Shumaila Furnaz - Academia.edu (original) (raw)

Papers by Shumaila Furnaz

European Journal of Neurology, 2001

ABSTRACT To study the efficacy and safety of botulinum toxin type A (BtxA) in the treatment of up... more ABSTRACT To study the efficacy and safety of botulinum toxin type A (BtxA) in the treatment of upper limb muscle spasticity, caused by stroke. This was a randomized, controlled trial. Patients received either placebo injections or a total of 1000 IU of BtxA (Dysport) into five muscles of the affected arm. Muscle tone was assessed using the Modified Ashworth Scale (MAS). Other outcome measures were the change in the joint range of motion (ROM), the Barthel index, pain score, goal attainment and the subjective evaluation of benefit by patients and investigators. The patients were assessed blind to randomization at baseline and 4, 8, 12 and 16 weeks after treatment. Fifty nine patients were recruited and received treatment. One patient was lost to follow-up before the last scheduled visit of the study. The group of patients who received BtxA had a significant reduction in the summed MAS score at week 4 compared with the placebo group (P=0.004). The magnitude of benefit over the 16 week follow-up period was significantly reduced for the BtxA group in the wrist (P=0.004) and the finger joints (P=0.001) when compared with the placebo. There was no statistically significant difference between the groups in the joint ROM, muscle pain, goal-attainment or the Barthel index scores at week 4 of the study. At week 16, the BtxA group showed significantly greater improvement in the passive ROM at the elbow (P=0.036). The patients' global assessment of benefit at the end of the study showed that 16 (50%) patients in the placebo group had 'much improved' or had 'some improvement' compared with 24 (92.3%) patients in the BtxA group (P=0.007). The investigators' rating for the same item was 16 (50%) and 23 (88.4%) patients, respectively (P=0.002). Sixteen and twenty patients in the BtxA and placebo groups, respectively, had an adverse event. The most frequently reported adverse events were accidental injury, respiratory and urinary tract infections and muscle pain. The findings of the present study suggest that treatment with BtxA in a dose of 1000 units reduces muscle tone in patients with post-stroke upper limb spasticity. This effect is sustained for at least 16 weeks. BtxA is safe in the dose used in this study. IMPORTANT NOTE: The authors wish to emphasize that the botulinum toxin preparation used in this study was Dysport (Ipsen Ltd) which has a different therapeutic equivalence from other commercially available product, Botox (Allergan Inc.).

PubMed, May 1, 2012

Following percutaneous intervention (PCI), restenosis, progression of disease and multi-vessel in... more Following percutaneous intervention (PCI), restenosis, progression of disease and multi-vessel involvement may require further intervention in the form of surgical revascularization. Patients with coronary artery bypass grafting (CABG) done after PCI were evaluated to find out the reason for the need of surgical revascularization. Over a period of 12 months, 610 patients underwent CABG. Out of them, 34 patients had previous PCI/stenting. Coronary risk factors including hypertension in 85%, diabetes mellitus in 60%, dyslipidemia in 60%, tobacco use in 50% and a positive family history was present in 53% of the patients. All patients were symptomatic. Multi-vessel disease was present in 67% and single vessel in 4.7%. The extent of disease and stenosis of stents were responsible for reintervention. Careful selection of patients is required in presence of multiple risk factors for coronary artery disease to provide maximum benefit by either PCI or CABG.

European Heart Journal - Quality of Care and Clinical Outcomes, Apr 8, 2019

Aims: The European Society of cardiology (ESC) EURObservational Research Programme (EORP) Europea... more Aims: The European Society of cardiology (ESC) EURObservational Research Programme (EORP) European Endocarditis (EURO-ENDO) registry aims to study the care and outcomes of patients diagnosed with infective endocarditis and compare findings with recommendations from the 2015 ESC Clinical Practice Guidelines for the management of infective endocarditis and data from the 2001 Euro Heart Survey. Methods and results: Patients (n=3116) aged over 18 years with a diagnosis of infective endocarditis based on the ESC 2015 infective endocarditis diagnostic criteria were prospectively identified between January 1 st , 2016 and March 31 st , 2018. Individual patient data were collected across 156 centres and 40 countries. The primary end-point is all-cause mortality in hospital and at 1-year. Secondary end-points are 1-year morbidity (all-cause hospitalisation, any cardiac surgery and infective endocarditis relapse), the clinical, epidemiological, microbiological, and therapeutic characteristics of patients, the number and timing of non-invasive imaging techniques, and adherence to recommendations as stated in the 2015 ESC Clinical Practice Guidelines for the management of infective endocarditis. Conclusion: EURO-ENDO is an international registry of care and outcomes of patients hospitalised with infective endocarditis which will provide insights into the contemporary profile and management of patients with this challenging disease.

Value in Health, May 1, 2013

pressure to quit. CONCLUSIONS: Developing smoking cessation interventions based on punitive incen... more pressure to quit. CONCLUSIONS: Developing smoking cessation interventions based on punitive incentives or policies such as smoke free campuses may benefit KSA in the long run. MPOWER program may not be enough for improving smoking cessation in Saudi college students. Investing in programs that can mould the young minds at an early age to quit smoking need to be developed.

Value in Health, 2012

To assess the impact of database development on clinical practice and quality of care. METHODS: W... more To assess the impact of database development on clinical practice and quality of care. METHODS: We chose the following aspects of patient care to be included in the database form: pre-surgery patient condition and medications, surgery information, recovery information, status of the patient atdischarge, 30days and 365-days post-surgery follow-up information.Information was collected through structured questionnaire and entered into Microsoft Access software. RESULTS: From January 2006-May 2011, there was 3418 open heart surgeries performed. The overall 30-daymortality was 3.6%. Post-surgery morbidity was 21.5%which includes 3.6% reoperation for bleeding 0.6% neurological 0.7% dialysis 1.3% heart failure 0.3% septicemia 1.8% prolonged ventilation 8.6% multiorgan failure and 0.9% respiratory complications 1.7% cardiac arrest,1.1% deep sternal wound infection 0.1% Follow up at30-days patients alive were 91.6% death 0.1% lost to follow-up 3.6%and 365-daysshowed that alive 93.2% death2.1% lost to followup,4.6%. CONCLUSIONS: Before this database, there was no way to monitor the risk factors, mortality and morbidity. Fortunately with the development of database, pre operation risk factors, post-surgery mortality and morbidity rates could easily be generated. Based on the prevalent risk factors coming up in our data we can help prevent the cardiac disease. It also helped in controlling preventable post-surgery complications. It also helps in identification of a gap inpatient knowledge regarding the use of warfarin after heart valve surgery and deficiencies in laboratory capabilities, both causing catastrophic complications. As a result, we modified our practice in an effort to address these issues and reduce the complication rates after heart valve surgery. Updated and stringently maintained database helps to identify deficiencies in practice and provides a direction for future improvement.

Journal of Primary Care & Community Health, 2020

Objective:Aim of this survey was to assess the prevalence of cardiovascular diseases (CVD) risk f... more Objective:Aim of this survey was to assess the prevalence of cardiovascular diseases (CVD) risk factors and attitude toward self-risk assessment among cardiac care physicians (who did not have CVD history), at a tertiary care cardiac center in Pakistan.Design:In this survey we included cardiac care givers who had a minimum of 1 year of working experience in a cardiac care center.Participants:Participants with self-reported history of established diagnosis of CVD were excluded. Face-to-face interviews were conducted with the help of a structured questionnaire which consisted of demographic information, data regarding established CVD risk factors, self-awareness, and attitude toward CVD risk assessment.Results:A total of 126 participants were interviewed, out of which 20.6% (26) were females and mean age was 36.1±7.6 years. The most prevalent CVD risk factor was family history of CVD (33.3%) followed by smoking (14.3%) and 23.8% had body mass index of ≥27.5 kg/m2. Around 23% of the participants did not know their cholesterol levels, similarly more than 74% were not aware of their high-density lipoproteins levels. More than 76% had never assessed their CVD risk and more than 37% don’t know or don’t have any opinion about their own CVD risk.Conclusions:The present study reveals low prevalence of conventional cardiac risk factors and marginally higher tendency of modifiable risk factors, such as smoking and obesity, among the cardiac physicians. A large proportion of these cardiac physicians have not yet assessed their CVD risk.

International Journal of Cardiovascular Research, 2019

Background: Hypertension has important effects on left ventricle and its early detection helps to... more Background: Hypertension has important effects on left ventricle and its early detection helps to avoid the cardiac complications. LV Twist in systole helps in storing potential energy while during diastole; LV untwist releases this energy. Speckle tracking echocardiography (STE) is angle-independent so allows a more detailed evaluation of myocardial deformation. Objective: This work aimed to assess the left ventricular torsion by speckle tracking in hypertensive patients. Patients and methods: The study was applied on 40 hypertensive patients and 20 age and sex matched control groups all had speckle tracking echocardiography of the LV, the basal and apical rotation were measured to assess the LV torsion. The 18 segment of LV strain were assessed and the net LV global longitudinal strain was calculated and demonstrated as bull's eye figure. Results: Hypertensive patients had higher mean values of both apical rotation and left ventricular twist than control group by a highly significant value (9.76 ± 4.98 vs. 4.03 ± 2.15, P valuec0.001) and (15.25 ± 4.10 vs. 9.90 ± 1.47, P value˂0.001) respectively. Hypertensive patients had a higher basal rotation than controls but did not reach a significant value (-6.01 ± 3.25 vs. -5.52 ± 2.63, P value 0.558). On the contrary; the global LV longitudinal strain was lower in hypertensive patients than control but did not reach a significant value (-18.48 ± 3.94 vs. -19.48 ± 3.57, P value 0.341). Conclusion: Hypertension affects myocardial structure and its systolic and diastolic functions; the left ventricular twist is an essential component of the systolic function that increases in hypertension as an early compensation for the systolic impairment. The detection of these changes achieved accurately by 2-D speckle tracking, can help in monitoring the treatment modalities of the patients for a better direction of treatment and thus, prevent further deterioration.

Value in Health, Nov 1, 2019

a multi-institutional database (Chang Gung Research Database, CGRD) containing the electronic med... more a multi-institutional database (Chang Gung Research Database, CGRD) containing the electronic medical records of approximately 1.3 million patients (6% of the Taiwanese population). Included were adult type 2 diabetes patients who had been newly prescribed SGLT2 inhibitors between 2016 and 2017, and these were followed up from initiation of SGLT2 inhibitors until their heart failure hospitalizations, last clinical visit or death before March 31, 2019. We used multi-variate Cox proportional hazard modeling, with adjustment for age of patient, gender, baseline glycemic controls, renal functions, co-morbidities and concomitant use of medication. Results: The database yielded 14,458 new users of SGLT2 inhibitors, with mean age 59.3 (SD 11.8) years old. Of these, 42.6% were female; 45.1% were newly receiving dapagliflozin. The total included amount of dapagliflozin use was 12,974 person-years, while total empagliflozin use was 15,413 person-years. New users of dapagliflozin were at lower risk of heart failure hospitalizations (adjusted HR: 0.70; 95% CI: 0.53-0.93) when compared to new users of empagliflozin. Falsification testing showed dapagliflozin and empagliflozin carried a similar risk of atrial fibrillation hospitalizations (adjusted HR: 1.04; 95% CI: 0.73-1.47). Conclusions: Patients with type 2 diabetes newly receiving dapagliflozin were at lower risk of heart failure hospitalizations when compared to empagliflozin users. Clinicians should be cognizant of the comparative differences between SGLT2 inhibitors when deciding medications for patients with type 2 diabetes.

DOAJ (DOAJ: Directory of Open Access Journals), 2022

Background In the era of COVID-19 where there is emphasis on the importance of wearing a mask, we... more Background In the era of COVID-19 where there is emphasis on the importance of wearing a mask, wearing it rightly is equally important. Therefore, the purpose of this study was to assess the knowledge, attitude and practice of wearing a mask in the general population of a developing country at three major tertiary care hospital. Materials and methods Participants of this cross-sectional study were patients and attendants at three major tertiary care hospital of Karachi Pakistan. Selected participants, through non-probability convenient sampling technique, were interviewed regarding knowledge, attitude, and practice of wearing mask using an Urdu translated version of a questionnaire used in an earlier study. Three summary scores (0 to 100) were computed to indicate participants' mask wearing practice, technique of putting it on, and technique of taking if off. Collected data were analyzed with the help of IBM SPSS version 19. Results A total of 370 selected individuals were interviewed, out of which 51.9% were male and mean age was 37.65±11.94 years. For more than 90% of the participants, wearing a face mask was a routine practicing during the pandemic. The mean practice score was 65.69±25.51, score for technique of putting on a face mask was 67.77±23.03, and score of technique of taking off a face mask was 51.01±29.23. Education level of participant tends to have positive relationship with all three scores, while presence of asthma or chronic obstructive pulmonary disease (COPD) as co-morbid had negative impact on mask wearing practice. Conclusion We have observed suboptimal knowledge, attitude and practice of wearing mask among the selected individuals. There is a continued need to spread awareness and educate general

Journal of Occupational and Environmental Medicine, Nov 23, 2020

Objectives: Aim of this study was to determine the depression, stress, and anxiety level among he... more Objectives: Aim of this study was to determine the depression, stress, and anxiety level among healthcare workers working at a tertiary care cardiac center of Karachi Pakistan during COVID-19 pandemic. Methods: This survey was conducted at the National Institute of Cardiovascular Disease (NICVD), Karachi, Pakistan. Participants of the study were fulltime employees of hospital. Data were collected using an online questionnaire and Depression, Anxiety and Stress - 21 (DASS-21) scale was used. Results: A total of 224 healthcare workers were included, 46 (20.5%) participants were screened for moderate to severe depression, 20.1% (45) for moderate to severe anxiety, and 14.7% (33) for moderate to severe stress. Conclusion: A significant levels of depression, anxiety, and stress were noted with the major concerns of workplace exposure, increased risk of infection, and transmission to their families and friends.

Value in Health, 2019

Heart

ObjectiveAs COVID-19 continues to affect the global population, it is crucial to study the impact... more ObjectiveAs COVID-19 continues to affect the global population, it is crucial to study the impact of the disease in vulnerable populations. This study of a diverse, international cohort aims to provide timely, experiential data on the course of disease in paediatric patients with congenital heart disease (CHD).MethodsData were collected by capitalising on two pre-existing CHD registries, the International Quality Improvement Collaborative for Congenital Heart Disease:Improving Care in Low- and Middle-Income Countriesand the Congenital Cardiac Catheterization Project on Outcomes. 35 participating sites reported data for all patients under 18 years of age with diagnosed CHD and known COVID-19 illness during 2020 identified at their institution. Patients were classified as low, moderate or high risk for moderate or severe COVID-19 illness based on patient anatomy, physiology and genetic syndrome using current published guidelines. Association of risk factors with hospitalisation and in...

European Heart Journal, 2021

Background Infective endocarditis (IE) is a life threatening disease associated with high mortali... more Background Infective endocarditis (IE) is a life threatening disease associated with high mortality and morbidity worldwide. We sought to determine how socio-economic factors may influence variations in epidemiology, clinical presentation, investigation and management (and their consequence upon clinical outcomes) in a large international multi-centre registry. Methods The ESC-EORPEURO-ENDO registry comprises a prospective cohort of 3116 adult patients admitted to 156 hospitals in 40 countries with IE between January 2016 and March 2018. We analysed the complete dataset to assess potentially important determinants of variation according to World Bank economic stratification (high income (Group 1) [73.8%]; upper-middle income (Group 2) [17.1%]; lower-middle income (Group 3)[9.1%]). Results Patients in Group 3 were younger (median age [IQR]: Group 1 - 66 [54–75] years; Group 2 - 57 [40–68] years; Group 3 - 33 [26–43] years; p<0.001) with a higher prevalence of smoking, intravenous ...

Emerging Health Threats Journal, 2011

Using a real-time syndromic surveillance system to track heat-related illnesses during a heat wav... more Using a real-time syndromic surveillance system to track heat-related illnesses during a heat wave Shandy Dearth, Kenneth Mulanya and Julia Butwin 40. Norovirus disease surveillance using Google search data

Infection, 2022

Purpose High mortality and a limited performance of valvular surgery are typical features of infe... more Purpose High mortality and a limited performance of valvular surgery are typical features of infective endocarditis (IE) in octogenarians, even though surgical treatment is a major determinant of a successful outcome in IE. Methods Data from the prospective multicentre ESC EORP EURO-ENDO registry were used to assess the prognostic role of valvular surgery depending on age. Results As compared to < 80 yo patients, ≥ 80 yo had lower rates of theoretical indication for valvular surgery (49.1% vs. 60.3%, p < 0.001), of surgery performed (37.0% vs. 75.5%, p < 0.001), and a higher in-hospital (25.9% vs. 15.8%, p < 0.001) and 1-year mortality (41.3% vs. 22.2%, p < 0.001). By multivariable analysis, age per se was not predictive of 1-year mortality, but lack of surgical procedures when indicated was strongly predictive (HR 2.98 [2.43-3.66]). By propensity analysis, 304 ≥ 80 yo were matched to 608 < 80 yo patients. Propensity analysis confirmed the lower rate of indication for valvular surgery (51.3% vs. 57.2%, p = 0.031) and of surgery performed (35.3% vs. 68.4%, p < 0.0001) in ≥ 80 yo. Overall mortality remained higher in ≥ 80 yo (in-hospital: HR 1.50[1.06-2.13], p = 0.0210; 1-yr: HR 1.58[1.21-2.05], p = 0.0006), but was not different from that of < 80 yo among those who had surgery (in-hospital: 19.7% vs. 20.0%, p = 0.4236; 1-year: 27.3% vs. 25.5%, p = 0.7176). Conclusion Although mortality rates are consistently higher in ≥ 80 yo patients than in < 80 yo patients in the general population, mortality of surgery in ≥ 80 yo is similar to < 80 yo after matching patients. These results confirm the importance of a better recognition of surgical indication and of an increased performance of surgery in ≥ 80 yo patients.