Medicine and Health Sciences Commons^™

High Resolution Melting: A Useful Field-Deployable Method To Measure Dhfr And Dhps Drug Resistance In Both Highly And Lowly Endemic Plasmodium Populations, Yaye Dié Ndiaye, Cyrille K. Diédhiou, Amy K. Bei, Baba Dieye, Aminata Mbaye, Nasserdine Papa Mze, Rachel F. Daniels, Ibrahima M. Ndiaye, Awa B. Déme, Amy Gaye, Mouhamad Sy, Tolla Ndiaye, Aida S. Badiane, Mouhamadou Ndiaye, Zul Premji, Dyann F. Wirth, Souleymane Mboup, Donald Krogstad, Sarah K. Volkman, Ambroise D. Ahouidi, Daouda Ndiaye

Pathology, East Africa

Background: Emergence and spread of drug resistance to every anti-malarial used to date, creates an urgent need for development of sensitive, specifc and feld-deployable molecular tools for detection and surveillance of validated drug resistance markers. Such tools would allow early detection of mutations in resistance loci. The aim of this study was to compare common population signatures and drug resistance marker frequencies between two populations with diferent levels of malaria endemicity and history of anti-malarial drug use: Tanzania and Sénégal. This was accomplished by implementing a high resolution melting assay to study molecular markers of drug resistance as compared to …

Reference Intervals For Thyroid Stimulating Hormone And Free Thyroxine Derived From Neonates Undergoing Routine Screening For Congenital Hypothyroidism At A University Teaching Hospital In Nairobi, Kenya: A Cross Sectional Study, Geoffrey Omuse, Ali Kassim, Francis Kiigu, Ra'ana Hussain, Mary Limbe

Pathology, East Africa

Background: In order to accurately interpret neonatal thyroid function tests (TFTs), it is necessary to have population specific reference intervals (RIs) as there is significant variation across different populations possibly due to genetic, environmental or analytical issues. Despite the importance of RIs, globally there are very few publications on RIs for neonatal TFTs primarily due to ethical and technical issues surrounding recruitment of neonates for a prospective study. To the best of our knowledge, this is the first report from Africa on neonatal RIs for TFTs.

Methods: We used hospital based data largely derived from neonates attending the wellness clinic …

Urolithiasis Analysis In A Multiethnic Population At A Tertiary Hospital In Nairobi, Kenya, Francis Kiigu, Alfred Hayombe, Daniel Maina

Pathology, East Africa

Background: Urolithiasis is a global problem whose incidence is reported to be on the rise across the world. Previously, urolithiasis was reported as being rare among the indigenous African population but recent data suggest otherwise. This study reviewed the demographic and clinical characteristics of patients with urolithiasis seen at the Aga Khan University hospital Nairobi (AKUHN) as well as the chemical composition of the stones and the modalities of therapy used.

Methods: This was a retrospective study which utilized patients’ clinical and laboratory records from 2013 to 2014. Sixty-seven symptomatic patients with confrmed urolithiasis formed the study. This study aimed …

Effects Of Bidi Smoking On All-Cause Mortality And Cardiorespiratory Outcomes In Men From South Asia: An Observational Community-Based Substudy Of The Prospective Urban Rural Epidemiology Study (Pure), Mylinh Duong, Sumathy Rangarajan, Xiaohe Zhang, Kieran Killian, Prem Mony, Sumathi Swaminathan, Ankalmadagu Venkatsubbareddy Bharathi, Sanjeev Nair, Krishnapillai Vijayakumar, Indu Mohan, Romaina Iqbal, Khawar Kazmi

Community Health Sciences

Background: Bidis are minimally regulated, inexpensive, hand-rolled tobacco products smoked in south Asia. We examined the effects of bidi smoking on baseline respiratory impairment, and prospectively collected data for all-cause mortality and cardiorespiratory events in men from this region.
Methods: This substudy of the international, community-based Prospective Urban Rural Epidemiology (PURE) study was done in seven centres in India, Pakistan, and Bangladesh. Men aged 35–70 years completed spirometry testing and standardised questionnaires at baseline and were followed up yearly. We used multilevel regression to compare cross-sectional baseline cardiorespiratory symptoms, spirometry measurements, and follow-up events (all-cause mortality, cardiovascular events, respiratory events) …

Unintended Pregnancies Among Married Women In Sindh Pakistan: Role Of Lady Health Workers, Sumera Aziz Ali, Unaib Rabbani

Community Health Sciences

Background: Unintended pregnancies, which pose substantial risks to both mothers and children, account for 24% of all pregnancies in Pakistan. Door to door visits and service provision by lady health workers (LHWs) may be related to the reduction of such pregnancies, particularly in rural areas. This study aimed to determine the association of knowledge about Lady Health Visitors (LHWs) and door to door visits by LHWs with unintended pregnancies among rural women.
Methods: We conducted a community-based, nested case-control study of 800 pregnant women, identified from the database of an active surveillance mechanism, which registers and follows all pregnant women …

The Effect Of Breastfeeding On The Cognitive And Language Development Of Children Under 3 Years Of Age: Results Of Balochistan-Early Childhood Development Project, Meesha Iqbal Iqbal, Ghazala Rafique, Sumera Aziz Ali

Community Health Sciences

Background: Breastfeeding is known to be an important factor in the overall growth and development of children. Breastfeeding is thought to lead to enhance cognitive and language development of a child. However, this association has not yet been scientifically and statistically established. This study aimed to explore this association in children under 3 years of age.
Methods: This was a secondary data-analysis of the baseline data of “Balochistan – Early Childhood Development Project”. The final sample comprised of 604 children less than 3 years of age. The children were selected by three-stage stratified random sampling from three districts of Balochistan …

Can Right To Health Help Policy Makers To Address Maternal Mortality?: A Short Communication, Sumera Aziz Ali, Nadir Suhail, Savera Aziz Ali

Community Health Sciences

No abstract provided.

Phenotypic Low-Level Isoniazid Resistance As A Marker To Predict Ethionamide Resistance In Mycobacterium Tuberculosis, Salima Qamar, Joveria Q. Farooqi, Kausar Jabeen, Rumina Hasan

Department of Pathology and Laboratory Medicine

Background: Tuberculosis is one of the most prevalent diseases in Pakistan. Pakistan has the highest burden of MDR-TB in the Eastern Mediterranean region. Ethionamide is an anti-tuberculous drug frequently used to treat MDR-TB. Its drug susceptibility testing is not easily available in resource limited settings. Since it acts on the same target protein as isoniazid (inhA protein encoded by inhA gene), we sought to find out if phenotypic isoniazid resistance can be a marker of ethionamide resistance.
Materials and Methods: This was a retrospective observational study conducted at the Aga Khan University hospital section of microbiology. Data was retrieved between …

Rapid Detection Of In Vitro Antituberculous Drug Resistance Among Smear-Positive Respiratory Samples Using Microcolony Detection-Based Direct Drug Susceptibility Testing Method, Irim Iftikhar, Seema Irfan, Joveria Farooqi, Zahida Azizullah, Rumina Hasan

Department of Pathology and Laboratory Medicine

Background: With the rise in multidrug-resistant tuberculosis, there is a search for newer techniques that will rapidly detect drug-resistant Mycobacterium tuberculosis. Although molecular techniques can detect resistance, culture is still considered gold standard, especially in resource-limited settings where quick, cheap, and easy techniques are needed. The aim of the study was to evaluate microcolony method thin layer agar (TLA) for quick detection of resistance against the first- and second-line antituberculous drugs in clinical isolates. This was a cross-sectional study performed at Aga Khan University Hospital.
Material and Methods: A total of 87 Z-N stain smear-positive pulmonary samples were received and …

Importance Of Physical Activity In Women, Minaz Mawani

Department of Medicine

No abstract provided.

Slc11a1 Polymorphisms And Host Susceptibility To Cutaneous Leishmaniasis In Pakistan., Mariam Sophie,, Abdul L Hameed Institute Of Biomedical And Genetic Engineering (Ibge), 24-Mauve Area, G- 9/1, Islamabad, Pakistan., Akhtar Muneer, Azam J. Samdani, Saima Saleem, Abid Azhar

Department of Medicine

Background:The vector-borne cutaneous leishmaniasis (CL) is endemic in several regions of Pakistan mainly affecting poor populations. Host genetic factors, particularly SLC11A1 (solute carrier transmembrane protein) within macrophages, play a crucial role in disease pathology and susceptibility. Association of SLC11A1 with cutaneous leishmaniasis, a neglected tropical disease, is not well established. Inconsistencies have been observed within different populations worldwide with respect to genetic susceptibility. This study was designed to investigate genetic variation(s) in SLC11A1 and to assess possible association with cutaneous leishmaniasis in Pakistan.

Results: Eight polymorphisms (rs2276631, rs3731864, rs2290708, rs2695342, rs201565523, rs17215556, rs17235409, rs17235416) were genotyped across SLC11A1 in …

An Analysis Of Perioperative Adverse Neurological Events Associated With Anesthetic Management At A Tertiary Care Center Of A Developing Country, Fauzia Anis Khan, Sobia Khan, Gauhar Afshan

Department of Anaesthesia

Background and Aims: Existing literature on neurological complications related to anesthesia is reported from affluent countries but the trends may vary in less affluent countries.MATERIAL AND Methods: The objective was to find the associated factors contributing to neurological adverse events occurring within 48 h of anesthesia and surgery. The existing departmental morbidity and mortality database was reviewed from 1992 to 2012 for major adverse neurological events. A standardized methodology was used in reviewing and classifying the data. All adverse events were predefined and categorized before filling the form into the following headers; meningitis, cord/plexus/peripheral nerve injury, stroke, paraparesis/paraplegia/quadriparesis/or quadriplegia, new …

Multi-Organ Dysfunction Secondary To Yellow Scorpion Sting, Muhammad Faisal Khan, Hameed Ullah

Department of Anaesthesia

Scorpion stings are common in tropical and subtropical regions. The history and clinical manifestation warrant urgent recognition and treatment. The incidence of scorpion stings in Pakistan is not known as there is no published data available in literature. We report our experience of a yellow scorpion sting victim who required intensive care admission after developing multi-organ dysfunction.

Acute Necrotizing Encephalopathy Of Childhood Secondary To Dengue Infection: A Case Report From Pakistan, Qalab Abbas, Sidra Kaleem Jafri, Sidra Ishaque, Muhammad T. Jamil

Department of Paediatrics and Child Health

Acute necrotizing encephalopathy of childhood (ANEC) is a rare condition mainly affecting children with a distinct clinico-radiologic pattern. Initially thought to be secondary to respiratory viral infections, there have been more insights to the pathogenesis of ANEC including genetics. We present a case of a girl who developed this condition with classical clinico-radiologic findings of ANEC secondary to severe dengue infection and could not survive. We report this case with the aim to raise awareness about this fatal complication of dengue infection as dengue has become a global health-care problem.

Clinical And Laboratory Profile Of Children With Cystic Fibrosis: Experience Of A Tertiary Care Center In Pakistan, Danish Abdul Aziz, Abdul Gaffar Billoo, Ahad Qureshi, Misha Khalid, Salman Kirmani

Department of Paediatrics and Child Health

Objective: To determine the clinical presentation, diagnostic investigations and laboratory workup done in admitted children with cystic fibrosis at Aga Khan University Hospital Karachi, Pakistan.
Methods: This is a three years retrospective study from January 2013 to December 2015 conducted at The Aga Khan University Hospital Karachi Pakistan, enrolling admitted patient from birth to 15 years of either gender, diagnosed with CF on the basis of clinical features and positive sweat chloride test. Different clinical presentations were noted including initial presentations. Sweat chloride values more than 60mmol/L were labeled as positive and consistent with diagnosis of CF. Available Delta F-508 …

Equivalence And Non-Inferiority Trials In A Snapshot, Salima Kerai

Department of Paediatrics and Child Health

No abstract provided.

Tuberculosis Control In Sindh, Pakistan: Critical Analysis Of Its Implementation, Ali H. Khan

Medical College Documents

Tuberculosis (TB) remains one of the main health problems despite preventive and control measures that have been taken in the past few decades. It is responsible for almost 8.8 million cases and 1.4 million deaths around the world. Lack of access to TB services is a barrier for empowering TB patients. In a country like Pakistan, controlling TB has become a challenge because of the lack of private sector involvement in a National Tuberculosis Control Program (NTP). Therefore, collaboration is needed between public, private and government sectors in treating TB as well as in improving the quality of the health …

Prevalence And Determinants Of Unintended Pregnancies Amongst Women Attending Antenatal Clinics In Pakistan, Atif Habib, Camille Raynes- Greenow, Sidrah Nausheen, Sajid Bashir Soofi, Muhammad Sajid, Zulfiqar A Bhutta, Kirsten I Black

Department of Paediatrics and Child Health

Background: Unintended pregnancies are a global public health concern and contribute significantly to adverse maternal and neonatal health, social and economic outcomes and increase the risks of maternal deaths and neonatal mortality. In countries like Pakistan where data for the unintended pregnancies is scarce, studies are required to estimate its accurate prevalence and predictors using more specific tools such as the London Measure of Unplanned Pregnancies (LMUP).
Methods: We conducted a hospital based cross sectional survey in two tertiary care hospitals in Pakistan. We used a pre tested structured questionnaire to collect the data on socio-demographic characteristics, reproductive …

Simplified Antibiotic Regimens For Treatment Of Clinical Severe Infection In The Outpatient Setting When Referral Is Not Possible For Young Infants In Pakistan (Simplified Antibiotic Therapy Trial [Satt]): A Randomised, Open-Label, Equivalence Trial, Fatima Mir, Imran Nisar, Shiyam S. Tikmani, Benazir Baloch, Sadia Shakoor, Fyezah Jehan, Imran Ahmed, Simon Cousens, Anita K M Zaidi

Department of Paediatrics and Child Health

Background: Parenteral antibiotic therapy for young infants (aged 0–59 days) with suspected sepsis is sometimes not available or feasible in countries with high neonatal mortality. Outpatient treatment could save lives in such settings. We aimed to assess the equivalence of two simplified antibiotic regimens, comprising fewer injections and oral rather than parenteral administration, compared with a reference treatment for young infants with clinical severe infection.
Methods: We undertook the Simplified Antibiotic Therapy Trial (SATT), a three-arm, randomised, open-label, equivalence trial in five communities in Karachi, Pakistan. We enrolled young infants (aged 0–59 days) who either presented at a primary health-care …

Erratum To: Neonatal Hyperbilirubinemia In Infants With G6pd C.563c>T Variant, Bushra Moiz, Amna Nasir, Sarosh Ahmed Khan, Saleema Amin Kherani, Maqbool Qadir

Department of Pathology and Laboratory Medicine

No abstract provided.

Wealth And Cardiovascular Health: A Cross-Sectional Study Of Wealth-Related Inequalities In The Awareness, Treatment And Control Of Hypertension In High-, Middle- And Low-Income Countries., Benjamin Palafox, Martin Mckee, Dina Balabanova, Khalid F. Khalid, Alvaro Jr Avezum, Ahmad Bahonar, Noorhassim Noorhassim, Jephat Chifamba, Clara K. Chow, Daniel J. Corsi, Gilles R. Dagenais, Rafael Diaz, Rajeev Gupta, Romaina Iqbal, Manmeet Kaur, Rasha Khatib, Annamarie Kruger, Iolanthe Marike Kruger, Fernando Lanas, Patricio Lopez-Jaramillo, Fu Minfan, Viswanathan Mohan, Prem K. Mony, Aytekin Oguz, Lia M. Palileo-Villanueva, Pablo Perel, Paul Poirier, Sumathy Rangarajan, Lei Rensheng, Annika Rosengren, Biju Soman, David Stuckler, S. V. Subramania, Koon Teo, Lungiswa P. Tsolekile, Andreas Wielgosz, Peng Yaguang, Karen Yeates, Mo Yongzhen, Khalid Yusoff, Rita Yusuf, Afzalhussein Yusufali, Katarzyna Zatońska, Salim Yusuf

Community Health Sciences

BACKGROUND:

Effective policies to control hypertension require an understanding of its distribution in the population and the barriers people face along the pathway from detection through to treatment and control. One key factor is household wealth, which may enable or limit a household's ability to access health care services and adequately control such a chronic condition. This study aims to describe the scale and patterns of wealth-related inequalities in the awareness, treatment and control of hypertension in 21 countries using baseline data from the Prospective Urban and Rural Epidemiology study.

METHODS:

A cross-section of 163,397 adults aged 35 to 70 …

E-Learning For Research Capacity Strengthening In Sexual And Reproductive Health: The Experience Of The Geneva Foundation For Medical Education And Research And The Department Of Reproductive Health And Research, World Health Organization, Karim Abawi, Venkatraman Chandra-Mouli, Igor Toskin, Mario Philip Festin, Lynn Gertiser, Raqibat Idris, Hanan Hamamy, Moazzam Ali, Ameyo Masakhwe Bonventure, Marleen Temmerman, Aldo Campana

Obstetrics and Gynaecology, East Africa

Abstract: Technological advancement has resulted in the increasing use of e-learning and online education, initially in high-income countries and increasingly in low- and middle-income countries.

Background: In 2010, the Geneva Foundation for Medical Education and Research, in collaboration with the World Health Organization and partner institutions, developed an online postgraduate course “From Research to Practice: Training Course in Sexual and Reproductive Health Research”. This course takes advantage of the advancing Internet technology to provide training opportunities to health professionals mostly from low- and middle-income countries whose access to quality education is constrained by time, financial resources, or both.

Case presentation: …

An Assessment Of Implementation Of Community - Oriented Primary Care In Kenyan Family Medicine Postgraduate Medical Education Programmes, Ian Nelligan, Jacob Shabani, Stephanie Taché, Gulnaz Mohamoud, Megan Mahoney

Family Medicine, East Africa

Background and objectives: Family medicine postgraduate programmes in Kenya are examining the benefits of Community-Oriented Primary Care (COPC) curriculum, as a method to train residents in population-based approaches to health care delivery. Whilst COPC is an established part of family medicine training in the United States, little is known about its application in Kenya. We sought to conduct a qualitative study to explore the development and implementation of COPC curriculum in the first two family medicine postgraduate programmes in Kenya.

Method: Semi-structured interviews of COPC educators, practitioners, and academic stakeholders and focus groups of postgraduate students were conducted with COPC …

The Uptake Of Skilled Birth Attendants’ Services In Rural Nepal: A Qualitative Study, Yuba Raj Baral, Jo Skinner, Edwin Van Teijlingen, Karen Lyons

Journal of Asian Midwives (JAM)

Aim and objective: The general aim of this research was to explore why women do or do not want to uptake Skilled Birth Attendants’ (SBAs) services during childbirth. The objective was to explore the factors affecting the uptake of SBAs’ services during childbirth in rural Nepal.
Methods: Semi-structured interviews were conducted. The data were analysed using thematic analysis.
Setting: The fieldwork was conducted in a rural area, in a western hill district of Nepal.
Participants: Interviews were conducted with 24 married women aged 18-49, who had given birth during the three years prior to the time of interview. Sixteen women …

Cost Analysis Of Large-Scale Implementation Of The ‘Helping Babies Breathe’ Newborn Resuscitation-Training Program In Tanzania, Sumona Chaudhury, Lauren Arlington, Shelby Brenan, Allan Kaijunga Kairuki, Amunga Robson Meda, Kahabi Isangula, Victor Mponzi, Dunstan Bishanga, Erica Thomas, Georgina Msemo, Mary Azayo, Alice Molinier, Brett D. Nelson

School of Nursing & Midwifery, East Africa

Background: Helping Babies Breathe (HBB) has become the gold standard globally for training birth-attendants in neonatal resuscitation in low-resource settings in efforts to reduce early newborn asphyxia and mortality. The purpose of this study was to do a first-ever activity-based cost-analysis of at-scale HBB program implementation and initial follow-up in a large region of Tanzania and evaluate costs of national scale-up as one component of a multi-method external evaluation of the implementation of HBB at scale in Tanzania.

Methods: We used activity-based costing to examine budget expense data during the two-month implementation and follow-up of HBB in one of the …

Does Empowerment Matter? Perceptions Of Nursing Leaders In Pakistan Through Qualitative Approach, Saleema A. Gulzar, Rozina Karmaliani Professor, Kausar S. Khan Ms, Rubina Barolia, Shirin Rahim, Aneeta Pasha

School of Nursing & Midwifery

Background: In a patriarchal society like Pakistan, where women are oppressed, women dominating professions like nursing is mostly seen as disempowered and requires considerable struggle to achieve its due recognition and respect.
Aim: This study aims to explore the experiences of empowerment among the nursing leaders of Pakistan. Methods: This study uses a qualitative descriptive design. Total of twelve Pakistani Nursing leaders were interviewed using semi-structured interview guideline to explore their experiences of empowerment.
Results: The study findings revealed five major categories which include: status of a nurse, nursing profession, power relationships, value-belief system, and leadership and management.
Conclusions: Nurses’ …

Shining A Light On Nursing Art In Pakistan, Shirin Rahim, Rafat Jan Ruknuddin, Kathryn L. Gramling

School of Nursing & Midwifery

Nursing is considered both science and art. Artful nursing has been essential for holistic nursing practice since the time of Nightingale, but it is getting neglected and has been lately limited to nursing literature (Gramling, 2004). This qualitative study seeks to gain an understanding of the perceptions of active nurses in Pakistan about nursing art and yields four major themes: artful nursing is embedded in humane responsiveness, artful nursing has healing power, artful nursing is a satisfying experience, and artful nursing is invisible in nursing practice. Study participants valued nursing art, and their perceptions illuminate Watson's Theory of Human Caring …

Ogilvie's Syndrome, Muhammad Waqas Khan, Sanniya Khan Ghauri, Sara Shamim

Department of Emergency Medicine

Ogilvie's syndrome, also known as 'paralytic ileus of the colon', is characterised by pseudo-obstruction of the large intestine in the absence of any mechanical obstructing component; and presents as a massively distended abdomen. If left untreated, it may lead to bowel perforation or ischemia. Ogilvie's syndrome usually presents as a postsurgical complication, mainly due to the lack and/or restriction of movement coupled with a possible electrolyte imbalance. Here, we present a case of a pre-surgical 63-year lady, having a right hip fracture, who came with complaints of severe abdominal pain and distension for 4 days. Abdominal X-rays showed massively dilated …

Uchunguzi (Journal Watch/Montre De Journal) December 2016, Benjamin Wachira

Emergency Medicine, East Africa

Uchunguzi means investigation in Swahili and provides a summary of some of the most recent international literature as presented in other leading journals, but with an emphasis on what is relevant to our continent

The Dynamics Of Adult Neurogenesis In Human Hippocampus, Amadi O. Ihunwo, Lackson H. Tembo, Charles Dzamalala

Brain and Mind Institute

The phenomenon of adult neurogenesis is now an accepted occurrence in mammals and also in humans. At least two discrete places house stem cells for generation of neurons in adult brain. These are olfactory system and the hippocampus. In animals, newly generated neurons have been directly or indirectly demonstrated to generate a significant amount of new neurons to have a functional role. However, the data in humans on the extent of this process is still scanty and such as difficult to comprehend its functional role in humans. This paper explores the available data on as extent of adult hippocampal neurogenesis …