Medicine and Health Sciences Commons^™

Antibiotics In Acute Calculous Cholecystitis : Do Tokyo Guidelines Influence The Surgeons’ Practices?, Hassaan Bari, Muhammad Rizwan Khan, Amir Hafeez Shariff, Amir Hafeez Shariff

Department of Surgery Docs

Abstract

OBJECTIVE:

To observe changes in surgeons' practice of antibiotic usage in patients with acute cholecystitis before and after the implementation of Tokyo Guidelines.

METHODS:

This retrospective, descriptive study was conducted at the Aga Khan University Hospital, Karachi, and comprised the medical records of all patients with the diagnosis of acute calculus cholecystitis who presented in 2009 and those who presented in 2014 after the implementation of Tokyo Guidelines. The major variables included patients' demographics, antibiotics used and surgical outcomes. SPSS 19 was used for data analysis.

RESULTS:

Of the 356 patients, 96(27%) were treated in 2009 and 260(73%) in …

Prevention Of Postpartum Haemorrhage By Community-Based Auxiliary Midwives In Hard-To-Reach Areas Of Myanmar: A Qualitative Inquiry Into Acceptability And Feasibility Of Task Shifting, Kyu Kyu Than, Yasmin Mohamed, Victoria Oliver, Theingi Myint, Thazin La, James G. Beeson, Stanley Luchters

Population Health, East Africa

Background: In Myanmar, postpartum haemorrhage is the leading cause of maternal mortality and contributes to around 30% of all maternal deaths. The World Health Organization recommends training and supporting auxiliary midwives to administer oral misoprostol for prevention of postpartum haemorrhage in resource-limited settings. However, use of misoprostol by auxiliary midwives has not formally been approved in Myanmar. Our study aimed to explore community and provider perspectives on the roles of auxiliary midwives and community-level provision of oral misoprostol by auxiliary midwives.

Methods: A qualitative inquiry was conducted in Ngape Township, Myanmar. A total of 15 focus group discussions with midwives, …

Unconditional Government Cash Transfers In Support Of Orphaned And Vulnerable Adolescents In Western Kenya: Is There An Association With Psychological Wellbeing?, Sylvia Shangani, Don Operario, Becky Genberg, Kipruto Kirwa, Miriam Midoun, Lukoye Atwoli, David Ayuku, Omar Gala ́Rraga, Paula Braitstein

Internal Medicine, East Africa

Background: Orphaned and vulnerable adolescents (OVA) in sub-Saharan Africa are at greater risk for adverse psychological outcomes compared with their non-OVA counterparts. Social interventions that provide cash transfers (CTs) have been shown to improve health outcomes among young people, but little is known about their impact on the psychological wellbeing of OVA.

Objective: Among OVA in western Kenya, we assessed the association between living in a household that received monthly unconditional government CTs and psychological wellbeing.

Methods: We examined the likelihood of depression, anxiety, post-traumatic stress symptoms (PTSS) and positive future outlook among 655 OVA aged between 10 and 18 …

Comparison Of Enteral Versus Intravenous Potassium Supplementation In Hypokalaemia In Paediatric Patients In Intensive Care Post Cardiac Surgery: Open-Label Randomised Equivalence Trial (Eips), Naveed Ur Rehman Siddiqui, Quratulain Merchant, Babar Hasan, Arjumand Rizvi, Muneer M Amanullah, Amina Rehmat, Anwarul Haque

Department of Surgery Docs

Objectives: The primary objective was to compare the efficacy of enteral potassium replacement (EPR) and intravenous potassium replacement (IVPR) as first-line therapy. Secondary objectives included comparison of adverse effects and number of doses required to resolve the episode of hypokalaemia.|
Trial design: The EIPS trial is designed as a randomised, equivalence trial between two treatment arms.
Study setting: The study was conducted at the paediatric cardiac intensive care unit (PCICU) at Aga Khan University Hospital, Karachi.
Participants: 41 patients (aged 1 month to 15years) who were admitted to PCICU post cardiac surgery were recruited (23 IVPR arm and 18 …

Nature, Scope And Use Of Economic Evaluation Of Healthcare Programmes: With Special Reference To Pakistan., Muhammad Ashar Malik, Saleem Perwaiz Iqbal, Farina Abrejo

Community Health Sciences

Economic evaluation (EE)/cost effectiveness analysis(CEA) of healthcare programmes is an emerging area, yet the resource base to apprehend EE/CEA is very limited in Pakistan. This paper attempts to fill this gap by providing a basic text in the field of EE with special reference to Pakistan. We used four dimensional criteria (available, relevant, complete and accurate) for reviewing the EE contents in the locally available textbooks and reading material on public health. We find CEA as core competency and skill of medical doctors in undergraduate medical curricula yet we could not find EE contents in the recommended textbooks. We find …

Did Contracting Effect The Use Of Primary Health Care Units In Pakistan?, Ashar Muhammad Malik, Ellen Van De Poel, Eddy Van Doorslaer

Community Health Sciences

For many years, Pakistan has had a wide network of Basic Health Units spread across the country, but their utilization by the population in rural and peri-urban areas has remained low. As of 2004, in an attempt to improve the utilization and performance of these public primary healthcare facilities, the government has gradually started contracting-in intergovernmental organizations to manage these BHUs. Using five nationally representative household surveys conducted between 2001 and 2012, and exploiting the gradual roll-out of this reform to apply a difference-in-difference approach, we evaluate its impact on BHU utilization. We find that contracting of the BHU management …

Clinical Characteristics And Outcome Of Budd-Chiari Syndrome At A Tertiary Care Hospital In Pakistan., Om Parkash, Aysha Khan, Saeed Hamid

Section of Gastroenterology

OBJECTIVE: To determine the clinical characteristics of Budd-Chiari syndrome (BCS), its causes and outcome at a tertiary care hospital.

STUDY DESIGN: An observational study

.PLACE AND DURATION OF STUDY: The Aga Khan University Hospital,Karachi, from 2004 to 2014.

METHODOLOGY: Aretrospective analysis of data was conducted. Apredesigned questionnaire was filled from medical records of patients with BCS. Clinical features, etiology, management and outcome was noted from 2004 to 2014. Descriptive statistics were determined.

RESULTS: Forty-five patients' charts were reviewed; 26 (57.8%) were male patients. The median (IQR) age at diagnosis was 26.0 (20.5 to 34.5) years. Primary BCS was seen in …

Knowledge And Awareness Regarding Cervical Cancer And Uptake Of Pap Smear Among Women In Karachi, Pakistan, Shama Razzaq, Sayeeda Amber Sayed Amber Sayeeda Amber Sayed, Sumera Aziz Ali

Community Health Sciences

Objective: To determine the knowledge regarding cervical cancer, its symptoms and risk factors among women of 18 years and above attending the gynecology OPD in two public hospitals Karachi, Pakistan.
Methodology: A cross-sectional survey was held from February to June 2013 in Karachi, Pakistan. 384 females aged 18 years and above attending gynecology clinics in two public sector hospitals were taken through non-probability sampling method. The knowledge was assessed using a point scale method which had binary response i.e. correct and incorrect. A score of 50% (≥ 11 correct responses) was considered as optimum knowledge.
Results: Overall knowledge of cervical …

Eliminating Wrong Blood Transfusions - Recent Advances, Farheen Karim, Salman Naseem Adil

Department of Pathology and Laboratory Medicine

No abstract provided.

Adaptation Of The Recent Life Changes Questionnaire (Rlcq) To Measure Stressful Life Events In Adults Residing In An Urban Megapolis In Pakistan, Azmina Artani, Shireen Shehzad, Iqbal Azam Syed, Moiz Abdul Sultan, Adeel Khoja, Ayeesha Kamran Kamal

Section of Neurology

Background: Contextually relevant stressful life events are integral to the quantification of stress. None such measures have been adapted for the Pakistani population.

Methods: The RLCQ developed by Richard Rahe measures stress of an individual through recording the experience of life changing events. We used qualitative methodology in order to identify contextually relevant stressors in an open ended format, using serial in-depth interviews until thematic saturation of reported stressful life events was achieved. In our next phase of adaptation, our objective was to scale each item on the questionnaire, so as to weigh each of these identified events, in terms …

Case Series Of Rare Interstitial Lung Disease (Ild)., Naveed Haroon Rashid, Saba Farooq, Mohammad Ahmed, Ali Bin Sarwar Zubairi

Department of Medicine

Pulmonary alveolar proteinosis (PAP) is a rare lung disease where periodic acid Schiff (PAS)-positive eosinophilic material accumulates in the alveoli of the lungs. Here we describe two cases of young males who presented with dynpnoea and weight loss. The HRCT scan of the chest in both cases showed the typical "crazy-paving" pattern and lung biopsies confirmed the diagnosis of PAP. They showed remarkable symptomatic improvement with therapeutic whole lung lavage.

Multidisciplinary Approach To The Prenatal Diagnosis And Post Natal Management Of A Large Suprasellar Arachnoid Cyst: A Case Report, Omar Irfan, Heera Nand Rathore, Sarfraz Karim, Shabina Ariff, Aneela Darbar

Medical College Documents

Arachnoid cysts are intra-arachnoid sacs filled with cerebrospinal fluid representing a rare occurence in neonates. We report the case of a suprasellar arachnoid cyst diagnosed prenatally at 21 weeks gestation on routine obstetric ultrasound. A cystic lesion was picked up incidentally at routine antenatal scan. The cyst was noted to be increasing in size over a series of radiological scans. The cyst was diagnosed as a suprasellar arachnoid cyst compressing the third ventricle and bilateral lateral ventricles. A left pteryonal craniotomy for cystocisternostomy of large suprasellar cyst was performed initially. Within a month the cyst recurred with clinical and radiological …

Development And Psychometric Testing Of An Instrument To Compare Career Choice Influences And Perceptions Of Nursing Among Healthcare Students, Sok Ying Liaw, Ling Ting Wu, Violeta Lopez, Yeow Leng Chow, Siriwan Lim, Eleanor Holroyd, Khoon Kiat Tan, Wenru Wang

School of Nursing & Midwifery, East Africa

Background: With the availability of more healthcare courses and an increased intake of nursing students, education institutions are facing challenges to attract school leavers to enter nursing courses. The comparison of career choice influences and perception of nursing among healthcare students can provide information for recruitment strategies. An instrument to compare the influences of healthcare career choice is lacking. The purpose of this study is to develop and evaluate the psychometric properties of an instrument to compare the influences of healthcare career choice with perceptions of nursing as a career choice.

Methods: The study was conducted in two phases. In …

Determinants Of Modern Contraceptive Use Among Sexually Active Men In Kenya, Rhoune Ochako, Marleen Temmerman, Mwende Mbondo, Ian Askew

Obstetrics and Gynaecology, East Africa

Background: Research in Kenya has focussed on family planning from women’s perspectives, with the aim of helping reduce the burden of unintended pregnancies. As such, the determinants of modern contraceptive use among sexually active women are well documented. However, the perspectives of men should be considered not only as women’s partners, but also as individuals with distinct reproductive histories and desires of their own. This study seeks to understand the determinants of modern contraceptive use among sexually active men, by exploring factors that are correlated with modern contraceptive use.

Methods: The data source is the nationally representative 2014 Kenya Demographic …

Manual Trans-Tracheal High Frequency Positive Pressure Ventilation For Left Main Bronchus And Carinal Mass Surgical Resection In A Child, Mohammad Irfan Akhtar, Faisal Junejo, Hamid Iqil Naqvi, Mohammad Hamid

Department of Anaesthesia

Inflammatory myofibroblastic tumor (IMT), also called pseudo-tumor, is a very rare condition and accounts for less than 1% of primary lung tumor. It is most common benign tumor of lung in children. This case is reported with the objective of highlighting the role of manual trans-tracheal high frequency positive pressure ventilation (HFPPV) in facilitating surgical resection with maintenance of adequate oxygenation and a little compromised ventilation. A 9-year boy, weighing 21 kg, was diagnosed as a case of IMT of left main bronchus on biopsy and was successfully treated by surgical excision through left thoracotomy. HFPPV through improvised technique was …

Governing Multisectoral Action For Health In Low- And Middle-Income Countries, Kumanan Rasanathan, Sara Bennett, Vincent Atkins, Robert Beschel, Gabriel Carrasquilla, Jodi Charles, Rajib Dasgupta, Kirk Emerson, Douglas Glandon, Churnrurtai Kanchanachitra, Shehla Zaidi

Community Health Sciences

No abstract provided.

Primary Adrenal Non-Hodgkin Lymphoma: A Case Report And Review Of The Literature, Nanik Ram, Owais Rashid, Saad Farooq, Imran Ulhaq, Najmul Islam

Section of Diabetes, Endocrinology and Metabolism

Background: Lymphomas are cancers that arise from the white blood cells and have been traditionally divided into two large subtypes: Hodgkin and non-Hodgkin lymphoma. B-cell lymphoma is the most common subtype of non-Hodgkin lymphoma; almost 85% of patients with lymphoma have this variant. Lymphomas can potentially arise from any lymphoid tissue located in the body; however, primary adrenal non-Hodgkin lymphoma is extremely rare. We report the history, examination findings, and laboratory results of a 50-year-old man diagnosed with a primary left adrenal diffuse large B-cell lymphoma.

CASE PRESENTATION: A 50-year-old Pakistani man presented to our hospital with progressively increasing pain …

Unmet Need For Surgery In South Asia, Sanjay Nagral, Maharra Hussain, Sarder A. Nayeem, Ranjan Dias, S. Ather Enam, Samiran Nundy

Section of Neurosurgery

No abstract provided.

Raising Taxes Key To Accelerate Tobacco Control In South Asia, Prabhat Jha, Javaid Khan, Sujata Mishra, Prakash Gupta

Section of Pulmonary & Critical Care

No abstract provided.

Diabetes, Cardiovascular Disease, And Chronic Kidney Disease In South Asia: Current Status And Future Directions, Anoop Misra, Nikhil Tandon, Shah Ebrahim, Naveed Sattar, Dewan Alam, Usha Shrivastava, K M Venkat Narayan, Tazeen H. Jafar

Section of Pulmonary & Critical Care

No abstract provided.

Mental Illness And Injuries: Emerging Health Challenges Of Urbanisation In South Asia, Devaki Nambiar, Junaid Razzak, Kaosar Afsana, Alayne M. Adams, Arif Hasan, Dinesh Mohan, Vikram Patel

Department of Emergency Medicine

No abstract provided.

On The Brink Of Conflict: The People Of South Asia Deserve Better, Zulfiqar Ahmed Bhutta, Samiran Nundy

Department of Paediatrics and Child Health

No abstract provided.

Expanding Access To Healthcare In South Asia, Shehla Zaidi, Prasanna Saligram, Syed Ahmed, Egbert Sonderp, Kabir Sheikh

Community Health Sciences

No abstract provided.

Progress In Maternal And Child Health: How Has South Asia Fared?, Nadia Akseer, Mahdis Kamali, Shams E. Arifeen, Ashar Muhammad Malik, Zaid Ahmad Bhatti, Naveen Thacker, Mahesh Maksey, Harendra D’Silva, Inacio Cm Da Silva, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

No abstract provided.

Conflict In South Asia And Its Impact On Health, Siddarth David, Rukhsana Gazi, Mohammed Shafiq Mirzazada, Chesmal Siriwardhana, Sajid Bashir Soofi, Nobhojit Roy

Department of Paediatrics and Child Health

South Asia has a large population affected by different types of protracted conflict and can provide critical insights to understand health challenges in conflict zones.
Health systems in conflict affected areas should prioritise domestic and gender-based violence, along with reproductive and sexual health services.
Mental health and psychosocial services for conflict-affected populations in South Asia need to be strengthened, and these services should be integrated into existing primary care platforms.
Building the capacity of the existing healthcare system and developing a trained local workforce can improve the access to and availability and acceptability of health services in conflict-affected communities.
Research …

Impact Of Maternal Respiratory Infections On Low Birth Weight - A Community Based Longitudinal Study In An Urban Setting In Pakistan, Asad Ali, Umber Zaman, Sadia Mahmud, Gul-E-Shehwar Zahid, Momin Kazi, William A. Petri, Zulfiqar Bhutta, Anita Zaidi, Molly A. Hughes

Department of Paediatrics and Child Health

Background: The health of mothers and their newborns is intricately related. The weight of the infant at birth is a powerful predictor of infant growth and survival, and is considered to be partly dependent on maternal health and nutrition during pregnancy. We conducted a longitudinal study in an urban community within Karachi to determine maternal predictors of newborn birth weight.Methods: Four hundred pregnant women were enrolled in the study during the period 2011-2013. Data related to symptoms of acute respiratory illness (fever, cough, difficulty breathing, runny nose, sore throat, headache, chills, and myalgia/lethargy) in the pregnant women were collected weekly …

Noninvasive Monitoring Intracranial Pressure - A Review Of Available Modalities, Marium Naveed Khan, Hussain Shallwani, Muhammad Ulusyar Khan, Muhammad Shahzad Shamim

Section of Neurosurgery

Background: Intracranial pressure (ICP) monitoring is important in many neurosurgical and neurological patients. The gold standard for monitoring ICP, however, is via an invasive procedure resulting in the placement of an intraventricular catheter, which is associated with many risks. Several noninvasive ICP monitoring techniques have been examined with the hope to replace the invasive techniques. The goal of this paper is to provide an overview of all modalities that have been used for noninvasive ICP monitoring to date.
Methods: A thorough literature search was conducted on PubMed, selected articles were reviewed in completion, and pertinent data was included in the …

Perioperative Steroids For Lumbar Disc Surgery: A Meta-Analysis Of Randomized Controlled Trials, Muhammad Waqas, Hussain Shallwani, Muhammad Shahzad Shamim, Khabir Ahmed

Department of Surgery Docs

Background: Our review question was "Does perioperative steroids administration, in comparison with other treatments or placebo, improve either postoperative pain control, length of hospital stay, or return to work in patients undergoing lumbar disc surgery?"
Methods: We searched PubMed, CINAHL PLUS, and Cochrane databases for randomized control trials (RCTs) studying the role of steroids for lumbar disc surgery. Studies that compared perioperative steroids with other treatments or placebo were included. Study outcomes included postoperative back pain, leg pain, length of hospital stay, and return to work. Data was extracted through a proforma. Means and mean differences were calculated for continuous …

Road Traffic Crash Related Injured And Fatal Victims In Karachi From 2007 To 2014: A Time-Series Analysis, Rashid Jooma, Masood Ali Shaikh

Section of Neurosurgery

Injuries and deaths due to road traffic crashes (RTC) are major public health concern. The Road Traffic Injury Research and Prevention Center, collects RTC data on injuries and fatalities from five emergency departments in Karachi. Data generating process (DGP) for RTC from 2007 to 2014, for monthly number of fatal and injured victims were analyzed using autoregressive integrated moving average and vector auto regression, time series models. Results provide strong evidence that the DGP for the current levels of the number of fatalities and injured owing to RTCs are significantly influenced by the own past history of the two series. …

Palliative Care: An Alien Concept In Pakistan, Nadia Pyarali Mulji, Sumaira Sachwani

School of Nursing & Midwifery

Every living being has to die. Respecting a dying individual’s personal values and preferences is a challenge. We live in a culture where family decisions are given priority over individual’s wish. To address this challenge, a concept of palliative or comfort care is newly introduced in Pakistan. Palliative care is a multidisciplinary specialty that emphases on prevention and relieving suffering as well as supporting the optimal quality of life of patients and their families (Bailey, Harman, Bruera, Arnold, & Savarese,2014). In Pakistan, the concept of palliative care is like a newborn baby who needs a lot of ethical attention in …