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Aziz M, Haghbin H, Gangwani MK, Fatima R, Sohail AH, Ali H, Alyousif ZA, Dahiya DS, Lee-Smith W, Beran A, Kamal F, Nawras A. Histological Outcomes of Pharmacological Interventions in Eosinophilic Esophagitis for Adults and Children: A Network Meta-analysis of Randomized Controlled Trials. J Clin Gastroenterol 2024:00004836-990000000-00296. [PMID: 38701235 DOI: 10.1097/mcg.0000000000002017] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 03/28/2024] [Indexed: 05/05/2024]
Abstract
INTRODUCTION Multiple pharmacological interventions have been studied for managing eosinophilic esophagitis (EoE). We performed a comprehensive systematic review and network meta-analysis of all available randomized controlled trials (RCT) to assess the efficacy and safety of these interventions in EoE in adults and children. METHODS We performed a comprehensive review of Embase, PubMed, MEDLINE OVID, Cochrane CENTRAL, and Web of Science through May 10, 2023. We performed frequentist approach network meta-analysis using random effects model. We calculated the odds ratio (OR) with 95% CI for dichotomous outcomes. RESULTS Our search yielded 25 RCTs with 25 discrete interventions and 2067 patients. Compared with placebo, the following interventions improved histology (using study definitions) in decreasing order on ranking: orodispersible budesonide (ODB) low dose, ODB high dose, oral viscous budesonide (OVB) high dose, fluticasone tablet 1.5 mg twice daily, fluticasone 3 mg twice daily, esomeprazole, dupilumab every 2 weeks, dupilumab weekly, OVB medium dose, fluticasone 3 mg daily, cendakimab 180 mg, prednisone, swallowed fluticasone, fluticasone tablet 1.5 mg daily, OVB low dose, reslizumab 3 mg/kg, reslizumab 1 mg/kg, and reslizumab 2 mg/kg. CONCLUSIONS Network meta-analysis demonstrates histological efficacy of multiple medications for EoE. Because of the heterogeneity and large effect size, we recommend more trials comparing pharmacotherapeutic interventions with each other and placebo. An important limitation of this study is absence of clinical efficacy data due to insufficient data. Other limitations include heterogeneity of operator, population, and outcome analysis.
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Affiliation(s)
- Muhammad Aziz
- Division of Gastroenterology and Hepatology, University of Toledo, Toledo, OH
| | - Hossein Haghbin
- Division of Gastroenterology, Ascension Providence Southfield, Southfield, MI
| | | | - Rawish Fatima
- Division of Rheumatology, University of Toledo, Toledo, OH
| | - Amir H Sohail
- Department of General Surgery, New York University Langone Health, Long Island, NY
| | - Hassam Ali
- Division of Gastroenterology and Hepatology, East Carolina University, Greenville, NC
| | | | - Dushyant S Dahiya
- Division of Gastroenterology and Hepatology, University of Kansas, Kansas City, KS
| | - Wade Lee-Smith
- University of Toledo Libraries, University of Toledo, Toledo, OH
| | - Azizullah Beran
- Division of Gastroenterology, Indiana University School of Medicine, Indianapolis, IN
| | - Faisal Kamal
- Division of Gastroenterology, Thomas Jefferson University, Philadelphia, PA
| | - Ali Nawras
- Division of Gastroenterology and Hepatology, University of Toledo, Toledo, OH
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Haghbin H, Zakirkhodjaev N, Fatima R, Kamal F, Aziz M. Efficacy and Safety of Thermal Ablation after Endoscopic Mucosal Resection: A Systematic Review and Network Meta-Analysis. J Clin Med 2024; 13:1298. [PMID: 38592137 PMCID: PMC10932371 DOI: 10.3390/jcm13051298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 02/20/2024] [Accepted: 02/23/2024] [Indexed: 04/10/2024] Open
Abstract
(1) Background: Large colonic polyps during colonoscopy can be managed by Endoscopic mucosal resection (EMR). To decrease the polyp recurrence rate, thermal ablation methods like argon plasma coagulation (APC) and snare tip soft coagulation (STSC) have been introduced. We performed this network meta-analysis to assess the efficacy and safety of these modalities. (2) Methods: We performed a comprehensive literature review, through 5 January 2024, of databases including Embase, PubMed, SciELO, KCI, Cochrane Central, and Web of Science. Using a random effects model, we conducted a frequentist approach network meta-analysis. The risk ratio (RR) with 95% confidence interval (CI) was calculated. Safety and efficacy endpoints including rates of recurrence, bleeding, perforation, and post polypectomy syndrome were compared. (3) Results: Our search yielded a total of 13 studies with 2686 patients. Compared to placebo, both APC (RR: 0.33 CI: 0.20-0.54, p < 0.01) and STSC (RR: 0.27, CI: 0.21-0.34, p < 0.01) showed decreased recurrence rates. On ranking, STSC showed the lowest recurrence rate, followed by APC and placebo. Regarding individual adverse events, there was no statistically significant difference between either of the thermal ablation methods and placebo. (4) Conclusions: We demonstrated the efficacy and safety of thermal ablation after EMR for decreasing recurrence of adenoma.
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Affiliation(s)
- Hossein Haghbin
- Division of Gastroenterology, Ascension Providence Hospital, Southfield, MI 48075, USA
| | - Nuruddinkhodja Zakirkhodjaev
- Division of Occupational and Environmental Medicine, The University of Texas Health Science Center at Houston, Houston, TX 77021, USA;
| | - Rawish Fatima
- Division of Rheumatology, University of Toledo, Toledo, OH 43606, USA;
| | - Faisal Kamal
- Division of Gastroenterology, Thomas Jefferson University, Philadelphia, PA 19144, USA;
| | - Muhammad Aziz
- Division of Gastroenterology and Hepatology, Bon Secours Mercy Health, Toledo, OH 43608, USA;
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Sidiki S, Fatima R, Hernández NC, Altorok N. Atezolizumab-Associated Retiform Purpura. Am J Ther 2024:00045391-990000000-00174. [PMID: 38335060 DOI: 10.1097/mjt.0000000000001665] [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: 02/12/2024]
Affiliation(s)
- Sabeen Sidiki
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH
| | - Rawish Fatima
- Division of Rheumatology, University of Toledo Medical Center, Toledo, OH
| | | | - Nezam Altorok
- Division of Rheumatology, University of Toledo Medical Center, Toledo, OH
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Fatima R, Khader Y, Lee-Smith W, Garg A, Altorok N, Aziz M. Safety and Efficacy of Anifrolumab for Systemic Lupus Erythematosus: Network Meta-analysis. Am J Ther 2023; 30:e487-e490. [PMID: 37713706 DOI: 10.1097/mjt.0000000000001564] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Rawish Fatima
- Division of Rheumatology, University of Toledo, Toledo, OH
| | - Yasmin Khader
- Department of Internal Medicine, University of Toledo, Toledo, OH
| | - Wade Lee-Smith
- University of Toledo Libraries, University of Toledo, Toledo, OH
| | - Anu Garg
- Department of Internal Medicine, University of Toledo, Toledo, OH
| | - Nezam Altorok
- Division of Rheumatology, University of Toledo, Toledo, OH
| | - Muhammad Aziz
- Department of Internal Medicine, University of Toledo, Toledo, OH
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Fatima R, Altorok N. Secukinumab-Induced Bullous Pemphigoid in a Patient With Psoriatic Arthritis. Am J Ther 2023; Publish Ahead of Print:00045391-990000000-00157. [PMID: 37285586 DOI: 10.1097/mjt.0000000000001642] [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: 06/09/2023]
Affiliation(s)
- Rawish Fatima
- Department of Rheumatology, University of Toledo Medical Center, Toledo, OH
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Fatima R, Yaqoob A, Qadeer E, Khan MA, Ghafoor A, Jamil B, Haq MU, Ahmed N, Baig S, Rehman A, Abbasi Q, Khan AW, Ikram A, Hicks JP, Walley J. Community- vs. hospital-based management of multidrug-resistant TB in Pakistan. Int J Tuberc Lung Dis 2022; 26:929-933. [PMID: 36163662 DOI: 10.5588/ijtld.21.0695] [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: 11/10/2022] Open
Abstract
BACKGROUND Multidrug-resistant TB (MDR-TB) treatment takes 18-24 months and is complex, costly and isolating. We provide trial evidence on the WHO Pakistan recommendation for community-based care rather than hospital-based care.METHODS Two-arm, parallel-group, superiority trial was conducted in three programmatic management of drug-resistant TB hospitals in Punjab and Sindh Provinces, Pakistan. We enrolled 425 patients with MDR-TB aged >15 years through block randomisation in community-based care (1-week hospitalisation) or hospital-based care (2 months hospitalisation). Primary outcome was treatment success.RESULTS Among 425 patients with MDR-TB, 217 were allocated to community-based care and 208 to hospital-based care. Baseline characteristics were similar between the community and hospitalised arms, as well as in selected sites. Treatment success was 74.2% (161/217) under community-based care and 67.8% (141/208) under hospital-based care, giving a covariate-adjusted risk difference (community vs. hospital model) of 0.06 (95% CI -0.02 to 0.15; P = 0.144).CONCLUSIONS We found no clear evidence that community-based care was more or less effective than hospital-based care model. Given the other substantial advantages of community-based care over hospital based (e.g., more patient-friendly and accessible, with lower treatment costs), this supports the adoption of the community-based care model, as recommended by the WHO.
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Affiliation(s)
- R Fatima
- Common Management Unit (TB, HIV/AIDS and Malaria), Islamabad, Pakistan
| | - A Yaqoob
- Common Management Unit (TB, HIV/AIDS and Malaria), Islamabad, Pakistan, University of Bergen, Bergen, Norway
| | - E Qadeer
- Ministry of National Health Services, Regulations and Coordination, Islamabad, Pakistan
| | - M A Khan
- Association for Social Development, Islamabad, Pakistan
| | - A Ghafoor
- National TB Control Program, Islamabad, Pakistan
| | - B Jamil
- Common Management Unit (TB, HIV/AIDS and Malaria), Islamabad, Pakistan
| | - M U Haq
- University of Bergen, Bergen, Norway, National TB Control Program, Islamabad, Pakistan
| | - N Ahmed
- Ojha Institute of Chest Diseases, Karachi, Pakistan
| | - S Baig
- Ojha Institute of Chest Diseases, Karachi, Pakistan
| | - A Rehman
- Gulab Devi Chest Hospital, Lahore, Pakistan
| | - Q Abbasi
- TB Samli Sanatorium Hospital, Murree, Pakistan
| | - A W Khan
- National TB Control Program, Islamabad, Pakistan
| | - A Ikram
- National Institute of Health, Islamabad, Pakistan
| | - J P Hicks
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, UK
| | - J Walley
- Nuffield Centre for International Health and Development, Leeds Institute of Health Sciences, University of Leeds, UK
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Ali MM, Baig MT, Huma A, Ibrahim S, Khan SA, Fatima R, Majeed S, Rawat A, Soomro H, Lodhi M, Jabeen A, Syed N, Huda A. Effect of Agaricus blazei Murill on exploratory behavior of mice-model. BRAZ J BIOL 2021; 84:e252575. [PMID: 34932635 DOI: 10.1590/1519-6984.252575] [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] [Received: 05/25/2021] [Accepted: 08/18/2021] [Indexed: 11/22/2022] Open
Abstract
Increased anxiety and depressive symptoms have reported to be its association with long term illness. Because of having unwanted effects of newly available drugs, patients administering anxiolytic drugs usually discontinue the treatment before they are completely recovered. Therefore, there is a serious need to develop new anxiolytic drugs. The anxiolytic effect of hydro-alcoholic extract of Agaricus blazei in animal models was assessed. 24 male mice (Mus musculus genus) were included in the study. Four groups were prepared and each group contained six animals. The groups were vehicle control, positive control (diazepam 1.0 mg/kg, i.p.) as well as two treatment groups receiving Agaricus blazei hydro-alcoholic extract at a dose of 136.50 mg/kg and 273.0 mg/kg orally. The Marble burying test, Nestlet shredding test and Light and Dark box test used to assess anxiolytic activity. Mice administered with diazepam 1.0 mg/kg, i.p. while hydro-alcoholic extract of AbM (136.50 and 273.0 mg/kg, respectively) was administered via oral route which exhibited marked reduction in number of marbles-burying as compared to vehicle control group. Mice administered with diazepam 1.0 mg/kg, i.p. and Oral administration of hydro-alcoholic extract of AbM (136.50 and 273.0 mg/kg, respectively) exhibited significant decrease in nestlet shredding in comparison to vehicle control group. The oral administration of hydro-alcoholic extract at a dose of 136.5mg/kg and 273mg/kg showed elevation in time spent in light box and was comparable to standard treated group while time spent by mice following oral administration of hydro-alcoholic extract of Agaricus blazei at a dose of 273.0 mg/kg also showed elevation and was found to be more near to standard treated group (diazepam 1 mg/kg, i.p.).
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Affiliation(s)
- M M Ali
- Ziauddin University, Faculty of Pharmacy, Department of Pharmaceutics, Karachi, Pakistan
| | - M T Baig
- Ziauddin University, Faculty of Pharmacy, Department of Pharmacy Practice, Karachi, Pakistan
| | - A Huma
- Ziauddin University, Faculty of Pharmacy, Department of Pharmacognosy, Karachi, Pakistan
| | - S Ibrahim
- Ziauddin University, Faculty of Pharmacy, Department of Pharmacology, Karachi, Pakistan
| | - S A Khan
- Memon Medical Institute Hospital, Karachi, Pakistan
| | - R Fatima
- Ziauddin University, Faculty of Pharmacy, Department of Pharmacy Practice, Karachi, Pakistan
| | - S Majeed
- Ziauddin University, Faculty of Pharmacy, Department of Pharmacology, Karachi, Pakistan
| | - A Rawat
- Ziauddin University, Faculty of Pharmacy, Department of Pharmacy Practice, Karachi, Pakistan
| | - H Soomro
- Ziauddin University, Faculty of Pharmacy, Department of Pharmaceutical Chemistry, Karachi, Pakistan
| | - M Lodhi
- Ziauddin University, Faculty of Pharmacy, Department of Pharmacology, Karachi, Pakistan
| | - A Jabeen
- Ziauddin University, Faculty of Pharmacy, Department of Pharmacology, Karachi, Pakistan
| | - N Syed
- Ziauddin University, Faculty of Pharmacy, Department of Pharmacy Practice, Karachi, Pakistan
| | - A Huda
- Sante Pharma (Pvt) Ltd, Karachi, Pakistan
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Nawaz MF, Fatima R, Gul S, Rana N, Ahmad I, Naseer J, Afzal S, Yasin G, Asif M, Khan SH, Altaf M. Study of human knowledge and attitude toward urban birds in Faisalabad city, Pakistan. BRAZ J BIOL 2021; 83:e249229. [PMID: 34669801 DOI: 10.1590/1519-6984.249229] [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] [Received: 02/28/2021] [Accepted: 05/11/2021] [Indexed: 11/22/2022] Open
Abstract
Birds are very valuable indicators of species richness and endemic patterns in a specified ecosystem, which eventually help the scientist to measure the environmental degradation. The aim of present study was to know human knowledge and attitude toward urban birds in Faisalabad city, Pakistan. The study conducted in four consecutive months: November 2019 to February 2020. Population of birds was noted from eight residential towns of Faisalabad city, data were collected through questionnaire. Faisalabad has a reasonably large population of birds and present data show that, there is a significant difference between favorite bird of residential areas and institutions. The pigeon received the most likeness in bird population among residential area residents, while the myna received the least. The most popular bird in Faisalabad institutions was the sparrow, while the least popular bird was the common myna. Bird adaptation percentage of residential areas and institutional areas of Faisalabad was the highest for parrot and sparrow respectively. People in residential areas and institutions, on the other hand, adapted least to common myna. It is concluded that people of the study area like birds and offered food and high population of birds are present in study area.
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Affiliation(s)
- M F Nawaz
- University of Agriculture, Department of Forestry and Range Management, Faisalabad, Pakistan
| | - R Fatima
- University of Agriculture, Department of Zoology, Wildlife and Fisheries, Faisalabad, Pakistan
| | - S Gul
- University of Karachi, Department of Botany, Karachi, Pakistan
| | - N Rana
- University of Agriculture, Department of Zoology, Wildlife and Fisheries, Faisalabad, Pakistan
| | - I Ahmad
- University of Agriculture, Department of Forestry and Range Management, Faisalabad, Pakistan
| | - J Naseer
- The Islamia University of Bahawalpur, Department of Forestry, Range and Wildlife Management, Bahawalpur, Pakistan
| | - S Afzal
- University of Sargodha, Department of Forestry, Range Management and Wildlife, Sargodha, Pakistan
| | - G Yasin
- The Islamia University of Bahawalpur, Department of Forestry, Range and Wildlife Management, Bahawalpur, Pakistan
| | - M Asif
- University of Agriculture, Department of Forestry and Range Management, Faisalabad, Pakistan
| | - S H Khan
- University of Agriculture, Department of Forestry and Range Management, Faisalabad, Pakistan
| | - M Altaf
- The Islamia University of Bahawalpur, Department of Forestry, Range and Wildlife Management, Bahawalpur, Pakistan
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Aziz M, Mehta TI, Weissman S, Sharma S, Fatima R, Khan Z, Dasari CS, Lee-Smith W, Nawras A, Adler DG. Do Water-aided Techniques Improve Serrated Polyp Detection Rate During Colonoscopy?: A Systematic Review With Meta-Analysis. J Clin Gastroenterol 2021; 55:520-527. [PMID: 33355836 DOI: 10.1097/mcg.0000000000001386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/26/2020] [Indexed: 12/10/2022]
Abstract
BACKGROUND AND STUDY AIMS The utility of water-aided techniques (WT): water exchange (WE) and water immersion (WI) have been studied extensively in the literature for improving colonoscopy outcome metrics such as adenoma detection rate. Serrated polyps owing to their location and appearance have a high miss rate. The authors performed a systematic review and meta-analysis of studies comparing WT with the standard gas-assisted (GA) method to determine if there was any impact on serrated polyp detection rate (SPDR) and sessile serrated polyp detection rate. METHODS The following databases were queried for this systematic review: Medline, EMBASE, Cochrane Library, CINAHL, and Web of Sciences. The authors only included randomized controlled trials (RCTs). The primary outcome was SPDR and secondary outcomes were sessile serrated polyp detection rate and cecal intubation rate. Risk ratios (RRs) were calculated for each outcome. A P-value <0.05 was considered to be statistically significant. RESULTS A total of 4 RCTs (5 arms) with 5306 patients (2571 in the GA group and 2735 in the WT group) were included. The SPDR was significantly increased for the WT group compared with GA (6.1% vs. 3.8%; RR, 1.63; 95% confidence interval, 1.24-2.13; P<0.001; I2=22.7%). A subgroup analysis for WE technique also demonstrated improved SPDR compared with the GA method (4.9% vs. 3.2%; RR, 1.57; 95% confidence interval, 1.15-2.14; P=0.004; I2=6.1%). CONCLUSIONS WT, particularly, the WE method results in improved SPDR. This technique should be encouraged in a clinical setting to detect these polyps to prevent interval colorectal cancer.
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Affiliation(s)
| | - Tej I Mehta
- Department of Medicine, University of South Dakota Sanford, School of Medicine, Vermillion, SD
| | - Simcha Weissman
- Department of Medicine, Hackensack University-Palisades Medical Center, North Bergen, NJ
| | | | | | - Zubair Khan
- Department of Gastroenterology, McGovern Medical School, University of Texas Health Science Center, Houston, TX
| | - Chandra S Dasari
- Department of Gastroenterology and Hepatology, Kansas City VA Medical Center, Kansas City, MO
| | | | - Ali Nawras
- Department of Gastroenterology and Hepatology, University of Toledo Medical Center
| | - Douglas G Adler
- Department of Gastroenterology, University of Utah, Salt Lake City, UT
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Fatima R, Assaly AR, Aziz M, Moussa M, Assaly R. The United States Medical Licensing Exam Step 2 Clinical Skills Examination: Potential Alternatives During and After the COVID-19 Pandemic. JMIR Med Educ 2021; 7:e25903. [PMID: 33878014 PMCID: PMC8092027 DOI: 10.2196/25903] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 03/24/2021] [Accepted: 04/12/2021] [Indexed: 05/18/2023]
Abstract
We feel that the current COVID-19 crisis has created great uncertainty and anxiety among medical students. With medical school classes initially being conducted on the web and the approaching season of "the Match" (a uniform system by which residency candidates and residency programs in the United States simultaneously "match" with the aid of a computer algorithm to fill first-year and second-year postgraduate training positions accredited by the Accreditation Council for Graduate Medical Education), the situation did not seem to be improving. The National Resident Matching Program made an official announcement on May 26, 2020, that candidates would not be required to take or pass the United States Medical Licensing Examination Step 2 Clinical Skills (CS) examination to participate in the Match. On January 26, 2021, formal discontinuation of Step 2 CS was announced; for this reason, we have provided our perspective of possible alternative solutions to the Step 2 CS examination. A successful alternative model can be implemented in future residency match seasons as well.
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Affiliation(s)
- Rawish Fatima
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH, United States
| | - Ahmad R Assaly
- College of Medicine and Life Sciences, The University of Toledo, Toledo, OH, United States
| | - Muhammad Aziz
- Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, OH, United States
| | - Mohamad Moussa
- Department of Emergency Medicine, University of Toledo Medical Center, Toledo, OH, United States
| | - Ragheb Assaly
- Division of Pulmonary and Critical Care Medicine, University of Toledo Medical Center, Toledo, OH, United States
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Balla M, Merugu G, Nesheiwat Z, Patel M, Sheikh T, Fatima R, Kotturi VK, Bommana V, Pulagam G, Kaminski B. Epidemiological and Clinical Characteristics of 217 COVID-19 Patients in Northwest Ohio, United States. Cureus 2021; 13:e14308. [PMID: 34079643 PMCID: PMC8162051 DOI: 10.7759/cureus.14308] [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: 11/26/2022] Open
Abstract
Background There is limited data on the clinical characteristics and predictors of mortality of coronavirus disease-2019 (COVID-19) in North West Ohio. We performed a retrospective review of patients hospitalized with COVID-19 in the ProMedica Health System in Northwest Ohio from March 25 to June 16, 2020. The study aims to identify epidemiological, clinical characteristics, and predictors of Mortality of COVID-19 patients in Northwest Ohio. Methods This study was conducted on 217 COVID-19 patients admitted to ProMedica Health System Hospitals in Northwest Ohio from March 25 to June 16, 2020. We collected data, including clinical signs, symptoms, and outcomes of the COVID-19 patients. We compared clinical signs and symptoms along with comorbidities of survivors and non-survivors. Results Of the 217 patients included in the study, the mean age of the population was 63.13 (SD 17.8), of which 194 (89.4%, mean age 61.7 years) survived while 23 (10.6%, mean age 74.6 years) died. Among them, 53% were females and 47% male. Common presenting symptoms were chest pain (91.71%), shortness of breath (79.7%), cough (71%), and fever (64%). Mortality was associated with age greater than 63 (p-value 0.0052) and hypertension (p-value: 0.0058) with marginal significance with gender (p-value: 0.0642), chest pain (p-value: 0.0944), and history of cancer (p-value: 0.0944). Conclusions Advanced age and hypertension (HTN) are independent predictors for increased mortality. History of cancer and chest pain are associated with increased mortality with marginal significance. Awareness among physicians about predictors of mortality is essential in dealing with COVID-19 patients. It is essential to educate the public about preventative strategies such as wearing masks to decrease mortality and morbidity from this pandemic.
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Affiliation(s)
- Mamtha Balla
- Internal Medicine, ProMedica Toledo Hospital, Toledo, USA.,Internal Medicine, The University of Toledo Medical Center, Toledo, USA
| | - Ganesh Merugu
- Geriatrics, The University of Toledo Medical Center, Toledo, USA
| | - Zeid Nesheiwat
- Internal Medicine, The University of Toledo Medical Center, Toledo, USA
| | - Mitra Patel
- Internal Medicine, The University of Toledo College of Medicine, Toledo, USA
| | - Taha Sheikh
- Internal Medicine, The University of Toledo Medical Center, Toledo, USA
| | - Rawish Fatima
- Internal Medicine, The University of Toledo Medical Center, Toledo, USA
| | - Vinay K Kotturi
- Family Medicine, The University of Toledo Medical Center, Toledo, USA
| | | | - Gautham Pulagam
- Internal Medicine, Medical University of the Americas, Charlestown, KNA
| | - Brian Kaminski
- Emergency Medicine, ProMedica Toledo Hospital, Toledo, USA
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12
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Merugu GP, Nesheiwat Z, Balla M, Patel M, Fatima R, Sheikh T, Kotturi V, Bommana V, Pulagam G, Kaminski B. Predictors of mortality in 217 COVID-19 patients in Northwest Ohio, United States: A retrospective study. J Med Virol 2021; 93:2875-2882. [PMID: 33350488 DOI: 10.1002/jmv.26750] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Revised: 12/17/2020] [Accepted: 12/20/2020] [Indexed: 01/06/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic continues to cause significant morbidity and mortality worldwide. This study aims to identify specific lab markers, complications, and treatments that may be associated with increased mortality in COVID-19 patients. This study is retrospective in nature; it included 217 COVID-19 positive patients who were admitted to a ProMedica Health System hospital in Northwest Ohio, United States, between March 25 and June 16, 2020. We collected various laboratory values, complications, and treatment courses. T test and χ2 analyses were used to predict mortality. COVID-19 test was confirmed via polymerase chain reaction. Of 217 patients included in the study, the mean age of the population was 63.13 (SD, 17.8), of which 194 (89.4%, mean age 61.7 years) survived while 23 (10.6%, mean age 74.6 years) died. Among them, 53% were females and 47% male. Laboratory values that were associated with mortality were low hemoglobin (p = .0046), elevated INR (p = .0005), low platelets (p = .0246) and elevated procalcitonin (p = .0472). Marginally significant laboratory values included elevated troponin (p = .0661), and elevated creatinine (p = .0741). Treatment with either antibiotic, antifungals, antivirals, blood transfusion, steroids, and intubation were all statistically significant for mortality. COVID-19 related complications with either ARDS, myocarditis, elevated INR, septic shock, or age greater than 63 were significant predictors of mortality. Low hemoglobin, elevated INR, Low platelet, elevated procalcitonin, treated with either antibiotic, antifungal, antiviral, blood transfusion, steroids, and intubation are associated with high mortality related to COVID-19 infection. Healthcare professionals must be aware of these predictors.
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Affiliation(s)
- Ganesh Prasad Merugu
- Division of Geriatric Medicine, Department of Family Medicine, University of Toledo-Health Sciences, Toledo, Ohio, USA
| | - Zeid Nesheiwat
- Department of Internal Medicine, University of Toledo-Health Sciences, Toledo, Ohio, USA
| | - Mamtha Balla
- Department of Internal Medicine, Promedica Toledo Hospital, University of Toledo, Toledo, Ohio, USA
| | - Mitra Patel
- Department of Internal Medicine, University of Toledo-Health Sciences, Toledo, Ohio, USA
| | - Rawish Fatima
- Department of Internal Medicine, University of Toledo-Health Sciences, Toledo, Ohio, USA
| | - Taha Sheikh
- Department of Internal Medicine, University of Toledo-Health Sciences, Toledo, Ohio, USA
| | - Vinay Kotturi
- Department of Internal Medicine, University of Toledo-Health Sciences, Toledo, Ohio, USA
| | - Venugopala Bommana
- Department of Internal Medicine, Promedica Toledo Hospital, University of Toledo, Toledo, Ohio, USA
| | - Gautham Pulagam
- Department of Internal Medicine, Medical University of the Americas, Charlestown, Massachusetts, USA
| | - Brian Kaminski
- Department of Emergency Medicine, Promedica Toledo Hospital, University of Toledo-Health Sciences, Toledo, Ohio, USA
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Fatima R, Arif T, Sami M. Star Shaped Aquatic Skin Eruption. Actas Dermosifiliogr (Engl Ed) 2020; 112:458. [PMID: 33307008 DOI: 10.1016/j.ad.2019.03.024] [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] [Received: 02/20/2019] [Revised: 03/02/2019] [Accepted: 03/06/2019] [Indexed: 10/22/2022] Open
Affiliation(s)
- R Fatima
- Departamento de Dermatología, Hospital General de Tadawi, Dammaam, Reino de Arabia Saudita
| | - T Arif
- Departamento de Dermatología, Hospital General de Tadawi, Dammaam, Reino de Arabia Saudita.
| | - M Sami
- Ellahi Medicare Clinic, Kashmir, India
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14
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Hussain M, Fatima R, Baig M, Masood N. Assessment of Tuberculosis case notification and percent change b/w public and private Tuberculosis health care facilities in Karachi, Pakistan-2016–17. Int J Infect Dis 2020. [DOI: 10.1016/j.ijid.2020.09.938] [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: 10/22/2022] Open
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15
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Aziz M, Haghbin H, Sharma S, Fatima R, Ishtiaq R, Chandan S, Mohan BP, Lee-Smith W, Hassan M, Nawras A. Safety of bariatric surgery in patients with inflammatory bowel disease: A systematic review and meta-analysis. Clin Obes 2020; 10:e12405. [PMID: 32877572 DOI: 10.1111/cob.12405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 04/02/2020] [Revised: 07/30/2020] [Accepted: 08/07/2020] [Indexed: 12/18/2022]
Abstract
The efficacy of bariatric surgery in achieving weight loss and preventing long-term comorbidities such as cardiovascular diseases, diabetes mellitus and osteoarthritis is well established. Data regarding safety of bariatric surgery in patients with inflammatory bowel disease (IBD) is scarce. We attempted a systematic review and meta-analysis to evaluate the complications following bariatric surgery in patients with IBD. The primary outcomes evaluated were wound infection, Clavien-Dindo grade > II complications and IBD exacerbation (within 1 year). Secondary outcomes evaluated included overall mortality, stricture, small bowel obstruction, acute kidney injury (AKI) and thromboembolism. Pooled outcomes (event rate) with 95% confidence interval (CI) were calculated using random effects model. A total of 14 studies (all observational) with 2608 patients were included. The rates of primary outcomes were: wound infection (4.1%, 95% CI: 0.9-7.2), Clavien-Dindo grade > II complications (2.0%, 95%: CI 0.6-3.5) and IBD exacerbation (4.3%, 95% CI: 0.7-7.9). The pooled rate for other outcomes was: mortality 0.1%, stricture 6.5%, small bowel obstruction 6.7%, AKI 2.2% and thromboembolism 0.1%. Bariatric surgery is relatively safe in patients with IBD and should be pursued to reduce comorbidities associated with obesity. Future comparative studies are needed to further assess the safety of bariatric surgery in population with and without IBD.
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Affiliation(s)
- Muhammad Aziz
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Hossein Haghbin
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Sachit Sharma
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Rawish Fatima
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Rizwan Ishtiaq
- Department of Internal Medicine, Mercy St. Vincent Medical Center, Toledo, Ohio, USA
| | - Saurabh Chandan
- Division of Gastroenterology and Hepatology, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Babu P Mohan
- Department of Internal Medicine, University of Arizona, Banner University Medical Center, Tucson, Arizona, USA
| | - Wade Lee-Smith
- University of Toledo Libraries, University of Toledo, Toledo, Ohio, USA
| | - Mona Hassan
- Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Ali Nawras
- Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, Ohio, USA
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16
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Fatima R, Yaqoob A. In Reply: How TB and COVID-19 compare: an opportunity to integrate both control programmes. Int J Tuberc Lung Dis 2020; 24:1227-1228. [DOI: 10.5588/ijtld.20.0571] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- R. Fatima
- Common Management Unit (TB, HIV/AIDS and Malaria), Islamabad, Pakistan
| | - A. Yaqoob
- Common Management Unit (TB, HIV/AIDS and Malaria), Islamabad, Pakistan, University of Bergen, Bergen, Norway, ,
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17
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Aziz M, Fatima R, Dong C, Lee-Smith W, Nawras A. The impact of deep convolutional neural network-based artificial intelligence on colonoscopy outcomes: A systematic review with meta-analysis. J Gastroenterol Hepatol 2020; 35:1676-1683. [PMID: 32267558 DOI: 10.1111/jgh.15070] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Revised: 02/29/2020] [Accepted: 04/05/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND AND AIM The utility of artificial intelligence (AI) in colonoscopy has gained popularity in current times. Recent trials have evaluated the efficacy of deep convolutional neural network (DCNN)-based AI system in colonoscopy for improving adenoma detection rate (ADR) and polyp detection rate (PDR). We performed a systematic review and meta-analysis of the available studies to assess the impact of DCNN-based AI-assisted colonoscopy in improving the ADR and PDR. METHODS We queried the following database for this study: PubMed, Embase, Cochrane Library, Web of Sciences, and Computers and Applied Sciences. We only included randomized controlled trials that compared AI colonoscopy to standard colonoscopy (SC). Our outcomes included ADR and PDR. Risk ratios (RR) with 95% confidence interval (CI) were calculated using random effects model and DerSimonian-Laird approach for each outcome. RESULTS A total of three studies with 2815 patients (1415 in SC group and 1400 in AI group) were included. AI colonoscopy resulted in significantly improved ADR (32.9% vs 20.8%, RR: 1.58, 95% CI 1.39-1.80, P = < 0.001) and PDR (43.0% vs 27.8%, RR: 1.55, 95% CI 1.39-1.72, P = < 0.001) compared with SC. CONCLUSION Given the results and limitations, the utility of AI colonoscopy holds promise and should be evaluated in more randomized controlled trials across different population, especially in patients solely undergoing colonoscopy for screening purpose as improved ADR will ultimately help in reducing incident colorectal cancer.
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Affiliation(s)
- Muhammad Aziz
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Rawish Fatima
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Charles Dong
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Wade Lee-Smith
- University of Toledo Libraries, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Ali Nawras
- Department of Gastroenterology, University of Toledo Medical Center, Toledo, Ohio, USA
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Aziz M, Haghbin H, Abu Sitta E, Nawras Y, Fatima R, Sharma S, Lee-Smith W, Duggan J, Kammeyer JA, Hanrahan J, Assaly R. Efficacy of tocilizumab in COVID-19: A systematic review and meta-analysis. J Med Virol 2020; 93:1620-1630. [PMID: 32918755 DOI: 10.1002/jmv.26509] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 09/04/2020] [Accepted: 09/08/2020] [Indexed: 02/06/2023]
Abstract
The efficacy of tocilizumab (TOC), monoclonal antibody against interleukin-6 (IL-6) receptor, in patients with coronavirus disease-2019 (COVID-19) patients has led to conflicting results. We performed a systematic review and meta-analysis to compare the efficacy of addition of TOC to standard of care (SOC) versus SOC in patients with COVID-19. We performed a comprehensive literature search of PubMed, Embase, Web of Science, WHO COVID, LitCOVID, and Cochrane databases. Pooled outcomes (overall mortality, need for mechanical ventilation, intensive care unit admission, and secondary infections) were compared using DerSimonian-Laird/Random-effects approach. Risk difference (RD), confidence interval (CI), and p values were generated. A total of 23 studies with 6279 patients (1897 in TOC and 4382 in SOC group, respectively) were included. The overall mortality was lower in TOC group compared to SOC group (RD: -0.06; CI: -0.12 to -0.01; p = .03). Subgroup analysis including studies with only severe cases revealed lower mortality (RD: -0.12; CI: -0.18 to -0.06; p < .01) and need for mechanical ventilation (RD: -0.11; CI: -0.19 to -0.02; p = .01) in TOC group compared to SOC group. The addition of TOC to SOC has the potential to reduce mortality and need for mechanical ventilation in patients with severe COVID-19. Randomized controlled trials are needed to validate this.
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Affiliation(s)
- Muhammad Aziz
- Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Hossein Haghbin
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Emad Abu Sitta
- Division of Infectious Disease, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Yusuf Nawras
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Rawish Fatima
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Sachit Sharma
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Wade Lee-Smith
- University of Toledo Libraries, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Joan Duggan
- Division of Infectious Disease, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Joel A Kammeyer
- Division of Infectious Disease, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Jennifer Hanrahan
- Division of Infectious Disease, University of Toledo Medical Center, Toledo, Ohio, USA
| | - Ragheb Assaly
- Division of Pulmonary, Critical Care, and Sleep Medicine, University of Toledo Medical Center, Toledo, Ohio, USA
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Affiliation(s)
- Muhammad Aziz
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH, USA,Address correspondence to: Muhammad Aziz, MD, Department of Internal Medicine, University of Toledo Medical Center, Mail Stop 1150, Toledo, Ohio 43613, USA. E-mail:
| | - Rawish Fatima
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Hossein Haghbin
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | | | - Ali Nawras
- Division of Gastroenterology and Hepatology, University of Toledo Medical Center, Toledo, OH, USA
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20
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Aziz M, Fatima R, Assaly R. Elevated interleukin-6 and severe COVID-19: A meta-analysis. J Med Virol 2020; 92:2283-2285. [PMID: 32343429 PMCID: PMC7267383 DOI: 10.1002/jmv.25948] [Citation(s) in RCA: 339] [Impact Index Per Article: 84.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/20/2020] [Accepted: 04/24/2020] [Indexed: 12/18/2022]
Affiliation(s)
- Muhammad Aziz
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio
| | - Rawish Fatima
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio
| | - Ragheb Assaly
- Division of Pulmonary and Critical Care Medicine, University of Toledo Medical Center, Toledo, Ohio
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21
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Aziz M, Weissman S, Fatima R, Khan Z, Mohan BP, Mehta TI, Lee-Smith W, Hassan A, Sciarra M, Nawras A, Adler DG. Impact of propofol sedation versus opioid/benzodiazepine sedation on colonoscopy outcomes: a systematic review with meta-analysis. Endosc Int Open 2020; 8:E701-E707. [PMID: 32490152 PMCID: PMC7247890 DOI: 10.1055/a-1135-8681] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 01/02/2020] [Indexed: 12/15/2022] Open
Abstract
Background and study aims Choice of sedation (propofol vs opioid/benzodiazepine) has been studied in the literature and has shown variable outcomes. The majority of recent studies have evaluated propofol sedation (PS) versus opioids, benzodiazepines, or a combination of both. We performed a systematic review and meta-analysis of studies comparing PS to other sedation methods to assess the impact on colonoscopy outcomes. Methods Multiple databases were searched and studies of interest were extracted. Primary outcome of the study was adenoma detection rate (ADR) and secondary outcomes included polyp detection rate (PDR), advanced adenoma detection rate (AADR), and cecal intubation rate (CIR). Results A total of 11 studies met the inclusion criteria with a total of 177,016 patients (148,753 and 28,263 in the opioids/benzodiazepine group and PS group, respectively). Overall, ADR (RR: 1.07, 95 % CI 0.99-1.15), PDR (RR: 1.01, 95 % CI 0.93-1.10), and AADR (RR: 1.17, 95 % CI 0.92-1.48) did not improve with the use of PS. The CIR was slightly higher for propofol sedation group (RR 1.02, 95 % CI 1.00-1.03). Conclusion Based on our analysis, PS and opioid/benzodiazepine sedation seem to have comparable ADR. Our results do not favor use of a particular sedation method and the choice of sedation should be individualized based on patient preference, risk factors and resource availability.
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Affiliation(s)
- Muhammad Aziz
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio, United States
| | - Simcha Weissman
- Department of Medicine, Hackensack University – Palisades Medical Center, North Bergen, New Jersey, United States
| | - Rawish Fatima
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio, United States
| | - Zubair Khan
- Department of Gastroenterology, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, Texas, United States
| | - Babu P. Mohan
- Department of Internal Medicine, Banner University Medical Center Tucson, Arizona, United States
| | - Tej I. Mehta
- Department of Medicine, University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota, United States
| | - Wade Lee-Smith
- University Libraries, University of Toledo, Ohio, United States
| | - Ammar Hassan
- Division of Gastroenterology, Hackensack University – Palisades Medical Center, North Bergen, New Jersey, United States
| | - Michael Sciarra
- Division of Gastroenterology, Hackensack University – Palisades Medical Center, North Bergen, New Jersey, United States
| | - Ali Nawras
- Department of Gastroenterology, University of Toledo, Toledo, Ohio, United States
| | - Douglas G. Adler
- Department of Gastroenterology, University of Utah, Salt Lake City, Utah, United States
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Aziz M, Sharma S, Ghazaleh S, Fatima R, Acharya A, Ghanim M, Sheikh T, Lee-Smith W, Hamdani SU, Nawras A. The anti-spasmodic effect of peppermint oil during colonoscopy: a systematic review and meta-analysis. MINERVA GASTROENTERO 2020; 66. [DOI: 10.23736/s1121-421x.20.02652-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
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23
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Aziz M, Fatima R, Lee-Smith W, Assaly R. The association of low serum albumin level with severe COVID-19: a systematic review and meta-analysis. Crit Care 2020; 24:255. [PMID: 32456658 PMCID: PMC7249975 DOI: 10.1186/s13054-020-02995-3] [Citation(s) in RCA: 111] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 05/14/2020] [Indexed: 12/16/2022] Open
Affiliation(s)
- Muhammad Aziz
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH USA
| | - Rawish Fatima
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, OH USA
| | - Wade Lee-Smith
- University of Toledo Libraries, University of Toledo Medical Center, Toledo, OH USA
| | - Ragheb Assaly
- Division of Pulmonary and Critical Care Medicine, University of Toledo Medical Center, Toledo, OH USA
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Aziz M, Weissman S, Khan Z, Fatima R, Lee-Smith W, Nawras A, Adler DG. Use of 2 Observers Increases Adenoma Detection Rate During Colonoscopy: Systematic Review and Meta-analysis. Clin Gastroenterol Hepatol 2020; 18:1240-1242.e3. [PMID: 31589976 DOI: 10.1016/j.cgh.2019.07.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 07/16/2019] [Accepted: 07/19/2019] [Indexed: 02/07/2023]
Abstract
Current efforts are directed toward improving quality metrics such as adenoma/polyp detection rates during colonoscopy to decrease the incidence of colorectal cancer.1 Previous studies have reported variable detection rates for adenomas/polyps during colonoscopy for active participation/observation by nurses, trainees, and/or technician (dual observer [DO] group) with an endoscopist.2,3 We performed a systematic review and meta-analysis to evaluate the detection rate of adenomas/polyps during colonoscopy via DO versus single observers (ie, endoscopist alone).
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Affiliation(s)
- Muhammad Aziz
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio
| | - Simcha Weissman
- Department of Medicine, Hackensack University, Palisades Medical Center, North Bergen, New Jersey
| | - Zubair Khan
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio
| | - Rawish Fatima
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio
| | | | - Ali Nawras
- Department of Gastroenterology, University of Toledo, Toledo, Ohio
| | - Douglas G Adler
- Department of Gastroenterology, University of Utah, Salt Lake City, Utah.
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25
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Sheikh T, Fatima R, Aziz M, Balla M, Georgescu C. Brodie's Abscess Masquerading as Vaso-occlusive Crisis in a Sickle-cell Disease Patient. Cureus 2020; 12:e7871. [PMID: 32489726 PMCID: PMC7255565 DOI: 10.7759/cureus.7871] [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: 12/04/2022] Open
Abstract
Brodie’s abscess is a rare form of subacute osteomyelitis, most commonly found in children between the ages of two to fifteen years. It has slight preponderance for males. It is characterised by centrally placed, well-circumscribed abscess within the medulla or metaphysis of long bone, most commonly tibia, surrounded by a sclerotic wall. It is sometimes considered a transitional phase for the development of chronic osteomyelitis due to infection persisting between two to six months without showing any systemic symptoms specific to osteomyelitis. It is assumed that it is clinically quiescent due to its intraosseous location. It rarely presents with overt symptoms, which occurs if either the abscess enlarges to create pressure against the periosteum, or if the purulent material extrudes from the confines from its sclerotic walls. Due to subliminal clinical features and indolent clinical course, radiologic investigations are the diagnostic modality of choice. Diagnosis requires a high degree of suspicion, especially in the scenario of sepsis with an unknown source of infection. We describe a case of Brodie's abscess in a sickle-cell disease patient which presented as episodes of vaso-occlusive crisis repeatedly before it was diagnosed along with a review of the literature.
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Affiliation(s)
- Taha Sheikh
- Internal Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, USA
| | - Rawish Fatima
- Internal Medicine, University of Toledo, Toledo, USA
| | - Muhammad Aziz
- Internal Medicine, University of Toledo, Toledo, USA
| | - Mamtha Balla
- Internal Medicine, ProMedica Toledo Hospital, Toledo, USA.,Internal Medicine, University of Toledo, Toledo, USA
| | - Claudiu Georgescu
- Internal Medicine, University of Toledo College of Medicine and Life Sciences, Toledo, USA
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26
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Tidman ASM, Fatima R. An unusual cutaneous manifestation of parvovirus B19 infection: papular-purpuric gloves-and-socks syndrome and petechial bathing trunk eruption. Clin Exp Dermatol 2020; 45:341-342. [PMID: 31400151 DOI: 10.1111/ced.14070] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2019] [Indexed: 11/28/2022]
Affiliation(s)
- A S M Tidman
- Department of Dermatology, University Hospital Crosshouse, Kilmarnock Road, Kilmarnock, KA2 0BE, UK
| | - R Fatima
- Department of Dermatology, University Hospital Crosshouse, Kilmarnock Road, Kilmarnock, KA2 0BE, UK
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27
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Aziz M, Ghanim M, Sheikh T, Sharma S, Ghazaleh S, Fatima R, Khan Z, Lee-Smith W, Nawras A. Rectal indomethacin with topical epinephrine versus indomethacin alone for preventing Post-ERCP pancreatitis - A systematic review and meta-analysis. Pancreatology 2020; 20:356-361. [PMID: 32107191 DOI: 10.1016/j.pan.2020.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 02/04/2020] [Accepted: 02/08/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND Recent studies have compared the utility of rectal indomethacin with topical epinephrine (IE) sprayed on duodenal papilla and rectal indomethacin alone (IS) to prevent post-ERCP pancreatitis (PEP) with conflicting results. We performed a systematic review and meta-analysis to evaluate the benefit of using the combination prophylaxis as oppose to rectal indomethacin alone. METHODS The following database were searched for our systematic review: PubMed∖Medline, Embase, Cochrane, and Web of Science. We included both randomized controlled trials (RCTs) and cohort studies. Primary outcome was incidence of PEP and secondary outcomes were adverse events and mortality. RESULTS A total of 3 studies (all RCTs) with 2244 patients (1132 in IS and 1112 in IE group) were included. The IE group did not demonstrate any significant benefit over IS group in preventing PEP (RR: 1.15, 95% CI 0.62-2.2), mortality (RR: 0.85, 95% CI 0.22-3.24) or overall adverse events (RR: 1.3, 95% CI 0.93-1.7). CONCLUSION The combination of rectal indomethacin and topical epinephrine failed to demonstrate any benefit over indomethacin alone in preventing PEP, decreasing mortality and overall adverse events.
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Affiliation(s)
- Muhammad Aziz
- Department of Internal Medicine, University of Toledo Medical Center, 3000 Arlington Ave, Toledo, OH, 43614, United States.
| | - Marcel Ghanim
- Department of Internal Medicine, University of Toledo Medical Center, 3000 Arlington Ave, Toledo, OH, 43614, United States.
| | - Taha Sheikh
- Department of Internal Medicine, University of Toledo Medical Center, 3000 Arlington Ave, Toledo, OH, 43614, United States.
| | - Sachit Sharma
- Department of Internal Medicine, University of Toledo Medical Center, 3000 Arlington Ave, Toledo, OH, 43614, United States.
| | - Sami Ghazaleh
- Department of Internal Medicine, University of Toledo Medical Center, 3000 Arlington Ave, Toledo, OH, 43614, United States.
| | - Rawish Fatima
- Department of Internal Medicine, University of Toledo Medical Center, 3000 Arlington Ave, Toledo, OH, 43614, United States.
| | - Zubair Khan
- Department of Gastroenterology, McGovern Medical School, University of Texas Health Science Center at Houston, 6431 Fannin St, Houston, TX, 77030, United States.
| | - Wade Lee-Smith
- University of Toledo Libraries, 3000 Arlington Ave, Toledo, OH, 43614, United States.
| | - Ali Nawras
- Department of Gastroenterology, University of Toledo Medical Center, 3000 Arlington Ave, Toledo, OH, 43614, United States.
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Aziz M, Weissman S, Mehta TI, Hassan S, Khan Z, Fatima R, Tsirlin Y, Hassan A, Sciarra M, Nawras A, Rastogi A. Efficacy of Hemospray in non-variceal upper gastrointestinal bleeding: a systematic review with meta-analysis. Ann Gastroenterol 2020; 33:145-154. [PMID: 32127735 PMCID: PMC7049242 DOI: 10.20524/aog.2020.0448] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [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: 08/25/2019] [Accepted: 11/20/2019] [Indexed: 12/16/2022] Open
Abstract
Background Recently, amongst other hemostatic modalities, Hemospray (TC-325) has emerged as an effective method for managing patients with non-variceal upper gastrointestinal bleeding (GIB). We conducted this systematic review and meta-analysis to assess the efficacy of Hemospray in patients with non-variceal upper GIB. Methods Our primary outcomes were clinical and technical success; secondary outcomes were aggregate rebleeding, early rebleeding, delayed rebleeding, refractory bleeding, mortality, and treatment failure. A meta-analysis of proportions was conducted for all reported primary and secondary outcomes. A relative risk meta-analysis was conducted for studies reporting direct comparisons between Hemospray and other hemostatic measures. Results A total of 20 studies with 1280 patients were included in the final analysis. Technical success of Hemospray was seen in 97% of cases (95% confidence interval [CI] 94-98%, I2=52.89%) and a significant trend towards increasing technical success was seen during publication years 2011-2019. Clinical success of Hemospray was seen in 91% of cases (95%CI 88-94%, I2=47.72%), compared to 87% (95%CI 75-94%, I2=0.00%) for other hemostatic measures. The secondary outcomes of aggregate rebleeding, early rebleeding, delayed rebleeding, refractory rebleeding, mortality and treatment failure following the use of Hemospray were seen in 27%, 20%, 9%, 8%, 8%, and 31% of cases, respectively. Conclusion Hemospray is safe, effective and non-inferior to traditional hemostatic measures for the management of non-variceal upper GIB, and can thus be used as an alternative option.
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Affiliation(s)
- Muhammad Aziz
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio (Muhammad Aziz, Zubair Khan, Rawish Fatima)
| | - Simcha Weissman
- Department of Medicine, Hackensack University-Palisades Medical Center, North Bergen, New Jersey (Simcha Weissman)
| | - Tej I Mehta
- Department of Medicine, University of South Dakota Sanford school of Medicine, Sioux Falls, South Dakota (Tej I. Mehta)
| | - Shafae Hassan
- Department of Gastroenterology, University of Toledo Medical Center, Toledo, Ohio (Shafae Hassan, Ali Nawras)
| | - Zubair Khan
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio (Muhammad Aziz, Zubair Khan, Rawish Fatima)
| | - Rawish Fatima
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio (Muhammad Aziz, Zubair Khan, Rawish Fatima)
| | - Yuriy Tsirlin
- Department of Gastroenterology, Maimonides Medical Center, Brooklyn, New York (Yuriy Tsirlin)
| | - Ammar Hassan
- Division of Gastroenterology and Hepatology, Hackensack University-Palisades Medical Center, North Bergen, New Jersey (Ammar Hassan, Michael Sciarra)
| | - Michael Sciarra
- Division of Gastroenterology and Hepatology, Hackensack University-Palisades Medical Center, North Bergen, New Jersey (Ammar Hassan, Michael Sciarra)
| | - Ali Nawras
- Department of Gastroenterology, University of Toledo Medical Center, Toledo, Ohio (Shafae Hassan, Ali Nawras)
| | - Amit Rastogi
- Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, Kansas (Amit Rastogi), USA
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Aziz M, Sharma S, Fatima R, Lee-Smith W, Sodeman T, Nawras A, Adler DG. How to increase proximal adenoma detection rate: a meta-analysis comparing water exchange, water immersion and air/CO 2 insufflation methods for colonoscopy. Ann Gastroenterol 2020; 33:178-186. [PMID: 32127739 PMCID: PMC7049237 DOI: 10.20524/aog.2020.0459] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [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: 11/15/2019] [Accepted: 12/30/2019] [Indexed: 12/12/2022] Open
Abstract
Background Recent meta-analyses have demonstrated a higher adenoma detection rate using the water exchange method (WE), compared to water immersion (WI) and air/CO2 insufflation (ACI). Proximal adenomas have a high miss rate owing to their location and appearance. We performed a systematic review and meta-analysis of studies comparing the WE and WI methods to the ACI method, with a primary focus on proximal adenoma detection rate. Methods The following databases were searched for our systematic review: Medline, Embase, Cochrane Library, CINAHL, and Web of Sciences. We included both randomized controlled trials and cohort studies. The primary outcome was proximal adenoma detection rate, and secondary outcomes were right adenoma detection rate and cecal intubation rate. Results A total of 12 studies (17 arms) with 5660 patients (2260 ACI, 2281 WE, and 1119 WI) were included. A higher proximal adenoma detection rate (risk ratio [RR] 1.30, 95% confidence interval [CI] 1.11-1.53; P=0.001) and right adenoma detection rate (RR 1.43, 95%CI 1.19-1.71; P≤0.001; I2=0%) were noted for the WE group compared to the ACI group. The WI group did not demonstrate a better detection rate of proximal or right adenomas. Conclusions The water exchange method for colonoscopy holds promise and should be encouraged in the clinical setting to increase proximal and right adenoma detection rates. This will in turn decrease the incidence of colorectal cancer.
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Affiliation(s)
- Muhammad Aziz
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio (Muhammad Aziz, Sachit Sharma, Rawish Fatima)
| | - Sachit Sharma
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio (Muhammad Aziz, Sachit Sharma, Rawish Fatima)
| | - Rawish Fatima
- Department of Internal Medicine, University of Toledo Medical Center, Toledo, Ohio (Muhammad Aziz, Sachit Sharma, Rawish Fatima)
| | - Wade Lee-Smith
- Department of Internal Medicine, University of Toledo Libraries, Toledo, Ohio (Wade Lee-Smith)
| | - Thomas Sodeman
- Department of Gastroenterology, University of Toledo Medical Center, Toledo, Ohio (Thomas Sodeman, Ali Nawras)
| | - Ali Nawras
- Department of Gastroenterology, University of Toledo Medical Center, Toledo, Ohio (Thomas Sodeman, Ali Nawras)
| | - Douglas G Adler
- Department of Gastroenterology, University of Utah, Salt Lake City, Utah (Douglas G. Adler), USA
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Fatima R, Yaqoob A. Strengthening and implementing operational research in National TB Programmes: the Global Fund's vital role. Int J Tuberc Lung Dis 2020; 24:259-260. [PMID: 32127114 DOI: 10.5588/ijtld.19.0611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- R Fatima
- Common Management Unit (TB, HIV/AIDS and Malaria), Islamabad, Pakistan, ,
| | - A Yaqoob
- Common Management Unit (TB, HIV/AIDS and Malaria), Islamabad, Pakistan, ,
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Weissman S, Chris-Olaiya A, Mehta TI, Aziz M, Alshati A, Berry R, Fatima R, Kolli S, Hassan A, Sciarra MA. A novel player: cyclosporine therapy in the management of inflammatory bowel disease. Transl Gastroenterol Hepatol 2019; 4:67. [PMID: 31620649 DOI: 10.21037/tgh.2019.08.08] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Accepted: 08/15/2019] [Indexed: 11/06/2022] Open
Abstract
Amongst other indications, cyclosporine therapy has emerged as a novel agent for the management of severe refractory ulcerative colitis (UC). In the historic population of patients receiving cyclosporine therapy-namely solid organ transplant patients-renal toxicity has proven to be a significant mitigating side effect limiting the therapeutic window. However, dose-limiting sequelae amongst patients receiving cyclosporine for inflammatory bowel disease (IBD) have not been as significant. As a result, the fear of renal toxicity as an adverse effect is less of a concern in IBD patients. The goal of this manuscript is to emphasize the need for future research to explore optimal drug dosing and extended use of cyclosporine therapy in the treatment of IBD-given its pathophysiology, efficacy, and safety profile in patients with IBD.
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Affiliation(s)
- Simcha Weissman
- Department of Medicine, Hackensack University-Palisades Medical Center, North Bergen, NJ, USA
| | | | - Tej I Mehta
- Department of Medicine, University of South Dakota Sanford school of Medicine, Sioux falls, SD, USA
| | - Muhammad Aziz
- Department of Medicine, University of Kansas Medical Center, Kansas City, MO, USA
| | - Ali Alshati
- Department of Medicine, Maricopa Integrated Health System, Creighton University, Phoenix, AZ, USA
| | - Rani Berry
- Department of Medicine, Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
| | - Rawish Fatima
- Department of Medicine, University of Toledo Medical Center, Toledo, OH, USA
| | - Sindhura Kolli
- Department of Medicine, The Brooklyn Hospital Center, Brooklyn, NY, USA
| | - Ammar Hassan
- Division of Gastroenterology and Hepatology, Hackensack University-Palisades Medical Center, North Bergen, NJ, USA
| | - Michael A Sciarra
- Division of Gastroenterology and Hepatology, Hackensack University-Palisades Medical Center, North Bergen, NJ, USA
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Abstract
Aim: Glioblastoma multiforme (GBM) carries a dismal prognosis. Integrated proteogenomic analysis was performed to understand GBM pathophysiology. Patients & methods: 17 patient samples were analyzed for driver mutations, oncogenes, major pathway alterations and molecular changes at gene and protein level. Clinical, treatment and survival data were collected. Results: Significantly mutated genes included TP53, EGFR, PIK3R1, PTEN, NF1, RET and STAG2. EGFR mutations noted included EGFRvIII-expression, EGFR-L816Q missense mutation-exon 21 and EGFR fusion (FGFR3-TACC3). TP53 mutations were noticed in COSMIC hot-spot driver gene and accompany IDH1 and ATRX mutations suggesting low- to high-grade glioma transformation. Proteomics showed higher (53%) EGFR expression than genomic expression (23%). MGMT methylation was present in two-thirds of cases. Conclusion: This study identifies a distinct biological process that may characterize each GBM differently. Proteogenomic data identify potential therapeutic targets of GBM.
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Affiliation(s)
- Samia Asif
- Saint Luke's Cancer Institute, University of Missouri, Kansas City, MO 64111, USA
| | - Rawish Fatima
- Saint Luke's Cancer Institute, University of Missouri, Kansas City, MO 64111, USA
| | - Rebecca Krc
- Saint Luke's Cancer Institute, University of Missouri, Kansas City, MO 64111, USA
| | - Joseph Bennett
- Saint Luke's Cancer Institute, University of Missouri, Kansas City, MO 64111, USA
| | - Shahzad Raza
- Saint Luke's Cancer Institute, University of Missouri, Kansas City, MO 64111, USA
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Asif S, Fatima R, Krc R, Bennett JG, Raza S. Proteogenomic characterization in glioblastoma multiforme. J Clin Oncol 2019. [DOI: 10.1200/jco.2019.37.15_suppl.e13521] [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: 11/20/2022] Open
Abstract
e13521 Background: Glioblastoma (GBM) is an aggressive primary brain tumor carrying a dismal prognosis. Understanding molecular architecture of GBM is crucial for development of successful therapies against it. In this study, we performed an integrated proteogenomic analysis to determine a more comprehensive understanding of GBM phenotype. Methods: We performed quantitative proteomics and integrative genomic analysis based on The Cancer Genome Atlas (TCGA) datasets of GBM on 17 consecutive GBM patients. We collected information on driver mutations, oncogenes, major pathway alterations, mutation burden and molecular changes at both gene and protein level as well as clinical, treatment and survival data for the entire group. Results: Significantly mutated genes include TP53, EGFR, PIK3R1, PTEN, NF1, RET and STAG2. EGFR alterations by DNA amplification with multiple mutation allele frequencies were seen in 5(29.4%) patients including EGFRvIII expression, L816Q EGFR missense mutation on exon 21 and EGFR fusion (FGFR3-TACC3); all three are potential therapeutic targets of novel agents including EGFRvIII-specific dendritic cell vaccine, EGFR inhibitors and FGFR inhibitors. TP53 mutation was noticed in 30% of patients. TP53 Mutations were noticed in COSMIC hot spot driver gene and accompany IDH1 and ATRX mutations suggesting transformation from low to high-grade glioma. Only 1 patient had a high mutation burden and expired 17 months after initial diagnosis. In contrast, proteomics showed significantly high(n = 9,53%) EGFR expression. 75% of GBMs were MGMT methylated, a predictive marker of response to temozolomide. Twelve of the 17 patients are still alive; median overall survival was 16.5 months. Lowest survival observed was 5 months. Conclusions: This study identifies a distinct biological process that may characterize each glioblastoma differently. Proteogenomic data effectively recognizes potential therapeutic targets of GBM such as Exon 21 missense mutation, previously reported in lung adenocarcinoma with promising response to anti-EGFR antibodies. Incorporation of Whole Genome Sequencing into clinical practice will allow identification of new treatment options for GBM.
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Affiliation(s)
- Samia Asif
- University of Missouri Kansas City, School of Medicine, Kansas City, MO
| | | | - Rebecca Krc
- University of Missouri Kansas City, School of Medicine, Kansas City, MO
| | - Joesph G. Bennett
- University of Missouri Kansas City, School of Medicine, Kansas City, MO
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Abstract
BACKGROUND Clostridium difficile infection (CDI) is a significant health burden, now recognized as the leading cause of acquired diarrhea in patients receiving antibiotic therapy. Complications of infection with this pathogen include severe diarrhea, causing electrolyte imbalances, dehydration, hemodynamic instability, toxic megacolon, shock, and death. Hence it is extremely paramount to stay updated on management options for this infection, especially in cancer patients. REVIEW This article presents an in-depth review of literature on the treatment modalities available for CDI in cancer patients. Relevant articles highlighting therapeutic and symptomatic management of CDI patients with underlying malignancy have been summarized. CONCLUSIONS Despite the current options available, more studies are needed to assess the newer therapeutic options that are being employed for populations other than cancer patients.
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Affiliation(s)
- Muhammad Aziz
- a Department of Internal Medicine , University of Kansas Medical Center , Kansas City , MO , USA
| | - Rawish Fatima
- b Department of Medicine , Dow University of Health Sciences , Karachi , Pakistan
| | - Lindsey N Douglass
- c Pharmacy Department , Saint Luke's Hospital of Kansas City , Kansas City , MO , USA
| | - Omar Abughanimeh
- d Department of Internal Medicine , Saint Luke's Hospital of Kansas City/University of Missouri , Kansas City , MO , USA
| | - Shahzad Raza
- e Department of Hematology & Oncology , St. Luke's Hospital of Kansas City/University of Missouri , Kansas City , MO , USA
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Abstract
Clostridium difficile is a gram-positive bacterium notorious for causing epidemic diarrhea globally with a significant health burden. The pathogen is clinically challenging with increasing antibiotic resistance and recurrence rate. We provide here an in-depth review of one particular strain/ribotype 027, commonly known as NAP1/B1/027 or North American pulsed-field gel electrophoresis type 1, restriction endonuclease analysis type B1, polymerase chain reaction ribotype 027, which has shown a much higher recurrence rate than other strains.
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Affiliation(s)
- Rawish Fatima
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Muhammad Aziz
- Internal Medicine, University of Kansas Medical Center, Kansas City, USA
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Asif S, Begemann M, Bennett J, Fatima R, Masood A, Raza S. Pembrolizumab in newly diagnosed EBV-negative extranodal natural killer/T-cell lymphoma: A case report. Mol Clin Oncol 2019; 10:397-400. [PMID: 30847181 DOI: 10.3892/mco.2019.1805] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Accepted: 01/14/2019] [Indexed: 02/06/2023] Open
Abstract
Extranodal natural killer (NK)/T-cell lymphoma (ENKTL) is a rare subtype of non-Hodgkin's lymphoma with a dismal prognosis. The pathogenesis almost invariably involves Epstein-Barr virus (EBV) infection, although EBV-negative ENKTLs are frequently reported in the western hemisphere. Treatment of these lymphomas consists of aggressive chemotherapy with dexamethasone, methotrexate, ifosfamide, L-asparaginase and etoposide (SMILE regimen). However, the SMILE regimen is poorly tolerated by elderly patients; therefore, treatment options are limited to palliative radiation and chemotherapy and/or hospice care. Recently, binding of programmed death (PD)-1 with its ligand (PD-L1) expressed on tumor cells was shown to downregulate effector T-cell function and may represent a potent mechanism of immune evasion in classical Hodgkin's lymphoma and aggressive B-cell lymphomas. Thus, targeting PD-L1/PD-1 to inhibit effector T-cell signaling may be a promising therapeutic strategy for these NK/T-cell lymphomas. We herein report the clinical efficacy and feasibility of the anti-PD-1 inhibitor pembrolizumab used concurrently with radiation therapy and as maintenance therapy in an elderly female patient. The findings demonstrated that pembrolizumab may be an effective and well-tolerated treatment for this type of lymphoma.
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Affiliation(s)
- Samia Asif
- Department of Hematological Malignancies, Saint-Luke's Cancer Institute/University of Missouri School of Medicine, Kansas City, MO 64111, USA
| | - Madeline Begemann
- Department of Hematological Malignancies, Saint-Luke's Cancer Institute/University of Missouri School of Medicine, Kansas City, MO 64111, USA
| | - Joseph Bennett
- Department of Hematological Malignancies, Saint-Luke's Cancer Institute/University of Missouri School of Medicine, Kansas City, MO 64111, USA
| | - Rawish Fatima
- Department of Hematological Malignancies, Saint-Luke's Cancer Institute/University of Missouri School of Medicine, Kansas City, MO 64111, USA
| | - Ashiq Masood
- Rush University Medical Center, Chicago, IL 60612, USA
| | - Shahzad Raza
- Department of Hematological Malignancies, Saint-Luke's Cancer Institute/University of Missouri School of Medicine, Kansas City, MO 64111, USA
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Najmi H, Ahmed H, Halepota GM, Fatima R, Ul Haq M, Yaqoob A, Latif A, Ahmad W, Khursheed A. Community-based integrated approach to changing women's family planning behaviour in Pakistan, 2014-2016. Public Health Action 2018; 8:85-90. [PMID: 29946525 DOI: 10.5588/pha.17.0097] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 03/08/2018] [Indexed: 11/10/2022] Open
Abstract
Setting: Karachi, Pakistan. Objective: To assess the effectiveness of a community-based integrated approach in changing women's behaviour regarding contraceptive use. Design: The Sukh Initiative is a multipronged approach with door-to-door services using community health workers to provide quality family planning/reproductive health services at both public and private facilities and a 24/7 family planning helpline service that provides youth skill-based education. Methods: Retrospective pre- and post-intervention data using samples of 5140 and 3810 women, respectively. Results: The contraceptive prevalence rate increased by 10.7%, from 42.3% at baseline to 53.0% mid-intervention, with an increase in use of modern contraceptive methods of 9.2%. A significant association was found between door-to-door counselling and the use of contraceptive methods (OR 3.4, 95%CL 2.9-4.1) and access to public and private facilities for modern contraceptives (OR 2.4, 95%CL 2.0-3.0). However, support group meetings and 24/7 helpline use did not show any association with use of contraceptive method. Conclusion: The study helped to increase access to and choice of family planning services through a community-based approach that successfully reduced unmet needs and improved continuity in contraceptive use.
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Affiliation(s)
- H Najmi
- Sukh Initiative, Aman Foundation-Aman Health Care Services, Karachi, Pakistan
| | - H Ahmed
- Sukh Initiative, Aman Foundation-Aman Health Care Services, Karachi, Pakistan
| | - G M Halepota
- Sukh Initiative, Aman Foundation-Aman Health Care Services, Karachi, Pakistan
| | - R Fatima
- Pakistan National Tuberculosis Programme, Islamabad, Pakistan
| | - M Ul Haq
- Pakistan National Tuberculosis Programme, Islamabad, Pakistan
| | - A Yaqoob
- Pakistan National Tuberculosis Programme, Islamabad, Pakistan
| | - A Latif
- Pakistan National Tuberculosis Programme, Islamabad, Pakistan
| | - W Ahmad
- Provincial Tuberculosis Control Programme, Baluchistan, Pakistan
| | - A Khursheed
- Provincial Tuberculosis Control Programme, Sindh, Pakistan
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Latif A, Ghafoor A, Wali A, Fatima R, Ul-Haq M, Yaqoob A, Abdullah Z, Najmi H, Khan NM. Did diabetes mellitus affect treatment outcome in drug-resistant tuberculosis patients in Pakistan from 2010 to 2014? Public Health Action 2018; 8:14-19. [PMID: 29581938 DOI: 10.5588/pha.17.0098] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 01/11/2018] [Indexed: 11/10/2022] Open
Abstract
Settings: All hospitals managing drug-resistant tuberculosis (DR-TB) according to national guidelines in Pakistan. Objectives: To assess the effect of diabetes mellitus (DM) and factors associated with unfavourable outcomes in DR-TB. Methods: A cross-sectional study based on a retrospective record review of patients enrolled on DR-TB treatment from 2010 to 2014 in Pakistan. DR-TB data reported to Pakistan's National TB Control Programme on a monthly basis were used for the study. Result: Among 5811 patients enrolled on second-line drugs, 8.8% had DM. Overall, 68.9% had favourable outcomes. No association was found between DM and DR-TB treatment outcomes (risk ratio 0.90, 95%CI 0.74-1.05). Unfavourable outcomes were more frequent among DR-TB patients with human immunodeficiency virus (HIV) co-infection (OR 11.58, 95%CI 2.20-60.72), extensively drug-resistant TB patients (OR 5.36, 95%CI 1.00-28.72), patients with exposure to both first-line and second-line anti-tuberculosis drugs (OR 2.45, 95%CI 1.21-4.97) and those with a previous history of treatment in the private sector (OR 1.53, 95%CI 1.16-2.02). Conclusion: Although there were limitations to correctly measuring DM and its management, DM appears not to be a risk factor for unfavourable outcomes in DR-TB patients in our study. DR-TB and HIV co-infection, second-line drug resistance and history of treatment in the private sector were nevertheless more frequently associated with adverse outcomes.
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Affiliation(s)
- A Latif
- National Tuberculosis Control Programme, Pakistan, Islamabad, Pakistan
| | - A Ghafoor
- National Tuberculosis Control Programme, Pakistan, Islamabad, Pakistan
| | - A Wali
- Provincial Tuberculosis Control Programme, Balochistan, Quetta, Pakistan
| | - R Fatima
- National Tuberculosis Control Programme, Pakistan, Islamabad, Pakistan
| | - Mahboob Ul-Haq
- National Tuberculosis Control Programme, Pakistan, Islamabad, Pakistan
| | - A Yaqoob
- National Tuberculosis Control Programme, Pakistan, Islamabad, Pakistan
| | - Z Abdullah
- Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan
| | - H Najmi
- Sukh Initiative, Aman Health Care Services, Aman Foundation, Karachi, Pakistan
| | - N M Khan
- National Tuberculosis Control Programme, Pakistan, Islamabad, Pakistan
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Aziz M, Pervez A, Fatima R, Bansal A. Pseudoephedrine Induced Ischemic Colitis: A Case Report and Review of Literature. Case Rep Gastrointest Med 2018; 2018:8761314. [PMID: 30050703 PMCID: PMC6046157 DOI: 10.1155/2018/8761314] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Accepted: 06/13/2018] [Indexed: 12/20/2022] Open
Abstract
Ischemic colitis due to medications is common, and a number of cases have been described with pseudoephedrine as the culprit agent. We present here an interesting case of a healthy female with no risk factors who developed pseudoephedrine induced ischemic colitis. This case serves to remind the healthcare providers about the utmost importance of obtaining a comprehensive history to aid with the diagnosis.
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Affiliation(s)
- Muhammad Aziz
- 1Department of Internal Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Asad Pervez
- 2Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Rawish Fatima
- 3Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Ajay Bansal
- 2Department of Gastroenterology and Hepatology, University of Kansas Medical Center, Kansas City, KS, USA
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Ali H, Alam S, Zafar F, Bushra R, Saleem S, Israr F, Naqvi GR, Mallick N, Tariq A, Fatima R. Drug Utilization Pattern of Ciprofloxacin, Meropenem and Amikacin in Tertiary Care Hospital in Pakistan. Indian J Pharm Sci 2018. [DOI: 10.4172/pharmaceutical-sciences.1000400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Aslam W, Tahseen S, Schomotzer C, Hussain A, Khanzada F, Ul Haq M, Mahmood N, Fatima R, Qadeer E, Heldal E. Gastric specimens for diagnosing tuberculosis in adults unable to expectorate in Rawalpindi, Pakistan. Public Health Action 2017; 7:141-146. [PMID: 28695088 DOI: 10.5588/pha.16.0126] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 03/20/2017] [Indexed: 11/10/2022] Open
Abstract
Setting: Adult pulmonary tuberculosis (TB) patients unable to expectorate quality sputum represent a diagnostic challenge. A private hospital in Pakistan routinely performs gastric aspiration in adults with difficulties expectorating. Objective: To assess the usefulness of gastric specimens (GS) in diagnosing pulmonary TB (PTB) and drug-resistant TB in adult presumptive TB patients unable to expectorate, and to compare the diagnostic yield and sensitivity of smear, culture and the Xpert® MTB/RIF assay. Design: This was a comparative cross-sectional study based on retrospective record review. Results: Of 900, 885 and 877 GS tested by smear, Xpert and culture, respectively, interpretable results were obtained for respectively 900 (100%), 859 (97.1%) and 754 (86.0%), with a diagnostic yield of respectively 23.6%, 30.3% and 24.9%. The yield was significantly higher for Xpert in previously treated patients. There were 313 patients with definite TB, defined as positive on Xpert and/or culture. The 82.8% sensitivity of Xpert was significantly higher than that of smear (61.0%) and culture (67.8%). Conclusion: GS obtained by aspiration under routine programme conditions is useful for detecting TB and drug-resistant TB in adult patients unable to expectorate. Xpert, with its rapid testing, high proportion of interpretable results and better sensitivity, can substantially improve the diagnosis of bacteriologically confirmed TB and rifampicin resistance.
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Affiliation(s)
- W Aslam
- National Tuberculosis Reference Laboratory, National Tuberculosis Control Program (NTP), Islamabad, Pakistan
| | - S Tahseen
- National Tuberculosis Reference Laboratory, National Tuberculosis Control Program (NTP), Islamabad, Pakistan
| | - C Schomotzer
- Rawalpindi Leprosy Hospital, Rawalpindi, Pakistan
| | - A Hussain
- National Tuberculosis Reference Laboratory, National Tuberculosis Control Program (NTP), Islamabad, Pakistan
| | - F Khanzada
- National Tuberculosis Reference Laboratory, National Tuberculosis Control Program (NTP), Islamabad, Pakistan
| | | | | | | | - E Qadeer
- Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | - E Heldal
- Independent Tuberculosis Consultant, Oslo, Norway
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42
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Khan BJ, Kumar AMV, Stewart A, Khan NM, Selvaraj K, Fatima R, Samad Z. Alarming rates of attrition among tuberculosis patients in public-private facilities in Lahore, Pakistan. Public Health Action 2017; 7:127-133. [PMID: 28695086 DOI: 10.5588/pha.17.0001] [Citation(s) in RCA: 9] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Accepted: 03/07/2017] [Indexed: 11/10/2022] Open
Abstract
Setting: All public-private mix (PPM) facilities caring for tuberculosis (TB) patients in Lahore city, Pakistan, under four models: PPM1 (general practitioners), PPM2 (non-governmental organisations), PPM3 (private hospitals) and PPM4 (others). Objective: To assess the pre-treatment loss to follow-up (LTFU), defined as patients documented in the laboratory registers but not in the treatment registers of any PPM facility, among sputum smear-positive TB patients diagnosed during January-March 2015, and unfavourable treatment outcomes among patients registered for treatment and associated factors. Design: This was a retrospective cohort study reviewing existing programme records. Poisson regression was used to identify factors associated with outcomes. Results: Of 2473 patients diagnosed, 1590 (64%) were lost to follow-up before treatment. This was higher among males (68%) and the elderly (79%), and lower among 'high positives' (smear grading 2+ or 3+, 53%) and in the PPM1 model (34%). Of 883 patients started on treatment, 165 (19%) had unfavourable outcomes: 8% LTFU, 5% treatment failure, 3% died and 3% not evaluated. Previously treated patients (34%) and children (44%) had the worst outcomes. Conclusion: Pre-treatment LTFU was alarmingly high and requires urgent attention, including the development and institution of mechanisms for patient tracking using information and mobile phone technology, and making TB notification mandatory in the private sector.
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Affiliation(s)
- B J Khan
- National Tuberculosis Control Program, Islamabad, Pakistan
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), South-East Asia Office, New Delhi, India.,The Union, Paris, France
| | - A Stewart
- College of Life and Environmental Science, Exeter University, Exeter, UK
| | - N M Khan
- National Tuberculosis Control Program, Islamabad, Pakistan
| | - K Selvaraj
- Department of Community Medicine, Pondicherry Institute of Medical Sciences, Puducherry, India
| | - R Fatima
- National Tuberculosis Control Program, Islamabad, Pakistan
| | - Z Samad
- National Tuberculosis Control Program, Islamabad, Pakistan
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43
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Waheed Y, Khan MA, Fatima R, Yaqoob A, Mirza A, Qadeer E, Shakeel M, Heldal E, Kumar AMV. Infection control in hospitals managing drug-resistant tuberculosis in Pakistan: how are we doing? Public Health Action 2017; 7:26-31. [PMID: 28775940 DOI: 10.5588/pha.16.0125] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2016] [Accepted: 02/07/2017] [Indexed: 11/10/2022] Open
Abstract
Setting: Ten hospitals managing drug-resistant tuberculosis (TB) in Pakistan. Objective: To assess the implementation of TB infection control (IC) practices and reasons for non-adherence to guidelines. Design: This was a descriptive study conducted between April and October 2016 with three components: 1) non-participant observation of service delivery areas (SDAs) (n = 82) in hospitals (n = 10) using structured checklists; 2) exit interviews with 100 patients (10 per hospital); and 3) interviews with 100 health-care workers (HCWs, 10/hospital). Results: Of the 82 SDAs, posters were displayed in 34 (41%), mechanical ventilation was implemented in 79% and functional ultraviolet germicidal irradiation (UVGI) was available in only 26%. Patient interviews showed 50-65% adherence to triage and use of personal protective measures. Key reasons for non-adherence were lack of adequate supplies, discomfort using N-95 masks, a lack of knowledge or training, perceived non-cooperation by patients, poor maintenance of mechanical ventilators and UVGI due to unstable electricity supply, a lack of clarity in roles (no-one designated in charge) and staff shortages and subsequent workloads. Adherence to natural ventilation usage was poor for reasons related to climate and privacy. Conclusion: Implementation of TBIC measures in hospitals was suboptimal. Urgent measures need to be put in place, including retraining of HCWs, addressing weaknesses in mask and poster supplies and constant supervision and monitoring.
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Affiliation(s)
- Y Waheed
- National Tuberculosis Control Programme, Islamabad, Pakistan
| | - M A Khan
- National Tuberculosis Control Programme, Islamabad, Pakistan
| | - R Fatima
- National Tuberculosis Control Programme, Islamabad, Pakistan
| | - A Yaqoob
- National Tuberculosis Control Programme, Islamabad, Pakistan
| | - A Mirza
- National Tuberculosis Control Programme, Islamabad, Pakistan
| | - E Qadeer
- National Tuberculosis Control Programme, Islamabad, Pakistan
| | - M Shakeel
- Royal Australian College of General Practitioners, East Melbourne, Victoria, Australia
| | - E Heldal
- Independent TB Consultant, Oslo, Norway
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.,The Union South-East Asia Office, New Delhi, India
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44
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Waheed Y, Khan MA, Fatima R, Yaqoob A, Mirza A, Qadeer E, Shakeel M, Heldal E, Kumar AMV. Infection control in hospitals managing drug-resistant tuberculosis in Pakistan: how are we doing? Public Health Action 2017. [DOI: 10.5588/pha.16.0125%0asetting] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/26/2023] Open
Affiliation(s)
- Y. Waheed
- National Tuberculosis Control Programme, Islamabad, Pakistan
| | - M. A. Khan
- National Tuberculosis Control Programme, Islamabad, Pakistan
| | - R. Fatima
- National Tuberculosis Control Programme, Islamabad, Pakistan
| | - A. Yaqoob
- National Tuberculosis Control Programme, Islamabad, Pakistan
| | - A. Mirza
- National Tuberculosis Control Programme, Islamabad, Pakistan
| | - E. Qadeer
- National Tuberculosis Control Programme, Islamabad, Pakistan
| | - M. Shakeel
- Royal Australian College of General Practitioners, East Melbourne, Victoria, Australia
| | - E. Heldal
- Independent TB Consultant, Oslo, Norway
| | - A. M. V. Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France, The Union South-East Asia Office, New Delhi, India
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45
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Wali A, Kumar AMV, Hinderaker SG, Heldal E, Qadeer E, Fatima R, Ullah A, Safdar N, Yaqoob A, Anwar K, Ul Haq M. Pre-treatment loss to follow-up among smear-positive TB patients in tertiary hospitals, Quetta, Pakistan. Public Health Action 2017; 7:21-25. [PMID: 28775939 DOI: 10.5588/pha.16.0118] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 01/31/2017] [Indexed: 11/10/2022] Open
Abstract
Setting: Three public sector tertiary care hospitals in Quetta, Balochistan, Pakistan, with anecdotal evidence of gaps between the diagnosis and treatment of patients with tuberculosis (TB). Objectives: To assess the proportion of pre-treatment loss to follow-up (LTFU), defined as no documented evidence of treatment initiation or referral in TB registers, among smear-positive pulmonary TB patients diagnosed in 2015, and the associated sociodemographic factors. Design: A retrospective cohort study involving the review of laboratory and TB registers. Results: Of 1110 smear-positive TB patients diagnosed (58% female, median age 40 years, 5% from outside the province or the country), 235 (21.2%) were lost to follow-up before starting treatment. Pre-treatment LTFU was higher among males; in patients residing far away, in rural areas, outside the province or the country; and in those without a mobile phone number. Conclusion: About one fifth of the smear-positive TB patients were lost to follow-up before starting treatment. Strengthening the referral and feedback mechanisms and using information technology to improve the tracing of patients is urgently required. Further qualitative research is needed to understand the reasons for pre-treatment LTFU from the patient's perspective.
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Affiliation(s)
- A Wali
- National Tuberculosis Control Programme, Ministry of National Health Services, Regulation and Coordination, Islamabad, Pakistan.,Provincial Tuberculosis Control Programme, Health Department, Balochistan, Pakistan
| | - A M V Kumar
- International Union Against Tuberculosis and Lung Disease (The Union), Paris, France.,The Union, South-East Asia Office, New Delhi, India
| | - S G Hinderaker
- Centre for International Health, University of Bergen, Bergen, Norway
| | - E Heldal
- Independent Tuberculosis Consultant, Oslo, Norway
| | - E Qadeer
- National Tuberculosis Control Programme, Ministry of National Health Services, Regulation and Coordination, Islamabad, Pakistan
| | - R Fatima
- National Tuberculosis Control Programme, Ministry of National Health Services, Regulation and Coordination, Islamabad, Pakistan
| | - A Ullah
- Provincial Tuberculosis Control Programme, Health Department, Balochistan, Pakistan
| | - N Safdar
- Centre for International Health, University of Bergen, Bergen, Norway.,Social and Health Inequalities Network, Islamabad, Pakistan
| | - A Yaqoob
- National Tuberculosis Control Programme, Ministry of National Health Services, Regulation and Coordination, Islamabad, Pakistan
| | - K Anwar
- Bridge Consultants Foundation, Karachi, Pakistan
| | - M Ul Haq
- National Tuberculosis Control Programme, Ministry of National Health Services, Regulation and Coordination, Islamabad, Pakistan
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46
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Shakoor S, Tahseen S, Jabeen K, Fatima R, Malik F, Rizvi A, Hasan R. Fluoroquinolone consumption and -resistance trends in Mycobacterium tuberculosis and other respiratory pathogens: Ecological antibiotic pressure and consequences in Pakistan, 2009–2015. Int J Mycobacteriol 2016; 5:412-416. [DOI: 10.1016/j.ijmyco.2016.07.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 07/26/2016] [Indexed: 10/21/2022] Open
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Jha R, Fatima R, Lakhtakia S, Jha A, Srikant P, Narayan G. Ledipasvir and sofosbuvir for treatment of post- renal transplant hepatitis C infection: A case report with review of literature. Indian J Nephrol 2016; 26:216-9. [PMID: 27194839 PMCID: PMC4862270 DOI: 10.4103/0971-4065.163432] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Liver disease due to hepatitis C infection in renal transplant recipients is difficult to treat and often associated with reduced patient survival. A 43-year-old male, a renal allograft recipient, presented at 6 years follow-up with significant weight loss over 3 months. He was detected to have new onset diabetes mellitus together with hepatitis C virus (HCV) infection (genotype 1). His HCV load remained high despite the change of immuno-suppression from tacrolimus to cyclosporine. A decision to treat with a new anti-viral combination of ledipasvir and sofosbuvir for 12 weeks was taken. Within 3 weeks, his raised serum transaminases levels normalized and viral load became undetectable. At the end of 16 weeks, he continues to do well with normal renal function, has sustained remission from hepatitis C infection and resolution of diabetes.
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Affiliation(s)
- R Jha
- Department of Nephrology, Medwin Hospital, Hyderabad, Telangana, India
| | - R Fatima
- Department of Nephrology, Medwin Hospital, Hyderabad, Telangana, India
| | - S Lakhtakia
- Department of Medical Gastroenterology, Asian Institute of Gastroenterology, Hyderabad, Telangana, India
| | - A Jha
- Department of Medicine, Mediciti Medical College, Hyderabad, Telangana, India
| | - P Srikant
- Department of Nephrology, Medwin Hospital, Hyderabad, Telangana, India
| | - G Narayan
- Department of Nephrology, Medwin Hospital, Hyderabad, Telangana, India
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48
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Fatima R, Qadeer E, Enarson DA, Creswell J, Stevens RH, Stevens R, Hinderaker SG, Anwar K, ul Haq M. Success of active tuberculosis case detection among high-risk groups in urban slums in Pakistan. Int J Tuberc Lung Dis 2016; 18:1099-104. [PMID: 25189559 DOI: 10.5588/ijtld.14.0001] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Pakistan, patients with symptoms suggestive of tuberculosis (TB) seek care from a wide array of health care providers, many of whom do not notify cases to the National TB Programme (NTP). SETTING We evaluated an active case detection intervention in five randomly selected districts in urban slums of Sindh Province, Pakistan. OBJECTIVE To evaluate the increase in case notification of smear-positive TB by active case finding at community-based chest camps by engaging the private providers. DESIGN A cross-sectional study of TB case detection associated with a project using integrated intervention and chest camps. RESULTS From April 2011 to September 2012, the total number of clients seen in the camps was 165 280. Of all the attendees, 13 481 (12.7%) were examined by sputum smear microscopy. The proportion of smear-positive results was significantly higher among those from engaged private providers than among those referred from camps (OR 1.54, 95%CI 1.42-1.66). During the project, the total number of smear-positive TB notifications increased over the intervention period from 5158 to 8275. CONCLUSION Active case detection by engaging private providers and chest camps can significantly increase the number of smear-positive TB case notifications.
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Affiliation(s)
- R Fatima
- National Tuberculosis Control Program Pakistan, Islamabad, Pakistan
| | - E Qadeer
- National Tuberculosis Control Program Pakistan, Islamabad, Pakistan
| | - D A Enarson
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | - J Creswell
- TB REACH Stop TB Partnership, World Health Organization, Geneva, Switzerland
| | | | | | | | | | - M ul Haq
- National Tuberculosis Control Program Pakistan, Islamabad, Pakistan
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49
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Fatima R, Qadeer E, Hinderaker SG, Yaqoob A, Enarson DA, Bassili A, ul Haq M, Javed B. Can the number of patients with presumptive tuberculosis lost in the general health services in Pakistan be reduced? Int J Tuberc Lung Dis 2016; 19:654-6. [PMID: 25946354 DOI: 10.5588/ijtld.14.0751] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The frequency of patients with presumptive tuberculosis (TB) who are not investigated by sputum smear microscopy is unknown in Pakistan. Using a simple intervention comparing patient and laboratory registers, patients with presumptive TB were identified in two districts from July to December 2013, a list of missing patients was prepared and the patients traced. The intervention significantly reduced the number of patients with presumptive TB lost, from 8.5% before the intervention to 6.9% after. A systematic comparison of out-patient and laboratory registers, followed by tracing missing persons, can reduce the proportion of patients with presumptive TB lost before diagnosis.
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Affiliation(s)
- R Fatima
- National Tuberculosis Control Program Pakistan, Islamabad, Pakistan
| | - E Qadeer
- National Tuberculosis Control Program Pakistan, Islamabad, Pakistan
| | | | - A Yaqoob
- National Tuberculosis Control Program Pakistan, Islamabad, Pakistan
| | - D A Enarson
- International Union Against Tuberculosis and Lung Disease, Paris, France; University of Stellenbosch, Cape Town, South Africa
| | - A Bassili
- Medical Research Institute, Alexandria University, Alexandria, Egypt; University of Bergen, Bergen, Norway
| | - M ul Haq
- National Tuberculosis Control Program Pakistan, Islamabad, Pakistan
| | - B Javed
- National Tuberculosis Control Program Pakistan, Islamabad, Pakistan
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50
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Fatima R, Qadeer E, Enarson DA, Hinderaker SG, Harris R, Yaqoob A, Bassili A. Investigation of presumptive tuberculosis cases by private health providers: lessons learnt from a survey in Pakistan. Public Health Action 2015; 4:110-2. [PMID: 26399209 DOI: 10.5588/pha.14.0010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2014] [Accepted: 04/15/2014] [Indexed: 11/10/2022] Open
Abstract
Pakistan's National Tuberculosis Control Programme (NTP) is missing data on many tuberculosis (TB) cases who visit private providers. A survey on the incidence and under-reporting of TB in Pakistan provided a database for exploring the investigation and referral of presumptive TB cases by private health providers. The survey showed that private health providers requested both sputum smear and X-ray for diagnostic investigations. Of 2161 presumptive TB cases referred, 1189 (55%) were sent for investigations to a district NTP TB centre, of whom only 314 (26.4%) were registered. This indicates an urgent need to strengthen the link between private health providers and NTP to enhance TB notification.
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Affiliation(s)
- R Fatima
- National Tuberculosis Control Programme Pakistan, Islamabad, Pakistan
| | - E Qadeer
- National Tuberculosis Control Programme Pakistan, Islamabad, Pakistan
| | - D A Enarson
- International Union Against Tuberculosis and Lung Disease, Paris, France
| | | | - R Harris
- Public Health England, London, UK
| | - A Yaqoob
- National Tuberculosis Control Programme Pakistan, Islamabad, Pakistan
| | - A Bassili
- World Health Organization Regional Office for the Eastern Mediterranean, Cairo, Egypt ; Medical Research Institute, Alexandria University, Alexandria, Egypt
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