Medicine and Health Sciences Commons^™

Mortality In Sepsis And Its Relationship With Gender., Nosheen Nasir, Bushra Jamil, Shahla Siddiqui, Fauzia A. Khan, Rabia Hussain

Department of Medicine

BACKGROUND AND OBJECTIVE:

Sepsis remains a leading cause of death across the world, carrying a mortality rate of 20-50%. Women have been reported to be less likely to suffer from sepsis and to have a lower risk of mortality from sepsis compared to men. The objective of this study was to determine the relationship between gender and mortality in sepsis, and compare cytokine profiles of male and female patients.

METHODS:

This was a prospective case series on 97 patients admitted with sepsis. Clinical and microbiological data was gathered, blood samples were collected for cytokine (IL-10, IL-6 and TNFα) levels and …

Optic Nerve Sheath Diameter Evaluated By Transorbital Sonography In Healthy Volunteers From Pakistan, Ali Asghar, Madiha Hashmi, Alia Hussain

Department of Anaesthesia

Objective: Raised intracranial pressure (ICP) is a common manifestation of severe brain injury. Rapid diagnosis and timely intervention is required to prevent secondary brain damage and death. Measurement of optic nerve sheath diameter (ONSD) by ultrasound is increasingly used as a marker to detect raised ICP. Knowledge of normal ONSD in a healthy population is essential to interpret this measurement. We aimed to evaluate normal optic nerve sheath diameter in healthy volunteers in Pakistan. Methodology: It was a prospective, observational study in which one hundred healthy volunteers of Pakistani origin, aged more than 18 years were recruited in the study. …

Track Extubation In Pediatric Congenital Heart Disease Open Heart Surgical Patients In Pakistan, Mohammad Irfan Akhtar

Department of Anaesthesia

No abstract provided.

Diagnostic Utility Of Who Defined Sepsis Syndromic Criteria With Procalcitonin In Identification Of Sepsis In Children With Suspected Infections, Samuel Owuor Akech

Master of Medicine in Paediatrics and Child Health

Title: Diagnostic Utility of WHO Defined Sepsis syndromic Criteria with Procalcitonin in Identification of Sepsis in Children with Suspected Infections Background: Bacterial infections are a major cause of morbidity and mortality in children but accurate and timely diagnosis remains a challenge to the frontline clinicians. Cultures of sterile bodily specimens are considered the gold standard but are insensitive and results are delayed. Procalcitonin (PCT) has recently emerged as a biomarker with high sensitivity and specificity making it superior to culture based techniques performed in non-ideal circumstances which prevail in resource poor settings. This study investigated the diagnostic utility World Health …

Global Collaboration Between Tanzania And Japan To Advance Midwifery Profession: A Case Report Of A Partnership Model, Yoko Shimpuku, Shigeko Horiuchi, Sebalda C. Leshabari, Dickson Mkoka, Yasuko Nagamatsu, Miwako Matsutani, Hiromi Eto, Michiko Oguro, Yukari Yaju, Mariko Iida, Columba Mbekenga, Lilian Mselle, Agnes Mtawa

School of Nursing & Midwifery, East Africa

The global health agenda to reduce maternal mortality is delayed in Sub-Saharan Africa. The shortage of skilled birth attendants in Tanzania hinders the improvement of midwifery care to prevent maternal mortality and morbidity. It is urgently neccesary to develop midwifery leaders capable of working as educators, researchers, administrators, and advanced practitioners, contributing to the improvement of midwifery care and maternal child health in their own country. This report describes the process of establishing the first midwifery master’s program in Tanzania through the efforts of two academic institutions, one in Tanzania and one in Japan. The collaboration developed a sustainable partnership …

End Stage Renal Disease: Seroprevalence Of Hepatitises B And C Along With Associated Aetiology And Risk Factors In Children, Syed Raza Shah, Muhammad Shahzeb Khan, Muhamad Tanveer Alam, Adnan Salim, Mehwish Hussain, Areeba Altaf

Section of Neurosurgery

Background: End Stage Renal Disease (ESRD) normally requires dialysis or transplantation for survival. Since ESRD patients are on long term dialysis, infections such as Hepatitis B (HBV) and Hepatitis C (HCV) are commonly reported.
Methods: This was a retrospective study carried out at a government hospital during a 12-month period from January 2013 to December 2013. The data was collected using a predesigned pro forma to note the etiology, gender, age, and HBsAg and anti-HCV test result of each patient.
Results: 444 children suffering from ESRD were included in our analysis. The mean age of sample was 12.7 ± 4.1 …

Fasting Headache, A Cross-Sectional Study, Adnan Salim, Muhammad Ahmed Ilyas, Mehwish Rizvi, Arzlan Ullaha Baig, Syed Hassaan Ahmed, Zuha Pandit, Muhammad Saleem Ilyas

Section of Neurosurgery

Headache is a predominant disorder in general population and is classified into primary and secondary forms by the International Headache Society. Fasting headache is currently classified in Group 10 of ICHD-III as “Headache attributed to disorders of homeostasis”. In spite of continuing research, there is still indistinctness regarding the exact cause of fasting headache. Hypoglycaemia, previous history of headache, stress, caffeine withdrawal, lack of sleep and female gender have been speculated as causative factors. Our rationale for this study is to find out what percentage of the population experiences fasting headache and to find out any link between the occurrence …

Acute Myocardial Infarction And Myocardial Ischemia-Reperfusion Injury: A Comparison, Satwat Hashmi, Suhail Al-Salam

Department of Biological & Biomedical Sciences

Myocardial infarction (MI) denotes the death of cardiac myocytes due to extended ischemia. Myocardial reperfusion is the restoration of coronary blood flow after a period of coronary occlusion. Reperfusion has the potential to salvage ischemic myocardium but paradoxically can cause injury, a phenomenon called as 'reperfusion injury' (IR). Standard histologic, immunohistochemical and Elisa techniques were used to study the histopathologic, oxidative, apoptotic and inflammatory changes in MI and IR. The IL-6 levels in the LV of the MI group were significantly raised as compared to the IR group (P=0.0008). Plasma IL-6 was also significantly increased in the MI group as …

Targeted Ultrasound Of An Indeterminate Breast Lesion On Mammography: When Does It Influence Management?, Saba Sohail, Imrana Masroor, Shaista Afzal

Department of Radiology

Objective: To determine the change over mammographic diagnosis, BI-RADS category and management following targeted ultrasound of an indeterminate lesion seen on mammography and associated factors, if any.
Study design: Descriptive, analytical study.
Place and duration of study: Radiology Department, The Aga Khan University Hospital and Clifton Medical Services, Karachi, from April 2010 to May 2011.
Methodology: Patients referred for targeted breast ultrasound following X-ray mammography were selected regardless of age. Targeted Ultrasound (TUS) was defined as a limited ultrasound of a specific lesion or breast part as indicated by the referring source. Comparison was made between the post mammography and …

Screening For G6pd Deficiency Among Neonates With Neonatal Jaundice Admitted To Tertiary Care Center: A Need In Disguise, Kishwer Kumar, Arjumand Sohaila, Shiyam Sunder Tikmani, Iqtidar Ahmed Khan, Anila Zafar

Department of Paediatrics and Child Health

This study was conducted to determine the association of Glucose-6-Phosphate Dehydrogenase (G-6-PD) deficiency among neonates admitted with jaundice at the neonatal intensive care unit, well baby nursery and neonatal step down nursery of the Aga Khan University Hospital, Karachi, Pakistan, from January to June 2010. A total of 205 neonates following the selection criteria were included. All selected neonates have their venous blood drawn, saved in EDTA bottle and sent to laboratory of The Aga Khan University Hospital (AKUH). The laboratory results of whether G-6-PD deficiency was present or not was recorded in the proforma. G-6-PD was deficient in 19 …

Autologous Hematopoietic Stem Cell Transplantation-10 Years Of Data From A Developing Country, Natasha Ali, Salman Naseem Adil, Mohammad Usman Shaikh

Department of Pathology and Laboratory Medicine

Intensive chemotherapy followed by autologous stem cell transplantation is the treatment of choice for patients with hematological malignancies. The objective of the present study was to evaluate the outcomes of patients with mainly lymphoma and multiple myeloma after autologous stem cell transplant. The pretransplant workup consisted of the complete blood count, an evaluation of the liver, kidney, lung, and infectious profile, chest radiographs, and a dental review. For lymphoma, all patients who achieved at least a 25% reduction in the disease after salvage therapy were included in the study. Mobilization was done with cyclophosphamide, followed by granulocyte colony-stimulating factor, 300 …

Hibernoma Larynx With Large Multinodular Goitre: Unusual Airway Challenge, Haissan Iftikhar, Moghira Siddiqui

Department of Surgery Docs

Abstract

A 56-year-old man presented with a 6-month history of progressively increasing neck swelling, dysphagia and hoarseness of voice. CT scan revealed multi-nodular goitre and also showed a lesion in the supraglottis. It also showed another lesion in the supraglottis. Fine-needle aspiration cytology of thyroid revealed follicular cells. Routine flexible laryngoscopy was performed to evaluate vocal cord function; however, we found a smooth well-defined lesion just above the glottis, obstructing the direct view of the vocal cords, and an endangered airway. A provisional diagnosis of a laryngeal cyst was made. With all necessary precautions intubation was performed with a bougie …

New And Contemporary Markers Of Prognosis In Nonmuscle Invasive Urothelial Cancer, Hammad Ather, Syed M Nazim

Department of Surgery Docs

Abstract

Nonmuscle invasive (NMI) urothelial cancer (UC) is associated with varied biological potential. It is characterized by frequent recurrence and progression, which thus worsens the oncological outcome. Nearly three-quarters of NMI UCs recur within 5 years, whereas half can progress during follow-up. Progression is particularly seen in T1 and carcinoma in situ (CIS). Undoubtedly, NMI UC is one of the most expensive cancers to manage. The European Organisation for Research and Treatment of Cancer (EORTC) risk calculator is a commonly used tool for assessing the recurrence and progression potential of a newly diagnosed cancer. The parameters used in the assessment …

Content Validity Of A Tool Measuring Medication Errors., Nishat Tabassum, Saleema Allana, Tanveer Saeed, Jacqueline Maria Dias

School of Nursing & Midwifery

The objective of this study was to determine content and face validity of a tool measuring medication errors among nursing students in baccalaureate nursing education. Data was collected from the Aga Khan University School of Nursing and Midwifery (AKUSoNaM), Karachi, from March to August 2014. The tool was developed utilizing literature and the expertise of the team members, expert in different areas. The developed tool was then sent to five experts from all over Karachi for ensuring the content validity of the tool, which was measured on relevance and clarity of the questions. The Scale Content Validity Index (S-CVI) for …

Residential Proximity To Major Roadways Is Associated With Increased Levels Of Ac133+ Circulating Angiogenic Cells, Dejarnett Natasha, Ray Yeager, Daniel J. Conklin, Jongmin Lee, Timothy E. O’Toole, James Mccracken, Wes Abplanalp, Sanjay Srivastava, Daniel W. W. Riggs, Jasmit Shah

Brain and Mind Institute

Objectives: Previous studies have shown that residential proximity to a roadway is associated with increased cardiovascular disease risk. Yet, the nature of this association remains unclear, and its effect on individual cardiovascular disease risk factors has not been assessed. The objective of this study was to determine whether residential proximity to roadways influences systemic inflammation and the levels of circulating angiogenic cells.

Approach and Results: In a cross-sectional study, cardiovascular disease risk factors, blood levels of C-reactive protein, and 15 antigenically defined circulating angiogenic cell populations were measured in participants (n=316) with moderate-to-high cardiovascular disease risk. Attributes of roadways surrounding …

Low Prevalence Of Asthma Among Textile Workers In Karachi, Pakistan, Sana Tanzil, Asaad A. Nafees

Community Health Sciences

Objective: To determine the prevalence of asthma in textile workers through post-bronchodilator spirometry and to compare the differences in prevalence based on different criteria used to assess asthma.
Methods: The cross-sectional study was conducted between July and December 2013 in Karachi, Pakistan, and comprised workers from15 textile mills in the city and its outskirts. Asthma and associated respiratory symptoms were assessed using the American Thoracic Society Division of Lung Diseases Questionnaire, and post-bronchodilator spirometry. SPSS 19 was used for statistical analysis.
Results: Among the 372 workers in the study, asthma was found in 19(5%) as diagnosed on post-bronchodilator spirometry. The …

Attitudes And Behaviours Of Maternal Health Care Providers In Interactions With Clients: A Systematic Review, P. Mannava, K. Durrant, J. Fisher, M. Chersich, Stanley Luchters

Population Health, East Africa

Background: High maternal mortality and morbidity persist, in large part due to inadequate access to timely and quality health care. Attitudes and behaviours of maternal health care providers (MHCPs) influence health care seeking and quality of care.

Methods: Five electronic databases were searched for studies from January 1990 to December 2014. Included studies report on types or impacts of MHCP attitudes and behaviours towards their clients, or the factors influencing these attitudes and behaviours. Attitudes and behaviours mentioned in relation to HIV infection, and studies of health providers outside the formal health system, such as traditional birth attendants, were excluded. …

Association Of Obesity With Infertility Among Pakistani Men: A Case Control Study, Nida Zahid, Sarah Saleem, Syed Iqbal Azam, Tariq Moatter

Community Health Sciences

Background: The reported prevalence of infertility in Pakistan is 21% of which 35% is contributed by male factor. Male infertility has multifactorial etiologies ranging from modifiable to genetic risk factors. Among all the risk factors that may account for male infertility, obesity is one of the emerging public health problems. Therefore, the aim of the study was to determine the association of obesity with infertility in Pakistani men.
Methods: We conducted a case control study. Cases were men with impaired semen parameters and controls did not have impaired semen parameters.
Results: The final multivariable logistic regression model after adjusting for …

Does Upgrade To Tri-Ventricular Pacemaker Improve Long-Term Clinical Response In Non-Responders To Biventricular Cardiac Resynchronization Therapy?, Sharon Hw Man, Jeilan Mohamed, Shoaib Siddiqui, G. André Ng

Internal Medicine, East Africa

Up to one third of patients with biventricular (BiV) cardiac resynchronization therapy (CRT) are non-responders.1 § Greater clinical response to CRT has been shown in patients given TriV CRT compared to BiV CRT as de novo device therapy. 2 This abstract investigates if upgrade to TriV CRT in non-responders to BiV CRT will improve long-term clinical outcome

Improving Medication Adherence In Stroke Patients Through Short Text Messages (Sms4stroke)-Study Protocol For A Randomized, Controlled Trial., Ayeesha Kamran Kamal, Quratulain Nauman Shaikh,, Omrana Pasha, Iqbal Azam Syed, Muhammad Islam, Adeel Ali Memon,, Hasan Rehman,, Muhammad Affan,, Sumaira Nazir, Salman Aziz,, Muhammad Jan, Anita Andani, Abdul Muqeet, Bilal Ahmed,, Shariq Khoja

Department of Medicine

Background: Stroke is a major cause of morbidity and mortality, especially in low and middle income countries. Medical management is the mainstay of therapy to prevent recurrence of stroke. Current estimates are that only 1 in 6 patients have perfect adherence to medication schedules. Using SMS (Short Messaging Service) as reminders to take medicines have been used previously for diseases such as diabetes and HIV with moderate success. We aim to explore the effectiveness and acceptability of SMS in increasing adherence to medications in patients with stroke.

Methods: This will be a randomized, controlled, assessor blinded single center superiority trial. …

A Qualitative Exploration Of The Emotional Wellbeing And Support Needs Of New Mothers From Afghanistan Living In Melbourne, Australia, Alana Russo, Belinda Lewis, Andrew Joyce, Belinda Crockett, Stanley Luchters

Population Health, East Africa

Background: The Afghan community is a priority population for many health and social services within the southeast region of Melbourne, which is home to the largest population of Afghanistan-born people within the state of Victoria. The majority of Afghan women arriving in Australia are of childbearing age, and evidence suggests that they are at increased risk of emotional challenges following birth as a result of the refugee and migration experience. This research aimed to explored the experiences of Afghan women living in Melbourne throughout pregnancy, birth, and early motherhood, and gain insight into the aspects of their experiences that they …

Symptomatic Surgically Treated Non-Neoplastic Cysts Of The Central Nervous System: A Clinicopathological Study From Pakistan, Nasir Ud Din, Huma Arshad, Zubair Ahmad, Sheema H Hasan, Mohammad Ehsan Bar

Department of Pathology and Laboratory Medicine

Objective: To report clinicopathologic features of symptomatic surgically removed non-neoplastic cysts of the central nervous system (CNS). Study Design: Case series. Place and Duration of Study: The Aga Khan University Hospital, Karachi, from 2003 to 2012. Methodology: All non-neoplastic CNS cysts reported during the study period were retrieved and reviewed. Age, gender, location, histologic type and clinical features were noted. Results: A total of 124 cysts were diagnosed in the study period. These included 44 epidermoid cysts (mean age 30.5 ± 13.8 years), 35 colloid cysts (mean age 31 ± 13.2 years), 32 arachnoid cysts (mean age 24.8 ± 20.2 …

Diagnostic Tcd For Intracranial Stenosis In Acute Stroke Patients: Experience From A Tertiary Care Stroke Center In Karachi, Pakistan., Ayeesha Kamran Kamal, Hasan Rehman, Nasir Mustafa, Bilal Ahmed, Mohammad Jan, Faisal Wadivalla, Syed Kamran

Department of Medicine

Background: Stroke is a common cause of morbidity and mortality around the world. Intracranial large artery atherosclerosis (ICAD) is a frequent etiology of stroke in the South Asian population. There is a need for widely available screening tools to identify patients that are at high risk of stroke due to ICAD for aggressive risk management. This study describes the experience of using the transcranial Doppler (TCD) as a screening tool for this purpose at a tertiary care hospital in a developing country.

Methods: 86 Patients admitted with stroke due to ICAD underwent TCD for six arteries (Right and left …

Unusual Presentation With Polymenorrhagia And Markedly High 17-Hydroxy Progesterone Levels In A Lady With Non-Classic Congenital Adrenal Hyperplasia., Azra Rizwan, Marium Hayat

Department of Medicine

Congenital adrenal hyperplasia is generally associated with oligo-amenorrhea, and its presentation with polymenorrhagia is rare. Here we present a case of an Asian female who presented with polymenorrhagia since menarche, increased body hair growth and enlargement of clitoris for 7-8 years. Examination revealed a normal Body Mass Index, moderate hirsutism, Tanner 5 breasts and significant clitoromegaly. Serum testosterone and 17-hydroxyprogesterone levels were elevated. Ultrasonography revealed normal adrenal glands and polycystic ovaries. adrenocorticotropic hormone stimulation test uncovered borderline cortisol deficiency. Oral dexamethasone was commenced and six months later, she showed improvement though there was no change in hirsutism or clitoromegaly. The …

Sexual And Reproductive Health Research And Research Capacity Strengthening In Africa: Perspectives From The Region., Richard Adanu, Michael T. Mbizvo, Adama Baguiya, Vincent Adam, Beyene W. Ademe, Augustine Ankomah, Godwin N. Aja, Ademola J. Ajuwon, Olapeju A. Esimai, Taofeek Ibrahim, Dintle K. Mogobe, Özge Tunçalp, Venkatraman Chandra-Mouli, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Developing the capacity to effectively carry out public health research is an integral part of health systems at both the national and global levels and strengthening research capacity is recognized as an approach to better health and development in low- and middle-income countries (LMICs). Especially fields such as sexual and reproductive health (SRH) would require inter-disciplinary teams of researchers equipped with a range of methodologies to achieve this. In November 2013, as part of the International Family Planning Conference in Addis Ababa, Ethiopia, a group of African researchers came together to discuss the gaps and strategies to improve sexual and …

Atrial Fibrillation In Sub-Saharan Africa: Epidemiology, Unmet Needs, And Treatment Options, Bruce Sheldon Stambler, Mzee Ngunga

Internal Medicine, East Africa

Health care in Sub-Saharan Africa is being challenged by a double burden of disease as lifestyle diseases common in the developed world, such as stroke and atrial fibrillation (AF), increase, while, simultaneously, health issues of the developing world in terms of communicable disease persist. The prevalence of AF is lower in Africa than in the developed world but is expected to increase significantly over the next few decades. Patients with AF in Africa tend to be younger and have a higher prevalence of rheumatic valvular heart disease than patients with AF in other regions. Permanent AF is the most prevalent …

The Mouse That Trolled: The Long And Tortuous History Of A Gene Mutation Patent That Became An Expensive Impediment To Alzheimer's Research, Tania M. Bubela, Saurabh Vishnubhakat, Robert Cook-Deegan

Office of the Provost

This case study presents the tale of the academic discovery of a rare mutation for early-onset Alzheimer's disease that was patented by a sole inventor and licensed to a non-practicing entity (NPE), the Alzheimer's Institute of America (AIA). Our aims are (1) to relate this story about patents, research tools, and impediments to medical progress, and (2) to inform ongoing debates about how patents affect research, disposition of university inventions, and the distribution of benefits from publicly funded research. We present an account of the hunt for Alzheimer's genes, their patenting, assignment, and enforcement based on literature, litigation records and …

Multiple Cerebral Hydatid Cysts In 8-Year-Old Boy: A Case Report And Literature Review Of A Rare Presentation, Muhammad Baba Khan, Muhammad Riaz, Muhammad Ehsan Bari

Section of Neurosurgery

Background: Multiple cerebral hydatid cysts are very rare with only a few reports in the literature detailing diagnostic workup, medical management, surgical techniques, possible complications, and outcomes.
Case description: We present the case of an 8-year-old boy who presented with progressively worsening headaches, vomiting, and intermittent fever since 20 days. Diagnostic workup was performed, and magnetic resonance imaging revealed multiple intracranial cysts predominantly in the right frontal region with significant mass effect. A total of 19 intracranial cysts were removed surgically, and the child recovered uneventfully.
Conclusions: Neurosurgeons should keep hydatidosis in the list of differentials when evaluating patients with …

Setting Up Triage Services In The Emergency Department: Experience From A Tertiary Care Institute Of Pakistan. A Journey Toward Excellence., Munawar Khursheed, Jabeen Fayyaz, Ahsan Jamil

Department of Emergency Medicine

The history of triage started from the French battle field for prioritizing patients. Emergency triage was started in early 1950's in USA in order to treat the sickest first. It has now become an integral component of all emergency departments (ED). The basic aim of triage is not only to sort out patients according to the criticality of their illness, but it also serves to streamline the patient flow. This will ultimately enable the ED physician to provide right management at the right time to the right patient in the available resources. In turn has a positive impact in reducing …

Review And Analysis Of Quality Healthcare System Enhancement In Developing Countries., Zohra Kurji, Zahra Zahra Shaheen Premani Shaheen, Yasmin Mithani

School of Nursing & Midwifery

Quality has multidimensional perspectives. It is a continuous and dynamic process. A systematic search of national and international literature was conducted from peer-reviewed databases MEDLINE, CINAHL and PubMed during January to July 2012. There are many frameworks to assess and measure quality. All frameworks give some levels in which quality could be assessed. Therefore, multiple frameworks should be used for measuring quality based on the situation and environment. Measuring quality is very important for primary healthcare programme, especially for developing countries because if we will not do quality assessment, our resources will not be utilised effectively and people may divert …