Publications by authors named "Saad Mahmood"

8 Publications

  • Page 1 of 1

Triggering and protective factors of burnout in medical resident physicians in a lower-middle-income country: A cross-sectional study.

Ann Med Surg (Lond) 2021 Jul 12;67:102500. Epub 2021 Jun 12.

Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan.

Background: Residents and interns are prone to emotional and physical exhaustion, also known as burnout. Burnout has not been studied much in physicians working in lower-middle income countries. We conducted this study to determine the burden of burnout among internal medicine residents and to identify triggering and protective factors associated with burnout.

Materials And Methods: A cross-sectional study was conducted at two institutes in Karachi from 2018 to 2019. All residents registered in the internal medicine program for at least 6 months were invited to participate via an online survey. An abbreviated version of the Maslach Burnout scale was used to measure burnout, and protective and triggering factors were recorded according to known factors.

Results: A total of 71 out of 92 (77%) residents participated. The mean (SD) age of the participants was 28 (3.1) years, 51 (71.8%) were females and 51 (71.8%) were junior residents. A total of 33 (46.5%) residents had burnout. Burnout and emotional exhaustion were more in female residents (p < 0.05). None of the triggering factors attained statistical significance. The protective factors for burnout which showed significant association were good relationship with friends (OR 0.1-95% CI 0.0, 0.6), exercise and extra-curricular activities (OR 0.2-95% CI 0.0, 0.7), celebrating accomplishments (OR 0.2-95% CI 0.0, 0.7), having enough money (OR 0.2-95% CI 0.0, 0.4), and ability to plan for future (OR 0.1-95% CI 0.0, 0.6).

Conclusion: More than a third of medicine residents suffered from burnout. We need to focus on rejuvenating activities for medicine residents to decrease burnout among them. If not addressed adequately this may result in a compromise in the quality of care being provided to patients.
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July 2021

Association of vitamin D deficiency and disease activity in systemic lupus erythematosus patients: Two-year follow-up study.

Arch Rheumatol 2021 Mar 10;36(1):101-106. Epub 2020 Dec 10.

Medical College, Aga Khan University, Karachi, Pakistan.

Objectives: This study aims to determine the prevalence of vitamin D deficiency in Pakistani systemic lupus erythematosus (SLE) patients and the effect of vitamin D deficiency on the severity and outcomes of SLE.

Patients And Methods: This retrospective study evaluated SLE patients presenting to our hospital between January 2009 and December 2018. A total of 98 patients (13 males, 85 females; mean age 39.8±14.9 years; range, 16 to 73 years) with vitamin D levels available at the time of diagnosis were included in the study. Disease activity was measured using SLE disease activity score at the time of diagnosis and at the two-year mark.

Results: Sixty-five patients were deficient in Vitamin D and out of those 46 were severely deficient. The severe disease group had more patients with vitamin D deficiency at both visits (43/78 and 33/46) while patients in remission all had normal vitamin D (12/12 and 14/14) (p≤0.001).

Conclusion: Vitamin D deficiency is common in SLE patients and also significantly associated with increased disease activity at the time of diagnosis and at the two-year mark. We hope this study becomes a platform for the global medical community to come together and implement early screening and monitoring of vitamin D levels and to determine the optimal level of supplementation for prevention of poor outcomes in SLE.
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March 2021

Neutrophils to Lymphocyte Ratio: Earliest and Efficacious Markers of Sepsis.

Cureus 2020 Oct 8;12(10):e10851. Epub 2020 Oct 8.

Department of Nursing and Midwifery, Aga Khan University Hospital, Karachi, PAK.

Background Neutrophil to lymphocyte ratio (NLR) can be easily calculated from the white cell differential count and is considered an auspicious marker for predicting different diseases, including sepsis. In this study, we aimed to compare the efficacy of NLR as a sepsis marker by comparing it with other markers of sepsis, such as C-reactive protein (CRP), procalcitonin, and the Sequential Organ Failure Assessment (SOFA) score. Methods A cross-sectional analytical study was conducted at the Aga Khan University Hospital from July 2019 to December 2019. A total of 168 patients who were admitted to the medicine department with a diagnosis of sepsis on arrival or during the hospital stay were enrolled. The neutrophil to lymphocyte ratio was calculated to form venous samples taken on admission and compared to the level of CRP, procalcitonin, culture reports, and the SOFA score as a predictor of sepsis. Results Out of 168 patients, 55.3% were male. The median age of the participants was 68.40 (interquartile range (IQR): 19.5) years in males and 64.0 (IQR: 18.0) in females. Procalcitonin was performed in 121 (72%) and CRP performed in 61 (36.3%) patients. The NLR showed significant associations with all the tested lab parameters of sepsis, such as CRP (p = 0.02), procalcitonin (p = 0.01), and SOFA score (p = 0.01). Values when analyzed according to culture-positive showed higher values in culture-positive samples but were not statistically significant. Conclusion Neutrophil to lymphocyte ratio is a cheap and rapidly available predictor of sepsis and has shown a significant correlation with other relatively expensive and non-rapidly existing markers of inflammation and sepsis. However, large prospective studies are needed to prove its real effectiveness as a marker of sepsis and its prognosis.
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October 2020

A Fatal Case of Primary Amoebic Meningoencephalitis (PAM) Complicated with Diabetes Insipidus (DI): A Case Report and Review of the Literature.

Case Rep Infect Dis 2020 24;2020:4925819. Epub 2020 Jul 24.

Department of Medicine, Aga Khan University Hospital, Stadium Road, Karachi, Pakistan.

is a highly infective free-living amoeba usually isolated from soil and fresh water and is primarily found to infect the central nervous system (CNS) resulting in primary amoebic meningoencephalitis (PAM). PAM as a cause of meningitis is often overlooked for other, more common causes of meningitis. Despite all the advances in antimicrobial therapy and supportive care systems, the mortality rate of this rare infection remains above 95% with the bulk of the cases being found in developed countries. We are presenting a case of a 44-year-old male with fever, worsening headache, and generalized weakness. Lumbar puncture showed a raised leucocyte count of 1100/L with predominant polymorphonuclear cells, and wet mount prep for was positive further confirmed with PCR. The patient was started Intravenous (IV) and intrathecal amphotericin-B, Per Oral (PO) miltefosine, IV rifampin, IV fluconazole, and IV dexamethasone. However, the patient started producing urine at 300-500 ml/hour. The patient's sodium levels increased from 144 to 175 mmol/L in 12 hours with raised serum osmolality and decreased urine osmolality and urine sodium. The patient was started on PO desmopressin of 0.2 micrograms twice daily after which his urine output dropped to 60-80 ml/hour and sodium decreased from 175 to 162 and, later 155 mmol/L; however, the patient expired. PAM is a rare and extremely fatal illness, but with increasing incidence now being reported in developing countries as a result of better diagnostics. DI is a very rare complication reported in these patients leading to poor outcome. The complication of diabetes insipidus (DI) has not been extensively studied in patients having PAM. Only three cases have been reported with this complication. No mechanism has been mentioned in the literature behind the development of DI in these patients, and no study has mentioned laboratory details of DI as mentioned in this report.
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July 2020

Knowledge and Beliefs Regarding Thalassemia in an Urban Population.

Cureus 2019 Jul 29;11(7):e5268. Epub 2019 Jul 29.

Internal Medicine, Dow Medical College and Civil Hospital, Karachi, PAK.

Background:  Thalassemia is one of the most common genetic blood disorders in Asia. Consanguineous marriages and avoiding pre-marital and antenatal screening are common in Pakistan due to psychosocial, cultural, and religious factors. Few studies have investigated the beliefs regarding thalassemia, especially in a developing country. The aim of this study was to assess the knowledge, beliefs, and practices regarding thalassemia in an urban population.

Method:  A cross-sectional descriptive study was conducted in the urban areas of Karachi, Pakistan over a period of six months during March 2016 through August 2016. Participants selected by representative sampling were interviewed face-to-face using a pre-designed, pre-tested questionnaire. The questionnaire was divided into four parts. The first part inquired about general demographic variables, while the second part assessed knowledge of the participant regarding thalassemia. The third and fourth parts were concerning the beliefs and practices regarding thalassemia. Data were entered and analyzed using the Statistical Package for Social Sciences (SPSS) Statistics, v. 24.0 (IBM SPSS Statistics, Armonk, NY).

Results:  Only 53% (n = 720) of the respondents had heard about thalassemia. The mean knowledge score was 5.8. The total possible score ranged between 0 - 12 with the higher scores indicating better knowledge. About three-quarters (70%) of the sample did not know that an individual can be a carrier of thalassemia. Less than half (38%) of the participants viewed premarital screening for thalassemia as necessary, with only 10% agreeing that thalassemia carriers should not marry. There was no pre-marriage counseling done in 98% of the families.  Conclusion: Our study highlights the prevalence of numerous myths and a low level of knowledge regarding thalassemia in an urban population of Pakistan.
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July 2019

The usefulness of Veno-Arterial Extracorporeal Membranous Oxygenation in Patients with Cardiogenic Shock.

Open Access Maced J Med Sci 2019 Jun 15;7(11):1768-1773. Epub 2019 Jun 15.

Critical Care Department, Cairo University Hospitals, Cairo, Egypt.

Background: Venoarterial extracorporeal membranous oxygenation is a form of temporary mechanical circulatory support that gets as a salvage technique in patients with cardiogenic shock, we intended to evaluate the effect of (VA ECMO) support on hemodynamics and lactate levels in patients with cardiogenic shock.

Aim: The aim of our study is to detect the ability to introduce veno-arterial extracorporeal membranous oxygenation (VA ECMO) as a temporary extracorporeal life support system (ECLS) in our unit, demonstrate the role of ECMO in cardiogenic shock patients regarding improving hemodynamics and microcirculation, and demonstrate the complications and drawbacks in our first center experience regarding VA ECMO.

Material And Methods: This was a single-centre observational study that included 10 patients admitted with cardiogenic shock for which VA ECMO was used as mechanical circulatory support.

Results: The MAP increased after initiation of the support. It was 41.8 ± 9.3 mmHg and 59.5 ± 6.8 mmHg (P = 0.005). The use of VA ECMO support was associated with a statistically significant decrease in the base deficit (-10.6 ± 4.2 and -6.3 ± 7.4, P = 0.038). The serum lactate declined from 5.9 ± 3.5 mmoL/L to 0.6 ± 4.4 mmoL/L by the use of VA ECMO; a statistically significant change (P = 0.005).

Conclusions: We concluded that VA ECMO as mechanical support for patients with cardiogenic shock might improve mean arterial blood pressure, base deficit and lactate clearance.
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June 2019

Reduction in unavailable-for-response episodes in a private emergency medical services agency.

J Emerg Manag 2016 Jan-Feb;14(1):79-84

Assistant Dean for Faculty Development, Lake Erie College of Osteopathic Medicine, Erie, Pennsylvania.

Objective: Increased demand for emergency medical services (EMS), financial constraints, emergency department overcrowding, EMS crews kept in hospital, all result in ambulance unavailability. This study seeks to identify daily temporal patterns for unavailable-for-response episodes, impact of increasing staffing during peak periods, and evaluating the extent of reduction in unavailable-for-response episodes due to temporally precise increases in staffing during critical time periods and the resulting cost/benefit analysis.

Design: The authors evaluated all EMS responses during a 7-month time period and recorded all unavailable-for-response episodes. This identified clusters of unavailable-for-response episodes for which incremental staffing changes were implemented. Internal audit of cost/revenues was recorded.

Setting: Midsized private EMS agency in Northwest Pennsylvania.

Subjects/participants: EMS Responders/Agency calls.

Interventions: Temporally precise increases in staffing during critical time periods/unavailable-for-response episodes.

Main Outcome Measure(s): Reduction in unavailable-for-response episodes, cost effectiveness.

Results: Evaluating 23,833 EMS responses that occurred during the study period, staffing changes resulted in a 93 percent average reduction and 100 percent maximum reduction in unavailable-for-response episodes and were cost effective, based on evaluation of cost versus revenue, in this EMS agency.

Conclusions: Identification of opportunities for system staffing improvement in a midsized EMS agency demonstrated feasibility and usability of mapping temporal patterns of unavailable-for-response episodes to substantially reduce the number of unavailable-for-response episodes and was cost effective.
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July 2016

Herbal treatment for cardiovascular disease the evidence based therapy.

Pak J Pharm Sci 2010 Jan;23(1):119-24

Department of Pharmaceutics, University of Karachi, Karachi, Pakistan.

More than 2000 plants have been listed in the Traditional (Herbal/Alternative) systems of medicine and some of these are providing comprehensive relief to the people suffering from cardio-vascular diseases, specially "hyperlipidemia" and "ischemic heart disease". WHO reports indicate that around eighty percent of the global population still relies on botanical drugs and several herbal medicines have advanced to clinical use in modern times. Based on these findings, present review is written to identify the "Pharmacology and Cardio-vascular Application" of four commonly used plants in Pakistan. These include, Crataegus oxycantha, Inula racemosa, Terminalia arjuna and Commiphora mukul. The selection of the plants in the present study is primarily based on their chemistry and pharmacological properties including toxicology reported in various research articles and reviews. Some very interesting findings have been observed and thus recorded and reported in this review.
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January 2010