Publications by authors named "Afzal S"

Introduction: Non-steroidal anti-inflammatory drugs are associated with severe gastrointestinal irritation upon prolonged use, largely due to their carboxylic (-- COOH) functional group.

Aim: To address this issue, we aimed to synthesize diclofenac conjugates with glucosamine and chitosan, converting the -COOH group into an amide (-CONH-) via a mechanochemical, environmentally friendly method.

Method: In this study, diclofenac acid was first converted to its acid chloride using thionyl chloride under mechanochemical conditions and subsequently reacted with glucosamine base and chitosan.

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Aim: Autosomal recessive primary hyperoxalurias (PH) are genetic disorders characterised by elevated oxalate production. Mutations in genes involved in glycoxylate metabolism are the underlying cause of PH. Type 1 PH (PH1) results in malfunctioning of alanine-glyoxylate aminotransferase enzymes of liver due to a change in the genetic sequence of alanine-glyoxylate aminotransferase (AGXT) gene.

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This study evaluated disease activity in people with Multiple Sclerosis (PwMS) who received immune checkpoint inhibitors (ICIs) compared to PwMS not treated with ICIs. There were 108 PwMS included (27 PwMS+ICIs and 81 PwMS controls), matched on age, sex, disease duration, DMTs, and MS disease course. Of 27 PwMS+ICIs, one (4%) had a relapse and four (15%) developed new MRI lesions without clinical symptoms.

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Myocardial infarction (MI) is the leading cause of death and disability worldwide. It occurs when a thrombus forms after an atherosclerotic plaque bursts, obstructing blood flow to the heart. Prompt and accurate diagnosis is crucial for improving patient survival.

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Osteoporosis is well noted to be a universal ailment that realization impaired bone mass and micro architectural deterioration thus enhancing the probability of fracture. Despite its high incidence, its management remains highly demanding because of the multifactorial pathophysiology of the disease. This review highlights recent findings in the management of osteoporosis particularly, gene expression and hormonal control.

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Background: Observational and genetic causal studies have shown an association between high concentrations of remnant cholesterol and increased risk of ischemic heart disease. However, findings from randomized intervention trials that reduced plasma triglycerides, a surrogate marker of remnant cholesterol, have been conflicting. The exact mechanisms by which remnant cholesterol contributes to atherosclerosis and, ultimately, ischemic heart disease remain incompletely understood.

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Background: Sansevieria trifasciata, common name, mother-in-law's tongue, is a member of the Agavaceae family. We undertook this study to evaluate the cytotoxicity of S. trifasciata leaf extract against two cancer cell lines as well as its antibacterial activities against six bacterial strains.

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Background: Total hip arthroplasty is one of the most successful and cost-effective interventions for improving quality of life. Dislocation is a well-recognised complication with a significant health and economic burden. The aim of this study was to establish the current management practices for patients presenting with a prosthetic hip dislocation.

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Background: Treating heavily calcified vessels is a challenging task in patients with an impaired left ventricular ejection fraction. Percutaneous mechanical circulatory support (pMCS) is increasingly used in patients in high-risk percutaneous coronary intervention (HRPCI).

Methods: In this retrospective registry, we investigated 25 patients undergoing a protected HRPCI receiving either intravascular lithotripsy (IVL + pMCS;  = 11) or rotational atherectomy (RA + pMCS;  = 14).

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Examining the cumulative evidence from randomized controlled trials (RCTs), evaluating the use of pharmacological agents for the treatment of COVID-19 infections in patients with critical illness. Databases Medline, Embase, Web of Science, Scopus, CINAHL, and Cochrane. Study Selection: Inclusion criteria were RCTs that enrolled patients with confirmed or suspected COVID-19 infection who are critically ill.

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Background: Total knee arthroplasty (TKA) offers substantially improved function for patients with severe osteoarthritis, but long-term success can be overshadowed by aseptic loosening, a complication with a multifactorial etiology. This study aims to investigate the association between BMI and the rate of aseptic loosening and other complications in patients undergoing primary TKA.

Methods: This retrospective cohort study examined 354 TKA patients, evenly categorized by BMI (≤ 30 kg/m² and > 30 kg/m²).

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Background Breast cancer (BC) is the leading cause of cancer-related deaths in women worldwide. There has been a significant increase in the incidence of BC in Pakistan. Family history, older age, obesity, tobacco use, oral contraceptive use, early menarche, and hormonal replacement therapy are among the major risk factors.

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Purpose: This study aims to analyze the challenges in financing the healthcare system of Pakistan and develop a comprehensive health financing strategy aimed at achieving universal health coverage (UHC).

Design/methodology/approach: The paper utilizes World Health Organization (WHO) framework on health financing to build the argument. It uses qualitative research design involving focus group discussions and in-depth interviews with key stakeholders, including Federal Board of Revenue, Ministry of Finance, Planning Commission, development partners, academia and health ministries at federal and provincial levels, as well as social health insurance entities.

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Background: Recent changes in Medicare reimbursement policies have facilitated the shift of primary total joint arthroplasty (TJA) volume to ambulatory surgical centers (ASC). The ASCs potentially provide a more cost-effective alternative to a hospital-setting TJA. This study investigated Medicare primary TJA utilization and reimbursement trends at ASCs compared to inpatient and outpatient settings between 2019 and 2022.

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Article Synopsis
  • The study investigated the serum calcium and vitamin D levels in elderly patients with intertrochanteric (IT) fractures, focusing on their relationship to the severity of stable versus unstable fractures.
  • Out of 286 patients analyzed, those with unstable IT fractures showed significantly lower vitamin D levels compared to those with stable fractures, while the difference in calcium levels was not significant.
  • The findings suggest that higher vitamin D levels might help prevent severe IT fractures, indicating the potential benefit of vitamin D supplementation in this patient population.
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Background: Pakistan, with its diverse points of entry, faced several challenges with implementing the International Health Regulations (IHR) ethically during the COVID-19 pandemic.

Aim: To explore the perceptions of point of entry health workers regarding the ethics challenges in implementing the IHR during the COVID-19 pandemic.

Methods: From December 2022 to March 2023, this qualitative study conducted 10 focused group discussions and key informant interviews with 40 participants from 10 points of entry in Pakistan and reviewed COVID-19 containment guidelines.

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A large amount of marble powder is abundantly available as a byproduct and waste in the marble industry, and its reinforcement has been attempted in several applications through surface modification. This article examines the use of MP in the production of rubber, paper, foam stabilizers, asphalt, paint, textiles, and adhesives. This article aims to provide a foundation for the surface modification of MP to enhance its properties and broaden its range of applications.

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This study aims to develop a benign and commercially viable method for the degradation of monoethanolamine (MEA) in the aqueous phase an ultraviolet/hydrogen peroxide (UV/HO) advanced oxidation process (AOP). The current investigation is novel in terms of detailed kinetic analysis and degradation mechanisms; the impact of pH and UV light intensity on MEA degradation was thoroughly examined. pH 9 was identified as the optimal condition, achieving a degradation efficiency of 76.

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Hepatitis B virus (HBV) infection is a major public health issue and is responsible for considerable morbidity and mortality globally. In Pakistan, the prevalence of chronic HBV infection varies from 2% to 4%, with an estimated exposure rate of approximately 34%. The major objective of this study was to determine the prevalence of HBV genotypes and the pattern of escape mutations in the HBV S gene in two major provinces of Pakistan: Punjab and Khyber Pakhtunkhwa.

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Introduction And Importance: Concurrent ipsilateral femoral malunion and nonunion present substantial clinical challenges requiring comprehensive surgical interventions. We describe a unique case of a 65-year-old male with these complications who was treated with a proximal femoral osteotomy, radical sequestrectomy, and free fibula graft.

Case Presentation: The patient underwent over 10 years of multiple surgical interventions, including hardware removal, local debridement, antibiotic-loaded cement spacer placement, autologous bone grafting, and external fixator applications, yet infectious non-union persisted.

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Introduction: Kirschner wires are frequently employed in orthopedic procedures. While most complications are minor, rare instances of distant pin migration can occur. Such migration is more prevalent in the shoulder region but has been reported elsewhere.

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Background And Aims: Statin therapy reduces myocardial infarction rate but whether it is associated with a shift of ST-elevation myocardial infarction (STEMI) towards non-ST-elevation myocardial infarction (non-STEMI) remains unknown. Thus, we tested the hypothesis that statin use is associated with less STEMI relative to non-STEMI in first-time myocardial infarction.

Methods: In a nationwide study, including 66,896 patients with first-time myocardial infarction between 2010 and 2021, we obtained multivariable risk estimates for STEMI versus non-STEMI according to any statin use, cumulated statin use, and daily statin dose.

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