Medicine and Health Sciences Commons^™

The Feasibility Of An Internet-Based Intervention For Chinese People With Mental Illness: A Survey Of Willingness And Attitude, Xiu-Y Yao, Zheng Li, David Arthur, Lili Hu, Gen Cheng

School of Nursing & Midwifery

Background: The easy accessibility, increasing usage, and low cost of internet make it a desirable way of providing health information and delivering interventions for health consumers. Studies in other countries have verified and confirmed the effectiveness of internet-based interventions among people with mental health problems. Similar programs have yet to commence in China. Purpose: This study investigated the willingness for, and attitude toward internet-based intervention in Chinese mental health service users and explored the feasibility of such an intervention.
Methods: A cross-sectional survey utilizing a self-developed questionnaire was administered to 186 mental health service users in Beijing, …

Self-Reported Attitudes And Behaviours Of Medical Students In Pakistan Regarding Academic Misconduct: A Cross-Sectional Study, Kulsoom Ghias, Ghulam Rehmani Lakho, Hamna Asim, Iqbal Syed Azam, Sheikh Abdul Saeed

Department of Biological & Biomedical Sciences

Background: Honesty and integrity are key attributes of an ethically competent physician. However, academic misconduct, which includes but is not limited to plagiarism, cheating, and falsifying documentation, is common in medical colleges across the world. The purpose of this study is to describe differences in the self-reported attitudes and behaviours of medical students regarding academic misconduct depending on gender, year of study and type of medical institution in Pakistan.
Methods: A cross sectional study was conducted with medical students from one private and one public sector medical college. A pre-coded questionnaire about attitudes and behaviours regarding plagiarism, lying, cheating and …

Compliance With Continuous Positive Airway Pressure (Cpap) Therapy For Obstructive Sleep Apnea Among Privately Paying Patients- A Cross Sectional Study, Syed Fayyaz Hussain, Muhammad Irfan, Zeeshan Waheed, Naveen Alam, Saba Mansoor, Muhammad Islam

Section of Pulmonary & Critical Care

Background: To evaluate the compliance, benefits and side effects associated with continuous positive airway pressure (CPAP) therapy among Pakistani patients treated for obstructive sleep apnea (OSA) in private sector.Methods: Patients diagnosed to have OSA based on overnight study who were recommended for CPAP therapy, between 1998 and 2003, were evaluated by telephonic survey and review of hospital notes. Compliance, benefits and side effects associated with CPAP therapy were assessed.Results: Out of 135 patients who were prescribed CPAP therapy, 75 could be contacted. Sixty (80%) started using CPAP within one month of diagnosis and 46 (61%) continued to use it long-term …

Westgate Shootings: An Emergency Department Approach To A Mass-Casualty Incident, Benjamin Wachira, Ramadhani Abdalla, Lee Wallis

Emergency Medicine, East Africa

At approximately 12:30 pm on Saturday September 21, 2013, armed assailants attacked the upscale Westgate shopping mall in the Westlands area of Nairobi, Kenya. Using the seven key Major Incident Medical Management and Support (MIMMS) principles, command, safety, communication, assessment, triage, treatment, and transport, the Aga Khan University Hospital, Nairobi (AKUH,N) emergency department (ED) successfully coordinated the reception and care of all the casualties brought to the hospital. This report describes the AKUH,N ED response to the first civilian mass-casualty shooting incident in Kenya, with the hope of informing the development and implementation of mass-casualty emergency preparedness plans by other …

Implementation And Evaluation Of The Helping Babies Breathe Curriculum In Three Resource Limited Settings: Does Helping Babies Breathe Save Lives? A Study Protocol, Akash Bang, Roopa Bellad, Peter Gisore, Patricia Hibberd, Archana Patel, Shivaprasad Goudar, Fabian Esamai, Norman Goco, Sreelatha Meleth, Richard J. Derman, Edward A. Liechty, Elizabeth Mcclure, Waldemar A. Carlo, Linda L. Wright

Paediatrics and Child Health, East Africa

Background: Neonatal deaths account for over 40% of all under-5 year deaths; their reduction is increasingly critical for achieving Millennium Development Goal 4. An estimated 3 million newborns die annually during their first month of life; half of these deaths occur during delivery or within 24 hours. Every year, 6 million babies require help to breathe immediately after birth. Resuscitation training to help babies breathe and prevent/manage birth asphyxia is not routine in low-middle income facility settings. Helping Babies Breathe (HBB), a simulation-training program for babies wherever they are born, was developed for use in low-middle income countries. We evaluated …

Randomised Double Blind Study To Compare Effectiveness Of Honey, Salbutamol And Placebo In Treatment Of Cough In Children With Common Cold, Adil Waris, William Macharia, E. K. Njeru, F. Essajee

Paediatrics and Child Health, East Africa

Background: Acute upper respiratory infection is the most common childhood illness and presents with cough, coryza and fever. Available evidence suggests that cough medicines may be no more effective than honey-based cough remedies.

Objective: To compare effectiveness of honey, salbutamol and placebo in the treatment of cough in children with acute onset cough.

Design: Randomised control trial

Setting: Aga Khan University Hospital Paediatric Casualty

Subjects: Children between ages one to twelve years presenting with a common cold between December 2010 and February 2012 were enrolled.

Outcome measures: Frequency, severity and extent to which cough bothered and disturbed child and parental …

Can Prophylactic Antibiotics For Aspiration Improve Stroke Outcomes? The Pantheris Trial., Ayeesha Kamran Kamal, Quratulain Shaikh

Department of Medicine

No abstract provided.

Self-Medication With Antibiotics Among Non-Medical University Students Of Karachi: A Cross-Sectional Study, Syed Jawad Shah, Hamna Ahmad, Rija Binte Rehan, Sidra Najeeb, Mirrah Mumtaz, Muhammad Hashim Jilani, Muhammad Sharoz Rabbani, Muhammad Zakariya Alam, Saba Farooq, M Masood Kadir

Community Health Sciences

Background: The prevalence of self -medication with antibiotics is quite high in developing countries as opposed to developed countries. Antibiotics are often taken erroneously for certain ailments, without having the appropriate knowledge of their use. This carries potential risks for the individual as well as the community, in form of several side effects such as antibiotic resistance. Therefore the prevalence of self-medicated antibiotics in developing countries needs to be studied.Methods: A descriptive cross-sectional study was carried out at six different non-medical universities of Karachi. 431 students were included in the study. Data was collected using self-administered questionnaires and analyzed using …

The Heart Weight–Body Weight Coefficient In Kenyans Aged 14 Years And Above, Mbayah Etabale

Master of Medicine in Anatomic Pathology

Background: The heart size has traditionally been assessed using absolute reference weights. But the heart weight (HW) has been shown to depend on one’s body size hence a better measure is the ratio of the HW to the body weight (BW) – the HW-BW coefficient. Initially noted to be 0.43% and 0.40% in males and females respectively, recent studies have shown an increase of up to 0.51%. Objective: To determine the HW-BW coefficient in Kenyans aged 14 years and above. Methods: One hundred and four deceased Kenyans aged 14 years and above, with no heart or chronic lung disease, were …

Acute Kidney Injury In Lymphoma: A Single Centre Experience, Muhammad Abdul Mabood Khalil, Hira Latif, Abdur Rehman, Waqar Uddin Kashif, Safia Awan, Zarghona Khalil, Uziar Mushtaq, Maria Ahmad, Muhammad Ashhad Ullah Khalil, Manickam Ranga Sami

Section of Nephrology

Background. Acute kidney injury (AKI) is a common but least studied complication of lymphoma.

Objective. To determine the frequency and predictors of AKI in lymphoma and to study the impact of AKI on hospital stay and mortality.

Methods. Retrospective review of medical records of hospitalized lymphoma patients aged ≥14 years between January 2008 and December 2011 was done.

Results. Out of 365 patients, AKI was present in 31.8% (116/365). Multivariate logistic regression analysis showed that independent predictors for AKI included sepsis (odds ratio (OR) 3.76; 95% CI 1.83-7.72), aminoglycosides (OR 4.75; 95% CI 1.15-19.52), diuretics (OR 2.96; 95% CI 1.31-6.69), …

The Effect Of A Preanaesthesia Clinic Consultation On Adult Patient Anxiety In Aga Khan University Hospital; A Cohort Study, Anthony Kamau

Master of Medicine in Anaesthesiology

Background: Preoperative anxiety is a common perioperative complication, according to studies done it is seen in approximately 11-80% of adults undergoing surgery. Various pharmacological and non pharmacological techniques have been used to reduce preop anxiety. One of the goals of the preanaesthesia clinic is to allay anxiety. Literature shows that a preanaesthesia clinic evaluation reduces anxiety however b current studies done on anxiety and the preanaesthesia clinic have not quantified this reduction. Objective: To determine the reduction in anxiety in patients evaluated in the clinic versus those evaluated in the ward. Study Design: A cohort and before – after study …

Residual Disease And Hpv Persistence After Cryotherapy For Cervical Intraepithelial Neoplasia Grade 2/3 In Hiv Positive Women In Kenya, Hugo De Vuyst, Nelly R. Mugo, Silvia Franceschi, Kevin Mckenzie, Vanessa Tenet, Julia Njoroge, Farzana S. Rana, Samah R. Sakr, Peter J.F. Snijders, Michael Chung

Pathology, East Africa

Objective: To assess residual cervical intraepithelial neoplasia (CIN) 2/3 disease and clearance of high-risk (hr) human papillomavirus (HPV) infections at 6 months after cryotherapy among HIV-positive women.

Design: Follow-up study.

Methods: 79 HIV-positive women received cryotherapy for CIN2/3 in Nairobi, Kenya, and underwent conventional cytology 6 months later. Biopsies were performed on high grade cytological lesions and hrHPV was assessed before (cervical cells and biopsy) and after cryotherapy (cells).

Results: At 6 months after cryotherapy CIN2/3 had been eliminated in 61 women (77.2%; 95% Confidence Interval, (CI):66.4–85.9). 18 women (22.8%) had residual CIN2/3, and all these women had hrHPV at …

Epidemiology Of Malaria In A Village In The Rufiji River Delta, Tanzania: Declining Transmission Over 25 Years Revealed By Different Parasitological Metrics, Anna Färnert, Victor Yman, Manijeh Vafa Homann, Grace Wandell, Leah Mhoja, Marita Johansson, Salome Jesaja, Johanna Sandlund, Kazuyuki Tanabe, Ulf Hammar, Matteo Bottai, Zul Premji, Anders Björkman, Ingegerd Rooth

Pathology, East Africa

Background: Assessments of the epidemiology of malaria over time are needed to understand changes in transmission and guide control and elimination strategies.

Methods: A longitudinal population study was established in 1985 in Nyamisati village in the Rufiji River Delta, Tanzania. A physician and research team lived in the village 1984–2000. Parasite prevalence by microscopy and two PCR methods, spleen rates and haemoglobin levels were measured in repeated cross-sectional surveys between 1985 and 2010. Passive surveillance of malaria cases was maintained until end 1999. Bed nets were distributed after the surveys 1993, 1999 and 2010.

Results: In 1985, overall parasite prevalence …

Uchunguzi (Journal Watch/Montre De Journal) April 2014, Benjamin Wachira

Family Medicine, East Africa

Content: If you want to know how we practised medicine 5 years ago, read a textbook. If you want to know how we practised medicine 2 years ago, read a journal. If you want to know how we practise medicine now, go to a (good) conference. If you want to know how we will practise medicine in the future, listen in the hallways and use FOAM (Joe Lex, 2012). FOAM is free, open-access medical education. As stated in the Hippocratic Oath: “…and to teach them this art – if they desire to learn it – without fee and covenant”, the …

Uchunguzi (Journal Watch/Montre De Journal) September 2014, Benjamin Wachira

Family Medicine, East Africa

No abstract provided.

Uchunguzi (Journal Watch/Montre De Journal) December 2014, Benjamin Wachira

Family Medicine, East Africa

No abstract provided.

Burden Of Epilepsy In Rural Kenya Measured In Disability-Adjusted Life Years, Fredrick Ibinda, Ryan Wagner, Melanie Bertram, Anthony Ngugi, Evasius Bauni, Theo Vos, Josemir Sander, Charles Newton

Family Medicine, East Africa

Objectives: The burden of epilepsy, in terms of both morbidity and mortality, is likely to vary depending on the etiology (primary [genetic/unknown] vs. secondary [structural/metabolic]) and with the use of antiepileptic drugs (AEDs). We estimated the disability-adjusted life years (DALYs) and modeled the remission rates of active convulsive epilepsy (ACE) using epidemiologic data collected over the last decade in rural Kilifi, Kenya.

Methods: We used measures of prevalence, incidence, and mortality to model the remission of epilepsy using disease-modeling software (DisMod II). DALYs were calculated as the sum of Years Lost to Disability (YLD) and Years of Life Lost (YLL) …

Exposure To Multiple Parasites Is Associated With The Prevalence Of Active Convulsive Epilepsy In Sub-Saharan Africa, Gathoni Kamuyu, Christian Bottomley, James Mageto, Brett Lowe, Patricia Wilkins, John C. Noh, Thomas B. Nutman, Anthony Ngugi, Rachael Odhiambo, Ryan Wagner, Angelina Kakooza-Mwesige, Seth Owusu-Agyei, Kenneth Ae-Ngibise, Honorati Masanja, Faith Osier, Peter Odermatt, Charles Newton

Family Medicine, East Africa

Background: Epilepsy is common in developing countries, and it is often associated with parasitic infections. We investigated the relationship between exposure to parasitic infections, particularly multiple infections and active convulsive epilepsy (ACE), in five sites across sub-Saharan Africa.

Methods and Findings: A case-control design that matched on age and location was used. Blood samples were collected from 986 prevalent cases and 1,313 age-matched community controls and tested for presence of antibodies to Onchocerca volvulus, Toxocara canis, Toxoplasma gondii, Plasmodium falciparum, Taenia solium and HIV. Exposure (seropositivity) to Onchocerca volvulus (OR = 1.98; 95%CI: 1.52-2.58, p

Conclusion: This study investigates how …

Premature Mortality In Active Convulsive Epilepsy In Rural Kenya: Causes And Associated Factors, Anthony Ngugi, Christian Bottomley, Gregory Fegan, Eddie Chengo, Rachael Odhiambo, Evasius Bauni, Brian Neville, Immo Kleinschmidt, Josemir W. Sander, Charles R. Newton

Family Medicine, East Africa

Objective: We estimated premature mortality and identified causes of death and associated factors in people with active convulsive epilepsy (ACE) in rural Kenya.

Methods: In this prospective population-based study, people with ACE were identified in a crosssectional survey and followed up regularly for 3 years, during which information on deaths and associated factors was collected. We used a validated verbal autopsy tool to establish putative causes of death. Age-specific rate ratios and standardized mortality ratios were estimated. Poisson regression was used to identify mortality risk factors.

Results: There were 61 deaths among 754 people with ACE, yielding a rate of …

18fdg Synthesis And Supply: A Journey From Existing Centralized To Future Decentralized Models, Maseeh Uz Zaman, Nosheen Fatima, Zafar Sajjad, Unaiza Zaman, Rabia Tahseen, Areeba Zaman

Department of Radiology

Positron emission tomography (PET) as the functional component of current hybrid imaging (like PET/ CT or PET/MRI) seems to dominate the horizon of medical imaging in coming decades. 18Flourodeoxyglucose (18FDG) is the most commonly used probe in oncology and also in cardiology and neurology around the globe. However, the major capital cost and exorbitant running expenditure of low to medium energy cyclotrons (about 20 MeV) and radiochemistry units are the seminal reasons of low number of cyclotrons but mushroom growth pattern of PET scanners. This fact and longer half-life of 18F (110 minutes) have paved the path of a centralized …

Mdct Of Small Bowel Obstruction: How Reliable Are Oblique Reformatted Images In Localizing Point Of Transition?, Wasim Memon, Yasir Jamil Khattak, Tariq Alam, Luca Maria Sconfienza, Muhammad Awais, Shayan Sirat Maheen Anwar

Department of Radiology

The goal of this study is to prospectively assess the additional value of oblique reformatted images for localizing POT, having surgery as a reference standard. Materials and Methods. 102 consecutive patients with suspected small bowel obstruction (SBO) underwent 64-slice multidetector row CT (MDCT) using surgical findings as reference standard. Two independent GI radiologists reviewed the CT scans to localize the exact POT by evaluating axial images (data set A) followed by axial, coronal, and oblique MPR images. CT findings were compared to surgical findings in terms of diagnostic performance. McNemar's test was used to detect any statistical difference in POT …

Child Sexual Abuse Leads To Psychological Disorders: Literature Review, Savera Aziz Ali, Sumera Aziz Ali

School of Nursing & Midwifery

This scholarly paper explains the relationship between child sexual abuse and psychological disorders. Childhood sexual abuse (CSA) is a forceful sexual contact with a child who is incapable of consenting. The impact of sexual abuse can range from physical to very severe psychological effects. Psychological disorders caused by child sexual abuse include panic disorder, anxiety, depression, substance abuse, low self-esteem and post-traumatic stress disorder. The phenomenon of child sexual abuse is shaped by some important theories like behavioral, psychodynamic, attachment, cognitive and integrated theory. These theories may help to develop a sound empirical base through which cost effective strategies can …

Assessment Of Apparent Diffusion Coefficient Values As Predictor Of Aggressiveness In Peripheral Zone Prostate Cancer: Comparison With Gleason Score, Shayan Sirat Maheen Anwar, Zahid Anwar Khan, Rana Shoaib Hamid, Fahd Haroon, Raza Sayani, Madiha Beg, Yasir Jamil Khattak

Department of Radiology

Purpose. To determine association between apparent diffusion coefficient value on diffusion-weighted imaging and Gleason score in patients with prostate cancer. Methods. This retrospective case series was conducted at Radiology Department of Aga Khan University between June 2009 and June 2011. 28 patients with biopsy-proven prostate cancer were included who underwent ultrasound guided sextant prostate biopsy and MRI. MRI images were analyzed on diagnostic console and regions of interest were drawn. Data were entered and analyzed on SPSS 20.0. ADC values were compared with Gleason score using one-way ANOVA test. Results. In 28 patients, 168 quadrants were biopsied and 106 quadrants …

Evaluation Of Multiple Choice And Short Essay Question Items In Basic Medical Sciences, Mukhtiar Baig, Syeda Kauser Ali, Sobia Ali, Nighat Huda

Department of Continuing Professional Education

OBJECTIVES:

To evaluate Multiple Choice and Short Essay Question items in Basic Medical Sciences by determining item writing flaws (IWFs) of MCQs along with cognitive level of each item in both methods.

METHODS:

This analytical study evaluated the quality of the assessment tools used for the first batch in a newly established medical college in Karachi, Pakistan. First and sixth module assessment tools in Biochemistry during 2009-2010 were analyzed. Cognitive level of MCQs and SEQs, were noted and MCQ item writing flaws were also evaluated.

RESULTS:

A total of 36 SEQs and 150 MCQs of four items were analyzed. The …

A Randomized Control Trial Comparing Weight Adjusted Dose Versus Fixed Dose Prophylactic Phenylephrine Infusion On Maintaining Systolic Blood Pressure During Caeserean Section Under Spinal Anaesthesia, Lucy Wambui Mwaura

Master of Medicine in Anaesthesiology

Background: Spinal anaesthesia is the standard of care for elective caesarean delivery. Its advantages over general anaesthesia include: decreased blood loss, reduced postoperative pain and faster recovery time. Despite these advantages, the sympathetic blockade induced by spinal anaesthesia results in 80 percent incidence of hypotension without prophylactic management. This hypotension can cause: nausea, vomiting, cardiovascular collapse or even loss of consciousness in the mother, and fetal acidosis. Current evidence supports co-loading with intravenous fluids in conjunction with the use of vasopressors as the most effective way to prevent and treat the hypotension. Phenylephrine is the accepted vasopressor of choice in …

Incidence And Risk Factors For Acute Myocardial Injury After Non-Cardiac Surgery At The Aga Khan University Hospital Nairobi, Salim Said Ahmed

Master of Medicine in Internal Medicine

Aim: To determine the incidence and risk factors for acute myocardial injury after non-cardiac surgery at Aga Khan University Hospital Nairobi. Design: Prospective cohort study Background: Myocardial injury is the most common major cardiovascular complication in patients undergoing non-cardiac surgery. Large numbers of intermediate-risk and high-risk cardiac patients will be undergoing surgery as the population grows older, and thus myocardial injury after non-cardiac surgery could be a rising problem. Patients and Setting: Adult participants undergoing intermediate and high risk non-cardiac surgery at the Aga Khan University Hospital Nairobi were evaluated for incidence and risk factors for myocardial injury after non-cardiac …

Comparison Of Cardiometabolic Risk Profile Between Hiv Patients On Art And Those Who Are Art Naïve, Erick Kimani Njenga

Master of Medicine in Internal Medicine

Background: Metabolic syndrome comprises of a set of aggregated risk factors that include: hypertension, central obesity, impaired fasting glucose, hypertriglyceridemia and low HDL-C (1)The is a noted increase in the prevalence of the metabolic syndrome cardiovascular risk factors in the HIV population. Methods: The study is a cross-sectional survey that enrolled 157 HIV positive patients over a 4 month period that were either newly diagnosed (HIV ART naïve) or were on ART from both the inpatient and outpatient setting. Data of their anthropometric, cardiovascular risk factors and clinical characteristics were collected with the aid of a standardized questionnaire and serum …

Androgen Receptor Expression And Associated Clinico-Pathologic Features In Primary Breast Cancer From Kenya, Joshua Kibera Chege

Master of Medicine in Anatomic Pathology

Introduction: Breast cancer is a heterogeneous group of diseases classified into various subtypes according to clinical, histological and molecular features as well as by the expression of prognostic and predictive biomarkers. New biomarkers are being studied which may be therapeutic targets in various breast cancer subtypes particularly triple-negative breast cancer. Recent studies show that androgen receptor (AR) expression can be used as a prognostic marker and there is evidence that anti-androgen therapy may be beneficial in oestrogen receptor negative breast cancer. Retrospective studies show that patients with breast cancers co-expressing androgen receptor and oestrogen receptor have a favourable prognosis and …

Fmic Annual Report 2014 | English, French Medical Institute For Mothers And Children

French Medical Institute for Mothers and Children (FMIC) Archives

No abstract provided.

Anesthesia For Cardiac Catheterization Procedures, A Hamid

Department of Anaesthesia

Anesthesiologist's involvement for the purpose of diagnostic and interventional procedures in cardiac catheterization laboratory has been evolving particularly since last two decades. Catheterization laboratory environment poses certain challenges for the anesthesiologist including unfamiliar remote location, exposure to radiation, limited help from colleagues and communication with cardiologists. Anesthesiologists working in catheterization laboratory are required to have adequate knowledge of the environment, personnel, fluoroscope, echocardiography and type of radio contrast dye during the procedure. Anyone who is exposed to radiation environment is expected to protect himself from the exposure and must also wear a dosimeter for cumulative exposure tracing.There is no ideal …