Medicine and Health Sciences Commons^™

Bowled Over By Cricket: Impact Of Tape-Ball Injuries On The Eyes, Salman Naveed Sadiq, Azam Ali, Bushra Usmani, Khabir Ahmed

Department of Surgery Docs

Abstract

PURPOSE:

The aim of this study was to describe the type and severity of tape-ball cricket-related eye injuries seen at a tertiary care hospital.

DESIGN:

A descriptive case series.

METHODS:

This study included all cases of tape-ball cricket-related eye injuries presenting to the Section of Ophthalmology, Aga Khan University Hospital, Karachi, from January 2014 to January 2015.

RESULTS:

A total of 20 patients with tape-ball cricket-related eye injuries were treated during this period. The right eye was involved in most (14/20) of the cases. The commonest presenting symptoms included reduced/blurred vision, ocular pain, redness, and floaters. Sixty percent (12/20) …

Journey From Black To Pink Gums: Management Of Melanin Induced Physiological Gingival Hyper Pigmentation, Huma Farid, Muhammad Saad Shinwari, Farhan Raza Khan, Farzin Tanwir

Department of Surgery Docs

Abstract

Smile is an expression of happiness, self-confidence, kindness and beauty. Along with teeth and lips, gingiva is also a vital component of smile. Melanin induced gingival hyper pigmentation may appear un-aesthetic especially when it is associated with high smile line, upper anterior labial segment and is uneven in appearance. It affects individuals from all races. Generally, it is believed that melanin induced gingival hyper pigmentation is confined to individuals from dark races. But studies have shown that Iranian, Indian, Italian, Arabian, Greek. German, French, Japanese, Chinese, Jewish, Thai, Malaysian and other ethnic groups also display clinical gingival pigmentation.1 Gingival …

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 Roy

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 …

Herpes Zoster During Immunosuppressive Therapy For Autoimmune Diseases, Mohammad Faizan Zahid, Mariam Ghufran, Armaghan-E-Rehman Mansoor, Muhammad Rizwan Sohail

Medical College Documents

Background: Patients on immunosuppressive therapy are at a greater risk for herpes zoster reactivation and are more likely to have adverse outcomes. Propylactic antivrials and vaccinations may potentially prevent these complications.Methods: Medical literature addressing the clinical course and therapy of herpes zoster in patients receiving immunosuppressive therapy for autoimmune disorders, and the roles of anti-viral prophylaxis and vaccination was reviewed. Research databases including PubMed, Ovid, Medline, Google Scholar and Cochrane were utilized.Results: Acyclovir and its derivatives are most commonly used in this setting for treatment and reduction of post-zoster complications. Foscarnet may be used for acyclovir-resistant strains. At both conventional …

Practice Of Endodontic Re-Treatment In Four Cities Of Pakistan, Sana Ehsen Nagi, Farhan Raza Khan, Munawar Rahman

Section of Dental-Oral Maxillofacial Surgery

Background: Root canal re-treatment is the procedure of choice when the primary root treatment fails but patient is inclined toward salvage of the tooth. The re-treatment is often a challenging procedure owing to lack to the predictability in the outcomes. Since, there is a no single way of planning and executing such procedure, a study was planned to assess the knowledge, attitude and practice regarding endodontic re-treatment among Pakistani dentists. The effect of clinical experience on the re-treatment planning was also determined.
Methods: A survey was conducted by distributing a questionnaire among 240 dentists practicing in four major cities of …

Ultrasound Shear Wave Elastography And Liver Fibrosis: A Prospective Multicenter Study, Joyce Sande, Suleman Verjee, Sudhir Vinayak, Farin Amersi, Munir Ghesani

Imaging & Diagnostic Radiology, East Africa

Aim: To assess the accuracy of shear wave elastography (SWE) alone and in combination with aminotransferase platelet ratio index (APRI) score in the staging of liver fibrosis.

Methods: A multicenter prospective study was conducted to assess the accuracy of SWE (medians) and APRI to predict biopsy results. The analysis focused on distinguishing the different stages of liver disease, namely, F0 from F1-4, F0-1 from F2-4, F0-2 from F3-4 and F0-3 from F4; F0-F1 from F2-F4 being of primary interest. The area under the receiver operating characteristic (AUROC) curve was computed using logistic regression model. The role of age, gender and …

Training Midwives To Perform Basic Obstetric Point-Of-Care Ultrasound In Rural Areas Using A Tablet Platform And Mobile Phone Transmission Technology—A Wfumb Coe Project, Sudhir Vinayak, Joyce Sande, Harvey Nisenbaum, Christian Pállson Nolsøe

Imaging & Diagnostic Radiology, East Africa

Point-of-care ultrasound (POCUS) has become a topical subject and can be applied in a variety of ways with differing outcomes. The cost of all diagnostic procedures including obstetric ultrasound examinations is a major factor in the developing world and POCUS is only useful if it can be equated to good outcomes at a lower cost than a routine obstetric examination. The aim of this study was to assess a number of processes including accuracy of images and reports generated by midwives, performance of a tablet-sized ultrasound scanner, training of midwives to complete ultrasounds, teleradiology solution transmissions of images via internet, …

Antenatal Umbilical Coiling Index And Newborn Outcomes: Cohort Study, Josephine Mwikali Ndolo, Sudhir Vinayak, Micah Ominde, William Stones

Imaging & Diagnostic Radiology, East Africa

Objectives: We aimed to test the predictive value of antenatal umbilical coiling index (aUCI) among a prospectively recruited cohort of antenatal women.

Methods: Women with singleton pregnancies were recruited at their second‑trimester scan. Images of the umbilical cord were used to calculate the aUCI. Pregnancy and birth outcomes were recorded and statistical associations between aUCI and small for gestational age (SGA) using international standard birth weight centiles and preterm birth were investigated (n = 430).

Results: aUCI results were consistent with the literature and showed good reproducibility between observers. Abnormal aUCI was not associated with SGA, but there was a …

Self- Assessed Level Of Competence Of Experienced Expatriate Nurses In Rural And Remote Settings, Salah Aqtash, Walter Frederick Robb, Lyndal Heather Hunter, Majdi Almuhtasib, Abeer Hamad, Sharon Brownie

School of Nursing & Midwifery, East Africa

We aimed to measure the self-assessed level of competence among nurses working in the public hospitals of Al-Gharbia Region, a remote rural region of United Arab Emirates, and to explore the factors associated with the nurses’ self-perceived competency. The Nurse Competency Scale, which measures the self-assessed level of competency of nurses, has been validated in a variety of clinical settings, in facilities of various sizes, and in small and large cohorts. However, its application among an expatriate nursing workforce working in small hospitals and health facilities in remote and rural areas has not been examined. We used the Nurse Competency …

‘I Stayed With My Illness’: A Grounded Theory Study Of Health Seeking Behaviour And Treatment Pathways Of Patients With Obstetric Fistula In Kenya, Anne Khisa, Grace M. Omoni, Isaac K. Nyamongo, Rachel F. Spitzer

School of Nursing & Midwifery, East Africa

Background: Obstetric fistula classic symptoms of faecal and urinary incontinence cause women to live with social stigma, isolation, psychological trauma and lose their source of livelihoods. There is a paucity of studies on the health seeking behaviour trajectories of women with fistula illness although women live with the illness for decades before surgery. We set out to establish the complete picture of women’s health seeking behaviour using qualitative research. We sought to answer the question: what patterns of health seeking do women with obstetric fistula display in their quest for healing?

Methods: We used grounded theory methodology to analyse data …

Mental Disorders And Associated Factors Among Adolescents In Juvenile Detention, Stewart Mbelwa

School of Nursing & Midwifery, East Africa

Introduction: The number of children and adolescents admitted in Dar es Salaam juvenile centers due to misbehavior and criminal offences has risen from 20 to 30 per month. Increasing aberrant behaviors in children have been linked to mental disorders. Assessment of presence mental health disorders as the main cause of these behaviors would be important to restore mental health of children and assist the system to impose a fair trial.

Objective: This study aimed to determine the presence of mental disorders and associated factors among children and adolescents within Dar es Salaam juvenile systems and explore factors that may affect …

Family Planning Practices Of Rural Community Dwellers In Cross River State, Nigeria., A. J. Etokidem, W. Ndifon, Ekaete Asuquo, J. Etowa

School of Nursing & Midwifery, East Africa

Background: Nigeria is the most populous nation in Africa and the seventh most populous in the world. Despite a high fertility rate of 5.5 per woman and a high population growth rate of 3.2%, Nigeria’s contraceptive prevalence is 15%, which is one of the lowest in the world. The objective of this study was to determine the knowledge of family planning and family planning preferences and practices of rural community women in Cross River State of Nigeria.

Materials and Methods: This was a cross-sectional study involving 291 rural women. Convenience sampling method was used. The women were assembled in a …

Pulmonary Hypertensive Crisis And Its Efficient Management. A Case Report And Literature Review, Karima Karam Khan, Fazal Hameed Khan

Department of Anaesthesia

Perioperative anaesthetic management of patients with pulmonary hypertensive crisis is complex and challenging because of limited window period and treatment options. This case report describes the successful management of a patient with severe valvular heart disease superimposed by severe pulmonary hypertension, who developed pulmonary hypertensive crisis soon after induction of general anaesthesia for cardiac surgery. Pulmonary hypertensive crisis is not a usual phenomenon in these patients, but if it occurs it can be fatal. Anticipatory care of the patient to prevent crisis is the mainstay of treatment, otherwise it adds additional morbidity to such patients. Fortunately our patient survived the …

Alcohol Use And Immune Reconstitution Among Hiv-Infected Patients On Antiretroviral Therapy In Nairobi, Kenya, Anthony Cagle, Christine Mcgrath, Barbra A. Richardson, Dennis Donovan, Sameh Sakr, Nelly Yatich, Richard Ngomoa, Agnes Chepngeno Langat, Grace John-Stewart, Michael Chung

Internal Medicine, East Africa

Studies on the effects of alcohol use on HIV disease progression have been contradictory, with at least one study finding a positive effect of low alcohol consumption on CD4 count. In addition, most such studies have taken place in the developed West. We investigated the association between alcohol use and immune reconstitution through CD4 count response among HIV-infected individuals on antiretroviral therapy (ART) at an urban sub-Saharan African clinic. This was a retrospective cohort study of treatment-naïve HIV-infected adults initiating ART in Nairobi, Kenya and followed for 12 months between January 2009 and December 2012. At enrollment, a standardized questionnaire …

Mhealth In Palliative Care For Cancer Patients & Care Givers, Newton Andebe, Peter Waiganjo, John Weru

Internal Medicine, East Africa

Patients and caregivers in palliative care experience multidimensional pain. In current practice, information about a cancer patient progress is known when they visit a clinic or make a distress call when their conditions worsen. This strategy is not efficient for systematic monitoring of symptoms, which is key in improving palliative care. Mobile phones have helped to transform healthcare through diagnosis, health education and symptoms management of chronic illnesses. In this study, a mobile phone assessment tool was implemented at an outpatient palliative care clinic for cancer patients in Aga Khan University Hospital, Nairobi. The usefulness of the mobile phone application …

Sentinel Lymph Node Biopsy Pathology And 2-Year Postsurgical Recurrence Of Breast Cancer In Kenyan Women, Nathan R. Brand, Ronald Wasike, Khalid Makhdomi, Rajendra Chauhan, Zahir Moloo, Samuel Gakinya, Alfred I. Neugut, Jo Anne Zujewski, Shahin Sayed

General Surgery, East Africa

Purpose: The goal of this study was to describe the pathologic findings and early follow-up experience of patients who underwent a sentinel lymph node biopsy (SLNB) at Aga Khan University Hospital (AKUH) between 2008 and 2017.

Patients and Methods: We performed a retrospective analysis of women with breast cancer who underwent an SLNB at AKUH between 2008 and 2017. The SLNB was performed on patients with stage I and stage II breast cancer, and identification of the sentinel lymph node was made by radioactive tracer, blue dye, or both, per availability and surgeon preference. Demographic, surgical, and pathologic data, …

Risk Factors For Hypoxia And Tachypnea Among Adolescents With Vertically-Acquired Hiv In Nairobi, Engi F. Attia, Noel S. Weiss, Elizabeth Maleche Obimbo, Christine J. Mcgrath, Anthony Cagle, Eoin T. West, El Antouny G. Neveen, Attwa Mena, Crothers Kristina, Michael Chung

Internal Medicine, East Africa

Background: Chronic lung diseases are increasingly recognized complications of vertically-acquired HIV among adolescents in sub-Saharan Africa and may manifest with hypoxia or tachypnea. We sought to determine the prevalence of and risk factors for hypoxia and tachypnea among adolescents with vertically-acquired HIV in Nairobi, Kenya.

Methods: We performed a cross-sectional analysis of 258 adolescents with vertically-acquired HIV who were initiating care at the Coptic Hope Center for Infectious Diseases. Adolescents with documented pneumonia were excluded. Hypoxia was defined as resting oxygen saturation ≤92%, and tachypnea was based on the 99th percentile of age-appropriate respiratory rates. Logistic regression models adjusted for …

Antenatal Corticosteroids For Women At Risk Of Imminent Preterm Birth In Low-Resource Countries: The Case For Equipoise And The Need For Efficacy Trials, Joshua P. Vogel, Olufemi T. Oladapo, Cynthia Pileggi-Castro, Ebunoluwa A. Adejuyigbe, Fernando Althabe, Shabina Ariff, Adejumoke Idowu Ayede, Abdullah H. Baqui, Anthony Costello, Davy M. Chikamata, Caroline Crowther, Bukola Fawole, Luz Gibbons, Alan H. Jobe, Monica Lulu Kapasa, John Kinuthia, Alka Kriplani, Oluwafemi Kuti, James Neilson, Janna Patterson, Gilda Piaggio, Rahat Qureshi, Zahida Qureshi, Mari Jeeva Sankar, Jeffrey S. A. Stringer, Marleen Temmerman, Khalid Yunis, Rajiv Bahl, A. Metin Gülmezoglu

Obstetrics and Gynaecology, East Africa

The scientific basis for antenatal corticosteroids (ACS) for women at risk of preterm birth has rapidly changed in recent years. Two landmark trials—the Antenatal Corticosteroid Trial and the Antenatal Late Preterm Steroids Trial—have challenged the long-held assumptions on the comparative health benefits and harms regarding the use of ACS for preterm birth across all levels of care and contexts, including resource-limited settings. Researchers, clinicians, programme managers, policymakers and donors working in low-income and middle-income countries now face challenging questions of whether, where and how ACS can be used to optimise outcomes for both women and preterm newborns.

In this article, …

Effects Of Injectable Progestogen Contraception Versus The Copper Intrauterine Device On Hiv Acquisition: Sub-Study Of A Pragmatic Randomised Controlled Trial, G. Justus Hofmeyr, Mandisa Singata-Madliki, Theresa A. Lawrie, Eduardo Bergel, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Evidence from observational studies suggests an increased risk of HIV acquisition among women using depot medroxyprogesterone acetate (DMPA) contraception.

Methods: Within the context of a South African programme to increase women's access to the intrauterine contraceptive device (IUD), we conducted a pragmatic, open-label, parallel-arm, randomised controlled trial (RCT) of the IUD versus injectable progestogen contraception (IPC) at two South African hospitals. The primary outcome was pregnancy; secondary outcomes included HIV acquisition. Consenting women attending termination of pregnancy services were randomised after pregnancy termination between July 2009 and November 2012. Condoms were promoted for the prevention of sexually transmitted infections. …

Use Of Visual Inspection With Acetic Acid, Pap Smear, Or High-Risk Human Papillomavirus Testing In Women Living With Hiv/Aids For Posttreatment Cervical Cancer Screening Same Tests, Different Priorities, Elkanah Omenge, Tao Liu, Astrid Christoffersen-Deb, Peter Itsura, John Oguda, Sierra Washington, David Chumba, Latha Pisharodi, Susan Cu-Uvin, Anne F. Rositch

Obstetrics and Gynaecology, East Africa

Objectives: Few studies have addressed optimal follow-up for HIV-infected women after cervical treatment. This study aimed to compare performance of three available tests to detect posttreatment cervical disease in HIV-infected women in Kenya.

Design: This is a prospective cohort study.

Methods: At least 6 months following cryotherapy, 517 HIV-infected women were evaluated concurrently with visual inspection with acetic acid (VIA), papanicolaou (Pap) smear, and high-risk human papillomavirus (HR-HPV) testing. Women positive by any test (low-grade squamous intraepithelial lesion for Pap) were scheduled for colposcopy and biopsy. Among 248 with histological confirmation [and 174 assumed to be truly negative for …

Management Of Simultaneous Bilateral Femur Fractures In A Tertiary Care Hospital: A Retrospective Review, Masood Umer, Syed Zohaib Gulzar Naqvi, Raza Askari, Umair Ashraf

Department of Surgery Docs

Abstract: Introduction: Bilateral long bone fractures are rare and usually are associated with increased risk of complications. These fractures are usually associated with poly traumatic injuries or high impact trauma resulting in shock. Commonest etiology is road traffic accident. Closed diaphyseal fractures are best managed by intramedullary nailing; management becomes difficult if there are open fractures and late arrival. In this study we intend to present our experience of managing these patients. Materials and Methods: Medical records of all adult patients (age more than 16 years of age) admitted at Aga Khan University and Hospital with bilateral femur fractures +/- …

Hernia Of Morgagni Presenting As Constipation In A 65-Year-Old Male, Hamza A Khan, Adeel Samad, Omar A Khan, Farida K Chagan, Jamal K Khan, Saulat H. Fatimi

Department of Surgery Docs

Hernia of Morgagni is congenital defects in the diaphragm. They are mostly asymptomatic and present with vague symptoms when they do so. A high index of suspicion is required for timely diagnose of this condition. Here we present the case of a 65-year-old male patient presented to our institute with constipation for the past six months. Chest radiology raised the suspicion of a hernia which was further confirmed by contrast studies. Laparotomy was done and the hernia sac identified, colon and greater omentum reduced and defect repaired. He was discharged in stable condition and was doing well on follow-up.

Clinical Profile And Short-Term Outcome Of Pediatric Hyperleukocytic Acute Leukemia From A Developing Country, Syed Ali Shazif Baqari, Anwarul Haque, Muhammad Shamvil Ashraf, Muhammad Matloob Alam, Zehra Fadoo

Section of Haematology/Oncology

This study was conducted to determine the frequency, clinical profile, and short-term outcome of children with hyperleukocytosis at two pediatric oncology centers in Karachi. Of a total 1,045 patients, 13.97% (n=146) patients had hyperleukocytosis. Majority (61.7%, n=90) were under 10 years of age and 76% (n=146) were male. The symptom duration before diagnosis was more than 30 days in 49.3% (n=72). The median WBC count was 181 x109/L (IQR=130.45- 298.3) and extreme hyperleukocytosis (>200 x109/L) was observed in 44.5% (n=65) patients. Majority (94.5%, n=138) of patients were diagnosed with acute lymphoblastic leukemia. One or more complications developed in 78% …

Survellience System For Child Abuse: Bridging The Gap Between Actual And Hidden Cases., Maryam Pyar Ali Lakhdir, Yasmin Parpio, Salima Farooq

Community Health Sciences

The dynamics of child abuse have been recognised as a global emerging social issue which is highly associated with child humiliation. The Government of Pakistan has taken many initiatives for addressing issues regarding child abuse and neglect and has designed laws to protect children against exploitation, abuse and violence; however, most of them are not enforced at all or poorly implemented due to lack of proper definition of child abuse and related terms, and different ways of reporting child abuse cases. Most of the non-governmental organisations (NGOs) in Pakistan target extreme cases of child sexual abuse such as child rape …

Role Of Mhealth Applications For Improving Antenatal And Postnatal Care In Low And Middle Income Countries: A Systematic Review, Anam Shahil Feroz, Shagufta Perveen, Wafa Aftab

Community Health Sciences

Background: From 1990 to 2015, the number of maternal deaths globally has dropped by 43%. Despite this, progress in attaining MDG 5 is not remarkable in LMICs. Only 52% of pregnant women in LMICs obtain WHO recommended minimum of four antenatal consultations and the coverage of postnatal care is relatively poor. In recent years, the increased cellphone penetration has brought the potential for mHealth to improve preventive maternal healthcare services. The objective of this review is to assess the effectiveness of mHealth solutions on a range of maternal health outcomes by categorizing the interventions according to the types of mHealth …

Vaccination Status And Factors For Non- Vaccination In Children At A Tertiary Care Hospital, Shiyam Sunder Tikmani, Tufail Soomro, Sumera Aziz Ali

Community Health Sciences

Immunization is a very effective strategy to prevent against common infectious disease. The objectives of the study were to determine the immunization status and reasons for non-vaccination of children coming to Civil Hospital Sukkur. This cross-sectional study was conducted pediatric OPD at Civil Hospital Sukkur from January 1, 2013, to June 30, 2013. Parents of children under five years of age brought their child to Outpatient Department of Civil Hospital Sukkur for any illness were asked to participate in the study. Parents who gave informed consent were included in the study. Data were collected using a small questionnaire by the …

Paediatric Inflammatory Bowel Disease: Clinical Presentation And Disease Location, Danish Abdul Aziz, Maryum Moin, Atif Majeed, Kamran Sadiq, Abdul Gaffar Biloo

Department of Paediatrics and Child Health

Objective: To determine different clinical presentationsand disease location demarcatedby upper and lower gastrointestinal endoscopyand relevant histopathologyin children diagnosed with inflammatory bowel disease (IBD).
Methods: This is 5 years (2010 to 2015) retrospective studyconducted at the Aga Khan University Hospitalenrolling65admitted children between 6 months to 15years from either gender, diagnosed with IBD on clinical presentation, endoscopy and biopsy. Different clinical presentations at the time of diagnosis were noted in different categories of the disease. All patients underwent upper and lower (up to the terminal ileum) endoscopy with multiple punch biopsies and histologic assessment of mucosal specimens. All endoscopies were done by …

Practical Neurology Linked To The Curriculum: An Online Resource, Dilraj Sokhi, Alice Brockington, Christine Lo

Internal Medicine, East Africa

Navigating the online galaxy for up-to-date evidence-based knowledge in clinical neurology can be a challenge. Practical Neurology is a noted and popular online clinical resource,1 which according to its website is "…practical in the sense of being useful for everyone who sees neurological patients and who want to keep up to date, and safe, in managing them." As UK-based neurology trainees, we have been fortunate to have automatic access to Practical Neurology during our training. We found that the articles adequately covered most elements in our syllabus and were ideal reference material for our department. This accords with the …

Fmic Annual Report 2017 | English, French Medical Institute For Mothers And Children

French Medical Institute for Mothers and Children (FMIC) Archives

No abstract provided.

Feasibility Of Antiretroviral Treatment Monitoring In The Era Of Decentralized Hiv Care: A Systematic Review, Minh D. Pham, Lorena Romero, Bruce Parnell, David A. Anderson, Suzanne M. Crowe, Stanley Luchters

Population Health, East Africa

Background: Regular monitoring of HIV patients who are receiving antiretroviral therapy (ART) is required to ensure patient benefits and the long-term effectiveness and sustainability of ART programs. Prompted by WHO recommendations for expansion and decentralization of HIV treatment and care in low and middle income countries, we conducted a systematic review to assess the feasibility of treatment monitoring in these settings.

Methods: A comprehensive search strategy was developed using a combination of MeSH and free text terms relevant to HIV treatment and care, health service delivery, health service accessibility, decentralization and other relevant terms. Five electronic databases and two conference …