Medicine and Health Sciences Commons^™

Impact Of Climate Change On Maternal Health In Pakistan: A Review Paper, Ihsan Ullah, Kiran Mubeen, Dilshad Begum, Rafat Jan

Journal of Asian Midwives (JAM)

Pakistan is one of the country’s most susceptible to the effects of climate change. Recent floods, heavy snowfall and rain have significantly impacted maternal and infant health. Indigenous women of child-bearing age especially those in rural areas are among the most vulnerable, facing food insecurity, disruptive food systems, rising food prices, and disrupted food production due to climate change. This review highlights a critical gap in research on indigenous women's maternal nutrition in the context of climate change, particularly in low- and middle-income countries. It emphasized the necessity for culturally responsive approaches and a deeper understanding of how climate change …

Maternal Care Providers’ Perspectives Of Selective Vs Routine Episiotomy, Uzma Akhtar, Salma Rattani, Rahila Meghani, Nadeem F. Zuberi

Journal of Asian Midwives (JAM)

Background: Normal Vaginal delivery is considered the favorable mode of delivery, but perineal trauma due to episiotomy is a significant concern in obstetric care nowadays. Although, routine episiotomy practice is discouraged because there is no evidence regarding its benefits, the rate of episiotomy is very high especially in lower-middle-income countries as compared to recommended rate given by the World Health Organization (WHO) which is 10% of all normal vaginal deliveries.
Method: Utilizing Preferred Reporting Items for Systematic Reviews and Meta-Analyses. (PRISMA) guidelines, the study searched for appropriate literature on Investigating Healthcare Professionals' Views on Selective versus Routine Episiotomy. Significant databases: …

Epidemiology Of Stroke And Risk Factors In Punjab, Pakistan: A Comprehensive Hospital-Based Study, Saima Ahmad, Adnan Khan, Fatima Gul Chaudhary, Haseeb Manzoor, Hira Jamil, Hamid Mahmood, Kausar Tayyab, Uchechukwu Levi Osuagwu

Pakistan Journal of Neurological Sciences (PJNS)

Background and Objective

Stroke is a significant global health challenge, particularly burdening low- and middle-income countries where it leads to substantial mortality and disability-adjusted life years. The objective of this study was to investigate the prevalence of stroke and its subtypes among adults in Pakistan's Punjab region.

Methods

This retrospective hospital-based study was conducted at Lahore General Hospital in Punjab, Pakistan, serving as the primary referral center for stroke cases. Medical records from January 2019 to December 2020 were reviewed using the International Classification of Diseases. A structured data collection form captured demographics, stroke types, risk factors, medical histories, and …

Electrodiagnostic Patterns In Neuromuscular Disorders: A Retrospective Cross-Sectional Study From A Tertiary Care Hospital, Ayisha Farooq Khan, Sajid Hameed, Dureshahwar Kanwar, Sara Khan

Pakistan Journal of Neurological Sciences (PJNS)

Background and Objective

Electromyography (EMG) and nerve conduction studies (NCS) are essential for diagnosing neuromuscular disorders and differentiating various peripheral nervous system conditions. The objective of this study was to assess the prevalence and trends of neuromuscular disorders based on EMG/NCS findings in a tertiary care center in Pakistan.

Methods

This retrospective cross-sectional study was conducted at the neurophysiology laboratory of Aga Khan University Hospital from 1st January 2023 to 31st December 2023. A total of 961 EMG/NCS records were analyzed, including both inpatient and outpatient cases. Data was extracted from the EMG registry, and findings were categorized into mononeuropathy, …

Clinical And Radiological Profile Of Patients Presenting With Neurolisteriosis: A Retrospective Study From A Tertiary Care Hospital, Zainab Memon, Muhammad Abdullah, Fatima Mubarak

Pakistan Journal of Neurological Sciences (PJNS)

Background and Objective

Neurolisteriosis, a central nervous system (CNS) infection caused by Listeria monocytogenes, is associated with significant morbidity and mortality, particularly in elderly and immunocompromised individuals. The objective of this study was to analyze the clinical and radiological data from the patients of this disease presenting to a tertiary care hospital.

Methods

This retrospective review analyzed clinical, laboratory, and neuroimaging data from 12 patients diagnosed with neurolisteriosis at Aga Khan University Hospital between September 2018 and March 2024. Diagnosis was confirmed through blood and/or cerebrospinal fluid cultures or polymerase chain reaction assays. Data was analyzed using Statistical Package for …

Houge-Janssens Syndrome-1 Associated With Protein Phosphatase 2 Regulatory Subunit B’ Delta And Epilepsy: A Case Report, Dua Saleem, Fizza Akbar, Noor Zeeshan, Rabab Jafry, Salman Kirmani, Sidra Kaleem Jafri

Pakistan Journal of Neurological Sciences (PJNS)

Houge-Janssens syndrome 1 is a rare autosomal dominant disorder with approximately 100 case reports worldwide. Here, we present a case of a Pakistani toddler who presented with epilepsy and developmental delay. Family history was significant with reported and documented developmental delays in both father and elder sister, with subsequent improvement. Trio-whole-genome sequencing (WGS) and Sanger sequencing were performed, revealing a heterozygous LP variant NM_006245.4: c.626A>C, p.(His209Pro) in the girl. The same variant was also identified in her father and sister. This case sheds light on the variability of phenotypic expression amongst affected individuals and recommends the need for further …

High Dose Methylprednisolone In Children With Severe Headache In Viral Encephalitis: A Case Series, Abia Abdullah, Jay Kumari, Prem Chand

Pakistan Journal of Neurological Sciences (PJNS)

Severe headache is a common symptom in children with viral encephalitis (VE), yet effective symptom-specific therapies are limited. In this case series, we present three children of ages 15, 14, and seven diagnosed with VE who presented with severe headaches unresponsive to standard analgesics but showed significant clinical improvement following high-dose methylprednisolone therapy. Although this is not first line treatment, these cases suggest a possible role for methylprednisolone in alleviating severe VE-associated headaches. Further controlled studies are needed to establish its effectiveness and safety in such settings.

Acute Flaccid Myelitis Caused By Enterovirus Infection- A Case Report, Ahmad Bilal, Tipu Sultan, Zia Ur Rehman, Arshad Mehmood, Amber Shabir, Javeria Raza

Pakistan Journal of Neurological Sciences (PJNS)

Enterovirus is a member of the Picornaviridae family, an enterovirus. It is suspected of causing a polio-like disorder called acute flaccid myelitis (AFM). This case report aims to present a 10-year-old boy who presented with neurological manifestations of weakness of lower limbs and urinary retention. He had reduced tone, absent reflexes, and palpable bladder. MRI spine revealed inflammation in grey matter of spinal cord. He was treated with high dose steroids and IVIG but no improvement was observed. Enterovirus was isolated from his stool sample. The patient received supportive care and physiotherapy with gradual improvement after months, having no evidence …

Severe Falciparum Malaria In Young Children Is Associated With An Increased Risk Of Post-Discharge Hospitalization: A Prospective Cohort Study, Robert Opoka, Ruth Namazzi, Dibyadyuti Datta, Paul Bangirana, Andrea L. Conroy, Michael J. Goings, Kagan A. Mellencamp, Chandy C. John

Paediatrics and Child Health, East Africa

Background Few studies have described post-discharge morbidity of children with specifc manifestations of severe malaria (SM) beyond severe malarial anaemia or cerebral malaria.

Methods Children 6 months to 4 years of age admitted at Jinja and Mulago hospitals in Uganda, with one or more of the fve most common forms of SM, cerebral malaria (n=53), respiratory distress syndrome (n=108), malaria with complicated seizures (n=160), severe malarial anaemia (n=155) or prostration (n=75), were followed for 12 months after discharge, alongside asymptomatic community children (CC) (n=120) of similar ages recruited from the households or neighbourhoods of the children with SM. Incidence and …

Kinetics Of Naturally Induced Binding And Neutralising Anti-Sars-Cov-2 Antibody Levels And Potencies Among Sars-Cov-2 Infected Kenyans With Diverse Grades Of Covid-19 Severity: An Observational Study, John Kimotho, Yiakon Sein, Shahin Sayed, Reena Shah, Mansoor Saleh, Ann Karanu, Viviane Oluoch, Jasmit Shah, Julius Mutiso, Zaitun Nneka, Alfred Mburu, Peter Betti, Francis M. Ndungu

Pathology, East Africa

Background: Given the low levels of coronavirus disease 2019 (COVID-19) vaccine coverage in sub-Saharan Africa (sSA), despite high levels of natural severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) exposures, strategies for extending the breadth and longevity of naturally acquired immunity are warranted. Designing such strategies will require a good understanding of naturally acquired immunity.

Methods: We measured whole-spike immunoglobulin G (IgG) and spike-receptor binding domain (RBD) total immunoglobulins (Igs) on 585 plasma samples collected longitudinally over five successive time points within six months of COVID-19 diagnosis in 309 COVID-19 patients. We measured antibody-neutralising potency against the wild-type (Wuhan) SARS-CoV-2 …

Labrad : Vol 49, Issue 2 - December 2024, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• EDITORIAL
• ARTICLES
• Anti-Glomerular Basement Membrane (GBM) Disease: Pathogenesis, Presentation, and Diagnostic Insights
• Advanced Total Laboratory Automation (TLA) Workflow: A Comprehensive Approach towards High-Throughput Analyzers in Clinical Chemistry
• Precision Under Pressure: Challenges in Therapeutic Drug Monitoring for Immunosuppressants
• Frozen Section: Diagnostic Accuracy, Pitfalls and Use of Digital Pathology
• Working Environment Perspective of a Learner
• AI Training: A Must-Have Skill for Tomorrow’s Radiologists
• Challenges in Blood Supply: Importance of Voluntary Donations
• Leadership Skills and Emotional Intelligence For Professional Capacity Building in Histopathology – A Broad Perspective
• Factor VIII and XI Deficiency; A Finding That Could Have Been Missed-A Case Report
• Accelerated Phase …

Blood Biomarkers In Down Syndrome: Facilitating Alzheimer's Disease Detection And Monitoring, Melissa Petersen, Lisi Flores-Aguilar, Elizabeth Head, Laia Montoliu-Gaya, Andre Strydom, Sarah Pape, Juan Fortea, Nicholas Ashton, Chinedu Momoh, Sid O'Bryant

Brain and Mind Institute

Blood-based biomarkers continue to be explored for disease detection, monitoring of progression, and therapeutic outcomes as the diagnostic determination of Alzheimer's Disease in Down Syndrome (DS-AD) remains challenging in clinical settings. This perspective highlights the current status of this effort. Overall, amyloid (A), tau (T), and neurodegeneration (AT[N]) blood-based biomarkers have been shown to increase with disease pathology for individuals with DS. Phosphorylated tau biomarkers (p-tau217, p-tau181) have been consistently shown to track disease progression for DS-AD and are likely good candidates for use in clinical settings. Biomarkers of inflammation (glial fibrillary acidic protein) also show promise; however, additional work …

Engaging Fathers(To-Be): A Pilot Study On The Adaptation And Programme Experience Of Sms4baba Intervention In Kenya’S Informal Settlements, Vibian Angweny, Richard Fletcher, Paul Mwangi, Margaret Kabue, Rachel Odhiambo, Stephen Mulupi, Emmanuel Obulemire, Eunice Njoroge, Eunice Ombech, Mercy Mokaya, Moses Wesala, Joyce Marangu, Amina Abubakar

Institute for Human Development, East Africa

Background Engaging fathers(to-be) can improve maternal, newborn, and child health outcomes. However, father-focused interventions in low-resource settings are under-researched. As part of an integrated early childhood development pilot cluster randomised trial in Nairobi’s informal settlements, this study aimed to test the feasibility of a text-only intervention for fathers (SMS4baba) adapted from one developed in Australia (SMS4dads).

Methods A multi-phased mixed-methods study, which included an exploratory qualitative phase and pre-post evaluation of the adapted SMS4baba text-only intervention was conducted between 2019 and 2022. Three focusgroup discussions (FGDs) with 19 fathers were conducted at inception to inform SMS4baba content development; two post-pilot …

Dynamics Of The Blood Plasma Proteome During Hyperacute Hiv-1 Infection, Jamirah Nazziwa, Eva Freyhult, Mun-Gwan Hong, Emil Johansson, Filip Årman, Jonathan Hare, Kamini Gounder, Melinda Rezeli, Tirthankar Mohanty, Amin Hassan

Institute for Human Development, East Africa

The complex dynamics of protein expression in plasma during hyperacute HIV-1 infection and its relation to acute retroviral syndrome, viral control, and disease progression are largely unknown. Here, we quantify 1293 blood plasma proteins from 157 longitudinally linked plasma samples collected before, during, and after hyperacute HIV-1 infection of 54 participants from four sub-Saharan African countries. Six distinct longitudinal expression profiles are identified, of which four demonstrate a consistent decrease in protein levels following HIV-1 infection. Proteins involved in inflammatory responses, immune regulation, and cell motility are significantly altered during the transition from pre-infection to one month post-infection. Specifically, decreased …

Plasma Transfusion In The Intensive Care Unit, Maite M. T. Van Haeren, Senta Jorinde Raasveld, Sanne De Bruin, Merijn C. Reuland, Claudia Van Den Oord, Jimmy Schenk, Cécile Aubron, Jan Bakker, Maurizio Cecconi, Marcus Lance

Anaesthesiology, East Africa

Background: Current guidelines discourage prophylactic plasma use in non-bleeding patients. This study assesses global plasma transfusion practices in the intensive care unit (ICU) and their alignment with current guidelines.

Study Design and Methods: This was a sub-study of an international, prospective, observational cohort. Primary outcomes were in-ICU occurrence rate of plasma transfusion, proportion of plasma events of total blood products events, and number of plasma units per event. Secondary outcomes included transfusion indications, INR/PT, and proportion of events for non-bleeding indications.

Results: Of 3643 patients included, 356 patients (10%) experienced 547 plasma transfusion events, accounting for 18% …

Management Of Adult Sepsis In Resource-Limited Settings: Global Expert Consensus Statements Using A Delphi Method, Louise Thwaites, Prashant Nasa, Brett Abbenbroek, Vu Quoc Dat, Simon Finfer, Arthur Kwizera, Lowell Ling, Suzana M. Lobo, Robert Sinto, Wangari Siika

Anaesthesiology, East Africa

Purpose: To generate consensus and provide expert clinical practice statements for the management of adult sepsis in resourcelimited settings.

Methods: An international multidisciplinary Steering Committee with expertise in sepsis management and including a Delphi methodologist was convened by the Asia Pacifc Sepsis Alliance (APSA). The committee selected an interna‑ tional panel of clinicians and researchers with expertise in sepsis management. A Delphi process based on an iterative approach was used to obtain the fnal consensus statements.

Results: A stable consensus was achieved for 30 (94%) of the statements by 41 experts after four survey rounds. These include …

High Yield Of Congenital Hypothyroidism Among Infants Attending Children Hospital, Nairobi, Kenya. Facility Based Study In The Absence Of Newborn Screening, Menbere Kahssay, Thomas Ngwiri

Paediatrics and Child Health, East Africa

Objectives: Congenital hypothyroidism (CHT) is a treatable cause of intellectual disability. Late diagnosis and delayed initiation of treatment leads to irreversible neurodevelopmental and intellectual disability. Thus, newborn screening is crucial. However, 71 % of babies are born in an area with no established newborn screening program and Kenya is not an exception. We aimed to determine the incidence of CHT, developmental outcomes of patients in the absence of newborn screening.

Methods: A retrospective data of subjects who met the inclusion criteria, newborn and infants from 3 days to 2 years whose thyroid function test (TFT) was undertaken during well baby …

“Breaking Barriers: Empowering African Youth Through Implementation Of A Therapeutic Patient Education Program For Juvenile Idiopathic Arthritis”, Wafa Hamdi, Angela Migowa, Hanene Lassoued Ferjani, Alia Fazaa, Saoussen Miladi, Kaouther Maatallah, Kawther Ben Abdelghani, Ayodele Faleye

Paediatrics and Child Health, East Africa

Introduction: Patient education is crucial in managing chronic diseases like Juvenile Idiopathic Arthritis (JIA). Traditional methods such as videos and brochures often fail to maintain long-term knowledge retention. Therapeutic Patient Education (TPE) offers a more effective, patient-centered approach.

Objective: PAFLAR aimed to implement a TPE program with a “train the trainers” masterclass to ensure effective delivery and improve outcomes for children with JIA.

Methods: PAFLAR’s TPE program was designed through a focus group, involving a literature review and strategic planning for the implementation step. The program includes specialized training for healthcare professionals enhancing their abilities to deliver …

Editorial – Dec 2024, Edwin Van Teijlingen, Abeer Musaddique, Rafat Jan

Journal of Asian Midwives (JAM)

No abstract provided.

Enhancing Respiratory Health With Post-Yoga Exercises During Pregnancy, Hiromi Ito-Kaneko, Masayuki Uehara

Journal of Asian Midwives (JAM)

Pregnancy results in enlarged uterus and diaphragm elevation, which may cause shallow breathing. These changes often cause nocturnal dyspnea, chest discomfort, and difficulty breathing, especially late pregnancy. Training of pregnant women for extending their exhalation reduces suffocation during movement, increasing comfort during pregnancy. In prenatal yoga, deep breathing is practiced and has a relaxing effect.
The purpose of this study is to determine whether yoga exercises during pregnancy improves exhalation length.
We enrolled 152 pregnant women and used a chronograph to measure their exhalation length pre- and post-yoga exercises and compared exhaled breath length by gestational age group. The pre-yoga …

The Role Of Midwives In Achieving The Global Sustainable Development Goals, Bakhtawar Muhammad Hanif Khowaja Bk, Elizabeth K. Darling

Journal of Asian Midwives (JAM)

The sustainable development goals (SDGs) provide a comprehensive framework for global development. Midwives are playing an important role in achieving the targets of the world’s priority agendas. They are actively involved in achieving the targets of SDG#2 by providing education to women on their nutritional requirements, supporting postnatal women with breastfeeding, and educating communities on the use of clean water, sanitation, and hygiene management. Beyond counseling and educating communities on nutrition and hygiene management, they are also involved in improving other health-related outcomes that are indicators for SDG#3, such as improving maternal and child immunization, counseling mothers on tobacco …

Factors Influencing Colostrum Avoidance In Developing Countries: Insights From A Literature Review, Muhammad Zeeshan Aslam, Jonathan Johnson, Marina Baig, Abeer Musaddique

Journal of Asian Midwives (JAM)

Introduction: Colostrum is a thick, sticky, clear and yellowish-coloured milk produced after the first few hours of birth until day 3. It consists of vitamin A, proteins, lipids, potassium, and maternal antibodies, including lactoferrin, immunoglobulin, growth factors and antimicrobial factors. Colostrum avoidance is the practice of squeezing out, pumping, and discarding the first milk. Various studies have reported colostrum avoidance worldwide, but its prevalence is higher in developing countries. Every day, approximately 3000 to 4000 infants die due to diarrhea and respiratory infections in developing countries, and one of the leading causes is colostrum avoidance. Infants are unable to take …

Compassionate Care In Times Of Loss: Unraveling Nurses’ And Midwives’ Perspectives To Assess Preparedness In Stillbirth: A Review Article, Nabila Salim Ali, Arusa Lakhani, Salma Rattani, Sidrah Nausheen

Journal of Asian Midwives (JAM)

Perinatal death, including stillbirth, is a tragic event that significantly impacts holistically the well-being of affected families, particularly in low-middle-income countries (LMICs), where the incidence is alarmingly high. This paper explores the profound effects of stillbirth on parental mental health, emphasizing the associated risks of mental health challenges and examining the crucial role of nurses and midwives in managing stillbirth, from providing immediate emotional support to facilitating long-term coping strategies. Despite their essential role, they face significant challenges, including inadequate training, emotional burdens, and the need for culturally sensitive care practices. Through a comprehensive review of the literature, this paper …

Improve The Referral System Of Health Care Organizations In Rural Community Settings Of Pakistan Using Health Information Technology (Hit) - A Protocol, Saleema A. Gulzar, Alishah Aziz Gulzar, Zahid Ali Faheem, Ayesha Arif, Aamir Sarfaraz

Journal of Asian Midwives (JAM)

Pakistan is a developing country, with 65% of the population residing in rural areas. The rural population is considered vulnerable mainly due to several factors, including poverty. Climate change and the area's topography limit their access to basic human needs such as basic healthcare, affecting their quality of life. Most people lack basic information about the location and availability of healthcare facilities, including hospitals, diagnostic centres, pharmacies, and general clinics. Hence, the rural healthcare system lacks primary care physicians, nurses, midwives and allied health professionals. Inappropriate infrastructure makes it challenging to retain qualified professionals. A non-profit and non-governmental entity aims …

Kolcaba’S Comfort Theory: A Framework For Understanding The Significance Of Skin-To-Skin Care After Childbirth, Aqsa Nizar Ali

Journal of Asian Midwives (JAM)

Despite the WHO recommendations and evidenced-based results of skin-to-skin contact, it is quite an uncommon practice witnessed after childbirth. Compared to research conducted in low and middle-income nations, the majority of the studies conducted in high-income countries revealed greater rates of SSC [11]. Skin-to-skin contact, a nurturing practice, has gained significant recognition as a cornerstone of early infant care. Beyond its physiological benefits, skin-to-skin contact fosters a profound sense of comfort and connection between mother and infant. Kolcaba's theory of comfort, a comprehensive framework for understanding and promoting comfort, provides a valuable lens to explore the multifaceted benefits of skin-to-skin …

Burden Of Vascular Neurological Disorders: A Cross-Sectional Multicenter Study, Shafaq Saleem, Safia Awan, Ibrar Rafiq, Muhammad Hassan Shaikh, Anjum Farooq, Maimoona Siddiqui, Zainab Aslam Saeed Memon, Alam Ibrahim Siddiqui

Pakistan Journal of Neurological Sciences (PJNS)

Background and Objective

Stroke remains a leading cause of morbidity and mortality worldwide, with a particularly high burden in low- and middle-income countries (LMICs) such as Pakistan. Despite its growing prevalence, limited nationwide data exist on vascular diseases, their risk factors, and disability outcomes. The objective of this study was to identify the frequency and age-stratified type of vascular disease incidence among in-patient hospital admissions.

Methods

A retrospective observational study was conducted across 39 neurology centers in Pakistan, spanning both public and private sectors from August 2017 to December 2019. Data on demographics, comorbidities, and stroke type were systematically collected …

Electrographic Significance Of Periodic Discharges And Association With Etiology And Outcome In A Tertiary Care Hospital: A Retrospective Cohort Study, Hina Imtiaz, Zainab Memon, Ayisha Farooq Khan, Dureshahwar Kanwar, Safia Awan

Pakistan Journal of Neurological Sciences (PJNS)

Background and Objective

Periodic discharges on electroencephalograms (EEGs) are rhythmic waveforms that may indicate acute or subacute brain injury. This aim of this study was to determine the frequency distribution of periodic discharge subtypes on EEG and to assess their association with underlying etiologies and clinical outcomes in a tertiary care hospital.

Methods

This retrospective observational cohort study included neurological patients aged ≥18 years admitted to the medical ICU or ward of Aga Khan University Hospital between January 1, 2021, and January 1, 2023, with periodic discharges on EEG. Patients with prior traumatic brain injury were excluded. Data on demographics, …

Epilepsy In Pakistani Adolescents Amid The Vaping Epidemic, Maheen Kalwar, Eisha Tur Raazia, Harmain Naz Shaikh

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

New Onset Seizures Evolving Into Refractory Status Epilepticus In The Setting Of Covid-19: A Case Report, Mahira Mushtaq, Zuha Amin, Shafaq Saleem, Fowzia Siddiqui

Pakistan Journal of Neurological Sciences (PJNS)

The novel Coronavirus disease (COVID-19) has been shown to involve the nervous system (both central and peripheral), with or without respiratory involvement in multiple ways. Although not much is known about this disease yet, seizures and status epilepticus which may evolve into refractory status epilepticus have been associated with it along with other manifestations like encephalopathy, neuropathies etc. The mechanism for development of seizures with COVID-19 related disease is not entirely known however it can be the consequence of “cytokine release syndrome” or “cytokine storm” which has been associated with this virus. Patients with COVID-19 infection who develop resistant status …

Pakistan Ischemic Stroke Guidelines, Anjum Farooq, Maria Khan, Ayesha Zafar, Husnain Hashim, Fozan Khan, Abdul Malik, Ayeesha Kamran Kamal Aga Khan University, Karachi, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

Stroke is the second leading cause of death and disability. Mortality related to stroke is very high in low- and middle-income countries. Stroke imposes a great socioeconomical burden in Pakistan. It is important to take important steps for prevention and proper management of stroke in country. Purpose of developing stroke guidelines is to improve stroke care in Pakistan. Guidelines are designed to help neurologists and general practitioners for treating stroke. American stroke guidelines, NICE guidelines, Canadian guidelines and multiple important articles including those emphasizing stroke care in low- and middle-income countries were studied, and these current guidelines were designed in …