Medical Specialties Commons^™

Teleneurology Based Management Of Infantile Spasms During Covid-19 Pandemic: A Consensus Report By The South Asia Allied West Syndrome Research Group, Priyanka Madaan, Jitendra Kumar Sahu, Jithangi Wanigasinghe, Kanij Fatema, Kyaw Linn, Mimi Lhamu Mynak, Nicolás Garófalo Gómez, Pauline Samia, Prakash Poudel, Prem Chand

Paediatrics and Child Health, East Africa

With telehealth services rescuing patients with chronic neurological disorders during the COVID-19 pandemic, there is a felt need for simplified teleneurology protocols for neurological disorders in children. Infantile spasms is an epileptic encephalopathy where treatment lag is a significant predictor of outcome. It is one such condition where telemedicine can make a remarkable difference when in-person consultations are delayed or are not possible. However, the adverse effect profile of the first-line therapeutic options, the need for frequent follow-up, underdeveloped telemedicine services, lack of a rational protocol, poor awareness about infantile spasms, a lesser level of parental understanding, and scarcity of …

Telementoring For Breast Surgeons Practicing In Remote Areas, Fatima Mubarik, Hania Shahzad, Syeda Sakina Abidi, Sana Zeeshan, Lubna Mushtaque Vohra, Sadaf Khan, Abida Khalil Sattar

Medical College Documents

Telementorship allows an expert surgeon to mentor another surgeon through an advanced procedure from a remote location via 2-way audio-visual communication. The current article was planned to review the existing literature and evaluate the utility of telementorship regarding educating rural surgeons in Pakistan about multidisciplinary breast cancer care. Publications from 2016 to 2020 were searched on PubMed and GoogleScholar and 10 most recent publications were selected. Review of literature revealed that even though telementorship in this context might be comparable to onsite mentorship, multiple concerns need to be addressed before its implementation. These include lack of concrete evidence regarding its …

Surgical Education And Training During The Covid-19 Pandemic: Strategies And Solutions For Pakistan, Edward Anthony Joseph, Russell S. Martins, Javeria Tariq, Namrah Aziz, Hina Inam, Mahim Malik

Medical College Documents

The coronovirus disease-2019 pandemic has severely impacted surgical education and training in Pakistan and worldwide, causing problems, such as risk of infection, limited hands-on training, examination delays, and trainee redeployment to non-surgical specialties. The current review was planned to describe innovative strategies adopted by surgical training programmes worldwide in order to suggest comprehensive recommendations at the level of the College of Physicians and Surgeons Pakistan and individual institutions to counter the challenges presented by the pandemic in Pakistan. The innovative use of technology, including open-access online educational portals, virtual educational activities and simulation-based learning, can help reform education delivery during …

Risk Factors For Suicide In Bangladesh: Case-Control Psychological Autopsy Study, S M Yasir Arafat, M A. Mohit, Mohammad S I. Mullick, Russell Kabir, Murad M. Khan

Department of Psychiatry

Background: Suicide is an important, understudied public health problem in Bangladesh, where risk factors for suicide have not been investigated by case-control psychological autopsy study.
Aims: To identify the major risk factors for suicide in Dhaka, Bangladesh.
Methods: We designed a matched case-control psychological autopsy study. We conducted a semi-structured interview with the next-of-kin of 100 individuals who died by suicide and 100 living controls, matched for age, gender and area of residence. The study was conducted from July 2019 to July 2020.
Results: The odds ratios for the risk factors were 15.33 (95% CI, 4.76-49.30) for the presence of …

The Influence Of Coronavirus Disease-2019 (Covid-19) On Parkinson’S Disease: An Updated Systematic Review, Vikash Jaiswal, Danah Alquraish, Zouina Sarfraz, Azza Sarfraz, Shavy Nagpal, Prakriti Singh Shrestha, Dattatreya Mukherjee, Prathima Guntipalli, Diana F. Sánchez Velazco, Arushee Bhatnagar

Department of Paediatrics and Child Health

Background: COVID-19 has affected global communities with multiple neurological complications in addition to other critical medical issues. COVID-19 binds to the host's angiotensin-converting enzyme 2 (ACE2) receptors, which are expressed in the neurons and glial cells, acting as an entry port to the central nervous system (CNS). ACE2 receptors are abundantly expressed on dopamine neurons, which may worsen the prognosis of motor symptoms in Parkinson's disease (PD). SARS-CoV-2 may lead to an indirect response via immune-mediated cytokine storms and propagate through the CNS leading to damage. In this systematic review, we aim to provide thorough analyses of associations between COVID-19 …

Association Of Helicobacter Pylori Caga And Vaca Genotypes With Gastric Adenocarcinoma In Kenya, Priscilla Waithira Njenga

Master of Medicine in Anatomic Pathology

Background: Helicobacter pylori infects approximately half of the world’s population. The main virulence factors, CagA and VacA, are associated with chronic gastritis and cancer. Notable geographic and temporal variations in the prevalence and genotypes of H. pylori in relation to gastric pathologies have been observed, however, their significance and trends in African populations is scantly described. The aim of this study was to investigate the association of H. pylori and its respective CagA and VacA genotypes with gastric adenocarcinoma and to describe the trends of H. pylori genotypes over the last 8 years (2012-2019). Materials and Methods: A total of …

Learning From Changes Concurrent With Implementing A Complex And Dynamic Intervention To Improve Urban Maternal And Perinatal Health In Dar Es Salaam, Tanzania, 2011-2019, Brenda Sequeira Dmello, Ziada Sellah, Grace Magembe, Natasha Housseine, Nanna Maaløe, Thomas Van Den Akker, Dan W. Meyrowitsch, Timothy Mushi, Mangalu Masweko, Dorcas Jidayi, Jos Van Roosmalen, Hussein Kidanto

Faculty of Health Sciences, East Africa

Introduction Rapid urbanisation in Dar es Salaam, the main commercial hub in Tanzania, has resulted in congested health facilities, poor quality care, and unacceptably high facility-based maternal and perinatal mortality. Using a participatory approach, the Dar es Salaam regional government in partnership with a non-governmental organisation, Comprehensive Community Based Rehabilitation in Tanzania, implemented a complex, dynamic intervention to improve the quality of care and survival during pregnancy and childbirth. The intervention was rolled out in 22 public health facilities, accounting for 60% of the city’s facility births.

Methods Multiple intervention components addressed gaps across the maternal and perinatal continuum of …

Covid-19 Presenting With Spontaneous Pneumothorax, Intisar Ahmed, Hunaina Shahab, Muhammad Arslan Ahmed, Muhammad Sohaib

Section of Cardiology

The coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The disease mainly affects respiratory system. Its common clinical findings include fever, cough and shortness of breath. Characteristic radiological features of the disease include peripherally distributed, bilateral ground-glass opacities, predominantly involving the lower lung zones. In this report, we present a case of COVID-19 disease presenting with spontaneous pneumothorax. A 26-year male patient was admitted to the Emergency Department with fever, dry cough, shortness of breath and right-sided chest pain. Radiographic imaging of the patient revealed pneumothorax on the right and peripherally distributed non-homogenous opacification. …

Determining The Disability Status Of Adult Patients Post General Intensive Care Unit (Icu) Discharge At The Aga Khan University Hospital, Nairobi Using The World Health Organization Disability Assessment Schedule 2.0(Whodas)., Khadija Ahmed

Master of Medicine in Anaesthesiology

Background: Critical care has evolved throughout the years since the polio outbreak when the first ICU was set up in the USA. There is an increasing number of survivors of critical illness. The survivors have been shown to have prolonged physical, cognitive, and psychological impairments. There is no current information on the status of this patient post-ICU in Africa. Objectives: To measure the disability status of adult patients post general Intensive Care Unit (ICU) Discharge Using WHODAS 2.0.To determine the factors associated with the degree of disability. Methodology: This was a cross-sectional analytical study. Patients admitted to AKUHN ICU, were …

Prevalence And Severity Of Malnutrition In People Living With Hiv On Chronic Haemodialysis In Dar Es Salaam., Hanifa Mbithe

Master of Medicine in Internal Medicine

BACKGROUND: Human immunodeficiency virus is still a global burden more so in sub-Saharan Africa. Chronic kidney disease and end-stage renal disease are important comorbid conditions that are prevalent in HIV-infected individuals. Patients who are HIV positive and on hemodialysis have triple risk factors for development of malnutrition (i.e. Human immunodeficiency virus, chronic kidney disease, and haemodialysis). Malnutrition greatly impacts these patient’s morbidity and mortality and thus the great need to address this gap which will improve their prognosis. OBJECTIVE: The objective of the study was to assess the prevalence and severity of malnutrition in people living with HIV on chronic …

Post Operative Sore Throat: Comparison Between Macintosh Versus Video Laryngoscope In Patients Intubated By Trainee Anaesthetists - A Randomised Control Trial, Amin Ahmed Kapadia, Faraz Shafiq, Amir Raza

Department of Anaesthesia

Objectives: Postoperative sore throat (POST) is a common complication related to endotracheal intubation. The aim of this study was to compare the incidence of POST in patients intubated by trainee anaesthetist using Video Laryngoscope™ (VDL) or Conventional Macintosh Laryngoscope (CL).
Methods: Total 110 patient scheduled for elective laparoscopic cholecystectomy were included from main operating room of Aga Khan University Hospital between June 2017-2018. The standardized perioperative protocol was used for general anaesthesia. Selected patients were randomly allocated into conventional laryngoscopy (CL) group or video laryngoscopy (VDL) group. The evaluation of sore throat was done at 1st, 12th and 24th hour …

Sexual Behaviour Patterns And Sti Risk: Results Of A Cluster Analysis Among Men Who Have Sex With Men In Portugal, Karel Blondeel, Sonia Dias, Martina Furegato, Armando Seuc, Ana Gama, Ricardo Fuertes, Luís Mendão, Marleen Temmerman, Igor Toskin

Obstetrics and Gynaecology, East Africa

Objectives: Portugal has the highest HIV incidence rate in Western Europe. The proportion assigned to sexual contact between men recently increased to more than 30% of all HIV infections. Men who have sex with men (MSM) are vulnerable to the acquisition of other sexually transmitted infections (STIs), increasing the per-contact risk of HIV infection. Building on syndemic theory, the aim of this analysis was to identify patterns of current sexual behaviour in MSM, and explore their relationship with self-reported current, past STI diagnoses and HIV positive serostatus.

Design: A cross-sectional behavioural survey was conducted in Portugal among MSM, using a …

Imaging Patterns Of Encephalopathy In Patients With Covid-19, Kumail Khandwala, Fatima Mubarak, Nadeem Ahmad

Department of Radiology

The aim of this retrospective observational study was to describe the neuroimaging manifestations of patients with COVID-19. This study was conducted at Aga Khan University Hospital, Karachi, Pakistan from March to July 2020. COVID-19 patients with neurological symptoms and positive neuroimaging were included after confirmation of COVID-19 by polymerase chain reaction test (PCR). In the 12 included patients, seizures and altered mentation were predominant neurological manifestations. Three cases had acute watershed infarcts (25%), two cases had posterior cerebral artery territorial infarcts (16.7%), two cases had periventricular corona radiata infarcts (16.7%), three cases had hypoxic ischemic encephalopathy (25%), two cases had …

Uptake And Determinants Of Cervical Cancer Screening Among Health Care Workers In Aga Khan University Hospital, Nairobi Kenya., Doreen Moraa Osoro

Master of Medicine in Obstetrics and Gynecology

Background: The cancer burden has been rising globally. The reported incidence of cervical cancer is 13.1 / 100,000 globally and 40 / 100,000 in Kenya. Up to 88% of all cervical cancer deaths have been reported in lower to middle-income countries. In comparison, developed countries had up to two to four times lower rates of cervical cancer incidence and mortality. The burden of cancers attributable to carcinogenic infections has potentially modifiable risk factors, for which prevention tools already exist. There is a gap in the implementation of evidence-based interventions including primary prevention with the HPV vaccine and secondary prevention with …

Repair Of Vesicouterine Fistula By Not Using Traditional O' Connor Method, Lubna Razzak, Raheela Mohsin Rizvi

Department of Obstetrics & Gynaecology

A 25-year-old female patient visited our clinic with complaint of cyclic haematuria. She had previous two Caesarean Sections at a secondary care hospital. Her complete urinalysis showed abundant red blood cells. Through computed tomography a fistula tract between the posterior wall of the bladder and the anterior wall of the lower uterine segment was diagnosed. The Cystoscopy revealed a fistulous opening with a diameter of nearly 1.5 cm localized between the bladder and uterine cavity. Fistulae was repaired by abdominal approach without transection of bladder. Surgery was performed by mobilization of bladder and wide anterior uterine dissection. A 2cm defect …

Challenges During Colonoscopy In Women With A Prior Hysterectomy, Lubna Kamani, Nazish Butt, Hanisha Khemani

Section of Gastroenterology

No abstract provided.

Simulation Based Team Training In Surgery - A Review, Syed Muhammad Nazim, Qamar Riaz

Section of Urology

The healthcare environment in surgery is complex, dynamic and often ambiguous. Besides subject knowledge and technical skills, other competencies, such as team work, communication skills and situation awareness, are required to ensure better patient-related outcome. Teams that demonstrate poor non-technical skills make more technical errors, often resulting in patient morbidity or mortality. Different hospital-based locations, such as operating rooms, intensive care units, emergency rooms and surgical wards, are the areas where poor team dynamics prevail. Simulation-based team training is a strategy to provide inter-professional training and experiential learning opportunities for surgeons, anaesthetists and allied health professionals. It helps them to …

The Injustice Of Unfit Clinical Practice Guidelines In Low-Resource Realities, Nanna Maaløe, Anna Marie Rønne Ørtved, Jane Brandt Sørensen, Brenda Sequeira Dmello, Thomas Van Den Akker, Monica Lauridsen Kujabi, Hussein Kidanto, Tarek Meguid, Ib Christian Bygbjerg

Obstetrics and Gynaecology, East Africa

To end the international crisis of preventable deaths in low-income and middle-income countries, evidence-informed and cost-efficient health care is urgently needed, and contextualised clinical practice guidelines are pivotal. However, as exposed by indirect consequences of poorly adapted COVID-19 guidelines, fundamental gaps continue to be reported between international recommendations and realistic best practice. To address this long-standing injustice of leaving health providers without useful guidance, we draw on examples from maternal health and the COVID-19 pandemic. We propose a framework for how global guideline developers can more effectively stratify recommendations for low-resource settings and account for predictable contextual barriers of implementation …

Planned Delivery At 37 Weeks Gestation Versus Expectant Management For Non-Severe Chronic Hypertension, A Systematic Review., Jackson Njuguna

Master of Medicine in Obstetrics and Gynecology

Background: Chronic hypertension is independently associated with an increased incidence of adverse maternal and perinatal outcomes. Delayed delivery carries maternal risks, while early delivery increases fetal risk, so appropriate timing is important. The optimal timing of delivery for women with this condition has not been adequately addressed by the available literature. Objective: To review the literature that assesses the benefits and risks of a policy of planned delivery versus expectant management in pregnant women with non-severe chronic hypertension at 37 weeks gestation. Our primary outcomes were composite maternal outcome (super-imposed pre-eclampsia, placental abruption, maternal admission to intensive care unit and …

Aesthetic Rehabilitation In A Patient With Skeletal Mandibular Deficiency And Open Bite: Journey From Splinted Metalloceramic Prosthesis To All-Ceramic Crowns, Rizwan Nazeer, Shizrah Jamal, Farhan Raza Khan

Section of Dental-Oral Maxillofacial Surgery

This case report is of a 31-year-old female who presented with splinted and faulty metalloceramic prosthesis on maxillary anterior teeth, which was responsible for localised periodontal disease and poor aesthetics. At multiple sites the ceramic had chipped off and the prosthesis colour did not match with the adjacent healthy teeth. A multidisciplinary approach of endodontics, periodontics and prosthodontics was employed for this case. The treatment plan consisted of removing the faulty prosthesis, endodontic retreatment of inadequately root-treated teeth and endodontics in the other coronally prepared abutment teeth. Crown lengthening surgery was performed for the correction of periodontal pockets and high …

Inculcating Research Curriculum In Operative Dentistry - Endodontics Residency Programme: Experience And Outcomes, Farhan Raza Khan, Rabia Ghafoor, Fahad Umer, Munawar Rahman

Section of Dental-Oral Maxillofacial Surgery

Incorporating research education and training in residency curriculum increases the understanding of evidence-based decision-making among doctors in training. Evidence suggests that the addition of research is linearly associated with improvement in clinical competence, and encourages the residents to shape their career as clinical investigators. The current paper was planned to share the experience of adding research into the core curriculum of Operative Dentistry-Endodontics residency programme at a tertiary care university hospital, and to evaluate the outcome achieved with that change.

Concomitant Essential Thrombocythemia And Mature B -Lymphoproliferative Disorder In A Patient, Ayesha Butt, Ruhul Quddus, Natasha Bahadur Ali

Section of Haematology/Oncology

A-64-year old male presented with cough, weight loss, and maculopapular rash for 15-20 days. On examination, he was found to have cervical lymphadenopathy and splenomegaly. His leukocyte count was 62.1x109/L, platelets were 1169x109/L and LDH was 816 IU/L. Peripheral blood film showed a leukoerythroblastic picture with thrombocytosis. He was started on hydroxyurea and allopurinol. Subsequently, bone marrow evaluation was done which depicted increased lymphoid cells with an M:E ratio of 4:1. Cellular areas exhibited an increase in myeloid precursors along with prominent lymphoid cells and abundant megakaryocytes. Immunohistochemistry showed an increase in B-lymphocytes. Grade MF-2 reticulin fibrosis was noted. Overall …

The Effectiveness Of Digital Health Interventions For Weight Loss In Postpartum Women: A Systematic Review And Meta-Analysis, Logan Rabuogi

Master of Medicine in Family Medicine

Objectives: This systematic review and meta-analysis aimed (1) to determine the effectiveness of digital health intervention (DHI) components on weight loss in postpartum women, (2) to determine the effect of DHIs on body mass index and (3) to determine the attrition rates within DHIs. Methods: Electronic searches were conducted on PubMed (MEDLINE), Cochrane Library, Google Scholar, and Web of Science from inception to 22nd April 2020. Studies included were; (1) randomized controlled trials (RCT), quasi-experimental trials, and controlled before-after studies (2) of weight loss interventions delivered by either website, Internet, email, computer, Apps, SMS, phone call, or video player (3) …

Radiographic Patterns Of Different Aetiologies Of Community Acquired Pneumonia In Patients Presenting To Aga Khan University, Hanika Ajaykumar Patel

Master of Medicine in Imaging and Diagnostic Radiology

Background: Community-acquired pneumonia (CAP) is a major cause of significant morbidity and mortality globally. The spectrum of causative organisms of CAP varies markedly with region as well as with the immune status of the patient. Chest radiography remains an important initial imaging modality in the diagnostic work-up of patients with CAP. Although previous studies have highlighted major trends and radiographic patterns of various causative organisms of CAP, there is a paucity of recent literature within Sub-Saharan Africa on these various radiographic patterns. Objective: The primary objective of this study was to identify the association between the radiographic patterns of different …

Innovation In Surgical Training: Simulating Prosthetic Heart Valves And Annuloplasty Rings Using Pacifiers For Cardiac Surgery Wet-Labs In A Resource Limited Setting, Sara Iqbal, Waris Ahmad

Section of Cardiothoracic Surgery

Conducting a hands-on cardiac wet-lab on valvular surgeries in a resource-limited setting is restricted by the lack of prosthetic heart valves and annuloplasty rings for developing cognitive and technical skills required to understand and protect the three-dimensional cardiac anatomy. In recent times, simulation is regarded as an effective tool in surgical education and has proven to improve the technical skills of trainees. The current short report presents a novel simulator to mimic heart valve replacement surgeries by using a pacifier as a prosthetic valve and annuloplasty ring. Considering resource-constraints in the local context, pacifier-based valve simulators can be usedful as …

Paradigm Shift In The Surgical Training: The Era Of Innovation, Simulation And Beyond, Syed Shahabuddin, Shiraz Hashmi, Yasir Khan, Shahid Ahmed Sami

Section of Cardiothoracic Surgery

This is an era of transformation of surgical education and training. Modern methods of training are being introduced at a rapid pace and are being adopted in surgical practice not only to improve the outcomes and patient satisfaction, but also to provide an opportunity to develop a new well-structured training curriculum by integrating both traditional and modern approaches to teach and learn surgical skills. Various surgical simulators are in use as training aids and are constantly undergoing further refinement and development. To achieve a smooth transition in surgical training to modern methods, a structured programme has to be developed and …

Surgical Education And Training, Ather Enam, Hammad Ather, Nadeem Ahmed Siddiqui

Section of Neurosurgery

No abstract provided.

Workplace Based Assessment: Tools To Assess Competencies In A Clinical Setting, Amber Shahmim Sultan, Rahila Ali, Sara Shakil, Rehan Nasir Khan

Department for Educational Development

The apprenticeship model has been used for long in surgical training. It initially provides opportunity to the trainee to observe the attending surgeon, followed by gradual introduction to surgical technique under direct supervision and later with detached supervision. The attending provides informal feedback at different intervals to the trainee. Several changes have been made in postgraduate programmes with a shift towards using workplace-based assessment tools for formative and summative evaluation of the trainee's clinical skills.

Impact Of A Global Pandemic On Surgical Education And Training- Review, Response, And Reflection, Sabah Uddin Saqib, Omair Saleem, Amna Riaz, Qamar Riaz, Hasnain Zafar

Section of General Surgery

The catastrophic effects of the coronavirus disease-2019 global pandemic have revolutionised human society. The unprecedented impact on surgical training needs to be analysed in detail to achieve an understanding of how to deal with similar situations arising in the foreseeable future. The challenges faced by the surgical community initiated with the suspension of clinical activities and elective practice, and included the lack of appropriate personal protective equipment, and the self-isolation of trainees and reassignment to coronavirus patient-care regions. Together, all these elements had deleterious effects on the psychological health of the professionals. Surgical training irrespective of specialty is equally affected …

Peer-Led Surgery Education: A Model For A Surgery Interest Group, Muhammad Ali, Shahmir Chauhan, Ayesha Noor, Sadaf Khan, Ather Enam, Sig Core

Medical College Documents

We present a systematic, sustainable, student-led model for a Surgery Interest Group in a low and middle-income country setting to encourage other medical students to establish similar groups in their institutions. Our model was developed at the Aga Khan University Medical College, Karachi, and is comprised of medical students, teaching associates, residents, faculty and alumni. The group focuses on connecting medical students with an interest in surgery with opportunities to help them match in surgery training programs. The opportunities include, but are not limited to, skill development, personal development, mentorship and research. Our model has shown growth and expansion over …