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  1. Article: Evaluating students' experiences in self-regulated smart learning environment.

    Gambo, Yusufu / Shakir, Muhammad Zeeshan

    Education and information technologies

    2022  Volume 28, Issue 1, Page(s) 547–580

    Abstract: The increasing development in smart and mobile technologies transforms a learning environment into a smart learning environment that can support diverse learning styles and skills development. An online learner needs to be supported for an engaging and ... ...

    Abstract The increasing development in smart and mobile technologies transforms a learning environment into a smart learning environment that can support diverse learning styles and skills development. An online learner needs to be supported for an engaging and active learning experience. Previously, this progressive research developed and implemented a self-regulated smart learning environment (mobile app) among final-year undergraduate students to support online learning experiences. To understand students' experiences, there is a need to evaluate the mobile app. However, there is a lack of a well-documented study investigating students' experiences in terms of usability, challenges, and factors influencing satisfaction to inform a decision regarding future implementation. This study attempts to fill these gaps by exploring these experiences for sustainable future implementation. The study used cyclical mixed-method evaluations to explore the experiences of 85 final-year undergraduate students. The quantitative data were collected using a survey on the constructs of the research model previously developed to evaluate factors influencing students' satisfaction, and the qualitative used focus group discussions to explore usability experiences and challenges of implementations. The quantitative data were analyzed using SPSS 25 to confirm the structural equation model's relationship. The qualitative data were analyzed using a thematic process to understand students' experiences. The findings from the first mixed-method evaluation show that students were able to follow the learning process, and the application supported their online learning experiences. However, a student expressed the need to improve user functionalities to motivate and engage them in the learning process. The suggestions were incorporated into the mobile app development for the second evaluation. The findings from the second evaluation revealed similar support. However, students suggested a web-based version to support different operating systems and improve interactions. Furthermore, the information system qualities and moderating factors investigated supported students' satisfaction. Future research could explore facilitators' experiences in the mobile app for sustainable development and implementation for engaging online learning experiences and skills development.
    Language English
    Publishing date 2022-07-04
    Publishing country Netherlands
    Document type Journal Article
    ZDB-ID 2001930-0
    ISSN 1573-7608 ; 1360-2357
    ISSN (online) 1573-7608
    ISSN 1360-2357
    DOI 10.1007/s10639-022-11126-0
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  2. Article ; Online: Molecular Profiling of Brain Tumors in LMICs: Achievable or Impossible?

    Irshad, Hammad Atif / Shaikh, Taha / Shakir, Muhammad / Gilani, Ahmed

    Journal of cancer policy

    2024  , Page(s) 100481

    Language English
    Publishing date 2024-04-26
    Publishing country England
    Document type Letter
    ISSN 2213-5383
    ISSN (online) 2213-5383
    DOI 10.1016/j.jcpo.2024.100481
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  3. Article ; Online: Diagnostic Accuracy of Intraoperative Brain Smear: A Meta-Analysis of Studies from Resource-Limited Settings.

    Shakir, Muhammad / Irshad, Hammad Atif / Lodhi, Bilal Ahmed / Jehanzeb, Hamzah / Shaikh, Taha / Enam, Syed Ather

    World neurosurgery

    2024  

    Abstract: Background: Intraoperative brain smear is an easy, rapid, and cost-effective technique for immediate diagnosis of brain tumors. Earlier studies have gauged its application on limited number of samples, but its diagnostic accuracy especially in low- ... ...

    Abstract Background: Intraoperative brain smear is an easy, rapid, and cost-effective technique for immediate diagnosis of brain tumors. Earlier studies have gauged its application on limited number of samples, but its diagnostic accuracy especially in low-resource settings, where its practice would be extremely helpful, is still undetermined. To investigate the diagnostic accuracy of intraoperative brain smear in resource-limited settings for diagnosis of brain tumors.
    Methods: A systematic search was conducted on PubMed, Google Scholar, Scopus, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Embase for all articles utilizing intraoperative brain smears that were extracted. Studies from low- and middle-income countries (LMICs) with test performance characteristics were selected and subsequent values were summarized using a hierarchical summary receiver operating characteristic (ROC) curve via STATA and pooled using a random-effects model on MetaDiSc 2.0.
    Results: Twelve studies consisting of 1124 patients were identified. Six studies included both adult and pediatric population groups, while 4 investigated adults and 2 included pediatric patients. The pooled diagnostic odds ratio (OR) was calculated to be 212.52 (CI: [104.27-433.13]) of Bivariable pooled specificity and sensitivity were 92% (CI: [86%-96%]) and 96% (CI: [93%-98%]), respectively.
    Conclusions: Our study shows that intraoperative brain smear is not only an accurate and sensitive diagnostic modality in resource-rich settings, but it is also equally useful in resource-limited settings, making it an ideal method for rapid diagnosis.
    Language English
    Publishing date 2024-01-10
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2534351-8
    ISSN 1878-8769 ; 1878-8750
    ISSN (online) 1878-8769
    ISSN 1878-8750
    DOI 10.1016/j.wneu.2024.01.023
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  4. Article ; Online: Unveiling the silent threat of new onset atrial fibrillation in covid-19 hospitalized patients: A retrospective cohort study.

    Shakir, Muhammad / Hassan, Syed Muhammad / Adil, Ursala / Abidi, Syed Muhammad Aqeel / Ali, Syed Ahsan

    PloS one

    2024  Volume 19, Issue 1, Page(s) e0291829

    Abstract: Background: COVID-19, a highly infectious respiratory disease, has been associated with a range of cardiovascular complications. One of the most commonly reported cardiovascular issues in COVID-19 patients is the development of arrhythmias. Among all ... ...

    Abstract Background: COVID-19, a highly infectious respiratory disease, has been associated with a range of cardiovascular complications. One of the most commonly reported cardiovascular issues in COVID-19 patients is the development of arrhythmias. Among all types of arrhythmias, atrial fibrillation is the most frequently observed. Atrial fibrillation is characterized by an irregular and often rapid heartbeat, and it can be a serious and potentially life-threatening condition.
    Objective: To investigate the incidence and association of new onset atrial fibrillation in COVID-19 hospitalized patients and its impact on survival.
    Method: A retrospective cross-sectional study that encompassed all patients, both positive and negative for COVID-19, who were consecutively admitted to the Aga Khan University Hospital in Karachi, a tertiary care facility, from June 2021 to December 2021.
    Results: A total of 1,313 patients who met the inclusion criteria of our study were enrolled as participants. These patients were then stratified into two groups based on COVID-19 status: the study group (COVID-19 positive) comprised 626 (47.7%) patients and the control group (COVID-19 negative) consisted of 687 (52.3%) patients. The incidence of new-onset atrial fibrillation was 85 (13.6%) in COVID-19 positive compared to 43 (5.2%) in COVID-19 negative group. The study found a strong association between COVID-19 and new-onset atrial fibrillation in both univariate (unadjusted odd ratio 2.35 [95% CI, 1.60-3.45], p-value < 0.01) and a multiple-adjusted regression analysis (adjusted odd ratio 3.86 [95% CI, 2.31-6.44], p-value < 0.01).
    Conclusion: These findings highlight the importance of vigilant monitoring of cardiovascular complications in COVID-19 patients, especially those with pre-existing conditions that predispose them to the development of atrial fibrillation. The study underscores the need for prompt recognition and management of new onset atrial fibrillation in COVID-19 patients, as this may mitigate the risk of adverse outcomes and improve overall prognosis.
    MeSH term(s) Humans ; Atrial Fibrillation/complications ; Atrial Fibrillation/epidemiology ; Retrospective Studies ; Cross-Sectional Studies ; COVID-19/complications ; COVID-19/epidemiology ; Hospitalization ; Risk Factors
    Language English
    Publishing date 2024-01-19
    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.0291829
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  5. Article ; Online: Does gender disparity exist in neurosurgery training? Evidence from a nationwide survey from Pakistan.

    Shakir, Muhammad / Irshad, Hammad Atif / Altaf, Ahmed / Ladak, Shamila / Aziz, Hafiza Fatima / Enam, Syed Ather

    Medical education online

    2024  Volume 29, Issue 1, Page(s) 2310385

    Abstract: Gender disparities are prevalent in the neurosurgical field, particularly for female trainees, despite the growing demand for neurosurgeons. The situation is bleaker in low-and middle-income countries, where gender disparities among neurosurgical ... ...

    Abstract Gender disparities are prevalent in the neurosurgical field, particularly for female trainees, despite the growing demand for neurosurgeons. The situation is bleaker in low-and middle-income countries, where gender disparities among neurosurgical trainees have not been evaluated. We aimed to gauge the gender differences in opportunities and perceptions of neurosurgery training in Pakistan by comparing responses between males and females. A nationwide web-based survey was conducted in Pakistan, covering 22 College of Physicians and Surgeons of Pakistan (CPSP) accredited neurosurgery training programs. Convenience sampling was used with a pilot-tested questionnaire. Data analysis was performed using SPSS version 26. A total of 120 trainees participated in our survey. The mean age of the participants was 30.4 ± 4.1 years, with 29.2% females and 70.8% males. Concerns about gender equity were more among females (34.3%) than males (27.1%). Poor work-life balance was reported by more females (34.3%) than males (30.6%). Burnout due to working hours was strongly agreed by more females (54.3%) than males (35.3%). More females (40%) acknowledged sufficient mentorship opportunities versus males (25%). Female respondents (65.7%) worked 50-100 hours per week, less than males (69.4%). Satisfaction with surgical exposure was lower among females (2.9%) compared to males (18.8%). More females reported access to teaching courses (82.9% vs. 77.6% males) and neurosurgical conferences (85.7% vs. 80.0% males), cadaver workshops (17.1% vs. 12.9% males), morbidity and mortality meetings (88.6% vs. 82.4% males), case-based sessions (82.9% vs. 75.3% males), and radiology discussions (82.9% vs. 74.1% males). Our study highlights substantial gender gaps in neurosurgical training, concerns over working hours, burnout, mentorship, work-life balance, and gender equity. These findings underscore the necessity for interventions to rectify these disparities and foster gender equity in neurosurgical training.
    MeSH term(s) Male ; Humans ; Female ; Adult ; Neurosurgery/education ; Pakistan ; Neurosurgeons ; Surveys and Questionnaires ; Burnout, Professional
    Language English
    Publishing date 2024-01-30
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2052877-2
    ISSN 1087-2981 ; 1087-2981
    ISSN (online) 1087-2981
    ISSN 1087-2981
    DOI 10.1080/10872981.2024.2310385
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  6. Article ; Online: Exploring the neurosurgery training landscape in Pakistan: A trainee's perspective in resource-limited settings.

    Shakir, Muhammad / Irshad, Hammad Atif / Khowaja, Aly Hamza / Altaf, Ahmed / Enam, Syed Ather

    World neurosurgery: X

    2024  Volume 22, Page(s) 100346

    Abstract: Background: Shortage of neurosurgeons in Pakistan, one per 720,000 people, stems from a lack of trainees. Therefore, it is vital to assess the training experience, career opportunities, and satisfaction levels of neurosurgical trainees in Pakistan.: ... ...

    Abstract Background: Shortage of neurosurgeons in Pakistan, one per 720,000 people, stems from a lack of trainees. Therefore, it is vital to assess the training experience, career opportunities, and satisfaction levels of neurosurgical trainees in Pakistan.
    Methods: A nationwide survey was conducted, covering 22 CPSP-accredited neurosurgery training programs in Pakistan. Convenience sampling was utilized with a pilot tested questionnaire and responses were analyzed using STATA 15.
    Results: The response rate was 98% (120/122) with 70.8% male and mean age of 30.4 ± 4.1 years. Training programs included teaching courses (79%) and journal club (66%); however, there was a lack of cadaver workshops (14%) and cranial model-based stimulation (22%). 67% of trainees lacked publications in indexed journals. 69% worked 50-100 h weekly, with 62% experiencing burnout due to workload and hours and a third reporting poor work-life balance. Trainees dedicated more to operating rooms (37%, 10-24 h/week) and clinics (34%, 24-48 h/week) compared to study (42%, <5 h/week) and research (64%, <5 h/week). Gender equality was rated poorly by 50%. Disparities emerged in subspecialty exposure, with over half of trainees lacking exposure to deep brain stimulation (67%), and epilepsy (75%). 52.5% of the training institutes did not offer fellowships and 64.1% of trainees planned to pursue fellowships abroad.
    Conclusions: Steps need to be taken to improve working hours, gender equity, and increase simulation courses, diversify subspecialty exposure, and promote research initiatives.
    Language English
    Publishing date 2024-02-24
    Publishing country United States
    Document type Journal Article
    ISSN 2590-1397
    ISSN (online) 2590-1397
    DOI 10.1016/j.wnsx.2024.100346
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  7. Article ; Online: Impact of medical school experiences on the career choice of neurosurgery: a cross- sectional study from Pakistan.

    Shakir, Muhammad / Irshad, Hammad Atif / Ali, Eisha Abid / Adil, Amna / Altaf, Ahmed / Enam, Syed Ather

    BMC medical education

    2024  Volume 24, Issue 1, Page(s) 465

    Abstract: Background: Pakistan grapples with the issue of an inadequate neurosurgery workforce but the reasons for such a disparity remain uncertain. Previous studies have highlighted how various factors including medical school experiences have an impact on ... ...

    Abstract Background: Pakistan grapples with the issue of an inadequate neurosurgery workforce but the reasons for such a disparity remain uncertain. Previous studies have highlighted how various factors including medical school experiences have an impact on career choice, but no study has delved into the impact of medical school exposure among Pakistani medical students, especially for the field of neurosurgery. This study aims to evaluate the impact of neurosurgery exposure, mentorship, and interest groups on medical students' decision to pursue neurosurgery.
    Methods: A national cross-sectional survey was conducted in Pakistan, collecting data from medical students, interns, and medical officers over a one-month period. Ethical approval was obtained from the Ethical Review Committee at Aga Khan University, Pakistan. The data was analyzed using SPSS version 26.
    Results: Out of 2618 participants, 38.0% were male and 62.0% were female, with an average age of 21.82 years (± 2.65). Among them, only 358 (13.6%) were interested in pursuing neurosurgery as a career, while the remaining 2,260 (86.3%) were not. More females (58.9%) than males (41.1%) expressed interest in pursuing neurosurgery as their intended career. Most medical students interested in pursuing neurosurgery were in the early years of their medical school (1st Year: 19.6%, 2nd Year: 26.0%, 3rd Year: 20.9%). In our study, students from public sector institutions (52.2%) showed more interest in neurosurgery as a career choice compared to those from private sector institutions (44.1%). The main deterrents for choosing neurosurgery were intense training (42.2%), work-life balance (39.9%), limited residency slots (56.7%), medical knowledge (34.1%), and surgical skills (36.6%).
    Conclusion: This study highlights the need for increased student engagement to inculcate the decision to pursue neurosurgery among medical students in Pakistan. A significant gap is highlighted, with the majority of interested students in early years. Public sector students show higher interest than their private sector counterparts. However, barriers like intense training, limited residency slots, and work-life balance concerns influence career choice. Targeted interventions like mentorship programs are crucial for fostering future neurosurgeons and advancing patient care and research. By addressing the identified disparities in experiences and promoting a supportive educational environment, it is possible to cultivate a future generation of skilled and dedicated neurosurgeons who can contribute to advancements in patient care and research in the field.
    MeSH term(s) Humans ; Career Choice ; Pakistan ; Cross-Sectional Studies ; Male ; Female ; Neurosurgery/education ; Students, Medical/psychology ; Young Adult ; Schools, Medical ; Adult ; Surveys and Questionnaires ; Mentors
    Language English
    Publishing date 2024-04-26
    Publishing country England
    Document type Journal Article
    ZDB-ID 2044473-4
    ISSN 1472-6920 ; 1472-6920
    ISSN (online) 1472-6920
    ISSN 1472-6920
    DOI 10.1186/s12909-024-05452-9
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  8. Article: Changes in serum lipids with the onset and progression of Diabetic Retinopathy in Type-II Diabetes Mellitus.

    Gitay, Mehnaz Nuruddin / Sohail, Arisha / Arzoo, Yasmeen / Shakir, Muhammad Ali

    Pakistan journal of medical sciences

    2023  Volume 39, Issue 1, Page(s) 188–191

    Abstract: Objective: To investigate the role of serum lipids in the onset and progression of Diabetic Retinopathy (DR) in Type-II diabetes (T2DM) individuals.: Methods: This cross-sectional study was conducted at the National Institute of Diabetes and ... ...

    Abstract Objective: To investigate the role of serum lipids in the onset and progression of Diabetic Retinopathy (DR) in Type-II diabetes (T2DM) individuals.
    Methods: This cross-sectional study was conducted at the National Institute of Diabetes and Endocrinology (NIDE), Dow University of Health Sciences (DUHS) from March to May 2019. After signing the informed consent, healthy controls (n=30), T2DM patients (diabetic n=30), proliferative (PDR n=30) and non-proliferative (NPDR n= 30) of age 18 to 65 years were selected by convenient sampling. Background information was gathered through interviews and the fundoscopy was done. Fasting five ml venous blood samples were collected and analysed for triglycerides (TGs), cholesterol, HDL, LDL, VLDL and the HbA1c using commercially available assays. The SPSS, version 24.0, was used for data analysis.
    Results: The HbA1c level was high in the diabetes, NPDR and PDR groups than control (p<0.05). The serum TGs and cholesterol were raised while the HDL was low in the diabetes group than in control (p<0.05). The cholesterol and LDL were high in the diabetes group compared to NPDR and PDR groups (p<0.05). The cholesterol and VLDL showed a positive moderately strong correlation with HbA1c in the PDR group (p<0.05).
    Conclusion: The serum lipid levels vary with the HbA1c levels and greater degree of derangement is observed with increasing mean HbA1C independent of diabetic retinopathy. For this reason, strict control of HbA1c and serum lipid level by lifestyle and/or pharmacologic intervention is recommended in diabetes with or without retinopathy.
    Language English
    Publishing date 2023-01-24
    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.39.1.6265
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    Zs.A 3948: Show issues Location:
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  9. Article ; Online: Mucormycosis in a patient with COVID-19 with uncontrolled diabetes.

    Shakir, Muhammad / Maan, Muhammad Hassaan Arif / Waheed, Shahan

    BMJ case reports

    2021  Volume 14, Issue 7

    Abstract: A wide range of bacterial and fungal coinfections may be associated with COVID-19. We report a case of rhino-orbital mucormycosis in a patient with COVID-19. A 67-year-old man, known case of diabetes, hypertension and ischaemic heart disease, was being ... ...

    Abstract A wide range of bacterial and fungal coinfections may be associated with COVID-19. We report a case of rhino-orbital mucormycosis in a patient with COVID-19. A 67-year-old man, known case of diabetes, hypertension and ischaemic heart disease, was being treated for COVID-19 pneumonia when he developed right cheek eschar and ophthalmoplegia. Imaging studies revealed pansinusitis of bilateral maxillary and sphenoid sinuses with thickening and enhancement of right-sided soft tissue, lacrimal gland, mastication muscles, temporal lobe infiltrate and cerebellum infarct. Emergency right face debridement, right eye exenteration and bilateral functional endoscopic sinus surgery were done. Histopathological examination confirmed mucormycosis diagnosis. He was given amphotericin B and broad-spectrum antibiotics. It is important to have high index of suspicion for fungal coinfections in patients with COVID-19 with pre-existing medical conditions. There is a need to emphasise judicious and evidence-based use of immunomodulators in patients with COVID-19 to avoid triggering and flaring up of fungal infections.
    MeSH term(s) Aged ; Antifungal Agents/therapeutic use ; COVID-19 ; Diabetes Mellitus/microbiology ; Eye Infections, Fungal/drug therapy ; Humans ; Male ; Mucormycosis/complications ; Mucormycosis/diagnosis ; Mucormycosis/drug therapy ; Orbital Diseases/drug therapy
    Chemical Substances Antifungal Agents
    Language English
    Publishing date 2021-07-29
    Publishing country England
    Document type Case Reports ; Journal Article
    ISSN 1757-790X
    ISSN (online) 1757-790X
    DOI 10.1136/bcr-2021-245343
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  10. Article: Idiopathic Pulmonary Fibrosis Comorbid With Mediastinal Small Cell Carcinoma: A Clinical Dilemma.

    Shakir, Muhammad Hassan / Abdul Basit, Salman / Ray, Barun K / Zaidi, Syed Muhammad Hussain / Chaudhary, Taibah / Amjad, Mohammad Asim

    Cureus

    2024  Volume 16, Issue 2, Page(s) e53578

    Abstract: We present an interesting case of mediastinal small cell carcinoma (MSCC), an exceedingly rare entity, comorbid with idiopathic pulmonary fibrosis (IPF). A 66-year-old female was first seen in the pulmonology office for abnormal chest computed tomography  ...

    Abstract We present an interesting case of mediastinal small cell carcinoma (MSCC), an exceedingly rare entity, comorbid with idiopathic pulmonary fibrosis (IPF). A 66-year-old female was first seen in the pulmonology office for abnormal chest computed tomography (CT) findings of right apical bronchiectasis and subpleural fibrotic changes with focal pleural thickening along the fissures, along with a right lower lobe nodule. Pulmonary function testing (PFT) showed an obstructive pattern with modest bronchodilator response, although subsequent PFT showed a worsening restrictive pattern with a worsening DLCO. On a follow-up CT one year later, a soft tissue density with peripheral calcification was found in the anterior mediastinum, later found to be hypermetabolic on a PET scan. Radiographically, fibrosis worsened with the appearance of worsening diffuse bilateral coarse reticular interstitial changes with lower lobe predominance, honeycombing, and areas of ground-glass opacity. A biopsy of the mediastinal lesion showed a high-grade neuroendocrine tumor. Cam5.2, insulinoma-associated protein-1, synaptophysin, and thyroid transcription factor-1 immunostains were positive. She underwent four cycles of chemotherapy with cisplatin and etoposide with a total of 60 Gy of radiation. Mediastinal mass started to decrease in size. Her respiratory status, imaging, and PFTs continued to show evidence of IPF progression. Prednisone resulted in modest clinical and radiographic response. Steroid-sparing therapy with mycophenolate mofetil, although effective, had to be discontinued due to GI bleeding. Anti-fibrotic therapy was deferred due to evidence showing a lack of clinical improvement. We discuss the existing evidence available on IPF management and proceed to highlight the deficiencies in existing data available on the management of IPF and MSCC in these patients. Most of the cases of MSCC reported in the past have managed MSCC using guidance from treatment practices for small cell lung cancer. No reported cases discuss or describe the management of IPF and MSCC in the very rare cohort of patients our case represents.
    Language English
    Publishing date 2024-02-04
    Publishing country United States
    Document type Case Reports
    ZDB-ID 2747273-5
    ISSN 2168-8184
    ISSN 2168-8184
    DOI 10.7759/cureus.53578
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