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  1. Article: Pneumonia classification: A limited data approach for global understanding.

    Haque, Anwar Ul / Ghani, Sayeed / Saeed, Muhammad / Schloer, Hardy

    Heliyon

    2024  Volume 10, Issue 4, Page(s) e26177

    Abstract: As the human race has advanced, so too have the ailments that afflict it. Diseases such as pneumonia, once considered to be basic flu or allergies, have evolved into more severe forms, including SARs and COVID-19, presenting significant risks to people ... ...

    Abstract As the human race has advanced, so too have the ailments that afflict it. Diseases such as pneumonia, once considered to be basic flu or allergies, have evolved into more severe forms, including SARs and COVID-19, presenting significant risks to people worldwide. In our study, we focused on categorizing pneumonia-related inflammation in chest X-rays (CXR) using a relatively small dataset. Our approach was to encompass a comprehensive view, addressing every potential area of inflammation in the CXR. We employed enhanced class activation maps (mCAM) to meet the clinical criteria for classification rationale. Our model incorporates capsule network clusters (CNsC), which aids in learning different aspects such as geometry, orientation, and position of the inflammation seen in the CXR. Our Capsule Network Clusters (CNsC) rapidly interpret various perspectives in a single CXR without needing image augmentation, a common necessity in existing detection models. This approach significantly cuts down on training and evaluation durations. We conducted thorough testing using the RSNA pneumonia dataset of CXR images, achieving accuracy and recall rates as high as 98.3% and 99.5% in our conclusive tests. Additionally, we observed encouraging outcomes when applying our trained model to standard X-ray images obtained from medical clinics.
    Language English
    Publishing date 2024-02-14
    Publishing country England
    Document type Journal Article
    ZDB-ID 2835763-2
    ISSN 2405-8440
    ISSN 2405-8440
    DOI 10.1016/j.heliyon.2024.e26177
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  2. Article ; Online: Comparison Of Two Definitions (P-Rifle And Kdigo) For Prevalence Of Acute Kidney Injury And In Hospital Mortality In A Paediatric Intensive Care Unit Of Pakistan.

    Usman, Parveen / Qaisar, Habib / Haque, Anwar Ul / Abbas, Qalab

    Journal of Ayub Medical College, Abbottabad : JAMC

    2022  Volume 34, Issue 1, Page(s) 112–117

    Abstract: Background: To compare the Paediatric RIFLE (p-RIFLE) and Kidney Disease Improving Global Outcomes (KDIGO) definitions of acute kidney injury (AKI) for frequency of (AKI) and in-hospital mortality in critically ill children.: Methods: Retrospective ... ...

    Abstract Background: To compare the Paediatric RIFLE (p-RIFLE) and Kidney Disease Improving Global Outcomes (KDIGO) definitions of acute kidney injury (AKI) for frequency of (AKI) and in-hospital mortality in critically ill children.
    Methods: Retrospective review of medical records of all patients (aged 1 month - 16 years) admitted in Paediatric Intensive Care Unit from January 2015-December 2016, with length of stay >48 hours, was done. Patients with chronic kidney disease were excluded. Receiver operating characteristic (ROC) curves were used to evaluate the performance of the p-RIFLE and KDIGO criteria to predict the AKI related mortality. Logistic regression analysis was done to determine the association of different variables with mortality in AKI patient based on p-RIFLE, KDIGO. A p-value of <0.05 was considered significant.
    Results: Out of total 823 patients admitted during the study period, 562 patients were included in the study. Median age was 2 years (Interquartile range 8 years). Acute kidney injury frequency according to p-RIFLE and KDIGO were 391 (70%), and 372 (66%) respectively. Overall, 106/823 (12.8%) children died during study period, 78 (19.9%) in AKI by p-RIFLE and 76 (20.4%) in AKI by KDIGO died. The area-under- curve for in-hospital mortality for p-RIFLE and KDIGO criteria were 0.525 (p=0.427), and 0.534 (p=0.276), respectively.
    Conclusions: P-RIFLE is more sensitive compared to KDIGO in diagnosing AKI in critically ill children; identifying a greater number of moderate staged AKI cases. Greater AKI severity is associated with higher mortality in critically ill children.
    MeSH term(s) Acute Kidney Injury/diagnosis ; Acute Kidney Injury/epidemiology ; Child ; Critical Illness ; Female ; Hospital Mortality ; Humans ; Intensive Care Units ; Intensive Care Units, Pediatric ; Male ; Pakistan/epidemiology ; Prevalence ; Retrospective Studies
    Language English
    Publishing date 2022-04-07
    Publishing country Pakistan
    Document type Journal Article
    ZDB-ID 2192473-9
    ISSN 1819-2718 ; 1025-9589
    ISSN (online) 1819-2718
    ISSN 1025-9589
    DOI 10.55519/JAMC-01-9147
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  3. Article: Gastrointestinal Complications in Critically Ill Children: Experience from A Resource-Limited Country.

    Ishaque, Sidra / Shakir, Mariam / Ladak, Asma / Haque, Anwar Ul

    Pakistan journal of medical sciences

    2021  Volume 37, Issue 3, Page(s) 657–662

    Abstract: Objectives: To determine the frequency and predictors of outcome of gastrointestinal complications (GIC) in critically ill children.: Methods: This descriptive study was prospectively conducted in The Pediatric Intensive Care Unit (PICU), The Aga ... ...

    Abstract Objectives: To determine the frequency and predictors of outcome of gastrointestinal complications (GIC) in critically ill children.
    Methods: This descriptive study was prospectively conducted in The Pediatric Intensive Care Unit (PICU), The Aga Khan University Hospital (AKUH), Karachi, from September 2015 to January 2017. After obtaining approval from the Ethical Review Committee of AKUH and informed consent from the parents, all children (aged one month to 18 years), of either gender, admitted to the Pediatric Intensive Care Unit (PICU) during the study period were included. The frequency of the defined GIC: vomiting, high gastric residue volume (GRV), diarrhea, constipation, and gastrointestinal bleed were recorded daily for the first week of the PICU stay. The data was collected by the primary investigator on a predesigned data collection form with inclusion of variables and predictors in light of existing literature and local expertise. The questionnaire was shared with the Pediatric Critical Care Medicine faculty and a consensus was sought on the elements to be incorporated.
    Results: GIC developed within the first 48 hours of admission in 78 (41%) patients. Of the patients who developed GIC, 37 (47.4%) patients developed high GRV: 31 (39.7%) patients developed constipation, 18 (23.1%) patients developed vomiting, 14 (17.9%) patients developed abdominal distension. With regards to prevalence by occurrence, 32/78 (41%) of patients presented with two GI complications, followed by 21 patients (27%) who presented with a single GIC. Only 11 patients (14%) presented with more than three complications. Median length of stay was higher in patients with GIC (8 days) than with those who did not develop GIC (4 days). The frequency of gastrointestinal complications was significantly higher in children receiving mechanical ventilation, on sedatives and relaxants and those with multiorgan dysfunction syndrome (MODS) and inotropes.
    Conclusion: GI complications are a frequent occurrence in the PICU and are associated with worse clinical outcomes. The use of sedative drugs and the presence of shock with MODS were amongst the important contributing factors.
    Language English
    Publishing date 2021-05-19
    Publishing country Pakistan
    Document type Journal Article
    ZDB-ID 2032827-8
    ISSN 1681-715X ; 1682-024X ; 1017-4699
    ISSN (online) 1681-715X
    ISSN 1682-024X ; 1017-4699
    DOI 10.12669/pjms.37.3.3493
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  4. Article ; Online: High Flow Nasal Cannula Therapy in Children with Acute Respiratory Insufficiency in the Pediatric Intensive Care Unit of a Resource-limited Country: A Preliminary Experience.

    Saeed, Bushra / Azim, Asim / Haque, Anwar Ul / Abbas, Qalab

    Journal of the College of Physicians and Surgeons--Pakistan : JCPSP

    2021  Volume 31, Issue 1, Page(s) 110–112

    Abstract: A retrospective study was performed in children (aged one month - 16 years) receiving HFNC to determine the frequency, efficacy and adverse effects of high flow nasal cannula (HFNC) therapy in the pediatric intensive care unit (PICU), from January to ... ...

    Abstract A retrospective study was performed in children (aged one month - 16 years) receiving HFNC to determine the frequency, efficacy and adverse effects of high flow nasal cannula (HFNC) therapy in the pediatric intensive care unit (PICU), from January to December 2017. Treatment failure was defined as clinical deterioration on HFNC therapy such that mechanical ventilation (MV) was required. Clinical parameters before and after HFNC were assessed using repeated measures analysis of variance. A total of 120 patients received HFNC therapy (21% of total admissions). Primary diagnosis were respiratory disease (50%), central nervous system diseases (14.2%), sepsis (10.8%), and postoperative care (10%). Mean duration of HFNC was 27.5 ±19.7 hours and mean PICU length of stay was 6 ± 6 days. Pneumothorax developed in four patients. MV was required in 28 patients, and subsequently, 15 deaths occurred in that group. HFNC is a frequently used, safe and effective therapy for children requiring respiratory support in PICU. Key Words: Respiratory insufficiency, Non-invasive ventilation, Paediatric intensive care unit.
    MeSH term(s) Cannula ; Child ; Humans ; Intensive Care Units, Pediatric ; Length of Stay ; Oxygen Inhalation Therapy ; Respiratory Insufficiency/therapy ; Retrospective Studies
    Language English
    Publishing date 2021-01-30
    Publishing country Pakistan
    Document type Journal Article
    ZDB-ID 2276646-7
    ISSN 1681-7168 ; 1022-386X
    ISSN (online) 1681-7168
    ISSN 1022-386X
    DOI 10.29271/jcpsp.2021.01.110
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  5. Article: Red blood cell transfusion in critically-ill children and its association with outcome.

    Sohail, Hafsa / Ahmed, Shah Ali / Usman, Parveen / Khalid, Farah / Haque, Anwar Ul / Abbas, Qalab

    JPMA. The Journal of the Pakistan Medical Association

    2021  Volume 71, Issue 8, Page(s) 1967–1971

    Abstract: Objective: To determine the indications and threshold of haemoglobin levels for packed red blood cell transfusion and its association with outcomes in a paediatric intensive care setting.: Methods: The retrospective study was conducted in the ... ...

    Abstract Objective: To determine the indications and threshold of haemoglobin levels for packed red blood cell transfusion and its association with outcomes in a paediatric intensive care setting.
    Methods: The retrospective study was conducted in the paediatric intensive care unit of the Aga Khan University Hospital, Karachi, and comprised medical records of all inpatients with age between 1 month and 16 years who received packed red blood cell transfusions between January and December 2017. Data was retrieved from the hospital database and was analyzed using SPSS 22.
    Results: Of the 147 subjects with a mean age of 67.89±65.8 months, 76(51.7%) were males. Mean paediatric risk of mortality score was 11.72±7.86. Major admitting diagnosis included sepsis and multiorgan dysfunction 50(34%), respiratory diseases 26(17.7%) and haematology/oncology diseases 22(15%). The indications for transfusion was low haemoglobin in 90(61.2%) patients, shock 29(19.7%) and hypoxia 28(19%). Acute transfusion reaction was observed in 1(0.7%) patient; 120(82%) required mechanical ventilation; and 94(64%) required inotropic support. Of the total, 88(59.9%) patients survived. Paediatric risk of mortality score, need for inotropic support and mechanical ventilation were associated with mortality (p<0.05).
    Conclusions: Packed red blood cell transfusion, which is frequently prescribed in intensive care settings, was not found to be associated with favourable outcome.
    MeSH term(s) Child ; Critical Illness ; Erythrocyte Transfusion ; Humans ; Infant ; Intensive Care Units, Pediatric ; Male ; Respiration, Artificial ; Retrospective Studies
    Language English
    Publishing date 2021-08-21
    Publishing country Pakistan
    Document type Journal Article
    ZDB-ID 603873-6
    ISSN 0030-9982
    ISSN 0030-9982
    DOI 10.47391/JPMA.110
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  6. Article ; Online: Efficacy and Safety of Phosphate Enema as a therapeutic agent in Hypophosphatemia in Critically Ill Children.

    Ahmed, Abdul Rahim / Ullah, Raza / Haque, Anwar Ul / Rahman, Faiza / Mirza, Sadiq / Jurair, Humaira

    Journal of the College of Physicians and Surgeons--Pakistan : JCPSP

    2021  Volume 31, Issue 3, Page(s) 356–358

    Abstract: The aim of the study was to evaluate the safety and efficacy of oral administration of phosphorous enema in hypophosphatemia (HP) in critically ill children admitted in the pediatric intensive care unit (PICU) of The Indus Hospital, Karachi, from ... ...

    Abstract The aim of the study was to evaluate the safety and efficacy of oral administration of phosphorous enema in hypophosphatemia (HP) in critically ill children admitted in the pediatric intensive care unit (PICU) of The Indus Hospital, Karachi, from September 2018 to August 2019. This was a retrospective review of 31 critically ill children with hypophosphatemia who received 1 ml/kg/day of phosphate enema through nasogastric tube or orally for phosphate replacement, with serial phosphorus level monitoring along with observation for its side effects. The results showed that the rise of serum phosphorus level was observed in all cases and 64.5% of cases achieved target phosphorus level with no adverse reactions observed. Sample size although limited, it is safe to state that oral phosphate enema is safe and effective for correction of hypophosphatemia in critically ill children. Key Words: Hypophosphatemia, Enema, Pediatric intensive care unit.
    MeSH term(s) Child ; Critical Illness ; Enema ; Humans ; Hypophosphatemia/drug therapy ; Phosphates ; Retrospective Studies
    Chemical Substances Phosphates
    Language English
    Publishing date 2021-01-05
    Publishing country Pakistan
    Document type Journal Article
    ZDB-ID 2276646-7
    ISSN 1681-7168 ; 1022-386X
    ISSN (online) 1681-7168
    ISSN 1022-386X
    DOI 10.29271/jcpsp.2021.03.356
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  7. Article ; Online: Safety and Efficacy of Aminophylline in Intrathecal Methotrexate-related Neurological Toxicity in Large Pediatric Oncology Centre.

    Razi, Wajeeha / Haque, Anwar Ul / Sadiq, Hassaan / Ullah, Raza / Jabbar, Naeem / Mirza, Sadiq

    Journal of the College of Physicians and Surgeons--Pakistan : JCPSP

    2021  Volume 31, Issue 4, Page(s) 481–484

    Abstract: Children with acute lymphoblastic leukemia, receiving intrathecal methotrexate (IT-MTX), develop acute and subacute neurological dysfunction in 3-15% of cases. Altered level of consciousness, seizure, and stroke-like manifestations are among the most ... ...

    Abstract Children with acute lymphoblastic leukemia, receiving intrathecal methotrexate (IT-MTX), develop acute and subacute neurological dysfunction in 3-15% of cases. Altered level of consciousness, seizure, and stroke-like manifestations are among the most common presentations. MRI of the brain in an early stage is consistent with white matter leukoencephalopathy. There are no specific guidelines for the treatment of such a syndrome. An elevated cerebrospinal fluid (csf) adenosine concentration causes vasodilatation in the brain and leads to cerebral ischemia, which may be reduced by aminophylline infusion. The study is a retrospective data analysis in which electronic data records of 30 patients, collected from September 2017 - August 2019. The primary objective of the study was to evaluate the safety and efficacy of aminophylline in IT-MTX induced neurotoxicity. Aminophylline infusion was used in 30 patients with IT-MTX neurotoxicity. Twenty-five patients (83.33%) showed dramatic improvement of neurologic signs and symptoms within 48 hours. Aminophylline was, hence, coined as a salvageable therapy. No noticeable side effects were observed during treatment with aminophylline infusion. Key Words: Intrathecal methotrexate, Neurotoxicity, Children, Cancer, Aminophylline.
    MeSH term(s) Aminophylline ; Child ; Humans ; Methotrexate/adverse effects ; Neurotoxicity Syndromes ; Precursor Cell Lymphoblastic Leukemia-Lymphoma/drug therapy ; Retrospective Studies
    Chemical Substances Aminophylline (27Y3KJK423) ; Methotrexate (YL5FZ2Y5U1)
    Language English
    Publishing date 2021-04-09
    Publishing country Pakistan
    Document type Journal Article
    ZDB-ID 2276646-7
    ISSN 1681-7168 ; 1022-386X
    ISSN (online) 1681-7168
    ISSN 1022-386X
    DOI 10.29271/jcpsp.2021.04.481
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  8. Article ; Online: Early postoperative arrhythmias after pediatric congenital heart disease surgery: a 5-year audit from a lower- to middle-income country.

    Ishaque, Sidra / Akhtar, Saleem / Ladak, Asma Akbar / Martins, Russell Seth / Memon, Muhammad Kamran Younis / Kazmi, Alisha Raza / Mahmood, Fatima / Haque, Anwar Ul

    Acute and critical care

    2022  Volume 37, Issue 2, Page(s) 217–223

    Abstract: Background: Arrhythmias are known complication after surgery for congenital heart disease (CHD). This study aimed to identify and discuss their immediate prevalence, diagnosis and management at a tertiary care hospital in Pakistan.: Methods: A ... ...

    Abstract Background: Arrhythmias are known complication after surgery for congenital heart disease (CHD). This study aimed to identify and discuss their immediate prevalence, diagnosis and management at a tertiary care hospital in Pakistan.
    Methods: A retrospective study was conducted at a tertiary care hospital in Pakistan between January 2014 and December 2018. All pediatric (<18 years old) patients admitted to the intensive care unit and undergoing continuous electrocardiographic monitoring after surgery for CHD were included in this study. Data pertaining to the incidence, diagnosis, and management of postoperative arrhythmias were collected.
    Results: Amongst 812 children who underwent surgery for CHD, 185 (22.8%) developed arrhythmias. Junctional ectopic tachycardia (JET) was the most common arrhythmia, observed in 120 patients (64.9%), followed by complete heart block (CHB) in 33 patients (17.8%). The highest incidence of early postoperative arrhythmia was seen in patients with atrioventricular septal defects (64.3%) and transposition of the great arteries (36.4%). Patients were managed according to the Pediatric Advanced Life Support guidelines. JET resolved successfully within 24 hours in 92% of patients, while 16 (48%) patients with CHB required a permanent pacemaker.
    Conclusions: More than one in five pediatric patients suffered from early postoperative arrhythmias in our setting. Further research exploring predictive factors and the development of better management protocols of patients with CHB are essential for reducing the morbidity and mortality associated with postoperative arrhythmia.
    Language English
    Publishing date 2022-02-03
    Publishing country Korea (South)
    Document type Journal Article
    ZDB-ID 3003021-3
    ISSN 2586-6060 ; 2586-6052
    ISSN (online) 2586-6060
    ISSN 2586-6052
    DOI 10.4266/acc.2020.00990
    Database MEDical Literature Analysis and Retrieval System OnLINE

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  9. Article ; Online: Laboratory Blood Testing In Paediatric Intensive Care Unit Of A University Hospital: Are We Doing It Appropriately?

    Sohail, Hafsa / Bibi, Shazia / Hakeem, Mahnaz / Haque, Anwar Ul / Abbas, Qalab

    Journal of Ayub Medical College, Abbottabad : JAMC

    2020  Volume 32, Issue 3, Page(s) 421–423

    Abstract: Retrospective chart review of all children (aged-one month to 16 years) admitted in our paediatric intensive care from June to November 2016 was done to determine the indication of different laboratory tests. LBT indications were defined into: diagnostic/ ...

    Abstract Retrospective chart review of all children (aged-one month to 16 years) admitted in our paediatric intensive care from June to November 2016 was done to determine the indication of different laboratory tests. LBT indications were defined into: diagnostic/case findings/screening tests to make a diagnosis; haemostatic tests (to monitor function or identify before clinical signs and symptoms) and therapeutic /monitoring tests to get the level of drug directly or getting level of marker as a guide to therapy. Laboratory tests reports which were within normal range more than once were labelled as in-appropriate tests. In total 274 patients, Haemostatic tests were performed for mean of 35.18±56.72 times (range of 0-429), monitoring for mean of 9.38±20 times (range 0-165), and therapeutic tests (3.26±11.25). Most common tests included serum Sodium levels (7.83±12.73), Serum Potassium (8.19±12.80), bicarbonate (7.75±11.9). 13.40±9.11 tests were done on first day and 13.0±8.49/day tests were performed afterwards. Cumulatively 54.31±74.21 tests were performed/ patients out of which 18.5±37.82 were inappropriate.
    MeSH term(s) Adolescent ; Blood Chemical Analysis/statistics & numerical data ; Child ; Child, Preschool ; Humans ; Infant ; Intensive Care Units, Pediatric ; Laboratories, Hospital/statistics & numerical data ; Retrospective Studies ; Unnecessary Procedures/statistics & numerical data
    Language English
    Publishing date 2020-08-23
    Publishing country Pakistan
    Document type Journal Article
    ZDB-ID 2192473-9
    ISSN 1819-2718 ; 1025-9589
    ISSN (online) 1819-2718
    ISSN 1025-9589
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  10. Article ; Online: Teaching Basic Pediatric Intensive Care Course to Pediatric Residents and Consultants.

    Jurair, Humaira / Abbas, Qalab / Haque, Anwar Ul

    Journal of the College of Physicians and Surgeons--Pakistan : JCPSP

    2017  Volume 27, Issue 10, Page(s) 669

    MeSH term(s) Adult ; Child ; Consultants ; Critical Care ; Curriculum ; Education, Medical, Graduate/methods ; Educational Measurement ; Humans ; Intensive Care Units, Pediatric ; Internship and Residency ; Pediatrics/education ; Physicians ; Teaching
    Language English
    Publishing date 2017-10-21
    Publishing country Pakistan
    Document type Journal Article
    ZDB-ID 2276646-7
    ISSN 1681-7168 ; 1022-386X
    ISSN (online) 1681-7168
    ISSN 1022-386X
    DOI 2736
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