Medicine and Health Sciences Commons^™

Self-Glucose Monitoring And Glycaemic Control At A Tertiary Care University Hospital, Karachi, Pakistan, Khurshid Khowaja, Humaira Waheed

Section of Diabetes, Endocrinology and Metabolism

OBJECTIVE: To explore the association between Self Monitoring of Blood Glucose (SMBG) levels and improved glycemic control (HbA1c level) among type 2 diabetic patients, receiving oral hypoglycaemic agents and insulin, and to ascertain the factors influencing SMBG.

METHOD: Using Comparative cross sectional study design five hundred Type 2 diabetes patients through convenient sampling between 30-70 years were interviewed through a structured questionnaire in year 2006 and 2007 at AKUH Ambulatory setting. These 500 subjects were divided as 250 in case (doing SMBG) and 250 in control (not doing SMBG) groups.

RESULTS: We identified that HbA1c value was maintained at good …

Evaluation Of Health Workforce Competence In Maternal And Neonatal Issues In Public Health Sector Of Pakistan: An Assessment Of Their Training Needs, Shabina Ariff, Sajid B. Soofi, Kamran Sadiq, Asher B. Feroze, Shuaib Khan, Sadiqua N. Jafarey, Nabeela Ali, Zulfiqar A. Bhutta

Department of Paediatrics and Child Health

Background: More than 450 newborns die every hour worldwide, before they reach the age of four weeks (neonatal period) and over 500,000 women die from complications related to childbirth. The major direct causes of neonatal death are infections (36%), Prematurity (28%) and Asphyxia (23%). Pakistan has one of the highest perinatal and neonatal mortality rates in the region and contributes significantly to global neonatal mortality. The high mortality rates are partially attributable to scarcity of trained skilled birth attendants and paucity of resources. Empowerment of health care providers with adequate knowledge and skills can serve as instrument of change. Methods: …

Cardiac Surgery In Octogenarians, Asmatullah Khan, Hassan Khan, Saulat H. Fatimi, Asadullah Khan

Section of Cardiothoracic Surgery

In Europe and North America, cardiac surgery can be done successfully on octogenarians, but differences in patient selection, surgical and bypass techniques prevent us from concluding similarly in Pakistan. This study investigated the short and long-term outcomes of cardiac surgery in octogenarians operated over a 5 years period at The Aga Khan University Hospital, from January 2001 to December 2006. Seventeen octogenarians, (mean age 81.7 ± 2.3) underwent coronary artery bypass graft (CABG). Thirty-days hospital mortality was reported in only 1 patient. Surgical complication of any kind was reported in 13 (76.5%) patients with pleural effusion being the commonest in …

Investment In Paediatric Tuberculosis Prevention In Pakistan: Loss Or Gain, Emad Uddin Siddiqui, Kiran Ejaz, Saira Lone, Syed Jamal Raza

Department of Paediatrics and Child Health

OBJECTIVE: To assess the effectiveness of paediatric tuberculosis prevention, by reevaluation factors in children exposed to tuberculosis from less privileged strata of Pakistan.

METHODS: This cross sectional descriptive study was conducted at National Institute of Child Health, from January 2004 to December 2005. Paediatric patients under 15 years of either gender, diagnosed with active tuberculosis were enrolled. Interviews were conducted with parents regarding common preventive measures and factors advocating tuberculosis spread. Later factors leading to non-compliance to safety recommendations were also evaluated.

RESULTS: Fifty five (70%) children younger than 5 years, had index cases in direct contact within their own …

Acute Administration Of Rt-Pa For Acute Stroke In Pakistani Patients--What Does The Available Evidence Teach Us, Maria Khan, Ayeesha Kamran Kamal

Section of Neurology

No abstract provided.

Neonatal Mortality And Prevalence Of Practices For Newborn Care In A Squatter Settlement Of Karachi, Pakistan: A Cross-Sectional Study., Afsheen Ayaz, Sarah Saleem

Department of Pathology and Laboratory Medicine

Background: During the past two decades there has been a sustained decline in child and infant mortality, however neonatal mortality has remained relatively unchanged. Almost all neonatal deaths (99%) occur in developing countries, where the majority are delivered at homes. Evidence suggests that these deaths could be prevented by simple, inexpensive practices and interventions during the pregnancy, delivery and postnatal period. In Pakistan over the last decade extensive efforts have been made by the international donors and government to implement these practices. However, limited attempts have been made to explore if these efforts have made a difference at the grass …

Prevalence Of Mistreatment Or Belittlement Among Medical Students--A Cross Sectional Survey At A Private Medical School In Karachi, Pakistan., Sana Shoukat, Mariam Anis, Danesh K Kella, Fahad Qazi, Fatima Samad, Faizia Mir, Maryah Mansoor, Mohammad B Parvez, Bushra Osmani, Sukaina A Panju, Haider Naqvi

Department of Psychiatry

Background: Mistreatment or belittlement of medical students either by faculty or fellow students has often been reported. Perception of mistreatment has also been associated with increased degree of psychological morbidity. There is a lack of such studies being conducted amongst the medical students of Pakistan. The aim of this study was to determine the prevalence and forms of perceived mistreatment and presence of mental health morbidity in a private medical school in Pakistan. Also, any association between mental health morbidity and mistreatment was to be identified. Methods: A cross sectional study was carried out on medical students from Aga Khan …

Gender Difference In Age At Onset Of Schizophrenia: A Cross Sectional Study From Pakistan, Imama Naqvi, Muhammad Murtaza, Muhammad Ressam Nazir, Haider Ali Naqvi

Department of Psychiatry

OBJECTIVE: To validate the effect of gender on age at onset of schizophrenia in a developing country

METHODS: Medical records of 252 patients diagnosed with schizophrenia according to DSM-IV criteria at a tertiary care hospital in Karachi, Pakistan between 2002 and 2008 were reviewed using a structured questionnaire. Age at onset was defined as age at onset of psychotic symptoms, age at first contact with a health care provider and age at first hospitalization. Socio-demographic variables were reported using descriptive statistics and all measures of age at onset were compared across gender using t-test.

RESULTS: There were 119 women and …

Clonal Dissemination Of Vana Positive Enterococcus Species In Tertiary Care Hospitals In Karachi, Pakistan, Naima Fasih, Afia Zafar, Erum Khan, Kausar Jabeen, Rumina Hasan

Department of Pathology and Laboratory Medicine

OBJECTIVE: To perform molecular typing of vancomycin resistant Enterococcus spp. (VRE) strains endemic in various hospitals of Karachi, to characterize the mechanism of glycopeptide resistance and assess the genetic relatedness, for understanding its transmission locally.

METHOD: This was a cross sectional study conducted in the clinical and research laboratory of Aga Khan University Hospital (AKUH), Karachi, Pakistan from October 2007 to September 2008. Non-duplicate 86 (65 AKUH and 21 non-AKUH) VRE strains were included. Molecular typing of nosocomial isolates of VRE was carried out by using Pulsed field gel electrophoresis (PFGE) and identification of vanA and vanB genes were performed …

Demographic And Clinical Features Of Dengue Fever In Pakistan From 2003-2007: A Retrospective Cross-Sectional Study., Erum Khan, Mehreen Kisat, Nabil Khan, Amna Nasir, Salma Ayub, Rumina Hasan

Department of Pathology and Laboratory Medicine

Background: Demographic features of dengue fever have changed tremendously in Pakistan over the past two decades. Small scale studies from all over the country have reported different aspects of individual outbreaks during this time. However, there is scarcity of data looking at the overall trend of dengue virus infection in the country. In this study, we examined annual trends, seasonality, and clinical features of dengue fever in the Pakistani population.
Methods: Demographic information and dengue IgM status of all patients tested for dengue IgM antibody at Aga Khan University Hospital from January 2003 to December 2007 were analyzed to look …

Imminent Epidemic Of Diabetes Mellitus In Pakistan: Issues And Challenges For Health Care Providers, Waris Qidwai, Tabinda Ashfaq

Department of Family Medicine

No abstract provided.

Medical Ethics: A Slow But Sustained Revolution In Pakistan’S Healthcare, Muhammad Shahid Shamim, Muhammad Shahzad Shamim

Section of Neurosurgery

No abstract provided.

Predictors Of Obesity Among Post Graduate Trainee Doctors Working In A Tertiary Care Hospital Of Public Sector In Karachi, Pakistan, Sajid Mahmood, Muhammad Kazim Rahim Najjad, Nasir Ali, Naeem Yousuf, Yasir Hamid

Community Health Sciences

Objectives: To identify the predictors of obesity among post graduate trainee doctors working in a tertiary care hospital of public sector at Karachi, Pakistan.
Methods: A cross sectional analytical study was conducted at one of the tertiary care hospitals of public sector in Karachi. Information was collected from 117 post graduate trainee doctors via pre-tested self administered questionnaire and standard tools were used for height and weight measurement. Obesity was defined as body mass index (BMI) > or =23 by using South Asian cut-off points. SPSS version 16 was used for data analysis, and logistic regression technique was applied to come …

Inducible Clindamycin Resistance Due To Expression Of Erm Genes In Staphylococcus Aureus: Report From A Tertiary Care Hospital Karachi, Pakistan, Naima Fasih, Seema Irfan, Afia Zafar, Erum Khan, Rumina Hasan

Department of Pathology and Laboratory Medicine

OBJECTIVE: To assess the frequency of phenotypic expression of inducible resistance of clindamycin due to expression of erm genes, in clinical isolates of Staphylococcus aureus (S. aureus), by double disk diffusion test (D-test).

METHOD: This was a cross sectional study conducted in the clinical laboratory of Aga Khan University Hospital, Karachi. A total of 2432, non duplicate clinical isolates of S. aureus, consisting of 1562 methicillin sensitive S. aureus (MSSA) and 870 methicillin resistant S. aureus (MRSA), were selected from February 2007 to January 2008. One hundred and thirty eight isolates of S. aureus were selected based on discordant resistance …

The Challenge Of Head & Neck Squamous Cell Carcinoma Control In Pakistan, Syed Mohammad Asad Zaidi, Nauman Fazal Manzoor, Shabbir Akhtar

Section of Otolaryngology, Head & Neck Surgery

No abstract provided.

Childhood Injuries In Pakistan: Results From Two Communities, Seema Zainulabdin Lasi, Ghazala Rafique, Habib Peermohammad

Human Development Programme

The study aimed at determining the incidence, nature, and extent of childhood injuries in two suburban and rural communities of Pakistan. The findings of the study are based on a cross-sectional survey of 2,292 children aged 1-8 years. Information was sought retrospectively from the primary caregiver on the occurrence of injury that required formal or informal medical consultation during the past three months. The incidence rate of non-fatal injuries that required care outside home for children aged 1-8 years was 19.7 injuries per 100 person (child)-years of exposure [95% confidence interval (CI) 16.41-23.51]: 26.5 injuries per 100 person (child)-years of …

Treatment Of Intracranial Aneurysms Using Detachable Coils; Initial Results At A University Hospital In Pakistan, Rana Shoaib Hamid, Tanveer-Ul-Haq, Ishtiaq Chishti, Muhammad Azeemuddin, Zafar Sajjad, Basit Salam

Department of Radiology

OBJECTIVE: To evaluate the technical success, safety and outcome of endovascular coiling procedure in intracranial aneurysms.

METHODS: From April 2003 to April 2009, 43 patients (23 males and 20 females), age range 11 to 70 years, mean age 46.67 +/- 11.57 years were treated for intracranial aneurysms by detachable coil deployment at Radiology Department of Aga Khan University Hospital. Aneurysm rupture with subarachnoid haemorrhage was the cause of presentation in 39 patients while 4 patients were diagnosed with un-ruptured aneurysms. At time of presentation, grading of subarachnoid haemorrhage was done according to Hunt and Hess grading system. Eleven patients presented …

Trends In Undergraduate Teaching Of Parasitology In Medical Schools Of Pakistan, Vikram Mehraj, Taimur Saleem, Saima Lalani, Nadia Sani, Imran Khan, Fatima Afridi, Hina Irfan, Mohammad Asim Beg

Department of Pathology and Laboratory Medicine

OBJECTIVE: Parasitic diseases are a major public health problem in the tropical and sub tropical countries including the subcontinent region. We aimed to assess methods of Parasitology education in medical schools of Karachi Pakistan.

METHODS: Ten medical schools in Karachi, Pakistan were sent a structured questionnaire collecting information on different aspects of Parasitology education. The collected data was analyzed using SPSS version 14.0.

RESULTS: The response rate of this study was 90%. Majority of the schools in Karachi, Pakistan (78%) taught Parasitology concurrently with Microbiology, Pathology, Pharmacology and Forensic medicine in third and fourth year of undergraduate training. More than …

Effectiveness Of Counseling For Anxiety And Depression In Mothers Of Children Ages 0-30 Months By Community Workers In Karachi, Pakistan: A Quasi Experimental Study, Niloufer Sultan Ali, Badar S. Ali, Iqbal Azam Syed, Ali Khan Khuwaja

Department of Family Medicine

Background: The prevalence of anxiety/depression is quite high during the perinatal period but unfortunately its detection and treatment have been less than satisfactory. Moreover, many women are reluctant to take pharmacotherapy for fear of excretion of drugs into their breast milk. This study assesses the effectiveness of counseling from minimally trained community health workers in reducing anxiety/depression, the rate of recurrence and the interval preceding recurrence in women during first two and a half years after childbirth.
Methods: In a quasi-experimental study, community women from two under-privileged communities were trained in data gathering, teaching healthy child-rearing practices, basic counseling skills, …

Effects Of A Perindopril-Based Blood-Pressure-Lowering Regimen In Patients With Previous Stroke Or Transient Ischaemic Attack (Progress). How Do The Results Affect Practice In Pakistan, Maria Khan, Ayeesha Kamran Kamal

Section of Neurology

No abstract provided.

Situational Analysis Of Household Energy And Biomass Use And Associated Health Burden Of Indoor Air Pollution And Mitigation Efforts In Pakistan, Zafar Fatmi, Asma Rahman, Ambreen Kazi, Muhammad Masood Kadir, Nalini Sathiakumar

Community Health Sciences

Biomass fuel burning leads to high levels of suspended particulate matter and hazardous chemicals in the indoor environment in countries where it is in common use, contributing significantly to indoor air pollution (IAP). A situational analysis of household energy and biomass use and associated health effects of IAP was conducted by reviewing published and un-published literature about the situation in Pakistan. In addition to attempt to quantify the burden of ill health due to IAP, this paper also appraises the mitigation measures undertaken to avert the problem in Pakistan. Unfortunately, IAP is still not a recognized environmental hazard in Pakistan …

Knowledge And Awareness About Cervical Cancer And Its Prevention Amongst Interns And Nursing Staff In Tertiary Care Hospitals In Karachi, Pakistan., Syed Faizan Ali, Samia Ayub, Nauman Fazal Manzoor, Sidra Azim, Muneeza Afif, Nida Akhtar, Wassi Ali Jafery, Imran Tahir, Syed Farid-Ul-Hasnian, Najam Uddin

Community Health Sciences

Background and Objective: Cervical cancer is one of the leading causes of morbidity and mortality amongst the gynecological cancers worldwide, especially in developing countries. It is imperative for at least health professionals in developing countries like Pakistan to have a sound knowledge about the disease. This study was carried out to assess the knowledge and awareness about cervical cancer and its prevention amongst health professionals in tertiary care hospitals in Karachi, Pakistan.
Methods and Design: A cross-sectional, interview based survey was conducted in June, 2009. Sample of 400 was divided between the three tertiary care centers. Convenience sampling was applied …

High Dose Atorvastatin After Stroke Or Transient Ischaemic Attack (Sparcl)--Does Every Stroke Patient In Pakistan Deserve A Statin, Maria Khan, Ayeesha Kamran Kamal

Section of Neurology

No abstract provided.

Contracting Of Primary Health Care Services In Pakistan: Is Up-Scaling A Pragmatic Thinking, Babar Shaikh, F. Rabbani, Najibullah Safi, Zia Dawar

Community Health Sciences

Quite often, public health care systems in developing countries are struggling because of incompetence and a lack of provider responsiveness to the needs of consumers. On the contrary, the private sector dominates the system of health provision. In recent years, contracting has been experimented as an approach to ensure delivery of comprehensive public health services in an efficient, effective, superior and fair manner and has generally thrived well. The state's healthcare system in Pakistan has suffered a lot, owing to structural fragmentation, resource scarcity, inefficiency and lack of functional specificity, gender insensitivity and inaccessibility. However, partnering with the private sector …

A Multicentre Matched Case Control Study Of Risk Factors For Preeclampsia In Healthy Women In Pakistan., Uzma Shamsi, Juanita Hatcher, Azra Shamsi, Nadeem Zuberi, Zeeshan Qadri, Sarah Saleem

Community Health Sciences

Background: Preeclampsia is one of the leading causes of maternal and perinatal morbidity and mortality world-wide. The risk for developing preeclampsia varies depending on the underlying mechanism. Because the disorder is heterogeneous, the pathogenesis can differ in women with various risk factors. Understanding these mechanisms of disease responsible for preeclampsia as well as risk assessment is still a major challenge. The aim of this study was to determine the risk factors associated with preeclampsia, in healthy women in maternity hospitals of Karachi and Rawalpindi. Methods: We conducted a hospital based matched case-control study to assess the factors associated with preeclampsia …

Increase In Isolation Of Extended Spectrum Beta Lactamase Producing Multidrug Resistant Non Typhoidal Salmonellae In Pakistan., Kauser Jabeen, Afia Zafar, Seema Irfan, Erum Khan, Vikram Mehraj, Rumina Hasan

Department of Pathology and Laboratory Medicine

Background:Increasing resistance to quinolones and ceftriaxone in non typhoidal Salmonellae is a global concern. Resistance to quinolone and 3rd generation cephalosporin amongst non typhoidal Salmonellae (NTS) from Pakistan has been reported in this study.

Methods:

Retrospective analysis of laboratory data was conducted (1990-2006). NTS were isolated and identified from clinical samples using standard microbiological techniques. Antimicrobial susceptibility testing was performed by Kirby Bauer. Extended spectrum beta lactamase production (ESBL) was detected using combined disc method. Ciprofloxacin sensitivity was detected by nalidixic acid screening method. Minimum inhibitory concentration (MIC) of ciprofloxacin was determined by agar dilution method. Statistical analysis was …

Parotidectomy: A Review Of 112 Patients Treated At A Teaching Hospital In Pakistan, Naeem Sultan Ali, Ahmad Nawaz, Shaheryar Rajput, Mubasher Ikram

Section of Otolaryngology, Head & Neck Surgery

Objective:The Purpose of this study was to analyze the clinical presentation, histopathology and complications following parotid surgery.

Methods:

We retrospectively reviewed the charts of 112 Patients who underwent parotidectomy from January 2000 to February 2010. Data including age, sex, clinical signs and symptoms, histology and complication were collected from medical records.

Results:

Of the total, 82 (74%) had benign lesions, 30 (36%) had malignant tumors. The most common benign tumor was pleomorphic adenoma (57%), and the most common malignant tumor was mucoepidermoid carcinoma (16%). Analysis of the correlation between fine-needle aspiration cytology and final histology revealed that fine-needle aspiration …

The International Surgical Trial In Intracerebral Haemorrhage (Stich)--What Are Its Implications In A Resource Limited Health System Like Pakistan, Maria Khan, Ayeesha Kamran Kamal

Section of Neurology

No abstract provided.

Comparing Modelled Predictions Of Neonatal Mortality Impacts Using List With Observed Results Of Community-Based Intervention Trials In South Asia, Ingrid K. Friberg, Zulfiqar Ahmed Bhutta, Gary L. Darmstadt, Abhay Bang, Simon Cousens, Abdullah H. Baqui, Vishwajeet Kumar, Neff Walker, Joy E. Lawn

Woman and Child Health

Background:There is an increasing body of evidence from trials suggesting that major reductions in neonatal mortality are possible through community-based interventions. Since these trials involve packages of varying content, determining how much of the observed mortality reduction is due to specific interventions is problematic. The Lives Saved Tool (LiST) is designed to facilitate programmatic prioritization by modelling mortality reductions related to increasing coverage of specific interventions which may be combined into packages.
Methods: To assess the validity of LiST outputs, we compared predictions generated by LiST with observed neonatal mortality reductions in trials of packages which met inclusion criteria …

Growing Burden Of Neurological Diseases In Pakistan � Need For A National Health Survey, Mohammad Wasay, Shaukat Ali

Department of Medicine

No abstract provided.