Institution
Aga Khan University Hospital
Healthcare•Karachi, Pakistan•
About: Aga Khan University Hospital is a healthcare organization based out in Karachi, Pakistan. It is known for research contribution in the topics: Population & Medicine. The organization has 3001 authors who have published 3485 publications receiving 40110 citations.
Topics: Population, Medicine, Health care, Pregnancy, Cancer
Papers published on a yearly basis
Papers
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Tehran University of Medical Sciences1, Alexandria University2, Mayo Clinic3, Innsbruck Medical University4, King Saud University5, Aga Khan University6, Aga Khan University Hospital7, Mahidol University8, Ankara University9, Chang Gung University10, University of Coimbra11, Peking Union Medical College12, University of Baghdad13, Athens Regional Medical Center14, Jordan Hospital15, Hokkaido University16, University of Lisbon17, Peking University18
TL;DR: Behçet's disease (BD) is a chronic, relapsing, inflammatory vascular disease with no pathognomonic test.
Abstract: Objective
Behcet's disease (BD) is a chronic, relapsing, inflammatory vascular disease with no pathognomonic test. Low sensitivity of the currently applied International Study Group (ISG) clinical diagnostic criteria led to their reassessment.
Methods
An International Team for the Revision of the International Criteria for BD (from 27 countries) submitted data from 2556 clinically diagnosed BD patients and 1163 controls with BD-mimicking diseases or presenting at least one major BD sign. These were randomly divided into training and validation sets. Logistic regression, ‘leave-one-country-out’ cross-validation and clinical judgement were employed to develop new International Criteria for BD (ICBD) with the training data. Existing and new criteria were tested for their performance in the validation set.
Results
For the ICBD, ocular lesions, oral aphthosis and genital aphthosis are each assigned 2 points, while skin lesions, central nervous system involvement and vascular manifestations 1 point each. The pathergy test, when used, was assigned 1 point. A patient scoring ≥4 points is classified as having BD. In the training set, 93.9% sensitivity and 92.1% specificity were assessed compared with 81.2% sensitivity and 95.9% specificity for the ISG criteria. In the validation set, ICBD demonstrated an unbiased estimate of sensitivity of 94.8% (95% CI: 93.4–95.9%), considerably higher than that of the ISG criteria (85.0%). Specificity (90.5%, 95% CI: 87.9–92.8%) was lower than that of the ISG-criteria (96.0%), yet still reasonably high. For countries with at least 90%-of-cases and controls having a pathergy test, adding 1 point for pathergy test increased the estimate of sensitivity from 95.5% to 98.5%, while barely reducing specificity from 92.1% to 91.6%.
Conclusion
The new proposed criteria derived from multinational data exhibits much improved sensitivity over the ISG criteria while maintaining reasonable specificity. It is proposed that the ICBD criteria to be adopted both as a guide for diagnosis and classification of BD.
854 citations
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TL;DR: The non-fasting ApoB/ApoA1 ratio was superior to any of the cholesterol ratios for estimation of the risk of acute myocardial infarction in all ethnic groups, in both sexes, and at all ages, and it should be introduced into worldwide clinical practice.
739 citations
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University of Cambridge1, University College London2, McGill University3, University of Leicester4, University of Bristol5, University of Copenhagen6, University of London7, Copenhagen University Hospital8, University of Queensland9, University of Washington10, University of Vermont11, Sir Charles Gairdner Hospital12, University of Western Australia13, Ontario Institute for Cancer Research14, University of Würzburg15, ETH Zurich16, University of Edinburgh17, University of Warwick18, Utrecht University19, National Heart Foundation of Australia20, Boston University21, University of Kiel22, University of Lübeck23, University Hospital Regensburg24, King's College London25, Mario Negri Institute for Pharmacological Research26, Wake Forest University27, Karolinska Institutet28, University of Leeds29, Harvard University30, Group Health Cooperative31, McMaster University32, University of Oxford33, University of Glasgow34, Imperial College London35, Medical University of Graz36, University of Ulm37, Goethe University Frankfurt38, Lund University39, Helmholtz Zentrum München40, Robert Koch Institute41, Ludwig Maximilian University of Munich42, Umeå University43, University of Pennsylvania44, Johns Hopkins University45, Clinical Trial Service Unit46, Aga Khan University Hospital47, Robertson Centre for Biostatistics48, Tufts University49, University of Bonn50, Erasmus University Rotterdam51, Karolinska University Hospital52, University of Groningen53, Northwestern University54, University of California, Los Angeles55, Glasgow Royal Infirmary56, Glasgow Clinical Research Facility57
TL;DR: Human genetic data indicate that C reactive protein concentration itself is unlikely to be even a modest causal factor in coronary heart disease.
Abstract: Objective To use genetic variants as unconfounded proxies of C reactive protein concentration to study its causal role in coronary heart disease. Design Mendelian randomisation meta-analysis of ind ...
583 citations
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TL;DR: Assessment of the effectiveness of community-based intervention packages in reducing maternal and neonatal morbidity and mortality; and improving neonatal outcomes suggests concerns regarding insufficient information on sequence generation and regarding failure to adequately address incomplete outcome data.
Abstract: Background
While maternal, infant and under-five child mortality rates in developing countries have declined significantly in the past two to three decades, newborn mortality rates have reduced much more slowly. While it is recognised that almost half of the newborn deaths can be prevented by scaling up evidence-based available interventions such as tetanus toxoid immunisation to mothers; clean and skilled care at delivery; newborn resuscitation; exclusive breastfeeding; clean umbilical cord care; management of infections in newborns, many require facility based and outreach services. It has also been stated that a significant proportion of these mortalities and morbidities could also be potentially addressed by developing community-based packages interventions which should also be supplemented by developing and strengthening linkages with the local health systems. Some of the recent community-based studies of interventions targeting women of reproductive age have shown variable impacts on maternal outcomes and hence it is uncertain if these strategies have consistent benefit across the continuum of maternal and newborn care.
The objective of this review is to assess the effectiveness of community-based intervention packages in reducing maternal and neonatal morbidity and mortality; and improving neonatal outcomes.
477 citations
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TL;DR: There was no significant effect for VAS on mortality due to measles, respiratory disease, and meningitis, and a 12% observed reduction in the risk of all-cause mortality for vitamin A compared with control using a fixed-effect model.
Abstract: Background
Vitamin A deficiency (VAD) is a major public health problem in low- and middle-income countries, affecting 190 million children under five years of age and leading to many adverse health consequences, including death. Based on prior evidence and a previous version of this review, the World Health Organization has continued to recommend vitamin A supplementation for children aged 6 to 59 months. There are new data available from recently published randomised trials since the previous publication of this review in 2010, and this update incorporates this information and reviews the evidence.
Objectives
To assess the effects of vitamin A supplementation (VAS) for preventing morbidity and mortality in children aged six months to five years.
Search methods
In March 2016 we searched CENTRAL, Ovid MEDLINE, Embase, six other databases, and two trials registers. We also checked reference lists and contacted relevant organisations and researchers to identify additional studies.
Selection criteria
Randomised controlled trials (RCTs) and cluster-RCTs evaluating the effect of synthetic VAS in children aged six months to five years living in the community. We excluded studies involving children in hospital and children with disease or infection. We also excluded studies evaluating the effects of food fortification, consumption of vitamin A rich foods, or beta-carotene supplementation.
Data collection and analysis
For this update, two reviewers independently assessed studies for inclusion and abstracted data, resolving discrepancies by discussion. We performed meta-analyses for outcomes, including all-cause and cause-specific mortality, disease, vision, and side effects. We used the GRADE approach to assess the quality of the evidence.
Main results
We identified 47 studies (4 of which are new to this review), involving approximately 1,223,856 children. Studies took place in 19 countries: 30 (63%) in Asia, 16 of these in India; 8 (17%) in Africa; 7 (15%) in Latin America, and 2 (4%) in Australia. About one-third of the studies were in urban/periurban settings, and half were in rural settings; the remaining studies did not clearly report settings. Most of the studies included equal numbers of girls and boys and lasted about a year. The included studies were at variable overall risk of bias; however, evidence for the primary outcome was at low risk of bias. A meta-analysis for all-cause mortality included 19 trials (1,202,382 children). At longest follow-up, there was a 12% observed reduction in the risk of all-cause mortality for vitamin A compared with control using a fixed-effect model (risk ratio (RR) 0.88, 95% confidence interval (CI) 0.83 to 0.93; high-quality evidence). This result was sensitive to choice of model, and a random-effects meta-analysis showed a different summary estimate (24% reduction: RR 0.76, 95% CI 0.66 to 0.88); however, the confidence intervals overlapped with that of the fixed-effect model. Nine trials reported mortality due to diarrhoea and showed a 12% overall reduction for VAS (RR 0.88, 95% CI 0.79 to 0.98; 1,098,538 participants; high-quality evidence). There was no significant effect for VAS on mortality due to measles, respiratory disease, and meningitis. VAS reduced incidence of diarrhoea (RR 0.85, 95% CI 0.82 to 0.87; 15 studies; 77,946 participants; low-quality evidence) and measles (RR 0.50, 95% CI 0.37 to 0.67; 6 studies; 19,566 participants; moderate-quality evidence). However, there was no significant effect on incidence of respiratory disease or hospitalisations due to diarrhoea or pneumonia. There was an increased risk of vomiting within the first 48 hours of VAS (RR 1.97, 95% CI 1.44 to 2.69; 4 studies; 10,541 participants; moderate-quality evidence).
Authors' conclusions
Vitamin A supplementation is associated with a clinically meaningful reduction in morbidity and mortality in children. Therefore, we suggest maintaining the policy of universal supplementation for children under five years of age in populations at risk of VAD. Further placebo-controlled trials of VAS in children between six months and five years of age would not change the conclusions of this review, although studies that compare different doses and delivery mechanisms are needed. In populations with documented vitamin A deficiency, it would be unethical to conduct placebo-controlled trials.
375 citations
Authors
Showing all 3015 results
Name | H-index | Papers | Citations |
---|---|---|---|
Zulfiqar A Bhutta | 165 | 1231 | 169329 |
Khalid S. Khan | 92 | 684 | 33700 |
Danish Saleheen | 86 | 213 | 60659 |
Muhammad Riaz | 58 | 934 | 15927 |
Adil H. Haider | 58 | 408 | 12563 |
Marleen Temmerman | 56 | 276 | 16943 |
Tazeen H. Jafar | 56 | 190 | 26929 |
Abdul Waheed | 49 | 205 | 6057 |
Wasim Jafri | 45 | 262 | 11861 |
Muhammad Umar | 45 | 228 | 5851 |
Zohra S Lassi | 43 | 160 | 7186 |
Muneeb Ahmed | 41 | 137 | 6437 |
Saeed Hamid | 41 | 218 | 8360 |
Rumina Hasan | 39 | 184 | 5356 |
Sajjad Hussain | 39 | 517 | 7090 |