Medical Specialties Commons^™

Reading Between The Joints-Using Spinal Magnetic Resonance Imaging For Evaluation Of Instability, Komal Naeem, S. Ather Enam

Section of Neurosurgery

No abstract provided.

Retinitis Pigmentosa Genes Implicated In South Asian Populations: A Systematic Review, Sidra Zafar, Khabir Ahmed, Azam Ali, Rashid Baig

Section of Ophthalmology

Retinitis pigmentosa is one of the most prevalent causes of inherited retinal dystrophies worldwide. The widespread custom of consanguineous marriages in South Asian countries puts the population at risk for autosomal recessive disorders including retinitis pigmentosa. This systematic review was done between May and December 2015.A comprehensive literature search was carried out using MEDLINE and CINAHL databases and all relevant articles on causative mutations for non-syndromic Retinitis pigmentosa from 1999 till 2015 were included. Overall, 41 articles were identified involving 66 families; 28(68%)from Pakistan, 12(29%) from India and 1(2.4%) from Bangladesh. No data was available from the rest of countries …

Disseminated Hydatid Cyst Of Liver And Lung, Nousheen Iqbal, Muhammad Hussain, Romana Idress, Muhammad Irfan

Section of Pulmonary & Critical Care

Hydatid cyst commonly affects liver followed by lung, but rarely affects both organs simultaneously. Here we presented a patient who presented with concurrent involvement of both lungs and liver. Patient presented with dyspnoea and generalised weakness with bilateral rounded opacities throughout the lung field of variable sizes. CT scan chest with contrast showed multiple rounded soft tissue density in both lungs and liver. Patient underwent mini thoracotomy which revealed multiple cystic lesions throughout lung. ELISA for anti-Echinococcusantibodies shows positive titres. Due to extensive involvement, patient was started on medical treatment albendazole. The patient showed significant improvement both clinically …

Knowledge About Asthma: A Cross-Sectional Survey In 4 Major Hospitals Of Karachi, Pakistan, Omar Irfan, Babar Irfan, Zain Ahmad Khan, Maha Tahir, Ali Bin Sarwar Zubairi, Javaid Ahmad Khan

Section of Pulmonary & Critical Care

Objective: To determine knowledge and misconceptions about asthma among the local population..Methods: This cross-sectional study was conducted at four tertiary care hospitals; Aga Khan University Hospital, Civil Hospital Karachi, Jinnah Postgraduate Medical Centre and Ojha Institute of Chest Diseases, Karachi, from October to November 2016, and comprised hospital attendants. The questionnaire used in the study comprised 26 questions answered with a true, false or not sure answer.SPSS 20 was used for data analysis.Results: There were 400 participants. The overall mean age was 41.2±14.2 years, and 214(53.5%) of the participants were males. Moreover, 75(19%) participants thought that asthma was a psychological …

Comparison Between Endoscopic And Microscopic Approaches For Surgery Of Pituitary Tumours, Inamullah Khan, Muhammad Shahzad Shamim

Section of Neurosurgery

Surgical techniques for resection of pituitary tumours have come a long way since it was first introduced in late 18th century. Nowadays, most pituitary surgeries are performed through trans-nasal trans-sphenoidal approach either using a microscope, or an endoscope. Herein the authors review the literature and compare these two instruments with regards to their outcomes when used for resection of pituitary tumours. .

Methanol Poisoning: 27 Years Experience At A Tertiary Care Hospital, Fareed Ahmed, Nadeem Ullah Khan, Noman Ali, Asher Feroze

Department of Emergency Medicine

Methanol toxicity can result in serious morbidity and mortality without timely diagnosis and treatment. Many cases of methanol poisoning outbreaks have been noted in our population but no study has been performed to estimate methanol exposure and its outcomes and complications. A retrospective study was conducted to review all the cases of methanol poisoning admitted from January 1988 to December 2015 at the Aga Khan University Hospital. A total of 35 methanol poisoning cases were reported. All the patients were male, and the mean age was 36.2±8.6 years. The mean Glasgow Coma Scale score on presentation in the emergency was …

Flipped Classroom Instructional Approach In Undergraduate Medical Education, Syeda Sadia Fatima, Fazal Manzoor Arain, Ather Enam

Department of Biological & Biomedical Sciences

Objective: In this study we implemented the “flipped classroom” model to enhance active learning in medical students taking neurosciences module at Aga Khan University, Karachi.
Methods: Ninety eight undergraduate medical students participated in this study. The study was conducted from January till March 2017. Study material was provided to students in form of video lecture and reading material for the non-face to face sitting, while face to face time was spent on activities such as case solving, group discussions, and quizzes to consolidate learning under the supervision of faculty. To ensure deeper learning, we used pre- and post-class …

Factors Associated With Women's Intention To Request Caesarean Delivery In Dar Es Salaam, Tanzania, C G. Misaeli, B A. Kamala, A H. Mgaya, Hussein Kidanto

Faculty of Health Sciences, East Africa

Background. In the past decade, the rate of caesarean section (CS) has increased dramatically in many parts of the world. At Muhimbili National Hospital (MNH) there has been a dramatic rise in the caesarean section rate over the past decade.

Objective. To determine the incidence of maternal request for CS and factors associated with intention to request caesarean section at the MNH antenatal clinic.

Methods. We conducted a cross-sectional study from August to October 2014. A structured questionnaire gathered participants’ background and obstetric information, perceptions and opinions regarding a request for caesarean section, and the respective reasons for …

Factors Associated With Low Birthweight In Term Pregnancies: A Matched Case-Control Study From Rural Pakistan, Atif Habib, Greenow Cr, S Ariff, Sajid Bashir Soofi, A Hussain, Q Junejo, A Hussain, F Shaheen, K Black

Woman and Child Health

Low birthweight (LBW) remains a significant public health problem in Pakistan and further understanding of factors associated with LBW is required. We conducted a hospital-based matched case control study to identify risk factors associated with LBW in a rural district of Pakistan. We found that illiteracy (AOR: 2.68; 95% CI: 1.59 - 4.38), nulliparity (AOR: 1.82; 95% CI: 1.26-2.44), having a previous miscarriage/abortion (AOR: 1.22; 95% CI: 1.06-2.35), having < 2 antenatal care (ANC) visits during last pregnancy (AOR: 2.43; 95% CI: 1.34-2.88), seeking ANC in third trimester (AOR: 3.62; 95% CI : 2.14-5.03), non-use of iron folic acid during last pregnancy (AOR: 2.72; 95% CI: 1.75-3.17), having hypertension during last pregnancy (AOR: 1.42; 95% CI: 1.13-2.20), being anemic (AOR: 2.67; 95% CI: 1.65-5.24) and having postpartum weight of

Prevalence Of High Risk Hpv In Hiv+ And Hiv-Women With Cervical Dysplasia At The Moi Teaching And Referral Hospital, Seth Kirui, Kirtika Patel, Elkanah Omenge

Obstetrics and Gynaecology, East Africa

Background: Cervical cancer, caused by Human Papillomavirus, is the second commonest cancer among women. HIV+ women are at a higher risk of acquiring HPV, developing pre-cervical cancer lesions (dysplasia) and cervical cancer. Early diagnosis is key to prevention of cervical cancer but reduced sensitivities and specificities of available screening methods pose challenges. The role of HPV in VIA related dysplasia has not been extensively interrogated. We sought to understand HPV infection in the context of HIV status and its relationship to VIA dysplasia

Objectives: To compare prevalence of high risk HPV in HIV positive and HIV negative women with and …

Modifiers Of The Effect Of Maternal Multiple Micronutrient Supplementation On Stillbirth, Birth Outcomes, And Infant Mortality: A Meta-Analysis Of Individual Patient Data From 17 Randomised Trials In Low-Income And Middle-Income Countries, Emily R. Smith, Anuraj H. Shankar, Lee S-F Wu, Said Aboud, Seth Adu Afarwuah, Hasmot Ali, Rina Agustina, Shams Arifeen, Per Ashorn, Arjumand Rizvi

Department of Paediatrics and Child Health

Background: Micronutrient deficiencies are common among women in low-income and middle-income countries. Data from randomised trials suggest that maternal multiple micronutrient supplementation decreases the risk of low birthweight and potentially improves other infant health outcomes. However, heterogeneity across studies suggests influence from effect modifiers. We aimed to identify individual-level modifiers of the effect of multiple micronutrient supplements on stillbirth, birth outcomes, and infant mortality in low-income and middle-income countries.
Methods: This two-stage meta-analysis of individual patient included data from 17 randomised controlled trials done in 14 low-income and middle-income countries, which compared multiple micronutrient supplements containing iron-folic acid versus iron-folic …

Geo-Spatial Reporting For Monitoring Of Household Immunization Coverage Through Mobile Phones: Findings From A Feasibility Study, Abdul Momin Kazi, M. Ali, Ayub Khan, Hussain Kalimuddin, K. Zubair, A.N. Kazi, Azmina Artani, Syed Asad Ali

Department of Paediatrics and Child Health

Background: The addition of Global Positioning System (GPS) to a mobile phone makes it a very powerful tool for surveillance and monitoring coverage of health programs. This technology enables transfer of data directly into computer applications and cross-references to Geographic Information Systems (GIS) maps, which enhances assessment of coverage and trends.
Objective: Utilization of these systems in low and middle income countries is currently limited, particularly for immunization coverageassessments and polio vaccination campaigns. We piloted the use of this system and discussed its potential to improve the efficiency of field-based health providers and health managers for monitoring of the immunization …

Susceptibility Pattern Of Methicillin Resistant Staphylococcus Aureus To Vancomycin And Other Alternate Agents: Report From A Private Sector Hospital Laboratory, Faryal Saleem, Naima Fasih, Afia Zafar

Department of Pathology and Laboratory Medicine

With increasing prevalence of methicillin resistant Staphylococcus aureus in clinical settings and injudicious use of antibiotics, resistance among MRSA against commonly used antibiotics is increasing. To assess the susceptibility pattern of MRSA against vancomycin, linezolid, tigecycline, rifampicin, fosfomycin fusidic acid, clindamycin, trimethoprim-sulfamethoxazole and teicoplanin, minimum inhibitory concentrations (MICs) for given antimicrobials were performed on 234 MRSA clinical isolates using automated VITEK 2 system. Vancomycin, linezolid, rifampicin, clindamycin, co-trimoxazole and teicoplanin susceptibilities were interpreted according to CLSI breakpoints, while tigecycline, fosfomycin and fusidic acid were interpreted according to BSAC breakpoints. All isolates were found susceptible to vancomycin, tigecycline, teicoplanin and linezolid. …

Concordance Of Cerebrospinal Fluid Latex Particle Agglutination Test With Csf And Blood Culture Among Children With Acute Bacterial Meningitis, Muhammad Khalid, Ali Faisal Saleem

Department of Paediatrics and Child Health

No abstract provided.

Susceptibility Pattern Of Methicillin Resistant Staphylococcus Aureus To Vancomycin And Other Alternate Agents: Report From A Private Sector Hospital Laboratory, Faryal Saleem, Naima Fasih, Afia Zafar

Department of Pathology and Laboratory Medicine

With increasing prevalence of methicillin resistant Staphylococcus aureus in clinical settings and injudicious use of antibiotics, resistance among MRSA against commonly used antibiotics is increasing. To assess the susceptibility pattern of MRSA against vancomycin, linezolid, tigecycline, rifampicin, fosfomycin fusidic acid, clindamycin, trimethoprim-sulfamethoxazole and teicoplanin, minimum inhibitory concentrations (MICs) for given antimicrobials were performed on 234 MRSA clinical isolates using automated VITEK 2 system. Vancomycin, linezolid, rifampicin, clindamycin, cotrimoxazole and teicoplanin susceptibilities were interpreted according to CLSI breakpoints, while tigecycline, fosfomycin and fusidic acid were interpreted according to BSAC breakpoints. All isolates were found susceptible to ancomycin, tigecycline, teicoplanin and linezolid. …

Prevalence And Risk Of Hepatitis E Virus Infection In The Hiv Population Of Nepal, Ananta Shrestha, Anurag Adhikar, Manjula Bhattarai, Ramanuj Rauniyar, Jose D. Debes, André Boonstra, Thupten K. . Lama, Mamun Al Mahtab, Amna Subhan Butt, Sheikh Mohammad Fazle Akbar

Section of Gastroenterology

Background: Infection with the hepatitis E virus (HEV) can cause acute hepatitis in endemic areas in immune-competent hosts, as well as chronic infection in immune-compromised subjects in non-endemic areas. Most studies assessing HEV infection in HIV-infected populations have been performed in developed countries that are usually affected by HEV genotype 3. The objective of this study is to measure the prevalence and risk of acquiring HEV among HIV-infected individuals in Nepal.

Methods: We prospectively evaluated 459 Human Immunodeficiency Virus (HIV)-positive individuals from Nepal, an endemic country for HEV, for seroprevalence of HEV and assessed risk factors associated with HEV infection. …

Educating Before Birth Via Talking To The Baby In The Womb: Prenatal Innovations, Shelina Bhamani

Department of Obstetrics & Gynaecology

Education is the only major weapon that enables nations to progress socio-economically and gives a huge rise to their human development index. More so, it is considered to be the most fundamental requirement for poverty eradication, for addressing socio-political issues and for stabilizing peace and harmony among nations. Education is a lifelong process and does not have a preset parameter for its accessibility and provision (Sharkey, 1998). Learning is innate and natural and the human mind is set to learn since its conception. Additionally, in the recent era, investigations are focused on education and learning even before birth and extensive …

Response To Comment On Mohammad Hamid Et Al (J Pak Med Assoc 67: 1019; 2017) - Incidence And Pattern Of Thrombocytopenia In Cardiac Surgery Patients, Khalid Ahsan

Department of Anaesthesia

No abstract provided.

Distal Humeral Fractures-Current Concepts, James C. Beazley, Njalalle Baraza, Robert Jordan, Chetan S. Modi

General Surgery, East Africa

Background: Distal humerus fractures constitute 2% of all fractures in the adult population. Although historically, these injuries have been treated non-operatively, advances in implant design and surgical technique have led to improved outcomes following operative fixation.

Methods: A literature search was performed and the authors' personal experiences are reported.

Results: This review has discussed the anatomy, classifications, treatment options and surgical techniques in relation to the management of distal humeral fractures. In addition, we have discussed controversial areas including the choice of surgical approach, plate orientation, transposition of the ulnar nerve and the role of elbow arthroplasty.

Conclusion: Distal humeral …

Women And Substance Use: A Qualitative Study On Sexual And Reproductive Health Of Women Who Use Drugs In Delhi, India, Vartika Sharma, Avina Sarna, Waimar Tun, Lopamudra Ray Saraswati, Ibou Thior, Ira Madan, Stanley Luchters

Population Health, East Africa

Objectives: To explore contextual factors that increase vulnerabilities to negative sexual and reproductive health (SRH) outcomes and possible differences in SRH-related behaviours and the needs of women who use drugs (WUD) through non-injecting and injecting routes.

Design: Qualitative study design using semi-structured in-depth interviews.

Participants: Twenty women who injected drugs in the past 3months and 28 women who reported using drugs through non-injecting routes in the past 1month.

Setting: Interviews were conducted at community-based, drop-in centres in Delhi, India.

Results: Study findings illustrate that WUD were sexually active and had multiple sex partners including clients of sex work. Transient relationships …

Pattern Of Neurological Diseases In Adult Outpatient Neurology Clinics In Tertiary Care Hospital, Safia Awan, Saad Shafqat, Ayeesha Kamran Kamal, Aziz Sonawalla, Sarwar Jamil Siddiqui, Fowzia Siddiqui, Mohammad Wasay

Section of Neurology

Objectives: The burden of neurological diseases in developing countries is rising although little is known about the epidemiology and clinical pattern of neurological disorders. The objective of this study was to understand the burden of disease faced by neurologists a in tertiary care setting.

Results: A prospective observational study was conducted of all presentations to neurology clinics at Aga Khan University Hospital Karachi over a period of 2 years. A total of 16,371 out-patients with neurological diseases were seen during the study period. The mean age of the study participants were 46.2 ± 18.3 years and 8508 (52%) were male. …

Ischaemic Pituitary Tumour Apoplexy And Concurrent Meningitis: A Diagnostic Dilemma, Haris Hakeem, Shayan Sirat Maheen Anwar,, Sarwar Jamil Siddiqui

Section of Neurology

Pituitary tumour apoplexy is a rare but potentially life threatening clinical syndrome that mostly results from haemorrhage in the pre-existent tumour. Pure ischaemic subtype of apoplexy is even rarer. The presentation can be hard to differentiate clinically from bacterial meningitis. Moreover, the presence of one does not necessarily exclude the other and early diagnosis of both conditions is imperative for timely management. We report a case of ischaemic pituitary tumour apoplexy that may have precipitated in the setting of bacterial meningitis.

An Adult With Polyneuropathy And Hypogonadism Due To Poems Syndrome, Saba Zaidi, Sidra Sattar, Bhojo A Khealani

Section of Neurology

POEMS (acronym for polyneuropathy, organomegaly, endocrinopathy, M protein myeloma and skin changes), is a rare disease which occurs in the setting of plasma cell dyscrasias. We describe a case of an adult lady who presented with gradual onset weakness of all four limbs and multisystem involvement characterized by pedal edema, ascites, hyperpigmentation and hypogonadism. Nerve conduction study showed severe sensorimotor polyneuropathy. Serum immunofixation showed lambda light chain restricted monoclonal gammopathy. Bone marrow biopsy consistent with plasma cell dyscrasia. Hormonal assay showed decreased FSH, LH and estradiol levels which led us to diagnosis of hypogonadotrophic hypogonadism. The patient responded well to …

Diagnostic Challenges In Prostate Cancer And 68ga-Psma Pet Imaging: A Game Changer?, Maseeh Uz Zaman, Nosheen Fatima, Areeba Zaman, Mahwsih Sajid, Unaiza Zaman, Sidra Zaman

Department of Radiology

Creative Commons Attribution LicenseProstate cancer (PC) is the most frequent solid tumor in men and the third most common cause of cancer mortalityamong men in developed countries. Current imaging modalities like ultrasound (US), computerized tomography (CT),magnetic resonance imaging (MRI) and choline based positron emission (PET) tracing have disappointing sensitivity fordetection of nodal metastasis and small tumor recurrence. This poses a diagnostic challenge in staging of intermediateto high risk PC and restaging of patients with biochemical recurrence (PSA >0.2 ng/ml). Gallium-68 labeled prostatespecific membrane antigen (68Ga-PSMA) PET imaging has now emerged with a higher diagnostic yield. 68Ga-PSMAPET/CT or PET/MRI can be …

Outcomes Of High Risk Patients With Febrile Neutropenia At A Tertiary Care Center, Asif Husain Osmani, Adnan Abdul Jabbar, Manesh Kumar Gangwani, Bilal Hassan

Department of Radiation Oncology

Creative Commons Attribution LicenseFever during chemotherapy-induced neutropenia continues to be a major cause of morbidity and mortality incancer patients. Mortality depends on the duration and degree of neutropenia, bacteremia, sepsis, performance status,comorbidities and other parameters. The highest mortality rates in cancer patients hospitalized with febrile neutropenia(FN) are observed in those with documented infection. The objectives of the study were to present available tools forrisk assessment, to review pathogens causing infections in adult FN patients and to assess outcomes. Methods: Thiscross sectional study was conducted on adult culture positive FN patients admitted to the Hematology/Oncologyservice at the Aga Khan University Hospital, …

Frequency Of G6pd Mediterranean In Individuals With And Without Malaria In Southern Pakistan, Bushra Moiz, Haroon Muhammad Arshad, Ahmed Raheem Raheem, Hasan Hayat, Najia Karim Ghanchi, M Asim Beg

Department of Pathology and Laboratory Medicine

Background: Pakistan has an estimated annual burden of 1.5 million malaria cases. The current situation calls for an efective malaria control and eradication programme in this country. Currently, primaquine is an attractive option for eliminating reservoirs of Plasmodium vivax hypnozoites and killing gametocytes of Plasmodium falciparum. However, this drug causes haemolysis in individuals who are glucose-6-phosphate (G6PD) defcient. It is important to map G6PD defciency and malaria distribution in Pakistan to design an efective malaria eradication regimen. Frequency of G6PD defciency (G6PDd) in malaria patients has not been reported from Pakistan in any meaningful way. The purpose of this study …

Missed Immunization Opportunities Among Children Under 5 Years Of Age Dwelling In Karachi City, Asif Khaliq, Sayeeda Amber Sayed, Syed Abdullah Hussaini, Kiran Azam, Mehak Qamar

Department of Paediatrics and Child Health

Background: Immunization is the safest and effective measure for preventing and eradicating various communicable diseases. A glaring immunization gap exists between developing and industrialized countries towards immunization, because the developing countries including Pakistan are still striving to provide basic immunization to their children. The purpose of this study was to access the prevalence and factors of missing immunization among under 5-year children of Karachi.
Methods: A cross sectional study was conducted from June 2015 to October 2015 among different outpatient clinics of Karachi. Parents who had child less than 5 year of age were approached by non-probability purposive sampling. Data …

Influenza Epidemiology And Immunization During Pregnancy: Final Report Of A World Health Organization Working Group, Deshayne B. Fell, Eduardo Azziz-Baumgartner, Michael G. Baker, Maneesh Batra, Julien Beauté, Philippe Beutels, Niranjan Bhat, Zulfiqar Ahmed Bhutta, Cheryl Cohen, Rehana Salam

Department of Paediatrics and Child Health

From 2014 to 2017, the World Health Organization convened a working group to evaluate influenza disease burden and vaccine efficacy to inform estimates of maternal influenza immunization program impact. The group evaluated existing systematic reviews and relevant primary studies, and conducted four new systematic reviews. There was strong evidence that maternal influenza immunization prevented influenza illness in pregnant women and their infants, although data on severe illness prevention were lacking. The limited number of studies reporting influenza incidence in pregnant women and infants under six months had highly variable estimates and underrepresented low- and middle-income countries. The evidence that maternal …

Delayed Spinal Cord Infarction Following Anterior Cervical Surgical Decompression, Muhammad Faheem Khan, Rashid Jooma, Fauzan Alam Hashmi, Muhammad Faraz Raghib

Section of Neurosurgery

Anterior cervical discectomy and fusion (ACDF) for cord compression is a safe and effective procedure with good outcomes. However, worsening of myelopathy is the most feared adverse event of the surgery. We report the case of a 36-year-old male patient who presented with an acute non-traumatic C5-6 cervical disc herniation causing incomplete quadriparesis. He underwent an uncomplicated ACDF at C5-6, and after an initial period of improvement, he developed a delayed onset of an anterior cord syndrome on day 3, without any discerning cause. We have reviewed similar cases reported in the literature and believe that our patient's postsurgical course …

Bk Polyomavirus Virus Hemorrhagic Cystitis Following Allogeneic Bone Marrow Transplant With Haploidentical Related Donor: Case Reports From Two Patients, Danish Shakeel, Natasha Bahadur Ali, Mohammad Usman Shaikh, Salman Adil

Section of Haematology/Oncology

BK virus is well known to be associated with allograft failure in renal transplant recipients due to polyomavirus-associated nephropathy (PVAN). BK viruses are increasingly recognized an important cause of hemorrhagic cystitis during hematopoietic stem cell transplantation (HSCT). Here we describe two patients with acute lymphoblastic leukemia who received a haplo identical match related donor hematopoietic stem cell transplant after myeloablative conditioning and post-transplant cyclophosphamide. They developed cytology proven BK Virus cystitis. Both were treated with Leflunomide. Treatment was effective in alleviating the symptoms temporarily but eventually the symptoms progressed and resulted in mortality of both patients.