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  1. Article ; Online: Global Immunization Crisis Amid the COVID-19 Pandemic: Implications for Pediatric Oncology.

    Bukhari, Syed Ibrahim / Jehan, Fyezah / Belgaumi, Asim

    JCO global oncology

    2024  Volume 10, Page(s) e2300477

    Abstract: Declining herd immunity and severe manifestation of vaccine preventable infections underscores the need for vaccinations campaigns to urgently vaccinate children who missed their routine immunizations. ...

    Abstract Declining herd immunity and severe manifestation of vaccine preventable infections underscores the need for vaccinations campaigns to urgently vaccinate children who missed their routine immunizations.
    MeSH term(s) Child ; Humans ; COVID-19/prevention & control ; Pandemics/prevention & control ; Immunization ; Vaccination ; Neoplasms
    Language English
    Publishing date 2024-02-29
    Publishing country United States
    Document type Editorial
    ISSN 2687-8941
    ISSN (online) 2687-8941
    DOI 10.1200/GO.23.00477
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  2. Article: Student experiences of simulation-based learning and its impact on their performance in Objective Structured Clinical Examination in Pediatrics - A mixed method study.

    Saeed, Sana / Afzal, Azam / Khalid, Farah / Jehan, Fyezah

    Pakistan journal of medical sciences

    2023  Volume 39, Issue 4, Page(s) 978–982

    Abstract: Objective: This study aims to assess the effectiveness of integrating simulation for teaching pediatric clinical examination skills to undergraduate, MBBS Year-IV medical students at The Aga Khan University, Karachi, Pakistan.: Methods: In this mixed ...

    Abstract Objective: This study aims to assess the effectiveness of integrating simulation for teaching pediatric clinical examination skills to undergraduate, MBBS Year-IV medical students at The Aga Khan University, Karachi, Pakistan.
    Methods: In this mixed method study, the Objective Structured Clinical Examination (OSCE) scores of the students who were taught using simulation (batch 2017-2018) were compared with the batch of the academic year 2016 -2017 (taught via traditional methods). In order to explore the experiences of the intervention group, a questionnaire with four open-ended questions was administered at the end of the clerkship.
    Results: Students who were taught by simulation, scored significantly higher on the clinical skills stations in Objective Structured Clinical Examination, than in the pre-intervention group (p-value <0.01). The students quoted safety of the learning environment, opportunities for deliberate practice, debriefing and facilitation skills maximized quoted that their experience of learning through simulation, however, some challenges were identified for future improvement.
    Conclusion: The result of the study suggested simulation as a useful instructional strategy for teaching examination skills to students in their early years. The student gained confidence through deliberate practice and feedback without compromising patient safety, which translated into improved performance in the high-stakes OSCE examination at the end of the clerkship.
    Language English
    Publishing date 2023-08-08
    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.39.4.7287
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  3. Article ; Online: Using big data for risk stratification of childhood pneumonia in low-income and middle-income countries (LMICs): Challenges and opportunities.

    Sheikh, Maheen / Jehan, Fyezah

    EBioMedicine

    2021  Volume 74, Page(s) 103740

    MeSH term(s) Big Data ; Child ; Child, Preschool ; Developing Countries ; Humans ; Pneumonia/epidemiology ; Pneumonia/etiology ; Public Health Surveillance ; Risk Assessment ; Risk Factors ; Socioeconomic Factors
    Language English
    Publishing date 2021-12-13
    Publishing country Netherlands
    Document type Letter
    ZDB-ID 2851331-9
    ISSN 2352-3964
    ISSN (online) 2352-3964
    DOI 10.1016/j.ebiom.2021.103740
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  4. Article: Pulse oximetry: why oxygen saturation is still not a part of standard pediatric guidelines in low-and-middle-income countries (LMICs).

    Sheikh, Maheen / Ahmad, Huzaifa / Ibrahim, Romesa / Nisar, Imran / Jehan, Fyezah

    Pneumonia (Nathan Qld.)

    2023  Volume 15, Issue 1, Page(s) 3

    Abstract: Background: With the high frequency of acute respiratory infections in children worldwide, particularly so in low-resource countries, the development of effective diagnostic support is crucial. While pulse oximetry has been found to be an acceptable ... ...

    Abstract Background: With the high frequency of acute respiratory infections in children worldwide, particularly so in low-resource countries, the development of effective diagnostic support is crucial. While pulse oximetry has been found to be an acceptable method of hypoxemia detection, improving clinical decision making and efficient referral, many healthcare set ups in low- and middle-income countries have not been able to implement pulse oximetry into their practice.
    Main body: A review of past pulse oximetry implementation attempts in low- and middle-income countries proposes the barriers and potential solutions for complete integration in the healthcare systems. The addition of pulse oximetry into WHO health guidelines would prove to improve detection of respiratory distress and ensuing therapeutic measures. Incorporation is limited by the cost and unavailability of pulse oximeters, and subsequent oxygen accessibility. This restriction is compounded by the lack of trained personnel, and healthcare provider misconceptions. These hurdles can be combated by focus on low-cost devices, and cooperation at national levels for development in healthcare infrastructure, resource transport, and oxygen delivery systems.
    Conclusion: The implementation of pulse oximetry shows promise to improve child morbidity and mortality from pneumonia in low- and middle-income countries. Steady measures taken to improve access to pulse oximeters and oxygen supplies, along with enhanced medical provider training are encouraging steps to thorough pulse oximetry integration.
    Language English
    Publishing date 2023-02-05
    Publishing country England
    Document type Journal Article ; Review
    ZDB-ID 2803296-2
    ISSN 2200-6133
    ISSN 2200-6133
    DOI 10.1186/s41479-023-00108-6
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  5. Article: Perspectives of residents, students and faculty about residents as teachers at a University Hospital in Karachi.

    Raza, Mahanoor / Madhwani, Akber / Jehan, Fyezah / Saeed, Sana

    JPMA. The Journal of the Pakistan Medical Association

    2022  Volume 72, Issue 4, Page(s) 714–744

    Abstract: This was a cross sectional study, conducted at the Aga Khan University, Karachi, from December 2018 to December 2019, to determine the residents' performance as teachers and understand the difficulties they faced. Anonymous feedback was obtained from ... ...

    Abstract This was a cross sectional study, conducted at the Aga Khan University, Karachi, from December 2018 to December 2019, to determine the residents' performance as teachers and understand the difficulties they faced. Anonymous feedback was obtained from students (n=200) to rate the teaching skills of residents in the paediatric department. The residents (n=60) also filled out an anonymous survey to assess their teaching performance and barriers to teaching. Furthermore, the faculty rated the residents' teaching abilities on a 5-point scale. A total of 145 (98.7%) students considered teaching as an important role of the residents. Ten (40%) residents identified themselves as beginners in teaching. The main barriers were time limitation (n=19, 76%), critical patients (n=3, 12%) and lack of appropriate skills (n=3, 12%).
    MeSH term(s) Child ; Cross-Sectional Studies ; Faculty, Medical ; Hospitals ; Humans ; Internship and Residency ; Students ; Teaching
    Language English
    Publishing date 2022-05-26
    Publishing country Pakistan
    Document type Journal Article
    ZDB-ID 603873-6
    ISSN 0030-9982
    ISSN 0030-9982
    DOI 10.47391/JPMA.1361
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  6. Article ; Online: Predictors of Respiratory Syncytial Virus, Influenza Virus, and Human Metapneumovirus Carriage in Children Under 5 Years With WHO-Defined Fast-Breathing Pneumonia in Pakistan.

    Nisar, Muhammad Imran / Kerai, Salima / Shahid, Shahira / Qazi, Muhammad Farrukh / Rehman, Sarah / Aziz, Fatima / Jehan, Fyezah

    Influenza and other respiratory viruses

    2024  Volume 18, Issue 4, Page(s) e13285

    Abstract: Background: Pneumonia is a leading cause of morbidity and mortality in children < 5 years. We describe nasopharyngeal carriage of respiratory syncytial virus (RSV), human metapneumovirus (hMPV), and influenza virus among children with fast-breathing ... ...

    Abstract Background: Pneumonia is a leading cause of morbidity and mortality in children < 5 years. We describe nasopharyngeal carriage of respiratory syncytial virus (RSV), human metapneumovirus (hMPV), and influenza virus among children with fast-breathing pneumonia in Karachi, Pakistan.
    Methods: We performed a cross-sectional analysis of nasopharyngeal swabs from children aged 2-59 months with fast-breathing pneumonia, enrolled in the randomized trial of amoxicillin versus placebo for fast-breathing pneumonia (RETAPP) (NCT02372461) from 2014 to 2016. Swabs were collected using WHO standardized methods, processed at the Aga Khan University, Pakistan. Viral detection was performed using LUMINEX xTAG respiratory viral panel assay and logistic regression identified clinical and sociodemographic predictors.
    Findings: Of the 1000 children tested, 92.2% (n = 922) were positive for viral carriage. RSV, hMPV, and influenza virus were detected in 59 (6.4%), 56 (6.1%), and 58 (6.3%) children and co-infections in three samples (two RSV-hMPV and one influenza-hMPV). RSV carriage was common in infants (56%), we observed a higher occurrence of fever in children with hMPV and influenza virus (80% and 88%, respectively) and fast breathing in RSV (80%) carriage. RSV carriage was positively associated with a history of fast/difficulty breathing (aOR: 1.96, 95% CI 1.02-3.76) and low oxygen saturation (aOR: 2.52, 95% CI 1.32-4.82), hMPV carriage was positively associated with a complete vaccination status (aOR: 2.22, 95% CI 1.23-4.00) and body temperature ≥ 37.5°C (aOR: 2.34, 95% CI 1.35-4.04) whereas influenza viral carriage was associated with body temperature ≥ 37.5°C (aOR: 4.48, 95% CI 2.53-7.93).
    Conclusion: We observed a high nasopharyngeal viral carriage among children with WHO-defined fast-breathing pneumonia in Pakistan. Fever, difficulty in breathing, hypoxia and vaccination status are important clinical predictors for viral nonsevere community-acquired pneumonia.
    MeSH term(s) Child ; Child, Preschool ; Humans ; Infant ; Cross-Sectional Studies ; Fever ; Influenza, Human/epidemiology ; Metapneumovirus ; Orthomyxoviridae ; Pakistan/epidemiology ; Respiratory Syncytial Virus, Human ; World Health Organization
    Language English
    Publishing date 2024-04-09
    Publishing country England
    Document type Journal Article
    ZDB-ID 2274538-5
    ISSN 1750-2659 ; 1750-2640
    ISSN (online) 1750-2659
    ISSN 1750-2640
    DOI 10.1111/irv.13285
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    Zs.A 6568: Show issues Location:
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  7. Article ; Online: Identification of potential therapeutic intervening targets by in-silico analysis of nsSNPs in preterm birth-related genes.

    Azmi, Muhammad Bilal / Khan, Waqasuddin / Azim, M Kamran / Nisar, Muhammad Imran / Jehan, Fyezah

    PloS one

    2023  Volume 18, Issue 3, Page(s) e0280305

    Abstract: Prematurity is the foremost cause of death in children under 5 years of age. Genetics contributes to 25-40% of all preterm births (PTB) yet we still need to identify specific targets for intervention based on genetic pathways. This study involved the ... ...

    Abstract Prematurity is the foremost cause of death in children under 5 years of age. Genetics contributes to 25-40% of all preterm births (PTB) yet we still need to identify specific targets for intervention based on genetic pathways. This study involved the effect of region-specific non-synonymous variations and their transcript level mutational impact on protein functioning and stability by various in-silico tools. This investigation identifies potential therapeutic targets to manage the challenge of PTB, corresponding protein cavities and explores their binding interactions with intervening compounds. We searched 20 genes coding 55 PTB proteins from NCBI. Single Nucleotide Polymorphisms (SNPs) of concerned genes were extracted from ENSEMBL, and filtration of exonic variants (non-synonymous) was performed. Several in-silico downstream protein functional effect prediction tools were used to identify damaging variants. Rare coding variants were selected with an allele frequency of ≤1% in 1KGD, further supported by South Asian ALFA frequencies and GTEx gene/tissue expression database. CNN1, COL24A1, IQGAP2 and SLIT2 were identified with 7 rare pathogenic variants found in 17 transcript sequences. The functional impact analyses of rs532147352 (R>H) of CNN1 computed through PhD-SNP, PROVEAN, SNP&GO, PMut and MutPred2 algorithms showed impending deleterious effects, and the presence of this pathogenic mutation in CNN1 resulted in large decrease in protein structural stability (ΔΔG (kcal/mol). After structural protein identification, homology modelling of CNN1, which has been previously reported as a biomarker for the prediction of PTB, was performed, followed by the stereochemical quality checks of the 3D model. Blind docking approach were used to search the binding cavities and molecular interactions with progesterone, ranked with energetic estimations. Molecular interactions of CNN1 with progesterone were investigated through LigPlot 2D. Further, molecular docking experimentation of CNN1 showed the significant interactions at S102, L105, A106, K123, Y124 with five selected PTB-drugs, Allylestrenol (-7.56 kcal/mol), Hydroxyprogesterone caproate (-8.19 kcal/mol), Retosiban (-9.43 kcal/mol), Ritodrine (-7.39 kcal/mol) and Terbutaline (-6.87 kcal/mol). Calponin-1 gene and its molecular interaction analysis could serve as an intervention target for the prevention of PTB.
    MeSH term(s) Humans ; Infant, Newborn ; Exons ; Genes, Regulator ; Molecular Docking Simulation ; Premature Birth/genetics ; Progesterone ; Polymorphism, Single Nucleotide
    Chemical Substances Progesterone (4G7DS2Q64Y)
    Language English
    Publishing date 2023-03-07
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2267670-3
    ISSN 1932-6203 ; 1932-6203
    ISSN (online) 1932-6203
    ISSN 1932-6203
    DOI 10.1371/journal.pone.0280305
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  8. Article ; Online: Structural Changes in the Brain on Magnetic Resonance Imaging in Malnourished Children: A Scoping Review of the Literature.

    Ayaz, Ahmed / Nisar, Imran / Muhammad, Ameer / Ahmed, Kheezran / Chand, Prem / Jehan, Fyezah

    Pediatric neurology

    2023  Volume 149, Page(s) 151–158

    Abstract: Background: This review was conducted to summarize the current evidence on the structural findings seen in brain magnetic resonance imaging (MRI) in malnourished children and the effect of optimized nutritional supplementation on brain development as ... ...

    Abstract Background: This review was conducted to summarize the current evidence on the structural findings seen in brain magnetic resonance imaging (MRI) in malnourished children and the effect of optimized nutritional supplementation on brain development as studied through MRI.
    Methods: A systematic search was carried out in PubMed, Embase, The Cochrane Library, Web of Science (Clarivate Analytics), WHO ICTRP Clinical Trials in Children, and ClinicalTrials.gov using a predefined search criterion for relevant literature from inception to January 2022. The primary outcome of the study was structural changes observed in the brain on MRI.
    Results: The most common abnormal findings on MRI in malnourished infants were cerebral atrophy and dilated ventricles. Furthermore, a higher proportion of breast milk, calorie, and lipid intake in the diet was significantly associated with increased brain volumes; this also increased the likelihood of normal MRI scores at term. When followed till adolescence, it was observed that these infants had increased neonatal weight gain and a higher intelligence quotient when compared with the group.
    Conclusions: In conclusion, most children with moderate/severe malnutrition had abnormal MRI findings, mostly cerebral atrophy with or without ventricular dilatation. Since none of the studies measured the degree of atrophy or ventricular dilatation, it was not possible to assess the effect of the severity of malnutrition on brain atrophy. A universal measurement or scoring system for assessing the degree of brain atrophy is needed to help correlate the severity of malnutrition with the degree of brain atrophy and monitor the effects of nutritional rehabilitation over time.
    MeSH term(s) Adolescent ; Female ; Infant ; Infant, Newborn ; Child ; Humans ; Brain/diagnostic imaging ; Child Nutrition Disorders ; Malnutrition ; Atrophy ; Magnetic Resonance Imaging
    Language English
    Publishing date 2023-08-29
    Publishing country United States
    Document type Journal Article ; Review
    ZDB-ID 639164-3
    ISSN 1873-5150 ; 0887-8994
    ISSN (online) 1873-5150
    ISSN 0887-8994
    DOI 10.1016/j.pediatrneurol.2023.08.020
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  9. Article ; Online: Amoxicillin Course Length or Use in Childhood Pneumonia in Underserved Areas. Reply.

    Jehan, Fyezah / Nisar, Imran / Rizvi, Arjumand

    The New England journal of medicine

    2020  Volume 383, Issue 14, Page(s) 1392–1393

    MeSH term(s) Amoxicillin ; Anti-Bacterial Agents ; Child ; Humans ; Medically Underserved Area ; Pneumonia
    Chemical Substances Anti-Bacterial Agents ; Amoxicillin (804826J2HU)
    Language English
    Publishing date 2020-09-30
    Publishing country United States
    Document type Letter ; Comment
    ZDB-ID 207154-x
    ISSN 1533-4406 ; 0028-4793
    ISSN (online) 1533-4406
    ISSN 0028-4793
    DOI 10.1056/NEJMc2026544
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  10. Article ; Online: Critical illness related to community acquired pneumonia, its epidemiology and outcomes in a pediatric intensive care unit of Pakistan.

    Zeeshan, Arsheen / Abbas, Qalab / Siddiqui, Arsalan / Khalid, Farah / Jehan, Fyezah

    Pediatric pulmonology

    2021  Volume 56, Issue 12, Page(s) 3916–3923

    Abstract: Background: To determine the epidemiology and outcomes in critically ill children admitted with severe community acquired pneumonia (CAP) and to identify risk factors associated with mortality in a pediatric intensive care unit (PICU) METHODS: ... ...

    Abstract Background: To determine the epidemiology and outcomes in critically ill children admitted with severe community acquired pneumonia (CAP) and to identify risk factors associated with mortality in a pediatric intensive care unit (PICU) METHODS: Retrospective review of medical records of all children (age 1 month to 18 years) admitted to PICU with CAP from January 2013 to March 2018 was done. Patients admitted in last 2 weeks before current illness and those with bronchiolitis (based on clinical diagnosis) were excluded. Data were collected on a structured proforma and included demographic, clinical data, comorbidities, therapeutic information, laboratory data, and outcome data. Results were presented as mean with SD and frequency with percentages. Factors associated with mortality were analyzed, using logistic regression for both univariate and multivariate analyses.
    Results: A total of 187 children with severe CAP were identified, 53.5% (n = 100) were <1 year of age and 65.2% (n = 122) were male, 32.6% (n = 61) were underweight, and 24.6% (n = 46) were stunted. A total of 94% (175) required mechanical ventilation. Mortality among the cohort was 20.3% (n = 38) with median length of mechanical ventilation 4 (2-8) days, and median length of PICU stay was 6 (4-12) days. PRISM score >10 on admission, presence of systemic illness, empyema, and length of PICU stay 14 (±2) days were associated with increased mortality among critically ill children admitted with CAP (p < .05).
    Conclusions: Severe illness on presentation, presence of systemic illness and empyema are associated with increased mortality in children admitted to the PICU with severe CAP.
    MeSH term(s) Aged ; Child ; Critical Illness ; Humans ; Infant ; Intensive Care Units, Pediatric ; Length of Stay ; Male ; Pakistan/epidemiology ; Pneumonia/epidemiology ; Retrospective Studies ; Severity of Illness Index
    Language English
    Publishing date 2021-09-21
    Publishing country United States
    Document type Journal Article
    ZDB-ID 632784-9
    ISSN 1099-0496 ; 8755-6863
    ISSN (online) 1099-0496
    ISSN 8755-6863
    DOI 10.1002/ppul.25668
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