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Harris TR, Bhutta ZA, Qureshi I, Kharma N, Raza T, Hssain AA, Pathare AS, D'Silva A, Khatib MY, Mohamedali MGH, Macineira IMG, Garcia Hernandez VR, Garcia JR, Thomas SH, Pathan SA. A randomised clinical trial of awake prone positioning in COVID-19 suspects with acute hypoxemic respiratory failure. Contemp Clin Trials Commun 2024; 39:101295. [PMID: 38689829 PMCID: PMC11059337 DOI: 10.1016/j.conctc.2024.101295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 02/22/2024] [Accepted: 03/27/2024] [Indexed: 05/02/2024] Open
Abstract
Background Awake prone position (APP) has been reported to improve oxygenation in patients with COVID-19 disease and to reduce the requirement for invasive mechanical ventilation for patients requiring support with high flow nasal cannula. There is conflicting data for patients requiring lower-level oxygen support. Research question Does APP reduce escalation of oxygen support in COVID-19 patients requiring supplementary oxygen?The primary outcome was defined as an escalation of oxygen support from simple supplementary oxygen (NP, HM, NRB) to NIV (CPAP or BiPAP), HFNC or IMV; OR from NIV (CPAP or BiPAP) or HFNC to IMV by day30. Study design Two center, prospective, non-blind, randomised controlled trial. Patients with confirmed or suspected COVID-19 pneumonia requiring ≥ 5 liters/min oxygen to maintain saturations ≥ 94 % were randomised to either APP or control group. The APP group received a 3-h APP session three times per day for three days. Results Between 9 May and July 13, 2021, 89 adults were screened and 61 enrolled, 31 to awake prone position and 30 controls. There was no difference in the primary outcome, 7 (22.6 %) patients randomised to APP and 9 (30.0 %) controls required escalation of oxygen support (OR 0.68 (0.22-2.14), P = 0.51). There were no differences in any secondary outcomes, in APP did not improve oxygenation. Interpretation In COVID-19 patients, the use of APP did not prevent escalation of oxygen support from supplementary to invasive or non-invasive ventilation or improve patient respiratory physiology. Trial registration NCT04853979 (clinicaltrials.gov).
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Affiliation(s)
- Tim R.E. Harris
- Corporate Department of Emergency Medicine, Hamad Medical Corporation, Qatar
- Queen Mary University London, United Kingdom
| | - Zain A. Bhutta
- Corporate Department of Emergency Medicine, Hamad Medical Corporation, Qatar
- Department of Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Isma Qureshi
- Corporate Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Nadir Kharma
- Corporate Department Medical Intensive Care, Hamad General Hospital, Doha, Qatar
- Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Tasleem Raza
- Corporate Department Medical Intensive Care, Hamad General Hospital, Doha, Qatar
| | - Ali Ait Hssain
- Corporate Department Medical Intensive Care, Hamad General Hospital, Doha, Qatar
| | - Ankush Suresh Pathare
- Corporate Department of Emergency Medicine, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ashwin D'Silva
- Corporate Department of Emergency Medicine, Hazm Mebaireek General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mohamad Yahya Khatib
- Corporate Medical Intensive Care, Head of Unit, Hazm Mebaireek General Hospital, Doha, Qatar
| | - Mohamed Gafar Hussein Mohamedali
- Corporate Department Internal Medicine, Head of Unit, Hazm Mebaireek General Hospital, Doha, Qatar
- Instructor in Clinical Medicine, Weill Cornell Medicine, Qatar
| | | | | | - Jorge Rosales Garcia
- Corporate Department Medical Intensive Care, The Cuban Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Stephen H. Thomas
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center & Harvard Medical School, Boston, MA, USA
- Queen Mary University London, United Kingdom
| | - Sameer A. Pathan
- Corporate Department of Emergency Medicine, Hamad Medical Corporation, Qatar
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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Bhutta ZA, Akhtar N, Pathan SA, Castren M, Harris T, Ganesan GS, Kamran S, Thomas SH, Cameron PA, Azad AM, Puolakka T. Epidemiological profile of stroke in Qatar: Insights from a seven-year observational study. J Clin Neurosci 2024; 123:30-35. [PMID: 38520927 DOI: 10.1016/j.jocn.2024.03.014] [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: 09/24/2023] [Revised: 03/05/2024] [Accepted: 03/14/2024] [Indexed: 03/25/2024]
Abstract
OBJECTIVES Stroke prevalence is progressively increasing in developing countries due to increased vascular risk factors. This study aims to describe the epidemiology, prevalent risk factors, and outcomes of stroke in a multi-ethnic society of Qatar. MATERIALS AND METHODS We conducted a retrospective analysis of all patients with suspected stroke admitted to stroke services between January 2014 and September 2020. RESULTS A total of 11,892 patients were admitted during this period with suspected stroke. Of these, the diagnosis was ischemic stroke (48.8 %), transient ischemic attack (10.3 %), intracerebral hemorrhage (10.9 %), cerebral venous sinus thrombosis (1.3 %), and stroke mimics (28.6 %). The median age was 52 (43-62), with a male-female ratio of 3:1. The study population was predominantly Asian (56.8 %) and Arab (36 %). The majority of the patients were hypertensive (66.8 %), diabetic (47.9 %), and dyslipidemic (45.9 %). A history of prior stroke was observed in 11.7 %, while 0.9 % had prior transient ischemic attack. Among ischemic strokes, 31.7 % arrived within 4.5 h, 12.5 % received thrombolysis, and 4.6 % underwent thrombectomy. Median Door-to-Needle time was 51 (33-72) minutes. The average length of stay was 5.2 ± 9.0 days, with 71.5 % discharged home, 13.8 % transferred to rehabilitation, 9.3 % to other specialties, 3 % to long-term care, and 2.4 % suffered in-hospital mortality. CONCLUSION Stroke in Qatar is characterized by a younger, expatriate-dominant cohort, with notable prevalence of ischemic and hemorrhagic stroke and a distinct risk factor profile. Further analysis of epidemiological differences among different population groups can inform targeted policies for prevention and management to reduce the burden of disease.
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Affiliation(s)
- Zain A Bhutta
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar; Department of Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| | - Naveed Akhtar
- Department of Neurology, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar.
| | - Sameer A Pathan
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar; Blizard Institute of Barts & The London School of Medicine, Queen Mary University of London, UK; School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Maaret Castren
- Department of Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
| | - Tim Harris
- Blizard Institute of Barts & The London School of Medicine, Queen Mary University of London, UK.
| | - Gowrii S Ganesan
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar.
| | - Saadat Kamran
- Department of Neurology, Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar.
| | - Stephen H Thomas
- Blizard Institute of Barts & The London School of Medicine, Queen Mary University of London, UK; Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA.
| | - Peter A Cameron
- The Alfred Hospital, Emergency and Trauma Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Aftab M Azad
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar.
| | - Tuukka Puolakka
- Department of Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
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3
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Thomas CE, Pathan SA, Bhutta ZA, Qureshi I, Thomas SH. Standard vs. modified vestibular/ocular motor screening for emergency department prediction of symptom persistence 1 week after minor head injury. Eur J Emerg Med 2023; 30:450-452. [PMID: 37883241 DOI: 10.1097/mej.0000000000001076] [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: 10/28/2023]
Affiliation(s)
- Caroline E Thomas
- B.S. candidate, Department of Chemistry, Georgetown University, Washington, DC, USA
| | - Sameer A Pathan
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
- Barts & The London School of Medicine and Barts Health NHS Trust, London, UK
- School of Public Health and Preventative Medicine, Monash University, Melbourne, Australia
| | - Zain A Bhutta
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
- Department of Emergency Medicine and Services, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Isma Qureshi
- Department of Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Stephen H Thomas
- Barts & The London School of Medicine and Barts Health NHS Trust, London, UK
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, USA
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Bhutta ZA, AKHTAR NAVEED, Pathan SA, Puolakka T, Harris T, Ganesan GSS, Kamran S, Thomas SH, Cameron P, Castren MK. Abstract TP195: A Comprehensive Epidemiology Of Stroke In A Multi Ethnic Society: An Analysis Of A Nationwide Stroke Data From 2014 - 2020. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.tp195] [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: 11/16/2022]
Abstract
Introduction:
The prevalence of stroke is progressively increasing in developing countries owing to the increase in vascular risk factors in the population. Risk factors vary significantly in different population groups leading to variations in disease progression, management and outcomes. This study aims to describe the epidemiology, prevalent risk factors and outcomes in a multi ethnic society of Qatar.
Methods:
We conducted a retrospective cohort study that included all patients with suspected stroke admitted to Hamad General Hospital, Doha Qatar between April 30, 2014 till September 15, 2020.
Results:
A total of 11,892 patients were admitted during this period with suspected stroke. Of these, Ischemic stroke (IS; 48.8%), Transient ischemic attack (TIA; 10.3%), Intracerebral hemorrhage (ICH; 10.9%), Stroke mimics (28.6%) and Cerebral venous sinus thrombosis (CVST; 1.3%). Mean age was 53.1
+
14.1 and a male to female ratio of 3:1. Study population was majorly Asian (56.8%) and Arab (36%); while African (4.5%), Caucasian (2.6%) and Others (0.1%) formed minority of the population. Asian population (South Asian; 49.7
+
11.6 and Far Eastern; 47.4
+
9.9) were younger as compared to Arabs (58.9
+
15.9). Majority of the patients were hypertensive (66.8%), diabetic (47.9%) and dyslipidemic (45.9%) on admission, while cardiac diseases (14.7%) and DVT (0.3%) were observed in fewer patients. Patients with a history of prior stroke were 11.7%, while 0.9% had a prior TIA. In IS patients, 31.7% of the patients arrived ED within the 4.5-hour thrombolysis window, 12.5% received thrombolysis and 4.6% received thrombectomy. The average Door-to-Needle time for IS patients was 58.9
+
39.5 minutes. The average length of stay was 5.2
+
9.0 days with 71.5% discharged home, 13.8% transferred to rehabilitation, 9.3% to other specialties, 3% to long term care and 2.4% suffered in-hospital mortality.
Conclusion:
The patients suffering Stroke in Qatar are relatively younger than western population. Highly prevalent vascular risk factors could explain younger presentation and relatively high burden of stroke. Further analysis of epidemiological differences between ethnic subgroups can help tailoring effective preventive and management policies to reduce the burden of disease.
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Affiliation(s)
| | | | | | - Tuukka Puolakka
- Dept of Emergency Medicine and Services, Helsinki Univ Hosp and Univ of Helsinki, Helsinki, Finland
| | - Tim Harris
- Emergency Medicine, Hamad Med Corp, Doha, Qatar
| | | | - Saadat Kamran
- Hamad General Hosp, Weil Cornell Sch of Medicine, Qatar, Doha, Qatar
| | | | - Peter Cameron
- The Alfred Hosp, Emergency and Trauma Cntr , Monash Univ, Melbourne, Australia
| | - Maaret K Castren
- Dept of Emergency Medicine and Services, Helsinki Univ Hosp and Univ of Helsinki, Helsinki, Finland
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Bhutta ZA, AKHTAR NAVEED, Pathan SA, Puolakka T, Harris T, Ganesan GSS, Kamran S, Thomas SH, Cameron P, Castren MK. Abstract TP71: Characteristics And Demographics Of Patients Using Emergency Medical Services For Suspected Acute Stroke And Its Impact On Long-term Outcomes In A Multi Ethnic Population. Stroke 2022. [DOI: 10.1161/str.53.suppl_1.tp71] [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: 11/16/2022]
Abstract
Introduction:
Acute ischemic stroke (IS) patients who receive IV thrombolysis are more likely to have good long-term prognosis. Unfortunately, more than two-third of IS patients present outside the therapeutic window. The use of emergency medical services (EMS) can reduce pre-hospital delay and increase likelihood of treatment with t-PA. We aim to determine the characteristic variations amongst the suspected acute stroke patients using EMS.
Methods:
In this retrospective observational study, all suspected acute stroke patients admitted to Hamad General Hospital from April 30, 2014 to September 15, 2020 were included. We evaluated demographics, clinical features, impact on treatment and associated factors in EMS versus non-EMS group.
Results:
During the study period, 11892 patients presented as suspected acute stroke. Of these, 65.1% used EMS (EMS-group). Mean age in EMS group was 53.4
+
14.1 versus 52.6
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14.0 in non-EMS group (p = 0.003). Male to female ratio in both groups was 3:1. The proportion of patients who used EMS were higher in the Asian (66.8%), African (66.8%) and Caucasian (66.6%) population as compared to Arabs (61.9%). EMS use in Qatari population (59.2%) was relatively low. Intracerebral hemorrhage patients (82.4%) had a significantly higher EMS use followed by IS (65.7%) and cerebral venous thrombosis (64.7%); p<0.001. Symptom onset time of less than 4.5 hours at presentation was reported by 41% in EMS-group versus 24.3% in Non-EMS group. Patients with prior stroke (65.5%) and transient ischemic attack (58.4%) preferred EMS as compared to Non-EMS group (34.5% and 41.5%). Patients with unilateral weakness (66.4%) aphasia (78.2%), neglect (78.2%), dysarthria (68.4%), loss of consciousness (83.3%) and seizures (83.9%) had a higher use of EMS versus non-EMS group. The thrombolysis rate in EMS group was high vs non-EMS (82.4% vs 17.6%; p<0.001) with a door-to-needle time significantly lower in the EMS group (56.4
+
38.2 vs 75.7
+
43.8; p<0.001).
Conclusion:
EMS use facilitate rapid transfer, timely stroke evaluation and management of patients who need time-critical care. Patient characteristics and demographics, clinical symptoms and stroke type are associated with early stroke recognition and EMS use leading to higher recanalization rate.
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Affiliation(s)
| | | | | | - Tuukka Puolakka
- Dept of Emergency Medicine and Services, Helsinki Univ Hosp and Univ of Helsinki, Helsinki, Finland
| | - Tim Harris
- Emergency Medicine, Hamad Med Corp, Doha, Qatar
| | | | - Saadat Kamran
- Hamad General Hosp, Weil Cornell Sch of Medicine, Qatar, Doha, Qatar
| | | | - Peter Cameron
- Emergency Medicine, The Alfred Hosp, Emergency and Trauma Cntr , Monash Univ, Melbourne, Australia
| | - Maaret K Castren
- Dept of Emergency Medicine and Services, Helsinki Univ Hosp and Univ of Helsinki, Helsinki, Finland
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Kodumayil SA, Kodumayil A, Thomas SA, Pathan SA, Bhutta ZA, Qureshi I, Azad A, Harris TR, Thomas SH. Q-DEPICT: Qatar Determining Emergency Physician Incidence of COVID-Positive Testing. Qatar Med J 2021; 2021:44. [PMID: 34660215 PMCID: PMC8501270 DOI: 10.5339/qmj.2021.44] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Accepted: 08/15/2021] [Indexed: 11/05/2022] Open
Abstract
Despite protective measures such as personal protective equipment (PPE) and a COVID airway management program (CAMP), some emergency physicians will inevitably test positive for COVID. We aim to develop a model predicting weekly numbers of emergency physician COVID converters to aid operations planning. The data were obtained from the electronic medical record (EMR) used throughout the national healthcare system. Hamad Medical Corporation's internal emergency medicine workforce data were used as a source of information on emergency physician COVID conversion and numbers of emergency physicians completing CAMP training. The study period included the spring and summer months of 2020 and started on March 7 and ran for 21 whole weeks through July 31. Data were extracted from the system's EMR database into a spreadsheet (Excel, Microsoft, Redmond, USA). The statistical software used for all analyses and plots was Stata (version 16.1 MP, StataCorp, College Station, USA). All data definitions were made a priori. A total of 35 of 250 emergency physicians (14.0%, 95% CI 9.9%–19.9%) converted to a positive real-time reverse transcriptase-polymerase chain reaction (PCR) during the study's 21-week period. Of these. only two were hospitalized for having respiratory-only disease, and none required respiratory support. Both were discharged within a week of admission. The weekly number of newly COVID-positive emergency physicians was zero and was seen in eight of 21 (38.1%) weeks. The peak weekly counts of six emergency physicians with new COVID-positive were seen in week 14. The mean weekly number of newly COVID-positive emergency physicians was 1.7 ± 1.9, and the median was 1 (IQR, 0 to 3). This study demonstrates that in the State of Qatar's Emergency Department (ED) system, knowing only four parameters allows the reliable prediction of the number of emergency physicians likely to convert COVID PCR tests within the next week. The results also suggest that attention to the details of minimizing endotracheal intubation (ETI) risk can eliminate the expected finding of the association between ETI numbers and emergency physician COVID numbers.
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Affiliation(s)
| | - Ashid Kodumayil
- Department of Emergency Medicine, Hamad General Hospital, Doha 3050, Qatar E-mail:
| | - Sarah A Thomas
- BSc Candidate in Medical Biosciences, Faculty of Medicine, Imperial College London, UK
| | | | | | - Isma Qureshi
- Department of Emergency Medicine, Hamad General Hospital, Doha 3050, Qatar E-mail:
| | - Aftab Azad
- Department of Emergency Medicine, Hamad General Hospital, Doha 3050, Qatar E-mail:
| | - Tim R Harris
- Department of Emergency Medicine, Hamad General Hospital, Doha 3050, Qatar E-mail: .,Blizard Institute, Barts and The London School of Medicine, Queen Mary Univ. of London, UK
| | - Stephen H Thomas
- Department of Emergency Medicine, Hamad General Hospital, Doha 3050, Qatar E-mail: .,Blizard Institute, Barts and The London School of Medicine, Queen Mary Univ. of London, UK
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Pathan SA, Thomas CE, Bhutta ZA, Qureshi I, Thomas SA, Moinudheen J, Thomas SH. Qatar Prediction Rule Using ED Indicators of COVID-19 at Triage. Qatar Med J 2021; 2021:18. [PMID: 34422577 PMCID: PMC8359675 DOI: 10.5339/qmj.2021.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Accepted: 02/04/2021] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION The presence of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) and its associated disease, COVID-19 has had an enormous impact on the operations of the emergency department (ED), particularly the triage area. The aim of the study was to derive and validate a prediction rule that would be applicable to Qatar's adult ED population to predict COVID-19-positive patients. METHODS This is a retrospective study including adult patients. The data were obtained from the electronic medical records (EMR) of the Hamad Medical Corporation (HMC) for three EDs. Data from the Hamad General Hospital ED were used to derive and internally validate a prediction rule (Q-PREDICT). The Al Wakra Hospital ED and Al Khor Hospital ED data formed an external validation set consisting of the same time frame. The variables in the model included the weekly ED COVID-19-positivity rate and the following patient characteristics: region (nationality), age, acuity, cough, fever, tachypnea, hypoxemia, and hypotension. All statistical analyses were executed with Stata 16.1 (Stata Corp). The study team obtained appropriate institutional approval. RESULTS The study included 45,663 adult patients who were tested for COVID-19. Out of these, 47% (n = 21461) were COVID-19 positive. The derivation-set model had very good discrimination (c = 0.855, 95% Confidence intervals (CI) 0.847-0.861). Cross-validation of the model demonstrated that the validation-set model (c = 0.857, 95% CI 0.849-0.863) retained high discrimination. A high Q-PREDICT score ( ≥ 13) is associated with a nearly 6-fold increase in the likelihood of being COVID-19 positive (likelihood ratio 5.9, 95% CI 5.6-6.2), with a sensitivity of 84.7% (95% CI, 84.0%-85.4%). A low Q-PREDICT ( ≤ 6) is associated with a nearly 20-fold increase in the likelihood of being COVID-19 negative (likelihood ratio 19.3, 95% CI 16.7-22.1), with a specificity of 98.7% (95% CI 98.5%-98.9%). CONCLUSION The Q-PREDICT is a simple scoring system based on information readily collected from patients at the front desk of the ED and helps to predict COVID-19 status at triage. The scoring system performed well in the internal and external validation on datasets obtained from the state of Qatar.
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Affiliation(s)
| | | | | | | | - Sarah A Thomas
- Bachelor Candidate in Medical Biosciences, Faculty of Medicine, Imperial College London, UK
| | | | - Stephen H Thomas
- Hamad Medical Corporation, Doha, Qatar E-mail:
- Blizard Institute of Barts & The London School of Medicine, Queen Mary Univ. of London, UK
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Rodriguez-Sibaja MJ, Villar J, Ohuma EO, Napolitano R, Heyl S, Carvalho M, Jaffer YA, Noble JA, Oberto M, Purwar M, Pang R, Cheikh Ismail L, Lambert A, Gravett MG, Salomon LJ, Drukker L, Barros FC, Kennedy SH, Bhutta ZA, Papageorghiou AT. Fetal cerebellar growth and Sylvian fissure maturation: international standards from Fetal Growth Longitudinal Study of INTERGROWTH-21 st Project. Ultrasound Obstet Gynecol 2021; 57:614-623. [PMID: 32196791 DOI: 10.1002/uog.22017] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Revised: 02/26/2020] [Accepted: 03/07/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To construct international ultrasound-based standards for fetal cerebellar growth and Sylvian fissure maturation. METHODS Healthy, well nourished pregnant women, enrolled at < 14 weeks' gestation in the Fetal Growth Longitudinal Study (FGLS) of INTERGROWTH-21st , an international multicenter, population-based project, underwent serial three-dimensional (3D) fetal ultrasound scans every 5 ± 1 weeks until delivery in study sites located in Brazil, India, Italy, Kenya and the UK. In the present analysis, only those fetuses that underwent developmental assessment at 2 years of age were included. We measured the transcerebellar diameter and assessed Sylvian fissure maturation using two-dimensional ultrasound images extracted from available 3D fetal head volumes. The appropriateness of pooling data from the five sites was assessed using variance component analysis and standardized site differences. For each Sylvian fissure maturation score (left or right side), mean gestational age and 95% CI were calculated. Transcerebellar diameter was modeled using fractional polynomial regression, and goodness of fit was assessed. RESULTS Of those children in the original FGLS cohort who had developmental assessment at 2 years of age, 1130 also had an available 3D ultrasound fetal head volume. The sociodemographic characteristics and pregnancy/perinatal outcomes of the study sample confirmed the health and low-risk status of the population studied. In addition, the fetuses had low morbidity and adequate growth and development at 2 years of age. In total, 3016 and 2359 individual volumes were available for transcerebellar-diameter and Sylvian-fissure analysis, respectively. Variance component analysis and standardized site differences showed that the five study populations were sufficiently similar on the basis of predefined criteria for the data to be pooled to produce international standards. A second-degree fractional polynomial provided the best fit for modeling transcerebellar diameter; we then estimated gestational-age-specific 3rd , 50th and 97th smoothed centiles. Goodness-of-fit analysis comparing empirical centiles with smoothed centile curves showed good agreement. The Sylvian fissure increased in maturation with advancing gestation, with complete overlap of the mean gestational age and 95% CIs between the sexes for each development score. No differences in Sylvian fissure maturation between the right and left hemispheres were observed. CONCLUSION We present, for the first time, international standards for fetal cerebellar growth and Sylvian fissure maturation throughout pregnancy based on a healthy fetal population that exhibited adequate growth and development at 2 years of age. © 2020 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- M J Rodriguez-Sibaja
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
- Maternal-Fetal Medicine Department, National Institute of Perinatology, Mexico City, Mexico
| | - J Villar
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - E O Ohuma
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
- Centre for Statistics in Medicine, Botnar Research Centre, University of Oxford, Oxford, UK
| | - R Napolitano
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - S Heyl
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - M Carvalho
- Faculty of Health Sciences, Aga Khan University, Nairobi, Kenya
| | - Y A Jaffer
- Department of Family & Community Health, Ministry of Health, Muscat, Sultanate of Oman
| | - J A Noble
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - M Oberto
- S.C. Ostetricia 2U, Città della Salute e della Scienza di Torino, Turin, Italy
| | - M Purwar
- Nagpur INTERGROWTH-21st Research Centre, Ketkar Hospital, Nagpur, India
| | - R Pang
- School of Public Health, Peking University, Beijing, China
| | - L Cheikh Ismail
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- Clinical Nutrition and Dietetics Department, University of Sharjah, Sharjah, United Arab Emirates
| | - A Lambert
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - M G Gravett
- Departments of Obstetrics & Gynecology and of Public Health, University of Washington, Seattle, WA, USA
| | - L J Salomon
- Department of Obstetrics and Fetal Medicine, Hôpital Necker Enfants Malades, Université Paris Descartes, Paris, France
| | - L Drukker
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - F C Barros
- Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, Pelotas, Brazil
| | - S H Kennedy
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - Z A Bhutta
- Center for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - A T Papageorghiou
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
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Irfan FB, Castren M, Bhutta ZA, George P, Qureshi I, Thomas SH, Pathan SA, Alinier G, Shaikh LA, Suwaidi JA, Singh R, Shuaib A, Tariq T, McKenna WJ, Cameron PA, Djarv T. Ethnic differences in out-of-hospital cardiac arrest among Middle Eastern Arabs and North African populations living in Qatar. Ethn Health 2021; 26:460-469. [PMID: 30303400 DOI: 10.1080/13557858.2018.1530736] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2017] [Accepted: 09/26/2018] [Indexed: 06/08/2023]
Abstract
Aims: There are very few studies comparing epidemiology and outcomes of out-of-hospital cardiac arrest (OHCA) in different ethnic groups. Previous ethnicity studies have mostly determined OHCA differences between African American and Caucasian populations. The aim of this study was to compare epidemiology, clinical presentation, and outcomes of OHCA between the local Middle Eastern Gulf Cooperation Council (GCC) Arab and the migrant North African populations living in Qatar.Methods: This was a retrospective cohort study of Middle Eastern GCC Arabs and migrant North African patients with presumed cardiac origin OHCA resuscitated by Emergency Medical Services (EMS) in Qatar, between June 2012 and May 2015.Results: There were 285 Middle Eastern GCC Arabs and 112 North African OHCA patients enrolled during the study period. Compared with the local GCC Arabs, univariate analysis showed that the migrant North African OHCA patients were younger and had higher odds of initial shockable rhythm, pre-hospital interventions (defibrillation and amioderone), pre-hospital scene time, and decreased odds of risk factors (hypertension, respiratory disease, and diabetes) and pre-hospital response time. The survival to hospital discharge had greater odds for North African OHCA patients which did not persist after adjustment. Multivariable logistic regression showed that North Africans were associated with lower odds of diabetes (OR 0.48, 95% CI 0.25-0.91, p = 0.03), and higher odds of initial shockable rhythm (OR 2.86, 95% CI 1.30-6.33, p = 0.01) and greater scene time (OR 1.02 95% CI 1.0-1.04, p = 0.02).Conclusions: North African migrant OHCA patients were younger, had decreased risk factors and favourable OHCA rhythm and received greater ACLS interventions with shorter pre-hospital response times and longer scene times leading to better survival.
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Affiliation(s)
- Furqan B Irfan
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- College of Osteopathic Medicine, Michigan State University, East Lansing, MI, USA
| | - Maaret Castren
- Helsinki University and Department of Emergency Medicine and Services, Helsinki University Hospital, Helsinki, Finland
| | - Zain A Bhutta
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Pooja George
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Isma Qureshi
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Stephen H Thomas
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Sameer A Pathan
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Guillaume Alinier
- Hamad Medical Corporation Ambulance Service, Medical City, Doha, Qatar
- School of Health and Social Work, Paramedic Division, University of Hertfordshire, Hatfield, UK
| | - Loua A Shaikh
- Hamad Medical Corporation Ambulance Service, Medical City, Doha, Qatar
| | - Jassim A Suwaidi
- Adult Cardiology, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Rajvir Singh
- Cardiology Research, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ashfaq Shuaib
- Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar
| | - Tooba Tariq
- Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | | | - Peter A Cameron
- The Alfred Hospital, Emergency and Trauma Centre, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Therese Djarv
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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10
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Omrani AS, Pathan SA, Thomas SA, Harris TR, Coyle PV, Thomas CE, Qureshi I, Bhutta ZA, Mawlawi NA, Kahlout RA, Elmalik A, Azad AM, Daghfal J, Mustafa M, Jeremijenko A, Soub HA, Khattab MA, Maslamani MA, Thomas SH. Randomized double-blinded placebo-controlled trial of hydroxychloroquine with or without azithromycin for virologic cure of non-severe Covid-19. EClinicalMedicine 2020; 29:100645. [PMID: 33251500 PMCID: PMC7678437 DOI: 10.1016/j.eclinm.2020.100645] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [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: 09/05/2020] [Revised: 10/27/2020] [Accepted: 10/29/2020] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Hydroxychloroquine (HC) ± azithromycin (AZ) is widely used for Covid-19. The Qatar Prospective RCT of Expediting Coronavirus Tapering (Q-PROTECT) aimed to assess virologic cure rates of HC±AZ in cases of low-acuity Covid-19. METHODS Q-PROTECT employed a prospective, placebo-controlled design with blinded randomization to three parallel arms: placebo, oral HC (600 mg daily for one week), or oral HC plus oral AZ (500 mg day one, 250 mg daily on days two through five). At enrollment, non-hospitalized participants had mild or no symptoms and were within a day of Covid-19 positivity by polymerase chain reaction (PCR). After six days, intent-to-treat (ITT) analysis of the primary endpoint of virologic cure was assessed using binomial exact 95% confidence intervals (CIs) and χ2 testing. (ClinicalTrials.gov NCT04349592, trial status closed to new participants.). FINDINGS The study enrolled 456 participants (152 in each of three groups: HC+AZ, HC, placebo) between 13 April and 1 August 2020. HC+AZ, HC, and placebo groups had 6 (3·9%), 7 (4·6%), and 9 (5·9%) participants go off study medications before completing the medication course (p = 0·716). Day six PCR results were available for all 152 HC+AZ participants, 149/152 (98·0%) HC participants, and 147/152 (96·7%) placebo participants. Day six ITT analysis found no difference (p = 0·821) in groups' proportions achieving virologic cure: HC+AZ 16/152 (10·5%), HC 19/149 (12·8%), placebo 18/147 (12·2%). Day 14 assessment also showed no association (p = 0·072) between study group and viral cure: HC+AZ 30/149 (20·1%,), HC 42/146 (28·8%), placebo 45/143 (31·5%). There were no serious adverse events. INTERPRETATION HC±AZ does not facilitate virologic cure in patients with mild or asymptomatic Covid-19. FUNDING The study was supported by internal institutional funds of the Hamad Medical Corporation (government health service of the State of Qatar).
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Affiliation(s)
- Ali S. Omrani
- Department of Medicine, Hamad Medical Corporation Communicable Diseases Center, Doha, Qatar
| | - Sameer A. Pathan
- Department of Emergency Medicine, Hamad General Hospital, Doha 3050, Qatar
- Blizard Institute, Barts and The London School of Medicine, Queen Mary Univ. of London, UK
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Sarah A. Thomas
- BSc Candidate in Medical Biosciences, Faculty of Medicine, Imperial College London, UK
| | - Tim R.E. Harris
- Department of Emergency Medicine, Hamad General Hospital, Doha 3050, Qatar
- Blizard Institute, Barts and The London School of Medicine, Queen Mary Univ. of London, UK
| | - Peter V. Coyle
- Departments of Virology and Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha
| | - Caroline E. Thomas
- Department of Emergency Medicine, Hamad General Hospital, Doha 3050, Qatar
| | - Isma Qureshi
- Department of Emergency Medicine, Hamad General Hospital, Doha 3050, Qatar
| | - Zain A. Bhutta
- Department of Emergency Medicine, Hamad General Hospital, Doha 3050, Qatar
| | - Naema Al Mawlawi
- Departments of Virology and Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha
| | - Reham Al Kahlout
- Departments of Virology and Laboratory Medicine and Pathology, Hamad Medical Corporation, Doha
| | - Ashraf Elmalik
- Department of Pharmacy, Hamad General Hospital, Doha, Qatar
| | - Aftab M. Azad
- Department of Emergency Medicine, Hamad General Hospital, Doha 3050, Qatar
| | - Joanne Daghfal
- Department of Medicine, Hamad Medical Corporation Communicable Diseases Center, Doha, Qatar
| | - Mulham Mustafa
- Department of Medicine, Hamad Medical Corporation Communicable Diseases Center, Doha, Qatar
| | - Andrew Jeremijenko
- Department of Medicine, Hamad Medical Corporation Communicable Diseases Center, Doha, Qatar
| | - Hussam Al Soub
- Department of Medicine, Hamad Medical Corporation Communicable Diseases Center, Doha, Qatar
| | - Mohammed Abu Khattab
- Department of Medicine, Hamad Medical Corporation Communicable Diseases Center, Doha, Qatar
| | - Muna Al Maslamani
- Department of Medicine, Hamad Medical Corporation Communicable Diseases Center, Doha, Qatar
- Department of Medicine, Weill Cornell Medical College in Qatar, Doha, Qatar
| | - Stephen H. Thomas
- Department of Emergency Medicine, Hamad General Hospital, Doha 3050, Qatar
- Blizard Institute, Barts and The London School of Medicine, Queen Mary Univ. of London, UK
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11
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Shahzad T, Mohamed Salih Mustafa M, Bhutta ZA, Edmund Harris T. A case of aortic dissection with highly suggestive features of COVID-19. Qatar Med J 2020; 2020:34. [PMID: 33282717 PMCID: PMC7684546 DOI: 10.5339/qmj.2020.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Accepted: 09/20/2020] [Indexed: 11/25/2022] Open
Abstract
Introduction: Aortic dissection is a cardiovascular emergency with an overall in-hospital mortality rate of 27.4%, and with every hour without intervention, the mortality rate increases by 1%–2% in the first 48 hours. Thoracic aortic dissection typically presents with tearing chest, back, or abdominal pain. Coronavirus disease 2019 (COVID-19) is a viral disease caused by severe acute respiratory syndrome–coronavirus 2 (SARS–Cov2), which has been declared a pandemic by the World Health Organization (WHO) and usually manifests with respiratory symptoms, including cough, shortness of breath, flu-like symptoms, and fever. This case report highlights an important impact of the COVID-19 pandemic on the identification and management of aortic dissection in the emergency department. Case report: A 35-year-old Bahraini male, a suspected case of Marfan syndrome, presented with complaints of shortness of breath and worsening productive cough after returning from the United States (U.S). He denied any chest, back, or abdominal pain, dizziness, weakness in any limb, gait disturbance, headache, or change in vision. He was considered high risk for COVID-19 because of the recent travel and respiratory symptoms and was diagnosed incidentally with ascending aortic dissection along with a right lung consolidation. His SARS–Cov2 PCR came negative thrice during hospital stay, and he underwent elective cardiothoracic surgery. Conclusion: The COVID-19 pandemic has been a major stressor for the healthcare system worldwide, inflicting serious threats. Aortic dissection is one of the major life-threatening diseases that needs to be identified early on in the emergency department; however, in this case delayed diagnosis raised significant concerns due to underlying evolving triaging system for COVID-19 and atypical and overlapping clinical presentation. Further research is needed to look for COVID-19–associated factors, affecting the standard of care in the emergency department. Improving handover can directly impact patient care; therefore, it should be optimized.
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Affiliation(s)
- Tahir Shahzad
- Emergency Department, Hamad Medical Corporation Qatar, Doha, Qatar
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12
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Napolitano R, Molloholli M, Donadono V, Ohuma EO, Wanyonyi SZ, Kemp B, Yaqub MK, Ash S, Barros FC, Carvalho M, Jaffer YA, Noble JA, Oberto M, Purwar M, Pang R, Cheikh Ismail L, Lambert A, Gravett MG, Salomon LJ, Bhutta ZA, Kennedy SH, Villar J, Papageorghiou AT. International standards for fetal brain structures based on serial ultrasound measurements from Fetal Growth Longitudinal Study of INTERGROWTH-21 st Project. Ultrasound Obstet Gynecol 2020; 56:359-370. [PMID: 32048426 DOI: 10.1002/uog.21990] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 01/27/2020] [Accepted: 01/27/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To create prescriptive growth standards for five fetal brain structures, measured using ultrasound, in healthy, well-nourished women at low risk of impaired fetal growth and poor perinatal outcome, taking part in the Fetal Growth Longitudinal Study (FGLS) of the INTERGROWTH-21st Project. METHODS This was a complementary analysis of a large, population-based, multicenter, longitudinal study. The sample analyzed was selected randomly from the overall FGLS population, ensuring an equal distribution among the eight diverse participating sites and of three-dimensional (3D) ultrasound volumes across pregnancy (range: 15-36 weeks' gestation). We measured, in planes reconstructed from 3D ultrasound volumes of the fetal head at different timepoints in pregnancy, the size of the parieto-occipital fissure (POF), Sylvian fissure (SF), anterior horn of the lateral ventricle, atrium of the posterior horn of the lateral ventricle (PV) and cisterna magna (CM). Fractional polynomials were used to construct the standards. Growth and development of the infants were assessed at 1 and 2 years of age to confirm their adequacy for constructing international standards. RESULTS From the entire FGLS cohort of 4321 women, 451 (10.4%) were selected at random. After exclusions, 3D ultrasound volumes from 442 fetuses born without a congenital malformation were used to create the charts. The fetal brain structures of interest were identified in 90% of cases. All structures, except the PV, showed increasing size with gestational age, and the size of the POF, SF, PV and CM showed increasing variability. The 3rd , 5th , 50th , 95th and 97th smoothed centiles are presented. The 5th centiles for the POF and SF were 3.1 mm and 4.7 mm at 22 weeks' gestation and 4.6 mm and 9.9 mm at 32 weeks, respectively. The 95th centiles for the PV and CM were 8.5 mm and 7.5 mm at 22 weeks and 8.6 mm and 9.5 mm at 32 weeks, respectively. CONCLUSIONS We have produced prescriptive size standards for fetal brain structures based on prospectively enrolled pregnancies at low risk of abnormal outcome. We recommend these as international standards for the assessment of measurements obtained using ultrasound from fetal brain structures. © 2020 Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- R Napolitano
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - M Molloholli
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - V Donadono
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - E O Ohuma
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
- Centre for Statistics in Medicine, Botnar Research Centre, University of Oxford, Oxford, UK
| | - S Z Wanyonyi
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - B Kemp
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - M K Yaqub
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - S Ash
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - F C Barros
- Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, Pelotas, Brazil
| | - M Carvalho
- Faculty of Health Sciences, Aga Khan University, Nairobi, Kenya
| | - Y A Jaffer
- Department of Family & Community Health, Ministry of Health, Muscat, Sultanate of Oman
| | - J A Noble
- Department of Engineering Science, Institute of Biomedical Engineering, University of Oxford, Oxford, UK
| | - M Oberto
- S.C. Ostetricia 2U, Città della Salute e della Scienza di Torino, Italy
| | - M Purwar
- Nagpur INTERGROWTH-21st Research Centre, Ketkar Hospital, Nagpur, India
| | - R Pang
- School of Public Health, Peking University, Beijing, China
| | - L Cheikh Ismail
- Clinical Nutrition and Dietetics Department, University of Sharjah, Sharjah, United Arab Emirates
| | - A Lambert
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
| | - M G Gravett
- Departments of Obstetrics and Gynecology, and of Public Health, University of Washington, Seattle, WA, USA
| | - L J Salomon
- Department of Obstetrics and Fetal Medicine, Hôpital Necker Enfants Malades, Université Paris Descartes, Paris, France
| | - Z A Bhutta
- Center for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - S H Kennedy
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - J Villar
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - A T Papageorghiou
- Nuffield Department of Women's & Reproductive Health, University of Oxford, Oxford, UK
- Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
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13
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Bhutta ZA, Qureshi I, Shujauddin M, Thomas SA, Masood M, Dsouza LB, Iqbal N, Irfan FB, Pathan SA, Thomas SH. Characterizing Agreement in the Level of Interarm Blood Pressure Readings of Adults in the Emergency Department (CALIBRATE Study). Qatar Med J 2020; 2020:14. [PMID: 32391250 PMCID: PMC7198471 DOI: 10.5339/qmj.2020.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 12/01/2019] [Indexed: 11/03/2022] Open
Abstract
Background: Increased interarm systolic blood pressure difference (IASBPD) is one of the major predictors of cardiovascular disease. An IASBPD of >10 mmHg is of clinical significance. However, studies have reported a high number of patients visiting the emergency department (ED) with high IASBPD and varying correlation of IASBPD to age, ethnic background, and comorbidities such as hypertension and diabetes. Objective: The CALIBRATE study aimed to measure the IABPDs in the multiethnic patient population presenting to the ED in Qatar and to assess the distribution of IASBPD in this population. Methods: In a sitting position, two consecutive blood pressure (BP) measurements were recorded from the right and left arms for each participant using a calibrated automated machine and appropriate cuff sizes. The data were recorded using predefined data fields, including patient demographics, past medical, and social and family history. The continuous variables were reported as mean or median based on the distribution of data. The data were analyzed using Stata MP 14.0. Results: A total of 1800 patients, with a mean age of 34 (10) years, were prospectively recruited from the ED. The median absolute systolic BP difference (ΔSBP) between the right and left arms was 6 (3-10) mmHg, and it was the same for the first (ΔSBP1) and the second readings (ΔSBP2). The absolute average of ΔSBP1 and ΔSBP2 was 7 (4-10) mmHg. The difference in systolic BP difference (SBP) of < 20 mmHg for interarm blood pressure was seen in the 95th percentile of the population. No meaningful association could be detected between the IABPD and the study variables such as age, demographics, regions of interest, and risk factors. Conclusion: In population presenting to the ED, the IASBPD of at least 20 mmHg reached at the 95th percentile, validating the known significant difference. The utility of SBP difference can be improved further by taking the average of two individual readings.
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Affiliation(s)
- Z A Bhutta
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.,Translational Research Institute, Hamad Medical Corporation, Doha, Qatar
| | - I Qureshi
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.,Translational Research Institute, Hamad Medical Corporation, Doha, Qatar
| | - M Shujauddin
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - S A Thomas
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - M Masood
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - L B Dsouza
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.,Translational Research Institute, Hamad Medical Corporation, Doha, Qatar
| | - N Iqbal
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.,Weil Cornell Medical College in Qatar, Doha, Qatar
| | - F B Irfan
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.,Translational Research Institute, Hamad Medical Corporation, Doha, Qatar
| | - S A Pathan
- Department of Emergency Medicine, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.,Translational Research Institute, Hamad Medical Corporation, Doha, Qatar
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14
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Dsouza LB, Pathan SA, Bhutta ZA, Thomas SA, Momin U, Mirza S, Elanani R, Qureshi R, Khalaf W, Thomas SH. ABC/2 estimation in intracerebral hemorrhage: A comparison study between emergency radiologists and emergency physicians. Am J Emerg Med 2019; 37:1818-1822. [DOI: 10.1016/j.ajem.2018.12.036] [Citation(s) in RCA: 3] [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: 08/01/2018] [Revised: 12/15/2018] [Accepted: 12/18/2018] [Indexed: 11/16/2022] Open
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15
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Meher S, Cuthbert A, Kirkham JJ, Williamson P, Abalos E, Aflaifel N, Bhutta ZA, Bishop A, Blum J, Collins P, Devane D, Ducloy‐Bouthors A, Fawole B, Gülmezoglu AM, Gutteridge K, Gyte G, Homer CSE, Mallaiah S, Smith JM, Weeks AD, Alfirevic Z. Core outcome sets for prevention and treatment of postpartum haemorrhage: an international Delphi consensus study. BJOG 2018; 126:83-93. [DOI: 10.1111/1471-0528.15335] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2018] [Indexed: 11/26/2022]
Affiliation(s)
- S Meher
- Department of Women's and Children's Health University of Liverpool Liverpool UK
- Birmingham Women's and Children's NHS Foundation Trust Birmingham UK
| | - A Cuthbert
- Department of Women's and Children's Health University of Liverpool Liverpool UK
| | - JJ Kirkham
- Department of Biostatistics University of Liverpool Liverpool UK
| | - P Williamson
- Department of Biostatistics University of Liverpool Liverpool UK
| | - E Abalos
- Centro Rosarino de Estudios Perinatales (CREP) Rosario Argentina
| | - N Aflaifel
- Department of Women's and Children's Health University of Liverpool Liverpool UK
| | - ZA Bhutta
- Division of Women and Child Health Aga Khan University Karachi Pakistan
- The Hospital for Sick Children Toronto Canada
| | - A Bishop
- Cochrane Pregnancy and Childbirth Group University of Liverpool Liverpool UK
| | - J Blum
- Gynuity Health Projects New York NY USA
| | - P Collins
- Institute of Infection and Immunity School of Medicine Cardiff University Cardiff UK
| | - D Devane
- HRB‐Trials Methodology Research Network School of Nursing and Midwifery National University of Ireland Galway Galway Ireland
| | | | - B Fawole
- Department of Obstetrics and Gynaecology College of Medicine University of Ibadan Ibadan Nigeria
| | - AM Gülmezoglu
- The UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP) World Health Organization Geneva Switzerland
| | - K Gutteridge
- Sandwell and West Birmingham Hospitals NHS Trust Birmingham UK
| | - G Gyte
- Cochrane Pregnancy and Childbirth Group University of Liverpool Liverpool UK
| | - CSE Homer
- Centre for Midwifery, Child and Family Health University of Technology Sydney Sydney NSW Australia
| | | | - JM Smith
- Jhpiego/Johns Hopkins University Baltimore MD USA
| | - AD Weeks
- Department of Women's and Children's Health University of Liverpool Liverpool UK
| | - Z Alfirevic
- Department of Women's and Children's Health University of Liverpool Liverpool UK
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16
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Pathan SA, Mitra B, Bhutta ZA, Qureshi I, Spencer E, Hameed AA, Nadeem S, Tahir R, Anjum S, Cameron PA. A comparative, epidemiological study of acute renal colic presentations to emergency departments in Doha, Qatar, and Melbourne, Australia. Int J Emerg Med 2018; 11:1. [PMID: 29299773 PMCID: PMC5752646 DOI: 10.1186/s12245-017-0160-9] [Citation(s) in RCA: 11] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 12/26/2017] [Indexed: 11/24/2022] Open
Abstract
Background This study aimed to compare the epidemiology, clinical presentations, management, and outcomes of renal colic presentations in two major academic centers from geographically diverse populations: Qatar (a country in the Afro-Asian stone belt) and South-Eastern Australia (not within a stone belt). Methods We undertook a retrospective cohort study of patients with renal colic who presented to the Hamad General Hospital Emergency Department (HGH-ED), Qatar, and The Alfred ED, Melbourne, Australia, during a period of 1 year from August 1, 2012, to July 31, 2013. Cases were identified using ICD-9-CM codes, and an electronic template was used to record the data on predefined clinical variables. Results A total of 12,223 from the HGH-ED and 384 from The Alfred ED were identified as renal colic presentations during the study period. The rate of renal colic presentations at the HGH-ED was 27.9 per 1000 ED visits compared to 6.7 per 1000 ED visits at The Alfred ED. Patients presenting to the HGH-ED were significantly younger [34.9 years (29.0–43.4) than The Alfred ED [48 years (37–60); P < 0.001]. The median stone size was larger in the HGH-ED group [6 (4–8) mm] versus The Alfred ED group [4 (3–6) mm, P < 0.001]. The intervention rate in the stone-positive population was significantly higher in the HGH-ED group as opposed to The Alfred ED group (38.7 versus 11.9%, P < 0.001). At the time of discharge, The Alfred ED group received fewer analgesic prescriptions (55.8 versus 83.5%, P < 0.001) and more tamsulosin prescriptions (25.3 versus 11.7%, P < 0.001). Conclusions Renal colic presentations to the HGH-ED, Qatar, were younger, with larger stone size mostly located in the lower ureter, compared to The Alfred ED, Melbourne, Australia. The findings suggest that the benefits of treatment including medical expulsion therapy will vary between the two populations. Differences in epidemiology and patient mix should be considered while tailoring strategies for effective management of patients with renal colic in a given setting.
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Affiliation(s)
- Sameer A Pathan
- Emergency Department, Hamad General Hospital, Hamad Medical Corporation, P.O.BOX 3050, Doha, Qatar. .,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia. .,National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia.
| | - Biswadev Mitra
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia.,Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia
| | - Zain A Bhutta
- Emergency Department, Hamad General Hospital, Hamad Medical Corporation, P.O.BOX 3050, Doha, Qatar
| | - Isma Qureshi
- Emergency Department, Hamad General Hospital, Hamad Medical Corporation, P.O.BOX 3050, Doha, Qatar
| | - Elle Spencer
- National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia
| | - Asmaa A Hameed
- Emergency Department, Hamad General Hospital, Hamad Medical Corporation, P.O.BOX 3050, Doha, Qatar
| | - Sana Nadeem
- Emergency Department, Hamad General Hospital, Hamad Medical Corporation, P.O.BOX 3050, Doha, Qatar
| | - Ramsha Tahir
- Emergency Department, Hamad General Hospital, Hamad Medical Corporation, P.O.BOX 3050, Doha, Qatar
| | - Shahzad Anjum
- Emergency Department, Hamad General Hospital, Hamad Medical Corporation, P.O.BOX 3050, Doha, Qatar
| | - Peter A Cameron
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia.,Emergency & Trauma Centre, The Alfred Hospital, Melbourne, Australia
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17
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George T, Elgharbawy MA, Fathi AA, Bhutta ZA, Pathan SA, Jenkins D, Thomas SH. Inaccuracy in electronic medical record-reported wait times to initial emergency physician evaluation. International Journal of Healthcare Management 2017. [DOI: 10.1080/20479700.2017.1418277] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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18
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Bhutta ZA, Qureshi I, Shujauddin M, Thomas S, Masood M, Dsouza LB, Iqbal N, Irfan FB, Pathan SA, Thomas SH. Abstract P491: Characterizing Agreement in Level of Inter-extremity Blood-Pressure Readings of Adults in the Emergency Department (CALIBRATE Study). Hypertension 2017. [DOI: 10.1161/hyp.70.suppl_1.p491] [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: 11/16/2022]
Abstract
Introduction:
Inter-arm blood-pressure difference (IBPD) has been studied previously in multiple settings, but few reports are available from the Emergency department (ED) setting, where BP varies significantly due to acute medical conditions or stress from various factors. CALIBRATE aims to study the inter-arm blood pressure differences in the patients presenting to the ED in Qatar and to assess the IBPD distribution in this population.
Methods:
In sitting position, two consecutive BP measurements were obtained from the right and left arm for each participant using calibrated automated machines and appropriate cuff sizes. Considering the demographic mix of the population presenting to the ED, a 1:1 of male to female and 2:1 for GCC (Gulf Cooperation Council) to non-GCC recruitment strategy was predefined. The data were recorded using predefined data fields including patient demographics, past medical, social and family history. The continuous variables were reported as mean (SD) or median (IQR) based on the distribution of data. The data was analyzed using Stata MP 14.0 (College Station, Texas).
Results:
A total of 1800 patients were prospectively recruited from the ED. The mean age was 34 (10) years. The absolute systolic blood pressure (ΔSBP) difference between the right and left arm was same for the first (ΔSBP1) and the second reading (ΔSBP2), as 6 mmHg (3-10). The absolute average of ΔSBP1 and ΔSBP2
was 7 mmHg (4-10). The difference in SBP of less than 20 mmHg for IBP was seen in 95
th
percentile of the population with single reading, whereas, with the average of two individual readings it was observed in 97
th
percentile. No meaningful association could be detected between the significant IBPD
and the study variables such as age, demographics, regions of interest and risk factors. Although, patients with diagnosed hypertension met the pre-defined criterion for significance, this difference was not clinically significant. There was no significant difference between IBPD noted for the Asia-pacific or Arab population.
Conclusion:
In population presenting to the ED, the IBPD of at least 20 mmHg reached at 95
th
percentile validating the known significant difference. The utility of SBP difference can be improved further by taking the average of two individual readings.
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19
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Pathan SA, Bhutta ZA, Moinudheen J, Jenkins D, Farook S, Qureshi I, George P, Irfan FB, Al Khal AL, Thomas SH. Partial replacement of board-certified specialist-grade physicians with emergency medicine trainees in a busy emergency department: Lack of adverse effect on time to physician. Journal of Emergency Medicine, Trauma and Acute Care 2017. [DOI: 10.5339/jemtac.2017.7] [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: 11/03/2022] Open
Abstract
Objectives: Standard emergency department (ED) operation goals include minimization of the time interval between patients' initial ED presentation and initial emergency physician (EP) evaluation. Following up on previous work defining factors influencing the “time to physician” (tMD) in a busy ED, the current study was undertaken to evaluate whether tMD was adversely impacted by the ED's partial replacement of specialist-grade EPs with emergency medicine (EM) trainees (at the resident and fellow level). Methods: This retrospective study was conducted for four months (September–December 2015) using an ED administrative database (EDAD) in an urban academic tertiary ED with an annual census of approximately 500,000; during the four study months, the ED census was 165,969. To minimize confounding by time of day and related factors, data analysis focused solely on the “day shift” (0600–1400) of each of the study period's 122 days. EDAD data were combined with EP rostering data to generate a multivariate linear regression model that assessed the dependent variable tMD, for significant changes associated with increasing proportion – not necessarily always the same as increasing the absolute number of trainees (i.e., summed residents and fellows as a total percent of all on-duty EPs). There were trainees in the study ED throughout the study, but the trainee numbers as a proportion of the overall physician staffing fluctuated, thus providing a basis for analysis. The model adjusted for covariates previously demonstrated to impact tMD at the study center. Analyses were conducted with Stata 14MP, with statistical significance defined at p < 0.05 and confidence intervals (CIs) reported at the 95% level. Results: In an acceptable regression model that adjusted for multiple parameters influencing tMD, the introduction of a covariate representing the proportion of on-duty trainee physicians was very small in magnitude (β estimate 0.07, 95% CI − 0.16 to 0.30) and not statistically significant (p = 0.53). Conclusions: A multivariate analysis adjusting for variables contributing to tMD showed no indication of adverse tMD impact from partial replacement of board-certified specialist-grade EPs with EM trainees given adequate supervision by properly trained faculty.
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Affiliation(s)
- Sameer A. Pathan
- 1Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Zain A. Bhutta
- 1Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Jibin Moinudheen
- 1Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Dominic Jenkins
- 1Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Saleem Farook
- 1Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Isma Qureshi
- 1Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Pooja George
- 1Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Furqan B. Irfan
- 1Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Abdul Latif Al Khal
- 1Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
- 2Weill Cornell Medical College in Qatar, Doha, Qatar
| | - Stephen H. Thomas
- 1Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
- 2Weill Cornell Medical College in Qatar, Doha, Qatar
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20
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Pathan SA, Bhutta ZA, Moinudheen J, Jenkins D, Silva AD, Sharma Y, Saleh WA, Khudabakhsh Z, Irfan FB, Thomas SH. Marginal analysis in assessing factors contributing time to physician in the Emergency Department using operations data. Qatar Med J 2017; 2016:18. [PMID: 28293539 PMCID: PMC5339449 DOI: 10.5339/qmj.2016.18] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2016] [Accepted: 10/27/2016] [Indexed: 11/03/2022] Open
Abstract
Background: Standard Emergency Department (ED) operations goals include minimization of the time interval (tMD) between patients' initial ED presentation and initial physician evaluation. This study assessed factors known (or suspected) to influence tMD with a two-step goal. The first step was generation of a multivariate model identifying parameters associated with prolongation of tMD at a single study center. The second step was the use of a study center-specific multivariate tMD model as a basis for predictive marginal probability analysis; the marginal model allowed for prediction of the degree of ED operations benefit that would be affected with specific ED operations improvements. Methods: The study was conducted using one month (May 2015) of data obtained from an ED administrative database (EDAD) in an urban academic tertiary ED with an annual census of approximately 500,000; during the study month, the ED saw 39,593 cases. The EDAD data were used to generate a multivariate linear regression model assessing the various demographic and operational covariates' effects on the dependent variable tMD. Predictive marginal probability analysis was used to calculate the relative contributions of key covariates as well as demonstrate the likely tMD impact on modifying those covariates with operational improvements. Analyses were conducted with Stata 14MP, with significance defined at p < 0.05 and confidence intervals (CIs) reported at the 95% level. Results: In an acceptable linear regression model that accounted for just over half of the overall variance in tMD (adjusted r2 0.51), important contributors to tMD included shift census (p = 0.008), shift time of day (p = 0.002), and physician coverage n (p = 0.004). These strong associations remained even after adjusting for each other and other covariates. Marginal predictive probability analysis was used to predict the overall tMD impact (improvement from 50 to 43 minutes, p < 0.001) of consistent staffing with 22 physicians. Conclusions: The analysis identified expected variables contributing to tMD with regression demonstrating significance and effect magnitude of alterations in covariates including patient census, shift time of day, and number of physicians. Marginal analysis provided operationally useful demonstration of the need to adjust physician coverage numbers, prompting changes at the study ED. The methods used in this analysis may prove useful in other EDs wishing to analyze operations information with the goal of predicting which interventions may have the most benefit.
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Affiliation(s)
- Sameer A Pathan
- Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Zain A Bhutta
- Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Jibin Moinudheen
- Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Dominic Jenkins
- Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Ashwin D Silva
- Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Yogdutt Sharma
- Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Warda A Saleh
- Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Zeenat Khudabakhsh
- Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Furqan B Irfan
- Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
| | - Stephen H Thomas
- Department of Emergency Medicine, Hamad Medical Corporation, Bin Omran, Off Al-Rayyan Road, P.O. Box 3050, Doha, Qatar
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21
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Kamran S, Akhtar N, Salam A, Alboudi A, Kamran K, Ahmed A, Bhutta ZA, Irfan FB, Shuaib A. Abstract TP135: Late Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Stroke: Role of Infarct Growth. Stroke 2017. [DOI: 10.1161/str.48.suppl_1.tp135] [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: 11/16/2022]
Abstract
Objective:
The purpose of this multi-institutional pooled data analyses from three countries was to determine the impact of DHC timing on the functional outcomes in patients operated beyond 48 hours in comparison with DHC under 48 hours. In addition factors leading to early or late DHC were also identified.
Methods:
Retrospective, multicenter cross-sectional study to measure outcome following DHC <48 or >48 hours using the modified Rankin Scale [mRS] and dichotomized as favorable ≤4 or unfavorable >4, at three months.
Results:
In total 137 patients underwent DHC. There was no significant difference in the functional outcome [P=0.140] and mortality [P=0.975] but with a trend towards better outcome in patients operated over 48 hours. Multivariate analysis showed age ≥ 55, MCA with additional infarction, septum pellucidum deviation ≥1cm, and uncal herniation was independent predictor of poor functional outcome at three months. In the ‘‘best’’ multivariate model IGR >7.5ml/hr, MCA with additional infarction, and patients with temporal lobe involvement were independently associated with surgery under 48 hours. Both first infarct growth rate [IGR1] [DHC<48 hours, 15.2± 8.1ml/hr vs. >48 hours, 7.1 ± 5.03ml/hr] [P<0.001] and second infarct growth rate [IGR2] [DHC 48 13.64 ±8.76 ml/hr, > 48 hours 7.15 ±6.23 ml/hr [P<0.001] were nearly double in patients with early surgery [<48 hours].
Conclusions:
There was no significant difference in the functional outcome and mortality in patients operated >48 hours of stroke onset compared to early [<48 hours]. Time to surgery had no impact on functional outcome. Our data identifies IGR, temporal lobe involvement and MCA with additional infarct were independent predictors of early surgery.
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Affiliation(s)
| | | | | | - Aymen Alboudi
- NEUROSCIENCE, Rashid Hosp, Dubai, United Arab Emirates
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22
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Kamran S, Qidwai U, Akhtar N, Bhutta ZA, Salam A, Shuaib A. Abstract TP62: To Determine the Evolution of Stroke Volume Overtime Using ANFIS. Stroke 2017. [DOI: 10.1161/str.48.suppl_1.tp62] [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: 11/16/2022]
Abstract
Background:
There is limited information on evolution of temporal lesion volumetric changes in acute ischemia. Though infarct evolves in natural logarithmic or linear pattern in acute phase [24 hrs] both fail to predict the lesion volume in later phase [48,96,200 hours]. Maximum infarct volume [MIV] measured by these methods don’t reach a plateau at the infinite point in time, not true in clinical medicine. Instead of probability based statistical methods we used Adaptive Neuro-Fuzzy Inference System [ANFIS]. ANFIS utilizes features of human brain fundamental to the learning process, pattern modeling and perceptive inference. The purpose is to identify the best method to predict stroke volume at various time intervals.
Methods:
We used pooled hemicraniectomy database to select patients with three CT scans. Measurement of the infarct volume [IV] was done using ABC/2 method. Maximum infarct volume [MIV] was calculated using last CT before DHC. Time was measured from stroke onset to CT. Mean measured MIV was used as standard to compare the outcome by various methods. A Pseudo-Monte-Carlo scheme was utilized in improving the accuracy of the classification.
Results:
There were 66 patients with 3 CT-scans. We used MATLAB-2015 with Fuzzy Logic Toolbox functions to determine the pattern of infarct growth [Linear, Logarithmic, Exponential and ANFIS] and to determine the best predictive method at various time intervals. Of the measured IV on CT 1 and 2, 40 patients [60%] data set was used for training the ANFIS system while remaining 26 [40%] was used for testing. Mean measured MIV was 332±112.21 cm
3
[min 112.86 cm
3
, max 650 cm
3
] at mean time 67.75±67.39 hour [min 21.30 hours, max 350 hours]. Mean MIV measured by ANFIS 319.05±94.58 cm
3
[p=0.32], Linear 251.77±154.46 cm
3
[p=0.01], Logarithmic 259.68±88.76 cm
3
[p=0.00], and Exponential 157.80±84.05 cm
3
Conclusion:
ANFIS predicted the third infarct volume with high degree of accuracy across various time intervals. ANFIS method can provide an excellent model for forecasting infarct volume and growth rate, characterizing the evolution of lesion and pathological stages for mechanistic studies and therapeutic interventions of stroke disease.
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23
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Kamran S, Akhtar N, Bhutta ZA, Salam A, Alboudi A, Rashid H, Kamran K, Ahmed A, Own AM, Rukun SA, Inshasi J, Deleu D, Sulaiti GA, Shuaib A. Abstract TP124: Decompressive Hemicraniectomy for Malignant Middle Cerebral Artery Stroke: South Asian Experience. Stroke 2017. [DOI: 10.1161/str.48.suppl_1.tp124] [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: 11/16/2022]
Abstract
Objective:
The randomized trials and pooled analysis showed improved outcome and reduced mortality in malignant middle cerebral artery [MMCA] undergoing decompressive hemicraniectomy (DHC) within 48 hours of stroke onset. This could be due to highly selective patient population in trials, not reflecting real world practice. Furthermore, with ischemic stroke being so common in the South Asian and Middle Eastern population, there still exists very little published data on DHC in MMCA stroke patients.
Methods:
Retrospective, multicenter cross-sectional study to measure outcome following DHC using the modified Rankin Scale [mRS] and dichotomized as favorable ≤4 or unfavorable >4, at three months.
Results:
In total 137 patients underwent DHC. At 90 days, mortality was 16.8%, 61.3% of patients survived with an mRS ≤4 and 38.7% had an mRS of >4. Age (55 years), diabetes [p=0.004], hypertension [p=0.021], pupillary abnormality [p=0.048], uncal herniation [p=0.007], temporal lobe involvement [p=0.016], additional infarction [MCA + ACA, PCA] [P=0.001], and infarction growth rates [P=0.025] was significantly higher in patients with unfavorable prognosis in univariate analysis. Multivariate analysis showed age, additional infarction, septum pellucidum deviation >1cm and uncal herniation to be associated with a significantly poor prognosis. Time to surgery had no impact on outcome [p=0.109].
Conclusions:
Similar to the effects observed in the studies from the West, DHC improves functional outcome in predominantly South Asian patients with MMCA stroke. Increasing age, MCA with additional infarctions, septum pellucidum deviation 1cm and uncal herniation were significant predictors of disability and poor functional outcomes. Time to surgery had no impact on functional outcome.
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Affiliation(s)
| | | | | | | | - Aymen Alboudi
- NEUROSCIENCE, Rashid Hosp, Dubai, United Arab Emirates
| | | | | | | | | | | | - Jihad Inshasi
- NEUROSCIENCE, Rashid Hosp, Dubai, United Arab Emirates
| | - Dirk Deleu
- NEUROSCIENCE, Hamad Med Corp, Doha, Qatar
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24
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Hirst JE, Villar J, Victora CG, Papageorghiou AT, Finkton D, Barros FC, Gravett MG, Giuliani F, Purwar M, Frederick IO, Pang R, Cheikh Ismail L, Lambert A, Stones W, Jaffer YA, Altman DG, Noble JA, Ohuma EO, Kennedy SH, Bhutta ZA. The antepartum stillbirth syndrome: risk factors and pregnancy conditions identified from the INTERGROWTH-21 st Project. BJOG 2016; 125:1145-1153. [PMID: 28029221 PMCID: PMC6055673 DOI: 10.1111/1471-0528.14463] [Citation(s) in RCA: 61] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To identify risk factors for antepartum stillbirth, including fetal growth restriction, among women with well-dated pregnancies and access to antenatal care. DESIGN Population-based, prospective, observational study. SETTING Eight international urban populations. POPULATION Pregnant women and their babies enrolled in the Newborn Cross-Sectional Study of the INTERGROWTH-21st Project. METHODS Cox proportional hazard models were used to compare risks among antepartum stillborn and liveborn babies. MAIN OUTCOME MEASURES Antepartum stillbirth was defined as any fetal death after 16 weeks' gestation before the onset of labour. RESULTS Of 60 121 babies, 553 were stillborn (9.2 per 1000 births), of which 445 were antepartum deaths (7.4 per 1000 births). After adjustment for site, risk factors were low socio-economic status, hazard ratio (HR): 1.6 (95% CI, 1.2-2.1); single marital status, HR 2.0 (95% CI, 1.4-2.8); age ≥40 years, HR 2.2 (95% CI, 1.4-3.7); essential hypertension, HR 4.0 (95% CI, 2.7-5.9); HIV/AIDS, HR 4.3 (95% CI, 2.0-9.1); pre-eclampsia, HR 1.6 (95% CI, 1.1-3.8); multiple pregnancy, HR 3.3 (95% CI, 2.0-5.6); and antepartum haemorrhage, HR 3.3 (95% CI, 2.5-4.5). Birth weight <3rd centile was associated with antepartum stillbirth [HR, 4.6 (95% CI, 3.4-6.2)]. The greatest risk was seen in babies not suspected to have been growth restricted antenatally, with an HR of 5.0 (95% CI, 3.6-7.0). The population-attributable risk of antepartum death associated with small-for-gestational-age neonates diagnosed at birth was 11%. CONCLUSIONS Antepartum stillbirth is a complex syndrome associated with several risk factors. Although small babies are at higher risk, current growth restriction detection strategies only modestly reduced the rate of stillbirth. TWEETABLE ABSTRACT International stillbirth study finds individual risks poor predictors of death but combinations promising.
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Affiliation(s)
- J E Hirst
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - J Villar
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - C G Victora
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brazil
| | - A T Papageorghiou
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - D Finkton
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - F C Barros
- Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, Brazil.,Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, Pelotas, RS, Brazil
| | - M G Gravett
- Global Alliance to Prevent Prematurity and Stillbirth (GAPPS), Seattle, WA, USA
| | - F Giuliani
- Dipartimento di Scienze della Sanità Pubblica e Pediatriche, Università degli Studi di Torino, Torino, Italy
| | - M Purwar
- Nagpur INTERGROWTH-21st Research Centre, Ketkar Hospital, Nagpur, India
| | - I O Frederick
- Center for Perinatal Studies, Swedish Medical Center, Seattle, WA, USA
| | - R Pang
- School of Public Health, Peking University, Beijing, China
| | - L Cheikh Ismail
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - A Lambert
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - W Stones
- Faculty of Health Sciences, Aga Khan University, Nairobi, Kenya
| | - Y A Jaffer
- Department of Family & Community Health, Ministry of Health, Muscat, Oman
| | - D G Altman
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - J A Noble
- Department of Engineering Science, University of Oxford, Oxford, UK
| | - E O Ohuma
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK.,Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology & Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - S H Kennedy
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
| | - Z A Bhutta
- Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan.,Center for Global Health for Sick Children, Toronto, ON, Canada
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25
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Moinudheen J, Pathan SA, Bhutta ZA, Jenkins DW, Silva AD, Sharma Y, Saleh WA, Khudabakhsh Z, Irfan FB, Thomas SH. Marginal analysis in assessing factors contributing time to physician in Emergency Department using operations data. Journal of Emergency Medicine, Trauma and Acute Care 2016. [DOI: 10.5339/jemtac.2016.icepq.7] [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: 11/03/2022] Open
Abstract
Background: Standard Emergency Department (ED) operations goals include minimization of the time interval (hereafter tMD) between patients' initial ED presentation and initial physician evaluation.
Methods: The study was conducted using one month (May 2015) of an ED administrative database (EDAD), in HGH-ED, during the study month the ED saw 39,593 cases. The first step was generation of a multivariate model identifying the parameters associated with delay in tMD. In the second step, predictive marginal probability analysis was used to calculate the relative contributions of key covariates as well as demonstrate the likely tMD impact on modifying those covariates with operational improvements. Analyses were conducted with STATA 14 MP, with significance defined at p < .05 and confidence intervals (CIs) reported at the 95% level.
Results: In an acceptable linear regression model that accounted for just over half of the overall variance in tMD (adjusted r2 .51), important contributors to tMD included shift census (p = .008), shift time of day (p = .002), and physician coverage n (p = .004). Marginal predictive probability analysis was used to predict the overall tMD impact (improvement from 50 to 43 minutes, p < .001) of consistent staffing with 22 physicians.
Conclusions: The analysis identified expected variables contributing to tMD with regression demonstrating significance and effect magnitude of alterations in covariates including patient census, shift time of day, and physician n. Marginal analysis provided operationally useful demonstration of the need to adjust physician coverage numbers, prompting changes at the study ED.
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Affiliation(s)
| | | | - Zain A. Bhutta
- Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Yogdutt Sharma
- Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Warda A. Saleh
- Emergency Medicine, Hamad Medical Corporation, Doha, Qatar
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26
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Irfan FB, Pathan SA, Bhutta ZA, Abbasy ME, Elmoheen A, Alsaeidy AM, Tariq T, Hugelmeyer CD, Dardouri H, Khial NB, Daniel CY, Silva AD, Farook KS, Sharma Y, Thomas SH. ED case presentations during the largest sandstorm in the Middle East. Journal of Emergency Medicine, Trauma and Acute Care 2016. [DOI: 10.5339/jemtac.2016.icepq.164] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Background: The State of Qatar experienced a sandstorm on 1 April 2015, lasting approximately 12 hours, with winds blowing at more than 100 km/hr and average particulate matter of approximately 10 μm in diameter. The Emergency Department of the main tertiary hospital in Qatar managed 62% of the total emergency calls. The peak load of patients during the event manifested approximately 6 hours after the onset.
Methods: A retrospective review of patient mix and case load was performed for patients presenting to Emergency Department during and after the sandstorm.
Results: A total of 254 cases with respiratory illness presented to the Emergency Department within 12 hours of sandstorm onset. Of these cases, 42 had respiratory failure, of which 19 required intubation and 23 were managed conservatively. Of the remaining 212 cases, 28 with severe respiratory exacerbation of asthma, 15 with COPD exacerbation and 169 with minor asthma exacerbation were managed conservatively. In addition, a total of 26 patients presented with ophthalmological complaints. Of these, 12 had foreign body removed from the eye under slit lamp and took topical medication and antibiotics. The remaining 14 patients with anterior eye chamber emergencies were managed conservatively.
Conclusions: Patients presented mainly with exacerbations of asthma and respiratory distress, ophthalmic emergencies and vehicular trauma. Surprisingly, incidence of pedestrian injuries did not vary. With the outline of adaptations and specific areas for improvement identified in this review, we hope that future sandstorm emergencies will be better positioned to respond with optimum efficiency and effectiveness.
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Bartlett LA, LeFevre AE, Mir F, Soofi S, Arif S, Mitra DK, Quaiyum MA, Shakoor S, Islam MS, Connor NE, Winch PJ, Reller ME, Shah R, El Arifeen S, Baqui AH, Bhutta ZA, Zaidi A, Saha S, Ahmed SA. The development and evaluation of a community-based clinical diagnosis tool and treatment regimen for postpartum sepsis in Bangladesh and Pakistan. Reprod Health 2016; 13:16. [PMID: 26916141 PMCID: PMC4766721 DOI: 10.1186/s12978-016-0124-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 01/25/2016] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Postpartum sepsis accounts for most maternal deaths between three and seven days postpartum, when most mothers, even those who deliver in facilities, are at home. Case fatality rates for untreated women are very high. Newborns of ill women have substantially higher infection risk. METHODS/DESIGN The objectives of this study are to: (1) create, field-test and validate a tool for community health workers to improve diagnostic accuracy of suspected puerperal sepsis; (2) measure incidence and identify associated risk factors and; (3) describe etiologic agents responsible and antibacterial susceptibility patterns. This prospective cohort study builds on the Aetiology of Neonatal Infection in South Asia study in three sites: Sylhet, Bangladesh and Karachi and Matiari, Pakistan. Formative research determined local knowledge of symptoms and signs of postpartum sepsis, and a systematic literature review was conducted to design a diagnostic tool for community health workers to use during ten postpartum home visits. Suspected postpartum sepsis cases were referred to study physicians for independent assessment, which permitted validation of the tool. Clinical specimens, including urine, blood, and endometrial material, were collected for etiologic assessment and antibiotic sensitivity. All women with puerperal sepsis were given appropriate antibiotics. DISCUSSION This is the first large population-based study to expand community-based surveillance for diagnoses, referral and treatment of newborn sepsis to include maternal postpartum sepsis. Study activities will lead to development and validation of a diagnostic tool for use by community health workers in resource-poor countries. Understanding the epidemiology and microbiology of postpartum sepsis will inform prevention and treatment strategies and improve understanding of linkages between maternal and neonatal infections.
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Affiliation(s)
- L A Bartlett
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
| | - A E LeFevre
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
| | - F Mir
- Department of Paediatrics and Child Health, Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan.
| | - S Soofi
- Department of Paediatrics and Child Health, Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan.
| | - S Arif
- Department of Paediatrics and Child Health, Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan.
| | - D K Mitra
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
| | - M A Quaiyum
- Centre for Reproductive Health, icddr,b, Dhaka, Bangladesh.
| | - S Shakoor
- Department of Paediatrics and Child Health, Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan.
| | - M S Islam
- Department of Microbiology, The Child Health Research Foundation, Dhaka Shishu Hospital, Dhaka, Bangladesh.
| | - N E Connor
- Department of Microbiology, The Child Health Research Foundation, Dhaka Shishu Hospital, Dhaka, Bangladesh.
| | - P J Winch
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
| | - M E Reller
- Division of Medical Microbiology, Department of Pathology, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
| | - R Shah
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
| | - S El Arifeen
- Centre for Child and Adolescent Health, icddr,b, Dhaka, Bangladesh.
| | - A H Baqui
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
| | - Z A Bhutta
- Department of Paediatrics and Child Health, Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan.
| | - A Zaidi
- Department of Paediatrics and Child Health, Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan.
| | - S Saha
- Department of Microbiology, The Child Health Research Foundation, Dhaka Shishu Hospital, Dhaka, Bangladesh.
| | - S A Ahmed
- Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
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Anwar S, Iqbal MP, Azam I, Habib A, Bhutta S, Soofi SB, Bhutta ZA. Urban and rural comparison of vitamin D status in Pakistani pregnant women and neonates. J OBSTET GYNAECOL 2015; 36:318-23. [PMID: 26466513 DOI: 10.3109/01443615.2015.1050647] [Citation(s) in RCA: 11] [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] [Indexed: 01/09/2023]
Abstract
We undertook a cross-sectional study in rural Jehlum and urban Karachi to evaluate the prevalence of vitamin D deficiency in Pakistani pregnant women and neonates and to assess any association of serum 25(OH) vitamin D [25(OH)D] concentration with vitamin D binding protein (Gc) genotypes. Altogether, 390 women and 266 neonates were recruited from urban and rural sites, respectively. Serum 25(OH)D was measured by an immunoassay, while Gc genotypes were identified using polymerase chain reaction followed by restriction fragment length polymorphism or PCR-RFLP. One-way analysis of variance or ANOVA and linear regression were used for statistical analysis. In urban Karachi, 99.5% of women and 97.3% of neonates were vitamin D deficient (< 50 nmol/L), while 89% of women and 82% of neonates were deficient in rural Jehlum. Gc genotypes were not associated with serum 25(OH)D concentrations in both women and their neonates. We conclude that vitamin D deficiency is highly prevalent in Pakistani women and their neonates, and Gc genotypes are not associated with serum 25(OH)D concentrations.
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Affiliation(s)
- S Anwar
- a Centre of Excellence in Women and Child Health, Aga Khan University , Stadium Road, Karachi , Pakistan
| | - M P Iqbal
- b Department of Biological and Biomedical Sciences , Aga Khan University , Stadium Road, Karachi , Pakistan
| | - I Azam
- c Community Health Science, Aga Khan University , Stadium Road, Karachi , Pakistan
| | - A Habib
- a Centre of Excellence in Women and Child Health, Aga Khan University , Stadium Road, Karachi , Pakistan
| | - S Bhutta
- d Department of Obstetrics & Gynecology , Jinnah Postgraduate Medical Center , Karachi , Pakistan
| | - S B Soofi
- a Centre of Excellence in Women and Child Health, Aga Khan University , Stadium Road, Karachi , Pakistan
| | - Z A Bhutta
- a Centre of Excellence in Women and Child Health, Aga Khan University , Stadium Road, Karachi , Pakistan
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Akseer N, Kamali M, Husain S, Mirza M, Bakhache N, Bhutta ZA. Strategies to avert preventable mortality among mothers and children in the Eastern Mediterranean Region: new initiatives, new hope. East Mediterr Health J 2015; 21:361-73. [PMID: 26343127 DOI: 10.26719/2015.21.5.361] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We conducted an assessment of maternal, newborn and child health and progress towards achieving Millennium Development Goals (MDG) 4 and 5 in the Eastern Mediterranean Region (EMR). We provide recommendations for scaling up and sustaining gains post-2015. Data were obtained from global data repositories. We constructed time trends from 1990 to 2013 and evaluated inequities across the Region. Under-5, neonatal and maternal mortality rates decreased 46%, 35%, and 50% respectively from 1990 to 2013. Pneumonia and diarrhoea accounted for 50% of all post-neonatal deaths; pregnancy- and delivery-related complications were the leading causes of neonatal and maternal deaths. Coverage of maternal, newborn and child health interventions is suboptimal, and poverty, food insecurity and conflict are pervasive across the Region. The EMR has made progress but is unlikely to attain MDG 4 and 5 targets. To sustain and further accelerate gains, the Region must reduce inequities and scale up implementation of recommendations made by the independent Expert Review Group.
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Affiliation(s)
- N Akseer
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - M Kamali
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - S Husain
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - M Mirza
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - N Bakhache
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada
| | - Z A Bhutta
- Centre for Global Child Health, Hospital for Sick Children, Toronto, Canada; Center of Excellence in Women and Child Health, The Aga Khan University, Karachi, Pakistan
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Rashidian A, Omidvari AH, Vali Y, Mortaz S, Yousefi-Nooraie R, Jafari M, Bhutta ZA. The effectiveness of regionalization of perinatal care services--a systematic review. Public Health 2015; 128:872-85. [PMID: 25369352 DOI: 10.1016/j.puhe.2014.08.005] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [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: 11/15/2013] [Revised: 06/26/2014] [Accepted: 08/04/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND Several reports recommend the implementation of perinatal regionalization for improvements in maternal and neonatal outcomes, while research evidence on the effectiveness of perinatal regionalization has been limited. The interventional studies have been assessed for robust evidence on the effectiveness of perinatal regionalization on improving maternal and neonatal health outcomes. METHODS Bibliographic databases of Medline, EMbase, EconLit, HMIC have been searched using sensitive search terms for interventional studies that reported important patient or process outcomes. At least two authors assessed eligibility for inclusion and the risk of biases and extracted data from the included studies. As meta-analysis was not possible, a narrative analysis as well as a 'vote-counting' analysis has been conducted for important outcomes. RESULTS After initial screenings 53 full text papers were retrieved. Eight studies were included in the review from the USA, Canada and France. Studies varied in their designs, and in the specifications of the intervention and setting. Only three interrupted time series studies had a low risk of bias, of which only one study reported significant reductions in neonatal and infant mortality. Studies of higher risk of bias were more likely to report improvements in outcomes. CONCLUSIONS Implementing perinatal regionalization programs is correlated with improvements in perinatal outcomes, but it is not possible to establish a causal link. Despite several high profile policy statements, evidence of effect is weak. It is necessary to assess the effectiveness of perinatal regionalization using robust research designs in a more diverse range of countries.
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Affiliation(s)
- A Rashidian
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran; Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
| | - A H Omidvari
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Y Vali
- Knowledge Utilization Research Center, Tehran University of Medical Sciences, Tehran, Iran; School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - S Mortaz
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
| | - R Yousefi-Nooraie
- Health Research Methodology Program, Department of Clinical Epidemiology and Biostatistics, McMaster University, Ontario, Canada
| | - M Jafari
- Health Management and Economics Research Center, School of Health Management and Information Sciences, Tehran University of Medical Sciences, Tehran, Iran; Department of Health Services Management, School of Health Management and Information Sciences, Tehran University of Medical Sciences, Tehran, Iran
| | - Z A Bhutta
- Division of Women and Child Health, The Aga Khan University, Karachi, Pakistan
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Papageorghiou AT, Kennedy SH, Salomon LJ, Ohuma EO, Cheikh Ismail L, Barros FC, Lambert A, Carvalho M, Jaffer YA, Bertino E, Gravett MG, Altman DG, Purwar M, Noble JA, Pang R, Victora CG, Bhutta ZA, Villar J. International standards for early fetal size and pregnancy dating based on ultrasound measurement of crown-rump length in the first trimester of pregnancy. Ultrasound Obstet Gynecol 2014; 44:641-8. [PMID: 25044000 PMCID: PMC4286014 DOI: 10.1002/uog.13448] [Citation(s) in RCA: 152] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
OBJECTIVES There are no international standards for relating fetal crown-rump length (CRL) to gestational age (GA), and most existing charts have considerable methodological limitations. The INTERGROWTH-21(st) Project aimed to produce the first international standards for early fetal size and ultrasound dating of pregnancy based on CRL measurement. METHODS Urban areas in eight geographically diverse countries that met strict eligibility criteria were selected for the prospective, population-based recruitment, between 9 + 0 and 13 + 6 weeks' gestation, of healthy well-nourished women with singleton pregnancies at low risk of fetal growth impairment. GA was calculated on the basis of a certain last menstrual period, regular menstrual cycle and lack of hormonal medication or breastfeeding in the preceding 2 months. CRL was measured using strict protocols and quality-control measures. All women were followed up throughout pregnancy until delivery and hospital discharge. Cases of neonatal and fetal death, severe pregnancy complications and congenital abnormalities were excluded from the study. RESULTS A total of 4607 women were enrolled in the Fetal Growth Longitudinal Study, one of the three main components of the INTERGROWTH-21(st) Project, of whom 4321 had a live singleton birth in the absence of severe maternal conditions or congenital abnormalities detected by ultrasound or at birth. The CRL was measured in 56 women at < 9 + 0 weeks' gestation; these were excluded, resulting in 4265 women who contributed data to the final analysis. The mean CRL and SD increased with GA almost linearly, and their relationship to GA is given by the following two equations (in which GA is in days and CRL in mm): mean CRL = -50.6562 + (0.815118 × GA) + (0.00535302 × GA(2) ); and SD of CRL = -2.21626 + (0.0984894 × GA). GA estimation is carried out according to the two equations: GA = 40.9041 + (3.21585 × CRL(0.5) ) + (0.348956 × CRL); and SD of GA = 2.39102 + (0.0193474 × CRL). CONCLUSIONS We have produced international prescriptive standards for early fetal linear size and ultrasound dating of pregnancy in the first trimester that can be used throughout the world.
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Affiliation(s)
- A T Papageorghiou
- Nuffield Department of Obstetrics & Gynaecology and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK
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Abstract
OBJECTIVE The purpose of this article is to explore the traditional newborn-care beliefs and practices and to identify factors that affect newborn health, aiming to design an appropriate, culturally-sensitive and acceptable intervention to reduce neonatal morbidity and mortality. METHODS A cross sectional study was conducted in the district of Gilgit in Pakistan. A structured questionnaire was administered to 708 mothers who gave birth to a live child in the past one year. Descriptive and inferential analysis was performed to identify socio-economic and health care factors associated with newborn care practices. RESULTS Illiterate mothers were more likely to use harmful newborn care practices, while those seeking health care from private sector were less likely to use harmful newborn care practices. Ninety-four percent of the newborns were given a bath soon after birth, likelihood to be 2 times more amongst illiterate mothers. Cord application was a very common practice, mostly with matti (crashed apricot seed), and a majority of the mothers reported newborn massage generally with mustard oil. The administration of colostrum as the first feed was relatively common in the study area. Twenty-seven percent of mothers reported giving pre-lacteals; from which prominent feeds included salt water (44%) and cow's milk (26%). Initiation of breastfeeding within 1 hour after birth was (71%), while (29%) reported to breastfeed their newborn within 24 hours. Thirty-seven percent newborns were exclusively breastfed for six months. CONCLUSION This study underscores the existence and predominance of risky practices in newborn care; that stresses the need for health education programs to ensure safety of the newborn.
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Affiliation(s)
- G N Khan
- Division of Women & Child Health, Aga Khan University, Karachi, Pakistan
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Eskenazi B, Bradman A, Finkton D, Purwar M, Noble JA, Pang R, Burnham O, Cheikh Ismail L, Farhi F, Barros FC, Lambert A, Papageorghiou AT, Carvalho M, Jaffer YA, Bertino E, Gravett MG, Altman DG, Ohuma EO, Kennedy SH, Bhutta ZA, Villar J. A rapid questionnaire assessment of environmental exposures to pregnant women in the INTERGROWTH-21st Project. BJOG 2013; 120 Suppl 2:129-38, v. [PMID: 24028080 DOI: 10.1111/1471-0528.12430] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2013] [Indexed: 11/28/2022]
Abstract
Impaired fetal growth and preterm birth are the leading causes of neonatal and infant mortality worldwide and there is a growing scientific literature suggesting that environmental exposures during pregnancy may play a causal role in these outcomes. Our purpose was to assess the environmental exposure of the Fetal Growth Longitudinal Study (FGLS) participants in the multinational INTERGROWTH-21(st) Project. First, we developed a tool that could be used internationally to screen pregnant women for such exposures and administered it in eight countries on a subsample (n = 987) of the FGLS participants. The FGLS is a study of fetal growth among healthy pregnant women living in relatively affluent areas, at low risk of adverse pregnancy outcomes and environmental exposures. We confirmed that most women were not exposed to major environmental hazards that could affect pregnancy outcomes according to the protocol's entry criteria. However, the instrument was able to identify some women that reported various environmental concerns in their homes such as peeling paint, high residential density (>1 person per room), presence of rodents or cockroaches (hence the use of pesticides), noise pollution and safety concerns. This screening tool was therefore useful for the purposes of the project and can be used to ascertain environmental exposures in studies in which the primary aim is not focused on environmental exposures. The instrument can be used to identify subpopulations for more in-depth assessment, (e.g. environmental and biological laboratory markers) to pinpoint areas requiring education, intervention or policy change.
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Affiliation(s)
- B Eskenazi
- Center for Environmental Research and Children's Health (CERCH), School of Public Health, University of California, Berkeley, CA, USA
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Bhutta ZA, Giuliani F, Haroon A, Knight HE, Albernaz E, Batra M, Bhat B, Bertino E, McCormick K, Ochieng R, Rajan V, Ruyan P, Cheikh Ismail L, Paul V. Standardisation of neonatal clinical practice. BJOG 2013; 120 Suppl 2:56-63, v. [DOI: 10.1111/1471-0528.12312] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2012] [Indexed: 11/27/2022]
Affiliation(s)
- ZA Bhutta
- Division of Women & Child Health; The Aga Khan University; Karachi; Pakistan
| | - F Giuliani
- SCDU Neonatologia; Dipartimento di Scienze Pediatriche e dell'Adolescenza; Università degli Studi di Torino; Torino; Italy
| | - A Haroon
- Division of Women & Child Health; The Aga Khan University; Karachi; Pakistan
| | - HE Knight
- Nuffield Department of Obstetrics & Gynaecology; Oxford Maternal & Perinatal Health Institute; Green Templeton College; University of Oxford; Oxford; UK
| | | | - M Batra
- University of Washington School of Medicine; Seattle; WA; USA
| | - B Bhat
- Department of Family & Community Health; Ministry of Health; Muscat; Sultanate of Oman
| | - E Bertino
- SCDU Neonatologia; Dipartimento di Scienze Pediatriche e dell'Adolescenza; Università degli Studi di Torino; Torino; Italy
| | - K McCormick
- Department of Paediatrics; John Radcliffe Hospital; Oxford; UK
| | - R Ochieng
- Faculty of Health Sciences; Aga Khan University; Nairobi; Kenya
| | - V Rajan
- Ketkar Nursing Home; Nagpur; India
| | - P Ruyan
- Maternal & Child Health Centre; Beijing Obstetrics & Gynaecology Hospital; Capital Medical University; Beijing; China
| | - L Cheikh Ismail
- Nuffield Department of Obstetrics & Gynaecology; Oxford Maternal & Perinatal Health Institute; Green Templeton College; University of Oxford; Oxford; UK
| | - V Paul
- Department of Paediatrics and WHO Collaborating Centre for Training & Research in Newborn Care; All India Institute of Medical Sciences; New Delhi; India
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Villar J, Altman DG, Purwar M, Noble JA, Knight HE, Ruyan P, Cheikh Ismail L, Barros FC, Lambert A, Papageorghiou AT, Carvalho M, Jaffer YA, Bertino E, Gravett MG, Bhutta ZA, Kennedy SH. The objectives, design and implementation of the INTERGROWTH-21stProject. BJOG 2013; 120 Suppl 2:9-26, v. [PMID: 23678873 DOI: 10.1111/1471-0528.12047] [Citation(s) in RCA: 194] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- J Villar
- Nuffield Department of Obstetrics & Gynaecology, and Oxford Maternal & Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK Centre for Statistics in Medicine, University of Oxford, Oxford, UK Ketkar Nursing Home, Nagpur, India Department of Engineering Science, University of Oxford, Oxford, UK School of Public Health, Peking University, Beijing, China Programa de Pós-Graduação em Saúde e Comportamento, Universidade Católica de Pelotas, Pelotas, RS, Brazil Programa de Pós-Graduação em Epidemiologia, Universidade Federal de Pelotas, Pelotas, RS, Brazil Faculty of Health Sciences, Aga Khan University, Nairobi, Kenya Department of Family & Community Health, Ministry of Health, Muscat, Sultanate of Oman Dipartimento di Scienze Pediatriche e dell'Adolescenza, Cattedra di Neonatologia, Università degli Studi di Torino, Torino, Italy University of Washington School of Medicine, Seattle, WA, USA Division of Women & Child Health, The Aga Khan University, Karachi, Pakistan
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Affiliation(s)
- ZA Bhutta
- Division of Women & Child Health; The Aga Khan University; Karachi; Pakistan
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Memon ZA, Khan MI, Soofi S, Muhammad S, Bhutta ZA. A cross sectional survey of newborn care practices in rural Sindh, Pakistan: implications for research and policy. J Neonatal Perinatal Med 2013; 6:137-144. [PMID: 24246516 DOI: 10.3233/npm-1366712] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Of annual four million neonatal deaths, majority in the developing world, approximately three-quarters die within the first week of life. Pakistan has one of the highest newborn mortality rates. STUDY DESIGN We conducted a cross sectional study to assess knowledge, attitudes and practices of women of reproductive age in rural Pakistan. RESULTS Of 1490 mothers interviewed, prevalence of newborn care practices ranged between 32% (early bathing of newborn) and 69% (use of traditional cord applications). Uptake of antenatal care services was identified as a strong predictor of good newborn care after controlling for skilled birth attendance, socio-economic status, age of mother and sex of infant (OR = 1.26; 95% CI: 1.00-1.57). CONCLUSIONS The association of uptake of antenatal care services with good newborn care highlights the necessity to improve coverage of services with the integration of counseling about newborn care in order to reduce the burden of neonatal morbidity and mortality.
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Affiliation(s)
- Z A Memon
- Maternal and Newborn Health Programme-Research and Advocacy Fund, Islamabad, Pakistan Department of Pediatrics and Child Health, The Aga Khan University, Karachi, Pakistan
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Affiliation(s)
- Z S Lassi
- Women & Child Health Division, The Aga Khan University, Karachi, Pakistan
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Shoukat S, Gowani SA, Taqui AM, Ul Hassan R, Bhutta ZA, Malik AI, Sherjeel SA, Sheheryar Q, Dhakam SH. Adherence to the European Society of Cardiology (ESC) guidelines for chronic heart failure--a national survey of the cardiologists in Pakistan. BMC Cardiovasc Disord 2011; 11:68. [PMID: 22093082 PMCID: PMC3250933 DOI: 10.1186/1471-2261-11-68] [Citation(s) in RCA: 6] [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] [Subscribe] [Scholar Register] [Received: 01/29/2011] [Accepted: 11/17/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aims of this study were to evaluate the awareness of and attitudes towards the 2005 European Society of Cardiology (ESC) guidelines for Heart Failure (HF) of the cardiologists in Pakistan and assess barriers to adherence to guidelines. METHODS A cross-sectional survey was conducted in person from March to July 2009 to all cardiologists practicing in 4 major cities in Pakistan (Karachi, Lahore, Quetta and Peshawar). A validated, semi-structured questionnaire assessing ESC 2005 Guidelines for HF was used to obtain information from cardiologists. It included questions about awareness and relevance of HF guidelines (See Additional File 1). Respondents' management choices were compared with those of an expert panel based on the guidelines for three fictitious patient cases. Cardiologists were also asked about major barriers to adherence to guidelines. RESULTS A total of 372 cardiologists were approached; 305 consented to participate (overall response rate, 82.0%). The survey showed a very high awareness of CHF guidelines; 97.4% aware of any guideline. About 13.8% considered ESC guidelines as relevant or very relevant for guiding treatment decisions while 92.8% chose AHA guidelines in relevance. 87.2% of respondents perceived that they adhered to the HF guidelines. For the patient cases, the proportions of respondents who made recommendations that completely matched those of the guidelines were 7% (Scenario 1), 0% (Scenario 2) and 20% (Scenario 3). Respondents considered patient compliance (59%) and cost/health economics (50%) as major barriers to guideline implementation. CONCLUSION We found important self reported departures from recommended HF management guidelines among cardiologists of Pakistan.
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Affiliation(s)
- Sana Shoukat
- Internal Medicine, Emory University School of Medicine, Atlanta, GA, USA.
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Villar J, Knight HE, de Onis M, Bertino E, Gilli G, Papageorghiou AT, Ismail LC, Barros FC, Bhutta ZA. Conceptual issues related to the construction of prescriptive standards for the evaluation of postnatal growth of preterm infants. Arch Dis Child 2010; 95:1034-8. [PMID: 20371586 DOI: 10.1136/adc.2009.175067] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [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] [Indexed: 11/03/2022]
Abstract
Monitoring and interpreting the growth of preterm infants is a major clinical task for neonatologists. The effectiveness of this process depends upon the robustness of the standard selected. Concerns have been raised regarding the nature of the charts currently being used, as well as their appropriateness for present-day neonatal care. To overcome these problems, there is a need for new prescriptive standards based on a population of preterm infants without evidence of impaired fetal growth and born to low-risk women followed up since early pregnancy for precise gestational age dating. Preterm infants contributing to the new standards should be free of congenital malformations and major clinical conditions associated with impaired postnatal growth. These infants should receive standardised, evidence-based clinical care and should follow current feeding recommendations based on exclusive/predominant breastfeeding. This strategy should provide a population that is conceptually as close as possible to the prescriptive approach used for the construction of the WHO infant and child growth standards. New international standards constructed in this way should contribute to the evidence-based care of these preterm infants.
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Affiliation(s)
- J Villar
- Nuffield Department of Obstetrics and Gynaecology, and Oxford Maternal and Perinatal Health Institute, Green Templeton College, University of Oxford, Oxford, UK.
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Siddiqui AR, Lee K, Bennett D, Yang X, Brown KH, Bhutta ZA, Gold EB. Indoor carbon monoxide and PM2.5 concentrations by cooking fuels in Pakistan. Indoor Air 2009; 19:75-82. [PMID: 19076247 DOI: 10.1111/j.1600-0668.2008.00563.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
UNLABELLED In developing countries biomass combustion is a frequently used source of domestic energy and may cause indoor air pollution. Carbon monoxide (CO)and particulate matter with an aerodynamic diameter of 2.5 lm or less (PM2.5)were measured in kitchens using wood or natural gas (NG) in a semi-rural community in Pakistan. Daytime CO and PM2.5 levels were measured for eight continuous hours in 51 wood and 44 NG users from December 2005 to April 2006. The laser photometer PM2.5 (Dustrak, TSI) was calibrated for field conditions and PM2.5 measurements were reduced by a factor of 2.77. CO was measured by an electrochemical monitor (Model T15v, Langan). The arithmetic mean for daytime CO concentration was 29.4 ppm in wood users; significantly higher than 7.5 ppm in NG users (P < 0.001). The arithmetic mean for daytime PM2.5 concentrations was 2.74 mg/m3 in wood users; significantly higher than 0.38 mg/m3 in NG users (P < 0.001). Higher peak levels of CO and PM2.5 were also observed in wood users. Time spent in the kitchen during fuel burning was significantly related to increasing CO and PM2.5 concentrations in wood users.These findings suggest that cooking with wood fuel may lead to hazardous concentrations of CO and PM2.5. PRACTICAL IMPLICATIONS Biomass combustion is frequently used in developing countries for cooking. This study showed very high level of air pollution in kitchens using wood as the cooking fuel. Many people, especially women and children, are vulnerable to exposure to very high levels of air pollutants as they spend time in the kitchen during cooking hours.
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Affiliation(s)
- A R Siddiqui
- Department of Public Health Sciences, University of California at Davis, CA, USA
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Akram SK, Akram M, Bhutta ZA, Soder O. Human placental IGF-I and IGF-II expression: correlating maternal and infant anthropometric variables and micronutrients at birth in the Pakistani population. Acta Paediatr 2008; 97:1443-8. [PMID: 18624994 DOI: 10.1111/j.1651-2227.2008.00930.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To correlate infant birth weight with maternal and infant biometric data, including the expression of placental IGF-I and IGF-II at birth, and levels of serum zinc and ferritin. METHODS The data consisted of observations from 89 women from Karachi, Pakistan. Placental and cord blood samples were taken immediately following delivery and were subsequently divided into two groups, small and large for gestational age (SGA and LGA). RESULTS The mean birth weight was 2.79 kg; the prevalence of SGA being 13.4% (< or =10th percentile); the prevalence of LGA being 23.6% (> or =90th percentile). Placental IGF-I and IGF-II mRNA expression was greater in the LGA group (p < 0.05). Furthermore, a significant correlation was noted between infant birth weight and maternal anthropometric parameters (p < 0.01). Cord zinc levels were also significantly higher in the LGA group (p < 0.05). CONCLUSION Maternal anthropometry, along with placental IGF-I and IGF-II mRNA levels, correlated significantly with infant birth weight suggesting the importance of these growth factors for birth weight outcomes. The higher zinc levels in the LGA group also suggest the importance of this micronutrient in foetal growth. Our results suggest that growth problems have a multifactorial aetiology arising from within the infant rather than due to maternal constraint alone.
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Affiliation(s)
- S K Akram
- Department of Women and Children's Health, Karolinska Hospital, Stockholm, Sweden.
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Jafar TH, Qadri Z, Islam M, Hatcher J, Bhutta ZA, Chaturvedi N. Rise in childhood obesity with persistently high rates of undernutrition among urban school-aged Indo-Asian children. Arch Dis Child 2008; 93:373-8. [PMID: 17942586 PMCID: PMC2532954 DOI: 10.1136/adc.2007.125641] [Citation(s) in RCA: 86] [Impact Index Per Article: 5.4] [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] [Indexed: 12/13/2022]
Abstract
BACKGROUND Childhood obesity is an emerging global public health challenge. Evidence for the transition in nutrition in Indo-Asian developing countries is lacking. We conducted these analyses to determine the trends in nutritional status of school-aged children in urban Pakistan. METHODS Data on the nutritional status of children aged 5 to 14 years from two independent population-based representative surveys, the urban component of the National Health Survey of Pakistan (NHSP; 1990-1994) and the Karachi survey (2004-2005), were analysed. Using normative data from children in the United States as the reference, trends for age- and gender-standardised prevalence (95% CI) of underweight (more than 2 SD below the weight-for-age reference), stunted (more than 2 SD below the height-for-age reference) and overweight and obese (body mass index (BMI) 85(th) percentile or greater) children were compared for the two surveys. The association between physical activity and being overweight or obese was analysed in the Karachi survey using logistical regression analysis. RESULTS 2074 children were included in the urban NHSP and 1675 in the Karachi survey. The prevalence of underweight children was 29.7% versus 27.3% (p = 0.12), stunting was 16.7% versus 14.3% (p = 0.05), and prevalence of overweight and obese children was 3.0 versus 5.7 (p<0.001) in the NHSP and Karachi surveys, respectively. Physical activity was inversely correlated with being overweight or obese (odds ratio, 95% CI, 0.51, 0.32-0.80 for those who engaged in more than 30 minutes of physical activity versus those engaged in less than 30 minutes' activity). CONCLUSIONS Our study highlights the challenge faced by Pakistani school-aged children. There has been a rapid rise in the number of overweight and obese children despite a persistently high burden of undernutrition. Focus on prevention of obesity in children must include strategies for promoting physical activity.
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Affiliation(s)
- T H Jafar
- Clinical Epidemiology Unit, Department of Community Health Sciences and Medicine, Aga Khan University, Stadium Road, Karachi, Pakistan.
| | - Z Qadri
- Clinical Epidemiology Unit, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - M Islam
- Clinical Epidemiology Unit, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - J Hatcher
- Clinical Epidemiology Unit, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
| | - Z A Bhutta
- Department of Paediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - N Chaturvedi
- National Heart and Lung Institute, Imperial College London, UK
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Nizami SQ, Bhutta ZA, Siddiqui AA, Lubbad L. Enhanced detection rate of typhoid fever in children in a periurban slum in Karachi, Pakistan using polymerase chain reaction technology. Scand J Clin Lab Invest 2007; 66:429-36. [PMID: 16901852 DOI: 10.1080/00365510600791724] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Yield of blood culture in clinically suspected cases of typhoid fever is low, whereas indirect serological diagnostic tests are unreliable. Hence, polymerase chain reaction (PCR)-based detection of Salmonella enterica Serovar typhi was used as an aid for diagnosis of typhoid fever in addition to other diagnostic tests. Two periurban communities in Karachi were selected for an epidemiological study of typhoid fever. The aim of the study was to assess whether PCR increased the detection rate of typhoid fever in children in the community. MATERIAL AND METHODS Children aged 2 to 14 years presenting with fever lasting for three or more days were selected. PCR using Hashimoto's protocol based on ViaB gene sequence was used in addition to blood culture and other serological tests. RESULTS Of the 214 children included in the study, blood culture was found positive for S. enterica S. typhi in 26 (12.4%) cases, whereas 24 children (11.7%) were diagnosed as suffering from typhoid fever when the PCR-based method was used. Both tests were positive in only 10 (4.9%) children. The number of children found positive for either test was 40. PCR increased the rate of detection of typhoid fever by 51%. CONCLUSION The sensitivity, specificity, +ve and -ve predictive values of PCR in this study were 40%, 93%, 45% and 92%, respectively.
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Affiliation(s)
- S Q Nizami
- Department of Pediatrics, The Aga Khan University and Hospital, Karachi, Pakistan.
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Abstract
BACKGROUND Multiple-micronutrient deficiencies often coexist in low- to middle-income countries. They are exacerbated in pregnancy due to the increased demands, leading to potentially adverse effects on the mother. Substantive evidence regarding the effectiveness of multiple-micronutrient supplements (MMS) during pregnancy is not available. OBJECTIVES To evaluate the benefits to mother and infant of multiple-micronutrient supplements in pregnancy and assess the risk of excess supplementation and potential adverse interactions between micronutrients. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 December 2005). SELECTION CRITERIA All prospective randomised controlled trials evaluating micronutrient supplementation during pregnancy and its effects on the pregnancy outcome. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted the data. MAIN RESULTS Nine trials (15,378 women) are included. When compared with supplementation of two or less micronutrients or no supplementation or a placebo, multiple-micronutrient supplementation resulted in a statistically significant decrease in the number of low birthweight babies (relative risk (RR) 0.83; 95% confidence interval (CI) 0.76 to 0.91), small-for-gestational-age babies (RR 0.92; 95% CI 0.86 to 0.99) and in maternal anaemia (RR 0.61; CI 0.52 to 0.71). However, these differences lost statistical significance when multiple-micronutrient supplementation was compared with iron folic acid supplementation alone. No statistically significant differences were shown for the outcomes of preterm births and perinatal mortality in any of the comparisons. A number of prespecified clinically important outcomes could not be assessed due to insufficient or non-available data from the included trials. These include placental abruption, congenital anomalies including neural tube defects, premature rupture of membranes, pre-eclampsia, miscarriage, maternal mortality, neurodevelopmental delay, very preterm births, cost of supplementation, side-effects of supplements, maternal wellbeing or satisfaction and nutritional status of children. AUTHORS' CONCLUSIONS The evidence provided in this review is insufficient to suggest replacement of iron and folate supplementation with a multiple-micronutrient supplement. A reduction in the number of low birthweight and small-for-gestational-age babies and maternal anaemia has been found with a multiple-micronutrient supplement against supplementation with two or less micronutrients or none or a placebo, but analyses revealed no added benefit of multiple-micronutrient supplements compared with iron folic acid supplementation. These results are limited by the small number of studies available. There is also insufficient evidence to identify adverse effects and to say that excess multiple-micronutrient supplementation during pregnancy is harmful to the mother or the fetus. Further research is needed to find out the beneficial maternal or fetal effects and to assess the risk of excess supplementation and potential adverse interactions between the micronutrients.
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Affiliation(s)
- B A Haider
- The Aga Khan University Hospital, Department of Paediatrics, PO Box 3500, Stadium Road, Karachi, Pakistan
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Abstract
BACKGROUND Vitamin B6 plays vital roles in numerous metabolic processes in the human body, such as nervous system development and functioning. It has been associated with some benefits in non-randomised studies, such as higher Apgar scores, higher birthweights, and reduced incidence of pre-eclampsia and preterm birth. Recent studies also suggest a protection against certain congenital malformations. OBJECTIVES To evaluate the clinical effects of vitamin B6 supplementation during pregnancy and/or labour. SEARCH STRATEGY We searched the Cochrane Pregnancy and Childbirth Group Trials Register (30 December 2005). SELECTION CRITERIA We included randomised controlled trials comparing vitamin B6 administration in pregnancy and/or labour with: placebos, no supplementations, or supplements not containing vitamin B6. DATA COLLECTION AND ANALYSIS Two authors independently extracted data and assessed trials for methodological quality. We used relative risk and weighted mean difference with 95% confidence intervals. MAIN RESULTS Five trials (1646 women) were included. Four trials used blinding. One had adequate method of randomisation and allocation concealment; four did not report this. Three trials had large losses to follow up. Vitamin B6 as oral capsules or lozenges resulted in decreased risk of dental decay in pregnant women (capsules: relative risk (RR) 0.84; 95% confidence interval (CI) 0.71 to 0.98; one trial, n = 371; lozenges: RR 0.68; 95% CI 0.56 to 0.83; one trial, n = 342). A small trial showed reduced mean birthweights with vitamin B6 supplementation (weighted mean difference -0.23 kg; 95% CI -0.42 to -0.04; n = 33; one trial). We did not find any statistically significant differences in the risk of eclampsia (capsules: n = 1242; three trials; lozenges: n = 944; one trial), pre-eclampsia (capsules n = 1197; two trials; lozenges: n = 944; one trial) or low Apgar scores at one minute (oral pyridoxine: n = 45; one trial), between supplemented and non-supplemented groups. No differences were found in Apgar scores at one or five minutes, or breastmilk production between controls and women receiving oral (n = 24; one trial) or intramuscular (n = 24; one trial) loading doses of pyridoxine at labour. AUTHORS' CONCLUSIONS There were few trials, reporting few clinical outcomes and mostly with unclear trial methodology and inadequate follow up. There is not enough evidence to detect clinical benefits of vitamin B6 supplementation in pregnancy and/or labour other than one trial suggesting protection against dental decay. Future trials assessing this and other outcomes such as orofacial clefts, cardiovascular malformations, neurological development, preterm birth, pre-eclampsia and adverse events are required.
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Shah U, Moatter T, Bhutta ZA. Profile and factors determining outcome in a cohort of cystic fibrosis patients seen at the Aga Khan University Hospital, Karachi, Pakistan. J Trop Pediatr 2006; 52:132-5. [PMID: 16582405 DOI: 10.1093/tropej/fmi080] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [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] [Indexed: 11/13/2022]
Abstract
Cystic fibrosis is the most common potentially lethal autosomal recessive, genetic disease associated with pulmonary and pancreatic insufficiency. It is caused by variations in the CFTR (cystic fibrosis transmembrane regulator) gene. The most common mutation in the CFTR gene designated DeltaF508, is found in only 33 per cent of CF patients in Pakistan. The variability in presentation and clinical severity of disease may be a function of genotypic-phenotypic factors. Our aim was to attempt to define the disease in this region and to lay the ground work for future mutational analysis. This study was a retrospective chart review was conducted to identify cystic fibrosis patients seen at the Aga Khan University Hospital over a 10-year period. Our study identified 56 patients diagnosed by a pilocarpine iontophoresis sweat test. A chart review was then done to look at the various clinical profiles. 58.3 per cent of our patients presented in the first 6 months of life supporting the hypothesis that CF may be a severe disease in Asians with an earlier age of presentation. Most of the patients (80.6 per cent) presented with pulmonary problems while 83.9 per cent had failure to thrive. The most frequently isolated pathogen was Pseudomonas aeruginosa in 87.5 per cent of the patients tested. 70 per cent of the patients died in the first year of life. The clinical parameters studied suggest a severe form of CF in Pakistani patients and provides a foundation for future studies to define genotype/phenotype correlations of the specific mutations involved in Pakistani CF patients.
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Affiliation(s)
- Uzma Shah
- Pediatric Gastroenterology, Hepatology and Nutrition, The Aga Khan University Hospital, Karachi, Pakistan
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Abstract
BACKGROUND Fluoroquinolones are recommended as first-line therapy for typhoid and paratyphoid fever, but how they compare with other cheaper antibiotics and different fluoroquinolones is unclear. OBJECTIVES To evaluate fluoroquinolone antibiotics for treating enteric fever in children and adults compared with other antibiotics, different fluoroquinolones, and different treatment durations of the same fluoroquinolone. SEARCH STRATEGY We searched the Cochrane Infectious Diseases Group Specialized Register (August 2004), CENTRAL (The Cochrane Library Issue 3, 2004), MEDLINE (1966 to August 2004), EMBASE (1974 to August 2004), LILACS (1982 to August 2004), conference proceedings, reference lists, and contacted researchers. SELECTION CRITERIA Randomized controlled trials of fluoroquinolones in people with blood or bone marrow culture-confirmed enteric fever. DATA COLLECTION AND ANALYSIS Two reviewers independently assessed the methodological quality of trials and extracted data. We calculated the odds ratio (OR) for dichotomous data with 95% confidence intervals. We analysed norfloxacin separately. MAIN RESULTS Thirty-three trials met the inclusion criteria; 22 had unclear allocation concealment, and 29 were not blinded. Three trials exclusively included children, and two studied outpatients. The main analysis examined clinical failure, microbiological failure, and relapse. Compared with chloramphenicol, fluoroquinolones were not statistically significantly different for clinical (544 participants) or microbiological failure (378 participants) in adults; they reduced clinically diagnosed relapse in adults (OR 0.14, 0.04 to 0.50; 467 participants, 6 trials), but this was not statistically significant in participants with blood culture-confirmed relapse (121 participants, 2 trials). Compared with co-trimoxazole, we detected no statistically significant difference (82 participants, 2 trials). Among adults, fluoroquinolones reduced clinical failure compared with ceftriaxone (OR 0.08, 0.01 to 0.45; 120 participants, 3 trials), but showed no difference for microbiological failure or relapse. We detected no statistically significant difference between fluoroquinolones and cefixime (80 participants, 1 trial) or azithromycin (152 participants, 2 trials). In trials of hospitalized children, fluoroquinolones were not statistically significantly different from ceftriaxone (60 participants, 1 trial, involving norfloxacin) or cefixime (82 participants, 1 trial). Norfloxacin had more clinical failures than other fluoroquinolones (417 participants, 5 trials). Trials comparing different durations of fluoroquinolone treatment showed no statistically significant differences (693 participants, 8 trials). AUTHORS' CONCLUSIONS Many trials were small, and methodological quality varied widely. Although enteric fever most commonly affects children, trials in this group were particularly sparse. Insufficient data in all comparisons preclude any firm conclusions to be made regarding superiority of fluoroquinolones over first-line antibiotics in children and adults.
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Bhutta ZA, Khan I. Multiple-micronutrient supplementation for women during pregnancy. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2004. [DOI: 10.1002/14651858.cd004905] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Abstract
Despite the hype and ostensible investments in child survival strategies, the state of child health in much of the developing world is alarming. Not only are global investments and support programmes for child health by the development agencies declining, but commensurate support for maternal and child health by poor countries themselves is poor. In order to make a meaningful contribution to maternal and child health and survival, a multi-pronged approach is needed which not only focuses on the proximal determinants of child health but also some of the underlying factors governing the status of women in society and expenditures on health and development.
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Affiliation(s)
- Z A Bhutta
- The Husein Lalji Dewraj of Paediatrics & Child Health, The Aga Khan University, Karachi 74800, Pakistan.
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