islamabad, Pakistan
| | - Nadeem Iqbal
- Department of Urology, Shifa College of Medicine, Shifa International Hospital, Islamabad, Pakistan
| | - Muhammad Usman Shabbir
- Department of Urology, Shifa College of Medicine, Shifa International Hospital, Islamabad, Pakistan
| | - Abdul Ahad Ehsan Sheikh
- Department of Urology, Shifa College of Medicine, Shifa International Hospital, Islamabad, Pakistan
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Iqbal N, Assad S, Rahat Aleman Bhatti J, Hasan A, Shabbir MU, Akhter S. Comparison of Extracorporeal Shock Wave Lithotripsy for Urolithiasis Between Children and Adults: A Single Centre Study. Cureus 2016; 8:e810. [PMID: 27800291 PMCID: PMC5085830 DOI: 10.7759/cureus.810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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] [Indexed: 11/10/2022] Open
Abstract
Objective To retrospectively evaluate the effectiveness of extracorporeal shock wave lithotripsy (ESWL) for urolithiasis and compare the results between children and adults. Materials and methods From January 2011 to January 2015 (four years), ESWL was performed in 104 children and 300 adults for urolithiasis. MODULITH® SLX-F2 lithotripter (Storz Medical AG, Tägerwilen, Switzerland) equipment was used for ESWL. The stone-free rates, the number of ESWL sessions required, complication rates and ancillary procedures used were evaluated in a comparative manner. Results The mean age ± standard deviation (SD) of children was 7.84±4.22 years and of adults was a 40.22±1.57 years. Mean ± SD of the stone size was 1.28±61 cm in the adults while 1.08 ± 0.59 cm in the children. In adults, the complications included steinstrasse in six (1.98%) patients, fever in 15 (4.95%), hematuria in 19 (6.28%) and sepsis in six (1.98%) patients. In children, steinstrasse was observed in two (1.9%), mild fever in two (1.9%), hematuria in six (5.7%) and sepsis was seen in four (3.8%) patients. The overall complication rate in the adults and in the children, it was found to be 46/300 (15%) and in the children, it was seen to be 14/104 (13%). No statistical difference was found in post-ESWL complications between children and adults (P>0.05). Ancillary procedures including double J (DJ) stent were used in 13 (12.5%) children and 87 (29%) adults. There was a better stone clearance rate in children i.e. 79% as compared to 68% in adults (X2: P=0.036). Conclusion Children can achieve high stone-free rates after ESWL with a lower need for repeat ancillary procedures as compared to adults. However, there is a difference in the post-ESWL complications between these groups.
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Affiliation(s)
- Nadeem Iqbal
- `Department of Urology, Shifa International Hospital, Islamabad, Pakistan
| | - Salman Assad
- Department of Neurology & Neurosurgery, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | | | - Aisha Hasan
- Department of Urology, Shifa International Hospital, Islamabad, Pakistan
| | | | - Saeed Akhter
- Department of Urology, Shifa International Hospital, Islamabad, Pakistan
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Zafar R, Haris M, Assad S, Shabbir MU, Ghazanfar H, Malik SA, Khalid T, Abbas AH, Saleem AA. Core Measures for Congestive Heart Failure in a Tertiary Care Setting in Pakistan. Cureus 2016; 8:e728. [PMID: 27630801 PMCID: PMC5016042 DOI: 10.7759/cureus.728] [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] [Indexed: 11/05/2022] Open
Abstract
PURPOSE Heart failure presents a huge burden for individual patients and the healthcare system as a whole. This study aims to assess the adherence to these core measures as identified by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)/ American Heart Association (AHA) by physicians of Pakistan. MATERIALS AND METHODOLOGY We conducted a cross-sectional study in Shifa International Hospital, Islamabad, Pakistan from the period of April 2013 to April 2016. Patients with a primary diagnosis of heart failure were drawn from a coding section of hospital's record department. Data was evaluated to assess how strictly doctors were following core measures identified by JCAHO/AHA for the given diagnosis. Inclusion criteria for this study were patients ≥ 17 years of age and patients with a primary diagnosis of heart failure according to New York Heart Association (NYHA) classification. Patients with congenital anomalies and structural heart wall problems, like sarcoidosis, hemochromatosis, and amyloidosis, were excluded from the study. RESULTS Mean ejection fraction (EF) was found to be 27.23 ± 11.72 percent. Symptoms assessment of heart failure was done in 16/421 (3.8%) patients according to NYHA classification and in 405/421 (96.2%) patients according to outpatient-based heart failure assessment based on physician's experience other than NYHA classification. Left ventricle ejection fraction (LVEF) was assessed in 411/421 (97%) patients. Out of these, 336/411 (81.7%) patients had EF < 40%. Mean EF was found to be significantly higher in females as compared to males (p < 0.001). Three hundred and thirty-six out of 411 (81.7%) patients with EF < 40% needed angiotensin converting enzyme inhibitors (ACEi) and beta-blocker (BB) prescriptions. ACEi were prescribed only to 230/336 (68.7%) patients and 248/336 (73.8%) patients were given BB with documented contraindication to ACEi and BB in 7.36% and 17% patients, respectively. There was no significant association between gender and mean duration of hospitalization (p = 0.411). No significant association was found between EF ≤ 40% and mean duration of hospitalization (p = 0.426). CONCLUSION We found that symptom assessment of congestive heart failure (CHF) patients, according to NYHA guidelines, are strikingly low. Also, a significant percentage of patients who need ACEi and BB are not prescribed the required medications despite echocardiography showing low left ventricular function.
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Affiliation(s)
- Rizwan Zafar
- Department of Cardiology, Shifa College of Medicine, Islamabad, Pakistan
| | - Muhammad Haris
- Department of Cardiology, Shifa College of Medicine, Islamabad, Pakistan
| | - Salman Assad
- Department of Neurology & Neurosurgery, Shifa Tameer-e-Millat University, Islamabad, Pakistan
| | | | - Haider Ghazanfar
- Department of Pathology, Shifa College Of Medicine, Islamabad, Pakistan
| | - Sarah A Malik
- Department of Internal Medicine, Shifa College of Medicine, Islamabad, Pakistan
| | | | - Ali H Abbas
- Department of Internal Medicine, Shifa College of Medicine, Islamabad, Pakistan
| | - Asad A Saleem
- Department of Cardiology, Shifa College of Medicine, Islamabad, Pakistan
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Iqbal N, Yasir M, Shabbir MU, Assad S, Mahnoor N, Naqvi SA, Zaki A, Hussain I, Akter S. MP54-09 COMPARISON OF EXTRACORPOREAL SHOCK WAVE LITHOTRIPSY FOR UROLITHIASIS BETWEEN CHILDREN AND ADULTS: A SINGLE CENTRE STUDY. J Urol 2016. [DOI: 10.1016/j.juro.2016.02.579] [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: 11/27/2022]
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