Medicine and Health Sciences Commons^™

Acute Syphilitic Posterior Placoid Chorioretinopathy: A Case Report, Rehman Siddiqui, Syed Zohaib Maroof Hussain, Irfan Jeeva, Raeefuddin Ahmed

Section of Ophthalmology

A 25-year-old male presented with a complaint of acute visual loss in his right eye for two days. There was a history of visual loss in the left eye six months ago. Comprehensive eye examination showed evidence of posterior uveitis, and a placoid lesion on the right fundus. Further physical examination showed maculopapular rashes on the upper back which was highly suggestive of syphilis. Blood tests for venereal disease research laboratory (VDRL) test and fluorescent treponemal antibody absorption (FTA-ABS) test were ordered, which were both positive. Ocular syphilis should be suspected in all cases of uveitis. Early diagnosis and prompt …

Significance Of Micro-Rna Expression In Patients With Meningioma, Rida Mitha, Muhammad Shahzad Shamim

Section of Neurosurgery

Recent brain tumour research has shown abnormalities in gene expression as key features for almost all common brain tumours investigated. However, there is increasing evidence that epigenetic abnormalities are also crucial for tumorigenesis. Epigenetic abnormalities are heritable alterations affecting gene expression without changing the primary DNA sequence. Epigenetic abnormalities in meningiomas include abnormal microRNA expression, altered DNA methylation and histone and chromatin modifications. In this review we identify the role of altered expression of microRNA in the development and recurrence of meningioma. Based on the review of current literature, extensive knowledge of micro-RNA expression cannot only determine tumour recurrence and …

Effectiveness Of High-Fidelity Simulation In Nursing Education For End-Of-Life Care: A Quasi-Experimental Design, Salma Rattani, Zohra Kurji, Amina Aijaz Khowaja Ap, Jacqueline Maria Dias, Anila Naz Alisher

School of Nursing & Midwifery

Background: Providing end of life (EOL) care is a component of palliative care but dealing with dying patients and their family members is stressful for the healthcare providers. To prepare them for providing EOL care, the high-fidelity simulation could be used as a pedagogy in which real-life scenarios are used on the computerized manikins mimicking the real patients.
Aims: The aim of this study was to measure the effectiveness of high-fidelity simulation to teach EOL care in the palliative nursing course in the undergraduate nursing education program at the School of Nursing and Midwifery at Aga Khan University which is …

Association Of Circulatory Kisspeptin Levels And Hormonal Interplay With Male Infertility: A Cross-Sectional Study In Karachi, Pakistan, Rehana Rehman, Kaleem Ahmed, Nida Zahid, Faiza Alam, Syeda Sadia Fatima

Department of Biological & Biomedical Sciences

Objectives: To determine the impact of Kisspeptin on male reproductive axis in a selected urban population.
Methods: The cross-sectional study was conducted at the Sindh Institute of Reproductive Medicine in collaboration with Aga Khan University, Karachi, from July, 2017, to February, 2018, and comprised infertile males with abnormal sperm parameters who were placed in Group A and fertile males with normal sperm parameters placed in Group B. Serum samples were estimated for Kisspeptin, follicle stimulating hormone, luteinizing hormone, testosterone and sex hormone-binding globulin using enzyme-linked immunosorbent assay. Data was analysed using SPSS 22.
Results: Of the 313 male subjects, 178(57%) …

Getting Accepted – Successful Writing For Scientific Publication: A Research Primer For Low- And Middle-Income Countries, Erin L. Simon, Maxwell Osei-Ampofo, Benjamin Wachira, James Kwan

Emergency Medicine, East Africa

Clear and precise writing is a vital skill for healthcare providers and those involved in global emergency care research. It allows one to publish in scientific literature and present oral and written summaries of their work. However, writing skills for publishing are rarely part of the curriculum in the healthcare education system. This review gives you a step-by-step guide on how to successfully write for scientific publication following the IMRaD principle (Introduction, Methods, Results, and Discussion) with every part supporting the key message. There are specific benefits of writing for publication that justify the extra work involved. Any lessons learned …

Magnitude Of Screening For Gestational Diabetes Mellitus In An Urban Setting In Tanzania; A Cross-Sectional Analytic Study, Akampa Mukuve, Mariam Noorani, Ibrahim Sendagire, Miriam Mgonja

Faculty of Health Sciences, East Africa

Background

Medical screening detects risk factors for disease or presence of disease in otherwise well persons in order to intervene early and reduce morbidity and mortality. During antenatal care (ANC) it is important to detect conditions that complicate pregnancy, like gestational diabetes mellitus (GDM). Despite international and local guidelines recommending screening for GDM during ANC, there is evidence to suggest that the practice was not being carried out adequately. A major challenge may be lack of consensus on uniform GDM screening and diagnostic guidelines internationally and locally.

The primary objective was to determine the magnitude of screening for GDM among …

Delivering Water, Sanitation And Hygiene Interventions To Women And Children In Conflict Settings: A Systematic Review, Daina Als, Sarah Meteke, Marianne Stefopulos, Michelle F. Gaffey, Mahdis Kamali, Mariella Munyuzangabo, Shailja Shah, Reena P. Jain, Amruta Radhakrishnan, Fahad J. Siddiqui, Anushka Ataullahjan, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background: Access to safe water and sanitation facilities and the adoption of effective hygiene practices are fundamental to reducing maternal and child morbidity and mortality globally. In armed conflict settings, inadequate water, sanitation and hygiene (WASH) infrastructure poses major health risks for women and children. This review aimed to synthesise the existing information on WASH interventions being delivered to women and children in conflict settings in low-income and middle-income countries (LMICs) and to identify the personnel, sites and platforms being used to deliver such interventions.
Methods: We conducted a systematic search for publications indexed in four databases, and grey literature …

Delivery Of Sexual And Reproductive Health Interventions In Conflict Settings: A Systematic Review, Mariella Munyuzangabo, Dina Sami Khalifa, Michelle F. Gaffey, Mahdis Kamali, Fahad J. Siddiqui, Sarah Metek, Shailja Shah, Reena P. Jain, Daina Als, Amruta Radhakrishnan, Anushka Ataullahjan, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background: It is essential to provide comprehensive sexual and reproductive health (SRH) interventions to women affected by armed conflict, but there is a lack of evidence on effective approaches to delivering such interventions in conflict settings. This review synthesised the available literature on SRH intervention delivery in conflict settings to inform potential priorities for further research and additional guidance development.
Methods: We searched MEDLINE, Embase, CINAHL and PsycINFO databases using terms related to conflict, women and children, and SRH. We searched websites of 10 humanitarian organisations for relevant grey literature. Publications reporting on conflict-affected populations in low-income and middle-income countries …

Detection Of Types Of Hpv Among Hiv-Infected And Hiv-Uninfected Kenyan Women Undergoing Cryotherapy Or Loop Electrosurgical Excision Procedure, Elkanah Omenge, Jordan P. Emont, Aaron Ermel, Tao Liu, Victor Omodi, Yan Tong, Peter Itsura, Philip Tonui, Titus Maina, John M. Ong’Echa

Obstetrics and Gynaecology, East Africa

Objective: To assess the baseline types of HPV infection among HIV-positive and HIV-negative women in western Kenya undergoing cryotherapy or loop electrosurgical excision procedure (LEEP) for cervical intraepithelial neoplasia.

Methods: A prospective observational study was conducted of baseline HPV characteristics of women undergoing visual inspection with acetic acid (VIA) and cryotherapy or LEEP. After a positive VIA in HIV-positive and HIV-negative women, data on demographics, CD4 count, and use of antiretroviral therapy and a cervical swab were collected. HPV typing was performed using the Roche Linear Array.

Results: Of 175 participants, 86 (49.1%) were HIV-positive and had a higher prevalence …

Persistence Of Oncogenic And Non-Oncogenic Human Papillomavirus Is Associated With Human Immunodeficiency Virus Infection In Kenyan Women, Yan Tong, Philip Tonui, Aaron Ermel, Elkanah Omenge, Nelson Wong, Titus Maina, Stephen Kiptoo, Kapten Muthoka, Patrick J. Loehrer, Darron R. Brown

Obstetrics and Gynaecology, East Africa

Objectives: Cervical cancer is caused by persistent infection with oncogenic, or “high-risk” types of human papillomaviruses, and is the most common malignancy in Kenyan women. A longitudinal study was initiated to investigate factors associated with persistent human papillomavirus detection among HIV-infected and HIV-uninfected Kenyan women without evidence of cervical dysplasia.

Methods: Demographic/behavioral data and cervical swabs were collected from HIV-uninfected women (n = 82) and HIV-infected women (n = 101) at enrollment and annually for 2 years. Human papillomavirus typing was performed on swabs (Roche Linear Array). Logistic regression models of human papillomavirus persistence were adjusted for demographic …

Video Analysis Of Newborn Resuscitations After Simulation-Based Helping Babies Breathe Training, Ingunn Anda Haug, Kari Holte, Catherine L. Chang, Carolyn Purington, Joar Eilevstjønn, Anita Yeconia, Hussein Kidanto, Hege L. Ersdal

Obstetrics and Gynaecology, East Africa

Background: Simulation-based Helping Babies Breathe (HBB) training is currently rolled-out in around 80 low-income countries with various results.

Method: Workflow was analyzed in 76 video-recorded newborn resuscitations performed by regularly HBB-trained nurse-midwives over 3 years in rural Tanzania.

Results: Actual newborn resuscitation practice deviated from HBB intention/guideline: most newborns underwent prolonged suction and stimulation before ventilation; ventilation was delayed and frequently interrupted. Nurse-midwives often worked together.

Conclusions:There is a gap between training intention and clinical practice. HBB trainings should focus more on urgency, ventilation skills, and team training. Combining clinical debriefing with HBB simulations could facilitate continuous learning and …

A Rare Case Of Three Years Disease Free Survival In A Locally Advanced Parathyroid Carcinoma Successfully Excised By Complete Surgical Resection, Abdul Ahad Sohail, Bushra Ayub, Syed Akbar Abbas, Shafqat Ali Sheikh, Talha Ahmed Qureshi, Muhammad Usman Tariq, Asad Diwan

Department of Surgery Docs

Parathyroid carcinoma (PC) is one of the rarest malignancies making approximately 0.005% of all cancers. It may arise sporadically or less commonly, in conjunction with genetic endocrine syndromes. Due to the rarity of the disease, no general consensus or definitive guidelines exist for its pre-operative diagnosis, management, or follow up. Surgical tumor removal is the gold standard treatment to prevent its recurrence. Parathyroid carcinoma has a high recurrence rate ranging from 40 to 60% in recent literature. We report a case of a seventy-year-old elderly female with locally advanced parathyroid carcinoma successfully surgically excised completely with a 3 year disease …

Postoperative Myocardial Injury In A Patient With Left Ureteric Stone And Asymptomatic Covid-19 Disease, Nadeem Kassam, Omar Aziz, Ally Zain Ismail, Rodgers Swai, Samina Somji, Robert Mvungi, Mustaafa Bapumia, Ali Akbar Zehri, Salim Surani

Internal Medicine, East Africa

Coronavirus disease 2019 (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It was first identified on 8thDecember 2019 in Wuhan, Hubei, China, and has since spread globally to become an emergency of international concern. Patients infected with SARS-CoV-2 may be asymptomatic or present with symptoms ranging from mild clinical manifestations: such as fever, cough, and sore throat to moderate and severe form of the disease such as pneumonia and acute respiratory distress syndrome (ARDS). In some patients, SARS-CoV-2 can affect the heart and cause myocardial injury which is evidenced either by electrocardiographic (ECG) changes …

Aggressive Angiomyxoma In The Ischiorectal Fossa, Asra Wahid, Abdul Hakeem, Sadaf Khan

Medical College Documents

Aggressive Angiomyxoma (AA) is a soft tissue tumour that principally affects women of the reproductive age, primarily involving the pelvis and the perineum. Despite being slow growing, it is classified as aggressive due to its locally infiltrative nature and high recurrence. It is rare, often asymptomatic and is misdiagnosed. However, it has characteristic features on radiographic imaging. Complete surgical resection is the ideal approach to treat AA. We report a case of an aggressive angiomyxoma in a 17 year old female, located in the ischiorectal fossa and diagnosed incidentally on a magnetic resonance imaging (MRI). The lesion was excised without …

Post-Vaccination Pharyngeal-Cervical-Brachial Variant Of Guillain-Barré Syndrome, Funmilola T. Taiwo, Daniel E. Ezuduemoih, Philip Adebayo

Internal Medicine, East Africa

The pharyngeal-cervical-brachial (PCB) variant of Guillain-Barré syndrome (GBS) is very rare. It is characterized by weakness of the upper extremities associated with bulbar symptoms and facial diplegia. Documented cases were post-infectious, a post-vaccination occurrence has not been documented in the available literature. Even rarer is the occurrence of any variant of GBS following the mumps measles rubella (MMR) vaccine. The neurophysiological hallmark of PCB variant of GBS is a combination of myelinopathy and axonopathy, hence, its consideration as a subtype of the acute motor axonal neuropathy (AMAN) variant. It should be suspected in any case of acute-onset flaccid symmetrical weakness …

Recommendations: Putting An End To Child Labour In Pakistan!, Meesha Iqbal, Zafar Fatmi, Kausar S. Khan, Asaad Ahmed Nafees, Neelma Amjad

Community Health Sciences

Child labour is rampant in Pakistan since ages. Laws, policies, programmes and strategies to eliminate child labour have been in place with little gain. Implementation of laws and sustainability of programmes offer barriers to eliminate the menace. We recommend a new approach of regulating child labour as a strategy to eliminate it in the longer run. Model districts with drop-in-centres offering free education to the working children should be constructed. The key stakeholders should unite on a common platform to formulate guidelines defining the nature and duration of work for children in various sectors such that they have sufficient time …

Furrowed Tongue, Fatten Lip And Facial Droop, Philip Adebayo, Hanifa Mbithe

Internal Medicine, East Africa

No abstract provided.

Inspire : Vol 3, Issue 7, Department Of Medicine

INSPIRE – Department of Medicine Archives

Content

• Medicine at National and International Forums
• Tele ICU Initiatives- Providing Quality Care to COVID-19 Patients Across Pakistan
• Dapagliflozin; breakthrough in management of Heart Failure with & without Type-II Diabetes
• Pioneering; First-Ever ‘Virtual Annual Research Day’
• Featured Faculty: Dr Ali Sarwar Zubairi “Maintain a decent work-life balance and spend time with family particularly your parents”
• Publications

Invasive Liver Abscess Syndrome Caused By Klebsiella Pneumoniae: First Tanzanian Experience, Nadeem Kassam, Omar Aziz, Samina Somji, Zainab Yusuf Fidaali, Salim Ramzan Surani

Internal Medicine, East Africa

Over the past 20 years there has been growing awareness of community-acquired primary liver abscess caused by strains of Klebsiella pneumoniae (K. pneumoniae) especially in patients of Asian descent, a minority of which are characterized by metastatic spread. A common and frequent destructive complication is endophthalmitis as well as the involvement of the central nervous system (CNS), causing suppurative meningitis or brain abscess. Here we report a case of invasive liver abscess caused by K. pneumoniae in an Asian patient who presented to our hospital in Tanzania with bilateral lower limb swelling for 6 weeks with acute onset of difficulty …

Diagnostic Value Of Mean Elasticity Index As A Quantitative Shear Wave Elastography Parameter For Prediction Of Malignancy In Small Suspicious Solid Thyroid Nodules, Saba Sohail, Sameera Kaliq Uz Zaman

Department of Radiology

Objective: To determine the diagnostic accuracy of mean elasticity index (Emean) on quantitative shear wave elastography (SWE) in detection of malignancy in small solid suspected malignant thyroid nodules on ultrasound, taking histopathology as the gold standard.
Study design: Analytical study.
Place and duration of study: Department of Radiology, Dow Medical College, Dow University of Health Sciences (DUHS) and Dr. Ruth K. M. Pfau Civil Hospital, Karachi from September 2017 to March 2018.
Methodology: Adult patients of either gender with suspected malignant thyroid nodules (solid, ≤10 mm) were subjected to SWE examination. All patients underwent thyroid surgery later. Histopathological findings were …

In Response To Letter Title "Immediate Hemodynamic And Gaseous Exchange Effect Of Bi-Level Positive Airway Pressure After Cardiac Surgery: Our Insight To Hamid Et Al.'S Study", Mohammad Hamid, Mohammad Irfan Akhtar, Saba Ahmed

Department of Anaesthesia

No abstract provided.

Major Septal Defects: Comparative Study Of Down Syndrome And Non-Down Syndrome Infants, Before And After Surgery, Saleha Aziz, Maaha Ayub, Laiba Masood, Muneer Amanullah, Rukhsana Hameed, Shiraz Hashmi, Waris Ahmad

Medical College Documents

Objective: To compare pre-operative, intra-operative, and post-operative parameters in Down syndrome (DS) and non-DS patients with atrioventricular septal defects (AVSD) and inlet ventricular septal defects (VSD) in a tertiary care hospital in Pakistan.
Methods: We conducted a retrospective study at Aga Khan University, Pakistan. All complete atrioventricular septal defect (CAVSD), partial atrioventricular septal defect (PAVSD), and VSD with inlet extension surgical cases from January 2007 to January 2019 were included. Patients with congenital heart diseases other than those listed above were excluded.
Results: In 61 cases, 18 had DS. Median age, mean body surface area (BSA), and height were lower …

Outcome Of Cranial Firearm Injuries In Civilian Population Based On A Novel Classification System, Farrukh Javeed, Asad Abbas, Lal Rehman, Syed Raza Khairat Rizvi, Ali Afzal, Hafiza Fatima Aziz

Section of Neurosurgery

Background: Cranial firearm injuries (CFAIs) are expected to be frequent during warfare; however, it is becoming increasingly common among civilian population in our part of the world. These injuries are associated with significant morbidity and mortality in addition to financial loss. The objective of our study is to evaluate the pattern of gunshot injuries to cranium and their outcome.
Methods: The study was conducted on 114 patients presenting with CFAIs to Jinnah Postgraduate Medical Centre, Karachi, Pakistan, between June 2015 and January 2019. Patients were evaluated with respect to age, gender, pattern of injury, Glasgow coma scale on arrival, radiological …

Improving The Coverage And Accuracy Of Syphilis Testing: The Development Of A Novel Rapid, Point-Of-Care Test For Confirmatory Testing Of Active Syphilis Infection And Its Early Evaluation In China And South Africa, Minh D. Pham, Amy Wise, Mary L. Garcia, Huy Van, Shuning Zheng, Yasmin Mohamed, Yan Han, Wan-Hui Wei, Yue-Ping Yin, Stanley Luchters

Population Health, East Africa

Background: Current point-of-care tests (POCT) for syphilis, based on the detection of Treponema pallidum (TP) total antibodies, have limited capacity in distinguishing between active and past/treated syphilis. We report the development and early evaluation of a new prototype POCT based on the detection of TP-IgA antibodies, a novel biomarker for active syphilis.

Methods: The TP-IgA POCT (index test) was developed in response to the World Health Organisation (WHO) target product profile (TPP) for a POCT for confirmatory syphilis testing. Two sub-studies were conducted consecutively using 458 pre-characterised stored plasma samples in China (sub-study one, addressing the criteria for the WHO …

Towards Effective Management Protocols: A Transnational Review Of The State-Of-The-Art Of Coronavirus Disease 2019 (Covid-19) In Pakistan And The United Arab Emirates, Maryam Ehtesham, Talal Almas, Absam Akbar, Muhammad Ali Niaz, Noreen Zia

Medical College Documents

Coronavirus disease 2019 (COVID-19) has proliferated rapidly in Pakistan, adversely affecting every province. The grave repercussions that the pandemic has elicited in Pakistan have evoked a dire need for drastic measures to be employed at both the governmental and provincial levels. Due to the inequitable appropriation of healthcare resources with respect to the various provinces, however, a stark contrast in terms of morbidity and mortality persists. Furthermore, considering that Pakistani citizens constitute a noteworthy proportion of expatriates residing in the United Arab Emirates (UAE) and the close proximity of the two countries, due consideration of the situation in the UAE …

Effects Of Coronavirus (Covid-19) Pandemic On Orthopedic Residency Program In The Seventh Largest City Of The World: Recommendations From A Resource-Constrained Setting, Marij Zahid, Syed Arif Ali, Naveed Baloch, Shahryar Noordin

Section of Orthopaedic Surgery

The coronavirus (COVID-19) pandemic has hit the entire world hard. Since its inception from Wuhan China the whole world is affected now. Health care facilities and workers are overwhelmed and the situation is changing on daily basis. With the changes in the dynamics of the hospitals, residency and fellowships training programs have also suffered undoubtedly. Due to decreased elective cases and outpatient clinics surgical training gets compromised, however on the other side this physical distancing and isolation have proven to be effective measures in controlling the disease. In this article we share our experience of effect of COVID-19 pandemic on …

Manuscript Writing And Publication Workshop: An Invoking Pilot Study On Enhancing Cognitive Research Capabilities In Health Sciences Institutes Of Pakistan, Mehwish Hussain, Rehana Rehman, Mukhtiar Baig

Department of Biological & Biomedical Sciences

Background: With an upsurge in research in developing countries, researchers from allied sciences need to augment their skills for disseminating research work worldwide. Training workshop is one of the quick interventions which can enhance writing skills and ease research publication.
Objective: We designed this research to explore the perception of the faculty of different higher education institutes (HEIs) regarding manuscript writing and to assess the impact of these workshops in the improvement of cognitive capabilities of preliminary researchers in Pakistan.
Methodology: We conducted workshops in HEIs of Sindh, Pakistan. Contents of the workshop covered algorithm of writing manuscript and related …

Differences In Angiographic Profile And Immediate Outcome Of Primary Percutaneous Coronary Intervention In Otherwise Risk-Free Young Male Smokers, Salik Ahmed, Sanam Khowaja, Saher Khowaja, Tariq Ashraf, Kanwal Aamir, Mahesh K. Batra, Musa Karim, Muhammad Anis M. Ahmedani, Syed Z. Jamal

Section of Internal Medicine

Introduction: Cigarette smoking is a well-established risk factor for the development and progression of coronary artery disease (CAD) and it is strongly related to cardiac morbidity and mortality. Therefore, this study aimed to compare the angiographic profile and immediate clinical outcomes in young male smokers and non-smokers without any other cardiac risk factors presented with ST-elevation myocardial infarction (STEMI).
Methods: This study includes young (≤40 years) male patients presented without cardiac risk factors other than smoking. Angiographic profile and immediate outcome of primary percutaneous coronary intervention (PCI) were collected from the hospital database.
Results: A total of 580 young male …

Perceptions Of Stakeholders About The Role Of Health System In Suicide Prevention In Ghizer, Gilgit-Baltistan, Pakistan, Anila Anjum, Tazeen S. Ali, Nousheen Pradhan, Murad M. Khan Dr., Rozina Karmaliani Professor

Community Health Sciences

Background: Suicide is a serious global public health problem, with more than 800,000 people dying by suicide worldwide every year. 79% of suicides happen in Low and Middle-Income Countries (LMICs), where lack of national suicide prevention programs coupled with inadequate MH facilities for early identification and treatment of mental disorders add to seriousness of the problems. Although there is paucity of research, studies suggest that the rate of suicide in district Ghizer, Gilgit-Baltistan (GB), in northern Pakistan may be higher compared to rest of the country.
Methods: This study aimed to explore the perceptions of stakeholders about the role of …

Achieving Accurate Estimates Of Fetal Gestational Age And Personalised Predictions Of Fetal Growth Based On Data From An International Prospective Cohort Study: A Population-Based Machine Learning Study, Russell Fung, Jose Villar, Ali Dashti, Leila Cheikh Ismail, Eleonora Staines-Uria, Eric O. Ohuma, Maria Carvalho, Shama Munim, Zulfiqar Ahmed Bhutta, International Fetal And Newborn Growth Consortium For The 21st Century (Intergrowth-21st)

Department of Obstetrics & Gynaecology

Background: Preterm birth is a major global health challenge, the leading cause of death in children under 5 years of age, and a key measure of a population's general health and nutritional status. Current clinical methods of estimating fetal gestational age are often inaccurate. For example, between 20 and 30 weeks of gestation, the width of the 95% prediction interval around the actual gestational age is estimated to be 18-36 days, even when the best ultrasound estimates are used. The aims of this study are to improve estimates of fetal gestational age and provide personalised predictions of future growth.
Methods: …