Medicine and Health Sciences Commons^™

Concordance Of Cerebrospinal Fluid Latex Particle Agglutination Test With Csf And Blood Culture Among Children With Acute Bacterial Meningitis, Muhammad Khalid, Ali Faisal Saleem

Department of Paediatrics and Child Health

No abstract provided.

Susceptibility Pattern Of Methicillin Resistant Staphylococcus Aureus To Vancomycin And Other Alternate Agents: Report From A Private Sector Hospital Laboratory, Faryal Saleem, Naima Fasih, Afia Zafar

Department of Pathology and Laboratory Medicine

With increasing prevalence of methicillin resistant Staphylococcus aureus in clinical settings and injudicious use of antibiotics, resistance among MRSA against commonly used antibiotics is increasing. To assess the susceptibility pattern of MRSA against vancomycin, linezolid, tigecycline, rifampicin, fosfomycin fusidic acid, clindamycin, trimethoprim-sulfamethoxazole and teicoplanin, minimum inhibitory concentrations (MICs) for given antimicrobials were performed on 234 MRSA clinical isolates using automated VITEK 2 system. Vancomycin, linezolid, rifampicin, clindamycin, cotrimoxazole and teicoplanin susceptibilities were interpreted according to CLSI breakpoints, while tigecycline, fosfomycin and fusidic acid were interpreted according to BSAC breakpoints. All isolates were found susceptible to ancomycin, tigecycline, teicoplanin and linezolid. …

Prevalence And Risk Of Hepatitis E Virus Infection In The Hiv Population Of Nepal, Ananta Shrestha, Anurag Adhikar, Manjula Bhattarai, Ramanuj Rauniyar, Jose D. Debes, André Boonstra, Thupten K. . Lama, Mamun Al Mahtab, Amna Subhan Butt, Sheikh Mohammad Fazle Akbar

Section of Gastroenterology

Background: Infection with the hepatitis E virus (HEV) can cause acute hepatitis in endemic areas in immune-competent hosts, as well as chronic infection in immune-compromised subjects in non-endemic areas. Most studies assessing HEV infection in HIV-infected populations have been performed in developed countries that are usually affected by HEV genotype 3. The objective of this study is to measure the prevalence and risk of acquiring HEV among HIV-infected individuals in Nepal.

Methods: We prospectively evaluated 459 Human Immunodeficiency Virus (HIV)-positive individuals from Nepal, an endemic country for HEV, for seroprevalence of HEV and assessed risk factors associated with HEV infection. …

Educating Before Birth Via Talking To The Baby In The Womb: Prenatal Innovations, Shelina Bhamani

Department of Obstetrics & Gynaecology

Education is the only major weapon that enables nations to progress socio-economically and gives a huge rise to their human development index. More so, it is considered to be the most fundamental requirement for poverty eradication, for addressing socio-political issues and for stabilizing peace and harmony among nations. Education is a lifelong process and does not have a preset parameter for its accessibility and provision (Sharkey, 1998). Learning is innate and natural and the human mind is set to learn since its conception. Additionally, in the recent era, investigations are focused on education and learning even before birth and extensive …

Association Of Vitamin D Binding Protein Polymorphism With Risk Of Type 2 Diabetes Mellitus In A Pakistani Urban Population: A Case Control Study, Khalida Iqbal, Najmul Islam, Iqbal Azam, Ali Asghar, Naseema Mehboobali, Mohammad Perwaiz Iqbal

Department of Biological & Biomedical Sciences

Objective: To assess if genotypes/diplotypes of vitamin D binding protein have any association with type 2 diabetes mellitus.
Methods: This case-control study was conducted from January 2013 to July 2015 at the endocrinology clinics of the Aga Khan University Hospital, Karachi, and comprised adult patients with type 2 diabetes and their age- and gender-matched healthy controls. Venous blood was obtained and assessed for serum/plasma 25 hydroxyvitamin D, parathyroid hormone, calcium, alkaline phosphatase and creatinine. Deoxyribonucleic acid was isolated and genotyping was done by polymerase chain reaction-restriction fragment length polymorphismprocedures.
Results: Of the 330 participants, there were 165(50%) …

Factors Associated With Hiv Testing Among Young Men Who Have Sex With Men In Myanmar: A Cross-Sectional Study, Minh D. Pham, Poe Poe Aung, Aye Kyawt Paing, Naanki Pasricha, Paul A. Agius, Waimar Tun, Ashish Bajracharya, Stanley Luchters

Population Health, East Africa

Introduction: In Myanmar, men who have sex with men (MSM) experience high risk of HIV infection. However, access to HIV testing and prevention services remains a challenge among this marginalized population. The objective of this study was to estimate population prevalence and correlates of prior HIV testing among young MSM (YMSM) and informs the development of HIV testing and intervention programmes that respond to the specific needs of this population.

Methods: Five hundred and eighty-five YMSM aged 18 to 24 years were recruited using respondent-driven sampling (RDS) in a cross-sectional survey conducted in six townships of Myanmar. RDS-adjusted population estimates …

Response To Comment On Mohammad Hamid Et Al (J Pak Med Assoc 67: 1019; 2017) - Incidence And Pattern Of Thrombocytopenia In Cardiac Surgery Patients, Khalid Ahsan

Department of Anaesthesia

No abstract provided.

Distal Humeral Fractures-Current Concepts, James C. Beazley, Njalalle Baraza, Robert Jordan, Chetan S. Modi

General Surgery, East Africa

Background: Distal humerus fractures constitute 2% of all fractures in the adult population. Although historically, these injuries have been treated non-operatively, advances in implant design and surgical technique have led to improved outcomes following operative fixation.

Methods: A literature search was performed and the authors' personal experiences are reported.

Results: This review has discussed the anatomy, classifications, treatment options and surgical techniques in relation to the management of distal humeral fractures. In addition, we have discussed controversial areas including the choice of surgical approach, plate orientation, transposition of the ulnar nerve and the role of elbow arthroplasty.

Conclusion: Distal humeral …

Women And Substance Use: A Qualitative Study On Sexual And Reproductive Health Of Women Who Use Drugs In Delhi, India, Vartika Sharma, Avina Sarna, Waimar Tun, Lopamudra Ray Saraswati, Ibou Thior, Ira Madan, Stanley Luchters

Population Health, East Africa

Objectives: To explore contextual factors that increase vulnerabilities to negative sexual and reproductive health (SRH) outcomes and possible differences in SRH-related behaviours and the needs of women who use drugs (WUD) through non-injecting and injecting routes.

Design: Qualitative study design using semi-structured in-depth interviews.

Participants: Twenty women who injected drugs in the past 3months and 28 women who reported using drugs through non-injecting routes in the past 1month.

Setting: Interviews were conducted at community-based, drop-in centres in Delhi, India.

Results: Study findings illustrate that WUD were sexually active and had multiple sex partners including clients of sex work. Transient relationships …

Pattern Of Neurological Diseases In Adult Outpatient Neurology Clinics In Tertiary Care Hospital, Safia Awan, Saad Shafqat, Ayeesha Kamran Kamal, Aziz Sonawalla, Sarwar Jamil Siddiqui, Fowzia Siddiqui, Mohammad Wasay

Section of Neurology

Objectives: The burden of neurological diseases in developing countries is rising although little is known about the epidemiology and clinical pattern of neurological disorders. The objective of this study was to understand the burden of disease faced by neurologists a in tertiary care setting.

Results: A prospective observational study was conducted of all presentations to neurology clinics at Aga Khan University Hospital Karachi over a period of 2 years. A total of 16,371 out-patients with neurological diseases were seen during the study period. The mean age of the study participants were 46.2 ± 18.3 years and 8508 (52%) were male. …

Ischaemic Pituitary Tumour Apoplexy And Concurrent Meningitis: A Diagnostic Dilemma, Haris Hakeem, Shayan Sirat Maheen Anwar,, Sarwar Jamil Siddiqui

Section of Neurology

Pituitary tumour apoplexy is a rare but potentially life threatening clinical syndrome that mostly results from haemorrhage in the pre-existent tumour. Pure ischaemic subtype of apoplexy is even rarer. The presentation can be hard to differentiate clinically from bacterial meningitis. Moreover, the presence of one does not necessarily exclude the other and early diagnosis of both conditions is imperative for timely management. We report a case of ischaemic pituitary tumour apoplexy that may have precipitated in the setting of bacterial meningitis.

An Adult With Polyneuropathy And Hypogonadism Due To Poems Syndrome, Saba Zaidi, Sidra Sattar, Bhojo A Khealani

Section of Neurology

POEMS (acronym for polyneuropathy, organomegaly, endocrinopathy, M protein myeloma and skin changes), is a rare disease which occurs in the setting of plasma cell dyscrasias. We describe a case of an adult lady who presented with gradual onset weakness of all four limbs and multisystem involvement characterized by pedal edema, ascites, hyperpigmentation and hypogonadism. Nerve conduction study showed severe sensorimotor polyneuropathy. Serum immunofixation showed lambda light chain restricted monoclonal gammopathy. Bone marrow biopsy consistent with plasma cell dyscrasia. Hormonal assay showed decreased FSH, LH and estradiol levels which led us to diagnosis of hypogonadotrophic hypogonadism. The patient responded well to …

Diagnostic Challenges In Prostate Cancer And 68ga-Psma Pet Imaging: A Game Changer?, Maseeh Uz Zaman, Nosheen Fatima, Areeba Zaman, Mahwsih Sajid, Unaiza Zaman, Sidra Zaman

Department of Radiology

Creative Commons Attribution LicenseProstate cancer (PC) is the most frequent solid tumor in men and the third most common cause of cancer mortalityamong men in developed countries. Current imaging modalities like ultrasound (US), computerized tomography (CT),magnetic resonance imaging (MRI) and choline based positron emission (PET) tracing have disappointing sensitivity fordetection of nodal metastasis and small tumor recurrence. This poses a diagnostic challenge in staging of intermediateto high risk PC and restaging of patients with biochemical recurrence (PSA >0.2 ng/ml). Gallium-68 labeled prostatespecific membrane antigen (68Ga-PSMA) PET imaging has now emerged with a higher diagnostic yield. 68Ga-PSMAPET/CT or PET/MRI can be …

Outcomes Of High Risk Patients With Febrile Neutropenia At A Tertiary Care Center, Asif Husain Osmani, Adnan Abdul Jabbar, Manesh Kumar Gangwani, Bilal Hassan

Department of Radiation Oncology

Creative Commons Attribution LicenseFever during chemotherapy-induced neutropenia continues to be a major cause of morbidity and mortality incancer patients. Mortality depends on the duration and degree of neutropenia, bacteremia, sepsis, performance status,comorbidities and other parameters. The highest mortality rates in cancer patients hospitalized with febrile neutropenia(FN) are observed in those with documented infection. The objectives of the study were to present available tools forrisk assessment, to review pathogens causing infections in adult FN patients and to assess outcomes. Methods: Thiscross sectional study was conducted on adult culture positive FN patients admitted to the Hematology/Oncologyservice at the Aga Khan University Hospital, …

Frequency Of G6pd Mediterranean In Individuals With And Without Malaria In Southern Pakistan, Bushra Moiz, Haroon Muhammad Arshad, Ahmed Raheem Raheem, Hasan Hayat, Najia Karim Ghanchi, M Asim Beg

Department of Pathology and Laboratory Medicine

Background: Pakistan has an estimated annual burden of 1.5 million malaria cases. The current situation calls for an efective malaria control and eradication programme in this country. Currently, primaquine is an attractive option for eliminating reservoirs of Plasmodium vivax hypnozoites and killing gametocytes of Plasmodium falciparum. However, this drug causes haemolysis in individuals who are glucose-6-phosphate (G6PD) defcient. It is important to map G6PD defciency and malaria distribution in Pakistan to design an efective malaria eradication regimen. Frequency of G6PD defciency (G6PDd) in malaria patients has not been reported from Pakistan in any meaningful way. The purpose of this study …

“My Hands Are Tied”: Nurses’ Perception Of Organizational Culture In Kenyan Private Hospitals, Gladys Mbuthia, Sharon Brownie, Eleanor Holroyd

School of Nursing & Midwifery, East Africa

It is estimated that by 2030 the global shortage of nurses and midwives will be 7.6 million, with African countries among the most adversely affected. Within this context, it is important to understand the specific organizational factors that contribute to registered nurses (RNs)’ decisions to remain or leave their workplaces in East Africa. The aim of this study was to commence exploration of these factors by exploring nurses’ perceptions of organizational culture of selected private hospitals in Kenya. A small-scale exploratory qualitative approach was employed, with eight nurses undertaking semi-structured interviews. There were five female and three male nurses. All …

Missed Immunization Opportunities Among Children Under 5 Years Of Age Dwelling In Karachi City, Asif Khaliq, Sayeeda Amber Sayed, Syed Abdullah Hussaini, Kiran Azam, Mehak Qamar

Department of Paediatrics and Child Health

Background: Immunization is the safest and effective measure for preventing and eradicating various communicable diseases. A glaring immunization gap exists between developing and industrialized countries towards immunization, because the developing countries including Pakistan are still striving to provide basic immunization to their children. The purpose of this study was to access the prevalence and factors of missing immunization among under 5-year children of Karachi.
Methods: A cross sectional study was conducted from June 2015 to October 2015 among different outpatient clinics of Karachi. Parents who had child less than 5 year of age were approached by non-probability purposive sampling. Data …

Influenza Epidemiology And Immunization During Pregnancy: Final Report Of A World Health Organization Working Group, Deshayne B. Fell, Eduardo Azziz-Baumgartner, Michael G. Baker, Maneesh Batra, Julien Beauté, Philippe Beutels, Niranjan Bhat, Zulfiqar Ahmed Bhutta, Cheryl Cohen, Rehana Salam

Department of Paediatrics and Child Health

From 2014 to 2017, the World Health Organization convened a working group to evaluate influenza disease burden and vaccine efficacy to inform estimates of maternal influenza immunization program impact. The group evaluated existing systematic reviews and relevant primary studies, and conducted four new systematic reviews. There was strong evidence that maternal influenza immunization prevented influenza illness in pregnant women and their infants, although data on severe illness prevention were lacking. The limited number of studies reporting influenza incidence in pregnant women and infants under six months had highly variable estimates and underrepresented low- and middle-income countries. The evidence that maternal …

Delayed Spinal Cord Infarction Following Anterior Cervical Surgical Decompression, Muhammad Faheem Khan, Rashid Jooma, Fauzan Alam Hashmi, Muhammad Faraz Raghib

Section of Neurosurgery

Anterior cervical discectomy and fusion (ACDF) for cord compression is a safe and effective procedure with good outcomes. However, worsening of myelopathy is the most feared adverse event of the surgery. We report the case of a 36-year-old male patient who presented with an acute non-traumatic C5-6 cervical disc herniation causing incomplete quadriparesis. He underwent an uncomplicated ACDF at C5-6, and after an initial period of improvement, he developed a delayed onset of an anterior cord syndrome on day 3, without any discerning cause. We have reviewed similar cases reported in the literature and believe that our patient's postsurgical course …

Bk Polyomavirus Virus Hemorrhagic Cystitis Following Allogeneic Bone Marrow Transplant With Haploidentical Related Donor: Case Reports From Two Patients, Danish Shakeel, Natasha Bahadur Ali, Mohammad Usman Shaikh, Salman Adil

Section of Haematology/Oncology

BK virus is well known to be associated with allograft failure in renal transplant recipients due to polyomavirus-associated nephropathy (PVAN). BK viruses are increasingly recognized an important cause of hemorrhagic cystitis during hematopoietic stem cell transplantation (HSCT). Here we describe two patients with acute lymphoblastic leukemia who received a haplo identical match related donor hematopoietic stem cell transplant after myeloablative conditioning and post-transplant cyclophosphamide. They developed cytology proven BK Virus cystitis. Both were treated with Leflunomide. Treatment was effective in alleviating the symptoms temporarily but eventually the symptoms progressed and resulted in mortality of both patients.

Pancreaticogastrostomy - An Alternate For Dealing With Pancreatic Remnant After Pancreaticoduodenectomy - Experience From A Tertiary Care Center Of Pakistan, Tabish Chawla, Hassaan Bari, Shahrukh Effendi

Section of General Surgery

Whipple's pancreaticoduodenectomy has been refined over the years to be a safe operation though the morbidity rate still remains high (30-50%). Pancreatic fistula is the most important cause of mortality following pancreaticoduodenectomy. To prevent it, surgeons have used two anastomotic techniques: pancreaticojejunostomy and pancreaticogastrostomy. Recent studies found that pancreaticogastrostomy is associated with fewer overall complications than pancreaticojejunostomy. This is a retrospective review of patients who underwent Whipple's at Aga Khan University Hospital and had pancreaticogastrostomy as a preferred anastomosis for pancreatic stump. Forty four patients met the inclusion criteria, 27 were male. No patient developed post-operative pancreatic fistula, 13 (31%) …

Development Of A Unifying Target And Consensus Indicators For Global Surgical Systems Strengthening: Proposed By The Global Alliance For Surgery, Obstetric, Trauma, And Anaesthesia Care (The G4 Alliance), Adil H. Haider, John W. Scott, Colin D. Gause, Mira Meheš, Grace Hsiung, Albulena Prelvukaj, Dana Yanocha, Lauren M. Baumann, Faheem Ahmed, Asad Latif

Section of General Surgery

After decades on the margins of primary health care, surgical and anaesthesia care is gaining increasing priority within the global development arena. The 2015 publications of the Disease Control Priorities third edition on Essential Surgery and the Lancet Commission on Global Surgery created a compelling evidenced-based argument for the fundamental role of surgery and anaesthesia within cost-effective health systems strengthening global strategy. The launch of the Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care in 2015 has further coordinated efforts to build priority for surgical care and anaesthesia. These combined efforts culminated in the approval of a World Health …

Role Of 5-Ala In Improving Extent Of Tumour Resection In Patients With Glioblastoma Multiforme, Muhammad Waqas, Inamullah Khan, Muhammad Shahzad Shamim

Section of Neurosurgery

Goal of surgery for patients with Glioblastoma Multiforme (GBM) is gross total resection with no new neurological deficits. Surgical resection is often restricted due the difficulty in differentiating the tumour from surrounding normal brain using either naked eye, or standard intra-operative white light microscopy. GBM uptakes orally administered 5-ALA becomes fluorescent when viewed by a special light, and this property has been used to improve intra-operative tumour identification. This technique should therefore allow better extent of tumour resection. The hypothesis has been tested through several studies and even though most studies are of low quality, they strongly favour the use …

Case Of Undiagnosed Pneumocystis Pneumonia (Pcp, Verda Arshad, Nousheen Iqbal, Haider Ali Saleem, Muhammad Irfan

Section of Pulmonary & Critical Care

Pneumocystis pneumonia (PCP) is an opportunistic fungal infection that is usually seen in immunocompromised patients, especially those with HIV, malignancies, organ transplants and on drug therapies like chemotherapy and steroids. PCP has subacute presentation in patients with AIDS which if left untreated gets worse and is a significant cause of morbidity and mortality. Here we present a case of PCP went undiagnosed, partially due to the patient being unaware of his HIV positive status and partially because no organism could be found under the microscope.

Video Microscope Robotic Arm-Assisted, Neuronavigation-Guided Glioma Resection And Regional Sampling, Muhammad Waqas, Ather Enam, Fauzan A Hashmi, Fatima Mubarak, Fazal Arain

Section of Neurosurgery

High-grade gliomas possess internal pathological heterogeneity. Selective sampling of different tumor regions can help in the study of this heterogeneity. In this report, we have described the use of a novel navigation and optical system for the selective regional sampling of a high-grade glioma lesion. A 45-year-old gentleman presented to us with complaints of intermittent frontal headaches for past eight months. On examination, he had subtle pyramidal weakness in left upper and lower extremities. Magnetic resonance imaging (MRI) showed a large contrast-enhancing, space-occupying lesion in the right frontal lobe causing perilesional edema and midline shift. We marked four different regions …

A Resident's Note, Syed Muhammad Mustahsan

Department of Emergency Medicine

No abstract provided.

Internal Mammary Artery Flow In Different Racial Groups Of Pakistan, Mudassir Iqbal Dar, Asim Hassan Dar, Mansoor Ahmed, Abdul Haseeb, Muhammad Bilal

Department of Biological & Biomedical Sciences

Objective: To find out any differences in free flow of internal mammary artery among different ethnic groups.
Methods: This observational, cross-sectional study was conducted at the Civil Hospital, Karachi, from January 2013 to December 2015, and comprised patients who underwent coronary artery bypass grafting. The participants were divided into 5 groups, i.e. Sindhi, Muslim migrants from India, Punjabi, Pathan and Balochi patients. Free flow of internal mammary artery was measured immediately after harvesting within a syringe, and its flow was measured in 30 seconds. SPSS 18 was used for data analysis.
Results: Of the 158 patients, 44(27.8%) …

Mini-Craniotomy Under Local Anesthesia For Chronic Subdural Hematoma: An Effective Choice For Elderly Patients And For Patients In A Resource-Strained Environment, Shaikh Danish Mahmood, Muhammad Waqas, Mirza Zain Baig, Aneela Darbar

Medical College Documents

Background: Mini-craniotomy for chronic subdural hematoma (CSDH) is associated with lower rates of recurrence. However, the procedure is performed mostly with the patient under general anesthesia (GA) and therefore frequently requires an intensive care unit (ICU) facility, especially in the elderly population. Because of the unavailability of ICU beds, and to avoid GA, we started to perform this procedure with the patient under local anesthesia (LA).
Materials and methods: This was a retrospective medical chart review conducted in the section of Neurosurgery at the Aga Khan Hospital in Karachi, Pakistan. The study duration was 1 year. We included patients aged …

Oral Sildenafil Use In Neonates With Persistent Pulmonary Hypertension Of Newborn, Ali Shabbir Hussain, Syed Rehan Ali, Shakeel Ahmed, Farah Naz Qamar, Anila Haroon

Department of Paediatrics and Child Health

Background: The prevalence of PPHN has been estimated at 1.9 per 1000 live births. After the discovery of iNO's, its efficacy and benefit in PPHN is well established. Even in the best of centers equipped with iNo and ECMO the mortality is around 20%. Also, iNO is expensive and difficult to administer and monitor which makes it difficult choice in our part of the world. Furthermore About 40% of patients do not respond or have rebound pulmonary hypertension after discontinuation. Owing to these reasons, other treatment modalities like phosphodiesterase inhibitors such as Sildenafil need to be evaluated.
Methods: We report …

Is Obesity Endemic To Pakistan?, Fariha Hasan, Bilal Hasan

Medical College Documents

No abstract provided.