Medicine and Health Sciences Commons^™

Children’S Oxygen Administration Strategies Trial (Coast): A Randomised Controlled Trial Of High Flow Versus Oxygen Versus Control In African Children With Severe Pneumonia, Kathryn Maitland, Sarah Kiguli, Robert Opoka, Peter Olupot-Olupot, Charles Engoru, Patricia Njuguna, Victor Bandika, Ayub Mpoya, Andrew Bush, Thomas Williams

Paediatrics and Child Health, East Africa

Background: In Africa, the clinical syndrome of pneumonia remains the leading cause of morbidity and mortality in children in the post-neonatal period. This represents a significant burden on in-patient services. The targeted use of oxygen and simple, non-invasive methods of respiratory support may be a highly cost-effective means of improving outcome, but the optimal oxygen saturation threshold that results in benefit and the best strategy for delivery are yet to be tested in adequately powered randomised controlled trials. There is, however, an accumulating literature about the harms of oxygen therapy across a range of acute and emergency situations that …

Cime Newsletter : January 2018, Cime

Centre for Innovation in Medical Education (CIME) Archives

- His Highness the Aga Khan Inaugurates CIME

- Reflecting on 2017

- MagnifiScience Exhibition 2017

- The Team at Cime Successfully Launch First Clinical Simulation Workshop

- Global Encounters

- Heart Attack on a Plate

- Clinical Simulation Workshop for Yusra University Islamabad

- SPIE Again in Action

- Future Leaders @ CIME

- Innovation Day

- In Case You Missed!

- Publications

Fmic Annual Report 2018 | Dari (دری), French Medical Institute For Mothers And Children

French Medical Institute for Mothers and Children (FMIC) Archives

No abstract provided.

Fmic Annual Report 2018 | English, French Medical Institute For Mothers And Children

French Medical Institute for Mothers and Children (FMIC) Archives

No abstract provided.

Fluid Choice During Perioperative Care In Children: A Survey Of Present‑Day Proposing Practice By Anesthesiologists In A Intertiary Care Hospital, Muhammad Faisal Khan, Khalid Maudood Siddiqui, Ali Asghar

Department of Anaesthesia

Background: Perioperative fluid therapy in pediatrics has always been a challenging avenue for anesthesiologists.

Inappropriate choice of fluid leads to multiple side effects, for instance iatrogenic hyponatremia. Our aim was to observe the

current practice of perioperative fluid therapy in pediatric population undergoing surgery in a tertiary care hospital.

Methods: After obtaining approval from the Departmental Research Review Committee, a survey form including questions

was emailed to anesthesiologists from January 2015 to June 2015. Individual responses were recorded and analyzed.

Results: Overall response was 100% from consultant and resident, and total 55 anesthesiologists were participated in

this survey. Majority of …

Provision Of Medical Supply Kits To Improve Quality Of Antenatal Care In Mozambique: A Stepped-Wedge Cluster Randomised Trial, Ana Pilar Betrán, Eduardo Bergel, Sally Griffin, Armando Melo, My Huong Nguyen, Alicia Carbonell, Santos Mondlane, Mario Merialdi, Marleen Temmerman, A Metin Gülmezoglu

Obstetrics and Gynaecology, East Africa

Background: High levels of maternal and newborn mortality and morbidity remain a daunting reality in many lowincome countries. Several interventions delivered during antenatal care have been shown to improve maternal and newborn outcomes, but stockouts of medical supplies at point of care can prevent implementation of these services. We aimed to evaluate whether a supply chain strategy based on the provision of kits could improve quality of care.

Methods: We did a pragmatic, stepped-wedge, cluster-randomised controlled trial at ten antenatal care clinics in Mozambique. Clinics were eligible if they were not already implementing the proposed antenatal care package; they served …

The Satisfactory Growth And Development At 2 Years Of Age Of The Intergrowth-21st Fetal Growth Standards Cohort Support Its Appropriateness For Constructing International Standards., José Villar, Leila Cheikh Ismail, Eleonora Staines Urias, Francesca Giuliani, Sikolia Wanyonyi

Obstetrics and Gynaecology, East Africa

Background: The World Health Organization recommends that human growth should be monitored with the use of international standards. However, in obstetric practice, we continue to monitor fetal growth using numerous local charts or equations that are based on different populations for each body structure. Consistent with World Health Organization recommendations, the INTERGROWTH-21st Project has produced the first set of international standards to date pregnancies; to monitor fetal growth, estimated fetal weight, Doppler measures, and brain structures; to measure uterine growth, maternal nutrition, newborn infant size, and body composition; and to assess the postnatal growth of preterm babies. All these standards …

The Global Impact Of The Dracma Guidelines Cow’S Milk Allergy Clinical Practice, Alessandro Fiocchi, Holger Schunemann, Ignacio Ansotegui, Amal Assa’Ad, Sami Bahna, Roberto Berni Canani, Martin Bozzola, Lamia Dahdah, Christophe Dupont, Motohiro Ebisawa, Elena Galli, Haiqi Li, Rose Kamenwa, Gideon Lack, Alberto Martelli, Ruby Pawankar, Maria Said, Mario Sánchez-Borges, Hugh Sampson, Raanan Shamir, Jonathan Spergel, Luigi Terracciano, Yvan Vandenplas, Carina Venter, Susan Waserman, Gary Wong, Jan Brozek

Paediatrics and Child Health, East Africa

Background: The 2010 Diagnosis and Rationale for Action against Cow’s Milk Allergy (DRACMA) guidelines are the only Grading of Recommendations Assessment, Development and Evaluation (GRADE) guidelines for cow’s milk allergy (CMA). They indicate oral food challenge (OFC) as the reference test for diagnosis, and suggest the choice of specific alternative formula in different clinical conditions. Their recommendations are flexible, both in diagnosis and in treatment.

Objectives & methods: Using the Scopus citation records, we evaluated the influence of the DRACMA guidelines on milk allergy literature. We also reviewed their impact on successive food allergy and CMA guidelines at national and …

Prevalence Of Positive Depression Screen Among Post Miscarriage Women- A Cross Sectional Study, Steve Mutiso, Alfred Murage, Abraham Mukaindo

Obstetrics and Gynaecology, East Africa

Background: Miscarriages are a common pregnancy complication affecting about 10–15% of pregnancies. Miscarriages may be associated with a myriad of psychiatric morbidity at various timelines after the event. Depression has been shown to affect about 10–20% of all women following a miscarriage. However, no data exists in the local setting informing on the prevalence of post-miscarriage depression. We set out to determine the prevalence of positive depression screen among women who have experienced a miscarriage at the Aga Khan University hospital, Nairobi.

Methods: The study was cross-sectional in design. Patients who had a miscarriage were recruited at the post-miscarriage clinic …

Female Sex Workers Experiences Of Using Contraceptive Methods: A Qualitative Study In Kenya, Rhoune Ochako, Jerry Okal, Steven Kimetu, Ian Askew, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Female Sex Workers (FSWs) are predisposed to a broad range of social, sexual and reproductive health problems such as sexually transmitted infections (STIs)/HIV, unintended pregnancy, violence, sexual exploitation, stigma and discrimination. Female sex workers have unmet need for contraceptives and require comprehensive Sexual and Reproductive Health (SRH) prevention interventions. Existing programs pay little attention to the broad sexual and reproductive health and rights of these women and often focus on HIV and other STIs prevention, care and treatment while neglecting their reproductive health needs, including access to family planning methods. The aim of this study is, therefore, to explore …

Outcome Of Traumatic Brain Injury In Children By Using Rotterdam Score On Computed Tomography, Anwarul Haque, Zehra Dhanani, Amin Ali, Basit Salam, Qalab Abbas, Gohar Javed, Humaira Jurair

Department of Paediatrics and Child Health

Background: The Rotterdam Score (RS) on CT head is a new evolving clinical tool as a predictor of mortality in Traumatic Brain Injury (TBI). The objective of this study is to assess the outcome of children with TBI admitted in paediatric intensive care unit (PICU) of a tertiary-care, university hospital by using RS.
Methods: This was a prospective observational study conducted on children (age: 1mo -16yr) with TBI admitted in PICU of Aga Khan University Hospital from 2013 to 2016. RS on CT was calculated by a radiologist. All patients were managed according to according to Paediatric Brain Trauma Foundation …

Hemimegalencephaly: Seizure Outcome In An Infant After Hemispherectomy, Prem Chand, Pooja Manglani, Qalab Abbas

Department of Paediatrics and Child Health

Isolated hemimegalencephaly (iHME) is a rare form of congenital malformation of cortical development characterized by enlargement of all or part of one cerebral hemisphere. It typically presents with intractable seizures, developmental delay, contralateral hemiparesis, and hemianopia. We report a case of an 18-month-old girl who presented first with focal seizures at tenth day of life, with no other physical or behavioral abnormality. Initial EEG showed excessive sharp EEG transients more over the right hemisphere; repeated EEG showed spikes, polyspikes, sharps, and slow wave discharges predominately over the right hemisphere. MRI of the brain showed asymmetric enlargement of the right cerebral …

What’S Coming For Health Science And Policy In 2018? Global Experts Look Ahead In Their Field, Soumya Swaminathan, Robin S. Room, Louise C. Ivers, Graham Hillis, Rebecca F. Grais, Zulfiqar Ahmed Bhutta, Peter Byass

Department of Paediatrics and Child Health

No abstract provided.

Factors Influencing Choice Of Skilled Birth Attendance At Anc: Evidence From The Kenya Demographic Health Survey, Caroline Nyongesa, Xiaoyue Xu, John J. Hall, William Macharia, Faith Yego, Brigid Hall

Paediatrics and Child Health, East Africa

Background: In Kenya, skilled attendance at delivery is well below the international target of 90% and the maternal mortality ratio is high at 362 (CI 254–471) per 100,000 live births despite various interventions. The preventative role of skilled attendance at delivery makes it a benchmark indicator for safe motherhood.

Methods: Maternal health data from the Service Provision Assessment Survey, a subset of the 2010 Kenya Demographic Health Survey was analyzed. Logistic regression models were employed using likelihood ratio test to explore association between choice of skilled attendance and predictor variables.

Results: Overall, 94.8% of women are likely to seek …

Overexpression Of Egfr In Oral Premalignant Lesions And Oscc And Its Impact On Survival And Recurrence, Yumna Mirza, Syed Adnan Ali, Mohammad Sohail Awan, Romana Idress, Sana Naeem, Nida Zahid, Urooj Qadeer

Department of Surgery Docs

Introduction: Oral squamous cell carcinoma (OSCC) the sixth leading cancer worldwide ranks as the most common cancer in males, and the third most common in females in Pakistan. It is influenced by risk factors which are widely consumed in our population. The epidermal growth factor receptor (EGFR) is a tyrosine kinase receptor that is imperative for cell signalling, growth and differentiation. It is mutated and overexpressed in a variety of cancers, while in OSCC it has been linked to poor patient survival; premalignant to malignant transformation and recurrence. This study investigates the use of EGFR as a prognostic factor …

A Rare Case Of Presacral Epidermoid Cyst In An Adult Male: Emphasis On Diffusion Weighted Magnetic Resonance Sequences In Preoperative Imaging., Muhammad I. Alvi, Fatima Mubarak, Kumail Khandwala, Muhammad Nanish Barakzai, Aisha Memon

Department of Radiology

Epidermoid cyst of the presacral space is a rare congenital lesion of ectodermal origin. Presacral epidermoid cysts have been previously reported in women, however are extremely rare in males. We report a case of presacral epidermoid cyst in a 55-year-old male who presented to our emergency department with acute urinary retention and history of chronic constipation. A non-contrast computed tomography scan was performed with suspicion of urolithiasis, which revealed a well circumscribed low attenuation presacral mass. Magnetic resonance imaging (MRI) of the pelvis was subsequently performed to further characterize the lesion. The mass was returning hypointense T1 and hyperintense T2 …

A Rare Cause Of Recurrent Constipation With Abdominal Pain And Distension, Shahab Abid, Dawar Khan

Section of Gastroenterology

No abstract provided.

A Randomized Control Trial Comparing Train Of Four Ratio > 0.9 To Clinical Assessment Of Return Of Neuromuscular Function Before Endotracheal Extubation On Critical Respiratory Events In Adult Patients Undergoing Elective Surgery At A Tertiary Hospital In Nairobi, Isaac Adembesa, Vitalis Mung’Ayi, Zul Premji, Dorothy Kamya

Anaesthesiology, East Africa

Background: There is increasing evidence that the incidence of postoperative residual paresis after using neuromuscular blockers ranges from 24 to 50% in post anaesthesia care unit (PACU) and is associated with postoperative complications such as critical respiratory events as evidenced by hypoxia, hypoventilation and upper airway obstruction. Quantitative neuromuscular monitoring (such as the assessment of Train of four (TOF) ratio) and reversal of neuromuscular blockers has been shown to reduce postoperative residual paresis. There are very few outcome studies on effect of residual paresis in PACU. There is a paucity of published randomized controlled trials investigating whether using a TOF …

Inequities In Antenatal Care, And Individual And Environmental Determinants Of Utilization At National And Sub-National Level In Pakistan: A Multilevel Analysis, Ambreen Sahito, Zafar Fatmi

Community Health Sciences

Background: Nationally representative surveys are vital for gauging progress in health and planning health services. However, often marred with inadequate analysis to provide any guidance to health policy and planning. Most recent Pakistan Demographic and Health Survey (PDHS) 2012-2013 is an inclusive nationally representative investigation. Nonetheless, its published report offers limited evidence regarding antenatal care (ANC). Furthermore, after 18th constitutional amendment, policies are principally made at provincial level in Pakistan; therefore, it is imperative to have contextual evidence at sub-national level to feed programs and policies.
Methods: We analysed 7142 women with a recent birth, to assess the …

Neurological Involvement Associated With Plasmodium Vivax Malaria From Pakistan, Yousaf Abdullah Khan, Usman Hameed Mian, Najia Karim Ghanchi, Ali Bin Sarwar Zubairi, Mohammad Asim Beg

Department of Pathology and Laboratory Medicine

Plasmodium vivax is the most common specie causing malaria outside Africa with approximately 13.8 million reported cases worldwide. We report case of P. vivax infection with cerebral involvement. A nine year old boy presented with high grade fever accompanied by projectile vomiting and abnormal behavior later he developed seizures, shock, and unconsciousness. P. vivax monoinfection was diagnosed based on peripheral smears and PCR. After antimalarial therapy, patient made full recovery. Current case highlights increasing trend of cerebral complications caused by P. vivax.

High Heterotrophic Counts In Potable Water And Antimicrobial Resistance Among Indicator Organisms In Two Peri-Urban Communities Of Karachi, Pakistan, Sadia Shakoor, Imran Ahmed, Saima Mukhtiar, Israr Ahmed, Farzeen Hirani, Shazia Sultana, Rumina Hasan

Department of Pathology and Laboratory Medicine

Objective: Fecal contamination of potable water leads to unsafe water supply. Although many urban areas of large metropolitan cities receive safe water, peri-urban areas are often not monitored by public health authorities and water supply and quality remain unknown. We assessed microbiological quality and rates of antimicrobial resistance in viable indicator bacteria in two peri-urban communities of Karachi, Pakistan. Water samples were collected over 5 months (October 2015 to February 2016) from these peri-urban communities and samples were processed for microbiological quality as per Standing Committee of Analysts, United Kingdom and World Health Organization guidelines and criteria for drinking water. …

Evaluation Of Micro Leakage Of Root Canals Filled With Different Obturation Techniques: An In Vitro Study, Maham Muneeb Lone, Farhan Raza Khan

Section of Dental-Oral Maxillofacial Surgery

Background: Despite a plethora of studies done comparing different obturation techniques using gutta-percha, there is no consensus as to which obturation technique results in a 'better' sealing of root canal space. Aims of the study are to compare mean apical micro leakage in root canals of extracted teeth obturated with cold laterally compacted gutta-percha and thermoplasticised injectable gutta-percha using calcium hydroxide based sealer.
Methods: It was an in-vitro experimental study carried out using extracted teeth. After access cavity preparation and canal preparation in 70 teeth, they were randomly divided into 2 groups and filled with two different obturation …

Factors Affecting Treatment Duration - A Dilemma In Orthodontics, Saman Faruqui, Mubassar Fida, Attiya Shaikh

Section of Dental-Oral Maxillofacial Surgery

Background: One of the first concerns of new orthodontic patients, apart from the outcome, is the duration of treatment. A better understanding of orthodontic treatment duration as well as factors affecting the treatment duration is useful for efficient patient counselling and improved clinical practice. Hence, the objectives of this study are to compare the treatment durations of subjects with Class I and Class II division 1 (II/1) malocclusions, and to identify the factors affecting the treatment duration of these malocclusions.

Methods: This was a chart review conducted in the orthodontic department of the Aga Khan University Hospital, Karachi. …

Evaluation Of Micro Leakage Of Root Canals Filled With Different Obturation Techniques: An In Vitro Study, Maham Muneeb Lone, Farhan Raza Khan

Section of Dental-Oral Maxillofacial Surgery

Background: Despite a plethora of studies done comparing different obturation techniques using gutta-percha, there is no consensus as to which obturation technique results in a 'better' sealing of root canal space. Aims of the study are to compare mean apical micro leakage in root canals of extracted teeth obturated with cold laterally compacted gutta-percha and thermoplasticised injectable gutta-percha using calcium hydroxide based sealer.
Methods: It was an in-vitro experimental study carried out using extracted teeth. After access cavity preparation and canal preparation in 70 teeth, they were randomly divided into 2 groups and filled with two different obturation …

Health Systems Readiness For Adopting Mhealth Interventions For Addressing Non-Communicable Diseases In Low- And Middle-Income Countries: A Current Debate, Anam Shahil Feroz, Muhammad Masood Kadir, Sarah Saleem

Community Health Sciences

In low-and-middle-income countries, epidemiologic transition is taking place very rapidly from communicable diseases to non-communicable diseases. NCDs mortality rates are increasing faster and nearly 80% of NCDs deaths occur in LMICs. Existing weak health systems of LMICs are undergoing a devastating human and economic toll as a result of increasing treatment costs and losses to productivity from NCDs. At the same time, the increasing penetration of mobile phone technology and the spread of cellular network and infrastructure have led to the introduction of the mHealth field. While mHealth field offers a great promise to prevent and control non-communicable diseases in …

Impact Of Vision Impairment And Self-Reported Barriers To Vision Care: The Views Of Elders In Nuwara Eliya District, Sri Lanka, W. Holmes, R. Shajehan, S. Kitnasamy, C. Abeywickrama, Y. Arsath, F. Gnanaraj, S. Inbaraj, G. Jayakody, K. Durran, Stanley Luchters

Population Health, East Africa

The growing burden of vision impairment (VI) among older people is a development challenge in Asian countries. This study aimed to understand older people’s views and experiences about the impact of VI and barriers to eye care to inform policies to address this challenge. We conducted 12 focus group discussions in 2013 with retired Tamil and Sinhala elders in Nuwara Eliya district, Sri Lanka (n = 107). Data were analysed thematically. Older people described the broad impacts VI has on their lives. They worry about becoming dependent. VI restricts their ability to contribute to their families and communities, access …

Involving Men To Improve Maternal And Newborn Health: A Systematic Review Of The Effectiveness Of Interventions, Mariam Tokhi, Liz Comrie-Thomson, Jessica Davis, Anayda Portela, Matthew Chersich, Stanley Luchters

Population Health, East Africa

Background: Emerging evidence and program experience indicate that engaging men in maternal and newborn health can have considerable health benefits for women and children in low- and middle-income countries. Previous reviews have identified male involvement as a promising intervention, but with a complex evidence base and limited direct evidence of effectiveness for mortality and morbidity outcomes.

Objective: To determine the effect of interventions to engage men during pregnancy, childbirth and infancy on mortality and morbidity, as well as effects on mechanisms by which male involvement is hypothesised to influence mortality and morbidity outcomes: home care practices, care-seeking, and couple relationships. …

Midwives’ Knowledge Of Baby Friendly Hospital Initiative In Uganda, Jaliah Namutebi, Hanifah Nakanwagi, Leila Naluyima, Grace Edwards

School of Nursing & Midwifery, East Africa

The Baby Friendly Hospital Initiative (BFHI) is a worldwide programme well known to midwives globally for supporting the initiation of successful breastfeeding. In low resource countries, initiation of breastfeeding immediately after birth would help to reduce neonatal complications such as infection. Knowledge of the 10 steps is critical for midwives in developing countries, yet our research in Uganda suggested that midwives’ knowledge is poor, despite a commitment at government level. There is a disconnect between policy and practice which must be addressed to ensure that midwives give standardised advice to new mothers to ensure successful and exclusive breastfeeding. This is …

Factors Influencing High Prevalence Of Fresh Still Births In Mbagathi County Hospital, Nairobi - Kenya, Abednego Ongeso, Magdalene Lukorito, Jane Kabo

School of Nursing & Midwifery, East Africa

Background: The annual global burden of stillbirths is approximately 2.6 million, 98% of which occur in Sub Saharan Africa. In 2016, approximately 24 still births per month occurred in Mbagathi County Hospital (MCH) representing a 33.3% increase from 2015. A third of these were Fresh Still Births (FSBs).

Objectives: To establish factors influencing increase in FSB among women delivering at MCH.

Methodology: The study was conducted at MCH postnatal ward. A descriptive cross sectional study design was employed. Forty three respondents with FSBs were consecutively sampled. Clearance to conduct the study was sought from Ethics Review Committee, MCH and respondents. …

Examining Nursing Practices For Management Of Sepsis In Low Income Countries: The Case Of Uganda, Cliff Aliga, Judith Mutyabule, Grace Nakate, Abigail Emelonye

School of Nursing & Midwifery, East Africa

Examining nursing practice guidelines to improve quality of care for patients with sepsis in low income countries is required.

A large amount of information about best practice standards in sepsis management is available for healthcare professionals; however, implementation and adherence to practice guidelines recommended by the Surviving Sepsis Campaign remains low in low income countries.

A formal scope of practice for nursing and midwifery as a professional guideline is absent and national clinical guideline for Uganda remains unclear regarding the specific management of sepsis.

Inadequate documentation of patient care in Uganda makes sepsis cases difficult to be early detected.

Research …