Medicine and Health Sciences Commons^™

A Critical Analysis Of The Current State Of Neurosurgery Training In Pakistan, Muhammad Shahzad Shamim, Muhammad Zubair Tahir, Saniya Siraj Godil, Rajesh Kumar, Arshad Ali Siddiqui

Section of Neurosurgery

Objective: To observe interdepartmental variation in the availability of resources and academic activities within the various neurosurgery programs of Pakistan.
Methods: This was a proforma-based survey of neurosurgery trainees and young neurosurgeons of Pakistan, looking at the academic infrastructure and output of their programs. The proforma was filled by 36 respondents from 11 neurosurgery centers of the country. All these centers were accredited for neurosurgery training in Pakistan.
Results: Out of the 36 respondents, 30 were completing a Fellowship training (FCPS) and six were enrolled for a Master in Surgery (MS) program. About 80% of the participants used the Youman's …

Proposals For A Scheme For Continuing Professional Development In Pakistan, Rashid Jooma

Section of Neurosurgery

No abstract provided.

Integration Of Geriatrics Into A Spiral Undergraduate Medical Curriculum In Pakistan: Evaluation And Feedback Of Third-Year Medical Students., S. R. Sabzwari, S. Bhanji, Rukhsana W. Zuberi

Department of Family Medicine

Background: In the last decades there has been a sharp rise in the elderly population throughout the world. The unique needs of the elderly require a multidisciplinary and comprehensive medical approach. None of the 50 medical schools in Pakistan teach geriatrics in their undergraduate or postgraduate training. This paper discusses the development and implementation of the first geriatric curriculum in a medical school of Pakistan and its effect on knowledge and attitudes of third-year medical students.
Methods: The curriculum was designed through collaboration and approval of various academic departments at the Aga Khan University in Karachi Pakistan. After a review …

Determining The Factors Associated With Unmet Need For Family Planning: A Cross-Sectional Survey In 49 Districts Of Pakistan, Waqas Hameed, Syed Khurram Azmat, Mohsina Bilgrami, Muhammad Ishaqe

Community Health Sciences

Introduction & Background: Around 137 million women in the developing world who would like to avoid childbearing are unable to do so, despite a huge increase in contraceptive access and use globally. Ironically, the prevalence of unmet need in Pakistan is among the highest in the world despite being one of the first countries in South Asia to launch national family planning program. The aim of this paper is to estimate the prevalence of unmet need for contraception and to indentify the factors associated with it.
Methods: A cross-sectional survey was conducted in forty nine districts of Pakistan across all …

Frequency And Associated Factors For Care Giving Among Elderly Patients Visiting A Teaching Hospital In Karachi, Pakistan., Waris Qidwai Dr, Mohammad Uzair Abdul Rauf, Seema Sakina, Ayesha Hamid, Sidra Ishaque, Tabinda Ashfaq

Department of Family Medicine

Objective: To study frequency and associated factors for care giving among elderly Patients visiting a teaching hospital in Karachi, Pakistan.
Methodology: A cross sectional questionnaire-based study was conducted at the Community Health Centre (CHC), Aga Khan University Hospital (AKUH) Karachi, Pakistan from September to November 2009. All individuals, visiting the CHC and aged 65 years or above were interviewed after taking written informed consent.
Results: A total of 400 elderly completed the interview. Majority were females, 65-69 years age, More than half of the individuals ie: 227 (85%) had received Care Giver experience for assistance and among these 195(72%) had …

Gender Roles And Their Influence On Life Prospects For Women In Urban Karachi, Pakistan: A Qualitative Study, Tazeen S. Ali, Gunilla Krantz, Raisa Gul, Nargis Asad, Eva Johansson, Ingrid Mogren

School of Nursing & Midwifery

BACKGROUND: Pakistan is a patriarchal society where men are the primary authority figures and women are subordinate. This has serious implications on women's and men's life prospects.
OBJECTIVE: The aim was to explore current gender roles in urban Pakistan, how these are reproduced and maintained and influence men's and women's life circumstances.
DESIGN: Five focus group discussions were conducted, including 28 women representing employed, unemployed, educated and uneducated women from different socio-economic strata. Manifest and latent content analyses were applied.
FINDINGS: TWO MAJOR THEMES EMERGED DURING ANALYSIS: 'Reiteration of gender roles' and 'Agents of change'. The first theme included perceptions …

The Association Between Parity, Infant Gender, Higher Level Of Paternal Education And Preterm Birth In Pakistan: A Cohort Study, Kiran Shaikh, Shahirose Sadrudin Premji, Marianne S. Rose, Ambreen Kazi, Shaneela Khowaja, Suzanne Tough

School of Nursing & Midwifery

Background:

High rates of antenatal depression and preterm birth have been reported in Pakistan. Self reported maternal stress and depression have been associated with preterm birth, however findings are inconsistent. Cortisol is a biological marker of stress and depression, and its measurement may assist in understanding the influence of self reported maternal stress and depression on preterm birth.

Methods:

In a prospective cohort study pregnant women between 28 to 30 weeks of gestation from the Aga Khan Hospital for Women and Children completed the A-Z Stress Scale and the Centre for Epidemiology Studies Depression Scale to assess stress and depression …

Anaesthesia As A Career Choice In A Developing Country; Effect Of Clinical Clerkship, Fauzia Khan, Fauzia Nasim Minai, Shahla Siddiqui

Department of Anaesthesia

OBJECTIVE: To explore the fourth year medical student's knowledge regarding anaesthesia as a specialty, their attitude towards anaesthesia as a career choice and the effect of clinical clerkship on these.

METHODS: This survey was conducted in the Department of Anaesthesia of a university medical centre in a developing country. One hundred and fifty year four medical students rotating in anaesthesia were enrolled. They were asked to fill a structured questionnaire before (pre) and after (post) their anaesthesia rotation. The questionnaire sought information on their perception of anaesthesia as a specialty, role of anaesthetists clerkship duration, and reasons for considering or …

Clinical Profile And Outcomes Of Paediatric Patients With Diabetic Ketoacidosis At A Tertiary Care Hospital In Pakistan, Madiha Syed, Fariha Batool Khawaja, Taimur Saleem, Umair Khalid, Abdul Rashid, Khadija Nuzhat Humayun

Department of Paediatrics and Child Health

OBJECTIVES: This study aims to present an experience in the management and clinical features of 88 children presenting with diabetic ketoacidosis (DKA) from Pakistan.

METHODS: A retrospective medical chart review of all patients, < or = 15 years of age, who presented to the Aga Khan University Hospital, Karachi, Pakistan in the last ten years with a diagnosis of diabetic ketoacidosis was carried out. Severity of DKA was defined as mild (venous pH < 7.30 or bicarbonate=15mEq/l), moderate (venous pH < 7.2 or bicarbonate = 10 mEq/l) and severe (venous pH < 7 or bicarbonate < 5 mEq/l). These classes correspond to 1st, 2nd and 3rd degrees of diabetic ketoacidosis severity respectively. Cases in which diabetic ketoacidosis had occurred at onset of diabetic diagnosis were not included in the study.

RESULTS: Mean age was 7.5 +/- 3.6 years; 58 (66%) patients were male. Twenty six patients had mild diabetic ketoacidosis, 44 had moderate while 18 had severe diabetic ketoacidosis at the time of presentation. Severity of diabetic ketoacidosis was significantly associated with the presence of infection, history of omission of insulin, poor compliance, presence of shock at time of presentation, length of stay in the hospital, final …

Population Attributable Risk Of Unintentional Childhood Poisoning In Karachi Pakistan, Bilal Ahmed, Zafar Fatmi, Amna R Siddiqui

Department of Medicine

Background: The percentage of unintentional childhood poisoning cases in a given population attributable to specific risk factors (i.e., the population attributable risk) which can be calculated, determination of such risk factors associated with potentially modifiable risk factors, are necessary to focus on the prevention strategies.

Methods: We calculated PARs, using 120 cases with unintentional poisoning and 360 controls in a hospital based matched case- control study. The risk factors were accessibility to hazardous chemicals and medicines due to unsafe storage, child behavior reported as hyperactive, storage of kerosene and petroleum in soft drink bottles, low socioeconomic class, less education of …

Knowledge, Perceptions And Myths Regarding Infertility Among Selected Adult Population In Pakistan: A Cross-Sectional Study, Sumera Ali, Raafay Sophie, Ayesha M. Imam, Faisal I. Khan, Syed F. Ali, Annum Shaikh, Syed Farid-Ul-Hasnain

Community Health Sciences

Background: The reported prevalence of infertility in Pakistan is approximately 22% with 4% primary and 18% secondary infertility. Infertility is not only a medical but also a social problem in our society as cultural customs and perceived religious dictums may equate infertility with failure on a personal, interpersonal, or social level. It is imperative that people have adequate knowledge about infertility so couples can seek timely medical care and misconceptions can be rectified.We aim to assess the knowledge, perception and myths regarding infertility and suggest ways to improve it. Methods: A cross-sectional survey was carried out by interviewing a sample …

A Silent Storm: Hepatitis C In Pakistan, Noureen Jiwani, Raisa B. Gul

School of Nursing & Midwifery

No abstract provided.

Depression And Its Associated Risk Factors In Medical And Surgical Post Graduate Trainees At A Teaching Hospital: A Cross Sectional Survey From A Developing Country, Aisha Yousuf, Sidra Ishaque, Waris Qidwai

Department of Family Medicine

Objectives: To determine the frequency of depression among post graduate medical trainees in a teaching hospital of Pakistan and to explore the associated factors contributing to depression in them. Methods: It's a cross-sectional study at the Aga Khan University Hospital, Karachi. It was done in June 2008 till August 2008. Zung Self-Rating Depression Scale was administered among 172 post graduate trainees. Self administered questionnaires were used to assess the associated demographic and work related risk factors. Adjusted odds ratios (OR) were calculated by logistic regression. Results: The survey response rate was 172(82.69%). Depression in the overall sample was 103(59.88%), of …

Road Traffic Injuries In Rawalpindi City, Pakistan., Umar Farooq, Junaid Ali Bhatti, M. Siddiq, M. Majeed, N. Malik, Junaid Razzak, M. M. Khan

Department of Emergency Medicine

Data on road traffic accident (RTA) injuries and their outcome are scarce in Pakistan. This study assessed patterns of RTA injuries reported in Rawalpindi city using standard surveillance methods. All RTA injury patients presenting to emergency departments of 3 tertiary care facilities from July 2007 to June 2008 were included. RTA injuries (n = 19 828) accounted for 31.7% of all injuries. Among children aged 0-14 years females suffered twice as many RTA injuries as males (21.3% versus 11.4%), whereas this trend reversed for the age group 15-24 years (41.9% versus 21.7%). One-fifth of injuries were either fractures or concussion. …

Elderly Patients And Their Health In Pakistan: Current Status, Issues, Challenges And Opportunities, Waris Qidwai, Tabinda Ashfaq

Department of Family Medicine

No abstract provided.

Spectrum Of Antihypertensive Therapy In South Asians At A Tertiary Care Hospital In Pakistan., Aysha Almas, Salik Ur Rehman Iqbal, Anabia Ehtamam, Aamir Hameed Khan

Department of Medicine

Background: Despite available guidelines on hypertension (HTN), use of antihypertensives is variable. This study was designed to ascertain frequency of Patients on monotherapy and > 1 antihypertensive therapy and also to ascertain proportion of Patients on diuretic therapy. Methods: It was a crossectional study conducted on 1191 adults(age > 18 yrs)hypertensive Patients selected by computerized International Classification of Diseases -9-coordination and maintenance (ICD-9-CM) presenting to a tertiary care hospital in Pakistan. Data on demographics, comorbids, type of antihypertensive drug, number of antihypertensive drug and mean duration of antihypertensive drug was recorded over 1.5 year period (2008-09). Blood pressure was recorded on admission. …

Benzodiazepine Use Among Adults Residing In The Urban Settlements Of Karachi, Pakistan: A Cross Sectional Study., Saleem P. Iqbal, Syed Ahmer, Salima Farooq, Yasmin Parpio, Ambreen Tharani, Rashid A. M Khan, Mohammad Zaman

Department of Paediatrics and Child Health

Background: There are hardly any studies carried out in Pakistan on the usage of benzodiazepines at the level of community. This research was aimed to determine the frequency of benzodiazepine use, along with its associations with socio-demographic and clinical characteristics among community dwelling adults, residing in two urban settlements of Karachi, Pakistan. Methods: We performed a cross sectional study from August 2008 to December 2009, in 2 areas of Karachi, namely Garden and Sultanabad. We followed the systematic sampling strategy to randomly select the households, with an adult of either sex and of age 18 years or more. Data collection …

What Is The Role Of B-Vitamins In Stroke Prevention In Pakistan, Maria Khan, Emmon Raza, Ayeesha Kamran Kamal

Section of Neurology

No abstract provided.

Application Of Geographical Information System (Gis) For Mapping Road Traffic Injuries Using Existing Source Of Data In Karachi, Pakistan--A Pilot Study, Junsid Razzak, Uzma R. Khan, Sabeena Jalal

Department of Emergency Medicine

OBJECTIVE: To assess the feasibility of using Geographical Information System for mapping of road traffic injuries with an existing data source in a developing country.

METHODS: The study was a retrospectives case series of road traffic injury cases registered with the medico-legal office located in the three major trauma centers in Karachi for the period of January 1, 2004 till December 31st, 2004. Spatial data analysis was performed using ARCVIEW 3.1.

RESULTS: Out of 3650 of all road traffic injury, only 3% had locations detailed and accurate enough allowing mapping on a GIS map in the first attempt. Even after …

Treatment Outcome Of Multi-Drug Resistant Tuberculosis Treated As Outpatient In A Tertiary Care Center, Zeeshan Waheed, Muhammad Irfan, Ahmed Suleman Haque, Muhammad Owais Khan, Atif Zubairi, Noor Ul Ain, Javaid A. Khan

Section of Pulmonary & Critical Care

INTRODUCTION: Community-based out-patient treatment for multidrug-resistant tuberculosis (MDR TB) is relatively new concept with reported successful outcomes.

OBJECTIVE: To assess the treatment outcomes of HIV negative multidrug-resistant tuberculosis (MDR TB) patients treated as outpatient at a tertiary care center in Karachi, Pakistan.

METHODS: A retrospective observational study of 53 consecutive, culture proven HIV negative MDR TB patients (resistant at least to both Isoniazid (H) and Rifampin(R) treated at Aga Khan University Hospital, Karachi between August 1999 and March 2007. Data were collected on predesigned performa regarding patient’s demography, clinical features, radiological findings, drug sensitivity, treatment and outcome.

RESULTS: A total …

Comparison Of Chromogenic Urinary Tract Infection Medium With Cysteine Lactose Electrolyte Deficient Media In A Resource Limited Setting, Saba Qaiser, Muhammad Zeeshan, Kausar Jabeen, Tanwir Ahsan, Afia Zafar

Department of Pathology and Laboratory Medicine

OBJECTIVES: To compare the chromogenic UTI medium (CUM) with cysteine lactose electrolyte deficient medium (CLED) in terms of isolation of uropathogens, turnaround time and cost.

METHODS: A total of 251 urine samples were selected and inoculated on both CLED and CUM, growth was observed after 24 and 48 hours of incubation. Isolates were identified by colony's colour and biochemical tests. Turnaround time for identification and cost was calculated till final identification of microorganisms.

RESULTS: A discrepancy in isolation was observed in seven samples with growth on CUM in 24 hours while in 48 hours on CLED. There was 100% agreement …

Prevalence Of Physical Inactivity And Barriers To Physical Activity Among Obese Attendants At A Community Health-Care Center In Karachi, Pakistan., Nafisa Samir, Sadia Mahmud, Ali Khan Khuwaja

Department of Family Medicine

Background: Overweight and obesity are significant public health problems worldwide with serious health consequences. With increasing urbanization and modernization there has been an increase in prevalence of obesity that is attributed to reduced levels of physical activity (PA). However, little is known about the prevalence of physical inactivity and factors that prohibit physical activity among Pakistani population. This cross-sectional study is aimed at estimating the prevalence of physical inactivity, and determining associated barriers in obese attendants accompanying Patients coming to a Community Health Center in Karachi, Pakistan.
Findings: PA was assessed by using international physical activity questionnaire (IPAQ). Barriers to …

Evaluation Of Prevalence Of Low And High Level Mupirocin Resistance In Methicillin Resistant Staphylococcus Aureus Isolates At A Tertiary Care Hospital, Summiya Nizamuddin, Seema Irfan, Afia Zafar

Department of Pathology and Laboratory Medicine

OBJECTIVE: To evaluate the trend of mupirocin resistance in MRSA, isolated at the Clinical Microbiology Laboratory of a tertiary care hospital.

METHODS: A total of 200 MRSA strains recovered over a 2 year period from various body sites were tested using the 5 and 200 microg discs of mupirocin to detect its resistance.

RESULTS: High level and low level mupirocin resistance were detected in zero and 1% of MRSA strains, respectively. Resistance to other non beta lactam antibiotics was also high. No MRSA strains were found to be resistant to vancomycin and tegicycline.

CONCLUSION: Mupirocin resistance was found to be …

Ngos And Government Partnership For Health Systems Strengthening: A Qualitative Study Presenting Viewpoints Of Government, Ngos And Donors In Pakistan, Iram Ejaz, Babar T. Shaikh, Narjis Rizvi

Community Health Sciences

Background: Health systems are expected to serve the population needs in an effective, efficient and equitable manner. Therefore, the importance of strengthening of public, private and community health systems has been emphasized time and again. In most of the developing countries, certain weaknesses and gaps in the government health systems have been hampering the achievement of improved health outcomes. Public sector in Pakistan has been deficient in the capacity to deliver equitable and quality health services and thus has been grossly underutilized.Methods: A qualitative study comprising in-depth interviews was conducted capturing the perceptions of the government functionaries, NGO representatives …

Underestimation Of Weight And Its Associated Factors Among Overweight And Obese Adults In Pakistan: A Cross Sectional Study, Seema Bhanji, Ali Khan Khuwaja, Fawad Siddiqui, Iqbal Azam Syed, K. Kazmi

Department of Family Medicine

Background: Weight loss is known to decrease the health risks associated with being overweight and obese. Awareness of overweight status is an important determinant of weight loss attempts and may have more of an impact on one's decision to lose weight than objective weight status. We therefore investigated the perception of weight among adults attending primary care clinics in Karachi, Pakistan, and compared it to their weight categories based on BMI (Body Mass Index), focusing on the underestimation of weight in overweight and obese individuals. We also explored the factors associated with underestimation of weight in these individuals.
Methods: This …

Knowledge And Practice Gaps Among Pediatric Nurses At A Tertiary Care Hospital Karachi Pakistan, Rozina Roshan Essani, Tazeen S. Ali

School of Nursing & Midwifery

The advancement in medical science has created health care environments that require nursing professionals who posses specialized clinical knowledge and skills to provide care and deal with critically and acutely ill children. This study explored gaps between knowledge and practice as perceived by the registered nurses of pediatric units by further recommending the changes suggested by them. A descriptive exploratory Study Design under the quantitative research methodology was utilized using universal sampling of all pediatric nurses working at a tertiary care hospital in Karachi, Pakistan. The gaps between knowledge and practice, as perceived by the participants, were categorized into five …

Evaluation Of Predominant Neisseria Gonorrhoeae Strain Types And Its Correlation With Fluoroquinolone Resistance In Pakistan, Summiya Nizamuddin, Kauser Jabeen, Afia Zafar

Department of Pathology and Laboratory Medicine

OBJECTIVE: To study the predominant Neisseria gonorrhoeae strain types in Pakistan and to evaluate their correlation with fluoroquinolone resistance.

METHOD: A total of 314 strains were collected from 2007-2009. Of these 112 strains were randomly selected for serotyping via the coagglutination technique. Fluoroquinolone susceptibility was checked through the E-test method. Chi square was performed to assess the correlation between the strain type and fluoroquinolone resistance pattern.

RESULTS: N. gonorrhoeae isolates were typed in two serogroups and 28 serovars. Serogroup WI comprised 40% (n = 45) whereas WII/WIII was 60% (n = 67). Most commonly isolated serovar belonged to serogroup WI …

Does Improving Maternal Knowledge Of Vaccines Impact Infant Immunization Rates? A Community-Based Randomized-Controlled Trial In Karachi, Pakistan, Aatekah Owais, Beenish Hanif, Amna R. Siddiqui, Ajmal Agha, Anita K. M. Zaidi

Department of Paediatrics and Child Health

Background: In Pakistan, only 59-73% of children 12-23 months of age are fully immunized. This randomized, controlled trial was conducted to assess the impact of a low-literacy immunization promotion educational intervention for mothers living in low-income communities of Karachi on infant immunization completion rates. Methods: Three hundred and sixty-six mother-infant pairs, with infants aged Results: Baseline characteristics among the two groups were similar. At 4 month assessment, among 179 mother-infant pairs in the intervention group, 129 (72.1%) had received all 3 doses of DPT/Hepatitis B vaccine, whereas in the control group 92/178 (51.7%) had received all 3 doses. Multivariable analysis …

Evaluation Of Compliance And Outcomes Of A Management Protocol For Massive Postpartum Hemorrhage At A Tertiary Care Hospital In Pakistan, Lumaan Sheikh, Nida Najmi, Umair Khalid, Taimur Saleem

Department of Obstetrics & Gynaecology

Background: Massive postpartum hemorrhage is a life threatening obstetric emergency. In order to prevent the complications associated with this condition, an organized and step-wise management protocol should be immediately initiated.

Methods: An evidence based management protocol for massive postpartum hemorrhage was implemented at Aga Khan University Hospital, Karachi, Pakistan after an audit in 2005. We sought to evaluate the compliance and outcomes associated with this management protocol 3 years after its implementation. A review of all deliveries with massive primary postpartum hemorrhage (blood loss >= 1500 ml) between January, 2008 to December, 2008 was carried out. Information regarding mortality, mode …

An Insight Into The Suspected Hba2' Cases Detected By High Performance Liquid Chromatography In Pakistan., Maliha Nusrat, Bushra Moiz, Amna Nasir, Mashhooda Rasool Hashmi

Department of Pathology and Laboratory Medicine

Background:Hemoglobin A2' (delta 16 Gly Arg) is globally the commonest delta chain variant of HbA2. It is clinically and hematologically silent but its sole importance lies in the underestimation of HbA2 quantity during the workup of beta-thalassaemia trait. High performance liquid chromatography (HPLC) identifies it as a small S-window peak with a mean retention time of 4.59 0.03 minutes. This study aims at describing the frequency of detection of HbA2' by HPLC in Pakistan and its confirmation at a molecular level. Potential HbA2' cases were identified by a retrospective review of 10186 HPLC chromatograms in year 2006. Prospective samples …