Medicine and Health Sciences Commons^™

Parental Control And Monitoring Of Young People's Sexual Behaviour In Rural North-Western Tanzania: Implications For Sexual And Reproductive Health Interventions, Joyce Wamoyi, Angela Fenwick, Mark Urassa, Basia Zaba, William Stones

Obstetrics and Gynaecology, East Africa

Background

Parenting through control and monitoring has been found to have an effect on young people's sexual behaviour. There is a dearth of literature from sub-Saharan Africa on this subject. This paper examines parental control and monitoring and the implications of this on young people's sexual decision making in a rural setting in North-Western Tanzania.

Methods

This study employed an ethnographic research design. Data collection involved 17 focus group discussions and 46 in-depth interviews conducted with young people aged 14-24 years and parents/carers of young people within this age-group. Thematic analysis was conducted with the aid of NVIVO 7 software. …

Association Of Depression With Treatment Outcomes In Type 2 Diabetes Mellitus: A Cross-Sectional Study From Karachi, Pakistan, Saman I. Zuberi, Ehsan U. Syed, Junaid A. Bhatti

Section of Diabetes, Endocrinology and Metabolism

Background: To assess the associations of depression with glycemic control and compliance to self-care activities in adult Patients with Type 2 Diabetes Mellitus. Methods: This cross-sectional study was conducted at a tertiary-care hospital in Karachi (Aga Khan University Hospital). Equal numbers of depressed and non-depressed Patients were consecutively recruited from the diabetic clinic. Information on demographic and clinical characteristics was collected in face-to-face interviews and from medical records. Hospital Anxiety Depression Scale (HADS) was used to measure depression. Associations of depressed status (HADS >= 8) with poor glycemic control (Hemoglobin A1c level >= 7%) and compliance to self-care activities were …

Intradiploic Epidermoid Cyst Overlying The Torcula: A Surgical Challenge, Amad Naseer Khan, Salema Khalid, Ather Enam

Medical College Documents

Intradiploic tumours are rare, slow growing tumours that can present in many different ways, including a painless lump, tenderness, headache and rarely with focal neurological signs. The authors present the case of a gentleman in whom the tumour presented in an unusual location and presented a surgical challenge. The major take home message from this case report is that an epidermoid cyst overlying the torcula is to be approached with great caution and care and is without doubt a surgical challenge.

Prevalence Of Head Lice And Hygiene Practices Among Women Over Twelve Years Of Age In Sindh, Balochistan, And North West Frontier Province: National Health Survey Of Pakistan, 1990-1994., Sadia Mahmud, Gregory Pappas, Wilbur C Hadden

Community Health Sciences

Background: Head lice infestation is an infection of the scalp and skin which causes blood loss, discomfort, and social and psychological distress with the possibility of secondary bacterial infections occurring at scratch sites. In Pakistan, although some small scale studies have been conducted to investigate prevalence of head lice in school children and the general population, no population based estimates have been reported. The National Health Survey of Pakistan (NHSP 1990 - 94) was a nationally representative health examination survey of the Pakistani population. The NHSP is the first population based household survey to collect data on the prevalence of …

Palinopsia From A Posteriorly Placed Glioma - An Insight Into Its Possible Causes, Amad Naseer Khan, Rakesh Sharma, Salema Khalid, David Mckean, Richard Armstrong, Christopher Kennard

Section of Neurology

Palinopsia is a distortion of processing in the visual system in which images persist or recur after the visual stimulus has been removed. It is a dysfunction of the association areas at the junction of temporal, occipital and parietal lobes and can be triggered by any lesion or dysfunction in this region. Here, the authors report the case of a Patient with a glioma involving this region of the brain, who presented with palinopsia that subsequently disappeared once the tumour was surgically debulked. In the few cases of palinopsia that have been published so far, no such case has ever …

An Analysis Of The Clinical Practice Of Emergency Medicine In Public Emergency Centres In Kenya, Benjamin W. Wachira

Master of Medicine in Internal Medicine

Objectives: To describe the case mix, interventions, procedures and management of patients in public accident and emergency departments (A&Es) in Kenya. Methods: This was an observational study of patients who presented to 15 A&Es from 1 October to 31 December 2010. The study was conducted across Kenya in two national referral hospitals, five secondary level hospitals, and eight primary level hospitals. All patients presenting alive to the A&E during the 24 hour study period that were seen by a doctor or clinical officer were included in the study. A data collection form was completed by the primary investigator at the …

Carotid Cavernous Fistula In A Patient With Coronary Artery Disease, Omer Ashraf, Syed Shahabuddin, Muhammad Ehsan Bari, Hasanat Sharif

Section of Cardiology

Carotid cavernous fistulas are abnormal communications between the carotid and cavernous vasculature, with potential for serious neurological and ocular sequelae. There is considerable literature on the neuro-radiological management of carotico-cavernous fistula depending upon their flow status. The coronary artery bypass grafting (CABG) for coronary artery disease (CAD) is a well established method of revascularization. However, the association of carotid cavernous fistula in presence of CAD is an infrequent occurrence. We present a case of coronary artery disease scheduled for bypass surgery, developed spontaneous bilateral carotid cavernous fistulas, highlighting a unique aspect of association between coronary and carotid disease.

Causes Of Smoking In Pakistan: An Analysis Of Social Factors, Sobia Nizami, Zain A Sobani, Emmon Raza, Noor-Ul-Ain Baloch, Javaid Khan

Section of Pulmonary & Critical Care

OBJECTIVE: To determine the factors contributing to the initiation and propagation of smoking in visitors to a major tertiary health center in Karachi, Pakistan.

METHODS: Seven major contributing factors to the initiation and propagation of smoking were presented to consenting study participants (n=170) in a questionnaire. Participants were then requested to use their experience and opinion to rate each of the given factors on a scale of 1 to 5 regarding its importance as a causative factor in the initiation and propagation of smoking. Results were analyzed using SPSSv16.0.

RESULTS: Preliminary analysis revealed occupational stress relief as the most important …

Involvement Of Medical Students And Fresh Medical Graduates Of Karachi, Pakistan In Research, Kiran Ejaz, Muhammad Shahid Shamim, Muhammad Shahzad Shamim, Syed Abid Hussain

Department of Emergency Medicine

OBJECTIVE: To study the involvement in research, of final year medical students and fresh graduates of Karachi, Pakistan and to identify the factors influencing their interest in medical research.

METHODS: A cross-sectional, questionnaire based study was conducted in 2007-2008. Five institutes representing the private and public hospitals in the city were selected by cluster sampling. Final year medical students and fresh graduates were included. Descriptive statistics were charted using SPSS v.16 after double data entry.

RESULTS: Out of 378, 186 (49%) participants had journal reading habits due to the requirement of their institution. Mostly, 157 (41%) undergraduates had already participated …

Cardiac Electrophysiology Studies And Ablations For Treatment Of Supraventricular Arrhythmias--An Initial Experience From Karachi, Azam Shafquat, Aamer Imdad, Salman Khalid, Syed Zahid Jamal

Section of Cardiology

OBJECTIVES: To review the clinical experience, complications and outcome of Cardiac Electrophysiology Studies and Catheter Radiofrequency Ablation in treatment of supraventricular tachycardias in Karachi.

METHODS: A retrospective review of records of all patients who underwent an electrophysiological study and radiofrequency ablation at National Institute of Cardiovascular Diseases and Aga Khan University Hospital from 2005 to 2007 was performed. Patient's demographics, disease and procedural data were collected and analyzed using SPSS.V.II.

RESULTS: We enrolled 168 patients, 150 (89%) from National Institute of Cardiovascular Diseases and 18 (11%) from Aga Khan University Hospital. Sample had 86 (51%) male participants. The mean age …

Pathogenesis, Diagnosis And Management Of Primary Melanoma Of The Colon, Umair Khalid, Taimur Saleem, Ayesha Mallick Imam, Muhammad Rizwan Khan

Department of Surgery Docs

Background:Melanomas within the alimentary tract are usually metastatic in origin. On the other hand, primary melanomas of the gastrointestinal tract are relatively uncommon. There are several published reports of melanomas occurring in the esophagus, stomach, small bowel, and anorectum. The occurrence of primary melanoma of the colon has, however, only been rarely reported. The optimum modus operandi for the management of primary colonic melanoma remains nebulous due to the limited number of reports in literature.

Methods:

A comprehensive search of Medline, Cochrane and Highwire was performed using the following keywords: 'melanoma', 'malignant melanoma', 'primary melanoma', 'colon', 'gastrointestinal tract', 'alimentary …

Size Or The Number Of Portal Tracts: Which Matters In A Liver Biopsy Core In Chronic Hepatitis C?, Om Parkash, Khalid Mumtaz, Zubair Ahmed, Saeed Hamid, Fatima Jafri, Wasim Jafri

Section of Gastroenterology

Liver biopsy has an important role in staging of fibrosis (SoF) and grading of inflammation (GoI) in chronic hepatitis C (CHC) patients. The effect of size and number of portal tracts (NoP) on grading and staging of liver biopsy was evaluated. A total of 150 consecutive liver biopsy core (LBC) of patients with CHC were obtained. There were 98 (65.3%) males. Mean length of LBC was 1.45 ± 0.48 cm. Mean number of portal tracts (NoP) was 11±4.6. Mean length of LBC was greater (1.60±0.45 cm) in stage 4 (n=41; 27.3%) and lesser (1.28+0.39) in stage 1 (n=23; 15%, p=0.04). …

Detection Of Ndm-1-Producing Klebsiella Pneumoniae In Kenya., Laurent Poirel, Gunturu Revathi, Sandrine Bernabeu, Patrice Nordmann

Pathology, East Africa

Seven carbapenem-resistant NDM-1-positive Klebsiella pneumoniae isolates were recovered from patients hospitalized between 2007 and 2009 in different wards at a referral and tertiary care center in Nairobi. Most of the isolates were obtained from urine. All isolates carried the bla_NDM-1 carbapenemase gene previously reported from India, Pakistan, and the United Kingdom. These isolates were clonally related and expressed many other resistance determinants, including β-lactamases CTX-M-15, OXA-1, OXA-9, CMY-6, and aminoglycoside resistance methylase RmtC. This work corresponds to the first report of NDM-1 producers in Africa.

What Are The Therapeutic Options For Strokes Secondary To Intracranial Large Artery Stenosis?, Maria Khan, Ayeesha Kamran Kamal

Section of Neurology

No abstract provided.

Primary Amebic Meningoencephalitis Caused By Naegleria Fowleri, Karachi, Pakistan., Sadia Shakoor, Mohammad Asim Beg,, Syed Faisal Mahmood, Rebecca Bandea, Rama Sriram, Fatima Noman, Farheen Ali,, Govinda S. Visvesvara, Afia Zafar

Department of Medicine

We report 13 cases of Naegleria fowleri primary amebic meningoencephalitis in persons in Karachi, Pakistan, who had no history of aquatic activities. Infection likely occurred through ablution with tap water. An increase in primary amebic meningoencephalitis cases may be attributed to rising temperatures, reduced levels of chlorine in potable water, or deteriorating water distribution systems.

What Are The Therapeutic Options For Strokes Secondary To Intracranial Large Artery Stenosis?, Maria Khan, Ayeesha Kamran Kamal

Department of Medicine

No abstract provided.

Safety Of Insulin Tolerance Test For The Assessment Of Growth Hormone Deficiency In Children, Saira Waqar Lone, Yasir Naqi Khan, Farah Qamar, Irum Atta, Mohsina Noor Ibrahim, Jamal Raza

Department of Paediatrics and Child Health

OBJECTIVE: To determine the safety of insulin tolerance test (ITT) for assessing growth hormone (GH) deficiency in children.

METHODS: This hospital based study was conducted at the National Institute of Child Health, Karachi from 1st November 2008 till 30th October 2009. All children suspected of growth hormone deficiency, were included after excluding all other causes of short stature. Verbal informed consent was taken from the parents. Children less than 2 years of age, weighing less than 10 kg, untreated/inadequately treated hypothyroidism or Addison's disease, epilepsy, having history of hypoglycaemic fits or cardiac disease were excluded. All children were subjected to …

Continuous Ambulatory Peritoneal Dialysis (Capd) Associated Peritonitis In A Child: A Rare Case Of Peritonitis Caused By Sphingomonous Paucimobilis, Arwa Quresh Tambawala, Sadaf Hamid, Iqtidar Khan, Asad Ali

Department of Paediatrics and Child Health

First identified in 1977, Sphingomonous Paucimobilis has emerged as an opportunistic human pathogen. It is primarily known to cause a range of mostly nosocomial, non-life-threatening infections that typically are easily treated by antibiotic therapy. Sources of its isolation linked to clinical disease include blood, spinal fluid and leg ulcers. It has also been reported as a rare cause of peritonitis in patients on continuous ambulatory peritoneal dialysis. We present a case of a child with peritonitis due to this organism. Clinical features, bacteriology and treatment option and response have been discussed.

Prevalence Of Resistance Associated Polymorphisms In Plasmodium Falciparum Field Isolates From Southern Pakistan, Najia Karim Ghanchi, Johan Ursing, Mohammad A. Beg, Maria I. Veiga, Sana Jafri, Andreas Martensson

Department of Pathology and Laboratory Medicine

Background:Scarce data are available on Plasmodium falciparum anti-malarial drug resistance in Pakistan. The aim of this study was, therefore, to determine the prevalence of P. falciparum resistance associated polymorphisms in field isolates from southern Pakistan.
Methods:
Blood samples from 244 Patients with blood-slide confirmed P. falciparum mono-infections were collected between 2005-2007. Single nucleotide polymorphisms in the P. falciparum chloroquine resistance transporter (pfcrt K76T), multi drug resistance (pfmdr1 N86Y), dihydrofolate reductase (pfdhfr A16V, N51I, C59R, S108N, I164L) and dihydropteroate synthetase (pfdhps A436S, G437A and E540K) genes and pfmdr1 gene copy numbers were determined using PCR based methods.
Results:The prevalence …

Participating In A Community Of Learners Enhances Resident Perceptions Of Learning In An E-Mentoring Program: Proof Of Concept, Timona Obura, William. E. Brant, Fiona Miller, I. J. Parboosingh

Obstetrics and Gynaecology, East Africa

Background

Community learning and e-mentoring, learning methods used in higher education, are not used to any extent in residency education. Yet both have the potential to enhance resident learning and, in the case of community learning, introduce residents to basic lifelong learning skills. We set out to determine whether residents participating in an Internet based e-mentoring program would, with appropriate facilitation, form a community of learners (CoL) and hold regular community meetings. We also determined resident and faculty perceptions of CoL and Internet sessions as effective learning experiences.

Methods

A six-month e-mentoring pilot was offered to 10 Radiology residents in …

Incidence And Impact Of Baseline Electrolyte Abnormalities In Patients Admitted With Chemotherapy Induced Febrile Neutropenia., Asim Jamal Shaikh, Samira Ahmed Bawany, Nehal Masood, Ausaf Ahmed Khan, Ahmed Nadeem Abbasi, Syed Najeeb Niamutullah, Adnan Zaidi, Salman Adil, Shiyam Kumar

Section of Haematology/Oncology

Background: Febrile neutropenia (FN) and myelosupression remain a challenging oncologic medical emergency and dose limiting toxicity associated with chemotherapy for cancers. Various factors are known to affect the outcomes for Patients diagnosed with FN. Electrolyte abnormalities have commonly been observed, but the real incidence and their impact has been only scarcely studied in literature. Methods: This was a prospective, observational study. A total of two hundred and fifteen (215) Patients admitted between January 2007 and August 2008 were included. Analysis of data was made using SPSS version16.0. Toxicity profile was graded according to CTC version 3.0. Results: Almost equal number …

Cilostazol Versus Aspirin For Secondary Prevention Of Vascular Events After Stroke Of Arterial Origin, Ayeesha Kamran Kamal, Imama Naqvi, Muhammad R Husain, Bhojo A Khealani

Section of Neurology

Background:Aspirin is widely used for secondary prevention after stroke. Cilostazol has shown promise as an alternative to aspirin in Asian people with stroke. ObjectiveS: To determine the relative effectiveness and safety of cilostazol compared directly with aspirin in the prevention of stroke and other serious vascular events in Patients at high vascular risk for subsequent stroke, those with previous transient ischaemic attack (TIA) or ischaemic stroke of arterial origin. SEARCH STRATEGY: We searched the Cochrane Stroke Group Trials Register (last searched September 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2009, Issue 4), MEDLINE (1950 …

Complementary Feeding: A Global Network Cluster Randomized Controlled Trial, Nancy F. Krebs, K. Michael Hambidge, Manolo Mazariegos, Jamie Westcott, Norman Goco, Linda L. Wright, Marion Koso-Thomas, Antoinette Tshefu, Carl Bose, Omrana Pasha, Robert Goldenberg, Elwyn Chomba, Waldemar Carlo, Mark Kindem, Abhik Das, Ty Hartwell, Elizabeth Mcclure

Community Health Sciences

Background: Inadequate and inappropriate complementary feeding are major factors contributing to excess morbidity and mortality in young children in low resource settings. Animal source foods in particular are cited as essential to achieve micronutrient requirements. The efficacy of the recommendation for regular meat consumption, however, has not been systematically evaluated. Methods/Design: A cluster randomized efficacy trial was designed to test the hypothesis that 12 months of daily intake of beef added as a complementary food would result in greater linear growth velocity than a micronutrient fortified equi-caloric rice-soy cereal supplement. The study is being conducted in 4 sites of the …

Osteochondral Grafting Of Knee Joint Using Mosaicplasty, Muhammad Abdul Wajid, Muhammad Idrees Shah, Mohsin E. Azam, Tashfeen Ahmad

Section of Orthopaedic Surgery

Focal cartilage defects of articular surface-traumatic and degenerative are difficult to treat, thus a variety of surgical techniques have been developed and reported for treatment of such defects. Procedures such as Priddies perforations, microfracture, abrasion chondroplasty have shown long-term results which are often less than adequate. One of the reasons is that all these techniques lead to the formation of fibrocartilage which has inferior mechanical properties as compared to the native hyaline cartilage. Mosaicplasty is a procedure which aims at replacing the lost articular cartilage with hyaline cartilage including underlying bone support, thus providing adequate stability to the cartilage and …

Arthroscopic Repair Of Meniscal Tears With Inside-Out Technique, Hasnain Raza, Kashif Abbas, Masood Umer

Section of Orthopaedic Surgery

Objective: To review the clinical results of arthroscopic meniscal repair and to identify factors that may affect the outcome.
Methods: A total of 15 arthroscopic meniscal repairs with inside-out in 14 patients over a 7-year period were evaluated retrospectively. The mean age was 41.2 +/- 11.5 years with a range of 26-64 years. Eleven patients underwent repair for medial meniscal tear, two patients for lateral meniscus and one patient for both in the same knee. All patients were functionally evaluated by Lysholm functional knee scores over an average follow-up of 1 year and 5 months (range: 0.5-7 years).
Results: The …

Thoracolumbar Tuberculosis: Implications For Appropriate Management Based On Disease Location And Proposal Of A Novel Scoring System, Shahryar Noordin, Salim Allana, Tashfeen Ahmad, Zafar Sajjad, Khabir Ahmad, Ather Enam, Riaz Hussain Lakdawala

Section of Orthopaedic Surgery

Objective: To identify factors indicating disease severity in patients with thoracolumbar tuberculosis requiring surgical intervention.
Design: Medical charts of patients who underwent surgery for thoracic and lumbar spinal tuberculosis from 1990-2005 were reviewed. Patients with different levels of disease were compared in terms of neurological deficits, duration of symptoms, previous antituberculous therapy, nutritional status and associated co-morbids.
Results: Ninety-three patients aged 7-77 years (mean age 40 years) were included. Thoracic spine was involved in 80% of operated patients, and lumbar spine in 20%. Severe neurological impairment (Frankel A to C) was present in 68% of patients with thoracic disease, as …

Abdominal Angina: A Rare Cause Of Chronic Abdominal Pain, Ziaur Rehman, Abdul Rehman Alvi, Ziad Sophie

Section of General Surgery

We report here a case of chronic postprandial abdominal pain and weight loss of more than one year duration. He was diagnosed to have abdominal angina (chronic mesenteric ischemia) on CT angiography. Open surgical revascularization procedure-right common iliac mesenteric polytetrafluoroethylene (PTFE) bypass graft achieved positive short and longterm outcome with follow-up of twenty two months.

Differentiating Asthma From Its Mimics, Zeeshan Waheed, Muhammad Irfan, Mohammad Salih, Ali Bin Sarwar Zubairi

Section of Pulmonary & Critical Care

All that wheezes is not asthma this adage accredited to Chevalier Jackson emphasizes the importance of differentiating asthma from its mimics, particularly if the patient is not responding to usual therapy. The above statement also warrants further diagnostic evaluation and management of non-asthma conditions that mimic asthma. We present here a case of a middle aged female who presented with severe bronchospasm, initially labeled as asthma but was resistant to usual anti-asthma therapy. After further workup she was eventually diagnosed to have esophageal achalasia.

Disability, Depression And Disc Surgery: Lets Be Careful With The Evidence, Muhammad Shahzad Shamim

Section of Neurosurgery

No abstract provided.

Nurses' Knowledge Of Evidence-Based Guidelines For Prevention Of Ventilator-Associated Pneumonia In Critical Care Areas: A Pre And Post Test Design, Sm Meherali, Y Parpio, Tazeen S. Ali, F Javed

School of Nursing & Midwifery

Background: Ventilator associated pneumonia (VAP) is a common hospital acquired pneumonia inventilated patients. VAP is associated with increasedmorbidity, mortality duration of hospitalization and cost of treatment. Critical care nurses are usually unaware of evidence based preventiveguidelines for VAP, resulting in negative impact on all aspects of patient care. This studyinvestigated the impact of a 5-hour teaching moduleon nurses’ knowledge to practice evidence based guidelines for the prevention of VAP.
Methods: This study was conducted at a private tertiary care teaching hospital in Karachi, Pakistan. Single group pre-test post-test design was used. Fortynurses were included in the study. The knowledge of …