Medicine and Health Sciences Commons^™

Frequency Of Early Morbidities In Low Birth Weight Neonates At The Aga Khan University Hospital, Karachi, Saroop Chand, Fayaz Ahmed Memon, Muhammad Hussain Shah, Abdul Lateef Leghari, Parveen Uzma, Rohan Advani, Muhammad Sohail Salat, Shabina Ariff

Department of Paediatrics and Child Health

Background:
Globally, approximately 14.6% children are born with low birth weight (LBW) annually. In Pakistan, this figure however reaches approximately 16%. Low birth weight infants are vulnerable to develop early morbidities like hypothermia, hypoglycemia, respiratory distress syndrome and hypocalcemia. There is a scarcity of statistics which creates a gap in development of strategies for improving quality of care in developing countries. The aim of our study was to determine the frequency of early morbidities such as respiratory distress syndrome (RDS), hypoglycemia, hypothermia and hypocalcemia in low birth weight neonates.
Methodology:
prospective descriptive study was conducted via non-probability sampling technique from …

Microbial Profile And Antibiotic Susceptibility Trend In Postoperative Endophthalmitis: A 12-Year Review, Rashid Baig, Pushpa Bhawan Mal, Khabir Ahmed, Salman Naveed Sadiq, Sidra Zafar, Ghazala Jabeen, Saajan Kukreja

Section of Ophthalmology

Objective: To identify the microbial profile and susceptibility pattern of pathogens responsible for culture-proven postoperative endophthalmitis, and to investigate possible trends in both pathogens and antibiotic sensitivities.
Methods: The retrospective study was conducted at Aga Khan University Hospital, Karachi, and comprised record of ophthalmology patients from January 1, 2005, to December 31, 2016. Culture and sensitivity reports of vitreous and aqueous humor samples from all the patients were retrieved from the medical record section of the hospital. SPSS 19 was used for data analysis.
Results: Of the samples of 202 patients with a mean age of 58.2±15.8 years, 106(52.5%) were …

Teaching "Shock Pathophysiology" By Flipped Classroom, Syeda Sadia Fatima, Satwat Hashmi, Rehana Rehman, Rozmeen Akbar

Department of Biological & Biomedical Sciences

Objective: To assess usefulness of flipped style of teaching conducted as small-group format in Cardiovascular and Respiration module for Year-I undergraduate medical students at Aga Khan University.
Methods: The study was planned and conducted over a period of eight months from March to October 2017 including the time taken for planning, mock run, execution followed by analysis and dissemination. It was carried out at the Aga Khan University Medical College, Karachi. Pre and post test scores of students after flipped class room sessions was compared. Moreover, perception of students was assessed on Likert scale (0-4) by a pretested validated questionnaire. …

Kangaroo Mother Care: Opportunities And Implications For Rural Pakistan, Hasan Nawaz Tahir, Zafar Fatmi

Community Health Sciences

Neonatal mortality comprises 40% of total under-5 mortality, globally. Kangaroo mother care (KMC) is one of the most cost-effective interventions to reduce neonatal mortality. KMC does not require highend equipment, intensive care facilities or technical knowledge. A recent meta-analysis reported that KMC may reduce neonatal mortality in preterm and low birth weight neonates up to 36%. A review of enablers and barriers of KMC suggests that KMC can be integrated in maternal health care system by giving awareness, involving family and giving ownership of the intervention to the community. If supported with minimal incentives it would reduce the cost of …

Effect Of Increasing Age On Percutaneous Coronary Intervention Vs Coronary Artery Bypass Grafting In Older Adults With Unprotected Left Main Coronary Artery Disease: A Meta-Analysis And Meta-Regression, Mahin R. Khan, Waleed T. Kayani, Waqas Ahmad, Malalai Manan, Ravi S. Hira, Ihab Hamzeh, Hani Jneid, Salim S. Virani, Neal Kleiman, Nasser Lakkis

Office of the Provost

Background: Older adults (≥70-year-old) are under-represented in the published data pertaining to unprotected left main coronary artery disease (ULMCAD).
Hypothesis: Percutaneous coronary intervention (PCI) might be comparable to coronary artery bypass grafting (CABG) for revascularization of ULMCAD.
Methods: We compared PCI versus CABG in older adults with ULMCAD with an aggregate data meta-analyses (4880 patients) of clinical outcomes [all-cause mortality, myocardial infarction (MI), repeat revascularization, stroke and major adverse cardiac and cerebrovascular events(MACCE)] at 30 days, 12-24 months & ≥36 months in patients with mean age ≥70 years and ULMCAD. A meta-regression analysis evaluated the effect of age on mortality …

Cime Newsletter : November 2019, Cime

Centre for Innovation in Medical Education (CIME) Archives

-Pakistan Air Force Lands Again @ CIME
-SeeMe in Singapore!
-SeeMe in Finland!
-Healthcare Assistants refresh their skills
-SimMan takes drugs!
-Body Mechanics in Patient Moving and Handling
-Training in techniques of Continuous Renal Replacement Therapy (CRRT) Needs Simulation

Prevalence And Correlates Of Depressive Symptoms Among Adults Living With Hiv In Rural Kilifi, Kenya, Moses K. Nyongesa, Paul Mwangi, Stanley W. Wanjala, Agnes M. Mutua, Charles R. J. C. Newton, Amina Abubakar

Institute for Human Development, East Africa

Background: Published research on depression among people living with HIV/AIDS (PLWHA) from Africa is increasing, but data from Kenya remains scarce. This cross-sectional study measured the prevalence and correlates of depressive symptoms among PLWHA in rural Kilifi, on the Kenyan coast.

Methods: Between February and April 2018, we consecutively recruited and interviewed 450 adults living with HIV and on combination antiretroviral therapy (cART). Depressive symptoms were assessed with the 9-item Patient Health Questionnaire (PHQ-9), with a positive depression screen defined as PHQ-9 score ≥ 10. Measures of psychosocial, health, and treatment characteristics were also administered.

Results: The overall prevalence of …

Association Of Female Sexual Dysfunction And Fertility: A Cross Sectional Study, Felix Oindi, Alfred Murage, Valentino Manase Lema, Abraham Mukaindo

Obstetrics and Gynaecology, East Africa

Background: Sexual function plays an essential role in the bio-psychosocial wellbeing and quality of life of women and disturbances in sexual functioning often result in significant distress. Female sexual dysfunction (FSD) and subfertility are common problems affecting approximately 43 and 20% of women respectively. However, despite the high prevalence of both conditions, little has been studied on the effects of subfertility on sexual functioning especially in sub-Saharan Africa. We set out to compare the prevalence of female sexual dysfunction in patients on assessment for sub-fertility and those either seeking or already on fertility control services at a private tertiary teaching …

Chronic Maternal Depressive Symptoms Are Associated With Reduced Socio-Emotional Development In Children At 2 Years Of Age: Analysis Of Data From An Intervention Cohort In Rural Pakistan, Clariana V R. De Oliveira, Muneera Rasheed, Aisha K. Yousafzai

Department of Paediatrics and Child Health

Background: Maternal depression affects a high proportion of women during the antenatal and postnatal period in low- and middle-income countries. While maternal depression is recognized as a significant risk for poor early child development that warrants interventions, the effects of chronic maternal depression on children's development are less understood.
Objective: To determine the association of chronicity of maternal depressive symptoms and early child development in a rural population in southern Pakistan.
Materials and Methods: This study employs data from the "Pakistan Early Child Development Scale-Up Trial," a randomized controlled study that evaluated the integration of responsive stimulation and nutrition interventions …

Association Of Exposure To Civil Conflict With Maternal Resilience And Maternal And Child Health And Health System Performance In Afghanistan, Nadia Akseer, Arjumand Rizvi, Zaid Ahmad Bhatti, Jai K. Das, Karl Everett, Aneesa Arur, Mickey Chopra, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Importance: Current studies examining the effects of Afghanistan's conflict transition on the performance of health systems, health service delivery, and health outcomes are outdated and small in scale and do not span all essential reproductive, maternal, newborn, and child health interventions.
Objective: To evaluate associations of conflict severity with improvement of health system performance, use of health services, and child nutrition outcomes in Afghanistan during the 2003 to 2018 reconstruction period.
Design, setting, and participants: This population-based survey study included a sequential cross-sectional analysis of individual-level panel data across 2 periods (2003-2010 and 2010-2018) and a difference-in-differences design. Surveys included …

Creation Of Radiocephalic Arteriovenous Fistula In A Patient With Failed Brachiocephalic Arteriovenous Fistula, Zia Ur Rehman

Department of Surgery Docs

Abstract are not provided by the author/publisher

Factors Related To Congenital Heart Disease In Offspring From Women With Rheumatic Heart Disease: Case Reports From Moi Teaching And Referral Hospital, Eldoret, Kenya, Philippe P. A, Elkanah Omenge, Barasa F. A

Obstetrics and Gynaecology, East Africa

Maternal exposure to environmental factors has been reported to be associated with birth defects. Congenital heart defects are the most common and are associated with high morbidity and mortality in offspring. However, the relation of maternal rheumatic heart disease to congenital heart defects in the offspring is a rare event not yet reported. The authors report 2 cases of infants with congenital heart defects born from mothers with rheumatic heart disease. This study highlights factors related to congenital heart defects in both newborns.

Is There Value To Sub-Specialty Training In Sub-Saharan Africa?, Elkanah Omenge, S. E. Sinasac, Peter Itsura, Philip Tonui, B. Rosen, A. Covens

Obstetrics and Gynaecology, East Africa

Over the past three decades, Africa has focused on combatting infectious diseases, such as tuberculosis, malaria, and HIV/ AIDS. As treatment strategies for infectious diseases have improved over time, life expectancy has increased, shifting the burden to chronic diseases, such as cancer. The WHO has now identified non-communicable diseases, including cancer, as the new epidemic in sub-Saharan Africa1. Cancer incidence and mortality are increasing rapidly in low and middle-income countries (LMIC) as compared to high-income countries. By 2020, it is predicted that 70% of all new cancers worldwide will occur in LMIC2. In 2012 850 000 new cancers were diagnosed …

Assessing The Adherence Of Obstetricians Towards Postpartum Diabetes Screening Guidelines: A Pre- And Post-Intervention Study At Secondary Care Hospital In Karachi, Pakistan, Sadiqa Munir Razzaqui, Neelofur Babar, Zaib Un Nisa Memon, Sarah Rafiq

Department of Obstetrics & Gynaecology

Objective: To assess the adherence level of obstetricians towards postpartum diabetes screening guidelines.
Methods: The quasi-experimental pre- and post-intervention study was conducted from May 2014 to April 2015 at Aga Khan Hospital for Women-Karimabad, Karachi, and comprised all obstetricians practicing at the time. All the booked women with gestational diabetes delivered in the 6 months before refresher lecture (group 1) and those delivering in the 6 months following the intervention (group 2) were included. Data was analysed using SPSS 19.
Results: Of the 550 cases, 275(50%) each were in groups 1 and 2. All pregnant women had live-birth. The intervention …

Prevalence Of Malaria Reported During Summer And Winter At A Tertiary Care Hospital In Karachi, Pakistan, Fazal M. Arain, Aisha Memon, Roohi Jamal, Ahmed Raheem Buksh, Mohammad Asim Beg

Department of Biological & Biomedical Sciences

This study was designed to determine the prevalence and type of malaria cases that presented throughout the year 2014 in a tertiary care hospital in Karachi, Pakistan. A total of 1099 cases, (377 females, 722 males) were reported. Plasmodium vivax (P. vivax) was discovered in 93.7% cases compared to 6.3% Plasmodium falciparum (P. falciparum). Based on the highest and lowest weather temperatures, in summer (June, July and August) and in winter (December, January and February) were differentiated. The number of cases were greater during summer months compared to winter. Interestingly, the ratio of P. falciparum to P. vivax during winter …

This Disease Is “Not For Hospital”: Myths And Misconceptions About Cancers In Northern Nigeria, Ahmed Sarki, Babangida L. Roni

School of Nursing & Midwifery, East Africa

Cancers are one of the major chronic diseases in Nigeria, with over 100,000 new cases and 70,000 cancer deaths recorded annually. Notwithstanding the public health significance of cancers in Nigeria, there is a dearth of evidence relating to cancers in the country, with most of the few available studies conducted in the Southern regions. This paper aimed to highlight some longstanding myths and misconceptions about cancers in the Northern Nigerian region. We consulted key stakeholders including individuals, local leaders, traditional medicine practitioners, and healthcare professionals. The most common myths and misconceptions about cancers in Northern Nigeria include the following: people …

Recent Updates In The Management Of Merkel Cell Carcinoma, Ahmed Nadeem Abbasi, Syed Mustajab Ahmed, Bilal Mazhar Qureshi

Department of Radiation Oncology

Merkel cell carcinoma is an aggressive non-melanomatous cutaneous tumour of neuroendocrine origin with an increasing incidence in the recent years. It is a tumour of the elderly and immunosuppressed, which most often appears on sun-exposed areas of the body. The clinical features of the cutaneous or subcutaneous lesions hardly contribute to the diagnosis, and, hence, histopathology and immunohistochemistry play a vital role in diagnosis. The latest staging system by the American Joint Committee on Cancer includes non-nodal invasion to adjacent structures i.e. bone, muscle, fascia, or cartilage into the criteria, in additionto size and depth of invasion. The management reliesheavily …

Time To Adopt Developmental Origins Of Health And Disease (Dohad) Science In Pakistan, Rozina Nuruddin, Akbar Shoukat Ali, Nuruddin Badruddin Mohammed

Community Health Sciences

No abstract provided.

Inspire : Vol 2, Issue 11, Department Of Medicine

INSPIRE – Department of Medicine Archives

Content

• Message From the Chair
• AKU Dermatology TOACS Workshop
• Tawazun
• Estimation of the Global Burden of Disease Workshop\
• Team Gastroenterology, AKU and World Congress of Gastroenterology 2019
• Medicine at National and International Forums
• Featured Faculty: Dr Sadia Masood “Learn to embrace challenges rather than avoid them because, even when you can’t overcome the challenge, you will still grow as a person.”
• Publications

Apasl Hcv Guidelines Of Virus-Eradicated Patients By Daa On How To Monitor Hcc Occurrence And Hbv Reactivation, Tatsuo Kanda, George K K. Lau, Lai Wei, Mitsuhiko Moriyama, Ming-Lung Yu, Wang-Long Chuang, Alaaeldin Ibrahim, Cosmas Rinaldi Adithya Lesmana, Saeed Hamid, Wasim Jafri

Section of Gastroenterology

In the direct-acting antiviral (DAA) era for hepatitis C virus (HCV) infection, sustained virological response (SVR) is very high, but close attention must be paid to the possible occurrence of hepatocellular carcinoma (HCC) and reactivation of hepatitis B virus (HBV) in patients with co-infection who achieved SVR in short term. HCC occurrence was more often observed in patients with previous HCC history. We found occurrence of HCC in 178 (29.6%) of 602 patients with previous HCC history (15.4 months mean follow-up post-DAA initiation) but, in contrast, in only 604 (1.3%) of 45,870 patients without previous HCC history (18.2 months mean …

Utilization And Outcomes With Low Dose Tissue Plasminogen Activator As Intravenous Thrombolytic Therapy For Ischaemic Stroke At Aga Khan University Hospital, Karachi: A Retrospective Analysis, Masood Uz Zaman Babar, Ammar Zaman Khan, Haris Hakeem, Jaleed Gilani, Mohammad Wasay

Section of Neurology

Objective: To determine the utilisation of intravenous tissue plasminogen activator at a certain dose for ischaemic stroke thrombolysis and to compare the outcomes with those of a different dosage mentioned in literature.
Methods: The retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised medical records from January, 2007, to October, 2016, of all patients having received intravenous tissue plasminogen activator for ischaemic stroke thrombolysis. Primary safety outcome variables included symptomatic intracerebral haemorrhage after the start of treatment (0.6mg/kg) and death within three months as per the modified Rankin scale 6. Secondary efficacy outcome variable was functional …

Current State Of Knowledge Of Basic Life Support In Health Professionals Of The Largest City In Pakistan: A Cross-Sectional Study, Babar Irfan, Ibrahim Zahid, Muhammad Sharjeel Khan, Omar Abdul Aziz Khan, Shayan Zaidi, Safia Awan, Sobia Bilal, Omar Irfan

Section of Neurology

Background: Basic Life Support (BLS) is the recognition of sudden cardiac arrest and activation of the emergency response system, followed by resuscitation, and rapid defibrillation. According to WHO, Pakistan has one of the highest mortality rates from accidental deaths therefore assessment and comparison of BLS knowledge in health professionals is crucial. We thereby aim to assess and compare the knowledge of BLS in doctors, dentists and nurses.

Methods: A multi-centric cross-sectional survey was conducted in Karachi at different institutions belonging to the private as well as government sector from January to March 2018. We used a structured questionnaire which was …

Academic Performance In Adolescent Students: The Role Of Parenting Styles And Socio-Demographic Factors – A Cross Sectional Study From Peshawar, Pakistan, Sarwat Masud, Syed Hamza Mufarrih, Nada Qaisar Qureshi, Fahad Khan, Saad Khan, Naseem Khan

Department of Medicine

Academic performance is among the several components of academic success. Many factors, including socioeconomic status, student temperament and motivation, peer, and parental support influence academic performance. Our study aims to investigate the determinants of academic performance with emphasis on the role of parental styles in adolescent students in Peshawar, Pakistan. A total of 456 students from 4 public and 4 private schools were interviewed. Academic performance was assessed based on self-reported grades in the latest internal examinations. Parenting styles were assessed through the administration of the Parental Bonding Instrument (PBI). Regression analysis was conducted to assess the influence of socio-demographic …

Evaluation Of A Maternal, Neonatal And Child Health Intervention Package In A Rural District Of Pakistan: A Quasi-Experimental Study, Atif Habib, Kirsten I. Black, Camille Raynes Greenow, Mushtaq Mirani, Sajid Muhammad, Fariha Shaheen, Monika Christofori Khadka, Annette Vondeling, Shabina Ariff, Sajid Bashir Soofi

Department of Paediatrics and Child Health

Background: Pakistan is among the countries which have the highest maternal, neonatal and child mortality rates. Immediate efforts are required to enable Pakistan to achieve the health related sustainable development goals. The continuum of care interventions can substantially reduce the mortality burden, however local evidence to implement them is lacking in Pakistan. We implemented the maternal, neonatal and child health intervention package comprised of health facility strengthening, capacity building, continuum of care interventions and community mobilization and evaluated its effectiveness on maternal, neonatal and child health care practices and neonatal mortality.
Methods: The intervention package was delivered through existing public …

Rethinking Community Based Strategies To Tackle Health Inequities In South Asia, Zulfiqar Ahmed Bhutta, Abhay Bang, Kaosar Afsana, Bishal Gyawali, Mohammed Shafiq Mirzazada, Renuka Jayatissa

Department of Paediatrics and Child Health

No abstract provided.

Relationship Between Smoking Habit And Sperm Parameters Among Patients Attending An Infertility Clinic, Rehana Rehman, Nida Zahid, Sofia Amjad, Mukhtiar Baig, Zohair Jamil Gazzaz

Department of Biological & Biomedical Sciences

Background: This study aimed to estimate stress markers, oxidative stress (OS), reproductive hormones and sperm parameters in male smokers and non-smokers and observe the impact of oxidative stress markers and smoking on sperm count, motility and morphology in a selected population of Karachi, Pakistan.
Methods: This cross-sectional study was conducted from July 2017 to July 2018 at Aga Khan University (AKU), in Karachi, Pakistan. The subjects were recruited from the Sindh Institute of Reproductive Medicine (SIRM), Karachi based on defined inclusion criteria. The subjects were categorized into fertile and infertile based on cut off values of sperm parameters as recommended …

Perceptions Of Health Professionals Regarding Minimally Invasive Tissue Sampling (Mits) To Identify The Cause Of Death In Stillbirths And Neonates: Results From A Qualitative Study, Anam Shahil Feroz, Anum Shiraz Ali, Mohsina Noor Ibrahim, Elizabeth M. Mcclure, Shiyam Sunder Tikmani, Sayyeda Reza, Zahid Abbasi, Afia Zafar, Sameen Siddiqi, Sarah Saleem

Community Health Sciences

Background: Pakistan is considered to be one of the riskiest places in the world for childbirth as measured by its high stillbirth and neonatal mortality rates. Complete diagnostic autopsy remains the gold standard to determine the cause of death (CoD); however, it is not routinely implemented due to religious objections, sociocultural beliefs, limited resources and low demand from physicians and families. Recently, minimally invasive tissue sampling (MITS) using needle biopsies of multiple tissues to obtain tissue for histological examination and organism identification with PCR has been developed and promoted to determine CoD in low-resource areas. To ensure successful implementation of …

Systematic Review Of Doppler For Detecting Intrapartum Fetal Heart Abnormalities And Measuring Perinatal Mortality In Low‐ And Middle‐Income Countries, Marya Plotkin, Benjamin Kamala, Jim Ricca, Linda Fogarty, Sheena Currie, Hussein Kidanto, Stephanie B. Wheeler

Obstetrics and Gynaecology, East Africa

Background: Using Doppler to improve detection of intrapartum fetal heart rate (FHR) abnormalities coupled with appropriate, timely intrapartum care in low-and middle-income countries (LMIC) can save lives.

Objective: To review studies using Doppler to improve detection of intrapartum FHR abnormalities and intrapartum care quality in LMIC health facilities.

Search strategy: PubMed, Web of Science, Embase, Global Health, and Scopus were searched from inception to October 2018 by combining terms for Doppler, perinatal outcomes, and FHR monitoring.

Selection criteria: Selected studies compared Doppler and Pinard stethoscope for detecting/monitoring intrapartum FHR, or described provider and maternal preferences for FHR monitoring in LMIC …

Women And Children Living In Areas Of Armed Conflict In Africa: A Geospatial Analysis Of Mortality And Orphanhood, Zachary Wagner, Sam Heft-Neal, Paul H. Wise, Robert E. Black, Marshall Burke, Ties Boerma, Zulfiqar Ahmed Bhutta, Eran Bendavid

Department of Paediatrics and Child Health

Background:
The population effects of armed conflict on non-combatant vulnerable populations are incompletely understood. We aimed to study the effects of conflict on mortality among women of childbearing age (15–49 years) and on orphanhood among children younger than 15 years in Africa.
Methods:
We tested the extent to which mortality among women aged 15–49 years, and orphanhood among children younger than 15 years, increased in response to nearby armed conflict in Africa. Data on location, timing, and intensity of armed conflicts were obtained from the Uppsala Conflict Data Program, and data on the location, timing, and outcomes of women and …

Fostering Productive Conversations In A Kenyan Tertiary Intensive Care Unit: Lessons Learnt, Sayed Karar, Jamila Nambafu, Feroza Daroowalla

Internal Medicine, East Africa

Effective communication remains key in delivery of comprehensive care to patient especially in the intensive care unit (ICU) setting. However, many providers, for various reasons, struggle with the art of effective communication adversely affecting relationship with patients and their families. Little is known or has been published about effective communication in ICUs within sub-Saharan Africa.