Medicine and Health Sciences Commons^™

Estimating The Pre- And Post-Diagnosis Costs Of Tuberculosis For Adults In Pakistan: Household Economic Impact And Costs Mitigating Strategies, Shama Razzaq, Aysha Zahidie, Zafar Fatmi

Community Health Sciences

Background: Despite free tuberculosis (TB) care in Pakistan, patients still have to bear high costs, which push them into poverty. This study estimated the pre- and post-diagnosis costs households bear for TB care, and investigated coping mechanisms among adults ≥ 18 years in Karachi, Pakistan.
Methods: We conducted a cross-sectional study comprising of 516 TB patients identified with completion of at least one month intensive treatment from four public sector health facilities from two institutes in Karachi, Pakistan. A standardized questionnaire to estimate patient's costs was administered. The study outcomes were direct medical and non-medical costs, and indirect costs. The …

Association Of Trauma Center Designation With Postdischarge Survival Among Older Adults With Injuries, Molly P. Jarman, Ginger Jin, Joel S. Weissman, Arlene S. Ash, Jennifer Tjia, Ali Salim, Adil Haider, Zara Cooper

Section of General Surgery

Importance: Trauma centers improve outcomes for young patients with serious injuries. However, most injury-related hospital admissions and deaths occur in older adults, and it is not clear whether trauma center care provides the same benefit in this population.
Objective: To examine whether 30- and 365-day mortality of injured older adults is associated with the treating hospital's trauma center level.
Design, setting, and participants: This prospective, population-based cohort study used Medicare claims data from January 1, 2013, to December 31, 2016, for all fee-for-service Medicare beneficiaries 66 years or older with inpatient admission for traumatic injury in 2014 to 2015. Data …

Measurement Characteristics And Correlates Of Hiv-Related Stigma Among Adults Living With Hiv: A Cross-Sectional Study From Coastal Kenya, Stanley W. Wanjala, Moses Nyongesa, Paul Mwangi, Agnes M. Mutua, Stanley Luchters, Charles R J C Newton, Amina Abubakar

Institute for Human Development

Objective We studied the psychometric properties of the 12-item short version of the Berger HIV stigma scale and assessed the correlates of HIV-related stigma among adults living with HIV on the Kenyan coast.

Design Cross-sectional study.

Setting Comprehensive Care and Research Centre in the Kilifi County Hospital.

Participants Adults living with HIV on combination antiretroviral therapy were recruited and interviewed between February and April 2018 (n=450).

Main outcome measures HIV-related stigma.

Results 450 participants with a median age of 43 years (IQR=36–50) took part in the study. Of these, 356 (79.1%) were female. Scale reliability and validity were high (alpha=0.80, …

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. …

Covid-19 And Adult Acute Lymphoblastic Leukemia: Presentation And Management, Ayesha Butt, Natasha Bahadur Ali

Medical College Documents

No abstract provided.

Correlates Of Health-Related Quality Of Life Among Adults Receiving Combination Antiretroviral Therapy In Coastal Kenya, Moses K. Nyongesa, Paul Mwangi, Stanley Wanjala, Agnes M. Mutua, Hans M. Koot, Pim Cuijpers, Charles R. J. C. Newton, Amina Abubakar

Institute for Human Development

Background: Health-related quality of life (HRQoL) is an important metric of perceived wellbeing in people living with HIV/AIDS (PLWHA). However, research on HRQoL among PLWHA in sub-Saharan Africa is limited. This study investigates factors associated with HRQoL among PLWHA in Kilifi, coast of Kenya.

Methods: Between February and April 2018, 450 adults living with HIV and on combined antiretroviral therapy (cART) between 18 to 60 years were sequentially recruited from an HIV-specialized clinic. The Functional Assessment of HIV Infection (FAHI) questionnaire, previously adapted for assessing HRQoL in this setting, was slightly modified and administered to participants alongside other …

Falls Prevention Among Older Adults At A Nursing Home In A Northern Suburban Of Perth In Western Australia, Horatius Musembi, Deborah Sundin

School of Nursing & Midwifery, East Africa

The objective was to identify factors leading to falls and determine the role of nurses and carers play in falls prevention. A retrospective audit of the performance of nurses and carers regarding falls prevention among older adults was used. Residents who had a fall during July 2015 (n=25) were identified using purposeful sampling. Data for this study were collected from the files of these residents. Data analysis was done by using the Fisher exact test which was appropriate for the collected data. Residents aged 85-89 years had the most falls (32%); however, one resident who fell five times in the …

Screening Tools For Hiv-Associated Neurocognitive Disorders Among Adults Living With Hiv In Sub-Saharan Africa: A Scoping Review, Patrick N. Mwangala, Charles R. Newton, Melanie Abas, Amina Abubakar

Institute for Human Development

Background: People living with HIV are at risk of developing HIV-associated neurocognitive disorders (HAND) which adversely affects their quality of life. Routine screening of HAND in HIV care is recommended to identify clinically important changes in cognitive functioning and allow for early interventions. However, HAND detection in routine clinical practice has never been reported in sub-Saharan Africa (SSA), partly due to a lack of adequately standardized screening tools. This review was conducted to identify the commonly used screening tools for HAND in SSA and document their psychometric properties and diagnostic accuracy.
Methods: We searched Ovid Medline, PsycINFO and Web of …

Spinal Cord Injury Without Radiographic Abnormality (Sciwora) In Adults: A Report Of Two Cases, Adil Aziz Khan, Shafaq Mahmood, Tayyaba Saif, Aleesha Gul

Section of Internal Medicine

Spinal cord injury without any radiographic abnormality (SCIWORA) is rare in adults. We describe here two case reports of adult patients, who presented to us with quadriplegia, following a road traffic accident. Plain radiography and computed tomography (CT) of cervical spine were normal. Hence the patients were diagnosed as cases of adult SCIWORA. However, subsequent magnetic resonance imaging (MRI) of the two patients revealed cervical cord injury in the form of cord contusion and disc protrusion, respectively. Patient with cord contusion was managed medically, whereas the patient with disc lesion was treated with discectomy. Patient treated with discectomy showed marked …

Primary Anaplastic Pleomorphic Xanthoastrocytoma In Adults. Case Report And Review Of Literature, Usama Khalid Choudry, Saad Akhtar Khan, Amjad Qureshi, Muhammad Ehsan Bari

Section of Neurosurgery

Background: Pleomorphic xanthoastrocytoma (PXA) classified as a low Grade (WHO II) astrocytic neoplasm. It is known for its relatively favorable prognosis. It most commonly occurs in young adults. Malignant progression in PXA has been frequently reported since its first description in 1979; however, the presentation of a primary anaplastic PXA tumor with an aggressive clinical course in adults is rare especially in the later age group.
Case description: We present a case of primary anaplastic PXA in a 53 year old male that manifested with an early recurrence pattern at 9 weeks. Treatment performed was surgical excision and external beam …

Varied Presentation Of Celiac Disease In Pakistani Adults, Zaigham Abbas, Sajjad Raza, Javed Yakoob, Shahab Abid, Saeed Hamid, Hasnain Shah, Wasim Jafri

Section of Gastroenterology

he objective of this retrospective study was to evaluate presentation of celiac disease in adults. It included 77 patients, 41 (53.2%) males with median age 26 years and median body mass index of 18 (16 â�� 22) kg/m2. Typical presentation with gastrointestinal symptoms was seen in 76.6%. Atypical presentation with extra intestinal complaints in 7.8% and silent presentation in 15.6%. Major symptoms were diarrhea in 64.9%, weight loss 36.4%, abdominal pain 35.1%, vomiting 32.5%, pallor 24.7%, and weakness 13%. Iron deficiency was documented in 20.8%, B12 deficiency in 9.1%, folic acid deficiency in 6.5% and vitamin D deficiency in 10.4%. …

Rotational Vs. Standard Smooth Laryngeal Mask Airway Insertion In Adults, Dileep Kumar, Mueenullah Khan, Muhammad Ishaq

Department of Anaesthesia

OBJECTIVE: To compare the ease of insertion between rotational laryngeal mask airway (LMA) insertion and Brain's LMA insertion technique in terms of number of LMA insertion attempts, time duration of LMA insertion and complications: trauma, laryngospasm, and hypoxaemia.

STUDY DESIGN: Randomized control study.

PLACE AND DURATION OF STUDY: The Aga Khan University Hospital, Karachi, from September 2006 to May 2007.

METHODOLOGY: One hundred ASA I and II adults undergoing short elective surgical procedures requiring general anaesthesia with spontaneous breathing were enrolled. Following pre-oxygenation, anaesthesia was induced with propofol 2 mg/kg and fentanyl 2 mug/kg. Patients were randomly assigned into one …

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 …

Association Of Depression With Newly Diagnosed Type 2 Diabetes Among Adults Aged Between 25 To 60 Years In Karachi, Pakistan., Shazia Perveen, Muhammad S Otho, Muhammad N Siddiqi, Juanita Hatcher, Ghazala Rafique

Section of Cardiothoracic Surgery

Background:The combination of depression with type 2 diabetes is a public health problem. If diabetes is managed in its initial phase, the morbidity and mortality due to this combination may be prevented at an early stage. Therefore, we aimed to determine the association of depression with newly diagnosed type 2 diabetes among adults aged between 25 to 60 years in Karachi, Pakistan.

Methods:

From July 2006 to September 2007, a matched case control study (n = 592) was conducted in Civil Hospital, Karachi. Incident cases of type 2 diabetes (n = 296) diagnosed within one month were recruited from …

Knowledge, Attitudes And Practices Regarding Dengue Fever Among Adults Of High And Low Socioeconomic Groups, Madiha Syed, Taimur Saleem, Umme-Rubab Syeda, Manal Habib, Rehan Zahid, Atif Bashir, Madiha Rabbani, Madiha Khalid, Asif Iqbal, Ehsen Zawwar Rao, Shujja-Ur-Rehman, Sarah Saleem

Community Health Sciences

OBJECTIVE: To ascertain the knowledge, attitudes and practices of selected adult population in Pakistan regarding Dengue Fever.METHODS: A cross sectional survey was conducted among selected communities with different socio-economic backgrounds in Karachi, Pakistan. A sample size of 440 adults (aged 18 years and above) were interviewed using a pre-tested questionnaire regarding their knowledge, attitude and practices about dengue fever. A composite scoring system, based on the answers given in the questionnaire, was used to establish the level of awareness in the population. The division of the higher and lower socio-economic groups was based on their income and locality; both these …

An Open Study To Assess The Safety And Efficacy Of Heprovac-B Vaccine 10 Mcg-Dose For Adults, Hasnain Ali Shah, Wasim Jafri

Section of Gastroenterology

Heprovac B is a novel recombinant vaccine. There are many vaccines available in Pakistani market but Heprovac B claims to be immunogenic even at 10 meg dose. Aim of the study is to determine whether using 10 meg of Heprovac B vaccine is safe and effective in producing sufficient immunity in Pakistani population. One hundred and twenty five subjects, who fulfilled the Inclusion criteria, were enrolled for the study. Heprovac B was administered in a three-dose regimen given at 0, 1 and 6 months and adverse events were recorded. Immunogenicity was tested by measuring hepatitis B surface antibody one month …