Medical Specialties Commons^™

Are Serum Leptin Levels Predicted By Lipoproteins, Vitamin D And Body Composition?, Aysha Habib Khan, Syeda Sadia Fatima, Ahmed Raheem, Lena Jafri

Department of Pathology and Laboratory Medicine

BACKGROUND: Both obesity and vitamin D deficiency are important health issues in Pakistan. The connection between body composition, Vitamin D and leptin in young adults is important to be studied as body composition may affect bone health and therefore the possibility of osteoporosis in later life. Few studies have attempted to investigate the effect of body composition and leptin with vitamin D in adolescence. AIM: To investigate the association of serum leptin with body composition, lipids and 25-hydroxyvitamin D (25OHD) in adults. METHODS: This cross-sectional study was conducted on 167 apparently healthy adults. Demographics were recorded, bioelectrical impedance analysis was …

Management Of Parturient With Triplet Pregnancy And Placenta Percreta: Importance Of Multi-Disciplinary Approach, Samina Ismail, Akbar Azizullah

Department of Anaesthesia

Obstetric conditions like placenta percreta and multiple pregnancies can be extremely challenging as they pose a high risk for both the mother and infants. In placenta percreta, placental villi penetrate through the wall of uterus into the surrounding organs including the bladder and carry a risk of massive maternal bleeding. Multiple pregnancies have greater complication rate than that in singleton pregnancy. Successful management of such challenges are best done by a multidisciplinary teamwork, where all members of a perinatal team are involved in decision making and management. We report the successful management of a triplet gestation associated with placenta percreta.

Perfect Recipes For Obstetric Anesthesia: Need Of Caution In The Resource Constraint Environment, Samina Ismail, Malika Hameed

Department of Anaesthesia

No abstract provided.

Orthokeratinized Odontogenic Cyst (Ooc): Clinicopathological And Radiological Features Of A Series Of 10 Cases, Nasir Ud Din, Maha Zubair, Jamshid Abdul-Ghafar, Zia Ullah Khan, Zubair Ahmad

Department of Pathology and Laboratory Medicine

Background: Orthokeratinized Odontogenic Cyst (OOC) is a rare, developmental odontogenic cyst which was considered in the past to be a variant of Odontogenic keratocyst (OKC) later renamed as keratocystic odontogenic tumor (KCOT). The treatment of OOC is by enucleation and the prognosis, following enucleation is excellent with a recurrence rate of less than 2%. On the other hand, OKC has a recurrence rate between 8 and 25% after enucleation. Thus it is important to differentiate between the two entities.
Methods: All cases reported in our section as OOC during the period 2013 to 2018 were retrieved from the surgical pathology …

Cancer And How The Patients See It; Prevalence And Perception Of Risk Factors: A Cross-Sectional Survey From A Tertiary Care Centre Of Karachi, Pakistan, Saira Saeed, Javaid Khan, Nousheen Iqbal, Sana Irfan, Alviya Shafique, Safia Awan

Section of Pulmonary & Critical Care

Background: The incidence of cancer is rising but data available regarding prevalence of cancer and patient perception of the disease in Pakistan is limited. It is difficult to deal with Cancer if the main causes are negligence towards risk factors and bizarre myths. This study was aimed to investigate common cancer presentations at a government sector hospital and to gain insight into patient knowledge of the disease.

Methods: This was a cross-sectional study conducted on cancer patients from Jinnah Postgraduate Medical Centre. A self-made questionnaire was used to assess the norms related to cancer prevalence in our society, associated myths, …

Diffuse Low-Grade Glioma - Changing Concepts In Diagnosis And Management: A Review, Rashid Jooma, Muhammad Waqas, Inamullah Khan

Section of Neurosurgery

Though diffuse low-grade gliomas (dLGGs) represent only 15% of gliomas, they have been receiving increasing attention in the past decade. Significant advances in knowledge of the natural history and clinical diversity have been documented, and an improved pathological classification of gliomas that integrates histological features with molecular markers has been issued by the WHO. Advances in the radiological assessment of dLGG, particularly new magnetic resonance imaging scanning sequences, allow improved diagnostic and prognostic information. The management paradigms are evolving from "wait and watch" of the past to more active interventional therapy to obviate the risk of malignant transformation. New surgical …

Factors Associated With Postoperative Pain Among Patients After Cardiac Surgery In The Tertiary Care Teaching Hospital Of Karachi, Pakistan, Sineer Micah, Rubina Barolia, Yasmin Parpio, Santosh Kumar, Hasanat Sharif

School of Nursing & Midwifery

Background: Pain is the subjective feeling of an individual, which affects the overall recovery of patients after cardiac surgery. Postoperative pain is the most inadequately managed symptom of cardiac surgery. Subsequently, there are many factors that can either hinder or facilitate pain management, including patients' beliefs, cultural values, physiological features, hospital policies, and healthcare providers' knowledge and beliefs. The purpose of this research was to identify factors associated with postoperative pain and its management, after cardiac surgery, among patients in a tertiary care hospital in Karachi, Pakistan.
Methods: Quantitative correlational study design was employed to attain the study purpose. Data …

Role Of Surgery In Spinal Metastases, Altaf Ali Laghari, Humza Faisal Siddiqui, Muhammad Shahzad Shamim

Section of Cardiology

Spinal metastases constitute two-third of all cases of bone metastases. Surgical intervention in these tumours has been recommended in highly selective cases, for confirming diagnosis, stabilizing the spine, and decompressing nerves or spinal cord for alleviation of pain and preservation of function.In this article,the authors have reviewed available evidence on role of surgery in spinal metastases and have presented results of selected papers on this vast topic.

Defining The Hemodynamic Response Of Hypertensive And Normotensive Subjects Through Serial Timed Blood Pressure Readings In The Clinic, Hunaina Shahab, Hamza Sohail Khan, Aysha Almas, Sohail Abrar Khan, Azmina Artani, Aamir Hameed

Section of Cardiology

Background: Every third patient in the clinic is misdiagnosed due to white-coat phenomenon, necessitating needless and costly treatment. We aimed to study the hemodynamic response of the physician's visit on hypertensive and normotensive patients by investigating the trend of blood pressure (BP) before, during and 15 min after the physician-patient encounter.
Methods: A descriptive, cross-sectional study was conducted over a period of 8 months in the cardiology clinics at the Aga Khan University Hospital, Karachi. Both hypertensive and normotensive patients, aged ≥18 years, were recruited. Pregnant females or those with a history of volume loss were excluded. BP readings were …

May Measurement Month 2017: An Analysis Of The Blood Pressure Screening Campaign Results In Pakistan-South Asia, Mohammad Ishaq, Feroz Memon, Thomas Beaney, Xin Xia, Elsa Kobeissi, Neil R. Poulter

Section of Cardiology

Elevated blood pressure (BP) is a growing burden worldwide, leading to over 10 million deaths each year. May Measurement Month (MMM) is a global initiative aimed at raising awareness of high BP and to act as a temporary solution to the lack of screening programs worldwide. Hypertension is a global health concern for developing countries. In Pakistan, apart from few population-based studies which evaluated the prevalence of hypertension, there is no current nationally representative study (the latest nationwide survey was conducted more than two decades ago). Pakistan Hypertension League, in accordance with the International Society of Hypertension directive under the …

The Use Of Folic Acid In Dengue: Has It Any Value?, Asif Ali Shah, Ahsan Ali Syed, Saad Bin Zafar, Safia Awan

Section of Internal Medicine

Folic acid is used in dengue patients. Our study aims to compare the duration of recovery of thrombocytopenia in patients with dengue infection who received folic acid and those who did not. We retrospectively reviewed the medical records of adult patients admitted over six years with a diagnosis of dengue. Of 2216 patients, 1464 fulfilled the inclusion criteria. Group A were those patients who received folic acid and group B were those who did not. A total of 1322 (90.3%) patients received folic acid. The mean time period required for platelets to double the nadir was 1.7 (±2.2) days in …

Comparison Of The Depth Of Cure Of Flowable Composites Polymerized At Variable Increment Thicknesses And Voltages: An In Vitro Study, Sadia Tabassum, Muhammad Hasan Hameed, Farhan Raza Khan

Section of Dental-Oral Maxillofacial Surgery

Objectives: The aim of this study is to compare the depth of cure of two composite materials (SDR and Filtek bulk-fill) cured at variable increment depths (2, 4, and 6 mm) and voltages (180 and 220 volts).
Materials and Methods: Each sample of the composite material was packed in a mold of 2 mm, 4 mm, and 6 mm and curing light (quartz tungsten halogen) of optimal intensity was exposed for 20 s at 2 different voltages on each specimen. After curing, the specimens were removed and the composite on the nonexposed end was scraped with a plastic instrument. The …

Subsequent Event Risk In Individuals With Established Coronary Heart Disease, Riyaz S. Patel, Vinicius Tragante, Amand F. Schmidt, Raymond O. Mccubrey, Michael V. Holmes, Laurence J. Howe, Kenan Direk, Axel Åkerblom, Karin Leander, Salim S. Virani

Office of the Provost

Background: The Genetics of Subsequent Coronary Heart Disease (GENIUS-CHD) consortium was established to facilitate discovery and validation of genetic variants and biomarkers for risk of subsequent CHD events, in individuals with established CHD.
Methods: The consortium currently includes 57 studies from 18 countries, recruiting 185 614 participants with either acute coronary syndrome, stable CHD, or a mixture of both at baseline. All studies collected biological samples and followed-up study participants prospectively for subsequent events.
Results: Enrollment into the individual studies took place between 1985 to present day with a duration of follow-up ranging from 9 months to 15 years. Within …

Raised Levels Of Ifn-Gamma And Il-13 Are Associated With Pre-Diabetes Amongst Newly Diagnosed Patients With Tuberculosis, Zahra Hasan, Muhammad Irfan, Qamar Masood, Owais Ahmed, Shoaib Rao, Umme Salama Moosajee, Naseem Salahuddin

Department of Pathology and Laboratory Medicine

Objective: To investigate pre-diabetes and diabetes in newly-diagnosed tuberculosis patients and to assess the association of serum cytokine levels with diabetes status.
Methods: The cross-sectional study was conducted at Indus Hospital and The Aga Khan University Hospital, Karachi from May to November 2015, and included patients of either gender aged 18 years or more with a confirmed diagnosis of tuberculosis who were either newly diagnosed or had received up to 1 month of anti-tuberculosis therapy were included. Patients were enrolled from among those presenting to the clinics at Indus Hospital, Karachi, and the Department of Medicine, Aga Khan University Hospital …

Antimicrobial Susceptibility Patterns Of Salmonella Species In Southern Pakistan, Ghulam Shabbir Laghari, Zahid Hussain, Syed Zohaib Maroof Hussain, Haresh Kumar, Syed Mohammad Mazhar Uddin,, Aatera Haq

Section of Internal Medicine

Introduction Typhoid fever is a major infectious disease among the pediatric population of Pakistan. With inappropriate use of antibiotics and rising trends of multidrug-resistant (MDR) and extended drug-resistant (XDR) typhoid, it is becoming a public health emergency. This study evaluated the current trends in antibiotic susceptibilities to Salmonella (S) typhi and paratyphi A, B, and C in southern Pakistan. Materials and methods This cross-sectional study, conducted in the Pediatrics Department, Civil Hospital, Jamshoro from July to December 2018, included children with S. typhi and S. paratyphi A and B strains isolated from the laboratory-based culture of blood samples. Results There …

Retrospective Study Of Patients With Hyperphenylalaninemia: Experience From A Tertiary Care Center In Pakistan, Sibtain Ahmed, Hafsa Majid, Lena Jafri, Aysha Habib Khan, Zeba Zulfiqar Ali, Bushra Afroze

Department of Pathology and Laboratory Medicine

Objective: To assess the clinical and biochemical features as well as outcome of perphenylalaninemia patients.
Methods: The descriptive retrospective study was conducted at the Aga Khan University Hospital, Karachi, and comprised data from January 2013 to February 2017 of plasma amino acid analysed at the Biochemical Genetic Laboratory of patients with phenylalanine levels >120 umol/L. Medical charts of patients registered with the Metabolic Clinics were reviewed, while outside referrals were contacted by telephone to collect data on a pre-structured questionnaire. Data was analysed using SPSS 21.
Results: Of the 18 patients, 13(72%) were males. Overall median age was 606 days …

Survival And Treatment Outcomes Of Metaplastic Breast Carcinoma: Single Tertiary Care Center Experience In Pakistan, Zarka Samoon, Madiha Beg, Romana Idress, Adnan Jabbar

Department of Radiation Oncology

Background: Metaplastic breast carcinoma (MBC) is a rare disease with incidence of less than 1%. MBC present with a larger tumor size, less number of nodes involved, mostly undifferentiated triple negative tumors. We aimed to determine progression-free and overall survival and reported hospital-based incidence of MBC.
Material and Methods: A retrospective closed Cohort study elicited data of 42 patients with MBC from January 2008 to December 2013; followed till August 2016. Kaplan-Meier method was applied to compute overall and progression-free survival analysis. Cox Proportional hazard ratios were computed to assess associations between survival and independent variables.
Results: Hospital-based incidence of …

Rare Variant Of Guillain-Barré Syndrome After Chikungunya Viral Fever, Sajid Hameed, Sara Khan

Section of Neurology

Chikungunya (CHIK) viral fever is a self-limiting illness that presents with severe debilitating arthralgia, myalgia, fever and rash. Neurological complications are rare. We present a case of a 36-year-old woman who presented with acute onset progressive difficulty swallowing and left arm weakness. She was diagnosed with CHIK viral fever 4 weeks prior to admission. After investigations, she was diagnosed with a pharyngeal-cervical-brachial variant of Guillain-Barré syndrome. In hospital, she required ventilator support. Her condition improved after five sessions of intravenous immunoglobulin with almost complete resolution within 6 months of symptom onset. With frequent CHIK outbreaks, the neurological complications are increasingly …

The Incidence Of Pregnancy Hypertension In India, Pakistan, Mozambique, And Nigeria: A Prospective Population-Level Analysis., Laura A. Magee, Sumedha Sharma, Hannah L. Nathan, Olalekan O. Adetoro, Mrutynjaya B. Bellad, Shivaprasad Goudar, Rahat Qureshi, Andrew H. Shennan, Zulfiqar A. Bhutta, Peter Von Dadelszen

Department of Paediatrics and Child Health

Background:
Most pregnancy hypertension estimates in less-developed countries are from cross-sectional hospital surveys and are considered overestimates. We estimated population-based rates by standardised methods in 27 intervention clusters of the Community-Level Interventions for Pre-eclampsia (CLIP) cluster randomised trials.
Methods and findings:
CLIP-eligible pregnant women identified in their homes or local primary health centres (2013–2017). Included here are women who had delivered by trial end and received a visit from a community health worker trained to provide supplementary hypertension-oriented care, including standardised blood pressure (BP) measurement. Hypertension (BP ≥ 140/90 mm Hg) was defined as chronic (first detected at <20 weeks gestation) or gestational (≥20 weeks); pre-eclampsia was gestational hypertension plus proteinuria or a pre-eclampsia-defining complication. A multi-level regression model compared hypertension rates and types between countries (p < 0.05 …

Contextual Design Choices And Partnerships For Scaling Early Child Development Programmes, Kate M. Milner, Raquel Bernal Salazar, Sunil Bhopal, Alexandra Brentani, Pia Rebello Britto, Tarun Dua, Melissa Gladstone, Esther Goh, Jena Hamadani, Muneera Rasheed

Department of Paediatrics and Child Health

Translating the Nurturing Care Framework and unprecedented global policy support for early child development (ECD) into action requires evidence-informed guidance about how to implement ECD programmes at national and regional scale. We completed a literature review and participatory mixed-method evaluation of projects in Saving Brains®, Grand Challenges Canada® funded ECD portfolio across 23 low- and middle-income countries (LMIC). Using an adapted programme cycle, findings from evaluation related to partnerships and leadership, situational analyses, and design for scaling ECD were considered. 39 projects (5 'Transition to Scale' and 34 'Seed') were evaluated. 63% were delivered through health and 84% focused on …

National Approach To Standardize And Improve Mechanical Ventilation, Yaseen M. Arabi, Zohair Al Aseri, Tareef Alaama, Abdulrahman Alqahtani, Abdulrhman Alharthy, Abdullah Almotairi, Eman Al Qasim, Abdullah A. Alzahrani, Mohammed Al Qarni, Asad Latif

Department of Anaesthesia

NASAM (National Approach to Standardize and Improve Mechanical Ventilation) is a national collaborative quality improvement project in Saudi Arabia. It aims to improve the care of mechanically ventilated patients by implementing evidence-based practices with the goal of reducing the rate of ventilator-associated events and therefore reducing mortality, mechanical ventilation duration and intensive care unit (ICU) length of stay. The project plans to extend the implementation to a total of 100 ICUs in collaboration with multiple health systems across the country. As of March 22, 2019, a total of 78 ICUs have registered from 6 different health sectors, 48 hospitals, and …

Response To A Case Report Titled: Anaesthetic Management Of A Patient With Left Ventricular Non-Compaction Undergoing Laparotomy, Faraz Shafiq, M Irfan Ul Haq, Anwar Ul Huda

Department of Anaesthesia

No abstract provided.

The Use Of An ‘Acclimatisation’ Heatwave Measure To Compare Temperature-Related Demand For Emergency Services In Australia, Botswana, Netherlands, Pakistan, And Usa, Naomi Van Der Linden, Thomas Longden, John R. Richards, Munawar Khursheed, Wilhelmina M. T. Goddijn, Michiel J. Van Veelen, Uzma R. Khan, M. Christien Van Der Linden

Department of Emergency Medicine

Background: Heatwaves have been linked to increased risk of mortality and morbidity and are projected to increase in frequency and intensity due to climate change. The current study uses emergency department (ED) data from Australia, Botswana, Netherlands, Pakistan, and the United States of America to evaluate the impact of heatwaves on ED attendances, admissions and mortality.
Methods: Routinely collected time series data were obtained from 18 hospitals. Two separate thresholds (≥4 and ≥7) of the acclimatisation excess heat index (EHIaccl) were used to define "hot days". Analyses included descriptive statistics, independent samples T-tests to determine differences in case mix between …

Endovascular Coiling Versus Neurosurgical Clipping For Aneurysmal Subarachnoid Hemorrhage: A Systematic Review And Meta-Analysis, Syed Ijlal Ahmed, Gohar Javed, Syeda Beenish Bareeqa, Syeda Sana Samar, Ali Shah, Arwa Giani, Zainab Azam, Abeer Tasleem, Syed Hasham Humayun

Section of Neurosurgery

Background: Aneurysmal subarachnoid hemorrhage is a frequently devastating condition with a reported incidence of between 10 and 15 people per 100,000 in the United States. Currently, according to the best of our knowledge, there are not enough meta-analyses available in the medical literature of the last five years which compare the risks and benefits of endovascular coiling with neurosurgical clipping.
Methods: Twenty-two studies were selected out of the short-listed studies. The studies were selected on the basis of relevance to the topic, sample size, sampling technique, and randomization. Data were analyzed on Revman software.
Results: Mortality was found to be …

Lifestyle, Cardiovascular Risk Knowledge And Patient Counselling Among Selected Sub-Saharan African Family Physicians And Trainees. African Journal Of Primary Health Care & Family Medicine, Pius O. Ameh, Kenneth Yakubu, Miriam Miima, Olugbemi Popoola, Gulnaz Mohamoud, Klaus B. Von Pressentin

Family Medicine, East Africa

Background: Cardiovascular disease (CVD)-related deaths in sub-Saharan Africa (SSA) are on the rise, and primary care physicians could facilitate the reversal of this trend through treatment and prevention strategies.

Aim: The aim of this study was to determine the relationship between physician lifestyle practices, CVD prevention knowledge and patient CVD counselling practices among family physicians (FPs) and family medicine (FM) trainees affiliated to FM colleges and organisations in SSA.

Setting: FPs and FM trainees affiliated to FM colleges and organisations in Anglophone SSA.

Methods: A web-based cross-sectional analytical study was conducted using validated, self-administered questionnaires. Following …

A Mixed Method Multi-Country Assessment Of Barriers To Implementing Pediatric Inpatient Care Guidelines, Kirkby D. Tickell, Dorothy I. Mangale, Stephanie N. Tornberg-Belanger, Celine Bourdon, Johnstone Thitiri, Molline Timbwa, Jenala Njirammadzi, Wieger Voskuijl, Ali Faisal Saleem, Zaubina Kazi

Department of Paediatrics and Child Health

Introduction: Accelerating progress in reducing child deaths is needed in order to achieve the Sustainable Development Goal child mortality target. This will require a focus on vulnerable children-including young children, those who are undernourished or with acute illnesses requiring hospitalization. Improving adherence to inpatient guidelines may be an important strategy to reduce child mortality, including among the most vulnerable. The aim of our assessment of nine sub-Saharan African and South Asian hospitals was to determine adherence to pediatric inpatient care recommendations, in addition to capacity for and barriers to implementation of guideline-adherent care prior to commencing the Childhood Acute Illness …

Mental Health Services For Youth In The Eastern Mediterranean Region: Challenges And Opportunities (Editorial), Atif Rahman, Hesham M. Hamoda, Afarin Rahimi-Movaghar, Murad M. Khan Dr., Khalid Saeed

Department of Psychiatry

The Global Burden of Disease study shows that the burden from mental and substance use disorders, measured in Disability Adjusted Life Years (DALYs), has steadily risen in the Eastern Mediterranean Region (EMR) over the last three decades and is higher than the global average for almost all EMR countries). Even more alarming is the finding that depression, self-harm, anxiety and conduct disorders constitute four of the top 10 causes of DALYs among girls and boys aged 15-19 years and suicide is a leading cause of adolescent mortality.

Hematological Profile And Gametocyte Carriage In Malaria Patients From Southern Pakistan, Najia Karim Ghanchi, Mohammad Hassaan Khan, Muhammad Abdullah Arain, Mustafa Bin Ali Zubairi, Ahmed Raheem Buksh, Muhammad A. Khan, Mohammad A. Beg

Department of Pathology and Laboratory Medicine

Background: Malarial infection is a major cause of concern, both worldwide and in Pakistan. Gametocytes are the sexual forms of the parasite that are essential for transmission. They fuse inside the mosquito to develop sporozoites. Gametocytes of the plasmodium parasites, which cause the infection, differentiate into male and female gametocytes. These gametocytes constitute the sexual stage of the malaria parasite and are essential in transmission of the disease from human to vector Anopheles. Gametocytes are affected by factors such as host immunity, drug treatment, reticulocytemia, anemia, low levels of asexual parasitemia and stress to the parasite. The aim of this …

Progress In Adolescent Health And Wellbeing: Tracking 12 Headline Indicators For 195 Countries And Territories, 1990–2016, Peter S. Azzopardi, Stephen J. C. Hearps, Kate L. Francis, Elissa C. Kennedy, Ali H. Mokdad, Nicholas J. Kassebaum, Stephen Lim, Caleb M. S. Irvine, Theo Vos, Alex D. Brown, Surabhi Dogra, Stuart A. Kinner, Natasha S. Kaoma, Mariam Naguib, Nicola J. Reavley, Jennifer Requejo, John S. Santelli, Susan M. Sawyer, Vegard Skirbekk, Marleen Temmerman, Jordan Tewhaiti-Smith, Joseph L. Ward, Russell M. Viner, George C. Patton

Obstetrics and Gynaecology, East Africa

Background: Rapid demographic, epidemiological, and nutritional transitons have brought a pressing need to track progress in adolescent health. Here, we present country-level estimates of 12 headline indicators from the Lancet Commission on adolescent health and wellbeing, from 1990 to 2016.

Methods: Indicators included those of health outcomes (disability-adjusted life-years [DALYs] due to communicable, maternal, and nutritional diseases; injuries; and non-communicable diseases); health risks (tobacco smoking, binge drinking, overweight, and anaemia); and social determinants of health (adolescent fertility; completion of secondary education; not in education, employment, or training [NEET]; child marriage; and demand for contraception satisfied with modern methods). We drew …

Ectopic Thyroid Mass Separately Present In Mediastinum And Not A Retrosternal Extension: A Report Of Two Cases, Abdul Ahad Sohail, Syed Shahabuddin, Moghira Iqbaluddin Siddiqui

Department of Surgery Docs

Retrosternal extension of goiter is one of the most common types of masses in the superior mediastinum. These types of goiters classically present with compressive symptoms such as dyspnea, dysphonia, dysphagia, or sleep apnea. Surgical treatment with a total thyroidectomy and complete removal of the intrathoracic portion of thyroid is the gold standard treatment. These cervicomediastinal lesions at times may not be continuous, and a sternotomy may be required for complete and safe excision of the mediastinal mass to achieve decompression of the surrounding structures and preventing the hemorrhagic complications if attempted from cervical incision. We present a summary of …