Medical Specialties Commons^™

Frequency Of Alk Rearrangement By Fish Testing And Its Correlation With Alk-Ihc In Adenocarcinoma Of Primary Lung Origin, Samar Moattar, Namrah Anwar, Tariq Moatter, Shahid Pervez

Department of Pathology and Laboratory Medicine

Anaplastic lymphoma kinase (ALK) gene can be oncogenic either by forming fusion with other genes, amplification of the gene or by having mutations. ALK rearrangement can either be detected by standard “fluorescence in situ hybridization (FISH)” or “immunohistochemistry (IHC)”. Objective of this study was to record the prevalence of ALK rearrangement in adenocarcinoma of Primary Lung origin and compare it with ALK-IHC staining. Data of 64 patients of lung adenocarcinoma from 2015-2017 was analyzed. All of the FFPE biopsies were tested for EGFR (qPCR) followed by ALK rearrangement (by FISH and IHC) on EGFR negative samples. Out of 64 samples, …

Role Of Tnf Α, Il-6 And Cxcl10 In Dengue Disease Severity, Kiran I. Masood, Bushra Jamil, Maryam Rahim, Muniba Islam, Muhammad Farhan, Zahra Hasan

Department of Pathology and Laboratory Medicine

Background and objective: Dengue virus infections (Dengue) have become increasingly common in Pakistan and can result in case fatalities if not managed appropriately. Patients with Dengue virus infection may be asymptomatic or present with Dengue fever (DF), Dengue with warning signs (DWS) or severe Dengue (SD). Severity in Dengue is coincident with an exacerbated production of lymphocyte-induced cytokines and chemokines which are associated with plasma leakage. We investigated the association of circulating levels of cytokines such as Interleukin (IL)-6, tumor necrosis factor (TNF)-alpha and CXCL-10 in Dengue patients with differing severity of disease.
Material and methods: Dengue infection was confirmed …

Women And Maternal Health Care Providers’ Perceptions, Beliefs And Attitudes Towards Use Of Epidural Analgesia For Labour Pain Relief, Stella Njenga

Master of Medicine in Obstetrics and Gynecology

Background: Epidural analgesia (EA) is considered the gold standard for relief of labour pains due to its effectiveness, safety and flexibility of use. There is a disparity of utilization between high and low & middle income countries with lack of knowledge and resources implicated. Aga Khan University Hospital Nairobi is a well-resourced facility with a well-established EA service. This study explores the perceptions, beliefs and attitudes of women seen at the facility towards EA and how these affect their decision to use the method. It also explores health care providers’ views on the method and how they influence the women’s …

Fibrous Pseudotumor Of Tunica Albuginea Testis Mimicking Testicular Neoplasm In A Young Man, Nazim Syed Muhammad, Ayesha Nusrat, Zehra Kazmi

Section of Urology

ntrascrotal lesions are common findings with a majority occurring in paratesticular tissue. Fibrous pseudotumors are rare, benign lesions of the testicular tunics and present with mass lesion(s) in the scrotum. Preoperative clinical and radiological diagnosis is challenging. We report a case of a 34-year-old man who presented with a 3-year history of left testicular swelling and was advised left radical orchidectomy by another surgeon. Physical examination revealed a firm, nontender mass attached to the lower pole of the testis. Testicular tumor markers were all negative, and ultrasound scan showed a relatively hypoechoic lesion closely associated with the left testis and …

Acinetobacter Infections: A Retrospective Study To Determine In – Hospital Mortality Rate And Clinical Factors Associated With Mortality, Rajiv Patel

Master of Medicine in Internal Medicine

Background: Acinetobacter infections are increasingly being recognized as a cause for significant in – hospital morbidity and mortality worldwide. Increasingly multi – drug resistant strains of Acinetobacter are being isolated, increasing the burden on healthcare resources. Our objectives were to determine the outcomes and clinical factors related to outcomes of Acinetobacter infections at the Aga Khan University Hospital. Methods: A retrospective study of Acinetobacter infections (from any site) was conducted. Patient records were used to gather relevant clinical information. The collected data was tabulated and analysed for any significant differences in demographic or clinical variables. The Pearson Chi squared test …

Amniotic Fluid Embolism, Nadia Nawaz, Ahmed Raheem Buksh

Department of Obstetrics & Gynaecology

Amniotic fluid embolism is a rare and severe problem in obstetric patients. We experienced a 21-year primigravida who underwent emergency cesarean section due to sudden collapse and fetal distress after rupture of membranes in labour. Subsequently, she developed intraoperative coagulopathy, hemorrhage, hypotension, and respiratory collapse requiring ventilation. Both maternal and neonatal lives were saved with full recovery and discharged in stable condition. The clinical diagnosis of amniotic fluid embolism (AFE) was made, which is a very rare complication of pregnancy/puerperium with varying presentation, ranging from cardiac arrest, circulatory collapse and death through mild degrees of organ system dysfunction with or …

Monitoring Of Birth Registry Coverage And Data Quality Utilizing Lot Quality Assurance Sampling Methodology: A Pilot Study, Shiyam Sunder Tikmani, Sarah Saleem, Elizabeth Mcclure, Farnaz Naqvi, Farina Abrejo, Zahid Soomro, Dennis Wallace, Robert L. Goldenberg

Community Health Sciences

Background: Effectively monitoring the coverage and quality of data in low-resource settings is challenging. Lot quality assurance sampling (LQAS) is a method to classify coverage as adequate or inadequate. The aim of this pilot study is sought to determine the coverage and quality of a birth registry in a rural district in Pakistan.
Methods: This survey was conducted in 14 clusters of Thatta, Pakistan. LQAS methodology was used to monitor the birth registry from December 2015 to February 2016. We randomly selected 19 villages from each cluster. We used a short questionnaire to review the quality of data collection for …

The Project To Understand And Research Preterm Pregnancy Outcomes And Stillbirths In South Asia (Purpose): A Protocol Of A Prospective, Cohort Study Of Causes Of Mortality Among Preterm Births And Stillbirths, Elizabeth M. Mcclure, Sarah Saleem, Shivaprasad S. Goudar, Sangappa Dhaded, G. Guruprasad, Yogesh Kumar, Shiyam Sunder Tikmani, Muhammad Masood Kadir, Jamal Raza, Haleema Yasmin

Community Health Sciences

Background: In South Asia, where most stillbirths and neonatal deaths occur, much remains unknown about the causes of these deaths. About one-third of neonatal deaths are attributed to prematurity, yet the specific conditions which cause these deaths are often unclear as is the etiology of stillbirths. In low-resource settings, most women are not routinely tested for infections and autopsy is rare.
Methods: This prospective, cohort study will be conducted in hospitals in Davengere, India and Karachi, Pakistan. All women who deliver either a stillbirth or a preterm birth at one of the hospitals will be eligible for enrollment. …

Neuroimmunology Diagnostics, Mohammad Saeed, Tariq Gazdar, Nadir Ali Syed, Arsalan Ahmad

Pakistan Journal of Neurological Sciences (PJNS)

Neuroimmunology has led to advanced diagnostics of previously cryptic disorders, using autoantibody testing against neurological targets. Neuropsychiatric syndromes and autoimmune encephalitis can now be routinely diagnosed using specialized antibody tests such as immunofluorescence and immunoblot assays in specialized laboratories. This helps in early and accurate diagnosis, leading to favorable patient prognosis. Here, we briefly review the diagnostics for Neuroimmunologic and related disorders including autoimmune encephalitis, demyelinating diseases, neuropathies, paraneoplastic syndromes, stiffperson syndrome, inflammatory myopathies as well as Alzheimer’s disease.

Cerebral Venous Thrombosis Presenting As Subarachnoid Haemorrhage, Farheen Niazi

Pakistan Journal of Neurological Sciences (PJNS)

We present a 31 years old lady who was 19 days postpartum who was admitted with fits and loss of consciousness. At presentation Glasgow Coma Scale was 8/15. No focal deficit. CT scan brain showed findings suggestive of subarachnoid haemorrhage(SAH) in left sylvian fissure along with few parenchymal haemorrhagic areas in frontal and parietal lobes. MRI brain and MRV confirmed superior sagittal sinus thrombosis, inferior sagittal, straight and right transverse and sigmoid sinus thrombosis. Patient was treated conservatively and was anticoagulated for 6 months and had a complete recovery. Further workup of thrombophilia was negative. Postpartum being the only risk …

Pattern Of Mental Health Disorders In Adult Population Attending A Tertiary Mental Health Care Setting, Nasir Mehmood, Uroosa Talib, Raza Ur Rehman

Pakistan Journal of Neurological Sciences (PJNS)

Mental health disorders contribute significantly to the global burden of disease (32.4%), . Mental health disorders are the 4th leading cause of disability in developed countries, and the most disabling disorders in low-income and middle-income countries (LAMIC). Over one third of people in most LIMIC fulfill sufficient diagnostic criteria for a mental health disorder at some point in their life.

Profile Of Dementia Patients From A Tertiary Care Center In Karachi, Pakistan, Qurat Ul Ain Khan, Sana Siddiqui, Mohammad Zaman, Abdullah Waqar, Sumera Aziz Ali

Pakistan Journal of Neurological Sciences (PJNS)

BACKGROUND: According to an estimate currently over 46 million people live with dementia worldwide and 58% reside in developing countries. However like some other developing countries, not much is known about the demographics, characteristics, and associated conditions of those suffering from dementia in Pakistan. OBJECTIVE: To study profile of dementia patients from a tertiary care hospital in Karachi, Pakistan.

Association Of Serum Albumin Levels And Guillain Barre Syndrome (Gbs) Outcome., Mazhar Badshah, Ghulam Shabbir, Sumaira Fazal Nabi, Daniyal Ahmed

Pakistan Journal of Neurological Sciences (PJNS)

Guillain-Barre syndrome (GBS) is a polyradiculoneuropathy characterized by a rapidly progressive bilateral paresis of the limbs. Nadir is typically reached within a number of days or weeks, followed by a recovery that is generally much slower and often incomplete. Guillain-Barre syndrome is usually preceded by infection or other immune stimulation that induces an aberrant autoimmune response targeting peripheral nerves and their spinal roots.IVIG and Plasmapheresis are used first line treatments in GBS treatment. For better assessment of treatment response, biomarkers reflecting Plasmapheresis and IVIG efficacy are needed. Aim of this study is to determine serum albumin as an independent biomarker …

Circadian Variation Of Brain Proteins: Importance In Experiments, Muhammad Rafiq, Zahid Mahmood, Sajed Ali

Pakistan Journal of Neurological Sciences (PJNS)

Circadian (from the Latin word circa, meaning 'about', and dies, meaning 'day') rhythms are the rhythms occurring within a period of 24 hours and are endogenously driven in biochemical, physiological or behavioral processes [1]. Circadian rhythms are also entrained by the external environmental cues called zeitgebers, the primary one of which is day light [2]. Circadian rhythms have been widely observed in plants, animals, fungi and cyanobacteria [3]. The study of the biological processes that vary during different time of the day, is called chronobiology. A number of studies on mammalian species have confirmed that the circadian pacemaker resides in …

Child Protection In Pakistan: Legislation & Implementation, Sana Younus, Aisha S Chachar, Ayesha Mian

Pakistan Journal of Neurological Sciences (PJNS)

Children are an integral part of any society. Their dependency on others for the fulfilment of their basic needs like food, shelter, education, safety and security makes them a vulnerable group. Society is judged on its ability to provide for the needs of the vulnerable. Provision of each of these needs is the responsibility of primary caregivers but requires assistance from multiple agencies working at the national level to ensure an effective delivery. Children’s rights can be defined as “the rights, which are concerned both with the protection of the individual child and with the creation of the conditions in …

Letter To The Editor: Digital Dementia-Is Smart Technology Making Us Dumb?, Sanaa Moledina, Adeel Khoja

Section of Internal Medicine

No abstract provided.

Ultrasound-Guided Peripheral Nerve Blocks In High-Risk Patients, Requiring Lower Limb (Above And Below Knee) Amputation, Faisal Shamim, Malika Hameed, Nadeem Ahmed Siddiqui, Shemila Abbasi

Department of Anaesthesia

A case series of five high-risk patients with lower limb ischemia, sepsis, altered coagulation, and multi-organ dysfunction requiring emergent or urgent lower limb amputation is presented. Use of peripheral nerve blocks for below and above knee amputations is quite uncommon which provides better hemodynamic stability and pain management, especially in the very sick patients. The surgeries were successfully carried out under ultrasound-guided combined femoral and sciatic nerve blocks. All five patients obtained adequate level of block at the area of amputation. There were no complications related to anesthetic management. Patients remained hemodynamically stable and pain-free during surgery and postoperatively. Combined …

Trends And Determinants Of Stillbirth In Developing Countries: Results From The Global Network’S Population-Based Birth Registry, Sarah Saleem, Shiyam Sunder Tikmani, Elizabeth M. Mcclure, Janet L. Moore, Iqbal Azam Syed, Sangappa M. Dhaded, Shivaprasad S. Goudar, Ana Garces, Sumera Aziz Ali, Farnaz Naqvi

Community Health Sciences

Background: Stillbirth rates remain high, especially in low and middle-income countries, where rates are 25 per 1000, ten-fold higher than in high-income countries. The United Nations' Every Newborn Action Plan has set a goal of 12 stillbirths per 1000 births by 2030 for all countries.
Methods: From a population-based pregnancy outcome registry, including data from 2010 to 2016 from two sites each in Africa (Zambia and Kenya) and India (Nagpur and Belagavi), as well as sites in Pakistan and Guatemala, we evaluated the stillbirth rates and rates of annual decline as well as risk factors for 427,111 births …

Improving Pregnancy Outcomes In Low- And Middle-Income Countries, Robert L. Goldenberg, Elizabeth M. Mcclure, Sarah Saleem

Community Health Sciences

This paper reviews the very large discrepancies in pregnancy outcomes between high, low and middle-income countries and then presents the medical causes of maternal mortality, stillbirth and neonatal mortality in low-and middle-income countries. Next, we explore the medical interventions that were associated with the very rapid and very large declines in maternal, fetal and neonatal mortality rates in the last eight decades in high-income countries. The medical interventions likely to achieve similar declines in pregnancy-related mortality in low-income countries are considered. Finally, the quality of providers and the data to be collected necessary to achieve these reductions are discussed. It …

Pituitary Tuberculoma, Amir Humza Sohail, Umar Farooq Bhatti, Najmul Islam

Section of Diabetes, Endocrinology and Metabolism

Tuberculosis rarely involves the hypothalamo-pituitary region and constitutes only 1% of the lesions involving the sellar and/or suprasellar region. Coleman and Meredith first reported pituitary tuberculosis in 1940, and only a handful of cases have been reported ever since. It may manifest as a chiasmal syndrome due to compression of the optic chiasm or as hypopituitarism due to pituitary destruction. It has a characteristic radiological appearance and can mimic a pituitary adenoma. Diagnostic procedures, such as trans-sphenoidal biopsy, are crucial for accurate diagnosis. We report a case of a 32-year male, who presented with complaints of headache and decreased visual …

Incidence Of Unintended Pregnancy Among Female Sex Workers In Low-Income And Middle-Income Countries: A Systematic Review And Meta-Analysis, Frances H. Ampt, Lisa Willenberg, Paul A. Agius, Matthew Chersich, Stanley Luchters, Megan S. C. Lim

Population Health, East Africa

Objectives: To determine the incidence of unintended pregnancy among female sex workers (FSWs) in lowincome and middle-income countries (LMICs).

Design: We searched MEDLINE, PsychInfo, Embase and Popline for papers published in English between January 2000 and January 2016, and Web of Science and Proquest for conference abstracts. Meta-analysis was performed on the primary outcomes using random effects models, with subgroup analysis used to explore heterogeneity.

Participants: Eligible studies targeted FSWs aged 15–49 years living or working in an LMIC.

Outcome measures: Studies were eligible if they provided data on one of two primary outcomes: incidence of unintended pregnancy and incidence …

Misplaced Central Venous Catheter In Carotid Artery During Emergency Surgery For The Total Correction Of Tetralogy Of Fallot Of An Adolescent Boy, Shabbir Ahmed, Faisal Junejo, Fazal Wahab Khan

Department of Anaesthesia

Ultrasound-guided central venous cannulation is now considered as the standard of care, and this has largely replaced blind central venous cannulation using anatomical landmarks. We are reporting a case of inadvertent placement of central venous catheter in the right common carotid artery with the use of ultrasound guidance during emergency surgery for the total correction of Tetralogy of Fallot (ToF). This patient luckily had a favourable outcome despite this inadvertent catheter placement which was not recognised even after completion of surgery .The patient also received drug infusions of inotropes and vasopressors through this malplaced central line into the aorta. The …

Pre-Anaesthetic Assessment Of Intracranial Pressure Using Optic Nerve Sheath Diameter In Patients Scheduled For Elective Tumour Craniotomy, Faraz Shafiq, Muhammad Asghar Ali, Fauzia Khan

Department of Anaesthesia

Background: The objective of study was to determine the pre-anaesthetic status of intracranial pressure (ICP), using ultrasonographic measurement of optic nerve sheath diameter (ONSD) inpatient scheduled for elective tumour craniotomy. The secondary objective was to compare the diagnostic accuracy of ONSD guided rise in ICP with clinical and radiographic parameters. This is prospective observational study, conducted at single neurosurgical theatre of The Aga Khan University over a period of one year.
Methods: After getting ethical approval and informed consent patient fulfilling inclusion criteria and planned for elective tumour craniotomy were enrolled in study. The clinical and radiographic signs predicting the …

A Comparison Of Caesarean Section Rates Before And After Introduction Of Free Maternity Services At Maragua Level Iv Hospital, Grace Rwamba

Master of Medicine in Family Medicine

Introduction: At population level, a caesarean section (CS) rate between 10 and 15 percent is considered optimal for maternal and infant health outcomes and a useful process indicator of quality of care. However, that there has been a worldwide increase of CS rates in the past three decades. Compared to vaginal birth, questions abide of appropriateness, balance of risk versus benefit and cost implications to the health care system. Introduction of free maternity services (FMS) in June 2013has been known to increase health facility deliveries. However it may affect the quality of care offered in these facilities due to a …

Factors Associated With Development Of Retinopathy Of Prematurity In Three Private Tertiary Hospitals In Kenya, Annette A. Metho

Master of Medicine in Paediatrics and Child Health

Introduction: Retinopathy of prematurity (ROP) is a condition that affects mainly premature infants. It’s characterized by abnormal retinal vascular growth which in its most severe form can result in blindness due to retinal detachment, and in less severe untreated forms, can result in marked visual impairment. Retinopathy of prematurity is one of the preventable causes of blindness. Research Question: What are the factors associated with development of retinopathy of prematurity in screened preterm infants in three private tertiary hospitals in Kenya? Study Objectives: This study aimed to identify factors associated with development of retinopathy of prematurity in screened preterm infants …

Determining The Level Of Agreement For Atherosclerotic Cardiovascular Disease Risk Stratification Between Coronary Artery Calcium Score And Traditional Cardiovascular Risk Models., Menge Kuria

Master of Medicine in Imaging and Diagnostic Radiology

Introduction: Estimating the risk of future cardiovascular (CV) events is an essential step in the management and prevention of cardiovascular diseases. Many cardiovascular risk tools are available such as the Framingham Risk Score (FRS), the American Heart Association/ American College of Cardiology (AHA/ACC) and the International Society of Hypertension and World Health Organization (ISH/WHO) risk charts. Regrettably, none of these tools has yet to be validated based on data from our Kenyan population. This study, therefore, sought to compare the accuracy of FRS and ACC/AHA in a Kenyan population. The risk estimates derived from the CV tools were correlated with …

Prevalence Of Metastatic Disease In Newly Diagnosed Breast Cancer Patients As Seen On Contrast Enhanced Computed Tomography Of The Chest, Abdomen And Pelvis At The Aga Khan University Hospital, Nairobi., Gregory Obala

Master of Medicine in Imaging and Diagnostic Radiology

Introduction: Breast cancer patients have traditionally been screened for occult metastases with abdominal ultrasound, chest radiography and bone scan although the use of modern tests with greateraccuracy such as computed tomography (CT), 2-[fluorine-18] fluoro-2-deoxy-d-glucose positron emission tomography (FDG PET) and Magnetic resonance (MR) imaging is on the increase. The use of contrast enhanced CT (CECT) in the staging of patients with newly diagnosed breast cancer has increased greatly in clinical practice in view of it being widely available and relatively cheapwhen compared to other modalities such as MRI and PET imaging. The clinical utility of routine staging CECT is yet …

Reference Intervals For Prothrombin Time And Activated Partial Thromboplastin Time Derived From Black African Blood Donors At A University Teaching Hospital In Nairobi, Kenya, Abubakar Abdillah

Master of Medicine in Clinical Pathology

Introduction: Prothrombin time (PT) and activated partial thromboplastin time (APTT) are important coagulation screening tests that give an insight into how well the extrinsic and intrinsic arms of the coagulation cascade are performing. For correct interpretation of laboratory results and avoidance of errors and misdiagnosis, population specific RIs are most appropriate. In a healthcare setting, it is up to the laboratory to establish RIs for use for the particular analytes that they run, or at least verify the RIs availed by the manufacturer of the reagents for a particular analyte. Objectives: This study aimed to establish reference intervals (RIs) for …

Two To Nine Year Review Of Breast Conservation Therapy (Bct) For Breast Carcinoma: Clinico-Pathological Features And Survival In A Single Centre In East Africa, George Orerah

Master of Medicine in General Surgery

Introduction: Breast conservation therapy compares to mastectomy in terms of overall survival and disease free survival. However it’s utilization in most parts of the sub-Sahara Africa is minimal with various factors cited: patient preference, provider preference and adverse effects of or limited access to radiation therapy. The aim of this study was to determine the clinico-pathological profile and outcomes of breast cancer patients treated with breast conservation therapy or mastectomy at a single referral centre. Methods: The Aga khan university hospital is one of the institutions in East Africa, where breast conservation therapy is practiced. We retrospectively analysed the details …

Effect Of Life Skills Building Education And Micronutrient Supplements Provided From Preconception Versus The Standard Of Care On Low Birth Weight Births Among Adolescent And Young Pakistani Women (15–24 Years): A Prospective, Population-Based Cluster-Randomized Trial, Jo-Anna B. Baxter, Yaqub Wasan, Sajid Bashir Soofi, Zamir Suhag, Zulfiqar Ahmed Bhutta

Department of Paediatrics and Child Health

Background: Risk factors known to impact maternal and newborn nutrition and health can exist from adolescence. If an undernourished adolescent girl becomes pregnant, her own health and pregnancy are at an increased risk for adverse outcomes. Offering preconception carefrom adolescence could provide an opportunity for health and nutrition promotion to improve one's own well-being, as well as future pregnancy outcomes and the health of the next generation.
Methods: The Matiari emPowerment and Preconception Supplementation (MaPPS) Trial is a population-based two-arm, cluster-randomized, controlled trial of life skills building education and multiple micronutrient supplementation provided in a programmatic context to evaluate the …