Medical Specialties Commons^™

High Pati Score Is Associated With Increase Mortality In Patients With Penetrating Abdominal Injuries: A Retrospective Review, Syed Zohaib Gulzar Naqvi, Shahrukh Effendi, Hasnain Zafar

Section of General Surgery

Background: Worldwide, injuries due to violence constitute eighth leading cause of death. Penetrating abdominal injuries account for third most common area involved. Inliterature PATI has been utilized to estimate the severity of abdominal trauma, decision making regarding repairing the damage and even risk of post-operative complications. We aimed and intended to use PATI score (penetrating abdominal trau-ma index) as a more accurate method of quantifying the extent of damage in patients with the penetrat-ing abdominal trauma and association of high PATI score (>25) with mortality.
Objective: To determine the association of mortality in patient with penetrating abdominal trauma with …

Response To The Comments: "Prospective Case Control Evaluation Of Epidural Midazolam For Improving Pain And Ambulation After Microdiscectomy", Muhammad Shahzad Shamim

Section of Neurosurgery

No abstract provided.

The Diagnostic Accuracy Of Determine™ Tb Lam Antigen In Detection Of Extra Pulmonary Tuberculosis (Eptb), Fatimah Osman Juma

Master of Medicine in Internal Medicine

Background: TB remains a key global health challenge; particularly Extra pulmonary Tuberculosis (EPTB) and is also a major cause of morbidity and mortality in sub-Saharan Africa. The increasing incidence of EPTB compounded by difficulties in making a timely diagnosis portends to poor prognosis and increased mortality. Delays in diagnosis and misdiagnosis of EPTB in suspected patients account for mortality as well. Challenges in diagnosis of EPTB are mainly due to disease related factors, the paucibacillary nature of disease and challenges with sample collection and processing. Reference standard test such as TB culture, geneXpert and histology which are used in the …

Effect Of Provision Of An Integrated Neonatal Survival Kit And Early Cognitive Stimulation Package By Community Health Workers On Developmental Outcomes Of Infants In Kwale County, Kenya: Study Protocol For A Cluster Randomized Trial, Lisa G. Pell, Diego G. Bassani, Lucy Nyaga, Isaac Njagi, Catherine Wanjiku, Thulasi Thiruchselvam, William Macharia, Ripudaman S. Minhas, Patricia Kitsao-Wekulo, Amyn Lakhani, Zulfiqar Ahmed Bhutta, Robert Armstrong, Shaun K. Morris

Paediatrics and Child Health, East Africa

Background: Each year, more than 200 million children under the age of 5 years, almost all in low- and middle-income countries (LMICs), fail to achieve their developmental potential. Risk factors for compromised development often coexist and include inadequate cognitive stimulation, poverty, nutritional deficiencies, infection and complications of being born low birthweight and/or premature. Moreover, many of these risk factors are closely associated with newborn morbidity and mortality. As compromised development has significant implications on human capital, inexpensive and scalable interventions are urgently needed to promote neurodevelopment and reduce risk factors for impaired development.

Method/Design: This cluster randomized trial aims at …

Self-Reported Practices Among Traditional Birth Attendants Surveyed In Western Kenya: A Descriptive Study, Sherri Bucher, Olive Konana, Edward Liechty, Ana Garces, Peter Gisore, Irene Marete, Constance Tenge, Evelyn Shipala, Linda Wright, Fabian Esamai

Paediatrics and Child Health, East Africa

Background: The high rate of home deliveries conducted by unskilled birth attendants in resource-limited settings is an important global health issue because it is believed to be a significant contributing factor to maternal and newborn mortality. Given the large number of deliveries that are managed by unskilled or traditional birth attendants outside of health facilities, and the fact that there is on-going discussion regarding the role of traditional birth attendants in the maternal newborn health (MNH) service continuum, we sought to ascertain the practices of traditional birth attendants in our catchment area. The findings of this descriptive study might help …

Setting Research Priorities To Improve Global Newborn Health And Prevent Stillbirths By 2025, Sachiyo Yoshida, José Martines, Peter Gisore, Joy E. Lawn, Stephen Wall, Joăo Paulo Souza

Paediatrics and Child Health, East Africa

Background: In 2013, an estimated 2.8 million newborns died and 2.7 million were stillborn. A much greater number suffer from long term impairment associated with preterm birth, intrauterine growth restriction, congenital anomalies, and perinatal or infectious causes. With the approaching deadline for the achievement of the Millennium Development Goals (MDGs) in 2015, there was a need to set the new research priorities on newborns and stillbirth with a focus not only on survival but also on health, growth and development. We therefore carried out a systematic exercise to set newborn health research priorities for 2013–2025.

Methods: We used adapted Child …

Validity Of Intracerebral Haemorrhge Score In Predicting Prognosis Of Hemorrhagic Stroke, Muhammad Aslam Rind, Muzaffar Sheikh, Manzoor Ali Lakhair, Maria Nazir, Sadia Sheikh

Pakistan Journal of Neurological Sciences (PJNS)

Stroke is a common neurological disorder, leading cause of death and disability worldwide. Intra cerebral hemorrhage comprises of 10-15% of all strokes but associated with high risk of morbidity and mortality than cerebral infraction .The ICH Score is a good prognostic tool calculated very easily, when it is used to predict 30 day morality. Objective:To determine the validity of Intracerebral hemorrhagic score in predicting prognosis (adverse outcome or death) in patients of hemorrhagic stroke.Material&Methods:This case series study was carried out at department of medicine Liaquat medical University Hospital Jamshoro and Hyderabad from June 16th 2012 to December 15th 2012.Eighty nine …

Demographic Profile And Associations Of Dialysis Dependent Chronic Kidney Disease Patients In Federal Capital Of Pakistan., Ali Zohair Nomani, Mansoor Iqbal, Faisal Bacha, Shahzad Mughal, Haris Majid Rajput, Mazhar Badshah, Rao Suhail Yasin Khan

Pakistan Journal of Neurological Sciences (PJNS)

Depression is quite prevalent in patients with chronic kidney disease. Knowing the frequency of depression in such patients and its association with different variables may be helpful in devising strategies for better and timely management of such patients in our setup. Materials and methods: This cross sectional study was conducted by recruiting 315 patients of either gender, ≥ 18 years of age with chronic kidney disease (CKD) and receiving care at Pakistan Institute of Medical Sciences, Islamabad. Patients were divided into two groups; group A: pre-dialysis and group B: dialysis (End Stage Renal Disease). Prevalence of depression in CKD and …

Primary Anaplastic Pleomorphic Xanthoastrocytoma In Adults. Case Report And Review Of Literature, Usama Khalid Choudry, Saad Akhtar Khan, Amjad Qureshi, Muhammad Ehsan Bari

Section of Neurosurgery

Background: Pleomorphic xanthoastrocytoma (PXA) classified as a low Grade (WHO II) astrocytic neoplasm. It is known for its relatively favorable prognosis. It most commonly occurs in young adults. Malignant progression in PXA has been frequently reported since its first description in 1979; however, the presentation of a primary anaplastic PXA tumor with an aggressive clinical course in adults is rare especially in the later age group.
Case description: We present a case of primary anaplastic PXA in a 53 year old male that manifested with an early recurrence pattern at 9 weeks. Treatment performed was surgical excision and external beam …

Cerebral Venous Sinus Thrombosis With Tentorial Haemorrhagic Infarctions In Combined Proteins Deficiency And Hyperhomocysteinemia Treated With Anticoagulation- Limited Evidence With Good Results: A Case Report, Muhammad Waqas, Muhammad Akbar Baig, Shahan Waheed Aga Khan University, Munawar Khursheed

Department of Emergency Medicine

We are presenting a case of a 40-year-old lady who presented with sudden loss of consciousness. Computed Tomography scan of her brain revealed the presence of blood in her sub-arachnoid space on her right hemisphere, cerebral oedema, and cerebral venous sinus thrombosis later magnetic Resonance Imaging revealed extensive cerebral venous sinuses thrombosis formation associated with supra and infra-tentorial haemorrhages. Elevated levels of plasma homocysteine and deficient levels of protein S. Patient was anticoagulated with warfarin and INR was monitored. She recovered successfully with no complication of anticoagulation observed. The use of anticoagulation had a favourable outcome in our …

Small Bowel Ascaris Infestation: A Diagnostic Challenge, Muhammad Waqas Khan, Sanniya Khan Ghauri

Department of Emergency Medicine

Ascariasis is a common infestation in developing countries where there is poor hygiene. A majority of the cases are asymptomatic, with a few cases presenting with mild abdominal pain and nutritional deficiencies in the long term. Here we present a case of a young boy who presented as a diagnostic dilemma, with signs of acute intestinal obstruction without any supporting radiological evidence. A barium study revealed the presence of low-burden Ascaris infestation that was managed medically.

The Impact And Successes Of A Paediatric Endocrinology Fellowship Program In Africa, Gordon Otieno Odundo, Thomas Ngwiri, Olivia Otuoma, Paul Laigong, Renson Mukhwana, Mary Limbe, Nadia Musimbi Chanzu

Paediatrics and Child Health, East Africa

Background: The prevalence and distribution of endocrine disorders in children in Africa are not well known because most cases are often undiagnosed or diagnosed too late. The awareness of this led to the launch of the Paediatric Endocrinology Training Center for Africa (PETCA) designed to improve quality and access to health care by training paediatricians from Africa in paediatric endocrinology.

Methods: The fellowship is undertaken over an 18-month period: six months of clinical and theoretical training in Kenya, nine months of project research at the fellow’s home country, and three months of consolidation in Kenya. Upon completion, certified paediatricians are …

High Prevalence Of Liver Fibrosis In Patients With Human Immunodeficiency Virus Monoinfection And Human Immunodeficiency Virus Hepatitis-B Co-Infection As Assessed By Shear Wave Elastography: Study At A Teaching Hospital In Kenya, Samuel Gitau, Sudhir Vinayak, Micah Ominde, Rodney Adam, Reena Shah

Imaging & Diagnostic Radiology, East Africa

Objectives:The aim of this study was to determine the prevalence of liver fibrosis in patients with human immunodeficiency virus (HIV) monoinfection versus those with HIV hepatitis-B virus (HBV) co-infection as assessed with shear wave elastography (SWE) in a tertiary sub-Saharan Africa hospital.

Materials and Methods:A total of 105 consecutive patients, 70 with HIV monoinfection and 35 with HIV-HBV co-infection, had liver elastography obtained using SWE to assess for the presence of liver fibrosis the cutoff of which was 5.6 kPa. Assessment of aspartate aminotransferase-to-platelet ratio index (APRI) score (a noninvasive serum biomarker of liver fibrosis) in these patients …

Remission Of Psychosis In Treatment-Resistant Schizophrenia Following A Seizure: A Case Report, Hena Jawaid, Sana Younus, Hanif Mesiya

Department of Psychiatry

The authors report a case of treatment-resistant schizophrenia in a 22-year-old woman, who, despite multiple trials of antipsychotics, did not respond to treatment. Clozapine treatment was initiated, but the patient's symptoms did not remit until after she had a clozapine-induced seizure. The authors discuss the importance in considering that electroconvulsive therapy may be effective in reducing positive and negative symptoms in patients suffering from treatment-resistant schizophrenia.

Comparison Of Clinical Laboratory Standards Institute And European Committee On Antimicrobial Susceptibility Testing Guidelines For The Interpretation Of Antibiotic Susceptibility At A University Teaching Hospital In Nairobi, Kenya: A Cross-Sectional Study, Ali Kassim, Geoffrey Omuse, Zul Premji, Gunturu Revathi

Pathology, East Africa

Background: The Clinical Laboratory Standards Institute (CLSI) and the European Committee on Antimicrobial Susceptibility Testing (EUCAST) guidelines are the most popular breakpoint guidelines used in antimicrobial susceptibility testing worldwide. The EUCAST guidelines are freely available to users while CLSI is available for non-members as a package of three documents for US $500 annually. This is prohibitive for clinical microbiology laboratories in resource poor settings. We set out to compare antibiotic susceptibility determined by the two guidelines to determine whether adoption of EUCAST guidelines would significantly affect our susceptibility patterns.

Methods: We reviewed minimum inhibitory concentrations (MIC) of various antibiotics routinely …

Reference Intervals For Thyroid Stimulating Hormone And Free Thyroxine Derived From Neonates Undergoing Routine Screening For Congenital Hypothyroidism At A University Teaching Hospital In Nairobi, Kenya: A Cross Sectional Study, Geoffrey Omuse, Ali Kassim, Francis Kiigu, Syeda Hussain, Mary Limbe

Pathology, East Africa

Background: In order to accurately interpret neonatal thyroid function tests (TFTs), it is necessary to have population specific reference intervals (RIs) as there is significant variation across different populations possibly due to genetic, environmental or analytical issues. Despite the importance of RIs, globally there are very few publications on RIs for neonatal TFTs primarily due to ethical and technical issues surrounding recruitment of neonates for a prospective study. To the best of our knowledge, this is the first report from Africa on neonatal RIs for TFTs.

Methods: We used hospital based data largely derived from neonates attending the wellness clinic …

Isolated Gastric Tuberculosis Mimicking Malignancy, Wasim Memon, Saad Siddiqui

Department of Radiology

Isolated tuberculosis of upper gastrointestinal tract is a rare pathology, often mimicking malignancy in clinical presentation and radiological features. We present a case of middle aged gentleman with isolated tuberculosis of stomach, proven on histopathology and showing remarkable improvement on follow up.

Institutionalized Training Of Research Editors, Saba Sohail, Jamshed Akhtar

Department of Radiology

No abstract provided.

Association Of Caregiver Quality Of Care With Neurocognitive Outcomes In Hiv-Affected Children Aged 2–5 Years In Uganda, Judith Bass, Noeline Nakasujja, Itziar Familiar-Lopez, Alla Sikorskii, Sarah Murray, Robert Opoka, Jura Augustinavicius, Michael Boivin

Paediatrics and Child Health, East Africa

Abstract: Children affected by HIV are at increased risk of developmental and neuropsychological disturbances due to direct effects of HIV on the brain and direct effects associated with living in poverty. Caregivers can play an important role, through quality caregiving, in mitigating the negative effect of these stressors. This study used baseline data from an ongoing caregiver training intervention trial to evaluate the association between quality of caregiver-child interactions and neurocognitive outcomes in rural HIV-infected and HIV-exposed but uninfected children in Uganda. We also assessed the extent to which caregiver distress moderated this relationship. Data on 329 caregiver-child dyads were …

Endometrial Tuberculosis Compounding Polycystic Ovary Syndrome In A Subfertile Woman: A Case Report, Charles Mariara, Angela Koech, P. Waweru, Alfred Murage

Obstetrics and Gynaecology, East Africa

Background: Asymptomatic female genital tuberculosis can impair tubal and endometrial function and later present as subfertility. A majority of the patients with genital tuberculosis in endemic regions present with subfertility and the delay in presentation, coupled with the potential the disease has in mimicking other gynecological conditions, renders it elusive. In addition to the challenge of diagnosing genital tuberculosis, fertility outcomes after treatment are not impressive. This is particularly so in the background of another confounding subfertility factor to which interventional efforts may initially be directed, at the expense of undiagnosed genital tuberculosis. We therefore present a case of subfertility …

Who Statement On Caesarean Section Rates, A. P. Betran, M. R. Torloni, J. J. Zhang, A. M. Gulmezoglu, Marleen Temmerman, Who Working Group On Caesarean Section

Obstetrics and Gynaecology, East Africa

In 1985 when a group of experts convened by the World Health Organization in Fortaleza, Brazil, met to discuss the appropriate technology for birth, they echoed what at that moment was considered an unjustified and remarkable increase of caesarean section (CS) rates worldwide.1 Based on the evidence available at that time, the experts in Fortaleza concluded: ‘there is no justification for any region to have a caesarean section rate higher than 10–15%’.1 Over the years, this quote has become ubiquitous in scientific literature, being interpreted as the ideal CS rate. Although this reference range was intended for ‘populations’, which are …

Right-Sided Congenital Diaphragmatic Hernia And Myelomeningocele: A Rare Association, Syed Rehan Ali, Shakeel Ahmed

Department of Paediatrics and Child Health

Congenital diaphragmatic hernia (CDH) is a rare birth defect with a prevalence of < 0.5 per 1,000 live births. Majority of these defects are left-sided as most studies suggest that frequency of right-sided CDH was 10% of the total. The association of CDH with myelomeningocele (MMC) is extremely rare; as in Sweed's study of 116 consecutive cases of CDH, the incidence of associated MMC with CDH was stated as 4.3%. There has been one previous case report of leftsided CDH, MMC and hydrocephalus prenatally diagnosed; but to the best of authors' knowledge, this is the first reported case of the above constellation with a right-sided CDH diagnosed prenatally.

Atrial Thrombus In A Premature Newborn Following Cardio-Pulmonary Resuscitation, Syed Rehan Ali, Shakeel Ahmed, Nadeem Aslam, Heeramani Lohana

Department of Paediatrics and Child Health

Critically ill newborns, whether term or preterm, are at great risk for developing symptomatic thromboembolic disease. Comorbidities like inflammation, DIC, fluctuations in cardiac output, congenital heart disease, as well as central venous or arterial catheters, are the predisposing risk factors. Clinically symptomatic or asymptomatic cases are usually picked up by echocardiography, usually done for other indications. Management usually comprises of observation, heparin therapy, thrombo-embolectomy, and catheter directed revascularization. We present a case of premature neonate who developed thrombus at inter-atrial septum as a possible consequence of cardiopulmonary resuscitation, detected by echocardiography. Conversely, there is always a possibility of paradoxical emboli …

Evaluation Of Solar Disinfection Of Water Intervention Delivered Through Lady Health Workers In Reduction Of Diarrheal Episodes In Under Five Children, Shabina Ariff, Ubaidullah Khan, Ali Turab, Imtiaz Hussain, Atif Habib, Tarab Mansoor, Dania Mallick, Zamir Suhag, Zaid Bhatti, Imran Ahmed, Sajid Bashir Soofi, Zulfiqar A Bhutta

Department of Paediatrics and Child Health

Background: Solar Water Disinfection (SODIS) is a simple, inexpensive and sustainable means of daily household treatment for drinking and storage of water. Globally, over a billion people lack access to safe drinking water. As many as half million under five children die annually due to diarrheal illnesses. Most of these deaths are concentrated in Africa and South Asia. Unsafe water is one of the most critical risk factors for diarrhoea. Systematic reviews indicate that interventions to improve the microbial quality of drinking water in households are effective at reducing diarrhoea illnesses and thereby contribute significantly in reducing deaths due to …

Autologous Transplant In Lymphomas In Current Era Of Immunotherapy, Natasha Ali, Mohammad Khurshid

Department of Pathology and Laboratory Medicine

No abstract provided.

A Histopathological Outlook On Nephrotic Syndrome: A Pediatric Perspective, M K. Arif, M Arif, N Amjad

Department of Paediatrics and Child Health

The developing world is observing changing histopathological patterns of idiopathic nephrotic syndrome (INS). However, the true burden of non-minimal change disease (non-MCD) presenting as INS remains unestimated owing to a paucity of data on renal biopsies. Data were collected from January 2006 to June 2014 on 75 children up to 16 years of age who underwent renal biopsies for INS. Mean age at biopsy was 11.2 ± 3.7 years. The male to female ratio was 1.5:1. A total of 25 (33.3%) children were steroid sensitive, 36 (48%) were steroid resistant, 10 (13.3%) were steroid dependent and 4 (5.3%) came with …

Flaviviruses As A Cause Of Undifferentiated Fever In Sindh Province, Pakistan: A Preliminary Report, Erum Khan, Joveria Q. Farooqi, Kelli L. Barr, Dhani Prakoso, Amna Nasir, Akbar Kanji, Sadia Shakoor, Faisal Riaz Malik, Rumina Hasan, John A. Lednicky

Department of Pathology and Laboratory Medicine

Arboviral diseases are expanding worldwide, yet global surveillance is often limited due to diplomatic and cultural barriers between nations. With human encroachment into new habitats, mosquito-borne viruses are also invading new areas. The actual prevalence of expanding arboviruses is unknown in Pakistan due to inappropriate diagnosis and poor testing for arboviral diseases. The primary objective of this study was to document evidence of flavivirus infections as the cause of undifferentiated fever in Pakistan. Through a cooperative effort between the USA and Pakistan, patient exposure to dengue virus (DENV), West Nile virus (WNV), and Japanese encephalitis virus (JEV) was examined in …

Effect Of Mobile Phone Text Messages Reminders On Uptake Of Routine Immunization Among Children In Pakistan- Study Protocol For A Randomized Clinical Trial, Abdul Momin Kazi, Murtaza Ali, Khurram Zubair, Hussain Kalimuddin, Syed Asad Ali

Department of Paediatrics and Child Health

Introduction: Routine Immunization (RI) is considered one of the best public health interventions to decrease child morbidity and mortality. The RI coverage in Pakistan is still well below the desired level, leading to continued polio transmission, large measles outbreaks and thousands of deaths from vaccine-preventable illnesses. Different innovative and cost effective strategies are required to look into for enhancement in vaccination uptake and coverage. We plan to test the effectiveness of reminders to parents/caregivers on cell phones through short messaging system (SMS) in improving vaccine uptake and on-time routine immunization for children in Pakistan.
Methods and Analysis: A parallel-randomized controlled …

A Pre-Post Study Of A Multi-Country Scale Up Of Resuscitation Training Of Facility Birth Attendants: Does Helping Babies Breathe Training Save Lives?, Roopa M. Bellad, Akash Bang, Waldemar A. Carlo, Elizabeth M. Mcclure, Sreelatha Meleth, Norman Goco, Shivaprasad S. Goudar, Richard J. Derman, Patricia L. Hibberd, Archana Patel, Fabian Esamai, Sherri Bucher, Peter Gisore, Linda L. Wright

Paediatrics and Child Health, East Africa

Background: Whether facility-based implementation of Helping Babies Breathe (HBB) reduces neonatal mortality at a population level in low and middle income countries (LMIC) has not been studied. Therefore, we evaluated HBB implementation in this context where our study team has ongoing prospective outcome data on all pregnancies regardless of place of delivery.

Methods: We compared outcomes of birth cohorts in three sites in India and Kenya pre-post implementation of a facility-based intervention, using a prospective, population-based registry in 52 geographic clusters. Our hypothesis was that HBB implementation would result in a 20 % decrease in the perinatal mortality rate (PMR) …

Translational Research And Complexity Of Clinical Practice: Issues, Challenges, And Way Forward, Waris Qidwai

Department of Family Medicine

No abstract provided.