Medical Specialties Commons^™

Covid-19 In Hemodialysis Patients, Sonia Yaqub, Amna Hamid, Zarghoona Naeem

Section of Nephrology

No abstract provided.

Brain Abscess Caused By Lactococcus Lactis In A Young Male, Intisar Ahmed, Kashif Aziz, Hameed Tareen, Muhammad Arslan Ahmed

Section of Cardiology

Lactococcus lactis cremoris is one of the gram positive cocci, not known to be pathogenic in humans. We report a case of brain abscess due to lactococcus lactis in an adolescent. An 18-year male with congenitally corrected transposition of great arteries and dextrocardia was admitted with fever, headache and right-sided numbness. Magnetic resonance imaging revealed a well circumscribed irregular heterogeneous abnormal signal intensity lesion in left temporo-parietal lobe having central area of diffusion restriction and peripheral wall enhancement on post-contrast images. He underwent mini-craniotomy for abscess drainage. Pus culture revealed growth of lactococcus lactis. He was treated with ceftriaxone and …

Acute Urinary Retention: Should We Call It A Manifestation Of Appendicitis?, Sadaf Sheikh, Umair Javed, Muhammad Akbar Baig

Department of Emergency Medicine

Acute urinary retention (AUR) is a fairly common presentation in the elderly; but interesting to be noted in a healthy young individual as a manifestation of acute appendicitis. We present a case of a 32-year gentleman with decreased urine output with mild tenderness at the supra-pubic region; which was later on, shifted to the right iliac fossa. Computed tomography of the abdomen showed acute appendicitis. Emergency physicians are challenged to recognize the uncommon presentation of acute appendicitis and need to be reminded of this common complaint as a rare presentation of it. This case also stresses on the repeated abdominal …

Online Assessment In Undergraduate Medical Education: Challenges And Solutions From A Lmic University, Syeda Sadia Fatima, Romana Idrees, Kauser Jabeen, Saniya Sabzwari, Sadaf Khan

Department of Biological & Biomedical Sciences

Background and objectives: The Covid-19 pandemic has caused large-scale disruption in almost all educational programs across the world. Planning and rapid implementation of assessment through an online format presents the next set of novel challenges that must be addressed by academic administrations across the globe.
Methods: This cross-sectional study was conducted between March to August 2020 at the Aga Khan University Medical College. Two hundred medical students of year 1 and 2 participated in the study. We describe the planning, processes, and outcomes of online assessments using video communication platforms conducted at a private university in Pakistan. Standardized protocols were …

Improved Clinical Competence And Patients Satisfaction: Comparison Of Patient-Centered, Interdisciplinary Collaborative Round Versus Traditional Post-Partum Round, Arshia Javed, Arjumand Sohaila, Irfan Sheikh, Nida Qadir

Department of Obstetrics & Gynaecology

The origin of the patient-centered interdisciplinary collaborative round, which involves health care members of all levels at a time, is an effective and emerging approach to offer inpatient healthcare. Traditionally, post-partum rounds at teaching hospitals consisted of separate visits from all members of the obstetric team that resulted in patient inconvenience, care insufficiencies, and communication gaps. The main objective of this study was to assess the patient's satisfaction level from the traditional post-partum round versus the patient-centered collaborative care (PCCC) round. This study showed that in the traditional round, the patient's satisfaction with the treatment was 95.1%; whereas, in PCCC …

Vitamin D Status And Pulmonary Exacerbations In Children And Adolescents With Cystic Fibrosis: Experience From A Tertiary Care Center, Danish Abdul Aziz, Syeda Khadija Fatima, Haissan Iftikhar, Fatima Mir

Department of Paediatrics and Child Health

Background: The function of Vitamin D in preventing inflammation and infection has been studied previously for different pathologies in different populations globally. Relationships between serum Vitamin D levels and its effect on pulmonary exacerbations in the cystic fibrosis (CF) population are not well studied in our part of the world. Therefore, we aimed to ascertain the Vitamin D status in pediatric and adolescent CF patients and its association with pulmonary exacerbations.
Materials and methods: A retrospective study was conducted at The Aga Khan University Hospital from 2015 to 2018. Patients of CF with sweat chloride value >60 mmol/l and who …

Prognostic Significance Of Ischaemic Electrocardiographic Changes During Stress Testing In Patients With Normal Nuclear Myocardial Perfusion Imaging, Ghufran Adnan, Fateh Ali Tipoo Sultan, Umaira Alauddin, Maria Ali Khan

Section of Cardiology

Objective: To evaluate cardiovascular outcomes in patients with normal nuclear myocardial perfusion imaging, but ischaemic electrocardiogram changes during pharmacological or exercise stress tests.
Methods: The retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised data of patients who underwent either pharmacological or exercise stress myocardial perfusion scan and had a normal scan with ischaemic electrocardiogram changes between January 2013 and December 2014. All cardiac events, including angina, myocardial infarction, heart failure, coronary revascularisation and cardiac death, as well as non-cardiac deaths were noted. Data was analysed using STATA 14.2.
Results: Of the 2770 patients whose data …

Muslim Men’S Perceptions And Attitudes On Family Planning: A Qualitative Study In Wajir And Lamu Counties In Kenya, Batula Abdi, Jerry Okal, Gamal Serour, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

In patriarchal societies like Kenya, understanding men’s perceptions and attitudes on family planning is critical given their decision-making roles that affect uptake of contraception. Yet, most programmes mainly target women as primary users of contraceptive methods since they bear the burden of pregnancy. However, women-focused approaches tend to overlook gender power dynamics within relationships, with men wielding excessive power that determines contraception use or non-use. A qualitative study involving focus group discussions and in-depth interviews was conducted in the two predominantly Muslim communities of Lamu and Wajir counties, Kenya. Open-ended questions explored perspectives, attitudes and men’s understanding of contraception, family …

Surgery For Pelvic Organ Prolapse And Stress Urinary Incontinence And Female Sexual Functions: A Quasi-Experimental Study, Saida Abrar, Raheela Mohsin Rizvi, Huda Saleem

Department of Obstetrics & Gynaecology

Objectives: To assess the effect of pelvic organ prolapse (POP) and/or stress urinary incontinence (SUI) on various domains of female sexual functions in patients before and after reconstructive surgery for these pelvic floor disorders.
Methods: We conducted a quasi-experimental study of 126 women aged 25-65 years, presenting with POP / SUI, from January 1st 2019 to December 31st 2019 at Aga Khan University Hospital. POP surgery was performed only in patients with symptomatic POP ≥ stage 2 according to POP-Q (quantification). Sexual functions were assessed using Female Sexual Function Index (FSFI) questionnaire, among sexually active women at baseline and 18 …

Hypertrophic Gastric Folds With Hypomagnesemia, Linking The Dots, Mansoor Zafar, Tila Muhammad, Najam-Us-Saher Rizvi, Muhammad Toqeer

Section of Internal Medicine

A Caucasian man in early 80s was seen in Gastroenterology Clinic, following, referral from the Endocrinology Clinic for concerns for CT Abdomen requested for tiredness and weight loss of three kilograms. The patient also had microcytic picture with low MCV and Ferritin and hypomagnesemia. The CT suggested gross circumferential thickening of the wall of stomach with advice for invasive investigations to further characterise the CT findings. The Endoscopy suggested grossly enlarged rugae in the stomach, and enlarged gastric polyps. Patient was assured no new sinister abnormality. Treatment challenges to consider were to stop acid suppression by prescribing Proton Pump Inhibitors …

Correlation Of Serum Calcium With Severity Of Acute Ischaemic Stroke, Ainan Arshad, Saad Bin Zafar Mahmood, Ahmed Ayaz, Mehsa Hashim, Eisha Hanan

Section of Internal Medicine

Stroke results in the death of around 6.5 million people annually with a majority of these occurring in developing countries. Serum calcium has been hypothesised to play a significant role in causing ischaemic stroke. This retrospective observational study was conducted to determine the correlation, if any, between serum calcium and the severity of acute ischaemic stroke in our population. Two hundred and seventy-nine patients admitted with acute ischaemic stroke were enrolled in the study. Of the 279 patients 162 (58%) were male and mean age was 62.4 ± 3.8 years. Characteristics of stroke patients were compared with stroke severity. Mean …

A Cross Sectional Evaluation Of The Corona-Score For Swift Identification Of Sars-Cov-2 Infection At A Tertiary Care Hospital In Pakistan, Sibtain Ahmed, Muhammad Umer Naeem Effendi, Zeeshan Ansar Ahmed, Imran Siddiqui, Lena Jafri

Department of Pathology and Laboratory Medicine

Background: The Corona-Score is one of the first and most widely used predictive model for coronavirus 2 (SARS-CoV-2) infection. The purpose of this study was to validate the performance of Corona-Score in a cohort of Pakistani patients pursuing care for suspected infection.
Methods: After seeking institution's ethical committee exemption, results of serum lactate dehydrogenase (LDH), C-reactive protein (CRP), ferritin, absolute lymphocyte and neutrophil counts, chest x-ray findings and demographics of suspected COVID-19 cases with respiratory symptoms were recouped from electronic medical record. The pre-validated score as proposed by Kurstjens S et al., was calculated. The subjects were divided into SARS-CoV-2 …

A Qualitative Endline Evaluation Study Of Male Engagement In Promoting Reproductive, Maternal, Newborn, And Child Health Services In Rural Kenya, Adelaide Lusambili, Stefania Wisofschi, Constance Shumba, Peter Muriuki, Jerim Obure, Michaela Mantel, Lindsay Mossman, Rachel Pell, Lucy Nyaga, Anthony Ngugi, James Orwa, Stanley Luchters, Kennedy Mulama, Terrance J. Wade, Marleen Temmerman

Population Health, East Africa

Background: Globally, male involvement in reproductive, maternal, newborn, and child health (RMNCH) is associated with increased benefits for women, their children, and their communities. Between 2016 and 2020, the Aga Khan University implemented the Access to Quality of Care through Extending and Strengthening Health Systems (AQCESS), project funded by the Government of Canada and Aga Khan Foundation Canada (AKFC). A key component of the project was to encourage greater male engagement in RMNCH in rural Kisii and Kilifi, two predominantly patriarchal communities in Kenya, through a wide range of interventions. Toward the end of the project, we conducted a …

Clinical Validation Of A Sensitive Test For Saliva Collected In Healthcare And Community Settings With Pooling Utility For Severe Acute Respiratory Syndrome Coronavirus 2 Mass Surveillance, Panelnikhil S. Sahajpal, Ashis K. Mondal, Sudha Ananth, Allan Njau, Pankaj Ahluwalia, Vamsi Kota, Kevin Caspary, Ted M. Ross, Michael Farrell, Michael P. Shannon

Pathology, East Africa

The clinical performance of saliva compared with nasopharyngeal swabs (NPSs) has shown conflicting results in healthcare and community settings. In the present study, a total of 429 matched NPS and saliva sample pairs, collected in either healthcare or community setting, were evaluated. Phase-1 (protocol U) tested 240 matched NPS and saliva sample pairs; phase 2 (SalivaAll protocol) tested 189 matched NPS and saliva sample pairs, with an additional sample homogenization step before RNA extraction. A total of 85 saliva samples were evaluated with both protocols. In phase-1, 28.3% (68/240) samples tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) …

Translation And Validation Of Training Needs Analysis Questionnaire Among Reproductive, Maternal And Newborn Health Workers In Tanzania, Tumbwene Mwansisya, Columba Mbekenga, Kahabi Isangula, Loveluck Mwasha, Eunice Pallangyo, Grace Edwards, James Orwa, Michaela Mantel, Micheal Mugerwa, Leonard Subi, Secilia Mrema, David Siso, Edna Selestine, Marleen Temmerman

School of Nursing & Midwifery, East Africa

Background: Continuous professional development (CPD) has been reported to enhance healthcare workers’ knowledge and skills, improve retention and recruitment, improve the quality of patient care, and reduce patient mortality. Therefore, validated training needs assessment tools are important to facilitate the design of effective CPD programs.

Methods: A cross-sectional survey was conducted using self-administered questionnaires. Participants were healthcare workers in reproductive, maternal, and neonatal health (RMNH) from seven hospitals, 12 health centers, and 17 dispensaries in eight districts of Mwanza Region, Tanzania. The training needs analysis (TNA) tool that was used for data collection was adapted and translated into …

A Prospective Observational Study Of Community Acquired Pneumonia In Kenya: The Role Of Viral Pathogens, Jamila Nambafu, Mary Achakolong, Fridah Mwendwa, Jumaa Bwika, Felix Riunga, Samuel Gitau, Hanika Patel, Rodney Adam

Internal Medicine, East Africa

Background: Lower respiratory tract infections continue to contribute significantly to morbidity and mortality across all age groups globally. In sub-Saharan Africa, many studies of community acquired pneumonia in adults have focused on HIV-infected patients and little attention has been given to risk factors and etiologic agents in an urban area with a more moderate HIV prevalence.

Methods: We prospectively enrolled 77 patients admitted to a 280 bed teaching hospital in Kenya with radiographically confirmed community acquired pneumonia from May 2019 to March 2020. The patients were followed for etiology and clinical outcomes. Viral PCR testing was performed using …

Frequency Of Early Postoperative Adverse Events (Aes) In Adult Patients Undergoing Elective Neurosurgical Intervention At Tertiary Care Center In Pakistan, Mansoor Chandio, Faraz Shafiq, Ather Enam

Department of Anaesthesia

Objective: The postoperative period is critical in neurosurgical patients, where the incidence of postoperative AEs is significantly high. Most of events occurs during recovery phase and has got relation to anaesthetic management. The objective of study was to determine frequency of early AEs in elective neurosurgical patients.
Methods: This cross sectional study was conducted at our tertiary care center. The duration of study was one year, from August 2017-July 2018. The data was collected using predesigned proforma. The assessment was done on arrival in recovery room (T1) and then at forty five minutes (T2), twenty-fourth hour (T3) and forty-eighth hour …

Mental Disorders Among Health Care Workers At The Early Phase Of Covid-19 Pandemic In Kenya; Findings Of An Online Descriptive Survey, Edith Kamaru Kwobah, Ann Mwangi, Kirtika Patel, Thomas Mwogi, Robert Kiptoo, Lukoye Atwoli

Internal Medicine, East Africa

Background: Healthcare workers responding to the Corona Virus Pandemic (COVID-19) are at risk of mental illness. Data is scanty on the burden of mental disorders among Kenyan healthcare workers responding to the pandemic that can inform mental health and psychosocial support. The purpose of this study was to establish the frequency and associated factors of worry, generalized anxiety disorder, depression, posttraumatic stress disorder and poor quality of sleep among Kenyan health care workers at the beginning of COVID-19 pandemic.

Methods: We conducted an online survey among 1,259 health care workers in Kenya. A researcher developed social demographic questionnaire and several …

Covid-19 And Mental Well-Being Of Nurses In A Tertiary Facility In Kenya, Sayed Karar, Jasmit Shah, Zohray Talib

Internal Medicine, East Africa

Background: The 2019 coronavirus disease (COVID-19) epidemic is a global health emergency which has been shown to pose a great challenge to mental health, well-being and resilience of healthcare workers, especially nurses. Little is known on the impact of COVID-19 among nurses in sub-Saharan Africa.

Methods: A cross sectional study was carried out between August and November 2020 among nurses recruited from the Aga Khan University Hospital, Nairobi. The survey questionnaire consisted of six components- demographic and work title characteristics, information regarding care of COVID-19 patients, symptoms of depression, anxiety, insomnia, distress and burnout, measured using standardized questionnaires. Multivariable logistic …

Comparative Analysis Of Triple-Negative Breast Cancer Transcriptomics Of Kenyan, African American And Caucasian Women, Mansoor Saleh, Darshan Shimoga Chandrashekar

Haematology and Oncology, East Africa

Purpose: Triple-negative breast cancer (TNBC) patients of various ethnic groups often have discrete clinical presentations and outcomes. Women of African descent have a disproportionately higher chance of developing TNBCs. The aim of the current study was to establish the transcriptome of TNBCs from Kenyan (KE) women of Bantu origin and compare it to those TNBCs of African-Americans (AA) and Caucasians (CA) for identifying KE TNBC-specific molecular determinants of cancer progression and potential biomarkers of clinical outcomes.

Patients and Methods: Pathology-confirmed TNBC tissues from Kenyan women of Bantu origin (n = 15) and age and stage range matched AA (n = …

Burden Of Transport-Related Injuries In The Eastern Mediterranean Region: A Systematic Analysis For The Global Burden Of Disease Study 2017, Gbd 2017 Emr Transport Injuries Collaborators, Saeid Safiri, Mark J M. Sullman, Timo Lajunen, Tetiana Hill, Amir Almasi-Hashiani, Maziar Moradi-Lakeh, Farshad Farzadfar, Sadaf G. Sepanlou, Zulfiqar Ahmed Bhutta

Centre of Excellence in Women and Child Health

Background: Transport-related injuries (TIs) are a substantial public health concern for all regions of the world. The present study quantified the burden of TIs and deaths in the Eastern Mediterranean region (EMR) in 2017 by sex and age.
Methods: TIs and deaths were estimated by age, sex, country, and year using Cause of Death Ensemble modelling (CODEm) and DisMod-MR 2.1. Disability-adjusted life years (DALYs), which quantify the total burden of years lost due to premature death or disability, were also estimated per 100000 population. All estimates were reported along with their corresponding 95% uncertainty intervals (UIs).
Results: In 2017, there …

Adenoid Cystic Carcinoma Of External Auditory Canal: A Rare Disease, Abdul Basit Shah Vardag, Muhammad Hassan Danish, Mohammad Sohail Awan, Muhammad Usman Tariq, Omaima Anis Bhatti, Muhammad Hammad Deewani

Section of Otolaryngology, Head & Neck Surgery

External auditory canal, like other epithelialized surfaces is predisposed to malignancies such as Squamous cell carcinomas (SCC), melanomas and adenocarcinomas. In this background, malignancies like adenoid cystic carcinoma (ACC) are a rare occurrence and need to be thoroughly evaluated both locally and for distant extension. The malignancy needs to be addressed with an aggressive approach surgically with adequate marginal clearance. The role of radiation is debatable considering the outcomes in the limited data. Here we present the case of a 35-year-old female who came in with otalgia and otorrhea associated with a mass in the external auditory canal. After biopsy …

Collet-Sicard Syndrome Due To Concurrent Extramedullary Intracranial Plasmacytoma And Jugular Venous Sinus Thrombosis In Multiple Myeloma, Dilraj Sokhi, Caroline Wangui Mithi, Farah Ebrahim, Adil Salyani, Sheila Waa, Riyat Malkit

Internal Medicine, East Africa

In a patient with Collet- Sicard syndrome and multiple myeloma, both extramedullary plasmacytomas and internal jugular vein- sigmoid sinus thrombosis should be consid- ered as they can coexist.

Plasma Cell Leukemia: A Review Of 3 Cases Managed In Kenya, Matilda Ong’Ondi, Elizabeth Kagotho

Pathology, East Africa

Plasma Cell Leukemia (PCL) is a rare and aggressive form of plasma cell dyscrasia that can arise either de novo (primary plasma cell leukemia) or evolve from previously diagnosed and treated multiple myeloma (secondary PCL). We highlight three clinical cases with very different presentations as a reminder of this diagnosis. (e cases also highlight the diversity and variability that cover a patient’s journey that is highly dependent on accessibility based on financial capability and social support. (e clinical presentation is more aggressive due to the higher tumour burden and more proliferative tumor cells with cytopenias being profound and more organomegaly. …

Publisher Correction To: Development Of The Asia Pacific Consortium On Osteoporosis (Apco) Framework: Clinical Standards Of Care For The Screening, Diagnosis, And Management Of Osteoporosis In The Asia-Pacific Region, M Chandran, P J. Mitchell, T Amphansap, S K. Bhadada, M Chadha, D-C Chan, Y-S Chung, P Ebeling, N Gilchrist, Aysha Habib Khan

Department of Pathology and Laboratory Medicine

No abstract provided.

Comparison Of Clinical Characteristics And Outcomes Between Covid-19 Pneumonia And H1n1 Influenza, Nosheen Nasir, Iffat Khanum, Kiren Habib, Rimsha Ahmed, Mujahid Hussain, Zahra Hasan, Muhammad Irfan

Department of Medicine

Introduction: The COVID-19 pandemic has been likened to the 2009 H1N1 influenza pandemic. We aim to study the similarities and differences between patients hospitalized with COVID-19 and H1N1 influenza in order to provide better care to patients, particularly during the co-circulation of Influenza A Subtype H1N1 and SARS-CoV-2.
Material and methods: A retrospective cohort study was conducted in order to compare clinical characteristics, complications, and outcomes of hospitalized patients with PCR-confirmed H1N1 influenza pneumonia and COVID-19 at a tertiary care center in Karachi, Pakistan.
Results: A total of 115 patients hospitalized with COVID-19 were compared with 55 patients with H1N1 …

Perception Of Non-Alcoholic Fatty Liver Disease: Real-Life Experience From Pakistan, Nazish Butt, Muhammad Ali Khan, Lajpat Rai, Riaz Hussain Channa, Hanisha Khemani, Amanullah Abbasi

Section of Gastroenterology

Introduction: Non-alcoholic fatty liver disease (NALFD) has become one of the most pervasive causes of hepatic pathology. Because of its marked association with metabolic syndrome, type II diabetes and cardiovascular disease, NAFLD has gained substantial focus recently. Its prevalence and incidence are on the rise in Pakistan. However, due to its indolent and mostly asymptomatic course, NAFLD is often overlooked. This reckless behavior towards a potentially deadly disease is influenced most notably by disinformation or flawed perception, although there are a number of other complex socioeconomic components to this as well. With respect to NAFLD, the gap between disease understanding …

Direct Maternal Morbidity And The Risk Of Pregnancy-Related Deaths, Stillbirths, And Neonatal Deaths In South Asia And Sub-Saharan Africa: A Population-Based Prospective Cohort Study In 8 Countries, Imran Ahmed, Shabina Ariff, Zulfiqar Ahmed Bhutta, Muhammad Ilyas, Fyezah Jehan, Usma Mehmood, Karim Muhammad, Muhammad Imran Nisar, Sajid Bashir Soofi, Yaqub Wasan, Anita K. M. Zaidi

Woman and Child Health

Background: Maternal morbidity occurs several times more frequently than mortality, yet data on morbidity burden and its effect on maternal, foetal, and newborn outcomes are limited in low- and middle-income countries. We aimed to generate prospective, reliable population-based data on the burden of major direct maternal morbidities in the antenatal, intrapartum, and postnatal periods and its association with maternal, foetal, and neonatal death in South Asia and sub-Saharan Africa.
Methods and findings: This is a prospective cohort study, conducted in 9 research sites in 8 countries of South Asia and sub-Saharan Africa. We conducted population-based surveillance of women of reproductive …

Impact Of Covid-19 On Family Planning, Bakhtawar M H. Khowaja, Quratulain Shalwani

Department of Obstetrics & Gynaecology

No abstract provided.

Tocilizumab And Covid-19: A Meta-Analysis Of 2120 Patients With Severe Disease And Implications For Clinical Trial Methodologies, Azza Sarfraz, Zouina Sarfraz, Muzna Sarfraz, Hinna Aftab, Zainab Pervaiz

Department of Paediatrics and Child Health

Background/aim: Since the outbreak of the COVID-19, numerous therapies to counteract this severe disease have emerged. The benefits of Tocilizumab for severely infected COVID-19 patients and the methodologies of ongoing clinical trials are explored.
Materials and methods: A systematic search adhering to PRISMA guidelines was conducted in PubMed, Cochrane Central, medRxiv, and bioRxiv using the following keywords: “Tocilizumab,” “Actemra,” “COVID-19.” An additional subsearch was conducted on Clinicaltrials.gov to locate ongoing tocilizumab trials.
Results: A total of 13 studies were included in the meta-analysis comprising 2120 patients. The treatment group had lower mortality compared to the control group (OR = 0.42, …