Medicine and Health Sciences Commons^™

Parallel Ngo Networks For Hiv Control: Risks And Opportunities For Ngo Contracting., Shehla Zaidi, Xaher Gul, Noureen Aleem Nishtar

Community Health Sciences

Policy measures for preventive and promotive services are increasingly reliant on contracting of NGOs. Contracting is a neo-liberal response relying on open market competition for service delivery tenders. In contracting of health services a common assumption is a monolithic NGO market. A case study of HIV control in Pakistan shows that in reality the NGO market comprises of parallel NGO networks having widely different service packages, approaches and agendas. These parallel networks had evolved over time due to vertical policy agendas. Contracting of NGOs for provision of HIV services was faced with uneven capacities and turf rivalries across both NGO …

Triple Valve Endocarditis By Mycobacterium Tuberculosis: A Case Report., Quratulain Shaikh, Syed Faisal Mahmood

Department of Medicine

BACKGROUND:

Granulomas caused by Mycobacterium Tuberculosis have been observed at autopsy in the heart, pre-dominantly in the myocardium and endocardium, but rarely involving the coronary vessels and valvular structures. Mycobacterium tuberculosis valvular endocarditis is extremely rare, with most reports coming from autopsy series.

CASE PRESENTATION:

We report the case of a 17 year old immunocompetent girl who presented with history of fever, malaise, foot gangrene and a left sided hemiparesis. On investigation she was found to have infective endocarditis involving the aortic, mitral and tricuspid valves. She had developed a right middle cerebral artery stroke. She underwent dual valve replacement …

Fulminant Invasive Aspergillosis Of The Mediastinum In An Immunocompetent Host: A Case Report., Muhammad Tariq Shakoor, Samia Ayub, Zunaira Ayub, Syed Faisal Mahmood

Department of Medicine

Introduction: Invasive aspergillosis is a serious complication in immunocompromised patients. It is an opportunistic disease, which predominantly occurs in the lungs, although dissemination to virtually any organ is possible. Invasive aspergillosis in an immunocompetent patient with extension to the mediastinum has rarely been reported. Here, we present the case of a patient with no apparent immunodeficiency state, who presented with Aspergillus endocarditis and fulminant invasive aspergillosis with extensive involvement of the mediastinal structures, which ultimately was responsible for her death. To the best of our knowledge, this is the first reported case in the literature on fulminant invasive mediastinal aspergillosis …

Prolonged Intermediate Syndrome Pue To Prganophosphate Poisoning, Nadeem Ullah Khan, Muhammad Junaid Patel, M. N.M. Hifath, Saima Kamal, Syed Ather Hussain

Department of Emergency Medicine

Organophosphate poisoning can present as acute cholinergic syndrome, Intermediate syndrome and delayed neuropathy. Intermediate syndrome secondary to organophosphate poisoning is a serious health problem leading to increased morbidity and mortality. The incidence of problem varies and range from 8%-84% of organophosphate poisoning cases. The factors account for this difference is nature of organophosphate compound, severity of poisoning and inadequate Oxime therapy. The recognition of this syndrome is important as organophosphate poisoning is common in our country. We presented this case of organophosphate poisoning leading to prolonged intermediate syndrome. The muscle weakness associated with this syndrome generally resolves in 5-18 days …

Randomized Controlled Trial Of Interferon Gamma Versus Amantadine In Combination With Interferon Alpha And Ribavirin For Hepatitis C Genotype 3 Non-Responders And Relapsers, Z Abbas, Sajjad Raza, Saeed Hamid, Wasim Jafri

Section of Gastroenterology

OBJECTIVES: To evaluate the efficacy and safety of triple combination regimens comprising of interferon alpha-2b (IFN-alpha) and ribavirin plus either IFN-gamma or amantadine in genotype 3 patients, responders or relapsers to interferon plus ribavirin combination.

METHODS: Patients were randomized to receive IFN-alpha 3MU thrice a week, ribavirin 800-1200 mg per day with either IFN-gamma 2 MU thrice a week or amantadine 100 mg twice daily. Treatment was continued for 48 weeks in patients showing complete or partial (2 log reduction) early virological response (EVR) at 12 weeks and negative PCR at 24 weeks.

RESULTS: Total enrollments were 44; 25 were …

Knowledge And Attitudes About Tetanus And Rabies: A Population-Based Survey From Karachi, Pakistan, Mohammad Wasay, Abdul Malik, Ammad Fahim, Adnan Yousuf, Rajesh Chawla, Haroon Daniel, Muhammad Rafay, Iqbal Azam, Junaid Razzak

Section of Neurology

OBJECTIVE: To evaluate public knowledge regarding predisposing factors, fatality and prevention of Tetanus and Rabies and attitudes toward vaccination and post-exposure prophylaxis.

METHODS: A population-based, cross-sectional survey was conducted in all the 18 towns of Karachi, the largest metropolitan city of Pakistan, from December 2007 to January 2008. Men and women of more than 18 years of age were included in the study which used a self-reporting questionarre as its tool.

RESULTS: There were 1201 people interviewed by the study. The majority of respondents had known or heard about Tetanus (n = 973; 81%) and rabies (n = 699; 58%). …

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

Section of Gastroenterology

OBJECTIVE: To assess the nutritional status via the SGA (subjective global assessment) screening tool of patients at all stages of hepatitis C virus (HCV) liver disease.

STUDY DESIGN: Descriptive study.

PLACE AND DURATION OF STUDY: Out-patient Clinics of the Aga Khan University Hospital, Karachi, conducted from October 2009 to January 2011.

METHODOLOGY: Patients with hepatitis C virus infection and their HCV-negative attendants were enrolled from the outpatient clinics, and categorized into 4 groups of 100 patients each: healthy controls (HC), those with chronic hepatitis C infection (CHC), compensated cirrhotics (CC) and decompensated cirrhotics (DC). The validated subjective global assessment (SGA) …

Nitric Oxide Metabolites As Biomarkers For Influenza-Like Acute Respiratory Infections Presenting To The Emergency Room, Asad Mian, Federico R Laham, Andrea T Cruz, Harsha Garg, Charles G Macias, A. Chantal Caviness, Pedro A Piedra

Department of Emergency Medicine

Aims: Nitric oxide (NO) is increased in the respiratory tract in pulmonary infections. The aim was to determine whether nasal wash NO metabolites could serve as biomarkers of viral pathogen and disease severity in children with influenza-like illness (ILI) presenting to the emergency department (ED) during the 2009 influenza A H1N1 pandemic.
Methods: Children ≤18 years old presenting to the ED with ILI were eligible. Nasal wash specimens were tested for NO metabolites, nitrate and nitrite, by HPLC and for respiratory viruses by real-time PCR.
Results: Eighty-nine patients with ILI were prospectively enrolled during Oct-Dec, 2009. In the …