Digital Commons Network^™

Severe Anaphylactic Reaction At Induction Of Anaesthesia, Aliya Ahmed, Anand Kumar

Department of Anaesthesia

Anaphylaxis is an IgE mediated severe allergic reaction causing release of vasoactive substances from mast cells and basophils after re-exposure to an antigen. Signs and symptoms include flushing, urticaria, hypotension, tachycardia, bronchospasm, cardio-respiratory arrest etc. It can occur at induction of anaesthesia when multiple drugs are being administered, but prompt diagnosis with correct management is the key to a successful outcome. This case report describes a patient who developed severe bronchospasm with difficulty in inflating the lungs and dropping oxygen saturations, alongwith hypotension, tachycardia and widespread flushing, at induction of anaesthesia for elective breast surgery. She was promptly managed and …

Significance Of Caga Status And Vaca Subtypes Of Helicobacter Pylori In Determining Gastric Histopathology In Pakistan, Javed Yakoob, Shahab Abid, Z Abbas, Wasim Jafri, Z Ahmed, Muhammad Islam

Section of Gastroenterology

No abstract provided.

Health Seeking Behaviour And Health Services Utilization Trends In National Health Survey Of Pakistan: What Needs To Be Done?, Babar T. Shaikh, Juanita Hatcher

Community Health Sciences

In developing countries, health seeking behaviours and health care services utilization patterns have been studied and the determinants have been classified in physical, socio-economic, cultural and political contexts. This paper is based on a systematic review of peer-reviewed literature on the relationship of factors affecting health service utilization and the focus has been on Pakistan. For this purpose, National Health Survey (NHS) of Pakistan, conducted in 1990-1994, has been critically reviewed. The review reveals specific behaviours following gender differences, socio-cultural milieu, disease patterns, household economics etc. Thus it becomes imperative to design evidence based policies by developing the understanding of …

Poor Knowledge--Predictor Of Nonadherence To Universal Precautions For Blood Borne Pathogens At First Level Care Facilities In Pakistan, Naveed Z. Janjua, Mahreen Razaq, Subhash Chandir, Shafquat Rozi, Bushra Mahmood

Community Health Sciences

Background: We conducted an assessment of knowledge about blood borne pathogens (BBP) and use of universal precautions at first level care facilities (FLCF) in two districts of Pakistan.Methods: We conducted a cross-sectional survey and selected three different types of FLCFs ; public, general practitioners and unqualified practitioners through stratified random sampling technique. At each facility, we interviewed a prescriber, a dispenser, and a housekeeper for knowledge of BBPs transmission and preventive practices, risk perception, and use of universal precautions. We performed multiple linear regression to assess the effect of knowledge score (11 items) on the practice of universal precautions score …

Eight Key Household Practices Of Integrated Management Of Childhood Illnesses (Imci) Amongst Mothers Of Children Aged 6 To 59 Months In Gambat, Sindh, Pakistan, Ajmal Agha, Muhammad Younus, Muhammed Masood Kadir, Sajid Ali, Zafar Fatmi

Community Health Sciences

Objective:

To determine Knowledge, Attitudes and Practices (KAP) regarding eight key integrated management of childhood illness (IMCI) suggested practices and the association of these key practices with stunting as outcome.

Methods:

Sampling proportionate to sub-population sizes was employed to ensure representation from all the Union Councils of taluka Gambat-Sindh.

Results:

Low female education and mobility show the status of child's first care provider in a typical rural community. Few women knew about giving more food to a child suffering from diarrhoea. Moreover, very few exclusively breastfed their children for first 4-6 months, got their children completely immunized, washed hands before …

Thirty Years Of Alma Ata Pledges: Is Devolution In Pakistan An Opportunity For Rekindling Primary Health Care?, Babar T. Shaikh, Muhammad Masood Kadir, Gregory Pappas

Community Health Sciences

The 1978 Alma Ata Conference presented the manifesto to attain global health for the next century by providing basic health care aimed at the urban and rural poor of the developing world. While the goals of Alma Ata were noble, they were untenable. Today, developing countries face serious issues of equity in health care delivery and fairness in health care management with even a greater need to transform the management systems and practice. Primary health care remains a cornerstone of building the capacity of health systems. Devolution in health sector in Pakistan seems like a chance to re-exert Alma Ata …

Labrad : Vol 32, Issue 2 - May 2007, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• Transcription Mediated Amplification for the Diagnosis of HCV RNA
• Vanillyl Mandelic Acid
• Diagnosis of Pneumocystic Jiroveci Infection in Microbiology Laboratory
• Lab Diagnosis of Metabolic Bone Diseases
• 24 Hours Urinary Specimen Collection
• Genetic Analysis of Duchenne Muscular Dystrophy
• Hybrid of Cystic Adenomatoid Malformation with Pulmonary Sequestration
• How Can We Achieve Good Response from Trans-Artial Chemo-Embolization (TACE)?
• Anti factor Xa Assay
• Automated Reticulocyte Count
• Triple Screen Test2
• 2nd Biennial Conference for Chemical Pathologists: PSCP Collaborate with AKU

Quality In Early Childhood Education: Assessing Early Child Development - A Holistic Approach For Ages 3-6 Years, Seema Lasi, Sanober Nadeem, Irum Fatima

Book Chapters / Conference Papers

Early childhood lays strong foundations for adulthood. Experiences, positive or negative, during this period have long-lasting effects. The purpose of this paper is to underscore the need for an integrated approach towards early years, particularly pre-school period (3 to 6 years). The article also introduces to ‘Record of Early Childhood Growth and Development’ developed by Human Development Programme of Aga Khan University to measure holistic child development.

Awareness About Reproductive Health And Rights Among Students Of A Public University In Karachi, Pakistan: A Cross Sectional Study, Naheed Nabi, Waris Qidwai, Farhat Batool,, Iqbal Azam

Department of Family Medicine

Objective: To determine the knowledge, attitude and practices of Karachi University students about reproductive health and rights.
Design: Cross sectional study Methods: A survey was conducted from February to May 2005 to determine the understanding and knowledge related to reproductive health and rights among the students of the department of Biochemistry, University of Karachi, Pakistan. A pre-coded questionnaire was developed and pre-tested. The questionnaire was introduced to those students, who agreed to participate in the study. Data collected was double entered and analyzed on SPSS and Epi-info latest version.
Results: Fifty five percent (55%) of participants believed …

Soils: A Contemporary Perspective, Cheryl Palm, Pedro Sanchez, Sonya Ahamed, Alex Awiti

East Africa Institute

Soils are viewed in the context of ecosystem services, soil processes and properties, and key attributes and constraints. The framework used is based on the premise that the natural capital of soils that underlies ecosystem services is primarily determined by three core soil properties: texture, mineralogy, and soil organic matter. Up-to-date descriptions and geographical distribution of soil orders as well as soil attributes and constraints are given, along with the relationships between soil orders, properties, and biomes. We then relate ecosystem services to specific soil processes, soil properties, and soil constraints and attributes. Soil degradation at present is not adequately …

Prevalence And Factors Associated With Postpartum Vaginal Infection In The Khyber Agency Federally Administered Tribal Areas, Pakistan, Nasreen Ghani, Rafat Jan Rukanuddin, Tazeen S. Ali

School of Nursing & Midwifery

Objective: To estimate the prevalence and to identify the factors associated with vaginal infection among the married women between the ages of 15-49 years residing in the Khyber Agency (FATA), Pakistan.
Methods: A cross-sectional study was conducted in the month of July 2005 on 1084 mothers by using random sampling strategy in Khyber Agency Pakistan by trained nurses. The descriptive and multivariate statistics were computed.
Results: The multivariate analysis showed that the associated factors with vaginal infection were the use of unhygienic material to soak up the lochia [aOR=3.45, 95% CI (1.36, 8.75)], bathing after 40 days [aOR=2.10, 95% …

Adoption Practices Among Couples With Secondary Infertility In Karachi: A Triangulation Study Design, Tazeen S. Ali, Neelofar Sami

School of Nursing & Midwifery

Objective: To explore the perceptions and experiences of couples with secondary infertility regarding adoption practices; to estimate the prevalence of adoption among couples with secondary infertility, and to study the adopted child preference pattern.
Methods: To fulfill the objectives of the study both qualitative and quantitative study designs were utilized. In qualitative explorative study design, three Focus Group discussions were conducted with married fertile women to explore their perceptions for adoption practices. Moreover, eight in-depth interviews were conducted with women with secondary infertility to explore their experiences. For quantitative methodology, a case series of 400 secondary infertile couples was conducted. …

Are Unhygienic Practices During The Menstrual, Partum And Postpartum Periods Risk Factors For Secondary Infertility?, Tazeen S. Ali, Neelofar Sami, Ali Khan Khuwaja

School of Nursing & Midwifery

This study was aimed at identifying practices during the menstrual, partum and postpartum periods posing possible risk factors contributing towards secondary infertility in women of a selected population in Karachi, Pakistan. A matched case-control study was conducted from April 2003 to March 2004. Four hundred cases were selected from five infertility clinics affiliated with tertiary-care hospitals, and 400 age-matched controls were recruited from the neighbourhood of each case. After taking written consents, trained interviewers conducted interviews using a pretested structured questionnaire. Factors found to be independently associated with secondary infertility were: previous delivery at an unclean place (adjusted odds ratio …

Labrad : Vol 32, Issue 1 - January 2007, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• T-Cell Receptor (TcR) Gene Rearrangement Studies: A Useful Adjunct for the Diagnosis of T-Cell Lymphoproliferative Disorders
• Vitamin D Measurement
• Quiz
• Ristocetin Cofactor Activity
• Portal Biliopathy- An Uncommon Cause of Biliary Obstruction
• Laboratory Diagnosis of Hepatitis C: Transition from Serological to Molecular Methods
• Answer to Quiz
• Dengue Fever
• Bone Densitometry (DEXA Scanning) in the Diagnosis of Osteoporosis
• Western Blot for HIV 1 Virus
• 8th Sheffield International Conference - Diagnostic Imaging

Factor Structure And Clinical Implications Of Child Behavior Checklist/1.5-5 Ratings In A Sample Of Girls Adopted From China, Tony Xing Tan, Robert F. Dedrick, Kofi Marfo

Institute for Human Development, East Africa

Objective: This study assessed psychometric properties of the Child Behavior Checklist (CBCL/1.5-5) and explored clinical insights from its use in a sample of adopted Chinese girls.

Methods: Parental ratings were obtained on 707 adopted Chinese girls, ages 1.50-5.92 years (M = 3.24, SD = 1.26). Confirmatory factor analysis (CFA), employing robust weighted least squares estimation, was used to evaluate the instrument's seven-factor correlated structure. Profiles of scores were analyzed descriptively for clinical insights.

Results: The CFAs indicated that the fit of Achenbach and Rescorla's (2000 Manual for the ASEBA preschool forms & profiles. Burlington, VT: University of Vermont, Research Centre …

Adults' Perceived Prevalence Of Enteric Fever Predicts Laboratory-Validated Incidence Of Typhoid Fever In Children, Xinguang Chen, Bonita Stanton, Al Pach, Andrew Nyamete, R. Leon Ochiai, Linda Kaljee, Baiqing Dong, Dipika Sur, S.K. Bhattacharya, Siti Sapardiyah Santoso, Magdarina Agtini, Zahid Memon, Zulfiqar Ahmed Bhutta, Canh Gia Do, Lorenz Von Seidlein, John Clemens

Centre of Excellence in Women and Child Health

This study was undertaken to develop a model to predict the incidence of typhoid in children based on adults’ perception of prevalence of enteric fever in the wider community. Typhoid cases among children, aged 5-15 years, from epidemic regions in five Asian countries were confirmed with a positive Salmonella Typhi culture of the blood sample. Estimates of the prevalence of enteric fever were obtained from random samples of adults in the same study sites. Regression models were used for establishing the prediction equation. The percentages of enteric fever reported by adults and cases of typhoid incidence per 100,000, detected through …

Maternal Characteristics In Relation To Income In A Semi-Rural Community In Pakistan, A R. Siddiqui

Community Health Sciences

Women's health and socioeconomic status is fundamental to development. The aim of this study was to evaluate the relationship of monthly household income with demographic, nutritional and social characteristics in women living in a semi-rural location near Karachi. Thus 1111 mothers with at least 1 child under 5 years of age were interviewed. Self-reported monthly income was positively associated with gravidity, mid upper-arm circumference, cooking frequency per day and self and spousal literacy; it was negatively associated with number of occupants per room, wood used as cooking fuel, and spouse in a skilled occupation. Income is dependent on non-income factors …

Noncommunicable Diseases And Injuries: Action Needed In South Asia Too, Ali Khan Khuwaja, Riaz Qureshi, Zafar Fatmi

Community Health Sciences

No abstract provided.

Metabolic Syndrome: Frequency And Gender Differences At An Out - Patient Clinic, Firdous Jahan, Riaz Qureshi, Tasneem Borhany, Hasan Bin Hamza

Department of Family Medicine

Objective: To determine the frequency of metabolic syndrome among patients attending an out-patient clinic of a teaching hospital and to compare the clinical features regarding metabolic syndrome among males and females.
Study Design: Cross-sectional study.
Place and Duration: Aga Khan University Hospital (AKUH), Executive and Family Medicine Clinics, from December 2004 to April 2005.
Patients and Methods: All adults, above 25 years, attending the clinics for an executive check-up and giving informed consent were included in the study. Data was collected through a structured questionnaire administered to those eligible to participate. Metabolic syndrome was defined according to ATP-III guidelines. …

Evaluation Of Immune Response To Hepatitis B Vaccine In Health Care Workers At A Tertiary Care Hospital In Pakistan: An Observational Prospective Study, Mohammad Zeeshan, Kauser Jabeen, Anita Nausheen Akbar Ali, Ailia Wilayat Ali, Saadia Z Farooqui, Vikram Mehraj, Afia Zafar

Department of Pathology and Laboratory Medicine

Background: Seroconversion rates reported after Hepatitis B virus (HBV) vaccination globally ranges from 85–90%. Health care workers (HCWs) are at high risk of acquiring HBV and non responders' rates after HBV vaccination were not reported previously in Pakistani HCWs. Therefore we evaluated immune response to HBV vaccine in HCWs at a tertiary care hospital in Karachi, Pakistan.
Methods: Descriptive observational study conducted at Aga Khan University from April 2003 to July 2004. Newly HBV vaccinated HCWs were evaluated for immune response by measuring serum Hepatitis B surface antibody (HBsAb) levels, 6 weeks post vaccination.
Results: Initially 666 employees were included …

Biliary Tract Obstruction In Chronic Pancreatitis, Abdallah Abdulkarim, Jake E. J. Krige, Philippus C. Bornman

General Surgery, East Africa

Bile duct strictures are a common complication in patients with advanced chronic pancreatitis and have a variable clinical presentation ranging from an incidental finding to overt jaundice and cholangitis. The diagnosis is mostly made during investigations for abdominal pain but jaundice may be the initial clinical presentation. The jaundice is typically transient but may be recurrent with a small risk of secondary biliary cirrhosis in longstanding cases. The management of a bile duct stricture is conservative in patients in whom it is an incidental finding as the risk of secondary biliary cirrhosis is negligible.

Initial conservative treatment is advised in …

Anaesthesia For Interventional Neuroradiology, Aliya Ahmed

Department of Anaesthesia

There have been rapid and significant advances in diagnostic and interventional radiology, including interventional neuroradiology, in recent years. Many intracranial vascular pathologies are being successfully managed by endovascular interventional neuroradiology techniques. These techniques include procedures like embolization of vascular tumours and arterio-venous malformations, coiling of cerebral aneurysms. etc. The support of anaesthesia team is requested for these therapeutic endovascular neuroradiological procedures. The main aims of the anaesthesiologist during any interventional neuroradiology procedure are provision of a physiologically stable and immobile patient, alteration of arterial blood pressure as necessary, and appropriate and timely management of complications. Provision of anaesthesia in remote …

Women's Empowerment And Health: The Role Of Institutions Of Power In Pakistan, N Qureshi, B T. Shaikh

Community Health Sciences

Women's right to health has been reiterated many times. However, there are social and cultural barriers in developing countries that hinder their empowerment. Women's low status, deprivation of education and lack of control over their own lives and bodies have a negative impact on their health status and that of their families. This paper discusses women's empowerment and health within the framework of the 4 institutions of power in a society-family, community, health care systems and the state--with special reference to the situation in Pakistan. It concludes that to improve women's health status, concerted efforts are needed by all these …

Akhuwat Issue No. 65, Aga Khan University

AKHUWAT Newsletters

• The Convocation Ceremony, 2006
• Workshop on Health Administration: Strategic Planning and Performance Management (SPPM)
• Patient Satisfaction Survey
• JCIA Dashboard of Clinical and Managerial Indicators
• Face to Face with Dr Zulfiqar Bhutta, Chair and Professor, Department of Paediatrics
• Visit of the Ambassador of the Czech Republic to Aga Khan University Advanced Nursing Studies Programme in Nairobi, Kenya
• Transition towards betterment of Nursing in Afghanistan
• Appointment of Dr. Mir Afzal Tajik as Head of Professional Development Central (PDC), Chitral
• AKU Student Night 2006
• Third Annual Olympiad held on 'Environment and Infections’ at AKU-IED
• Research Seminar on Adult Literacy and Academic Literacy
• Graduation …

Maternal Risk Factors Associated With Low Birth Weight In Karachi: A Case-Control Study, S A. Rizvi, J Hatcher, I Jehan, R Qureshi

Community Health Sciences

To evaluate maternal risk factors associated with low birth weight (LBW) among women aged 15-35 years, we carried out a hospital-based, case-control study on 262 cases (mothers of neonates weighing < or = 2.5 kg) and 262 controls (mothers of neonates weighing > 2.5 kg). Odds of delivering a low-birth-weight baby decreased with increase in maternal haemoglobin [odds ratio (OR): 0.701; 95% confidence interval (CI): 0.62-0.79]. Odds were greater among mothers not using iron supplements during pregnancy (OR: 2.88; 95% CI: 1.83-4.54). Mothers of LBW babies had lower haemoglobin levels before delivery.

Medicinal Importance Of Grapefruit Juice And Its Interaction With Various Drugs, Jawad Kiani, Sardar Z. Imam

Medical College Documents

Grapefruit juice is consumed widely in today's health conscious world as a protector against cardiovascular diseases and cancers. It has however, been found to be an inhibitor of the intestinal cytochrome P - 450 3A4 system, which is responsible for the first pass metabolism of many drugs. The P - glycoprotein pump, found in the brush border of the intestinal wall which transports many of these cytochrome P - 450 3A4 substrates, has also been implicated to be inhibited by grapefruit juice. By inhibiting these enzyme systems, grapefruit juice alters the pharmacokinetics of a variety of medications, leading to elevation …

Child Health And Survival In The Eastern Mediterranean Region, Zulfiqar A. Bhutta, Asim Belgaumi, Rab Mohammad Abdur, Zein Karrar, Mohamed Khashaba, Nezha Mouane

Department of Paediatrics and Child Health

No abstract provided.

Diabetes Knowledge, Beliefs And Practices Among People With Diabetes Attending A University Hospital In Karachi, Pakistan, G Rafique, S I. Azam, F White

Community Health Sciences

A structured questionnaire on knowledge, beliefs and practices regarding diabetes was administered to 199 persons with diabetes (92.5% type 2) attending the Aga Khan University Hospital, Karachi. Mean age [standard deviation (SD)] was 53 (11) years. Mean duration of diabetes (SD) was 8 (7) years in men and 9 (6) years in women. Men had a significantly better knowledge score than women (P = 0.02); there was no significant difference in the beliefs and practices scores. Scores were classed as good (> 60%) in only 13.6% of participants for knowledge, 17.6% for beliefs and 11.2% for practices. About 38% of …

Aku Newsletter : September 2006, Volume 7, Issue 2, Aga Khan University

The Aga Khan University Newsletters

No abstract provided.

Triple Therapy For Helicobacter Pylori Infection In Patients Presenting To A Tertiary Care Center In Pakistan, Shahab Abid, Javed Yakoob, Wasim Jafri, Z Abbas, Khalid Mumtaz

Section of Gastroenterology

No abstract provided.