Syed Raza Shah

Bibliometric analysis of the top 50 cited respiratory articles

Background: Citation classics have been published in almost all medical fields. The main objective of this study was to provide the readers with a complete updated guide using two different citation tracking sources in assessing respiratory literature published in respiratory specific or general medical journals. Methods: Scopus Library database (www.scopus.com) was used to determine the 50 most cited articles regarding respiratory medicine using the subject category “respiratory system.” The results from the database were sorted using the option “Times cited.” Results: The top 50 articles were published during the time period 1987–2008, with most articles (n = 22) published from 1996 to 2000.The topic that had the highest number of articles (n = 15) was chronic obstructive pulmonary disorders (COPD) followed by asthma (n = 10). Conclusion: A periodic evaluation of the top cited articles can help researchers identify the quality of work in respiratory system and pinpoint subtopics which have not been given due consideration.

Acute Kidney Injury Recognition and Management: A Review of the Literature and Current Evidence.

Acute renal failure is defined as a rapid decrease in the glomerular filtration rate, occurring over a period of hours to days and by the inability of the kidney to regulate fluid and electrolyte homeostasis appropriately. AKI is a catastrophic, life-threatening event in critically ill patients. AKI can be divided into pre-renal injury, intrinsic kidney disease (including vascular insults) and obstructive uropathies. The prognosis of AKI is highly dependent on the underlying cause of the injury. Children who have AKI as a component of multisystem failure have a much higher mortality rate than children with intrinsic renal disease. Treatment of AKI is subjected to risk stratification and ongoing damage control measures, such as patients with sepsis, exposure to nephrotoxic agents, ischemia, bloody diarrhea, or volume loss, could be helped by optimizing the fluid administrations, antibiotics possessing least nephrotoxic potential, blood transfusion where hemoglobin is dangerously low, limiting the use of nephrotoxic agents including radio contrast use, while maximize the nutrition. Acute kidney injury remains a complex disorder with an apparent differentiation in pathology between septic and nonseptic forms of the disease. Although more studies are still required, progress in this area has been steady over the last decade with purposeful international collaboration.

Recovery of myofilament function through reactivation of glycogen synthase kinase 3β (GSK-3β): mechanism for cardiac resynchronization therapy

The burden of noncommunicable diseases (NCDs) is emerging as a major public health challenge for the world. NCDs are projected to account for around 75 % of global mortality by the year 2020. The most common and problematic of all noncommunicable conditions is heart disease. As such, the weight of evidence supporting the routine use of cardiac resynchronization therapy (CRT) as a fruitful treatment for patients with ventricular dyssynchrony and moderate to severe chronic systolic heart failure is now quite substantial. The recent study done by Kirk et al. adds to our understanding of the effects of CRT in treating heart failure patients. Whether the current observations and findings extend to the more common clinical situations remains to be determined.

Effects of colchicine on pericardial diseases: a review of the literature and current evidence

Colchicine, extracted from the colchicum autumnale plant, used by the ancient Greeks more than 20 centuries ago, is one of the most ancient drugs still prescribed even today. The major mechanism of action is binding to microtubules thereby interfering with mitosis and subsequent modulation of polymorphonuclear leukocyte function. Colchicine has long been of interest in the treatment of cardiovascular disease; however, its efficacy and safety profile for specific conditions have been variably established in the literature. In the subset of pericardial diseases, colchicine has been shown to be effective in recurrent pericarditis and post-pericardiotomy syndrome (PPS). The future course of treatment and management will therefore highly depend on the results of the ongoing large randomized placebo-controlled clinical trial to evaluate the efficacy and safety of colchicine for the primary prevention of several postoperative complications and in the perioperative period. Also, given the positive preliminary outcomes of colchicine usage in pericardial effusions, the future therapeutical use of colchicine looks promising. Further study is needed to clarify its role in these disease states, as well as explore other its role in other cardiovascular conditions.

Bioresorbable vascular scaffold versus metallic stent in percutaneous coronary intervention: results of the AIDA trial

ABSTRACT Drug-eluting stents have significantly improved the long-term outcomes of percutaneous coronary intervention (PCI) by decreasing the excessive growth of neointima. However, conventional stents have some limitations. PCI with a bioresorbable vascular scaffold (BVS) has emerged as an alternative since the presence of the prosthesis in the coronary artery is transient. A US Food and Drug Administration advisory panel of experts recommended approval of BVS based on the analysis of its risks and rewards in July 2016. In June 2017, the preliminary results of the Amsterdam Investigator-initiateD Absorb Strategy All-comers (AIDA) trial were released. This randomized controlled trial compared an everolimus-eluting BVS with an everolimus-eluting metallic stent in the context of routine clinical practice. The preliminary results revealed no significant difference in target-vessel failure when BVS was compared with metallic stenting. However, during the 2 years of follow-up, BVS was associated with a higher rate of device thrombosis. This is seen as an important development in the trial. There are some concerns regarding stent thrombosis and the restoration of real vessel functionality in the long term. For these reasons, for now, metallic stents remain the treatment of choice for PCI.

End Stage Renal Disease: Seroprevalence of Hepatitises B and C along with Associated Aetiology and Risk Factors in Children

Background. End Stage Renal Disease (ESRD) normally requires dialysis or transplantation for survival. Since ESRD patients are on long term dialysis, infections such as Hepatitis B (HBV) and Hepatitis C (HCV) are commonly reported. Methods. This was a retrospective study carried out at a government hospital during a 12-month period from January 2013 to December 2013. The data was collected using a predesigned pro forma to note the etiology, gender, age, and HBsAg and anti-HCV test result of each patient. Results. 444 children suffering from ESRD were included in our analysis. The mean age of sample was 12.7 ± 4.1 years. Sixty percent (n = 262) of the children were boys. The most common etiology of ESRD was kidney stones (n = 44, 29.3%). HBV was positive in 11 children (2.5%) while HCV was positive in 13 (2.9%). Conclusion. This study asserts the need for carrying out further work to confirm these findings and expand our recommendations. It is imperative to reliably determine the burden of HBV and HCV disease and to determine the aetiology of their spread especially in children with ESRD.

Use of Cyclosporine Therapy in Steroid Resistant Nephrotic Syndrome (SRNS): A Review

A chronic, progressive disorder Steroid Resistant Nephrotic Syndrome (SRNS) accounts for 10-20% of all children with Nephrotic Syndrome. It is a heterogeneous disorder comprised of persistent edema, proteinuria, hypoalbuminemia and hyperlipidemia. Treatment for steroid-resistant nephrotic syndrome (SRNS) is challenging and children who suffer from SRNS require aggressive treatment to achieve remission. Calcineurin inhibitors have been used more in an empirical manner than on the basis of clear rationale. It was in 1984 when cyclosporine was first considered for the treatment of steroid resistant nephrotic syndrome. Cyclosporin is a calcineurin inhibitor that suppresses immune response by downregulating the transcription of various cytokine genes. Till now many studies have been conducted to determine dosages, duration of therapy, side effects and advantages of cyclosporine. Treatment of SRNS remains a difficult challenge in pediatric nephrology. Treatment should be individualized according to the underlying histopathology, and clinical and environmental conditions of the children. There is an urgent need to distinguish as soon as possible those patients who may benefit from prolonged immunosuppressive treatment from those who will not benefit from such treatment and who will just suffer from its major side effects. The emerging evidence that the majority of genetic forms of SRNS should receive symptomatic treatment only, should also be clinically tested and studies baring its significance should be evaluated in the future.

Transforming patient care by introducing an electronic medical records initiative in a developing country

The incorporation of an electronic medical record into patient care is a priority in developed countries, but faces significant obstacles for adoption in developing countries. The goal of our study was to define and assess the efficiency of a personalized intervention on village physicians’ use of electronic medical records in rural community health services of underprivileged areas. Six towns were selected with two bordering local health stations from each town. One was randomly given to the intervention group and the other to the control group. A structured on-site intervention was provided to village physicians in the intervention group, for 7 months. The results showed that in the intervention group, the percentage of households with complete records increased. The percentage of clinic medical records and complete child vaccination in the intervention group also increased from 2 to 14 percent (p = <0.05) and from 10 to 23 percent (p = 0.05), respectively. Our investigation demonstrated that on-site education, supervision, and technical support directly correlate with improved use of electronic medical record. Our results report the challenges in implementing such a system and the steps being taken to enhance likelihood of sustainability.

Social support in the developing world, a useful treatment for burn patients

A review of all children (0–18 years) admitted under the care of the senior author to the Yorkshire Regional Paediatric burn unit with a scald was performed. Data was collected prospectively over a 12-month period and all children treated as per the algorithm. Children referred to the burns unit were assessed by the senior author within 24 h of admission, the burn wound cleaned and an Urgotul SSD dressing applied. 24–48 h after scald, all wounds >5% total body surface area (TBSA) based on consultant clinical assessment are taken to the operating room for one of three procedures according to depth: (1) superficial dermal wounds – dermabrasion and Biobrane dressing; (2) mid-dermal wounds – dermabrasion, application of ReCell and Biobrane dressing; (3) full-thickness wounds – dermabrasion and early application of STSG. Burns with varying depths are treated with a combination of techniques. Patients are excluded from the algorithm if the child is considered ‘high risk’ for anaesthesia or if the parents decline early surgical intervention. 40 patients have been suitable for early surgical management. Patients varied in age from 9 months to 15 years (mean age of 2 years) and 60% were boys. Mean hospital stay was 4.5 days. 20 patients had Biobrane, 13 had ReCell/Biobrane and 7 patients had early STSG. Six Biobrane patients and 5 ReCell/Biobrane patients underwent further STSG. Two of the early STSG group underwent further STSG. Independent scar assessments were rated as good to excellent in the Biobrane and ReCell/Biobrane groups and good in the STSG group. Patients managed by our treatment algorithm have benefitted from early access to specialist services and the provision of first aid and antimicrobial dressings. Debridement of the burn wound in the operating room allows the burn team to assess the wound easily and commence a definitive surgical treatment depending on the depth of the injury. Since commencing the algorithm there has been a reduction in the total number of skin grafts required, with the majority of the mid and deep dermal wounds successfully treated with a single ReCell/Biobrane procedure. Other findings have included faster wound healing, reduced donor site morbidity (for ReCell patients compared to conventional STSG) and better functional and aesthetic scar outcomes. Analgesic and dressing costs have reduced, saving 29% compared to conventional delayed surgery for non-healing wounds. We believe early treatment of all patients in the operating room following scald injury allows wounds to be ‘rescued’ from progression. Further expansion of this series and comparative studies are necessary to further the evidence base and improve this novel protocol. More often than not, dermal preserving surgery with dermabrasion, ReCell and biological dressings for mid to deep dermal wounds can be the definitive method for closure, and early wound healing equates to better scar outcomes and reduced overall costs.

Topical vasodilator response in skeletonized internal mammary artery: Is there really a difference?

Aim of the Study: Coronary artery bypass graft surgery is the gold standard for the treatment of multivessel and left main coronary artery disease. However, there is considerable debate that whether left internal mammary artery (IMA) should be taken as pedicled or skeletonized. This study was conducted to assess the difference in blood flow after the application of topical vasodilator in skeletonized and pedicled IMA. Materials and Methods: In this study, each patient underwent either skeletonized (n = 25) or pedicled IMA harvesting (n = 25). The type of graft on each individual patient was decided randomly. Intraoperative variables such as conduit length and blood flow were measured by the surgeon himself. The length of the grafted IMA was carefully determined in vivo, with the proximal and distal ends attached, from the first rib to IMA divergence. The IMA flow was measured on two separate occasions, before and after application of topical vasodilator. Known cases of subclavian artery stenosis and previous sternal radiation were excluded from the study. Results: The blood flow before the application of topical vasodilator was similar in both the groups (P = 0.227). However, the flow was significantly less in pedicled than skeletonized IMA after application of vasodilator (P < 0.0001). Similarly, the length of skeletonized graft was significantly higher than the length of pedicled graft (P < 0.0001). Conclusion: Our study signifies that skeletonization of IMA results in increased graft length and blood flow after the application of topical vasodilator. However, we recommend that long-term clinical trials should be conducted to fully determine long-term patency rates of skeletonized IMA.