Boerhaave's syndrome is a potential lethal condition which presents not only a diagnostic but also a therapeutic challenge. Errors in... more
Boerhaave's syndrome is a potential lethal condition which presents not only a diagnostic but also a therapeutic challenge. Errors in diagnosis are usually caused by unawareness of its varied and atypical presentations. All clinicians need to be aware of this lethal disease, its frequent unusual presentations and the importance of early diagnosis.
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Introduction: Mortality rates from severe sepsis remain at 40- 45% in lesser developed countries.Our primary objective was to determine compliance with the Surviving Sepsis Guidelines and identify organizational factors related to greater... more
Introduction: Mortality rates from severe sepsis remain at 40- 45% in lesser developed countries.Our primary objective was to determine compliance with the Surviving Sepsis Guidelines and identify organizational factors related to greater compliance. Methods: In this prospective,cohort study, ICU care-givers from the WHO Eastern Mediterranean region (EMRO), were invited to fill out a survey on care practices for patients with Severe Sepsis. Adherence to the resuscitation and management bundles of the 2012 Surviving Sepsis Guidelines was used to measure compliance, with > 60% adherence defined as Overall Compliance. We classified countries according to the World Bank's Income Classification, 2013 into high, mid and low-income countries. The study was approved by the Hospital Research Committee. Results: 133 responses from 11 countries were received; 95 from high-income (Saudi Arabia, Bahrain), 8 mid-income (Lebanon,Jordan,Turkey,Iran,Libya) and 30 from low-income (Pakistan,Syr...
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The objective of this study was to assess the promptness of antibiotic administration to patients presenting with sepsis and the effects on survival and length of hospitalization. Consecutive, adult patients presenting with Systemic... more
The objective of this study was to assess the promptness of antibiotic administration to patients presenting with sepsis and the effects on survival and length of hospitalization. Consecutive, adult patients presenting with Systemic Inflammatory Response Syndrome (SIRS) to the emergency department of the Aga Khan University hospital were enrolled in a prospective, observational study over a period of 4 months. Univariate, multivariate regression modeling and one-way ANOVA were used to examine the effects of various variables on survival and for significant differences between timing of antibiotic administration and survival, two-sided p values < 0.05 were considered significant. One hundred and eleven patients were enrolled. Severe sepsis was present in 52% patients; the most frequent organism isolated was Salmonella typhi (18%). Overall mortality was 35.1%. One hundred (90.1%) patients received intravenous antibiotics in the Emergency room; average time from triage to actual adm...
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To reduce rates of nosocomial pneumonia and cost of antibiotic therapy. By means of a policy implementation the following broad spectrum antibiotics were restricted to usage in the ICU for 72 hours: Cefepime, Meropenem, Imipenem, Tazocin,... more
To reduce rates of nosocomial pneumonia and cost of antibiotic therapy. By means of a policy implementation the following broad spectrum antibiotics were restricted to usage in the ICU for 72 hours: Cefepime, Meropenem, Imipenem, Tazocin, Polymixin B and Vancomycin, after an institutional based pharmacy and therapeutic committee approval. The ICU pharmacist would alert the ICU residents or consultants after 48 hours of the computer based antibiotic entry that the order would expire within hours. Telephone approval was obtained followed by a formal consultation if deemed necessary by the ID specialist or primary team. Antibiotic usage was standardized by defined daily doses (DDDs) per 1000/patient-days. A cumulative 34% reduction was seen in the use of all broad spectrum antibiotics in our ICU after the enforcement of the antibiotic restriction policy. The largest reduction was seen in the use of Tazocin (190 DDDs) and Meropenem (60 DDDs). The policy resulted in a reduction by 40% of...
Research Interests: Developing Countries, Vancomycin, Humans, Program Development, Developing Country, and 13 moreInfectious Disease, Multidrug Resistance, Microbial genetic and drug resistance, Cephalosporins, Organizational Policy, Clinical Sciences, Policy Implementation, Spectrum, Anti-Bacterial Agents, Ventilator Associated Pneumonia, Intensive Care Units, Imipenem, and Cumulant
Pneumonia is a common complication after acute stroke. It affects the outcome adversely. However, data regarding microbiology of stroke-associated pneumonia and its effect on outcome is scarce. Stroke-associated pneumonia was identified... more
Pneumonia is a common complication after acute stroke. It affects the outcome adversely. However, data regarding microbiology of stroke-associated pneumonia and its effect on outcome is scarce. Stroke-associated pneumonia was identified through chart review of all ICD-9 identified adult stroke patients admitted to our hospital over a period of four years (1998-2001). The demographical, laboratory, radiological, microbiological data and outcome of patients with stroke-associated pneumonia were recorded and analysed. 443 patients with stroke were admitted over the four-year period and 102 (23 percent) had stroke-associated pneumonia. Their ages range from 28 to 100 (mean 64+/-14) years. 69 (68 percent) were men. Median length of stay was nine days compared to four days for all stroke patients. 68 (67 percent) patients manifested pneumonia within 48 hours and 34 (33 percent) after 48 hours of admission. Yield of tracheal aspirate cultures was 38 percent and that of chest radiographs wa...
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To determine the outcome of patients discharged home on portable ventilator. Descriptive study. The Aga Khan University Hospital, Karachi from January 2000 to December 2004. All ventilator-dependent patients discharged home were... more
To determine the outcome of patients discharged home on portable ventilator. Descriptive study. The Aga Khan University Hospital, Karachi from January 2000 to December 2004. All ventilator-dependent patients discharged home were contacted. Survivors were administered the EQ-5D Quality-of-Life instrument. SPSS version 13 was used to analyze data. Eleven patients were discharged home on invasive ventilation. Mean age was 49 years (range 10-98 years). Cause of ventilatory failure were cervical spine trauma in 36%, primary neurological disease in 27%, critical illness neuropathy and respiratory failure in 18% each. Survival rate was 73%, with three deaths. Mean duration of ventilation was 9.45 months (95% CI 3.24, 15.67). Rate of successful weaning after discharge was 36%, with 4 patients off all forms of ventilatory support and 2 on only nocturnal support. A 2.8 (95% CI 0.5, 16.6) relative risk towards successful weaning was associated with the presence of a family member as the primar...
Research Interests: Pakistan, Quality of life, Survival Analysis, Treatment Outcome, Adolescent, and 7 moreHumans, Child, Female, Male, Aged, Middle Aged, and Adult
Boerhaave's syndrome is a potential lethal condition which presents not only a diagnostic but also a therapeutic challenge. Errors in diagnosis are usually caused by unawareness of its varied and atypical presentations. All clinicians... more
Boerhaave's syndrome is a potential lethal condition which presents not only a diagnostic but also a therapeutic challenge. Errors in diagnosis are usually caused by unawareness of its varied and atypical presentations. All clinicians need to be aware of this lethal disease, its frequent unusual presentations and the importance of early diagnosis.
Research Interests:
To assess results with NIV in acute hypercapneic respiratory failure and to identify outcome predictors. This was a retrospective observational study on consecutive patients presenting with acute type II respiratory failure and meeting... more
To assess results with NIV in acute hypercapneic respiratory failure and to identify outcome predictors. This was a retrospective observational study on consecutive patients presenting with acute type II respiratory failure and meeting criteria for NIV use over a 5 year period. Patients presenting with haemodynamic instability, inability to protect their airway, malignant arrhythmias and recent oesophageal surgery were excluded. Univariate and Multivariate regression analysis was used to determine the impact on survival. A p value of < 0.05 was considered statistically significant. Software used was SPSS 14. Total numbers of patients included were 119; 52.9% were males. Mean age was 63.4 +/- 11.9 years. Overall Survival to discharge rate was 76.5%, intubation rate was 12.6% and mean length of stay was 11.4 +/- 10.9 days. Statistically significant improvements were observed in the pH and PaCO2 at 24 hours and 48 hours compared to baseline (7.28 v/s 7.37, p < 0.001; 74.2 v/s 65,...
Research Interests: Pakistan, Humans, Female, Male, Regression Analysis, and 13 moreRisk factors, Length of Stay, Respiratory Failure, Clinical Sciences, Middle Aged, Retrospective Studies, Multivariate Regression, Risk Factors, Hospital Mortality, Observational Study, Hydrogen-Ion Concentration, Overall Survival, and Predictive value of tests
Background: Acute Respiratory Distress Syndrome is an uncommon but frequently fatal presentation of pulmonary TB. We attempted to identify whether a specific M. tuberculosis genotype occurs more commonly in patients who develop ARDS.... more
Background: Acute Respiratory Distress Syndrome is an uncommon but frequently fatal presentation of pulmonary TB. We attempted to identify whether a specific M. tuberculosis genotype occurs more commonly in patients who develop ARDS. Methods: An ...
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ABSTRACT To determine the outcome of patients discharged home on portable ventilator. Descriptive study. Place and Duration of Study: The Aga Khan University Hospital, Karachi from January 2000 to December 2004. All ventilator-dependent... more
ABSTRACT To determine the outcome of patients discharged home on portable ventilator. Descriptive study. Place and Duration of Study: The Aga Khan University Hospital, Karachi from January 2000 to December 2004. All ventilator-dependent patients discharged home were contacted. Survivors were administered the EQ-5D Quality-of-Life instrument. SPSS version 13 was used to analyze data. Eleven patients were discharged home on invasive ventilation. Mean age was 49 years (range 10-98 years). Cause of ventilatory failure were cervical spine trauma in 36%, primary neurological disease in 27%, critical illness neuropathy and respiratory failure in 18% each. Survival rate was 73%, with three deaths. Mean duration of ventilation was 9.45 months (95% CI 3.24, 15.67). Rate of successful weaning after discharge was 36%, with 4 patients off all forms of ventilatory support and 2 on only nocturnal support. A 2.8 (95% CI 0.5, 16.6) relative risk towards successful weaning was associated with the presence of a family member as the primary care giver. Mean scores on the EQ-5D descriptive tool were; mobility 2 (-/+0.82), self-care 2 (-/+0.82), usual activities 1.86 (-/+0.69), pain/discomfort 1.43(-/+0.79), anxiety/depression 1.29 (-/+0.76). Mean score on the EQ-VAS was 48.2(-/+ 27.3). In carefully selected patients, home ventilation is a viable option with the expectation of successful weaning and survival. Patients discharged home on ventilation reported a reasonably good quality of life with proportionately more problems related to independence compared to overall well-being.
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Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in patients on mechanical ventilation and results in increases in mortality, prolonged hospitalization and costs. Preventive measures for VAP are... more
Ventilator-associated pneumonia (VAP) is the most common nosocomial infection in patients on mechanical ventilation and results in increases in mortality, prolonged hospitalization and costs. Preventive measures for VAP are well-documented and evidence-based, yet remain poorly implemented in most intensive care units. We undertook an observational pre and post-intervention study to assess whether an educational programme focusing on preventive practices for VAP could reduce the incidence. Six hundred and seventy-seven adult patients, mechanically ventilated for &amp;amp;amp;amp;gt;48 h were included in the study population. An evidence-based guideline for preventive practices at the bedside was developed and disseminated to the intensive care unit staff. VAP incidence rates before and after implementation of the educational programme were compared. VAP infection rates reduced by 51%, from a mean of 13.2+/-1.2 in the pre-intervention period to 6.5+/-1.5/1000 device days in the post-intervention period (mean difference 6.7; 95% CI: 2.9-10.4, P =0.02). A multidisciplinary educational programme geared towards intensive care unit staff can successfully reduce the incidence rates of VAP. Further studies will be needed to assess the impact on broader outcome measures such as costs or mortality.
Research Interests: Program Evaluation, Evidence Based Medicine, Pakistan, Education Policy, Hospital Infection, and 19 moreBenchmarking, Humans, Infection Control, Pneumonia, Hospital, Incidence, Length of Stay, Clinical Sciences, Intensive Care Unit, Adult, Patient Care Team, Mechanical Ventilation, Intervention study, Ventilator Associated Pneumonia, Clinical Competence, Hospital Mortality, Cooperative Behavior, Cross-infection, and Preventive measures(Benchmarking, Humans, Infection Control, Pneumonia, Hospital, Incidence, Length of Stay, Clinical Sciences, Intensive Care Unit, Adult, Patient Care Team, Mechanical Ventilation, Intervention study, Ventilator Associated Pneumonia, Clinical Competence, Hospital Mortality, Cooperative Behavior, Cross-infection, and Preventive measures)
(Benchmarking, Humans, Infection Control, Pneumonia, Hospital, Incidence, Length of Stay, Clinical Sciences, Intensive Care Unit, Adult, Patient Care Team, Mechanical Ventilation, Intervention study, Ventilator Associated Pneumonia, Clinical Competence, Hospital Mortality, Cooperative Behavior, Cross-infection, and Preventive measures)
Serum levels of the inflammatory C-X-C motif chemokine 10 (CXCL10) are raised in tuberculosis (TB). CXCL10 gene expression is downregulated in monocytes by metabolically active vitamin D3 (1,25dihydroxy vitamin D). Stratification of... more
Serum levels of the inflammatory C-X-C motif chemokine 10 (CXCL10) are raised in tuberculosis (TB). CXCL10 gene expression is downregulated in monocytes by metabolically active vitamin D3 (1,25dihydroxy vitamin D). Stratification of patients by serum 25hydroxyvitamin D (25[OH]D) levels at baseline showed that treatment-induced decrease in CXCL10 occurred in those with &amp;amp;amp;amp;amp;amp;#39;insufficient&amp;amp;amp;amp;amp;amp;#39; and &amp;amp;amp;amp;amp;amp;#39;deficient&amp;amp;amp;amp;amp;amp;#39; but not in those with &amp;amp;amp;amp;amp;amp;#39;optimal&amp;amp;amp;amp;amp;amp;#39; levels. In the deficient group, 25(OH)D showed an inverse correlation with CXCL10 levels. CXCL10 may thus be a useful biomarker for the follow-up of response to treatment. However, CXCL10 levels should be interpreted taking into account the baseline serum vitamin D levels of the TB patients.
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... He visited the local hospital and was suspected to have left-sided parapneumonic pleural effusion. ... 391-394. Abstract/FREE Full Text. ↵ Giulekas, D, Papacosta, D, Papaconstantinou, C, et al Recurrent anaphylactic shock as a... more
... He visited the local hospital and was suspected to have left-sided parapneumonic pleural effusion. ... 391-394. Abstract/FREE Full Text. ↵ Giulekas, D, Papacosta, D, Papaconstantinou, C, et al Recurrent anaphylactic shock as a manifestation of echinococcosis: report of a case. ...
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PURPOSE:Physiologic deterioration is expected to precede most cardiopulmonary arrests. Investigators have proposed an early warning system coupled with a &amp;quot;Rapid Response Team&amp;quot; to help prevent deterioration to... more
PURPOSE:Physiologic deterioration is expected to precede most cardiopulmonary arrests. Investigators have proposed an early warning system coupled with a &amp;quot;Rapid Response Team&amp;quot; to help prevent deterioration to cardiac arrest. However a &amp;quot;Rapid Response Team&amp;quot; is an addition to ...
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Objective: To reduce rates of nosocomial pneumonia and cost of antibiotic therapy. Methods: By means of a policy implementation the following broad spectrum antibiotics were restricted to usage in the ICU for 72 hours: Cefepime,... more
Objective: To reduce rates of nosocomial pneumonia and cost of antibiotic therapy. Methods: By means of a policy implementation the following broad spectrum antibiotics were restricted to usage in the ICU for 72 hours: Cefepime, Meropenem, Imipenem, Tazocin, ...
Research Interests: Developing Countries, Vancomycin, Humans, Program Development, Developing Country, and 13 moreInfectious Disease, Multidrug Resistance, Microbial genetic and drug resistance, Cephalosporins, Organizational Policy, Clinical Sciences, Policy Implementation, Spectrum, Anti-Bacterial Agents, Ventilator Associated Pneumonia, Intensive Care Units, Imipenem, and Cumulant
1. J Coll Physicians Surg Pak. 2008 Mar;18(3):193-4. Preventive medicine practices by primary care providers in Karachi. Patel MJ, Salahuddin N, Kashif W, Riaz M, Tariq M, Samdani AJ, Khan MS, Ayaz SI, Sorathia A, Furqan ...