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Aga Khan University

2021

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Articles 271 - 300 of 796

Full-Text Articles in Medicine and Health Sciences

Biomarkers For Impending Risk Of Osteoporosis In Premenopausal Women, Rehana Rehman, Ali Usman, Aisha Sheikh, Rozeena Baig Aug 2021

Biomarkers For Impending Risk Of Osteoporosis In Premenopausal Women, Rehana Rehman, Ali Usman, Aisha Sheikh, Rozeena Baig

Department of Biological & Biomedical Sciences

Objective: To compare 'cytokines' and 'bone turnover markers' in pre- and post-menopausal women and identify their relationship with bone mineral density (BMD) in both groups. Study Design: A cross-sectional study.
Place and duration of study: Department of Biological & Biomedical Sciences, The Aga Khan University, Karachi, Pakistan, from June 2017 to August 2019.
Methodology: Groups comprised of healthy premenopausal and postmenopausal women from the general population belonging to different ethnic groups and socio-economic status. Serum cytokines and bone turnover markers were assessed by solid-phase immunoassays, BMD (gm /cm2)] measurement was performed by dual-energy X-ray absorptiometry at the hip, lumbar spine, …


Anaesthetic Management Of Tracheal Injury Following Blunt Neck Trauma: An Unusual Late Presentation, Muhammad Saad Yousuf, Mohammad Bin Pervez, Saulat Fatimi, Khalid Samad Aug 2021

Anaesthetic Management Of Tracheal Injury Following Blunt Neck Trauma: An Unusual Late Presentation, Muhammad Saad Yousuf, Mohammad Bin Pervez, Saulat Fatimi, Khalid Samad

Department of Anaesthesia

Tracheal injuries, following blunt neck trauma, are life-threatening surgical emergencies with high risk of mortality. A high index of suspicion is necessary to avoid missing an occult injury because delays in diagnosis and definitive treatment are associated with poorer outcomes. We, herein, report a case of a 28-year man who presented in Emergency Department 15 days after blunt neck trauma from an accident involving electric cable. Anaesthetic challenges, airway management and importance of effective close loop communication, during repair of complex tracheal reconstruction, will be discussed in this case report.


Seizure Control After Surgical Resection Of Insular Glioma, Fatima Gauhar, Saqib Kamran Bakhshi, Muhammad Shahzad Shamim Aug 2021

Seizure Control After Surgical Resection Of Insular Glioma, Fatima Gauhar, Saqib Kamran Bakhshi, Muhammad Shahzad Shamim

Medical College Documents

Insular gliomas most commonly present with drug-resistant seizures, irrespective of the tumour grade. Even though surgery is the mainstay of treatment, complex anatomical location and close proximity to eloquent cortex makes surgical resection difficult. Herein the authors have reviewed the literature with regards to seizure control after surgical management of these tumours. The review does not address quality of life, or survival benefits of surgery. In summary, excision of these gliomas significantly improves seizure control, and extent of resection along-with trans-cortical approach are important predictors of seizure outcome.


Probabilistic Measures Of Hiv-1 Transmission In Different Hiv-1 Key Population Groups Of Larkana, Pakistan, Syed Rizwan-Ul-Hasa, Abiha Abdullah, Shakil Arshad Siddiqui, Shakil Ahmed, Sharaf Ali Shah, Fatima Mir, Syed Hani Abidi Aug 2021

Probabilistic Measures Of Hiv-1 Transmission In Different Hiv-1 Key Population Groups Of Larkana, Pakistan, Syed Rizwan-Ul-Hasa, Abiha Abdullah, Shakil Arshad Siddiqui, Shakil Ahmed, Sharaf Ali Shah, Fatima Mir, Syed Hani Abidi

Medical College Documents

Objective: To estimate the probability of human immunodeficiency virus (HIV)-1 transmission from different key HIV population groups using probabilistic modelling.
Methods: This study was conducted in December 2020. A probabilistic model was used to estimate the probability of HIV-1 transmission from different key HIV population groups in Larkana. Our model was run on three probabilistic assumptions: 1) each replication gave two conceivable results: 'true' or 'false'; 2) the chance of giving a 'true' result is the same for each replication; and 3) the replications are independent - 'true' in one will not impact the likelihood of 'true' in another.
Results: …


Point-Of-Care Testing And Treatment Of Sexually Transmitted And Genital Infections During Pregnancy In Papua New Guinea (Wantaim Trial): Protocol For An Economic Evaluation Alongside A Cluster-Randomised Trial, Neha Batura, Olga Pm Saweri, William Pomat, Caroline Homer, Rebecca Guy, Stanley Luchters, Glen Mola, Lisa M. Vallely, Christopher Morgan, Grace Kariwiga Aug 2021

Point-Of-Care Testing And Treatment Of Sexually Transmitted And Genital Infections During Pregnancy In Papua New Guinea (Wantaim Trial): Protocol For An Economic Evaluation Alongside A Cluster-Randomised Trial, Neha Batura, Olga Pm Saweri, William Pomat, Caroline Homer, Rebecca Guy, Stanley Luchters, Glen Mola, Lisa M. Vallely, Christopher Morgan, Grace Kariwiga

Population Health, East Africa

Introduction: Left untreated, sexually transmitted and genital infections (henceforth STIs) in pregnancy can lead to serious adverse outcomes for mother and child. Papua New Guinea (PNG) has among the highest prevalence of curable STIs including syphilis, chlamydia, gonorrhoea, trichomoniasis and bacterial vaginosis, and high neonatal mortality rates. Diagnosis and treatment of these STIs in PNG rely on syndromic management. Advances in STI diagnostics through point-of-care (PoC) testing using GeneXpert technology hold promise for resource-constrained countries such as PNG. This paper describes the planned economic evaluation of a cluster-randomised cross-over trial comparing antenatal PoC testing and immediate treatment of curable STIs …


Operational Experiences Associated With The Implementation Of Near Point-Of-Care Early Infant Diagnosis Of Hiv In Myanmar: A Qualitative Study, Win Lei Yee, Hla Htay, Yasmin Mohamed, Claire E. Nightingale, Htay Htay Tin, Win Thein, Latt Latt Kyaw, Win Win Yee, Moe Myat Aye, Stanley Luchters Aug 2021

Operational Experiences Associated With The Implementation Of Near Point-Of-Care Early Infant Diagnosis Of Hiv In Myanmar: A Qualitative Study, Win Lei Yee, Hla Htay, Yasmin Mohamed, Claire E. Nightingale, Htay Htay Tin, Win Thein, Latt Latt Kyaw, Win Win Yee, Moe Myat Aye, Stanley Luchters

Population Health, East Africa

Background: Timely diagnosis and early initiation of life-saving antiretroviral therapy are critical factors in preventing mortality among HIV-infected infants. However, resource-limited settings experience numerous challenges associated with centralised laboratory-based testing, including low rates of testing, complex sample referral pathways and unacceptably long turnaround times for results. Point-of-care (POC) HIV testing for HIVexposed infants can enable same-day communication of results and early treatment initiation for HIV-infected infants. However, complex operational issues and service integration can limit utility and must be well understood prior to implementation. We explored and documented the challenges and enabling factors in implementing the POC Xpert® HIV-1 …


Community-Driven Data Revolution Is Feasible In Developing Countries: Experiences From An Integrated Health Information And Surveillance System In Kenya, Anthony Ngugi, Gijs Walraven, James Orwa, Adelaide Lusambili, Maureen Kimani, Stanley Luchters Aug 2021

Community-Driven Data Revolution Is Feasible In Developing Countries: Experiences From An Integrated Health Information And Surveillance System In Kenya, Anthony Ngugi, Gijs Walraven, James Orwa, Adelaide Lusambili, Maureen Kimani, Stanley Luchters

Population Health, East Africa

Over the period of the Millennium Development Goals (2000-15), it became clear that there was a pressing need and an increasing capacity for a ‘data revolution’ to inform the global health development agenda. In most developing countries, data on key indicators were collected through laborious and retrospective surveys that were as much as five years out-of-date, or through passive reporting systems that relied on routinely generated health facility data. Gaps in the primary data were filled by modelled estimates, which often relied on inadequate assumptions.


Red Blood Cell Transfusion In Critically-Ill Children And Its Association With Outcome, Hafsa Sohail, Shah Ali Ahmed, Parveen Usman, Farah Khalid, Anwar Ul Haque, Qalab Abbas Aug 2021

Red Blood Cell Transfusion In Critically-Ill Children And Its Association With Outcome, Hafsa Sohail, Shah Ali Ahmed, Parveen Usman, Farah Khalid, Anwar Ul Haque, Qalab Abbas

Department of Emergency Medicine

Objective: To determine the indications and threshold of haemoglobin levels for packed red blood cell transfusion and its association with outcomes in a paediatric intensive care setting.
Methods: The retrospective study was conducted in the paediatric intensive care unit of the Aga Khan University Hospital, Karachi, and comprised medical records of all inpatients with age between 1 month and 16 years who received packed red blood cell transfusions between January and December 2017. Data was retrieved from the hospital database and was analyzed using SPSS 22.
Results: Of the 147 subjects with a mean age of 67.89±65.8 months, 76(51.7%) were …


Variances In Bcg Protection Against Covid-19 Mortality: A Global Assessment, Zouina Sarfraz, Azza Sarfraz, Krunal Pandav, Sarabjot Singh Makkar, Saman Hasan Siddiqui, Gaurav Patel, Tania Platero-Portillo, Bishnu Mohan Singh, Mohamed Iburahim Haja Maideen, Deepika Sarvepalli, Muzna Sarfraz Aug 2021

Variances In Bcg Protection Against Covid-19 Mortality: A Global Assessment, Zouina Sarfraz, Azza Sarfraz, Krunal Pandav, Sarabjot Singh Makkar, Saman Hasan Siddiqui, Gaurav Patel, Tania Platero-Portillo, Bishnu Mohan Singh, Mohamed Iburahim Haja Maideen, Deepika Sarvepalli, Muzna Sarfraz

Department of Paediatrics and Child Health

The BCG vaccine is known to impart nonspecific immunological benefits alongside conferring protection to tuberculosis in endemic regions. It is also known to protect against bladder cancer and other respiratory tract infections. During the coronavirus disease 2019 (COVID-19) pandemic, the BCG vaccine has gained attention due to its role in conferring protective immunity. We demonstrate the potential immunological protective mechanisms that play a role against COVID-19. We conduct a global assessment of the countries that have the highest and lowest mortality rates determined by an a priori methodology. Lastly, we discuss the potential limitations of incorporating BCG vaccines as potential …


Effectiveness Of Typhoid Conjugate Vaccine Against Culture-Confirmed Salmonella Enterica Serotype Typhi In An Extensively Drug-Resistant Outbreak Setting Of Hyderabad, Pakistan: A Cohort Study, Mohammad Tahir Yousafzai, Sultan Karim, Sonia Qureshi, Abdul Momin Kazi, Hina Memon, Amber Junejo, Zohra Khawaja, Najeeb Ur Rehman, Muhammad Sajid Ansari, Rafey Ali, Heera Mani Lohana, Farah Naz Qamar Aug 2021

Effectiveness Of Typhoid Conjugate Vaccine Against Culture-Confirmed Salmonella Enterica Serotype Typhi In An Extensively Drug-Resistant Outbreak Setting Of Hyderabad, Pakistan: A Cohort Study, Mohammad Tahir Yousafzai, Sultan Karim, Sonia Qureshi, Abdul Momin Kazi, Hina Memon, Amber Junejo, Zohra Khawaja, Najeeb Ur Rehman, Muhammad Sajid Ansari, Rafey Ali, Heera Mani Lohana, Farah Naz Qamar

Department of Paediatrics and Child Health

Background: Salmonella enterica serotype Typhi (S Typhi) is a major public health problem in low-income and middle-income countries. We aimed to investigate the effectiveness and impact of the typhoid conjugate vaccine Typbar-TCV against S Typhi among children in an outbreak setting of extensively drug-resistant (XDR) S Typhi in Pakistan.
Methods: This cohort study was done from Feb 21, 2018, to Dec 31, 2019. A census survey of all households located in the Qasimabad and Latifabad subdistricts of Hyderabad, Pakistan, was done at baseline, and 174 005 households were registered in the census. The Typbar-TCV immunisation campaign was initiated at temporary …


Application Of The Ultra-Poverty Graduation Model In Understanding Community Health Volunteers’ Preferences For Socio-Economic Empowerment Strategies To Enhance Retention: A Qualitative Study In Kilifi, Kenya, Njeri Nyanja, Nelson Nyamu, Lucy Nyaga, Sophie Chabeda, Adelaide Lusambili, Marleen Temmerman, Michaela Mantel, Anthony Ngugi Aug 2021

Application Of The Ultra-Poverty Graduation Model In Understanding Community Health Volunteers’ Preferences For Socio-Economic Empowerment Strategies To Enhance Retention: A Qualitative Study In Kilifi, Kenya, Njeri Nyanja, Nelson Nyamu, Lucy Nyaga, Sophie Chabeda, Adelaide Lusambili, Marleen Temmerman, Michaela Mantel, Anthony Ngugi

Family Medicine, East Africa

Background: A significant shortage of healthcare workforce exists globally. To achieve Universal Healthcare cover- age, governments need to enhance their community-based health programmes. Community health volunteers (CHVs) are essential personnel in achieving this objective. However, their ability to earn a livelihood is compromised by the voluntary nature of their work; hence, the high attrition rates from community-based health programmes. There is an urgent need to support CHVs become economically self-reliant. We report here on the application of the Ultra-Poverty Graduation (UPG) Model to map CHVs’ preferences for socio-economic empowerment strategies that could enhance their retention in a rural area …


Barriers To Timely Disclosure Of Hiv Serostatus: A Qualitative Study At Care And Treatment Centers In Dar Es Salaam, Tanzania, Neelam Ismail, Nancy Matillya, Riaz Ratansi, Columba Mbekenga Aug 2021

Barriers To Timely Disclosure Of Hiv Serostatus: A Qualitative Study At Care And Treatment Centers In Dar Es Salaam, Tanzania, Neelam Ismail, Nancy Matillya, Riaz Ratansi, Columba Mbekenga

Family Medicine, East Africa

Introduction: Disclosure of Human Immunodeficiency Virus (HIV) status is important to prevent the spread of HIV and maintain the health of people living with HIV, their spouses, and the community. Despite the benefits of disclosure, many people living with HIV delay disclosing their status to those close to them thereby increasing the risk for disease transmission. This study aimed to determine the barriers to timely disclosure of HIV serostatus for people living with HIV in Dar es Salaam, Tanzania, and identify what motivated disclosure.

Methods: A qualitative descriptive study using in-depth individual interviews was conducted with10 participants attending …


“Old People Problems”, Uncertainty And Legitimacy: Challenges With Diagnosing Parkinson's Disease In Kenya, Natasha Fothergill-Misbah, Richard Walker, Judith Kwasa, Juzar Hooker, Kate Hampshire Aug 2021

“Old People Problems”, Uncertainty And Legitimacy: Challenges With Diagnosing Parkinson's Disease In Kenya, Natasha Fothergill-Misbah, Richard Walker, Judith Kwasa, Juzar Hooker, Kate Hampshire

Internal Medicine, East Africa

Very little is known about the experience of people living with Parkinson's disease (PD) in low- and middle-income countries, such as those in sub-Saharan Africa. The number of specialists in the region is low and awareness is limited among the population and healthcare professionals. Drawing on ten months of ethnographic fieldwork in urban and rural Kenya with 55 people living with PD (PwP), 23 family members and 22 healthcare professionals from public and private clinics, we set out to understand the experience of diagnosis among PwP in Kenya. The diagnostic journeys of our study participants were typically long, convoluted and …


Differences In Socio-Demographic And Risk Factor Profile, Clinical Presentation, And Outcomes Between Patients With And Without Rhd Heart Failure In Sub-Saharan Africa: Results From The Thesus-Hf Registry, Clovis Nkoke, Albertino Damasceno, Christopher Edwards, Beth Davison, Gad Cotter, Mahmoud Sani, Lauren Gaeta, Okechukwu S. Ogah, Charles Mondo, Gerald Yonga Aug 2021

Differences In Socio-Demographic And Risk Factor Profile, Clinical Presentation, And Outcomes Between Patients With And Without Rhd Heart Failure In Sub-Saharan Africa: Results From The Thesus-Hf Registry, Clovis Nkoke, Albertino Damasceno, Christopher Edwards, Beth Davison, Gad Cotter, Mahmoud Sani, Lauren Gaeta, Okechukwu S. Ogah, Charles Mondo, Gerald Yonga

Internal Medicine, East Africa

Background: Rheumatic heart disease (RHD) was found in the THESUS-HF registry to be the third most common cause of acute heart failure (AHF) in Sub-Saharan Africa.

Methods: One thousand six patients with AHF from 9 Sub-Saharan African countries were recruited in THESUS-HF, of which 143 (14.3%) had RHD-AHF. Clinical characteristics and outcomes in patients with RHD-AHF and non-RHD-AHF were compared. Kaplan-Meier plots for time to all-cause death and/or HF readmission according to the presence of RHD-AHF and non-RHD-AHF were performed and survival distributions compared using the log-rank test. Cox regression was used to determine the hazard ratio of …


Comparison Of Perioperative Analgesia Between Intravenous Paracetamol And Fentanyl For Rigid Hysteroscopy: A Randomised Control Trial, Dileep Kumar, Kamal Kumar, Mohammad Hamid Aug 2021

Comparison Of Perioperative Analgesia Between Intravenous Paracetamol And Fentanyl For Rigid Hysteroscopy: A Randomised Control Trial, Dileep Kumar, Kamal Kumar, Mohammad Hamid

Department of Anaesthesia

Objective: To compare efficacy of intravenous paracetamol and fentanyl for intra-operative and post-operative analgesia in patients undergoing rigid hysteroscopy.
Method: The prospective randomised control trial was conducted at Aga Khan University Hospital, Karachi, from October 2016 to June 2017, and comprised patients aged 18-65 years with American Society of Anesthesiologists grade I or II undergoing hysteroscopy who were randomised into paracetamol group P and fentanyl group F. Anaesthesia induction technique was standardised and analgesia in group P was paracetamol 15mg/Kg administered 15-30 minutes pre-surgery, and in group F, it was fentanyl 2mcg/kg administered at induction of anaesthesia. Intra-operative pain was …


Synchronous Primary Diffuse Large B-Cell Lymphoma And Papillary Thyroid Carcinoma: A Case Report Highlighting "Lymphoma First Approach", Rahim Dhanani, Ambreen Abdullah Unar, Muhammad Hassan Danish, Hamdan Ahmed Pasha, Ummiya Tahir, Mubasher Ikram Aug 2021

Synchronous Primary Diffuse Large B-Cell Lymphoma And Papillary Thyroid Carcinoma: A Case Report Highlighting "Lymphoma First Approach", Rahim Dhanani, Ambreen Abdullah Unar, Muhammad Hassan Danish, Hamdan Ahmed Pasha, Ummiya Tahir, Mubasher Ikram

Section of Otolaryngology, Head & Neck Surgery

Papillary thyroid carcinoma (PTC) is the most common type of all thyroid carcinomas and accounts for up to 90% of all thyroid malignancies. It is the most indolent form of the disease and has an excellent prognosis. On the other hand, Primary thyroid lymphoma (PTL) is a rare entity accounting for only about 1% to 5% of all thyroid malignancies and only 2% of extranodal lymphomas. Synchronous PTC and PTL is a very rare condition and only a few cases have been reported in the literature up till now. We report one such case in a 52-year-old lady who was …


An Audit Of Gynae-Oncology Practices In Ovarian Cancer Treatment Based On Enhanced Recovery After Surgery (Eras) Protocol Amongst Two Gynae-Oncology Units, In Uk And In Pakistan, Uzma Chishti, Munazza Akhtar, Aliya Aziz, Amber Ahmed, Desmond Pj Barton Aug 2021

An Audit Of Gynae-Oncology Practices In Ovarian Cancer Treatment Based On Enhanced Recovery After Surgery (Eras) Protocol Amongst Two Gynae-Oncology Units, In Uk And In Pakistan, Uzma Chishti, Munazza Akhtar, Aliya Aziz, Amber Ahmed, Desmond Pj Barton

Department of Obstetrics & Gynaecology

Objective: To compare peri-operative practices and complications in ovarian cancer patients undergoing upfront surgery for primary disease under enhanced recovery after surgery protocol and traditional practices.
Methods: The retrospective cross-sectional study was done at the gynaecology departments of St Georges Hospital, United Kingdom, and the Aga Khan Hospital, Pakistan, and comprised data of an equal number of ovarian cancer patients from each centre who underwent ovarian cancer surgery from January 2015 to December 2016. The former centre practiced the enhanced recovery after surgery protocol, while the latter centre followed traditional practices. Data was analysed using SPSS 19.|
Results: Of the …


Smart Watch Detection Of Supraventricular Tachycardia (Svt): First Case From Tanzania, Nadeem Kassam, Omar Aziz, Eric Aghan, Samina Somji, Hanifa Mbithe, Mustaafa Bapumia, Robert Mvungi, Salim Surani Aug 2021

Smart Watch Detection Of Supraventricular Tachycardia (Svt): First Case From Tanzania, Nadeem Kassam, Omar Aziz, Eric Aghan, Samina Somji, Hanifa Mbithe, Mustaafa Bapumia, Robert Mvungi, Salim Surani

Internal Medicine, East Africa

Smartwatches like the Apple Watch have been on the rise worldwide and their use is gaining popularity in developing countries. Their ability to detect dysrhythmias is well documented. Present practice discourages the use of these devices as a diagnostic tool. Nevertheless, atypical findings from these devices should be clinically investigated. This case demonstrates an eventual diagnosis of supraventricular tachycardia (SVT) based on an Apple watch alert which was subsequently confirmed by electrophysiological evaluation.


Health-Related Quality Of Life Of Children With Gastroesophageal Reflux Disease After Nissen Fundoplication And Gastrostomy Tube Insertion, Felix Wafula Musibi Aug 2021

Health-Related Quality Of Life Of Children With Gastroesophageal Reflux Disease After Nissen Fundoplication And Gastrostomy Tube Insertion, Felix Wafula Musibi

Theses & Dissertations

Background: Gastroesophageal reflux disease (GERD) negatively impacts the health-related quality of life (HRQoL). Nissen fundoplication is done when medical treatment fails. Goal of therapy is to eliminate symptoms and improve quality of life.

Justification: HRQoL is a key indicator that we can use to evaluate the impact of our interventions so that we can make evidence-based decisions and advice our patients appropriately based on the outcomes of these interventions.

Objectives: The primary objective was to assess the HRQoL of children with GERD after Nissen fundoplication alone or Nissen fundoplication and gastrostomy tube insertion.

Methods: Design- Observational …


The Prevalence Of Albuminuria In Children With Chronic Kidney Disease In Two Tertiary Hospitals In Nairobi, Kenya, Mercy Wambui Githumbi Aug 2021

The Prevalence Of Albuminuria In Children With Chronic Kidney Disease In Two Tertiary Hospitals In Nairobi, Kenya, Mercy Wambui Githumbi

Theses & Dissertations

Background: Chronic kidney disease (CKD) is a major health problem globally. In Africa, the burden in children remains unclear and is often reported as low. In developing countries, it is mainly due to secondary causes and nephrotic syndrome, while in the developed countries it is mainly due to congenital anomalies of kidney and urinary tract (CAKUT). The Kidney Disease: Improving Global Outcomes (KDIGO) defines CKD and utilises glomerular filtration rate (GFR) and albuminuria as an additional factor. Albuminuria is significant in prognostication of individuals with CKD as it is a marker of kidney damage. It is correlated with outcomes including …


Prevalence And Social Determinants Of Alcohol Use Disorders In Patients Attending Primary Care Clinics In Nairobi Kenya, Verah Kabwayi Aug 2021

Prevalence And Social Determinants Of Alcohol Use Disorders In Patients Attending Primary Care Clinics In Nairobi Kenya, Verah Kabwayi

Theses & Dissertations

No abstract provided.


Detection Of Typhoid Carriers By Duodenal Fluid Culture In A Tertiary Care Hospital, Karachi: A Cross-Sectional Study, Sonia Qureshi, Mohammad Tahir Yousafzai, Shafquat Rozi, Shahida Qureshi, Aneeta Hotwani, Kamran Sadiq, Om Parkash, Abdul Momin Kazi, Furqan Kabir, Hadi Usmani, Farah Naz Qamar Aug 2021

Detection Of Typhoid Carriers By Duodenal Fluid Culture In A Tertiary Care Hospital, Karachi: A Cross-Sectional Study, Sonia Qureshi, Mohammad Tahir Yousafzai, Shafquat Rozi, Shahida Qureshi, Aneeta Hotwani, Kamran Sadiq, Om Parkash, Abdul Momin Kazi, Furqan Kabir, Hadi Usmani, Farah Naz Qamar

Department of Paediatrics and Child Health

We aimed to detect typhoid carriers by performing duodenal fluid culture in patients in a tertiary care hospital in Pakistan. A cross-sectional study was conducted during 2017 at the Aga Khan University Hospital, Karachi. Patients who underwent upper gastrointestinal endoscopy were included. Participants were interviewed, and duodenal fluid samples were taken for culture to detect Salmonella typhi (S. typhi) and paratyphi. A polymerase chain reaction on 100 randomly selected sub-samples was also conducted. A total of 477 participants were enrolled. The mean age was 42.4±15.5 years. History of typhoid fever was present in 73 (15.3%) participants. Out of the 477 …


Long-Term Clinical And Functional Outcomes Of Distally Based Sural Artery Flap: A Retrospective Case Series, Pervaiz Hashmi, Abeer Musaddiq, Muhammad Ali, Alizah Hashmi, Marij Zahid, Zohaib Nawaz Jul 2021

Long-Term Clinical And Functional Outcomes Of Distally Based Sural Artery Flap: A Retrospective Case Series, Pervaiz Hashmi, Abeer Musaddiq, Muhammad Ali, Alizah Hashmi, Marij Zahid, Zohaib Nawaz

Section of Orthopaedic Surgery

Background: Reconstruction of soft tissue defects around the lower leg, foot and ankle is a challenge for orthopedic surgeons. These defects commonly occur as a result of trauma, infection and tumor excision. Sural artery neurovascular island flap is a relatively thin, pliable and insensate flap with minimum donor-site morbidity and acceptable aesthetic outcome.
Methods: A retrospective analysis of a case series was conducted, all operated by a single surgeon over a period of 25 years from July 1996 to February 2020. Data were collected through a structured proforma; the variables included were as follows: demographic data, mechanism of injury, defect …


Establishing Reference Interval For Thyroid-Stimulating Hormone In Children Below Two-Year Ages In Pakistani Population, Siraj Muneer, Imran Siddiqui, Hafsa Majid, Lena Jafri, Khadija N Humayun, Sibtain Ahmed, Aysha Habib Khan Jul 2021

Establishing Reference Interval For Thyroid-Stimulating Hormone In Children Below Two-Year Ages In Pakistani Population, Siraj Muneer, Imran Siddiqui, Hafsa Majid, Lena Jafri, Khadija N Humayun, Sibtain Ahmed, Aysha Habib Khan

Department of Pathology and Laboratory Medicine

Introduction: Reference intervals (RIs) of thyroid-stimulating hormone (TSH) and free thyroxine (FT4) are age, assay and population specific. Currently, the age and assay-specific RIs for TSH are not available for children under two years of age. This study aimed to establish reference intervals for serum concentrations of TSH and FT4 in healthy children aged 1-24 months as per CLSI C28-A3 guidelines.
Methods: This prospective cross-sectional study was conducted in children from 1 to 24 months visiting the clinical laboratory for serum vitamin D testing but without any recent illness, hospitalization, medication and history of maternal thyroid diseases from August 2018 …


Predicting The Environmental Suitability For Onchocerciasis In Africa As An Aid To Elimination Planning, Elizabeth A. Cromwell, Joshua C P. Osborne, Thomas R. Unnasch, Maria-Gloria Basáñez, Katherine M. Gass, Kira A. Barbre, Elex Hill, Kimberly B. Johnson, Katie M. Donkers, Zulfiqar Ahmed Bhutta Jul 2021

Predicting The Environmental Suitability For Onchocerciasis In Africa As An Aid To Elimination Planning, Elizabeth A. Cromwell, Joshua C P. Osborne, Thomas R. Unnasch, Maria-Gloria Basáñez, Katherine M. Gass, Kira A. Barbre, Elex Hill, Kimberly B. Johnson, Katie M. Donkers, Zulfiqar Ahmed Bhutta

Centre of Excellence in Women and Child Health

Recent evidence suggests that, in some foci, elimination of onchocerciasis from Africa may be feasible with mass drug administration (MDA) of ivermectin. To achieve continental elimination of transmission, mapping surveys will need to be conducted across all implementation units (IUs) for which endemicity status is currently unknown. Using boosted regression tree models with optimised hyperparameter selection, we estimated environmental suitability for onchocerciasis at the 5 × 5-km resolution across Africa. In order to classify IUs that include locations that are environmentally suitable, we used receiver operating characteristic (ROC) analysis to identify an optimal threshold for suitability concordant with locations where …


Poliovirus Excretion Among Children With Primary Immune Deficiency In Pakistan: A Pilot Surveillance Study Protocol, Asma Sadruddin Pethani, Zaubina Kazi, Ujala Nayyar, Muhammad Shafiq-Ur-Rehman, Mohammad Tahir Yousafzai, Mach Ondrej, Ali Faisal Saleem Jul 2021

Poliovirus Excretion Among Children With Primary Immune Deficiency In Pakistan: A Pilot Surveillance Study Protocol, Asma Sadruddin Pethani, Zaubina Kazi, Ujala Nayyar, Muhammad Shafiq-Ur-Rehman, Mohammad Tahir Yousafzai, Mach Ondrej, Ali Faisal Saleem

Department of Paediatrics and Child Health

Introduction: Children with primary immunodeficiency disorders (PID) are more susceptible to developing viral infections and are at a substantially increased risk of developing paralytic poliomyelitis. Such children, if given oral polio vaccines tend to excrete poliovirus chronically that may lead to the propagation of highly divergent vaccine-derived poliovirus (VDPV). Consequently, they may act as a reservoir for the community by introducing an altered virus potentially imposing a risk to global polio eradication. However, the risks of chronic and prolonged excretion are not well characterised in the study context. This study seeks to establish a pilot surveillance system for successful identification …


Impact Of Coronavirus Disease 2019 On Prevention And Elimination Strategies For Hepatitis B And Hepatitis C, Syed Tabish Rehman, Hareem Rehman, Shahab Abid Jul 2021

Impact Of Coronavirus Disease 2019 On Prevention And Elimination Strategies For Hepatitis B And Hepatitis C, Syed Tabish Rehman, Hareem Rehman, Shahab Abid

Section of Pulmonary & Critical Care

The coronavirus disease 2019 (COVID-19) pandemic has resulted in significant morbidity and mortality since its first case was discovered in December 2019. Since then, multiple countries have witnessed a healthcare system collapse due to the overwhelming demand for COVID-19 care. Drastic measures have been taken globally in order to curb the spread of the virus. However, those measures have led to the disruption of other aspects of healthcare, increasing the burden due to other medical conditions. We have also stepped back in achieving the ambitious goal set in place by World Health Organization to eliminate viral hepatitis as a public …


Barriers To Access Of Healthcare Services For Rural Women – Applying Gender Lens On Tb In A Rural District Of Sindh, Pakistan, Shifa Salman Habib, Wafa Zehra Jamal, Syed Muhammad Asad Zaidi, Junaid Ur-Rehman Siddiqui, Hira Mustafa Khan, Jacob Creswell, Srichand Batra, Anna Versfeld Jul 2021

Barriers To Access Of Healthcare Services For Rural Women – Applying Gender Lens On Tb In A Rural District Of Sindh, Pakistan, Shifa Salman Habib, Wafa Zehra Jamal, Syed Muhammad Asad Zaidi, Junaid Ur-Rehman Siddiqui, Hira Mustafa Khan, Jacob Creswell, Srichand Batra, Anna Versfeld

Community Health Sciences

Background: Women in rural districts of Pakistan face numerous barriers to healthcare, rendering gender-responsive health programming important, including for Tuberculosis (TB). This study was conducted to assess the general understanding of TB and of access to healthcare for women, as a first step towards implementation of a gender responsive TB programme in TandoAllayar, a rural district of Pakistan.
Methods: A total of 36 participants were interviewed. The focus group discussion guide comprised of questions on: (1) family/household dynamics (2) community norms (3) healthcare system (4) women’s access to healthcare (5) TB Awareness;, and (6) women’s access to TB Care.
Results: …


Clinical Features And Outcomes Of Critically Ill Patients With Elizabethkingia Meningoseptica: An Emerging Pathogen, Abdullah Umair, Nosheen Nasir Jul 2021

Clinical Features And Outcomes Of Critically Ill Patients With Elizabethkingia Meningoseptica: An Emerging Pathogen, Abdullah Umair, Nosheen Nasir

Department of Medicine

Background: Elizabethkingia meningoseptica, formerly known as Chryseobacterium meningosepticum, is a non-motile, non-fastidious, catalase and oxidase-positive, aerobic, glucose-non-fermentative, Gram-negative bacillus that was first defined by Elizabeth O. King in 1959. It has emerged as an opportunistic pathogen that has infected patients in extreme age groups and immunocompromised individuals, especially in intensive care settings. There has been an increased interest in this pathogen due to its increasing occurrence around the world, ubiquitous nature, and inherent capacity for antimicrobial resistance.
Methods: We describe an observational study at a tertiary care center in Karachi, Pakistan, based on patients admitted between January 2013 and December …


Acceptance Of Covid-19 Vaccine In Pakistan: A Nationwide Cross-Sectional Study, Mohammad Aadil Qamar, Omar Irfan, Rubaid A. Dhillon, Areesh Bhatti, Mir Ibrahim Sajid, Safia Awan, Wajiha Rizwan, Ali Bin Sarwar Zubairi, Zouina Sarfraz, Javaid Ahmed Khan Jul 2021

Acceptance Of Covid-19 Vaccine In Pakistan: A Nationwide Cross-Sectional Study, Mohammad Aadil Qamar, Omar Irfan, Rubaid A. Dhillon, Areesh Bhatti, Mir Ibrahim Sajid, Safia Awan, Wajiha Rizwan, Ali Bin Sarwar Zubairi, Zouina Sarfraz, Javaid Ahmed Khan

Department of Paediatrics and Child Health

Introduction: The coronavirus disease 2019 (COVID-19) vaccine is available across various countries worldwide, with public-private partnerships ensuring all individuals are vaccinated through a phased approach. Irrespective of the geographical spread, several myths pertaining to the COVID-19 vaccine have stemmed, ultimately limiting the national administration of vaccines and rollouts. This study assessed the acceptance of the COVID-19 vaccine among the general public in Pakistan.
Methods: A pre-validated questionnaire was administered from January 2021 to February 2021 to assess the public attitude and acceptance of the COVID-19 vaccine. Logistic regression analyses were run to identify factors associated with the acceptance among the …