Medicine and Health Sciences Commons^™

The Use Of Video Role Play For Teaching Therapeutic Communication Skills, Hong- Gu He, Sandra Mackey, Anthony O'Brien, Elaine Ng, David Arthur

School of Nursing & Midwifery

No abstract provided.

Phasing Out The General Nursing Diploma Programme At Aga Khan University School Of Nursing Karachi, Pakistan, Salma Amin Rattani, Laila Akbar Ali, Shireen Salim Velji, Amina Malik

School of Nursing & Midwifery

Aga Khan University was established as medical complex in 1980 and in 1983 received charter as first private university in Pakistan. Thus nursing education moved under the umbrella of a university which allowed starting under graduate and graduate degree education and in light of global trends in nursing profession and staffing and financial impact of nursing education, 2010 was the last intake of university's founding programme; general nursing diploma. Concerns; male vs female nurses and taking nursing education as an easy route to enter in higher education resulting in unattained staffing require deliberations by stake holder including Pakistan Nursing Council.

Albumin Precursorandhsp70modulatecornealwoundhealinginanorgan Culturemodel, Anwar Ali Siddiqui Aga Khan University, Shamim Mushtaq Shamim Mushtaq, Zulfiqaralinaqvi Zulfiqaralinaqvi, Nikhatahmed Nikhatahmed

Department of Biological & Biomedical Sciences

In order to investigate the role of albumin precursor and Hsp70 in corneal wound healing, we have analyzed the distribution of these proteins in wounded and non-wounded corneas of rabbits and the effects of topical applications of anti-albumin precursor and anti-Hsp70 antibodies on wound healing. Anti-albumin precursor and anti-Hsp70 antibodies were topically applied in healing corneal epithelium of rabbit eyes in organ culture. Corneas were allowed to heal in vitro for up to 120 h in serum-free medium with 5 and 10 μg/ml or without (migrating control) anti-albumin precursor/ or anti-Hsp70 antibodies. Fibronectin (Fb) (5 μg/ml) was used as a …

Antispasmodic And Ca++ Antagonist Potential Of Marrubiin, A Labdane Type Diterpene From Phlomis Bracteosa, Javid Hussain, Riaz Ullah, Arif-Ullah Khan, Fazal Mabood, Mohammad Raza Shah, Ahmed Al-Harrasi, Anwar Gilani

Department of Biological & Biomedical Sciences

A tricyclic labdane type diterpene was isolated for the first time from ethyl acetate soluble part of Phlomis bracteosa. Its structure was confirmed by x-ray which was found to be marrubiin. When studied in isolated rabbit jejunum, marrubiin caused concentration-dependent relaxation of spontaneous and high K+ (80 mM)-induced contractions, like that caused by verapamil, indicating that marrubiin exhibits spasmolytic activity, possibly mediated through Ca++ channel blocking action.

Requirement Of Argininosuccinate Lyase For Systemic Nitric Oxide Production, Ayelet Erez, Sandesh Cs. Nagamani, Oleg A. Shchelochkov, Muralidhar H. Premkumar, Philippe M. Campeau Campeau, Yuqing Chen, Harsha K. Garg, Li Li, Asad Mian, Terry K. Bertin, Jennifer O. Black, Heng Zeng, Yaoping Tang, Anilkumar K. Reddy, Marshall Summar, William E. O’Brien, David G. Harrison, William E. Mitch, Juan C. Marini, Judy L. Aschner, Nathan S. Bryan, Brendan Lee

Department of Emergency Medicine

Nitric oxide (NO) is crucial in diverse physiological and pathological processes. We show that a hypomorphic mouse model of argininosuccinate lyase (encoded by Asl) deficiency has a distinct phenotype of multiorgan dysfunction and NO deficiency. Loss of Asl in both humans and mice leads to reduced NO synthesis, owing to both decreased endogenous arginine synthesis and an impaired ability to use extracellular arginine for NO production. Administration of nitrite, which can be converted into NO in vivo, rescued the manifestations of NO deficiency in hypomorphic Asl mice, and a nitric oxide synthase (NOS)-independent NO donor restored NO-dependent vascular reactivity in …

Redo Coronary Artery Surgery; Early And Intermediate Outcomes From A Tertiary Care Hospital In A Developing Country, Syed Shahabuddin, Junaid Alam Ansari, Fahad Jawaid Siddiqui, Muneer Amanullah, Shahid Ahmed Sami

Section of Cardiothoracic Surgery

OBJECTIVE: To evaluate outcomes of re-operative coronary artery surgery in a tertiary care hospital in a developing country.

METHOD: Preoperative, intra-operative and postoperative variables were analyzed in 82 consecutive patients who underwent re-operative coronary surgery on cardiopulmonary bypass.

RESULTS: The mean age was 63.3 +/- 7.7 years, 91.2% were male and 9.8% female. Coronary artery disease risk factors were present in more than 50% of the patients. History of preoperative myocardial infarction was positive in 56% patients. There was strong clinical and angiographic indication for surgery with unstable angina in 50% patients and > 80% had multivessel disease. Only 5% patients …

Continuing Medical Education And Pharmaceutical Industry, Farhan Saeed Vakani, Wasim Jafri, Almas Amin, Mughis Sheerani

Department of Continuing Professional Education

Continuing medical education providers' (academia) and industrial relationship is drawing attention all over the world. To date, there are no national commercial support guidelines available in Pakistan to properly regulate cooperation between the two distinct entities. However, the fact is that the future of all continuing medical education depends on pharmaceutical support and the providers are heavily dependent on the pharmaceutical industry to remain in action. It should always be remembered that medical education and profession is regarded as a moral of enterprise based on a blind faith between the physician and the patient. The funding support by the industry …

A Ten-Year Review Of Neonatal Bloodstream Infections In A Tertiary Private Hospital In Kenya, Ruchika Kohli-Kochhar, Geoffrey Omuse, Gunturu Revathi

Pathology, East Africa

Introduction: Neonatal mortality in developing countries is usually due to an infectious cause. The gold standard of investigation in developing countries is a positive blood culture. It is important to know the aetiology of neonatal bloodstream infections so that empiric treatment can be effective.

Methodology: We conducted a retrospective clinical audit over ten years between January 2000 until December 2009, looking at the aetiology of both early and late onset neonatal sepsis. We analysed data from 152 (23%) patient isolates out of 662 suspected cases of neonatal sepsis.

Results: Our study revealed that Gram-positive organisms were the predominant cause of …

Malaria Rapid Testing By Community Health Workers Is Effective And Safe For Targeting Malaria Treatment: Randomised Cross-Over Trial In Tanzania, M. Mubi, A. Janson, M. Warsame, A. Martensson, K. Kallander, M.G. Petzold, B. Ngasala, G. Maganga, L.L. Gustafsson, A. Massele, G. Tomson, Zul Premji, A. Bjorkman

Pathology, East Africa

Background: Early diagnosis and prompt, effective treatment of uncomplicated malaria is critical to prevent severe disease, death and malaria transmission. We assessed the impact of rapid malaria diagnostic tests (RDTs) by community health workers (CHWs) on provision of artemisinin-based combination therapy (ACT) and health outcome in fever patients.

Methodology/Principal Findings: Twenty-two CHWs from five villages in Kibaha District, a high-malaria transmission area in Coast Region, Tanzania, were trained to manage uncomplicated malaria using RDT aided diagnosis or clinical diagnosis (CD) only. Each CHW was randomly assigned to use either RDT or CD the first week and thereafter alternating weekly. …

Pre-Referral Rectal Artesunate In Severe Malaria: Flawed Trial, K.F. Hirji, Zul Premji

Pathology, East Africa

Background:Immediate injectable treatment is essential for severe malaria. Otherwise, the afflicted risk lifelong impairment or death. In rural areas of Africa and Asia, appropriate care is often miles away. In 2009, Melba Gomes and her colleagues published the findings of a randomized, placebo-controlled trial of rectal artesunate for suspected severe malaria in such remote areas. Enrolling nearly 18,000 cases, the aim was to evaluate whether, as patients were in transit to a health facility, a pre-referral artesunate suppository blocked disease progression sufficiently to reduce these risks. The affirmative findings of this, the only trial on the issue thus far, …

Aggressive Embryonal Rhabdomyosarcoma Presenting As Schwanoma : A Case Report, Mohammad Sohail Awan, Montasir Junaid, Zain A. Sobani

Department of Radiology

Rhabdomyosarcomas (RMS) are thought to arise from pluripotent muscle cell precursors intended to form the bodyís future striated muscle. Due to the wide distribution of striated muscle across the body these tumors may appear anywhere and cause symptoms accordingly. Presenting symptoms are highly variable and based on the tumor size and location making clinical diagnosis difficult. The diagnosis of RMS is based on histological examination; however they express varying cytologic pictures representing the different stages of rhabdomyoblasts and their development into skeletal muscle presenting pictures from highly to poorly differentiated neoplasms. Therefore their histological diagnosis also requires the use of …

Setting Research Priorities To Reduce Almost One Million Deaths From Birth Asphyxia By 2015, Joy E. Lawn, Rajiv Bahl, Staffan Bergstrom, Zulfiqar Ahmed Bhutta, Gary L. Darmstadt, Matthew Ellis, Mike English, Jennifer J. Kurinczuk, Anne C. C. Lee, Mario Merialdi, Mohamed Mohamed, David Osrin, Robert Pattinson, Vinod Paul, Siddarth Ramji, Ola D. Saugstad, Lyn Sibley, Nalini Singhal, Steven N. Wall, Dave Woods, John Wyatt, Kit Yee Chan, Igor Rudan

Woman and Child Health

No abstract provided.

The State Of Emergency Care In The Republic Of Kenya, Benjamin Wachira, Ian Martin

Family Medicine, East Africa

Approximately 580,000 km2 in size, the Republic of Kenya is as big as Botswana but only half the size of countries like South Africa, Mali, and Angola. Kenya is comprised of eight provinces: Central, Coast, Eastern, Nairobi, North Eastern, Nyanza, Rift Valley, and Western. The 2009 census revealed a population of over 38 million people, with a population density of approximately 66 persons per square kilometre. Majority of the population (68%) lives in rural areas, as compared with the sub-Saharan African average of approximately 62%. With a gross domestic product (GDP) per capita of US $1,600 in 2010, Kenya is …

Oral Hygiene Kap Assessment And Dmft Scoring Among Children Aged 11-12 Years In An Urban School Of Karachi, Farhan Vakani, Nadia Basaria, Shahjahan Katpar

Department of Continuing Professional Education

Objective:To assess the oral hygiene knowledge, attitude and practices among school children and evaluate their DMFT (Decayed/Missing/Filled Teeth) scores.

Study Design:

Cross-sectional study.

Place and Duration of Study:

A private school of Karachi from March to April 2008.

Methodology:

Convenient sample comprising 300 students of grade 6 within the age group of 11-12 years was selected. A knowledge, attitude and practices survey questionnaire based on quantitative indicators was filled by the students. Clinical examination was done for DMFT. Data analysis was done by using SPSS version 11. Associations were assessed using chi-square test and a p-value of < 0.001 was considered significant.

Results:

There …

Fmic Annual Report 2011 | English, French Medical Institute For Mothers And Children

French Medical Institute for Mothers and Children (FMIC) Archives

No abstract provided.

Efficacy And Safety Of Quinine Loading Dose In Patients With Severe Falciparum Malaria At A Tertiary Care Hospital In Pakistan, M. Tariq, Taimur Saleem, Hamid Ullah, Vikram Mehraj, Abdul Jawwad Samdani, Syeda Hena Kazmi, Syed Imran Ayaz, Mehmood Riaz, Muhammad Junaid Patel, Mohammed Asim Beg

Section of Internal Medicine

OBJECTIVE: To compare the clinical outcomes of a loading dose regimen of quinine with a uniform dose regimen in patients with severe falciparum malaria.

METHODS: A retrospective chart review of 315 patients admitted with severe falciparum malaria and treated with quinine at a tertiary care teaching hospital of Karachi, Pakistan during 1999-2006 was conducted. Group A with 103 patients (32.7%) was given an initial loading dose of quinine while group B with 212 patients (67.3%) did not receive the loading dose. The two groups were compared in terms of reduction of parasite load, resolution of fever, recovery of consciousness and …

Suicide Bombing: A Geopolitical Perspective, Haider Naqvi, Syed Faraz Kazim, Shafqat Huma

Department of Psychiatry

Suicide bombing is a very complex phenomenon. It has been a focus of research in recent times. However inherent biases of researchers muddle the picture: researchers from western countries focus the issue around political liberty and notion of democracy, while those from Islamic countries tend to take the afterlife-reward notion as an incentive for suicide bombing. However in order to understand this complex phenomenon it is important to consider the contextual factors. In this review we have attempted to highlight various geopolitical factors which contribute to increased incidence of suicide bombing in South East Asia.

Survey Of “Northern” Child And Maternal Health Research Being Conducted In Canada, M. H. George, Robert Armstrong

Paediatrics and Child Health, East Africa

Objectives: The purpose of the study is to better understand the scope of research being conducted by Canadian paediatric and maternal health centres on the topic of maternal child health of northern populations. In addition, the results are intended to help assess the prospects for the creation of a research network dedicated to this topic.

Study design: Questionnaire study complemented with review of database.

Methods: Data were collected using a short questionnaire with qualitative and quantitative questions. Surveys were sent by email to members of two Canadian national paediatric groups, representing 17 organizations. Supplementary information was obtained through review of …

Anaesthetic Challenges In Emergency Surgical Repair Of Acute Aortic Dissection Rupturing Into The Pericardium In A Pregnant Patient, Mohammad Irfan Akhtar, Khalid Samad

Department of Anaesthesia

Acute aortic dissection in pregnancy is a serious situation, because rapid and appropriate surgical decision making is required to save the life of both mother and baby. Aortic dissection is rare in young women but is likely during pregnancy (third trimester) secondary to the hyperdynamic and hypervolaemic circulatory state associated with pregnancy. A 35 years old 27 weeks pregnant patient weighing 90 kg presented in the emergency with severe chest pain. In the immediate post cardiopulmonary bypass period, the patient started bleeding profusely from the anastamotic sites irrespective of utilization of all the conventional methods of haemostasis including multiple units …

Aortic Dissection Or Myocardial Infarction?, Saulat H. Fatimi, Maria Mahboob, Awais Ashfaq

Section of Cardiothoracic Surgery

Aortic dissection is a rare and a life threatening event. Classically, aortic dissection presents as sudden, severe chest, back or abdominal pain that is characterized as ripping or tearing in nature. However, a timely diagnosis can be elusive in the event of an atypical presentation. So, a high index of clinical suspicion is mandatory for the accurate and rapid diagnosis of aortic dissection .We report a case of a 56 years old male who presented with signs and symptoms of myocardial infarction and was later found to have aortic dissection. This patient was successfully managed with surgery.

Validation Of Updated Partin’S Table In Pakistani Patients Undergoing Radical Prostatectomy For Prostate Cancer, Nazim Muhammad, Farhat Abbas, Nuzhat Faruqui, Muhammad Islam, Zubair Ahmad

Section of Urology

Objectives: To establish the usefulness and validity of 2007 Partin’s table in our population with prostate cancer.
Materials and methods: Between January 1998 to June 2009, all patients with clinically localized carcinoma prostate who were treated with intent of radical retro-pubic prostatectomy (RRP) were included. Clinical, operative and pathological data was gathered. All biopsy and final histopathology Gleason scores were re-assigned in a double blind manner. Pre-operative serum PSA, TNM clinical stage and biopsy Gleason scores were plotted on Partin’s table and its predictive value and pathological findings of specimen were compared and analyzed by using Receiver operating characteristic …

The Lived Experience Of Discontinuing Hormonal Contraception Among Women In Rural Uganda, Joseph Mwizerwa, Locsin C. Rozzano

School of Nursing & Midwifery, East Africa

The purpose of the study was to describe the experience of discontinuing hormonal contraceptive use among women in rural Uganda. A significant number of women in Uganda discontinue hormonal contraception even though such method has been effective. Consequently, these women have unprotected sex, although not wanting to conceive. Narrative descriptions of the experiences by eight women were analyzed using content analysis. The findings describe the experience as Frustration and Helplessness, Living in Fear of Uncertainty, Ingenuity of using other methods of contraception, thus fostering the Accomplishments of being a wife, mother, and woman. Implications for nursing practice, research, and education …

Accuracy Of Computed Tomography In Diagnosing Malignancy In Solitary Pulmonary Lesions, Imaad-Ur-Rehman, Wasim Memon, Yousuf Husen, Waseem Akhtar, Raafay Sophie, Muhammad Akbar Baig

Department of Radiology

OBJECTIVE: To evaluate accuracy of Computed Tomography (CT) for diagnosing malignancy in solitary pulmonary lesions (SPLs).

METHODS: A prospective cross-sectional study was conducted from 20-01-2007 to 30-06-2008 at the Radiology department, Aga Khan University Hospital (AKUH) Karachi. Fifty-three patients with solitary pulmonary lesions (SPLs) seen in prior chest x-rays or chest CT scans were referred to radiology department for CT guided biopsy. CT scan was performed for each patient prior to biopsy and CT evaluation of the SPLs was performed followed by CT guided Biopsy. Histopathological diagnosis of the lesion was taken as the gold standard.

RESULTS: CT was found …

Course And Outcome Of Obstetric Patients Admitted To A University Hospital Intensive Care Unit, F. Githae, Vitalis Mung’Ayi, William Stones

Anaesthesiology, East Africa

Background: Obstetric Critical Care is an important service in the reduction of maternal morbidity and mortality, but few developing country data are available.

Objectives: To review all maternity patients admitted to the ICU over a seven year period to determine the causes and outcomes of these admissions and the frequency and causes of maternal morbidity and mortality.

Design: Retrospective patient file and ICU chart review.

Subjects: ICU Charts and medical files of obstetric patients admitted to the ICU at The Aga Khan University Hospital between (November 2003 – November 2010) were reviewed.

Setting: The ICU at The Aga Khan University …

Anthropometric Measurements As A Risk For Hypertensive Disorders In Pregnancy: A Hospital Based Study In South Asian Population, Ferha Saeed, Ahmed Jawad, Asma Azmat, Iqbal Azam Syed, Safdar Kagazwala

Department of Obstetrics & Gynaecology

Objectives: To determine the relationship between pregnancy induced hypertensive diseases and obesity.

Methods: A retrospective case controlled study was performed at Aga Khan University Hospital including records from July 2000 to June 2005. All women developing hypertension with or without proteinuria after 20 weeks of pregnancy (n = 218) were included. Categories of pregnancy induced hypertensive diseases (PIHD) were defined according to National high blood pressure working group and ACOG committee bulletin. Controls were selected randomly with a ratio of 1:1.7 between cases and controls.

Results: The estimated prevalence of pre-eclampsia in our institution is 1.9%. Earlier reports suggested mostly …

A Qualitative Study: Why Prolonged Stay In The Recovery Room?, Sharifa B. Lalani, Fauzia Ali, Zeenatkhanu Kanji, Salma Jaffer, Mohammed Ali

School of Nursing & Midwifery, East Africa

There are a number of factors that prolong patients’ stay in the recovery room (RR), which are related to system or clinical issues. However, less has been discovered from the RR nurses about reasons for prolonged patient stay and recommendations to solve this issue. Prolonged patient stay of more than 2 hours in the RR interferes with the primary role of the RR nurse, which is to provide care to immediate postanaesthesia patients. Consequently, this could affect the operating room schedule, normal flow of patients to the RR and discharge to the nursing units.

Aplastic Anemia: Clinicohaematological Features, Treatment And Outcome Analysis, Rabia Wali, Zehra Fidoo, Salman Adil, Muhammad Ahmed Naqvi

Department of Pathology and Laboratory Medicine

Objective: To determine the clinicohaematological features, treatment and outcome of children diagnosed with aplastic anemia at a single institution.

Study Design: Observational study.

Place and Duration of Study: The Aga Khan University Hospital, Karachi, from January 1999 till December 2008.

Methodology: Medical records of children aged less than 15 years of age diagnosed with aplastic anemia were reviewed. Clinicohaematological features, treatment and its response to therapy and outcome were recorded. Results were described in percentages.

Results: Ninety patients were diagnosed to have aplastic anemia (AA); 65 were male during the study period. Age ranged from 1 to 15 years. Fever …

Immunoproliferative Small Intestinal Disease (Ipsid), Shahid Pervez, Khalid Mumtaz, Syed Siddiq Ullah, Nake Akhtar, Naureen Ali, Hina Aaqil

Department of Pathology and Laboratory Medicine

This study describes the frequency, demographics, clinical presentation, endoscopic findings, histopathological features, treatment and outcome of 'Immunoproliferative small intestinal disease' (IPSID). Archives contained a total of 27 cases of IPSID diagnosed and treated over an 18-year period. A M: F ratio of 2.4:1 was seen with a mean and median ages of 28.7 and 25 years. Most patients (68.8%) presented with abdominal pain and diarrhoea. In the majority (62.5%), duodenum was the primary site of involvement. Endoscopy showed polypoidal, raised or flat lesions. Biopsy findings included blunting or flattening of villi with dense plasma cell infiltrate and lymphoepithelial lesions. Twenty-four …

Gastric Malt Lymphoma: A Rarity, Shahid Pervez, Naureen Ali, Hina Aaqil, Khalid Mumtaz, Syed Siddiq Ullah

Department of Pathology and Laboratory Medicine

Association of Helicobacter pylori (H. Pylori) infection with gastric ‘Mucosa Associated Lymphoid Tissue’ (MALT) lymphomas (MALTomas) is well established. In this study the frequency and characteristics of gastric MALToma over a period of 18 years was evaluated. During this period 24 patients with gastric MALToma were diagnosed; out of them, 13 (54.2%) had active H. Pylori infection. The mean and median age was 49.7 and 53.5 years. The male: female ratio was 17:7. The common presenting complaints were epigastric pain (n=10) and dyspepsia (n=9). Endoscopic findings revealed mild gastric hyperemia (n=16), superficial erosions (n=4) and superficial ulcers (n=4). It was …

Efficacy And Safety Of Artemether-Lumefantrine In The Treatment Of Acute, Uncomplicated Plasmodium Falciparum Malaria: A Pooled Analysis, M. Makanga, Q. Bassat, C.O. Falade, Zul Premji, S. Krudsood, P. Hunt, V. Walter, H.-P. Beck, A.-C. Marrast, M. Cousin, P.J. Rosenthal

Pathology, East Africa

Randomized trials have confirmed the efficacy and safety of artemether-lumefantrine (AL) for treatment of uncomplicated Plasmodium falciparum malaria. Data from seven studies supported by Novartis (1996-2007), including 647 adults (> 16 years of age, 83.3% completed the study) and 1,332 children (≤ 16 years of age, 89.3% completed the study) with microscopically confirmed uncomplicated P. falciparum malaria and treated with the recommended regimen of AL, were pooled. The 28-day polymerase chain reaction-corrected parasitologic cure rate (primary efficacy endpoint) was 97.1% (495 of 510) in adults and 97.3% (792 of 814) in children (evaluable population). Gametocytemia prevalence after day was 4.2% …