Medicine and Health Sciences Commons^™

Association Of Tobacco Use And Other Determinants With Pregnancy Outcomes: A Multicentre Hospital-Based Case-Control Study In Karachi, Pakistan., Shafquat Rozi, Zahid Ahmad Butt, Nida Zahid, Saba Wasim, Kashif Shafique

Community Health Sciences

OBJECTIVES:

The study aimed to identify the effects of maternal tobacco consumption during pregnancy and other factors on birth outcomes and obstetric complications in Karachi, Pakistan.

DESIGN:

A multicentre hospital-based case-control study.

SETTING:

Four leading maternity hospitals of Karachi.

PARTICIPANTS:

A random sample of 1275 women coming to the gynaecology and obstetric department of selected hospitals for delivery was interviewed within 48 hours of delivery from wards. Cases were women with adverse birth outcomes and obstetric complications, while controls were women who had normal uncomplicated delivery.

PRIMARY AND SECONDARY OUTCOME MEASURES:

Adverse birth outcomes (preterm delivery, low birth weight, stillbirth, …

An Overview Of Pathophysiology, Assessment And Management Strategies Of Post Stroke Shoulder Subluxation, Sarah Razaq, Farooq Azam Rathore

Pakistan Journal of Neurological Sciences (PJNS)

Shoulder subluxation is a common complication after stroke. It can result in soft tissue damage, stretching of the joint capsule, rotator cuff injury, and in some cases pain. An estimated 17-81 % of stroke patients have shoulder subluxation. It limits the use of affected extremity in addition to the weakness resulting from stroke itself. It can delay the neurological recovery in hemiplegic stroke patients. The etiology is multifactorial and the underlying mechanisms alongwith its association with shoulder pain are not clearly understood. This makes management of post stroke shoulder- subluxation a challenge for stroke management team. This review provides an …

Knowledge, Attitude And Practice Of Epilepsy Among Schoolteachers In Pakistan, Syed Wasim Akhtar Wasim Akhtar, Zarine Mogal

Pakistan Journal of Neurological Sciences (PJNS)

Assessment of Knowledge, Attitude and Practice (KAP) concerning epilepsy among schoolteachers in Pakistan. No such study has previously been conducted in this country and results would help formulate a comprehensive plan of action to address this important issue.

Reliability Of Overbite Depth Indicator (Odi) And Anteroposterior Dysplasia Indicator (Apdi) In The Assessment Of Different Vertical And Sagittal Dental Malocclusions: A Receiver Operating Characteristic (Roc) Analysis, Farheen Fatima, Mubassar Fida, Attiya Shaikh

Department of Surgery Docs

Abstract

INTRODUCTION::

Differential diagnosis of skeletal and dental relationships is crucial for planning orthodontic treatment. Overbite depth indicator (ODI) and anteroposterior dysplasia indicator (APDI) had been introduced in the past for assessment of vertical and sagittal jaw relationships, respectively.

OBJECTIVE: :

The objectives of this study were to evaluate the reliability of ODI and APDI in overbite and Angle malocclusions, as well as assess their diagnostic reliability among males and females of different age groups.

MATERIAL AND METHODS: :

This study was conducted using pretreatment dental casts and lateral cephalograms of 90 subjects. For ODI, subjects were divided into three …

Clinical Care Of Incarcerated People With Hiv, Viral Hepatitis, Or Tuberculosis, Josiah D. Rich, Curt G. Beckwith, Alexandria Macmadu, Brandon D L Marshall, Lauren Brinkley-Rubinstein, Joseph J. Amon, M-J Milloy, Maximilian R F King, Jorge Sanchez, Lukoye Atwoli

Internal Medicine, East Africa

The burden of HIV/AIDS and other transmissible diseases is higher in prison and jail settings than in the non-incarcerated communities that surround them. In this comprehensive review, we discuss available literature on the topic of clinical management of people infected with HIV, hepatitis B and C viruses, and tuberculosis in incarcerated settings in addition to co-occurrence of one or more of these infections. Methods such as screening practices and provision of treatment during detainment periods are reviewed to identify the effect of community-based treatment when returning inmates into the general population. Where data are available, we describe differences in the …

Obesity, An Emerging Epidemic In Pakistan-A Review Of Evidence., Sana Tanzil, Tanzil Jamali

Community Health Sciences

BACKGROUND:

In Pakistan, the disease pattern is facing a huge changeover from acute and communicable diseases to the non-communicable diseases. Moreover, an emerging epidemic of obesity is still under recognized in Pakistan. A detailed review and dissemination of the existing knowledge to determine the extent of burden of obesity can help understand this important public health issue.

METHODS:

A detailed literature review was conducted through PubMed search engines, regarding obesity burden in Pakistan. The original peer reviewed research articles, reports of WHO in English language, non-government organizations reports were included in the review. "Obesity AND Pakistan" were used as a …

Progestogen-Only Contraceptive Use Among Breastfeeding Women: A Systematic Review., Sharon J. Phillips, Naomi K. Tepper, Nathalie Kapp, Kavita Nanda, Marleen Temmerman, Kathryn M. Curtis

Obstetrics and Gynaecology, East Africa

Background: Postpartum women need effective contraception. Concerns have been raised that use of progestogen-only contraceptives (POCs) may affect breastfeeding performance and infant health outcomes.

Objectives: We investigated the clinical outcomes of breastfeeding duration, initiation of supplemental feeding and weaning, as well as infant outcomes including infant growth, health and development among breastfeeding women using POCs compared with breastfeeding women not using POCs.

Search strategy: We searched the PubMed database for all articles published from database inception through December 2014.

Selection criteria: We included primary research studies of breastfeeding women of any age or parity who received POCs, including progestogen-only pills, …

Countdown To 2015 Country Case Studies: What Can Analysis Of National Health Financing Contribute To Understanding Mdg 4 And 5 Progress?, Carlyn Mann, Courtney Ng, Nadia Akseer, Zulfiqar Ahmed Bhutta, Josephine Borghi, Tim Colbourn, Patricia Hernández-Peña, Luis Huicho, Muhammad Ashar Malik, Melisa Ashar Martinez-Alvarez, Spy Munthali, Ahmad Shah Salehi, Mekonnen Tadesse, Mohammed Yassin, Peter Berman

Community Health Sciences

Background

Countdown to 2015 (Countdown) supported countries to produce case studies that examine how and why progress was made toward the Millennium Development Goals (MDGs) 4 and 5. Analysing how health-financing data explains improvements in RMNCH outcomes was one of the components to the case studies.

Methods

This paper presents a descriptive analysis on health financing from six Countdown case studies (Afghanistan, Ethiopia, Malawi, Pakistan, Peru, and Tanzania), supplemented by additional data from global databases and country reports on macroeconomic, health financing, demographic, and RMNCH outcome data as needed. It also examines the effect of other contextual factors presented in …

Comparison Of Hemodynamic Effects And Negative Predictive Value Of Normal Adenosine Gated Myocardial Perfusion Scan With Or Without Caffeine Abstinence, Maseeh Uz Zaman, Nosheen Fatima, Areeba Zaman, Unaiza Zaman, Rabia Tahseen

Department of Radiology

For vasodilator stress, myocardial perfusion imaging (MPI) with at least 12-h caffeine abstinence is recommended, as it attenuates cardiovascular hyperemic response of adenosine and dipyridamole. However, many published conflicting results have shown no significant effect upon perfusion abnormalities in MPI performed without caffeine abstinence. The aim of this study was to compare the hemodynamic changes and negative predictive value (NPV) of normal MPIs with adenosine stress performed with or without caffeine abstinence. This was a prospective study that accrued 50 patients from May 2013 till September 2013 and followed till November 2014. These patients had a normal adenosine-gated MPI (GMPI) …

Mapping Of Research On Maternal Health Interventions In Low- And Middle-Income Countries: A Review Of 2292 Publications Between 2000 And 2012, Matthew Chersich, Duane Blaauw, Mari Dumbaugh, Loveday Penn-Kekana, Siphiwe Thwala, Leon Bijlmakers, Emily Vargas, Elinor Kern, Josephine Kavanagh, Stanley Luchters

Population Health, East Africa

Background: Progress in achieving maternal health goals and the rates of reductions in deaths from individual conditions have varied over time and across countries. Assessing whether research priorities in maternal health align with the main causes of mortality, and those factors responsible for inequitable health outcomes, such as health system performance, may help direct future research. The study thus investigated whether the research done in low- and middle-income countries (LMICs) matched the principal causes of maternal deaths in these settings.

Methods: Systematic mapping was done of maternal health interventional research in LMICs from 2000 to 2012. Articles were included on …

“A Baby Was An Added Burden”: Predictors And Consequences Of Unintended Pregnancies For Female Sex Workers In Mombasa, Kenya: A Mixed-Methods Study, Stanley Luchters, Wilkister Bosire, Amy Feng, Marlise L. Richter, Nzioki King’Ola, Frances Ampt, Marleen Temmerman, Matthew F. Chersich

Population Health, East Africa

Introduction: Female sex workers (FSW) have high rates of unintended pregnancy, sexually transmitted infections including HIV, and other adverse sexual and reproductive health outcomes. Few services for FSWs include contraception. This mixed-methods study aimed to determine the rate, predictors and consequences of unintended pregnancy among FSWs in Mombasa, Kenya.

Methods: A prospective cohort study of non-pregnant FSWs was conducted. Quantitative data were collected quarterly, including a structured questionnaire and testing for pregnancy and HIV. Predictors of unintended pregnancy were investigated using multivariate logistic regression. Qualitative data were gathered through focus group discussions and in-depth interviews with FSWs who became pregnant …

Health Workers’ Perspectives, Knowledge And Skills Regarding Community Case Management Of Childhood Diarrhoea And Pneumonia: A Qualitative Inquiry For An Implementation Research Project “Nigraan” In District Badin, Sindh, Pakistan, Fauziah Rabbani, Shagufta Perveen, Wafa Aftab, Aysha Zahidie, Kashif Sangrasi, Shamim Ahmad Qazi Ahmad Qazi

Community Health Sciences

BACKGROUND:

Pakistan's Lady Health Worker Programme aims to provide care to children sick with pneumonia and diarrhoea, which continues to cause 27 % under-five mortality in Pakistan. The quality of supervision received by Lady Health Workers (LHWs) in the programme influence their knowledge and skills, in turn impacting their ability to provide care.

METHODS:

This study is part of an implementation research project titled "Nigraan" (an Urdu word meaning supervisor), and explores LHW and Lady Health Supervisor (LHS) perspectives regarding the role of supervision in improving LHWs performance and motivation in district Badin, Sindh, Pakistan. Their knowledge and skills regarding …

Economic Burden Of Mental Illnesses In Pakistan., Ashar Muhammad Malik, Murad Moosa Khan

Community Health Sciences

BACKGROUND:

The economic consequences of mental illnesses are much more than health consequences. In Low and Middle Income Countries (LMIC) the economic impact of mental illnesses is rarely analyzed. This paper attempts to fill the gap in research on economics of mental health in LMIC. We provide economic burden of mental illness in Pakistan that can serve as an argument for reorienting health policy, resource allocation and priority settings.

AIM:

To estimate economic burden of mental illnesses in Pakistan.

METHODS:

The study used prevalence based cost of illnesses approach using bottom-up costing methodology. We used Aga Khan University Hospital, Psychiatry …

Clinical Utility Of Immature Platelet Fraction - An Advanced Parameter In Laboratory Hematology, Muhammad Shariq Shaikh, Sidra Asad Ali

Department of Pathology and Laboratory Medicine

No abstract provided.

World Brain Day 2016: Celebrating Brain Health In An Ageing Population, Mohammad Wasay, Wolfgang Grisold, William Carroll, Raad Shakir

Section of Neurology

No abstract provided.

Nutrition In Intensive Care In Adults Review Of The Literature And Development Of Evidence Based Feeding Protocols., Sarah Ikram, Erfan Hussain,, Ali Bin Sarwar Zubairi

Department of Medicine

The subject of nutrition in intensive care is broad.Thenutrition support therapy plays a crucial role in the management of critically ill patients. This review was carried out to address the existing controversies and to recognise the current practice guidelines for the management of nutrition in intensive care units (ICUs) in adults. A PubMed search was carried out for clinical trials addressing the current nutrition practice in ICUs, recommendations for calculating energy requirements and efficacy of an algorithmic approach to nutritional delivery in an ICU setting. Algorithms were developed and modified for the practice of nutrition in an adult ICU in …

Ischemic Strokes: Observations From A Hospital Based Stroke Registry In Bangladesh., Nirmalenduk Bikash Bhowmik, Aamir Abbas, Mohammad Saifuddin, Md. Rashedul Islam, Rumana Habib, Aminur Rahman, Md. Amirul Haque,, Zahid Hassan, Mohammad Wasay

Department of Medicine

Background. Stroke is an important morbidity for low and middle income countries like Bangladesh. We established the first stroke registry in Bangladesh. Methods. Data was collected from stroke patients who were admitted in Department of Neurology of BIRDEM with first ever stroke, aged between 30 and 90 years. Patients with intracerebral hemorrhage, subarachnoid and subdural hemorrhage, and posttrauma features were excluded. Results. Data was gathered from 679 stroke patients. Mean age was 60.6 years. Almost 68% of patients were male. Small vessel strokes were the most common accounting for 45.4% of all the patients followed by large vessel getting affected …

Glucose Monitoring In Pregnancy Complicated By Diabetes., Aisha Sheikh, Abdul Jabbar

Department of Medicine

Diabetes in pregnancy is associated with adverse maternal and neonatal outcomes. Due to variations in insulin resistance throughout pregnancy there is a continuous need to implement Medical Nutrition Therapy (MNT), exercise and pharmacological treatments which have to be escalated. Self-monitoring of blood glucose (SMBG) is integral to the management of diabetes in pregnancy. Proper implementation of SMBG in pregnant women with diabetes requires patient education and understanding of its applications and limitations. Real-time results enable individuals to make informed daily self-care decisions regarding diet, exercise, and insulin. Retrospective analysis of SMBG data enables clinicians to develop individualized care plans, informing …

Venous Thromboembolism Following Hematopoietic Stem Cell Transplantation-A Systematic Review And Meta-Analysis, Mohammad Faizan Zahid, M Hassan Murad, Mark R. Litzow, William J. Hogan, Mrinal S. Patnaik, Alok Khorana, Alex C. Spyropoulos, Shahrukh K. Hashmi

Medical College Documents

Venous thromboembolism (VTE) is a common complication of hematopoietic stem cell transplantation (HSCT). Graft-versus-host disease (GVHD) is another complication of HSCT that may modify the risk of VTE. Our objective was to explore the incidence of VTE (deep venous thrombosis and pulmonary embolism) following HSCT and to evaluate its association with GVHD. A comprehensive search of Medline In-Process & Other Non-Indexed Citations, MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Scopus was conducted to search for both retrospective and prospective HSCT studies which had reported VTE. Random-effects meta-analysis was used to pool incidence rates. We included 17 studies reporting …

Pleural Effusion As A Manifestation Of Multiple Myeloma, Nousheen Iqbal, Muhammad Usman Tariq, Mohammad Usman Shaikh, Hashir Majid

Section of Pulmonary & Critical Care

Multiple myeloma is a clonal B-cell malignancy, characterised by proliferation of plasma cells and secretion of paraproteins. These plasma cells accumulate predominantly in the bone marrow; rarely, they invade other areas, especially the thorax. Myeloma presenting with a pleural effusion is rare and reported in only 6% of patients with myeloma. Such patients generally present late and have a poor prognosis. Here, we describe a patient presenting with a lung mass, renal failure and a massive unilateral pleural effusion due to multiple myeloma who was treated successfully.

Effectiveness Of An Interventional Program For The Management Of Hypertension Through Strengthening Of The Health Care Delivery System : A Pilot Study, Waris Qidwai, Khawar Kazmi, Kashmira Nanji, Sana Anees

Department of Family Medicine

Background: The aim of the study was to assess the effectiveness of an interventional program to improve hypertension management through strengthening of the health care delivery system.
Methods: A pilot study was conducted from February to December 2014 in two off-site Family Medicine clinics of the Aga Khan Hospital Karachi, Pakistan. Patients aged > 40 years, with known hypertension were included. At the intervention site, Family Physicians were trained; individual and group education sessions were conducted for catchment population, while usual care was provided at the control site. Referral system between primary, secondary and tertiary levels of care was …

Type 1 Diabetes Mellitus Presenting With Diabetic Ketoacidosis (Dka) In A Neonate, Fareed Ahmed, Sayyeda Ghazala Kazi, Waqas Khan

Department of Emergency Medicine

Neonatal diabetes mellitus (NDM) is a rare manifestation with an incidence of one affected individual among 400000 live births. NDM can be divided into Transient (TNDM) and Permanent (PNDM) types. A significant overlap occurs between both groups, to an extent that TNDM cannot be distinguished from PNDM based solely on clinical features. Diabetic ketoacidosis (DKA) is the leading cause of morbidity and mortality in children with type 1 diabetes mellitus (TIDM). DKA at diagnosis is more common in young children near the age of five years. Neonatal DKA is a rare occurrence causing it to be missed in the differential …

“Let’S Work: Involving Nursing Students In The Care Of Elderly People At Nursing Home”, Mehtab Qutbuddin Jaffer, Shanaz Hussein Cassum

School of Nursing & Midwifery

Working in nursing homes is the most challenging task for a nursing staff, but at the same time it can be a spirit jarring experience for young nursing students. From the perspective of nursing students, often students find it difficult to deal with elderly people living in the nursing home. They feel stressed, depressed, and insecure when asked to communicate with elderly people. At the Aga Khan University School of Nursing and Midwifery (AKU-SONAM), baccalaureate nursing students chose an elective course on care of elderly clients, where theory is offered in a blended form and clinical experience is provided by …

Three Siblings With Familial Non-Medullary Thyroid Carcinoma: A Case Series, Owais Rashid, Naeemul Haque, Saad Farooq, Zareen Kiran,, Sabeeh Siddique, Shahid Pervez

Department of Biological & Biomedical Sciences

Abstract

BACKGROUND:

In 2015, thyroid carcinoma affected approximately 63,000 people in the USA, yet it remains one of the most treatable cancers. It is mainly classified into medullary and non-medullary types. Conventionally, medullary carcinoma was associated with heritability but increasing reports have now begun to associate non-medullary thyroid carcinoma with a genetic predisposition as well. It is important to identify a possible familial association in patients diagnosed with non-medullary thyroid carcinoma because these cancers behave more destructively than would otherwise be expected. Therefore, it is important to aggressively manage such patients and screening of close relatives might be justified. Our …

Important Steps To Maintain The Privacy Of Patients In The Hospital, Savera Aziz Ali, Minaz Mawani, Gulshan Bano, Sumera Aziz Ali

School of Nursing & Midwifery

Women are considered as vulnerable groups in our society in spite of their defined women rights by various laws. This shows that unfortunately these laws are not implemented practically in the real life. Society is shaped by the individuals and everyone should be responsible for advocating their own rights as well as the right of others especially of the vulnerable groups within the population.

Making Lectures Memorable: A Cognitive Perspective, Azam Afzal, Shazia Babar

Department of Continuing Professional Education

Lectures have been a cornerstone of medical education since the introduction of a discipline based curricular model more than two hundred years ago. Recently this instructional strategy has come under criticism because of its reliance on passive learning. There are still many medical schools that cover content predominantly through lectures due to its feasibility. With the introduction of the flipped classrooms, lectures have been given a new lease of life.
Improving cognitive imprinting during lectures would enhance retrieval and promote long term storage. Simplifying the content reduces the cognitive load of the information being received and makes it more meaningful …

Pharmacy Newsletter : August 2016, Pharmacy Department

Department of Pharmacy Archives

Content:

• Pharmacy Help Desk Service.
• New Guidelines for the Management of Aspergillosis
• Overview of New CHEST Antithrombotic Guideline for Treatment of VTE (10th Edition)
• Immunization against Pneumococcal
• FDA Warnings 2016

Effects Of Responsive Stimulation And Nutrition Interventions On Children's Development And Growth At Age 4 Years In A Disadvantaged Population In Pakistan: A Longitudinal Follow-Up Of A Cluster-Randomised Factorial Effectiveness Trial, Aisha K. Yousafzai, Jelena Obradovic, Muneera A. Rasheed, Arjumand Rizvi, Ximena A. Portilla, Nicole Tirado-Strayer, Saima Siyal, Uzma Memon

Department of Paediatrics and Child Health

Background: A previous study in Pakistan assessed the effectiveness of delivering responsive stimulation and enhanced nutrition interventions to young children. Responsive stimulation significantly improved children's cognitive, language, and motor development at 2 years of age. Both interventions significantly improved parenting skills, with responsive stimulation showing larger effects. In this follow-up study, we investigated whether interventions had benefits on children's healthy development and care at 4 years of age.
Methods: We implemented a follow-up study of the initial, community-based cluster-randomised effectiveness trial, which was conducted through the Lady Health Worker programme in Sindh, Pakistan. We re-enrolled 1302 mother-child dyads (87% of …

Omitting Histopathology In Wrist Ganglions. A Risky Proposition, Akbar Jaleel Zubairi, Santosh Kumar, Yasir Mohib, Rizwan Haroon Rashid, Shahryar Noordin

Department of Surgery Docs

ABSTRACT Objectives: To identify incidence and utility of histopathology in wrist ganglions. Methods: A retrospective study of 112 patients operated for wrist swellings between January 2009 and March 2014 at Aga Khan University Hospital, Karachi, Pakistan, was conducted. Medical records were reviewed for demographics, history, location and associated symptoms, provisional diagnosis and operative details. Histopathology reports were reviewed to confirm the final diagnosis. Results: One hundred and twelve patients were included in the study (34 males and 78 females) with a mean age of 28 ± 12 years. Ninety-five percent of ganglia were dorsally located and 85% were solitary in …

Adrenalectomy For Solitary Metastasis Of Hepatocellular Carcinoma Post Liver Transplantation: Case Report And Literature Review, Imran K. Jalbani, Nazim Syed Muhammad, Usman Tariq Siddiqui, Farahat Abbas

Department of Surgery Docs

Abstract

Liver transplantation (LT) is the treatment of choice for localized hepatocellular carcinoma (HCC) associated with cirrhosis. Extra hepatic metastasis is the most common cause of death in these patients. There is very little evidence regarding the natural history and treatment options for patients developing HCC recurrence after LT. Surgical resection offers a unique opportunity for solitary metastasis. We report a 61 year old male with solitary right adrenal metastasis 15 months post LT which was managed with open adrenalectomy. The patient is alive and disease free 24 months after the surgery. The case, histo-pathological findings and literature review is …