Medicine and Health Sciences Commons^™

Population Health Metrics Research Consortium Gold Standard Verbal Autopsy Validation Study: Design, Implementation, And Development Of Analysis Datasets, C.J.L. Murray, A.D. Lopez, R. Black, R. Ahuja, S.M. Ali, A. Baqui, L. Dandona, E. Dantzer, Vinita Das, U. Dhingra, A. Dutta, W. Fawzi, A.D. Flaxman, S. Gomez, B. Hernandez, R. Joshi, H. Kalter, A. Kumar, V. Kumar, R. Lozano, M. Lucero, S. Mehta, B. Neal, S.L. Ohno, R. Prasad, D. Praveen, Zul Premji, D. Ramirez-Villalobos, H. Remolador, I. Riley, M. Romero, M. Said, D. Sanvictores

Pathology, East Africa

Background: Verbal autopsy methods are critically important for evaluating the leading causes of death in populations without adequate vital registration systems. With a myriad of analytical and data collection approaches, it is essential to create a high quality validation dataset from different populations to evaluate comparative method performance and make recommendations for future verbal autopsy implementation. This study was undertaken to compile a set of strictly defined gold standard deaths for which verbal autopsies were collected to validate the accuracy of different methods of verbal autopsy cause of death assignment.

Methods: Data collection was implemented in six sites in four …

Role Of Leptin And Its Receptors In The Pathogenesis Of Thyroid Cancer, Shahabuddin, Azhar Hussain, Abdul K Siraj, Omar S Khan, Prashant P Bavi, Khawla S Al-Kuraya

Centre for Regenerative Medicine & Stem Cell Research

Leptin is a multifunctional adipose-derived cytokines that play a critical role in bodyweight homeostasis and energy balance. Recently, leptin and leptin receptor dysreulation have been reported in variety of malignant cells including thyroid. Leptin modulates growth and proliferation of cancer cells via activation of various growth and survival signaling pathways including JAK/STAT, PI3-kinase/AKT and/or Map kinases. In this review, current understanding of leptin's role in the pathogenesis of thyroid cancer has been described.

Resveratrol Suppresses Constitutive Activation Of Akt Via Generation Of Ros And Induces Apoptosis In Diffuse Large B Cell Lymphoma Cell Lines, Azhar Hussain, Shahabuddin, Rong Bu, Omar S. Khan, Saeeda O. Ahmed, Maqbool Ahmed, Khawla S. Al-Kuraya

Centre for Regenerative Medicine & Stem Cell Research

Background: We have recently shown that deregulation PI3-kinase/AKT survival pathway plays an important role in pathogenesis of diffuse large B cell lymphoma (DLBCL). In an attempt to identify newer therapeutic agents, we investigated the role of Resveratrol (trans-3,4′, 5-trihydroxystilbene), a naturally occurring polyphenolic compound on a panel of diffuse large B-cell lymphoma (DLBCL) cells in causing inhibition of cell viability and inducing apoptosis.
Methodology/Principal Findings: We investigated the action of Resveratrol on DLBCL cells and found that Resveratrol inhibited cell viability and induced apoptosis by inhibition of constitutively activated AKT and its downstream targets via generation of reactive oxygen species …

Postoperative Sensitivity In Class V Composite Restorations: Comparing Soft Start Vs. Constant Curing Modes Of Led., Fahad Umer, Frahan Raza Khan

Department of Surgery Docs

Background: One of the major disadvantages associated with using composites is polymerization shrinkage, stresses are generated at the margins, and if these stresses exceed the bond strength, microleakage occurs at the tooth restoration interface which causes ingress of cariogenic bacteria, post-operative sensitivity, and secondary caries. LED offers several curing modes: constant cure, ramped cure, and soft start cure. It is claimed that soft start polymerization mode produces less polymerization shrinkage and consequently less postoperative sensitivity. Objective:To compare the postoperative sensitivity in Class V composite restorations using soft start and constant LED curing modes. Materials and

Methods:

Using the appropriate …

Implementing Routine Provider-Initiated Hiv Testing In Public Health Care Facilities In Kenya: A Qualitative Descriptive Study Of Nurses' Experiences, Catrin Evans, Eunice Ndirangu

School of Nursing & Midwifery, East Africa

Routine 'provider-initiated testing and counselling' (PITC) for HIV has been implemented amidst concern over how consent, confidentiality and counselling (the 3C’s) can be maintained in underresourced health care settings. In Kenya, PITC has been rolled out since 2005, HIV prevalence is 7.1% and over 86% of adults have not been tested. Kenyan nurses are the main cadre implementing PITC but little is known about their experiences of incorporating HIV testing into everyday practice and the challenges faced in maintaining the 3’Cs within their work environments. This study aimed to explore these issues and adopted a qualitative multi-method design using a …

Genome-Wide Association Study Identifies 12 New Susceptibility Loci For Primary Biliary Cirrhosis, George Mells, James Floyd, Katherine Morley, Heather Cordell, Christopher Franklin, So-Youn Shin, Michael Heneghan, James Neuberger, Peter Donaldson, Darren Day, Samantha Ducker, Agnes Muriithi, Elizabeth Wheater, Christopher Hammond, Muhammad Dawwas, Uk-Pbc Consortium, David Jones, Leena Peltonen, Graeme Alexander, Richard Sandford, Carl Anderson

School of Nursing & Midwifery, East Africa

In addition to the HLA locus, six genetic risk factors for primary biliary cirrhosis (PBC) have been identified in recent genome-wide association studies (GWAS). To identify additional loci, we carried out a GWAS using 1,840 cases from the UK PBC Consortium and 5,163 UK population controls as part of the Wellcome Trust Case Control Consortium 3 (WTCCC3). We followed up 28 loci in an additional UK cohort of 620 PBC cases and 2,514 population controls. We identified 12 new susceptibility loci (at a genome-wide significance level of P < 5 × 10⁻⁸) and replicated all previously associated loci. We identified three further new loci in a meta-analysis of data from our study and previously published GWAS results. New candidate genes include STAT4, DENND1B, CD80, IL7R, CXCR5, TNFRSF1A, CLEC16A and NFKB1. This study has considerably expanded our knowledge of the genetic architecture of PBC

Reduction Of Mammoplasty Using Inferior Pedicle In Heavy Breasts (Macromastia)., Stanley Ominde Khainga, Ronald Wasike, P. K. Biribwa

General Surgery, East Africa

Symptoms associated with heavy breasts are pain in the upper part of the body; back pains, poor body posture and headache. These patients also have difficulties in finding suitable clothes and experience poor self-image and problems such as establishing sexual relationships. Reduction mammoplasty procedure provides weight and volume reduction of the breast as well as enhancement of the aesthetic appearance of the breasts. In this study, the inferior pedicle technique was used in reduction of thirty five patients over the last four years with macromastia. In all the patients except three, good results were achieved. One patient suffered nipple necrosis …

Addressing The Challenges Of Practicing Breast Cytology In A Tertiary Teaching Hospital In Kenya, Neeta Kumar, Shahin Sayed, Zahir Moloo, Rajendra Chauhan

General Surgery, East Africa

Objectives: To assess diagnostic accuracy of breast cytology through histological correlation and identify reasons for diagnostic pitfalls.

Methods: A total of 2700 cases were reported in cytology during the study period of 14 months, of which 1100 (40%) were from breast lesions. Only 96 (9%) cases had histological follow up in the form of core biopsy, lumpectomy and/or mastectomy. The cases in which cytology diagnosis did not match with histology diagnosis were reviewed by two pathologists and reasons for the diagnostic pitfalls in cytology were recorded. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of cytology were …

Apache-Ii Score Correlation With Mortality And Length Of Stay In An Intensive Care Unit, Saad Ahmed Naved,, Shahla Siddiqui, Fazal Hameed Khan

Department of Anaesthesia

Objective: To correlate the APACHE-II score system with mortality and length of stay in ICU. Study Design: Cohort study. Place and Duration of Study: The Intensive Care Unit (ICU) of the Aga Khan University Hospital, Karachi, from May 2005 to May 2006. Methodology: All adult patients who were admitted in the ICU were included. APACHE-II score was calculated at the second and seventh days of admission in the ICU. Patients who were discharged alive from the ICU or died after first APACHE-II Score (at 2nd day) were noted as the primary outcome measurement. Second APACHE-II score (at 7th day) was …

Post-Dural Puncture Posterior Reversible Encephalopathy Syndrome, Fauzia N. Minai, Syeda Fauzia Hasan, Mughis Sheerani

Department of Anaesthesia

We report the case of a young patient with 36 weeks pregnancy, and an acute respiratory infection with severe bronchospasm, who developed an occipital headache and neck pain on the third day of inadvertent dural puncture during placement of combined epidural spinal anaesthesia for caesarian section. It was diagnosed as post-dural puncture headache until generalised tonic clonic siezures occurred the next day raising the suspicion of postpartum eclampsia or meningitis. Posterior reversible encephalopathy syndrome was diagnosed on MRI of the brain which showed features of reversible ischemia in the posterior region of the brain. With anticonvulsant therapy and antibiotics there …

Bacterial Vaginosis Is Associated With Uterine Cervical Human Papillomavirus Infection: A Meta-Analysis, Evy Gillet, Joris Fa Meys, Hans Verstraelen, Carolyne Bosire, Philippe De Sutter, Marleen Temmerman, Davy Vanden Broeck

Obstetrics and Gynaecology, East Africa

Background: Bacterial vaginosis (BV), an alteration of vaginal flora involving a decrease in Lactobacilli and predominance of anaerobic bacteria, is among the most common cause of vaginal complaints for women of childbearing age. It is well known that BV has an influence in acquisition of certain genital infections. However, association between BV and cervical human papillomavirus (HPV) infection has been inconsistent among studies. The objective of this meta-analysis of published studies is to clarify and summarize published literature on the extent to which BV is associated with cervical HPV infection.

Methods: Medline and Web of Science were systematically searched for …

Eltrombopag For Management Of Chronic Immune Thrombocytopenia (Raise): A 6-Month, Randomised, Phase 3 Study, Gregory Cheng, Mansoor Saleh, Claus Marcher, Sandra Vasey, Bhabita Mayer, Manuel Aivado, Michael Arning, Nicole Stone, James Bussel

Haematology and Oncology, East Africa

Background: Eltrombopag is an oral thrombopoietin receptor agonist for the treatment of thrombocytopenia. We aimed to compare the response to once daily eltrombopag versus placebo in patients with chronic immune thrombocytopenia during a 6-month period.

Methods: We undertook a phase 3, double-blind, placebo-controlled study in adults with previously treated immune thrombocytopenia of more than 6 months’ duration who had baseline platelet counts lower than 30 000 per μL. Patients were randomly allocated (in a 2:1 ratio) treatment with local standard of care plus 50 mg eltrombopag or matching placebo once daily for 6 months. Randomisation was done centrally with a …

Labrad : Vol 36, Issue 1 - January 2011, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• Routine and Special Liver Function Tests
• Management of Coagulopathy Associated with Liver Disease
• Significance of Clinical and Laboratory Scoring System in Diagnosis of Disseminated Intravascular Coagulation in Chronic Liver Disease
• Laboratory Diagnosis of Hydatid Disease
• Laboratory Diagnosis of Amoebiasis
• Improvement of Bacteriological Yield of Liver Abscess by use of Anaerobic Chambers
• Radiofrequency Ablation of Liver Tumours
• HER2 in Breast Cancer: Frequently Asked Questions
• Clinical Laboratory Continuing Medical Education (CME) Seminar
• World Blood Donor Day at Aga Khan University Blood Bank

Plasmodium Falciparum Population Dynamics During The Early Phase Of Anti-Malarial Drug Treatment In Tanzanian Children With Acute Uncomplicated Malaria, A.M. Carlsson, B.E. Ngasala, S. Dahlstrom, C. Membi, I.M. Veiga, L. Rombo, S. Abdulla, Zul Premji, J.P. Gil, A. Bjorkman, A. Martensson

Pathology, East Africa

Background: This study aimed to explore Plasmodium falciparum population dynamics during the early phase of anti-malarial drug treatment with artemisinin-based combination therapy in children with clinical malaria in a high transmission area in Africa.

Methods: A total of 50 children aged 1-10 years with acute uncomplicated P. falciparum malaria in Bagamoyo District, Tanzania, were enrolled. Participants were hospitalized and received supervised standard treatment with artemether-lumefantrine according to body weight in six doses over 3 days. Blood samples were collected 11 times, i.e. at time of diagnosis (-2 h) and 0, 2, 4, 8, 16, 24, 36, 48, 60 and 72 …

Effectiveness Of Artemether-Lumefantrine Provided By Community Health Workers In Under-Five Children With Uncomplicated Malaria In Rural Tanzania: An Open Label Prospective Study, B.E. Ngasala, M. Malmberg, A.M. Carlsson, P.E. Ferreira, M.G. Petzold, D. Blessborn, Y. Bergqvist, J.P. Gil, Zul Premji, A. Martensson

Pathology, East Africa

Background: Home-management of malaria (HMM) strategy improves early access of anti-malarial medicines to high-risk groups in remote areas of sub-Saharan Africa. However, limited data are available on the effectiveness of using artemisinin-based combination therapy (ACT) within the HMM strategy. The aim of this study was to assess the effectiveness of artemether-lumefantrine (AL), presently the most favoured ACT in Africa, in under-five children with uncomplicated Plasmodium falciparum malaria in Tanzania, when provided by community health workers (CHWs) and administered unsupervised by parents or guardians at home.

Methods: An open label, single arm prospective study was conducted in two rural villages …

Community Screening And Treatment Of Asymptomatic Carriers Of Plasmodium Falciparum With Artemether-Lumefantrine To Reduce Malaria Disease Burden: A Modelling And Simulation Analysis, S.E. Kern, A.B. Tiono, M. Makanga, A. Gbadoe, Zul Premji, O. Gaye, I. Sagara, D. Ubben, M. Cousin, F. Oladiran, O. Sander, B. Ogutu

Pathology, East Africa

Background: Asymptomatic carriers of Plasmodium falciparum serve as a reservoir of parasites for malaria transmission. Identification and treatment of asymptomatic carriers within a region may reduce the parasite reservoir and influence malaria transmission in that area.

Methods: Using computer simulation, this analysis explored the impact of community screening campaigns (CSC) followed by systematic treatment of P. falciparum asymptomatic carriers (AC) with artemether-lumefantrine (AL) on disease transmission. The model created by Okell et al (originally designed to explore the impact of the introduction of treatment with artemisinin-based combination therapy on malaria endemicity) was modified to represent CSC and treatment of …

Diagnosis Of Langerhans Cell Histiocytosis On Fine Needle Aspiration Cytology: A Case Report And Review Of The Cytology Literature, Neeta Kumar, Shahin Sayed, Sudhir Vinayak

Pathology, East Africa

A case of multifocal Langerhans cell histiocytosis in a two-year-old child is presented where fine needle aspiration was helpful in achieving a rapid and accurate diagnosis in an appropriate clinical and radiological setting. This can avoid unnecessary biopsy and guide the management especially where access to histopathology is limited. The highly characteristic common and rare cytological features are highlighted with focus on differential diagnoses and causes of pitfalls.

Overuse Of Antibiotics In Children For Upper Respiratory Infections (Uris): A Dilemma, Malika Taufiq, Rukhsana Wamiq Zuberi

Department for Educational Development

No abstract provided.

Predictors Of The Intracerebral Hemorrhage Volume In Hypertensive Patients, Mohammad Wasay, Adnan Yousuf, Darshan Lal, Safia Awan

Section of Neurology

Background: Hemorrhage volume is an important predictor of outcome in Patients with intracerebral hemorrhage (ICH). It is not clear why in some Patients ICH volume is larger than in others. Identification of modifiable factors responsible for large-volume hemorrhage in hypertensive Patients may help to reduce ICH-related morbidity and mortality. Objective: The objective of this study was to identify predictors of large-volume ICH in hypertensive Patients. Methods:At a tertiary care center in Karachi (Pakistan), 157 hypertensive Patients with ICH were prospectively analyzed in 2008-2009, and hemorrhage volumes were determined using CT or MRI and various factors, including duration of hypertension, …

Viewpoint: My Journey From The Us Back To Pakistan: What Keeps Me Here, Saad Shafqat

Section of Neurology

No abstract provided.

What Modifiable Risk Factors Lead To Strokes In Our Part Of The World, Maria Khan, Ayeesha Kamran Kamal

Section of Neurology

No abstract provided.

Undetected Common Variable Immune Deficiency In A Young Adult Of Pakistani Descent., M Owais Khan, Adil Iqba Memon, Ali Bin Sarwar Zubairi, Asifali Imam

Department of Medicine

Common variable immune deficiency (CVID) is a syndrome which is due to deficiency of humoral immune response resulting in increased susceptibility to infections We report a case of CVID in a 24-year-old male whopresented with a history of recurrent pneumonias.

What Modifiable Risk Factors Lead To Strokes In Our Part Of The World?, Maria Khan, Ayeesha Kamran Kamal

Department of Medicine

No abstract provided.

Perception And Practices Of Breastfeeding Of Infants 0-6 Months In An Urban And A Semi-Urban Community In Pakistan: A Cross-Sectional Study, Sumera Ali, Syed Faizan Ali, Ayesha Mallick Imam, Samia Ayub, Abdul Gaffar Billoo

Department of Paediatrics and Child Health

OBJECTIVE: To investigate mother's perception and practices about breastfeeding and their socio-demographic correlate in infants equal to or less than 6 months.

METHODS: A cross-sectional study was carried out on 200 mother-infant pairs who visited the health care centers, Bilal Colony (semi-urban) and the Aga Khan University (urban), for their well baby follow-ups and vaccination using convenient sampling. Frequencies and percentages were computed and Chi-square was used to find associations between socio-demographics of mothers and their perception and practices about breastfeeding.

RESULTS: Exclusive breastfeeding was reported by about 54% of the mothers. Thirty-five percent of the mothers gave prelacteal feed, …

Significance Of Pyuria In The Diagnosis Of Urinary Tract Infections In Neonates, Arshalooz J Rahman, Farah Naz, Sohail Ashraf

Department of Paediatrics and Child Health

OBJECTIVES: To determine the significance of pyuria as a predictor of culture proven urinary tract infections (UTI) in neonates and to assess the frequency of urinary tract anomalies in neonates with pyuria.

METHODS: Prospective study conducted at the neonatal intensive care unit of a tertiary care hospital; (Liaquat National Hospital Karachi) for a period of 4 months from April 2008 to August 2008. One hundred and ten consecutive infants < or = 28 days of age admitted to the NICU of Liaquat National Hospital for medical reasons were included in the study. Information regarding age, gender, antenatal history, birth weight, clinical examination, laboratory findings and outcome were recorded on a questionnaire. Septic work up was performed and urine samples were collected using urethral catheterization. Patients showing any number of white blood cells on microscopy were included and their urine sent for culture. All patients had Ultrasound done during their hospital stay and those patients with any renal abnormality were further investigated with Micturating cyestoretherogram (MCUG) at 6 weeks.

RESULTS: Out of one hundred and ten patients admitted, thirty five patients showed the presence of pus cells in urine and were included in the study. Of the 35 neonates with …

Availability And Affordability Of Essential Medicines: Exploring The Health Seeking Behaviours And Health Service Utilisation For Children Under-5 Years Living In Squatter Settlement Of Karachi, Pakistan, Yasir Shafiq, Babar Tasneem Shaikh, Ramesh Kumar

Department of Paediatrics and Child Health

Background: Child health outcomes in the poor communities are largely affected by the non-availability of essential medicines at government health facilities and non-affordability of prescribed medicines at private retail pharmacies. This phenomenon largely defines health seeking behaviours and health service utilisation patterns of the families of the children.
Methods: Using observational visits, we examined the shelf-availability of medicines for children less than 5 years of age at a rural health centre and conducted focus group discussions with the mothers to explore the effects of non-availability and non-affordability of medicines. We also validated all information by interviewing the health care providers …

Stem Cells For Spinal Cord Regeneration: Current Status, Zain A. Sobani, Syed A. Quadri, Ather Enam

Section of Neurosurgery

Background: Nearly 11,000 cases of spinal cord injury (SCI) are reported in the United States annually. Current management options give a median survival time of 38 years, however, no rehabilitative measures are available. Stem cells have been under constant research given their ability to differentiate into neural cell lines replacing non functional tissue. Efforts have been made to establish new synapses and provide a conducive environment, by grafting cells from autologous and fetal sources, including embryonic or adult stem cells, Schwann cells, genetically modified fibroblasts, bone stromal cells, and olfactory ensheathing cells and combinations/ variants thereof.
Methods: In order to …

Anxiety And Depression Among Outpatients With Type 2 Diabetes: A Multi-Centre Study Of Prevalence And Associated Factors., Ali Khan Khuwaja, Saima Lalani, Raheem Dhanani, Iqbal Syed Azam, Ghazala Rafique, Franklin White

Department of Family Medicine

Background: Anxiety and depression contribute to poor disease outcomes among individuals with diabetes. This study aimed to assess the prevalence of anxiety and depression and to identify their associated factors including metabolic components among people with type 2 diabetes. Methods: We conducted a cross-sectional, multi-center study in four out-Patient clinics in Karachi, Pakistan. In all, 889 adults with type-2 diabetes were included in this study. Anxiety and depression were measured by using the Hospital Anxiety and Depression Scale (HADS). Multivariable analysis using multiple logistic regression was carried out to evaluate the combined effect of various factors associated with anxiety and …

A Simple Method To Reduce Infection Of Ventriculoperitoneal Shunts Clinical Article, Atiq-Ur Rehman, Tausif-Ur Rehman, Hassaan H. Bashir, Vikas Gupta

Department of Medicine

Object: Postoperative shunt infection is the most common and feared complication of ventriculoperitoneal (VP) shunt placement for treatment of hydrocephalus. The rate of shunt infection is highest in the 1st postoperative month. The most common organisms responsible for shunt infection include coagulase-negative Staphylococcus and Staphylococcus aureus. This suggests a transfer of Patient's skin flora via the surgeons' glove as a possible means of infection. The authors conducted a study to determine if the rate of postoperative shunt infections could be reduced simply by changing gloves before handling the shunt catheter. Methods: A total of 111 neonates born with congenital hydrocephalus …

Communities, Birth Attendants And Health Facilities: A Continuum Of Emergency Maternal And Newborn Care (The Global Network's Emonc Trial), Omrana Pasha, Robert L. Goldenberg, Elizabeth M. Mcclure, Sarah Saleem, Shivaprasad S. Goudar, Fernando Althabe, Archana Patel, Fabian Esamai, Ana Garces, Elwyn Chomba, Manolo Mazariegos, Bhala Kodkany, Jose M. Belizan, Richard J. Derman, Patricia L. Hibberd, Waldemar A. Carlo, Edward A. Liechty, K. Michael Hambidge, Pierre Buekens, Dennis Wallace, Lisa Howard-Grabman, Suzanne Stalls, Marion Koso-Thomas, Alan H. Jobe, Linda L. Wright

Community Health Sciences

Background: Maternal and newborn mortality rates remain unacceptably high, especially where the majority of births occur in home settings or in facilities with inadequate resources. The introduction of emergency obstetric and newborn care services has been proposed by several organizations in order to improve pregnancy outcomes. However, the effectiveness of emergency obstetric and neonatal care services has never been proven. Also unproven is the effectiveness of community mobilization and community birth attendant training to improve pregnancy outcomes. Methods/Design: We have developed a cluster-randomized controlled trial to evaluate the impact of a comprehensive intervention of community mobilization, birth attendant training and …