Medicine and Health Sciences Commons^™

Trends In Premature Mortality From Acute Myocardial Infarction In The United States, 1999 To 2019, Sourbha S. Dani, Ahmad N. Lone, Zulqarnain Javed, Muhammad S. Khan, Muhammad Zia Khan, Edo Kaluski, Salim S. Virani, Michael D. Shapiro, Miguel Cainzos‐Achirica, Khurram Nasir

Office of the Provost

Pagination are not provided by the author/publisher. This work was published before the author joined Aga Khan University.

Cost-Effectiveness Analysis Of Implementing An Integrated Neonatal Care Kit To Reduce Neonatal Infection In Rural Pakistan, Fiona Muttalib, Karen Chung, Lisa Grace Pell, Shabina Ariff, Sajid Soofi, Shaun K. Morris, Beate Sander

Department of Paediatrics and Child Health

Objective:
To evaluate the cost-effectiveness of distribution of the integrated neonatal care kit (iNCK) by community health workers from the healthcare payer perspective in Rahimyar Khan, Pakistan.
Setting:
Rahimyar Khan, Pakistan.
Participants:
N/A.
Intervention:
Cost-utility analysis using a Markov model based on cluster randomised controlled trial (cRCT: NCT02130856) data and a literature review. We compared distribution of the iNCK to pregnant mothers to local standard of care and followed infants over a lifetime horizon.
Primary and secondary outcome measures:
The primary outcome was incremental net monetary benefit (INMB, at a cost-effectiveness threshold of US$15.50), discounted at 3%. Secondary outcomes …

Diagnostic Value Of Endoscopic Ultrasonography For Common Bile Duct Dilatation Without Identifiable Etiology Detected From Cross-Sectional Imaging, Nonthalee Pausawasdi, Penprapai Hongsrisuwan, Lubna Kamani, Kotchakon Maipang, Phunchai Charatcharoenwitthaya

Section of Gastroenterology

Background/aims: Endoscopic ultrasonography (EUS) is warranted when cross-sectional imaging demonstrates common bile duct (CBD) dilatation without identifiable causes. This study aimed to assess the diagnostic performance of EUS in CBD dilatation of unknown etiology.
Methods: Retrospective review of patients with dilated CBD without definite causes undergoing EUS between 2012 and 2017.
Results: A total of 131 patients were recruited. The mean age was 63.2±14.1 years. The most common manifestation was abnormal liver chemistry (85.5%). The mean CBD diameter was 12.2±4.1 mm. The area under the receiver operating characteristic curve (AUROC) of EUS-identified pathologies, including malignancy, choledocholithiasis, and benign biliary stricture …

Nutritional Support And Prophylaxis Of Azithromycin For Pregnant Women To Improve Birth Outcomes In Peri-Urban Slums Of Karachi, Pakistan-A Protocol Of Multi-Arm Assessor-Blinded Randomized Controlled Trial (Mumta Pw Trial), Ameer Muhammad, Zoha Zahid Fazal, Benazir Baloch, Muhammad Imran Nisar, Fyezah Jehan, Yasir Shafiq

Medical College Documents

Background: Maternal undernutrition is critical in the etiology of poor perinatal outcomes and accounts for 20% of small-for-gestational-age (SGA) births. High levels of food insecurity, antenatal undernourishment, and childhood undernutrition necessitate the supplementation of fortified balanced energy protein (BEP) during pregnancy in low-income settings especially with scarce literature available in this subject. Hence, this paper extensively covers the protocol of such a trial conducted in an urban slum of Karachi, Pakistan.
Methods: The trial is community-based, open-labelled, four-arm, and randomized controlled that will include parallel group assignments with a 1:1:1:1 allocation ratio in low-income squatter settlements in urban Karachi, Pakistan. …

Changes In Patterns And Outcomes Of Trauma Patients After Betterment In Law And Order Situation Of The City, Sabah Uddin Saqib, Hasnain Zafar

Section of General Surgery

Objective: To assess the impact of the law and order situation of a city on the pattern of traumatic injuries and the overall outcomes of trauma victims.
Methods: The retrospective study of prospective trauma surgery data was done at Aga Khan University Hospital, Karachi, and comprised data of patients with torso injuries before the improvement of law and order situation from January 2012 to March 2013 in Group A, and of those with similar injuries after the law and order situation improved in the city from January 2018 to March 2019 in Group B. The required data was collected by …

The Role Of Emergency Departments For Antimicrobial Stewardship In Covid-19 Pandemic; The Time Is Now, Madiha Ismail, Nazeer Najeeb Kapadia, Sara Usman

Department of Emergency Medicine

No abstract provided.

Authorship Equity And Gender Representation In Global Oncology Publications, Paula Hornstein, Hubert Tuyishime, Miriam Mutebi, Nwamaka Lasebikan, Fidel Rubagumya, Temidayo Fadelu

General Surgery, East Africa

Purpose: Authorship gender disparities persist across academic disciplines, including oncology. However, little is known about global variation in authorship gender distribution.

Methods: This retrospective cross-sectional study describes the distribution of author gender as determined from the first name across variables such as authorship position (first, middle, and last), country region, and country income level. The 608 articles with 5,302 authors included in this analysis were published in the Journal of Clinical Oncology Global Oncology, from its inception in October 2015 through March 2020. Primary outcome measure was author gender on the basis of first name probabilities assessed by …

Intraoperative Post Partum Hemorrhage In A Patient With Dengue Fever, Usama Ahmed, Asiyah Aman

Department of Anaesthesia

A 33 year old obstetric patient with mild fever of undiagnosed etiology underwent emergency caesarean section under general anesthesia. She had platelet count of 98,000 per microliter and increased APTT of 37.8 s at the time of surgery. After uneventful anesthetic induction and delivery of fetus, slow and oozing type of bleeding led to massive hemorrhage. Patient remained vitally stable throughout perioperative phase and was extubated. Next day, patient's dengue IgM antibody was reported positive. Neonate was well and his dengue test was negative. Pregnant women are at high risk of developing severe complications of dengue fever with unclear mechanisms …

Qualitative Study Exploring The Feasibility, Usability And Acceptability Of Neonatal Continuous Monitoring Technologies At A Public Tertiary Hospital In Nairobi, Keny, Mai-Lei Woo Kinshella, Violet Naanyu, Dorothy Chomba, Mary Waiyego, Jessica Rigg, Jesse Coleman, Bella Hwang, J. Mark Ansermino, William Macharia, Amy Sarah Ginsburg

Paediatrics and Child Health, East Africa

Objective: To assess the feasibility, usability and acceptability of two non-invasive, multiparameter, continuous physiological monitoring (MCPM) technologies for use in neonates within a resource-constrained healthcare setting in sub-Saharan Africa.

Design: A qualitative study using in-depth interviews and direct observations to describe healthcare professional and caregiver perspectives and experiences with investigational MCPM technologies from EarlySense and Sibel compared with selected reference technologies.

Setting: Pumwani Maternity Hospital is a public, high-volume, tertiary hospital in Nairobi, Kenya.

Participants: In-depth interviews were conducted with five healthcare administrators, 12 healthcare providers and 10 caregivers. Direct observations were made of healthcare providers using the technologies on …

Fear, Faith And Finances: Health Literacy Experiences Of English And Swahili Speaking Women Newly Diagnosed With Breast And Cervical Cancer, Diana Kassaman, Tayreez Mushani, Peterson Kiraithe, Sharon Brownie, Margaret Barton-Burk

School of Nursing & Midwifery, East Africa

Breast and cervical cancer are among the leading causes of cancer-related deaths globally. In Kenya, delayed presentation and diagnosis contribute to breast and cervical cancer mortality. The Kenyan government acknowledges the cancer burden with estimated 39,000 new cases diagnosed and 27,000 deaths per annum. Mortality can be reduced if cancer is diagnosed early and with appropriate treatment. Health Literacy (HL) about cancer screening, diagnosis and treatment is important in reducing mortality, but there is little understanding about HL levels, experiences of patients diagnosed with breast and cervical cancer and the contexts in which they make decisions. In this study, health …

Severe Mixed Mitral Valve Disease Due To Massive Mitral Annular Calcification: A Case Report And Literature Review, Fateh Ali Tipoo Sultan, Sheema Saadia

Section of Cardiology

We present an unusual case of massive mitral annular calcification (MAC) leading to severe mixed mitral valve disease, viz severe mitral regurgitation and severe mitral stenosis. To our knowledge, severe mixed mitral valve disease secondary to MAC is extremely rare. The patient (a 65-year-old lady) presented with worsening shortness of breath and signs of congestive heart failure. Echocardiographic examination revealed massive mitral annular calcification. Despite the massive annular calcification, she had experienced neither embolism nor endocarditis in the past. Because of severe symptomatic mitral regurgitation and mitral stenosis, surgery was advised; however, the patient declined it.

Variability Of Respiratory Rate Measurements In Neonates- Every Minute Counts, Catherine Muthoni, J. Mark Ansermino, William Macharia, Dustin T. Dunsmuir

Paediatrics and Child Health, East Africa

Background: Respiratory rate is difficult to measure, especially in neonates who have an irregular breathing pattern. The World Health Organisation recommends a one-minute count, but there is limited data to support this length of observation. We sought to evaluate agreement between the respiratory rate (RR) derived from capnography in neonates, over 15 s, 30 s, 120 s and 300 s, against the recommended 60 s.

Methods: Neonates at two hospitals in Nairobi were recruited and had capnograph waveforms recorded using the Masimo Rad 97. A single high quality 5 min epoch was randomly chosen from each subject. For each selected …

Psychosocial And Mental Health Challenges Faced By Emerging Adults Living With Hiv And Support Systems Aiding Their Positive Coping: A Qualitative Study From The Kenyan Coast, Moses K. Nyongesa, Carophine Nasambu, Rachael Mapenzi, Hans M. Koot, Pim Cuijpers, Charles R. J. C. Newton, Amina Abubakar

Institute for Human Development

Background: In sub-Saharan Africa, there is little data on the challenges faced by young people living with HIV tran- sitioning into adult life. Adapting the socio-ecological framework, this qualitative study investigated the challenges faced by emerging adults living with HIV from a rural Kenyan setting. Additionally, the study explored support systems that aid positive coping among these young adults.

Methods: In April 2018, in-depth interviews were conducted with a convenience sample of 22 young adults living with HIV (12 females), 18–24 years old, from rural Kilifi, coast of Kenya. Data were analyzed thematically using NVIVO 11 software.

Results …

Busting Contraception Myths And Misconceptions Among Youth In Kwale County, Kenya: Results Of A Digital Health Randomised Control Trial, Peter Gichangi, Lianne Gonsalves, Jefferson Mwaisaka, Mary Thiongo, Ndema Habib, Michael Waithaka, Tigest Tamrat, Alfred Agwanda, Hellen Sidha, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Objectives: The objective of this randomised controlled trial in Kenya was to assess the effect of delivering sexual and reproductive health (SRH) information via text message to young people on their ability to reject contraception-related myths and misconceptions.

Design and setting: A three-arm, unblinded randomised controlled trial with a ratio of 1:1:1 in Kwale County, Kenya.

Participants and interventions: A total of 740 youth aged 18–24 years were randomised. Intervention arm participants could access informational SRH text messages on-demand. Contact arm participants received once weekly texts instructing them to study on an SRH topic on their own. Control arm participants …

Delivery Room St Segment Analysis To Predict Short Term Outcomes In Near-Term And Term Newborns, Jørgen Linde, Anne Lee Solevåg, Joar Eilevstjønn, Ladislaus Blacy, Hussein Kidanto, Hege Ersdal, Claus Klingenberg

Obstetrics and Gynaecology, East Africa

Background: ST-segment changes to the fetal electrocardiogram (ECG) may indicate fetal acidosis. No large-scale characterization of ECG morphology immediately after birth has been performed, but ECG is used for heart rate (HR) assessment. We aimed to investigate ECG morphology immediately after birth in asphyxiated infants, using one-lead dry-electrode ECG developed for HR measurement.

Methods: Observational study in Tanzania, between 2013-2018. Near-term and term infants that received bag-mask ventilation (BMV), and healthy controls, were monitored with one-lead dry-electrode ECG with a non-diagnostic bandwidth. ECGs were classified as normal, with ST-elevations or other ST-segment abnormalities including a biphasic ST-segment. We analyzed ECG …

Genetic Diversity In L1 Orf Of Human Papillomavirus In Women With Cervical Cancer With And Without Human Immunodeficiency Virus In Botswana And Kenya, Leabaneng Tawe, Wonderful T. Choga, Giacomo M. Paganotti, Ontlametse T. Bareng, Tlhalefo D. Ntereke, Pleasure Ramatlho, Doreen Ditshwanelo, Simani Gaseitsiwe, Ishmael Kasvosve, Elkanah Omenge

Obstetrics and Gynaecology, East Africa

Background: The variation of human papillomavirus (HPV) genotypes shapes the risks of cervical cancer and these variations are not well defined in Africa. Nucleotide changes within the L1 gene, nucleotide variability, and phylogeny were explored in relation to HIV in samples from Botswana and Kenya. Methods: A total of 98 HPV-positive cervical samples were sequenced to identify diferent HPV variants. Phylogenetic inferences were used to determine HPV genotypes and investigate the clustering of sequences between women living with HIV (WLWHIV) and -women not living with HIV (WNLWHIV). Results: Out of 98 generated sequences, 83.7% (82/98) participants had high-risk (HR) HPV …

Stereotactic Radiosurgery For Pituitary Adenomas: A Review Of Literature, Kaynat Siddiqui, Saqib Kamran Bakhshi, Muhammad Shahzad Shamim

Section of Neurosurgery

Stereotactic radiosurgery (SRS) is a choice of treatment for pituitary adenomas (PA), particularly for residual or recurrent disease, apart from surgery. It has a progression free survival and endocrine remission rate comparable to surgery, with fewer side effects, making it an ideal tool for dealing with PA. In this review, we have discussed the role of SRS for primary as well as post-operative residual/ recurrent PA, and have assessed its safety and outcomes.

D-Dimer Testing In Covid-19: From Basics To Clinical Application, Bushra Moiz

Department of Pathology and Laboratory Medicine

No abstract provided.

Risk Factors And Compliance Of Surviving Sepsis Campaign: A Retrospective Cohort Study At Tertiary Care Hospital, Farheen Yousuf, Ayesha Malik, Ayesha Saba, Sana Sheikh

Department of Obstetrics & Gynaecology

Background and objective: Sepsis is one of the leading causes of direct maternal mortality in Pakistan. It is recommended that the first three hours after the presentation are crucial. During this time implementation of surviving sepsis campaign resuscitation bundles reduces maternal mortality. Our objective was to assess the factors contributing to puerperal sepsis and the compliance of "surviving sepsis campaign resuscitation bundles in puerperal sepsis" for the management of puerperal sepsis.
Methods: This was a retrospective record review for five years from January 2011-December 2015. All women who fulfilled the inclusion criteria of puerperal sepsis were included and data from …

Still Birth Classification: Application Of Relevant Condition At Death (Recode) Classification System In A Tertiary Care Hospital Of Pakistan, Urooj Kashif, Shelina Bhamani, Asma Patel, Zaheena Shamsul Islam

Department of Obstetrics & Gynaecology

Objectives: To determine the cause of stillbirth after application of relevant condition at death (ReCoDe) classification system.
Methods: This was a retrospective cross sectional study of 207 women diagnosed with stillbirth after 24 completed weeks of pregnancy at the Aga Khan University Hospital (AKUH), Karachi between 1st January 2015 and 31st December 2019. The primary objective was to find the cause of stillbirth according to the new classification of relevant condition at death (ReCoDe).
Results: There were a total of 32413 live births and 207 stillbirths during the study period thus stillbirth rate of 6 per 1000 live births. In …

Clinical Characteristics And Prognostic Factors Of Atrial Fibrillation At A Tertiary Center Of Pakistan – From A South-Asian Perspective – A Cross-Sectional Study, Intisar Ahmed, Aiysha Nasir, Pirbhat Shams, Hunaina Shahab, Muhammad Hassan, Faryal Subhani, Ghurfan Adnan, Awais Farhad, Aamir Hameed, Yawer Saeed

Section of Cardiology

Background: There is lack of large data from South-Asian region on atrial fibrillation and it is imperative that clinical presentation, prognostic factors, management pursued, and outcomes are known for this part of the world. Once collective evidence for the region is known, region-specific guidelines can be laid forward.
Objectives: To evaluate clinical characteristics and prognostic factors of atrial fibrillation at a tertiary care center of Pakistan.
Methods: This was a retrospective study conducted at a tertiary care center of Pakistan. Period of study ranged from July-December 2018. All hospitalized patients who were admitted with atrial fibrillation as a primary or …

Bibliometric Study On The Literature Related To Dental Research And Education Published In Journal Of Pakistan Medical Association, Samira Adnan, Kamil Zafar, Farhan Raza Khan, Rizwan Ullah

Section of Dental-Oral Maxillofacial Surgery

Objective: To analyse characteristics of literature related to dental research and education published in a single medical journal, The Journal of Pakistan Medical Association.
Method: The bibliometric study was conducted at the Sindh Institute of Oral Health Sciences, Jinnah Sindh Medical University from March till May 2020, and comprised electronic and hand search of scientific literature relevant to dentistry published in the Journal of Pakistan Medical Association from the first issue published in 1953 till March 2020. The selected articles were analysed for year of publication, field of study, type of article, institute and country of first author, number of …

Comparison Of Surface Defects In Protaper Next And Hyflex Edm Files After Single Clinical Use: A Stereoscopic Evaluation, Faizan Javed, Momina Anis Motiwala, Farhan Raza Khan, Rabia Ghafoor

Section of Dental-Oral Maxillofacial Surgery

Objective: To compare the surface defects created on the ProTaper Next files versus HyFlex Electrical Discharge Machining files after single clinical use in molars.
Methods: The cross-sectional study was conducted in the dental department of the Aga Khan University Hospital, Karachi, from December 2018 to June 2019, and comprised Nickel-Titanium files belonging to HyFlex Electrical Discharge Machining and ProTaper Next to perform complete root canal treatment of molar teeth. The files were first visually examined and then analysed under 25.6x magnification using a stereomicroscope for the evaluation of surface defects. A photographic record was maintained and studied. Data was analysed …

Hypertension Pharmacological Treatment In Adults: A World Health Organization Guideline Executive Summary, Akram Al-Makki, Donald Dipette, Paul K. Whelton, M Hassan Murad, Reem A. Mustaf, Shrish Acharya, Hind Mamoun Beheiry, Beatriz Champagne, Kenneth Connell, Unab I. Khan

Department of Family Medicine

Hypertension is a major cause of cardiovascular disease and deaths worldwide especially in low- and middle-income countries. Despite the availability of safe, well-tolerated, and cost-effective blood pressure (BP)-lowering therapies, <14% of adults with hypertension have BP controlled to a systolic/diastolic BP <140/90 mm Hg. We report new hypertension treatment guidelines, developed in accordance with the World Health Organization Handbook for Guideline Development. Overviews of reviews of the evidence were conducted and summary tables were developed according to the Grading of Recommendations, Assessment, Development, and Evaluations approach. In these guidelines, the World Health Organization provides the most current and relevant evidence-based guidance for the pharmacological treatment of nonpregnant adults with hypertension. The recommendations pertain to adults with an accurate diagnosis of hypertension who have already received lifestyle modification counseling. The guidelines recommend BP threshold to initiate pharmacological therapy, BP treatment targets, intervals for follow-up visits, and best use of health care workers in the management of hypertension. The guidelines provide guidance for choice of monotherapy or dual therapy, treatment with single pill combination medications, and use of treatment algorithms for hypertension management. Strength of the recommendations was guided by the quality of the underlying evidence; the tradeoffs between desirable and undesirable effects; patient's values, resource considerations and cost-effectiveness; health equity; acceptability, and feasibility consideration of different treatment options. The goal of the guideline is to facilitate standard approaches to pharmacological treatment and management of hypertension which, if widely implemented, will increase the hypertension control rate world-wide.

Role Of Micrornas In Non-Functioning Pituitary Adenoma, Mehak Ismail Rajani, Yumna Mirza, Rohan Advani, Syed Muhammad Adnan Ali, Ather Enam

Centre for Innovation in Medical Education

Non-functioning pituitary adenomas account for 30% of anterior pituitary tumours. Based on their inability to secrete hormones, these are often diagnosed incidentally or due to pressure symptoms. Understanding the pathogenesis of these adenomas can provide insight into factors leading to its progression and serving as biomarkers for early recognition. A literature search was performed in the current narrative review for articles published in PubMed for the last 10 years till January 2020 on micro-ribonucleic acid involved in the pathogenesis of non-functioning pituitary adenomas. Of the 478 articles found, 21(4.4%) were filtered. In total, 106 micro-ribonucleic acids were identified, 25(23.5%) of …

Practices Of Vitamin D Supplementation Leading To Vitamin D Toxicity: Experience From A Low-Middle Income Country, Siraj Muneer, Imran Siddiqui, Hafsa Majid, Nawazish Zehra, Lena Jafri, Aysha Habib

Department of Pathology and Laboratory Medicine

Introduction: The trend of prescribing VD preparations for nonspecific body aches and self-medication has increased significantly. The importance of vitamin D toxicity (VDT) has been underestimated and under recognized. This study was done to determine the frequency toxicity (>150 ng/ml) in subjects for 25-hydroxyvitamin D (25OHD) and evaluate the vitamin D (VD) supplements used by these subjects.
Methodology: This descriptive cross-sectional study was conducted at the Section of Chemical Pathology, Aga Khan University Hospital Karachi from April 2020 to March 2021. Subjects with 25OHD toxicity were contacted and information related to history of calcium and VD supplementation were collected. …

Associations Between Eight Earth Observation-Derived Climate Variables And Enteropathogen Infection: An Independent Participant Data Meta-Analysis Of Surveillance Studies With Broad Spectrum Nucleic Acid Diagnostics, Josh M. Colston, Benjamin F. Zaithcik, Hamada S. Badr, Eleanor Burnett, Syed Asad Ali, Ajit Rayamajhi, Syed M. Satter, Daniel Eibach, Ralf Krumkamp, M Imran Nisar, Anita K. M. Zaidi, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Diarrheal disease, still a major cause of childhood illness, is caused by numerous, diverse infectious microorganisms, which are differentially sensitive to environmental conditions. Enteropathogen‐specific impacts of climate remain underexplored. Results from 15 studies that diagnosed enteropathogens in 64,788 stool samples from 20,760 children in 19 countries were combined. Infection status for 10 common enteropathogens—adenovirus, astrovirus, norovirus, rotavirus, sapovirus, Campylobacter, ETEC, Shigella, Cryptosporidium and Giardia—was matched by date with hydrometeorological variables from a global Earth observation dataset—precipitation and runoff volume, humidity, soil moisture, solar radiation, air pressure, temperature, and wind speed. Models were fitted for each pathogen, accounting …