Medicine and Health Sciences Commons^™

Disclosure Of Hiv Status To Children In Resource-Limited Settings: A Systematic Review, Rachel C. Vreeman, Anna Maria Gramelspacher, Peter Gisore, Michael L. Scanlon, Winstone M. Nyandiko

Paediatrics and Child Health, East Africa

Introduction: Informing children of their own HIV status is an important aspect of long-term disease management, yet there is little evidence of how and when this type of disclosure takes place in resource-limited settings and its impact.

Methods: MEDLINE, EMBASE and Cochrane Databases were searched for the terms hiv AND disclos* AND (child* OR adolesc*). We reviewed 934 article citations and the references of relevant articles to find articles describing disclosure to children and adolescents in resource-limited settings. Data were extracted regarding prevalence of disclosure, factors influencing disclosure, process of disclosure and impact of disclosure on children and caregivers.

Results: …

Glue Sniffing Neuropathy And Review Of Literature, Hazim Brohi, Al Amri A. Saeed, Osamma Shams, Al Jundi E Ziad, Alreshi M Noauf, Abualela Handi, Khotani Amal, Babakkor Mohammed

Pakistan Journal of Neurological Sciences (PJNS)

Glue sniffing neuropathy commonly known as n-hexane neuropathy. It is well documented that industrial exposure to n-hexane causes neuropathy, however it is less well recognized that inhalation of n-hexane present in the vapors can also cause neuropathy However such patients are not seen that frequently. The acute worsening also generates differential diagnosis of GBS. Most of literature is reported from west .We report such case for the first time from Saudi Arabia. A 35 year old male presented to us with progressive numbness followed by weakness in both legs since last three weeks. Over next two week he became chair …

What Diabetics Know About Diabetes?, Hazim Brohi, Aftab Ahmed Laghari, Shahid A Mirza, Arif Memon, Johar Khanzada, Tooba Rehman

Pakistan Journal of Neurological Sciences (PJNS)

Patient’s lack of understanding of disease hinders in proper control of disease thus increasing the morbidity and mortality. Review of the studies done in this region, dose not provide a detail account of patients understanding about the disease. Majority of patients when interviewed in clinics do not know the right answer to cause, level of desired sugar, possible complication. Material and methods: Hospital-based cross-sectional KAP study was conducted on diabetic patients visiting the diabetic clinic in two tertiary care Hospitals and a diabetic poly clinic in different areas of Karachi during the month of September 2012. Results: The mean age …

Not All Asymptomatic Carotid Plaques Are Equal: Some Require Intervention, Iram Naz

Pakistan Journal of Neurological Sciences (PJNS)

Ischemic stroke represents a major health hazard around the world, which has a severe impact on society and the health-care systems. Roughly, 15% of all strokes can be attributed to significant atherosclerotic disease of the carotid arteries. Some patients presenting with disabling strokes for the first time cannot benefit from carotid revascularization having lost the opportunity of prevention. We know that all symptomatic patients were once asymptomatic. Hence, after identifying high risk carotid plaques and patient’s characteristics suitable for interventions, they should be offered carotid revascularization at specialized centers (with low perioperative stroke and death rates) to prevent stroke and …

Are We Ready For A New Epidemic Of Under Recognized Liver Disease In South Asia Especially In Pakistan? Non Alcoholic Fatty Liver Disease, Om Parkash, Saeed Hamid

Section of Gastroenterology

Nonalcoholic fatty liver disease (NAFLD) is increasingly recognized as an important public health problem nowadays. NAFLD encompass a variety of liver pathologies including simple steatosis, NASH, fibrosis, cirrhosis and finally cancer. It is associated with obesity, metabolic syndrome, dyslipidaemia, Insulin resistance (IR) and type 2 diabetes. It is the most common chronic liver disease in USA and considered to be increasing in Asia Pacific region including South Asia however there is no community based study from Pakistan. Customarily NAFLD had been regarded as a benign disease; however clinical as well as epidemiological studies had contradicted this belief because approximately 20% …

An Unusual Combination Of Extra-Adrenal Pheochromocytoma And Arteriovenous Malformation Of The Ureter In A Young Adult, Ali Khawaja, Wajahat Aziz, Syed Muhammad Nazim, Farhat Abbas

Section of Urology

We present a case of a 24-year-old gentleman who presented with painless pan haematuria for 2 weeks. During the workup, he was diagnosed to have a retrocaval mass after a CT scan while cystoscopy revealed a polypoidal pulsating lesion in the left ureter. After surgical manipulation of the retrocaval mass, the blood pressure of the patient raised to 260/130 mm Hg. It was completely resected and diagnosed as extra-adrenalpheochromocytoma (paraganglioma) after histopathology. The lesion in the ureter was completely excised and fulgurated and diagnosed as anarteriovenous malformation. To the best of our knowledge, this is the first patient to be …

Renal Arteriovenous Malformation: An Unusual Cause Of Recurrent Haematuria, Mazhar Ali, Wajahat Aziz, Farhat Abbas

Section of Urology

A 54-year-old woman presented with gross painless haematuria. Initial workup showed no abnormality except mild hydronephrosis on CT scan. Cystoscopy and retrograde pyelography did not find any gross lesion and her urine cytology was also negative. She had recurrent haematuria so her CT was reviewed with the radiologist with clinical suspicion of arteriovenous malformation (AVM) which was suggested by relatively increased contrast density in the hemiazygous vein and renal vein in the arterial phase. She underwent angioembiolisation of left renal AVM after which her haematuria settled.

Validation Of The Ottawa Ankle Rules At A Tertiary Teaching Hospital: A Cross-Sectional Study, Mark Karanja Tharao

Master of Medicine in General Surgery

Introduction: Ankle joint and foot injuries are among the commonest injuries seen at the Accident and Emergency Department of any hospital. Within the United States it is the second most common musculoskeletal injury seen by physicians. Assessment of these injuries is done clinically and when deemed necessary a radiograph is requested. Studies have shown that radiographs are ordered in over 95% of cases yet the prevalence of fractures is in the range of 15-20%. This means that more than 80% of patients are exposed to unnecessary radiation. The Ottawa ankle rules have been designed to reduce the need for performing …

Limited Effectiveness Of Hiv Prevention For Young People In Sub-Saharan Africa: Studying The Role Of Intervention And Evaluation, Kristien Michielsen, Marleen Temmerman, Van Rossem

Obstetrics and Gynaecology, East Africa

On average, 2,500 young people (15-24 years) get -infected with HIV every day; 80% of which live in sub-Saharan Africa. Since no cure or vaccine is available, reducing sexual risk behaviour in this group is crucial in tackling the epidemic. The general objective of this doctoral study was to improve the effectiveness of HIV prevention interventions for young people in sub-Saharan Africa. First, we assessed the overall effectiveness of such interventions (systematic literature review, meta-analysis). Secondly, we evaluated a school-based peer-led HIV prevention interventions in Rwanda (longitudinal, non-randomized controlled trial), to get insight into how interventions are developed, implemented and …

Prolonged Sexual Abstinence After Childbirth: Gendered Norms And Perceived Family Health Risks. Focus Group Discussions In A Tanzanian Suburb, Columba Mbekenga, Andrea B. Pembe, Elisabeth Darj, Kyllike Christensson, Pia Olsson

School of Nursing & Midwifery, East Africa

Background: Prolonged sexual abstinence after childbirth is a socio-cultural practice with health implications, and is described in several African countries, including Tanzania. This study explored discourses on prolonged postpartum sexual abstinence in relation to family health after childbirth in low-income suburbs of Dar es Salaam, Tanzania.

Methods: Data for the discourse analysis were collected through focus group discussions with first-time mothers and fathers and their support people in Ilala, Dar es Salaam, Tanzania.

Results: In this setting, prolonged sexual abstinence intended at promoting child health was the dominant discourse in the period after childbirth. Sexual relations after childbirth involved the …

Prevalence And Factors Associated With Depression Among Patients With Epilepsy In A Kenyan Tertiary Care Hospital, Nduku Kiko

Master of Medicine in Internal Medicine

Aim: To determine the prevalence and factors associated with depression in patients with epilepsy at Aga Khan University Hospital Nairobi. Design: Cross-sectional Survey Background: Depression is a recognized common co-morbidity of epilepsy that often goes untreated and has great impact on quality of life of patients and management of patients with epilepsy. Patients and Setting: Patients with epilepsy on follow up at the Aga Khan University Hospital were evaluated for presence and factors associated with depression. Methodology: The study recruited eligible patients with epilepsy who were on follow up in the neurology clinic. Beck Depression Inventory was administered to evaluate …

Early Onset Type 2 Diabetes And Associated Risk Factors, Grace Nyambura Kiraka

Master of Medicine in Clinical Pathology

Background: The incidence of type 2 diabetes in patients below the age of 40 (early onset diabetes) is markedly on the rise and has been linked increased prevalence of risk factors such as the metabolic syndrome and family history of diabetes. Objective: To determine the proportion of patients with type 2 diabetes at Aga Khan University Hospital Nairobi (AKUHN) who have early onset type 2 diabetes and the association of age of onset with risk factors (family history of diabetes, obesity, waist circumference, hypertension, low HDL cholesterol and hypertriglyceridaemia) in this group of patients. Methods: This was a cross sectional …

Primary Antiretroviral Drug Resistance Profiles Among Hiv-1 Therapy Naïve Patients In Two Referral Hospitals In Kenya, Simon Onsongo Nyangena

Master of Medicine in Clinical Pathology

Objective: To characterize antiretroviral drug resistance mutations among drug naïve patients in two referral hospitals in Kenya Background: Acquired immunodeficiency syndrome (AIDS) caused by Human immunodeficiency virus (HIV) was first described in 1982. Since then the virus has spread globally to infect millions of people. HIV was first described in Kenya in the period between 1984/1985. Currently, Kenya has an estimated HIV-1 prevalence of 6.2% with a country population of about 40 million people. With the introduction of antiretroviral drugs, the survival of most HIV patients has been prolonged markedly. However this is greatly threatened by increasing rates of antiretroviral …

Prevalence Of Vitamin D Deficiency In An Ethnic African Urban Obstetric Population In An Equatorial City Hospital, Raj Hasmukh Dodia

Master of Medicine in Obstetrics and Gynecology

Introduction: Low Vitamin D levels in pregnancy have been associated with an increased risk of gestational diabetes, pre-eclampsia, bacterial vaginosis, preterm birth, disordered fetal skeletal homeostasis, and impaired offspring lung health. As a result, current public health advice in several countries is to universally supplement Vitamin D during pregnancy. Data regarding the Vitamin D levels of the ethnic obstetric population in Kenya are not available; hence recommendations for Vitamin D supplementation have no scientific basis. Objectives of study: This research was carried out to determine the prevalence of deficiency of Vitamin D in ethnic African obstetric patients who had delivered …

The Effectiveness Of Educational Support To Orphans And Vulnerable Children In Tanzania And Uganda, Mary Shann, Malcolm Bryant, Mohamad Brooks, Paul Bukuluki, Denis Muhangi, Joe Lugalla, Gideon Kwesigabo

Institute for Educational Development, East Africa

Little evidence is available to assist policy makers and donors in deciding what kinds of programs in developing countries are more likely to be effective in supporting the entry and continuation of OVC in secondary schools. This is particularly important for females whose education has direct bearing on child mortality in the next generation. This study gathered four kinds of educational outcome measures in two East African countries ravaged by the AIDS/HIV pandemic. The goal was to determine whether direct scholarship aid to individual students versus various forms of block grants would be more effective in promoting lower rates of …

Controversies About Radioactive Iodine-131 Remnant Ablation In Low Risk Thyroid Cancers: Are We Near A Consensus?, Maseeh Uz Zaman, Nosheen Fatima, Ajit Kumar Padhy, Unaiza Zaman

Department of Radiology

Well differentiated thyroid cancers (WDTC), including papillary (80%) and follicular (10%) types, are the most common endocrine cancers globally. Over the last few decades most the diagnosed cases have fallen into low risk categories. Radioactive iodine-131 (RAI) has an established role in reducing recurrence and improving the survival in high risk patients. In patients with primary tumor size <1 >cm, RAI is not recommended by many thyroid societies. However, low risk WDTC has been an arena of major controversies, most importantly the role and dose of adjuvant RAI for remnant ablation to minimize chances of recurrence and improving survival. This review …

Effects Of Intravenous Diclofenac On Postoperative Sore Throat In Patients Undergoing Laparoscopic Surgery At Aga Khan University Hospital, Nairobi: A Prospective, Randomized, Double Blind Controlled Trial, Thang'a P., Dorothy Kamya, Vitalis Mung’Ayi

Anaesthesiology, East Africa

Background: Postoperative sore throat is the commonest complication after endotracheal intubation. The efficacy of intravenous non-steroidal anti-inflammatory drugs in alleviating postoperative sore throat has not been investigated.

Objective: To evaluate the effect of intravenous diclofenac sodium on the occurrence and severity of postoperative sore throat.

Methods: 42 in-patients scheduled for laparoscopic surgery were randomized into two equal groups to receive either a single dose of 75mg intravenous diclofenac sodium in addition to standard treatment taken at our hospital for the prevention of postoperative sore throat or to receive standard treatment only. All patients were interviewed postoperatively at 2, 6 and …

The Sociodemographic And Health-Related Characteristics Of A Regional Population With Chronic Disease At An Interprofessional Student-Assisted Clinic In Queensland Capricornia Allied Health Partnership, Kerrie-Anne Frakes, Sharon Brownie, Lauren Davies, Mary-Ellen Miller, Zephanie Tyack

School of Nursing & Midwifery, East Africa

Objective: This paper describes the socio-demographic and health-related characteristics of people with chronic disease attending an inter-professional student-assisted clinic in regional Queensland.

Design: A retrospective review of data collected during the first 10 months of operation of the clinic was conducted.

Setting, participants and outcome measures: Data was collected on up to 378 patients during an intake appointment at the Capricornia Allied Health Partner-ship (CAHP) community-based clinic and compared with normative reference groups where available. Socio-demographic characteristics included age, gender and education level; health-related characteristics included body mass index and hospitalizations in the previous 12months; and risk factors included prescribed …

The Prevalence Of Smoking And The Knowledge Of Smoking Hazards And Smoking Cessation Strategies Among Hiv Positive Patients In Johannesburg, South Africa, Peter Waweru, R. Anderson, H. Steel, Wdf. Venter, D. Murdoch, C. Feldman

Internal Medicine, East Africa

Background: While the detrimental effects of smoking among HIV positive patients have been well documented, there is a paucity of data regarding cigarette smoking prevalence among these patients in South Africa.

Objectives: To establish the frequency, demographics, and knowledge of harmful effects and of smoking cessation strategies among HIV-positive patients in Johannesburg, South Africa.

Methods: A prospective cross-sectional survey, using a structured questionnaire interview, of HIV-positive patients attending the HIV Clinic at the Charlotte Maxeke Johannesburg Academic Hospital between 1 July 2011 and 31 October 2011.

Results: Of 207 HIV positive patients attending an ARV roll-out clinic, 31 (15%) were …

Uterine Fibroid Embolization For Symptomatic Fibroids; Correlation Of Mid-Term Changes In Disease-Specific Symptoms And Magnetic Resonance Imaging Results At A Teaching Hospital In Kenya, John Kiprop Mutai

Master of Medicine in Imaging and Diagnostic Radiology

Background: Uterine fibroid embolization, though a widely available option in high income countries in managing symptomatic fibroids is relatively new in the East African region. It is currently offered at only one tertiary facility for the past three years. The symptom and radiological response in these patients, who literature suggests may have bigger fibroid burden and worse symptoms, is the subject of this study. Objective: Characterization of MRI imaging features in women undergoing uterine fibroid embolization and identification of clinical correlates in an African population. Methods: Patients with symptomatic fibroids who are selected to undergo UFE at the hospital formed …

The Role Of Inflammation In Contrast Induced Nephropathy, Elijah A. Kwasa

Master of Medicine in Imaging and Diagnostic Radiology

Background: Intravenously administered iodinated contrast media are widely and liberally used in daily diagnostic radiological investigations. Contrast-induced nephropathy (CIN) is notable as the third commonest cause of hospital-acquired renal injury. Justification: The global prevalence of CIN from various studies ranges from 2-5% but an incidence of CIN of 12-14% in Kenya was highlighted by a recent study without an explanation for the markedly increased incidence. Intravascular contrast has been demonstrated to commonly cause renal vasoconstriction. However, the low incidence of CIN in the general population infers that contrast alone cannot be a causative insult. This study proposes that inflammatory states, …

Rational Use Of Antibiotics--A Quality Improvement Initiative In Hospital Setting, Sidrah Nausheen, Rabia Hammad, Ambreen Khan

Department of Obstetrics & Gynaecology

Objectives: To minimise irrational use of antibiotics by implementing guidelines for antibiotic usage in obstetrics and Gynaeocology.
Methods: The observational study was conducted from January to December 2010 at the maternity unit of Aga Khan Hospital for Women and children, Kharadar, a secondary care facility in Karachi, Pakistan. Data was collected from medical records related to the study period. Prophylactic antibiotics were given according to the American College of Obstetricians and Gynaecologists recommendation 2009. Surveillance was done by surgical site infection rates and infectious morbidity. Data was analysed on SPSS 13.
Results: Therapeutic antibiotic use was rationalized, reducing the use …

Assessment Of Experimental Animal Model For Training Obstetric Anal Sphincter Injury Techniques, Raheela Mohsin Rizvi

Department of Obstetrics & Gynaecology

The Multiparous Goat Pelvic Model was used to train obstetricians and residents for perineal and anal sphincter anatomy and techniques of repair of Obstetric Anal Sphincter Injuries (OASIs). The purpose of this study was to assess the similarity of this model with human anatomy and the usefulness of goat model for training obstetricians for perineal tears. Six workshops were conducted between June 2009 and December 2010. A total of 90 participants, including 64(70.3%) residents and 26(28.5%) consultants in Obstetrics and Gynaecology, attended hands-on training workshops using experimental goat pelvic model for the repair of perineal tears. Among the consultants, 23 …

A Review Of Comparison Of Complications Of Vaginal Hysterectomy With And Without Concomitant Surgery For Sui: A 5 Years’ Experience At A Tertiary Care Hospital Of Pakistan, Raheela Mohsin Rizvi, Munnazza Akhtar, Nadeem F. Zuberi

Department of Obstetrics & Gynaecology

Objective. The study was performed to review the complications of surgery for POP with or without surgery for SUI. This included the need for second procedure two years after the primary surgery. Study Design. We conducted a retrospective cross-sectional comparative study at the Aga Khan University, Karachi, Pakistan. International Classification of Diseases, 9th revision, Clinical Modification (ICD-9-CM) was used to identify women who underwent vaginal hysterectomy with anterior/posterior repair alone and those with concomitant tension-free vaginal tape surgery for urodynamic stress incontinence. Results. The 28 cases of VH/repair combined with TVT were compared for complications with 430 cases of VH …

Frequent Hypomethylation Of Ptgs2 Gene Promoter In Human Term Placenta, Nuruddin Mohammad, Ahmed Yaqinuddin, Fatima Kakal, Lumaan Sheikh, Rahat Qureshi, Mehreen Soman

Department of Obstetrics & Gynaecology

Background: Gene expression profiles of several tumor suppressor genes are regulated by the methylation and demethylation of their promoters. Here, we aim to identify and quantify the methylation status of four tumor suppressor genes from placentas at term and compare them with the maternal white-blood-cells.

Methods: In order to achieve this objective, DNA enriched from twenty placentas at term and maternal white blood cells was bisulfite-converted and amplified using quantitative real-time methyl-light polymerase chain reaction for the four-genes studied (RASSF1A, APC, RAR-beta, and PTGS2).

Results: Among the four genes examined, RASSF1A, APC and RAR-beta promoter regions were hypermethylated in all …

Abstracts 4th Pediatric Neurology Conference Children Medical Center, Lahore February 2013, Tipu Sultan, Tahir Masood Ahmed Masood Ahmed

Pakistan Journal of Neurological Sciences (PJNS)

Clinical data of 100 patients being treated as TBM (group A) admitted in the Neurology department, and another 100 patients with diagnosis of meningitis, encephalitis or cerebral malaria (group B) were evaluated. History, clinical examination and relevant investigations were evaluated and Kenneth Jones criteria were applied to both groups. All children were followed and their outcome was also studied.

Tracheal Reconstruction For Comlex Acute Tracheal Stenosis, Saulat H. Fatimi, M.Qasim Raza, Alina Ghani, Nilay Shah, Awais Ashfaq

Section of Cardiothoracic Surgery

Tracheal stenosis refers to a reduction in the size of the tracheal lumen and can be due to a myriad of reasons, but the most common remains trauma. In iatrogenic situations, internal trauma is the most likely culprit, resulting from prolonged intubation. Our case reviews a patient who developed severe tracheal stenosis (90% reduction in lumen size) within a month of a threeday- long intubation, and presented to the emergency room with dyspnea, orthopnea, and stridor. Tracheal reconstruction with resection of the stenosed segment and end-to-end anastomosis was done. The patient returned a month later with re-stenosis, and underwent tracheal …

Mucor Mycosis: A Fulminant Case With Extensive Involvement And Remarkable Recovery, Asif Sa

Pakistan Journal of Neurological Sciences (PJNS)

Mucor mycosis is a rare but fatal illness. It is seen in diabetics and immune compromised individuals. A case is presented with fulminant course, rapid progression and extensive involvement. He was treated with Fungizone and Itraconazole alongwith surgical debridement of infected nasal mucosa. Recommendation is made to increase the awareness of this fatal illness among local practitioners.

Development Of Neurology In Pakistan., Sardar M. Alam

Pakistan Journal of Neurological Sciences (PJNS)

On the eve of the 20th Annual Neurology Conference we can look back over the last two decades to assess the development of Neurology in Pakistan. Neurology first functioned under the banner of Pakistan Academy of Neurological Sciences (PANS) and then as Pakistan Society of Neurology (PSN).

Role Of Complementary And Alternative Medicine In Cardiovascular Diseases, Waris Qidwai, Peng Nam Yeoh, Victor Inem, Kashmira Nanji, Tabinda Ashfaq

Department of Family Medicine

No abstract provided.