Medicine and Health Sciences Commons^™

Operationalization Of Bi-Directional Screening For Tuberculosis And Diabetes In Private Sector Healthcare Clinics In Karachi, Pakistan, Mashal S. Basir, Shifa Salman Habib, Syed M A. Zaidi, Saira Khowaja, Hamidah Hussain, Rashida A. Ferrand, Aamir J. Khan

Community Health Sciences

Background: Many countries are facing overlapping epidemics of tuberculosis (TB) and diabetes mellitus (DM). Diabetes increases the overall risk of developing Tuberculosis (TB) and contributes to adverse treatment outcomes. Active screening for both diseases can reduce TB transmission and prevent the development of complications of DM. We investigated bi-directional TB-DM screening in Karachi, Pakistan, a country that ranks fifth among high TB burden countries, and has the seventh highest country burden for DM.
Methods: Between February to November 2014, community-based screeners identified presumptive TB and DM through verbal screening at private health clinics. Individuals with presumptive TB were referred for …

Empowering Hiv-Infected Women In Lowresource Settings: A Pilot Study Evaluating A Patient-Centered Hiv Prevention Strategy For Reproduction In Kisumu, Kenya, Okeoma Mmeje, Betty Njoroge, Pauline Wekesa, Alfred Murage, Raphael O. Ondondo, Sheryl Van Der Poel, Mary A. Guze, Starley B. Shade, Elizabeth A. Bukusi, Deborah Cohan, Craig R. Cohen

Obstetrics and Gynaecology, East Africa

Background: Female positive/male negative HIV-serodiscordant couples express a desire for children and may engage in condomless sex to become pregnant. Current guidelines recommend antiretroviral treatment in HIV-serodiscordant couples, yet HIV RNA viral suppression may not be routinely assessed or guaranteed and pre-exposure prophylaxis may not be readily available. Therefore, options for becoming pregnant while limiting HIV transmission should be offered and accessible to HIV-affected couples desiring children.

Methods: A prospective pilot study of female positive/male negative HIV-serodiscordant couples desiring children was conducted to evaluate the acceptability, feasibility, and effectiveness of timed vaginal insemination. Eligible women were 18-34 years with regular …

Is Repeat Abortion A Public Health Problem Among Chinese Adolescents? A Cross-Sectional Survey In 30 Provinces, Jinlin Liu, Shangchun Wu, Jialin Xu, Marleen Temmerman, Wei-Hong Zhang, The Inpac Group

Obstetrics and Gynaecology, East Africa

The Chinese Family Planning (FP) programme mainly focuses on married couples, and young unmarried women have limited access. This cross-sectional study aims to identify risk factors related to repeat abortions in Chinese adolescents receiving abortions. Data were collected using a questionnaire for all women seeking abortions within 12 weeks of pregnancy during a period of 2 months in 297 participating hospitals randomly selected across 30 provinces of China in 2013. Only the adolescents (younger than the minimum legal married age of 20 years) were included in this study. Of the 2370 adolescents who were receiving abortions, 927 (39%) were undergoing …

Current Situation And Future Recommendations For Neurophysiology Services In Pakistan, Imran Ahmad, Farooq Azam Rathore

Pakistan Journal of Neurological Sciences (PJNS)

Clinical neurophysiology is defined as “a medical specialty that studies the central and peripheral nervous systems through the recording of bioelectrical activity, whether spontaneous or stimulated”.1 There are different models of practice for clinical neurophysiology around the world. In some countries it is considered to be an independent specialty, while in other countries it is integrated with neurology.

Infected Non-Union Of Tibia Treated With Ilizarov External Fixator: Our Experience, Shah Fahad, Aysha Habib, Muhammad Awais, Masood Umer, Haroon Rashid

Section of Orthopaedic Surgery

Introduction: Tibia is the most common long bone fractured due its vulnerable subcutaneous location and most often associated with acquired complications of delayed union or non-union due to infection. Amongst the various treatment options to treat them, the Ilizarov external fixator application is considered superior due to its multiple advantages. The objective of this study was to analyse the role of Ilizarov fixation in infected tibial non-union, as well as to assess bony union and associated functional outcomes.
Materials and Methods: A retrospective review was conducted for the duration between 1st January 2005 to 31st December 2016. Total of fifty-one …

Does Surgeon Experience Influence The Amount Of Radiation Exposure During Orthopedic Procedures?: A Systematic Review, Azeem Tariq Malik, Hamid Hussain Rai, Riaz Hussain Lakdawala

Section of Orthopaedic Surgery

With an increasing use of intraoperative fluoroscopy in operating rooms worldwide, the topic of radiation exposure has become a major concern among hospital staff, doctors and patients alike. Since fluoroscopy has become an integral part in orthopedic intraoperative management, we sought to identify whether surgeon grade or experience plays a role in the amount of radiation used and consequently exposed. We performed a systematic review examining the association between surgeon experience and radiation exposure using primary outcome measures (radiation dose and total screening time/fluoroscopy time). To be included in the review, the study population had to compare varying surgeon experience …

Template Operative Note: A Better Documentation, Fareed Ahmed Shaikh, Abdul Rehman Alvi, Noman Shahzad, Tanzeela Gala, Ghulam Murtaza

Section of General Surgery

Operative notes are a valuable part of patient's medical record, and carry the medico-legal significance. One way of improving it is to introduce the template form operative notes. Only few studies have been done worldwide to compare both the forms of operative notes. This cross-sectional study was conducted in the department of General Surgery, AKUH. This included the patients who underwent Laparoscopic cholecystectomy (Complying with inclusion criteria) from August 2013 till March 2014. Out of 24 patients, 19 were females. The completeness of data in template group was significantly better than traditional group (79.2% vs. 8.3%). There was no significant …

Choice Of Therapeutic Anti-Seizure Medication In Patients With Brain Tumour, Altaf Ali Laghari, Syed Ijlal Ahmed, Namra Qadeer, Muhammad Shahzad Shamim

Section of Neurosurgery

Seizures are common in patients with brain tumours, even though prophylactic anti-seizure treatment for all patients with brain tumours is not recommended. Newer anti-epileptic drugs have shown benefits that outweigh the side effects of treatment and can also be given in combination with traditional anti-epileptic drugs. The authors have reviewed the literature on the various combinations of anti-epileptics in patients with seizures and brain tumours.

Cardiovascular Disease Risk Factors In Pakistani Population With Newly Diagnosed Type 2 Diabetes Mellitus: A Cross-Sectional Study Of Selected Family Practitioner Clinics In Four Provinces Of Pakistan (Cardip Study), Syed Abbas Raza, Mariam Hassan, Farhana Badar, Farah Rasheed, Fouzia Meerza, Sumeyya Azam, Ali Jawa, Imtiaz Hassan, Faisal Masood Qureshi, Najmul Islam

Section of Diabetes, Endocrinology and Metabolism

Objective: To explore cardiovascular risk factors in people with newly-diagnosed type 2 diabetes mellitus.

Methods: The cross-sectional, prospective, multicentre, study was conducted from June 2014 till July 2015 at family practice clinics in 27 cities across Pakistan, and comprised individuals aged 30-50 years diagnosed with type 2 diabetes mellitus within the preceding six months. Laboratory investigations were conducted at Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, and Aga Khan University Hospital, Karachi. The 10-year absolute risk of fatal or non-fatal coronary heart disease and stroke was calculated using the United Kingdom Prospective Diabetes Study Risk Engine version 2.0. …

Rationale And Protocol For Estimating The Economic Value Of A Multicomponent Quality Improvement Strategy For Diabetes Care In South Asia, Kavita Singh, Mohammed K. Ali, Raji Devarajan, Roopa Shivashankar, Dimple Kondal, Vamadevan S. Ajay, V. Usha Menon, Premlata K. Varthakavi, Vijay Viswanathan, Qamar Masood

Section of Diabetes, Endocrinology and Metabolism

Background: Economic dimensions of implementing quality improvement for diabetes care are understudied worldwide. We describe the economic evaluation protocol within a randomised controlled trial that tested a multi-component quality improvement (QI) strategy for individuals with poorly-controlled type 2 diabetes in South Asia.

Methods/Design: This economic evaluation of the Centre for Cardiometabolic Risk Reduction in South Asia (CARRS) randomised trial involved 1146 people with poorly-controlled type 2 diabetes receiving care at 10 diverse diabetes clinics across India and Pakistan. The economic evaluation comprises both a within-trial cost-effectiveness analysis (mean 2.5 years follow up) and a microsimulation model-based cost-utility analysis (life-time horizon). …

Serum Anti Mullerian Hormone And Renalase Levels In Predicting The Risk Of Preeclampsia, Zehra Jamil, Sana Shahid, Erum Baig, Rida Ahmad, Faryal Subhani, Syeda Sadia Fatima

Department of Biological & Biomedical Sciences

Objective: The aim of the study was to explore the association of serum AMH and Renalase with the risk of preeclampsia thereby assessing them as screening tools, reducing the risk of gravid consequences of preeclampsia.
Materials and Methods: This cross-sectional study recruited n = 95 pregnant women between 14 and 32 gestational weeks. They were categorized as a) women with gestational hypertension (n = 45); b) women with pre-eclampsia (n = 20) and c) normotensive pregnant women (n = 30) according to the ACOG criteria. Anthropometrics data and blood and urine samples were collected. AMH and Renalase levels were measured …

Longer Trinucleotide Repeats Of Androgen Receptor Gene: Infertility In Males, Mussarat Ashraf, Hemaila Tariq, Rehana Rehman

Department of Biological & Biomedical Sciences

No abstract provided.

Comparison Of Serum Levels Of Vitamin D And Vitamin D-Binding Protein In Normal, Osteopenic And Osteoporotic Postmenopausal Women, Rafat Murad, Tabassum Mahboob, Rehana Rehman, Rozeena Baig

Department of Biological & Biomedical Sciences

Objective: To compare the serum levels of vitamin D, vitamin D binding protein (VDBP) calcium and phosphate in normal, osteopenic and osteoporotic postmenopausal women categorized on the basis of bone mineral density (BMD) scores.
Methods: A cross sectional study carried out from May 2017 to August 2018. BMD measured by Dual energy X-ray Absorptiometry categorized women (aged 20- 70 years) into normal (n=37) (T score ≥ -1.0) osteopenic (n=25) (-2.5< T score, < -1) and osteoporotic (n= 26) (T score < -2.5) according to WHO classification. Serum concentrations of vitamin D, VDBP, calcium, phosphate analyzed by enzyme linked immunosorbent assay were compared by Analysis of Variance.
Results: In normal females higher levels of vitamin D and VDBP were observed [15.82 (8 - 69.18), 469.9 (269.57 - 875.55)] vs. osteopenic [(7.45 (4.66 - 15.1), 296.05 (232.58 - …

Management Of Non-Epileptic Seizures Through Hypnosis: A Case Study, Muhammad Rafiq, Sana Zaheer

Pakistan Journal of Neurological Sciences (PJNS)

Conversion disorder is associated with diverse somatic complaints including visual deficiency, psychogenic nonepileptic seizures, lethargy, paralyses etc. Studies have revealed that in addition to pharmacological treatment, psychological intervention including hypnosis has a significant impact in the management of conversion disorder. The current case study was focused to see any effect of unique hypnotic technique, Circle Therapy for the management of conversion disorder. The patient A.J. was referred for the evaluation and psychological management ofnon-epileptic seizures. After a complete physical and psychological observation and interview, stressors were identified a n d the patient underwent brief hypnotic session and it was suggested …

Multiple Sclerosis In Pakistan And Need For Multiple Sclerosis Registry, Haris Majid Rajput, Mohammad Wasay, Mazhar Badshah, Muhammad Hassan

Pakistan Journal of Neurological Sciences (PJNS)

Multiple sclerosis(MS) is an acquired chronic demyelinating disease of central nervous system is a leading cause of non-traumatic disability in young with significant socioeconomic impact. The aim of this study was to provide a comprehensive review of all available data of MS in Pakistan.

A Race Inside The Body: Decision Of The Fate Of Newborn, Shyrose Sultan, Samreen Siraj, Zainish Zafarullah Hajani, Afsheen Hirani, Nasreen Rafiq

School of Nursing & Midwifery

Sex-selective abortion is the killing of a girl fetus merely due to its gender. It has become an emerging problem in developing countries mainly due to lack of resources and cultural stereotypes. Illegal abortions have increased and are jeopardizing not only the gender ratio but also the health of the mother by exposing them to complications and violating their rights. The aim of this paper is to evaluate a case scenario based on many ethical dilemmas and questions that arise form it. The paper presents the problem in light of major ethical principles and theories by counteracting each argument with …

Exploring Lived Experiences Of Married Pakistani Women Post-Mastectomy, Laila Hussain, Zeenatkhanu Kanji, Sharifa Bashir Lalani, Shabnam Moledina, Abida K. Sattar

School of Nursing & Midwifery

Objective: This qualitative descriptive exploratory study aimed to explore the lived experiences of married Pakistani women, 2 years post-mastectomy.
Methods: Twelve participants were recruited through purposive sampling from outpatient oncology clinic from a tertiary care hospital in Pakistan. Interviews were audio-taped and transcribed, and then themes and sub-themes were identified.
Results: Women verbalized a range of their experiences throughout the span from diagnosis to mastectomy. One over arching theme, quality of life and four main themes and their subthemes emerged from the data. Following are the themes; from history to diagnosis, worries, coping strategies, and recommendations.
Conclusions: The study findings …

Primary Pulmonary Plasmacytoma Presenting With Rare Igg Lambda Monoclonal Gammopathy, Yasmin Rahim, Farrukh Zia Tareen, Rashida Ahmed, Javaid Khan

Section of Pulmonary & Critical Care

Extramedullaryplasmacytoma (EMP) represents a peculiar and typically progressive malignancy that can originate outside the bone marrow. Primary pulmonary plasmacytoma (PPP) is a rare subset of EMP, confined to the lung. A 55-year-old man, diabetic, non-smoker presented to our clinic with a right chest wall swelling. A routine chest radiograph showed a well-circumscribed opacity in the right upper lung zone. A CT of the chest revealed a large right upper lobe mass with extensive local infiltration. Biopsy and immunohistochemical evaluation led to a diagnosis of PPP. Screening for multiple myeloma was negative. Serum immunofixation showed an IgG lambda monoclonal gammopathy, found …

Value Of Periodic Transcutaneous Daytime Carbon Dioxide Monitoring In Screening For Respiratory Failure In Patients With Amyotrophic Lateral Sclerosis, Muhammad K Rafiq

Pakistan Journal of Neurological Sciences (PJNS)

There is no single test currently available, which can predict respiratory failure in patients with amyotrophic lateral sclerosis (ALS) with high sensitivity and specificity. This study explores the potential use of transcutaneous carbon dioxide (PtcCO2) monitoring in early detection of respiratory failure in ALS.

Prevalence Of Stress And Depression Among University Students Of Karachi, Nida Naseem, Lubna Naz, Nazneen Zehra

Pakistan Journal of Neurological Sciences (PJNS)

Stress is an all-time concerned issue in undergraduate students. Stress levels are high due to workload, pressure of academic and extra-curricular activities and unhealthy lifestyle. Though stress can be beneficial for academic growth but increased magnitude can be harmful for physiological, psychological and social aspects.

Evaluating Quality Of Contraceptive Counseling: An Analysis Of The Method Information Index, Karen T. Chang, Mulenga Mukanu, Ben Bellows, Waqas Hameed, Amanda M. Kalamar, Karen A. Grépin, Xaher Gul, Nirali M. Chakraborty

Community Health Sciences

The Method Information Index (MII) is calculated from contraceptive users' responses to questions regarding counseling content-whether they were informed about methods other than the one they received, told about method-specific side effects, and advised what to do if they experienced side effects. The MII is increasingly reported in national surveys and used to track program performance, but little is known about its properties. Using additional questions, we assessed the consistency between responses and the method received in a prospective, multicountry study. We employed two definitions of consistency: (1) presence of any concordant response, and (2) absence of discordant responses. Consistency …

Medical Doctors' Offline Computer-Assisted Digital Education: Systematic Review By The Digital Health Education Collaboration, Hayfaa Abdelmageed Wahabi, Samia Ahmed Esmaeil, Khawater Hassan Bahkali, Maher Abdelraheim Titi, Yasser Sami Amer, Amel Ahmed Fayed, Amr Jamal, Nasriah Zakaria, Amna Rehana Siddiqui, Monika Semwal

Community Health Sciences

Background: The widening gap between innovations in the medical field and the dissemination of such information to doctors may affect the quality of care. Offline computer-based digital education (OCDE) may be a potential solution to overcoming the geographical, financial, and temporal obstacles faced by doctors.
Objective: The objectives of this systematic review were to evaluate the effectiveness of OCDE compared with face-to-face learning, no intervention, or other types of digital learning for improving medical doctors' knowledge, cognitive skills, and patient-related outcomes. Secondary objectives were to assess the cost-effectiveness (CE) of OCDE and any adverse effects.
Methods: We searched major bibliographic …

Cime Newsletter : February 2019, Cime

Centre for Innovation in Medical Education (CIME) Archives

-Programmed to Deliver
-Interviewing a mental health client: A ‘How To’ workshop for nurses
-The Basics of Critical Care made interactive through simulation
-A Critical Care Toolkit for Nursing Students
-Managing Medical Emergencies in the Dental Chair
-Celebrating CIME’s Culture Day – any excuse to get dressed up!

Early Neonatal Vitamin A Supplementation And Infant Mortality: An Individual Participant Data Meta-Analysis Of Randomised Controlled Trials, Rajiv Bahl, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: Biannual vitamin A supplementation is a well-established survival tool for preschool children 6 months and older in vitamin A deficient populations but this schedule misses the opportunity to intervene on most young infant deaths. Randomised trials of neonatal vitamin A supplementation (NVAS) in the first few days of life to assess its impact on under 6-month mortality in low/middle-income countries have had varying results.
Methods: Investigators of 11 published randomised placebo-controlled NVAS trials (n=163 567 children) reanalysed their data according to an agreed plan and pooled the primary outcomes of mortality from supplementation through 6 and 12 months of …

Effectiveness Of 10-Valent Pneumococcal Conjugate Vaccine Against Vaccine-Type Invasive Pneumococcal Disease In Pakistan, Atif Riaz, Syed Mohiuddin, Sara Husain, Mohammad Tahir Yousafzai, Muhammad Sajid, Furqan Kabir, Najeeb Rehman, Waseem Mirza, Basit Salam, Naila Naila, Khatidja Pardhan, Anita K. M. Zaidi, Syed Asad Ali

Department of Paediatrics and Child Health

Objective: To assess the effectiveness of 10-valent pneumococcal conjugate vaccine (PCV10) against invasive pneumococcal disease (IPD) due to vaccine serotypes of Streptococcus pneumoniae post introduction of the vaccine into the routine immunization program in Pakistan.
Methods: A matched case-control study was conducted at 16 hospitals in Sindh Province, Pakistan. Children aged (eligible to receive PCV10) who presented with radiographically confirmed pneumonia and/or meningitis were enrolled as cases. PCR for the lytA gene was conducted on blood (for radiographic pneumonia) and cerebrospinal fluid (for meningitis) samples to detect S. pneumoniae. The proportion of IPD due to vaccine serotypes (including vaccine-related serogroups) …

Dengue Fever Presenting As Quadriparesis Due To Hypokalaemia: A Rare Presentation, Syed Muhammad Zubair, Syed Ahsan Ali, Saira Furqan

Section of Internal Medicine

Dengue is one of the leading causes of arthropod borne viral haemorrhagic fever. Majority of the times, it clinically manifests as fever, arthralgia and rash; however, we present a case of a young man who presented with progressively increasing weakness of all four limbs. Initial investigations showed low potassium, hence he was managed as hypokalaemic periodic paralysis. With initial history of fever and low platelets, dengue was suspected. Dengue antibody was checked which came out to be positive. Potassium was replaced which led to improvement in power of his limbs. He was discharged in a stable condition with a diagnosis …

Femoral Vein Transposition Arteriovenous Fistula Is A Feasible Option In "Selected" Patients As Hemodialysis Access, Zia Ur Rehman, Asfia Arham, Ziad Sophie

Section of Cardiothoracic Surgery

Introduction: Lower extremity hemodialysis access is offered to the patients who have severe central venous stenosis. Femoral vein transposition arteriovenous fistula (FV tAVF) is an alternative to lower leg arteriovenous prosthetic grafts. Its safety and patency is under observation.
Materials and Methods: This is a retrospective review of patients who had FV tAVF between January 2011 and March 2016. Preoperative clinical findings, intraoperative findings, postoperative complications, and patency of the AVF were noted and analyzed.
Results: There were 7 patients who underwent FV tAVF during this study period. Most patients were female (6 : 1), with mean …

Understanding Constipation: A Cross-Sectional Study From A Developing Country Setting, Minaz Mawani, Abdul Azeem, Sakina Gheewala, Nazish Butt, Shahab Abid

Section of Gastroenterology

A cross-sectional study was conducted in the Gastroenterology Clinics of The Aga Khan Hospital and Jinnah Postgraduate Medical Centre in Karachi. All patients complaining of constipation were included. Patients with alarm features were excluded. Interviews were conducted by trained doctors using a structured Rome III based pre-tested questionnaire and Bristol Stool Form Scale. Out of 396 participants, 186 (47.0%) had FC and 209 (52.7%) had IBS-C. Based upon Bristol Stool Form Scale, only 214 (54%) reported to have slow transit constipation (BSS <2). A higher proportion of women reported severe form of constipation as compared to men (81.5%, n=150 vs. 65.1%, n=138 p<0.001). However, a higher percentage of men reported using medications to treat their symptoms (71.2%, n=151 vs. 57.1%, n=105 p=0.003). Proper understanding of patient's symptoms is essential for optimizing individual patient management.

Inspire : Vol 2, Issue 3, Department Of Medicine

INSPIRE – Department of Medicine Archives

Content

• Message From the Chair
• Department of Medicine Strategic Planning Retreat
• Life Notes by Dr. Saad Shafqat
• Department of Medicine at National and International Forums
• What Are Academics Around the World Reading This Month?
• Featured Faculty Profile
• Dr. Syedah Saira Bukhari; “Choose to be kind.”
• Events Around the Corner
• Publications

Adult-Onset Still’S Disease Triggered By Pregnancy, Saleem Abdulkarim, Fredrick Otieno, Sayed Karar

Internal Medicine, East Africa

Adult-onset Still’s disease (AOSD) is an inflammatory disorder with arthritis, quotidian fever, evanescent rash, elevated white cell count, elevated ferritin, and abnormal liver function tests. The diagnosis requires the exclusion of other inflammatory, infectious, and malignant conditions. Onset of AOSD, though rare, has been known to occur in pregnancy. We present a 28-year-old woman diagnosed with AOSD at 3 months gestation.