Medical Specialties Commons^™

Burden Of Care As Perceived By Informal Caregivers Of The Patients Receiving Chemotherapy In Tertiary Care Hospital Of Karachi, Pakistan, Asher Ghori, Rubina Barolia, Naghma Rizvi, Ghulam Qadir

School of Nursing & Midwifery

Background: Almost 32.5 million people are diagnosed with cancer annually. The huge number of cancer patients with deteriorating health renders a far greater number of informal caregivers bearing the burden of care in different forms and magnitude. The main purpose of the study was to explore the types of burden perceived by the informal caregivers and the factors associated with the caregiving burden.
Methods: A quantitative descriptive cross-sectional study design was adopted to answer the research questions from April to May 2016. Around 200 informal caregivers were recruited from one of the tertiary hospitals of Karachi, Pakistan. The modified ZBIS …

Covid-19 Pandemic: Economic Burden On Patients With Musculoskeletal Injuries In A Tertiary Care Hospital Of Lmic; Retrospective Cross Sectional Study, Pervaiz Hashmi, Shah Fahad, Hammad Naqi Khan, Marij Zahid, Anum Sadruddin Pidani, Shahryar Noordin

Section of Orthopaedic Surgery

Covid-19 has adversely impacted the health care organizations by over burdening with Covid patients and suspending the elective surgeries and clinics. Hospitalization during pandemic may increase health cost of patients for elective and emergency procedure due to extra cost of covid testing and isolation. A single center retrospective study was conducted to quantify losses due to postponement of elective surgeries and extra cost for procurement of PPEs. The secondary objective was to see the effect of Covid -19 on the total costs of inpatient care during Covid era.
Patient and method: We included all the patients admitted in orthopedic section …

Illness Severity And Outcomes Among Enteric Fever Cases From Bangladesh, Nepal, And Pakistan: Data From The Surveillance For Enteric Fever In Asia Project, 2016-2019, Ashley T. Longley, Caitlin Hemlock, Kashmira Date, Stephen P. Luby, Jason R. Andrews, Samir K. Saha, Isaac I. Bogoch, Mohammad Tahir Yousafzai, Denise O. Garrett, Farah Naz Qamar

Department of Paediatrics and Child Health

Background: Enteric fever can lead to prolonged hospital stays, clinical complications, and death. The Surveillance for Enteric Fever in Asia Project (SEAP), a prospective surveillance study, characterized the burden of enteric fever, including illness severity, in selected settings in Bangladesh, Nepal, and Pakistan. We assessed disease severity, including hospitalization, clinical complications, and death among SEAP participants.
Methods: We analyzed clinical and laboratory data from blood culture-confirmed enteric fever cases enrolled in SEAP hospitals and associated network laboratories from September 2016 to September 2019. We used hospitalization and duration of hospital stay as proxies for severity. We conducted a follow-up interview …

Healthcare Utilization Patterns For Acute Febrile Illness In Bangladesh, Nepal, And Pakistan: Results From The Surveillance For Enteric Fever In Asia Project, Jason R. Andrews, Krista Vaidya, Shampa Saha, Mohammad Tahir Yousafzai, Caitlin Hemlock, Ashley Longley, Kristen Aiemjoy, Alexander T. Yu, Isaac I. Bogoch, Farah Naz Qamar

Department of Paediatrics and Child Health

Background: Characterizing healthcare-seeking patterns for acute febrile illness is critical for generating population-based enteric fever incidence estimates from facility-based surveillance data.
Methods: We used a hybrid model in the Surveillance for Enteric Fever in Asia Project (SEAP) to assess incidence of enteric fever at 6 study hospitals in 3 countries. We recruited individuals presenting to the hospitals and obtained blood cultures to evaluate for enteric fever. For this analysis, we undertook cluster random household surveys in Dhaka, Bangladesh (2 sites); Karachi, Pakistan; Kathmandu, Nepal; and Kavrepalanchok, Nepal between January 2017 and February 2019, to ascertain care-seeking behavior for individuals with …

Challenges For Dementia Care And Research In Pakistan, Fatima Siddiqui, Qurat Khan, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

Dementia is a syndrome characterized by a decline in cognition and memory severe enough to interfere with daily life activities and is one of the major causes of disability and dependency in elderly worldwide with Alzheimer’s disease being the most common cause of dementia (1). 703 million individuals (9% of the world’s population) are more than 65 years of age and this number will double by the end of 2050 reaching 1.5 billion (16% of the world’s population) (2). Ageing has been the fastest in Eastern and South Eastern countries (3). Despite being a global health priority, with significant social …

Epidemiology Of Staphylococcus Aureus Infections In Kenya: Current State, Gaps And Opportunities, Justin Nyasinga, Geoffrey Omuse, John Njenga, Andrew Nyerere, Shima Abdulgader, Mae Newton, Andrew Whitelaw, Gunturu Revathi

Pathology, East Africa

Staphylococcus aureus has maintained its clinical relevance as a major cause of hospital and community acquired infections globally with a high burden of antimicrobial resistance (AMR). Though reported, the burden of infection, antimicrobial resistance and molecular epidemiology of S. aureus are not well defined in Kenya. This descriptive review evaluated reported data on the detection and characterization of S. aureus infections in Kenya. Published data between 2000 and 2020 were evaluated. S. aureus isolation frequencies varied from 1% in blood specimens to 52.6% among skin and soft tissues infections while MRSA rates ranged from 1% to 84.1%. While penicillin resistance …

Early Marriage And Early Childbearing In South Asia: Trends, Inequalities, And Drivers From 2005 To 2018, Samuel Scott, Phuong Hong Nguyen, Sumanta Neupane, Priyanjana Pramanik, Priya Nanda, Zulfiqar Ahmed Bhutta, Kaosar Afsana, Purnima Menon

Woman and Child Health

Early marriage (EM) and early childbearing (ECB) have far-reaching consequences. This study describes the prevalence, trends, inequalities, and drivers of EM and ECB in South Asia using eight rounds of Demographic and Health Survey data across 13 years. We report the percentage of ever-married women aged 20-24 years (n = 105,150) married before 18 years (EM) and with a live birth before 20 years (ECB). Relative trends were examined using average annual rate of reduction (AARR). Inequalities were examined by geography, marital household wealth, residence, and education. Sociodemographic drivers of changes for EM were assessed using regression decomposition analyses. We …

Rigorous Hand Hygiene Practices Among Health Care Workers Reduce Hospital-Associated Infections During The Covid-19 Pandemic, Rozina Roshan, Anam Shahil Feroz, Zohra Rafique, Nazleen Virani

Section of Internal Medicine

The experiences of these recent months have left us with as many new questions as they have given us new solutions. The main question that infection prevention and control department is having these days is "Why have hospital-associated infections (HAIs) reduced during COVID-19 pandemic?" What is the one unique strategy that has brought decline in increasing HAIs? Would it be appropriate to say that rigorous hand hygiene practices among health care workers (HCWs) have reduced HAIs in a tertiary care hospital of Pakistan? This commentary is written to understand the effect of rigorous hand hygiene among HCWs on number of …

Promoting Positive Birth Experiences: Supporting Pregnant And Lactating Women During The Covid-19 Crisis, Marina Baig, Shelina Bhamani, Zohra Kurji, Lumaan Sheikh, Rozina Karmaliani

Journal of Asian Midwives (JAM)

The World Health Organization (WHO) declared the COVID-19 outbreak a public health emergency of international concern, in January 2020. While international organizations and governments strive to strengthen the world’s emergency response mechanism to combat the pandemic, the public in general faces anxiety and fear. One of the most vulnerable groups is pregnant and lactating women. The pandemic has given rise to many apprehensions about the state of their health and well-being as well as that of their unborn or newly born child. A live Facebook session was conducted by a group of experts from a private university in Karachi, Pakistan, …

Contraceptive And Reproductive Health Practices Of Unmarried Women Globally, 1999 To 2018: Systematic Review And Meta-Analysis, Meng-Yao Wang, Marleen Temmerman, Wei-Hong Zhang, Yu Fan, Yi Mu, Si-Ping Mo, Ai Zheng, Jin-Ke Li

Obstetrics and Gynaecology, East Africa

Background: Premarital sex practices and contraceptive prevalence rate (CPR) among unmarried women worldwide remain unclear, even though unmarried women tend to have multiple sex partners over time, which makes their sexual behaviors particularly important to the sexual and reproductive health of society more broadly.

Methods: We searched the MEDLINE, PubMed, and Google Scholar databases for relevant articles published between January 1, 1999 and December 31, 2018. Data on prevalence of premarital sexual intercourse, use of highly prevalent contraceptive methods, as well as CPR overall and at first sexual intercourse were extracted and estimated using a DerSimonian- Laird random effects model. …

Acute Ischemic Stroke Treatment Barriers In Pakistan, Saima Ahmad, Umair Rashid, Ossama Mansour, Sohail Akhtar

Pakistan Journal of Neurological Sciences (PJNS)

Worldwide stroke is the second most common cause of death and the third most common cause of disability (1). No large-scale epidemiological studies are available to determine the true incidence of stroke in Pakistan. There is only one published stroke prevalence study which was conducted in a community residing in Karachi, the prevalence was 4.8%, however the results of the study should be interpreted with caution as a non-validated questionnaire was used. (2). Another community-based survey suggested as estimated 21.8% prevalence of stroke in an urban slum of Karachi (3). These studies although published in local journals but do not …

Spectrum Of Fugitive Diagnosis Of Neurological Disorders In Elderly, Safia Bano, Ayesha Aslam, Adnan Tariq, Adnan Mahmood, Rashid Imran, Ahsan Numan

Pakistan Journal of Neurological Sciences (PJNS)

ABSTRACT BACKGROUND Fugitive diagnosis “escape from true diagnosis” of neurological disorders is very common in elderly patients. It’s not always an underlying disease symptom or progression in old age. Aim of this study is to determine the frequency and nature of fugitive diagnosis of neurodegenerative brain disorders in old age. MATERIAL AND METHODS STUDY DESIGN A study was conducted in private Neuro-clinic in Lahore. Study duration is 3 years from to 1st January, 2017 to 31th December, 2019. It was a prospective, cross sectional study. Inclusion criteria: 1) Age >60years 2) Neurodegenerative brain disorders including vascular dementia 3) with or …

Prevalence Of Depression In Patients With Migraine, A Cross-Sectional Study From A Tertiary Care Hospital, Zuhaib Ahmed, Umar Farooque, Aijaz Ali, Syeda Urooj Riaz, Muhammad Ramzan, Vijaya Chaitanya Bollampally, Ehtesham Zahoor, Omer Cheema, Mujeeb Ur Rehman, Rizwan Farooque, Muhammad Daim Bin Zafar

Pakistan Journal of Neurological Sciences (PJNS)

BACKGROUND Headache is one of the most common presenting complaints in patients attending primary care centers and the majority of them have primary headache syndromes. Depressive disorders are among the leading causes of disability globally and can further complicate the clinical manifestation if coupled with other comorbidities. Therefore, the primary objective of our study was to determine the prevalence of depression in migraine patients presenting at a tertiary care hospital to better understand the leading causes of the disease. METHODS A cross-sectional study was carried out between December 2019 and June 2020 (six months) including 66 migraine patients between 18 …

Factors Affecting Treatment Compliance In Psychiatric Setting, Yasirah Gohar, Uroosa Talib, Nasir Mehmood

Pakistan Journal of Neurological Sciences (PJNS)

No abstract provided.

Evaluation Of Post Therapy Functional Status And Residual Weakness Of Patients With Guillain-Barre Syndrome, Iqra Athar, Anam Anis, Mansoor Iqbal, Sumaira Nabi, Mazhar Badshah, Syeda Rida

Pakistan Journal of Neurological Sciences (PJNS)

ABSTRACT: Introduction: The annual global incidence of Guillain-Barre Syndrome is approximately 1–2 per 100,000 person-years. Data on Guillain-Barre Syndrome is very rare from Pakistan, we conducted a retrospective study to assess the clinical presentation, and treatment response of these patients.

Obturator Nerve Block With Aqueous Phenol Reduces Hip Adductor Spasticity – A Single Centre Experience, Sarah Razaq, Fahim Anwar, Muhammad Aleem Arshad

Pakistan Journal of Neurological Sciences (PJNS)

ABSTRACT

Aim: Spasticity is a cardinal symptom of upper motor neuron disorders. It affects different individuals differently.

Spasticity in the hip adductor muscles can be very painful and may result in postural abnormalities and hip deformities

that interfere with walking, transferring and perineal hygiene. The study aimed to assess the effectiveness of phenol

obturator nerve block on hip adductor spasticity caused by the upper motor neuron lesions.

Materials and methods: This is a single-centre retrospective study of all patients with known spasticity in the hip

adductors who were assessed suitable for phenol nerve block of the obturator nerve. All patients …

Assessment Of Dementia Caregiver Burden In Karachi, Pakistan Using 10/66 Protocol, Qurat Ul Ain Khan

Pakistan Journal of Neurological Sciences (PJNS)

ABSTRACT INTRODUCTION: Care arrangements and caregiver burden of people with dementia (PWD) are different in low and middle income countries (LMICs) than in developed countries. This is the first study in Pakistan assessing caregiver burden using the 10/66 protocol. METHOD: PWD were recruited from outpatient clinics and from the community in Karachi and were diagnosed according to DSM-IV TR. Three scales were used: 1. Zarit Burden Interview (ZBI) to assess caregiver burden. 2. Caregiver Activity Survey (CAS) to assess activities that the caregiver engaged in the last 24 hours to care for PWD and 3. General Health Questionnaire- 12 (GHQ …

A Case Of Heroin Induced Toxic Leukoencephalopathy, Sidra Sattar, Saba Zaidi

Pakistan Journal of Neurological Sciences (PJNS)

ABSTRACT: Heroin-induced leukoencephalopathy comes under the category of Toxic leukoencephalopathies. We report the case of middle-aged gentleman with the history of polysubstance abuse who presented with recurrent falls, difficulty in walking and drowsiness. Diffuse white matter changes were appreciated on MRI Brain with sparing of cerebellum. In context of his history of inhalational heroin abuse with extensive symmetrical white matter changes in cerebrum, a diagnosis of heroin induced toxic leukoencephalopathy was made.

Hemichorea Associated With Type 2 Diabetes: A Rare Neurological Complication, Waleed Shahzad, Tehmina Inayat, Fibhaa Syed, Mohammad Ali Arif, Muhammad Hassan, Haris Majid Rajput, Mazhar Badshah

Pakistan Journal of Neurological Sciences (PJNS)

Diabetic hemichorea/hemiballism is a spectrum of hyper kinetic, involuntary, irregular, purposeless, non-rhythmic, rapid and unsustained movements flowing from one part of the body to another. It involves contra lateral basal-ganglia and often striatum of the brain. Here we are reporting an un-usual case of choreiform movement disorder which was sudden in onset. It was accompanied with abnormally high values of blood glucose. Our patient had a complete remission of symptoms after an adequate control of blood glucose was achieved. This case illustrates the importance and rarity of hyperglycemia as a rare cause of hemichorea. It recovers rapidly and has a …

Longitudinally Extensive Transverse Myelitis And Neuromyelitis Optica Spectrum Disorder: A Tertiary Care Centre Experience, Safia Bano, Muhammad Athar Javed, Ahsan Numan

Pakistan Journal of Neurological Sciences (PJNS)

ABSTRACT OBJECTIVE: To determine the frequency of longitudinally extensive transverse myelitis and Causes of longitudinally extensive transverse myelitis METHODOLOGY: A Cross-Sectional, retrospective study was conducted at Neurology Department, Mayo Hospital, Lahore from 1st January 2015 to 31st December 2015. Patients were included from inpatient with history of weakness of lower limbs/all four limbs with or without visual disturbances. History and clinical examination was consistent with transverse myelitis. Neuroimaging (MRI brain, (orbit in case of optic neuritis) and spinal cord) was done followed by LP/CSF, Vasculitis screening.

Towards Pragmatic Adaptations: Orthopedic Surgery Amidst The Coronavirus Disease 2019 Pandemic, Maryam Ehtesham, Talal Almas, Muhammad Ali Niaz, Absam Akbar

Medical College Documents

No abstract provided.

Change In The Spectrum Of Orthopedic Trauma: Effects Of Covid-19 Pandemic In A Developing Nation During The Upsurge; A Cross-Sectional Study, Pervaiz Mahmood Hashmi, Marij Zahid, Syed Arif Ali, Hammad Naqi Khan, Anum Sadruddin Pidani, Alizah Pervaiz Hashmi, Shahryar Noordin

Section of Orthopaedic Surgery

Background: The COVID-19 pandemic has caused a great impact on orthopedic surgery with a significant curtailment in elective surgeries which is the major bread and butter for orthopedic surgeons. It was also observed that the spectrum of orthopedic trauma injuries has shifted from more severe and frequent road traffic accidents (high energy trauma) to general, low energy house-hold injuries like low energy fractures in the elderly, pediatric fractures, house-hold sharp cut injuries and nail bed lacerations. The aim of this study is to appraise the effect of the COVID-19 pandemic on orthopedic surgical practice, both inpatient and outpatient facility.
Materials …

Longitudinally Extensive Transverse Myelitis: A Sub-Saharan Conundrum, Antonina Obayo, Sylvia Mbugua, Sayed Karar

Internal Medicine, East Africa

Spinal cord schistosomiasis is a rare, underdiagnosed manifestation of schistosomiasis. We present the case of a 36-year-old male who presented to our institution with a one-week history of low back pain with rapidly progressive lower limb weakness, loss of sensation, and flaccid paraparesis. An MRI of the spine showed a longitudinally extensive transverse myelitis from T6 to L1, with enhancement at the cauda equina region. Further review of the images and serological tests eventually led to diagnosis of spinal schistosomiasis. He was treated with praziquantel and high-dose steroids, with minimal improvement in his symptoms.

Effect Of A Mobile Phone Intervention For Female Sex Workers On Unintended Pregnancy In Kenya (Whisper Or Shout): A Cluster-Randomised Controlled Trial, Frances H. Ampt, Megan S. C. Lim, Paul A. Agius, Kelly L'Engle, Griffins Manguro, Caroline Gichuki, Peter Gichangi, Walter Jaoko, Marleen Temmerman, Stanley Luchters

Obstetrics and Gynaecology, East Africa

Background: Female sex workers in low-income and middle-income countries face high risks of unintended pregnancy. We developed a 12-month, multifaceted short messaging service intervention (WHISPER) for female sex workers in Kenya who had the potential to become pregnant, to improve their contraceptive knowledge and behaviours. The aim of this study was to assess the effectiveness of the intervention to reduce the incidence of unintended pregnancy among sex workers in Kenya compared with an equal-attention control group receiving nutrition-focused messages (SHOUT).

Methods: Our two-arm, cluster-randomised controlled trial was done in sex-work venues in two subcounties of Mombasa, Kenya (Kisauni and Changamwe). …

Trend Analysis Of Lab Tests Requisitions Of Covid-19 Prognostic Biomarkers At A Clinical Chemistry Reference Laboratory-An Observational Study, Sibtain Ahmed, Farooq Ghani

Department of Pathology and Laboratory Medicine

Background: Biochemical parameters, such as C-reactive protein (C-RP), Procalcitonin (PCT), Lactate dehydrogenase (LDH) and Ferritin are associated with COVID-19 severity and prognosis. This trend analysis of COVID-19 prognostic biomarker requisitions is aimed at providing a reflection of the clinical practices adopted amidst the peak of the pandemic. This knowledge of the prognostic biomarkers utilized, will further aid to classify patients based on their risk, for optimal resource allocation and improve outcomes.
Material & methods: This cross-sectional study was conducted at the clinical chemistry laboratory at the Aga Khan University Hospital (AKUH), Karachi Pakistan. A team consisting of two clinical chemistry …

Typhoid And Paratyphoid Cost Of Illness In Pakistan: Patient And Health Facility Costs From The Surveillance For Enteric Fever In Asia Project Ii, Nelly Mejia, Farah Naz Qamar, Mohammad Tahir Yousafzai, Jamal Raza, Denise O. Garrett, Kashmira Date, Taiwo Abimbola, Sarah W. Pallas

Department of Paediatrics and Child Health

Background: The objective of this study was to estimate the cost of illness from enteric fever (typhoid and paratyphoid) at selected sites in Pakistan.
Methods: We implemented a cost-of-illness study in 4 hospitals as part of the Surveillance for Enteric Fever in Asia Project (SEAP) II in Pakistan. From the patient and caregiver perspective, we collected direct medical, nonmedical, and indirect costs per case of enteric fever incurred since illness onset by phone after enrollment and 6 weeks later. From the health care provider perspective, we collected data on quantities and prices of resources used at 3 of the hospitals, …

Multiomics Characterization Of Preterm Birth In Low- And Middle-Income Countries, Fyezah Jehan, Muhammad Imran Nisar, Muhammad Ilyas, Usma Mehmood, Aneeta Hotwani, Ambreen Nizar, Sajid Muhammad, Waqasuddin Khan, Javairia Khalid, Furqan Kabir

Department of Paediatrics and Child Health

Importance: Worldwide, preterm birth (PTB) is the single largest cause of deaths in the perinatal and neonatal period and is associated with increased morbidity in young children. The cause of PTB is multifactorial, and the development of generalizable biological models may enable early detection and guide therapeutic studies.
Objective: To investigate the ability of transcriptomics and proteomics profiling of plasma and metabolomics analysis of urine to identify early biological measurements associated with PTB.
Design, setting, and participants: This diagnostic/prognostic study analyzed plasma and urine samples collected from May 2014 to June 2017 from pregnant women in 5 biorepository cohorts in …

Burden Of Culture Confirmed Enteric Fever Cases In Karachi, Pakistan: Surveillance For Enteric Fever In Asia Project (Seap), 2016-2019, Mohammad Tahir Yousafzai, Seema Irfan, Rozina Thobani, Abdul Momin Kazi, Aneeta Hotwani, Ashraf M. Memon, Khalid Iqbal, Saqib Hamid Qazi, Nasir S. Saddal, Najeeb Rehman, Irum Fatima Dehraj, Mohammed J. Hunzai, Junaid Mehmood, Farah Naz Qamar

Department of Paediatrics and Child Health

Background: The Surveillance for Enteric Fever in Asia Project (SEAP) is a multicenter, multicountry study conducted in Pakistan, Nepal, and Bangladesh. The objectives of the study were to characterize disease incidence among patients with enteric fever. We report the burden of enteric fever at selected sites of Karachi, Pakistan.
Methods: During September 2016 to September 2019, prospective surveillance was conducted at inpatient, outpatient, surgical departments, and laboratory networks of Aga Khan University Hospital, Kharadar General Hospital, and surgery units of National Institute of Child Health and Jinnah Postgraduate Medical Centre. Socio-demographic, clinical, and laboratory data were obtained from all suspected …

A Cluster-Based, Spatial-Sampling Method For Assessing Household Healthcare Utilization Patterns In Resource-Limited Settings, Alexander T. Yu, Rajani Shakya, Bikram Adhikari, Dipesh Tamraka, Krista Vaidya, Stace Maples, Kashmira Date, Isaac I. Bogoch, Farah Naz Qamar, Mohammad Tahir Yousafzai

Department of Paediatrics and Child Health

Background: Implementation of population-based surveys is resource intensive and logistically demanding, especially in areas with rapidly changing demographics and incomplete or no enumeration of the underlying population and their residences. To remove the need for pre-enumeration and to simplify field logistics for the population healthcare utilization survey used for the Surveillance for Enteric Fever in Asia Project in Nepal, we incorporated a geographic information system-based geosurvey and field mapping system into a single-stage cluster sampling approach.
Methods: A survey was administered to ascertain healthcare-seeking behavior in individuals with recent suspected enteric fever. Catchment areas were based on residential addresses of …

Utilization Of Blood Culture In South Asia For The Diagnosis And Treatment Of Febrile Illness, Caitlin Hemlock, Stephen P. Luby, Shampa Saha, Farah Naz Qamar, Jason R. Andrews, Samir K. Saha, Dipesh Tamrakar, Kashmira Date, Ashley T. Longley, Denise O. Garrett, Isaac I. Bogoch

Department of Paediatrics and Child Health

Background: Blood culture is the current standard for diagnosing bacteremic illnesses, yet it is not clear how physicians in many low- and middle-income countries utilize blood culture for diagnostic purposes and to inform treatment decisions.
Methods: We screened suspected enteric fever cases from 6 hospitals in Bangladesh, Nepal, and Pakistan, and enrolled patients if blood culture was prescribed by the treating physician. We used generalized additive regression models to analyze the probability of receiving blood culture by age, and linear regression models to analyze changes by month to the proportion of febrile cases prescribed a blood culture compared with the …