Digital Commons Network^™

Comparison Of Multiple Obesity Indices For Cardiovascular Disease Risk Classification In South Asian Adults: The Carrs Study., Shivani A. Patel, Mohan Deepa, Roopa Shivashankar, Mohammed K. Ali, Deksha Kapoor, Ruby Gupta, Dorothy Lall, Nikhil Tandon, Viswanathan Mohan, Muhammad Masood Kadir, Zafar Fatmi, Dorairaj Prabhakaran, K. M. Venkat Narayan

Community Health Sciences

BACKGROUND:

We comparatively assessed the performance of six simple obesity indices to identify adults with cardiovascular disease (CVD) risk factors in a diverse and contemporary South Asian population.

METHODS:

8,892 participants aged 20-60 years in 2010-2011 were analyzed. Six obesity indices were examined: body mass index (BMI), waist circumference (WC), waist-height ratio (WHtR), waist-hip ratio (WHR), log of the sum of triceps and subscapular skin fold thickness (LTS), and percent body fat derived from bioelectric impedance analysis (BIA). We estimated models with obesity indices specified as deciles and as continuous linear variables to predict prevalent hypertension, diabetes, and high cholesterol …

Repeat 24-Hour Recalls And Locally Developed Food Composition Databases: A Feasible Method To Estimate Dietary Adequacy In A Multi-Site Preconception Maternal Nutrition Rct., Rebecca L. Lander, K. Michael Hambidge, Nancy F. Krebs, Jamie E. Westcott, Ana Garces, Lester Figueroa, Gabriela Tejeda, Adrien Lokangaka, Tshilenge S. Diba, Manjunath S. Somannavar, Ranjitha Honnayya, Sumera Aziz Ali, Umber S. Khan, Elizabeth M. Mcclure, Vanessa R. Thorsten, Kristen B. Stolka, For The Women First Preconception Nutrition Trial Group

Community Health Sciences

Background:

Our aim was to utilize a feasible quantitative methodology to estimate the dietary adequacy of >900 first-trimester pregnant women in poor rural areas of the Democratic Republic of the Congo, Guatemala, India and Pakistan. This paper outlines the dietary methods used.

Methods:

Local nutritionists were trained at the sites by the lead study nutritionist and received ongoing mentoring throughout the study. Training topics focused on the standardized conduct of repeat multiple-pass 24-hr dietary recalls, including interview techniques, estimation of portion sizes, and construction of a unique site-specific food composition database (FCDB). Each FCDB was based on 13 …

Selective Screening For Organic Acidurias And Amino Acidopathies In Pakistani Children, Noreen Abbas Sherazi, Aysha Habib Khan, Lena Jafri, Azeema Jamil, Nasir Ali Khan, Bushra Afroze

Department of Pathology and Laboratory Medicine

Objective: To determine the frequency of organic acidurais (OA) and amino acidopathies (AA) in selected high-risk patients screened in two years.
Study Design: Retrospective Observational study.
Place and Duration of Study: The Aga Khan University Hospital (AKUH), Karachi, from January 2013 to December 2014.
Methodology: Patients with OA and AA were included in the study and patients with IMDs other than OA and AA were excluded. Amino acids and organic acids were analyzed on high performance liquid chromatography and gas chromatography-mass spectrometry respectively. Clinical data and chromatograms of patients screened for IMDs were reviewed by chemical pathologist and metabolic physician. …

Using Mobile Health (Mhealth) Technology In The Management Of Diabetes Mellitus, Physical Inactivity, And Smoking, Hasan Rehman, Ayeesha Kamran Kamal, Saleem Sayani, Pamela B. Morris, Anwar T. Merchant, Salim S. Virani

Department of Medicine

Purpose of Review: Cardiovascular mortality remains high due to insufficient progress made in managing cardiovascular risk factors such as diabetes mellitus, physical inactivity, and smoking. Healthy lifestyle choices play an important role in the management of these modifiable risk factors. Mobile health or mHealth is defined as the use of mobile computing and communication technologies (i.e., mobile phones, wearable sensors) for the delivery of health services and healthrelated information. In this review, we examine some recent studies that utilized mHealth tools to improve management of these risk factors, with examples from developing countries where available.
Recent Findings: The mHealth …

Causal Pathways From Enteropathogens To Environmental Enteropathy: Findings From The Mal-Ed Birth Cohort Study, Margaret N. Kosek, Zulfiqar Ahmed Bhutta, Anita K. M. Zaidi, Imran Ahmed, Syed Asad Ali, Muneera Rasheed, Sajid Bashir Soofi, Ali Turab, Didar Alam, Shahida Qureshi

Department of Paediatrics and Child Health

Background: Environmental enteropathy (EE), the adverse impact of frequent and numerous enteric infections on the gut resulting in a state of persistent immune activation and altered permeability, has been proposed as a key determinant of growth failure in children in low- and middle-income populations. A theory-driven systems model to critically evaluate pathways through which enteropathogens, gut permeability, and intestinal and systemic inflammation affect child growth was conducted within the framework of the Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) birth cohort study that included children from eight countries. …

March 2017 (Issue 3) : Fighting Depression With Food, Aga Khan University Hospital, Karachi

Nutrition and Food Services Department (NFSD) Archives

• Dietary Counselling Components
• Research Findings from Dietary Counselling
• Nutrients to Focus on and Foods Rich in Those Nutrients

March 2017 (Issue 2) : Food – Drug Interactions, Aga Khan University Hospital, Karachi

Nutrition and Food Services Department (NFSD) Archives

• Risk Factors for Interactions
• How Are Drugs Used by the Body?
• How Interactions Happen
• Avoiding Food/Drug and Drug/Nutrient Interactions

March 2017 (Issue 1) : Choosing Whole Grain Foods, Aga Khan University Hospital, Karachi

Nutrition and Food Services Department (NFSD) Archives

• Look For Grains on Food Labels
• How Much Whole Grain Is Needed Everyday
• What is Gluten In tolerance
• How Can I Store Grains
• How to Add Whole Grains in Daily Diet
• Tips to Include Grains in Children’s Diet

Endothelin Signaling In Bone, Jasmin Kristianto, Michael Johnson, Rafia Afzal, Robert D. Blank

Department of Anaesthesia

The endothelin (ET) system includes 3 small peptide hormones and a pair of G-protein-coupled receptors. This review first outlines the ET signaling pathway and ET metabolism. Next, it summarizes the role of ET1 signaling in craniofacial development. Then, it discusses observations relating ET signaling to osteoblastic and other osteosclerotic processes in cancer. Finally, it describes recent work in our laboratory that points to endothelin signaling as an upstream mediator of WNT signaling, promoting bone matrix synthesis and mineralization. It concludes with a statement of some remaining gaps in knowledge and proposals for future research.

Transcranial Direct Current Stimulation And Stroke Recovery: Opportunities And Challenges, Murtaza G, Hussain F, Iqbal M, Shahid Bashir

Pakistan Journal of Neurological Sciences (PJNS)

Transcranial direct current stimulation (tDCS) is one type of neuromodulation, which is an emerging technology that holds promise for the future studies on therapeutic and diagnosis applications in treatment of neurological and psychiatric diseases. However, there is a serious question among developing countries with limited financial and human resources, about the potential returns of an investment in this field and regarding the best time to transfer this technology from controlled experimental settings to health systems in the public and private sectors. This article reviews the tDCS as tools of neuromodulation for stroke and discusses the opportunities and challenges available for …

Beyond Theatres : Issue 1, 2017, Department Of Surgery

Department of Surgery Archives

No abstract provided.

Homocysteine As A Biomarker For Thrombosis: What Is The Learning Curve?, Bushra Moiz

Department of Pathology and Laboratory Medicine

No abstract provided.

Validation Of Bioelectrical Impedance Analysis For Assessing Dry Weight Of Dialysis Patients In Pakistan, Huma Asmat, Romaina Iqbal, Fatima Sharif, Aamer Mahmood, Aamir Abbas, Waqar Kashif

Department of Medicine

Accurate dry weight estimation (DW) to achieve euvolemia is one of the key objectives of hemodialysis (HD). While conventionally DW is estimated by clinical examination, bioelectrical impedance analysis (BIA) has been proposed as an objective method to determine DW and has been tested extensively in the Western population. We aim to validate BIA for determining DW in a Pakistani population against the conventional clinician's method. This is a single-center validation study conducted at two outpatient HD units of Aga Khan Hospital, Karachi. One hundred and forty-eight DW readings of patients who were on maintenance HD were taken both by BIA …

X-Linked Agammaglobulinemia - First Case With Bruton Tyrosine Kinase Mutation From Pakistan, Samreen Kulsom Zaidi, Sonia Qureshi, Farah Naz Qamar

Department of Paediatrics and Child Health

X-linked agammaglobulinemia (XLA) is a primary immunodeficiency with more than 600 mutations in Bruton tyrosine kinase (Bkt) gene which are responsible for early-onset agammaglobulinemia and repeated infections. Herein we present a case of a 3-year-old boy with history of repeated diarrhoea and an episode of meningoencephalitis with hemiplegia. The workup showed extremely low levels of immunoglobulin with low CD+19 cells. Genetic analysis showed Btk mutation 18 c.1883delCp.T628fs. To the best of our knowledge this is the first report of a case of XLA confirmed by molecular technique from Pakistan.

Anemia In Children With Palmar Pallor Aged 02 Months To 05 Years, Saroop Chand, Farzana Shaikh, Chetan Das, Yasmeen Memon, Mohammad Akbar Nizamani, Zulfiqar Ali Qutrio Baloch

Department of Paediatrics and Child Health

Objective:
To determine the frequency of anemia in children with palmar pallor aged 02 months to 05 years.
Patients and Methods:
This cross sectional descriptive study of six months (01-12-2012 to 31-05-2013) was conducted in the department of paediatrics at Liaquat University Hospital Hyderabad. All the children, from 02 months to 05 years, of either gender had palmar pallor on examination were recruited and evaluated for anemia by assessing the level of haemoglobin and categorized anemia as mild, moderate and severe. The data was analyzed in SPSS version 16.00, the frequency and percentage was calculated. The chi-square test was applied …

Utilization Of Health Services In A Resource-Limited Rural Area In Kenya: Prevalence And Associated Household-Level Factors, Anthony Ngugi, Felix Agoi, Megan R. Mahoney, Amyn Lakhani, David Mang’Ong’O, Esther Nderitu, Robert Armstrong, Sarah Macfarlane

Faculty of Health Sciences, East Africa

Background: Knowledge of utilization of health services and asso- ciated factors is important in planning and delivery of interventions to improve health services coverage. This knowledge is however limited in many developing countries. We determined the preva- lence and factors associated with health services utilization in a rural area of Kenya. Our findings inform the local health management in development of appropriately targeted interventions.

Methods: Design: Cluster sample survey. Population: Residents of Kaloleni sub-County in Kenya.

Participants/respondents: Household key informants. Outcomes: (i) History of illness for household members and (ii) health services utilization in the preceding month, (iii) factors associated …

February 2017 (Issue 2) : Tips To Increase Physical Activity, Aga Khan University Hospital, Karachi

Nutrition and Food Services Department (NFSD) Archives

• Why is it important?
• How much physical activity do we need?
• Why is physical activity important?
• Practical Tips to Increase Activity

February 2017 (Issue 1) : Tips To Improve Water Intake, Aga Khan University Hospital, Karachi

Nutrition and Food Services Department (NFSD) Archives

• Functions of Water in the Body
• How Much to Drink
• How to Make Kids Drink Water
• How to Increase Water Intake
• Do not Forget Milk

Gestational Diabetes Mellitus And The Predisposing Factors, Syeda Sadia Fatima, Rehana Rehman, Faiza Alam, Sarosh Madhani, Bushra Chaudhry, Taseer Ahmed Khan

Department of Biological & Biomedical Sciences

Objective: To evaluate the occurrence of gestational diabetes mellitus and its association with demographic and anthropometric variables in pregnant women.
Methods: This cross-sectional study was conducted at the Aga Khan University Hospital, Abbasi Shaheed Hospital and Memon Hospital in Karachi, from February 2014 to December 2015, and comprised pregnant women who were screened by 75-g 2-hour oral glucose tolerance test, (24-28 weeks of gestation) and classified as per the criteria of the International Association of Diabetes and Pregnancy Study Group. Weight, body mass index and serum glycated haemoglobin levels were measured. Women with pre-gestational diabetes were excluded. SPSS 21 was …

Childhood And Adolescent Obesity: Primary Health Care Physicians’ Perspectives From Riyadh, Saudi Arabia, Faiza Nasser Alotaibi, Majeedah Alotaibi, Shiakhah Alanazi, Hanan Al-Gethami, Deemah Alateeq, Rowaydah Mishiddi, Amna Rehana Siddiqui

Community Health Sciences

BACKGROUND & OBJECTIVES:

Primary health care (PHC) physicians are foremost to confront childhood and adolescent obesity. Our objective was to evaluate PHC Physicians perspectives for managing overweight/obesity in children and adolescents.

METHODS:

PHC services from eight public hospitals in Riyadh participated. A self-administered tool maintaining anonymity evaluated facilitators and barriers for managing overweight/obese children and adolescent patients. Physicians who 'always' recommended weight management for an overweight / obese patient during past year, by involving patient, parents, and others were classified as having positive and appropriate practice.

RESULTS:

Of the 58 respondents, 51.7% had appropriate practices. Lack of patient motivation (82.2%), …

Parental Perception And Childhood Obesity: Contributors To Incorrect Perception, Hiba Ashraf, Nida Ilyas Shamsi, Ruhma Ashraf

Medical College Documents

Objectives: To determine parental recognition of their child's weight, and to identify the contributing reasons for incorrect perception.

Method: This cross-sectional study was conducted from April to October 2010 at Aga Khan University Hospital, Karachi, and comprised parents of healthy children aged 5-14 years. An interviewer-based pre-tested questionnaire consisting of socio-demographic details, anthropometric measurements, and parental perception about their child's weight was administered. Data was analysed using SPSS 21. Both univariate and multivariate logistic regression were applied to assess for the risk factors associated with incorrect parental perception.

Results: Parents of a total of 330 eligible children …

Effect Of Puerperal Infections On Early Neonatal Mortality: A Secondary Analysis Of Six Demographic And Health Surveys, Saverio Bellizzi, Quique Bassat, Howard L. Sobel, Mohamed M. Ali, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Around 1.5 million annual neonatal deaths occur in the first week of life, and infections represent one of the major causes in developing countries. Neonatal sepsis is often strictly connected to infection of the maternal genital tract during labour.

Methods: The association between signs suggestive of puerperal infection and early neonatal mortality (life) was performed using Demographic and Health Surveys (DHS) data of six countries, conducted between 2010 and 2013. The population attributable fraction (PAF) was generated using the estimates on early neonatal mortality of a 1990-2013 systematic analysis for the Global Burden of Disease Study.

Results: Signs of …

January 2017 (Issue 2) : Safe Use Of Microwave, Aga Khan University Hospital, Karachi

Nutrition and Food Services Department (NFSD) Archives

• How Does a Microwave Cook
• Injury Risk
• Safety Tips
• Use Microwave Safe Containers
• Avoid Super-Heated Water
• Check for Damage To Machine
• How to Report Problems

Can Clinical Staging Of Primary Amoebic Meningoencephalitis Be Of Any Therapeutic Benefit, Abdul Mannan Baig Dr., Armaghan-E-Rehman Mansoor

Department of Biological & Biomedical Sciences

Naegleria fowleri, is a free-living amoeba (FLA) known to infect humans and cause a fatal disease called primary amoebic meningoencephalitis (PAM). All of the patients are commonly admitted to the emergency room (ER). Often, treatment in the ER is delayed due to the rarity of disease leading to a delay in the diagnosis and late arrival of patients to the ER. The attempts to reduce raised intracranial pressure and subsequent herniation of the brain stem are challenging and become the cause of death in the affected patients during their stay in ER. Use of drugs like mannitol to reduce raised …

January 2017 (Issue 1) : Dysmotility, Aga Khan University Hospital, Karachi

Nutrition and Food Services Department (NFSD) Archives

• Causes of Dysmotility
• Measuring Transit Time
• Dietary and Life Style Changes

Total Knee Arthroplasty: Risk Factors For Allogeneic Blood Transfusions In The South Asian Population, Syed Hamza Mufarrih, Nada Qaisar Qureshi, Arif Ali, Azeem Tariq Malik, Huda Naim, Shahryar Noordin

Section of Orthopaedic Surgery

Background: Total knee arthroplasty (TKA) is the recommended treatment for end-stage knee osteoarthritis. Considering the various risks associated with intra and postoperative blood transfusions, better understanding is required with respect to the risk factors contributing to a greater possibility of blood transfusion during or after surgery. Although literature highlights several such factors, our study is among the first to identify these risk factors in the South Asian population which differs from other populations in several ways.
Methods: The study consists of a review of 658 patients undergoing TKA from 2005 to 2015. Data was obtained from patient medical records and …

The Genesis Of Biopolitics And Modern Arabic Medical Discourse In Early Modern Egypt, 1805–1882, Kamran I. Karimullah

Governance Programme Papers

No abstract provided.

Cultural Practices Of Rearing Preterm Infants: A Qualitative Study In A Tertiary Care Hospital, Karachi, Pakistan, Salima Sulaiman Gulamani, Ambreen Tharani, Sharifa Bashir Lalani, Kiran Shaikh

School of Nursing & Midwifery

The research work explores the cultural practices of feeding and hygiene of preterm infants in the Pakistani context. A Qualitative descriptive-exploratory design has been used. Purposive sampling was utilized to recruit 17 mothers, who met inclusion criteria from a largest government tertiary care hospital in Karachi, Pakistan. The semi-structured interview was used to collect the data, which lasted for approximately 45-60 minutes. Thematic analysis was conducted to analyze the key findings of the study. Welcoming newborn with 'honey' and herbal remedies were reported as a common ritual among mothers. Findings revealed differences in the time period of initial bath given …

Exploring The Impact Of Gender Inequities On The Promotion Of Cardiovascular Health Of Women In Pakistan, Rubina Barolia, Alexander M. Clark, Gina M. Higginbottom

School of Nursing & Midwifery

Cardiovascular disease exerts an enormous burden on women's health. The intake of a healthy diet may reduce this burden. However, social norms and economic constraints are often factors that restrain women from paying attention to their diet. Underpinned by critical realism, this study explores how gender/sex influences decision-making regarding food consumption among women of low socioeconomic status (SES). The study was carried out at two cardiac facilities in Karachi, Pakistan, on 24 participants (male and female from different ethnic backgrounds), who had received health education. Using an interpretive descriptive approach, the study identified major barriers to a healthy diet: proscribed …

Mass Deworming To Improve Developmental Health And Wellbeing Of Children In Low-Income And Middle-Income Countries: A Systematic Review And Network Meta-Analysis, Vivian A. Welch, Elizabeth Ghogomu, Alomgir Hossain,, Shally Awasthi, Zulfiqar Ahmed Bhutta, Chisa Cumberbatch, Robert Fletcher, Jessie Mcgowan, Shari Krishnaratne, Elizabeth Kristjansson

Department of Paediatrics and Child Health

Background: Soil-transmitted helminthiasis and schistosomiasis, considered among the neglected tropical diseases by WHO, affect more than a third of the world’s population, with varying intensity of infection. We aimed to evaluate the eff ects of mass deworming for soil-transmitted helminths (with or without deworming for schistosomiasis or cointerventions) on growth, educational achievement, cognition, school attendance, quality of life, and adverse effects in children in endemic helminth areas.

Methods: We searched 11 databases up to Jan 14, 2016, websites and trial registers, contacted authors, and reviewed reference lists. We included studies published in any language of children aged 6 months to …