Medicine and Health Sciences Commons^™

A Case Of An Anomalous Right Coronary Artery Arising From The Left Coronary Cusp, Muhammad Shabbir Rawala, Ahmer A. Longi, Arfeen A. Khan, Syed Inam Rizvi, Syed B. Rizvi

Section of Internal Medicine

An anomalous origin of the right coronary artery is usually asymptomatic. It is mostly found incidentally on an invasive diagnostic angiogram. It does lead to an increased risk of sudden cardiac death, especially in younger patients. We present a case of a 41-year-old who had presented to the hospital with complaints of chest pain. The patient was evaluated by cardiology who performed an angiography that identified an anomalous origin of the right coronary artery arising from the left coronary cusp but no evidence of coronary artery disease. Once identified, these anomalous vessels should be corrected surgically, as these conditions increase …

Xanthogranulomatous Pyelonephritis: Synchronous Upper And Lower Gastrointestinal Bleed, Muhammad Usman Mirza, John Van Taunay, Muhammad Waleed, Shiva Shankar Vangimalla, Sharana Hegde, Muhamad Alhaj Moustafa

Medical College Documents

Xanthogranulomatous pyelonephritis (XGP) is a rare chronic granulomatous destructive process of the renal parenchyma. It is caused by a chronic inflammatory process due to recurrent urinary tract infections and/or obstructing renal calculi. Rarely, it presents with advanced complications including abscesses and fistula formations. In this article, we report a unique presentation of XGP with simultaneous upper and lower gastrointestinal bleeding in the setting of XGP with reno-gastric and reno-colic fistulas.

Evaluation Of Cervical Spine Posture After Functional Therapy With Twin-Block Appliances: A Retrospective Cohort Study, Adeel Tahir Kamal, Mubassar Fida

Section of Dental-Oral Maxillofacial Surgery

Introduction: It has been postulated that a change in cervical posture occurs as a consequence of forward repositioning of the mandible. Therefore, the objective of this study was to compare the cervical spine posture between subjects with and without functional appliance therapy.
Methods: A retrospective cohort study was conducted with the use of pre- and post-functional therapy cephalograms of orthodontic patients. A total of 60 subjects was composed of 2 groups of 30 subjects each: those who underwent treatment with a twin-block (TB) functional appliance and a control group selected from the Bolton-Brush Growth Study. Three sagittal and 7 cervical …

Quality Initiative To Reduce Cardiac Ct Angiography Radiation Exposure In Patients With Congenital Heart Disease, Fatima Ali, Arjumand Rizvi, Huzaifa Ahmad, Phillip Mcgonagill, Muneeb Khan, Rajesh Krishnamurthy, Zafar Jamil, Naila Nadeem, Mohammad Yousuf, Babar Hasan

Department of Paediatrics and Child Health

Background: The use of cardiac computed tomography angiography (CCTA) as a complementary diagnostic modality to echocardiography in patients with congenital heart diseases (CHDs) is expanding in low- and middle-income countries. The adoption of As Low As Reasonably Achievable techniques is not widespread, resulting in significant unintended radiation exposure, especially in children. Simple quality improvement measures geared toward reducing radiation dose can have a impact on patient safety in resource-limited centers in low- and middle-income countries.
Objectives: To determine how a quality improvement initiative can reduce radiation exposure during CCTA in patients with CHD.
Methods: We designed a key driver -based …

Mortality And Cardiovascular And Respiratory Morbidity In Individuals With Impaired Fev 1 (Pure): An International, Community-Based Cohort Study, Mylinh Duong, Shofiqul Islam, Sumathy Rangarajan, Darryl Leong, Om Kurmi, Koon Teo, Kieran Killian, Gilles Dagenais, Scott Lear, Romaina Iqbal

Community Health Sciences

Background: The associations between the extent of forced expiratory volume in 1 s (FEV₁) impairment and mortality, incident cardiovascular disease, and respiratory hospitalisations are unclear, and how these associations might vary across populations is unknown.
Methods: In this international, community-based cohort study, we prospectively enrolled adults aged 35-70 years who had no intention of moving residences for 4 years from rural and urban communities across 17 countries. A portable spirometer was used to assess FEV₁. FEV₁ values were standardised within countries for height, age, and sex, and expressed as a percentage of the country-specific predicted …

Khat Use And Psychotic Symptoms In A Rural Khat Growing Population In Kenya: A Household Survey, Linnet Ongeri, Fredrick Kirui, Erastus Muniu, Veronica Manduku, Leah Kirumbi, Lukoye Atwoli, Safari Agure, Peter Wanzala, Lydia Kaduka, Mercy Karimi, Richard Mutisya, Elizabeth Echoka, Joseph Mutai, David Mathu, Charles Mbakaya

Internal Medicine, East Africa

Background:Khat is an amphetamine like psychostimulant chewed by over 10 million people globally. Khat use is thought to increase the risk of psychosis among its chewers. The evidence around this however remains inconclusive stemming from the scanty number of studies in this area and small study sample sizes. We undertook a large household survey to determine the association between psychotic symptoms and khat chewing in a rural khat growing and chewing population in Kenya.

Methods:For this cross-sectional household survey, we randomly selected 831 participants aged 10 years and above residing in the Eastern region of Kenya. We used …

New Oral Anticoagulants Versus Warfarin For Cerebral Venous Thrombosis: A Multi-Center, Observational Study, Mohammad Wasay, Maria Khan, Haris Majid Rajput, Salman Farooq, Mohammed Ibrahim Memon, Suhail Abdulla Alrukn, Abdul Malik, Foad Abd-Allah, Raja Farhat Shoaib, Rizwana Shahid, Sadia Nishat, Safia Awan

Section of Neurology

No abstract provided.

A New Health Care Model For Pakistan, Mohammad Wasay, Ashar Malik

Section of Neurology

No abstract provided.

The Incidence, Aetiology, And Adverse Clinical Consequences Of Less Severe Diarrhoeal Episodes Among Infants And Children Residing In Low-Income And Middle-Income Countries: A 12-Month Case-Control Study As A Follow-On To The Global Enteric Multicenter Study (Gems), Karen L. Kotloff, Dilruba Nasrin, William C. Blackwelder, Yukun Wu, Tamer Farag, Sandra Panchalingham, Samba O. Sow, Anita K. M. Zaidi, Shahida Qureshi, Farheen Quadri

Department of Paediatrics and Child Health

Background: Diarrheal diseases remain a leading cause of illness and death among children younger than 5 years in low-income and middle-income countries. The Global Enteric Multicenter Study (GEMS) has described the incidence, aetiology, and sequelae of medically attended moderate-to-severe diarrhoea (MSD) among children aged 0-59 months residing in censused populations in sub-Saharan Africa and south Asia, where most child deaths occur. To further characterise this disease burden and guide interventions, we extended this study to include children with episodes of less-severe diarrhoea (LSD) seeking care at health centres serving six GEMS sites.
Methods: We report a 1-year, multisite, age-stratified, matched …

Regional Variation In Comorbid Prediabetes And Diabetes And Associated Factors Among Hypertensive Individuals In Rural Bangladesh, Pakistan, And Sri Lanka, Liang Feng, Aliya Naheed, H. Asita De Silva, Imtiaz Jehan, Rubhana Raqib, Md Tauhidul Islam, Nathasha Luke, Anuradhani Kasturiratne, Hamida Farazdaq, Sahar Senan, Tazeen Jafar, Cobra-Bps Study Group

Community Health Sciences

We aimed to explore the cross-country variation in the prevalence of comorbid prediabetes or diabetes and determine the sociodemographic, lifestyle, and clinical factors, especially body mass index (BMI) and waist circumference, associated with comorbid diabetes in individuals with hypertension in rural South Asia. We analyzed cross-sectional data of 2426 hypertensive individuals of ≥40 years from 30 randomly selected rural communities in Bangladesh, Pakistan, and Sri Lanka. Prediabetes was defined as fasting plasma glucose (FPG) between 100 and 125 mg/dL without use of antidiabetic treatment and diabetes as FPG ≥126 mg/dL or use of antidiabetic medication. The prevalence (95% CI) of …

Developing A Rubric To Assess Critical Thinking In A Multidisciplinary Context In Higher Education, Sadia Muzaffar Bhutta, Sahreen Chauhan, Syeda Kauser Ali, Raisa B. Gul, Shanaz Hussein Cassum, Tashmin Khamis

School of Nursing & Midwifery

Critical thinking (CT) is a generic attribute that is greatly valued across academic disciplines in higher education, and around the globe. It is also defined as one of the graduate attributes of higher education for the sample private university where this research was conducted, as it is perceived that CT helps the graduate to become ‘engaged citizens’ in the twenty-first century. Despite the well-documented importance of CT, its assessment remains a challenge. This study addresses this challenge through the systematic development and field-testing of a rubric for assessing critical thinking in a multidisciplinary context in higher education. A multidisciplinary group …

My Husband Will Love Me More If I Give Birth To More Children: Rural Women’S Perceptions And Beliefs On Family Planning Services Utilization In A Low Resource Setting, Agnes Msoka, Eunice Pallangyo, Sharon Brownie, Eleanor Holroyd

School of Nursing & Midwifery, East Africa

Introduction: Responsibility for family planning in low resource settings is almost solely delegated to women, with very low male involvement. This study investigated rural Tanzanian women’s perceptions and cultural beliefs of the barriers to family planning services utilization.

Methods: This study used a qualitative descriptive approach drawing on four group discussions with 20 purposively selected married women with two or more children. The study followed COREQ guidelines for reporting qualitative studies. Data were collected from participants at four health facilities in Bagamoyo and Kisarawe districts in Pwani, Tanzania.

Results: Participants’ occupations included housewives, small-scale farmers, and entrepreneurs. Most women were …

Improving Identification And Child-Focused Collaborative Care For Children Of Parents With A Mental Illness In Tyrol, Austria, Hanna Christiansen, Annette Bauer, Batool Fatima, Melinda Goodyear, Ingunn Olea Lund, Ingrid Zechmeister-Koss, Jean Lillian Paul

Community Health Sciences

Background: Children of parents with a mental illness (COPMI) are more likely to experience negative long-term adversities. However, interventions to support their needs early can significantly enhance adjustment and reduce negative outcomes. Approximately one in four children currently lives with a parent with mental illness worldwide. The lifelong impact for individuals, governments, and broader society is likely to be substantial. There are significant workforce barriers to the early identification of COPMI and addressing their needs, particularly within the adult mental health care system. The current study aims to reduce such barriers and to improve identification of COPMI in the current …

Are Serum Leptin Levels Predicted By Lipoproteins, Vitamin D And Body Composition?, Aysha Habib Khan, Syeda Sadia Fatima, Ahmed Raheem, Lena Jafri

Department of Pathology and Laboratory Medicine

BACKGROUND: Both obesity and vitamin D deficiency are important health issues in Pakistan. The connection between body composition, Vitamin D and leptin in young adults is important to be studied as body composition may affect bone health and therefore the possibility of osteoporosis in later life. Few studies have attempted to investigate the effect of body composition and leptin with vitamin D in adolescence. AIM: To investigate the association of serum leptin with body composition, lipids and 25-hydroxyvitamin D (25OHD) in adults. METHODS: This cross-sectional study was conducted on 167 apparently healthy adults. Demographics were recorded, bioelectrical impedance analysis was …

Management Of Parturient With Triplet Pregnancy And Placenta Percreta: Importance Of Multi-Disciplinary Approach, Samina Ismail, Akbar Azizullah

Department of Anaesthesia

Obstetric conditions like placenta percreta and multiple pregnancies can be extremely challenging as they pose a high risk for both the mother and infants. In placenta percreta, placental villi penetrate through the wall of uterus into the surrounding organs including the bladder and carry a risk of massive maternal bleeding. Multiple pregnancies have greater complication rate than that in singleton pregnancy. Successful management of such challenges are best done by a multidisciplinary teamwork, where all members of a perinatal team are involved in decision making and management. We report the successful management of a triplet gestation associated with placenta percreta.

Perfect Recipes For Obstetric Anesthesia: Need Of Caution In The Resource Constraint Environment, Samina Ismail, Malika Hameed

Department of Anaesthesia

No abstract provided.

Sedentary Lifestyle And Framingham Risk Scores: A Population-Based Study In Riyadh City, Saudi Arabia, Aljohara M. Alquaiz, Amna Siddiqui, Ambreen Kazi, Mohammad Ali Batais, Ali M. Al-Hazmi

Community Health Sciences

Background: Studies from Saudi Arabia have reported a continued increase in the prevalence of cardiovascular diseases and their associated risk factors. The objective of this study was to measure the gender differences in the cardiovascular disease (CVD) risk based on Framingham risk scores (FRS) and to explore the association of FRS with sedentary life style including physical inactivity, sitting time and central obesity among Saudi adults.
Methods: A cross-sectional survey was conducted on 2997 Saudi adults (males = 968, females = 2029) selected from 18 primary health care centres in Riyadh city, from December 2014 to August 2015. A detailed …

Childhood Oral Infections And Subclinical Atherosclerosis In Adulthood: Should We Wait For Causality Or Just Treat?, Anwar T. Merchant, Salim S. Virani

Office of the Provost

No abstract provided.

Orthokeratinized Odontogenic Cyst (Ooc): Clinicopathological And Radiological Features Of A Series Of 10 Cases, Nasir Ud Din, Maha Zubair, Jamshid Abdul-Ghafar, Zia Ullah Khan, Zubair Ahmad

Department of Pathology and Laboratory Medicine

Background: Orthokeratinized Odontogenic Cyst (OOC) is a rare, developmental odontogenic cyst which was considered in the past to be a variant of Odontogenic keratocyst (OKC) later renamed as keratocystic odontogenic tumor (KCOT). The treatment of OOC is by enucleation and the prognosis, following enucleation is excellent with a recurrence rate of less than 2%. On the other hand, OKC has a recurrence rate between 8 and 25% after enucleation. Thus it is important to differentiate between the two entities.
Methods: All cases reported in our section as OOC during the period 2013 to 2018 were retrieved from the surgical pathology …

Blended Learning: Call Of The Day For Medical Education In The Global South, Zehra Jamil, Azra Naseem, Eman Rashwan, Sumrah Khalid

Department of Biological & Biomedical Sciences

Blended learning (BL) is an e-learning approach that combines the strengths of both online and face-to-face learning, creating meaningful interactions between students, teachers, and resources. This paper explores students’ expectations and satisfaction with, and participation in, a basic science course offered through BL approaches in an undergraduate medical education programme in Pakistan. Developmental anatomy (embryology) was redesigned as a BL course and offered to a hundred first-year students. Both online activities and technology-assisted face-to-face interactive discussions were used in each topic. Students’ expectations were gathered at the start of the course and perceptions regarding their satisfaction with the course was …

Cancer And How The Patients See It; Prevalence And Perception Of Risk Factors: A Cross-Sectional Survey From A Tertiary Care Centre Of Karachi, Pakistan, Saira Saeed, Javaid Khan, Nousheen Iqbal, Sana Irfan, Alviya Shafique, Safia Awan

Section of Pulmonary & Critical Care

Background: The incidence of cancer is rising but data available regarding prevalence of cancer and patient perception of the disease in Pakistan is limited. It is difficult to deal with Cancer if the main causes are negligence towards risk factors and bizarre myths. This study was aimed to investigate common cancer presentations at a government sector hospital and to gain insight into patient knowledge of the disease.

Methods: This was a cross-sectional study conducted on cancer patients from Jinnah Postgraduate Medical Centre. A self-made questionnaire was used to assess the norms related to cancer prevalence in our society, associated myths, …

Diffuse Low-Grade Glioma - Changing Concepts In Diagnosis And Management: A Review, Rashid Jooma, Muhammad Waqas, Inamullah Khan

Section of Neurosurgery

Though diffuse low-grade gliomas (dLGGs) represent only 15% of gliomas, they have been receiving increasing attention in the past decade. Significant advances in knowledge of the natural history and clinical diversity have been documented, and an improved pathological classification of gliomas that integrates histological features with molecular markers has been issued by the WHO. Advances in the radiological assessment of dLGG, particularly new magnetic resonance imaging scanning sequences, allow improved diagnostic and prognostic information. The management paradigms are evolving from "wait and watch" of the past to more active interventional therapy to obviate the risk of malignant transformation. New surgical …

Students’ Perspectives Regarding Clinical Preceptors (Cps) In The Baccalaureate Undergraduate Nursing Programme In Karachi, Pakistan, Amina Aijaz Khowaja Ap, Jacqueline Maria Dias

School of Nursing & Midwifery

Introduction: Clinical practice is considered an integral part of nursing education. It is in the clinical area that the students integrate the theory learnt in the classroom into practice. An enabling clinical environment with the assistance of a clinical preceptor (CP) ensuresthat student nurses become independent practitioners and competent in their roles and responsibilities.
Design : A comprehensive study was undertaken to explore the emerging role of CPs in Pakistan. This research has been reported in the literature. This paper will deal exclusively with the perceptions of nursing students when working with CPs in the four-year undergraduate baccalaureate program at …

Factors Associated With Postoperative Pain Among Patients After Cardiac Surgery In The Tertiary Care Teaching Hospital Of Karachi, Pakistan, Sineer Micah, Rubina Barolia, Yasmin Parpio, Santosh Kumar, Hasanat Sharif

School of Nursing & Midwifery

Background: Pain is the subjective feeling of an individual, which affects the overall recovery of patients after cardiac surgery. Postoperative pain is the most inadequately managed symptom of cardiac surgery. Subsequently, there are many factors that can either hinder or facilitate pain management, including patients' beliefs, cultural values, physiological features, hospital policies, and healthcare providers' knowledge and beliefs. The purpose of this research was to identify factors associated with postoperative pain and its management, after cardiac surgery, among patients in a tertiary care hospital in Karachi, Pakistan.
Methods: Quantitative correlational study design was employed to attain the study purpose. Data …

Role Of Surgery In Spinal Metastases, Altaf Ali Laghari, Humza Faisal Siddiqui, Muhammad Shahzad Shamim

Section of Cardiology

Spinal metastases constitute two-third of all cases of bone metastases. Surgical intervention in these tumours has been recommended in highly selective cases, for confirming diagnosis, stabilizing the spine, and decompressing nerves or spinal cord for alleviation of pain and preservation of function.In this article,the authors have reviewed available evidence on role of surgery in spinal metastases and have presented results of selected papers on this vast topic.

Defining The Hemodynamic Response Of Hypertensive And Normotensive Subjects Through Serial Timed Blood Pressure Readings In The Clinic, Hunaina Shahab, Hamza Sohail Khan, Aysha Almas, Sohail Abrar Khan, Azmina Artani, Aamir Hameed

Section of Cardiology

Background: Every third patient in the clinic is misdiagnosed due to white-coat phenomenon, necessitating needless and costly treatment. We aimed to study the hemodynamic response of the physician's visit on hypertensive and normotensive patients by investigating the trend of blood pressure (BP) before, during and 15 min after the physician-patient encounter.
Methods: A descriptive, cross-sectional study was conducted over a period of 8 months in the cardiology clinics at the Aga Khan University Hospital, Karachi. Both hypertensive and normotensive patients, aged ≥18 years, were recruited. Pregnant females or those with a history of volume loss were excluded. BP readings were …

May Measurement Month 2017: An Analysis Of The Blood Pressure Screening Campaign Results In Pakistan-South Asia, Mohammad Ishaq, Feroz Memon, Thomas Beaney, Xin Xia, Elsa Kobeissi, Neil R. Poulter

Section of Cardiology

Elevated blood pressure (BP) is a growing burden worldwide, leading to over 10 million deaths each year. May Measurement Month (MMM) is a global initiative aimed at raising awareness of high BP and to act as a temporary solution to the lack of screening programs worldwide. Hypertension is a global health concern for developing countries. In Pakistan, apart from few population-based studies which evaluated the prevalence of hypertension, there is no current nationally representative study (the latest nationwide survey was conducted more than two decades ago). Pakistan Hypertension League, in accordance with the International Society of Hypertension directive under the …

Cime Newsletter : March - April 2019, Cime

Centre for Innovation in Medical Education (CIME) Archives

-Tools in Critical Care Nursing
-SIMWARS
-Marching in step: Boot Camp for the New Private Wing
-Protecting our most vulnerable Pneumonia
-Clinical Simulation Educators Programme: Championing the Cause
-Artificial Intelligence?
-Be Prepared: Mass Casualty Incidents can happen at any time.

Pharmacy Newsletter : April 2019, Pharmacy Department

Department of Pharmacy Archives

Content:

• New Dosing Recommendations for Safe Use of Colistin
• Fournier’s Gangrene reported with SGLT2 Inhibitors for Diabetes
• Drug Use : The Three Dosage form of Fosfomycin
• Losartan, An Effective Alternative Approach in Managing Marfan Syndrome
• Pediatric Dose Calculation when no Pediatric Dose Available?

The Use Of Folic Acid In Dengue: Has It Any Value?, Asif Ali Shah, Ahsan Ali Syed, Saad Bin Zafar, Safia Awan

Section of Internal Medicine

Folic acid is used in dengue patients. Our study aims to compare the duration of recovery of thrombocytopenia in patients with dengue infection who received folic acid and those who did not. We retrospectively reviewed the medical records of adult patients admitted over six years with a diagnosis of dengue. Of 2216 patients, 1464 fulfilled the inclusion criteria. Group A were those patients who received folic acid and group B were those who did not. A total of 1322 (90.3%) patients received folic acid. The mean time period required for platelets to double the nadir was 1.7 (±2.2) days in …