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Arteriovenous malformations in the ileum are a rare cause of gastrointestinal bleeding in young adults with few reported cases and pose difficulty in diagnosing. They usually present with chronic gastrointestinal bleed. A 30-year-old... more
Arteriovenous malformations in the ileum are a rare cause of gastrointestinal bleeding in young adults with few reported cases and pose difficulty in diagnosing. They usually present with chronic gastrointestinal bleed. A 30-year-old woman presented with an acute episode of hematochezia with a history of intermittent melena for 1.5 years. Complete blood count revealed a low hemoglobin level of 3.5g/dl and hypochromic microcytic anemia. Oesophago-gastro-duodenoscopy was normal; however, a colonoscopy revealed the terminal ileum and colon filled with blood. Computed tomography-Angiogram showed local intraluminal contrast extravasation in the ileum. Explorative laparotomy and on-table enteroscopy were performed identifying a small elevated, pigmented, and eroded mucosa (5 to 6 mm) in proximal ileum; resection and primary anastomosis were performed. The patient was followed after surgical resection and her symptoms improved dramatically with no additional episodes of melena and with the...
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Research Interests: Surgery, Medicine, Complication, Etiology, Typhoid Fever, and 3 morePerforation, Peritonitis, and Ileus
Introduction: Omega-3 fatty acids have for long been shown to reduce the incidence of cardiovascular (CV) diseases. Omega-3 fatty acids mainly exist in the form of eicosapentaenoic acid (EPA) and docosahexaenoic acid in fish oils. Cod... more
Introduction: Omega-3 fatty acids have for long been shown to reduce the incidence of cardiovascular (CV) diseases. Omega-3 fatty acids mainly exist in the form of eicosapentaenoic acid (EPA) and docosahexaenoic acid in fish oils. Cod liver oil is found to have a high concentration of these omega-3 fatty acids. This study aims to explore the benefits of using cod liver oil in reducing the incidence of myocardial infarction (MI) among at-risk patients. Method: This open-label placebo-controlled two-arm interventional study was conducted in the internal medicine and cardiology unit of tertiary care hospital between January 2018 to January 2021. During this period, 870 patients at risk of CV events were enrolled in the study after obtaining informed consent. The study group received 415 mg cod liver oil daily, in addition to their current treatment, in a bottle without label and the control group received no additional treatment to their standard treatment. Patients were followed up fo...
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Introduction There are few cardiovascular risk factors that are unique to females, such as after menopause, lipid profiles change unfavorably. Another risk factor that might be associated with an increased risk of cardiovascular diseases... more
Introduction There are few cardiovascular risk factors that are unique to females, such as after menopause, lipid profiles change unfavorably. Another risk factor that might be associated with an increased risk of cardiovascular diseases in women is the incidence of miscarriages and abortions. In this study, we will determine the association between the previous history of pregnancy loss and myocardial infarction (MI). Methods This case-control study was conducted from December 2019 to January 2021. We enrolled 600 female patients with a confirmed diagnosis of MI from the outpatient department (OPD) of the cardiology and internal medicine unit of a tertiary care hospital in Pakistan. Another 600 female participants without the diagnosis of MI were enrolled from the OPD as the control group. Participants were asked about the history of pregnancy, including the number of miscarriages, abortions, and stillbirths. Results Participants with myocardial infarction had experienced greater t...
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Introduction The association between continuous use of nonsteroidal anti-inflammatory drugs (NSAIDs) and hyperkalemia is not consistent in the literature and creates grounds for further large-scale trials, particularly in patients with a... more
Introduction The association between continuous use of nonsteroidal anti-inflammatory drugs (NSAIDs) and hyperkalemia is not consistent in the literature and creates grounds for further large-scale trials, particularly in patients with a chronic disease that affects renal function, such as diabetes mellitus (DM). In this study, we will compare mean serum potassium level and the prevalence of hyperkalemia in diabetic and non-diabetic patients based on their use of NSAIDs. Methods This case-control study was conducted in the internal medicine unit of a tertiary care hospital from May 2019 to December 2020. After taking informed consent, 700 patients with a confirmed diagnosis of type 2 DM, of either gender, were enrolled in the study via consecutive convenient non-probability technique. Another set of 700 participants from the public were enrolled as the reference or control group. Continuous NSAID use was defined as NSAID used for a minimum of 20 days in the last 30 days. Blood was d...
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Research Interests: Medicine, Urine, Hyperuricemia, Berberine, Uric Acid, and 4 moreUrinary System, Gout, Allopurinol, and Creatinine
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Highlights • Vitamin D deficiency can not only affect bones but have association with cardiovascular effects.• The likelihood of unfavorable cardiovascular outcomes, especially major adverse cardiovascular event (MACE), new MI, and... more
Highlights • Vitamin D deficiency can not only affect bones but have association with cardiovascular effects.• The likelihood of unfavorable cardiovascular outcomes, especially major adverse cardiovascular event (MACE), new MI, and all-cause mortality among deficient vitamin D patient is poorly understood.• This is a first and most comprehensive meta-analysis with the largest sample size thus far comparing vitamin D levels in terms of cardiovascular outcomes.• High risk patients need to monitor vitamins level and implement vitamins supplementation to avoid adverse outcomes especially elder females.
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Introduction: COVID-19 vaccines became available after being carefully monitored in clinical trials with safety and efficacy on the human body. However, a few recipients developed unusual side effects, including cerebral venous sinus... more
Introduction: COVID-19 vaccines became available after being carefully monitored in clinical trials with safety and efficacy on the human body. However, a few recipients developed unusual side effects, including cerebral venous sinus thrombosis (CVST). We aim to systematically review the baseline features, clinical characteristics, treatment, and outcomes in patients developing CVST post-COVID-19 vaccination. Methods: This study was conducted according to the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) 2020 guideline. Investigators independently searched PubMed, Embase, and Google Scholar for English language articles published from inception up until September 10, 2021, reporting the incidence of CVST post-COVID-19 vaccines. We analyzed CVST patients’ baseline data, type of vaccines, clinical findings, treatment, and outcomes. Our systematic review process yielded patient-level data. Result: The final analysis included 25 studies that identified 80 pa...
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Isolated hemimegalencephaly (HME) is a rare congenital malformation of brain development, remarkable for its extreme asymmetry, and is characterized by the overgrowth of part or whole hemisphere. The enlarged hemisphere is manifested by... more
Isolated hemimegalencephaly (HME) is a rare congenital malformation of brain development, remarkable for its extreme asymmetry, and is characterized by the overgrowth of part or whole hemisphere. The enlarged hemisphere is manifested by hamartomatous characteristics with a dysplastic cell array of atypical morphology. Traditionally the genetic theories regarding the pathogenesis of HME are considered due to disturbance in cell signaling during neuroblast migration, cell differentiation, and proliferation, pattering, and symmetry. HME can present as isolated or associated with several neurocutaneous syndromes. The clinical picture varies depending on the severity of the malformation; however, HME patients typically exhibit refractory epilepsy, macrocephaly, colpocephaly, global developmental delay, intellectual disability, hemibody hypertrophy, and hemiparesis. Early diagnosis is crucial because despite neuroimaging and pathologic evidence, hemimegalencephaly sometimes still is unrec...
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Background: COVID-19 was initially considered to be a respiratory illness, but current findings suggest that SARS-CoV-2 is increasingly expressed in cardiac myocytes as well. COVID-19 may lead to cardiovascular injuries, resulting in... more
Background: COVID-19 was initially considered to be a respiratory illness, but current findings suggest that SARS-CoV-2 is increasingly expressed in cardiac myocytes as well. COVID-19 may lead to cardiovascular injuries, resulting in myocarditis, with inflammation of the heart muscle. Objective: This systematic review collates current evidence about demographics, symptomatology, diagnostic, and clinical outcomes of COVID-19 infected patients with myocarditis. Methods: In accordance with PRISMA 2020 guidelines, a systematic search was conducted using PubMed, Cochrane Central, Web of Science and Google Scholar until August, 2021. A combination of the following keywords was used: SARS-CoV-2, COVID-19, myocarditis. Cohorts and case reports that comprised of patients with confirmed myocarditis due to COVID-19 infection, aged >18 years were included. The findings were tabulated and subsequently synthesized. Results: In total, 54 case reports and 5 cohorts were identified comprising 215...
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SARS-CoV-2 causing coronavirus disease 2019 emerged in Wuhan, China in December 2019 as a cluster of atypical pneumonia and now it has been declared a pandemic by the World Health Organization and has caused the death of approximately one... more
SARS-CoV-2 causing coronavirus disease 2019 emerged in Wuhan, China in December 2019 as a cluster of atypical pneumonia and now it has been declared a pandemic by the World Health Organization and has caused the death of approximately one million people. Coagulopathy has been found in association with COVID-19 due to inflammation, endothelial damage, hypoxia, and diffuse intravascular coagulation (DIC). Here, we discussed a 60-year-diabetic, hypertensive female who was initially presented as a case COVID-19 and was later on diagnosed as pulmonary embolism secondary to COVID-19.
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Introduction: Severe manifestation of Coronavirus disease 2019 (COVID-19) appears to be linked to massive inflammatory response. Glucocorticoids may help to prevent respiratory failure and death by modulating inflammation-mediated lung... more
Introduction: Severe manifestation of Coronavirus disease 2019 (COVID-19) appears to be linked to massive inflammatory response. Glucocorticoids may help to prevent respiratory failure and death by modulating inflammation-mediated lung damage. Nonetheless, there is little conclusive evidence that it is effective in COVID-19 patients.The current study was Arch Intern Med Res 2021; 4 (4): 260-266 DOI: 10.26502/aimr.0078 Archives of Internal Medicine Research 261 proposed to see the differences in several outcomes between the severe COVID-19 patients who received usual care plus dexamethasone (the dexamethasone group), The current study was proposed to see the differences in several outcomes between the severe COVID-19 patients who received usual care plus dexamethasone (the dexamethasone group), and those who did not receive dexamethasone (the usual care group). Methods: This retrospective study was conducted at Hayatabad Medical Complex Peshawar Pakistan (Isolation units for COVID-19). Patients with severe COVID-19 admitted to hospital from March to July 2020 were included in the study. Data was collected using structured format. Mean differences were calculated using independent sample t test whereas Chi square test was used for determination of association. Results: A total of 193 patients were included in the final analysis. No significant difference in age, gender, respiratory rate, C-reactive protein, and lactate dehydrogenase between the groups was observed. Patients who received usual care plus dexamethasone were discharged earlier from hospital (8.20 ± 1.90 vs. 11.20 ± 2.40, p< 0.001), and had low percentage of mechanical ventilation (MV) requirement (15.10% vs. 28.30%, p = 0.02). Overall mortality was low in dexamethasone group, however no difference in mortality rate between both the two groups was noted (9.80% vs. 19.70%, p = 0.058). Furthermore, in comparison to the usual care group, mortality rate in patients on MV was lower in dexamethasone group (56.50% vs.23.50%, p = 0.03). Conclusion: Patient who received usual care plus dexamethasone had lower hospitalization days; proportion of patients receiving mechanical ventilation as well as days on MV was lower as compared to usual care group. Similarly, mortality in patients requiring MV was also low in dexamethasone group. Large scale experimental studies are needed to confirm these findings.
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Hemimegalencephaly is a rare congenital malformation of cortical development usually associated with developmental delay and refractory epilepsy that sooner or later require hemispherectomy.