Medicine and Health Sciences Commons^™

Joint Association Of Urinary Sodium And Potassium Excretion With Cardiovascular Events And Mortality: Prospective Cohort Study, Martin O'Donnell, Andrew Mente, Sumathy Rangarajan, Matthew J. Mcqueen, Neil O'Leary, Lu Yin, Xiaoyun Liu, Sumathi Swaminathan, Rasha Khatib, Romaina Iqbal

Community Health Sciences

Objective: To evaluate the joint association of sodium and potassium urinary excretion (as surrogate measures of intake) with cardiovascular events and mortality, in the context of current World Health Organization recommendations for daily intake (<2.0 g sodium, >3.5 g potassium) in adults.
Design: International prospective cohort study.
Setting: 18 high, middle, and low income countries, sampled from urban and rural communities.
Participants: 103 570 people who provided morning fasting urine samples.
Main outcome measures: Association of estimated 24 hour urinary sodium and potassium excretion (surrogates for intake) with all cause mortality and major cardiovascular events, using multivariable Cox regression. A six category …

Posterior Reversible Encephalopathy Syndrome (Pres) Presenting As Transient Complete Visual Loss, Nismat Javed, Sohail Naseem, Mohammad Amer Awan, Shahzad Khan Siddique, Arsalan Ahmad

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Application Of Epley Maneuver In Treating Benign Paroxysmal Positional Vertigo (Bppv), Nasir Yaqoob, Arif Herekar

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Cognitive And Brain Plasticity By Performing Small Scale Brain Activities In Youth, Sonya Arshad, Muhammad Nisar, Mushkbar Fatima, Sadaf Ahmed

Pakistan Journal of Neurological Sciences (PJNS)

Is playing video game really a waste of time? No…!!! It’s merely a simple way of making the brain physiology better, smarter and faster. Great quality games, which are testing, enlightening, and retaining, can make learning charming and compelling. Studies have shown that people who are engaged in playing video games have more grey matter in their brains which results in boosting up their cognitive skills.

Antioxidative Activity Of Clove (Syzygium Aromaticum) Oil Administration In Middle Cerebral Artery Occlusion (Mcao) Models Of Acute Focal Cerebral Ischemia, Hira Jawed, Mufzala Shamim, Sumera Sohail, Uzma Firdous, Nazish Iqbal Khan

Pakistan Journal of Neurological Sciences (PJNS)

Stroke is a multifactorial neurological deficit syndrome. Oxidative stress is the principal underlying pathophysiological mechanism of ischemic stroke associated with neuronal damage and neuroinflammation.

Effect Of 10-Valent Pneumococcal Conjugate Vaccine On The Incidence Of Radiologically-Confirmed Pneumonia And Clinically-Defined Pneumonia In Kenyan Children: An Interrupted Time-Series Analysis, Micah Silaba, Michael Ooko, Christian Bottomley, Joyce Sande, Rachel Benamore, Kate Park, James Ignas, Kathryn Maitland, Neema Mturi, Anne Makumi

Imaging & Diagnostic Radiology, East Africa

Background: Pneumococcal conjugate vaccines (PCV) are highly protective against invasive pneumococcal disease caused by vaccine serotypes, but the burden of pneumococcal disease in low-income and middle-income countries is dominated by pneumonia, most of which is non-bacteraemic. We examined the effect of 10-valent PCV on the incidence of pneumonia in Kenya.

Methods: We linked prospective hospital surveillance for clinically-defined WHO severe or very severe pneumonia at Kilifi County Hospital, Kenya, from 2002 to 2015, to population surveillance at Kilifi Health and Demographic Surveillance System, comprising 45000 children younger than 5 years. Chest radiographs were read according to a WHO standard. A …

Use Of 3d Imaging For Providing Insights Into High-Order Structure Of Mitotic Chromosomes, Mohammad Yusuf, Kohei Kaneyoshi, Kiichi Fukui, Ian Robinson

Centre for Regenerative Medicine & Stem Cell Research

The high-order structure of metaphase chromosomes remains still under investigation, especially the 30-nm structure that is still controversial. Advanced 3D imaging has provided useful information for our understanding of this detailed structure. It is evident that new technologies together with improved sample preparations and image analyses should be adequately combined. This mini review highlights 3D imaging used for chromosome analysis so far with future imaging directions also highlighted.

Cyto-Histologic Discordancy In Patients Undergoing Thyroidectomy At Aga Khan University Hospital, Moses Barasa, Abdulkarim Abdallah

General Surgery, East Africa

Fine needle aspiration cytology (FNAC) findings are the basis upon which decision and type surgery is made. Therefore the diagnostic accuracy and utility of FNAC being such an integral tool in management of thyroid lesions must be evaluated for cyto-histologic discrepancy from time to time as a quality assurance measure. The objective was to compare thyroid fine-needle aspiration cytology (FNAC) with final histopathological findings at in patients undergoing thyroidectomy. This was a cross-sectional retrospective study at Aga Khan university hospital, Nairobi. Cyto-histologic discrepancy was found in 19(25%) of cases with false positive and negative rates at 9% and 16%. False …

Establishing Cohorts To Generate The Evidence Base To Reduce The Burden Of Breast Cancer In Sub-Saharan Africa: Results From A Feasibility Study In Kenya, Sujha Subramanian, Robai Gakunga, Madeleine D. Jones, Asaph Kinyanjui, Emily' Ochieng, Nancy Gikaara, Florence Maluni, David Wata, Anne Korir, Miriam Mutebi, Zipporah Ali

General Surgery, East Africa

Purpose: By 2025, Kenya is estimated to experience a two-thirds increase in the incidence of breast cancer. Local research is necessary to generate evidence to inform policy, public health, and medical practice. There have been no longitudinal cohort studies in sub-Saharan Africa of women with and without breast cancer. Our aim is to assess the feasibility of conducting cohort studies in Kenya that consider clinical characteristics, socioeconomic factors, and self-care behaviors.

Methods: We initiated a short-term follow-up cohort study of women with and without a diagnosis of breast cancer with baseline face-to-face data collection and one follow-up interview …

Healthy Heart Africa-Kenya: A 12-Month Prospective Evaluation Of Program Impact On Health Care Providers' Knowledge And Treatment Of Hypertension, Elijah N. Ogola, Francis O. Okello, Jane L. Herr, Elizabeth Macgregor-Skinner, Ashling Mulvaney, Gerald Yonga

Internal Medicine, East Africa

Background: Given the rising burden of hypertension in Africa, the Healthy Heart Africa program was developed to improve access to quality hypertension care in the primary care setting. The Healthy Heart Africa program provides a comprehensive, coordinated intervention directed at health care providers (HCPs) and the general public.

Objective: The impact of Healthy Heart Africa on HCPs' knowledge of hypertension and facility-level services in Kenya was evaluated by a 12-month prospective study.

Methods: Intervention facilities were selected by stratified random sampling and matched to similar control facilities. Intervention facilities received a hypertension treatment protocol, equipment, training and patient education materials, …

Assessment Of Clinical Outcomes In Patients Presenting With Transverse Myelitis: A Tertiary Care Experience From A Developing Country, Aijaz Ali, Syeda Beenish Bareeqa, Amir Riaz, Syed Ijlal Ahmed,, Muhammad Hassan Shaikh, Muhammad Ishaq Ghauri

Department of Medicine

Background: Transverse myelitis (TM) is an inflammatory disorder of spinal cord, characterized by acute or sub-acute dysfunction of spinal cord affecting the motor, sensory, and autonomic systems. It may be idiopathic or related to other diseases. Although some patients recover from TM with minor or no residual problems, others suffer permanent impairments that affect their ability to perform ordinary tasks of daily living. Our objective was to determine the frequency of different clinical outcomes in patients presenting with TM.

Methods: It was a prospective cohort clinical study conducted from May 2018 till October 2018. Study was conducted in the Department …

Dermoid Cyst With No Intracranial Extension: A Case Report And Literature Review, Asra Tanwir, Noor Malik, Gohar Javed, Romana Idress

Section of Neurosurgery

Background: Dermoid cysts are cystic inclusion tumors. They comprise hair follicles, sweat glands, and sebaceous glands. They have lining of stratified squamous epithelium. The most common areas involved are face, lower back, and ovaries. Congenital cystic dermoid involving the anterior fontanelle with no intracranial extension is a rare scalp swelling. We present a case of dermoid cyst with no intracranial extension.
Case description: We report a case of 4-month-old child presented with a history of a scalp swelling since birth. The swelling increased in size progressively. Magnetic resonance imaging of the brain revealed extracranial cystic lesion over anterior fontanelle with …

The Salt Between The Beans: A Qualitative Study Of The Role Of Auxiliary Midwives In A Hard-To-Reach Area Of Myanmar, Kyu Kyu Than, Stanley Luchters, Khaing Nwe Tin, Thazin La, James Beeson, Alison Morgan

Population Health, East Africa

Background: Auxiliary Midwives (AMWs) are unpaid volunteer health workers assisting qualified paid midwives in maternal and child health care mainly in hard-to-reach areas of Myanmar. This paper describes the relationship between AMWs and the health system in providing maternal and child services as perceived by the community, AMWs themselves and health care providers in one remote township of Myanmar.

Method: A qualitative study was conducted in Ngape Township, Myanmar. A total of 15 focus group discussions with midwives, AMWs, community members and mothers were conducted. Ten key informant interviews were performed with national, district and township level health planners and …

The Utility Of Neutrophil Gelatinase-Associated Lipocalin (Ngal) As A Marker Of Acute Kidney Injury (Aki) In Critically Ill Patients, Shabnum Khawaja, Lena Jafri, Imran Siddiqui, Madiha Hashmi, Farooq Ghani

Department of Pathology and Laboratory Medicine

In current clinical practice, Serum Creatinine (SCr) is a commonly used marker for the diagnosis of acute kidney injury (AKI). Unfortunately, due to a delayed increase in SCr, it is unable to accurately estimate the timing of the injury. The purpose of this study was to assess the ability of plasma neutrophil gelatinase-associated lipocalin (pNGAL) to predict AKI in critically ill adult patients. The study was conducted at the Section of Chemical Pathology, Department of Pathology& Laboratory Medicine in collaboration with Department of Anesthesiology, at Aga Khan University Hospital in Karachi, Pakistan. Subjects in the age groups of18 to …

Improving Nursing Documentation Via Reducing The Written Work Load, Anaiz Ahmed Khowaja, Nasreen Rafiq

School of Nursing & Midwifery

With the growth in the health care industry around the world and introduction to new technologies in the system, the uses of traditional methods in nursing practices are reducing. These modern work practices are meant to reduce human effort without compromising on the quality. Where as dealing with documentation whereas always has been a major challenge in providing the better health care. The project thus outlines the improving nursing documentation via reducing the written work load to increase work efficiency.

Health Care Seeking For Maternal And Newborn Illnesses In Low- And Middle-Income Countries: A Systematic Review Of Observational And Qualitative Studies, Zohra S. Lassi, Philippa Middleton, Zulfiqar Ahmed Bhutta, Caroline Crowther

Woman and Child Health

Background: In low- and middle-income countries, a large number of maternal and newborn deaths occur due to delays in health care seeking. These delays occur at three levels i.e. delay in making decision to seek care, delay in access to care, and delay in receiving care. Factors that cause delays are therefore need to be understand to prevent and avoid these delays to improve health and survival of mothers and babies.
Methods: A systematic review of observational and qualitative studies to identify factors and barriers associated with delays in health care seeking.
Results: A total of 159 observational and qualitative …

National Policies And Care Provision In Pregnancy And Childbirth For Twins In Eastern And Southern Africa: A Mixed-Methods Multi-Country Study, Claudia Hanson, Stephen Munjanja, Agnes Binagwaho, Bellington Vwalika, Andrea B. Pembe, Elsa Jacinto, George K. Chilinda, Kateri B. Donahoe, Sikolia Wanyonyi, Peter Waiswa, Muchabayiwa F. Gidiri, Lenka Benova

Obstetrics and Gynaecology, East Africa

Background: High-risk pregnancies, such as twin pregnancies, deserve particular attention as mortality is very high in this group. With a view to inform policy and national guidelines development for the Sustainable Development Goals, we reviewed national training materials, guidelines, and policies underpinning the provision of care in relation to twin pregnancies and assessed care provided to twins in 8 Eastern and Southern African countries: Kenya, Malawi, Mozambique, Rwanda, Tanzania, Uganda, Zambia, and Zimbabwe.

Methods and findings: We located policies and guidelines by reviewing national repositories and by contacting experts to systematically map country-level maternal and newborn training materials, guidelines, and …

Qualitative Assessment Of South African Healthcare Worker Perspectives On An Instrument-Free Rapid Cd4 Test, Fiona Scorgie, Yasmin Mohamed, David Anderson, Suzanne M. Crowe, Stanley Luchters, Matthew F. Chersich

Population Health, East Africa

Background: Accurate measurement of CD4 cell counts remains an important tenet of clinical care for people living with HIV. We assessed an instrument-free point-of-care CD4 test (VISITECT® CD4) based on a lateral flow principle, which gives visual results after 40 min. The test involves five steps and categorises CD4 counts as above or below 350 cells/μL. As one component of a performance evaluation of the test, this qualitative study explored the views of healthcare workers in a large women and children’s hospital on the acceptability and feasibility of the test.

Methods: Perspectives on the VISITECT® CD4 test were elicited through …

Expression Of Cyclin D1 In Clear Cell Sarcoma Of Kidney. Is It Useful In Differentiating It From Its Histological Mimics?, Nasir Uddin Ahmed, Khurram Minhas, Jamshid Abdul Ghafar, Arsalan Ahmed, Zubair Ahmad

Department of Pathology and Laboratory Medicine

Background: Clear cell sarcoma of the kidney (CCSK) is a rare malignant pediatric renal neoplasm with a heterogeneous histological appearance which often results in misdiagnosis. There are no specific immunohistochemical markers which can help in differentiating CCSK from other pediatric renal neoplasms. Recently Cyclin D1 has been investigated as a possible marker in this regard. In this study, we aim to determine the usefulness of Cyclin D1 in differentiating between CCSK and other pediatric renal neoplasms and to compare our results with those of recently published studies.
Methods: A total of 48 cases of CCSK, Wilms tumor (WT), renal rhabdoid …

Structured On-The-Job Training To Improve Retention Of Newborn Resuscitation Skills: A National Cohort Helping Babies Breathe Study In Tanzania, Mary Drake, Dunstan R. Bishanga, Akwila Temu, Mustafa Njozi, Erica Thomas, Victor Mponzi, Lauren Arlington, Georgina Msemo, Mary Azayo, Allan Kairuki, Amunga R. Meda, Kahabi Isangula, Brett D. Nelson

School of Nursing & Midwifery, East Africa

Background: Newborn resuscitation is a life-saving intervention for birth asphyxia, a leading cause of neonatal mortality. Improving provider newborn resuscitation skills is critical for delivering quality care, but the retention of these skills has been a challenge. Tanzania implemented a national newborn resuscitation using the Helping Babies Breathe (HBB) training program to help address this problem. Our objective was to evaluate the effectiveness of two training approaches to newborn resuscitation skills retention implemented across 16 regions of Tanzania.

Methods: An initial training approach implemented included verbal instructions for participating providers to replicate the training back at their service delivery site …

Patterns And Outcomes Of Paediatric Trauma At A Tertiary Teaching Hospital In Kenya, Anthony Ndung'u, Jared Sun, Joan Musau, Eunice Ndirangu

School of Nursing & Midwifery, East Africa

Introduction: Trauma continues to be a major cause of morbidity and mortality especially in the paediatric population of low- and middle-income countries such as Kenya. The aim of this study was to establish the profile and outcomes of admitted paediatric trauma cases at the Aga Khan University Hospital, Nairobi.

Methods: This retrospective, descriptive study involved a 12-month chart review (January 2016–December 2016). A total of 218 records were identified of which 144 were reviewed.

Results: Most injuries were amongst boys (65.3%) and the very young (mean age 6), occurred in private residences (42.4% homes, 25.7% residential institutions), were typically caused …

Correction To: Nasopharyngeal Carriage Of Streptococcus Pneumoniae In Children Under 5 Years Of Age Before Introduction Of Pneumococcal Vaccine (Pcv10) In Urban And Rural Districts In Pakistan, Muhammad Imran Nisar, Kanwal Nayani, Tauseef Akhund, Atif Riaz, Omar Irfan, Sadia Shakoor, Sehrish Muneer, Sana Muslim, Aneeta Hotwani, Furqan Kabir, Cynthia Whitney, Lindsay Kim, Velusamy Srinivasan, Syed Asad Ali, Anita K. M. Zaidi, Fyezah Jehan

Department of Paediatrics and Child Health

No abstract provided.

Motor-Vehicle Crash Patient Injury Patterns From A Level One Trauma Center In A Metropolitan City: A Cross-Sectional Study, Obada Hasan, Sadaf Sheikh, Asad Abbas, Nida Zahid, Naveed Baloch

Section of Orthopaedic Surgery

Introduction: Motorcycles are an inexpensive and popular mode of transportation in Karachi, Pakistan, despite the increasing number of motor vehicle injuries. Although motorcycle-related injuries have been studied previously, to our knowledge, there are no published reports on the orthopedic injuries associated with motorcycles crashes.
Methods: We conducted a cross-sectional study of medical records of patients with motorcycle-related injuries in 2015, at the Aga Khan University in Karachi, Pakistan. We reviewed the patient demographic and medical data, helmet use, the Glasgow coma score, the spectrum of injuries, length of stay, specific injury diagnosis, and final disposition of patients. Data were analyzed …

Analysing Outcomes Through Orthopaedic Trauma Registry: A Prospective Cohort Study, Tashfeen Ahmad, Zehra Abdul Muhammad, Shahryar Noordin, Ammar Humayun

Section of Orthopaedic Surgery

Objective: To develop a registry for recording injury-specific data to identify gaps and improve care.
Methods: The prospective cohort study was conducted at Aga Khan University Hospital, Karachi, from June 2015 to July 2018 though enrollment of patients with limb trauma is continuing to date. Data on injuries and management related to Tibia shaft fractures was collected from medical records, and outcomes were assessed on follow-up visits. Internationally validated injury-specific scores were utilised for assessing functional, clinical and radiological outcomes. SPSS version 19 was used for data analysis.
Results: There were 763 patients with 825 limb injuries. Of the injuries, …

Amoebic Liver Abscess: Outcomes Of Percutaneous Needle Aspiration Vs Drain Placement In Paediatric Population, Areej Saleem, Saqib Hamid Qazi, Waseem Mirza, Sarah Masroor Jeelani

Section of Paediatric Surgery

Objective: To compare the effectiveness of percutaneous catheter drain placement with percutaneous needle aspiration in terms of hospital stay, time to resolution of symptoms and cost of intervention performed.
Methods: The retrospective cohort study was conducted at Aga Khan University Hospital, Karachi, and comprised data of patients with amoebic liver abscess from, January 2006 to December 2016 which was collected using non-probability purposeful sampling. Primary outcome included length of hospital stay, time to resolution of symptoms and cost of intervention. Secondary outcomes included development of complications, need for re-intervention and abscess resolution. SPSS 22 was used for data analysis. . …

Primary Trauma Care: A Training Course For Healthcare Providers In Developing Countries, Saqib Kamran Bakhshi, Rashid Jooma

Section of Neurosurgery

Outcomes of injury in low and middle income countries may be compromised by skill deficiencies of healthcare providers. Short subspecialty training courses can be a useful solution to skill-deficits. We report on the Primary Trauma Care programme, a 2-day course designed to train frontline health workers in resuscitation and early management of the injured with limited resources and equipment. Developed for use in weak health systems and now conducted in over 70 countries, the programme is cost-efficient with built-in design sustainability by way of early transfer of ownership to local partners to effect a cascade of trauma courses in their …

Diabetes Prevalence Survey Of Pakistan (Dps-Pak): Prevalence Of Type 2 Diabetes Mellitus And Prediabetes Using Hba1c: A Population-Based Survey From Pakistan, Azizul L Hasan Aamir, Saeed A. Mahar, Faisal Masood Qureshi, Ibrar Ahmad, Ali Jawa, Aisha Sheikh, Abbas Raza, Sheraz Fazid, Zahid Jadoon, Osama Ishtiaq

Section of Diabetes, Endocrinology and Metabolism

Objectives: We conducted a Pakistan-wide community-based survey on the prevalence of type 2 diabetes using glycated haemoglobin (HbA1c) as the screening test. The aim was to estimate diabetes prevalence across different demographic groups as well as all regions of Pakistan.

Design, settings and participants: Multistaged stratified cluster sampling was used for the representative selection of people aged ≥20 years, residing in 378 sampled clusters of 16 randomly selected districts, in this cross-sectional study. Eligible participants had blood drawn for HbA1c analyses at field clinics near to their homes. The oral glucose tolerance test (OGTT) was conducted on a subsample of …

Surgical Care For All - Much Work To Be Done, Ather Enam, Sadaf Khan

Section of Neurosurgery

No abstract provided.

Turnover Propensity Among Nurses In Pakistan: Overview And Management, Anaiz Ahmed Khowaja, Nasreen Rafiq, Fazal Rabi, Nazia Merchant, Neelam Rafiq, Sanam Zulfiqar

School of Nursing & Midwifery

Human resource management is an important stake of health care systems. Today, the increase in the burden of diseases has increased the demands of health care professionals in particular Nurses who are the key assets to these agencies. Unfortunately, there is a huge difference between the numbers of nurses between developed and developing countries. Various databases were used to identify this gap, rationales behind its existence and recommendations to improve it.

Liaison Psychiatry Services In Wales, Tayyeb Tahir, Adam Watkins, Philip Slack

Brain and Mind Institute

Aims and method: Recent funding from Welsh Government for mental health has helped to develop liaison psychiatry services in Wales. Systematic data collection was undertaken to map the liaison psychiatry services in Wales in collaboration with the Royal College of Psychiatrists in Wales and Public Health Wales 1000 Lives Improvement. A questionnaire was designed and circulated to all the health boards in Wales to gather information to map liaison psychiatry services in Wales. Up-to-date information was confirmed in January 2018, via email.

Results: Over the past 2 years, liaison psychiatry services have been set up in six out of …