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Article: Clinical features, diagnosis and management of COVID-19 patients in the outdoor setting.

Jamil, Bushra

JPMA. The Journal of the Pakistan Medical Association

2020 Volume 70Suppl 3, Issue 5, Page(s) S52–S55

Abstract: In a brief span of a few months, coronavirus disease (COVID-19) pandemic has brought a major paradigm shift in operation of clinical services around the world. Infection may be mild, moderate or severe; many remain asymptomatic. High burden of non- ... ...

Abstract	In a brief span of a few months, coronavirus disease (COVID-19) pandemic has brought a major paradigm shift in operation of clinical services around the world. Infection may be mild, moderate or severe; many remain asymptomatic. High burden of non-communicable and communicable diseases theoretically puts Pakistani population at increased risk of severe COVID-19 infection. Considering the universal risk of infection, the outpatient services in Pakistan need to be redesigned. Starting with risk assessment of the facility and provision of a dedicated telephone connection, structure and workflow need to be redesigned in order to minimise risk of exposure to healthcare professionals, staff and patients. Patients with COVID-19 patients should be identified before they arrive in the facility and should be served expeditiously, in an environment which prevents cross-transmission of infection. Tele-consultation is assuming an important role. Changes which are taking place in response to Covid-19 pandemic will have far reaching effects on clinical services in Pakistan.
MeSH term(s)	Ambulatory Care/methods ; Ambulatory Care/standards ; Betacoronavirus ; COVID-19 ; Coronavirus Infections/diagnosis ; Coronavirus Infections/epidemiology ; Coronavirus Infections/prevention & control ; Coronavirus Infections/therapy ; Delivery of Health Care/methods ; Delivery of Health Care/standards ; Humans ; Pakistan ; Pandemics/prevention & control ; Pneumonia, Viral/diagnosis ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/prevention & control ; Pneumonia, Viral/therapy ; Remote Consultation ; Risk Assessment ; SARS-CoV-2
Keywords	covid19
Language	English
Publishing date	2020-06-09
Publishing country	Pakistan
Document type	Journal Article
ZDB-ID	603873-6
ISSN	0030-9982
ISSN	0030-9982
DOI	10.5455/JPMA.12
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Pakistan's HIV high-risk populations: Critical appraisal of failure to curtail spread beyond key populations.

Raza, Hussain Ahmed / Raja, Mohummad Hassan Raza / Khakwani, Muhammad Mussab / Jamil, Bushra

IJID regions

2024 Volume 11, Page(s) 100364

Abstract: Pakistan has been a hub of several HIV outbreaks over the last 2 decades, with four major outbreaks being registered since 2018. There has been a recent rise in HIV infections, especially in high-risk populations, mainly consisting of people who inject ... ...

Abstract	Pakistan has been a hub of several HIV outbreaks over the last 2 decades, with four major outbreaks being registered since 2018. There has been a recent rise in HIV infections, especially in high-risk populations, mainly consisting of people who inject drugs, men who have sex with men, prisoners, the transgender women community, and female sex workers. Consistently poor infection control practices, unregulated unsafe blood transfusion, questionable ethical practices by healthcare providers, and a general lack of awareness are the main drivers of recent HIV outbreaks, with these issues exacerbated by the presence of untrained health care providers. To stop the spread of HIV systemically and sustainably, aggressive measures need to be taken at all levels by all concerned stakeholders that not only deal with building up testing, tracing, and treatment capabilities but also address underlying grassroots problems that have largely been ignored to date.
Language	English
Publishing date	2024-04-07
Publishing country	England
Document type	Journal Article ; Review
ISSN	2772-7076
ISSN (online)	2772-7076
DOI	10.1016/j.ijregi.2024.100364
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: HIV at a crossroads in Pakistan.

Raza, Hussain A / Raja, Mohummad H R / Khakwani, Muhammad M / Jamil, Bushra

The lancet. HIV

2024 Volume 11, Issue 5, Page(s) e283

MeSH term(s)	Humans ; HIV Infections/epidemiology ; Pakistan/epidemiology ; Female ; Male
Language	English
Publishing date	2024-02-09
Publishing country	Netherlands
Document type	Journal Article ; Letter
ISSN	2352-3018
ISSN (online)	2352-3018
DOI	10.1016/S2352-3018(24)00087-0
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Article: Clinical features, diagnosis and management of COVID-19 patients in the outdoor setting

Jamil, Bushra

J Pak Med Assoc

Abstract	In a brief span of a few months, coronavirus disease (COVID-19) pandemic has brought a major paradigm shift in operation of clinical services around the world. Infection may be mild, moderate or severe; many remain asymptomatic. High burden of non-communicable and communicable diseases theoretically puts Pakistani population at increased risk of severe COVID-19 infection. Considering the universal risk of infection, the outpatient services in Pakistan need to be redesigned. Starting with risk assessment of the facility and provision of a dedicated telephone connection, structure and workflow need to be redesigned in order to minimise risk of exposure to healthcare professionals, staff and patients. Patients with COVID-19 patients should be identified before they arrive in the facility and should be served expeditiously, in an environment which prevents cross-transmission of infection. Tele-consultation is assuming an important role. Changes which are taking place in response to Covid-19 pandemic will have far reaching effects on clinical services in Pakistan.
Keywords	covid19
Publisher	WHO
Document type	Article
Note	WHO #Covidence: #592824
Database	COVID19

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Book ; Online: Clinical features, diagnosis and management of COVID-19 patients in the outdoor setting

Jamil, Bushra

Department of Medicine

2020

Abstract	In a brief span of a few months, coronavirus disease (COVID-19) pandemic has brought a major paradigm shift in operation of clinical services around the world. Infection may be mild, moderate or severe; many remain asymptomatic. High burden of non-communicable and communicable diseases theoretically puts Pakistani population at increased risk of severe COVID-19 infection. Considering the universal risk of infection, the outpatient services in Pakistan need to be redesigned. Starting with risk assessment of the facility and provision of a dedicated telephone connection, structure and workflow need to be redesigned in order to minimise risk of exposure to healthcare professionals, staff and patients. Patients with COVID-19 patients should be identified before they arrive in the facility and should be served expeditiously, in an environment which prevents cross-transmission of infection. Tele-consultation is assuming an important role. Changes which are taking place in response to Covid-19 pandemic will have far reaching effects on clinical services in Pakistan.
Keywords	Coronavirus ; Signs ; Symptoms ; Diagnosis ; Outpatient care ; Infectious Disease ; Virus Diseases ; covid19
Subject code	610
Publishing date	2020-05-01T07:00:00Z
Publisher	eCommons@AKU
Publishing country	pk
Document type	Book ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Pathways to prevention: insights on stemming HIV outbreaks in Larkana, Pakistan.

Raza, Hussain Ahmed / Raja, Mohummad Hassan Raza / Khakwani, Muhammad Mussab / Khakwani, Minahil / Jamil, Bushra

JPMA. The Journal of the Pakistan Medical Association

2024 Volume 74, Issue 3, Page(s) 544–548

Abstract: In the past two decades, Pakistan has faced multiple human immunodeficiency virus outbreaks, with Larkana appearing to be the hub of such outbreaks. While the previous Larkana outbreaks happened in high-risk populations, the alarming outbreak in 2019 ... ...

Abstract	In the past two decades, Pakistan has faced multiple human immunodeficiency virus outbreaks, with Larkana appearing to be the hub of such outbreaks. While the previous Larkana outbreaks happened in high-risk populations, the alarming outbreak in 2019 occurred in a low-risk paediatric population, raising several concerning questions. Human immunodeficiency virus infections spilling into the general population is indicative of a steady increase in the number of cases, and the failure of control strategies to stem the concentrated epidemic from evolving. Although several causative factors have been identified from previous outbreaks, the one that occurred in 2019 may have been influenced by an additional, hitherto unexplored factor; child sexual abuse. The current narrative review was planned to summarise human immunodeficiency virus risk factors and causes identified in previous Larkana epidemics, to explore potential reasons for the outbreaks in children, and to discuss possible steps needed for stemming human immunodeficiency virus outbreaks in Pakistan.
MeSH term(s)	Child ; Humans ; HIV ; Pakistan/epidemiology ; HIV Infections/epidemiology ; HIV Infections/prevention & control ; Disease Outbreaks/prevention & control ; Risk Factors
Language	English
Publishing date	2024-03-25
Publishing country	Pakistan
Document type	Review ; Journal Article
ZDB-ID	603873-6
ISSN	0030-9982
ISSN	0030-9982
DOI	10.47391/JPMA.9042
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Article ; Online: Predicting Development Of Critical Illness In Patients With Covid-19 Presenting To A Tertiary Care Hospital In A Developing Country.

Jibril, Huzefa / Arshad, Ainan / Martins, Russell Seth / Jamil, Bushra

Journal of Ayub Medical College, Abbottabad : JAMC

2022 Volume 34, Issue 2, Page(s) 256–262

Abstract: Background: With the increasing number of COVID-19 patients and limited resources available to accommodate them, there is a need for risk stratification tools to ensure better utilization of resources.: Methods: We conducted a retrospective ... ...

Abstract	Background: With the increasing number of COVID-19 patients and limited resources available to accommodate them, there is a need for risk stratification tools to ensure better utilization of resources. Methods: We conducted a retrospective observational cohort study in patients discharged from the COVID designated areas of a large tertiary care hospital in Karachi, Pakistan from the 1st of May to the 31st of July, 2020. 581 patients were included and the COVID GRAM score was calculated at the time of admission and patients developing critical disease as per COVID GRAM study criteria (need of intensive care unit admission, invasive ventilation or death) after 24 hours of admission were noted. Results: The mean age of the study population was 56.3±14.8 years. Patients that developed critical illness (as per COVID GRAM study criteria) beyond 24 hours after admission had higher COVID GRAM scores at admission versus those that did not (183.2±80.7 versus 130.3±42.6). The Area under the Receiver Operator Curve for the COVID gram score to predict critical illness in the study population was 0.802 (95% confidence interval, 0.753-0.850). On binary logistic multivariable regression analysis, the COVID GRAM and SOFA scores on admission and need of ICU admission during hospitalization were significant predictors of mortality 24 hours after admission. Conclusions: The COVID GRAM score is a useful risk assessment tool and can be used for appropriate allocation and prioritization of resources where they are most needed.
MeSH term(s)	Adult ; Aged ; COVID-19/epidemiology ; Critical Care ; Critical Illness/epidemiology ; Developing Countries ; Hospital Mortality ; Humans ; Intensive Care Units ; Middle Aged ; Retrospective Studies ; Tertiary Care Centers
Language	English
Publishing date	2022-05-01
Publishing country	Pakistan
Document type	Journal Article ; Observational Study
ZDB-ID	2192473-9
ISSN	1819-2718 ; 1025-9589
ISSN (online)	1819-2718
ISSN	1025-9589
DOI	10.55519/JAMC-02-8926
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article ; Online: Nasopharyngeal Tuberculosis.

Ahmed, Shanila / Mustahsan, Syed Muhammad / Jamil, Bushra / Ilyas, Faiza

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

2022 Volume 32, Issue 4, Page(s) S39–S40

Abstract: Tuberculosis is a well-known communicable infectious disease and can involve almost any organ of the body. Upper respiratory tract involvement is seen in only 1.9% and involvement of the nasopharynx is even rarer, accounting for only 0.1%. The occurrence ...

Abstract	Tuberculosis is a well-known communicable infectious disease and can involve almost any organ of the body. Upper respiratory tract involvement is seen in only 1.9% and involvement of the nasopharynx is even rarer, accounting for only 0.1%. The occurrence of nasopharyngeal tuberculosis (NPTB) is very rare even in endemic areas. Herein, we report two cases of NPTB in which patients had the previous history of chronic ear infection; and later were found to have NPTB. Initial symptoms of NPTB can be vague and easily be misdiagnosed. The literature is scarce on NPTB. To the best of our knowledge, no such cases have ever been reported from Pakistan. Although the incidence of NPTB is very low since we live in a country where tuberculosis incidence is really high, its possibility should be kept in mind as one of the differential diagnoses. Key Words: Nasopharyngeal, Tuberculosis, Otitis media, Fungal, Infection.
MeSH term(s)	Diagnosis, Differential ; Humans ; Nasopharynx/microbiology ; Nose ; Otitis Media/diagnosis ; Otitis Media/epidemiology ; Tuberculosis/diagnosis ; Tuberculosis/drug therapy ; Tuberculosis/epidemiology
Language	English
Publishing date	2022-05-23
Publishing country	Pakistan
Document type	Case Reports
ZDB-ID	2276646-7
ISSN	1681-7168 ; 1022-386X
ISSN (online)	1681-7168
ISSN	1022-386X
DOI	10.29271/jcpsp.2022.Supp1.S39
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Article: Association Between Raised HbA1c Levels and Hemorrhagic Transformation in Patients With Ischemic Stroke.

Afzal, Benish / Ali, Syed Ahsan / Jamil, Bushra

Cureus

2021 Volume 13, Issue 11, Page(s) e19935

Abstract: Background Glycated hemoglobin (HbA1c) is a commonly used indicator of glycemic control in diabetes mellitus. Uncontrolled diabetes can lead to cardiovascular complications. Ischemic strokes are often complicated by hemorrhagic transformation, which is ... ...

Abstract	Background Glycated hemoglobin (HbA1c) is a commonly used indicator of glycemic control in diabetes mellitus. Uncontrolled diabetes can lead to cardiovascular complications. Ischemic strokes are often complicated by hemorrhagic transformation, which is the conversion of an infarcted area into an area of hemorrhage. The purpose of this study is to determine the association of raised HbA1c levels with the occurrence of hemorrhagic transformation in ischemic stroke. Methods This is a prospective, single-center cohort study of patients admitted to the Neurology and Medicine wards between June 1 and November 30, 2019. Inclusion criteria included adult patients who were admitted with acute ischemic stroke and had been tested for HbA1c on presentation. There were 110 ischemic stroke patients enrolled in our database. An HbA1c level >53 mmol/mol was considered raised. A comparison was done between the group with raised HbA1c levels and the group with target levels of HbA1c for the occurrence of hemorrhagic transformation. Brain imaging was used to diagnose hemorrhagic transformation. Results Out of 110 study participants with ischemic stroke, 70 (63.6%) patients had a history of prior known diabetes. The mean HbA1c levels were 7.44 ± 1.79%. A total of 77% of diabetic patients had raised HbA1c levels (>7%). Hemorrhagic transformation was seen in 21 (19.1%) patients, of whom only 38% (n=8) had raised HbA1c levels. The association between raised HbA1c and hemorrhagic transformation was not found to be statistically significant (p = 0.225). Conclusion In this study of patients with ischemic stroke, raised HbA1c levels were not found to be associated with hemorrhagic transformation. There is a need for larger scale studies to find out the cause and mechanism of hemorrhagic transformation in ischemic stroke.
Language	English
Publishing date	2021-11-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.19935
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Outcome of Atrial Fibrillation in Patients With Sepsis.

Afzal, Benish / Ali, Syed Ahsan / Jamil, Bushra

Cureus

2021 Volume 13, Issue 10, Page(s) e19159

Abstract: Background Atrial fibrillation (AF) is one of the most frequent arrhythmias in critically ill patients. Sepsis is a major cause of inpatient mortality and it has been associated with cardiac arrhythmias. The objective of this study was to study the ... ...

Abstract	Background Atrial fibrillation (AF) is one of the most frequent arrhythmias in critically ill patients. Sepsis is a major cause of inpatient mortality and it has been associated with cardiac arrhythmias. The objective of this study was to study the outcome of atrial fibrillation in patients who are admitted with sepsis. Methods This is a prospective, single-center cohort study of patients admitted to the Medicine Department between June 1, 2019, and November 30, 2019. The inclusion criteria were adult patients with sepsis and septic shock. In this study, 113 patients were enrolled and outcomes were compared between the group that developed atrial fibrillation during the hospital stay and the group without atrial fibrillation. Results There were 57 (50.4%) patients with AF including 23 (20.4%) who also had a prior history. Total inpatient mortality was 42 (37.2%), of which 17 patients (40.5%) had AF. AF was not found to be associated with higher mortality or increased length of hospital stay (p-value 0.103 and 0.858, respectively). Conclusion AF was not found to be a cause of higher mortality in patients with sepsis or septic shock. There is a need for larger-scale studies to find out the causes of high inpatient mortality in sepsis and the need for local guidelines regarding the management of AF in critically ill patients.
Language	English
Publishing date	2021-10-31
Publishing country	United States
Document type	Journal Article
ZDB-ID	2747273-5
ISSN	2168-8184
ISSN	2168-8184
DOI	10.7759/cureus.19159
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