Medicine and Health Sciences Commons^™

Cime Newsletter : September 2017, Cime

Centre for Innovation in Medical Education (CIME) Archives

- The Team at CIME Successfully Launch First Clinical Simulation Workshop

- Raising the Standards of Health for Mothers and Children in Central and South Asia

- Successful Opthalmology Sessions

- Scientific Events

- Heart Attack on a Plate

- Blog

Pharmacy Newsletter : September 2017, Pharmacy Department

Department of Pharmacy Archives

Content:

• Drug - Drug Interaction-A case Report
• Survey on Knowledge and Awareness of Pharmacists about Venous
• Pregnancy Risk & Lactation Safety of Antiretroviral (HIV)
• Dengue Vaccine - Hope for Future

Control Of Hypertension Among Diabetic Patients In A Referral Hospital In Tanzania: A Cross-Sectional Study, Semvua B. Kilonzo, Daniel W. Gunda, Fatma Bakshi, Fredrick Kalokola, Henry A. Mayala, Hollo Dadi

Internal Medicine, East Africa

BACKGROUND: Hypertension is common among diabetic patients. The co-existence of two conditions carries an excessive risk of severe complications and mortalities. Limited information exists on the determinants of poor hypertension control among these patients. We aimed at determining the prevalence and factors associated with poor hypertension control in these patients.

METHODS: Data of diabetic patients who were also hypertensive attending an outpatient clinic from 1 August 2015 to 31 December 2015 at Bugando Medical Centre were retrospectively analyzed. Uncontrolled hypertension was defined as a blood pressure of ≥130mmHg and/or ≥80mmHg systolic and diastolic respectively. A designed questionnaire was used to …

Knowledge And Utilisation Of Emergency Contraception Pills Among Female Undergraduate Students At The University Of Nairobi, Kenya, Mwaniki Grace Nyambura, James N. Kiarie, Elkanah Omenge, Okubatsion Tekeste Okube

Obstetrics and Gynaecology, East Africa

Background: Emergency Contraception (EC) is used after unprotected sexual intercourse, following sexual abuse, misuse of regular contraception or non-use of contraception. Seventeen percent of pregnancies in Kenya are unintended, potentially leading to unsafe abortion that contributes to the high maternal mortality rate in Country. According to 2016 Kenya Demographic and Health Survey (KDHS), the maternal mortality ratio was 362 maternal deaths per 100,000 live births. Female students in University or College are vulnerable to unplanned pregnancies and illegal abortions resulting in mortality, morbidity and psychosocial problems. Knowledge on EC is very important for students as they are not in stable …

Transverse Vaginal Septum: Report Of Two Patients With Mri Findings, Shaista Afzal, Imrana Masroor, Saira Naz, Shazia Bhurgri

Department of Radiology

The transverse vaginal septum is a rare form of Mullerian duct anomaly, and is a disorder of vertical fusion of Mullerian system with the sinovaginal bulb. Magnetic resonance imaging (MRI)is very useful in the detection, classification and management planning of this rare anomaly. We present two cases of transverse vaginal septum in two patients of different age groups and with different clinical presentations. The findings on MRI, related to presence of vaginal septum and the management work-up, are also discussed.

Hemimegalencephaly With Intractable Epilepsy: A Case Report, Prem Chand, Muhammad Faraz Raghib, Muhammad Sohail Salat

Department of Paediatrics and Child Health

Isolated Hemimegalencephaly (iHME) is a rare form of congenital malformation of cortical development.It is characterized by enlargement of all or part of one cerebral hemisphere. It typically presents with intractable seizures, mental retardation, developmental delay, contralateral hemiparesis and hemianopia. The patient was a five and half month's old baby girl who presented first with focal seizures at 10th day of life. No other physical or behavioral abnormality was noted. However, Initial EEG showed excessive sharp EEG transients more over the right hemisphere, repeated EEG showed spikes, polyspikes, sharps and slow wave discharges predominately over right hemisphere. MRI brain showed asymmetric …

Harlequin Colour Change, Suneeta Khemani, Shirin Bahadur Ali, Sarfaraz Karim, Mohammad Ali Yezdan

Department of Paediatrics and Child Health

Harlequin colour change (HCC) is a rare, benign and transient colour change presenting in normal healthy neonates in initial days of life and resolves spontaneously. It is thought to be due to hypothalamic immaturity, leading to capillary bed dysregulation. Gravity might also play a role, as this is apparent on the dependent side. It is important for physicians to recognize this phenomenon so that they do not order any irrelevant investigations. Here, we present a case of a healthy neonate who had HCC, which was unilateral, well demarcated erythema, with patchy pallor. Baby was vitally stable at that time. This …

Diabetes And Coronary Artery Disease: Role Of Functional Imaging, Maseeh Uz Zaman, Nosheen Fatima

Department of Radiology

No abstract provided.

Neuroimmunology: An Expanding Frontier In 21st Century Neurology, Mohammad Saeed, Arsalan Ahmad

Pakistan Journal of Neurological Sciences (PJNS)

The recent discovery of functional lymphatic vessels lining the dural sinuses shattered the long held view of the absence of CNS lymphatic vas culature and provided solid neuroanatomical ground for Neuroimmunology1. Moreover, it has been shown that there is the presence of what is known as the inflammatory reflex.

Neurological Disorder Burden In Faisalabad, Punjab-Pakistan:Data From The Major Tertiary Carecenters Of The City, Ghulam Hussain, Asif Shahzad, Haseeb Anwar, Shahid Mahmood Baig, Asghar Shabbir, Jose-Luis Gonzalez De Aaguilar

Pakistan Journal of Neurological Sciences (PJNS)

The burden of neurological disorders (NDs) in developing countries is 4-5%, compared to 10-11% in developed countries. This burden is rising in developing countries due to prolonged life expectancy, improved health facilities, easy access to diagnostic facilities, and a trend in urbanization. There is inadequate data about the epidemiology of major NDs in Pakistan and most available information are hospital-based estimations or physicians’ collected data.

Impulsivity In Patients With Attempted Suicide Presenting At A Tertiary Care Hospital In Karachi, Ayesha Abdul Hameed, Haresh Kumar, Sarika Bai, Azra Shaheen, Ravi Athwani, Mohammad Munir Hamirani

Pakistan Journal of Neurological Sciences (PJNS)

OBJECTIVE: To determine the prevalence of impulsivity in patients who attempted suicide presenting at a tertiary care hospital, Karachi. STUDY DESIGN: Cross sectional study. STUDY SETTING: Study was led in the Psychiatry Department, Abbasi Shaheed Hospital, Karachi. DURATION OF STUDY:Six month after approval of synopsis. SUBJECTS AND METHODS: Data was prospectively collected from patients after taking verbal consent. Permission was taken from ethical review committee. 95 patients presenting to the Psychiatry Department who met the inclusion criteria were included. A brief history about suicide attempt and demographic data was taken from the patient and confirmed by an attendee. The researcher …

Chronic Tension-Type Headache As A Risk Factor Of Myofascial Trigger Points In Upper Trapezius Muscle Fibers In Neck Pain Patients, Aisha Amin, Umer Maqsood, Farah Niaz Awan, Hafiz Sheraz Arshad, Ali Hamza Arshad

Pakistan Journal of Neurological Sciences (PJNS)

Chronic tension type headache (CTTH) is one of the very common neurological conditions which have striking impact on daily functional activities. In tension type headaches the myofascial TrP's are frequently examined .It is observed that myofascial pain syndrome is frequent determinant of chronic nonspecific neck pain.

Kernohan–Woltman Notch Phenomenon:Case Report And Review Of Literature, Fareed Ahmed, Muhammad Shahzad Shamim, Sidra Asad Ali

Pakistan Journal of Neurological Sciences (PJNS)

Subdural hematoma (SDH) is usually secondary to mechanical trauma. Spontaneous subdural hematoma is still rare with unclear pathophysiology. The classic findings of subdural hematoma is sudden drop in mental status, an ipsilateralmydriasis with contralateral hemiparesis. However SDH can sometimes compress the contralaterl corticospinal tract resulting in ipsilateral motor weakness, this phenomenon is known as Kernohan-Woltman Notch Phenomenon.

A Prevalent Disease Missed Under Cover Of An Uncommon Disorder- A Learning Experience In Clinical Practice, Sarah Razaq, Saeed Bin Ayaz, Aleem Arshad, Hussain Rashid Ihsan

Pakistan Journal of Neurological Sciences (PJNS)

Musculoskeletal pains are secondary complication of a my apathic disorder but other causes must be ruled out through meticulous evaluation. We report a case of distal my apathy who developed back pain due to tuberculous spondylitis but was overlooked and his complaint of backache was considered outcome of mechanical deterioration of vertebral column resulting from weakness of para spinal muscles due to my apathy. After detailed evaluation, his unnoticed ailment was identified and he was started off with the right management.

Cerebral Venous Sinus Thrombosis In A Patient With Undiagnosed Factor Vii Deficiency, Hira Qadir, Anila Rashid, Salman Naseem Adil

Department of Pathology and Laboratory Medicine

Factor VII (FVII) deficiency is one of the rare inherited bleeding disorders. Thrombosis has been occasionally described in inherited FVII deficiency. Here, we report a young female with undiagnosed FVII deficiency who presented with cerebral venous sinus thrombosis (CVST). Oral contraceptive pill was found to be prothrombotic risk factor. The CVSToccurred in spite of the congenital FVII deficiency indicating that no definitive antithrombotic protection is assured by this defect. Low molecular weight heparin and anti-Xa assay were found to be safe choice of anticoagulation and monitoring, respectively, in this patient

Effects Of Bomb Blast Injury On The Ears: The Aga Khan University Hospital Experience, Talha Ahmed Qureshi,, Mohammad Sohail Awan, Nabeel Hamayun Hassan, Agha Hussain Aftab, Syed Adnan Ali

Section of Otolaryngology, Head & Neck Surgery

Abstract Objective: To evaluate the frequency and effects of blast-related otologic injuries. Methods: This retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised charts of patients who were victims of bomb explosions between January 2011 and July 2013. Frequency and percentages were reported using cross tabulation with size of bomb, distance of person from blast and the presence of victim in open or closed space. Association of associated variables were also analysed. Results: Of the 100 patients, 81(81%) were men and 19(19%) were women. Besides, 68(68%) patients were aged <30 years. Also, 78(78%) subjects were exposed to < 80kg of explosives and 68(68%) were at a distance of>10m. Furthermore, 61(61%) patients were exposed to …

Readiness For Antimicrobial Resistance (Amr) Surveillance In Pakistan; A Model For Laboratory Strengthening, Dania Khalid Saeed, Rumina Hasan, Mahwish Naim, Afia Zafar, Erum Khan, Kauser Jabeen, Seema Irfan, Imran Ahmed Haq, Mohammad Zeeshan, Zabin Wajidali, Joveria Farooqi, Sadia Shakoor, Abdul Chagla, Jason Rao

Department of Pathology and Laboratory Medicine

Background: Limited capacity of laboratories for antimicrobial susceptibility testing (AST) presents a critical diagnostic bottleneck in resource limited countries. This paper aims to identify such gaps and to explore whether laboratory networks could contribute towards improving AST in low resource settings.
Methods: A self-assessment tool to assess antimicrobial susceptibility testing capacity was administered as a pre-workshop activity to participants from 30 microbiology laboratories in 3 cities in Pakistan. Data from public and private laboratories was analyzed and capacity of each scored in percentage terms. Laboratories from Karachi were invited to join a support network. A cohort of five laboratories that …

Readiness For Antimicrobial Resistance (Amr) Surveillance In Pakistan; A Model For Laboratory Strengthening, Dania Khalid Saeed, Rumina Hasan, Mahwish Naim, Afia Zafar, Erum Khan, Kauser Jabeen, Seema Irfan, Imran Ahmed Haq, Mohammad Zeeshan, Zabin Wajidali, Joveria Farooqi, Sadia Shakoor, Abdul Chagla, Jason Rao

Department of Pathology and Laboratory Medicine

Background: Limited capacity of laboratories for antimicrobial susceptibility testing (AST) presents a critical diagnostic bottleneck in resource limited countries. This paper aims to identify such gaps and to explore whether laboratory networks could contribute towards improving AST in low resource settings.
Methods: A self-assessment tool to assess antimicrobial susceptibility testing capacity was administered as a pre-workshop activity to participants from 30 microbiology laboratories in 3 cities in Pakistan. Data from public and private laboratories was analyzed and capacity of each scored in percentage terms. Laboratories from Karachi were invited to join a support network. A cohort of five laboratories that …

Carotid Intima Media Thickness Percentiles For Pakistani Population, Waseem Mirza, Mubashir Aslam Arain, Arif Ali, Vaqar Bari, Mirza Kazim Ali, Kainat Fatima

Department of Radiology

Carotid artery intima media thickness estimation is a well-established way of cardio vascular disease evaluation. The purpose of this cross-sectional study was to develop normal carotid intima media thickness percentile values for a Pakistani cohort. Data was collected at the Departments of Radiology and Family Medicine, The Aga Khan University Hospital, Karachi, from April 2014 to August 2015. High frequency ultrasound of carotid was done in 257 patients [97 male (38%), 160 female (62%)] without any known carotid artery disease. Reference ranges (90% range between 5th and 95th centiles) were constructed for each common carotid and internal carotid artery measurement …

Covering The Cover, Wei Wu, Jingdi Chen, Qianshan Ding, Dongmei Yang, Honggang Yu, Jun Lin

Department of Medicine

Background/Aims: Endoscopic submucosal dissection has been widely accepted. At present, the number of antiplatelet (APT) users has been growing. Moreover, because of high risks of thromboembolism, some patients need to continuously receive APT agents. The relationship between hemorrhage and continuous therapy with low-dose aspirin (LDA) remains controversial.

Materials and Methods: A systematic search was conducted; studies were screened out- if data of no-anticoagulant/APT drugs use and interrupted and continued-LDA use were reported separately. The Newcastle-scale was chosen to assess the quality of the included studies. Review Manager 5.2 was used for quality assessment statistical analysis, and the odd ratio (OR) …

Effectiveness Of Transcutaneous Bilirubin Measurement In Managing Neonatal Jaundice In Postnatal Ward Of A Tertiary Care Hospital In Pakistan, Ali Shabbir Hussain, Muhammad Hussain Shah, Maryam Lakhdir, Shabina Ariff, Simon Demas, Fatima Qaiser, Syed Rehan Ali

Department of Paediatrics and Child Health

Introduction: Neonatal jaundice is a common cause of concern in immediate newborn period for parents as well as for the caregivers. Babies with visible jaundice are identified by the healthcare provider, and blood samples are sent for confirmation. Clinical expertise varies from person to person and may lead to sending excessive blood sampling. Obtaining blood bilirubin samples is a painful procedure; it predisposes the baby to infections and requires skilled health personnel. Moreover, laboratory tests are costly and time consuming, leading to unnecessary delays in commencing phototherapy and discharge from hospital. Transcutaneous bilirubinometer has been in use for a long …

Post-Traumatic Stress Disorder And Its Predictors In Emergency Medical Service Personnel: A Cross-Sectional Study From Karachi, Pakistan, Salima Kerai, Uzma R. Khan, Muhammad Islam, Nargis Asad, Junaid Razzak, Omrana Pasha

Department of Paediatrics and Child Health

Background: Emergency medical service (EMS) personnel who work to provide emergency medical care at the scene and during transportation are exposed to various kinds of stressors and are particularly susceptible to developing stress-reactions. This study assesses symptoms of post-traumatic stress disorder and its predictors among the personnel of a selected EMS in Karachi, Pakistan.
Methods: Data were gathered from 518 personnel working in an EMS setting from February to May 2014. Participants were screened for post-traumatic stress symptoms using the Impact of Event Scale-Revised (IES-R). Demographic and work-related characteristics, coping styles and the social support systems of the participants were …

Control Of Hypertension Among Diabetic Patients In A Referral Hospital In Tanzania: A Cross-Sectional Study, Semvua B. Kilonzo, Daniel W. Gunda, Fatma Bakshi, Fredrick Kalokola, Henry A. Mayala, Hollo Dadi

Faculty of Health Sciences, East Africa

Background:

Hypertension is common among diabetic patients. The co-existence of two conditions carries an excessive risk of severe complications and mortalities. Limited information exists on the determinants of poor hypertension control among these patients. We aimed at determining the prevalence and factors associated with poor hypertension control in these patients.

Methods:

Data of diabetic patients who were also hypertensive attending an outpatient clinic from 1 August 2015 to 31 December 2015 at Bugando Medical Centre were retrospectively analyzed. Uncontrolled hypertension was defined as a blood pressure of ≥130mmHg and/or ≥80mmHg systolic and diastolic respectively. A designed questionnaire was used …

Estimates Of Burden And Consequences Of Infants Born Small For Gestational Age In Low And Middle Income Countries With Intergrowth-21st Standard: Analysis Of Cherg Datasets, Anne C C Lee, Naoko Kozuki, Simon Cousens, Gretchen A. Stevens, Hannah Blencowe, Mariangela F. Silveira, Ayesha Sania, Heather E. Rosen, Christentze Schmiegelow, Linda S. Adair, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Objectives: To estimate small for gestational age birth prevalence and attributable neonatal mortality in low and middle income countries with the INTERGROWTH-21st birth weight standard.
Design: Secondary analysis of data from the Child Health Epidemiology Reference Group (CHERG), including 14 birth cohorts with gestational age, birth weight, and neonatal follow-up. Small for gestational age was defined as infants weighing less than the 10th centile birth weight for gestational age and sex with the multiethnic, INTERGROWTH-21st birth weight standard. Prevalence of small for gestational age and neonatal mortality risk ratios were calculated and pooled among these datasets at the regional level. …

Progress And Priorities For Reproductive, Maternal, Newborn, And Child Health In Kenya: A Countdown To 2015 Country Case Study, Emily C. Keats, Anthony Ngugi, William Macharia, Nadia Akseer, Emma Nelima Khaemba, Zaid Ahmad Bhatti, Arjumand Rizvi, John Tole, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: Progress in reproductive, maternal, newborn, and child health (RMNCH) in Kenya has been inconsistent over the past two decades, despite the global push to foster accountability, reduce child mortality, and improve maternal health in an equitable manner. Although several cross-sectional assessments have been done, a systematic analysis of RMNCH in Kenya was needed to better understand the push and pull factors that govern intervention coverage and influence mortality trends. As such, we aimed to determine coverage and impact of key RMNCH interventions between 1990 and 2015.
Methods: We did a comprehensive, systematic assessment of RMNCH in Kenya from 1990 …

Combining Magnetic Resonance Spectroscopy And Magnetic Resonance Imaging In Diagnosing Focal Brain Lesions In Children, Farah Naz Farid, Waseem Mirza, Nauman Hashmani

Section of Ophthalmology

Introduction: We attempted to find the sensitivity and specificity of various pediatric brain masses in the Pakistani population while keeping histopathology or clinical diagnosis as the gold standard.
Methods: This was a retrospective study that was conducted from January 2007 to January 2016. We reviewed the records of 204 patients that presented to the radiology department of Aga Khan University Hospital (AKUH). Out of the 204, 135 pediatric patients in the 0–18 age group with focal brain lesions who underwent magnetic resonance spectroscopy (MRS) and a biopsy or clinical diagnosis were included. If histopathology was available, it was taken as …

Role Of Metastasectomy And Chemotherapy In Carcinoma Of Uterine Cervix, Nasir Ali, Muhammad Atif Mansha, Ahmed Nadeem Abbasi, Bilal Mazhar Qureshi

Department of Radiation Oncology

Squamous cell carcinoma of uterine cervix is potentially a curable disease; however, many patients treated with definitive chemoradiotherapy develop distant metastases, with few of them having a single metastatic deposit. There are no guidelines for the treatment of patients with oligometastatic cervical cancer.We present a case of a patient with International Federation of Gynecology and Obstetrics (FIGO) Stage IIB squamous cell carcinoma of uterine cervix. She was successfully treated with concurrent chemoradiotherapy with definitive intent. One year later, she developed a solitary pulmonary nodule for which she underwent resection followed by chemotherapy. She is free of any local or distant …

Proximal Femur Locking Plate For Sub-Trochanteric Femur Fractures: Factors Associated With Failure, Akbar Zubairi, Rizwan Haroon Rashid, Marij Zahid, Pervaiz Mahmood Hashmi, Shahryar Noordin

Section of Orthopaedic Surgery

Introduction: Proximal femur locking compression plates (PF-LCP) have gained popularity since their inception due to superior biomechanical stability and durability but clinical experience has shown conflicting results including implant failure.
Objective: To study the incidence of implant failure in patients with sub-trochanteric fractures managed with proximal femoral locking compression plate and identify potential risk factors associated with the failure.
Materials & Methods: Fifty patients with sub-trochanteric fractures, operated upon with titanium PF-LCP were included in the study from January 2012 to December 2014. These plates were of two designs including one five 5.0 mm proximal locking screws (implant A) and …

Peer Violence Perpetration And Victimization: Prevalence, Associated Factors And Pathways Among 1752 Sixth Grade Boys And Girls In Schools In Pakistan, Rozina Karmaliani Professor, Judith Mcfarlane, Rozina Somani, Hussain Maqbool Ahmed Khuwaja, Shireen Shehzad Bhamani, Tazeen Saeed Ali, Saleema A. Gulzar, Yasmeen Hassan Somani, Esnat D. Chirwa, Rachel Jewkes

School of Nursing & Midwifery

Background: Child peer violence is a global problem and seriously impacts health and education. There are few research studies available in Pakistan, or South Asia. We describe the prevalence of peer violence, associations, and pathways between socio-economic status, school performance, gender attitudes and violence at home.
Methods: 1752 children were recruited into a cluster randomized controlled trial conducted on 40 fairly homogeneous public schools (20 for girls and 20 for boys), in Hyderabad, Pakistan. This was ranging from 20-65 children per school. All children were interviewed with questionnaires at baseline.
Results: Few children had no experience of peer violence in …

Diabetes In Sub-Saharan Africa: From Clinical Care To Health Policy., Rifat Atun, Justine I. Davies, Edwin A.M. Gal, Till Bärnighausen, David Beran, Andre Pascal Kengne, Naomi S. Levitt, Florence Mangugu, Moffat J. Nyirenda, Graham D. Ogle, Kaushik Ramaiya

Paediatrics and Child Health, East Africa

Rapid demographic, sociocultural, and economic transitions are driving increases in the risk and prevalence of diabetes and other non-communicable diseases (NCDs) in sub-Saharan Africa. The impacts of these transitions and their health and economic consequences are evident. Whereas, in 1990, the leading causes of death in sub-Saharan Africa were HIV/AIDS, lower respiratory infections, diarrhoeal diseases, malaria, and vaccine-preventable diseases in children, in more recent years, cardiovascular diseases and their risk factors are replacing infectious diseases as the leading causes of death in this region, and rates of increase of cardiovascular risk factors are predicted to be greater in sub-Saharan Africa …