Digital Commons Network^™

Esophageal Squamous Cell Carcinoma Risk Factors In A Kenyan Population: A Case Control Study, Stanley M. Machoki

Master of Medicine in General Surgery

Background: Esophageal squamous cell carcinoma (ESCC) is a common malignancy inKenya with a dismal outcome with a majority of patients presenting late. The factors that are operative in the etiology of this disease and its geographic distribution withinKenya have not been characterized thus far. Objectives: The objective of this study was to determine the association of ESCC with Khat chewing, which is prevalent in parts ofKenya, and other commonly implicated risk factors (i.e. smoking, alcohol, diet, socioeconomic status, caustic ingestion and first degree family history of ESCC). We also determined the geographic (provincial) origin, age/sex and ethnicity of cases visiting …

A Strong Foundation, Khush Funer Murtaza

Professional Development Centre, Gilgit

No abstract provided.

Community Acquired Pneumonia: Risk Factors Associated With Mortality In A Tertiary Care Hospitalized Patients, Muhammad Irfan, Syed Fayyaz Hussain, Khubaib Mapara, Shafia Memon, Mohammed Mogri, Muniza Bana, Amna Malik, Sara Khan, Nadia A Khan

Section of Pulmonary & Critical Care

OBJECTIVE: To evaluate risk factors associated with mortality in patients hospitalized with CommunityAcquired Pneumonia (CAP) from a developing country.

METHODS: An observational study was conducted on adult patients admitted with a diagnosis of CAP from January 2002 to August 2003 at Aga Khan University hospital, Karachi, Pakistan. Clinical records were reviewed for demographic characteristics, clinical and laboratory features, hospital course, and risk factors associated with mortality.

RESULTS: A total of 329 patients (187 males) were admitted with CAP. Two-third of patients had underlying co-morbid medical illnesses. Complications developed in 15.7% cases and the overall mortality rate was 11%. Risk factors …

Vitamin B12 Deficiency--A Major Cause Of Megaloblastic Anaemia In Patients Attending A Tertiary Care Hospital, Saira Perwaiz Iqbal, Ghulam Nabi Kakepoto, Saleem Perwaiz Iqbal

Department of Pathology and Laboratory Medicine

BACKGROUND: Folate and vitamin B12 deficiencies have been known to cause megaloblastic anaemia. Since the deficiencies of these two vitamins are very common in Pakistani population, it would be imperative to investigate their role in causing megaloblastic anaemia. The objective of this study was to find out the contribution of folate and vitamin B12 deficiencies in causing megaloblastic anaemia in our patient population.

METHODS: In this retrospective cohort study, clinical records of 220 patients (101 females and 119 males with an age range of 1-80 years) who presented themselves with macrocytic anaemia at the Aga Khan University Hospital were collected. …

A Study On The Effect Of Baby Walker On Mean Age Acquisition Of Motor Skills In Infants, Ahmad Talebian, Ali Honarpishe, Abbas Taghavi, Esmail Fakharian, Mahdi Parsa, Gholam Abbas Mousavi

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Consanguinity Among The Risk Factors For Underweight In Children Under Five: A Study From Rural Sindh, S. F. Hasnain, S. K. Hashmi

Community Health Sciences

BACKGROUND: Malnutrition is a common problem, especially in developing countries. Of the 11 million children under 5 who die each year in the developing countries mainly from preventable causes, the death of about 54% are either directly or indirectly attributable to malnutrition. The objectives of this study were to assess the prevalence and associated factors for underweight in rural Sindh.METHODS: A cross-sectional survey was conducted in Jhangara Town, located in District Dadu, Sindh. Eight hundred children under 5 years of age were enrolled. A questionnaire was used to elicit required information and anthropometric measurements were made.RESULTS: The overall prevalence for …

Comparison Of Oral Versus Injectable Vitamin-D For The Treatment Of Nutritional Vitamin-D Deficiency Rickets, Abdul Gaffar Billoo, Ghulam Murtaza, M. Ashraf Memon, Sultan Ahmed Khaskheli, Khalid Iqbal, Masood Hussain Rao

Department of Paediatrics and Child Health

OBJECTIVE: To assess the safety and acceptability of a single dose of vitamin-D versus the efficacy of injectable Vitamin-D versus oral vitamin-D.

STUDY DESIGN: Case control.

PLACE AND DURATION OF STUDY: It was carried out at the Department of Paediatrics, Kharadar General Hospital, Karachi, from August 2003 to April 2004.

METHODOLOGY: Children of the age of 6 months to 3 years with clinical, biochemical and radiological evidence of vitamin- D deficiency rickets were included. The history, clinical examination, complete blood picture, serum calcium. Phosphorus, alkaline phosphatase and X-ray of wrist joint were done. The children were divided into two groups …

Directing Diarrhoeal Disease Research Towards Disease-Burden Reduction, Margaret Kosek, Claudio F. Lanata, Robert E. Black, Damian G. Walker, John D. Snyder, Mohammed Abdus Salam, Dilip Mahalanabis, Olivier Fontaine, Zulfiqar Ahmed Bhutta, Shinjini Bhatnagar, Igor Rudan

Woman and Child Health

Despite gains in controlling mortality relating to diarrhoeal disease, the burden of disease remains unacceptably high. To refocus health research to target disease-burden reduction as the goal of research in child health, the Child Health and Nutrition Research Initiative developed a systematic strategy to rank health research options. This priority-setting exercise included listing of 46 competitive research options in diarrhoeal disease and their critical and quantitative appraisal by 10 experts based on five criteria for research that reflect the ability of the research to be translated into interventions and achieved disease-burden reduction. These criteria included the answerability of the research …

Reforming Education In Pakistan – Tracing Global Links, Sajid Ali, Malik S. A. Tahir

Institute for Educational Development, Karachi

This paper is about tracing global links in national education reforms in Pakistan. The paper tries to describe globalization and its general effects on national policies. It particularly highlights the effects of globalization on education reforms, which are: competitiveness-driven, finance-driven and equity-driven. In light of these global education reform patterns the paper explores the major educational reforms being pursued in Pakistan since 1990s. The paper argues that globalization has seriously challenged the national reform policies, which are now becoming more and more globally driven. Rather than out rightly rejecting all global policies, engaging critically with them is the stance of …

Emergency Contraception: Knowledge And Attitudes Of Family Physicians Of A Teaching Hospital, Karachi, Pakistan, Hamza M. Abdulghani, Syed I. Karim, Farhana Irfan

Department of Family Medicine

This study was conducted to assess the knowledge of family medicine providers and their attitudes towards emergency contraception in a teaching hospital in Karachi, Pakistan. A 21-item questionnaire containing the demographic profile of respondents and questions concerning knowledge of and attitudes towards emergency contraception was distributed among participants. In total, 45 interviews were conducted, with a response rate of 100%, with faculty physicians (33%), residents (27%), medical officers (40%), 36% male and 64% female physicians, of them, the majority (64%) were married. Although the large majority (71%) of the respondents reported considerable familiarity with emergency contraception, objective assessment revealed deficiencies …

Acetabular Morphometry And Prevalence Of Hip Dysplasia In The South Asian Population, Masood Umer, Yasir J. Sepah, Sharjeel Asif, Iqbal Azam Syed, Muhammad Umar Jawad

Section of Orthopaedic Surgery

We carried out a cross-sectional study to measure the association of the seven acetabular parameters with pelvic morphometry and prevalence of hip dysplasia in our population. Convenience sampling was carried out and 250 consecutive patients who came to AKUH for intravenous pyelogram and had no complaints in the region of the hip joint were enrolled in the study. Post-micturition standardized plain antero-posterior pelvic radiographs of 250 asymptomatic adults (500 hip joints) was studied. There were 136 males (54.4%) and 114 females (45.6%). Mean age of our study population was 38 years (15-78 years). The average center edge angle was 35.5±6.6° …

Impact Of Infection Control Activities On The Rate Of Needle Stick Injuries At A Tertiary Care Hospital Of Pakistan Over A Period Of Six Years: An Observational Study., Afia Zafar, Faiza Habib, Roshan Hadwani, Muslima Ejaz, Khurshid Khowaja, Rozina Khowaja, Seema Irfan

Department of Pathology and Laboratory Medicine

Background:Accidental exposure to blood and body fluids is frequent among health care workers. They are at high risk of nosocomial transmission of blood borne pathogens due to injuries caused by used sharps. We are reporting impact of surveillance and educational program on the rate of needle stick injuries among health care workers at a tertiary care hospital in Pakistan.

Methods:

At Aga Khan University Hospital sharp injuries are reported to infection control office. To reduce these incidents a quality improvement project was inducted in the year 2005. Health care workers were educated, surveillance data from 2002 to 2007 was …

Sero-Negative Celiac Disease With Dermatitis Herpetiformes: A Case Report., Mehreen Adhi, Asma Farooq, Syed Ali Hamid, Rabia Hasan, Salman Mamji, Akhtar Ali Baloch

Department of Surgery Docs

Introduction:We report a case of sero-negative celiac disease in Pakistan. Case Presentation: A 20-year-old female presented with papulovesicular rash for 15 years, diarrhea for 8 years, spasms of hands and twitching of face for 4-5 months. She had mild anemia, low vitamin-D3 and serum calcium. On exclusion of other causes of malabsorption, anti-tissue transglutaminase antibodies (immunoglobulin-A & immunoglobulin-G), anti-endomysial antibodies, total immunoglobulin-A levels and skin biopsy were performed, which were normal. Intestinal biopsy revealed subtotal villous atrophy. Patient was prescribed gluten-free diet, to which she responded with alleviation of symptoms.

Conclusions:

Negative serology should not rule out celiac disease, …

Delivering Interventions To Reduce The Global Burden Of Stillbirths: Improving Service Supply And Community Demand., Zulfiqar A Bhutta, Gary L Darmstadt, Rachel A Haws, Mohammad Yawar Yakoob, Joy E Lawn

Woman and Child Health

Background:Although a number of antenatal and intrapartum interventions have shown some evidence of impact on stillbirth incidence, much confusion surrounds ideal strategies for delivering these interventions within health systems, particularly in low-/middle-income countries where 98% of the world's stillbirths occur. Improving the uptake of quality antenatal and intrapartum care is critical for evidence-based interventions to generate an impact at the population level. This concluding paper of a series of papers reviewing the evidence for stillbirth interventions examines the evidence for community and health systems approaches to improve uptake and quality of antenatal and intrapartum care, and synthesises programme and …

Reducing Stillbirths: Behavioural And Nutritional Interventions Before And During Pregnancy., Mohammad Yawar Yakoob, Esme V Menezes, Tanya Soomro, Rachel A Haws, Gary L Darmstadt, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background:The vast majority of global stillbirths occur in low- and middle-income countries, and in many settings, the majority of stillbirths occur antenatally, prior to the onset of labour. Poor nutritional status, lack of antenatal care and a number of behaviours increase women's risk of stillbirth in many resource-poor settings. Interventions to reduce these risks could reduce the resulting burden of stillbirths, but the evidence for the impact of such interventions has not yet been comprehensively evaluated.

Methods:

This second paper of a systematic review of interventions that could plausibly impact stillbirth rates covers 12 different interventions relating to behavioural …

Reducing Stillbirths: Prevention And Management Of Medical Disorders And Infections During Pregnancy., Esme V Menezes, Mohammad Yawar Yakoob, Tanya Soomro, Rachel A Haws, Gary L Darmstadt, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background:An estimated two-thirds of the world's 3.2 million stillbirths occur antenatally, prior to labour, and are often overlooked in policy and programs. Poorly recognised, untreated or inadequately treated maternal infections such as syphilis and malaria, and maternal conditions including hypertensive disorders, are known risk factors for stillbirth.

Methods:

We undertook a systematic review of the evidence for 16 antenatal interventions with the potential to prevent stillbirths. We searched a range of sources including PubMed and the Cochrane Library. For interventions with prior Cochrane reviews, we conducted additional meta-analyses including eligible newer randomised controlled trials following the Cochrane protocol. We …

Folic Acid And Vitamin B6 Deficiencies Related Hyperhomocysteinemia In Apparently Healthy Pakistani Adults; Is Mass Micronutrient Supplementation Indicated In This Population, Perwaiz Iqbal, Bo S Lindblad, Naseema Mehboobali, Farzana A Yusuf, Abrar H Khan, Saleem Perwaiz Iqbal

Department of Biological & Biomedical Sciences

OBJECTIVE: To determine the plasma/serum levels of homocysteine, and vitamins folate, B6 and B12, in Pakistani healthy adults.STUDY DESIGN: Cross-sectional study.PLACE AND DURATION OF STUDY: The Aga Khan University, from October 2006 to April 2008.METHODOLOGY: Fasting levels of plasma/serum folic acid, pyridoxal phosphate (PLP), vitamin B12 and homocysteine were determined in 290 apparently healthy hospital personnel from institutions in two cities of Pakistan. Spearman correlation test and linear regression analysis was conducted.RESULTS: There were 219 males and 71 females with mean age of 46+/-10.5 years and mean body mass index of 23.5 +/-3.8. Mean plasma homocysteine levels in Pakistani normal …

Aku Newsletter : Spring 2009, Volume 10, Issue 1, Aga Khan University

The Aga Khan University Newsletters

No abstract provided.

Fight Against Chronic Diseases (High Blood Pressure, Stroke, Diabetes And Cancer) In Pakistan; Cost-Effective Interventions, Mohammad Wasay, Abdul Jabbar

Department of Medicine

No abstract provided.

Prevalence Of Obesity In School-Going Children Of Karachi., Haider Javed Warraich, Faisal Javed, Mohammed Faraz-Ul-Haq, Fariha Batool Khawaja, Sarah Saleem

Community Health Sciences

Background: Obesity is an emerging problem in Pakistan. The authors sought to determine prevalence of obesity and malnutrition in school-going children, from grades 6(th) to 8(th) of different schools of Karachi and assess associations that affect the weight of the children.
Methodology/Principal Findings: A cross sectional Study Design with children studying in grades 6(th) to 8(th) grade, in different schools of Karachi. We visited 10 schools of which 4 consented, two subsidized government schools and two private schools. A questionnaire was developed in consultation with a qualified nutritionist. Height and weight were measured on calibrated scales. A modified BMI criterion …

Risks For Preterm Delivery And Low Birth Weight Are Independently Increased By Severity Of Maternal Anaemia, Hussein Kidanto, Ingrid Mogren, Gunilla Lindmark, Siriel Massawe, Lennarth Nystrom

Faculty of Health Sciences, East Africa

OBJECTIVE: To estimate the effect of the severity of maternal anaemia on various perinatal outcomes.

DESIGN: A cross-sectional study.

SETTING: Labour Ward, Muhimbili National Hospital, Dar es Salaam, Tanzania.

METHOD: The haemoglobin of eligible pregnant women admitted for delivery between 15 November 2002 and 15 February 2003 was measured. Data on socio-demographic characteristics, iron supplementation, malaria prophylaxis, blood transfusion during current pregnancy, and current and previous pregnancy outcomes were collected and analysed. Anaemia was classified according to the World Health Organization (WHO) standards: normal - Hb >11.0 g/dl; mild - Hb 9.0 - 10.9 g/dl; moderate - …

The Health Seeking Behaviour Of Elderly Population In A Poor-Urban Community Of Karachi, Pakistan, Abdullah Ladha, Romaisa Shamim Khan, Awais Amjad Malik, Sana Farooq Khan, Beenish Khan, Irum Nawaz Khan, Samiullah, Waleed Tallat Kayani, Sarah Saleem

Community Health Sciences

OBJECTIVES: To presents socio-demographic characteristics and health seeking behaviour of elderly and to determine frequency of Diabetes Mellitus and Hypertension in elderly population of a poor peri-urban community in Karachi, Pakistan.

METHODS: A cross-sectional study was conducted, targeting population aged 65 or above. A total of 438 respondents were interviewed after taking informed consent, between November 2005 and December 2005. Frequencies and Chi square values were calculated for different variables using SPSS 13.0.

RESULTS: Total population surveyed comprised of 438 elderly, 158 (36%) women and 280 (63.9%) men. Mean age for the population was 71.44 +/- 7.74. A total of …

Secondary Prevention Of Heart Disease - Knowledge Among Cardiologists And Omega-3 (Omega-3) Fatty Acid Prescribing Behaviors In Karachi, Pakistan, Saqib A. Gowani, Sana Shoukat, Ather M. Taqui, Hashim M. Hanif, Wasiq F. Rawasia, Zeeshan Qadri, Sajid H. Dhakam

Section of Cardiology

Background: The use of omega-3 fatty acids is a currently proven strategy for secondary prevention of heart disease. The prescription practices for this important nutraceutical is not currently known. It is imperative to assess the knowledge of cardiologists regarding the benefits of omega-3 fatty acids and to determine the frequency of its prescription. The aim of the study was to determine the practices and associations of dietary fish prescribing among cardiologists of Karachi and to assess their knowledge of fish oil supplementation and attitudes toward dietary practices. Methods: A cross sectional survey was conducted during the period of January to …

In Vitro And In Vivo Anthelmintic Activity Of Terminalia Arjuna Bark, Hafiz Allah Bachaya, Zafar Iqbal, Muhammad Nisar Khan, Abdul Jabbar, Anwar Hassan Gilani, Islam-Ud Din

Department of Biological & Biomedical Sciences

The present study was carried out to evaluate the anthelmintic activity of Terminalia arjuna (Roxb.) bark locally used as an anthelmintic. Lethal median concentration (LC50 values) of methanolic extract of T. arjuna bark in egg hatch and larval development tests against Haemonchus contortus ova and larva were found to be 645.65 and 467.74 μg mL-1, respectively. Inadult motility assay, efficacy of the extract was evident by the mortality of H. contortus at different hours post exposure. Invivo results revealed maximum (87.3%) egg count percent reduction (ECR) in sheep treated with crude methanolic extract @ 3 g kg-1 body …

Characteristics Of Hiv-Infected Children Seen In Western Kenya, W Nyandiko, A. Mwangi, S. O. Ayaya, E. C. Nabakwe, C. N. Tenge, R. C. Vreeman, Peter Gisore

Paediatrics and Child Health, East Africa

Objectives: To describe the characteristics and outcomes of children registered for care in a large HIV care programme in Western Kenya.

Design: A retrospective descriptive study.

Setting: USAID-AMPATH HIV clinics in health centres; district and sub-district hospitals; Moi Teaching and Referral Hospital in Western Kenya.

Subjects: HIV-infected children below age of 15 years seen in a network of 18 clinics in Western Kenya.

Interventions: Paediatric HIV diagnosis and care including treatment and prevention of opportunistic infections and provision of combination antiretroviral therapy (CART).

Main outcome measures: Diagnosis, clinical stage and immune status at enrollment and follow-up; hospitalisation and death. Descriptive …

Clinico-Pathologic Characteristics And Treatment Outcomes In Children With Neuroblastoma At The Kenyatta National Hospital, Nairobi., Grace Kitonyi, William Macharia, Otieno Walter Mwanda, R. Pamnani

Paediatrics and Child Health, East Africa

Objective: To determine clinical-pathologic characteristics, treatment modalities and treatment outcomes of children diagnosed with neuroblastoma.

Design: Cross- sectional descriptive study based on secondary data from patient records.

Setting: Records department of Kenyatta National Hospital (KNH), a tertiary teaching and referral hospital based in Nairobi.

Subjects: Children aged 15 years and below, admitted with the diagnosis of neuroblastoma, between January 1997 and December 2005.

Main outcome measures: Presenting clinical features, diagnostic modalities including laboratory and imaging data, treatment modalities, response to treatment and patient survival.

Results: Twenty six patients were eligible for the study; 13 males and 13 females giving a …

Feasibility Study On Result-Based Financial Mechanisms For Mnch, Shehla Zaidi, Zulfiqar Ahmed Bhutta, Asad Saeed, Ajmal Agha, Ghulam Haider Akhund, Zohra Lassi, Farhan Saeed Vakani, Yasser Kureshi, Mohammad Faisal, Tanweer Hussain, Murad Charania

Community Health Sciences

No abstract provided.

A Comparison Of Treatments Offered To Patients With Nonalcoholic Steatohepatitis, Saleem Perwaiz Iqbal, Sadia Mahmud, Saeed Hamid, Omrana Pasha, Khabir Ahmad

Department of Paediatrics and Child Health

OBJECTIVE: To compare various treatment options provided to patients with Nonalcoholic Steatohepatitis (NASH) and assess improvement in liver status via reduction in serum Alanine Aminotransferase (ALT) levels.

STUDY DESIGN: Retrospective cohort study.

PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi, from April 2000 to April 2007.

METHODOLOGY: All available records of patients aged between 20-70 years, fatty liver on ultrasound, elevated serum ALT and having at least one follow-up, after a baseline visit were included. The patients had variable number of follow-ups and a maximum of 3 follow-ups were considered. Information was collected on demographic and clinical …

Prevalence And Factors Associated With Intestinal Parasitic Infection Among Children In An Urban Slum Of Karachi., Vikram Mehraj, Juanita Hatcher, Saeed Akhtar, Ghazala Rafique, Mohammad Asim Beg

Department of Pathology and Laboratory Medicine

Background:Intestinal parasitic infections are endemic worldwide and have been described as constituting the greatest single worldwide cause of illness and disease. Poverty, illiteracy, poor hygiene, lack of access to potable water and hot and humid tropical climate are the factors associated with intestinal parasitic infections. The study aimed to estimate prevalence and identify factors associated with intestinal parasitic infections among 1 to 5 years old children residing in an urban slum of Karachi Pakistan. Methods And Principal
Findings:A cross sectional survey was conducted from February to June 2006 in Ghosia Colony Gulshan Town Karachi, Pakistan. A simple random …

Surgical Management Of Blunt Pancreatic Trauma: A Modus Operandi Or Individualized Therapy?, Muhammad Rizwan Khan, Kiran Ejaz

Section of General Surgery

The overall rate of blunt pancreatic trauma observed in level one trauma centers is rather low compared to other injuries, with a reported prevalence of 0.4 per 100,000 hospital admissions. The situation may be further complicated by the presence of associated major visceral injuries in these patients. A number of previous reports indicate that blunt pancreatic trauma carries high morbidity and mortality rates, especially when diagnosis is delayed or inappropriate surgery is attempted. Many mandate prompt surgical explorations for organ-specific diagnosis on CT; however other literature and upcoming studies prove otherwise. Over the years, several technologic advances have increased the …