Medical Specialties Commons^™

Health Professionals' Experiences And Views On Obstetric Ultrasound In Vietnam: A Regional, Cross-Sectional Study, Sophia Holmlund, Pham Thi Lan, Kristina Edvardsson, Ho Dang Phuc, Joseph Ntaganira, Rhonda Small, Hussein Kidanto, Matilda Ngarina, Ingrid Mogren

Obstetrics and Gynaecology, East Africa

Objectives: Obstetric ultrasound is an important part of antenatal care in Vietnam, although there are great differences in access to antenatal care and ultrasound services across the country. The aim of this study was to explore Vietnamese health professionals' experiences and views of obstetric ultrasound in relation to clinical management, resources and skills.

Design: A cross-sectional questionnaire study was performed as part of the CROss Country UltraSound study.

Setting: Health facilities (n=29) in urban, semiurban and rural areas of Hanoi region in Vietnam.

Participants: Participants were 289 obstetricians/gynaecologists and 535 midwives.

Results: A majority (88%) …

Resilience And Quality Of Life (Qol) Of Head And Neck Cancer And Brain Tumour Survivors In Pakistan: An Analytical Cross-Sectional Study Protocol, Nida Zahid, Wardah Khalid, Khabir Ahmad, Shireen Shehzad, Iqbal Azam Syed, Nargis Asad, Adnan Jabbar, Mumtaz J Khan, Ather Enam

Department of Surgery Docs

Background: Cancer is a devastating disease and has detrimental effects on the quality of life (QoL) of cancer survivors and interferes with their treatment compliance. The aim of the study is to assess resilience and QoL among cancer survivors and to evaluate the important factors affecting their resilience and QoL, with respect to the Pakistani cultural context.
Method and Analysis: A cross-sectional study will be conducted at a tertiary care hospital in Karachi, Pakistan. A minimum sample size of 250 head and neck cancers and 250 brain tumour survivors with 10% inflation for non-response rate will be required. The SD …

Bayesmetab: Treatment Of Missing Values In Metabolomic Studies Using A Bayesian Modeling Approach, Jasmit Shah, Guy N. Brock, Jeremy Gaskins

Internal Medicine, East Africa

Background: With the rise of metabolomics, the development of methods to address analytical challenges in the analysis of metabolomics data is of great importance. Missing values (MVs) are pervasive, yet the treatment of MVs can have a substantial impact on downstream statistical analyses. The MVs problem in metabolomics is quite challenging and can arise because the metabolite is not biologically present in the sample, or is present in the sample but at a concentration below the lower limit of detection (LOD), or is present in the sample but undetected due to technical issues related to sample pre-processing steps. The …

Xpert® Mtb/Rif Assay On Formalin-Fixed Paraffin-Embedded Tissues In The Diagnosis Of Extrapulmonary Tuberculosis, Allan Njau, Samuel Gakinya, Shahin Sayed, Zahir Moloo

Pathology, East Africa

Background: Diagnosis of extrapulmonary tuberculosis continues to be a challenge due to the complexity of the causative organism and the wide array of pathologic features seen in this infection. Xpert MTB/RIF can be used on fresh or frozen tissue specimens for diagnosis of tuberculosis with good results. However, there is little data on its use with formalin-fixed paraffin-embedded (FFPE) tissues.

Objectives: The aim of this study was to demonstrate the potential utility of Xpert MTB/RIF and to compare its performance to Ziehl-Neelsen staining for the detection of Mycobacterium tuberculosis from FFPE tissues using histological features from haematoxylin and eosin staining …

Prevalence And Correlates Of Cardiometabolic Multimorbidity Among Hypertensive Individuals: A Cross-Sectional Study In Rural South Asia—Bangladesh, Pakistan And Sri Lanka, Liang Feng, Imtiaz Jehan, H Asita De Silva, Aliya Naheed, Hamida Farazdaq, Samina Hirani Samina Hirani, Anuradhani Kasturiratne, Channa D. Ranasinha, Md Tauhidul Islam, Ali Tanweer Siddiquee, Tazeen Jafar

Community Health Sciences

Objective: To determinate the prevalence and correlates of cardiometabolic multimorbidity (CMM), and their cross-country variation among individuals with hypertension residing in rural communities in South Asia.
Design: A cross-sectional study.
Setting: Rural communities in Bangladesh, Pakistan and Sri Lanka.
Participants: A total of 2288 individuals with hypertension aged ≥40 years from the ongoing Control of Blood Pressure and Risk Attenuation- Bangladesh, Pakistan and Sri Lanka clinical trial.
Main outcome measures: CMM was defined as the presence of ≥2 of the conditions: diabetes, chronic kidney disease, heart disease and stroke. Logistic regression was done to evaluate the correlates of CMM.
Results: …

Incidence Of Intraocular Lens Exchange After Cataract Surgery, Maram E. A. Abdalla Elsayed, Khabir Ahmad, Abdulelah A. Al-Abdullah, Rizwan Malik, Rajiv Khandekar, Hernan Martinez-Osorio, Marco Mura, Patrik Schatz

Department of Surgery Docs

Intraocular lens (IOL) exchange after cataract surgery is unusual but may be associated with suboptimal visual outcome. The incidence of IOL exchange has not been consistently estimated. Such information is invaluable when counseling patients prior to cataract surgery. We examined the incidence of, and indications and risk factors for, IOL exchange after cataract surgery. We also assessed visual outcome of eyes that had an IOL exchange. A cohort design was used to estimate the incidence of IOL exchange and a case-control design to identify factors associated with it. All phacoemulsification surgeries with IOL (n = 17415 eyes) during 2010-2017 and …

Effects Of Implementing Free Maternity Service Policy In Kenya: An Interrupted Time Series Analysis, Evaline Lang’At, Lillian Mwanri, Marleen Temmerman

Obstetrics and Gynaecology, East Africa

Background: Maternal and perinatal mortality is a major public health concern across the globe and more so in low and middle-income countries. In Kenya, more than 6000 maternal deaths, and 35,000 stillbirths occur each year. The Government of Kenya abolished user fee for maternity care under the Free Maternity Service policy, in June of 2013 in all public health facilities, a move to make maternity services accessible and affordable, and to reduce maternal and perinatal mortality.

Method: An observational retrospective study was carried out in 3 counties in Kenya. Six maternal health output indicators were observed monthly, 2 years pre …

Critically Ill Obstetric Patients In Resource-Limited Settings, Samina Ismail, Muhammad Sohaib

Department of Anaesthesia

No abstract provided.

Obstetric Patients Requiring Critical Care: Retrospective Study In A Tertiary Care Institute Of Pakistan, Samina Ismail, Muhammad Sohaib

Department of Anaesthesia

Background: The outcome of obstetric patients admitted to the intensive care unit (ICU) depends on the number of factors. The objective of this study is to review the outcomes of these patients with regard to pregnancy status, source of admission, and their presenting illness at time of admission to ICU.
Materials and Methods: A retrospective study was undertaken for all obstetric patients admitted to the ICU of a private tertiary care hospital of Pakistan from 2014 to 2018. The data were reviewed thorough ICU log sheet, electronic medical records, and online laboratory data. The data included patient demographics, pregnancy status, …

Factors Leading To Meconium Aspiration Syndrome In Term- And Post-Term Neonates, Saroop Chand, Aamna Salman, Razia Mustafa Abbassi, Abdul Rehman Siyal, Fayaz Ahmed Memon, Abdul Lateef Leghari, Ashmal Sami Kabani, Sajid Ali

Department of Pathology and Laboratory Medicine

Background:
Meconium aspiration syndrome (MAS) is considered a major cause of respiratory morbidity. It is a common issue encountered in the delivery room and newborn nursery. There is a need to identify the factors that lead to MAS to develop strategies to screen such patients at an early stage to decrease the mortality and morbidity. The objective of this study was to determine the factors leading to MAS in neonates delivered at ≥37 weeks of gestational age.
Methods:
A cross-sectional study was conducted through non-probability consecutive sampling technique at Liaquat University Hospital, Hyderabad from August 2016 to February 2017. All …

Factors Leading To Meconium Aspiration Syndrome In Term- And Post-Term Neonates, Saroop Chand, Aamna Salman, Razia Mustafa Abbassi, Abdul Rehman Siyal, Fayaz Ahmed Memon, Abdul Lateef Leghari, Ashmal Sami Kabani, Sajid Ali

Department of Paediatrics and Child Health

Background: Meconium aspiration syndrome (MAS) is considered a major cause of respiratory morbidity. It is a common issue encountered in the delivery room and newborn nursery. There is a need to identify the factors that lead to MAS to develop strategies to screen such patients at an early stage to decrease the mortality and morbidity. The objective of this study was to determine the factors leading to MAS in neonates delivered at ≥37 weeks of gestational age.
Methods: A cross-sectional study was conducted through non-probability consecutive sampling technique at Liaquat University Hospital, Hyderabad from August 2016 to February 2017. All …

Management And Outcomes Of Gastrointestinal Congenital Anomalies In Low, Middle And High Income Countries: Protocol For A Multicentre, International, Prospective Cohort Study, Naomi Jane Wright, Andrew Leather, Nick Sevdalis, Niyi Ade-Ajayi, Adesoji O. Ademuyiwa, Emmanuel A. Ameh, Justine Davies, Kokila Lakhoo, Samuel Parker, Muhammad Arshad

Section of Paediatric Surgery

Introduction: Congenital anomalies are the fifth leading cause of death in children globally, contributing an estimated half a million deaths per year. Very limited literature exists from low and middle income countries (LMICs) where most of these deaths occur. The Global PaedSurg Research Collaboration aims to undertake the first multicentre, international, prospective cohort study of a selection of common congenital anomalies comparing management and outcomes between low, middle and high income countries (HICs) globally.
Methods and Analysis: The Global PaedSurg Research Collaboration consists of surgeons, paediatricians, anaesthetists and allied healthcare professionals involved in the surgical care of children globally. Collaborators …

Gbs With Non-Hodgkin Lymphoma, A Rarity, Javaria Munir, Umer Aziz Qazi

Pakistan Journal of Neurological Sciences (PJNS)

Patients of Non-Hodgkin’s lymphomas may develop neurological signs and symptoms. This case is of a 76 year old male recently diagnosed with Non-Hodgkin’s lymphoma and on chemotherapy who presented with sudden bilateral leg weakness and inability to walk. The signs and symptoms, neurological examinations and Nerve conduction studies revealed a polyneuropathy which was consistent with Guillain-Barré syndrome (GBS). This has been seen in patients with Hodgkin's lymphoma but is rare in NHL.

Neurotoxicity In A Young Patient With Diffuse Large B-Cell Lymphoma After First Dose Of Intrathecal Triple Therapy., Ali Sajjad, Sajid Hameed, Sara Khan

Pakistan Journal of Neurological Sciences (PJNS)

Intrathecal triple chemotherapy (ITT) including cytarabine arabinoside, methotrexate and glucocorticoids is a standard regimen for prophylaxis and treatment of hematological malignancies, owing to their high proclivity for invasion of the neuraxis. Unfortunately, intrathecal chemotherapy is associated with various neurological adverse effects including seizures, encephalopathy, myelopathy, arachnoiditis and cauda/conus syndrome. We present a case of 33-year-old lady with primary bone diffuse large B-cell lymphoma. She had received 4 cycles of R-CHOP* and later 2 cycles of R-DHAP**. The first dose of ITT was administered along with the last cycle of R-DHAP. On the third day post-ITT, she developed acute bilateral lower …

Extended Window Intravenous Thrombolysis: Is Conventional Window Of 4.5 Hours Coming To An End?, Malik Muhammad Adil, Narmeen Masood

Pakistan Journal of Neurological Sciences (PJNS)

The current standard of care to treat acute stroke patients presenting within 4.5 hours of stroke symptom onset is intravenous (IV) Alteplase.1 Over the past decade, tremendous efforts have been made to challenge the conventional window of 4.5 hours for the administration of Alteplase to expand the patient population which can benefit from thrombolysis. Based on the recent meta-analysis, 2 we have strong evidence supporting the use of IV thrombolysis in patients presenting between 4.5 to 9 hours of symptom onset with favorable perfusion imaging and it appears that the era of the conventional 4.5 hours window may be coming …

Children With Strabismus: Is There Psychological Impact On Mothers?, Syed Usman Bin Mehmood, Sidra Zafar, Azhar Hussain, Zafar Iqbal

Section of Ophthalmology

No abstract provided.

Colostrum And Mature Breast Milk Analysis Of Serum Irisin And Sterol Regulatory Element-Binding Proteins-1c In Gestational Diabetes Mellitus, Syeda Sadia Fatima, Erum Khalid, Asma Akbar Ladak, Syed Adnan Ali

Department of Biological & Biomedical Sciences

Background: We aimed to evaluate irisin and SREBP-1c levels in serum, colostrum and mature breast milk in women with and without gestational diabetes (GDM); and to relate them with maternal glucose, lipid profile and weight status of babies.
Methods: GDM positive women (n = 33) and normal glucose tolerant women (NGT) (n = 33) were recruited. Maternal blood samples were collected at 28th week of gestation and later at 6-week post-partum while breast milk samples of the lactating mothers were collected within 72 hours of birth (colostrum) and at 6 weeks post-partum (mature milk). Irisin and SREBP-1c levels were analyzed …

Illegal Motorcycle Street Racing- A Growing Threat To Public Safety, Madiha Mumshad, Aisha Ashraf

Department of Emergency Medicine

No abstract provided.

Correction To: Severity Of Depression, Anxious Distress And The Risk Of Type 2 Diabetes - A Population-Based Cohort Study In Sweden, Anna Deleskog, Rickard Ljung, Yvonne Forsell, Alicia Nevriana, Aysha Almas, Jette Möller

Section of Internal Medicine

Abstract

It was highlighted that the original article [1] contained an error in the flow chart in Fig. 1.

Risk Factors For Mortality Of Patients With Ceftriaxone Resistant E. Coli Bacteremia Receiving Carbapenem Versus Beta Lactam/Beta Lactamase Inhibitor Therapy, Nosheen Nasir, Sara Ahmed, , Samrah Razi, Safia Awan, Syed Faisal Mahmood

Section of Internal Medicine

Objective: Extended spectrum β-lactamases (ESBL) producing Enterobacteriaceae predominantly E. coli and K. pneumoniae bacteremia have limited treatment options and high mortality. The objective was to determine the risk factors for in-hospital mortality particularly treatment with carbapenem versus beta lactam/beta lactamase combination (BL/BLI) in patients with ceftriaxone resistant E. coli bacteremia. A retrospective cohort study was conducted at the Aga Khan University, Karachi, Pakistan. Adult patients with sepsis and monomicrobial ceftriaxone resistant E. coli bacteremia were enrolled. Factors associated with mortality in patients were determined using logistic regression analysis.

Results: Mortality rate was 37% in those empirically treated with carbapenem …

Early Second Trimester Twin-To-Twin Transfusion Syndrome In Monoamniotic Twin Pregnancy: The Cause And Management–A Case Report From Resource Limited Settings, Philippe P. A., Andrew Cheruiyot, Sahara Shurie, M Pallavi, Elkanah Omenge

Obstetrics and Gynaecology, East Africa

Monoamniotic twin pregnancies are the least common type of twin pregnancies, associated with high foetal death rates. In addition, twin-to-twin transfusion syndrome is a rare event in monoamniotic twins. The expectant management of early single-twin foetal demise is challenging due to risk to the surviving co-twin, and psychological impact on the mother. The authors report the case of early second trimester single-twin foetal demise, likely due to twin-to-twin transfusion syndrome in monochorionic twin pregnancy. The 22-year-old primigravida presented with vaginal bleeding in monoamniotic twin pregnancy. She then had sudden single-twin intrauterine demise at 16 weeks of gestation that ended with …

A Case Of Retroperitoneal Fibrosis Secondary To Chronic Periaortitis, Mariam Omar, Naushad Karim, Saeed Samnakay

Imaging & Diagnostic Radiology, East Africa

Retroperitoneal fibrosis is a rare inflammatory disorder causing increased fibrotic deposition in the retroperitoneum, often leading to ureteral obstruction. We present a case report of a 33-year-old male with 2-month history of back pain. Initial imaging showed thickening around the infrarenal aorta. Six months later the patient presented with renal failure; a CT abdomen revealed extensive soft tissue mass around the aorta resulting in ureteral obstruction. Histology results of biopsy of the soft tissue mass revealed retroperitoneal fibrosis. It is important for clinicians to treat periaortitis early as this can prevent progression to retroperitoneal fibrosis which can cause severe secondary …

Science Of Lifestyle; Strategies For Change, Raza Ur Rahman

Pakistan Journal of Neurological Sciences (PJNS)

Since the start of 21st century the focus of medical treatment is changing from curative to the preventive medicine and now functional recovery and quality of life are the outcome of curative medicine. These new outcomes of modern medicine can be achieved through adopting the strategies that enhance wellness of patient. The methods of enhancing wellness are in practice since centuries and their effectiveness has been handed down through word of mouth and tradition. They continue to evolve and were first documented in 1970s, by Canyon Ranch1, as a strategy to improve health through the principles of a healthy lifestyle. …

Post-Stroke Seizures: A Clinically Oriented Analysis, Sajid Hameed, Haris Hakeem, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

Stroke is an important cause of secondary epilepsy, especially in the elderly. Not only does this impact morbidity and mortality in an adverse way, it also prolongs the hospitalization. Various risk factors have been described in literature that increase the risk of seizures in a patient with stroke. Post stroke seizures fall on a spectrum of acute symptomatic and unprovoked seizures with varying pathophysiology and risk of subsequent development of epilepsy. Hence, the treatment approaches are also different. However, randomized controlled trials are lacking to guide monitoring and management strategies in post stroke seizures and the approaches remain individualized to …

An Overview Of Autism: Is It Treatable In Pakistan?, Tania Nadeem, Rabeeka Aftab, Nargis Asad

Pakistan Journal of Neurological Sciences (PJNS)

Autism Spectrum Disorder (ASD) is a clinically complex, pervasive neurodevelopmental disorder with early appearing social communication deficits and repetitive sensory–motor behaviors.1 Although affected individuals differ significantly from one another, typically the disorder is characterized by impairment in social reciprocity and communication. Children usually have speech delays or lack of social interaction including: lack of eye contact, limited response to name, decreased interest in peers, and restricted shared attention with parents.1 Autistic individuals also exhibit repetitive behaviors like flapping, lining, or stacking objects and narrowly focused rigid interests such as paying particular attention to spinning objects.1 It usually manifests before 3 …

What, When And For Whom Model Of Nutrition: A Health Management Approach, Muhammad Rafiq

Pakistan Journal of Neurological Sciences (PJNS)

Studies have shown that nutrition plays an important role in the pathophysiology of different health issues either physiological, or psychological. Nutrition is implicated in the development of health issues in different ways. The purpose of this mini review was to suggest a comprehensive model of nutrition, “What, When and for Whom Model of Nutrition”, in the light of existing literature. For this purpose, existing literature was explored to study the role of nutrition on mental health in perspective to, what type of nutrition, when it is consumed and/or who consumes it. Researchers concluded that it is not only what we …

Diagnostic Dilemmas Of Progressive Supranuclear Palsy, Humera Saeed, Qurat Ul Ain Khan, Syeda Masharab Jilani, Syeda Maheen Batool

Pakistan Journal of Neurological Sciences (PJNS)

In this report authors discuss similarities between psychiatric phenomenon i.e. catatonia and neuropsychiatric syndromes such as progressive supranuclear palsy (PSP) in a 51 years old male, known case of hypertension and diabetes, who presented to the psychiatric services with mutism, stereotypical movements of upper limbs, echolalia, anteriorly flexed neck, swallowing difficulty, decreased oral intake, urinary and fecal incontinence for a period of 1 year worsened for 6 months. Patient was initially treated for catatonia with benzodiazepines and electroconvulsive therapy but did not improve. A neuropsychiatric consultation was sought and a diagnosis of possible PSP was made according to the National …

The Natural Predominant Sleeping Positions In Cerebral Palsy; Does It Correlate With The Type Of Cerebral Palsy?, Sarah Razaq, Muhammad Aleem Arshad, Tahira Amjad

Pakistan Journal of Neurological Sciences (PJNS)

To see the natural positions of cerebral palsy subjects during sleep and their correlation with the particular type of cerebral palsy.

Tacrolimus-Associated Posterior Reversible Encephalopathy Syndrome In Allogenic Hematopoietic Stem Cell Transplant, Hina Imtiaz, Maryam Jamil Syed, Dureshahwar Kanwar, Bushra Taimuri, Sajid Hameed

Pakistan Journal of Neurological Sciences (PJNS)

Tacrolimus is an immunosuppressive drug used to lower the risk of transplant rejection in individuals after solid organ or hematopoietic transplantation. Cases of posterior reversible encephalopathy syndrome (PRES) as a complication of tacrolimus therapy are infrequently documented. The pathogenesis of this phenomenon is not well understood. Here, we report a case of an 18-year-old female with a history of acute myeloid leukemia that developed PRES after undergoing an allogeneic stem cell transplant and subsequent immunosuppressive therapy with tacrolimus.

Detection And Concentration Of Plasma Aflatoxin Is Associated With Detection Of Oncogenic Human Papillomavirus In Kenyan Women, Jianjun Zhang, Elkanah Omenge, Philip Tonui, Yan Tong, Titus Manai, Stephen Kiptoo, Kapten Muthoka, John Groopman, Joshua Smith, Erin Madeen

Obstetrics and Gynaecology, East Africa

Background: Cervical cancer is common in Kenyan women. Cofactors in addition to infection with oncogenic human papillomavirus (HPV) are likely to be important in causing cervical cancer, because only a small percentage of HPV-infected women will develop this malignancy. Kenyan women are exposed to dietary aflatoxin, a potent carcinogen and immunosuppressive agent, which may be such a cofactor.

Methods: Demographics, behavioral data, plasma, and cervical swabs were collected from 88 human immunodeficiency virus-uninfected Kenyan women without cervical dysplasia. Human papillomavirus detection was compared between women with or without plasma aflatoxin B1-lysine (AFB1-lys) and evaluated in relation to AFB1-lys concentration.

Results: …