Medicine and Health Sciences Commons^™

Management Of Arachnoid Cysts: A Comprehensive Review, Fatima Mustansir, Sanaullah Bashir, Aneela Darbar

Section of Neurosurgery

Arachnoid cysts are non-neoplastic, intracranial cerebrospinal fluid (CSF)-filled spaces lined with arachnoid membranes. Large arachnoid cysts are often symptomatic because they compress surrounding structures; therefore, they must be treated surgically. As several surgical management options exist, we explore the best approach according to each major type of arachnoid cyst: middle cranial fossa cyst, suprasellar cyst, intrahemispheric cyst, and quadrigeminal cyst.

Evaluating The Effectiveness Of Text Messaging And Phone Call Reminders To Minimize No Show At Pediatric Outpatient Clinics In Pakistan: Protocol For A Mixed-Methods Study, Sana Saeed, Noureen Somani, Fatima Sharif, Abdul Momin Kazi

Department of Paediatrics and Child Health

Background: Missing health care appointments without canceling in advance results in a no show, a vacant appointment slot that cannot be offered to others. No show can be reduced by reminding patients about their appointment in advance. In this regard, mobile health (mHealth) strategy is to use text messaging (short message service, SMS), which is available on all cellular phones, including cheap low-end handsets. Nonattendance for appointments in health care results in wasted resources and disturbs the planned work schedules.
Objectives: The purpose of this study is to evaluate the efficacy of the current text messaging (SMS) and call-based …

Challenges In Day-To-Day Midwifery Practice; A Qualitative Study From A Regional Referral Hospital In Dar Es Salaam, Tanzania, Hanna Strømholt Bremnes, Åsil Kjøl Wiig, Muzdalfat Abeid, Elisabeth Darj

Faculty of Health Sciences, East Africa

Background:

Maternal and infant mortality rates in Tanzania have decreased over the past decades, but remain high. One of the challenges the country faces, is the lack of skilled health care workers. High fertility rates make midwives and their patients particularly susceptible to stress as a result of understaffing.

Objective:

This paper explores the challenges midwives face in their day-to-day practice at a regional referral hospital in Tanzania, and investigates which measures the midwives themselves find necessary to implement to improve their situation.

Methods:

A qualitative study design with focus group discussions (FGDs) was employed to explore which challenges the …

Geospatial Inequalities And Determinants Of Nutritional Status Among Women And Children In Afghanistan: An Observational Study, Nadia Akseer, Zaid Ahmad Bhatti, Taufiq Mashal, Sajid Bashir Soofi, Rahim Moineddin, Robert E Black Md, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: Undernutrition is a pervasive condition in Afghanistan, and prevalence is among the highest in the world. We aimed to comprehensively assess district-level geographical disparities and determinants of nutritional status (stunting, wasting, or underweight) among women and children in Afghanistan.
Methods: The study used individualised data from the recent Afghanistan National Nutrition Survey 2013. Outcome variables were based on growth and weight anthropometry data, which we analysed linearly as Z scores and as dichotomous categories. We analysed data from a total of almost 14 000 index mother–child pairs using Bayesian spatial and generalised least squares regression models accounting for the …

Seroprevalence Of Anti-Polio Antibodies In Children From Polio High Risk Area Of Afghanistan: A Cross Sectional Survey 2017, Imtiaz Hussain, Ondrej Mach, Nasir A. Hamid, Zaid Bhatti, Deborah D. Moore, Shahid Khan, Hasan Khan, William C. Weldon, Zulfiqar Ahmed Bhutta, Sajid Bashir Soofi

Department of Paediatrics and Child Health

Background: Afghanistan is one of the remaining wild-poliovirus (WPV) endemic countries. We conducted a seroprevalence survey of anti-poliovirus antibodies in Kandahar Province.
Methods: Children in two age groups (6–11 months and 36–48 months) visiting Mirwais hospital in Kandahar for minor ailments unrelated to polio were enrolled. After obtaining informed consent, we collected venous blood and conducted neutralization assay to detect poliovirus neutralizing antibodies.
Results: A total of 420 children were enrolled and 409/420 (97%) were analysed. Seroprevalence to poliovirus type 1 (PV1) was 97% and 100% in the younger and older age groups respectively; it was 71% and 91% for …

Diversity Unsupported Is Diversity Derailed, Kauser Jabeen, Kulsoom Ghias

Department of Pathology and Laboratory Medicine

In this view point challenges of a diverse student body and its impact on quality of education and student’ social interactions are discussed. Enhanced institutional responsibility and ownership of all institutional members to provide adequate support for all individuals that make up the student body has been discussed as a major strategy to overcome these challenges.

30-Day Readmission Rate And Its Causes In General Surgical Patients, Rizwan Sultan, Umme Hani Abdullah, Tabish Chawla

Section of General Surgery

Objective: To find out the 30-day readmission rate for different surgical procedures and determine the causes for readmissions.
Study Design: An audit report.
Place and duration of study: Department of Surgery, The Aga Khan University Hospital, Karachi, in the calendar year 2014.
Methodology: Records were retrospectively reviewed for 30-day readmission rate and their cause in general surgical patients who underwent a general surgical procedure at The Aga Khan University Hospital, Karachi, in the year 2014.
Results: Out of 217 (6.4%) readmissions in 3,387 patients, more than 50% unplanned readmissions were avoidable. The highest readmission rate was after placement of feeding …

Resolution Of Gestational Gigantomastia With Termination Of Pregnancy, Syed Sarmad Bukhari, Haris Manan, Mah Muneer Khan, Syed Shahmeer Raza

Section of Neurosurgery

Less than 100 cases of gestational gigantomastia have been described in literature. The aetiology and risk factors are not well-established. Various treatments have been used with some consensus. We present the case of a 47-year-old female who presented to us with bilateral gigantomastia in her 16th week of gestation. She had massively enlarged breasts which were very painful. Relevant laboratory investigations were normal. An incisional biopsy done prior to, and two trucut samples at presentation to us, showed normal breast tissue proliferation. In the absence of adequate pain control, it was decided to electively terminate the pregnancy and give a …

Cardiac Magnetic Resonance Imaging In A Young Patient With Left Ventricular Spongiform Cardiomyopathy: A Case Report And Review Of Literature, Bilal Hussain, Fateh Ali Tipoo Sultan

Section of Cardiology

Left ventricular spongiform or non compaction cardiomyopathy is one of the rarer forms of cardiomyopathy with a reported prevalence of 0.014-0.05% in adults. It is characterized by severe left ventricular systolic dysfunction occurring secondary to the failure of the myocardium to fuse resulting in non-compacted myocardium with a trabeculated appearance of the myocardium. Initially described on the basis of 2-D echocardiography, the identification of left ventricular non compaction has now improved with the introduction of sophisticated imaging modalities such as cardiac magnetic resonance imaging that allows better visualization of the non-compacted myocardium assisting in accurate diagnosis. We report a case …

Predictors Of Low Birth Weight And 24-Hour Perinatal Outcomes At Muhimbili National Hospital In Dar Es Salaam, Tanzania: A Five-Year Retrospective Analysis Of Obstetric Records, Benjamin Anathory Kamala, Andrew Hans Mgaya, Matilda Michael Ngarina, Hussein Kidanto

Faculty of Health Sciences, East Africa

Introduction: The global prevalence of low birth weight (LBW) is 16%, representing more than 20 million infants worldwide, of which 96% are born in low-income countries. This study aimed to determine the prevalence, predictors and perinatal outcomes of LBW newborns.

Methods: We conducted a retrospective analysis of data obtained from the hospital's obstetric and neonatal database. Descriptive statistics and multivariate logistic regression were performed with 95% confidence intervals (CI).

Results: The prevalence of LBW was 21% (n = 8,011) and two-thirds of these were delivered at term. Seven percent of newborns were stillbirths and 2% died within 24hrs after birth. …

Constrictive Pericarditis Presenting As Bilateral Pleural Effusion: A Report Of Two Cases, Manesh Kumar Gangwani, Salman B. Mahmood,, Fariha Hasan, Javaid Khan

Section of Pulmonary & Critical Care

Constrictive pericarditis is a rare presentation. We need a very high index of clinical suspicion to diagnose the disease. It most commonly presents secondary to tuberculosis (TB) in the developing world and post-radiation therapy in the developed world. Classically, it presents with symptoms of heart failure and as pericardial thickening or calcification on imaging studies. In hospital settings, constrictive pericarditis is not usually considered as a differential in patients presenting with pleural effusion. According to the literature, associated pleural effusions in cases of constrictive pericarditis could be left-sided. Herein, we present two unusual presentations of cases with bilateral pleural effusions. …

Prognostic Implications Of Histological Clear Cells In High-Grade Intracranial Ependymal Tumors: A Retrospective Analysis From A Tertiary Care Hospital In Pakistan, Fauzan Alam Hashmi, Hamid Hussain Rai, Muhammad Faheem Khan, Muhammad Ehsan Bari

Section of Neurosurgery

Background: Clear cell variant in ependymal tumors is rare. We aimed to compare the features and outcome of the World Health Organization (WHO) Grade 3 ependymal tumors with clear cells to the WHO Grade 3 classic anaplastic ependymoma (AE).
Materials and methods: A retrospective cohort study conducted at the Department of Neurosurgery, Aga Khan University, Pakistan, from 2003 to 2013. The medical records and radiology of patients with proven histopathology were reviewed. The analysis was done on SPSS 20.
Results: Nine cases of clear cell variant and 23 cases of classic AE were found, both of which combined equated to …

Depression In Adult Patients With Primary Brain Tumours: A Review Of Independent Risk Factors, Anum Sadruddin Pidani, Aaida Mumtaz Rao, Muhammad Shahzad Shamim

Section of Neurosurgery

Depression is considered an under-diagnosed problem, especially in patients with malignancies. Patients with brain tumours in particular, have a relatively higher risk of developing depression, which is multifactorial. Herein, the authors review the recent literature on the prevalence of depression in patients with brain tumours, and explore the various risk factors involved.

Experiences Of The Breast Cancer Patients Undergoing Radiotherapy At A Public Hospital Peshawar Pakistan, Gulzar Habibullah, Raisa Raisa, Shanaz Hussein Cassum, Rehana Elahi

School of Nursing & Midwifery

Objective: This study aimed to explore the experiences of female breast cancer patients undergoing radiotherapy (RT) in a public hospital in Peshawar, Pakistan.
Methods: This study employed a descriptive exploratory method. A purposive sample of 14 breast cancer women undergoing RT was selected for this study. Data were collected over the period of 5 months, using a semi-structured interview guide and conducting in-depth face-to-face interviews. These interviews were audio taped and transcribed by a bilingual transcriber. The translated version of the interview was coded, and the analysis was done manually.
Results: Four main categories emerged from data analysis, which were: …

Faculty Perception About Active Learning Strategies: A Cross Sectional Survey, Shams Ul Huda, Tazeen Saeed Ali, Shanaz Hussein Cassum, Kashmira Nanji, Jehanzaib Khan Yousafzai

School of Nursing & Midwifery

Background: Nursing education in Pakistan has evolved over the last two decades, and it has shifted from the traditional three-year diploma program to the baccalaureate degree program. However, still traditional learning strategies are used in teachings ineffective in producing quality graduates; hence these graduates lack the necessary skills to face the challenges, diversity, and the dynamics of complex nursing care in Pakistan.
Purpose: The purpose of this study was to determine the perception of faculty members and barriers in the utilization of Active Learning (AL) strategies at undergraduate nursing degree programs in Khyber Pakhtunkhwa (KPK) province Pakistan.
Methods: Cross Sectional …

Inpatient Satisfaction At Different Public Sector Hospitals Of A Metropolitan City In Pakistan: A Comparative Cross-Sectional Study, Mehwish Hussain, Rehana Rehman, Zia Ikramuddin, Nava Asad, Ayesha Farooq

Department of Biological & Biomedical Sciences

Objective: To observe inpatient satisfaction at different public sector hospitals of Karachi, Pakistan.
Methods: A cross sectional study was carried out during 2010-2012 in four major public sector hospitals of Karachi. A total of 710 patients completed the study. Responses were gathered in a self-structured questionnaire that comprised of four dimensions of satisfaction with doctor, staff, administration and treatment. Average Score of each dimension was taken and compared using one way analysis of variance.
Result: Satisfaction with doctors, staff and administration of provincial and federal hospitals were comparatively similar (P > 0.05). However, satisfaction with treatment significantly differed in all four …

Cross Talk Between Serum Kisspeptin-Leptin During Assisted Reproduction Techniques, Rehana Rehman, Zehra Jamil, Aqsa Khalid, Syeda Sadia Fatima

Department of Biological & Biomedical Sciences

Background & Objective: Leptin facilitates onset of puberty by impact on hypothalamic Kisspeptin, gonadotropin releasing hormone, follicle stimulating and luteinizing hormone. The link of peripheral Leptin-Kisspeptin in regulating the ovarian and endometrial tissue in relation to adiposity is unknown. Therefore, we wanted to identify Kisspeptin-Leptin association with body mass index (BMI) and success of assisted reproductive treatments (ART) in infertile females.
Methods: A cross sectional study was carried from August 2014 till May 2016 after receiving ethical approval at Australian Concept Infertility Medical Centre, and Aga Khan University. The study group comprised of females with an age range …

Stress Of Infertility: Can The Couple Cope?, Faiza Alam, Taseer Ahmed Khan, Rehana Rehman

Department of Biological & Biomedical Sciences

No abstract provided.

Non O1, Non O139 Vibrio Cholerae Bacteraemia In An Infant; Case Report And Literature Review, Mirza Zain Baig, Umme Hani Abdullah, Yusra Shafquat, Khadija Nuzhat Humayun, Afia Zafar

Medical College Documents

Non 01, Non O139 Vibrio cholerae bacteraemia is a rare but potentially fatal occurrence. There have been very few incidents of this infection from around the world. The treatment regimen of antibiotics also varies in literature. We present a case of bacteraemia caused by Non O1, Non O139 Vibrio cholerae along with associated risk factors, disease manifestations, laboratory diagnosis and treatment regimen. This serves to add additional information regarding symptoms and signs of this infection along with management of patient. Knowledge regarding this topic shall be highly useful to professionals if further cases are detected. In the discussion section, a …

Accuracy Of Specimen Radiography In Assessing Complete Local Excision With Breast-Conservation Surgery, Saira Naz, Imrana Masroor, Shaista Afzal Saeed, W. Akhtar, Sehrish Butt, Zafar Sajjad, Anwar Ahmad

Department of Radiology

OBJECTIVE: The aim of this study was to evaluate the accuracy of “X- ray examination of surgically resected specimen‘‘ in assessing complete local excision (CLE).

MATERIALS AND METHODS: In this retrospective cross sectional study, data were collected for all female breast cancer cases who underwent breast-conserving surgery after needle localization of mammographically visible disease. Males, patients with mammographically invisible disease and cases with benign or inconclusive histopathology, those undergoing modified radical mastectomy and individuals with dense breast parenchyma were excluded. We evaluated radiography of resected specimens to assess margin spiculation, distance of mass/microcalcification from the excised margin, presence of a …

Diagnostic Accuracy Of Pelvic Mri For Determination Of The Cervical Involvement In Endometrial Cancer., Imrana Masroor, Sadia Rashid, Shaista Afzal Saeed, Saira Naz, Muhammad Azeemuddin

Department of Radiology

OBJECTIVE: To determine the diagnostic accuracy of pelvic MRI for assessment of the cervical involvement in endometrial cancer.

STUDY DESIGN: Cross-sectional analytical study.

PLACE AND DURATION OF STUDY: Radiology Department of the Aga Khan University Hospital, Karachi from January 2014 to December 2015.

METHODOLOGY: Patients with biopsy-proven endometrial cancer were included, who had both their MRI and histopathological diagnosis performed at our institution. Those patients treated with chemo/radiotherapy or had incomplete medical records, were excluded. The extent of cervical involvement by endometrial carcinoma was seen on T2WI images, and findings were correlated after surgery taking histopathology as the gold standard. …

Myocardial Perfusion Imaging: The Gatekeeper And Advisor, Maseeh Uz Zaman, Nosheen Fatima

Department of Radiology

No abstract provided.

Torsion Of Ovarian Dysgerminoma In A Child: Role Of Computed Tomography., Kumail Khandwala, Jehanzeb Shahid, Naila Nadeem, Muhammad Usman Tariq

Department of Radiology

Dysgerminomas are malignant germ cell tumors of the ovary that most commonly occur in the adolescent population. Ovarian dysgerminomapresenting with complications like torsion is a rare entity in the pediatric age group. Cross-sectional imaging plays a crucial role in diagnosis, tumor staging before surgical resection, and for planning adjuvant chemotherapy. We report a case of a nine-year-old female who presented to the emergency room (ER) with abdominal distention and abdominal pain. Computed tomography scan revealed a large right-sided pelvic mass with areas of low attenuation, speckled calcification, peritumoral free fluid, and a twisted vascular pedicle that was likely originating from …

Cime Newsletter : April 2018, Cime

Centre for Innovation in Medical Education (CIME) Archives

- Practice 360º – Training 108 junior doctors from across Pakistan

- Hackers in Action Again!

- Palliative Care Simulation Workshop

- Simulation Workshops – Urology Week

- A ‘resilience awareness’ afternoon at CIME

- “Urinar” – A Webinar on Transurethral Resection of Bladder Tumor (TURBT) and LASER Surgery Workshop

- World Oral Health Day

- In Case You Missed!

- A New Arrival in CIME

- The Essex Bird’s Story

Palliative Surgical Gastrostomy Under Ultrasound‑Guided Bilateral Rectus Sheath Blocks In A Head And Neck Cancer Patient, Saima Rashid, Faisal Shamim,, Maha Khan, Robyna Khan

Department of Anaesthesia

No abstract provided.

Pharmacy Newsletter : April 2018, Pharmacy Department

Department of Pharmacy Archives

Content:

• New Guidelines of Clostridium Difficile Infection (CDI
• Botulinum Toxin Type –A: An Option to Treat Carpal Tunnel Syndrome (CTS)
• Adverse Drug Reactions (ADR) Reporting Trend at AKUH – Year 2017
• Medication Reconciliation: Step to Enter Patient Home Medication Entry

A Comprehensive Meta-Analysis Of Stem Cell Therapy For Chronic Angina, Rahman Shah, Samuel B. Latham, Sajjad A. Khan, Muhammad Shahreyar, Inyong Hwang, Ion S. Jovin

Section of Internal Medicine

Background: A substantial proportion of patients with coronary artery disease do not achieve complete revascularization and continue to experience refractory angina despite optimal medical therapy. Recently, stem cell therapy has emerged as a potential therapeutic option for these patients. However, findings of individual trials have been scrutinized because of their small sample sizes and lack of statistical power. Therefore, we conducted an updated comprehensive meta-analysis of available randomized controlled trials (RCTs) with the largest sample size ever reported on this subject.
Hypothesis: In patients with chronic angina stem cell therapy improves clinical outcomes.
Methods: Scientific databases and websites were searched …

Loss Of Mecp2 In Adult 5-Ht Neurons Induces 5-Ht1a Autoreceptors, With Opposite Sex-Dependent Anxiety And Depression Phenotypes, Tristan J. Philippe, Faranak Vahid-Ansari, Zoe R. Donaldson, Brice Le François, Amin Zahrai, Valérie Turcotte-Cardin, Mireille Daigle, Jonathan James, René Hen, Zul Merali, Paul R. Albert

Brain and Mind Institute

The 5-HT1A autoreceptor mediates feedback inhibition of serotonin (5-HT) neurons, and is implicated in major depression. The human 5-HT1A gene (HTR1A) rs6295 risk allele prevents Deaf1 binding to HTR1A, resulting in increased 5-HT1A autoreceptor transcription. Since chronic stress alters HTR1A methylation and expression, we addressed whether recruitment of methyl-binding protein MeCP2 may alter Deaf1 regulation at the HTR1A locus. We show that MeCP2 enhances Deaf1 binding to its HTR1A site and co-immunoprecipitates with Deaf1 in cells and brain tissue. Chromatin immunoprecipitation assays showed Deaf1-dependent recruitment of MeCP2 to the mouse HTR1A promoter, and MeCP2 modulated human and mouse HTR1A gene …

Resolution Of Symptomatic Secondary Empty Sella Syndrome Following Lumbar-Peritoneal Shunt., Waseem Mehmood Nizamani, Mubbashira Siddiqui, Sehrish Nizar Ali Momin, Waqas Muhammad, Rashid Jooma

Department of Radiology

Background: Post‑surgical empty sella is related to the removal of pituitary tumors either from the transcranial or transphenoidal route, rendering diaphragma sellae incompetent at the end of the procedure. This subsequently leads to herniation of the third ventricle and optic apparatus into the empty sella. Studies have shown that in 50% of the cases, individuals with primary and secondary empty sella syndrome have developed defects in the visual fields. Benign increased intracranial pressure, cerebrospinal rhinorrhea, papilledema, and abnormalities affecting visual acuity may also occur as a result of empty sella.

Case Description: This case report discusses a rare treatment …

Adequacy Of Platelet Counting By Automated Haematology Analyzers: An Insight On Current Methodologies, Muhammad Shariq Shaikh, Noor Rahman Khan, Zeeshan Ansar Ahmed

Department of Pathology and Laboratory Medicine

No abstract provided.