Medicine and Health Sciences Commons^™

Outcome Of Radiologically Placed Tunneled Haemodialysis Catheters, Raza Sayani, Muhammad Anwar, Tanveer-Ul-Haq, Nauman Al-Qamari, Muhammad Asif Bilal

Department of Radiology

Objective: To study the outcome of radiologically placed double lumen tunneled haemodialysis catheters for the management of renal failure.STUDY Design: Case series.PLACE AND DURATION OF STUDY: Interventional Suite of Radiology Department at the Aga Khan University Hospital, Karachi, from April 2010 to June 2011.METHODOLOGY: All consecutive patients who were referred to the department of radiology by the nephrologists for double lumen tunneled haemodialysis catheter (Permacath) placement during the study period were included. Patients with septicemia, those for whom follow-up was not available, those coming for catheter exchange or who died due to a noncatheter related condition were excluded. A radio-opaque, …

Labrad : Vol 39, Issue 2 - December 2013, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• Diagnosis of Inborn Errors of Metabolism in Pakistan
• Inherited Metabolic Disorders-Presenting as Metabolic Emergencies
• Role of Biochemical Genetics Laboratary in Evaluation of IEM
• Amino Acid Chromatography for the Diagnosis of Inborn Error of Metabolism
• Polymorphism in Methylenetetrahydrofolate Reductase (MTHFR) Gene
• Diagnosis of Tyrosinemia Type I
• Congential Hypothyroidism
• Congential Adrenal Hyperplasia, An Insight of Laboratory
• Inaugration Ceremony of Section of biochemical Genetics Laboratory

Locking Compression Plate In Musculoskeletal Oncology'a Nriend In Need', Masood Umer, Kashif Abbas, Shahid Khan, Haroon Ur Rashid

Department of Surgery Docs

Abstract

BACKGROUND:

We are presenting our experience in the use of locking compression plate (LCP) after juxta-articular oncological resections in addition to its use in pathologic fracture.

METHODS:

A retrospective audit of skeletal reconstruction using LCP in 25 cases of long bone tumors was performed from 2008 to 2010. Reconstruction following limb salvage surgery was done in 17 patients and internal fixation of pathological fracture was done in 8 patients. All patients were available for > 12 months of follow-up, and thus assessed for union at the resected ends.

RESULTS:

There were 8 males and 17 females in the study. The …

Rectal Carcinoma Under 40 Years Of Age: Seven-Year Post-Treatment Follow-Up At A Tertiary Care Hospital In Pakistan, Naveed Haroon, Salma Khan, Rehman Alvi

Department of Surgery Docs

Objectives: To determine epidemiological characteristics, clinical presentation, histopathological features, and long-term follow-up of patients below 40 years of age with carcinoma rectum.Methods: The retrospective case series comprised all patients presenting with histopathological diagnosis of carcinoma rectum with age 15-40 years at the Aga Khan University Hospital between January 1994 and December 2004. Details regarding patient demographics, pre-operative assessment, management and tumour grade and stage were obtained from a prospectively maintained database. Continuous and categorical variables in the data were analysed.Results: Of the 23 patients in the study, 14 (60.89%) were male and 9 (39.13%) were female. Mean age of the …

13th Annual International Neurology Update Meeting & 6th Biennial Stroke Conference, 13th Annual International Neurology Update Meeting & 6th Biennial Stroke Conference

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Determinants Of Child And Forced Marriage In Morocco: Stakeholder Perspectives On Health, Policies And Human Rights, Alexia Sabbe, Halima Oulami, Wahiba Zekraoui, Halima Hikmat, Marleen Temmerman, Els Leye

Obstetrics and Gynaecology, East Africa

Background: In Morocco, the social and legal framework surrounding sexual and reproductive health has transformed greatly in the past decade, especially with the introduction of the new Family Law or Moudawana. Yet, despite raising the minimum age of marriage for girls and stipulating equal rights in the family, child and forced marriage is widespread. The objective of this research study was to explore perspectives of a broad range of professionals on factors that contribute to the occurrence of child and forced marriage in Morocco.

Methods: A qualitative approach was used to generate both primary and secondary data for the analysis. …

Primary Healthcare Providers’ Views On Improving Sexual And Reproductive Healthcare For Adolescents In Bolivia, Ecuador, And Nicaragua, Lina Jaruseviciene, Miguel Orozco, Marcia Ibarra, Freddy Cordova Ossio, Bernardo Vega, Nancy Auquilla, Joel Medina, Anna C. Gorter, Peter Decat, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Objectives: To elicit the views of primary healthcare providers from Bolivia, Ecuador, and Nicaragua on how adolescent sexual and reproductive health (ASRH) care in their communities can be improved.

Methods: Overall, 126 healthcare providers (46 from Bolivia, 39 from Ecuador, and 41 from Nicaragua) took part in this qualitative study. During a series of moderated discussions, they provided written opinions about the accessibility and appropriateness of ASRH services and suggestions for its improvement. The data were analyzed by employing a content analysis methodology.

Results: Study participants emphasized managerial issues such as the prioritization of adolescents as a patient group and …

Challenges Posed By Mental Disorders, Substance Abuse And Neurological Disorders: Need For A Joint Action By Psychiatrists And Neurologists, Mowadat H Rana, Haider A Naqvi

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Chronic Relapsing Inflammatory Optic Neuropathy (Crion), Muhammad Athar Athar Javed, Adnan Hameed Gill Dr, Ahmad Furqan Dr

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Frequency Of Dementia In Parkinson’S Disease, Noor Ahmed Khosa, Ammanullah Kakar, Wazir Akbar

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Tuberculosis Affecting The Nervous System: Can We Trace The Source Of Infection?, Naila Shahbaz, Saima Kashif, Hina Mushtaq

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Correlation Between Central Corneal Thickness Measurements Using Two Uifferent Ultrasonic Pachymeters, Sharmeen Akram, Zarksis H, Anklesaria A, Khabir Ahmad

Department of Surgery Docs

Purpose: To assess correlation between central corneal thickness measurements using two different ultrasonic pachymeters. Material and Methods: This prospective study involved normal subjects aged 16 to 45 years. Central corneal thickness was measured in 47 eyes by two ultrasonic pachymeters – Tomey SP – 100 and Sonomed 300 AP. Correlations between CCT measurements assessed by the two pachymeters were tested by Pearson correlation. Results: Forty seven eyes were included in the study. The mean (± SD) age of the subjects was 27.79 years (± 6.88).The mean (± SD) Tomey Pachymeter CCT was 536.45 m (34.37) and the mean (SD) Sonomed …

Screening For Tuberculosis In Pregnancy: Do We Need More Than A Symptom Screen? Experience From Western Kenya, R J. Kosgei, D Szkwarko, S Callens, P Gichangi, Marleen Temmerman, A-B Kihara, J J. Sitienei, E J. Cheserem, P M. Ndavi, A J. Reid, E J. Carter

Obstetrics and Gynaecology, East Africa

Objectives: 1) To explore the utility of tuberculosis (TB) symptom screening for symptoms of ⩾2 weeks’ duration in a routine setting, and 2) to compare differences in TB diagnosis between human immunodeficiency virus (HIV) infected and non-HIV-infected pregnant women in western Kenya.

Design: Comparative cross-sectional study among pregnant women with known HIV status screened for TB from 2010 to 2012, in Eldoret, western Kenya.

Results: Of 2983 participants, respectively 34 (1%), 1488 (50.5%) and 1461 (49.5%) had unknown, positive and negative HIV status. The median age was respectively 30 years (interquartile range [IQR] 26–35) and 26 years (IQR 24–31) in …

Conscientious Objection To Provision Of Legal Abortion Care, Brooke R. Johnson Jr, Eszter Kismödi, Monica V. Dragoman, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Despite advances in scientific evidence, technologies, and human rights rationale for providing safe abortion, a broad range of cultural, regulatory, and health system barriers that deter access to abortion continues to exist in many countries. When conscientious objection to provision of abortion becomes one of these barriers, it can create risks to women’s health and the enjoyment of their human rights. To eliminate this barrier, states should implement regulations for healthcare providers on how to invoke conscientious objection without jeopardizing women’s access to safe, legal abortion services, especially with regard to timely referral for care and in emergency cases when …

Consensus Interferon Plus Ribavirin For Hepatitis C Genotype 3 Patients Previously Treated With Pegylated Interferon Plus Ribavirin, Zaigham Abbas, Ghiasun Nabi Tayyab, Mustafa Qureshi, Mohammad Sadik Memon, Amna Subhan, Tanzila Shakir, Wasim Jafri, Saeed Hamid

Section of Gastroenterology

Background

Not enough data are available about the effectiveness of consensus interferon (CIFN) among HCV genotype 3 patients who failed to respond to pegylated interferon and ribavirin.

Objectives

We aimed to assess the efficacy and safety of CIFN and ribavirin in non-responders and relapsers to pegylated interferon with ribavirin therapy.

Patients and Methods

This open-label investigator-initiated study included 44 patients who received CIFN 15 µg /day plus ribavirin 800-1200 mg daily. In patients with an early virological response (EVR), the dose of CIFN was reduced to 15 µg thrice a week for further 36 weeks. Patients with delayed virological response …

First Report Of Ndm-1-Producing Acinetobacter Baumannii In East Africa, Gunturu Revathi, Kristopher L. Siu, Po-Liang Lu, Li-Yueh Huang

Pathology, East Africa

Background: The emergence of carbapenem-resistant Acinetobacter baumannii (CRAB) was observed in a Kenyan hospital from 2009 to 2010. Further investigation of the dissemination of CRAB isolates and the molecular characterization of associated resistance determinants were therefore performed.

Methods: Antibiotic susceptibilities were determined by broth microdilution and Etest. Metallo-blactamases were detected by Etest method. Clonal relationships were studied by pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST). b-Lactam and aminoglycoside resistance determinants and the clonal relatedness to widespread European clones were studied by PCR and sequencing.

Results: Sixteen CRAB isolates from 10 patients possessed six pulsotypes; half of the isolates …

High Hiv Incidence Among Persons Who Inject Drugs In Pakistan: Greater Risk With Needle Sharing And Injecting Frequently Among The Homeless., Rab Nawaz Samo, Arshad Altaf, Ajmal Agha, Omrana Pasha, Shafquat Rozi, Ashraf Memon, Saleem Azam, Meridith Blevins, Sten Vermund, Sharaf Ali Shah

Community Health Sciences

BACKGROUND:

The incidence of HIV among persons who inject drugs (PWIDU) has fallen in many nations, likely due to successes of clean needle/syringe exchange and substance abuse treatment and service programs. However in Pakistan, prevalence rates for PWID have risen dramatically. In several cities, prevalence exceeded 20% by 2009 compared to a 2003 baseline of just 0.5%. However, no cohort study of PWID has ever been conducted.

METHODS:

We enrolled a cohort of 636 HIV seronegative PWID registered with three drop-in centers that focus on risk reduction and basic social services in Karachi. Recruitment began in 2009 (March to June) …

City Tumour Board Karachi: An Innovative Step In Multidisciplinary Consensus Meeting And Its Two Years Audit., Asghar Hussain Asghar, Ahmed Nadeem Abbasi, Abid Jamal, Ghulam H, Sadia Rizvi

Department of Medicine

Management of cancer patients is a team work which usually comprises of surgeons, oncologists, radiologists, pathologists, psychiatrist, nutritionist and a nurse. Any patient who is suffering from any tumour needs a multimodality meeting as cancer treatment is not a single persons job. Most of the time, it is difficult to get the whole team together for a plan discussion due to their busy schedule. This problem was overcome by starting a tumour board meeting early morning of Sunday in Karachi which was named "City Tumour Board (CTB) Karachi". Its first meeting was held on Sunday March 28, 2010 and since …

Clinically Significant Contrast Induced Acute Kidney Injury After Non-Emergent Cardiac Catheterization--Risk Factors And Impact On Length Of Hospital Stay., Waqar Kashif, Ali Khawaja, Syed Ather Hussain

Department of Medicine

Objective: To evaluate the frequency and risk factors associated with clinically significant contrast-induced nephropathy(CIN) in patients undergoing non-emergent coronary angiography.

Study Design: Descriptive study.

Place and Duration of Study: The Aga Khan University Hospital, Karachi, from January 2005 to December 2007.

Methodology: Case records of patients who underwent coronary angiography with a serum creatinine of ≥ 1.5 mg/dl atthe time of procedure were evaluated. Clinically significant contrast induced nephropathy (CSCIN) was defined as either doubling of serum creatinine from baseline value within a week following the procedure or need for emergency hemodialysis after the procedure.Results: One hundred …

Peripartum Cardiomyopathy: Ten Year Experience At A Tertiary Care Hospital In Pakistan., Abid Laghari, Aamir Hameed, K. Kazmi

Department of Medicine

Background: There is very little literature regarding peripartum cardiomyopathy from the Asian countries. We conducted this study to determine demographic details, clinical presentations, complications and recovery of left ventricular (LV) systolic function in peripartum cardiomyopathy (PPCMP) patients of Pakistani origin.

Method: A ten year retrospective case series of PPCMP was conducted at the Aga Khan University Hospital. Patients were also followed up for six months after presentation, with special regard to improvement in the LV function.

Results: Total 45 patients were included, 25 (55.5%) primigravida and 8 (17.7%) gravida 2 and the remaining 12 (26.6%) were multigravida. Fourteen patients (31.1%) …

Tumor Necrosis Factor -Α, Interleukin-10, Intercellular And Vascular Adhesion Molecules Are Possible Biomarkers Of Disease Severity In Complicated Plasmodium Vivax Isolates From Pakistan., Afsheen Raza, Najia K. Ghanchi, Ali Bin Sarwar Zubairi, Ahmed Raheem, Sobia Nizami, Mohammad Asim Beg

Department of Medicine

Background: Cytokine-mediated endothelial activation pathway is a known mechanism of pathogenesis employed by Plasmodium falciparum to induce severe disease symptoms in human host. Though considered benign, complicated cases of Plasmodium vivax are being reported worldwide and from Pakistan. It has been hypothesized that P.vivax utilizes similar mechanism of pathogenesis, as that of P.falciparum for manifestations of severe malaria. Therefore, the main objective of this study was to characterize the role of cytokines and endothelial activation markers in complicated Plasmodium vivax isolates from Pakistan.

Methods and Principle Findings: A case control study using plasma samples from well-characterized groups suffering from P.vivax …

Granulocyte-Colony Stimulating Factor For Mobilizing Bone Marrow Stem Cells In The Sub Acute Stroke. How Safe Is The Use Of Granulocyte-Colony Stimulating Factor In Sub-Acute Stroke? Is This Stem Cell Trial Of Recovery Enhancement Beneficial?, Fauzia Nomani, Ayeesha Kamran Kamal

Department of Medicine

No abstract provided.

Comparing Papanicolau Smear, Visual Inspection With Acetic Acid And Human Papillomavirus Cervical Cancer Screening Methods Among Hiv-Positive Women By Immune Status And Antiretroviral Therapy, Michael Chung, K. P. Mckenzie, H. D. Vuyst, B. A. Richardson, Farzana Rana, R. Pamnani, J. W. Njoroge, E. Nyongesa-Malava, S. R. Sakr, G. C. John-Stewart, N. R. Mugo

Internal Medicine, East Africa

Background: A rigorous comparison of cervical cancer screening methods utilizing data on immune status, antiretroviral therapy (ART) and colposcopy-directed biopsy has not been performed among HIV-positive women.

Methods: Between June and November 2009, 500 HIV-positive women were enrolled at an HIV treatment clinic in Nairobi, Kenya, and underwent Papanicolau (Pap) smear, visual inspection with acetic acid (VIA), human papillomavirus (HPV) and colposcopydirected biopsy (gold standard). Positive Pap smear (ASCUS, LSIL, HSIL), VIA, HPV and their combinations were compared with CIN2/3+. Sensitivity, specificity and AUC (sensitivity and 1-specificity) were compared using pairwise tests and multivariate logistic regression models that included age, …

Anthracycline-Induced Cardiotoxicity: Prospective Cohort Study From Pakistan, Abdul Sattar Shaikh, Ali Faisal Saleem, Shazia Samad Mohsin, Muhammad Matloob Alam, Mehnaz Atiq Ahmed

Department of Paediatrics and Child Health

Objectives: To identify anthracycline-induced acute (within 1 month) and early-onset chronic progressive (within 1 year) cardiotoxicity in children younger than 16 years of age with childhood malignancies at a tertiary care centre of Pakistan.

Design: Prospective cohort study.

Setting: Aga Khan University, Karachi, Pakistan.

Participants: 110 children (aged 1 month–16 years).

Intervention: Anthracycline (doxorubicin and/or daunorubicin).

Outcome measurements: All children who received anthracycline as chemotherapy and three echocardiographic evaluations (baseline, 1 month and 1 year) between July 2010 and June 2012 were prospectively analysed for cardiac dysfunction. Statistical analysis including systolic and diastolic functions at baseline, 1 month and 1 …

A Literature Review About Effectiveness Of Massage Therapy For Cancer Pain., Salima Somani, Saima Merchant, Sharifa Bashir Lalani

School of Nursing & Midwifery

This literature review explores the effectiveness of massage therapy to reduce cancer pain. As part of the review, systematic literature search was carried out on various electronic databases and specialised journals. Included are 19 research-based articles and 8 review articles. The review suggests that cancer has become a common health problem in the world and most of the cancer patients are going through intense and unbearable pain. Studies have reported that most of the cancer patients' pain reduced with therapeutic massage. Seventy-three per cent of cancer patients use massage therapy in the USA. Few studies are available in the context …

Love And Belonging: Strategies To Help Mentally Ill Patients, Shirin Rahim

School of Nursing & Midwifery

Love and belonging is a concept, used by Abraham Maslow (a humanistic psychologist) in his motivation theory. Love and belonging is one of the human needs in Maslow's hierarchy and required to be fulfilled in order to achieve self-actualization. According to Lisbeth (2003) “Because of the social nature of humans and the long developmental period from birth to adulthood, the need for love and belonging is closely linked to the need for survival” (p.128). If a child is left with unmet need of love and belonging he may feel difficulties in forming lasting relations in future also and may get …

Importance Of Clinical Toxicology Teaching And Its Impact In Improving Knowledge: Sharing Experience From A Workshop, Nadeem Ullah Khan, Jabeen Fayyaz, Uzma Rahim Khan, Asher Feroze

Department of Emergency Medicine

Objective: To assess the impact of a one-day clinical toxicology workshop in improving knowledge.Methods: A one-day clinical toxicology workshop was conducted as a pre-conference workshop of the Annual Emergency Medicine Conference at the Aga Khan University Hospital, Karachi, in April 2012. The course was composed of poisoning-related common clinical scenarios. The pre-test and post-test understanding was used to assess the impact of the course in improving knowledge. The participants also evaluated the workshop as a whole thorough written evaluation forms. SPSS 19 was ued for statistical analysis of the data.RESULT: There were 22 participants in the course. The pre-test mean …

Hirayama Disease, A Rare Cause Of Posture Related Cord Compression: A Case Report From Radiological Perspective, Shumaila Arooj, Fatima Mubarak, Muhammad Azeemuddin, Zafar Sajjad, Wasey Jilani

Department of Radiology

Hirayama Disease is a disease of young adults lying in the age group between twenty to thirty years. It is an extremely uncommon disorder. Its other synonyms are juvenile muscular atrophy of the distal upper extremity (JMADUE) or monomelic amyotrophy (MMA). A previously healthy 25-year-old man presented with gradually increasing weakness in both hands for the past few years. There was neither history of trauma nor family history of neuromuscular disease. MRI was advised. Routine cervical sagittal MR images (Non-flexion or extension) revealed cord flattening and atrophy at C5 to C7 levels.There was evidence of syrinx. Flexion MRI was performed …

Community-Based Management And Outcome Of Omphalitis In Newborns In Karachi, Pakistan, Farah Naz Qamar, Shiyam Sundar Tikmani, Fatima Mir, Anita Kazmi Mehdi Zaidi

Department of Paediatrics and Child Health

Objectives: To describe the clinical profile and outcome in newborns with omphalitis managed with home or clinic-based therapy.
Methods: The descriptive study was conducted from September 2004 to August 2007 in three low-income communities in Karachi, Pakistan. Newborns with omphalitis detected by community health workers through active surveillance were referred to local clinics. Those with physician-confirmed omphalitis were treated for 7 days with topical gentian violet or oral cephalexin (as monotherapy) or topical gentian violet and oral cephalexin (combination therapy) at physician discretion, or injectable therapy (procaine penicillin and gentamicin) if clinical signs of sepsis were also present and family …

Incidence And Outcome Of Small For Gestational Age Fetuses: An Experience From A Secondary Care Hospital, Riffat Bano, Nousheen Asim, Ammara Mushtaq, Mehreen Adhi, Noureen Afzal

Department of Obstetrics & Gynaecology

The objective of the study was to determine the frequency and outcome of Small for Gestational Age (SGA) foetuses, and its association with the mode of delivery, foetal birthweight, maternal age and gestational age. It was a hospital-based descriptive study, conducted at Aga Khan Hospital for Women, Karachi, from January 2009 to December 2010. Mode of deliveries, foetal birthweight, maternal age and gestational age of SGA foetuses were recorded and analszed. Of a total of 6024 deliveries during the study period, 722(11.98%) had SGA foetuses. Maternal age in such cased ranged between 20-40 years in 588(81.44%), while 406(56.23%) of these …