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The Professional Medical Journal , 2010,
Abstract: To know efficacy of combination of standard interferon α2b and ribavirin in chronic hepatitis C. Design: Prospectiveand analytical. Setting: CMH Bahawalpur. Period: Nov 2008 to Dec 2009. Materials and methods: A total of 126 patients, 104 males and 22females, fulfilling inclusion and exclusion criteria were started combination treatment. Of these, 110 (87.3%) completed the treatment while 16(12.7%) patients could not complete the treatment so they were dropped out of this study. Patients were started on Interferon α2b in a dose ofthree million units sub-cutaneous (s/c) thrice a week along with daily Ribavirin 1000 milligram (mg) and 1200 mg orally for patients weighing lessor more than 75 kilogram (kg) respectively. The primary outcomes, normalization of ALT and undetectable HCV-RNA by PCR, were determinedat end of three and six months of treatment. Results: From Nov 2008 to Dec 2009, a total of 110 patients were treated with combination ofInterferon α2b and Ribavirin for 24 weeks. Sixty eight patients (62%), 52 males and 12 females showed “end of treatment response” (ETR).Conclusions: Results of the study show effectiveness of the combination therapy of standard interferon and ribavirin for Chronic Hepatitis C.Results of this study are comparable to local and international studies.
Molecular epidemiology of Hepatitis B virus genotypes in Pakistan
Muhammad Alam, Sohail Zaidi, Salman Malik, Shahzad Shaukat, Asif Naeem, Salmaan Sharif, Mehar Angez, Javed Butt
BMC Infectious Diseases , 2007, DOI: 10.1186/1471-2334-7-115
Abstract: A total of 690 individuals were enrolled for HBV screening with EIA and nested PCR. Positive samples were further analyzed to determine HBV genotypes (A-F) by multiplex-PCR using type specific primers.110 (15.94%) individuals were positive for HBV, including 64% males and 36% females. Out of these, 66 samples (65.34%) were classified into genotype D, 27 (26.73%) were of genotype B while 5(4.95%) had genotype A. In 3 (2.98%) samples, multiple genotypes were detected (genotype A+B; 2(1.99%) and genotypes B+D; 1(0.99%). Nine (8.18%) samples remained untyable.In Asia, genotypes B and C are the most prevalent but our study reveals that genotype D is predominant and HBV infection constitutes a significant health problem in Pakistan.Hepatitis B virus (HBV) infection is a well recognized and major health problem leading to significant morbidity and mortality worldwide especially in the developing countries. Approximately, 2 billion people in the world have been infected by HBV [1], 400 million of who are chronic carriers [2]. The virus causes acute hepatitis of varying severity [3] and persists in 95% of children and 2–10% of adult patients [4] leading to chronic liver disease, cirrhosis, hepatocellular carcinoma [5] and even fulminant hepatitis [6]. In Pakistan, HBV infection rate is increasing day by day. The reason may be the lack of proper health facilities or poor economical status and less public awareness about the transmission of major communicable diseases like Hepatitis B virus, Hepatitis C virus and Human Immunodeficiency Virus.Hepatitis B virus exhibits genetic variability with an estimated rate of 1.4 – 3.2 × 10-5 nucleotide substitution per site per year [7] which resulted in well recognized subtypes of the virus. In addition, virus variants arise during replication as a result of nucleotide misincorporations in the absence of any proof reading capacity by the viral polymerase. HBV has been classified into 8 well defined genotypes on the basis of an inter-grou
Genetic relationships and epidemiological links between wild type 1 poliovirus isolates in Pakistan and Afghanistan
Mehar Angez, Shahzad Shaukat, Muhammad M Alam, Salmaan Sharif, Adnan Khurshid, Syed Zahoor Zaidi
Virology Journal , 2012, DOI: 10.1186/1743-422x-9-51
Abstract: In order to find the origins and routes of wild type 1 poliovirus circulation, polioviruses were isolated from faecal samples of Acute Flaccid Paralysis (AFP) patients. We used viral cultures, two intratypic differentiation methods PCR, ELISA to characterize as vaccine or wild type 1 and nucleic acid sequencing of entire VP1 region of poliovirus genome to determine the genetic relatedness.One hundred eleven wild type 1 poliovirus isolates were subjected to nucleotide sequencing for genetic variation study. Considering the 15% divergence of the sequences from Sabin 1, Phylogenetic analysis by MEGA software revealed that active inter and intra country transmission of many genetically distinct strains of wild poliovirus type 1 belonged to genotype SOAS which is indigenous in this region. By grouping wild type 1 polioviruses according to nucleotide sequence homology, three distinct clusters A, B and C were obtained with multiple chains of transmission together with some silent circulations represented by orphan lineages.Our results emphasize that there was a persistent transmission of wild type1 polioviruses in Pakistan and Afghanistan during 2005-2007. The epidemiologic information provided by the sequence data can contribute to the formulation of better strategies for poliomyelitis control to those critical areas, associated with high risk population groups which include migrants, internally displaced people, and refugees. The implication of this study is to maintain high quality mass immunization with oral polio vaccine (OPV) in order to interrupt chains of virus transmission in both countries to endorse substantial progress in Eastern-Mediterranean region.Since 1988 the world has come very close to eradicate polio through global polio eradication initiative [1]. The objective of this initiative was to interrupt wild PVs as soon as possible to achieve certification of Global Polio Eradication and to strengthen the routine immunization and surveillance as well. Since
Serology based disease status of Pakistani population infected with Hepatitis B virus
Muhammad Alam, Soahil Zaidi, Salman Malik, Asif Naeem, Shahzad Shaukat, Salmaan Sharif, Mehar Angez, Anis Khan, Javed Butt
BMC Infectious Diseases , 2007, DOI: 10.1186/1471-2334-7-64
Abstract: A total of 1300 individuals were screened for HBV infection markers including HBsAg, anti-HBsAg, HBeAg and anti-HBcAg. The association of these disease indicators was compared with patients' epidemiological characteristics like age, socio-economic status and residential area to analyze and find out the possible correlation among these variables and the patients disease status.52 (4%) individuals were found positive for HBsAg with mean age 23.5 ± 3.7 years. 9.30%, 33.47% and 12% individuals had HBeAg, antibodies for HBsAg, and antibodies for HBcAg respectively. HBsAg seropositivity rate was significantly associated (p = 0.03) with the residing locality indicating high infection in rural areas. Antibodies titer against HBsAg decreased with the increasing age reflecting an inverse correlation.Our results indicate high prevalence rate of Hepatitis B virus infection and nationwide vaccination campaigns along with public awareness and educational programs are needed to be practiced urgently.Hepatitis B virus (HBV) infection is a major health problem leading to significant morbidity and mortality worldwide especially in the developing countries like Pakistan. Approximately 2 billion people in the world have been infected by HBV [1], 400 million of who are chronic carriers [2]. The virus causes acute hepatitis of varying severity [3] and persists in 95% of children and 2–10 % of adult patients [4] leading to chronic liver disease, cirrhosis, hepatocellular carcinoma [5] and even fulminant hepatitis [6].In Pakistan, HBV infection rate is increasing day by day. The reason may be the lack of proper health facilities or poor economical status and less public awareness about the transmission of major communicable diseases like hepatitis B, hepatitis C and Human Immunodeficiency syndrome.This research study was conducted to assess the major epidemiological factors linked with hepatitis B virus infection. Therefore, serological testing of randomly selected individuals was performe
Epidemiology and clinical findings associated with enteroviral acute flaccid paralysis in Pakistan
Mohsan Saeed, Sohail Z Zaidi, Asif Naeem, Muhammad Masroor, Salmaan Sharif, Shahzad Shaukat, Mehar Angez, Anis Khan
BMC Infectious Diseases , 2007, DOI: 10.1186/1471-2334-7-6
Abstract: Stool specimens of 1775 children, aged less than 15 years, suffering from acute flaccid paralysis were collected after informed consent within 14 days of onset of symptoms during January 2003 to September 2003. The specimens were inoculated on RD and L20B cells using conventional tube cell culture while micro-neutralization test was used to identify the non-polio enterovirus (NPEV) serotypes. Detailed clinical information and 60-days follow-up reports were analyzed for NPEV-associated AFP cases.NPEV were isolated from 474 samples. The male to female ratio was 1.4:1. The isolation of NPEV decreased significantly with the increase in age. Cases associated with fever at the onset of NPEV-associated AFP were found to be 62%. The paralysis was found asymmetrical in 67% cases, the progression of paralysis to peak within 4 days was found in 72% cases and residual paralysis after 60 days of paralysis onset was observed in 39% cases associated with NPEV. A clinical diagnosis of Guillian-Barre syndrome was made in 32% cases. On Microneutralization assay, echo-6 (13%) and coxsackievirus B (13%) were the most commonly isolated serotypes of NPEV along with E-7, E-13, E-11, E-4 and E-30. The isolates (n = 181) found untypable by the antiserum pools were confirmed as NPEV by PCR using Pan-Enterovirus primers.The present study suggests that NPEV are a dominant cause of AFP and different serotypes of NPEV are randomly distributed in Pakistan. The untypable isolates need further characterization and analysis in order to determine their association with clinical presentation of a case.Enteroviruses (genus Enterovirus, family Picornaviridae) are among the most common viruses infecting humans worldwide. Enteroviruses are associated with diverse clinical syndromes ranging from minor febrile illness to severe, potentially fatal conditions (e.g., aseptic meningitis, encephalitis, paralysis, myocarditis, and neonatal enteroviral sepsis) and could be linked with the development of some chron
Serotype Diversity of Astroviruses in Rawalpindi, Pakistan during 2009–2010
Muhammad Masroor Alam, Adnan Khurshid, Muhammad Suleman Rana, Shahzad Shaukat, Salmaan Sharif, Mehar Angez, Muhammad Naeem, Syed Sohail Zahoor Zaidi
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0061667
Abstract: Astroviruses are globally known enteropathogens causing gastroenteritis and diarrhea, with eight well defined serotypes. Epidemiological studies have recognized serotype-1 as the most common subtype but no such data is available in Pakistan. During 2009–2010, we found astroviruses in 41 out of 535 (7%) samples collected from hospitalized children. Thirty one strains belonged to serotype-1 and clustered into two distinct lineages. Serotype-3, -4 and -6 were detected with 97–98% genetic homology to Indian and Chinese strains.
Characterization of a Novel Enterovirus Serotype and an Enterovirus EV-B93 Isolated from Acute Flaccid Paralysis Patients
Shahzad Shaukat, Mehar Angez, Muhammad Masroor Alam, Salmaan Sharif, Adnan Khurshid, Tariq Mahmood, Syed Sohail Zahoor Zaidi
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0080040
Abstract: Non-polio enteroviruses (NPEVs) are among the most common viruses infecting humans worldwide. Most of these infections are asymptomatic but few can lead to systemic and neurological disorders like Acute Flaccid Paralysis (AFP). Acute Flaccid Paralysis is a clinical syndrome and NPEVs have been isolated frequently from the patients suffering from AFP but little is known about their causal relationship. The objective of this study was to identify and characterize the NPEV serotypes recovered from 184 stool samples collected from AFP patients in Federally Administered Tribal Areas (FATA) in north-west of Pakistan. Overall, 44 (95.6 %) isolates were successfully typed through microneutralization assay as a member of enterovirus B species including echovirus (E)-2, E-3, E-4, E-6, E-7, E-11, E-13, E-14, E-21 and E-29 while two isolates (PAK NIH SP6545B and PAK NIH SP1202B) remained untypeable. The VP1 and capsid regions analysis characterized these viruses as EV-B93 and EV-B106. Phylogenetic analysis confirmed that PAK NIH isolates had high genetic diversity and represent distinct genotypes circulating in the country. Our findings highlight the role of NPEVs in AFP cases to be thoroughly investigated especially in high disease risk areas, with limited surveillance activities and health resources.
The Professional Medical Journal , 2010,
Abstract: Objectives: To analyze the rate of Pneumothorax after CT guided TNAB of lung masses , and correlating it with the size of thelesion. Design: Descriptive study. Setting: Department of Radiology Mayo Hospital, Lahore. Period: From June 2002 to April 2003, Patientsand method: Seventy patients underwent CT guided FNA of the chest masses. Results: Out of Seventy, 18 patients i.e.; 26 % developedPneumothorax. Lesion less than 1 cm , out of 6 patients 3 developed pneumothorax ( 50 %), lesions 1-2 cm 5 out of 11 developedpneumothorax(45%), lesions with size of 2-3 cm 5 out of 14 patients developed pneumothorax ( 35%), lesions between 3-4 cm 2 out of 8developed pneumothorax (25%), lesion sized 4-5 cm 1 out of 15 developed pneumothorax (6%), and lesion with more than 5 cm size 1 out of 16 developed pneumothorax ( 6%) . Conclusion: The study shows that the rate of Pneumothorax after CT guided TNAB of Lung Massesincreases as the size of the lesion decreases.
The Professional Medical Journal , 2010,
Abstract: Objective: To know the findings of MDCT in cases of Abdominal Tuberculosis. Patients and Methods: Fifty eight patients withsuspicion of abdominal tuberculosis were scanned and the findings were evaluated. All the patients received IV and oral contrast. The patients were referred from the medical and surgical departments of Shalamar Hospital, Lahore. Toshiba 4 Slice Aquilion was used for scanning. The exclusion criterion was patients on Anti tuberculous drugs and urogenital tuberculosis. Results Following 6 findings were observed in 47 abnormal scans, Out of other 11 scans 9 had other diseases like diverticulitis, Appendicitis and Bowel Lymphoma. 2 were normal. Close medical and Surgical follow up was obtained in all cases. Ascites = 35, Omental / Mesenteric Thickening / Involving = 27, Small Bowel wall thickening = 07, Large bowel wall thickening including Caecal wall thickening = 06, Abdominal Lymphadenopathy= 26, Solid Organ Involvement, Liver=01, Spleen=02. Conclusion: Ascites was the most common finding in Patients with Abdominal Tuberculosis and Involvement of liver being the least common finding amongst the group.
Human Parechovirus Genotypes -10, -13 and -15 in Pakistani Children with Acute Dehydrating Gastroenteritis
Muhammad Masroor Alam, Adnan Khurshid, Shahzad Shaukat, Muhammad Suleman Rana, Salmaan Sharif, Mehar Angez, Nadia Nisar, Muhammad Naeem, Syed Sohail Zahoor Zaidi
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0078377
Abstract: Human parechoviruses are known to cause asymptomatic to severe clinical illness predominantly respiratory and gastroenetric infections. Despite their global prevalence, epidemiological studies have not been performed in Pakistan. In this study, we retrospectively analyzed 110 fecal specimen and found 26 (24%) positive for viral RNA with HPeV-10 (n = 3, 23%), HPeV-13 (n = 4, 31%) and HPeV-15 (n = 6, 46%) genotypes. Clinical features of patients with different HPeV genotypes were compared. All HPeV positive children were aged ≤4 years (mean 13.92 months). The male-to-female ratio was 1: 1.17 (46.2 vs 53.8%) with significant association (p = .031) to HPeV infectivity. HPeV-10 and -13 were found during summer while HPeV-15 was only detected during late winter season. Disease symptoms were more severe in children infected with HPeV-10 and -13 as compared to HPeV-15. Fever and vomiting were observed in 100% cases of HPeV-10 and -13 while only 17% patients of HPeV-15 had these complaints. Phylogenetic analyses showed that HPeV-10, -13 and -15 strains found in this study have 9–13%, 16.8% and 21.8% nucleotide divergence respectively from the prototype strains and were clustered to distinct genetic lineages. This is the first report of HPeV-15 infection in humans although first identified in rhesus macaques. The arginine-glycine-aspartic acid (RGD) motif present at the C-terminal of VP1 responsible for the viral attachment to cellular integrins was not found in all of these strains. In conclusion, these findings enhance our knowledge related to the epidemiology and genetic diversity of the HPeV in Pakistan and support the need for continued laboratory based surveillance programs especially in infants and neonatal clinical settings. Further, the parechovirus pathogenesis, cross-species transmission and disease reservoirs must be ascertained to adopt better prevention measures.
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