Medicine and Health Sciences Commons^™

Effectiveness Of Interventions To Screen And Manage Infections During Pregnancy On Reducing Stillbirths: A Review, Sidra Ishaque, Mohammad Yawar Yakoob, Aamer Imdad, Robert L. Goldenberg, Thomas P. Eisele, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background:Infection is a well acknowledged cause of stillbirths and may account for about half of all perinatal deaths today, especially in developing countries. This review presents the impact of interventions targeting various important infections during pregnancy on stillbirth or perinatal mortality.
Methods: We undertook a systematic review including all relevant literature on interventions dealing with infections during pregnancy for assessment of effects on stillbirths or perinatal mortality. The quality of the evidence was assessed using the adapted Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach by Child Health Epidemiology Reference Group (CHERG). For the outcome of interest, namely …

Effect Of Breastfeeding Promotion Interventions On Breastfeeding Rates, With Special Focus On Developing Countries, Aamer Imdad, Mohammad Yawar Yakoob, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background:Given the recognized benefits of breastfeeding for the health of the mother and infants, the World Health Organization (WHO) recommends exclusive breastfeeding (EBF) for the first six months of life. However, the prevalence of EBF is low globally in many of the developing and developed countries around the world. There is much interest in the effectiveness of breastfeeding promotion interventions on breastfeeding rates in early infancy.

Methods:

A systematic literature was conducted to identify all studies that evaluated the impact of breastfeeding promotional strategies on any breastfeeding and EBF rates at 4-6 weeks and at 6 months. Data were …

Effect Of Screening And Management Of Diabetes During Pregnancy On Stillbirths, Madiha Syed, Hasan Javed, Mohammad Yawar Yakoob, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background:Diabetes during pregnancy is associated with significant risk of complications to the mother, fetus and newborn. We reviewed the potential impact of early detection and control of diabetes mellitus during pregnancy on stillbirths for possible inclusion in the Lives Saved Tool (LiST).

Methods:

A systematic literature search up to July 2010 was done to identify all published randomized controlled trials and observational studies. A standardized data abstraction sheet was employed and data were abstracted by two independent authors. Meta-analyses were performed with different sub-group analyses. The analyses were graded according to the CHERG rules using the adapted GRADE criteria …

Impact Of Maternal Education About Complementary Feeding And Provision Of Complementary Foods On Child Growth In Developing Countries, Aamer Imdad, Mohammad Yawar Yakoob, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background:Childhood undernutrition is prevalent in low and middle income countries. It is an important indirect cause of child mortality in these countries. According to an estimate, stunting (height for age Z score < -2) and wasting (weight for height Z score < -2) along with intrauterine growth restriction are responsible for about 2.1 million deaths worldwide in children < 5 years of age. This comprises 21 % of all deaths in this age group worldwide. The incidence of stunting is the highest in the first two years of life especially after six months of life when exclusive breastfeeding alone cannot fulfill the energy needs of a rapidly growing child. Complementary feeding for an infant refers to timely introduction of safe and nutritional foods in addition to breast-feeding (BF) i.e. clean and nutritionally rich additional foods introduced at about six months of infant age. Complementary feeding strategies encompass a wide variety of interventions designed to improve not only the quality and quantity of these foods but also improve the feeding behaviors. In this review, we evaluated the effectiveness of two most commonly applied strategies of complementary feeding i.e. timely provision of appropriate complementary foods (+/- nutritional counseling) and education to mothers about practices of complementary feeding on growth. Recommendations have been made for input to the Lives Saved Tool (LiST) model by following standardized guidelines developed by Child Health Epidemiology Reference Group (CHERG).

Methods:

We conducted a systematic review of published randomized and quasi-randomized trials on PubMed, Cochrane Library and WHO regional databases. The included studies were abstracted and graded according to Study Design, limitations, intervention details and outcome effects. The primary outcomes were change in weight and height during the study period among children 6-24 months of age. We hypothesized that provision of complementary food and education of mother …

Impact Of Vitamin A Supplementation On Infant And Childhood Mortality, Aamer Imdad, Mohammad Yawar Yakoob, Christopher Sudfeld, Batool A. Haider, Robert E. Black, Zulfiqar Ahmed Bhutta

Woman and Child Health

Introduction:Vitamin A is important for the integrity and regeneration of respiratory and gastrointestinal epithelia and is involved in regulating human immune function. It has been shown previously that vitamin A has a preventive effect on all-cause and disease specific mortality in children under five. The Purpose of this paper was to get a point estimate of efficacy of vitamin A supplementation in reducing cause specific mortality by using Child Health Epidemiology Reference Group (CHERG) guidelines.

Methods:

A literature search was done on PubMed, Cochrane Library and WHO regional data bases using various free and Mesh terms for vitamin A …

Neonatal Resuscitation And Immediate Newborn Assessment And Stimulation For The Prevention Of Neonatal Deaths: A Systematic Review, Meta-Analysis And Delphi Estimation Of Mortality Effect, Anne C. C. Lee, Simon Cousens, Stephen N. Wall, Susan Niermeyer, Gary L. Darmstadt, Waldemar A. Carlo, William J. Keenan, Zulfiqar Ahmed Bhutta, Christopher Gill, Joy E. Lawn

Woman and Child Health

Background: Of 136 million babies born annually, around 10 million require assistance to breathe. Each year 814,000 neonatal deaths result from intrapartum-related events in term babies (previously "birth asphyxia") and 1.03 million from complications of prematurity. No systematic assessment of mortality reduction from tactile stimulation or resuscitation has been published. Objective:To estimate the mortality effect of immediate newborn assessment and stimulation, and basic resuscitation on neonatal deaths due to term intrapartum-related events or preterm birth, for facility and home births.

Methods:

We conducted systematic reviews for studies reporting relevant mortality or morbidity outcomes. Evidence was assessed using GRADE criteria …

Preventive Zinc Supplementation In Developing Countries: Impact On Mortality And Morbidity Due To Diarrhea, Pneumonia And Malaria, Mohammad Yawar Yakoob, Evropi Theodoratou, Afshan Jabeen, Aamer Imdad, Thomas P. Eisele, Joy Ferguson, Arnoupe Jhass, Igor Rudan, Harry Campbell, Robert E. Black, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background:Zinc deficiency is commonly prevalent in children in developing countries and plays a role in decreased immunity and increased risk of infection. Preventive zinc supplementation in healthy children can reduce mortality due to common causes like diarrhea, pneumonia and malaria. The main objective was to determine all-cause mortality and cause-specific mortality and morbidity in children under five in developing countries for preventive zinc supplementation. Data sources/review methods: A literature search was carried out on PubMed, the Cochrane Library and the WHO regional databases to identify RCTs on zinc supplementation for greater than 3 months in children less than 5 …

Role Of Calcium Supplementation During Pregnancy In Reducing Risk Of Developing Gestational Hypertensive Disorders: A Meta-Analysis Of Studies From Developing Countries, Aamer Imdad, Afshan Jabeen, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background:Hypertension in pregnancy stand alone or with proteinuria is one of the leading causes of maternal mortality and morbidity in the world. Epidemiological and clinical studies have shown that an inverse relationship exists between calcium intake and development of hypertension in pregnancy though the effect varies based on baseline calcium intake and pre-existing risk factors. The Purpose of this review was to evaluate preventive effect of calcium supplementation during pregnancy on gestational hypertensive disorders and related maternal and neonatal mortality in developing countries.
Methods: A literature search was carried out on PubMed, Cochrane Library and WHO regional databases. Data …

Screening And Triage Of Intrauterine Growth Restriction (Iugr) In General Population And High Risk Pregnancies: A Systematic Review With A Focus On Reduction Of Iugr Related Stillbirths, Aamer Imdad, Mohammad Yawar Yakoob, Saad Siddiqui, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background:There is a strong association between stillbirth and fetal growth restriction. Early detection and management of IUGR can lead to reduce related morbidity and mortality. In this paper we have reviewed effectiveness of fetal movement monitoring and Doppler velocimetry for the detection and surveillance of high risk pregnancies and the effect of this on prevention of stillbirths. We have also reviewed effect of maternal body mass index (BMI) screening, symphysial-fundal height measurement and targeted ultrasound in detection and triage of IUGR in the community.

Methods:

We systematically reviewed all published literature to identify studies related to our interventions. We …

The Effect Of Folic Acid, Protein Energy And Multiple Micronutrient Supplements In Pregnancy On Stillbirths, Aamer Imdad, Mohammad Yawar Yakoob, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background:Pregnancy is a state of increased requirement of macro-and micronutrients, and malnourishment or inadequate dietary intake before and during pregnancy, can lead to adverse perinatal outcomes including stillbirths. Many nutritional interventions have been proposed during pregnancy according to the nutritional status of the mother and baseline risk factors for different gestational disorders. In this paper, we have reviewed three nutritional interventions including peri-conceptional folic acid supplementation, balanced protein energy supplementation and multiple micronutrients supplementation during pregnancy. This paper is a part of a series to estimate the effect of interventions on stillbirths for input to Live Saved Tool (LiST) …

The Effect Of Providing Skilled Birth Attendance And Emergency Obstetric Care In Preventing Stillbirths, Mohammad Yawar Yakoob, Mahrukh Ayesha Ali, Mohammad Usman Ali, Aamer Imdad, Joy E. Lawn, Nynke Van Den Broek, Zulfiqar Ahmed Bhutta

Woman and Child Health

Background:Of the global burden of 2.6 million stillbirths, around 1.2 million occur during labour i.e. are intrapartum deaths. In low-/middle-income countries, a significant proportion of women give birth at home, usually in the absence of a skilled birth attendant. This review discusses the impact of skilled birth attendance (SBA) and the provision of Emergency Obstetric Care (EOC) on stillbirths and perinatal mortality.

Methods:

A systematic literature search was performed on PubMed/MEDLINE, Cochrane Database and the WHO regional libraries. Data of all eligible studies were extracted into a standardized Excel sheet containing variables such as participants' characteristics, sample size, location, …

Care During Labor And Birth For The Prevention Of Intrapartum-Related Neonatal Deaths: A Systematic Review And Delphi Estimation Of Mortality Effect, Anne C. C. Lee, Simon Cousens, Gary L. Darmstadt, Hannah Blencowe, Robert Pattinson, Neil F. Moran, G. Justus Hofmeyr, Rachel A. Haws, Shereen Zulfiqar Bhutta, Joy E. Lawn

Department of Obstetrics & Gynaecology

Background: Our objective was to estimate the effect of various childbirth care packages on neonatal mortality due to intrapartum-related events ("birth asphyxia") in term babies for use in the Lives Saved Tool (LiST).

Methods: We conducted a systematic literature review to identify studies or reviews of childbirth care packages as defined by United Nations norms (basic and comprehensive emergency obstetric care, skilled care at birth). We also reviewed Traditional Birth Attendant (TBA) training. Data were abstracted into standard tables and quality assessed by adapted GRADE criteria. For interventions with low quality evidence, but strong GRADE recommendation for implementation, an expert …

Evaluation Of Compliance And Outcomes Of A Management Protocol For Massive Postpartum Hemorrhage At A Tertiary Care Hospital In Pakistan, Lumaan Sheikh, Nida Najmi, Umair Khalid, Taimur Saleem

Department of Obstetrics & Gynaecology

Background: Massive postpartum hemorrhage is a life threatening obstetric emergency. In order to prevent the complications associated with this condition, an organized and step-wise management protocol should be immediately initiated.

Methods: An evidence based management protocol for massive postpartum hemorrhage was implemented at Aga Khan University Hospital, Karachi, Pakistan after an audit in 2005. We sought to evaluate the compliance and outcomes associated with this management protocol 3 years after its implementation. A review of all deliveries with massive primary postpartum hemorrhage (blood loss >= 1500 ml) between January, 2008 to December, 2008 was carried out. Information regarding mortality, mode …

Effect Of Case Management On Neonatal Mortality Due To Sepsis And Pneumonia, Anita K. M. Zaidi, Hammad A. Ganatra, Sana Syed, Simon Cousens, Anne C. C. Lee, Robert Black, Zulfiqar A. Bhutta, Joy E. Lawn

Department of Paediatrics and Child Health

Background: Each year almost one million newborns die from infections, mostly in low-income countries. Timely case management would save many lives but the relative mortality effect of varying strategies is unknown. We have estimated the effect of providing oral, or injectable antibiotics at home or in first-level facilities, and of in-Patient hospital care on neonatal mortality from pneumonia and sepsis for use in the Lives Saved Tool (LiST). Methods: We conducted systematic searches of multiple databases to identify relevant studies with mortality data. Standardized abstraction tables were used and study quality assessed by adapted GRADE criteria. Meta-analyses were undertaken where …

Role Of Multidetector Computed Tomography (Mdct) In Patients With Ovarian Masses., Fatima Mubarak, Muhammad Shahbaz Alam, Waseem Akhtar, Saima Hafeez, Noureen Nizamuddin

Department of Radiology

Objective:To evaluate the diagnostic accuracy of multidetector 64-slice computed tomography (MDCT) in the diagnosis and differentiation of benign and malignant ovarian masses using histopathology and surgical findings as the gold standard. Material And

Methods:

This study was conducted in Aga Khan University Hospital, Karachi, Pakistan. Data was reviewed retrospectively from 1 November 2008 to 12 December 2009. One hundred Patients found to have ovarian masses on CT scan were included in the study. CT scan was performed in all these Patients after administration of oral and IV contrast. Ovarian masses were classified as benign and malignant on scan findings. …

An Insight Into The Suspected Hba2' Cases Detected By High Performance Liquid Chromatography In Pakistan., Maliha Nusrat, Bushra Moiz, Amna Nasir, Mashhooda Rasool Hashmi

Department of Pathology and Laboratory Medicine

Background:Hemoglobin A2' (delta 16 Gly Arg) is globally the commonest delta chain variant of HbA2. It is clinically and hematologically silent but its sole importance lies in the underestimation of HbA2 quantity during the workup of beta-thalassaemia trait. High performance liquid chromatography (HPLC) identifies it as a small S-window peak with a mean retention time of 4.59 0.03 minutes. This study aims at describing the frequency of detection of HbA2' by HPLC in Pakistan and its confirmation at a molecular level. Potential HbA2' cases were identified by a retrospective review of 10186 HPLC chromatograms in year 2006. Prospective samples …

T-Tube Management Of Late Esophageal Perforation, Irfan Qadir, Hasnain Zafar, Mubashir Zareen Khan, Hasanat Mohammad Sharif

Section of General Surgery

Esophageal perforation is a serious condition with a high mortality rate. Management strategy of such a patient depends on the extent of perforation and the time interval between perforation and diagnosis. The use of a T tube to treat delayed esophageal perforation with complete resolution and no need for future definitive surgery has been less frequently described. We adapted this principle in successful management of a 73 year old patient with four days history of fever, shortness of breath, chest pain and radiological evidence of perforation.

The Constant Threat Of Terrorism: Stress Levels And Coping Strategies Amongst University Students Of Karachi, Ayesha Ejaz Ahmed, Komal Masood, Sohni Vicky Dean, Tanzila Shakir, Ahmed Abdul Hafeez Kardar, Usman Barlass, Syed Haider Imam, Mohammad Ghawar Khan Mohmand, Hussain Ibrahim, Imad Saeed Khan, Usman Akram, Farid Hasnain

Department of Psychiatry

OBJECTIVES: To assess the levels of stress in the face of terrorism and the adopted coping strategies, amongst the student population of universities in Karachi

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METHODS: A descriptive, cross sectional study was conducted on undergraduate students from four universities of Karachi. Self-administered questionnaires were filled out by 291 students. Pearson Chi-Square test was used to assess associations between stress levels and different variables at a level of significance of 0.05%

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RESULTS: A total of 65.8% of the students had mild stress levels, 91.5% of university students were exposed to terrorism through television, while only 26.5% students reported personal …

Food For Thought: Eathing For The Baby & You, Cassandra Fernandes Faria

Institute for Educational Development, Karachi

No abstract provided.

Dual Chamber Pacemaker Implants--A New Opportunity In Pakistan For Children With Congenital And Acquired Complete Heart Block, Awais Ashfaq, Mansoor Ahmed Khan, Mehnaz Atiq, Muhammad Muneer Amanullah

Section of Cardiothoracic Surgery

Implantation of cardiac pacemakers has been practiced for at least five decades with continuous developments of the hardware. The invention of dual chamber pacemakers has initiated a debate concerning its superiority over single chamber ventricular pacemakers. Throughout the world, surgeons have been using dual chambered permanent pacemakers with successful follow ups. However, Pakistan has not yet taken the advantage of such pacemaker devices till now. We report three cases that underwent a dual chamber permanent pacemaker implantation for the first time in children less than 8 kg with successful follow ups.

Transjugular Intrahepatic Portosystemic Shunt (Tips); Review Of Initial Experience At Aga Khan University Hospital, Rana Shoaib Hamid, Tanveer-Ul-Haq, Muhammad Azeemuddin, Zafar Sajjad, Ishtiaq Chishti, Basit Salam

Department of Radiology

OBJECTIVE: To retrospectively assess the therapeutic effectiveness and safety of transjugular intrahepafic portosystemic shunt (TIPS) in patients with portal hypertension related complications.

METHODS: Over a period of 7.5 years 19 patients (10 males and 9 females, age range 25-69 years) were referred for TIPS at our radiology department. Thirteen patients suffered from liver cirrhosis while 6 had Budd Chiari syndrome. All patients were evaluated with colour doppler ultrasonography and cross sectional imaging. Shunt procedures were performed under sedation or general anaesthesia through internal jugular approach. Metallic self expandable uncovered stents were placed in 15 patients and covered stent in 1 …

Goldston Syndrome, Zainab Hussain, Imrana Masroor, Qurrat-Ul-Ain Haider, Tariq Alam

Department of Radiology

Goldston syndrome is a rare entity describing the association of polycystic kidneys and Dandy Walker malformation with or without hepatic fibrosis. A 28 years old pregnant woman came to radiology department for the first antenatal scan. Ultrasound showed a single fetus corresponding to 27 week of gestation. The fetal brain revealed deficient vermis with a posterior fossa cyst communicating with the 4th ventricle suggestive of Dandy-Walker malformation (DWM). The kidneys were enlarged, and echogenic containing small cysts with associated amniotic fluid index of 5 cm suggestive of Oligohydramnios. A diagnosis of Goldston syndrome was suggested. These findings were confirmed on …

Primary Hyperparathyrodism In Pregnancy And Review Of Literature, Tahira Naru, Rozilla Sadia Khan, Mohammed Ataullah Khan

Department of Obstetrics & Gynaecology

hyperparathyroidism (PHPT) is rare condition during pregnancy; however, it can carry significant risks to both mother and foetus during and after the pregnancy. The definitive treatment is parathyroidectomy undertaken preferably in the second or early third trimester. A case of asymptomatic PHPT diagnosed and treated by parathyroidectomy in the third trimester is described.

An In Vitro Evaluation Of Microleakage In Class V Preparations Restored With Hybrid Versus Silorane Composites., Fahad Umer, Farah Naz Farid, Farhan Raza Khan

Section of Dental-Oral Maxillofacial Surgery

Aim: To compare the difference in microleakage values using conventional and new low-shrink Silorane composites using the dye penetration method. Background: With improvement in adhesive technology, problems associated with composites have been largely overcome. However, microleakage due to polymerization shrinkage still remains a challenge. New Silorane-based composites are alleged to have less than 1% polymerization shrinkage, which would potentially decrease the microleakage, and hence, resolve this longstanding issue. Materials And Methods: The teeth were randomly divided into three groups (A,B, and C). Group A was restored with conventional composite (Valux() Plus), with a total-etch protocol, Group B was restored with …

Gradenigo's Syndrome: Surgical Management In A Child, Hassan Nabeel Humayun, Shabbir Akhtar, Shakeel Ahmed

Section of General Surgery

Otits media is a common problem. Some of its complications that were seen frequently in the preantibiotic era are rare today. We report a case of an 8 year boy who presented with earache, retro-orbital pain and diplopia secondary to a sixth nerve palsy--Gradenigo's syndrome. In this syndrome infection from the middle ear spreads medially to the petrous apex of the temporal bone. Work-up includes CT scan of the temporal bones. Timely management with intravenous antibiotics (+ surgery) is needed to prevent intra-cranial complications.

Sunitinib Plus Paclitaxel Versus Bevacizumab Plus Paclitaxel For First-Line Treatment Of Patients With Advanced Breast Cancer: A Phase Iii, Randomized, Open-Label Trial, Nicholas Robert, Mansoor Saleh, Devchand Paul, Daniele Generali, Laurent Gressot, Mehmet Copur, Adam Brufsky, Susan Minton, Jeffrey Giguere, John W. Smith Ii

Haematology and Oncology, East Africa

Introduction: A multicenter, open-label phase III study was conducted to test whether sunitinib plus paclitaxel prolongs progression-free survival (PFS) compared with bevacizumab plus paclitaxel as first-line treatment for patients with HER2− advanced breast cancer.

Patients and Methods: Patients with HER2− advanced breast cancer who were disease free for ≥ 12 months after adjuvant taxane treatment were randomized (1:1; planned enrollment 740 patients) to receive intravenous (I.V.) paclitaxel 90 mg/m2 every week for 3 weeks in 4-week cycles plus either sunitinib 25 to 37.5 mg every day or bevacizumab 10 mg/kg I.V. every 2 weeks.

Results: The trial was terminated early …

Risk Factors Associated With Helicobacter Pylori Infection Treatment Failure In A High Prevalence Area., Javed Yakoob, Wasim Jafri, Z Abbas, Shahab Abid, S Naz, Khan R, A. B. Khalid

Section of Gastroenterology

Triple therapy is commonly used for the treatment of Helicobacter pylori infection. We determined risk factors associated with its failure in compliant patients focusing on H. pylori density, virulence marker and 23S ribosomal RNA (rRNA) point mutations associated with clarithromycin resistance. H. pylori infection was diagnosed by 14C urea breath test (14C UBT) and rapid urease test or histology. Triple therapy with esomeprazole 20 mg b.i.d., amoxicillin 1 g b.i.d. and clarithromycin 500 mg b.i.d. was prescribed for 10 days. 14C UBT was repeated 4 weeks after treatment. In total, 111 patients [69 (62%) males] with a mean age of …

Characteristics Of An Adult Photosensitive Cohort, Mubashira Hashmi, Mazhar Mobin, Khurram A Siddiqui

Section of Neurology

Intermittent Photic Stimulation (IPS) is a well recognized provocation maneuver during EEG recording which helps in identifying underlying photosensitivity. The frequency and characteristics of various responses to photosensitivity among our adult patients was determine. EEGs of subjects > or =15 years from 2003-2006, were reviewed. Two main photosensitive responses were observed: Photoparoxysmal (PPR) and Photic-driving response (PDR). Demographic and clinical data was also collected. Out of 5950 EEG's performed, response to IPS were detected in 1.2% (n=73) of EEGs. Out of which 49 (67%) had PDR and 24 (33%) had PPR. Mean age of PPR group was 25.7 +/- 12 years …

Helicobacter Pylori: Association With Gall Bladder Disorders In Pakistan, Javed Yakoob, M. R. Khan, Z. Abbas, W. Jafri, R. Azmi, Z. Ahmad, S. Naeem, L. Lubbad

Department of Medicine

Helicobacter species colonise the biliary tract and therefore this study explores the relationship between of Helicobacter pylori and cholecystitis. Bile and gall bladder tissue samples were obtained from 144 Patients who underwent cholecystectomy. Of these, 89 had chronic cholecystitis with cholelithiasis, 44 had gall bladder carcinoma and 11 had gall bladder polyps. Histopathology examination included special staining and immunohistochemistry (IHC), while Helicobacter species (H. pylori, H. bilis and H. hepaticus) were detected by the polymerase chain reaction (PCR). Sequencing and BLAST query of PCR products was undertaken and samples were considered to contain H. pylori if both PCR and IHC …

Can We Stop The Stroke Epidemic In Pakistan?, Ismail A. Khatri, Mohammad Wasay

Department of Medicine

No abstract provided.