Medicine and Health Sciences Commons^™

Antimicrobial Resistance And Neisseria Gonorrhoeae Multiantigen Sequence Typing (Ng-Mast) Genotypes In N. Gonorrhoeae During 2012-2014 In Karachi, Pakistan, Kausar Jabeen, Bhawan Mal P, Khan E, Chandio S, Jacobsson S, Unemo M

Department of Pathology and Laboratory Medicine

Background: Globally, increasing antimicrobial resistance (AMR) in Neisseria gonorrhoea has led to decreased treatment options for gonorrhoea. Continuous monitoring of resistance is crucial to determine evolving resistance trends in Neisseria gonorrhoea and to suggest treatment recommendations. Quality assured gonococcal AMR data from Pakistan are mainly lacking. This study was performed to determine prevalence and trends of gonococcal AMR and molecular epidemiology of local strains during 2012-2014 in Karachi, Pakistan.

Methods: Gonococcal isolates (n = 100) were obtained from urogenital specimens submitted to the Aga Khan University Laboratory, Karachi, Pakistan. Antimicrobial susceptibility was determined using Etest and molecular epidemiology was …

Awareness Regarding Application Of Endotracheal Tube (Ett) Cuff Pressure Measuring Gauge In Anesthesia Practice; Acritical Step To Avoid Postintubation Tracheal Stenosis In Critically Ill Patients On Prolonged Mechanical Ventilator, Mohammad Irfan Akhtar

Department of Anaesthesia

No abstract provided.

Severity Of Lower Urinary Tract Symptoms Among Middle Aged And Elderly Nigerian Men: Impact On Quality Of Life, Patrick Temi Adegun, Philip Adebayo, Peter Olufemi Areo

Internal Medicine, East Africa

Objectives. To compare the severity of LUTS among middle aged and elderly Nigerian men and determine the influence of LUTS severity on QoL.

Methods. This cross-sectional study was conducted among new patients presenting with LUTS attending Urology clinic between 2011 and 2015. Assessment of symptoms was based on IPSS and bother score completed by the eligible subjects on the same day of their clinic visits.

Results. Four hundred patients were studied comprising 229 middle aged and 171 elderly men. Interquartile range (IQR) of IPSS scores for men < 65 years and those ≥65 years was 14.0 (16.0) and 19 (15.0), respectively (p < 0.001). Mild LUTS was significantly associated with best, good, and poor quality of life while moderate LUTS was associated with poor QoL. Severe LUTS was significantly associated with all the categories of QoL (Best-Worst). Among the cohort of subjects with poor QoL, elderly patients had a significantly higher median IPSS score (p < 0.05).

Conclusions. There is no level of severity of LUTS in which patients’ QoL …

Increasing Hiv-1 Pretreatment Drug Resistance Among Antiretroviral-Naïve Adults Initiating Treatment Between 2006 And 2014 In Nairobi, Kenya, Michael Chung, Silverman Rachel, Beck Ingrid, Yatich Nelly, Dross Sandra, Jennifer Mckernan-Mullin, Stephen Bii, Kenneth Tapia, Joshua Stern, Chohan Bhavna, Samah R. Sakr, James N. Kiarie

Internal Medicine, East Africa

Antiretroviral-naïve adults initiating antiretroviral therapy in Nairobi, Kenya were tested for HIV-1 drug resistance at codons K103N, Y181C, G190A, M184V, and K65R using an oligonucleotide ligation assay. Prevalence of pretreatment drug resistance increased from 3.89% in 2006 to 10.93% in 2014 (P < 0.001), and 95% of those with resistance had at least one nonnucleoside reverse transcriptase inhibitor mutation. Resistance to tenofovir (K65R) was found in 2014 but not in 2006.

Nurses' Involvement In Hiv Policy Formulation In Nigerian Health Care System, Ekaete Asuquo, Josephine Bassey Etowa, Wendy A. Gifford, Dave Holmes

School of Nursing & Midwifery, East Africa

Background of study: Nigerian national policy on HIV stresses the need for the adoption of multi-sectoral and multi-disciplinary approach in policy formulation, with the health sector taking the lead. This calls for collaboration among the various stakeholders including nurses in policy development initiatives to ensure that diverse health care needs and disciplinary perspectives are captured in HIV health policies.

Purpose: This paper will present the findings of a recent study which examined nurse’s involvement in policy development in the context of mother-to-child transmission (MTCT) of HIV in Nigeria.

Methodology: A qualitative case study design under the guiding tenets of critical …

Health Care Seeking Behaviours In Pregnancy In Rural Sindh, Pakistan: A Qualitative Study, Rahat Najam Qureshi, Sana Sheikh, Asif Raza Khowaja, Zahra Hoodbhoy, Shujaat Zaidi, Diane Sawchuck, Marianne Vidler, Zulfiqar A. Bhutta, Peter Von Dadeslzen

Department of Paediatrics and Child Health

Background: Pakistan has alarmingly high numbers of maternal mortality along with suboptimal care-seeking behaviour. It is essential to identify the barriers and facilitators that women and families encounter, when deciding to seek maternal care services. This study aimed to understand health-seeking patterns of pregnant women in rural Sindh, Pakistan.
Methods: A qualitative study was undertaken in rural Sindh, Pakistan as part of a large multi-country study in 2012. Thirty three focus group discussions and 26 in-depth interviews were conducted with mothers [n=173], male decision-makers [n=64], Lady Health Workers [n=64], Lady Health Supervisors [n=10], Women Medical Officers [n=9] and Traditional Birth …

Community's Perceptions Of Pre-Eclampsia And Eclampsia In Sindh Pakistan: A Qualitative Study, Asif Raza Khowaja, Rahat Najam Qureshi, Sana Sheikh, Shujaat Zaidi, Rehana Salam, Diane Sawchuck, Marianne Vidler, Peter Von Dadelszen, Zulfiqar Bhutta

Department of Paediatrics and Child Health

Background: Maternal mortality is of global public health concern and >99% of maternal deaths occur in less developed countries. The common causes of direct maternal death are hemorrhage, sepsis and pre-eclampsia/eclampsia. In Pakistan, pre-eclampsia/eclampsia deaths represents one-third of maternal deaths reported at the tertiary care hospital settings. This study explored community perceptions, and traditional management practices about pre-eclampsia/eclampsia.
Methods: A qualitative study was conducted in Sindh Province of Pakistan from February to July 2012. Twenty-six focus groups were conducted, 19 with women of reproductive age/mothers-in-law (N=173); and 7 with husbands/fathers-in-law (N=65). The data were transcribed verbatim in Sindhi and Urdu, …

The Feasibility Of Community Level Interventions For Pre-Eclampsia In South Asia And Sub-Saharan Africa: A Mixed-Methods Design, Asif Raza Khowaja, Rahat Najam Qureshi, Diane Sawchuck, Olufemi T. Oladapo, Olalekan O. Adetoro, Elizabeth A. Orenuga, Mrutyunjaya Bellad, Ashalata Mallapur, Umesh Charantimath, Esperanca Sevene

Department of Paediatrics and Child Health

Background: Globally, pre-eclampsia and eclampsia are major contributors to maternal and perinatal mortality; of which the vast majority of deaths occur in less developed countries. In addition, a disproportionate number of morbidities and mortalities occur due to delayed access to health services. The Community Level Interventions for Pre-eclampsia (CLIP) Trial aims to task-shift to community health workers the identification and emergency management of pre-eclampsia and eclampsia to improve access and timely care. Literature revealed paucity of published feasibility assessments prior to initiating large-scale community-based interventions. Arguably, well-conducted feasibility studies can provide valuable information about the potential success of clinical trials …

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

Emergency Medicine, East Africa

When someone telephones for an ambulance, an interaction ensues which should be efficient and effective to facilitate a speedy dispatch of the appropriate level of vehicle, equipment and personnel to where it is needed. The process in South Africa begins with a three-part opening sequence which typically identifies the organisation, introduces the call-taker (CT) and invites the caller to proceed with the business of the call. In a recent project conducted in a South African emergency service, the researchers aimed to ascertain the impact of the CT’s identification sequence on the progression of the call and to determine whether there …

Neuromyelitis Optica (Devic’S Disease) In A 10 Years Old Boy., Dr.Farida Jan, Amber Shabir, Shahnaz Ibrahim

Pakistan Journal of Neurological Sciences (PJNS)

Neuromyelitis optica (NMO) also known as Devic’s disease is an acute demyelinating disorder combined with optic neuritis and transverse myelitis.A 10 years old boy presented in the ER with the complaints of fever and back pain for past 10 days and inability to walk for 6-7 days. He had developed urinary retention and constipation for the past 5 days along with abdominal distension. There was also blurring of vision in the left eye with only light perception and rapid afferent papillary defect was present while the right eye was normal. The provisional diagnosis was Transverse myelitis vsNeuromyelitisoptica (NMO). CSF revealed …

10-Year Pattern Of Admissions In Psychiatric Unit At A Tertiary Care Hospital In Pakistan., Raza Ur Rahman, Abdul Ghani Khan, Naila Naerm Shahbaz

Pakistan Journal of Neurological Sciences (PJNS)

To identify the pattern of psychiatric morbidity in hospitalized patients of a tertiary care unit.Design; Details of patient’s admissions from the case register of psychiatric unit were recorded retrospectively.The study was conducted in Dept. of Psychiatry Jinnah Postgraduate Medical Centre JPMC Karachi and included data of ten years. RESULTS;- TA total of 5527 patients were hospitalized during period of ten years (1995 – 2004). Among them 62.612% (n = 3461) were males and 37.38 (n = 2066) were females. The majority of patients were in the age range of 15 – 44 years. On the basis of ICD classification, mood …

Biventricular Thrombus In Hypereosinophilic Syndrome Presenting With Shortness Of Breath, Abdul Baqi, Shahan Waheed, Fateh Ali Tipoo Sultan, Aamir Hameed

Section of Cardiology

A 48 years old male presented to clinic with 12 months of low grade fever with shortness of breath which has progressively worsened with no associated weight loss, night sweats or loss of appetite. There was no prior history of chronic illness before the current illness. Laboratory workup revealed a high white blood cell count with predominant eosinophils. Chest X-ray was normal. Transthoracic echocardiography and Cardiac Magnetic Resonance showed biventricular thrombi. On further extensive workup the findings were consistent with hypereosinophilic syndrome. The patient was started on oral steroids, hydroxyurea, imatanib mesylate and oral anticoagulation. The patient responded to the …

Tobacco Cessation Treatment: Knowledge, Attitude And Practices Of Physician In Karachi, Pakistan: A Cross Sectional Study, Muhammad Naeem, Muhammad Irfan, Minaz Mawani, Zeeshan Waheed, Ahmed Suleman Haque, Ali Bin Sarwar Zubairi, Javaid Khan

Section of Pulmonary & Critical Care

Introduction: Tobacco smoking is a public health problem leading to substantial morbidity and mortality with around 80% of the deaths occurring in developing countries. Physician intervention has been shown to increase cessation rates. The study aims to assess knowledge, attitudes and practices of physicians in tobacco cessation treatment in Karachi Pakistan.

Methods: A descriptive cross sectional study was carried out between June to December 2013. All practicing physicians from Karachi were recruited. Survey questionnaire was distributed among randomly selected physicians after obtaining their consent. The study was approved by ethics review committee of The Aga Khan University Hospital.

Results: A …

Imaging Guided Breast Interventions, Imrana Masroor, Shaista Afzal, Saira Naz Sufian

Department of Radiology

Breast imaging is a developing field, with new and upcoming innovations, decreasing the morbidity and mortality related to breast pathologies with main emphasis on breast cancer. Breast imaging has an essential role in the detection and management of breast disease. It includes a multimodality approach, i.e. mammography, ultrasound, magnetic resonance imaging, nuclear medicine techniques and interventional procedures, done for the diagnosis and definitive management of breast abnormalities. The range of methods to perform biopsy of a suspicious breast lesion found on imaging has also increased markedly from the 1990s with hi-technological progress in surgical as well as percutaneous breast biopsy …

Contemporary Data On Cardiovascular Diseases In Indians: American College Of Cardiology's Pinnacle India Quality Improvement Program, Ankur Kalra, Nathan Glusenkamp, William J. Oetgen, Salim S. Virani

Office of the Provost

No abstract provided.

Preferred Features Of E-Mental Health Programs For Prevention Of Major Depression In Male Workers: Results From A Canadian National Survey, Jianli Wang, Raymond W. Lam, Kendall Ho, Mark Attridge, Bonnie M. Lashewicz, Scott B. Patten, Alain Marchand, Alice Aiken, Norbert Schmitz, Zul Merali

Brain and Mind Institute

Background: Major depression is a prevalent mental disorder and imposes considerable burden on health and productivity. Men are not immune to major depression, yet they often delay seeking help because of perceived stigma and gender norms. E-mental health programs hold potential for early prevention of major depression. However, we have little knowledge about men's preferences for design features of e-mental health programs.

Objectives: The objective of this study was to (1) estimate and compare the proportions of Internet use for medical information, preferred design features, and likely use of e-mental health programs; (2) examine factors associated with the likely use …

Cost Of Management Of Severe Pneumonia In Young Children: Systematic Analysis, Shanshan Zhang, Peter M. Sammon, Isobel King, Ana Lucia Andrade, Cristiana M. Toscano, Sheila N. Araujo, Anushua Sinha, Shabir A. Madh, Gulam Khandaker, Jiehui Kevin Yin, Robert Booy, Tanvir M. Huda, Qazi S. Rahman, Shams El Arifeen, Angela Gentile, Norberto Giglio, Mejbah U. Bhuiyan, Katharine Sturm Ramirez, Bradford D. Gessner, Mardiati Nadjib, Phyllis J. Carosone– Link, Eric Af Simões, Jason A. Child, Imran Ahmed, Zulfiqar Ahmed Bhutta, Sajid Bashir Soofi

Department of Paediatrics and Child Health

Background: Childhood pneumonia is a major cause of childhood illness and the second leading cause of child death globally. Understanding the costs associated with the management of childhood pneumonia is essential for resource allocation and priority setting for child health.
Methods: We conducted a systematic review to identify studies reporting data on the cost of management of pneumonia in children younger than 5 years old. We collected unpublished cost data on non–severe, severe and very severe pneumonia through collaboration with an international working group. We extracted data on cost per episode, duration of hospital stay and unit cost of interventions …

Perforated Sub-Hepatic Appendix; Rare Presentation Of A Common Disease., Huzaifa Ali Jaliawala, Fatima Mannan, Roger Gill, Abdul Rehman Alvi

Department of Surgery Docs

Abstract

An elderly gentleman presented to our emergency with a 10-day history of right upper quadrant pain and nausea with associated tenderness on examination. His white cell counts were raised with predominant neutrophils with ultrasound evidence of a heterogeneous sub-hepatic collection, not associated with fever, diarrhoea or vomiting. He had a similar episode 3 weeks ago, which resolved with antibiotics. Initially thought to be a perforated acute appendicitis or a liver abscess a CT scan was done to further substantiate our finding. This to the contrary revealed a perforated sub hepatic appendix. Patient was treated conservatively with IV fluids and …

Preventing Stroke At Door Step– Need For A Paradigm Shift In Delivery Of Preventive Healthcare, Ismail A. Khatri, Saad Farooq, Muneeza A. Khatri

Pakistan Journal of Neurological Sciences (PJNS)

Although stroke is a preventable disease, it is increasing globally. Only few risk factors are responsible for much of the leading noncommunicable diseases, yet those remain poorly controlled, despite being the most affordable way of promoting health and preventing disease [1]. Lifestyle modification including cessation of smoking, making aerobic physical activity a routine, certain changes in diet, and aggressive management of risk factors are all part of stroke prevention strategies [2].

Frequency Of Cranial Autonomic Symptoms (Cas) In Migraine Patients, Sadaf Nasir, Naureen Abrar, Khalid Sher, Shahnaz Shahnaz

Pakistan Journal of Neurological Sciences (PJNS)

Of all the painful states that afflict humans, headache is undoubtedly the most frequent and common reason for seeking medical help. Headache has over 300 different types and different etiologies; migraine is one of them and continues being an under diagnosed condition in many of cases as it can be accompanied by symptoms commonly associated with other causes of facial pain. Out of 28 million people in USA who have history of headache and symptoms which mimic the typical migraine only 48% are diagnosed of migraine.

Two Cases Of Hyperkalemia Presenting As Acute Demyelinating Polyneuropathy: Clinical And Electrophysiological Reversibility With In 72 Hours With Potassium Correction., Waseem Tariq, Arsalan Ahmad,Md

Pakistan Journal of Neurological Sciences (PJNS)

GullianBarre syndrome (GBS) is the most common cause of acute flaccid paralysis.Hypokalemia can present with flaccid paralysis and nerve conduction studies show axonal neuropathy.Here we present two cases who were initially admitted with suspicion of GBS but later on baseline investigations showed very high serumpotassium and in both cases nerve conduction showed acute demyelinating polyneuropathy.They were admitted in high dependency units and urgent dialysis was done.In first case NCS were repeated 72 hours of correction of hyperkalemia and they showed significant improvement. In second patient NCSwere repeated after 24 hours and they showed mild improvement in all parameters.

Frequency Of Intraventricular Extension In Intracerebral Hemorrhage And Its Outcome At Day 30., Farheen Niazi,, Muhammad Irshad

Pakistan Journal of Neurological Sciences (PJNS)

Intracerebral hemorrhage (ICH) accounts for 10 to 15% of all strokes, and is found to have a disproportionately high morbidity and mortality.1 Extension of the hemorrhage intothe ventricles (40% occurrence) can happen early or late in the course of events.2 OBJECTIVE: To determine the frequency of Intraventricular extension in patients with intracerebralhaemorrhage and its outcome at day 30 by measuring disability using Modified Rankin Scale.STUDY DESIGN: Descriptive case series.PLACE AND DURATION OF STUDY: Study was carried out from 1st December 2010 to 31st May, 2011 in the department of Neurology, PIMS, Islamabad, Pakistan SUBJECT AND METHODS:93 patients of intracerebralhaemorrhage were …

10thannual Neurology Research Day, May 2016 Abstracts Shifa International Hospital, Islamabad, Rohaan Noor, Komal Gilani, Umer Farooq, Sabul Zafar, Fatima Aurangzaib.

Pakistan Journal of Neurological Sciences (PJNS)

Burden of headache has been assessed in adults in countries worldwide, and is high, but data for children and adolescents is sparse. The objective of this study is to fill the information gap for adolescents.

Surgical Outcome Of Benign Intracranial Hypertension In Terms Of Improvement In Vision, Naeem Ul Haq, Naseer Hassan, Muhammad Ishaq, Muhammad Usman

Pakistan Journal of Neurological Sciences (PJNS)

To know about surgical outcome of benign intracranial hypertension in terms of improvement of vision.METHODOLOGY ; This Prospective observational study was conducted at of 22 patients operated in neurosurgery unit lady reading hospital Peshawar from Jan 2011 to Jun2014. Written consent was obtained from all the patients or their relatives All patients of either age and sex with Diagnosed cases of BIH were included in the study, Patients with depressed conscious level, malignant hypertension, space occupying lesion in brain on MRI and those Patients unfit or unwilling for surgery were excluded from the study. Patients particulars like age ,gender , …

Editorial - Jam June 2016, Rafat Jan, Edwin Van Teijlingen

Journal of Asian Midwives (JAM)

No abstract provided.

News & Events

Journal of Asian Midwives (JAM)

No abstract provided.

Needs And Expectations: A Membership Survey Of The Midwifery Association In Afghanistan, Sabera Turkmani, Cristina De Nicolás, Fatima Gohar, Pashtoon Azfar Zyaee

Journal of Asian Midwives (JAM)

A survey of the Afghan Midwives Association (AMA) members was conducted in April 2013 to determine the profile of the midwifery workforce, and to provide guidance on the professional needs and expectations of midwives in the future. Of the estimated 3,000 members across the country, around 500 participated in the Annual Congress, 400 questionnaires were distributed randomly among participants, and 357 were returned (89% response rate representing 12% of the overall membership).

The results showed that most members are pleased with the Association, and value its work, particularly its ability to advocate on their behalf with the Ministry of Public …

Birthing Centres In Nepal: Recent Developments, Obstacles And Opportunities, Preeti K. Mahato, Edwin Van Teijlingen, Padam Simkhada, Catherine Angell

Journal of Asian Midwives (JAM)

Background: Establishing and promoting birthing centers (BCs) can be one strategy to increase access to emergency obstetric care and skilled attendants at birth, to avert many maternal deaths. BCs are a component of local health service delivery, whereby midwives (or health care professionals with midwifery competencies) provide maternity services to generally healthy women with uncomplicated pregnancies, mostly in the community setting.
Methods: A literature review was carried out involving searches and appraisals of relevant literature on birthing centers in Nepal, South Asia, and other similar settings.
Findings//Conclusion: In Nepal, midwife-led care in BCs was found to be …

Perceptions Of The Role Of The Man In Family Planning, During Pregnancy And Childbirth: A Qualitative Study With Fifteen Nepali Men, Magdalena Mattebo, Bharati Sharma, Erica Dahlkvist, Eleonor Molinder, Kerstin Erlandsson

Journal of Asian Midwives (JAM)

Introduction: In Nepal, by tradition, family life and marriage are generally controlled by patriarchal norms, sanctions, values and gender differences. Women in Nepal have limited possibilities to make decisions regarding their sexual and reproductive health, as the husbands and other elders in the family make most of the decisions regarding family planning, pregnancy and childbirth.
Aim: To describe the perceptions of Nepali men regarding the role of the man with respect to family planning, pregnancy and childbirth.
Methods: A qualitative study was conducted with 15 Nepali men in both urban and rural areas. The material was analyzed through inductive …

Misconceptions And Mismanagement Of Menstruation Among Adolescents Girls Who Do Not Attend School In Pakistan, Naghma Rizvi, Tazeen Saeed Ali

Journal of Asian Midwives (JAM)

Background: Menstruation is perceived and interpreted differently under different social and cultural norms. There are a number of different practices, conceptions and misconceptions that have been reported in studies conducted in various countries. In Pakistan, there is a dearth of knowledge related to hygienic and unhygienic practices, discomforts, misconceptions related to nutrition, and restrictions imposed during menstruation. Therefore, this study was conducted with the objectives to identify the conceptions and misconceptions about menstruation, explore hygienic and unhygienic practices during menstruation along with the socio- cultural and religious restrictions imposed, and the discomforts with its management among adolescents who do not …