Medicine and Health Sciences Commons^™

Childhood And Adolescent Obesity: Primary Health Care Physicians’ Perspectives From Riyadh, Saudi Arabia, Faiza Nasser Alotaibi, Majeedah Alotaibi, Shiakhah Alanazi, Hanan Al-Gethami, Deemah Alateeq, Rowaydah Mishiddi, Amna Rehana Siddiqui

Community Health Sciences

BACKGROUND & OBJECTIVES:

Primary health care (PHC) physicians are foremost to confront childhood and adolescent obesity. Our objective was to evaluate PHC Physicians perspectives for managing overweight/obesity in children and adolescents.

METHODS:

PHC services from eight public hospitals in Riyadh participated. A self-administered tool maintaining anonymity evaluated facilitators and barriers for managing overweight/obese children and adolescent patients. Physicians who 'always' recommended weight management for an overweight / obese patient during past year, by involving patient, parents, and others were classified as having positive and appropriate practice.

RESULTS:

Of the 58 respondents, 51.7% had appropriate practices. Lack of patient motivation (82.2%), …

Validation Of Respiratory Questionnaire For Lung Function Assessment Among An Occupational Group Of Textile Workers In Pakistan, Tanzil Jamali, Asaad Ahmed Nafees

Community Health Sciences

Objective: To determine the association of spirometric lung pattern with respiratory symptoms and to validate the American Thoracic Society respiratory questionnaire for lung function assessment among textile workers.
Methods: This cross-sectional survey was conducted from August to December 2009 among adult textile workers of Karachi. Data was collected through the American Thoracic Society Division of Lung Disease respiratory questionnaire and the lung function was assessed by using a spirometer. Results of three acceptable readings of spirogram were recorded and the best of the three readings was used for analysis. SPSS 19 was used for data analysis.
Results: There were 372 …

Coinfection With Lichtheimia Corymbifera And Aspergillus Flavus In An Immune-Competent Patient Mimicking As Pulmonary-Renal Syndrome, Ali Bin Sarwar Zubairi, Farah Idress, Kauser Jabeen, Saima Kamal, Afia Zafar

Department of Medicine

Lichtheimia corymbifera and Aspergillus flavus pulmonary coinfection has been rarely reported in immune-competent patients. We report case of a young male who presented with clinical features of pulmonary-renal syndrome and was later diagnosed to have bilateral polymicrobial fungal lung infection.

Barriers And Perceptions Regarding Code Status Discussion With Families Of Critically Ill Patients In A Tertiary Care Hospital Of A Developing Country: A Cross-Sectional Study, Ahsan A. Syed, Aysha Almas, Quratulain Naeem, Umer F. Malik, M. Tariq

Department of Medicine

Background: In Asian societies including Pakistan, a complex background of illiteracy, different familial dynamics, lack of patient’s autonomy, religious beliefs, and financial constraints give new dimensions to code status discussion. Barriers faced by physicians during code status discussion in these societies are largely unknown.
Aim: To determine the barriers and perceptions in discussion of code status by physicians.
Design: Questionnaire-based cross-sectional study.
Setting and participants: This study was conducted in the Department of Medicine of The Aga Khan University Hospital, Karachi, Pakistan. A total of 134 physicians who had discussed at least five code statuses in their lifetime were included. …

Parental Perception And Childhood Obesity: Contributors To Incorrect Perception, Hiba Ashraf, Nida Ilyas Shamsi, Ruhma Ashraf

Medical College Documents

Objectives: To determine parental recognition of their child's weight, and to identify the contributing reasons for incorrect perception.

Method: This cross-sectional study was conducted from April to October 2010 at Aga Khan University Hospital, Karachi, and comprised parents of healthy children aged 5-14 years. An interviewer-based pre-tested questionnaire consisting of socio-demographic details, anthropometric measurements, and parental perception about their child's weight was administered. Data was analysed using SPSS 21. Both univariate and multivariate logistic regression were applied to assess for the risk factors associated with incorrect parental perception.

Results: Parents of a total of 330 eligible children …

Factors That Influence Advance Directives Completion Amongst Terminally Ill Patients At A Tertiary Hospital In Kenya, Stephen Omondi, John Weru, Asim Jamal, Gerald Yonga

Internal Medicine, East Africa

Background: An advance directive (AD) is a written or verbal document that legally stipulates a person’s health care preference while they are competent to make decisions for themselves and is used to guide decisions on lifesustaining treatment in the event that they become incapacitated. AD can take the form of a living will, a limitation of care document, a do-not-resuscitate order, or an appointment of a surrogate by durable power of attorney. The completion rate of AD varies from region to region, and it is influenced by multiple factors. The objectives of this study were to determine the proportion of …

Effect Of Puerperal Infections On Early Neonatal Mortality: A Secondary Analysis Of Six Demographic And Health Surveys, Saverio Bellizzi, Quique Bassat, Howard L. Sobel, Mohamed M. Ali, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Around 1.5 million annual neonatal deaths occur in the first week of life, and infections represent one of the major causes in developing countries. Neonatal sepsis is often strictly connected to infection of the maternal genital tract during labour.

Methods: The association between signs suggestive of puerperal infection and early neonatal mortality (life) was performed using Demographic and Health Surveys (DHS) data of six countries, conducted between 2010 and 2013. The population attributable fraction (PAF) was generated using the estimates on early neonatal mortality of a 1990-2013 systematic analysis for the Global Burden of Disease Study.

Results: Signs of …

Incidence Of Venous Thromboembolism In Cancer Patients Treated With Cisplatin Based Chemotherapy - A Cohort Study, Muhammad Nauman Zahir, Quratulain Shaikh, Munira Shabbir-Moosajee, Adnan Abdul Jabbar

Department of Radiation Oncology

Background: Cancer related thrombosis not only increases morbidity and mortality but also poses a significant financial burden on health care system. Risk of venous thromboembolism (VTE) in these patients substantially increases with the addition of chemotherapy. Lately, cisplatin has been implicated as an independent factor. There is little data estimating the risk of venous thromboembolism in patients receiving cisplatin based chemotherapy when compared to other chemotherapeutic agents.Methods: Patients who had received chemotherapy between November 2010 and October 2012 were retrospectively identified from a single institute cancer registry. 200 patients who had received cisplatin based chemotherapy were identified as the exposed …

Vaccine Coverage And Adherence To Epi Schedules In Eight Resource Poor Settings In The Mal-Ed Cohort Study, Christel Hoest, Jessica C. Seidman, Gwenyth Lee, James A. Platts-Mills, Syed Asad Ali, Maribel Paredes Olortegui, Pascal Bessong, Ram Chandyo, Sudhir Babji, Venkata Raghava Mohan

Department of Paediatrics and Child Health

Background: Launched in 1974, the Expanded Program on Immunization (EPI) is estimated to prevent two-three million deaths annually from polio, diphtheria, tuberculosis, pertussis, measles, and tetanus. Additional lives could be saved through better understanding what influences adherence to the EPI schedule in specific settings.
Methods: The Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) study followed cohorts in eight sites in South Asia, Africa, and South America and monitored vaccine receipt over the first two years of life for the children enrolled in the study. Vaccination histories were obtained …

Systemic Sclerosis: Clinical Manifestations, Anesthetic And Orthopedic Considerations In A Patient, Obada Hasan, Muneeba Jessar, Muhammad Ashar, Shahryar Noordin, Tashfeen Ahmad

Section of Orthopaedic Surgery

Introduction: Systemic sclerosis is a rare and progressive multisystem autoimmune disorder that is characterized pathologically by vascular abnormalities, connective tissue sclerosis and atrophy of skin and various internal organs (e.g., alimentary tract, lungs, heart, kidney, CNS), and autoantibodies. With an unknown etiology, Scleroderma is a complex polygenetic disease. A recent Genome Wide Association Study (GWAS) confirmed a strong association with the Major Histocompatibility Complex (MHC) and autoimmunity. We provide a case scenario along with a review of the systems involved and challenges physicians can face in dealing with this rare disease.
Case Presentation: Our patient, a known case of systemic …

Neurorobotics In Pakistan, Ather Enam, Muhammad Waqas

Section of Neurosurgery

No abstract provided.

Prevalence Of Non-Alcoholic Fatty Liver Disease In Overweight And Obese Children Seeking Ambulatory Health Services In Nairobi, Anne Njeri Mburu

Master of Medicine in Paediatrics and Child Health

Introduction: Non-alcoholic fatty liver disease is often an asymptomatic condition one of the leading causes of chronic liver disease and is associated with an increase in cardiovascular morbidity. Being overweight or obese has been positively linked to non-alcoholic fatty liver disease in children. There is evidence to show that when detected early, non-alcoholic fatty liver disease is reversible primarily upon institution of lifestyle changes targeted at weight reduction. Establishing the prevalence of non-alcoholic fatty liver disease in overweight and obese Kenyan children would serve as a benchmark for long term monitoring of associated morbidity and guide in public health policies …

Complication Rate And Diagnostic Yield Of Percutaneous Native Kidney Biopsies: A 10-Year Experience At A Tertiary Care Hospital In Pakistan, Sonia Yaqub, Nayla Ahmed, Urooj Fatima, Ayesha Maqbool, Waqar Ashif, Syed A. Hussain

Section of Nephrology

The use of an automated biopsy device, and real-time ultrasound for percutaneous kidney biopsies (PKBs) has improved the likelihood of obtaining adequate tissue for diagnosis and also has reduced the complications associated with the procedure. We aimed to determine the frequency and type of complications associated with PKB and to determine the diagnostic yield. It was a retrospective file-based review of cases who underwent PKB of native kidney between January 2003 and December 2013 at the Aga Khan University Hospital in Karachi, Pakistan. PKBs were performed by trained nephrologists or radiologists using an automated device with a 16/18-gauge needle under …

Quality Assurance Self-Assessment: A Catalyst At Aga Khan University, Tashmin Khamis, Khairunnisa Dhamani

Faculty of Health Sciences, East Africa

This article describes the establishment of the Aga Khan University’s Network of Quality Assurance and Improvement in promoting the principles of quality in its programmes. As an international university, the experiences and lessons learned have the potential to inform quality assurance and improvement in similar contexts. The authors reflect on past attempts to improve the quality of educational offerings, which were primarily traditional quality assurance audits. With the advent of the Inter-University Council for East Africa self-assessment process, the next generation of quality assurance and improvement was launched for the Aga Khan University programmes. They found the self-assessment process effective …

Reflections On An Innovative Mentoring Partnership Facilitators And Inhibitors To Success In Faculty Development, Tashmin Khamis, Marilyn Chapman

Faculty of Health Sciences, East Africa

The need for more interactive, learner-centred pedagogies at Aga Khan University in East Africa led to the development of a partnership with Academics without Borders (AWB). AWB recruited three nursing faculty volunteers to provide mentorship to the nursing faculty at the three Aga Khan University Advanced Nursing Studies campuses in East Africa. As part of the evaluation and as a strategy to improve the quality of the mentoring and the project, the authors developed an action research study to identify facilitators and inhibitors to the success of this inter-cultural initiative. In this article, the authors share their observations and reflections …

Emotional And Relationship Dynamics Between Hiv Serodiscordance And Concordance Couples: A Narrative Literature Review And Theoretical Framework, Amani Mwakalapuka, Ipyana Mwampagatwa, Theodora Bali, Masumbuko Mwashambwa, Stephen Kibusi, Tumbwene Mwansisya

School of Nursing & Midwifery, East Africa

Tanzania is among the countries with high prevalence of HIV prevalence in the World. Despite the fact that the epidemic has been, and still is a threat to persons of all ages, recent studies have suggested that most new infections occur among couples in stable relationships. Infected couples are categorised into two: the positive concordant, where both the partners are HIV positive; and sero-discordant couples, where one partner is HIV positive while the other is negative. Recently, researchers and many other stake-holders working on the HIV/AIDS epidemic have given a remarkable attention to this astonishing reality. For instance one study …

Complications Of In-Patient Cerebral Angiography: Comparison Between Patients With And Without Sub Arachnoid Haemorrhage, Yaseen Rauf, Usman Tariq Siddiqui, Gohar Javed

Section of Neurosurgery

Objective: To compare complications of cerebral angiography among patients with and without subarachnoid haemorrhage.
Methods: This retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised records of patients undergoing inpatient therapeutic and diagnostic cerebral angiographies from 2001 to 2010. The patients were divided into subarachnoid and non-subarachnoid haemorrhage groups. During the study period no modifications were made to the operational protocol and all patients were subjected to the same procedure and prophylactic care.
Results: Of the 93 patients, 42(45.2%) were women and 51(54.8%) were men. The overall mean age was 45.27±16.15 years (range: 4-80 years). The …

Attitude Towards Gender Roles And Violence Against Women And Girls (Vawg): Baseline Findings From An Rct Of 1752 Youths In Pakistan, Tazeen S. Ali, Rozina Karmaliani, Judith Mcfarlane, Hussain M. A. Khuwaja, Yasmeen Somani, Esnat D. Chirwa, Rachel Jewkes

School of Nursing & Midwifery

Background: Violence against women is driven by gender norms that normalize and justify gender inequality and violence. Gender norms are substantially shaped during adolescence. Programs offered through schools offer an opportunity to influence gender attitudes toward gender equity if we understand these to be partly shaped by peers and the school environment.
Objective: We present an analysis of the baseline research conducted for a randomized controlled trial with 1752 grade 6 boys and girls and their attitudes toward gender roles, VAWG, and associated factors.
Methods: We used baseline data from a cluster randomised control study. Interviews were …

Cultural Practices Of Rearing Preterm Infants: A Qualitative Study In A Tertiary Care Hospital, Karachi, Pakistan, Salima Sulaiman Gulamani, Ambreen Tharani, Sharifa Bashir Lalani, Kiran Shaikh

School of Nursing & Midwifery

The research work explores the cultural practices of feeding and hygiene of preterm infants in the Pakistani context. A Qualitative descriptive-exploratory design has been used. Purposive sampling was utilized to recruit 17 mothers, who met inclusion criteria from a largest government tertiary care hospital in Karachi, Pakistan. The semi-structured interview was used to collect the data, which lasted for approximately 45-60 minutes. Thematic analysis was conducted to analyze the key findings of the study. Welcoming newborn with 'honey' and herbal remedies were reported as a common ritual among mothers. Findings revealed differences in the time period of initial bath given …

Association Of Awareness About Hepatitis C Infection With Patterns Of Health Seeking Behavior Among Hepatitis C Patients In Karachi, Pakistan, Shahina S. Pirani, Saleema Allana, Tazeen S. Ali, Faisal Wasim Ismail

School of Nursing & Midwifery

Background: Hepatitis C infection is one of the significant causes of morbidity and mortality throughout the world. In Pakistan, hepatitis C infection rate is 4.8%, which is the second highest prevalence rate among all developing countries. This study aimed to identify the association between awareness about hepatitis C infection and pattern of health seeking behavior among patients living with hepatitis C in Karachi, Pakistan.
Methods: A descriptive, cross-sectional study was conducted among 250 hepatitis C patients who were recruited from the Aga Khan University Hospital and the Civil Hospital Karachi, Pakistan between March and May 2013. Data were …

Exploring The Impact Of Gender Inequities On The Promotion Of Cardiovascular Health Of Women In Pakistan, Rubina Barolia, Alexander M. Clark, Gina M. Higginbottom

School of Nursing & Midwifery

Cardiovascular disease exerts an enormous burden on women's health. The intake of a healthy diet may reduce this burden. However, social norms and economic constraints are often factors that restrain women from paying attention to their diet. Underpinned by critical realism, this study explores how gender/sex influences decision-making regarding food consumption among women of low socioeconomic status (SES). The study was carried out at two cardiac facilities in Karachi, Pakistan, on 24 participants (male and female from different ethnic backgrounds), who had received health education. Using an interpretive descriptive approach, the study identified major barriers to a healthy diet: proscribed …

Studies On Antihyperlipidemic And Endothelium Modulatory Activities Of Polyherbal Formulation (Pol4) And Its Ingredients In High Fat Diet-Fed Rats, Abdul Malik, Malik H Mehmood, Muhammad S Akhtar, Anwar Gilani

Department of Biological & Biomedical Sciences

A compound herbal formulation (POL4) is used traditionally in interior parts (Distt. Badin) of Sindh, Pakistan, for the treatment of metabolic disorders like diabetes and hyperlipidemia. This study is aimed to determine the effectiveness of POL4 and its ingredients in hyperlipidemia and associated endothelial dysfunction and hypertension. POL4 is composed of equal proportion of Nigella sativa, Cichorium intybus, Trigonella foenum graecum and Gymnema sylvestre mixed in powdered form. Chronic (6 to 7 weeks) administration of POL4 and its ingredients mixed in diet caused a notable attenuation in total cholesterol, low density lipoprotein cholesterol, triglycerides, atherogenic index, C-reactive protein and glucose, …

Dialectics Of Imagination And Experimentation: Basic Science Research In Developing Countries, Hr Ahmad, Na Khan

Department of Biological & Biomedical Sciences

No abstract provided.

Uchunguzi (Journal Watch/ Montre De Journal) June 2017, Benjamin Wachira

Emergency Medicine, East Africa

The purpose of an effective emergency care system is to provide universal emergency care to all regardless of socioeconomic status, to stabilise patients who have a life-threatening illness or injury, and to reduce consequences of preventable mortality, morbidity and disability. Unfortunately, the limited availability of resources remains a significant barrier to the development and implementation of emergency care systems in low- and middle-income countries (LMICs). In this recent study from Cameroon, of 3201 participants from 619 households surveyed, 1113 (34.8%) had experienced one or more emergency conditions in the previous year. Despite this high incidence of emergency conditions, only 7% …

Thyroid Ultrasound: State Of The Art Part 1 - Thyroid Ultrasound Reporting And Diffuse Thyroid Diseases, Manjiri Dighe, Richard Barr, Jörg Bojunga, Vito Cantisani, Maria Cristina Chammas, David Cosgrove, Xin-Wu Cui, Yi Dong, Franziska Fenner, Maija Radzina, Sudhir Vinayak, Jun-Mei Xu, Christoph F. Dietrich

Imaging & Diagnostic Radiology, East Africa

Accurate differentiation of focal thyroid nodules (FTL) and thyroid abnormalities is pivotal for proper diagnostic and therapeutic work-up. In these two part articles, the role of ultrasound techniques in the characterization of FTL and evaluation of diffuse thyroid diseases is described to expand on the recently published World Federation in Ultrasound and Medicine (WFUMB) thyroid elastography guidelines and review how this guideline fits into a complete thyroid ultrasound exam.

Post-Traumatic Stress Disorder Associated With Natural And Human-Made Disasters In The World Mental Health Surveys, Evelyn J. Bromet, Lukoye Atwoli, Norito Kawakami, Fernando Navarro-Mateu, P Piotrowski, A J. King, Sergio Aguilar-Gaxiola, Jordi Alonso, Brentan Bunting, Koen Demyttenaere

Internal Medicine, East Africa

Background: Research on post-traumatic stress disorder (PTSD) following natural and human-made disasters has been undertaken for more than three decades. Although PTSD prevalence estimates vary widely, most are in the 20–40% range in disaster-focused studies but considerably lower (3–5%) in the few general population epidemiological surveys that evaluated disaster-related PTSD as part of a broader clinical assessment. The World Mental Health (WMH) Surveys provide an opportunity to examine disaster-related PTSD in representative general population surveys across a much wider range of sites than in previous studies.

Method: Although disaster-related PTSD was evaluated in 18 WMH surveys, only six in high-income …

Prevalence And Possible Factors Associated With Anaemia, And Vitamin B 12 And Folate Deficiencies In Women Of Reproductive Age In Pakistan: Analysis Of National-Level Secondary Survey Data, Sajid Bashir Soofi, Gul Nawaz Khan, Kamran Sadiq, Shabina Ariff, Atif Habib, Sumra Kureishy, Imtiaz Hussain, Muhammad Umer, Zamir Suhag, Arjumand Rizvi, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Objective: To determine the prevalence and possible factors associated with anaemia, and vitamin B12 and folate deficiencies in women of reproductive age (WRA) in Pakistan.
Methods: A secondary analysis was conducted on data collected through the large-scale National Nutrition Survey in Pakistan in 2011. Anaemia was defined as haemoglobin levels /dL, vitamin B12 deficiency as serum vitamin B12 levels of /mL (150 pmol/L) and folate deficiency as serum folate levels /mL (10 nmol/L).
Results: A total of 11 751 blood samples were collected and analysed. The prevalence of anaemia, vitamin B12 deficiency and folate deficiency was 50.4%, 52.4% and 50.8%, …

Tuberous Sclerosis Complex In The Western Cape, South Africa: The Clinical Presentation Features, E. Kija, B. Schlegel, Pauline Samia, M. Wessels, J. M. Wilmshurst

Paediatrics and Child Health, East Africa

Tuberous sclerosis complex (TSC) is a genetic neurocutaneous condition, which affects multiple organ systems. This study aimed to determine the presenting features of children with TSC in Cape Town, South Africa. A cross-sectional study was conducted at a TSC clinic, and clinical features at presentation were prospectively collected. Thirty-nine children (23 boys; median age 10 (range 1 - 26) years; median diagnosis age 16 (0 - 153) months) were recruited. Twenty-one (54%) children presented with focal seizures. Seven (18%) children had epileptic spasms. Skin manifestations led to a diagnosis in 13 (33%) and neuroimaging in 22 (56%) children. Antenatal screening …

The 17th International Congress On Infectious Diseases Workshop On Developing Infection Prevention And Control Resources For Low- And Middle-Income Countries, Sangeeta Sastry, Nadia Masroor, Gonzalo Bearman, Rana Hajjeh, Alison Holmes, Ziad Memish, Britta Lassmann, Didier Pittet, Fiona Macnab, Rachel Kamau, Evelyn Wesangula, Paras Pokharel, Paul Brown, Frances Daily, Fatma Amer, Jaime Torres, Miguel O’Ryan, Gunturu Revathi, Andre Bulabula, Shaheen Mehtar

Pathology, East Africa

Hospital-acquired infections (HAIs) are a major concern to healthcare systems around the world. They are associated with significant morbidity and mortality, in addition to increased hospitalization costs. Recent outbreaks, including those caused by the Middle East respiratory syndrome coronavirus and Ebola virus, have highlighted the importance of infection control. Moreover, HAIs, especially those caused by multidrug-resistant Gram-negative rods, have become a top global priority. Although adequate approaches and guidelines have been in existence for many years and have often proven effective in some countries, the implementation of such approaches in low- and middle-income countries (LMICs) is often restricted due to …

Emergency Medical Services (Ems) Training In Kenya: Findings And Recommendations From An Educational Assessment, Benjamin Nicholson, Chelsea Mccollough, Benjamin Wachira, Nee-Kofi Mould-Millman

Emergency Medicine, East Africa

Background: Over the past twenty years, Kenya has been developing many important components of a prehospital emergency medical services (EMS) system. This is due to the ever-increasing demand for emergency medical care across the country. To better inform the next phase of this development, we undertook an assessment of the current state of EMS training in Kenya.

Methods: A group of international and Kenyan experts with relevant EMS and educational expertise conducted an observational qualitative assessment of Kenyan EMS training institutions in 2016. Three assessment techniques were utilised: semi-structured interviews, document review, and structured observations. Recommendations were reached through a …