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Management Of Late Presentation Congenital Heart Disease, Parvathi U. Iyer U. Iyer, Guillermo E. Moreno,, Luiz Fernando Caneo, Tahira Faiz, Lara S. Shekerdemian, Krishna S. Iye

Section of Cardiothoracic Surgery

In many parts of the world, mostly low- and middle-income countries, timely diagnosis and repair of congenital heart diseases (CHDs) is not feasible for a variety of reasons. In these regions, economic growth has enabled the development of cardiac units that manage patients with CHD presenting later than would be ideal, often after the window for early stabilisation - transposition of the great arteries, coarctation of the aorta - or for lower-risk surgery in infancy - left-to-right shunts or cyanotic conditions. As a result, patients may have suffered organ dysfunction, manifest signs of pulmonary vascular disease, or the sequelae of …

Exploring Diet, Exercise, Chronic Illnesses, Occupational Stressors And Mental Well-Being Of Healthcare Professionals In Punjab, Pakistan, Waqas Ahmed, Ahmed Waqas, Haider Ali Saleem, Sadiq Naveed

Section of Dental-Oral Maxillofacial Surgery

OBJECTIVE:
This data set was compiled to assess mental well-being, dietary pattern and physical health parameters of health care professionals in Pakistan. DATA DESCRIPTION:
The Warwick-Edinburgh mental well-being scale was first evaluated for the Pakistani population then used, along with other measures like body mass index, exercise and dietary habits to assess health and wellbeing of health care providers. The importance of the data lies in the fact that no previous records or data exists in our knowledge that used a subjective index to assess wellbeing in Pakistani population. Furthermore, this data may be used as part of a global …

High Burden Of Subclinical Lead Toxicity After Phase Out Of Lead From Petroleum In Pakistan, Hafsa Majid, Aysha Habib Khan, Nadeem Ullah Khan, Imran Siddiqui, Farooq Ghani, Lena Jafri

Department of Pathology and Laboratory Medicine

Objective: To evaluate the frequency of subclinical lead toxicity.
Study design: Cross-sectional study.
Place and duration of study: Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi, from January 2011 to December 2014.
Methodology: Analysis of laboratory data for blood lead levels (BLL) was performed. Lead was tested by atomic absorption spectrometer. For all subjects, only initial test results were included while the results of repeated testing were excluded. Exemption was sought from institutional ethical review committee. BLL of 2-10 ug/dl and 10-70 ug/dl in children and adults, respectively were taken as subclinical lead toxicity.
Results: Amongst …

High Burden Of Subclinical Lead Toxicity After Phase Out Of Lead From Petroleum In Pakistan, Hafsa Majid, Aysha Habib Khan, Nadeem Ullah Khan, Imran Siddiqui, Farooq Ghani, Lena Jafri

Department of Pathology and Laboratory Medicine

Objective: To evaluate the frequency of subclinical lead toxicity.
Study design: Cross-sectional study.
Place and duration of study: Department of Pathology and Laboratory Medicine, The Aga Khan University Hospital, Karachi, from January 2011 to December 2014.
Methodology: Analysis of laboratory data for blood lead levels (BLL) was performed. Lead was tested by atomic absorption spectrometer. For all subjects, only initial test results were included while the results of repeated testing were excluded. Exemption was sought from institutional ethical review committee. BLL of 2-10 ug/dl and 10-70 ug/dl in children and adults, respectively were taken as subclinical lead toxicity.
Result: Amongst …

Cxc Chemokines Exhibit Bactericidal Activity Against Multidrug-Resistant Gram-Negative Pathogens, Erum Khan, Matthew A. Crawford, Debra J. Fisher, Lisa M. Leung, Sara Lomonaco, Christine Lascols, Antonio Cannatelli,, Gian Maria Rossolini, Yohei Doi, David R. Goodlett

Department of Pathology and Laboratory Medicine

The continued rise and spread of antimicrobial resistance among bacterial pathogens pose a serious challenge to global health. Countering antimicrobial-resistant pathogens requires a multifaceted effort that includes the discovery of novel therapeutic approaches. Here, we establish the capacity of the human CXC chemokines CXCL9 and CXCL10 to kill multidrug-resistant Gram-negative bacteria, including New Delhi metallo-beta-lactamase-1-producing Klebsiella pneumoniae and colistin-resistant members of the family Enterobacteriaceae that harbor the mobile colistin resistance protein MCR-1 and thus possess phosphoethanolamine-modified lipid A. Colistin-resistant K. pneumoniae isolates affected by genetic mutation of the PmrA/PmrB two-component system, a chromosomally encoded regulator of lipopolysaccharide modification, and containing …

Spectrum Of Celiac Disease In Paediatric Population: Experience Of Tertiary Care Center From Pakistan, Danish Abdul Aziz, Misha Kahlid, Fozia Memon, Kamran Sadiq

Department of Paediatrics and Child Health

Objective: To determine clinical features and relevant laboratory investigations of patient with celiac disease (CD) and comparing classical celiac disease (CCD) with Non-diarrheal celiac disease (NDCD).
Methods: This is a five years retrospective study conducted at The Aga Khan University Hospital Karachi, Pakistan from January 2010 to December 2015, enrolling children from one year to 15 years of either gender diagnosed as celiac disease in accordance with revised ESPGHAN criteria. Biopsy samples with grade 2 or more on Modified Marsh Classification were considered as consistent with celiac disease. Celiac patients were categorized into Classical celiac disease (with Chronic Diarrhea) and …

Understanding Biological Mechanisms Underlying Adverse Birth Outcomes In Developing Countries: Protocol For A Prospective Cohort (Amanhi Bio-Banking) Study, Abdullah H. Baqui, Rasheda Khanam, Fyezah Jehan, Muhammad Imran Nisar, Atiya Hussain, Muhammad Ilyas, Aneeta Hotwani, Muhammad Sajid, Shahida Qureshi, Anita K. M. Zaidi

Department of Paediatrics and Child Health

Objectives: The AMANHI study aims to seek for biomarkers as predictors of important pregnancy-related outcomes, and establish a biobank in developing countries for future research as new methods and technologies become available.
Methods: AMANHI is using harmonised protocols to enrol 3000 women in early pregnancies (8-19 weeks of gestation) for population-based follow-up in pregnancy up to 42 days postpartum in Bangladesh, Pakistan and Tanzania, with collection taking place between August 2014 and June 2016. Urine pregnancy tests will be used to confirm reported or suspected pregnancies for screening ultrasound by trained sonographers to accurately date the pregnancy. Trained study field …

Societal Costs Of Micronutrient Deficiencies In 6- To 59-Month-Old Children In Pakistan, Simon Wieser, Beatrice Brunner, Christina Tzogiou, Rafael Plessow, Michael B. Zimmermann, Jessica Farebrother, Sajid Bashir Soofi, Zaid Ahmad Bhatti, Imran Ahmed, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: In Pakistan, nearly half of children younger than 5 years are stunted, and 1 in 3 is underweight. Micronutrient deficiencies, a less visible form of undernutrition, are also endemic. They may lead to increased morbidity and mortality as well as to impaired cognitive and physical development.
Objective: To estimate the lifetime costs of micronutrient deficiencies in Pakistani children aged between 6 and 59 months.
Methods: We develop a health economic model of the lifetime health and cost consequences of iodine, iron, vitamin A, and zinc deficiencies. We assess medical costs, production losses in terms of future incomes lost, and …

November 2017 (Issue 2) : Folic Acid And Neural Tube Defects, Aga Khan University Hospital, Karachi

Nutrition and Food Services Department (NFSD) Archives

• What is folic acid?
• Folic Acid and Neural Tube Defect
• Other Benefits of Folic Acid
• Folic Acid Supplments in Pregnancy
• Sources of Folate

Tackling The Health Burden Of Air Pollution In South Asia, Bhargav Krishna, Kalpana Balakrishnan, Amna R. Siddiqui, Bilkis A. Begum, Damodar Bachani, Michael Brauer

Community Health Sciences

No abstract provided.

November 2017 (Issue 1) : Celiac Disease And Nutrition, Aga Khan University Hospital, Karachi

Nutrition and Food Services Department (NFSD) Archives

• What is celiac disease?
• What are the symptoms of celiac disease?
• How is celiac disease treated?
• What foods can be consumed?
• Food label reading guide

Modelling Stunting In List: The Effect Of Applying Smoothing To Linear Growth Data, Simon Cousens, Jamie Perin, Parul Christian, Lee Shu-Fune Wu, Sajid Bashir Soofi, Zulfiqar Ahmed Bhutta, Claudio Lanata, Richard L. Guerrant, Aldo A. M. Lima, Kåre Mølbak

Department of Paediatrics and Child Health

Background: The Lives Saved Tool (LiST) is a widely used resource for evidence-based decision-making regarding health program scale-up in low- and middle-income countries. LiST estimates the impact of specified changes in intervention coverage on mortality and stunting among children under 5 years of age. We aimed to improve the estimates of the parameters in LiST that determine the rate at which the effects of interventions to prevent stunting attenuate as children get older.
Methods: We identified datasets with serial measurements of children's lengths or heights and used random effects models and restricted cubic splines to model the growth trajectories of …

Water, Sanitation And Hygiene Interventions For Acute Childhood Diarrhea: A Systematic Review To Provide Estimates For The Lives Saved Tool, Nazia Darvesh, Jai K. Das, Tyler Vaivada, Michelle F. Gaffey, Kumanan Rasanathan, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: In the Sustainable Development Goals (SDGs) era, there is growing recognition of the responsibilities of non-health sectors in improving the health of children. Interventions to improve access to clean water, sanitation facilities, and hygiene behaviours (WASH) represent key opportunities to improve child health and well-being by preventing the spread of infectious diseases and improving nutritional status.
Methods: We conducted a systematic review of studies evaluating the effects of WASH interventions on childhood diarrhea in children 0–5 years old. Searches were run up to September 2016. We screened the titles and abstracts of retrieved articles, followed by screening of the …

The East Africa Dialogue Series:Youth, Urbanization, Growth & Inequality, Alex Awiti, Bruce Scott

East Africa Institute

While nationalism and sovereign assertions are on the ascendancy, we live in a world that has never been more connected. But as East Africans, our common challenges and shared aspirations transcend geography and politics. Moreover, globalization, technology, climate change, disease pandemics and terrorism have weaved nations into interdependent social and geopolitical realities. The objective of the East Africa Dialogue Series (EADS) was to gather reliable evidence and make such evidence available to a wide range of stakeholders who then use the evidence to stimulate dialogue, debate, reflection and action to address urgent challenges. The dialogue series focused on three challenges; …

Knowledge About Asthma: A Cross-Sectional Survey In 4 Major Hospitals Of Karachi, Pakistan, Omar Irfan, Babar Irfan, Zain Ahmad Khan, Maha Tahir, Ali Bin Sarwar Zubairi, Javaid Ahmad Khan

Section of Pulmonary & Critical Care

Objective: To determine knowledge and misconceptions about asthma among the local population..Methods: This cross-sectional study was conducted at four tertiary care hospitals; Aga Khan University Hospital, Civil Hospital Karachi, Jinnah Postgraduate Medical Centre and Ojha Institute of Chest Diseases, Karachi, from October to November 2016, and comprised hospital attendants. The questionnaire used in the study comprised 26 questions answered with a true, false or not sure answer.SPSS 20 was used for data analysis.Results: There were 400 participants. The overall mean age was 41.2±14.2 years, and 214(53.5%) of the participants were males. Moreover, 75(19%) participants thought that asthma was a psychological …

Factors Associated With Low Birthweight In Term Pregnancies: A Matched Case-Control Study From Rural Pakistan, Atif Habib, Greenow Cr, S Ariff, Sajid Bashir Soofi, A Hussain, Q Junejo, A Hussain, F Shaheen, K Black

Woman and Child Health

Low birthweight (LBW) remains a significant public health problem in Pakistan and further understanding of factors associated with LBW is required. We conducted a hospital-based matched case control study to identify risk factors associated with LBW in a rural district of Pakistan. We found that illiteracy (AOR: 2.68; 95% CI: 1.59 - 4.38), nulliparity (AOR: 1.82; 95% CI: 1.26-2.44), having a previous miscarriage/abortion (AOR: 1.22; 95% CI: 1.06-2.35), having < 2 antenatal care (ANC) visits during last pregnancy (AOR: 2.43; 95% CI: 1.34-2.88), seeking ANC in third trimester (AOR: 3.62; 95% CI : 2.14-5.03), non-use of iron folic acid during last pregnancy (AOR: 2.72; 95% CI: 1.75-3.17), having hypertension during last pregnancy (AOR: 1.42; 95% CI: 1.13-2.20), being anemic (AOR: 2.67; 95% CI: 1.65-5.24) and having postpartum weight of

Pattern Of Neurological Diseases In Adult Outpatient Neurology Clinics In Tertiary Care Hospital, Safia Awan, Saad Shafqat, Ayeesha Kamran Kamal, Aziz Sonawalla, Sarwar Jamil Siddiqui, Fowzia Siddiqui, Mohammad Wasay

Section of Neurology

Objectives: The burden of neurological diseases in developing countries is rising although little is known about the epidemiology and clinical pattern of neurological disorders. The objective of this study was to understand the burden of disease faced by neurologists a in tertiary care setting.

Results: A prospective observational study was conducted of all presentations to neurology clinics at Aga Khan University Hospital Karachi over a period of 2 years. A total of 16,371 out-patients with neurological diseases were seen during the study period. The mean age of the study participants were 46.2 ± 18.3 years and 8508 (52%) were male. …

Association Of Vitamin D Binding Protein Polymorphism With Risk Of Type 2 Diabetes Mellitus In A Pakistani Urban Population: A Case Control Study, Khalida Iqbal, Najmul Islam, Iqbal Azam, Ali Asghar, Naseema Mehboobali, Mohammad Perwaiz Iqbal

Department of Biological & Biomedical Sciences

Objective: To assess if genotypes/diplotypes of vitamin D binding protein have any association with type 2 diabetes mellitus.
Methods: This case-control study was conducted from January 2013 to July 2015 at the endocrinology clinics of the Aga Khan University Hospital, Karachi, and comprised adult patients with type 2 diabetes and their age- and gender-matched healthy controls. Venous blood was obtained and assessed for serum/plasma 25 hydroxyvitamin D, parathyroid hormone, calcium, alkaline phosphatase and creatinine. Deoxyribonucleic acid was isolated and genotyping was done by polymerase chain reaction-restriction fragment length polymorphismprocedures.
Results: Of the 330 participants, there were 165(50%) …

Modifiers Of The Effect Of Maternal Multiple Micronutrient Supplementation On Stillbirth, Birth Outcomes, And Infant Mortality: A Meta-Analysis Of Individual Patient Data From 17 Randomised Trials In Low-Income And Middle-Income Countries, Emily R. Smith, Anuraj H. Shankar, Lee S-F Wu, Said Aboud, Seth Adu Afarwuah, Hasmot Ali, Rina Agustina, Shams Arifeen, Per Ashorn, Arjumand Rizvi

Department of Paediatrics and Child Health

Background: Micronutrient deficiencies are common among women in low-income and middle-income countries. Data from randomised trials suggest that maternal multiple micronutrient supplementation decreases the risk of low birthweight and potentially improves other infant health outcomes. However, heterogeneity across studies suggests influence from effect modifiers. We aimed to identify individual-level modifiers of the effect of multiple micronutrient supplements on stillbirth, birth outcomes, and infant mortality in low-income and middle-income countries.
Methods: This two-stage meta-analysis of individual patient included data from 17 randomised controlled trials done in 14 low-income and middle-income countries, which compared multiple micronutrient supplements containing iron-folic acid versus iron-folic …

October 2017 (Issue 2) : Nutritional Guidelines For Patients Of Chronic Obstructive Pulmonary Disease (Copd), Aga Khan University Hospital, Karachi

Nutrition and Food Services Department (NFSD) Archives

• Why do copd patients lose wieght?
• What is a good diet for copd patient?
• How to Safely Add Extra Calories in Food
• Tips for Healty Eating For Copd Patients

October 2017 (Issue 1) : Nuts & Their Health Benefits, Aga Khan University Hospital, Karachi

Nutrition and Food Services Department (NFSD) Archives

• What are nuts?
• Do nuts provide nutrients?
• Are roasted nuts better than raw nuts?
• Are nuts beneficial for health?
• The daily intake quantities

Predictive Accuracy Of Anti Mullerian Hormone As Indicator Of Ovarian Follicle Loss In Cyclophosphamide Treated Mice, Zehra Jamil, Khalida Perveen, Rabia Malik, Lubna Avesi

Department of Biological & Biomedical Sciences

Objective: To evaluate the strength of anti-mullerian hormone in reflecting the stages of ovarian toxicity-induced by cyclophosphamide.
Methods: This study was conducted in December 2014 and comprised female mice that were divided into four groups: group A served as control, group B received three weekly injections of cyclophosphamide, group C was co administered alpha-tocopherol along with cyclophosphamide, while group D solely received alpha-tocopherol. The ovaries were evaluated for follicular dynamics, and anti-mullerian hormone was assessed using mouse enzyme-linked immunosorbent assay kit. The data was analysed using SPSS 19.
Results: There were 40 mice in the study. Histological analysis revealed severely …

Is Obesity Endemic To Pakistan?, Fariha Hasan, Bilal Hasan

Medical College Documents

No abstract provided.

Labrad : Vol 43, Issue 2 - October 2017, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• Clinical Applications of Platelet-Rich Plasma
• Rota Virus: Diagnosis & Prevention of Infection
• Anti-Musk Antibodies for Seronegative Myasthenia Gravis
• Clinical Utility of Plasma Homocysteine
• Patient Based Quality Control: Hitting a Moving Target
• Diagnosing Alkaptonuria: A Rare Inherited Metabolic Disease
• Recently Described Soft Tissue Lesions: An Update
• A Snapshot of the Standards of Medical Care -2017: American Diabetes Association Guidelines

Burden Of Zinc (Zn) Deficiency: A High Volume Clinical Laboratory Data Analysis, Hafsa Majid, Shabnum Khawaja, Aysha Habib Khan, Imran Siddqui, Farooq Ghani, Lena Jafri

Department of Pathology and Laboratory Medicine

A cross-sectional survey was done at the Section of Chemical Pathology, Department of Pathology and Laboratory Medicine, AKUH, Karachi, to determine frequency of Zn deficiency, the second major micronutrient deficiency in developing countries, in subjects coming for investigations. Data of plasma Zn, from Jan 2013 to Dec 2014 was analyzed and deficiency was labeled at <65ug/dl. Total 469 subjects were tested for plasma Zn levels over the period of 24 months and complete information was available for 422 subjects, included in final analysis. Median age of subjects was 13 yrs (IQR 7-35) and 57% were male. Mean plasma Zn levels of the total subjects were 105±42.6ug/dl. Out of the total subjects 13.5% (n=57) had Zn deficiency (mean plasma Zn 52±11 ug/dl), and most of them were of age group 6-16yrs. These findings advocate that diet of Pakistani children should be revised in order to provide sufficient amounts of Zn.

Measuring Home Environments Across Cultures: Invariance Of The Home Scale Across Eight International Sites From The Mal-Ed Study, Paul C. Jones, Laura L. Pendergast, Barbara A. Schaefer, Muneera Rasheed, Erling Svensen, Rebecca Scharf, Rita Shrestha, Angelina Maphula, Reeba Roshan, Zeba Rasmussen

Department of Paediatrics and Child Health

The home environment provides the context for much of a child's early development. Examples of important aspects of the home environment include safety, cleanliness, and opportunities for cognitive stimulation. This study sought to examine the psychometric properties of an adapted form of the Home Observation for the Measurement of the Environment (HOME; Caldwell & Bradley, 1984, 2003) across the eight international sites of the MAL-ED project (Dhaka, Bangladesh; Vellore, India; Bhakatapur, Nepal; Naushahro Feroze, Pakistan; Fortaleza, Brazil; Loreto, Peru; Venda, South Africa; Haydom, Tanzania), to identify a factor structure that fit the data at all sites, and to derive a …

A Protocol For Quality Improvement Programme To Reduce Central Line-Associated Bloodstream Infections In Nicu Of Low And Middle Income Country, Ali Shabbir Hussain, Syed Rehan Ali, Shabina Ariff, Saba Arbab, Simon Demas, Jehan Zeb, Arjumand Rizvi

Department of Paediatrics and Child Health

Introduction: Central line-associated bloodstream infections (CLABSI) are the most important cause of morbidity and mortality in critically ill patients. Evidence-based interventions when used in form of a bundle have proven to decrease CLABSI. Our unit has a high CLABSI rate (9/1000 central line days). Therefore, we intend to introduce evidence-based CLABSI prevention package in our practice to improve CLABSI rates in our NICU within limited resources.
Methods and Analysis: The study will be conducted using preanalysis and postanalysis design from January 2016 to December 2017. It is going to be conducted in three phases with phase I being the preimplimentation …

Conditional Random Slope: A New Approach For Estimating Individual Child Growth Velocity In Epidemiological Research, Michael Leung, Diego G. Bassani, Amy Racine‐Poon, Anna Goldenberg, Syed Asad Ali, Gagandeep Kang, Prasanna S. Premkumar, Daniel E. Roth

Department of Paediatrics and Child Health

Objectives: Conditioning child growth measures on baseline accounts for regression to the mean (RTM). Here, we present the “conditional random slope” (CRS) model, based on a linear-mixed effects model that incorporates a baseline-time interaction term that can accommodate multiple data points for a child while also directly accounting for RTM.
Methods: In two birth cohorts, we applied five approaches to estimate child growth velocities from 0 to 12 months to assess the effect of increasing data density (number of measures per child) on the magnitude of RTM of unconditional estimates, and the correlation and concordance between the CRS and four …

Evaluation Of Xpert Mtb/Rif Testing For Rapid Diagnosis Of Childhood Pulmonary Tuberculosis In Children By Xpert Mtb/Rif Testing Of Stool Samples In A Low Resource Setting, Zahra Hasan, Sadia Shakoor, Fehmina Arif, Aisha Mehnaz, Alnoor Akber, Marium Haider, Akber Kanji, Rumina Hasan

Department of Pathology and Laboratory Medicine

Objective: Children with tuberculosis (TB) remain underdiagnosed due to difculty in testing for Mycobacterium tuberculosis (MTB) infection. We evaluated the Xpert MTB/RIF assay for respiratory and stool testing in children for pulmonary TB through a cross-sectional study at tertiary care facilities in Karachi, Pakistan. Fifty children aged 0–15 years screened by a modifed Kenneth-Jones (KJ) score were included. Mycobacterial culture of respiratory samples was the microbiological standard against stool Xpert TB results. All positive TB cases were compared against a treatment response standard (TRS).
/="/">Results: Twelve study subjects were diagnosed by Xpert TB and nine by MTB culture. Compared …

Enhanced Physical Endurance And Improved Memory Performance Following Taurine Administration In Rats, Irfan Sajid, Saara Muddasir, Shaista Emad, Zehra Batool, Saima Khaliq, Lubna Anis, Saiqa Tabassum, Syeda Madiha, Laraib Liaquat, Sadia Sadir, Tahira Perveen, Saida Haider

Department of Biological & Biomedical Sciences

Energy drinks enhance physical endurance and cognitive ability. The ingredients present in these drinks are considered as ergogenic and have memory boosting effects. In the present study effects of taurine administration for one week was monitored on physical exercise and memory performance in rats. Animals were divided into two groups namely control and test. Taurine was injected intraperitoneally to the test group at the dose of 100mg/kg. After one week of treatment rats were subjected to physical exercise and memory task. Results of this study revealed that rats injected with taurine for one week exhibited improved muscular strength as well …