Medicine and Health Sciences Commons^™

A Single Centre Experience Of Local Perforator Flaps In Oncoplastic Breast Surgery: A Cross-Sectional Study, Sana Zeeshan, Lubna Vohra, Uzma Shamsi, Nida Zahid, Danish Ali, Nargis Asad, Cristina Garusi

Section of General Surgery

Background & objectives: Various oncoplastic techniques have emerged over the years to preserve breast cosmesis and symmetry without compromising the principles of tumor excision. One of the newer techniques for breast volume replacement to achieve symmetry and cosmesis is the use of fasciocutaneous pedicled chest wall perforator flaps or local perforator flaps (LPF). The objectives of this study were to document the details of the surgical procedure as well as patient-reported satisfaction and well-being following the procedure using a validated BREAST-Q tool among Pakistani women.
Materials & methods: This cross-sectional study was conducted from March 2019 to February 2021 enrolling …

Factors Affecting Health-Seeking Behaviour Among Men Who Have Sex With Men In Starehe Sub-County, Nairobi City County, Anthony Omariba

MSc in Advanced Practice Nursing

Men who have sex with other men (MSM) exist in Africa, as they do elsewhere. The continued proscription of MSM behavior leads to exclusion and discrimination. According to a global report, MSMs are responsible for most HIV transmission. MSMs in Kenya constantly fear being hurt because of their sexual orientation, and there is scant knowledge of their health-seeking behavior. There is a need to improve the health of this group to lower disease spread to achieve global HIV reduction. This study aims to explore MSM healthcare-seeking behavior, describe barriers to healthcare-seeking, and establish perceptions of the sexual risks associated with …

Impairment-Based Multidisciplinary Rehabilitation Management In Multiple Sclerosis In Pakistan, Sarah Razaq, Fahim Anwar, Wasim Wali

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Psychiatric Manifestations Of Dengue Fever- A Case Report From Pakistan, Ifrah Hambal, Samrah Nasir, Tania Nadeem

Pakistan Journal of Neurological Sciences (PJNS)

A 29-year-old male presented to Aga Khan University Hospital with complaints of fever, body-aches, vomiting and one episode of gum bleeding. A Dengue antigen test done prior to presentation was positive. He was admitted for medical management. During hospital stay, the patient developed manic symptoms including over-talkativeness, expansive mood, disinhibited behavior, excessive planning, paranoia and aggression. He remained oriented to time, place and person and neurological examination was unremarkable. He was managed with anti-psychotics and benzodiazepines, and his psychiatric symptoms improved with improvement in his medical condition. This case highlights the possibility of psychiatric manifestations occurring in context of a …

Short, Medium And Long Term Neurological Manifestations And Outcome In Covid-19 Patients, Sajid Hameed, Bashir Soomro, Samar Iltaf, Abdul Malik, Anjum Farooq, Alam Ibrahim Siddiqi, Safia Awan, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

Background and objective: There is a need to improve the understanding of Covid-19 neurological complications in a temporal manner. The objective of our study was to find out temporal relationship of neurological manifestations and outcome in Covid-19 Patients.

Methods: This was a multi-center observational study from six centers in Pakistan. Data of covid patients with six months follow up was retrospectively collected from the hospital records. Time periods were divided into short-term (< 1 month), medium-term (2-3 months) and long-term (>4 months). SPSS version 26.0 (SPSS Inc., Chicago, IL, USA) was used to analyze the data.

Results: Neurological manifestations were reported in 208 out of 905 covid …

Decompressive Hemicraniectomy For Patients With Malignant Cerebral Venous Sinus Thrombosis, Sadaf Majid, Waseem Tariq Malik, Asfandyar Khan Niazi, Ehsan Ul Haq, Hina Yusuf, Raja Farhat Shoaib, Maimoona Siddiqui Siddiqui

Pakistan Journal of Neurological Sciences (PJNS)

Background and objective: Cerebral venous sinus thrombosis (CVST) is a rare cause of stroke and may lead to the development of raised intracranial pressure due to edema, infarct or bleed. These patients may require decompressive hemicraniectomy to reduce the raised intracranial pressure. However, the evidence for hemicraniectomy in these patients is scanty. Our objective was to perform a retrospective chart review to describe the clinical characteristics of patients who underwent decompressive hemicraniectomy for malignant CVST and their outcomes.

Methods: We retrospectively analyzed the medical records of patients with CVST who underwent decompressive hemicraniectomy between 2013 and 2020 at Shifa International …

Hurdles Of Intravenous Thrombolysis In Acute Ischemic Stroke At Balochistan, Anjum Farooq, Muhammad Essa, Nimra Shafique, Sakina Gull

Pakistan Journal of Neurological Sciences (PJNS)

Background and objective: Intravenous thrombolysis (IVT) with alteplase tPA (tissue plasminogen Activator) is the FDA approved treatment for acute ischemic stroke. The objective of this study was to determine the hurdles of intravenous thrombolysis in acute ischemic stroke in Balochistan.

Methods: A prospective cross-sectional observational study was carried out from June 2021 to December 2021 at Neurology department of Bolan Medical Complex Hospital Quetta on 272 patients of acute ischemic stroke who fulfilled the criteria. Proforma was filled by relative or patient after informed consent. Proforma included sex, age, diagnosis, time of presentation after stroke and reason of delay. Data …

Multiple Sclerosis And Parkinson’S Disease: Poles Apart Or Cut From The Same Cloth?, Wajid Jawaid

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

The Ward Round: Friend Or Foe In Postgraduate Training? A Grounded Theory Study Of Residents’ Perspectives, Mariam Noorani

Paediatrics and Child Health, East Africa

The ward round has traditionally been a learning activity in medical education. Apart from education, ward rounds have multiple roles including patient care and communication. Some studies have described the ward round as an ideal place to learn patient management while others reported that little learning happens on rounds due to lack of time and patient volume. This study aimed to develop a deeper understanding of ward round learning from the perspec-tive of postgraduate trainees. A constructivist grounded theory approach was used and data was collected during focus group discussions. Data were analyzed by initial coding, then grouped into focused …

Ispad Clinical Practice Consensus Guidelines 2022: Assessment And Management Of Hypoglycemia In Children And Adolescents With Diabetes, Mary B. Abraham, Beate Karges, Klemen Dovc, Diana Naranjo, Ana Maria Arbelaez, Joyce Mbogo, Ganesh Javelikar, Timothy W. Jones, Farid H. Mahmud

Paediatrics and Child Health, East Africa

No abstract provided.

Acute Kidney Injury In Hospitalized Children With Sickle Cell Anemia, Anthony Batte, Sahit Menon, John Ssenkusu, Sarah Kiguli, Robert Kalyesubula, Joseph Lubega, Edrisa Ibrahim Mutebi, Robert Opoka, Chandy John, Michelle Starr

Paediatrics and Child Health, East Africa

Background: Children with sickle cell anemia (SCA) are at increased risk of acute kidney injury (AKI) that may lead to death or chronic kidney disease. This study evaluated AKI prevalence and risk factors in children with SCA hospitalized with a vaso-occlusive crisis (VOC) in a low-resource setting. Further, we evaluated whether modifcations to the Kidney Disease: Improving Global Outcomes (KDIGO) defnition would infuence clinical outcomes of AKI in children with SCA hospitalized with a VOC.

Methods: We prospectively enrolled 185 children from 2 – 18 years of age with SCA (Hemoglobin SS) hospitalized with a VOC at a tertiary hospital …

To Err Is Human; Acute Appendicitis A Mistaken Clinical Identity For Metastatic Follicular Thyroid Carcinoma, A Case Report, Ahmed Jusabani, Neelam Ismail, Zainab Fidaali, Ramadhani Mjejwa, Tausi Maftah, Ally Zain Ismail

Faculty of Health Sciences, East Africa

Introduction and importance: Thyroid cancer accounts for majority of endocrine cancers with follicular thyroid cancer the second most common. It tends to spread via hematogenous route with distant metastasis thus besides presenting as a neck mass it may also present with symptoms tallying to regions of metastasis which may misguide the diagnosis. We report a case of a 50-year-old man who presented with features of appendicitis only to discover metastatic right iliac bone follicular thyroid cancer. We describe our experience on diagnostic formulation, radiological work up, surgery, radioactive iodine therapy and follow up.

Case presentation: 50-year-old man presenting with acute …

Anticancer Effect Of Illicium Verum (Star Anise Fruit) Against Human Breast Cancer Mcf-7 Cell Line, Asra Khan Pahore, Shagufta Khan, Nasim Karim

Department of Biological & Biomedical Sciences

Objective: To investigate the anticancer effect of Illicium verum against human breast cancer MCF-7 cell line.
Methods: An experimental study was conducted in Multidisciplinary and Tissue Culture Laboratory, Aga Khan University in collaboration with Pharmacology Department of Bahria University Medical and Dental College, Karachi, Pakistan from January 2021 to June 2021. MCF-7 cells of Luminal-A breast cancer were seeded in 96-well plate and treated with I.verum methanol extract. After incubation, MTT (3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide) dye was used for cell viability and cell proliferation assays to determine the number of dead and viable cells, and the absorbance was measured using an enzyme-linked …

Feasibility Of Project Echo Telementoring To Build Capacity Among Non-Specialist Emergency Care Providers, Grace Wanjiku, Lindsay Dreizler, Gregory Bell, Benjamin Wachira

Emergency Medicine, East Africa

The COVID-19 pandemic has led to global disruptions in emergency medicine (EM) teaching and training and highlighted the need to strengthen virtual learning platforms. This disruption coincides with essential efforts to scale up training of the emergency healthcare workforce, particularly in low-resource settings where the specialty is not well developed. Thus, there is growing interest in strengthening virtual platforms that can be used to support emergency medicine educational initiatives globally. These platforms must be robust, context specific and sustainable in low-resource environments. This report describes the implementation of Project ECHO (Extension for Community Healthcare Outcomes), a telementoring platform originally designed …

Effectiveness Of Non-Invasive Respiratory Support Strategies In Patients With Covid-19: A Systematic Review And Meta Analysis, Vinesh Kumar, Umair Arshad Malik, Reshman Kumari, Berkha Berkha, Vijay Kumar, Manoj Kumar, Simran Simran, Suman Suman, Bushra Nasim

Medical College Documents

Background: The effectiveness of non-invasive respiratory strategies, namely CPAP and HFNO, in reducing the risk of mortality and tracheal intubation in patients with severe COVID-19 is not well established.
Methods: A thorough literature search was conducted across 3 electronic databases (Medline, EMBASE and Cochrane Central) from inception through July 2022. Randomized controlled trials (RCTs) and observational studies assessing the impact of CPAP or HFNO on clinical outcomes in patients infected with COVID-19 were considered for inclusion. End-points included all-cause mortality and risk of tracheal intubation. Evaluations were reported as risk ratios (RRs) with 95% confidence intervals (CI) and analysis was …

Labrad : Vol 47, Issue 2 - December 2022, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• From the Editor’s Desk
• Case Quiz
• Contrast Enhanced Spectral Mammography Clinical Usefulness of Biochemical Parameters in Prenatal Diagnosis of Down Syndrome In First and Second Trimester
• The Science of Efficiency in a Clinical Laboratory
• Updates in new WHO Blue Book
• Monkeypox vs. COVID-19
• From the Diary of a Researcher- Notes on Understanding Beta-Thalassemia and Metabolic Bone Disease
• Significance of Audit in a Clinical Laboratory
• Microsatellite Instability (MSI) Testing
• Pre-Analytical Variables Affecting Coagulation Testing
• Grading of Soft Tissue Sarcomas
• Recent Updates in 2022 WHO Classification of Thyroid Neoplasms
• MMR and MSI Testing in Malignancies
• Transforming Pedagogical Framework of Pathology through Social …

Inspire : Vol 5, Issue 12, Department Of Medicine

INSPIRE – Department of Medicine Archives

• Message from the Chair
• 7^th WOHC Singapore
• World Stroke Day
• PZP Hospitalist Grand Round
• PADCON
• PZP Hospitalist Grand Round
• International Kidney Transplant Symposium
• UPDATES ON COPD
• In-depth- featuring Assistant Prof. Dr Mehreen Arshad
• What are Academics Around the World Reading This Month?
• Publications

Management Of Multisystem Inflammatory Syndrome In Children (Mis-C) In Resource Limited Settings: The Kenyan Experience, Angela Migowa, Pauline Samia, Del-Rossi Sean, Oliver Ombeva Malande, Jasmit Shah, Chemutai Kenei, Joy Ayaya, Daisy Jeruto, Laura Oyiengo, Laura Lewandowski

Paediatrics and Child Health, East Africa

Background: Since the onset of the recent COVID-19 pandemic, there have been growing concerns regarding multisystem inflammatory syndrome in children (MIS-C). This study aims to describe the clinico-epidemiological profile and challenges in management of MIS-C in low-middle income countries by highlighting the Kenyan experience.

Methods: A retrospective study at the Aga Khan University Hospital Nairobi, Avenue Hospital Kisumu and Kapsabet County Referral Hospital was undertaken to identify cases of MIS-C. A detailed chart review using the World Health Organization (WHO) data collection tool was adapted to incorporate information on socio-demographic details and treatment regimens.

Findings: Twenty children with MIS-C were …

Blackwater Fever And Acute Kidney Injury In Children Hospitalized With An Acute Febrile Illness: Pathophysiology And Prognostic Significance, Andrea Conroy, Michael Hawkes, Aleksandra Leligdowicz, Ivan Mufumba, Michelle Starr, Kathleen Zhong, Sophie Namasopo, Robert Opoka, Chandy John, Kevin C. Kain

Paediatrics and Child Health, East Africa

Background: Acute kidney injury (AKI) and blackwater fever (BWF) are related but distinct renal complications of acute febrile illness in East Africa. The pathogenesis and prognostic signifcance of BWF and AKI are not well understood.

Methods: A prospective observational cohort study was conducted to evaluate the association between BWF and AKI in children hospitalized with an acute febrile illness. Secondary objectives were to examine the association of AKI and BWF with (i) host response biomarkers and (ii) mortality. AKI was defned using the Kidney Disease: Improving Global Outcomes criteria and BWF was based on parental report of tea-colored urine. Host …

Acceptability And Feasibility Of A Low-Cost Device For Gestational Age Assessment In A Low-Resource Setting: Qualitative Study, Angela Koech, Peris Muoga Musitia, Grace Mwashigadi, Mai-Lei Woo Kinshella, Marianne Vidler, Marleen Temmerman, Rachel Craik, J. Alison Noble, Peter Dadelszen Von Dadelszen, Aris T . Papageorghiou

Obstetrics and Gynaecology, East Africa

Background: Ultrasound for gestational age (GA) assessment is not routinely available in resource-constrained settings, particularly in rural and remote locations. The TraCer device combines a handheld wireless ultrasound probe and a tablet with artificial intelligence (AI)-enabled software that obtains GA from videos of the fetal head by automated measurements of the fetal transcerebellar diameter and head circumference.

Objective: The aim of this study was to assess the perceptions of pregnant women, their families, and health care workers regarding the feasibility and acceptability of the TraCer device in an appropriate setting.

Methods: A descriptive study using qualitative methods was conducted in …

Perceptions Of Orthopaedic Medicine Students And Their Supervisors About Practice-Based Learning: An Exploratory Qualitative Study, Muhamed Nsubuga, Robert Opoka, Moses Galukande, Ian G. Munabi, Aloysius . Mubuuke, Sarah Kiguli

Paediatrics and Child Health, East Africa

Background: Practice-based learning is crucial in forming appropriate strategies for improving learning among the medical students that support the country’s understaffed health sector. Unsatisfactory learning consequently results in poor performance of students and poor quality of health care workforce in the long run. Exploring the perceptions about the current practice-based learning system and how to improve is thus vital. This study set out to explore the perceptions of Orthopaedic medicine students and their supervisors about practice-based learning at a tertiary training hospital.

Methods: This was an exploratory phenomenological qualitative study that involved in-depth interviews among 10 Orthopedic students during their …

Rare Causes Of Genital Fistula In Nine African Countries: A Retrospective Review, Carrie J. Ngongo, Thomas J.I.P. Raassen, Marietta Mahendeka, Ladeisha Lombard, Jos Van Roosmalen, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Most genital fistulas result from prolonged, obstructed labor or surgical complications. Other causes include trauma (from accidents, traditional healers, or sexual violence), radiation, carcinoma, infection, unsafe abortion, and congenital malformation.

Methods: This retrospective records review focuses on rare fistula causes among 6,787 women who developed fistula after 1980 and sought treatment between 1994 and 2017 in Tanzania, Uganda, Kenya, Malawi, Zambia, Rwanda, Ethiopia, Somalia, and South Sudan. We compare fistula etiologies across countries and assess associations between rare causes and type of incontinence (urine, feces, or both).

Results: Rare fistula accounted for 1.12% (76/6,787) of all fistulas, including traumatic …

The East Africa Consortium For Human Papillomavirus And Cervical Cancer In Women Living With Hiv/Aids, Y. Tong, Elkanah Omenge, M. Nakalembe, P. Tonui, P. Itsura, K. Muthoka, M. Titus, S. Kiptoo, A. Mwangi, J. Ong’Echae

Obstetrics and Gynaecology, East Africa

The East Africa Consortium was formed to study the epidemiology of human papillomavirus (HPV) infections and cervical cancer and the influence of human immunodeficiency virus (HIV) infection on HPV and cervical cancer, and to encourage collaborations between researchers in North America and East African countries. To date, studies have led to a better understanding of the influence of HIV infection on the detection and persistence of oncogenic HPV, the effects of dietary aflatoxin on the persistence of HPV, the benefits of antiretroviral therapy on HPV persistence, and the differences in HPV detections among HIV-infected and HIV-uninfected women undergoing treatment for …

Perpetuation Of Gender Discrimination In Pakistani Society: Results From A Scoping Review And Qualitative Study Conducted In Three Provinces Of Pakistan, Tazeen Saeed Ali, Shahnaz Shahid Ali, Sanober Nadeem, Zahid Memon, Sajid Bashir Soofi, Falak Madhani, Yasmin Karim, Shah Mohammad, Zulfiqar Ahmed Bhutta

School of Nursing & Midwifery

Background: Gender discrimination is any unequal treatment of a person based on their sex. Women and girls are most likely to experience the negative impact of gender discrimination. The aim of this study is to assess the factors that influence gender discrimination in Pakistan, and its impact on women's life.
Methods: A mixed method approach was used in the study in which a systematic review was done in phase one to explore the themes on gender discrimination, and qualitative interviews were conducted in phase two to explore the perception of people regarding gender discrimination. The qualitative interviews (in-depth interviews and …

Experiences Of Mothers And Significant Others In Accessing Comprehensive Healthcare In The First 1000 Days Of Life Post-Conception During Covid-19 In Rural Uganda, Grace Nakate, Sean Mackay, Eunice Ndirangu, Valerie Fleming

School of Nursing & Midwifery, East Africa

Background: COVID-19 presented an unprecedented global public health challenge because of its rapid and relentless spread, and many countries instituted lockdowns to prevent the spread of infection. Although this strategy mayhave been appropriate to reduce infection, it presented unintended difficulties in rural Uganda, especially in maternal and born newborn care. For example, some services were suspended, meaning the nearest health facility was at a considerable distance. This study explored the experiences of mothers and their significant others of comprehensive care in the first 1000 days of life post-conception during the COVID-19 pandemic in Bunghokho-Mutoto sub-county, Mbale District, Uganda.

Methods …

Does Social Pension Buy Improved Mental Health And Mortality Outcomes For Senior Citizens? Evidence From South Africa's 2008 Pension Reform, Cyprian Mostert, Diana Mackay, Alex Awiti, Manasi Kumar, Zul Merali

Brain and Mind Institute

In South Africa, men were traditionally eligible to receive government pensions at 65 years. However, that eligibility criterion was changed in 2008 to allow men to receive a pension payout at 60 years. This study is designed to quantify the impact of the 2008 pension reform on mental health outcomes (depression and traumatic stress) and deaths among 60-year-old men from disadvantaged households without advanced education. This analysis used secondary data issued by Statistic South Africa- General Household Survey. Men who reported earning a pension at 60 years from 2008 to 2014 were exposed to the 2008 pension reform and thus …

Interpersonal Psychotherapy’S Problem Areas As An Organizing Framework To Understand Depression And Sexual And Reproductive Health Needs Of Kenyan Pregnant And Parenting Adolescents: A Qualitative Study, Manasi Kumar, Obadia Yator, Vincent Nyongesa, Martha Kagoya, Shillah Mwaniga, Joseph Kathono, Isaiah Gitonga, Nancy Grote, Helena Verdeli, Keng Yen Huang

Brain and Mind Institute

Background: Peripartum adolescents experience signifcant interpersonal transitions in their lives. Depression and emotional distress are often exacerbated by adolescents’ responses to these interpersonal changes. Improved understanding of pregnancy-related social changes and maladaptive responses to these shifts may inform novel approaches to addressing the mental health needs of adolescents during the perinatal period. The paper aims to understand the sources of psychological distress in peripartum adolescents and map these to Interpersonal Psychotherapy’s (IPT) problem areas as a framework to understand depression.

Method: We conducted interviews in two Nairobi primary care clinics with peripartum adolescents ages 16–18 years (n=23) with …

Cultural And Contextual Adaptation Of Mental Health Measures In Kenya: An Adolescent-Centered Transcultural Adaptation Of Measures Study, Vincent Nyongesa, Shillah Mwaniga, Joseph Kathono, Obadia Yator, Beatrice Madeghe, Sarah Kanana, Beatrice Amugune, Naomi Anyango, Darius Nyamai, Manasi Kumar

Brain and Mind Institute

Introduction: There is paucity of culturally adapted tools for assessing depression and anxiety in children and adolescents in low-and middle-income countries. This hinders early detection, provision of appropriate and culturally acceptable interventions. In a partnership with the University of Nairobi, Nairobi County, Kenyatta National Hospital, and UNICEF, a rapid cultural adaptation of three adolescent mental health scales was done, i.e., Revised Children’s Anxiety and Depression Scale, Patient Health Questionnaire-9 and additional scales in the UNICEF mental health module for adolescents.

Materials and methods: Using a qualitative approach, we explored adolescent participants’ views on cultural acceptability, comprehensibility, relevance, and completeness of …

Health And Socioeconomic Resource Provision For Older People In South Asian Countries: Bangladesh, India, Nepal, Pakistan And Sri Lanka Evidence From Neesama, Natasha Roya Matthews, George James Porter, Mathew Varghese, Nidesh Sapkota, Murad Khan, Ammu Lukose, Stella-Maria Paddick, Malathie Dissanayake, Naila Zaman Khan, Richard Walker

Brain and Mind Institute

Background: The global population is ageing rapidly, with low- and middle-income countries (LMICs) undergoing a fast demographic transition. As the number of older adults in LMICs increases, services able to effectively address their physical and mental health needs will be increasingly important.

Objective: We review the health and socioeconomic resources currently available for older people in South Asian countries, Bangladesh, India, Nepal, Pakistan and Sri Lanka, to identify gaps in available resources and assess areas for improvement.

Methods: We conducted a search of grey and published literature via Google Search, Compendex, EBSCO, JSTOR, Medline, Ovid, ProQuest databases, …

Neurological Manifestations Of Cerebral Venous Thrombosis: Experience From A Tertiary Care Center, Anum Irfan, Soban Khan, Zaid Waqar, Sumaira Nabi, Bushra Khalid, Muhammad Tariq

Pakistan Journal of Neurological Sciences (PJNS)

Background and objective: Cerebral venous thrombosis (CVT) is a common cause of cerebrovascular accident (stroke). CVT is caused due to blockage in blood flow either in cerebral veins or in dural sinuses. The objective of this study was to determine prevalence of various clinical and imaging characteristics in patients with cerebral venous thrombosis.

Methods: A descriptive retrospective cross-sectional patient data was collected from November 2019 to February 2021. This study was conducted in Neurology Department in Pakistan Institute of Medical Sciences (PIMS), Islamabad, Pakistan. This study contains patient medical histories of 60 patients who were admitted in two and a …