Medicine and Health Sciences Commons^™

Caesarean Section Rates In South Asian Cities: Can Midwifery Help Stem The Rise?, Sulochana Dhakal Rai, Amudha Poobalan, Rafat Jan, Malin Bogren, Juliet Wood, Ganesh Dangal, Pramod Regmi, Edwin Van Teijlingen, Keshar Bahadur Dhakal, Sahib Jan Badar, Farhana Shahid

Journal of Asian Midwives (JAM)

Introduction: Caesarean section (CS) is a life-saving surgical intervention for delivering a baby when complications arisein childbirth. World Health Organization recommends a rate of CS from 10% to 15%. However, CS rates increased steadily in recent decades and have almost doubled from 12.1% in 2000 to 21.1% in 2015. Therefore, this has become a global public health problem. The main purpose of the scoping review article is to give an overview and analysis of the rising CS use in four South Asian countries: Bangladesh, India, Nepal and Pakistan.
Methods: A scoping review was carried-out using several bibliographic electronic databases (MEDLINE, …

Effect Of Target Controlled Propofol Infusion Versus Intermittent Boluses During Oesophagogastroduodenoscopy: A Randomized Controlled Trial, Catherine Ndosi, Vitalis Mung’Ayi, Ednah Gisore, Samina Mir

Anaesthesiology, East Africa

Background: Propofol is administered as intermittent boluses to achieve deep sedation to facilitate oesophagogastroduodenoscopy. Target controlled infusion (TCI) can be employed for this purpose.

Methods: 176 adults were randomly allocated into two groups of 88 patients. Control group: Received an initial bolus of propofol 1mg/kg, with repeat boluses of 0.25mg/kg. Intervention group: Received an initial target effect-site concentration of 4mcg/ml, followed by maintenance target effect-site concentration of 2.5mcg/ml, titrated by 0.5mcg/ml from baseline infusion rate as needed. Oxygen saturation, blood pressure and heart rate were evaluated immediately before administering the sedative and at 2.50, 5.00, 7.50 and 10.00 minutes. Oxygen …

Eel Fish Bite: An Impending Emergency In Arabian Sea, Sadia Zafar, Zafar Fatmi

Community Health Sciences

No abstract provided.

Rare Presentation Of Cerebral Venous Sinus Thrombosis, Haris Majid Rajput, Anam Anis, Iqra Athar, Neelma Naz Khattak, Hanin Tanich, Mazhar Badshah

Pakistan Journal of Neurological Sciences (PJNS)

We report case of a 16 year old girl with no known co-morbidities, presented with headache, quadriparesis and sudden vision loss. She had pallor and BMI was 33.09kg/m2. She had left 6th nerve palsy, bilateral papilledema and no perception of light. Motor examination showed power of 4/5 in all four limbs with bilateral extensor plantars. Neuroimaging was suggestive of superior saggital sinus thrombosis. CSF opening pressure was 72 cm of water.20 ml CSF was drained leading to improvement in headache and visual acuity. CVST presenting with quadriparesis and visual loss is a rare entity. Common presentations of CVST include headache, …

Cerebral Venous Sinus Thrombosis With Positive Dengue Serology, Sajid Hameed, Owais Hashmat, Mubashar Memon, Muhammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

Dengue fever is a viral febrile illness caused by dengue virus and spread by Aedes mosquito worldwide. It usually manifests as an acute fever associated with body ache, skin rash, and thrombocytopenia. Neurological manifestations are relatively uncommon but well-known. We report a case of a 25-year-old male patient who presented to our hospital with acute febrile illness, headache, and vomiting. Extensive laboratory investigations were done and he was diagnosed with cerebral venous sinus thrombosis. Dengue serology was positive. He was treated with anticoagulation and hydration with complete recovery. The treatment with anticoagulation is challenging due to accompanying thrombocytopenia. Only two …

Culture Bound Syndromes In Pakistan: Implications And Strategic Vision For Health Management, Lamae Zulfiqar, Nazish Idrees, Muhammad Rafiq

Pakistan Journal of Neurological Sciences (PJNS)

Understanding the culture a person belongs to is crucial as it forms the beliefs, values, perspectives, worries and hopes. It can then be used to assess the problems a person goes through and devise a treatment plan with a focus on belief system of a person. Culture bound syndromes are common in every society but are usually overlooked or given less consideration by professionals. These syndromes are belief systems associated with various diseases and disorders and can be very helpful in treatment, if understood in the perspective of a particular person as every syndrome is perceived differently by an individual …

Can Early Orthotic Support And Physical Therapy Improve The Functional Level And Decrease Rate Of Surgical Interventions In Spastic Cerebral Palsy?, Sarfraz Ahmad, Syeda Rahat, Syeda Bushra

Pakistan Journal of Neurological Sciences (PJNS)

cerebral palsy is a disorder of movement and posture that results from a non progressive lesion of brain within 3 years of age. To determine the role of early orthotics and physical therapy in improving the functional status and in decreasing the rate of surgical interventions in management of spastic diplegic cerebral palsy child.

Mental Health Of University Male Students Viewing Internet Pornography: A Qualitative Study, Komal Razzaq, Muhammad Rafiq

Pakistan Journal of Neurological Sciences (PJNS)

This research was carried out to explore psychosocial and mental health issues of adults viewing pornography on the internet. Study Design: For this purpose, a qualitative research design was used. Method: In- depth interviews were conducted with twenty five university male students to explore the psychosocial issues in cases of internet pornography. After gathering the data from participants, a software, NVivo11 Plus was used for data management and analysis. This was also used for labelling and themes and categories generation. Results: After data analysis, main three categories generated on psychosocial issues associated with viewing internet pornography which were psychological issues, …

Rhabdomyolysis Due To Status Epilepticus Causing Acute Renal Failure, Iqra Athar, Neelma Naz Khattak, Haris Majid Rajput, Anam Anis, Hanin Tanich, Mazhar Badshah

Pakistan Journal of Neurological Sciences (PJNS)

Acute renal failure is one of the most common complications of rhabdomyolysis. Rhabdomyolysis is a serious syndrome and should be suspected in patients presenting after direct or indirect muscle injury, seizures, strenuous exercise, crush injuries and ingestion of drug or toxins. Rhabdomyolysis secondary to status epilepticus is a serious complication, leading to life threatening acute renal failure. Therefore, early recognition of risk of rhamdomylosis in status epilepticus and initiation of treatment is important.

Empowerment Of Primary Health Care In An Outreach Resource-Limited District In Punjab: A Strategy For Improving Adherence To Antiepileptic Drug Treatment In Children With Epilepsy., Muhammad Akbar Malik, Arshad Rafique, Ahmad Omar Virk

Pakistan Journal of Neurological Sciences (PJNS)

There is wide acknowledgement of the need for community involvement in the optimal management of children with epilepsy (CWE) in outreach financially constrained districts of the developing countries, but there is scarce data on comprehensive community-based childhood epilepsy treatment programs assessment.

Neurology Training In Pakistan: 2020-2025, Safia Bano, Sarwar Jamil Siddique, Ahsan Numan Numan

Pakistan Journal of Neurological Sciences (PJNS)

As the year 2019 comes to end, many advances in neurology has been occurred over worldwide and is still going on. The emergence of new devices and drugs will help neurologists with additional therapeutic options to optimize the patient care especially in more complex cases. Antibody therapies especially monoclonal antibodies are flooding the landscape in nearly every discipline of neurology is no exception. We watched newer clinical trials, gain FDA approval for use, and many more therapeutic evidence-based interventions enter the pipeline. Neurology in the 20th century has undergone extraordinary changes, particularly in the past few decades. We trace the …

Development And Validation Of Juvenile Criminal Thinking Styles’ Inventory, Fatima Sana, Muhammad Rafiq

Pakistan Journal of Neurological Sciences (PJNS)

The current research explored the styles of criminal thinking among juvenile delinquents in Pakistani cultural context. Initially, 40 juvenile delinquents were interviewed individually to generate an item pool of 34 distinct thought statements. After excluding repetitive items a list of 19 items was piloted on 30 juvenile delinquents as a self-report measure of 5-point rating scale (Juvenile Criminal Thinking Styles’ Inventory). Finally, a sample of 211 juvenile delinquents were given the final list of 19 items, Measure of Criminal Social Identity (Boduszek, Adamson, Shevlin, & Hyland, 2012; Shagufta, 2015), and a demographic form. Principal Component factor analysis determined a three …

Distal Splenorenal Shunt (Dsrs) In Children With Extrahepatic Portal Hypertension, Zia Ur Rehman, Zafar Nazir

Department of Surgery Docs

Portal hypertension (PH) is infrequent in children as compared to adults. Currently, repetitive endoscopic ablation of varices is standard treatment. However, endoscopic facilities are not readily available in resource-limited settings. We reviewed the indications, operative morbidity, mortality, shunt patency and re-bleeding episodes in nine patients (age range 6-16 years, M:F 6:3) who had DSRS for recurrent GI bleeding not responding to endoscopic treatment and hypersplenism. DSRS is a safe and effective treatment alternative in resource limiting setting for preventing bleeding and improving hypersplenism in children with extrahepatic portal hypertension.

Intravenous Dexamethasone Along With Caudal Block Improves Analgesic Efficacy Following Day-Case Inguinal Hernia Repair In Children: A Randomized Controlled Trial, Amjad Nadeem, Aliya Ahmed

Department of Anaesthesia

Objective: To assess the effectiveness of intravenous dexamethasone along with caudal block in improving analgesia following inguinal hernia repair in children.
Methods: The double-blind randomised controlled trial was conducted over a 6-month period from June 01, 2016 to November 30, 2016 at the Aga Khan University Hospital, Karachi, and comprised patients aged 1-5 years, scheduled for elective inguinal hernia repair. The subjects were randomised into two groups using the sealed envelope technique. Group D patients received 0.5mg/kg dexamethasone intravenous in 5ml, and group P was given placebo (5ml 0.9% saline). Assessment of postoperative pain was made through the faces, legs, …

Occupational Health Outcomes Among International Migrant Workers, Kristine Husøy Onarheim, Dianne Egli-Gany, Wafa Aftab

Community Health Sciences

No abstract provided.

Extract And Active Principal Of The Neotropical Vine Souroubea Sympetala Gilg. Block Fear Memory Reconsolidation, Anthony Murkar, Hristian Cayer, Jon James, Tony Durst, John T. Arnason, Pablos E. Sanchez-Vindas, M. Otarola Rojas, Zul Merali

Brain and Mind Institute

Background: Souroubea sympetala Gilg. is a neotropical vine native to Central America, investigated as part of a targeted study of the plant family Marcgraviaceae. Our previous research showed that extract of S. sympetala leaf and small branch extract had anxiolytic effects in animals and acts as an agonist for the GABAA receptor at the benzodiazepine binding site. To date, the potential effects of S. sympetala and its constituents on reconsolidation have not been assessed. Reconsolidation, the process by which formed memories are rendered labile and susceptible to change, may offer a window of opportunity for pharmacological manipulation of learned fear. …

Mr Perfusion Imaging, Techniques And Role In Differentiating Radiation Necrosis And Tumor Recurrence, Raima Zakaria, Fatima Mubarak, Muhammad Shahzad Shamim

Department of Radiology

High grade brain tumours are treated with surgery, chemotherapy and radiation therapy and despite such aggressive treatment, can recur in a short span of time. MRI scan has been the conventional diagnostic modality to diagnose recurrence, although at times it becomes difficult for the neuroradiologists to differentiate between tumour recurrence and radiation necrosis. Herein lies the emergent need to explore the efficacy of functional imaging to assist in this diagnostic challenge. Recent studies have sought to do so with promising implications, which we have attempted to summarize in this review.

Hypertension As A Reason For Cancellation Of Elective Surgical Cases On Day Of Surgery: A Five Year Audit Report From The Aga Khan University Hospital Karachi, Abdul Monem, Amjad Nadeem, Fauzia Khan

Department of Anaesthesia

Objective: To assess the controllable factors in preventing undue cancellation of elective surgical cases and to suggest measures to address the issue.
Methods: The retrospective audit was conducted at the Aga Khan University Hospital, Karachi, and comprised all cancellations of elective surgery from 2011 to 2015. The cases reviewed had been cancelled primarily due to hypertension. A three-member committee regularly reviewed files regarding case cancellations and data was gathered.
Results: Of the 42,242 surgical cases scheduled during the period, 2903 (6.8%) were cancelled. In 11(0.37%) of these cases, hypertension was the primary reason. Of them, 10(91%) were men and 1(9%) …

Burnout, Job Dissatisfaction, And Mental Health Outcomes Among Medical Students And Health Care Professionals At A Tertiary Care Hospital In Pakistan: Protocol For A Multi-Center Cross-Sectional Study, Syed Hamza Mufarrih, Aeman Naseer, Nada Qaisar Qureshi, Zohaib Anwar, Nida Zahid, Riaz Hussain Lakdawala, Shahryar Noordin

Department of Biological & Biomedical Sciences

Burnout, a state of vital exhaustion, has frequently been related to work-related stress and job dissatisfaction. Given the emotionally and physically challenging nature of their work, high rates of burnout have been reported among health care professionals. This may put them at a higher risk for of suffering from adverse mental health outcomes, including depression, anxiety and stress. In our study, we aim to assess the prevalence i of and associations among burnout and job dissatisfaction and adverse mental health outcomes in a developing country, where the challenges faced by the health care system are unique. Facilities are over-burdened and …

Pediatric Brainstem Gliomas: An Institutional Experience, Altaf Ali Laghari, Mirza Zain Baig, Muhammad Ehsan Bari, Aneela Darbar, Naureen Mushtaq, Umme E Hani Abdullah, Daniya Aziz Khan

Section of Neurosurgery

Objective: The aim of this study was to analyze the clinical profiles and outcomes of pediatric brainstem gliomas treated at our institute.
Methodology: We reviewed the files of 18 pediatric age group patients diagnosed with brainstem glioma at our institution. The following variables were recorded: age, sex, duration of symptoms, date of diagnosis, main clinical symptoms, Karnofsky performance status score, magnetic resonance imaging findings, histopathology findings, details of the treatment given, disease progression, and date of mortality/last follow-up. This data were then transferred to SPSS version 23 which was used for further analysis.
Results: The mean age of our cohort …

Psychosocial Factors Of Deliberate Self-Harm In Afghanistan: A Hospital Based, Matched Case-Control Study, Akbar Paiman, Murad M. Khan Dr., Tazeen S. Ali, Nargis Asad, Iqbal Azam Syed

Department of Psychiatry

Background: Deliberate self-harm is not only a major global public health problem but also an important index of psychological distress and a risk factor for suicide.
Aims: We aimed to determine the psychosocial risk factors for deliberate self-harm in patients aged ≥ 16 years presenting to tertiary care hospitals in Kabul, Afghanistan.
Methods: A matched case-control study was conducted from February 2015 to May 2015. We recruited 185 cases (patients with deliberate self-harm) and 555 age- and sex-matched controls (patients with general medical conditions) from 4 tertiary care hospitals in Kabul. We developed a questionnaire to record the sociodemographic characteristics …

The Epidemiological Burden Of Obesity In Childhood: A Worldwide Epidemic Requiring Urgent Action, Mariachiara Di Cesare, Maroje Sorić, Pascal Bovet, J Jaime Miranda, Zulfiqar Ahmed Bhutta, Gretchen A. Stevens, Avula Laxmaiah, Andre-Pascal Kengne, James Bentham

Department of Paediatrics and Child Health

Background: In recent decades, the prevalence of obesity in children has increased dramatically. This worldwide epidemic has important consequences, including psychiatric, psychological and psychosocial disorders in childhood and increased risk of developing non-communicable diseases (NCDs) later in life. Treatment of obesity is difficult and children with excess weight are likely to become adults with obesity. These trends have led member states of the World Health Organization (WHO) to endorse a target of no increase in obesity in childhood by 2025.
Main body: Estimates of overweight in children aged under 5 years are available jointly from the United Nations Children's Fund …

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 …

Determinants Of Linear Growth Faltering Among Children With Moderate-To-Severe Diarrhea In The Global Enteric Multicenter Study, Rebecca L. Brander, Patricia B. Pavlinac, Judd L. Walson, Grace C. John-Stewart, Marcia R. Weaver, Abu S. G Faruque, Anita K. M. Zaidi, Dipika Sur, Samba O. Sow, M Jahangir Hossain

Department of Paediatrics and Child Health

Background: Moderate-to-severe diarrhea (MSD) in the first 2 years of life can impair linear growth. We sought to determine risk factors for linear growth faltering and to build a clinical prediction tool to identify children most likely to experience growth faltering following an episode of MSD.
Methods: Using data from the Global Enteric Multicenter Study of children 0-23 months old presenting with MSD in Africa and Asia, we performed log-binomial regression to determine clinical and sociodemographic factors associated with severe linear growth faltering (loss of ≥ 0.5 length-for-age z-score [LAZ]). Linear regression was used to estimate associations with ΔLAZ. A …

Does Depressed Persons With Non-Cardiovascular Morbidity Have A Higher Risk Of Cvd? A Population-Based Cohort Study In Sweden, Aysha Almas, Jette Moller, Romaina Iqbal, Andreas Lundin, Yvonne Forsel

Section of Internal Medicine

Background: Depression often co-exists with non-cardiovascular morbid conditions. Whether this comorbidity increases the risk of cardiovascular disease has so far not been studied. Thus, the aim of this study was to determine if non-cardiovascular morbidity modifies the effect of depression on future risk of CVD.
Methods: Data was derived from the PART study (acronym in Swedish for: Psykisk hälsa, Arbete och RelaTioner: Mental Health, Work and Relationships), a longitudinal cohort study on mental health, work and relations, including 10,443 adults (aged 20-64 years). Depression was assessed using the Major Depression Inventory (MDI) and self-reported data on non-cardiovascular morbidity was assessed …

Determinants Of Campylobacter Infection And Association With Growth And Enteric Inflammation In Children Under 2 Years Of Age In Low-Resource Settings, Md Ahshanul Haque, James A. Platts-Mills, Estomih Mduma, Ladaporn Bodhidatta, Pascal Bessong, Sadia Shakoor, Gagandeep Kang, Margaret N. Kosek, Aldo A M Lima, Zulfiqar Ahmed Bhutta

Department of Pathology and Laboratory Medicine

Campylobacter species infections have been associated with malnutrition and intestinal inflammation among children in low-resource settings. However, it remains unclear whether that association is specific to Campylobacter jejuni/coli. The aim of this study was to assess the association between both all Campylobacter species infections and Campylobacter jejuni/coli infections on growth and enteric inflammation in children aged 1-24 months. We analyzed data from 1715 children followed from birth until 24 months of age in the MAL-ED birth cohort study, including detection of Campylobacter species by enzyme immunoassay and Campylobacter jejuni/coli by quantitative PCR in stool samples. Myeloperoxidase (MPO) concentration in stool, …

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, East Africa

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 …

Plasma Cell Leukemia Mimicking Hairy Cell Leukemia: Extended Role Of Immunophenotyping In Correct Diagnosis, Ayesha Majeed Memon, Natasha Ali

Department of Pathology and Laboratory Medicine

No abstract provided.

A Novel Training Simulator For Portable Ultrasound Identification Of Incorrect Newborn Endotracheal Tube Placement – Observational Diagnostic Accuracy Study Protocol, Hasan S. Merali, Mark O. Tessaro, Khushboo Q. Ali, Shaun K. Morris, Sajid Bashir Soofi, Shabina Ariff

Department of Paediatrics and Child Health

Background: Endotracheal tube (ETT) placement is a critical procedure for newborns that are unable to breathe. Inadvertent esophageal intubation can lead to oxygen deprivation and consequent permanent neurological impairment. Current standard-of-care methods to confirm ETT placement in neonates (auscultation, colorimetric capnography, and chest x-ray) are time consuming or unreliable, especially in the stressful resuscitation environment. Point-of-care ultrasound (POCUS) of the neck has recently emerged as a powerful tool for detecting esophageal ETTs. It is accurate and fast, and is also easy to learn and perform, especially on children.
Methods: This will be an observational diagnostic accuracy study consisting of two …

Changes In Ventricular Depolarisation Vectors During Exercise Caused By Regional Myocardial Ischaemia, Cameruddin Vellani, Satwat Hashmi, Sadia Mahmud, Mohammad Yusuf, Safia Awan, Khawar Kazmi

Section of Cardiology

Research at the Aga Khan University for several years has been directed to find a reliable, low-cost, portable, non-invasive method for identification of coronary artery disease, its location and extent. A new method has been devised to measure the magnitude and direction of cardiac electrical vectors in three perpendicular planes during physical exercise to identify reduction in myocardial excitability as the electrophysiological marker of hypoxia. This report shows that changes in electrical forces due to exercise-induced regional hypoxia serve as indicators of reversible myocardial ischaemia. Changes in the magnitude and direction of vectors at stages of the Bruce protocol were …