We describe two patients with renal transplants who developed pseudotumor cerebri (PTC) in the co... more We describe two patients with renal transplants who developed pseudotumor cerebri (PTC) in the course of their follow-up. They illustrate the diagnostic challenge in such situations. Patients with renal transplants usually have many other associated conditions which may lead to headache, visual disturbances or papilledema. A high index of suspicion is necessary for prompt diagnosis and management of this rare and serious but treatable combination.
Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia
Between September 1988 and end of 1995, 170 renal transplantations were performed at the King Fah... more Between September 1988 and end of 1995, 170 renal transplantations were performed at the King Fahad National Guard Hospital, Riyadh. There were 102 cadaver donor (CAD) and 68 living related donor (LRD) transplants. All patients received triple drug immunosuppression. Patients with delayed graft function received anti-thymocyte globulin instead of cyclosporin until recovery of graft function. The 1,3 and 5 year graft survival was as follows: all transplants 83.5%, 77.6%, 74.7% respectively; LRD transplants, 89.7%, 85.2%, 80.9% respectively; CAD transplants, 81.0%, 72.5%, 70.5% respectively. The commonest cause of graft loss was chronic rejection. The 1,3 and 5 year patient survival was as follows: all transplants, 97.0%, 94.7%, 93.5% respectively; LRD transplants, 98.5%, 97.0%, 95.5% respectively; CAD transplants, 96.0%, 93.0%, 92.0% respectively. The overall results in our center are comparable to those published from other centers in Saudi Arabia and abroad.
Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia
The charts of 175 renal transplant recipients were retrospectively reviewed. The mean duration of... more The charts of 175 renal transplant recipients were retrospectively reviewed. The mean duration of follow up since the transplantation was 4.17 +/- 1.66 years. Apart from cyclosporin induced tremor, which occurred almost in all patients, 22 patients (12.5%) had neurological disorders during their follow up (mean annual incidence of 3%). Eight patients had epileptic seizures, seven had strokes, four had neurological infections, two developed a pseudotumor cerebri syndrome, two neuropathies, one myopathy and one conus medullaris infarction. This study demonstrates that neurological disorders are not uncommon in renal transplant recipients and that their mechanisms are variable and may be related to the underlying diseases such as hypertension and diabetes; to the operation itself; to the side effects of immunosuppression agents or rarely, they can accompany graft rejection.
... safety. KH Mujtaba Quadri Sameer Omar Huraib Riyadh, Saudi Arabia References 1. Jarvis WR, Ed... more ... safety. KH Mujtaba Quadri Sameer Omar Huraib Riyadh, Saudi Arabia References 1. Jarvis WR, Edwards JR, Culver DH et al: Nosocomial infection rates in adult and paediatric Intensive Care Units in the United States. Am ...
To demonstrate that evidence-based medicine (EBM) training can be imparted in developing countrie... more To demonstrate that evidence-based medicine (EBM) training can be imparted in developing countries using minimal resources. Development of a minimal cost workshop with validation of gain in EBM skills using the Berlin questionnaire. Teaching hospital in Pakistan. Multidisciplinary faculty from The Shifa College of Medicine and Nursing, Pakistan. A 14-hour locally-tailored McMaster-style workshop, using a problem-based, learner-focused small group format, with pre- and post-workshop evaluation of EBM skills. Analysis of the pre- and post-Berlin questionnaires of the participants revealed that the pre-workshop Berlin questionnaire score for the group was 4.7+/-2.3, with a post-workshop Berlin score of 7.6+/-1.0 (p<0.001). EBM workshops can be locally-tailored in developing countries, where access to such workshops is generally not available. Workshops can serve to promote EBM skills in faculty, who can then help to disseminate and model concepts. The process increases awareness and...
Pharmacists possess pivotal competencies and expertise in developing clinical pathways (CPs). We ... more Pharmacists possess pivotal competencies and expertise in developing clinical pathways (CPs). We present a tertiary care facility experience of pharmacists vis-a-vis interprofessional collaboration for designing and implementing CPs. We participated in the development of CPs as leading members of a collaborative team of healthcare professionals. We reviewed literature, aligning it with hospital formulary and institutional standards, and participated in weekly team meetings for six months. Several tools and services were adapted to guide prescribing and standardization of care through time-bound order sets. Fifteen CPs leading to admissions in medical wards were developed and integrated into Computerized Prescriber Order Entry (CPOE) sets. Tools and services included (1) reporting of creatinine clearance to guide optimum dosing; (2) advisory flags for dosing and infusion rates; (3) piloting of medication reconciliation and counseling services before discharge were initiated; (4) Arab...
Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia
Clinical pathways have shown conflicting evidence in improvement of several patient-centered outc... more Clinical pathways have shown conflicting evidence in improvement of several patient-centered outcomes across different clinical settings. However, the effectiveness of clinical pathway in management of acute kidney injury (AKI) has not been reported. Therefore, we aimed to assess the length of hospital stay (LOS) and patient-centered outcomes in community acquired AKI and compared pathway care (PC) versus usual care (UC). The CHAMP-Path AKI Trial is a pragmatic, parallel, single-blind randomized controlled trial. Physicians were randomized to provide either UC or PC. Patients were randomized through a computer-generated sequence. Allocation was concealed. Patients presenting to the emergency department with AKI and hemodynamic stability, who were over 14 years with a serum creatinine greater than 1.5 times the baseline were eligible. Patients with chronic kidney disease stages 4 or 5, kidney transplantation recipients, those admitted with obstructive uropathy, suspected glomerular o...
Hepatitis C virus (HCV) infection in hemodialysis patients is well recognized, and constitutes a ... more Hepatitis C virus (HCV) infection in hemodialysis patients is well recognized, and constitutes a major problem for dialysis units worldwide. The prevalence of anti-HCV positivity among dialysis patients varies in different countries (5%-85% worldwide),1 but may exceed 95% in some ...
Journal of Ayub Medical College, Abbottabad : JAMC
The early diagnosis of Rheumatoid arthritis can improve clinical outcomes, in terms of morbidity ... more The early diagnosis of Rheumatoid arthritis can improve clinical outcomes, in terms of morbidity and mortality. This study evaluates the role of evidence informed diagnostic reasoning in the early diagnosis of Rheumatoid arthritis. A cross-sectional survey was conducted on 200 respondents inclusive of doctors and medical students, at Shifa college of Medicine, Islamabad from April to December 2010. A questionnaire with three common clinical scenarios of low, intermediate and high pre-test probability for rheumatoid arthritis (RA) was provided to the respondents. The differences between the reference and respondents' estimates of pre and post-test probability were used to assess the respondents' clinical diagnostic reasoning process, as a tool to diagnose RA early. Respondents were also enquired about the cost effectiveness or potential harms of Rheumatoid factor (RF). Consecutive sampling technique was used and the data was analysed using SPSS-15. In all scenarios, the pre-t...
JPMA. The Journal of the Pakistan Medical Association, 2012
To determine the perceptions of the medical community about urine culture in diagnosing urinary t... more To determine the perceptions of the medical community about urine culture in diagnosing urinary tract infections. The cross-sectional survey based of consecutive sampling was conducted at Shifa International Hospital, Islamabad, on 200 doctors, including medical students of the Shifa College of Medicine, from April to October 2010. A questionnaire with three common clinical scenarios of low, intermediate and high pre-test probability for urinary tract infection was used to assess the behaviour of the respondents to make a decision for urine culture test. The differences between the reference estimates and the respondents' estimates of pre- and post-test probability were assessed. The association of estimated probabilities with the number of tests ordered was also evaluated. The respondents were also asked about the cost effectiveness and safety of urine culture and sensitivity. Data was analysed using SPSS version 15. In low pre-test probability settings, the disease probability...
Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia
Iron Supplementation is crucial in raising hematocrit as well as dosage saving for recombinant hu... more Iron Supplementation is crucial in raising hematocrit as well as dosage saving for recombinant human erythropoietin therapy (rHuEPO) in maintenance hemodialysis patients. Intravenous iron has proved to be both safe and efficacious in this patient's population. However, the exact iron requirement has not been worked our. In this study we found that 1000 mg of element iron (given as iron saccharate) per moth was effective in maintaining hematocrit and hemoglobin at 33% and 110 gm/L respectively, and reducing the erythropoietin (EPO) dosage by about 20% in maintenance hemodialysis patients who were iron-replete. The serum ferritin increased from 219+/-144 to 320+/-234 microg/L (P< 0.05). There were no major side effects and patients tolerated the monthly iron therapy well. Our study suggests that intravenous iron saccharate (100 mg/month) is effective and safe in patients on maintenance hemodialysis receiving RHUEPO.
JPMA. The Journal of the Pakistan Medical Association, 2007
To observe the advantages of implementing learner - centered evidence based format morning report... more To observe the advantages of implementing learner - centered evidence based format morning report at King Abdulaziz National Guard Hospital, Alhasa, Saudi Arabia. We modified conventional morning report by changing to a semicircular seating pattern to promote small group interactive discussions during case presentations. A facilitator was appointed to guide the sessions and asking problem based questions emanating from patient centered discussions. The question was formulated based on Evidence based medicine principles on a modified educational prescription and assigned to a volunteer to be answered in subsequent morning report sessions. Volunteers were asked to mention the search strategy, results and the evaluation of the process. The perceptions of the participants regarding the new format were assessed by a 17-statement questionnaire rated on Likert scale. A total of 46 different types of questions were asked during the initial 3-month period. All of them were answered. Particip...
JPMA. The Journal of the Pakistan Medical Association, 2007
Evidence-based Medicine (EBM) is the process of systematically reviewing, appraising and using cl... more Evidence-based Medicine (EBM) is the process of systematically reviewing, appraising and using clinical research findings to aid the delivery of optimal clinical care to patients. EBM has become popular due to: the need for valid information about diagnosis, prognosis, therapy and prevention during patient care; traditional sources such as textbooks and expert opinion being frequently out-of-date; and knowledge of current best evidence declining with time from graduation from medical college. EBM has become feasible for practicing clinicians due to: new strategies for appraising studies; availability of systematic reviews (summaries) of current best evidence; and information technology (computers with Internet access). In a resource-limited country such as Pakistan, an evidence-based approach can be cost-effective by reducing clinical practices that have no proven benefit. Commonly perceived obstacles to EBM include limited access to computers, the Internet and online resources. Rel...
We describe two patients with renal transplants who developed pseudotumor cerebri (PTC) in the co... more We describe two patients with renal transplants who developed pseudotumor cerebri (PTC) in the course of their follow-up. They illustrate the diagnostic challenge in such situations. Patients with renal transplants usually have many other associated conditions which may lead to headache, visual disturbances or papilledema. A high index of suspicion is necessary for prompt diagnosis and management of this rare and serious but treatable combination.
Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia
Between September 1988 and end of 1995, 170 renal transplantations were performed at the King Fah... more Between September 1988 and end of 1995, 170 renal transplantations were performed at the King Fahad National Guard Hospital, Riyadh. There were 102 cadaver donor (CAD) and 68 living related donor (LRD) transplants. All patients received triple drug immunosuppression. Patients with delayed graft function received anti-thymocyte globulin instead of cyclosporin until recovery of graft function. The 1,3 and 5 year graft survival was as follows: all transplants 83.5%, 77.6%, 74.7% respectively; LRD transplants, 89.7%, 85.2%, 80.9% respectively; CAD transplants, 81.0%, 72.5%, 70.5% respectively. The commonest cause of graft loss was chronic rejection. The 1,3 and 5 year patient survival was as follows: all transplants, 97.0%, 94.7%, 93.5% respectively; LRD transplants, 98.5%, 97.0%, 95.5% respectively; CAD transplants, 96.0%, 93.0%, 92.0% respectively. The overall results in our center are comparable to those published from other centers in Saudi Arabia and abroad.
Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia
The charts of 175 renal transplant recipients were retrospectively reviewed. The mean duration of... more The charts of 175 renal transplant recipients were retrospectively reviewed. The mean duration of follow up since the transplantation was 4.17 +/- 1.66 years. Apart from cyclosporin induced tremor, which occurred almost in all patients, 22 patients (12.5%) had neurological disorders during their follow up (mean annual incidence of 3%). Eight patients had epileptic seizures, seven had strokes, four had neurological infections, two developed a pseudotumor cerebri syndrome, two neuropathies, one myopathy and one conus medullaris infarction. This study demonstrates that neurological disorders are not uncommon in renal transplant recipients and that their mechanisms are variable and may be related to the underlying diseases such as hypertension and diabetes; to the operation itself; to the side effects of immunosuppression agents or rarely, they can accompany graft rejection.
... safety. KH Mujtaba Quadri Sameer Omar Huraib Riyadh, Saudi Arabia References 1. Jarvis WR, Ed... more ... safety. KH Mujtaba Quadri Sameer Omar Huraib Riyadh, Saudi Arabia References 1. Jarvis WR, Edwards JR, Culver DH et al: Nosocomial infection rates in adult and paediatric Intensive Care Units in the United States. Am ...
To demonstrate that evidence-based medicine (EBM) training can be imparted in developing countrie... more To demonstrate that evidence-based medicine (EBM) training can be imparted in developing countries using minimal resources. Development of a minimal cost workshop with validation of gain in EBM skills using the Berlin questionnaire. Teaching hospital in Pakistan. Multidisciplinary faculty from The Shifa College of Medicine and Nursing, Pakistan. A 14-hour locally-tailored McMaster-style workshop, using a problem-based, learner-focused small group format, with pre- and post-workshop evaluation of EBM skills. Analysis of the pre- and post-Berlin questionnaires of the participants revealed that the pre-workshop Berlin questionnaire score for the group was 4.7+/-2.3, with a post-workshop Berlin score of 7.6+/-1.0 (p<0.001). EBM workshops can be locally-tailored in developing countries, where access to such workshops is generally not available. Workshops can serve to promote EBM skills in faculty, who can then help to disseminate and model concepts. The process increases awareness and...
Pharmacists possess pivotal competencies and expertise in developing clinical pathways (CPs). We ... more Pharmacists possess pivotal competencies and expertise in developing clinical pathways (CPs). We present a tertiary care facility experience of pharmacists vis-a-vis interprofessional collaboration for designing and implementing CPs. We participated in the development of CPs as leading members of a collaborative team of healthcare professionals. We reviewed literature, aligning it with hospital formulary and institutional standards, and participated in weekly team meetings for six months. Several tools and services were adapted to guide prescribing and standardization of care through time-bound order sets. Fifteen CPs leading to admissions in medical wards were developed and integrated into Computerized Prescriber Order Entry (CPOE) sets. Tools and services included (1) reporting of creatinine clearance to guide optimum dosing; (2) advisory flags for dosing and infusion rates; (3) piloting of medication reconciliation and counseling services before discharge were initiated; (4) Arab...
Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia
Clinical pathways have shown conflicting evidence in improvement of several patient-centered outc... more Clinical pathways have shown conflicting evidence in improvement of several patient-centered outcomes across different clinical settings. However, the effectiveness of clinical pathway in management of acute kidney injury (AKI) has not been reported. Therefore, we aimed to assess the length of hospital stay (LOS) and patient-centered outcomes in community acquired AKI and compared pathway care (PC) versus usual care (UC). The CHAMP-Path AKI Trial is a pragmatic, parallel, single-blind randomized controlled trial. Physicians were randomized to provide either UC or PC. Patients were randomized through a computer-generated sequence. Allocation was concealed. Patients presenting to the emergency department with AKI and hemodynamic stability, who were over 14 years with a serum creatinine greater than 1.5 times the baseline were eligible. Patients with chronic kidney disease stages 4 or 5, kidney transplantation recipients, those admitted with obstructive uropathy, suspected glomerular o...
Hepatitis C virus (HCV) infection in hemodialysis patients is well recognized, and constitutes a ... more Hepatitis C virus (HCV) infection in hemodialysis patients is well recognized, and constitutes a major problem for dialysis units worldwide. The prevalence of anti-HCV positivity among dialysis patients varies in different countries (5%-85% worldwide),1 but may exceed 95% in some ...
Journal of Ayub Medical College, Abbottabad : JAMC
The early diagnosis of Rheumatoid arthritis can improve clinical outcomes, in terms of morbidity ... more The early diagnosis of Rheumatoid arthritis can improve clinical outcomes, in terms of morbidity and mortality. This study evaluates the role of evidence informed diagnostic reasoning in the early diagnosis of Rheumatoid arthritis. A cross-sectional survey was conducted on 200 respondents inclusive of doctors and medical students, at Shifa college of Medicine, Islamabad from April to December 2010. A questionnaire with three common clinical scenarios of low, intermediate and high pre-test probability for rheumatoid arthritis (RA) was provided to the respondents. The differences between the reference and respondents' estimates of pre and post-test probability were used to assess the respondents' clinical diagnostic reasoning process, as a tool to diagnose RA early. Respondents were also enquired about the cost effectiveness or potential harms of Rheumatoid factor (RF). Consecutive sampling technique was used and the data was analysed using SPSS-15. In all scenarios, the pre-t...
JPMA. The Journal of the Pakistan Medical Association, 2012
To determine the perceptions of the medical community about urine culture in diagnosing urinary t... more To determine the perceptions of the medical community about urine culture in diagnosing urinary tract infections. The cross-sectional survey based of consecutive sampling was conducted at Shifa International Hospital, Islamabad, on 200 doctors, including medical students of the Shifa College of Medicine, from April to October 2010. A questionnaire with three common clinical scenarios of low, intermediate and high pre-test probability for urinary tract infection was used to assess the behaviour of the respondents to make a decision for urine culture test. The differences between the reference estimates and the respondents' estimates of pre- and post-test probability were assessed. The association of estimated probabilities with the number of tests ordered was also evaluated. The respondents were also asked about the cost effectiveness and safety of urine culture and sensitivity. Data was analysed using SPSS version 15. In low pre-test probability settings, the disease probability...
Saudi journal of kidney diseases and transplantation : an official publication of the Saudi Center for Organ Transplantation, Saudi Arabia
Iron Supplementation is crucial in raising hematocrit as well as dosage saving for recombinant hu... more Iron Supplementation is crucial in raising hematocrit as well as dosage saving for recombinant human erythropoietin therapy (rHuEPO) in maintenance hemodialysis patients. Intravenous iron has proved to be both safe and efficacious in this patient's population. However, the exact iron requirement has not been worked our. In this study we found that 1000 mg of element iron (given as iron saccharate) per moth was effective in maintaining hematocrit and hemoglobin at 33% and 110 gm/L respectively, and reducing the erythropoietin (EPO) dosage by about 20% in maintenance hemodialysis patients who were iron-replete. The serum ferritin increased from 219+/-144 to 320+/-234 microg/L (P< 0.05). There were no major side effects and patients tolerated the monthly iron therapy well. Our study suggests that intravenous iron saccharate (100 mg/month) is effective and safe in patients on maintenance hemodialysis receiving RHUEPO.
JPMA. The Journal of the Pakistan Medical Association, 2007
To observe the advantages of implementing learner - centered evidence based format morning report... more To observe the advantages of implementing learner - centered evidence based format morning report at King Abdulaziz National Guard Hospital, Alhasa, Saudi Arabia. We modified conventional morning report by changing to a semicircular seating pattern to promote small group interactive discussions during case presentations. A facilitator was appointed to guide the sessions and asking problem based questions emanating from patient centered discussions. The question was formulated based on Evidence based medicine principles on a modified educational prescription and assigned to a volunteer to be answered in subsequent morning report sessions. Volunteers were asked to mention the search strategy, results and the evaluation of the process. The perceptions of the participants regarding the new format were assessed by a 17-statement questionnaire rated on Likert scale. A total of 46 different types of questions were asked during the initial 3-month period. All of them were answered. Particip...
JPMA. The Journal of the Pakistan Medical Association, 2007
Evidence-based Medicine (EBM) is the process of systematically reviewing, appraising and using cl... more Evidence-based Medicine (EBM) is the process of systematically reviewing, appraising and using clinical research findings to aid the delivery of optimal clinical care to patients. EBM has become popular due to: the need for valid information about diagnosis, prognosis, therapy and prevention during patient care; traditional sources such as textbooks and expert opinion being frequently out-of-date; and knowledge of current best evidence declining with time from graduation from medical college. EBM has become feasible for practicing clinicians due to: new strategies for appraising studies; availability of systematic reviews (summaries) of current best evidence; and information technology (computers with Internet access). In a resource-limited country such as Pakistan, an evidence-based approach can be cost-effective by reducing clinical practices that have no proven benefit. Commonly perceived obstacles to EBM include limited access to computers, the Internet and online resources. Rel...
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