Medicine and Health Sciences Commons^™

Identification Of Different Personality Traits Among Teenagers And Their Effect On Behavioural Conduct, Muhammad Yasir Tarar, Umair Sharif, Muhammad Waqar Abbas

Pakistan Journal of Neurological Sciences (PJNS)

To identify different personality traits among teenagers To give recommendations to help teenagers create a balance in personality development. METHODS: This research is based on a cross sectional study conducted at Services Institute of Medical Sciences, catering to the freshmen of MBBS. The tenure for the research lasted 8 months starting March 2017- October 2017.The estimated target population accounted to 100 teenage students who were incorporated for the research through convenient sampling. Selection criteria for the chosen sample was based on their age, institute and mental well-being. Any student over and above 19 years, not enrolled in SIMS or suffering …

Are Prophylactic Intravenous Antibiotics Required In Routine Shoulder Arthroscopic Surgery? A Systematic Review Of The Literature, Njalalle Baraza, Jordan Leith

General Surgery, East Africa

Purpose: The purpose of this study was to find out from the literature the difference in infection rates between patients who did and patients who did not receive prophylactic antibiotics in arthroscopic shoulder surgery.

Methods: We conducted a comprehensive search of the literature using Medline Ovid for prospective studies that looked at infection as the primary outcome following shoulder arthroscopy. The articles were then assessed for study design, outcome, and relevance to the specific question as part of the critical appraisal.

Results: Eight partially relevant articles were obtained from the search, but there were no prospective studies comparing infection in …

Treatment Options For Primary Cns Lymphoma, Abid Laghari, Syed Ijlal Ahmed, Adnan Jabbar, Muhammad Shahzad Shamim

Section of Haematology/Oncology

Primary CNS lymphoma (PCNSL) is a rare and aggressive brain tumour that is uniformly fatal. The rarity of the disease and the poor response to treatment makes it difficult to reach a consensus with regards to treatment options. In this review, the authors have discussed different treatment modalities used in the management of PCNSL including chemotherapy, surgery and radiation, as well as the results of recent clinical trials on treatment options for PCNSL.

Clinical Audit To Assess Delays In Chemotherapy Administration At Daycare Oncology Center At A Tertiary Care Hospital In Karachi, Pakistan, Arifa Aziz, Zarka Samoon, Mohammad Khurshid, Afsheen Feroz, Nadia Ayoub, Safia Awan, Madhia Beg

Section of Haematology/Oncology

Aim: There were delays reported by patients in chemotherapy administration in daycare oncology. Therefore, we decided to audit all processes which are involved in chemotherapy administration. The objective was to improve our service by decreasing the time between admission and initiation of chemotherapy and identify the reasons for delays.

Materials and Methods: The audit was conducted in three parts. In Review I, audit tool was developed and information documented of 109 patients receiving chemotherapy at daycare center from April 14 to May 13, 2015. Five processes were assessed out of which delay in initial assessment by the nurse was the …

Exchangeable Zinc Pool Size At Birth In Pakistani Small For Gestational Age And Appropriate For Gestational Age Infants Do Not Differ But Are Lower Than In Us Infants, Shabina Ariff, Nancy F. Krebs, Jamie E. Westcott, K Michael Hambidge, Leland V. Miller, Arjumand Rizvi, Sajid Bashir Soofi, Zulfiqar A. Bhutta

Department of Paediatrics and Child Health

Objectives: Small for gestational age (SGA) infants are more susceptible to infectious morbidity and growth faltering compared to their appropriate for gestational age (AGA) counterparts. Zinc supplementation of SGA infants may be beneficial but the underlying susceptibility to zinc deficiency of SGA infants has not been examined.
Methods: In a community-based, observational, longitudinal study in a peri-urban settlement of Karachi, Pakistan, we compared the size of the exchangeable zinc pools (EZPs) in term SGA and AGA infants at birth and at 6 months of age, hypothesizing that the EZP would be lower in the SGA group. To measure EZP size, …

A Tale Of Two Countries: Progress Towards Unaids 90‐90‐90 Targets In Botswana And Australia, Tafireyi Marukutira, Mark Stoove, Shahin Lockman, Lisa A. Mills, Tendani Gaolathe, Refeletswe Lebelonyane, Joseph N. Jarvis, Sherrie L. Kelly, David P. Wilson, Stanley Luchters

Population Health, East Africa

UNAIDS 90‐90‐90 targets and Fast‐Track commitments are presented as precursors to ending the AIDS epidemic by 2030, through effecting a 90% reduction in new HIV infections and AIDS‐related deaths from 2010 levels (HIV epidemic control). Botswana, a low to middle‐income country with the third‐highest HIV prevalence, and Australia, a low‐prevalence high‐income country with an epidemic concentrated among men who have sex with men (MSM), have made significant strides towards achieving the UNAIDS 90‐90‐90 targets. These two countries provide lessons for different epidemic settings. This paper discusses the lessons that can be drawn from Botswana and Australia with respect to their …

Inequalities In The Use Of Secondary Prevention Of Cardiovascular Disease By Socioeconomic Status: Evidence From The Pure Observational Study, Adrianna Murphy, Benjamin Palafox, Owen O'Donnell, David Stuckler, Pablo Perel, Khalid F. Alhabib, Alvaro Avezum, Xiulin Bai, Jephat Chifamba, Romaina Iqbal

Community Health Sciences

Background: There is little evidence on the use of secondary prevention medicines for cardiovascular disease by socioeconomic groups in countries at different levels of economic development.
Methods: We assessed use of antiplatelet, cholesterol, and blood-pressure-lowering drugs in 8492 individuals with self-reported cardiovascular disease from 21 countries enrolled in the Prospective Urban Rural Epidemiology (PURE) study. Defining one or more drugs as a minimal level of secondary prevention, wealth-related inequality was measured using the Wagstaff concentration index, scaled from -1 (pro-poor) to 1 (pro-rich), standardised by age and sex. Correlations between inequalities and national health-related indicators were estimated.
Findings: The …

Effectiveness Of Training On De-Escalation Of Violence And Management Of Aggressive Behavior Faced By Health Care Providers In A Public Sector Hospital Of Karachi, Lubna Baig, Sana Tanzil, Shiraz Shaikh, Ibrahim Hashmi, Muhammad Arslan Khan, Maciej Polkowski

Community Health Sciences

Background: Considering high burden of violence against healthcare workers in Pakistan APPNA Institute of Public Health developed a training to prevent reactive violence among healthcare providers. The purpose of this training was to equip healthcare providers with skills essential to control aggressive behaviors and prevent verbal and non-verbal violence in workplace settings. This study assesses the effectiveness of training in prevention, de-escalation and management of violence in healthcare settings.
Methods: A quasi-experimental study was conducted in October, 2016 using mixed method concurrent embedded design. The study assessed effectiveness of de-escalation trainings among health care providers working in emergency and gynecology …

Cold Agglutinins In Peripheral Blood With Atypical Cells With An Owl-Eye Appearance In Bone Trephine, Ayesha Majeed Memon, Farheen Karim

Department of Pathology and Laboratory Medicine

Autoimmune hemolytic anemia (AIHA) is a form of hemolytic anemia in which red cells lysis occurs due to presence of an autoantibody. Association of AIHA is well known with lymphoproliferative disorders, especially with non-Hodgkin's lymphoma. However, AIHA in association with Hodgkin's lymphoma is seen occasionally. Of the AIHA associated with Hodgkin's lymphoma, most are of warm type or mixed type. Cold AIHA, as seen in our case, is very rare in Hodgkin's lymphoma.

Integrating Tuberculosis And Antimicrobial Resistance Control Programmes, Rumina Hasan, Sadia Shakoor, Johanna Hanefeld, Mishal Khan

Department of Pathology and Laboratory Medicine

Many low- and middle-income countries facing high levels of antimicrobial resistance, and the associated morbidity from ineffective treatment, also have a high burden of tuberculosis. Over recent decades many countries have developed effective laboratory and information systems for tuberculosis control. In this paper we describe how existing tuberculosis laboratory systems can be expanded to accommodate antimicrobial resistance functions. We show how such expansion in services may benefit tuberculosis case-finding and laboratory capacity through integration of laboratory services. We further summarize the synergies between high-level strategies on tuberculosis and antimicrobial resistance control. These provide a potential platform for the integration of …

Melas: A Complex And Challenging Diagnosis, Kumail Khandwala, Anwar Ahmad, Taha Sheikh

Department of Radiology

Mitochondrial encephalopathy, lactic acidosis and stroke-like episodes (MELAS) is a rare multisystem disorder and is the most common maternally inherited mitochondrial disease. This condition has a special predilection for the nervous system and muscles. Typical findings on brain imaging include stroke-like areas, calcification of basal ganglia and brain atrophy. This accounts for the disease being, both clinically and radiologically, mistaken for ischemic stroke. The differentiation features from stroke include comparatively young age of the patients, site of the lesions, and relative overlap between the cerebral vasculature territories. In this case report, we discuss a 16-year male with clinical and radiological …

Role Of 18 Fdg Pet/Ct In Breast Cancer., Nosheen Fatima, Maseeh Uz Zaman

Department of Radiology

No abstract provided.

Diagnostic Efficiency Of Multidetector Computed Tomography In The Evaluation Of Clinically Equivocal Cases Of Acute Appendicitis With Surgical Correlation, Jawaid Iqbal, Raza Sayani, Misbah Tahir, Syed Mustahsan

Department of Radiology

Acute appendicitis is one of the most frequent causes of lower abdominal pain and requires immediate surgical intervention. The diagnosis often poses a lot of challenge even to experienced surgeon. Those patients with equivocal symptoms may require different imaging modalities like radiography, contrast examination and ultrasound with limited utility. Multidetector computed tomography (MDCT) used in suspected acute appendicitis has, however, resulted in improved diagnostic accuracy and also reduction of negative surgeries. Objective We intend to determine the diagnostic efficiency of MDCT in clinically equivocal cases of acute appendicitis correlating it with surgical/histopathological findings. Materials and methods A group of 116 …

Clinicoradiological Correlation Of Infarct Patterns On Diffusion-Weighted Magnetic Resonance Imaging In Stroke, Zainab Hussain, Kiran Hilal, Muhammad Ahmad, Zafar Sajjad, Raza Sayani

Department of Radiology

Diffusion-weighted magnetic resonance imaging (DW-MRI) represents a major advance in the early diagnosis of acute ischemic stroke. It can detect edema due to ischemia in the brain tissue. It not only establishes the presence and location of ischemic brain injury but also a relatively new concept is the determination of infarct patterns seen on diffusion imaging and its clinical correlation. Objective To determine the frequency of various infarct patterns and their relationship with functional outcome of the patient. Materials and methods A total of 108 patients with acute stroke were enrolled by purposive sampling. Magnetic resonance imaging (MRI) was obtained …

The Advocacy Role Of The World Federation Of Neurology, Wolfgang Grisold, Mohammad Wasay

Section of Neurology

No abstract provided.

Acute Onset Of Quadriplegia Secondary To Hypoparathyroidism: Mimicker Of Aman Variant Of Gbs, Syeda Saba Zaidi, Tahira Siddiqui, Sarwar Jamil Siddiqui

Section of Neurology

Acute onset of quadriplegia is a rare phenomenon seen with hypocalcemia due to hypoparathyroidism. We describe a 33-year gentleman who presented with weakness of all four limbs and areflexia. ECG showed QT abnormality. Nerve conduction study revealed normal sensory and significantly low motor CMAP amplitudes in both the upper and lower extremities. This nerve conduction study can be seen in acute motor neuropathy of various etiologies, among which GBS is the most worrisome. Our patient found to have low calcium and parathyroid hormone level. His symptoms improved after calcium replacement. Occurrence of quadriplegia in hypoparathyroidism, and its improvement after correction …

Melas: A Complex And Challenging Diagnosis, Kumail Khandwala, Anwar Ahmad, Taha Sheikh

Department of Radiology

Mitochondrial encephalopathy, lactic acidosis and stroke-like episodes (MELAS) is a rare multisystem disorder and is the most common maternally inherited mitochondrial disease. This condition has a special predilection for the nervous system and muscles. Typical findings on brain imaging include stroke-like areas, calcification of basal ganglia and brain atrophy. This accounts for the disease being, both clinically and radiologically, mistaken for ischemic stroke. The differentiation features from stroke include comparatively young age of the patients, site of the lesions, and relative overlap between the cerebral vasculature territories. In this case report, we discuss a 16-year male with clinical and radiological …

Superior Mesenteric Artery Syndrome In An 18-Year Old Female: Case Report, Karishma Lal, Akash Khetpal, Muhammad Saad Ali Mallick, Ansab Godil, Arsalan Majeed Adam, Zahid Ali Memon

Medical College Documents

We report an unusual case of an 18-year old woman, who presented to Civil Hospital Karachi in May 2016 with complaints of vomiting, abdominal pain, dysphagia, altered bowel habits, loss of appetite and chronic weight loss. On examination, abdomen was found to be soft and non-tender with discomfort on breathing. CT angiogram revealed reduction of aortomesenteric angle and aortomesenteric distance which were both consistent with superior mesenteric artery syndrome. Reduction in angle was thought to be because of weight loss and adipose tissue depletion so patient was started on enteral and parenteral nutritional supplements. Upon seeing little to no improvement, …

Turmeric For Prevention Of Dementia: Food For Thought, Mustafa M. Husain, Yamna Channa, Mohan Chilukuri

Medical College Documents

No abstract provided.

Relationships Among Common Illness Symptoms And The Protective Effect Of Breastfeeding In Early Childhood In Mal-Ed: An Eight-Country Cohort Study, Stephanie A. Richard, Benjamin J. J. Mccormick, Jessica C. Seidman, Zeba Rasmussen, Margaret N. Kosek, Elizabeth T. Rogawski, William Petri, Anurahda Bose, Zulfiqar Ahmed Bhutta, Ali Turab

Department of Paediatrics and Child Health

Children in low-income countries experience multiple illness symptoms in early childhood. Breastfeeding is protective against diarrhea and respiratory infections, and these illnesses are thought to be risk factors of one another, but these relationships have not been explored simultaneously. In the eight-site MAL-ED study, 1,731 infants were enrolled near birth and followed for 2 years. We collected symptoms and diet information through twice-weekly household visits. Poisson regression was used to determine if recent illness history was associated with incidence of diarrhea or acute lower respiratory infections (ALRI), accounting for exclusive breastfeeding. Recent diarrhea was associated with higher risk of incident …

Human West Nile Virus Disease Outbreak In Pakistan, 2015–2016, E. Khan, Kelli L. Barr, Joveria Farooqi, Dhani Prakoso, Alizae Abbas, Zain Y. Khan, Shanze Ashi, Kehkashan Imtiaz, Z Aziz, Faisal Malik

Department of Pathology and Laboratory Medicine

Like most of the world, Pakistan has seen an increase in mosquito-transmitted diseases in recent years. The magnitude and distribution of these diseases are poorly understood as Pakistan does not have a nation-wide system for reporting disease. A cross-sectional study to determine which flaviviruses were causing of arboviral disease in Pakistan was instituted. West Nile virus (WNV) is a cause of seasonal fever with neurotropic findings in countries that share borders with Pakistan. Here, we describe the active and persistent circulation of WNV in humans in the southern region of Pakistan. This is the first report of WNV causing neurological …

Adolescence And The Next Generation, George C. Patton, Craig A. Olsson, Vegard Skirbekk, Richard Saffery, Mary E. Wlodek, Peter S. Azzopardi, Marcin Stonawski, Bruce Rasmussen, Elizabeth Spry, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Adolescent growth and social development shape the early development of offspring from preconception through to the post-partum period through distinct processes in males and females. At a time of great change in the forces shaping adolescence, including the timing of parenthood, investments in today's adolescents, the largest cohort in human history, will yield great dividends for future generations.

Emergence Of An Extensively Drug-Resistant Salmonella Enterica Serovar Typhi Clone Harboring A Promiscuous Plasmid Encoding Resistance To Fluoroquinolones And Third-Generation Cephalosporins, Rumina Hasan, Sadia Shakoor, Farah Naz Qamar, Dania Khalid Saeed, Ghazala Shaheen, Shahida Qureshi, Mohammad Tahir Yousafzai, Muhammad Khalid Salim, Zahra Hasan, Elizabeth J. Klemma, Andrew J. Page, Kim Judge, Vanessa K. Wong, Timothy J. Dallman, Satheesh Nair, Stephen Baker, Gordon Dougan

Department of Pathology and Laboratory Medicine

Antibiotic resistance is a major problem in Salmonella enterica serovar Typhi, the causative agent of typhoid. Multidrug-resistant (MDR) isolates are prevalent in parts of Asia and Africa and are often associated with the dominant H58 haplotype. Reduced susceptibility to fluoroquinolones is also widespread, and sporadic cases of resistance to third-generation cephalosporins or azithromycin have also been reported. Here, we report the first large-scale emergence and spread of a novel S. Typhi clone harboring resistance to three first-line drugs (chloramphenicol, ampicillin, and trimethoprim-sulfamethoxazole) as well as fluoroquinolones and third-generation cephalosporins in Sindh, Pakistan, which we classify as extensively drug resistant …

Occupational Exposure To Hiv In A Developing Country: Assessing Knowledge And Attitude Of Healthcare Professional Before And After An Awareness Symposium, Samina Ismail, Safia Awan, Rubaba Naeem, Sarfraz Siddiqui, Badar Afzal, Bushra Jamil, Uzma Rahim Khan

Department of Anaesthesia

Objective: Health care providers (HCPs) are at risk of occupational exposure to HIV infection. In developing world these exposure occur due to general lack of awareness, education and structured training of HCPs. The objective of the study was to asses if continuing medical education symposium can be used as an effective educational tool to improve attitude, awareness and knowledge regarding occupational exposure to HIV infection. This quasi-experimental study was conducted among HCPs from Karachi, Pakistan. After assessing the baseline knowledge, awareness, and attitude by means of pretest; HCPs were reassessed with posttest after an education symposium on occupational exposure to …

Promising Biomarkers Of Environmental Enteric Dysfunction: A Prospective Cohort Study In Pakistani Children., Najeeha Talat Iqbal, Kamran Sadiq, Sana Syed, Tauseefullah Akhund, Fayyaz Umrani, Sheraz Ahmed, Mohammad Yawar Yakoob, Najeeb Rehman, Shahida Qureshi, Syed Asad Ali

Department of Paediatrics and Child Health

Environmental Enteric Dysfunction (EED), a syndrome characterized by chronic gut inflammation, contributes towards stunting and poor response to enteric vaccines in children in developing countries. In this study, we evaluated major putative biomarkers of EED using growth faltering as its clinical proxy. Newborns (n = 380) were enrolled and followed till 18 months with monthly anthropometry. Biomarkersassociated with gut and systemic inflammation were assessed at 6 and 9 months. Linear mixed effects model was used to determine the associations of these biomarkers with growth faltering between birth and 18 months. Fecal myeloperoxidase (neutrophil activation marker) at 6 months [β = …

Putative Adult Neurogenesis In Old World Parrots: The Congo African Grey Parrot (Psittacus Erithacus) And Timneh Grey Parrot (Psittacus Timneh), Pedzisai Mazengenya, Adhil Bhagwandin, Paul R. Manger, Amadi O. Ihunwo

Brain and Mind Institute

In the current study, we examined for the first time, the potential for adult neurogenesis throughout the brain of the Congo African grey parrot (Psittacus erithacus) and Timneh grey parrot (Psittacus timneh) using immunohistochemistry for the endogenous markers proliferating cell nuclear antigen (PCNA), which labels proliferating cells, and doublecortin (DCX), which stains immature and migrating neurons. A similar distribution of PCNA and DCX immunoreactivity was found throughout the brain of the Congo African grey and Timneh grey parrots, but minor differences were also observed. In both species of parrots, PCNA and DCX immunoreactivity was observed in …

Suicide And Deliberate Self-Harm In Pakistan: A Scoping Review, Sualeha S. Shekhani, Shagufta Perveen, Dur-E-Sameen Hashmi, Khawaja Akbar, Sara Bachani, Murad M. Khan Dr.

Department of Psychiatry

Background: Suicide is a major global public health problem with more than 800,000 incidents worldwide annually. Seventy-five percent of the global suicides occur in low and middle-income countries (LMICs). Pakistan is a LMIC where information on suicidal behavior is limited. The aim of the review is to map available literature on determinants, risk factors and other variables of suicidal behavior in Pakistan.
Method: This study was based on Arksey and O'Malley's methodological framework of scoping review, combining peer reviewed publications with grey literature. Ten databases including Applied Social Sciences Index and Abstracts (ASSIA), Cochrane Trials Register (CRG), Cumulative Index to …

Breast Cancer Knowledge, Perceptions And Practices In A Rural Community In Coastal Kenya, Shahin Sayed, Anthony Ngugi, Megan R. Mahoney, Jaameeta Kurji, Zohray M. Talib, Sarah B. Macfarlane, Theresa A. Wynn, Mansoor Saleh, Amyn B Lakhani, Esther Nderitu, Felix Agoi, Zul Premji, Jo Anne Zujewski, Zahir Moloo

Pathology, East Africa

Background: Data on breast healthcare knowledge, perceptions and practice among women in rural Kenya is limited. Furthermore, the role of the male head of household in influencing a woman’s breast health seeking behavior is also not known. The aim of this study was to assess the knowledge, perceptions and practice of breast cancer among women, male heads of households, opinion leaders and healthcare providers within a rural community in Kenya. Our secondary objective was to explore the role of male heads of households in influencing a woman’s breast health seeking behavior.

Methods: This was a mixed method cross-sectional study, conducted …

Machine Learning From Fetal Flow Waveforms To Predict Adverse Perinatal Outcomes: A Study Protocol, Zahra Hoodbhoy, Babar Hasan, Fyezah Jehan, Bart Bijnens, Devyani Chowdhury

Department of Paediatrics and Child Health

Background: In Pakistan, stillbirth rates and early neonatal mortality rates are amongst the highest in the world. The aim of this study is to provide proof of concept for using a computational model of fetal haemodynamics, combined with machine learning. This model will be based on Doppler patterns of the fetal cardiovascular, cerebral and placental flows with the goal to identify those fetuses at increased risk of adverse perinatal outcomes such as stillbirth, perinatal mortality and other neonatal morbidities.
Methods: This will be prospective one group cohort study which will be conducted in Ibrahim Hyderi, a peri-urban settlement in south …

Haemodynamic Assessment And Support In Sepsis And Septic Shock In Resource-Limited Settings, David Misango, Rajyabardhan Pattnaik, Tim Baker, Martin W. Dünser, Arjen M. Dondorp, Marcus J. Schultz, Global Intensive Care Working Group†, Of The European Society Of Intensive Care Medicine (Esicm) And The Mahidol Oxford Tropical Medicine Research Unit (Moru) In Bangkok, Thailand

Anaesthesiology, East Africa

Background: Recommendations for haemodynamic assessment and support in sepsis and septic shock in resource-limited settings are largely lacking.

Methods: A task force of six international experts in critical care medicine, all of them members of the Global Intensive Care Working Group of the European Society of Intensive Care Medicine and with extensive bedside experience in resource-limited intensive care units, reviewed the literature and provided recommendations regarding haemodynamic assessment and support, keeping aspects of efficacy and effectiveness, availability and feasibility and affordability and safety in mind.

Results: We suggest using capillary refill time, skin mottling scores and skin temperature gradients; suggest …