Medical Specialties Commons^™

Availability, Affordability, And Consumption Of Fruits And Vegetables In 18 Countries Across Income Levels: Findings From The Prospective Urban Rural Epidemiology (Pure) Study., Victoria Miller, Salim Yusuf, Clara K. Chow, Mahshid Dehgha, Daniel J. Corsi, Karen Lock, Barry Popkin, Sumathy Rangarajan, Rasha Khatib, Scott A. Lear, Prem Mony, Manmeet Kaur, Viswanathan Mohan, Krishnapillai Vijayakumar, Rajeev Gupta, Annamarie Kruger, Lungiswa Tsolekile, Noushin Mohammadifard, Omar Rahman, Annika Rosengren, Alvaro Avezum, Andrés Orlandini, Noorhassim Ismail, Patricio Lopez-Jaramillo, Afzalhussein Yusufali, Kubilay Karsidag, Romaina Iqbal, Jephat Chifamba, Solange Martinez Oakley, Farnaza Ariffin, Katarzyna Zatonska, Paul Poirier, Li Wei, Bo Jian, Chen Hui, Liuxu Xu, Bai Xiulin, Koon Teo, Andrew Mente

Community Health Sciences

BACKGROUND:

Several international guidelines recommend the consumption of two servings of fruits and three servings of vegetables per day, but their intake is thought to be low worldwide. We aimed to determine the extent to which such low intake is related to availability and affordability.

METHODS:

We assessed fruit and vegetable consumption using data from country-specific, validated semi-quantitative food frequency questionnaires in the Prospective Urban Rural Epidemiology (PURE) study, which enrolled participants from communities in 18 countries between Jan 1, 2003, and Dec 31, 2013. We documented household income data from participants in these communities; we also recorded the diversity …

Comparing Effectiveness Of Active And Passive Client Follow-Up Approaches In Sustaining The Continued Use Of Long Acting Reversible Contraceptives (Larc) In Rural Punjab: A Multicentre, Non-Inferiority Trial, Waqas Hameed, Syed Khurram Azmat, Moazzam Ali, Muhammad Ishaque, Ghazunfer Abbas, Erik Munroe, Rebecca Harrison, Wajahat Hussain Shamsi, Ghulam Mustafa, Omar Farooq Khan

Community Health Sciences

Background: The use of long-acting reversible contraceptive (LARC) methods is very low in Pakistan with high discontinuation rates mainly attributed to method-related side effects. Mixed evidence is available on the effectiveness of different client follow-up approaches used to ensure method continuation. We compared the effectiveness of active and passive follow-up approaches in sustaining the use of LARC-and within 'active' follow-up, we further compared a telephone versus home-based approach in rural Punjab, Pakistan.
Methods: This was a 12-month multicentre non-inferiority trial conducted in twenty-two (16 rural- and 6 urban-based) franchised reproductive healthcare facilities in district Chakwal of Punjab province, between November …

Performance Of Point-Of-Care Cd4 Testing Technologies In Resource-Constrained Settings: A Systematic Review And Meta-Analysis, Minh D. Pham, Paul A. Agius, Lorena Romero, Peter Mcglynn, David Anderson, Suzanne M. Crowe, Stanley Luchters

Population Health, East Africa

Background: Point-of-care (POC) CD4 testing increases patient accessibility to assessment of antiretroviral therapy eligibility. This review evaluates field performance in low and middle-income countries (LMICs) of currently available POC CD4 technologies.

Methods: Eight electronic databases were searched for field studies published between January 2005 and January 2015 of six POC CD4 platforms: PointCare NOW™, Alere Pima™ CD4, Daktari™ CD4 Counter, CyFlow® CD4 miniPOC, BD FACSPresto™, and MyT4™ CD4. Due to limited data availability, meta-analysis was conducted only for diagnostic performance of Pima at a threshold of 350 cells/μl, applying a bivariate multi-level random-effects modelling approach. A covariate extended model was …

Increased Level Of Morning Surge In Blood Pressure In Normotensives: A Cross-Sectional Study From Pakistan, Aysha Almas, Fatehali Tipoo Sultan, Khawar Kazmi

Department of Medicine

Objective: To determine the mean morning surge (MS) in blood pressure, the frequency of increased morning surge in normotensive subjects, and to compare those with morning surge with those without MS.
Study Design: A cross-sectional, comparative study.
Place and Duration of Study: The Department of Medicine, The Aga Khan University Hospital, Karachi, from April 2011 to March 2012.
Methodology: Adult normotensive healthy volunteers aged 35 to 65 years were inducted. Their ambulatory blood pressure (ABP) was measured over a 24-hour period, using digital ambulatory blood pressure monitors. Morning surge was calculated as the average of four readings after waking …

An Unusual Pathogen Causing Native Valve Endocarditis., Aneela Hussain, Nosheen Nasir, Bushra Jamil

Department of Medicine

No abstract provided.

Potential For Task-Sharing To Lady Health Workers For Identification And Emergency Management Of Pre-Eclampsia At Community Level In Pakistan, Rehana A. Salam, Rahat Najam Qureshi, Sana Sheikh, Asif Raza Khowaja, Diane Sawchuck, Marianne Vidler, Peter Von Dadelszen, Shujaat Zaidi, Zulfiqar Bhutta

Department of Paediatrics and Child Health

Background: An estimated 276 Pakistani women die for every 100,000 live births; with eclampsia accounting for about 10% of these deaths. Community health workers contribute to the existing health system in Pakistan under the banner of the Lady Health Worker (LHW) Programme and are responsible to provide a comprehensive package of antenatal services. However, there is a need to increase focus on early identification and prompt diagnosis of pre-eclampsia in community settings, since women with mild pre-eclampsia often present without symptoms. This study aims to explore the potential for task-sharing to LHWs for the community-level management of pre-eclampsia and eclampsia …

Health Care Provider Knowledge And Routine Management Of Pre-Eclampsia In Pakistan, Sana Sheikh, Rahat Najam Qureshi, Asif Raza Khowaja, Rehana Salam, Marianne Vidler, Diane Sawchuck, Peter Von Dadelszen, Shujat Zaidi, Zulfiqar Bhutta

Department of Paediatrics and Child Health

Background: Maternal mortality ratio is 276 per 100,000 live births in Pakistan. Eclampsia is responsible for one in every ten maternal deaths despite the fact that management of this disease is inexpensive and has been available for decades. Many studies have shown that health care providers in low and middle-income countries have limited training to manage patients with eclampsia. Hence, we aimed to explore the knowledge of different cadres of health care providers regarding aetiology, diagnosis and treatment of pre-eclampsia and eclampsia and current management practices.
Methods: We conducted a mixed method study in the districts of Hyderabad and Matiari …

Burden And Associated Factors For Caregivers Of The Elderly In A Developing Country, S Sabzwari, A Munir Badini, Z Fatmi, T Jamali, S Shah

Department of Family Medicine

The elderly population in South Asia is growing. In Pakistan trained caregivers are scarce and culturally not acceptable. This study assessed the level of stress experienced by caregivers of the elderly and determined the association of care giving burden with different characteristics of the elderly. A cross-sectional, questionnaire based study was conducted using nonprobability purposive sampling. All consenting participants aged 60 years and above needing help with at least one activity of daily living or two instrumental activities of daily living were included. 350 participants were assessed for perceived care giver burden. Care providers were mostly female (68.9%). Half (50.3%) …

Co-Existing Spinal Intradural Ependymal Cyst And Sacral Tarlov Cyst In Adult-Onset Tethered Cord Syndrome With Syringomyelia: Case Report And Literature Review, Hamid H. Rai, Muhammad F. Khan, Ather Enam, Imtiaz Hashmi

Section of Neurosurgery

Background: Synchronous spinal intradural ependymal cysts and sacral Tarlov cysts in adult onset tethered cord syndrome are extremely rare.
Case description: A 23-year-old male presented with back pain radiating into both lower extremities, accompanied by acute onset of gait difficulty and sphincter dysfunction. Magnetic resonance imaging identified a low lying conus medullaris, syringomyelia with septations extending from T12 to S1, a tethered cord, and a thickened filum terminale with a sacral Tarlov cyst. The patient underwent a L3-4 laminectomy for decompression of syringomyelia and excision/biopsy of a space occupying lesion along with S1-2 laminectomy for cord untethering and Tarlov cyst …

Molecular Characterization Of Staphylococcus Aureus Isolates From Various Healthcare Institutions In Nairobi, Kenya: A Cross Sectional Study, Geoffrey Omuse, Kristien Nel Van Zyl, Kim Hoek, Shima Abdulgader, Samuel Kariuki, Andrew Whitelaw, Gunturu Revathi

Pathology, East Africa

Background: Staphylococcus aureus (S. aureus) has established itself over the years as a major cause of morbidity and mortality both within the community and in healthcare settings. Methicillin resistant S. aureus (MRSA) in particular has been a major cause of nosocomial infections resulting in significant increase in healthcare costs. In Africa, the MRSA prevalence has been shown to vary across different countries. In order to better understand the epidemiology of MRSA in a setting, it is important to define its population structure using molecular tools as different clones have been found to predominate in certain geographical locations.

Methods: We carried …

Economic Impact Of Moderate-Vigorous Physical Activity Among Those With And Without Established Cardiovascular Disease: 2012 Medical Expenditure Panel Survey, Javier Valero-Elizondo, Joseph A. Salami, Chukwuemeka U. Osondu, Oluseye Ogunmoroti, Alejandro Arrieta, Erica S. Spatz, Adnan Younus, Jamal S. Rana, Salim S. Virani, Ron Blankstein

Office of the Provost

Background: Physical activity (PA) has an established favorable impact on cardiovascular disease (CVD) outcomes and quality of life. In this study, we aimed to estimate the economic effect of moderate-vigorous PA on medical expenditures and utilization from a nationally representative cohort with and without CVD.
Methods and results: The 2012 Medical Expenditure Panel Survey data were analyzed. Our study population was limited to noninstitutionalized US adults ≥18 years of age. Variables of interest included CVD (coronary artery disease, stroke, heart failure, dysrhythmias, or peripheral artery disease) and cardiovascular modifiable risk factors (CRFs; hypertension, diabetes mellitus, hypercholesterolemia, smoking, and/or obesity). Two-part …

Preconception Optimization Of Glycaemic Control In Diabetes, Najmul Islam

Section of Diabetes, Endocrinology and Metabolism

The prevalence of Diabetes Mellitus is increasing worldwide. In developing countries 25% of adult females with diabetes are in the reproductive age. Thus in developing countries increased number of pregnancies are complicated by diabetes. Uncontrolled diabetes in pregnancy is associated with increased risk for both mother and foetus. These risks can be minimized by good control of diabetes before and during pregnancy. Management in the preconception period is discussed in this review article. Detailed management involves general advice of lifestyle modification followed by specific details of screening for complications of diabetes. Changes in the drugs for both glycaemic control and …

Brainstem Tuberculoma As A Manifestation Of Paradoxical Reaction In A Patient With Tuberculous Meningitis., Farheen Niazi, Mazhar Badshah

Pakistan Journal of Neurological Sciences (PJNS)

Tuberculosis commonly involves the CNS, During drug treatment of CNS tuberculosis paradoxical response (PR) may occasionally occur. The term “paradoxicalresponse”refers to the development of previously nonexistent tuberculosis lesions or worsening of preexisting lesions during antituberculosis treatment( ATT). Etiology is still not clear but delayed type hypersensitivity and alteration in immune system is thought to be a cause. Continued treatment improves PR without severe sequelae. We report a 41 year-old female patient with tuberculous meningitis(TBM) who developed brainstem tuberculomaduring the course of ATT, after about 9 months of treatment as a paradoxical response to ATT. Early identification, continuation of ATT with …

In-Hospital Outcome In Patients With Spontaneous Intracerebral Hemorrhage (Ich), Faraz Ahmed, Mazhar Badshah, Sumaira Nabi

Pakistan Journal of Neurological Sciences (PJNS)

Spontaneous intracerebral hemorrhage (ICH) is associated with a high in-hospital mortality and morbidity. One radiological parameter which was found significant in predicting mortality was the presence of hydrocephalus on CT brain (plain). The aim of this study was to determine the frequency of hydrocephalus in patients with spontaneous ICH and to determine the in-hospital outcome in patients of spontaneous ICH with hydrocephalus.MATERIALS AND METHODS: This was a descriptive case series carried out in Department of Neurology, Pakistan institute of Medical Sciences, Islamabad from December 30, 2013 to June 29, 2014. All patients who meet the inclusion criteria were selected for …

The Rise And Rise Of Neurosurgery: Academic Journey Of A Young Department In A Developing Country, Muhammad Shahzad Shamim, Hamid Hussain Rai Hussain Rai

Pakistan Journal of Neurological Sciences (PJNS)

The Section of Neurosurgery, part of the Department of Surgery, and the Mind and Brain Service Line at the Aga Khan University Hospital Karachi, has come a long way since its recognition in mid-90s. Although the program itself was recognized in late 90’s and the first resident graduated in 2004, it wasn't until 2008 that it assumed its current shape of a formal, structured training program. Currently it has six full-time faculty members, one part-time faculty member, two instructors, and a team of 12 residents. Following are few of the innovations introduced within the program over the last few years.

Awareness About The Signs, Symptoms And The Risk Factors Of Stroke In Patients With Stroke: A Multicentre Study, Nausheen Farooq, Haider Darain

Pakistan Journal of Neurological Sciences (PJNS)

The aim of this survey was to determine the levels of awareness regarding symptoms, warning signs and risk factors of stroke in patients with stroke. For the latter purpose, a total of 500 participants who had stroke were recruited from four different hospitals of Rawalpindi and Islamabad. Patients who were already diagnosed by physicians with either type of stroke (haemorrhagic and ischemic) were included in this trial. Data was collected through a questionnaire and was analysed in SPSS version 20. Both male and female population were included in this study. The minimum age for the patients to be included was …

Subarachnoid Hemorrhage:Unusual Situations Leading To Sah And Underlying Principles Of Physics Behind Its Complications, Ali Zohair Nomani, Sumaira Nabi

Pakistan Journal of Neurological Sciences (PJNS)

Multiple authors have identified the most unusual novel associations as precipitant factors of subarachnoid hemorrhage and the knowledge of these and pathogenesis in background is necessary to suspect and therefore timely diagnose subarachnoid bleed and understand the mechanism of its subsequent complications. Objective: We herein describe unusual causes of subarachnoid bleed reported in various case reports with a comprehensive but elaborative review describing underlying pathogenesis and physiological mechanisms behind these precipitants and complications. Evidence Review: We sorted unusual causes of subarachnoid hemorrhage from literature review. By conducting meticulous scrutinization on search engines likePubmed®, Medline ®, Medline Plus ®, PubMed Central …

Adem, Diagnostic Dilemma, A Tertiary Care Hospital Experience:, Rajesh Kumar, Hazim Brohi

Pakistan Journal of Neurological Sciences (PJNS)

Acute disseminated encephalomyelitis (ADEM) is an uncommon inflammatory demyelinating disease of the central nervous system that usually occurs following a viral infection or vaccination, bacterial or parasitic infection, or even spontaneously. ADEM is a monophasic; poly symptomatic disorder but it may present with various combinations of motor, sensory, visual and cognitive symptoms. Some case reports of ADEM presented as psychiatric disorders primarily as confusion psychosis and at times dissociative disorder. At times, the diagnosis becomes a dilemma due to multifaceted picture. Due to confusion physician may go to extreme range of tests with no specific conclusion. Debates regarding exact diagnosis …

Burden Of Diabetes Mellitus And Role Of Telemedicine In Its Management: Narrative Review, Gulshan Bano, Savera Aziz Ali, Minaz Mawani, Sumera Aziz Ali

Section of Diabetes, Endocrinology and Metabolism

Objective: The purpose of this review is to summarize the findings regarding the prevalence and risk factors of Diabetes Mellitusin developed and developing world and to review the management options for Diabetes Mellitus especially the role of telemedicine.

Methodology: Extensive literature review was carried by retrieving articles from various databases like Pub med, Google scholar, Science direct, Scopus and Archives of Medicine. Relevant articles were retrieved from different databases by using text words and phrases like ‘Diabetes Mellitus’, ‘Management’, ‘risk factors’, ‘prevalence of Diabetes’, ‘telemedicine’, ‘e- health’. Types of studies were descriptive studies, systematic reviews and various reports. …

Management And Outcomes Of Intramedullary Spinal Cord Tumors: A Single Center Experience From A Developing Country, Dr Saqib Kamran Bakhshi, Muhammad Waqas, Baila Shakaib, Ather Enam

Section of Neurosurgery

Background: Intraoperative neurophysiology, high magnification microscopes, and ultrasonic aspirators are considered essential aid for the safe resection of intramedullary spinal cord tumors (IMSCTs). Most centers in developing countries such as Pakistan still lack these facilities. The purpose of this study was to review the management of IMSCTs at our hospital and to determine factors associated with the outcomes of surgery.
Methods: This was a retrospective review of medical records of adult patients undergoing surgery for IMSCT over 12 years. The institutional ethical review committee approved this study. Data were collected regarding demographics, clinical and radiological features, and surgical details. Modified …

Uchunguzi (Journal Watch/Montre De Journal) September 2016, Benjamin Wachira

Emergency Medicine, East Africa

Most states in the USA have ‘Good Samaritan’ laws that oblige doctors to stop and render emergency treatment under certain circumstances, without incurring legal liability even if they are negligent. Whether doctors are legally obliged to stop and render assistance at road accidents in most countries across the world remains controversial. In 1978, the South African Medical and Dental Council ruled that ‘in cases of emergency a practitioner is obliged to render assistance in all circumstances’. It has therefore been said that ‘where persons are in a situation where their life or health will be seriously endangered unless they receive …

Spontaneous Uterine Rupture At 28 Weeks: A Case Report, Mahreen Rasool, Imrana Masroor, Shafia Shakoor, Shama Munim

Department of Radiology

Abstract

Spontaneous Uterine rupture is associated with massive intra-peritoneal bleed which can be fatal if not recognized. We report a case of 32 year old multigravida at 28 weeks of gestation with history of liver cysts, previous caesarean and uterine curettage, who presented with acute abdominal pain and tenderness; ultrasound revealed placenta percreta. CT abdomen showed haemoperitoneum. The patient underwent emergency caesarean hysterectomy due to uterine rupture at the cornual site.

The Duration Of Pubertal Growth Peak Among Three Skeletal Classes, Waqar Jeelani, Mubassar Fida, Attiya Shaikh

Department of Surgery Docs

ABSTRACT

Introduction:

Pubertal growth peak is closely associated with a rapid increase in mandibular length and offers a wide range of therapeutic modifiability.

Objective:

The aim of the present study was to determine and compare the mean ages of onset and duration of pubertal growth peak among three skeletal classes.

Methods:

A retrospective cross-sectional study was conducted using lateral cephalograms of 230 subjects with growth potential (110 males, 120 females). Subjects were categorized into three classes (Class I = 81, Class II = 82, Class III = 67), according to the sagittal relationship established between the maxilla and the mandible. …

Morbidity Of Colostomy Reversal, Salma Khan, Abdul Rehman Alvi, , Zara Awan, Naveed Haroon Rashid

Department of Surgery Docs

Abstract

OBJECTIVE:

To determine morbidity after colostomy reversal at a tertiary care hospital.

METHODS:

The retrospective case series was conducted at the Aga Khan University Hospital, Karachi, and comprised records of patients aged 15 years or more who underwent colostomy reversal from January 2003 to December 2011. Data was collected regarding demographics, procedure dates, indication, as well as type and location of colostomy. Details of colostomy reversal, including pre-operative, intra-operative and post-operative variables were recorded.

RESULTS:

The mean age of the 96 patients was 40±16 years; 72(75%) of them being males. The most frequent indications for fashioning of colostomy were …

Association Of Iron Deficiency Anemia In Children With Febrile Convulsions, Vikash Lal, Haresh Kumar, Shahina Hanif, Om Parkash, Suneel Arwani

Pakistan Journal of Neurological Sciences (PJNS)

:To determine the association of iron deficiency anemia in children presented with febrile convulsion. Study Design: Case control study Setting: The pediatric unit III,Civil Hospital,Karachi. Duration: Six months from 30th April 2013 to 1st November 2013 Material and Methods: History regarding age, sex, developmental milestones, family history of febrile seizures or epilepsy, mean of the temperature peak at admission, and the underlying illness were recorded for all cases and controls, as well as details of seizure history, duration and frequency. Blood samples were collected in the Paediatric wardsfor measurements of hemoglobin, serum ferritin, MCV, MCH and MCHC, serum electrolytes, serum …

Predictive Model For Blood Product Use In Coronary Artery Bypass Grafting, Hasanat Sharif, Hamza Zaheer Ansari, Awais Ashfaq, Wasiq Faraz Rawasia, Gulshan Bano, Shiraz Hashmi

Section of Cardiothoracic Surgery

Objective: To build a clinical predictive model to determine the need for transfusing blood and its products in coronary artery bypass grafting (CABG) procedures in South East Asian population.STUDY Design: Analytical study.PLACE AND DURATION OF STUDY: Section of Cardiothoracic Surgery, Aga Khan University Hospital, Karachi, from January 2006 to October 2014.METHODOLOGY: Information on pre-, intra- and postoperative variables were collected for all adult patients who underwent on-pump CABG. The patients grouped into those who received blood and its components, and those who did not. Aunivariate as well as multivariate logistic model was built to determine the predictors of transfusion.Results: A …

Magnetic Resonance Imaging Of Intracranial Extramedullary Haematopoiesis In Β-Thalassemia: A Case Report, Mahnoor Hafeez, Ateeque Ahmed Khan

Pakistan Journal of Neurological Sciences (PJNS)

We report the Magnetic Resonance Imaging of intracranial extramedullaryhematopoiesis in 21 years old β-thalassemic patient who presented to the Neurology Department of Civil Hospital Karachi with seizures. The MR exam revealed multiple intracranialextra-axial masses;isointense on T1W sequence and hypointenseon T1W, T2W, FLAIR, DWI sequence and ADC (b value= 1000 sec/mm2) with avid post contrast enhancement. Plain CT of the Head documented the presence of multiple hyperdenseextra-axial masses with mean value of 45 HU. Extramedullary hematopoiesis is the formation and development of blood cells in tissues outside of the medulla of the bone. The most common sites of involvement are the …

“More Than Meets The Eye” Non Secretory Myeloma Presenting As Cidp In A Patient With Longstanding Diabetic Polyneuropathy. A Diagnostic And Therapeutic Challenge., Farheen Niazi, Arsalan Ahmad

Pakistan Journal of Neurological Sciences (PJNS)

Diagnosing chronic inflammatory polyradiculopathy in patients with pre-existing diabetic sensorimotor polyneuropathy is a diagnostic challenge. We present a case of a 69 years old who presented with weakness of legs for two months,he was diagnosed as having CIDP on the background of diabetic sensorimotor polyneuropathy, further and extensive workup revealed the final diagnosis of nonsecretory myeloma. Diagnosing non secretory myeloma is itself a diagnostic challenge and usually first line investigations for the workup of myeloma are negative as was the case in our patient. Our patient with CIDP had raised free light chains of kappa which made the final diagnosis …

Association Of Tobacco Use And Other Determinants With Pregnancy Outcomes: A Multicentre Hospital-Based Case-Control Study In Karachi, Pakistan., Shafquat Rozi, Zahid Ahmad Butt, Nida Zahid, Saba Wasim, Kashif Shafique

Community Health Sciences

OBJECTIVES:

The study aimed to identify the effects of maternal tobacco consumption during pregnancy and other factors on birth outcomes and obstetric complications in Karachi, Pakistan.

DESIGN:

A multicentre hospital-based case-control study.

SETTING:

Four leading maternity hospitals of Karachi.

PARTICIPANTS:

A random sample of 1275 women coming to the gynaecology and obstetric department of selected hospitals for delivery was interviewed within 48 hours of delivery from wards. Cases were women with adverse birth outcomes and obstetric complications, while controls were women who had normal uncomplicated delivery.

PRIMARY AND SECONDARY OUTCOME MEASURES:

Adverse birth outcomes (preterm delivery, low birth weight, stillbirth, …

An Overview Of Pathophysiology, Assessment And Management Strategies Of Post Stroke Shoulder Subluxation, Sarah Razaq, Farooq Azam Rathore

Pakistan Journal of Neurological Sciences (PJNS)

Shoulder subluxation is a common complication after stroke. It can result in soft tissue damage, stretching of the joint capsule, rotator cuff injury, and in some cases pain. An estimated 17-81 % of stroke patients have shoulder subluxation. It limits the use of affected extremity in addition to the weakness resulting from stroke itself. It can delay the neurological recovery in hemiplegic stroke patients. The etiology is multifactorial and the underlying mechanisms alongwith its association with shoulder pain are not clearly understood. This makes management of post stroke shoulder- subluxation a challenge for stroke management team. This review provides an …