Medicine and Health Sciences Commons^™

Non-Traditional Risk Factors And The Risk Of Myocardial Infarction In The Young In The Us Population-Based Cohort, Chayakrit Krittanawong, Yiming Liu, Dhruv Mahtta, Bharat Narasimhan, Zhen Wang, Hani Jneid, Jacqueline E. Tamis-Holland, Alam Mahboob, Usman Baber, Salim S. Virani

Office of the Provost

Although most prevalent in elderly, myocardial infarction (MI) also affects younger adults. We sought to investigate baseline characteristics in young patients (<55 >years) with MI using the National Inpatient Sample (NIS) database between 2004 and 2015. Multivariable logistic regression models were used to assess factors associated with acute myocardial infarction (AMI) in young patients. After multivariable analyses adjusted for age, sex, race, family history of atherosclerosis, body mass index (BMI), diabetes, hypertension, hyperlipidemia, chronic kidney disease, and current cigarette smoking; novel risk factors such as human immunodeficiency virus (HIV), systemic lupus erythematosus (SLE), and obstructive sleep apnea (OSA) were associated …

Trends In And Predictors Of Pregnancy Termination Among 15–24 Year-Old Women In Nigeria: A Multi-Level Analysis Of Demographic And Health Surveys 2003–2018, Franklin I. Onukwugha, Monica A. Magadi, Ahmed Sarki, Lesley Smith

School of Nursing & Midwifery, East Africa

Background: Three-quarters of pregnancy terminations in Africa are carried out in unsafe conditions. Unsafe abortion is the leading cause of maternal mortality among 15–24 year-old women in Sub-Saharan Africa. Greater understanding of the wider determinants of pregnancy termination in 15–24 year-olds could inform the design and development of interventions to mitigate the harm. Previous research has described the trends in and factors associated with termination of pregnancy for women of reproductive age in Nigeria. However, the wider determinants of pregnancy termination have not been ascertained, and data for all women have been aggregated which may obscure differences by age groups. …

Operability, Usefulness, And Task-Technology Fit Of An Mhealth App For Delivering Primary Health Care Services By Community Health Workers In Underserved Areas Of Pakistan And Afghanistan: Qualitative Study, Shehla Zaidi, Abdul Momin Kazi, Atif Riaz, Ammarah Ali, Rabia Najmi Taha, Rawshan Jabeen, Umerdad Khudadad, Saleem Sayani

Community Health Sciences

Background: The recent proliferation of digital health technology in low- and middle-income countries has made it possible for community health workers (CHWs) to use mobile health (mHealth) to perform tasks such as data collection and training. Although most studies focus on the prospect of digital apps to motivate and connect CHW, only a few have captured end-user experiences with mobile-based apps. We examined the experience of frontline health workers with a move towards digitalized real-time data to record maternal and childcare services in remote areas of Afghanistan and Pakistan.
Objective: Our study aimed to explore CHW perceptions on the operability …

Prophylactic Mesh Placement For The Prevention Of Incisional Hernia In High-Risk Patients After Abdominal Surgery: A Systematic Review And Meta-Analysis, Jawad Ahmed, Nimra Hasnain, Iayla Fatima, Farheen Malik, Muhammad A. Chaudhary, Junaid Ahmad, Mehreen Malik, Laraib Malik, Muhammad Osama, Mirza Zain Baig, Faisal Khosa, Faiz Bhora

Department of Anaesthesia

Background and objectives: In high-risk populations, the efficacy of mesh placement in incisional hernia (IH) prevention after elective abdominal surgeries has been supported by many published studies. This meta-analysis aimed at providing comprehensive and updated clinical implications of prophylactic mesh placement (PMP) for the prevention of IH as compared to primary suture closure (PSC).
Materials and methods: PubMed, Science Direct, Cochrane, and Google Scholar were systematically searched until March 3, 2020, for studies comparing the efficacy of PMP to PSC in abdominal surgeries. The main outcome of interest was the incidence of IH at different follow-up durations. All statistical analyses …

Challenges In Teaching Palliative Care Module Virtually During Covid-19 Era, Shanaz Hussein Cassum, Khairunnisa Mansoor, Amina Hirji, Amber David, Amina Aijaz Khowaja

School of Nursing & Midwifery

With the COVID-19 pandemic hitting the global community, routine activities of universities, offices, and industries have been hindered. People are being forced to rethink the ways of working virtually from home for providing education, business, and health services in this social distancing during the COVID era. This sudden shift also posed challenges of online teaching in a private university, in urban Karachi, Pakistan. The Aga Khan University, School of Nursing and Midwifery recently conducted an online palliative care module using a virtual learning environment and Microsoft Teams for Trainee Nurse Interns. Although the first experience of online teaching and learning …

Cardiac Magnetic Resonance Evaluation Of Cardiac Masses In Patients With Suspicion Of Cardiac Masses On Echo Or Computed Tomography, Fateh Ali Tipoo Sultan, Syed Waqar Ahmed

Section of Cardiology

Objectives: In recent years, cardiac magnetic resonance (CMR) imaging has emerged as an important tool in the identification and characterization of cardiac masses. No imaging data on cardiac masses are available from Pakistan. We aimed to review the clinical presentation, CMR findings, and outcome of patients referred for CMR due to suspicion of cardiac masses on echocardiogram or computed tomography (CT).
Material and methods: We reviewed all the patients referred for CMR at Aga Khan University Hospital, Karachi, from January 2011 to March 2020, with the suspicion of cardiac mass on echocardiogram and/or CT. Only those with the confirmed diagnosis …

Stroke In Young Adults: Current Trends, Opportunities For Prevention And Pathways Forward, Tamer Yahya, Mohammad Hashim Jilani, Safi U. Khan, Reed Mszar, Syed Zawahir Hassan, Michael J. Blaha, Ron Blankstein, Salim S. Virani, Michelle C. Johansen

Office of the Provost

Cardiovascular disease remains a major contributor to morbidity and mortality in the US and elsewhere, and stroke is a leading cause of disability worldwide. Despite recent success in diminishing stroke incidence in the general US population, in parallel there is now a concerning propensity for strokes to happen at younger ages. Specifically, the incidence of stroke for US adults 20-44 years of age increased from 17 per 100,000 US adults in 1993 to 28 per 100,000 in 2015. Occurrence of strokes in young adults is particularly problematic as these patients are often affected by physical disability, depression, cognitive impairment and …

Applying The Robson Classification To Routine Facility Data To Understand The Caesarean Section Practice In Conflict Settings Of South Kivu, Eastern Dr Congo, Guy Mulinganya, Espoir Bwenge Malembaka, Melissa Lukula Akonkwa, Dieudonne´ Mpunga Mukendi, Etienne Kajibwami Birindwa, Ghislain Maheshe Balemba, Marleen Temmerman, Albert Mwembo Tambwe, Bart Criel, Ghislain Bisimwa Balaluka

Obstetrics and Gynaecology, East Africa

Introduction: Sub-Saharan Africa has low Caesarean (CS) levels, despite a global increase in CS use. In conflict settings, the pattern of CS use is unclear because of scanty data. We aimed to examine the opportunity of using routine facility data to describe the CS use in conflict settings.

Methods: We conducted a facility-based cross-sectional study in 8 health zones (HZ) of South Kivu province in eastern DR Congo. We reviewed patient hospital records, maternity registers and operative protocol books, from January to December 2018. Data on direct conflict fatalities were obtained from the Uppsala Conflict Data Program. Based on conflict …

Can Simulators Be Applied To Improve Cataract Surgery Training: A Systematic Review, Taha Muneer Ahmed, Badrul Hussain, Rehman Siddiqui

Medical College Documents

Objective: The purpose of this paper was to conduct a systematic review of existing literature on simulation-based training of cataract surgery. Available literature was evaluated and projections on how current findings could be applied to cataract surgery training were summarised. The quality of included literature was also assessed.
Methods and analysis: The PubMed, Embase and Cochrane Library databases were searched for articles pertaining to simulation training in cataract surgery on 18 November 2019. Selected articles were qualitatively analysed.
Results: A total of 165 articles were identified out of which 10 met inclusion criteria. Four studies reported construct validity of the …

Current Challenges Of Digital Health Interventions In Pakistan: Mixed Methods Analysis, Abdul Momin Kazi, Saad Ahmed Qazi, Nazia Ahsan, Sadori Khawaja, Fareeha Sameen, Muhammad Ayub Khan Mughal, Zabin Wajidali, Hussain Kalimuddin, Yasir Rauf, Fatima Mahmood

Department of Paediatrics and Child Health

Background: Digital health is well-positioned in low and middle-income countries (LMICs) to revolutionize health care due, in part, to increasing mobile phone access and internet connectivity. This paper evaluates the underlying factors that can potentially facilitate or hinder the progress of digital health in Pakistan.
Objective: The objective of this study is to identify the current digital health projects and studies being carried out in Pakistan, as well as the key stakeholders involved in these initiatives. We aim to follow a mixed-methods strategy and to evaluate these projects and studies through a strengths, weaknesses, opportunities, and threats (SWOT) analysis to …

African League Against Rheumatism (Aflar) Preliminary Recommendations On The Management Of Rheumatic Diseases During The Covid-19 Pandemic, Richard Oluyinka Akintayo, Rachid Bahiri, Yasser El Miedany, Hakeem Olaosebikan, Asgar Ali Kalla, Adewale Olukayode Adebajo, Angela Migowa, Samy Slimani, Ouma Devi Koussougbo, Ben Abdelghani Kawther

Paediatrics and Child Health, East Africa

Objectives: To develop recommendations for the management of rheumatic and musculoskeletal diseases (RMDs) during the COVID-19 pandemic.

Method: A task force comprising of 25 rheumatologists from the 5 regions of the continent was formed and operated through a hub-and-spoke model with a central working committee (CWC) and 4 subgroups. The subgroups championed separate scopes of the clinical questions and formulated preliminary statements of recommendations which were processed centrally in the CWC. The CWC and each subgroup met by several virtual meetings, and two rounds of voting were conducted on the drafted statements of recommendations. Votes were online-delivered and …

Musculoskeletal Tumours Throughout History And Beyond: Clinical Features, Imaging, Staging And Biopsy, Akbar Jaleel Zubairi, Obada Hussein Hasan, Mohammad Mustafa, Masood Umer

Section of Orthopaedic Surgery

Background: Over the last century, there has been a remarkable development in the study of bone and soft tissue sarcomas. This is primarily due to the improved knowledge of the nature of these lesions and the improved imaging technology. In literature there are many protocols that are being used and all of them have reported various advantages and disadvantages of each technique used. However, there is no set guideline and whatever has been proposed has been developed on the basis of the experience of different centres and different surgeons.
Objective: The current systematic review was planned to thoroughly evaluate the …

Cerebellar Mutism Syndrome After Surgical Resection Of Posterior Fossa Neoplastic Lesions, Saqib Kamran Bakhshi, Rida Mitha, Naureen Mushtaq, Muhammad Shahzad Shamim

Section of Neurosurgery

Cerebellar Mutism Syndrome (CMS) is a well-described clinical entity that complicates surgeries for posterior fossa tumours; more so in children than adults. This review focuses on the current understanding of CMS, its incidence and risk factors. Incidence showed a variable range in retrospective studies due to variety of definitions. Risk factors can be classified as either modifiable including surgical technique, or non-modifiable which include tumour related factors. A positive correlation has been associated between tumour pathology, brain stem invasion and size of tumour at time of presentation with development of CMS.

Localizing An Occult Insulinoma By Selective Calcium Arterial Stimulation Test: First Ever Experience And A New Dimension To Diagnosis In Pakistan, Muhammad Owais Rashid, Sumerah Jabeen, Zareen Kiran,, Khurram Minhas, Muhammad Azeemuddin, Najmul Islam

Section of Diabetes, Endocrinology and Metabolism

Insulinomas are rare, usually benign, solitary tumours accounting for 60% of islet cell tumours. These tumours can be difficult to localize preoperatively due to their small size. We present a challenging case of a 40 year old male with frequent hypoglycaemic spells and endogenous hypoglycaemia who presented as a diagnostic dilemma. Patient had an occult insulinoma with inconclusive CT Abdomen, MRI Abdomen and Octreotide scan. The final localization of the tumour was made by selective arterial calcium stimulation testing (SCAT), done for the first time in Pakistan at Aga Khan University Hospital. This was followed by successful distal pancreatectomy as …

Vitamin D Usage Among Pakistani Population - Too Much Of A Good Thing, Bhagwan Das, Sarah Nadeem

Section of Diabetes, Endocrinology and Metabolism

No abstract provided.

Medicolegal Issues In Neurology Practice In Pakistan, Ismail A Khatri, Maimoona Siddiqui

Pakistan Journal of Neurological Sciences (PJNS)

Neurology despite its challenges have made tremendous improvement in past few decades. At the same time, the rapid advancement of media and internet has changed the traditional doctor-patient relationship into one of a service provider-consumer relationship1. The health service is now considered a commodity, and has become prone to lack of trust and litigation. Medical professionalism is challenged by increasing commercialism and influence of legal system

Neurological Care And Training In The Times Of Covid-19: A Tertiary Care Center Experience, Lubna Ashraf Jafri, Maryam Javed, Ali Sajjad, Dureshahwar Kanwar, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

Resilience in these challenging times of COVID-19 at a professional and personal level is cardinal. Trainees and faculty have had to adapt to this adversity with striking limitations on formal neurological, neurovascular and neurophysiological residencies and fellowships. The revision of schedules and reallocation of assignments to cope with the practical aspects in a teaching tertiary care hospital have been overbearing. Novel structural innovation, testing, communications and supervision to assure a modified yet impactful training educational programme is mandatory and the need of the hour. Healthcare service providers remain at the highest risk of acquiring COVID-19 worldwide. Urgent measures to educate …

Venous Stroke Secondary To Varicella Zoster Virus Infection, Asma Akbar Ladak, Salman Farooq

Pakistan Journal of Neurological Sciences (PJNS)

This is a case of cerebral venous sinus thrombosis (CVST) as a rare complication of varicella Zoster infection. A young male with no significant medical history presented with generalized tonic clonic seizures preceded by vesicular rash on the face diagnosed as Varicella zoster infection. The MRI showed bilaterial superficial hemorrhagic infarcts involving frontal and temporal lobes and MR Venogram was consistent with extensive CVST involving superioir sagittal, right transverse and superficial veins. After initial treatment with antiepileptic and anticoagulant, he showed marked improvement in symptomatology and made complete recovery subsequently with recanalization of sinuses seen on a follow up MRV …

Hepetatis C Virus A Rare Cause Of Cereberal Venous Sinus Thrombosis, Haris Majid Rajput, Iqra Athar, Neelma Naz Khattak, Anam Anis, Mazhar Badshah

Pakistan Journal of Neurological Sciences (PJNS)

Cerebral venous sinus thrombosis is challenging condition because of its variability of underlying pathological causes. Numerous conditions can cause cerebral venous sinus thrombosis (CVST), and often more than one cause can be found in an individual patient. The causes leading to CVST can be classified into two broad categories; infective and non-infective. Among infective causes, chronic hepatitis C infection is considered as one of the extremely rare causes of cerebral venous sinus thrombosis.

Disease Modification Trials In Parkinsons Disease: A Review, Ramla Nayaib Hashmi, Ummul Kiram

Pakistan Journal of Neurological Sciences (PJNS)

Among the common neurological disorders worldwide, Parkinson’s disease has a major share. Currently, only symptomatic therapies are available for it without any approved neuromodulation drugs as all the previously done disease modification trials have failed. There is a dire need for such therapies. Disease modification trials include all types of intervention targeting the degeneration process which underlies the disease process and thus slows it down or the treatment aim to regenerate or replace the neurons which are lost. There are many reasons for the failure of trials. This review emphasize the need for disease modification trials, causes of failure of …

Cerebral Venous Sinus Thrombosis Associated With Coronavirus Infection (Covid-19), Sajid Hameed, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

Coronavirus disease 2019 (COVID-19) is a severe acute respiratory syndrome (SARS) caused by the SARS-CoV-2 coronavirus. Despite its primarily respiratory involvement, an increased propensity for systemic inflammation, neuroinvasion, and thromboembolic events has been reported. This systemic prothrombotic state may predispose to cerebral venous sinus thrombosis (CVST), which is an uncommon cerebrovascular disease with hypercoagulability as one of its important risk factors. We conducted a literature search using the PubMed electronic database and reviewed the published literature for a possible association of CVST with the COVID-19 disease.

Secondary Prevention Of Cardiovascular Diseases In India: Findings From Registries And Large Cohorts, Hasan Rehman, Ankur Kalra, Ajar Kochar, Angad S. Uberoi, Deepak L. Bhatt, Zainab Samad, Salim S. Virani

Section of Cardiology

Several registries and quality improvement initiatives have focused on assessing and improving secondary prevention of CVD in India. While the Treatment and Outcomes of Acute Coronary Syndromes in India (CREATE), Indian Heart Rhythm Society-Atrial Fibrillation (IHRS-AF), and Trivandrum Heart Failure (THF) registries are limited to collecting data, the Tamil Nadu-ST-Segment Elevation Myocardial Infarction (TN-STEMI) program was aimed at examining and improving access to revascularization after an ST-elevation myocardial infarction (STEMI). The Acute Coronary Syndromes: Quality Improvement in Kerala (ACS-QUIK) study recruited hospitals from the Kerala ACS registry to assess a quality improvement kit for patients with ACS while the Practice …

Etiology Of Acute Undifferentiated Fever In Patients Presenting To The Emergency Department Of A Tertiary Care Center In Karachi, Pakistan, Noman Ali, Nadeem Ullah Khan, Shahid Shahid, Syed Mustahsan

Department of Emergency Medicine

Objective: Our study aimed at identifying the characteristics and etiology of various causes of acute undifferentiated fever in patients presenting to the emergency department of a tertiary care hospital.
Methods: This was a retrospective study conducted at the department of emergency medicine, Aga Khan University Hospital from January to June 2016. Adult patients presenting to Emergency department with acute undifferentiated fever were enrolled. Descriptive statistics were calculated in terms of mean±SD for continuous variables like age of the patients and duration of fever, whereas frequency and percentage were computed for categorical variables like gender and causes of fever.
Results: A …

Quantifying Long-Term Health And Economic Outcomes For Survivors Of Group B Streptococcus Invasive Disease In Infancy: Protocol Of A Multi-Country Study In Argentina, India, Kenya, Mozambique And South Africa, Proma Paul, Simon R. Procter, Ziyaad Dangor, Quique Bassat, Amina Abubakar, Sridhar Santhanam, Romina Libster, Bronner P. Gonçalves, Shabir A. Madhi, Azucena Bardají

Institute for Human Development, East Africa

Sepsis and meningitis due to invasive group B Streptococcus (iGBS) disease during early infancy is a leading cause of child mortality. Recent systematic estimates of the worldwide burden of GBS suggested that there are 319,000 cases of infant iGBS disease each year, and an estimated 147,000 stillbirths and young-infant deaths, with the highest burden occurring in Sub-Saharan Africa. The following priority data gaps were highlighted: (1) long-term outcome data after infant iGBS, including mild disability, to calculate quality-adjusted life years (QALYs) or disability-adjusted life years (DALYs) and (2) economic burden for iGBS survivors and their families. Geographic data gaps were …

Stakeholders’ Expectations Of Graduates Of A Work-Study Nursing Upskilling Programme In East Africa, Sharon Brownie, Samwel Gatimu, Isabel Kambo, Joseph Mwizerwa, Eunice Ndirangu

School of Nursing & Midwifery, East Africa

Sound alignment of stakeholders’ expectations and graduate ability forms the reputational hallmark of a university’s education programmes. However, little is currently known about stakeholders’ expectations of graduates of work-study nursing upskilling programmes in low- and middle-income settings. Information is needed to ensure the quality and adequacy of curricula in such settings. The main aim of the current study was to explore the nursing stakeholders’ expectations of graduates of work-study nursing upskilling programmes. An exploratory qualitative study was conducted between March and October 2016 in three low- and middle-income countries in East Africa. Forty-two representatives of nursing employers, regulators and professional …

Impact Of Humanities And Social Sciences Curriculum In An Undergraduate Medical Education Programme, Kulsoom Ghias, Kausar S. Khan, Rukhsana Ali, Shireen Azfar, Rashida Ahmed

Department of Biological & Biomedical Sciences

Objective: To evaluate the impact of humanities and social sciences curriculum in an undergraduate medical education programme.
Methods: The qualitative study was conducted from May 2016 to May 2017 at a private medical college in Karachi where humanities and social sciences subject is an art of the undergraduate curriculum as a 6-week module at the start of Year 1 of the five-year programme. Focus group discussions were held with students from all the five years as well as with faculty related to humanities and social sciences, basic sciences and their clinical counterparts. The views of alumni of the undergraduate programme …

Brucellosis In Pakistan: A Neglected Zoonotic Disease, Meesha Iqbal, Zafar Fatmi, Mumtaz Ali Khan

Community Health Sciences

Brucellosis is a zoonotic disease; endemic but neglected in the South Asian countries including Pakistan. It causes economic loss to the livestock sector and leads to systemic infection in humans. Brucellosis was neglected in Pakistan since long. According to the Staged Tool for the Elimination of Brucellosis (STEB), Pakistan carries a grim landscape of the disease with no structured control activities. This article describes the five-year national brucellosis control strategic plan (2018-2023) formulated by the government of Pakistan using the one-health approach for the prevention and control of disease across the country. The plan incorporates components of surveillance, research, diagnostic …

What Will It Take To Implement Health And Health-Related Sustainable Development Goals?, Zulfiqar Ahmed Bhutta, Sameen Siddiqi, Wafa Aftab, Fahad Javaid Siddiqui, Luis Huicho, Roman Mogilevskii, Qamar Mahmood, Peter Friberg, Fawad Akbari

Woman and Child Health

No abstract provided.

Maternal And Perinatal Outcomes In Women With Eclampsia By Mode Of Delivery At Riley Mother Baby Hospital: A Longitudinal Case-Series Study, Philippe Amubuomombe Poli, Koech Irene, Richard Mogeni, Ann Mwangi, Andrew Cheruiyot, Elkanah Omenge

Obstetrics and Gynaecology, East Africa

Background: Eclampsia, considered a serious complication of preeclampsia, remains a life-threatening condition among pregnant women. It accounts for 12% of maternal deaths and 16–31% of perinatal deaths worldwide. Most deaths from eclampsia occurred in resource-limited settings of sub-Saharan Africa. This study was performed to determine the optimum mode of delivery, as well as factors associated with the mode of delivery, in women admitted with eclampsia at Riley Mother and Baby Hospital.

Methods: This was a hospital-based longitudinal case-series study conducted at the largest and busiest obstetric unit of the tertiary hospital of western Kenya. Maternal and perinatal variables, such as …

Cerebral Cavernous Malformation Presenting As Seizures, Hazim Brohi, Ayisha Farooq, Bushra Rehan, Muhammad Mairaj Khan

Pakistan Journal of Neurological Sciences (PJNS)

Cerebral cavernous malformations (CCMs) is one of the rare vascular malformation. It is diagnosed by characteristic lesions on magnetic resonance imaging (MRI). CCMs typically appears as a “popcorn-like” masses on T2-weighted images on MRI studies.And clinically can lead to headaches, seizures,focal neurological deficits or intracerebral hemorrhages. . A familial form is suggested if lesions are multiple, and a sporadic form, if single