Medicine and Health Sciences Commons^™

Environmental Enteropathy In Undernourished Pakistani Children: Clinical And Histomorphometric Analyses, Sana Syed, Sunil Yeruva, Jeremy Herrmann, Anne Sailer, Kamran Sadiq, Najeeha Talat Iqbal, Furqan Kabir, Kumail Ahmed, Shahida Qureshi, Syed Asad Ali

Department of Paediatrics and Child Health

Despite nutrition interventions, stunting thought to be secondary to underlying environmental enteropathy (EE) remains pervasive among infants residing in resource-poor countries and remains poorly characterized. From a birth cohort of 380 children, 65 malnourished infants received 12 weeks of nutritional supplementation with ready-to-use therapeutic food (RUTF). Eleven children with insufficient response to RUTF underwent upper endoscopy with duodenal biopsies, which were compared with U.S., age-matched specimens for healthy, celiac disease, non-celiac villous atrophy, non-celiac intraepithelial lymphocytosis, and graft-versus-host disease patients. Of the 11 children biopsied, EE was found in 10 (91%) with one subject with celiac disease. Morphometry demonstrated decreased …

Frequency Of Alk Rearrangement By Fish Testing And Its Correlation With Alk-Ihc In Adenocarcinoma Of Primary Lung Origin, Samar Moattar, Namrah Anwar, Tariq Moatter, Shahid Pervez

Department of Pathology and Laboratory Medicine

Anaplastic lymphoma kinase (ALK) gene can be oncogenic either by forming fusion with other genes, amplification of the gene or by having mutations. ALK rearrangement can either be detected by standard “fluorescence in situ hybridization (FISH)” or “immunohistochemistry (IHC)”. Objective of this study was to record the prevalence of ALK rearrangement in adenocarcinoma of Primary Lung origin and compare it with ALK-IHC staining. Data of 64 patients of lung adenocarcinoma from 2015-2017 was analyzed. All of the FFPE biopsies were tested for EGFR (qPCR) followed by ALK rearrangement (by FISH and IHC) on EGFR negative samples. Out of 64 samples, …

Letter To The Editor: Digital Dementia-Is Smart Technology Making Us Dumb?, Sanaa Moledina, Adeel Khoja

Section of Internal Medicine

No abstract provided.

Women And Maternal Health Care Providers’ Perceptions, Beliefs And Attitudes Towards Use Of Epidural Analgesia For Labour Pain Relief, Stella Njenga

Master of Medicine in Obstetrics and Gynecology

Background: Epidural analgesia (EA) is considered the gold standard for relief of labour pains due to its effectiveness, safety and flexibility of use. There is a disparity of utilization between high and low & middle income countries with lack of knowledge and resources implicated. Aga Khan University Hospital Nairobi is a well-resourced facility with a well-established EA service. This study explores the perceptions, beliefs and attitudes of women seen at the facility towards EA and how these affect their decision to use the method. It also explores health care providers’ views on the method and how they influence the women’s …

Asian Midwifery In 2018, Rafat Jan, Edwin Van Teijlingen

Journal of Asian Midwives (JAM)

No abstract provided.

Fibrous Pseudotumor Of Tunica Albuginea Testis Mimicking Testicular Neoplasm In A Young Man, Nazim Syed Muhammad, Ayesha Nusrat, Zehra Kazmi

Section of Urology

ntrascrotal lesions are common findings with a majority occurring in paratesticular tissue. Fibrous pseudotumors are rare, benign lesions of the testicular tunics and present with mass lesion(s) in the scrotum. Preoperative clinical and radiological diagnosis is challenging. We report a case of a 34-year-old man who presented with a 3-year history of left testicular swelling and was advised left radical orchidectomy by another surgeon. Physical examination revealed a firm, nontender mass attached to the lower pole of the testis. Testicular tumor markers were all negative, and ultrasound scan showed a relatively hypoechoic lesion closely associated with the left testis and …

Acinetobacter Infections: A Retrospective Study To Determine In – Hospital Mortality Rate And Clinical Factors Associated With Mortality, Rajiv Patel

Master of Medicine in Internal Medicine

Background: Acinetobacter infections are increasingly being recognized as a cause for significant in – hospital morbidity and mortality worldwide. Increasingly multi – drug resistant strains of Acinetobacter are being isolated, increasing the burden on healthcare resources. Our objectives were to determine the outcomes and clinical factors related to outcomes of Acinetobacter infections at the Aga Khan University Hospital. Methods: A retrospective study of Acinetobacter infections (from any site) was conducted. Patient records were used to gather relevant clinical information. The collected data was tabulated and analysed for any significant differences in demographic or clinical variables. The Pearson Chi squared test …

Relationship Of Family Members’ Support With Practice Of Community Midwives In Rural Sindh, Pakistan, Farida Shah, Farhana Shahid, Jamila Haider, Syfoor Ali, Bibi Ara, Misri Bano

Journal of Asian Midwives (JAM)

Background: Pakistan has one of the highest maternal mortality rates in the world. Community Midwives (CMWs) were introduced in 2006 as a new cadre of birth attendants who would bring midwifery services to rural areas by being based in designated communities. The CMWs face many obstacles and retaining them in practice is a challenge. This study aimed to examine whether there was a relationship between family support and CMWs retention in midwifery practice. We hoped to learn about influences on retention that might improve the Maternal Newborn and Child Health (MNCH) programme.
Methods: This was a cross-sectional survey conducted in …

Gender Inequalities And Childbearing: A Qualitative Study Of Two Maternity Units In Nepal, Lesley Milne, Jillian C M Ireland Ms, Edwin Van Teijlingen, Vanora Hundley, Padam P. Simkhada

Journal of Asian Midwives (JAM)

The role and status of women in South Asian countries like Nepal are widely recognised to be lower than that of men. This gender inequality can be found throughout all levels of society. Our study is about the influence of gender on pregnancy and childbirth, which are very much in the female domain in South Asia, both at home and in health facilities.
A mixed-method, qualitative research study was undertaken in two birthing facilities in Kathmandu Valley to examine barriers to women accessing these services from the perspective of hospital staff. Thematic analysis identified seven subthemes related to gender, namely: …

Amniotic Fluid Embolism, Nadia Nawaz, Ahmed Raheem Buksh

Department of Obstetrics & Gynaecology

Amniotic fluid embolism is a rare and severe problem in obstetric patients. We experienced a 21-year primigravida who underwent emergency cesarean section due to sudden collapse and fetal distress after rupture of membranes in labour. Subsequently, she developed intraoperative coagulopathy, hemorrhage, hypotension, and respiratory collapse requiring ventilation. Both maternal and neonatal lives were saved with full recovery and discharged in stable condition. The clinical diagnosis of amniotic fluid embolism (AFE) was made, which is a very rare complication of pregnancy/puerperium with varying presentation, ranging from cardiac arrest, circulatory collapse and death through mild degrees of organ system dysfunction with or …

Monitoring Of Birth Registry Coverage And Data Quality Utilizing Lot Quality Assurance Sampling Methodology: A Pilot Study, Shiyam Sunder Tikmani, Sarah Saleem, Elizabeth Mcclure, Farnaz Naqvi, Farina Abrejo, Zahid Soomro, Dennis Wallace, Robert L. Goldenberg

Community Health Sciences

Background: Effectively monitoring the coverage and quality of data in low-resource settings is challenging. Lot quality assurance sampling (LQAS) is a method to classify coverage as adequate or inadequate. The aim of this pilot study is sought to determine the coverage and quality of a birth registry in a rural district in Pakistan.
Methods: This survey was conducted in 14 clusters of Thatta, Pakistan. LQAS methodology was used to monitor the birth registry from December 2015 to February 2016. We randomly selected 19 villages from each cluster. We used a short questionnaire to review the quality of data collection for …

The Project To Understand And Research Preterm Pregnancy Outcomes And Stillbirths In South Asia (Purpose): A Protocol Of A Prospective, Cohort Study Of Causes Of Mortality Among Preterm Births And Stillbirths, Elizabeth M. Mcclure, Sarah Saleem, Shivaprasad S. Goudar, Sangappa Dhaded, G. Guruprasad, Yogesh Kumar, Shiyam Sunder Tikmani, Muhammad Masood Kadir, Jamal Raza, Haleema Yasmin

Community Health Sciences

Background: In South Asia, where most stillbirths and neonatal deaths occur, much remains unknown about the causes of these deaths. About one-third of neonatal deaths are attributed to prematurity, yet the specific conditions which cause these deaths are often unclear as is the etiology of stillbirths. In low-resource settings, most women are not routinely tested for infections and autopsy is rare.
Methods: This prospective, cohort study will be conducted in hospitals in Davengere, India and Karachi, Pakistan. All women who deliver either a stillbirth or a preterm birth at one of the hospitals will be eligible for enrollment. …

Out-Of-School Children: Examining The Reasons In Semi- Urban Setting In Pakistan, Nousheen Pradhan, Tanzil Jamali, Shireen Shehzad Bhamani, Tazeen Saeed Ali, Rozina Karmaliani

Community Health Sciences

Globally, 57 million primary age children remain out-of-school. In South Asia, Pakistan has the highest (34%) out-of-primary school age children. This paper highlights the proportion of out-of-school children with reasons and children’s educational attainment in the semi-urban community of Pakistan. A cross-sectional survey was conducted by using systematic sampling in a semi-urban town in Karachi, Pakistan. Chi-square was used to describe the difference in the educational achievements with age and gender of the children with p-value < 0.05, considered as significant. Among 254 surveyed households, 22.9% of the children (age 3-15 years) were found out-of-school, with no significant gender difference among boys (11.6%) and girls (11.1 %). A large group of young children (3-6 years of age) were found out-of-school with boys 71.6% (n=68) and girls 67.03% (n=61). Children’s lack of interest in education was the major (42%) reason, followed by high school expenses (23%). Children’s educational attainment was significantly (p<0.000) related to age and gender. At the local community level, teachers and Taluka Education Officers have a pivotal role to play towards increasing primary school enrollment and mobilizing the resources to overcome financial hardships faced by the parents for their children’s education in early years. Nousheen Akber Pradhan is a Senior Instructor at the Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan

Neuroimmunology Diagnostics, Mohammad Saeed, Tariq Gazdar, Nadir Ali Syed, Arsalan Ahmad

Pakistan Journal of Neurological Sciences (PJNS)

Neuroimmunology has led to advanced diagnostics of previously cryptic disorders, using autoantibody testing against neurological targets. Neuropsychiatric syndromes and autoimmune encephalitis can now be routinely diagnosed using specialized antibody tests such as immunofluorescence and immunoblot assays in specialized laboratories. This helps in early and accurate diagnosis, leading to favorable patient prognosis. Here, we briefly review the diagnostics for Neuroimmunologic and related disorders including autoimmune encephalitis, demyelinating diseases, neuropathies, paraneoplastic syndromes, stiffperson syndrome, inflammatory myopathies as well as Alzheimer’s disease.

Cerebral Venous Thrombosis Presenting As Subarachnoid Haemorrhage, Farheen Niazi

Pakistan Journal of Neurological Sciences (PJNS)

We present a 31 years old lady who was 19 days postpartum who was admitted with fits and loss of consciousness. At presentation Glasgow Coma Scale was 8/15. No focal deficit. CT scan brain showed findings suggestive of subarachnoid haemorrhage(SAH) in left sylvian fissure along with few parenchymal haemorrhagic areas in frontal and parietal lobes. MRI brain and MRV confirmed superior sagittal sinus thrombosis, inferior sagittal, straight and right transverse and sigmoid sinus thrombosis. Patient was treated conservatively and was anticoagulated for 6 months and had a complete recovery. Further workup of thrombophilia was negative. Postpartum being the only risk …

Pattern Of Mental Health Disorders In Adult Population Attending A Tertiary Mental Health Care Setting, Nasir Mehmood, Uroosa Talib, Raza Ur Rehman

Pakistan Journal of Neurological Sciences (PJNS)

Mental health disorders contribute significantly to the global burden of disease (32.4%), . Mental health disorders are the 4th leading cause of disability in developed countries, and the most disabling disorders in low-income and middle-income countries (LAMIC). Over one third of people in most LIMIC fulfill sufficient diagnostic criteria for a mental health disorder at some point in their life.

Profile Of Dementia Patients From A Tertiary Care Center In Karachi, Pakistan, Qurat Ul Ain Khan, Sana Siddiqui, Mohammad Zaman, Abdullah Waqar, Sumera Aziz Ali

Pakistan Journal of Neurological Sciences (PJNS)

BACKGROUND: According to an estimate currently over 46 million people live with dementia worldwide and 58% reside in developing countries. However like some other developing countries, not much is known about the demographics, characteristics, and associated conditions of those suffering from dementia in Pakistan. OBJECTIVE: To study profile of dementia patients from a tertiary care hospital in Karachi, Pakistan.

Association Of Serum Albumin Levels And Guillain Barre Syndrome (Gbs) Outcome., Mazhar Badshah, Ghulam Shabbir, Sumaira Fazal Nabi, Daniyal Ahmed

Pakistan Journal of Neurological Sciences (PJNS)

Guillain-Barre syndrome (GBS) is a polyradiculoneuropathy characterized by a rapidly progressive bilateral paresis of the limbs. Nadir is typically reached within a number of days or weeks, followed by a recovery that is generally much slower and often incomplete. Guillain-Barre syndrome is usually preceded by infection or other immune stimulation that induces an aberrant autoimmune response targeting peripheral nerves and their spinal roots.IVIG and Plasmapheresis are used first line treatments in GBS treatment. For better assessment of treatment response, biomarkers reflecting Plasmapheresis and IVIG efficacy are needed. Aim of this study is to determine serum albumin as an independent biomarker …

Circadian Variation Of Brain Proteins: Importance In Experiments, Muhammad Rafiq, Zahid Mahmood, Sajed Ali

Pakistan Journal of Neurological Sciences (PJNS)

Circadian (from the Latin word circa, meaning 'about', and dies, meaning 'day') rhythms are the rhythms occurring within a period of 24 hours and are endogenously driven in biochemical, physiological or behavioral processes [1]. Circadian rhythms are also entrained by the external environmental cues called zeitgebers, the primary one of which is day light [2]. Circadian rhythms have been widely observed in plants, animals, fungi and cyanobacteria [3]. The study of the biological processes that vary during different time of the day, is called chronobiology. A number of studies on mammalian species have confirmed that the circadian pacemaker resides in …

Child Protection In Pakistan: Legislation & Implementation, Sana Younus, Aisha S Chachar, Ayesha Mian

Pakistan Journal of Neurological Sciences (PJNS)

Children are an integral part of any society. Their dependency on others for the fulfilment of their basic needs like food, shelter, education, safety and security makes them a vulnerable group. Society is judged on its ability to provide for the needs of the vulnerable. Provision of each of these needs is the responsibility of primary caregivers but requires assistance from multiple agencies working at the national level to ensure an effective delivery. Children’s rights can be defined as “the rights, which are concerned both with the protection of the individual child and with the creation of the conditions in …

Concepts, Protocol, Variations And Current Trends In Surgery First Orthognathic Approach: A Literature Review, Hafiz Taha Mahmood, Maheen Ahmed, Mubassar Fida, Adeel Tahir Kamal, Farheen Fatima

Section of Dental-Oral Maxillofacial Surgery

In the current era of expedited orthodontics, among many clinicians, tertiary care hospitals and patients, surgery first orthognathic approach (SFOA) has gained popularity. The advantages of SFOA (face first approach) are the reduced overall treatment duration and the early improvement in facial esthetics. In SFOA, the absence of a presurgical phase allows surgery to be performed first, followed by comprehensive orthodontic treatment to achieve the desired occlusion. The basic concepts of surgery early, surgery last, SFOA and Sendai SFOA technique along with its variations are reviewed in the present article. The recent advancement in SFOA in the context of preoperative …

Ultrasound-Guided Peripheral Nerve Blocks In High-Risk Patients, Requiring Lower Limb (Above And Below Knee) Amputation, Faisal Shamim, Malika Hameed, Nadeem Ahmed Siddiqui, Shemila Abbasi

Department of Anaesthesia

A case series of five high-risk patients with lower limb ischemia, sepsis, altered coagulation, and multi-organ dysfunction requiring emergent or urgent lower limb amputation is presented. Use of peripheral nerve blocks for below and above knee amputations is quite uncommon which provides better hemodynamic stability and pain management, especially in the very sick patients. The surgeries were successfully carried out under ultrasound-guided combined femoral and sciatic nerve blocks. All five patients obtained adequate level of block at the area of amputation. There were no complications related to anesthetic management. Patients remained hemodynamically stable and pain-free during surgery and postoperatively. Combined …

Trends And Determinants Of Stillbirth In Developing Countries: Results From The Global Network’S Population-Based Birth Registry, Sarah Saleem, Shiyam Sunder Tikmani, Elizabeth M. Mcclure, Janet L. Moore, Iqbal Azam Syed, Sangappa M. Dhaded, Shivaprasad S. Goudar, Ana Garces, Sumera Aziz Ali, Farnaz Naqvi

Community Health Sciences

Background: Stillbirth rates remain high, especially in low and middle-income countries, where rates are 25 per 1000, ten-fold higher than in high-income countries. The United Nations' Every Newborn Action Plan has set a goal of 12 stillbirths per 1000 births by 2030 for all countries.
Methods: From a population-based pregnancy outcome registry, including data from 2010 to 2016 from two sites each in Africa (Zambia and Kenya) and India (Nagpur and Belagavi), as well as sites in Pakistan and Guatemala, we evaluated the stillbirth rates and rates of annual decline as well as risk factors for 427,111 births …

Improving Pregnancy Outcomes In Low- And Middle-Income Countries, Robert L. Goldenberg, Elizabeth M. Mcclure, Sarah Saleem

Community Health Sciences

This paper reviews the very large discrepancies in pregnancy outcomes between high, low and middle-income countries and then presents the medical causes of maternal mortality, stillbirth and neonatal mortality in low-and middle-income countries. Next, we explore the medical interventions that were associated with the very rapid and very large declines in maternal, fetal and neonatal mortality rates in the last eight decades in high-income countries. The medical interventions likely to achieve similar declines in pregnancy-related mortality in low-income countries are considered. Finally, the quality of providers and the data to be collected necessary to achieve these reductions are discussed. It …

Pituitary Tuberculoma, Amir Humza Sohail, Umar Farooq Bhatti, Najmul Islam

Section of Diabetes, Endocrinology and Metabolism

Tuberculosis rarely involves the hypothalamo-pituitary region and constitutes only 1% of the lesions involving the sellar and/or suprasellar region. Coleman and Meredith first reported pituitary tuberculosis in 1940, and only a handful of cases have been reported ever since. It may manifest as a chiasmal syndrome due to compression of the optic chiasm or as hypopituitarism due to pituitary destruction. It has a characteristic radiological appearance and can mimic a pituitary adenoma. Diagnostic procedures, such as trans-sphenoidal biopsy, are crucial for accurate diagnosis. We report a case of a 32-year male, who presented with complaints of headache and decreased visual …

Incidence Of Unintended Pregnancy Among Female Sex Workers In Low-Income And Middle-Income Countries: A Systematic Review And Meta-Analysis, Frances H. Ampt, Lisa Willenberg, Paul A. Agius, Matthew Chersich, Stanley Luchters, Megan S. C. Lim

Population Health, East Africa

Objectives: To determine the incidence of unintended pregnancy among female sex workers (FSWs) in lowincome and middle-income countries (LMICs).

Design: We searched MEDLINE, PsychInfo, Embase and Popline for papers published in English between January 2000 and January 2016, and Web of Science and Proquest for conference abstracts. Meta-analysis was performed on the primary outcomes using random effects models, with subgroup analysis used to explore heterogeneity.

Participants: Eligible studies targeted FSWs aged 15–49 years living or working in an LMIC.

Outcome measures: Studies were eligible if they provided data on one of two primary outcomes: incidence of unintended pregnancy and incidence …

Genetic Sequencing For Surveillance Of Drug Resistance In Tuberculosis In Highly Endemic Countries: A Multi-Country Population-Based Surveillance Study, Matteo Zignol Md, Andrea Maurizio Cabibbe, Anna S. Dean, Philippe Glaziou, Natavan Alikhanova, Cecilia Ama, Sönke Andres, Anna Barbova, Rumina Hasan, Zahra Hasan

Department of Pathology and Laboratory Medicine

Background: In many countries, regular monitoring of the emergence of resistance to anti-tuberculosis drugs is hampered by the limitations of phenotypic testing for drug susceptibility. We therefore evaluated the use of genetic sequencing for surveillance of drugresistance in tuberculosis.
Methods: Population-level surveys were done in hospitals and clinics in seven countries (Azerbaijan, Bangladesh, Belarus, Pakistan, Philippines, South Africa, and Ukraine) to evaluate the use of genetic sequencing to estimate the resistance of Mycobacterium tuberculosisisolates to rifampicin, isoniazid, ofloxacin, moxifloxacin, pyrazinamide, kanamycin, amikacin, and capreomycin. For each drug, we assessed the accuracy of genetic sequencing by a comparison of the adjusted …

Role Of Tnf Α, Il-6 And Cxcl10 In Dengue Disease Severity, Kiran I. Masood, Bushra Jamil, Maryam Rahim, Muniba Islam, Muhammad Farhan, Zahra Hasan

Department of Pathology and Laboratory Medicine

Background and objective: Dengue virus infections (Dengue) have become increasingly common in Pakistan and can result in case fatalities if not managed appropriately. Patients with Dengue virus infection may be asymptomatic or present with Dengue fever (DF), Dengue with warning signs (DWS) or severe Dengue (SD). Severity in Dengue is coincident with an exacerbated production of lymphocyte-induced cytokines and chemokines which are associated with plasma leakage. We investigated the association of circulating levels of cytokines such as Interleukin (IL)-6, tumor necrosis factor (TNF)-alpha and CXCL-10 in Dengue patients with differing severity of disease.
Material and methods: Dengue infection was confirmed …

Misplaced Central Venous Catheter In Carotid Artery During Emergency Surgery For The Total Correction Of Tetralogy Of Fallot Of An Adolescent Boy, Shabbir Ahmed, Faisal Junejo, Fazal Wahab Khan

Department of Anaesthesia

Ultrasound-guided central venous cannulation is now considered as the standard of care, and this has largely replaced blind central venous cannulation using anatomical landmarks. We are reporting a case of inadvertent placement of central venous catheter in the right common carotid artery with the use of ultrasound guidance during emergency surgery for the total correction of Tetralogy of Fallot (ToF). This patient luckily had a favourable outcome despite this inadvertent catheter placement which was not recognised even after completion of surgery .The patient also received drug infusions of inotropes and vasopressors through this malplaced central line into the aorta. The …

Pre-Anaesthetic Assessment Of Intracranial Pressure Using Optic Nerve Sheath Diameter In Patients Scheduled For Elective Tumour Craniotomy, Faraz Shafiq, Muhammad Asghar Ali, Fauzia Khan

Department of Anaesthesia

Background: The objective of study was to determine the pre-anaesthetic status of intracranial pressure (ICP), using ultrasonographic measurement of optic nerve sheath diameter (ONSD) inpatient scheduled for elective tumour craniotomy. The secondary objective was to compare the diagnostic accuracy of ONSD guided rise in ICP with clinical and radiographic parameters. This is prospective observational study, conducted at single neurosurgical theatre of The Aga Khan University over a period of one year.
Methods: After getting ethical approval and informed consent patient fulfilling inclusion criteria and planned for elective tumour craniotomy were enrolled in study. The clinical and radiographic signs predicting the …