Medicine and Health Sciences Commons^™

True Knot Of Umbilical Cord: Case Report And Review Of Literat, Momna Khan, Sana Zahiruddin, Maria Iftikhar

Department of Obstetrics & Gynaecology

True knot of umbilical cord (TKUC) is a rare abnormality. When it becomes tight, it may lead to the obstruction of the foetal circulation and intrauterine death (IUD). We present two cases of TKUC managed at The Aga Khan University Hospital with two extreme outcomes. A 22 years old primigravida was diagnosed with unexplained intrauterine foetal demise at 28th week gestation. She delivered vaginally after induction and tight TKUC was identified as a cause of IUD. The second patient delivered an alive healthy male baby vaginally who was found to have a lose TKUC.

Inspiring Health Worker Motivation With Supportive Supervision: A Survey Of Lady Health Supervisor Motivating Factors In Rural Pakistan, Fauziah Rabbani, Leah Shipton, Wafa Aftab, Kashif Sangrasi, Shagufta Perveen, Aysha Zahidie

Community Health Sciences

BACKGROUND:

Community health worker motivation is an important consideration for improving performance and addressing maternal, newborn, and child health in low and middle-income countries. Therefore, identifying health system interventions that address motivating factors in resource-strained settings is essential. This study is part of a larger implementation research project called Nigraan, which is intervening on supportive supervision in the Lady Health Worker Programme to improve community case management of pneumonia and diarrhea in rural Pakistan. This study explored the motivation of Lady Health Supervisors, a cadre of community health workers, with particular attention to their views on supportive supervision.

METHODS:

Twenty-nine …

Available Interventions For Prevention Of Cotton Dust-Associated Lung Diseases Among Textile Workers, Asaad Ahmed Nafees, Zafar Fatmi

Community Health Sciences

The authors reviewed literature on interventions for cotton dust-associated lung diseases among textile workers. Internet sources (PubMed, Cochrane Library, Google and Google Scholar) were accessed and interventions were categorized into: Engineering or administrative controls, or personal protective equipment (PPE). Ten relevant articles were shortlisted, five related to engineering controls (pre-processing, bactericidal treatment of cotton, improved workplace design, machinery and dust control measures). Administrative controls may involve setting standards, environmental surveillance, periodic medical examinations, and workers training. Although specific guidelines are available regarding the use of PPEs, but there was little literature on their effectiveness. It was concluded that there is …

Motivation And Retention Of Physicians In Primary Healthcare Facilities: A Qualitative Study From Abbottabad, Pakistan, Sayed Masoom Shah, Shehla Zaidi, Jamil Ahmed, Shafiq Ur Rehman

Community Health Sciences

BACKGROUND:

Workforce motivation and retention is important for the functionality and quality of service delivery in health systems of developing countries. Despite huge primary healthcare (PHC) infrastructure, Pakistan's health indicators are not impressive; mainly because of under-utilization of facilities and low patient satisfaction. One of the major underlying issues is staff absenteeism. The study aimed to identify factors affecting retention and motivation of doctors working in PHC facilities of Pakistan.

METHODS:

An exploratory study was conducted in a rural district in Khyber Puktunkhwa (KP) province, in Pakistan. A conceptual framework was developed comprising of three organizational, individual, and external environmental …

Pattern Of Relapse In Paediatric Acute Lymphoblastic Leukaemia In A Tertiary Care Unit, Emaduddin Siddiqui, Sayyeda Ghazala Kazi, Muhammad Irfan Habib, Khalid Mehmood Ahmed Khan, Nukhba Zia

Department of Emergency Medicine

OBJECTIVE:

To determine the frequency, site and time to relapse from diagnosis, and to see the relationship of relapse with important prognostic factors.

METHODS:

The prospective descriptive observational study was conducted at the National Institute of Child Health, Karachi, June 2005 to May 2007, and comprised newly-diagnosed cases of acute lymphoblastic leukaemia. Bone marrow aspiration was done on reappearance of blast cells in peripheral smear and cerebrospinal fluid. Detailed report was done each time when intra-thecal chemotherapy was given or there were signs and symptoms suggestive of central nervous system relapse. SPSS 12 was used for data analysis.

RESULTS:

Of …

Frequency And Outcome Of Meningitis In Pediatric Intensive Care Unit Of Pakistan, Amna Jawaid, Surriya Bano, Anwarul Haque, Khubaib Arif

Department of Emergency Medicine

Meningitis is a leading cause of morbidity and mortality worldwide in intensive care settings. The aim of this study was to assess the frequency and outcome in children with meningitis through a retrospective chart review done in pediatric intensive care unit of a tertiary care hospital from January 2000 to December 2014. During these 14 years, 64 patients were admitted with meningitis in pediatric intensive care unit. Out of 64, 36 were diagnosed with pyogenic meningitis, 18 patients with viral meningitis, and 10 with tuberculous meningitis. Most complications were observed in the initial 48 hours. Most common presentation was altered …

Primary Melanotic Schwannoma With Typical Histology, Usman B. Mahmood, Fazal Wahab Khan, Benish Fatima, Muhammad Usman Tariq, Saulat Hasnain Fatimi

Department of Surgery Docs

Abstract

We present a case of a 17-year male with a soft tissue density spreading from the neural foramina (T3) of the spinal cord and involving the right upper thoracic cavity. We managed the patient through surgical intervention and resected the complete tumor. Gross definition and microscopic findings of the resected tissue revealed the definitive diagnosis of melanotic schwannoma. The histological characteristics in this case were very specific and harbour an important diagnostic clue for this rare disease. Malignant melanoma was ruled out on the basis of histological findings. The patient recovered completely and was healthy on one-year follow-up.

Acceptability And Feasibility Of Point-Of-Care Cd4 Testing On Hiv Continuum Of Care In Low And Middle Income Countries: A Systematic Review, Minh D. Pham, Paul A. Agius, Lorena Romero, Peter Mcglynn, David Anderson, Suzanne M. Crowe, Stanley Luchters

Population Health, East Africa

Background: CD4 testing is, and will remain an important part of HIV treatment and care in low and middle income countries (LMICs). We report the findings of a systematic review assessing acceptability and feasibility of POC CD4 testing in field settings.

Methods: Electronic databases were searched for studies published in English between 2005 and 2015 that describe POC CD4 platforms. Studies conducted in LMICs and under field conditions outside a laboratory environment were eligible. Qualitative and descriptive data analysis was used to present the findings.

Results: Twelve studies were included, 11 of which were conducted in sub-Saharan countries and used …

Intertrochanteric Hip Fractures In Octogenarian Patients: Do We Need To Rethink Fixation Strategy?, Shahryar Noordin, Shahbano 1, Tashfeen Ahmad, Idrees Shah

Department of Surgery Docs

Abstract

OBJECTIVE:

To compare outcomes in octogenarians with younger patients up to 1 year after undergoing dynamic hip screw fixation for intertrochanteric fractures to see the effectiveness of the implant.

METHODS:

The retrospective case-control study was conducted at The Aga Khan University and comprised records of patients who underwent dynamic hip screw surgery between January 1, 2010, and December 31, 2012. They were divided into two groups based on their age:. Group A <80 years; and Group B > 80 years. All patients had a one-year follow-up> Data including mortality, morbidity, radiological healing time, postoperative ambulatory status and Harris hip score were recorded.

RESULTS:

Of the …

Global Burden Of Maternal And Congenital Syphilis In 2008 And 2012: A Health Systems Modelling Study, N. Saman Wijesooriya, Roger W. Rochat, Mary L. Kamb, Prasad Turlapati, Marleen Temmerman, Nathalie Broutet, Lori M. Newman

Obstetrics and Gynaecology, East Africa

Background: In 2007, WHO launched a global initiative for the elimination of mother-to-child transmission of syphilis (congenital syphilis). An important aspect of the initiative is strengthening surveillance to monitor progress towards elimination. In 2008, using a health systems model with country data inputs, WHO estimated that 1·4 million maternal syphilis infections caused 520 000 adverse pregnancy outcomes. To assess progress, we updated the 2008 estimates and estimated the 2012 global prevalence and cases of maternal and congenital syphilis.

Methods: We used a health systems model approved by the Child Health Epidemiology Reference Group. WHO and UN databases provided inputs on …

Peer Pressure And Family Smoking Habits Influence Smoking Uptake In Teenage Boys Attending School: Multilevel Modeling Of Survey Data., Shafquat Rozi, Sadia Mahmud, Gillian Lancaster, Nida Zahid

Community Health Sciences

Introduction:

Among young teens, about one in five smokes worldwide. Adolescents spend a considerable amount of their time in school, and the school environment is therefore important for child health practices and outcomes.

Objectives:

We aimed to investigate the impact on smoking behavior of the school environment and the personal characteristics of male teenage students attending schools in Pakistan, taking into account the survey sampling structure.

Methods:

A two-stage cluster sampling with stratification was employed, and we interviewed 772 male secondary school students. We adopted random effect and generalizing estimating equation models.

Results:

Peer pressure in particular had a strong …

Dissemination And Spread Of New Delhi Metallo-Beta-Lactamase-1 Superbugs In Hospital Settings, Erum Khan, Seema Irfan, Binish Arif Sultan, Amna Nasir, Rumina Hasan

Department of Pathology and Laboratory Medicine

Objective:
To find out frequency of isolation of carbapenem-resistant enterobacteriaceae and the predominantly responsible metallo-beta-lactamasegene in a hospital setting.
Methods:
The descriptive, cross-sectional study was conducted from May 2009 to June 2012 at the Aga Khan University Hospital, Karachi, and comprised non-duplicate clinical carbapenem-resistant enterobacteriaceae isolates obtained from different collection units across Pakistan. Kirby-Bauer disk diffusion screening of carbapenem-resistant enterobacteriaceae was confirmed by minimum inhibitory concentration using E-test. Polymerase chain reaction assay was performed to detect blaKPC, blaNDM-1, blaIMP, and blaVIM genes. In addition variable number tandem repeat typing was performed on selected cluster of New Delhi metallo-beta-lactamase-1- positive …

Three Siblings With Familial Non-Medullary Thyroid Carcinoma: A Case Series, Muhammad Owais Rashid, Naeemul Haq, Saad Farooq, Zareen Kiran,, Sabeehuddin Siddique, Shahid Pervez, Najmul Islam

Department of Pathology and Laboratory Medicine

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 case …

Standard Post-Stroke Care: Far From Reality In Pakistan., Shahvaiz Magsi, Adeel Khoja, Mansoor Ali Merchant Rameez

Department of Medicine

No abstract provided.

Participatory Approaches Involving Community And Healthcare Providers In Family Planning/Contraceptive Information And Service Provision: A Scoping Review., Petrus S. Steyn, Joanna Paula, Peter Gichangi, Jennifer A. Smit, Theresa Nkole, James Kiarie, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

As efforts to address unmet need for family planning and contraception (FP/C) accelerate, voluntary use, informed choice and quality must remain at the fore. Active involvement of affected populations has been recognized as one of the key principles in ensuring human rights in the provision of FP/C and in improving quality of care. However, community participation continues to be inadequately addressed in large-scale FP/C programmes. Community and healthcare providers’ unequal relationship can be a barrier to successful participation. This scoping review identifies participatory approaches involving both community and healthcare providers for FP/C services and analyzes relevant evidence. The detailed analysis …

Partnership In Action: A Case Study In Nursing Workforce And Leadership Development In East Africa, Sharon Brownie

School of Nursing & Midwifery, East Africa

Session presented on Saturday, July 23, 2016: East Africa suffers an inordinate burden of disease and does not have the numbers of suitably qualified nurses and midwives to address this challenge.' Focussed efforts in nursing workforce capacity building are needed to build capacity within nursing education, practice and leadership. An enhanced nursing and midwifery workforce is needed across all disciplines with development required at all levels including upgrade of the existing workforce, development of speciality qualifications and enhancement of leadership capacity.'This presentation involves a case study in which university private-public partnerships have successful contributed to nursing capacity enhancement of nursing …

Caesarean Section Surgical Techniques: All Equally Safe, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Since 1985, a caesarean section rate of 10–15% has been deemed optimum by the international health-care community.1 When caesarean section rates rise towards 10% across a population, maternal and newborn deaths decrease; when they are higher than 15%, there is no evidence of reduced mortality.1 Complications of caesarean sections can be substantial and sometimes permanent for both mothers and babies, and can result in disability or death, especially in settings with inadequate facilities or capacity to undertake safe surgery and treat surgical complications.

Epidemiology And Outcomes Of Out-Of-Hospital Cardiac Arrest In A Developing Country-A Multicenter Cohort Study., Minaz Mawani, Muhammad Masood Kadir, Iqbal Azam Syed, Amber Mehmood, Bryan Mcnally, Kent Stevens,, R. Nuruddin, Mohammad Ishaq, J. Razzak

Section of Cardiology

Background

Out-of-hospital cardiac arrest (OHCA) is one of the leading causes of death and disability worldwide. Overall survival after an OHCA has been reported to be poor and limited studies have been conducted in developing countries. We aimed to investigate the rates of survival from OHCA and explore components of the chain of survival in a developing country.

Methods

We conducted a multicenter prospective cohort study in the emergency departments (ED) of five major public and private sector hospitals of Karachi, Pakistan from January 2013 to April 2013. Twenty-four hour data collection was performed by trained data collectors, using a …

‘Essential But Not Always Available When Needed’ – An Interview Study Of Physicians’ Experiences And Views Regarding Use Of Obstetric Ultrasound In Tanzania, Annika Åhman, Hussein Kidanto, Matilda Ngarina, Kristina Edvardsson, Rhonda Small, Ingrid Mogren

Faculty of Health Sciences, East Africa

Background The value of obstetric ultrasound in high-income countries has been extensively explored but evidence is still lacking regarding the role of obstetric ultrasound in low-income countries.

Objective We aimed to explore experiences and views among physicians working in obstetric care in Tanzania, on the role of obstetric ultrasound in relation to clinical management.

Design A qualitative study design was applied. Data were collected in 2015, through 16 individual interviews with physicians practicing in obstetric care at hospitals in an urban setting in Tanzania. Data were analyzed using qualitative content analysis.

Results Use of obstetric ultrasound in the management of …

Control Of Poisoning Through Product Labeling Of Hazardous Chemicals, Nadeem Ullah Khan, Arshad Iqbal, Sadaf Sheikh

Department of Emergency Medicine

No abstract provided.

Analysis Of The Health Care System Of Pakistan: Lessons Learnt And Way Forward., Zohra Kurji, Zahra Shaheen Premani, Yasmin Mithani

School of Nursing & Midwifery

BACKGROUND:

Pakistani health care system is in progress and since last year, Pakistan has tried to make much improvement in its health care delivery system and has brought out many reforms.

METHODS:

A systematic search of national and international literature was looked from peerreviewed databases form MEDLINE, CINAHL, and PubMed.

RESULTS:

There is little strength in health care delivery system in Pakistan like making health policies, participating in Millennium Development Goals program, initiating vertical programs and introducing Public Private Partnership, improving human resource development and infrastructure by making Basic Health Unit and Rural Health Centres. However, these all programs are …

Important Strategies For Effective Family Planning Counseling, Savera Aziz Ali, Minaz Mawani, Gulshan Bano, Sumera Aziz Ali

School of Nursing & Midwifery

No abstract provided.

Tobacco Control Laws In Pakistan And Their Implementation: A Pilot Study In Karachi, Javaid Ahmed Khan, Abdul Malik Amir Humza Sohail, Muhammad Arslan Arif Maan

Section of Pulmonary & Critical Care

Objective: In order to limit the high prevalence of tobacco use in Pakistan various tobacco control laws have been implemented. The objective of this study is to serve as a pilot study to assess the implementation of these laws in the largest city of Pakistan, Karachi.

Methods: A cross-sectional study was conducted in Karachi. The implementation of tobacco control laws in 'smoke-free' places, the adherence of tobacco companies to these laws, the regulation of cigarette sale, and the awareness and views of the general public regarding tobacco control laws were assessed via direct observation by visits and through self-administered …

Use Of Smokeless Tobacco In Medical Students And Hypertension, Sumera Aziz Ali

Community Health Sciences

No abstract provided.

Significantly Low Effective Dose From 18fdg Pet/Ct Scans Using Dose Reducing Strategies: "Lesser Is Better", Maseeh Uz Zaman, Nosheen Fatima, Unaiza Zaman, Rabia Tahseen

Department of Surgery Docs

Abstract

BACKGROUND:

Fluorodeoxyglucose (18FDG) PET/CT imaging has become an important component of the management paradigm in oncology. However, the significant imparted radiation exposure is a matter of growing concern especially in younger populations who have better odds of survival. The aim of this study was to estimate the effective dose received by patients having whole body 18FFDG PET/CT scanning as per recent dose reducing guidelines at a tertiary care hospital.

MATERIALS AND METHODS:

This prospective study covered 63 patients with different cancers who were referred for PET/CT study for various indications. Patients were prepared as per departmental protocol and 18FDG …

Stretching The Boundaries Of Medical Education: A Case Of Medical College Embracing Humanities And Social Sciences In Medical Education, Kulsoom Ghias, Kausar S. Khan, Rukhsana Ali, Shireen Azfar, Rashida Ahmed

Community Health Sciences

Objective:

Aga Khan University, a private medical college, had a vision of producing physicians who are not only scientifically competent, but also socially sensitive, the latter by exposure of medical students to a broad-based curriculum. The objective of this study was to identify the genesis of broad-based education and its integration into the undergraduate medical education program as the Humanities and Social Sciences (HASS) course.

Methods:

A qualitative methodology was used for this study. Sources of data included document review and in-depth key informant interviews. Nvivo software was utilized to extract themes.

Results:

The study revealed the process of operationalization …

Relationship Of Tumor Thickness With Neck Node Metastasis In Buccal Squamous Cell Carcinoma: An Experience At A Tertiary Care Hospital, Sadaf Qadeer Ahmed, Montasir Junaid, Sohail Awan, Moaz M. Choudhary, Maliha Kazi, Aria Masoom, Hareem Usman Khan

Department of Surgery Docs

Introduction Squamous cell carcinoma is the most common malignancy of the head and neck, with the buccal mucosa being the most common site involved. Early locoregional metastasis is a hallmark of this disease, and early stage tumors may harbor metastatic nodes that are occult. Certain parameters can help identify high-risk patients for whom the pattern of occult nodal metastasis can be predicted. Tumor thickness is one such objective parameter. Objective To determine the relationship of tumor thickness with neck node metastasis in squamous cell carcinoma of the buccal mucosa. Methods A retrospective chart review of 102 patients with biopsy-proven squamous …

Comparison Of Ureteric Stone Size, On Bone Window Versus Standard Soft-Tissue Window Settings, On Multi-Detector Non-Contrast Computed Tomography., Hussam Uddin Soomro, Hammad Ather, Basit Salam

Department of Surgery Docs

Abstract

OBJECTIVE:

To compare the difference in mean stone size, as measured on bone window vs standard soft-tissue window setting using multi-detector computed tomography (MDCT) in patients with a solitary ureteric stone.

PATIENTS AND METHODS:

In all, 60 patients presenting to the emergency and outpatient departments of a University Hospital from May 2015 to October 2015 and fulfilling the inclusion criteria were included in the study. A 64-slice MDCT was used to assess the locations and size of the ureteric stones. A consultant radiologist independently analysed the MDCT scans of all the patients. The mean difference in stone size was …

In-Vitro Comparison Of Micro-Leakage Between Nanocomposite And Microhybrid Composite In Class V Cavities Treated With The Self-Etch Technique, Syeda Mahvish Hussain, Farhan Raza Khan

Department of Surgery Docs

Abstract

BACKGROUND:

When a light cure composite resin is used to restore a class V lesion, certain stresses are generated at the tooth-restoration interface. If these stresses exceed the bond strength of the restorative material, microscopic gaps are formed which eventually cause micro-leakage at the tooth-restoration interface. The objective of the present study was to compare the micro-leakage values at the tooth-restoration interface using dye penetration method between a Nano filled and a Micro hybrid light cured composite resin in class V cavities using the self-etch technique.

METHODS:

Sixty class V cavities were made coronal to the cemento-enamel junction in …

Male Involvement In Reproductive, Maternal And Child Health: A Qualitative Study Of Policymaker And Practitioner Perspectives In The Pacific, Jessica Davis, Joseph Vyankandondera, Stanley Luchters, David Simon, Wendy Holmes

Population Health, East Africa

Background: The importance of involving men in reproductive, maternal and child health programs is increasingly recognised globally. In the Pacific region, most maternal and child health services do not actively engage expectant fathers and fathers of young children and few studies have been conducted on the challenges, benefits and opportunities for involving fathers. This study explores the attitudes and beliefs of maternal and child health policymakers and practitioners regarding the benefits, challenges, risks and approaches to increasing men's involvement in maternal and child health education and clinical services in the Pacific.

Methods: In-depth interviews were conducted with 17 senior maternal …