Digital Commons Network^™

Adolescent Food Insecurity In Rural Sindh, Pakistan: A Cross-Sectional Survey, Sana Sheikh, Romaina Iqbal, Rahat Qureshi, Iqbal Azam Syed, Rubina Barolia

Department of Obstetrics & Gynaecology

Background: Food insecurity (FI) is alarmingly high in developing countries including Pakistan. A quarter of Pakistan's population consists of adolescents yet there is no information on their experience of FI. FI at adolescent age have long term effect on mental and physical health hence we aimed to determine the prevalence of food insecurity (FI) among adolescents and compare it with household FI, and assess social determinants of adolescent FI.
Methods: A cross-sectional survey on 799 households with unmarried adolescents was conducted from September 2015 to June 2016 in three union councils of Hyderabad, Pakistan. Unmarried 10-19 years old girls and …

Late Weaning And Maternal Closeness, Associated With Advanced Motor And Visual Maturation, Reinforce Autonomy In Healthy, 2-Year-Old Children, José Villar, Roseline Ochieng, Eleonora Staines-Urias, Michelle Fernandes, Marc Ratcliff, Manorama Purwar, Fernando Barros, Bernardo Horta, Maria Carvalho, Zulfiqar Ahmed Bhutta

Woman and Child Health

We studied neurodevelopmental outcomes and behaviours in healthy 2-year old children (N = 1306) from Brazil, India, Italy, Kenya and the UK participating in the INTERGROWTH-21^st Project. There was a positive independent relationship of duration of exclusive breastfeeding (EBF) and age at weaning with gross motor development, vision and autonomic physical activities, most evident if children were exclusively breastfed for ≥7 months or weaned at ≥7 months. There was no association with cognition, language or behaviour. Children exclusively breastfed from birth to6 months had, in a dose-effect pattern, adjusting for confounding factors, higher scores for "emotional reactivity". The positive …

Delivering Mental Health And Psychosocial Support Interventions To Women And Children In Conflict Settings: A Systematic Review, Mahdis Kamali, Mariella Munyuzangabo, Fahad J. Siddiqui, Michelle F. Gaffey, Sarah Meteke, Daina Als, Reena P. Jain, Amruta Radhakrishnan, Shailja Shah, Anushka Ataullahjan, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background: Over 240 million children live in countries affected by conflict or fragility, and such settings are known to be linked to increased psychological distress and risk of mental disorders. While guidelines are in place, high-quality evidence to inform mental health and psychosocial support (MHPSS) interventions in conflict settings is lacking. This systematic review aimed to synthesise existing information on the delivery, coverage and effectiveness of MHPSS for conflict-affected women and children in low-income and middle-income countries (LMICs).
Methods: We searched Medline, Embase, Cumulative Index of Nursing and Allied Health Literature (CINAHL) and Psychological Information Database (PsycINFO)databases for indexed literature …

Continuity Of Care And Outpatient Management For Patients With And At High Risk For Cardiovascular Disease During The Covid-19 Pandemic: A Scientific Statement From The American Society For Preventive Cardiology, Amit Khera, Seth J. Baum, Ty J. Gluckman, Martha Gulati, Seth S. Martin, Erin D. Michos, Ann Marie Navar, Pam R. Taub, Peter P. Toth, Salim S. Virani

Office of the Provost

The coronavirus disease 2019 (COVID-19) pandemic has consumed our healthcare system, with immediate resource focus on the management of high numbers of critically ill patients. Those that fare poorly with COVID-19 infection more commonly have cardiovascular disease (CVD), hypertension and diabetes. There are also several other conditions that raise concern for the welfare of patients with and at high risk for CVD during this pandemic. Traditional ambulatory care is disrupted and many patients are delaying or deferring necessary care, including preventive care. New impediments to medication access and adherence have arisen. Social distancing measures can increase social isolation and alter …

Prediction Of Cognitive And Intellectual Competence In Kindergarten Schools Associated With General Measures Of Health: A Study On Children With Age Ranges Between 4 To 7 Years, Abeer Musaddiq, Yusra Saleem, Muhammad Bilal Siddiqui, Shamoon Noushad, Sadaf Ahmed

Pakistan Journal of Neurological Sciences (PJNS)

BACKGROUND Stunting refers to the low “height-for-age” measurement. Literature suggests that it is associated with delayed or diminished physical development, cognition and intellectual abilities. OBJECTIVES: This study aimed to estimate the physical growth measures among children under 4 to 7 years of age and to determine its relationship with cognitive deficits & intellectual performances.

Myotonic Dystrophy In A Pakistani Family: A Case Series And Literature Review, Waleed Shahzad, Muhammad Hassan, Mazhar Badshah, Haris Majid Rajput, Zakir Jan, Tehmina Inayat

Pakistan Journal of Neurological Sciences (PJNS)

Myotonic dystrophy also known as (Steinert's disease) is a clinically and genetically heterogeneous multisystem disorder with a prevalence of 1 in 8000 in the general population. It is inherited as an autosomal dominant trait. It is characterized by myotonia, myopathy of voluntary and involuntary muscles, frontal baldness in men, cardiac conduction abnormalities, cataracts, intellectual deterioration and endocrinopathies. Affected men may have gonadal atrophy and infertility. On the other hand women are generally fertile. We report a case series of three individuals belonging to the same family presenting with characteristic features of myotonic dystrophy. The presentation of these cases depicts that …

Immediate Changes In Hemodynamics And Gas Exchange After Initiation Of Noninvasive Ventilation In Cardiac Surgical Patients, Mohammad Hamid, Mohammad Irfan Akhtar, Saba Ahmed

Department of Anaesthesia

Introduction: Cardiac surgery is associated with pulmonary dysfunction and complications such as prolonged intubation and reintubation. Bilevel positive airway pressure (BiPAP) machine has been used in the clinical settings to improve oxygenation, reduce work of breathing, and avoid reintubation. The effect of BiPAP on cardiovascular parameters is not well established, and very few studies have targeted hemodynamic changes. The aim of the study was to assess the immediate effect of BiPAP on respiratory and hemodynamic parameters in post-cardiac surgery patients.
Materials and methods: This quasi-experimental study was done on 33 adult cardiac surgery patients. Ethical review committee approval was sought …

Direct Assessment Of Mental Health And Metabolic Syndrome Amongst Indonesian Adolescents: A Study Design For A Mixed-Methods Study Sampled From School And Community Settings, Peter S. Azzopardi, Lisa Willenberg, Nisaa Wulan, Yoga Devaera, Bernie Medise, Aida Riyanti, Ansariadi Ansariadi, Susan Sawyer, Tjhin Wiguna, Stanley Luchters

Population Health, East Africa

Non-communicable diseases (NCDs) are the leading cause of morbidity and mortality globally, with the burden largely borne by people living in low- and middle-income countries. Adolescents are central to NCD control through the potential to modify risks and alter the trajectory of these diseases across the life-course. However, an absence of epidemiological data has contributed to the relative exclusion of adolescents from policies and responses. This paper documents the design of a study to measure the burden of metabolic syndrome (a key risk for NCDs) and poor mental health (a key outcome) amongst Indonesian adolescents. Using a mixed-method design, we …

Mainstreaming Nutrition Services: Stabilization Centers And Outpatient Therapeutic Program Centers, Ashar Muhammad Malik

Community Health Sciences

No abstract provided.

A Descriptive Study Of Double Burden Of Malnutrition In Mothers Of Children With Severe Acute Malnutrition Admitted In Children Hospital And Institute Of Child Health, Multan, Saadia Khan, Umme Ammara, Reema Arshad, Farah Naz, Kamran Ishfaq

Department of Paediatrics and Child Health

Objective: To assess the nutritional status of mothers of severely malnourished children, and to evaluate the factors associated with inadequate caloric intake of children with severe acute malnutrition versus sufficient caloric intake by mothers.
Methods: The cross-sectional descriptive study was conducted from January to June 2016 at Children Hospital and Institute of Child Health, Multan, Pakistan, and comprised mothers of severely malnourished children admitted for treatment. Data was collected using a questionnaire administered through interviews. Elements noted included body mass index, 24-hour recall, dietary restriction during pregnancy, lactation and complimentary feeding patterns of the children. The mothers were also examined …

Oxidative Stress And Male Infertility: A Cross Sectional Study, Rehana Rehman, Sofia Amjad, Hemaila Tariq, Nida Zahid, Masnoon Akhter, Mussarat Ashraf

Department of Biological & Biomedical Sciences

Objective: To compare stress markers and antioxidants in fertile and infertile males, and to explore their effects on reproductive hormones and fertility.
Methods: The cross-sectional case-control study was conducted from July 2017 to July 2018 at the Islamabad Clinic Serving Infertile Couples, Islamabad, Pakistan, and comprised male subjects aged 25-55 years. Infertile subjects were the cases, while healthy fertile males acted as the controls. Stress hormones cortisol and adrenaline and antioxidants glutathione peroxidase and superoxide dismutase were measured using enzyme-linked immunosorbent assay. Data was analysed using SPSS 22.
Results: Of the 376 subjects, 241(64%) were cases and 135(36%) were controls. …

International Standards For Fetal Brain Structures Based On Serial Ultrasound Measurements From The Fetal Growth Longitudinal Study Of The Intergrowth-21 St Project, Raffaele Napolitano, Malid Molloholli, Vera Donadono, Eric O. Ohuma, Sikolia Wanyonyi, Bryn Kemp, Mohammad K. Yaqub, Stephen Ash, Fernando C. Barros, Maria Carvalho

Obstetrics and Gynaecology, East Africa

Objective: To create prescriptive growth standards for five fetal brain structures, measured by ultrasound, from healthy, well-nourished women, at low risk of impaired fetal growth and poor perinatal outcomes, taking part in the Fetal Growth Longitudinal Study (FGLS) of the INTERGROWTH-21st Project.

Methods: This was a complementary analysis of a large, population-based, multicentre, longitudinal study. We measured, in planes reconstructed from 3-dimensional (3D) ultrasound volumes of the fetal head at different time points in pregnancy, the size of the parieto-occipital fissure (POF), Sylvian fissure (SF), anterior horn of the lateral ventricle (AV), atrium of the posterior ventricle (PV) and cisterna …

Adequacy Of Hemodialysis And Its Associated Factors Among Patients Undergoing Chronic Hemodialysis In Dar Es Salaam, Tanzania, Samina Somji, Pascal Ruggajo, Sibtain Moledina

Internal Medicine, East Africa

The worldwide prevalence of maintenance hemodialysis continues to rise. An adequate delivery of hemodialysis dose as measured by Kt/V or urea reduction ratio is a crucial determinant of clinical outcome for chronic hemodialysis patients. )e aim of this study was to assess the adequacy of hemodialysis and its associated factors among patients undergoing chronic hemodialysis in Dar es Salaam. )is was a cross-sectional study done on patients undergoing chronic hemodialysis in four dialysis centers in Dar es Salaam. Sociodemographic information and treatment characteristics were collected. Urea reduction rate and single-pool Kt/V were calculated to determine the adequacy of hemodialysis. )e …

High-Sensitivity C-Reactive Protein Discordance With Atherogenic Lipid Measures And Incidence Of Atherosclerotic Cardiovascular Disease In Primary Prevention: The Aric Study, Renato Quispe, Erin D. Michos, Seth S. Martin, Rishi Puri, Peter P. Toth, Jassim Al Suwaidi, Maciej Banach, Salim S. Virani, Roger S. Blumenthal, Steven R. Jones

Office of the Provost

Background: Inflammation is an independent causal risk factor for atherosclerotic cardiovascular diseases (ASCVDs). However, whether hsCRP (high‐sensitivity C‐reactive protein) is prognostic across various levels of atherogenic lipid measures such as low‐density lipoprotein cholesterol, non–high‐density lipoprotein cholesterol, apolipoprotein B and total cholesterol/high‐density lipoprotein cholesterol in primary prevention is unknown.
Methods and Results: We studied 9748 ARIC (Atherosclerosis Risk in Communities) study participants who were free of ASCVD at baseline (visit 4, 1996–1998) and had measurements of lipids, apolipoprotein B, and hsCRP. We used multivariable adjusted Cox models to estimate the risk of incident ASCVD events associated with hsCRP levels (less than/greater …

Prevalence And Determinants Of Anemia Among Women Of Reproductive Age In Developing Countries, Sumera Aziz Ali, Umber S. Khan, Anam Shahil Feroz

Community Health Sciences

Anemia is one of the major causes of maternal mortality and morbidity across the globe, affecting around two-thirds of pregnant women in developing countries. The objective of this study was to synthesise study findings regarding the prevalence and determinants of anemia among women of reproductive age in developing countries. A total of 28 articles were reviewed by two authors for preliminary screening after removing overlapping information. Finally, 15 studies conducted from 2000 to 2015 were included in the review. The average prevalence of anemia was found to be 46.5% with a range of 18.1% to 75% in different studies. Factors …

Adequacy Of Hemodialysis And Its Associated Factors Among Patients Undergoing Chronic Hemodialysis In Dar Es Salaam, Tanzania, Samina S. Somji, Pascal Ruggajo, Sibtain Moledina

Internal Medicine, East Africa

The worldwide prevalence of maintenance hemodialysis continues to rise. An adequate delivery of hemodialysis dose as measured by Kt/V or urea reduction ratio is a crucial determinant of clinical outcome for chronic hemodialysis patients. The aim of this study was to assess the adequacy of hemodialysis and its associated factors among patients undergoing chronic hemodialysis in Dar es Salaam. This was a cross-sectional study done on patients undergoing chronic hemodialysis in four dialysis centers in Dar es Salaam. Sociodemographic information and treatment characteristics were collected. Urea reduction rate and single-pool Kt/V were calculated to determine the …

Inspire : Vol 3, Issue 2, Department Of Medicine

INSPIRE – Department of Medicine Archives

Content

• Message From the Chair
• Pulse 2020
• Data Science in Health
• Medicine at National and International Forums
• Featured Faculty: Dr Adeel ur Rehman “Your work should speak for you.”

Diarrhoeal Disease And Subsequent Risk Of Death In Infants And Children Residing In Low-Income And Middle-Income Countries: Analysis Of The Gems Case-Control Study And 12-Month Gems-1a Follow-On Study, Myron M. Levine, Dilruba Nasrin, Sozinho Acácio, Quique Bassat, Helen Powell, Sharon M. Tennant, Samba O. Sow, Anita K. M. Zaidi, Shahida Qureshi, Farheen Quadri

Department of Paediatrics and Child Health

Background: The Global Enteric Multicenter Study (GEMS) was a 3-year case-control study that measured the burden, aetiology, and consequences of moderate-to-severe diarrhoea (MSD) in children aged 0-59 months. GEMS-1A, a 12-month follow-on study, comprised two parallel case-control studies, one assessing MSD and the other less-severe diarrhoea (LSD). In this report, we analyse the risk of death with each diarrhoea type and the specific pathogens associated with fatal outcomes.
Methods: GEMS was a prospective, age-stratified, matched case-control study done at seven sites in Africa and Asia. Children aged 0-59 months with MSD seeking care at sentinel health centres were recruited along …

Preconception Nutrition Intervention Improved Birth Length And Reduced Stunting And Wasting In Newborns In South Asia: The Women First Randomized Controlled Trial, Sangappa M. Dhaded, K. Michael Hambidge, Sumera Aziz Ali, Manjunath Somannavar, Sarah Saleem, Omrana Pasha, Umber Khan, Veena Herekar Herekar, Sunil Vernekar, Yogesh Kumar S

Community Health Sciences

South Asia has >50% of the global burden of low birth weight (LBW). The objective was to determine the extent to which maternal nutrition interventions commenced before conception or in the 1st trimester improved fetal growth in this region. This was a secondary analysis of combined newborn anthropometric data for the South Asian sites (India and Pakistan) in the Women First Preconception Maternal Nutrition Trial. Participants were 972 newborn of mothers who were poor, rural, unselected on basis of nutritional status, and had been randomized to receive a daily lipid-based micronutrient supplement commencing ≥3 months prior to conception (Arm 1), …

A Multicenter Case Control Study Of Association Of Vitamin D With Breast Cancer Among Women In Karachi, Pakistan, Uzma Shamsi, Shaista Khan, Syed Iqbal Azam, Aysha Habib, Amir Maqbool, Mohammad Hanif, Tiffany Gill, Romaina Iqbal, David Callen

Community Health Sciences

Background: The prevalence of vitamin D inadequacy and breast cancer are both high among women living in Karachi, Pakistan.
Methods: A matched case control study was conducted in two hospitals of Karachi, Pakistan to evaluate the association of vitamin D (serum 25-hydroxyvitamin D) concentrations, vitamin D supplementation and sun exposure with breast cancer among Pakistani women. A total of 411 newly diagnosed histologically confirmed primary breast cancer cases were enrolled and 784 controls, free of breast and any other cancers, were matched by age (year of birth ± 5 years), residence in the same geographic area and study site. Information …

Naringenin Protects Alcl3/D-Galactose Induced Neurotoxicity In Rat Model Of Ad Via Attenuation Of Acetylcholinesterase Levels And Inhibition Of Oxidative Stress, Saida Haider, Laraib Liaquat, Saara Muddasir, Zehra Batool, Rafat Ali Siddiqui, Saiqa Tabassum, Sidrah Shahzad, Sahar Rafiq, Narjis Naz

Department of Biological & Biomedical Sciences

Currently prescribed medications for the treatment of Alzheimer's disease (AD) that are based on acetylcholinesterase inhibition only offer symptomatic relief but do not provide protection against neurodegeneration. There appear to be an intense need for the development of therapeutic strategies that not only improve brain functions but also prevent neurodegeneration. The oxidative stress is one of the main causative factors of AD. Various antioxidants are being investigated to prevent neurodegeneration in AD. The objective of this study was to investigate the neuroprotective effects of naringenin (NAR) against AlCl3+D-gal induced AD-like symptoms in an animal model. Rats were orally pre-treated with …

A Novel Histological Index For Evaluation Of Environmental Enteric Dysfunction Identifies Geographic-Specific Features Of Enteropathy Among Children With Suboptimal Growth, Ta-Chiang Liu, Kelley Vanbuskirk, Syed Asad Ali, M. Paul Kelly, Lori R. Holtz, Omer H. Yilmaz, Kamran Sadiq, Najeeha Talat Iqbal, Beatrice Amadi, Sana Syed

Department of Paediatrics and Child Health

Background: A major limitation to understanding the etiopathogenesis of environmental enteric dysfunction (EED) is the lack of a comprehensive, reproducible histologic framework for characterizing the small bowel lesions. We hypothesized that the development of such a system will identify unique histology features for EED, and that some features might correlate with clinical severity.
Methods: Duodenal endoscopic biopsies from two cohorts where EED is prevalent (Pakistan, Zambia) and North American children with and without gluten sensitive enteropathy (GSE) were processed for routine hematoxylin & eosin (H&E) staining, and scanned to produce whole slide images (WSIs) which we shared among study pathologists …

Using Mobile Phones To Improve Community Health Workers Performance In Low-And-Middle-Income Countries, Anam Shahil Feroz, Rawshan Jabeen, Sarah Saleem

Community Health Sciences

Background: In low-and-middle-income countries community health workers are the core component of the PHC system as they act as a liaison between the communities and the healthcare facilities. Evidence suggests that the services offered by these workers have helped in the decline of maternal and child morbidity and mortality rates and the burden of communicable and non-communicable diseases. However, the coverage and the overall progress towards achieving the SDG targets is very sluggish. The recent consensus concerning this current pace of progress, is that it relates to financial and human resources constraints. CHWs are overburdened as they are expected to …

Spotlight On Icosapent Ethyl For Cardiovascular Risk Reduction: Evidence To Date, Xiaoming Jia, Stephanie Koh, Mahmoud Al Rifai, Roger S. Blumenthal, Salim S. Virani

Office of the Provost

Icosapent ethyl is a highly purified formulation of eicosapentaenoic acid, a type of omega-3 fatty acid contained in fish oil. While omega-3 fatty acids have long been thought to have cardioprotective benefits, the Reduction of Cardiovascular Events with EPA-Intervention Trial (REDUCE-IT) has helped to establish icosapent ethyl as an evidence-based therapy for risk reduction of atherosclerotic cardiovascular disease (ASCVD). REDUCE-IT, however, was by no means an overnight success story. Close examination of the evidence shows that the trial was a culmination of many lessons learned from previous studies. The purpose of this manuscript is to review contemporary evidence of icosapent …

Congenital Morgagni Hernia Presenting As Complete Small Bowel Obstruction In The Adult - A Case Report, Sabah Uddin Saqib, Kulsoom Hamid, Tabish Umer Chawla

Section of General Surgery

Introduction: Congenital Diaphragmatic hernia (CDH) is a condition in which there is a defect in the diaphragm present at the time of birth. Morgagni hernia is one of the two most common types of CDH which constitutes 2%-4% of diaphragmatic hernias. They mostly remain silent or discovered as an incidental finding on radiological studies. Symptomatic adult Morgagni hernias are extremely rare.
Presentation of case: Elderly woman presented with a 1-day history of abdominal pain, vomiting, and acute onset of respiratory distress. There was no history of trauma to the chest or abdomen. After initial resuscitation, a Chest x-ray was performed …

Evaluation For Association Between Maternal Microbiota And Development Of Necrotizing Enterocolitis Or Gram-Negative Bacteremia In Preterm Infants, Mei Chi Quek

Master of Medicine in Paediatrics and Child Health

Background: Preterm birth is the leading cause of perinatal morbidity and mortality worldwide. There is a need for a better understanding of the correlation of vaginal microbiota with adverse preterm outcomes. Our study aimed to explore how the vaginal microbiota influences the outcome of the preterm infants, determine whether fecal microbiota in premature infants differs from that in term infants, and explore the microbiota pattern in preterm neonates who received multiple antibiotics. Method: A prospective cohort design was used to enroll 33 women admitted in spontaneous labor between 25 to 36 weeks, and 33 controls matched for age and parity …

Individualized Breastfeeding Support For Acutely Ill, Malnourished Infants Under 6 Months Old, Martha Mwangome, Sheila Murunga, Jane Kahindi, Prinilla Gwiyo, Grace Mwasho, Alison Talbert, Laura Kiige, Betty Samburu, Neema Mturi, Amina Abubakar, Caroline Jones, James A. Berkley

Institute for Human Development, East Africa

Reestablishing exclusive breastfeeding is the cornerstone of the 2013 World Health Organization (WHO) treatment guidelines for acute malnutrition in infants less than 6 months. However, no studies have investigated guideline implementation and subsequent outcomes in a public hospital setting in Africa. To facilitate implementation of the WHO 2013 guidelines in Kilifi County Hospital, Kenya, we developed standard operating procedure, recruited, and trained three breastfeeding peer supporters (BFPS). Between September 2016 and January 2018, the BFPS provided individual breastfeeding support to mothers of infants aged 4 weeks to 4 months admitted to Kilifi County Hospital with an illness and acute malnutrition …

Serum 25-Hydroxyvitamin D Levels In Children With Mild And Severe Atopic Asthma, Rhoda Ndinda Masaku

Master of Medicine in Paediatrics and Child Health

Background: Asthma is a chronic respiratory illness affecting an estimated 334 million people worldwide, including 14% of the total pediatric population. It results in significant morbidity, and therefore the etiologies and risk factors associated with asthma are of great interest. Serum 25- hydroxyvitamin D (25(OH)D) has substantial immunomodulatory effects on the innate immune system. It reduces the probability of viral respiratory infections and asthma exacerbations by potentiating the anti-inflammatory action of corticosteroids. Objectives: This study was conducted to determine if there was a difference in serum 25-hydroxyvitamin D levels between children with mild and severe atopic asthma and explored the …

Fmic Annual Report 2020 | English, French Medical Institute For Mothers And Children

French Medical Institute for Mothers and Children (FMIC) Archives

No abstract provided.

Neonatal Jaundice And Developmental Impairment Among Infants In Kilifi, Kenya, Dorcas N. Magai, Michael Mwaniki, Amina Abubakar, Shebe Mohammed, Anne L. Gordon, Raphael Kalu, Paul Mwangi, Hans M. Koot, Charles R. Newton

Institute for Human Development, East Africa

Background: Neonatal jaundice (NNJ) is common in sub‐Saharan Africa (SSA), and it is associated with sepsis. Despite the high incidence, little has been documented about developmental impairments associated with NNJ in SSA. In particular, it is not clear if sepsis is associated with greater impairment following NNJ.

Methods: We followed up 169 participants aged 12 months (57 cases and 112 controls) within the Kilifi Health Demographic Surveillance System. The diagnosis of NNJ was based on clinical laboratory measurement of total serum bilirubin on admission, whereas the developmental outcomes were assessed using the Developmental Milestones Checklist and Kilifi Development …