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Prevalence And Possible Factors Associated With Anaemia, And Vitamin B 12 And Folate Deficiencies In Women Of Reproductive Age In Pakistan: Analysis Of National-Level Secondary Survey Data, Sajid Bashir Soofi, Gul Nawaz Khan, Kamran Sadiq, Shabina Ariff, Atif Habib, Sumra Kureishy, Imtiaz Hussain, Muhammad Umer, Zamir Suhag, Arjumand Rizvi, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Objective: To determine the prevalence and possible factors associated with anaemia, and vitamin B12 and folate deficiencies in women of reproductive age (WRA) in Pakistan.
Methods: A secondary analysis was conducted on data collected through the large-scale National Nutrition Survey in Pakistan in 2011. Anaemia was defined as haemoglobin levels <12 g/dL, vitamin B12 deficiency as serum vitamin B12 levels of <203 pg/mL (150 pmol/L) and folate deficiency as serum folate levels <4 ng/mL (10 nmol/L).
Results: A total of 11751 blood samples were collected and analysed. The prevalence of anaemia, vitamin B12 deficiency and folate deficiency was 50.4%, 52.4% and 50.8%, respectively. After adjustment, the following factors were positively associated with anaemia: living in Sindh province (RR 1.07; 95%CI 1.04 to 1.09)P<0.00, food insecure with moderate hunger (RR 1.03; 95%CI 1.00 to 1.06)P=0.02, four or more pregnancies (RR 1.03; 95%CI 1.01 to 1.05)P<0.00, being underweight (RR 1.03; 95%CI 1.00 to 1.05)P=0.02, being overweight or obese (RR 0.95; 95%CI 0.93 to 0.97)P<0.00 and weekly intake of leafy green vegetables (RR 0.98; 95%CI 0.95 to 1.00)P=0.04. For vitamin B12 deficiency, a positive association was observed with rural population (RR 0.81; 95%CI 0.66 to 1.00)P=0.04, living in Khyber Pakhtunkhwa province (RR 1.25; 95%CI 1.11 to 1.43)P<0.00 and living in Azad Jammu and Kashmir (RR 1.50; 95%CI 1.08 to 2.08)P=0.01. Folate deficiency was negatively associated with daily and weekly intake of eggs (RR 0.89; 95%CI 0.81 to 0.98)P=0.02 and (RR 0.88; 95%CI 0.78 to 0.99)P=0.03.
Conclusions: In Pakistan, …

5th National Headache Update, Abdul Malik

Pakistan Journal of Neurological Sciences (PJNS)

Headache is one of the most common disorders worldwide. On the World Health Organization's ranking of causes of disability, this would bring headache disorders into the 10 most disabling conditions for both genders, and into the five most disabling for women. The prevalence of headache disorders in Pakistan is high, and would be at least on par with that reported in other parts of the world, although a recent epidemiological survey suggests that the prevalence of migraines could be as high as 22%, almost twice that noted in the international literature. Over the years, the Pakistan Headache Society (PHS) has …

Hypermucoviscous Klebsiella Syndrome It's In The Community!, Muneeba Ahsan Sayeed, Nida Latif, Syed Faisal Mahmood

Section of Internal Medicine

Hypermucoviscous Klebsiella syndrome is a unique syndrome caused by a new variant of Klebsiella pneumoniae (KP), characterized by abscess formation at distant body sites. This emerging KP strain is different from the usual classic strains in having the rmp gene which increases capsule formation making this strain resistant to phagocytosis and helping in its dissemination to distant organs. A 50 years old diabetic man presented with facial swelling after dental procedure which progressively increased despite being on antibiotics. On examination he was febrile, had neck swelling with signs of inflammation and tender hepatomegaly. Ultrasonography showed submental and liver abscesses which …

Dementia Survey Among Attendees Of A Dementia Awareness Event In Karachi, Pakistan, Qurat Ul Ain Khan, Yusra Hanif Khan, Mohammad Zaman Khan, Shireen Najam

Pakistan Journal of Neurological Sciences (PJNS)

There is little information available about peoples'knowledgeregarding symptoms of dementia, dementia diagnosis, and care arrangementsfor dementia patients in Pakistan. Aims: We aimed to find out if patients with dementia and their caregivers were aware of diagnosis, the most common and most distressing symptoms, and care arrangement for these patients.

Lefort 1 Access For Juvenile Nasopharyngeal Angiofibroma Treated Without Angiographic Embolization., Shaheen Ahmed, Muhammad Imran, Atiq Ahmed Khan, Anwar Ali, Syed Ijlal Ahmed, Asim Rehmani, Muhammad Faaiq Ali

Pakistan Journal of Neurological Sciences (PJNS)

To assess and analyze the clinical presentation of Juvenile nasopharyngeal angiofibroma and analyze the complications associated with JNA resection without pre surgical embolization using LeFort 1.

Cime Newsletter : December 2017, Cime

CIME Newsletter

- Advanced Airway Management Course

- Simulation Workshop on Care of Patients With Urological Disorders

- Simulation Workshop on Care of Patients With Urological Disorders

- Clinical Simulation Workshop for Yusra University Islamabad

- Simulation Workshop on Neonatal Resuscitation

- Karachi Medical and Dental College Students on tour of our Facility

Remaining Dentine Thickness Of Root Canals Prepared With K-3 And Protaper Rotary Systems, Sana Ehsen Nagi, Farhan Raza Khan, Munawar Rahman

Section of Dental-Oral Maxillofacial Surgery

Objective: To compare the remaining dentine thickness of root canals prepared with K-3 and ProTaper files..Methods: This in-vitro experimental study was conducted from 1st April-30th September 2015 at the dental clinics of Aga Khan University Hospital, Karachi, and comprised human teeth. Extracted human premolars and molars were included in the study using non-probability consecutive sampling. Canals were randomly allocated into two groups i.e. K-3 and ProTaper. Changes in inner and outer walls of canals were measured using Vixwin software at 1mm, 4mm, 7mm and 10mm from the apex. SPSS 20 was used for data analysis.Results: Of the 214 canals, 107(50%) …

Is Antimicrobial Photodynamic Therapy A Useful Therapeutic Protocol For Oral Decontamination? A Systematic Review And Meta-Analysis, Sergio Varelakellesarian, Faisal Qayyum, Paula C.De Freitas, Zohaib Akram, Fawad Javed

Section of Dental-Oral Maxillofacial Surgery

BACKGROUND:
The aim of the present systematic review and meta-analysis was to assess the efficacy of antimicrobial photodynamic therapy (aPDT) as a therapeutic protocol for oral decontamination.
METHODS:
In order to address the focused question: Is aPDT a useful therapeutic protocol for oral decontamination?, an electronic search without time or language restrictions was conducted up to July 2017 in indexed databases using the combination of different key words including photochemotherapy, lasers, photodynamic therapy, disinfection, mouth, saliva and oral. The exclusion criteria included reviews, case-reports, case-series, commentaries, letters to the editor, interviews, and updates. Four randomized control trials were included and …

Spectrum Of Celiac Disease In Paediatric Population: Experience Of Tertiary Care Center From Pakistan, Danish Abdul Aziz, Misha Kahlid, Fozia Memon, Kamran Sadiq

Department of Paediatrics and Child Health

Objective: To determine clinical features and relevant laboratory investigations of patient with celiac disease (CD) and comparing classical celiac disease (CCD) with Non-diarrheal celiac disease (NDCD).
Methods: This is a five years retrospective study conducted at The Aga Khan University Hospital Karachi, Pakistan from January 2010 to December 2015, enrolling children from one year to 15 years of either gender diagnosed as celiac disease in accordance with revised ESPGHAN criteria. Biopsy samples with grade 2 or more on Modified Marsh Classification were considered as consistent with celiac disease. Celiac patients were categorized into Classical celiac disease (with Chronic Diarrhea) and …

Flipped Classroom Instructional Approach In Undergraduate Medical Education, Syeda Sadia Fatima, Fazal Manzoor Arain, Ather Enam

Department of Biological & Biomedical Sciences

Objective: In this study we implemented the “flipped classroom” model to enhance active learning in medical students taking neurosciences module at Aga Khan University, Karachi.
Methods: Ninety eight undergraduate medical students participated in this study. The study was conducted from January till March 2017. Study material was provided to students in form of video lecture and reading material for the non-face to face sitting, while face to face time was spent on activities such as case solving, group discussions, and quizzes to consolidate learning under the supervision of faculty. To ensure deeper learning, we used pre- and post-class …

Labrad : Vol 43, Issue 2 - October 2017, Aga Khan University Hospital, Karachi

LABRAD

• Clinical Applications of Platelet-Rich Plasma
• Rota Virus: Diagnosis & Prevention of Infection
• Anti-Musk Antibodies for Seronegative Myasthenia Gravis
• Clinical Utility of Plasma Homocysteine
• Patient Based Quality Control: Hitting a Moving Target
• Diagnosing Alkaptonuria: A Rare Inherited Metabolic Disease
• Recently Described Soft Tissue Lesions: An Update
• A Snapshot of the Standards of Medical Care -2017: American Diabetes Association Guidelines

Enhanced Physical Endurance And Improved Memory Performance Following Taurine Administration In Rats, Irfan Sajid, Saara Muddasir, Shaista Emad, Zehra Batool, Saima Khaliq, Lubna Anis, Saiqa Tabassum, Syeda Madiha, Laraib Liaquat, Sadia Sadir, Tahira Perveen, Saida Haider

Department of Biological & Biomedical Sciences

Energy drinks enhance physical endurance and cognitive ability. The ingredients present in these drinks are considered as ergogenic and have memory boosting effects. In the present study effects of taurine administration for one week was monitored on physical exercise and memory performance in rats. Animals were divided into two groups namely control and test. Taurine was injected intraperitoneally to the test group at the dose of 100mg/kg. After one week of treatment rats were subjected to physical exercise and memory task. Results of this study revealed that rats injected with taurine for one week exhibited improved muscular strength as well …

Cime Newsletter : July 2017, Cime

CIME Newsletter

- Future Leaders@CIME

- 360 Video

- Clinical Simulation

Stages Of Chronic Kidney Disease And Soluble Transferrin Receptor (Stfr), Ferritin, Ratio, Faiza Alam Faiza Alam, Syeda Sadia Fatima, Sabeela Noor Sabeela Noor, Ahmed Bilal, Rehana Rehman

Department of Biological & Biomedical Sciences

Objective: To assess the ratio of soluble transferrin receptor to ferritin in different stages of chronic kidney disease.
Methods: This case-control study was conducted at the Aga Khan University Hospital and the Jinnah Postgraduate Medical Centre, Karachi, from January to September 2014, and comprised chronic kidney disease patients and healthy controls. Group 1 comprised controls, whereas groups 2, 3 and 4 had patients based on their mean glomerular filtration rate. SPSS 19 was used for data analysis.
Results: Of the 170 participants, 126(74.1%) were cases and 44(25.9%) were controls. The overall mean age was 55.87±3.48 years and the mean body …

Is Time Of Birth A Predictor Of Adverse Perinatal Outcome? A Hospital-Based Cross-Sectional Study In A Low-Resource Setting, Tanzania, Andrew H. Mgaya, Januarius Hinju, Hussein Kidanto

Faculty of Health Sciences, East Africa

Background Inconsistent evidence of a higher risk of adverse perinatal outcomes during off-hours compared to office hours necessitated a search for clear evidence of an association between time of birth and adverse perinatal outcomes.

Methods A cross-sectional study conducted at a tertiary referral hospital compared perinatal outcomes across three working shifts over 24 h. A checklist and a questionnaire were used to record parturients’ socio-demographic and obstetric characteristics, mode of delivery and perinatal outcomes, including 5th minute Apgar score, and early neonatal mortality. Risks of adverse outcomes included maternal age, parity, referral status and mode of delivery, and were assessed …

Advancing Gaming Technology In Neurological Rehabilitation, Samreen Sadiq, Iqra Khan

Pakistan Journal of Neurological Sciences (PJNS)

The consumption of gaming technology has recently gain unexpected significance in medical health care for neurological rehabilitation. With increasing interest in exergames study, numerous definitions and terminology have been introduced to describe this term. Researchers from health-related background acknowledged the fact that engaging in video gaming was not always sedentary and might act as a means to ensure more physical work. Simplifying the terminology exergames are those types of gaming technology or multimedia communications that necessitate the player to perform physical activity during play.

Cime Newsletter : June 2017, Cime

CIME Newsletter

- A Milestone in Simulation Embracing Flip Style Teaching

- Regional Simulation Experts spend a day at CIME

- Rapid Response Team Simulation Video

- CIME on the intranet NOW

- Introducing our latest acquisition: Mr Talha Ahmed

- Orthopaedic Review Course

- Moulage

- Another first: Neuro Simulation Workshop Complete IT integration of the Dental Lab

- Fundamental Critical Care Support

- Provider Course

- A Surgical Skills workshop

- A Spinal Trauma Workshop

- IED and CIME

Five-Year Follow-Up Of A Coronally Advanced Flap Over Grafted Bone And Restorative Composite In Maxillary Recession Defect., Syeda Mahvash Hussain, Farhan Raza Khan

Section of Dental-Oral Maxillofacial Surgery

Periodontal plastic surgery has become a predictable method of managing gingival recession defects. In the current case report, a five-year follow-up of a coronally advanced flap surgery with bone graft along with endodontics and fixed prosthodontic rehabilitation is reported in the maxillary anterior sextant of a middle aged female. The present case demonstrates that deep and wide gingival defects can be treated with coronally positioned surgical flap without a connective tissue graft. Amultidisciplinary management approach was adopted in this case that yielded predictable outcome.

Nature, Scope And Use Of Economic Evaluation Of Healthcare Programmes: With Special Reference To Pakistan., Muhammad Ashar Malik, Saleem Perwaiz Iqbal, Farina Abrejo

Community Health Sciences

Economic evaluation (EE)/cost effectiveness analysis(CEA) of healthcare programmes is an emerging area, yet the resource base to apprehend EE/CEA is very limited in Pakistan. This paper attempts to fill this gap by providing a basic text in the field of EE with special reference to Pakistan. We used four dimensional criteria (available, relevant, complete and accurate) for reviewing the EE contents in the locally available textbooks and reading material on public health. We find CEA as core competency and skill of medical doctors in undergraduate medical curricula yet we could not find EE contents in the recommended textbooks. We find …

In Pursuit Of Quality Research: Editors' Perspective, Jamshed Akhtar, Saba Sohail

Department of Radiology

No abstract provided.

Adaptation Of The Recent Life Changes Questionnaire (Rlcq) To Measure Stressful Life Events In Adults Residing In An Urban Megapolis In Pakistan, Azmina Artani, Shireen Shehzad, Iqbal Azam Syed, Moiz Abdul Sultan, Adeel Khoja, Ayeesha Kamran Kamal

Section of Neurology

Background: Contextually relevant stressful life events are integral to the quantification of stress. None such measures have been adapted for the Pakistani population.

Methods: The RLCQ developed by Richard Rahe measures stress of an individual through recording the experience of life changing events. We used qualitative methodology in order to identify contextually relevant stressors in an open ended format, using serial in-depth interviews until thematic saturation of reported stressful life events was achieved. In our next phase of adaptation, our objective was to scale each item on the questionnaire, so as to weigh each of these identified events, in terms …

Development And Psychometric Testing Of An Instrument To Compare Career Choice Influences And Perceptions Of Nursing Among Healthcare Students, Sok Ying Liaw, Ling Ting Wu, Violeta Lopez, Yeow Leng Chow, Siriwan Lim, Eleanor Holroyd, Khoon Kiat Tan, Wenru Wang

School of Nursing & Midwifery, East Africa

Background: With the availability of more healthcare courses and an increased intake of nursing students, education institutions are facing challenges to attract school leavers to enter nursing courses. The comparison of career choice influences and perception of nursing among healthcare students can provide information for recruitment strategies. An instrument to compare the influences of healthcare career choice is lacking. The purpose of this study is to develop and evaluate the psychometric properties of an instrument to compare the influences of healthcare career choice with perceptions of nursing as a career choice.

Methods: The study was conducted in two phases. In …

Thyroid Ultrasound: State Of The Art. Part 2 - Focal Thyroid Lesions., Manjiri Dighe, Richard Barr, Jörg Bojunga, Vito Cantisani, Maria Cristina Chammas, David Cosgrove,, Xin Wu Cui, Yi Dong, Franziska Fenner, Maija Radzina, Sudhir Vinayak, Jun Mei Xu, Christoph F Dietrich

Department of Radiology

Abstract

Accurate differentiation of focal thyroid nodules (FTL) and thyroid abnormalities is pivotal for proper diagnostic and therapeutic work-up. In these two part articles, the role of ultrasound techniques in the characterization of FTL and evaluation of diffuse thyroid diseases is described to expand on the recently published World Federation in Ultrasound and Medicine (WFUMB) thyroid elastography guidelines and review how this guideline fits into a complete thyroid ultrasound exam.

Students' Perceptions Of Usefulness Of Anatomy Demonstrations In Traditional And Hybrid Undergraduate Medical Education Curricula, Ayesha Saba Naz, Rehana Rehman, Zehra Jamil, Khalid Ahmed, Ambreen Surti

Department of Biological & Biomedical Sciences

A cross-sectional study was carried out to study students' perceptions on the usefulness of Anatomy demonstrations (AD) in the undergraduate medical education by comparing the Conventional Medical College (CMC) and problem-based learning as hybrid curriculum (HMC). Purposive sampling technique was used and all students were included. The completed questionnaire responses were returned by 92 CMC and 87 HMC students. CMC cohort understood the structural relationship more than HMC (p=0.03). AD helped 50 students (54%) of CMC to get through the theory examination, however 73 (84%) students of HMC found them useful in preparation for theory examinations (p<0.001). The importance of AD as a major content delivery strategy cannot be overemphasized in the anatomy curriculum and useful teaching strategies from various undergraduate medical curricula, such as the use of the plastic and plastinated models and the session handouts.

Assessing Decision Of Inpatient Or Outpatient Care In Community Acquired Pneumonia: Apt Care Study, Saleem Ullah, Javaid Khan, Amanullah Khan, Irfan Hashemy

Section of Pulmonary & Critical Care

Objective: To estimate the proportion of community-acquired pneumonia patients with disagreement between Confusion, Uraemia, Respiratory rate, Blood pressure, age > 65 years recommendation and physician\\\'s decision to hospitalise or not.
Methods: This cross-sectional nation-wide, non-interventional, cross-sectional study was carried out across 10 cities of Pakistan from December 2011 to May 2012, and recruited consenting adult patients with confirmatory diagnosis of community-acquired pneumonia on chest X-ray. Confusion, Uraemia, Respiratory rate, Blood pressure, age > 65 years recommendation for each patient was determined at the time of analysis. This recommendation was compared with treatment decision made by the physician. Disagreement was considered when the …

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

Faculty of Health Sciences, East Africa

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

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

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

Assessment Of Childhood Domestic Injuries Among Joint And Nuclear Families Of Karachi, Asif Khaliq, Amreen Rao, Shahroz Siddiqui, Ghulam Mujtaba Nasir

Department of Biological & Biomedical Sciences

To assess the frequencies and factors of domestic injuries among children aged less than 5 years. This is a cross sectional study, in which parents who have child less than 5 years of age were targeted. A total of 246 participants had provided satisfactory information and they were approached by non-probability purposive sampling technique from January 2016 to June 2016. The data was entered in Excel and then imported to SPSS 19.0 for inferential analysis. In this study, 89.8% (n = 221) mothers and 10.2% (n = 25) father who had participated. 52.08% (n = 123) parents were from joint …

Re-Structuring University Hospital’S Internship Program Using Kern’S Six-Step Model Of Instructional Design, M. Tariq, Muhammad Shahzad Shamim, Amna Subhan Butt, Sana Saeed, Zia Ur Rehman, Barkat Virani, Asghar Ashraf, Irum Qamar, Farah Qamar, Raheela Mohsin Rizvi, Swaleha Tariq, Qurratulain Naeem

Department of Surgery

Abstract Background: Internship is a phase of training wherein a graduate learns in the context of practice, acquiring skills under supervision so that he/she may become capable of functioning independently. We are reporting the process of curriculum restructuring for strengthening the Internship Program at this university hospital. Methodology: We used Kerns’ six-step model to evaluate and restructure the internship curriculum. Step 01: Problem Identification & General need assessment- Thorough literature review revealed Internship as the crucial year of training that needs to be fashioned around the competencies required to make good doctors

Validation Of Respiratory Questionnaire For Lung Function Assessment Among An Occupational Group Of Textile Workers In Pakistan, Tanzil Jamali, Asaad Ahmed Nafees

Community Health Sciences

Objective: To determine the association of spirometric lung pattern with respiratory symptoms and to validate the American Thoracic Society respiratory questionnaire for lung function assessment among textile workers.
Methods: This cross-sectional survey was conducted from August to December 2009 among adult textile workers of Karachi. Data was collected through the American Thoracic Society Division of Lung Disease respiratory questionnaire and the lung function was assessed by using a spirometer. Results of three acceptable readings of spirogram were recorded and the best of the three readings was used for analysis. SPSS 19 was used for data analysis.
Results: There were 372 …

An Analysis Of Perioperative Adverse Neurological Events Associated With Anesthetic Management At A Tertiary Care Center Of A Developing Country, Fauzia Anis Khan, Sobia Khan, Gauhar Afshan

Department of Anaesthesia

Background and Aims: Existing literature on neurological complications related to anesthesia is reported from affluent countries but the trends may vary in less affluent countries.MATERIAL AND Methods: The objective was to find the associated factors contributing to neurological adverse events occurring within 48 h of anesthesia and surgery. The existing departmental morbidity and mortality database was reviewed from 1992 to 2012 for major adverse neurological events. A standardized methodology was used in reviewing and classifying the data. All adverse events were predefined and categorized before filling the form into the following headers; meningitis, cord/plexus/peripheral nerve injury, stroke, paraparesis/paraplegia/quadriparesis/or quadriplegia, new …