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Fulltext Stratification of Acute Kidney Injury in COVID-19

Mallhi TH, Khan YH, Adnan AS

Am J Trop Med Hyg, 2020 Dec;103(6):2164-2167.
PMID: 33124548 DOI: 10.4269/ajtmh.20-0794

Despite myriad improvements in the care of COVID-19 patients, atypical manifestations are least appreciated during the current pandemic. Because COVID-19 is primarily manifesting as an acute respiratory illness with interstitial and alveolar pneumonia, the possibility of viral invasions into the other organs cannot be disregarded. Acute kidney injury (AKI) has been associated with various viral infections including dengue, chikungunya, Zika, and HIV. The prevalence and risks of AKI during the course of COVID-19 have been described in few studies. However, the existing literature demonstrate great disparity across findings amid variations in methodology and population. This article underscores the propensity of AKI among COVID-19 patients, limitations of the exiting evidence, and importance of timely identification during the case management. The prevalence of AKI is variable across the studies ranging from 4.7% to 81%. Evidence suggest old age, comorbidities, ventilator support, use of vasopressors, black race, severe infection, and elevated levels of baseline serum creatinine and d-dimers are independent risk factors of COVID-19 associated with AKI. COVID-19 patients with AKI also showed unsatisfactory renal recovery and higher mortality rate as compared with patients without AKI. These findings underscore that AKI frequently occurs during the course of COVID-19 infection and requires early stratification and management.
Fulltext Prevalence and Associated Complication of Acute Kidney Injury Among Dengue Patients

Khan Y, Sarriff A, Khan AH, Adnan AS, Jummat F, Mallhi TH

Value Health, 2014 Nov;17(7):A811.
PMID: 27203069 DOI: 10.1016/j.jval.2014.08.551
Fulltext Osteoporosis: are healthcare professionals missing an opportunity

Khan YH, Mallhi TH, Sarriff A, Khan AH

Springerplus, 2013;2:463.
PMID: 24083110 DOI: 10.1186/2193-1801-2-463

OBJECTIVES: The objective of the current study is to analyze different approaches of pharmacists and general practitioners towards availability and use of osteoporosis prescreening tools and to find out reasons that explain non utilization of such tools in clinical practice.
SETTINGS: Among General practitioners and Community pharmacists in Pulau Penang, Malaysia.
METHODOLOGY: An explorative cross sectional study was carried out using convenience sampling approach. A pre-validated self- administered questionnaire was used to carry out the study. A total of 170 healthcare professionals participated in study.
MAIN OUTCOME: Evaluation of awareness, use and opinions of healthcare professionals regarding osteoporosis prescreening tools.
RESULTS: Response rate of study was 56%. The mean age of the participants was 39.00 + 7.89 years. Less than one third of participants were familiar with term prescreening tools or Clinical decision rules. The only osteoporosis prescreening tool that was recognized and used by majority of participants was FRAX. Participants agreed that low level of awareness regarding availability of prescreening tools poses hindrance in utilization of such tools in clinical practice. Majority of participants showed willingness to gain information and use such tools in future.
CONCLUSIONS: The results of our study demonstrate an urgent need of implementation of osteoporosis prescreening tools educational and awareness programs among healthcare professionals.
Zika in India and the need for transparent reporting

Mallhi TH, Khan YH, Tanveer N, Khan AH, Bukhsh A

Travel Med Infect Dis, 2017 Jul-Aug;18:75-76.
PMID: 28709958 DOI: 10.1016/j.tmaid.2017.07.005
Prevalence of Chronic Kidney Disease in Asia: A Systematic Review of Population-Based Studies

Khan YH, Mallhi TH, Sarriff A, Khan AH, Tanveer N

J Coll Physicians Surg Pak, 2018 Dec;28(12):960-966.
PMID: 30501836 DOI: 10.29271/jcpsp.2018.12.960

Chronic kidney disease (CKD) is an asymptomatic disease associated with high morbidity and life-threatening complications that lead to decreased life expectancy. Worldwide prevalence of CKD is escalating at an alarming rate. Large population-based representative surveys have been reported in Western countries to estimate the prevalence of the disease. However, there is paucity of data as far as developing nations are concerned. Asia is the world's largest continent accommodating maximum number of under-developed and developing countries with an unclear picture of prevalence of CKD. Current review attempts to give an insight to the prevalence of CKD in this region by combining population-based surveys. This review will assist in estimating the burden of CKD in Asia, so that appropriate control measures could be designed.
Crimean-Congo haemorrhagic fever virus and Eid-Ul-Adha festival in Pakistan

Mallhi TH, Khan YH, Sarriff A, Khan AH

Lancet Infect Dis, 2016 12;16(12):1332-1333.
PMID: 27998596 DOI: 10.1016/S1473-3099(16)30453-4
Fulltext First chikungunya outbreak in Pakistan: a trail of viral attacks

Mallhi TH, Khan YH, Khan AH, Tanveer N, Qadir MI

New Microbes New Infect, 2017 Sep;19:13-14.
PMID: 28663798 DOI: 10.1016/j.nmni.2017.05.008

Despite explicit warning from the National Institute of Health, Pakistan experienced its first chikungunya outbreak in the metropolis of Karachi. We underscore the attention of health authorities and healthcare professionals towards contributing factors associated with this outbreak and the measures required to combat this viral disease.
Defining acute kidney injury in dengue viral infection by conventional and novel classification systems (AKIN and RIFLE): a comparative analysis

Mallhi TH, Khan AH, Sarriff A, Adnan AS, Khan YH, Jummaat F

Postgrad Med J, 2016 Feb;92(1084):78-86.
PMID: 26729887 DOI: 10.1136/postgradmedj-2015-133582

Several criteria have been used to stratify acute kidney injury (AKI) in dengue infection and have resulted in variations in its incidence as well as clinic-laboratory characteristics. The current study was aimed to compare three commonly used criteria of AKI among patients with dengue.
Progression and outcomes of non-dialysis dependent chronic kidney disease patients: A single center longitudinal follow-up study

Khan YH, Sarriff A, Adnan AS, Khan AH, Mallhi TH, Jummaat F

Nephrology (Carlton), 2017 Jan;22(1):25-34.
PMID: 26718476 DOI: 10.1111/nep.12713

AIM: Despite increase global prevalence of End stage renal disease (ESRD) and subsequent need for renal replacement therapy (RRT), relatively little is known about disease progression and prognosis of earlier stages of CKD. Current study was conducted to examine rate of CKD progression, predictors of ESRD and death.
METHODS: A total 621 patients with estimated glomerular filtration rate (eGFR) of 15-59ml/min/1.73m(2) (CKD stage 3 & 4) were selected and followed up for 10 years or until ESRD or death, whichever occurred first. Subjects who did not meet inclusion criteria were excluded (n=1474).
RESULTS: Annual cumulative decline in eGFR was 3.01±0.40 ml/min/1.73m(2) . Overall disease progression was observed in 60% patients while 18% died. Among patients with CKD stage 3, 21% progressed to stage 4, 10% to stage 5ND (non-dialysis) and 31% to RRT while mortality was observed in 16% patients. On the other hand, 8% patients with CKD stage 4 progressed to stage 5ND, 31% to RRT and mortality was observed in 24% cases. Patients with CVD, higher systolic blood pressure, elevated phosphate levels, heavy proteinuria, microscopic hematuria and use of diuretics were more likely to develop ESRD. Advancing age, low eGFR, low systolic blood pressure, low hemoglobin and baseline diabetes were found to be significant predictors of mortality while being female reduced risk of mortality.
CONCLUSION: Our data suggest that, in this CKD cohort, patients were more likely to develop ESRD than death. Prime importance should be given to mild forms of CKD to retard and even reverse CKD progression.
Fulltext A Survey of Knowledge and Attitude of Menopause Among Post-Menopausal Women in Pakistan

Mallhi TH, Qadir MI, Khan YH, Khan AH, Adnan AS

Value Health, 2014 Nov;17(7):A731.
PMID: 27202612 DOI: 10.1016/j.jval.2014.08.083
Review: Ajwa date (Phoenix dactylifera)- an emerging plant in pharmacological research

Mallhi TH, Qadir MI, Ali M, Ahmad B, Khan YH, Rehman A

Pak J Pharm Sci, 2014 May;27(3):607-16.
PMID: 24811825

Date Fruits are consumed in Arab areas for a long time as a part of essential diet. Phoenix dactylifera belongs to family Arecaceae and its leaves, barks, pits, fruits and pollens have anticancer, antioxidant, hepatoprotective, antidiabetic, antihypertensive, antiulcertavie, anti-inflammatory, antiproliferative, antimutagenic, antidiarheal, antibacterial, antifungal and antiviral potential. Besides these, Dates also increase level of estrogen, testosterone, RBCs, Hb, PCV, reticulocytes and platelet counts. It can also cure lead induced heamotoxicity, side effects of methylprednisolon, male and female infertility. It has also cerebroprotective, neuroprotective and haemopoietic activity. Phoenix dactylifera can be used for number of complications if further evaluated and isolated. The present paper is an overview of pharmacological properties of Phoenix dactylifera reported in literature.
Leptospirosis; A Zoonotic, Morbid and Fatal Disease: A Record Viewing Study

Mallhi TH, Khan AH, Adnan AS, Sarriff A, Jummaat F, Khan YH

Value Health, 2015 Nov;18(7):A843.
PMID: 26534509 DOI: 10.1016/j.jval.2015.09.390
Characteristics and Outcomes of Patients with Dengue Viral Infection During The Hospitalization At Tertiary Care Hospital

Mallhi TH, Khan AH, Adnan AS, Sarriff A, Jummaat F, Khan YH

Value Health, 2015 Nov;18(7):A841.
PMID: 26534496 DOI: 10.1016/j.jval.2015.09.378
Fulltext Clinico-laboratory spectrum of dengue viral infection and risk factors associated with dengue hemorrhagic fever: a retrospective study

Mallhi TH, Khan AH, Adnan AS, Sarriff A, Khan YH, Jummaat F

BMC Infect Dis, 2015 Sep 30;15:399.
PMID: 26423145 DOI: 10.1186/s12879-015-1141-3

BACKGROUND: The incidence of dengue is rising steadily in Malaysia since the first major outbreak in 1973. Despite aggressive measures taken by the relevant authorities, Malaysia is still facing worsening dengue crisis over the past few years. There is an urgent need to evaluate dengue cases for better understanding of clinic-laboratory spectrum in order to combat this disease.
METHODS: A retrospective analysis of dengue patients admitted to a tertiary care teaching hospital during the period of six years (2008 - 2013) was performed. Patient's demographics, clinical and laboratory findings were recorded via structured data collection form. Patients were categorized into dengue fever (DF) and dengue hemorrhagic fever (DHF). Appropriate statistical methods were used to compare these two groups in order to determine difference in clinico-laboratory characteristics and to identify independent risk factors of DHF.
RESULTS: A total 667 dengue patients (30.69 ± 16.13 years; Male: 56.7 %) were reviewed. Typical manifestations of dengue like fever, myalgia, arthralgia, headache, vomiting, abdominal pain and skin rash were observed in more than 40 % patients. DHF was observed in 79 (11.8 %) cases. Skin rash, dehydration, shortness of breath, pleural effusion and thick gall bladder were more significantly (P 40 years (OR: 4.1, P
Dengue-induced Acute Kidney Injury (DAKI): A Neglected and Fatal Complication of Dengue Viral Infection--A Systematic Review

Mallhi TH, Sarriff A, Adnan AS, Khan YH, Hamzah AA, Jummaat F, et al.

J Coll Physicians Surg Pak, 2015 Nov;25(11):828-34.
PMID: 26577971 DOI: 11.2015/JCPSP.828834

Dengue Viral Infection (DVI) imperils an estimated 2.5 billion people living in tropical and subtropical regions. World Health Organization (2011) guidelines also classified dengue as 'Expanded Dengue Syndrome' to incorporate wide spectrum of unusual manifestations of dengue infection affecting various organ systems - including liver, kidney, heart and brain. Renal involvements are least appreciated area of dengue infection, therefore, we systematically reviewed studies describing renal disorders in dengue infection, with emphasis on Acute Kidney Injury (AKI). The purpose of current review is to underscore clinicians’attention to this neglected intricacy of DVI. It suggests that dengue induced renal involvements vary from glomerulonephritis, nephrotic range proteinuria and AKI. We observed great disparity in incidence of AKI among dengue patients, based upon criteria used to define AKI. AKI among dengue patients was found to be associated with significant morbidity, mortality and longer hospitalization, adding financial burden to patients and healthcare system. Additionally, we identified several predictors of AKI in dengue patients including old age, obesity, severe dengue infection and concurrent bacterial or viral infection. Direct viral injury and deposition of antigen-antibody complex in glomerulus were found to be possible causes of renal disorders in dengue infection. Prior knowledge of clinico-laboratory characteristics and risk factors with early detection of AKI by using appropriate criteria would not only reduce morbidity and mortality but also decrease burden to patients and healthcare system.
Fulltext Dengue Infection. What Criteria Do we Use?

Mallhi TH, Khan AH, Sarriff A, Adnan AS, Khan YH

J Coll Physicians Surg Pak, 2016 Mar;26(3):238-9.
PMID: 26975963 DOI: 03.2016/JCPSP.238239
Blood Pressure and Mortality in Hemodialysis Patients: A Systematic Review of an Ongoing Debate

Khan YH, Sarriff A, Adnan AS, Khan AH, Mallhi TH

Ther Apher Dial, 2016 Oct;20(5):453-461.
PMID: 27151394 DOI: 10.1111/1744-9987.12406

Hypertension is prevalent in 75-80% of hemodialysis patients and remains the most controversial prognostic marker in end stage kidney disease patients. In contrast to the general population where systolic blood pressure of ≤120 mm Hg is considered normal, a debate remains regarding the ideal target blood pressure in hemodialysis patients. Using the PUBMED and EMBASE databases, the research studies that evaluated the relationship between blood pressure measurements and mortality in hemodialysis patients were searched. Thirteen studies were identified from different regions of the world. Five studies reported low predialysis systolic blood pressure as a prognostic marker of mortality. Other studies showed varying results and reported postdialysis systolic blood pressure as well as ambulatory blood pressure as better predictors of mortality and emphasized their optimized control. One study in this review concluded that there is no direct relationship between mortality and blood pressure if the patients are on anti-hypertensive medications. The observed all-cause mortality varied from 12% to 36%, whereas the cardiovascular mortality varied from 16% to 60%. On the basis of studies included in the current review, a low predialysis systolic blood pressure (<120 mm Hg) is shown to be a widely accepted prognostic marker of mortality while ambulatory blood pressure best predicts CV mortality. Therefore, we recommend that apart from routine BP (pre, post and intradialysis) monitoring in centers, assessment of ambulatory BP must be mandatory for all patients to reduce CV mortality in hemodialysis patients.
Fulltext Association of Ward Acquired, On-admission, Progressive and Non-progressive AKI with Death among Dengue Patients: A Hidden Relationship

Mallhi TH, Khan AH, Sarriff A, Adnan AS, Khan YH

Acta Med Port, 2016 Feb;29(2):157-8.
PMID: 27234957 DOI: 10.20344/amp.6900
Managing Hot Flushes in Menopausal Women: A Review

Mallhi TH, Khan YH, Khan AH, Mahmood Q, Khalid SH, Saleem M

J Coll Physicians Surg Pak, 2018 Jun;28(6):460-465.
PMID: 29848424 DOI: 10.29271/jcpsp.2018.06.460

Hot flushes during menopause are distressing for women and result in poor quality of life. Purpose of the current review was to evaluate the available treatment modalities that should be utilised for the management of hot flushes. Menopause refers to last menses of women life and can be declared after amenorrhea of 12 months. Vasomotor symptoms including hot flushes and night sweats are common after menopause, affecting almost 50 - 85% women older than 45 years. The mean increment in core body and skin temperature is 0.5°C and 0.25 - 3°C during a hot flush attack. Low level of estrogen during menopause and its association in triggering episodes of hot flushes, is still under debate. The most accepted hypothesis is a narrowing of the thermoneutral zone (TNZ) triggered by estrogen fluctuations. Although, hormone replacement therapy (HRT) remains the standard treatment for the alleviation of such symptoms, incidence of life threatening side effects restrained medical professionals from its use. Complications associated with the use of HRT can be avoided by appropriate evaluation of patients before initiating therapy. Several guidelines have also recommended HRT (estrogen and progesterone) to be safe for up to a period of seven years. Both hormonal and non-hormonal treatments are used for the management of hot flushes. Since hot flushes are the least appreciated and neglected complication of menopause, current review provides detailed information on its background, pathophysiology and management, and emphasises the need of its treatment.
Effect of vitamin E in non-alcoholic fatty liver disease: a systematic review and meta-analysis of randomised controlled trials

Amanullah I, Khan YH, Anwar I, Gulzar A, Mallhi TH, Raja AA

Postgrad Med J, 2019 Nov;95(1129):601-611.
PMID: 31434683 DOI: 10.1136/postgradmedj-2018-136364

The efficacy of vitamin E among patients with non-alcoholic fatty liver disease (NAFLD) is unclear. The current qualitative and quantitative analyses aimed to ascertain the efficacy of vitamin E on clinical outcomes of patients with NAFLD. A systematic search of randomised controlled trials (RCTs) was performed using databases (PubMed, ProQuest, Scopus, EBSCOhost and Ovid) from inception to July 2018. Trials meeting the inclusion criteria were subjected to quality assessment using the Jadad Scoring. All trials meeting the prerequisites information for meta-analysis were subjected to quantitative synthesis of results. Nine RCTs (five in adults and four in children) were included. Four of the five RCTs on adults demonstrated significant improvements in alanine transaminase and other liver function surrogates in patients with NAFLD. On the other hand, only one of the four RCTs conducted on children showed significant improvements in liver functions with the use of vitamin E. Although quantitative synthesis of available data revealed insignificant differences between vitamin E and placebo, still the use of vitamin E improves the level of alanine transaminase and aspartate transaminase by -1.96 and -0.59, with heterogeneity of I2=67% and I2=0%, respectively. Adjuvant vitamin E therapy provides significant biochemical and histological improvements in adult patients with NAFLD, while paediatric patients showed insignificant efficacy compared with placebo. Lifestyle interventions along with vitamin E can provide much better results. Data, including the impact of vitamin E on hepatic histology, are still lacking. Moreover, the short duration of trials limits the conclusion on the safety and efficacy of proposed treatments.

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