Medical Specialties Commons^™

Relationship Between Smoking Habit And Sperm Parameters Among Patients Attending An Infertility Clinic, Rehana Rehman, Nida Zahid, Sofia Amjad, Mukhtiar Baig, Zohair Jamil Gazzaz

Department of Biological & Biomedical Sciences

Background: This study aimed to estimate stress markers, oxidative stress (OS), reproductive hormones and sperm parameters in male smokers and non-smokers and observe the impact of oxidative stress markers and smoking on sperm count, motility and morphology in a selected population of Karachi, Pakistan.
Methods: This cross-sectional study was conducted from July 2017 to July 2018 at Aga Khan University (AKU), in Karachi, Pakistan. The subjects were recruited from the Sindh Institute of Reproductive Medicine (SIRM), Karachi based on defined inclusion criteria. The subjects were categorized into fertile and infertile based on cut off values of sperm parameters as recommended …

Perceptions Of Health Professionals Regarding Minimally Invasive Tissue Sampling (Mits) To Identify The Cause Of Death In Stillbirths And Neonates: Results From A Qualitative Study, Anam Shahil Feroz, Anum Shiraz Ali, Mohsina Noor Ibrahim, Elizabeth M. Mcclure, Shiyam Sunder Tikmani, Sayyeda Reza, Zahid Abbasi, Afia Zafar, Sameen Siddiqi, Sarah Saleem

Community Health Sciences

Background: Pakistan is considered to be one of the riskiest places in the world for childbirth as measured by its high stillbirth and neonatal mortality rates. Complete diagnostic autopsy remains the gold standard to determine the cause of death (CoD); however, it is not routinely implemented due to religious objections, sociocultural beliefs, limited resources and low demand from physicians and families. Recently, minimally invasive tissue sampling (MITS) using needle biopsies of multiple tissues to obtain tissue for histological examination and organism identification with PCR has been developed and promoted to determine CoD in low-resource areas. To ensure successful implementation of …

Systematic Review Of Doppler For Detecting Intrapartum Fetal Heart Abnormalities And Measuring Perinatal Mortality In Low‐ And Middle‐Income Countries, Marya Plotkin, Benjamin Kamala, Jim Ricca, Linda Fogarty, Sheena Currie, Hussein Kidanto, Stephanie B. Wheeler

Obstetrics and Gynaecology, East Africa

Background: Using Doppler to improve detection of intrapartum fetal heart rate (FHR) abnormalities coupled with appropriate, timely intrapartum care in low-and middle-income countries (LMIC) can save lives.

Objective: To review studies using Doppler to improve detection of intrapartum FHR abnormalities and intrapartum care quality in LMIC health facilities.

Search strategy: PubMed, Web of Science, Embase, Global Health, and Scopus were searched from inception to October 2018 by combining terms for Doppler, perinatal outcomes, and FHR monitoring.

Selection criteria: Selected studies compared Doppler and Pinard stethoscope for detecting/monitoring intrapartum FHR, or described provider and maternal preferences for FHR monitoring in LMIC …

Women And Children Living In Areas Of Armed Conflict In Africa: A Geospatial Analysis Of Mortality And Orphanhood, Zachary Wagner, Sam Heft-Neal, Paul H. Wise, Robert E. Black, Marshall Burke, Ties Boerma, Zulfiqar Ahmed Bhutta, Eran Bendavid

Department of Paediatrics and Child Health

Background:
The population effects of armed conflict on non-combatant vulnerable populations are incompletely understood. We aimed to study the effects of conflict on mortality among women of childbearing age (15–49 years) and on orphanhood among children younger than 15 years in Africa.
Methods:
We tested the extent to which mortality among women aged 15–49 years, and orphanhood among children younger than 15 years, increased in response to nearby armed conflict in Africa. Data on location, timing, and intensity of armed conflicts were obtained from the Uppsala Conflict Data Program, and data on the location, timing, and outcomes of women and …

Fostering Productive Conversations In A Kenyan Tertiary Intensive Care Unit: Lessons Learnt, Sayed Karar, Jamila Nambafu, Feroza Daroowalla

Internal Medicine, East Africa

Effective communication remains key in delivery of comprehensive care to patient especially in the intensive care unit (ICU) setting. However, many providers, for various reasons, struggle with the art of effective communication adversely affecting relationship with patients and their families. Little is known or has been published about effective communication in ICUs within sub-Saharan Africa.

Sclerosing Peritonitis Presenting As Complete Mechanical Bowel Obstruction: A Case Report, Sabah Saqib, K. M. Inam Pal

Section of General Surgery

Introduction: Sclerosing peritonitis or abdominal cocoon syndrome is characterized by small bowel loops completely encapsulated by a fibrocollagenous membrane in the center of the abdomen. Although cocooning of the abdomen is mostly seen in patients on peritoneal dialysis, it can occur de novo; it very rarely manifests as complete mechanical bowel obstruction.
Case Presentation: A 46-year-old Asian man presented with complete mechanical bowel obstruction. He had previous attacks of partial bowel obstruction during the past 6 to 8 months, which was misdiagnosed as abdominal tuberculosis because tuberculosis is very prevalent in the region in which he lives. He took anti-tuberculosis …

Prevalence Of And Factors Associated With Female Sexual Dysfunction Among Women Using Hormonal And Non-Hormonal Contraception At The Aga Khan University Hospital Nairobi, Momin Butt, Valentino Lema, Abraham Mukaindo, Gulnaz Mohamoud, Jacob Shabani

Family Medicine, East Africa

Background: Female sexual function (FSD) is a complex phenomenon. It integrates all body systems and is influenced by a variety of factors. Contraceptives have shown to have variable effects on FSD. In Kenya, the majority of women use hormonal contraception with high rates of discontinuation of use, attributed to related side effects such as weight loss and loss of libido.

Aim: To determine the prevalence of and the factors affecting FSD among women using contraception in our setting.

Setting: The study was carried out at the Aga Khan University Hospital, Nairobi, at various clinical sites.

Methods: A cross-sectional study was …

Value Of Elastography In Differentiating Benign From Malignant Breast Lesions Keeping Histopathology As Gold Standard, Faryal Farooq, Syed Mubarak, Shaista Shaukat, Noman Khan, Kahkashan Jafar, Tariq Mahmood, Muhammad Arif Saeed

Department of Radiology

Background: Breast cancer is the most common cancer in females, both in developed and developing countries. Pakistan has the highest breast cancer incidence rate in Asia. Guidelines recommend screening for detecting breast cancer with mammography and ultrasonography (US). Shear-wave elastography (SWE) is a newer technique that can aid additional characterization of breast lesions.
Objective: The aim of this study was to determine the diagnostic accuracy of breast ultrasound elastography in differentiating benign from malignant breast lesions using histology diagnosis as the gold standard.
Materials and methods: The study was conducted at the Abbasi Shaheed Hospital and Jinnah Post Graduate Medical …

Granuloma Whorls, Farrukh Zia, Natasha Bahadur Ali

Section of Haematology/Oncology

What is the significance of bone marrow examination in presence of peripheral cytopenias? It is still regarded as a mandatory investigation to diagnose hematological disorders. In this case, bone marrow trephine was initially done as a diagnosis of exclusion for ITP, whereas it revealed multiple granulomas suggesting mycobacterium tuberculosis infection.

Methicillin Resistant Staphylococcus Aureus Outbreak In A Neonatal Intensive Care Unit, Seema Irfan, Imran Ahmed, Farida Lalani, Naureen Anjum, Nadia Mohammad, Maria Owais, Afia Zafar

Department of Pathology and Laboratory Medicine

The global and national burden of communicable and noncommunicable diseases continues to rise, thus making access to Healthcare workers (HCWs) colonized with methicillin-resistant Staphylococcus aureus (MRSA) may pose transmission risk to vulnerable patients including neonates. This study reports an MRSA outbreak in a level-II neonatal intensive care unit (NICU) of a secondary care hospital in Pakistan. Once identified, an infection control team from the parent hospital visited the facility, risk factors were listed and infection control measures taken to control the outbreak. Screening cultures of NICU staff and environmental cultures from NICU were obtained for the presence of MRSA. Five …

Potential Causes Of Early Death Among Admitted Newborns In A Rural Tanzanian Hospital, Robert Moshiro, Jeffrey M. Perlman, Paschal Mdoe, Hussein Kidanto, Jan Terje Kvaløy, Hege L. Ersdal

Obstetrics and Gynaecology, East Africa

Background: Approximately 40,000 newborns die each year in Tanzania. Regional differences in outcome are common. Reviewing current local data, as well as defining potential causal pathways leading to death are urgently needed, before targeted interventions can be implemented

Objective: To describe the clinical characteristics and potential causal pathways contributing to newborn death and determine the presumed causes of newborn mortality within seven days, in a rural hospital setting.

Methods: Prospective observational study of admitted newborns born October 2014–July 2017. Information about labour/delivery and newborn management/care were recorded on data collection forms. Causes of deaths were predominantly based on clinical diagnosis. …

Molecular Characterization Of Multidrug-Resistance In Gram-Negative Bacteria From The Peshawar Teaching Hospital, Pakistan, A. Masseron, L. Poirel, B. Jamil Ali, M. A. Syed, P. Nordmann

Section of Pulmonary & Critical Care

Extended-spectrum β-lactamases, carbapenemases, 16S rRNA methylases conferring pan-drug aminoglycoside resistance and colistin resistance were investigated among Gram-negative bacteria recovered from clinical samples (infections) from 200 individuals hospitalized at the Khyber Teaching Hospital of Peshawar, north Pakistan, from December 2017 to March 2018. Out of 65 isolates recovered, 19% were carbapenem resistant and 16% carried a bla NDM-1 gene, confirming the widespread distribution of NDM producers in this country. The association of the NDM carbapenem-resistance determinant, together with the extended-spectrum β-lactamase CTX-M-15 and 16S rRNA methylases, was frequent, explaining the multidrug-resistance pattern observed. All isolates remained susceptible to colistin.

Burden And Risk Of Neurological And Cognitive Impairment In Pediatric Sickle Cell Anemia In Uganda (Brain Safe): Final Results Of The Cross-Sectional Analysis, Nancy Green, Deogratias Munube, Paul Bangirana, Linda Buluma, Bridget Kebirungi, Robert Opoka, Ezekiel Mupere, Philip Kasirye, Sarah Kiguli, Annet Birabwa

Paediatrics and Child Health, East Africa

Background: Children with sickle cell anemia (SCA) are highly susceptible to stroke and other manifestations of pediatric cerebral vasculopathy. Detailed evaluations in sub-Saharan Africa are limited.

Methods: We aimed to establish the frequency and types of pediatric brain injury in a cross-sectional study at a large SCA clinic in Kampala, Uganda in a randomly selected sample of 265 patients with HbSS ages 1–12 years. Brain injury was defined as one or more abnormality on standardized testing: neurocognitive impairment using an age-appropriate test battery, prior stroke by examination or transcranial Doppler (TCD) velocities associated with stroke risk in children with …

Intestinal Permeability And Inflammation Mediate The Association Between Nutrient Density Of Complementary Foods And Biochemical Measures Of Micronutrient Status In Young Children: Results From The Mal-Ed Study, Benjamin J J. Mccormick, Laura E. Murray-Kolb, Gwenyth O. Lee, Kerry J. Schulze, A Catharine Ross, Aubrey Bauck, Aldo A M. Lima, Bruna L L. Maciel, Ali Turab, Zulfiqar Ahmed Bhutta, Mal-Ed Network Investigators, Shahida Qureshi, Muneera Rasheed, Sajid Bashir Soofi, Anita K. M. Zaidi

Woman and Child Health

Background: Environmental enteric dysfunction (EED) is thought to increase the risk of micronutrient deficiencies, but few studies adjust for dietary intakes and systemic inflammation.
Objective: We tested whether EED is associated with micronutrient deficiency risk independent of diet and systemic inflammation, and whether it mediates the relation between intake and micronutrient status.
Methods: Using data from 1283 children in the MAL-ED (Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health) birth cohort we evaluated the risk of anemia, low retinol, zinc, and ferritin, and high transferrin receptor (TfR) at 15 mo. We …

It’S Not Always Occam's Razor – The Case Of A Young Man With Subaortic Membrane With Superimposed Pulmonary Thromboembolism And Left Main Coronary Artery Disease, Hunaina Shahab, Abdul Baqi, Yusra Askari, Qurrat Ul Ain Aqeel, Kumail Khandwala

Section of Cardiology

Subaortic membrane (SAM) is a discrete fibromuscular structure which causes left ventricular outflow tract obstruction and leads to the symptomatology of valvular aortic stenosis. It is known to be associated with other congenital cardiac defects in around 30% of cases. However, it has not been associated with chronic pulmonary thromboembolism in the past. We present a case of a middle-aged Pakistani man who presented with dyspnea and hemoptysis. He was found to have a SAM and severe pulmonary hypertension on transthoracic echocardiogram. A coronary angiogram revealed non-obstructive left main coronary artery disease. A computed tomography (CT) scan chest was done …

Labrad : Vol 45, Issue 3 - October 2019, Aga Khan University Hospital, Karachi

LABRAD - Departments of Pathology & Laboratory Medicine and Radiology Archives

• Therapeutic Drug Monitoring for Antibiotics in Infections
• Biomarkers of Sepsis
• Serum Procalcitonin Level - Marker of Bacterial Infection
• Bone Marrow Findings in Malaria
• Antibiogram: A Clinicians’ Reference for Antibiotic Selection
• Laboratory Diagnosis of Meningitis
• Detection of Pneumocystis Jirovecii by PCR
• Microbiology Quiz
• Radiology Pathology Correlation- Orthopedic Pathology
• Role of Imaging in the Diagnosis and Management of Hepatic Abscess
• The Best of the Past
• Microbiology Quiz’s Answer
• Polaroid

Predictors For Expired Co2 In Neonatal Bag-Mask Ventilation At Birth: Observational Study, Kari Holte, Hege Langli Ersdal, Joar Eilevstjønn, Monica Thallinger, Jørgen Linde, Claus Klingenberg, Rene Holst, Samwel Jatosh, Hussein Kidanto, Ketil Stordal

Obstetrics and Gynaecology, East Africa

Background: Expired carbon dioxide (ECO2) indicates degree of lung aeration immediately after birth. Favourable ventilation techniques may be associated with higher ECO2 and a faster increase. Clinical condition will however also affect measured values. The aim of this study was to explore the relative impact of ventilation factors and clinical factors on ECO2 during bag-mask ventilation of near-term newborns.

Methods: Observational study performed in a Tanzanian rural hospital. Side-stream measures of ECO2, ventilation data, heart rate and clinical information were recorded in 434 bag-mask ventilated newborns with initial heart rate <120 beats per minute. We studied ECO2 by clinical factors (birth weight, Apgar scores and initial heart rate) and ventilation factors (expired tidal volume, ventilation frequency, mask leak and inflation pressure) in random intercept models and Cox regression for time to ECO2 >2%.

Results: ECO2 rose non-linearly with increasing expired tidal volume …

Radical Hysterectomy For Operable Early Cervical Cancer In Hiv-Positive And Hiv-Negative Women In Western Kenya, Peter M. Itsura, Rachel N. Deraney, Elkanah Omenge, Philip Tonui, Barry Rosen, Susan Cu-Uvin

Obstetrics and Gynaecology, East Africa

Radical hysterectomy is well tolerated with no increase in complications in HIV-infected women and is an appropriate form of treatment for early-stage cervical cancer in HIV-infected women.

Regional Variation In Chronic Kidney Disease And Associated Factors In Hypertensive Individuals In Rural South Asia: Findings From Control Of Blood Pressure And Risk Attenuation-Bangladesh, Pakistan And Sri Lanka, Liang Feng, Hithanadura Asita De Silva, Imtiaz Jehan, Anuradhani Kasturiratne, Gulshan Himani, Mohammad Abul Hasnat, Tazeen Jafar, Cobra-Bps Study Group

Community Health Sciences

Background: We aimed to determine the prevalence of chronic kidney disease (CKD) and its cross-country variation among hypertensive individuals in rural Bangladesh, Pakistan and Sri Lanka. We also explored the factors associated with CKD in these populations.
Method: We studied baseline data from the Control of Blood Pressure and Risk Attenuation-Bangladesh, Pakistan and Sri Lanka (COBRA-BPS) trial, an ongoing cluster randomized controlled trial on 2643 hypertensive adults ≥40 years of age from 30 randomly selected rural clusters, 10 in each of the three countries. CKD was defined as an estimated glomerular filtration rate (eGFR) /min/1.73 m2 or a urine albumin:creatinine …

Infections In Patients With Multiple Myeloma Treated With Conventional Chemotherapy: A Single-Center, 10-Year Experience In Pakistan, Mohammad Faizan Zahid, Natasha Ali, Myra Nasir, Maria Haider Baig, Mustafa Iftikhar, Syed Usman Bin Mahmood, Arhama Malik, Sara Atif, Mohammad Asim Beg

Department of Pathology and Laboratory Medicine

Introduction: Multiple myeloma (MM) is a common hematologic malignancy with variable degrees of immunodeficiency. Disease- and treatment-related compromise of the immune system predisposes patients to infections, which are a major cause of morbidity and mortality.
Objective: We aimed to establish the incidence and main characteristics of infections in MM patients treated at our center over a 10-year period.
Method and results: Of the 412 patients retrospectively analyzed, 154 (37.4%) were documented to have at least one episode of infection and were included in this study. A total of 244 infectious episodes were documented. The most common site of infection was …

A Study To Assess The Relationship Between Attention Deficit Hyperactivity Disorder And Obstructive Sleep Apnea In Adults, Sean Hesselbacher, Akshar A. Aiyer, Salim R. Surani, Alishah A. Suleman, Joseph Varon

Internal Medicine, East Africa

The association between obstructive sleep apnea (OSA) and attention deficit hyperactivity disorder (ADHD) is well-established in children. However, there is a paucity of literature regarding this association in adults. The aim of this study was to determine if ADHD is more common in adult patients with OSA. All patients referred to a sleep center for sleep evaluation were administered the Adult ADHD Self-Report Scale and diagnostic polysomnogram. The ADHD screen is considered positive if 4 of 6 questions in part A of the screening questionnaire were answered abnormally. The study population consisted of 194 participants, predominantly male (62%), Caucasian (54%), …

Global Burden Of Atherosclerotic Cardiovascular Disease In People With Hepatitis C Virus Infection: A Systematic Review, Meta-Analysis, And Modelling Study, Kuan Ken Lee, Dominik Stelzle, Rong Bing, Mohamed Anwar, Fiona Strachan, Sophia Bashir, David E. Newby, Jasmit Shah, Michael Chung, Gerald S. Bloomfield

Internal Medicine, East Africa

Background: More than 70 million people worldwide are estimated to have hepatitis C virus (HCV) infection. Emerging evidence indicates an association between HCV and atherosclerotic cardiovascular disease. We aimed to determine the association between HCV and cardiovascular disease, and estimate the national, regional, and global burden of cardiovascular disease attributable to HCV.

Methods: For this systematic review and meta-analysis, we searched MEDLINE, Embase, Ovid Global Health, and Web of Science databases from inception to May 9, 2018, without language restrictions, for longitudinal studies that evaluated the risk ratio (RR) of cardiovascular disease in people with HCV compared with those without …

Routine Late Trimester Ultrasound For The Detection Ofsmall-For-Gestational-Age And Growth-Restricted Fetus Inlow-Risk Pregnancy: A Randomised Controlled Trial, Sikolia Wanyonyi, Doreen Osoro, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Objectives: To compare the proportion of small-for-gestational-age and fetal growth-restricted fetuses detected in women offered a routine growth ultrasound to those either offered selective or no ultrasound in the third trimester.

Methods: An open-label randomised control trial was conducted at the Aga Khan University Hospital, Nairobi. Eligible women were randomised into either the intervention or control group. Women in the intervention arm had a mandatory third trimester ultrasound for fetal growth performed between 36 weeks 0 days to 37 weeks 6 days. Those in the control group had a selective growth scan done if the clinician suspected abnormal fetal growth. …

Longitudinally Extensive Transverse Myelitis With Seropositive Chikungunya, Sajid Hameed, Mubashar Memon, Hina Imtiaz, Dureshahwar Kanwar

Section of Neurology

Chikungunya viral (CHIKV) fever is often a self-limiting febrile illness associated with severe debilitating arthralgia. Neurological complications associated with CHIKV, although rare, have been reported in literature; however, longitudinally extensive transverse myelitis (LTEM) is rarely associated with it. We present a case of a middle-aged man with a 1-week history of low-grade fever and arthralgia followed by urinary retention and quadriplegia. A sensory level was noted at T2. On subsequent investigations, he was diagnosed with LETM. Although LETM is commonly seen in patients with neuromyelitis optica, the other possible etiologies are inflammatory and parainfectious. To date, only two cases of …

Complications Of Ultrasound-Guided Liver Biopsy At A Tertiary Care Hospital In Pakistan: An Audit, Basit Salam, Fatima Mubarak, Yusra Waheed, Noman Khan

Department of Radiology

Introduction: Liver diseases account for two million deaths per year worldwide, half of which are attributed to complications of cirrhosis. Liver conditions have wide-ranging serological findings and imaging appearances and may require biopsy for a definitive diagnosis. Despite ultrasound (US) guidance, liver biopsy is an invasive procedure and the expected benefit must outweigh risks involved.
Objective: The purpose of the audit was to calculate complication rates of US-guided liver biopsy and summarize institutional data pertaining to the procedure.
Materials and Methods: The audit was performed at Aga Khan University Hospital, Karachi, Pakistan. All consecutive patients undergoing liver biopsy from February …

Use Of Machine Learning Algorithms For Prediction Of Fetal Risk Using Cardiotocographic Data, Zahra Hoodbhoy, Mohammad Noman, Ayesha Shafique, Ali Nasim, Devyani Chowdhury, Babar Hasan

Department of Paediatrics and Child Health

Background: A major contributor to under-five mortality is the death of children in the 1^st month of life. Intrapartum complications are one of the major causes of perinatal mortality. Fetal cardiotocograph (CTGs) can be used as a monitoring tool to identify high-risk women during labor.
Aim: The objective of this study was to study the precision of machine learning algorithm techniques on CTG data in identifying high-risk fetuses.
Methods: CTG data of 2126 pregnant women were obtained from the University of California Irvine Machine Learning Repository. Ten different machine learning classification models were trained using CTG data. Sensitivity, precision, …

Frequency And Early Complications Of Late Preterm Infants: A Descriptive Analysis From Two Secondary-Care Hospitals Of Karachi, Waqar Khowaja, Abdul Lateef Leghari, Ali Shabbir Hussain, Shabina Ariff, Iqtidar Khan

Department of Paediatrics and Child Health

Introduction: Globally, prematurity accounts for 12.7% of all live births while late preterm accounts for around three-fourth (73%) of these premature births. In Pakistan, the prevalence of prematurity is approximately 18.89%. Late preterm infants often have weight and size similar to some term infants, but they are still metabolically and physiologically immature. Hence, these infants, as compared to term infants, are at a higher risk of developing medical complications, which results in higher morbidity and mortality during the birth hospitalization. We aim to determine the frequency of early complications in late preterm infants during their stay at Aga Khan Secondary-care …

Frequent Refresher Training On Newborn Resuscitation And Potential Impact On Perinatal Outcome Over Time In A Rural Tanzanian Hospital: An Observational Study, Estomih Mduma, Jan Terje Kvaløy, Eldar Soreide, Erling Svensen, Paschal Mdoe, Jeffrey Perlman, Caroline Johnson, Hussein Kidanto, Hege Langli Ersdal

Obstetrics and Gynaecology, East Africa

Objectives: Globally, perinatal mortality remains high, especially in sub-Saharan countries, mainly because of inadequate obstetric and newborn care. Helping Babies Breathe (HBB) resuscitation training as part of a continuous quality improvement (CQI) programme may improve outcomes. The aim of this study was to describe observed changes in perinatal survival during a 6-year period, while adjusting for relevant perinatal risk factors.

Setting: Delivery rooms and operating theatre in a rural referral hospital in northern-central Tanzania providing comprehensive obstetric and basic newborn care 24 hours a day. The hospital serves approximately 2 million people comprising low social-economic status.

Participants: …

Current Management Of Glioma In Pakistan, Umme E Hani Abdullah, Altaf Ali Laghari, Muhammad Usman Khalid, Huzaifa Bin Rashid, Fatima Ali, Adnan Jabbar, Asim Hafiz, Muhammad Shahzad Shamim, Ather Enam

Section of Neurosurgery

To date, information on the management of specific neurosurgical tumors, such as glioma, in Pakistan remains scattered and scarce. Our review synthesizes the predicaments of glioma management routinely presented to the neurosurgery, medical oncology, radiation oncology, and radiology departments in Pakistan. Expert opinions were integrated from each of the relevant fields in the form of personal citations. The data presented in our review were collected from various PubMed and non-PubMed indexed articles, coupled with various health reports from the Government of Pakistan along with the World Health Organization. Through these data, it was postulated that the utilization of innovative and …

Effects Of Accelerated Versus Standard Care Surgery On The Risk Of Acute Kidney Injury In Patients With A Hip Fracture: A Substudy Protocol Of The Hip Fracture Accelerated Surgical Treatment And Care Track (Hip Attack) International Randomised Controlled Trial, Flavia K. Borges, P J. Devereaux, Meaghan Cuerden, Mohit Bhandari, Ernesto Guerra-Farfán, Ameen Patel, Alben Sigamani, Masood Umer, John Neary, Maria Tiboni

Section of Orthopaedic Surgery

Introduction: Inflammation, dehydration, hypotension and bleeding may all contribute to the development of acute kidney injury (AKI). Accelerated surgery after a hip fracture can decrease the exposure time to such contributors and may reduce the risk of AKI.
Methods and analysis: Hip fracture Accelerated surgical TreaTment And Care tracK (HIP ATTACK) is a multicentre, international, parallel-group randomised controlled trial (RCT). Patients who suffer a hip fracture are randomly allocated to either accelerated medical assessment and surgical repair with a goal of surgery within 6 hours of diagnosis or standard care where a repair typically occurs 24 to 48 hours after …