Medical Specialties Commons^™

Awareness And Approach To Headache: A Survey Of Family Physicians In Pakistan, Abdul Malik, Safia Awan, Aziz Sonawalla, Fayyaz Ahmed, Mohammad Wasay

Pakistan Journal of Neurological Sciences (PJNS)

Headache is one of the most common complaints in the general population and the most common symptom for a neurology out-patient visit. According to the WHO, the prevalence of adults complaining of recent headache (at least one episode within the last year) is 47%. Despite the large burden of disease, headaches are often overlooked, underdiagnosed and under-resourced. There are several reasons that include lack of awareness among the general public and healthcare professionals and lack of training at both undergraduate and post-graduate level. There is limited data available from many third world countries including Pakistan. Family Physicians (FPs) equivalent to …

Awareness Of Stroke Among General Practitioners, Waleed Shahzad, Hafiza Faiza Mushtaq, Tehmina Inayat, Muhammad Hassan, Haris Majid Rajput, Mazhar Badshah

Pakistan Journal of Neurological Sciences (PJNS)

Stroke is the 2nd leading cause of death and 3rd leading cause of disability after cancer and ischemic heart disease. The recognition of acute stroke symptoms and knowledge about timely and prompt referral of a patient for possible thrombolysis is a need of time for which general practitioners (as they have to be the first responders many a times across Pakistan) need to be equipped with the advance knowledge about stroke treatment.

Azygos Anterior Cerebral Artery Causing Bifrontal Infarcts: A Case Report, Abdul Khaliq, Palwasha Gul, Pari Gul

Pakistan Journal of Neurological Sciences (PJNS)

The azygos anterior cerebral artery (AACA) is an uncommon anatomical variant. There is absence of the anterior communicating artery (ACom) and bilateral anterior cerebral arteries (ACA) form a common trunk and travels superiorly in the interhemispheric fissure. It can result in bilateral frontal infarcts in case of thromboembolism. Therefore its correct diagnosis is of grave importance for better patient clinical outcome. Cerebrovascular infarction is a common condition, however simultaneous symmetrical bilateral infarction secondary to arterial occlusion is a rare entity. We report a case of a 50 years male with thromboembolic event in azygos anterior cerebral artery resulting in bifrontal …

Bilateral Carotid Body Tumors: A Case Report And Review, Dr Asma, Pari Gul, Palwasha Gul

Pakistan Journal of Neurological Sciences (PJNS)

Carotid body tumors (CBTS) also known as chemodectomas are a type of paragangliomas which originate from the carotid body. Carotid body tumors present as a palpable mass in anterolateral aspect of the neck causing splaying of the external carotid artery (ECA) and internal carotid artery (ICA). Bilateral carotid body tumors are uncommon with a reported incidence of 5 - 10%. CBTs are commonly seen in 4th to 5th decades with female predilection. We report a case of 16 years old boy with bilateral carotid body tumors.

Association Of Fahr Disease With Rhabdomyolysis And Hypoparathyroidism, Suneel Kumar, Ahsan Ali Gaad, Mohsin Irshad Abbasi, Munir Afzal, Shahnaz Shah, Dileep Kumar

Pakistan Journal of Neurological Sciences (PJNS)

Fahr syndrome is an idiopathic deposition of calcium in the basal ganglia (most commonly in the Globus pallidus) of the brain; other most common sites may include striatum pallidum. It can have a wide variety of presentations like progressive psychosis, dementia, movement disorders, gait disturbances or it can also be asymptomatic. Department of Neuro-medicine Hyderabad admitted this 28 year old male first. And then was referred to us in the department of Neuro-medicine JPMC Karachi. He is a known case of epilepsy for 8 years, who now presented with the complaint of fever, fits, and altered sensorium for 3 days. …

Rapidly Progressive Dementia A Case Of Sporadic Creutzfeldt-Jakob Disease (Scjd), Harwindar Kumar, Mian Ayaz Ul Haq, Saad Ali Saddiqui, Jasvindar Kumar, Amjad Iqbal, Danish Nabi

Pakistan Journal of Neurological Sciences (PJNS)

Sporadic CJD is a rare and fatal spongiform encephalopathy characterized by rapidly progressive dementia and myoclonus. It is a rare cause of dementia with an estimated incidence of the disease in one patient per million per year worldwide, however, no data is available for Pakistan. As it is a rare cause of dementia, so rarely considered in differential diagnosis of rapidly progressive dementia.

Diagnostic Dilemma In Non-Ketotic Hyperglycemic Seizures On Mr Imaging, Javerya Sattar, Ateeq Ahmed Khan

Pakistan Journal of Neurological Sciences (PJNS)

Acute metabolic encephalopathy is potentially a reversible condition and requires an early diagnosis and management to reduce morbidity and mortality, as in under diagnosed patients, permanent damage can result. Diabetic encephalopathy is an emerging complication of both type I and type II diabetes. Besides T1 hperintensities in bilateral basal ganglia in diabetic encephalopathy patients, reported in most of the literature reviewed, patients with hyperglycemic seizures can present with subcortical hyperintensities , with predilection for occipital lobes. Here, we report a case of type II diabetic, 40 year-female patient who was referred for MR brain to our department, presented with acute …

Challenges & Barriers For Neuro Rehabilitation In Developing Countries, Muhammad Naveed Babur, Maria Liaqat

Pakistan Journal of Neurological Sciences (PJNS)

People with disabilities especially neurological disabilities have many unmet health and rehabilitation needs, face barriers in accessing mainstream health-care services, and consequently have poor health. There are not sufficient epidemiological studies from Pakistan which assess barriers to neurorehabilitation and ways to counter it.

Task Sharing And Shifting To Provide Pathology Diagnostic Services: The Kenya Fine-Needle Aspiration Biopsy Cytology And Bone Marrow Aspiration And Trephine Biopsy Training Program, Shahin Sayed, Andrew Field, Jamilla Rajab, Anderson Mutuiri, Jessie Githanga, Mary Mungania, Nancy Okinda, Zahir Moloo, Abubakar Abdillah, Brian Ayara, Erick Chesori, Julia Muthua, Leah Obosy, Thaddeus Massawa, Okoth Obiero, Elizabeth Kagotho, Peter K. Shikuku, Andrew K. Gachii, Eunidah Migide, Donstefano Muninzwa, Sanford M. Dawsey, Lucy Muchiri

Pathology, East Africa

Purpose: Fine-needle aspiration biopsy (FNAB) cytology is a simple, inexpensive, and accurate diagnostic test for benign, infectious, and malignant lesions of the breast, thyroid, lymph nodes, and other organs. Similarly, bone marrow aspiration and trephine (BMAT) biopsy procedures are relatively simple and inexpensive techniques that are important for diagnosing and monitoring many hematologic diseases including leukemias and lymphomas. However, the scarcity of pathologists in Kenya limits patient access to these simple diagnostic tests. We describe a task sharing and shifting program that sought to improve the provision of FNABs and BMAT biopsies in tertiary public hospitals in Kenya.

Methods: Between …

Challenges Faced By Pakistani Healthcare System: Clinician's Perspective, Faran Khalid, Ahmed Nadeem Abbasi

Department of Radiation Oncology

Abstract are not provided by the author/publisher

Successful Anesthetic Management Of Patient With Stiff Person Syndrome, Muhammad Sohaib, Sarfraz Siddiqui

Department of Anaesthesia

We herein describe the successful anesthetic management of a patient with stiff person syndrome undergoing right total hip replacement under spinal anesthesia. We also describe the problems associated with general anesthesia. The advantage of using regional anesthesia in these patients is the avoidance of muscle relaxants. The use of general anesthesia carries the risk of hypotonia in stiff person syndrome postoperatively due to enhancement of γ aminobutyric acid (GABA) action on synaptic transmission by drugs that have a γ GABA agonistic action.

Advancing Universal Health Coverage In South Asian Cities: A Framework, Alayne M. Adams, Devaki Nambiar, Sameen Siddiqi, Bushra Binte Alam, Srinath Reddy

Department of Paediatrics and Child Health

No abstract provided.

Measuring And Understanding Social-Emotional Behaviors In Preschoolers From Rural Pakistan, Jenna E. Finch, Aisha Khizar Yousafzai, Muneera Rasheed, Jelena Obradović

Department of Paediatrics and Child Health

The Strengths and Difficulties Questionnaire (SDQ) is widely-used to measure symptoms of common childhood behavioral problems that may lead to mental health difficulties. In a sample of 1,302 highly-disadvantaged mothers and their preschoolers, we evaluated the factor structure and reliability of the parent-report version of the SDQ in rural Pakistan. Confirmatory factor analyses suggested that the original structure of the SDQ was not appropriate for our data. We created conceptually- and empirically-coherent measures of children’s externalizing behavior problems and prosocial skills. Child and family correlates of social-emotional behaviors were similar to those found in other countries, supporting the validity of …

Tuberculous Granuloma On Bone Marrow Trephine, Farheen Karim, Hira Qadir

Department of Pathology and Laboratory Medicine

Bone marrow examination is a useful tool for diagnosis of many diseases. The utility of bone marrow examination in workup of pyrexia of unknown origin cannot be undermined. Bone trephine of patients presenting with pyrexia of unknown origin must be carefully looked upon for granulomas for evaluation of tuberculosis. In this case, bone marrow trephine aided in timely diagnosis of tuberculosis in a patient.

The Logistics Of Voucher Management: The Underreported Component In Family Planning Voucher Discussions, Moazzam Ali, Madeline Farron, Syed Khurram Azmat, Waqas Hameed

Community Health Sciences

Background: The purpose of health care vouchers or coupons is to receive a health service in exchange which is fully or partially subsidized, such as any treatment offered for communicable disease; for immunization; antenatal care-/postnatal care-related maternal health services; a family planning (FP) service; or to get a health commodity like a medicine. Vouchers are targeted for a group of people who can benefit the most such as on the basis of poverty ranking, marginalized or living in rural areas. According to the World Health Organization, voucher schemes in the area of sexual and reproductive health are considered of high …

Characteristics Of Traumatic Out-Of-Hospital Cardiac Arrest Patients Presenting To Major Centers In Karachi, Pakistan-A Longitudinal Cohort Study, Minaz Mawani, Muhammad Masood Kadir, Iqbal Azam Syed, Junaid Abdul Razzak

Section of Cardiology

Background: Trauma is the leading cause of death for adults under 44 years of age. Survival after traumatic out-of-hospital cardiac arrest (OHCA) has been reported to be poor, and its epidemiology is not well defined. A few studies have reported better survival in response to pre-hospital life-saving interventions. Currently, no published data on traumatic cardiac arrests in the field exist from low- and lower middle-income countries. We aimed to explore the epidemiology and outcomes of traumatic OHCA patients from Karachi, Pakistan. We conducted a longitudinal cohort study at emergency departments (ED) of five major public and private hospitals of the …

“His Mind Will Work Better With Both Of Us”: A Qualitative Study On Fathers’ Roles And Coparenting Of Young Children In Rural Pakistan, Joshua Jeong, Saima Siyal, Günther Fink, Dana Charles Mccoy, Aisha Khizar Yousafzai

Department of Paediatrics and Child Health

Background: Parents are the primary providers of nurturing care for young children’s healthy early development. However, the literature on parenting in early childhood, especially in low- and middle-income countries, has primarily focused on mothers. In this study, we investigate how parents make meaning of fathers’ parenting roles with regards to their young children’s early health and development in rural Pakistan.
Methods: Data were collected between January and March 2017 through in-depth interviews with fathers (N = 33) and their partners (N = 32); as well as separate focus group discussions with fathers (N = 7) and mothers (N = 7). …

His Mind Will Work Better With Both Of Us”: A Qualitative Study On Fathers’ Roles And Coparenting Of Young Children In Rural Pakistan, Joshua Jeong, Saima Siyal, Günther Fink, Dana Charles Mccoy, Aisha Khizar Yousafzai

Department of Paediatrics and Child Health

Background: Parents are the primary providers of nurturing care for young children’s healthy early development. However, the literature on parenting in early childhood, especially in low- and middle-income countries, has primarily focused on mothers. In this study, we investigate how parents make meaning of fathers’ parenting roles with regards to their young children’s early health and development in rural Pakistan.
Methods: Data were collected between January and March 2017 through in-depth interviews with fathers (N = 33) and their partners (N = 32); as well as separate focus group discussions with fathers (N = 7) and mothers (N = 7). …

Multicentre Pilot Study Evaluation Of Lung Ultrasound For The Management Of Paediatric Pneumonia In Low-Resource Settings: A Study Protocol, Jennifer L. Lenahan, Giovanni Volpicelli, Alessandro Lamorte, Fyezah Jehan, Quique Bassat, Amy Sarah Ginsburg

Department of Paediatrics and Child Health

Introduction:
Pneumonia is the leading infectious cause of death among children under 5 years of age worldwide. However, pneumonia is challenging to diagnose. Lung ultrasound (LUS) is a promising diagnostic technology. Further evidence is needed to better understand the role of LUS as a tool for the diagnosis of childhood pneumonia in low-resource settings.
Methods and analysis:
This study aims to pilot LUS in Mozambique and Pakistan and to generate evidence regarding the use of LUS as a diagnostic tool for childhood pneumonia. Children with cough <14 days with chest indrawing (n=230) and without chest indrawing (n=40) are enrolled. World Health Organization Integrated Management of Childhood Illness assessment is performed at enrolment, along with a chest radiograph and LUS examination. Respiratory and blood specimens are collected for viral and bacterial testing and biomarker assessment. Enrolled children are followed for 14 days (in person) and 30 days (phone call) post-enrolment with LUS examinations performed on Days 2, 6 and 14. Qualitative and quantitative data are also collected to assess feasibility, usability and acceptability of LUS among healthcare providers and caregivers. The primary outcome is LUS findings at enrolment with secondary outcomes including patient outcomes, repeat LUS findings, viral and bacterial test results, and patient status after 14 and 30 days of follow-up.
Ethics and dissemination:
This trial was approved by the Western Institutional Review Board as …

Impact Of Maternally Derived Pertussis Antibody Titers On Infant Whole-Cell Pertussis Vaccine Response In A Low Income Setting, Romesa Ibrahim, Syed Asad Ali, Abdul Momin Kazi, Arjumand Rizvi, L. Beryl Guterman, Robert A. Bednarczyk, Ellie Kim, Sohee Park, Simon Paulos, Amilia Jeyachandran

Department of Paediatrics and Child Health

Background: Maternal vaccines against pertussis are not yet recommended in the developing world. Besides unclear burden estimates, another concern is that transplacental transfer of maternal pertussis antibodies could result in attenuation of the immune response to whole cell pertussis (DTwP) primary vaccination series in infants. This study was taken up to determine whether higher levels of maternal pertussis antibodies attenuate immune response of infants to DTwP vaccination series given at 6-10-14 weeks of age.
Methodology: A total of 261 pregnant women and their infants from four low-income settlements in Karachi, Pakistan were enrolled in this study. The study endpoints were …

Phase I Of The Surveillance For Enteric Fever In Asia Project (Seap): An Overview And Lessons Learned, Caitlin Barkume, Kashmira Date, Samir K. Saha, Farah Qamar, Dipika Sur, Jason R. Andrews, Stephen P. Luby, M Imran Khan, Alex Freeman, Mohammad Tahir Yousafzai, Denise Garret

Department of Paediatrics and Child Health

Objective: The objective of Phase I of the Surveillance for Enteric Fever in Asia Project (SEAP), a multiphase surveillance study characterizing the burden of disease in South Asia, was to inform data collection for prospective surveillance and to capture clinical aspects of disease.
Methods: Through a retrospective record review conducted at hospitals in Bangladesh, India, Nepal, and Pakistan, we examined laboratory and clinical records to assess the culture positivity rate for Salmonella Typhi and Salmonella Paratyphi, age and sex distribution, and antimicrobial susceptability in each country.
Results: Of all blood cultures performed in Bangladesh, India, Nepal, and Pakistan, 1.5%, 0.43%, …

Integrating Facility-Based Surveillance With Healthcare Utilization Surveys To Estimate Enteric Fever Incidence: Methods And Challenges, Jason R. Andrews, Caitlin Barkume, Alexander T. Yu, Samir K. Saha, Farah Qamar, Denise Garrett, Stephen P. Luby

Department of Paediatrics and Child Health

Cohort studies and facility-based sentinel surveillance are common approaches to characterizing infectious disease burden, but present trade-offs; cohort studies are resource-intensive and may alter disease natural history, while sentinel surveillance underestimates incidence in the population. Hybrid surveillance, whereby facility-based surveillance is paired with a community-based healthcare utilization assessment, represents an alternative approach to generating population-based disease incidence estimates with moderate resource investments. Here, we discuss this method in the context of the Surveillance for Enteric Fever in Asia Project (SEAP) study. We describe how data are collected and utilized to adjust enteric fever incidence for blood culture sensitivity, facility-based enrollment, …

A Retrospective Study Of Laboratory-Based Enteric Fever Surveillance, Pakistan, 2012-2014, Farah Naz Qamar, Mohammad Tahir Yousafzai, Shazia Sultana, Attaullah Baig, Sadia Shakoor, Farzeen Hirani, Abdul Wassay, Sehrish Khushboo, Junaid Mehmood, Alexander Freeman

Department of Paediatrics and Child Health

Introduction: The Surveillance for Enteric Fever in Asia Project (SEAP) is a multisite surveillance study designed to capture morbidity and mortality burden of enteric fever (typhoid and paratyphoid) in Bangladesh, Nepal, and Pakistan. We aim to describe enteric fever disease burden, severity of illness, and antimicrobial resistance trends in Pakistan.
Methods: In this retrospective, cross-sectional study, laboratory records of hospitalized patients who received a blood culture in any of 3 Aga Khan University hospitals in Karachi and Hyderabad, Pakistan, from 2012 to 2014 were reviewed. A case was defined as having a positive blood culture for Salmonella Typhi (S. Typhi) …

Serous Cystadenoma Of Pancreas : A Clinicopathologic Experience Of 23 Cases From A Major Tertiary Care Center, Muhammad Usman Tariq, Zubair Ahmad, Jamshid Abdul Ghafar, Nasir Ud Din

Department of Pathology and Laboratory Medicine

Background: Serous cystadenomas of pancreas are rare benign epithelial neoplasms, which predominantly occur in the pancreatic body and tail of elderly females. Majority of these tumors have microcystic appearance. Macrocystic and solid variants have also been described. A number of more aggressive cystic pancreatic lesions are included in the differential diagnosis. Distinction from such lesions is important for optimal management.
Objective: Our aim was to study the clinical and histological features of serous cystadenomas which would be helpful in making their correct diagnosis and understanding their behavior.
Methods: We reviewed 23 cases of serous cystadenomas diagnosed in our institution between …

Oral Ondansetron Administration To Nondehydrated Children With Diarrhea And Associated Vomiting In Emergency Departments In Pakistan: A Randomized Controlled Trial, Stephen B. Freedman, Sajid Bashir Soofi, Andrew R. Willan, Sarah Williamson Urquhart, Noshad Ali, Jianling Xie, Fady Dawoud, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Study objective: We determine whether single-dose oral ondansetron administration to children with vomiting as a result of acute gastroenteritis without dehydration reduces administration of intravenous fluid rehydration.
Methods: In this 2-hospital, double-blind, placebo-controlled, emergency department–based, randomized trial conducted in Karachi Pakistan, we recruited children aged 0.5 to 5.0 years, without dehydration, who had diarrhea and greater than or equal to 1 episode of vomiting within 4 hours of arrival. Patients were randomly assigned (1:1), through an Internet-based randomization service using a stratified variable-block randomization scheme, to single-dose oral ondansetron or placebo. The primary endpoint was intravenous rehydration (administration of 20 …

Surgical Management Of Metastatic Lesions Of Proximal Femur And The Hip, Mujahid Jamil Khattak, Umair Ashraf, Zohaib Nawaz, Shahryar Noordin, Masood Umer

Section of Orthopaedic Surgery

Metastatic bony lesions involving proximal femur and hip joint pose a challenge to orthopedic surgeons. Lesions in this important weight-bearing zone of the femur weaken its ability to sustain load causing pain and impending pathologic fracture. These Patients warrant multidisciplinary approach including orthopedic surgeons, oncologist and medical specialties. Management of these lesions has evolved over the last 60 years from benign neglect to internal fixation and recently to prosthetic reconstruction for optimum function. Decision for surgical approach requires consideration for location of the lesion, presence of a fracture, tumor type, cortical destruction, patient's life expectancy, patient preferences and the expected …

Ankle Arthrodesis Using Ilizarov Ring Fixator: A Primary Or Salvage Procedure?: An Analysis Of Twenty Cases, Obada Hasan, Shah Fahad, S. Sattar, Masood Umer, Haroon Rashid

Section of Orthopaedic Surgery

Introduction: Ankle arthrodesis using the Ilizarov technique provides high union rate with the added benefits of early weight-bearing, and the unique advantage of its ability to promote regeneration of soft tissue around the bone, including skin, muscle and neuro-vascular structures, and its versatility to allow correction of the position of the foot by adjusting the frame post-operatively as needed. We describe our experience with this technique and the functional outcomes in our patients.
Materials and Methods: This retrospective study was conducted in 20 ankle fusion cases using the Ilizarov method between the years 2007 and 2017. We defined success in …

Radiological And Clinical Outcomes In Patients Undergoing Anterior Cervical Discectomy And Fusion: Comparing Titanium And Peek (Polyetheretherketone) Cages, Muhammad Junaid, Mamoon Ur Rashid, Syed Sarmad Bukhari, Mamoon Ahmed

Section of Neurosurgery

Objectives: To study clinical and radiological outcomes in patients who had undergone the procedure of anterior cervical discectomy and fusion with titanium or PEEK (polyetheretherketone) cages for cervical disc prolapse.
Methods: This is a retrospective/non-randomized study which was conducted at the Combined Military Hospital Peshawar. Study interval was four years from 1st October, 2010 to 31st September, 2014. Total number of included patients were 149. All of the patients had undergone the procedure of anterior cervical discectomy and fusion with titanium or PEEK (polyetheretherketone) cages. All of the patients had plain MRI cervical spine done for diagnosis of anterior cervical …

Tumour Treating Fields (Ttfs) For Paediatric Brain Tumours, Brain Metastases And Other Novel Applications, Farhan Arshad Mirza, Muhammad Shahzad Shamim

Section of Neurosurgery

Tumour treating fields (TTFs) are now FDA approved for high grade glioma treatment. Novel application of this treatment modality is being assessed for paediatric brain tumours and intracranial metastatic disease. Clinical trials are being conducted to test the efficacy of this treatment modality as adjuvant therapy to current standard of care. Here we will discuss the existing literature on TTF its role in pathologies other than GBM. In addition, aspects of safety, compliance and cost are also discussed.

Large Mediastinal Mass In A 15-Year-Old Boy, Mariyam Gohar Ali, Ali Bin Sarwar Zubairi, Farah Naz Qamar

Section of Pulmonary & Critical Care

Hyperimmunoglobulin E syndrome is a rare multisystem inherited disorder characterised by high serum IgE levels, skin disorder causing eczema, dermatitis, recurrent staphylococcal infections and pulmonary infections and various skeletal and connective tissue abnormalities. Common presentation is with recurrent skin and sinopulmonary infections. Several features unrelated to immune system such as characteristic facial features, hyperextensibility of joints, multiple bone fractures and craniosynostosis have been described in the literature. We describe a rare presentation of this disease with invasive aspergillosis presenting as mediastinal mass with extension to mediastinalstructures and pulmonary vasculature.