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Antenatal Care And The Occurrence Of Low Birth Weight Delivery Among Women In Remote Mountainous Region Of Chitral, Pakistan, Z. Ahmed, S. Khoja, Suha S. Tirmizi

Obstetrics and Gynaecology, East Africa

Objective: Low birth weight (LBW) is closely associated with perinatal morbidity and bears an increased risk for subsequent infant morbidity. The study aimed to assess low birth weight delivery factors among women in Chitral, Pakistan.

Methodology: Mixed Methodology was adopted. Structured data collection tool was used to collect information from medical records of 1316 mothers, followed by interviews and focus group discussions to understand the causes and their remedies. The main outcome measure was infants born with low birth weight LBW (<2.5kg).

Result: There was a significant association between the occurrence of low birth weight and maternal education, paternal education, …

Situation Analysis Of Child Labour In Karachi, Pakistan: A Qualitative Study, Asaad Ahmed Nafees, Kausar S. Khan, Zafar Fatmi, Mubashir Aslam

Community Health Sciences

In Karachi, large employment opportunities, burgeoning population and the availability of cheap labour might be the contributing factors for the increasing prevalence of child labour. A literature review was conducted in 2007 that included published and unpublished literature since 2000. Various organizations working in the field were also covered, while the perception of the child labourers was covered through three focus group discussions. Common health issues among the child labourers in Karachi included respiratory illnesses, fever and generalised pains, as well as drug and sexual abuse. Organisations working for child labour could be broadly categorised into those working for legal …

Epidemiological Ins And Outs Of Helicobacter Pylori: A Review, Jibran Sualeh Muhammad, Syed Faisal Zaidi, Toshiro Sugiyama

Department of Biological & Biomedical Sciences

Helicobacter pylori infection is now recognised as a worldwide problem. It is the most common cause of chronic gastritis, and is strongly linked to peptic ulcer disease and gastric cancer. A comprehensive understanding of epidemiological ins and outs of H. pylori infection is very important in solving the patho-physiological enigma and might help in leading towards better management and prognosis of infection. This article presents a review of the literature on the epidemiology of H. pylori infection from 2006 to 2011. The authors used Medical Subject Heading (MeSH) terms 'Helicobacter' with 'epidemiology,' 'transmission' or 'risk factor' to search PubMed database. …

Non-Diabetic Renal Disease In Patients With Type-2 Diabetes Mellitus, Sonia Yaqub, Waqar Kashif, Syed Ather Hussain

Section of Nephrology

Diabetic nephropathy (DN) is the leading cause of end-stage renal disease in diabetics worldwide, yet most patients with type-2 diabetes mellitus are not formally evaluated with a renal biopsy. The diagnosis is almost always based on clinical grounds. A wide spectrum of non-diabetic renal disease (NDRD) is reported to occur in patients with type-2 diabetes. It has been estimated that up to one-third of all diabetic patients who present with proteinuria are suffering from NDRD. The aim of this analysis was to evaluate the prevalence and etiology of NDRD in patients with type-2 diabetes. We retrospectively reviewed the medical records …

Beyond Theatres : Issue 2, 2012, Department Of Surgery

Department of Surgery Archives

No abstract provided.

Carrs Surveillance Study: Design And Methods To Assess Burdens From Multiple Perspectives, Manisha Nair, Mohammed K. Ali, Vamadevan S. Ajay, Roopa Shivashankar, Viswanathan Mohan, Rajendra Pradeepa, Hassan Mehmood Khan, Muhammad Masood Kadir, Zafar Fatmi, K Srinath Reddy, Nikhil Tandon, Km Venkat Narayan, Dorairaj Prabhakaran

Community Health Sciences

Background: Cardio-metabolic diseases (CMDs) are a growing public health problem, but data on incidence, trends, and costs in developing countries is scarce. Comprehensive and standardised surveillance for non-communicable diseases was recommended at the United Nations High-level meeting in 2011.
Aims: To develop a model surveillance system for CMDs and risk factors that could be adopted for continued assessment of burdens from multiple perspectives in South-Asian countries.
Design: Hybrid model with two cross-sectional serial surveys three years apart to monitor trend, with a three-year prospective follow-up of the first cohort.Sites: Three urban settings (Chennai and New Delhi in India; Karachi in …

Frequency Of Poor Quality Of Life And Predictors Of Health Related Quality Of Life In Cirrhosis At A Tertiary Care Hospital Pakistan, Om Parkash, Romaina Iqbal, Fatima Jafri, Iqbal Azam, Wasim Jafri

Section of Gastroenterology

Background

Cirrhosis produces variety of symptoms which eventually lead to a negative impact on Health Related Quality of Life (HRQOL). The general aim of this study was to evaluate the magnitude of poor HRQOL and to assess factors related with HRQOL in patients with CLD in Pakistan.

Findings

This was a cross sectional study conducted in gastroenterology outpatient clinics of Aga Khan University Hospital, Karachi on adult patients with cirrhosis. In this study chronic liver disease questionnaire (CLDQ) was used to assess HRQOL of these patients and CLDQ score was used as an outcome measure to determine factors related with …

Carrs Surveillance Study: Design And Methods To Assess Burdens From Multiple Perspectives, Manisha Nair, Mohammed K. Ali, Vamadevan S. Ajay, Roopa Shivashankar, Viswanathan Mohan, Rajendra Pradeepa, Mohan Deepa, Hassan Mehmood Khan, Muhammad Masood Kadir, Zafar Fatmi, Srinath Srinath Reddy, Nikhil Tandon, Km Venkat Narayan, Dorairaj Prabhakaran

Community Health Sciences

Background: Cardio-metabolic diseases (CMDs) are a growing public health problem, but data on incidence, trends, and costs in developing countries is scarce. Comprehensive and standardised surveillance for non-communicable diseases was recommended at the United Nations High-level meeting in 2011.
Aims: To develop a model surveillance system for CMDs and risk factors that could be adopted for continued assessment of burdens from multiple perspectives in South-Asian countries.
Design: Hybrid model with two cross-sectional serial surveys three years apart to monitor trend, with a three-year prospective follow-up of the first cohort.Sites: Three urban settings (Chennai and New Delhi in India; Karachi in …

Perception And Knowledge About Dietary Intake In Patients With Liver Cirrhosis And Its Relationship With The Level Of Education, Rustam Khan, Ashfaq Ahmed, Faisal Wasim Ismail, Shahab Abid, Safia Awan, Syed Hasnain Shah, Saeed Hamid, Wasim Jafri

Section of Gastroenterology

Objective: To determine patients perception and knowledge regarding diet in cirrhosis and its relationship with the level of patients education.
Study Design: Cross-sectional observational study. Place and Duration of Study: This study was conducted at Gastroenterology Outpatient Clinics at the Aga Khan University Hospital, Karachi, the Aga Khan Health Services, Malir, Karachi and Hamdard University, Karachi, from January to December 2010.
Methodology: Consecutive adult patients with compensated cirrhosis were enrolled. Demographic data, level of education, type and reason of food restriction as well as the source of dietary information was asked. Baseline laboratory test were performed, and nutritional status was …

Labrad : Vol 38, Issue 1 - July 2012, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• How to Investigate a Bleeding Disorder
• Nucleic Acid Testing at AKUH
• Lab Diagnosis of von Willebrand Disease
• Scoring Systems in Diagnosis of Disseminated Intravascular Coagulation
• Plasma and Platelet Transfusions in Liver Diseases
• Ristocetin Cofactor Activity
• All You Need to Know About Thrombophilia Screening
• Signifi cance of Antiphospholipid Antibodies
• Homocysteine as a Risk Factor of Thrombosis
• Report on 4th Biennial Course in Chemical Pathology

Grading Complication Following Radical Cystectomy And Ileal Conduit For Bladder Cancer Using Clavien Grading System, Syed Johar Raza, M Hammad Ather, Faisal Aziz Khan, Zaheer Alam

Section of Urology

Objective: To determine the 30-day complication rate of radical cystectomy and urinary diversion using a validated system.
Study Design: An analytical descriptive study.
Place and Duration of Study: The Aga Khan University Hospital, Karachi, from 1990 to 2010.
Methodology: Patients who had undergone ileal conduit (IC) formation, following radical cystectomy (RC) for muscle invasive transitional cell carcinoma, were studied, using a prospectively maintained data base. Basic details were determined, complications were noted and graded according to the modified Clavien grading system (CG). Results were presented using descriptive statistics.
Results: Of all the RC performed at this hospital 89 patients received …

Exploring The Contribution Of General Self-Efficacy To The Use Of Self-Care Symptom Management Strategies By People Living With Hiv Infection, Inge B. Corless, Dean Wantland, Kenn M. Kirksey, Patrice K. Nicholas, Sarie Human, John Arudo, Maria Rosa, Yvette Cuca, Sue Willard, Mary Jane Hamilton, Carmen Portillo, Elizabeth Sefcik, Linda Robinson, Cathy Bain, Shanaz Moezzi, Mary Maryland, Emily Huang, William L. Holzemer

School of Nursing & Midwifery, East Africa

General self-efficacy (GSE), the expectation that one is able to perform a behavior successfully, may differentiate those who are able to successfully utilize self-care symptom management strategies (SCSMS). This subanalysis (n = 569) of an international 12 site longitudinal randomized controlled trial (RCT) (n = 775), investigated GSE as an important factor determining symptom burden, SCSMS, engagement with the provider, and medication adherence over time, and identified differences in those with high and low GSE ratings concerning these variables. Parametric and nonparametric repeated-measures tests were employed to assess GSE and the perceived effectiveness of SCSMS for anxiety, depression, diarrhea, fatigue, …

Gender Differences In Risk Factors, Mortality, And Length Of Stay Of Patients Discharged From A Pakistani Stroke Unit: A Comparative Cross-Sectional Study, Farzin Majeed, Bilal Ahmed, Maria Khan, Shaista Anwar Siddiqi, Ayeesha Kamran Kamal

Department of Medicine

BACKGROUND: Differences between women and men in relation to stroke are increasingly being recognized. There is a scarcity of data on gender-based differences in stroke risk factors and outcomes from Pakistan.

METHODS: We enrolled 231 consecutive patients diagnosed with acute stroke. All patients received care along a standardized stroke pathway in a single stroke unit. We analyzed demographic and medical factors, NIHSS scores, and outcomes.

RESULTS: Of 213 consecutive hospitalized patients, 135 patients were men and 76 were women. The male to female ratio was 1.84. The mean age of males was 62.3913.56, as compared to females 61.15911.60 years. Hypertension, …

Frequency And Associated Factors For Anxiety And Depression In Pregnant Women: A Hospital-Based Cross-Sectional Study., Niloufer Sultan Ali, Iqbal Azam Syed, Badar S. Ali, Ghurnata Tabbusum, Sana S. Moin

Department of Family Medicine

Antepartum anxiety and/or depression is a major public health problem globally. The aim of this study was to estimate the frequency of antepartum anxiety and/or depression among pregnant women. This was a cross-sectional study conducted in a tertiary care hospital among pregnant women. A total of 165 pregnant women were interviewed by a clinical psychologist using HADS for assessing anxiety and/or depression and also collected information regarding sociodemographic, obstetric, family relationships, and home environment. Out of the total of 165 pregnant women about 70 percent of them were either anxious and/or depressed. The increasing age of women (P-value = 0.073), …

Comparison Of Different Craniofacial Patterns With Pharyngeal Widths, Sarwat Memon, Mubassar Fida, Attiya Shaikh

Section of Dental-Oral Maxillofacial Surgery

OBJECTIVE: To compare different craniofacial patterns with pharyngeal widths.

STUDY DESIGN: Cross-sectional analytical study.

PLACE AND DURATION OF STUDY: Orthodontic Clinic at the Aga Khan University Hospital, Karachi, from June 2002 to June 2010.

METHODOLOGY: Data were collected using pre-treatment records including orthodontic files and pre-treatment lateral cephalographs of 360 orthodontic patients. The inclusion criteria were subjects of Pakistani origin, aged between 14-20 years and having no pharyngeal pathology or complaints of nasal obstruction at the initial visit. The sample comprised a total of 360 subjects divided into 2 groups: skeletal Class I (n=180) and skeletal Class II (n=180) subdivided …

Improving Women And Family’S Health Through Integrated Microfinance, Health Education And Promotion In Rural Areas, Kahabi Isangula

School of Nursing & Midwifery, East Africa

While increasing number of women enjoys more freedom and power in urban areas, women in rural areas are at a disadvantage in almost all aspects of life when compared to men. Investing in economic empowerment of women particularly in rural areas by supporting them to implement local context based business ideas and basic finance capacity and skills development may reverse these trends, however, when combined with heath education and promotion through trainings focusing on preventive health yields greater impact. This paper is a systematic review of the peer - reviewed research papers and project reports in English language on how …

Clinical Utility Of Folate-Containing Oral Contraceptives., Zohra S Lassi, Zulfiqar Ahmed Bhutta

Woman and Child Health

Folate is a generic term for a water-soluble B-complex vitamin which plays an important role in protein synthesis and metabolism and other processes related to cell multiplication and tissue growth. Pregnant and lactating women are at increased risk of folic acid deficiency because generally their dietary folate is insufficient to meet their physiological requirements and the metabolic demands of the growing fetus. The evidence pertaining to the reduction of the risk of neural tube defects (NTDs) due to folate is so compelling that supplementation with 400 mug of folic acid to all women trying to conceive until 12 weeks of …

Malnutrition In Young Pakistani Children, Shela Akbar Ali Hirani

School of Nursing & Midwifery

Background: Pakistan is a developing country with the second highest infant and child mortality rate in South Asia. In this region, malnutrition underlies much of the high infant and under five child morbidity and mortality rates. Although struggle to tackle the issue of malnutrition among young Pakistani children has been going on since many decades, till yet a realistic solution for this growing problem has not been found.

Objective: This paper aims at reviewing literature to analyse the biological, maternal, socio-cultural, environmental, and politico-economical determinants of malnutrition among young children in Pakistan so that need based interventions can …

Biotinidase Deficiency In Pakistani Children; What Needs To Be Known And Done, Bushra Afroze, Mohammad Wasay

Department of Medicine

No abstract provided.

Response Of A Single 'Mega Intramuscular Dose' Of Vitamin D On Serum 25ohd And Parathyroid Hormone Levels, Aysha Habib, Dileep K Rohra, Shakil A Saghir, Shamsa K Udani, Richard Wood, Abdul Jabbar

Department of Pathology and Laboratory Medicine

Objective: To determine the changes produced in serum 25OHD and iPTH levels after 600,000 IU of injection cholecalciferol in volunteers. Study Design: Interventional study. Place and Duration of Study: Section of Chemical Pathology, Department of Pathology and Microbiology, the Aga Khan University Hospital, Karachi, from June 2009 - June 2010. Methodology: Volunteers of either gender aged 18-40 years with known 25OHD, calcium (Ca), creatinine (Cr) and phosphorous (P) levels were included in the study. Subjects on therapy like vitamin D and calcium supplements, corticosteroids or anti-epileptic medicines, primary hyperparathyroidism and hypercalcaemia, with co-morbidity like renal failure, liver disease and history …

Relationship Between Vitamin B12, Folate And Homocysteine Levels And H. Pylori Infection In Patients With Functional Dyspepsia: A Cross-Section Study, Shahid Rasool, Shahab Abid, Mohammad Perwaiz Iqbal, Naseema Mehboobali, Ghulam Haider, Wasim Jafri

Section of Gastroenterology

Background

H. pylori infection has been associated with many micronutrient deficiencies. There is a dearth of data from communities with nutritional deficiencies and high prevalence of H. pylori infection. The aim of this study was to determine the impact of H. pylori infection on serum levels of vitamin B₁₂, folate and homocysteine in patients with functional dyspepsia (FD).

Methods

One hundred and thirty-two patients with FD undergoing gastroscopy were enrolled. The serum was analyzed for B₁₂, folate and homocysteine levels before gastroscopy. H. pylori infection was diagnosed by histopathological examination of gastric biopsies and urea breath …

Antioxidant, Antimicrobial Properties And Phenolics Of Different Solvent Extracts From Bark, Leaves And Seeds Of Pongamia Pinnata (L.) Pierre, Zahid Iqbal Sajid, Farooq Anwar, Ghulam Shabir, Ghulam Rasul, Khalid M. Alkharfy, Anwarul Hassan Gilani

Department of Biological & Biomedical Sciences

This study appraises the antioxidant and antimicrobial attributes of various solvent extracts (absolute methanol, aqueous methanol, absolute ethanol, aqueous ethanol, absolute acetone, aqueous acetone, and deionized water) from bark, leaves and seeds of Pongamia pinnata (L.) Pierre. Maximum extraction yield of antioxidant components from bark (16.31%), leaves (11.42%) and seeds (21.51%) of P. pinnata was obtained using aqueous methanol (20:80). Of the extracts tested, the bark extract, obtained with aqueous methanol, exhibited greater levels of total phenolics [6.94 g GAE/100 g dry weight (DW)], total flavonoids (3.44 g CE/100 g DW), inhibition of linoleic acid peroxidation (69.23%) and DPPH radical …

Vitamin D Levels In Asymptomatic Adults--A Population Survey In Karachi, Pakistan, Adil Sheikh, Zeb Saeed, Syed Ali Danial Jafri, Iffat Yazdani, Syed Ather Hussain

Section of Nephrology

Background: It is well established that low levels of 25(OH) Vitamin D (/dL) are a common finding world over, affecting over a billion of the global population. Our primary objective was to determine the prevalence of vitamin D deficiency and insufficiency in the asymptomatic adult population of Karachi, Pakistan and the demographic, nutritional and co-morbidity characteristics associated with serum vitamin D levels. Methods: A cross-sectional population survey was conducted at two spaced out densely populated areas of the city. Serum levels of 25OH vitamin D were measured and GFR as renal function was assessed by using 4 variable MDRD formula. …

Protecting Pakistan's Health During The Global Economic Crisis, Rashid Jooma, A Khan, A A. Khan

Section of Neurosurgery

The world is facing an unprecedented global economic crisis, with many countries needing to reconsider their level of health care spending. This paper explores the many consequences of the global economic turndown on Pakistan's health, including reduced government and donor spending and increased poverty with the consequent diversion of funds away from health. Nevertheless, these challenges may provide opportunities not only to mitigate the adverse effects of the economic crisis but also to institute some much-needed reforms that may not receive political support during more affluent times. Our suggestions focus on setting priorities based on the national disease burden, prioritizing …

Continuous Renal Replacement Therapy, Gulzar Salman Amlani

School of Nursing & Midwifery

Acute renal failure refers to sudden deterioration in biochemical and physiological functioning of kidneys and often associated with multi organ failure. Continuous renal replacement therapy (CRRT) holds special significance for the treatment of renal failure due to a variety of factors. It is believed that CRRT helps in restoration of acid-base imbalances and electrolyte abnormalities. Along with that, with gradual solute removal, it ensures haemodynamic stability and prevents the risk of cerebral oedema in neurosurgery patients. Besides this, several studies have supported that CRRT enables practitioners to adjust drug dosages and prevent drug accumulation and overdose. In addition, gradual removal …

Nutritional Status In Patients With Hepatitis C, Faisal Wasim Ismail, Rustam A. Khan, Lubna Kamani, Ashfaq A. Wadalawala, Hasnain Ali Shah, Saeed Hamid, Wasim Jafri

Section of Gastroenterology

Objective: To assess the nutritional status via the SGA (subjective global assessment) screening tool of patients at all stages of hepatitis C virus (HCV) liver disease.
Study design: Descriptive study.
Place and duration of study: Out-patient Clinics of the Aga Khan University Hospital, Karachi, conducted from October 2009 to January 2011.
Methodology: Patients with hepatitis C virus infection and their HCV-negative attendants were enrolled from the outpatient clinics, and categorized into 4 groups of 100 patients each: healthy controls (HC), those with chronic hepatitis C infection (CHC), compensated cirrhotics (CC) and decompensated cirrhotics (DC). The validated subjective global assessment (SGA) …

An In Vivo Study On The Diuretic Activity Of Holarrhena Antidysenterica, Aslam Khan, Samra Bashir, Anwar Hassan Gilani

Department of Biological & Biomedical Sciences

Holarrhena antidysenterica is used as diuretic in traditional medicine. The aim of this study was to evaluate the crude extract of H. antidysentrica seeds (Ha.Cr) and its fractions, n-hexane (Ha.Hx), n-butanol (Ha.Bu) and aqueous (Ha.Aq), for their diuretic effect in Wistar rats and to investigate whether the activity is concentrated in any of the fractions. Wistar rats kept on fasting for 24 h with water ad labium, divided into normal, positive control and treated groups were orally given normal saline (20 ml/kg), hydrochlorothiazide (HCT; 10 mg/kg) and different doses of the plant material, respectively. Immediately after dosing, the rats were …

Vitamin D: Does It Play A Role In Psychiatry, Mukesh Mohan Bhimani

Department of Psychiatry

No abstract provided.

Schools As Potential Vaccination Venue For Vaccines Outside Regular Epi Schedule: Results From A School Census In Pakistan., Sajid Bashir Soofi, Inam-Ul Haq, M. Imran Khan, Muhammad Bilal Siddiqui, Mushtaq Mirani, Rehman Tahir, Imtiaz Hussain, Mahesh K Puri, Zamir Hussain Suhag, Asif R Khowaja, Abdul Razzaq Lasi, John D Clemens, Michael Favorov, R. Leon Ochiai, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: Vaccines are the most effective public health intervention. Expanded Program on Immunization (EPI) provides routine vaccination in developing countries. However, vaccines that cannot be given in EPI schedule such as typhoid fever vaccine need alternative venues. In areas where school enrolment is high, schools provide a cost effective opportunity for vaccination. Prior to start of a school-based typhoid vaccination program, interviews were conducted with staff of educational institutions in two townships of Karachi, Pakistan to collect baseline information about the school system and to plan a typhoid vaccination program. Data collection teams administered a structured questionnaire to all schools …

Skeletal Manifestations Of Scurvy: A Case Report From Dubai, Shahryar Noordin, Naveed Baloch, Muhammad Sohail Salat, Abdul Rashid Memon, Tashfeen Ahmad

Section of Orthopaedic Surgery

Introduction: Nutritional deficiencies are rarely reported in developed countries. We report a child of Pakistani origin brought up in Dubai who developed skeletal manifestations of scurvy due to peculiar dietary habits.
Case Presentation: A 4.5 year old boy presented with pain and swelling of multiple joints for three months and inability to walk for two months. Dietary history was significant for exclusive meat intake for the preceding two years. On examination the child's height and weight were below the 5th percentile for his age. He was pale and tachycardic. There was significant swelling and tenderness over the wrist, knee and …