Medicine and Health Sciences Commons^™

Case Report: Bicornuate Uterus – A Precipitator Of Maternal Morbidity, Merlin Mary James

Journal of Asian Midwives (JAM)

This case report concerns a woman diagnosed with a bicornuate uterus with ovarian torsion. She had been married for seven years and had conceived three times, giving birth to two live babies and had onespontaneous abortion. She was presently admitted to the hospital with complaints of pain in the left iliac fossa,which she had had for two hours before admission along with vomiting, severe bleeding, and burning micturition.During the abdominal examination, left iliac tenderness was present. During the speculum examination, cervical erosions were seen and discharge was present. A vaginal examination revealed a normal sized uterus and the left fornix …

National Skills Training Centre In India, Manju Chhugani, Ashin Merlin

Journal of Asian Midwives (JAM)

A key determinant which can ensure the quality of healthcare in public health institutions is the skill set of the individuals providing service delivery. Health professionals possess the skills and the expertise in this respect; however, they fail to utilize these optimally. This is because there is a disconnect between their knowledge and practice, it is now imperative tobridge the gap between basic education and clinical practice. The creation of skill labs is one way in which this gap can be addressed. Though India has seen a decline inboth the Maternal and Infant Mortality Rates, significant changes are yet to …

Factors Affecting The Midwifery-Led Service Provider Model In Pakistan, Surriya Shahnaz, Rafat Jan, Arusa Lakhani, Rozina Sikandar

Journal of Asian Midwives (JAM)

Background: Pakistan has a high rate of maternal and infant mortality, and a shortage of skilled birth attendants (SBAs). Many efforts have been made through the health sector and the international agencies to resolve the problem of both a high Infant Mortality Rate (IMR) and Maternal Mortality Ratio (MMR), but the desired outcomes have not been achieved so far. Literature shows that midwifery plays a significant role in the reduction of MMR and IMR in other parts of the world, and the implementation of a Midwifery-led Service Provider Model could help reduce these rates in Pakistan. This study aims to …

To Achieve Safe And Respectful Maternity Care In Tertiary Level Hospitals In Nepal, Relatives Are A Valued Addition To The Provision Of Maternity Care, Sabitri Sapkota, Jamuna T. Sayami, Maiya Manadhar, Kerstin Erlandsson

Journal of Asian Midwives (JAM)

Introduction: The White Ribbon Alliance for safe motherhood believes respectful maternity care is the universal right of every childbearing woman.
Methods: NHRC in 2012 approved an inquiry of respectful care at facility-based childbirth. Individual-, focus group interviews and content analysis was used for gathering and analysis of data.
Findings: The participating women and the SBAs shared similar views, and this was that together the SBAs and relatives ensured the women remained within the comfort and safety zone when giving birth in a tertiary level maternity unit.
Conclusion: The SBAs strategy of having relatives provides basic care alongside the provision of …

Community Based Skilled Birth Attendants Programme In Bangladesh; Intervention Towards Improving Maternal Health, Sabera Turkmani, Fatima Gohar

Journal of Asian Midwives (JAM)

Aim: To review the strength and weakness of a community based skilled birth attendant (CSBA) program in Bangladesh.
Specific Objective: To explore perceptions of the providers, decision makers and community regarding newly trained community based skilled birth attendants.
To understand challenges, gaps and obstacles and recommend potential solutions for programme improvement.
Design: A descriptive study, using a qualitative approach was chosen to elicit the views and experiences of different stakeholders and the beneficiaries of the program was undertaken. The study intended to enhance understanding on gaps and challenges during program implementation by getting insight into different views. The data were …

Is “Empowerment” A Trickle-Down Effect Of The Afghanistan Midwifery Education Program?, Fatima Gohar, Pashtoon A. Zyaee, Sabera Turkmani

Journal of Asian Midwives (JAM)

Introduction: The patriarchal Afghan society has thousands of years of history. For most parts it has been governed by its tribal systems. The society has systematically evolved with its thousands of years old tradition, which has resulted in the subjugation of women. Although it is widely assumed that the midwifery education program (MEP) has contributed to female empowerment, no formal investigation has been carried out that explores the actual impact of MEP on the status of women midwifery graduates. Therefore, this study systematically explores the trickle down effects of MEP on women’s empowerment.
Methodology:
Design: Exploratory qualitative study
Study sites: …

News & Events

Journal of Asian Midwives (JAM)

No abstract provided.

Jam Carries On To Serve Midwives And The Midwifery Profession, Rafat Jan

Journal of Asian Midwives (JAM)

No abstract provided.

Isolated Cardiac Amyloidosis: An Enigma Unravelled, Umair Khalid, Omar Awar, Gordana Verstovsek, Benjamin Cheong, Sarvari Venkata Yellapragada, Hani Jneid, Anita Deswal, Salim S. Virani

Office of the Provost

Amyloidosis is a rare, multisystem disease characterized by deposition of fibrils in extracellular tissue involving kidney, liver, heart, autonomic nervous system, and several other organs. This report discusses a 75-year-old male who presented with worsening dyspnea on exertion, orthopnea, and lower-extremity edema. On physical exam, he had elevated jugular venous pressure and lower-extremity edema. Electrocardiogram depicted low voltage in limb leads and a prolonged PR interval. Echocardiogram revealed left ventricular hypertrophy, severe biatrial dilatation, and restrictive filling physiology. Coronary angiography showed absence of significant epicardial coronary artery disease. On right heart catheterization, a "dip-and-plateau sign" was noted on right ventricular …

Vacuum Assisted Closure-Utilization As Home Based Therapy In The Management Of Complex Diabetic Extremity Wounds, Kamran Hafeez, Haroon Ur Rashid, Ghulam Mustafa Karim Khani, Darshan Kumar, Sunil Kumar

Section of Orthopaedic Surgery

Objective: Vacuum assisted closure is a reported technique to manage complex wounds. We have utilized this technique by using simple locally available material in the management of our patients on outpatient basis. The objective of this study is to present our experience.
Methods: This study was conducted from June 2011 to June 2013 at Dow University Hospital and Aga Khan University Hospital, Karachi. There were 38 patients managed with vacuum assisted closure. Mean age was 56±7.8 years. Twenty three patients presented with necrotizing fasciitis and 15 patients with gangrene. Lower limbs were involved in majority of the patients. Debridement or …

Impacts Of Signal Free Corridors On The Incidence Of Road Traffic Accidents In Karachi, Salman Zubair, Jamil H. Kazm, Syed Shahid Ali, Rashid Jooma, Zeeshan Akhtar

Section of Neurosurgery

Increase in road Traffic Accidents is a global phenomenon and Pakistan is no exception. In Karachi, this problem becomes severe due to rapid growth of population. This menace is ruining the lives of thousands of people and making Karachi a worrisome place to live. Recent road geometrical transitions in the city with insufficient accessories have been reducing the problem of traffic congestion to a limited extent. On the contrary, this has erupted as a problem of Road Traffic Accidents which is reaching out of proportions. Recently, induction of a unique feature named, Signal Free Corridor in Karachi has cost many …

The Patterns Of Health Seeking Behavior Among Patients With Hepatitis C In Karachi, Pakistan, Shahina Sabz Ali Pirani, Tazeen S. Ali, Saleema Allana, Faisal Wasim Ismail

School of Nursing & Midwifery

Background: The study aimed to assess the patterns of health seeking behavior and the level satisfaction with the health care providers among hepatitis C patients in Karachi, Pakistan.
Methodology: A descriptive, cross-sectional study was conducted among 250 hepatitis C patients, who were recruited from the Aga Khan University Hospital and the Civil Hospital Karachi, Pakistan, between March and May 2013.
Results: The patterns of health seeking behavior showed that a majority of the study participants approached a medical doctor (n=359), followed by spiritual healers (n=103), and a few participants approached traditional healers (n=38) and homeopaths (n=11). The pattern …

Health Promotion, Disease Prevention And Periodic Health Checks: Perceptions And Practice Among Family Physicians In Eastern Mediterranean Region, Waris Qidwai, Kashmira Nanji, Tawfik A M Khoja, Salman Rawaf, Nabil Yasin Al Kurashi, Faisal Alnasir, Mohammed Ali Al Shafaee, Mariam Al Shetti, Muntazar Bashir, Nagwa Eid Sobhy Saad, Sanaa Alkaisi, Wafa Halasa, Huda Al L-Duwaisan, Amal Al - Ali, Taghreed M. Faraha

Department of Family Medicine

Introduction: The aim of this study was to identify the current practices and perceptions of family physicians regarding health promotion, disease prevention including periodic screening and health checks in Eastern Mediterranean Region.
Methods: A multi-country cross-sectional study was conducted in six countries of EMR, from September 2014 to March 2015. Family Physicians who were currently practicing in different countries of EMR were invited to participate in the study through email. A pre-tested structured questionnaire was used for data collection. Data was entered and analyzed on SPSS 19 and logistic regression analysis was performed.
Results: A total of 100 physicians’ …

Antidiarrheal And Antispasmodic Activities Of Polygonum Bistorta Rhizomes Are Mediated Predominantly Through K+ Channels Activation, Muhammad Zeeshan Ali, Khalid Hussain Janbaz, Hassan Mehmood, Anwar Hassan Gilani

Department of Biological & Biomedical Sciences

Polygonum bistorta is a popular medicinal herb used to treat diarrhea. This study provides pharmacological basis to its folk use in diarrhea using in vivo and in vitro assays. Administration of P. bistorta rhizomes extract to mice offered protection against castor oil-induced diarrhea at 300-1,000 mg/kg and was found safe up to the dose of 5 g/kg. In isolated rabbit jejunum, the extract caused a dose-dependent relaxation of spontaneous and low K⁺ (25 mM)-induced contractions with weak effect against high K⁺ (80 mM). In tissues pretreated with glibenclamide or tetraethylammonium chloride (TEA), the relaxant effect of the extract …

Antidiarrheal And Antispasmodic Activities Of Adiantum Capillus-Veneris Are Predominantly Mediated Through Atp-Dependent K+ Channels Activation, Khalid Hussain Janbaz, Waseem Hassan, Hassan Mehmood, Anwar Hassan Gilani

Department of Biological & Biomedical Sciences

The study was tempted to explore the scientific basis for the medicinal use of Adiantum capillus-veneris L. in diarrhea using the in vivo and in vitro assays. The crude extract of dried leaves of A. capillus-veneris exhibited antidiarrheal effect against castor oil-induced diarrhea in mice at 300 and 500 mg/kg, similar to the effect loperamide. It was also found safe up to administered dose of 7 g/kg in mice. In isolated rabbit jejunum, extract of A. capillus-veneris showed a concentration-dependent relaxation of spontaneous and low K⁺ (25 mM)-induced contractions and had weak inhibitory effect on high K⁺ (80 …

Prevalence Of Vitamin D Deficiency In Exclusively Breastfed Infants At The Aga Khan University Hospital, Nairobi, Nusrat. A. Said

Master of Medicine in Paediatrics and Child Health

Introduction: Vitamin D deficiency in infants is a recognized cause of rickets. In the last few years, evidence has emerged of its association with lower respiratory tract infections, food allergy, type 1 diabetes, schizophrenia and various other extra skeletal health effects. Exclusively breastfed infants are especially vulnerable to vitamin D deficiency due to their dependence on previous trans-placental transfer of vitamin D from the mother, dietary vitamin D from breast milk and cutaneous synthesis of vitamin D on exposure to sunlight. The worldwide epidemic of Vitamin D deficiency in pregnancy and the low content of vitamin D in breast milk …

Parental Understanding Of Tuberous Sclerosis Complex, Pauline Samia, Kirsten A. Donald, Birgit Schlegel, Jo M. Wilmshurst

Paediatrics and Child Health, East Africa

Tuberous sclerosis complex is a genetic disorder with multisystem involvement that poses significant challenges to the affected child and family. Caregiver knowledge in the South African population has not previously been reported. A prospective study of the parents of 21 children with tuberous sclerosis complex was undertaken. Median parental age was 38 (interquartile range 34.5-45) years. Parents were randomly allocated to receive written information about the condition, or to receive verbal counselling already established in clinic. A significant difference (P ¼ .001) was observed in the change in the mean knowledge scores for the parent group that received written information …

Cross-Sectional Survey On Prevalence Of Attention Deficit Hyperactivity Disorder Symptoms At A Tertiary Care Health Facility In Nairobi, Susan Wamithi, Roseline Ochieng, Frank Njenga, Samuel Akech, William Macharia

Paediatrics and Child Health, East Africa

Background:Attention deficit hyperactivity disorder is the most common childhood neurobehavioral disorder with well documented adverse consequences in adolescence and adulthood, yet 60-80% of cases go undiagnosed. Routine screening is not practiced in most pediatric outpatient services and little information exists on factors associated with the condition in developing countries.

Methods:This was a questionnaire based cross-sectional survey whose primary objective was to determine prevalence of attention deficit hyperactivity disorder (ADHD) symptoms in children aged 6-12 years attending a tertiary care hospital Accidents and Emergency unit. Secondary objectives were to: (i) ascertain if physical injury and poor academic performance were …

Prevalence And Immediate Outcome Of Candida Colonized Preterm Neonates Admitted To Special Care Unit Of Mulago Hospital, Kampala Uganda, Yaser Abdallah, Deogratias Kaddu -Mulindwa, Jolly Nankunda, Philippa M. Musoke

Paediatrics and Child Health, East Africa

Background: Candida species is the third commonest cause of sepsis among neonates. Colonization by Candida is a predictor for candidemia among preterm neonates.

Objectives: To determine prevalence of early Candida colonization and early outcome among colonized preterm neonates admitted to Mulago hospital Special Care Unit.

Methods: A prospective observational cohort was conducted between December 2008 and April 2009. Preterm neonates aged >72 hours and less than one week were screened for Candida colonization of the groin, oral pharynx and rectum using CHROMagar. Colonized neonates were followed up for 14 days. Blood cultures were done for those with signs of …

Determining The Potential Scalability Of Transport Interventions For Improving Maternal, Child, And Newborn Health In Pakistan, Naeem Uddin Mian, Mariam Zahid Malik, Sarosh Iqbal, Muhammad Adeel Alvi, Zahid Memon, Muhammad Ashraf Chaudhry, Ashraf Majrooh, Shehzad Hussain Awan

Centre of Excellence in Women and Child Health

Background: Pakistan is far behind in achieving the Millennium Development Goals regarding the reduction of child and maternal mortality. Amongst other factors, transport barriers make the requisite obstetric care inaccessible for women during pregnancy and at birth, when complications may become life threatening for mother and child. The significance of efficient transport in maternal and neonatal health calls for identifying which currently implemented transport interventions have potential for scalability.
Methods: A qualitative appraisal of data and information about selected transport interventions generated primarily by beneficiaries, coordinators, and heads of organizations working with maternal, child, and newborn health programs …

Co-Targeting Of Cyclooxygenase-2 And Foxm1 Is A Viable Strategy In Inducing Anticancer Effects In Colorectal Cancer Cells, Maqbool Ahmed, Azhar Hussain, Abdul K. Siraj, Shahab Uddin, Nasser Al-Sanea, Fouad Al-Dayel, Mohammed Al-Assiri, Shaham Beg, Khawla S. Al-Kuraya

Centre for Regenerative Medicine & Stem Cell Research

Background: Cross-talk between deregulated signaling pathways in cancer cells causes uncontrolled growth and proliferation. These cancers cells become more aggressive and quickly develop resistance to therapy. Therefore targeting of these deregulated pathways simultaneously can result in efficient cell death of cancer cells. In this study we investigated co-expression of Cox-2 and FoxM1 in a cohort of colorectal carcinoma (CRC) samples and also examined whether inhibition of Cox-2 and FoxM1 simultaneously can lead to inhibition of cell viability and induction of apoptosis in colorectal cancer cell lines and in vivo xenograf
Methods: Protein expression of Cox-2 and FoxM1 was determined …

Polio Eradication And Health Systems In Karachi: Vaccine Refusals In Context, Svea Closser, Rashid Jooma, Emma Varley, Naina Qayyum, Sonia Rodrigues, Akasha Sarwar, Patricia Omidian

Section of Neurosurgery

Community and health worker engagement will be key to polio eradication in Karachi, Pakistan. In this study, the authors conducted participant observation, interviews, and a document review in SITE Town, Karachi, an area that in recent years has harbored poliovirus. SITE’s diverse population includes large numbers of internally displaced persons who are disproportionately affected by polio and are more likely than other populations to refuse the polio vaccine. Vaccine acceptance and worker motivation in SITE Town were shaped by the discrepancy in funding and attention for polio eradication campaigns as compared with routine services. Parental vaccine refusals stemmed from a …

Effectiveness Of Helmets In Preventing Severe Injuries In A Setting With Poorly Enforced Quality Standards, Junaid Ahmad Bhatti, Junaid A. Razzak, Rashid Jooma

Department of Emergency Medicine

Helmets save lives, yet many countries do not have laws about their quality assessment or how they should be worn. We assessed the effectiveness of helmet use in preventing injuries in such a setting. The data were extracted from a large road traffic injury surveillance study in Karachi, Pakistan. We assessed the association of wearing helmets with several injury outcomes including deaths, injury severity (via New Injury Severity Score, NISS ≥ 9) and moderate or severe injury (via Abbreviated Injury Score, AIS ≥ 2) to head, face, or other regions of the body. The data about helmet use was available …

Unforgiving Heat Wave Deaths In The Largest Metropolitan City Of Pakistan: Lessons Learned, Muhammad Akbar Baig, Shahan Waheed, Asad Mian, Erfaan Hussain

Department of Emergency Medicine

Heat stroke is a deadly condition that needs astute care and timely management. Recently, the city of Karachi in Pakistan has been the victim of an intense heat wave, which has resulted in an insurmountable loss of life. We observed various deficiencies in dealing with this national threat that provides us with a valuable lesson regarding the measures that can be undertaken to avoid such a disaster from occurring again.

Interaction And Cognitive Engagement In Online Discussions In Professional Development Leadership And Management Course At A Private Nursing Institution, Nimira Asif, Samina Vertejee, Sharifa Bashir Lalani

School of Nursing & Midwifery

In the Post RN BScN curriculum, one of the courses “Professional Development and Leadership (PDLM)” was offered as blended mode for the first time. In order to explore the students’ interactions and Cognitive Engagement (CE) in Online Discussion Forums (ODFs), the research team conducted a retrospective study for the first time at a private nursing institution of Karachi-Pakistan. The study was conducted by utilizing the retrospective qualitative paradigm of discourse analysis to understand student’s CE in ODFs. The study has addressed the following one main and three subsidiary research questions: How do threaded discussions (in the part of online forums) …

Prevalence Of Obesity And Overweight, Its Clinical Markers And Associated Factors In A High Risk South-Asian Population, Faridah Amin, Syeda Sadia Fatima, Najmul Islam, Anwar H. Gilani

Department of Biological & Biomedical Sciences

Background: Obesity is a global epidemic, which is a risk factor for cardiovascular diseases and metabolic abnormalities. It is measured by body mass index (BMI), waist circumference (WC), waist-hip ratio (WHR), body fat (BF) distribution and abdominal fat mass, each having its own merits and limitations. Variability in body composition between ethnic groups in South-Asians is significant and may not be truly reflected by BMI alone, which may result in misclassification. This study therefore, aims to determine the frequency of obesity, body fat composition and distribution, in a high risk population of an urban slum of Karachi, Pakistan. This survey …

Antidiarrhoeal, Antisecretory And Antispasmodic Activities Of Matricaria Chamomilla Are Mediated Predominantly Through K+-Channels Activation, Hassan Mehmood, Siraj Munir, Uzair Ali Khalid, Mudassir Asrar, Anwarul Hassan Gilani

Department of Biological & Biomedical Sciences

Background: Matricaria chamomilla commonly known as “Chamomile” (Asteraceae) is a popular medicinal herb widely used in indigenous system of medicine for a variety of ailments. However, there is no detailed study available showing its effectiveness in hyperactive gut disorders like, abdominal colic and diarrhoea. This study was designed to determine the pharmacological basis for the folkloric use of Matricaria chamomilla in diarrhoea.
Methods: The crude aqueous-methanolic extract of Matricaria chamomilla (Mc.Cr) was studied for its protective effect in mice against castor oil-induced diarrhoea and intestinal fluid accumulation. The isolated rabbit jejunum was selected for the in-vitro experiments using tissue bath …

Delivering Healthcare Services In Resource Constraint Countries Like Pakistan: Sustainable Options, Waris Qidwai

Department of Family Medicine

No abstract provided.

Prevalence Of Tobacco Use Among Women: A Cross Sectional Survey From A Squatter Settlement Of Karachi, Pakistan, Nousheen Iqbal, Muhammad Irfan, Nida Ashraf, Safia Awan, Javaid A. Khan

Section of Pulmonary & Critical Care

Background: While the prevalence of tobacco use has been slowly declining in the developed countries, rates have been steadily rising in the developing countries. This has led to a rapid rise in tobacco related lung diseases among women.

Objective: Determine the prevalence of tobacco use (both smoking and smokeless) among women in an urban squatter settlement (Orangi Town) in Karachi, Pakistan.

Methods: A cross-sectional survey was conducted on 19,325 females aged between 15 and 80 years in Orangi Town, an urban squatter settlement in Karachi, Pakistan. Modified questionnaire, developed by World Health Organization WHO and Global Adult …

Community-Based Perceptions Of Emergency Care In Kenya, Morgan C. Broccoli, Emilie J.B Calvello, Alexander P. Skog, Benjamin W. Wachira, Lee A. Wallis

Emergency Medicine, East Africa

Access to quality emergency services is an essential component of the human right to health, but barriers to emergency care are found throughout Africa and the wider world. Data to support the development of emergency care are essential to improve access to care and further infrastructure development. We undertook this study to understand the community's emergency care needs and the barriers they face when trying to access care and to engage community members with developing high impact solutions to expand access to essential emergency services.

To accomplish this, we used a qualitative research methodology to conduct 59 focus groups with …