Medicine and Health Sciences Commons^™

The Muranga Teleophthalmology Study: Comparison Of Virtual (Teleglaucoma) With In-Person Clinical Assessment To Diagnose Glaucoma, Dan Kiage, Irfan N. Kherani, Stephen Gichuhi, Karim F. Damji, Muindi Nyenze

Internal Medicine, East Africa

Purpose: While the effectiveness of teleophthalmology is generally accepted, its ability to diagnose glaucomatous eye disease remains relatively unknown. This study aimed to compare a web-based teleophthalmology assessment with clinical slit lamp examination to screen for glaucoma among diabetics in a rural African district.

Materials and Methods: Three hundred and nine diabetic patients underwent both the clinical slit lamp examination by a comprehensive ophthalmologist and teleglaucoma (TG) assessment by a glaucoma subspecialist. Both assessments were compared for any focal glaucoma damage; for TG, the quality of photographs was assessed, and vertical cup-to-disk ratio (VCDR) was calculated in a semi-automated manner. …

Utility Of Clinical Examination And Ct Scan In Assessment Of Penetrating Neck Trauma, Maliha Kazi, Montasir Junaid, Mumtaz Jamshed Khan, Naeem Sultan Ali, Aria Masoom

Section of Otolaryngology, Head & Neck Surgery

Managing penetrating injuries adequately and effectively depends a great deal on proper assessment of the injury. This study carried out was done at The Aga Khan University Hospital to assess the role of clinical examination and CT scan imaging in evaluation of penetrating neck injuries. A total of 68 students were included, with ages ranging from 3 to 74 years. The involved zones and the injured structures were noted. Results showed a high sensitivity of clinical examination in assessing vascular (81%) and airway trauma (77%), with a low sensitivity for esophageal trauma (34%). For CT scan the sensitivity was 90% …

Anti-Helicobacter Pylori Activity And Inhibition Of Helicobacter Pylori-Induced Release Of Il-8 In Ags Cells By Plant Extracts, Javed Yakoob, Zaigham Abbas, Rustam Khan, Muhammad Waqas Usman, Saeed Hamid, Safia Awan, Kanza Shamim, Syed Faisal Zaidi, Toshiro Sugiyama, Wasim Jafri

Section of Gastroenterology

Plants used in popular diet were studied for anti-Helicobacter pylori activity and their effect on the expression of interleukin-8 (IL-8) from H. pylori infected gastric epithelial cells. Extracts were prepared of Allium sativum (A. sativum), Cuminum cyminum (C. cyminum),Piper nigrum (P. nigrum) and their mix in two different dilutions. AGS cell line and H. pyloristrains were used for co-culture experiments. Extracts bactericidal activity was determined by a viable colony count. ELISA (Enzyme linked immunosorbent assay) was used to determine IL-8 expression. DNA extracted from bacterial cells was used for polymerase chain reaction (PCR) …

Yield Of Esophagogastroduodenoscopy And Colonoscopy In Cancer Of Unknown Primary, Muhammad Tayyab Usmani, Abdullah Bin Khalid, Syed Hasnain Ali Shah, Tauseef Ahmad, Saeed S Hamid, Syed M. Wasim Jafri

Section of Gastroenterology

Objectives: Carcinoma of unknown primary origin (CUP) is heterogeneous group of cancers. Role of gastrointestinal (GI) endoscopy in this entity is under investigated. Aim of this study was to evaluate yield of Colonoscopy and Esophagogastroduodenoscopy (EGD) in localizing primary tumor in patients with CUP.

METHODOLOGY: Patients with histopathologically proven CUP who underwent colonoscopy / EGD to find the primary tumor from December 2009 to December 2011 were included in the study. Abdominal symptoms and cytokeratin (CK) 7 and 20 markers were correlated with presence of primary in GI tract.

Results: After giving informed consent 86 patients were included …

Family Planning Knowledge, Attitude And Practice Among Married Couples In Jimma Zone, Ethiopia, Tizta Tilahun, Gily Coene, Stanley Luchters, Wondwosen Kassahun, Els Leye, Marleen Temmerman, Olivier Degomme

Population Health, East Africa

Background: Understanding why people do not use family planning is critical to address unmet needs and to increase contraceptive use. According to the Ethiopian Demographic and Health Survey 2011, most women and men had knowledge on some family planning methods but only about 29% of married women were using contraceptives. 20% women had an unmet need for family planning. We examined knowledge, attitudes and contraceptive practice as well as factors related to contraceptive use in Jimma zone, Ethiopia.

Methods: Data were collected from March to May 2010 among 854 married couples using a multi-stage sampling design. Quantitative data based on …

Antimicrobial Resistance Patterns In Extended-Spectrum Β-Lactamase Producing Escherichia Coli And Klebsiella Pneumoniae Isolates In A Private Tertiary Hospital, Kenya, Daniel Maina, Paul Makau, Andrew Nyerere, Gunturu Revathi

Pathology, East Africa

Background: Extended-Spectrum β-Lactamase (ESBL) producing Enterobacteriaceae have become widespread in hospitals and are increasing in community settings where they cause a variety of infections. In addition to hydrolyzing most beta-lactam agents, bacteria harboring these enzymes display resistance to other unrelated antimicrobial agents and thus often pose a therapeutic dilemma. Though these resistance patterns have been studied elsewhere within Africa, such data from hospitals in Kenya are scanty. We therefore undertook to determine these patterns at the Aga Khan University hospital by studying multidrug resistant Escherichia coli and Klebsiella pneumoniae isolates from patients' samples.

Findings: A total of 159 isolates (109 …

Relationship Between Exercise Induced Dyspnea And Functional Capacity With Doppler-Derived Diastolic Function, Sumera Nasim, Najaf Nadeem, Aysha Zahidie, Tabbasum Sharif

Community Health Sciences

Background

Dyspnea is the frequent cause of exercise intolerance and physical inactivity among patients referred for exercise tolerance test. Diastolic dysfunction has shown significant correlation with exercise capacity and exercise induced dyspnea. To find out the frequency of diastolic dysfunction (DD) and the relationships between impaired exercise capacity and exercise induced dyspnea with DD by Doppler-derived indices among patients referred for stress test in a tertiary care hospital of Karachi.

Methods

For this study 135 consecutive patients who were referred for stress test at our non-invasive lab were screened for eligibility. Patients with valvular pathology, atrial fibrillation (AF) and coronary …

My Patient Had A Small Vessel Stroke, Are Two Antiplatelet Agents Better Than One?, Muhammad Faisal Wadiwala, Ayeesha Kamran Kamal

Department of Medicine

No abstract provided.

Comparison Of Hemodynamic Response To Tracheal Intubation With Macintosh And Mccoy Laryngoscopes, Mehtab A. Haidry, Fauzia A. Khan

Department of Anaesthesia

Background: Use of McCoy blade laryngoscope avoids the lifting force in the vallecula and theoretically should lead to a lower hemodynamic response related to laryngoscopy and tracheal intubation. The available literature on the topic is conflicting.MATERIALS AND Methods: We studied the hemodynamic response to laryngoscopy and tracheal intubation in 60 ASA 1 AND 2 adult patients using either Macintosh or McCoy laryngoscopes. The change in systolic, diastolic, mean arterial pressure, and heart rate (HR) was observed for 10 min post intubation. Arrhythmias and ST changes were also observed.Results: The maximum change in HR was 18.7% in the Macintosh and 7.7% …

A Review Of G6pd Deficiency In Pakistani Perspective, Bushra Moiz

Department of Pathology and Laboratory Medicine

No abstract provided.

Frequency Of Precancerous Lesions In Endoscopic Gastric Biopsies In Chronic Gastritis, Saroona Haroon, Naveen Faridi, Faisal Rashid Lodhi, Shafaq Mujtaba

Department of Pathology and Laboratory Medicine

Objective:
To determine the frequency of precancerous lesions in endoscopic gastric biopsies of patients with chronic gastritis.STUDY Design: A case series.
Place and duration of study:
Department of Histopathology, Liaquat National Hospital, Karachi, from July 2008 to January 2009.METHODOLOGY: Over 6 months, 375 endoscopic gastric biopsies of patients with age group of 15-65 years having endoscopic chronic gastritis were included. From final biopsy report, basic information like patient demographics and presence of precancerous lesions i.e. activity (chronic active gastritis), atrophy (atrophic gastritis), intestinal metaplasia and dysplasia were recorded on proforma. Results were described as proportions and frequency.
Results:
The frequency …

Fiber-Free White Flour With Fructose Offers A Better Model Of Metabolic Syndrome, Faridah Amin, Anwar Hassan Gilani

Department of Biological & Biomedical Sciences

BACKGROUND: The metabolic syndrome (MS) is a combination of metabolic abnormalities that lead to an increased risk of cardiovascular diseases. Due to its rising incidence and demanding life-long use of multiple drugs, there is a growing interest in testing and developing new allopathic, complementary and alternative therapies for controlling or curing disorders of MS. The discovery of new therapeutic modalities requires animal models of disease and currently available models have limitations. Developing an appropriate animal model for MS to achieve various therapeutic targets remains a challenge and this study aims to develop a rat model which closely depicts MS in …

Prokinetic And Laxative Effects Of The Crude Methanolic Extract Of Viola Betonicifolia Whole Plant In Rodents, Naveed Muhammad, Najeeb Rehman,, Haroon Khan, Muhammad Saeed, Anwar Gilani

Department of Biological & Biomedical Sciences

Abstract Background: The present study was aimed to provide ethnopharmacological basis for the medicinal use of Viola betonicifolia whole plant in indigestion and constipation. Methods: Mice were used in in-vivo prokinetic and laxative studies while in-vitro experiments were conducted on isolated tissues of rabbit and guinea-pig gut preparations suspended in a tissue bath to measure isotonic contractions. Results: The crude methanolic extract of Viola betonicifolia (VBME) showed partially atropine-sensitive prokinetic (50 and 100 mg/kg) and laxative (30 and 100 mg/kg) activities in mice. When tested in isolated rabbit jejunum and guinea-pig ileum, VBME caused dose-dependent contractions at 0.01-0.3 mg/mL and …

Development And Pilot Implementation Of A Locally Developed Trauma Registry: Lessons Learnt In A Low-Income Country, Amber Mehmood, Junaid Abdul Razzak, Sarah Kabir, Ellen J. Mackenzie, Adnan A. Hyder

Department of Emergency Medicine

Background

Trauma registries (TRs) play an integral role in the assessment of trauma care quality. TRs are still uncommon in developing countries owing to awareness and cost. We present a case study of development and pilot implementation of “Karachi Trauma Registry” (KITR), using existing medical records at a tertiary-care hospital of Karachi, Pakistan to present results of initial data and describe its process of implementation.

Methods

KITR is a locally developed, customized, electronic trauma registry based on open source software designed by local software developers in Karachi. Data for KITR was collected from November 2010 to January 2011. All patients …

Disseminating Childhood Home Injury Risk Reduction Information In Pakistan: Results From A Community-Based Pilot Study, Aruna Chandran, Uzma Rahim Khan, Nukhba Zia, Asher Feroze, Sarah Stewart De Ramirez, Cheng-Ming Huang, Junaid A. Razzak, Adnan A. Hyder

Department of Emergency Medicine

Background: Most childhood unintentional injuries occur in the home; however, very little home injury prevention information is tailored to developing countries. Utilizing our previously developed information dissemination tools and a hazard assessment checklist tailored to a low-income neighborhood in Pakistan, we pilot tested and compared the effectiveness of two dissemination tools.

Methods: Two low-income neighborhoods were mapped, identifying families with a child aged between 12 and 59 months. In June and July 2010, all enrolled households underwent a home hazard assessment at the same time hazard reduction education was being given using an in-home tutorial or a pamphlet. …

School-Based Injury Outcomes In Children From A Low-Income Setting: Results From The Pilot Injury Surveillance In Rawalpindi City, Pakistan, Uzma Rahim Khan, Junaid A. Bhatti, Nukhba Zia, Umar Farooq

Department of Emergency Medicine

Background

School-based injuries account for one in five unintentional childhood injuries. Little is known about the epidemiology of school-based injuries in low-income settings. The objective of our study was to compare emergency department (ED) outcomes of the school-based injuries with respect to age, sex, and injury mechanisms in a Pakistani urban setting.

Findings

A pilot injury surveillance study was conducted at the EDs of three major tertiary-care hospitals of Rawalpindi city from July 2007 to June 2008 and included children of less than 15 years injured at school. The World Health Organization’s questionnaire for injury surveillance was used. There were …

Focused Abdominal Sonography For Trauma (Fast) In Blunt Paediatric Abdominal Trauma, Ahmad Vaqas Faruque, Saqib Hamid Qazi, Muhammad Arif Mateen Khan, Wassem Akhtar, Amina Majeed

Section of Paediatric Surgery

Objective: To evaluate the role of focussed abdominal sonography for trauma in blunt paediatric abdominal trauma patients, and to see if the role of computed tomography scan could be limited to only those cases in which sonography was positive.
Methods: The retrospective study covered 10 years, from January 1,2000 to December 31,2009, and was conducted at the Department of Radiology and Department of Emergency Medicine, Aga Khan University Hospital, Karachi. It comprised cases of 174 children from birth to 14 years who had presented with blunt abdominal trauma and had focussed abdominal sonography for trauma done at the hospital. The …

Intubation In Emergency Department Of A Tertiary Care Hospital In A Low-Income, Nadeem Ullah Khan, Uzma R. Khan, Kiran Ejaz, Humaid Ahmad, Nukhba Zia, Junaid Abdul Razzak

Department of Emergency Medicine

Objective: To study the indications, method, success rate and complications of intubation at the Emergency Department of a private, tertiary care hospital in Karachi, Pakistan.
Methods: The case series involved 278 patients above 14 years of age who underwent emergency intubation at the Emergency Department of Aga Khan University Hospital, Karachi between 1998 and 2003. Descriptive statistics were used to compare rapid sequence intubation with crash intubation. The level of significance was p<0.05.
Results: Of the total 278 intubations performed, 37 (13.3%) had to be left out for incomplete information. The study population remaining for inferential analysis comprised of 241 …

Experience Of Nurses With Using Ehealth In Gilgit-Baltistan, Pakistan: A Qualitative Study In Primary And Secondary Healthcare, Saleema A. Gulzar, Shariq Khoja, Afroz Sajwani

School of Nursing & Midwifery

Background: To improve the quality of health care in remote parts of Pakistan, a research project was initiated in the mountainous region of Gilgit-Baltistan using information and communication technology to improve patient care and support continuing education of health providers (eHealth). This paper describes the experience of nurses in using eHealth in their routine practices.
Methods: All health centres of Gilgit-Baltistan, Pakistan using eHealth as part of this study, were taken as a single case. These include four primary healthcare centres, three secondary care centres and one medical centre. In-depth interviews were conducted using semi-structured interview guide to study nurses' …

Nitric Oxide And Its Metabolites In The Critical Phase Of Illness: Rapid Biomarkers In The Making, Asad Mian, Mayank Aranke, Nathan S. Bryan

Department of Emergency Medicine

The potential of nitric oxide (NO) as a rapid assay biomarker, one that could provide a quantum leap in acute care, remains largely untapped. NO plays a crucial role as bronchodilator, vasodilator and inflammatory mediator. The main objective of this review is to demonstrate how NO is a molecule of heavy interest in various acute disease states along the emergency department and critical care spectrum: respiratory infections, central nervous system infections, asthma, acute kidney injury, sepsis, septic shock, and myocardial ischemia, to name just a few. We discuss how NO and its oxidative metabolites, nitrite and nitrate, are readily detectable …

Use Of Inhaled Pge1 To Improve Diastolic Dysfunction, Lvedp, Pulmonary Hypertension And Hypoxia In Ards—A Randomised Clinical Trial, Shahla Siddiqui, Nawal Salahuddin, Salwa Zubair, Muniza Yousuf, Iqbal Azam, Anwar Hassan Gilani

Department of Biological & Biomedical Sciences

Introduction: We wished to see the effects of inhaled PGE1 on diastolic dysfunction, left ventricular end diastolic pressure (LVEDP), pulmonary hypertension and hypoxia in ARDS patients.
Methods: This is a randomized, prospective, clinical trial conducted in the main adult intensive care unit of a tertiary care University hospital. A total of 67 patients were recruited. Inclusion criteria included all adult patients with a P/F ratio /or Pulmonary Artery systolic (Pa) pressures of >35 mmHg on Pulmonary artery catheter or suspected on clinical grounds. A transthoracic echo was performed to record the diastolic function, LVEDP and Pa pressures. Subsequently patients were …

Naeglaeria Infection Of The Central Nervous System, Ct Scan Findings: A Case Series, Rohana Naqi, Muhammad Azeemuddin

Department of Radiology

The imaging findings in four cases of a rare infection of the central nervous system caused by amoebae, Naeglaeria fowleri are presented. Naeglaeria fowleri are pathogenic free-living amoebae. They cause primary amoebic meningoencephalitis (PAM), a rapidly fatal disease of the central nervous system. The computed tomography brain findings in 3 (75%) of our cases of pan amoebic meningoencephalitis showed non-specific brain oedema; 2 (66%) of these cases also had moderate hydrocephalus and among that 1 (50%) case showed an old lacunar infarction in peri-ventricular region. In the remaining 1 (25%) case the scan was normal with no evidence of oedema …

Prevalence Of Hypertension In Healthy School Children In Pakistan And Its Relationship With Body Mass Index, Proteinuria And Hematuria, Arshalooz Jamila Rahman, Farah Naz Qamar, Sohail Ashraf, Zubair Ali Khowaja, Shafaq Binte Tariq, Hira Naeem

Department of Paediatrics and Child Health

To determine the prevalence of high blood pressure (BP) in healthy school Pakistani children and its association with high body mass index (BMI), asymptomatic hematuria and proteinuria, we studied 661 public school children and measured their body weight, height and BP and urine dipstick for hematuria performed on a single occasion. Hypertension (BP >95 th centile) and pre-hypertension (BP >90 th centile) were defined based on the US normative BP tables. Over-weight and obesity were defined according to the World Health Organization (WHO) classification of BMI. The mean age of the children was 14 ± 1.3 years. The mean BMI …

Pediatric Dentistry Training For Dentists In Pakistan, Farhan Raza Khan, Sadia Mahmud, Munawar Rahman

Section of Dental-Oral Maxillofacial Surgery

OBJECTIVE: In the last decade, a rapid growth has been observed in the number of dentists due to establishment of number of dental colleges in Karachi, Pakistan. There is an acute dearth of Pediatric Dentistry faculty in Pakistani dental institutions. Similarly, no post graduate Pediatric Dentistry fellowship program exists in the country. The objectives of this study are to map the pattern of pediatric dentistry services provided by the clinicians in teaching institutions and private practices of Karachi. METHODOLOGY: A cross sectional study conducted at dental departments of academic institutions and selected dental practices in different parts of Karachi. The …

Role Of Garlic Usage In Cardiovascular Disease Prevention: An Evidence-Based Approach, Waris Qidwai, Tabinda Ashfaq

Department of Family Medicine

Introduction:.Rapidly growing prevalence of cardiovascular disease is a major threat for the developed as well as developing world warranting urgent need of intervention. Complementary and alternative medicines are gaining popularity among general population because of their safety profile and easy administration. Garlic, in particular, is considered to be one of the best disease-preventive foods because of its potent and widespread effects. This study was done to find out the role of garlic usage in cardiovascular disease prevention.

Methodology : .Major databases including Google, PubMed,MEDLINE, and Cochrane library view were used for the literature search. Clinical trials conducted on humans assessing …

Protaper Rotary Instrument Fracture During Root Canal Preparation: A Comparison Between Rotary And Hybrid Techniques, Huma Farid, Farhan Raza Khan, Munawar Rahman

Section of Dental-Oral Maxillofacial Surgery

AIMS:

This study aimed to compare the frequency of ProTaper rotary instrument fracture with rotary (conventional) and hybrid (rotary and hand files) canal preparation techniques. Secondary objectives were to determine whether there was an association of ProTaper file fracture with the canal curvature and to compare the mean time required for canal preparation in the two techniques.

METHODS:

An in vitro experiment was conducted on 216 buccal canals of extracted maxillary and mandibular first molars. After creating an access cavity and a glide path for each canal, a periapical radiograph was taken and the canal curvature was measured with Schneider's …

The Evolution Of Comprehensive Cancer Care In Western Kenya, R. M. Strother, F. C. Asirwa, N. B. Busakhala, E. Njiru, Elkanah Omenge, F. Njuguna, J. Skiles, J. Carter, A. Mega, G.J.L. Kaspers

Obstetrics and Gynaecology, East Africa

In the next 20 years, it is expected that 70% of incident cancers will be diagnosed in the developing world. There exist very few models of cancer care delivery in resource constrained settings. We present a model of cancer care delivery that developed as a result of a multi-institutional collaboration between high-income country academic medical centers and a Kenyan medical school and governmental referral hospital. Based on the infrastructure provided by a successful HIV care program, AMPATH-Oncology presently offers a range of clinical services across the continuum of care, including cervical cancer and breast cancer screening, palliative care, and oncology …

Impact Of Water And Sanitation And Health Education Interventions On Health And Hygiene Behaviors: A Study From A Northern Pakistani Village, Aysha Zahidie, Fauziah Rabbani

Community Health Sciences

Introduction: Water and sanitation interventions were delivered in the northern areas of Pakistan as a joint venture of the Aga Khan University and the Aga Khan Health Systems Oshikhandass Diarrhea and Dysentery Project (1989-96) followed by the Aga Khan Water, Sanitation, Health and Hygiene Studies Program (WSHHSP). Through these interventions water treatment plants, new pit latrines along with a component of health education were introduced. Objectives: To explore perceptions, knowledge and practices of inhabitants of Oshikhandass village in Gilgit related to water quality, latrine use and hand washing following the intervention. Methods: Through a cross-sectional study during June-July 2012, six …

The Political Economy Of Undernutrition National Report: Pakistan, Shehla Zaidi, Zulfiqar Ahmed Bhutta, Shandana Khan Mohmand, Andres Mejia Acosta

Community Health Sciences

No abstract provided.

Public Private Partnerships For Improving Maternal And Neonatal Health Service Delivery A Review Of The Evidence, Shehla Zaidi, Rehana Salam, Zulfiqar Ahmed Bhutta, Shahid Ansari, Syeda Subika Rizvi, Beenish Fatima Zehra, Amin Pethani

Community Health Sciences

No abstract provided.