Medicine and Health Sciences Commons^™

Central Nervous System Tuberculosis In Children, Tipu Sultan

Pakistan Journal of Neurological Sciences (PJNS)

Brain and spinal cord tuberculosis are one of the commonest neurological infection in developing countries. Its associated with high morbidity and mortality. Diagnosis is based on clinical features, cerebrospinal fluid and brain imaging. Combination of antituberculous drugs should be started as early as possible to prevent the complications. The patient's clinical stage at presentation is the most important prognostic factor. Surgical procedures are directed at management of the hydrocephalus. Focal lesions, intracranial tuberculomas, and tuberculous abscesses, are usually located in cerebral or cerebellar hemispheres, uncommonly in brainstem and very rarely in spinal cord. They do not usually require surgical intervention …

Giant Ganglioneuroma In A 5-Year Child, Hamza Abdur Rahim Khan, Fazal Wahab Khan, Saulat H. Fatimi

Department of Surgery Docs

ABSTRACT We report a 5-year boy presenting with pain in the lower chest and upper abdomen. On evaluation with computed tomography scan of the chest, he was found to have a large 16 x 14 cm posterior mediastinal mass compressing the inferior vena cava and liver, and shifting the heart to the opposite side. Tumor was approached via right postero-lateral thoracotomy and dissected off from esophagus, heart, inferior vena cava and lungs. The entire tumor was resected without any complications. Postoperative course was unremarkable. Resection of the tumor was successful. The histopathology showed it to be giant ganglioneuroma with no …

Evaluation Of The Parasight Platform For Malaria Diagnosis, Yochay Eshel, Arnon Houri-Yafin, Hagai Benkuzari, Natalie Lezmy, Mamta Soni, Malini Charles, Jayanthi Swaminathan, Hilda Solomon, Pavithra Sampathkumar, Zul Premji, Caroline Mbithi, Zaitun Nneka, Simon Onsongo, Daniel Maina, Sarah Levy-Schreier, Caitlin Lee Cohen, Dan Gluck, Joseph Joel Pollak, Seth J. Salpeter

Pathology, East Africa

The World Health Organization estimates that nearly 500 million malaria tests are performed annually. While microscopy and rapid diagnostic tests (RDTs) are the main diagnostic approaches, no single method is inexpensive, rapid, and highly accurate. Two recent studies from our group have demonstrated a prototype computer vision platform that meets those needs. Here we present the results from two clinical studies on the commercially available version of this technology, the Sight Diagnostics Parasight platform, which provides malaria diagnosis, species identification, and parasite quantification. We conducted a multisite trial in Chennai, India (Apollo Hospital [n = 205]), and Nairobi, Kenya …

Anaesthetic Management In A Child With Goldenhar Syndrome, Waqas Ahmed Khan, Bushra Salim, Ausaf Ahmed Khan, Shakaib Chughtai

Department of Anaesthesia

Goldenhar syndrome is a congenital disorder involving deformities of the face. It usually affects one side of the face only and poses significant challenges in the airway management. We herein, report an 8-year boy, known case of Goldenhar syndrome, who presented to our radiology suite for a magnetic resonance imaging (MRI) brain, followed by a computed tomography (CT) scan brain. The boy had various features of Goldenhar syndrome, e.g. cleft palate, absent right eye and ear, right mandibular hypoplasia, micrognathia, and preauricular tags. His developmental milestones were delayed. Airway evaluation showed Mallampati class II with limited movements of head and …

Another Approach For Prone Positioning Under General Anaesthesia, Dileep Kumar, Mohammad Hamid, Kelash Kumar

Department of Anaesthesia

No abstract provided.

Physical Manipulation Of Larynx As A Technique For Insertion Of Nasogastric Tube, Sheema Siraj, Mehmood Mian, Fauzia Anis Khan

Department of Anaesthesia

No abstract provided.

Distribution Of Gastric Carcinoma In An Area With A High Prevalence Of Helicobacter Pylori., Javed Yakoob, Syeda Sadia Fatima, Z Abbas, Syed Farrukh Mustafa, Hamza Abdur Rahim Khan, Muhammad Faraz Raghib, Safia Awan, Zubair Ahmad

Section of Gastroenterology

BACKGROUND/AIMS:

South Asia is an enigma for gastric cancer (GC) because it is a low risk region with a high prevalence of Helicobacter pylori (H. pylori) infections. We evaluated the trend of GC clinical presentation and risk factors in patients with dyspeptic symptoms.

MATERIALS AND METHODS:

The medical records of patients, coded by the international classification of diseases (ICD-10-CM, 2015, Diagnosis Code C16.9) for malignancies of stomach diagnosed by esophagogastroduodenoscopy (EGD) and histopathology, were studied.

RESULTS:

394 GC cases with a mean age of 54±15 years, range of 18 to 88, were analyzed. 256 (65%) were male. Distal non-cardiac and …

Tobacco Control Environment: Cross-Sectional Survey Of Policy Implementation, Social Unacceptability, Knowledge Of Tobacco Health Harms And Relationship To Quit Ratio In 17 Low-Income, Middle-Income And High-Income Countries., Clara K. Chow, Daniel J. Corsi, Anna B. Gilmore, Annamarie Kruger, Ehimario Igumbor, Jephat Chifamba, Wang Yang, Li Wei, Romaina Iqbal, Prem Mony, Rajeev Gupta, Krishnapillai Vijayakumar, V Mohan, Rajesh Kumar, Omar Rahman, Khalid Yusoff, Noorhassim Ismail, Katarzyna Zatonska, Yuksel Altuntas, Annika Rosengren, Ahmad Bahonar, Afzal Hussein Yusufali, Gilles Dagenais, Scott Lear, Rafael Diaz, Alvaro Avezum, Patricio Lopez-Jaramillo, Fernando Lanas, Sumathy Rangarajan, Koon Teo, Martin Mckee, Salim Yusuf

Community Health Sciences

OBJECTIVES:

This study examines in a cross-sectional study 'the tobacco control environment' including tobacco policy implementation and its association with quit ratio.

SETTING:

545 communities from 17 high-income, upper-middle, low-middle and low-income countries (HIC, UMIC, LMIC, LIC) involved in the Environmental Profile of a Community's Health (EPOCH) study from 2009 to 2014.

PARTICIPANTS:

Community audits and surveys of adults (35-70 years, n=12 953).

PRIMARY AND SECONDARY OUTCOME MEASURES:

Summary scores of tobacco policy implementation (cost and availability of cigarettes, tobacco advertising, antismoking signage), social unacceptability and knowledge were associated with quit ratios (former vs ever smokers) using multilevel logistic regression …

Homocysteine As A Biomarker For Thrombosis: What Is The Learning Curve?, Bushra Moiz

Department of Pathology and Laboratory Medicine

No abstract provided.

Frequency Of Worsening Liver Function In Severe Dengue Hepatitis Patients Receiving Paracetamol: A Retrospective Analysis Of Hospital Data., Ahsan Ali Syed, Faisal Aslam, Haris Hakeem, Faraz Siddiqui, Noreen Nasir

Department of Medicine

Objective: To determine the frequency of worsening liver function among hospital in-patients with severe dengue hepatitis receiving paracetamol.

Methods: This retrospective study was conducted at the Department of Medicine, Aga Khan University Hospital, Karachi, and comprised records of dengue patients with severe hepatitis who received paracetamol for control of fever between June 2007 and December 2014. Alanine aminotransferase at baseline and following paracetamol administration was noted, as well as dosage and duration of paracetamol, along with participants' demographic details. Frequency of patients who developed worsening or improvement of alanine aminotransferase was also noted. SPSS 19 was used for data analysis. …

Validation Of Bioelectrical Impedance Analysis For Assessing Dry Weight Of Dialysis Patients In Pakistan, Huma Asmat, Romaina Iqbal, Fatima Sharif, Aamer Mahmood, Aamir Abbas, Waqar Kashif

Department of Medicine

Accurate dry weight estimation (DW) to achieve euvolemia is one of the key objectives of hemodialysis (HD). While conventionally DW is estimated by clinical examination, bioelectrical impedance analysis (BIA) has been proposed as an objective method to determine DW and has been tested extensively in the Western population. We aim to validate BIA for determining DW in a Pakistani population against the conventional clinician's method. This is a single-center validation study conducted at two outpatient HD units of Aga Khan Hospital, Karachi. One hundred and forty-eight DW readings of patients who were on maintenance HD were taken both by BIA …

Incidental Metastatic Mediastinal Atypical Carcinoid In A Patient With Parathyroid Adenoma: A Case Report., Zareen Kiran,, Asma Ahmed, Owais Rashid, Saira Fatima, Faizan Malik, Saulat H. Fatimi, Mubasher Ikram

Department of Medicine

Background: Atypical carcinoid arising from the mediastinal tissue is a rare neuroendocrine tumor and an association with parathyroid adenoma is very unusual. We report an unusual case of atypical carcinoid of mediastinum with metastasis in a patient presenting with parathyroid adenoma, which is the first case to be reported from Pakistan.

Case presentation: A 51-year-old Pakistani man was seen in postoperative intensive care after right parathyroidectomy and mediastinal mass resection for the management of postoperative hypocalcaemia. He had a background history of dyspnea. Examination was unremarkable. Preoperative laboratory evaluation revealed a calcium level of 12.7 mg/dl, phosphate of 1.9 mg/dl, …

Emerging Protagonists In Cancer Metastasis: An Oath Of Allegiance By Platelets, Akbar Shoukat Ali, Arzoo Ajaz, Heeba Hamid

Department of Anaesthesia

No abstract provided.

Anemia In Children With Palmar Pallor Aged 02 Months To 05 Years, Saroop Chand, Farzana Shaikh, Chetan Das, Yasmeen Memon, Mohammad Akbar Nizamani, Zulfiqar Ali Qutrio Baloch

Department of Paediatrics and Child Health

Objective:
To determine the frequency of anemia in children with palmar pallor aged 02 months to 05 years.
Patients and Methods:
This cross sectional descriptive study of six months (01-12-2012 to 31-05-2013) was conducted in the department of paediatrics at Liaquat University Hospital Hyderabad. All the children, from 02 months to 05 years, of either gender had palmar pallor on examination were recruited and evaluated for anemia by assessing the level of haemoglobin and categorized anemia as mild, moderate and severe. The data was analyzed in SPSS version 16.00, the frequency and percentage was calculated. The chi-square test was applied …

Utilization Of Health Services In A Resource-Limited Rural Area In Kenya: Prevalence And Associated Household-Level Factors, Anthony Ngugi, Felix Agoi, Megan R. Mahoney, Amyn Lakhani, David Mang’Ong’O, Esther Nderitu, Robert Armstrong, Sarah Macfarlane

Faculty of Health Sciences, East Africa

Background: Knowledge of utilization of health services and asso- ciated factors is important in planning and delivery of interventions to improve health services coverage. This knowledge is however limited in many developing countries. We determined the preva- lence and factors associated with health services utilization in a rural area of Kenya. Our findings inform the local health management in development of appropriately targeted interventions.

Methods: Design: Cluster sample survey. Population: Residents of Kaloleni sub-County in Kenya.

Participants/respondents: Household key informants. Outcomes: (i) History of illness for household members and (ii) health services utilization in the preceding month, (iii) factors associated …

Preventive Gabapentin Versus Pregabalin To Decrease Postoperative Pain After Lumbar Microdiscectomy: A Randomized Controlled Trial, Mohsin Qadeer, Muhammad Waqas, Muhammad Jawad Rashid, Ather Enam, Salman Sharif, Ghulam Murtaza

Section of Neurosurgery

Study design: Randomized controlled trial.
Purpose: The purpose of this study was to compare pregabalin and gabapentin for mean postoperative visual analog score (VAS) for pain in patients undergoing single-level lumbar microdiscectomy for intervertebral disc prolapse at a tertiary care hospital.
Overview of literature: Pregabalin has a superior pharmacokinetic profile and analgesic effect at lower doses than gabapentin; however, analgesic efficacy must be established during the perioperative period after lumbar spine surgery.
Methods: This randomized controlled trial was carried out at our institute from February to October 2011 on 78 patients, with 39 participants in each study group. Patients undergoing …

Mental Health Of African Asylum-Seekers And Refugees In Hong Kong: Using The Social Determinants Of Health Framework, William Chi Wai Wong, Sealing Cheung, Heidi Yin Hai Miu, Julie Chen, Kelley Ann Loper, Eleanor Holroyd

School of Nursing & Midwifery, East Africa

Background: Hong Kong is non-signatory to the 1951 Refugee Convention and its 1967 Protocol, and has no systematic domestic policies committed to the rights of asylum-seekers and refugees (ASRs). This creates a tenuous setting for African ASRs there. This study explored how mapped social determinates of health has impacted the mental health and wellbeing of African ASR’s in Hong Kong.

Methods: A cross-sectional survey was carried out with 374 African ASRs. The survey comprised of: (a) sociodemographics; (b) health status; (c) health behaviours; and, (d) social experiences. Associations between social determinants of health and depression screen were explored and multivariable …

Infection Control In Labor And Delivery Room, Learning From The Small Hospital Based Project, Savera Aziz Ali, Sumera Aziz Ali

School of Nursing & Midwifery

Background: It has been estimated that around 36% of the neonatal deaths occur due to infection in the lower and middle income countries. Infection control is a more substantial area of concern, particularly in Labor and delivery room. Multiple factors can cause infection in the labor room, therefore it is important to assess various factors of maternal and neonatal infection. Hence we explored multiple factors through this project and developed the action plan to address those factors effectively.
Methods: During our Leadership and Management course, we conducted a project in Labor room pertaining to a prevalent issue. The whole process …

Creating Enabling Environment For Student Engagement: Faculty Practices Of Critical Thinking, Shanaz Hussein Cassum, Raisa B. Gul

School of Nursing & Midwifery

Critical thinking (CT) is considered an important attribute in practice disciplines and faculty members in nursing, medicine, and education are expected to facilitate the development of CT in their graduates so that these individuals can be critical, reflective, competent, and caring professionals and service providers (Distler, 2007; Shiau & Chen, 2008; Worell & Profetto-McGrath, 2007). When students are actively engaged in their learning, and classrooms have an enabling environment, critical thinking is promoted. Teachers must reflect upon their teaching pedagogy when students do not participate in stimulating discussions, or asks questions in class. Research suggests that lack of understanding of …

Assessment Of Childhood Domestic Injuries Among Joint And Nuclear Families Of Karachi, Asif Khaliq, Amreen Rao, Shahroz Siddiqui, Ghulam Mujtaba Nasir

Department of Biological & Biomedical Sciences

To assess the frequencies and factors of domestic injuries among children aged less than 5 years. This is a cross sectional study, in which parents who have child less than 5 years of age were targeted. A total of 246 participants had provided satisfactory information and they were approached by non-probability purposive sampling technique from January 2016 to June 2016. The data was entered in Excel and then imported to SPSS 19.0 for inferential analysis. In this study, 89.8% (n = 221) mothers and 10.2% (n = 25) father who had participated. 52.08% (n = 123) parents were from joint …

18fdg Pet/Ct: A Sensitive Tool That Needs Better Users' Understanding, Maseeh Uz Zaman, Nosheen Fatima

Department of Radiology

No abstract provided.

Comparison Of The Effectiveness Of Zinc Supplementation In Tablets Form With That Of The Suspension Form In The Treatment Of Acute Diarrhoea, Sarwat Urooj, Hafeez Ullah Memon, Yasmeen Memon, Bibi Shazia Ali

Department of Paediatrics and Child Health

Objective: To compare the effectiveness of zinc supplementation in tablet form with that of the suspension form in the treatment of acute diarrhoea.Methods: A comparative study was carried out at the Liaquat University Hospital, Hyderabad, Pakistan from October 2008 to April 2009, and comprised children aged6-24 months suffering from acute diarrhoea. The patients were divided into two groups on the basis of even and odd numbers. Group A (even numbers) received dispersible zinc tablets, and group B (odd numbers) received zinc suspension. The patients were admitted for 3 days and improvement was checked at the end of 3rd day in …

Tailored Metabolic Workup For Urolithiasis – The Debate Continues, Hammad Ather, Imran Siddiqui, Tahmeena Siddiqui, M Nasir Sulaiman

Department of Surgery Docs

Abstract

Urolithiasis is one of the commonest afflictions of the urinary tract. Stones are of various chemical compositions, some share some common etiology; but most are specific to the structure and composition of stone. In view of highly recurrent nature of this condition, it is logical to have strategies for prevention. However, due to multiple factors most patients receive no or fragmented information on prevention. The current controversy is to the extent of metabolic workup in adult first time stone former. This requires longitudinal studies to show benefit in prevention strategies. Patients at high risk can have recurrence in weeks …

Hepatitis C Virus Seroprevalence In The General Female Population Of 9 Countries In Europe, Asia And Africa, Gary M. Clifford, Tim Waterboer, Bolormaa Dondog, You Lin Qiao, Dimitri Kordzaia, Doudja Hammouda, Namory Keita, , Nahid Khodakarami, Syed Ahsan Ali, Ang Tshering Sherpa, Witold Zatonski

Department of Surgery Docs

Abstract

BACKGROUND:

New oral treatments with very high cure rates have the potential to revolutionize global management of hepatitis C virus (HCV), but population-based data on HCV infection are missing in many low and middle-income countries (LMIC).

METHODS:

Between 2004 and 2009, dried blood spots were collected from age-stratified female population samples of 9 countries: China, Mongolia, Poland, Guinea, Nepal, Pakistan, Algeria, Georgia and Iran. HCV antibodies were detected by a multiplex serology assay using bead-based technology.

RESULTS:

Crude HCV prevalence ranged from 17.4% in Mongolia to 0.0% in Iran. In a pooled model adjusted by age and country, in …

Hookworm Infestation As A Cause Of Melena And Severe Anaemia In Farmer, Marvi Tariq, Syeda Maria Muzammil, Fareed Ahmed Sheikh, K. M. Inam Pal

Department of Surgery Docs

Abstract

Hookworm infections remain a major cause of morbidity in the developing world. Prevalence is highest in agricultural areas, where use of waste water for irrigation and poor hygiene increases infection rates among farmers. Infections present with gastrointestinal symptoms and chronic anaemia, and there are usually no signs of overt blood loss.
The following report describes a case of melena in a middle-aged farmer, where the diagnosis of hookworm infestation was delayed due to the unusual presentation. The patient underwent multiple blood transfusions before referral to the Aga Khan University Hospital (AKUH), Karachi and was managed conservatively with mebendazole at …

Superior Septal Approach Versus Left Atrial Approach For Mitral Valve Replacement: A Retrospective Cohort Study, Tooba Ansar, Taimur Asif Ali, Saneeha Shahid, Saulat H. Fatimi, Ghulam Murtaza

Department of Surgery Docs

Abstract

OBJECTIVE:

To compare the outcomes of superior septal approach and left atrial approach for mitral valve replacement.

METHODS:

This retrospective cohort study was conducted at the Aga Khan University Hospital, Karachi, and comprised records of patients who had undergone isolated mitral valve replacement from May 2003 to April 2012. Cases were reviewed for the outcomes [primary: loss of normal sinus rhythm; secondary: complications, residual defect and mortality]. Patients with prior history of dysrhythmia, low ejection fraction (<30%), emergency/redo mitral valve replacement and concomitant coronary artery bypass grafting were excluded. SPSS 19 was used for data analysis.

RESULTS:

Of the 78 patients, 52(66.67%) were of superior septal approach and 26(33.33%) of left atrial approach. Both groups were comparable for …

Itopride For Gastric Volume, Gastric Emptying And Drinking Capacity In Functional Dyspepsia, Shahab Abid, Wasim Jafri, Maseeh Uz Zaman, Rakhshanda Bilal, Safia Awan, Aamir Abbas

Section of Gastroenterology

AIM: To study the effect of itopride on gastric accommodation, gastric emptying and drinking capacity in functional dyspepsia (FD).

Methods: Randomized controlled trial was conducted to check the effect of itopride on gastric accommodation, gastric emptying, capacityof tolerating nutrient liquid and symptoms of FD. We recruited a total of 31 patients having FD on the basis of ROME III criteria. After randomization, itopride was received by 15 patients while 16 patients received placebo. Gastric accommodation was determined using Gastric Scintigraphy. ¹³C labeled octanoic breadth test was performed to assess gastric emptying. Capacity of tolerating nutrient liquid drink …

Coping Styles And Depression Among Patients With Solid Organ Cancers Attending Two Tertiary Care Hospitals Of Karachi: A Cross Sectional Study., Khadija Vadsaria, Adnan Jabbar, Iqbal Azam Syed, Sameera Rizvi, Ghulam Haider, Haider Naqvi

Community Health Sciences

Cancer undoubtedly affects patients in all aspects. Cancer diagnosis is a stressful event and coping is the primary mechanism used to adjust and counteract the stress. This study aims to assess the coping styles and prevalence of depression among solid organ cancer patients during treatment phase, attending two tertiary care hospitals of Karachi. A cross-sectional survey was conducted among solid organ cancer patients at Aga Khan University Hospital and Jinnah Post Graduate Medical Center. Coping and depression were assessed by Brief COPE and Self Reporting Questionnaire (SRQ) 20 respectively. Purposive sampling technique was used to recruit 488 patients. Coping styles …

Re-Structuring University Hospital’S Internship Program Using Kern’S Six-Step Model Of Instructional Design, M. Tariq, Muhammad Shahzad Shamim, Amna Subhan Butt, Sana Saeed, Zia Ur Rehman, Barkat Virani, Asghar Ashraf, Irum Qamar, Farah Qamar, Raheela Mohsin Rizvi, Swaleha Tariq, Qurratulain Naeem

Department of Surgery Docs

Abstract Background: Internship is a phase of training wherein a graduate learns in the context of practice, acquiring skills under supervision so that he/she may become capable of functioning independently. We are reporting the process of curriculum restructuring for strengthening the Internship Program at this university hospital. Methodology: We used Kerns’ six-step model to evaluate and restructure the internship curriculum. Step 01: Problem Identification & General need assessment- Thorough literature review revealed Internship as the crucial year of training that needs to be fashioned around the competencies required to make good doctors

Multilevel Modeling Of Binary Outcomes With Three-Level Complex Health Survey Data., Shafquat Rozi, Sadia Mahmud, Gillian Lancaster, Wilbur Hadden, Gregory Pappas

Community Health Sciences

Complex survey designs often involve unequal selection probabilities of clus-ters or units within clusters. When estimating models for complex survey data, scaled weights are incorporated into the likelihood, producing a pseudo likeli-hood. In a 3-level weighted analysis for a binary outcome, we implemented two methods for scaling the sampling weights in the National Health Survey of Pa-kistan (NHSP). For NHSP with health care utilization as a binary outcome we found age, gender, household (HH) goods, urban/rural status, community de-velopment index, province and marital status as significant predictors of health care utilization (p-value < 0.05). The variance of the random intercepts using scaling method 1 is estimated as 0.0961 (standard error 0.0339) for PSU level, and 0.2726 (standard error 0.0995) for household level respectively. Both esti-mates are significantly different from zero (p-value < 0.05) and indicate consid-erable heterogeneity in health care utilization with respect to households and PSUs. The results of the NHSP data analysis showed that all three analyses, weighted (two scaling methods) and un-weighted, converged to almost identical results with few exceptions. This may have occurred because of the large num-ber of 3rd and 2nd level clusters and relatively small ICC. We performed a sim-ulation study to assess the effect of varying prevalence and intra-class correla-tion coefficients (ICCs) on bias of fixed effect parameters and variance components of a multilevel pseudo maximum likelihood (weighted) analysis. The simulation results showed that the performance of the scaled weighted estimators is satisfactory for both scaling methods. Incorporating simulation into the analysis of complex multilevel surveys allows the integrity of the results to be tested and is recommended as good practice.