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Full-Text Articles in Diseases

The Mystery Of Covid-19 Reinfections: A Global Systematic Review And Meta-Analysis, Rubaid Azhar Dhillon, Mohammad Aadil Qamar, Jaleed Ahmed Gilani, Omar Irfan, Usama Waqar, Mir Ibrahim Sajid, Syed Faisal Mahmood Dec 2021

The Mystery Of Covid-19 Reinfections: A Global Systematic Review And Meta-Analysis, Rubaid Azhar Dhillon, Mohammad Aadil Qamar, Jaleed Ahmed Gilani, Omar Irfan, Usama Waqar, Mir Ibrahim Sajid, Syed Faisal Mahmood

Department of Medicine

Background: As the COVID-19 pandemic rages on, reports on disparities in vaccine roll out alongside COVID-19 reinfection have been emerging. We conducted a systematic review to assess the determinants and disease spectrum of COVID-19 reinfection.
Materials and methods: A comprehensive search covering relevant databases was conducted for observational studies reporting Polymerase Chain Reaction (PCR) confirmed infection and reinfection cases. A quality assessment tool developed by the National Institute of Health (NIH) for the assessment of case series was utilized. Meta-analyses were performed using RevMan 5.3 for pooled proportions of findings in first infection and reinfection with a 95% confidence interval …


Thrombosis With Thrombocytopenia Syndrome After Administration Of Azd1222 Or Ad26.Cov2.S Vaccine For Covid-19: A Systematic Review, Usama Waqar, Shaheer Ahmed, Syed M H Ali Gardezi, Muhammad Sarmad Tahir, Zain Ul Abidin, Ali Hussain, Natasha Bahadur Ali, Syed Faisal Mahmood Dec 2021

Thrombosis With Thrombocytopenia Syndrome After Administration Of Azd1222 Or Ad26.Cov2.S Vaccine For Covid-19: A Systematic Review, Usama Waqar, Shaheer Ahmed, Syed M H Ali Gardezi, Muhammad Sarmad Tahir, Zain Ul Abidin, Ali Hussain, Natasha Bahadur Ali, Syed Faisal Mahmood

Medical College Documents

Background: Cases of thrombosis with thrombocytopenia syndrome (TTS) have been reported following vaccination with AZD1222 or Ad26.COV2.S. This review aimed to explore the pathophysiology, epidemiology, diagnosis, management, and prognosis of TTS.
Methods: A systematic review was conducted to identify evidence on TTS till 4th September 2021. Case reports and series reporting patient-level data were included. Descriptive statistics were reported and compared across patients with different sexes, age groups, vaccines, types of thrombosis, and outcomes.
Findings: Sixty-two studies reporting 160 cases were included from 16 countries. Patients were predominantly females with a median age of 42.50 (22) years. AZD1222 was administered …


Upregulated Type I Interferon Responses In Asymptomatic Covid-19 Infection Are Associated With Improved Clinical Outcome, Kiran I. Masood, Maliha Yameen, Javeria Ashraf, Saba Shahid, Syed Faisal Mahmood, Asghar Nasir, Nosheen Nasir, Bushra Jamil, Najia Karim Ghanchi, Iffat Khanum, Safina Abdul Razzak, Akber Kanji, Rabia Hussain, Martin E. Rottenberg, Zahra Hasan Nov 2021

Upregulated Type I Interferon Responses In Asymptomatic Covid-19 Infection Are Associated With Improved Clinical Outcome, Kiran I. Masood, Maliha Yameen, Javeria Ashraf, Saba Shahid, Syed Faisal Mahmood, Asghar Nasir, Nosheen Nasir, Bushra Jamil, Najia Karim Ghanchi, Iffat Khanum, Safina Abdul Razzak, Akber Kanji, Rabia Hussain, Martin E. Rottenberg, Zahra Hasan

Department of Pathology and Laboratory Medicine

Understanding key host protective mechanisms against SARS-CoV-2 infection can help improve treatment modalities for COVID-19. We used a blood transcriptome approach to study biomarkers associated with differing severity of COVID-19, comparing severe and mild Symptomatic disease with Asymptomatic COVID-19 and uninfected Controls. There was suppression of antigen presentation but upregulation of inflammatory and viral mRNA translation associated pathways in Symptomatic as compared with Asymptomatic cases. In severe COVID-19, CD177 a neutrophil marker, was upregulated while interferon stimulated genes (ISGs) were downregulated. Asymptomatic COVID-19 cases displayed upregulation of ISGs and humoral response genes with downregulation of ICAM3 and TLR8. Compared across …


Human Papillomavirus-Associated Anal Squamous Intraepithelial Lesions In Men Who Have Sex With Men And Transgender Women Living With And Without Hiv In Karachi Pakistan: Implications For Screening And Prevention, Muslima Ejaz, Muhammad Mubarak, Tazeen Saeed Ali, Sören Andersson, Anna Mia Ekström Nov 2021

Human Papillomavirus-Associated Anal Squamous Intraepithelial Lesions In Men Who Have Sex With Men And Transgender Women Living With And Without Hiv In Karachi Pakistan: Implications For Screening And Prevention, Muslima Ejaz, Muhammad Mubarak, Tazeen Saeed Ali, Sören Andersson, Anna Mia Ekström

Community Health Sciences

Background: Anal squamous intraepithelial lesions (ASIL), strongly related to human papilloma virus (HPV) infection, is more prevalent among men who have sex with men (MSM). However, no such data are available for Pakistan yet, and neither HPV vaccination nor anal-cytology screening is implemented in Pakistan. The purpose of this first ever study was to assess the prevalence of HPV-related anal cytological abnormalities among MSM and transgender women living with and without HIV infection in Pakistan.
Methods: We conducted a cross-sectional study from March 2016 to November 2017 at sexual health centers run by the Perwaaz Trust and the National AIDS …


Non-Compliance To Social Distancing During Covid-19 Pandemic: A Comparative Cross-Sectional Study Between The Developed And Developing Countries, Faiqa Binte Aamir, Syeda Maria Ahmad Zaidi, Saadia Abbas, Syed Roohan Aamir, Syed Nauman Ahmad Zaidi, Karishma Kanhya Lal, Syeda Sadia Fatima Oct 2021

Non-Compliance To Social Distancing During Covid-19 Pandemic: A Comparative Cross-Sectional Study Between The Developed And Developing Countries, Faiqa Binte Aamir, Syeda Maria Ahmad Zaidi, Saadia Abbas, Syed Roohan Aamir, Syed Nauman Ahmad Zaidi, Karishma Kanhya Lal, Syeda Sadia Fatima

Medical College Documents

Background: Despite mass vaccination campaigns, the world has seen a steady rise in the number of SARS-CoV-2 cases, with 178,765,626 cases and 3,869,994 COVID-19 related deaths by June 19th, 2021. Therefore, it is important to enforce social distancing to control its spread. With the variation observed in the severity of the pandemic in different countries, it is also imperative to study the social distancing behaviors amongst the population in developed and developing countries.
Design and Methods: In this cross-sectional study, a total of 384 participants from 14 different countries were surveyed via an online REDCap form.
Results: In …


Covid-19 Vaccination In Sindh Province, Pakistan: A Modelling Study Of Health Impact And Cost-Effectiveness, Carl A B. Pearson, Fiammetta Bozzani, Simon R. Procter, Nicholas G. Davies, Maryam Huda, Henning Tarp Jensen, Marcus Keogh-Brown, Muhammad Khalid, Sedona Sweeney, Sergio Torres-Rueda Oct 2021

Covid-19 Vaccination In Sindh Province, Pakistan: A Modelling Study Of Health Impact And Cost-Effectiveness, Carl A B. Pearson, Fiammetta Bozzani, Simon R. Procter, Nicholas G. Davies, Maryam Huda, Henning Tarp Jensen, Marcus Keogh-Brown, Muhammad Khalid, Sedona Sweeney, Sergio Torres-Rueda

Community Health Sciences

Background: Multiple Coronavirus Disease 2019 (COVID-19) vaccines appear to be safe and efficacious, but only high-income countries have the resources to procure sufficient vaccine doses for most of their eligible populations. The World Health Organization has published guidelines for vaccine prioritisation, but most vaccine impact projections have focused on high-income countries, and few incorporate economic considerations. To address this evidence gap, we projected the health and economic impact of different vaccination scenarios in Sindh Province, Pakistan (population: 48 million).
Methods and findings: We fitted a compartmental transmission model to COVID-19 cases and deaths in Sindh from 30 April to 15 …


Impact Of Pulse Oximetry On Hospital Referral Acceptance In Children Under 5 With Severe Pneumonia In Rural Pakistan (District Jamshoro): Protocol For A Cluster Randomised Trial, Fatima Mir, Apsara Ali, Suhail Chanar, Amjad Hussain, Arjumand Rizvi, Imran Ahmed, Zahid Memon, Atif Habib, Sajid Bashir Soofi, Zulfiqar Ahmed Bhutta Sep 2021

Impact Of Pulse Oximetry On Hospital Referral Acceptance In Children Under 5 With Severe Pneumonia In Rural Pakistan (District Jamshoro): Protocol For A Cluster Randomised Trial, Fatima Mir, Apsara Ali, Suhail Chanar, Amjad Hussain, Arjumand Rizvi, Imran Ahmed, Zahid Memon, Atif Habib, Sajid Bashir Soofi, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: Pneumonia is a leading cause of death among children under 5 specifically in South Asia and sub-Saharan Africa. Hypoxaemia is a life-threatening complication among children under 5 with pneumonia. Hypoxaemia increases risk of mortality by 4.3 times in children with pneumonia than those without hypoxaemia. Prevalence of hypoxaemia varies with geography, altitude and severity (9%-39% Asia, 3%-10% African countries). In this protocol paper, we describe research methods for assessing impact of Lady Health Workers (LHWs) identifying hypoxaemia in children with signs of pneumonia during household visits on acceptance of hospital referral in district Jamshoro, Sindh.
Methods and analysis: A …


Infective Endocarditis Secondary To Mycoplasma Pneumoniae, Huzaifa Dawood, Saad Nasir, Reem M. Khair, Mustafa Dawood Aug 2021

Infective Endocarditis Secondary To Mycoplasma Pneumoniae, Huzaifa Dawood, Saad Nasir, Reem M. Khair, Mustafa Dawood

Section of Internal Medicine

Mycoplasma pneumoniae (MP) is a gram-positive bacterium most commonly associated with community-acquired pneumonia in adults. It can also involve other systems of the body. Cardiovascular complications include pericarditis, myocarditis, congestive cardiac failure, and, rarely, infective endocarditis. We report a case of infective endocarditis secondary to MP infection in an adult. We treated our patient with doxycycline, which showed significant improvement.


Clinical Features And Outcomes Of Critically Ill Patients With Elizabethkingia Meningoseptica: An Emerging Pathogen, Abdullah Umair, Nosheen Nasir Jul 2021

Clinical Features And Outcomes Of Critically Ill Patients With Elizabethkingia Meningoseptica: An Emerging Pathogen, Abdullah Umair, Nosheen Nasir

Department of Medicine

Background: Elizabethkingia meningoseptica, formerly known as Chryseobacterium meningosepticum, is a non-motile, non-fastidious, catalase and oxidase-positive, aerobic, glucose-non-fermentative, Gram-negative bacillus that was first defined by Elizabeth O. King in 1959. It has emerged as an opportunistic pathogen that has infected patients in extreme age groups and immunocompromised individuals, especially in intensive care settings. There has been an increased interest in this pathogen due to its increasing occurrence around the world, ubiquitous nature, and inherent capacity for antimicrobial resistance.
Methods: We describe an observational study at a tertiary care center in Karachi, Pakistan, based on patients admitted between January 2013 and December …


Risk Of Infection And Transmission Of Sars-Cov-2 Among Children And Adolescents In Households, Communities And Educational Settings: A Systematic Review And Meta-Analysis, Omar Irfan, Jiang Li, Kun Tang, Zhicheng Wang, Zulfiqar Ahmed Bhutta Jul 2021

Risk Of Infection And Transmission Of Sars-Cov-2 Among Children And Adolescents In Households, Communities And Educational Settings: A Systematic Review And Meta-Analysis, Omar Irfan, Jiang Li, Kun Tang, Zhicheng Wang, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background: There is uncertainty with respect to SARS-CoV-2 transmission in children (0-19 years) with controversy on effectiveness of school-closures in controlling the pandemic. It is of equal importance to evaluate the risk of transmission in children who are often asymptomatic or mildly symptomatic carriers that may incidentally transmit SARS-CoV-2 in different settings. We conducted this review to assess transmission and risks for SARS-CoV-2 in children (by age-groups or grades) in community and educational-settings compared to adults.
Methods: Data for the review were retrieved from PubMed, EMBASE, Cochrane Library, WHO COVID-19 Database, China National Knowledge Infrastructure (CNKI) Database, WanFang Database, Latin …


Characteristics Of Patients Presenting With Covid-19 From Balochistan Province And Lessons Learnt, Abida Munir Badini, Aurangzeb Badini, Naeem M. Mengal, Kashmira Nanji Jul 2021

Characteristics Of Patients Presenting With Covid-19 From Balochistan Province And Lessons Learnt, Abida Munir Badini, Aurangzeb Badini, Naeem M. Mengal, Kashmira Nanji

Department of Family Medicine

Objective: With the spread of COVID-19 in Pakistan, Balochistan province with its unique problems of lowest literacy rates in the country, limited resources and a flail health care system is reporting an increasing number of cases of COVID-19. This study discusses the epidemiological and clinical characteristics of COVID-19 patients from the Balochistan province.
Study design: Situation report Place and Duration of Study: The study was conducted in Balochistan province of Pakistan. The completion date for the study was April 30, 2020.
Methodology: The data was retrieved from the daily situation report from the Health Department, Government of Balochistan. Descriptive statistics …


Comparison Of Clinical Characteristics And Outcomes Between Covid-19 Pneumonia And H1n1 Influenza, Nosheen Nasir, Iffat Khanum, Kiren Habib, Rimsha Ahmed, Mujahid Hussain, Zahra Hasan, Muhammad Irfan Jun 2021

Comparison Of Clinical Characteristics And Outcomes Between Covid-19 Pneumonia And H1n1 Influenza, Nosheen Nasir, Iffat Khanum, Kiren Habib, Rimsha Ahmed, Mujahid Hussain, Zahra Hasan, Muhammad Irfan

Department of Medicine

Introduction: The COVID-19 pandemic has been likened to the 2009 H1N1 influenza pandemic. We aim to study the similarities and differences between patients hospitalized with COVID-19 and H1N1 influenza in order to provide better care to patients, particularly during the co-circulation of Influenza A Subtype H1N1 and SARS-CoV-2.
Material and methods: A retrospective cohort study was conducted in order to compare clinical characteristics, complications, and outcomes of hospitalized patients with PCR-confirmed H1N1 influenza pneumonia and COVID-19 at a tertiary care center in Karachi, Pakistan.
Results: A total of 115 patients hospitalized with COVID-19 were compared with 55 patients with H1N1 …


Clinical Characteristics And Outcomes Of Covid-19: Experience At A Major Tertiary Care Center In Pakistan, Nosheen Nasir, Kiren Habib, Iffat Khanum, Naveera Khan, Zehra Abdul Muhammad, Syed Faisal Mahmood Apr 2021

Clinical Characteristics And Outcomes Of Covid-19: Experience At A Major Tertiary Care Center In Pakistan, Nosheen Nasir, Kiren Habib, Iffat Khanum, Naveera Khan, Zehra Abdul Muhammad, Syed Faisal Mahmood

Section of Internal Medicine

Introduction: Limited data exist on clinical characteristics and outcomes of hospitalized COVID-19 patients in low-middle income countries. We aimed to describe the clinical spectrum and outcomes of hospitalized COVID-19 patients at a tertiary-care center in Karachi, Pakistan.
Methodology: We conducted an observational study of adult COVID-19 patients hospitalized between February-June 2020. Patients with a discharge diagnosis of COVID-19 and PCR positivity were included. We created logistic regression models to understand association of clinical characteristics with illness severity and in-hospital mortality.
Results: The study population comprised 445 patients [67% males, median age 53 (IQR 40-64) years]. Majority of patients (N = …


Serial Population-Based Serosurveys For Covid-19 In Two Neighbourhoods Of Karachi, Pakistan, Muhammad Imran Nisar, Nadia Ansari, Farah Khalid, Mashal Amin, Hamna Shahbaz, Aneeta Hotwani, Najeeb Rehman, Usma Mehmood, Arjumand Rizvi, Junaid Iqbal, Ali Faisal Saleem, Fyezah Jehan Mar 2021

Serial Population-Based Serosurveys For Covid-19 In Two Neighbourhoods Of Karachi, Pakistan, Muhammad Imran Nisar, Nadia Ansari, Farah Khalid, Mashal Amin, Hamna Shahbaz, Aneeta Hotwani, Najeeb Rehman, Usma Mehmood, Arjumand Rizvi, Junaid Iqbal, Ali Faisal Saleem, Fyezah Jehan

Department of Paediatrics and Child Health

Objective: To determine population-based estimates of COVID-19 in a densely populated urban community of Karachi, Pakistan.
Methods: Three cross-sectional surveys were conducted in April, June and August in low- and high-transmission neighborhoods. Participants were randomly selected to provide blood for Elecsys® immunoassay for detection of anti-SARS-CoV-2 antibodies. Bayesian regression model was used to estimate seroprevalence after adjusting for the demographic characteristics of each district RESULTS: We enrolled 3005 participants from 623 households. In Phase 2, adjusted seroprevalence was estimated as 8.7% (95% CI 5.1-13.1) and 15.1% (95% CI 9.4 -21.7) in low and high transmission areas respectively, compared to 0.2% …


Role Of Awake Prone Positioning In Patients With Moderate-To-Severe Covid-19: An Experience From A Developing Country, Iffat Khanum, Fatima Samar, Fatimah Yousuf, Safia Awan, Adil Aziz, Kiren Habib, Nosheen Nasir, Syed Faisal Mahmood, Bushra Jamil Mar 2021

Role Of Awake Prone Positioning In Patients With Moderate-To-Severe Covid-19: An Experience From A Developing Country, Iffat Khanum, Fatima Samar, Fatimah Yousuf, Safia Awan, Adil Aziz, Kiren Habib, Nosheen Nasir, Syed Faisal Mahmood, Bushra Jamil

Department of Medicine

There is limited evidence on the efficacy of awake prone positioning (PP) in non-ventilated patients with COVID-19 who have hypoxemia. We, therefore, aim to describe our experience with the use of early proning in awake, non-intubated patients with confirmed COVID-19. In our retrospective observational study, 23 patients with confirmed positive PCR test results for Severe Acute respiratory Syndrome Coronavirus-2 (SARS-CoV-2) and hypoxemia that required oxygen therapy with or without non-invasive ventilation were treated with PP. Patients were classified into mild, moderate and severe COVID-19 disease. There were no targeted number of hours for proning per day and patients were kept …


Antimicrobial Resistance And Covid-19: Intersections And Implications, Gwenan M. Knight, Rebecca E. Glover, C Finn Mcquaid, Ioana D. Olaru, Karin Gallandat, Quentin J. Leclerc, Naomi M. Fuller, Sam J. Willcocks, Rumina Hasan, Esther Van Kleef, Clare Ir Chandler Feb 2021

Antimicrobial Resistance And Covid-19: Intersections And Implications, Gwenan M. Knight, Rebecca E. Glover, C Finn Mcquaid, Ioana D. Olaru, Karin Gallandat, Quentin J. Leclerc, Naomi M. Fuller, Sam J. Willcocks, Rumina Hasan, Esther Van Kleef, Clare Ir Chandler

Department of Pathology and Laboratory Medicine

Before the coronavirus 2019 (COVID-19) pandemic began, antimicrobial resistance (AMR) was among the top priorities for global public health. Already a complex challenge, AMR now needs to be addressed in a changing healthcare landscape. Here, we analyse how changes due to COVID-19 in terms of antimicrobial usage, infection prevention, and health systems affect the emergence, transmission, and burden of AMR. Increased hand hygiene, decreased international travel, and decreased elective hospital procedures may reduce AMR pathogen selection and spread in the short term. However, the opposite effects may be seen if antibiotics are more widely used as standard healthcare pathways break …