Medicine and Health Sciences Commons^™

Role Of Surgery In Locally Advanced Prostate Cancer, Nazim Syed Muhammad, Farhat Abbas

Section of Urology

A significant proportion of patients present with locally advanced prostate cancer with inherent higher risk of local recurrence and systemic relapse after initial treatment. Recent literature favors combination of radiation therapy and extended hormonal therapy for this subset of patients. The effectiveness of Radical prostatectomy (RP) alone for locally advanced prostate cancer is controversial and is a focus of debate. However, it can decrease the tumor burden and allows the accurate and precise pathological staging with the need for subsequent treatment. Comparison of RP and other treatment modalities is difficult and incorrect because of inherent selection bias. RP as a …

Perceived Barriers To Utilizing Maternal And Neonatal Health Services In Contracted-Out Versus Government-Managed Health Facilities In The Rural Districts Of Pakistan, Atif Riaz, Shehla Zaidi, Asif Raza Khowaja

Community Health Sciences

Background: A number of developing countries have contracted out public health facilities to the Non-Government Organizations (NGOs) in order to improve service utilization. However, there is a paucity of in-depth qualitative information on barriers to access services as a result of contracting from service users’ perspective. The objective of this study was to explore perceived barriers to utilizing Maternal and Neonatal Health (MNH) services, in health facilities contracted out by government to NGO for service provision versus in those which are managed by government (non-contracted).

Methods: A community-based qualitative exploratory study was conducted between April to September 2012 at two …

Journey Over Four Decades To Discover New Definitions Of Stroke And Tia For 21st Century: Are We Ready For The Change?, Muhammad Athar Javed

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Under Recognized Entity: Chronic Inflammatory Demyelinating Polyneuropathy With Lupus, Ali Zohair Nomani, Haris Majid Rajput, Rao Sohail Yasin Khan, Mansoor Iqbal, Zakir Jan, Uzma Jamil, Mazhar Badshah, Muhammad Irshad

Pakistan Journal of Neurological Sciences (PJNS)

Chronic inflammatory demyelinating polyradiculoneuropathy (CIDP) is an acquired, autoimmune peripheral neuropathy. It has an insidious disease progression resulting in a debilitating illness. It is a well known neurological disorder. The causative factors are elucidating and it is generally considered idiopathic. However, its’ associations with various systemic disorders is well established albeit under recognized, especially with lupus as evident by few of the case reports/ series published in the recent past. The aim of this report is to highlight this neglected but important aspect of clinical neurology in common practice.

Eight – And - Half Syndrome: A Rare Neuro-Ophthalmic Syndrome “Possible Nine Syndrome”, Muslim Ali Lakhiar, Shaheen Ahmed Mughal

Pakistan Journal of Neurological Sciences (PJNS)

“Eight-and-half” syndrome is “one-and-a-half” syndrome characterized by conjugated horizontal gaze palsy and internuclearopthalmoplegia plus ipsilateral fascicular seventh nerve palsy. We report a case of 50 year old woman who presented with right eight and half syndrome together with contralateral hemiparesis and hemihypesthesia. Non contrast CT scan brain showed hyperdensesignal on right pontine region. MRI brain plain revealed hemorrhagicpontinetegmentuminfarction as well as corticospinal tract and medial meniscus. This spectrum of presentation suggests a possible “Nine syndrome” as a novel neuropthalmicpontine syndrome. The first of its kind ever reported from Pakistan

A 2 ½ Years Old Boy With Squint And Speech Loss, Shaila Ali, Zia Ur Rehman, Tipu Sultan

Pakistan Journal of Neurological Sciences (PJNS)

Tuberculosis of central nervous system is not uncommon in children of developing countries. Tuberculomaswere initially misdiagnosed due to lack of radiological expertise, un availability of CT scans and MRI. For early diagnosis and treatment, they should be kept in differential of space occupying lesions.We had a 2 ½ years old patient had fever, squint, aphasia and loss of motor milestones. On examination he was a malnourished child with right sided hypertonia and involvement of 9th and 10th cranial nerves with hepatospleenomegaly. His CRP was raised and CXRshowed B/L milliary shadowing which helped us to find out the primary focus leading …

Spectrum Of Neuromuscular Injuries In Victims Of Bomb Blasts, Dureshahwar Kanwar, Ambreen Iqrar, Zaitoon Shivji, Sara Khan

Pakistan Journal of Neurological Sciences (PJNS)

Introduction:
Bomb blast (BB) injuries outside war zones were a rare phenomenon until recently. With the spreading wave of terrorism across the globe, BB related trauma is resurfacing. Explosions can produce unique patterns of neuromuscular injury. No recent data exists categorizing such injuries.

Methods:
Medical records and electrodiagnostic findings of 20 patients with BB related neuromuscular injuries (NMI) were reviewed retrospectively.

Results:
Most common site of injury was the lower extremities (55%) with majority presenting clinically with foot drop (40%) or weakness (30%). 9/17 patients (45%) had associated shrapnel or penetrating trauma. 6/20 patients had associated fractures. The most …

An Ode To Neurology, Marina Wazir

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

National Guidelines For Diagnosis And Management Of Parkinson’S Disease In Pakistan, Nadir A Syed, Farwa Ali, Khalid Sher, Amer Ikram, Bashir Soomro, Naila Shahbaz, Mughis Sheerani, Sarwar Jamil, Ahsan Numan, Manzoor Lakhair, Irshad Awan, Saleem Barech, Haroon Basheer

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Vulnerable Road Users Are At Greater Risk During Ramadan -- Results From Road Traffic Surveillance Data., Amber Mehmood, Anoosh Moin, Irum Qamar Khan, Mohammad Umer Mir, Rashid Jooma

Department of Surgery Docs

Abstract

OBJECTIVE:

To assess how the frequency, nature and outcome of road traffic crashes differ during the fasting month of Ramadan.

METHODS:

The retrospective study was conducted in Karachi and comprised data from the Road Traffic Injury Surveillance Project which entailed information on all road traffic injury victims presenting to Emergency Departments in the city between September 2006 and September 2011. Data was analysed to find the frequency of road traffic crashes according to time of incident, road user group and survival. Ramadan and Non-Ramadan groups were compared with respect to time and frequency of incidents, road user group and …

Cost Of Primary Health Care In Pakistan, Muhammad Ashar Malik, Wahid Gul, Saleem Per Waiz Iqbal, Farina Abrejo

Community Health Sciences

Background: Detailed cost analysis is an important tool for review of health policy and reforms. We provide an estimate of cost of service and its detailed breakup on out-door patient visits (OPV) to basic health units (BHU) in Pakistan.

Method: Six BHUs were randomly selected from each of the five districts in Khyber Pukhtonkhawa (KPK) and two agencies in Federally Administered Tribal Areas (FATA) of Pakistan for this study. Actual expenditure data and utilization data in the year 2005 –06 of 42 BHUs was collected from selected district health offices in KPK and FATA. Costs were estimated for outpatient visits …

Uchunguzi (Journal Watchmontre De Journal) March 2015, Benjamin Wachira

Internal Medicine, East Africa

Uchunguzi means investigation in Swahili and provides a summary of some of the most recent international literature as presented in other leading journals, but with an emphasis on what is relevant to our continent.

Characterization Of Genomic Variations In Snps Of Pe_Pgrs Genes Reveals Deletions And Insertions In Extensively Drug Resistant (Xdr) M. Tuberculosis Strains From Pakistan., Akber Kanji, Zahra Hasan, Ruth Mcnerney, Mridul Nair, Asho Ali, Kim Mallard, Taane G. Clark, Ambreen Zaver, Sana Jafri,, Rumina Hasan

Department of Pathology and Laboratory Medicine

BACKGROUND:

Mycobacterium tuberculosis (MTB) PE_PGRS genes belong to the PE multigene family. Although the function of PE_PGRS genes is unknown, it is hypothesized that the PE_PGRS genes may be associated with antigenic variability in MTB.

MATERIAL AND METHODS:

Whole genome sequencing analysis was performed on (n=37) extensively drug-resistant (XDR) MTB strains from Pakistan, which included Lineage 1 (East African Indian, n=2); Other lineage 1 (n=3); Lineage 3 (Central Asian, n=24); Other lineage 3 (n=4); Lineage 4 (X3, n=1) and T group (n=3) MTB strains.

RESULTS:

There were 107 SNPs identified from the analysis of 42 PE_PGRS genes; of these, 13 …

Are Bp Readings Taken After A Patient-Physician Encounter In A Real-World Clinic Scenario The Lowest Of All The Readings In A Clinic Visit., Hunaina Shahab, Hamza Sohail Kan2 Khan, Aysha Almas, Sohail Abrar Khan, Aamir Hameed Khan

Department of Medicine

Objective: To determine the difference in Blood Pressure (BP) readings taken before, during and after the clinic encounter.

Study Design: Descriptive study.

Place and Duration of Study: Cardiology Clinic, The Aga Khan University Hospital, Karachi, from January to August 2013.

Methodology: Hypertensive and normotensive participants aged ≥ 18 years were recruited. Pre-clinic BP was measured by a nurse and in-clinic BP by a physician. After 15 minutes, two post-clinic BP readings were taken at 1 minute interval. All readings were taken using Omron HEM7221-E.

Results: Out of 180 participants, males were 57% and 130 (71%) were hypertensive. Mean SBP (Systolic …

Low Dose Albumin For The Prevention Of Renal Impairment Following Large Volume Paracentesis In Cirrhosis., Waqar Hussain, Abdullah Bin Khalid, Tayyab Usmani, Aiman Ghufran, Syed H Shah

Department of Medicine

OBJECTIVES: To evaluate the effect of low dose Albumin i.e. 4 grams per litre of ascitic fluid after large volume paracentesis (LVP) for the prevention of paracentesis induced circulatory dysfunction (PICD) related renal impairment in cirrhosis.

METHODS: Case records of all patients with cirrhosis who underwent LVP from January 12(th), 2011 till December 29(th), 2013 were reviewed. Patients were excluded if they had spontaneous bacterial peritonitis, creatinine >1.5 mg/dl, hepatoma or if volume of ascitic fluid removed was <5 litres. Data including age, gender, cause of cirrhosis, CTP score and volume of ascitic fluid drained were noted. In addition serum creatinine and serum sodium at baseline and one week post paracentesis were recorded.

RESULTS: Two hundred and fourteen patients with cirrhosis underwent LVP during the study period. One hundred and thirty nine patients met the …

Stroke Knowledge And Screening In A High Prevalence, Low Income Community, Maria Khan,, Hasan Rehman,, Ayeesha Kamran Kamal

Department of Medicine

No abstract provided.

Hiv Testing For Pmtct In Tanzania: Time To Move From ‘Voluntary’ To ‘Mandatory’?, Kahabi Isangula, Audrey Holmes, Sharon Brownie

School of Nursing & Midwifery, East Africa

Introduction: Every year many infants are infected with HIV, mostly in sub Saharan Africa. This is predominantly attributed to mother-to-child or “vertical” transmission during pregnancy, labor and delivery, and breastfeeding. Advances in antiretroviral therapy (ART) and funding have made the prevention of mother-to-child transmission (PMTCT) of HIV more affordable in sub-Saharan Africa. However, despite this advance and its potential in PMTCT, the uptake of HIV testing among pregnant women as an entry point to PMTCT services remains unsatisfactory in many countries.

Methods & Results: In the present paper, authors’ present a viewpoint that supports mandatory HIV testing for pregnant women …

Is 2015 The Primetime Year For Prehypertension? Prehypertension: A Cardiovascular Risk Factor Or Simply A Risk Marker?, Gabriel B. Habib, Salim S. Virani, Hani Jneid

Office of the Provost

No abstract provided.

Factors Affecting Ventriculoperitoneal Shunt Survival In Adult Patients, Farid Khan, Abdul Rehman, Muhammad Shahzad Shamim, Muhammad Ehsan Bari

Section of Neurosurgery

Background: Ventriculoperitoneal (VP) shunt insertion remains the mainstay of treatment for hydrocephalus despite a high rate of complications. The predictors of shunt malfunction have been studied mostly in pediatric patients. In this study, we report our 11-year experience with VP shunts in adult patients with hydrocephalus. We also assess the various factors affecting shunt survival in a developing country setting.
Methods: A retrospective chart analysis was conducted for all adult patients who had undergone shunt placement between the years 2001 and 2011. Kaplan-Meier curves were used to determine the duration from shunt placement to first malfunction and log-rank (Cox-Mantel) tests …

Immigrant Women's Experiences Of Maternity-Care Services In Canada: A Systematic Review Using A Narrative Synthesis, Gina M A. Higginbottom, Myfanwy Morgan, Mirande Alexandre, Yvonne Chiu, Joan Forgeron, Deb Kocay, Rubina Barolia

School of Nursing & Midwifery

Background: Canada's diverse society and its statutory commitment to multiculturalism means that a synthesis of knowledge related to the healthcare experiences of immigrants is essential to realise the health potential for future Canadians. Although concerns about the maternity experiences of immigrants in Canada are relatively new, recent national guidelines explicitly call for the tailoring of services to user needs. We therefore assessed the experiences of immigrant women accessing maternity-care services in Canada. In particular, we investigated the experiences of immigrant women in Canada in accessing and navigating maternity and related healthcare services from conception to 6 months postpartum in Canada. …

“We Have Been Working Overnight Without Sleeping”: Traditional Birth Attendants’ Practices And Perceptions Of Post-Partum Care Services In Rural Tanzania, Gladys R. Mahiti, Angwara D. Kiwara, Columba Mbekenga, Anna-Karin Hurtig, Isabel Goicolea

School of Nursing & Midwifery, East Africa

Background: In many low-income countries, formal post-partum care utilization is much lower than that of skilled delivery and antenatal care. While Traditional Birth Attendants (TBAs) might play a role in post-partum care, research exploring their attitudes and practices during this period is scarce. Therefore, the aim of this study was to explore TBAs’ practices and perceptions in post-partum care in rural Tanzania.

Methods: Qualitative in-depth interview data were collected from eight untrained and three trained TBAs. Additionally, five multiparous women who were clients of untrained TBAs were also interviewed. Interviews were conducted in February 2013. Data were digitally recorded and …

Polio - An Endemic Disease In Pakistan: Literature Review, Savera Aziz Ali, Nadir Suhail, Hunaina Hadi, Mohsina Hussain, Marium Manji, Jaweria Bano, Abdul Salam, Sajida Naseer, Sumera Aziz Ali

School of Nursing & Midwifery

Poliomyelitis is a highly contagious and incurable disease, which mainly affects children under five years of age leading to irreversible paralysis and possibly death. For decades, both private and government organizations have been putting efforts through their partnership to eradicate polio completely from the different parts of the globe and as a result of those efforts there are left only three countries which are currently polio endemic. Since Pakistan is one of those three countries which still remain polio endemic along with Afghanistan and Nigeria, it is significant to address this issue and work on the preventive measures to control …

The Artificial Divide Between Biomedical Sciences And Clinical Medicine In Undergraduate Medical Education, Abdul Rehman, Noor Ul-Ain Baloch, Muhammad Awais

Department of Biological & Biomedical Sciences

No abstract provided.

Self-Perceived Barriers To Eye Care In A Hard-To-Reach Population: The Karachi Marine Fishing Communities Eye And General Health Survey, Khabir Ahmad, Anthony B. Zwi, Daniel J. M. Tarantola, Tanveer Anjum Chaudhry

Department of Surgery Docs

Abstract

Purpose.: We examined self-reported barriers to eye care among marginalized, hard-to-reach fishing communities in Karachi, Pakistan.

Methods.: The Karachi Marine Fishing Communities Eye and General Health Survey was a cross-sectional survey conducted between March 2009 and April 2010 in fishing communities in Keamari, Karachi, located on the coast of the Arabian Sea. Adults aged ≥50 years living on seven islands and coastal areas were interviewed regarding sociodemographic background, experience of eye problems, eye care use, and barriers to access. They also were examined to determine visual acuity with a reduced logMAR chart and underwent a detailed eye examination.

Results.: …

Establishing Policy Foundations And Regulatory Systems To Enhance Nursing Practice In The United Arab Emirates, Sharon Brownie, Lyndal H. Hunter, Salah Aqtash, Gary E. Day

School of Nursing & Midwifery, East Africa

In 2009, the United Arab Emirates (UAE) established a Nursing and Midwifery Council with a mandate to develop standards for the registration and regulation of nursing and midwifery and to strengthen the nursing and midwifery workforce. Priorities included workforce Emiratization and the development of regulatory standards to support advanced and speciality nursing practice and new models of care—particularly for the management of noncommunicable diseases. This article provides background, context for, and best practice inputs to the effort to provide one unified framework of nursing regulation and licensure across the whole of the UAE. This article is intended for nurse leaders, …

Whole Genome Sequencing Based Characterization Of Extensively Drug-Resistant Mycobacterium Tuberculosis Isolates From Pakistan, Asho Ali, Zahra Hasan, Ruth Mcnerney, Kim Mallard, Grant Hill Cawthorne, Francesc Coll, Mridul Nair, Arnab Pain, Taane G. Clark, Rumina Hasan

Department of Pathology and Laboratory Medicine

Improved molecular diagnostic methods for detection drug resistance in Mycobacterium tuberculosis (MTB) strains are required. Resistance to first- and second- line anti-tuberculous drugs has been associated with single nucleotide polymorphisms (SNPs) in particular genes. However, these SNPs can vary between MTB lineages therefore local data is required to describe different strain populations. We used whole genome sequencing (WGS) to characterize 37 extensively drug-resistant (XDR) MTB isolates from Pakistan and investigated 40 genes associated with drug resistance. Rifampicin resistance was attributable to SNPs in the rpoB hot-spot region. Isoniazid resistance was most commonly associated with the katG codon 315 (92%) mutation …

Abuse Among School Going Adolescents In Three Major Cities Of Pakistan: Is It Associated With School Performances And Mood Disorders?, Saleem Khawaja, Adeel Khoja, Komal Motwani

Department of Medicine

Objective: To assess the proportion of various types of abuses and their association with school performances and psychological stress among adolescents from three major cities of Pakistan.

Methods: The cross-sectional school survey was conducted from March to September 2009, comprising adolescent students at six schools in Karachi, Lahore and Quetta. Data was collected using a self-administered and pre-tested questionnaire by trained medical students. SPSS 16 was used for statistical analysis..

Results: Of the 414 subjects in the study, there were 223(54%) boys and 191(46%) girls with an overall mean age of 14.36 ±1.08 years. In all, 140(33.7%) participants were physically …

Study Protocol: Asymptomatic Intracranial Atherosclerotic Disease In Pakistanis., Ayeesha Kamran Kamal, Farzin Majeed,, Omrana Pasha, Muhammad Islam, Iqbal Azam Syed, Muhammad Saleem Ilyas, Munawar Hussain, Kamran Masood, Bilal Ahmed, Sumaira Nazir,, Zafar Sajjad, Scott E. . Kasner

Department of Medicine

Background : Intracranial atherosclerotic disease (ICAD) is the most frequent subtype of ischemic stroke globally. It is important to describe the determinants of early ICAD as a strategy to prevent strokes from clinically evident and progressive ICAD. Our objective is to report the determinants of asymptomatic ICAD by linking the presence or absence of ICAD on magnetic resonance angiogram (MRA) with detailed risk assessment in asymptomatic adults.

Methods : This is an observational cross-sectional analytical study. We plan to recruit 200 adult participants from the radiology departments of two tertiary care centers of Karachi, Pakistan. The participants will first be …

Study Protocol: Validation And Adaptation Of Community-Worker-Administered Stroke Symptom Questionnaire In A Periurban Pakistani Community To Determine Disease Burden., Maria Khan, Ayeesha Kamran Kamal, Omrana Pasha, Muhammad Islam, Iqbal Azam Syed, Azam Virk, Alia Nasir, Anita Andani, Muhammad Jan, Anjum Akhtar, Junaid Abdul Razzak

Department of Medicine

Background : Stroke is the second leading cause of mortality and the leading cause of disability in the world today. The disease burden is on the rise in developing nations, but there is scarcity of data from these regions to inform policy decisions. Stroke burden can be determined by clinical diagnosis alone in the public health context and is a far more feasible way to assess disease status in low- to middle-income countries like Pakistan. We aim to translate and adapt a validated stroke symptom questionnaire, train community health workers in its administration, and verify it against assessment by two …

Uncovering The Concealed Part Of Motherhood-Postpartum Depression In Mothers, Hunaina Hadi, Shamsa Hadi

School of Nursing & Midwifery

Introduction: Motherhood is the most pleasing experience of a woman's life. Birth of a child gives birth to new hopes and ambitions. But Post-partum Depression is a condition when this blessing turns into curse. It can affect the mother, the partner and the child and can even lead to infanticide as well as maternal death, often by suicide.

Method: A qualitative systematic review was conducted through electronic medium to explore the relevant literature. Various databases i.e. Pubmed, Google search engines, Science Direct, JPMA, the Cumulative Index to Nursing and Allied Health Literature CINHAL and SAGA were used. Manual search was …