Medicine and Health Sciences Commons^™

Spectrum Of Acquired Demyelinating Disorders Of The Central Nervous System In Adults In A Tertiary Care Hospital, Muhammad Athar Javed, Dr Qamar Zaman, Dr Naveed Alam, Ather Enam

Pakistan Journal of Neurological Sciences (PJNS)

Acquired demyelinating disorders of the central nervous system are diverse group of conditions characterized by destruction or disturbance of myelin sheath in the central nervous system i.e. brain and spinal cord. These vary in their causes, clinical presentations, and prognosis.

Importance Of Measuring Non-Hdl Cholesterol In Type 2 Diabetes Patients., Nanik Ram, Bilal Ahmed, Fauzan Hashmi,, Abdul Jabbar

Department of Medicine

OBJECTIVE:

To study the correlation between Non-high-density lipoprotein and low-density lipoprotein cholesterol in patients with Type 2diabetes mellitus and the proportion of patients achieving Adult Treatment Panel III recommended goals.

METHODS:

The cross sectional study was conducted at the Diabetic Clinic, Aga Khan University Hospital, Karachi. Data of Type 2 diabetesmellitus patients who attended the clinic bewteen 2007 and 2011 was reviewed. All Type 2 diabetic patients of either gender with fasting lipid profile irrespective of taking lipid lowering therapy were included.Type-1 DM, gestational diabetes, type 2 diabetes patients with pregnancy and those with incomplete data were excluded. Correlation between …

Galectin-1 In Early Acute Myocardial Infarction, Suhail Al-Salam, Satwat Hashmi

Department of Biological & Biomedical Sciences

Myocardial infarction (MI) is the most serious manifestation of coronary artery disease and the cause of significant mortality and morbidity worldwide. Galectin-1(GAL-1), a divalent 14.5-kDa protein, is present both inside and outside cells, and has both intracellular and extracellular functions. Hypoxia inducible factor-1 alpha (HIF-1α) is a transcription factor mediating early and late responses to myocardial ischemia. Identification of the pattern of expression of GAL-1 and HIF-1α in the heart during the first 24 hours following acute MI will help in understanding early molecular changes in this event and may provide methods to overcome serious complications. Mouse model of MI …

Emerging Challenges And Health System Capacity: The Case Of Non- Communicable Diseases In Pakistan; A Review, Mubashir Zafar, Muhammad Ashar Malik

Community Health Sciences

Background: Pakistan is facing double burden of disease and the contribution of mortality by non-communicable diseases has over numbered the communicable diseases. The focus of health system of Pakistan is inclined more towards communicable disease and maternal & child health. Therefore, there is a need to review health policy, health sector budgeting and health setup in order to meet the needs of healthcare in context of non-communicable disease.

Objective: To review the health system capacity to manage the emerging challenge of non-communicable diseases in Pakistan.

Methodology: A thorough literature search on PubMed and Google Scholar was done. Reports from W.H.O, …

Resolving Ethical Dilemma: An Application Of A Theoretical Model, Lubna Ghazal, Zulekha Saleem, Gulzar Amlani

School of Nursing & Midwifery

Human error can occur in any profession. Medical errors most commonly occur in a health care system, which may delay patient’s recovery and produce harm to patients. However, when a medical error occurs, it is challenging to inform the incident to patients and their family. Health care professionals follow a professional code of ethics to do well and not harm patients. Historically, many of these errors were not disclosed to patients but the trend for more open disclosure of medical errors to patients and their families is a mutually beneficial and welcomed change.

Conversion Of Autoimmune Hypothyroidism To Hyperthyroidism, Saira Furqan, Naeem-Ul Haque, Najmul Islam

Section of Diabetes, Endocrinology and Metabolism

Background: Graves' disease and Hashimoto's thyroiditis are the two autoimmune spectrum of thyroid disease. Cases of conversion from hyperthyroidism to hypothyroidism have been reported but conversion from hypothyroidism to hyperthyroidism is very rare. Although such cases have been reported rarely in the past we are now seeing such conversions from hypothyroidism to hyperthyroidism more frequently in clinical practice.

Case Presentation: We are reporting three cases of middle aged Asian females who presented with classical symptoms of hypothyroidism and the investigations showed elevated thyroid stimulating hormone with positive thyroid antibodies. Diagnosis of autoimmune hypothyroidism was made and thyroxine replacement therapy …

Pituitary Stalk Interruption Syndrome Presenting As Short Stature: A Case Report, Nanik Ram, Syed Ahsan Ali, Syed Zubair Hussain

Section of Diabetes, Endocrinology and Metabolism

Introduction: Pituitary stalk interruption syndrome is a rare congenital abnormality of the pituitary that is responsible for anterior pituitary deficiency. It is characterized by a classic triad of interrupted pituitary stalk, absent or ectopic posterior pituitary, and anterior pituitary hypoplasia or aplasia. Clinical presentation varies according to age. In adults it presents as short stature and anterior pituitary deficiency. Without early diagnosis and treatment, mortality and morbidity in these patients is high. Early diagnosis and treatment of this rare disease can prevent permanent short statue of the patient. We report the first case of pituitary stalk interruption syndrome from …

Preablation Stimulated Thyroglobulin/Tsh Ratio As A Predictor Of Successful I(131)Remnant Ablation In Patients With Differentiated Thyroid Cancer Following Total Thyroidectomy, Syed Zubair Hussain, Maseeh Uz Zaman, Sarwar Malik, Nanik Ram, Ali Asghar, Unaib Rabbani, Nida Aftab, Najmul Islam

Section of Diabetes, Endocrinology and Metabolism

Background. About 90% of thyroid cancers are differentiated thyroid cancers. Standard treatment is total thyroidectomy followed by radioactive I(131)remnant ablation and TSH suppression with thyroxine. Unsuccessful ablation drastically affects the prognosis of patients with DTC particularly high risk individuals; therefore, identifying the factors that affect the success of ablation is important in the management of patients with DTC. sTg is a good predictor of successful ablation in DTC. Its levels can be influenced by tumor staging and TSH values, as well as other factors. Therefore, we did this study using TSH to correct the predictive value of sTg in …

Role Of Complementary And Alternative Medicine In Controlling Dyslipidemia, Waris Qidwai, Firdous Jahan, Kashmira Nanji

Department of Family Medicine

No abstract provided.

Perceived Barriers Among Pregnant Women Towards Cervical Cancer Screening, Visavilwa Vincent Lamuka

Master of Medicine in Family Medicine

Background: Cervical cancer remains the most common cancer in women in Eastern Africa in general and Tanzania in particular. However, to a large extent cervical cancer is preventable by effective screening programmes as has been demonstrated in many developed countries. Developing countries lack formal national screening programmes. Screening is usually mainly done opportunistically. Objective: To assess the perceived barriers to uptake of cervical cancer screening among pregnant women attending antenatal clinics in two hospitals in Dar es Salaam. Methodology: This was a qualitative study, conducted at two hospitals in Dar es salaam, a government facility (Amana District Hospital) and a …

An Assessment Of Whether Medical Doctors Have The Knowledge That Would Enable Them To Competently Deliver Tobacco Cessation Services, Miriam Miima Khamonya

Master of Medicine in Family Medicine

Background: Tobacco use is the leading cause of preventable morbidity and mortality globally. The international community recognizes this epidemic and compelling evidence exists on the significant contribution of the health care provider in propagating the success of tobacco cessation. The World Health Organization highlights minimal implementation of tobacco control policies by Tanzania despite a rise in tobacco use prevalence. Medical doctors’ competence is a reflection on our commitment to tobacco cessation service delivery. Main Objectives: To assess whether medical doctors have the knowledge that would enable them to competently deliver tobacco cessation services. Specific Objectives 1. To assess medical doctors’ …

Understanding And Managing Complications In Neurosurgery, Raza Sayyed, M Shahzad Shamim

Pakistan Journal of Neurological Sciences (PJNS)

It is a well-known surgical maxim that only two types of surgeons do not have surgical complications; those who do not operate, and those who lie. Surgical complications in other words, are unwanted but undeniable part of surgery. There is not one operation with a 0% complication rate and therefore statistically, if a surgeon does not have complications, he probably has not operated enough. Despite their inevitability, complications convey a sense of gravity to the public, health professionals, and the policy makers alike.

Delay In Diagnosis Of Motor Neuron Disease. A Tertiary Care Experience, Hazim Brohi, Naveed Uddin Ahmed, Rajesh Khatri, Ishaq Asghar

Pakistan Journal of Neurological Sciences (PJNS)

Motor Neuron Disease is a progressive neurological disorder with poor prognosis. Inability to correctly recognize the disease, leads to undue agony and diagnostic dilemma. Studies have been done to look at the average duration taken to diagnose the disease from the onset of symptoms. The literature shows that latency from symptom onset to diagnosis range from 10.6–17.5 months. No such study has been conducted in our region. We reviewed 62 patients referred to the neurophysiology lab from year 2009 to 2013 with quarry of MND. Only 40 patients were identified to fulfill the El Escorial criteria for MND. The median …

Assessing Interprofessional Continuing Education And Planning Ahead, Farhan Vakani, Mughis Sheerani

Pakistan Journal of Neurological Sciences (PJNS)

The purpose of this survey is to check the concept of Interprofessional education (IPE) to continuing education among working physicians.It assessed 150 randomly selected working physicians of the Aga Khan University Hospital. One -best type questionnaire was designed and piloted to check its completion within 90 seconds.Four quick questions were dedicated at C1 & C2 level focused to check the knowledge and understanding of the physicians to IPE. The results showed 100% response rate. Majority (i.e. > 80%) of the respondents were familiar with the term IPE.The next three items tested physicians understanding regarding the IPE ability to improve communication, teamwork, …

Crossed Cerebellar Diaschisis In Partial Status Epilepticus, Sahrish Aieshah Kazi, Rehmani Aniqah Jawad, Rashed Nazir, Shahid Ahmed Shah, Arsalan Ahmad

Pakistan Journal of Neurological Sciences (PJNS)

Crossed cerebellar diaschisis is a phenomena described as decrease in metabolism in the cerebellar hemisphere contralateral to the supratentorial lesion. A 61 year old man presented with status epilepticus. CT Brain showed small acute hemorrhage in left parietal lobe.MRI revealed diffusion restriction in right cerebral and left cerebellar hemispheres with hyperintensities on T2WI and FLAIR. However, CT perfusion was suggestive of increased perfusion in these areas. Periictal EEG showed frequent bursts of higher voltage spike and wave discharges over the right hemisphere. He was treated with IV antiepileptics. But he continued to deteriorate, and expired at 10th day of admission.

Neurostimulation For Refractory Primary Chronic Headache Disorders: A Review, Bindu Yoga, Modar Khalil, Hassan Zafar, Fayyaz Ahmed

Pakistan Journal of Neurological Sciences (PJNS)

Headache is the commonest symptom seen in both primary and secondary care. Vast majority are primary i.e. for which no underlying cause has been detected. Tension Headaches, Migraine and Cluster Headaches are the most common primary headache disorders in the population. Although most of the primary headache disorders can be satisfactorily treated with both acute and preventive medications, those that are refractory to conventional treatment pose a great challenge to the headache physician. Moreover some patients are not able to use traditional treatment due to intolerance and co-morbidities. Neurostimulation is a treatment modality that has been used in other neurological …

Gossypiboma Diagnosed Fifteen Years After A Cesarean Section: A Case Report, Abdul Rehman, Noor Ul-Ain Baloch, Muhammad Awais

Department of Biological & Biomedical Sciences

Gossypiboma, a retained surgical sponge, is a rare complication following any surgical procedure and is primarily a result of human error. Such patients often have vague clinical presentations and the diagnosis often comes as a surprise. We present the case of a 40-year-old woman who had a long-standing history of lower abdominal discomfort. She was diagnosed with a gossypiboma fifteen years after a cesarean section. All general physicians, surgeons and radiologists must be aware of this rare but clinically significant entity.

Pharmacological Basis For The Medicinal Use Of Rhus Coriaria In Hyperactive Gut Disorders, Khalid Hussain Janbaz, Arham Shabbir, Hassan Mehmood, Anwarul Hassan Gilani

Department of Biological & Biomedical Sciences

This study was aimed at providing the pharmacological basis for the medicinal use of Rhus coriaria in diarrhea. In mice, the crude of R. coriaria demonstrated antisecretory and antidiarrheal effects against castor oil-induced fluid accumulation and diarrhea at at 100 and 300 mg/kg, respectively, and was found safe up to tested dose of 5 g/kg. In isolated rabbit jejunum, R. coriaria exhibited concentration-dependent (0.01-3.0 mg/mL) relaxation of spontaneous and high K⁺ (80 mM)-induced contractions, similar to verapamil. The Ca⁺⁺ antagonist activity was confirmed when pretreatment of R. coriaria shifted Ca⁺⁺ concentration-response curves to the right with suppression …

Racecadotril For The Treatment Of Severe Acute Watery Diarrhoea In Children Admitted To The Kenyatta National Hospital - A Randomised Double Blinded Placebo Controlled Trial, Jaspreet Singh Gharial

Master of Medicine in Paediatrics and Child Health

Background: Diarrhoeal disease is the second most common cause of death in children under 5 years of age in Kenya. Treatment with Oral Rehydration Solution (ORS), elemental zinc and continued feeding (as recommended by the World Health Organisation) led to a significant reduction in mortality in the 1970s and 1980s, which has slowed since then. Adjunctive treatments have however, not gained much popularity either due to modest improvements in morbidity and mortality or unacceptable adverse effect profiles. Racecadotril, an enkephalinase inhibitor, has been used for over 2 decades in parts of Europe but is only recently gaining recognition in other …

Hospital-Acquired Malnutrition In Children In A Tertiary Care Hospital, Del-Rossi Sean Quadros

Master of Medicine in Paediatrics and Child Health

Introduction: Hospital-acquired Malnutrition occurs as a result of reduction in food intake, increased dietary loss and/or increased calorie requirements as a result of disease-induced high catabolic state. A child's nutritional status often deteriorates after admission to the hospital resulting in longer duration of hospital stay and increased risk of complications, which also increases treatment cost. Hospital-acquired Malnutrition is usually assessed using anthropometric measurements and/or serum pre-albumin. Objectives: This study sought to investigate the incidence of Hospital-acquired Malnutrition using anthropometric measurements and to determine diagnostic utility of serum pre-albumin in predicting weight change. A secondary objective was to identify factors associated …

Prevalence And Outcomes Of Acute Kidney Injury In Term Neonates With Perinatal Asphyxia, Dan Alaro, Bashir Admani, Lucy Wainaina, Rachel Musoke

Paediatrics and Child Health, East Africa

Background: The kidney is the most damaged organ in asphyxiated full-term infants. The severity of its damage is corre­lated with the severity of neurological damage. We determined the prevalence of perinatal asphyxia-associated acute kidney injury (AKI).

Methods: We conducted a prospective cohort study including 60 full-term neonates admitted at the Kenyatta National Hospital newborn unit (NBU) in Nairobi with hypoxic ischaemic encephalopathy (HIE) from June 2012 to November 2012. Renal function was assessed by measuring serum creatinine on day 3 of life. AKI was defined by a level of creatinine above 133 μmol/l. The degree of neurological impairment was determined …

Pediatric Cerebral Palsy In Africa: Where Are We?, Kirsten A. Donald, Angelina M. Kakooza, Robinson D. Wammanda, Macpherson Mallewa, Pauline Samia, Haydar Babakir, David Bearden, Annette Majnemer, Darcy Fehlings, Michael Shevell, Harry Chugani, Jo M. Wilmshurst

Paediatrics and Child Health, East Africa

Cerebral palsy is the most common cause of physical disability in children worldwide. However, little is reported on this condition in the African context. Doctors from 22 countries in Africa, and representatives from a further 5 countries outside Africa, met to discuss the challenges in the evaluation and management of children with cerebral palsy in Africa and to propose service needs and further research. Basic care is limited by the poor availability of diagnostic facilities or medical personnel with experience and expertise in managing cerebral palsy, exacerbated by lack of available interventions such as medications, surgical procedures, or even regular …

African Primary Care Research: Current Situation, Priorities And Capacity Building, Robert Mash, Akye Essuman, Riaz Ratansi, Felicity Goodyear-Smith, Klaus Von Pressentin, Zelra Malan, Marianne Van Lancker, Jan De Maeseneer

Faculty of Health Sciences, East Africa

The Sixth PRIMAFAMED (Primary Health Care/Family Medicine Education Network) workshop on ‘Capacity Building and Priorities in Primary Care Research’ was held in Pretoria, South Africa (SA), from 22 to 24 June 2014. Delegates from the following countries attended the workshop: Ghana, Nigeria, Uganda, Kenya, Tanzania, Sudan, Malawi, Zimbabwe, Botswana, Namibia, SA, Zambia, Ethiopia, Rwanda, Mozambique, Swaziland, Belgium, and Denmark (Figure 1). Delegates were from established or emerging departments of family medicine and primary care in these countries. The central theme of the workshop was primary care research – the current situation, the priorities for research and the need for capacity …

Understanding The Barriers To Contraceptive Use In Hiv-Positive Women Of Child Bearing Age In Dar-Es-Salaam, Tanzania, Tabitha-Alexandria Njeri Nyanja

Master of Family Medicine

Title: Understanding the barriers to contraceptive use among HIV-positive women of child bearing age in Dar-es-Salaam, Tanzania- a multi-site study Purpose: The purpose of this study was to explore the perceived barriers to contraceptive use and identify the factors that influence contraceptive choice, as well as the relationship of these among HIV-positive women living in an urban population in Dar-es-Salaam Tanzania. Goals and Objectives: To determine the perceived barriers to contraceptive use among HIV-positive women of child-bearing age attending the Care Treatment Centres (CTCs) Tanzania and in the President’s Emergency Plan for AIDS Relief (PEPFAR) supported CTCs within Dar-es-salaam. Methodology: …

Use Of Femoral Nail With Spiral Blade In Subtrochanteric Fractures, Masood Umer, Haroon Rashid, Idrees Shah, Irfan Qadir

Section of Orthopaedic Surgery

Objective: The aim of this study was to evaluate the outcome of acute subtrochanteric fractures managed with intramedullary nail and spiral blade fixation of the proximal fragment.
Methods: Charts of 33 patients (17 males and 16 females) with acute subtrochanteric fractures operated with intramedullary nail and spiral blade at our institution between March 2006 and February 2011 were retrospectively reviewed. The most common (67%) mechanism of injury was ground-level fall, predominantly involving elderly patients. Results were evaluated in terms of union time, implant failure rate, infection rate and functional outcome.
Results: Mean duration of surgery was 2.4 hours and average …

Women’S Perception And Attitude Towards Male Dominancy And Controlling Behaviors, Tazeen S. Ali, Noureen Karamali, Omer Malik

School of Nursing & Midwifery

Introduction/Background: The study was conducted in urban Karachi, Pakistan to investigate women’s perceptions and attitudes towards male dominancy, female autonomy, and controlling behavior of husbands.
Method: This was investigated in a population based study with a cross-sectional design, involving married women aged 25 to 60 years. A Structured questionnaire developed by World Health Organisation (WHO) on violence was used. Community midwives interviewed these married women living in pre-selected low, middle and upper socio-economic areas of urban Karachi, Pakistan.
Findings: This study revealed women’s overall perception regarding male dominancy and controlling behavior and highlighted this attitude, as being …

Refusal To Autopsy: A Societal Practice In Pakistan Context, Laila Akber Cassum

School of Nursing & Midwifery

Autopsies or post-mortem examinations have become a common practice in Western medicine for verifying the cause of death, and to obtain additional scientific information on certain diseases. In monotheistic religions autopsies present several ethical questions even though the advantages attributed to post-mortems in the West are well acknowledged by people living in this modern world. In Islamic Republic of Pakistan where Islam is the prevailing religion followed by the Muslims, Pakistani society have diverse perception, assumptions and hypothesis on the concept of autopsy. This presumption is due to presence of diverse objections raised in religious and sociocultural context. In our …

Complementary And Alternative Medicine In Oncology Nursing, Salima Somani, Fauziya Ali, Tazeen S. Ali, Nasreen Sulaiman Lalani

School of Nursing & Midwifery

Use of complementary and alternative medicine (CAM) has increased globally, particularly among oncology patients. This study investigated the knowledge, experience and attitudes of oncology nurses towards CAM. A quantitative study was conducted in tertiary care hospitals in Karachi, Pakistan, where 132 oncology nurses were surveyed. The survey revealed that more than 50% of nurses had never heard about many of the CAM therapies used in Pakistan. Approximately 65% of the nurses had knowledge about prayer and less than 30% had experience of CAM education or training. In addition, the majority of nurses had seen patients using CAM and felt that …

Associations Of Controlling Behavior, Physical And Sexual Violence With Health Symptoms, Tazeen S. Ali, Aamir Abbas, Fazal Ather

School of Nursing & Midwifery

Controlling behavior is often manifested as monitoring, coercing or threatening the partner. Globally, it has been experienced by the women (in range of 5.2% to 56.6%) and often results in their physical and mental ill health. To the best of our knowledge there is no published research on controlling behaviors. Therefore, a cross sectional study was conducted to measure the magnitude of the controlling behaviors and its association to some physical stress symptoms of women. The study was conducted in urban settings of Karachi, Pakistan, using simple random sampling technique. The data was collected by trained midwifes from the 759 …

Verbal Violence At Workplace: A Reality From Pakistani Context., Laila Akber Cassum

School of Nursing & Midwifery

Work place violence is the most distressing subject globally, and has been a concern for many decades affecting home and work environment.This cancer has even invaded health care sector worldwide. Nursing professionals whether they are at hospital or at academics institutions are subjected to violence. Although, it has been a burning issue, among nursing health care workers it has often gone unchecked, and people tend to accept it as the part of the system.

In this paper I would be discussing and deliberating that work place violence particularly verbal abuse is a serious matter and it can have negative consequences …