Browsing by Person "Siddiqui, Muhammad A."

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An overview of AVF maturation and endothelial dysfunction in an advanced renal failure
(BioMed Central, 2017-10-02) Siddiqui, Muhammad A.; Ashraff, Suhel; Santos, Derek; Carline, Tom
Blood donation among medical students: Knowledge, Attitude and Practices
(2012-05-26) Khan, Adeel Ahmed; Ahmed, Zeeshan; Siddiqui, Muhammad A.; Yaqoob, Kiran; Anis, Zulqarnain; Farooq, Saad
Introduction The healthy, active and receptive huge student population is potential blood donors to meet safe blood requirements. However, there is a paucity of studies on awareness and attitude among medical students on voluntary blood donation. The objective of this study was to determine the knowledge, attitude and practices about blood donation among medical students in three leading medical colleges of Karachi, Pakistan. Methods A cross-sectional study was conducted in three leading medical colleges of Karachi. A total of 599 medical students were interviewed using structured survey questionnaire. Medical students were selected on the basis of convenient non- probability sampling methodology. Chi-square test was used to find differences in knowledge, attitude and practices among medical students of pre-clinical years and clinical years and also among three medical colleges of Karachi. Results: Out of 599 medical students, 98.3% knew that donating blood saves life. However, only 23% of the medical students have ever donated blood in their life. 'Feeling of underweight', 'scared of donating blood', 'parent's prohibition' and 'not asked to donate blood' were the major reasons for not donating blood. 57.2% believed they should always take permission from their parents before donating blood. 82.6% thought in case of emergency, they will be willing to donate blood. 58.7% of student donated blood in post clinical years (Year 3-5), as compared to 41.3% of pre-clinical years (Year 1-2) students and their difference was found to be significant (P <0.01). The proportion of students that donated blood was also highest in private sector Liaquat National Medical college LNMC (41.3%) as compare to public sector Sindh Medical college SMC which was lowest (22.5%) and the difference among all three medical colleges was found to be significant (P<0.001). Conclusion: This study elicits the importance of adopting effective measures in our campuses to motivate about voluntary blood donation among students. Key Words: Knowledge; Attitude; blood donation; Medical students, Pakistan
Comparison of Siriraj Stroke Score with Computerized Tomography in Establishing the Type of the Stroke among Pakistani Population
(2015-09) Jamal, Q.; Rahman, A. S.; Razzaque, S.; Siddiqui, Muhammad A.; Ara, J.; Altaf, A.
Computed Tomography (CT) Scan is an accurate and a routinely done imaging technique to diagnose and differentiate haemorrhagic and ischaemic stroke. Siriraj Stroke Score (SSS) is weighted clinical score and European recognized for clinical and bedside differentiation between ischemic and haemorrhagic stroke. This study aimed to establish the accuracy of SSS in the bedside diagnosis of cerebral haemorrhage in comparison with CT scan to avoid delay in treatment. Total 152 patients were included in the study. Out of which 39.5% were male. Overall, mean age was 59.2811.91, 56.32 12.69 in haemorrhagic group and 62.3210.28 in non-haemorrhagic group. Sensitivity, specificity, PPV, and NPV of SSS for haemorrhagic stroke was 71.4%, 81.3%, 79.7% and 73.5% respectively. Overall accuracy for haemorrhagic stroke was found to be 76.3%. SSS had higher sensitivity for haemorrhagic stroke and is more sensitive in Asian population, but still not accurate enough to replace CT scan as investigation of choice but can plays a role to avoid delay in the management where CT scan is delayed or not available. 2015, TIP ARASTIRMALARI DERNEGI. All rights reserved.
Complications of Stump Healing Among Diabetic Population
(Society of Endocrinology and Metabolism of Turkey, 2018-06-19) Ashraff, Suhel; Siddiqui, Muhammad A.; Santos, Derek; Carline, Tom
Lower limb amputation is a major procedure performed in diabetic patients with multiple comorbidities. Almost 10% of the National Health Service budget is taken up by diabetes, with diabetes-related complications accounting for 80% of the costs. The process of wound healing is complex and involves regenerating the cellular organization and the tissue layers. Diabetics are five times more predisposed to wound infection than patients without diabetes mellitus. The amputated stump frequently becomes infected due to inadequate blood circulation, a weak immune system, and poorly controlled diabetes mellitus. Pain, stump edema, and osteomyelitis are significant complications associated with lower limb amputation wounds. A number of factors may substantiate the need for re-amputation, such as stump pain and/or phantom limb pain, delayed stump infection, the formation of symptomatic bone spurs, assessment of the skin flap designed to preserve stump length, and preparation of the stump for the prosthetic device. There are currently no reliable standards that can be referred to prior to leg amputation. The clinicians, therefore, have to rely on their judgment and investigatory parameters. The main purpose of this review is to discuss the difficulties of stump healing in the diabetic population.
Development of a prognostic model for fistula maturation in patients with advanced renal failure
(Queen Margaret University, Edinburgh, 2014) Siddiqui, Muhammad A.
A suitable type of vascular access has to be created to establish a connection between the circulation system of the patient and the haemodialysis cycle. The arteriovenous fistula (AVF) is considered to provide the best long-term functional vascular access, with reduced risk of thrombosis or infection and cost-effective. However, significant numbers of AVF, which fail to develop sufficiently for dialysis, are 28-53% of cases. This study aimed to explore the potential influence of blood markers and factors on the maturation of AVF, in patients who have undergone vascular access surgery and to develop and validate a prognostic model to determine the success of AVF maturation.
Development of a prognostic model for fistula maturation in patients with advanced renal failure
(2012-05-24) Siddiqui, Muhammad A.; Raza, Zahid; Santos, Derek; Ashraff, Suhel; Carline, Tom
Introduction This study aimed to explore the role of haematological markers and predictive factors on the maturation of arteriovenous fistulae in patients who underwent vascular access surgery at the Royal Infirmary of Edinburgh. Methods Retrospective analysis of 300 patients was retrieved who had undergone fistula creation between 2006 and 2009. A predictive model was developed using backward stepwise logistic regression. The model discrimination was assessed by the receiver operating characteristics curve and its calibration by the Hosmer and Lemeshow goodness of fit test. Results Three variables were identified which influenced fistula maturation. Gender - Males were twice as likely to undergo fistula maturation, compared to that of females (odds ratio [OR] 0.514; 95% confidence interval [CI] 0.308 to 0.857). Peripheral Vascular Disease - Patients with no evidence of PVD were three times more likely to mature their fistula (OR 3.140; 95% CI 1.596 to 6.177). Vein Size - A pre operative vein diameter > 2.5mm resulted in a five fold increase in fistula maturation compared to a vein size less than 2.5mm (OR 4.532; 95% CI 2.063 to 9.958). There was a good calibration as indicated by Hosmer and Lemeshow goodness of fit test (P=0.79) and the c-index was 0.677. Conclusion Gender, PVD and vein size are useful predictors of arteriovenous fistulae maturation. The clinical utility of these risk categories in the maturation of arteriovenous fistulae requires further clinical evaluation in a prospective study.
Development of a prognostic model for stump healing in patients with advanced atherosclerosis
(2012-05-24) Ashraff, Suhel; Raza, Zahid; Santos, Derek; Siddiqui, Muhammad A.; Carline, Tom
Introduction This study aimed to explore the role of haematological markers and predictive factors on the stump healing in patients who underwent lower extremity amputation surgery at the Royal Infirmary of Edinburgh. Methods Retrospective analysis of 300 patients was retrieved who had undergone lower extremity amputation surgery between 2006 and 2010. A predictive model was developed using backward stepwise logistic regression. The model discrimination was assessed by the receiver operating characteristics curve and its calibration by the Hosmer and Lemeshow goodness of fit test. Result Three variables were identified which influenced stump healing. Serum Sodium - The lower limb stump healing was 75% likely in patients with normal serum sodium compared to that of patients with abnormal serum sodium (odds ratio [OR] 1.756; 95% confidence interval [CI] 1.048-2.942) Serum Creatinine- Patients with normal serum creatinine were 66% more likely to have their stump healed (OR 1.664; 95% CI 0.94 to 2.946) Serum High Density Lipoproteins - A normal serum HDL resulted in a 75% more likely chance of healing compared to those with abnormal serum HDL (OR 1.753; 95% CI 1.061 to 2.895). There was a good calibration as indicated by Hosmer and Lemeshow goodness of fit test (P=0.879) and the c-index was 0.612. Conclusion Serum Sodium, Serum High Density Lipids and Serum creatinine are useful predictors of lower limb stump. The clinical utility of these risk categories in the healing of a lower limb stump requires further clinical evaluation in a prospective study.
Development of prognostic model for fistula maturation in patients with advanced renal failure
(BioMed Central, 2018-03-07) Siddiqui, Muhammad A.; Ashraff, Suhel; Santos, Derek; Rush, Robert; Carline, Tom; Raza, Zahid
Background: This study aimed to explore the role of patient's characteristic and haematological factors as predictive on the maturation of arteriovenous fistulae in patients who underwent vascular access surgery at the Royal Infirmary of Edinburgh. Methods: Retrospective data from 300 patients who had undergone fistula creation between February 2007 and October 2010 was examined. A predictive logistic regression model was developed using the backward stepwise procedure. Model performance, discrimination and calibration, was assessed using the receiver operating characteristics (ROC) curve and Hosmer and Lemeshow goodness of fit test. Results: Three variables were identified which independently influenced fistula maturation. Males were twice as likely to undergo fistula maturation, compared to that of females (odds ratio (OR) 0.514; 95% confidence interval (CI) 0.308-0.857), patients with no evidence of peripheral vascular disease (PVD) were three times more likely to mature their fistula (OR 3.140; 95% CI 1.596-6.177) and a pre-operative vein diameter > 2.5 mm resulted in a fivefold increase in fistula maturation compared to a vein size less than 2.5 mm (OR 4.532; 95% CI 2.063-9.958). The model for fistula maturation had fair discrimination as indicated by the area under the ROC curve (0.68; 95% CI 0.615-0. 738) but good calibration indicated by Hosmer and Lemeshow test (p = 0.79). Conclusion: Gender, PVD and vein size are independent predictors of arteriovenous fistula maturation. The clinical utility of these risk equation in the maturation of arteriovenous fistulae requires further validation in the newly treated patients.
Drug treatments for high cholesterol blood levels, with Atorvastatin versus Simvastatin: A Systematic review and Meta-analysis
(Queen Margaret University, 2008-08) Siddiqui, Muhammad A.
Objectives: Diabetes mellitus is a strong risk factor for atherosclerosis and is often characterized by hyperlipidemia. This review was done to evaluate the effectiveness of pharmacological management of hyperlipidemia with atorvastatin versus simvastatin in lowering high cholesterol among diabetic and cardiac patients. Sources: Trials were identified by searching four electronic databases (Medline, Cochrane, Pub Med, Scopus and Highwire) and the reference lists of eligible publications. Keywords: Dyslipidemia, statins and diabetes, atheroscelerosis, statins, atorvastatin, simvastatin Methods: We performed a systematic review of trials that randomly assigned participants to receive atorvastatins versus simvastatin or simvastatin versus placebo or atorvastatin versus placebo for a minimum of 6 week. A meta-analysis was performed using a fixed-effects model, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated to estimate pooled treatment effects. All statistical tests were two sided. Revman 5.0 version have been used to assess the difference between two treatment group. Result: Thirteen trials were included, involving a total of 20598 participants. Trials differed considerably in their inclusion criteria; outcomes measured, and type of lipid-lowering therapy used. The pooled results from all eligible trials indicated that atorvastatin therapy had no statistically significant effect than simvastatin on overall mortality (Risk Ratio (RR) 0.88; 95% confidence Interval (CI) 0.34 to 2.27; P = 0.78)) or on total cardiovascular events (RR 0.99; 95% CI 0.69 to 1.42, P = 0.95). However, analysis showed that atorvastatin significantly reduced the total blood cholesterol versus simvastatin (RR 0.74; CI 0.55 to 0.98). This was primarily due to a positive effect on total coronary events (RR 8.24; 95%CI 8.18 to 8.29; P < 0.00001). Greatest evidence of effectiveness came from the use of atorvastatin in people with blood cholesterol 3.5 mmol/litre. Conclusion: The role of statin therapy as a main component of cardiovascular risk reduction in-patients with diabetes. Atorvastatin have significantly better outcomes in lowering blood cholesterol against simvastatin but there was no significant difference in the mortality and total cardiovascular events.
Education in Action: Reflective Practice
(2012-07) Siddiqui, Muhammad A.
Action research and learning is a process to improve the practice of teaching and training by critical analysis and engage our self in designing and evaluating training programmes and continuing professional development. Personal narrative writing on our experiences and practice plays a vital role in learning and teaching. Self evaluation is useful to assess our performance using videotapes recording during teaching, logbooks, and personal portfolios. There is a strong relationship between research and teaching. Collaborative nature of learning and understanding of process of research is crucial for broad approach to educational enquiry, research and evaluation.
Effect of Exercise and Muscle Contraction on Insulin Action, Transportation and Sensitivity and Muscle Fibres in type II Diabetes Mellitus
(Scientific & Academic Publishing, 2012-11) Rehman, A. U.; Siddiqui, Muhammad A.; Ashraff, Suhel
This review will critically evaluate the role of exercise in increasing the insulin action, transportation and sensitivity in skeletal muscles. The review will also, try to explore the relationship between the insulin stimulation and glucose transporter type 4 (GLUT-4) protein after the exercise The secondary purpose of this review is to explore whether the exercise induced sensitivity of glucose transport activation is mediated by translocation of greater number of GLUT-4 to the cell surface, and the role of different types of exercise in increasing insulin sensitivity. The review concluded that the stimulation of insulin and exercise is relevant to the physiological developed process of GLUT-4, isoform gene expression is precise and associated with the exercise only. While performing the endurance exercise as well as resistance training we can maintain the muscle bulk and prevent the atrophy in DM. Furthermore, it was proved that the resistance training puts direct effects on the muscles glycogen uptake intracellular and extra cellular signalling pathway and GLUT4, when the subject fed the rich diet of carbohydrate and participates in the exercise. These effects also found in the non-diabetes and healthy subjects.
Effect of progressive resistive exercise training in improving mobility and functional ability of middle adulthood patients with chronic kidney disease
(Wolters Kluwer, 2015) Sah, Sanjiv K.; Siddiqui, Muhammad A.; Darain, Haider
Patients with chronic kidney disease (CKD) in their middle adulthood are more prone to reduced mobility than younger patients having the same medical condition. Progressive resistive exercise training (PRT) is deemed an effective treatment approach for the management of muscular weakness in patients with CKD. The present review is an attempt to understand the effectiveness of PRT in the mobility and functional ability of patients suffering from CKD. We systematically searched electronic databases, including Medline, Scopus, PubMed, CINAHL, PEDRo and Cochrane, to review the published literature on this subject. Electronic searches were limited to training programs carried out on resistive, aerobic, endurance and therapeutic exercises reporting outcome measures including muscular strength, size, physical function and functional capacity in the clinical population with CKD aged > 40 years. Studies with a minimum duration of eight weeks of exercise training or more were considered eligible for review. The methodological criteria of the included studies were assessed with the PEDro scale. A total of 80 articles were identified using the keywords in the above-mentioned databases. However, based on the study's inclusion and exclusion criteria, only 11 articles were finally included. The results of this review substantiate the effectiveness of PRT in patients with CKD. However, further research is warranted in this area due to the limited availability of high-quality published evidence.
Effects of cultural shock on foreign health care professionals: An analysis of key factors.
(GESDAV, 2012-05-03) Guru, Rakesh; Siddiqui, Muhammad A.; Ahmed, Zeeshan; Khan, Adeel Ahmed
This review is based upon the foreign health care professionals (FHCP) who goes to various developed countries (United Kingdom, United States of America, Australia, Germany and France) from developing countries (India, Pakistan, Africa, Philippines etc) for work to have a better life style, good income, more opportunities, but experienced cultural shock with other types of problem. Cultural shock- is the mixture of anxiety and feelings of confusion, excitement and insecurity and each person feels it differently. To explore this topic in depth, we divided the topic into separate themes to achieve maximum knowledge that followed by reflection, recommendations and conclusion. FHCP generally feel the unfamiliar environment when they visit to a completely different culture in a foreign country and feel certain problems (familial, professionals, technical etc.) along with cultural shock. Following these findings, we have identified three themes: The first theme will discuss about the cultural shock among FHCP and its impact. The second theme will be a focus on different issues of FHCP about their failure or struggle due to culture shock and third theme which is management challenges in order to establish appropriate culture in organization. For this review, we searched and selected various peer reviewed articles online using search engines and databases including Medline, Scopus, Cinhail and Cochrane and books from the University of Northampton library and peer reviewed journals including International Journal of Intercultural Relations, Human Resources for Health, British Medical Journal and Bulletin of The World Health Organization as well. This review will help to explore different aspects of FHCP such as adjustment with entirely different culture, lack of experience, different lifestyles, face problems being immigrants, and working in a completely different setup with certain rules and regulations.
End treatment response and sustained viral response in hepatitis C virus genotype 3 among Pakistani population
(2013-12) Amir, Muhammad; Rahman, Attiya Sabeen; Jamal, Qaiser; Siddiqui, Muhammad A.
BACKGROUND AND OBJECTIVES: This study aimed to determine the end treatment response (ETR) and sustained viral response (SVR) to interferon (IFN) and ribavirin in hepatitis C virus (HCV) genotype 3 in the Pakistani population. DESIGN AND SETTINGS: This is an interventional study conducted from January 2010 to December 2012 in Lyari General Hospital and Abbasi Shaheed Hospital, Karachi, outpatients department. METHODS: All patients with chronic hepatitis C genotype 3 infections were included. Patients with decom.pensated chronic liver disease, or having coexisting hepatitis B virus/human immunodeficiency virus were excluded. All patients received IFN alpha, 3 million international units (MIU), subcutaneously 3 times weekly and ribavirin >800 mg/d for a period of 6 months. Outcome parameters included ETR (negative polymerase chain reaction [PCR] at the end of therapy), SVR (negative PCR both at the end of treatment and 6 months later), and relapse (PCR negative at the end of treatment but positive 6 months later) were determined. RESULTS: A total of 1170 patients were included with a female to male ratio of 1.64:1 and a mean age of 31.6 (8.4) years. Among 1170 patients, 985 completed the therapy as per the protocol, 119 were defaulted (treatment abandoned before completion), and 66 had to stop treatment due to side effects. ETR was 74.1%, SVR was 98%, relapse rate was 1.5%, and 10.1% were nonresponders. SVR was seen only in patients who had achieved an ETR (n=867). SVR was achieved in 848 patients (out of 867) (98%), relapse was seen in 13 (1.5%), and 6 (0.7%) patients lost follow-up after stopping treatment. Patients achieving ETR and SVR had a mean serum alanine aminotransferase of 71.3 (57.1) and 71.0 (56.5), respectively, which is approximately twice the upper normal limit. CONCLUSION: The conventional IFN and ribavirin therapy in genotype 3 chronic HCV-infected patients gives an ETR and SVR of 74.1% and 98%, respectively.
Haemodialysis and Vascular Access in the End Stage Kidney Disease
(SciencePG, 2017-01-12) Siddiqui, Muhammad A.; Santos, Derek; Ashraff, Suhel; Carline, Tom
The efficiency of haemodialysis treatment relies on a functional status of vascular access. A vascular access makes life-saving haemodialysis treatments possible. The efficiency of haemodialysis treatment relies on a functional status of vascular access. The purpose of this review was to discuss the role of haemodialysis and vascular access in end stage kidney disease. Vascular access and its related problems represent the main factors that determine a rise in the rate of incidence of the disease among haemodialysis patients and, consequently, a rise in the healthcare expenses. Vascular access can be divided into three categories: arteriovenous fistula, central venous catheter and arteriovenous graft. Central venous catheter has a number of disadvantages, including a considerable risk of infection and mortality. It also has negative implications for the use of a fistula for dialysis. In contrast, arteriovenous fistula is the most beneficial method, as it has a low risk of infection and mortality, and can ensure long-term functional access. Furthermore, there are three configurations of native arteriovenous fistula that can be used for haemodialysis providing flexibility of approach depending on risk factors of the individual patient.
Health education in diabetic population: Current practice and future challenges.
(Scientific & Academic Publishing Co., 2012-08) Siddiqui, Muhammad A.; Ahmed, Zeeshan; Khan, Adeel Ahmed
The aim of this review is to discuss the role of health education, self-management and multidisciplinary approach and how they can improve to produce a framework for better practice. Diabetes is a growing problem in all over the world. It is associated with severe complications if it is not adequately controlled. Diabetes patients need to develop a range of com-petencies that allow them to take greater control over the treatment of their disease. This requires education that promotes health whilst respecting individuals' self-perceived needs and voluntary choices. However, such concept is not new in the field of diabetes; health professionals are still struggling with how to administer it successfully. Diabetic patients can be educated toward greater autonomy, but all health professionals are not ready to work in partnership with them. This review indicates that there are number of important changes which need to be taken. There is a need to gain better understanding of diabetes management and theoretical principles underlying patient empowerment and education. In order to achieve better outcomes and effective health care services, collaboration of different health care professional working in different setup is required.
Ischaemic stroke and peripheral artery disease
(Pakistan Medical Association, 2017-08-01) Rahman, A. S.; Akhtar, S. W.; Jamal, Q.; Sultana, N.; Siddiqui, Muhammad A.; Hassan, Z.
Objective: To determine the frequency of atherosclerosis by ankle brachial index in patients with an ischaemic stroke and to assess the association of carotid artery stenosis and ankle brachial index in ischaemic stroke. Methods: This cross-sectional study was conducted at Abbasi Shaheed Hospital, Karachi, from July 2011 to May 2014, and comprised patients with ischaemic stroke. The patients were classified according to the Asian stroke criteria for classification of brain infarction. Primary outcome measures included carotid artery stenosis and ankle brachial index. The other independent variables were age, gender, body mass index and waist circumference. SPSS 20 was used for data analysis. Results: A total of 327 patients were enrolled. The overall mean age was 57.612.8 years. Besides, 168(51.3%) participants were males. Peripheral artery disease was found in 60(18.3%) patients. Mild carotid artery stenosis was found in 182(55.6%) patients, moderate in 140(42.8%), severe in 3(0.9%) and complete occlusion in 2(0.6%) patients. In patients having mild carotid artery stenosis, 32(17.5%) had peripheral artery disease, whereas in patients with moderate carotid artery stenosis, 25(17.8%) had peripheral artery disease. Conclusion: Abnormally low ankle brachial index suggesting subclinical peripheral artery disease was 18%. Keywords: Ischaemic stroke, Peripheral artery disease, Ankle brachial index, Carotid artery stenosis. (JPMA 67: 1138; 2017)
Knowledge, Attitude and Practices about Blood Donation among Undergraduate Medical Students in Karachi
(2014-03-29) Ahmed, Zeeshan; Zafar, Mubashir; Khan, Adeel Ahmed; Anjum, Muhammad Umair; Siddiqui, Muhammad A.
Background: Blood donation is a major concern to the society as donated blood is lifesaving for individuals who need it. In Pakistan, the concept of voluntary blood donors is almost non-existent due to the absence of blood donor motivation and retention strategies. The healthy, active and receptive huge student population can be potential blood donor to meet the safe blood requirements. The objective of this study was to determine the knowledge, attitude and practices about blood donation among undergraduate medical students in Karachi. Methods: A cross sectional study was conducted in two public and one private medical college in Karachi from January to March 2012. A total of 600 medical students were interviewed with the help of structured questionnaire. Data analysis was performed in SPSS version 19. Multiple regressions were used to examine the effect of different independent variables on a single dependent variable to test the statistical significance at 95% confidence level. Results: The majority of participants (92%) had appropriate knowledge regarding the various aspects of blood donation. Attitude domain showed that around 42% of students were positive about blood donation. Around 50% of students showed willingness to donate blood. After adjusting for potential confounders, male gender was associated with appropriate knowledge, positive attitude and willingness for blood donation when compared against female gender. Conclusion: Good knowledge about blood donation practices is not transforming in donating blood. Interactive awareness sessions on blood donation should be organized during undergraduate years and opportunities for blood donation should be created for the students, which can greatly enhance the movement for voluntary non-remunerated blood donation-, to ensure good quality of blood and safe modern medical care.
Knowledge, Skills and Practices of Transient Ischemic Attack Intervention amongst General Practitioners in Karachi, Pakistan
(JPMS Publisher, 2014-10) Rahman, Attiya Sabeen; Jamal, Qaiser; Siddiqui, Muhammad A.; Riaz, Mehwish; Aatif, Sabeen; Suleman, Faisal
BACKGROUND: The role of a general practitioner (GP) in the early recognition, assessment and management of transient ischemic attack (TIA) is vital to prevent subsequent stroke. The aim of this study was to determine the GPs knowledge of TIA recognition, assessment, and management. METHODS: The study comprised a questionnaire survey of 228 GPs in all 19 towns of Karachi, Pakistan. The questionnaire consists of demographic details and case scenarios based questions which had three responses (yes, no, do not know). Case scenarios were based on the typical neurological cases seen in general practice. The sections covered risk stratification, investigations, and management of TIA. Questionnaire were provided and briefed to GPs by two-trained research assistants. Statistical analysis was performed using SPSS (IBM SPSS Statistics 20.0). Data were expressed in frequencies for all questionnaire responses and calculated for all variables in numbers and percentage. Cross tabulation was performed to determine, if there was a relationship between subgroups. Chi-square test was used for comparative analysis. RESULTS: All 228 GPs responded to the survey. Most of the GPs responded correctly to the stratification of risk of TIA, and early risk of subsequent stroke. Majority of the GPs correctly responded to the investigations and the management of TIA. Difficulty in accessing neurological consultation was not identified as a barrier (74%). CONCLUSION: This study concludes that, GPs can recognize TIA reasonably which is a major contribution to the assessment and management of TIA in the community. This is due to the continuous medical education and training in dealing with the specialized groups of patients.
Maturation of arteriovenous fistula: Analysis of key factors
(The Korean Society of Nephrology, 2017-12-31) Siddiqui, Muhammad A.; Ashraff, Suhel; Carline, Tom
The growing proportion of individuals suffering from chronic kidney disease has considerable repercussions for both kidney specialists and primary care. Progressive and permanent renal failure is most frequently treated with hemodialysis. The efficiency of hemodialysis treatment relies on the functional status of vascular access. Determining the type of vascular access has prime significance for maximizing successful maturation of a fistula and avoiding surgical revision. Despite the frequency of arteriovenous fistula procedures, there are no consistent criteria applied before creation of arteriovenous fistulae. Increased prevalence and use of arteriovenous fistulae would result if there were reliable criteria to assess which arteriovenous fistulae are more likely to reach maturity without additional procedures. Published studies assessing the predictive markers of fistula maturation vary to a great extent with regard to definitions, design, study size, patient sample, and clinical factors. As a result, surgeons and specialists must decide which possible risk factors are most likely to occur, as well as which parameters to employ when evaluating the success rate of fistula development in patients awaiting the creation of permanent access. The purpose of this literature review is to discuss the role of patient factors and blood markers in the development of arteriovenous fistulae.